OpenMed/multicare-articles huggingface dataset:
Case report: Stent-first strategy as a potential approach in the management of malignant right-sided colonic obstruction with cardiovascular risks
Authors: Tianyu Lin, Abdul Saad Bissessur, Pengfei Liao, Tunan Yu, Dingwei Chen
Journal: Front Surg (2022)
Keywords: cardiovascular risk, case report, colonic obstruction, coronary stent, self-expandable metallic stent, stent-first strategy
MeSH terms: Case Reports

In obstructing left-sided colonic or rectal cancer, endoscopic stent placement with the purpose of decompression and bridge to elective colon resection has been widely utilized and accepted. However, in malignant right-sided colonic obstruction, stent placement prior to colectomy is still highly controversial, due to lower clinical success and high anastomotic leak. We report a case of malignant right-sided colonic obstruction based on the radiological findings of irregular thickening of ascending colon wall and dilation of proximal large bowel on enhanced computed tomography scan. The 72-year-old woman presented with obvious abdominal distension. Due to concerning cardiovascular complications as intermittent chest pain and a long history of type 2 diabetes, a three-step therapeutic plan was instigated. Initially, a self-expandable metallic stent was placed palliatively to relieve the bowel obstruction. Consecutively, coronary angiography was performed, and two coronary stents were implanted to alleviate more than 80% stenosis of two main coronary arteries. One month later, laparoscopic radical resection of right colon and lymphadenectomy were successfully performed, with a blood loss less than 50 millimeters and a harvest of 29 lymph nodes, 1 being positive. The patient was discharged one week postoperatively with no complications, and received adjuvant chemotherapy one month later. During a follow-up of more than one year, the patient was in complete remission with no recurrence and cardiovascular events. In patients presenting with malignant right-sided colonic obstruction and peril of high cardiovascular risks, we propose colonic and coronary stent-first strategy to emergency surgery as a potential approach so as to ensure sufficient cardiovascular preparation improving perioperative safety. Moreover, the anatomical location of the tumor would be significantly achievable thus granting high-quality radical colon resection and lymphadenectomy.
Case Report: A Novel Pathogenic Missense Mutation in FAS: A Multi-Generational Case Series of Autoimmune Lymphoproliferative Syndrome
Authors: Claudia L Gaefke, Jonathan Metts, Donya Imanirad, Daime Nieves, Paola Terranova, Gianluca Dell'Orso, Eleonora Gambineri, Maurizio Miano, Richard F Lockey, Jolan Eszter Walter, Emma Westermann-Clark
Journal: Front Pediatr (2021)
Keywords: alps (autoimmune lymphoproliferative syndrome), fas, cytopenia, lymphoproliferation, novel mutation
MeSH terms: Case Reports

Autoimmune Lymphoproliferative Syndrome (ALPS), commonly caused by mutations in the FAS gene, is a disease with variable penetrance. Subjects may be asymptomatic, or they may present with lymphadenopathy, splenomegaly, cytopenias, or malignancy. Prompt recognition of ALPS is needed for optimal management. We describe a multi-generational cohort presenting with clinical manifestations of ALPS, and a previously unreported heterozygous missense variant of uncertain significance in FAS (c.758G >T, p.G253V), located in exon 9. Knowledge of the underlying genetic defect permitted prompt targeted therapy to treat acute episodes of cytopenia. This cohort underscores the importance of genetic testing in subjects with clinical features of ALPS and should facilitate the reclassification of this variant as pathogenic.
Paediatric antiretroviral overdose: A case report from a resource-poor area
Authors: Bryan A Ogoti, Angela A Otedo, Thomas M Chokwe
Journal: South Afr J HIV Med (2020)
Keywords: abacavir, antiretroviral, lamivudine, overdose, paediatrics, poisoning, resource-poor
MeSH terms: Case Reports

