OpenMed/multicare-articles huggingface dataset:
Cases of two patients with aortoduodenal fistula who underwent emergency operation
Authors: Shinichiro Makimoto, Tomoya Takami, Hiroshi Shintani, Naoki Kataoka, Tomoyuki Yamaguchi, Masafumi Tomita, Yoshiharu Shono, Satoshi Kuroyanagi
Journal: Int J Surg Case Rep (2020)
Keywords: endovascular aneurysm repair, gastrointestinal bleeding, primary aortoduodenal fistula, prosthetic graft replacement, secondary aortoduodenal fistula
MeSH terms: Case Reports

Introduction:
Aortoduodenal fistula (ADF) is a rare but life-threating condition, and it is an important cause of massive gastrointestinal bleeding. Primary ADF often occurs as a result of aortic aneurysm, and secondary ADF develops after the placement of aortic prosthetic graft.
Presentation of cases:
Case 1: A 64-year-old man with hematemesis was transferred to our hospital. The patient was diagnosed with primary ADF. Thus, we performed prosthetic graft replacement for an aortic aneurysm, and suturing of the duodenal fistula and duodenojejunal side-to-side anastomosis were performed. He was then discharged on the 35th postoperative day. After 2 years and 10 months, he died of other diseases. Case 2: A 76-year-old man with a history of abdominal aortic aneurysm repair with a prosthetic graft 5 years back who presented with hematemesis and melena was transferred to our hospital. The patient was diagnosed with secondary ADF, and an emergency endovascular aneurysm repair (EVAR) and suturing of the duodenal fistula were perfomed. He was transferred for rehabilitation purposes on the 108th postoperative day but eventually died of pneumonia 6 months after surgery.
Discussion:
ADF is associated with high mortality. Initial bleeding is usually minor and often intermittent. However, it leads to severe bleeding and hemorrhagic shock. EVAR is preferred over open surgery because it can be performed faster and is less invasive. Recently, in case of hemorrhagic shock, EVAR is used as first-line treatment.
Conclusion:
Accurate diagnosis and immediate treatment are important for the survival of patients with ADF.
Giant Cystic Pheochromocytoma with Low Risk of Malignancy: A Case Report and Literature Review
Authors: Ravi Maharaj, Sangeeta Parbhu, Wesley Ramcharan, Shanta Baijoo, Wesley Greaves, Dave Harnanan, Wayne A Warner
Journal: Case Rep Oncol Med (2017)
MeSH terms: Case Reports

Giant pheochromocytomas are rare silent entities that do not present with the classical symptoms commonly seen in catecholamine-secreting tumors. In many cases they are accidentally discovered. The algorithm to diagnose a pheochromocytoma consists of biochemical evaluation and imaging of a retroperitoneal mass. The female patient in this case report presented with a palpable abdominal mass and was cured with surgical resection. She suffered no recurrence or complications on follow-up. The left retroperitoneal mass measured 27 × 18 × 12 cm and weighed 3,315 grams. Biochemical, radiological, and pathological examinations confirmed the diagnosis of a pheochromocytoma. In this paper, we report on our experience treating this patient and provide a summary of all giant pheochromocytomas greater than 10 cm reported to date in English language medical journals. Our patient's giant cystic pheochromocytoma was the fourth heaviest and fifth largest maximal diameter identified using our literature search criteria. Additionally, this tumor had the largest maximal diameter of all histologically confirmed benign/low metastatic risk pheochromocytomas. Giant cystic pheochromocytomas are rare entities requiring clinical suspicion coupled with strategic diagnostic evaluation to confirm the diagnosis.
Upfront Radiotherapy with Concurrent and Adjuvant Vismodegib Is Effective and Well-Tolerated in a Patient with Advanced, Multifocal Basal Cell Carcinoma
Authors: Abigail I Franco, Gary Eastwick, Ramsay Farah, Marvin Heyboer, Mijung Lee, Paul Aridgides
Journal: Case Rep Dermatol Med (2018)
MeSH terms: Case Reports

