OpenMed/multicare-articles huggingface dataset:
Pleural Effusion or Main Left Bronchus Mucus Obstruction: To Drain or Not to Drain? Decision-Making for Young Surgeon on Call
Authors: Danilo Coco, Silvana Leanza
Journal: Case Rep Radiol (2018)
MeSH terms: Case Reports

Mucous plugs occur in a number of pulmonary conditions. Central right or left bronchus mucus plug causes complete pulmonary collapse making it an emergency life-threatening case. We describe the case of an 80-year-old man that, in postoperative period after a urological intervention, has had a progressive tachypnea and dyspnea during hospitalization for urological problems. Young surgeon on call was called.
Applied behavioral analysis for the skill performance of children with autism spectrum disorder
Authors: Alan Patricio da Silva, Italla Maria Pinheiro Bezerra, Thaiany Pedrozo Campos Antunes, Matheus Paiva Emidio Cavalcanti, Luiz Carlos de Abreu
Journal: Front Psychiatry (2023)
Keywords: applied behavior analysis, autism, autism spectrum disorder, behavior, cognition

Introduction:
Autism spectrum disorder (ASD) has characteristics that have been observed to develop over time, such as the difficulty of affective, sensory, and emotional processing, which trigger some problems during childhood, limiting children's development. Applied behavior analysis (ABA) is among the therapeutic approaches for ASD, in which treatment can be tailored according to the patient's objectives.
Objective:
Based on ABA, we aimed to analyze the therapeutic strategy for independence in different skill performance tasks of patients diagnosed with ASD.
Method:
This is a retrospective observational case series study including 16 children diagnosed with ASD who received ABA-based treatment at a therapeutic clinic in Santo Andre city, São Paulo State, Brazil. Individual task performance of different skill domains was registered in the ABA+ affective intelligence® software throughout the 12 months (from January 2021 to January 2022) of routine treatment.
Results:
The evolution of skills was observed between the T0 and T1 intervals, with improved skills over the observed period.
Conclusion:
The strategy based on the ABA methodology improved children's skill performance over the observed period.
Acquired tracheoesophageal fistula due to high intracuff pressure
Authors: Akmal A Hameed, Hasan Mohamed, Motasem Al-Mansoori
Journal: Ann Thorac Med (2008)
Keywords: cuff leak, endotracheal tube, intracuff pressure, tracheal damage, tracheoesophageal fistula
MeSH terms: Case Reports

High-compliance endotracheal tube cuffs are used to prevent gas leak and also pulmonary aspiration in mechanically ventilated patients. However, the use of the usual cuff inflation volumes may cause tracheal damage and lead to tracheoesophageal fistula.Tracheostomy tube cuffs seal against the tracheal wall and prevent leakage of air around the tube, assuring that the tidal volume is delivered to the lungs. In the past, high-pressure cuffs were used, but these contributed to tracheal injury and have been replaced by high-volume, low-pressure cuffs. For long-term applications, some newer tubes have low-profile (tight to shaft) cuffs that facilitate the tracheostomy tube changes by eliminating the lip that forms when standard cuffs are deflated.
Laser-assisted removal of aspirated thumbtacks by flexible bronchoscopy
Authors: Oren Fruchter, Benjamin D Fox, Yael Raviv, Mordechai R Kramer
Journal: Diagn Ther Endosc (2010)
MeSH terms: Case Reports

Background. Aspirated thumbtacks are difficult to extract as the sharp edge of the thumbtack often is well imbedded within bronchial wall and its removal is technically demanding and may cause complications such as bronchial mucosal tear and bronchial wall perforation. These sharp metal objects are commonly removed using rigid bronchoscopy since their removal through flexible bronchoscopy is considered to be dangerous. Objectives. To describe a technique for removal of sharp aspirated metal objects employing laser through flexible bronchoscopy. Methods. We report two patients in whom a new technique for removal of sharp aspirated metal objects utilizing Nd-Yag laser flexible bronchoscopy was used. Results. Successful and uncomplicated removal of the aspirated thumbpack by flexible bronchoscopy under conscious sedation was accomplished in the two patients described. Both patients were discharged within 24 hours. Conclusions. In patients with aspirated thumbtack laser-assisted breakage of the object through flexible bronchoscopy may obviate the need for rigid bronchoscopy or thoracotomy.
Non operative management of proximal posterior gastric injury in a trauma patient: A case report
Authors: Norah Alsubaie, Bushr Mrad, Abdullah Albdah, Nadia Aljomah, Thamer Nouh
Journal: Int J Surg Case Rep (2020)
Keywords: blunt abdominal trauma, nonoperative management, proximal posterior gastric injury
MeSH terms: Case Reports

