OpenMed/multicare-articles huggingface dataset:
Secretion of beta-human chorionic gonadotropin by non-small cell lung cancer: a case report
Authors: Saakshi Khattri, Abhirami Vivekanandarajah, Seema Varma, Frank Kong
Journal: J Med Case Rep (2011)

Introduction:
We describe a case of non-small cell lung cancer that was found to stain positive for beta-human chorionic gonadotropin on immunohistochemistry. Only a few case reports have described lung cancers that secrete beta-human chorionic gonadotropin.
Case presentation:
A 68-year-old Caucasian man presented with symptoms of weakness, fatigue and weight loss for the past two months. On examination, he was found to have generalized lymphadenopathy, and radiologic workup revealed numerous metastases in the lungs, liver and kidneys. Biopsy of the supraclavicular lymph node revealed metastatic large cell lung cancer with beta-human chorionic gonadotropin hormone positivity. The serum beta-human chorionic gonadotropin level was 11,286 mIU/ml (upper limit of normal, 0.5 mIU/ml in non-pregnant females). He was diagnosed with stage 4 lung non-small cell lung cancer. The patient refused chemotherapy. He was discharged home with hospice care.
Conclusion:
The markedly elevated serum values of beta-human chorionic gonadotropin initially prompted the medical team to investigate germinal tumors. In the presence of a negative testicular ultrasound, workup was performed to find an extratesticular source of the tumor. Finally, the diagnosis was made with a tissue biopsy. This case illustrates that atypical markers can be seen in many cancers, emphasizing the role of immunohistochemistry and tissue biopsy in establishing the diagnosis.
Pacing During and Physiological Response After a 12-Hour Ultra-Marathon in a 95-Year-Old Male Runner
Authors: Beat Knechtle, Zbigniew Jastrzebski, Thomas Rosemann, Pantelis T Nikolaidis
Journal: Front Physiol (2019)
Keywords: elderly, endurance, master athlete, performance, running

In recent years, outstanding performances of elderly people up to 100 years have been reported. In this case study, pacing during and recovery after a 12-h ultra-marathon were described for a 95-year old runner. The athlete achieved a total distance of 52.987 km. Pacing followed a parabolic pattern (U-shaped), where the speed decreased till the middle of the race and then increased. However, no end spurt was observed. A large main effect of lap quartile on speed was observed, where the second quartile was slower than the first quartile and forth. The smallest variability was shown in the first quartile and the largest in the second quartile. During recovery, erythrocytes, hemoglobin and hematocrit increased whereas thrombocytes and leucocytes decreased. CRP, GOT, GPT, y-GT, CK, and LDH were increased post-race and decreased to reference range during recovery. Also, creatinine and urea decreased during recovery. Creatinine clearance increased during recovery. Sodium increased during recovery and remained constantly within the reference range. During recovery body fat and visceral fat mass decreased, whereas body water and lean body mass increased. In summary, a 95-year-old man was able to run during 12 h using a U-shaped pacing and achieving a total distance of nearly 53 km. Increased selected hematological and biochemical parameters returned to pre-race values within a recovery phase of 5 days.
Acute Pancreatitis and Rhabdomyolysis with Acute Kidney Injury following Multiple Wasp Stings
Authors: Seo Hee Yang, Yeon Han Song, Tae Hoon Kim, Su Bin Kim, Sang Youb Han, Han-Seong Kim, Se Won Oh
Journal: Case Rep Nephrol (2017)
MeSH terms: Case Reports

Multiple wasp stings can induce multiple organ dysfunction by toxic reactions. However, acute pancreatitis is a rare manifestation in wasp sting injury. A 74-year-old woman visited the emergency department by anaphylactic shock because of multiple wasp stings. Acute kidney injury, rhabdomyolysis, hepatotoxicity, and coagulopathy were developed next day. Serum amylase and lipase were elevated and an abdominal computed tomography revealed an acute pancreatitis. Urine output was recovered after 16 days of oliguria (below 500 ml/day). Her kidney, liver, and pancreas injury gradually improved after sessions of renal replacement therapy.
Case report: Alexander's disease with "head drop" as the main symptom and literature review
Authors: Yujun Yuan, Qiong Wu, Liang Huo, Hua Wang, Xueyan Liu
Journal: Front Neurol (2022)
Keywords: alexander's disease, gfap, atonic seizure, epilepsy, genetic disorder
MeSH terms: Case Reports