We present a case report of a male with multifocal and extensive basal cell carcinoma. Due to extremely large size and deep tumor infiltration, he was not a surgical candidate. Combined modality treatment of fractionated radiation with concurrent vismodegib was chosen. Concurrent treatment was previously reported in the palliative and recurrent setting. This is the first case of concurrent vismodegib and radiation therapy for upfront definitive management. The patient experienced complete response in all treated lesions.
Breast Reconstruction With Local Flaps: Don't Forget Grandma
Authors: Bradley J Vivace, Swapnil D Kachare, Michael Ablavsky, Sara R Abell, Luke T Meredith, Christina N Kapsalis, Joshua H Choo, Bradon J Wilhelmi
Journal: Eplasty (2019)
Keywords: bilobed flap, breast reconstruction, local flaps, oncoplastic surgery, rhomboid flap
MeSH terms: Review

Objective: Lateral breast defects of various causes can be reconstructed with random patterned local flaps utilizing oncoplastic techniques. These local flaps are used frequently in other areas but are infrequent in breast reconstruction despite affording excellent utility in small lateral defects. We sought to demonstrate this with a case series involving 5 patients who underwent oncoplastic breast surgery with random patterned flap reconstruction. Methods: From 2016 to 2017, 3 different varieties of random flaps were used in 5 women requiring lateral breast defect reconstruction secondary to resection of localized cancer or cutaneous lesion. The local flaps included a rhomboid flap, the bilobed flap, and a rotational flap. Patients were then evaluated in the clinic 10 to 12 months postoperatively for complications, symmetry, and satisfaction of reconstruction. Results: In 4 of 5 patients, the local flap remained fully viable and there was no incidence of seroma, infection, or further complications. One patient developed a post-operative hematoma requiring evacuation and a second patient experienced distal flap necrosis and delayed wound healing. Patients reported satisfaction with the reconstruction. Conclusions: Several random patterned local flaps exist for a variety of breast defects. They can yield excellent cosmetic results, high patient satisfaction, and bolster a low rate of complications. Our case series emphasizes the utility of random patterned flaps for lateral breast oncoplastic reconstruction.
Aortic dissection presenting as a stroke: a case report
Authors: Rafi Daou, Danielle Abou Khater, Rita Khattar, Mariana Helou
Journal: Pan Afr Med J (2023)
Keywords: aortic dissection, case report, chest pain, dissection
MeSH terms: Aortic Dissection / complications, Aortic Dissection / diagnosis, Stroke / diagnosis, Stroke / drug therapy, Stroke / etiology, Case Reports, Cerebral Infarction, Chest Pain / etiology, Humans, Male, Middle Aged, Tomography, X-Ray Computed

Aortic dissection is an uncommon yet frequently fatal illness. Patients generally present with tearing chest pain with possible acute hemodynamic instability. Hence, early diagnosis and intervention is critical for survival. This is a case of a 62-year-old male who was transferred to our emergency department for severe chest pain, left side hemiplegia, left hemianopsia, left facial weakness, suggesting a right-sided stroke. A chest computed tomography angiogram showed an extensive circumferential aortic dissection of the intimal layer involving the great vessels. Antiplatelet medications were withheld, nicardipine was started, and the cardiothoracic surgeon was consulted. There was no indication for surgery, and patient was admitted to the intensive care unit. We highlight here the importance of considering an aortic dissection in patients who present with neurological symptoms and an acute history of tearing chest pain.
Late Occurring Medial Migration of a Lag Screw in Gamma Nailing
Authors: S van Hoef, M C H W Fuchs, R H M Ten Broeke
Journal: Case Rep Orthop (2016)

