OpenMed/multicare-articles huggingface dataset:
The fertility-sparing treatment and outcome of epithelioid trophoblastic tumor isolated to lung: a case report and review literature
Authors: Zengshu Huang, Yingjuan Yu, Darong Wen, Nan Wang, Liping Zeng
Journal: Front Oncol (2024)
Keywords: case report, epithelioid trophoblastic tumor (ett), fertility-sparing surgery, isolated pulmonary metastasis, literature review
MeSH terms: Case Reports

Background:
Epithelioid trophoblastic tumor (ETT) is the rarest gestational trophoblastic tumor, with poor response to chemotherapy. Hysterectomy, as the cornerstone therapy for early ETT, is particularly challenging in reproductive-age women who often have a strong desire for fertility preservation. The management of extra-uterine ETT could be even more complicated and inconsistent. Here we reported a case of isolated ETT lesions in lungs managed with thoracic surgery without hysterectomy.
Case presentation:
A 32-year-old woman presented with amenorrhea for 2 months. Her serum β- human chorionic gonadotropin (hCG) levels fluctuated between 52 and 75 mIU/mL. The patient underwent removal of intrauterine device and suction and curettage, but only proliferative endometrium was found. Methotrexate was given for a provisional diagnosis of ectopic pregnancy of unknown location, while β-hCG had no significant decline. She complained of mild chest pain during the past half year, and the chest computed tomography (CT) result showed two mixed ground-glass nodules of 24 mm × 14.2 mm in right upper lobe and 10 mm × 8 mm in the right lower lobe and a thin-walled cavity in the posterior segment of the left lower lobe. Right upper wedge resection and right lower segmentectomy were performed 3 months later. The result of the pathological examination of pulmonary mass indicated an epithelioid trophoblastic tumor. She was diagnosed with ETT at stage III (with right lung metastasis) according to FIGO 2000. Her menstrual cycle recovered within 1 month after the first thoracic surgery. However, β-hCG was elevated again to 9 mIU/mL, and the positron emission tomography/computed tomography (PET/CT) scans revealed the consolidation of the nodule in the left lower lobe which enlarged to about 1.0 cm × 1.7 cm. Her second pulmonary surgery without hysterectomy was conducted. Followed for 12 months for postoperative monitoring, the patient was found to be disease-free with negative results of serial serum β-hCG and chest CT.
Conclusion:
Our case highlights the efficacy of fertility-sparing surgery for isolated ETT in lungs. The surgical management of pulmonary isolated ETT could be individualized under long-term supervision. Sporadic reports on the favorable outcome of extra-uterine ETT with fertility-sparing surgery were described in the last decades. The safety of this surgical strategy might be warranted only if enough reliable data is accumulated.
Neuroanthropology of shamanic trance: a case study with a ritual specialist from Mexico
Authors: Hugo Toriz, Antonella Fagetti, Guadalupe Terán-Pérez, Roberto E Mercadillo
Journal: Front Psychol (2024)
Keywords: consciousness, divination, electroencephalography, limpia, neuroanthropology, shamanism, trance

In Mexico, shamans are recognized for the gift of entering a deep trance that allows them to know the origin of the diseases and conflicts that afflict people. They commonly treat patients through limpias (cleansing) to extract negative elements sent by a witch or that were "collected" in places that harbor "evil winds." We present a case study of an 81-year-old Mexican shaman who noticed her gift in childhood. Electroencephalographic recordings were made while the shaman performed three activities: reading cards to diagnose a patient and answer the questions he posed; limpia with chicken eggs, stones, and bells to absorb adverse "things"; and the incorporation trance through which the deceased is believed to occupy the shaman's body to use it as a communication channel. Alpha activity was observed when concentrated, suggesting a hypnagogic-like state. Predominant beta and gamma oscillations were observed, suggesting a potential plastic phenomenon that modulates the assimilation of external and internal referents guiding temporal schemes for action, attention, and the integration of mnemonic, sensory, and imaginative elements. We used a neuroanthropological approach to understand shamanic trance as a biological potential of the human brain to induce non-ordinary states of consciousness linked to cultural beliefs and practices.
Multimodal imaging in Ig G4- related aortitis: case report
Authors: Lindsay Benites-Yshpilco, Lucia Barriales-Revilla, Roberto Baltodano-Arellano, Luis Falcón-Quispe, Kelly Cupe-Chacalcaje, Ángela Cachicatari-Beltrán, Gerald Lévano-Pachas
Journal: Arch Peru Cardiol Cir Cardiovasc (2024)
Keywords: aortitis, echocardiography, doppler, echocardiography, transesophageal, multimodal imaging
MeSH terms: Case Reports

