OpenMed/multicare-articles huggingface dataset:
The absence of piriformis muscle, combined muscular fusion, and neurovascular variation in the gluteal region
Authors: Matheus Coelho Leal, João Gabriel Alexander, Eduardo Henrique Beber, Josemberg da Silva Baptista
Journal: Autops Case Rep (2021)
Keywords: anatomic variation, anatomy, buttocks, muscle, piriformis muscle syndrome
MeSH terms: Case Reports

The gluteal region contains important neurovascular and muscular structures with diverse clinical and surgical implications. This paper aims to describe and discuss the clinical importance of a unique variation involving not only the piriformis, gluteus medius, gluteus minimus, obturator internus, and superior gemellus muscles, but also the superior gluteal neurovascular bundle, and sciatic nerve. A routine dissection of a right hemipelvis and its gluteal region of a male cadaver fixed in 10% formalin was performed. During dissection, it was observed a rare presentation of the absence of the piriformis muscle, associated with a tendon fusion between gluteus and obturator internus, and a fusion between gluteus minimus and superior gemellus muscles, along with an unusual topography with the sciatic nerve, which passed through these group of fused muscles. This rare variation stands out with clinical manifestations that are not fully established. Knowing this anatomy is essential to avoid surgical iatrogeny.
Case Report: Replacement of PD-1 inhibitors with PD-L1 inhibitors in the treatment of squamous non-small-cell lung carcinoma
Authors: Tong Wu, Yujun Li, Xiaonan Cui, Chunxia Zhang
Journal: Front Immunol (2023)
Keywords: pd-l1 inhibitor, cardiotoxicity, case report, squamous nsclc, sugemalimab, tislelizumab
MeSH terms: Carcinoma, Non-Small-Cell Lung / drug therapy, Carcinoma, Squamous Cell / drug therapy, Lung Neoplasms / drug therapy, Case Reports, Cardiotoxicity, Humans, Immune Checkpoint Inhibitors / adverse effects, Immune Checkpoint Inhibitors, sugemalimab

Background:
Immune checkpoint inhibitor (ICI)-associated cardiotoxicity is a relatively uncommon immune-related adverse effects (irAEs) with a high mortality rate. There are few recommendations for the replacement of different immune checkpoint inhibitors in domestic and international reports.
Case presentation:
We report a case of a patient with squamous non-small cell lung carcinoma (squamous NSCLC) who developed cardiotoxicity after being treated with a programmed death-1 (PD-1) inhibitor and then changed to a PD-L1 inhibitor to continue the treatment. A significant benefit was observed after four cycles of immunotherapy, and no further cardiotoxicity occurred after the treatment was started.
Conclusion:
This case demonstrates that myocardial damage induced by tislelizumab (PD-1 inhibitor) can be improved after switching to sugemalimab (PD-L1 inhibitor) and that antitumor immunotherapy is effective. This result may have important implications for optimizing immunotherapy management regimens in cancer patients.
Managing Follicular Lymphoma in the Elderly Population
Authors: Jiao Jie Cherie Tan, Yuen Lei Sze, Clarice Choong Shi Hui
Journal: Case Rep Med (2023)
MeSH terms: Case Reports

Follicular lymphoma (FL) is one of the most commonly diagnosed types of indolent non-Hodgkin lymphoma (NHL). The median age of diagnosis for FL is 65 years old. Although the median life expectancy after diagnosis is approximately 10 years, the incurable disease has a high risk of transformation. This case report focuses on an 80-year-old patient diagnosed with low-grade follicular lymphoma which subsequently transformed leading to the patient's eventual demise as the patient took on the palliative intent. This case report aims to highlight the importance of clinical markers or prognostic factors to identify patients, specifically the elderly population who are at risk of transformation to aggressive forms when their FL remains at stage I-II phases. Currently, elderly patients with FL tend to be quickly dismissed with curative intent with chemotherapy, given their age and comorbidities, despite forming the majority of the population with follicular lymphoma. Age more than 60 years old has been shown to be one of the most powerful yet poor prognostic features in follicular lymphoma international prognostic index (FLIPI)-the main scoring system used for FL. Hence, further studies are required to look into the tailoring treatment for elderly patients with follicular lymphoma after risk stratifying them with appropriate clinical and prognostic markers.
Trisomy Xp and partial tetrasomy Xq resulting from gain of a rearranged X chromosome in a female fetus: pathogenic or not?
Authors: Maria Yiu, Zhongxia Qi, Anita Ki, Jingwei Yu
Journal: Mol Cytogenet (2015)
Keywords: amniocentesis, array cgh, chorionic villus sampling, genetic counseling, high risk pregnancy, prenatal diagnosis, sex chromosome abnormality, x inactivation
MeSH terms: Case Reports