Introduction:
Proximal postierior gastric injuries are challenging and are often overlooked and diagnosed late. We present a case of traumatic proximal posterior gastric injury.
Presentation of case:
A 34-year-old male patient presented with traumatic proximal posterior gastric injury secondary to falling from a height. Nonoperative treatment was achieved by placing a gastric stent and wide drainage that resulted in complete healing of the perforation within a period of 8 weeks.
Discussion:
There are no standard treatment guidelines for managing gastric leaks, except for surgical repair, in trauma patients. Management with a gastric stent has been proven effective in gastric leaks resulting from bariatric surgeries and surgical interventions for gastric cancer. This approach was followed in the management of our patient and showed promising results.
Conclusion:
Nonoperative management with an endoscopic stent can be considered a treatment option for leaks resulting from traumatic gastric injury.
Gallstone ileus from a non-calcified stone: a challenging diagnosis
Authors: Andrew Ian Goldfinch, Simon John Prowse
Journal: BJR Case Rep (2017)
MeSH terms: Case Reports

Gallstone ileus is an uncommon and often life-threatening complication of cholelithiasis. In this case, we discuss a difficult diagnostic case of gallstone ileus with a non-calcified gallstone. An 88-year-old female presented with abdominal pain and vomiting. A CT scan was arranged and showed an evolving bowel obstruction although no frank hyperdensity suggestive of a gallstone was noted. Initially the cause of the bowel obstruction was uncertain, but after discussion with the treating team and further review of the images, the patient was diagnosed with gallstone ileus. The patient underwent emergency surgery and a 41 mm obstructing calculus was removed from the patient's jejunum, later confirmed on histological diagnosis.
Arsenic Trioxide Treatment during Pregnancy for Acute Promyelocytic Leukemia in a 22-Year-Old Woman
Authors: Claire Cochet, Marion Simonet, Julie Cattin, Jean-Patrick Metz, Ana Berceanu, Eric Deconinck, Etienne Daguindau, Françoise Schillinger, Pierre Fenaux, Nicolas Mottet, Yohan Desbrosses
Journal: Case Rep Hematol (2020)
MeSH terms: Case Reports

Acute leukemia during pregnancy is rare (1 for 100000 pregnancies). The association of arsenic trioxide (ATO) and all-trans retinoic acid (ATRA) is known as the best therapy in standard-risk acute promyelocytic leukemia (APL). We describe the first case of a pregnancy with ATRA and ATO reported in the literature. In March 2018 at the University Hospital of Besançon, a 22-year-old woman was diagnosed with APL at 14 weeks of gestation (WG). She received a total of 2160 mg of ATRA and 930 mg of ATO between 14 and 35 WG. The mother's cytological remission was very fast. No maternal or fetal complications occurred during pregnancy. The pediatrics outcomes were good. Many case reports about ATRA exposure during the second and third trimesters report no serious adverse effect for pregnancy. ATO is teratogenic, genotoxic, and carcinogenic and passes through the placenta. Fetal exposure seems to be associated with bad pregnancy outcomes (preterm delivery, decreased birth weight, and fetal loss) and with lung diseases in young adults. No clinical trial is obviously possible, and the only data available are environmental exposure or animal studies. This case report may help medical teams to make hard decision for a treatment of APL during pregnancy.
Mechanical thrombectomy for acute multivessel occlusions with duplicated middle cerebral artery: A case report
Authors: Hai-Ji Han, Qiang Sang, Xi-Ming Wang, Yan-Feng Wu
Journal: Front Neurol (2023)
Keywords: acute ischemic stroke, duplicated middle cerebral artery, large vessel occlusion, mechanical thrombectomy, multivessel occlusions
MeSH terms: Case Reports

Acute multivessel occlusions generally have multisite clot burden with lower successful reperfusion rates, and cerebrovascular anatomical variants increase the challenge of endovascular clot retrieval. We report a case of acute anterior multivessel occlusions patient with duplicated middle cerebral artery. Combined balloon guide catheter with stent retriever and aspiration approach has gained complete revascularization and good functional outcomes at 3 months follow-up.
Efficacy of Nivolumab in a Patient with Metastatic Renal Cell Carcinoma and End-Stage Renal Disease on Dialysis: Case Report and Literature Review
Authors: Jawaher Ansari, Muhammad Ali, Ashraf Farrag, Arwa M Ali, Abdulaziz Alhamad
Journal: Case Reports Immunol (2018)
MeSH terms: Case Reports

