OpenMed/multicare-articles huggingface dataset:
Good Tumor Response to Chemoradioimmunotherapy in dMMR/MSI-H Advanced Colorectal Cancer: A Case Series
Authors: Chengjing Zhou, Ting Jiang, Yajie Xiao, Qiaoxuan Wang, Zhifan Zeng, Peiqiang Cai, Yongtian Zhao, Zhikun Zhao, Dongfang Wu, Hanqing Lin, Chao Sun, Rong Zhang, Weiwei Xiao, Yuanhong Gao
Journal: Front Immunol (2021)
Keywords: chemotherapy, colorectal cancer, immunotherapy, programmed cell death protein 1 inhibitor, radiotherapy
MeSH terms: Brain Neoplasms, Colorectal Neoplasms / therapy, Immune Checkpoint Inhibitors / therapeutic use, Microsatellite Instability, Neoplastic Syndromes, Hereditary, Radioimmunotherapy / adverse effects, Research Support, Non-U.S. Gov't, Adult, Colorectal Neoplasms / genetics, Female, High-Throughput Nucleotide Sequencing, Humans, Immune Checkpoint Inhibitors / adverse effects, Male, Middle Aged, Mutation, Immune Checkpoint Inhibitors, Turcot syndrome

Purpose:
Immune checkpoint blockade has led to a significant improvement of patient survival in metastatic colorectal cancer (CRC) with DNA mismatch repair-deficiency (dMMR)/microsatellite instability-high (MSI-H). However, not all these patients are sensitive to monoimmunotherapy. We firstly presented a case series of advanced dMMR/MSI-H CRCs treating with PD-1 inhibitor-based chemoradioimmunotherapy (CRIT).
Methods and materials:
We assessed the short-term efficacy and safety of CRIT in advanced dMMR/MSI-H CRCs, and also did next-generation sequencing (NGS) assays.
Results:
Our analysis included five advanced dMMR/MSI-H CRCs who have received toripalimab-based CRIT. Toripalimab was given 240mg every three weeks, and the radiation dose was 45-50 gray in 25 fractions. Chemotherapy regimens consisted of CAPOX in three patients, capecitabine in one patient, and mFOLFOX6 in one patient. Initially, two patients displayed complete response (CR), and three patients achieved partial response (PR) on imaging findings. Afterwards, one PR patient was confirmed pathological complete response after surgery, leading to three CR cases in total. Hematological toxicity was the most common adverse effect, and only two patients developed mild immune-related adverse effects besides. All the treatment-related adverse events were under control. Based on the NGS results, the median intratumor heterogeneity was 0.19 (range 0-0.957), which was less in CR patients than PR patients (P = 0.019). Genetic mutations at DNA damage repair genes and the JAK1 gene were also observed.
Conclusions:
For advanced dMMR/MSI-H CRC, anti-PD-1 based CRIT is effective and safe. Further studies are required to better clarify the potential role and mechanism of CRIT as a viable therapeutic strategy in this population.
A preconscious neural mechanism of hypnotically altered colors: a double case study
Authors: Mika Koivisto, Svetlana Kirjanen, Antti Revonsuo, Sakari Kallio
Journal: PLoS One (2013)
MeSH terms: Color Perception, Consciousness, Suggestion, Research Support, Non-U.S. Gov't, Adult, Amnesia / physiopathology, Amnesia / psychology, Beta Rhythm, Electroencephalography, Evoked Potentials, Visual, Female, Hallucinations / physiopathology, Hallucinations / psychology, Humans, Hypnosis, Middle Aged, Pattern Recognition, Visual, Photic Stimulation

Hypnotic suggestions may change the perceived color of objects. Given that chromatic stimulus information is processed rapidly and automatically by the visual system, how can hypnotic suggestions affect perceived colors in a seemingly immediate fashion? We studied the mechanisms of such color alterations by measuring electroencephalography in two highly suggestible participants as they perceived briefly presented visual shapes under posthypnotic color alternation suggestions such as "all the squares are blue". One participant consistently reported seeing the suggested colors. Her reports correlated with enhanced evoked upper beta-band activity (22 Hz) 70-120 ms after stimulus in response to the shapes mentioned in the suggestion. This effect was not observed in a control condition where the participants merely tried to simulate the effects of the suggestion on behavior. The second participant neither reported color alterations nor showed the evoked beta activity, although her subjective experience and event-related potentials were changed by the suggestions. The results indicate a preconscious mechanism that first compares early visual input with a memory representation of the suggestion and consequently triggers the color alteration process in response to the objects specified by the suggestion. Conscious color experience is not purely the result of bottom-up processing but it can be modulated, at least in some individuals, by top-down factors such as hypnotic suggestions.
Recurrent syncope, orthostatic hypotension and volatile hypertension: think outside the box
Authors: Thein Aung, Wuqiang Fan, Mahesh Krishnamurthy
Journal: J Community Hosp Intern Med Perspect (2013)
Keywords: baroreceptors, baroreflex failure, carotid sinus, orthostatic hypotension
MeSH terms: Case Reports

