OpenMed/multicare-articles huggingface dataset:
Coronary Revascularization of Giant Aneurysms in Children With Kawasaki Disease: A Report of Two Cases
Authors: Katsumi Akimoto, Mana Harada, Hisayuki Oda, Takeshi Furukawa, Ken Takahashi, Masahiko Kishiro, Toshiaki Shimizu, Keisuke Nakanishi, Shiori Kawasaki, Atsushi Amano
Journal: Front Pediatr (2020)
Keywords: children, collateral artery, coronary artery bypass grafting, ischemic heart disease, kawasaki disease
MeSH terms: Case Reports

In recent years, >100 cases of coronary artery stenotic lesions due to Kawasaki disease were treated with coronary artery bypass grafting (CABG). Surgical indications include stenosis of >75%, myocardial infarction history, electrocardiographic changes, and ischemia, as detected by myocardial scintigraphy and electrocardiography, due to drugs or exercise. Some centers have reported good patency rates, even in infants. The advantages of CABG in younger patients are minimal loss of left ventricular function, early elimination of post-operative ischemia risk, and improved quality of life. However, the disadvantage of performing CABG in younger patients is the small coronary artery diameter and the thin vessel wall, which can lead to post-operative occlusion, especially when performed by inexperienced surgeons. The optimal timing of CABG varies by institution and case, which depends on the presence or absence of complications, such as left ventricular dysfunction or valve regurgitation, and surgeon's experience. Importantly, unlike adult surgery, childhood CABG needs to be kept open for the very longest possible period of time to determine the optimal conditions for surgery. We report two pediatric cases of giant coronary artery aneurysms diagnosed in infancy. During school age, the patients had a mild decline of left ventricular ejection function. In one case, there were no clinical symptoms because of the development of collateral vessels and limitation of exercise. Both patients underwent surgery with good results. The gastric gastroepiploic artery could be anastomosed owing to the development of collateral blood vessels, although it was obstructed. At 1 year after surgery, both patients had a good post-operative course without complications of anastomotic stenosis or myocardial damage due to aneurysm resection. If conditions are favorable, bypass surgery can be postponed to several years until the coronary arteries are sufficiently large to warrant a delay in coronary artery stenosis in cases of infantile Kawasaki disease.
Case Report and Literature Review: Primary Pulmonary NUT-Midline Carcinoma
Authors: Yunxiang Zhang, Kai Han, Xiaotong Dong, Qian Hou, Tianbao Li, Li Li, Gengyin Zhou, Xia Liu, Guifeng Zhao, Wei Li
Journal: Front Oncol (2021)
Keywords: nut-midline carcinoma (nmc), bromodomain-containing protein 4 (brad4), genomic analysis, lung, nuclear protein of the testis (nut)
MeSH terms: Case Reports

Nuclear protein of the testis (NUT) carcinoma is a very rare and aggressive carcinoma characterized by chromosomal rearrangement. NUT-midline carcinoma (NMC) can occur anywhere in the body, but most of the tumors are found in the midline anatomic structure or mediastinum. Pulmonary-originated NMC is extremely rare and often difficult to be distinguished from other poorly differentiated tumors, making the diagnosis awfully challenged in clinical practice. There are less than 100 cases of NUT carcinoma reported so far. In this study, the diagnosis and molecular mechanisms of reported NUT carcinoma cases were reviewed. Furthermore, a case of primary pulmonary NUT-midline carcinoma and its pathological features was reported. The process of pathological identification and genomic analysis for establishing the diagnosis was discussed. We found that NUT carcinoma could be identified by combining CT, H&E staining, immunohistochemistry (IHC), and molecular tests. The development of NUT carcinoma might be associated with mutation of MYC, p63, and MED24 genes and the Wnt, MAPK, and PI3K signaling pathways. Our study provided a detailed molecular mechanistic review on NMC and established a procedure to identify pulmonary NMC.
Biologic excipients: Importance of clinical awareness of inactive ingredients
Authors: Yelena Ionova, Leslie Wilson
Journal: PLoS One (2020)
MeSH terms: Acute Kidney Injury / chemically induced, Anaphylaxis / chemically induced, Excipients / adverse effects, Hyperglycemia / chemically induced, Research Support, Non-U.S. Gov't, Review, Chemistry, Pharmaceutical, Excipients / therapeutic use, Humans, Mannitol / adverse effects, Mannitol / therapeutic use, Polysorbates / adverse effects, Polysorbates / therapeutic use, Sodium Chloride / adverse effects, Sodium Chloride / therapeutic use, Sucrose / adverse effects, Sucrose / therapeutic use, Water / adverse effects, Excipients, Polysorbates, Water, Mannitol, Sodium Chloride, Sucrose

