[ { "human_patient_id": "0", "human_patient_uid": "6623999-1-M", "PMID": "31312557", "title": "Complications of Microvascular Upper Lip and Free Grafted Nasal and Eyebrow Replantation After Assault via Human Bite", "patient": "A 46-year-old male with a past medical history of hypertension presented to our trauma bay with complex injuries of the right nose and midface, which included an amputated nose, upper lip and right eyebrow approximately 40 minutes after an assault including numerous human bite wounds. His right ala, right sidewall, and right upper lip were entirely missing, with nasal airways on each side visible. The amputated specimens included nasal tissue which measured approximately 4.0 x 4.0 cm, the eyebrow 2.0 x 2.0 cm, and the upper lip 1.0 x 11.7 cm (Figure ). After rapid sequence intubation, assessment, and stabilization, the patient was taken to the operating room about one hour after the initial presentation for reattachment and wound reconstruction.\nIn the OR, the superior labial artery and a small outflow vein, which was likely part of the superior labial venous plexus, were identified and isolated from the lateral portion of the lip. However, the nasal segment contained no identifiable viable artery or vein. Therefore, the nasal and eyebrow portions were replanted similarly to full thickness skin grafts and the upper lip was replanted using microvascular techniques. The segments of each vessel were flushed with heparinized saline. Then, the superior labial artery was anastomosed using 9-0 nylon interrupted sutures, followed by anastomosis of the vein using 9-0 nylon. After three hours and 19 minutes of operating time, arterial blood flow was immediately apparent, but venous flow was not definitive. The wounds of the upper eyelid and right cheek were debrided and then closed.\nTo improve the chance of tissue survival, our patient was scheduled to receive hyperbaric oxygen treatment within 24 hours post-operation. However, the patient reported that his ears could not tolerate the pressure and therapy was postponed until otolaryngology could insert tubes at the bedside. Additionally, he was receiving 30 mg of enoxaparin daily to mitigate the chance of outflow venous thrombosis. The replaced nasal and eyebrow tissue and the microsurgically replanted upper lip appeared to have some minor ischemia at the lateral margins (particularly of the nasal tip) that would most likely require revision, but the majority of the three portions appeared healthy (Figure ).\nLater that day, the patient reported upper extremity numbness. After a non-contrast CT showed no intracranial abnormality, he received 8.34 mg bolus of tPA followed by 75.1 mg of IV tPA over the course of an hour for possible ischemic stroke. Subsequent MRI showed a small acute left frontal cortical infarction. The next morning the patient reported chest discomfort and an EKG showed ST-segment elevation of inferior leads with elevated troponin peak of 132.2 due to myocardial infarction. The patient then underwent left heart catheterization that showed adequate flow and no need for further intervention. After these events, he received 30 mg of enoxaparin twice a day per protocol.\nAfter tPA treatment, there was marked continuous sanguineous discharge from the replant sites and the eyebrow, nose, and upper lip began to appear increasingly dusky. Our patient was determined to be a high-risk candidate for immediate revision surgery and plans for secondary reconstruction were made. The patient returned six days later for facial wound debridement of necrotic wounds of the upper lip, nose, and right forehead with subsequent placement of Integra artificial dermis (Figure ). He subsequently underwent nose and upper lip advancement flaps to save oral competence. A month later, nasal reconstruction was undertaken with a left paramedian forehead flap and full-thickness skin graft to upper lip and nose. The second stage of reconstruction was done one month later including the second stage of the paramedian flap, ear cartilage graft to the nose, and full-thickness skin graft of the upper lip (Figure ). Subsequent reconstruction one month later included an Abbe flap from the lower lip to the upper lip and final revision of the forehead flap. Overall, our patient was satisfied with the cosmetic and functional outcome of his reconstruction four months after his final surgery (Figure ).", "age": [ [ 46.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6623999.xml", "relevant_articles": { "31312557": "123", "31358106": "0", "21795130": "0", "30534477": "0", "19156461": "0" }, "similar_patients": { "7872872-1": "0", "3314807-1": "0", "5717909-1": "0", "5714988-1": "0", "4793788-1": "0" } }, { "human_patient_id": "1", "human_patient_uid": "8214889-1-M", "PMID": "34307217", "title": "Concomitant Langerhans cell histiocytosis of cervical lymph nodes in adult patients with papillary thyroid carcinoma: A report of two cases and review of the literature", "patient": "A 49-year-old female patient was diagnosed with a thyroid nodule on routine neck ultrasound; she had no family history of thyroid cancer. Laboratory tests showed euthyroidism. Neck ultrasound revealed partly cystic and hypoechoic nodules in both thyroid lobes, the largest of which was 10 x 8 x 15 mm in the right lobe. No enlarged neck lymph nodes were identified.\nUltrasound-guided FNA was performed and interpreted as suspicious for papillary thyroid carcinoma, and a total thyroidectomy was undertaken. The thyroid gland was received intact. Serial sectioning revealed multiple nodules. The tumor was identified in the right lobe, measuring 0.3x0.2x0.1cm. Microscopic examination revealed classic papillary thyroid microcarcinoma in multi-nodular goiter ().\nThe patient was discharged after a week and scheduled for close follow-up.\nFive months later, the patient presented with odynophagia. Physical examination showed a left neck mass, which on the ultrasound examination consisted of an enlarged rounded cortically thickened left level II lymph node measuring 1.5 x 2.5 cm, likely metastatic, with few smaller yet pathological left level Ib and II lymph nodes. Ultrasound-guided lymph node FNA was done. The smears showed cells with reniform nuclei and abundant eosinophilic cytoplasm. The nuclei displayed prominent grooving but no nuclear pseudoinclusions (). Many eosinophils were seen in the background. These cells were positive for CD68 and CD1a (1D) and negative for S100, ERG, and TTF1.\nThe diagnosis was consistent with Langerhans cell histiocytosis. Subsequently, a chest CT scan was performed and revealed small pulmonary nodules and cysts affecting both lungs, primarily seen in the lower lobes, likely due to pulmonary Langerhans cell histiocytosis (). After three months, the Chest CT scan showed unchanged bilateral pulmonary nodules with no mediastinal or axillary lymphadenopathy, and the bone scan revealed nonspecific lytic lesions within the proximal right femoral shaft. The patient was asked to stop smoking, and she was scheduled for a regular follow up CT scan every three months.", "age": [ [ 49.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC008xxxxxx/PMC8214889.xml", "relevant_articles": { "31310084": "0", "25349760": "123", "28858125": "123", "34307217": "12", "18439957": "12" }, "similar_patients": { "8392436-1": "0", "7640618-1": "0", "7784209-1": "0", "5649879-1": "0", "8214889-2": "13" } }, { "human_patient_id": "2", "human_patient_uid": "8214889-2-M", "PMID": "34307217", "title": "Concomitant Langerhans cell histiocytosis of cervical lymph nodes in adult patients with papillary thyroid carcinoma: A report of two cases and review of the literature", "patient": "A 69-year-old male presented a left thyroid nodule diagnosed on FNA cytology as papillary thyroid carcinoma. During investigations, the patient was found to have multiple bone lytic lesions. Biopsies of the lumbar vertebra and left clavicle showed Langerhans cell histiocytosis. The patient underwent total thyroidectomy with left cervical lymph node dissection. Sectioning of the specimen revealed two lesions in the right thyroid lobe measuring 3.7 X 3.5 X 2.5 cm and 0.7 X 0.7 X 0.5 cm and a single lesion in the left thyroid lobe measuring 1 X 0.7 X 0.7 cm.\nAdditionally, the left thyroid lobe showed a goitrous nodule measuring 3.7 X 3.5 X 2.5cm. The microscopic examination concluded a multifocal classical papillary carcinoma confined to the thyroid gland with no extra-capsular extension neither lymph node involvement. However, four lymph nodes showed morphologic features of focal involvement by Langerhans cell histiocytosis. Immunohistochemical stains have confirmed these features. The Langerhans cells were positive for CD1a and negative for TTF-1. The thyroid gland was extensively examined without any morphological evidence of Langerhans cell histiocytosis involvement.\nFour years later, the patient presented with anemia leukocytosis, and bone marrow biopsy showed marrow involvement by Langerhans cell histiocytosis (). The estimated degree of involvement was 40% with associated secondary myelofibrosis.", "age": [ [ 69.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC008xxxxxx/PMC8214889.xml", "relevant_articles": { "25349760": "123", "27867869": "123", "18439957": "12", "9255274": "123", "28858125": "123" }, "similar_patients": { "8214889-1": "12", "4202248-1": "12", "3643374-1": "0", "6211211-2": "0", "4372768-1": "0" } }, { "human_patient_id": "3", "human_patient_uid": "5732958-1-M", "PMID": "29312905", "title": "Atypical Late-Onset Immune Dysregulation, Polyendocrinopathy, Enteropathy, X-Linked Syndrome with Intractable Diarrhea: A Case Report", "patient": "A 6-year- and 9-month-old boy was referred to our hospital with a history of 6-month intractable diarrhea. Diarrhea was characterized by loose, yellow\u2013green, or green, non-bloody, two to three times per day. The boy was born at term, and his family history was normal. Before admission to our hospital, the patient suffered aggravated watery diarrhea for 15 days, 10 times daily, abdominal pain, 5 days of fever, and a weight loss of 3 kg. Laboratory tests showed a normal eosinophil counts, normal immunoglobulin G, IgA, IgM, and IgE levels. Lymphocyte subsets analysis revealed normal proportions of CD3, CD8 T cells, decreased proportions of CD19 T cells (5.74%, reference range: 14.35\u201322.65%) and CD4 T cells (25.77%, reference range: 29.78\u201339.94%) (Table ). A slightly low absolute natural killer cells (0.26 \u00d7 109/L, reference range: 0.28\u20130.63 \u00d7 109/L) and a low number of CD4 T cells (0.32 \u00d7 109/L, reference range: 0.71\u20131.84 \u00d7 109/L) were observed (Table ). Antineutrophil cytoplasmic and other autoantibodies, including diabetes-related autoantibodies, antithyroglobulin were all negative (Table ). The patient was treated with cefoperazone\u2013sulbactam for intestinal infection. Five days later, gastroscopy and colonscopy were performed for no improvement of symptoms. Colonscopy showed mucosal damages and ulceration, biopsy histology showed eosinophil infiltration (20\u201330/HP), and hyperplasia of lymphoid follicles. The patient was started with methylprednisolone for suspicion of Crohn\u2019s disease based on colonic ulcers and biopsy pathological features. Infliximab (5 mg/kg) was given for no significant remission after methylprednisolone treatment. Then, the patient was discharged for achieving a partial remission of diarrhea. Two weeks later, he was admitted to our hospital again for second course of infliximab. Diarrhea was still presented in the patient, and characterized by bloody, mucus-containing stools. Metronidazole was started due to Clostridium difficile infection (CDI). Oral methylprednisolone and deep hydrolyzed milk were given and discharged for partial improvement of symptom. Two weeks before the third admission, the boy suffered with severe watery diarrhea again, with occasionally bloody, mucus containing stools, more than 10 times per day, accompanied with abdominal pain and fever. During the third admission, vancomycin and teicoplanin were used to treat CDI, fluconazole and mycamine were used to treat Candida albicans infection which found in the mouth, ceftriaxone, and azithromycin were given to treat pneumoniae Mycoplasma. In addition, fecal microbiota transplantation (FMT) was performed to treat CDI (). Albumin, gamma globulin, red cell suspension, and frozen plasma were given due to hypoproteinemia. Parenteral nutrition and enteral nutrition were supported for failure to thrive. Diarrhea, abdominal pain, mucus-containing stools, and recurrent infections were not well controlled after more than 2 months of continuous treatment. Therefore, the patient was suspicious of immunodeficiency disease and extraction of peripheral blood for immune gene panel testing. Finally, the boy was diagnosed as IPEX syndrome due to a c.1190G>A (p. R397Q) mutation in exon 11 of the FOXP3 gene (Figure A). The patient\u2019s mother is a healthy carrier (Figure B). Two healthy siblings were excluded the same mutation by DNA Sanger sequencing (Figures C,D). At 3 months after the genetic diagnosis of IPEX, at the age of 7.5 years, the boy underwent matched sibling peripheral blood HSCT using reduced-intensity conditioning with busulfan, fludarabine, and cyclophosphamide, antithymocyte globulin. The CD34 cell dose was 7 \u00d7 106/kg, and the number of neutrophils was 3.09 \u00d7 109/L, platelets was 276 \u00d7 109/L in the day of engraftment. He continued to receive cyclosporine and methylprednisolone to prevent graft-versus-host disease. At day +14 post-HSCT, the short tandem repeat test showed that he engrafted with 100% of donor cells. Up to date, diarrhea, abdominal pain, and recurrent infections were well controlled after 6 months of HSCT, and Clostridium difficile (CD) test was negative.", "age": [ [ 6.0, "year" ], [ 9.0, "month" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5732958.xml", "relevant_articles": { "29312905": "123", "31810997": "0", "16525744": "0", "26754306": "0", "30044904": "0" }, "similar_patients": { "8185152-1": "1", "8491244-1": "123", "5028855-1": "123", "7294377-1": "0", "7505392-1": "0" } }, { "human_patient_id": "4", "human_patient_uid": "6426018-1-M", "PMID": "31020088", "title": "An unusual \u2018rite of passage\u2019 for an ablation catheter during left ventricular tachycardia ablation \u2013 a case report", "patient": "A 60-year-old man with repaired tetralogy of Fallot (TOF) and mitral valve (MV) repair for endocarditis as well as an implantable cardioverter-defibrillator for secondary prevention in situ was admitted with haemodynamic compromising monomorphic VT despite Bisoprolol 5 mg. His cardiovascular examination showed a mid-sternotomy scar and when in sinus rhythm the auscultation showed normal heart sounds with no murmurs. His jugular venous pressure was not raised with a blood pressure measured at 110/60 mmHg. His respiratory examination was unremarkable. A 12-lead electrocardiography documentation of the monomorphic VT (Figure ) demonstrated a right bundle branch block QRS morphology, transition in lead V4 with south-west axis, suggesting a VT exit from the LV lateral wall. Patient underwent VT ablation with three-dimensional (3D) EAM under general anaesthesia. The initial 3D-EAM of the LV was performed using the Orion catheter. After completion of the initial mapping, an ablation catheter was used for further point-by-point mapping at sites of interest. An irrigated 4-mm tip bidirectional steerable catheter (IntellaNav OI, Boston Scientific, Natick, MA, USA) was positioned in the LV for EAM via a steerable bidirectional sheath (Agilis, St. Jude Medical Inc., St. Paul, MN, USA) following an anterograde approach via a transseptal puncture.\nThe catheter moved freely within the LV until it became stuck. Fluoroscope suggested an extracardiac position. Contrast injection via the irrigation port of the catheters confirmed pericardial staining (Figure ), but it only became apparent on further withdraw of the catheter that the catheter was inside a coronary vein (see Figure and see ). Transthoracic echocardiography confirmed the intubation of basal LV wall with the catheter tip which then exited into the epicardial space (Figure ). The catheter was removed without any further sequelae. Subsequently the patient\u2019s Bisoprolol was increased and underwent a VT provocation test at 5-month follow-up with a negative result.", "age": [ [ 60.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6426018.xml", "relevant_articles": { "32725360": "123", "28347634": "123", "17587730": "123", "18202905": "0", "14689119": "123" }, "similar_patients": { "4359501-1": "123", "4661370-1": "123", "2766586-1": "123", "5986064-1": "123", "6601154-1": "123" } }, { "human_patient_id": "5", "human_patient_uid": "6939819-1-M", "PMID": "31912001", "title": "Successful treatment of a spontaneous right coronary artery dissection with a 4-mm diameter cutting balloon: a case report", "patient": "A 53-year-old woman presented to the Cardiology clinic with a 1-month history of retrosternal chest tightness since the bereavement of a friend. Examination was unremarkable. The past medical history included hypertension and there was a family history of premature coronary artery disease. The pain radiated to shoulders, arms, jawline and was present at rest. The patient was, therefore, admitted to hospital for urgent cardiac investigations and inpatient coronary angiography. Post-admission, despite medical therapy, she continued to experience ongoing chest pain in the days preceding and during angiography.\nBlood tests: Full blood count, renal function tests, and high-sensitivity troponin I levels were normal.\nEchocardiogram: Biventricular size and systolic function normal with no regional wall abnormalities and no significant valvular disease.\nTwelve-lead electrocardiogram (ECG): Sinus rhythm with T-wave inversion in the inferolateral leads.\nThe patient underwent coronary angiography via the right radial artery using a 6-Fr sheath. The left coronary artery was engaged using a Voda left 3.5 guide catheter and initial injections in the posteroanterior caudal view revealed TIMI 0 flow in the first obtuse marginal (OM1) branch (Figure ). The left anterior descending artery was free of disease and by the second contrast injection, OM1 flow had normalized (Figure ). Assessment of this vessel using optical coherence tomography (OCT) revealed no abnormalities (Figure ), suggesting that the temporary occlusion was due to vasospasm.\nThe right coronary artery (RCA) was engaged using a Judkins Right 4 catheter and selective angiography revealed a critical lesion in the mid-vessel (Figure ). In view of the history of stress-induced chest pain, the lesion was interrogated with OCT. This revealed a significant intramural haematoma within the mid-vessel causing a critical stenosis with a minimal luminal area of just 1 mm2 (Figure ).\nThese findings were consistent with Type 3 SCAD. In view of the patient\u2019s ongoing ischaemia and ECG changes, the decision was made to treat this lesion. A 2.5-mm semi-compliant balloon was inflated to six atmospheres to gently pre-dilate the vessel. Repeat angiography and OCT imaging revealed improved appearances of the lesion (Figure ).\nA 4 \u00d7 10 mm Flextome cutting balloon (Boston Scientific, MA, USA) was then gently inflated for 8 s to nominal pressure on three occasions (Figure ). This led to complete resolution of the intramural haematoma with only very minimal residual intimal dissection on OCT (Figure ). The maximal luminal area of the vessel by the end of the procedure increased to over 10 mm2.\nFinal angiographic appearances showed excellent resolution of the lesion and TIMI III flow (Figure ). The patient\u2019s symptoms resolved and she was subsequently discharged 2 days later on a regimen of aspirin and clopidogrel for 3 months and aspirin alone thereafter. This dual antiplatelet regimen was prescribed due to disruption of the intimal layer by balloon angioplasty. The patient was followed-up in clinic and found to be asymptomatic with no further recurrences of angina. She will be investigated for associated conditions such as fibromuscular dysplasia.", "age": [ [ 53.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC006xxxxxx/PMC6939819.xml", "relevant_articles": { "25810738": "0", "31912001": "123", "30615766": "1", "31911973": "12", "33738416": "0" }, "similar_patients": { "6276441-1": "123", "6939789-1": "12", "3242027-2": "0", "8564704-1": "0", "4631743-1": "12" } }, { "human_patient_id": "6", "human_patient_uid": "2967006-1-M", "PMID": "21060758", "title": "Cholestatic Hepatitis and Thrombocytosis in a Secondary Syphilis Patient", "patient": "On 21 May 2009, a 42-yr-old male patient visited our hospital because of malaise and jaundice. He had been working as an office manager of a trading company in China for two years. Two mild fever, and one month before examination, he felt unusual fatigue and jaundice. Twenty days before examination, he had been informed that his acute hepatitis was unusual because he had no hepatitis A, B, or C viral markers. He took herbal medication and received acupuncture in China under the diagnosis of acute hepatitis of unknown origin. His symptoms improved under herbal medication, but remained. He returned to Korea for treatment of the acute hepatitis. He had no other symptoms except for scanty whitish phlegm. He had been healthy until the recent illness. He was not currently on medication, was not an injecting drug abuser. He did not smoke nor drink alcohol. He had received no blood transfusion. He had been married for seven years, but had lived alone in China for two years. He was well oriented and his vital signs were normal. Physical examination revealed icteric sclera and tender hepatomegaly. No mucous membrane lesions nor lymphadenopathy were present and he was afebrile. Cutaneous manifestations consisted of macular and papular lesions, about 0.5 cm in diameter, localized on the trunk, palms, and soles (). Genital examination revealed no lesions nor ulcers. Lymph nodes were not palpable in the neck, axillary, or inguinal areas. Laboratory tests showed the following: alkaline phosphatase (ALP) 2,974 IU/L, gamma glutamyl transpeptidase (GGT) 1,755 IU/L, aspartate transaminase (AST) 89 IU/L, alanine transaminase (ALT) 119 IU/L, total bilirubin 8.3 mg/dL, direct bilirubin 6.9 mg/dL, creatinine 0.8 mg/dL, albumin 2.4 g/dL, total protein 9.2 g/dL, white blood cell (WBC) 13,600/\u00b5L, hemoglobin 9.7 g/dL, platelets 752,000/\u00b5L, international normalized ratio (INR) 1.06, venereal disease research laboratory (VDRL) was positive with a titer >1:1,024, and his fluorescent treponemal antibody absorption (FTA-ABS) was reactive. A hepatitis panel including IgM anti-HAV, HBsAg, and anti-HCV, antinuclear antibody, ceruloplasmin, copper, alpha-1 antitrypsin deficiency, and human immunodeficiency virus (HIV) were all nonreactive. Computerized tomography didn't show any evidence of bile duct obstruction. It showed also mildly enlarged liver, nonspecifically enlarged lymph nodes at the porta hepatis area, and thickened gall bladder wall (). Chest radiography was normal.\nLiver biopsy revealed portal-to-portal or portal to central zone bridge necrosis, and widening by lymphocyte infiltration, accompanied by intracanalicular and intracellular cholestasis. These findings were compatible with acute hepatitis (). A modified Warthin-Starry stain was negative for spirochetes. Skin biopsy revealed a perivascular mixed-cell infiltrate of prominent plasma cells, lymphocytes, and histiocytes around a blood vessel that contained swollen endothelial cells ().\nThe patient was treated with weekly intramuscular benzathine penicillin, 2,400,000 U, for a total of three doses. One week after treatment, his fatigue and rash were markedly improved. Three weeks after treatment, ALP was 288 IU/L, total bilirubin was 0.3 mg/dL () and four weeks after treatment, the VDRL titer was down to 1:64. He did not develop a Jarisch-Herxheimer reaction. Positive serologic tests and a prompt response to penicillin treatment confirmed the diagnosis of syphilitic cholestatic hepatitis.", "age": [ [ 42.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC002xxxxxx/PMC2967006.xml", "relevant_articles": { "26110300": "123", "27821033": "0", "8079944": "0", "17879418": "0", "28209108": "0" }, "similar_patients": { "8524898-1": "0", "3915726-1": "0", "5305665-1": "0", "5266344-1": "0", "8409462-1": "123" } }, { "human_patient_id": "7", "human_patient_uid": "3116546-1-M", "PMID": "21350287", "title": "Suppurative dacroadenitis causing ocular sicca syndrome in classic Wegener\u2019s granulomatosis", "patient": "A 27-year-old man complained of 2-month history of nasal stuffiness, epistaxis and maxillary sinus pain. One month later, he developed painful swellings over the outer part of both eyes. He was diagnosed elsewhere as presumed lid abscess and managed with antibiotics (amoxicillin-clavulanic acid) and drainage of purulent material from these swellings. He presented to us after another month with recurrence of eye swelling along with new development of dry cough. There was no history of redness of eyes, blurring of vision, diplopia, dry eyes, hemoptysis, dyspnea, fever, oliguria, hematuria, skin rash, tingling, burning or weakness in extremities, headache, seizures or altered sensorium. Examination revealed bilateral S-shaped swelling diagnosed as lacrimal gland swelling [] by our ophthalmologist. There was bilateral ptosis but no ophthalmoplegia or Horner\u2019s syndrome. There was no uveitis or retinal involvement. The patient was normotensive and systemic examination was unremarkable. Investigations revealed polymorphonuclear leukocytosis and thrombocytosis. Complement proteins C3, C4 and renal functions were normal. Urine examination revealed active sediments [white blood cells (WBC) 20-25/high power field (HPF), red blood cells (RBC) 6-8/HPF], but no albuminuria. Chest radiography and computerized tomography (CT) scan showed nodular and cavitating lesions [Fig. , ]. CT orbit did not reveal any retro-orbital mass. Culture of pus from past incisions over lacrimal gland did not reveal any organism. Incisional biopsy done from lateral aspect of left lacrimal gland swelling showed fibro-areolar tissue with necrotizing granulomatous vasculitis[]. Positive cytoplasmic-antineutrophil cytoplasmic antibody (c-ANCA) and high serine proteinase-3 levels (366 U/ml; normal <16 U/ml) confirmed the diagnosis of WG. The patient was treated with initial regimen of daily oral cyclophosphamide (2 mg/kg) and oral prednisolone (1 mg/kg) which was gradually tapered after initial remission was obtained.\nA month later, there was complete regression of lacrimal gland swelling, but left-sided ptosis [] continued to persist. He also developed marked dryness of eyes and Schirmer\u2019s I test was positive (2 mm wetting in both the eyes after 5 minutes). There was no dry mouth, diplopia or ophthalmoplegia. Antinuclear, anti Ro and anti La antibodies were negative. There was complete regression of lung cavities with the above treatment after 3 months. After 1 year of follow-up, the patient was in complete remission with no recurrence of lacrimal gland swelling or lung lesions. However, ptosis of the left eye and ocular dryness continued to persist and the patient required frequent instillations of artificial tear drops.", "age": [ [ 27.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3116546.xml", "relevant_articles": { "21350287": "12", "18373097": "0", "32282640": "0", "28367391": "0", "1877413": "0" }, "similar_patients": { "4931652-1": "123", "5402594-1": "0", "4463792-2": "0", "7430656-1": "0", "8348864-1": "0" } }, { "human_patient_id": "8", "human_patient_uid": "4275757-1-M", "PMID": "25412755", "title": "Suppurative thyroiditis due to aspergillosis: a case report", "patient": "A 20-year-old Caucasian man was diagnosed with SLE due to polyarthritis, pleuritis, positive antinuclear antibodies (ANA on human epithelial type 2; HEp-2), positive anti-double-stranded DNA, and biopsy-proven class IV glomerulonephritis. Methylprednisolone 1g/day was started for 3 days followed by prednisone 1mg/kg/day. After 1 month, active renal disease persisted and methylprednisolone treatment was repeated. Thereafter, severe pancytopenia and cytomegalovirus infection were identified. Gancyclovir was administered for 21 days with good response. Cyclophosphamide was started (500mg) but after 1 month he presented daily fever and neck pain. At physical examination, an anterior painful cervical prominence was observed; heart rate 122 beats per minute, temperature 37.9\u00b0C and oxygen saturation 91%. Piperacillin/tazobactam was started as pulmonary infection was detected. After 2 days, he developed hypoxemia, vascular shock, severe anemia, lymphopenia (300/mm3), and high C-reactive protein (137.5mg/L; normal range, NR, <5). Thyroid ultrasound revealed well-defined hypoechogenic clusters in both lobes. Thyroid-stimulating hormone (TSH) was suppressed, free thyroxine (T4) >74.6pmol/L (NR 7.7 to 18), total T4 189pmol/dL (NR 90 to 154), total triiodothyronine (T3) 1.15nmol/L (NR 1.23 to 1.85), and high serum thyroglobulin (650.6\u03bcg/L). A purulent substance was obtained on fine needle aspiration (FNA) and drained. Cytological analysis showed only pus cells. Thyrotoxicosis due to infectious thyroiditis was established. Fungal culture of thyroid abscess was partial positive. Amphotericin B and fluconazole were introduced. Tracheal and blood cultures were negative. Another thyroid ultrasound revealed persistent small clusters. He underwent drainage again but no secretion was obtained. He died at day 6 of hospital admission with suppressed TSH, lower free T4 but still high (47.6pmol/L) and low total T3 (0.60nmol/L). A culture of thyroid secretion took 10 days to reveal Aspergillus fumigatus, identified by septate hyphae, <5\u03bcm in thickness, with branching at acute angles, 2 days after his death.", "age": [ [ 20.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4275757.xml", "relevant_articles": { "25412755": "123", "7416706": "0", "15587780": "0", "32524014": "0", "23107155": "0" }, "similar_patients": { "5813473-1": "0", "4888935-1": "0", "8253658-1": "1", "7575781-1": "0", "7784154-1": "0" } }, { "human_patient_id": "9", "human_patient_uid": "5107222-1-M", "PMID": "27872645", "title": "Traumatic Lung Herniation following Skateboard Fall", "patient": "A 20-year-old healthy male presented to the emergency department after falling from a skateboard. He sustained blunt trauma to his right chest wall, resulting in pleuritic pain and mild dyspnea. Diagnostic workup included chest radiography (CXR), which showed no acute findings (). Further evaluation with chest computed tomography (CT) scan demonstrated fractures of the right 4th through 6th ribs. Herniation of the middle lobe of the right lung was also identified on CT scan ().\nThe patient was admitted for observation and pain management. His pain and dyspnea improved and he was managed conservatively. A repeat CXR on hospital day two was stable, and the patient was discharged home. Ten days after discharge a follow-up chest CT scan was completed and demonstrated a decrease in herniated lung ().", "age": [ [ 20.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5107222.xml", "relevant_articles": { "34145210": "123", "24295582": "12", "33395725": "0", "20549460": "0", "33145569": "0" }, "similar_patients": { "6378019-1": "0", "6107042-1": "13", "7430075-1": "0", "8241540-1": "0", "4393641-1": "0" } }, { "human_patient_id": "10", "human_patient_uid": "7925943-1-M", "PMID": "33717487", "title": "Salvage therapy of bleeding esophageal tumor by fully covered self-expandable metallic stent: A case report", "patient": "A 58-year-old woman was newly diagnosed with advance (T3N1M0) moderately differentiated squamous cell carcinoma of distal esophagus involving gastroesophageal junction. She received her first cycle of neoadjuvant chemotherapy Carboplatin and Paclitaxel. The next day, she presented to the emergency room with two episodes of hematemesis containing fresh blood. In addition to that she had progressive dysphagia for solids. She remained hemodynamically stable. The Rockall et al. score was 2, owing to the disseminated esophageal malignancy. Her blood reports showed a hemoglobin drop of 2.6 g from 13.1 to 10.5 mg/dL. The platelet count and coagulation profile were within the normal range along with the liver and renal functions also being unremarkable. After initial resuscitation, patient was made nil by mouth and started on proton pump inhibitor (PPI) infusion. After taking informed written consent, an upper GI endoscopy was done. The findings revealed a stenosing non-traversable tumor, starting at 33 cm from the incisors, containing old clotted blood as well as mild oozing, as shown in . Initially, an attempt was made to maintain hemostasis using conventional methods including adrenaline injection and hemospray, but this was unsuccessful for this purpose. In view of the stenosing tumor and ongoing bleed despite using the aforementioned measures, it was decided there and then to place a temporary 20 mm \u00d7 130 mm FCSEMS (nitinol). This would not only help to achieve luminal patency but would also aid in bleeding control due to the tamponade effect. Using a catheter, a guidewire was passed through the stricture and its position confirmed fluoroscopically, as shown in . An FCSEMS was deployed over the guidewire under both direct vision and fluoroscopic guidance, which is shown in and , respectively. No further episodes of hematemesis or melena were observed along with no further hemoglobin drop. Patient stayed for 72 h in the hospital and was later discharged with a follow-up plan for stent removal at 2 weeks. Patient, however, was lost to follow-up with the GI team but continued to have chemotherapy and radiation therapy. She was sent back for esophageal stent removal after 5 months. Esophago-gastro-duodenoscopy (OGD) revealed no bleed from tumor, stent was removed, and scope was passed freely across the tumor, as shown in . Patient followed up notes of radiation oncology clinics confirmed no episodes of upper GI bleed between the time of stent insertion and removal. No stent-related early and late complications were seen.", "age": [ [ 58.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC007xxxxxx/PMC7925943.xml", "relevant_articles": { "33717487": "123", "27916770": "123", "28414670": "0", "29282382": "0", "34732601": "0" }, "similar_patients": { "8241460-1": "0", "2908804-1": "0", "5815701-1": "0", "7325347-1": "0", "8075767-1": "0" } }, { "human_patient_id": "11", "human_patient_uid": "7871254-1-M", "PMID": "33547119", "title": "A Graceful EXIT impeded by obstetrical complications", "patient": "A 36-year-old gravida 5 para 3013 was referred to our fetal treatment centre at 24 weeks of gestation with a fetal diagnosis of congenital high airway obstruction syndrome (CHAOS) without additional anomalies (). Fetal imaging revealed a gap in the trachea, but sufficient tracheal length was present to permit access for tracheostomy. Fetal cytogenetics from an amniotic fluid sample revealed a normal karyotype and microarray. In a multidisciplinary conference involving the family, options were discussed to include termination of pregnancy, delivery with neonatal comfort care and an EXIT-to-airway procedure. The family was well informed that without an established airway at the time of delivery, a neonatal demise would be imminent. Fetoscopic laser decompression of CHAOS, feasible in select cases, was not considered in this scenario secondary to the long gap defect noted on fetal imaging, which would result in a low likelihood of a successful procedure, as well as the associated risks of surrounding tissue injury. Prematurity is also higher following fetoscopic procedures, and an EXIT procedure remains necessary regardless of decompression to develop an adequate airway at delivery. The family elected for a re-evaluation in the third trimester and returned at 31 weeks of gestational age for a repeat ultrasound and fetal MRI. She received weekly ultrasounds at the referring centre to determine fetal viability, monitor amniotic fluid volume and assess for signs of premature labour until she relocated to our centre. Findings on follow-up remained stable when compared with her earlier evaluation, with the exception of asymptomatic polyhydramnios.\nAfter follow-up counselling, the family elected to undergo an EXIT-to-airway procedure scheduled for 37 weeks of gestation. At this point, a call tree was established placing all key specialties on 24-hour availability until the procedure was completed. The gestational age chosen for the procedure was established to allow for further fetal growth and to promote fetal lung maturity.\nAt 34 weeks 5 days of gestation, she presented to labour and delivery at 03:00 on a Sunday morning with the complaint of gross rupture of membranes. On examination, her cervix was noted to be 4 cm dilated; there was gross pooling of amniotic fluid; and the umbilical cord was prolapsed through the cervix up to the level of the introitus (). The fetus was in the breech presentation. Contractions were occurring regularly at 4 min intervals with persistent variable fetal heart rate decelerations down to 80 beats/min. The call tree was activated. The patient was taken to the operating room and underwent general anaesthesia with endotracheal intubation, while the multidisciplinary team congregated to discuss adjustments to the procedure. The time from patient presentation in labour and delivery triage to induction of general anaesthesia was 59 min, with all essential team members present.\nThe decision was made to make a maternal midline laparotomy to provide sufficient access to completely exteriorise the late-preterm gravid uterus and to make a fundal hysterotomy to deliver the fetal head and neck first. The placenta was anterior, and the fetus was in the breech presentation in the setting of anhydramnios secondary to rupture of membranes. An attempt at external cephalic version was not deemed safe in the setting of anhydramnios, active labour and existing cord prolapse. For these reasons, the original plan to perform a maternal abdominal transverse skin incision with a low transverse uterine hysterotomy was therefore abandoned. The midline skin incision was made to just below the umbilicus with placement of a large Olexis O retractor (Applied Medical, Rancho Santa Margarita, Californis, USA) allowing the uterus to be exteriorised. The anaesthesiologist provided maximal halogenated agents with a mean alveolar concentration of 3, along with both nitroglycerin and terbutaline. Unfortunately, uterine relaxation was not sufficient to maintain optimal placental perfusion to the fetus. In an effort to expedite the procedure, the surgical team proceeded by placing a haemostatic myometrial box stitch at the fundus placed well away from the placental edge. The uterus was incised within the box stitch with electrocautery, and the amniotic sac was entered. Bainbridge clamps were used to compress the myometrium prior to placing uterine haemostatic staplers. Due to inadequate uterine relaxation, the thickened myometrium prohibited sufficient compression of tissue to allow for stapling. At this point, the uterine entry point was extended with electrocautery, and Allis clamps were used along the length of the hysterotomy to provide haemostasis. The fetal head and neck were then delivered followed immediately by an intramuscular injection of a cocktail containing atropine, rocuronium and fentanyl. A rapid intravenous infusion device was used to infuse warm lactated Ringer\u2019s solution through the hysterotomy to assist in maintaining uterine volume. Fetal monitoring performed throughout the procedure by fetal cardiology demonstrated intermittent bradycardia with rate as low as 88 beats/min and as high as 129 beats/min with depressed biventricular function. At this time, the paediatric surgeon and paediatric otolaryngologist worked in concert and established an airway via an endotracheal tube through a tracheostomy incision. The time from delivery of the head and neck until airway establishment was 3 min. The remainder of the baby was delivered; the umbilical cord was clamped and cut; and the infant was passed off to the neonatology team.\nThe neonatal response to initial resuscitation was an immediate return to a heart rate in the 150\u2019s bpm with an oxygen saturation of 100%. After stabilisation, bronchoscopy revealed laryngeal atresia below the level of the vocal cords with an intact trachea ().\nThe parturient was extubated after the placement of bilateral transversus abdominus plane blocks for postoperative pain control. Unfortunately, during the first 24 hours postpartum, the mother developed uterine atony necessitating the use of uterotonics and uterine balloon tamponade. She received a transfusion of 2 units of packed red blood cells. Subsequently, the mother remained inpatient for three postoperative days and was discharged in good condition without further complications from the surgical procedure.\nThe infant is doing well and remains with a tracheostomy awaiting definitive repair of the laryngeal atresia.", "age": [ [ 36.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC007xxxxxx/PMC7871254.xml", "relevant_articles": { "15121627": "13", "15915754": "13", "19396506": "13", "16308883": "1", "27684833": "13" }, "similar_patients": { "2817394-1": "123", "8142784-1": "123", "6230665-1": "123", "5935985-1": "0", "5265926-1": "123" } }, { "human_patient_id": "12", "human_patient_uid": "5555024-1-M", "PMID": "28831315", "title": "An Unexpected Case of Black Mamba (Dendroaspis polylepis) Bite in Switzerland", "patient": "While feeding a 5-year-old male black mamba, a 34-year-old snake breeder suddenly noticed a tiny bloody mark on his forearm and, at the same time, a slight tingling of his lips. He immediately realized that he had been bitten and called a befriended snake expert to seek advice. The patient was thus able to provide the first responders with detailed information about the snake and on where to obtain the corresponding antivenin. He instructed his wife to apply a pressure bandage to the forearm. Within the next five minutes, chest tightness, generalized paresthesia, and fasciculation occurred. Upon arrival of the ambulance, the patient was unable to walk, was tachypneic, and had prominent dysarthria. Assuming a concomitant allergic reaction, the paramedics administered methylprednisolone, clemastine, and adrenaline before transferring the patient to the nearest hospital. In the meantime, the Swiss helicopter ambulance collected the antivenin from one of the 8 national antivenin depots.\nForty minutes after the bite, the patient arrived in the emergency department, complaining of worsening fasciculations and paresthesia affecting the extremities and the face. On physical examination, he was fully conscious with a heart rate of 105/min and a blood pressure of 165/80 mmHg. He was tachypneic at 30/min. Pulse oximetry revealed an oxygen saturation of 95% on room air. There were two tiny puncture wounds with local swelling and redness on the left forearm. Motor function was normal, except for mild ptosis. Seventy minutes after the bite, the patient was given 2 vials (20 ml) of \u201cSAMIR Polyvalent Snake Antivenin\u201d together with 2.5 mg of IV midazolam for ongoing hyperventilation. Thereafter, the patient was transferred to our tertiary intensive care unit for further treatment.\nUpon arrival in our ICU, the patient was hemodynamically stable but still tachycardic and tachypneic. Fasciculations, dysarthria, and ptosis had slightly improved. ECG showed a grade 1 atrioventricular block without any other abnormalities. Initial laboratory tests were unremarkable, apart from moderate respiratory alkalosis. Over the next few hours, sweating, chills, and difficulty with swallowing as well as nausea occurred. However, the airway was never compromised, coughing reflex was intact, and respiratory failure did not occur. Therefore, and because of initial concerns about a possible allergic reaction, we decided against further antivenin administration. On the next day, symptoms of envenomation had improved, but the patient developed cellulitis of the bitten forearm and rhabdomyolysis, with a peak serum creatine kinase level of 16,049 U/L. Upon treatment with intravenous fluids and amoxicillin/sulbactam, his condition gradually improved. After four days in the hospital, he was discharged home with muscular pain as the only residual symptom. A few weeks later, the patient had fully recovered.", "age": [ [ 34.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5555024.xml", "relevant_articles": { "19274505": "123", "2382320": "1", "10628285": "123", "23469644": "123", "33516621": "123" }, "similar_patients": { "6161185-1": "123", "5022210-1": "13", "4999860-1": "123", "4891907-1": "13", "8638048-1": "123" } }, { "human_patient_id": "13", "human_patient_uid": "4545277-1-M", "PMID": "26347135", "title": "From Eye Drops to ICU, a Case Report of Three Side Effects of Ophthalmic Timolol Maleate in the Same Patient", "patient": "An 84-year-old male patient with past medical history consisting of hypertension, hypercholesterolemia, type 2 diabetes mellitus, and open angle glaucoma was admitted to ICU via A & E with an unwitnessed collapse and decreased level of consciousness. In emergency department (ED) his GCS was recorded as 5/15, blood sugar was found to be only 34 mg/dL, his heart rate was 34 beats per minutes (bpm), and BP was 58/43 mm Hg. His ECG showed sinus bradycardia with variable blocks including sinus node dysfunction and type 1 Mobitz heart block pattern (Figures and ). He was intubated and ventilated in ED and given dextrose 50% 100 mL and 0.5 mg Atropine. His heart rate rose to 88 bpm and with improvement of heart rate and correction of blood sugar his BP became 135/88 and his GCS improved to 13/15. Unfortunately, heart rate started to drop again to 40 s and blood sugar showed a downward trend for which he was given 1 mg glucagon and was transferred to ICU. By the time he reached ICU his heart rate had improved to 90 bpm. In ICU after 30 minutes his heart rate dropped again so he was given another dose of Atropine and a temporary transvenous pace maker (TPM) was inserted. The patient's blood sugar also improved temporarily but eventually required intravenous infusion of 10% dextrose for the next 12 hours before it was stabilized. His GCS improved to 14/15 and he was extubated the next day 16 hours after admission but repeated attempts to switch off his pace maker revealed underlying brady-arrythmias with heart rate dropping to 34\u201340 bpm associated with presyncopal symptoms comprising of deterioration in attention and episodes of drowsiness. The pace maker was eventually switched off after 26 hours of observation when no more episodes of bradycardia were observed.\nA detailed neurological assessment was carried out after extubation which showed the patient to be confused with no motor deficit. His CT brain was done which showed no abnormality and a detailed history was sought from the patient's wife who pointed out that the patient has been behaving in a weird and confused way for the last 5 days but his wife attributed that to demise of one of his close relative who died a week ago. She further added that he stopped taking his oral medications 2 days before he was admitted but he was given his eye drops regularly by his daughter who feared blindness in case the medication was not given. His drug history consisted of Enalapril 10 mg OD, Atorvastatin 10 mg OD, Metformin 500 mg BID, and Timolol Maleate 0.5% one drop each eye twice a day which was started 35 days before admission to ICU when he was diagnosed as a case of glaucoma.\nTilt table test was not carried out and keeping in view his improvement in blood sugar and heart rate after administration of glucagon his clinical picture of hypoglycemia, confusion, and bradyarrhythmia was recognized to be because of ophthalmic Timolol Maleate which was changed to Travoprost (a prostaglandin F2 analogue) after consulting the ophthalmologist.\nThe patient was kept under observation in ICU for another 24 hours. His intrinsic heart rate improved to 82 bpm and his TPM wire was removed before transferring to ward. Patient's confusion also improved gradually over the next 3 days and he was discharged on Enalapril, Travoprost, and Metformin. His followup for the next two months was unremarkable.", "age": [ [ 84.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4545277.xml", "relevant_articles": { "33666194": "0", "27127437": "0", "11404164": "0", "29382690": "0", "16822446": "0" }, "similar_patients": { "3963202-1": "123", "7937400-1": "12", "6521824-1": "0", "6288932-1": "0", "7605055-1": "0" } }, { "human_patient_id": "14", "human_patient_uid": "6358359-1-M", "PMID": "30681607", "title": "Primary plasmablastic plasmacytoma in the stomach of an immunocompetent adult", "patient": "In June 2018, a 65-year-old man presented at an outside facility with an epigastric discomfort and mass for about 2 months. The movable mass started as a small lump and gradually increased in size. Laboratory values were unremarkable. Gastroscopy revealed a malignant tumor in the gastric body. Pathology showed small cell malignant tumors. Histomorphometry showed that the tumor originated in the lymphoid and hematological system. There was too little biopsy tissue to determine the differentiation. In July 2018, the patient presented to our hospital for further diagnosis and treatment. We performed upper gastrointestinal contrast to identify the tumor site. Barium x-ray revealed that the tumor was located in the gastric body and about 102 mm size (Fig. ). Abdomen computed tomography (CT) showed that the gastric cavity was full of chyme, and the irregular soft tissue shadow was seen in the greater curvature, and the enhancement was obvious (Fig. ). It was considered as a malignant tumor of gastric body. To get more tissue, we conducted stomach puncture biopsy. Pathology showed small-round cell malignant tumors. And immunohistochemical examinations revealed that the tumor tend to be a plasma cell tumor. To exclude associated multiple myeloma (MM), patient underwent bone marrow biopsy. His bone marrow morphology test, peripheral blood smear, and serum protein electrophoresis were found to be normal. In September 2018, the patient underwent distal gastrectomy. The tumor located in the anterior wall of the stomach body near the greater curvature (Fig. ). The tumor was a centrally ulcerated, relatively well-demarcated bulky mass, measuring 90 \u00d7 90 mm in diameter (Fig. ). Histopathologic examination of the specimen revealed plasmablastic plasmacytoma originating in the stomach with transmural extension (Fig. ), but without lymph node metastasis. These cells were positive for CD38, CD138, MUM-1, bcl-2, and CD23 and negative for CD3, CD20, CD79a, CyclinD1, CD10, bcl-6, CD5, CK, EMA, and CD30, with a Ki-67 proliferative index of about 70% (Fig. ). The patient had a good postoperative recovery and other than ascites caused by hypoproteinemia, there was no complications and the patient was successfully discharged. To October 1, he is regularly followed up at a postoperative clinic and is doing well, and there is no plan for adjuvant treatment.", "age": [ [ 65.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6358359.xml", "relevant_articles": { "30681607": "123", "22066092": "0", "33887847": "0", "23840979": "0", "18775061": "0" }, "similar_patients": { "7524924-1": "123", "5342989-1": "0", "4324849-1": "123", "7004669-1": "0", "5732123-1": "0" } }, { "human_patient_id": "15", "human_patient_uid": "6686402-1-M", "PMID": "31391097", "title": "A giant solitary fibrous tumor of the adrenal gland in a 13-year old: a case report and review of the literature", "patient": "A 13-year-old Oromo girl presented with a progressively increasing right-sided abdominal mass, low-grade intermittent fever, and a dull right upper abdominal pain of 3 years\u2019 duration with no other associated symptoms. There were no known past illnesses and there was no family history of similar illness. She was given pain medications and antibiotics on various occasions but there was no improvement.\nHer general appearance was not acutely sick looking. Her vital signs were within normal limits. The pertinent abnormal finding was right-sided abdominal mass with well-defined medial and inferior border extending to right subcostal region. Complete blood count (CBC), urine analysis, and organ function tests were all normal. Ultrasound and a computed tomography (CT) scan demonstrated a huge vascular suprarenal mass displacing her right kidney caudally; it measurements were 16 \u00d7 19 cm and it contained multiple internal calcifications. There were no enlarged regional nodes and no vascular invasion.\nLaboratory tests for functional adrenal tumors including serum and 24-hour urine metanephrines were all normal.\nA working diagnosis of huge nonfunctional adrenal tumor was made and our patient underwent exploratory surgery through a bilateral subcostal incision. The operative findings were a well-capsulated and highly vascularized mass arising from the superior aspect of her right kidney, which got a significant blood supply from the right lobe of the liver. The mass was successfully and completely resected and the specimen subjected to histopathology.\nThe histopathology report showed 18 \u00d7 15 \u00d7 12 cm white solid mass with necrotic center arising from right adrenal gland. There was a patternless proliferation of spindle cells and ovoid cells that had mild pleomorphic nuclei and focally hyalinized stroma containing blood vessels. Mitosis was seen infrequently. These findings were consistent with a SFT of the adrenal gland.\nOur patient was followed-up for 3 months and is doing remarkable well and members of her family were very grateful.", "age": [ [ 13.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6686402.xml", "relevant_articles": { "31391097": "123", "26600897": "123", "16388322": "123", "17581624": "123", "22234036": "0" }, "similar_patients": { "7341564-1": "123", "3913141-1": "13", "8214900-1": "123", "7263850-1": "123", "8714050-1": "123" } }, { "human_patient_id": "16", "human_patient_uid": "5482014-1-M", "PMID": "28680202", "title": "Osteoid Osteoma Mimicking Inflammatory Synovitis", "patient": "A 20-year old male presented with complaint of pain for 8 months in left hip with limited range of motion. Pain usually becomes worse at night and was only relieved on medication. He had no previous history of any trauma. His X-ray hip joint was normal []. The patient then underwent both magneto resonance imaging (MRI) and a 99mTechnetium methylene diphosphonate (99mTc-MDP) bone scan. A 99mTc-MDP bone scan showed increased tracer uptake in left hip joint with a tiny faint focus of increased activity on neck of femur []. MRI showed significant joint effusion with abnormal focal signal intensity involving neck of left femur []. At this point, no specific diagnosis could be established. Patient underwent exploratory surgery but it was of no help. Post-operation his symptoms worsened further. Six months post-operatively, he underwent F-18 Fluoride positron emission tomography-computed tomography (PET-CT) bone scan that showed focal increased tracer uptake corresponding to a tiny calcified nidus along the anterior cortex of neck of femur with mild uptake in left hip joint and joint effusion. A diagnosis of osteoid osteoma with reactive synovitis was made []. Then, patient was taken up for radiofrequency ablation for osteoid osteoma and became pain free from the 4th day [].", "age": [ [ 20.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5482014.xml", "relevant_articles": { "34557440": "123", "19078224": "12", "27780509": "12", "32908769": "123", "28315917": "0" }, "similar_patients": { "5482014-3": "123", "5482014-2": "12", "8673447-1": "123", "5114262-1": "123", "4531450-1": "123" } }, { "human_patient_id": "17", "human_patient_uid": "5482014-2-M", "PMID": "28680202", "title": "Osteoid Osteoma Mimicking Inflammatory Synovitis", "patient": "A 16-year old male presented with severe pain and swelling of right elbow joint with restricted motion for past 4 months. The pain was not controlled by medication and was worse at night. Patient underwent both MRI and 99mTc-MDP bone scans. A 99mTc-MDP bone scan showed increased flow, blood pool, and tracer uptake in the region of right elbow []. MRI showed significant joint effusion and focus of low-signal intensity on T1 [] in olecranon fossa of right humerus. A review of bone scan also revealed a tiny focal uptake in olecranon fossa [arrow, []. Thus, a diagnosis of osteoid osteoma was made. Patient then underwent surgical removal of osteoid osteoma and histopathology confirmed the diagnosis [].", "age": [ [ 16.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5482014.xml", "relevant_articles": { "17088744": "13", "32724690": "13", "26110185": "123", "9537182": "12", "19537020": "123" }, "similar_patients": { "5482014-1": "1", "5482014-3": "1", "7726390-1": "13", "8281800-1": "13", "3603655-1": "13" } }, { "human_patient_id": "18", "human_patient_uid": "5482014-3-M", "PMID": "28680202", "title": "Osteoid Osteoma Mimicking Inflammatory Synovitis", "patient": "A 23-year old female presented with pain for 1 year in right hip joint, her pain became worse at night and was relieved with medication. She underwent an MRI 6 month back, which showed joint effusion and marrow edema in neck and trochanteric region of right femur. Possibility of infective/inflammatory pathology was considered. She was treated conservatively but was not relieved of pain. She underwent a repeat MRI after 6 months, which showed no significant interval change between two scans. For further evaluation, a bone scan was done that showed increased blood pool and 99mTc-MDP increased tracer uptake in proximal right femur noted []. A careful review of previous MRI showed a tiny focal signal abnormality in medial cortex of neck of femur []. A diagnosis of osteoid osteoma was suspected. For further evaluation, computed tomography (CT) was performed that showed small cortical lytic lesion with calcified nidus involving medial cortex of right femur []. The patient then underwent radiofrequency ablation for osteoid osteoma and became pain free [] on 2nd day of procedure.", "age": [ [ 23.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5482014.xml", "relevant_articles": { "34557440": "123", "20694724": "123", "16422232": "123", "19078224": "12", "3584451": "12" }, "similar_patients": { "5482014-1": "123", "5482014-2": "1", "4531450-1": "123", "5114262-1": "12", "4531450-5": "123" } }, { "human_patient_id": "19", "human_patient_uid": "4715357-1-M", "PMID": "26772735", "title": "Back-table procedure and auto-lung transplantation for locally advanced lung cancer: a case report", "patient": "A 59-year-old woman was admitted to our hospital with locally advanced lung adenocarcinoma. Chest computed tomography (CT) showed a tumor in the right upper lobe that had invaded the middle lobe and S6 segment, as well as hilar lymphadenopathy (#12u and #11 s) without mediastinal lymph node swelling (cT2aN1M0). An ESL procedure (right upper, middle lobectomies and S6 segmentectomy) that preserves the basal segment with a double-sleeve technique was considered in order to avoid a right pneumonectomy in this patient. Since successful ex situ auto-transplantation after a pneumonectomy for locally advanced lung cancer has been reported [, ], the Dokkyo Medical University Hospital Ethics Committee approved our protocol (#26030) for an operation including a back-table procedure and auto-lung transplantation after a pneumonectomy for locally advanced lung cancer to examine its merits. Such an auto-lung-transplantation protocol was performed in the present case for curative resection and basal-segment preservation. Consent to participate and to publish this study was obtained from the patient before surgery.\nWe initially performed a 5th intercostal posterolateral thoracotomy. After administration of intravenous heparin and prostaglandin E1, the pulmonary artery and vein were clamped, and the right pneumonectomy was completed. For a venous anastomosis between the lower pulmonary vein of the graft and upper pulmonary vein of the body, the pulmonary veins were dissected as distal as possible for the upper pulmonary vein and proximal as possible as for the lower pulmonary vein (Fig. ). Following completion of the pneumonectomy, the excised lung was irrigated with a cold low-potassium phosphate-buffered dextran glucose solution (EP-TU solution; Cell Science & Technology Institute, Sendai, Japan) to protect the lung graft from ischemia-reperfusion injury during preparation of the graft of the basal segment as a back-table procedure. At the same time, another surgeon performed a mediastinal lymph node dissection to shorten the operation time. Thereafter, basal segment auto-transplantation was performed in the order of bronchus, pulmonary artery, and pulmonary vein anastomosis. Finally, the basal pulmonary vein of the graft was anastomosed to the upper pulmonary vein orifice. The operation time was 359 min and blood loss was 305 g.\nThe postoperative course was uneventful and no ischemia-reperfusion injury was observed, and the patient was discharged from the intensive care unit 1 day after the operation. The pathological diagnosis was pT2aN2M0 adenocarcinoma. Following surgery, the patient received adjuvant chemotherapy with carboplatin and nab-paclitaxel. At 9 months after the operation, she had returned to normal life without recurrence of the primary disease.", "age": [ [ 59.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4715357.xml", "relevant_articles": { "26772735": "13", "22544868": "13", "18520799": "13", "30160841": "0", "20646582": "13" }, "similar_patients": { "5910445-1": "12", "7677413-1": "1", "8011401-1": "12", "4365813-1": "1", "8279690-1": "12" } }, { "human_patient_id": "20", "human_patient_uid": "3401852-1-M", "PMID": "22837571", "title": "Not Just Skin Deep: A Case Report of Multiple Endocrine Neoplasia Type 1", "patient": "A 41-year-old man was referred to the outpatient clinic of Dermatology, Medical College, Thiruvananthapuram, by surgical gastroenterologist for evaluation. He presented with asymptomatic skin lesions over the abdomen and front of neck of 3-year duration. For the last one and a half year he is having early morning fatigue, tremor, sweating and difficulty in holding objects. He was earlier diagnosed by a neurologist to have absence seizures and was put on anticonvulsants but there was no relief. He also gave a past history of two episodes of ureteric colic 6 years back. General examination was normal except for an increased arm span (height -165 cm, arm span - 179 cm) and an elevated blood pressure of 160/100 mm of Hg.\nDermatological examination revealed multiple discrete skin-colored soft as well as firm dome-shaped smooth papules of 0.5 cm diameter over the abdomen and lateral aspect of trunk []. A single 2 \u00d7 1 cm hyperpigmented macule with serrated margins was seen over the right side of chest []. Multiple discrete brownish macules as well as hyperpigmented and erythematous papules were seen over the anterior and lateral aspect of neck and pre-sternal area []. A single whitish papule of 0.5 cm was seen over the right lower gingival mucosa []. Examination of other systems was normal.\nWith these findings, the possibility of steatocystoma multiplex or neurofibroma or collagenoma with angiofibroma and caf\u00e9-au-lait macules was considered. In view of the late-onset cutaneous tumors and associated systemic symptoms, the patient was subjected to detailed investigations. The routine blood and urine examinations as well as liver and renal function tests were normal. Serum calcium level was 11mg% and serum phosphorus was decreased (1.9 mg%; normal value: 2.5 - 4.5 mg %). Random blood sugar was 51mg%. In view of the repeatedly low blood sugar values, serum insulin was measured. It was found that serum insulin was elevated (112.47 \u03bcIu/ ml; normal value: 2-25 \u03bcIu/ml) with an increased insulin/glucose ratio (2.205) and a slightly raised C-peptide level (4.16 mg/ml; normal value 1-3 mg/ml). The detection of hyper insulinemia prompted us to do a detailed endocrinological evaluation. Serum parathormone was elevated (151.4 pg/ml; normal value: 15-75 pg/ml) whereas the other hormones like thyroid hormones, cortisol, gastrin and prolactin were normal. Ultrasonographical examination of neck revealed a hypoechoic lesion of 5.3\u00d711 mm seen posterior to the right lobe of thyroid suggestive of parathyroid adenoma. Visual field examination, OGD scopy and X-ray skull were normal. Plain CAT scan of the abdomen showed a tumor involving the body and tail of pancreas and multiple calculi were noted in the left kidney. CAT scan of head was normal but MRI brain showed a space-occupying lesion in the pituitary suggestive of pituitary adenoma [].\nSkin biopsy of the papules over the abdomen showed normal epidermis with increased dense connective tissue in the dermis which on subjecting to Van Gieson's stain- a mixture of Picric acid and Acid Fuchsin- took up red color confirming the diagnosis of collagenoma []. Erythematous papule on the pre-sternal area for which a provisional diagnosis of angiofibroma was made, showed hyperkeratosis, acanthosis and dilated blood vessels in the upper dermis with perivascular infiltrate which was more in favor of seborrhoeic keratosis rather than angiofibroma. Thus a final diagnosis of MEN type 1 was arrived at. The patient underwent parathyroidectomy and enucleation of the pancreatic tumor. The serum insulin level was normalized and his hypoglycemic symptoms disappeared after the surgical treatment.", "age": [ [ 41.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3401852.xml", "relevant_articles": { "11454088": "0", "23346671": "0", "16901798": "0", "11081212": "0", "31851316": "0" }, "similar_patients": { "3712387-1": "123", "7905909-1": "123", "5654079-1": "1", "3354862-1": "0", "2877224-1": "123" } }, { "human_patient_id": "21", "human_patient_uid": "6182476-1-M", "PMID": "30345251", "title": "Endoscopic Balloon Dilation for Treatment of Congenital Antral Web", "patient": "We present the case of an eight-month-old Hispanic female with feeding refusal, vomiting, and poor growth. Upon presentation, her weight was at the 12th percentile and length was at the 11th percentile for age. Upper gastrointestinal contrast series revealed a congenital antral web. She was evaluated by the pediatric surgeon in Guatemala; however, the family preferred a less invasive approach. Therefore, she was referred to our institution for therapeutic endoscopy.\nUpper gastrointestinal endoscopy at our institution revealed a small membranous web in the antrum of the stomach, extending inward from the pylorus. Upon initial endoscopy, an Olympus GIF 160 (Olympus Co., Tokyo, Japan) endoscope with an external diameter of 8.6 mm was inserted atraumatically through a bite block and advanced through the esophagus and into the gastric antrum. Here, a congenital antral web measuring approximately 5 to 6 mm in diameter was identified (). Using a gentle torqueing maneuver, the scope was advanced beyond the web to reveal normal mucosa distally. Withdrawing the scope revealed a significant degree of antral web ablation secondary to the initial scope advancement. Controlled radial expansion balloons (CRE; Boston Scientific, Marlborough, MA, USA) were then used to sequentially dilate the antral web. The balloons were advanced in to the pylorus and gradually expanded first to 9 and 10 mm, then to 11 and 12 mm, then finally to 13.5 and 15 mm for 1 to 2 minutes per session. Upon reaching a diameter of 12 mm, the balloon met resistance and endoscopic visualization through the balloon showed disruption of the mucosa to reveal muscular fibers of the normal pylorus below (). The endoscope was then slowly withdrawn, revealing ablation of the web with no unintended injury (). The patient tolerated the procedure well, and after a period of observation, she was discharged with no significant complications. Upon returning to Guatemala, she underwent a second upper endoscopy with balloon dilation of the pylorus at 13 months of age, from 12 mm up to 15 mm in diameter, without any known complications.\nTwo years post operatively, follow up revealed continued improved feeding tolerance without recurrence of her symptoms. The patient's weight and height plots also improved from the 11th and 12th percentile respectively at the time of presentation to above the 75th percentile.", "age": [ [ 8.0, "month" ] ], "geneder": "F", "file_path": "noncomm/PMC006xxxxxx/PMC6182476.xml", "relevant_articles": { "30345251": "13", "24010106": "1", "21524632": "0", "11856138": "0", "3410245": "0" }, "similar_patients": { "8270046-1": "123", "6592458-1": "0", "3965945-1": "0", "3857875-1": "0", "3915862-1": "0" } }, { "human_patient_id": "22", "human_patient_uid": "8265084-1-M", "PMID": "34233728", "title": "Diagnostic workup for endometrioid borderline ovarian tumors (eBOT) requires histopathological evaluation of the uterus", "patient": "A 36-year old nulliparous female patient presented to our emergency department with acute lower abdominal pain, general discomfort, and elevated inflammatory markers. Her past medical history included obesity with a body-mass-index of 40, superficial vein thrombosis of the upper extremity and achilles tendon rupture. No bleeding abnormalities were reported. Cervical cancer screening including PAP smear was regularly performed and inconspicuous, most recently less than one year ago. On physical examination the patient presented significant rebound tenderness and involuntary guarding of the lower abdomen with a positive Blumberg sign. Speculum examination showed normal external female genitalia, normal vaginal epithelium, no abnormal discharge and a non-suspicious cervix. Significant cervical motion tenderness was observed during vaginal palpation. On vaginal ultrasound, the anteverted and anteflexed uterus showed no suspicious lesions. Bilateral adnexal masses with both cystic and solid aspects, remarkable hyperperfusion as well as free intraabdominal fluid were noted (Fig. a, b), suspicious for tubo-ovarian abscesses. During emergency laparoscopy, ruptured ovarian tumors with up to 8 cm sized cauliflower-like masses comprised of small cysts foremost of the right, but also of the left ovary were detected (Fig. a, b) and an enucleation of the cystic structures was performed.\nOn histopathological examination, a neoplasm with adeno-papillary growth of the inner female genital tract was described and the diagnosis of an eBOT with microinvasion of up to 1 mm was established. Following thorough postoperative discussion of the treatment options and their clinical impact, the patient decided against a fertility preserving approach favoring radical surgery including hysterectomy. Subsequently, laparoscopic staging was performed with hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy and extensive peritoneal staging. In final histopathological results, an unexpected, HPV-high risk associated, intracervical endometrioid adenocarcinoma of the cervix uteri with a transversal diameter of 12 mm was diagnosed so that this was attributed as the primary tumor with ovarian metastases (Fig. a-f). Consistent with HPV high-risk association, the tumor showed strong immunohistochemical expression of p16 in the ovary and in the endocervix. CT scan of the thorax and abdomen showed no other distant metastases so that a subsequent laparoscopic lymph node staging was carried out to excluded tumor-infiltrated pelvic or para-aortic lymph nodes. Accordingly, final histopathological assessment led to a tumor stage of pT1b1 with ovarian metastases, pN0, L0, V0, Pn0, G2, R0, FIGO IB1. As individual decision making, an extended adjuvant treatment was applied consisting of chemoradiation followed by chemotherapy with four cycles paclitaxel and carboplatin according to the protocol of the currently recruiting OUTBACK trial (NCT01414608).", "age": [ [ 36.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC008xxxxxx/PMC8265084.xml", "relevant_articles": { "27287505": "0", "32161199": "0", "17175478": "123", "33235131": "0", "31529365": "0" }, "similar_patients": { "8265084-2": "13", "5587927-1": "0", "8221843-1": "0", "7710170-1": "0", "8229055-1": "0" } }, { "human_patient_id": "23", "human_patient_uid": "8265084-2-M", "PMID": "34233728", "title": "Diagnostic workup for endometrioid borderline ovarian tumors (eBOT) requires histopathological evaluation of the uterus", "patient": "Before presentation to our hospital, the 27-year old nulliparous female, was diagnosed with a left-sided endometrioid BOT at an external institution. She had already undergone fertility-sparing surgery with adequate staging procedures including left-sided salpingo-oophorectomy and omentectomy by open surgery. External histopathological findings revealed a single peritoneal implant in the left paracolic gutter. Three months later she presented for first consultation to our department with a highly suspicious contralateral ovary in vaginal ultrasound (Fig. a, b). On physical examination, the patient presented with no acute distress and a soft, nontender, nondistended abdomen. She denied any abnormal vaginal bleeding. Pelvic examination was unremarkable as well as cervical cytology. Vaginal ultrasound revealed a 7 mm thickness endometrium of with slightly inhomogeneity but without any suspicious lesions. The right ovary presented highly suspicious for malignancy consisting of cystic and solid aspects with abnormal perfusion.\nAccording to her explicit request for fertility preservation, we performed a re-laparotomy with salpingo-oophorectomy of the right side and cryoconservation of healthy appearing ovarian tissue. To increase oncological safety in this constellation, hysteroscopy and curettage was additionally performed. Pathological evaluation revealed a progression of the previously diagnosed eBOT to a well-differentiated endometrioid ovarian carcinoma limited to the ovary and sized 25 mm, positive peritoneal washings and a corresponding FIGO stage IC3 with accompanying superficial endometriosis in peritoneal biopsies. Unexpectedly, uterine curettage revealed an endometrioid endometrial cancer (Fig. a-d). As a consequence, completion surgery consisting of a total abdominal hysterectomy, pelvic and para-aortic lymphadenectomy was performed. No further peritoneal lesions were noted. Histopathological examination diagnosed a moderately differentiated endometrioid endometrial cancer without extrauterine tumor growth with a corresponding FIGO stage IA (pT1a pN0 (0/65) L0 V0 Pn0 G2 R0). While both carcinomas of the ovary and of the endometrium displayed similar histomorphological and immunohistochemical characteristics, the possibility of an ovarian dissemination of the endometrial carcinoma could not be ruled out at this point. However, due to the limited extent of the endometrial cancer and the patient\u00b4s history of eBOT, it appeared more likely that two independent carcinomas developed synchronously. No mismatch repair deficiency was detected. Finally, an adjuvant mono chemotherapy consisting of six cycles carboplatin was recommended.", "age": [ [ 27.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC008xxxxxx/PMC8265084.xml", "relevant_articles": { "23327069": "123", "34926754": "0", "34187525": "123", "11744954": "123", "21941970": "0" }, "similar_patients": { "8265084-1": "123", "7733300-1": "123", "3934313-1": "0", "5587927-1": "1", "6006659-1": "0" } }, { "human_patient_id": "24", "human_patient_uid": "5109393-1-M", "PMID": "27853695", "title": "Aplasia Cutis Congenita of the Scalp with a Familial Pattern: A Case Report", "patient": "A 16 days old newborn female from Saudi Arabia was presented to the clinic with a skin defect localized on the scalp since birth. The baby did not suffer from any ailments, and her medical history was unremarkable. Her mother, 32 years old, denied any history of illnesses during her pregnancy, infection or drug intake taking including Non-Steroidal Anti-Inflammatory Drugs (NSAID) or methimazole. She completed 38 weeks of gestation, and delivered her baby via a normal vaginal delivery.\nThe newborn did not sustain any birth injury and did not suffer from any other abnormalities or feeding difficulties. She did not require any intensive care, and went home from hospital with her mother. Upon local examination, the defect was solitary, localized with an irregular shape and approximately 6\u00d76 cm in size (). The lesion involved the epidermis and the upper dermis only. Neurosurgical team was involved in the care of this patient. A CT Scan of the head was performed, and no deep tissue involvement was noted.\nReconstruction solutions were offered to the parents but they insisted on non-surgical intervention. Therefore, the patient was treated with non-invasive debridement of the lesion and local therapy, including gentle water cleansing and the application of topical antibiotic ointment. 6 months later, the patient has returned for a follow up. Scar tissue has formed over the defect (). Family history revealed that none of her parents had the same condition; however, two of her sisters did, and were diagnosed with cutis aplasia. The elder one is currently 4 years of age, with right unilateral terminal reduction of the first and second toes (). The other sister was born prematurely and died shortly after birth due to cardiac anomalies.", "age": [ [ 16.0, "day" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5109393.xml", "relevant_articles": { "27429826": "1", "2081667": "0", "29416223": "0", "15532231": "0", "26553203": "0" }, "similar_patients": { "4939192-1": "123", "6040269-1": "0", "5624250-1": "123", "7572678-1": "13", "3945765-1": "0" } }, { "human_patient_id": "25", "human_patient_uid": "4563188-1-M", "PMID": "26316439", "title": "A Case of Subclinical Hypothyroidism with Lingual and Right Pretracheal Ectopic Thyroid", "patient": "A 7-year-old girl presented with a 1-week history of swelling in the right anterior neck and submandibular area. Her past history and family history were noncontributary. Her growth pattern and development were also normal. Inspection of the neck revealed swellings in the right upper and left submandibular areas with no distortion of the overlying skin (). Physical examination revealed a fixed, hard, mildly tender pretracheal mass, 1.5x2.0 cm in size and another fixed, hard submandibular mass, 0.5x0.5 cm in size. There was no enlargement of the cervical lymph nodes. The remaining findings of the physical examination were unremarkable.\nThe masses were evaluated using ultrasonography (USG) and computed tomography (CT). USG examination revealed well-defined masses with heterogeneous echogenicity and the thyroid gland was not in the expected cervical location. Neck CT revealed aberrant thyroid tissue as a 1.3x2.3 cm, round-shaped, high-density mass in the right pretracheal area and another 1.4x1.6 cm mass with the same characteristics in the region of the tongue base (). A 99m-technetium pertechnetate thyroid scintigraphy was performed, which demonstrated two ectopic areas of uptake (upper anterior neck and lingual areas), confirming dual thyroid ectopia (). There was no uptake in the normal anatomical location of the thyroid gland. Based on these findings, a diagnosis of dual ectopic thyroid was made. Biochemical determinations were consistent with a state of subclinical hypothyroidism. Serum triiodothyronine level was 1.7 ng/mL (normal, 0.9-2.4 ng/mL); free thyroxine (fT4), 17.2 pmol/L (normal, 10-28 pmol/L) and thyroid-stimulating hormone (TSH) level was 9.49 mIU/L (normal, 0.7-6.4 mIU/L).\nFollowing the diagnosis, the patient was treated conservatively with oral levothyroxine, 0.05 mg per day. After treatment, she remained asymptomatic, the masses slightly decreased in size and repeated thyroid function tests were found to be within the normal limits.", "age": [ [ 7.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4563188.xml", "relevant_articles": { "26316439": "123", "23157170": "12", "17358039": "12", "12901819": "12", "26634164": "12" }, "similar_patients": { "4288225-1": "123", "3522407-1": "123", "4579621-1": "1", "5894311-1": "123", "8520570-1": "123" } }, { "human_patient_id": "26", "human_patient_uid": "4271715-1-M", "PMID": "25535572", "title": "Whole-body MRI as an unconventional diagnostic tool in a pediatric patient with systemic infection", "patient": "A 14-year-old girl with an uneventful clinical history suddenly developed a severe syndrome characterized by intermittent-remittent fever with spikes up to 41\u2103, headache, meningismus, drowsiness, myalgia, and arthralgia without arthritis. A mild liver and spleen enlargement was present.\nRoutine investigations showed increased acute phase reactants (erythrocyte sedimentation rate [ESR], levels of 90 mm/h; C-reactive protein [CRP], 14.7 mg/dl), anemia [hemoglobin 9.6 g/dl], total white cell count 6.4 \u00d7 103/\u00b5L, thrombocytopenia [128 \u00d7 103/\u00b5L], and liver involvement [aspartate transaminase 322 UI/L, alanine transaminase 485 UI/L, and \u03b3-GT 295 UI/L]). Serology for some hepatotropic viruses (i.e. hepatitis viruses A-B-C, Epstein-Barr virus, cytomegalovirus) was negative. The autoantibody panel showed a slight autoantibody positivity of anti-smooth muscle antibody (ASMA) (1:40) and perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) with an atypical pattern.\nDue to the increased transaminase and \u03b3-GT plasma levels a liver biopsy was performed with the results being consistent with a non-specific hepatitis pattern. Moreover, brain MRI, cerebrospinal fluid analysis and bacterial culture ruled out encephalo-meningitis; bone marrow biopsy and bone scintigraphy were also negative. Antibiotics treatment (amoxicillin-clavulanate 90 mg/kg/day three times a day) was started without significant clinical response. Since fever spikes and myalgia/arthralgia persisted, the girl was admitted to our department 30 days after disease onset.\nAt admission, the patient complained of recurrent fever spikes and severe malaise, although according to the parents\u2019 opinion the general conditions of the girl had been ameliorated. Laboratory investigations showed positive acute phase reactants (ESR 75 mm/h and CRP 3.9 mg/dl), hypergammaglobulinemia (1.73 g/dl) with increased IgM (241 mg/dl) and IgA (490 mg/dl) plasma concentrations: notably, transaminase activities were normal with persistently increased \u03b3-GT 114 UI/L. As a diagnosis had not yet been reached, we performed a WB-MRI on a 1.5 T MRI scanner (Achieva Intera; Philips Medical Systems, Best, The Netherlands) using body coil with a field of view covering from head to toes. WB-MRI images were acquired (and displayed) in coronal plane using a turbo spin echo T1-weighted (T1W) sequence (TR, 630 ms; TE, 17 ms; slice thickness, 5 mm; gap, 0.5 mm; NSA, 1) and a turbo spin echo STIR sequence (TR, 2800 ms; TE, 165 ms; TI, 64 ms; slice thickness, 5 mm; gap, 0.5 mm; NSA, 3). Total scan time was about 30 min. No contrast medium was administered during the examination.\nThe MR investigation was carried out with the aim to rule out hemato-oncologic diseases and occult abscess. Surprisingly the WB-MRI showed an unusual pattern characterized by millimetric, widespread punctate nodules, respectively hypo-hyperintense in T1W and STIR sequences. These nodules were mainly localized in the meta-epiphyseal regions of the long bones of both legs (mostly at the level of the distal femur and proximal tibia) as further documented by an additional dedicated MRI of both knees (, , , and ). According to the radiologist\u2019s opinion, these images were possibly related to a hematologic intramedullary spread of an infectious process or to a post-infectious thrombotic microangiopathy.\nUpon this finding, and taking into account the apparent self-limiting disease course and the rural area where the patient lived, further investigations were conducted to rule out zoonosis. Serologic assay of anti-Anaplasma phagocytophilum showed an IgM titer of 1:40 (positive, >1:64) and an IgG titer of 1:160 (positive, >1:64). Hence intravenous ceftriaxone treatment (80 mg/kg daily) was started with a prompt clinical improvement (i.e. disappearance of fever, myalgia, malaise, and headache). The patient has not had a relapse after about 1 year of treatment.", "age": [ [ 14.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC004xxxxxx/PMC4271715.xml", "relevant_articles": { "28991941": "0", "18408398": "0", "26110300": "13", "8008895": "0", "18037795": "0" }, "similar_patients": { "7609909-1": "123", "4581074-1": "0", "5619424-1": "0", "6881760-1": "0", "7456943-1": "0" } }, { "human_patient_id": "27", "human_patient_uid": "7513320-1-M", "PMID": "32967628", "title": "Neuronal intranuclear inclusion disease with mental abnormality: a case report", "patient": "A 62-year-old woman was admitted to our hospital because of mental abnormality and hypomnesia for 3 months. The main mental symptoms were gibberish, irrational talk, impaired mental attention, without apparent hallucinations and delusions. The patient did not present with fluctuating consciousness, lack of consciousness, or loss of consciousness. The family of the patient reported that she had a history of fever before she experienced the mental symptoms. Her highest body temperature was 38.6 \u00b0C. Her axillary temperature became normal after she received antibiotic therapy for 4 days. However, she gradually developed symptoms of mental abnormality. She also intermittently complained of abdominal pain, vomiting, constipation, and urinary incontinence for 1 month. She did not experience other discomforts, such as headaches, dizziness, and convulsion. She visited a local hospital in October 2018, and the routine blood test showed that the white blood cell counts were normal, and the percentage of lymphocytes was high. The blood potassium was 1.91 mmol/l (normal 3.5-5.3 mmol/l), and the prolactin level was 90.55 \u03bcg/l (normal 2.74\u201326.72 \u03bcg/l). The free thyroxine was slightly high, the thyroglobulin antibody was 12.32 IU/ml (normal 0\u2013115 IU/ml), and the thyroid peroxidase antibody was 10.42 IU/ml (normal 0\u201334 IU/ml). The testing results of antinuclear antibody, anti-neutrophil cytoplasmic antibody, anti-Jo-1 antibody, anti-dsDNA antibody, anti-Scl-70 antibody, anti-SSA antibody, and anti-SSB antibody were yielded negative, and the tests for hepatitis, HIV, and syphilis virus were also negative. The local hospital suspected intracranial infection, endocrine disease, and electrolyte disorders and gave her symptomatic treatment. Nevertheless, her symptoms showed no noticeable improvement. It was difficult to diagnose the disease, so the patient was admitted to our hospital. The patient had a history of diabetes, hypertension, erosive gastritis, and cataract surgery, but she had no family history of neurological diseases.\nThe physical examination revealed that her body temperature was 36.8 \u00b0C, and there was tenderness below the xiphoid. The neurological examination showed impaired mental attention and reaction capacity, slow speech, normal manifestations of the brain nerve, normal muscle strength, and muscle tone, negative meningeal irritation sign and pathological reflex, normal tendon reflex. The patient could not cooperate with the sensory system examination. The mini-mental state examination (MMSE) score was only 6/30.\nEncephalitis was initially suspected, and lumbar puncture was performed. The CSF examination showed that the CSF pressure was 110 mmH2O, and the white blood cell count was normal, but she had an increased total protein level of 0.57 g/l (normal 0.15\u20130.45 g/l) and a glucose level of 5.10 mmol/l (normal 2.2\u20133.9 mmol/l). The coxsackie B virus, enterovirus, and cytomegalovirus test levels were normal. Bacterial culture and Cryptococcus neoformans tests were negative. A contrast-enhanced MRI of the brain was normal. The diagnosis of encephalitis was excluded in general. However, leukoencephalopathy was evident on the T2 fluid-attenuated inversion recovery (FLAIR) images. A high-signal intensity in the white matter of the cerebral hemisphere, especially at the subcortex of the frontotemporal and corona radiata, was found on the T2 FLAIR images (Fig. a-c). The MRI imaging of the left basal ganglia and bilateral corona radiata showed lacunar infarction. Magnetic resonance angiography indicated that the blood vessels were normal. The DWI results revealed a symmetrically distributed strip-shaped high-intensity signal of the corticomedullary junction in the bilateral frontal, parietal, and temporal lobes (Fig. d-f).\nSkin biopsy samples were obtained at 10 cm above the patient\u2019s ankle. A light microscope was used to examine the samples, which showed hyperkeratosis of the epidermis. A few lymphocytes and tissue cells infiltrated through the superficial vessels of the dermis (Fig. a). Electron microscopy showed round-shaped intranuclear inclusions in the nucleus of the fibrocytes. The intranuclear inclusions had clear borders and were composed of fibrous substances without a membrane structure (Fig. b and c).\nThe fasting blood glucose was 9.48 mmol/l, and glycosylated hemoglobin was 6.6%. The routine urine test showed normal results. The patient presented with mental abnormality for 3 months. We did not consider the diagnoses of hypoglycemia, diabetic ketoacidosis, or hyperosmolar hyperglycemic syndrome. Furthermore, the patient did not present with depression, anxiety, consciousness disorders, hallucinations, and neurasthenia, which were common mental symptoms in patients with diabetes. The results of the electrolyte showed hypokalemia (2.6 mmol/L), hyponatremia (127.3 mmol/L), and hypochloremia (86.5 mmol/L). The renin-angiotensin-aldosterone system and cortisol hormone tests showed normal results. The MRI of the hypophysis showed no abnormal areas. The electroencephalography showed low-and moderate-amplitude desynchronized-mixed waves when she fell asleep.\nBrain protection and symptomatic therapy were given when the patient was hospitalized, and the symptoms were relieved. However, she still complained of recurrent vomiting and urinary incontinence. The patient was alive, and the condition of the patient did not worsen or improve for 6 months after she was discharged.", "age": [ [ 62.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7513320.xml", "relevant_articles": { "32967628": "12", "9597914": "0", "16022467": "0", "26175917": "0", "18753720": "0" }, "similar_patients": { "6908888-1": "123", "7298109-1": "12", "7140360-1": "123", "8011180-1": "123", "7928273-1": "1" } }, { "human_patient_id": "28", "human_patient_uid": "6813065-1-M", "PMID": "31647026", "title": "Tumor immune microenvironment and genomic evolution in a patient with metastatic triple negative breast cancer and a complete response to atezolizumab", "patient": "A 48-year-old woman with a long history of TNBC (Fig. ) was enrolled in the Phase 1a study of single agent atezolizumab (PCD4989g; NCT01375842) on March 5, 2013. In 1986, she presented with an early right breast cancer negative for the estrogen and progesterone receptors. Initial management included lumpectomy and radiotherapy, and then two chest wall recurrences were treated with surgery and adjuvant chemotherapy (1993). In 2009, the patient presented with another early right TNBC treated with surgery followed by chemotherapy with docetaxel + cyclophosphamide (T + C). She then developed skin nodules and left axillary lymphadenopathy and received palliative capecitabine. In 2010, she developed progressive mTNBC involving the sternum and mediastinal lymph nodes and received 9 cycles of gemcitabine, carboplatin, and iniparib (GCI) until summer 2011. In late 2011, lymph node recurrence was treated with axillary lymph node dissection (2/5 lymph nodes involved with tumor) and radiotherapy. In 2012, she developed progressive disease (PD) and received 3 cycles of a whole cell breast tumor vaccine, trastuzumab, and low dose cyclophosphamide (NCT00971737). Upon progression, she was enrolled in the Phase 1a PCD4989g atezolizumab monotherapy trial, first dosed on March 11, 2013. She had a partial response (PR) by Response evaluation criteria in solid tumors (RECIST) and Immune-related Response Criteria (irRC) after 4 cycles. On May 31, 2013, the patient had an irPR per irRC and unconfirmed PR per RECISTv1.1. In July 2013 she experienced a pseudoprogression: appearance of a new nodal lesion (PD by RECISTv1.1) while still responding according to irRC. She was clinically well and continued treatment. On November 2013, the patient progressed by both RECISTv1.1 and irRC with the appearance of two new nodal lesions. On January, 2014, her target lesions were still in response (Fig. a), while the new nodal lesions were enlarged but stable. On February 2014, after 16 cycles, she discontinued atezolizumab exposure per protocol, with close surveillance.\nOn March 26, 2014, she was diagnosed with a catheter-related deep vein thrombosis, with left arm edema and enlarged lymph nodes; lymph node biopsy showed scattered tumor cells, while she had an ongoing PR in the target lesions. On July 2014, she developed palpable left axillary lymph nodes with poorly differentiated carcinoma with extensive necrosis (Fig. b). On January 2015 a CT scan showed nodal PD and she re-initiated single agent atezolizumab on February 2015. While on re-treatment with atezolizumab she first had a PR in April 2015, and then a complete response (CR) in June 2016. As of the clinical data cutoff (December 31, 2016), she remained on treatment and in CR (Fig. ). This patient provides a unique opportunity to profile the immunogenomic evolution of the TiME before and during atezolizumab therapy.", "age": [ [ 48.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6813065.xml", "relevant_articles": { "31647026": "123", "16969029": "0", "32157060": "0", "32668858": "1", "26805079": "0" }, "similar_patients": { "7830150-1": "123", "8161821-1": "0", "8107674-3": "0", "8201609-1": "123", "8024449-1": "0" } }, { "human_patient_id": "29", "human_patient_uid": "6854275-1-M", "PMID": "31726255", "title": "Large paraesophageal hernia in elderly patients: Two case reports of laparoscopic posterior cruroplasty and anterior gastropexy", "patient": "An 88-year old woman presented with epigastric pain, nausea and hematemesis for the last 2 days, with a recurrent history of gastro-oesophageal reflux disease (GERD), and progressive food intolerance. She had a history of well-controlled hypertension, diabetes, and chronic obstructive pulmonary disease. Physical exam upon arriving to the emergency department revealed mild abdominal distention, with non-radiating epigastric pain, without rebound tenderness or guarding, while the rest of the physical exam was normal. EKG did not reveal any abnormalities. A chest X-ray showed clear lungs with a left thoracic opacity suggestive of a large hiatal hernia. The patient was admitted and an emergency upper gastrointestinal endoscopy was performed due to persisting hematemesis, showing a mild gastritis with a bleeding mucosal lesion in the migrated stomach body that was treated with hemoclips. Barium upper gastrointestinal series showed half the gastric body above the diaphragm in the right thorax, while the Gastro-oesophageal junction was also herniating into the chest, suggesting a type III mixed PEH. The distal oesophagus had a tortuous appearance, suggestive of a probable motor dysfunction. An abdominal CT-scan with IV injection confirmed the diagnosis of incomplete gastric volvulus associated with the PEH (). Due to persistent epigastric pain and food intolerance, the patient underwent a laparoscopic trans-hiatal hernia and volvulus reduction, with total excision of the hernia sac. Due to the patient\u2019s advanced age and comorbidities, we performed a posterior cruroplasty without mesh reinforcement, associated to an anterior gastropexy with continuous running suture with barbed non-resorbable 2/0, anchoring 3/4th of the stomach to the anterolateral abdominal muscles (). The patient tolerated the procedure very well, and had an uneventful 5 days hospital stay with progressive mixed diet. She was seen at 1 and 6 months of follow-up, confirming the complete resolution of her abdominal symptoms, without GERD and a much better food tolerance.", "age": [ [ 88.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6854275.xml", "relevant_articles": { "31726255": "123", "7648901": "13", "19693469": "0", "28372456": "123", "31338969": "123" }, "similar_patients": { "6854275-2": "13", "5676972-1": "13", "7505670-1": "123", "7955781-1": "12", "7524025-1": "123" } }, { "human_patient_id": "30", "human_patient_uid": "6854275-2-M", "PMID": "31726255", "title": "Large paraesophageal hernia in elderly patients: Two case reports of laparoscopic posterior cruroplasty and anterior gastropexy", "patient": "A 91-year old man presented with severe dyspnea and fever for the last two days. He had a history of controlled diabetes and hypertension with heart failure. He notes persisting vomiting and food intolerance for the last 7 days. Physical examination revealed absent sounds on both lungs, with a normal abdominal exam. CXR revealed bilateral pleural effusions, left pneumonia, with a left thoracic opacity, suggestive of a large PEH. He was admitted on midcare cardiology unit for medical conservative treatment including a nasogastric decompressive tube, resuscitation and intra-venous antibiotics. A thoraco-abdominal CT-scan showed a giant paraesophageal hernia with complete intramediastinal gastric volvulus (). After a multidisciplinary discussion, the surgical volvulus reduction was approved and consented, as the mainstay treatment for the patient. The family members were informed and consented on the potential risks and benefits of the procedure. The patient underwent an emergency laparoscopic abdominal trans-hiatal hernia reduction, including complete sac excision, which was tightly adherent to the posterior mediastinum and needed a perioperative guided gastroscopy for the oesogastric junction, with placement of a decompressive nasogastric tube. After complete gastric reduction and sac excision we performed a posterior cruroplasty reinforced with two ePTFE large strips (). We also performed an anterior gastropexy with continuous barbed running suture 2/0. A mediastinal drain 16Fr. was placed. The patient was hemodynamically stable throughout the whole procedure. The patient was placed in the intensive care unit, where he was stable without any surgical complication since both drain and abdomen were clear. Unfortunately, he developed an acute respiratory failure syndrome, and died on the 4th post-op. day.", "age": [ [ 91.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6854275.xml", "relevant_articles": { "31726255": "123", "31632706": "0", "33240716": "123", "31338969": "123", "7648901": "123" }, "similar_patients": { "6854275-1": "13", "8286180-1": "13", "6157200-1": "123", "2997277-1": "123", "4879081-1": "0" } }, { "human_patient_id": "31", "human_patient_uid": "7649467-1-M", "PMID": "33204965", "title": "Managing acute pulmonary embolism in primary care in a patient declining emergency department transfer: a case report", "patient": "A 74-year-old woman presented to a primary care physician with 10 days of mild, non-exertional pleuritic chest pain on deep inspiration and episodic low-grade subjective fever. She denied cough, shortness of breath, lower extremity symptoms, and urinary tract symptoms. She was haemodynamically stable, with normal vital signs as follows: blood pressure 110/69 mmHg, pulse 79 b.p.m., temperature 36.7\u00b0C, a normal respiratory rate, and oxygen saturation 98% on room air. Her body mass index was 20 kg/m2. Her physical examination was unremarkable, including heart, lung, and extremity evaluations.\nThe patient had fallen off a ladder 9 weeks earlier and sustained a tibial plateau fracture, which was treated with open reduction and internal fixation. She had completed her course of thromboprophylaxis without complication. At the time of presentation, she was recovering at home with her niece. She had no chronic medical conditions except osteoporosis and had no history of cardiac, pulmonary, renal, or venous thromboembolic disease.\nBlood tests and a urinalysis were completed that day. The urinalysis was normal and the complete blood count and estimated glomerular filtration rate were within normal limits. The D-dimer level was elevated at 1653 ng/mL (age-adjusted normal <740 ng/mL). The physician ordered a same-day CTPA at the on-campus radiology suite, but the patient preferred to go home to rest and wanted to defer the imaging for 3 days. The physician explained that the delay was not optimal but would suffice if the patient promised to go to the emergency department if she developed new or worsening symptoms. She agreed. She was not treated with pre-emptive anticoagulation.\nThe CTPA was performed as re-scheduled and identified a lobar embolus without signs of right ventricular dysfunction. The physician called the patient, explained the results, and advised her to report to the emergency department for evaluation and treatment. The patient, however, felt this was unnecessary because she was feeling better, and she requested comprehensive clinic-based care. The physician said he would call her back after evaluating her eligibility.\nThe on-call pulmonologist agreed that the patient met the criteria for outpatient care. Her vital signs were all normal. Her PE Severity Index (PESI) score and class of 74 points and class II, respectively, correlate with a low 30-day all-cause mortality., She also lacked evidence of right ventricular dysfunction on imaging, a criterion of the 2019 European Society of Cardiology (ESC) PE guidelines (). Additionally, she owned a phone, had ready access to transportation, and had strong family support, all of which favoured outpatient management.\nHer physician consulted the healthcare system\u2019s pharmacy-led anticoagulation management service about medication options. On their advice, he prescribed a 5-day course of subcutaneous enoxaparin (60 mg every 12 h) followed by oral dabigatran (150 mg twice daily) for 3 months, which were the medical group\u2019s formulary recommendations at the time. The physician communicated the treatment plan to the patient and her niece, along with basic education on anticoagulation, the expected disease course, and the indications to seek medical attention.\nThe anticoagulation pharmacist called the patient later that afternoon to continue patient and family education. The patient was seen in the clinic 2 days later and had a phone appointment with her primary care physician 1 week following that. She did not experience a recurrence or complications in the ensuing 3 months, after which the anticoagulation therapy was discontinued. Her D-dimer level shortly thereafter was within normal limits.", "age": [ [ 74.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC007xxxxxx/PMC7649467.xml", "relevant_articles": { "33204965": "123", "18171977": "0", "30018843": "0", "21043045": "0", "34112636": "123" }, "similar_patients": { "7873787-1": "13", "7647577-2": "123", "7648296-1": "123", "7819833-1": "13", "7647577-1": "123" } }, { "human_patient_id": "32", "human_patient_uid": "4532002-1-M", "PMID": "8882481", "title": "Acute Lung Injury after Phosgene Inhalation", "patient": "A 25 year-old female presented herself to a local clinic because of exposure to phogene. She had been in excellent health until September 8, 1995, when she was exposed to phosgene. She complained of coughing, chest tightness and dyspnea which were not relieved despite therapy with oxygen. She was transferred to CNUH about six hours after exposure.\nAdmitting vital signs were blood pressure 100/60 mmHg. pulse 110/min, respiration 20/min, temperature 36.4\u00b0C. Examination of the chest revealed bilateral inspiratory and expiratory crackles. The chest X-ray showed diffuse increased haziness on both lung field (). The WBC were 12.7 \u00d7 103/\u03bcl, the LDH 409 unit, initial arterial blood gases determinations on room air were, PaO2, 68.9 mmHg, PaCO2, 34.7 mmHg, pH, 7.392.\nThe patient was treated with a face mask with 8 L/min oxygen. On the second day of admission, she was transferred to the ICU with respiratory insufficiency. She had progressively increasing respiratory symptoms with the respiratory rate rising to 44/min, pulse rate to 114/min and blood pressure decreasing 70/40 mmHg. The WBC were 25.2 \u00d7 103/\u03bcl with 95.6% neutrophils and LDH was 665 unit. The arterial blood gases were PaO2, 41.2 mmHg, PaCO2 34.9 mmHg, pH, 7.364. The patient was intubated and ventilated with controlled mode and 8.0 cmH2O of positive-end expiratory pressure (PEEP) was applied. Two hours after ventilation, the patient became cyanotic and oxygen saturation decreased to 60% and a chest X-ray showed pneumothorax on the right thoracic cavity. Chest tube was inserted with a water seal bottle. Five hours after controlled ventilation, arterial blood gases on FiO2 0.6 were PaO2, 60.4 mmHg, PaCO2, 31.3 mmHg, pH, 7.520. Ventilation was controlled with diazepam and vecuronium to reduce anxiety and fighting.\nOn the third day of ventilation, she was weaned from the ventilator and extubated. The patient received methylprednisolone (500 mg) for 7 days, 2 days of furosemide (120 mg), aminophylline, dopamine and antibiotics from the day of admission.\nOn the fifteenth day following exposure, pulmonary function tests showed a restrictive pattern and the diffusion capacity was within the normal limit (). A follow-up chest X-ray was cleared to normal ().", "age": [ [ 25.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC004xxxxxx/PMC4532002.xml", "relevant_articles": { "24864580": "0", "2749017": "0", "899761": "0", "31620575": "0", "10836109": "0" }, "similar_patients": { "4532002-3": "123", "4532002-2": "1", "6786729-1": "0", "2872861-1": "0", "8511675-1": "123" } }, { "human_patient_id": "33", "human_patient_uid": "4532002-2-M", "PMID": "8882481", "title": "Acute Lung Injury after Phosgene Inhalation", "patient": "This 37 year-old male was admitted to CNUH about ten hours after phosgene exposure. Physical findings on admission were blood pressure 110/70 mmHg, pulse 154/min, respiration 30/min, temperature 36.4\u00b0C. Examination of the chest X-ray revealed bilateral diffuse pulmonary edema (). Initial blood gas determinations on room air were, PaO2, 61.8 mmHg, PaCO2, 37.6 mmHg, pH, 7.356.\nTen minutes later, he developed tachycardia and tachypnea despite therapy with oxygen and aminophylline. The arterial blood gases on 10 L/min oxygen were PaO2, 51.9 mmHg, PaCO2, 35.9 mmHg, pH, 7.317. The patient was immediately intubated and ventilated with controlled mode. Arterial blood gases were PaO2, 45.7 mmHg, PaCO2, 40.4 mmHg, pH, 7.301. The blood pressure was 80/50 mmHg. The patient was given fresh frozen plasma, as well as crystalloid solutions and dopamine to stabilize the circulation. After fluid administration, the arterial blood gases were PaO2, 35.2 mmHg, PaCO2, 61.5 mmHg, pH, 7.144. Metabolic acidosis was treated with NaHCO3, as required. However the patient had a progressive metabolic acidosis despite controlled ventilation and fluid administration. The patient died of uncontrolled hypoxemia.", "age": [ [ 37.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4532002.xml", "relevant_articles": { "20578420": "0", "3095675": "0", "9215487": "0", "9852697": "0", "2499211": "0" }, "similar_patients": { "4532002-1": "1", "4532002-3": "1", "6182792-2": "0", "4166386-1": "0", "2637259-1": "0" } }, { "human_patient_id": "34", "human_patient_uid": "4532002-3-M", "PMID": "8882481", "title": "Acute Lung Injury after Phosgene Inhalation", "patient": "The patient was a 30 year-old male who was exposed to phosgene twelve hours prior to admission to a local clinic complaining of dyspnea, coughing and sputum. Auscultation of the chest revealed coarse breath sound with crackles all over the lung fields. A chest X-ray showed bilateral diffuse interstitial infiltration. The WBC were 12.3 \u00d7 103/\u03bcl. Arterial blood gases were PaO2, 50.2 mmHg, PaCO2, 37.2 mmHg, pH, 7.401. The patient was transferred to CNUH with worsening dyspnea. The vital signs on admission were blood pressure 130/70 mmHg, pulse 89/min, respiration 28/min and temperature 36.5\u00b0C. The WBC were 18.0 \u00d7 103/\u03bcl with 98% neutrophils. The LDH was 350 unit. Initial blood gas determinations on room air were, PaO2, 55.3 mmHg, PaCO2, 26.7 mmHg. pH, 7.477. Twelve hours after admission, the patient began to have progressively increasing respiratory symptoms with the respiratory rate rising to 55/min. The patient was intubated and ventilated with controlled mode. Ventilation was maintained with diazepam and vecuronium and treated with methylprednisolone and aminophylline. Three hours after ventilation, the fraction of inspired oxygen could be reduced to 0.6. After 24 hours of ventilation with 6 cmH2O PEEP, he developed subcutaneous emphysema extending into the neck and anterior chest. The PEEP could be reduced and subcutaneous emphysema and arterial oxygenation did not get-worse. On the third day, the patient could be weaned from the ventilator and extubated. The patient was treated with methylprednisolone, aminophylline and antibiotics. Pulmonary function tests were performed on the fifth day following exposure and showed a restrictive pattern and a normal diffusion capacity ().\nThe three other patients exposed to phosgene were transferred to CNUH and all were in their early forties. Their complaints were also shortness of breath, chest tightness without derangements of vital signs and arterial blood gases. The pertinent findings in the physical examination were bilateral crackles over the lung fields and diffuse bilateral interstitial infiltrates on chest X-ray.\nThey were treated with supplemental oxygen by external devices, methylprednisolone, aminophylline and antibiotics. Their symptoms were gradually improved in 3 to 5 days of supportive care.", "age": [ [ 30.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4532002.xml", "relevant_articles": { "23842907": "123", "2237673": "0", "31620575": "0", "7934681": "0", "34277314": "0" }, "similar_patients": { "4532002-1": "123", "4532002-2": "1", "8511675-1": "123", "7725136-1": "0", "3790599-1": "0" } }, { "human_patient_id": "35", "human_patient_uid": "2694291-1-M", "PMID": "19568365", "title": "Serous Retinal Detachment Following Combined Photodynamic Therapy and Intravitreal Bevacizumab Injection", "patient": "A 53-year-old woman presented with metamorphopsia in her right eye. She was diagnosed with subfoveal CNV secondary to age-related macular degeneration (AMD) and the best-corrected visual acuity of the right eye was 20/50. PDT with Verteporfin was performed according to the standard protocol of the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Investigation and repeated after 5 months. The visual acuity of the involved eye did not change.\nFifteen months after the second PDT, fluorescein angiography of the affected eye revealed persistent subfoveal CNV and the best corrected visual acuity remained 20/50 (, ). Combined PDT according to the same standard protocol and 1.25 mg intravitreal bevacizumab injection was performed on the same day. One day after the treatment, the patient's vision had decreased to counting fingers. Fundus examination and optical coherence tomography (OCT) showed serous retinal detachment involving the macula ().\nOn post-treatmentday two, the patient was initiated on an oral steroid (Triamcinolone\u00ae 24 mg #1) to complete a two week course. One week into steroid therapy, the visual acuity remained the same, but OCT findings of the right eye showed decreased serous retinal detachment (). The vision slightly improved to 20/200 upon completion of the two week steroid course and fluorescein angiography showed decreased leakage of fluorescein dye ().", "age": [ [ 53.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC002xxxxxx/PMC2694291.xml", "relevant_articles": { "19568365": "123", "15499723": "12", "19787605": "0", "17891013": "123", "16395140": "1" }, "similar_patients": { "3102829-1": "123", "3263249-1": "1", "7899877-1": "123", "3032250-1": "123", "2629677-1": "12" } }, { "human_patient_id": "36", "human_patient_uid": "7292090-1-M", "PMID": "32743423", "title": "Rare case of Richter syndrome with testicular involvement successfully obtained good prognosis with rapid operation and immunochemotherapy", "patient": "A 72-year-old Asian male was consulted to our hospital with sudden scrotal swelling but no additional symptoms. His past history included low risk CLL in revised Rai stage 0 without any treatment 16 years ago. On physical examination, his left scrotum was slightly swollen, whereas his right scrotum had marked swelling and a detectable hard mass. Blood examination showed high levels of white blood cell (27 840 \u03bcL: normal range 3300\u20138600) and LDH (341 U/L: normal range 124\u2013222); however, other abnormalities including for the testicular tumor markers, serum alpha fetoprotein and human chorionic gonadotropin, were not evident. Enhanced CT showed a round, bilateral testicular tumors (right side 72 \u00d7 58 mm and left side 22 \u00d7 18 mm) with homogeneous iso-enhancement relative to normal testis, and 8-mm\u2013sized para-aortic masses. These masses were slightly and gradually enhanced in dynamic contrast-enhanced CT without any suspicious lesions of visceral metastases noted except the surrounding lesions of the para-aorta (Fig. a,b). MRI revealed a low intensity on T2-weighted images compared to those of normal testis and a low intensity on an apparent diffusion coefficients map (Fig. c,d). The clinical diagnosis was bilateral testicular tumors including malignant lymphoma, and after informed consent, an immediate bilateral orchiectomy was performed. The tumor was solitary, and rounded shape, with the cut surface of that showing a yellowish color (Fig. a). Pathological finding revealed that the tumor consisted of blastemal cells, each with an atypical small round shape, and scant cytoplasm. These cells morphologically composed of confluent sheets of large neoplastic B lymphocytes resembling either centroblasts or immunoblasts (Figs b,c,a). The tumor lesion of large neoplastic B lymphocytes was immunoreactive for CD20 (Fig. b), and negative for CD5 (Fig. c), CD3 (Fig. d), and CD23 (Fig. e). Atypical small round cells around large neoplastic B lymphocytes were immunoreactive for CD20, CD5, CD23, and Bcl2 (Fig. f), and negative for CD3. These histopathological findings were consistent with a DLBCL variant, a transformation of CLL, with the final diagnosis being RS. PET\u2013CT revealed the presence of positive lesions in the nasal septum, a tiny subcutaneous tumor in front of the left chest, and bilateral adrenal glands that could not be detected on CT (Fig. e\u2013h). Therefore, the patient immediately underwent an induction combination of rituximab with cyclophosphamide, doxorubicin, vincristine, prednisone immunochemotherapy, and the intrathecal administration of chemotherapeutic agents, including methotrexate, cytarabine, and prednisone. After four cycles of the regimen, the patient showed a complete response in an imaging study. Totally, eight cycles of chemotherapy was performed, and the patient was monitored on an outpatient basis. He was successfully in remission for 14 months after the end of immunochemotherapy.", "age": [ [ 72.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC007xxxxxx/PMC7292090.xml", "relevant_articles": { "24335377": "123", "19483402": "123", "8578983": "0", "10853335": "123", "31180818": "0" }, "similar_patients": { "7292114-1": "0", "6058375-1": "13", "8088880-1": "0", "4448048-1": "13", "6456129-1": "0" } }, { "human_patient_id": "37", "human_patient_uid": "6158368-1-M", "PMID": "30294303", "title": "An Association of PTPN11 and SHOX Mutations in a Male Presenting With Syndromic Growth Failure", "patient": "A 5.5-year-old boy visited the Endocrinological section of the Pediatric Unit of the General Hospital of Terni, Italy, due to short stature. His mother's height was 170 cm, and his father's height was 172 cm (target height: 177.5 cm = >50\u00b0 centile). In his family history, there was paternal familiarity for psychotic crises in his adolescence and mother with thrombophilia and history of five pregnancies with three spontaneous abortions and two parts. The mother took cardioaspirine during the pregnancy. No genetic disease was reported in his family. The child was born at term via spontaneous vaginal delivery. The birth weight was 3.050 gr (10\u00b0-25\u00b0 centile), and the birth length was 45 cm (below the third centile). A villocentesis performed at week 12 of gestation due to an alteration in nuchal translucency on obstetric ultrasound did not reveal any abnormality (46, XY). After birth, a small ventricular septal defect and mild bilateral pyelectasis were detected, but within 6 months, both of these abnormalities spontaneously disappeared. Bilateral orchiopexy was performed at 19 months of age for undescended testicles. Regarding linear growth, auxological data recorded by the primary care pediatrician revealed short stature that was 2 standard deviation (SD) below the 3\u00b0 centile on the Italian cross-sectional growth charts for height () since the first months of life. In the last 2 years, the child has exhibited an even more exacerbated decline in his growth curve. Before entering the hospital, first-level laboratory tests for the evaluation of short stature (i.e., full blood count, inflammatory markers, renal function, hepatic function, coeliac screening, and thyroid function tests) had been already performed. No abnormal results were evidenced. The bone age was delayed by 2 years.\nIn the hospital, his height was 99.2 cm (<3 SD), his weight was 15.5 kg (<3\u00b0 centile), and his growth velocity was 4 cm/year (<3\u00b0 centile). His arm span was of 94 cm, and his sitting height was of 55 cm: height ratio was <95%, his sitting height: height ratio was therefore >56% (slightly over the upper normal limit of 55.5%), and his body mass index was below the 50th centile (pathological Rappold index >8). Furthermore, he presented with unusual facial features that included hypertelorism, low-set ears, a low posterior hairline, down-slanting palpebral fissures, pectus excavatum, and ogival palate (Figure ).\nHowever, Madelung deformity was not suggested by clinical examination and not detected by wrist X-ray findings. Radiological and laboratory tests to rule out related renal, cardiac, ophthalmologic, and audiological abnormalities did not find any significant alterations. At an evaluation conducted by an infant neuropsychiatrist, the patient exhibited a mild cognitive impairment compared with the standard for his age that included a prevalent verbal difficulty compatible with the diagnosis of NS. EEG and cerebral magnetic resonance imaging results were normal. The peak growth hormone (GH) value in a clonidine stimulation test was in the normal range (12.7 mg/L). The IGF-1 level was 47 ng/mL (normal values for age: 32\u2013259 ng/mL).\nAlthough short stature was disproportionate, diagnosis of NS was suspected, and genetic tests of the PTPN11 gene were requested. The entire coding regions and intron-exon boundaries of the PTPN11 gene were amplificated by polymerase chain reaction using genomic DNA and sequence specific primers. Both forward and reverse strands were directly sequenced using an automatic DNA sequencer. The results confirmed NS because a c.922A>G (rs28933386) heterozygous mutation in exon 8 of the PTPN11 gene leading to a p.Asn308Asp substitution was identified (reference transcript NCBI NM_002834.3 and NP002825.3). This mutation has already been described as pathogenic by Siegfried et al. ().\nDue to the presence of a mesomelic short stature, the concurrent presence of two genetic mutations was considered and a genetic evaluation of the SHOX gene was requested. A test of chromosomal microarray analysis performed with the CGH array led to the identification of a micro-duplication at the level of the region PAR 1 (Xp22.33/Yp11.32) extended about 680 kb involving the SHOX gene. The microduplication in the pseudoautosomal region PAR1 has already been described in NS and its clinical significance therefore appears to be certain ().\nGH treatment (0.2 mg/kg/wk) was prescribed. At a follow-up assessment 18 months after the initiation of GH treatment (weight-appropriate dosage), the following data were collected: height, 109.8 cm (<2 SD); weight, 18 kg (<3\u00b0 centile); growth velocity, 7 cm/year (>90\u00b0 centile); arm span:height ratio, 96%; sitting height:height ratio: 56%. Further evaluations have been scheduled for every 6 months.", "age": [ [ 5.5, "year" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6158368.xml", "relevant_articles": { "31467065": "12", "23565409": "0", "8669965": "0", "11259236": "0", "10890200": "0" }, "similar_patients": { "5902492-1": "123", "5597878-1": "0", "5642084-1": "0", "5363169-1": "0", "5574094-1": "0" } }, { "human_patient_id": "38", "human_patient_uid": "7113615-1-M", "PMID": "32269902", "title": "Gyrate atrophy-like phenotype with normal plasma ornithine and low plasma taurine", "patient": "A 39-year-old male presented with the complaint of blurred vision, described as haziness, in his left eye of two months\u2019 duration. He acknowledged that he had experienced blurring of vision of both eyes 12 years ago, and that his vision improved and stabilized after using unrecalled topical medications. He reported little or no difficulty with night vision. Aside from occasional tearing, the patient had no other associated ocular symptoms. He had no known comorbid conditions and no systemic complaints. He denied any of his immediate family experiencing similar symptoms. He also denied consanguinity of his parents.\nSnellen uncorrected visual acuity in the right eye was 20/20, and the manifest refraction was plano. Snellen uncorrected visual acuity in the left eye was 20/100, which was best corrected to 20/20 with \u20131.25 D sphere =\u20130.75 D cylinder x90\u00b0. Color vision, gross eye examination findings, and intraocular pressures were within normal limits. Slit lamp examination showed a small and thin posterior subcapsular cataract in the left eye. Dilated fundus examination revealed in both eyes roundish gray patches of chorioretinal atrophy, some coalescing to form a gyrate shape, mostly located in the inferior retinal midperiphery and far periphery (Figure 1 ). No such lesions were seen in the macula. There was also peripapillary atrophy.\nOn fluorescein angiography, the patches appeared as hypofluorescent areas with faintly hyperfluorescent borders. Choroidal vessels were prominent within the lesions. Spectral-domain optical coherence tomography (OCT) of the macula revealed normal central foveal thickness in both eyes and perifoveal thinning, which was more pronounced in the left eye than in the right. Horizontal scans of the macula showed no abnormalities. Testing of the central 30 degrees of the visual field with the Octopus 300 perimeter (Haag-Streit AG, K\u00f6niz, Switzerland) revealed in each eye a superior arcuate scotoma and enlargement of the blind spot (Figure 2 ). There was inferior retinal nerve fiber layer (RNFL) thinning in the right eye on OCT of the optic nerve head and RNFL. Full-field electroretinogram (ERG) responses in light- and dark-adapted conditions showed A and B waveforms with amplitudes and implicit times that were generally within the normal range (Table 1 ). Waveform amplitudes in the left eye were mostly lower than those in the right eye. Multifocal ERG, which is more sensitive than full-field ERG in detecting local retinal dysfunction, was not available in our center and in other centers in the country and thus was not performed.\nQuantitative plasma amino acid analysis done after an overnight fast revealed a normal plasma ornithine level at 61 \u00b5mol/L (reference interval: 48\u2013195 \u00b5mol/L). Levels of the other amino acids, with the exception of taurine, were within normal limits. Plasma taurine concentration was below normal range at 36 \u00b5mol/L (reference interval: 54\u2013210 \u00b5mol/L). The amino acid analysis was done using ultrahigh performance liquid chromatography \u2013 Waters MassTrak amino acid analysis system. Reference intervals were adapted from the Princess Margaret Hospital for Children, Perth, Australia. Testing for OAT activity and OAT genetic testing were unavailable in our center and in nearby institutions and thus were not done. Nerve conduction studies revealed motor potentials within normal limits and normal F-waves but with reduction of sensory potentials of the right median nerve, indicative of mild carpal tunnel syndrome. Monopolar needle studies on the muscles of the right paracervical and paralumbar areas showed no signs of acute denervation.\nBased on the history, fundus findings, and results of ancillary tests, our patient was diagnosed as having a gyrate-atrophy-like phenotype. The patient was advised spectacle correction of his error of refraction, increased intake of taurine-rich foods, and once- or twice-yearly follow-up for monitoring of the lesions and possible repeat plasma amino acid analysis. Ophthalmologic examination of his parents and siblings was also recommended.", "age": [ [ 39.