An 81-year-old female was treated for a pertrochanteric multifragmentary fracture of the proximal femur with a third-generation Gamma nail. After 3 months she presented herself again with acute pain and inability to bear weight on the leg. Radiographs showed medial migration of the lag screw. She was treated with a total hip arthroplasty, after which she was successfully discharged. In this case report the possible causes of this late and unusual complication are discussed.
Role of Lung Function Monitoring by the Forced Oscillation Technique for Tailoring Ventilation and Weaning in Neonatal ECMO: New Insights From a Case Report
Authors: Genny Raffaeli, Chiara Veneroni, Stefano Ghirardello, Anna Lavizzari, Sofia Passera, Fabio Mosca, Giacomo Cavallaro, Raffaele L Dellacà
Journal: Front Pediatr (2018)
Keywords: extracorporeal life support, forced oscillation technique, lung mechanics, mechanical ventilation, newborns, respiratory insufficiency
MeSH terms: Case Reports

Respiratory management during extracorporeal membrane oxygenation (ECMO) is complex. Assessment of lung mechanics might support a patient-tailored ventilatory strategy. We report, for the first time, the use of the forced oscillation technique (FOT) to evaluate lung function during neonatal ECMO to improve the individualization of respiratory support. The patient was a formerly preterm infant at a corrected age of 40 weeks (gestational age 32 weeks) undergoing veno-arterial ECMO for refractory respiratory failure secondary to influenza A (H1N1) pneumonia. We used the FOT as a bedside non-invasive tool for daily monitoring of lung mechanics, from ECMO day 6 (E6) until decannulation. A small-amplitude, 5-Hz oscillatory pressure was overimposed on the ventilation waveform at the airway opening during positive end-expiratory pressure (PEEP) trials. From E6 to E9, lung mechanics changes with PEEP indicated a largely de-recruited and easily over-distendable lung that was not recruitable by applying lung-protective PEEP values. After surfactant and steroid administration, oscillatory reactance (Xrs) values began improving, suggesting a more recruited and pressure-recruitable lung. On E11, despite the lack of improvement in the radiographic appearance of the thorax, the FOT measurements showed a more recruited lung. Weaning from ECMO was started, and the patient was extubated within 48 h. The decannulation was successful, and the patient was extubated within 48 h after ECMO weaning. First-year respiratory and neurodevelopmental follow-up evaluation was unremarkable. This report suggests the potential usefulness of the FOT for monitoring the lung mechanics of ventilated newborns during ECMO to achieve individualized respiratory management. Such tailoring might improve neonatal outcomes and support clinicians with the establishment of a timely and safer weaning approach. These findings need to be verified on a larger population.
Intractable Posterior Epistaxis due to a Spontaneous Low-Flow Carotid-Cavernous Sinus Fistula: A Case Report and a Review of the Literature
Authors: A Giotakis, F Kral, H Riechelmann, M Freund
Journal: Case Rep Otolaryngol (2015)

We report a case of a 90-year-old patient with intractable posterior epistaxis presenting as the only symptom of a nontraumatic low-flow carotid-cavernous sinus fistula. Purpose of this case report is to introduce low-flow carotid-cavernous sinus fistula in the differential diagnosis of intractable posterior epistaxis. We provide a literature review for the sequence of actions for the confrontation of posterior epistaxis. We also emphasize the significance of the radiological diagnostic and therapeutic procedures in the management of posterior epistaxis due to pathology of the cavernous sinus. The gold-standard diagnostic procedure of carotid-cavernous sinus fistula is digital subtraction angiography (DSA). DSA with coils is also the state-of-the-art therapy. By failure of DSA, neurosurgery or stereotactic radiosurgery (SRS) may be used as alternatives. SRS may also be used as enhancement procedure of the DSA. Considering the prognosis of a successfully closed carotid-cavernous sinus fistula, recanalization occurs only in a minority of patients. Close follow-up is advised.
Peripheral ossifying fibroma in the oral cavity: MRI findings
Authors: Swapnali Chaudhari, Hemant R Umarji
Journal: Case Rep Dent (2011)
MeSH terms: Case Reports