Cytogenetic analysis of chorionic villous sampling revealed a mosaic karyotype with gain of a rearranged X chromosome. Microarray and additional studies indicated that the rearranged X carried an inverted duplication, a deletion and a satellited Xqter. Gain of this rearranged X was confirmed by follow-up amniocentesis and postnatal cord blood sample. A full-term infant girl was delivered and showed normal physical findings at both birth and 21-month follow-up examinations. Late replication studies demonstrated that the rearranged X was inactivated in all abnormal cells analyzed. Skewed X-inactivation may suppress the potentially deleterious effects of genomic imbalance; however, gain of X chromosomes, particularly rearranged X chromosomes, often presents challenges for prenatal genetic counseling. The gradation of clinical phenotype severity generally correlates with the number of additional X chromosomes. However, the X chromosome regions responsible for the abnormal phenotypes are poorly understood. This case will further elucidate the phenotypic effects of X inactivation and X chromosome abnormalities.
Prenatal Diagnosis of Atrioventricular Block and QT Interval Prolongation by Fetal Magnetocardiography in a Fetus with Trisomy 18 and SCN5A R1193Q Variant
Authors: Lisheng Lin, Miho Takahashi-Igari, Yoshiaki Kato, Yoshihiro Nozaki, Mana Obata, Hiromi Hamada, Hitoshi Horigome
Journal: Case Rep Pediatr (2017)
MeSH terms: Case Reports

We report a case of fetal trisomy 18 with SCN5A R1193Q variant that presented with sinus bradycardia, 2 : 1 atrioventricular block (AVB), and QT interval prolongation. These complex arrhythmias were diagnosed by fetal magnetocardiography combined with ultrasound findings. Advanced AVB and ventricular arrhythmias were confirmed after birth. Genetic testing of the baby revealed a SCN5A R1193Q variant, which we considered could account for the various arrhythmias in this case.
A case of unresectable rectal necrosis
Authors: Mohammed Nassif, Ahmed Ameer, Sarkis H Meterissian, Ari-Nareg Meguerditchian
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Introduction. Necrosis of the rectum is an uncommon finding due to abundant collateral vasculature. Its management remains challenging, without clear consensus in the literature. Case Report. We describe a case of a 53-year-old woman with multiple medical comorbidities that presented in septic shock and hematochezia. Colonoscopy revealed ischemic colitis. Conservative management was instituted. At two weeks, she presented evidence of peritonitis. Exploratory laparotomy revealed extensive necrosis of the left colon and rectum. Due to dense inflammation, resection was deemed unsafe. Therefore, a transverse ostomy with mucosal fistula was preformed. Multiple drains were left in place. The patient healed uneventfully. Conclusion. This case illustrates that, if extensive dissection of the distal colon and rectum is unsafe due to the patient's critical condition or technical feasibility, then a diverting ostomy of the proximal viable bowel along with a mucus fistula and good drainage of the abdomen represents an acceptable alternative.
Chylorrhea following laparoscopy assisted distal gastrectomy with D1+ dissection for early gastric cancer: A case report
Authors: Takanobu Yamada, Yasuyuki Jin, Kimiatsu Hasuo, Yukio Maezawa, Yuta Kumazu, Yasushi Rino, Munetaka Masuda
Journal: Int J Surg Case Rep (2013)
Keywords: chylorrhea, ladg, laparoscopic gastrectomy, postoperative complication

Introduction:
Chylorrhea is a form of lymphorrhea involving digested lipid products absorbed in the small intestine. Here we report a rare case of chylorrhea after laparoscopy-assisted distal gastrectomy (LADG) with D1+ dissection that resolved following administration of a low-fat diet.
Presentation of case:
A 35-year-old woman with early gastric cancer underwent LADG with D1+ dissection, and on postoperative day 4, the drain output increased and the fluid with a high triglyceride level (740mg/dL) changed from clear to milky. On postoperative day 6, oral intake of a low-fat diet was initiated after a 2-day fast, and the daily drain output decreased from postoperative day 9. The drain tube was withdrawn on postoperative day 15, and the patient was discharged on postoperative day 17.
Discussion:
D1+ dissection does not typically cause injury to the lymphatic trunks, cisterna chyli, or thoracic duct. The maximum output of chylous ascites was minimal, and thus, we assumed that chylorrhea occurred from slightly injured lymphatics with anatomical variation.
Conclusion:
Chylorrhea after LADG with D1+ dissection is very rare. The fasting of our case followed by a low-fat diet without TPN would be an effective therapy. As a result, our case recovered favorably without further therapy.
Intracranial hypotension with multiple complications: an unusual case report
Authors: Swetha Ade, Majaz Moonis
Journal: Case Rep Neurol Med (2013)