The baroreceptors in the neck and aortic arch are important regulators of sudden blood pressure changes. They are innervated by CN IX and X and synapse in the brainstem. Baroreceptor failure is an under-recognized cause of recurrent syncope, orthostatic hypotension, and volatile hypertension, which is refractory to and may in fact worsen with conventional treatments. Baroreflex failure can be the result of neck and chest radiation, head and neck surgery, and cerebrovascular accidents involving the brainstem nuclei. The management of baroreflex failure is a challenge since patient education, lifestyle changes, and family support are extremely important in managing blood pressure. Leg exercises and Thrombo-Embolic Deterrent Stockings (TED) stockings are important in treating orthostatic hypotension. Clonidine is the antihypertensive of choice for supine hypertension. Low-dose benzodiazepines are helpful in suppressing sympathetic surges. We have encountered two patients with baroreflex failure after chemotherapy and radiation to the neck or upper chest. Temporal relationship between symptoms onset and the history of head, neck, and upper chest radiation or trauma is important in reaching a diagnosis.
A case report of Andersen-Tawil syndrome misdiagnosed with myodystrophy
Authors: Xiuqin Zhao, Hengbing Zu, Kai Yao
Journal: Front Neurol (2023)
Keywords: andersen-tawil syndrome, kcnj2, anesthetic considerations, long-term exercise test, malignant hyperthermia
MeSH terms: Case Reports

Andersen-Tawil syndrome (ATS) is a rare periodic paralysis caused by the KCNJ2 gene mutation. Here, we report on an ATS patient misdiagnosed with myodystrophy. A 66-year-old man presented with a 60-year history of episodic weakness in the proximal muscles of the upper and lower limbs. The man has been diagnosed with muscle pathology and has undergone genetic examinations in many hospitals since childhood. We conducted a correct diagnosis in combination with the patient's history, electrical physiology, and genetic analysis and identified a heterozygous KCNJ2 gene variant (c.220A > G; p.T74A). Patients with ATS can develop permanent myasthenia characterized by chronic progressive myopathy. ATS patients should also pay special attention to the risks of anesthesia in surgery, including malignant hyperthermia (MH), muscle spasms affecting tracheal intubation or ventilation, and ventilator weakness. Early diagnosis and therapy could help delay the onset of myasthenia and prevent risks associated with anesthesia accidents.
Rifampin-warfarin interaction in a mitral valve replacement patient receiving rifampin for infective endocarditis: a case report
Authors: Amr Mohamed Fahmi, Osama Abdelsamad, Hazem Elewa
Journal: Springerplus (2016)
Keywords: infective endocarditis, mitral valve replacement, rifampin, warfarin

Introduction:
Warfarin therapy is associated with many drug interactions that may cause a significant alteration in its anticoagulant effect. Rifampin is a widely used antimicrobial that has major interactions with several medications including warfarin due to its strong P-glycoprotein and liver enzyme inducer activity especially on CYP2C9, CYP3A4, CYP1A2 and CYP2C19.
Presentation:
We report a case of a 34-year-old Srilankan female chronically treated with warfarin for her mitral valve replacement. The patient developed infective endocarditis and was started on a 6-week treatment with rifampin along with other antibiotics. Warfarin dose was increased from 52.5 to 210 mg/week over the course of the rifampin therapy, however, the INR remained subtherapeutic throughout the whole period and reached 2.4 by the end of rifampin therapy.
Discussion and evaluation:
Anticoagulation management was challenging in the period following the end of rifampin therapy as well, and multiple dose adjustments starting with an increase and followed by reduction were required till she was stable on an 80 mg/week warfarin dose 5 weeks post-rifampin therapy.
Conclusion:
Our findings suggest the importance of close monitoring of warfarin therapy during and after the use of rifampin to minimize the risks of under and over-anticoagulation and improve the safety and efficacy of warfarin therapy.
Acantholytic pityriasis rubra pilaris associated with imiquimod 3.75% application
Authors: Natasha Atanaskova Mesinkovska, Danyelle Dawes, Apra Sood, Wilma Bergfeld
Journal: Case Rep Dermatol Med (2011)
MeSH terms: Case Reports