The peripheral ossifying fibroma, a benign gingival overgrowth, occurs mainly in the anterior portion of the maxilla in young adults. The size of the lesion is usually less than 1.5 cm. We report a case of peripheral ossifying fibroma overlying the mandibular alveolar ridge of a 55-year-old female. MR scans showed a large exophytic soft tissue mass overlying mandibular alveolar ridge. The tumor revealed peripheral calcifications with slight erosion of adjacent cortical plate.
Importance of NAB2-STAT6 Fusion in the Diagnosis of Pancreatic Solitary Fibrous Tumor with Hamartoma-Like Features: A Case Report and Review of the Literature
Authors: Kei Tanaka, Takashi Kishimoto, Masayuki Ohtsuka, Yukio Nakatani, Masaru Miyazaki
Journal: Case Rep Pathol (2015)

We report a case of pancreatic hamartoma-like solitary fibrous tumor which was differentiated from pancreatic hamartoma with the detection of NAB2-STAT6 fusion, a specific mutation for solitary fibrous tumors. A pancreatic well-demarcated solid nodule, 21 × 17 mm, of 82-year-old man was surgically enucleated. Microscopic findings were close to a pancreatic hamartoma that consisted of sparsely distributed pancreatic ducts and acini in heavily collagenized fibrous stroma. Neither islet nor peripheral nerve existed in the tumor. The fibroblastic cells in the stroma were immune-positive for CD34, CD99, and bcl-2. But these expressions were not decisive in the differentiation between solitary fibrous tumor and pancreatic hamartoma, because CD34 was positive for both tumors, and CD99 and bcl-2 expressions were not elucidated in the previous cases of pancreatic hamartomas. Thus, we evaluated NAB2-STAT6 fusion. The fibroblastic cells were positive for STAT6 and sequencing analysis revealed the gene fusion between NAB2 exon 4 and STAT6 exon 2, with which the final diagnos is of solitary fibrous tumor was achieved. In conclusion, detection of NAB2-STAT6 fusion has a great diagnostic value for pancreatic solitary fibrous tumors with hamartoma-like features.
Frightening Complex Visual Hallucinations in an Elderly Patient with Ophthalmological Pathology and Vascular Dementia
Authors: Francesca Hill, Matthew Spurr, Joseph Stratford
Journal: Case Rep Psychiatry (2020)
MeSH terms: Case Reports

A lady in her 90s was referred to the Later Life Team (LLT) in a rural area of the United Kingdom with complex visual hallucinations (VH). She had significant ophthalmological pathology, including cataracts, a branch retinal vein occlusion, and vitreous haemorrhage. The hallucinations included seeing monkeys ripping the heads off of her cats and lions prowling the garden. The patient was distressed by the hallucinations and believed them to be real events. Her management involved low dose olanzapine and requesting that her ophthalmological surgery be expedited. The surgery resulted in a significant reduction in VH. A diagnosis of vascular dementia went on to be made following cognitive testing and imaging. The cognitive impairment may have contributed to the patient's inability to identify her experiences as hallucinations and thus render her without insight. A review of the computed tomography (CT) scans performed prior to the patient's presentation to our service confirmed significant vascular pathology including small vessel disease and lacunar infarcts. Cognitive testing confirmed a cognitive impairment which had gone unnoticed by her family. This case leads to an interesting discussion regarding diagnosis in complex VH in cases of significant ophthalmological pathology but a lack of insight. Various authors have proposed theories to explain VH; cortical release and the Perception and Attention Deficit (PAD) model are explored as possible explanations for the experiences of this patient.
Giant retroperitoneal lymphangioma in a 70-year-old male: a case report
Authors: Aymen Mabrouk, Farouk Ennaceur, Yasser Karoui, Eya Ben Nejma, Laila Jedidi, Mounir Ben Moussa
Journal: Pan Afr Med J (2022)
Keywords: cystic lymphangioma, case report, retro-peritoneal cyst
MeSH terms: Lymphangioma / diagnosis, Lymphangioma / surgery, Lymphangioma, Cystic / diagnosis, Lymphangioma, Cystic / pathology, Lymphangioma, Cystic / surgery, Retroperitoneal Neoplasms / diagnosis, Retroperitoneal Neoplasms / pathology, Retroperitoneal Neoplasms / surgery, Case Reports, Adult, Aged, Humans, Male, Pancreas / pathology, Retroperitoneal Space / pathology