We present the case of a 56-year-old patient with fever of unknown origin associated with chest and lumbar pain. Multimodality imaging revealed diffuse peri-aortitis in the thoracic aorta without involvement of the aortic valve, contributing substantially to the diagnosis of Ig G4-associated aortitis. Immunosuppressive therapy was started. Follow-up at five months with cardiac magnetic resonance imaging showed a reduction in the inflammatory process in the thoracic aorta.
Azygos Vein Pseudoaneurysm After Trauma: A Case Report
Authors: Kyle Nugent, Andrew McCague, Sage Rivard, Austin Henken-Siefken
Journal: Cureus (2024)
Keywords: azygos vein, azygos vein pseudoaneurysm, motor vehicle accident, pseudoaneurysm, trauma
MeSH terms: Case Reports

High-speed motor vehicle collisions (MVCs) often result in severe musculoskeletal, neurological, and vascular injuries. Among these, azygos vein pseudoaneurysms (AVPs) are a rare and potentially life-threatening vascular complication. Our case study highlights an instance of an AVP arising from a high-velocity MVC, underscoring their critical significance in trauma scenarios. Additionally, this report delves into the complexities of managing AVPs, both traumatic and idiopathic, emphasizing the urgent need for intervention and the intricacies of their treatment.
Nocardia farcinica infection presenting as a solitary bronchial neoplasm in an immunocompetent adult: a case report
Authors: Yuying Tan, Mei Yang, Chun Wan, Shijie Tang, Lin Liu, Lei Chen
Journal: Front Med (Lausanne) (2024)
Keywords: nocardia farcinica, bronchial neoplasm, immunocompetent adult, metagenomic next-generation sequencing, postural dyspnea
MeSH terms: Case Reports

Nocardia species are gram-positive, acid-fast, saprophytic, aerobic bacilli, predominantly resulting in opportunistic infections in immunocompromised individuals. Here, we reported a case of Nocardia infection in a 27-year-old woman with normal immunocompetence, who presented as a solitary neoplasm in the left principal bronchus with a chief complaint of postural dyspnea. By electrotomy via bronchoscopy, the neoplasm was successfully removed, and it was further identified as Nocardia farcinica by metagenomic next-generation sequencing.
Postpartum Psychosis as a Consequence of Thyroiditis Versus Relapse: A Diagnostic Dilemma
Authors: Alec Fulton, Neha Mittal, Anasua Deb
Journal: Cureus (2024)
Keywords: diagnostic dilema, management of thyrotoxicosis, postpartum psychosis, postpartum psychosis risk factors, postpartum thyroiditis
MeSH terms: Case Reports

Thyrotoxicosis can exhibit overlapping symptoms of psychosis in the general population. Each of these pathologies has well-established workups and management. Rare presentations of thyroiditis and psychosis in the postpartum state have been seen in case studies mostly, but data on the prevalence of postpartum psychosis in association with postpartum thyroiditis are not available. Here, we present a unique case of a patient with a history of bipolar disorder who originally presented with postpartum thyroiditis that was worked up and managed appropriately. However, on follow-up, the patient was found to have progressed into prominent psychosis. Both thyroiditis and psychosis were managed individually with full remission upon discharge and is doing well today. The co-occurrence of postpartum psychosis and thyroiditis presents a unique challenge for timely diagnosis and management. We present a case of a young woman initially diagnosed with postpartum thyroiditis needing further management of postpartum psychosis due to persistent symptoms. Clinical presentation supported with a prior history of mood disorder increases the likelihood of these diagnoses together.
A Diagnosis of Maternal 22q Duplication and Mosaic Deletion following Prenatal Cell-Free DNA Screening
Authors: Melissa A Hicks, Emilie Lalonde, Jessica Zoladz, Bernard Gonik, Salah Ebrahim
Journal: Case Rep Genet (2023)
MeSH terms: Case Reports