Imiquimod is an immunomodulator with both antitumor and antiviral properties. It is currently available in two cream formulations as Aldara (imiquimod 5%) and the newly approved Zyclara (imiquimod 3.75%). Imiquimod has been associated with localized erythema, crusting, and scaling at the site of application. However, more severe generalized skin eruptions including erythema multiforme, psoriasis, and hyperpigmentation have been described. The newly approved imiquimod 3.75% cream is a presumably safer alternative due to its lower concentration. This paper describes the development of generalized acantholytic pityriasis rubra pilaris after the treatment of an actinic keratosis on the forehead with imiquimod 3.75% cream.
A Huge Penile Fibroepithelial Polyp Treated with Partial Penectomy: A Case Report and Review of the Literature
Authors: Adel Alrabadi, Sohaib Alhamss, Yasmeen Z Qwaider, Saddam Al Demour
Journal: Case Rep Med (2020)
MeSH terms: Case Reports

Fibroepithelial polyps are benign tumors of mesodermal origin that usually arise on the surface of the skin and to a lesser extent in the urinary tract; however, their presence on the penis is extremely unusual. We report the case of a 73-year-old male with an extremely large broad-based penile fibroepithelial polyp (FEP) involving the penile shaft and glans penis associated with chronic condom catheter use and that was treated with partial penectomy. A review of the literature is included to highlight the rarity of this case. To the best of our knowledge, this is the largest mass of its kind to be reported on the penis.
Pleural effusion: a rare side effect of nilotinib-a case report
Authors: Hava Usküdar Teke, Olga Meltem Akay, Deniz Gören Şahin, Mustafa Karagülle, Eren Gündüz, Neslihan Andıç
Journal: Case Rep Med (2014)

Pleural effusion, as a side effect of tyrosine kinases, may be seen as most commonly associated with dasatinib and very rarely seen with nilotinib. In this report we present a chronic phase of CML case that was treated with nilotinib due to imatinib (Gleevec) allergy and had pleural effusion with nilotinib at 5th year of treatment. If pleural effusion develops in patients taking nilotinib and if this effusion is exudative and lymphocyte predominant, after ruling out pulmonary and cardiac etiologies, it must be associated with nilotinib; according to stage of effusion drug should be discontinued and/or steroid should be started and/or surgery should be performed.
Sonographic Presentation of the Geyser Sign
Authors: Syed Amir Gilani, Riffat Mehboob, Raham Bacha, Aima Gilani, Iqra Manzoor
Journal: Case Rep Med (2019)
MeSH terms: Case Reports

A case of geyser sign with acromioclavicular (AC) joint cyst with underlying rotator cuff tear is presented. Ultrasound modality is used to diagnose the clinical case of the AC cyst with positive geyser sign. A 91-year-old male patient presented with a complaint of right-sided shoulder and neck pain. The physical examination revealed a large lump on his right shoulder with restricted shoulder movements. During ultrasound examination, a chronic supraspinatus tendon (ST) tear and AC joint cyst with a positive geyser sign was observed. The ultrasound diagnosis was also confirmed with magnetic resonance imaging (MRI). AC joint cyst with geyser sign is a rare condition. Few cases have been published with this type of pathology. To our knowledge, this is the first report of its kind from Pakistani population.
A rare devastating complication of LASIK: bilateral fungal keratitis
Authors: H Taylan Sekeroglu, E Erdem, K Yar, M Yağmur, T R Ersoz, A Uguz
Journal: J Ophthalmol (2010)
MeSH terms: Case Reports

Purpose. To report an unusual case of severe bilateral fungal keratitis following laser in situ keratomileusis (LASIK). Method. A 48-year-old man developed bilateral diffuse corneal infiltration two weeks after LASIK. The corneal scrapings revealed fungal filaments but cultures were negative. Results. The corneal ulceration was improved on the left eye whereas spontaneous perforation occurred and finally evisceration was needed on the right eye despite topical and systemic antifungal treatment. Conclusions. Fungal keratitis, especially with bilateral involvement, is a very rare and serious complication of LASIK surgery. Clinical suspicion is crucial because most of fungal keratitis are misdiagnosed as bacterial keratitis and can lead serious visual results, even eye loss.
Idiopathic acquired leukonychia in a 34-year-old patient
Authors: Maria Rita Bongiorno, Mario Aricò
Journal: Case Rep Med (2009)
MeSH terms: Case Reports