Lymphangiomas are relatively rare benign congenital tumors of the lymphatic system. They are usually discovered during childhood and typically occur in the neck and axillary regions. Retroperitoneal lymphangiomas are a rare occurrence and represent 1% of all cases. Here, we presented a 70-year-old male who presented with abdominal discomfort and chronic constipation in the last three years. A computerized tomography scan showed a giant abdominal hypodense cystic mass measuring 195 x 145 mm, which laminates the abdominal aorta, the left iliac vessels, and the left ureter. The patient underwent surgical exploration. Due to the giant cystic volume, it was carefully opened, aspirated, and removed. The histopathological examination showed a retroperitoneal lymphangioma. In conclusion, giant retroperitoneal lymphangioma in an adult is a rare occurrence. The primary treatment is complete surgical excision. Histopathological examination is essential for diagnosis confirmation.
A Rare Aldosterone-Producing Adenoma Detected by 68Ga-pentixafor PET-CT: A Case Report and Literature Review
Authors: Yunying Cui, Yushi Zhang, Jie Ding, Huiping Wang, Xiaoshen Ma, Ou Wang, Xiaoyan Chang, Hao Sun, Li Huo, Anli Tong
Journal: Front Endocrinol (Lausanne) (2019)
Keywords: 68ga-pentixafor pet-ct, aldosterone-producing adenomas, blood pressure, parathyroid hormone, rare area
MeSH terms: Case Reports

Context: Primary aldosteronism represents an important and common cause of hypertension and is characterized by autonomous aldosterone secretion that results in severe hypertension and hypokalemia. Nonetheless, its manifestations are atypical in some cases, which renders its diagnosis difficult. Case Description: Presented in this report is a Chinese female patient with blood pressure in the high-normal range, and her parathyroid hormone was significantly elevated. Elevated plasma aldosterone concentration plus suppressed plasma rennin activity was suggestive of primary aldosteronism. 68Ga-pentixafor positron emission tomography/computed tomography revealed an aldosterone-producing adenoma, which was globally the second of its kind ever reported so far. Moreover, the tumor was located in an extremely rare area. Conclusions: Patients with primary aldosteronism may present with normal or high-normal blood pressure and a significantly elevated parathyroid hormone. 68Ga-pentixafor PET/CT is potentially a helpful tool for the non-invasive characterization of patients with primary aldosteronism.
Alagille Syndrome: A Case Report Highlighting Dysmorphic Facies, Chronic Illness, and Depression
Authors: James J Bresnahan, Zachary A Winthrop, Rabia Salman, Salman Majeed
Journal: Case Rep Psychiatry (2016)

Alagille syndrome is a rare multisystem disorder affecting the liver, heart, vertebrae, eyes, and face. Alagille syndrome shares multiple phenotypic variants of other congenital or chronic childhood illnesses such as DiGeorge syndrome, Down syndrome, spina bifida, type 1 diabetes mellitus, and cystic fibrosis. All of these chronic illnesses have well-established links to psychiatric conditions. There are few community resources for Alagille patients, as it is an extremely rare condition. Despite the overlap with other chronic childhood illnesses, the psychiatric manifestations of Alagille syndrome have not been previously discussed in literature. The current study is a case report of a twelve-year-old female hospitalized in our pediatric psychiatric hospital for suicidal ideation with intent and plan. The patient had major depressive disorder, anxiety, other specified feeding and eating disorder, and attention-deficit/hyperactive disorder.
Anterior Mandibular Segmental Distraction Osteogenesis: A Case Report
Authors: Thomas Starch-Jensen, Annette Dalgaard Kjellerup
Journal: Open Dent J (2018)
Keywords: bone lengthening, class ii malocclusion, dentistry, facial bones, orthodontics, orthognathic surgery
MeSH terms: Case Reports

