OpenMed/multicare-articles huggingface dataset:
Urachus adenocarcinoma mistaken for umbilical incision implant cancer after laparoscopic cholecystectomy: a case report
Authors: Yanxing Mai, Lei Feng, Zhenxi Liu, Yu Nie, Zesheng Jiang, Jiasheng Qin
Journal: Pathol Oncol Res (2023)
Keywords: case report, invasive adenocarcinoma, laparoscopic cholecystectomy, umbilical incision implant cancer, urachus adenocarcinoma
MeSH terms: Adenocarcinoma / surgery, Cholecystectomy, Laparoscopic / adverse effects, Urachus, Case Reports, Female, Humans, Middle Aged, Pain, Quality of Life, Urachal adenocarcinoma

Umbilical incision implant cancer after LC is rare. Elective cholecystectomy was planned for a 49 years-old female patient with symptomatic gallstones. The patient underwent transumbilical single-port LC after admission to our hospital. Gallbladder specimens were obtained directly through the umbilical puncture hole, and histopathology suggested chronic cholecystitis. Three months after surgery, the patient experienced painful induration in the umbilicus. We initially considered incision scar hyperplasia complicated with pain, and used drugs to treat it conservatively without taking special treatment measures. Six months after LC, the umbilical induration pain affected her quality of life, and the patient requested surgical resection. Preoperative ultrasonography and abdominal computerized tomography (CT) revealed nodular changes around the umbilicus and no abdominal mass. Local resection of the periumbilical mass was performed, and the pathological confirmation was invasive adenocarcinoma. Subsequently, the patient underwent repeat periumbilical mass enlargement resection. Postoperative pathology showed no cancer at the enlarged resection margin, yet the umbilical center pathology showed invasive adenocarcinoma. The excised pathology was sent to the Sun Yat-sen University Cancer Center for consultation because of the rare nature of the findings associated with the case. After consultation, a diagnosis of umbilical urachus adenocarcinoma was confirmed based on pathological morphology, immunohistochemistry, and the specific anatomical location of the tumor. This case report shown that when there is a persistent mass induration in the navel after LC surgery, the possibility of incision tumor should be considered, rather than simply excluding the possibility of a cancer based on a non-cancer medical history.
Anal disorders in pregnant and postpartum women: epidemiological, diagnostic and therapeutic aspects in 10 maternities of Bamako in Mali
Authors: Adégné Togo, Lassana Kanté, Abdoulmouinou Poudiougo, Amadou Traoré, Amadou Bocoum, Youssouf Traoré, Madiassa Konaté, Moussa Younoussa Dicko, Moussa Samaké, Bah Amadou, Hawa Touré, Laurent Abramowitz
Journal: Pan Afr Med J (2024)
Keywords: anal pathology, postpartum, pregnant women
MeSH terms: Anus Diseases / diagnosis, Anus Diseases / epidemiology, Anus Diseases / therapy, Hemorrhoids / diagnosis, Hemorrhoids / epidemiology, Hemorrhoids / therapy, Postpartum Period, Pregnancy Complications / diagnosis, Pregnancy Complications / epidemiology, Pregnancy Complications / therapy, Multicenter Study, Case Reports, Adolescent, Adult, Constipation / diagnosis, Constipation / epidemiology, Fecal Incontinence / diagnosis, Fecal Incontinence / epidemiology, Fecal Incontinence / etiology, Female, Fissure in Ano / diagnosis, Fissure in Ano / epidemiology, Fissure in Ano / therapy, Follow-Up Studies, Humans, Mali / epidemiology, Pregnancy, Prospective Studies, Risk Factors, Young Adult