Treatment of patients with metastatic renal cell carcinoma (mRCC) and end-stage renal disease (ESRD) on dialysis poses a therapeutic challenge, particularly as this patient group was excluded from the pivotal clinical trials. In addition, there is uncertainty regarding drug dosing/pharmacokinetics, lack of safety and efficacy data, and potential for increased toxicity when using targeted therapy or immunotherapy for the management of patients with mRCC on dialysis. Nivolumab, an anti-programmed death-1 immune checkpoint inhibitor antibody, is indicated for the treatment of patients with mRCC who have received prior antiangiogenic therapy. Given the above-mentioned uncertainties, clinicians may be reluctant to use nivolumab for this patient population, leading to potential denial of life-prolonging medications. We report the case of a 72-year-old gentleman with mRCC and ESRD on dialysis who received second-line nivolumab therapy and achieved an excellent symptomatic and radiological response, remaining progression-free for over 22 months. In addition, we have reviewed the pharmacokinetic data and published retrospective case studies to review the management options for patients with mRCC and ESRD on dialysis.
Carcinosarcoma of the breast: two case reports and review of the literature
Authors: Kristi M Esses, Ramona M Hagmaier, Susan A Blanchard, John J Lazarchick, Adam I Riker
Journal: Cases J (2009)

Carcinosarcoma of the breast, often referred to as metaplastic carcinoma of the breast, is a rare malignancy with two distinct cell lines described as a breast carcinoma of ductal type with a sarcoma-like component. Clinically, carcinosarcoma of the breast is an aggressive breast cancer. The prognosis for carcinosarcoma of the breast is less favorable compared to more common types of breast cancer such as infiltrating ductal or lobular carcinoma. Currently, the evaluation of breast carcinoma includes hormone receptor analysis of the tumor tissue, with those positive for estrogen or progesterone responding better to both hormonal and chemotherapy.Trastuzumab (Herceptin(R)) is available as an adjunct treatment for tumors which over-express the HER2/neu gene. Typically, metaplastic carcinomas of the breast do not express the estrogen or progesterone receptors and do not over-express the HER2/neu oncogene. As a result of this "triple negative" phenotype, such tumors tend to be more aggressive and are unlikely to respond to targeted therapy with Herceptin. The epidermal growth factor receptor HER-1/EGFR protein is expressed in the majority of metaplastic carcinomas and thus may serve as a potential therapeutic target for EGFR inhibitors such as gefitinib and cetuximab. The two cases we describe exemplify the aggressive nature of carcinosarcoma of the breast and support the findings that this tumor type does not express the common receptors found in other breast carcinomas. These case reports also emphasize the need for investigating the role for blockade of the HER-1/EGFR receptor with targeted therapies when found to be over-expressed in the primary tumor.
Postmenopausal woman with 24 kilograms ovarian mucinous cystadenoma: a rare case report
Authors: Dhruva Halani, Arpita Jaiswal
Journal: Pan Afr Med J (2023)
Keywords: ovarian cyst, case report, mucinous tumour, neoplasm, postmenopausal
MeSH terms: Cystadenoma, Mucinous / diagnosis, Cystadenoma, Mucinous / pathology, Cystadenoma, Mucinous / surgery, Ovarian Cysts / diagnosis, Ovarian Cysts / surgery, Ovarian Neoplasms / diagnosis, Ovarian Neoplasms / pathology, Ovarian Neoplasms / surgery, Case Reports, Ascites, Female, Humans, Middle Aged, Postmenopause

A case of a 53-year-old postmenopausal woman presenting a giant ovarian cystic mucinous tumor weighing 24 kg is reported here. When she was seen first at our outpatient clinic, she had gross abdominal distension since 2 years, and she complained of unbearable aggressive pain. Her computed tomography (CT) scan was done which came suggestive of ovarian serous cystadenoma of large massive size 35 x 40 x 32 cm with moderate ascites. On exploratory laparotomy, a giant, totally cystic, vascularized and smooth mass attached to the right ovary was encountered. On the postoperative tenth day, she was discharged without any problem. Histopathology report of the right ovarian cystic mass came suggestive of multiloculated cyst with capsule intact with Borderline Mucinous tumor of right ovary weighing 24 kg. This is both one of the largest known examples in the literature and the largest ovarian cyst ever seen at our institution.
Nasal Septal Agenesis and Attenuated Lower and Upper Lateral Cartilages in a 5-Year-Old Child: A Sporadic Finding
Authors: Khalid Murrad, Faris Aldaghri, Mohamed Amir Mrad
Journal: Eplasty (2016)
Keywords: agenesis, columella, nasal, septal, sporadic
MeSH terms: Case Reports