Background. Undiagnosed intracranial hypotension can result in several complications including subdural hematoma (SDH), subarachnoid hemorrhage (SAH), dural venous sinuses thrombosis (CVT), cranial nerve palsies, and stupor resulting from sagging of the brain. It is rare to see all the complications in one patient. Furthermore, imaging of the brain vasculature may reveal incidental asymptomatic small aneurysms. Given the combination of these imaging findings and a severe headache, the patients are often confused to have a primary subarachnoid hemorrhage. Case Report. We present a patient with spontaneous intracranial hypotension (SIH) who had an incidental ophthalmic artery aneurysm on MR imaging, and this presentation led to coiling of the aneurysm. The key aspect in the history "postural headaches" was missed, and this led to life threatening complications and unnecessary interventions. Revisiting the history and significant improvement in symptoms following an epidural blood patch resulted in the diagnosis of SIH. Conclusion. We strongly emphasize that appropriate history taking is the key in the diagnosis of SIH and providing timely treatment with an epidural blood patch could prevent potentially life threatening complications.
Myocardial infarction in a pregnant woman revealing a transitional deficit in protein S: a rare case report
Authors: Souleymane Diakite, Fatima Zohra Radi, Jamila Zarzur, Mohamed Cherti
Journal: Pan Afr Med J (2019)
Keywords: myocardial infarction, pregnancy, protein s deficiency
MeSH terms: Acute Coronary Syndrome / diagnosis, Myocardial Infarction / diagnosis, Pregnancy Complications, Cardiovascular / diagnosis, Protein S Deficiency / complications, Case Reports, Acute Coronary Syndrome / etiology, Adult, Female, Humans, Myocardial Infarction / etiology, Myocardial Ischemia / diagnosis, Myocardial Ischemia / etiology, Pregnancy

The occurrence of myocardial ischemia and myocardial infarction in pregnancy is relatively rare, the occurrence of myocardial infarction in pregnancy is associated with cardiovascular risk factors. The deficiency of coagulation regulatory systems in the occurrence of venous thrombosis is well established; however, their role in arterial thrombosis is controversial. Here, we present an interesting case of a 34-year-old of acute myocardial syndrome without persistent ST segment elevation, which revealed transient protein S deficiency. Management of acute coronary syndrome (ACS) during pregnancy may represent a unique clinical challenge. In this manuscript, we review the clinical presentation, anatomic considerations, and management strategy in our patient presenting with ACS. Objective: this case highlights the importance of multimodality approach to help to obtain a more timely diagnosis of myocardial infarction in pregnancy and the importance collaboration between obstetricians, cardiologists, pediatricians and anesthesiologists to ensure optimal care.
The Role of Multifocal Intraocular Lens Implantation in Extreme Axial Myopia: A Case Report and Literature Review
Authors: Stephen A LoBue, Thomas M Catapano, Brittany B DeNaro, Christopher Shelby, Wyche T Coleman
Journal: Cureus (2023)
Keywords: cataract extraction, extreme myopia, high myopia, lasik, multifocal intraocular lenses
MeSH terms: Case Reports

The prevalence of high myopia is rising globally. In addition to an increased risk of retinal detachment, high myopia is associated with earlier cataract formation. Patients with myopia are also often more motivated to become spectacle-independent after a lens procedure. However, the use of multifocal intraocular lens (MfIOL) remains controversial for patients with extreme myopia, which is classified as patients with an axial length >28 mm. Here, we present the case of a 64-year-old patient with visually significant cataract and extreme axial myopia >31 mm in both eyes who desired to be spectacle-independent. A preoperative workup revealed a normal macula with peripheral lattice degeneration. On optical coherence tomography, the macula had a normal fovea contour without the presence of a staphyloma. A thorough peripheral examination was performed by a retina specialist which required no prophylactic treatment. Pentacam analysis demonstrated a low spherical aberration and minimal ectasia risk. Cataract surgery was uneventful with a 5 mm laser capsulotomy centered over the visual axis with the placement of a trifocal intraocular lens. Two months after the cataract surgery, the remaining refractive error was corrected with a laser-assisted in situ keratomileusis enhancement. The patient achieved an uncorrected distance visual acuity of 20/15- and uncorrected near visual acuity of J1+ in both eyes. Overall, this case report and review aims to highlight important preoperative, intraoperative, and postoperative techniques to improve patient outcomes with MfIOL in patients with extreme myopia.
B-cell lymphoma of the mandible: a case report
Authors: Ali Adouani, Jed Bouguila, Yassine Jeblaoui, Mehdi Ben Aicha, Mouhamed Ali Abdelali, Mouna Hellali, Karima Zitouni, Landolsi Amani, Zairi Issam
Journal: Clin Med Oncol (2008)
Keywords: b-cell lymphoma, intraosseous lymphoma, mandible, non-hodgkin’s lymphoma