Introduction:
Toxic side effects from antiretroviral overdose in children have not been widely reported. Antiretroviral drugs are widely used as oral medications throughout sub-Saharan Africa.
Patient presentation:
We describe the clinical presentation and management of a 3-year-old male in rural Kenya, who accidentally overdosed on abacavir/lamivudine combination pills. The number of pills taken was approximately 250 tablets, that is 15 g of abacavir and 7.5 g of lamivudine. He presented 24 hours later to Homabay County Referral Hospital, with unresponsiveness, inability to feed and absence of playfulness. Physical examination revealed a sick-looking, 'unconscious' child, responding only to voice, with tachycardia, hypertension and moderate dehydration.
Management and outcome:
He was managed conservatively with rehydration, namely intravenous 1125 mL of 5% dextrose in 0.9% saline, and the monitoring of his neurologic status, urine output and all vital signs. He regained normal neurological function after 24 hours, and recovered uneventfully, but was lost to follow-up.
Conclusion:
In an area endemic for HIV and where antiretroviral drug use is commonplace, there is a need for health education to ensure that parents keep drugs out of the reach of children. In the case of a suspected overdose, parents need to be reminded to seek medical attention immediately. Physician awareness of the clinical presentation, management and challenges with an antiretroviral drug overdose is also important.
Large Vestibular Schwannoma: A Two-Stage Surgery
Authors: José Orlando de Melo Junior, José Alberto Landeiro, Roberto Leal da Silveira
Journal: Cureus (2023)
Keywords: acoustic neuroma, cerebellopontine angle tumour, retrosigmoid approach, staged surgery, vestibular schwannoma
MeSH terms: Case Reports

Treatment of large vestibular schwannoma (VS) has historically centered on total resection of the lesion. Staged surgery has been used for VS that is highly vascularized, unexpected events during surgery, and thinned and stretched facial nerve with serious adherence causing difficult dissection. We present a case of a patient with a large VS resected through a two-stage surgery through the same retrosigmoid craniotomy.
An unusual cause of inspiratory stridor in the newborn: congenital pharyngeal teratoma--a case report
Authors: Anna Posod, Elke Griesmaier, Andrea Brunner, Claus Pototschnig, Rudolf Trawöger, Ursula Kiechl-Kohlendorfer
Journal: BMC Pediatr (2016)
MeSH terms: Pharyngeal Neoplasms / diagnosis, Respiratory Sounds / etiology, Teratoma / diagnosis, Case Reports, Female, Humans, Infant, Newborn, Pharyngeal Neoplasms / complications, Pharyngeal Neoplasms / congenital, Teratoma / complications, Teratoma / congenital

Background:
Neonatal inspiratory stridor is an important examination finding that requires immediate and adequate evaluation of the underlying etiology. Depending on the severity of the airway obstruction and the presence or absence of associated symptoms such as respiratory distress and feeding problems, early initiation of a complete diagnostic workup can be crucial. The most common cause of neonatal inspiratory stridor is laryngomalacia, however, several differential diagnoses need to be investigated. More rare causes include oral or laryngeal masses. Teratomas of the head and neck region are one of the most unusual causes of respiratory distress during the neonatal period. We present a case of a mature teratoma in the oropharynx presenting with airway obstruction in a newborn infant.
Case presentation:
A four-day-old female Caucasian infant was admitted to the neonatal intensive care unit of our hospital because of inspiratory stridor and profound desaturations while feeding. Diagnostic workup by ultrasound, magnetic resonance imaging and flexible endoscopy revealed a pediculated lesion in the pharyngeal region causing intermittent complete airway obstruction. The mass was surgically removed by transoral laser resection on the seventh day of life. Histological evaluation was consistent with a mature teratoma without any signs of malignancy. The further hospital course was uneventful, routine follow-up examinations at 3, 6 and 9 months of age showed no evidence of tumor recurrence.
Conclusion:
Neonatal stridor is a frequent symptom in the neonatal period and is mostly caused by non-life-threatening pathologies. On rare occasions, however, the underlying conditions are more critical. A careful stepwise diagnostic investigation to rule out these conditions, to identify rare causes and to initiate early treatment is therefore warranted.
Mimicking Myelodysplastic Syndrome: Importance of Differential Diagnosis
Authors: Thomas Luo, Joanna Zurko, John Astle, Nirav N Shah
Journal: Case Rep Hematol (2021)
MeSH terms: Case Reports