Concurrent microduplication and microdeletion of the chromosome 22q11.2 region are a rarely reported phenomenon. We describe a case of germline 22q11.21 microduplication syndrome with concurrent mosaic 22q11.2 deletion in a pregnant patient, identified by chromosomal microarray and FISH after noninvasive prenatal genetic screening (cfDNA) results discordant with family history. The patient was referred to maternal-fetal medicine (MFM) at 14 weeks' gestation secondary to an SNP-based cfDNA result of a suspected maternal 22q11.2 deletion and a fetal risk of 1 in 2 for 22q11.2 deletion syndrome. The patient reported a similar cfDNA result in a previous pregnancy; however postnatal chromosomal microarray on that child identified an atypical 22q11.21 microduplication. We report the maternal chromosomal microarray findings of a germline 726 kb 22q11.21 duplication and a mosaic 1.33 Mb 22q11.2 deletion and highlight the copy number variant data generated by cfDNA in this unique case. This family adds to the limited literature of concurrent 22q11.2 microduplication and microdeletion carriers.
Case report: Rare variants in the MTRR gene, 66GG and 524TT cause hyperhomocysteinemia and folic acid deficiency linked to schizophrenia
Authors: Chih-Chia Huang
Journal: Front Psychiatry (2024)
Keywords: msr, mtrr, delayed diagnosis, folic acid, hyperhomocysteinemia
MeSH terms: Case Reports

We present an adult patient with schizophrenia who was later found to have hyperhomocysteinemia, a condition that increases the risk of several diseases, due to a deficiency in folic acid. Although folic acid supplementation quickly normalized the hyperhomocysteinemia and folic acid levels, it did not significantly improve the overall mental and cognitive health. Genotype analysis was performed and the patient was found to have two pathogenic variants in the MTRR gene, 66GG and 524TT, which encodes for methionine synthase reductase (MSR), an enzyme crucial for homocysteine metabolism. The results can shed light on the reasons behind the patient's hyperhomocysteinemia and folic acid deficiency. Hyperhomocysteinemia confers an increased risk of several diseases. Indeed, the patient has neurodevelopment and cardiovascular health problems for decades. Given the rarity of the condition and the nonspecific nature of the symptoms, the detection of hyperhomocysteinemia or MSR deficiency can often be delayed or overlooked. Considering the potential irreversible and detrimental consequences of prolonged hyperhomocysteinemia and folic acid deficiency that our patient is likely experiencing, we suggest that clinicians be vigilant for associated signs when they encounter adolescents exhibiting psychotic symptoms, especially those with additional physical symptoms and a history of resistance to treatment.
Short-term intervention complemented by wearable technology improves Trichotillomania - A naturalistic single-case report
Authors: Konstantin W Leibinger, Eileen Murray, Steffen Aschenbrenner, Jennifer Randerath
Journal: Front Psychol (2023)
Keywords: trichotillomania, habit-reversal training, naturalistic psychotherapy research, single-case report, wearable device, wearable technology

There is a growing interest in using wearable technology for the treatment of body-focused repetitive behaviors (BFRBs), such as Trichotillomania. Yet, to our knowledge, few studies address the applicability and use of wearable technology as a therapeutic element in more naturalistic situations. Here we would like to introduce its potential use combined with a Habit-Reversal Training in a single-case experimental design. In practice, individuals with BFRBs frequently show complex constellations of psychiatric disorders. Accordingly, the here presented participant was diagnosed with Trichotillomania as well as comorbid ADHD and examination phobia. The participant was offered to wear an unobtrusive and user-friendly vibration device that sent an alarm when her critical hairpulling behaviors occurred. The complementing Habit-Reversal Training included an Awareness Training supported by the vibration alarm of the wearable device. It further included a Competing Response Training by learning benign behaviors that could replace the hairpulling behavior. The frequency of hairpulling episodes was assessed using daily self-reports and by using the monitoring function of the wearable device. The intervention procedure was implemented into the participant's everyday life and evaluated over the course of 214 days. The results indicated a significant reduction in the daily episodes of hair pulling. Our preliminary findings suggest that the here applied intervention has the potential to effectively treat Trichotillomania in individuals with comorbid disorders in psychotherapeutic outpatient care. Certainly, group-studies will need to further validate the approach's effectiveness.
Gynecomastia in a Man With Adrenal Mass
Authors: Jasmine Saini, Patrick Navin, Michael Rivera, Irina Bancos
Journal: JCEM Case Rep (2023)
Keywords: adrenal cancer, adrenocortical carcinoma, estrogen, feminization
MeSH terms: Case Reports