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7113615.xml", "relevant_articles": { "34577819": "12", "27099847": "0", "26392445": "0", "32675127": "0", "27295601": "0" }, "similar_patients": { "5661182-1": "1", "3782588-1": "13", "8536154-1": "0", "5465797-1": "0", "8189782-1": "0" } }, { "human_patient_id": "39", "human_patient_uid": "3389662-1-M", "PMID": "22792498", "title": "Four-Rooted Mandibular First Molar with an Unusual Developmental Root Fusion Line: A Case Report", "patient": "A 27-year-old female reported with the chief complaint of a \u201cfractured filling\u201d in her left lower back tooth. History revealed intermittent pain localized to the same tooth during mastication. The tooth was previously restored with a silver amalgam restoration 7 years back. Clinical examination revealed a silver amalgam restoration with secondary caries in the left mandibular first molar (tooth 19) which was tender to percussion. Vitality tests elicited no response. Preoperative radiographs showed widening of periodontal ligament space in relation to the mesial root apex. In addition, radiographic apical contour of the tooth suggested that there might be two distal and two mesial roots (). From the clinical and radiographic findings a diagnosis of pulpal necrosis with symptomatic apical periodontitis was made and endodontic treatment was initiated.\nFollowing endodontic access cavity preparation, two mesial and one buccally placed distal canal orifice was identified. Upon visual inspection of the floor of the pulp chamber using a dental operating microscope, a dark line was observed extending from the distal canal orifice towards the distolingual corner. At this corner, the overlying dentin was removed and a second distal canal orifice was detected. The conventional access was modified to improve access to the additional canals (). Root canal orifices were named as per the nomenclature proposed by Albuquerque et al. []. Working length was confirmed () and the canals were instrumented. Calcium hydroxide was placed as an intracanal medicament with a lentulospiral and the access cavity was sealed with Cavit G. The patient was asymptomatic at the next appointment, a week later, which allowed for root canal obturation and a coronal composite restoration ().", "age": [ [ 27.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3389662.xml", "relevant_articles": { "18792626": "0", "20126913": "123", "26430309": "0", "29422476": "123", "30729957": "123" }, "similar_patients": { "6939968-1": "123", "6104376-1": "123", "5863398-1": "123", "3514951-1": "123", "3698596-1": "123" } }, { "human_patient_id": "40", "human_patient_uid": "6125953-1-M", "PMID": "30185168", "title": "Relapse of chronic melioidosis in a paediatric cystic fibrosis patient: first case report from Malaysia", "patient": "A 14-year-old Chinese Malaysian boy presented to University Malaya Medical Centre, Kuala Lumpur in September 2013 with history of recurrent pneumonia, poor growth and steatorrhoea since childhood. He had finger clubbing and bronchiectasis. Later, he was diagnosed with CF and Pseudomonas aeruginosa was isolated from his sputum. He received 3 weeks of intravenous ceftazidime (50 mg/kg/dose, QDS) and gentamicin (5 mg/kg/dose, OD). He was discharged with azithromycin (5 mg/kg EOD), nebulised gentamicin (80 mg BD) amongst other CF-related medications. In November 2013, he was readmitted with a pulmonary exacerbation and his sputum sample grew methicillin-resistant Staphylococcus aureus (MRSA) and he received intravenous vancomycin, oral rifampicin (300 mg BD) and sodium fusidate (500 mg TDS) with significant clinical improvement. During a follow-up visit in December 2013, he had a productive cough but was apyrexic. He was empirically treated with oral ciprofloxacin (750 mg BD) and the sputum sample later isolated B.pseudomallei. As he clinically improved, the treatment regimen remained unchanged. Subsequently, the repeat sputum samples were negative for B.pseudomallei and he continued to remain active with good exercise tolerance and relatively stable lung function. It is noteworthy that he had been residing in an urban area of non-endemicity for melioidosis and there were no other known risk factors identified.\nIn August 2014, he was admitted with another pulmonary exacerbation and his cultured sputum grew B.pseudomallei and Pseudomonas spp. His chest radiograph showed diffused interstitial changes with bronchiectasis throughout both lungs with minimal pleural effusions. He received 2 weeks of intravenous ceftazidime (2 g; 6hourly) and amikacin (720 mg; 15 mg/kg/OD). Upon completion of antibiotics, he remained afebrile and the chest auscultatory findings improved. He was discharged with 6 months of oral doxycycline, and co-trimoxazole to treat the B.pseudomallei and 3 months of nebulized amikacin for chronic P.aeruginosa. He still continued on his alternate day of azithromycin (250 mg).\nA detailed travel history revealed that in June 2014, he visited recreational parks in Sabah, Malaysia. During the visit, he went jungle trekking, snorkeling and dipped in a hot-water spring. It is noteworthy that melioidosis is endemic in Sabah, one of the two East Malaysian states on the island of Borneo, where B.pseudomallei prominently occurs in soil and water. Later then, he was admitted 3 monthly for antibiotic tuning and his sputum culture had no specific bacterial growth.\nIn August 2015, there was a decline in his lung function tests with deterioriorating cough. A bronchoscopy was performed and Burkholderia cepacia was isolated from his bronchoalveoloar lavage specimen, while acid-fast bacillus (AFB) smear was weakly positive. Initially, the patient was treated with intravenous imipenem and ceftazidime for 3 weeks but had recurrence of fever. However, the sputum AFB smears remained positive although the suspected nontuberculous mycobacterium could not be isolated despite various culturing techniques. Therefore, the antibiotics were changed to intravenous meropenem, doxycycline, amikacin and oral clarithromycin to treat both the B.cepacia and the suspected nontuberculous mycobacterium.\nUpon discharge, he had been continuing with amoxicillin-clavulanate and doxycycline for 6 months, which helped with weight gain and secretion reduction. Repeat AFB smear remained negative for the subsequent 5 months. However, in January 2016, further decline in his lung function was observed with worsening respiratory symptoms. A chest computed tomography showed worsening bronchiectasis, tree in bud appearance in the lung peripheries, patchy consolidation and several enlarged lymph nodes at the right paratracheal region (Fig. ). His sputum sample grew P.aeruginosa and was also strongly positive for AFB. Intravenous meropenem and ceftazidime (for P.aeruginosa) and combination therapy of rifampicin, ethambutol, azithromycin and nebulized amikacin (for nontuberculous mycobacterium) was started. He improved clinically and was discharged with the above oral medications for 6 months.\nB.pseudomallei was isolated once again in April 2016 and he was treated with intravenous amoxicillin-clavulanate and ceftazidime for 3 weeks. He was then discharged with 6 months of oral amoxicillin-clavulanate. However, in May 2016, his antibiotics were changed to levofloxacin (750 mg) and clarithromycin (500 mg). Following that, for the next 8 months, his sputum sample continued to grow B.pseudomallei but was negative for AFB. Despite many admissions for intravenous antibiotics against B.pseudomallei, the patient passed away from end stage respiratory failure in February 2017. Bacteriological reports were reviewed, and over the 3 years, the patient had several infective exacerbations and his sputum samples grew Gram-negative organisms that were later identified to be B.pseudomallei, Pseudomonas spp., P.aeruginosa, or B.cepacia (Table ).\nAll the isolates were found to have different susceptibility patterns (resistant to co-trimoxazole; intermediate to doxycycline and susceptible to all other antibiotics). The B.pseudomallei isolated in 2013, 2014 and 2016 (UMC083, UMC 082 and UMC114, respectively), were also further confirmed as B.pseudomallei using API 20NE (Biomerieux, France), Ashdown agar and also an in-house polymerase chain reaction (PCR) using specific primers []. However, we were not able to obtain the B.pseudomallei isolated in 2017.\nThe isolates were characterized by multilocus sequence typing (MLST), a method of molecular subtyping that compares sequences of seven housekeeping genes [], and repetitive-element PCR (rep-PCR). It appeared that these isolates were of two different sequence type (ST); ST51 (UMC083 and UMC114), which is a common ST found widely in Malaysia, Thailand, Singapore, Hong Kong and China, and ST1644, (UMC082) a new ST. The STs were deposited in the B.pseudomallei MLST database ().", "age": [ [ 14.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6125953.xml", "relevant_articles": { "9386356": "0", "30185168": "123", "16083051": "0", "21485159": "0", "11905031": "0" }, "similar_patients": { "5525215-1": "0", "5297019-1": "13", "2844380-1": "13", "5513036-1": "13", "4062509-1": "0" } }, { "human_patient_id": "41", "human_patient_uid": "5067395-1-M", "PMID": "27777921", "title": "Pathologic Fracture of the Femur in Brown Tumor Induced in Parathyroid Carcinoma: A Case Report", "patient": "A 57-year-old female patient came to the hospital with pain in both thighs, especially on the right side. The pain was exacerbated during weight bearing and walking and decreased while resting.\nIn the physical examination, there was direct tenderness in the right thigh and right groin region. But no edema or external abnormality was observed. The range of motion of the hip joint was normal, and there were no abnormal neurological findings. On the simple radiographic inspection, the cortical bone of the right proximal femur was thinned and showed cystic change. Decreased bone density was also observed and the trabecular bone of the overall femur was thinned (). The magnetic resonance imaging (MRI) was performed on the part showing cystic bone change to determine the bone tumor. Lesions with a low signal in T1WI () and a high signal in T2W1 () were observed in the proximal femur on both sides and in the right pubis. Based on the MRI findings, brown tumor was suspected. An additional blood test was conducted and serum intact parathyroid hormone was 2,720 pg/mL (normal, 15-65 pg/mL), alkaline phosphatase was 2,417 U/L (normal, 104-338 U/L), calcium was 14.5 mg/dL (normal, 8.6-10.4 mg/dL), and phosphate was 2.0 mg/dL (normal, 2.6-4.4 mg/dL). To find out the cause of hyperparathyroidism, we did the ultrasonography of the thyroid. Since a nodule was observed in the left lobe of the parathyroid, fine needle aspiration was performed to obtain pathological results from the parathyroid. Furthermore as malignant change could not be excluded with the presence of a relatively large nodule, a parathyroidectomy was decided.\nOn the 14th day from admission, the day for parathyroidectomy, the patient felt sudden pain in the right thigh while getting up from a bed to sit down in the morning, and radiographic inspection was performed. In the femur anteroposterior and lateral images, a pathological fracture was confirmed in a site where the brown tumor had formed (). Closed reduction and internal fixation with the intramedullary nailing was performed in orthopaedic surgery department, and a biopsy was conducted using specimen tissue obtained during the medullary reaming. And the additional biopsy was performed along with the parathyroidectomy in the head and neck surgery department. The blood calcium concentration decreased to 10.0 mg/dL after the surgery, and the blood parathyroid hormone concentration became normalized after a month (). In a biopsy on the femoral lesion, brown tumor was diagnosed. The biopsy of the parathyroid confirmed the parathyroid carcinoma. Four months after the surgery, the union of the fracture was confirmed (). The patient became capable of walking without a crutch or walkers by a follow-up ten months after the surgery.", "age": [ [ 57.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5067395.xml", "relevant_articles": { "27777921": "13", "34343791": "13", "33990191": "123", "11393391": "123", "33489969": "123" }, "similar_patients": { "5990527-1": "123", "8122575-1": "123", "7815671-1": "123", "6371999-1": "123", "4435992-1": "123" } }, { "human_patient_id": "42", "human_patient_uid": "2696413-1-M", "PMID": "19493351", "title": "Unusual presentation of Lynch Syndrome", "patient": "A 40-year old Northern European male was first seen in the genetics clinic in 1994. He had a history of leiomyosarcoma of the thigh at age 36, treated with a compartmental resection and post-operative radiotherapy and male breast cancer (stage T2N0M0) for which he had a right mastectomy. The relevant family history at presentation was a paternal history of a father (an ex-smoker but non-drinker) with oesophageal cancer at 47, and a paternal grandfather and two paternal uncles who had been affected with colon cancer in their forties (Figure ).\nInitial diagnoses considered included Li Fraumeni syndrome [], which is associated with germline mutations in the TP53 gene, due to the presence of a sarcoma and breast cancer in the proband. Mutations in the hMSH2 gene, which had been recently cloned at that time were also considered as the paternal branch of the family including the uncles and grandfather fitted the Amsterdam I criteria. Full sequencing of the TP53 gene from blood DNA was uninformative and mutation testing for mismatch repair mutations was not available at that time. Subsequently, BRCA2 was considered a candidate gene because of the presence of male breast cancer, but no mutations were found in either BRCA1 or BRCA2 by screening of the full coding sequences of these genes with dHPLC and large rearrangement testing by MLPA.\nThe patient went on to develop two further primaries \u2013 colon cancer at 48 years (a T1 tumour, treated with a sub-total colectomy) and prostate cancer at 50 years treated with brachytherapy. In addition, over the next decade the family history continued to evolve with the development of cervical adenosquamous carcinoma in his sister, an oligodendroglioma in his niece, a further case of colon cancer in a cousin and a prostate cancer in the proband's close relatives (Figure ). Immunohistochemical studies of his breast carcinoma and sarcoma showed loss of hMLH1 staining (Figure ) while hMSH2 and hMSH6 staining were normal. Staining was not available in the tumours from his immediate relatives, but an additional 8 cancers and one adenoma from other known mutation carriers in a different branch of the same family also showed loss of hMLH1 staining (data not shown) while hMSH2 and hMSH6 staining were normal. MSI testing was less extensively available in the family. While a high level of MSI was demonstrable in the proband's sarcoma (with three markers D5S346, D17S250, D2S123), it was not evident in his breast cancer, despite both tumours losing protein expression. This is likely to be a function of the known insensitivity of markers optimised for the detection of MSI in colorectal cancers, being used to try to detect MSI in other tumour types []. MSI was also demonstrated in 5 samples (4 cancers and one adenoma) from other known carriers in the second branch of the family.\nMolecular analysis of the proband's germline DNA identified a missense variant in the hMLH1 gene (reference sequence NM_000249.2) in exon 2 at nucleotide position 200 (c.200G>A), which predicts substitution of glycine 67 with a glutamic acid residue (p.Gly67Glu). This putative p.Gly67Glu mutation segregates with cancer predisposition in nine family members (see Figure ). The proband is currently well and has surveillance with annual sigmoidoscopy and upper gastrointestinal endoscopy, annual chest wall examination, 6 monthly and PSA level measurements and sarcoma follow-up.", "age": [ [ 40.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC002xxxxxx/PMC2696413.xml", "relevant_articles": { "16426447": "12", "17572079": "0", "15466831": "123", "23695190": "0", "10709098": "12" }, "similar_patients": { "2759639-1": "0", "5011803-1": "0", "4593327-1": "12", "3913615-1": "0", "4586434-2": "0" } }, { "human_patient_id": "43", "human_patient_uid": "8477828-1-M", "PMID": "34660381", "title": "Surgical Nuances of Intramedullary White Epidermoid Cyst in the Conus Medullaris: A Rare Entity", "patient": "In the first case, a 32-year-old male presented with a complaint of lower backache for 5 years, which progressively increased in intensity, radiating to the left leg. The patient had left lower limb weakness in the form of difficulty in walking. There was no sphincter involvement. On examination, the power of the left knee 4/5, ankle in dorsiflexion and plantar flexion 4/5, left extensor hallucis longus 3/5, and the left Babinski sign was positive. No history of previous spine intervention was present. Magnetic resonance imaging (MRI) of the spine revealed intramedullary lesion in the conus at L1\u20132. Lesion was hyperintense with areas of isointense on T1-weighted image and heterogenous on T2 weighted image. Margins were enhanced on contrast T1 weighted MRI []. The patient underwent D12\u2013L2 laminectomy. The dura was opened and intramedullary cystic lesion was found at the conus. The lesion was thin-walled with visualization of intrinsic yellowish content. Posterior midline myelotomy was performed followed by evacuation of dirty yellowish pultaceous material suggestive of EC. The cyst wall was firmly adhered to the conus medullaris proximally and nerve roots distally. The cyst was evacuated, but the wall could not be excised to prevent injury to neural tissue; hence, epithelial lining of the cyst wall was biopsied and extensively electrocoagulated to prevent recurrence. On histopathology, the cyst was lined by keratinizing stratified squamous epithelium and contained degenerated lamellated keratinous material []. All these features were characteristic of intramedullary white EC. Immediately after the surgery, the patient worsened to Grade 3/5 power in the right lower limb with foot drop, which partially recovered over a period of the next 6 months. Left-sided weakness totally recovered after surgery.", "age": [ [ 32.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC008xxxxxx/PMC8477828.xml", "relevant_articles": { "34660381": "123", "25621066": "123", "25582755": "123", "22058362": "0", "20036544": "123" }, "similar_patients": { "8477828-2": "123", "2989522-1": "13", "4301493-1": "123", "5652103-1": "123", "3639845-1": "123" } }, { "human_patient_id": "44", "human_patient_uid": "8477828-2-M", "PMID": "34660381", "title": "Surgical Nuances of Intramedullary White Epidermoid Cyst in the Conus Medullaris: A Rare Entity", "patient": "A 42-year-old male, presented with a complaint of numbness over the left foot for 5\u20136 months. On examination, the power of the left ankle was 3/5, left extensor hallucis longus was 3/5, and 50% loss of sensation of touch, pain, and temperature at L3\u2013L5 dermatome. Sphincter involvement was absent. History of previous spine surgery or lumbar puncture was absent. MRI spine revealed intramedullary lesion in the conus at D12\u2013L1. Lesion was hyperintense with areas of isointense on T1-weighted image and heterogenous on T2 weighted image []. The patient was operated with D12\u2013L1 laminectomy. The dura was opened in the midline and intramedullary cystic lesion was found at the conus. Posterior midline myelotomy was performed followed by evacuation of yellowish pultaceous material. The cyst wall was firmly adhered to the neural tissue of conus medullaris and could not be excised to prevent injury to neural tissue. The cyst was evacuated and the epithelial lining of the cyst wall was electrocoagulated although not extensively to prevent any new deficit, based on previous experience. On histopathology, the cyst was lined by stratified squamous epithelium and underlying fibro collagenous tissue showed hemorrhage and lymphomononuclear infiltrate []. All these features were characteristic of intramedullary white EC. Immediately after the surgery, the patient recovered completely with no new deficit. On 5 months, follow-up patient developed numbness with recurrence of the cyst at the same site. The patient was advised to repeat surgery, which he refused.", "age": [ [ 42.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC008xxxxxx/PMC8477828.xml", "relevant_articles": { "34660381": "123", "20036544": "123", "19929345": "12", "25582755": "123", "29527391": "123" }, "similar_patients": { "8477828-1": "123", "3639845-1": "123", "4301493-1": "123", "2989522-1": "123", "5652103-1": "123" } }, { "human_patient_id": "45", "human_patient_uid": "7992738-1-M", "PMID": "33911598", "title": "Red Scrotum Syndrome Treatment with Pregabalin: A Case Series", "patient": "A 28-year-old male patient presented with persistent scrotal erythema and inguinal striae of 6 months duration. He had a previous diagnosis of onychomycosis and tinea cruris treated with itraconazole. He had employed a topical combination cream of betamethasone, gentamicin, and clotrimazole for 14 months in the inguinal region with suspension 6 months before evaluation. He referred erythema, warmth, and dysesthesia. On examination, the patient had scrotal involvement and atrophic inguinal striae. The patient was treated with pregabalin 150 mg at night for 3 months with complete remission.", "age": [ [ 28.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC007xxxxxx/PMC7992738.xml", "relevant_articles": { "8683785": "0", "22741151": "0", "15386205": "0", "8571346": "0", "32776466": "0" }, "similar_patients": { "7992738-3": "123", "7992738-5": "123", "7992738-4": "123", "7992738-2": "123", "7768563-1": "0" } }, { "human_patient_id": "46", "human_patient_uid": "7992738-2-M", "PMID": "33911598", "title": "Red Scrotum Syndrome Treatment with Pregabalin: A Case Series", "patient": "A 53-year-old male patient presented with scrotal erythema of 2 months duration. He had a previous diagnosis in another institution of contact dermatitis in the area. He had employed topical hydrocortisone and other non-specified topical treatments for 2 months. He referred erythema, a burning sensation, and pain in the scrotum. Clinical examination revealed bright-red erythema in the scrotum. No clinical signs or suggestive symptoms of contact dermatitis were noted. The patient had suspended topical treatment 2 months before evaluation. Because of the low-suspicion of contact dermatitis, patch test was considered not appropriate at the time. The patient was treated with pregabalin 150 mg at night for 2 months with complete remission.", "age": [ [ 53.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC007xxxxxx/PMC7992738.xml", "relevant_articles": { "30219785": "0", "33911598": "123", "17366682": "0", "10826093": "0", "16556279": "0" }, "similar_patients": { "7992738-1": "123", "7491356-1": "0", "7992738-3": "123", "8115187-1": "0", "3113738-1": "0" } }, { "human_patient_id": "47", "human_patient_uid": "7992738-3-M", "PMID": "33911598", "title": "Red Scrotum Syndrome Treatment with Pregabalin: A Case Series", "patient": "A 63-year-old male patient presented with scrotal erythema of 3 months duration. He had a previous diagnosis of tinea cruris and had employed a combination cream of betamethasone, gentamicin, and clotrimazole for 1 month. He referred erythema, a burning sensation, and warmth. Clinical examination revealed scrotal erythema. Treatment with pregabalin 150 mg at night for 1 month resulted in complete remission.", "age": [ [ 63.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC007xxxxxx/PMC7992738.xml", "relevant_articles": { "33217827": "0", "6383734": "0", "27266640": "0", "33911598": "123", "24249898": "0" }, "similar_patients": { "7992738-5": "123", "7992738-1": "123", "7992738-4": "123", "7992738-2": "123", "7392473-1": "0" } }, { "human_patient_id": "48", "human_patient_uid": "7992738-4-M", "PMID": "33911598", "title": "Red Scrotum Syndrome Treatment with Pregabalin: A Case Series", "patient": "A 57-year-old male patient presented with scrotal and penile erythema of 3 months duration. He had a history of combination cream (betamethasone, gentamicin, and clotrimazole) used for 2 months (). He referred a 3-month symptomatology of erythema, dysesthesia, pain and warmth. Pregabalin 150 mg nightly and doxycycline 100 mg every 24-hour resulted in complete resolution after 1-month of treatment ().", "age": [ [ 57.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC007xxxxxx/PMC7992738.xml", "relevant_articles": { "33911598": "123", "1337070": "0", "8852473": "0", "17618179": "0", "12571794": "0" }, "similar_patients": { "7992738-5": "123", "7992738-3": "123", "7992738-1": "123", "7992738-2": "123", "7808678-1": "0" } }, { "human_patient_id": "49", "human_patient_uid": "7992738-5-M", "PMID": "33911598", "title": "Red Scrotum Syndrome Treatment with Pregabalin: A Case Series", "patient": "A 53-year-old male patient presented with scrotal erythema of 3 months duration. He had a previous diagnosis of tinea cruris and had employed desonide and a combination cream of betamethasone/gentamicin/clotrimazole for 2 months. He referred a 3-month symptomatology of erythema, warmth, pain, a burning sensation, pruritus and dysesthesia. Pregabalin 150 mg nightly was prescribed. At 1-month follow-up the patient referred 70% symptomatology improvement with slight drowsiness. After 3 months of therapy, the patient referred complete remission.", "age": [ [ 53.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC007xxxxxx/PMC7992738.xml", "relevant_articles": { "33911598": "123", "6383734": "0", "33217827": "0", "24249898": "0", "9568414": "0" }, "similar_patients": { "7992738-3": "123", "7992738-1": "123", "7992738-4": "123", "7992738-2": "123", "7392473-1": "0" } }, { "human_patient_id": "50", "human_patient_uid": "5560459-1-M", "PMID": "28831451", "title": "DNA Repair Defect and RAS Mutation in Two Patients With Schistosoma mansoni\u2013Associated Colorectal Cancer: Carcinogenesis Steps or Mere Coincidence?", "patient": "The first patient was a 45-year-old woman who presented with abdominal pain, weight loss, and diarrhea. She underwent a colonoscopy in October 2014, which revealed a 3-cm tumor in her cecum. A right colectomy was performed in January 2015, and a well-differentiated mucinous adenocarcinoma of 2.5 \u00d7 1.5 \u00d7 1.5 cm invading into the muscularis propria was identified. No perineural or lymphovascular invasion was observed, but a mild tumor inflammatory infiltrate was present. Margins were free, and metastasis to one of 24 lymph nodes was documented. Ileal schistosomiasis was found in the specimen. MSI was confirmed by immunohistochemistry (loss of MLH1 and PMS2). All RAS mutations were negative. She received 6-month adjuvant capecitabine- and oxaliplatin-based chemotherapy. Last follow-up visit was on June 13, 2016.", "age": [ [ 45.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5560459.xml", "relevant_articles": { "26600781": "0", "18788447": "0", "28133142": "0", "32426365": "0", "29650856": "0" }, "similar_patients": { "5560459-2": "13", "7492975-1": "13", "2752792-1": "0", "4649730-1": "0", "6505212-1": "0" } }, { "human_patient_id": "51", "human_patient_uid": "5560459-2-M", "PMID": "28831451", "title": "DNA Repair Defect and RAS Mutation in Two Patients With Schistosoma mansoni\u2013Associated Colorectal Cancer: Carcinogenesis Steps or Mere Coincidence?", "patient": "The second patient was a 47-year-old man who had a personal history of hepatosplenic schistosomiasis. In 2012, he underwent a right hemicolectomy as a result of complications of appendicitis. In March 2014, splenectomy and an esophageal varices clamp were performed as a result of GI hemorrhage. In November 2014, he presented with diarrhea, and colonoscopy showed a 2-cm tumor next to the ileum\u2013transverse colon anastomosis. In March 2015, the specimen analyzed from a segmental colectomy showed a 3.5 \u00d7 1.8 cm mucinous moderately differentiated adenocarcinoma infiltrating subserosa, with free margins, presence of lymphovascular invasion, no perineural infiltration, and a mild lymphocytic infiltrate observed. No lymph nodes were identified in the specimen, but a granulomatous reaction in response to Schistosoma eggs in his ileum and colonic mucosa and Merkel diverticula were described by the pathologist. MSI was negative by immunohistochemistry, but exon 2 KRAS mutation (c.38G>A:p.G13D) was identified. Because of his comorbidities, he did not receive adjuvant chemotherapy. Last follow-up visit was on June 13, 2016.", "age": [ [ 47.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5560459.xml", "relevant_articles": { "33076984": "0", "27597923": "0", "32156891": "0", "29394781": "0", "33996527": "0" }, "similar_patients": { "5560459-1": "123", "7164716-1": "0", "6896927-1": "0", "6745160-1": "0", "7691197-1": "0" } }, { "human_patient_id": "52", "human_patient_uid": "6967331-1-M", "PMID": "32026967", "title": "Neural block therapy for radiation enteritis: a case report", "patient": "The patient was a 58-year-old woman suffering from lower abdominal pain and vomiting, which gradually worsened from the start of December 2017. An upper gastrointestinal endoscopy revealed multiple gastric ulcers and scars, and lower gastrointestinal endoscopy revealed inflammation in the large intestine. The patient had undergone surgery in 1997 for cervical carcinoma, followed by postoperative radiotherapy that involved irradiation of her pelvis and stomach. On the basis of the symptoms, endoscopy findings, and medical history, the patient was diagnosed with refractory multiple gastric ulcers, enterocolitis, and paralytic ileus due to late radiation-induced sequelae.\nAs a result of frequent vomiting, the patient had become unable to ingest orally. She was hospitalized in October 2018 and fasted before being placed under central venous nutrition control. Hyperbaric oxygen therapy was started to treat the intractable multiple gastric ulcers and ileus. Thirty treatment sessions were scheduled over a period of approximately 1\u20132 months. Pentazocine and tramadol were administered to treat the abdominal pain, but these achieved poor results.\nAt hospitalization, the patient was 155 cm tall and weighed 43 kg. Although she exhibited abdominal distention, no muscular defense or rebound pain was observed. On percussion, the bowel sound was attenuated. A blood examination revealed anemia, slight liver dysfunction, low protein levels, and hypoalbuminemia. An abdominal X-ray showed several small intestinal niveau and extension of the colon and small intestine by intestinal gas (Fig. a).\nThe patient experienced increased lower abdominal pain during bowel movements and felt relieved after defecation. Consequently, we hypothesized that her abdominal pain was due to poor peristalsis of the intestinal tract and that blocking the sympathetic nerve of the intestinal tract would help normalize the peristaltic movement and relieve the pain. The pain was strongest in the lower abdomen at the level of the 12th thoracic nerve. An epidural catheter was inserted via the lumbar1\u20132 intervertebral space, and continuous epidural anesthesia with 0.2% ropivacaine at 4 ml/h was administered for 1 week, resulting in good control of the lower abdominal pain and defecation. This allowed the tramadol, which promotes constipation, to be discontinued. A block of the inferior mesenteric artery plexus with ethanol was performed, resulting in an immediate improvement in the patient\u2019s bowel movements and defecation, and a reduction in lower abdominal pain, now measured as 3 on a numerical rating scale (NRS = 3). An abdominal X-ray was performed after the block procedure, showing the number of intestinal niveau and the amount of gas had decreased, as compared to that before the block (Fig. b). The control of lower abdominal pain was effective, and defecation was noted. Tube feeding was started 4 days after the inferior mesenteric artery plexus block, and oral feeding was started 2 days later.\nTwelve days after the block, the patient\u2019s lower abdominal pain increased to NRS 8 and there was recrudescence of the vomiting. An abdominal computed tomography (CT) scan showed dilation of the small intestine, as well as the formation of niveau; however, no bowel obstruction or disruption of blood flow was observed (Fig. a).\nAn upper gastrointestinal contrast examination with contrast medium (Gastrografin\u00ae, Bayer Yakuhin Ltd., Osaka, Japan) showed relatively good peristaltic movement of the large and small intestine but poor gastric peristaltic movement. A large amount of food residue was also observed. An epidural catheter was inserted via the thoracic 6\u20137 intervertebral space for innervation of the upper gastrointestinal tract, including the stomach and small intestine, and continuous epidural anesthesia with 0.2% ropivacaine at 4 ml/h was started. This alleviated the abdominal pain, and the vomiting disappeared.\nApproximately 2 weeks later, continuous epidural anesthesia was stopped, and a splanchnic nerve block with ethanol was performed (Fig. c). This resulted in an improvement in the lower abdominal pain to NRS 1, as well as an increase in food intake. The following day, CT showed a large improvement in the ileus (Fig. b). An upper gastrointestinal contrast examination showed that peristaltic movement of the upper gastrointestinal tract had improved (Fig. ). The subsequent course was good, and the hyperbaric oxygen therapy was completed. The patient was discharged from hospital at the end of January. At the outpatient visit 2 weeks later, the general condition of the patient was good and she could orally intake her normal diet.", "age": [ [ 58.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6967331.xml", "relevant_articles": { "10445777": "0", "7801006": "0", "10359987": "0", "15952487": "0", "32879725": "0" }, "similar_patients": { "6966938-1": "0", "7671973-1": "0", "8065084-1": "1", "7310884-1": "0", "5112325-1": "0" } }, { "human_patient_id": "53", "human_patient_uid": "3001200-1-M", "PMID": "21157564", "title": "Eumycetoma versus actinomycetoma: Diagnosis on cytology", "patient": "A 45-year-old man, farmer by occupation, presented clinically with a slow growing, slightly tender, firm mass on the plantar aspect of left foot for 3 years, measuring 5\u00d74\u00d73 cm. There were multiple discharging sinuses covered with blood mixed purulent exudates. Radiograph showed features of osteomyelitis and soft tissue shadow. A tentative clinical diagnosis of tuberculous osteomyelitis was proposed. Imprint smears were made from the discharge and fine needle aspiration cytology (FNAC) was done using a 23-gauge needle, attached to a 10-ml syringe. Aspirate consisted of sero-sanguinous, pus like material. Alcohol fixed smears were stained with Papanicolaou (Pap stain), while air-dried smears were stained with May-Gr\u00fcnwald-Giemsa (MGG) stain. Simultaneously, Periodic acid Schiff (PAS), Gram\u2019s stain and acid fast bacilli (AFB) stains were performed. Additionally, fungal and bacterial cultures were carried out.\nBoth FNAC smears and imprint smears comprised plenty of pus cells, some lymphocytes, histiocytes and foreign body giant cells in a necrotic background. Several brown to black colonies were seen. On higher magnification, these consisted of septate, branching fungal hyphae embedded in a cement-like matrix [Figures and ]. PAS stain highlighted the branching hyphae []. AFB and Gram\u2019s stains were negative. The cytological diagnosis of eumycotic mycetoma was rendered with suggestion of Madura foot. The excised surgical specimen confirmed the diagnosis of eumycetoma. The fungal species was identified as Madurella mycetomatis on subsequent fungal culture.", "age": [ [ 45.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3001200.xml", "relevant_articles": { "21157564": "12", "18540305": "12", "25804004": "12", "10607010": "12", "23475692": "12" }, "similar_patients": { "5492756-1": "1", "7504861-1": "1", "5879847-1": "0", "3168029-1": "1", "3480772-1": "1" } }, { "human_patient_id": "54", "human_patient_uid": "3230026-1-M", "PMID": "22148003", "title": "Fatal Rhabdomyolysis in a Patient with Liver Cirrhosis after Switching from Simvastatin to Fluvastatin", "patient": "A 56-yr-old man with liver cirrhosis caused by the hepatitis B virus visited our hospital on December 30, 2008 for evaluation of weakness in his lower legs of 1-week duration. He first experienced discomfort and myalgia in his lower legs, which worsened over time and made him unable to walk. He had undergone a percutaneous coronary intervention 10 yr previously at the local hospital and had taken simvastatin (20 mg/day) regularly since then. He was diagnosed with Child-Pugh C cirrhosis due to hepatitis B virus a year ago and followed-up at the same hospital with stable liver function in a compensated state. Ten days before visiting our hospital, he was switched from simvastatin to fluvastatin (20 mg/day) by his doctor, as the patient was concerned about his liver disease. In addition to fluvastatin (20 mg/day), his medications included aspirin (100 mg/day), betaxolol (10 mg/day), candesartan (16 mg/day), lactulose (30 mL/day), and entecavir (0.5 mg/day) without diuretics or fibrates. His medical history was significant for no alcohol use and 10 pack-years of smoking, but he had quit smoking 10 yr previously.\nThe patient's blood pressure was 122/76 mmHg, his temperature was 36.8\u2103, his pulse was 63 beats/min, weight was 98 kg, and his body mass index was 29.8 kg/m2. He had mild tenderness of the lower extremities but all other assessments were unremarkable. Laboratory findings included sodium 125 mM/L, potassium 5.1 mM/L, chloride 97 mM/L, phosphorus 3.1 mg/dL, CO2 24.4 mM/L, serum creatinine 1.0 mg/dL, blood urea nitrogen 21 mg/dL, glucose 176 mg/dL, calcium 8.3 mg/dL, phosphorus 3.1 mg/dL, aspartate transaminase 1,303 IU/L (normal < 40), alanine transaminase 354 IU/L (normal < 40), alkaline phosphatase 145 IU/L (normal 40 to 120), total bilirubin 4.6 mg/dL, direct bilirubin 1.4 mg/dL, protein 8.0 g/dL, albumin 2.7 g/dL, and uric acid 3.5 mg/dL. His hematocrit was 38.5%, platelet count was 80,000/\u00b5L, and white blood cell count was 11,100/\u00b5L, with 18.5% lymphocytes, 69.7% polymorphonuclear leukocytes, 10.% monocytes, 1.4% eosinophils, and 0.2% basophils. His prothrombin time (PT) was 1.78 INR (40.7%) and activated partial thromboplastin time (aPTT) was 36.5 seconds. His total serum creatine kinase (CK) was 36,804 IU/L (normal 50 to 250 IU/L) and his CK-MB was 157.0 ng/mL (normal < 5 ng/mL). Thyroid function test was within normal limits. Urinalysis revealed no red or white blood cells, positive dipsticks for protein, occult blood, bilirubin and urobilinogen, but negative for glucose. A 99mTc-diphosphonate scintigram bone scan showed increased uptake over all extremities and muscles of the thorax and abdomen ().\nThe patient was diagnosed with fluvastatin-induced rhabdomyolysis. Treatment with fluvastatin, betaxolol and candesartan was discontinued, and he received massive hydration and urine alkalization. He was treated with intravenous sodium bicarbonate (100 mEq in 1,000 mL of half-normal saline at a rate of up to 500 mL/h or 50 mEq/h) titrated to a urine pH > 6.5. He was administered a 20-80 mg dose of intravenous furosemide to maintain diuresis. The extent of rhabdomyolysis progressed despite supportive treatment. His CK concentration was increased to 166,160 IU/L, and renal failure occurred. He underwent continuous renal replacement therapy on day 7, but his renal function did not recover and hepatic function worsened, with PT prolonged to 3.8 INR (18%) and total bilirubin increased to 24.5 mg/dL (). He died due to rhabdomyolysis complicated by hepatic failure on day 15.", "age": [ [ 56.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3230026.xml", "relevant_articles": { "20966146": "123", "26521193": "0", "22148003": "123", "10441997": "123", "8990484": "0" }, "similar_patients": { "3884116-1": "123", "5265797-1": "13", "3186895-1": "0", "5646314-1": "0", "2721943-1": "0" } }, { "human_patient_id": "55", "human_patient_uid": "4830721-1-M", "PMID": "27123347", "title": "The Use of Plasma-Derived Complement C1-Esterase Inhibitor Concentrate (Berinert\u00ae) in the Treatment of Angiotensin Converting Enzyme-Inhibitor Related Angioedema", "patient": "A 56-year-old Caucasian male presented with a sensation of swelling in the throat, hoarseness, difficulty swallowing, and slight soreness in the right side of the throat. The symptoms were present when the patient awoke in the morning and progressed in a few hours, which caused him to seek medical assistance. At the local emergency department, a swollen tongue was found and the on-call otorhinolaryngologist was contacted. The patient had no known food allergies and no previous history of angioedema or urticarial eruptions. The patient did not present any signs of anaphylaxis (e.g., urticarial eruption, pruritus, hypotension, bronchospasm, or vomiting). It was unravelled that the patient 5 years ago was taking an ACE-inhibitor as an antihypertensive drug on a daily basis and thus bradykinin mediated angioedema was suspected. The patient was immediately transferred to the department of otorhinolaryngology. On admission, the symptoms were unchanged and the vital signs were normal. Lung and heart auscultation were normal. The clinical otorhinolaryngological assessment showed a moderate angioedema of the right side of the base of the tongue, the uvula, and the right palate-pharyngeal arch. Fibre-optic assessment of the pharynx showed a moderate swelling of the right side of the lingual tonsil and a severe mucosal swelling of the right side of the hypopharynx, the piriform sinus, the right aryepiglottic fold, and the right ventricular fold. The vocal folds were unaffected. Articulation was slightly impaired by the swelling. The voice was hoarse, but the respiration was unaffected. Besides a single small and sore lymph node on the right side of the neck, there were no palpable cervical lymph nodes. A bedside sonography of the neck revealed an inconspicuous lymph node with normal hilar flow in level Ib/II equivalent to the palpable lymph node. Blood samples (electrolytes, red and white blood cell count, and C-reactive protein) were normal except for a subnormal level of P-potassium 3.0 mmol/L (3.5\u20134.5 mmol/L). Since there were no signs of an anaphylactic reaction, tryptase was not measured. The patient did not present with symptoms and clinical findings compatible to upper airway infection (no fever, odynophagia, mucosal hyperaemia, or lymphadenitis). The patient had earlier suffered from a single deep vein thrombosis and was known to have type 2 diabetes, hypertension, hypercholesterolemia, and secondary polycythaemia due to smoking. He had no positive family history for angioedema and no prior swelling episodes. The medical history did not reveal any signs of allergic disease or malignancy. Complement analysis was not performed in the acute phase, as the biochemical analysis requires several days.\nOn admission, 40 milligrams of corticosteroid (Solu-Medrol\u00ae) had initially been administered intravenously. However, as the history revealed, ACEi-AE was suspected and an effect of corticosteroid could not be expected and was not awaited. Treatment with antihistamine was expected to be ineffective; thus, an antihistamine was not administrated. On suspicion of ACEi-AE, 2000 units of (18 units/kg) plasma-derived C1-inhibitor concentrate (Berinert) was administered intravenously over a course of 10 minutes. The patient rapidly reported to have decreased symptoms, but a fibre-optic reassessment was not performed until 5 hours after the infusion. A significant decrease in severity of the angioedema was observed. The patient was observed in the in-patient department for 24 hours and at discharge the angioedema had completely resolved, which was confirmed by fibre-optic reassessment. At the time of admission, the patient received an ACE-inhibitor, a calcium-antagonist, acetylsalicylic acid, a statin, and a non-beta-cell stimulating antidiabetic drug (Metformin\u00ae). The patient was thoroughly instructed never to take ACE-inhibitor again. The patient was enrolled in a large international multicenter DNA sequencing study (Prediction-ADR) in which further evaluation, including DNA testing for genetic mutations in the bradykinin pathway, is currently performed.", "age": [ [ 56.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4830721.xml", "relevant_articles": { "25745598": "12", "34330175": "12", "33628527": "1", "28125922": "1", "12639808": "0" }, "similar_patients": { "3666183-1": "123", "6081190-1": "1", "8326613-1": "12", "8603774-1": "12", "6280524-1": "12" } }, { "human_patient_id": "56", "human_patient_uid": "4213137-1-M", "PMID": "25378901", "title": "Bilateral endogenous Candida albicans subretinal abscess with suspected mixed bacterial infection", "patient": "A 64-year-old man visited Jichi Medical University Hospital complaining of left eye visual loss and floaters in the right eye. He was referred to us by the Department of Allergy and Rheumatism of our hospital, having been administrated 40 mg of oral prednisolone for more than 6 weeks as treatment for interstitial pneumonia accompanying rheumatoid arthritis. His medical history included metastatic rectal cancer, intestinal obstruction, and pericarditis.\nBest-corrected visual acuity (BCVA) was 20/20 in the right eye and 8/200 in the left eye. Funduscopy revealed round yellowish-white subretinal lesions with retinal hemorrhage in both eyes ().\nLaboratory studies showed elevated titers of the anti-Toxoplasma, anti-Herpes simplex virus IgG, anti-Herpes simplex virus IgM, and anti-cytomegalovirus IgG antibodies, as well as low cell lymphocyte and CD4-positive lymphocyte counts. In contrast, the white blood cell count, C-reactive protein, and \u03b2-D glucan levels were not increased.\nNo abnormalities were noted on blood culture or whole-body contrast computed tomography.\nAdministration of oral anti-Toxoplasma (acetylspiramycin 1,800 mg/day) and anti-viral drugs (valganciclovir 1,800 mg/day) was initiated. However, the lesions expanded in both eyes.\nDiagnostic vitrectomy of the left eye was performed 4 weeks after the initial examination. Although the vitreous fluid sample was subjected to broad-range PCR, multiplex PCR, and other culture tests, no positive results were obtained.\nBased on the fundus findings, broad-spectrum antibiotic treatment (imipenem/cilastatin 2,000 mg/day and amikacin 600 mg/day) was initiated, under suspicion of bacterial infections including Nocardia. However, the lesions did not improve. Thus, antibiotics (ceftazidime 2 mg, vancomycin 1 mg, and voriconazole 0.05 mg/0.1 mL each) were injected into the vitreous cavity 6 weeks after the initial examination, and a vitreous tap was simultaneously performed. Broad-range PCR of the vitreous fluid showed 3.75\u00d7104 copies/mL of bacterial 16s ribosomal RNA, strongly suggesting bacterial infection. Albeit with antibiotic treatment, the lesions further deteriorated BCVA to light perception ().\nSeven weeks after the initial examination, exenteration of the left eye was performed. Immediately after the operation, microscopic observation of the removed and then Gram-stained tissue revealed Gram-negative rods. However, no bacteria corresponding to these organisms grew in culture of either the removed tissue or vitreous fluid, and only C. albicans was isolated. Sheep blood agar and chocolate agar were used for culture and intubated with 5% carbon dioxide at 35\u00b0C for 48 hours. The picture of the Gram-stained sample was taken from this culture (, left). Then, the colonies grown on these cultures were harvested and cultivated on the CHROMagar\u00ae for identification. The picture of the agar plate shows the colonies that are green in color on the CHROMagar\u00ae suggesting the species of C. albicans based on its color (, right).\nBased on these findings, mixed bacterial and fungal infection was considered, and simultaneous systemic administrations of antibiotics (levofloxacin 500 mg/day) and maximum-dose antifungal agent (fosfluconazole 600 mg/day) were initiated. In addition, antibiotics (ceftazidime 2 mg, vancomycin 1 mg, and voriconazole 0.05 mg/0.1 mL each) were injected into the vitreous cavity of the right eye three times from 8 weeks to 10 weeks after the initial examination. Broad-range PCR of the vitreous fluid obtained from simultaneous vitreous tap 8 weeks after the initial examination revealed 7.19\u00d7104 copies/mL of bacterial 16s ribosomal RNA, and 1.85\u00d7105 copies/mL of fungal 28s ribosomal RNA, suggesting a fungus-dominant mixed infection.\nThe subretinal abscess in the right eye expanded, approaching the central fovea (), and BCVA decreased to 2/200. Vitrectomy combined with cataract surgery and silicone oil injection was performed 10 weeks after the initial examination. C. albicans was detected by vitreous fluid culture. Systemic administration of the antifungal agent was continued after surgery, and the lesions healed under silicone oil (). The fundus had stabilized 1 year and 4 months after the initial examination, and BCVA was maintained at 4/200.", "age": [ [ 64.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4213137.xml", "relevant_articles": { "25378901": "123", "26746839": "0", "29237498": "0", "7785693": "0", "12140041": "0" }, "similar_patients": { "8237134-1": "123", "3636104-1": "123", "6176285-1": "123", "6080441-1": "123", "4442280-1": "1" } }, { "human_patient_id": "57", "human_patient_uid": "7670772-1-M", "PMID": "33198722", "title": "Rapidly progressive metastatic cholangiocarcinoma in a postpartum patient with cystic fibrosis: a case report", "patient": "A 26-year-old female with CF (genotype F508del/F508del), with a baseline forced expiratory volume in 1 s (FEV1) of 21% predicted and a 6-l home oxygen requirement, was undergoing evaluation for bilateral lung transplantation. Her medical history included recurrent respiratory infections with multi-drug resistant pathogens, pancreatic insufficiency, malnutrition requiring percutaneous gastrostomy feeds, atrioventricular nodal reentry tachycardia status post ablation, and the recent delivery of a healthy baby. She had no history of biliary tract stones, cirrhosis, hepatitis B, or hepatitis C. As part of the lung transplantation workup a CT scan of the chest, abdomen, and pelvis revealed a new peripherally enhancing 6.3 cm mass in the right lobe of her liver, and subsequent MRI suggested intrahepatic cholangiocarcinoma. At this time, the patient reported feeling a hard mass under her right ribs along with intermittent right upper quadrant pain and fullness, anorexia, weight loss, and daily subjective fevers for several weeks.\nUltrasound-guided biopsy identified the mass as an adenocarcinoma, with positive staining for cytokeratin 7 (CK7), GATA-3, a transcription factor important in the regulation of certain genes, and p40, a marker of squamous differentiation. Notably, the tumor was negative for estrogen receptor (ER), thyroid transcription factor 1 (TTF-1), cytokeratin 20 (CK20), and high risk human papillomavirus ribonucleic acid in situ hybridization (HR HPV RNA ISH), and therefore did not support tumor origin of breast or gynecologic, lung, lower gastrointestinal, or cervical or head/neck, respectively. Serum tumor markers demonstrated normal alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA) levels, but a markedly elevated carbohydrate antigen (CA)19\u20139 level of 5949.5 U/mL (0\u201336 U/mL), which can be elevated in pancreatic, gastric, hepatobiliary, and colonic malignancies. Given the tumor location, serum markers, and pathology findings, the tumor was thought to be most consistent with a primary cholangiocarcinoma.\nThe patient underwent complete staging following hospital discharge, where radiation therapy with curative intent was recommended. Ultimately her poor performance status, chronic pulmonary disease, and risk of severe life-threatening infection influenced the decision not to pursue systemic chemotherapy or surgery as the initial treatment modality. However, prior to starting treatment, she developed pneumonia leading to acute respiratory failure requiring intubation. A second CT of the chest, abdomen, and pelvis (4 weeks from the initial CT) revealed the liver mass had grown to 13.6 \u00d7 10 cm and there were patchy pulmonary consolidations concerning for both pneumonia and metastatic disease. Positron emission tomography (PET) scan demonstrated uptake in the lungs bilaterally, mediastinal lymph nodes, right iliac, and right femur, consistent with metastatic disease. Given her critical condition, it was decided she was no longer a candidate for treatment of her cancer. She was transitioned to home hospice where she passed away approximately 10 weeks after the initial CT.\nAutopsy revealed a 20 \u00d7 17 \u00d7 23 cm tan mass in the right lobe of the liver (Fig. a and b), consistent with intrahepatic cholangiocarcinoma (Fig. c), along with metastatic deposits in the heart/epicardium (Fig. d), bilateral lungs (Fig. e), anterior/posterior cul-de-sacs, left ovary, vaginal adventitia, spleen, diaphragm and bone marrow (Fig. f).\nIntrahepatic cholangiocarcinoma can resemble adenocarcinomas from other sites, and because there are no histologic markers that can reliably make the distinction, it is often difficult to distinguish them from metastatic tumors []. Due to a lack of a dominant tumor at other possible primary sites at autopsy, and a morphology showing anastomosing glands in a fibrotic stroma with focal squamous differentiation, cholangiocarcinoma was favored in this case.", "age": [ [ 26.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7670772.xml", "relevant_articles": { "23220842": "12", "29900024": "0", "24891967": "12", "28599947": "0", "32307602": "12" }, "similar_patients": { "6467432-1": "1", "4440284-1": "0", "4727413-1": "0", "4825171-1": "0", "8419549-1": "0" } }, { "human_patient_id": "58", "human_patient_uid": "7703350-1-M", "PMID": "33344270", "title": "Multiple osteolytic lesions due to Double-Expressor Primary non-Hodgkin Lymphoma of the Bone", "patient": "A 74-year-old woman was admitted because of right ankle pain swelling and gait impairment over the past month. She denied fever, weight loss, or night sweats. Her medical history was otherwise unremarkable. The ankle plain radiography disclosed an osteolytic lesion.\nOn physical examination, she was in good performance status (PS), and except for a minor swelling of the right ankle, the remaining physical signs were unremarkable. The hemogram was within normal limits, but the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were 61 mm/h and 7.45 mg/dL (reference range RR; <0-5 mg/dL) respectively. Serum calcium was 13.2 mg/dL (RR; 8.5-10.5 mg/dL) and lactate dehydrogenase was of (LDH) 683 U/L (RR; 230-460 U/L). Plain radiography of the right ankle revealed disruption of fibula\u2019s architectural structure, compatible with an osteolytic lesion ().\nFurther imaging with Magnetic Resonance Imaging (MRI) demonstrated complete distortion of the architecture of distal fibular metaphysis by a pathological tissue that infiltrates the bone cortex and marrow and extends to the surrounding soft tissue. Other findings included multiple lesions, possibly attributed to metastatic neoplastic disease, on the lower half of the right tibia, fibula, talus, and metatarsal bones ().\nBone marrow (BM) biopsy, as well as neck, chest, and abdominal computed tomography, were free of disease.\nMoreover, the patient underwent whole-body imaging with positron emission tomography/computed tomography (PET/CT) scan that revealed pathological uptake of 18-FDG by the whole skeleton, particularly cranial and long bones (). Many of these lesions\u2019 sites were accompanied by soft tissue masses, particularly in the lower extremities and the maxilla (SUV max: 15). Increased 18-FDG uptake was also noted in the nasal and zygomatic bones, bilaterally (SUV max: 20), as well as in the cervical, iliac and inguinal lymph nodes (SUV max: 5.5) and regionally in BM (findings consistent with infiltrating disease).\nThe patient underwent a biopsy of the fibula. The histopathological examination showed diffuse infiltration of large-sized cells. Neoplastic cells expressed the B-cell associated antigens CD20, CD79a, PAX5, BCL-6, MUM-1, BCL-2 (80%) [BCL-2(124) Mouse Monoclonal Antibody -Cell Marque], SIg/CIgM(k) and C-MYC (> 40%) [c-MYC(Y69) Rabbit Monoclonal Primary Antibody-Roche]. The expression of CD3, CD4, CD8, CD5, CD23, CD30, CD10, CyclinD1 was negative. Additionally, in situ, hybridization for EBER was negative. The proliferation fraction, as detected by Ki-67 (MIB-1 antigen), was 90%. Fluorescence in situ hybridization (FISH) tests did not reveal rearrangement for C-MYC and BCL2 genes. The above histological findings were compatible with the diagnosis of DLBCL not otherwise specified, DLBCL-NOS with no germinal center B-cells (non-GCB) phenotype, and double expression of C-MYC and BCL-2 (, , , ).\nThus, the patient was diagnosed with a multifocal double expressor DE-PLB, stage IVEA according to Ann Arbor classification with International Prognostic Index (IPI) score: 5, age-adjusted IPI score: 3, and NCCN-IPI [International Prognostic Index for patients with diffuse large B-cell lymphoma) score: 7 (high risk).\nDuring the hospitalization, the patient experienced a pathological fracture in the lower third of the right femur, which was treated surgically. However, it has aggravated her PS to 4, according to ECOG. Subsequently, the patient received prophylactic local radiotherapy (RT) with a total dose of 36cGy, in the lower third of both legs and was treated with 2 cycles R-CNOP (Rituximab- Cyclophosphamide, Mitoxantrone, Vincristine, and Prednisone). Unfortunately, she experienced septic shock during the neutropenic phase after the 2nd cycle of R-CNOP and succumbed to multiorgan failure.", "age": [ [ 74.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC007xxxxxx/PMC7703350.xml", "relevant_articles": { "18024371": "12", "31818069": "123", "28579851": "123", "26462634": "12", "30998153": "12" }, "similar_patients": { "8710498-1": "13", "6408176-1": "123", "6058375-1": "123", "6247723-1": "13", "7809830-1": "13" } }, { "human_patient_id": "59", "human_patient_uid": "5379814-1-M", "PMID": "28413542", "title": "Lateral ventricular gliosarcoma with attachment to septum pellucidum", "patient": "A 28-year-old male presented with raised intracranial pressure for two months. Neurological examination of the patient revealed bilateral papilledema. However, there were no focal deficits. MR of the patient revealed T1 hypointense, T2 hyperintense intraventricular lesion filling the bilateral lateral ventricle with avid contrast uptake and central non-enhancing area [Figure \u2013]. There was a non-enhancing area in the right frontal lobe contiguous with the intraventricular lesion as apparent on T2 and FLAIR images []. Patient underwent a parasagittal craniotomy and near total excision of the tumor. The tumor was pinkish gray, very vascular and had areas of necrosis along with thrombosed vessels within. Septum pellucidum was involved and was resected partly along with the tumor. The floor of both lateral ventricles could be appreciated after resection. The right frontal lobe appeared normal intraoperatively. Histopathological evaluation of the resected specimen revealed features of a high-grade tumor comprising of biphasic population of malignant cells. Tumor cells were highly pleomorphic comprising of malignant glial cells including many bizarre tumor giant cells intermixed with bundles of malignant spindle cells. Mitosis was brisk. There was intense endothelial cell proliferation and large areas of palisaded necrosis. Tumor cells showed immunoreactivity for glial fibrillary acidic protein (GFAP) and vimentin [Figure \u2013]. The patient had a prolonged post-op course due to venous edema which gradually resolved, and he has been subjected to radiotherapy.", "age": [ [ 28.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5379814.xml", "relevant_articles": { "15344901": "0", "34382251": "123", "16131776": "0", "25250653": "123", "26155787": "0" }, "similar_patients": { "5482168-1": "0", "4846394-1": "123", "4040033-1": "123", "5700025-1": "123", "3251541-1": "12" } }, { "human_patient_id": "60", "human_patient_uid": "5084711-1-M", "PMID": "27800519", "title": "Clofazimine Enteropathy: A Rare and Underrecognized Complication of Mycobacterial Therapy", "patient": "A 68-year-old female patient with a past medical history of diffuse large B-cell (double hit) lymphoma, status post chemotherapy, as well as peripheral stem cell transplantation (PSCT) complicated by disseminated M. abscessus infection of the skin was referred to the gastroenterology clinic for evaluation of postprandial abdominal pain, diarrhea, weight loss, and melena. She had been recently started on clofazimine and tigecycline due to previous adverse effects from azithromycin. Two months before PSCT (November 2012), the patient developed a catheter-related blood stream infection with M. abscessus that was treated with catheter removal and initial therapy with oral azithromycin, levofloxacin, and amikacin. Two days later, levofloxacin was changed to amikacin after the organism was identified as M. abscessus and preliminary susceptibilities determined resistance to fluoroquinolones. The patient completed a 4-week course of antimicrobial therapy with azithromycin, imipenem, and amikacin complicated by amikacin-induced ototoxicity and nephrotoxicity. The patient rapidly cleared the bacteremia within 48 hours after central venous catheter removal and had no other manifestations of infection. In January 2013, she underwent autologous PSCT and within 2 months she developed multiple skin nodules. Nodule biopsies led to the diagnosis of relapsed disseminated M. abscessus infection. The patient had previously documented ototoxicity secondary to amikacin and was therefore started on treatment with azithromycin, tigecycline, and imipenem. In addition, the patient was found to have new lung nodules on a thoracic computed tomography scan. After 3 months of therapy (June 2013), she developed hepatotoxicity with severe transaminitis and diarrhea. An extensive hepatology evaluation attributed the hepatotoxicity to azithromycin. Because of the patient's history of ototoxicity and renal injury due to amikacin and the possible hepatotoxicity from azithromycin, clofazimine treatment was initiated. In vitro susceptibility testing of the M. abscessus demonstrated susceptibility to tigecycline and clofazimine with resistance to augmentin, bactrim, and linezolid. After obtaining compassionate use and Investigational New Drug (IND) approval through the Florida Department of Health, the patient's regimen was changed to high-dose clofazimine (200 mg by mouth daily) and tigecycline (50 mg IV twice daily). High-dose clofazimine was chosen based on history of disseminated and recurrent mycobacterial infection in a highly immunocompromised patient. Four months later (October 2013), the patient's skin lesions had resolved and repeat chest imaging revealed resolution of the previously noted lung nodules (Figure ).\nOne month after initiating clofazimine, the patient developed severe diarrhea with up to 20 watery bowel movements a day. Her diarrhea persisted despite discontinuation of her azithromycin. The evaluation for weight loss demonstrated severe malabsorption including anemia (hemoglobin of 10 g per dL), with macrocytosis (mean corpuscular volume 109.1 fl, red cell distribution width 19.3% [reference range, 11.5%\u201315.0%]), decreased levels of prealbumin of 8 mg per dL (reference range, 20\u201340 mg per dL), and decreased albumin (2.1 g per dL [reference range, 3.2\u20135 .0 g per dL]). Laboratory evaluation also revealed a fat-soluble vitamin deficiency as well as other vitamin deficiencies including folate, vitamin D, 25-OH, and total serum carotene.\nAfter 7 months on high-dose clofazimine, she presented with hematochezia, failure to thrive with a 17-pound weight loss (127 lb to 110 lb), persistent diarrhea, and right lower quadrant abdominal pain. Physical examination revealed tenderness of the right lower quadrant on deep palpation, 2+ pitting edema in the lower extremities bilaterally, and maroon stools on rectal exam. She had no evidence of recurrent mycobacterium infection nor of relapsing lymphoma.\nEndoscopic evaluation revealed black pigmentation of the duodenum. Colonoscopy demonstrated severely congested mucosa with petechiae in the terminal ileum (Figure 2A). Small bowel and terminal ileum biopsies revealed intestinal mucosa with focal villous blunting and widening due to numerous crystal-laden macrophages infiltrating the superficial lamina propria, consistent with crystal-storing histiocytosis, which is indicative of clofazimine enteropathy (Figure 2B). Clofazimine and all M. abscessus treatment was subsequently discontinued, and the patient had no further gastrointestinal bleeding. She experienced complete resolution of her diarrhea 3 months later, with a 15-pound weight gain noted within 4 months of the discontinuation of the clofazimine. She was initially treated with parenteral nutrition but is now maintained on an oral diet with no recurrence of her gastrointestinal symptoms or of her mycobacterial infection 2 years after the diagnosis of clofazimine enteropathy. This adverse drug effect was reported to the US Food and Drug Administration (FDA).", "age": [ [ 68.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5084711.xml", "relevant_articles": { "19753835": "1", "23257257": "0", "32148178": "0", "26643335": "0", "20138481": "0" }, "similar_patients": { "8288603-2": "0", "8426173-1": "0", "4693336-1": "0", "6245610-1": "0", "6831809-1": "0" } }, { "human_patient_id": "61", "human_patient_uid": "3032248-1-M", "PMID": "21157077", "title": "An unusual case of intraorbital foreign body and its management", "patient": "A 25-year-old male who suffered a work-related accident in a plastic manufacturing industry was brought to our emergency department after hot molten plastic splashed into his right eye. He was brought 6 h after the incident. The patient complained of immediate vision loss associated with severe pain and a burning sensation. According to the patient, he was not using any protective glasses and the temperature of the molten polymer was 240 degrees Fahrenheit. No first-aid was administered to him during this period.\nOn examination, he had no light perception in his right eye. The left eye vision was 20/20; J1. The right eye showed severe periocular edema with a black hardened plastic foreign body protruding from the lower lid and medial canthal area []. Superficial burns involving the right cheek were evident. Extraocular movements were restricted in all gazes Examination of the anterior segment of the right eye showed conjunctival congestion and chemosis with diffuse corneal edema. The pupil was fixed and mid-dilated with normal anterior chamber depth. Intraocular pressure (IOP) with tonopen was 86 mmHg. An examination of the fundus showed hyperemic optic disc with blurred margins, diffuse retinal edema with scattered pre- and sub-retinal hemorrhages.\nThe patient was started on actazolamide 500 mg tablets and timolol maleate 0.5% eye drops. Lateral canthotomy with cantholysis of both crura of lateral canthal tendon was performed as well. A computed tomography (CT) scan was ordered, which showed a hyper dense IOrFB in the inferomedial quadrant of the right orbit, displacing the globe upwards. Hypodense areas inside the mass were evident, suggestive of air entrapment []. There was no extension to the sinuses or the nasal cavity, and the globe was intact. The optic nerve was not clearly visualized.\nThe patient was operated under general anesthesia. The hardened plastic material was lying embedded at the right medial canthal area and the lower lid. The entry wound was enlarged and the foreign body was removed in toto. It measured 2.5 \u00d7 3.5 \u00d7 5.0 cm []. The globe was found to be intact. However, the wound depth extended down to the periosteum of the inferior orbital rim with extensive edema of the surrounding skin. The lower lid wound was sutured in one layer using interrupted 6-0 nylon sutures.\nPostoperatively, the patient was administered intravenous injections of cefotaxime (1 gm) and dexamethasone (4 mg) twice daily in the ward. On the second postoperative day, the wound was healthy. The cornea was clear and IOP was 18 mmHg. The pupil remained dilated and fixed. B-scan ultrasonography (USG) showed widening of Tenon\u2019s space, suspicious of blood clot around the optic nerve. Three daily doses of intravenous methyl prednisolone (1 gm/day) were administered, but the patient reported no improvement in his vision. The patient was discharged on Ciprofloxacin tablets 1 gm/day and prednisolone tablets (1 gm/kg body weight) in a weekly tapering dose.\nAt the 3-week follow-up consultation, the skin of the medial three-fourth of the lower lid surrounding the entry wound had sloughed out. The necrosis of the tissues extended up to the orbital rim, medial portion of the upper lid and the medial canthal area []. Wound debridement was required and broad-spectrum systemic antibiotics (capsule ampicillin + dicloxacillin 500 mg twice/day) was restarted. Fundus examination showed resolution of retinal hemorrhages and optic atrophy. A staged reconstruction of the right medial canthal area, including the upper and lower eyelids, was performed using a combination of forehead and tarso-conjunctival flaps techniques [Figs. and ]. Although acceptable cosmesis was achieved [], the patient did not recover his vision. Protective polycarbonate glasses for constant wear was prescribed to the patient.", "age": [ [ 25.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3032248.xml", "relevant_articles": { "15878523": "0", "27486810": "0", "16249757": "0", "26808177": "0", "32890154": "0" }, "similar_patients": { "8011473-1": "0", "2993987-1": "123", "7452952-1": "123", "2907039-1": "0", "4687199-1": "0" } }, { "human_patient_id": "62", "human_patient_uid": "6042163-1-M", "PMID": "30050269", "title": "Congenital Midline Cervical Cleft with Respiratory Epithelium: A Rare Association", "patient": "A 1-year-old boy presented to us with complaints of a reddish patch on the anterior aspect of his neck with deficient skin over the lesion since birth. There was no associated history of any discharge, trauma, or bleeding. On examination, a single anterior cervical midline skin defect measuring 3 cm \u00d7 2 cm was present. There was an external opening of a sinus seen at the inferior margin of the defect []. No discharge was reported from the sinus opening. A diagnosis of midline cervical cleft was made, and the patient was taken up for surgery. The entire lesion along with the sinus tract down to the pretracheal fascia was excised. The sinus opening was connected to two small cysts inferiorly, and hence, the dissection was extended till manubrium sterni for complete excision. The skin defect was closed by a Z-plasty to avoid a contracture and flexion deformity of the neck []. Histology revealed two cystic lesions. The smaller cyst was lined by squamous epithelium, while the larger cyst was lined mostly by squamous epithelium and focally by respiratory epithelium []. The subepithelial stroma shows few serous acini. There was no evidence of thyroid tissue or lymphoid follicles. The features were consistent with congenital midline cleft cyst. On follow-up, the wound showed good healing and the child is asymptomatic.", "age": [ [ 1.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6042163.xml", "relevant_articles": { "22356439": "12", "33663147": "123", "19999364": "123", "29093979": "0", "30627168": "12" }, "similar_patients": { "3533160-1": "123", "6556223-1": "123", "3081487-1": "0", "5122306-1": "0", "8451376-1": "0" } }, { "human_patient_id": "63", "human_patient_uid": "3834551-1-M", "PMID": "24215787", "title": "A patient with medication-resistant epilepsy featuring psychosensorial and psychotic symptoms presenting with significant functional improvement on psychotherapeutic treatment: a case report", "patient": "Our patient was 21 years old when he was first hospitalized. This single, Caucasian, right-handed man was living with his mother and had finished high school five years earlier. During this period, he did not pursue any goal-oriented projects; he did not work or try to go back to school, and spent most of his time withdrawn in his bedroom. He had no siblings and very little contact with his father. He had been drug free for the past year and his family history for neurological and psychotic disorders was negative.\nHe was admitted to the emergency ward of a psychiatric hospital about four years ago after a court order was issued to evaluate his mental state. Three days earlier, our patient had been arrested after his mother called the police to report being assaulted and threatened by him. The fight took place after she had scolded him for being lazy and aloof. His initial psychiatric evaluation revealed a very fragile mental state for at least the five previous years. After quitting school because of a lack of motivation, our patient started to spend most of his time reading about subjects related to spirituality. Previously, he had been a relatively good student, with no disruptive behavior and above average marks. He seemed obsessed with developing new concepts to reach a more \u2018perfect\u2019 existence and thought that studying anything but these subjects was simply futile. The initial mental examination, performed at the time of his admission, revealed coherent speech but a perplexed attitude and what sounded like loose associations. He seemed suspicious, but he had no suicidal or homicidal thoughts. He claimed feeling odd sensations in his mind and in his body that could be linked to some sort of \u2018evolutionary\u2019 process resulting from spiritual uplift. He also reported non-specific visual hallucinations (seeing odd shapes and colored lines) and what sounded like auditory hallucinations and telepathic powers. There was no hypergraphism and hypermoralism. His medical history was not contributory. The initial diagnosis was a possible schizophreniform disorder and our patient was admitted. His Global Assessment of Functioning (GAF) scale score was marked at 25, and a dose of risperidone 1mg at bedtime was initiated.\nAn electroencephalogram (EEG) was performed shortly after his admission and revealed a background symmetric alpha rhythm of about 10Hz, predominantly in the posterior and temporal regions of the brain, coupled with an important subcortical epileptic activity with 3 to 5Hz of slow, pointed waves outbursts. The results of a thorough neurological examination were perfectly normal. However, our patient reported having frequent \u2018d\u00e9j\u00e0 vu\u2019 sensations and depersonalization tantrums over the past few years to the consultant neurologist. The neurologist concluded our patient was a case of partial complex epilepsy with psychosensorial and psychotic symptoms and prescribed levetiracetam 500mg twice a day. Meanwhile, the risperidone was ceased since our patient showed worsening of certain symptoms. A neuropsychological evaluation showed important deficits in executive functions (especially working memory and concentration) and lack of motivation, probably secondary to intellectual understimulation for a long period of time. However, since our patient had no developmental delay up to the middle of high school, his intellectual potential was probably superior and was enhanced with proper management and stimulation. A control EEG performed one month later showed no improvement and carbamazepine continued release was progressively increased to 400mg twice a day (blood concentration stabilized at 40\u03bcmol/L). The results of a computed tomography (CT) scan and cerebral magnetic resonance imaging (MRI) study were both normal. Follow-up EEGs (performed six months after his first admission) continued to show the same epileptic activity and carbamazepine was stopped and replaced by valproic acid (up to 500mg twice a day with blood concentration stabilized at 452\u03bcmol/L). In spite of this, his EEG results remained practically unchanged.\nEven though abnormal epileptic activity remained, our patient showed significant improvement during this period. Three months after admission, our patient left the hospital and started an integrated psychological therapy (IPT) group three times a week, a program that combines neurocognitive and social cognitive interventions with social skills approaches for patients who are schizophrenic. IPT has been shown to be an effective rehabilitation approach for patients experiencing psychotic disorders []. In addition, he was also integrated into a rehabilitation home in order to practice these skills in a protected and proactive setting adapted to his strengths and weaknesses and willing to follow his pace of learning. Monthly individual cognitive-behavioral therapy (CBT) sessions, adapted for psychotic patients [,], were also initiated by the treating psychiatrist to further potentiate the treatment. In a matter of months, our patient realized his deficits in social interactions. When confronted with them, he tried to isolate himself by going back to his old thoughts on spirituality and pursuit of a perfect world. However, these beliefs were found to be primitive psychological defense mechanisms and our patient himself knew this. The previous visual and tactile hallucinations became much more scattered and were more the fruits of odd interpretations of reality. Almost a year and a half after being hospitalized, he started a job reinsertion program and is looking forward to moving into his own apartment. The final psychiatric diagnosis was a psychotic disorder and personality change due to a general medical condition (epilepsy). However, despite active epilepsy, non-responsive to medication, he has managed to control a lot of symptoms deriving from the intertwining of his organic and psychiatric disorders. A control neuropsychological evaluation performed more than a year after the first one revealed steady scores for executive functions, but significant improvement in speed of information processing. His most recent GAF scale score was 65.", "age": [ [ 21.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3834551.xml", "relevant_articles": { "24215787": "123", "17565293": "12", "20414058": "12", "22297319": "13", "26126399": "0" }, "similar_patients": { "8450362-1": "123", "4493816-1": "13", "5134243-1": "1", "6005892-1": "123", "2803848-1": "123" } }, { "human_patient_id": "64", "human_patient_uid": "3141624-1-M", "PMID": "21733146", "title": "Composite lymphoma in the anterior mediastinum: a case report and review of the literature", "patient": "The 37-year-old woman presented with a three-month history of continuous pain in the right shoulder and chest. She was taken to our department of cardiothoracic surgery. Physical examination was remarkable for palpable lymph nodes in the bilateral supraclavicular fossae. Chest computed tomography (CT) revealed an oval mass located in the anterior mediastinum. Circumambient lung tissue was involved. Haematological findings were: WBC 15.40 \u00d7 109/L, platelets 364 \u00d7 109/L, prothrombin time 10.3 sec. Her erythrocyte sedimentation rate (ESR), blood biochemistry, electrolytes, blood urea nitrogen and serum creatinine, urine analysis and the endocrine profile were within normal range except hemoglobin (106 g/L) and tumor specific growth factor (67 U/ML). The abdominal ultrasonography did not reveal any other abnormality.\nThe surgery was performed with the patient under general anesthesia and left lateral decubitus position. The procedure revealed an oval tumor, volume of which was 7 cm \u00d7 4.5 cm \u00d7 2.5 cm, in the anterior mediastinum and circumambient lung tissue was involved. Pathologic findings during surgery showed that the tumor was off-white with obscure boundaries and hard in consistence (Figure ). The result of pathology hinted that the tumor maybe malignant lymphoma. The tumor and circumambient lung tissue which was involved were excised.\nHistology showed the tumor was nodular and different nodules were separated by collagen fibers (Figure ). There were two morphologically and immunophenotypically distinct components. The great mass of nodules showed a pleomorphic cellular infiltrate containing lymphocyte, eosinophile granulocyte, neutrophile granulocyte and numerous large Hodgkin/Reed-Sternberg cells. The Reed-Sternberg cells were positive for CD30, CD15 and MUM1 but negative for CD20, CD79a, CD3, Pax-5, CD68, bcl-6, CD10, CD45, Ig\u03ba, Ig\u03bb and epithelial membrane antigen (Figure , Figure ). Other nodules displayed sheets of relatively uniform large lymphoid cells with typical morphologic features of large cell lymphoma which showed uniform expression of CD20, CD79a, MUM1, CD45, Ig\u03bb, Pax-5 and absence of CD30, CD15, CD3, CD10, bcl-6, Ig\u03ba, CD68 and epithelial membrane antigen (Figure , Figure ). All the primary antibodies are listed in Table . Neither cell population showed makers of EBV infection by EBER in situ hybridization (PanPath Company, Amsterdam, Netherlands). On the basis of histomorphology at light microscopy, the presence of immunohistochemical staining and in situ hybridization, a diagnosis of CL, combination of NSHL and DLBCL, in the anterior mediastinum was made. The patient received six courses of CHOP chemotherapy (a course of treatment every two weeks) and twenty three times radiotherapy (Gross Tumor Volume, GTV = 40Gy/20f; Planning Target Volume, PTV = 36 Gy/20f). After treatment, lymph nodes in the bilateral supraclavicular fossa disappeared. The total follow-up period was thirty three months after surgery. The repeated CT scans, abdominal ultrasonography and tumor specific growth factor every three months revealed no recurring or residual lesion.", "age": [ [ 37.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3141624.xml", "relevant_articles": { "8554112": "0", "26715530": "12", "16891197": "12", "17380443": "0", "25099172": "12" }, "similar_patients": { "4693434-1": "123", "3751155-1": "0", "5282821-1": "0", "8173411-1": "0", "3524032-1": "0" } }, { "human_patient_id": "65", "human_patient_uid": "4924495-1-M", "PMID": "27398253", "title": "Bi-lobed Perirectal Epidermoid Cyst: An Unusual Cause of Hematochezia in a Middle-aged Woman", "patient": "We report a case of a 58-year-old Spanish woman resident in New York who presented at our facility with complaints of constipation which had worsened over the past 6 months and onset of hematochezia of a 3 days duration. Her past medical history was statistically significant for schizoaffective disorder and gastroesophageal reflux disease.\nClinical examination revealed a healthy middle-aged woman with a body mass index of 28.1 kg/m2 and normal vital signs. The only abnormal finding on clinical examination was a palpable circumscribed mass compressing on her rectum by digital rectal examination. Her rectum was also filled with hard, pellet-like feces, and altered blood. Blood electrolytes were normal and complete blood count was also normal. Her admitting hematocrit was 46%, and fecal occult blood test was positive. Alpha-fetoprotein, carcinoembryonic antigen, and ca - 199 tumor markers were all normal. The patient was admitted and serial hematocrit measurements remained within normal limits. An upper gastrointestinal endoscopy on the 2nd day of admission showed gastritis.\nPelvic MRI [Figures and ] revealed a 7.5 cm \u00d7 5 cm \u00d7 6 cm cystic pelvic mass adherent anteriorly to the left lateral wall of the rectum and also adherent to the sacrum posteriorly. There were compression and displacement of the rectal lumen anteriorly and to the right. There was an absence of the uterus from a prior hysterectomy. There was no pelvic sidewall adenopathy or free fluid in the pelvis.\nThe clinical consideration at this juncture was the possibility of a developmental cyst with low considerations for cystic ovarian or rectal neoplasms due to negative relevant symptomatology and negative tumor markers. A colonoscopy revealed a significant narrowing of the rectum with mucosal erythema and inflammation but no active bleeding. There was no evidence of intra-luminal communication of the tumor.\nShe underwent an elective surgical excision in which the posterior trans-sacrococcygeal technique was utilized. The patient was positioned in the jackknife position, and a midline incision was made over the coccyx and deepened to the bone with resection of the coccygeal bone. The posterior rectal fat was carefully dissected utilizing both blunt, sharp dissection, and the mass [] was completely excised from surrounding structures. Grossly, the cyst was tan \u2013 colored, weighed approximately 0.8 kg and measured 10 cm \u00d7 6 cm \u00d7 7 cm in its greatest dimension. It contained a cheesy gelatinous material. Intraoperative flexible proctoscopy confirmed an intact rectum. The surgical wound was closed in layers with a size 10 Jackson-pratt drain left in situ. Pathology was compatible with the epidermoid cyst. No coccygeal involvement, no atypia or malignancy was identified on histology. She was subsequently discharged on the third postoperative day following drain removal. The patient remains recurrence-free 1 year postsurgical resection.", "age": [ [ 58.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC004xxxxxx/PMC4924495.xml", "relevant_articles": { "27398253": "123", "2083466": "0", "17952536": "0", "24393234": "123", "34392019": "0" }, "similar_patients": { "4581409-1": "0", "5997078-1": "0", "7106870-1": "123", "3295332-1": "123", "2827428-1": "123" } }, { "human_patient_id": "66", "human_patient_uid": "8314798-1-M", "PMID": "34336448", "title": "A Case of Ventricular Fibrillation in Asymptomatic COVID-19", "patient": "A 40-year-old male with no past medical history was found unconscious by bystanders after he had been out for a recreational jog. Upon the arrival of medical services, the patient was found to be in VF cardiac arrest and required two shocks before the return of spontaneous circulation. The downtime was reported to be about 15 minutes. Per history obtained from family members, the patient had never experienced any cardiac symptoms such as palpitations or chest pain and had no COVID-19 symptoms.\nThe patient had no significant personal medical history, took no medications, and exercised regularly with no difficulties. Family history was notable for coronary artery disease (CAD) in his brother, which had been diagnosed at age 50, and myocardial infarction (MI) in his father at age 72. There was no family history of sudden cardiac death.\nGiven the patient\u2019s young age and absence of underlying cardiac issues, the differentials for his VF arrest were broad. Etiologies considered included ischemic heart disease, structural heart diseases such as hypertrophic cardiomyopathy, anomalous origin of coronary arteries, myocarditis, arrhythmogenic right ventricular cardiomyopathy, primary electrical abnormalities such as long QT syndrome, and Brugada syndrome, and non-cardiac etiologies such as a massive pulmonary embolism (PE).\nA basic metabolic panel showed no significant electrolyte abnormalities. The initial troponin-T level was within normal limits. Electrocardiogram (ECG) on admission showed normal sinus rhythm, non-specific T-wave changes in anteroseptal leads, and a QTc of 445 ms (Figure ). A transthoracic echocardiogram (TTE) showed normal LV systolic and diastolic functions with no valvular pathology or regional wall motion abnormalities. A chest CT with PE protocol showed no significant pulmonary emboli. Per institutional policy, the patient was tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via nasopharyngeal swab polymerase chain reaction (PCR) test, which returned positive. A subsequent SARS-CoV-2 antibody test was also positive.\nThe patient was emergently intubated for airway protection and taken to the catheterization lab where coronary angiography showed non-obstructive proximal left anterior descending (LAD) artery disease with 55-60% stenosis and flow distal to the lesion with Thrombolysis in Myocardial Infarction (TIMI) score of 3. Left circumflex and right coronary arteries were disease-free (Figures , ). The left ventriculogram showed normal systolic function with no wall motion abnormalities. The patient was then admitted to the ICU for therapeutic hypothermia. He received convalescent plasma, remdesivir, and dexamethasone for his COVID-19 infection. During his ICU stay, he had one episode of monomorphic ventricular tachycardia (VT) in the setting of agitation and hypoxia that terminated spontaneously in less than three seconds. He continued to improve and was eventually extubated and discharged home.\nLater on, an outpatient single-photon emission CT (SPECT) pharmacological myocardial perfusion scan showed no anterior ischemia or scar (Figure ). A subsequent cardiovascular magnetic resonance (CMR) imaging showed normal LV and RV sizes and functions with no late gadolinium enhancement. The patient eventually received a single-chamber VVI implantable cardiac defibrillator (ICD) for secondary prevention of VF. Subsequent outpatient genetic testing with INVITAE\u00ae Arrhythmia and Cardiomyopathy Comprehensive Panel (Invitae, San Francisco, CA) revealed no genetic variants known to cause arrhythmia. At the one- and four-month follow-ups, the patient remained asymptomatic and ICD interrogation revealed normal sinus rhythm with no episodes of arrhythmia.", "age": [ [ 40.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC008xxxxxx/PMC8314798.xml", "relevant_articles": { "30532882": "0", "30100680": "0", "33173649": "0", "34786270": "0", "32219357": "0" }, "similar_patients": { "7292685-1": "12", "7793225-1": "123", "7824658-1": "123", "8015162-6": "0", "8664766-1": "123" } }, { "human_patient_id": "67", "human_patient_uid": "5972309-1-M", "PMID": "29872416", "title": "The Face-to-Face Still-Face (FFSF) Paradigm in Clinical Settings: Socio-Emotional Regulation Assessment and Parental Support With Infants With Neurodevelopmental Disabilities", "patient": "Peter and his family arrived to our clinical service when he was 14 months old. Perinatal anamnesis documented full-term birth after cesarean section with adequate extra-uterus adjustment, risk for insulin-dependent diabetes mellitus and reduced cranial diameters and good general health conditions at discharge from the Neonatal Intensive Care Unit (NICU). At 1 month, the analyses confirmed the significant reduction in brain volume. A diagnostic follow-up at 5 months documented the onset of epileptic seizures. Overall, Peter appeared to be easily dysregulated by moderate-to-high intensity stimulations and poor emotional regulation were reported.\nTo obtain more specific and fine-grained information on Peter\u2019s emotional regulation during a standardized observational procedure.\nDuring the Play episode, Peter was specifically sensitive to tactile (e.g., mother caressing) and auditory (e.g., mother singing) stimulations. In response to this kind of stimulations, Peter showed positive emotionality (e.g., rhythmic movements of the chest and arms together with wide mouth opening). During the Still-Face episode, Peter immediately appeared alert and sensitive to the suspension of maternal communication by exhibiting an immediate stress response (i.e., increase of motor activity and emergence of disorganized movements of the chest and arms). Interestingly, specific patterns of dyadic matching behaviors emerged including attempts to reach out with the arms directed to the mother\u2019s body while simultaneously seeking eye-contact with her in order to be picked up. Such relational regulatory strategies were something that Peter usually did not show when distressed, as he easily became disorganized.\nDuring the maternal unavailability episode Peter shows a clear ability to regulate his own behavior and emotions through relational strategies, something otherwise non-observable with a different observational procedure. Although such regulatory strategies may not be usual for the infant, it is clinically relevant to highlight that in response to specific relational and environmental adjustments (i.e., face-to-face interaction, lowered stimulation, enough time to organize other-directed attempts to self-regulate) Peter can access to more adaptive strategies to achieve regulation. This knowledge enriches the picture of Peter difficulties in self-stabilization and highlights a dyadic pattern to reinforce in order to support infant\u2019s socio-emotional regulation.", "age": [ [ 14.0, "month" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5972309.xml", "relevant_articles": { "17174607": "0", "20853543": "0", "25793693": "0", "2004871": "0", "33280810": "0" }, "similar_patients": { "6978278-1": "0", "5972309-2": "123", "6132374-2": "1", "4040883-1": "0", "8508312-1": "0" } }, { "human_patient_id": "68", "human_patient_uid": "5972309-2-M", "PMID": "29872416", "title": "The Face-to-Face Still-Face (FFSF) Paradigm in Clinical Settings: Socio-Emotional Regulation Assessment and Parental Support With Infants With Neurodevelopmental Disabilities", "patient": "Eleanor arrived at our clinical service with her family at 26 months of age for a behavioral evaluation. She had received a diagnosis of autism spectrum disorder with severe mental retardation (Development Quotient = 50; Bayley scales, ) 2 months before. The neuropsychiatrist who referred the case was worried about the apparent total absence of social and relational engagement of the child, even when the parent or the psychologist tried to elicit any response.\nTo explore Eleanor\u2019s sensitivity to the manipulation of maternal responsiveness.\nDue to Eleanor\u2019s age, the carpet setting was chosen. The father decided to participate in the FFSF paradigm with his daughter. Moreover, we decided to use a modified FFSF paradigm (i.e., prolonged 4-min-lasting Play episode) to give the infant more opportunities to exhibit some relational behavior. During the Play episode, Eleanor\u2019s attentional focus was mainly on objects (e.g., a toy-car) with very limited gazes to the father. The father pushed the toy car several times and when it hit the wall Eleanor produced screams of excitement without looking at the parent. When the Still-Face episode started, the father had already pushed the car for the umpteenth time. The car hit the wall and Eleanor showed the usual reaction. Nonetheless, as the father was not communicating with the infant in any way, after 30\u201340 s Eleanor produced intentional vocalizations directed to the father, approached him physically, exhibited a brief gaze directed to his face and attempted to hug the parent. Interestingly, when the Reunion phase started, the father tried to re-engage the child in the usual toy car game, but she seemed to be less interested and produced some negative emotional vocalizations (i.e., carry-over effect).\nThe use of the FFSF paradigm with Eleanor and her father allowed to observe something unexpected. First, it is certainly true that the lack of social responsiveness is a core feature of autism spectrum disorder and of Eleanor\u2019s functional behavioral organization. Still, it was evident that when the rupture in father\u2013infant interaction occurred, Eleanor started displaying more intentional and other-directed communicative behaviors to re-engage the father and to obtain physical proximity. Moreover, during the Reunion episode Eleanor also showed to the primary activation of a motivational system related to bonding and comfort that overcame the need and the pleasure to engage in ritualized play scripts. While taking into account her relational and communicative deficit, Eleanor showed an unexpected pattern of other-directed behavior in response to the caregiver\u2019s interactive change. In this case, the FFSF allowed to focus Eleanor\u2019s residual interactive competencies showing her contribution in mutual regulation processes. Here, the FFSF highlighted fine-grained information on dyadic matching and mismatching states, as well as the attempts of reparation performed by the child.", "age": [ [ 26.0, "month" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5972309.xml", "relevant_articles": { "25774280": "123", "30919751": "0", "12296876": "0", "7298409": "0", "24833270": "0" }, "similar_patients": { "5972309-2": "123", "5920445-1": "1", "5972309-1": "123", "7246703-1": "123", "5920445-2": "13" } }, { "human_patient_id": "69", "human_patient_uid": "5972309-3-M", "PMID": "29872416", "title": "The Face-to-Face Still-Face (FFSF) Paradigm in Clinical Settings: Socio-Emotional Regulation Assessment and Parental Support With Infants With Neurodevelopmental Disabilities", "patient": "Nicholas is a 5-month-old infant who was transferred to our Institute after 4 months of NICU hospitalization in the community hospital. He suffered from a severe neonatal injury with several cerebral lesions due to a prolonged hypoxia at birth. Nicholas\u2019 parents reported sad feelings and anger for the infant\u2019s condition. Moreover, they also found no pleasure in the interaction with Nicholas and they reported that, despite their attempts to stimulate him, he was totally unexpressive and unresponsive in daily interactions.\nTo discuss with the mother on these topics: (1) increasing maternal acknowledgment of Nicholas\u2019 regulation needs and communicative signals; (2) promoting more adaptive ways of interacting with him.\nDuring the Play episode, the mother talked loudly, moved the baby\u2019s hands with a directive style and repeatedly invited him to engage in singing together. Nicholas alternated fussiness and self-absorbed behaviors (i.e., lack of social responsiveness). During the Still-Face episode, Nicholas responded with the following behavioral sequence: (1) self-absorbed behaviors along with few rapid gazes directed to the mother, (2) rapid increase in fussiness and cry and behavioral disorganization, (3) a gradual stabilization with a prolonged state of mother-directed attention and positive emotionality while looking at the mother. As soon as the Reunion episode started, the mother rapidly tried to re-engage with Nicholas with the same high-energy and physical stimulations that characterized the Play episode. Nicholas reacted to these stimulations by becoming fussy and avoidant.\nThe consultation with Nicholas\u2019 mother had some pivotal moments. First, when the mother looked at Nicholas clearly smiling at her during the Still-Face episode she seemed to be surprised and she said \u201cI can\u2019t believe it. I didn\u2019t catch that during the session.\u201d This emergent state of curiosity and surprise about her infant\u2019s communicative behaviors allowed the psychologist to work with the parent on her mental representation of Nicholas\u2019 socio-emotional regulation functioning. Secondly, when the mother was watching the Reunion episode, the psychologist said: \u201cI wonder why he is getting fussy again.\u201d This open question facilitated some exchanges with the mother on the better ways to interact with Nicholas. Some key points emerged, such as the importance of (1) reducing the quantity and energy of physical contacts, (2) increasing the use of visual cues and emotional facial displays, (3) leaving more silent moments to allow Nicholas to achieve a stable behavioral state and to be more available to interact.\nDuring the consultation, Nicholas\u2019 mother was able to explore specific aspects of the interaction with the infant and better ways to repair interactive ruptures. In particular, she achieved a deeper acknowledgment of the relevance of his communicative behaviors and regulatory needs and she got access to more adequate ways to engage with him.", "age": [ [ 5.0, "month" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5972309.xml", "relevant_articles": { "8278086": "0", "5847188": "0", "28087522": "0", "24475510": "0", "26359435": "0" }, "similar_patients": { "5972309-2": "123", "5972309-1": "123", "8508312-1": "0", "5920445-2": "0", "4199089-1": "0" } }, { "human_patient_id": "70", "human_patient_uid": "5972309-4-M", "PMID": "29872416", "title": "The Face-to-Face Still-Face (FFSF) Paradigm in Clinical Settings: Socio-Emotional Regulation Assessment and Parental Support With Infants With Neurodevelopmental Disabilities", "patient": "Sarah was 8 months old when she first came to our clinical unit with her family. Sarah had a severe visual impairment. Moreover, Sarah\u2019s mother reported that she faced many challenges in trying to understand her daughter and interacting with her in a reciprocal satisfying way. The visual impairment of the infant was a great barrier for the mother, who reported feelings of sadness and inadequacy as a caregiver.\nTo support the mother in detecting communicative intent and participation in Sarah\u2019s behavior during the interaction and to increase the opportunity for the dyad to perceive more pleasure in their relationship.\nWe videotaped the FFSF paradigm with Sarah and her mother. During the Play episode, Sarah demonstrated to be able to orient her attention to auditory stimuli (e.g., maternal voice), but the mother rarely interpreted and responded properly to her orientation as communicative signals. The mother was frequently silent producing few attempts to engage with Sarah and remaining physically distant. The mother used the pacifier any time Sarah displayed minimal distress. The interaction appeared to be very difficult and \u2013 according to maternal reports \u2013 not very satisfying. During the Still-Face episode Sarah stood relatively quiet, with very few movements of the arms and legs. Nonetheless, a few seconds after the Still-Face episode onset she started to protrude in the direction of the mother, producing a lot more vocalizations compared to the Play episode and showing increased distress and negative emotionality. As soon as the Reunion episode started, the mother resumed to interact with Sarah and said: \u201cOh, you\u2019re here then!\u201d During the reunion phase the mother appeared more active in the interaction with her daughter and, after a period of negativity (i.e., 3040 s), Sarah displayed a smile toward her mother.\nDuring the consultation the Sarah\u2019s mother immediately said that she had never seen Sarah being so communicative and that the observation procedure \u201cliterally opened a new window in our relationship.\u201d Looking at Sarah\u2019s response to the Still-Face episode further allowed the mother and the psychologist to identify specific communicative behaviors which were previously undetected by the mother (e.g., active requests of being picked up, attentional focus on the mother, and sensitivity to maternal lack of communications). Moreover, the mother acknowledged that Sarah was indeed interested in interacting with her even in the presence of visual impairment. This increased acknowledgment of Sarah\u2019s availability and desire to interact, and was also an opportunity to set up a collaborative consultation on specific modalities to reach out to Sara and to achieve better emotional closeness and reciprocal satisfaction.\nThis clinical vignette suggests that the joint observation of FFSF promote in the Sarah\u2019s mother some changes in mental representation of her own infant. In turn, it reflects on subtle modifications in the maternal interactive style during interaction with Sarah.", "age": [ [ 8.0, "month" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5972309.xml", "relevant_articles": { "6566129": "0", "27618467": "0", "29799842": "0", "9689240": "0", "31012289": "0" }, "similar_patients": { "6746349-2": "0", "4138773-1": "0", "5972309-1": "123", "7246703-1": "123", "5920445-2": "0" } }, { "human_patient_id": "71", "human_patient_uid": "2812738-1-M", "PMID": "20142860", "title": "Primary Sj\u00f6gren's syndrome manifesting as multiple cranial neuropathies: MRI findings", "patient": "A 47-year-old woman presented with 2 days' history of right facial weakness and pain in the right periauricular area. Two months earlier she had had acute-onset deafness on the right side. The general physical examination was unremarkable. Neurological examination showed right lower motor neuron facial palsy and reduced taste sensation on the right half of the tongue. Hearing was reduced on the right side and the Rinne test and Weber test were suggestive of sensory neural hearing loss (SNHL).\nAlthough the erythrocyte sedimentation rate (ESR) was 105 mm/h, other routine laboratory investigations were normal. Magnetic resonance imaging (MRI) of the brain showed mild diffuse thickening and gadolinium enhancement of the duramater in the falx cerebri and cerebellar tentorium. Furthermore, an intensely enhancing, enlarged pituitary gland was also noted [Figures and ]. An audiogram revealed moderate right SNHL.\nReview of the patient's medical history showed that she had had complaints of a dry sensation of the mouth, burning eyes, and polyarthralgias for the past 2 years. Rheumatoid factor was positive at a titer of 53 IU/ml (normal: <15) and antinuclear antibody (ANA) was positive at a titer of 1.10 by the enzyme immunoassay technique (normal: <0.7). Antibodies to SS-A and SS-B were also strongly positive. Anti-ds DNA and antibodies to Sm, RNP, and Scl-70 were negative. Serum immune electrophoresis revealed no monoclonal gammopathy. Schirmer test showed decreased lacrimation and a lower labial biopsy showed significant lymphocytic infiltration []; these findings were consistent with the diagnosis of Sj\u00f6gren syndrome (SS). Nerve conduction study revealed bilateral mild carpal tunnel syndrome and right facial neuropathy. Additionally, a cerebrospinal fluid (CSF) study showed normal protein and sugar and a cell count of 5 cells/mm3 (all lymphocytes). Gram's staining and AFB staining of the CSF was normal and the VDRL test was negative. Serum angiotensin converting enzyme (ACE) level was also normal. In view of the pituitary gland infiltration, an endocrine workup was done. Thyroid function test, serum cortisol and ACTH levels, and the water deprivation test for diabetes insipidus were all normal; serum prolactin was mildly raised at 37.6 ng/ml (normal: 2-25 ng/ml). Based on these findings, we diagnosed primary SS, with probable lymphocytic CNS involvement. The patient was treated with IV methylprednisolone pulse therapy, with 1 g/day for three successive days, followed by 0.5 mg/kg/day oral prednisolone, with gradual tapering of the dose. Later, weekly methotrexate at a dose of 10 mg/week was added. Follow-up brain MRI after 6 months of treatment showed a minimal decrease in the pituitary gland enlargement and the meningeal thickening []. The patient's symptoms, except for the dryness of the mouth, resolved with treatment. Over the next 1 year, she had three episodes of transient diplopia due to lateral rectus palsy. She recovered from all these attacks within a few weeks after the dose of steroids was increased. Two years after the first evaluation, she was readmitted with acute-onset dysphagia, nasal regurgitation, and hoarseness of voice. On examination, she was found to have right IXth, Xth, and XIIth cranial nerve palsies, without any long tract signs or cerebellar signs. Repeat MRI did not reveal any fresh brainstem lesions. She was treated with a 3-day course of methylprednisolone injection (1 g/day) and recovered completely in 2 weeks' time.", "age": [ [ 47.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC002xxxxxx/PMC2812738.xml", "relevant_articles": { "16022467": "0", "19928688": "123", "7873285": "0", "30332362": "0", "23817300": "0" }, "similar_patients": { "6487149-1": "123", "3788296-1": "0", "3420584-1": "0", "3841634-1": "123", "4813064-1": "0" } }, { "human_patient_id": "72", "human_patient_uid": "4175602-1-M", "PMID": "25264532", "title": "Endometrial carcinoma arising in a bicornuate uterus", "patient": "A 65-year-old obese woman (gravida 3 and para 2) presented to a private clinic with a complaint of vaginal bleeding for 3 months, having been menopausal since age 55. The result of Pap smear was atypical glandular cells, favor neoplastic with negative HPV (human papillomavirus) DNA test. The patient had history of hypertension and hyperlipidemia. Her medications included estrogen replacement therapy and aspirin for 4 years.\nShe was referred to the Yonsei University Wonju Severance Christian Hospital for definitive diagnosis and therapy. Abdominal computed tomography revealed uterus didelphys with complete duplication of uterine horn and cervices and suspicious 2.0\u00d71.7-cm-sized, oval-shaped relatively soft tissue mass in right cervix. Abdominal ultrasonography result showed mild fatty liver change with two hepatic cysts in S6 (0.7 cm) and S7 (2.2 cm). PET-CT (positron emission tomography-computed tomography) revealed focal FDG (fludeoxyglucose) uptakes in the left uterine cavity.\nUterine endometrial and cervical biopsies were performed. The endometrial biopsy revealed malignant tumor, suggestive of undifferentiated carcinoma while cervical and endocervical biopsies showed inflammatory change.\nTotal abdominal hysterectomy, bilateral salpingo-oophorectomy, and staging workup (bilateral pelvic lymph node dissection and pelvic washings) were performed. At the time of surgery, it was determined that the patient had a bicornuate uterus. Gross examination revealed a bicornuate uterus () (left horn 6.5\u00d74\u00d73.5 cm, right horn 7\u00d74\u00d73 cm) with a single cervix (4\u00d73.5\u00d73 cm). On opening, the entire endometrium of left horn showed an ill-defined white-gray granular mass, measuring about 6\u00d74\u00d70.5 cm (). The endometrium of right horn was grossly unremarkable with focal granular irregularity in the lower uterine segment. The myometrium revealed two small leiomyomas in the right horn, measuring 2 cm in diameter in the larger one. The attached bilateral ovaries and tubes showed no gross abnormality.\nMicroscopic examination revealed a mixed endometrioid adenocarcinoma (80% component) () and undifferentiated carcinoma (20% component) () in the left endometrium. The endometrioid adenocarcinoma had less than 50% solid areas, hence designated as International Federation of Gynecology and Obstetrics (FIGO) grade II. Immunohistochemical stains showed positivity for EMA, CAM 5.2, estrogen and progesterone receptors in endometrioid adenocarcinoma component while undifferentiated carcinoma component showed no positivity (). The Immunohistochemical stain for cytokeratin showed diffuse positivity in endometrioid adenocarcinoma component and focal positivity in undifferentiated carcinoma component (). The tumor showed superficial invasion (0.4 cm in maximum depth) into the myometrium (2.5 cm in thickness). The endometrium of right horn showed a tiny focus of endometrioid adenocarcinoma, measuring less than 1 mm in diameter. The bilateral adnexae, parametria and pelvic lymph nodes were all free from tumor. The disease was consistent with FIGO stage IA (T1aN0Mx). Other histological findings were adenomyosis and leiomyomas in myometrium. The patient recovered from surgery and is receiving chemoand radiotherapy.", "age": [ [ 65.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC004xxxxxx/PMC4175602.xml", "relevant_articles": { "29779939": "123", "23327069": "0", "28277338": "0", "24842355": "123", "17175478": "0" }, "similar_patients": { "8134959-1": "0", "4160600-1": "0", "7465332-1": "0", "7841739-1": "0", "6360826-1": "0" } }, { "human_patient_id": "73", "human_patient_uid": "7519980-1-M", "PMID": "33014066", "title": "Polymyxin B-Induced Skin Hyperpigmentation", "patient": "A 68-year-old man presented with acute swelling of his right scrotum with obvious pain. His body temperature was 38.4\u00b0C. After physical and radiological examinations, the patient was diagnosed with right epididymitis with an abscess. He was admitted to the urological surgery department for antibacterial therapy for two weeks. Subsequently, he underwent a resection of the right epididymis and abscess. However, 24 hours after surgery, he experienced septic shock and was transferred to the intensive care unit for further treatment. A blood culture suggested a Klebsiella pneumoniae infection (KPI). The patient was treated with cefepime, imipenem, piperacillin-tazobactam, and tigecycline, but his symptoms did not improve. Subsequently, he was confirmed to have multidrug-resistant KPI. Polymyxin B (500,000 units, intravenous, q 12 hours) was administered with meropenem (2 g, intravenous, q 8 hours) and tigecycline (100 mg, intravenous, q 12 hours), and his symptoms improved. On the 8th day of polymyxin B therapy, the patient developed a red, scattered, dotted, pruritic rash on his trunk and limbs. On the 14th day of polymyxin B therapy, the rash subsided and the pruritus slightly improved; however, the patient's face and neck changed from a normal yellow color to a slightly black color. Despite this adverse event, polymyxin B therapy was continued for a total of 17 days due to its effectiveness against the multidrug-resistant KPI. Seven days after the withdrawal of polymyxin B, the color of the patient's face and neck was completely black (). The patient's scalp and feet underwent desquamation, which lasted for 10 days. Cod liver oil ointment was administered three times a day to lubricate and protect the newly grown epidermis. The patient was advised to let the skin layer fall off naturally and not to peel it in order to prevent a skin infection.\nOne nurse was assigned to care for the patient and record the changes in hyperpigmentation daily. The patient and his family were counseled regarding the psychological effects of the hyperpigmentation. Twenty-four days after the withdrawal of polymyxin B, the skin around the patient's eyes and nose began to fade significantly, followed gradually by the whole face and neck. The desquamation of the patient's feet improved. Sixty days after the withdrawal of polymyxin B, the hyperpigmentation of the patient's face and neck skin was almost entirely resolved ().", "age": [ [ 68.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7519980.xml", "relevant_articles": { "33014066": "123", "32386075": "123", "29973293": "12", "19202043": "0", "31467732": "0" }, "similar_patients": { "5623770-1": "0", "3228238-2": "0", "4065743-1": "0", "3228238-1": "0", "5813425-1": "0" } }, { "human_patient_id": "74", "human_patient_uid": "8043562-1-M", "PMID": "33889340", "title": "Gadolinium-based coronary angiography in a patient with prior known anaphylaxis to iodine-based dye", "patient": "We present the case of a 63-year-old female with prior percutaneous revascularizations after a single vein bypass graft to the left anterior descending artery, presented with Canadian Cardiovascular Society (CCS) Angina Grade III. Physical examination and laboratory were unremarkable. She had a history of known, severe, life-threatening anaphylactic reactions to previous iodinated dye usage leading to respiratory arrest requiring intubation (despite adequate prophylaxis with steroids and antihistamines). Given her prior history of anaphylactic reaction to iodinated contrast, progressive escalation of medical therapy without repeat angiography was recommended. However, the patient continued to experience a progressive decline in quality of life despite maximal medical therapy. Therefore, coronary and bypass graft angiography was recommended. Coronary and bypass graft angiography was performed using 24 cc of undiluted Gadodiamide (OMNISCAN) with a power injector (ACIST\u00ae) without any incidents or premedication. The patient\u2019s coronary artery disease was essentially unchanged from her prior angiogram () and further intensification of anti-anginal therapy was recommended. Patient was monitored for 24 hours for arrhythmia and had repeat renal function in 24 hours and one-week post procedure, were within the normal limits.", "age": [ [ 63.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC008xxxxxx/PMC8043562.xml", "relevant_articles": { "33889340": "123", "19797832": "12", "12546322": "0", "33643727": "0", "33425567": "0" }, "similar_patients": { "7319803-1": "123", "8186911-1": "0", "8229972-1": "0", "6456877-1": "0", "7790304-1": "0" } }, { "human_patient_id": "75", "human_patient_uid": "3809230-1-M", "PMID": "24353598", "title": "Intragastric rupture of splenic artery aneurysms: Three case reports and literature review", "patient": "A 51-year-old cirrhotic man presented with abdominal pain for one day. He then had a sudden upper gastrointestinal bleeding and a contrast-enhanced computed tomography (CT) demonstrated that a ruptured SAA located near to splenic hilum and formation of hematoma in left epigastric region (). Further ultrasonography confirmed liver cirrhosis and ascites. He underwent an urgent laparotomy. After dissection of severely adhered tissues, a pulsatile mass approximate 4.8 cm\u00d75.6 cm\u00d74.9 cm was found closely adhensive to stomach and splenic hilum. SAA resection, splenectomy, gastric suture and conventional splenorenal shunt were performed thereafter and the recovery was uneventful.", "age": [ [ 51.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3809230.xml", "relevant_articles": { "28468689": "123", "20035097": "12", "24790764": "0", "32587452": "123", "32047630": "123" }, "similar_patients": { "2803867-1": "123", "5798071-1": "123", "5043529-1": "123", "6663117-1": "0", "4593983-1": "0" } }, { "human_patient_id": "76", "human_patient_uid": "3809230-2-M", "PMID": "24353598", "title": "Intragastric rupture of splenic artery aneurysms: Three case reports and literature review", "patient": "A 42-year-old man presented with sudden abdominal pain and hematochezia for one day. He had a past history of splenoectomy three years prior for traffic injury. He was alcoholic and was once diagnosed as alcoholic cirrhosis. On admission, he was hypotensive at 91/60 mm Hg, and tachycardia with a pulse of 118 beats/min. Upon physical examination, he was found to have a distended abdomen and slight tenderness in periumbilical region, and the shifting dullness sign were noted. Ultrasonography of the abdomen revealed liver cirrhosis, massive ascite. Apart from slightly decreased hemoglobin 11.6g/dL, all other laboratory examinations were unremarkable. He was admitted to gastroenterology ward under the diagnosis of bleeding esophageal varices or peptic ulcer and decompensated alcoholic cirrhosis with ascites.\nAfter his admission, he complained of a progressive distending abdomen and underwent a paracentesis which showed a bloody ascite. Another check of hemoglobin decreased to 8.9 g/dL and an urgent contrast-enhanced CT demonstrated giant hematoma in lesser sac and peri-pancreatic space. Subsequently, he underwent emergency laparotomy and two liters of blood and was found in the abdomen. Severe adhesions were encountered in the peritoneal cavity. Following a careful dissection of severely adhered tissues and removal of clots, blood was suspected to be oozing from the gastric coronary vein, which was sutured subsequently and the patient was sent to intensive care unit. From then on, hemoglobin fluctuated around 11.5 g/dL in the following 66 hrs, followed by a sudden decrease to 9.6 g/dL and 7.5 g/dL on 4th day postoperation. Bedside ultrasonography and contrast-enhance CT demonstrated hematoma again in lesser sac and peri-pancreatic space. Therefore, digital subtraction angiography (DSA) of celiac and superior mesenteric arteries were performed which showed a 2-cm-diameter saccular aneurysm that arised from the middle-distal splenic artery. The aneurysm disappeared after embolization with multiple coils placed in splenic artery segments proximal and distal to the aneurysmal neck (). Unfortunately, the patient underwent a second laparotomy because of his hemoglobin kept dropping. After careful clean of 1000 ml blood and clots, a ruptured and bleeding SAA was found to be tightly adhensive to the neighbouring posterior wall of the stomach. Partial pancreatectomy involving pancreatic tail and aneurysm resection, and gastric suture were performed, after which the patient had an unremarkable recovery and was discharged 20 days later.", "age": [ [ 42.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3809230.xml", "relevant_articles": { "31885937": "123", "31317221": "0", "18344639": "0", "21392850": "0", "20035097": "0" }, "similar_patients": { "4005481-1": "123", "8605961-1": "0", "7744231-1": "12", "6100622-1": "13", "6820883-1": "0" } }, { "human_patient_id": "77", "human_patient_uid": "3809230-3-M", "PMID": "24353598", "title": "Intragastric rupture of splenic artery aneurysms: Three case reports and literature review", "patient": "A 63-year-old man presented to the emergency department with epigastric pain, malaise, and hematochezia for one day. Except for a history of aortic valve replacement three years ago, there was no other remarkable pertinent finding in his medical history. The patient was afebrile, conscious and haemodynamically stable at triage. After a non-enhanced abdominal CT which demonstrated left renal infarction and suspected acute pancreatitis, the patient was admitted to gastroenterology ward with the diagnosis of upper gastrointestinal bleeding, left renal infarction and possible acute pancreatitis. Upon his arrival on the ward, he suddenly became hypotensive and collapsed, and was found to have profuse sweating. After fluid resuscitation, the patients regained consciousness soon. Emergency contrast-enhanced abdominal CT revealed splenic artery aneurysm rupture and intraabdominal bleeding, left renal and splenic infarction (). Unfortunately, he developed massive bleeding from upper gastrointestinal tract and subsequently cardiopulmonary arrest. Cardiopulmonary resuscitation was unsuccessful and the patient expired. The case was finally diagnosed as infective endocarditis complicated with ruptured infections splenic artery aneurysm and infarction of spleen and left kidney.", "age": [ [ 63.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3809230.xml", "relevant_articles": { "23535580": "0", "22698828": "0", "32587452": "12", "26425272": "0", "12751013": "0" }, "similar_patients": { "8581505-1": "0", "5116513-1": "0", "5661138-1": "0", "3396346-1": "0", "4891546-1": "0" } }, { "human_patient_id": "78", "human_patient_uid": "3853606-1-M", "PMID": "24349847", "title": "Periapical Infection Masquerading as a Nasal Pustule", "patient": "A 28-year-old male presented at the Restorative dental clinic, University of Benin Teaching Hospital, Benin City, Nigeria with a discolored maxillary left central incisor (tooth #11) of 4 years duration [], patient could not remember what happened to the tooth, examination of the tooth revealed Ellis class I fracture on the mesial incisial edge of the tooth. However, there was no carious lesion on the tooth. Pulp sensibility test with electric pulp tester was not responsive, and periapical radiolucency was evident in the periapical radiograph. Root canal treatment was commenced on tooth #11 immediately, through an access cavity on the palatal surface of the tooth. The canal was irrigated with 0.9% saline and 2.5% sodium hypochlorite solution. Intracanal medicament (calcium hydroxide) was placed in the canal, and the access cavity was temporarily sealed with zinc oxide eugenol. Patient was given a 2 day appointment for determination of working length of the tooth since the working length was not determined during the initial visit because of time constrains and continuation of the root canal treatment. Patient showed up for his appointment, examination revealed that the tooth was asymptomatic, but there was a discharging sinus in the floor of the right nostril [].\nA further history revealed that the patient had been under the care of an Otorhinolargngologist for about 2 years for the treatment of the discharging sinus that he had been on several antibiotics, which he could not remember their names. The temporary seal and intracanal medicament were removed and the canal was checked using paper points, pus was revealed in the canal. Canal was the irrigated with 2.5% sodium hypochlorite and 0.9% saline alternatively. The working length was established at 29 mm using radiographic method [].\nBiomechanical preparation of the canal was done using the step back under copious irrigation. Non-setting calcium hydroxide dressing was placed in the canal as inter-appointment medicament and the patient was giving a 4 week appointment. Patient returned 4 weeks later symptom free and complete healing of the sinus in the floor of the right nostril. Canal was obturated with guttapercha using the cold lateral condensation technique []. Access was sealed with glass ionomer cement and the patient was given a 1 month review appointment. Review after 1 month showed that the patient was asymptomatic, and there was no sinus in the floor of the nose, Subsequent reviews at the 3 months and 6 months revealed no symptoms.", "age": [ [ 28.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3853606.xml", "relevant_articles": { "34760068": "13", "2641427": "0", "22814696": "123", "23112492": "123", "33950926": "0" }, "similar_patients": { "3740659-2": "13", "3636845-1": "13", "3192519-1": "123", "5093245-3": "123", "4127701-1": "123" } }, { "human_patient_id": "79", "human_patient_uid": "6397822-1-M", "PMID": "30842957", "title": "Congenital analbuminemia in a patient affected by hypercholesterolemia: A case report", "patient": "A 39-year-old woman with history of hypercholesterolemia referred asthenia and heaviness in both legs. She had sedentary lifestyle, balanced diet and did not complain intestinal issues.\nHer weight was 56 kg, height 170 cm, body mass index 19 kg/m2, waist circumference 73 cm and her blood pressure was tested at a value of 13/10 KPa.\nShe was born from healthy and non-consanguineous parents and her development was normal. She had not familiarity for early cardiovascular disease, and did not report personal history of hypertension, chronic kidney or liver diseases.\nDuring her life she needed hospitalizations for a miscarriage (28 years old) and a delivery of a healthy male newborn by caesarean section (30 years old). The pedigree of her family is reported in Figure and shows the premature death of one of her brothers for unknown reasons at the age of 1 wk.