Bowel transit disturbances favored by pregnancy and injuries during childbirth would be triggering or aggravating factors for anal pathologies. The objective of this work was to study the epidemiology, diagnosis, and treatment of anal pathologies during pregnancy and 6 weeks after delivery. We carried out a prospective, multi-centric, and analytical study in 10 obstetric units in Bamako from June 1st, 2019, to May 31st, 2020. After informed consent, we enrolled all first-trimester pregnant women admitted to the hospitals and who were followed up through the postpartum. We conducted a rectal examination in each participant and an anoscope in those with an anal symptom. Hemorrhoidal diseases were diagnosed in the case of external hemorrhoids (thrombosis or prolapse) or internal hemorrhoids. During the study period, we followed up 1,422 pregnant women and we found 38.4% (546) with anal pathologies (hemorrhoidal diseases in 13% (192), anal fissure in 10.5% (150) and anal incontinence in 8.6% (123). Risk factors for the hemorrhoidal disease were age of patient ≥30 years old aRR=5.77, 95% CI 4.57-7.34; p=0.000; a existence of chronic constipation aRR=2.61, 95% CI 1.98-3.44; p=0.000; newborn weight >3500 g aRR= 1.61, 95% CI 1.25-2.07; p=0.000 and fetal expulsion time >20 minutes aRR= 6.04, 95% CI 5.07-7.27; p=0.000. The clinical signs observed were constipation, anal pain, bleeding, and pruritus. The treatment was based on counseling on hygiene and diet, the use of laxatives, local topicals, and analgesics along perineal rehabilitation. Anal pathologies were common during pregnancy and 6 weeks after delivery. Pregnant women must be screened systematically for such pathologies. Early diagnostic and appropriate treatment would reduce serious complications.
Multimodality imaging in diagnosing lipomatous atrial septal hypertrophy with atrial septal defect: a case report
Authors: Yi Yu, Ming Ding, Jin-Lan Chen, Ting Wang, Yu-Han Chen, Xiao-Min Yang, Su-Yun Chen, Yue-Peng Wang, Yi-Gang Li
Journal: Front Cardiovasc Med (2023)
Keywords: atrial septal defect, case report, lipomatous atrial septal hypertrophy, multimodality imaging, transesophageal echocardiography
MeSH terms: Case Reports

Background:
Lipomatous atrial septal hypertrophy (LASH) with atrial septal defect (ASD) is a rare congenital anomaly. Although LASH is a histologically benign cardiac lesion characterized by excessive fat deposition in the interatrial septum that spares the fossa ovale, it has been associated with supraventricular arrhythmias or sick sinus syndrome. Application of multimodal imaging is crucial for accurate diagnosis, appropriate treatment of LASH with ASD, and follow-up.
Case summary:
A 68-year-old female patient presented with recurrent chest tightness and palpitation. Multimodal imaging revealed the characterizations of LASH and ASD. Two-dimensional transesophageal echocardiography showed a "dumbbell"-shaped involvement of the cephalad and caudal regions with sparing of a single secundum ASD. The septum with a brightness feature is an uncommon condition characterized by the deposition of unencapsulated fat cells in the atrial septum. Real-time four-dimensional transesophageal echocardiography reflected the lipomatous hypertrophy of the atrial septum and an oval-shaped ASD. Cardiac computer tomography angiography later confirmed this finding. The patient achieved a good clinical response with an ASD percutaneous occlusion guided by intracardiac echocardiography (ICE).
Conclusion:
This case demonstrates a LASH combined with ASD. Multimodality imaging can provide an accurate diagnosis and may guide the procedure for precise occlusion.
Hepatopulmonary Syndrome Diagnosis in the ICU: The Relevance of Bedside Contrast Saline Echocardiography
Authors: Rita Morais Passos, Francisca Cardoso, Francisco Teixeira da Silva, Rogério Corga da Silva, José Caldeiro
Journal: Cureus (2024)
Keywords: chronic liver disease, hepatopulmonary syndrome, orthodeoxia, pulmonary vascular dilations, saline contrast echocardiography
MeSH terms: Case Reports

Hepatopulmonary syndrome (HPS) is an underdiagnosed complication of chronic liver disease (CLD) characterised by the presence of hypoxaemia due to intrapulmonary vascular dilatations. We present two cases of HPS diagnosed during their stay in the ICU. Both patients had a medical history of alcoholic CLD with portal hypertension (PH). The first patient was transferred to the ICU for acute hypoxic respiratory failure (AHRF) due to decompensated cirrhosis with large-volume hydrothorax and diagnosis of acute-on-chronic liver failure (ACLF) grade 2. The presence of orthodeoxia, an alveolar-arterial oxygen gradient (O2 A-a grad) of 27 mmHg and positive contrast saline echocardiography confirmed the HPS diagnosis. The second patient was transferred to our general ICU from the surgical ward where he was initially admitted with mild AHRF due to polytrauma conditioning left side rib fractures and a small contusion in the left inferior lobe. Upon ICU admission, he was diagnosed with septic shock (nosocomial pneumonia as the primary site of infection) and required invasive mechanical ventilation. During the initial period of his ICU stay, although an improvement in multiple organ dysfunction was observed, severe AHRF persisted. Moreover, O2 A-a grad of 30 mmHg and positive bedside contrast saline echocardiography confirmed the HPS diagnosis. In this study, we discuss the diagnostic approach of HPS and the increasing relevance of contrast saline echocardiography at the bedside, particularly in critically ill patients. The performance of this technique by trained intensivists at the bedside in the ICU minimises critical moments, such as the time required for intra-hospital transport of patients for complementary examinations, considering they have severe ventilatory compromise, thereby allowing HPS diagnosis with high sensitivity.
Importance of genetic sequencing studies in managing chronic neonatal diarrhea: a case report of a novel variant in the glucose-galactose transporter SLC5A1
Authors: Lizbeth López-Mejía, Sara Guillén-Lopez, Marcela Vela-Amieva, Rosalía Santillán-Martínez, Melania Abreu, María Dolores González-Herrra, Rubicel Díaz-Martínez, Juan Gaspar Reyes-Magaña
Journal: Front Pediatr (2024)
Keywords: sglt-1, slc5a1, case report, glucose–galactose malabsorption, inborn errors of metabolism, infantile diarrhea, sodium/glucose cotransporter
MeSH terms: Case Reports