We present a rare case of a 34-year-old patient with persistent, progressive, acquired leukonychia totalis and partialis. Idiopathic acquired leukonychia is a rare chromatic disorder of the nail not associated with other abnormalities and discernible etiology. Our case report did not link the inheritance of leukonychia with diverse clinical syndromes. To our knowledge, only five cases of idiopathic, acquired, true total leukonychia were found in literature. This case was the sixth patient with asymptomatic idiopathic, white fingernails, and toenails without a hereditary cause.
Fetal mesenchymal hamartoma of the liver: A case report and literature review
Authors: Xin Liu, Sha Tian, Zhenchuang Zhu, Fei Peng, Qiang Yuan, Xufei Duan, Xueqiang Yan
Journal: Front Pediatr (2022)
Keywords: fetus, liver tumor, mesenchymal hamartoma, prenatal examination, treat

This paper reports the diagnosis and treatment process of a case of fetal mesenchymal hamartoma of the liver (MHL), and reviews the previous literature reports. At 38+2 weeks of gestation, prenatal ultrasound found a well bound mixed solid and cystic mass, which was located at the lower edge of the right lobe of the liver and in front of the right kidney of the fetus, but the source and nature of the mass were not clear by ultrasound. Due to the approaching due date, the fetus showed no other abnormal symptoms, and no special treatment was given with the consent of the family members. A female fetus was delivered weighing 3,520 g at 39 weeks. An exploratory laparotomy was performed on the eighth day after delivery. During the operation, it was found that the tumor originated from the fifth, sixth and seventh hepatic segment and the corresponding hepatic segments were removed. Recovery was uneventful and the infant was discharged on the 6th day after surgery. Follow-up at 2 years showed a thriving young girl, and there was no tumor recurrence.
Case report: Rare intrapulmonary malignant mesothelioma complicated with myositis
Authors: Dandan Gong, Jian Yu, Xiaodong Jiang
Journal: Front Oncol (2022)
Keywords: cancer-associated myositis, lung parenchyma, mesothelioma, oncology, primary
MeSH terms: Case Reports

Malignant pleural mesothelioma is an uncommon aggressive tumor. Its incidence is even lower when the lung parenchyma is the primary site. Myositis is a common paraneoplastic syndrome, but it rarely presents with malignant pleural mesothelioma. This report presents a rare intrapulmonary malignant mesothelioma complicated by cancer-associated myositis. The patient presented with limb muscle weakness as the first symptom and was diagnosed with intrapulmonary malignant mesothelioma complicated by cancer-associated myositis on the basis of clinical, histological, immunohistochemical, and radiological findings. The patient responded poorly to conventional hormone therapy and died of respiratory failure within 2 months after the first presence of limb muscle weakness.
Assessment and Retrieval of Aspirated Tracheoesophageal Prosthesis in the Ambulatory Setting
Authors: Karuna Dewan, Andrew Erman, Jennifer L Long, Dinesh K Chhetri
Journal: Case Rep Otolaryngol (2018)
MeSH terms: Case Reports

Tracheoesophageal prosthesis (TEP) is the most common voice restoration method following total laryngectomy. Prosthesis extrusion and aspiration occurs in 3.9% to 6.7% and causes dyspnea. Emergency centers are unfamiliar with management of the aspirated TEP. Prior studies report removal of aspirated TEP prostheses under general anesthesia. Laryngectomees commonly have poor pulmonary function, posing increased risks for complications of general anesthesia. We present a straightforward approach to three cases of aspirated TEP prosthesis removed in the ambulatory setting. In each case, aspirated TEP was diagnosed with flexible bronchoscopy under local anesthesia at the time of consultation, and all prostheses were retrieved atraumatically using a biopsy grasper forceps inserted via the side channel of the bronchoscope. The aspirated TEP prosthesis can be safely and efficiently removed via bedside bronchoscopy.
Dyspnea and wheezing: still a challenge for pulmonologists
Authors: Ana Sofia Castro, Ana Barroso, Sara Conde, Bárbara Parente
Journal: Case Rep Pulmonol (2012)