Copper deficiency is a rare nutritional deficiency with hematological manifestations that mimic those found in myelodysplastic syndrome, a hematological malignancy incurable without allogeneic hematopoietic stem cell transplantation. Bone marrow biopsy findings and peripheral blood counts are oftentimes insufficient to differentiate the two conditions. Moreover, the symptoms of copper deficiency can arise years after the surgery, making diagnosis a challenge. In patients with new-onset pancytopenia, copper deficiency must be considered on the differential, especially in the setting of known risk factors such as bariatric surgery, zinc supplementation, and celiac disease. Herein, we present a case of a 61-year-old female with a remote history of gastric bypass being evaluated for MDS in the context of progressive pancytopenia and new-onset paresthesias. The patient was found to have low serum copper and ceruloplasmin. Copper supplementation largely resolved the hematological abnormalities, but the limb paresthesias remain. This case highlights the need to identify copper deficiency early and distinguish it from MDS in order to prevent permanent neurological deficits and catastrophic response should the patient undergo hematopoietic stem cell transplantation.
Second Trimester Heterotopic Triplet Pregnancy with Intrauterine Twin Pregnancy and Ruptured Interstitial Pregnancy: A Maternal Near-Miss Case Report
Authors: Charles Nkurunziza, Theogene Rurangwa, Vincent Ngendahimana, Urania Magriples
Journal: Case Rep Obstet Gynecol (2020)
MeSH terms: Case Reports

Heterotopic pregnancy is defined as the occurrence of simultaneous intrauterine and extrauterine pregnancies. It is a rare, potentially life-threatening condition and infrequent in natural conceptions. Here, we report a case of spontaneous heterotopic triplet pregnancy with ruptured cornual ectopic pregnancy and simultaneous twin intrauterine pregnancies at 18 weeks of gestation. The event led to miscarriage of all fetuses from both the ectopic and the intrauterine twin pregnancies.
Fibrosarcoma of mandible: a case report
Authors: Monal B Yuwanati, J V Tupkari
Journal: Case Rep Dent (2011)
MeSH terms: Case Reports

Fibrosarcoma is a malignant mesenchymal neoplasm of fibroblasts that rarely affects the oral cavity and can cause local recurrences or metastasis. In this paper, a case of fibrosarcoma in the posterior area of mandible in a 44-year-old woman is described. Clinical examination revealed a growth on right mandibular third molar region extending on the buccal and the lingual side. There was history of extraction of posterior teeth. Radiologically, there was a diffuse bone loss. Microscopically, the tumor showed an intense proliferation of fibroblasts of variable size and shape. These cells were arranged in parallel bands and partly crossing each other. The cells exhibited increased mitotic activity and nuclear pleomorphism. Immunohistochemically the cells showed immunoreactivity only for vimentin while they exhibited negativity towards S-100 protein, cytokeratin cocktail, HMB-45, desmin, smooth muscle actin, and epithelial membrane antigen (EMA). Based on findings the final diagnosis of fibrosarcoma was made.
Oral Verruciform Xanthoma within Lichen Planus: A Case Report and Literature Review
Authors: Vasileios I Theofilou, Alexandra Sklavounou, Prokopios P Argyris, Evanthia Chrysomali
Journal: Case Rep Dent (2018)
MeSH terms: Case Reports

Background:
Verruciform xanthoma is an uncommon benign tumor, which exhibits a wide range of clinical patterns. The occurrence of the lesion in patients with immune-mediated mucocutaneous diseases may suggest a role of localized epithelial cell damage and chronic inflammation in its pathogenesis.
Case report:
A case of verruciform xanthoma on the tongue of a 56-year-old female with oral lichen planus is reported. An asymptomatic pink-white lesion with a granular surface was observed in the left lateral lingual border, which was closely associated with a white plaque and striae. An incisional biopsy was performed, and histologically, epithelial projections in a verrucous pattern were observed. In the subepithelial connective tissue, aggregates of foamy cells that exhibited immunoreactivity for CD68 were noted. The final diagnosis was verruciform xanthoma. The mucosa adjacent to the lesion demonstrated histopathological features consistent with lichen planus.
Conclusions:
A total of twelve cases of oral verruciform xanthomas in patients with oral lichen planus including the present case have been reported in the literature. The clinician should be aware that verruciform xanthoma may mimic malignancy, and therefore, biopsy is required for definitive diagnosis to be established, especially when this tumor develops within conditions that show potential for malignant transformation.
Hemiparesis caused by cervical spontaneous spinal epidural hematoma: a report of 3 cases
Authors: Kinya Nakanishi, Naoki Nakano, Takuya Uchiyama, Amami Kato
Journal: Adv Orthop (2011)
MeSH terms: Case Reports