Introduction:
Congenital glucose-galactose malabsorption (CGGM) is a rare autosomal recessive disorder that primarily causes chronic intractable diarrhea. This study aims to describe the clinical history, laboratory profile, diagnostic workflow, and management of the first patient reported with CGGM in Mexico.
Methods:
The case involves a Mexican female infant with recurrent admissions to the emergency room since birth due to chronic diarrhea.
Results:
The infant was born at term by C-section with a birth weight of 3.120 kg and height of 48 cm for consanguineous parents. She had been breastfed until day 5 of her life when she presented lethargy, diarrhea, abdominal discomfort, and jaundice. During the first evaluation at the emergency room, the significant laboratory finding was blood tyrosine elevation; afterward, amino acid and succinylacetone determinations were obtained, discarding tyrosinemia. When admitted to the hospital, an abdominal ultrasound detected a duplex collecting system. At this time, rice formula was introduced to the patient. She was discharged with jaundice improvement, but diarrhea persisted. Several formula changes had been made from rice to extensively hydrolyzed casein protein to whey-based, with no clinical improvement; the patient still had 10-12 excretions daily. In the second hospitalization, the patient presented anemia, severe dehydration, hyperammonemia, and renal tubular acidosis. A next-generation sequencing panel for inborn errors of metabolism and congenital diarrhea was performed, identifying a homozygous variant in SLC5A1 (c.1667T > C). The diagnosis of CGGM was made at 3 months of age. The infant was initially treated with a modular galactose-glucose-free formula with oil, fructose, casein, minerals, and vitamins until a commercial fructose-based formula was introduced. This led to a complete resolution of diarrhea and improved nutritional status.
Discussion:
Diagnosing CGGM is challenging for clinicians, and next-generation sequencing is a valuable tool for providing appropriate treatment. More detailed information on patients with this condition might lead to possible phenotype-genotype correlations. This case's primary clinical and biochemical findings were chronic diarrhea, anemia, jaundice, renal tubular acidosis, hyperammonemia, and initial hypertyrosinemia. Symptoms were resolved entirely with the fructose-based formula.
Case report: A rare case of desmoid-type fibromatosis originating in the small intestine
Authors: Junfeng Xie, Shichang Lai, Yangbiao Wang, Baolong Ye, Zhishun Huang, Kexing Xi
Journal: Front Med (Lausanne) (2023)
Keywords: aggressive fibromatosis, desmoid-type fibromatosis, differential diagnosis, small intestine, treatment
MeSH terms: Case Reports