Introduction:
The mandible is an infrequent localisation of primary osseous non-Hodgkin's lymphomas. Few cases of mandibular non-Hodgkin's lymphomas (NHL) have been reported.
Case report:
A rare condition of primary malignant non-Hodgkin's lymphoma of the mandible in 53-year-old man, was reported at the Department of Maxillofacial and Plastic Surgery in Charles Nicolle Hospital (Tunis, Tunisia). Histologic and Immunohistochemical (IHC) examination Confirmed a B-Cell lymphoma.
Discussion:
The purpose of this report is to describe this rare case of NHL of the mandible, explore the diagnosis and workup, and discuss treatment strategies. In this localisation, neither the clinical features nor the radiologic appearances are often pathognomonic.
Conclusion:
Particular care must be taken to consider lymphoma in the differential diagnosis because this uncommon lesion can pose significant diagnostic problems and is frequently misdiagnosed.
Leiomyoma of the fallopian tube found during laparoscopic myomectomy: A case report and review of the literature
Authors: Bing Cheng, Rui Wang, Yaoqun Fu, Xi Fu
Journal: Front Surg (2023)
Keywords: benign tumors, fallopian tube neoplasms, fertility, laparoscopic myomectomy, leiomyoma
MeSH terms: Case Reports

Leiomyoma of the fallopian tube is an extremely rare benign tumor of the fallopian tube. Because of the small number of cases, it is difficult to calculate their incidence. In this case report, we report a case of leiomyoma of the fallopian tube detected during laparoscopic myomectomy in a 31-year-old female with occasional pelvic pain. The patient was diagnosed with uterine leiomyoma based on a transvaginal ultrasound scan. She was operated and a 3*3 cm mass in the area of the isthmus of the left fallopian tube was observed. Three uterine leiomyomas and one leiomyoma of the fallopian tube were removed. Ultrasound at 6 months postoperatively showed no abnormality. Hysterosalpingo-contrast-sonography (HyCoSy) at 15 months postoperatively showed bilateral fallopian tubes were unobstructed. For those patients with fertility requirements, some fertility-preserving techniques can be used to allow complete resection of the leiomyoma and avoid tubal damage.
Extreme Anemia (Hemoglobin 1.8 g/dL) Secondary to Abnormal Uterine Bleeding
Authors: Ketaki Panse, Rachel Regn, Jonathan May
Journal: Case Rep Obstet Gynecol (2017)
MeSH terms: Case Reports, Retracted Publication

We present the case of a 39-year-old G5P5 woman who presented to the emergency department with complaints of shortness of breath, lightheadedness, and excessive uterine bleeding for 14 days, with a heart rate of 123 and a blood pressure of 137/65. Menses had been heavy for several months. A hemoglobin of 1.8 g/dL was discovered. An ultrasound revealed an 11.8 cm fibroid uterus, and the patient was transfused with 6 units of blood and placed on oral contraceptive pills.
Palinopsia Following Acute Unilateral Partial Vestibular Deafferentation: A Case Report
Authors: Caterina Stafuzza, Theodore Landis, Jean-Philippe Guyot
Journal: Front Neurol (2018)
Keywords: canalar-otolithic interactions, palinopsia, room tilt illusion, vestibular deafferentation, visual-vestibular interactions
MeSH terms: Case Reports