Introduction:
Skeletal Angle Class I patients with a severe dental Class II malocclusion are characterized by an unfavourable anterior-posterior relationship between the anterior dentoalveolar area and the skeletal base. Orthodontic alignment posing various treatment difficulties and surgical correction with bilateral sagittal split osteotomy may result in a compromised facial profile. Hence, anterior mandibular segmental distraction osteogenesis has been proposed as an alternative treatment modality for solving facial esthetics, anterior tooth crowding and an unfavourable relationship between the anterior dentoalveolar area and the skeletal base in skeletal Angle Class I patients with a severe dental Class II malocclusion. Limited skeletal relapse with predictable soft tissue changes have been documented in long-term studies. Thus, anterior mandibular segmental distraction osteogenesis seems to be a valuable and predictable surgical method for correction of selected cases of skeletal Class I patients with a severe dental Class II malocclusion.
Case report:
The purpose of this case report is to present the treatment of a 57-year-old female with a skeletal Angle Class I relation and a severe dental Class II malocclusion. Anterior mandibular segmental distraction osteogenesis as well as discussing the current knowledge about this treatment modality.
Conclusion:
The present case report illustrates that establishment of a harmonious relationship between the maxillary and mandibular arch in patients with a skeletal Angle Class I relation and a severe dental Class II malocclusion using anterior mandibular segmental distraction osteogenesis seems to be a predictable and applicable surgical method for selected cases and General Dental Practitioners, orthodontics and maxillofacial surgeons must have knowledge of this treatment modality.
Transient neonatal diabetes mellitus in a Turkish patient with three novel homozygous variants in the ZFP57 gene
Authors: Mehmet Boyraz, Korkut Ulucan, Necati Taşkın, Teoman Akçay, Sarah E Flanagan, Deborah J G Mackay
Journal: J Clin Res Pediatr Endocrinol (2013)
MeSH terms: DNA-Binding Proteins / genetics, Diabetes Mellitus / genetics, Infant, Newborn, Diseases / genetics, Mutation, Transcription Factors / genetics, Case Reports, Amino Acid Sequence, Chromosomes, Human, Pair 6 / genetics, DNA Methylation, DNA Mutational Analysis, Homozygote, Humans, Infant, Newborn, Male, Polymerase Chain Reaction, Repressor Proteins, Sequence Homology, Amino Acid, Turkey, DNA-Binding Proteins, Repressor Proteins, Transcription Factors, ZFP57 protein, human

Neonatal diabetes mellitus (NDM) is a rare form of diabetes that presents within the first six months of life. Nearly 70% of these cases have loss of methylation at the differentially methylated region on chromosome 6q24. To describe the findings in a Turkish male patient with NDM caused by a loss of methylation at chromosome 6q24 and three novel homozygous mutations in the ZFP57 gene, methylation-specific PCR was carried out at 6q24 and mutation analysis of ZFP57 gene was maintained by direct sequencing. Sequencing of ZFP57 gene revealed the hypomethylation of chromosome 6q24 and three novel mutations (chr6:29.641.413 A>T, 29.641.073 C>T, and 29.640.855 G>C), respectively. The latter mutation seems to display the patient's condition due to a highly conservative amino acid substitution in the protein. We suggest the ZFP57 gene as a causative factor for NDM and it should be considered in genetic testing. Further studies including functional analysis of the detected mutations will provide precise information regarding the effect of the mutations.