\nThe patient\u2019s lipid profile showed a significant elevation of the total (321 mg/dL), low-density lipoprotein (LDL) (161 mg/dL) and high-density lipoprotein (HDL) (118 mg/dL) cholesterol, whereas triglyceride levels were normal. Serum apolipoprotein-A and -B were 291 mg/dL (n.v. 115 mg/dL-210 mg/dL) and 145 mg/dL (n.v. 55 mg/dL-135 mg/dL) respectively.\nSince the patient and her relatives had neither clinical history nor physical signs (xanthoma and xanthelasma) of a genetic hypercholesterolemia, we studied other possible causes of her dyslipidemia through further laboratory tests. Blood count, liver and kidney function, coagulation tests, autoimmunity assays, PCR and urine dipstick were normal. Thyroid function tests displayed a subclinical hypothyroidism. Albumin level, detected by nephelometric method, was critically reduced (0.2 g/dL, n.v. 3.4 g/dL-5 g/dL) and total bilirubin was undetectable. Calcium level was 7.5 mg/dL (n.v. 8.5 mg/dL-10.1 mg/dL), total protein 5.8 g/dL (n.v. 6.4 g/dL-8.2 g/dL), pre-albumin 0.46 g/L (n.v. 0.2 g/L-0.4 g/L). Finally, serum protein electrophoresis (Figure ) showed the presence of a minimal amount of serum albumin (1.6%, n.v.55.8%-66.1%), with a simultaneous increase of the other serum protein fractions (alpha-1, alpha-2, beta-1, beta-2 and gamma), including transferrin (607 mg/dL, n.v. 200 mg/dL-360 mg/dL), alpha 1-antitrypsin (2.56 g/L, n.v. 0.9 g/L-2.0 g/L) and complement C4 (0.46 g/L, n.v. 0.10 g/L-0.40 g/L). Those seemed to compensate the lack of albumin[] .\nThese findings led us to investigate on the patient\u2019s hypoalbuminemia. Proteinuria was excluded by normal spot urine albumin/creatinine ratio and total protein/creatinine ratio. Other possible secondary causes of hypoalbuminemia, such as inflammatory state and insufficient hepatic synthesis, were ruled out by normal laboratory tests and abdominal ultrasonography. The latter was negative except for mild hepatic steatosis. All the other examined members of the family (her parents, her brother, and her son) showed albumin level close to the upper limit of the normal range, suggesting that they may be heterozygous for a variation in the ALB[] . For the above reasons, we tested the hypothesis of CAA by mutation analysis of the ALB[]. After we obtained informed consent, we collected blood samples from all the available members of the family and two unrelated healthy volunteers as a control, and extracted genomic DNA from whole blood. For a rapid identification of variations in the ALB, we used a gel-based mutation detection strategy, which we developed and applied to the identification of many other cases of CAA[]. Shortly, we PCR amplified the fourteen genomic fragments of the ALB encompassing the fourteen coding exons and their intron-exon junctions, using the specific primer pairs described by Watkins et al[] . The fragments were then examined by heteroduplex and SSCP analysis: The combination of these two techniques usually allowed us to identify the region of ALB containing the molecular defect, which was then submitted to direct DNA sequencing[]. In the present case heteroduplex analysis clearly indicated that the only detectable change in both homozygous and heterozygous samples occurred in the 386 bp long region amplified by using PCR primers A23A and A24A encompassing exon 12 and the intron 11-exon 12 and exon 12-intron 13 junctions (Figure ). All the other members of the family are heterozygous, since they show the presence of four bands corresponding to homoduplex and heteroduplex PCR products (Figure , lanes 2, 2\u2032, 3, 3\u2032, 4, 4\u2019 5, 5\u2019). The homozygous sample (Figure , lanes 1 and 1\u2032) revealed only one band but with a different mobility when compared with controls (Figure , lanes 6, 7, 6\u2032, and 7\u2032). No variation due to conformation polymorphism could be seen under these electrophoretic conditions (data not shown). The results of the DNA sequence analysis performed on the abnormal fragment showed that our patient is homozygous for a CA deletion near the 3\u2032 end of exon 12, at nucleotide positions c. 1614-1615, according to the Human Genome Variation Society rules, i.e,. starting from the initiator codon (Figure ). The subsequent frame-shift should give rise to a predicted translation product of 516 amino acid residues instead of the 585 found in the mature protein (p.Leu540Phefs*2), in which the sequence Cys(538)-Thr-Leu-Ser has been changed to Cys(538)-Thr-Phe-Stop. Unfortunately, we could not perform a search for this truncated variant in the serum of our patient, but no evidence was found so far for the presence of the putative albumin molecule produced in all the cases of CAA studied at the molecular level[,]. The electropherograms from the parents confirmed that they are both heterozygous for the same mutation (data not shown). This result brought to the molecular diagnosis of CAA in our patient.\nBased on the biochemical findings and on the mutation analysis of the ALB the final diagnosis was CAA and hypercholesterolemia, the latter not of genetic origin.\nCAA did not require albumin infusions, while hypercholesterolemia was successfully treated with atorvastatin. A low-cholesterol, low-saturated fat diet was prescribed without any significant effect on serum lipid (total cholesterol increased from 321 mg/dL to 334 mg/dL, LDL from 161 mg/dL to 192 mg/dL). Successful and well tolerated treatment with atorvastatin was started at the initial daily dose of 10 mg od, increased to 20 mg od: From baseline total and LDL cholesterol dropped by 23% and 47% respectively, HDL cholesterol increased by 22% while apolipoprotein-B decreased by 25%. Apolipoprotein-A showed no relevant modifications. This observation together with the low blood pressure might explain why, despite the high lipid levels, evident clinical signs of early atherosclerosis have not been observed in the patient[]: No plaques on carotid artery walls where found at ultrasound imaging study.\nThe patient undergoes clinical and laboratory follow-up twice a year. Atorvastatin treatment appears to be successful and well tolerated and so far she never needed albumin infusions.", "age": [ [ 39.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC006xxxxxx/PMC6397822.xml", "relevant_articles": { "30842957": "123", "30504296": "0", "9381993": "0", "18993152": "123", "27235445": "2" }, "similar_patients": { "7063871-1": "123", "3995635-1": "0", "3598816-1": "1", "4172812-1": "0", "4777904-1": "1" } }, { "human_patient_id": "80", "human_patient_uid": "5363123-1-M", "PMID": "28281481", "title": "A novel method of minimally invasive rectus abdominis muscle flap harvest: Laparoscopic surgeons take note", "patient": "A previously healthy 52-year-old female was diagnosed with a partially obstructing rectal cancer 8 cm from the anal verge. The patient underwent neoadjuvant chemoradiation followed by a robotic ultra-low anterior resection with a stapled anastomosis and proximal diversion. At 2-month post-operatively, a rectovaginal fistula was noted. The patient underwent a perineal repair of the fistula with gracilis muscle interposition flap. The loop ileostomy was reversed after endoscopic and radiological evidence of fistula healing. The fistula recurred 1 month later necessitating another ileostomy. Four weeks later, the fistula was repaired trans-abdominally as described below.\nA 5 cm Pfannenstiel incision was made and extended down to the anterior rectus sheath which was divided transversely. Flaps were created superiorly and inferiorly separating the rectus muscle from the anterior fascia followed by division of the peritoneum in the midline to enter the abdomen. Three 5-mm trocars were placed at the umbilicus, the right and left lower quadrants. After laparoscopic resection of the previous anastomosis and take down/repair of the fistula, a redo ultra-low anterior resection was performed with a transanal inter-sphincteric resection, coloanal pull-through and a hand-sewn anastomosis.\nThe left rectus muscle was then harvested in a laparoscopic-assisted fashion through the Pfannenstiel incision without longitudinal division of either anterior or posterior rectus sheaths []. The rectus muscle was divided superiorly at the level of the costal margin and inferiorly at the pubis while preserving the deep inferior epigastric vessels. The flap was then rotated and transposed between the rectum and the vagina and held by interrupted sutures. The transverse anterior rectus sheath incision was closed primarily. The total operative time was 4 h while the rectus harvest time was less than 45 min. The patient's post-operative course was uneventful with minimal pain, and the patient was discharged home after 6 days. The patient continued to do well at 4-month follow-up without any evidence of fistula recurrence or hernia formation.", "age": [ [ 52.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5363123.xml", "relevant_articles": { "33216503": "13", "28281481": "13", "33216502": "13", "8643728": "1", "10946930": "123" }, "similar_patients": { "2729290-1": "13", "3205369-1": "0", "7966635-1": "1", "7934615-1": "1", "6983492-1": "123" } }, { "human_patient_id": "81", "human_patient_uid": "7581149-1-M", "PMID": "33120806", "title": "Clinical characteristics and management of primary granulocytic sarcoma of the oral cavity", "patient": "A 49-year-old woman hospitalized at the Department of Plastic and Maxillofacial Surgery, presented with a growing mass in her left maxillary hard palate dating 2 months back. She was diagnosed with an oral ulcer at a local clinic, and received antibiotics. However, the symptoms did not improve; the mass became bigger and painful. Her past medical history was unremarkable without any systemic disease. No obvious physical findings were noted during general examination. She had no bouts of fever, chills, night sweats, vomiting, or weight loss. The intraoral examination revealed that there was a mass measuring 3.0 cm \u00d7 2.0 cm in size, with ulcerated surface mucosa in the left maxillary hard palate (Fig. ).\nTo obtain a definitive diagnosis, an incisional biopsy of the oral mass was performed under local anesthesia. Histologic examination using hematoxylin and eosin staining revealed that there was diffuse cell infiltration growth. Most cells were large, with vacuolated nuclei, obvious nucleoli and a basophilic cytoplasm containing granules (Fig. ). For the final diagnosis, immunohistochemistry (IHC) was performed, and the tumor cells tested positive for MPO, CD4, BCL-2, KI-67 (Fig. ), and CD117 and negative for CD3, CD5, CD20, CD56, bcl-6, Mum-1, CD123, MUM-1, TdT, Syn, SOX11, and C-myc. These results supported the diagnosis of GS.\nThe patient was then referred to the Hematology Department. Bone marrow aspiration was negative for malignant cells, and the laboratory test results revealed only monocytosis. Standard bone marrow cytogenetic analysis showed a normal karyotype and leukemia-related fusion gene detection was normal. Therefore, according to IHC and bone marrow aspiration results in combination with morphological features, the final diagnosis was intraoral primary GS.\nA chemotherapy regimen comprising idarubicin 8 mg VD d1\u20133 and cytarabine arabinoside 150 mg VD d1\u20137 idarubicin and cytarabine arabinoside was initiated. During chemotherapy, the patient only appeared mild nausea, vomiting and canker sores (grade II). These symptoms gradually eased without special therapy. After 2 cycles of idarubicin and cytarabine arabinoside regimen chemotherapy, the patient achieved complete remission. The tumor was barely visible in the left maxillary hard palate (Fig. ). The patient denied consolidation therapy or bone marrow transplant. Nevertheless, there has been no evidence of disease spread and progression after 1 year of follow-up.", "age": [ [ 49.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7581149.xml", "relevant_articles": { "33120806": "123", "2541189": "0", "8916314": "13", "8290968": "13", "23077109": "13" }, "similar_patients": { "8036079-1": "13", "6839179-1": "123", "7323804-1": "123", "7812042-1": "0", "6485888-1": "0" } }, { "human_patient_id": "82", "human_patient_uid": "4178198-1-M", "PMID": "25276482", "title": "Absent portal vein bifurcation: a rare variant and its clinical significance", "patient": "A 24-year-old-female patient reported to surgical outdoor with history of constipation, mild vague abdominal pain for 1 week. Menstrual cycle was regular. On examination, the vitals were stable. Central nervous system and cardiorespiratory system examination was normal. Abdomen was soft and non tender on palpation and revealed normal bowel sound on auscultation. Complete blood count and urine examination was normal. The patient had normal report of abdominal ultrasound study which was carried out two days back in private diagnostic center. Contrast-enhanced CT scan of abdomen was performed in our hospital after oral and intravenous contrast administration to the patient for further evaluation. Liver showed three hepatic veins such as right hepatic vein, middle hepatic vein and left hepatic vein draining to inferior venacava (). The hepatic veins are of normal caliber. MPV revealed single IHPV without bifurcation () entering the right lobe of liver, coursing anteriorly in an arch like pattern with decreasing caliber to reach the left lobe of liver and giving rise to segmental branches to both lobes of liver. The MPV caliber was normal and measures about 9 mm in diameter. Thick maximum intensity projection axial and oblique images showed MPV behind pancreatic neck, absence of MPV bifurcation at porta hepatis, single IHPV entering right lobe of liver, giving rise to segmental braches to both lobes of liver (). Both lobes of liver were of normal size. No intrahepatic biliary channel dilation was seen. Abdominal organs, bowel loops, and retroperitoneum were unremarkable in the abdominal CT study. The normal anatomical pattern of portal vein and hepatic veins in CT study of abdomen in another patient was shown in for comparison.", "age": [ [ 24.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC004xxxxxx/PMC4178198.xml", "relevant_articles": { "26465196": "0", "18216535": "0", "29214994": "0", "9922193": "0", "21107569": "12" }, "similar_patients": { "8511717-1": "0", "7576830-2": "0", "3932579-1": "0", "8067891-1": "0", "6805583-1": "0" } }, { "human_patient_id": "83", "human_patient_uid": "6188182-1-M", "PMID": "30349293", "title": "Complete response associated with lenalidomide and celecoxib in a case of primary refractory Hodgkin lymphoma", "patient": "A 35-year-old mentally disabled woman with a psychiatric history of obsessive behavior in childhood and anxiety disorder consulted the dermatology department for generalized pruritus. She was diagnosed with atopic dermatitis which resolved after corticoid-based therapy. In 2005, she was referred to our department because of laterocervical lymphadenopathies and night fever with intense sweating. Body computed tomography (CT) showed supra- and infra-diaphragmatic lymphadenopathies with various abdominal masses, the most relevant being 8\u00d76\u00d78 cm3. A biopsy of a lymphadenopathy revealed NS classic HL. With a final diagnosis of NS HL stage IIIB with an International Prognostic Score 2, she received six cycles of ABVD chemotherapy regimen with partial response and an early relapse in March 2006 (primary refractory to ABVD). This was followed by a salvage chemotherapy regimen (two cycles of ESHAP) with no response. In September 2006, a third chemotherapy regimen (four cycles of GemOx) was initiated with neutropenia and thrombocytopenia grade 4, which led to dose-intensity failures followed by chemotherapy discontinuation and radiotherapy consolidation. One month after the last radiotherapy session, the HL progressed; so, two cycles of IFE regimen were given with stable disease. Considering the basal comorbidities of the patient, we decided to pursue a watch-and-wait policy from 2008 to 2010, treating localized areas of progression with radiotherapy and obtaining transient partial responses (). In October 2010, a new mass appeared in D8\u2013D9, presenting with a medullar compression syndrome. After a biopsy that confirmed HL relapse, it was treated with radiotherapy and six cycles of GemOx, which led to a partial response. However, a new progression occurred in the left cervical and axillary nodes within 1 month, which was observed with a watch-and-wait policy with the consent of the family.\nIn May 2012, our patient presented a new clinically symptomatic disease progression confirmed by positron emission tomography (PET)/CT, requiring bendamustine 90 mg/m2 and finally reaching disease stability. In August 2014, the HL progressed again with significant B symptoms and worsening clinical status (). At this point, based on our experience of the potential role of COX-2 expression in HL, and that the patient was not a candidate for intensive chemotherapy and brentuximab was still not available in our center, we decided to start an experimental treatment with celecoxib 200 mg every 12 hours and lenalidomide 20 mg (for 3 of every 4 weeks). This regimen was obtained through a compassionate use request. Our patient received this treatment from August 2014 to January 2015 (six cycles) with unremarkable toxicity and excellent tolerance, finally showing a CR for the first time in both the interim after three cycles and the final CT/PET after six cycles (). This response was maintained in a new CT scan in August 2015. After this induction, we started 1 year of celecoxib maintenance (200 mg/12 hours) that had to be stopped because of anemia due to gastrointestinal bleeding in March 2016.\nIn July 2016, with the most durable response until that moment being 22 months, our patient presented a new disease relapse. CT/PET showed supra- and infra-abdominal adenopathies with associated hepatic and splenic lesions. As two different biopsies of hypermetabolic locations resulted negative and keeping in mind the asymptomatic situation of our patient, we decided to restart celecoxib 200 mg every 12 hours. In this context, the disease progressed to ascites requiring paracentesis. Biopsies were constantly negative until February 2017, when a final biopsy confirmed the persistence of HL. At that point, we decided to start brentuximab vedotin (two cycles). During the second cycle of brentuximab, the patient required intensive care admission due to a sepsis with a fatal outcome.", "age": [ [ 35.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC006xxxxxx/PMC6188182.xml", "relevant_articles": { "32170052": "1", "19608615": "12", "22034208": "12", "30349293": "123", "28937297": "12" }, "similar_patients": { "5019433-1": "0", "5036553-1": "12", "6458937-1": "12", "4053181-1": "12", "8161821-1": "0" } }, { "human_patient_id": "84", "human_patient_uid": "7533082-1-M", "PMID": "33024597", "title": "Case report of hyperacute edema and cavitation following deep brain stimulation lead implantation", "patient": "A 66-year-old female presented to our clinic with the mixed diagnosis of essential tremor and Parkinson\u2019s disease, as she had both resting and action components of tremor in bilateral upper extremities with bradykinesia and rigidity that were somewhat improved on levodopa. The tremor was largely refractory to medication and interfered with her quality of life. She underwent bilateral DBS lead electrode implantation targeting the dentatorubrothalamic tract, specifically, the ventral intermediate nucleus (Vim), in the thalamus using the standard stereotactic protocol.[] A trajectory through the ventricle was avoided. Normally, we start by implanting the microelectrodes on the more symptomatic side and then proceed to the other side. In this case, three microelectrodes were simultaneously descended to target the left Vim (as her symptoms were worse in her right hand) first, followed by another three microelectrodes to target the right Vim. Their cannulas were used for macrostimulation to assess for improvement and to choose the best trajectory. Electrode placement (Medtronic 3387 model, Minneapolis, MN, USA) then occurred after confirmed improvement in tremor. The rostral ends of the electrodes were left in a subgaleal pocket to be accessed during a subsequent staged procedure for extension and pulse generator placement. The lead placement was verified in the operating room theater with computed tomography (CT) imaging before closure. Surgery was uncomplicated, and the patient remained interactive and conversant throughout. She was admitted to our neurosurgical ICU as per routine. Head CT performed on early postoperative day (POD) 1 was unremarkable []. Physical examination revealed no deficit; the patient complained of headache with some nausea/vomiting. She desired to stay overnight. An examination later on the evening of POD 1 found her to be sleepy, and ultimately lethargic. Stat head CT performed revealed marked left-sided peri-lead edema extending into the centrum semiovale with cystic cavitation and trace right-sided edema []. Physical examination on the morning of POD 2 revealed the patient to be alert but with global aphasia (not following commands and not speaking), right-sided neglect, and plegic right upper extremity. Corticosteroids (IV dexamethasone) were begun early on POD 2. She later became increasingly lethargic, and over concerns for airway protection was intubated. Repeat head CT revealed increased edema.\nThe critical care team was concerned for fulminant gas- producing bacterial infection as suggested by neuroradiology interpretation of cavitation surrounding one lead and strongly pushed for lead removal, which was resisted. Vancomycin and meropenem were empirically begun. Systemic tests for infection, including C-reactive protein, erythrocyte sedimentation rate, and white blood cell counts, were normal, as well as blood cultures, which were ultimately negative at 24, 48, and 72 h. Such negative infectious workup and lack of change on serial repeat imaging disproved this idea. Magnetic resonance imaging could not be performed due to safety concerns at our institution with an incomplete DBS circuit. Acute venous infarction was also considered a possibility, but the radiological appearance of a cortical- subcortical typically wedge-shaped ischemic pattern was not present.[] This patient ultimately underwent tracheostomy and percutaneous endoscopic gastrostomy placement 6 days later. She was transferred to a rehabilitation facility on a steroid taper and subsequently discharged home on POD 40. She returned to the clinic 3 months after surgery fully recovered and ready for lead extension and pulse generator placement. Follow-up CT scans at the time showed significant resolution of the peri-lead edema and cystic cavitation [].", "age": [ [ 66.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC007xxxxxx/PMC7533082.xml", "relevant_articles": { "33024597": "123", "28208150": "123", "15642861": "0", "8748831": "0", "33408929": "0" }, "similar_patients": { "5391613-1": "123", "6744830-1": "123", "5990850-1": "0", "4863081-1": "0", "3589868-2": "0" } }, { "human_patient_id": "85", "human_patient_uid": "5996414-1-M", "PMID": "30002938", "title": "Arthroscopic Management and Radiographic Interpretation of an Everted Bony Bankart Lesion", "patient": "A 16-year-old male presented for evaluation of left shoulder pain, crepitus, and reduced ROM. Two weeks prior, he sustained a traumatic glenohumeral dislocation after a bicycle accident, which reduced spontaneously. Early rehabilitation provided no improvement to his restricted ROM or pain.\nOn physical examination, the patient appeared uncomfortable and extremely guarded. Apprehension and load and shift testing were consistent with anterior shoulder instability, and his ROM seemed reduced compared to typical dislocations. Plain film radiography revealed a 1 cm thin fragment of bone off the anterior glenoid, indicative of a bony Bankart (). Magnetic resonance imaging (MRI) confirmed this, but on critical examination of axial cuts, the fragment appeared flipped with subchondral bone superficial to articular cartilage (). Based on his pain and the redislocation rate of his age group after traumatic dislocations, surgery was recommended [].\nIntraoperatively, a posterior portal was created using bony landmarks, after which anterior and high rotator interval portals were established with the assistance of spinal needle localization to achieve an appropriate trajectory onto the glenoid. A 30\u00b0 arthroscope was placed in the high interval portal, adjacent to the biceps tendon, and was used for subsequent exploration of the joint and image capture. A thin bony fragment with the articular surface deep and the bony surface superficial was present (Figures and ). Both articular cartilage abrasion (), possibly from articulating with the exposed subchondral fragment, and a small Hill-Sachs lesion were present on the humeral head. The anterior portal was used to allow access for a liberator, grasper, and rasp which were used to free up the partially healed fragment, achieve reduction, and freshen bony edges. A transsubscapularis (TSS) portal, as described by Dwyer et al., was established using a percutaneous set (Arthrex, United States) and a small metal 5.4 mm cannula to minimize potential injury to the subscapularis muscle []. The fragment was fixed using a double row technique as described by Millet and Braun using three Arthrex PushLock 2.9 mm anchors (Arthrex, United States) and #2 FiberWire suture (Arthrex, United States) (Figures and ) []. The capsule was then advanced over the top of the fragment using three additional PushLock anchors ().\nPostoperatively, the patient had no major complications. He followed a graduated-intensity 18-week institutional physical therapy program consisting of two three-week and two six-week phases, which included passive and active ROM exercises and strengthening of shoulder musculature (). Plain film imaging four months postoperative indicated anatomic reduction of the fragment (). On examination, active shoulder ROM was assessed for both the repaired shoulder and the contralateral shoulder. Compared with the contralateral shoulder, the repaired shoulder exhibited the same ROM but lacked 15\u00b0 of external rotation with hands at sides and 15\u00b0 with the arm at 90\u00b0 abduction. The patient was seen again six months postoperative and on examination exhibited excellent strength and no instability symptoms but still lacked 15\u00b0 of external rotation both with arms at the sides and at 90\u00b0 of shoulder abduction. By this point in time, the patient had resumed sporting activities including cross-country skiing and track and field.", "age": [ [ 16.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5996414.xml", "relevant_articles": { "30002938": "123", "23127465": "123", "17359715": "13", "32741565": "1", "17530195": "13" }, "similar_patients": { "3505899-1": "123", "7285733-1": "12", "7276595-1": "123", "4733515-1": "123", "3475128-1": "123" } }, { "human_patient_id": "86", "human_patient_uid": "6977380-1-M", "PMID": "32015600", "title": "Acute Interstitial Nephritis in a Patient with High Aluminum Blood Levels: A Case Report", "patient": "A 67-year-old male with known case of hypertension for 10 years on Losartan and recent onset type 2 diabetes mellitus on Metformin with reasonable blood pressure and sugar control presented with history of loss of appetite, slowness of movements, decreased memory, frequent falls, and swaying to either side while walking for the last 3 months. He also gave a history of loss of appetite associated with nausea, occasional vomiting, and easy fatiguability. For his symptoms, he was taking over the counter indigenous medication for the last 6 months. He was evaluated by a neurologist, who did not notice any significant findings on examination. His cardiovascular, respiratory, and abdominal examination was noncontributory. Neurological examination revealed the presence of ataxia, dysmetria, dysdiadokokinesia, tremors, bradycardia, and mild rigidity. A neurological diagnosis of early Parkinsonson's disease was made and a magnetic resonance imaging (MRI) of the brain was done, which was suggestive of a encepaholapathy. There was no evidence of ischemic changes secondary to age, hypertension, and diabetes mellitus in the MRI []. His paraneoplastic panel and autoimmune markers were not contributory. (autoimmune encephalitis mosaic antibodies and paraneoplastic neuronal antibodies were all negative.)\nHis initial laboratory investigations showed normal hematological parameters, normal liver function tests, normocalcemia, normal electrolytes, and normal ammonia levels. His serum creatinine was high (2.2 mg/dl). The serum creatinine done 6 months back before starting the over the counter medications was normal at 1.4 mg/dl (normal range for the lab 0.9\u20131.5 mg/dl). Because of his worsening renal function he was evaluated by a nephrologist also. His urine examination was normal and his protein creatinine ratio was within normal range (0.12). His ultrasound of the abdomen revealed normal sized kidneys. He underwent a renal biopsy for unexplained renal dysfunction, which showed normal glomeruli with dense interstitial infiltrate consisting of mononuclear cells and eosinophils []. The electron microscopic examination revealed toxic vacuolation of the proximal tubules []. A diagnosis of interstitial nephritis with toxic proximal tubular injury was made and as the MRI was suggestive of a toxic/metabolic encepahalopathy, investigations were done to find a putative cause. As the basic metabolic evaluation did not reveal any plausible cause, a toxicology screen was asked for. The aluminum levels were above normal in the toxicology screen []. Treatment with desferroxime chelation was advised and the indigenous medicine was stopped. One month later the aluminum levels had reduced to 29.4 \u03bcg/l and the chelation was continued for another 4 weeks. A course of 6 weeks of low dose steroids (0.5 mg/kg/day) was also given for the interstitial inflammation. Currently, the patient has a normal serum creatinine (1.3 mg/dl) with complete resolution of the neurological symptoms. The cause of cerebral symptoms were believed to be because of aluminum toxicity as the symptoms resolved completely with aluminum chelation and it is speculated that the toxic proximal tubular injury can also be attributed to aluminum.\nThis patient developed neurological manifestations after 3 months of starting over the counter medications. His creatinine was only checked after 6 months of continuation of the medications. The complete resolution of his neurological and kidney injury simultaneously with the reduced aluminum levels (temporal association) suggests a putative role of aluminum in this patient's illness.", "age": [ [ 67.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6977380.xml", "relevant_articles": { "32015600": "123", "22826146": "0", "29043125": "0", "26425622": "0", "17975680": "0" }, "similar_patients": { "5704412-1": "0", "6607531-1": "1", "6823037-1": "0", "2813132-1": "0", "4616672-1": "0" } }, { "human_patient_id": "87", "human_patient_uid": "2729970-1-M", "PMID": "16778408", "title": "A Successful Live Birth Through in vitro Fertilization Program After Conservative Treatment of FIGO Grade I Endometrial Cancer", "patient": "A 36-yr-old woman visited in our infertility clinic, complaining of primary infertility for 1 yr. Her menstrual cycle was irregular, about 60-120 days, body mass index was 27.5 (body weight: 73 kg, height: 163 cm). She had a history of explo-laparotomy due to endometriosis. Neither she nor any other members of her family had diabetes or hypertension. Abdomino-pelvic examination showed the unremarkable findings and transvaginal ultrasonogram showed small uterine myoma, 24-21 mm, normal contour of endometrium, 10 mm, and well defined normal both ovaries. Full infertility work up was performed, results of semen analysis was normal, hormonal study (LH, FSH, Estradiol, Prolactin, TSH, Testosterone, DHEA-S) showed normal findings except high FSH level of 9.66 mIU/mL. The office endometrial aspiration biopsy showed secretory phase and finding of luteal phase defect. Hysterosalpingogram revealed one point filling defect in the uterine cavity and mild dilatation of ampullary portion of Fallopian tubes, but good intraperitoneal spillage (). On laparoscopic examination, peritubal adhesion was detected and adhesiolysis was performed. On hysteroscopic examination, there was a polypoid mass on fundal area and hysteroscopic biopsy and curettage was done. The pathologic evaluation of endometrial tissue revealed well differentiated endometrial adenocarcinoma (Grade 1, ) with positive estrogen and progesterone receptors. After curettage, we confirmed that there was no detectable endometrial mass or myometrial invasion or cervical involvement by MRI imaging (). Final diagnosis was primary infertility accompanying endometrial carcinoma, FIGO grade I without myometrial invasion.\nAfter counseling, the patient wished to retain her ability to conceive, so high dose progestin therapy was recommended. Oral megestrol acetate was prescribed 600 mg daily for 8 weeks. On follow-up hysteroscopic examination, she still got a small protruding mass on fundal area. We performed hysteroscopic biopsy and endometrial curettage. The pathologic evaluation of endometrium revealed complex hyperplasia without cellular atypia (). She continued to receive megestrol acetate but complained intolerable weight gain from 73 to 88 kg. We decided to reduce the dose to 400 mg, daily for 4 weeks, then 320 mg, daily for 12 weeks. After megestrol medication of total 71,680 mg during 24 weeks, we found smooth atrophic endometrium by hysteroscopic examination, and this was confirmed as atrophic endometrium through the histological examination of tissue obtained by curettage. Then we decided to perform IVF program in order to optimize the patient's potential for fertility and achieve a viable pregnancy without further delay.\nAfter pituitary down-regulation by the GnRHa (Buserelin acetate, Superfact\u00ae, Hoechst), follicle-stimulating hormone preparation (Follimon\u00ae, LGIC, Korea) was administrated, 375 IU daily for 12 days. The follicular growth was monitored from gonadotropin day 5 by 3 days interval and human chorionic gonadotropin (IVF-C\u00ae, LGIC, Korea) 10,000 IU was administrated when the at least 3 or more follicles reached 18 mm in diameter. And 35 hr later, oocytes aspiration was performed under the guidance of transvaginal ultrasonography. Two mature oocytes were retrieved and inseminated with her husband's prepared spermatozoa. Fifty seven hours after oocyte retrieval, the two high grade 4-cell embryos were transferred. Measurement of \u03b2-hCG revealed 3,449 mIU/mL on 19 days after embryo transfer, and on 23 days after embryo transfer, intrauterine single gestational sac with yolk sac and right tubal pregnancy were identified by transvaginal ultrasonogram. Right salpingectomy was performed under the epidural anesthesia, on 27 days after embryo transfer, we could detect the fetal pole with heart beat in the intrauterine gestational sac after that procedure. Then she received routine obstetrical care and delivered by Cesarean section at 38 weeks in gestational periods. The baby was female, 2,590 g, and the Apgar score was 8 at 1 min, 9 at 5 min. Placenta was grossly and microscopically normal, there was no evidence of residual tumor in the uterus and adnexa or abdominal organ.\nTwelve weeks after delivery, endometrial thickness measured by transvaginal ultrasonography was 4 mm and endometrial biopsy revealed no evidence of recurrent disease. Two years after delivery, she was healthy without any evidence of recurrent disease.", "age": [ [ 36.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC002xxxxxx/PMC2729970.xml", "relevant_articles": { "16778408": "123", "19401002": "123", "9224578": "0", "17390311": "0", "9749888": "0" }, "similar_patients": { "5296834-1": "123", "7253933-1": "0", "7469333-1": "0", "5424324-1": "0", "3136069-1": "0" } }, { "human_patient_id": "88", "human_patient_uid": "3920626-1-M", "PMID": "24587923", "title": "Ultrasound-Guided Multiple Peripheral Nerve Blocks in a Superobese Patient", "patient": "A 31-year-old, ASA II, superobese male patient (190 kg, 180 cm, BMI: 58 kg/m2) was admitted to the emergency department with a segmental Gustilo-Anderson type IIIA open tibial fracture and ankle dislocation following an in-vehicle traffic accident. The initial proper management of open fracture and joint dislocation was performed by orthopaedic and traumatology surgeons in the emergency department. The patient had no history of additional diseases. The preoperative airway examination revealed a class 3 Mallampati airway and, in light of the difficulty of intubation, an intrathecal block with a 150 mm needle was planned. After the written consent was obtained, 2 mg IV midazolam and 50 \u03bcg fentanyl were administered for sedation. The vertebral anatomical structures were barely distinguishable despite ultrasound guidance. After two unsuccessful attempts, we decided not to use spinal anesthesia and planned to perform a combined sciatic and femoral nerve block. As a tourniquet was not required above the knee, the blockade of these two nerves would be adequate for surgical anesthesia.\nBefore the femoral nerve block, the pannus was taped cephalad as the fatty tissue hanging from the abdomen made it difficult to access the inguinal region. The femoral nerve was identified at a depth of 5 cm with a linear US probe (Esaote, 10\u201318 MHz, Florence, Italy). Fifteen mL (8 mL of 0.5% levobupivacaine and 7 mL of 2% lidocaine) of local anesthetic mixture was administered around the femoral nerve using the in-plane approach. Due to the difficulties in situating the patient in the prone position, the distal extremities of the patient were elevated with folded blankets in the supine position (). The sciatic nerve could not be visualized despite several attempts using both linear and convex probes; therefore separate blocks of the tibial and common peroneal nerves were planned. The tibial nerve was identified in the popliteal fold, posterior to the popliteal artery at a depth of 3 cm (). Visualization of the tibial nerve was highly difficult in areas more proximal than the point 2 cm above the popliteal fossa. The common peroneal nerve (CPN) and the bifurcation of the sciatic nerve could not be visualized despite several attempts using both linear and convex probes. Therefore, 10 mL (7 mL of 0.5% levobupivacaine and 3 mL of 2% lidocaine) of local anesthetic mixture was administered around the tibial nerve 2 cm above the popliteal fold by using a linear probe. Screening was performed in the distal direction over the lateral side of the patient's leg with the linear probe placed transversely on the edge of the patella to identify the CPN (). The nerve was visualized posteriorly and laterally to the fibular head, 4 cm distally to the edge of the patella at a depth of 2 cm (). At this level, 10 mL (7 mL of 0.5% levobupivacaine and 3 mL of 2% lidocaine) of local anesthetic mixture was administered around the nerve with the in-plane technique using a linear probe. A 100 mm 21-G echogenic needle (Pajunk, Geisingen, Germany) was used for all blocks. A nerve stimulator was not used for any blocks since the patient had extremity pain associated with trauma. Surgical anesthesia was established within 30 minutes after anesthetic administration and no complications occurred in association with the blocks. Emergent reduction and fixation with an external fixator were performed for the ankle dislocation and fracture of the tibia. Additional local anesthetic injection or additional sedation was not required during the operation. The operation lasted for approximately 1.5 hours and was completed without problems. The patient's consent was obtained for the publication of this case report.", "age": [ [ 31.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3920626.xml", "relevant_articles": { "24587923": "123", "18433678": "123", "14552106": "13", "21920203": "13", "15641607": "123" }, "similar_patients": { "8086737-1": "123", "5265800-1": "123", "7785491-1": "123", "3357589-1": "123", "7728615-1": "0" } }, { "human_patient_id": "89", "human_patient_uid": "3877579-1-M", "PMID": "24455380", "title": "An Asymptomatic Large Anterior Sacral Meningocele in a Patient with a History of Gestation: A Case Report with Radiological Findings", "patient": "About 6 months before at 22 weeks of gestation, a cystic lesion was identified during a routine obstetric ultrasound examination of the pelvic area in a 23-year-old female patient without any previous discomfort. Due to the compression of the cyst on the cervix, the delivery was achieved by caesarean section. Postpartum ultrasonographic examination showed that there was a 7.5 \u00d7 8.5 cm sized thin-walled cystic lesion in the midline of the pelvic region compressing the rectum, uterus and bladder (). The origin of the lesion could not be determined during the ultrasonographic examination. The T2-weighted magnetic resonance imaging (MRI) showed a thin-walled hyperintensity in the uterus, and the rectum posterior while T1-weighted images revealed a hypointense cystic lesion. The cyst was not associated with the ovaries. The fourth and fifth sacral bones were not seen. In the posterior, the cyst was communicating with the spinal subarachnoid space (). Based on these findings, the patient was diagnosed with sacral agenesis and anterior sacral meningocele. In addition, MRI showed that the conus medullaris ended at the 4th lumbar spine level and a distinct arcuate uterus was observed. The patient's neurological examination was normal. Complete blood count and serum biochemical tests were within normal limits.\nBecause she planned another pregnancy, gynecological surgeons and neurosurgeons suggested to the patient a surgical management. But she denied.", "age": [ [ 23.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3877579.xml", "relevant_articles": { "15655569": "123", "24455380": "12", "17787029": "12", "31502806": "0", "24121814": "0" }, "similar_patients": { "6737057-1": "1", "3858770-1": "0", "2845143-1": "1", "2580018-1": "1", "5607803-1": "0" } }, { "human_patient_id": "90", "human_patient_uid": "5551476-1-M", "PMID": "28819572", "title": "A CAD/CAM Zirconium Bar as a Bonded Mandibular Fixed Retainer: A Novel Approach with Two-Year Follow-Up", "patient": "The case was of a 22-year-old woman complaining of headache for 18 months with severe episodes lasting around 6 hours, recurring about twice a month. Pain was located on the parietal regions, spreading to the orbit. Attacks were accompanied by nausea severe enough to hinder routine activities. The case was assessed by several specialists ruling out neurological, ophthalmological, and otorhinolaryngological pathologies. Cranial computed tomography (CT) and magnetic resonance imaging (MRI) revealed no pathology. Previous treatments considered nonsteroidal analgesics, physical therapy, hot and ice packs applications, and low-level laser therapy. All of them did not relieve pain to a satisfactory level. Her neurologist referred her to the orthodontic clinic suspecting a dilemma somewhere in her braces. The patient had fixed orthodontic appliance in the lower arch only with right first premolar extracted and space was closed with a satisfactory treatment outcome.\nClinical examination showed good oral hygiene with no signs of periodontal disease. Panoramic radiography (OPG) was normal. Occlusion was normal with no temporomandibular joint disorders. However, the patient reported that headache started 4 weeks after brackets bonding. At this stage, the patient was referred to a specialized center to test salivary biochemistry, particularly nickel and chromium levels. The chemical analyses were performed with a graphite furnace atomic absorption spectrometer using unstimulated salivary sample.\nAfter consultation with patient's neurologist, a decision was made to remove braces as soon as possible and provide her with a CAD/CAM zirconium bar as a bonded mandibular fixed retainer as the patient refused to wear any removable appliance. The treatment objectives were to (1) remove braces and retain teeth at their present position and (2) fabricate a bonded mandibular fixed retainer being biocompatible in attempt to relieve the patient's complaint.\nOcclusal rests of 2 mm depth were prepared on the mesial surface of first premolars. Brackets were covered with wax prior to impression taking to facilitate its removal. A definitive impression of the mandibular teeth was made with an alginate impression material and the master model was prepared from type IV stone (ResinRock, Whip Mix Europe, Dortmund, Germany). The working cast was mounted on articulator and scanned in the S600 ARTI scanner (Ice Zirkon, Zirkonzahn-ZA9246A, Italy) to transfer the baseline landmarks from the mandibular arch directly to the software (). The CAD/CAM design included a 1.8 mm width and a 1.4 mm thickness zirconium bar extended on the lingual surface of lower teeth from canine to canine and at 3.5 mm away from the free gingival margin. Occlusal rests were connected to the bar as well (). The finished design was directly milled using Zirkonzahn's Screw-Tec system.\nZirconium does not chemically adhere to enamel; therefore, the inner surface of the milled bar facing teeth was reduced manually and placed under an infrared lamp to dry for 40 minutes and then sintered overnight at 1,600\u00b0C in a sintering furnace Zirkonofen 700. Later, a thin layer of feldspathic ceramic was fired onto the bar () and subsequently received the treatments sandblast, hydrofluoric acid etching, and silane coupling while the outer part was glazed (). The try of insertion of the entire bar into the patient's mouth proceeded properly ensuring good marginal fitness. The retainer was cemented with two dual-cured cement types (Variolink II and RelyX ARC). The occlusal rest on the left side needed minimal reduction ().\nSalivary spectrophotometry analysis showed that nickel concentration was 4.230 \u03bcg/L and chromium was 12.520 \u03bcg/L. These concentrations were much lower than estimated toxic levels but comparable to the average dietary intake of nickel (200\u2013300 \u03bcg/day) and chromium (280 \u03bcg/day) []. Several in vitro studies found that release reached a maximum within the first month of boding and then diminished due to formation of surface oxide film which resists corrosion, thus slowing down the release of metals []. However, the case is different here where measurable amounts of nickel and chromium release were recorded after 22 months of treatment alerting possible association with the complaint.\nThe patient reported pain relief two weeks following cementation, and headache subsided completely after 6 weeks. Another atomic absorption spectrometer analysis was performed to test salivary nickel and chromium levels which showed negligible concentrations which might explain the patient's complaint. The patient was reviewed regularly for two years reporting no complaint (). Clinical evaluation appeared to give good functional value where the marginal fit of digitized CAD/CAM design and glazed surface offered an enhanced approach of fixed retention.", "age": [ [ 22.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5551476.xml", "relevant_articles": { "28819572": "13", "23646341": "12", "11605871": "12", "11138646": "12", "32865325": "12" }, "similar_patients": { "5371219-1": "123", "6720662-1": "0", "5644010-1": "123", "4439700-1": "0", "8248260-1": "123" } }, { "human_patient_id": "91", "human_patient_uid": "2851002-1-M", "PMID": "20379465", "title": "Case of Bilateral Retinal Neovascularization Associated with Chronic Idiopathic Myelofibrosis", "patient": "A 69-year-old man was referred to our clinic in August, 2006 presenting with decreased visual acuity in his right eye. He had been diagnosed with CIMF in July, 2000 and continued to have supportive care for CIMF throughout his follow-up. He had no specific ocular history and no history of irradiation. Visual acuities were 20/25 in the right eye and 20/20 in the left. Slit lamp examination showed no abnormalities on the conjunctiva, cornea, anterior chamber and iris. Fundus examination disclosed a mild vitreous hemorrhage in the right eye (). The peripheral fundi of both eyes showed marked vessel occlusion and microaneurysms in the temporal area. Fluorescein angiography in both eyes showed arteriovenous anastomosis with a marked area of nonperfusion and multiple sea-fan neovascularization on both eyes (). On laboratory examination, hemoglobin was 4.9 g/dL, platelet count was 63,000/mm3, and white blood cell count was 2,500/mm3 (with no blast cells). A peripheral blood smear test showed teardrop-shaped red cells. His fasting blood sugar value was normal, and the hemoglobin electrophoresis study was negative. Bone marrow examination showed hypocellular marrow with severe fibrosis and osteosclerosis (cellularity 11-20%), and no Philadelphia chromosome or BCR/ABL gene rearrangement was found.\nIn view of these findings, photocoagulation of the peripheral avascular retina of the left eye and laser photocoagulation with pars plana vitrectomy of the right eye were performed. Intraoperative findings were mild vitreous hemorrhage with a diffuse traction membrane around the temporal avascular retina. The vitreous hemorrhage and traction membrane were removed and laser photocoagulation was performed. Four weeks after surgery, his visual acuities were 20/25 in the right eye and 20/20 in the left, fundus examination of the right eye revealed no vitreous hemorrhage, and the retinal neovascularization had regressed in both eyes with good laser scars ().", "age": [ [ 69.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC002xxxxxx/PMC2851002.xml", "relevant_articles": { "20379465": "123", "2466138": "123", "11733270": "0", "24114504": "0", "33133713": "0" }, "similar_patients": { "3841957-1": "12", "3939753-1": "0", "5778555-1": "123", "8684531-1": "0", "5508471-1": "0" } }, { "human_patient_id": "92", "human_patient_uid": "8610452-1-M", "PMID": "34813455", "title": "Disseminated Kaposi Sarcoma", "patient": "A 28-year-old male presented to the emergency department (ED) with progressively worsening odynophagia and dysphagia. He had been diagnosed with human immunodeficiency virus five months prior after initially presenting to an outside hospital with odynophagia and weight loss. Given difficulty affording his antiretrovirals, he reported only intermittently taking emtricitabine-tenofovir and was lost to follow-up. He was unaware of his oral lesions and overall grim clinical status. Seven days prior to presentation he developed mild dyspnea as well as worsening dysphagia. Physical examination of the oral cavity revealed a 3 \u00d7 3 centimeter (cm) violaceous, pedunculated, midline posterior mass partially occluding the airway, as well as a 2 \u00d7 2 cm anterior hard palate, violaceous mass ().\nThe exam was also notable for extensive cervical and inguinal lymphadenopathy, global wasting, and a muffled voice. He was able to speak in full sentences, was tolerating his secretions, and did not have evidence of respiratory distress. Point-of-care ultrasound (POCUS) revealed reactive cervical lymphadenopathy ().\nComputed tomography soft tissue neck () and chest revealed nodular thickening of upper airway structures, cervical lymphadenopathy, diffuse ground-glass opacities, and large bilateral pleural effusions.\nHe was started on broad spectrum antibiotics including trimethoprim/sulfamethoxazole for Pneumocystis jirovecii pneumonia prophylaxis. Otolaryngology was consulted in the ED and performed a bedside laryngoscopy.. He was admitted for tracheostomy the following day. Excisional biopsy confirmed the diagnosis of disseminated Kaposi sarcoma. Given his extensive disease burden, he was started on systemic chemotherapy.", "age": [ [ 28.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC008xxxxxx/PMC8610452.xml", "relevant_articles": { "34813455": "123", "21686931": "0", "34079652": "0", "30409370": "0", "19715046": "0" }, "similar_patients": { "2976514-1": "0", "8033210-1": "0", "6559437-1": "0", "8159333-1": "0", "6735298-1": "13" } }, { "human_patient_id": "93", "human_patient_uid": "4508502-1-M", "PMID": "26197806", "title": "Large bowel obstruction resulting from bladder transitional cell carcinoma metastasis: a common cancer presenting in an uncommon manner", "patient": "A 49-year-old African-American male presented to the emergency room with abdominal distention and significant weight loss. The patient's surgical history was significant for radical cystoprostatectomy with appendectomy and creation of a Mainz pouch. The family history was noncontributory, and the patient is a nonsmoker.\nUpon examination of prior records, the patient was noted to have been admitted to the hospital 1-year previously for significant gross hematuria with impending clot retention. Cystoscopy showed a 6-cm mass with stippled calcifications located 3 cm lateral and superior to the left ureteral orifice. The tumor appeared broad based. CT scan showed no evidence of extravesicular disease. Transurethral resection of the entire bladder tumor was attempted; but due to the extent of tissue invasion and a drop in the patient's core temperature, the operation was aborted. Resection pathology confirmed a T2, Grade III TCC of the bladder.\nOne week later, a radical cystoprostatectomy with appendectomy and creation of a Mainz pouch was performed. Pathologic examination showed a poorly differentiated Grade III TCC between the smooth muscle bundles invading through the muscularis. There was no evidence of any tumor extension into the bladder neck, prostate gland, nor any nodal metastasis. Final staging was T2B N0M0. Additionally, a low-grade well-differentiated prostatic adenocarcinoma consistent with Gleason's score of 4 was found.\nApproximately 1 year after the cystoprostatectomy with a Mainz pouch, the patient presented with abdominal distension and weight loss and was admitted to the hospital for a sigmoidoscopy attempting to determine the etiology. The patient was given 100 mg of Demerol and 3 mg of Versed, but the procedure was aborted due to significant resistance met with the sigmoidoscope and excruciating pain. A barium enema was done showing an apple core lesion in the descending colon and sigmoid region with a large bowel obstruction. The patient elected to undergo left hemicolectomy with transverse colon end colostomy. Intraoperatively, a large descending colon mass, adherent to the left abdominal wall was identified and completely excised.\nPathologic examination revealed a 12.7-cm tumor, consistent with TCC. The tumor was found to ulcerate through the overlying mucosa of the colonic epithelium, with 5 of 23 mesenteric lymph nodes positive for metastatic involvement. The colonic and bladder specimen pathology were compared. Both the specimens were consistent with TCC.\nThe patient experienced no postoperative complications and made an uneventful recovery and was discharged June 2001. He continues to follow up with his urologist and oncologist on a regular basis. The patient was last seen by his oncologist in March 2015. He has no evidence of recurrent disease and is now celebrating his 13th year cancer free.", "age": [ [ 49.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4508502.xml", "relevant_articles": { "10368237": "123", "20807045": "12", "27276850": "12", "31083266": "0", "31956214": "0" }, "similar_patients": { "6896927-1": "13", "6732623-1": "12", "4251891-1": "12", "6890337-1": "12", "8563141-1": "12" } }, { "human_patient_id": "94", "human_patient_uid": "2740261-1-M", "PMID": "19830087", "title": "Postoperative spinal epidural hematoma resulting in cauda equina syndrome: a case report and review of the literature", "patient": "A 33-year-old Turkish woman patient was admitted with complaints of waist pain that extended down her left leg. She was diagnosed with left L5-S1 paramedian disc herniation and admitted for operation (). In her preoperative neurological examination, she showed a left laseque of 45 degree +, hypoesthesia in left L5, S1 dermatomes and left foot dorsiflexion (DF) strength of 4/5. Left L5 hemipartial laminectomy, L5-S1 discectomy, and foraminotomy were performed. No complication occurred during the operation. Postoperative early neurological examination did not determine any new neurologic deficit. At the postoperative 12th hour, neurological deficiency was observed. Upon neurological evaluation, left foot DF strength was 0/5, plantar flexion (PF) strength was 2/5, and urine incontinence and hypoesthesia in left L4, L5, S1 dermatomes were determined. Lumbar magnetic resonance imaging (MRI) confirmed acute SEH at the surgical site (), and the patient underwent reoperation. Blood clots were evacuated and decompression was performed. There was no active bleeding at the site (). Early clinical recovery was observed after reoperation, On postoperative 5th day neurological examination showed left foot DF strength 2/5, PF strength 5/5 and there was no urine incontinence. The patient was admitted to physical therapy and a rehabilitation program on the 7th day postoperation. 4 months postoperation, complete recovery was observed in the patient\u2019s motor deficits.", "age": [ [ 33.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC002xxxxxx/PMC2740261.xml", "relevant_articles": { "26573459": "123", "31374002": "0", "17939114": "0", "28643127": "0", "33107368": "0" }, "similar_patients": { "4895963-1": "123", "6389524-1": "0", "4158641-1": "0", "4244769-1": "123", "3095803-1": "123" } }, { "human_patient_id": "95", "human_patient_uid": "3868702-1-M", "PMID": "24368981", "title": "Operative Management in a Patient with Scapulothoracic Bursitis", "patient": "A 58-year-old male patient presented with a rapidly growing mass at the right posterior chest wall for one month. Initially, the patient had found an egg-sized lump at his right posterior chest wall. The patient received acupuncture at an oriental medicine clinic 10 days before admission. The soft mass showed relative hardening and rapid growth after the acupuncture.\nIn the physical examination, an approximately 5-cm mass was palpable at the right posterior lateral chest wall around the inferior angle of the scapula. The mass was mild and tender, without heat or redness. The patient had no history of trauma and had played golf excessively for the last six months.\nChest radiograph showed no bony abnormality or lung infiltration. Chest computed tomography showed a heterogeneous cystic mass on the right chest wall. A magnetic resonance axial T1-weighted image showed a well-demarcated lenticular mass lesion located in the right subscapular region between the serratus anterior muscle and the thoracic rib cage ().\nWe first recommended sonographically guided aspiration; however, the patient refused to undergo this procedure because of the possibility of recurrence after aspiration and rapid growth of mass. Excision of the mass was performed under general anesthesia. The patient was placed in a left lateral decubitus position. The latissimus dorsi and serratus anterior muscle were dissected after an incision was made over the right subscapular area. A soft, movable scapulothoracic mass, which was loosely attached between the serratus anterior and the intercostal muscle, was observed.\nA well-encapsulated cystic mass measuring 8\u00d75\u00d75 cm in size was excised. A hemorrhage occurred, which was suspected to be a result of acupuncture in an oriental medicine clinic (). A histopathologic examination showed a pseudocyst with a thickened fibrotic wall, which was filled with blood clots. Many lymphocyte proliferations were observed in the cystic wall without neoplastic cells ().\nThis patient's history included playing golf, pathological features, and radiological images; therefore, this patient was diagnosed with scapulothoracic bursitis. The patient recovered well after surgery. No chest wall pain was observed, and no recurrent mass was found at the 10-month follow-up. The patient still enjoys playing golf.", "age": [ [ 58.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3868702.xml", "relevant_articles": { "30641437": "123", "25911353": "0", "29223276": "0", "33829348": "0", "4044175": "0" }, "similar_patients": { "4086699-1": "0", "4602681-1": "1", "8274025-1": "0", "4757403-1": "0", "8026786-1": "0" } }, { "human_patient_id": "96", "human_patient_uid": "6350439-1-M", "PMID": "30648676", "title": "Management Issues During Postinfarction Ventricular Septal Defect and Role of Perioperative Optimization: A Case Series", "patient": "A 58-year-old male presented with increasing dyspnea following MI. He had thready pulse and blood pressure of 86/34 mmHg on dobutamine and adrenaline infusion at 10 and 0.1/\u03bcg/kg/min, respectively. His peripheral oxygen saturation was 88% on high flow oxygen with widespread bilateral lung opacities on chest X-ray. Blood investigations showed hemoglobin 13.5 g/dl, blood urea 142 mg/dl, serum creatinine 2.3 mg/dl, random blood sugar 170 mg/dl, serum sodium 128 meq/1, and serum potassium 5.1 meq/1. Urgent coronary angiography revealed blockade of left anterior descending (LAD) 90%, circumflex 50% and the total occlusion of right coronary artery (RCA). The RCA occlusion was stented successfully during the procedure. The transthoracic echocardiography showed left ventricular (LV) ejection fraction (EF) 20% and a large posterior-inferior ventricular septal defect (VSD) with a shunt gradient of 48 mmHg. Mechanical circulatory support was initiated with intra-aortic balloon pump (IABP) and as he was deteriorating rapidly, the decision was taken to perform an urgent operation with extracorporeal membrane oxygenation (ECMO) as a backup support.\nGeneral anaesthesia was induced with fentanyl/propofol in slow titrated dosage, and endotracheal intubation was facilitated with cisatracurium. Intraoperative transesophageal echocardiography (TEE) was consistent with preoperative TTE finding. Anaesthesia was maintained on propofol and cisatracurium infusion with supplemental midazolam, fentanyl boluses, and sevoflurane. The patient required O2:Air (80:20) to maintain oxygenation with increasing requirement for inotropic and vasoconstrictor support. We decided to go for immediate central cannulation and subsequent cardiopulmonary bypass following anaesthetic induction. Our main aim was to decrease the shunt, prevent hypoxia and to provide an early organ support. The VSD was approximately 3.5 cm in diameter repaired by a bovine pericardial patch, and the friable ventriculotomy was closed using interrupted pledgeted stitches. The coronary artery bypass graft was performed to artery LAD using left internal thoracic artery and venous graft to its diagonal branch. Postoperative TEE showed no residual VSD, and as expected, he was unable to wean from bypass machine. We decided to continue him on central ECMO support to decrease the tension on VSD pericardial patch during immediate postbypass period.\nPostoperatively, he required venovenous hemofiltration and the central ECMO switched over to peripheral with femoral cannulation after 72 h. He was eventually weaned from ECMO and IABP support on day 6 and required 43 days stay in cardiac rehabilitation facility and continued to do well following discharge and subsequent follow-up.", "age": [ [ 58.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6350439.xml", "relevant_articles": { "31438988": "0", "15384716": "123", "2784950": "0", "29221351": "123", "19438779": "0" }, "similar_patients": { "4312472-1": "123", "7319831-1": "0", "4236944-2": "13", "4236944-1": "123", "8130376-1": "123" } }, { "human_patient_id": "97", "human_patient_uid": "6350439-2-M", "PMID": "30648676", "title": "Management Issues During Postinfarction Ventricular Septal Defect and Role of Perioperative Optimization: A Case Series", "patient": "A 53-year-old man transferred 2 days following MI was awake, comfortable on room air, and hemodynamically stable without inotropes. His coronary angiogram revealed subtotal occlusion of LAD, and transthoracic echo showed a VSD 1.3 cm located on the anterior septum with EF 50%. He was scheduled for urgent closure of septal defect and a bypass grafting for LAD after the IABP insertion. General anesthesia was induced with remifentanil and propofol in titrated doses and maintained on midazolam, remifentanil, and propofol infusion with cisatracurium for muscle paralysis. The LAD grafting was performed, and the closure of defect was performed using Dacron patch and the pledgeted sutures to close ventriculotomy. He could be weaned off bypass without inotropes and was extubated on 1st postoperative day. The patient was discharged from intensive care in 48 h, and his remaining postoperative course was free of major complications.", "age": [ [ 53.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6350439.xml", "relevant_articles": { "25966145": "123", "17660177": "0", "9814790": "0", "21534456": "0", "8828329": "13" }, "similar_patients": { "6350439-1": "123", "6350439-4": "123", "6350439-3": "13", "4124570-1": "123", "7034194-1": "13" } }, { "human_patient_id": "98", "human_patient_uid": "6350439-3-M", "PMID": "30648676", "title": "Management Issues During Postinfarction Ventricular Septal Defect and Role of Perioperative Optimization: A Case Series", "patient": "A 56-year-old male admitted 4 days following a 2.2 cm postinfarction VSD on TTE. His BP was 102/66 mmHg on dobutamine 6 \u03bcg/kg/min. Coronary angiography revealed total occlusion of LAD and 70% posterior descending artery stenosis. The intraoperative TEE revealed a VSD found at middle of the very friable, necrotic anterior septum with poor ventricular function. VSD was closed with Dacron patch, and grafting for two diseased vessels was performed. The patient could be weaned off cardiopulmonary bypass (CPB) with moderate inotropes. However, unfortunately, postbypass TEE showed 0.3 cm residual leak that was left behind considering risk of second bypass and its consequences. He was carefully monitored, remained hemodynamically stable postoperatively, and required percutaneous closure to seal off the residual VSD in catheter room 4 weeks following surgery.", "age": [ [ 56.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6350439.xml", "relevant_articles": { "9502149": "13", "8360540": "0", "33502796": "123", "21918320": "12", "25966145": "0" }, "similar_patients": { "6350439-1": "123", "8081123-1": "0", "5914224-1": "0", "8445139-1": "123", "4236944-2": "13" } }, { "human_patient_id": "99", "human_patient_uid": "6350439-4-M", "PMID": "30648676", "title": "Management Issues During Postinfarction Ventricular Septal Defect and Role of Perioperative Optimization: A Case Series", "patient": "A 64-year-old man with acute MI underwent primary angioplasty to the RCA. However, his symptoms got worse over the next 12 h and developed sudden florid pulmonary edema although his hemodynamics was stable requiring low dose inotropes. Echocardiography revealed moderate left ventricular function with EF 43% and a large VSD measuring 2.9 cms located in the posterior part of the ventricular septum. He was eventually required mechanical ventilation, and mechanical circulatory support was initiated using IABP. In the following 24 h, his renal function deteriorated with progressively increasing requirement of inotropic support. The surgery was deferred to optimize his respiratory and renal function using diuretics, nitrates, positive pressure ventilation, and inotropes. Over the next 3 days, his oxygen requirement gradually decreased with improvement in renal and hemodynamic parameters. The patient was taken to the operating room with minimal mechanical ventilation support 6 days following the onset of acute MI. Anesthesia continued on midazolam, fentanyl, propofol, sevoflurane and cisatracurium for muscle paralysis. Surgical repair of the defect was performed, and the operation was completed with associated saphenous grafting to the circumflex territory. The patient could be weaned off with milrinone and noradrenaline, and the IABP could be continued in postoperative period. Patients required hemofiltration for 2 days postoperatively with gradual weaning of inotropes and discharged to the ward on day 5. The patient stayed for 21 days in cardiac rehabilitation and currently doing well 4 months following the surgery.", "age": [ [ 64.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6350439.xml", "relevant_articles": { "7594838": "123", "9350791": "0", "33371745": "0", "30279910": "0", "15011429": "0" }, "similar_patients": { "6350439-1": "123", "4124570-1": "123", "5144534-1": "0", "8108613-1": "123", "6350439-2": "123" } }, { "human_patient_id": "100", "human_patient_uid": "5992757-1-M", "PMID": "29879911", "title": "Primary aortoduodenal fistula associated with abdominal aortic aneurysm with presentation of gastrointestinal bleeding: a case report", "patient": "A 73-year-old man had a past operative history of ruptured colonic diverticulitis treated by Hartmann\u2019s procedure in 2007, and perforated peptic ulcer treated by pyloroplasty in 2009. He suffered from abdominal and tarry stool for 5 days in March 2011, so he was admitted to a rural hospital for further survey and medication. An initial upper GI endoscopy showed gastric ulcer only, but hypotension with tachycardia and a drop in hemoglobin of 9 g/dl from 12 g/dl occurred the next day. Intravenous fluid and blood transfusion with packed red blood cell were prescribed. Abdominal aortic aneurysm (AAA) with rupture was highly suspected, so CTA of aorta (Fig. ) was carried out which disclosed an AAA with swollen bowel loop. He was transferred to our emergency department (ED) for consideration of vascular surgical intervention.\nOn arrival in our ED, vital signs were a respiratory rate of 16 breaths per min, a heart rate of 130 beats per min, a blood pressure of 98/73 mmHg, and a body temperature of 35.6 \u00b0C. Physical examination revealed a pale conjunctiva, no heart murmur, clear breathing sound, old operative scar over middle abdomen, and hypoactive bowel sound with tenderness over the periumbilical region. Leukocytosis, anemia, abnormal liver profiles, and metabolic acidosis were found. Laboratory investigations were summarized in Table .\nA cardiovascular surgeon carried out emergent angiography of aorta, which depicted bleeding from the wall of the AAA and chronic total occlusion of the left external iliac artery, so a modified aorto-uni-iliac stent graft (Fig. ) was implanted with femoral-to-femoral bypass, which underwent smoothly. A general surgeon performed exploratory laparotomy and found a massive blood clot with a volume of about 1310 ml filling the entire lumen of the small intestine, a dilated and swollen duodenum about 6 cm in diameter with ecchymosis, and a fistula about 2x2cm over the third portion of the duodenum (Fig. ). Duodenostomy with primary closure for repair of fistula defect, partition of the duodenum between the 2nd and 3rd portions, and side-to-side gastrojejunostomy were completed smoothly. He was admitted to the surgical intensive care unit for postoperative care. CTA of aorta showed neither endoleakage nor intraabdominal abscess on postoperative day 17. He was discharged without complications and returned for follow up at the out-of-patient department on postoperative day 25.", "age": [ [ 73.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5992757.xml", "relevant_articles": { "29879911": "13", "9480573": "13", "17653010": "1", "19272568": "13", "34106145": "13" }, "similar_patients": { "6940160-1": "1", "7233937-1": "123", "3487019-1": "123", "6024772-1": "123", "5712197-1": "123" } }, { "human_patient_id": "101", "human_patient_uid": "7652779-1-M", "PMID": "33204631", "title": "A case report of Pasteurella multocida meningitis in a patient with non-traumatic skull base defect", "patient": "A 30 years old male patient presented to the hospital with a 2-day history of high-grade fever and headache. Headache was diffuse, moderate to severe in intensity, associated with pain and stiffness in neck, photophobia and vomiting. Condition was not associated with blurring of vision, double vision, vomiting, loss of consciousness or convulsions. There was no history of sore throat, cough, ear pain, ear discharge, motor weakness, sensory weakness, hearing difficulty, altered level of consciousness, abnormal jerky movements or skin rashes. Patient also reported persistent colorless discharge from nose and postnasal drip for 4 months. There was no history of ear fullness, persistent headache or head trauma. Patient was non-smoker and there was no history of alcohol use.\n6 weeks ago, patient was discharged from hospital after being treated as bacterial meningitis. The CSF examination for viral PCR and bacterial gram stain/culture was negative. He was treated with a 14-day course of intravenous (IV) ceftriaxone. He had complete recovery of symptoms without any neurological sequalae. During hospital stay at that time, he underwent MRI head which showed large bony defect in the sellar floor with soft tissue in the anterior aspect of the sella with infrasellar extension into the left sphenoid sinus ). Neurosurgery and otorhinolaryngology teams were consulted, and an elective endoscopic endonasal/open repair of the skull base defect was planned as outpatient after resolution of meningitis. Patient still had persistent rhinorrhea during this presentation as he did not undergo repair of bony defect of sellar floor.\nPhysical examination revealed a young adult well oriented to time, place and person. He was febrile with temperature of 38.9 degrees Celsius. Pulse, blood pressure and respiratory rate was normal. There were no skin rashes or scratch marks. GCS was 15/15. He had normal cranial nerves, motor and sensory examination. Neck stiffness, Kernig\u2019s and Brudzinski\u2019s signs were positive. Cardiovascular, chest and abdominal examination was normal.\nComplete blood count revealed neutrophilic leukocytosis with raised C reactive protein. Urea, creatinine, electrolytes and liver function tests were normal. Lumbar puncture was performed and cerebrospinal fluid (CSF) examination showed high white blood cell count with predominance of neutrophils, high protein and low glucose (). Viral PCR of CSF was negative. CSF culture showed gram negative coccobacilli () identified as Pasteurella multocida sensitive to ceftriaxone, ampicillin and penicillin. Blood cultures were negative. After confirmation of the organism, a retrospective history of contact with dogs, cats or other animals was taken which revealed that he often used to feed stray cats who lived around his house. However, there was no history of cat scratches, bites, licks or kisses on any part of the body. Patient was treated with IV ceftriaxone 2\u202fg twice a day for 14 days with complete resolution of his symptoms. He was offered surgical correction of his skull defect, but he preferred to do it in his home country. He was discharged with advice to avoid contact with dogs and cats till surgical correction of bony defect of skull.", "age": [ [ 30.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7652779.xml", "relevant_articles": { "33204631": "123", "23339213": "123", "26741691": "0", "14672011": "123", "27940753": "0" }, "similar_patients": { "5551538-1": "123", "8312997-1": "123", "4658792-1": "123", "3325437-1": "123", "8330204-1": "0" } }, { "human_patient_id": "102", "human_patient_uid": "3789634-1-M", "PMID": "24964413", "title": "Lacrimal sac compression by an anterior ethmoidal mucocele presenting as a late complication of dacryocystorhinostomy", "patient": "A 22-year-old lady presented to the Joint Ophthalmology & ENT watery eye clinic with a 12-month history of a painless lump in the medial corner of her left eye, which was not increasing in size. Six months after noticing this painless lump, she developed left-sided intermittent epiphora. At the age of 10, she first had a watery left eye, and following a DCR when she was 15 years old, her symptoms seemed to resolve until this episode. She denied any nasal symptoms.\nShe had a history of depression, for which she was on fluoxetine but was otherwise well. She smoked three cigarettes per day and drank alcohol occasionally.\nClinical examination revealed a small cystic swelling in her left medial canthus (Fig. ). There was no discharge on pressure, mild tenderness was elicited and the swelling was not compressible. The rest of the eye examination was normal with a visual acuity of 6/6 in both eyes.\nAnterior rhinoscopy showed a reasonable nasal airway with healthy mucosal lining. Flexible nasendoscopy revealed no nasal lesions with the septum slightly deviated to the right.\nAn MRI scan of the orbits showed a well-defined, thin-walled 22 \u00d7 16 mm cyst medial to the left orbit containing fatty/proteinaceous material, which was lying within and mildly expanding the left ethmoid air cells (Figs \u2013).\nA CT scan of the paranasal sinuses and orbits revealed the cystic expansile 1.6 cm mass at the left medial canthus to be of soft tissue density. The lateral wall of the mass expanded outwards into the orbit (suggesting an anterior ethmoidal mucocele) rather than being pushed medially (which could have been indicative of a dacryocystocele) (Fig. ).\nAll pre-operative blood tests were normal. A joint operating session by the ENT and Ophthalmic surgeons was planned with a view to performing an endoscopic left anterior ethmoidectomy with marsupialisation of the mucocele in combination with an endoscopic DCR.\nThe puncti were probed (Fig. ) and fluorescein dye instilled with no dye outflow to the left inferior meatus. It was not possible to pass the probe through the upper punctum so a mini-monoka DCR stent was inserted and secured (Figs. and ). Chloramphenicol eye drops were instilled.\nThe nasal cavity was prepared with modified Moffet's solution and a Storz 30\u00b0 endoscope used with visualisation of the nasal cavity on a monitor. An inferiorly based mucosal flap was elevated on the lateral nasal wall (Fig. ) with the incision performed using a small myotome. Removal of part of the lateral nasal wall anterior to uncinate process was performed for access to the lacrimal system (unciformian endonasal DCR)\n30\u00b0 punch forceps were used to nibble bone sequentially for adequate exposure. Further drilling of the lateral bony wall was undertaken with a small cutting burr. An endoscopic left anterior ethmoidectomy was performed (Fig. ) with marsupialisation of the mucocele (Fig. ) and trimming of the DCR stent (Fig. )\nPost-operatively, she was discharged the next day and advised to administer chloramphenicol eyedrops as well as betnesol nasal drops for a week. The DCR stent remained in situ for 3 months and was removed in the clinic. There was clinical resolution of the medial canthal swelling and epiphora.", "age": [ [ 22.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC003xxxxxx/PMC3789634.xml", "relevant_articles": { "24964413": "123", "19767912": "0", "25478271": "123", "23119936": "123", "23914647": "13" }, "similar_patients": { "4728984-1": "123", "6747856-1": "123", "4244941-1": "123", "7175067-1": "123", "2576271-1": "123" } }, { "human_patient_id": "103", "human_patient_uid": "3291727-1-M", "PMID": "22396705", "title": "A Case of Severe Aortic Valve Regurgitation Caused by an Ascending Aortic Aneurysm in a Young Patient With Autosomal Dominant Polycystic Kidney Disease and Normal Renal Function", "patient": "A 27-year-old Asian male with dyspnea upon exertion was referred to our outpatient cardiology clinic. The patient's dyspnea had worsened gradually over the prior 5-6 years and had been exacerbated over the past 3 months. The physical examination result was normal habitus, without Marfan's syndrome phenotypes. His vital signs were as follows: blood pressure, 126/78 mm Hg; pulse rate, 95 beats/minute; respiratory rate, 22 breaths/minute; body temperature: 36.7\u2103. Both jugular veins were slightly engorged. A high-pitched, blowing, holodiastolic murmur (grade V/VI) was clearly audible at the right sternal border of the third intercostal space. No crepitation or wheezing was observed in his chest, and his abdominal examination was normal. An electrocardiogram showed left ventricular hypertrophy and bi-atrial enlargement in normal sinus rhythm. Chest radiography revealed mild cardiomegaly without pulmonary congestion (). All blood chemistry profiles were within normal limits; they were as follows: fasting glucose 92 mg/dL, total cholesterol 214 mg/dL, creatinine 1.0 g/dL, blood urea nitrogen 21 mg/dL, uric acid 5.7 mg/dL. Echocardiogram showed left ventricular enlargement (end-diastolic dimension, 73 mm), left ventricular hypertrophy (septal wall thickness on diastole, 15 mm), and moderate left ventricular systolic dysfunction with a left ventricular ejection fraction of 36% (). Dimensions of the sinus of Valsalva and aortic valve opening were 56 mm and 34 mm (). Morphology of his aortic valve leaflets in a 2 dimensional echocardiogram was normal, but severe aortic valve regurgitation due to aortic root dilation was observed in a Doppler echocardiogram (). The chest CT confirmed marked aortic root dilation and ATAA (). Multiple variable-sized cystic lesions in the liver and both kidneys were observed in an abdominal-pelvic CT scan that was compatible with ADPCKD (). An operation was undertaken involving composite graft replacement of the aortic valve, aortic root and ascending aorta, otherwise known as the Bentall operation. The aortic root was excised and replaced with a 26-mm INTERGARD woven vascular graft (MAQUET GmbH & Co. KG, Rastatt, Germany). An aortic valve replacement was done with a Saint-Jude 25 mm mechanical aortic valve (St. Jude Medical, St. Paul, MN, USA). Both coronary arteries were re-implanted on the side of the graft. During weaning from cardiopulmonary bypass post-operatively, an intra-aortic balloon counter pulsation was inserted for prophylactic reasons against systolic dysfunction. In the pathological examination of the excised aorta, cystic medial necrosis, which had been defined as mucoid material accumulation, was noticed in the media on Hematoxylin and eosin (H & E) staining (). Necrotized, disorganized smooth muscle cells, and elastic fragmentations were observed in elastic fiber staining (). These findings were compatible with typical pathologic findings of large vessels in ADPCKD. The patient's recovery was quick, and it was without incident as far out as 4 years post-operation, with the exception of one small renal cyst rupture. After the operation, the patient has continued to take furosemide, spironolactone, angiotensin-converting enzyme inhibitor, and warfarin. The last measured serum creatinine level was 1.30 mg/dL (upper normal limit, 1.20 mg/dL).", "age": [ [ 27.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3291727.xml", "relevant_articles": { "11233249": "123", "34540507": "123", "19324145": "123", "9502145": "13", "9146307": "0" }, "similar_patients": { "3530726-1": "123", "4717593-1": "123", "4192413-1": "12", "4508655-1": "0", "3341429-1": "123" } }, { "human_patient_id": "104", "human_patient_uid": "7396064-1-M", "PMID": "32774983", "title": "A Case of Left Retroexternal Iliac Artery Megaureter Associated with Additional Renal and Vascular Congenital Anomalies", "patient": "A 96-year-old female body was received through the Saint Louis University Gift of Body Program of the Center for Anatomical Science and Education (CASE) with the signed informed consent from the donor. The CASE gift body program abides by all rules set forth by the Uniform Anatomical Gift Act (UAGA). Information obtained through the CASE program did not specify a cause of death but did mention a history of Alzheimer's disease, COPD, and atrial fibrillation in this donor. During dissection in 2018, it was observed that the donor was status post hysterectomy and status post ventral hernia repair with mesh.\nDuring routine dissection, a markedly dilated left ureter was noticed and further explored (). The left renal pelvis was located outside of the kidney sitting medially, inferiorly, and slightly posteriorly from the kidney. The path of the ureter curved slightly posteriorly and medially before turning laterally. The ureter then turned sharply medially and anteriorly before continuing over the psoas major muscle. The ureter was most dilated as it passed anteriorly to the left psoas minor muscle, where its diameter measured at 1.70 cm. The ureter then passed posterior to the EIA and anterior to the IIA, about 0.50 cm away from the bifurcation of the AA.\nUpon further dissection, it was found that what was initially identified as the left CIA was in fact the left EIA. The donor had three terminal arterial branches off the AA: the right CIA, left IIA, and left EIA. The left IIA branched off the posterior side of the AA. As a result, the median sacral artery was shifted and was observed branching off the right CIA (). After passing beneath the left EIA, the left ureter returned to a normal size (0.45 cm) and position following a normal path to the bladder ().\nThe three major calyces of the left kidney were found to join together outside of the kidney (). All arteries and veins of the left kidney were normal, and no evidence of hydronephrosis was observed (). Constriction of the ureteropelvic junction (UPJ) was noted, though this slight constriction did not result in any gross renal pathology ().\nFinally, the subject exhibited extensive surgical sutures, likely from the hysterectomy, along the lateral paravertebral muscles as well as near the left IIA, inferolateral to the ureter.", "age": [ [ 96.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7396064.xml", "relevant_articles": { "11494514": "0", "33489410": "0", "32774983": "1", "13222491": "0", "21534457": "0" }, "similar_patients": { "7801057-1": "0", "8616708-1": "0", "6442374-1": "0", "6966421-1": "0", "8483010-1": "0" } }, { "human_patient_id": "105", "human_patient_uid": "7045979-1-M", "PMID": "32140358", "title": "Undifferentiated Embryonal Sarcoma of the Liver Presents as a Molecular Mimic of Parasitic Infection", "patient": "A 15-year-old male, presented with fever, nausea, and three weeks of worsening right upper quadrant pain, preceded by three months of vague upper abdominal pain. Review of systems was otherwise normal. The patient had no travel history. Computed tomography (CT) imaging of the abdomen and pelvis showed an 18-cm heterogeneous hepatic mass as well as several pulmonary nodules (Figure , ).\nGiven the patient\u2019s history and the morphology of the lesion, an infectious process was initially suspected. A set of blood cultures was obtained, and serological tests including Entamoeba histolyticaantibody, serum (RIDASCREEN Entamoeba histolytica IgG, R-Biopharm AG, Darmstadt, Germany); Echinococcus antibody, IgG, serum (RIDASCREEN Echinococcus IgG, R-Biopharm AG, Darmstadt, Germany); and fungal antibodies by immunodiffusion were sent to Mayo Medical Laboratories. Initial complete blood count and blood chemistry results revealed elevated leukocytes (16,200/mm3), thrombocytes (536,000/mm3), bilirubin (2.1 mg/dL), lactate dehydrogenase (531 IU/L), gamma glyamyltransferase (119 U/L), and alkaline phosphatase (268 U/L), with normal liver transaminases and alpha-fetoprotein (AFP). Due to suspicion of a pyogenic or amoebic liver abscess, the patient was started on ceftriaxone and metronidazole.\nA CT-guided needle biopsy of the liver mass taken the next day was positive for malignant cells by hematoxylin and eosin staining; however, surrounding fluid was negative for infectious agent by culture. A second set of blood cultures continued to show no growth, and antibiotics were discontinued. Subsequent laparoscopic liver biopsy (Figure ) led to the diagnosis of undifferentiated embryonal sarcoma, but was negative for any infectious agent. The pathology report indicated markedly pleomorphic cells with brisk mitotic activity with no differentiation and areas of hemorrhage and necrosis. Immunohistochemical staining was positive for alpha-I-antitrypsin, vimentin, and desmin; weakly positive for OSCAR focal pancytokeratin; and negative for actin and hepatocyte specific antigen; together, this was most consistent with embryonal sarcoma. The presence of lung nodules suggested stage IV metastatic disease; however, these were not biopsied.\nThe ELISA serological results for infectious diseases, completed after the malignancy was confirmed by biopsy, were positive for antibodies against Echinococcosis and Entamoeba histolytica, and the fungal antibody panel was positive for Histoplasma. Subsequent specific testing for Histoplasma antibody via complement fixation and immunodiffusion was negative. These confounding positive antibody results were thought to be a false positive due to a cross-reaction with the patient\u2019s hepatic mass; as all cultures taken throughout including blood, needle biopsy, and wedge biopsy were negative.\nThe patient received four cycles of chemotherapy, consisting of ifosfamide and doxorubicin, followed by surgical resection of the residual tumor. Four months after his initial diagnosis, the patient underwent right hepatic trisegmentectomy along with resection of the right hemidiaphragm and mesh reconstruction. A magnetic resonance imaging scan 10 months after his initial admission revealed no evidence of disease, as did a follow-up CT scan of the chest taken 13 months after admission.", "age": [ [ 15.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7045979.xml", "relevant_articles": { "32140358": "12", "29226049": "12", "21735108": "0", "16261304": "0", "15682496": "123" }, "similar_patients": { "7752639-1": "123", "5926488-1": "0", "3287964-1": "0", "4472968-1": "0", "5996425-1": "0" } }, { "human_patient_id": "106", "human_patient_uid": "7057875-1-M", "PMID": "32181201", "title": "Cervicomedullary Ependymoma with Hemorrhage: A Case Report and Review of Literature", "patient": "A 37-year-old male presented with dysesthesia of 4 months' duration involving his both upper limbs. On enquiring further, it was revealed that his symptoms started all on a sudden before 4 months and has been gradually increasing ever since. There was no history of neck pain. There was no history of trauma to the neck. On examination, general examination was unremarkable. There were no cranial nerve palsies. Motor system examination revealed that he had Grade 5 power in both upper and lower limbs and deep tendon reflexes were normal. There was sensory loss involving upper limbs from the nape of the neck downward. Local skull and spine examination were normal.\nHe underwent a magnetic resonance imaging (MRI) of the brain along with cervical spine which showed an intra-axial tumor with a cystic component in the medullary region extending below to the second cervical vertebra [Figure and ]. The tumor was mildly hyperintense on T1-weighted image and hyperintense on T2-weighted image. There was minimal contrast enhancement of the cystic wall of the tumor. There was fluid level in the cavity which was hypointense on both T1 and T2 weighted images suggestive of previous hemorrhage [Figure -]. Our preoperative differential diagnosis included pilocytic astrocytoma, hemangioblastoma, and ependymoma.\nHe was taken up for surgery under neuromonitoring. He underwent a posterior fossa midline craniotomy along with a laminectomy of the first cervical vertebra in the prone position. The tumor was exposed in the midline. The cystic part of the tumor was let out which contained xanthochromic fluid, suggestive of previous bleeding. The tumor was soft and moderately vascular which had a well-demarcated margin with that of the normal cervical cord in the superficial part []. However, as the dissection progressed to the deeper parts, this demarcation was less well defined. The tumor was removed in piecemeal and intraoperative frozen section was done which was suggestive of high-grade glioma. The debulking of the tumor was performed during which profuse bleeding from the base was observed. A sudden drop in the transcranial motor evoked potentials as well as in blood pressure occurred associated with occurrence of arrhythmias after which the decision to proceed further was abandoned. Postoperatively, he was examined clinically and there were no new focal neurological deficits.\nThe histopathology of the tumor showed round cell tumor with rosette formation []. There was no evidence of calcification, necrosis, or neovascular proliferation. The MIB index was 3.7%. There was no mitosis. The tumor cells were positive for GFAP and EMA and negative for P53, synaptophysin, and NSE, suggestive of Grade 2 ependymoma.\nA repeat MRI with contrast was taken [] which showed residual tumor involving the base of the excision cavity. The option of a repeat surgery or wait and watch with serial imaging was discussed with the patient. After discussions with the family, the patient decided against surgery and is now on follow-up.", "age": [ [ 37.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC007xxxxxx/PMC7057875.xml", "relevant_articles": { "31240119": "123", "23050205": "123", "24535803": "123", "8311491": "12", "31653502": "123" }, "similar_patients": { "7869268-1": "13", "4623174-1": "1", "4352645-1": "13", "3858770-1": "13", "4849311-1": "13" } }, { "human_patient_id": "107", "human_patient_uid": "7527125-1-M", "PMID": "32879057", "title": "Reunification of a split sciatic nerve", "patient": "A variant SN was found during the routine dissection of a male Caucasian cadaver aged 72-years-old at death. The right SN was split by the PM into two roots, a superior CFN part and an inferior TN part (). The superior root was found to pierce the piriformis and the inferior root traveled inferior to the inferior border of the piriformis (infrapiriformis foramen). Distal (approximately 3 cm) to the piriformis, the CFN and TN were united by a communicating branch (Cb) descending superomedial to inferolateral in an oblique manner. The Cb was approximately 1 cm in width by 3 cm in length. Distal to this Cb, the CFN and TN continued toward the popliteal fossa and were distributed in normal fashion to the anterior/lateral and posterior compartments of the leg, respectively. No atrophy or other pathology was noted in any muscles of the leg and no other anatomical variations of the left or right lower limbs (including gluteal region) were noted.", "age": [ [ 72.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC007xxxxxx/PMC7527125.xml", "relevant_articles": { "23900507": "0", "30758526": "0", "30408241": "0", "23959929": "1", "24596750": "1" }, "similar_patients": { "3968270-1": "1", "6570691-1": "0", "7417135-1": "1", "6449585-1": "0", "5597060-1": "0" } }, { "human_patient_id": "108", "human_patient_uid": "4817472-1-M", "PMID": "27057047", "title": "Atypical Cutaneous Sporotrichosis in an Immunocompetent Adult: Response to Potassium Iodide", "patient": "A 54-year-old healthy male, presented with multiple, variably sized, nonhealing ulcers over his right lower leg since 3 months. It started as a single coin-sized ulcer over the shin, which rapidly increased in size with the simultaneous appearance of multiple new similar lesions and swelling over the right leg. The patient had received multiple courses of oral and intravenous antibiotics despite of which his disease was progressing. There was no history of apparent trauma or evidence of an immunocompromised state. History of excursion to Amazon rain forest 1-month prior to the onset of ulceration was present.\nCutaneous examination revealed irregularly shaped ulcers ranging in size from pinpoint to 9 cm \u00d7 5 cm, covered with seropurulent slough [] distributed nonlinearly over the extensor aspect of the right leg. Few of them were herpetiform in morphology. The involved limb presented a cellulitic picture with diffuse erythema and induration. There was no evidence of any preceding nodulation. A single thickened lymphatic cord was palpable on the medial aspect of the thigh in the later course of his disease.\nAll the hematological and biochemical investigations were normal except for a raised erythrocyte sedimentation rate (45 mm/h). Magnetic resonance imaging lower leg showed findings consistent with cellulitis with no deep extension, abscess, osteomyelitis, or muscular involvement.\nHistopathology and tissue culture samples were sent with a differential diagnosis of pyoderma gangrenosum, mycobacterial infection, cutaneous leishmaniasis, and deep fungal infection. Repeated cultures for the same were negative. Histopathology revealed multiple, poorly formed, epithelioid cell granulomas along with diffuse infiltrates of lympho-histiocytes, plasma cells, and neutrophils in the deeper dermis. Special stain (periodic acid-Schiff [PAS] and Gomori Methenamine silver stain) showed small budding and occasional elongated yeast cells in the dermis []. PAS stain from tissue imprints revealed cigar-shaped bodies suggesting Sprorothrix infection.\nPatient was started on itraconazole capsules 200 mg twice daily monotherapy, with only marginal response. He developed multiple subcutaneous nodules and an ulcer over the right thigh even after 6 weeks of treatment. Thus, saturated solution of potassium iodide (SSKI) was added with complete clearance of the lesions in 10 weeks.", "age": [ [ 54.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4817472.xml", "relevant_articles": { "19292371": "1", "12492973": "0", "28018688": "0", "10989578": "0", "19461242": "0" }, "similar_patients": { "4103297-1": "0", "7452005-1": "0", "5707842-1": "123", "7253847-1": "1", "7367591-1": "0" } }, { "human_patient_id": "109", "human_patient_uid": "4280498-1-M", "PMID": "25580133", "title": "Successful Use of Extracorporeal Membrane Oxygenation for Respiratory Failure Caused by Mediastinal Precursor T Lymphoblastic Lymphoma", "patient": "A 40-year-old male was admitted to hospital because of chest discomfort and dyspnea. The patient had been well until 2 weeks before admission, when chest pain, cough, and dyspnea had developed. Two days before admission, he could not lie down because of dyspnea. He went to another hospital and a chest X-ray (CXR) was performed. A CXR revealed a widened mediastinum and he was referred to the emergency department of our hospital.\nOn examination, he appeared dyspneic and presented with orthopnea. His vital signs were normal. He had no peripheral lymphadenopathy. Laboratory tests on admission showed elevated lactate dehydrogenase level of 744 IU/L. The result of arterial blood gas was normal (). A CXR revealed a widened mediastinum and left pleural effusion () and contrast enhanced computed tomography (CT) of the chest showed a mediastinal mass of 12 cm by 7 cm, compressing the trachea (). A CT revealed no lymphadenopathy other than the mediastinal lesion.\nOn hospital day 2, tracheal intubation was performed by an anesthesiologist as the patient was considered to have high risk of suffocation. During the tracheal intubation, the left main bronchus was obstructed completely by a mediastinal tumor and the patient suddenly developed hypoxia. Oxygen was administered through a tracheal tube but the oxygen saturation was approximately 80 percent. ECMO was introduced immediately to recover oxygenation, placing a venous cannula in the right common femoral vein and an arterial cannula in the jugular vein. A CXR after intubation revealed atelectasis of the left lung (). After introducing ECMO, oxygen saturation was maintained at about 98 percent and PaO2 was 96 mmHg (). Percutaneous fine needle biopsy of the mediastinal tumor was performed and the patient was transferred to the intensive care unit. A provisional pathological diagnosis was LBL. On hospital day 3, chemotherapy, comprised of adriamycin, vincristine, cyclophosphamide, and prednisolone (CHOP), was started to debulk the mediastinal lesion.\nAfter chemotherapy was started, the mediastinal mass shrank rapidly and oxygenation gradually improved. He was weaned from ECMO on hospital day 8 and weaned from the mechanical ventilation and was extubated on hospital day 28. He did not have any respiratory sequelae after extubation. The final pathological diagnosis was T-LBL. Chromosomal analysis did not reveal any abnormalities and an FISH of the BCR-ABL was negative. Acute Lymphoblastic Leukemia 202 protocol without imatinib (Japan Adult Leukemia Study Group) [] was started on hospital day 23 followed by subsequent consolidation chemotherapy. A CXR performed on day 71 shows disappearance of atelectasis and shrinkage of the mediastinal tumor (). A contrast enhanced CT of the chest performed on hospital day 87 confirmed partial remission of the tumor (). The patient's sister was confirmed as having full-matching HLA and the patient was referred to another hospital to receive allogeneic hematopoietic transplantation.\nAdverse reactions during clinical courses were febrile neutropenia, acute kidney injury, which did not require renal replacement therapy, and right femoral subcutaneous abscess caused by cannulation for ECMO. He did not develop bleeding or thromboembolism as complications of ECMO.", "age": [ [ 40.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4280498.xml", "relevant_articles": { "14978917": "12", "11193433": "12", "25572646": "12", "32641675": "12", "32381869": "123" }, "similar_patients": { "6133044-1": "0", "6831730-1": "123", "7488892-1": "0", "4336281-1": "0", "7511560-1": "0" } }, { "human_patient_id": "110", "human_patient_uid": "7229638-1-M", "PMID": "32416720", "title": "Outcomes of occipitocervical fixation using a spinous process screw in C2 as a third anchor point for occipitocervical fixation: a case presentation", "patient": "A 35-year-old man was hospitalized after a 10-year history of occipitocervical pain and limited mobility (Fig. ). Physical examination revealed mild tenderness in the back of the upper cervical vertebrae and limited mobility of the neck. The muscle strength of the limbs was grade 4, and there was slight loss of limb and trunk sensation. Excretory function was normal. Pathological reflexes were positive, and bilateral patellar tendon reflexes were hyperactive. Cervical anteroposterior and lateral plain radiography, cervical computed tomography (CT), and magnetic resonance imaging (MRI) revealed an occipitocervical junction deformity accompanied by spinal cord compression. Occipitocervical deformity was diagnosed. On the fifth day after admission, the patient underwent a corrective operation involving posterior reduction and occipitocervical fixation and fusion. The bone graft comprised both ilium and artificial bone.\nThe standard occipitocervical posterior midline approach was adopted to expose the posterior structures of the C0\u2013C3 vertebrae. Care was taken to protect the vertebral artery and posterior vascular plexus. Intraoperative fluoroscopy revealed that the occipitocervical joint sequence was good, and the reduction was successful. Screw insertion was a three-step process. First, occipital screws were inserted in the mediolateral tubercle and the occipital protrusion of the occipital bone (total of three occipital screws) []. Second, pedicle screws were inserted bilaterally in C2 using the Harms and Melcher technique [], and lateral mass screws were inserted bilaterally in C3 using the Roy\u2013Camille et al. technique []. Third, an additional spinous process screw (3.5 mm diameter, 20 mm long) was inserted vertically into C2 []. The depth and angle of its implantation was determined using the Goel and Kulkarni technique [], and the screw itself was chosen according to its length and diameter based on the patient\u2019s appearance on preoperative CT scans. Following screw insertion, three rods were then connected from C0 to C3. An occipital screw was placed in the occipital protrusion and connected to the C2 spinous process screw. A high-speed drill was used to prepare the bone graft bed on the posterior structure of the occipitocervical joint. The graft comprised bone from the posterosuperior ilium and artificial bone.\nThe patient could walk with a neck brace on postoperative day 3 and continued wearing the neck brace for the next 3 months. No neurovascular complications or incision infection were observed during the 24-month follow-up. Postoperative radiography showed that the internal fixation remained stable. Successful fusion was confirmed 4 months after the operation. Postoperative MRI showed that the occipitocervical decompression was sufficient, and there was no obvious spinal cord compression. The muscle strength of the limbs was grade 5, and at the 24-month follow-up visit the patient\u2019s sensation function had improved from its preoperative state (Fig. ).", "age": [ [ 35.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7229638.xml", "relevant_articles": { "32416720": "13", "25050682": "1", "15329228": "13", "19057245": "1", "10423787": "13" }, "similar_patients": { "7812719-1": "123", "5908617-1": "12", "4130956-1": "123", "3407708-1": "123", "3162686-1": "123" } }, { "human_patient_id": "111", "human_patient_uid": "6206793-1-M", "PMID": "30333342", "title": "The Value of Institutional Protocols and Focused Cardiac Ultrasound During a Case of Ultramassive Transfusion", "patient": "A 53-year-old African American female with a body mass index of 27.2 kg/m2 and a history of coronary artery disease, end-stage renal disease, cervical carcinoma and a right atrial thrombus, presented to our emergency department from an outside hospital bleeding profusely from her rectum. At an outside facility, two self-expanding nasal tampons (Rhino Rockets, Shippert Medical Technologies, Centennial, Colorado, USA) were placed in the rectum to control bleeding and two units of PRBCs were transfused. While still in the emergency department, MTP was started, and 2 g of intravenous tranexamic acid (TXA) were administered.\nThe patient was emergently taken to the operating room, but surgical efforts failed to control the bleeding as the pelvic radiation therapy she had previously received to treat a cervical carcinoma had distorted her anatomy such that her internal iliac artery could not be visualized. Proctoscopy performed after total colectomy revealed a still massive amount of blood coming from the lower rectum or anal canal. A balloon was fashioned with a Penrose drain and Foley catheter to create a tamponade effect in the rectum; however, this was effective for only a short while. Thromboelastography (TEG) results \u2013 a normal reaction time (R) time of 7 min, a decreased alpha angle of 40\u00b0 and decreased maximum amplitude of 36.7 mm \u2013 pointed toward a coagulopathy secondary to fibrinogen and platelet deficiency. The patient continued to receive fresh frozen plasma (FFP), cryoprecipitate and platelets. While there was a concern of a coagulopathy related to the apixaban, the patient was prescribed for atrial thrombus, the etiology of bleeding, in this case, was surgical. During the consultation with the interventional radiology service for angioembolization, she was brought to the Surgical Intensive Care Unit (SICU) for interval management with the rectal balloon in place.\nIn the SICU, two rapid transfuser devices (Level 1, H-1200 Fast Flow Fluid warmer, Dublin, OH, USA) were assembled, and a wide-bore central venous catheter was inserted. MT was continued with a goal mean arterial pressure (MAP) of 50\u201360 mmHg through the administration of blood products, norepinephrine, and vasopressin infusion and intermittent boluses of epinephrine. Resuscitation was guided by vital signs, bedside echocardiography, serial TEG and perfusion biomarkers such as serum lactate and base deficit. A >14 L blood loss was recorded in the SICU in 90 min.\nIn the interventional radiology suite, a fistula between the right common iliac and the rectum was identified as the source of bleeding. A 10 mm \u00d7 40 mm covered self-expanding intravascular stent (Fluency, Bard Peripheral Vascular, Tempe, AZ, USA) successfully stopped the bleeding. In total, the patient received 60 units PRBC, 23 units FFP, 20 packs of platelets, 6 units cryoprecipitate, 2 g TXA, 30 L of crystalloid, and 2 L of albumin in <7 h.\nSerial focused cardiac ultrasound (FoCUS) guided the resuscitation. Hypothermia, serum lactate, and base deficit improved from 35.4, 7 and \u2212 10\u201336.8, 1.9 and \u2212 4 respectively, in the next 4 h. By that point, the patient was able to follow commands and required minimal ventilatory support. In the ensuing days, there were no signs of lung injury, volume overload, coagulopathy, or cardiomyopathy. Her abdomen was closed 2 days later, successfully extubated shortly thereafter, and transferred to the floor.", "age": [ [ 53.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC006xxxxxx/PMC6206793.xml", "relevant_articles": { "30333342": "123", "22590946": "1", "34798700": "1", "30980747": "1", "27236329": "1" }, "similar_patients": { "5121457-1": "123", "3955500-1": "123", "5645592-1": "12", "5112224-1": "123", "7713822-1": "13" } }, { "human_patient_id": "112", "human_patient_uid": "7737437-1-M", "PMID": "33354373", "title": "Ocrelizumab-Induced Severe Colitis", "patient": "A 43-year-old Caucasian female presented with multiple episodes of loose, watery, dark stools. Her presentation was associated with gradual onset, colicky, lower abdominal pain since the previous day. She otherwise denied any fever, nausea, or vomiting, history of ill contact, or any history of travelling or taking outside food. No one within her household had similar symptoms.\nThe patient had been diagnosed several years earlier with multiple sclerosis (MS) and is wheel-chair-bound due to that disease. She had been prescribed alemtuzumab in a clinical trial 10 years preceding this presentation and had used teriflunomide for one year prior to being prescribed ocrelizumab by her neurologist\u2014she had received two doses six months apart. She denied any prior history of inflammatory bowel disease or bowel cancer.\nUpon examination, it was noted that she was afebrile and was haemodynamically stable. Examination of the abdomen revealed a soft abdomen with tenderness at the suprapubic and iliac regions with increased bowel sounds but no evidence of peritonism or organomegaly. Digital per rectal examination established an empty rectum.\nThe patient was ordered a range of initial laboratory and imaging investigations and follow-up diagnostics based on those findings (Tables and ). The abdominal X-ray () demonstrated a classical thumbprinting sign that was nonspecific but suspicious for clostridium difficile infection. Empirical antibiotics IV metronidazole and oral vancomycin were commenced for presumed clostridium difficile infection while awaiting for laboratory tests and histology results.\nThe patient's venous blood gas showed lactate of 4 mmol/L (normal range, 0.6\u20131.8 mmol/L) which prompted a CT abdomen. The CT demonstrated a pronounced colitis extending from the transverse colon to the sigmoid colon. When the patient did not respond to IV metronidazole and oral vancomycin, a flexible sigmoidoscopy was undertaken and showed nodular mucosa with white-yellowish adherent plaques with increasing severity from the rectosigmoid to the sigmoid (Figures and ). The histology from biopsies taken from various parts of the left colon was negative for cytomegalovirus (CMV) and clostridium difficile infection, but suggestive of biological medication effect.\nAccordingly, the patient was treated as ocrelizumab-induced colitis and commenced on intravenous hydrocortisone. Her CRP was downtrending on hydrocortisone. However, serial abdominal X-rays demonstrated ongoing gaseous distension, and she continued having watery bowel motions. The patient was referred to a tertiary hospital and colorectal surgeons for medication-resistant biological medication-induced colitis. She subsequently underwent a total colectomy and ileostomy formation.", "age": [ [ 43.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7737437.xml", "relevant_articles": { "22761206": "0", "23234822": "0", "15952487": "0", "16501861": "0", "31065468": "0" }, "similar_patients": { "8079880-1": "13", "5030415-1": "13", "7948695-1": "0", "5584999-1": "0", "5437480-1": "0" } }, { "human_patient_id": "113", "human_patient_uid": "7962320-1-M", "PMID": "33722205", "title": "Phenylketonuria and juvenile idiopathic arthritis: a case report", "patient": "A 4-year-old girl was considered as having phenylketonuria (PKU) at the age of 1 month due to her less dark pigmented hair and a positive neonatal screening for Phe.\nHer condition was confirmed by detecting homozygous mutation of PAH at nucleotide c.331 in exon 3 (c.331T > C) in the patient and heterozygous in both parents. The genetic sequencing was made in Beijing Kangxu Medical Research Center, Haidian District, Beijing, China. She was a term infant with a birth weight of 2700 g. There was no family history of arthritis or PKU. The baby was given a Phe-restricted diet. L-Amino acid-based medical foods (without Phe) provide ~ 80 % of the protein needs. The proportion of modified low-protein food was adjusted according to the concentration of regularly monitored blood Phe. She presented with normal motor development including walking and running, slight language delay and intellectual disability at 2 years old. At the age of 3.5 years, she presented with pain and swelling of her right ankle, right knee, and right hip joint (see Fig. ). At that time, serum Phe concentration was 22.8 mg/dL. Unresolved ankle pain and elevated serum Phe concentration prompted referral to West China Second University Hospital of Sichuan University at the age of 4.5 years. She had severe pain of bilateral ankles, knees, and knuckles. She could not walk or jump. The affected joints were swollen, hot, and painful. A radiograph of the lower limbs showed bone demineralization. Laboratory investigation demonstrated an increase in Phe (19.52 mg/dL reference range: < 1.8 mg/dL), C-reactive protein (33.6 mg/L; reference range: 0-5 mg/L), erythrocyte sedimentation rate (36mm/h; reference range: < 21mm/h), tumor necrosis factor alpha (10.9pg/ml; reference range: <8.1pg/ml), and interleukin 6 (41.87pg/ml; reference range: < 5.9pg/ml), and a positive rheumatoid factor. Liver function, renal function, bone marrow biopsy smear and bone marrow culture were normal. Autoantibodies, antineutrophil cytoplasmic antibodies, anticardiolipin antibody, mycoplasma pneumoniae antibody, HLA-B27, and PPD tests were all negative. She was diagnosed with JIA and treated with a nonsteroidal anti-inflammatory drug (naproxen), methotrexate and low dose prednisone. Her joint pain responded well to the therapy. The patient has had followed-up appointments every 3 months for 1 year. Now she is thriving and can walk normally, with no further complaint of joint pain. Serum Phe concentration has been maintained within the high-normal range. (The last serum Phe concentration is 12 mg/dL)", "age": [ [ 4.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7962320.xml", "relevant_articles": { "33722205": "13", "23430504": "1", "8779793": "0", "30504296": "0", "27089192": "0" }, "similar_patients": { "2885380-1": "1", "8411105-1": "1", "7559655-1": "0", "7189601-1": "1", "5461328-1": "0" } }, { "human_patient_id": "114", "human_patient_uid": "5635610-1-M", "PMID": "29017528", "title": "First case of Mycobacterium marseillense lymphadenitis in a child", "patient": "We evaluated a 4 years old girl, previously healthy, with no relevant family medical history. She was conducted to our clinic because of a submandibular lymphadenitis. A month before, during a 3 days fever period, a painful submandibular swelling was noted. Neck ultrasound (US) showed a 2-cm diameter lymphadenopathy with a conserved structure. Therapy with ibuprofen was then suggested. Because of symptoms persistence, a control US was repeated after 5 days. The lymph node was enlarged and presented a subverted structure, with hypoechogenic areas and an absent roundness index (Fig. ). Therapy with co-amoxiclav was immediately started at a dosage of 80 mg/kg/day for 6 days. Blood tests showed a slight increase in C-reactive protein values (53 mg/L; normal value <50 mg/L) and erythrocyte sedimentation rate (31 mm/h); serology for Cytomegalovirus confirmed a previous infection, while IgM for Epstein Barr Virus (EBV) were positive. Blood smear was normal. Tuberculin skin test resulted positive (10 mm infiltration diameter). QuantiFERON-TB Gold In-tube test and chest X-ray resulted negative.\nNeck US performed after 20 days was unchanged. Therefore the girl was referred to our infectious disease unit for further investigations. At physical examination, a fixed right submandibular lymphadenopathy, with an elastic consistency, painless and with no superficial skin alterations was detected. No other significant clinical features were described. Blood tests showed no alteration in blood count, inflammatory markers, liver function, lactic dehydrogenase, coagulation. Francisella tularensis and Toxoplasma gondii serology were negative. EBV serology showed evidence of a past infection.\nIn the suspicion of an NTM lymphadenitis, antimicrobial therapy with clarithromycin (15 mg/kg/die), and rifampicin (20 mg/kg per day) was started. A magnetic resonance imaging showed a confluent lymphonodal pack inside the inferior pole of the right parotid gland (4 \u00d7 4.2 \u00d7 2.9 cm) that was enhanced after contrast medium infusion. The enhancement involved also the whole parotid gland parenchyma and the ipsilateral sternocleidomastoid muscle.\nDue to sudden enlargement of swelling, exeresis of the lymph node was performed. Bacterioscopic exam showed a positivity for acid-fast bacilli, and the histological examination evidenced a granulomatous inflammation. Culture from the biopsy grew a M. marseillense strain, identified using a commercial kit (Hain Genotype Mycobacteria CM, Hain Lifescience, Germany) and sequencing the spacer region interposed between 16S and 23S rRNA genes, as described previously []. Because of a slow healing up of the surgical scar, ethambutol (25 mg/kg/die) was added to the previous therapy. Antimicrobial treatment was well tolerated by the patient and no adverse effect were reported. Blood exams and clinical assessment were periodically performed in order to evaluate potential drug-induced toxicity. Therapy was finally stopped 2 months after surgery.\nPeriodical blood tests and neck US were performed. At 10 months follow up visit, no relapse was found and the surgical scar was completely healed.", "age": [ [ 4.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5635610.xml", "relevant_articles": { "32787862": "0", "12010345": "123", "24409081": "0", "10093570": "0", "19551605": "123" }, "similar_patients": { "6052688-1": "0", "6765912-1": "0", "5075604-1": "123", "2908448-1": "123", "3492103-1": "123" } }, { "human_patient_id": "115", "human_patient_uid": "2802381-1-M", "PMID": "20048459", "title": "Dissociative fugue in the elderly", "patient": "A 62-year-old lady was found wandering in the premises of a famous temple town in Kerala. When the local police questioned her, she said that she had left her home a few days ago and would now like to return. She provided them with the telephone number and address of her residence based on which the police were able to reunite her with her family.\nOn her return, the family discovered that she quickly got back to her old household routine, but was unable to remember people (neighbors, local shopkeeper) and events that had taken place in the preceding weeks. She was also confused about where she had gone and what she had done when she left home, but was able to furnish proof that she had traveled by train to a temple in a neighboring state, where she had spent her childhood. As they could not understand her patches of memory loss, the family brought her for a neurological evaluation.\nAn interview revealed that she was treated in the outpatient unit of the hospital for a fall six weeks ago. She had fallen from the pillion seat of a scooter and had been brought to the Casualty Section for first aid. There was no loss of consciousness, headache, blurring of vision, or vomiting. She was evaluated as an in-patient for possible post-traumatic sequelae. Medical examination revealed that she was hypertensive, but not on regular treatment. A neurological evaluation at that stage revealed no anomalies in her cognition or behavior. The CT scan and profile on blood investigations were within normal limits.\nOn this follow up, the Mini Mental State Examination score was 27. With no neurological problems elicited on examination and investigation, a working diagnosis of pseudo-dementia was made and a course of anti-depressants was prescribed.\nOn follow up, there was improvement in her mood, but the amnesia persisted. She was therefore referred for evaluation, to the clinical psychologist.\nIn this patient, there were no neurological or behavioral symptoms in the immediate post-traumatic period, except for mild features of a depressive disorder. The question here would be whether absence of \u201cpositive findings\u201d could truly rule out organic causes for such impulsivity in behavior. A referral to the mental health practitioner is sometimes a resisted step in the treatment process, especially in a country such as India. It is only when the investigations rule out organicity, that \u201cpsychogenicity\u201d of a symptom is considered.\nIn appearance, she was an obese lady who appeared anxious and tearful. She was initially unwilling to answer questions and repeatedly said that she could not remember what had happened. Speech was slow, but relevant and coherent. Mood was depressed; there was guilt and ideas of hopelessness. There were no hallucinations or delusions. Apart from deficits in semantic memory, there were no anomalies in primary mental functions.\nOn account of her apparent distress while answering questions, sessions of hypnosis were attempted. However, we encountered resistance and therefore, a supportive client-centered approach was adopted, with which she appeared to be more comfortable.\nFormal psychometric assessment was deferred, in favor of serial Mental State Examinations.\nOver the next three sessions, she was able to recall incidents of the preceding weeks. The most distressing episode according to her was the argument she had had with her husband. She felt that despite decades of managing the household and coping with several psychosocial stressors, the husband was overly critical of her. She described the intense grief she experienced that had prompted her to walk away from home. She visited several local temples before boarding a train to a famous temple town. After a day's stay there, she traveled by train to a temple in a neighboring state. It was the first time she was traveling alone by train, and she reported that she traveled ticketless on certain parts of the travel. She reported that she did not plan her movements, but seemed to instinctively move from one place to the other. It was only upon her return to her home state, after a few days that her memory \u201creturned\u201d and she went up to a local policeman and asked for help. She reported feeling very guilty over her \u201cflight,\u201d but insisted that there was no deliberate attempt to cause distress to her family. She did not remember people whom she was in contact with, during the travel, but could produce some of the tickets she had used. She had a purse with some money, but had pawned jewellery to purchase clothes and a few other necessities for herself. On her return, she was also very perplexed about the identity of some of the people around her and did not understand why she could not identify them.\nThere had been no incidents of similar behavior in the past; there were no reports of seizures, somnambulism, or other parasomnias. There were no differences in behavior and cognitive functions following the injury. The family described her as a quiet, responsible individual who had efficiently managed the household. Prior to her flight, she had participated actively in a family function; on her return, despite several cues, she could not recall the event or her family members who had reunited after a long while.\nWe considered the diagnosis of fugue because of the organized flight from home with significant disruption of her social and occupational routine, as also the absence of pre-morbid neurological or psychiatric problems and the self-remitting course of the altered behavior. The amnesia noted on her return was episodic and circumscribed (restricted to a few select people). The odd points in the case were the age and the absence of severe psychological trauma that could have precipitated the flight.\nAs we report the case, the client has returned to her pre-morbid level of functioning and comes regularly for follow up. She continues to be on a mild course of anti-depressants and supportive therapy. We plan to monitor her cognitive and psychiatric status over regular follow-up sessions and taper the sessions gradually if she maintains this improvement.", "age": [ [ 62.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC002xxxxxx/PMC2802381.xml", "relevant_articles": { "30998493": "0", "16318071": "0", "6570608": "0", "1068960": "0", "5197328": "0" }, "similar_patients": { "3821211-1": "1", "3292982-1": "13", "4139079-1": "13", "4253364-1": "1", "5920445-2": "1" } }, { "human_patient_id": "116", "human_patient_uid": "2693561-1-M", "PMID": "17297276", "title": "Ten Trigger Fingers in an Adult Man : A Case Report", "patient": "A 39-yr-old man visited the clinic due to trigger finger disease in every digit of both hands which had been aggravated during the past 3 months. A year ago, the patient was treated three times with local steroid injections in both trigger thumbs. Since childhood, the patient has suffered from tingling sensation, coldness and bluish discoloration of his fingers during winter and cold weather. Therefore, the patient had to constantly wear gloves.\nThe patient's symptom was aggrevated after changing his occupation to a laborer 3 months ago. He had worked for 6 hr a day and 6 days a week by using vibrating tools with forceful hand grip such as grinders.