Palinopsia is defined as the persistence or reappearance of images after cessation of the visual stimulus. One patient presented episodes of palinopsia after the functional loss of the 3 semicircular canals of the right ear while the otolithic function was preserved. None of classical causes was identified in this patient, intoxications, brain tumors, migraines, psychiatric disorders, etc. For a movement to be perceived as a single event, central processes of temporal integration are necessary to correct the shift between the rapid vestibular information, and the slow visual information. However, it has been shown on animal models that vestibular inputs are slower than normal in case of peripheral deafferentation limited to the canalar function with preservation of the otolithic function, which is the case in this patient. Therefore, we hypothesize that episodes of palinopsia he presents result from the fact that temporal integration processes do not take into account the slower than normal vestibular information due to the peripheral disorder and continue to slow it down. Thus, the patient keeps the visual image in memory until the late arrival of the vestibular information.
Tuberculous infection of thyroid gland: a case report
Authors: Prince Cheriyan Modayil, Anna Leslie, Antony Jacob
Journal: Case Rep Med (2009)
MeSH terms: Case Reports

Introduction. Tuberculosis is one of the leading causes of morbidity and mortality and almost one-third of the world is infected with this disease. Tuberculosis has been reported in many parts of the human body. But thyroid gland involvement is extremely rare and its true incidence is unknown. Case Presentation. We present the case of a 26-year-old woman who presented with a thyroid cyst which turned out to be a primary mycobacterium tuberculosis infection. Conclusion. The correct diagnosis of thyroid tuberculosis is important because of the availability of medical treatment and the limited role of surgery.
Difficult Preoperative Diagnosis of Suspected Metal Hypersensitivity in a Case with Early Failure of Bipolar Hemiarthroplasty
Authors: Airi Shimmyo, Yu Takeda, Shigeo Fukunishi
Journal: Case Rep Orthop (2023)
MeSH terms: Case Reports

Background:
Metal hypersensitivity is a rare complication after total hip arthroplasty (THA), and no reliable diagnostic method for metal hypersensitivity to orthopedic metal implants has yet been established. Case report. A 57-year-old woman underwent hemiarthroplasty using a metal implant despite a skin allergy to metal jewelry. Two years after surgery, the patient developed early hemiarthroplasty failure and refractory erythema. Although the patient was clinically suspected to have a hypersensitivity to metal, the preoperative screening test was negative, and patient underwent revision surgery with cemented THA. Postoperatively, the erythema as well as her hip pain disappeared completely.
Conclusion:
Patients with clinically suspected metal hypersensitivity should undergo primary and revision total hip arthroplasty using hypoallergenic implants regardless of preoperative screening results.
Three Cases of Anaplastic Thyroid Carcinoma Transformation and Leukocytosis during Lenvatinib Treatment
Authors: Hiroyuki Iwasaki, Soji Toda, Daisuke Murayama, Hiroyuki Takahashi
Journal: Case Rep Endocrinol (2020)
MeSH terms: Case Reports

Since 2015, the cancer treatment lenvatinib has been used for patients with advanced radioactive iodine- (RAI-) refractory thyroid differentiated cancer; however, the drug's long-term effects have not been fully investigated. We report three cases in which lenvatinib treatment initially improved the patients' conditions, although they all died approximately 2 months after leukocytosis due to very aggressive disease progression with anaplastic thyroid carcinoma transformation. Serum interleukin-6 (IL-6) was elevated in all three cases, and granulocyte-colony stimulating factor (G-CSF) was elevated in two cases. The patients had a similar clinical course, with multiorgan metastasis and aggressive disease progression. Even with advanced cancer, lenvatinib has provided control of the disease. However, as long-term use of lenvatinib grows, it is possible that similar cases will increase, and we report our findings as an alert to other clinicians.
Cardiac Tamponade as the Initial Presentation of Acute Myeloid Leukemia: A Case Report with Review of the Literature
Authors: Dillon Karmo, Adam Hafeez, Alexandra Halalau, Siddhartha Yadav
Journal: Case Rep Oncol Med (2018)
MeSH terms: Case Reports

Acute myeloid leukemia (AML) is a complex disease with a variety of presentations. A large pericardial effusion is rare, occurring in less than 0.5% of all patients with AML prior to treatment. A 34-year-old male presented with dyspnea, malaise, and weight loss. On physical exam, he was noted to be hypoxic, tachypneic, tachycardic, and hypotensive. He had cervical lymphadenopathy and jugular venous distention. His WBC count was 110 bil/L with 33% blasts. Bone marrow biopsy confirmed AML with 60% blasts. Leukemic cells were also seen in the cerebrospinal fluid on lumbar puncture. An echocardiogram revealed a large pericardial effusion causing tamponade. He underwent emergent pericardiocentesis, and malignant cells were present in the pericardial fluid. Induction therapy with standard dose cytarabine and daunorubicin was initiated, and bone marrow biopsy 14 days later showed no residual AML. This case demonstrates the importance of a thorough evaluation of each organ system when caring for a patient with AML.