Due to the complexity and fragility of biological drug products, several challenges exist in their formulation development. Excipients are added to increase product stability, maintain tonicity, and facilitate drug delivery. The potential implications of these additive substances merit clinical consideration. We assessed the safety risk of excipients on the basis of their type and variability through an assessment framework, which quantifies excipient complexity in 230 biological formulations, and identifies excipient-related adverse events through published case reports. A biologic on average contained 4.45 excipients, half of that found in oral medications. The frequency distribution was heavily skewed towards the most commonly occurring excipients: water (40.4%), sodium chloride (38.3%), polysorbate 80 (28.7%), sucrose (24.4%), and mannitol (20.9%), with 44.4% of formulations not listing the concentration of the most commonly occurring inactive ingredients. A literature search revealed only 17 case reports of excipient-related adverse events, suggesting the need for more clarity for clinicians on the safety of chemical additives. These cases included injection site reactions, anaphylaxis, hyperglycemia, and acute renal failure. With the expansion of the biopharmaceutical market, it is important to consider the safety data of biologic excipients, so that therapy can be tailored appropriately for a specific patient.
Arthritis of the sternoclavicular joint masquerading as rupture of the cervical oesophagus: a case report
Authors: Iraklis E Katsoulis, Manuela Bossi, Nisal Damani, Jeremy I Livingstone
Journal: J Med Case Rep (2009)

Introduction:
Sternoclavicular septic arthritis is a rare condition and accounts only for 1% of cases of septic arthritis in the general population. The most common risk factors are intravenous drug use, central-line infection, distant-site infection, immunosuppression, trauma and diabetes mellitus. This is a report of an unusual case where this type of arthritis was masquerading as rupture of the cervical oesophagus.
Case presentation:
A 63-year-old man presented complaining of right neck pain and dysphagia following a bout of violent coughing. Physical examination revealed cellulitis extending from the right sternoclidomastoid region to the anterior upper chest. Computed tomography showed inflammatory changes behind the right sternoclavicular joint with mediastinitis and ipsilateral pleural effusion. These findings raised the suspicion of spontaneous rupture of the cervical oesophagus. Management involved jejunal feeding along with broad-spectrum antibiotics. The inflammation, however, relapsed after discontinuation of the antibiotics and this time, computed tomography pointed to a diagnosis of arthritis of the sternoclavicular joint. The patient responded completely to a 6-week course of oral penicillin, flucloxacillin and metronidazole.
Conclusion:
Sternoclavicular arthritis is a rare condition that has been associated with a variety of predisposing factors. It may, however, occur in otherwise completely healthy individuals and should be included in the differential diagnosis of other inflammatory conditions of the neck and upper chest.
Oral contraceptive-related transverse sinus thrombosis as an initial manifestation of antiphospholipid syndrome in the absence of systemic lupus erythematosus
Authors: Payam Saadat, Reza Mohseni-Ahangar
Journal: Caspian J Intern Med (2017)
Keywords: anticardiolipin antibody, antiphospholipid antibody, antiphospholipid syndrome, lateral sinus thrombosis, oral hormonal contraceptives
MeSH terms: Case Reports

Background:
Cerebral venous sinus thrombosis is a rare and potentially life-threatening neurologic manifestation of antiphospholipid syndrome. Oral contraceptive pills (OCP) may increase the risk of vascular events, even in people without family history of venous thrombosis.
Case presentation:
A 31-year-old woman with four weeks of constant headache and history of taking OCP for one year has been selected for this study. The results of magnetic resonance imaging (MRI) of brain and venography confirmed a diagnosis of cerebral venous sinus thrombosis. The serum anticardiolipin and antiphospholipid antibodies were elevated and a definitive diagnosis of antiphospholipid syndrome was made.
Conclusion:
The present report demonstrates the importance of screening for antiphospholipid antibodies in patients presenting with cerebral venous sinus thrombosis despite history of taking OCP.
Intraductal tubular papillary neoplasm (ITPN), a novel entity of pancreatic epithelial neoplasms and precursor of cancer: A case report and review of the literature
Authors: Stefan Fritz, Regina Küper-Steffen, Katharina Feilhauer, Christof M Sommer, Götz M Richter, Alexander Bosse, René Hennig, Jörg Köninger
Journal: Int J Surg Case Rep (2019)
Keywords: cancer risk, cystic tumors of the pancreas, itpn, intraductal tubular papillary neoplasm, pancreas