Estrogen-secreting adrenocortical carcinoma (ACC) is exceedingly rare, representing 1% to 2% of all ACCs. We present a case of a 65-year-old man diagnosed with an estrogen-secreting, 4.3-cm right adrenal mass discovered during work-up for bilateral gynecomastia. Gynecomastia and hyperestrogenism resolved after laparoscopic adrenalectomy, and pathology was reported as adrenocortical adenoma. However, 5 years later, he again developed bilateral gynecomastia because of recurrent hyperestrogenism. Imaging revealed multiple metastases in the abdomen. Urine steroid profiling demonstrated increased androgen precursors, androgen metabolites, and glucocorticoid precursors. Ultrasound-guided biopsy of one of the metastases confirmed ACC. Initial therapy included debulking surgery with removal of metastatic lesions. Mitotane therapy was initiated 4 weeks later along with hydrocortisone for anticipated mitotane-induced adrenal insufficiency. Histopathology from the adrenalectomy specimen 5 years earlier was rereviewed and confirmed ACC. Estrogen-secreting adrenal tumors are exceedingly rare, and the majority are malignant. This case underlines the importance of making an initial accurate diagnosis of adrenal malignancy that allows better surgical planning and appropriate monitoring. Indeterminate imaging characteristics of the adrenal mass, as well as the presentation with estrogen excess, suggested an elevated risk for ACC. Initial pathology-based misdiagnosis illustrates the need for an expert adrenal pathologist to review these rare tumors.
Paraparesis due to angio-neurotropic Gurltia paralysans in a domestic cat (Felis catus) and retrospective study on feline gurltiosis cases in South America
Authors: Marcelo Gómez, Pamela Muñoz, Manuel Moroni, Marcelo Mieres, Valentina Bernal, Carla Rosenfeld, Anja Taubert, Carlos Hermosilla
Journal: Front Vet Sci (2024)
Keywords: gurltia paralysans, domestic cats, feline gurltiosis, neuroparasitosis, paraparesis

Introduction:
The nematode Gurltia paralysans is a neglected angio-neurotropic parasite causing chronic meningomyelitis in domestic cats (Felis catus) as well as wild felids of the genus Leopardus in South America. Adult G. paralysans nematodes parasitize the leptomeningeal veins of the subarachnoid space and/or meningeal veins of the spinal cord parenchyma. The geographic range of G. paralysans encompasses rural and peri-urban regions of Chile, Argentina, Uruguay, Colombia and Brazil.
Methods:
This case report presents clinical and pathological findings of a G. paralysans-infected cat suffering from severe thrombophlebitis and meningomyelitis resulting in ambulatory paraparesis. Neurological examination of affected cat localized the lesions at the thoracolumbar (T3-L3) and lumbosacral (L4-Cd4) segments. Molecular and morphological characteristics of extracted nematodes from parasitized spinal cord veins confirmed G. paralysans. Additionally, data obtained from a questionnaire answered by cat owners of 12 past feline gurltiosis cases (2014-2015) were here analyzed. Questionnaire collected data on age, gender, geographic location, type of food, hunting behavior, type of prey, and other epidemiological features of G. paralysans-infected cats.
Results and discussion:
Data revealed that the majority of cats originated from rural settlements thereby showing outdoor life styles with hunting/predatory behaviors, being in close contact to wild life [i.e. gastropods, amphibians, reptiles, rodents, birds, and wild felids (Leopardus guinia)] and with minimal veterinary assistance. Overall, this neglected angio-neurotropic G. paralysans nematode still represents an important etiology of severe thrombophlebitis and meningomyelitis of domestic cats living in endemic rural areas with high biodiversity of definitive hosts (DH), intermediary (IH), and paratenic hosts (PH). The intention of this study is to generate awareness among veterinary surgeons as well as biologists on this neglected feline neuroparasitosis not only affecting domestic cats but also endangered wild felid species of the genus Leopardus within the South American continent.
Tuberculosis Meningitis in a 9-Month-Old Girl during the COVID-19 Pandemic
Authors: Amir-Hassan Bordbari, Kobra Sheidaee, Azin Hajialibeig, Mohammad Reza Navaeifar, Maedeh Gooran, Mohammad Sadegh Rezai
Journal: Case Rep Med (2024)
MeSH terms: Case Reports

Tuberculous meningitis (TBM) is a serious form of TB disease that can result in high morbidity and mortality, particularly if there are delays in diagnosis and treatment. In this case report, a 9-month-old girl was admitted with persistent vomiting and focal seizures. On examination, she was found to have a right-side hemiparesis. Brain imaging showed intense nodular leptomeningeal enhancement, hydrocephalus, a hypolucent lesion in the left basal ganglia, arterial stenosis and vasculitis, and an old ischemic insult. The patient was initially diagnosed with an acute ischemic stroke and was treated with aspirin and antiepileptic drugs. The patient's condition failed to improve despite initial treatment, leading to further diagnostic procedures. The results uncovered a diagnosis of TBM. The case highlights the importance of considering TBM as a possible cause of neurological symptoms, especially during the coronavirus disease 2019 (COVID-19) pandemic where similar symptoms can be present in cases of neurological complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and multisystem inflammatory syndrome in children (MIS-C).
Radiotherapy for Non-Hodgkin's lymphoma with cardiac infiltration: A case report
Authors: Weifeng Wang, Zhuo Zhang, Xiaocong Deng, Anqi Gu, Xianzhao Chen, Yizheng Cai, Yuting Zhao
Journal: Front Oncol (2023)
Keywords: non-hodgkin’s lymphoma, cardiac infiltration, case report, radiotherapy, zanubrutinib
MeSH terms: Case Reports

