OpenMed/multicare-articles huggingface dataset:
Treatment-resistant pediatric giant prolactinoma and multiple endocrine neoplasia type 1
Authors: Hoong-Wei Gan, Chloe Bulwer, Owase Jeelani, Michael Alan Levine, Márta Korbonits, Helen Alexandra Spoudeas
Journal: Int J Pediatr Endocrinol (2015)
Keywords: familial prolactinoma, macroprolactinoma, multiple endocrine neoplasia type 1, pituitary neoplasms, survivorship
MeSH terms: Case Reports

Background:
Pediatric pituitary adenomas are rare, accounting for <3 % of all childhood intracranial tumors, the majority of which are prolactinomas. Consequently, they are often misdiagnosed as other suprasellar masses such as craniopharyngiomas in this age group. Whilst guidelines exist for the treatment of adult prolactinomas, the management of childhood presentations of these benign tumors is less clear, particularly when dopamine agonist therapy fails. Given their rarity, childhood-onset pituitary adenomas are more likely to be associated with a variety of genetic syndromes, the commonest being multiple endocrine neoplasia type 1 (MEN-1).
Case description:
We present a case of an early-onset, treatment-resistant giant prolactinoma occurring in an 11-year-old peripubertal boy that was initially sensitive, but subsequently highly resistant to dopamine agonist therapy, ultimately requiring multiple surgical debulking procedures and proton beam irradiation. Our patient is now left with long-term tumor- and treatment-related neuroendocrine morbidities including blindness and panhypopituitarism. Only after multiple consultations and clinical data gained from 20-year-old medical records was a complex, intergenerationally consanguineous family history revealed, compatible with MEN-1, with a splice site mutation (c.784-9G > A) being eventually identified in intron 4 of the MEN1 gene, potentially explaining the difficulties in management of this tumor. Genetic counseling and screening has now been offered to the wider family.
Conclusions:
This case emphasizes the need to consider pituitary adenomas in the differential diagnosis of all pediatric suprasellar tumors by careful endocrine assessment and measurement of at least a serum prolactin concentration. It also highlights the lack of evidence for the optimal management of pediatric drug-resistant prolactinomas. Finally, the case we describe demonstrates the importance of a detailed family history and the role of genetic testing for MEN1 and AIP mutations in all cases of pediatric pituitary adenoma.
Dramatic response of nail psoriasis to infliximab
Authors: Gilles Safa, Laure Darrieux
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Nail psoriasis, affecting up to 50% of psoriatic patients, is an important cause of serious psychological and physical distress. Traditional treatments for nail psoriasis, which include topical or intralesional corticosteroids, topical vitamin D analogues, photochemotherapy, oral retinoids, methotrexate, and cyclosporin, can be time-consuming, painful, or limited by significant toxicities. Biological agents may have the potential to revolutionize the management of patients with disabling nail psoriasis. We present another case of disabling nail psoriasis that responded dramatically to infliximab.
Iatrogenic duodenal perforation treated with endoscopic placement of metallic clips: a case report
Authors: Missale Solomon, Alexander Schlachterman, Ricardo Morgenstern
Journal: Case Rep Med (2012)
MeSH terms: Case Reports

Perforation is one of the major complications encountered during endoscopic procedures. The standard of care for these complications is either surgical intervention or nonoperative medical approach with antibiotics and bowel rest with or without parenteral alimentation. Metallic clips, initially developed to secure hemostasis in bleeding, have been successfully used to close perforations in the gastrointestinal tract (GI) including the duodenum. This avoids perioperative morbidities associated with surgical intervention while limiting the leakage of intestinal contents and peritoneal contamination that is possible with medical management. We present a case of a patient with a lateral duodenal perforation during an endoscopic retrograde cholangiopancreatography (ERCP) which was successfully treated with immediate placement of metallic endoclips.
Synchronous plexiform neurofibroma in the arytenoids and neurofibroma in the parapharynx in a patient with non-neurofibromatosis: a case report
Authors: Hee Young Son, Hyun Seok Shim, Jin Pyeong Kim, Seung Hoon Woo
Journal: J Med Case Rep (2013)