Introduction: Cartilaginous nasal septal agenesis is a rare finding. In fact, just one case has been reported to have congenital agenesis of all nasal cartilages in a 6-year-old child by Bakhshaee et al. The literature review shows another case that was reported by Ozek et al in Turkey, where they reported a case of total nasal agenesis that was associated with Tessier no. 30. We could not find a similar case in the literature where only agenesis of the nasal cartilaginous septum was present. Methods/Case Report: This is a case report of a 5-year-old child presenting to our clinic with agenesis of his nasal septum and attenuation of the upper and lower lateral cartilages. His parents were seeking a corrective procedure to improve the shape of his nose. He was a male child with a right unilateral cleft lip and palate that were corrected surgically in 2009 (lip repair) and 2010 (palate repair), respectively. Results: On postoperative week 3, the patient's mother brought him to the emergency department with a history of falling on his face while playing at home. Examination revealed swelling of the nose but no breathing difficulties. He still had an acceptable augmented nose but with sings of deviation and collapse. Discussion: We report this case to find an answer to how such cases can be approached in the future in terms of the surgical intervention required and to study the options of redoing such cases.
Congenital syphilis like many years ago
Authors: Giulia Brighi, Giorgia Farneti, Antonella Marangoni, Elisabetta Tridapalli, Iria Neri, Maria Grazia Capretti, Giacomo Faldella
Journal: Case Rep Infect Dis (2011)
MeSH terms: Case Reports

This case concerns a premature infant with typical signs of congenital syphilis born to an untreated foreign mother. Syphilis prevalence in pregnant women has been rising in Italy since the beginning of the 21st century, mainly due to immigration. A correct antenatal syphilis screening and consequent adequate therapy of pregnant woman are fundamental to prevent the neonatal infection.
Down syndrome phenotype in a boy with a mosaic microduplication of chromosome 21q22
Authors: Franziska Schnabel, Mateja Smogavec, Rudolf Funke, Silke Pauli, Peter Burfeind, Iris Bartels
Journal: Mol Cytogenet (2018)
Keywords: dyrk1a, down syndrome, down syndrome critical region, microduplication, mosaicism
MeSH terms: Case Reports

Background:
Down syndrome, typically caused by trisomy 21, may also be associated by duplications of the Down syndrome critical region (DSCR) on chromosome 21q22. However, patients with small duplications of DSCR without accompanying deletions have rarely been reported.
Case presentation:
Here we report a 5½-year-old boy with clinical features of Down syndrome including distinct craniofacial dysmorphism and sandal gaps as well as developmental delay. Conventional karyotype was normal, whereas interphase FISH analysis revealed three signals for DSCR in approximately 40% of lymphocytes and 80% of buccal mucosa cells. Array-CGH analysis confirmed a 2.56 Mb duplication of chromosome 21q22.13q22.2 encompassing DYRK1A.
Conclusion:
This presents one of the smallest duplications within DSCR leading to a Down syndrome phenotype. Since the dosage sensitive gene DYRK1A is the only duplicated candidate DSCR gene in our patient, this finding supports the hypothesis that DYRK1A contributes to dysmorphic and intellectual features of Down syndrome even in a mosaic state.
Secondary Pulmonary Hypertension and Right-Sided Heart Failure at Presentation in Grave's Disease
Authors: Swapnil Panjabrao Ganeshpure, Gaurang Nandkishor Vaidya, Vipul Gattani
Journal: Case Rep Endocrinol (2012)

A young female presented with evidence of right-sided heart failure and was subsequently found to have significant pulmonary artery hypertension (PAH). Because of her normal left ventricular function and pulmonary capillary wedge pressure, the most probable site of etiology seemed to be the pulmonary vasculature. All the common possible secondary causes of PAH were ruled out, but during the investigations, she was found to have elevated thyroid function tests compatible with the diagnosis of Grave's disease. The treatment of Grave's disease, initially by medications and subsequently by radioiodine therapy, was associated with a significant reduction in the pulmonary artery systolic pressure. The purpose of this case report is to highlight one of the unusual and underdiagnosed presentations of Grave's disease.
Envenomation caused by Rhopalurus amazonicus Lourenço, 1986 (Scorpiones, Buthidae) in Pará State, Brazil
Authors: Deyanira Fuentes-Silva, Alfredo P Santos Jr, Joacir Stolarz Oliveira
Journal: J Venom Anim Toxins Incl Trop Dis (2014)
Keywords: brazilian amazon, envenomation, pará, rhopalurus amazonicus, scorpion sting, venomous animals
MeSH terms: Case Reports