Background:
Desmoid-type fibromatosis (DF) is characterized by a rare monoclonal fibroblast proliferation that exhibits variable and unpredictable clinical presentation. DF can be classified into sporadic and hereditary types. Despite extensive research efforts, the exact etiology of DF remains elusive.
Case description:
A 31-year-old male patient presented to the hospital with a progressively growing mass in the right lower abdomen, accompanied by abdominal discomfort. Symptoms are discovered 1 week before admission. Enteroscopy revealed no evidence of colonic abnormalities, and blood tests did not indicate any abnormalities. Due to the indeterminate nature of the mass during surgery, a partial resection of the ileum and cecum was performed, followed by ileocolonic end-to-end anastomosis, with no postoperative complications. The final pathological diagnosis confirmed primary desmoid-type fibromatosis of the distal ileum (invasive fibromatosis). To effectively manage DF, we recommend a follow-up schedule for patients. This includes appointments every 3 months in the first year following surgery, followed by appointments every 6 months up to the fifth year, and then once a year thereafter. The follow-up examinations should include collection of the patient's medical history, physical examination, blood tests, ultrasounds, CT scans, and other relevant assessments. During the first year of the follow-up period, no further treatment was administered, and the patient remained disease-free.
Conclusion:
Desmoid-type fibromatosis (DF) originating from the small intestine is an extremely rare condition that exhibits local invasiveness and can be life-threatening. Despite its benign histology, DF has a high local recurrence rate and lacks metastatic potential. Diagnosis of DF remains challenging, especially in cases where surgical intervention is not feasible due to asymptomatic patients or partial organ impairment. In such cases, a "watchful waiting" approach is recommended as the initial treatment strategy. However, when preoperative diagnosis is difficult, surgery is typically considered the best option. Given the potential for local recurrence and the uncertain long-term prognosis, regular follow-up is necessary.
Percutaneous microchannel unilateral approach bilateral micro decompression for adjacent segmental degeneration after lumbar fusion at 10 years: a case report and review of literature
Authors: Tingxin Zhang, Gang Gao, Feng Gao, Nana Guo, Yongjiang Wang
Journal: Front Surg (2024)
Keywords: adjacent segmental degeneration, lumbar, micro decompression, microchannel, percutaneous microchannel
MeSH terms: Case Reports

Background:
Adjacent segmental degeneration after lumbar fusion is one of the common long-term complications after lumbar fusion. With the continuous development of adjacent segmental degeneration, patients who fail conservative treatment often need reoperation to relieve symptoms. In recent years, the technique of bilateral microdecompression through unilateral approach under microchannel has been widely used in the treatment of lumbar degenerative diseases. However, the efficacy of this procedure for adjacent-segment degeneration after lumbar fusion has not been established. Here, we report a case of bilateral microscopic decompression via a unilateral approach through a microchannel in a patient with adjacent segmental degeneration after lumbar fusion.
Case report:
A 70-year-old male patient was admitted to hospital because of lumbago accompanied by left lower extremity pain, numbness and weakness for 2 years, which aggravated for 2 months. Ten years ago, he underwent PLIF for lumbar spinal stenosis, and recovered well after the operation. According to imaging data and physical examination, the diagnosis was adjacent segmental degeneration after lumbar fusion. Bilateral microdecompression was performed through a unilateral approach under a microchannel. Good clinical outcomes was observed through 1-year postoperative follow-up.
Conclusions:
This report reports the successful treatment of a patient with ASD 10 years after lumbar fusion. Bilateral microdecompression via a unilateral approach under a microchannel is a safe and effective method for the treatment of ASD after lumbar fusion with good surgical outcomes.
Grade IV Glioma Potentially Disguised As COVID-19 Encephalitis
Authors: Austin Patrick Eisenberg, Nicolina Scibelli, Hannah Fischer, Victor Collier
Journal: Cureus (2024)
Keywords: acute cva, case report, covid-19, glioblastoma multiforme, viral encephalitis
MeSH terms: Case Reports

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2), which became a pandemic in March 2020. Since that time, research has shed light on this disease's pulmonary, cardiac, and hematologic complications. However, we are still unraveling the complex neurologic sequelae of COVID-19. Here we present the case of a 58-year-old female who presented with weakness, gaze preference, and aphasia. She was diagnosed with a stroke which was managed medically. The patient returned two weeks later with memory loss and aphasia. An MRI was consistent with temporal lobe encephalitis, although a lumbar puncture was unremarkable. A polymerase chain reaction (PCR) test for COVID-19 was positive. Treatment was initiated for viral encephalitis with patient improvement. She was discharged a second time, and approximately three months later, she presented again with unrelenting headaches. Further imaging revealed a mass that was determined to be a grade IV glioma. Cases of glioma after viral encephalitis have been studied, but a clear link with COVID-19 has not been established.
Tuberculous Meningitis: An Endemic Cause of Intracranial Hypertension
Authors: Miguel Costa, João Pedro Caria, João Bilardo Caiano, Alexandra Caeiro, Fernando Maltez
Journal: Cureus (2024)
Keywords: increased intracranial pressure, mycobacterium tuberculosis, presumptive diagnosis, sixth cranial nerve palsy, tuberculosis meningitis
MeSH terms: Case Reports