Introduction:
Plexiform neurofibroma of the larynx is a rare disease. In this report, we present a plexiform neurofibroma in the arytenoids and neurofibroma in the parapharynx detected coincidently.
Case presentation:
A 56-year-old Asian woman presented with respiratory distress and episodes of apnea at night. A solitary mass from the left arytenoids was found to be nearly obstructing the airway and causing the sleep apnea. There was also a parapharynx mass protruding into the pharynx. The parapharynx tumor was removed with the lateral incision approach, and the arytenoid tumor was removed with a transoral carbon dioxide laser. The pathologic diagnosis was plexiform neurofibroma for the arytenoid mass and neurofibroma for the parapharynx mass.
Conclusion:
We have reported an extremely rare case of plexiform neurofibroma in the arytenoids and neurofibroma in the parapharynx. This entity may be considered in the differential diagnosis of all laryngeal and parapharynx masses.
Left atrial appendage aneurysm in pediatrics: Case study and literature review
Authors: Kambiz Norozi, Mathushan Subasri, Luis Altamirano Diaz, Osami Honjo
Journal: Front Cardiovasc Med (2023)
Keywords: case report, left atrial appendage aneurysm, literature review, pediatric cardiac surgery, pediatric cardiology
MeSH terms: Case Reports

Left atrial appendage aneurysm (LAAA) is a rare cardiac pathology that is often identified in adulthood. There are a myriad of presentations related to atrial appendage enlargement, but most are asymptomatic. Pediatric cases of LAAA are extremely rare. We report a case of an incidental giant LAAA found in a healthy 6-year-old boy. He was successfully treated with surgical resection. A review of the literature shows that the presentation of LAAA in pediatrics likely involves cardiac or respiratory symptoms but can also be incidental findings. Similar to adults, diagnosis requires cardiac imaging, with echocardiography being the mainstay. Surgical intervention is indicated in symptomatic and most asymptomatic patients to prevent complications. More research is warranted into the optimal timing of surgery and alternative surgical approaches for complex cases.
Neonatal Arterial Tortuosity and Adult Aortic Aneurysm-Is There a Missing Link?-A Case Report
Authors: Srabani Bharadwaj, Charmaine Chan, Jonathan Choo Tze Liang, Sarat Kumar Sanamandra, Marielle Valerie Fortier, Ai Ling Koh, Sreekanthan Sundararaghavan
Journal: Front Pediatr (2022)
Keywords: aortic aneurysm, arterial tortuosity, hydrops fetalis, neonatal, pediatric
MeSH terms: Case Reports

We report a novel case of a full term newborn with non-immune fetal hydrops and arterial tortuosity mimicking a double aortic arch, and cranial fractures in the immediate neonatal period. The infant had no classic features of neonatal arterial tortuosity syndrome or Loeys Dietz syndrome apart from bilateral inguinal hernia. He also had skeletal manifestations in the form of fractures in the neonatal period without any trauma during birth and without clinical evidence of Osteogenesis Imperfecta. A heterozygous missense variant of uncertain significance was detected in MYH11 gene which is increasingly recognized to be belonging to the familial/hereditary thoracic aneurysm and aortic dissection group of disorders. Fetal hydrops as an association with arterial tortuosity has not been reported in the literature. We hypothesize the possible mechanism behind developing fetal hydrops in this case and discuss the genetic and phenotypic heterogeneity of the Familial Thoracic Aortic Aneurysm and Dissection (FTAAD) group of conditions highlighting the unique phenotypic and genotypic presentations. We recommend a high index of suspicion and vigilance in the early detection of such potentially lethal conditions with sequelae also in adulthood.
Nonsurgical Treatment of Type II Dens Invaginatus in a Maxillary Lateral Incisor Using Cone-Beam Computed Tomography
Authors: Mohsen Afkar, Mahboubeh Gholamshahi, Mehdi Mohammadi
Journal: Iran Endod J (2018)
Keywords: cone-beam computed tomography, dens invaginatus, maxillary lateral incisor
MeSH terms: Case Reports