\nHis mother and maternal aunt also had a history of operative treatments due to multiple trigger fingers. Examination showed obvious nodules on the A1 pulleys in both thumbs, middle fingers and ring fingers for which the patient always felt uncomfortable. There were no nodules in the index and little fingers even though an intermittent triggering occurred particularly in the morning and after working. He could not perform a forceful grip when flexing the fingers due to pain and tendon entrapment at the A1 pulley (). In addition, he could not extend his fingers freely (). The Allen test was normal. Initial plain radiographs showed dense bone island in the middle phalanx shaft of the right little finger and in the metacarpal head of the left thumb. Laboratory test for thyroid functioning was normal. The patient refused to do the provocative test for Raynaud's disease.\nTo relieve the symptoms, A1 pulley was released in all ten fingers: longitudinal incision for the fourth finger of the right hand and transverse incisions for the other 9 fingers. Intraoperatively, a partial tear of the flexor pollicis longus tendon and hypertrophied A1 pulleys in both thumbs were observed. There were no nodules in the flexor tendons and no tears in the other flexor tendons. All fingers except both thumbs did not have any nodules in the flexor tendons or tears of the flexor tendons. The partial tear of both flexor pollicis longus tendons in both thumbs might be due to previous steroid injections. After operation, the patient had a recovery period for a month without working. Three months after the operation, the patient could return to his previous job without discomfort and showed normal range of motion in all fingers. The previous symptoms such as impairment of a forceful grip and locking in flexion disappeared completely ().", "age": [ [ 39.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC002xxxxxx/PMC2693561.xml", "relevant_articles": { "17297276": "13", "28709917": "12", "8919502": "1", "21045021": "13", "10584936": "13" }, "similar_patients": { "3636491-1": "123", "3263289-1": "123", "5439395-1": "123", "4996053-1": "123", "5714987-1": "13" } }, { "human_patient_id": "117", "human_patient_uid": "3530859-1-M", "PMID": "23304619", "title": "Absence of mTOR Inhibitor Effect on Hepatic Cyst Growth: A Case Report of a Kidney Transplant Recipient with Autosomal Dominant Polycystic Kidney Disease", "patient": "A 50-year-old man with autosomal dominant polycystic kidney disease (ADPKD) evolved to end-stage renal failure and hemodialysis was started in 1992. Because of voluminous kidneys, a right nephrectomy was performed in 1992, followed by the left one in 1994. In April 1998, a deceased donor kidney transplantation was performed in the right iliac fossa. Induction therapy consisted in seven days of polyclonal anti-T-cell globulin (thymoglobulin), because of delayed graft function. Maintenance immunosuppression consisted of cyclosporine (CsA) and prednisone. Steroids were withdrawn in December 1998. No acute rejection was observed. At one month, the serum creatinine was 130 \u03bcmol/L and the glomerular filtration rate was estimated at 61 mL/min/1.73 m2 by MDRD. The serum creatinine remained stable during the followup and was of 113 \u03bcmol/L in March 2011.\nDuring the followup in our outpatient clinic, the patient suffered from recurrent episodes of hepatic cyst infections, treated by antibiotics. In April 2007, bloating and abdominal discomfort developed. An abdominal MRI was performed showing a marked hepatomegaly with incomplete chronic Budd-Chiari syndrome, due to extrinsic venous compression by voluminous liver cysts. Because of worsening symptoms and many hepatic cyst infections, a new MRI was performed in June 2008, showing an increasing liver volume without progression of the Budd-Chiari syndrome. The liver volume was 3517 mL at this time. Because of preliminary data suggesting a potential benefit of mammalian target of rapamycin (mTOR) inhibitors therapy on hepatic cyst growth, CsA was stopped and sirolimus started at 0.5 mg/d to achieve serum levels between 4 and 6 ug/L (). MRIs were performed during the mTOR therapy because of worsening symptoms, and a followup was made with volumetric hepatic MRI. Only total hepatic volume was measured. Six months later, a new MRI showed a continuing increase in liver volume, which was estimated at 3883 mL. In November 2009, the liver volume was 4240 mL and in June 2010, 4400 mL (). The chronic partial Budd-Chiari syndrome did not change.\nUnder sirolimus therapy, our patient did not report adverse events like cutaneous rash, diarrhea, and aphthous stomatitis, but he developed important legs edema. Hyperlipidemia was controlled with pravastatin and there was no significant proteinuria. Because of the continuing increase in liver volume (i.e., no significant effect of sirolimus) and the important discomfort due to bilateral legs edema, sirolimus was stopped and CsA restarted in June 2010. The differential diagnosis of leg edema was venous compression due to hepatomegaly. After restarting CsA therapy, the leg edema resolved, which was consistent with a sirolimus side effect. Fifteen months after sirolimus was stopped, a new MRI was done. The liver volume was at 4700 mL (). The average hepatic growth over the two years of sirolimus therapy was of 37.5 mL per month versus 20 mL per month with cyclosporine.", "age": [ [ 50.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3530859.xml", "relevant_articles": { "23304619": "123", "20466742": "123", "18199797": "123", "26912555": "123", "12687325": "0" }, "similar_patients": { "8344107-1": "123", "7837753-1": "0", "8551365-1": "0", "4432419-1": "13", "5466357-1": "1" } }, { "human_patient_id": "118", "human_patient_uid": "2933638-1-M", "PMID": "20731843", "title": "Gallbladder agenesis diagnosed intra-operatively: a case report", "patient": "A 79-year-old Caucasian man presented to the clinic with reduced appetite, unintentional weight loss of approximately 6 kg, and a history of fatty food intolerance. He denied any abdominal pain or febrile episodes, and physical examination was unremarkable. Biochemical investigations, however, revealed deranged liver-function tests with total bilirubin, 66 \u03bcmol/L; ALT, 122IU/L; ALP, 274IU/L; and gamma GT, 864IU/L.\nAn abdominal ultrasound showed a dilated common bile duct (CBD) with stones inside it. The gallbladder was not visualized, but strong echoes with acoustic shadowing were seen, suggesting a contracted gallbladder. A computed tomography (CT) scan revealed stenosis of the proximal CBD and dilated intra- and extra-hepatic bile ducts. Furthermore, it showed a small pseudocystic structure that was assumed to be a shrunken gallbladder.\nThe patient proceeded to endoscopic retrograde cholangiopancreatography (ERCP), which showed multiple stones (the largest measuring 1.5 cm) in the CBD, which could not be removed, and so a stent was inserted (see Figure ). The gallbladder was not visualized, but this was thought to be the result of insufficient contrast. A repeated ERCP a few months later was reported as having cleared the CBD of all stones; the stent was removed, but the gallbladder had still not been visualized. As he had developed some intermittent right upper quadrant pain over this time, he was listed for a laparoscopic cholecystectomy for presumed choledocholithiasis.\nAt laparoscopy, a small fibrous remnant was seen in the gallbladder fossa, but the gallbladder could not be found despite an extensive search of all possible ectopic sites. Conversion to an open procedure and on-table cholangiogram revealed a dilated CBD and confirmed gallbladder agenesis (see Figure ). The CBD was explored, numerous stones removed, and a T-tube was inserted.\nPost-operatively, he made an uneventful recovery, and remains symptom free.", "age": [ [ 79.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC002xxxxxx/PMC2933638.xml", "relevant_articles": { "16888397": "123", "7665818": "0", "17519841": "0", "1375152": "0", "22776221": "0" }, "similar_patients": { "3286734-1": "0", "5704883-1": "0", "8238397-1": "0", "8057131-1": "0", "2627237-1": "0" } }, { "human_patient_id": "119", "human_patient_uid": "5729642-1-M", "PMID": "29215816", "title": "Efficacy of Afatinib in a Previously-Treated Patient with Non-Small Cell Lung Cancer Harboring HER2 Mutation: Case Report", "patient": "A 50-year-old Korean woman who had never smoked visited our lung cancer clinic in February 2015. She complained of upper airway infection symptoms of mild back pain followed by cough with sputum and rhinorrhea. Computed tomography (CT) from an outside hospital showed a right upper lobar mass with enlargement of adjacent interlobar lymph node, and miliary distribution of multiple tiny nodules in both lungs (). She was diagnosed with stage IV lung adenocarcinoma with metastases to both lungs, T12 spine, left femur and brain that was proven by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), positron emission tomography and brain magnetic resonance imaging (MRI). Her initial tumor biopsy from primary mass and lymph nodes was negative for EGFR mutation and ALK translocation.\nShe received four cycles of pemetrexed and cisplatin, and her tumor burden was retained as stable disease (). She stopped the chemotherapy due to poor performance status without maintenance therapy. Upon progression of right upper lobar mass, multiple lung nodules and metastatic lymphadenopathies after 2 months without subsequent treatment (), she received gefitinib for the next 2 months. Subjectively-rated symptoms of nausea and myalgia seemed to ease, but gefitinib was finally stopped due to aggravation of gastrointestinal toxicity and lung-to-lung metastases (). Thereafter, progression in brain metastasis was also demonstrated in follow-up MRI. She suffered from general weakness, nausea and back pain, and so was reluctant to receive further cytotoxic chemotherapy.\nIn September 2015, she agreed to be tested for another activating mutation using previously achieved specimen by EBUS-TBNA. Pathologic examination revealed a poorly differentiated atypical cell nest with focal glandular differentiation (). Immunohistochemical stain for c-erbB2 showed weak membranous staining (). After direct sequencing as screening test, the following next generation sequencing (NGS) of the tissue revealed a HER2 exon 20 mutation with A-to-G base change at nucleotide 2437 (c.2437A>G), which led to substitution of aspartate for asparagine at position 813 (p.N813D) (). This mutation has never been reported. In October 2015, she started afatinib 40 mg daily. An initial clinical and radiologic response was achieved within a month. She professed a sense of well-being and relief of back pain, and simple chest X-ray showed more decreased lung nodules grossly. During week 6 of treatment, a CT assessment revealed a partial response in extracranial lesions with prominent regression of primary lung tumors in the right upper lobe and lung-to-lung metastases (). Brain metastases had maintained the stable state, and she did not complain of any neurologic symptom or sign. After stepwise dose reduction to 20 mg due to stomatitis and nausea, she has continued the medication until February 2016 without deterioration of subjective symptom and tumor burden. Last CT scan on January 2016 still showed a partial response in extracranial lesion, but brain MRI revealed mild increase of metastases. At last visit on February 2016, the patient complained of general weakness and anorexia with stomatitis, and thereafter she was lost to follow-up.", "age": [ [ 50.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5729642.xml", "relevant_articles": { "25732916": "12", "23254266": "12", "16407879": "12", "32626622": "12", "19881244": "12" }, "similar_patients": { "6823937-1": "123", "7683654-1": "123", "7748360-1": "13", "7870175-1": "123", "8674488-1": "13" } }, { "human_patient_id": "120", "human_patient_uid": "6646857-1-M", "PMID": "31410348", "title": "Investigation of psoriasis skin tissue by label-free multi-modal imaging: a case study on a phototherapy-treated patient", "patient": "A female patient aged 60 years (with skin type III according to Fitzpatrick), with moderate chronic plaque psoriasis (Psoriasis Area and Severity Index [PASI] =7.7), came to the dermatological clinic to receive phototherapy. The study was approved by the Ethics Committee at the University of Gothenburg and the National Data Inspection Board (approval number DNR:089\u201312, T285-16). The patient\u00b4s written informed consent was obtained for case details and publishing accompanying images. The patient was treated with NBUVB therapy (311 nm, according to standard protocol, 28 sessions, total dose 3.0 J/cm2 (increasing from 0.3 to 3.0 J/cm2) and psoriasis significantly improved (PASI =0.6). Four 4 mm punch biopsies were taken, one from intralesional psoriatic skin and one from perilesional healthy skin (about 2 cm from the psoriasis plaque) before and 24 hours after the last NBUVB session (). The biopsies were wrapped in aluminum foil and frozen at \u221270\u00b0C. Each sample was sectioned into 10 \u03bcm thin slices and placed on conductive glass slides. The whole process is illustrated in . The sections on the slides were used as they were for NLM and ToF-SIMS measurements; no treatment was done before the measurements. For histological assessment, the frozen sectioned slides were stained with H&E ().", "age": [ [ 60.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC006xxxxxx/PMC6646857.xml", "relevant_articles": { "31309611": "123", "20826993": "123", "19822480": "12", "31799260": "12", "22026392": "12" }, "similar_patients": { "3051098-1": "123", "3276776-1": "123", "8611516-1": "12", "7989782-1": "12", "6990267-1": "12" } }, { "human_patient_id": "121", "human_patient_uid": "6393145-1-M", "PMID": "30170469", "title": "Management of epidermal cysts arising from scar tissues", "patient": "A 50-year-old Korean man presented with a keloid scar on his anterior chest wall, which had developed 1 year prior following trauma and had gradually enlarged beyond the original wound's boundaries. He complained about pain and itching sensations in the keloid scar. The keloid scar measured about 5 cm and was located on the sternal area; a cystic lesion with a pin-point-sized skin opening was present at the center of the keloid scar (Fig. A). The cystic lesion was absent before the traumatic event, and dermoscopic examination revealed an EC with a central skin opening (Fig. B). The patient was asked to choose which among the 2 treatment options to undergo: total excision of the scar tissue including the cyst or laser therapy for the keloid and cystic lesion; the patient chose the latter method. First, laser therapy using a 595-nm pulsed dye laser (Vbeam; Candela Corporation, Wayland, MA) with a 7-mm spot size at a fluency of 12 J/cm2 and a 20-ms pulse width was performed to manage the keloid scar. Adjacent, nonoverlapping laser pulses were applied to the entire surface of the keloid scar. Epidermal cooling was achieved using a cryogen spray cooling device, which had a spurt duration of 30 ms with a delay of 30 ms. These procedures were performed 3 times with 3-week intervals. Second, laser therapy using a carbon dioxide laser (Spectra SP carbon dioxide laser, 20 Hz, 250 \u03bcs pulse width, 17 mJ; Lutronic, Korea) to create multiple punctures, resulting in a 2 to 4 mm hole, was performed to manage the EC. Gentle pressure and squeezing led to the exudation of the cyst's internal contents through the hole, and the remaining visible cystic walls were cauterized using the carbon dioxide laser. We applied Steri-Strip skin closures (3 M, Maplewood, MN) to the wound without surgical sutures. There were no postoperative complications, such as infection or wound dehiscence. The EC healed completely following the carbon dioxide laser therapy. We performed 5 further pulsed dye laser cycles on the whole keloid scar (Fig. C and D). After completing the laser therapy, Mepiform dressing (M\u00f6lnlycke Health Care, Oakville, Ontario, Canada), which is a self-adherent soft silicone dressing designed for scar management, was used by the patient for 5 months (Fig. E and F). There were no EC recurrences or keloid overgrowth during the 2-year follow-up period, and the patient was satisfied with the final outcome (Fig. G).", "age": [ [ 50.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6393145.xml", "relevant_articles": { "26735516": "123", "2807888": "1", "33645505": "123", "33002270": "123", "30132109": "0" }, "similar_patients": { "6393145-2": "12", "5965339-1": "112", "3199429-1": "0", "5965338-1": "0", "7004727-1": "12" } }, { "human_patient_id": "122", "human_patient_uid": "6393145-2-M", "PMID": "30170469", "title": "Management of epidermal cysts arising from scar tissues", "patient": "A 43-year-old woman presented with post-Bacillus Calmette\u2013Gu\u00e9rin vaccination keloid scars on both shoulders. A protruding lesion had developed at the center of the keloid scar on her right shoulder 3 months prior. The lesion had increased in size, and she had squeezed out the lesion's contents several times. However, the lesion had become swollen again and was painful. When she visited our clinic, the lesion had already ruptured, and inflammation had spread to the surrounding keloid scar tissue. The keloid scar on the patient's right shoulder measured about 9 \u00d7 7 cm, and the ruptured lesion measured 2 \u00d7 1.5 cm (Fig. A). We excised all the keloid tissue including the ruptured lesion, and repaired the wound using subdermal 3-0 PDS (Ethicon, Inc., Somerville, NJ) and interrupted 5-0 Ethilone (Ethicon, Inc.) sutures, primarily (Fig. B\u2013D). Histopathologically, a large laminated keratin-filled cyst was present in the dermis surrounded with a dense collagenous keloid scar (Fig. E). The cyst wall consisted of stratified squamous epithelium with a granular layer, which was consistent with an EC. The adjacent dermis contained characteristic broad, eosinophilic, and homogeneous keloidal collagen bundles (Fig. F). There were no postoperative complications, such as an infection or wound dehiscence. The stitches were removed 14 days postoperatively, and Steri-Strip skin closures were applied for 1 month to prevent wound dehiscence and scar widening. Subsequently, the patient used Mepiform and applied a personalized compression garment for 5 months (Fig. G and H). There were no EC recurrences or keloid overgrowth during the 1-year follow-up period, and the patient was satisfied with the final outcome.", "age": [ [ 43.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6393145.xml", "relevant_articles": { "2807888": "0", "15897406": "1", "8252010": "13", "32774941": "12", "10771477": "1" }, "similar_patients": { "6393145-1": "123", "7397415-1": "123", "7004727-1": "12", "4976908-1": "13", "5965339-1": "12" } }, { "human_patient_id": "123", "human_patient_uid": "7203463-1-M", "PMID": "32426365", "title": "Postoperative Adjuvant Chemotherapy Regimen of CAPOX Combined With Ninjin'yoeito in an Elderly Patient With Stage III Colon Cancer: A Case Report", "patient": "A 75-year-old woman with a medical history of hypertension presented at another institution with fecal occult blood, and a colonoscopy showed a type II tumor in the sigmoid colon. She was referred to our hospital for tumor resection, where colonoscopy determined that the tumor was located 23 cm from the anal verge. Histopathology of a biopsy specimen revealed a moderately differentiated tubular adenocarcinoma. Enhanced computed tomography of the thorax and abdomen showed sigmoid colon wall thickening. Regional lymph node metastasis was suspected, but no evidence of distant metastasis was observed. A blood examination revealed an elevated carcinoembryonic antigen (CEA) concentration (32.7 ng/ml). Following a diagnosis of cancer of the sigmoid colon, clinical stage IIIb [cT4a, N1b, M0], a laparoscopic sigmoid colectomy was performed without complications. The postoperative histopathological examination revealed a moderately differentiated to mucinous adenocarcinoma. Three of the 16 retrieved lymph nodes contained malignant cells. Finally, the cancer was classified as stage IIIb [pT4a, pN1b, M0]. The patient recovered uneventfully and was discharged 10 days after the surgery. Following the diagnosis of stage III colorectal cancer, the patient was recommended to receive adjuvant chemotherapy with CAPOX starting 4 weeks after surgery. The selected regimen consisted of capecitabine (1,000 mg/m2 orally twice daily) for 14 days and L-OHP (130 mg/m2 intravenous infusion) on the first day of each cycle, with a periodicity of 3 weeks over 3 months (four cycles). The anticancer drug dosage was reduced to 80% because of the patient's age. The patient had postoperative physical weakness and appetite loss, and also received 7.5 g of NYT daily throughout the course of adjuvant chemotherapy. She did not report any events of peripheral loss of appetite, general fatigue, peripheral neuropathy, neutropenia, or febrile neutropenia. Adverse effects were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. She has not experienced any recurrence during a 1-year postoperative follow-up.", "age": [ [ 75.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7203463.xml", "relevant_articles": { "32426365": "123", "34004454": "123", "25731334": "12", "25731277": "13", "23268039": "123" }, "similar_patients": { "8613574-1": "123", "4086702-1": "0", "3624980-1": "13", "8606881-1": "13", "7788145-1": "0" } }, { "human_patient_id": "124", "human_patient_uid": "4621338-1-M", "PMID": "26550511", "title": "Follicular Thyroid Carcinoma Metastatic to the Kidney: Report of a Case with Cytohistologic Correlation", "patient": "A 45-year-old African American female presented for evaluation of a left renal mass. She did not complain of any urinary symptoms such as flank pain or hematuria, and her past medical history was significant for type 2 diabetes mellitus, gastric bypass surgery, and thyroid cancer diagnosed at an outside hospital 20 years previously, which was treated by total thyroidectomy. However, the histologic type of the thyroid tumor was unknown, and neither the outside medical records nor histologic sections of the thyroid tumor were available for review. The patient's primary care physician had told her that imaging studies of her left kidney were suspicious for renal cell carcinoma and had suggested that she undergo nephrectomy. A CT of the abdomen and pelvis revealed a 7.5 \u00d7 6.8 cm, exophytic, homogeneously enhancing mass in the inferior pole of the left kidney. There was no evidence of hydronephrosis or nephrolithiasis, and the urinary bladder, ureters, and adrenal glands were all unremarkable. A percutaneous CT-guided core biopsy of the mass was performed (), and imprints and histologic sections of the biopsy specimen were evaluated and deemed positive for metastatic FTC.\nNine months following biopsy, the patient underwent left radical nephrectomy, and examination of histologic sections of the resection specimen confirmed the cytologic diagnosis made on the core biopsy specimen. She did well in the immediate postoperative period, with no evidence of wound infection, and was discharged. Three years later, she was admitted for malnutrition and dehydration due to an anastomotic leak from her previous gastric bypass surgery. She was discharged after a 2-month inpatient stay, during which she underwent gastrostomy tube placement, and has not been hospitalized since. A repeat CT at that time showed several hypodense lesions in the right kidney, as well as one of intermediate density measuring up to 1 cm in greatest dimension that had remained stable since the previous CT, 3 years earlier. The patient was subsequently lost to follow-up.", "age": [ [ 45.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4621338.xml", "relevant_articles": { "26550511": "123", "31258806": "0", "21562838": "0", "28954751": "123", "33087685": "0" }, "similar_patients": { "4781945-1": "0", "6252184-1": "123", "5333435-1": "123", "4839819-1": "0", "6969647-1": "123" } }, { "human_patient_id": "125", "human_patient_uid": "4300032-1-M", "PMID": "25628903", "title": "A Case of Healthcare Associated Pneumonia Caused by Chryseobacterium indologenes in an Immunocompetent Patient", "patient": "82-year-old male patient was admitted to hospital with the complaint of altered mental status in July 2014. In April 2014, he was taken to hospital because of traffic accident. Computerized tomography (CT) was performed and it revealed subarachnoid hemorrhage. He was followed up at neurosurgery clinic. He was operated on because of left tibia fracture and discharged with full recovery two weeks later. He was admitted to neurosurgery clinic again with the complaints of vertigo, nausea, and vomiting in June 2014. CT revealed chronic subdural hematoma and subdural hygroma. At the same day, he was immediately operated on and haematoma was evacuated. He was discharged ten days later. Then he was admitted to neurosurgery clinic again with altered mental status in June 23, 2014. Physical examination revealed no pathological findings except disorientation. Laboratory tests revealed leucocyte 7.8 K/\u03bcL, hemoglobin 10.8 g/dL, platelet 252 K/\u03bcL, procalcitonin 0.26 ng/mL, and CRP 8.18 mg/dL. Urine tests revealed pyuria and urine culture was performed. Brain CT was performed and bilateral subdural hematoma was noted. On the second day of admission dyspnea occurred, and he was intubated and transferred to neurosurgery intensive care unit. Thorax CT was performed; an air cyst in right lobe, bronchiectasis, and a consolidated area in left lobe were noted. Piperacillin/tazobactam therapy was initiated empirically. On the third day, transtracheal aspirate sample was sent to microbiology laboratory. Antimicrobial therapy was modified to ertapenem after urine culture yielded ESBL (+).\nE. coli and C. indologenes were isolated from transtracheal aspirate sample. Antimicrobial susceptibility test revealed resistance to carbapenems and sensitivity to levofloxacin. Levofloxacin was added to antimicrobial therapy on the 6th day of admission. On follow-up, after the second day of therapy modification, improvement on blood gas parameters was observed and the patient was extubated. He was transferred to neurosurgery clinic and antimicrobial therapy continued. He was discharged on the 15th day of admission with cure.", "age": [ [ 82.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4300032.xml", "relevant_articles": { "25628903": "123", "21677495": "0", "3741708": "0", "2789861": "0", "3283592": "0" }, "similar_patients": { "6791203-1": "0", "5692238-1": "13", "4327554-1": "0", "6071627-1": "0", "8382309-1": "0" } }, { "human_patient_id": "126", "human_patient_uid": "5989513-1-M", "PMID": "29785999", "title": "Swept source optical coherence tomography-angiography of an infarct of a small intra-neural branch of central retinal artery simulating cilio-retinal artery", "patient": "A 56-year-old man with episodic transient visual loss in right eye (OD), of 2 days duration. He was not symptomatic at presentation and was using anti-coagulants for cardiovascular disease. Visual acuity was 6/6 both eyes (OU). Intra-ocular pressure and anterior segment were normal OU. OD had a finger like area of macular whitening sparing the fovea. This area corresponded to the vascular bed of a clinically appearing cilio-retinal artery (cilio-RA) []. However, on fluorescein angiography, the artery filled along with branches of central RA (CRA) [Fig. and ]. Swept source optical coherence tomography (SS-OCT) showed inner and middle retinal edema with shadowing of underlying layers []. The superficial capillary plexus was less affected on SS-OCT angiography (SS-OCTA). The deeper plexus revealed reduced capillary density nasal to the fovea, with an adjacent hypo-dense capillary nonperfusion area [Figure and ]. A diagnosis of occlusion of intra-neural branch of CRA was made.", "age": [ [ 56.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5989513.xml", "relevant_articles": { "30799915": "0", "34003897": "0", "28574924": "0", "26355822": "12", "30900586": "0" }, "similar_patients": { "8081080-1": "1", "6727698-1": "0", "8476279-1": "0", "5782462-1": "1", "6612075-1": "0" } }, { "human_patient_id": "127", "human_patient_uid": "4996060-1-M", "PMID": "27583266", "title": "Resection arthroplasty after failure of a radial head prosthesis: a case report", "patient": "We report the case of a 25-year-old male, right handed, who suffered from a fracture-dislocation of the left radial head (Mason IV) after a motorcycle incident (). The patient underwent acute surgery for one attempt of open reduction and internal fixation. It resulted impossible for the comminution of the fracture and the surgeons proceeded to resection of the radial head followed by the implant of a press-fit radial head prosthesis (MoPyC, Tornier SAS Etablissement Bioprofile, Grenoble, France), through a postero-lateral access using the Kocher muscular interval. An insufficient intra-operatively stability requested a reinsertion of collateral lateral ligament performed by a Mytec anchor 2.0. The ligament reinsertion and the implant was initially protected and stabilized with an articulated external fixator, maintained for 40 days after surgery (). The intra-operatively evaluation of flex-extension was complete (0\u2013140\u00b0). The patient was dismissed without any major complications.\nOne year after surgery, the patient underwent a clinical, functional and radiological evaluation, under the control of clinicians not involved in the surgery. The patient was also asked to answer the following questionnaires: VAS (visual analogic scale), DASH (disability of the arm, shoulder and hand), MEPS (Mayo elbow performance score) and the Oxford elbow score.\nThe ROM showed a flexion of the elbow of 140\u00b0 with a lag extension of 25\u00b0, reducible to 20\u00b0 passively and a complete prono-supination. The elbow was stable on both studied plane. An area of paresthesia was evidenced on the ulnar nerve territory, and the strength showed physiological values. The average results of the scores were the following: VAS 3, DASH 12.5, MEPS 85 and an Oxford Elbow score of 34.\nThe same patient, at a distance of about 2.5 years from the first traumatic episode, came again to our attention with pain in the left elbow, which appeared after a movement of prono-supination in extension. A rupture of the prosthetic stem was shown on the radiographs (). The patient underwent, as a result, a new surgical procedure. During surgery, after the prosthetic removal, stability tests were performed under anesthesia showing an acceptable stability of the elbow. Based on this evaluation, it was decided not to implant a new radial head prosthesis (). The patient was dismissed without any further complication.\nTwenty-seven months after the second surgery, the patient was evaluated investigating all the same parameters listed above. ROM, sensibility and strength showed values similar to those of the previous evaluation (); the paresthesias on the ulnar nerve territory persisted. The varus and valgus stability, evaluated with the elbow in extension, and in 30\u00b0 and 70\u00b0 of flexion, appeared similar to the opposite elbow. The new scores showed average results of: VAS 1, DASH 4.2, MEPS 100 e Oxford Elbow Score 46. The scores showed better results than the previous one, and the patient reported a subjective improvement, compared to the time spent with the prosthesis.", "age": [ [ 25.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4996060.xml", "relevant_articles": { "16468050": "123", "24252824": "12", "28676727": "12", "10791667": "12", "22342604": "12" }, "similar_patients": { "8311746-1": "12", "4866299-1": "12", "3263472-3": "123", "8420832-1": "123", "7846681-1": "123" } }, { "human_patient_id": "128", "human_patient_uid": "6078126-1-M", "PMID": "30094415", "title": "Carotidynia Alias Transient Perivascular Inflammation of the Carotid Artery (TIPIC Syndrome)", "patient": "A 55-year-old woman reported a 24-hour history of unusual pain in her left carotid area irradiating to the ear. Colour Doppler ultrasound revealed an eccentric hypoechoic thickening (black arrows on Figure ) of the proximal bulbar internal carotid but also partially of the carotid bifurcation itself. A thin hyperechoic atheromatous fibrous plaque was also visible (small white arrows on Figure ) but no significant stenosis was found. Contrast-enhanced ultrasound showed normal capillary distribution of micro bubbles in the hypo echoic thickening, therefore excluding haematoma (Figure , black arrows). The avascular fibrous plaque was well demonstrated (small black arrows). Unenhanced Axial T1-weighted Magnetic Resonance (MR) imaging showed an hypo intense tissue (Figure , black arrows) around the proximal internal carotid. Intense enhancement of this tissue was shown on fat-saturated contrast enhanced T1-weighted images (Figure ). Carotidynia or TIPIC syndrome was diagnosed and the woman was immediately treated with non-steroid anti-inflammatory drugs. Doppler ultrasound performed after 14 days already showed rapid regression of both the symptoms and the perivascular inflammatory sheath (black arrows on Figure ).", "age": [ [ 55.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6078126.xml", "relevant_articles": { "30657525": "0", "2602095": "0", "23150534": "0", "31037091": "12", "15773312": "12" }, "similar_patients": { "6032496-1": "0", "8542256-1": "0", "5632850-1": "123", "6788358-1": "0", "3040919-1": "0" } }, { "human_patient_id": "129", "human_patient_uid": "4906870-1-M", "PMID": "27307674", "title": "Early functional, esthetic, and psychological rehabilitation of preschool child with nonsyndromic oligodontia and anodontia in mixed dentition stage through conservative systematic approach: A case report with 5-year follow-up", "patient": "A 6-year-old boy presented with noneruption of teeth. His parents seemed to be normal and they denied any history of similar condition in their respective families. The parents revealed that the child was progressing at an average pace in school. The child had sparse, fine, blond hair, especially at the temple area and eyebrows. The lower facial height decreased due to an over closed profile, making the lips appear prominent. Examination of nails revealed no abnormality. His behavior in the dental office was age appropriate. An intraoral examination revealed complete anodontia in the mandibular arch and alveolar ridges appeared considerably shallow []. Hypodontia was observed in the maxillary arch with only maxillary left deciduous first molar and bilateral deciduous second molars present. Buccal mucosa, palate, and floor of the mouth were normal. Vertical dimension was considerably lost. Radiographic evaluation revealed that the tooth germs of only 11 and 21 were present in the maxillary arch and there were no evident tooth germs of deciduous and permanent teeth in the mandibular arch []. His nails were normal []. Child was referred to the Department of Pediatrics for assessment. A diagnosis of nonsyndromic oligodontia and anodontia was made. Family pedigree was not studied.\nOral rehabilitation, with removable prosthesis, mandibular complete denture, and maxillary removable partial dentures, was planned with frequent follow-up and multiple prosthesis to accommodate age changes. The first visit was purely introductory. The parents were explained the plan of treatment. The procedure of denture fabrication closely paralleled that for the conventional denture technique but with a few notable exceptions. Initial impressions were made in modeling compound (DPI Pinnacle, Mumbai, India). Custom acrylic resin trays were fabricated from the resultant casts. A wax spacer was adapted over the nonstress bearing areas. The maxillary and mandibular trays verified for accuracy and were border-molded with green stick compound (DPI Pinnacle Tracing Sticks, Mumbai, India). The final wash impressions were obtained with zinc oxide eugenol (DPI Impression Paste, Mumbai, India). Temporary record bases were fabricated using cold cure acrylic resin followed by wax occlusion rims over them. The pattern denture base was verified intraorally for accuracy and jaw relations were recorded. The mandibular rest position was estimated extraorally, and the upper lip was used as a guide for the location of the incisal edges of the upper anterior teeth. The orientation of occlusal plane was kept lower than the level of the mandibular foramen unlike the occlusal plane in the adult patient. Teeth arrangement was done following conventional technique. No attempt was made to balance the occlusion. During the try-in appointment, it was observed that the part of incisal edge of the maxillary right permanent central incisor had erupted above the gingival margin and was interfering with the retention of the maxillary temporary denture base, as it had not pierced through the gingiva till the secondary impression was made. A window was created just palatal to maxillary right deciduous incisors and canine to accommodate the erupting permanent tooth []. Furthermore, the right maxillary anterior had to be placed more labially for the same reason. Try-in was done and the child's joy to see his artificial teeth was very obvious. Dentures were processed with heat-cured acrylic resin following compression molding technique and polished. The maxillary removable partial denture retention was assisted with clasps on deciduous second molars. At the insertion appointment, the complete incisal edge of the maxillary permanent right central incisor had erupted in the oral cavity, so further widening of the window created to accommodate the erupting tooth was done. The maxillary partial and mandibular complete dentures were inserted [Figures and ]. Instructions about oral hygiene were given, and the parents were asked to supervise the child's oral hygiene. The patient was advised to maintain a soft diet for the first few days and to remove the dentures at night and during the sports activities. Recall appointments were scheduled for 24 h and then weekly.\nThe parents reported no problem in retention of the prosthesis. Initially, the patient had some difficulty in accepting the dentures and was unable to keep them in the mouth for long periods. However, shortly, he was fully adjusted to using the dentures. Patient was on a monthly recall schedule for continuous monitoring to track the eruption of 11 and observe the status of 21 and to allow the necessary adjustments of his denture to accommodate the erupting permanent tooth/teeth. The maxillary permanent right central incisor erupted completely through the window in the prosthesis. After 2 years, the patient reported difficulty in wearing the dentures. The dentures were replaced with the new prosthesis following the technique as earlier accommodating the erupted permanent right incisor and the growth changes in the jaws []. No change in the status of the unerupted 21 was observed.\nAt the beginning of therapy, the patient was quiet and withdrawn. He became communicative and his speech skills improved after the insertion of dentures. Development of a good psychological self-image was achieved through the esthetic improvement. Facial profile and expression improved with the prosthesis. The cosmetic effect alone seemed to transform the patient into a socially acceptable individual. Future treatment will include relining, rebasing, or remaking of the dentures to accommodate growth and development and definitive restorations at an appropriate age.", "age": [ [ 6.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4906870.xml", "relevant_articles": { "21560739": "3", "21394410": "0", "20230975": "3", "11460279": "0", "24015016": "3" }, "similar_patients": { "3728879-1": "123", "3794510-1": "123", "5443647-1": "0", "4034639-1": "123", "3539337-1": "123" } }, { "human_patient_id": "130", "human_patient_uid": "3435864-1-M", "PMID": "22977334", "title": "Hemorrhagic Cardiac Tamponade: Rare Complication of Radiofrequency Ablation of Hepatocellular Carcinoma", "patient": "A 56-year-old Malay man with chronic hepatitis B, not on regular follow-up, who first presented to a private medical center with abdominal distension in July 2010, was diagnosed with hepatocellular carcinoma and referred to our institute for further management.\nAt our institute, a dynamic CT scan of the liver revealed five hypervascular lesions at segments IVa, VII and VIII in the background of cirrhosis. The largest lesion at segment IVa, measured 4.3 \u00d7 3.5 cm and associated splenomegaly and esophageal varices but no ascites was observed ().\nLocal treatment of the multicentric HCC using RFA was planned in agreement with the patient. During the pre-procedural assessment, the patient was incidentally found to have a small ventricular septal defect with left to right shunting. However, the chamber sizes and left ventricular ejection fraction were normal.\nAt the time of treatment, he had Child Class A compensated liver disease with the following laboratory test results: serum albumin, 32 g/L; serum bilirubin, 21 \u00b5mol/L; alanine aminotransferase (ALT), 45 IU/L; aspartate aminotransferase (AST), 54 IU/L; platelet count, 61 \u00d7 109/L; International Normalised Ratio, 1.2; and alpha fetoprotein (AFP), 23.8 ng/mL.\nThe procedure was performed under general anesthesia and fluoroscopic CT guidance (Somatom Definition AS, Siemens Medical Solutions, Erlangen, Germany) using a 10 cm long expandable 15 G StarBurst XL radiofrequency (RF) needle (RITA Medical System, Mountain View, CA, USA) with an array diameter of 5 cm. The RF current generator used was the 1500X RF generator system (RITA Medical System, Mountain View, CA, USA). Four grounding pads were placed on the patient's thighs. The patient's pulse-oximetry, arterial blood pressure, and cardiac activity were monitored during the entire procedure. Under CT fluoroscopic guidance, the largest tumour in segment IVa was identified. The needle tip was placed such that the thines at 2 cm deployment covered the outer margins of the tumour. Deployment was monitored under CT fluoroscopic guidance. This lesion was ablated to 5 cm after which the needle was repositioned twice to ablate the medial and lateral margins to provide a 5 mm margin around the tumour. The entire process was constantly monitored using CT fluoroscopy. The area of coagulation necrosis was seen within the tumour () with no evidence of any pericardial fluid. During the attempt to remove the RF needle from segment IVa, the thines would not retract. Significant force was finally used to retract the thines.\nThe operator then decided to ablate the lesion in segment VI. During placement of the needle, it was noted that there was an expanding pericardial effusion (). The procedure was aborted to facilitate the management of the cardiac tamponade. Immediate pericardiocentesis performed by a cardiologist, was noted to be haemorrhagic. Approximately 300 mL of blood was aspirated but the patient was persistently hypotensive and an emergency sternostomy was performed. Intra-operatively, two litres of blood was evacuated from the pericardium. A puncture wound was noted at the anterior cardiac vein (right marginal vein) (), which could have led to the haemorrhagic cardiac tamponade. In addition, inflammatory changes are also seen in the adjacent diaphragm but no evidence of any ablation change was seen in the pericardium. The anterior cardiac vein (right marginal vein) was repaired and haemostasis was secured.\nThe patient was stable post-surgery. While in the intensive care unit, his condition gradually deteriorated with the development of liver failure, upper gastrointestinal bleeding, pneumonia, and sepsis. The patient expired 19 days after the primary event.", "age": [ [ 56.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3435864.xml", "relevant_articles": { "17213421": "0", "30544457": "123", "14610704": "123", "15657824": "13", "8219001": "1" }, "similar_patients": { "6310525-1": "13", "3789050-1": "13", "4504562-1": "13", "3022176-1": "13", "5331644-1": "13" } }, { "human_patient_id": "131", "human_patient_uid": "8410551-1-M", "PMID": "34324792", "title": "Dramatic response to alectinib in a patient with -rearranged squamous cell lung cancer", "patient": "A 70-year-old female patient without a history of smoking presented with a subcutaneous tumor in the left thigh. Positron emission tomography (PET)-computed tomography (CT) scans revealed a 4.0 \u00d7 4.2-cm mass in the upper left lung lobe and multiple muscular and bone metastatic lesions (Figure ). She was diagnosed with stage IVB cancer (T2bN0M1c). Her performance status was 1 and serum carcinoembryonic antigen (CEA) level was 18.6 (normal range, 0\u20135.0) ng/ml.\nPathological examination of the resected subcutaneous tumor in the left thigh revealed moderately differentiated SCC with cornification (Figure ). Immunohistochemical analysis revealed diffuse and strongly positive staining for pan-cytokeratin, cytokeratin 5/6, and p40, although the cells were negative for thyroid transcription factor-1, CK7, napsin A, and CD56 (Figure ). The tumor expressed wild-type epidermal growth factor receptor (EGFR) based on the molecular analysis of exons 18\u201321 and was diffusely and strongly positive (3+) for ALK by intercalated antibody-enhanced immunohistochemistry with an ALK detection kit (Nichirei Bioscience; Figure ). Based on fluorescence in situ hybridization (FISH) using break-apart probes for ALK (Figure ), the patient was diagnosed with SCC harboring EML4-ALK rearrangement and treated with alectinib (300 mg twice daily). Two months later, PET-CT images revealed dramatic shrinkage in the size of primary tumor in the left upper lung lobe and reduction in the size of multiple muscular, bone, and skin metastases (Figure ); therefore, the patient was considered to have achieved partial response to alectinib according to the Response Evaluation Criteria in Solid Tumors guidelines (version 1.1). Although she experienced recurrence after a durable response of 9.5 months, there were no severe alectinib-related adverse events.", "age": [ [ 70.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC008xxxxxx/PMC8410551.xml", "relevant_articles": { "29744229": "123", "34404075": "123", "30790150": "123", "29524063": "123", "34729013": "123" }, "similar_patients": { "5501098-1": "123", "5878901-1": "123", "4027997-1": "12", "7767140-1": "123", "4846625-1": "123" } }, { "human_patient_id": "132", "human_patient_uid": "8188872-1-M", "PMID": "34124553", "title": "Bail-out edge-to-edge mitral repair for an acute single leaflet device attachment: a case report", "patient": "A 78-year-old male presented to our hospital with a recent history of acute decompensated heart failure due to severe MR, based on long-standing ischaemic heart disease which had been treated by coronary bypass and implantable cardioverter defibrillator for secondary prevention. At presentation, an auscultatory examination revealed a holosystolic murmur of a grade IV/VI was audible at the left fifth mid-clavicular line with radiation to the left axilla. No peripheral oedema was documented. The exertional dyspnoea was graded in New York Heart Association functional Class II. Six-minute walk distance was 403 m. N-terminal pro brain-type natriuretic peptide was 990 ng/L (normal < 486 ng/L). The prescribed medication was torasemide 20 mg, bisoprolol 10 mg, and amlodipine 10 mg and dabigatran 150 mg.\nTransoesophageal echocardiography demonstrated an A2 segment pseudo-prolapse with an eccentric MR jet to the posterior direction, which appeared to result from mitral annular enlargement due to left atrial dilatation (volume 49 mL/m2) with the anteroposterior diameter of 38 mm, but no relevant LV cavity enlargement with the end-diastolic diameter of 52 mm and the ejection fraction of 64% (). As a result, the coaptation angle of both leaflets increased to 148\u00b0, where the angles between the mitral annular plane and leaflets reduced to 21\u00b0 as to the anterior leaflet, comparing the posterior leaflet with 28\u00b0, in absence of relevant apical leaflet tethering (coaptation depth 6 mm) (). A three-dimensional colour Doppler echocardiography revealed a large MR orifice area of 0.78 cm2 with the width of 17 mm ().\nDue to a prohibitive risk for redo surgery, the local multidisciplinary heart team decided to treat the patient using TMVr. In consideration of pathoanatomy of MV and a regurgitation width of 17 mm, we selected the PASCAL\u00ae Transcatheter Valve Repair System (Edwards Life Scientific, Irvine, CA, USA). The PASCAL was placed successfully between segments A2 and P2 (). The target posterior leaflet showed a thick basal part of 12.1 mm and a thin distal part of 4.7 mm with a total of 16.8 mm. The clasped length was 9.1 mm (). After PASCAL release, the MR severity was reduced to mild (); however, an acute SLDA occurred 2 min later (). The posterior leaflet was shortened to 12.3 mm (), and the device was moving back and forth instable, while the residual MR remained unchanged because the large-profile device worked like as a central spacer for the coaptation defect (). The mean transmitral gradient was 2 mmHg after PASCAL implantation. Due to the limited MV orifice area for a second PASCAL device with device width of 10 mm, we decided to stabilize the PASCAL device and both leaflets by a MitraClip XTR\u00ae (Abbott Vascular Structural Heart, Menlo Park, CA) with a device width of 4 mm. After exchanging the guide catheters, the leaflets adjacent to the PASCAL device were captured by the MitraClip XTR (), in which the residual length of the posterior leaflet was 5.5 mm after closing the clip (). The PASCAL device was stabilized (, , Video S) and the residual MR remained mild with a mean transmitral gradient of 3 mmHg (). The patient was successfully discharged 2 days after the procedure with mild MR, stable devices implanted and no post-procedural mitral stenosis with the mean gradient of 4.7 mmHg.", "age": [ [ 78.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC008xxxxxx/PMC8188872.xml", "relevant_articles": { "32845361": "123", "32735734": "123", "34479788": "13", "34124553": "123", "31451915": "123" }, "similar_patients": { "7319845-2": "123", "8189303-1": "123", "8664752-1": "123", "5368525-1": "0", "8517867-1": "123" } }, { "human_patient_id": "133", "human_patient_uid": "6378482-1-M", "PMID": "30800304", "title": "Computer-assisted navigation as a diagnostic tool in revision total hip arthroplasty: A case report", "patient": "A 58-year-old female presented with a chief complaint of left hip pain of 5 months\u2019 duration. The patient had been seen approximately 10 months prior to presentation, shortly after experiencing a \u201cclunk\u201d in her right hip. She reported that her pain was stable and had not increased since that episode. Relevant history included a left primary THA approximately 25 years ago. The patient also reported a right primary THA at the age of 33 years, followed by a head and liner exchange 10 years later due to poly wear and broken tine. A right total knee arthroplasty procedure was performed approximately 1 year ago. Comorbid conditions reported included degenerative joint disease, thrombocytopenia, cirrhosis of the liver, lumbar spondylosis and anemia. The patient had been managing any ongoing hip pain with anti-inflammatories and routine monitoring of poly wear with annual radiographs.\nOn physical examination, a pain-free range of motion (ROM) of the affected hip was noted, although the patient demonstrated hesitation at the extremes of motion. Slightly reduced ROM was noted with internal and external rotation when compared with the right hip. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were normal. Radiographs were obtained and revealed severe polyethylene wear and asymmetry in the left hip (). Some acetabular and proximal femoral lysis was noted, although there was no change in the acetabulofemoral component interface.\nThe pre-operative plan for this patient was to exchange the polyethylene liner only; however, during surgery, it was observed that the locking mechanism on the poly component was incompetent. Furthermore, intraoperative measurement with the navigation system indicated anteversion of 5\u00b0 (radiographic definition), revealing a cup component significantly more retroverted than the 18\u00b0 indicated by the pre-operative radiograph (). A decision was made to exchange both the liner and the cup component ().\nSurgery was successful, and post-operatively, the patient was prescribed standard posterior hip precautions with toe-touch weight-bearing for 6 weeks. At 2 weeks post-op, the patient was progressing well.", "age": [ [ 58.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC006xxxxxx/PMC6378482.xml", "relevant_articles": { "19242700": "13", "28557297": "13", "32951060": "13", "8014641": "13", "27298960": "13" }, "similar_patients": { "7510184-1": "123", "4719376-1": "123", "5974678-1": "123", "8519234-1": "123", "6284071-1": "123" } }, { "human_patient_id": "134", "human_patient_uid": "5890585-1-M", "PMID": "29675350", "title": "Postoperative intraocular lens opacification", "patient": "A 68-year-old woman was well healthy and underwent phacoemulsification and IOL implantation in the right eye at a local clinic in March 2012. Postoperative vision decreased, and she visited to our clinic 1 month later. Biomicroscopy revealed corneal edema with a vision of 20/200 in the right eye. Then, an uneventful n-DSAEK was smoothly performed in her right eye 4 months later. A donor corneoscleral button was mounted on an artificial anterior chamber and dissected with automated microkeratome (Moria, Inc, France). After 8-mm trephination, a thin lenticule was placed on Busin glide and pulled into anterior chamber by forceps, where it was unfolded and attached to the recipient cornea by air bubble for 10 min. The final air was left as the graft size at the end of surgery. Postoperatively, the lenticule was well attached to the cornea. Topical 0.1% betamethasone was prescribed four times daily and was tapered to twice daily 2 months later. Postoperative vision improved to 20/40. Nine months after surgery, a 3-mm circumscribed opacification was seen in the anterior surface of the IOL within the pupil region []. The opacification was characterized by fine and white granular deposits. The vision of the right eye slightly decreased to 20/50. However, the opacification did not increase and her vision was 20/50 during the 3-year follow-up.", "age": [ [ 68.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5890585.xml", "relevant_articles": { "29675350": "1", "27006326": "1", "29034156": "1", "27209860": "0", "29018756": "0" }, "similar_patients": { "5637382-1": "123", "3521400-1": "0", "4926573-1": "1", "3603711-1": "0", "7560278-1": "1" } }, { "human_patient_id": "135", "human_patient_uid": "5890585-2-M", "PMID": "29675350", "title": "Postoperative intraocular lens opacification", "patient": "A 61-year-old man with diabetes mellitus underwent uneventful phacoemulsification and implantation of IOL (AcrySof SA60AT; Alcon Surgery) in the right eye in December 2013. Later, he presented with proliferative diabetic retinopathy, retinal detachment, and vitreous hemorrhage with a vision of hand motion in the right eye. PPV and silicone oil tamponade were performed in November 2014. Postoperative course was smooth and vision was 20/120. Removal of silicone oil and intravitreal air injection was performed in March 2016, and postoperative vision was 20/100. However, whitish granular deposits were observed in the anterior surface of the IOL confined to the pupillary zone 1 month after surgery and vision decreased to 20/120 []. The opacification and his vision were stationary in the 9-month follow-up.\nAnterior segment optical coherence tomography (AS-OCT; Cirrus HD-OCT; Carl Zeiss Meditec Co. Ltd.; Tokyo, Japan) revealed hyperreflective opacity in the anterior surface of the IOLs in the two cases [Figure and ].", "age": [ [ 61.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5890585.xml", "relevant_articles": { "29675350": "12", "30100764": "12", "16939886": "12", "27278374": "12", "29786004": "12" }, "similar_patients": { "4166256-1": "1", "7355360-2": "1", "6432846-1": "1", "3380672-1": "0", "8423897-1": "0" } }, { "human_patient_id": "136", "human_patient_uid": "3180694-1-M", "PMID": "21892966", "title": "Immunohistochemical comparison of CD5, lambda, and kappa expression in primary and recurrent buccal Mucosa-associated lymphoid tissue (MALT) lymphomas", "patient": "A 66-year-old Japanese woman with swelling of the right buccal mucosa was referred to our hospital. She was generally healthy and her medical, dental, and family histories were normal. Routine laboratory examinations did not reveal any abnormalities.\nThe lesion was excised and was pathologically diagnosed as a MALT lymphoma tumor with a t(11;18)(q21;q21) chromosome translocation []. Swelling of the right buccal mucosa recurred 2 years later. Clinical examination at that time revealed a sessile, hard, elastic, and movable mass in the right buccal mucosa; similar to previous clinical findings, this mass was covered with normal mucosa.\nThe recurrent tumor was excised under general anesthesia, and general safety margins were maintained. The recurrent tumor was similar to the primary tumor; a sessile, white, elastic, and circumscribed mass. The recurrent tumor was well demarcated and was covered with normal mucosa. The length of the recurrent tumor was 3.3 cm.\nTo determine whether the lymphoma had spread to other sites, computed tomography (CT) scans and magnetic resonance imaging (MRI) of the whole body were performed and endoscopic examination of the stomach was added. All test results were negative for the presence of lymphoma in the other sites. Clinically, the patient remained in good general health, and evidence of tumor reactivation 6 months after the treatment was lacking.\nParaffin sections of the primary tumor revealed (under a low-power field) some colonized lymphoid follicles with a mantle zone and diffuse proliferation of tumor cells in the marginal zone (Figure ). On the other hand, paraffin sections of the recurrent tumor revealed that the tumor cells showed follicular colonization in the germinal centers throughout the tumor (Figure ).\nUnder high-power fields, small- or medium-sized centrocyte-like cells with indented nuclei and moderate cytoplasm volume were found in the primary and recurrent tumor (Figure and ). Monocytoid B-cells with round nuclei and abundant, pale cytoplasm and neoplastic cells with Dutcher bodies were more abundant in the primary tumor than in the recurrent tumor (Figure and ).\nIn addition, plasmacytoid differentiation was more prevalent in the recurrent tumor than in the primary tumor (Figure and ).\nFor immunohistochemical analyses, paraffin sections were incubated with primary antibodies, including CD10 (M0727, DAKO, Copenhagen, Denmark), CD20 (M0755, DAKO), CD43 (MT1 clone, Leica Microsystems, UK), CD79a (JCB117 clone, Dakocytomation, Denmark), Bcl-2 (M0887, DAKO), Bcl-6 (M7211, Dakocytomation), IgG (A0423, DAKO), IgG4 (05-3800, Nichirei-Zymed, Tokyo, Japan), IgM (A0425, Dakocytomation), Lambda (A0193, DAKO), Kappa (A0191, DAKO), cyclin D1 (SP4 clone, DBIOSYS, Washington D.C, U.S.A), CK (AE1/3) (M0835, DAKO), and Helicobacter pylori (B0471, Dakocytomation).\nThe sites for antigen-antibody reactions were visualized using a standard avidin-biotinylated-peroxidase complex method. The primary tumor cells were positive for bcl-2, CD20, CD43, CD79a, Lambda, Kappa and was negative for CD10, IgG, IgG4, IgM, cyclin D1, bcl-6, CK (AE1/3), and Helicobacter pylori (data not shown) []. The overall staining results of the recurrent tumor were similar to those of the initial tumor. The recurrent tumor showed negativity for CD10, IgG, IgG4, IgM, cyclin D1, Bcl-6, CK (AE1/3), and Helicobacter pylori (data not shown) except that the recurrent tumor showed negativity for lambda and weak positivity for kappa.\nA previous study revealed that MALT lymphomas that express CD5 tend to recur and disseminate []. To ascertain whether the primary tumor expressed CD5, the tumor specimen was incubated with a CD5 antibody. Moreover, expressions of lambda and kappa in the primary tumor specimen were compared with those in the recurrent tumor specimen.\nImmunohistochemical examination of CD5, lambda, and kappa expressions revealed that the primary tumor was positive for CD5 (Figure ), kappa (Figure ), and lambda (Figure ), but the recurrent tumor was weakly positive for CD5 (Figure ) and kappa (Figure ).\nWith respect to lambda positivity, the recurrent tumor showed negativity (Figure ).", "age": [ [ 66.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3180694.xml", "relevant_articles": { "21892966": "12", "20676680": "12", "23981946": "12", "19404026": "12", "11881734": "12" }, "similar_patients": { "7728126-1": "1", "5107237-1": "0", "3298797-1": "1", "3080319-1": "0", "5017047-1": "1" } }, { "human_patient_id": "137", "human_patient_uid": "4451656-1-M", "PMID": "26097326", "title": "Dentin dysplasia type I \u2013 A rare entity", "patient": "An 18-year-old female patient reported to our department with the complaint of poor esthetic appearance due to missing upper and lower front teeth since 4 years and seeking prosthetic treatment. Patient gave no history of trauma and extractions in relation with the missing teeth. The patient reported that the teeth exfoliated due to loosening. The patient's medical history was not contributory. Family history revealed no such abnormality among other family members.\nOn intraoral examination [] the morphologic appearance and color of the permanent teeth were normal. In maxillary arch, the missing teeth were from right canine region to left canine region and in mandibular arch, all the incisors were missing. There was generalized grade II and grade III mobility. Oral hygiene was poor and there were plaque and calculus deposits in all the quadrants. Restorations were present in left maxillary first molar and mandibular second molar.\nPanoramic radiograph [] revealed adequate enamel thickness on the cuspal tips of all the teeth. There was no root formation in most of the teeth while some of the teeth exhibited short, blunted and malformed roots of only a few millimeters with obliterated pulp chambers. The mandibular first left molar tooth had taurodontism like appearance. Well-defined periapical radiolucencies were present in association with the apex of the mandibular left first molar and right first and second molar.\nAlthough the patient had attained her physical maturity and was ready for definitive dental treatment but her physical, financial and psychological situations were important to be considered in selecting the final treatment plan. The following treatment plan was formulated for the patient. Dietary and oral hygiene instructions were given to the patient and extraction of the teeth that were mobile was advised along with the rehabilitation of the missing teeth with prosthesis.\nThe right maxillary first molar tooth was extracted and sent to Department of Oral Pathology and Microbiology. Clinical examination of the gross specimen [] revealed an intact tooth. The tooth crown was of normal dimensions measuring around 7.5 mm but the roots were short and measured about 6 mm. The specimen was sectioned mesiodistally into halves. The mesiodistally cut tooth surface showed total obliteration of pulp chambers with dentin. One half of the cut tooth specimen was decalcified in 10% nitric acid and processed for hematoxylin-eosin (H and E) staining. Other half of the cut tooth specimen was used for preparing ground section.\nThe ground section [Figure and ] showed normal crown outline with normal enamel covering. A thin layer of superficial mantle dentin appeared but the pulp chamber was totally obliterated by an unusual calcified material consisting of atypical tubular dentin and osteodentin covered by thin discontinuous layer of cementum. Normal dentinal tubule formation appeared to have been blocked and the new dentin so formed around obstacle, gave rise to the characteristic appearance of \u201clava flow around the boulder\u201d [].\nHistopathologic examination of the decalcified hematoxylin-eosin section [] showed total obliteration of pulp that was filled with tubular dentin, osteodentin and irregular, globular masses of dentin [Figure and ]. A cluster of odontoblasts was seen within the globular masses of dentin.\nBased on the clinical, radiographic, gross features and histological examination of the ground section and decalcified section, diagnosis of dentin dysplasia type I was made.", "age": [ [ 18.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC004xxxxxx/PMC4451656.xml", "relevant_articles": { "3858776": "12", "8362047": "0", "9630763": "0", "10029964": "2", "9612158": "2" }, "similar_patients": { "3162862-1": "123", "2823758-1": "1", "8123254-1": "123", "6018135-1": "123", "4212168-1": "123" } }, { "human_patient_id": "138", "human_patient_uid": "5013050-1-M", "PMID": "27656159", "title": "Cotard Delusion in the Context of Schizophrenia: A Case Report and Review of the Literature", "patient": "\u2018Mr. C\u2019 is a 58-year-old Navy veteran with a history of substance use disorder in sustained remission, traumatic brain injury (TBI), mild neurocognitive impairment, and a 15-year diagnosis of schizophrenia. Importantly, his sister indicated that Mr. C suffered his first psychiatric break during adolescence. He was prescribed medication, but his parents, who indicated their preference for treating his condition with prayer, refused these. He has been living with his sister for the past 20 years and participates in all activities of daily living. He is a widower and is currently unemployed. His TBI history includes a single episode approximately 25 years ago when he fell off a moving train, requiring extended hospitalization. Mr. C was brought in to our Veterans Affairs (VA) hospital by his sister after calling the Veterans\u2019 Crisis Line with SI. One week earlier there was an altercation with his brother-in-law resulting in Mr. C attacking him with a crowbar and the sister intervening. On admission, the family reported that Mr. C was taking venlafaxine and quetiapine.\nUpon initial interview, Mr. C was grossly oriented, with psychomotor agitation, mildly pressured speech, anxious mood, and restricted affect. Thought process was tangential, and his cooperation was poor due to his preoccupation with delusions that he was dead, that nothing existed. He felt his body was being energized by demons: \u201cThese demons are my energy, I am dead, how can I have any energy?\u201d He perseverated on this content despite attempts to engage him: \u201cHow can you help me, I am dead.\u201d When asked about suicidal ideation (SI) he indicated, \u201cI am dead, how can I be suicidal?\u201d When providers commented on the novelty of speaking with a dead person, he replied, \u201cMaybe you are dead too.\u201d Importantly, his nihilistic beliefs included strong religiously mediated content not shared by his family. Mr. C. made the comments: \u201cThat physical God is alive because he has a physical body, but the demons inside me keep me dead, keep me from being alive.\u201d \u201cIt is not nice meeting the devil, all the demonic spirits are tormenting me and raping me.\u201d He believed his insides were being corroded by demons and indicated that he had repeatedly sodomized himself to try and purge himself of the demons. Mr. C\u2019s sister indicated that the onset of his religiously themed delusional symptoms began after his TBI when he became convinced that a miracle had occurred during the accident and he became aware of his \u201cdead nature.\u201d\nMagnetic resonance imaging (MRI) performed in April 2015 revealed mild global volume loss for age with widening of the Sylvian fissure bilaterally. Neither evidence of past acute TBI or white matter abnormalities were noted on fluid-attenuated inversion recovery (FLAIR) imaging (Figure ). Neuropsychological testing administered during the index hospitalization was significant for impairment on tasks of processing speed, simple attention, verbal learning and memory, aspects of executive functioning (set-shifting, verbal fluency), facial recognition, and affect naming and recognition. Aspects of visuospatial discrimination and construction, confrontation naming, and visual memory were intact (Table ).\nUpon initial presentation, given the patient\u2019s aggressive and activated behavior as well as sleep difficulties, venlafaxine was discontinued and quetiapine was titrated to 700 mg. Divalproex was added during the admission for mood stabilization and titrated to 750 mg. During his 2 weeks on the inpatient ward repeated inquiry about his religious experience and his relationship to God led to changes in the content of Mr. C\u2019s delusion from literal and concrete beliefs that he was physically dead to more abstract and metaphorical descriptions of spiritual death. His belief that only God was physically alive remained, and his belief that demons possessed his body persisted. Continued probing about the patient\u2019s existence demonstrated further amelioration of the nihilistic content. A month into his admission when asked if his daily activities (eating, drinking, showering) were evidence that he was in fact physically alive, he indicated that he was \u2018probably alive.\u2019\nMr. C continued to be alert and oriented to person, place, and time, with evidence of increased insight into his preoccupation with his belief that he was dead. Approximately 1 month into his admission he recognized when the content of his speech began to focus on death, demons, and self-negation, at which point he would stop and remark, \u2018There I go again talking about all that dead stuff.\u2019 He was ultimately discharged after 5 weeks of hospitalization. On discharge, the patient\u2019s brother noted that he was less delusional and more linear than at baseline.", "age": [ [ 58.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5013050.xml", "relevant_articles": { "27656159": "13", "16722041": "0", "15633074": "13", "11640447": "0", "12938754": "0" }, "similar_patients": { "7797418-1": "123", "3136022-1": "123", "6370624-2": "123", "7889332-1": "12", "8474022-1": "123" } }, { "human_patient_id": "139", "human_patient_uid": "7008279-1-M", "PMID": "32082687", "title": "Two Different Clinical Approaches with Mortality Assessment of Four Cases: Complete and Incomplete Type of Abdominal Cocoon Syndrome", "patient": "A 30-year-old male patient with nausea, vomiting, and abdominal pain complaints lasting for a few days presented to our clinic. In his anamnesis, he had several previous abdominal pain attacks which healed themselves. He had not had any abdominal surgery or medicine use before. Clinical examination revealed a tender and distended abdomen. Plain X-ray of the abdomen showed air-fluid levels of small bowel type. On the other hand, abdominal CT revealed dilatation and wall thickness in the terminal ileum (). No abnormality was observed in laboratory parameters. An exploratory surgery with a laparotomy method was decided with \u201cacute mechanical intestinal obstruction\u201d prediagnosis. During the laparotomy, a cocoon-like fibrous tissue of about 20 cm diameter was observed around the ileum. Small bowel was relieved through cutting the fibrous membrane. Since the circulation was normal in bowel segment, no resection was made. The patient was discharged on the fourth day after the operation.", "age": [ [ 30.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7008279.xml", "relevant_articles": { "31692629": "123", "26566436": "0", "22522743": "123", "25077611": "0", "31391122": "0" }, "similar_patients": { "7008279-2": "123", "7282167-1": "123", "3588397-1": "123", "3533629-1": "0", "6023681-1": "13" } }, { "human_patient_id": "140", "human_patient_uid": "7008279-2-M", "PMID": "32082687", "title": "Two Different Clinical Approaches with Mortality Assessment of Four Cases: Complete and Incomplete Type of Abdominal Cocoon Syndrome", "patient": "A 47-year-old male patient presented to our hospital with the complaints of constipation, nausea, and vomiting for three days. No significant medical or clinical record was apparent in his medical past, including any previous abdominal operations or medication use. Clinical examination revealed signs of only abdominal distension. Plain abdominal X-ray indicated air-fluid levels while abdominal CT showed proximally dilated clustered terminal ileum and cecum. Laboratory parameters were normal, and exploratory laparotomy was carried out. During laparotomy, a cocoon-like fibrotic tissue with a diameter of about 10 cm was found to surround internally herniated ileum and cecum (). Bowel loops were relaxed after cutting the fibrous structure. Since the circulation was normal in the affected bowel segment, resection was not made during the laparotomy. The patient was discharged five days after the operation with no complications.", "age": [ [ 47.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7008279.xml", "relevant_articles": { "31692629": "123", "26729826": "0", "19705509": "0", "11785375": "0", "17616031": "123" }, "similar_patients": { "7008279-1": "123", "6368205-1": "0", "7282167-1": "123", "6470434-1": "123", "5913910-1": "0" } }, { "human_patient_id": "141", "human_patient_uid": "7008279-3-M", "PMID": "32082687", "title": "Two Different Clinical Approaches with Mortality Assessment of Four Cases: Complete and Incomplete Type of Abdominal Cocoon Syndrome", "patient": "A thirty-eight-year-old female patient applied to our hospital with the complaints of swelling, vomiting, and constipation for a week. She had sigmoid colon tumor diagnosis two months ago and underwent left hemicolectomy. Clinical examination revealed only distended abdomen. Plain X-ray of the abdomen indicated air-fluid levels while abdominal CT showed clustering of proximally dilated ileum and cecum. Laboratory findings were normal (Figures and ). Exploratory laparotomy showed pronounced adhesion in the abdomen. It was observed that small bowels, colon, stomach, and liver were adhered as surrounded en bloc by a fibrous capsule in a way that anatomic boundaries could not be distinguished (Figures and ). No area was observed for adhesiolysis or resection in the patient diagnosed to have ACS. Due to continuous vomiting and lack of oral intake, percutaneous gastrostomy (PG) was applied for palliative purposes. Abdominal fascia was extremely rigid and not suitable for closing. The skin was closed with primary suture, and the patient was monitored in surgical oncology department in postoperative period. The patient became ex on the 37th postoperative day.", "age": [ [ 38.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7008279.xml", "relevant_articles": { "11785375": "0", "30742293": "0", "26170747": "0", "22606588": "0", "31337629": "0" }, "similar_patients": { "7008279-4": "123", "7864741-1": "0", "1421435-1": "123", "3830831-1": "0", "7011585-1": "0" } }, { "human_patient_id": "142", "human_patient_uid": "7008279-4-M", "PMID": "32082687", "title": "Two Different Clinical Approaches with Mortality Assessment of Four Cases: Complete and Incomplete Type of Abdominal Cocoon Syndrome", "patient": "A sixty-four-year-old female patient applied to our hospital with the complaints of abdominal swelling, vomiting, and constipation which had been continuing for three days. Her history revealed TAH+BSO+pelvic and para-aortic lymph node dissection due to endometrium cancer a month ago. Clinical examination showed only abdominal distension. No feature was observed in plain abdominal X-ray and abdominal CT examinations. Laboratory parameters were normal (Figures and ). Exploratory laparotomy was decided for the patient. Advanced level adhesion was observed in the abdomen during laparotomy. The small bowels, colon, stomach, and liver were adhered and surrounded en bloc by a fibrous capsule in a way that anatomic boundaries could not be distinguished (Figures and ). No area was found appropriate for adhesiolysis or resection in this ACS patient. Percutaneous gastrostomy (PG) was applied to the patient with palliative purposes because of her continuous vomiting and lack of oral food intake. Abdominal fascia was extremely rigid and was not suitable for closing. The skin was closed with primary suture. The patient became ex on the 25th postoperative day.", "age": [ [ 64.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7008279.xml", "relevant_articles": { "15952487": "0", "11785375": "0", "26729826": "0", "23367829": "0", "27324519": "0" }, "similar_patients": { "7008279-3": "123", "4704422-1": "0", "7763638-1": "0", "6023681-1": "13", "7864741-1": "0" } }, { "human_patient_id": "143", "human_patient_uid": "3732640-1-M", "PMID": "23970984", "title": "Pseudomyopathic Changes in Needle Electromyography in Lambert-Eaton Myasthenic Syndrome", "patient": "A 69-year-old female (patient 1 in ) developed a gait disturbance 6 months before admission and suffered from the gradual progression of weakness in her extremities. On admission, neurological examination showed proximal muscle weakness and reduced deep tendon reflex. Routine laboratory test results were unremarkable. Antinuclear antibodies, anti-acetylcholine (ACh) receptor antibody, and anti-voltage-gated calcium channel (VGCC) antibodies were negative. The results of chest and abdominal CT were unremarkable. In a nerve conduction study, CMAPs had slightly low amplitudes, and nerve conduction velocities were normal in the median and ulnar nerves. Needle EMG showed early recruitment and polyphasic MUPs with short durations and low amplitudes, suggesting the diagnosis of myopathy. Interestingly, the myopathic EMG findings were improved after sustained strong muscle contraction for 10 s; the MUP sizes returned to normal after a sustained strong muscle contraction, and the early recruitment of MUPs in the weak contraction was clearly normalized in the biceps brachii muscle (). Thereafter, we performed an RNS test because she complained of easy fatigability. The RNS test showed an obvious incremental response of the CMAP amplitude of the abductor digiti minimi muscle after high-rate stimulation of the ulnar nerve, indicating the diagnosis of LEMS [\u2013]. We examined the patient for systemic malignancies, and the endoscopic examination of the colon revealed adenocarcinoma in the sigmoid colon. Her muscle weakness slightly improved after resection of the colon cancer.", "age": [ [ 69.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3732640.xml", "relevant_articles": { "25444432": "12", "11002732": "0", "4852602": "0", "20717748": "12", "33598584": "0" }, "similar_patients": { "2816344-1": "123", "3819895-1": "0", "8027959-1": "0", "5689432-1": "13", "6323386-1": "12" } }, { "human_patient_id": "144", "human_patient_uid": "6025712-1-M", "PMID": "29954416", "title": "Common symptoms for a rare disease in a girl with sarcoidosis: a case report", "patient": "A 12-year-old girl presented to her general pediatrician complaining of asthenia and weight loss in the previous month. Her past medical and family history were unremarkable. Physical examination revealed a painless hepato-splenomegaly without additional clinical signs. Abdominal ultrasound revealed an inhomogeneous liver appearance, abdominal lymphadenopathy and a hypo-echogenic solid neoformation in front of the celiac artery (35 \u00d7 13 mm). The patient was admitted to the Department of Pediatrics of the Meyer Children\u2019s Hospital for further diagnostic investigations.\nPhysical examination revealed palpable spleen and liver, a right inguinal lymph node of 1 cm and a lymph node in supraclavicular location, without any further objective anomaly. She had no fever. Initial laboratory tests found microcytic iron deficiency anemia (Hb = 9.8 g/dl, MCV = 65.5 ft., Ferritin = 4 ng/ml), with normal erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), normal total protein and protein electrophoresis, a slight increase of lipase and colic acids with normal amylase. Blood biochemistry for kidney and liver function and urinalysis were normal. Primary immunologic work-up including lymphocyte subset and immunoglobulin levels were normal. Tests for malignancies (tumor markers and peripheral blood smear) and infectious investigations, including Mantoux Test and IGRA Assay resulted negative.\nChest X-ray was negative. Magnetic resonance imaging (MRI) examination of the superior and inferior abdomen with contrast medium confirmed increased liver dimensions and its structural inhomogeneity with zones of signal alteration: some nodular, other confluent. It also revealed increased spleen size with zones of nodular signal alteration and multiple nodular formations in the following locations: hepatic hilar, mesenteric, lombo-aortic, at the retrocavity of the epiploon, and the greatest one in front of the celiac artery (diameter > 3.5 cm).\nSuspecting a systemic lymphoproliferative disease, we performed liver and lymph node ultrasound-guided biopsy, which showed negativity of Polymerase chain reaction (PCR) for potential agents of infectious diseases (including Mycobacteria and Bartonella species) on lymph node material, while it highlighted a non-necrotizing granulomatous inflammation, resembling sarcoidosis, and aspects of non-specific inflammation of the liver. (Fig. , ).\nSubsequently, we carried out measurements of serum and urinary calcium, serum phosphorus, Angiotensin-Converting Enzyme (ACE), followed by a complete cardiac evaluation, and a complete ophthalmologic evaluation (including slit lamp), all of which resulted within normality.\nAt this point, given the biopsy results, we performed further lung studies: pulmonary function tests which showed mild restriction and decreased alveolar capillary diffusion. The chest X-Ray revaluation revealed a pattern compatible with mild fibrosis and enlarged lymph nodes. We decided to carry out a high-resolution chest computed tomography (CT), which showed widespread fibrous strands and multiple enlarged lymph nodes (right paratracheal area, at the supraaortic trunk origin, subcarinal, with the largest in this location measuring 30 \u00d7 17 mm, pericardiophrenic, bilaterally at axillary level and along the mammary vessels). The bronchoscopic investigation with analysis of the broncho-alveolar lavage (BAL) fluid revealed: macrophages 70%, neutrophils 4% and lymphocytes 26% with a CD4/CD8 ratio of 9.2 (pathological value > 3.5).\nBased on these results, we carried out further investigations on liver tissue and lymph node with histochemical techniques: CD68 + nodules were found, suggestive of microgranulomas (Fig. and ).\nHaving ruled out other diagnoses, with suggestive histological findings in two different tissues (liver and lymph nodes) and considering lung involvement, we made the diagnosis of pediatric-onset adult sarcoidosis.\nDuring hospitalization, the condition of the child had always been good and she had always been afebrile. Considering lymph node hypertrophy and the signs of initial portal hypertension (due to compression of the hepatic vessels), we started therapy with prednisone 40 mg/day, and subsequent cross-therapy with mycophenolate mofetil (250 mg/m2 increasing up to 1 g/m2).\nThe girl came back to our attention a month after discharge for a follow-up visit: she was found in good general condition, with hepatomegaly and without other clinical signs or symptoms. A brain MRI was performed in order to rule out cerebral involvement and it revealed normal findings. One year later she maintained good clinical condition and normal laboratory tests, therefore MMF was gradually reduced and definitively suspended after 18 months. Now her periodic follow up consist of clinical and laboratory evaluation every 6 months and annual pulmonary function tests, unless clinical or laboratory new findings.", "age": [ [ 12.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6025712.xml", "relevant_articles": { "10746264": "12", "8677665": "0", "33824809": "0", "19928550": "0", "11708013": "0" }, "similar_patients": { "3601503-1": "0", "7886481-1": "123", "6446437-1": "123", "8293858-1": "123", "5964286-1": "0" } }, { "human_patient_id": "145", "human_patient_uid": "3283755-1-M", "PMID": "22363384", "title": "A Case of Acute Myocardial Infarction With ST-Segment Elevation in a Lead Augmented Right Vector Caused by a Left Main Coronary Artery Vasospasm", "patient": "A 35-year-old female presented to our hospital with squeezing chest pain for a duration of 15 minutes. She was a current smoker (20 pack years) without any other risk factors of cardiovascular disease. On physical examination, her blood pressure was 145/80 mm Hg, and pulse rate was 96 beats per minute. Chest radiography showed mild cardiomegaly with mild pulmonary congestion. The initial electrocardiogram (ECG) revealed 2-mm ST segment depression in leads V3-6 and up to a 1-mm ST segment depression in leads I, aVL, II, aVF with a 2-mm ST segment elevation in the aVR lead (). An initial cardiac enzyme profile revealed elevation of creatine phosphokinase (CK), 195 U/L (normal range, 26-174); CK-MB, 49 \u00b5g/L (normal range, 0-3); and elevated troponin-I of 3.87 ng/mL (normal range, 0-0.05). Emergency coronary angiography showed a 90% narrowing of the LMCA () and a normal right coronary artery without significant narrowing (). During coronary angiography, the patient complained of chest pain with a sudden decrease in systolic blood pressure to 90 mm Hg. However, after administering 100 \u00b5g of intracoronary nitrate, the chest pain was relieved and a re-angiography showed a completely resolved LMCA spasm without residual luminal stenosis (). IVUS showed only a minimal concentric plaque in the LMCA without significant narrowing (). Therefore, we stopped the procedure without intervention. After the procedure, an ST depression in leads I, aVL, II, aVF, and V3-6 and an ST elevation in aVR were completely resolved on the ECG (), and the cardiac enzymes had decreased to the normal range (CK, 41; CK-MB, 22 \u00b5g/L; and troponin-I, 1.31 ng/mL). The patient was discharged on the eighth hospital day receiving 40 mg of oral nitrate, 180 mg of diltiazem, 100 mg of aspirin, and 10 mg of rosuvastatin per day. A follow-up coronary angiography taken 9 months later showed no spasms or stenosis. The patient has exhibited no signs of angina for 2 years and has remained on medication in outpatient clinics.", "age": [ [ 35.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC003xxxxxx/PMC3283755.xml", "relevant_articles": { "30167000": "123", "17084920": "0", "29381986": "0", "19356809": "12", "24094806": "12" }, "similar_patients": { "3858950-1": "123", "3443728-1": "123", "4310983-1": "12", "6831224-1": "0", "7754087-1": "12" } }, { "human_patient_id": "146", "human_patient_uid": "3981231-1-M", "PMID": "24765489", "title": "Syringomyelia Regression after Shunting of a Trapped Fourth Ventricle", "patient": "A 28-year-old female was admitted in our department because of a large right-sided intracerebral hemorrhage as a result of a ruptured arteriovenous malformation. She underwent neurosurgical and endovascular treatment. Due to a post hemorrhagic hydrocephalus external ventricular drain was performed. During the intensive care treatment she unfortunately developed meningitis. After antibiotic treatment, the meningitis was cured and a ventriculo peritoneal shunt was performed. However, the follow up imaging, revealed an isolated enlarged fourth ventricle despite shunting of the lateral ventricles. Therefore a shunting of the fourth ventricle has been done as well. Nearly 22 months later the patient presented again with secondary walking and coordination impairment.\nNeurological examination showed increasing ataxia and eye movement disorder beside the known left-sided hemiparesis. Cranial computed tomography (CT) demonstrated remarkable dilation of fourth ventricle indicating a shunt dysfunction. Furthermore syringomyelia without tonsil herniation has occurred, which was identified through cervical magnetic resonance imaging (MRI) extending from C2 to C7. The complete replacement of the dysfunctional shunt system was immediately performed. Postoperatively, the syringomyelia resolved within 6 months and the associated neurological deficits improved as well. An entire resolution of the trapped fourth ventricle was confirmed on CT scan ().", "age": [ [ 28.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC003xxxxxx/PMC3981231.xml", "relevant_articles": { "24765489": "123", "12640587": "123", "2023674": "123", "10226289": "123", "3265630": "12" }, "similar_patients": { "3483335-1": "123", "3669471-1": "123", "3463835-1": "123", "6744829-1": "0", "5432447-1": "123" } }, { "human_patient_id": "147", "human_patient_uid": "5344426-1-M", "PMID": "28424553", "title": "The world of targeted therapies in kidney cancers: pitfalls, tips and tricks", "patient": "In 2004, a 66-year-old man was diagnosed with a papillary grade 2 nonmetastatic right renal cancer and was treated with radical right nephrectomy. A nonspecific 10 mm-diameter tumor was detected on his left kidney, and hence, he was placed under close surveillance. In 2005, a partial left nephrectomy was performed but no pathological signs of malignancy could be evidenced. In 2006, the patient was diagnosed with a prostatic adenocarcinoma, and hence, a radical prostatectomy was performed without any complication. A few months later, multiple suspect left renal lesions were identified and a left radical nephrectomy was recommended by the multidisciplinary urologic board after meeting. Pathological analyses revealed a papillary renal cancer. The patient underwent hemodialysis 3 days a week (Monday, Wednesday and Friday) after bilateral complete nephrectomy and was closely monitored. Hemodialysis was performed between 2007 and 2010 without any complications. In 2010, a 70 mm local recurrence was diagnosed in the left renal fossa bed. Biopsies were performed, evidencing a recurrence of the papillary renal cancer. Since complete resection was impossible and in agreement with patient\u2019s nephrologists, sunitinib was initiated in August 2010. For the first cycle, the smallest recommended dose of sunitinib was administered (ie, 37.5 mg/day). Sunitinib cycles consisted of 28 days on and 14 days off treatment. All along sunitinib administration, blood pressure was monitored weekly. He was considered to be stable and did not require treatment initiation.\nGrade 3 vomiting occurred during all hemodialysis sessions performed following the first sunitinib initiation. Anticipatory nausea/vomiting was not suspected since the patient was not reported to be anxious and anxiolytic treatments did not decrease the symptoms. However, the 14 days treatment break was associated with a complete resolution of nausea and a related-to-sunitinib side effect was suspected.\nOndansetron was prescribed during the whole second cycle of sunitinib, but grade 1\u20132 vomiting during hemodialysis sessions was still reported. Digestive symptoms ceased again during the sunitinib off period.\nBecause of a grade 2 thrombocytopenia, the third cycle was delayed and the sunitinib dose was reduced to 25 mg/day. Despite the dose reduction and ondansetron systematic administration, grade 1 vomiting under hemodialysis was systematic during the sunitinib administration. Vomiting only stopped after sunitinib was replaced with another TT because of disease progression after three sunitinib cycles.", "age": [ [ 66.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5344426.xml", "relevant_articles": { "20948925": "13", "23070386": "123", "19167044": "13", "22911381": "123", "23412117": "123" }, "similar_patients": { "5344426-2": "123", "5859488-1": "13", "4995784-1": "13", "4138367-1": "13", "8388173-1": "1" } }, { "human_patient_id": "148", "human_patient_uid": "5344426-2-M", "PMID": "28424553", "title": "The world of targeted therapies in kidney cancers: pitfalls, tips and tricks", "patient": "In 2008, a 69-year-old man was diagnosed with a nonmetastatic Fuhrman grade 3 left RCC. A radical left nephrectomy was performed, and the patient was monitored for 2 years without any other medical complications. No renal failure or electrolyte disorders were reported. In 2010, a metastatic progression was suspected on a systematic computed tomography scan, with lateral aortic nodes involvement and a left renal fossa tumor extended to the left colon and diaphragm. Sunitinib was initiated at 37.5 mg/day after biopsies confirmed a histology-proven metastatic RCC recurrence. The patient was treated with a 28-day on and 14-day off schedule. Plasma uric acid was normal at baseline. During the first cycle of this treatment, the patient presented his very first episode of gout attack located on a big toe. As it was reported to be normal in 30% of acute gout attacks if assessed immediately, the plasma uric acid concentration was assessed 15 days later, which was 81 mg/L (normal plasma uric acid concentration <70 mg/L). No concomitant renal failure, hemoglobin and/or hematocrit disorder, or concurrent medication intake other than sunitinib (acetylsalicylic acid, diuretics, pyrazinamide, ethambutol, etc.) were reported. Purine-rich food and alcohol were cutoff, but the patient did not consume much of them. Allopurinol (100 mg/day) was initiated before the second cycle of sunitinib without colchicine because interactions with sunitinib were feared. Two months later, during the fourth sunitinib cycle, the patient developed a similar acute gout attack without any identified triggering factor. Allopurinol dose was increased to maximum (300 mg/day), while sunitinib was maintained at 37.5 mg/day until progression. The patient kept sticking to his purine-depleted diet. Iterative gout attacks of lower intensity were still periodically reported during the following months under sunitinib therapy. After progression, a new line of treatment was initiated. Sunitinib discontinuation was followed by a total regression of gout attacks.", "age": [ [ 69.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5344426.xml", "relevant_articles": { "23275777": "13", "23448320": "13", "17137406": "13", "27192659": "13", "23282195": "13" }, "similar_patients": { "5344426-1": "13", "6538120-1": "13", "7870256-1": "13", "4621341-1": "123", "5286781-1": "13" } }, { "human_patient_id": "149", "human_patient_uid": "5344426-3-M", "PMID": "28424553", "title": "The world of targeted therapies in kidney cancers: pitfalls, tips and tricks", "patient": "In 2010, a 68-year-old woman was diagnosed with an abdominal-metastatic grade 3 RCC. Following total nephrectomy, the patient was treated with sunitinib from March to June 2010. Due to poor hepatic tolerance and tumor progression, the patient was switched to everolimus. Unfortunately, in the months following the second-line treatment initiation, she was diagnosed with everolimus-related bilateral interstitial pneumonia, requesting for urgent everolimus discontinuation. A third-line treatment based on sorafenib was initiated in January 2011. Despite immediate grade 1 abdominal, facial and truncal rash, sorafenib was continued at 200 mg twice a day. Twelve days later, the patient reported grade 3 dysesthesia of the whole scalp, negatively affecting her quality of life. The differential diagnosis of migraine was rejected by neurologists, and first-line migraine treatments did not improve dysesthesia. Sorafenib was stopped 15 days after the onset of dysesthesia and when the symptoms intensified. Sorafenib discontinuation resulted in a complete dysesthesia resolution in the following days.", "age": [ [ 68.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5344426.xml", "relevant_articles": { "20593250": "13", "27840968": "13", "21914504": "13", "20884115": "13", "23475104": "0" }, "similar_patients": { "4288490-1": "123", "7425249-1": "123", "4091496-1": "0", "5907256-1": "123", "5371698-1": "0" } }, { "human_patient_id": "150", "human_patient_uid": "5344426-4-M", "PMID": "28424553", "title": "The world of targeted therapies in kidney cancers: pitfalls, tips and tricks", "patient": "In 1998, a radical nephrectomy was performed on a 79-year-old man with an intent to cure nonmetastatic grade 2 RCC. Histology-proven metastatic progression was diagnosed in 2006, with a painful 50\u00d750 mm lytic lesion of the left scapula. A palliative radiotherapy was successfully performed (39 Gy, 3 Gy/fraction) with significant pain relief. Because of the patient\u2019s age, bevacizumab was initiated in monotherapy at a third of the recommended dose (ie, 5 mg/kg intravenously every 3 weeks instead of 10 mg/kg every 2 weeks). The patient was 88 years old at that time but was still in excellent condition. Bevacizumab could be continued for another 5 years with a perfect tolerance and good efficacy: Scapula metastasis was stable (43\u00d738 mm) and painless. Bevacizumab was stopped in 2011, considering the extended absence of cancer progression. Six months later, an isolated progression of the scapula lesion was reported, with an increasing left shoulder pain and an increasing metastasis volume (50\u00d760 mm). Bevacizumab was readministered in 2012 with a pain resolution, and tumor volume decreased in 9 weeks. To date, the patient is still alive with an excellent tolerance. Intermittent (\u201cstart-and-stop\u201d) bevacizumab is continued with a clear on/off effect on pain relief.", "age": [ [ 79.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5344426.xml", "relevant_articles": { "24469853": "3", "34689306": "3", "32648383": "3", "33776758": "3", "23640292": "3" }, "similar_patients": { "4698998-1": "12", "3625760-1": "23", "8483845-1": "0", "7884808-1": "123", "6198218-1": "0" } }, { "human_patient_id": "151", "human_patient_uid": "3097628-1-M", "PMID": "21614243", "title": "Haemorrhaging lesion in the breast: is there a role for embolisation?", "patient": "The patient was a thirty-year old clerk. She complained of an abnormal warm sensation in her left breast. She consulted her doctors regarding this problem, but was reassured that it was normal. Sixteen months later she noted a definite lump in her left breast, and an excision biopsy was done. The lump recurred two months later, and a similar procedure was performed. Both biopsies were reported as benign haemangiomas. The lesion recurred during the next two months and, this time, she approached our clinic. Physical examination revealed a mass which measured approximately 6 cm. She was advised mastectomy with immediate breast reconstruction. She refused, but one month later, returned to our hospital with a haemorrhaging lesion in the left breast (). She was found to be pale, but was haemodynamically stable. She underwent radiological embolisation of the lesion. The angiogram showed a tumour blush that had feeding arteries from branches of the left internal mammary artery and lateral thoracic artery. Embolisation of the feeding vessels was done using polyvinyl alcohol (PVA). Post-embolisation images showed complete occlusion of these feeding vessels (). She later consented for mastectomy. The tumour was completely excised and was reported as a grade 2 angiosarcoma. Radiotherapy of the chest wall was given, and investigations showed multiple lung metastases and bone metastases. She, however, refused palliative chemotherapy. Five months after mastectomy, she returned with right hypochondrium pain and abdominal distension. On clinical examination, she was pale. Her haemoglobin was 6 g/dl with a platelet count of 83 x 109/L. The low platelet count could be attributed to continuing platelet consumption due to formation of thrombi in the vascular metastatic lesions. Her abdomen was found to be grossly distended, tense, and tender. The fluid thrill test was positive. CT scan of the abdomen revealed multiple liver metastases with free fluid in the peritoneal cavity. The main hepatic artery was successfully embolised. Palliation of symptoms was achieved with analgesics, repeated peritoneal tapping, and blood transfusions. The patient also developed minor local recurrence on the chest wall, which fortunately did not bleed. Seven months after treatment and 28 months after initial excision biopsy, she deteriorated rapidly and passed away.", "age": [ [ 30.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3097628.xml", "relevant_articles": { "2817911": "123", "22370045": "13", "19081840": "13", "11057329": "13", "27239068": "0" }, "similar_patients": { "5422314-1": "12", "3423769-1": "12", "5582568-1": "12", "3319780-1": "12", "5510970-1": "12" } }, { "human_patient_id": "152", "human_patient_uid": "5100086-1-M", "PMID": "27751977", "title": "18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging in a Patient with HIV (-) Kaposi Sarcoma", "patient": "A 65-year-old female patient was referred to our hospital with complaints of swelling and nodular skin lesions on both legs. She had a history of rheumatoid arthritis and treatment with corticosteroid medication for five years. On physical examination, dark blue-purplish macular and nodular skin lesions were observed on the legs along with pretibial edema (). The lesions that had appeared within a few months were not painful. She was diagnosed with KS with biopsy of the skin lesions (). Laboratory tests were within normal limits except an elevated erythrocyte sedimentation rate. Anti-HIV antibody was negative. She was referred to our department for initial staging with 18F-FDG PET/CT imaging. A whole body 18F-FDG PET/CT imaging was performed 60 minutes after 370 megabequerel 18F-FDG injection using an integrated PET/CT scanner (Siemens, Biograph mCT, Germany). 18F-FDG PET/CT imaging showed multiple nodular skin lesions with increased FDG uptake on both legs (SUVmax: 6.1). In addition, there were hypermetabolic bilateral inguinal and popliteal lymph nodes (SUVmax: 3.6-5.6) ().", "age": [ [ 65.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5100086.xml", "relevant_articles": { "32049734": "2", "24686217": "2", "32558715": "2", "22617236": "2", "19716248": "2" }, "similar_patients": { "3628259-1": "0", "2651438-1": "0", "7745868-1": "0", "4745406-1": "0", "6717711-1": "0" } }, { "human_patient_id": "153", "human_patient_uid": "6856949-1-M", "PMID": "31781092", "title": "Complete Multilineage CD4 Expression Defect Associated With Warts Due to an Inherited Homozygous CD4 Gene Mutation", "patient": "A 45-year-old Caucasian female born to first-cousin parents, with two healthy children and without any relevant family history record of prior diseases, was seen at the service of Dermatology (University of Coimbra, Coimbra, Portugal) in March 2014 because of persistent extensive, skin-colored, exuberant, and disfiguring warts in both feet and hands since the age of 10 years (). Warts were refractory to treatment with keratolytic agents, cryosurgery, and excision, with minor improvement after treatment with acitretin in association with topical 50% urea cream. Apart from this, the patient did not describe recurrent infection-related episodes or diseases, except for past medical history of measles and mumps during her infancy and varicella infection during her first pregnancy, which all resolved without complications. Of note, such past history of infections is not rare among the patient age-matched Portuguese population since vaccination for these diseases was introduced in the Portuguese national vaccination program years after she was born (1969): in 1974 for measles, in 1987 for mumps, and in 2004 for varicella (\u2013). In fact, outbreaks of measles and mumps have been reported in Portugal until the late 80s to mid-90s, with peaks of >10,000 cases per year (, ).\nIn addition, she referred allergic rhino-conjunctivitis treated with cetirizine and fluticasone, and chronic polyarthralgias in the absence of impaired functionality. Serological studies were negative for (severe) infections, including HIV 1/2, HTLV-1, and syphilis. In turn, she showed IgG antibodies for ubiquitous pathogens including CMV >250 arbitrary units (AU/ml) (positive threshold >6AU/ml) and Epstein\u2013Barr virus VCA = 192 U/ml (positive threshold >20 U/ml) and EBNA = 24 U/ml (positive threshold >20 U/ml) in the absence of serum IgM antibodies for these pathogens (0.06 AU/ml; positive threshold >6AU/ml). Slightly increased serum IgG levels (IgG: 1,430 mg/dl), associated with normal IgA (278 mg/dl), IgM (67 mg/dl), C3 (1.4 g/L), C4 (0.33 g/L), and C1 inhibitor (0.318 g/L) serum levels, were detected. In addition, anti-neutrophil and anti\u2013double-strand DNA autoantibodies were negative, while antinuclear autoantibodies were weakly positive. Screening for immunological alterations by flow cytometry () (\u2013) using the EuroFlow Primary Immunodeficiency Orientation Tube (PIDOT) (, ) showed an absolute defect of CD4-expressing T-cells (<0.01 cells/\u03bcl), with normal total T-cell, CD8+ TCR\u03b3\u03b4\u2212 T-cell, and NK-cell (absolute) numbers, associated with consistently increased B-cell counts vs. age-matched normal reference values. Importantly, (TCR\u03b1\u03b2+ TCR\u03b3\u03b4\u2212) DN T-cells were significantly expanded (). Signs/symptoms associated with primary immunodeficiency other than persistent warts in the feet and hands were not observed either at presentation or during the subsequently 5-year follow-up period. Of note, peripheral blood (PB) monocytes and DCs showed no cell surface expression of CD4.", "age": [ [ 45.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6856949.xml", "relevant_articles": { "31781092": "12", "23273235": "2", "27424140": "2", "32362967": "2", "9622837": "2" }, "similar_patients": { "7877069-1": "0", "7685648-1": "0", "4562156-1": "1", "6174357-1": "1", "6369201-1": "1" } }, { "human_patient_id": "154", "human_patient_uid": "4408682-1-M", "PMID": "25948949", "title": "Yolk sac tumor of cryptorchid testis diagnosed by fine needle aspiration cytology", "patient": "A 2-year-old boy presented to the pediatric surgical Out Patient Department (OPD) with 5 days history of a right sided abdominal mass. On examination the lump was 5 cm \u00d7 5 cm in size, firm in consistency with restricted mobility. It was situated in the right lumbar and iliac regions. Clinically, diagnosis of a renal mass? Wilm's tumor was suggested. On ultrasound, a tumor was noticed at the right renal hilum, causing ureteric narrowing with resultant hydronephrosis along with presence of multiple, large oval, heteroechoic lesions in the right iliac region and reteroperitoneum. Possibility of lymphoma was suggested. Due to the absent testis in the right scrotum, testicular neoplasm was not excluded. Ultrasound guided FNAC was performed. A blood mixed mucoid aspirate was obtained. Smears were highly cellular showing tumor cells in variably sized loose clusters with occasional cells forming glomeruloid structures []. The tumor cells were seen embedded in metachromatic basement membrane like material. Individual cells were large, showing moderate anisocytosis, high nucleocytoplasmic ratio. The nuclei were round to oval with irregular nuclear membranes, coarsely clumped chromatin and 0-1 nucleoli. Cytoplasm was moderate in amount and vacuolated in a few cells. There was abundant mucoid material in the background with presence of intracytoplasmic as well as extracellular periodic acid-Schiff (PAS) positive hyaline globules. Diagnosis of yolk sac tumor was made. This was corraborated by the raised alpha feto-protein (AFP) levels (>2000 ng/mL). Beta human chorionic gonadotropin (hCG) levels were within normal limits (1.61 mIU/mL). contrast-enhanced computed tomography (CECT) of the chest and abdomen were performed and revealed an elongated nearly oval shaped heterogeneously enhancing lesion in the right lower abdomen. Multiple heterogeneously enhancing retroperitoneal lymph nodes, right sided hydroureteronephrosis with left sided pleural deposits was also seen. In view of undescended testis, possibility of germ cell malignancy was suggested. Excision of the lump was carried out. A solid globular mass was received. It was gray to yellow in colour with some myxoid areas. Also present in the specimen were attached epididymis and spermatic cord. Sections were taken extensively and showed features consistent with yolk sac tumor with cells arranged in microcystic-reticular, myxomatous and focal macrocystic, alveolar-glandular and papillary patterns []. The rete testis, epididymis and surgically resected end of the spermatic cord were free of tumor. A single focus of lymphovascular invasion was identified. The tumor was seen reaching upto the tunica albuginea and showed a focal breach. Intracytoplasmic and extracellular hyaline globules present in the tumor were PAS positive and diastase resistant. The individual tumor cells were positive for pancytokeratin on immunohistochemistry. CD30, epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA) were negative ruling out embryonal carcinoma and choriocarcinoma. The patient was started on chemotherapy and is currently under follow-up.", "age": [ [ 2.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4408682.xml", "relevant_articles": { "26823835": "12", "2438437": "123", "1281767": "123", "11012991": "123", "2421530": "0" }, "similar_patients": { "5492755-1": "0", "3480776-1": "0", "3643368-1": "0", "3835910-1": "1", "2596792-1": "0" } }, { "human_patient_id": "155", "human_patient_uid": "7292685-1-M", "PMID": "32542152", "title": "Presumed Alcohol-Induced Ventricular Tachycardia Storm: A Case Report", "patient": "The patient was a 36-year-old male with a history of cardiac arrest five years earlier, status post-implantable cardioverter-defibrillator (ICD) placement with no other comorbidities; the patient was not on chronic medications. He presented to the emergency department (ED) in the morning complaining of palpitations and three ICD shocks overnight. He admitted that he had consumed six drinks containing vodka the night before, but stated that he only drank sporadically and rarely had more than one drink. The patient reported palpitations prior to the ICD shock and mild chest pain after the shock delivery but denied shortness of breath, dizziness, and loss of consciousness.\nIn the ED, his initial vital signs were as follows: blood pressure of 120/75 mmHg, heart rate of 85 bpm, afebrile, and oxygen saturation of 98% on room air. He was initially placed on telemetry, which showed atrial fibrillation with heart rate in the 90s; however, subsequent 12-lead electrocardiogram (EKG) demonstrated that he had spontaneously converted into sinus rhythm, with no ST deviations and a QTc of 461 msec. Additionally, there were no significant laboratory abnormalities (complete blood count within normal limits, Mg 2.2 mEq/L, K 3.6 mEq/L, Ca 9.6 mg/dL, Phos 3.4 mg/dL, Cr 1.0 mg/dL); troponin was negative (ref <0.3 ng/mL), and urine toxicology was negative for cocaine, amphetamines, barbiturates, cannabinoid, and opiates. The ethanol level was not checked.\nWhile in the ED, the patient was found to have multiple episodes of non-sustained ventricular tachycardia (VT) on telemetry, which resulted in another ICD shock. He was admitted to the cardiac care unit (CCU) and given lidocaine bolus 100 mg, followed by continuous infusion at 2 mg/min. The patient continued to have multiple episodes of VT and ICD shocks, and amiodarone infusion was started at 1 mg/min after an initial bolus of 150 mg. Because of the increasing distress and agitation, the patient was sedated and intubated. Despite dual anti-arrhythmic therapy, he continued to have VT storm and received approximately 25 ICD shocks in two hours, followed by ventricular fibrillation (VF), requiring external defibrillation and cardio-pulmonary resuscitation for eight minutes. A review of the patient\u2019s EKG during VT storm indicated premature ventricular complex (PVC) triggering polymorphic VT with the R-on-T phenomenon (Figure ).\nGiven his unstable condition, a short-term external circulatory assist device was placed, and he was started on extracorporeal membrane oxygenation (ECMO) support. He continued on amiodarone drip and temperature control through the ECMO circuit thermoregulator. No recurrent episode of VT/VF or ICD shock was noted after the ECMO placement. Initial transthoracic echocardiogram (TTE) showed severe global hypokinesis (ejection fraction of 20%), with no regional wall motion abnormality. The patient initially required norepinephrine and dobutamine for pressor and inotropic support but was able to wean off vasopressors, sedation, and he tolerated ECMO flow reduction overnight. A Repeat TTE performed one day later showed normal left ventricular function, making ECMO withdrawal possible on the third day of admission. The patient was subsequently extubated and found to have no residual neurological deficits. Amiodarone was discontinued, and he was started on oral flecainide 100 mg twice daily and diltiazem 120 mg daily for PVC suppression. He remained in sinus rhythm, with no ventricular ectopy on telemetry.\nA cardiac MRI was performed and showed no late post-gadolinium myocardial enhancement suggestive of myocardial fibrosis and no evidence of structural abnormalities; however, the test was suboptimal because of artifacts. A cardiac positron emission tomography (PET) scan demonstrated a structurally normal heart, with no evidence of infiltrative or inflammatory disease. As there was no ventricular ectopy on telemetry for several days, it was determined that an electrophysiology study would likely not be beneficial. The patient was discharged after 10 days of hospital course.\nOf note, the patient had experienced an earlier similar episode of VT/VF cardiac arrest at 31 years of age. At that time, the patient had drunk at least four drinks with vodka the night before the event, which he described as an unusual amount of alcohol for him. After his wife had witnessed him collapsing in the morning, EMS had been contacted, and he had been successfully resuscitated after seven defibrillations and a total on-scene time of approximately 38 minutes. Subsequent in-hospital workup had shown normal coronary arteries on angiography and a structurally normal heart with an ejection fraction of 60% on TTE. One of the patient's EKGs demonstrated a prolonged QTc (540 msec), and he had an ICD implanted for secondary prevention prior to discharge. As an outpatient, he had a genetic test for long QTc syndrome, reportedly inconclusive. No history of early coronary disease, cardiomyopathy, or sudden death in his family had been reported. He has two children who also underwent a genetic test for long QT, both negative. Upon follow-up, the patient\u2019s EKG had shown a QTc of 428 msec. The patient had never experienced an episode of ICD shock until his presentation to ED five years later.", "age": [ [ 36.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7292685.xml", "relevant_articles": { "33552893": "1", "16886137": "13", "23574305": "1", "18297382": "123", "32169057": "123" }, "similar_patients": { "4980497-1": "123", "5941966-1": "123", "5733204-1": "123", "7449639-1": "123", "8221133-1": "123" } }, { "human_patient_id": "156", "human_patient_uid": "4246919-1-M", "PMID": "25435971", "title": "Characteristic waffle-like appearance of gastric linitis plastica: A case report", "patient": "A 66-year-old female was admitted to Kagawa University Hospital (Kagawa, Japan) with the complaint of intermittent epigastric pain that was exacerbated by fasting. The patient had a history of hypertension and obstructive sleep apnea syndrome. Physical examination upon admission revealed no anemia (via conjunctival pallor examination), jaundice or pulmonary abnormalities. On palpation, the abdomen of the patient was soft and flat, with no areas of tenderness. Furthermore, pretibial edema was not observed and superficial lymph nodes were not palpable. Serum concentrations of the tumor markers, carcinoembryonic antigen and carbohydrate antigen 19-9, were within the normal ranges (<5 ng/ml and 0\u201337 U/ml, respectively). However, X-ray examination indicated reduced gastric distension, as well as deformation of the stomach, which exhibited a leather bottle-like appearance (). In addition, the lower gastric body demonstrated luminal narrowing and increased rigidity, with a depressed lesion (longest diameter, 20 mm) at the posterior wall of the gastric antrum and abdominal computed tomography revealed thickening of the antrum. No lymphadenopathy was observed. Additionally, endoscopy revealed an ulcerative lesion covered by a white necrotic substance on the posterior wall of the antrum () and severe luminal narrowing, with poor distension of the lower gastric body. The upper gastric body, however, demonstrated good extension when compared with the middle and lower gastric bodies. The folds of the gastric antrum were flexible, stretched smoothly, and crossed one another, resulting in a waffle-like appearance on the greater curvature of the upper gastric body (). Analysis of biopsy specimens from the ulcerative lesion revealed a poorly differentiated adenocarcinoma containing signet ring cells, however, adenocarinoma was absent from biopsy specimens obtained from the abnormally crossed folds. Due to the morphological changes that occured in the gastric folds, creating the waffle-like appearance, it was determined that cancer cell invasion of the upper gastric body was likely, and a total gastrectomy was performed. The resected specimen revealed the wall thickening and crossing folds of the gastric body () that were previously observed by endoscopy. Microscopic examination revealed that cancer cells had spread throughout the upper gastric body and had infiltrated the vessels in the submucosa, predominately into the muscularis propria, and marginally into the serosa (). Immunohistochemical examination revealed positive staining for MUC5AC and MUC6 (gastric marker mucins) and negative staining for MUC2 and CD10 (intestinal marker mucins), indicating gastric-type mucin expression. The final diagnosis, according to the Japanese Classification of Gastric Carcinoma (), was T4aN3aM0, clinical stage IIIC advanced gastric cancer. The patient was discharged 17 days after surgery without complications and commenced three cycles of S-1 adjuvant chemotherapy (80 mg/day, days 1\u201328) for 16 weeks. Following three courses of chemotherapy for 16 weeks, treatment was terminated due to patient fatigue. The patient has survived and is without disease recurrance 14 months after surgery.", "age": [ [ 66.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4246919.xml", "relevant_articles": { "25435971": "123", "26189522": "123", "29017601": "123", "19779777": "0", "33468847": "123" }, "similar_patients": { "5658322-1": "13", "5987488-1": "13", "3142508-1": "0", "7933322-1": "123", "4179970-1": "123" } }, { "human_patient_id": "157", "human_patient_uid": "5005233-1-M", "PMID": "27572829", "title": "Concomitant existence of pheochromocytoma in a patient with multiple endocrine neoplasia type 1", "patient": "A 44-year-old Japanese man was referred to our hospital complaining of a large tumor that had been accidentally pointed out in a medical examination as being an esophageal submucosal tumor. Relevant family history brought to light that his father had been diagnosed as having MEN1. Our patient had undergone total parathyroidectomy and autologous transplantation for primary hyperparathyroidism at the age of 18. His height and weight were 187 cm and 120 kg, respectively, with a body mass index of 34 kg/m2 on admission. He also complained of sleep apnea and bilateral nipple discharge. He was not aware of the hypoglycemic symptoms before the admission, but he frequently encountered the symptoms under nutritional management after the admission. Laboratory data of blood chemistry were normal as well as the tumor markers, such as carcinoembryonic antigen and carbohydrate antigen 19-9, whereas neuron specific \u03b3-enolase was high (19.1 ng/ml). Hormonal examinations revealed a hypoglycemia, a hyperinsulinemia (fasting serum glucose, insulin levels, and hemoglobin A1c, 76 mg/dl, 134.5 \u03bcU/ml, and 4.5 %, respectively), a hyperprolactinemia (serum prolactin level 871.2 ng/ml), and elevated urinary catecholamines. On an enhanced thin-slice abdominal computed tomography (CT), a large tumor was detected in the pancreatic tail, showing heterogeneous enhancement with partial calcification and cystic components. Its maximum diameter was about 18 cm (Fig., ). Other than a pancreatic tail tumor, six enhanced liver tumors, a right adrenal tumor (3.9 cm in diameter), and a left adrenal tumor (2.6 cm in diameter) were found (Fig. , ). The right adrenal tumor was heterogeneously enhanced. An endoscopic ultrasonography (EUS) revealed four tumors in the body and tail of the pancreas, except for the giant tumor, and abundant blood flow in all these tumors. Immunohistochemical examinations of a EUS-guided fine-needle aspiration biopsy showed that the giant pancreatic tumor and liver tumors were positive for chromogranin A, synaptophysin, and CD56; thus, the tumors were diagnosed as being a pancreatic neuroendocrine tumor (NET) and its liver metastases. They were NET G1 as the labeling index of Ki67 was 1.8 %. A calcium gluconate injection into the distal splenic artery during a selective intra-arterial calcium injection test resulted in a marked increase in serum insulin and C-peptide. Both 123I-metaiodobenzylguanidine scintigraphy and 131I-adosterol scintigraphy showed high radioactivity in the right adrenal tumor and no radioactivity in the left one. The left adrenal tumor was therefore diagnosed as having a non-functional adenoma. A magnetic resonance imaging (MRI) identified a heterogeneous pituitary adenoma, 3.1 cm in diameter.\nHis pedigree diagram is shown in Fig. . Five patients with MEN1, including our patient who has an MEN1 gene mutation, were identified within his family. Furthermore, the genetic examination revealed a deletion mutation (g.249_252delGTCT) at codons 83\u201384 in exon 2. He underwent distal pancreatectomy, splenectomy, cholecystectomy, right adrenalectomy, abdominal subcutaneous tumor excision, and cutaneous tumor biopsy for the purpose of tumor volume reduction. Six tumors in the resected pancreas were diagnosed as being pancreatic NETs. The giant tumor in the pancreatic tail was insulinoma, and NET G2 as the Ki67 labeling index was 4.2 % (Fig. ). Of the other five lesions, two tumors consisted of the insulin-positive tumor cells with less than 0.1 % of the Ki67 index, and three tumors consisted of the glucagon-positive tumor cells with less than 0.1 % of the Ki67 index. These tumors were diagnosed as being non-functional NET G1 because no symptom due to a glucagon excess was encountered. A non-functional adrenal cortical adenoma, measuring 1.3 cm in maximum diameter, and a pheochromocytoma, measuring 4.7 cm in maximum diameter, coexisted in the right adrenal gland (Fig. ). The abdominal subcutaneous tumor was found to be a neurofibroma, and the cutaneous tumor was a fibroma.\nDuring the postoperative outpatient follow-up, he developed diabetes mellitus and required treatment with an oral antidiabetic drug. For the treatment of his pituitary prolactinoma, cabergoline was administered. Octreotide therapy for the multiple liver metastases of the NETs began 2 months after the operation. After the ninth administration of the octreotide, three new lesions were detected in the liver on a CT scan. His general condition was judged to be tolerable to undergo liver resection, and the radiological examinations showed that there was no recurrence except the liver. Complete surgical resection of liver metastases was therefore achieved by an extended right posterior segmentectomy with partial hepatectomy of S2, S3, and S8. Immunohistochemical examination revealed that liver metastases were derived from a glucagon-positive tumor of the pancreatic NET. The Ki67 labeling index of these lesions ranged from 1.5 to 5.4 %.\nNineteen months after the hepatectomy, a CT scan revealed a small nodule in the S4 of the liver. Twenty-three months after the hepatectomy, gadoxetic acid- or gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRI demonstrated multiple liver tumors. We started everolimus therapy following a diagnosis of unresectable pancreatic NET recurrence. He is still alive after 4 years and 4 months after the initial surgery, although he is suffering from worsened diabetes mellitus, a pituitary prolactinoma that led to a hemorrhage into the pituitary tumor, and an increasing size of the left nonfunctional adrenal tumor.", "age": [ [ 44.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5005233.xml", "relevant_articles": { "27572829": "13", "29696066": "123", "14718149": "123", "29102861": "123", "30692412": "123" }, "similar_patients": { "3039620-1": "123", "8092117-1": "123", "5687133-1": "123", "8047461-1": "13", "5110455-1": "13" } }, { "human_patient_id": "158", "human_patient_uid": "5427706-1-M", "PMID": "28553421", "title": "Irreducible Anterior Shoulder Dislocation with Interposition of the Long Head of the Biceps and Greater Tuberosity Fracture: A Case Report and Review of the Literature", "patient": "A 57-year-old male patient was transferred to the emergency department after a road traffic accident. He had a fall from his bike and his right arm was crashed by the following car. On clinical examination, he had pain and obvious deformity in the shoulder while he was unable to move his arm in any direction, especially in external rotation. He had numbness in the regimental badge region of the axillary nerve and normal radial pulse at the wrist. Radiological examination showed an anterior shoulder dislocation with impaction of the humeral head underneath glenoid and associated fracture of the greater tuberosity (Fig. ). He had no other skeletal or visceral injuries. After conscious sedation, an effort for closed reduction (3 attempts) was performed in the emergency room but was unsuccessful. For reasons unrelated to the patient or the disease a CT-scan of the shoulder was not possible to be performed at that time. The patient was transferred immediately to the operative theatre for closed manipulation under general anaesthesia in order to reduce the dislocation and avoid further neurological compromise; a CT-scan and/or MRI has been scheduled for the next morning. Despite prompt sedation and muscle relaxation the shoulder was still unable to interpose. Open reduction was accomplished thereafter using the deltopectoral approach; the biceps tendon was found entrapped posterolateral between the humeral head and the tuberosity fragment preventing once again reduction of the glenohumeral joint. (Fig. ). Tenotomy and tenodesis of the frayed biceps at the level of pectoralis major was performed using a bone anchor; the transverse ligament at the bicipital groove had been torned. Next, the subscapularis was incised, 1 cm medial to its insertion at the lesser tubercle, and retracted medially after separated from the capsule. The latter was incised and the labrum was clearly visualized and was found to be intact inferomedially. Using longitudinal traction and finger manipulation in an anterior direction the humeral head was finally reduced revealing a large triangular Hill-Sachs lesion at its posterior part. The greater tuberosity was fixed back to its bed using heavy transosseous sutures (Fig. ). The capsule and subscapularis tendon were repaired anatomically with sutures and the shoulder joint was found stable through a full range of motion of internal rotation and external rotation with the arm in adduction and at 90\u00b0 of abduction. The patient had an uneventful postoperative recovery without neurovascular compromise. Pendulum exercises initiated from the second postoperative day followed by passive assisted forward flexion and limitation of active internal rotation for 4 weeks. At the last follow up, one year postoperatively he had a stable joint, full range of motion and a Constant score of 90 (Fig. ).", "age": [ [ 57.