Background:
Intraductal tubular papillary neoplasm (ITPN) displays a very rare subtype of epithelial neoplasms of the pancreas. ITPN is characterized by intraductal tubulopapillary growth and cellular dysplasia. In contrast to intraductal papillary neoplasm (IPMN) no overt epithelial mucin production is observed. To date, little is known about ITPN and particularly about pancreatic cancer arising in this tumor entity.
Case presentation:
A 68-year-old male presented at our hospital with a distal bile duct occlusion suspicious for adenocarcinoma of the pancreatic head. Preoperative staging revealed no signs of distant metastasis. The patient was surgically explored and pylorus preserving duodenopancreatectomy was performed for a solid pancreatic head tumor. Final histopathology surprisingly revealed an ITPN with an associated invasive carcinoma pT3, pN0 (0/12), R0, G2.
Discussion:
Patients with ITPN frequently present with jaundice suspicious for a bile duct stenosis or a malignant tumor of the pancreatic head. Although, it is possible to diagnose ITPN by endoscopic retrograde cholangiopancreaticography, many tumors are found not before histopathological examination. Differential diagnosis includes ductal adenocarcinoma of the pancreas, neuroendocrine tumors, IPMN, distal bile duct tumors, and solid pseudopapillary neoplasms. Using immunohistochemistry, other entities of pancreatic tumors can be ruled out. In case of R0 resection oncological prognosis is described to be more favorable when compared to regular ductal adenocarcinoma.
Conclusion:
ITPN displays a rare entity of pancreatic neoplasms. As shown in the present case report, there is a relevant potential of malignant transformation and therefore radical surgical resection and oncologic follow-up is warranted.
Case report: A case of neuro-Behçet's syndrome presenting as brain stem mass lesions
Authors: Folusakin Ayoade, Salma Hernandez, Nadine Montreuil, Katherine Drews-Elger, Tanya Quiroz, Candice A Sternberg
Journal: Front Neurol (2023)
Keywords: brain stem, genital ulcer, immunoglobulin, neuro-behçet's, uveitis
MeSH terms: Case Reports

Neuro-Behçet's syndrome, a severe and rare manifestation of Behçet's disease (BD), can be misdiagnosed due to its challenging clinical presentation. This article presents the case of a 20-year-old cis-gender male with intermittent fever, bilateral uveitis, and neurological symptoms who was found to have multiple brain stem mass lesions on brain imaging. A careful medical history elicited recurrent painful oral and genital ulcerations which were important in making the correct diagnosis. As there are no validated criteria or definite set of tests available to confirm neuro-Behçet's disease, the diagnosis is often established by exclusion after ruling out other potential etiologies. In our case, after an extensive negative workup for infectious, neuro-degenerative and malignant etiologies combined with the patient's medical history, a diagnosis of Behçet's disease with neurological involvement (neuro-Behçet's syndrome) was made. High doses of steroids were given, and the patient had a favorable outcome. Repeated magnetic resonance imaging of the brain 2 years later showed no new brain lesions. Neuro-Behçet's disease should be included as a differential diagnosis of unexplained brain stem lesions in the right clinical context. In these situations, providers should obtain medical histories related to genital and oral ulcers and eye problems as these may help to narrow down the diagnosis. The clinical presentation and challenges of this uncommon presentation of BD including a brief literature review of neuro-Behçet's disease with brain stem mass lesions are discussed in this case study.
Point-of-Care Ultrasound Identifies Decompensated Heart Failure in a Young Male with Methamphetamine-Associated Cardiomyopathy Presenting in Severe Sepsis to the Emergency Department
Authors: David Kinas, Michael Dalley, Kayla Guidry, Mark A Newberry, David A Farcy
Journal: Case Rep Emerg Med (2018)
MeSH terms: Case Reports