We report three cases of spontaneous spinal epidural hematoma (SSEH) with hemiparesis. The first patient was a 73-year-old woman who presented with left hemiparesis, neck pain, and left shoulder pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C3-C6 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The second patient was a 62-year-old man who presented with right hemiparesis and neck pain. A cervical MRI scan revealed a right posterolateral dominant epidural hematoma at the C6-T1 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The third patient was a 60-year-old woman who presented with left hemiparesis and neck pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C2-C4 level. The condition of the patient improved with conservative treatment. The classical clinical presentation of SSEH is acute onset of severe irradiating back pain followed by progression to paralysis, whereas SSEH with hemiparesis is less common. Our cases suggest that acute cervical spinal epidural hematoma should be considered as a differential diagnosis in patients presenting with clinical symptoms of sudden neck pain and radicular pain with progression to hemiparesis.
Acute necrotizing colitis due to sigmoid colon cancer
Authors: Hiroki Matsunaga, Dai Shida, Makoto Kamesaki, Yuichi Hamabe
Journal: World J Surg Oncol (2014)
MeSH terms: Colitis / etiology, Colonic Neoplasms / complications, Sigmoid Neoplasms / complications, Case Reports, Acute Disease, Aged, Colectomy, Colitis / pathology, Colitis / surgery, Colonic Neoplasms / pathology, Colonic Neoplasms / surgery, Female, Humans, Necrosis, Prognosis, Sigmoid Neoplasms / pathology, Sigmoid Neoplasms / surgery

When obstructive colitis becomes fulminant, it is known as 'acute necrotizing colitis'. We report a rare case of acute necrotizing colitis due to sigmoid colon cancer, in which shock status occurred within ten hours of onset. A 79-year-old female with acute abdominal pain was transported to our hospital with acute shock. Abdominal enhanced computed tomography revealed thickening of the wall of the sigmoid colon and marked dilation of the proximal colon. Emergency surgery was performed with the intraoperative findings of severe sigmoid colon stenosis and proximal dilation of the colon without perforation, and a large volume of putrid ascitic fluid. The intestine was proximally dilated and black in color, from the sigmoid colon to the ileum 60 cm proximal to the terminal ileum, suggesting acute necrosis. Total colectomy with 80 cm resection of terminal ileum and ileostomy was performed. Whereas acute necrotizing colitis is a rare condition and its etiology remains obscure, the chronic ischemic state must play some role. Our patient was of advanced age and had diabetes mellitus and hypertension. These factors might lead to a chronic ischemic state of the bowel due to arteriosclerosis. In addition to the underlying condition, massive bacterial reflux into the ileum from the colon might cause the capillary vasoconstriction of the bowel that led to her critical state.
Case Report: Genetic Double Strike: VEXAS and TET2-Positive Myelodysplastic Syndrome in a Patient With Long-Standing Refractory Autoinflammatory Disease
Authors: Fabian Lötscher, Luca Seitz, Helena Simeunovic, Adela-Cristina Sarbu, Naomi A Porret, Laurence Feldmeyer, Luca Borradori, Nicolas Bonadies, Britta Maurer
Journal: Front Immunol (2022)
Keywords: mds, tet2, vexas syndrome, autoinflammation, vasculitis
MeSH terms: DNA-Binding Proteins / genetics, Dioxygenases / genetics, Hereditary Autoinflammatory Diseases / genetics, Mutation, Myelodysplastic Syndromes / genetics, Ubiquitin-Activating Enzymes / genetics, Case Reports, Adrenal Cortex Hormones / therapeutic use, Aged, Hereditary Autoinflammatory Diseases / diagnosis, Hereditary Autoinflammatory Diseases / drug therapy, Humans, Male, Myelodysplastic Syndromes / diagnosis, Adrenal Cortex Hormones, DNA-Binding Proteins, UBA1 protein, human, Dioxygenases, TET2 protein, human, Ubiquitin-Activating Enzymes

Somatic genetic mutations involving the innate and inflammasome signaling are key drivers of the pathogenesis of myelodysplastic syndromes (MDS). Herein, we present a patient, who suffered from a long-standing refractory adult-onset autoinflammatory syndrome (AIS), previously interpreted as various distinct rheumatic disorders. Developing pancytopenia and particularly macrocytic anemia prompted the screening for a hematological malignancy, which led to the diagnosis of a TET-2-positive MDS. The impressive and continuously changing range of organ involvement, with remarkable refractoriness to anti-inflammatory treatment, exceeded the common autoinflammatory phenotype of MDS patients. This prompted us to suspect a recently discovered disease, characterized by somatic mutations of the UBA1 gene: the VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome, which was ultimately confirmed by genetic testing. Reevaluation of previous bone marrow biopsies showed the presence of characteristic vacuoles in myeloid- and erythroid progenitor cells. Our case illustrates that the triad of an unresponsive multisystemic autoinflammatory disease, hematological abnormalities and vacuoles in myeloid- and erythroid progenitors in the bone marrow biopsy should prompt screening for the VEXAS syndrome.
Repair of an Extensive Furcation Perforation with CEM Cement: A Case Study
Authors: Mohammad Jafar Eghbal, Mahta Fazlyab, Saeed Asgary
Journal: Iran Endod J (2014)
Keywords: biocompatibility, cem cement, dental cements, calcium enriched mixture, endodontics, furcation perforation, root canal therapy, treatment outcome
MeSH terms: Case Reports