Schwannoma is a neurogenic tumor originating from the nerve sheath Schwann cells. Intrathoracic location is rare, and the endobronchial location is exceptional. Schwannoma is a rare tumor; the majority of lesions are benign and usually asymptomatic. The authors present a case report of a 83-year-old woman, nonsmoker, observed in the emergency department for wheezing and cough lasting for 2 months. Chest tomography showed a right hilar pulmonary mass, ill defined, with thick and irregular walls, centered on the upper lobe bronchus, which was obliterated. Fiberoptic bronchoscopy showed a necrotic mass obstructing the right upper lobe bronchus whose biopsy allowed the diagnosis of benign schwannoma. Subsequently, the patient carried tumor ablation by laser bronchoscopy, with the resolution of the respiratory symptoms. This case stands out for its rarity but also because it is an excellent example of the importance of endoscopic techniques for therapeutic purposes. Schwannoma is a benign tumor in which surgical or endoscopic intervention generally prevents local recurrence and associated clinical manifestations.
A case report of cerebral venous sinus thrombosis presenting with rapidly progressive dementia
Authors: Yaqiang Li, Mei Zhang, Min Xue, Ming Wei, Jiale He, Chunhui Dong
Journal: Front Med (Lausanne) (2022)
Keywords: anticoagulant, cerebral venous sinus thrombosis (cvst), dementia, idiopathic intracranial hypertension (iih), rapidly progressive dementia
MeSH terms: Case Reports

Background:
Cerebral venous sinus thrombosis (CVST) is a rare but serious and treatable cause of neurologic symptoms. Due to the variable clinical presentation, CVST was often misdiagnosed. According to published case reports, common clinical manifestations of CVST include headache, focal neurological deficit, epilepsy, papilledema, etc. It is rare, nevertheless, to mention cases of rapidly progressive dementia (RPD).
Case presentation:
We reported a case of a 62-year-old retired male accountant, a Han Chinese from eastern China, who initially presented with slow response and memory decline. Until 2 months later, his memory declined and slow response deteriorated significantly, and he could not even complete simple tasks like brushing his teeth, washing his face, washing his feet, and dressing himself, and sometimes developed fecal incontinence. His neuropsychological test demonstrated severe cognitive decline. The cerebrospinal fluid (CSF) studies revealed markedly high opening pressure (260 mm of water), and coagulation tests indicated a mild elevation of D-Dimer of 1.19 mg/L. The magnetic resonance venography (MRV) showed thrombosis of the left transverse sinus, sigmoid sinus, and jugular venous bulb and was diagnosed as CVST. He switched from subcutaneous low molecular weight heparin (LMWH) and transitioned to oral anticoagulants at the time of discharge. The repeated CSF studies revealed normal opening pressure. After 5 days of anticoagulant treatment, his symptoms considerably improved, and a 1-month follow-up revealed that he had fully healed with no signs of recurrence.
Conclusion:
This case demonstrated the clinical heterogeneity of CVST, which should be taken into account for differential diagnosis of RPD. This case study also offered fresh data for the categorization of the clinical traits and the diagnosis of CVST.
Oxygen Venous Embolism After Hydrogen Peroxide Use During Percutaneous Nephrolithotomy
Authors: John Michael DiBianco, Jessica Lange, Daniel Heidenberg, Patrick Mufarrij
Journal: J Endourol Case Rep (2019)
Keywords: hydrogen peroxide, nephrolithiasis, oxygen pulmonary embolus, percutaneous nephrolithotomy
MeSH terms: Case Reports

Background: Hydrogen peroxide (H2O2) is a common antiseptic that is available without a prescription in the United States, and it is indicated for minor dermal abrasion; mouth, gum, or dental irritations; and removal of oral secretion. Several other medical uses have also been described, including clot dissolution during endoscopic gastrointestinal evaluation, cleansing of orthopedic surgical sites, and bladder irrigation. However, these uses of H2O2, as well as high-dose ingestion, have been associated with a wide variety of medical complications, including but not limited to air pulmonary embolism and stroke. Case Presentation: Our patient is a 51-year-old female with a medical history of hypertension, familial, hypercholesterolemia, gallstones, depression, coronary artery disease (identified on calcium study because of familial hypercholesterolemia), nephrolithiasis, and recurrent cystitis. She required percutaneous nephrolithotomy and had H2O2 administered for clot dissolution. The clinical and temporal evidence would suggest a transient pulmonary air embolus after the intrarenal administration of or irrigation with H2O2, large amounts under high pressure. Conclusion: This represents the first reported incidence of air embolus as a result of intrarenal administration of H2O2.