We describe a case of a young male who presents to the emergency department with severe sepsis and decompensated heart failure with underlying Methamphetamine-Associated Cardiomyopathy that was previously undiagnosed. This presentation is unique because Methamphetamine-Associated Cardiomyopathy is an uncommonly reported condition that presented in a complex clinical scenario of severe sepsis and decompensated congestive heart failure. We discuss how we used point-of-care ultrasound (POCUS) in this case to identify an unsuspected disease process and how it changed our initial resuscitation strategy and management. Emergency physicians can utilize point-of-care ultrasound (POCUS) to help identify these high-risk patients in the emergency department and guide appropriate resuscitation. Methamphetamine-Associated Cardiomyopathy (MAC) is an infrequently described complication of methamphetamine abuse, most commonly presented as a nonischemic dilated cardiomyopathy. With the rise in methamphetamine abuse in the United States, complications from methamphetamine use are more commonly presenting to the emergency department. Proper education and rehabilitation, with a goal of abstinence from amphetamine use, may allow patients to potentially regain normal cardiac function. Since the majority of patients present late with severe cardiac dysfunction, early detection is essential amongst critically ill patients since recognition may significantly influence ED management.
Primary jejunal melanoma as a cause of adult intussusception: a case report and review of literature
Authors: Samuel Adegboyega Olatoke, Suleiman Olayide Agodirin, Adedire Timilehin Adenuga, Bashir Oladimeji Lawal, Kazeem Olatunde Ibrahim, Olaleke Oluwasegun Folaranmi
Journal: Pan Afr Med J (2019)
Keywords: jejunal melanoma, nigeria, adult intussusception, case report
MeSH terms: Intussusception / etiology, Jejunal Neoplasms / diagnosis, Melanoma / diagnosis, Case Reports, Review, Abdominal Pain / etiology, Female, Humans, Intestinal Obstruction / diagnosis, Intestinal Obstruction / etiology, Intussusception / diagnosis, Jejunal Neoplasms / complications, Melanoma / complications, Middle Aged

Primary melanoma of the small bowel is a rare clinical entity with a paucity of published reports in literature. Most cases of gastrointestinal melanomas are metastatic lesions arising from skin or ocular origins. This is a case report of a 63 year old female with adult intussusception with jejunal melanoma as the lead point. The index patient had a long history of abdominal pain associated with significant weight loss and presented with features of intestinal obstruction. The possibility of a regressed or unidentified extra-intestinal site cannot be absolutely excluded as the patient did not have a PET scan. Due to the vague nature of clinical symptoms and signs, the diagnosis of small bowel melanoma is difficult, especially in patients with no obvious cutaneous pathology. A high index of suspicion for melanoma as a malignant lead point for adult intussusception should always be entertained.
Pleomorphic adenoma of minor salivary gland with therapeutic misadventure: a rare case report
Authors: Jagdeep S Thakur, Narinder K Mohindroo, Shobha Mohindroo, Dev R Sharma, Anamika Thakur
Journal: BMC Ear Nose Throat Disord (2010)

Background:
The benign tumors of nasopharynx are least encountered tumors in otolaryngology, as nasopharynx is considered one of notorious anatomical site for the malignant tumors. Pleomorphic adenoma of the minor salivary gland of nasopharynx and parapharyngeal space is rare. We present a pleomorphic adenoma of minor salivary gland which was mismanaged.
Case presentation:
An adult male presented with left nostril obstruction for five months. The examination found big mass extending from nasopharynx to oropharynx. On CT scan, this tumor was quite big and extending to the parapharyngeal space. The FNAB found it a carcinoma but it did not respond to radiotherapy. The excision biopsy of tumor revealed it as pleomorphic adenoma. We found only five published reports on this tumor arising from nasopharynx.
Discussion and conclusion:
Although, in this case report exact origin of the tumor could not be ascertained as it also appeared to be a parapharyngeal tumor but we kept the possibility of a nasopharyngeal tumor on the basis of clinical features. The pleomorphic adenoma of nasopharynx is rare. It can be misdiagnosed as malignant epithelial tumor on histopathology. The differentiation from its malignant variant is also difficult. A possibility of benign tumor should always be kept in nasopharyngeal growth with no evidence of metastasis, and histopathological diagnosis of growth should be available before any definitive treatment.
A 6-Year-Old Boy with COVID-19-Positive Pleural Effusion and Kawasaki-Like Features
Authors: Sedigheh Yousefzadegan, Ramin Zare Mahmoudabadi, Golnaz Gharehbaghi
Journal: Case Rep Pediatr (2021)
MeSH terms: Case Reports

The ongoing outbreak of the novel coronavirus (SARS-CoV-2) has exposed many pediatric patients from around the world to coronavirus disease. Although pleural effusions are classified as atypical features of COVID-19 infection, we report a 6-year-old boy who had a positive IgG antibody ELISA test for COVID-19 and presented with respiratory distress, bilateral pleural effusions, and signs and symptoms of multisystem inflammatory syndrome. The RT-PCR test of the pleural fluid specimen was positive for novel coronavirus. To our knowledge, this is the first pediatric report of a COVID-19-positive pleural fluid.
Intussusception after laparoscopic one anastomosis gastric bypass: A rare complication
Authors: Manar A Al Sulaiti, Abdulla Darwish, Khalid Al Khalifa
Journal: Int J Surg Case Rep (2019)
Keywords: bowel obstruction, case report, intussusception, laparoscopic one anastomosis gastric bypass