Alexander's disease (AxD) is a rare autosomal dominant hereditary disorder that is caused by the mutations in the GFAP gene, which encodes the glial fibrillary acidic protein (GFAP). This neurogenerative disease has many clinical manifestations, and the onset of disease spans a wide range of ages, from newborns to children, adults, and even the elderly. An overaccumulation of the expression of GFAP has a close causal relationship with the pathogenesis of Alexander's disease. Usually, the disease has severe morbidity and high mortality, and can be divided into three distinct subgroups that are based on the age of clinical presentation: infantile (0-2 years), juvenile (2-13 years), and adult (>13 years). Children often present with epilepsy, macrocephaly, and psychomotor retardation, while adolescents and adults mainly present with muscle weakness, spasticity, and bulbar symptoms. Atonic seizures are a type of epilepsy that often appears in the Lennox-Gastaut syndrome and myoclonic-astatic epilepsy in early childhood; however, the prognosis is often poor. Atonic episodes are characterized by a sudden or frequent reduction in muscle tone that can be local (such as head, neck, or limb) or generalized. Here, we report a 4-year-old girl whose main symptoms were intermittent head drop movements, which could break the frontal frame and even bleed in severe conditions. A video-encephalography (VEEG) showed that the nodding movements were atonic seizures. A head magnetic resonance imaging (MRI) revealed abnormal signals in the bilateral paraventricular and bilateral subfrontal cortex. The gene detection analyses indicated that the GFAP gene exon 1 c.262 C>T was caused by a heterozygous mutation, as both her parents were of the wild-type. The girl had no other abnormal manifestations except atonic seizures. She could communicate normally and go to kindergarten. After an oral administration of sodium valproate, there were no atonic attacks. Although epilepsy is a common symptom of Alexander's disease, atonic seizures have not been reported to date. Therefore, we report a case of Alexander's disease with atonic seizures as the main symptom and provide a review of the literature.
Secondary cervical elongatio due to large Gartner cyst: A rare case
Authors: Surahman Hakim, Yulia Margaretta Sari, Achmad Kemal Harzif
Journal: Int J Surg Case Rep (2020)
Keywords: elongatio coli, large gartner cyst, manchester forthegill
MeSH terms: Case Reports

Introduction:
The exact mechanism by which pelvic tissues lose their anatomic support and undergo descent through the genital hiatus remains elusive. In this case, large Gartner cyst causes secondary cervix elongatio due to the weight of the cyst. Gartner cyst arise from the remnants of the mesonephric ducts. They are typically located in the anterolateral wall and are small. The rarity of this case is very interesting because of the mass size reaches 15 cm and causes cervical elongation.
Presentation of case:
This article report a case of 37 years old women who complained large mass came out from vagina. Patient was diagnosed with large anterior vaginal cyst and cervical elongatio. Ultrasound finding suggested that the cyst was originated from anterior wall of vagina in accordance with Gartner cyst. Patient underwent cyst excision, there was no connection between the cyst and urethra. Operation was continued with Manchester Forthegill to restore normal anotomy of the cervix.
Discussion:
Secondary cervical elongatio in this case was caused by large Gartner cyst, eventhough there are possibility involvement of other factors. Cervical elongatio plays important role in the decision of operation in this case after removal vaginal cyst.
Conclusion:
Secondary cervix elongation due to Large Gartner cyst is rare condition. Enlarge cyst causes secondary cervix elongatio, and operation technique was also challenging.
Dengue fever and chikungunya virus infections: identification in travelers in Uganda - 2017
Authors: John T Kayiwa, Annet M Nankya, Irene Ataliba, Charity A Nassuna, Isaac E Omara, Jeffrey W Koehler, John M Dye, Eric C Mossel, Julius J Lutwama
Journal: Trop Dis Travel Med Vaccines (2019)
Keywords: chikungunya, dengue, international traveler
MeSH terms: Case Reports

Arboviruses are (re-) emerging viruses that cause significant morbidity globally. Clinical manifestations usually consist of a non-specific febrile illness that may be accompanied by rash, arthralgia and arthritis and/or with neurological or hemorrhagic syndromes. The broad range of differential diagnoses of other infectious and non-infectious etiologies presents a challenge for clinicians. While knowledge of the geographic distribution of pathogens and the current epidemiological situation, incubation periods, exposure risk factors and vaccination history can help guide the diagnostic approach, the non-specific and variable clinical presentation can delay final diagnosis. This case report summarizes the laboratory-based findings of three travel-related cases of arbovirus infections in Uganda. These include a patient from Bangladesh with chikungunya virus infection and two cases of dengue fever from Ethiopia. Early detection of travel-imported cases by public health laboratories is important to reduce the risk of localized outbreaks of arboviruses such as dengue virus and chikungunya virus. Because of the global public health importance and the continued risk of (re-) emerging arbovirus infections, specific recommendations following diagnosis by clinicians should include obtaining travel histories from persons with arbovirus-compatible illness and include differential diagnoses when appropriate.
Case Report: Laparoscopic hepatectomy in an elderly patient with major comorbidities
Authors: Georgios C Sotiropoulos, Nikolaos Machairas, Ioannis D Kostakis
Journal: F1000Res (2017)
Keywords: comorbidity, elderly, geriatric, hepatectomy, laparoscopic, liver resection