This is a clinical report of a case of Oehlers type II dens invagination in left maxillary lateral incisor. A 12-year-old female patient was referred to endodontic department of Islamic Azad University. She reported history of pain and swelling on left anterior maxilla. Due to the insufficient information from conventional radiography, cone-beam computed tomography (CBCT) was ordered. CBCT revealed apical lucency and two separate canals. Conventional root canal therapy was done using warm vertical technique for invaginated canal. One year follow-up radiographies showed periapical repair and absence of symptoms.
Asymptomatic Pancreatic Metastasis from Renal Cell Carcinoma Diagnosed 21 Years after Nephrectomy
Authors: Megumi Zianne, Naoki Takahashi, Akihiko Tsujibata, Kazuhiro Miwa, Yoshinori Goto, Yutaka Matano
Journal: Case Rep Gastrointest Med (2017)
MeSH terms: Case Reports

This report presents our experience with a case of pancreatic metastasis of renal cell carcinoma (RCC) at a long-term follow-up after nephrectomy. A 73-year-old man underwent nephrectomy for right RCC 21 years ago; computed tomography (CT) scanning on routine follow-up revealed a solid mass in the tail of the pancreas, and magnetic resonance imaging (MRI) showed some tumors in the head and tail of the pancreas. The patient was asymptomatic and allergic to contrast medium. Therefore we could not perform contrast CT/MRI for further examination to diagnose pancreatic tumors. We undertook endoscopic ultrasonography (EUS) and detected a hypervascular and low echoic mass; tumor tissues were obtained by EUS-guided fine-needle aspiration (EUS-FNA). Pathological diagnosis revealed pancreatic metastasis of clear cell RCC; this was similar to the pathological findings of tumor tissues initially obtained by nephrectomy. EUS-FNA was extremely useful for the definitive diagnosis of a rare type of pancreatic tumor.
Acute haematogenous metacarpal osteomyelitis in children: a case report and review of literature
Authors: Jordi Colomina Morales, Laura Soria Villegas, Joan Carles Monllau García
Journal: Case Rep Infect Dis (2011)
MeSH terms: Case Reports

Metatarsal osteomyelitis in children is a very uncommon disease, and this can make diagnosis difficult leading to a delay in treatment that can cause complications like brachymetacarpia or loss of function. We present an infant affected by granulomatous chronic disease with acute haematogenous osteomyelitis of the fourth metacarpal. Serratia marcescens was found to be the pathogenic agent. Treatment was antibiotics and debridement. Bone healed with little length discrepancy but functional result was normal.
Giant Prolactinoma of Young Onset: A Clue to Diagnosis of MEN-1 Syndrome
Authors: Chandrika Jayakanthi Subasinghe, Noel Somasundaram, Pathmanathan Sivatharshya, Lalana Devi Ranasinghe, Márta Korbonits
Journal: Case Rep Endocrinol (2018)
MeSH terms: Case Reports

Multiple endocrine neoplasia (MEN) type 1 syndrome is an autosomal dominant disorder caused by germline mutations in MEN1 gene, characterized by tumours in endocrine and nonendocrine organs. Giant prolactinoma is defined as tumours larger than 40mm with very high prolactin secretion. We report two unrelated Sri Lankan patients (8-year-old boy and a 20-year-old female) who presented with giant prolactinomas with mass effects of the tumours. The female patient showed complete response to medical therapy, while the boy developed recurrent resistant prolactinoma needing surgery and radiotherapy. During follow-up, both developed pancreatic neuroendocrine tumours. Genetic analysis revealed that one was heterozygous for a nonsense mutation and other for missense mutation in MEN1 gene. Screening confirmed familial MEN-1 syndrome in their families. High clinical suspicion upon unusual clinical presentation prompted genetic evaluation in these patients and detection of MEN1 gene mutation. Pituitary adenomas in children with MEN-1 syndrome are larger tumours with higher rates of treatment resistance. This report emphasizes importance of screening young patients with giant prolactinoma for MEN-1 syndrome and arranging long-term follow-up for them expecting variable treatment outcomes. Sri Lanka requires further studies to describe the genotypic-phenotypic variability of MEN-1 syndrome in this population.
Treatment of postoperative non-union with internal fixation loosening of Garden IV femoral neck fracture with teriparatide in a young adult: A case report
Authors: Lili Lai, Yifan Li, Miaoda Shen, Xuanwei Wang, Cheng Zhong, Sanzhong Xu
Journal: Front Surg (2022)
Keywords: case report, femoral neck fracture, fracture nonunion, teriparatide, young adults
MeSH terms: Case Reports