Scorpions, mainly those belonging to the genus Tityus cause many deaths and injuries in Brazil, with tens of thousands of envenomations notified every year. However, injuries involving other scorpion species are scarcely registered. Among the sixteen species of the genus Rhopalurus, Thorell, 1876, described up to date, nine are found in this country, with only a confirmed case of human envenomation provoked by R. agamemnon Koch, 1839. The present case reports, for the first time, a case of scorpion sting in a human victim involving Rhopalurus amazonicus, endemic species of the west region of the Pará state, Amazon, Brazil. The symptoms of envenomation were local pain and paresthesia. This study contributes to develop the knowledge on venomous scorpions, particularly those that may cause envenomations in this region.
A case report and genetic characterization of a massive acinic cell carcinoma of the parotid with delayed distant metastases
Authors: Anthony C Nichols, Michelle Chan-Seng-Yue, John Yoo, Sumit K Agrawal, Maud H W Starmans, Daryl Waggott, Nicholas J Harding, Samuel A Dowthwaite, David A Palma, Kevin Fung, Bret Wehrli, S Danielle Macneil, Philippe Lambin, Eric Winquist, James Koropatnick, Joe S Mymryk, Paul C Boutros, John W Barrett
Journal: Case Rep Oncol Med (2013)

We describe the presentation, management, and clinical outcome of a massive acinic cell carcinoma of the parotid gland. The primary tumor and blood underwent exome sequencing which revealed deletions in CDKN2A as well as PPP1R13B, which induces p53. A damaging nonsynonymous mutation was noted in EP300, a histone acetylase which plays a role in cellular proliferation. This study provides the first insights into the genetic underpinnings of this cancer. Future large-scale efforts will be necessary to define the mutational landscape of salivary gland malignancies to identify therapeutic targets and biomarkers of treatment failure.
A Global Collaboration to Develop and Pilot Test a Mobile Application to Improve Cancer Pain Management in Nepal
Authors: Virginia T LeBaron, Bethany J Horton, Abish Adhikari, Sandhya Chapagain, Manita Dhakal, Rajesh Gongal, Regina Kattel, Ganesh Koirala, Anna Kutcher, Ben Hass, Martha Maurer, Daniel Munday, Bijay Neupane, Krishna Sharma, Ramila Shilpakar, Amuna Shrestha, Sudip Shrestha, Usha Thapa, Rebecca Dillingham, Bishnu D Paudel
Journal: Front Pain Res (Lausanne) (2022)
Keywords: nepal, cancer, capacity building, mobile applications, mobile health, pain, pain management guidelines, palliative care

Introduction:
Quality palliative care, which prioritizes comfort and symptom control, can reduce global suffering from non-communicable diseases, such as cancer. To address this need, the Nepalese Association of Palliative Care (NAPCare) created pain management guidelines (PMG) to support healthcare providers in assessing and treating serious pain. The NAPCare PMG are grounded in World Health Organization best practices but adapted for the cultural and resource context of Nepal. Wider adoption of the NAPCare PMG has been limited due to distribution of the guidelines as paper booklets.
Methods:
Building on a long-standing partnership between clinicians and researchers in the US and Nepal, the NAPCare PMG mobile application ("app") was collaboratively designed. Healthcare providers in Nepal were recruited to pilot test the app using patient case studies. Then, participants completed a Qualtrics survey to evaluate the app which included the System Usability Scale (SUS) and selected items from the Mobile App Rating Scale (MARS). Descriptive and summary statistics were calculated and compared across institutions and roles. Regression analyses to explore relationships (α = 0.05) between selected demographic variables and SUS and MARS scores were also conducted.
Results:
Ninety eight healthcare providers (n = 98) pilot tested the NAPCare PMG app. Overall, across institutions and roles, the app received an SUS score of 76.0 (a score > 68 is considered above average) and a MARS score of 4.10 (on a scale of 1 = poor, 5 = excellent). 89.8% (n = 88) "agreed" or "strongly agreed" that the app will help them better manage cancer pain. Age, years of experience, and training in palliative care were significant in predicting SUS scores (p-values, 0.0124, 0.0371, and 0.0189, respectively); institution was significant in predicting MARS scores (p = 0.0030).
Conclusion:
The NAPCare PMG mobile app was well-received, and participants rated it highly on both the SUS and MARS. Regression analyses suggest end-user variables important to consider in designing and evaluating mobile apps in lower resourced settings. Our app design and pilot testing process illustrate the benefits of cross global collaborations to build research capacity and generate knowledge within the local context.