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5427706.xml", "relevant_articles": { "28553421": "13", "33665321": "123", "19226030": "123", "25091158": "0", "23027494": "123" }, "similar_patients": { "3063348-1": "123", "7669257-1": "123", "2531121-1": "123", "4733515-1": "123", "4410472-1": "123" } }, { "human_patient_id": "159", "human_patient_uid": "8246944-1-M", "PMID": "33277709", "title": "Bullous pemphigoid caused by contact allergy to bone cement: A case report", "patient": "A 69-year-old man was seen at our Dermatology Department with complaints of blistering disease on his right leg. The complaints had started 2 to 3 weeks after knee replacement surgery on the right knee. First, small vesicles had appeared on his knee. These, however, continued to multiply and became larger in the following weeks. The blisters progressed and after few weeks resulted in large erosions that were resistant to treatment with local corticosteroids.\nSkin biopsies, direct (DIF) and indirect immunofluorescence (IIF), and salt-split skin results were all consistent with BP. Except for the right leg, there was no other skin or mucous membrane involvement.\nSix months after the surgery, complaints gradually disappeared. No relapse appeared in the following year. The patient had no change in systemic medication in this period as a possible explanation of this cure. Because of the atypical course of his disease and at his specific insistence, he was referred for patch tests.\nPatch tests were performed on the upper back with the European baseline series, a local extension of the baseline series, an acrylate series, and a metal series. Allergens were tested using van der Bend test chambers (Brielle, the Netherlands) applied on the upper back and covered with Fixomull stretch (BSN Medical, Hamburg, Germany). Readings were performed on day (D) 2, D4, and D7 according ESCD criteria. Tests were positive for 2-hydroxyethyl methacrylate 2.0% pet. (D2: ?+, D4: +, D7: +), methyl methacrylate 2.0% pet. (D2: ?+, D4: +, D7: +), ethylene glycol dimethacrylate 2.0% pet. (D2: -, D4: +, D7: +), triethylene glycol dimethacrylate 2.0% pet. (D2: ?+, D4: +, D7: ?+), and tetrahydrofurfuryl methacrylate 2.0% pet. (D2: ?+, D4: ?+, D7: +).\nContact sensitization to several methacrylates was regarded as being of probable clinical relevance for the complaints of the patient. Prior to the knee replacement procedure, the patient had no contact with methacrylates as far as could be determined that could have caused sensitization.", "age": [ [ 69.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC008xxxxxx/PMC8246944.xml", "relevant_articles": { "10328556": "0", "16283908": "2", "16536809": "2", "18976382": "2", "21392027": "2" }, "similar_patients": { "6852493-1": "123", "6766847-1": "12", "7496776-2": "123", "6899871-1": "1", "6772995-1": "1" } }, { "human_patient_id": "160", "human_patient_uid": "4280452-1-M", "PMID": "25566055", "title": "Long-Term Survival in a Case of Pleomorphic Carcinoma with a Brain Metastasis", "patient": "A 71-year-old male presented with aphasia and muscle weakness of the left side of his body. He was suspected of having a central nervous system disorder and underwent head brain CT that showed a 50 \u00d7 50 mm mass lesion in the right frontal lobe (fig. ). His chest X-ray showed a mass shadow with a cavity in the right-middle lung field (fig. ). The chest CT also showed a 70 \u00d7 68 mm mass with a cavity in the right lower lobe (fig. ). The level of tumor markers like carcinoembryonic antigen, cytokeratin 19 fragments and pro-gastrin-releasing peptide were not elevated. Based on these clinical findings, the patient was diagnosed with lung cancer with a single brain metastasis.\nCraniotomy was performed because the patient's central nervous system's symptoms were severe and his Eastern Cooperative Oncology Group performance status was zero. The brain tumor in the right frontal lobe was completely removed, and the pathological diagnosis was confirmed as sarcomatoid pattern carcinoma. A CT-guided percutaneous lung biopsy proved that the pathological diagnosis of the right lung mass was spindle cell carcinoma. The patient was therefore diagnosed as having pleomorphic carcinoma of the lung with a single brain metastasis (clinical T3N0M1b stage IV).\nAfter craniotomy, the patient underwent 6 courses of chemotherapy (carboplatin AUC 4 on day 1 and gemcitabine 800 mg/m2 on days 1 and 8, repeated every 3 weeks). After chemotherapy, the chest CT showed a reduced nodular shadow (62 \u00d7 50 mm) (fig. ), while 18F-fluorodeoxyglucose positron emission tomography showed no uptake in the lymph nodes (data not shown). The patient achieved a partial response by preoperative chemotherapy and underwent a right-lower lobectomy, partial resection of a right S2 segment, parietal pleurectomy, and mediastinal lymph node dissection through a posterolateral thoracotomy. This surgery was required because of the possibility of invasion into the right upper lobe and the parietal pleura.\nMacroscopically, the tumor was 64 \u00d7 48 mm in size (fig. ). Microscopically large, spindle-shaped atypical cells had sarcomatously proliferated into most of the tumor portions (fig. ). The tumor had invaded the parietal pleura but not the S2 segment. There was no lymph node metastasis. The final diagnosis was pathological T3N0M1b PC of the lung stage IV. Immunohistochemically, the MIB-1 index of the specimen obtained by CT-guided percutaneous lung biopsy before preoperative chemotherapy was high at 60% (fig. ), whereas that of the resected tumor was low at 10% (fig. ).\nThe patient is alive after 7 years, with no signs of tumor recurrence.", "age": [ [ 71.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4280452.xml", "relevant_articles": { "25963779": "123", "25434449": "123", "23367857": "123", "28599947": "12", "30174901": "123" }, "similar_patients": { "5319945-1": "123", "6820648-1": "123", "4706535-1": "123", "7841735-1": "1", "8502716-1": "123" } }, { "human_patient_id": "161", "human_patient_uid": "7269886-1-M", "PMID": "32161199", "title": "Malignant transformation arising from mature cystic teratoma of the ovary presenting as ovarian torsion: a case report and literature review", "patient": "A 51-year-old premenopausal woman gravida 3, para 3, was diagnosed with left MCTO 7 years ago. The size of the MCTO was 59 mm at the time of diagnosis. She underwent regular ovarian examination for 2 years after the diagnosis but had not visited the hospital for 5 years. She had a history of appendectomy at 7 years of age and received medication for hyperthyroidism since she was 37 years old. She experienced left lower abdominal pain for 2 days and visited the hospital due to increasing pain. Physical examination showed a flat abdomen with tenderness around the left lower abdomen. A solid tumor was palpable by bimanual examination on the left side. Transvaginal ultrasonography revealed a 91-mm cystic and solid ovarian mass on the left ovary (). She was diagnosed with ovarian tumor torsion and had to undergo emergency surgery. Height, weight, and body mass index (BMI) were 165 cm, 96 kg, and 35.3 kg/m\n2, respectively. Body temperature was within the normal range, pulse rate was 84 beats/min, and blood pressure was 121/55 mmHg. Peripheral blood examination showed that the white blood cell count was 8,820/\u03bcL, red blood cell count was 4.65 \u00d7 10 6/\u03bcL, hemoglobin was 12.1 g/dL, and hematocrit was 37.5%. Biochemical data revealed that the C-reactive protein level was as high as 13.9 mg/dL. Levels of tumor makers, namely serum \u03b1-fetoprotein, carbohydrate antigen 19-9 (CA19-9), CA125, and squamous cell carcinoma (SCC) antigen were 4.0 ng/mL (reference, <10.0 ng/mL), < 2.0 U/mL (reference, < 37.0 U/mL), 84.1 U/mL (reference, < 35.0 U/mL), and 1.4 ng/mL (reference, < 1.5 ng/mL), respectively. Laparotomy was immediately performed. Operative findings showed 360\u00b0 torsion of the left ovarian tumor without ascites in the pelvic cavity. There were no sign of congestion and rupture on the surface of the twisted ovary. The uterus and right ovary appeared normal. Left salpingo-oophorectomy was performed. The duration of operation was 54 min, and the volume of blood loss was 30 mL. The diameter of the extirpated ovarian tumor was 11 cm, and the tumor contained fat and hair. Histopathological findings showed both components of mature cystic teratoma and SCC with marked nuclear and cellular atypia in the solid part (). The pathological diagnosis was malignant transformation with SCC of MCTO. We recommended staging laparotomy to determine the treatment strategy. The patient refused to undergo the procedure; subsequently, a strict follow-up for stage IA ovarian cancer was conducted. The patient was discharged from the hospital 10 days post operation. On postoperative day 112, the serum CA125 level was as high as 101.4 U/mL. Positron-emission tomography and computed tomography (CT) showed some nodal lesions with remarkable uptake of 18F-fluorodeoxy glucose (). She was referred to a university hospital due to cancer recurrence. Her BMI was as high as 37.8 kg/m\n2, and biochemical examination showed that she had hyperlipidemia and diabetes mellitus. The serum CA125, SCC antigen, CA19-9, and carcinoembryonic antigen (CEA) levels were 216 U/mL (reference, < 35.0 U/mL), 2.0 ng/mL (reference, < 1.5 ng/mL), < 2.0 U/mL (reference, < 37.0 U/mL), and 3.5 ng/mL (reference, < 5.0 ng/mL), respectively. The patient underwent radical surgery with total abdominal hysterectomy, right salpingo-oophorectomy, partial omentectomy, and pelvic and para-aortic lymph node dissection. Operative findings revealed that there was no ascites or dissemination in the abdominal cavity; no metastatic lesion was found in the uterus and right adnexa. The enlarged pelvic and para-aortic lymph nodes were removed. Thereafter, complete surgical treatment was achieved. The duration of operation was 360 min, and the volume of blood loss was 370 mL. Histopathological examination showed positive lymph nodes with SCC. The numbers of positive/total resected lymph nodes in the left obturator, left external iliac, and para-aortic nodes were 1/5, 2/7, and 1/1, respectively. Immunostaining was performed to assess whether the tumor cells were of epithelial or germ cell origin (); the results confirmed recurrence of the malignant transformation of MCTO with SCC (). The postoperative course was uneventful, and the patient was discharged 10 days post-op. She received 6 courses of conventional paclitaxel and carboplatin as adjuvant chemotherapy. She has had no recurrence for 2 years after treatment. The treatment course is shown in .", "age": [ [ 51.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC007xxxxxx/PMC7269886.xml", "relevant_articles": { "32161199": "123", "14658608": "123", "34567852": "123", "18592797": "13", "27734419": "0" }, "similar_patients": { "4579907-1": "0", "8450167-1": "123", "7733300-1": "0", "4981951-1": "0", "5457762-1": "123" } }, { "human_patient_id": "162", "human_patient_uid": "7773813-1-M", "PMID": "33392076", "title": "Lung Adenocarcinoma Harboring EGFR Kinase Domain Duplication (EGFR-KDD) Confers Sensitivity to Osimertinib and Nivolumab: A Case Report", "patient": "A 45-year-old male underwent a left upper lobectomy and postoperative pathology revealed invasive stage IIIA lung adenocarcinoma (). Targeted next- generation sequencing (NGS) with a customized panel (Geneseeq Prime panel) designed to target 425 cancer-specific genes was performed, and four somatic mutations and copy number alterations (CNAs) were identified, including EGFR-KDD of exon 18-25 [mutant allele frequency (MAF): 13.5%], EGFR amplification (4.5-fold), TP53 p.Y220C (MAF: 37.0%), and RB1 single copy loss (). The tumor mutation burden (TMB) was estimated to be 1.1 mutation/Mb. The patient received pemetrexed and cisplatin as adjuvant chemotherapy. Four months later, he progressed with liver metastasis in left lobe ().\nThen, the patient was treated with Icotinib and the metastasis shrunk. Unfortunately, the drug resistance was observed only after 4 months, as evidenced by the fact that previously responsive liver lesion progressed. Left hepatic re-biopsy confirmed metastatic adenocarcinoma and target sequencing (Geneseeq Prime panel) detected the same EGFR-KDD (MAF: 4.9%) as well as mutation of TP53 p.Y220C (MAF: 0.5%) (). The TMB was calculated as 2.2 mutation/Mb.\nDocetaxel and cisplatin were initiated as the second-line therapy. However, the left hepatic metastasis enlarged rapidly after 2 cycles of chemotherapy. The blood carcinoembryonic antigen (CEA) level increased from 9.5 mg/ml (before chemotherapy) to 22.7 mg/ml. Even worse, a right hepatic metastasis appeared soon afterward. Radiofrequency ablation (RFA) of liver was conducted on both of the left and right hepatic metastases, but no reduction in liver lesions was observed, and the CEA level showed a slight increase from 7.3 to 10.3 mg/ml.\nAfterward, the patient started taking Osimertinib (80 mg once daily). Encouragingly, both liver lesions showed significant regression (). One month after initiation of Osimertinib, the CEA level decreased to 5.4 mg/ml, and remained at normal level for 18 months. Moreover, the progression-free survival (PFS) reached 21 months. However, the CEA level increased to 23.1 mg/ml at the 19th month after the initiation of Osimertinib treatment, and 2 months later, the patient progressed with enlarged mediastinal lymph nodes () with the CEA level of 73.9 mg/ml. Resampling and targeted sequencing (Geneseeq Prime panel) consistently identified EGFR-KDD (MAF: 33.9%), as well as EGFR amplification (6.6-fold), TP53 p.Y220C (MAF: 53.3%), and a new mutation of RELN p.G1774E (MAF: 45.4%) (). The estimated TMB increased to 3.4 mutation/Mb. In addition, the assessment of PD-L1 expression using antibody 28-8 (pharm Dx, Dako\u2019s Platform) showed tumor proportion score (TPS) of 1%.\nOn these bases, the fourth-line salvage therapy using Nivolumab was prescribed and the therapeutic efficacy was considerable, as evidenced by the decreased CEA, regressed mediastinal lymph nodes, reduced metastases in both left and right liver (). Specifically, the CEA level decreased from 143.6 to 41.8 mg/ml one month later. The PFS reached 7 months and no obvious adverse effects were observed. The quality of life was in good status during the Nivolumab treatment. After that, the patient progressed with enlarged liver metastasis. Unfortunately, the patient was also infected with tuberculosis, and his condition took a sharp turn for the worse due to both tumor progression and tuberculosis. The families gave up further treatment and the patient died 4 months later.", "age": [ [ 45.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7773813.xml", "relevant_articles": { "33392076": "123", "32642185": "123", "34871271": "123", "32206560": "123", "33906716": "123" }, "similar_patients": { "6794845-1": "1", "6549664-1": "12", "5983145-1": "13", "8100222-1": "13", "5564797-1": "13" } }, { "human_patient_id": "163", "human_patient_uid": "4769751-1-M", "PMID": "26981307", "title": "Coexisting Situs Inversus Totalis and Immune Thrombocytopenic Purpura", "patient": "A 35-year-old woman was referred to our clinic with a diagnosis of ITP resistant to medical treatment in whom a splenectomy was indicated. For 7 years, she had been treated regularly with 1 mg/kg/day methylprednisolone and episodic intravenous immunoglobulin (IVIG) in the hematology clinic and had persistent thrombocytopenia of 3,000\u201360,000/mm3, ongoing menorrhagia, and ecchymosis. The patient had two healthy births after IVIG treatment. Preoperatively, dextrocardia was detected on an electrocardiogram and thoracoabdominal computed tomography (CT) showed situs inversus totalis. In addition to mirror imaging of the normal anatomic locations of all organs, the spleen measured 13 \u00d7 6 cm and there was a 1.5 cm accessory spleen in the right upper quadrant (). Although no abnormalities were seen in the head and body of the pancreas, no pancreatic tail was seen. In other words, the pancreas had not crossed over to the right side of the superior mesenteric vascular axis and there was no pancreatic tissue near the splenic hilum (). The patient underwent a laparoscopic splenectomy () with no complications or adverse events following surgery. She was discharged on the third postoperative day with thrombocyte count of 155,000/mm3.", "age": [ [ 35.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4769751.xml", "relevant_articles": { "29561447": "12", "21053486": "12", "31229770": "123", "16287009": "123", "17171807": "12" }, "similar_patients": { "6597495-1": "123", "4593983-1": "0", "4788994-1": "0", "7581981-1": "0", "4980885-1": "0" } }, { "human_patient_id": "164", "human_patient_uid": "6406141-1-M", "PMID": "30899503", "title": "Emphysematous cystitis in an elderly Japanese patient with type 2 diabetes mellitus", "patient": "An 85-year-old woman with type 2 diabetes mellitus presented to the emergency department of our hospital with coma and shock. She had not visited any hospital previously, had never been examined for complications of diabetes, and had never consumed any medications before. On admission, her vital signs were as follows: consciousness, Glasgow Coma Scale score 3/15 (E1V1M1); blood pressure, 80/40 mm Hg; pulse rate, 130 bpm; and temperature, 37.3\u00b0C. Laboratory analysis revealed neutropenia (neutrophils count, 640/\u00b5L) and elevated C-reactive protein level to 12.73 mg/dL. The levels of blood glucose and hemoglobin (Hb)A1c were 237 mg/dL and 12.1%, respectively. Blood and urine cultures showed the presence of Escherichia coli. CT of the abdomen and pelvis without contrast revealed diffuse gas collection within the urinary bladder wall (Figures , , ), which is a typical sign of EC caused by gas-forming bacteria., The patient was intensively treated with a broad-spectrum antibiotic meropenem hydrate and a vasopressor, and was put on respirator and catheterized; however, she died within 2 days due to circulatory failure. Based on literature review, including our study, from 2016 to 2018 in Japan, the mortality rate of EC is 26% (Table ). This study may provide a new insight into this disease.", "age": [ [ 85.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6406141.xml", "relevant_articles": { "9184021": "0", "7612389": "0", "8217415": "0", "29212999": "1", "22164402": "0" }, "similar_patients": { "3068105-1": "123", "3519746-1": "13", "6118292-1": "13", "8219389-1": "0", "8077829-1": "123" } }, { "human_patient_id": "165", "human_patient_uid": "4396650-1-M", "PMID": "25897230", "title": "Catatonia in Down syndrome; a treatable cause of regression", "patient": "NK is a Caucasian female, 15 years old, in ninth grade at presentation, with mild intellectual disability (ID), (intellectual quotient [IQ] =55\u201369), atrioventricular canal repair at age 6 months, and no previous psychiatric history. She presented with a 6-month history of gradual development of slow motor activity, reduced speech with increased latency, unusual movements such as repetitive movements and posturing, blunted and inappropriate affect, mood lability, sleep disturbance, slow eating, and a general decline in previously attained skills, all of which supported the catatonia diagnosis. Family history was significant for maternal anxiety. Previous medical work-up included brain magnetic resonance imaging (MRI), electroencephalograms (EEGs), computed tomography scan of sinuses, thyroid function tests, and polysomnogram to rule out sleep apnea, all with normal findings. The only exceptions were evidence of previous Mycoplasma and Epstein\u2013Barr virus infections. Recent stressors included transition to high school and the death of a grandmother a year earlier.\nAt presentation, she had received low-dose clonazepam for 1 month with some improvement in symptoms. Previous medication trials included ethosuximide for 2 weeks (no effect); a trial of lisdexamfetamine (resulted in agitation, mood and sleep dysregulation, and possible hallucinations); and citalopram 20 mg, which may have led to further decline in ADL. Based on this presentation, NK was diagnosed with unspecified catatonia. Treatment with lorazepam 1.5 mg three times daily was initiated, and gradually titrated to a total dosage of 12 mg daily with some improvement in functioning. However, psychomotor slowing and mood lability persisted and was impairing. She was therefore hospitalized and started on ECT; lorazepam was continued and citalopram discontinued. She responded well to ECT and continued a tapering course of ECT, ending having had a total of 26 treatments. During this time, she was also started on lithium carbonate and amiloride 5 mg for renal protection. When her symptoms recurred 3 months later, she received a second course of 21 bilateral ECT over 7 months with 100% recovery.\nShe continues to receive maintenance ECT at 2-week intervals, primarily to control motor symptoms, and has received a total of 73 treatments over the past 31 months. Lithium was discontinued due to lack of response and side effects (polyuria and weight gain).", "age": [ [ 15.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC004xxxxxx/PMC4396650.xml", "relevant_articles": { "20159196": "123", "34956685": "13", "11281518": "13", "18327024": "123", "13677953": "0" }, "similar_patients": { "4396650-2": "123", "4396650-3": "123", "4396650-4": "123", "4439498-1": "123", "8144290-1": "123" } }, { "human_patient_id": "166", "human_patient_uid": "4396650-2-M", "PMID": "25897230", "title": "Catatonia in Down syndrome; a treatable cause of regression", "patient": "CU is a Caucasian female, aged 16 years old at presentation, with moderate ID (IQ =40\u201354), no previous psychiatric history, and a family history of anxiety in a first-degree relative. At baseline, CU attended school and functioned at preschool level. Recent stressors included parental marital stress and family relocation. Symptoms were first noted 2.5 years prior to presentation, when she was diagnosed with a presumed Hashimoto\u2019s encephalopathy at an outside institution. At that time, her symptoms included grimacing, eye blinking, and decline in functioning. She was noted to have elevated thyroglobulin antibodies (711 IU/mL) and marginally increased thyroid peroxidase antibodies (45 units/mL) but normal thyroid stimulating hormone, and free T4 and T3 levels. Routine spinal fluid analysis, EEGs, and brain MRI were normal. Oral prednisone was initiated with some improvement, although it is unclear how long she remained well. Two years later, she presented to our institution, with reoccurrence of symptoms of 7 months\u2019 duration. Symptoms included periods of prolonged immobility, agitation, repetitive and darting eye movements, involuntary movements of the mouth and flicking movements of her fingers, depressed mood, decline in ADL, apparent loss of hedonic capacity, staring, and decreased speech output.\nIn addition to routine medical tests, thyroid functions, thyroglobulin antibody, and thyroid microsomal antibody; single-nucleotide polymorphism chromosomal microarray; creatinine phosphokinase; hepatitis A, B and C antibodies; paraneoplastic antibody (immunoglobulin G N-methyl-D-aspartate receptor); 25 hydroxy vitamin D; brain MRI; and, EEG disclosed no significant abnormalities.\nCU was diagnosed with unspecified catatonia. Symptoms supporting the catatonia diagnosis included reduced motor activity, episodes of increased activity, grimacing, stereotyped finger movements, staring, reduced speech, and decline in skill level. Mood symptoms, not specific to the catatonia diagnosis, were also noted. An oral challenge dose of lorazepam 1 mg resulted in an immediate but short-lived improvement. Lorazepam was gradually increased to a maximum dose of 5.5 mg four times daily with limited improvement in symptoms. Lamotrigine was later added and titrated up to 150 mg daily for mood stabilization with no significant impact. Due to progressive decline, ECT was initiated. At the time of writing this report, CU has received 86 bilateral ECT treatments over a 6-month period with notable improvement. Her mother believes CU has regained 100% of her baseline functioning. There are no reported symptoms 5 months after discontinuing ECT. She continues to receive lorazepam 10 mg/day and memantine 20 mg/day and is closely monitored for recurrence of symptoms.", "age": [ [ 16.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC004xxxxxx/PMC4396650.xml", "relevant_articles": { "20159196": "123", "25787102": "0", "34277291": "12", "32577332": "123", "30983904": "12" }, "similar_patients": { "4396650-4": "123", "4396650-1": "123", "4396650-3": "123", "8144290-1": "123", "4439498-1": "123" } }, { "human_patient_id": "167", "human_patient_uid": "4396650-3-M", "PMID": "25897230", "title": "Catatonia in Down syndrome; a treatable cause of regression", "patient": "SH is a biracial male, aged 16 years old at presentation, with moderate ID (IQ =40\u201354) whose only medical problems were hypothyroidism diagnosed at age 5 years, constipation, and mild congenital right-sided cerebral palsy. At 13 years of age, SH developed uncharacteristic aggression and an inability to perform previously mastered tasks. Numerous antipsychotic agents were tried, all of which failed to stop his progressive decline. His parents and referring clinician attributed his decline to a trial of fluoxetine that they associated with periods of immobility lasting several minutes, chewing but not swallowing, inability to complete simple tasks, and high-frequency self-injurious behaviors. These symptoms improved but did not reverse upon discontinuation of fluoxetine. At 16 years of age, SH presented for a second opinion due to acute exacerbation of symptoms in the previous 8 to 10 weeks. Presenting symptoms included increased motor activity interspersed with episodic cessation of all activity for a few seconds, vocal stereotypies, staring spells, jerky head movements (tics), unprovoked aggression, reduced sleep, slowed and reduced food intake, and weight loss.\nSH was diagnosed with unspecified catatonia. Symptoms supporting the diagnosis included episodes of both reduced and increased activity, periodic cessation of all motor activity, repetitive and meaningless utterances (also known as \u201cverbal stereotypies\u201d or \u201cverbigeration\u201d), staring, decline in skills, and a markedly slow food intake rate that resulted in progressive weight loss. Laboratory tests (complete blood count, comprehensive metabolic panel, thyroid and liver function tests, antinuclear antibodies, thyroid antibodies, 24-hour EEGs with video recording, and MRI) were within normal limits.\nLorazepam treatment was initiated but a maximum dose of 11 mg/day did not result in consistent improvement. Subsequently, he was treated with bilateral ECT with excellent response. The parents believe that he has regained 100% of his baseline function. At the time of writing this report, he has received a total 76 bilateral electrode placement (BL ECT) over the past 18 months and continues to receive weekly maintenance treatment. So far, attempts to taper the frequency of ECT have resulted in return of symptoms. A trial of lithium, administered at a therapeutic dose and over a 1-year period, was discontinued due to the lack of additional benefit. A future trial with memantine may be considered, although this agent was not helpful in the past when administered concurrently with an antipsychotic agent.", "age": [ [ 16.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4396650.xml", "relevant_articles": { "34335326": "13", "17565293": "12", "20414058": "12", "33070587": "0", "27428481": "13" }, "similar_patients": { "4396650-4": "123", "4396650-2": "123", "4396650-1": "123", "8144290-1": "123", "8024572-1": "123" } }, { "human_patient_id": "168", "human_patient_uid": "4396650-4-M", "PMID": "25897230", "title": "Catatonia in Down syndrome; a treatable cause of regression", "patient": "BN is a Caucasian male with no previous psychiatric problems, who was aged 18 years old at presentation. His only medical problems were alopecia areata successfully treated at age 12 years and mild Raynaud\u2019s phenomenon. Despite moderate-range ID (based on IQ testing), he demonstrated higher-than-expected adaptive functioning, including playing the piano, reading, and working part-time. Family history was positive for adult-onset hypothyroidism and Raynaud\u2019s in the father. There was no history of stressors.\nSymptoms emerged at age 17 years, 5 months, with progressive psychomotor slowing, episodic immobility, freezing, reduced speech and eye-blink rate, loss of hedonic capacity, grimacing and holding his tongue out, repeated shrugging and turning of the shoulders, slow eating, and stereotyped movements of the fingers. There were no sleep problems and minimal snoring. Neurological examination was normal except for overall motor slowing. Neurologic testing was unremarkable, including brain MRI, routine and 24-hour EEGs. Laboratory testing included comprehensive metabolic profile (CMP), complete blood count, B12, B6, and folate levels; iron, total iron binding capacity, and iron saturation; thyroid panel including anti-thyroglobulin and thyroid peroxidase antibodies; rapid plasma reagin (RPR); creatinine phosphate; ceruloplasmin; sedimentation rate; and a comprehensive immune function evaluation. Immune studies were positive for mildly elevated antinuclear, anti-streptococcal, and anti-Mycoplasma antibodies; elevated serum immunoglobulin G levels against dopamine D1 receptor, dopamine D2 receptor, and tubulin; and elevated serum induction of Ca2+/calmodulin-dependent kinase II in human neuronal cell lines.\nA lorazepam (1.5 mg, IV) challenge resulted in marked improvement in motor symptoms lasting approximately 24 hours. Based on these findings and due to the lack of evidence to suggest another underlying medical or neuropsychiatric disorder, BN was diagnosed with unspecified catatonia. Symptoms supporting the catatonia diagnosis were progressive motor slowing, periodic cessation of all motor activity (freezing episodes), grimacing, posturing (a posture or movement maintained for a prolonged period), staring, loss of previously gained skills, markedly slowed food intake, negativism, and a loss of hedonic capacity. Lorazepam was titrated to a maximum dose of 20 mg/day resulting in 80% of baseline function. ECT was initiated due to failure to achieve baseline. At the time of writing, the patient has had an immediate and robust response to 12 bilateral treatments, with more spontaneous speech and fluidity of movement. The plan is to continue ECT until return to baseline function is attained.", "age": [ [ 18.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4396650.xml", "relevant_articles": { "17565293": "12", "20414058": "12", "10203957": "123", "10619284": "13", "20123920": "13" }, "similar_patients": { "4396650-2": "123", "4396650-3": "123", "4396650-1": "123", "8024572-1": "123", "8032932-1": "0" } }, { "human_patient_id": "169", "human_patient_uid": "7755544-1-M", "PMID": "33408586", "title": "Pregnancy Management in a Patient With Congenital Heart Disease and Severe Right Ventricle to Pulmonary Artery Conduit Stenosis", "patient": "A 29-year-old female in her second pregnancy, with a history of tetralogy of Fallot or ventricular septal defect with pulmonary atresia, had undergone 4 surgeries during her childhood, including a modified Blalock-Taussig shunt, patch repair of ventricular septal defect, and a right ventricle (RV) to pulmonary artery (PA) conduit. At 20 weeks\u2019 gestation during her first pregnancy, she developed severe symptomatic stenosis of the RV to PA conduit with a Doppler gradient of 98 mmHg, thus requiring a 22-mm balloon dilatation and Genesis XD stent as a temporizing measure until definitive repair could be undertaken postpartum. However, she was lost to follow-up after delivery of her first child and did not undergo postpartum repair of her RV to PA conduit stenosis.\nThe patient presented to our clinic during her second pregnancy at 21 weeks of gestation. Thus far, her pregnancy had been uncomplicated and prenatal testing to date had found no abnormalities in fetal development. On presentation, she admitted to mild dyspnea on exertion at a distance of 20 yards. On examination, the patient was tachycardic and normotensive with normal oxygenation. She was euvolemic with hemoglobin of 13.5 g/dL and creatinine of 0.7 mg/dL. Echocardiogram showed normal left ventricular ejection fraction (LVEF) of 60% to 65%, with mild right atrial (RA) dilatation, evidence of RV hypertrophy, and an estimated RV pressure of 82 mmHg. The PA conduit was severely stenosed, with a mean gradient of 52 mmHg and unrestricted pulmonic valve insufficiency. Our assessment determined her modified World Health Organization (WHO) pregnancy risk classification to be II-III (moderately increased risk of maternal mortality and moderate morbidity).\nShe was seen again in clinic at 34 weeks\u2019 gestation. Her symptoms and repeat echocardiogram were unchanged from the previous visit. However, at 36.5 weeks\u2019 gestation, 2-dimensional echocardiogram done in preparation for delivery identified severe conduit stenosis with a mean gradient of >75 mmHg, peak gradient of 98 mmHg with a peak velocity of 5 m/s, and unrestricted pulmonic valve insufficiency. The patient's RV pressures at the time also exceeded 71 mmHg. Despite the severe restenosis and unrestricted insufficiency of her PA conduit, her symptoms remained New York Heart Association (NYHA) class II. The plan was to admit the patient prior to cesarean section for assessment of heart failure and bilateral tubal ligation at 37 weeks\u2019 gestation.\nAs planned, she was admitted at 37 weeks for delivery and was cared for by a multidisciplinary team involving obstetrics, ACHD specialists, heart failure specialists, obstetric anesthesia, maternal fetal medicine, and the neonatal intensive care unit.\nThe patient underwent a successful low transverse cesarean section and bilateral tubal ligation under epidural block with an estimated blood loss of 1,100 mL. Postdelivery echocardiogram showed normal LVEF of 55% to 60%, RA and RV dilatation with RV hypertrophy, and no change in RV pressure or valve gradient. The RV to PA conduit stenosis had decreased to a peak velocity of <4.8 m/s and a mean gradient of <56 mmHg with unrestricted insufficiency.\nThe patient had an uncomplicated postoperative course, only requiring some gentle hydration, and was discharged 3 days postpartum. She was scheduled for follow-up for severe conduit stenosis at 6 weeks postpartum to discuss management options.", "age": [ [ 29.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7755544.xml", "relevant_articles": { "33408586": "123", "8308385": "1", "9834593": "123", "8555607": "3", "23561818": "3" }, "similar_patients": { "6120336-1": "123", "8557348-1": "12", "7386052-1": "12", "8564701-1": "12", "2729471-1": "12" } }, { "human_patient_id": "170", "human_patient_uid": "7922450-1-M", "PMID": "33707906", "title": "Dual Oxygen Therapy in COVID-19 Patient: A Method to Improve Oxygenation", "patient": "A 64-year-old COVID-19 patient was presented with respiratory distress to our intensive care unit. High-resolution computed tomography revealed severe involvement of both the lungs. Supplemental oxygen was given at 15 L/min. The peripheral saturation of oxygen was 90% and arterial blood gas (ABG) analysis showed a pH 7.33, PCO2 30.40, PO2 73.8, Na 130, K 4.21, and HCO3 17.9. Non-invasive ventilation (CPAP) was ensued with Fio2 70%, pressure support 14, and positive end-expiratory pressure (PEEP) 7 (cm H2O). Despite increasing the FiO2 to 100%, the clinical status of the patient deteriorated the next day. He became tachypneic (respiratory rate (RR) > 35) with peripheral oxygen saturation of less than 90%. Extra oxygen through a nasal cannula at 10 L/min () was added. This was done to decrease the rebreathing of expired air inside the NIV mask and in the anatomical dead space of the nasopharynx. Soon, we found improvement in oxygen saturation (SpO2 > 95%) with ABG showing PO2 85 mm Hg and PCO2 37.", "age": [ [ 64.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC007xxxxxx/PMC7922450.xml", "relevant_articles": { "15891327": "123", "34412752": "12", "33575513": "123", "30861261": "0", "25944940": "123" }, "similar_patients": { "7922450-1": "123", "7744734-1": "12", "2772242-1": "12", "8489803-1": "13", "8178127-1": "1" } }, { "human_patient_id": "171", "human_patient_uid": "7922450-2-M", "PMID": "33707906", "title": "Dual Oxygen Therapy in COVID-19 Patient: A Method to Improve Oxygenation", "patient": "A 70-year-old hypertensive and diabetic male patient was admitted to our ICU with respiratory distress following COVID-19 infection. Chest x-ray showed bilateral diffuse infiltrates. ABG on 15 L of oxygen by non-rebreathing mask showed severe hypoxia (Pao2/Fio2 < 100), and respiratory acidosis with pH 7.52, PO2 56.3, PCO2 31.5, SpO2 <90. We gave non-invasive ventilation (CPAP) support with Fio2 80%, pressure support 14, and PEEP 7 (cm H2O). On the third day of CPAP therapy, the patient was unable to maintain oxygen saturation (SpO2 < 92%) despite FiO2 100% and became more tachypnic (RR > 40). There was increased respiratory distress and SpO2 decreased to <90% despite FiO2 100%. We gave supplemental oxygen by nasal cannula with O2 flow 10 L by another flowmeter (). The patient became more comfortable, and SpO2 increased to 95%. ABG showed PO2 90 mm Hg, PCO2 35, and SpO2 97%. The patient recovered successfully from respiratory distress.", "age": [ [ 70.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC007xxxxxx/PMC7922450.xml", "relevant_articles": { "26836924": "12", "34963717": "12", "25859313": "12", "24885124": "12", "34412752": "12" }, "similar_patients": { "5613614-1": "123", "7744734-1": "12", "7584836-1": "12", "3401823-1": "12", "8178127-1": "1" } }, { "human_patient_id": "172", "human_patient_uid": "3557002-1-M", "PMID": "23358558", "title": "Diagnostic dilemma: Saccular aneurysm or pseudoaneurysm of the ascending aorta with dissection above level of leaflets", "patient": "An 85-year-old Kurdish man lived in Iran, had been referred for elective coronary angiography and was admitted because of typical chest pain but with mild intensity. One year ago he had experienced an episode of chest pain accompanied by troponin elevation that had been considered acute coronary syndrome. However, he had not been underwent coronary angiography, with any reason that we do not know. After that event, he did not have typical coronary symptoms until current presentation. He was scheduled for angiography because of typical chest pain and old electrocardiographic (ECG) changes.\nInitially, His physical exam was unremarkable, ECG showed normal sinus rhythm with Q waves and inversion of T waves in II, III and aVF leads without any acute or new findings. Chest X-ray revealed the bulge aortic knob contour (). Routine transthoracic echocardiography, including the suprasternal view, showed dilated ascending aorta (4.6 cm) () and mild commissural aortic regurgitation preserved left ventricular systolic function. During catheterization, the left Judkins catheter passed without any problem, but we could not pass the right Judkins catheter, hence pigtail catheter was inserted and aortic root angiography showed the localized bulging of ascending aorta, but we were not sure whether it is dissection with true aneurysm or pseudoaneurysm? The findings on coronary artery angiography were unremarkable.\nMultislice spiral CT angiography revealed aneurysmal dilation of ascending aorta from sinotubular junction with the saccular aneurysm at the proximal part of arch with a 37 mm per 56 mm maximum diameter (). There was extension of thrombosis into the proximal part of right brachiocephalic artery, but ostia of both arteries did not involve with the aneurysm. The patient had been referred for surgery.\nDuring surgery we found the dissection of ascending aorta till distal to brachiocephalic artery (transverse arch involvement). Dissection flap was composed of some parts of intima and media layers (). Replacement of ascending and transverse aorta was performed with interposition tubular graft 30 and valve sparing. The operation and recovery was uneventful.", "age": [ [ 85.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3557002.xml", "relevant_articles": { "23358558": "123", "15285377": "123", "30533134": "123", "17996316": "123", "25028613": "123" }, "similar_patients": { "7405101-4": "123", "7732573-1": "123", "8164716-1": "123", "8317293-1": "123", "4083777-1": "123" } }, { "human_patient_id": "173", "human_patient_uid": "5842979-1-M", "PMID": "29568629", "title": "Disseminated cutaneous histoplasmosis with laryngeal involvement in a setting of immune reconstitution inflammatory syndrome", "patient": "A 39-year-old man presented with a 3-month history of skin lesions involving the face, neck and extremities. The patient was diagnosed as being HIV-positive a month earlier and was commenced on antiretroviral treatment abacavir 300 mg bd, lamivudine 300 mg bd and efavirenz 600 mg once daily, because of impaired renal function or pre-renal failure. The patient was hydrated with an improvement in the renal function. Two weeks after the development of the skin lesions, the patient complained of a sore throat and hoarseness of his voice.\nOn clinical examination, the patient had multiple translucent, clustered, umbilicated papules and nodules in the centrofacial region and neck with necrotic centres. In addition, there were verrucous plaques and nodules on the ears and upper limbs ( and ). Chest X-ray was normal with no lung, hilar or mediastinal lymph nodes. A fibre-optic laryngoscopy revealed a supraglottitis with ulceration on the lingual surface of the epiglottis ().\nRoutine blood investigations demonstrated elevation of the liver enzymes with an infiltrative pattern (AST-63/ALT 70/ALP -219/Gamma GT-291). Abdominal ultrasound revealed an enlarged liver with abnormal parenchyma. The kidneys and the rest of the abdomen were normal. The initial CD4 count performed prior to the commencement of antiretrovirals was 2 cells/\u00b5L with a viral load greater than one million copies/mL. A repeat test (eight weeks later) showed a CD4 count of 124 cells/\u00b5L with a viral load of less than 20 copies/mL. Urinalysis and urine histoplasma antigen test were negative. Histology of the liver, larynx and sections of the skin demonstrated pandermal necrotising granulomatous inflammation. Grocott-Gomori methenamine silver and PAS stains revealed a relative paucity of intracellular oval, narrow-neck budding fungal organisms morphologically in keeping with Histoplasma capsulatum var. capsulatum ( and ). Fungal culture of liver, epiglottis ulcer and skin confirmed the diagnosis of histoplasmosis.\nOn the basis of the clinical presentation, initial worsening of the disease and rapid elevation of the CD4+ T-cell count with lowering of the HIV viral load, the patient most likely has histoplasmosis associated IRIS. The patient was commenced on intravenous amphotericin B (0.8 mg/kg/day) for two weeks and continued with his antiretroviral treatment. He had an excellent response to this treatment and was discharged on itraconazole 100 mg twice a day.", "age": [ [ 39.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5842979.xml", "relevant_articles": { "29568629": "123", "11703524": "123", "24118343": "0", "21987498": "1", "31706701": "123" }, "similar_patients": { "5843213-1": "13", "5843156-1": "123", "5304559-1": "123", "6399754-1": "123", "4540502-1": "123" } }, { "human_patient_id": "174", "human_patient_uid": "4779810-1-M", "PMID": "26955617", "title": "Uncommon Primary Synovial Chondromatosis Involving Only the Infrapatellar Fat Pad in an Elderly Patient", "patient": "A 76-year-old male presented with a six-month history of pain in his right knee joint. The pain occurred insidiously without any antecedent trauma. He exhibited no signs of meniscal tear, ligamentous injury, or limitation of motion, but had pain on terminal extension. He also complained of intermittent pain while walking, but he denied any pain at rest or constitutional symptoms.\nAn initial physical examination showed no specific swelling of the right knee joint. He experienced anterior knee pain on terminal extension with a limited knee extension of 10\u00b0. The patient showed neither ligamentous instability nor positive findings on mechanical tests.\nSimple radiographs of the knee showed no definite osteoarthritic change on the tibiofemoal joint or a soft tissue density lesion, although small calcification was observed on the suprapatellar pouch (). T1-weighted MRI scans of the right knee joint showed a lobulated, well-defined mass in the IFP with intermediate signal intensity, whereas T2-weighted images showed homogeneous and relatively high signal intensity but no hypointense areas such as calcified nodules or hemosiderin deposits. Both T1 and T2 weighted images showed that the mass was bisected by band-like septa of low signal intensity ().\nThe patient underwent arthroscopic excision. Conventional anteromedial and anterolateral portals were introduced to confirm the preoperative MRI findings. Far medial and far lateral portals were made to clearly visualize the mass and thoroughly remove it arthroscopically. The arthroscopic findings showed a whitish, ovoid-shaped mass buried in the IFP ().\nAfter debridement of some of the fat pad adjacent to the mass, a freely movable large-sized mass was exposed (). The mass was completely excised with a punch and shaver and completely removed. No damage to the cruciate ligament was found but mild osteoarthritic changes, considering the old age, were shown, such as minimal meniscus tear and articular cartilage wear. Histopathological examination of the mass showed unevenly distributed plump chondrocytes with cellular atypia, some binucleated, within irregularly-shaped nests of cells. Neither zonal ring-like calcification nor enchondral ossification was observed (). These findings were consistent with a diagnosis of primary synovial chondromatosis. At 20-month follow-up, the patient was taking part in normal daily activities.", "age": [ [ 76.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4779810.xml", "relevant_articles": { "34721915": "0", "26960422": "12", "19292408": "123", "21410113": "123", "23436874": "2" }, "similar_patients": { "3687912-1": "0", "5114262-1": "123", "5728001-1": "123", "5718790-1": "0", "5141313-1": "0" } }, { "human_patient_id": "175", "human_patient_uid": "4333552-1-M", "PMID": "25709283", "title": "Acute onset bilateral myopia in convalescence phase of varicella infection", "patient": "A 13-year-old boy presented with sudden onset of painless blurring of vision in his both eyes. He had a history of exanthematous fever 20 days back and was treated symptomatically. There were healing skin lesions on face, abdomen and upper and lower limbs []. On examination, the un-corrected visual acuity in oculi uterque (OU) was 3/60, and best corrected visual acuity was 6/6; N-8 with \u2212 3.00 Diopter spherical (DS) correction. Intraocular pressure (IOP) was 14 and 15 mm Hg, respectively in the right and left eye. Anterior chambers (AC) were quiet and shallow, and on gonioscopy angles were open to anterior trabecular meshwork. By immersion A-scan ultrasonography AC depth (ACD) were 3.47 and 3.41 mm, and lens thickness were 3.64 mm and 3.61 mm, respectively in the right and left eye. Pupils were symmetrical, round, regular and reactive to light. Fundus examination was significant for the presence of bilateral retinal folds in the macular region bilaterally []. B scan ultrasonography showed features of annular cilliochoroidal effusion []. A dermatology opinion was taken, which pointed toward varicella, and serum was positive for the specific immunoglobulin M (1.14) antibodies. Patient was started on oral prednisone (50 mg/day) and topical homatropine 2% thrice daily.\nAt 1 week follow up unaided distance vision OU had improved to 6/6, and near vision was N-24. The oral prednisolone and homatropine was stopped over 2 weeks. At 4 weeks, unaided vision OU was 20/20; N-6. The AC angle was open to sclera spur on gonioscopy and fundus examination was un-remarkable.", "age": [ [ 13.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4333552.xml", "relevant_articles": { "29681836": "0", "33978626": "0", "32818333": "0", "18182113": "12", "28744386": "123" }, "similar_patients": { "4871965-1": "0", "4313501-1": "123", "5644413-1": "12", "6815337-1": "123", "8409355-1": "0" } }, { "human_patient_id": "176", "human_patient_uid": "4852060-1-M", "PMID": "27170922", "title": "Low Voltage Electric Current Causing Ileal Perforation: A Rare Injury", "patient": "An 8-year old male child presented after 10 days of sustaining electric burn over left forearm, chest, and abdominal wall. He sustained electrical burn accidently after touching electrical cable which was described as low voltage current. After sustaining electric burn, patient was brought to the private hospital. They managed patient with dressing and medications. There were no abdominal complaints at that time so he was discharged. After a week he developed abdominal pain with distension. On examination, there was necrosis of skin with eschar on the left lower abdomen with entry wound on left forearm and exit wound over left lower abdomen. He was dehydrated with pulse 100/mint. It was 2nd degree burn. Abdomen was distended and tender. On investigation hemoglobin was 11.7 gm%, TLC- 17000/mm3, serum electrolytes, liver function test, serum amylase and lipase were in normal limits. In urine analysis albumin was present. ECG was normal. Ultrasound abdomen showed thick inter-loop collection, dilatation of small bowel loops, and collapsed colon. X-ray abdomen revealed free gas under both domes of diaphragm. He was diagnosed as having bowel perforation leading to peritonitis. Immediate exploratory laparotomy was performed. There was around 50 cc of bilious fluid in peritoneal cavity with plenty of flakes over intestine. On further exploration, a perforation (0.5x0.5cm) found in the proximal ileum. Refreshing of the margins of perforation was done and primary closure performed (Fig. 1). Patient recovered uneventfully and was discharged on 7th postoperative day. Electric burn healed at the time of discharge. At follow up patient remained healthy.", "age": [ [ 8.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4852060.xml", "relevant_articles": { "24459356": "13", "24360004": "13", "16998411": "13", "3886090": "13", "31692629": "0" }, "similar_patients": { "3505287-1": "123", "5217140-1": "123", "6044477-1": "0", "5670268-1": "0", "3078481-1": "0" } }, { "human_patient_id": "177", "human_patient_uid": "4706724-1-M", "PMID": "26746693", "title": "Small vessel microembolization and acute glomerulonephritis following infection of aesthetic filler implants", "patient": "A 57-year-old woman was admitted for painful lower leg ulcers. Past history included subcutaneous injection of esthetic filler material in the lower legs 20 years ago, hypothyroidism and HIV infection on highly active antiretroviral therapy (HAART: raltegravir, abacavir, lamivudine). Viral load was negative and CD4 cells were 600/\u03bcl. One year before admission, bilateral torpid lower leg ulcers developed after minor trauma and progressively expanded. She was treated with diclofenac.\nOn admission blood pressure was 190/88 mmHg (previously normal) and she had extensive necrotic ulceration and edema in both lower legs. Key lab results were serum creatinine 1.5 mg/dl (previously 1.0 mg/dl), serum albumin 3.5 mg/dl, serum cholesterol 139 mg/dl, complement factor 3 (C3) nadir 63 mg/dl, normal C4, polyclonal hypergammaglobulinemia, urinary albumin:creatinine ratio 2082 mg/g, urinary protein:creatinine ratio 3557 mg/g and urinary sediment containing 20\u201340 red blood cells/high power field. ANCA, ANA, and anti-GBM were negative. Ulcer cultures grew Group A streptococcus pyogenes.\nKidney biopsy (two cores; 9 and 11 mm long) containing 26 glomeruli, 2 of them completely sclerosed, disclosed diffuse proliferative glomerulonephritis characterized by glomerular hypercellularity due to mesangial proliferation and endocapillary leukocytic infiltration (Fig. ). Trichrome staining revealed subepithelial fuchsinophilic deposits. Jones silver stain did not show spikes or basement membrane reduplication (Fig. ). Coarse mesangial and peripheral capillary loop staining for C3 was seen on immunofluorescence (Fig. ), without IgG, IgA or IgM deposition. Round translucent, non-birefringent microspherical bodies (30\u201335 \u03bcm) resembling adipocytes were identified within some capillary lumens (Figs. and ). Microspheres were also seen in a globally sclerosed glomerulus (Fig. ). In the tubulointerstitial compartment, intratubular red blood cell casts, acute tubular damage and patchy interstitial lymphocytic infiltrates were noted. Vessels showed arteriolar hyalinosis and moderate myointimal hyperplasia. Ultrastructural study revealed subepithelial deposits (\u2018humps\u2019) (Fig. ).\nTreatment included local debridement, antibiotics and angiotensin converting enzyme inhibitors. Estimated glomerular filtration rate, C3 and microhematuria normalized at month 3, 5 and 12, respectively, while albuminuria progressively improved over the next 12 months (Fig. ). One year after the initial admission, angiotensin converting enzyme inhibitors had been stopped and serum creatinine was 0.9 mg/dl, estimated glomerular filtration rate 94 ml/min/1.73 m2, urinary albumin:creatinine ratio 188 mg/g and urinary sediment contained no red blood cells/high power field.", "age": [ [ 57.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4706724.xml", "relevant_articles": { "18318244": "12", "14712359": "123", "30683055": "0", "23387284": "0", "28509301": "0" }, "similar_patients": { "7045629-1": "123", "4720204-1": "0", "8255749-1": "12", "5512846-1": "0", "4346693-1": "0" } }, { "human_patient_id": "178", "human_patient_uid": "4319332-1-M", "PMID": "25684928", "title": "Rheumatoid arthritis affecting temporomandibular joint", "patient": "A 22-year-old female patient visited the outpatient department with a complaint of pain in the left jaw joint region since 1\u00bd months. On eliciting the history, patient had pain on mastication and difficulty in opening the mouth due to which she was on the soft diet. Medical history revealed that she was diagnosed with RA 6 months back. The patient took homeopathy medicines for 1 month. But presently was not on any medication. On clinical examination of TMJ, the following signs and symptoms were assessed: Left side TMJ was associated with pain, TMJ range of motion was limited, associated with pain while maximum unassisted mouth opening (18 mm) and while lateral excursion [], deviation of mandible toward left side while opening mouth was noticed. No clicking sounds on opening, closing and lateral movements. Muscles of mastication were tender on palpation. Intra orally, no teeth were carious, no occlusal prematurity was noticed. On radiological examination, panoramic radiograph depicted irregular erosions in the left condyle and decreased joint space both on right and left side. The findings were of degenerative joint disease but nonspecific due to the overlapping of structures []. TMJ tomography both open and closed mouth revealed slight erosion in the anterior surface of the left condyle but was not clearly appreciated []. Further evaluation was carried out by CBCT.\nCone beam computed tomography images revealed sclerosis of the outer surface of the condylar head, narrowing of the articular space bilaterally (more on the left). Coronal left closed mouth view revealed loss of joint space, loss of cortical bone on the superior surface and condylar head erosions compared to right side, which shows normal joint space and condylar structure [Figure and ]. Coronal left open mouth view revealed narrowing of the articular space and erosions on superior head of condyle and right side depicting no changes in the joint space [Figure and ]. Sagittal view open and closed mouth revealed decrease in joint space with erosions of the superior surface of the condyle on the left side [Figures and , and ]. Hand wrist radiograph revealed the joint space narrowing of the distal phalange of the right thumb, narrowing of 3rd and 4th proximal phalanges and erosion of the middle phalange seen of index finger []. Knee and shoulder joint radiographs revealed no changes. Serum investigations were advised and it revealed rheumatoid factor (RF)-340 IU/ml (normally <40 IU/mL), C-reactive protein (CRP)-368 mg/dl (normally <0.8 mg/dL), erythrocyte sedimentation rate (ESR)-40 mm/h (normally <20 mm/h in females). All serum markers for RA were elevated. Final diagnosis of RA affecting TMJ was arrived at.\nPatient was referred to rheumatologist for the further treatment, and she was prescribed Tab Methotrexate 75 mg once a week for 2 months and anti-inflammatory drug twice a day for 15 days and patient responded well to the treatment. Liver function test was also monitored with periodic follow-up. After 2 months of the follow-up, patient reported relief of pain and improvement in mouth opening.", "age": [ [ 22.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC004xxxxxx/PMC4319332.xml", "relevant_articles": { "23559927": "2", "23053253": "12", "19668996": "12", "11094371": "12", "23280030": "12" }, "similar_patients": { "3996894-1": "123", "6933989-1": "12", "8365916-1": "12", "6421772-1": "12", "3870132-1": "1" } }, { "human_patient_id": "179", "human_patient_uid": "5451783-1-M", "PMID": "28607795", "title": "Recurrent Lateral Ventricular Enterogenous Cyst: A Report of an Extreme Rare Case", "patient": "The patient was a 45-year-old man who presented with a headache for 3 months which was progressive and had been intolerable for 2 weeks. However, the patient was a football player with good health. There was no such family history and family members were perfectly well. There were no other clinical symptoms reported by the patient.\nThe patient was advised to do CT-scan and MRI. Interestingly both CT-scan and MRI revealed brilliantly enhancing left lateral ventricular lesion with unilateral hydrocephalus (). T1 Image axial view postcontrast () and precontrast film () were also examined. T1 image of coronal view in postcontrast film was also evaluated (). T2 image in sagittal view () also found the SOL.\nFlare image () was examined as well. All other investigations were within normal limit. Then the patient was advised for surgery for removal of the lesion. In this context, left parietal craniotomy was performed with total removal of the lesion through intraparietal approach. Reversal from GA and the postoperative period was uneventful and the patient had got rid of clinical symptom completely after surgery.\nThe tumor was well defined preoperatively and was removed under microscopic surgery meticulously. The patient was very poor to bear the cost of postoperative CT-scan and hence it was not done. The biopsy was sent for histopathological examination. The lesion was nearly spherical measuring 3.0 cm + 2.5 cm, whitish, and firm.\nThere was no evidence of necrosis. Microscopy revealed multicystic appearance with cyst lined by columnar epithelium with apical mucin. Few goblet cells were seen. Few areas had shown pseudostratified lining epithelium with nuclear hyperchromasia, nuclear enlargement, and increased mitosis.\nThere was no evidence of stromal invasion. The mucinous material was seen within the lumen. Hemosiderin laden macrophages were present in the stroma. It was confirmed as a lateral ventricular enterogenous cyst. Then the patient was well in around one year. After about one year of the surgical removal of the lesion, there was a recurrence of a headache whose intensity was more than the previous one.\nThen the patient was advised to do a CT-scan which revealed lesion of the same pattern in the same location as before (). The patient was reexplored surgically and the tumor was removed completely through the same route and histopathology was again revealed it as a case of the enterogenous cyst. Again the total removal of the lesion from the brain was confirmed by postoperative CT-scan. Then the patient was advised for radiotherapy. After completion of radiotherapy, the patient was perfectly well at 13th postoperative month ().", "age": [ [ 45.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5451783.xml", "relevant_articles": { "28607795": "123", "18661025": "0", "15617312": "0", "22759717": "0", "2274842": "0" }, "similar_patients": { "7442918-1": "0", "8039191-1": "0", "6417341-1": "0", "3909849-1": "0", "5108115-1": "0" } }, { "human_patient_id": "180", "human_patient_uid": "8114115-1-M", "PMID": "33964714", "title": "Cerebellar liponeurocytoma, a rare tumor: Case report and review of the literature", "patient": "A 50-year-old female patient, known case of hypertension (HTN) and taking normatin as a medication, was in her usual state of health until 6 months prior to admission when she started to complain from headache, tinnitus and vertigo. She sought medical advice and was treated as otitis media (according to the patient).\nBefore ten days from her admission to our hospital, she had episodes of imbalance while she was walking and recurrent vomiting.\nOnce again, she sought medical help and, after a brain CT and a brain MRI were done, the doctors found a left cerebellar tumor (). In the upcoming days, she was referred to our hospital in April 2019 for further evaluation and surgical management.\nThe patient came to our hospital by her own (using public transportation) because there were no facilities for the tumor management in other places and there was no need to being transported by ambulance.\nWe did a physical examination focused on a neurological examination due to her symptoms and diagnosis. The patient was conscious, oriented and alert, with a Glasgow coma scale (GCS) of 15/15.\nThe cranial nerves were intact, and she was positive for cerebellar signs. She also was positive for the Romberg sign, had an ataxic gait and could not perform the tandem gait.\nThe patient then underwent surgery in which a midline suboccipital craniectomy with microscopic gross total resection (GTR) of the left cerebellar tumor and a cranioplasty under neuromonitoring was performed successfully.\nThe surgery was smooth and without intraoperative complications with an estimated blood loss of 500 cc.\nAfter the surgery, the patient was transferred to the ICU in good conditions with stable vital signs, conscious, oriented, alert and a GCS of 15/15. The cranial nerves were intact, she was able to move all limbs freely and the wound was dry and clean. Afterwards, she was discharged in good conditions, with stable vital signs and no complications or sequela.\nAccording to the histology department, the specimen that they received in formalin consisted of a multiple pieces and fragments of a grayish tissue measuring in aggregate 7.5 \u00d7 5 cm grossly. Further microscopic investigations of the histologic sections showed a biphasic tumor with a mixture of neurocytes and lipidized cells in which the neurocytes were arranged in density cellular sheets of monotonous cells with scanty and often clear cytoplasm, rounded to oval nuclei and salt-and-pepper chromatin. Lipidized cells were clustered and resembling mature adipocytes.\nRare mitotic figures were noted and were investigated. The tumor cells were positive for synaptophysin and neuron specific enolase (ESN) immunostains, focal for glial fibrillary acidic protein (GFAP) and negative for epithelial membrane antigen (EMA).\nWith all these histological findings, it was concluded that the sample was consistent with a cerebellar liponeurocytoma, WHO grade 2.\nAfter a month from the operation, the patient came to the out-patient clinic for follow-up in which we could see that she was in good conditions, with no complains and the cerebellar signs were gone. Since there was no residual tumor left after the surgery and there were no symptoms showing us cerebellar involvement, there was no need for our patient to take radiotherapy once she was discharged.\nSince the patient did not come to us again, we suspect that she is not complaining from any other symptom in the neurosurgical field.", "age": [ [ 50.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC008xxxxxx/PMC8114115.xml", "relevant_articles": { "9789311": "0", "23595173": "12", "1297560": "0", "7612389": "0", "33964714": "123" }, "similar_patients": { "5445196-1": "123", "8369514-1": "0", "8015589-1": "0", "6044141-1": "0", "6444560-1": "123" } }, { "human_patient_id": "181", "human_patient_uid": "8568535-1-M", "PMID": "34745681", "title": "A Rare Case of Fatal Hemorrhagic Stroke in a Young Female with Early Mixed Connective Tissue Disease", "patient": "A 43-year-old healthy Caucasian female presented to primary care with short (7\u201310 days), recurrent flares of lower extremity tenderness, swelling, and redness over several months. She also reported myalgias in the upper back and neck, and a one-year history of headache with transient, reoccurring curtain-like visual disturbances in her right eye that ophthalmology diagnosed as ocular migraines. A rheumatologic workup was initiated. Labs were positive for an elevated sedimentation rate (ESR) 31 mm/H (normal 0\u201320 mmH), positive antinuclear antibodies (ANA), and an elevated ribonucleoprotein antibodies (RNP) 2.4 AI (reference <1.0 AI). Double-stranded (DS) DNA 1 IU/mL (<4 = Neg), antichromatin (AC), anti-Smith (SM), SM/RNP, and lyme disease antibodies were negative. Based on these results, the patient received a presumptive diagnosis of undifferentiated connective tissue disease (UCTD), started 20 mg of oral prednisone as needed for flares, and referred to rheumatology.\nTwo months after her initial evaluation, the patient continued to experience episodes or erythema nodosum of the lower extremities. She also began to experience early signs of Raynaud's phenomenon, chest pain, and visual disturbances concerning for amaurosis fugax. A personal symptom journal kept by the patient indicated transient episodes of fatigue and painful hand/finger swelling with petechiae and purpura. Magnetic resonance imaging (MRI) of the brain was ordered, and repeat labs done by rheumatology showed an elevated ESR, 39 mm/H; RNP, 1.8 AI; CRP, 3.7 (normal <0.8 mg/dL); and a negative antineutrophil cytoplasmic antibody (ANCA), myeloperoxidase antibodies, proteinase-3 antibodies, and ANA. Complement C3, 118 mg/dL (normal 90\u2013180 mg/dL), and C4, 29 mg/dL (normal 16\u201347 mg/dL), were within normal limits. The patient was referred for further evaluation at an academic medical center.\nThe MRI showed a 6 mm lacunar infarct within the left cerebellum and a 12 mm hemorrhage along a cortical sulcus of the right frontal lobe. The findings were noted to be \u201cabnormal\u201d for a woman in her early forties, and a further work was recommended for vasculitis and/or connective tissue disease via magnetic resonance angiography (MRA). The MRA and ophthalmological assessment were unremarkable, and cardiology found no evidence of vascular disease on carotid ultrasound and no evidence of exercise-induced myocardial ischemia on stress echocardiogram.\nA second rheumatological consult was completed where concern for possible evolving MCTD was raised; however, the diagnosis of UCTD was retained due to the negative ANA. Seven months following her initial presentation, the patient saw neurology where she reported worsening lightheadedness and 6-7/10 bifrontal/apical headaches lasting hours to days over the previous month. Despite the history of arthralgias/myalgias, purpura, chest pain, evidence of cerebral hemorrhage, and initial labs showing nonspecific inflammation and markers of autoimmunity, vasculitis was considered low on the differential due to a lack of a clear prodromal history and changes in cognition. Similarly, neuro-ophthalmology found no definite retinal vasculitis and believed her homonymous right visual field defect to be associated with the brain lesion previously appreciated on MRI and not amaurosis fugax. A nonemergent repeat MRI with contrast and an MR venogram of the brain were ordered by neurology to rule out thrombosis and evaluate for new lesions.\nApproximately two months after her neurology appointment, the patient presented to the emergency room with a severe, right-sided headache with a left-sided visual disturbance. Shortly after arrival, the patient became delirious and exhibited seizure-like activity. A computerized tomography scan (CT) of the brain was conducted that showed a right parietal lobe intraparenchymal hemorrhage approximately 5 \u00d7 3 \u00d7 5 cm in size with secondary mass effect including mid- and hind-brain herniation (see ). A CTA showed multifocal narrowing and an abnormal \u201cbeaded\u201d contour of the entire cerebral arterial vasculature consistent for vasculitis. Neurosurgical assets were not available, and the patient was transferred to a sister center where craniectomy was performed to evacuate intracerebral hemorrhage and treat intracranial hypertension (see ). Postoperative prognosis was poor, and palliative measures were initiated. The patient passed away peacefully surrounded by family several days later.", "age": [ [ 43.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC008xxxxxx/PMC8568535.xml", "relevant_articles": { "34745681": "123", "17086001": "123", "33391903": "123", "1813187": "123", "31848526": "123" }, "similar_patients": { "6057280-1": "0", "7356121-1": "13", "7358906-1": "1", "8412197-1": "13", "8715838-1": "13" } }, { "human_patient_id": "182", "human_patient_uid": "7891271-1-M", "PMID": "33629014", "title": "To treat or not to treat: left ventricular thrombus in a patient with cerebral amyloid angiopathy: a case report", "patient": "A 66-year-old woman with no prior cardiac history was admitted for primary percutaneous intervention with intermittent atypical chest pain radiating to the jaw for 1 day, and ST elevation on the electrocardiogram (ECG). Her past medical history included surgical removal of superficial melanoma of the thorax and left shoulder in 2008 and 2016, without evidence of metastasis. She suffered from impaired memory since 5 years, and probable CAA was diagnosed 2 months prior to the myocardial infarction. There were no other cardiac risk factors present at admission. Physical examination was without abnormalities.\nSinus rhythm was observed on the admission ECG, with normal heart axis, narrow QRS (120 ms) with ST elevation in leads V2 through V6. No conduction disturbances were present ().\nA significant rise-and-fall of serum troponin was measured with a peak of 131 ng/L (cTnl (Cardiac-specific Troponin I) n < 14 ng/L). Other laboratory results were unremarkable with normal liver and renal function.\nRadial approach coronary angiography was performed and the culprit vessel was shown to be the left anterior descending artery of the left coronary artery with a 100% obstruction in the distal segment. Two 2.5\u201316 mm drug eluting stents were placed with restoration of thrombolysis in myocardial infarction 2 flow (). Other coronary vessels were non-obstructed. Echocardiography with microbubbles (Optison\u2122) injection revealed an LV function of 35% with hypokinesia of the anterior wall with akinesia of apical segments and aneurysm formation, without LV thrombi present (, Video Appendix).\nPatient received medical treatment with aspirin, clopidogrel, a statin, a betablocker, and an angiotensin-converting enzyme inhibitor initially. During outpatient follow-up, LV function remained stable at 35%. An LV mass was detected after 6 months ().\nThe neurologist was consulted regarding this complication and its therapeutic consequences. A conjoined decision was made by the cardiologist and neurologist to discontinue aspirin and clopidogrel and start apixaban twice daily 5 mg, based on its efficacy- and safety profile in CAA patients with atrial fibrillation (AF) as well as multidisciplinary consensus. Despite stable cardiac function, she suffered from an ischaemic stroke 1 year later, the LV thrombus considered being the cause.\nWith no new ICH or hemosiderosis present on repeat brain magnetic resonance imaging (MRI), apixaban was discontinued and phenprocoumon [vitamin K antagonist (VKA)] was started. During follow-up, no complications or adverse events were reported.", "age": [ [ 66.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC007xxxxxx/PMC7891271.xml", "relevant_articles": { "33629014": "13", "30167000": "123", "28567361": "123", "29725361": "123", "30533145": "0" }, "similar_patients": { "8343441-1": "12", "4897916-1": "12", "6392610-1": "12", "6439425-1": "0", "6439423-1": "123" } }, { "human_patient_id": "183", "human_patient_uid": "4634743-1-M", "PMID": "26543559", "title": "A striking response of plasmablastic lymphoma of the oral cavity to bortezomib: a case report", "patient": "The patient is a 58 year-old Japanese male presented with a rapidly progressive history of a swelling on his left cheek and restricted mouth opening. He had no history of HIV infection, multiple myeloma or underlying immunosuppression. Physical examination showed a bleeding tumor of the oral cavity. The laboratory findings on admission were: hemoglobin 10.9 g/dL, white blood cell count 11.4\u00d7109/L, platelet 197\u00d7109/L serum lactate dehydrogenase (LDH) 2232 U/L (normal value: 119\u2013229), serum creatinine 1.68 mg/dL (normal value: 0.6\u20131.1), serum uric acid 12.7 mg/dL (normal value: 3.6\u20138.0), serum potassium 4.9 mg/dL (normal value: 3.6\u20134.9), serum phosphorus 6.2 mg/dL (normal value: 2.5\u20134.7), serum calcium 11.3 mg/dL (normal value: 8.7\u201310.3). Serum IgG, IgM, and IgA levels were within the normal range. Serum protein electrophoresis had no M-spike. Serology for HIV was negative. There were no osteolytic lesions on bone survey. A computed tomography (CT) demonstrated a bulky tumor localized in the mucosa of the oral cavity (Fig. ), without enlargement of the systemic lymph nodes. Biopsy of the oral mass showed diffuse proliferation of large lymphoid cells (Fig. ) with centroblastic morphology, which were positive for CD138 (Fig. ), CD38 (Fig. ), CD56, and MUM-1 (Fig. ) and negative for CD20 (Fig. ), CD79a (Fig. ), CD3 and BCL-6. EBV-encoded RNA in situ hybridization (EBER-ISH) (Fig. ) and HHV8 (Fig. ) were negative. The Ki-67 proliferation index was almost 100 % (Fig. ). No apparent plasmacytic differentiation of the tumor cells was observed. G-banding analysis of the tumor showed abnormal karyotypes: 46, X, \u2212Y, dup(1)(q42q21), \u22126, +7, +7, \u22128, add(14)(q32), add(20)(p11.2), +mar/ 82<3n>, XX,-Y, dup(1)\u00d72, \u22124, +5, +6, +6, +7, +7, +7, +7, +7, \u22128, \u22128, +9, +9, +11, add(14)\u00d72, +15, +5mar. Although no lymphoma cells were found in his peripheral blood, bone marrow examination showed infiltration of large atypical lymphoid cells, suggesting bone marrow involvement. The patient was diagnosed with stage IVA PBL.\nImmediately after diagnosis, the patient was treated with THP-COP composed of pirarubicin, cyclophosphamide, vincristine and prednisolone. Since pirarubicin (THP) has been reported to have comparable efficacy to doxorubicin with a lower incidence of cardiac toxicity in aggressive non-Hodgkin lymphoma treatment, THP-COP therapy was used []. Intravenous hydration and allopurinol also started.\nDespite the prompt treatment, the oral tumor continued to enlarge, with increasing risk of suffocation. Therefore, bortezomib was started on day 9 of admission. Bortezomib was given at a dose of 1.3 mg/m2 on days 1, 8 and 15 without dexamethasone in the first cycle. In the second cycle, the patient was treated with bortezomib in combination with dexamethasone. One week after the initiation of bortezomib, a marked regression of the oral tumor was observed, and one month after its initiation, no significant swelling of the oral cavity was detected (Fig. ). Serum LDH levels also rapidly improved. However, since resistance to bortezomib developed after the third cycle of bortezomib, the patient was salvaged with EPOCH and irradiation. He had disease-progression and died five months post-diagnosis.", "age": [ [ 58.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4634743.xml", "relevant_articles": { "26543559": "123", "16860177": "3", "24888801": "3", "29851545": "3", "25794560": "3" }, "similar_patients": { "6058375-1": "123", "6408176-1": "123", "4426646-1": "13", "5124468-1": "123", "5735622-1": "123" } }, { "human_patient_id": "184", "human_patient_uid": "2978447-1-M", "PMID": "21116367", "title": "Removal of migrated metallic prostatic stent by holmium laser", "patient": "A 90-year-old male with a history of diabetes mellitus, hypertension, IHD, and right-sided hemiplegia presented to a urologist with recurrent episodes of retention of urine due to prostatic hyperplasia. Considering his medical co-morbidity, a prostatic stent (Urolume) was placed instead of surgery. Approximately 9 months later, he presented to us with severe dysuria, hematuria and poor stream, and urinary tract infection since the last 3 months.\nOn admission, his physical examination was normal except for right hemiparesis. The prostate had a benign feel on rectal examination. Urinalysis showed pyuria and microscopic hematuria. A urine culture was positive for E. coli. An ultrasonography revealed normal kidneys with approximately 75 gms of prostate. An echogenecity of the Urolume stent was visible in the bladder. Hence, removal of stent was planned.\nA urethrocystoscopy showed a normal urethra with big median and lateral lobes of prostate. The Urolume stent had migrated into the bladder lying in a pool of pus flakes. We tried to remove it using alligator forceps but the stent could not be withdrawn into the sheath of cystoscope. Hence, the stent was cut into small pieces using a Holmium: YAG laser using 550 micron fiber with a power setting of 1.2 J and 20 HZ. The stent fragments were removed by withdrawing them into the sheath using grasping forceps. Subsequently, the enlarged prostate was enucleated by Holmium laser. The post-operative period was uneventful and the patient could pass urine satisfactorily after removal of the catheter on the second day after the operation.", "age": [ [ 90.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC002xxxxxx/PMC2978447.xml", "relevant_articles": { "21116367": "13", "11164168": "13", "7692100": "13", "33457695": "13", "9598500": "12" }, "similar_patients": { "3519115-1": "123", "5966682-1": "123", "4273508-1": "12", "6100697-1": "123", "3996739-1": "12" } }, { "human_patient_id": "185", "human_patient_uid": "6511931-1-M", "PMID": "31123680", "title": "Adult-onset mitochondrial encephalopathy in association with the MT-ND3 T10158C mutation exhibits unique characteristics: A case report", "patient": "A 52-year-old female presented with a sudden onset of right-sided numbness and weakness that was accompanied by a left temporal cluster-like headache. No fever or prodromal infection was found at disease onset.\nThe family and personal history was unremarkable.\nOn physical examination, the height and weight of the patient were 154 cm and 56 kg, respectively. Vital signs were normal, as were heart, lung and abdominal exami-nations. Neurological examination showed intact mental status, with normal speech and comprehension. Mild 4/5 right-sided hemiparesis was present with normal tone in both the arm and leg, though no other focal neurological deficits were found. After admission, she complained of discomfort and tingling in the right leg, after which a generalized tonic-clonic seizure for 3 min occurred before it was stopped by a bolus of intravenous diazepam.\nLaboratory tests, including D-dimer, lactic acid, and serum autoantibody levels, as well as thyroid function and tumor markers indicated no apparent abnormalities. Glucose tolerance and lactic acid movement tolerance tests were normal. A lumbar puncture was performed, and her open intracranial pressure was 180 mm H2O. Cerebrospinal fluid (CSF) testing showed that cell counts and protein, glucose, chloride, monoclonal antibody, adenosine deaminase, and lactate dehydrogenas levels were within normal ranges.\nMRI demonstrated a lamellar left parietal lobe lesion predominantly involving the cortex, with hyperintensity on both diffusion-weighted imaging and fluid-attenuated inversion recovery (Figure ). The apparent diffusion coefficient map revealed a preserved, isointense signal. No abnormalities were found by susceptibility weighted imaging or magnetic resonance angiography and venography (Figure ). Due to the stroke-like onset pattern and MRI features, further thrombophilia screening was performed and showed decreased protein S activity. A diagnosis of cortical venous thrombosis was first proposed. Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) was also considered but temporarily excluded because of the incomplete manifestation and lack of genetic evidence. Anticoagulation therapy was initiated, and follow-up was performed to maintain the international normalized ratio (INR) within the target range.\nTwo months later, the patient was readmitted for subacute cognitive impairment. She was unable to identify and communicate with family members; she also had difficulty understanding questions or instructions and instead responded by repeating the word \"nothing\". During hospitalization, a secondary generalized seizure occurred, initially with eyes gazing to the right and then convulsion developing, which lasted for approximately 10 s before self-alleviation. Neurological examination suggested transcortical sensory aphasia, with fully covered limb strength. Blood tests and CSF examination were normal; INR was 2.21. On repeated MRI, new lesions were identified in the left temporal lobe and were also detected 10 days later in the right temporal lobe on radiological follow-up (Figures and ). Although the MRI signal characteristics are consistent with the initial findings, the original lesion in the left parietal lobe had been alleviated, with cortical atrophy. We further conducted magnetic resonance spectroscopy (MRS), which revealed markedly elevated lactate (Lac) concentrations in the regions of interest in the left temporal lesion (Figure ). Mitochondrial encephalopathy was diagnosed, and genetic testing using peripheral blood was performed. However, DNA testing for frequent MELAS and myoclonic epilepsy with ragged red fibers syndrome mutations were negative. Because of the lack of symptoms of muscle weakness or pain, the patient declined our suggestion of performing a muscle biopsy. Anticoagulation therapy was terminated, and levetiracetam (1000 mg/d) was administered.\nAt 3 mo after her second admission, the patient was experiencing involuntary movement in her left limbs, with repetitive flexion/extension. An MRI scan showed a hyperintense signal abnormality in the right parietal lobe (Figure ). Brachial biceps biopsy was performed. Histopathology revealed no abnormalities, and no necrotic or regenerating fibers were observed; ragged-red fibers and intense succinate dehydrogenase activity were not detected. Nonetheless, complete sequencing of mitochondrial DNA samples extracted from the biopsied muscle revealed a heteroplasmic m.10158T>C mutation, with a heteroplasmy level of 69.6%, in the mitochondrial complex I subunit gene MT-ND3. In contrast, this mutation was not found in her peripheral blood cells.\nThe diagnosis was MELAS syndrome harboring the m.10158T>C mutation.\nWe administered levetiracetam (1000 mg/d) and oxcarbazepine (400 mg/d) to control epilepsy. Q10 and L-arginine were also administered.\nOver the next 6 mo, the present patient did not manifest any further stroke-like episodes.", "age": [ [ 52.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC006xxxxxx/PMC6511931.xml", "relevant_articles": { "27920873": "12", "32000557": "12", "32541454": "123", "9868308": "12", "15233272": "12" }, "similar_patients": { "5729248-1": "1", "6505262-1": "1", "7255082-1": "123", "7298965-1": "123", "6365425-1": "123" } }, { "human_patient_id": "186", "human_patient_uid": "2992660-1-M", "PMID": "21120069", "title": "Membranous variety of rectal atresia - primary management in a neonate", "patient": "A 3-day-old female child, (full-term, normal delivery) weighing 2.75 kg at birth with stable vitals, moderate abdominal distension and history of not being able to pass meconium was referred to us. Examination showed normal anal opening but red rubber catheter could not be passed beyond 3 cm of anal verge. Spine and external genitalia were normal. X-ray (invertogram with red rubber catheter passed through anal opening) showed catheter abutting the air column in the bowel) [].\nWith anal retractors anal canal was opened but upper-end of membrane could not be seen.\nAn endoscopy was done with a 7.5F cystoscope. About 3 cm from the anal verge, the anal canal ended blindly and a membrane was visualized at the blind end. We incised the outer mucosal membrane, i.e. of the distal pouch with a bugbee, but the vision was lost due to technical reasons. Then anal retractors were used, and after the incision on the mucosa of the distal pouch, the inner mucosal membrane was seen bulging significantly due to meconium within it [].\nTransanal membranotomy was done. Postoperatively, on day one, dye study was done and feeds were started. Patient was discharged on day 4.", "age": [ [ 3.0, "day" ] ], "geneder": "F", "file_path": "comm/PMC002xxxxxx/PMC2992660.xml", "relevant_articles": { "12544517": "0", "6633429": "0", "15622579": "0", "19856187": "0", "7634974": "0" }, "similar_patients": { "4841376-1": "123", "5762197-1": "123", "3195957-1": "123", "5615904-1": "0", "4021029-1": "123" } }, { "human_patient_id": "187", "human_patient_uid": "6458798-1-M", "PMID": "31000922", "title": "Lumbar artery injury: A rare source of perirenal hematoma following percutaneous renal procedures", "patient": "A 12-year-old boy with a large retroperitoneal sarcoma with bilateral obstructive uropathy was planned for bilateral ureteric stenting. His preoperative serum creatinine was raised and coagulation parameters were normal. Cystoscopy showed a deformed bladder with severe bullous edema of the trigone. Both the ureteric orifices could not be identified on cystoscopy; hence, a decision of antegrade ureteral stenting was taken. Based on the preoperative plain computed tomography (CT) scan determined landmark of the renal pelvis, a Chiba-needle puncture was made 5 cm lateral to the midline at the level of the third lumbar vertebra. Once the right pelvicalyceal system was opacified, mid calyceal puncture was made using an 18G three-part percutaneous access needle (Surgimedik Healthcare India Pvt. Ltd, Mumbai, India). Guidewire could be negotiated into the bladder, and antegrade double-J stent was placed. A similar procedure was performed on the left side. The procedure was uneventful.\nPostprocedure, the patient had a progressively increasing abdominal distension, right flank pain, and hypotension. Bedside ultrasonography indicated a large right perirenal hematoma. Contrast-enhanced CT scan confirmed the hematoma [] and demonstrated active contrast leak from the right lumbar artery during the arteriography phase of the CT scan. Renal vessels appeared normal. In view of the dropping blood pressure and hemoglobin levels, a decision of angioembolization was taken.\nTransfemoral aortography and renal angiography were performed. Renal vasculature was normal. Selective catheterization of the second right lumbar artery confirmed the extravasation of contrast solution from the middle part of the anterior branch of lumbar artery. The bleeding vessel was embolized using polyvinyl alcohol particles (Boston Scientific Target Therapeutics, California, USA). Posttranscatheter embolization, the pain reduced and blood pressure stabilized. There was no increase in the size of hematoma over a 1-week hospitalization period.", "age": [ [ 12.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6458798.xml", "relevant_articles": { "25439405": "123", "19508736": "123", "16482862": "123", "29518872": "0", "31000922": "13" }, "similar_patients": { "4996616-1": "123", "2955227-1": "0", "4231155-1": "0", "5021480-1": "123", "6429714-1": "123" } }, { "human_patient_id": "188", "human_patient_uid": "6458798-2-M", "PMID": "31000922", "title": "Lumbar artery injury: A rare source of perirenal hematoma following percutaneous renal procedures", "patient": "The second patient was a 45-year-old recently diagnosed patient of chronic kidney disease. An ultrasonography controlled renal biopsy was performed. Immediately after the biopsy, the patient complained of significant flank pain with hypotension. An urgent CT scan was performed that showed a large left perirenal and retroperitoneal hematoma with bleeding from the left lumbar artery []. Transfemoral aortography and renal angiography confirmed the renal vessels to be normal. Active bleeding was documented from the second left lumbar artery. He was also managed by an emergency transcatheter angioembolization of the lumbar artery using gelatin foam (Gelfoam, Upjohn, Kalamazoo, MI, USA). Postembolization, the hematoma stabilized, pain reduced, and blood pressure stabilized. At 3-month follow-up, ultrasonography showed a small residual hematoma.", "age": [ [ 45.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6458798.xml", "relevant_articles": { "26784934": "123", "30555677": "123", "26199475": "123", "33175365": "0", "3953574": "13" }, "similar_patients": { "6031947-2": "0", "7119147-1": "123", "6047838-1": "123", "8403712-1": "0", "3109788-1": "0" } }, { "human_patient_id": "189", "human_patient_uid": "7655561-1-M", "PMID": "32700224", "title": "Endovascular treatment of ischemic large-vessel stroke due to infective endocarditis: case series and review of the literature", "patient": "A 30-year-old female patient was brought to our emergency department 4 h after she developed right-sided hemiparesis, aphasia, right homonymous hemianopia, right central facial paralysis and reduced sensation in the right side of the body while she was at the gym (NIHSS 22). A month earlier, she presented to her local general practitioner (GP) with symptoms including sore throat, lethargy and general malaise. Her GP found no specific abnormalities on thorough general examination. CT of the brain showed already established changes in the left middle cerebral artery territory with an Alberta stroke program early CT score (ASPECTS) of 6. CT angiography of the brain showed a thrombus in the terminal segment of the left internal carotid artery (ICA). Thrombolysis was not performed because of the low ASPECT score on the CT brain. Mechanical thrombectomy was performed using a combination of aspiration and stent retriever, and partial recanalization was obtained (TICI 2a). A day later, the CT of the brain showed haemorrhagic transformation with an intraparenchymal haematoma centred in the left lentiform nucleus and her NIHSS was unchanged. At the same time, she developed rising fever and elevated CRP (145 mg/L). On day 4 of her admission, transthoracic echocardiogram showed vegetation on the aortic valve with associated severe aortic regurgitation. Left ventricular function was unimpaired. Blood cultures were positive for Gram-negative diplococcus, identified as Neisseria gonorrhoeae. She was therefore treated with ceftriaxone and azithromycin. After 3 months, her mRS was 3.", "age": [ [ 30.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7655561.xml", "relevant_articles": { "34820038": "123", "7517690": "0", "8689796": "12", "7893538": "12", "10457939": "12" }, "similar_patients": { "5590346-1": "13", "5943549-1": "13", "8120027-1": "13", "4239408-1": "13", "3787621-1": "1" } }, { "human_patient_id": "190", "human_patient_uid": "7655561-2-M", "PMID": "32700224", "title": "Endovascular treatment of ischemic large-vessel stroke due to infective endocarditis: case series and review of the literature", "patient": "A 67-year-old male patient was transferred from a local hospital to our emergency department 3 h after sudden onset of left sided weakness, sensory disturbance and dysarthria. His NIHSS was 17. The patient was initially admitted for infective endocarditis of his native mitral valve and he was supposed to valve replacement surgery soon. Blood culture was positive for Gemella morbillorum. Computer tomography (CT) with CT angiography showed an occlusion of the M1 segment of the right middle cerebral artery. ASPECT score was 8 (Fig. ). Because of the evidence of endocarditis, intravenous thrombolysis was not considered an option. However, based on the large vessel occlusion, mechanical thrombectomy was performed under local anaesthetic with sedation. Endovascular thrombectomy was then performed with successful aspiration of the clot (TICI 3) (Fig. ). No immediate complications were recorded after the procedure. After 24 h, his NIHSS dropped to 13. Mitral valve replacement surgery was successfully performed 1 month later. At neurological follow-up after 3 months, the patient showed no neurological deficits (NIHSS 0) and mRS score of 0.", "age": [ [ 67.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7655561.xml", "relevant_articles": { "29109882": "123", "28348787": "12", "30315557": "12", "28544844": "12", "30060127": "123" }, "similar_patients": { "7655561-3": "123", "7522393-1": "123", "5943549-1": "123", "6180256-1": "123", "6993298-1": "13" } }, { "human_patient_id": "191", "human_patient_uid": "7655561-3-M", "PMID": "32700224", "title": "Endovascular treatment of ischemic large-vessel stroke due to infective endocarditis: case series and review of the literature", "patient": "A 65-year-old female patient with staphylococcal native mitral valve infective endocarditis had a witnessed onset of right-sided hemiparesis and aphasia (NIHSS 18). The patient was initially admitted in a local hospital for infective endocarditis and treated with teicoplanin and gentamicin. The patient was brought to our emergency department 3 h and 45 min after she developed her stroke symptoms. Her past medical history included also liver cirrhosis, type 2 diabetes, hypertension and breast cancer. CT angiography showed an occlusion of both M2 divisional branches. Intravenous thrombolysis was contraindicated because of the evidence of endocarditis. Mechanical thrombectomy was considered due to the large vessel occlusion. Despite several attempts at aspiration, the clot remained in situ with the final angiography demonstrating a subtotal occlusion of both the M2 divisional branches (TICI 1). After 24 h, her NIHSS was 21 and the CT showed no haemorrhagic transformation. At neurological follow-up after 3 months, her mRS score was 4.", "age": [ [ 65.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7655561.xml", "relevant_articles": { "33066888": "13", "28348787": "1", "33839380": "13", "33360518": "1", "28669652": "123" }, "similar_patients": { "7655561-2": "123", "7568088-1": "13", "7655561-1": "123", "4322655-1": "13", "7522393-1": "123" } }, { "human_patient_id": "192", "human_patient_uid": "3913427-1-M", "PMID": "24876322", "title": "Confirmed testicular torsion in a 67 year old", "patient": "A 67-year-old male presented to the emergency department with a 10-day history of left-sided testicular pain. Symptoms were of gradual onset, and were initially treated with antibiotics from his general practitioner. There was no history of trauma, injury, pyrexia or voiding symptoms. Urine dipstick test was negative.\nExamination revealed an acutely tender left groin and left testicle with a markedly enlarged, erythematous left hemi-scrotum. Antibiotics were changed to doxycycline from ciprofloxacin, and the patient was referred for an urgent ultrasound which was performed the following day. Full blood count revealed white cell count of 8.2\u00d7109/L with a C-reactive protein (CRP) of 48 mg/L. All other blood tests were normal.\nAn ultrasound scan revealed no vascularity within the left testicle. The patient was taken for scrotal exploration under general anaesthetic. This revealed a torted left testicle with no pus present. A left orchidectomy was performed along with right-sided testicular fixation. The patient had an uneventful post-operative course, and was discharged home the following day.", "age": [ [ 67.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3913427.xml", "relevant_articles": { "32001538": "0", "24198833": "0", "21255387": "0", "26966225": "0", "23704472": "123" }, "similar_patients": { "3355702-1": "0", "2438311-1": "0", "4862172-1": "0", "8525670-1": "0", "5798121-1": "0" } }, { "human_patient_id": "193", "human_patient_uid": "4485202-1-M", "PMID": "26240733", "title": "Recurrent Hemorrhagic Pericardial Effusion and Tamponade due to Filariasis Successfully Treated with Ivermectin and Albendazole", "patient": "A 30-year-old female with severe breathlessness since 2 days prior to admission. She complained of cough and breathlessness on exertion and low grade fever since 3 weeks and generalized weakness since 1 week. On examination, she was severely dyspneic and had pulsus paradoxus. Echocardiogram showed massive pericardial effusion with cardiac tamponade [].\nPericardiocentesis was done and 1,300 ml of hemorrhagic fluid was collected. A continuous drain was put. Results of complete blood picture were: Total count - 6,800/mm3, polymorphs - 67%, lymphocytes - 23%, eosinophils - 06%, monocytes - 04%, platelet count - 160,000/mm3, hemoglobin - 11 g%, erythrocyte sedimentation rate (ESR) - 40 1 h., human immunodeficiency virus (HIV)-nonreactive, and hepatitis B surface antigen (HBsAg)-negative. Complete urine examination, blood sugar, urea, creatinine, and electrolytes; all were in normal range. Cytological analysis of fluid showed - 7,000 cells/mm3, (neutrophils - 35%, lymphocytes - 65%, plenty of red blood cells (RBC)), negative for malignant cells, sugar - 61 mg%, proteins - 6 g%, albumin - 2.5 g%, adenosine deaminase (ADA) - 23 U/L, acid-fact bacilli (AFB) - negative; microscopy and routine cultures were negative for bacteria.\nWhile screening the smears, a few large, long, smooth-walled, refractile unstained worm-like structures were observed. The organisms were identified as Mf of W. bancrofti in the smears stained by Leishman's stain []. Peripheral blood smears were negative for Mf. Patient was started on diethylcarbamazine (DEC) 100 mg twice daily. The patient improved rapidly and subsequently discharged. DEC was continued for 3 weeks. Six weeks later she presented with similar complain. Cardiac echocardiogram showed massive pericardial effusion with cardiac tamponade. Pericardiocentesis was done and 1,100 mL of hemorrhagic fluid was collected. Cytology showed plenty of RBC, occasional pus cells, and microfilaria of W. bancrofti []. There was no evidence of malignant cells. Hematological and biochemical tests were within normal limits. HIV and HBsAg were nonreactive. Adenosine deaminase (ADA) level was 22 U/L. She was treated with single dose of 12 mg ivermectin and albendazole 400 mg. The patient improved rapidly by next day and effusion was grossly reduced by the 2nd day. Albendazole was continued for another 2 weeks. The patient is doing well and is on regular follow-up since then.", "age": [ [ 30.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC004xxxxxx/PMC4485202.xml", "relevant_articles": { "26240733": "123", "18344697": "2", "33510532": "123", "29437733": "123", "20135723": "123" }, "similar_patients": { "6380535-1": "123", "3169864-1": "123", "2824875-1": "123", "4306077-1": "123", "5320880-1": "12" } }, { "human_patient_id": "194", "human_patient_uid": "3740661-1-M", "PMID": "23956592", "title": "Hyperplasia of the mandibular body: An anomaly in a developmental anomaly", "patient": "A 30-year-old male reported to dental O.P. with the complaint of asymmetric appearance of the face. The swelling had been present from childhood and had become evident after puberty. Patient had no history of significant medical problems, trauma or family history of any hereditary disease.\nClinical examination revealed a diffuse enlargement of the lower one-third of the right side of the face. The enlargement was also seen to involve the lower border of the right mandible []. Intra oral examination revealed a swelling involving both the buccal and lingual aspect of the right mandible. The enlargement was more prominent on the buccal side, extending from the distal aspect of 45 to the distal aspect of 47 obliterating the vestibule. On palpation, the enlargement was bony hard in consistency. No sign of inflammation of the overlying mucosa was seen. Intra oral examination revealed an impacted 38 and missing 48 []. Furthermore, observed was that the lesion had not caused any malocclusion [].\nOrthopantamogram (OPG) revealed an increase in vertical height of the body of the right mandible of normal bone density. The ramus and condyle of the affected side were normal. An OPG taken at the age of 25 years (5 years back) and the current OPG showed the lesion was stable [].\nComputed tomography (CT) axial image revealed a solitary well-defined homogenous mass seen on the right body of the mandible measuring around 2 cm \u00d7 3 cm with uniform radiopacity. Bony enlargement was seen on both buccal and lingual side, buccal aspect being more prominent than the contralateral side. The bony enlargement can be well-appreciated in three dimensional (3D) CT. Furthermore observed in the radiographs, the enlargement was restricted to the body and did not extend to the condyle, which later aided in the diagnosis [].\nThe histopathology showed compact bone and numerous, small marrow spaces. The compact bone exhibited reversal and resting lines with osteoblastic rimming. Osteocytes could also be seen entrapped within the bone [].\nBased on the clinical, radiographic and histopathologic findings the diagnosis of hyperplasia of the right mandible was given.", "age": [ [ 30.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3740661.xml", "relevant_articles": { "23787824": "12", "28913275": "0", "8717116": "0", "6936475": "12", "22718952": "0" }, "similar_patients": { "4462820-1": "1", "8543996-1": "1", "4922235-1": "1", "4906882-1": "1", "7546283-1": "1" } }, { "human_patient_id": "195", "human_patient_uid": "3167246-1-M", "PMID": "21487745", "title": "Right-sided invasive metastatic thymoma of the heart", "patient": "A 25-year-old Nigerian man presented to our emergency department with complaints of tiredness, night sweats, and dizziness on exertion. On clinical examination the patient had facial swelling and venous distension in the neck. Blood pressure was 135/77 mmHg with pulsus paradoxus. Cardiac auscultation was normal. The liver was enlarged. There was no peripheral oedema. Electrocardiography showed sinus tachycardia of 110 beats/min, a vertical axis, QS pattern in V1 and a Q wave in V2 and low voltages in the limb leads. Laboratory testing showed lymphocytosis, increased creatinine (120 mmol/l) and abnormal liver enzymes (total bilirubin 47 \u03bcmol/l, aspartate aminotransferase 124 U/l, alanine aminotransferase 200 U/l and \u03b3-glutamyl transferase 268 U/l). On chest X-ray, right pleural effusion and mediastinal widening were seen. With abdominal ultrasound the liver diameter was 17.5 cm, with ascites, pleural and pericardial effusion and hepatopetal flow in the portal vein. Transthoracic echocardiography revealed a mass almost completely occupying the right atrium and ventricle with a distended inferior vena cava (Fig. ). The pressure gradient over the tricuspid valve was 25 mmHg (PAP 25 + 15 mmHg). Pericardial effusion was present. Computed tomography (CT) of the thorax with contrast injected into the right antecubital vein revealed a mass in the anterior mediastinum with no clear distinction from the surrounding structures. There was a lack of contrast in the innominate and superior caval veins, and contrast filled the right atrium through the inferior caval vein by way of collateral veins. A large right atrial filling defect was found with faint filling of the right ventricle (Fig. ).\nDue to the important haemodynamic compromise, the induction of anaesthesia was possible only after initiation of cardiopulmonary bypass with cannulation of femoral vessels under local anaesthesia. A large mass was removed from the right atrium (7 \u00d7 5 \u00d7 5 cm), but tumour tissue extending into the superior vena cava was only partially removed. Histology was compatible with type B2 thymoma. Moreover, within the tumour, immature T cells were found, with positive CD4, CD8, CD5, TdT and cytoplasmatic CD3 immunostaining. After an uneventful recovery, the patient was referred for palliative chemotherapy with cisplatinum, adriamycin and cyclophosphamide. Six months later, after four cycles of chemotherapy, regression of the residual tumour was seen and additive radiotherapy was planned.", "age": [ [ 25.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3167246.xml", "relevant_articles": { "17982975": "12", "22430283": "123", "31700934": "13", "7616035": "13", "27099229": "123" }, "similar_patients": { "5566969-1": "1", "7891261-1": "123", "5159291-1": "123", "4236611-1": "0", "3890009-1": "1" } }, { "human_patient_id": "196", "human_patient_uid": "4697248-1-M", "PMID": "26755841", "title": "A rare cause of respiratory distress after transthoracic oesophagectomy", "patient": "A 39-year-old woman, known case of oesophageal carcinoma, was scheduled for TTE with extended two-field lymphadenectomy with gastric pull-up with cervical neck oesophago-gastric anastomosis and feeding jejunostomy. She had history of hypertension since 4 years and controlled on amlodipine (10 mg) and atenolol (50 mg). She had also received pre-operative radiotherapy. The anaesthetic management and monitoring were as per institutional protocol and was administered epidural and general anaesthesia. As a part of operative procedure, right intercostal drain (ICD) and corrugated neck drain were placed. The intraoperative period was uneventful. She was shifted to Intensive Care Unit (ICU) for post-operative monitoring and analgesia. Three hours later, she developed respiratory distress and air leak through right ICD. Her oxygen saturation decreased from 97% to 84% over \u00bd h in spite of oxygen supplementation with Hudson mask. On auscultation, air entry was decreased on the right side and the percussion note was tympanic. She was put on oxygen at 15 L/min through Venturi mask (FiO2 0.60). Subsequent chest radiograph revealed right pneumothorax despite ICD being in situ. Another ICD tube was inserted in the right thorax to relieve pneumothorax. The respiratory distress was only partially relieved and the air leak from the ICD continued. Due to on-going respiratory distress, the patient's trachea was intubated. Fibreoptic bronchoscopy was done to rule out airway injury that was also normal. Hence, we suspected air leak from the cervical drain and it was decided to remove the cervical drain and suture the defect. After removal of the cervical drain, the air leak stopped. Chest X-ray showed inflated lungs and patient had symptomatic improvement. The patient was subsequently extubated and shifted to the ward.", "age": [ [ 39.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC004xxxxxx/PMC4697248.xml", "relevant_articles": { "34150204": "123", "29207778": "123", "28751430": "13", "31902940": "123", "21897521": "12" }, "similar_patients": { "4697248-2": "123", "4173476-1": "0", "4966357-1": "123", "3299122-1": "123", "2943707-1": "12" } }, { "human_patient_id": "197", "human_patient_uid": "4697248-2-M", "PMID": "26755841", "title": "A rare cause of respiratory distress after transthoracic oesophagectomy", "patient": "A 56-year-old man, case of carcinoma mid-oesophagus underwent TTE with extended two-field lymphadenectomy with gastric pull-up and oesophago-gastric anastomosis in neck. He had received pre-operative chemo-radiotherapy. The procedure was done under epidural and general anaesthesia with conventional monitoring. Right ICD and corrugated neck drain were placed. Intraoperative period was uneventful. Patient was shifted to ICU for post-operative management. The patient developed respiratory distress and air leak through right ICD and saturation decreased to 86% despite oxygen supplementation. Air entry was decreased on the right side. Chest radiograph revealed right pneumothorax despite ICD being in situ. It was decided to conduct bronchoscopy. Before bronchoscopy, we observed bubbles (air leak) from neck drain site. On removal of corrugated neck drain and resuturing the neck wound, air leak stopped and there was no further respiratory distress. Oxygen saturation improved to 96% over next 30 min. Chest X-ray revealed no pneumothorax and patient was shifted to the ward.", "age": [ [ 56.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4697248.xml", "relevant_articles": { "23500739": "13", "28751430": "13", "19463579": "13", "8990817": "123", "22675022": "12" }, "similar_patients": { "4697248-1": "123", "4966357-1": "123", "3299122-1": "123", "2494542-1": "123", "7991776-1": "123" } }, { "human_patient_id": "198", "human_patient_uid": "2556681-1-M", "PMID": "18798981", "title": "Extrarenal multiorgan metastases of collecting duct carcinoma of the kidney: A case series", "patient": "A 55-year-old man presented with fever and abdominal pain. Abdominal CT showed swelling of the right kidney and low attenuation areas (Figure ). Laboratory tests and renal CT imaging were suggestive of pyelonephritis. However, multiple cavitary lesions were also found on the routine chest radiography performed on admission. VATS (Video-Assisted Thoracic Surgery) lung biopsy confirmed the diagnosis of metastatic adenocarcinoma presumably from the kidney. Therefore, a renal tumor with multiple pulmonary metastases, was considered. At the time, transitional cell carcinoma (TCC) was suspected, which later proved to be a misdiagnosis, and chemotherapy with MVAC (methotrexate, vinblastine, adriamycin, and cisplatin) was given. However, the chemotherapy was not effective, and the patient died of respiratory failure 2 months later. On autopsy, the primary tumor was found to be a collecting duct carcinoma, and there were lung, liver, spleen, bone marrow, right adrenal gland, and para-aortic lymph node metastases. CT done while the patient was alive detected lung (Figure ), liver (Figure ), and para-aortic lymph node (Figure ) metastases.", "age": [ [ 55.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC002xxxxxx/PMC2556681.xml", "relevant_articles": { "18798981": "123", "29269648": "0", "33597366": "0", "2992973": "0", "30692298": "0" }, "similar_patients": { "2556681-2": "123", "2818621-1": "0", "5437508-1": "0", "7479808-1": "0", "5512023-1": "0" } }, { "human_patient_id": "199", "human_patient_uid": "2556681-2-M", "PMID": "18798981", "title": "Extrarenal multiorgan metastases of collecting duct carcinoma of the kidney: A case series", "patient": "A 77-year-old man was admitted to our department after developing a fever and backache. Based on CT findings (Figure ) and laboratory test results, pyelonephritis was initially suspected. Antibiotic therapy improved his symptoms and laboratory indicators of inflammation. One year later, he complained of backache. CT revealed a progressively enlarging renal lesion, multiple liver masses, enlargement of the para-aortic lymph nodes, and multiple osteoblastic and osteoclastic lesions (Figure ). A renal tumor with multiple metastases was suspected considering the clinical course and imaging findings retrospectively. At the time, TCC was suspected, which later proved to be a misdiagnosis. MVAC therapy was given without effect, and 1 year later the patient died of cardiac failure that was unrelated to the treatment. On autopsy, the primary tumor was found to be a collecting duct carcinoma, and liver, right adrenal gland, right upper ureter, bone marrow, para-aortic and mediastinal lymph node, and bone metastases were found.", "age": [ [ 77.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC002xxxxxx/PMC2556681.xml", "relevant_articles": { "18798981": "123", "33597366": "0", "33468806": "0", "32381945": "0", "22736929": "0" }, "similar_patients": { "2556681-1": "123", "5127916-1": "0", "7479808-1": "0", "4899403-1": "0", "7770600-1": "0" } }, { "human_patient_id": "200", "human_patient_uid": "4875656-1-M", "PMID": "27206484", "title": "Novel\nPSEN1 G209A mutation in early-onset Alzheimer dementia supported by structural prediction", "patient": "A 54-year-old right-handed woman presented 12-year history of progressive memory decline. She was a university educated woman. At the age of 42 years, her main symptoms were that she forgot names and needed to make notes. She had poorer recall of information than the others at her school of hotel management. In contrast, she was independent in all activities of daily living but her mood was depressed. At initial consultation, when she was 45 years old, general neurological exam was unremarkable. Attention, language and visuospatial function and frontal executive function were normal. Apraxia, dyscalculia and Gerstmann syndrome were not shown. However, Hopkin\u2019s verbal learning test showed that free-recall score was 21 (5-8-8) and 20 min delayed-recall was 2. Its recognition score presented that true positive was 8 and false positive was 3. Delayed recall of Rey figure score was 5.5. Mini-Mental State Examination (MMSE) was 27/30, time orientation 4/5 and three word recall 2/3. Magnetic Resonance Imaging (MRI) scan are shown in Fig. . The upper axial and coronal FLAIR images showed that medial temporal lobe atrophy was not prominent but bilateral parietal atrophy was on. Her APOE genotype was homozygous for \u03b53. Her mother had dementia at the age of 40s and died before 60s. No specific diagnosis was made in her mother. Her father and only brother did not show dementia. She has two daughters, 29 and 26 years old. The initial clinical impression was mild cognitive impairment with depression. However, AD could not be ruled out. She showed progressive deterioration in verbal and visual memory. At the age of 53, her MMSE was 2/30 and clinical dementia rate (CDR) was 3. She was able to respond only to her name and distinguish her daughter from unfamiliar people. She needed personal care. Her brain MRI (Fig. , lower) demonstrated that global cortical atrophy, more prominent in medial temporal and parietal lobes. FDG-PET (fludeoxyglucose- positron emission tomography) of the patient reveals the bilateral temporal, parietal, precuneal and frontal hypometabolism (Fig. ). They consent to perform genetic sequencing on her and her 2 daughters. We screened the APP, PSEN1, PSEN2 and PRNP (prion protein) gene.", "age": [ [ 54.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4875656.xml", "relevant_articles": { "9566008": "12", "11217688": "12", "16998567": "0", "11277107": "12", "10198910": "12" }, "similar_patients": { "4382926-1": "12", "7079379-1": "1", "6940111-1": "1", "3625161-1": "1", "6753911-1": "1" } }, { "human_patient_id": "201", "human_patient_uid": "3833043-1-M", "PMID": "24282779", "title": "Unusually Prolonged Motor and Sensory Block Following Single Injection Ultrasound-Guided Infraclavicular Block With Bupivacaine and Dexamethasone", "patient": "A 35 years-old male with left distal radius and ulna fracture was scheduled for closed reduction and percutaneous pinning. His Physical examination was normal. The patient did not have any past surgeries and didn\u2019t take any medication. The patient was somewhat anxious about having surgery under general anesthesia and requested the regional anesthesia. Standard monitoring including non-invasive blood pressure recording, pulse oximetery and electrocardiography were applied and a single injection ultrasound guided infraclavicular block was implemented for the procedure. Midazolam 2 mg was given intravenously 10 minutes before the start of the block, and IV fentanyl (75 micg) before insertion of the needle was administered. We used a Honda HS \u2013 2100 System and a 7.5-10 MHz linear ultrasound probe. The patient assumed a supine position and turned his head to the opposite side.\nWith the probe placed in a parasagital plane medial and inferior to the coracoids process, we obtained a clear short-axis image of the axillary artery. The entry point of the needle was anesthetized with lidocaine (3 mL, 1%). Then, using an in-plane approach, a 22 gauge, 100-mm short bevel insulated needle (pajunk, UniPlex NanoLine) was advanced and placed posterior to the axillary artery, next to the posterior cord. After reassuring that the needle tip is in correct location, and confirming a negative aspiration for blood, we slowly injected bupivacaine (30 mL, 0.25%) and dexamethasone (8 mg), and then withdrew the needle. During the injection no adverse effect was noticed. Five minutes after the injection muscle coordination in the extremity was lost and the pain diminished substantially. These were indicative of an impending successful block. After 15 minutes the surgery was allowed to start. The surgical procedure (closed reduction and percutaneous pinning) lasted 40 minutes. After the end of surgery, the patient was monitored for half an hour in the PACU and then transferred to ward.\nThe next morning, we were informed that the patient had not recovered completely from the motor and sensory blockade. Examination of the patient proved the same. The patient\u2019s condition was reassessed once more 24 hours after the performance of the block. No significant change in the patient\u2019s condition was found; complete motor and sensory blockade was persistent. Despite that the patient had no complaint about pain or paresthesia during injection of the local anesthetic and that we did not notice any unusual resistance to injection, a complete motor and sensory block in C6, C7, and C8 had remained, and the possibility of damage to nerves emerged. A nerve conduction study was requested and until then a trained nurse from acute pain service was put in charge of evaluating the patient every hour. It was approximately thirty hours after the original injection that the nurse reported the patient had felt occasional stabbing pain in his fingers. Expecting that recovery would gradually come about, the nerve conduction study was postponed to a later time in the next morning. Complete recovery of motor and sensory functions required 42 hours. Second examination of the brachial plexus 24 hours later did not reveal any residual motor or sensory blockade.", "age": [ [ 35.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3833043.xml", "relevant_articles": { "9835979": "12", "17720113": "12", "24370820": "123", "29505566": "0", "2236710": "123" }, "similar_patients": { "5749212-1": "12", "7378598-1": "12", "6330729-1": "12", "7387002-1": "12", "5403097-1": "1" } }, { "human_patient_id": "202", "human_patient_uid": "8525254-1-M", "PMID": "34703417", "title": "An enormous pelvic tumor in a 46-year-old woman with an elevated serum CA 125 level, what lies beneath it? Investigation of uterine tumors in postmenopausal women", "patient": "A 46-year-old postmenopausal woman was admitted to our ED with complaints of massive abdominal distention which started gradually 30 days ago. She also complained of difficulty in breathing and ambulation. There were no other gastrointestinal, gynecological, or urinary symptoms. The woman had a significant past medical history of hypertension. Her family history is negative for ovarian and breast cancer in first-degree relatives. On physical examination, the patient\u2019s abdomen was distended. Blood analysis revealed hemoglobin of 13.9 g/dL, 8280 leukocytes, and 226 000 platelets. All tumor markers were within normal limits. However, the ovarian cancer antigen (CA 125) level was 260.9 U/mL (normal range: 0\u201335 U/mL). Abdominal and pelvis MRI was performed, which revealed a huge pelvic-abdominal mass measuring approximately 22 x 15 x 12 cm (). As there was a strong suspicion of malignancy, the patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. The enormous lobulated tumor weighing 6.7 kg had a thick wall with solid and cystic areas (). Her final histopathology report was suggestive of uterine leiomyoma. The patient had no intra-operative or postoperative complications. On day 5 after the surgery, the patient was discharged home. Three months following the surgery, the CA 125 levels had regressed to the normal range. The patient has since been symptom-free, and the CA 125 levels have also remained normal.", "age": [ [ 46.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC008xxxxxx/PMC8525254.xml", "relevant_articles": { "34703417": "123", "32802022": "23", "34191791": "123", "33100951": "23", "16265850": "0" }, "similar_patients": { "7422285-1": "123", "6975244-1": "123", "5796437-1": "123", "4452815-1": "0", "7571862-1": "0" } }, { "human_patient_id": "203", "human_patient_uid": "3197537-1-M", "PMID": "21970745", "title": "Manifestation of a sellar hemangioblastoma due to pituitary apoplexy: a case report", "patient": "An 80-year-old Caucasian woman was admitted to our hospital with a 12-year history of an endocrine inactive steady sellar mass lesion (13 mm in diameter; Figure ). Our patient had been previously asymptomatic with no pituitary hormone deficiency or visual impairments. Moreover, our patient had a medical history of good health with only minor health issues that included hypertension and osteoporosis. However, prior to hospital admission, she had recently experienced two severe headache attacks; the last episode was accompanied by nausea, vomiting and blurred vision. Hyponatremia (120 mEq/L) with low serum osmolality (247 mOsm/L) and highly elevated urine osmolality (695 mOsm/L) were detected. An endocrinological investigation revealed hypocortisolism with no other hormone disturbances. Fundoscopy showed no pathological findings. However, further ophthalmologic examination with Goldman perimetry confirmed a bitemporal hemianopsia accentuated on her right side. Her neurological examination results were otherwise normal. After substitution therapy with hydrocortisone, our patient rapidly improved and her headaches subsided.\nFindings from a magnetic resonance imaging (MRI) scan were suggestive of an acute hemorrhage of the sellar process, consistent with pituitary apoplexy (Figure ). Except for an age-consistent vascular leukoencephalopathy, the diagnostic imaging showed no further pathological findings. Our tentative diagnosis at this point was a pituitary adenoma with pituitary apoplexy.\nDue to these clinical and radiological findings, the decision was made to surgically remove the tumor. A gross total extirpation using a transnasal, transsphenoidal approach to the pituitary mass was successfully performed. Intraoperatively, the tumor appeared yellowish-brown, was relatively firm and was located within a sellar hematoma cavity, which was evacuated.\nPostoperatively, our patient's visual field deficits improved markedly on clinical examination and Goldman perimetry confirmed a partial recovery of her bitemporal visual field deficits. Endocrinological studies showed panhypopituitarism with partial and transient diabetes insipidus. Our patient received substitution therapy with hydrocortisone, levothyroxine and transient therapy with desmopressin. Overall, our patient remained in good health with a satisfactory level of performance. A repeat MRI scan taken 16 months after surgery showed good chiasmatic decompression with no residual tumor mass (Figure ).\nThe resected tumor was examined with light microscopy, which revealed a small, well circumscribed, non-adenomatous tumor surrounded by slightly compressed remnants of adenohypophyseal parenchyma (Figure ). The tumor was richly vascularized with an observable reticular mesh of thin-walled capillaries interspersed with large epithelioid-looking cells (Figure ). Pale eosinophilic cytoplasm showed xanthomatous or vacuolar change (Figure ). Immunohistochemistry confirmed the expression of the endothelial-associated markers CD31 and CD34 in the intratumoral capillaries, although not in the stromal cells themselves. Conversely, the stromal cells were diffusely immunoreactive for vimentin, with a minority of cells also coexpressing S100 protein and epithelial membrane antigen (Figure ). No inflammatory infiltrate was detected except for the occasional mast cell (Figure ). Staining for cytokeratins tested negative, as did the Langerhans-cell-associated marker CD1a. Less than 1% of lesional cell nuclei were labeled with the cell proliferation-associated antigen Ki-67.