Background:
Postoperative non-union of femoral neck fracture often needs secondary operation. We report a case of a postoperative non-union of femoral neck fracture treated with teriparatide.
Case presentation:
A young male patient with Garden IV femoral neck fracture who showed no obvious signs of healing 3 months after percutaneous hollow nail fixation in which the fracture line was enlarged and the hollow nail was withdrawn. Bone non-union healed after 6 months of continuous subcutaneous injection of teriparatide at a dosage of 20 mg/day after the patient refused a secondary surgery. As far as we know, there have been no relevant reports on this type of fracture yet.
Conclusions:
Teriparatide is expected to be beneficial in treating young patients with a displaced femoral neck fracture who have difficulty in healing from non-union and who are keen on avoiding secondary surgery.
Acute presentation of giant sporadic vestibular schwannoma with massive hemorrhage: A critical review with a case illustration
Authors: Nitish Nayak, Anil Kumar Sharma, Surendra Kumar Gupta, Prashant Raj Singh
Journal: Brain Spine (2022)
Keywords: cerebellopontine angle lesion, giant vestibular schwannoma, intratumoral hemorrhage
MeSH terms: Case Reports

Introduction:
Hemorrhage in vestibular schwannoma (VS) is a rare but potentially devastating complication, owing to the proximity to the brainstem and small space in the posterior fossa.
Research question:
it is a challenge to manage such patients, coming in emergency in comatose state and whether early intervention can reverse the consequence or not.
Material and methods:
A 42-year-old male presented in emergency room (ER) with sudden onset of severe headache followed by loss of consciousness, with GCS- 3 (E1V1M1) and mid-dilated fixed pupil. Computer tomography (CT scan) head revealed a large hematoma in the right cerebellopontine angle (CP) with hydrocephalus, requiring urgent CSF diversion (External Ventricular Drain) in the ER. Subsequently microsurgical excision of the tumor was done after few days, once patient has shown improvement in GCS. Histopathology confirmed it as hemorrhagic VS. Post-operatively, he had right HB (House- Brackemann) grade IV facial weakness which could not be appreciated in preoperative phase. He gradually recovered well and was able to walk without support at the time of discharge.
Result:
At 4 months follow up, facial weakness slightly improved to HB grade III, and patient was doing his daily activity without difficulty. Follow-up magnetic resonance imaging (MRI) imaging showed a small residue near internal acoustic meatus (IAM).
Discussion and conclusion:
Hemorrhage in VS is associated with increased morbidity and mortality; and few times, urgent intervention can save life despite of comatose state of the patient.
Neuroendocrine tumour in a patient with neurofibromatosis type 1 and HIV
Authors: Juliane Hiesgen, Ebrahim Variava
Journal: South Afr J HIV Med (2015)
MeSH terms: Case Reports

We report the case of an HIV-positive female patient with neurofibromatosis type 1 who was treated for recurrent peptic ulcer disease and later developed diabetes mellitus and chronic diarrhoea. A metastasising somatostatinoma was histologically proven and evidence of a concomitant gastrin-producing neuroendocrine tumour was found. Neuroendocrine tumours (NETs) are very rare neoplasms originating from a wide variety of endocrine and nervous system tissue with the ability to produce different hormones. A somatostatin- and gastrin-secreting NET in a patient with HIV has not been reported in the literature, to the best of our knowledge. We discuss oncogenic pathomechanisms related to the underlying conditions and propose stringent monitoring for tumours in HIV-positive patients with phakomatoses as well as initiation of antiretroviral therapy.
Acquired Coagulopathy and Hemorrhage Secondary to Subcutaneous Heparin Prophylaxis
Authors: Maria Sunseri, Tania Ahuja, Tanya Wilcox, David Green
Journal: Case Rep Hematol (2018)
MeSH terms: Case Reports