Tuberculous meningitis (TBM) presents a complex clinical scenario, often marked by delayed recognition and high mortality. Our case involves a 27-year-old woman from Nepal with no significant medical history, presented with a two-week history of fatigue, altered consciousness, dizziness, vomiting, fever, holocranial headache, and photophobia. Initial examination revealed signs consistent with meningitis, including fever, hypertensive state, prostration, bilateral exophthalmos, sixth cranial nerve paresis, and positive Kernig/Brudzinski signs. Cerebrospinal fluid (CSF) exhibited characteristics typical of TBM: turbidity, lymphocytic-predominant pleocytosis, low glucose, and elevated protein. The patient was promptly started on meningeal doses of vancomycin, ceftriaxone, and acyclovir. However, persistent fever, neurological deterioration, and signs of increased intracranial pressure led to the decision to initiate conventional empiric treatment of tuberculosis (TB) with isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE) and dexamethasone 1 week before cultural positivity for Mycobacterium tuberculosis of CSF. The case underscores the importance of considering TBM in patients from endemic regions, interpreting CSF findings, and initiating empirical treatment in critical scenarios, contributing to a positive patient outcome despite the diagnostic challenges.
Promising response of proliferative glomerulonephritis with monoclonal IgG deposits to low-dose daratumumab: a case report
Authors: Hongyao Xu, Yao Huang, Ling Dong, Hua Yu, Bo Lin
Journal: Front Med (Lausanne) (2024)
Keywords: mgrs, pgnmid, case report, daratumumab, proliferative glomerulonephritis with monoclonal igg deposits
MeSH terms: Case Reports

Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) is a rare disease without standardized treatment modalities. Daratumumab is a human IgG monoclonal anti-CD38 antibody that has been demonstrated to be highly effective and safe in the treatment of PGNMID. This article reports a 66-year-old female who suffered from edema in both lower limbs and face for 6 years with mild proteinuria and hypoproteinemia. Renal biopsy displayed eight glomeruli, among which two presented with glomerulosclerosis, and the remaining six exhibited moderate diffuse hyperplasia of glomerular mesangial cells and stroma with endothelial cell proliferation. Immunofluorescence microscopy revealed lumpy and diffuse deposits of C3, C1q, IgG, and κ light chain in the glomerular mesangium, with strongly positive staining for IgG3 and varying degrees of weak to negative staining for IgG1, IgG2, IgG4, and λ light chain. Additionally, ultrastructural analysis unveiled that the glomerular basement membrane was segmentally thickened, accompanied by diffuse pedicle fusion, segmental tethered insertion, subendothelial deposits, and electron-dense material in tethered areas. The patient received a total dose of 800 mg of daratumumab (400 mg daily for two consecutive days), as well as daily prednisone (25 mg) and valsartan (80 mg), for treatment and achieved complete remission after three-month follow-up. This case represents an early attempt to treat PGNMID with low-dose daratumumab but requires long-term follow-up.
Successful Recanalization by Intravenous Thrombolysis in a Patient With Calcified Cerebral Emboli With Major Vessel Occlusion: A Case Report
Authors: Hajime Ikenouchi, Takuya Saito, Shota Igasaki, Yuichi Kawabata, Yukako Yazawa
Journal: Cureus (2024)
Keywords: acute ischemic stroke, calcified cerebral emboli, intravenous thrombolysis, major vessel occlusion, mobile calcified emboli
MeSH terms: Case Reports

A 69-year-old man, with a history of left superficial temporal artery-middle cerebral artery bypass due to cerebral infarction by left internal carotid artery occlusion, was hospitalized with acute right hemispatial neglect and left hemiparesis. Diffusion-weighted imaging showed a high-intensity lesion in the right insular cortex. Although there seemed to be no arterial occlusion in magnetic resonance angiography (MRA), non-contrast computed tomography (CT) on admission showed calcification in the right Sylvian fissure. As hyperacute ischemic stroke within 4.5 hours after onset, we used an intravenous recombinant tissue plasminogen activator, and his symptoms improved. Follow-up MRA revealed recanalization of the right M2 branches with distal migration of calcification. Although calcification was identified on non-contrast CT in the initial assessment, the diagnosis of middle cerebral artery occlusion was missed. Therefore, arterial occlusion should be considered when calcification is observed in the brain sulcus. This case also illustrated that intravenous thrombolysis may be effective even in calcified cerebral emboli with major vessel occlusion.