Background:
Non-Hodgkin's lymphoma (NHL) with cardiac infiltration has a poor prognosis. The median OS of patients failing to respond to chemotherapy has been reported to be 1 month vs. 18 months in patients responding to chemotherapy.
Case presentation:
Herein, we reported a case of a 57-year-old male confirmed with diffuse large B-cell lymphoma who received radiation therapy of 150-cGy daily, administered in 30 fractions to the volume of cardiac infiltration, resulting in complete relief. Chemotherapy had no curative effect. The patient was subsequently enrolled in a clinical trial and received oral administration of zanubrutinib 80mg twice daily, after which he achieved complete remission. The progression-free survival was from diagnosis (January 7, 2020) to the follow-up (September 20, 2022), amounting to 32 months.
Conclusion:
Proper irradiation dose and timing of treatment can relieve NHL symptoms.
Anterior pushing technique for a broken scalpel blade in lumbar discectomy: a case report
Authors: Dejan Čeleš, Mladen Gasparini, Janez Mohar
Journal: Front Surg (2023)
Keywords: ct angiography, anterior pushing technique, broken scalpel blade, discectomy, laparoscopy, retroperitoneal space
MeSH terms: Case Reports

The presence of broken surgical blades or other surgically uncontrolled sharp and pointed objects in the disc space is a rare but potentially severe complication of posterior lumbar spine procedures. Herein, we report the case of a 59-year-old female patient with a history of lumbar decompression and interspinous process device implantation who underwent an instrumented revision of the lumbosacral junction. During the L5-S1 discectomy, the scalpel blade broke, and the broken fragment could not be retrieved through the posterior approach. With regard to the vascular anatomy, we partially pushed the fragment through the anterior annulus into the retroperitoneal space. In addition, pedicle screws were locked to ensure the stability of the construct. The fractured blade fragment was eventually removed by laparoscopy 1 week after the initial procedure. This experience suggests that the anterior pushing technique with fluoroscopy is an option in rare cases where a broken scalpel blade cannot be reached through the posterior approach. In such cases, computed tomography angiography is recommended.
The Great Masquerade: Not All Coronary Artery Stenosis Are Created Equal
Authors: Prasanti A Kotta, Ajit K Koduri, Jeffrey Berman, Veronica V Rosen, Waleed T Kayani
Journal: Methodist Debakey Cardiovasc J (2024)
Keywords: intracoronary ntg, intravascular ultrasound, myocardial bridging, vasospastic angina
MeSH terms: Coronary Angiography, Coronary Stenosis / diagnostic imaging, Coronary Stenosis / physiopathology, Coronary Stenosis / therapy, Coronary Vasospasm / diagnosis, Coronary Vasospasm / diagnostic imaging, Coronary Vasospasm / drug therapy, Coronary Vasospasm / physiopathology, Coronary Vasospasm / therapy, Nitroglycerin / administration & dosage, Vasodilator Agents / administration & dosage, Vasodilator Agents / therapeutic use, Case Reports, Angina Pectoris / diagnostic imaging, Angina Pectoris / etiology, Cocaine-Related Disorders / complications, Diagnosis, Differential, Humans, Male, Middle Aged, Predictive Value of Tests, Severity of Illness Index, Smoking / adverse effects, Treatment Outcome, Nitroglycerin, Vasodilator Agents

We present the case of a 60-year-old male, with active smoking and cocaine use disorder, who reported progressive chest pain. Various anatomical and functional cardiac imaging, performed to further evaluate chest pain etiology, revealed changing severity and distribution of left main artery (LMA) stenosis, raising suspicion for vasospasm. Intracoronary nitroglycerin relieved the vasospasm, with resolution of the LMA pseudostenosis. A diagnosis of vasospastic angina (VA) led to starting appropriate medical therapy with lifestyle modification counselling. This case highlights VA, a frequently underdiagnosed etiology of angina pectoris. We discuss when to suspect VA, its appropriate work-up, and management.