Unfractionated heparin and low-molecular-weight heparins are commonly used as thromboprophylaxis for hospitalized patients. Though generally considered safe at prophylactic doses, cases of catastrophic hemorrhage have been reported. The proposed mechanism involves bioaccumulation of heparin through saturation of the rapid-elimination pathway in its metabolism. We present an unusual case of an average-weight man with metastatic melanoma who suffered hemorrhage with syncope and end-organ damage while on prophylactic three times daily unfractionated heparin. Coagulation studies were consistent with heparin toxicity. Despite administration of protamine, the clearance of heparin was remarkably delayed, as demonstrated by serial coagulation studies. We review the suspected risk factors for heparin bioaccumulation and the emerging understanding of this unusual adverse event involving a nearly ubiquitous medication.
A Rare Case of Pneumopericardium in the Setting of Tuberculous Constrictive Pericarditis
Authors: Lauro L Abrahan Iv, Stephanie Martha O Obillos, Jaime Alfonso M Aherrera, Jose Donato A Magno, Celia Catherine C Uy-Agbayani, Ulysses King G Gopez, Jobelle Joyce Anne R Baldonado
Journal: Case Rep Cardiol (2017)
MeSH terms: Case Reports

A 28-year-old Filipino male was admitted due to high-grade fevers and dyspnea on a background of chronic cough and weight loss. Due to clinical and echocardiographic signs of cardiac tamponade, emergency pericardiocentesis was performed on his first hospital day. Five days after, chest radiographs showed new pockets of radiolucency within the cardiac shadow, indicative of pneumopericardium. On repeat echo, air microbubbles admixed with loculated effusion were visualized in the anterior pericardial space. Constrictive physiology was also supported by a thickened pericardium, septal bounce, exaggerated respiratory variation in AV valve inflow, and IVC plethora. A chest CT scan confirmed the presence of an air-fluid level within the pericardial sac. The patient was started on a quadruple antituberculosis regimen and IV piperacillin-tazobactam to cover for superimposed acute bacterial pericarditis. Pericardiectomy was performed as definitive management, with stripped pericardium measuring 5-7 mm thick and caseous material extracted from the pericardial sac. Histopathology was consistent with tuberculosis. This report highlights pneumopericardium as a rare complication of pericardiocentesis. We focused on the utility of echocardiography for diagnosing and monitoring this condition on a background of tuberculous constrictive pericarditis, ultimately convincing us that pericardiectomy was necessary, instead of the usual conservative measures for pneumopericardium.
Case Report: Spontaneous simultaneous coronary and carotid dissection in a young cannabis user
Authors: Hassen Ibn Hadj Amor, Imen Touil, Seif Boukriba, Skander Bouchnak, Salma Kraiem, Ramzi Rouabhia
Journal: F1000Res (2021)
Keywords: cannabis, acute coronary syndrome, carotid dissection, coronary dissection, ischemic stroke
MeSH terms: Acute Coronary Syndrome, Cannabis / adverse effects, Stroke / etiology, Case Reports, Adolescent, Carotid Arteries, Dissection, Humans

Due to legalization of its consumption in some countries and its medical use as well as low toxic potential, cannabis remains the most widely used drug around the world and the rate of usage is only increasing. Nevertheless, there are several case reports of vascular complications following cannabis use even in young people without cardiovascular risk factors. We report the case of a cannabis smoker presenting to the emergency room for an ischemic stroke associated with an acute coronary syndrome related to a spontaneous simultaneous double dissection of the carotid artery and the left anterior descending artery, with a favourable outcome under medical treatment. This case shows the seriousness of complications due to the cannabis consumption, hence the need to limit or even prohibit its consumption.
Kids' Perceptions toward Children's Ward Healing Environments: A Case Study of Taiwan University Children's Hospital
Authors: Jeng-Chung Woo, Yi-Ling Lin
Journal: J Healthc Eng (2016)
MeSH terms: Health Facility Environment, Hospitals, Pediatric, Adolescent, Child, Grounded Theory, Humans, Perception, Reproducibility of Results, Taiwan

This paper summarizes the opinions of experts who participated in designing the environment of a children's hospital and reports the results of a questionnaire survey conducted among hospital users. The grounded theory method was adopted to analyze 292 concepts, 79 open codes, 25 axial codes, and 4 selective codes; in addition, confirmatory factor analysis and reliability analysis were performed to identify elements for designing a healing environment in a children's hospital, and 21 elements from 4 dimensions, namely, emotions, space design, interpersonal interaction, and pleasant surroundings, were determined. Subsequently, this study examined the perceptions of 401 children at National Taiwan University Children's Hospital. The results revealed that, regarding the children's responses to the four dimensions and their overall perception, younger children accepted the healing environment to a significantly higher degree than did older children. The sex effect was significant for the space design dimension, and it was not significant for the other dimensions.