\nGiven the above findings, we identified the tumor as an intrapituitary example of capillary hemangioblastoma (World Health Organization grade I). Since our patient displayed no clinical stigmata of VHL disease, genetic testing was not performed.", "age": [ [ 80.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3197537.xml", "relevant_articles": { "21970745": "123", "15256331": "123", "31484850": "12", "14714755": "123", "1762658": "123" }, "similar_patients": { "3750462-1": "123", "4782882-1": "123", "7772154-1": "123", "5287946-1": "123", "3537696-1": "123" } }, { "human_patient_id": "204", "human_patient_uid": "7552379-1-M", "PMID": "33050932", "title": "Orthostatic hypotension secondary to a suspected thymoma in a dog: a case report", "patient": "An eleven-year-old male, castrated, 47.2 kg Labrador Retriever presented to the Virginia-Maryland College of Veterinary Medicine Veterinary Teaching Hospital (VTH) in November 2018 for placement of a urethral stent. The patient had been diagnosed with transitional cell carcinoma via traumatic catheterization in January 2018, for which he had been seen monthly at the primary referral veterinary center to receive routine ultrasound examinations and chemotherapy (mitoxantrone 6.2 mg intravenously monthly) through October 2018. Over time the patient developed stranguria and there was evidence of thickening of the prostatic urethra in addition to a tumor present in the trigone. At presentation to the VTH, the patient was receiving piroxicam 17 mg q24h PO, milk thistle 175 mg q24h PO, S-adenosyl-methionine 400 mg q24h PO, omega fatty acid supplement 1600 mg q24h PO, and a vitamin B12 supplement.\nFrom the time of initial diagnosis, routine monthly CBCs had been performed with no major abnormalities detected. Biochemical screening had been performed intermittently, with serial monitoring of BUN and Creatinine during chemotherapy treatment. At presentation for placement of the stent, the patient\u2019s most recent bloodwork showed a slightly elevated BUN at 30 mg/dL (Reference Interval (RI) 7\u201327), elevated ALT at 159 U/L (RI 10\u2013125), elevated ALKP at 981 U/L (RI 23\u2013212), a slight neutrophilia at 13,110/\u03bcL (RI 2950-11,640), urine specific gravity 1.027, and a moderate amount of both blood and protein on free-catch urinalysis. Remaining values were unremarkable and within normal reference ranges. Physical examination revealed obesity (body condition score 8/9), mild to moderate hindlimb muscle atrophy, moderate dental tartar, several epidermal collarettes across the ventral abdomen, and a prominent urethra on rectal examination; all other findings were unremarkable. Ultrasound of the urogenital tract revealed thickening of the proximal urethral wall extending cranially into the neck of the bladder, punctate hyperechoic foci throughout the prostate, and a dilated left kidney pelvis and associated ureter.\nBased on these findings, it was elected to perform cystoscopy with placement of a ureteral and/or urethral stent to relieve the stranguria. The patient was fasted overnight before anesthesia. Maropitant 1 mg/kg subcutaneously was administered prior to butorphanol 0.2 mg/kg intramuscularly and an intravenous catheter was placed to facilitate anesthetic induction. Induction consisted of intravenous fentanyl 5\u03bcg/kg followed by alfaxalone 1 mg/kg to effect. Following endotracheal intubation, the patient was maintained on sevoflurane in 100% oxygen with a fentanyl continuous rate infusion (CRI) at 10\u03bcg/kg/hr. and lactated ringer\u2019s solution (LRS) at 5 mL/kg/hr. Anesthetic monitoring included capnography, pulse oximetry, esophageal temperature, electrocardiography (ECG), fractional expired sevoflurane (FESevo), fractional inspired oxygen percentage (FiO2), and direct arterial blood pressure.\nFollowing placement of monitoring equipment, the patient was repositioned from sternal to dorsal recumbency in preparation for cystoscopy. At this time, mean arterial pressure (MAP) declined from 61 mmHg to 40 mmHg while the heart rate began increasing from 128 beats per minute (bpm). Sevoflurane was reduced while a fluid bolus of 10 mL/kg was initiated and a dopamine CRI started at 5\u03bcg/kg/min. The blood pressure did not improve, with the MAP around 45 mmHg, and the heart rate continued to climb to 180 bpm with the appearance of intermittent ventricular premature complexes. Lidocaine 2 mg/kg was bolused intravenously and a CRI at 2 mg/kg/hr. started while dopamine was increased to 10\u03bcg/kg/min. Sevoflurane administration was discontinued and the breathing system flushed with fresh oxygen. Blood pressure began to increase to a MAP of 70 mmHg with the heart rate lowering to 100 bpm and the patient began to move slightly, so fentanyl was increased to 15\u03bcg/kg/hr. while sevoflurane was restarted and maintained below FESevo 1.3%. As the patient returned to a surgical plane of anesthesia, the blood pressure decreased again, although less dramatically to a MAP of 65 mmHg. Dopamine was increased to 12\u03bcg/kg/min and a norepinephrine CRI at 0.1\u03bcg/kg/min was started. This ultimately provided a balance that maintained blood pressure while keeping the patient adequately anesthetized for cystoscopy and allowed the dopamine to be reduced to 5\u03bcg/kg/min. The patient was moved from dorsal to left lateral recumbency and hypotension returned, but it responded more quickly to increases in dopamine and norepinephrine than previously. Once stent placement was completed, the patient was put into a sternal position in the thorax with pelvic limbs laterally, at this point the blood pressure began to rise quickly to a MAP of nearly 90 mmHg, and both dopamine and norepinephrine were discontinued.\nTwo days after uneventful recovery and discharge, the patient presented to the primary veterinary referral center with epistaxis and an incidental cranial mediastinal mass was diagnosed on thoracic radiographs. The client did not wish to pursue further workup and Yunnan Baiyao was prescribed for the epistaxis. However, the stranguria that resolved with the stent placement returned over the following 2 months and it was elected to re-evaluate the first stent and potentially place a second stent. No further epistaxis episodes occurred.\nThe presence of a mass in the chest, confirmed via radiographs following discharge from the first visit, and the decline and then improvement in hemodynamics correlating to changing body position during the first anesthetic episode, made us believe that positioning was going to play a key role in management of blood pressure in the second anesthetic episode. The patient\u2019s condition was largely unchanged from the first physical examination, and bloodwork was similar. Coagulation parameters were normal. Cytologic evaluation of an aspirate of the mass, obtained via thoracic ultrasound, was most suggestive of thymoma as reported by a board-certified veterinary clinical pathologist, who also recommended biopsy with histopathology for confirmation. Although this was not pursued by the client, computed tomography (CT) imaging was performed to rule out presence of a nasal mass and to better clarify size and exact location of the thoracic mass with respect to major vessels and the heart.\nThe patient was premedicated with morphine 0.5 mg/kg and midazolam 0.2 mg/kg intramuscularly 1 h after receiving maropitant 1 mg/kg subcutaneously. Following sedation and catheter placement, induction was performed with a mixture of propofol 3 mg/kg and ketamine 3 mg/kg to effect. Propofol and Lidocaine CRIs were used for maintenance in place of sevoflurane, but the same monitoring as prior was utilized, including direct arterial blood pressure. Sternal recumbency was maintained throughout sedation, induction, and CT imaging. Due to the fast onset and short-acting vasoconstrictive effects of phenylephrine, it was administered in 1\u03bcg/kg boluses intravenously as needed for mild hypotension (MAP of 59-62 mmHg) during the early part of the anesthetic event, while the patient remained sternal. During this period, the blood pressure was responsive to phenylephrine and increased to a MAP of 65-75 mmHg shortly following boluses. The dramatic and poorly-responsive hypotension of the first anesthetic episode was not observed and the heart rate ranged from 80 to 110 bpm. CT imaging of the nasal cavity was unremarkable but it revealed a left cranial mediastinal, lobular, 7.5 cm (width) \u00d7 5.8 cm (height) \u00d7 6.8 cm (length) soft-tissue attenuating mass with an irregular fluid-attenuating central portion. It was noted to be causing rightward deviation of the cranial vena cava without direct vascular compression in the sternal position. For comparison, the heart measured 9.4 cm \u00d7 5.9 cm \u00d7 10.5 cm. Figures and illustrate a dorso-ventral and sagittal view of the mass as found on CT imaging.\nFollowing CT imaging, the primary clinician requested left lateral recumbency for abdominal fluoroscopy and cystoscopy. As soon as the patient was re-positioned the mean arterial pressure dropped to 42 mmHg within 60 s. A dose of phenylephrine at 1\u03bcg/kg given intravenously failed to improve MAP in this instance. The patient was returned to sternal recumbency and MAP steadily increased back to its value prior to the change to lateral recumbency (MAP 63 mmHg). Ultimately the patient was maintained with the thorax sternal and the abdomen in oblique left lateral for the remainder of the procedure with no recurrent dramatic blood pressure changes.", "age": [ [ 11.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7552379.xml", "relevant_articles": { "32108177": "0", "19535698": "0", "27655646": "0", "27125331": "0", "23236555": "0" }, "similar_patients": { "7333263-2": "0", "7197330-1": "0", "7333263-1": "0", "7871641-1": "0", "7076047-1": "0" } }, { "human_patient_id": "205", "human_patient_uid": "8650747-1-M", "PMID": "34934504", "title": "Fiberoptic-guided tracheal intubation under precise anesthesia and topicalization with spontaneous respiration preservation for an uncooperative patient with severe postburn mentosternal contracture", "patient": "A 33-year-old woman, with severe postburn mentosternal contracture and cicatricial carcinoma, presented for skin grafting surgery in our hospital. The burn occurred when she was 4-year-old. She underwent two reconstructive procedures at 7 and 14 years in local medical centers. Due to the pain caused by the occurrence of cicatricial carcinoma, affecting eating and speaking, she had tried several medical centers for treatment in the past year, but failed for unsuccessful ATI. In preoperative physical examination, severe scar contractures and large tumor of approximately 15 \u00d7 12 cm were observed on the lower lip, neck, and anterior chest (Figure ); the chin, chest, and bilateral armpits fused together; the cervicomental and mentosternal angles completely obliterated; the anterior neck structures, including the larynx, the trachea, and the carotid arteries, were unidentifiable or impalpable. Mouth opening was limited (15 mm) and Mallampati test could not be performed. The left nostril was obstructive for stenosis, but the right nostril breathing was smooth. Preoperative X-rays and a computed tomography scan (data not shown) revealed distortion of the upper airway and no stenosis of the trachea. It was difficult to perform face mask ventilation because of the nearly fixed neck and regressed mandible.\nAccording to the guidelines on the management of difficult airway, awake flexible bronchoscopic intubation with topicalization is preferred in such patients, but the patient rejected ATI for discomfort and nociceptive recall before. Meanwhile, other awake strategies, including lightwand, GlideScope\u24c7 Video laryngoscope, laryngeal mask airway, oral or nasal blind intubation, retrograde intubation, surgical tracheostomy, seem impossible. Therefore, a flexible bronchoscopic intubation protocol under precise sedation, topicalization, and spontaneous respiration preservation seems a promising strategy, but the airway should be secured for there was no definite backup plan.\nA written informed consent was taken with explanation focused on the risks of difficult airway. Atropine 0.5 mg was intramuscular injected to reduce secretion 30 min before transferring to the operating room. The patient was monitored by respiration rate, ventilation volume, pulse oximetry, electrocardiogram, blood pressure and bispectral index (BIS), and preoxygenated once she arrived in the operation room. Vital signs were stable. A pillow and some folded sheets were stuffed between the patient back and the operating bed to make her feel comfortable. Intravenous midazolam 2 mg and sufentanil 5 \u03bcg were given. Nasal passage was anesthetized by pledgets with 2% lidocaine and 0.25% phenylephrine. Sevoflurane 2% with a flow rate of 4 L/min with 100% O2 was administered via an endoscopic mask connected to the ventilator circuit. The concentration of sevoflurane was gradually increased to 4% and stopped when the BIS reached 55\u201360 within 3 min, then airway reassessment and precise topicalization were achieved by a modified SAYGO technique., , An epidural catheter (Figure ), with an outer diameter of 3.8 mm, was fixed and 1.5 cm longer was applied at the end of the fiberscope (MDH A10; Zhuhai Mindhao Medical Technology Co., Ltd., ShenZhen, China). Topicalization was achieved by spraying 2% lidocaine (7 ml) via the catheter onto the posterior nasal canal, pharyngeal cavity, epiglottis, glottis, and tracheal (Figure ). Meanwhile, supplemental oxygen 10 L/min was delivered by a hose (Figure ) through the mouth to avoid hypoxemia. When lidocaine worked, about 5 minutes later, sevoflurane was inhaled again until the BIS reached 55\u201360. Then, a Parker Flex-Tip\u00ae tube with an inner diameter of 6.0 mm (Lead Medical Instrument Co., Ltd., Guangzhou, China), which was heated by 40 \u2103 and lubricated in advance, was successfully and smoothly inserted into the trachea from the direction of flexible bronchoscopy (Figure ). No stress reactions, including cough, hypertension, tachycardia, arrhythmia, hypoxia, and bronchospasm, and no intubation related complications, such as airway trauma, airway obstruction, and bleeding, were occurred during intubation. Finally, the patient was very satisfied with this experience after emergence.", "age": [ [ 33.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC008xxxxxx/PMC8650747.xml", "relevant_articles": { "10232724": "123", "9771172": "13", "32051940": "13", "30402550": "13", "8533873": "13" }, "similar_patients": { "3558652-1": "123", "6425646-1": "123", "5288426-1": "123", "7724123-1": "123", "5838199-1": "13" } }, { "human_patient_id": "206", "human_patient_uid": "7705285-1-M", "PMID": "33238758", "title": "Tattoo Granulomas With Uveitis", "patient": "A 32-year-old Caucasian male presented to the Ophthalmology Service at the Rocky Mountain\nRegional Veterans Affairs Medical Center for evaluation of several months of bilateral eye\nredness and blurry vison. Review of systems was notable for simultaneous onset of diffuse\nerythema, tenderness, induration, and pruritus of a large black ink tattoo over the right\narm and chest (). This\ntattoo was inked 1 year prior to presentation. He had 2 other tattoos completed 10 years\nbefore, which were unaffected ().\nAt the time of initial presentation, ophthalmological examination with slit lamp revealed\nanterior chamber inflammation and iris synechiae. On optical coherence tomography, there was\nevidence of macular edema (). Skin examination was significant for inflammation, induration, and scant\ndesquamation in a pattern that closely matched the borders of the tattoo. Lungs were clear\nto auscultation. The rest of the history and physical examination was unremarkable.\nNo clinical or serological evidence for other uveitis-associated diseases was elicited,\nincluding infections, sarcoidosis, or spondylarthritis. Comprehensive metabolic panel,\ncomplete blood count, urinalysis, thyroid stimulating hormone, free T4, ferritin, creatine\nphosphokinase, and aldolase tests were within normal limits. Erythrocyte sedimentation rate\nwas 13 mm/h, and serum angiotensin-converting enzyme concentration was 86 U/L (14-82).\nC-reactive protein, HLA-B27, antinuclear antibody, antineutrophil cytoplasmic antibody\n(including cytoplasmic, perinuclear, and atypical ANCA), lysozyme, QuantiFERON, HIV,\nhepatitis B and C serologies, rheumatoid factor, anticyclic citrullinated peptide\nantibodies, and computed tomography of the chest were all within normal limits. Punch\nbiopsies of the affected skin were obtained. Histological examination revealed granulomatous\ninflammation with associated tattoo ink deposition consistent with foreign body-type\ngranulomatous reaction ().\nMelan A immunostain highlighted scattered single junctional benign melanocytes with control\nsamples staining appropriately.\nThe patient was initially treated with topical ocular glucocorticoids without significant\nimprovement. He then required oral methylprednisolone 24 mg daily, tapered to 4 mg daily\nover 6 days. This agent led to rapid resolution of the inflammatory tattoo changes, but not\nof the macular and optic disc edema. A sub-tenon\u2019s triamcinolone injection to both eyes\nresolved his ocular manifestation; however, tapering of his systemic glucocorticoids caused\nhis tattoo manifestations to reappear. Adalimumab at 40 mg subcutaneously every other week\nsatisfactorily terminated all of his symptoms. Unfortunately, after 3 months of therapy,\npatient developed an injection site reaction. Certolizumab 200 mg SQ every 2 weeks was\ninstituted. A follow-up examination 4 months later revealed minimal, if any, subtle\ninflammation in both eyes, mild worsening of the macular edema in his left eye, and visual\nacuity of 20/20 by Snellen chart.", "age": [ [ 32.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC007xxxxxx/PMC7705285.xml", "relevant_articles": { "24875002": "123", "32967569": "123", "34761138": "123", "32812789": "123", "32782801": "123" }, "similar_patients": { "7388091-1": "123", "6943294-1": "123", "4016568-1": "123", "4883984-1": "13", "3957044-1": "123" } }, { "human_patient_id": "207", "human_patient_uid": "4618334-1-M", "PMID": "26635879", "title": "Systemic Levamisole-Induced Vasculitis in a Cocaine User without Cutaneous Findings: A Consideration in Diagnosis", "patient": "A 43-year-old homeless male presented with several weeks of weight loss, bilateral burning foot pain, and overall weakness that had progressed to an inability to walk. The past medical history was largely unknown but included admission to a different hospital two years prior with acute kidney injury secondary to rhabdomyolysis, with a serum creatinine of 1.5 mg/dL on discharge. The social history was significant for crack-cocaine use. On admission, he appeared cachectic and had a temperature of 38.7\u00b0C. On the neurological exam, he had impaired soft touch sensation bilaterally up to the ankles and diffuse weakness. There were no skin abnormalities seen.\nThe creatinine on admission was 3.93 mg/dL, and the BUN was 55 mg/dL (upper limit of normal is 1.0 mg/dL and 25 mg/dL, resp.). A globulin gap was present with a total protein of 6.7 g/dL and albumin of 1.4 g/dL. Urinalysis demonstrated moderate protein and blood, with a spot protein-creatinine ratio of 1 : 55 mg/mg (upper limit of normal is 0.11 mg/mg). There was no peripheral eosinophilia. Microscopic urinalysis showed granular casts but no red blood cell casts. His urine tested positive for eosinophils. Cocaine metabolites were found on urine toxicology. HIV, anti-nuclear and anti-glomerular basement membrane antibodies, RPR, and hepatitis B and C serologies were negative. There were no abnormal bands on serum or urine protein electrophoresis. ANCA were strongly positive at 1 : 5120 (upper limit of normal is less than 1 : 20) with a perinuclear staining pattern and myeloperoxidase reactivity at 76 AU/mls (upper limit of normal is less than 19 AU/mls). Kidney biopsy specimen had a total of 21 glomeruli, out of which only two were globally sclerotic. The majority of glomeruli showed pauci-immune necrotizing crescentic glomerulonephritis (). A prominent plasma cell-rich tubulointerstitial nephritis was also present.\nBased on his laboratory findings and renal biopsy, a diagnosis of microscopic polyangiitis was considered, but levamisole-induced ANCA vasculitis remained a likely possibility given his history of cocaine use. The presence of interstitial nephritis on biopsy was felt to explain the eosinophils in his urine, a finding previously reported in cocaine users []. He was treated with pulse methylprednisolone 1000 mg for three days and 600 mg of IV cyclophosphamide. His creatinine peaked to 7.21 mg/dL during hospitalization but stabilized at 6.25 mg/dL after treatment. The patient was counseled on abstaining from cocaine and was discharged on 40 mg of prednisone per day with instructions to follow-up for monthly cyclophosphamide injections at renal clinic.\nThe patient was readmitted one month later with increasing lower extremity swelling and pain. He had been off prednisone since discharge and had ongoing crack-cocaine use. Renal function had declined, reaching serum creatinine of 8.8 mg/dL. He was treated with cyclophosphamide and prednisone, and his fluid status and electrolyte abnormalities were corrected. Renal function did not improve with treatment, and hemodialysis was initiated.", "age": [ [ 43.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4618334.xml", "relevant_articles": { "27119429": "123", "26425622": "123", "30232205": "123", "34765369": "123", "25420411": "123" }, "similar_patients": { "4849970-1": "123", "4528898-1": "123", "8259466-1": "123", "5116358-1": "123", "8146206-1": "123" } }, { "human_patient_id": "208", "human_patient_uid": "7706432-1-M", "PMID": "33312970", "title": "Gossypiboma: What Happens When a Mop is Left in a Thigh for ten Years", "patient": "A 70-year-old gentleman presented with a painless swelling in the right thigh for 7 months, which was spontaneous. He had a history of femur shaft fracture, for which open femur nailing was done 10 years ago. Postoperatively, he had uneventful wound healing and fracture union. He has no recollection of any complications following the surgery and was able to walk full-weight-bearing without any aid. Clinically, he had a large diffuse swelling on the anterolateral aspect of the right thigh which was around 10 cm \u00d7 8 cm. The swelling was firm, non-tender, and non-pulsatile, with ill-defined margins. The presence of a longitudinal scar along the entire length of the lateral aspect of the thigh was noted, which had healed by primary intention (). The right hip and knee movements were normal. Routine hematological tests were done, including erythrocyte sedimentation rate and C-reactive protein. All the blood reports were normal.\nX-rays of the femur were done in anteroposterior and lateral views () which showed an irregular, hypertrophic cortical reaction with the bony remodeling in the proximal femur and an excavated lateral femoral cortex with a broken intramedullary nail in situ.\nMagnetic resonance imaging (MRI) of the right thigh was done, which showed a large, well defined, and heterogenous soft-tissue mass on the anterolateral aspect (T1 and T2 images). Post-contrast images showed a heterogeneous and patchy uptake (). These findings were consistent with a soft-tissue tumor. We, however, did not perform a computed tomography (CT) scan for this patient.\nAfter the MRI, we decided to do a closed needle biopsy along the previous surgical scar under local anesthesia in the operating theatre. The biopsy report was inconclusive, demonstrating fibrinous blood material and granulation tissue suggestive of a chronic hematoma.\nAs the patient was symptomatic, we decided to plan a surgical excision of the lesion. Under epidural anesthesia, in the supine position. The skin incision was taken along the previous scar on the lateral aspect of the thigh. Granulation tissue and fibrosed muscles overlying the mass were carefully separated. We noticed a mass adherent to the lateral aspect of the femur extending intramedullary up to the implant. Using a cautery, we separated the mass from the bone extending up to the intramedullary nail. The excised specimen measured 24 cm in length and 15 cm in breadth. An intraoperative frozen section analysis was done that revealed a chronic inflammatory reaction and no evidence of sarcoma. The defect after excision of the mass was filled with frozen allograft. The excised specimen was solid with a fibrotic wall; on gross examination, after dissecting the specimen, a mop was found ( and ).\nThe sample was sent for histological study which revealed fibrous strands, clots, hemolyzed pigments of red blood cells inflammatory cells, and multiple fiber strands. The foreign material was studied under polarized light () and confirmed the diagnosis of gossypiboma by demonstrating cotton fibers. The specimen was reported as an accumulation of blood products and their degraded components and not a tumor.\nThe patient had an uneventful surgical procedure and was mobilized and rehabilitation was started on day 1 postoperatively.", "age": [ [ 70.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC007xxxxxx/PMC7706432.xml", "relevant_articles": { "27298868": "123", "33413245": "123", "7783356": "123", "32705383": "13", "31165193": "123" }, "similar_patients": { "8319740-1": "123", "4744070-1": "0", "8191858-1": "123", "3505896-1": "123", "7880828-1": "0" } }, { "human_patient_id": "209", "human_patient_uid": "3921285-1-M", "PMID": "24527200", "title": "Successful Treatment of Infantile Fibrosarcoma Spinal Metastasis by Chemotherapy and Stereotactic Hypofractionated Radiotherapy", "patient": "A previously healthy 8-month-old boy presented with a 3\u00d73 cm mass in the right lower leg, which was surgically excised. Pathological analysis confirmed the diagnosis of infantile fibrosarcoma and the surgical margin was not clear. His parents refused reexcision but accepted monitoring by regular imaging. However, a mass was detected again in the same area two years after surgery. Therefore, the patient then underwent complete excision, and recurrent sarcoma was confirmed histologically. After the second resection, the patient had monthly follow-up and no evidence of disease was observed on an ongoing one year.\nA surveillance whole-body fludeoxyglucose positron emission tomography scan conducted 3 years after the initial presentation demonstrated a recurrent mass in the right lower leg, one micrometastatic lesions at the left proximal fibula and another macrometastasis in the 4th lumbar vertebral column, respectively. Lumbar spine magnetic resonance imaging (MRI) revealed a contrast-enhancing lesion of 1.6 cm in the posterior aspect of the 4th lumbar vertebral column without spinal canal compression (). To preserve right lower leg, debulking surgery of the recurrent lesion was performed, and the histological features were found to be consistent with recurrent sarcoma with rhabomyosarcomatous differentiation. Two weeks after the surgery, the patient started to receive chemotherapy with a VAC regimen composed of vincristine (1.5 mg/m2), dactinomycin (0.045 mg/kg), and cyclophosphamide (2.2 g/m2) for a total of 44 weeks treatment course.\nGiven the potential risk of spinal pathologic fracture and myelopathy, radiotherapy was chosen to treat the 4th lumbar vertebral metastatic lesion. Cyberknife\u00ae hypofractionated radiotherapy was decided due to the solitary nature of the metastasis and fewer sessions are needed, which would decrease the frequency of general anesthesia for radiotherapy. The patient was immobilized in a vacuum mattress. Fused enhanced computed tomography (CT) (Accuray) and MRI scans were used in the treatment planning. The delineation of the gross tumor volume (GTV) and the organs at risk was carried out on the planning CT. Given the potential risk of kyphosis and scoliosis by asymmetric irradiation of the spine, the whole involved vertebra was contoured as the GTV. Clinical target volume was equal to the GTV and no margin was added to obtain the planning target volume (PTV), which was 8.84 mL. No fiducial or other markers were implanted to localize the irradiated area. A total of 26 Gy was prescribed to the 75% isodose line, covering 92.64% of the PTV with a maximal spinal cord dose of 744.26 cGy (). Cyberknife\u00ae stereotactic body radiotherapy was performed on the 15th, 16th, 19th, and 20th of October 2009 with a mean procedure time of 83 min (range 56 min to 128 min). The radiotherapy course was conducted in a manner concomitant with the first cycle of chemotherapy. During the radiotherapy, immobilization was aided by general anesthesia, and X-sight spine tracking (Accuray Inc.) was used to minimize setup error.\nThe patient tolerated the anesthesia and immobilization well and remained still during the radiotherapy. Up to the date of this report, i.e., 33 months after radiotherapy, the patient remains neurologically stable and 23% reduction in tumor volume was achieved on the surveillance MRI scans (). No acute radiation toxicity was found.", "age": [ [ 8.0, "month" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3921285.xml", "relevant_articles": { "24527200": "123", "19165075": "123", "33327288": "123", "34221611": "123", "19004569": "123" }, "similar_patients": { "4905706-1": "123", "8519193-1": "13", "7489324-1": "123", "5991927-1": "0", "8407259-1": "0" } }, { "human_patient_id": "210", "human_patient_uid": "7238323-1-M", "PMID": "32454833", "title": "Type II Diabetes Patients under Sildenafil Citrate: Case Series Showing Benefits and a Side Effect", "patient": "A 62-year-old male, married, retired, with type 2 diabetes for more than 15 years, background to rheumatoid arthritis and myocardial revascularization, with no history of using alcohol or tobacco, without neuropathy, feeling pain in right foot which showed signs of dry necrosis in the plate and in the digital pulp of the third finger, and partial necrosis in the hallux reported. He Presented with distal pulses in the finger extremities, without fever, heartbeat of 80/min fc, and Pa 13 \u00d7 9 and was attended at the Diabetic Foot Treatment Center with diagnosis of type II diabetes and ischemic diabetic foot. He presented with progressive and painful necrotic plaques in the right hallux and 3rd right foot pod. The color of the feet was purple with fuming appearance. In terms of background, the patient reported treatment with a rheumatologist at the Hospital das Cl\u00ednicas in S\u00e3o Paulo due to arthritis of the hands and coronary stent placement for 6 months at INCOR-SP. He was being medicated with prednisone, clopidogrel, and metformin.\nAfter clinical evaluation, he was medicated with Cilostazol 50, and an arterial echo Doppler of the lower limbs was requested. This examination concluded that the arterial trunks had vascular patency with three-phase flow. There was a minor, noticeable improvement of the right toes after two months of treatment with Cilostazol but with worsening of the contralateral toes. There were fixed cyanosis and resting pain of the 3rd and 4th toes of the left foot. Even an intensive care treatment by photodynamic therapy (PDT) did not improve the condition of the diabetic foot []. After consulting his cardiologist to authorize the use of SC, this drug was administered at the daily dose of 50 mg. This treatment was maintained for 10 months, with remission of the endpoint ischemia. The patient reported feeling well, and PDT started to respond well. After 5 PDT sections, feet lesion healed and the patient regained his colored feet and reported no pain ().\nOne year after discharge, the patient returned again with lesion in his 1st left toe, ischemia in the 2nd right toe, with a necrotic plaque and ulcerated digital pulp, a lot of resting pain, and left lateral hallux ulcer. SC was once again administered, this time in doses of 50 mg every 12 hours (100 mg/day). After 3 months and 6 PDT sections, the 1st left toe had already healed, but the patient started to report hypoglycemia attacks. The use of Metformin and fasting was discontinued, as long as glucose levels were kept between 82 and 93 mg/dl, and SC was reduced again to 50 mg. The treatment of the 2nd finger, which was initially ulcerated, was finalized by PDT, and the patient was discharged.\nDuring this relatively long period (more than two years), glycemia was obtained daily throughout several months, and average values are shown in . It is clear that SC allowed for a reduction and stabilization of glycemic values, with the extra benefit of having improved also the microvasculature, as indicated by the cure of the diabetic foot. It is also possible to note that there is an effect of the dose of SC, since during the 100 mg/day period, glycemia was significantly lower than in the other three periods in which the patient received a SC dose of 50 mg/day. However, as mentioned above, patient 1 under 100 mg/day of SC had an important hypoglycemic event, which was not observed at the 50 mg/day dose.", "age": [ [ 62.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7238323.xml", "relevant_articles": { "15973811": "1", "2254674": "1", "27159595": "12", "33980300": "1", "31681700": "12" }, "similar_patients": { "6907714-1": "1", "3701851-1": "13", "6503200-1": "1", "7335304-1": "12", "2906497-1": "1" } }, { "human_patient_id": "211", "human_patient_uid": "7238323-2-M", "PMID": "32454833", "title": "Type II Diabetes Patients under Sildenafil Citrate: Case Series Showing Benefits and a Side Effect", "patient": "A 73-year-old male, medical doctor, widower for 2 years, lives in the house with his two children. He is a social ethicist, smoker for 40 years, and quitted smoking 18 years ago as a response for the diagnosis of pulmonary emphysema, asthma, and systemic arterial hypertension (SAH). 10 years ago, he was diagnosed with Type 2 diabetes mellitus and dyslipidemia. For the long-term asthmatic status, he uses formoterol fumarate dihydrate 200 mg with bisoprolol hemifumarate 1.25 mg daily (inhaled bronchial dilator) 1x daily; for systemic arterial hypertension, losartan and hydrochlorothiazide 50/12.5 mg (morning and afternoon); for dyslipidemia, rosuvastatin 20 mg, AAS 100 mg.\nTwo months after starting SC, the patient reported having an important hypoglycemic attack (glucose level of 27 mg/dl) (). 3 hours after starting this episode, this patient still presented dysarthria, mental confusion, and loss of consciousness and was hospitalized in the ICU with good recovery after glucose replacement. The use of SC was suspended during the hospitalization period, and the medication for diabetes was resumed. After dismissal from the hospital, SC was reintroduced at a dose of 25 mg 3 times per day, and postprandial glucose remained around 138 mg/dl, even when consuming sweets; sulfonylurea (gliclazide) has been discontinued and home glycemia ranged from 101 to 117 mg/dl. Six months after the episode, the patient showed stabilization of symptoms with normal blood pressure, 61 beats per minute, 95% O2.", "age": [ [ 73.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7238323.xml", "relevant_articles": { "26521193": "123", "20425675": "12", "12725703": "123", "24990091": "0", "16627385": "" }, "similar_patients": { "7238323-1": "123", "6410487-1": "12", "8369979-1": "0", "3410296-1": "123", "6277870-2": "0" } }, { "human_patient_id": "212", "human_patient_uid": "4351841-1-M", "PMID": "25884693", "title": "Complete heart block in dengue complicating management of shock due to both bleeding and leakage: a case report", "patient": "A 26 year old South-Asian female, having irregular menstrual cycles but was otherwise healthy presented with fever to the accident & emergency unit with severe generalized myalgia and arthralgia. Clinical assessment revealed a tachycardia with a pulse rate of 108 b.p.m and an initial blood pressure of 90/50 mmHg, indicating shock. Clinical picture favored dengue fever with the classic repertoire of symptoms. Since the patient had taken mefenamic acid, a non steroidal anti-inflammatory agent (NSAID) for myalgia for a few days, her complaint of fever for only one day at presentation suggested an erroneous timeline and a late presentation. Rest of the systemic examination was normal and clinically there was no evidence of leakage of fluid in the chest and abdomen on presentation. She was started immediately on an intravenous infusion of 0.9% saline. Preliminary whole blood analysis demonstrated a low haematocrit of 32% with a reduced haemoglobin of 10.4 g/dL (11\u201317) and a platelet count of 173 \u00d7 10 9/L (150\u2013450). Despite fluid replacement her blood pressure declined to 80/40 mmHg with development of shock together with a reduction of the haematocrit to 29%. At this stage haemorrhagic shock was suspected on a background of NSAID usage. She was transfused with cross matched packed red cells urgently and stabilization of the haemodynamic parameters were noted with a borderline but stable blood pressure of 100/60 mmHg. Haematocrit also stabilized at 35%. An ultra sound scan failed to reveal either leakage of fluid into pleural cavity or the presence of ascitic fluid and intra-abdominal heaemorrhage. However the patient suffered heavy per vaginal bleeding which continued. She was observed in a high dependency setting and 8 hours after admission and clinical stabilization, she developed bradycardia, which was confirmed on electrocardiogram (ECG). In addition to sinus bradycardia, the ECG showed T wave inversions from V2- V5 (Figure ). Cardiac insult due to dengue virus infection was suspected, although creatine kinase-MB was normal and Troponin I remained negative. ECG was done serially to monitor the progression and on the second day of hospitalization revealed the occurrence of complete heart block with atrio-ventricular dissociation and a junctional rhythm with a short P-R interval (Figure ). Despite this, the blood pressure remained within acceptable safe limits. In view of satisfactory peripheral perfusion a clinical decision was made not to insert a temporary pacemaker, but to continue close observation for possible haemodynamic compromise occurring due to arrhythmia or worsening due to its presence.\nPrimary dengue virus infection was confirmed by the presence of positive IgM antibodies with negative IgG antibodies on day 2 of hospitalization. Platelet counts on day 2 of hospitalsation was 157 \u00d7109/L(150\u2013450), but haematocrit value started to rise to 42 and then 45 within a few hours, and clinical examination revealed a right sided pleural effusion which was confirmed on sonographic imaging with the presence of pleural fluid and additionally fluid in the hepatorenal pouch. Fluid resuscitation and replacement was carried out in accordance with the national guidelines on dengue management. Serum magnesium levels were within reference range, with a value of 2.07 mg/dL (1.58-2.55). Serum sodium and potassium values were within reference throughout her stay. Initial serum ionized calcium levels were found to be low normal with a value of 1.14 mmol/L(1.12-1.32) Subsequent ionized calcium levels were found reduced to a value of 1 mmol/L (1.12-1.32). In the background of ECG changes, hypocalcemia was corrected cautiously with intravenous calcium gluconate and the electrolytes were monitored regularly, though the cardiac rhythm remained unchanged. Post correction serum ionized calcium was 1.17 mmol/L and later 1.22 mmol/L (1.12-1.32). Two dimensional echocardiogram revealed an ejection fraction of 50% with normal valves, normal sized atria and ventricles with no systolic wall motion abnormalities though myocardial depression was observed. Liver function tests revealed elevated enzymes. Aspartate transaminase and alanine transaminase were 141U/L (<40) and 119 U/L (<40) respectively and later rose to the highest recorded value of 320 U/L(<40) and 187U/L (<40) respectively. Gamma GT was also elevated at 347.5 U/L (7\u201350). Total protein was normal with a value of 62.4 g/L (60\u201385) but albumin was marginally reduced to 30.9 g/L (35\u201354). The patient remained clinically stable but the persistence of bleeding prompted a blood picture analysis to identify and exclude features of disseminated intravascular coagulation (DIC). Blood picture revealed moderately low platelets and reactive lymphocytes but no features of DIC. However thromboelastography revealed hypocoagulation, platelet deficiency and fibrinogen deficiency. In light of low platelets (lowest nadir of 10x109/L) and continuous per vaginal bleeding 4 units of factor VII complex was given. Normal sinus rhythm was noted on day 5 of admission, though she remained bradycardic till the time of discharge from hospital.\nThe bleeding ceased and platelet counts rose gradually. The patient made good clinical recovery with the pleural effusion subsiding and vaginal bleeding ceasing. ECG showed resolution upon review two weeks later.", "age": [ [ 26.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4351841.xml", "relevant_articles": { "25884693": "123", "25889043": "123", "32913689": "123", "33117649": "0", "28183503": "0" }, "similar_patients": { "4862122-1": "13", "5219719-1": "123", "6714390-1": "12", "7223658-1": "0", "4152580-1": "123" } }, { "human_patient_id": "213", "human_patient_uid": "5078658-1-M", "PMID": "27807496", "title": "Schwannomatosis of Cervical Vagus Nerve", "patient": "A 40-year-old male patient presented to our department with complaints of right sided neck swelling that had gradually progressed in size over the past 5 yrs. He does not give any history of hoarseness of voice, recent cough, or light headedness. He complains of difficulty swallowing and also in neck movements. On examination of the patient, a firm, immobile, nontender swelling of size 10 \u00d7 10 cm was found, which involved the right side of neck. It was seen extending from behind the right sternocleidomastoid muscle to just across the midline of neck. Vertically, it extended from the hyoid bone to the sternal end of right clavicle. It was nonpulsatile and no murmur was audible. Carotid artery was displaced clinically by the mass. Examination revealed all cranial nerves to be within normal limits. No other swellings were palpable in the neck ().\nCervical spine and thoracic X-rays were taken to see for tracheal obstruction and mediastinal shadow as well as pre-op planning. Cervical X-ray did not show any tracheal narrowing while there was a slight suspicion of mediastinal widening ().\nFor further characterisation of the swelling, a contrast enhanced computed tomography was done which showed presence of fairly well-defined hypodense mass lesions in the right side of neck extending to upper mediastinum. The largest lesion was approximately 4.2 \u00d7 5.4 cm in anteroposterior and transverse dimensions. The craniocaudal extent of the lesions was approx. 17.8 cm. There was poor contrast enhancement of the lesions with few mildly enhancing internal components. The upper part of the mass was abutting the pterygoid muscles and the C2 vertebrae. The lower level of the lesion was at the level of the carina. The masses in the neck were mainly involving the right carotid space displacing and separating the carotid arteries and the internal jugular vein suggestive of a neurogenic tumor. The lesions were also displacing the right SCM muscle and right submandibular gland. The thyroid and cricoid cartilages, hypopharynx, larynx, and trachea were displaced to the left without obvious evidence of erosion or infiltration. In the mediastinum, the lesion was seen to displace the azygous vein, right brachiocephalic vein, and superior vena cava and abutting the aortic arch and right main bronchus. The thyroid gland appeared normal. There was no obvious cervical lymph node enlargement, no intracranial extension, nor any obvious bone or cartilage erosion in the area of study. The present CECT was suggestive of a neurogenic tumor probably from the right vagus nerve ().\nA Tc99m thyroid scintigraphy was done from another institution before presentation which showed presence of normal thyroid gland with normal uptake, but for the presence of a cold nodule in the right lobe. Under USG guidance, an FNA was done from the cold nodule in the right lobe of thyroid. FNAC result revealed a benign colloid nodule. As malignancy was ruled out, no further action was taken on the thyroid gland. The swelling in question was not evident on the scintigraphy ().\nAn FNA was taken from the swelling in question, which was inconclusive.\nFurther routine workup was done which included basic blood and renal and thyroid workup which were within normal limits, and patient was prepared for surgery.\nUnder general anesthesia, a collar-line transverse incision was made 1 cm below the cricoid cartilage and extending along the anterior border of the right sternocleidomastoid. After raising subplatysmal flaps, the strap muscles were separated, and the lesion was visualised. A yellowish mass lesion was visualised extending beyond the midline which appeared well-defined and well-encapsulated. It was dissected from the adjacent tissue and found to have posterior attachment to the ipsilateral vagus nerve. The vagus nerve was splayed over its surface and carefully dissected off the swelling, thereby preserving the whole of the nerve. There was an episode of bradycardia during this manoeuvre, but it was transient and the rest of the procedure was uneventful ().\nAfter successful removal of the lesion, there were multiple other similar swellings seen discontinuous from the first, along the vagus nerve, proximal and distal to the first swelling. They were also dissected away from the vagus nerve and removed in toto. Lesions involving the submandibular area were also resected. The mediastinal lesion seen on imaging was removed along with the first specimen via the same incision itself. Hemostasis was ensured and the wound was closed in layers after placing a suction drain. The patient had an uneventful postoperative period and was discharged on the 5th post-op day. There was no obvious evidence of vagus nerve injury, no hoarseness, or cough ().\nIn total, there were 5 specimens, of which one was a lymph node from level 2 that was also excised ().\nFinal histopathology report showed the presence of schwannoma with degeneration, composed of focal hypercellular (Anthony A) areas and hypocellular areas (Anthony B). Immunohistochemical examination of tumor cells showed strong S-100 positivity. Therefore, a final diagnosis of vagal nerve schwannomatosis was obtained. The lymph node was histologically unremarkable.", "age": [ [ 40.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5078658.xml", "relevant_articles": { "23936960": "123", "30785006": "123", "11222217": "2", "29785209": "0", "31832104": "0" }, "similar_patients": { "7945733-1": "0", "4931786-1": "0", "5857344-2": "123", "4739406-1": "123", "8557702-1": "123" } }, { "human_patient_id": "214", "human_patient_uid": "3724718-1-M", "PMID": "23879452", "title": "Primary Epstein-Barr virus infection with polyradiculitis: a case report", "patient": "A 35-year-old woman presented with five days of nightly accentuated burning pain in both legs leading to massive sleep disturbance. The pain was predominantly located in the dorsal thighs and radiated to the calves. She reported some relief through walking around at night and showering her legs with hot water. Back pain, gait or sensory disturbances and bladder dysfunction were denied. Nonsteroidal anti-inflammatory drugs did not alleviate pain, neither did pramipexole, which had been prescribed for suspected restless leg syndrome. One week before she had had a sore throat and had been clinically diagnosed for streptococcal tonsillitis and treated empirically with penicillin. Her past medical and family history was unremarkable. Clinical examination revealed no focal-neurologic signs. There were no sensory deficits and deep tendon reflexes were symmetrically normoactive. Furthermore, we found no palpable lymph node swelling and no signs of pharyngitis. Motor and sensory nerve conduction studies were normal, as were F-responses of the tibial nerve. Abdominal Ultrasound demonstrated a slightly enlarged spleen. Blood sampling showed relative lymphocytosis, and elevated liver enzymes. Cerebrospinal fluid analysis revealed 18 white blood cells/\u03bcl (90% lymphocytes, 10% monocytes), 83mg/dl protein, and blood\u2013brain-barrier dysfunction (albumin CSF/serum quotient 12.5 \u00d7 10-3) without intrathecal immunoglobulin synthesis. Virological studies detected EBV VCA IgG and IgM in serum, whereas EBV EBNA-1 IgG was negative. Moreover, EBV-PCR (RealStar\u00ae EBV PCR Kit 1.0, altona Diagnostics GmbH, Germany) was positive in blood and CSF (1000 copies/ml each) suggesting primary EBV infection involving the nervous system. Further laboratory investigations were not indicative for infections with streptococcus, borrelia, syphilis, HIV, hepatitis virus A, B or C (serological tests in blood, borrelia and syphilis additionally in CSF), VZV, HSV or enteroviruses (VZV- and HSV-IgG-specificity-indices and PCR in CSF). Under initially started empiric therapy with intravenous acyclovir for possible VZV or HSV radiculitis and analgesic treatment with oral tramadol the patient completely recovered within a few days. After receiving negative results for VZV and HSV, acyclovir was ceased on day six.", "age": [ [ 35.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3724718.xml", "relevant_articles": { "32536667": "123", "34187795": "123", "33774857": "2", "3036714": "2", "31687393": "2" }, "similar_patients": { "8460942-1": "123", "8544377-1": "0", "4295133-1": "123", "6546850-1": "0", "5530449-1": "0" } }, { "human_patient_id": "215", "human_patient_uid": "3047823-1-M", "PMID": "21373326", "title": "Barbicidal overdose", "patient": "A 53-year-old female was blue lighted into our emergency department resuscitation room by ambulance crew as she appeared extremely cyanotic from face to feet. She complained of nausea, vomiting and difficulty in breathing. Her most striking feature was a bluish hue of her face (Fig. ) including her lips and forearms. She looked as if she had fallen onto blue ink and had some residual staining. However, closer examination revealed that this discolouration was present throughout, including her nails (Fig. ). Oxygen therapy had made no difference to her appearance. She appeared confused and was unable to give any coherent history.\nShe was tachycardic (130/min) and tachypnoeic (30/min), and had a SpO2 of 90% on 15 l oxygen; blood pressure was 100/50 mmHg. Chest examination revealed few crackles in both mid zones, and a possible chemical/apsiration pneumonitis was suspected. She had a history of deliberate self harm. She had no allergies and worked as a beautician by profession.\nArterial blood gas (ABG) analysis on oxygen showed pH 7.41 (7.35\u20137.45), pCO2 3.44 kPa (4.7\u20136), pO2 31.6 kPa (11\u201313 on room air), lactate 11.0 (<2), base excess \u22127.2 mmol/l (\u22122\u2013+2) and HCO3 19.4 mmol/l (24\u201331). The patient continued to receive high-flow oxygen and intravenous access was gained, and bloods tests, including paracetomol and salicylate levels, and a urine toxicology for the usual drugs of abuse were requested. These subsequently turned out to be negative. She was treated with intravenous crystalloids for compensated metabolic acidosis and treated with antibiotics to cover for aspiration pneumonia. A differential diagnosis for high anion gap metabolic acidosis was worked out using the common mnemonic (MUD PILES\u2014Methanol, Uremia, Diabetic ketoacidosis, Paraldehyde, Iron, Lactic acid, Ethanol and ethylene glycol, and Salicylates, respectively) as the anion gap was 21 (3\u201311). Despite her treatment, there was no sign of improvement. The initial chest x-ray was normal.\nA diagnosis of methaemoglobinemia was suspected in our patient as she demonstrated (1) central cyanosis unresponsive to oxygen therapy with no previous history of congenital cardiac disease or causes for pulmonary hypertension; (2) decreased oxygen saturation on the pulse oximeter with a near normal pO2; (3) difference in the arterial blood gas (95%) and the pulse oximeter (90%) oxygen saturation measurements; and (4) she was a beautician with a history of self harm (beauty products when ingested can result in methaemoglobinaemia). An urgently requested methaemoglobin (MetHb) level showed a raised MetHb level (50.3%), which confirmed the diagnosis. She was subsequently treated with a slow intravenous dose of methylene blue (2 mg/kg). Clinical improvement was marked within 20 min. Her tachycardia and tachypnoea began to settle, and she was now able to communicate.\nHer repeat ABG, 30 min post treatment, showed pH 7.37, pCO2 4.12, pO2 11.6, lactate 6.4, base excess \u22126.8, cHCO3 19.2 and MetHb 2.9%. She acknowledged the fact that she had consumed alcohol but refused to answer the deliberate self-harm questions. She was observed in a resuscitation room with regular ABG monitoring through an arterial line and then transferred to the intensive care unit where her recovery was complicated by the development of ARDS. ARDS was confirmed on a CT scan and was thought to be vasogenic or neurogenic in origin rather than aspiration or infective. She gradually improved and was eventually discharged from the hospital about 10 days later. Psychiatric counseling revealed that she had ingested a barbicide, and out-patient follow-up including chest clinic was arranged prior to discharge from the hospital. She was reviewed in the chest clinic for up to 3 months and had made an excellent recovery and did not have any ongoing respiratory symptoms, and hence was discharged from follow-up.", "age": [ [ 53.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC003xxxxxx/PMC3047823.xml", "relevant_articles": { "21344737": "0", "26305085": "1", "9368896": "13", "21660520": "0", "20120442": "123" }, "similar_patients": { "4421581-1": "12", "8330395-1": "12", "5111284-1": "123", "6467431-1": "123", "4118515-1": "123" } }, { "human_patient_id": "216", "human_patient_uid": "3438424-1-M", "PMID": "22977783", "title": "Alien Hand Syndrome in Stroke - Case Report & Neurophysiologic Study -", "patient": "A 72 year-old man developed right side weakness after a left ACA infarction and was transferred to the department of rehabilitation medicine 7 weeks after the attack. He had no remarkable medical history but was diagnosed with diabetes at our hospital. He had a family history of ischemic stroke (affecting his younger brother). On transfer to our department, he was alert but had cognitive impairment with a K-MMSE (Korean version of the Mini-Mental Status Examination) score of 13. Manual muscle test (MMT) grades of his right upper extremity-were all 3/5, lower extremity test grades were 2/5 except for ankle plantar flexor grades of 1/5, and dorsiflexor grades were 0/5. He had no spasticity in his elbow and knee joints, and had a modified Ashworth scale (MAS) score of zero. His sensory function was intact and deep tendon reflex was normoactive. He complained that his hand moved abnormally against his will. He could grasp and release with his bare hands on the doctor's order, but when grasping some objects with his palm, he was unable to release them. Brain magnetic resonance imaging (MRI) revealed acute cerebral infarction at the left ACA region (). For TMS, we used a Magstim 200 monopulse\u00ae (Magstim co., Whiteland, UK) connected to a figure-eight coil (7 cm outer diameter for each loop) with a maximum magnetic strength of 2.0 tesla. The coil was initially centered on the vertex, perpendicular to the scalp, with the handle pointing posteriorly at a 45 degree angle from the median sagittal line and then moved in 1 cm steps in anterior-posterior and medial-lateral directions. Motor evoked potentials (MEP) were recorded from the first dorsal interosseous (FDI) muscle with a surface gel electrode. The active electrode was placed over the muscle belly and the reference electrode over the distal interphalangeal joint of the index finger. The signals were displayed by Keypoint\u00ae EMG (Dantec, Skovlunde, Denmark) and stored in a laboratory computer. Using a paired pulse magnetic stimulation technique, we studied intracortical inhibition (ICI) and intracortical facilitation (ICF). In this case, when we stimulated the left motor cortex area, the resting motor threshold (rMT) was 54% of the maximum magnetic strength and the MEP amplitude was 287 \u00b5V. At the right motor cortex area, the rMT was 57% and the MEP amplitude was 579 \u00b5V. In the ICF study, when we stimulated the left motor cortex area, the MEP amplitude was increased to 1,697 \u00b5V. In the ICI study, the amplitude was not suppressed, but rather increased to 1,170 \u00b5V (). The SEP studiesusing median nerve stimulation showed normal values with no statistically significant difference between sides ().", "age": [ [ 72.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3438424.xml", "relevant_articles": { "11685404": "2", "8026122": "2", "28858700": "2", "28955250": "2", "22695363": "2" }, "similar_patients": { "3438424-2": "1", "6267358-1": "0", "3411427-1": "1", "3825955-1": "0", "7381274-1": "1" } }, { "human_patient_id": "217", "human_patient_uid": "3438424-2-M", "PMID": "22977783", "title": "Alien Hand Syndrome in Stroke - Case Report & Neurophysiologic Study -", "patient": "A 47 year-old woman developed left side weakness after a right ACA infarction and was transferred to the department of rehabilitation medicine 3 weeks post onset. She had no remarkable medical history but was diagnosed with diabetes at our hospital. She had no family history of stroke. On transfer to our department, her mental status was alert but she had mild attention deficit. Her speech was normal and a K-MMSE score was 25. MMT grades of her left upper and lower extremities were all 3/5, except the wrist flexor and wrist extensor scores were both 2/5. She could perform fine motor activity with her left hand. She had no spasticity in her elbow and knee joints, with a MAS score of zero. Her deep tendon reflex was normoactive. Her superficial sensory responses were intact, but proprioception was impaired. She complained that her left hand was out of her control; her left hand \"took away\" objects out of her right hand. Her hands appeared to be directed at opposing purposes, showing 'intermanual conflict'. A brain MRI revealed acute cerebral infarction at the right ACA region, mainly at the right frontal lobe and corpus callosum (). In this case, when we stimulated the right motor cortex area, the rMT was 44% and the MEP amplitude was 314 \u00b5V. At the left motor cortex area, the rMT was 44% and the MEP amplitude was 456 \u00b5V. In the ICF study, when we stimulated the right motor cortex area, the MEP amplitude was increased to 876 \u00b5V. In the ICI study, theamplitude was not suppressed, but rather increased to 867 \u00b5V (). The SEP studies using median\nnerve stimulation were normal with no significant differences between sides ().", "age": [ [ 47.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC003xxxxxx/PMC3438424.xml", "relevant_articles": { "7517690": "12", "9311007": "0", "9490897": "12", "2184966": "12", "11296406": "0" }, "similar_patients": { "3438424-1": "", "5449119-1": "0", "3309387-1": "1", "4392685-1": "1", "6786383-1": "1" } }, { "human_patient_id": "218", "human_patient_uid": "7275243-1-M", "PMID": "32550029", "title": "Apexification with Calcium Hydroxide vs. Revascularization", "patient": "A healthy 7-year-old boy was referred from the dental emergency department to the pediatric dentistry department in the Dental School of Casablanca.\nClinical examination revealed that the child has a flexible splint on maxillary teeth and a coronal restoration with a glass ionomer on 11. Radiographic examination showed incomplete root formation of both central incisors (Nolla's stage 8: short root with thin walls) ().\nBased on the emergency file, it was found that the boy fell at school three weeks ago. Clinical examination revealed that 11 had a lateral luxation with an uncomplicated crown fracture and 21 had a subluxation. Emergency treatment was carried out on the same day and consisted of reattaching the tooth fragment, repositioning 11 with a gentle digital pressure, and stabilizing it with a flexible splint. One week after trauma, the patient presented with intraoral swelling on 11 revealing necrosis. Consequently, an endodontic treatment was performed and the root canal was instrumented using hand files with gentle irrigation using 0.5% sodium hypochlorite. Calcium hydroxide was placed as intracanal medication. The access cavity was sealed with glass ionomer cement.\nFor this purpose, the apexification technique using calcium hydroxide has been initiated on 11. The calcium hydroxide was renewed once resorbed. A regular clinical and radiological follow-up was carried out to check the vitality of 21 ().\n6 months after the beginning of the treatment of 11, a radiolucent lesion in the periapical region was detected on 21 (). The negative response to the cold test confirms a pulp necrosis. Considering the immaturity of the tooth and the thinness of the root and after obtaining parental consent, the optimal treatment option was revascularization.\nAn access cavity was made under a dental dam. Once the canal orifice was well cleared, gentle root canal irrigation was performed with 2% sodium hypochlorite followed by irrigation with saline solution. Subsequently, the root canal was dried with large paper points until they were removed without evidence of fluids and filled with calcium hydroxide used as intracanal medication. A temporary restoration using a glass ionomer was placed.\nThe patient was recalled 4 weeks after the first appointment. The tooth was clinically and radiologically asymptomatic. In the second session, the tooth was anaesthetized, accessed, and irrigated gently with 2% sodium hypochlorite followed by saline solution to remove calcium hydroxide. The bleeding was induced with manual K files introduced into the root canal and placed at 2 mm beyond the working length. Once the blood clot was formed, MTA was placed in the cervical third of the root canal (). The access cavity was sealed with a glass ionomer.\nThree months after performing revascularization treatment, visible root edification was observed (). The 6-month follow-up showed an important thickening of the root with calcification of the canal. Concerning 11, a renewal of the calcium hydroxide was carried out once the material has been absorbed ().\nAfter 24 months of apexification treatment on 11, we noticed the formation of an apical barrier which was easily crossable with a file (). To solve that problem, the apical third was sealed using MTA and then the coronal two-third with warm gutta-percha. Concerning 21, the canal was almost completely obliterated with an extension of the root ().", "age": [ [ 7.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7275243.xml", "relevant_articles": { "18554187": "123", "23402520": "13", "34912424": "3", "19519861": "123", "20002804": "123" }, "similar_patients": { "5110882-1": "123", "8375852-1": "123", "3284018-1": "123", "8328711-1": "123", "7558519-1": "123" } }, { "human_patient_id": "219", "human_patient_uid": "4159969-1-M", "PMID": "25175670", "title": "Oliguric acute kidney injury as a main symptom of bradycardia and arteriosclerosis resolved by pacemaker implantation: a case report", "patient": "A 76-year-old man of Caucasian ethnicity was hospitalized for syncope 2 years before index hospitalization. Comorbidities included liver cirrhosis (Child-Pugh A) due to non-alcoholic fatty liver disease, type-2 diabetes, hypertension, and suspected Alzheimer-type dementia. Etiologically unclear transitory ischemic attacks had been diagnosed before. Holter electrocardiogram (ECG) showed a first-degree atrioventricular block and three episodes of bradycardia with minimal cardiac frequencies of 37bpm that were deemed unlikely as a cause for syncope. Schellong test revealed a hypodynamic cardiac response, that is, his heart rate stayed at 50bpm after change from supine to upright position. Hypoglycemia (under insulin therapy) was not detected prior, during or after hospitalization. A concomitant AKI (AKIN 2, maximum creatinine: 297\u03bcmol/L) was regarded as pre-renal, and syncope was attributed to arterial hypotension and hypovolemia. Following intravenous rehydration, he was discharged with spironolactone 150mg/day and propranolol 100mg/day for liver cirrhosis, donepezil 10mg/day for suspected dementia, amlodipine 10mg/day, and insulin subcutaneous injection (average: 50IU/day).\nAt index hospitalization, he (body mass index: 35.2) was admitted with nausea and vomiting for 3 days, as well as dizziness due to a presumed hepatic encephalopathy. On admission, vital parameters including blood pressure (150/80mmHg), heart rate (62bpm), and temperature and physical examination including cardiopulmonary state were unrevealing. Specifically, ascites and peripheral edema were absent. He was oriented to person, place, and time. Physical reactions were slowed though. Compared to baseline values prior to hospitalization (serum creatinine: 139\u03bcmol/L, estimated glomerular filtration rate\n[]: 43.2\u03bcmol/L/1.73m2), serum creatinine was elevated on admission (Table \n). Glutamate-oxaloacetate transaminase (0.64), gamma-glutamyltransferase (2.46), and international normalized ratio (1.13) were slightly elevated; serum albumin (31g/L) was decreased. Other laboratory values including inflammation parameters (leukocyte count, C-reactive protein), total serum protein, bilirubin, glutamate-pyruvate transaminase, and alkaline phosphatase were within normal range. Partial respiratory insufficiency and metabolic acidosis (pH: 7.326, oxygen partial pressure: 55.8mmHg, carbon dioxide partial pressure: 29.0mmHg, bicarbonate: 14.7mmol/L, base excess: -9.7) were found on admission. His urine test showed microalbuminuria (<300mg/day), microscopic hematuria, and leukocyturia consistent with urinary tract infection. Concomitant medication largely remained unchanged since discharge 2 years ago. ECG showing sinus rhythm and the known first-degree atrioventricular block was without change since the last ambulatory cardiology check 1 year before. During hospitalization, he was bed-bound. Gastroscopy proved helicobacter-negative gastritis. An intravenous fluid challenge using sterile saline was performed for suspected, however clinically inapparent, hypovolemia. Despite fluid challenge, oliguria suddenly developed shortly after admission, serum creatinine remained high (Table \n). A pre- and post-renal cause of AKI was excluded. Myocardial infarction as a possible cause of hemodynamic instability was ruled out in repeat laboratory and ECG examinations. Echocardiography showed a normal systolic left-ventricular function, yet left-ventricular hypertrophy and diastolic dysfunction accompanied by a mild mitral regurgitation and an enlarged left atrium. Nephrotoxins and/or nephrotoxic medications were not applied. Euglycemia was verified during the whole index hospitalization. Kidney sonography revealed normal-sized kidneys with a centralized arterial perfusion (Figure \n), and an increased renal resistive index (1.0 on both sides) reflecting a diastolic no-flow condition. Of importance, a bradycardia (less than 50bpm) was present during ultrasound. Propranolol was discontinued at once, thereafter urine output improved (Table \n). In a Holter ECG 3 days following propranolol cessation, an intermittent third-degree atrioventricular block with pauses for less than 3 seconds was found (Figure \n). He was subjected to pacemaker insertion on day 11 after admission. Thereafter, renal function in terms of urine output and serum creatinine remained stable. Beta-blocker therapy was reinstituted. By discharge to a rehabilitation facility 14 days after pacemaker insertion, renal function in terms of serum creatinine further improved (Table \n), body weight remained constant in comparison to admission, and peripheral edema was absent.\nAt discharge, spironolactone 50mg daily, propranolol 25mg thrice daily, amlodipine (5mg daily), donezepil (10mg daily), and antidiabetic medication including sitagliptin and insulin were maintained. Ramipril (5mg daily), torasemide (20mg daily), acetylsalicylic acid (100mg daily), simvastatin (20mg daily), and pantoprazole (20mg daily) were prescribed.\nRenal recovery continued after discharge, the prehospitalization level of creatinine was reached within 1 month following discharge.During the 4 months following discharge, amlodipine and ramipril were discontinued. Otherwise, medication has not changed. Syncope has not occurred again. His overall condition improved considerably. He was not bed-bound; he was alert and he could walk short distances with walking aid. Symptoms consistent with hepatic encephalopathy or progressive dementia were not present. Four weeks after discharge, his mini-mental state examination yielded 22 (out of 30) points. A neurologic reassessment was recommended regarding the ongoing donepezil treatment. At 4-months follow-up, sonography of his kidneys showed persistent renal resistive index of 1.0 on both sides (Figure \n).", "age": [ [ 76.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4159969.xml", "relevant_articles": { "25175670": "123", "27784284": "123", "32274878": "0", "11853904": "12", "26715569": "0" }, "similar_patients": { "7001335-1": "0", "5081674-1": "123", "5848589-1": "0", "8404648-1": "123", "3937139-1": "0" } }, { "human_patient_id": "220", "human_patient_uid": "3863515-1-M", "PMID": "24369470", "title": "Biventricular Failure due to Stress Cardiomyopathy after Pericardiectomy for Constrictive Pericarditis", "patient": "A 40-year-old woman originally from Ecuador was referred to our institution for evaluation of progressive dyspnea on exertion. Two months prior to her presentation, she was treated at an outside hospital for presumed community acquired pneumonia with symptoms of dyspnea on exertion, fevers, chills, and productive cough. After not seeing measurable improvement, the patient then presented to the emergency department at another institution where a transthoracic echocardiogram (TTE) revealed that the patient had a large pericardial effusion with tamponade physiology and a normal left ventricular ejection fraction (LVEF) of 60%. Pericardiocentesis was performed with 700 cc of fluid removed, which grew Mycobacterium tuberculosis (TB). The patient's purified protein derivative (PPD) skin test was positive. The patient was started on anti-TB therapy and discharged.\nShe continued to complain of persistent dyspnea on exertion and thus was referred to our institution for a repeat of TTE at the outpatient cardiac diagnostic center. TTE revealed the rare presystolic flow through pulmonic valve, excessive variation in the mitral valve and aortic valve spectral Doppler velocities, and markedly thickened pericardium (Figures \u2013), consistent with constriction []. The study also demonstrated septal bounce, small pericardial effusion, and pleural effusion. The patient was admitted for further evaluation. On admission, the patient's vital signs showed a temperature of 37 degrees Celsius, a blood pressure of 108/70, a heart rate of 117, and respiratory rate of 20 with an oxygen saturation of 99% in room air. Her exam revealed a young woman in mild distress with 11 cm internal jugular vein distension, decreased breath sounds at lung bases bilaterally and scant bibasilar crackles, regular tachycardia, and bilateral lower extremity edema. Her BNP was 124, CRP was 5.1, and WBC count was 5.9 with a normal differential. Her complete metabolic panel was unremarkable. The patient underwent a left and right heart catheterization due to the suspicion of constrictive pericarditis. A coronary angiogram demonstrated no obstructive epicardial coronary artery disease. The right heart catheterization revealed elevated right atrial pressure, right ventricular end diastolic pressure, and an elevated pulmonary capillary wedge pressure. Simultaneous right and left ventricular pressure tracings demonstrated discordant respiratory variation consistent with constrictive pericarditis. A computed tomography (CT) scan of her chest with contrast confirmed marked thickening of both the parietal and pleural pericardial surfaces, measuring up to 13.4 mm in thickness, and a large right-sided pleural effusion (Figures and ). Cardiac magnetic resonance imaging (MRI) with and without contrast showed diffuse pericardial thickening (), which showed intense delayed gadolinium contrast enhancement () that did not involve the myocardium. Additionally, there was a greater interventricular septal bounce during diastole and inspiration, consistent with chronic inflammatory constrictive pericarditis.\nDue to her worsening symptoms and diagnosis of constrictive pericarditis, she was referred to cardiothoracic surgery at our institution for pericardiectomy. The surgery was without incident and the surgical samples were sent for pathology. While being negative for AFB by concentrated smear and culture, the stripped pericardium showed noncaseating granulomas, extensive fibrosis, and severe lymphohistiocytic infiltrate.\nIn the immediate postoperative period, the patient began to develop signs and symptoms of central volume overload, heart failure, and hypotension. An electrocardiogram (ECG) at this time showed sinus tachycardia with nonspecific ST-T abnormalities with poor R wave progression, new from prior ECGs. A subsequent TTE on postoperative day one showed significant changes from the prior study, with severely decreased biventricular dysfunction. The LVEF was severely depressed at 26%, with early evidence of elevated filling pressure within the left ventricle, indicated by the time difference between pulmonary vein (Ar) duration and mitral A-wave duration (Ar-A) of positive 46 ms. For the right ventricle, fractional area change (FAC) was abnormally low at 29%, with reduced tricuspid annular plane systolic excursion (TAPSE) distance of 0.96 cm. There was also moderate tricuspid regurgitation, enlarged right atrium (area 27 cm2), and moderately elevated pulmonary artery systolic pressure of 41 mmHg. There was akinesis of the entire apical and midventricular segments of both the right and left ventricles (Figures \u2013) with hypercontractile base. Findings were consistent with stress cardiomyopathy.\nWhile in critical condition postoperatively, the patient had episodes of atrial fibrillation and atrial tachycardia, for which she was chemically cardioverted with intravenous amiodarone, with subsequent conversion to sinus rhythm. Initially, the patient required multiple vasopressors and inotropes (epinephrine, norepinephrine, milrinone, and dopamine drip) to maintain her blood pressure and cardiac output, while gentle diuresis was achieved carefully for the symptoms of heart failure. Once the patient was hemodynamically stable, she was placed on appropriate oral medical therapy, including carvedilol and furosemide, followed by gradual clinical improvement and was able to be discharged on postoperative day 10. Due to decreased urine output and hypotension, an angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker was not initiated at the time. A posthospital TTE 7 weeks after discharge showed normalized function of both the right and left ventricles (Figures \u2013).", "age": [ [ 40.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3863515.xml", "relevant_articles": { "18754936": "123", "1579752": "12", "24995118": "0", "20666277": "123", "11357803": "123" }, "similar_patients": { "7501910-1": "123", "6426027-1": "123", "5984425-1": "123", "5467283-1": "123", "2771803-1": "1" } }, { "human_patient_id": "221", "human_patient_uid": "4280383-1-M", "PMID": "25566486", "title": "Apraxia of Eyelid Opening After Brain Injury: A Case Report", "patient": "A 49-year-old and otherwise healthy man underwent a traffic accident and was transferred to emergency room in an unconscious state. Brain computed tomography (CT) revealed traumatic subdural and epidural hemorrhage at the bilateral frontal lobes and right temporal lobe. No abnormality in the extrapyramidal motor system including the basal ganglia was present (). The initial Glasgow Coma Scale (GCS) score was 5 (eye opening response [E]=1, verbal response [V]=0, motor response [M]=4). After receiving burr-hole trephination and hematoma drainage, the patient was reevaluated to have a GCS score of 11 (E1, V5, M5). Although verbal and motor responses improved after surgery, he was unable to open his eyes even with a strong painful stimulus. In spite of gradual recovery of mental status and motor function, voluntary eye opening was still not observed. After being transferred to the rehabilitation unit, the patient was examined for the neurological function with mental status being alert and the Mini-Mental State Examination score at 7. He exhibited left side weakness that was graded fair to good in a manual muscle test. The pupils were 3 mm in diameter, symmetrical, and equally reactive with extraocular movements fully intact. With the patient unable to open his eyes on command, an examiner elevated the patient's eyelid and found no abnormality in the ocular motor function. No evidence of other apraxia, such as buccofacial and limb apraxia, was present. He received comprehensive rehabilitation treatment, but AEO did not improve. We planned on treating the patient with levodopa/benserazide 200/50 mg twice a day with the informed consent of the patient. On the fifth day of the treatment, he started to open his eyes on command intermittently (). We confirmed no visual loss since he was able to recognize color and count fingers during spontaneous eye opening. With continued treatment, the interval between command and eye opening gradually shortened while the duration of spontaneous eye opening increased. This result was even more apparent when eating and undergoing physical training. We presumed that the dopaminergic treatment had a beneficial effect on AEO and tried to increase dose frequency from twice to three times daily to investigate a dose-dependent response. However, in the third day of the dosage modulation, aggressive behaviors emerged, and the treatment was withheld for three days. Even though the aggressiveness subsided shortly thereafter, the patient again exhibited difficulty in voluntary eye opening. After the resolution of the behavioral problem, the treatment was resumed twice a day. With AEO ameliorated, as evident in spontaneous eye opening during eating and physical training, the patient was discharged and has been closely followed up on an outpatient basis with the treatment of levodopa/benserazide 200/50 mg twice a day. He is currently capable of voluntary eye opening that is sustained much longer than before being discharged.", "age": [ [ 49.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4280383.xml", "relevant_articles": { "25566486": "123", "25932428": "1", "8810853": "12", "17576707": "1", "15040654": "13" }, "similar_patients": { "7939211-1": "0", "7395526-1": "123", "4514315-1": "0", "7151171-1": "123", "7407378-1": "123" } }, { "human_patient_id": "222", "human_patient_uid": "4346118-1-M", "PMID": "25881250", "title": "Successful treatment of severe sepsis and diarrhea after vagotomy utilizing fecal microbiota transplantation: a case report", "patient": "Our patient was a 44-year-old woman who underwent proximal gastrectomy and bilateral truncal vagotomy for a gastric neuroendocrine tumor. Her immediate postoperative course was uneventful, and no surgical complications, such as anastomotic fistula, were observed. On the third postoperative day, she presented with abdominal discomfort and bloating, nausea and vomiting (Figure ). On the fourth postoperative day, the patient developed severe, watery diarrhea. Her blood pressure suddenly decreased to 60/38 mmHg for unknown reason. An examination revealed that her body temperature was 37.2\u00b0C, her pulse was increased at 126 beats/minute, her respiratory rate was 28 breaths/minute and her blood oxygen saturation was 86%. A complete blood count was obtained, and the results revealed a white blood cell count of 2.9 \u00d7 109/L with 83% neutrophils and 13% lymphocytes. Analysis of blood gas showed that the patient\u2019s blood lactate level was 8.2 mmol/L and base excess was \u22129.2. Serum level of C-reactive protein (CRP) was 143.4 mg/L. Blood and urine were collected for bacterial culture, and both test results were negative. The patient was urgently transferred to the ICU. On the fifth postoperative day, her temperature rose to 39.6\u00b0C and her pulse rate was 145 beats/minute, and she developed respiratory distress (Additional file ). Endotracheal intubation was performed to allow mechanical ventilation (Figure ). Her degree of diarrhea was aggravated, with a passage of greenish, watery liquid exceeding 1,800 ml. Her white blood cell count had increased to 7.9 \u00d7 109/L, and the proportion of neutrophils had risen to 98%. Her platelet count had decreased, and a coagulation test showed a prolonged time to coagulation. Sulbactam, ornidazole, vecuronium, norepinephrine, hydrocortisone and intensive intravenous fluids were administered, owing to concern about septic shock []. The patient was then treated with venovenous extracorporeal membrane oxygenation (VV-ECMO) via percutaneous access and continuous renal replacement therapy (CRRT). During the following days, the patient\u2019s vital signs and clinical condition gradually stabilized. VV-ECMO and CRRT were stopped on the 12th postoperative day, but the patient\u2019s diarrhea did not shown any improvement. On the next day, her fever reoccurred, with a peak temperature of 38.7\u00b0C (Additional file ). Her white blood cell count rose further to 18.0 \u00d7 109/L with 89% neutrophils and 10% lymphocytes. Her blood cultures now yielded Acinetobacter baumannii and Enterococcus faecalis, revealing a polymicrobial sepsis. Multiple antibiotics, including imipenem, caspofungin, penicillin and/or linezolid, and even probiotic bifidobacteria, were administered. Abdominal computed tomography (CT) was performed on days 15 and 22 postsurgery, and no intraabdominal free fluid or abscesses was noted (Additional file and Additional file ). The therapeutic strategies with antibiotics and probiotic were continued until 28 days, when the patient still had a fever (38.3\u00b0C) and the volume of watery stools reached 2,855 ml. On that day, the patient\u2019s blood culture grew Propionibacterium acnes. Her white blood cell count returned to normal, but her CRP level remained as high as 103.3 mg/L. The timeline shown in Figure depicts the temporal course of our patient\u2019s treatment.", "age": [ [ 44.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4346118.xml", "relevant_articles": { "15952487": "0", "23160592": "0", "21654166": "123", "16156319": "123", "28557733": "0" }, "similar_patients": { "7866958-1": "123", "8627859-1": "13", "6208074-1": "0", "8571909-1": "123", "6658372-1": "123" } }, { "human_patient_id": "223", "human_patient_uid": "5009574-1-M", "PMID": "27625889", "title": "Total temporary occlusion of blood flow for several hours to treat a giant deep arteriovenous malformation: A series of multiple operations to save a young life", "patient": "The 9-year-old otherwise healthy girl presented with minimal physical clumsiness and progressive mild left hemiparesis. Magnetic resonance imaging (MRI) revealed a giant deep AVM. This lesion was considered a grade-V AVM according to Spetzler\u2013Martin scale. Surgical treatment of the AVM was declined as it was too risky. Radiosurgical treatment was instituted due to the size and location of the AVM. She received one course of radiotherapy (20 Gr) resulting in a slight reduction in the size of the AVM. Last follow-up digital subtraction angiography (DSA) at the age of 12 showed no change in AVM [Figure and ]. At the age of 18, she admitted to our hospital with loss of consciousness and left hemiparesis (mRS score 5). A computed tomography (CT) scan revealed large intracerebral hemorrhage [] due to ruptured arteriovenous malformation.\nThe decision on the surgical treatment of the AVM was made with a help of endovascular embolization. Onyx embolization was admitted with minor success. Treatment continued with microsurgery. The patient was taken to the operative theater for the removal of intracerebral hematoma and resection of the AVM. During the evacuation of hematoma major intraoperative bleeding (1 L) occurred from Onyx embolized intranidal aneurysm. Bleeding was effectively held by emergency clipping of some feeders originating from the middle cerebral artery (MCA). Resection of the AVM could not be performed because of the unstable medical conditions of the patient.\nPostoperatively, the patient clinical condition was the same neurologically as during admission. However, 3 days after the first operation, the patient's condition deteriorated suggesting intracranial hypertension. The patient underwent a placement of external drainage catheter with the intracranial pressure monitor. Intracranial hypertension was eliminated. Further treatment continued with a new round of endovascular modality. A new attempt of Onyx embolization through the posterior cerebral artery (PCA) was made. On the same day, the patient underwent a second microsurgical operation using the same craniotomy. We used total temporary clipping under mild hypothermia (33\u00b0C) for almost 4 hours; P2 segment of PCA, A1 segment of anterior cerebral artery, anterior choroidal artery (AChA), and the supraclinoid segment of internal carotid artery (ICA) []. Most of the lateral part of AVM underwent removal []. A postoperative angiogram demonstrated remaining medial and some of the lateral parts of AVM []. MRI with diffusion-weighted imaging (DWI) performed next day showed a lack of global ischemia []. The next day the patient underwent the third operation using the same craniotomy. Remaining part of the medial AVM was completely removed, and only a small lateral part was left.\nThree weeks after the third operation, shunt for cerebrospinal fluid diversion was inserted, and the patient remained conscious with left hemiparesis. The patient was transported to the department of neurology for rehabilitation. However, few days later, new minor bleeding occurred, adjacent to the residual part of the AVM. Two embolizations were performed through MCA and PCA. Residual part filling via MCA was completely occluded, however, small residual filling via PCA remained [Figure and ].\nShunt for cerebrospinal fluid diversion was removed. Ten days later, the patient underwent the last microsurgical operation. Eventually, AVM was completely occluded [Figure \u2013]. The patient was discharged with strong left hemiparesis, visual changes, memory difficulties, and aphasia (mRS score 4). These symptoms gradually improved, and 5 years after her initial surgery, she could walk without assistance, however, visual changes and memory difficulties remained (mRS score 3) [].", "age": [ [ 9.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5009574.xml", "relevant_articles": { "26015523": "123", "28530159": "13", "8321406": "123", "2234310": "123", "19636505": "123" }, "similar_patients": { "3262997-1": "123", "3883274-1": "123", "4209707-1": "123", "8482807-2": "123", "7820263-1": "123" } }, { "human_patient_id": "224", "human_patient_uid": "4691603-1-M", "PMID": "26788381", "title": "Recurrent Hepatocellular Carcinoma in Patient with Crohn's Disease: Incidental or Expected Outcome of Azathioprine?", "patient": "We present a case of a 62-year-old male with 42-year history of small intestinal CD diagnosed at the age of 20, requiring two small bowel resection surgeries during this course of time. Our patient was solely on prednisone therapy for an extended period of time and switched to AZA (150 mg daily) for the last 21 years with relatively well controlled symptoms. During routine follow-up screening tests, he was incidentally found to have left lobe liver mass and was diagnosed with HCC for which he received left lobe hepatectomy at the age of 58. The AZA dose was reduced to 50 mg daily.\nOn subsequent follow-up, four years after the initial resection, he was found to have liver mass and was admitted to the hospital for further evaluation. On presentation to hospital, the patient appeared well without any evidence of jaundice or stigmata of chronic liver disease. Preoperative blood work including liver profile and viral hepatitis markers was entirely normal: AST 18 U/L (<37 U/L), ALT 16 (<60 U/L), albumin 3.5 g/dL (3.5\u20135 g/dL), bilirubin 0.8 mg/dL (0.3\u20131.2 mg/dL), and INR 1.0, alpha-fetoprotein 10.3 ng/mL (<6.1 ng/mL), prothrombin time 13.3 seconds, and platelet count 210/\u03bcL.\nTriple phase contrast enhanced CT of abdomen showed solitary mass in the segment 5 of the right lobe measuring 2.2 \u00d7 1.6 \u00d7 2.1 cm, with arterial enhancement and early wash out in the venous phase, and no evidence of lymphadenopathy or extrahepatic metastasis (Figures and ).\nThe decision toward surgical excision of the tumor was made. Patient underwent laparoscopic resection of segment 5 with no postoperative complications. Microscopically, the resected mass showed moderately differentiated hepatocellular carcinoma without evidence of microvascular invasion ().\nThere was no postoperative adverse events and AZA was discontinued and patient was kept on oral budesonide.", "age": [ [ 62.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4691603.xml", "relevant_articles": { "9873092": "123", "21667209": "123", "30642152": "0", "34138407": "123", "32990785": "123" }, "similar_patients": { "8020406-1": "13", "6313029-1": "12", "4531615-1": "12", "6758958-1": "12", "4461943-1": "1" } }, { "human_patient_id": "225", "human_patient_uid": "3076253-1-M", "PMID": "21450058", "title": "Brucellosis presenting as piriformis myositis: a case report", "patient": "A 19-year-old Caucasian man presented to our emergency department complaining of right hip pain and fever. Our patient had been in excellent health until pain developed three days before his presentation. A day before admission, his temperature rose to 38.5\u00b0C, with rigors and sweating. He had no history of tobacco use, alcohol use, intravenous drug use, or any other factors for HIV infection. Our patient's medical history was unremarkable. A physical examination revealed painful hip movement and a positive straight leg raise sign, without any other significant abnormalities. Further investigation was deemed necessary and our patient was subsequently admitted to the hospital.\nResults of a hip X-ray were unremarkable. Laboratory tests revealed a white blood cell count of 14,900 cells/mm3 (normal 4000 to 11,000 cells/mm3) with 70% neutrophils (normal 50% to 70%). He also had elevated inflammatory markers with erythrocyte sedimentation rate (ESR) 120 mm/1 hour (normal: 0 to 20 mm/1 hour) and a C-reactive protein (CRP) level of 16.76 mg/dL (normal: <0.8 mg/dL). His creatine phosphokinase (CPK) level was 52 IU/L (normal: <190 IU/L) and lactate dehydrogenase (LDH) level was 366 IU/L (normal 120 to 230 IU/L). Specimens of blood and urine were obtained for culture. The same day, he was submitted to a computed tomography (CT) scan of the abdomen, which did not show any significant abnormality.\nA pelvic magnetic resonance imaging (MRI) scan was performed two days later with a 1 Tesla Gyroscan Intera scanner. Imaging included spin-echo (SE) T1-weighted imaging, short tau inversion recovery (STIR), and SE T1-weighted imaging fat suppression with intravenous gadolinium contrast injection (FAT-SAT+GD) images in the axial plane and SE T1-weighted imaging, TSE T2-weighted imaging, STIR, and T1-weighted imaging SE FAT-SAT+GD in the coronal lane.\nThe examination revealed a markedly enlarged right piriformis muscle on the T1-weighted image (Figure ). On the STIR images there was an abnormally high signal intensity in the muscle, suggestive of edema (Figure ).\nAfter gadolinium administration there was widespread pathological enhancement, consistent with the presence of myositis. Inflammatory changes were also depicted in the adjacent soft tissues, spreading along the fascial planes (Figure ).\nSerology with a standard tube agglutination test revealed a titer of >1/1280 for B melitensis. Two blood culture tests were also positive for B melitensis. Antibiotic treatment for brucellosis was initiated, with doxycycline 100 mg twice daily, rifampin 900 mg daily and ciprofloxacin 500 mg twice daily.\nThen, three days after the initial MRI scan our patient was submitted for a bone scintigram, which showed an increased uptake of radiopharmaceutical agent in the right hip, as well as high osteoblastic activity in the right sacroiliac joint. Our patient was dismissed from hospital three weeks later. After six months of antibiotic treatment our patient was asymptomatic. At that time he was submitted to a follow-up MRI, which exhibited complete resolution of the previous findings (Figure ). Our patient has remained asymptomatic to date.", "age": [ [ 19.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3076253.xml", "relevant_articles": { "15776239": "2", "15778951": "0", "9428073": "2", "15065172": "0", "16481909": "2" }, "similar_patients": { "7936015-1": "123", "8447970-1": "123", "4137595-1": "123", "3894445-1": "0", "8460931-1": "123" } }, { "human_patient_id": "226", "human_patient_uid": "2633324-1-M", "PMID": "19159470", "title": "Non-prostatic pathology on prostate needle-biopsy \u2013 colorectal carcinoid: a case report", "patient": "The 71-year-old Caucasian male subject without any comorbidity participated in the Dutch section of the European Randomized Study of Screening for Prostate Cancer (ERSPC). This study has been ongoing for almost 15 years in 8 European countries and aims to explore the feasibility of population-based screening for prostate cancer []. Almost 270.000 men have been randomized to the screening or control group. Prostate biopsy indications have changed during the course of the study, but include abnormal digital rectal examination (DRE) and/or transrectal ultrasound (TRUS) findings, and/or elevated levels of prostate specific antigen (PSA) in the blood serum and/or PCA3 (Prostate Cancer Gene 3) in the urine [].\nIn October 2007 our patient was screened using a measurement of the PSA serum level. His PSA was with 1.2 ng/ml below the biopsy-threshold of 3.0 ng/ml. However, as this man had also consented in participating in the PCA3 side study, his urinary sample (collected after DRE) was subjected to PCA3 analysis, which resulted in a score of 13. Since a threshold of PCA3 > 10 was used as a biopsy indication, this prompted DRE, TRUS, and lateralised sextant TRUS-guided prostate biopsies [].\nNo abnormalities were found during DRE and TRUS. Prostate volume measured by planimetric calculation was 30.9 cc. Histopathologic evaluation revealed no prostate cancer in the 6 biopsy-cores. However, in 2 of the 3 needle-biopsies that also contained rectal mucosa (number IV and V; taken from the left lateral side of the basis and middle of the prostate), a carcinoid was coincidentally found in the rectal mucosa. Small nests, glands and strands consisting of epithelial cells were present within the rectal muscularis mucosae (Figure ). These epithelial cells were characterised by an eosinophilic, finely granular cytoplasm, a round nucleus and inconspicuous nucleolus. No significant atypia, mitotic activity or necrosis was encountered. Additional immunohistochemical stainings showed strong expression of chromogranin and synaptophysin compatible with a carcinoid/low-grade neuroendocrine tumour. Molecular investigation eliminated the option of mixing of specimens.\nOur patient was informed about the benign outcome of his prostate biopsies and the remarkable finding in the rectal mucosa by the principal investigator of the ERSPC and he was advised to make an appointment with the gastroenterologist. Besides constipation, no complaints of the gastroenterologic tract or lab changes were found. A colonoscopy was performed, during which two polyps were seen, the first at 2 cm from the anus and the second at 90 cm. The carcinoid was not detected during colonoscopy, probably because it was located in the submucosa. Both polyps were removed endoscopically and sent in for pathologic examination. The lesion in the rectum was a tubulovillous adenoma with low-grade dysplasia. The second was a hyperplastic polyp without any adenomatous changes. Because of the first finding, the patient was advised to undergo a control colonoscopy after 6 years. Until today the incidental finding of carcinoid did not have any clinical consequences for this patient.", "age": [ [ 71.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC002xxxxxx/PMC2633324.xml", "relevant_articles": { "16388507": "2", "9839522": "2", "18406045": "2", "22104592": "2", "24815452": "2" }, "similar_patients": { "6884880-1": "0", "4262882-1": "0", "4904708-1": "12", "5033499-1": "0", "6884880-2": "0" } }, { "human_patient_id": "227", "human_patient_uid": "4123506-1-M", "PMID": "25133008", "title": "Achalasia Secondary to Submucosal Invasion by Poorly Differentiated Adenocarcinoma of the Cardia, Siewert II: Consideration on Preoperative Workup", "patient": "A 51-year-old man suffered from progressive dysphagia to solids for over about 6 months and slow weight loss of 5 kg was referred to our institution with the presumptive diagnosis of achalasia. Preoperative workup consisted in a careful clinical history, correct interpretation of anamnesis, and symptoms; then esophagogastroduodenoscopy was performed and showed a dilated esophagus without evident mucosal lesion, and the passage through the cardia was more difficult: \u201ccrossing snap\u201d passage. Manometry revealed absence of peristalsis and impaired swallow-induced LES relaxation with classic manometric pattern (). The barium swallow showed an emptying defect with \u201cbird beak\u201d sign and narrowing at esophageal junction (). We made a diagnosis of esophageal achalasia and performed a laparoscopic Heller's myotomy with Dor fundoplication (Figures and ). We use the laparoscopic approach to perform this kind of surgery. Several studies demonstrate that this is the best way to treat this pathology. We use Veres' needle placed in Palmer's point to create pneumoperitoneum and then we place five trocars: the first 10\u201312 mm trocar is placed in supraumbilical region, two 10\u201312 mm trocars in right and left side, and two 5 mm trocars in paraxiphoid region and left iliac region []. The surgical exploration of peritoneal cavity does not reveal any anatomic abnormality or suspect neoplastic lesions or secondary localizations. Two months after surgery, the patient complained of worsening dysphagia. We repeated several esophagogastroduodenoscopies with numerous biopsies that showed only cardia inflammation and were negative for malignancy. Tumor markers were negative too. Balloon dilatation was performed to improve symptoms. Persisting dysphagia, one month after we performed EUS with biopsies, showed infiltrating gastric adenocarcinoma of the cardia (T3 WHO, Siewert II) (). After staging CT scan, total gastroesophagectomy was performed, with D2 lymph-node resection and Roux-en-Y reconstruction. The surgical specimen contained a thick, hard tumor 3,6 \u00d7 2,5 \u00d7 1,3 cms located in the gastroesophageal junction (Siewert II), extensively infiltrating the wall and reaching in some areas the subserosal layer (Figures and ). Histological finding was \u201cpoorly differentiated adenocarcinoma (WHO: G3)\u201d (Figures and ).", "age": [ [ 51.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4123506.xml", "relevant_articles": { "32095124": "123", "11330375": "123", "7297373": "12", "33207406": "123", "10941858": "13" }, "similar_patients": { "2879845-1": "1", "2749184-1": "13", "4729731-1": "13", "5422214-1": "13", "2615037-1": "13" } }, { "human_patient_id": "228", "human_patient_uid": "4518353-1-M", "PMID": "26229565", "title": "Amyloidosis involving the respiratory system: 5-year's experience of a multi-disciplinary group's activity", "patient": "A 71-year-old non-smoker woman presented at our ambulatory with persistent dyspnea despite many months therapy with systemic steroids and inhaled bronchodilator plus steroids for a previous history of bronchial asthma. Lung function tests showed a plateau in the middle of the expiratory part of the flow-volume curve without significant improvement after short-acting beta2 agonist inhalation, suggesting the presence of intra-thoracic irreversible obstruction []. At the chest X-ray, a relevant latero-lateral stenosis of the distal trachea was evident. Chest computed tomography (CT) scan was then performed showing a diffuse thickening of lateral right tracheal wall until the carina with involvement of right upper lobe bronchus and apical segmental bronchus. Fibrobronchoscopy confirmed the presence of tracheal right deviation with a stenosis of about the 25% of the distal tracheal lumen extended to the right upper lobe bronchus caused by marked mucosal hypertrophy []. Bronchial biopsy was positive to the Congo red stain so the diagnosis of primary tracheo-bronchial amyloidosis (isolated AL) was performed. The presence of extra-pulmonary lesions was then excluded through radiological examination (total-body CT scan) and immunological and serological chemistry tests (immunoglobulins and pro-B-type natriuretic peptid -pro-BNP- measurement, Bence Jones protein lab test, routine blood tests). The patient was successfully treated with the placement of a metallic tracheal stent following a Nd-Yag laser-assisted disobstruction of central airways.", "age": [ [ 71.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC004xxxxxx/PMC4518353.xml", "relevant_articles": { "10862454": "12", "3968279": "2", "9516099": "12", "10723948": "12", "11834039": "0" }, "similar_patients": { "1464140-1": "12", "2768251-1": "12", "5813723-1": "12", "6784665-1": "12", "3833405-1": "12" } }, { "human_patient_id": "229", "human_patient_uid": "4518353-2-M", "PMID": "26229565", "title": "Amyloidosis involving the respiratory system: 5-year's experience of a multi-disciplinary group's activity", "patient": "A 71-year-old male patient, former smoker, had a diagnosis of cardiac amyloidosis treated since few years with talidomide, melphalan, and disodic pamidronate. He presented at our ambulatory with worsening dyspnea. The chest X-ray showed bilateral pleural effusion despite of optimized diuretics therapy. Serum pro-BNP was within normal values. Chest and abdomen CT-scan was performed showing moderate bilateral pleural effusion, pleural thickening with enhancement after contrast mean injection, and multiple micro-calcifications in the distal lung regions and in the spleen. Lung function tests resulted in severe restrictive impairment (vital capacity (VC), total lung capacity (TLC), residual volume (RV), and forced vital capacity (FVC): 40%, 43%, 42%, and 45% of the predicted values) and severe diffusing capacity of the lung for carbon monoxide (CO)(DLCO) reduction (38% of the predicted value). The chemical-physical analysis demonstrated the trasudative nature of the drained pleural fluid. The diagnosis of primary systemic AL amyloidosis with pleural involvement was then performed by means of tissue specimen examination obtained with the Cope needle pleural biopsy.", "age": [ [ 71.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4518353.xml", "relevant_articles": { "19601532": "12", "10611952": "12", "30653153": "12", "10728736": "12", "8960664": "12" }, "similar_patients": { "3521818-1": "0", "6463652-1": "0", "6393107-1": "1", "5728972-1": "0", "4005159-1": "1" } }, { "human_patient_id": "230", "human_patient_uid": "4518353-3-M", "PMID": "26229565", "title": "Amyloidosis involving the respiratory system: 5-year's experience of a multi-disciplinary group's activity", "patient": "A 53-year-old, non-smoker, male patient came to our ambulatory and subsequently admitted in our Respiratory Intensive Care Unit for severe dyspnea associated with severe non-hypercapnic hypoxemia (PaO2/FiO2 ratio 120; PaCO2 28.5 mmHg, pH 7.485). He had a history of chronic kidney failure due to type I membrano-proliferative glomerulonephritis. As the hypoxemia was refractory to high-flow oxygen-therapy (Reservoir mask with O2 at 15 liters per minute), a trial of non invasive ventilation (NIV) delivered via a full-face mask was attempted (mode Pressure-support, PS = 20 cm H2O; PEEP 8 cm H2O; FiO2 0.80); then, after 20 hours, endotracheal intubation and invasive mechanical ventilation resulted mandatory due to NIV failure. Chest CT-scan showed a pattern of bilateral alveolar consolidations and ground glass areas suggesting three possible diagnostic hypotheses: Organizing pneumonia (OP), vasculitis, or Goodpasture syndrome [].\nA large battery of immunological and microbiological investigations resulted negative. Fibro-bronchoscopy with bronchoalveolar lavage fluid (BAL) and transbronchial lung biopsy (TBLB) were performed during NIV; the histological exam of the collected tissue showed a pathologic pattern of unspecific neutrophilic capillaritis. As the patient refused to underwent surgical biopsy, the empiric therapy with intravenous pulsed bolus of cyclophosphamide and steroids was given. He died after a worsening of his clinical conditions, radiological findings, and lung gas exchange. The autopsy reported systemic AL amyloidosis with prevalent lung and renal involvement.", "age": [ [ 53.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4518353.xml", "relevant_articles": { "10836106": "12", "25852758": "123", "25043135": "123", "12033093": "23", "19637990": "13" }, "similar_patients": { "4832462-1": "1", "6664529-1": "1", "8491835-1": "1", "6994211-1": "13", "8059757-1": "13" } }, { "human_patient_id": "231", "human_patient_uid": "8008538-1-M", "PMID": "33781325", "title": "Granulomatous interstitial polymyositis and intramuscular neuritis in a dog", "patient": "A 6-year-old, Norwegian born, intact male Russian Tsvetnaya Bolonka, 6 kg, was referred to the Norwegian University of Life Sciences (NMBU) at the Small Animal Teaching Hospital with a 4.5-months history of progressive weakness. Starting with weakness of the tail and reduced general condition, the clinical signs progressed to include dysphonia, muscle pain, and lameness of the pelvic limbs, more prominent on the right. Two months prior to referral, magnetic resonance imaging (MRI) and computed tomography (CT) of the lumbar region had been performed, demonstrating asymmetrical pelvic limb muscle atrophy involving particularly the right iliopsoas and quadriceps musculature. Several years before the first clinical signs of the progressive weakness appeared the dog was diagnosed with hypothyroidism and had been treated with substitution therapy since then. He had never left Norway.\nGeneral physical examination revealed reduced muscle mass of the proximal muscles of the right pelvic limb and the dog was afebrile (38.8 \u00b0C). On neurologic examination, the dog was ambulatory but paraparetic, more pronounced on the right, with an obvious hypoflexion of the hip joint, bunny-hopping gait, and a paretic tail. Cranial nerves were normal except for the observed dysphonia, whereas postural reactions were decreased in both pelvic limbs with reduced spinal reflexes in the right pelvic limb. The neuroanatomic localisation was considered to be the neuromuscular system. Differential diagnoses included inflammatory, as well as non-inflammatory, myopathies/neuropathies.\nA complete blood count (CBC) and serum biochemistry profile revealed mildly increased creatinine phosphokinase, but was otherwise unremarkable. Toxoplasma gondii-specific IgM titre was border line (1:32) while IgG was negative, as was a follow-up IgM titre. Neospora caninum antibody titres were negative, and serum total thyroxine concentration was within the reference range.\nBy the time of a planned revisit to NMBU for laryngeal inspection, diagnostic imaging, electrodiagnostics, and biopsies 2 weeks after referral, the clinical signs had progressed further and the dog was now showing general paresis in all four limbs. During a light plane of anaesthesia, laryngeal inspection was performed showing immobile arytenoids and vocal cords bilaterally, indicative of a laryngeal paresis causing the dysphonia. Pre- and post-contrast CT examinations of the whole body were performed under general anaesthesia in dorsal recumbency. Iohexol (Omnipaque 300 mgI/mL, GE Healthcare AS, Oslo, Norway) dosed at 600 mg iodine/kg was administrated intravenously and CT images were acquired using a 4-detector row CT scanner (BrightSpeed, GE Healthcare), 1.25 mm slice thickness, 0.625 mm overlap, using helical acquisition in bone and soft tissue algorithms. The CT-examination revealed bilateral muscle atrophy with various degrees of fat infiltration evident in the muscles of the thigh, thoracic limbs, and head. The muscle atrophy was most prominent on the right side of the back (Fig. ), right pelvic limb, and right aspect of the head (temporal and masseter muscles). Changes in the triceps musculature were most prominent on the left side. Electromyography performed under general anaesthesia showed spontaneous activity in multiple muscle groups. Motor nerve conduction velocity was measured to be 40.5 m per second (m/s) (mean \u00b1 SEM in healthy dogs: 60 \u00b1 1.1 m/s []) in the ulnar nerve, and no other nerves were tested. Muscle biopsies were taken from the right biceps femoris muscle, the left triceps muscle, and the longissimus dorsi muscles bilaterally, and submitted for a routine muscle biopsy panel established at the Neuropathology Laboratory, Ludwig-Maximilians-Universit\u00e4t, M\u00fcnchen, Germany. On histological examination, all muscle samples revealed multifocal interstitial and occasionally fibre-directed lymphohistiocytic infiltrates which, in some fields, were accompanied by granulomatous changes with giant cells and/or epithelioid macrophages (Fig. ). Intramuscular nerve branches were diffusely affected by endoneurial granulomatous changes. Perimysium and endomysium showed moderately increased amounts of fibrocollagenous tissue accompanied by patchy areas of mild perimysial lipomatosis. Grocott\u2019s methenamine silver stain for fungi, Fite Faraco stain for acid-fast bacteria and Gram stain were all negative. Likewise, 16s rRNA polymerase chain reaction was negative for bacterial sequences. Based on these findings, aseptic granulomatous polymyositis and neuritis were diagnosed.\nFollowing the negative microbial investigations, treatment was initiated with glucocorticoids (prednisolone) 1.7 mg/kg per os (p.o) twice daily for 2 weeks, followed by gradual tapering to a lower maintenance dose. At a revisit 1 month later, clinical signs had improved but were still present. Gradual improvement of the clinical signs continued over the next few months and then stabilised. At this point, neurologic examination revealed mild reductions of the right pelvic limb flexor reflex and the patellar reflex. Gait evaluation showed circumduction of the right pelvic limb but was otherwise normal. There were no signs of dysphonia or laryngeal paralysis and the tail had regained its normal position. Approximately 1 year after initiating treatment the dog had a mild relapse of clinical signs while receiving prednisolone at a dose of 0.75 mg/kg every third day. Following a dose increase, the owner reported an immediate positive response. The dog was re-examined again 16 months after initiating treatment. Gait evaluation was normal except for a mild gait disturbance of the right pelvic limb. Electromyography was repeated and spontaneous activity was still observed in several muscle groups, but to a lesser extent than before. Motor nerve conduction velocity of the right ulnar nerve was measured to be 48.0 m/s. A CT was performed and revealed similar findings as previously, except for an increased amount of subcutaneous fat, predominantly of the dorsum, considered most likely to represent an adverse effect of prednisolone treatment.\nTwo years after the first visit, the dog presented to the Emergency Service at NMBU with clinical signs of lethargy, pyrexia (40.2 \u00b0C), weakness, and coughing. Blood analysis, ultrasound, and CT were in agreement with a septic condition and the dog was treated accordingly. However, three days later the dog went into cardiac arrest and died. Autopsy was performed at the pathology department of NMBU and further muscle/nerve samples were sent to the Neuropathology Laboratory, Ludwig-Maximilians-Universit\u00e4t, M\u00fcnchen, for follow-up. The autopsy revealed purulent myocarditis, fibrinous pericarditis, interstitial nephritis, and centrilobular necrosis and thrombosis of the liver. Several muscle samples showed changes corresponding to a multifocal, subacute suppurative myositis with fibre necrosis. Muscle atrophy and intermediate neuropathy featuring axonal atrophy and partial demyelination were also present. No granulomatous changes were seen at that stage. Adipose tissue in between the muscle fibres had increased, which is expected when inflammatory changes is restricted to the interstitial compartments (Fig. ). Microbiology samples taken from the liver and spleen showed moderate growth of Escherichia coli, confirming the final septic condition.", "age": [ [ 6.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC008xxxxxx/PMC8008538.xml", "relevant_articles": { "33781325": "0", "19448867": "0", "22177595": "0", "8217405": "0", "30884008": "0" }, "similar_patients": { "3528443-1": "0", "5650981-1": "0", "6272042-1": "0", "4908694-1": "0", "7074614-1": "0" } }, { "human_patient_id": "232", "human_patient_uid": "6432875-1-M", "PMID": "30931260", "title": "CT-Proven Ischaemic Stroke as the First Manifestation of Occult Lung Cancer", "patient": "A 74-year-old woman, with controlled hypertension and dyslipidaemia, presented to the emergency department due to altered speech, left-sided facial droop and decreased muscle strength on the right side of her body with 12 hours of evolution. Physical examination showed aphasia, central facial nerve palsy on the left side, slight right-sided hemiparesis, Babinski\u2019s sign on the left and fever. Computed tomography of the head (head-CT) showed bilateral nucleocapsular and subcortical fronto-parietal ischaemic infarctions of unknown date. The electrocardiogram (ECG) showed sinus rhythm and the thorax x-ray a small left pleural effusion. Blood analysis showed 14,400 leucocytes/\u03bcl, increased C-reactive protein (217.8 mg/l), LDH 459 U/l and INR 1.57. The patient was medicated with aspirin and hospitalized with ischaemic stroke. Blood cultures were collected. Doppler ultrasonography of the neck vessels and a trans-thoracic echocardiogram showed no alterations. Magnetic resonance imaging (MRI) revealed multiple acute ischaemic infarctions scattered over both cerebellar and cerebral hemispheres, reflecting strokes in the posterior and anterior circulations ().\nGiven the possibility of cardioembolic aetiology, enoxaparin was initiated (on the 7th day of hospitalization), however transoesophageal echocardiography showed no alterations. Neurological deficits deteriorated on the day anticoagulation was started, leading to prostration. Head-CT was repeated, revealing a massive parenchymal haematoma in the left frontal region which led to suspension of the enoxaparin.\nAfter the most common stroke aetiologies were excluded, the following examinations were performed, but showed no alterations: lupus anticoagulant, anticardiolipin and anti-beta2-glycoprotein I antibodies, antithrombin III, proteins S and C, antineutrophil cytoplasmic autoantibodies, mutation of the prothrombin gene and factor V Leiden, and HIV, HBV, HCV and VDRL serologies. Antinuclear antibodies were positive (1:160) and D-dimers were high at 1,644 \u03bcg/l (normal <230 \u03bcg/l), while fibrinogen was low at 1.4 g/l (normal 2\u20134 g/l).\nA whole-body CT scan revealed a solid lesion in the left lower lobe of the left lung, multiple mediastinal pathological lymph nodes, peripheral lung thromboembolism with greater expression on the right, right femoropopliteal venous thrombosis and splenic and renal infarctions (\u2013).\nFaced with the impossibility of resuming anticoagulation immediately, a filter was placed on the inferior vena cava. Cerebral angiography showed occlusion of the right internal carotid artery (recall previous normal Doppler ultrasonography of the neck vessels) and excluded vasculitis.\nEndoscopic ultrasound-guided transoesophageal biopsy of a mediastinal lymph node revealed non-small cell lung cancer. Immunohistochemistry testing for the lung cancer subtype proved inconclusive.\nDisseminated intravascular coagulation (DIC) with multiple brain and systemic thrombotic events was diagnosed as a manifestation of a paraneoplastic syndrome of the hidden lung neoplasia. With favourable evolution of the brain haemorrhage, enoxaparin was resumed 2 weeks after the event. However, as there were new thromboembolic events despite the reintroduction of anticoagulation, it was definitively suspended due to progressively worsening thrombocytopenia.\nDuring hospitalization, the patient remained feverish, with high inflammatory parameters, but no infectious source was identified and microbiological cultures were negative. Such alterations were considered to be correlated with systemic thromboses.\nAt this stage, the patient was mute and tetraparetic, with a level 4 performance status (ECOG). It was decided in a multidisciplinary meeting not to start cytostatics as no benefit was anticipated in view of the advanced neoplasia (stage IIIB/IV) and a high degree of dependence. The patient was referred to palliative care and died a few days later.", "age": [ [ 74.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC006xxxxxx/PMC6432875.xml", "relevant_articles": { "30931260": "13", "28068928": "12", "19198235": "123", "25786753": "123", "15315300": "123" }, "similar_patients": { "6601689-1": "123", "7675902-1": "123", "8188717-1": "13", "4355600-1": "0", "5796812-1": "1" } }, { "human_patient_id": "233", "human_patient_uid": "7718702-1-M", "PMID": "33276808", "title": "Refractory secondary pneumothorax complicated with lung cancer treated by bronchial occlusion: a case report", "patient": "An 80-year-old Japanese man hospitalized due to acute exacerbation stemming from asthma and COPD overlap presented with left-side pneumothorax caused by respiratory tract infection. Subsequently, a chest drain tube was inserted; however, a tumor suspicious for lung cancer was present at the entrance of the left upper lobe bronchus. The lung could not be sufficiently expanded, and an air leak was present. We performed pleurodesis twice (first: 200 mL of autologous blood and 4 g of talc; second: 200 mL of autologous blood), but the air leak persisted. Since surgical treatments were considered high risk for this patient due to poor lung function, we decided to treat by bronchial occlusion with EWS. Under bronchoscopy, a tumor was observed with a smooth surface at the entrance of the upper left lobe (Fig. ). A balloon occlusion test was performed using a balloon catheter (Edwards Lifesciences Corporation, Irvine, CA, USA) with a diameter of 4 Fr and an inflated balloon diameter of 9 mm, to determine the affected bronchi. After the entire left lower lobe bronchus was occluded by the balloon, the air leak ceased. Subsequently, bronchography was performed to identify the affected bronchi at the subsegmental bronchial level. The catheter was inserted into the subsegmental bronchus, and a contrast medium (iopamidol 5 mL and saline 15 mL) was injected from the tip. The contrast medium was injected from the left B8a and left B8b bronchi (Fig. ). Fluoroscopy confirmed contrast leakage from the left B8b bronchus into the thoracic cavity, and we suspected major leakage at the bronchi leading from the left B8b and the left B6 bronchi (Fig. ). We then successfully inserted a medium-sized EWS into the left B8b bronchus. Subsequently, we attempted to insert a large-sized EWS into the left B6 bronchus, but the fitting was difficult. Thus, we cut the end of the EWS to size and inserted it into the left B6a bronchus. After EWS insertions, the air leak clearly decreased. Finally, occluding the left B6 and left B8 bronchi by balloon catheter, we confirmed a slight but further decrease in air leakage. Therefore, we judged the remaining air leak to be minor. After bronchial occlusion, we performed pleurodesis twice (first: Picibanil (OK-432) 5 KE; Chugai Pharmaceutical Co. Ltd, Tokyo, Japan, minocycline 300 mg; second: 50% glucose solution and 120 mL of autologous blood), and the air leak ceased completely. The chest drain tube was successfully removed. Several days later, he was diagnosed with pyothorax. The empyema cavity was confined to a small area, and it was difficult to puncture. Therefore, we treated with antibiotics (tazobactam-piperacillin 4.5 g 4 times a day). After 4 weeks of antibiotics therapy, he was transferred to a rehabilitation hospital.", "age": [ [ 80.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7718702.xml", "relevant_articles": { "33276808": "123", "10925718": "13", "31902940": "123", "10654534": "123", "10077366": "3" }, "similar_patients": { "4969844-1": "123", "6212298-1": "123", "6176309-1": "123", "4452674-1": "123", "7871201-1": "123" } }, { "human_patient_id": "234", "human_patient_uid": "6582860-1-M", "PMID": "31275672", "title": "A Rare Case of Herpes Simplex Virus-2 Hepatitis with Negative Serology", "patient": "A 19-year-old female with no significant past medical history was referred to the emergency department from her antenatal clinic for further evaluation of fever 102 F, headache, malaise, nausea, and vomiting of 4-days duration following mild sore throat. She was in her 28th week of gestation on presentation. Physical examination showed an obese and anxious-appearing lady in mild respiratory distress with gravid abdomen. She weighed 142 kilograms (kg) with a BMI of 44.3. Her blood pressure was 111/60 mmHg, respiratory rate 24, heart rate 111, temperature 101.8 F, and oxygen saturation 96% on 2 liters (L) nasal cannula oxygen. She had dry mucous membranes, with no oral thrush or ulcers. Her abdomen was gravid with focal areas of tenderness, bowel sounds were heard, and fetal movement was detected. Pulmonary and cardiovascular examinations were unremarkable.\nHer initial laboratory tests were significant for white blood cell (WBC) count of 11.8 K/uL with 78% neutrophil predominance and lymphopenia (0.77 K/uL). Although she had no urinary symptoms, urinalysis showed bacteriuria, confirmed as group B streptococcus agalactiae (GBS) with cultures. Initial chest X-ray and liver enzymes on admission were unremarkable. She was started on intravenous fluids for suspected gastroenteritis and oral cephalexin for asymptomatic GBS infection. Stool studies for clostridium difficile, comprehensive panel, ova, and parasites were ordered which all returned negative. However, she continued to spike fever through the third day of hospitalization prompting expansion of antibiotic coverage to Vancomycin and Zosyn (). Liver transaminases which had been normal began to spike. Aspartate aminotransferase (AST) was 190, alanine aminotransferase (AST) was 135, and alkaline phosphatase was 110 while bilirubin remained normal. Serum Tylenol and hepatitis A, B, and C serologies were negative. Infectious Disease (ID) consultation was requested who recommended further infectious work-up with CMV, EBV, HIV, HSV, Rickettsia, and Leptospira serologies.\nThe patient continued to spike high grade fever reaching 103 F on day 4 of admission despite being on broad-spectrum antibiotics and negative infectious work-up including the aforementioned serologies. She also developed bloody diarrhea and acute kidney injury (AKI) prompting evaluation for possible Hemolytic Uremic Syndrome (HUS) and autoimmune diseases which all returned negative as well. Right upper quadrant ultrasound showed normal liver and gallbladder morphologies. Magnetic resonance imaging of the abdomen and pelvis without contrast showed diffuse T2 hyperintensity throughout the liver compatible with acute liver injury but was negative for any focal intra-abdominal or pelvic abscess.\nOne week into her hospitalization, her AST and ALT kept trending up reaching a peak of 1712 U/L and 845 U/L, respectively (), mildly elevated alkaline phosphatase 140, INR 1.6, normal total bilirubin, absolute lymphocyte count of 0.11 K/uL, persistently negative blood cultures, and serum creatinine increased to 2.9 mg/dL, all concerning for a disseminated process. She became increasingly lethargic, tachycardic, and tachypneic necessitating care in the intensive care unit. With uprising liver enzymes and negative extensive infectious and rheumatologic work-up including Hep A, B, C serologies and PCR, EBV, CMV, Parvovirus, Rickettsia, and Leptospiral serologies, as well as negative HSV 1 and 2 IgM and IgG antibodies, antinuclear, and anti-liver-kidney microsomal antibodies, normal cryoglobulins, ceruloplasmin, alpha 1 antitrypsin and serum copper levels, and largely unremarkable imaging and stool studies, a decision was made to proceed with a liver biopsy. At this time, empiric acyclovir was started while other antibiotics were discontinued per ID recommendations.