Surgeons have been hesitant to proceed to hepatectomy in elderly patients, due to the higher rate of comorbidities and the reduced reserves. An 81-year-old male with hepatocellular carcinoma in the segment VI of the liver and several major cardiovascular, pulmonary and metabolic comorbid illnesses was referred to our department for treatment. He underwent transarterial chemoembolization of the liver tumor and afterwards he underwent laparoscopic resection of the hepatic segment VI, with an uneventful postoperative course. This case indicates that laparoscopic liver resections could be applied even to elderly patients with major comorbidities after optimization of their medical status.
Posttraumatic Stress Disorder and Related Disorders among Female Yazidi Refugees following Islamic State of Iraq and Syria Attacks-A Case Series and Mini-Review
Authors: Inga Gerdau, Jan Ilhan Kizilhan, Michael Noll-Hussong
Journal: Front Psychiatry (2017)
Keywords: yazidi, abuse history, mental disorders, posttraumatic stress disorder, somatic symptom disorder, transcultural psychiatry
MeSH terms: Case Reports

Following the severe attacks by the so-called "Islamic State of Iraq and Syria" on the Yazidi population, which started in summer 2014, the state government of Baden-Württemberg, Germany, funded a Special-Quota Project to bring 1,000 very ill or left-behind women and children who were being held hostage to 22 cities and towns in Baden-Württemberg to receive integrated care. Here, we report for the first time on the cases of four Yazidi women living in Ulm, Germany, focusing on the clinically observed and psychometrically assessed mental phenomena or disorders. Our primary aim was to explore what International Classification of Diseases, 10th Revision diagnoses are present in this population. Although highly traumatized, these women were suffering primarily from adjustment disorder rather than posttraumatic stress disorder according to official classification systems. Despite their symptoms of depression and anxiety, the women's responses to self-assessment questionnaires provided no evidence of compulsion, somatization, or eating disorders. The results suggest that further investigation of the individual-level effects of rape and torture, as well the historic, systemic, and collective effects, e.g., on families and societies, is required.
Autopsy findings of acute erythroid leukemia
Authors: Mayur Parkhi, Nabhajit Mallik, Deepesh Lad, Man Updesh Singh Sachdeva, Amanjit Bal, Pankaj Malhotra, Suvradeep Mitra
Journal: Autops Case Rep (2023)
Keywords: autopsy, diagnosis, differential, leukemia, erythroblastic, acute, pancytopenia, tumor suppressor protein p53
MeSH terms: Case Reports

Acute erythroid leukemia (AEL) is an exceedingly uncommon but distinct hematological malignancy that shows neoplastic proliferation of erythroid precursors with maturation arrest and no significant myeloblasts. We describe an autopsy case of this rare entity in a 62-year-old man with co-morbidities. He underwent a bone marrow (BM) examination for pancytopenia during the first outpatient department visit, which revealed an increased number of erythroid precursors with dysmegakaryopoiesis suggesting the possibility of Myelodysplastic syndromes (MDS). Thereafter, his cytopenia got worsened, warranting blood and platelet transfusions. Four weeks later on the second BM examination, AEL was diagnosed based on morphology and immunophenotyping. Targeted resequencing for myeloid mutations revealed TP53 and DNMT3A mutations. He was initially managed along febrile neutropenia with the stepwise escalation of antibiotics. He developed hypoxia attributed to anemic heart failure. Subsequently, he had hypotension and respiratory fatigue pre-terminally and succumbed to his Illness. A complete autopsy showed infiltration of various organs by AEL and leukostasis. Besides, there was extramedullary hematopoiesis, arterionephrosclerosis, diabetic nephropathy (ISN-RPS class II), mixed dust pneumoconiosis, and pulmonary arteriopathy. The histomorphology of AEL was challenging, and the differential diagnoses were many. Thus, this case highlights the autopsy pathology of AEL, an uncommon entity with a strict definition, and its relevant differentials.
Safety of ChAdOx1 nCoV-19 vaccination in patients with end-stage renal disease on hemodialysis
Authors: I-Ning Yang, Chin-Li Lu, Hung-Jen Tang, Yu-Chi Kuo, Li-Hwa Tsai, Kuan Chieh Tu, Jhi-Joung Wang, Chih-Chiang Chien
Journal: PLoS One (2022)
MeSH terms: COVID-19 Vaccines / adverse effects, COVID-19 / prevention & control, Kidney Failure, Chronic / etiology, Kidney Failure, Chronic / therapy, Research Support, Non-U.S. Gov't, ChAdOx1 nCoV-19, Female, Humans, Male, Renal Dialysis, Vaccination / adverse effects, COVID-19 Vaccines, ChAdOx1 nCoV-19