Introduction:
Intussusception after one anastomosis gastric bypass is a rare postoperative complication that occurs with bowel obstruction. The diagnosis may be challenging because of long-standing, intermittent, nonspecific symptoms. Our paper describes an unusual case of antegrade intussusception that occurred 28 months after laparoscopic one anastomosis gastric bypass surgery.
Presentation:
A 30-year-old female known to have diabetes mellitus type 2, who presented with epigastric pain. A computed tomography scan revealed a jejuno-jejunal intussusception. After resection and primary end-to-end hand-sewn anastomosis of the biliary limb, the patient was discharged on the 6th day postoperatively and recovered uneventfully. We belief this is the first report describing a case of intussusception post one anastomosis gastric bypass.
Discussion:
Gastric bypass surgeries have recently become a popular method for the surgical treatment of morbid obesity worldwide. The reported intussusception incidence after Roux-en-Y gastric bypass (RYGB) is approximately 0.1-0.3%, but not described in one anastomosis gastric bypass surgery. Approximately two-thirds of patients show recurrent chronic and colicky pain. Surgical intervention is essential.
Conclusion:
Clinicians should be aware of such condition in patients with history of bariatric surgery who present with long-standing, intermittent abdominal pain.
Novel BRAF Alteration in a Sporadic Pilocytic Astrocytoma
Authors: Sonika Dahiya, Jinsheng Yu, Aparna Kaul, Jeffrey R Leonard, David H Gutmann
Journal: Case Rep Med (2012)
MeSH terms: Case Reports

Pilocytic astrocytoma (PA) is the most frequently encountered glial tumor (glioma or astrocytoma) in children. Recent studies have identified alterations in the BRAF serine/threonine kinase gene as the likely causative mutation in these childhood brain tumors. The majority of these genetic changes involve chromosome 7q34 tandem duplication, resulting in aberrant BRAF fusion transcripts. In this paper, we describe a novel KIAA1549:BRAF fusion transcript in a sporadic PA tumor associated with increased ERK activation and review the spectrum of BRAF genetic alterations in this common pediatric low-grade central nervous system neoplasm.
Hypoparathyroidism Causing Seizures: When Epilepsy Does Not Fit
Authors: Faheem Seedat, Reyna Daya, Sindeep A Bhana
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

A 24-year-old man presented to the Chris Hani Baragwanath Academic Hospital emergency department with recurrent seizures having previously been diagnosed with epilepsy from age 14. The biochemical investigations and brain imaging were suggestive of seizures secondary to hypocalcemia, and a diagnosis of idiopathic hypoparathyroidism was confirmed. After calcium and vitamin D replacement, the patient recovered well and is seizure free, and off antiepileptic therapy. This case highlights the occurrence of brain calcinosis in idiopathic hypoparathyroidism; the occurrence of acute symptomatic seizures due to provoking factors other than epilepsy; and the importance, in the correct clinical setting, of considering alternative, and sometimes treatable, causes of seizures other than epilepsy.
Vincristine-induced cranial neuropathy
Authors: Ahmad Talebian, Razieh Moazam Goudarzi, Mahdi Mohammadzadeh, Azadeh Sadat Mirzadeh
Journal: Iran J Child Neurol (2014)
Keywords: ptosis, side effect, vincristine, wilms’ tumor
MeSH terms: Case Reports

Vincristine (VCR) is a vinca alkaloid that is used for treatment of many malignancies. The vinca alkaloids are neurotoxic, usually causing a peripheral neuropathy, but cranial neuropathies are rare as side effects. Described here is the case of a 2.5-year-old boy, a known case of Wilms' tumor, treated by vincristine (0.067 mg/kg/day) and dactinomycin (0.045 mg/kg/day) after surgery. Three weeks after treatment, he presented with bilateral ptosis. Neurological examination revealed bilateral ptosis with normal pupillary reflex and eye movement. He received 3.015 mg cumulative dose of vincristine before development of ptosis. Treatment with pyridoxine (150 mg/m2 p.o. BID) and pyridostigmine (3 mg/kg p.o. BID) was started as neuroprotective agents, and after 7 days the problem disappeared. The treatment continued for 6 weeks and there were no signs of ptosis or a recurrence in follow up 2 months later.