\nWithin the first 24 hours of starting acyclovir, AST and ALT began to downtrend while fever and diarrhea improved (). Despite negative HSV-2 serologies, the PCR was reported on hospital day-8 with a very high viral load >100 million DNA copies/ml following which she reported a remote history of cold sores but denied a history of genital ulcers. A diagnosis of HSV hepatitis was made and she was transitioned to Val-acyclovir 1 gram three times daily to complete 14 days of therapy, then to resume acyclovir 400 mg three times daily until delivery to prevent recurrence. On the 12th day of hospitalization, she was discharged home without needing a biopsy anymore and with complete resolution of symptoms and improvement of liver enzymes and AKI; AST 72, ALT 208, alkaline phosphatase 150, total bilirubin 0.5 and creatinine 0.5. She remained symptom-free with complete normalization of creatinine and liver enzymes at outpatient follow-up two weeks after discharge. She was eventually delivered of a healthy baby boy via cesarean section at 38 weeks of gestation with no peripartum complications.", "age": [ [ 19.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6582860.xml", "relevant_articles": { "32025418": "123", "34330325": "12", "25423497": "12", "30186097": "12", "31275672": "123" }, "similar_patients": { "4528901-1": "123", "7054783-1": "123", "8360263-1": "12", "7581048-1": "12", "8638779-1": "0" } }, { "human_patient_id": "235", "human_patient_uid": "8259021-1-M", "PMID": "34225811", "title": "Fulminant myocarditis induced by immune checkpoint inhibitor nivolumab: a case report and review of the literature", "patient": "A 56-year-old Chinese man was diagnosed with colonic carcinoma with liver and lung metastases (T2N0M1b, stage IV). His family history and social history were noncontributory. He underwent Hartmann operation in November 2016. The patient\u2019s tumor tissue was classified as wild-type genotypes of dMMR, KRAS, NRAS, and BRAF. Then he was treated with 12 cycles of XELOX chemotherapy combined with cetuximab. The patient underwent hepatectomy at Mayo Clinic in the United States in December 2017 after treatment with a single 6 Gy dose of local liver radiation for six times. Afterward, he underwent folinic acid\u2013fluorouracil\u2013irinotecan (FOLFIRI) combined with panitumumab chemotherapy for seven cycles after the operation. Because chest and abdomen computed tomography (CT) scan revealed new lesions in the liver and lungs in November 2018, he received six cycles of immunotherapy with nivolumab (140 mg daily), an anti-PD-1 antibody, within 3 months. His myocardial enzymes and echocardiography were normal before nivolumab treatment. He presented progressive chest tightness and pain after 1.5 months of taking nivolumab. Laboratory tests after admission to hospital revealed elevated serum NT-proBNP (180.40 ng/L, normal < 125 ng/L), CK-MB (8.99 ng/mL, normal < 4.87 ng/mL) and troponin T (0.23 ng/mL, normal < 0.014 ng/mL). Transthoracic echocardiography showed a left ventricular ejection fraction (LVEF) of 50%. Electrocardiogram reported sinus bradycardia and inverted T wave in lead II, III, and aVF. Three days later, these laboratory tests showed further increased NT-proBNP (612.30 ng/L), CK-MB (12.33 ng/mL), and troponin T (0.49 ng/mL). Coronary artery CT angiography revealed no coronary artery lesions. The serological analysis of antiviral antibodies did not suggest myocarditis-associated viral infection. Considering the relation of onset time and the drug therapy, the most likely diagnosis was fulminant myocarditis secondary to nivolumab administration.\nThe patient rapidly experienced cardiogenic shock and was transferred to intensive care unit after cardiopulmonary resuscitation and tracheal intubation. He revived within half an hour with blood pressure of 89/52 mmHg on the support of 8 \u00b5g/kg/minute dopamine and 0.12 \u00b5g/kg/minute epinephrine. NT-proBNP was higher than 15,000 ng/L (Fig. ). Electrocardiogram showed a heart rate of 108 beats/minute with wide QRS and arrhythmia. Echocardiography revealed declined movement of the left ventricle multisegments and the right ventricle free wall, and LVEF was 25% (Fig. ). The patient was unconscious and exhibited hypotension, tachycardia, high lactic acid, and anuria. Then, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was used to support his circulation. After 24 hours, the patient regained consciousness, and the urine output was 15\u201330 ml/hour. Also, the blood lactate concentration and heart rate were decreased. Dopamine and epinephrine were continued (8 \u00b5g/kg/minute dopamine and 0.08 \u00b5g/kg/minute epinephrine). Intravenous methylprednisolone (160 mg/day) was used for the first 3 days, followed by a dose of 80 mg/day, and intravenous immunoglobulin therapy at 25 g/day for 5 consecutive days. In addition, the patient developed severe pneumoniae caused by Klebsiella pneumoniae. We used the antibiotics based on the drug susceptibility testing. NT-proBNP, CK-MB, and troponin T levels were decreasing gradually. Echocardiograms showed the LVEF improved gradually (Figs. , ). The patient regained consciousness, command action, and sinus rhythm. ECMO flow rate was gradually decreased to 1.5 L/minute. Respiratory and circulatory function was clinically stable. The 24-hour urine volume was 2400 ml. After 8 days support, he was successfully weaned from ECMO. At this moment, transthoracic echocardiography revealed an abnormal echo in the right atrium (considering thrombosis or neoplasm), about 19.0 \u00d7 7.3 mm, attached to the interatrial septum, while left ventricular ejection fraction is 33%. Therefore, oral anticoagulation warfarin (2.5 mg/day) was used. During the following days, marked clinical and laboratory improvement was observed. Steroids were then gradually tapered. The patient was transferred to the ward on day 14. The further clinical course was uneventful. Finally, the patient was discharged on day 45 without complication, with LVEF of 42% (Fig. ). Also, he took some medications (methylprednisolone 36 mg daily orally, metoprolol succinate 23.75 mg twice daily orally, pantoloc 40 mg daily orally) according to the doctor\u2019s prescription when discharged from hospital. Through follow-up by telephone, we learned that the patient died from an unknown reason 1 month after being discharged from the hospital.", "age": [ [ 56.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC008xxxxxx/PMC8259021.xml", "relevant_articles": { "30563577": "123", "31624755": "0", "18353234": "3", "24119694": "2", "25745797": "0" }, "similar_patients": { "8285988-1": "", "8518217-1": "13", "7543120-1": "1", "4818500-1": "0", "8477521-1": "13" } }, { "human_patient_id": "236", "human_patient_uid": "8532189-1-M", "PMID": "34707957", "title": "Pasteurella multocida Infection Presented With Frequent Diarrhea in the Cirrhotic Patient", "patient": "A 49-year-old woman presented with diarrhea approximately once every 30 min for two days prior to her visit. On arrival, she had a fever of 39.0\u00b0C with chills. The patient had persistent diarrhea and fever and had trouble moving; hence she required emergency assistance and was brought to our hospital. She was a current smoker, who smoked 10 cigarettes/day for 29 years and consumed 1,500 mL of cocktails per day. She owned a pet cat, and the cat licked her body surface regularly. She had a history of depression; however, she had not consulted a doctor for five years. She had no other medical history and was not taking any medications, including any over-the-counter medications.\nHer height and body weight were 162 cm and 60 kg, respectively. On admission, consciousness was assessed using the Glasgow Coma Scale (score, 14) (E4V4M6), her body temperature was 38.0\u2103, pulse was 132 beats/min, blood pressure was 88/51 mmHg, respiratory rate was 24 breaths/min, and the peripheral arterial oxygen saturation was 94% (nasal cannula, 1 L). Physical examination revealed livedo reticularis on the lower limbs. There was no site of soft tissue infection with redness, heat, or swelling throughout the body. The blood tests that were performed are shown in Table . Arterial blood gas analysis showed mixed alkalosis and hyperlactatemia (serum lactate, 8.4 mg/dL). Conventional abdominal computed tomography revealed mild enlargement and a diffuse low-density area of the liver.\nThe patient was admitted to the intensive care unit in a state of septic shock with alcoholic cirrhosis, hypokalemia (serum potassium, 1.9 mEq/L) with frequent diarrhea, and disseminated intravascular coagulation syndrome. The clinical course of the patients is shown in Figure . Blood, urine, and spinal fluid specimens were cultured, and piperacillin-tazobactam (4.5 g) was administered as an empiric therapy with the initiation of potassium replacement through a central vein. On the same day, the antibacterial agents were changed to meropenem (1 g every 12 h) and vancomycin (1.5 g every 24 h) due to deteriorating clinical conditions. Artificial respiration was started on the same day as the patient's respiratory condition worsened. After admission, she did not have frequent diarrhea. On the second day of admission, the patient\u2019s renal function (serum creatinine, 2.6 mg/dL) and liver function (prothrombin time, 35.6%; total bilirubin, 6.0 mg/dL) worsened, thereby requiring continuous hemodiafiltration (CHDF), plasma exchange therapy, and coagulation factor replacement. In addition, venoglobulin and amikacin 400 mg were administered for sepsis. The dosage of meropenem was changed to a severe dose of 2 g every 12 h considering the worsening clinical condition and the dosage of vancomycin was changed to 1 g every 24 h as the renal function worsened and CHDF was initiated. However, metabolic acidosis and hyperlactatemia progressed, and the patient died in the early hours of the third sick day. On the third day of admission, blood culture yielded P. multocida, which was susceptible to piperacillin-tazobactam and meropenem.", "age": [ [ 49.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC008xxxxxx/PMC8532189.xml", "relevant_articles": { "34707957": "13", "26997934": "123", "28183503": "0", "16408432": "123", "26255008": "123" }, "similar_patients": { "8205601-1": "13", "5041574-1": "13", "3958989-1": "123", "8440108-1": "123", "6090845-1": "123" } }, { "human_patient_id": "237", "human_patient_uid": "8291187-1-M", "PMID": "33421986", "title": "Identification of a Novel\nCSNK2A1-PDGFRB Fusion Gene in a Patient\nwith Myeloid Neoplasm with Eosinophilia", "patient": "A 37-year-old man was admitted to local hospital with weight loss, night sweat,\nrepeating fever for a week in April 2018. The patient\u2019s initial laboratory\nexamination showed that leukocyte count was 12.48\u00d7109/L with 37%\neosinophilia in the peripheral blood, hemoglobin concentration was 127 g/L and\nplatelet count was 146\u00d7109/L. The initial bone marrow (BM)\naspirates and biopsy showed hyper leukocytes and significantly increased eosinophils\n(8%), and neutrophil alkaline phosphatase score was 18 ( and ). Above all, these inspections were consistent with a diagnosis of\nMPN. Then the patient was administrated with 20 mg prednisone per day, but it showed\nno any effect with white blood cell (WBC) 15.1\u00d7109/L, hemoglobin\n108 g/L, platelet 114\u00d7109/L, eosinophils\n5.13\u00d7109/L (33.91%) in peripheral blood.\nThe suite of fluorescence in situ hybridization (FISH) assay on the\nBM aspirate was used to detect BCR-ABL,\nPDGFRA, PDGFRB, and FGFR1\nrearrangement. MPN FISH assay showed PDGFRB arrangement positive.\nThe karyotype analysis of BM cells showed 46,XY[20].\nPatient\u2019s RNA was extracted from BM cell by Trizol methods according to the\nmanufacturer\u2019s protocol (Invitrogen, Waltham, MA) for RNA-sequencing\n(RNA-seq) in July 2018. RNA quality and concentration were estimated by Nano Drop\nND-2000 (Thermo Fisher Scientific, Waltham, MA). Paired-end reads were generated\nfrom the complementary DNA (cDNA) libraries using an Illumina Next Seq 550\ninstrument (Illumina, San Diego, CA). Then we used star-fusion software to analyze\nthe RNA-seq raw data [] (). Standard\nsettings were applied for all three tools and reads were aligned to the Genome\nReference Consortium Human Build 37 (GRCh37). RNA-seq revealed that\nPDGFRB fused with CSNK2A1 gene. To confirm the\nfusion, reverse transcription\u2013polymerase chain reaction (RT-PCR) was\nperformed with CSNK2A1-PDGFRB forward primer:\n5\u2032-GTGCCAAGCAGGGCCAGAGT-3\u2032, reverse primer\n5\u2032-AGGGTGCGTCCCAGCACAAG-3\u2032. The reciprocal\nPDGFRB-CSNK2A1 fusion forward primer:\n5\u2032-TCAGAGCTGACACTGGTTCG-3\u2032, reverse primer:\n5\u2032-GATGTTGGGACCTCCTCTCAA-3\u2032. The PCR products was purified with PCR\npurification kit (Tiangen, Beijing, China) and sequenced by GENEWIZ Biotechnology\nCo., Ltd. (Suzhou, Jiangsu, China). The sequence was analyzed using the BLAST\nprogram ().\nGiven the existence of PDGFRB fusion, he received imatinib therapy with 200 mg every\nday orally in September 2018. Two months later, the laboratory examination showed\nthat WBC was 6.14\u00d7109/L with 2.8% eosinophilia in the peripheral\nblood (). Finally, real-time quantitative reverse transcription PCR was\nperformed to quantify the fusion gene and showed negative in 8 months after imatinib\ntreatment. To date, the patient acquired sustained molecular complete remission for\n2 years until the last follow-up.", "age": [ [ 37.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC008xxxxxx/PMC8291187.xml", "relevant_articles": { "33421986": "123", "28725989": "123", "16960151": "123", "23186533": "123", "30726835": "123" }, "similar_patients": { "7797573-1": "0", "6542082-1": "1", "6791222-1": "1", "8130325-1": "0", "6329120-1": "13" } }, { "human_patient_id": "238", "human_patient_uid": "2804036-1-M", "PMID": "20066165", "title": "Pneumothorax and Pneumomediastinum in Pregnancy: A Case Report", "patient": "A 37-years-old primigravida at 40 weeks gestation was brought to our hospital by ambulance following collapse at home. No obstetric notes were brought in. On admission she was anxious, apyrexial, dyspnoeic, and distressed.\nOn clinical examination she was hypoxic, with oxygen saturation of 68% on air and respiratory rate of 30/minutes. Blood pressure was 150/90, and Glascow coma scale was 11/15. There were no signs of labour. Soon after arrival she had a seizure. Following the seizure there was an episode of fetal bradycardia and an urgent caesarean section was performed under GA. The baby was delivered in good condition. There was no evidence of placental abruption or any other cause for fetal bardycardia. Patient's vitals were stable during the caesarean section. She was transferred to Intensive Care Unit, where she was intubated and ventilated. A CT chest showed extensive bilateral pnenumothoarces of greater than 70% in the left side and extensive opacities in the semicollapsed right lower lobe (see Figures and ). The CT head was normal. A left-sided chest drain was inserted on the same day. This was removed on the following day after patient's clinical condition had improved. Patient has no symptoms or signs which suggestive of Pre-eclamsia.\nFollowing the caesarean section the family arrived. At this stage we found that the patient had longstanding right pleural endometriosis with multiple pneumothoraces and hydrothoraces and underwent right-sided pleurodesis in 2003. This lady was booked in at tertiary hospital for pregnancy care. She had regular followups with a Chest physician and Obstetrician. At 29 weeks gestation the patient had presented with mild dyspneoa and the chest X-ray revealed a small effusion but no significant pneumothorax. The cardiothoracic surgeon suggested that since the pleura was well stuck down, there was a low risk for expanding pnuemothorax. This patient still presented with severe hypoxia with pneumothorax. The Cardiothoracic surgeon further advised assistance with instrumental delivery as small risk of increased pneumothorax in the second stage of labour during pushing. Epidural or spinal anaesthesia was recommended and to avoid General anaesthesia. If general anaesthesia was needed then intermittent positive pressure ventilation should be used. The Obstetrician had planned for induction of labour at 41 weeks gestation. On the 4th day of postcaesarian section, the patient again complained of shortness of breath. On general examination the patient was dyspneic and tachypneic. Her blood pressure was normal, she had no proteinuria, and her liver function and platelets were within normal limits.\nChest X-ray showed that she had left-sided lower lobe pneumonia and was started on intravenous tazocin, IV gentamicin, and then on oral erythromycin. Patient recovered well and was transferred to a tertiary hospital.", "age": [ [ 37.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC002xxxxxx/PMC2804036.xml", "relevant_articles": { "22927264": "123", "20066165": "123", "26839696": "123", "7788829": "0", "15321464": "0" }, "similar_patients": { "2543003-1": "1", "2823759-1": "0", "3532913-1": "0", "2957859-1": "0", "6307190-1": "0" } }, { "human_patient_id": "239", "human_patient_uid": "5707817-1-M", "PMID": "29187154", "title": "Thymoma with acute gastric volvulus: a case report", "patient": "A 43-year-old man was admitted to our hospital for acute postprandial abdominal pain, nausea and vomiting, without dyspnea and myasthenia. There was no history of trauma. Physical examination found that trachea shifted to the right, breathing sound over the left lower chest decreased, cardiac border shifted to the right and tenderness in the upper abdomen. A chest X-ray showed that mediastinum and trachea shifted to the right and the left diaphragm lifted. Upper digestive tract radiograph (Fig. ) showed left diaphragm elevated, gastric fundus and body lifted with nearly vertical gastroesophageal angle. A diagnosis of organoaxial gastric volvulus was suspected. On CT scan (Fig. ), an irregular mass was found in the anterior mediastinum, about 6.8 \u00d7 9.5 cm, left diaphragm was elevated, stomach, spleen, parts of bowels were lifted. Emergency gastroscopy (Fig. ) demonstrated gastric body volvulus. He was treated with endoscopic de-rotation.\nThe ultrasound guided biopsy of mediastinal mass was performed for this patient. The pathological findings revealed type B3 thymoma. According to the imaging examination he was diagnosed as Masaoka stage III thymoma. The thymoma of this patient presented with extensive pericardium, aorta arch and its branch infiltration, so it was considered as unresectable disease.\nThe patient with technically unresectable disease received radiotherapy from December 2013. Gastric volvulus still attacked about once a month, with the incentives of cold, satiety or spicy food. Each time endoscopic de-rotation was needed to relieve the symptoms. In 10 months later, CT scan showed the mass in the anterior mediastinum shrank, but a new small lesion developed on the left pleura. CT-guided biopsy of the pleural mass was performed. The histopathology and immunohistochemistry proved thymoma metastasis. The chemotherapy of carboplatin combined with paclitaxel was given for four cycles. He also received radiotherapy on the pleural mass. Disease was stable for 7 months. Gastric volvulus still occurred with less frequency of about every three to four months, and the symptoms were less severe. The left pleural effusion developed in May 2015. The disease was evaluated as progression. Then he received the chemotherapy of ADOC regimen (cisplatin, doxorubicin, vincristine, cyclophosphamide) for 2 cycles. Till March 2017, he was still alive with slow progression. The gastric volvulus still occurred every 3\u20134 months.", "age": [ [ 43.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5707817.xml", "relevant_articles": { "29187154": "123", "9087296": "123", "28923678": "12", "8149014": "1", "26238590": "12" }, "similar_patients": { "4322698-1": "123", "3893332-1": "123", "4879081-1": "123", "4355547-1": "123", "8520479-1": "13" } }, { "human_patient_id": "240", "human_patient_uid": "8255712-1-M", "PMID": "34248587", "title": "Severe Adult Still's Disease Complicated by Purtscher-Like Retinopathy Treated with Intravenous Pulse Methylprednisolone and Tocilizumab", "patient": "A 29-year-old Japanese woman was admitted with lowered consciousness and a high fever (>39\u00b0C), arthralgia, sore throat, and lymphadenopathy that had persisted for a week. She had a history of juvenile idiopathic arthritis and macrophage activation syndrome when she was 9 years old and was treated with oral prednisolone until she was 15 years old. Brain MRI showed bilateral swelling and high signal intensity in the basal ganglia and thalamus according to T2-weighted images and fluid-attenuated inversion recovery images (shown in Fig. , b). Blood examinations revealed the following: leukocyte count, 5,100/\u03bcL (88% neutrophils); hemoglobin, 14.3 g/dL; platelets, 110,000/\u03bcL; C-reactive protein, 5.36 mg/dL; erythrocyte sedimentation rate, 29 mm/h; slightly elevated liver enzymes (aspartate aminotransferase, 84 U/L, and alanine aminotransferase, 16 U/L), elevated soluble interleukin-2 receptor, 1,261 U/mL, and an elevated serum ferritin level of 4,088 ng/mL (reference range, 5\u2013152 ng/mL). The kidney function test results were within normal limits, the antinuclear antigen was at the borderline level, and the rheumatoid factor and antineutrophil cytoplasmic antibody tests were negative. Her cerebrospinal fluid (CSF) on admission showed an opening pressure of 7 cm H2O, 7 cells/mm3 (71% lymphocytes), increased protein levels (265 mg/dL; normal, <40 mg/dL), and a slightly low glucose level (48 mg/dL; normal, >50 mg/dL). Blood, urine, and CSF cultures were negative. Viral meningitis (human herpesvirus 1\u20136) was excluded using CSF in a polymerase chain reaction assay. An extensive infectious disease evaluation was negative. Her consciousness disorder improved without treatment, and her brain MRI also showed an improvement 3 weeks after admission (shown in Fig. , d). Nevertheless, a high fever, arthritis, and salmon-colored rash on her trunk and limbs persisted (shown in Fig. ). Abdominal CT revealed splenomegaly.\nAfter excluding infections, malignancies, and other rheumatic diseases, ASD was diagnosed based on the presence of fever, arthritis, rash, lymphadenopathy, splenomegaly, and hepatic dysfunction, according to the Yamaguchi criteria []. Her schistocytosis and worsening of anemia (hemoglobin, 8.7 g/dL) became clinically evident, and oral prednisolone of 45 mg (1 mg/day/kg) was administered. TMA was ruled out because of her normal platelet count (162,000/\u03bcL), normal kidney function (creatinine, 0.60), and normalized fever without any neurological signs. After administering oral prednisone for 2 days, the patient presented with blurred vision in the left eye and was referred to the ophthalmology department. Her best-corrected visual acuity was 20/17 in each eye, and her intraocular pressure was normal at the initial visit. A slit-lamp examination of the anterior segment of the eye was unremarkable. A funduscopic examination revealed bilateral cotton-wool spots, Purtscher flecken, and a small number of intraretinal hemorrhages around the optic nerve and in the posterior pole (shown in Fig. ), which were compatible with Purtscher-like retinopathy []. Optical coherence tomography showed inner retinal thickening consistent with cotton-wool spots in both eyes (shown in Fig. ). Fundus fluorescein angiography showed hypofluorescence in the early phase and increased permeability in the late phase, consistent with the lesions (shown in Fig. ). There was no apparent nonperfusion area in either eye.\nDespite treatment with high-dose oral prednisolone for 2 weeks, her laboratory data gradually worsened, showing elevated serum ferritin levels (5,663 ng/mL) and developed macrophage activation syndrome []. Therefore, intravenous pulse methylprednisolone therapy was initiated at 1,000 mg/day for 5 days, followed by oral prednisolone of 90 mg (2 mg/kg/day). Nine days after the administration of intravenous pulse methylprednisolone therapy, the patient's serum ferritin levels dropped to 462 ng/mL, and aspartate aminotransferase levels and the platelet count fell within normal limits. TCZ (8 mg/kg every week during hospitalization and 8 mg/kg every 2 weeks after discharge) was administered considering the severity of ASD (shown in Fig. ). The patient visited the ophthalmology department again 15 days after the administration of intravenous pulse methylprednisolone therapy, and her funduscopic examination revealed reduced bilateral cotton-wool spots and Purtscher flecken (shown in Fig. ). Her ASD was successfully treated, and the oral prednisolone treatment was tapered. Although her Purtscher-like retinopathy improved as her ASD activity decreased, nerve fiber layer defect (NFLD) in both eyes appeared 7 months after initial visit (shown in Fig. ). Humphrey visual field testing showed visual field defect corresponding to NFLD (shown in Fig. ). At her last visit, that was 1 year after the administration of intravenous pulse methylprednisolone therapy, the patient was taking prednisolone (5 mg/day) and continuing TCZ, and she remained in good health without a major ASD flare.", "age": [ [ 29.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC008xxxxxx/PMC8255712.xml", "relevant_articles": { "34248587": "123", "24027253": "0", "29208852": "0", "1813187": "0", "10614170": "0" }, "similar_patients": { "3724690-1": "123", "5027298-1": "123", "6381903-1": "0", "4772632-1": "0", "5848347-1": "13" } }, { "human_patient_id": "241", "human_patient_uid": "3017929-1-M", "PMID": "21234204", "title": "Anatomically corrected malposition of great arteries", "patient": "A 26-year-old female with NYHA class III dyspnea on exertion and easy fatigability was referred for surgery with the diagnosis of congenitally corrected transposition of great arteries (CCTGA), restrictive subaortic ventricular septal defect (VSD) and severe subpulmonic left ventricular outflow tract (LVOT) obstruction. She was on Propranolol. Clinical examination showed an acyanotic patient with low volume pulses and a grade 3/6 ejection systolic murmur over the left sternal border. Chest X-ray revealed normal heart size, left ventricular (LV) type of apex, right aortic arch, and convex left upper border, suggestive of dilated ascending aorta and normal lung vascularity.\nTransthoracic echocardiography (TTE) showed situs solitus, levocardia, AV concordance, side by side orientation of the ventricles, and an anterior leftward aorta. The aorta appeared to override the interventricular septum but no definite VSD could be seen probably because of poor echo window. The pulmonary artery was seen to arise from the right ventricle with no evidence of pulmonary stenosis. A high velocity jet was seen in the subaortic region with a gradient of 100 mmHg. Double outlet right ventricle (DORV) with severely restrictive VSD, L-malposed aorta and unrestricted pulmonary blood flow was suspected on echo.\nElectrocardiogram (ECG) revealed sinus rhythm, right axis deviation and LV dominance. The right axis deviation in the ECG was probably due to the side by side orientation of the ventricles. Catheterization showed situs solitus, atrioventricular (AV) and ventriculoarterial (VA) concordance with L-malposed aorta, LV pressure of 215 mmHg and RV pressure of 25 mmHg. There was a gradient of 140 mmHg during pullback from LV to aorta, suggesting severe subaortic LVOT obstruction. LV angiogram [] showed severe hypertrophy of LV, long tunnel-like fixed subaortic stenosis and mid-ventricular systolic narrowing. A diagnosis of ACMGA with severe tunnel-like obstruction of the LVOT was made after catheterization. She underwent LVOT resection and LVOT enlargement with modified Konno technique (ventricular septum opened below the subaortic area with resection of hypertrophied septum, followed by closure of iatrogenic VSD with bovine pericardial patch). The abnormal segmental relationship [] necessitated a combined transaortic and transatrial approach. She had an uneventful postoperative period. Postoperative echocardiogram revealed good relief of LVOT obstruction with residual gradient of 45 mmHg, mainly at mid cavity region []. On 6 months follow up, she was asymptomatic with mild to moderate AR and LVOT turbulence with a gradient of 20 mmHg.", "age": [ [ 26.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3017929.xml", "relevant_articles": { "8138692": "123", "20676000": "123", "8222151": "13", "11486184": "13", "20049461": "123" }, "similar_patients": { "3701784-1": "123", "8597615-1": "123", "6586116-1": "123", "7319856-1": "123", "6177097-1": "123" } }, { "human_patient_id": "242", "human_patient_uid": "3170633-1-M", "PMID": "21843324", "title": "Pulmonary histoplasmosis presenting as chronic productive cough, fever, and massive unilateral consolidation in a 15-year-old immune-competent boy: a case report", "patient": "A 15-year-old East African boy was referred to our hospital with a diagnosis of recurrent TB. Upon review, the patient was found to have a history of productive cough and intermittent low-grade evening fevers for one year and shortness of breath for one week prior to presentation. One year and five months prior to his presentation to our hospital, he had presented to a peripheral hospital with similar symptoms and had been diagnosed with sputum acid-fast bacilli (AFB) and smear-positive TB. He had been treated with anti-TB medications, which brought him only mild relief. Two months after completing anti-TB therapy, his cough and fevers worsened, for which a re-treatment regimen of anti-TB medications, including two months of intramuscular streptomycin, were started on the basis of clinical findings. The sputum examination for AFB had not been repeated. Four months into the course of his second course of anti-TB therapy, the patient stopped taking his medications because he reportedly experienced only mild relief of his symptoms. Repeat Ziehl-Neelsen staining performed two months prior to his admission to our institution was negative for AFB, and no more drugs were given. One week prior to his admission to our hospital, the patient developed progressively worsening shortness of breath, which was even worse while he was lying flat and was associated with dull left-sided chest pain.\nHis social history was significant for crushing stones (rock cutting) for two years, but he had no history of smoking or working in the mining industry. He had no history of TB or other lung disease in his family.\nHis physical examination revealed that he was fully conscious, afebrile, slightly wasted, and dyspneic. His oxygen saturation level was 96% on room air, and his other vital signs were normal. His respiratory examination revealed a respiratory rate of 25 cycles/minute and chest bulging on his left side, but his trachea was centrally located. Other findings on the left side included decreased chest expansion, increased tactile vocal fremitus, dull percussion note, and bronchial breath sounds. The rest of the respiratory examination was unremarkable.\nThe patient was admitted to the medical ward with a diagnosis of recurrent TB with massive left-sided consolidation. A complete blood count revealed a white blood cell count of 8.7 cells/mm3 with a differential of 69% neutrophils, 23% lymphocytes, 6% monocytes, and 1% eosinophils. His hemoglobin level was 10.6 g/dL, and his platelet count was 504 cells/mm3. His erythrocyte sedimentation rate was 20 mm/hour. His renal and liver function tests were within normal ranges. A rapid test for HIV was performed and was negative. Sputum tests for Gram staining and Ziehl-Neelsen staining were both negative. A chest radiograph revealed features of huge left-sided consolidation with complete opacification of the left hemithorax (Figure ). His chest ultrasound revealed that the left lung was completely consolidated. There was no pleural or pericardial effusion, and his right lung was completely normal. Following these examinations, the patient was empirically re-started on the retreatment regimen for recurrent TB, and the cardiothoracic surgery team was consulted about performing a lung biopsy. The cardiothoracic surgery team felt that the patient was too unstable for surgery and requested that medical management be continued until the patient's condition improved.\nOn hospital day 3, the patient's condition started deteriorating, with worsening shortness of breath, wheezing, and hypoxia (oxygen saturation 82% to 90% on room air). He was admitted to the intensive care unit, where his anti-TB medications were continued, together with oxygen therapy. On hospital day 7, the patient died before any further intervention could be performed.\nA post-mortem examination was performed by the hospital's pathologists. As shown in Figures and , the histopathologic examination revealed a huge mass in the left lung with necrosis and suppurative caseation. Microscopic examination of caseous material was negative for AFB. PAS staining was positive and cytological examination revealed yeast cells and capsules of non-viable fungi, suggestive of H. capsulatum. Because of resource limitations at our hospital, no further tests could be performed. The pathologist's impression was that the patient had had pulmonary histoplasmosis.", "age": [ [ 15.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3170633.xml", "relevant_articles": { "15336585": "12", "30560051": "0", "22081196": "0", "31511162": "0", "32321231": "0" }, "similar_patients": { "7586409-1": "0", "8464323-1": "1", "5402664-1": "0", "5467283-1": "0", "6196693-1": "0" } }, { "human_patient_id": "243", "human_patient_uid": "6709018-1-M", "PMID": "31348261", "title": "A novel homozygous deletion in ATP6V0A4 causes distal renal tubular acidosis", "patient": "A 2-month, 24-day-old girl was referred to our department presenting with recurrent vomiting. The birth and medical history were uneventful. The patient had metabolic acidosis (pH 7.267, bicarbonate 17.6 mmol/L), alkaline urine (pH 7.5), and hypokalemia (serum potassium 2.4 mmol/L). An ultrasound of the kidneys demonstrated increased echo reflectance at the bilateral medulla. The patient was initially given common treatments to replace fluids and to correct the acidosis and hypokalemia. However, the metabolic acidosis and hypokalemia remained during for 4 days (Table ). Meanwhile, the hearing, liver function, renal function, count of blood cell, C-reactive protein, and erect abdominal x-ray results were normal. Because hereditary dRTA was suspected, the patient was treated with potassium citrate on day 5 after admission. Since treatment initiation, the patient has shown normal pH and potassium levels.\nGenomic deoxyribonucleic acid (DNA) was extracted from whole blood using the QIAamp DNA Mini Kit (Qiagen, Shanghai, China) per the manufacturer's instructions. A minimum of 3 \u03bcg DNA was used for the indexed Illumina libraries according to the manufacturer's protocol (MyGenostics, Inc., Beijing, China). DNA fragments with sizes ranging from 350 bp to 450 bp and those including the adapter sequences were selected for the DNA libraries. Next, the genes associated with the endocrine system were selected using a gene capture strategy and the GenCap custom enrichment kit (MyGenostics, Inc., Beijing, China) following the manufacturer's protocol. The biotinylated capture probes (80\u2013120-mer), were designed to tile all of the exons with non-repeated regions.\nThe patient was found to have a homozygous deletion in exons 13 and 14 of the ATP6V0A4 gene, which confirmed the diagnosis (Fig. ). Moreover, quantitative real-time polymerase chain reaction (PCR) (qRT-PCR) of exons 13 and 14 from the ATP6V0A4 gene using 3 primer pairs was performed on both the patient and her parents using a SYBR@Premix Ex TaqTM (TAKARA, Japan). The Applied Biosystems 7500 real-time PCR system was applied to amplify and quantify the ribonucleic acid (RNA). The relative RNA quantity was calculated based on the comparative Ct and analyzed by the Sequence Detection System software package version 2.0 (PE Applied Biosystems, Carlsbad, CA). The patient's father was found to have a heterozygous deletion of the same regions whereas the mother was found to be normal (Fig. ).", "age": [ [ 2.0, "month" ], [ 24.0, "day" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6709018.xml", "relevant_articles": { "31348261": "123", "30558562": "123", "23729491": "12", "33934480": "0", "28509214": "123" }, "similar_patients": { "6006740-1": "1", "6297984-1": "123", "3014749-2": "0", "7325154-1": "0", "6625038-1": "0" } }, { "human_patient_id": "244", "human_patient_uid": "5892980-1-M", "PMID": "29785314", "title": "Osteochondroma of the Scapula with Accessory Nerve (XI) Compression", "patient": "A 25-year-old male presented at our clinics for a right shoulder pain related to a dorsal scapular mass first observed 4 months earlier. The main symptom was a shoulder discomfort when lying on his back, sometimes compromising the sleep. The patient also complained of some weakness when using his right arm under the shoulder level. The medical history consisted in a unique kidney and past treatments for a nodular sclerosis-subtype Hodgkin lymphoma (chemotherapy and radiotherapy, last treatment twelve years ago and no recurrence).\nThe physical examination revealed a nonmobile 3 cm T \u00d7 3 cm AP \u00d7 2 cm CC hard mass on the posterior superomedial angle of the right scapula, sensitive to palpation (). Muscle trophicity was symmetrical. The right shoulder presented a full range of motion in all directions without scapulothoracic dyskinesis. Weakness and pain were observed when raising the right shoulder or during active abduction (at all levels).\nA right shoulder radiological series including AP, lateral, and Neer views was described normal and conducted additional investigations. A thoracic computed tomography was performed and described a 2.6 cm T \u00d7 2.6 cm AP \u00d7 2.2 cm CC solid bone mass at the posterior aspect of the superomedial angle of the scapula. The diagnosis of an osteochondroma without signs of malignancy was stated (). No adenopathy or recurrence of the past Hodgkin lymphoma was observed. Retrospectively, the mass was apparent on the shoulder Neer view. A magnetic resonance imaging (MRI) including the right shoulder and scapula confirmed the benign character of the osteochondroma. The accessory nerve (XI) was compressed between the osteochondroma and the deep layer of the trapezius; no muscle atrophy was described ().\nThe osteochondroma was surgically removed under general anesthesia. The patient was prone, and a 10 cm incision was centered on the mass. The trapezius muscle was split at its superior part at the level of the scapula spine. The accessory nerve was visualized and protected in the deep layer of the trapezius muscle. The osteochondroma was exposed and resected from the supraspinatous fossa with an osteotome. The mass was perfectly smooth and measured 3 cm T \u00d7 3 cm AP \u00d7 2 cm CC (). The integrity of the accessory nerve was checked before closure. The histopathologic analysis confirmed the diagnosis of a benign osteochondroma ().\nThe shoulder was immobilized in a sling 10 days for wound care. Free mobilization was then granted. No physiotherapy was needed.\nThe patient was followed annually up to 3 years. He regained full shoulder range of motion and complete symmetric trapezius and rotator cuff strength. The patient has no clinical and radiological recurrence of the osteochondroma.", "age": [ [ 25.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5892980.xml", "relevant_articles": { "29785314": "123", "34518177": "123", "34466190": "123", "7746252": "12", "15756527": "123" }, "similar_patients": { "3391786-1": "123", "5404176-1": "123", "5867559-1": "123", "1839090-1": "123", "2729973-1": "0" } }, { "human_patient_id": "245", "human_patient_uid": "3912772-1-M", "PMID": "24551005", "title": "Squash cytology of primary central nervous system lymphoma in an immunocompetent patient", "patient": "This was a case report of a 38-year-old male patient who was admitted to neurosurgery with a history of headache and neck pain since 2 months. No history of antecedent head trauma, febrile illness, photophobia, seizures or previous diagnosis of any malignancy was present. He didn\u2032t have lymphadenopathy or hepatosplenomegaly. Neurologic examination was not revelatory as no abnormality was found. His peripheral smear examination was normal. He was negative for human immunodeficiency virus (HIV).\nMRI of the brain revealed a well-defined lobulated focal mass measuring 4.5 cm \u00d7 3.6 cm \u00d7 3.5 cm with extensive adjacent white matter edema in right parieto-occipital lobe causing mass effect on right lateral and third ventricle and basal ganglia region with contralateral midline shift of 9 mm. On T1-weighted images mass was isointense to gray matter []. On T2-weighted and fluid-attenuated inversion recovery images, it appeared iso to mildly hyperintense []. There was mild restricted diffusion. The lesion showed intense homogeneous enhancement on post contrast study [Figure and ]. Small area of central necrosis was seen within the mass. MR spectroscopy revealed an elevated choline and lipid lactate. MRI findings were concluded as glioma.\nPatient underwent craniotomy for micro-neurosurgical complete resection by aspiration of the suspected glioma. Squash preparations were made from tissue received for frozen section and stained with hematoxylin and eosin. Monomorphic lymphoid tumor cells were seen without any fibrillary background []. The cells had large nuclei with prominent nucleoli and scant to moderate cytoplasm. Further, lymphoid cells having a blast like appearance with cytoplasmic vacuoles were recognized better on Leishman stain []. Tingible body macrophages and lymphoglandular bodies were seen. The frozen sections showed the tumor cells in sheets, but the cytologic details were not clear.\nWith intraoperative diagnosis of lymphoma infiltration on squash smears, on table bone marrow aspiration was done from the sternum to rule out hemopoietic malignancy in the marrow. The bone marrow smears showed normal marrow cells.\nA squash unstained smear was further studied with immunocytochemistry for CD45 (with a satisfactory positive control). The smears showed cytoplasmic CD45 positivity in intact tumor cells [].\nThe paraffin sections revealed the typical lymphoma cells displaying perivascular pattern and invading the brain [Figure and ]. The starry sky appearance was also seen []. The diagnosis of PCNSL was conferred. The immunohistochemical studies showed CD20 positivity [] in lymphoma cells while they were negative for CD3, CD10, Bcl2, Bcl6 [Figure \u2013] and CD99. CD3 positive reactive T cells were seen amidst the lymphoma cells []. The negativity of lymphoma cells for CD10, Bcl2, Bcl6 and positivity to CD20 indicate the non-germinal center B-cell phenotype.\nThe final diagnosis of diffuse large B cell primary CNS lymphoma (DLBCL) was given. Post-operative contrast CT showed complete removal of the lesion and the patient received chemo and radiotherapy. MRI after 2\u00bd years follow-up showed no evidence of recurrence.", "age": [ [ 38.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3912772.xml", "relevant_articles": { "24551005": "12", "22389885": "123", "18701864": "123", "31799320": "12", "24427370": "12" }, "similar_patients": { "6712912-1": "123", "5899004-1": "123", "5928293-1": "123", "4164299-1": "123", "4349017-1": "1" } }, { "human_patient_id": "246", "human_patient_uid": "7792014-1-M", "PMID": "33413267", "title": "Severe hypercalcemia caused by parathyroid hormone in a rectal cancer metastasis: a case report", "patient": "A 68 years old male had undergone total mesorectal excision 10 years before a skeletal metastasis of the lower leg was diagnosed. The patient was otherwise healthy except mild hypertension and there was no familial accumulation of endocrine or malignant diseases. Histology from the primary surgery showed a 5 cm intermediately differentiated adenocarcinoma of the rectum with no signs of neuroendocrine biology. The tumor was CK7 negative and CK20 positive. Distance to the nearest circumferential margin was 3 mm, and end resection margins were clear. There was no infiltration in the removed lymph nodes nor signs of distant metastases, thus the final TNM status was pT3N0M0. Total calcium was normal (2.37 mmol/L). Carcinoembryonic antigen (CEA) dropped from 18.0 \u03bcg/L preoperatively to 1.5 \u03bcg/L after surgery. No neo-adjuvant or adjuvant radiochemotherapy was given during the primary treatment. He underwent standard follow-up regimen with bloodwork, rectoscopies, ultrasound of the liver and chest x-ray for 4 years without any signs of relapse. CEA values were stable under 2.0 \u03bcg/L and only 1.0 \u03bcg/L when follow-up was completed.\nTen years after surgery, the patient presented with a tumor in the lower leg. X-ray and magnetic resonance imaging showed a 4.4 cm osteolytic lesion of the fibular head, in addition to a 4.7 cm tumor in the left lung and paratracheal pathological lymph nodes. Biopsies of the fibular head confirmed adenocarcinoma negative for CK7 and positive for CK20, and the pathologist concluded metastasis from the rectal cancer. The histological pattern was similar to the previously resected rectal tumor (Fig. ). CEA had now increased to 15.4 \u03bcg/L. He was treated by radiation therapy to the leg (8 Gy \u00d7 1) and commenced chemotherapy (fluorouracil, irinotecan, calcium folinate and bevacizumab). His lung pathology stabilized during this treatment and he reported less pain from the leg after the radiation therapy. However, the fibular tumor progressed radiologically and was 7 cm in diameter when it was resected 15 months after discovery. Resection margins were uncertain, and he developed a wound infection with a chronic fistula to the skin.\nThree months later, the patient presented with hypercalcemia after being normocalcemic during all previous follow-up. Due to rapidly growing inguinal and retroperitoneal lymph nodes, he started treatment with fluorouracil, leucovorin, and oxaliplatin (FLOX). CT-scan showed stable disease after three cycles of therapy. Bloodwork revealed that CEA had increased markedly to 380 \u03bcg/L. He developed severe hypercalcemia with free ionized calcium reaching 1.81 mmol/L (total calcium 3.33 mmol/L), concurrent with peaks in CEA and PTH levels (Fig. ). Creatinine and estimated GFR was normal, phosphorus was low (0.62 mmol/L), and 1,25-dihydroxyvitamin D was low (24 nmol/L). He had no arrhythmias or other clinical symptoms related to the hypercalcemia. Fluid therapy and zoledronic acid had only short-lasting effect on the calcium levels. PTHrP was negative, but intact PTH was elevated to 54.4 pmol/L (normal range 1.1\u20137.5 pmol/L). The lab used a standard two-site immunoassay for measurement of the 84 amino acid long PTH, requiring binding in both the N and C terminals for detection. The high PTH led us to consider primary hyperparathyroidism as a differential diagnosis. Ultrasound of the neck and parathyroid scintigraphy with 900 MBq of 99mTc-methoxyisobutylisonitrile (MIBI) showed no signs of parathyroid adenomas. The diagnostic challenge was to distinguish primary hyperparathyroidism from ectopic PTH production in a colorectal bone metastasis or potentially another tumor.\nTo investigate if the tumor of the fibular head was responsible for the PTH elevation, we biopsied the tumor and stained for PTH. No significant staining was observed, using monoclonal antibody immunohistochemistry. Because such a large tumor can contain different clones of cells, a negative biopsy does not rule out that PTH could be produced from a part of the tumor not represented in the biopsy. Also, PTH immunohistochemistry on bone biopsies could be false negative for unknown technical reasons. We therefore measured blood PTH levels while excluding the lower right leg from the circulation by use of a blood pressure cuff on the thigh (modified Casanova test [], Fig. a). PTH levels measured in blood samples from the arm fell rapidly during the 20 min of right leg ischemia, consistent with local PTH production from the fibular tumor (Fig. b).\nWe concluded that the diagnosis was hypercalcemia caused by PTH secretion from the bone metastasis in the fibular head, and focused further treatment against the fibular tumor. The osteoclast inhibitor denosumab 120 mg was administered subcutaneously and further radiotherapy was given to the lower leg (3 Gy \u00d7 10). This made free calcium level stabilize at values around 1.40 mmol/L, and PTH was also attenuated (Fig. ). The patient received further cycles with FLIRI/bevacizumab until a year before his death. Six months before the patient died, another surge in PTH and calcium levels arose. Now, the patient received another course of radiotherapy (4 Gy \u00d7 5) towards his fibula, followed by a drop in PTH levels and normalization of calcium levels. No adverse events or side effects were reported by the patients or treating clinicians. The patient did not develop further episodes of severe hypercalcemia during the remainder of his life and died approximately 24 months after the first incident of severe hypercalcemia, due to disseminated disease involving skin, lymph nodes, lung, pancreas and brain.\nAs immunohistochemistry failed to show PTH in the fibular bone metastasis, we analyzed messenger ribonucleic acid (mRNA) from the same biopsies post mortem. Despite the long interval from biopsy to RNA extraction (5\u201316 years), we were able to extract total RNA from formalin-fixed paraffine embedded (FFPE) tissue sections and quantified PTH by reverse transcriptase quantitative polymerase chain reaction (RT-qPCR). We found evidence of PTH transcription in both the original rectal specimen and in the fibular biopsy taken after onset of hypercalcemia, but not in the fibular biopsy that was taken before onset of hypercalcemia, nor in ipsilateral inguinal lymph node metastasis (Fig. ). This is consistent with development of clinically significant PTH production within the fibular metastasis, after local recurrence and radiation therapy to the lower leg.", "age": [ [ 68.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7792014.xml", "relevant_articles": { "1592895": "12", "8855805": "12", "7910069": "12", "2056982": "12", "1997510": "12" }, "similar_patients": { "6056365-1": "12", "5035774-1": "1", "3000473-1": "1", "8016748-2": "1", "5420110-1": "1" } }, { "human_patient_id": "247", "human_patient_uid": "8095300-1-M", "PMID": "34084036", "title": "Full-thickness macular hole formation following antivascular endothelial growth factor injection in a case of hemicentral retinal vein occlusion", "patient": "A 62-year-old female presented with chief complaints of floaters in the right eye (RE) for 3 weeks. She was a known diabetic (on OHD) since 6 years and hypertensive since 10 years (on treatment), rheumatoid arthritis (on treatment), and with no known adverse drug reactions. Her best-corrected visual acuity (BCVA) was 4/60 in RE and 6/6 in left eye (LE). On examination, her anterior segment revealed normal findings in both the eyes except for relative afferent pupillary defect in RE. Posterior segment revealed multiple intraretinal haemorrhages all over the superior quadrant, engorged tortuous blood vessels, and CME in RE while there was no abnormality in LE. A provisional diagnosis of RE hemicentral retinal vein occlusion (CRVO) with CME was made []. Her blood pressure was 160/90 mm of Hg, and her blood investigations showed deranged lipid profile and raised blood sugar. Optical coherence tomography (OCT) showed a central macular thickness of 551 \u03bc with intraretinal cystic spaces and fluid []. Fundus fluorescein angiography of RE revealed capillary dropouts and nonperfusion areas corresponding to the area of vein occlusion along with angiographic CME. She received a single intravitreal injection bevacizumab following which her vision improved to 6/36. Her OCT of RE revealed a full thickness MH a month later! [ and ] She was explained about requiring surgery. Over the next 18 months, she received 5 more injections of intravitreal Bevacizumab. Her RE BCVA before vitrectomy was 6/18. A 25G vitrectomy was performed and intraoperatively posterior vitreous detachment (PVD) had to be induced, conventional internal limiting membrane peeling done and a tamponade of C3F8 (perfluoropropane) was given. Four months postsurgery, her RE BCVA 6/24 with cataract formation and MH Type 1 (U-shaped) closure was seen [ and ]. In the subsequent months, she underwent cataract extraction following which she developed CME. She underwent scatter laser (sectoral superior quadrant) in her RE along with intravitreal injection Ranibizumab three times. She has remained in regular follow-ups ever since and her BCVA has remained stable at 6/9 [].", "age": [ [ 62.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC008xxxxxx/PMC8095300.xml", "relevant_articles": { "16525823": "12", "30421618": "13", "32899012": "123", "34921989": "123", "22615698": "123" }, "similar_patients": { "7508106-1": "13", "7043158-1": "13", "5288508-2": "0", "7774200-1": "123", "6113825-1": "123" } }, { "human_patient_id": "248", "human_patient_uid": "3359438-1-M", "PMID": "22655286", "title": "A Primary Synovial Sarcoma of Lung", "patient": "A 55-year-old male presented with left-sided pleuritic chest pain for 2 months and progressively increasing shortness of breath with dry cough for 1.5 months. Chest pain was not relieved by simple analgesic. Shortness of breath was not associated with wheeze. Initially cough was nonproductive; later it became productive with scanty white mucoid expectoration, but there was no history of hemoptysis. He smoked 25 bidis daily for last 32 years, i.e., he was exposed to 8 pack year smoking. But there was no history of past exposure to asbestos. On general survey, mild pallor was present, but there were no clubbing and palpable cervical and axillary lymph node. His respiratory rate was 24 breaths/min, pulse rate 108 beats/min, and blood pressure 120/80 mm Hg.\nExamination of respiratory system revealed decreased movement of the left side of the chest wall with ipsilateral fullness. Trachea was shifted to right. Vocal fremitus was diminished and percussion note was dull over all areas of left side. Vesicular breath sound was diminished and vocal resonance was decreased on the left side. Examination of abdomen did not reveal any lymphadenopathy, ascites, and hepatosplenomegaly. Other systems were within normal limit.\nComplete hemogram and blood biochemistries were within normal limit. Left-sided homogenous opacity along with contralateral mediastinal shifting was seen on chest X-ray. Sputum for acid fast bacilli (AFB) and malignant cell were negative. A total of 500 mL of pleural fluid was aspirated from the left side and pleural fluid analysis revealed lymphocyte predominant, exudative, hemorrhagic pleural effusion with adenosine deaminase value, 17.5 U/L. Papanicolaou stain of pleural fluid revealed no malignant cell. On contrast enhanced computed tomography (CECT) of thorax a large heterogeneous mass with multiple areas of necrosis, occupying almost whole of left hemithorax was seen along with left-sided pleural effusion []. CT-guided fine needle aspiration cytology (FNAC) revealed spindle cell neoplasm. On histopathological section of CT-guided tru-cut biopsy, it was shown that there were sheets of spindle cells with plump nuclei, moderate degree of nuclear polymorphism, and mitotic Figures in more than one high power field \u2013 suggestive of spindle cell sarcoma []. However, immunohistochemistry revealed that tumor cells expressed epithelial membrane antigen, CD99, bcl-2 and calponin and were immunonegative for cytokeratin []. Hence, final impression from immunohistochemistry was primary synovial sarcoma of lung.", "age": [ [ 55.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3359438.xml", "relevant_articles": { "22655286": "12", "26714576": "0", "22345919": "0", "21358103": "12", "31559102": "0" }, "similar_patients": { "4765279-1": "1", "4220322-1": "0", "4789394-1": "0", "4180649-1": "0", "3775202-1": "0" } }, { "human_patient_id": "249", "human_patient_uid": "3579744-1-M", "PMID": "23351285", "title": "Undifferentiated pleomorphic sarcoma with osteoclast-like giant cells of the female breast", "patient": "A 50-year-old woman presented to the Breast Unit of Sant\u2019 Anna and San Sebastiano Hospital of Caserta, Italy, after becoming aware of a non-tender lump in the median areolar area of her right breast. She first noticed the mass one month previously. During this period, she did not have any pain or discharge from the nipple. Further, she had no family history of malignancy, including breast cancer. She was in antihypertensive therapy.\nShe had never undergone any radiation and hormone replacement therapy. On physical examination, the patient had a demarcated, mobile, firm and fast-growing mass in her right breast.\nThe mass was not tender, approximately 4 cm in diameter, and was detected in the median areolar area of the right breast. There was no clinical evidence of regional lymphadenopathy.\nMammography revealed an opaque and ovoid lesion occupying the median equatorial region of the right breast; this lesion was 35 mm in diameter, with regular margins, moderate intensity and homogeneous density; there was no evidence of defined focus of pathological calcification (Figure ). Ultrasonography revealed a bulky, firm, hypoechoic lesion, with blurred and irregular margins, richly vascularized on color Doppler, with high speed systolic flow. This mass was 45 mm in diameter, and referred to as a heteroplastic lesion. There was no evidence of lymphadenopathy.\nUltrasound-guided fine needle aspiration on the lesion showed epithelioid and spindle cells, which were positive only to the immunohistochemical staining for vimentin and so we suspected a mesenchymal lesion.\nAn ultrasound-guided core needle biopsy performed subsequently showed connective tissue, including cells similar to those already present in the needle aspirate and there were many multinuclear osteoclast-like giant cells. The immunohistochemical staining confirmed the mesenchymal nature of the lesion (positivity for vimentin), but did not indicate clearly a specific histotype for the actin, CD34 and S100 protein negativity.\nPreoperative examination consisted of a complete blood count, serum kidney and liver function, thyroid function test, and tests for the levels of several hormones related to the development of gynecomastia, including estrogen, testosterone, prolactin and gonadotrophic hormones as well as cancer markers (CEA, CA 15\u20133, CA 125). Ultrasound (US) of the abdomen failed to document any abnormalities. An isotope bone scan did not reveal any abnormal uptake. All results were within the normal limits.\nThe patient underwent total mastectomy without axillary lymph node dissection, awaiting histology.\nMacroscopic examination of the specimen, measuring 19 \u00d7 15 \u00d7 8 cm and including the normal nipple, revealed a grayish, apparently delimited nodular lesion, measuring 10 cm in diameter, with cystic-necrotic and few hemorrhagic areas. The lesion was 0.5 cm away from the fascia and 1 cm away from the skin; furthermore, another grayish nodular lesion measuring 1.5 cm was in the subcutaneous tissue.\nMicroscopic examination of the sections from the specimen showed nodular proliferation of pleomorphic-spindle-shaped and ovoid cells, with connective tissue septa, mixed with many multinuclear osteoclast-like giant cells that did not show, mainly, malignant features (Figures a-b; Figure a, b).\nNecrotic areas and abnormal mitosis were identified. Immunohistochemical stainings for Cytokeratin Pan (Figure a), Cytokeratin 7-8-18-19, EMA (epithelial membrane antigen), S100 protein, SMA (smooth muscle actin) and CD34 were negative; immunohistochemical staining for vimentin was positive (Figure b). Mitotic activity was observed with a high proliferation index, assessed with Ki67. Moreover, in the surrounding parenchymal component, there were multiple foci of intraductal carcinoma, evaluated with immunohistochemical staining for muscle actin and collagen IV. The lesion was contained within the margins of excision.\nThe histological and immunohistochemical findings established the diagnosis of undifferentiated pleomorphic sarcoma with osteoclast-like giant cells of the breast.\nThe patient was monitored after the operation and we did not consider that adjuvant treatment was necessary in the presence of adequate local control and in the absence of metastatic spread of the disease. Follow-up mammography has been satisfactory to date, and she remained well without tumor recurrence at 15 months.", "age": [ [ 50.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3579744.xml", "relevant_articles": { "11180771": "123", "23351285": "123", "15737051": "12", "11668248": "123", "28253912": "0" }, "similar_patients": { "2526983-1": "1", "4947292-1": "123", "7762671-1": "123", "1808459-1": "123", "3670645-1": "123" } }, { "human_patient_id": "250", "human_patient_uid": "8153095-1-M", "PMID": "34039283", "title": "Rat bite fever with osteomyelitis and discitis: case report and literature review", "patient": "A 55-year old male presented to an academic medical center in February 2020 with a six-week history of increasing midline back pain. He had a history of chronic mid- and lower back pain as the result of degenerative disc disease, however his pain had abruptly worsened in the 6 weeks prior to presentation. Pain was worsened with trying to sit up straight or walk. Pain was partially relieved with acetaminophen, ibuprofen, and oxycodone 5 mg tablets taken as needed. He reported no associated fevers, chills, or night sweats. He did not recall a febrile illness prior to the onset of symptoms. He did report anorexia and 15-pound weight loss in the last 6 weeks. His medical history included chronic obstructive pulmonary disease, chronic hepatitis C infection, hyperlipidemia, generalized anxiety disorder, and lumbar degenerative disc disease. His surgical history was notable for cervical spine laminectomy in the remote past. His social history was notable for heavy and ongoing tobacco use with a 60 pack-year smoking history. He denied alcohol or illicit drug use including intravenous drug use.\nHe was afebrile and hemodynamically stable on presentation. Physical exam revealed a gaunt Caucasian male in moderate distress due to pain. Poor dentition was noted. His cardiopulmonary examination was unremarkable. On spinal examination, no bony tenderness was elicited upon palpation of the thoracic and lumbar spine, however paraspinal tenderness was noted in the lumbar spine. Neurologic examination including strength and sensation of the lower extremities was intact. Babinski reflex was downward bilaterally.\nMRI with and without gadolinium contrast revealed abnormal enhancement of the lower endplate of the L2 vertebral body as well as diffuse enhancement of the L3 vertebral body with irregularity of the upper endplate. This abnormal enhancement extended to the intervertebral disc. Findings were suggestive of discitis with osteomyelitis not excluded. Additionally, there was enhancement and thickening in the anterior epidural space measuring 2 mm \u00d7 4 mm which may represent epidural abscess or hematoma (Fig. ). Laboratory evaluation including CBC with differential and comprehensive metabolic panel was unremarkable. Sedimentation rate was 36 mm/hr. and C-reactive protein was 30.1 mg/L. Blood cultures were sterile.\nBased on initial results of clinical, laboratory, and radiographic evaluation, antibiotic therapy was withheld. CT-guided aspiration of the L2-L3 disc was performed for culture and histopathology. Gram stain revealed Gram variable rods. Histopathology revealed fibrocartilage with degenerative changes and acute inflammation suggestive of discitis (Fig. ). He was seen in Infectious Diseases outpatient consultation, initially offered intravenous antibiotic therapy however patient requested oral antibiotic therapy for empiric treatment of discitis. He was started on treatment with cephalexin 1 g by mouth three times a day as well as linezolid 600 mg by mouth twice a day. (Initially, prior to the revelation of RBF infection, linezolid was chosen (in addition to cephalexin) because Gram stain revealed Gram-positive rods. The intention was to cover Corynebacterium spp. and coagulase-negative staphylococci, skin flora which tend to have resistance to beta-lactams but susceptibility to vancomycin or linezolid.) Cultures were sent to a reference laboratory, with growth noted on Mueller-Hinton media with 5% sheep blood. The organism was identified as Streptobacillus moniliformis by matrix-assisted laser desorption ionization time-of-flight mass spectroscopy (MALDI-TOF). On further history, it was revealed that patient had two pet rats and had sustained numerous bites in the last 1 year prior to symptom onset. In vitro susceptibility testing using broth microdilution revealed low MIC for penicillin (< 0.06 \u03bcg/ml), ampicillin (< 0.12 \u03bcg/ml), and ceftriaxone (< 0.06 \u03bcg/ml), with elevated MIC > 4 \u03bcg/mL for gentamicin. The patient\u2019s symptoms dramatically improved with cephalexin so a decision was made not to switch to oral or IV penicillin. Linezolid was discontinued after 2 weeks once culture results were available. He completed 6 weeks of oral cephalexin therapy with dramatic improvement of back pain. The patient was offered TEE to evaluate for endocarditis. However, he declined to have the test done as this coincided with the onset of CoVID-19 pandemic.", "age": [ [ 55.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC008xxxxxx/PMC8153095.xml", "relevant_articles": { "27965310": "123", "30397618": "123", "22472806": "123", "32055441": "123", "25767594": "123" }, "similar_patients": { "8519187-1": "13", "8085636-1": "123", "5628438-1": "123", "6136886-1": "123", "7916262-1": "123" } }, { "human_patient_id": "251", "human_patient_uid": "4356420-1-M", "PMID": "25789000", "title": "Complete response to comprehensive treatment of a primary hepatic diffuse large B cell lymphoma: A case report", "patient": "In April 2006, an abdominal computed tomography (CT) scan revealed multiple solid hypodense lesions with a size of 18\u00d718 mm in a 56-year-old male undergoing a routine physical examination at The Affiliated Cancer Hospital of Zhengzhou University (Zhengzhou, China). After four months, further CT scans detected an irregular nodular mass with a size of at least 125\u00d7100 mm. The patient did not present any symptoms, such as fever, respiratory problems, weakness, anorexia or weight loss. The patient had a 20-year history of hepatitis B virus infection and had been receiving treatment with lamivudine.\nClinical examination detected hepatomegaly (45 mm) below the right costal margin, while no other abnormalities were observed. The liver was nontender, with an irregular surface on the right side. Viral markers were found to be positive for hepatitis B and negative for hepatitis C. Fluorescence in situ hybridization revealed EBV-DNA levels of 5\u00d7106 copies/ml. The results of further examinations, including a baseline electrocardiogram, chest CT scan, complete blood count, liver function test and kidney function test, were found to be normal. In addition, the levels of lactase dehydrogenase, uric acid, calcium, \u03b1-fetoprotein, \u03b2-2-microglobulin and carcinoma embryonic antigen were normal. An abdominal and pelvic CT scan revealed an irregular nodular mass in the right lobe of the liver with a size of at least 125\u00d7100 mm (). No other abnormal findings were detected at the abdomen and pelvis. Furthermore, a chest and neck CT scan demonstrated normal lung fields and no mediastinal or paratracheal lymphadenopathy. Bone marrow biopsy identified no evidence of tumor involvement. Ultimately, a diagnostic liver biopsy was performed, which revealed sheets and nests of round cells, surrounded by mature lymphoid cells at the periphery. These cells were positive for the CD20 and leukocyte common antigen markers (). The findings were consistent with non-Hodgkin\u2019s lymphoma (NHL) of diffuse large B-cell type. Therefore, the final diagnosis of the patient in the present study was PHL of diffuse large B-cell type at stage IE, according to the Ann Arbor staging system, since a single extranodal site was involved ().\nThe patient received R-CHOP chemotherapy, which involved administration of the following: 375 mg/m2 rituximab [intravenously (IV)] over 6 h on day \u20131; 750 mg/m2 cyclophosphamide over 3 h, 2 mg vincristine and 50 mg/m2 doxorubicin (IV) on day 1; and 40 mg/m2 prednisolone (orally) on days 1\u20135, every 21-day cycle. An abdominal CT scan was performed following two cycles of chemotherapy, which revealed a marked regression of the lesion to 58\u00d758 mm in the right lobe of the liver (). Following two further cycles of R-CHOP, an abdominal CT scan detected that the mass was slightly enlarged, having a size of 62\u00d759 mm ().\nSubsequently, the right liver of the patient was treated with radiotherapy at a dose of 40 Gy over 28 days (2 Gy fractions, days 1\u20135). CT scans revealed further regression of the liver lesion to 26\u00d732 mm following radiotherapy (). In addition, the patient received treatment with the R-Hyper-CVAD/R-HD MTX-ara-C regimen, following radiotherapy. The regimen consisted of two cycles of dose-intensive therapy courses with rituximab and Hyper-CVAD (R-Hyper-CVAD) therapy alternating with rituximab and high-dose methotrexate (MTX) and cytosine arabinoside (ara-C) therapy (R-HD MTX-ara-C). The R-Hyper-CVAD regimen involved administration of the following: 375 mg/m2 rituximab (IV) on day \u20131; 300 mg/m2 cyclophosphamide (IV) over 3 h every 12 h for six doses on days 1\u20133; 300 mg/m2 mesna by continuous infusion initiated along with cyclophosphamide administration and ending 6 h after the last dose of cyclophosphamide; 2 mg vincristine (IV) on days 4 and 11; 50 mg/m2 doxorubicin (IV) on day 4; and 40 mg dexamethasone daily on days 1\u20134 and 11\u201314. The R-HD MTX-ara-C regimen involved administration of the following: 375 mg/m2 rituximab on day 1; 200 mg/m2 MTX (IV) over 2 h, followed by 800 mg/m2 IV over 24 h on day 1; 15 mg citrovorum factor rescue every 6 h, initiated 24 h after completion of MTX infusion and increased to 50 mg every 6 h when MTX levels were >20 mmol/l at the end of the infusion, >1 mmol/l at 24 h after infusion or >0.1 mmol/l at 48 h after infusion, until MTX levels were <0.1 mM; 3 g/m2 ara-C over 2 h every 12 h on days 2 and 3; and 50 mg methylprednisolone (IV) twice daily on days 1 through 3. After three cycles of the R-Hyper-CVAD/R-HD MTX-ara-C regimen, abdominal CT scans revealed that the liver lesion disappeared and the patient achieved complete remission (). Following complete remission, the patient was subjected to maintenance therapy by administration of 375 mg/m2 rituximab on day 1 and every three months thereafter for a total of seven doses. The patient remained in a stable and healthy condition, with regular follow-ups for >3 years.", "age": [ [ 56.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4356420.xml", "relevant_articles": { "11900213": "0", "15022284": "0", "20379108": "123", "10971734": "0", "32171071": "123" }, "similar_patients": { "4579810-1": "13", "4269308-1": "123", "6761274-1": "0", "6719254-1": "123", "3965717-1": "123" } }, { "human_patient_id": "252", "human_patient_uid": "5695022-1-M", "PMID": "29234547", "title": "Testicular Cancer Presenting as Gastric Variceal Hemorrhage", "patient": "A 26-year-old man arrived at the emergency department with a seven-day history of hematemesis and melena. He had no previous medical history and did not drink alcohol or used any illicit drug or medication.\nPhysical examination on admission showed blood pressure of 100/60 mmHg, a temperature of 36\u00b0C (96.8\u00b0F), a pulse rate of 90/min, and a respiratory rate of 22/min; his height was 1.75 m, weight 98 kg, and BMI 32 kg/m2. He experienced pain with deep palpation in the epigastrium and no organomegaly or lymphadenopathy was identified. The left scrotal sac was enlarged and indurated and there was a mass in the left scrotum that was indistinguishable from the left testis and provoked displacement of structures of the penis and right testis (the right scrotum was empty). No inguinal lymphadenopathy was identified.\nLaboratory tests revealed normal liver function. Hemoglobin was 9.13 g/dl, MCV was 87.9 fL, WBC was 11.9 K/uL, neutrophils were 9.81 K/uL, lymphocyte count was 1.59 K/uL, and platelet level was 252 K/uL. Serum glucose level was 106 mg/dl, BUN was 38 mg/dl, creatinine was 0.9 mg/dl, and calcium was 8.9 mg/dl. Serum alpha-fetoprotein (AFP) level was 17,090 ng/mL, lactate dehydrogenase was 1480 U/L (normal range: 91\u2013180 IU/L), and human chorionic gonadotropin level was 287.4 IU/mL.\nAfter resuscitation with crystalloid solutions, he underwent upper endoscopy. The gastroenterologist found abundant active bleeding, for which orotracheal intubation was decided to provide airway protection. The patient was transferred to the intensive care unit. A second upper endoscopy revealed a type 1 isolated gastric varix, treated with cyanoacrylate without complications ().\nA scrotal US showed a large heterogeneous image in the left testicle area, with an echogenic and cystic solid component and flow presence with color Doppler assessment.\nA contrasted CT scan of the thorax, abdomen, and pelvis showed a liver of normal size and density with multiple retrocrural, retroperitoneal, mesenteric, and left iliac metastatic lymphadenopathy which caused extrinsic compression of the portal vein along with splenic vein partial thrombosis with left-sided portal hypertension and perigastric and perisplenic collateral neovascularization (). A heterogeneous, well defined mass was found in the left testicle, 16.7 \u00d7 16.1 \u00d7 14.9 cm, with a solid component that was enhanced with the administration of contrast, as well as a cystic component. There was also invasion of the left spermatic cord.\nThe patient was extubated after surveillance and transferred to the Internal Medicine Department. We started chemotherapy with etoposide 100 mg/m2 and cisplatin 20 mg/m2, and seven days later the patient underwent a left radical orchiectomy by an inguinal approach with left hemiscrotectomy, without complications. Following this intervention, serum alpha-fetoprotein (AFP) level was reduced to 350 ng/mL, and the human chorionic gonadotropin level was 50 IU/mL.\nA postoperative biopsy showed a pure testicular teratoma () with glandular formations and the presence of cartilage (a) and respiratory epithelium, with ciliated columnar cells alternating with goblet cells (b).\nThe patient was discharged after showing clinical improvement to receive ambulatory chemotherapy.", "age": [ [ 26.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5695022.xml", "relevant_articles": { "29234547": "123", "20383188": "123", "9487296": "0", "31807430": "123", "6193860": "0" }, "similar_patients": { "6196924-1": "13", "8453063-1": "0", "7986722-1": "13", "5470564-1": "13", "8439170-1": "123" } }, { "human_patient_id": "253", "human_patient_uid": "7886549-1-M", "PMID": "33623695", "title": "PAX2 variant associated with bilateral kidney agenesis and broad intrafamilial disease variability", "patient": "Post-mortem examination of a 15 + 2 deceased female foetus born to a 39-year-old healthy woman revealed isolated bilateral kidney agenesis. The father of the foetus was diagnosed with kidney hypoplasia and minimal change nephropathy at the age of 36 years due to persistent proteinuria. Subsequently, he was diagnosed with hypertension and hyperuricaemia, both requiring medical therapy. However, at the age of 53 years, kidney function was only mildly impaired. The father has a strong family history of kidney disease ().\nDNA extracted from foetal tissue was analysed using array comparative genomic hybridization. No pathogenic genomic copy number variants were identified. Subsequently, a gene panel (including CAKUT genes BMP7, CDC5L, CHD1L, EYA1, FRAS1, FREM1, FREM2, GATA3, GREM1, GRIP1, HNF1B, ITGA8, PAX2, RET, ROBO2, SALL1, SIX2, SIX5 and TBX18) was targeted for sequencing to identify putative disease-associated variants using next-generation sequencing. Smaller indels, up to 50 bp, were called in the variant analysis pipeline, whereas exon deletion/duplications were analysed using a copy number variation tool. These analyses only identified a heterozygous PAX2 missense variant c.68T>C [p.(Leu23Pro)].\nSubsequently, the PAX2 candidate variant was assessed for cosegregation with kidney phenotypes in the family under study. The variant was identified in all family members affected by kidney disease for which DNA was available (). The kidney phenotypes seen in the family were remarkably heterogeneous, including bilateral kidney agenesis, minimal change nephropathy, ureteropelvic junction obstruction, duplex kidney with hydronephrosis of upper pole system and bilateral kidney hypoplasia with end-stage renal failure in early adult life or with only moderate chronic kidney failure in late adult life.\nTo study whether the severe foetal phenotype was exacerbated by additional variants in modifier genes, an additional 138 genes previously associated with kidney disease were analysed, including GREB1L, FGF20 and LMX1B. No additional candidate variants were identified.\nRetinal examination of Patient III-3 revealed unilateral optic nerve coloboma and retinal examination of Patient IV-3 revealed unilateral optic pit ().", "age": [ [ 0.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC007xxxxxx/PMC7886549.xml", "relevant_articles": { "33623695": "12", "29194579": "12", "29100091": "12", "24429398": "12", "32643034": "12" }, "similar_patients": { "7678048-1": "0", "8593884-1": "0", "6309388-1": "0", "5368915-1": "0", "6525401-1": "0" } }, { "human_patient_id": "254", "human_patient_uid": "5463136-1-M", "PMID": "28630775", "title": "A Rare Case of Paraneoplastic Aortitis Associated with Chronic Myelomonocytic Leukemia", "patient": "A 68-year-old Caucasian woman recently diagnosed with CMML presented to our rheumatology office for evaluation of an abnormal chest computed tomography (CT) showing inflammation surrounding the entire thoracic and abdominal aorta. She was experiencing shortness of breath, fatigue, fevers, and night sweats for about four months previously. She additionally had an unintentional weight loss of 35 pounds over the past 2 years which was initially attributed to Nissen fundoplication procedure for gastroesophageal reflux. She denied any headaches, vision changes, scalp tenderness, jaw pain, dysphagia, joint pain, joint swelling, muscle pain, or photosensitivity.\nFor the past eight months, she had been undergoing hematological workup of abnormal blood counts. Her white blood cell (WBC) counts were elevated with monocytosis and varying degrees of neutrophilia over the past 3 years. She had thrombocytosis. Her initial evaluation was negative for BCR-ABL PCR testing, Janus kinase-2, calreticulin, and MPL mutations. There was no hepatosplenomegaly on imaging. After these tests returned negative, she was planned for a bone marrow biopsy for further evaluation of monocytosis but opted to wait as she was asymptomatic. However, she presented back with a nontender, erythematous lesion on her left breast. About two weeks later, similar scattered pink small dermal papulonodules were present on the posterior neck, left shoulder, abdomen, and left thigh. Left breast punch biopsy described a dense dermal infiltrate with small lymphocytes with cytologic atypia. There was no significant epidermal involvement. The lymphocytes were positive for CD4 and CD43, myeloperoxidase, and lysozyme. The overall morphologic and immunohistochemical findings were those of a malignant neoplasm. Although this was originally thought to be a possible T cell lymphoma, case was discussed at the hematopathology conference and the overall presentation correlated with more systemic process, such as CMML.\nSubsequent bone marrow biopsy and aspiration showed pieces of hypercellular bone marrow with overall cellularity of 50%, trilineage hematopoiesis, hypogranular myeloid cells, and increase of monocytoid cells with somewhat immature appearing features. Increased monocytosis (20%) with oval-shaped, slightly irregular nuclei was present. There was no evidence of fibrosis on reticulin staining. Adequate megakaryopoiesis and erythropoiesis without dysplastic changes was noted. The myeloid-to-erythroid ratio was mildly increased. Cytogenetic evaluation exhibited a normal karyotype (46, XX). Flow cytometry revealed CD14+/CD16- monocytes that are characteristic of CMML []. CMML diagnosis was made based on the above findings, persistent peripheral blood monocytosis \u2265 1 \u00d7 109/L, with monocytes accounting for \u226510% of the WBC count, no evidence of PDGFRA/PDGFRB, <20% blasts in the blood and bone marrow, not meeting WHO criteria for BCR-ABL1 positive chronic myeloid leukemia, primary myelofibrosis, polycythemia vera, or essential thrombocytosis and all other causes of monocytosis excluded []. For staging, she underwent positron emission tomography (PET) and computed tomography (CT) scans and both imaging studies showed soft tissue density surrounding the entirety of the thoracic and abdominal aorta, consistent with large-vessel vasculitis (see Figures and ).\nLaboratory studies were positive for antinuclear antibody (ANA) with a titer of 1 : 640 in a nucleolar and speckled pattern as well as elevated RNP antibody (ab) at 1.1. Her inflammatory markers were elevated: erythrocyte sedimentation rate (ESR) 36 mm/hr and C-reactive protein (CRP) 35.3 mg/L. The negative serologies included an anti-neutrophil cytoplasmic ab, anti-proteinase 3 ab, anti-myeloperoxidase ab, SS-A/SS-B ab, anti-Smith ab, anti-dsDNA ab, anti-smooth muscle ab, rheumatoid factor, anti-cyclic citrullinated peptide ab, and hepatitis panel.\nFor symptomatic aortitis, we started treatment with prednisone 1 mg/kg/day. Within a week, patient had significant improvement. Her shortness of breath subsided and she felt strong and energetic. Objectively, while on steroid therapy, her WBC count initially dropped. Since the aortitis related symptoms were improving, the hematology team planned to start her on treatment with a hypomethylating agent\u2014azacitidine.\nSteroid therapy was slowly tapered given her good response to initial high-dose steroids. However, two months later, she developed steroid-induced myopathy and prednisone was tapered more quickly. Within two weeks, she became more dyspneic and hypoxic. Her respiratory status deteriorated quickly, requiring intubation and mechanical ventilation. She was treated with broad-spectrum antibiotics for possible infectious etiology. CT chest demonstrated stable aortitis but increased diffuse ground-glass opacity throughout both lungs and bilateral pulmonary consolidation. These findings were attributed to paraneoplastic infiltrates from leukemia and less likely to be infectious. Cultures from bronchoalveolar lavage and Pneumocystis jirovecii testing were negative. Coincidentally, prior to this admission, she had a stable WBC count of 18,600/\u03bcL that now has progressed to WBC count of 77,000/\u03bcL, despite negative infectious workup, aortitis being asymptomatic and stable on CT imaging study.\nGiven her clinical deterioration from leukemia, in her final days she received her first treatment of CMML with hydroxyurea, then underwent leukapheresis, and received one dose of chemotherapy with decitabine one day prior to expiration. Unfortunately, she continued to deteriorate and was placed on hospice. Her family refused an autopsy.", "age": [ [ 68.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5463136.xml", "relevant_articles": { "26493409": "123", "26535170": "0", "23160592": "0", "20012960": "0", "29642214": "0" }, "similar_patients": { "6579327-1": "1", "6557017-1": "13", "5069777-1": "13", "6339764-1": "0", "4415678-1": "123" } }, { "human_patient_id": "255", "human_patient_uid": "4964326-1-M", "PMID": "27410917", "title": "CHYLOTHORAX IN PARACOCCIDIOIDOMYCOSIS", "patient": "A 52-year-old woman presented with a nine month history of generalized lymphadenopathy, skin lesions (multiple crusts all over her body), low fever, weight loss of more than 30 kg, vomiting, abdominal distension, mild dyspnea and a left breast mass (measuring 50 x 10 mm). She denied having any allergies or previous relevant diseases.\nShe was hospitalized for further investigation. Laboratory testing findings showed negative serology for HIV and viral hepatitis, anemia (hemoglobin 11.0 g/dL), and low serum albumin (2.3 g/dL), mild (prerenal) acute kidney injury, and elevated C-reactive protein (over 8 times the maximum reference value).\nChest radiography was performed and showed mild/moderate bilateral pleural effusions. In addition, the patient underwent a computed tomography (CT) of the neck, chest and abdomen. CT revealed the presence of a breast mass, generalized necrotic lymph node enlargement (cervical, axillary, mediastinal, abdominal and inguinal), mild splenomegaly, pleural effusion and ascites ().\nShe underwent a thoracocentesis that disclosed the presence of a milky fluid whose analysis showed a triglyceride concentration > 600 mg/dL, with no neoplastic cells. Additionally, paracentesis was performed, and the finding was consistent with chylous ascites, and neoplastic cells were not found.\nBiopsies of the breast mass (core biopsy), skin lesions and enlarged inguinal lymph nodes were performed and stained using the Grocott-Gomori methenamine-silver (GGMS) technique, the gold standard to diagnose paracoccidioidomycosis according to guidelines. All of the biopsies revealed the presence of large round yeast cells with multiple narrow-based budding daughter cells, characteristic of Paracoccidioides brasiliensis.\nThereafter, liposomal amphotericin B was prescribed, as well as a high protein and low fat diet (supplemented with medium chain triglycerides). Despite the treatment, her clinical status worsened, with development of severe acute kidney injury that required renal replacement therapy, pneumonia, septic shock, and she subsequently died.", "age": [ [ 52.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC004xxxxxx/PMC4964326.xml", "relevant_articles": { "27410917": "123", "31157180": "0", "2278229": "0", "33790180": "0", "21918321": "0" }, "similar_patients": { "7417084-1": "13", "3407757-1": "13", "4633558-1": "0", "5459556-1": "0", "6375378-1": "0" } }, { "human_patient_id": "256", "human_patient_uid": "3097565-1-M", "PMID": "21633584", "title": "Adhesive bowel obstruction? Not always", "patient": "A 58-year-old man presented acutely with clinical and radiological (plain abdominal X-rays) features of SBO. There was no significant past medical history. Past surgical history included cholecystectomy and emergency laparotomy for perforated appendicitis, which were performed years ago. On physical examination, he was hemodynamically stable. His abdomen was diffusely distended and tender, with no signs of peritoneal irritation. There were no palpable masses and bowel sounds were high-pitched. No external hernias were identified. All laboratory investigations were within normal limits, including hemoglobin concentration. Given that, adhesions were considered the most likely cause. Following an unsuccessful trial of conservative management including nasogastric aspiration and intravenous fluids for 48 hours; contrasted abdominal CT was performed on day 3. This revealed a mass in the ileocecal region [], for which he subsequently underwent right hemicolectomy. Histology revealed diffuse B-cell Non-Hodgkin\u2019s lymphoma of the terminal ileum. The patient was referred for chemotherapy. Four years on, he remained disease-free.\nAdhesive SBO accounts for about 1% of all emergency surgical admissions and 3.3% of all emergency laparotomies.[] It can occur any time following initial surgery.[] While management of uncomplicated adhesive SBO is largely conservative, the debate remains over the optimal duration for such non-operative management[] since only 8% of cases require surgical intervention. Confounding obstructive lesion of the intestine in patients with previous laparotomy is extremely uncommon. As adhesive SBO was the most likely diagnosis, our patient\u2019s initial management was considered acceptable. Early high-resolution imaging may elucidate etiology and consolidate clinical management plans.[] In our patient\u2019s case, early CT scan would have led to immediate laparotomy without delay. Therefore, if surgical intervention is deferred on clinical grounds, CT scan should be performed as soon as practicable, provided that there are no contraindications.", "age": [ [ 58.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3097565.xml", "relevant_articles": { "21633584": "123", "31559107": "123", "17879683": "123", "34182911": "123", "30882714": "13" }, "similar_patients": { "4560130-1": "0", "7801865-1": "0", "5400442-1": "1", "8684331-1": "123", "8394647-1": "123" } }, { "human_patient_id": "257", "human_patient_uid": "4782405-1-M", "PMID": "27011444", "title": "Unusual presentation of filariasis as an abscess: A case report", "patient": "A 17-year-old female patient presented with a subcutaneous swelling on the flexor surface of the lower part of the left arm for last 3 weeks. The swelling was accompanied by mild pain. It was 2 cm \u00d7 2 cm, spherical in shape with well-defined margins. The swelling was freely mobile without any signs of acute inflammation. The patient did not reveal any other swelling in the body. Routine hematologic tests showed complete blood count and erythrocyte sedimentation rate within normal limits. Peripheral smear prepared from the patient's blood did not demonstrate any parasite. Absolute eosinophil count and eosinophil count were within normal limits (absolute eosinophil count 200/mm3, eosinophils 2%).\nClinical diagnosis of neurofibroma/lipoma was made by a treating physician and the patient was referred to the Department of Pathology for FNAC, which was done using a 10 mL syringe and a 22 gauge needle under aseptic precautions yielded pus. Aspirated material was spread on slides, air-dried, and stained with Giemsa stain and Ziehl-Neelsen stain for acid-fast bacilli.\nCytological examination of Giemsa-stained smear showed a large number of microfilaria in the background of degenerated inflammatory cells that comprised of neutrophils, eosinophils, histiocytes, and lymphocytes. The microfilaria had typical features of the presence of hyaline sheath, cephalic space, and tail end devoid of nuclei. Thus, these Wuchereria belonged to the species bancrofti [].\nZiehl-Neelsen staining did not show any acid-fast bacilli.\nThe patient was treated with diethylcarbamazine [100 mg ter die sumendum (TDS)] for 21 days and kept on follow-up. The swelling subsided by the end of the 3rd week.", "age": [ [ 17.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC004xxxxxx/PMC4782405.xml", "relevant_articles": { "30976331": "2", "29118472": "2", "20795463": "2", "10599014": "2", "10499195": "0" }, "similar_patients": { "5320880-1": "123", "4520045-1": "123", "3593495-1": "123", "6767797-1": "13", "6909590-1": "123" } }, { "human_patient_id": "258", "human_patient_uid": "6734496-1-M", "PMID": "31531277", "title": "Panscleritis masquerading as an attack of primary acute angle closure glaucoma", "patient": "A 50-year-old female was referred to us as a case of primary acute angle closure attack in the right eye and for laser PI. She had redness, watering, and severe ocular pain in her right eye (RE) for 1 day. The visual acuity was 6/18 in the right eye (RE) and 6/6 in the left eye (LE). LE had a deep anterior chamber (AC) and a normal fundus. Slit lamp examination of RE revealed conjunctival chemosis, circumcorneal congestion, shallow AC, and no AC cells (Figure 1a,b ). Intraocular pressure (IOP) was 38 mmHg in RE and 12 mmHg in LE by applanation. A diagnosis of acute primary ACG due to pupillary block mechanism in RE was considered. However, additional findings included swelling of the upper eyelid, scleral tenderness, clear cornea, reactive round pupil, fine choroidal folds (Figure 1e ), shallow peripheral annular choroidal detachment, and limitation of ocular movement with pain in RE. She had a history of such an episode three years back. Due to these factors, a suspicion of scleritis with secondary ACG was also kept as a differential diagnosis. An ultrasonogram (USG) B-scan of RE showed fluid accumulation in the subtenon space with thickening of the ocular coats (Figure 1c ). Ultrasound biomicroscopy (UBM) revealed thickening of the sclera and supraciliary effusion along with some anterior rotation of the ciliary body (Figure 1d ). Fundus fluorescein angiography made the choroidal folds obvious (Figure 1f ). She was diagnosed to have diffuse anterior scleritis and posterior scleritis (panscleritis) with secondary ciliochoroidal effusion and ACG in RE. She was started on topical atropine sulfate drop 1% thrice a day, brimonidine tartrate drop 0.15% twice a day, prednisolone acetate 1% 4 times a day in RE, tablet acetazolamide 250 mg twice daily, and intravenous methylprednisolone 1 mg once daily for three consecutive days. At day two, there was an improvement in lid swelling, ocular pain, ocular motility, conjunctival chemosis, and congestion, and the vision improved to 6/9 in RE. The anterior chamber deepened and the IOP was 8 mmHg in RE. Oral acetazolamide were stopped. After three days of pulse steroid, she was shifted to oral prednisolone 1 mg/kg/day and atropine/prednisolone drops were continued. At 1 week, the UBM showed resolved ciliary effusion. She was negative for antinuclear antibody (ANA), anti-neutrophilic cytoplasmic antibody (P-ANCA, and C-ANCA), anti-citrullinated cyclopeptide (anti-CCP), and VDRL (venereal disease research laboratory). Angiotensin converting enzyme, chest X-ray, and Mantoux were unremarkable. Erythrocyte sedimentation rate was 28 (normal 0\u201320) mm in the first hour, and C-reactive protein was 21 (normal <10) mg/L. There was no history of tick bite or herpes zoster ophthalmicus. The oral and topical steroid was tapered and atropine/antiglaucoma drops were stopped. At 1 month, her best-corrected visual acuity was 6/6 in either eye, the eyes were quiet, and the choroidal folds in the right eye had disappeared (Figure 2a ). The eye remained stable till the last follow-up at 8 months, and the anterior chamber remained deep (Figure 2b ).", "age": [ [ 50.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6734496.xml", "relevant_articles": { "31531277": "123", "32984647": "0", "28981391": "123", "31671201": "123", "33223857": "0" }, "similar_patients": { "4889796-1": "123", "5301125-1": "0", "8081079-2": "0", "8081079-1": "0", "8409355-1": "0" } }, { "human_patient_id": "259", "human_patient_uid": "7375796-1-M", "PMID": "32696811", "title": "Long-term positive severe acute respiratory syndrome coronavirus 2 ribonucleic acid and therapeutic effect of antivirals in patients with coronavirus disease: Case reports", "patient": "On March 10, 2020, a 50-year-old man, positive for SARS-CoV-2, was admitted to Wuhan Huoshenshan Hospital (Wuhan, China) after 47 days of cough and fever (). On February 15, nucleic acid results for SARS-CoV-2 were positive. Previous treatments included arbidol (0.2 g, thrice daily) and lianhua qingwen granules (6 g, thrice daily). On admission, peripheral oxygen saturation was 96% in ambient air and respiratory rate was 18 breaths/minute. Immunoglobulin M (IgM) and Immunoglobulin G (IgG) levels for SARS-CoV-2 were, respectively, 53.12 g/L and 173.69 g/L (normal range for both: <10 g/L; Shenzhen YHLO Biotech Co., Ltd., Shenzhen, China). Computed tomography (CT) findings showed a bilateral, scattered, high-density shadow and fiber- and spine-like opacities. From March 10 to 22, convalescent plasma from COVID-19 patients (200 mL, March 17 and 18), recombinant human interferon (0.3 mL, atomized inhalation, once daily), lianhua qingwen granules (6 g, thrice daily), and arbidol (2 tablets, thrice daily) were administered as treatment; on March 23, chloroquine phosphate (2 tablets, twice daily) was administered instead of arbidol. On March 23, SARS-CoV-2 RNA were positive. A CT scan showed substantial improvement, with no obvious pulmonary lesions, on March 24. He was treated with ritonavir-boosted danoprevir (DNVr) alone (100/100 mg, one tablet twice daily). From April 3 to 5, nucleic acid test results for SARS-CoV-2 were all negative. SARS-CoV-2 IgM and IgG levels were markedly reduced (5.38 g/L and 108.68 g/L, respectively). On April 7, he was discharged from the hospital after three consecutively negative SARS-CoV-2 RNA. The duration from positive SARS-CoV-2 RNA to three consecutive negative results was 55 days.", "age": [ [ 50.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7375796.xml", "relevant_articles": { "32710647": "12", "32504052": "12", "33216694": "12", "33247152": "12", "32771637": "12" }, "similar_patients": { "7375796-4": "123", "7375796-3": "123", "7375796-2": "12", "8299274-1": "13", "7734121-2": "123" } }, { "human_patient_id": "260", "human_patient_uid": "7375796-2-M", "PMID": "32696811", "title": "Long-term positive severe acute respiratory syndrome coronavirus 2 ribonucleic acid and therapeutic effect of antivirals in patients with coronavirus disease: Case reports", "patient": "On March 12, 2020, an 81-year-old man diagnosed with COVID-19 was admitted to Huoshenshan Hospital following 50 days of intermittent fever and 40 days of chest distress and shortness of breath (). Type 2 diabetes mellitus, hypertension, and aortic dissection were associated comorbidities. On February 1, nucleic acid results for SARS-CoV-2 were positive. During prior hospitalization, digestive tract bleeding with black stool were observed; a CT scan showed bilateral patch shadow, a small amount of pleural effusion on the right lung, and aortic dissection. On admission, SARS-CoV-2 IgM and IgG levels were, respectively, 20.89 g/L and 187.92 g/L. Treatment included chloroquine phosphate (2 tablets, twice daily) and/or convalescent plasma from COVID-19 patients (400 mL) from March 15 to 26. On March 23, nucleic acid test results were positive for swab. On March 25, the patient\u2019s feces were positive for SARS-CoV-2 RNA. A CT scan showed substantial improvement, with marked reduction of pulmonary lesions, on March 24. On March 27, he received DNVr treatment alone (100/100 mg, one tablet twice daily). On April 5, after three consecutive negative nucleic acid test results, he was discharged and transferred to another hospital for further treatment of comorbidities. The duration from positive SARS-CoV-2 RNA to three consecutive negative results was 65 days.", "age": [ [ 81.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7375796.xml", "relevant_articles": { "32771637": "12", "32222992": "12", "32663490": "12", "34221722": "12", "34231777": "12" }, "similar_patients": { "7375796-1": "123", "7375796-3": "123", "7375796-4": "123", "8299274-1": "13", "7373607-1": "12" } }, { "human_patient_id": "261", "human_patient_uid": "7375796-3-M", "PMID": "32696811", "title": "Long-term positive severe acute respiratory syndrome coronavirus 2 ribonucleic acid and therapeutic effect of antivirals in patients with coronavirus disease: Case reports", "patient": "On March 13, 2020, a 42-year-old male with COVID-19 was admitted to Huoshenshan Hospital with 1 month of cough and fatigue and 10 days of fever (). Prior history included a diagnosis of chronic hepatitis C in 2015 that was successfully cured, with sustained negative results of hepatitis C virus (HCV) RNA. On February 14, nucleic acid results for SARS-CoV-2 were positive. Previous treatments consisted of lianhua qingwen granules (6 g, thrice daily) and ribavirin (900-1200 mg, thrice daily). On admission, CT results showed bilateral, multiple, scattered, and flaky high-density shadows and ground-glass opacities. On March 27, nucleic acid test results were positive. On March 31, a CT scan showed substantial improvement, with marked reduction of pulmonary lesions. On April 3, he was treated with DNVr (100/100 mg, one tablet twice daily). On April 14, he was discharged from the hospital following two consecutive negative SARS-CoV-2 test results. The duration from positive SARS-CoV-2 RNA to two consecutive negative results was 58 days.", "age": [ [ 42.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7375796.xml", "relevant_articles": { "32869227": "12", "32771637": "12", "34508809": "1", "32663490": "123", "32873230": "12" }, "similar_patients": { "7375796-4": "123", "7375796-1": "123", "7375796-2": "123", "8299274-1": "13", "8111112-2": "12" } }, { "human_patient_id": "262", "human_patient_uid": "7375796-4-M", "PMID": "32696811", "title": "Long-term positive severe acute respiratory syndrome coronavirus 2 ribonucleic acid and therapeutic effect of antivirals in patients with coronavirus disease: Case reports", "patient": "On March 29, 2020, a 33-year-old male with COVID-19 was admitted to Huoshenshan Hospital with 64 days of cough, chest distress, and shortness of breath as well as 7 days of backache (). On January 31, CT results showed bilateral ground glass opacities. On February 6, nucleic acid results for SARS-CoV-2 were positive. On March 30, CT results showed bilateral small flocculent densities, ground glass opacities, and a solitary pulmonary nodule in the middle lobe of right lung. Previous treatments included lianhua qingwen granules (6 g, thrice daily), arbidol (0.2 g, thrice daily), and ritonavir-boosted lopinavir (2 tablets, once every 12 hours). On April 2, nucleic acid test results were positive. On April 4, he was treated with DNVr (100/100 mg, one tablet twice daily). On April 14, he was discharged from the hospital following two consecutive negative SARS-CoV-2 test results. The duration from positive SARS-CoV-2 RNA to two consecutive negative results was 66 days.", "age": [ [ 33.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7375796.xml", "relevant_articles": { "32869227": "12", "32771637": "12", "34302258": "123", "33101790": "12", "32677909": "123" }, "similar_patients": { "7375796-1": "123", "7375796-3": "123", "7375796-2": "123", "7734121-4": "12", "7734121-3": "12" } }, { "human_patient_id": "263", "human_patient_uid": "6079567-1-M", "PMID": "30123278", "title": "8q22.1 Microduplication Syndrome: Why the Brain Should Be Spared? A Literature Review and a Case Report", "patient": "Our patient is an 8-year-old girl, with a positive family history for both skeletal malformations and bipolar disorders (BD). Her pre-perinatal history was uneventful. She was referred to our Unit because of learning difficulties and behavioural problems. The neurological examination did not show focal neurological deficits. Dysmorphic features were evident at the first observation. She showed several facial dimorphisms such as flat face, blepharophimosis, hypertelorism, broad nasal bridge, and high palate. Bones and joints defects were also evident: pectum excavatum, single transverse palmar crease, brachydactyly, flat foot, and stature below 25th percentile (). Because of these features, she previously underwent genetic consultation and performed array-CGH analysis revealing a chromosomic 8q22.1-q22.3 duplication (hg19/96.846.254-101.630.576x3, 101.726.279x2) encompassing the GDF6 and SDC2 genes, inherited from her father. Thus, our 8-year-old girl presented with clinical and genetic features of Leri's pleonosteosis, within a larger microduplication involving different genes not strictly related to our patient phenotype. In particular, the hypothesis of autosomal recessive optic atrophy (OPA6) was excluded by a general ophthalmologic examination and a fundus examination, since the contiguous region 8q21.13-q22.1 is responsible for recessive optic atrophy [].\nShe also met the DSM-5 criteria for attention-deficit/hyperactivity disorder (ADHD), specific learning disorder, speech sound disorder, and developmental coordination disorder. In particular, she showed a highly pressured pattern of speech, difficulty in sustaining attention, high levels of activity, and low frustration tolerance. Furthermore, she presented a pattern of bipolar-like phenomena that did not meet the criteria for bipolar I, bipolar II, or cyclothymic disorder. Nevertheless, according to DSM-5 category, she met the criteria for the diagnosis of \u201cother specified bipolar and related disorder\u201d owing to the occurrence of hypomania episode without prior major depressive episode or a manic episode.\nThe clinical features are shared with both her father and her grandfather that present an overlapping duplication in the 8q22.1-q22.3 region. They show facial dimorphism (flat face, blepharophimosis, hypertelorism, and broad nasal bridge) and brachydactyly and are affected, respectively, by cyclothymic disorder and bipolar II disorder. Also her grandfather's brother received a diagnosis of bipolar II disorder. Unfortunately, he has never performed an array-CGH analysis, but he shows skeletal malformations consistent with Leri's disorder. Along paternal line of our patient, more members are affected by mood disorders associated with skeletal deformations. Unfortunately, none of them agreed to perform the array-CGH analysis, thus the information is incomplete to build a family tree chart. Nevertheless, the chromosome 8q22.1 microduplications were documented in our patient and his father and grandfather.\nOur 8-year-old girl's developmental milestones had been mildly delayed. In particular, she presented a delayed achievement of the expressive language. Thus she started a speech-language therapy when she was 4-year-old and continued it for two years. During infancy, she also presented a divergent strabismus surgically treated at the age of 3 years. She also had genu recurvatum and hip developmental dysplasia (type-II Graf) within the first year of life. Our first neurological examination failed to detect major focal signs, but gross and fine coordination impairments with orofacial dyspraxia and speech phonological deficits were observed.\nThe behavioural observation revealed high levels of impulsivity and a persistently elated mood with increased activity and energy for most of the day. She often displayed restlessness, hyperactivity, and difficulty remaining focused. She also was more talkative than usual and prone to engage conversations with strangers in public, with an indiscriminately friendly approach and a high level of enthusiasm. On the whole, her social behaviour towards adults was often inappropriate. Furthermore, the conversation content appeared inappropriate to the contest with flight of ideas and abrupt shifts from one topic to another. She also showed amusing irrelevancies and theatrical mannerisms and an inflated self-esteem with uncritical self-confidence. Moreover, rapid shifts in mood over brief periods of time might occur. During these episodes, her mood became irritable and she presented decreased need for sleep, diminished ability to concentrate, inconclusiveness, and angry bursts when her wishes were denied.\nThe neuropsychological assessment included the cognitive profile (WISC IV) [], visual perception and motor coordination (VMI) [], executive functions (TOL) [], and verbal and spatial memory (Corsi test) []. The IQ score was in the low average (total IQ score 88), with the lowest score in nonverbal and fluid reasoning (perceptual reasoning index = 80). A moderate impairment was revealed in visuospatial short-term working memory (Corsi backward span = 2; \u22121.89 SD) and in backward verbal span (digit backward span = 2; \u22121.29 SD). Planning ability was largely below the average (rule violations = T > 100, >\u22122 SD; number of additional moves = T > 100, >\u22122 SD, TOL), suggesting a poor mental planning and problem-solving skills. She also showed deficits in visual perception and motor coordination skills at the visual-motor integration test (VMI Beery, 1997; standard score = 78; 7th percentile). The reading and writing tests scored below the average (oral reading speed of a text: 0.88 syllables/seconds/\u22122 DS; number of errors = 14/5\u00b0 percentile; writing errors: \u22122 DS). She lacked knowledge of spelling rules that made her enable to read and write complex words. In general, she showed difficulties in managing the aspect of phonological processing which underpins the acquisition of literacy. Working out meaning from a whole sentence was another of her weaknesses due to the working memory deficit. Instead, when dealing with words in isolation, she had less difficulty in comprehension. She also showed very low concentration and attention abilities. During the assessment, she had to be constantly refocused and prompted to continue. All in all, our patient's neurodevelopment and psychiatric symptoms caused a marked impairment, especially in social relationship and in academic performance.", "age": [ [ 8.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6079567.xml", "relevant_articles": { "28141724": "1", "26348973": "1", "33080761": "1", "10424142": "1", "16119480": "12" }, "similar_patients": { "4378869-1": "1", "1774568-1": "1", "4514383-2": "1", "5833775-1": "1", "7246703-1": "1" } }, { "human_patient_id": "264", "human_patient_uid": "3533612-1-M", "PMID": "23346424", "title": "Triple Teeth: Report of an Unusual Case", "patient": "A six-year-old boy was reported with chief complaint of large tooth in the lower jaw. His medical and family history was noncontributory. Intraoral examination revealed unusual presence of large fused triple teeth at incisor region on right side and erupted permanent central and lateral incisors on left side of mandible (Figures and ). There was deep vertical groove at the union without caries or any other dental abnormalities. Intraoral periapical radiograph shows fusion of two primary incisors with supernumerary tooth (triple teeth), with separate pulp chamber and root canals, erupting succedaneous lateral incisor and canine but absence of central incisor on right side as its position and mesiodistal dimension resemble erupted lateral incisor on left side (). It was diagnosed as an unusual case of triple teeth in deciduous anterior region which is of incomplete fusion. Since the fused teeth were asymptomatic, recall examination was planned until exfoliation of triple teeth.", "age": [ [ 6.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3533612.xml", "relevant_articles": { "26962321": "12", "12028316": "12", "16903442": "12", "15871454": "1", "16167609": "12" }, "similar_patients": { "3899555-1": "1", "3918350-1": "12", "7364066-1": "1", "5571395-1": "123", "5571395-2": "123" } }, { "human_patient_id": "265", "human_patient_uid": "4394673-1-M", "PMID": "25901270", "title": "Lung Perfusion SPECT: Application in a Patient With Tetralogy of Fallot and Suspected Pulmonary Thromboemboli", "patient": "A 22-year-old female patient was admitted for surgery to revise her Waterston central aortopulmonary shunt. She had the history of TF, pulmonary valve stenosis, ventricular septal defect and major aortopulmonary collateral artery. Her shunt was placed at the age of 5 years then complicated with stenosis for which a stent was placed and re-dilated 1 year ago. After echocardiography reported minimal aorto-pulmonary shunt flow, a decision was made to operate the patient for revision of the central shunt. Midsternal incision was done and a polytetrafluoroethylene (PTFE) tube was inserted between the ascending aorta and right pulmonary branch, where the previous Gortex was located. Patient recovery and rehabilitation after surgery was optimal until the patient experienced abrupt left-sided pleuritic chest pain and dyspnea. Arterial O2 saturation diminished to 75%. The patient was referred to the department of nuclear medicine for perfusion and ventilation lung scanning. Perfusion lung scan was done with 4 mCi 99m Technetium labeled macroaggregated albumin (total particle count 120,000) in planar anterior, posterior, lateral and multiple oblique projections (). The left lung was generally hypoperfused more in the upper zone. No clear evidence of PTE was detected in the planar views. Additionally, the brain, renal parenchyma and the thyroid demonstrated uptake due to the right to left shunt (). Ventilation scan was not performed due to logistic problems; the available ventilation tracer in Iran is 81Kr, which is distributed only on Wednesdays. Afterward, a 2-hour delayed SPECT imaging was done (). There was a large wedge-shaped peripheral defect in the apicoposterior segment of the left upper lobe. The finding was interpreted as either acute/chronic PTE or secondary to developmental/iatrogenic vascular abnormality. Therapeutic dose of intravenous IV heparin was administrated (500 U/hour). Meanwhile, the patient underwent CT angiography reporting postoperative atelectatic changes in the bilateral lower lobes without evidence in support of PTE. The IV heparin was changed to warfarin after 5 days when the symptoms improved gradually and the arterial O2 saturation increased to 92% in room atmosphere. Pulmonary angiography was not performed as the patient was improving. She was discharged with good general condition and no specific pulmonary symptoms.", "age": [ [ 22.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC004xxxxxx/PMC4394673.xml", "relevant_articles": { "25901270": "123", "24296395": "123", "19241309": "123", "7493573": "123", "18640353": "12" }, "similar_patients": { "5791498-1": "123", "7026590-1": "12", "3590970-1": "1", "5460971-1": "123", "4932759-1": "123" } }, { "human_patient_id": "266", "human_patient_uid": "8215969-1-M", "PMID": "34177537", "title": "Localized Immunoglobulin Light-Chain Amyloidosis of the Ulnar Nerve", "patient": "A 54-year-old female patient presented to our clinic with complaints of occasional pain, numbness, and paralysis of her right hand. She began to notice weakness of her left hand that had begun 2 years earlier. She had no history of trauma and no family history of amyloid neuropathy. She had a history of ovarian tumor 25 years ago and thyroid tumor 5 years ago, both of which healed after surgical resection.\nPhysical examination revealed a mass 5 \u00d7 3 cm in the ulnar side of her left proximal forearm shown in Figure . The lesion was firm, nonpulsatile, and tender on palpitation. She had numbness on the ulnar side of her left hand and fingers. The 2-point discrimination test revealed that 15 mm at the lateral side of the ring finger 10 mm at the little finger. She had muscle weakness with abduction and adduction of the ring finger and the little finger, but no deficit in the range of motion in the elbow. The electrophysiological study revealed a significant decrease in the motor nerve conduction velocity of the ulnar nerve from distal to the mass to proximal to the mass. MRI revealed that the ulnar nerve was swollen longitudinally, had a spindle shape, and measured 3.0 \u00d7 2.7 cm in the axial plane and 7.2 cm longitudinally shown in Figure . The swollen lesion had a relatively homogeneous isosignal intensity on T1-weighted images and had relative heterogeneous enhancement after the intravenous administration of gadolinium (Gd)-based contrast agent with the findings of flow void. Based on these findings, the differential diagnoses included a vascular malformation that surrounded and compressed the ulnar nerve. Excisional biopsy was not performed because of the risk of hemorrhage and iatrogenic nerve injury. The lesion was instead surgically explored with a longitudinal incision shown in Figure . The operative findings showed no vascular malformation; however, the ulnar nerve fascicles were swollen and degenerated. The affected lesion had changed into a yellow tissue shown in Figure . After the yellow tissue was carefully removed microscopically, approximately 7 cm defects remained between intact nerve fascicles. The resected tissue was hard and had a stick-like shape shown in Figure .\nThe histopathological examination showed degenerated connective tissue with diffuse eosinophilic deposition, which included calcification, ossification, and chondroid tissue shown in Figure and b. No intact nerve tissue remained. The deposit was positive for Congo red stain and appeared apple-green under polarized light, which suggested the diagnosis of amyloid neuropathy shown in Figure .\nImmunohistochemical staining showed that the deposit was immunopositive for light-chain \u03bb antibody shown in Figure . The deposit was immunonegative for amyloid A, transthyretin, and light-chain \u03ba. Therefore, the pathological diagnosis was AL amyloidosis.\nTo determine the association with systemic involvement, we conducted screening examinations. Bone marrow aspiration, cerebrospinal fluid examination, echocardiography, electromyography of the legs, chest computed tomography, and MRI of the brain and legs showed negative results. Physical examination revealed no sign of macroglossia or purpura on the skin. Autonomic dysfunction, including orthostatic hypotension, was not present. The only positive results were from the blood test, which showed high serum levels of amyloid protein A (159.2 \u03bcg/mL [<8.0]).\nTwo months postoperatively, the patient underwent nerve transplantation for reconstruction of the ulnar nerve. The sural nerve was sacrificed from the left lower leg and transplanted to the defect of the ulnar nerve. One year postoperatively after the nerve transplantation, she had no apparent evidence of metastasis or local recurrence. There was no recovery of numbness in the ring and little finger and the muscle weakness still had no recovery.", "age": [ [ 54.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC008xxxxxx/PMC8215969.xml", "relevant_articles": { "34177537": "123", "23192580": "123", "2465129": "12", "24839432": "123", "30361046": "12" }, "similar_patients": { "7446554-1": "13", "7816534-1": "123", "6303969-1": "13", "8405418-1": "13", "7750753-1": "13" } }, { "human_patient_id": "267", "human_patient_uid": "6481245-1-M", "PMID": "31010317", "title": "Concurrent Squamous Cell Carcinoma and Chronic Lymphocytic Leukemia Presenting as an Enlarging Neck Mass", "patient": "Our patient is a 58-year-old African American woman who initially presented to an outside facility of difficulty swallowing, neck pain, fatigue, and shortness of breath for 3 months. She had bilateral neck swelling, greater on the left side, that started about a year prior to her presentation. This patient also had a 4-day history of productive cough and nasal drainage. She had a 30-pack year history and consumed approximately 12 beers daily for years.\nShe reported a history of CLL and having been treated with chemotherapy, but she was unsure of the regimen. Examination findings and computed tomography (CT) scan of neck at the outside facility were concerning for impending airway compromise, and she was transferred to our hospital to be evaluated by an otorhinolaryngology or oral and maxillofacial surgery service.\nDuring her evaluation in our emergency department, she was noted to have a muffled voice with mild gurgling of secretions with speech. Large, fixed cervical and submandibular lymph node, and a large left neck mass were present. Enlarged axillary lymph nodes were palpated bilaterally. The uvula and posterior oropharynx were not visible due to her tongue and left neck mass. White blood cell (WBC) count was 83 600/mm3. She was started on dexamethasone to reduce the compression of the neck mass on the airway. The oral and maxillofacial surgery service team evaluated her and determined that a definitive airway was not indicated. She was admitted to the medical intensive care unit for close airway monitoring.\nThe oncology team became involved at this time. Her CLL was the suspected etiology of the neck mass and lymphadenopathy, and intravenous fluids and allopurinol were started to prevent tumor lysis syndrome. Further laboratory workup showed the predominantly lymphocytic, elevated WBC count as before and a normocytic anemia, hemoglobin 10.6 g/dL. Smudge cells were present on the peripheral blood smear. Iron studies, B12, and folate were normal. Flow cytometry was pending ( and ).\nCT chest showed lymphadenopathy of the mediastinum, right hilum, bilateral axilla, submental, and supraclavicular lymph nodes. Consolidative and ground glass opacities were also present in the bilateral lung fields ().\nPartially confluent retroperitoneal, mesenteric, pelvic, and inguinal lymphadenopathy were noted on CT abdomen and pelvis. These findings were consistent with known CLL.\nIn addition to CLL, diagnoses considered included Richter transformation. We proceeded to obtain biopsies of the left neck mass.\nAround this time outside records were received. Our patient had been treated with rituximab and chlorambucil 5 months prior after presenting with similar symptoms. She had been incidentally found with a WBC count of 40 000/mm3 several years before. She was lost to follow-up after both occasions. We started her on rituximab for treating CLL with possible Richter transformation. The tentative plan was to treat with fludarabine, cyclophosphamide, rituximab (FCR) if CLL or rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) if Richter transformation had occurred.\nFlow cytometry showed a CD5+ mature B-cell lymphoma consistent with CLL, 13q deletion, and mild CD38 positivity. Over the next few days, she had improvement in her neck pain. The mass and lymph nodes decreased in size. The WBC count decreased to 40 000/mm3. Biopsy of the neck mass showed squamous cell carcinoma (SCC) with extensive necrosis involving lymphoid tissue.\nWith evidence of a second malignancy with possible significant oropharyngeal involvement, direct laryngoscopy with biopsy was pursued ( and ).\nDirect laryngoscopy was performed and showed a large mass involving the right tonsil extending to midline of the posterior oropharynx. Biopsies were obtained. Posterior oropharynx, right tonsil, and right nasopharynx biopsy contained invasive keratinizing SCC, moderately differentiated, with basaloid features. The nasopharyngeal biopsy also included atypical lymphoid infiltrate consistent with involvement by CLL.\nThis patient\u2019s case was discussed at the tumor board. Given the widespread involvement of her disease, she was diagnosed with Stage IV oropharyngeal SCC. She was not at candidate for resection and was to be treated with high-dose cisplatin (25 mg/m2) weekly for 6 cycles and radiotherapy. Treatment was to be delayed for her Rai Stage III CLL out of priority since her airway compromise was attributed to the SCC and the CLL component had been partially treated with rituximab.\nAt time of discharge, she had continued improvement of her symptoms. The plan was for her to follow with our medical oncology and radiation oncology teams as an outpatient. However, due to long distance from home, she established care at an outside facility.", "age": [ [ 58.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6481245.xml", "relevant_articles": { "31010317": "123", "21430370": "0", "28483134": "0", "16247665": "123", "15160967": "0" }, "similar_patients": { "5371210-1": "1", "8255663-1": "123", "6460839-1": "123", "5890962-1": "12", "5858612-1": "123" } }, { "human_patient_id": "268", "human_patient_uid": "3830255-1-M", "PMID": "24250107", "title": "Filarial abscess in the submandibular region", "patient": "A 25-year-old lady presented to dental out-patient services with swelling and pain in the right side of the face. Local examination showed a fluctuant swelling measuring 5 mm \u00d7 3 cm over the right side of the angle of mandible []. The swelling was warm and tender on palpation with signs of impending rupture. Clinical examination of the orofacial region did not reveal any odontogenic or non-odontogenic foci of infection. Patient's vitals were in the normal limits. All the hematological parameters were normal except for borderline leukocytosis and a low hemoglobin level. Incision and drainage (I and D) of the abscess was carried out under local anesthesia. As the patient was in her 12th week of gestation, antibiotics were prescribed in consultation with the gynecologist.\nOn a follow-up visit after 2 weeks, a painless indurated swelling at the same site was noted [, inset]. Pus culture carried out during the incision and drainage had not revealed any bacterial growth. As the condition was not resolving, a fine needle aspiration cytology (FNAC) was advised in consultation with the pathologist, to rule out tubercular infection.\nAspirate from the swelling yielded purulent material. The smears were moderately cellular and showed abundant necrotic debris within which were seen polymorphs and histiocytes. One of the smears revealed the presence of a single microfilaria of W. bancrofti, which was rounded anteriorly and tapered posteriorly []. The caudal end of the microfilariae had a clear space free of nuclei. After the aspiration, the patient was admitted and a midnight blood sample was taken. The wet mount preparation showed motile microfilariae, which confirmed the diagnosis of filariasis.\nSince, the patient was in the first trimester of pregnancy, decision was taken to start the anti-filarial drugs after delivery.", "age": [ [ 25.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC003xxxxxx/PMC3830255.xml", "relevant_articles": { "26634138": "12", "25298612": "12", "10499195": "0", "19693940": "0", "26865993": "12" }, "similar_patients": { "3593495-1": "1", "5259939-1": "1", "4664843-1": "1", "1552058-1": "1", "5559836-1": "1" } }, { "human_patient_id": "269", "human_patient_uid": "7178951-1-M", "PMID": "32336975", "title": "Severe eosinophilic asthma and aspirin-exacerbated respiratory disease associated to eosinophilic gastroenteritis treated with mepolizumab: a case report", "patient": "A 49 years-old woman with ten-year recurrent non-bloody watery diarrhea and abdominal pain came to our observation in 2015. No family history of gastrointestinal disorders was detected. A full ileocolonscopy performed 5 years before (no biopsies collected) was normal, leading to a diagnosis of an irritable bowel syndrome, so managed with symptomatic drugs without significant clinical benefit. She had also an history of repeated endoscopic sinus surgery (ESS) because of polyps\u2019 recurrence, aspirin-exacerbated respiratory disease and severe eosinophilic asthma with frequent exacerbations, requiring short courses of oral corticosteroids. Over the years, it appeared that oral steroids induced also a complete relief of gastrointestinal symptoms, with a relapse at withdrawal. Therefore, the patient had repeated steroids exposure, developing dependence and several side-effects.