Background:
COVID-19 vaccination is essential. However, no study has reported adverse events (AEs) after ChAdOx1 nCoV-19 vaccination in patients with end-stage renal disease (ESRD) on hemodialysis (HD). This study investigated the AEs within 30-days after the first dose of ChAdOx1 nCoV19 (Oxford-AstraZeneca) in ESRD patients on HD.
Methods and findings:
A total of 270 ESRD patients on HD were enrolled in this study. To determine the significance of vascular access thrombosis (VAT) post vaccination, we performed a self-controlled case study (SCCS) analysis. Of these patients, 38.5% had local AEs; local pain (29.6%), tenderness (28.9%), and induration (15.6%) were the most common. Further, 62.2% had systemic AEs; fatigue (41.1%), feverishness (20%), and lethargy (19.9%) were the most common. In addition, post-vaccination thirst affected 18.9% of the participants with female predominance. Younger age, female sex, and diabetes mellitus were risk factors for AEs. Five patients had severe AEs, including fever (n = 1), herpes zoster (HZ) reactivation (n = 1), and acute VAT (n = 3). However, the SCCS analysis revealed no association between vaccination and VAT; the incidence rate ratio (IRR)-person ratio was 0.56 (95% CI 0.13-2.33) and 0.78 (95% CI 0.20-2.93) [IRR-event ratio 0.78 (95% CI 0.15-4.10) and 1.00 (95% CI 0.20-4.93)] in the 0-3 months and 3-6 months period prior to vaccination, respectively.
Conclusions:
Though some ESRD patients on HD had local and systemic AEs after first-dose vaccination, the clinical significance of these symptoms was minor. Our study confirmed the safety profile of ChAdOx1 nCoV-19 in HD patients and presented a new viewpoint on vaccine-related AEs. The SCCS analysis did not find an elevated risk of VAT at 1 month following vaccination. Apart from VAT, other vaccine-related AEs, irrespective of local or systemic symptoms, had minor clinical significance on safety issues. Nonetheless, further coordinated, multi-center, or registry-based studies are needed to establish the causality.
Recurrent spontaneous pneumothorax in a 42 years old woman with pulmonary lymphangioleiomyomatosis: insights and pitfalls of the surgical treatment
Authors: Kyriakos Spiliopoulos, Angeliki Tsantsaridou, Rodula Papamichali, Konstantina Kimpouri, Nicolaos S Salemis, George K Koukoulis, Nicolaos B Tsilimingas
Journal: J Clin Med Res (2013)
Keywords: lymphangioleiomyomatosis, pneumothorax, renal angiomyolipomas
MeSH terms: Case Reports

Lymphangioleiomyomatosis (LAM) is a rare disease that occurs predominantly in females between the ages of 30 and 50 years and is clinically characterized by progressive dyspnoea on exertion, recurrent pneumothoraces, abdominal and thoracic lymphadenopathy, as well tumors-like angiomyolipomas and lymphangiomyomas. We present the case of a 42-year-old woman, who developed recurrent pneumothoraces and was subsequently diagnosed with LAM. Although pneumothorax is a common complication of the disease, its optimal approach to treatment and prevention remains unclear. Chemical or surgical pleurodesis are often performed in order to prevent recurrence, but may predispose to perioperative complications in the event of future lung transplantation.
Idiopathic Bilateral Extraocular Myositis in a Subject With Poorly Controlled Type 2 Diabetes Mellitus: Case Report
Authors: Fuminori Tatsumi, Yoshiro Fushimi, Junpei Sanada, Masashi Shimoda, Kenji Kohara, Tomohiko Kimura, Atsushi Obata, Shuhei Nakanishi, Tomoatsu Mune, Kohei Kaku, Hideaki Kaneto
Journal: Front Med (Lausanne) (2021)
Keywords: a rare case, diabetic neuropathy, extraocular muscle paralysis, idiopathic bilateral extraocular myositis, type 2 diabetes mellitus
MeSH terms: Case Reports