Iatrogenic perforation of the furcation area in multi-rooted molars during preparation of the access cavity can potentially lead to tooth extraction. The present case report describes the nonsurgical endodontic management of an extensive pulp chamber floor perforation in a first mandibular molar with calcium enriched mixture (CEM) cement. The perforation was chemically cleaned and then physically sealed with CEM cement. Root canal therapy was completed and the tooth was then restored with amalgam. A one-year follow-up revealed the absence of symptoms of infection/inflammation as well as clinical and radiographic signs/symptoms and therefore, can be interpreted as a favorable treatment outcome.
Congenital Perirectal Dermoid Cyst: A Rare Cause of Complex, Recurrent Pediatric Fistula-in-ano
Authors: Wesley E Barry, Grace E Asuelime, Shengmei Zhou, Jeffrey Hammoudeh, Henri R Ford, Eugene S Kim
Journal: Front Pediatr (2018)
Keywords: anal fistula, dermoid cyst, fistula-in-ano, infection, pediatric surgery
MeSH terms: Case Reports

Perianal abscess and fistula-in-ano are well-described in the pediatric population. They are most common in infants less than 1 year of age and often resolve with oral antibiotics; occasionally they require drainage or fistulotomy. The etiology is commonly associated with cryptoglandular obstruction and subsequent infection, however alternative diagnoses should be considered in cases of recurrent abscesses and fistulae that are refractory to standard treatments. In this report, we present the case of an 8-year-old boy with a complex, recurrent fistula-in-ano that resulted from a rare congenital perirectal dermoid cyst.
Inadvertent subclavian artery cannulation: endovascular repair using a collagen closure device-report of two cases and review of the literature
Authors: Ganapathy Ananthakrishnan, Richard D White, Rajesh Bhat, Sam Chakraverty
Journal: Case Rep Vasc Med (2012)
MeSH terms: Case Reports

Inadvertent line insertion into the subclavian artery is an uncommon complication of subclavian venous catheterisation, and its timely recognition is vital to minimise risk of harm to the patient. We describe the radiographic, computed tomographic (CT), and angiographic findings in two patients and illustrate the subsequent endovascular management using collagen vascular closure devices.
Survival after left ventricular free wall rupture in an elderly woman with acute myocardial infarction treated only medically
Authors: Víctor Hugo Roa-Castro, Ervin Molina-Bello, Hector Valenzuela-Suárez, Tobías Rotberg-Jagode, Nilda Espinola-Zavaleta
Journal: Case Rep Vasc Med (2012)
MeSH terms: Case Reports

Pseudoaneurysm of the left ventricle is rare and may occur as a result of transmural myocardial infarction. The course of rupture after acute myocardial infarction varies from a catastrophic event, with an acute tear leading to immediate death (acute rupture), or slow and incomplete tear leading to a late rupture (subacute rupture). Incomplete rupture may occur when the thrombus and haematoma together with the pericardium seal the rupture of the left ventricle and may develop into a pseudoaneurysm. Early diagnosis and treatment is essential in this condition. Two-dimensional color Doppler echocardiography is the first-choice method for most patients with suspected left ventricular pseudoaneurysm (LVP) and suggests left ventricular rupture in 85% to 90% of patients. We report the case of an 87-year-old woman presenting with symptoms and findings of myocardial infarction and left ventricular free wall rupture with a pseudoaneurysm formation diagnosed by echocardiography and confirmed on CT, MRI, and NM. She received only intense medical treatment, because she refused surgery with a favorable outcome. After 24-month followup, she is in NYHA functional class II. The survival of this patient is due to the contained pseudoaneurysm by dense pericardial adhesions, related to her previous coronary bypass surgery.