Background: Extraocular myositis is characterized by acute onset of orbital pain, extraocular muscle swelling, absence of thyroid disease, and effectiveness of steroid therapy. While oculomotor nerve paralysis is often observed in subjects with diabetes mellitus, extraocular muscle paralysis is very rare among various diabetic mononeuropathies. In addition, while most diabetic mononeuropathies are observed as sporadic and/or unilateral neuropathy, bilateral mononeuropathy is also very rare. Case presentation: A 58-year-old male visited our institution due to diplopia. He was diagnosed as type 2 diabetes mellitus about 10 years before and treated with oral diabetes agents. To examine the cause of his symptom, he was hospitalized in our institution. Slight ptosis was observed, and failure of adduction was observed in the right eye. Glycemic control was poor; HbA1c was 9.3%. Liver, renal, and thyroid function were within normal range. Immunoglobulin (Ig) G was slightly high, but IgA, IgM, and IgG4 were within normal range. Various antibodies were all negative. Angiotensin-converting enzyme level was within normal range. There were no abnormalities in brain magnetic resonance imaging (MRI). After admission, to alleviate glucose toxicity, we started insulin therapy. On day 17, adduction failure of the left eye was observed in addition to the right eye. Vertical movement was also impaired in both eyes. Slight ptosis was observed in both eyes, and the right eye was completely close. In orbital MRI, some high signal was detected in both extraocular muscles. We performed steroid pulse therapy twice. About 4 months later, ptosis and vertical and horizontal movements in both eyes were almost completely recovered. Finally, we diagnosed him as idiopathic bilateral extraocular myositis. Conclusions: We should bear in mind the possibility of idiopathic bilateral extraocular myositis especially in subjects with poor glycemic control, although its incident rate is extremely rare.
Retrograde Intramedullary Nail Fixation for Derotational Femoral Osteotomy for Recurrent Femoropatellar Instability
Authors: Maximiliano Barahona, Alvaro Zamorano, Cristian Barrientos, Mauricio Guzmán, Yoshiro Sato, Jaime Hinzpeter
Journal: Case Rep Orthop (2019)
MeSH terms: Case Reports

Axial alignment of the femur and tibia is often misdiagnosed in patients with patellofemoral stability problems. Femoral torsion is critical for patellofemoral biomechanics, so it must be evaluated in every patient before the plan of surgery is decided. This case describes a femoral derotational osteotomy due to excessive internal torsion of the femur fixed with a retrograde femoral nail. This type of fixation provides a biomechanical advantage compared to plates. At the two-year follow-up, the patient achieved excellent results, reaching a functional score of 91 points on the Lysholm scale. Derotational femoral osteotomy should be considered in patellofemoral pathology, and a retrograde femoral nail is a valid fixation method for this surgery.
Spinal anaesthesia in a restless eclamptic with undiagnosed second twin: case report
Authors: Jide Michael Afolayan, Babatunde Ajayi Olofinbiyi, Oluwadare Martins Ipinnimo
Journal: Pan Afr Med J (2015)
Keywords: eclampsia, caesarean section, general anaesthesia, spinal anaesthesia
MeSH terms: Anesthesia, Spinal / methods, Cesarean Section / methods, Eclampsia, Case Reports, Female, Humans, Magnesium Sulfate / administration & dosage, Pregnancy, Pregnancy, Twin, Psychomotor Agitation, Young Adult, Magnesium Sulfate

The use of sub-arachnoid block in a restless eclamptic is not very common. Studies have demonstrated some benefits of sub-arachnoid block over general anaesthesia in stable eclamptic but its role in the management of unstable eclampsia has not been established. Reported below is an eclamptic parturient who was restless despite magnesium sulphate regimen and possesed features suggestive of difficult airway who had uneventful subarachnoid- block for caesarean section.
The spectrum of clinical presentation in haploinsufficiency of A20; a case report of a novel mutation in TNFAIP3 gene
Authors: M Debeljak, S Blazina, J Brecelj, T Avčin, N Toplak
Journal: Front Pediatr (2023)
Keywords: ngs genetic testing, tnfaip3 gene, case report, clinical presentation, haploinsufficiency a20
MeSH terms: Case Reports

Haploinsufficiency of A20 was first described in 2016 as a new autoinflammatory disease that clinically presents as early-onset Behcet's disease. After the publication of the first 16 cases, more patients were diagnosed and described in the literature. The spectrum of clinical presentation has expanded. In this short report, we present a patient with a novel mutation in the TNFAIP3 gene. The clinical presentation included signs of an autoinflammatory disease with recurrent fever, abdominal pain, diarrhea, respiratory tract infections, and elevated inflammatory parameters. We will emphasize the importance of genetic testing, especially in patients with various clinical signs that do not fit a single autoinflammatory disease.