\nAt admission to our department, she complained watery diarrhea (5\u20136 bowel movements/day) preceded by abdominal pain. Her vital signs were: SpO2 95% (room air), Temperature 35.8 \u00b0C, Heart Rate 100 bpm, Respiratory Rate 18/m, Blood Pressure 108/60 mmHg.\nPhysical examination was significant only for mild tenderness in the mesogastric area with intact bowel sounds. No organomegaly was found. Visual analog scale (VAS) score for abdominal pain was moderate/severe (60). Besides elevated peripheral blood eosinophil (0.38 \u00d7 109/L) laboratory tests were unremarkable. Stool examinations were negative for parasitic, bacteria and clostridium difficile infections. Pulmonary functional tests revealed a Forced Expiratory Volume in the first second (FEV1) of 63% (of predicted value), Asthma Control Test (ACT) score was 13, Sino-Nasal Outcome Test (SNOT-22) was 93, Lund\u2013Mackay (LM) score was 20. Baseline mean OCS dose was 15 mg of prednisone per day. Four OCS requiring asthmatic exacerbations occurred during the previous year.\nAn ileocolonscopy revealed a normal aspect of the mucosa of each explored segment, except for a small polyp (2 mm) in the rectum, that was removed. Biopsies collected from apparently normal mucosa showed instead an important linfoplasmacellular and granulocytic infiltrate in the lamina propria with a predominance of eosinophils (Fig. a, b).\nMoreover, no significant findings emerged from gastroscopy, but biopsy specimens, collected in antrum, showed as well as the linfomonocytic and eosinophil granulocytic infiltrate disrupting the glandular structures (Fig. c).\nAccording to the immunopathogenetic mechanisms of the diseases and in order to spare oral steroids, in 2017, we started treatment with subcutaneous MEP at the standard dose of 100 mg every 4 weeks, using the severe eosinophilic asthma schedule.\nAs expected, blood eosinophil count was reduced after the first administration, and became lower and lower during the next 48 weeks (30 cells/mm3). After 3 months, patient experienced a significant improvement of sinusitic, respiratory as well as gastrointestinal symptoms. FEV1 and SNOT-22 were evaluated at 6 and 12 month, showing a global improvement (75% and 95%; 51 and 21 respectively). ACT raised to 23. LM score reduced to 8 at month 12. VAS score for abdominal pain reduced to 20 after 3 months so gradually all oral corticosteroids were successfully reduced by patient. After 6 months, patient was in steroid-free clinical remission with a stool frequency of 1\u20132 movements/day of normal feces (type 3 according to the Bristol stool chart) and a complete resolution of abdominal pain. BMI (Body Mass Index) reduced from 28 to 23 and none asthma exacerbation occurred during the first year of treatment and until the last follow-up evaluation (24 months) [].\nEndoscopies were repeated in order to obtain new biopsy specimens, showing a remission of the disease in term of eosinophilic inflammation, glands where normal and neither reactive hyperchromatic changes, nor mucin depletion can be appreciated (Fig. d\u2013f).\nBasophils activation was evaluated after 12 months of MEP, using the surface molecules CD203c, CD63 and CD125, showing a reduction of activation percentages. Results are shown in Fig. a, b []. Serum IL-5 levels (R&D Systems; sensitivity: 0.29 pg/ml) were measured at baseline and after 3, 6 and 12 months of treatment and are shown in Fig. . Serum IL-5 was non-quantifiable at baseline and showed an increase with peak on 6 months as expected and previously demonstrated by Pouliquen et al. in 2015 (Fig. c) [].", "age": [ [ 49.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7178951.xml", "relevant_articles": { "33910399": "123", "34285513": "123", "34419679": "12", "34628831": "123", "32347992": "123" }, "similar_patients": { "8239622-1": "13", "6681373-1": "12", "7443779-1": "12", "7910093-10": "12", "7288423-1": "123" } }, { "human_patient_id": "270", "human_patient_uid": "6995319-1-M", "PMID": "32082655", "title": "A Rare Case of Extracavitary Primary Effusion Lymphoma in the Bladder and Ureter", "patient": "A 76-year-old Chinese male, former smoker, with no other significant past medical history or other high-risk behavior and not on medications presented to the hospital for worsening right lower extremity swelling, erythema, and pain. The swelling suddenly started 3 days ago, with occasional cough and dyspnea on exertion. He denied trauma or injury to the area, fever, chills, chest pain, nausea, vomiting, abdominal pain, and dysuria. He did mention some unintentional weight loss. Physical exam was pertinent for right leg swelling, decreased breath sounds on right side, and abdominal distension.\nLaboratory analysis revealed mild leukocytosis with normal differentials, mild anemia (Hb 10.6 g/dl), and a normal platelet count of 386 K/\u03bcl. His creatinine was elevated. HIV and hepatitis testing were negative. Epstein\u2013Barr virus (EBV) serology signified a past infection. HHV-8 serology testing was not available. Bilateral Doppler ultrasound results were negative for deep vein thrombosis, and a ventilation-perfusion (VQ) scan revealed a low probability for pulmonary embolism.\nRenal ultrasound demonstrated moderate hydronephrosis on the right and mild hydronephrosis on the left, with no evidence of calculi in the kidney, ureters, and bladder. Computed tomography (CT) and a following positron emission tomography (PET) scan revealed a mass like encasement of the proximal right ureter and bladder (Figures and ), along with retroperitoneal lymphadenopathy on the right side. Moderate to large pleural effusion was noted on the chest CT scan. Subcutaneous lymphedema was seen on magnetic resonance imaging (MRI) of the right lower extremity. His ejection fraction was normal on echocardiogram. Patient refused a lumbar puncture. He did not have any neurological symptoms.\nUrine cytology revealed atypical urothelial cells. Patient underwent cystoscopy and right ureteroscopy, demonstrating bullous edema and erosion at the bilateral trigone areas and in the right mid-distal ureter. Bladder biopsy was taken and a right ureteral stent was placed. The patient also underwent a diagnostic and therapeutic thoracentesis.", "age": [ [ 76.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6995319.xml", "relevant_articles": { "34616251": "0", "27001591": "0", "29518872": "0", "8217405": "0", "27287597": "0" }, "similar_patients": { "7717988-1": "123", "7061813-1": "123", "8449067-1": "0", "8437410-1": "12", "7263757-1": "0" } }, { "human_patient_id": "271", "human_patient_uid": "5072567-1-M", "PMID": "27789975", "title": "Peters plus anomaly in a Cameroonian child: a case report", "patient": "We report the case of a 3-month-old male infant with bilateral corneal opacity since birth who was transferred from the pediatric unit for further ophthalmic care. Written informed consent was obtained from the patient\u2019s parents to publish this report. Prenatal and natal history were unremarkable apart from the fact that the mother, aged 35 years at the time of childbirth, was HIV positive. There was no family history of similar ocular disorders or other congenital anomalies. Upon initial ophthalmic examination, a positive light pursuit was found. There was a homogeneous bilateral central corneal opacity without neovascularization. Ophthalmologic examination under general anesthesia revealed a deep anterior chamber with iris strands that crossed the anterior chamber from the iris. The lens was transparent on the edges and did not adhere to the cornea. The retina was difficult to evaluate because of central corneal opacity. The intraocular pressure measured with a Schiotz tonometer was respectively 18 mmHg and 20 mmHg in the right and left eye. Other malformed features found in the physical pediatric examination included: broadening of the nose base and microcephaly (), bilateral polydactyly with camptodactyly, clinodactyly of the supernumerary finger (), an umbilical hernia with hypochromic macules of the abdomen () and bilateral supernumerary toe with hypertrophy of the hallux (). There were no genital, vertebral, or cardiac anomalies on pediatric physical examination. Laboratory examination revealed that the child was also HIV positive. The diagnosis of Peters plus anomaly Type 1 was made. Management consisted of the administration of mydriatics, one drop two times per day, 3 days a week. One drop of dorzolamide in the evening was also prescribed. Immediate penetrating keratoplasty (PKP) in both the eyes was advised. After being informed that this intervention was not available in our country, the parents did not bring the child back for further consultation, and were lost to follow-up.", "age": [ [ 3.0, "month" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5072567.xml", "relevant_articles": { "29325387": "123", "12747655": "12", "27789975": "1", "17413971": "123", "9713059": "123" }, "similar_patients": { "4619091-1": "1", "7350768-1": "1", "7092513-1": "1", "7747085-1": "1", "4649710-1": "1" } }, { "human_patient_id": "272", "human_patient_uid": "6451185-1-M", "PMID": "30967935", "title": "Simultaneous gastric and colonic erosions from gastric band and its tubing in the setting of recurrent intra-abdominal infection", "patient": "A 59-year-old female patient presented to her local family doctor with chronic generalized intermittent colicky abdominal pain and altered bowel habit for a few months. She has no other associated symptoms. She previously had laparoscopic adjustable gastric band (LAGB) insertion 8 years prior with good result (BMI pre-procedure was 56 kg/m2, and now 36 kg/m2). Her other comorbidities include hypertension and colonic diverticular disease with previous acute diverticulitis. She was organized to have an elective colonoscopy. Colonoscopy revealed tubular foreign body embedded in the wall of colon, with an entry and exit point, ~55 cm from anal verge (Fig. ). There was also significant sigmoid and descending colon diverticular disease.\nCT abdomen with oral and intravenous contrast was organized to further investigate the tubular foreign body. It revealed concurrent gastric band erosion into gastric lumen and connection tubing eroding into the posterior wall of transverse colon and exiting inferiorly (Figs \u2013). There was no evidence of any oral contrast leak from the stomach.\nThis patient has previously been admitted for acute diverticulitis 4 years prior. Reviewing prior imaging did not reveal any gastric or colonic erosion. The gastric band tubing is noted to be running along the inflamed colon. Since the initial admission for acute diverticulitis, she has had multiple further acute diverticulitis episodes, which were treated with oral antibiotics. We suspect recurrent diverticulitis lead to the erosion of the gastric band into the colon and stomach.\nAs part of the surgical management, both colorectal and upper GI surgeon were involved in the operation. Patient underwent laparoscopic removal of gastric band and laparoscopic assisted wedge resection of transverse colon. The gastric band was removed following adhesiolysis and the gastric defect was repaired with intracorporeal suturing. The gastric band port was subsequently removed. Gastroscopy was done to ensure the repair was airtight. For the colectomy, transverse colon and splenic flexure was mobilized laparoscopically and the transverse colon was extracted through the gastric band port site for external inspection. A tract was identified passing from the antimesenteric border to colonic lumen and then along the colonic mesentery. A wedge resection performed with stapler end to side anastomosis. Flexible sigmoidoscopy was performed to confirm the anastomosis was airtight. Her post-operative recovery was uneventful, and she continued to be well on post-operative follow up in clinic. She remains well on subsequent phone follow up 12 months post operatively.", "age": [ [ 59.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC006xxxxxx/PMC6451185.xml", "relevant_articles": { "30967935": "123", "20033349": "123", "30363251": "123", "29946666": "13", "30466412": "123" }, "similar_patients": { "5451660-1": "123", "3269383-1": "123", "4189050-1": "123", "6007341-1": "13", "5710516-1": "123" } }, { "human_patient_id": "273", "human_patient_uid": "8136325-1-M", "PMID": "34054497", "title": "Activation of a Quiescent Choroidal Neovascularization in a Patient with Age-Related Macular Degeneration", "patient": "In 2015, a 59-year-old man was diagnosed with exudative AMD in his left eye. The diagnosis was based on fundus examination, optical coherence tomography, and fluorescein angiography. His best-corrected visual acuity (BCVA) in the left eye was 0.4. Since then, he was regularly treated with anti-VEGF injections (aflibercept, according to the label). So far, overall, he has received 26 injections into the left eye (every 2 months). The right eye did not show any signs and symptoms of wet AMD (BCVA = 1.0).\nIn 2017, with the advent of OCTA or angio-OCT, we were able to use this technique in all patients with AMD. The angio-OCT en face examination (Avanti with AngioVue OCTA; Optovue, Inc., Fremont, CA, USA) confirmed the presence of CNV in the left eye. Surprisingly, OCTA revealed the presence of 2 quiescent, asymptomatic, nonexudative type 1 CNVs in the right eye, too (shown in Fig. ). The bigger CNV was irregular, glomerular-shaped, composed of small, rather dense, capillaries with longer tangled filaments located under the RPE, in the subfoveal region. The smaller one was more difficult to detect. It had more regular and round shaped with loops, located in the upper area of the macular region. Structural OCT showed flat, irregular pigment epithelium elevation in the areas corresponding to both CNVs; no fluid was observed, and BCVA was 1.0. Since then, we have performed the angio-OCT examination at least every 2 months. The shape and size of these nonexudative CNVs remained unchanged, and the patient did not report any disturbances in the right eye for almost 2 years. Then on May 2019, we observed the activation of the upper, smaller CNV, which started to grow, producing sprouting, dense and thin capillaries with loops, yet BCVA was still 1.0. However, the growth of the pigment epithelial detachment was not pronounced. Four months later, subretinal and intraretinal fluid, subretinal hyperreflective mass, retinal hemorrhages, and perilesional dark halo appeared, and BCVA decreased to 0.7 (shown in Fig. ). The shape, size, and morphology of the bigger, subfoveal CNV seemed to be the same. The anti-VEGF therapy was started immediately, and the patient responded well to the treatment (so far, he has received 5 injections of aflibercept according to the label). His BCVA improved to 1.0. The edema has gone; the subretinal fluid and retinal hemorrhages have disappeared, but the shape and size of the CNVs have not changed.", "age": [ [ 59.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC008xxxxxx/PMC8136325.xml", "relevant_articles": { "32231830": "123", "29411259": "123", "33451290": "123", "32880161": "123", "32993567": "123" }, "similar_patients": { "7899877-1": "123", "7811211-1": "123", "6873050-1": "123", "5859615-1": "123", "7727127-1": "12" } }, { "human_patient_id": "274", "human_patient_uid": "6777934-1-M", "PMID": "31598433", "title": "Periventricular Hyperintensities Mimicking Multiple Sclerosis", "patient": "A 28-year-old woman presented to our tertiary care hospital reporting concerns of left arm weakness and paresthesia for three hours. The weakness started suddenly when she was sitting in her office. Two weeks before presentation, she developed right leg weakness at breakfast that resolved completely within 1.5 hours. One week before presentation, she developed the blurred vision in both eyes that also resolved completely within one hour. Her mother was diagnosed with MS at age 40 and is on treatment with frequent relapses. The rest of the patient\u2019s medical and surgical history was unremarkable.\nHer Glasgow Coma Scale score was 13/15 (eye [E] 4, verbal [V] 5, motor [M] 4). Her blood pressure was 110/70 mmHg, heart rate was 80 beats/minute, respiratory rate was 20 breaths/minute, and she was afebrile. Her neurological examination showed normal mentation with intact cranial nerves with unremarkable results from her funduscopic examination. Her motor examination showed normal bulk in all muscles with no fasciculation and tremors. Her motor strength, as tested on the Motor Research Council scale, was as follows. Her neck muscles flexion was 5/5, and extension was 5/5. Her right deltoid was 5/5, left was 4/5. Her biceps and triceps were 5/5 (right) and 3/5 (left). Her right iliopsoas was 4/5; her left was 5/5. Her knee flexion/extension was 4/5 (right), 5/5 (left), and foot dorsi/plantar flexion was 5/5. Her right biceps/triceps reflexes were 2+, her left biceps/triceps reflexes were 3+. Her patellar reflex was 2+, and her ankle reflex was 2+. Her Babinski reflex was absent. She was able to walk without support. The findings of her cerebellar and sensory exams were unremarkable.\nHer care team suspected transient ischemic attack, and she was sent for urgent computed tomography (CT), which showed no remarkable findings. Blood and metabolic profile test findings were unremarkable, and her low-density lipoprotein was 150 mg/dl. Her cerebrospinal fluid detailed report findings were within reference ranges with no oligoclonal bands and a healthy IgG index, but her MRI showed periventricular hyperintensities in the periventricular area (Figure ). Magnetic resonance angiography findings were unremarkable.\nWe started the patient on 1000 mg of IV methylprednisolone daily to treat the suspected acute flare of MS. After three days of treatment, the patient\u2019s symptoms were improved, and she was discharged on aspirin and glatiramer acetate (GA) with instructions to return after one month for follow-up if she remains stable. She visited the outpatient clinic after six months and was doing fine, but she reported that she was experiencing difficulty concentrating and was unable to work with enthusiasm. She also reported concerns about frequent mood changes and being mostly tearful when she was formerly a very happy person. We sent the patient for a psychiatric evaluation and checked for NOTCH3 mutation. To our surprise, she had a missense mutation in exon 11 of NOTCH3, a mutation suggestive of CADASIL. Her GA was stopped, and she started aspirin and statin therapy with the advice of further cognitive evaluations and regular psychiatric assessments. She was also advised to seek genetic counseling and testing of NOTCH3 mutation in her mother.", "age": [ [ 28.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6777934.xml", "relevant_articles": { "5197328": "0", "30998493": "0", "16318071": "0", "1068960": "0", "23160592": "0" }, "similar_patients": { "8392782-1": "0", "7290259-1": "0", "8337157-1": "0", "7450886-1": "0", "7389875-1": "0" } }, { "human_patient_id": "275", "human_patient_uid": "5343247-1-M", "PMID": "28326205", "title": "Shigella sonnei Bacteremia Presenting with Profound Hepatic Dysfunction", "patient": "A 27-year-old African American male with a history of morbid obesity status post-Roux-en-Y gastric bypass 9 years prior presented with painful nonbloody mucoid diarrhea, icterus, and dark urine of four-day duration. He described recent travel with family to a beach resort in the United States during which he noted that two family members had developed a self-limited diarrheal illness. Three days after exposure, he noted abdominal cramps followed by hourly watery yellow stools without blood. He also had intermittent nausea and an episode of bilious vomiting and reports not eating since onset of diarrheal illness. He noticed a 17-pound weight loss over 1 week. He had no fevers, chills, or rash. There was no preceding history of eating uncooked fish or meats and he had no tick exposure. Medication history included Lisinopril and Amlodipine, and he denied any new medications or alcohol use. He admitted to homosexual intercourse.\nHe was acutely ill-looking with icteric sclera and dry mucus membranes. Vitals signs showed low-grade fever of 100.2\u00b0F and pulse rate of 126 beats per minute. Cardiac, lung, and skin examinations were unremarkable. Abdomen was diffusely tender with hyperactive bowel sounds without peritoneal signs.\nLaboratory data was remarkable for leukopenia of 2200/\u03bcL, hemoglobin of 12.7 g/dL, normal platelet of 158,000/\u03bcL, sodium of 128 meq/L and potassium of 3.2 meq/L, acute kidney injury with creatinine of 1.59 mg/dL (baseline of 0.63 mg/dL), BUN of 41 mg/dL, and anion gap of 19. After intravenous hydration, hemoglobin dropped to 10.1 g/dL and platelet to 96,000/\u03bcL. Sodium, BUN, and creatinine also improved with rehydration. He was also noted to have elevated transaminases AST 201 IU/L and ALT 73 IU/L, elevated total bilirubin of 8.2 mg/dL, direct bilirubin of 4.4 mg/dL, normal alkaline phosphatase of 66 IU/L, albumin of 3.2 g/dL, normal lipase of 40 U/L, and elevated lactate of 3.5 meq/L. INR was elevated to 1.8; however, he had normal haptoglobin 236 mg/dL (36\u2013195 mg/dL) and LDH 177 IU/L (normal: 94\u2013202 IU/L). Hepatitis panel was negative. Patient also tested negative for HIV, CMV, EBV, and Parvovirus B19 infection. Tylenol level was normal. Urinalysis showed moderate bilirubinuria. Stool study was positive for Shigella sonnei but was otherwise negative for bacteria, ova, or parasites. Rickettsia rickettsii IgM was positive and he was treated with Doxycycline. Other workup for tick-borne infection including Lyme, Babesia, Ehrlichia, and Anaplasma was negative. Autoimmune workups including ANA, antismooth muscle, liver/kidney microsome, and mitochondrial antibodies were negative. Alpha-1 antitrypsin and ceruloplasmin were also normal.\nAbdominal ultrasound showed a diffusely increased heterogeneous liver echogenicity with underlying hepatomegaly consistent with hepatic steatosis. Hepatoportal duplex showed patent portal vein and hepatic artery. Computed tomography of the abdomen and pelvis was significant for hepatic steatosis, hepatomegaly, mild right colitis, and absence of gallstones. Magnetic resonance cholangiopancreatography (MRCP) was unremarkable with normal intra- and extrahepatic biliary tree.\nDuring his hospital course, bilirubin trended up to 9 mg/dL and INR peaked at 2.9. Patient was not encephalopathic. Given impending hepatic failure, recommendation was made to transfer the patient to a transplant center but he declined. He was treated with N-acetylcysteine. Blood culture initially reported as Gram-negative rods presumptively Escherichia coli (E. coli) was later confirmed to be Shigella sonnei. Urine culture remained negative. He was treated with ciprofloxacin based on sensitivity results with an improvement in diarrhea frequency and downward trend in transaminases. He remained stable and was discharged home on Day 8. He was doing well 4 months later with normal cell counts, normal liver, and kidney function.", "age": [ [ 27.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5343247.xml", "relevant_articles": { "28326205": "123", "26521193": "0", "25844525": "0", "8079944": "0", "19203989": "0" }, "similar_patients": { "4260426-1": "0", "6599465-1": "0", "6949660-1": "123", "3884854-1": "0", "6350132-1": "0" } }, { "human_patient_id": "276", "human_patient_uid": "3646506-1-M", "PMID": "23557091", "title": "A case report of semitendinosus tendon autograft for reconstruction of the meniscal wall supporting a collagen implant", "patient": "A 32 year old man was referred because of left knee pain. Six months before he had a subtotal meniscectomy of the medial meniscus for a bucket handle tear. He was a local policeman that could not develop his work because of non-responsive pain in prolonged stand up position and severe limitation for running and other sports activities.\nPhysical examination revealed a varus morphotype with positive meniscal maneuvers and medial joint pain. Radiographic imaging showed impingement of the medial compartment corresponding to a Fairbank grade II. The report of magnetic resonance imaging indicated a small medial meniscus remnant, almost absent in body and no posterior horn attachment with a focal osteochondritis of the medial femoral condyle. An arthroscopic evaluation was recommended and different therapeutic options were explained.\nAfter informed consent and pre-surgical study, knee arthroscopy was performed under epidural anesthesia and preventive ischemia of the left lower extremity. Arthroscopy showed absence of part of the body and posterior horn of medial meniscus (Figure A and B). The anterior part of the meniscal tissue showed degenerative signs. In the lateral area of the medial femoral condyle near the notch, a focal Outerbridge chondral injury grade III was observed. The remaining meniscal tissue was regularized until reaching a healthy-look tissue and the meniscal wall was reconstructed with autologous graft with a double semitendinosus tendon. The tendon was identified through an oblique incision over the tibial insertion of the hamstrings. The graft was introduced through the antero-medial portal across the anterior capsule, pulling on the sutures through a tibial tunnel that was previously drilled in antero-posterior and medio-lateral direction pointing to the insertion of the posterior horn (Figures B and A). The graft was fixed with sutures \u201coutside-in\u201d to the menisco-tibial ligaments and then sutured to the anterior horn remainder, \u201cinside-out\u201d in the body, \u201call inside\u201d in the posterior horn and a tibial staple distally to the tibial tunnel (Figure A and B).\nThe knee was immobilized at 20 degrees of flexion for 3 weeks. Partial weight bearing was authorized at the third post-operative week. Then, range of motion was allowed from 0 to 90 degrees until the sixth week. Postoperative physical examination was made, showing only mild effusion of the knee. After six weeks, progressive flexion was permitted. A 1.5 Tesla MRI in coronal plane (FigureA) showed that the double semitendinosus tendon reached the lateral margin of the lateral tibial plateau. In sagittal plane (FigureB) a bulky posterior graft was adapted to the posterior tibial plateau.\nFive months later he underwent a new arthroscopy. The new reconstructed \u201cmeniscal wall\u201d with semitendinosus tendon was stable and invaded by a synovial tissue similar to the native tissue (Figure A and B). The anterior horn showed an oblique tear with degenerative appearance in the graft union and the osteochondral lesion reduced its size with some fibrocartilage areas. The anterior horn of medial meniscus was regularized and a collagen meniscal implant of 40 mm was inserted. The CMI was attached to the new meniscal rim with sutures \u201call-inside\u201d in the posterior horn (Figure A) and sutures \u201coutside-in\u201d for the body and anterior horn (Figure B). In addition, microfractures were performed in the area of osteochondritis with stabilization of the edges of the cartilage defect with a radiofrequency terminal.\nIn the postoperative period, the knee movement was limited from 0\u00b0 and 30\u00b0 during the first week, until 60\u00b0 between first and third week and up to 90\u00b0 between third and sixth week. Then, free range of motion was allowed and a progressive partial weight bearing was authorized in the third post-operative week.\nTwo months after the last surgery, the patient\u2019s physical examination revealed a joint range of motion of 0\u00ba to 120\u00b0, without effusion, moderate quadriceps atrophy and some occasional discomfort related with sustained load bearing.\nAfter 3 months, the patient was admitted in other Hospital because of an acute truncal viral encephalitis of unknown etiology. However, after a complete neurological examination any correlation with the knee surgery was discarded.\nAt 5 months, the patient only presented occasional discomfort in the popliteal region, mild atrophy of the quadriceps and minimum non inflammatory effusion that was drained and sent to microbiological study. The magnetic resonance imaging demonstrated that both grafts were correctly placed in middle and posterior zones with moderate anterior extrusion and marked synovitis. In the sample cultures, there was growth of colonies of Staphylococcus simulans. Despite that the culture results were considered to be a contaminating agent rather than a pathogen, antibiotic therapy was prescribed according to the antibiogram.\nAt 7 months, a diagnostic arthroscopy was performed because of persistent knee effusion with no local or systemic signs of infection. A marked generalized synovitis was observed, and three samples were taken for pathologic and microbiologic studies. Then, a partial synovectomy and joint toillette was performed. The meniscal implant was stable with complete integrity. The chondral defect of medial femoral condyle was covered with fibrocartilage. The results of the studies reported inflammatory synovitis with no pathogens growth.\nTen months after the placement of the CMI, the patient only complained of occasional discomfort related with periods of increased physical activity. MRI showed reduced synovitis and no osteoarthritis progression neither posterior extrusion of the implant were observed (Figure A and B).\nAfter two years of the CMI surgery, the patient had no medial compartment pain neither activity daily living limitations and only complained of non specific discomfort with intense activities. In the Lysholm-Gillquist score 92 points was obtained. The varus deformity was not increased. The MRI revealed the correct fitting and complete integration of implants except moderate extrusion of the anterior horn. No significant degenerative changes were observed. (FigureA andB).", "age": [ [ 32.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3646506.xml", "relevant_articles": { "19292299": "12", "30240302": "12", "25155049": "12", "18536902": "123", "17171330": "13" }, "similar_patients": { "8464142-1": "12", "8673431-1": "0", "5704831-1": "123", "6130588-1": "123", "5245953-1": "123" } }, { "human_patient_id": "277", "human_patient_uid": "4158112-1-M", "PMID": "25221677", "title": "Collagenous Colitis Associated with Protein Losing Enteropathy in a Toddler", "patient": "A 15-month-old male, with a past medical history significant for microcornea, was admitted to our hospital with progressive peripheral edema for two weeks. Parents reported 4-5 explosive diarrheal bowel movements per day for approximately 4 weeks prior to presentation. The bowel movements were described as yellow-green in color, with associated \u201clittle globules,\u201d liquid to pasty in consistency without blood or mucus. Shortly before admission, he began vomiting after almost every meal. On physical exam he was ill-appearing, afebrile, with significant facial and upper and lower limb edema. Laboratory investigations revealed the following: white blood cells, 14.5/mm3; C-reactive protein, <0.03 mg/dL; total protein, 3.6 g/dL; plasma albumin, 2.4 mg/dL; no abnormalities in liver, renal, and thyroid function tests; normal results of urinalysis and no proteinuria. Immunoglobulin A tissue transglutaminase, Epstein-Barr virus profile, and Cytomegalovirus profile were all negative. Stool for bacterial and viral cultures, Giardia antigen, white cells, and blood occult were also negative. Stool for alpha-1 antitrypsin was elevated at >1.33 mg/g (normal <0.62 mg/g), consistent with protein losing enteropathy. Upper endoscopy showed edematous antral and duodenal mucosa. The rectal and sigmoid mucosa appeared normal on flexible sigmoidoscopy. Biopsies from the colon and rectal mucosa showed patchy increased subepithelial bands of collagen of variable thicknesses consistent with collagenous colitis. The collagen deposition was highlighted with Masson trichrome staining (). The gastric biopsy contained chronic gastritis with increased fibrosis and collagen deposition but no clear subepithelial collagen band (). The duodenal biopsy showed foci of possible increased collagen in the mucosa, but not enough to be diagnostic for duodenal involvement of collagenous mucosal inflammatory disease (). Budesonide was then initiated at 3 mg per day for 5 days but he continued with diarrhea and protein loss requiring parenteral nutrition replacement. Intravenous methylprednisolone was then added at 2 mg/kg/day and a marked improvement in his symptoms was noticed. He gradually tolerated oral intake and was weaned off total parenteral nutrition over a one-week period. He was discharged home on prednisolone 1 mg/kg/dose in addition to 3 mg per day of budesonide. He continued to do well after weaning off prednisone over two months. An attempt to discontinue budesonide led to worsening diarrhea and a requirement for reinduction for remission with oral steroid along with budesonide. He was then maintained on 3 mg of budesonide per day and continued to do well clinically. Upper endoscopy and colonoscopy were repeated 5 months later and showed persistent collagenous colitis without gastric or duodenal involvement. Biopsies at endoscopy and colonoscopy one year after presentation were normal on maintenance budesonide. He continued to do clinically well thereafter with no GI symptoms.", "age": [ [ 15.0, "month" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4158112.xml", "relevant_articles": { "22149977": "123", "10406251": "123", "10207732": "13", "32766018": "123", "24039441": "123" }, "similar_patients": { "7060430-1": "12", "2740095-2": "12", "7444891-1": "12", "5827903-1": "12", "6323406-1": "12" } }, { "human_patient_id": "278", "human_patient_uid": "4528880-1-M", "PMID": "26425627", "title": "Adolescent Premature Ovarian Insufficiency Following Human Papillomavirus Vaccination", "patient": "Menarche at age 13 years in 2007 was followed by light periods, which became heavier and regularized over the next 12 months. HPV4 was administered in February, May, and August of 2008 (Department of Health New South Wales. 2011). Cycles became irregular early in 2009 and become scant and infrequent in 2010. Menstruation ceased in January 2011 and hot flushes commenced. There was no past history of significant illness or surgery. She was a nonsmoker, took no medications, and had no history of injury. Body mass index was 22.6 kg/m2. There was no family history of premature menopause. At her initial consultation for oligomenorrhea becoming amenorrhea, she was prescribed the OCP without investigation. She was not sexually active.\nShe declined the OCP and consulted a second clinician. Investigations revealed that follicle-stimulating hormone was 108 U/L (menopausal range 20-140 U/L); luteinizing hormone was 31 U/L (menopausal range 10-65 U/L); estradiol was low at 63 pmol/L (normal follicular range >110 pmol/L, menopausal range = 40-200 pmol/L). Progesterone was 1.1 nmol/L (menopausal range <2.2 nmol/L). Anti-M\u00fcllerian hormone was <1.0. There were no antiovarian antibodies or antiadrenal antibodies detected. Thyroid peroxidase antibodies were 2 IU/mL and thyroglobulin antibodies were 44 IU/mL (levels up to 100 IU/mL can occur in normal subjects). A pelvic ultrasound was reported normal. Full blood count, renal, liver and thyroid function, and prolactin were normal. Premature ovarian failure was diagnosed at age 16 years. Some irregular anovulatory pattern bleeds occurred before commencement of hormone replacement therapy.\nKaryotype was 46XX. Galactosemia testing was negative. Fragile X testing was normal.\nThis girl was counseled about the need for bone strength preservation. Her bone mineral density testing suggested femoral neck to be in the low range for age, height, and weight at 0.766 g/cm2 and lumbar spine bone mineral density to be normal for height and weight but lower than the expected range for age at 0.903 g/cm2. She is considering ovarian tissue cryopreservation.", "age": [ [ 13.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4528880.xml", "relevant_articles": { "26024933": "123", "20135568": "0", "22580548": "2", "8862496": "2", "9823745": "0" }, "similar_patients": { "4528880-1": "1", "8687844-1": "1", "8414738-1": "1", "4170085-1": "0", "6552943-1": "0" } }, { "human_patient_id": "279", "human_patient_uid": "4528880-2-M", "PMID": "26425627", "title": "Adolescent Premature Ovarian Insufficiency Following Human Papillomavirus Vaccination", "patient": "An 18-year-old young woman presented with 6 months amenorrhea. Menarche had occurred at age 11 years. She suffered from mild cerebral palsy (possibly due to low birth weight of 1.88 kg at 38 weeks\u2019 gestation), mild asthma, Asperger\u2019s syndrome, anxiety, and epileptic events from age 14 to 15 years, considered secondary to cerebral palsy. She had a ruptured appendix at age 12 years. There was no other significant past history; no drug usage; she did not smoke or drink alcohol, and had not become sexually active. Sertraline was used for treatment of anxiety from 2009 to 2010 followed by fluoxetine. There was a family history of osteoarthritis and osteopenia and of pancreatic cancer; no family history of premature menopause. The OCP was commenced at age 12 years. The attending gynecologist recorded \u201calthough her periods were reasonably normal, she was put on the pill (20 \u00b5g ethinyloestradiol and 100 \u00b5g levonorgestrol) the next year because coping with her periods made her anxiety and depression symptoms worse.\u201d Her first HPV4 vaccination was administered at age 12 years and 9 months; the second vaccination near her 13th birthday, and the third vaccination at age 13 years and 5 months. The first HPV4 vaccination was given concomitantly with hepatitis B vaccination in the other arm. OCP usage continued for 2 years to age 14 years. It was briefly ceased at age 14 and this was followed by 3 months amenorrhea. OCP was then resumed without further investigation. At age 18 years, the OCP was again ceased and amenorrhea again ensued.\nFollicle-stimulating hormone 1 month later was elevated at 44.5 IU/L (menopausal range is 25-130 IU/L). Luteinizing hormone was 29.2 IU/L (basal range 2.0-12, midcycle peak range 8.0-90, postmenopausal range 5.0-62 IU/L). Estradiol was 157 pmol/L. She continued amenorrheic and presented again for investigation 6 months later. At this time, follicle-stimulating hormone remained elevated at 34 IU/L. Luteinizing hormone was elevated at 46 IU/L. Estrodiol (Oest2) was 413 pmol/L and progesterone 2 nmol/L. Anti-M\u00fcllerian hormone was 1.5 pmol/L (14.0-30.0 pmol/L normal; levels <14 pmol/L suggest diminished ovulatory reserve) tested by Beckman Coulter Gen II ELISA assay. Anti-M\u00fcllerian hormone repeated 6 months later was <1 pmol/L and estradiol was <37 pmol/L. At this time and at age 18 years POI was diagnosed.\nFull blood count, iron levels, liver function, blood glucose, and renal function were normal. Thyroid-stimulating hormone was normal 0.4 mIU/L (normal 0.3-3.5 mIU/L) and thyroid antibodies were normal. Prolactin was normal 294 mIU/L. Testosterone 0.9 nmol/L (normal 0.2-1.8 nmol/L); free androgen index 2.6 (normal 0.3-4.0); iron studies were normal. There were no antiadrenal or antiovarian antibodies detected. Morning cortisol was 218 nmol/L (normal range 160-650) nmol/L, ACTH 14 ng/L (normal range 9-51 ng/L), growth factor-1 27 nmol/L (normal range 21-76 nmol/L). Pelvic ultrasound performed at the time when the anti-M\u00fcllerian hormone level was 1.5 showed a normal uterus with an endometrial echo of 8.2 mm. Transvaginal ultrasound was declined and the left ovary was not visualized. The right ovary was 3.1 cm3 in size and there was a 9-mm follicle within it. Brief menstrual bleeds then occurred for 4 months before amenorrhea resumed.\nTesting for Fragile X revealed 2 normal-sized triplet alleles 23 and 37 cytosine\u2013guanine\u2013guanine n repeats (the normal zone is <44). Testing for galactosemia showed a normal Gal-1-P uridyl transferase-RC at 0.31 U/g hemoglobin (normal range 0.26-0.52 U/g). Records reported a vitamin B12 deficiency at age 16 years, but levels of vitamin B12 were within normal limits at 275 pmol/L (normal range 135-650 pmol/L). Karyotype was established as 46XX.\nThis young woman elected to undergo right ovary cryopreservation through Monash IVF in the hope that future developments, such as stimulation of ovarian stem cells, may be of later benefit. She was not deemed a suitable candidate for gonadotropin stimulation for oocyte preservation due to the undetectable anti-M\u00fcllerian hormone level. The pathologist described the macroscopic appearance of the ovary as \u201ccystic and disrupted.\u201d Microscopic histology of three right ovarian biopsies reported fibrovascular connective tissue with no primordial follicles in the ovarian cortex of sample one. Ovarian sample 2 reported a cystic follicle and a cystic corpus luteum but no primordial follicles within surrounding parenchyma. Ovarian sample 3 reported \u201cfibrofatty connective tissue only. No ovarian parenchyma is identified.\u201d Summary: \u201cLevels through all tissue containing ovarian parenchyma show a single primordial follicle. No other follicular structures are identified.\u201d No samples contained evidence of atypia or malignancy (Sullivan Nicolaides Pathology. Brisbane, Queensland, Australia). Personal communication with the reporting pathologist confirmed no lymphoid or granulomatous inflammation and suggested the ovarian appearance was \u201cconsistent with that of a woman in her late forties.\u201d\nShe has been counseled about bone density preservation and the need for hormone replacement therapy. This case was notified to the Therapeutic Goods Administration (TGA) of Australia in January 2014 (reference number 333136) as diagnosed POI. Its listing as \u201camenorrhoea\u201d on the TGA database in May 2014 was later altered to POF (July 2014).", "age": [ [ 18.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4528880.xml", "relevant_articles": { "26024933": "12", "7852525": "0", "19657814": "0", "7962424": "0", "18581773": "0" }, "similar_patients": { "5597078-1": "1", "8601299-1": "1", "8687844-1": "1", "8414738-1": "1", "4212146-1": "1" } }, { "human_patient_id": "280", "human_patient_uid": "4528880-3-M", "PMID": "26425627", "title": "Adolescent Premature Ovarian Insufficiency Following Human Papillomavirus Vaccination", "patient": "Menarche had commenced at age 10 years, and was followed by regular menses. The first 2 HPV4 vaccinations were received at age 14 years and the third vaccine after turning 15 years in 2008 (Department of Health New South Wales. School vaccination programme. Vaccinations administered February 18, May 23, and October 24 in 2008). The patient reports \u201cprior to this, my periods were like clockwork.\u201d The period due after the third vaccination dose was 2 weeks late and was the first late period she had experienced. The next period occurred 2 months later. The next and final menstruation occurred 9 months later, approximately 1 year after completion of the third HPV4 vaccination. Hot flushes developed and 10 kg weight gain was noted over the next year. Previously present acne improved. Pelvic ultrasound was unremarkable apart from a 3.7-mm endometrial width and the absence of visible ovarian follicles. She had not become sexually active, had no history of drug or alcohol usage and there was no history of trauma, surgery or of significant past illness. There was no family history of premature menopause. She was allergic to benzoyl peroxide. POF was diagnosed just before her 17th birthday.\nAt age 15 years, initial testing was undertaken: testosterone was 1.1 nmol/L (normal range <2.6), sex hormone binding globulin 41 nmol/L (normal range 20-118 nmol/L), free androgen index 2.7% (normal range <7.2%). There is no significant further testing until nearly 17 years of age: prolactin 160 mIU/L (normal range 40-570 mIU/L), thyroid-stimulating hormone 1.1 mIU/L (normal range 0.5-4.5 mIU/L), dihydroepiandrostenedione (DHEA-S) 3.5 \u00b5mol/L (normal range 3.6-9.8 \u00b5mol/L), androstenedione 1.8 nmol/L (normal range 1.0-11.5 nmol/L), testosterone <0.7 nmol/L (normal range <3.2 nmol/L), serum hormone binding globulin 32 nmol/L (normal range 30-90 nmol/L), free androgen index <2.2%, luteinizing hormone 32.8 IU/L (midcycle range 17.7-47.5; postmenopausal range >9.3 IU/L), follicle-stimulating hormone 73.8 IU/L (midcycle range 9.6-24.1; postmenopausal >50 IU/L), estradiol <100 pmol/L (midcycle range 500-1500; postmenopausal <100 pmol/L). Estradiol (radioimmune assay) <10 pmol/L. Repeated hormone levels 7 weeks later revealed luteinizing hormone 42.9 IU/L, follicle-stimulating hormone 61.8 IU/L, and estradiol 18 pmol/L. Antiovarian antibodies were negative <1:10 and antiadrenal antibodies were negative. Anti-M\u00fcllerian hormone level was unrecordable. Bone mineral density scan was reported normal at age 17 years and 1 month (z-score 0.9 for lumbar spine and 1.4 for \u201cwhole body\u201d).\nWhen reviewed in the Department of Clinical Endocrinology at Westmead Hospital, New South Wales, it was determined that she would not respond to gonadotropin stimulation for oocyte collection for cryopreservation. She has been counseled about the need for bone preservation and is currently on hormone replacement therapy. This case was reported to the Therapeutic Goods Administration of Australia in April 2014. No response was received and the case was renotified to the TGA in June 2014 and to the New South Wales Chief Medical Officer. Reference number and notification response are awaited. Consultation for ovarian cryopreservation has commenced.", "age": [ [ 10.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4528880.xml", "relevant_articles": { "23649638": "0", "28348072": "", "32349465": "0", "7962424": "0", "31269583": "0" }, "similar_patients": { "4528880-1": "1", "8601299-1": "0", "4868814-1": "0", "7667354-1": "0", "4508269-1": "0" } }, { "human_patient_id": "281", "human_patient_uid": "4395951-1-M", "PMID": "25878749", "title": "Concurrent acute disseminated encephalomyelitis and Guillain\u2013Barr\u00e9 syndrome in a child", "patient": "A 10-year-old boy presented with inability to walk since 2 days with difficulty in swallowing, dysphonia and drooling of saliva. There was no history of recent infection, fever, diarrhea, convulsions or trauma or recent immunization. His antenatal, postnatal details were not significant.\nOn clinical evaluation, he was conscious and irritable. Neurological examination revealed the generalized hypotonia; weakness started with lower limbs then progressed to involve both upper limbs. However, respiration was normal. The anterior abdominal muscles were weak, and the patient could support himself with difficulty in sitting position. He had lower motor neuron type of facial paralysis.\nThe patient had irritability and fundoscopy was suggestive of bilateral papilledema. Hence, cerebrospinal fluid analysis was deferred in our patient. He was treated for raised intracranial pressure with mannitol and 3% NaCl. Emergency computed tomography (CT) scan head was done which revealed vasogenic edema in bilateral fronto-parietal and left temporal regions and infarcts. Further evaluation with MRI study was suggested.\nMagnetic resonance imaging brain study was done based on CT scan findings MRI revealed white matter lesions in the brain, pons and thoracic levels of the spinal cord. It revealed peripherally enhancing lesions in right fronto-parietal and left fronto-temporo-parieto-occipital region involving grey and white matter, subcortical region and corpus callosum; suggestive of ADEM. Multiple altered signal intensity areas, largest size 5.3 cm \u00d7 3.6 cm, were seen involving grey matter and bilateral periventricular deep white matter [].\nElectro-diagnosis showed an important reduction of conduction velocity that is, mild generalized motor sensory axonal polyneuropathy (acute motor and sensory axonal neuropathy-GBS).\nFundus evaluation revealed bilateral optic neuritis after 3 weeks of illness [Figure and ]. However, there was no clinical deterioration of vision or retro-orbital pain.\nBased on clinical findings and electromyography-nerve conduction velocity, a diagnosis of GBS was made and based on MRI findings and fundoscopy, concurrent diagnosis of ADEM and GBS was considered.\nHence, the treatment followed with intravenous immunoglobins (2 g/kg) for 2 days and intravenous methylprednisolone (30 mg/kg/day) for 3 days.\nThere was gradual improvement in motor power to 3/5 within about 2 weeks. The patient showed significant clinical improvement after 4 weeks and could stand with support and walk with assistance.\nThe patient was advised physiotherapy and discharged on oral steroids prednisolone at (1 mg/kg/day) in tapering doses over 4 weeks period. However, this could be considered as the first episode of MS with optic neuritis, therefore, our patient will be evaluated on follow-up for further episodes and treatment with immunomodulators.", "age": [ [ 10.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4395951.xml", "relevant_articles": { "29167658": "12", "25878749": "123", "22593657": "123", "21745776": "123", "31911876": "123" }, "similar_patients": { "6659433-1": "0", "7758787-1": "123", "5011863-1": "123", "7775929-1": "123", "5586132-1": "1" } }, { "human_patient_id": "282", "human_patient_uid": "3699936-1-M", "PMID": "23539015", "title": "Sarcoid-like lesions in Paracoccidioidomycosis: immunological\nfactors", "patient": "A 30-year-old woman complained of redness and pimples on the nose for 6 months. She had\nan infiltrated erythematous plaque with papules, pustules and telangiectasia all over\nthe nasal area (). Histopathology showed\nsuperficial and deep tuberculoid inflammatory infiltrate without caseous necrosis,\nconsistent with granulomatous rosacea. Fungi and acid fast-bacilli resistant staining\nnegative.\nThe disease progressed despite the rosacea treatment. The plaque became less defined and\nlarger (). There were four new\ninfiltrated erythematous-brownish sarcoidosis-like plaques on the left and right\neyebrows, on the right temporal region and on the left jaw ( and )\nThe investigation was extended to possible granulomatous infectious diseases. Chest\nX-ray was normal, PB serology, syphilis serology, Montenegro reaction and tuberculin\ntest (PPD) were non-reactive. The histology report was sustained after new biopsies\n().\nAfter l year of follow-up, the patient complained of throat pain. In the oral cavity\nthere was a slightly verrucous lesion with fine granulation tissue and bleeding points\nsimilar to strawberry-like stomatitis ().\nIn the middle of mixed inflammatory infiltrate there were some thick-walled spores with\ndouble contour and multiple budding, compatible with PB ( and ). After treatment, the\npatient achieved clinical cure.", "age": [ [ 30.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC003xxxxxx/PMC3699936.xml", "relevant_articles": { "21382292": "12", "18700468": "12", "33288364": "0", "15347488": "12", "21518580": "12" }, "similar_patients": { "5726683-1": "12", "3969700-1": "0", "6434751-1": "1", "3876008-1": "1", "4861575-1": "1" } }, { "human_patient_id": "283", "human_patient_uid": "4566418-1-M", "PMID": "26357841", "title": "Pseudoperipheral palsy: a case of subcortical infarction imitating peripheral neuropathy", "patient": "A 44-year-old, right-handed female presented with sudden hand motor deficits in her left hand. There was no trauma to the arm, she used no medications and she had no vascular risk factors.\nExamination revealed severe motor deficits of the left hand with extension of the three ulnar fingers and wrist, muscle atrophy in the first dorsal interosseous muscle, and claw hand deformity without sensory deficits (Fig. ). According to the Medical Research Council scale examination revealed grade 1 in the left wrist flexor, grade 4 in the left wrist extensor, grade 3 in the left fingers flexor and grade 4 in the left fingers extensor. Adduction and abduction of the left fingers were also severely impaired (grade 3). Deep tendon reflexes were mildly brisker ipsilateral to the affected hand. No Babinski sign was observed.\nCervical computed tomography (CT) was unremarkable. Peripheral motor nerve conduction velocities were normal. Small, discrete ischemic lesions appeared hyperintense on diffusion-weighted magnetic resonance imaging (MRI) sequence (upper arrows on Fig. ). The infarct was located in the right posterior part of the precentral hand knob area (upper arrow on 1d), near the central sulcus (lower arrow on Fig. ). CT angiography showed significant stenosis in the right proximal middle cerebral artery (MCA) trunk.\nTransesophageal echocardiogram and carotid ultrasound did not suggest an embolic source. Hypercoagulable screening and levels of markers specific to systemic vasculitis were all normal. An embolism arising from the ipsilateral MCA stenosis was subsequently considered as the etiology of the patient\u2019s symptoms, and she received acetylsalicylic acid and clopidogrel for secondary stroke prevention.\nAt the 2-month follow-up, the patient complained of fatigue and progressive headaches. Cerebrospinal fluid analysis was normal. Follow-up 3-Tesla MRI with gadolinium contrast revealed focal wall enhancement in the right proximal MCA (Fig. ), indicating cerebral angiitis. Multiple stenoses at the same location were seen on digital subtraction angiography (DSA) (Fig. ). Brain biopsy was not performed.\nCyclophosphamide infusions were administered with glucocorticoids over the subsequent 15 weeks. Left-hand motor function improved, aside from her left fifth finger.", "age": [ [ 44.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4566418.xml", "relevant_articles": { "16026048": "0", "26103813": "123", "8132422": "2", "11215263": "12", "9248342": "0" }, "similar_patients": { "7887466-1": "123", "4026617-1": "123", "8607187-1": "0", "3471260-1": "12", "3420447-1": "1" } }, { "human_patient_id": "284", "human_patient_uid": "5824528-1-M", "PMID": "29491615", "title": "Benign lymphoepithelial cyst of parotid gland: Review and case report", "patient": "A 35-year-old male reported to Government Dental College, Indore, before 3 years, with a soft, non-tender compressible diffuse swelling involving the left parotid gland for the last 9\u201310 months. The swelling was noted to have gradually increased in size and was measuring 3.5 cm \u00d7 2.5 cm \u00d7 4.5 cm at the time of presentation []. It was a well-defined smooth-walled cystic lesion seen in the superficial lobe of the left parotid gland. The patient denied any history of trauma to the parotid area. The overlying skin was normal in color and freely moveable over the mass. The function of facial nerve was normal. There was no associated regional lymphadenopathy or thyroid enlargement. Intraoral examination revealed a free flow of saliva from the left parotid (Stensen's duct) opening.\nThe preoperative diagnosis of this case remained uncertain as the nature and clinical symptoms resembled the other cystic lesions of the parotid gland such as retention cysts, extravasation cysts, or cystic degenerative salivary gland tumor.\nFurther investigations were done including orthopantomographic radiograph and lateral skull radiograph however, both revealed normal conditions.\nELISA-based HIV was nonreactive. In addition, the patient did not belong to the HIV high-risk group based on social and family histories Biochemical investigation revealed high protein content A simple magnetic resonance imaging (MRI) was done which showed \u201cA well-defined, thin, smooth-walled cystic lesion within the superficial part of the left parotid gland measuring about 3.7 cm \u00d7 2.6 cm \u00d7 4.2 cm. The fluid content of the lesion appeared hypertense on T1 as well as T2-weighted imaging (WI), suggestive of high proteinaceous or hemorrhagic content with no solid component. MRI picture was, therefore, indicative of a benign cystic lesion of the left parotid gland with a differential diagnosis of branchial cleft cyst [] Fine-needle aspiration cytology (FNAC): FNA of the mass yielded a chocolate brown, hemorrhagic fluid which on cytological examination revealed sparsely cellular smear consisting of inflammatory infiltrate predominantly with neutrophils, lymphocytes and cystic macrophages against a proteinaceous background suggestive of an infected cyst of the left parotid gland.\nHence, based on clinical presentation, aspiration and MRI, a final diagnosis of infected cyst of the left parotid gland was given.\nThe finding was explained and the patient agreed for the surgical excision of superficial parotid gland tissue under general anesthesia.\nAfter skin preparation with povidone solution, access to the cyst was made through the lower neck incision at the deepest neck crest which is found to be posteroinferior to the cyst. This helps to minimize the postoperative scarring and avoid from puncturing the cyst. The incision was then extended to the mastoid, posterior and inferior auricles. The incision was then performed layer by layer until it reached the platysma muscle. This muscle was dissected to expose the underneath cyst capsule. Once the plane between cyst capsule and platysma muscle was identified, the blunt dissection was carried out carefully separating the cyst from the sternocleidomastoid muscle posteriorly and the posterior belly of digastric muscle underneath with the preservation of facial nerve. However, the upper part of the cyst was found embedded in the parotid tissue, so part of the superficial lobe of the left parotid gland was excised together with the cyst. The specimen was then sent for histopathological examination (HPE).\nPatient recovery was nonincidental with no evidence of facial nerve palsy and wound infection.\nThe HPE showed a collapsed cyst wall with adjacent salivary gland and small reactive lymphoid tissue. The cyst was lined by thin ciliated columnar epithelium in some areas, cuboidal in other areas and flat squamous cells in still other areas. However, no nuclear atypia was seen. The appearance was that of a Lymphoepithelial cyst (LEC). The lymphoid tissue was of both diffuse and follicular nature [Figures \u2013].", "age": [ [ 35.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5824528.xml", "relevant_articles": { "29491615": "123", "1757841": "123", "18979123": "0", "21507444": "0", "30034966": "0" }, "similar_patients": { "3716020-1": "0", "5463163-1": "0", "4293854-1": "0", "7302534-1": "0", "6051554-1": "0" } }, { "human_patient_id": "285", "human_patient_uid": "3189149-1-M", "PMID": "21936912", "title": "Hyperferritinemia without iron overload in patients with bilateral cataracts: a case series", "patient": "A 32-year-old Caucasian man from Switzerland was referred for further evaluation of an elevated serum ferritin, the test for which was ordered because of tiredness. His serum ferritin concentration at presentation was markedly elevated at 1314 \u03bcg/L (normal range 30-400 \u03bcg/L), but the serum transferrin saturation of 23.3% was within our laboratory reference interval (normal range 15-50%).\nOur patient had no history of alcohol abuse or other metabolic diseases and no family history of hereditary hemochromatosis (HH). Clinical examination revealed no abnormalities. Further laboratory evaluation showed normal liver enzymes and normal hematological parameters.\nGenetic tests for HH showed a heterozygous H63D substitution in the HFE gene but wild-type sequence at the HFE C282Y locus. The histology of a liver biopsy specimen was normal, and did not show iron accumulation or steatosis. Together, these findings exclude a diagnosis of HH.\nUpon further evaluation, our patient revealed a history of bilateral cataracts at four years of age. His mother, his maternal aunt and maternal grandfather had all had nuclear cataracts at an early age (Figure ). Slit-lamp examination, direct illumination and retro-illumination of his lenses showed scattered, radially oriented flecks and crystalline deposits in both lenses (Figure ). Sequencing of the FTL gene using a previously described method [] showed a heterozygous c.33 C > A transversion in the IRE within the FTL 5'UTR. This mutation has been previously associated with the HHCS phenotype [].", "age": [ [ 32.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3189149.xml", "relevant_articles": { "17927936": "12", "15017658": "0", "34789084": "12", "12210292": "12", "30339210": "12" }, "similar_patients": { "3189149-2": "1", "4296220-1": "1", "7106592-1": "1", "7934381-1": "1", "7048005-1": "1" } }, { "human_patient_id": "286", "human_patient_uid": "3189149-2-M", "PMID": "21936912", "title": "Hyperferritinemia without iron overload in patients with bilateral cataracts: a case series", "patient": "A 49-year-old Caucasian man was referred to our department for further examination of a markedly elevated serum ferritin concentration, of 2012 \u03bcg/L (normal range 30-400 \u03bcg/L). This had been identified as an incidental finding during the investigation of an allergy. His serum transferrin saturation of 29% was within the normal range. His liver enzymes and hematological evaluation were normal. The HFE gene showed wild-type sequence and an abdominal ultrasound showed normal liver echotexture. Our patient reported bilateral lens replacements 20 years ago due to bilateral juvenile cataracts. His family history was not available because he was an orphan. Deoxyribonucleic acid (DNA) sequencing of the FTL 5'UTR revealed a heterozygous c.32G > C transversion. This mutation is also known to be associated with the clinical phenotype of HHCS [].", "age": [ [ 49.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3189149.xml", "relevant_articles": { "34789084": "12", "29426274": "12", "12730114": "12", "17927936": "12", "21936912": "12" }, "similar_patients": { "3189149-1": "1", "4296220-1": "1", "5787235-1": "1", "7048005-1": "1", "7106592-1": "1" } }, { "human_patient_id": "287", "human_patient_uid": "3934782-1-M", "PMID": "24575117", "title": "Revision of Perineal Urethrostomy Using a Meshed Split-Thickness Skin Graft", "patient": "A 45-year-old male patient underwent partial penectomy and distal urethrostomy for erythroplasia of Queyrat (i.e. carcinoma in situ of squamous cell carcinoma) in 2008. Since he was extremely dissatisfied with the remaining penile stump, he consulted our center about the option of phallic reconstruction. On June 14, 2010, phallic reconstruction was performed. The native urethra was lengthened by means of a radial forearm free flap. The phallus was reconstructed with an anterolateral thigh flap. The urethra was positioned inside the phallus according to the \u2018tube-in-a-tube\u2019 principle. In October 2012, the patient presented with obstructive voiding symptoms. A diagnostic urethroscopy showed a suspicious lesion in the remaining native, bulbar urethra, and biopsy confirmed the recurrence of a poorly differentiated squamous cell carcinoma of the urethra. On December 13, 2012, he underwent excision of the remaining native, bulbar urethra with the creation of a perineal urethrostomy at the membranous urethra. The perineal urethrostomy was performed using the technique as described by Blandy et al. []. Unfortunately, the postoperative period was complicated by bleeding, wound dehiscence and infection (fig. ). Finally, the perineal urethrostomy became completely obliterated and a suprapubic catheter was placed (fig. ). As the patient accepted this only as a temporary solution, we proposed the revision of the perineal urethrostomy using a meshed split-thickness skin graft. This procedure was performed on April 23, 2013. The patient was placed in the lithotomy position and a midline perineal incision was made. Dissection was continued up to the level of the urogenital diaphragm. A flexible cystoscope was inserted along the suprapubic tract and brought through the bladder neck into the posterior urethra. This marked the place of obliteration as the light of the cystoscope could be seen through the perineal incision. The urethra was opened on the tip of the cystoscope. All fibrotic tissue was further excised until only healthy urethral mucosa remained. The urethral stump was spatulated over 1.5 cm. Vicryl 4.0 stay sutures were placed at the mucosa to facilitate identification and to prepare the anastomosis for the graft (fig. ). A split-thickness graft (10 \u00d7 15 cm) was harvested from the skin of the left thigh and meshed 1:1. In the middle of the graft, an opening was made to anastomose with the urethral opening. The edges of the graft were further tailored and anastomosed with the perineal skin edges. Several additional quilting sutures were placed to fix the graft against the perineal graft bed (fig. ). A compressive dressing and a 20-Fr urethral catheter were left in place for 5 days. After 5 days, the dressing was removed with satisfactory graft take. Subsequently, the catheter was also removed. At present (6 months of follow-up), the patient is voiding well. Maximum and average urinary flow are 22 and 13 ml/s, respectively. His International Prostate Symptom score is 5/35. The perineal wound has healed well, with minimal contraction of the grafted area (fig. ). Through the neomeatus, a 20-Fr catheter can be passed without any difficulties, indicating a sufficient diameter.", "age": [ [ 45.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3934782.xml", "relevant_articles": { "24575117": "13", "33718814": "13", "21256550": "13", "34670918": "13", "21215434": "13" }, "similar_patients": { "4655270-1": "123", "6657190-1": "123", "6142115-1": "123", "7559505-1": "123", "6688390-1": "123" } }, { "human_patient_id": "288", "human_patient_uid": "6936936-1-M", "PMID": "31909389", "title": "Epithelial-myoepithelial carcinoma of the supraclavicular region: An unusual cause of dyspnea", "patient": "A 58-year-old woman presented with dyspnea and painless mass on the left supraclavicular area that had been present for a year. The patient\u2019s history included Diabetes Mellitus (DM) for two years and right hemithyroidectomy 15 years ago, which was the cause of benign thyroid nodule. There is mild fullness on the examination of the nasopharynx. Left vocal cord was observed paramedian fixation. The result of the nasopharynx biopsy of the patient was lymphoid hyperplasia. Neck ultrasonography (USG) showed a mass of 42x26 mm in the left supraclavicular region that was seen to be blooded with Doppler USG. Fine needle aspiration biopsy was reported as suspicious cytology. Ca, PTH, anti-TPO values were normal. Upper gastrointestinal system endoscopy was carried out. The result of the biopsy was superficial gastritis. Neck computed tomography (CT) and magnetic resonance imaging (MRI) were performed (, ).\nAn excisional biopsy was planned for the patient. As an intraoperative problem, it was seen that the left recurrent nerve was completely swollen by the tumor. Approximately 6x4x3 cm mass was totally excised. The pathological result was reported epithelial-myoepithelial carcinoma; the surgical margin was positive. Chemoradiotherapy was planned because of positive margin and big tumor size. No recurrence was detected in nearly 18-month follow-ups. Written informed consent was obtained from the patient for this study.", "age": [ [ 58.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC006xxxxxx/PMC6936936.xml", "relevant_articles": { "27635297": "0", "10432084": "2", "25548688": "2", "25400796": "0", "20508829": "123" }, "similar_patients": { "4058984-1": "0", "5294429-1": "0", "4124478-1": "0", "3572359-1": "0", "8323301-1": "0" } }, { "human_patient_id": "289", "human_patient_uid": "6890335-1-M", "PMID": "31770233", "title": "Familial hemophagocytic lymphohistiocytosis in a girl with a novel homozygous mutation of STX11", "patient": "A proband, female, aged 10 years and 3 months, with a medical history of recurrent fever and abdominal distention prior to the age of 5 years and 9 months, was admitted to our hospital with recurrent fever and cough for 3 days. Five years and nine months before admission to our hospital (when the child patient was 4 years and 6 months old), she was diagnosed with Epstein\u2013Barr virus (EBV)\u2013HLH due to fever, hepatosplenomegaly, pancytopenia, increase of ferritins and positive EBV-DNA, and thus was treated based on the HLH-2004 plan for 8 weeks. Treatment was then stopped, and the disease remained in continuous remission for 22 months. Three years and nine months before admission to our hospital, the patient was diagnosed as having a relapse of EBV\u2013HLH due to the aforesaid symptoms and her positive blood EBV\u2013DNA, and she was treated again by chemotherapy based on the HLH-2004 plan for 8 weeks. Symptoms relieved and she stopped taking drugs, and the duration of the disease remission reached about 19 months. Two years before admission to our hospital, the child patient developed recurrent fever and abdominal distension, which improved after receiving anti-infective therapy and taking dexamethasone (details not known) in a local clinic. She denied having a history of infectious disease and has been inoculated with hepatitis B vaccine, BCG vaccine, poliomyelitis attenuated live vaccine, diphtheria pertussis tetanus vaccine, measles attenuated live vaccine, and epidemic encephalitis B vaccine, without any abnormal reaction. The patient was born in full term, G3P3, her parents\u2019 marriage was consanguineous (Fig. ), and the two elder brothers respectively developed recurrent fever and abdominal distension symptoms similar to the patient's at the ages of 4 and 5 years and died of treatment failure in another hospital. Specific diagnosis and treatment as well as causes of death were unknown. After admission to our hospital, the child patient had a continuous high fever (39\u201340 \u00b0C), with an acute serious sickly appearance, without stained yellow skin or rash, but scattered ecchymosis was found. The superficial lymph nodes were not affected but her tonsils were slightly swollen. Medium and fine moist rales were heard in her right lung. Her abdomen was distended, the liver was 3.0 and 5.0 cm below the costal margin and the xiphoid, respectively. No abnormity was found in her nervous system. The hemogram revealed pancytopenia with the neutrophils 0.29 \u00d7 109/L, Hb 52 g/L, and platelets 6 \u00d7 109/L, respectively. The fibrinogen was decreased (the lowest value was 44 mg/dL), and the ferritin was elevated (995.3 ng/mL). Her triglyceride was normal, and a hemophagocytic phenomenon was found in a bone marrow examination. Multiple etiological examinations (blood culture, fungus G test and GM test, mycobacterium tuberculosis T-SPOT, mycoplasma, chlamydia and EBV-DNA [six repeated examinations], cytomegalovirus [CMV]-DNA, TORCH and seven combined examinations of respiratory viruses) were negative. According to eight HLH clinical diagnosis standards formulated by the International Histiocyte Society in 2004, the patient was clinically diagnosed as HLH. Due to a positive family history, in order to further specify the causes of the disease, we examined the activity of NK cells, the CD107a degranulation function of cytotoxic T lymphocytes and NK cells, as well as hereditary HLH-related gene mutations, and found that:\nthe activity of NK cells in the proband was reduced slightly, the CD107a degranulation function in cytotoxic T lymphocytes and NK cells also was obviously declined, and her parents also presented with reduced NK cell activity and slightly declined CD107a degranulation in CTL and NK cells (Fig. );\na homozygous mutation in STX11 (c.49C>T), which converted the codon encoding the glutamine amino acid at position 17 in syntaxin11 to a termination codon (p.Q17X), leading to early termination of the synthesis of syntaxin11 and loss of 240 amino acids (Fig. ).\nThis mutation was inherited from the parents of the proband (Figs. and ), and the result proved that the proband suffered from FHL-4. After admission to our hospital, the patient found relief after receiving treatment based on the HLH-2004 protocol; she has been alive for 6 years and 10 months since the onset, has stopped taking the dexamethasone and etoposide, but still takes cyclosporine orally to maintain treatment. She has undergone HLA matching and now is actively looking for a donor to undergo a hematopoietic stem cell transplantation.", "age": [ [ 10.0, "year" ], [ 3.0, "month" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6890335.xml", "relevant_articles": { "31770233": "123", "30486568": "12", "22339824": "123", "24340129": "1", "31761859": "13" }, "similar_patients": { "6379998-1": "123", "5415817-1": "123", "6824734-1": "13", "8167959-1": "123", "3935114-1": "13" } }, { "human_patient_id": "290", "human_patient_uid": "3083330-1-M", "PMID": "21477313", "title": "Cholestasis in patients with Cockayne syndrome and suggested modified criteria for clinical diagnosis", "patient": "Patient (1) is a 3 years old female, the second in order of birth of a first cousin marriage (Figures and ). She was referred to the genetic clinic at the age of one year with a provisional diagnosis of congenital Rubella syndrome. At presentation she had jaundice of one week duration, her length was 71.5 cm (less than - 4 SD), weight was 7 Kg (less than - 4 SD), and skull circumference was 39 cm (microcephalic). She had global developmental delay (that progressed in the next years), enophthalmia with characteristic physical appearance and cutaneous photosensitivity. Abdominal examination revealed an enlarged liver (8 cm below the costal margin) firm in consistency, with rounded border and smooth surface. She had moderate ascites with bilateral shifting dullness and bilateral lower limb oedema.\nALT was 94 IU/L (normal: 37), AST: 143 IU/L (normal: 40), total bilirubin: 5.9 mg/dl, direct bilirubin: 5 mg/dl, albumin: 1.5 g/dl. Prothrombin time (PT) was prolonged with INR: 1.7. Hepatitis A virus IgM, HBsAg, HBcAb IgM, hepatitis C virus antibodies were negative; CMV, EBV and rubella (IgG and IgM) were also negative. Plasma aminoacids revealed a mild elevation of methionine: 1.3 mg/dl (normal < 0.8) and an elevation of methionine/phenylalanine ratio: 1.41 (normal < 1.0). Acylcarnitine profile was normal. Total galactose (galactose and galactose 1- phosphate combined): 1.7 mg/dl (normal <15). Galactose 1- phosphate uridyle transferase was: 71.2 uM (normal >60). DNA testing for galactosemia mutation revealed no copies of the Q188r, S135L, K285N, or L195P (classical galactosemia) or N314D (Duarte galactosemia).\nSlit lamp examination revealed clear corneas and lens. Fundus examination showed pigments around the disc (bilateral retinal dystrophy). CT brain revealed central and cortical involutional brain changes. MRI brain revealed mild prominence of the brain sulci, fissures and basal cisterns with mildly dilated ventricular system more appreciated at the cerebellar hemispheres with mildly prominent cerebellar fissures. This is in addition to evidence of dysmyelinating process in the form of periventricular hyperintensity. Nerve conduction velocity and EMG showed normal studies.\nThe patient received ursodeoxycholic acid (UDCA) at a dose of 20 mg/kg/day, vitamin E (100 mg/day), aldactone (2 mg/kg/day), vitamin K (10 mg/day) and albumin transfusion. She gradually improved over one month and was discharged from the hospital on aldactone (12.5 mg/12 hrs) and vitamin K (10 mg once daily). Her investigations on discharge were: total bilirubin: 3.6 mg/dl, direct bilirubin: 2.1 mg/dl, albumin: 4 g/dl, AST: 54 IU/L, ALT: 100 IU/L, and normal PT. After 2 months, the amino acid profile was repeated and revealed normal results. At that time, all drugs were stopped and after 6 months the liver condition was completely normal with the mildly raised liver enzymes as the only abnormal finding.", "age": [ [ 3.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3083330.xml", "relevant_articles": { "16927859": "0", "12549795": "123", "25755474": "0", "12586238": "0", "23999958": "0" }, "similar_patients": { "3083330-2": "123", "3743144-1": "0", "6524007-1": "0", "5578537-1": "0", "3781627-1": "0" } }, { "human_patient_id": "291", "human_patient_uid": "3083330-2-M", "PMID": "21477313", "title": "Cholestasis in patients with Cockayne syndrome and suggested modified criteria for clinical diagnosis", "patient": "Patient (2) was the older brother of patient (1). He died after a prolonged attack of jaundice at the age of 2 years before patient (1) presented to our clinic. According to the parents' history and the available reports, the patient had growth failure, similar characteristic features to his sister, delayed physical and mental milestones, microcephaly, cutaneous photosensitivity and cataract. Fundus examination showed pigmentary retinopathy.", "age": [ [ 2.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3083330.xml", "relevant_articles": { "11784950": "12", "31056581": "12", "2079835": "0", "17486591": "12", "20523833": "0" }, "similar_patients": { "3083330-4": "12", "3174128-1": "0", "5552663-1": "1", "4617320-2": "1", "6180451-1": "0" } }, { "human_patient_id": "292", "human_patient_uid": "3083330-3-M", "PMID": "21477313", "title": "Cholestasis in patients with Cockayne syndrome and suggested modified criteria for clinical diagnosis", "patient": "Patient (3) is a 4 years old boy, the third in order of birth of first cousin marriage. He presented to the hepatology clinic with jaundice following an attack of vomiting and diarrhea. He had a similar attack at the age of two years that regressed spontaneously.\nOn examination the patient had progressive neurologic dysfunction, his height was 95 cm (-2 SD), weight was 13 kg (-3 SD) and skull circumference was 43 cm. He had characteristic physical appearance with enophthalmia, nystagmus, jaundice, and skin photosensitivity. His liver was 4 cm below the costal margin, firm in consistency with rounded border and smooth surface. The spleen was felt two cm below the costal margin. Neurological examination showed intention tremors, cerebellar ataxia, lost knee and preserved ankle deep reflexes. Chest and heart examination were clinically free.\nInvestigations at that time revealed ALT: 270 IU/L (N: 37), AST: 232 IU/L (N: 40) GGT: 183 (N: 50), total bilirubin: 3.35 mg/dl, direct bilirubin: 2.6 mg/dl, albumin: 3.2 g/dl, PT 11.7 sec. (INR: 1). Tests for HBV, HCV, and HAV revealed negative results. Ceruloplasmin level, protein electrophoresis and auto antibodies were also normal.\nAbdominal ultrasonography revealed enlarged liver with regular border, homogenous echopatteren, patent portal and hepatic veins. Fundus examination showed no abnormality. CT brain was normal, while MRI brain showed deep white matter signal alteration at the forceps minor and major regions, middle cerebellar peduncles, the posterior segmental aspects of the pontine isthmus and basis pontis. Those areas exhibited bright signal on FLAIR and T2W1, a picture consistent with dysmyelinating disease.\nThe patient received ursodeoxycholic acid at a dose of 20 mg/kg/day and vitamin E (100 mg/day). Two months later, ALT decreased to 83 IU/L, AST decreased to 95 IU/L, total bilirubin was: 1.7 mg/dl, direct bilirubin: 0.7 mg/dl, albumin: 3.2 g/dl, and PT 11.3 seconds.\nSix months later, the patient had another similar attack that was also precipitated by viral infection and was associated with increased tremors, ataxia and inability to walk. He received the same treatment with excellent response and complete recovery of liver functions, and improvement of ataxia, and tremors.", "age": [ [ 4.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3083330.xml", "relevant_articles": { "8079944": "12", "28326205": "0", "27821033": "0", "12586238": "0", "26521193": "0" }, "similar_patients": { "3083330-1": "123", "3915726-1": "123", "4821986-1": "12", "2628021-1": "0", "5578537-1": "0" } }, { "human_patient_id": "293", "human_patient_uid": "3083330-4-M", "PMID": "21477313", "title": "Cholestasis in patients with Cockayne syndrome and suggested modified criteria for clinical diagnosis", "patient": "Patient (5) is a one month old boy, the second in order of birth of first cousin marriage. He presented to the genetics clinic with microcephaly (skull circumference: 31 cm), small anterior fontanel, deep seated eyes, polydactyly of both hands and left foot. CT brain was normal. His older sister Patient (6): According to the parents' history and the medical reports, she had progressive neurological dysfunction, skin photosensitivity, microcephaly, enophthalmos, nystagmus, cataract, and spasticity of both lower limbs. Fundus examination revealed pigmentary retinopathy and CT brain showed calcification of basal ganglia. She developed jaundice after anaesthesia for cataract extraction at the age of 10 years and died soon after the operation as a result of hepatocellular failure.", "age": [ [ 1.0, "month" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3083330.xml", "relevant_articles": { "11140418": "0", "17975563": "1", "31692622": "13", "32550208": "0", "18925673": "0" }, "similar_patients": { "3174128-1": "0", "3083330-5": "1", "3083330-2": "1", "7802219-1": "0", "8143271-1": "0" } }, { "human_patient_id": "294", "human_patient_uid": "3083330-5-M", "PMID": "21477313", "title": "Cholestasis in patients with Cockayne syndrome and suggested modified criteria for clinical diagnosis", "patient": "Patient (7) is a 16 year old girl, the second in order of birth of first cousin marriage. She presented to the genetics clinic with severe growth retardation, progressive intellectual deterioration, deep seated eyes, bilateral cataract, and cerebellar ataxia. Her weight was 12.5 Kg (< 4SD), length was 120 cm (she could not stand), and skull circumference was 49.8 cm. Her abdominal examination revealed no organomegaly but her ALT was mildly elevated (46 IU/L, normal: 40). Nerve conduction velocity showed axonal neuropathic disease and audiometry showed moderate sensorineural hearing loss.", "age": [ [ 16.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3083330.xml", "relevant_articles": { "1300261": "1", "32532879": "1", "30287592": "0", "20414074": "12", "29710020": "0" }, "similar_patients": { "3083330-6": "1", "3083330-1": "1", "3083330-4": "1", "3083330-7": "1", "3083330-2": "1" } }, { "human_patient_id": "295", "human_patient_uid": "3083330-6-M", "PMID": "21477313", "title": "Cholestasis in patients with Cockayne syndrome and suggested modified criteria for clinical diagnosis", "patient": "Patient (8): is a 6 year old boy, the brother of patient (7). His height was 110 cm (< 4SD), his weight was 11.5 Kg (< 4SD) and skull circumference was 44 cm. He had the same characteristic physical features of his older sister with cataract and cerebellar ataxia. Abdominal examination revealed enlarged liver (palpable 4 cm below the costal margin). His chest and heart examination were clinically free.\nAbdominal ultrasound showed mildly enlarged liver with normal spleen. ALT was 135 IU/L (normal = 40), AST was 126 IU/L (normal = 37) and GGT was 85 U/L (normal = 50). Nerve conduction velocity showed axonal neuropathic disease and audiometery showed moderate sensorineural hearing loss.", "age": [ [ 6.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3083330.xml", "relevant_articles": { "25826795": "0", "26908705": "0", "19337171": "0", "32105028": "0", "33322867": "0" }, "similar_patients": { "3083330-7": "1", "3083330-5": "1", "3083330-2": "1", "3083330-1": "1", "6322173-1": "1" } }, { "human_patient_id": "296", "human_patient_uid": "3083330-7-M", "PMID": "21477313", "title": "Cholestasis in patients with Cockayne syndrome and suggested modified criteria for clinical diagnosis", "patient": "Patient (9): is a 2.5 year old girl, the youngest sister of patient (7 and 8). Her height was 90 cm and her weight was 8.5 Kg and skull circumference was 42 cm. She had bilateral cataract that was extracted at the age of 1.5 years and cerebellar ataxia. Abdominal examination revealed mildly enlarged liver which was palpable 2 cm below the costal margin. Her chest and heart examination were clinically free. Abdominal ultrasound showed no abnormalities apart from the mildly enlarged liver. ALT was 101 IU/L (normal = 40), AST was 49 IU/L (normal = 37) and GGT was 27 U/L (normal = 50). Although bilirubin level in this family was normal, GGT was mildly increased in patient (8). Table and demonstrates patient clinical criteria and laboratory investigations at time of presentation.", "age": [ [ 2.5, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3083330.xml", "relevant_articles": { "24027253": "0", "20814261": "0", "24360992": "2", "12586238": "0", "28700759": "2" }, "similar_patients": { "3083330-6": "1", "3083330-2": "1", "3083330-1": "1", "6322173-1": "1", "5578537-1": "0" } }, { "human_patient_id": "297", "human_patient_uid": "4372768-1-M", "PMID": "25800594", "title": "Insufficiency of Bone Scintigraphy in Vertebral Lesions of Langerhans Cell Histiocytosis Compared to F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and Diagnostic Computed Tomography", "patient": "Seventeen year old boy with mass lesion in the right neck and weight loss attended to the hospital. He had a family history of malignancy in his sister. He had bilateral exophtalmos, cervical lymphadenopathy approximately 3 cm in diameter, icterus and ulcers in the scalp in physical examination.\nComputed Tomography\nThe computed tomography images were obtained by a 64 channel multidetector CT device (Aquilion 64, Toshiba Medical Systems, Japan) with intravenous contrast medium administration and with slice thickness of 0.5 mm. The images were reconstructed in axial, coronal and sagittal planes and interpreted in soft tissue and bone windows.\nComputed tomography examination revealed multiple cervical, anterior mediastinal conglomerated lymph nodes and bilateral pulmonary nodules. Additionally lytic lesions in the corpus of T7, T10 and destruction of T2 vertebra by a soft tissue mass were reported in the diagnostic CT ().\nBone Scintigraphy\nThe bone scintigraphy was performed by a double head single photon emission tomography (SPECT) gamma camera (GE, Infinia II, Israel) equipped with low energy high resolution parallel hole collimator. After intravenous administration of 20 mCi (740 MBq) (according to the body weight) Tc-99m methylene diphosphonate (MDP) and waiting period of 2-3 hours, routine whole body, and additional spot images were obtained. Asymmetrical increased tracer accumulation in unexpected sites without history of previous trauma or surgery was accepted as disease extent.\nBone scintigraphy showed multiple increased activity in predominantly cranium, bilateral ribs and pelvic region () however, there was no sign of vertebral involvement; neither decreased nor increased activity accumulation.\nPET/CT Imaging\nThe patient fasted for 12 hours before PET/CT examination and his blood glucose concentration was 124 mg/dL. Imaging was performed by a PET/CT scanner (Siemens Biograph, 6 slice spiral CT integrated PET/CT, Siemens Medical System) after injection of 10 mCi (370 MBq) 18F-FDG and 60 minutes waiting interval. CT was performed from head to thigh with a slice thickness of 5.0 mm. For semi-quantitative assessment, regions of interests (ROIs) were produced. The maximum SUV (SUVmax) value was measured from ROI according to the standard formula. PET and CT datasets and fusion images were interpreted by an experienced nuclear medicine physician.\nIn the PET/CT images there were multiple hypermetabolic areas bilaterally in cervical region, mediastinal, abdominal and pelvic lymph nodes, anterior mediastinal mass () and in all the bone lesions identified in bone scintigraphy and CT , ). Additionally orbital involvement of the LCH is observed as increased FDG accumulation in the left orbita and the soft tissue component in CT (). Excisional biopsy of cervical lymph node revealed Langerhans cell histiocytosis. In the biopsy specimen there were atypical histiocytes infiltrating the whole lymph node, giant cells and microabcesses were present. Immunohistochemical analysis revealed positivity of CD3, CD8, CD5, CD20, CD15, CD68, S-100, Vimentin, LCA and CD1a and negativity of CD10, Pan CK, EMA, Fascin, CD38 and CD138.", "age": [ [ 17.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4372768.xml", "relevant_articles": { "21342722": "0", "21914229": "2", "21969781": "0", "33771130": "0", "23886160": "0" }, "similar_patients": { "3109824-1": "12", "3590935-1": "0", "3475922-1": "0", "3957972-1": "0", "4479915-1": "0" } }, { "human_patient_id": "298", "human_patient_uid": "6755105-1-M", "PMID": "31558980", "title": "Gallbladder cancer harboring ERBB2 mutation on the primary and metastatic site: A case report", "patient": "The patient was a previously healthy 73-year-old female who underwent curative resection for GBC (pT2N0M0 according to the eighth International union against cancer TNM classification). We performed next-generation sequencing (NGS)-based genomic profiling of the resected specimen using the NGS gene panel, Oncomine\u00ae Comprehensive Assay version 3 (OCA v.3, Thermo Fisher Scientific), which revealed ERBB2 Ser310Phe (c.929C>T; VAF, 18%) and TP53 Ser241Tyr (c.722C>A; VAF, 19%) mutations. One year later, a hepatic lesion was observed on follow-up imaging and she underwent surgical total biopsy for a pathological diagnosis.\nA patient had no symptoms and was in good health at the time of total biopsy.\nThe patient had no previous medical history.\nThe patient\u2019s physical examination was not remarkable and laboratory testing was within normal limits, including tumor markers, such as CA19-9 and CEA.\nContrasted computed tomography (CT) showed an ill-defined low attenuation lesion in the posterior lobe of the liver (Figure ).\nThe hepatic lesion was histologically diagnosed as well-differentiated adenocarcinoma and the histological findings of the hepatic lesion were similar to those of GBC (Figure ). Therefore, the lesion was considered a metastasis. Moreover, we performed genomic profiling from the liver tumor using the NGS panel, Oncomine\u00ae Target Test system (OTT, Thermo Fisher Scientific). This revealed ERBB2 Ser310Phe (c.929C>T; VAF, 26%), which was identical to the mutation detected in the sequencing result of the primary site; thus, the liver tumor was the most consistent with a metastasis of GBC rather than localized ICC. To evaluate HER2 overexpression in tumor cells, we performed immunohistochemistry of HER2, which was negative (HER2 score 0). Since TP53 was not included in the gene list of OTTs, TP53 mutation status at the metastatic site was not assessed.\nThe final diagnosis of the presented case is hepatic recurrence of GBC.\nAfter the total biopsy of liver metastasis, she was treated with two standard chemotherapy regimens, namely gemcitabine and cisplatin, and TS-1; however, her disease did not obtain clinical benefit from these treatments. After six months from hepatic resection, she was confirmed to have a progressive disease during second-line chemotherapy. At that time, she had liver and pulmonary recurrence, as well as pulmonary and inferior vena cava tumor embolism, which caused tachycardia and peripheral edema.\nConsidering no standard treatment beyond second-line for GBC, we treated the patient with lapatinib with a combination of capecitabine (lapatinib at a dose of 1250 mg per day continuously plus capecitabine at a dose of 2000 mg per square meter of body-surface area on days 1 through 14 of a 21 d cycle) based on the accumulating preclinical and clinical evidence that tumors with ERBB2 mutation benefit from HER2-targeted treatment.\nWithin a week of treatment, she experienced major subjective clinical improvement, which included resolution of peripheral edema. After 2 cycles of treatment, contrasted CT imaging showed a decrease in the size of tumor emboli and hepatic lesions (Figure ). However, after 4 cycles of treatment, the patient discontinued treatment due to grade 3 mucositis. Mucositis was gradually subsided over two weeks after discontinuation of the treatment. One month after discontinuation, her disease progressed, and she chose best supportive care.", "age": [ [ 73.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC006xxxxxx/PMC6755105.xml", "relevant_articles": { "31558980": "123", "18430248": "0", "24423963": "0", "15868082": "0", "26805079": "0" }, "similar_patients": { "6095987-1": "0", "6139108-1": "13", "7310851-1": "0", "8553255-1": "0", "5318308-1": "0" } }, { "human_patient_id": "299", "human_patient_uid": "4069803-1-M", "PMID": "25009755", "title": "Spindle cell carcinoma of the breast as complex cystic lesion: a case report", "patient": "A 54-year-old woman presented to her personal physician and complained the pain on her right breast. She underwent a breast surgery in our hospital. The patient and her family\u2019s medical histories were unremarkable.\nThe patient was 157 cm tall and weighed 53 kg. Physical examination of the right breast (area C) revealed an elastic hard mass measuring 2.5 cm \u00d7 2.5 cm. Margins were distinct, with relatively good mobility and a tumor-nipple distance of 3.2 cm. No axillary or cervical lymph nodes were palpable. Hematological and biochemical blood test results were normal. The levels of tumor markers, such as carcinoembryonic antigen, carbohydrate antigen 15-3, and National Cancer Center-Stomach-439, were within normal limits.\nMammography revealed an indistinct margined hyper dense mass in the right outer portion, which was assessed as Breast Imaging-Reporting and Data System category 4C (: MLO view, : CC view). Breast ultrasonography (US) revealed complex cystic lesion, and the tumor was large with 2.5 cm diameter (). Complex cystic lesion on US with blood content on fine-needle aspiration (FNA) cytology revealed malignant cells. Preoperative magnetic resonance imaging (MRI) findings and a T2 weight image revealed an early enhancement image with no intraductal spread (). No distant metastases was identified on computed tomography or bone scan. The tumor stage was T2N0M0. Breast-conserving surgery and sentinel lymph node biopsy were performed.\nThe results exposed two sentinel lymph nodes and no malignant cell. The tumor measured 2.0 cm in diameter and contained a central cystic area (,). Histopathological examination showed low papillary growth in the cystic cavity surface, which was covered by adenocarcinomatous components associated with some squamous metaplasia. Most of the lesions comprising the cyst wall were a mixture of irregular bundles of spindle-shaped tumor cells and fibrous connective tissue proliferation. The tumor was diagnosed as spindle cell ().\nImmunostaining of spindle-shaped tumor cells showed positive results for cytokeratin (AE1/AE3) and vimentin (,), partially positive results for s-100, and negative results for desmin and \u03b1-actin. The final histopathological diagnosis was spindle cell carcinoma. Histological grade from malignancy was grade III. Lymphatic invasion was negative, whereas blood vessel invasion was positive. Lymph node metastasis was negative, and p-stage I was diagnosed. Estrogen receptor, progesterone receptor, and human epidermal growth factor receptor type 2 (HER2), which showed negative results by biochemical tests, were called triple negative type in subtype classification. The postoperative course was uneventful. The patient received six courses of FEC-100 chemotherapy. Radiotherapy included simultaneous integrated boost enforced 60 Gy (2 Gy/day) to the residual breast tissue. After 24 months of postoperation, no recurrence has been detected.", "age": [ [ 54.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4069803.xml", "relevant_articles": { "25009755": "123", "25731380": "123", "27278481": "0", "28133050": "0", "31076887": "0" }, "similar_patients": { "3804141-1": "0", "5781267-1": "0", "7803857-1": "123", "6510746-1": "0", "3976087-1": "0" } }, { "human_patient_id": "300", "human_patient_uid": "8257329-1-M", "PMID": "34258079", "title": "A Calcifying Odontogenic Cyst Associated with Compound Odontoma Mimicking a Tooth Germ", "patient": "A 10-year-old male patient was referred to orthodontic traction of an impacted right lower first molar (tooth 46). During clinical examination, no alteration was noted except the absence of tooth 46. No abnormalities were detected in previous medical history. A cone-beam computed tomography (CBCT) showed the presence of a radiolucent image measuring <1 cm located between teeth 46 and 48, which was initially interpreted as a dental germ (). The patient was submitted to surgery under local anesthesia to achieve tooth crown exposure and bonding of an orthodontic device to traction of its right lower first molar. Six months after the procedure, in a routine panoramic radiograph during orthodontic treatment, a well-defined radiolucent image with radiopaque foci was identified in the region of the suggestive dental germ. Additionally, an increasing volume with cortical expansion and fenestration was observed in a CBCT investigation ().\nThereby, a provisional diagnostic hypothesis of odontogenic lesions was made, suggesting adenomatoid odontogenic tumor and COC. The chosen clinical conduct was the surgical enucleation of the lesion. A straight incision was made in the alveolar ridge with flap detachment to facilitate access to the lesion, and an aspiration puncture was performed revealing a liquid content (). During surgery, the lesion was completely detached from the mandibular bone, allowing visualization of a capsule with a cystic aspect (). The specimen was sent for histopathologic examination, and the microscopic findings revealed a cystic cavity lined by a thin odontogenic epithelium with ameloblastomatous features. Ghost cells and calcification foci were also observed. Furthermore, the formation of dentinoid matrix, immature enamel, and fibrous connective tissue was noticed. Therefore, the diagnosis of COC associated with odontoma was established (Figures and 3(b)). One year later, no signs of recurrence were observed and a CBCT revealed new bone formation in the region (). Currently, the patient is undergoing clinical and radiographic follow-up with pediatric dentistry specialists and orthodontists for adequate establishment of occlusal dynamics.", "age": [ [ 10.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC008xxxxxx/PMC8257329.xml", "relevant_articles": { "32026295": "123", "34258079": "123", "23633233": "123", "23633234": "123", "34790338": "123" }, "similar_patients": { "8235957-1": "0", "3972410-1": "123", "3703681-1": "13", "5005522-1": "123", "6889737-1": "123" } }, { "human_patient_id": "301", "human_patient_uid": "7868820-1-M", "PMID": "33757266", "title": "A case report of primary isolated extrahepatic hydatid cyst of the soft tissues of the breast and thigh", "patient": "A 32 year-old woman from a rural area, presented to the general surgery clinic with mild and continuous pain in the lateral aspect of her left thigh. Concomitantly, she was complaining of gradually increasing swelling in the lateral aspect of her left thigh for about 1\u202fyear duration. Family history and drug history was unremarkable. On examination, there was a round, non-tender, non-mobile mass in the lateral aspect of her left thigh. There was no overlying skin changes, ultrasound (US) showed 15cm\u202f\u00d7\u202f5cm solid-cystic lesion in the lateral aspect of the left thigh with multiple well-defined cystic lesions. Magnetic Resonance Imaging (MRI) showed a relative large multisystem lesion in the lateral aspect of the thigh with connection to the femoral bone, in favor of hydatid cyst (1 and 2). Chest X-ray and abdominal ultrasound excluded lung and liver HDs. ELISA test of Echinococcus Granulosa titer test was negative. A primary muscular Hydatid cyst was diagnosed and a pericystectomy was chosen as the preferred surgical treatment. Treatment involved 400\u202fmg of Albendazole twice per day for 10 days before and three months after surgery. The longitudinal incision (pericystectomy) was performed under spinal anesthesia in the anterolateral aspect of the left thigh (3). Cyst cavity was thoroughly irrigated with hypertonic saline and wound closed after putting a drain (3). The surgery has been carried out under the supervision of an attending general surgeon. Histopathological diagnosis confirmed the diagnosis of Hydatid Disease. The postoperative course of the patient was favorable. As Albendazole (400\u202fmg twice per day) started 10 days before surgery, it was continued for three month after surgery and there was no evidence of recurrence of the lesion during the 8 month follow-up.", "age": [ [ 32.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7868820.xml", "relevant_articles": { "33757266": "123", "30121397": "123", "22468070": "123", "28292371": "123", "29255673": "123" }, "similar_patients": { "3777318-1": "123", "7231815-1": "123", "3391869-1": "123", "3505896-1": "123", "4334633-1": "123" } }, { "human_patient_id": "302", "human_patient_uid": "7868820-2-M", "PMID": "33757266", "title": "A case report of primary isolated extrahepatic hydatid cyst of the soft tissues of the breast and thigh", "patient": "A 31\u202fyear-old housewife presented with a gradually progressive, painless lump in the left axillary tail of Spence since two years. There was no history of injury, no discharge from the nipple, and no family history of breast cancer. She did not provide a history of close contact with any animal. Examination revealed a firm lump measuring 5cm\u202f\u00d7\u202f5cm, non-mobile, in the left axillary tail of Spence. The rest of the left breast and nipple were normal. Collaborative ultrasonography study of the breasts revealed a thick walled cystic lesion with floating membranes and internal echoes in the region (1). The chest X-ray and ultrasonography of the abdomen of the patient were unremarkable. The patient underwent surgery for the removal of the lump. The surgery was performed by attending general surgeon and after general anesthesia a curvilinear incision in hair line margin, the cyst was removed in-toto. The excised cyst was oval in shape and measured 5\u202fcm\u202f\u00d7\u202f4.5\u202fcm\u202f\u00d7\u202f3\u202fcm. When the cyst was opened, endocysts were found confirming it to be a hydatid cyst (2). Albendazole (400\u202fmg twice per day) was continued and control imaging was performed. \u202fThere was no evidence of recurrence of the lesion during the 1\u202fyear follow-up.", "age": [ [ 31.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7868820.xml", "relevant_articles": { "33757266": "123", "24049840": "123", "30069219": "123", "11023090": "1", "22112739": "123" }, "similar_patients": { "7868820-1": "123", "4871477-1": "123", "4707791-1": "123", "5649819-1": "0", "5507569-1": "123" } }, { "human_patient_id": "303", "human_patient_uid": "7671876-1-M", "PMID": "33986210", "title": "Multiple Joint Osteonecrosis in a Patient on Long-term Intranasal Corticosteroids", "patient": "A 58-year-old female patient presented to the outpatient clinic complaining of a gradual onset of constant left knee pain of a 9-week duration after several visits to her primary care provider as well as an orthopaedic surgeon without improvement. No history of trauma was noted, and her pain was localized to the medial and anterior aspects of the knee. On examination, the patient walked with antalgic gait. Localized medial tenderness was elicited. No swelling nor signs of internal derangement were noted. She was able to extend to 0\u00b0 and flex to 135\u00b0. Knee radiographs were negative with maintained joint space and without evidence of fracture or notable osteoarthritis (Figure , A). The patient was presumed to have mild degenerative joint disease; therefore, she was prescribed naproxen and was sent to physical therapy for 4 weeks. On the follow-up, the pain did not improve, and she started to complain of similar pain affecting her right knee. MRI of the left knee was done that showed a large area of acute bone marrow edema with abnormal signal intensity in the medial tibial plateau measuring 6.5 \u00d7 5.2 cm, suggestive of insufficiency fracture (Figure , A and B). The knee was placed in a hinged brace, and the patient started to use a walker for protected weight-bearing. Medial history and medications were reviewed. She had hypothyroidism, hypertension, depression, and allergic rhinitis. Her medication included levothyroxine, escitalopram, hydrochlorothiazide, and intranasal corticosteroids (fluticasone propionate [Flonase] two puffs each nostril twice a day) for several years. She never smoked and often drank 1 to 2 glasses of wine a day.\nBecause of persistent pain of the right knee, MRI of the right knee was done that showed similar findings but more extensive compared to the left knee with partial collapse of the medial tibial plateau (Figure , C and D). A linear T2-hyperintense signal was identified in the medical and lateral meniscus as well but without definite articular surface tear. At that time, hip radiographs were done that showed no evidence of ON, and new knee radiographs showed bilateral subchondral sclerotic lesions, with collapse of the medial tibial plateau more severe in the right knee (Figure , B). She was treated conservatively with ibuprofen, gabapentin, diphosphonate (alendronate 70 mg once a week), and physical therapy. At 8 weeks of follow-up, her knee pain had become less intense, but she started to experience disabling pain in her left ankle. Ankle radiographs were negative. She was thought to have L5/S1 left radiculopathy; therefore, she underwent left L5/S1 transforaminal epidural steroid injection under fluoroscopy, which did not provide any benefit. Because of continuing pain, MRI of the left ankle was done that showed extensive ON involving the talus and navicular bones (Figure ). The patient received additional tests including connective tissue disease workup (complete blood count, erythrocyte sedimentation rate, C-reactive protein, urine analysis, serum creatinine, rheumatoid factor, antinuclear antibody, antidouble stranded DNA, lupus anticoagulant, and anticardiolipin antibodies), coagulation profile (prothrombin time, international normalized ratio, activated partial thromboplastin time, and fibrinogen), and thrombophilia workup (antithrombin, protein C, protein S, factor V Leiden, and factor VIII) to exclude underlying diseases that were negative.\nFollow-up knee radiographs showed progressive collapse of the medial tibial plateau with varus malalignment and secondary osteoarthritis bilaterally. The disease progressed to stage IV according to the Ficat and Arlet classification (Figure ) over 2 years. Staged bilateral total knee arthroplasty (TKA) was performed because of progressively worsening knee pain recalcitrant to conservative treatment (Figure ). Bone histopathology confirmed bone ON. The patient recovered well after TKA, with great improvement of pain and function at the 6-month follow-up. The mean knee injury and osteoarthritis outcome score (KOOS) pain scale improved from 38 before surgery to 83. Similarly, the mean KOOS function in daily living (ADL) scale improved from 37 before surgery to 85. The patient achieved an active range of knee motion from 0 to 128\u00b0 of flexion, with no extension lag. The left ankle was treated conservatively with solid ankle-foot orthosis to provide some comfort and to postpone the ankle surgery until she recovers from the TKA. The ankle ON progressed with talar collapse and secondary degenerative arthritis of the tibiotalar and subtalar joints (Figure ).", "age": [ [ 58.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7671876.xml", "relevant_articles": { "16881469": "12", "29779992": "123", "34141659": "13", "33986210": "123", "19995425": "12" }, "similar_patients": { "5521898-1": "123", "6709310-1": "12", "8316786-1": "12", "3486995-1": "123", "5245953-1": "12" } }, { "human_patient_id": "304", "human_patient_uid": "7772864-1-M", "PMID": "33442349", "title": "Endoscopic Diagnosis of Bouveret Syndrome", "patient": "An 82-year-old female patient was admitted to our emergency department because of hematemesis with a high-grade suspicion of upper gastrointestinal bleeding. Laboratory analysis revealed decreased hemoglobin (7.6 g/dL) and elevated infection signs (leukocyte count 27 \u00d7 109/L, C-reactive protein 15 mg/dL). Initial physical examination was notable for a soft abdomen with diffuse tenderness but without voluntary guarding. Due to beginning septic shock with increasing hemodynamic instability and loss of vigilance, the patient was referred to our intensive care unit. After need for intubation, a gastroscopy was performed. There was no endoscopic evidence for an upper gastrointestinal bleeding. However, endoscopy showed spontaneous penetration of the gallbladder (shown in Fig. ) and revealed plenty gallstones in the duodenal bulb (shown in Fig. ). Subsequent computed tomography confirmed the endoscopic findings demonstrating chronic cholecystitis with pneumobilia and gallbladder penetration in the duodenal bulb with entry of gallstones in the intestine (shown in Fig. ). Further, it revealed a reflective intestinal atony and a dilated stomach filled with contrast medium. Based on the endoscopic and CT scan findings, Bouveret syndrome due to penetration of gallstones in the duodenal bulb was diagnosed. On account of chronic cholecystitis and sepsis, open cholecystectomy and gallstone salvage from the duodenum were performed. Biliary enteric fistula was not found during surgery. Patient could be discharged after several days from the hospital.", "age": [ [ 82.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC007xxxxxx/PMC7772864.xml", "relevant_articles": { "33468893": "1", "16010248": "123", "21092262": "123", "32354592": "0", "16258210": "0" }, "similar_patients": { "7239796-1": "123", "2997099-1": "123", "7812896-1": "1", "4531617-1": "123", "8606037-1": "123" } }, { "human_patient_id": "305", "human_patient_uid": "7488399-1-M", "PMID": "32917164", "title": "Laparoscopic monolateral suspension for vaginal vault prolapse: a report of an exit surgical strategy during sacralcolpopexy", "patient": "We present the case of a 75-year-old woman who underwent a laparoscopic monolateral suspension for vaginal vault prolapse. The patient was a Caucasian woman in good general health with two previous spontaneous deliveries and a vaginal hysterectomy for uterine prolapse in 2001.\nShe was admitted to our hospital with a diagnosis of a recurrence of stage 4 of vaginal vault prolapse following the Pelvic Organ Prolapse Quantification (POP-Q) System, without stress urinary incontinence. The main symptoms she reported were a sense of weight and vaginal pressure. Considering the anamnesis, pelvic examination, clinical symptoms, and recurrence of pelvic organ prolapse, the surgical procedure chosen was a laparoscopic sacral colpopexy. The patient received adequate information on the surgical technique via laparoscopic access and, in case needed, via laparotomic or vaginal access.\nA consent form was provided and signed. During surgery, the parietal peritoneum was opened at the level of the sacral promontory with subsequent incision of the presacral fascia and identification of the longitudinal ligament. After the visualization of the right ureter and homolateral hypogastric inferior right nerve [], we performed a recto-vaginal dissection toward the perineal and anorectal junction together with dissection of the vesicovaginal space until the endopelvic fascia.\nIn our surgical practice, a 30 \u00d7 30 cm polypropylene mesh (Restorelle XL- Coloplast A/S, 3050 Denmark) with a single arm is used. Before its insertion in the abdominal cavity, the mesh is tailored only in the portion that will be anchored to the vaginal and rectal space, while the other end is left intact in its length and subsequently tailored after its attachment to the sacral promontory.\nAfter the mesh was anchored on the vesical-vaginal space with 12 interrupted sutures (Ethibond 3\u20130 needle), multiple attempts to fix the mesh to the sacral promontory were tried firstly with an Ethibond 0 needle and then with non-absorbable helicoidal clips (5 mm CapSure\u2013Permanent fixation System. Davol Inc. Subsidiary of C.R. Bard, Inc. 100 Crossings Boulevard Warwick, RI 02886 USA) but any attempt to penetrate the site was unsuccessful (Fig. ). Considering that the mesh was already fixed to the anterior and posterior vaginal compartment, we intraoperatively decided to convert the procedure into a modified laparoscopic lateral suspension (LLS) with a monolateral right mesh, on the basis of the original technique described by Dubuisson et al., where a V-shaped mesh is used []. We carried out a retroperitoneal tunnel using laparoscopic forceps through the right lateral access under transperitoneal visualization, putting in tension and fixing the mesh to the Camper fascia with two interrupted sutures, using an Ethibond 2\u20130 needle.\nAt the end of the procedure, the vaginal vault was well suspended (Fig. ). This strategy was possible because the sacral portion of the mesh was not shaped before its fixation to the sacral promontory and was long enough to allow its anchorage to the right lateral Camper fascia.\nDuring the post-operative recovery, we performed a 3D reconstruction CT scan to evaluate the sacrum which detected an exuberant osteophytic bridge at the level of the anterior right margin of L5 and S1 that protruded for 17 mm (Figs. and ).\nThe patient was discharged after 3 postoperative days with no post-surgical complication. At the follow-up visit, scheduled at 6 months after surgery, the vaginal vault was well suspended, with no signs of genital prolapse. The patient reported clinical well-being, without pelvic pressure or sensation of a vaginal bulge.", "age": [ [ 75.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7488399.xml", "relevant_articles": { "32917164": "123", "15770518": "13", "15082210": "13", "23001368": "1", "26867700": "1" }, "similar_patients": { "3112326-1": "123", "6135159-1": "123", "7812039-1": "123", "7455420-1": "123", "7292113-1": "123" } }, { "human_patient_id": "306", "human_patient_uid": "3793568-1-M", "PMID": "24124313", "title": "Surgical treatment of odontogenic myxoma and facial deformity in the same procedure", "patient": "A 25-year-old female patient was referred to our department with a chronic headache. Patient's first diagnosis hypothesis was sinusitis and she had previously been referred to an otolaryngologist. Waters\u2019 radiograph was performed, which demonstrated a limited radiopacity area into the right maxillary sinus. The patient's medical history was unremarkable. On physical examination, the patient was healthy, without swelling. The mucosa overlying the area of the lesion was the same color and texture as the surrounding mucosa. The sensory examination of the maxillary branch of the trigeminal nerve was normal bilaterally. Furthermore, she had aesthetic concerns about her high smile. Facial and cephalometrical examination revealed an excessively facial height and an excessive incisal and gingival display upon smiling. She was diagnosed with vertical maxillary excess and Class I malocclusion []. Initially, the patient was treated for third molar extraction 7 years ago; in this panoramic radiograph, was observed a discrete radiopacity area in the left maxillary sinus. It was probably an early stage of the lesion.\nA biopsy was taken with a Caldwell-Luc approach; histological result show abundant myxoid stroma with collagen fibrils presenting a diagnosis of OM.\nThe treatment planned was Le Fort I osteotomy with down-fracture to remove the tumor with segmental maxillectomy and 5 mm superior maxillary repositioning for better occlusion and facial esthetic.\nSurgery was performed under general anesthesia and nasal endotracheal intubation. Pre-orthognathic surgical models, radiographs, computed tomography face, photographs and biomodels were obtained before the surgery []. When the maxilla was down fractured, the tumor mass was visualized in the right maxillary sinus with four teeth involved in the lesion, which were removed. After the segmental maxillectomy, maxillary segment was stabilized with plate and screw in the anterior area on the right side and fixation on the anterior and posterior maxillary buttress on the left side. No intermaxillary fixation was used and it was not necessary turbinectomy.\nThe 3 years follow-up show satisfaction for the occlusal and esthetic result and the patient is disease-free []. A removable dental prosthesis without functional or aesthetic compromise is used [].", "age": [ [ 25.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC003xxxxxx/PMC3793568.xml", "relevant_articles": { "28980543": "0", "30581648": "123", "21924752": "0", "29283942": "123", "31901268": "0" }, "similar_patients": { "3141126-1": "0", "3399355-1": "0", "8116081-1": "0", "4327542-1": "0", "7016482-1": "0" } }, { "human_patient_id": "307", "human_patient_uid": "8249151-1-M", "PMID": "34258097", "title": "A Case of Hypersexuality in a Patient Receiving Aripiprazole for Schizophrenia", "patient": "The patient was a 24-year-old male with a past psychiatric history of schizophrenia who was seen in the outpatient clinic due to hypersexuality after starting aripiprazole. The patient had no known health problems. He had no history of head trauma, seizures, sexually transmitted disease, or significant substance abuse problems. He was first diagnosed with schizophrenia at the age of 19 years and was started on olanzapine, which he responded well to for years. The patient was living with his mother and had completed 11th grade level education. He did not have any history of developmental or intellectual difficulties. He was working part time in a fast food restaurant when he started to have the decline. He was single, never married, and had no significant other. The patient did not have very many acquaintances and led a quiet life. He has no known legal issues so far. The patient used cannabis occasionally when he was 17, but denied any use now. He did not have any problems with alcohol and or other illicit substances. He did not have any history of tobacco use. There was no known family history of mental illness.\nThe patient was previously stable on olanzapine 20 mg/day for four years and then became noncompliant due to unclear reasons, leading to worsening of psychotic symptoms. He was switched to oral aripiprazole 15 mg/day with a plan to switch to a long-acting injectable due to possible nonadherence. During the initial oral one-week trial, the patient became increasingly unstable, with physical and verbal altercations with his mother. The patient also ran away from home and lost his job due to public masturbation at his workplace. His mother also noticed that the patient was increasingly flirtatious and inappropriate in public with females, which were behaviors he had never displayed previously. Given his worsening behaviors, the patient was admitted to the inpatient unit and was switched to intramuscular injection (IM) of aripiprazole 400 mg, assuming that he would benefit from a long-acting injectable and that he could be non-adherent with the oral medication. He became increasingly sexually aroused and was acting inappropriate in the days following. During the hospital stay, there was an instance where he had sex with a female peer and had to be placed on 1 : 1 observation, i.e., one staff was assigned to continuously observe the patient. After discharge from the hospital, the patient needed constant reminders in his group home to keep his hands out of his pants. Despite these attempts to reduce the inappropriate behavior, the patient endorsed that his sexual arousal was more than normal after starting the aripiprazole. At this point in time, the patient had received two doses of aripiprazole 400 mg IM. While on aripiprazole, he did not show any gambling urges and or other impulsivity other than the sexual preoccupations. The sexual preoccupations started within a week of starting with aripiprazole. Further aripiprazole injections were discontinued, and the patient was again prescribed olanzapine 20 mg/day given his previous good response. In the group home, the patient continued to remain occasionally agitated with outbursts and required constant redirection about appropriate sexual behaviors in public. He also continued to display sexually inappropriate behaviors towards females in a day program and was banned from attending the program until he was able to behave appropriately. Although he had reduction in the intense sexual behaviors four weeks after stopping the aripiprazole injections, he did not completely return to baseline. Given his ongoing sexually inappropriateness and possible reports of being internally stimulated, he was started on paliperidone 6 mg/day for augmentation and with plan to taper and stop olanzapine. The patient started to have fewer outbursts and was noted to be in much better mood after three to four weeks of starting the paliperidone. He was noted to be less sexually preoccupied and with reduction in inappropriate behaviors in public. When writing this report, the patient was on both olanzapine 20 mg/day and paliperidone 6 mg/day, with the goal of attaining paliperidone monotherapy, initially oral and subsequently long-acting injections. The patient continued to live in the group home to learn social skills before moving into independent housing. After 12 weeks of paliperidone use, the patient was completely free from hypersexual thoughts and behaviors.", "age": [ [ 24.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC008xxxxxx/PMC8249151.xml", "relevant_articles": { "30323602": "123", "17119107": "13", "26923999": "123", "28953839": "0", "12033473": "0" }, "similar_patients": { "8705137-1": "123", "7212450-1": "123", "8339295-1": "12", "7929663-1": "12", "8144290-2": "12" } }, { "human_patient_id": "308", "human_patient_uid": "8570985-1-M", "PMID": "34754694", "title": "A Case of Cytomegalovirus Encephalitis in Cluster of Differentiation Four Cell Counts Greater Than 50", "patient": "A 36-year-old Hispanic male with no past medical history presented to the emergency department (ED) with shortness of breath (SOB), initially with exertion and then also at rest. For three days prior to the arrival, the patient reported decreased oral intake and dry cough, but otherwise, the review of systems was negative. On arrival, vital signs were 103/66 mmHg, 120 beats per minute, initially saturating 77% on room air, but improved on 10-L non-rebreather mask.\nOn examination, he was tall, thin, in acute respiratory distress using accessory muscles to breathe, and with decreased breath sounds throughout all lung fields. Initial labs were remarkable for hyponatremia (128 mEq/L), a corrected anion gap of 13, with arterial blood gas indicative of primary metabolic acidosis with mixed respiratory alkalosis, acute kidney injury (Cr of 1.10 mg/dL), normocytic anemia (Hbg of 11.7 gm/dL, mean corpuscular volume [MCV] of 84 fL), and elevated inflammatory markers (D-dimer of 2.04 mcg/mL FEU, ferritin >1,000 ng/mL, lactate dehydrogenase of 814 units/L, creatinine kinase of 140 unit/L, and C-reactive protein [CRP] of 108 mg/L). Electrocardiogram revealed sinus tachycardia at a rate of 110, without ST or T wave abnormalities. Chest x-ray (Figure ) demonstrated hazy pan-lobar infiltrates concerning atypical pneumonia. The patient underwent computerized tomography (CT) angiogram (Figure ) to rule out pulmonary embolism, which revealed extensive interstitial infiltrates with consolidation, especially in the posterior right upper lobe and right lower lobe.\nInitial hospital course\nAdmission labs for respiratory viral panel, influenza, procalcitonin, and COVID PCR were all negative. The patient was treated with convalescent plasma, Remdesevir, Decadron 6 mg IV daily, and vitamin C and zinc supplementation. On day 2, a repeat COVID-19 PCR was negative, and the patient remained dependent on a 4-L nasal cannula. The hyponatremia and tachycardia resolved with adequate oral hydration. Sputum cultures grew Gram-positive cocci in clusters, and the patient was started on Doxycycline 100 mg twice daily, intravenous (IV) Vancomycin 1 gram twice daily, and intravenous Zosyn 3.375 mg thrice daily for broad-spectrum coverage. At this stage, the patient\u2019s imaging and clinical signs were concerning for Pneumocystis jirovecii (PCP). The patient reported unprotected receptive same-sex intercourse but denied a history of illicit drug use or transfusions in the past. The patient then revealed that he was diagnosed with HIV seven years ago. HIV was positive, and IV Bactrim 360 mg thrice daily and oral Prednisone 40 mg twice daily were started for PCP treatment. Bactrim was changed to Atovaquone oral 750 mg twice daily because of acute renal failure. Sputum cultures were positive for methicillin-susceptible Staphylococcus aureus (MSSA) pneumonia, and ceftriaxone 1 gram IV daily was continued. Azithromycin was initiated for Mycobacterium avium complex (MAC) prophylaxis. It was discontinued when the CD4 count returned as 145/mcL, with a viral load of 5,882,600 copies/mL.\nEvents following the diagnosis of HIV\nBy hospital day 4, the patient became more emotionally labile, appeared very anxious, and was tachycardic again. Depression screening was positive; however, the patient refused medical therapy at that time. He remained dependent on a 2-L nasal cannula at rest but became hypoxic (80%) on ambulation. Acid-fast bacilli were negative. Rapid plasma reagin (RPR) was positive. Fluorescent treponemal antibodies (FTAs) were sent, which returned positive. Syphilis was treated with intramuscular (IM) Benzathine Penicillin G. The patient never underwent bronchoscopy as there was enough clinical evidence to suggest PCP. By hospital day 7, a rapid response was called for an unwitnessed fall. The patient was actively hallucinating and agitated, stating that \u201ca car hit me and that\u2019s why I fell.\u201d A CT of the brain without contrast was negative for acute pathology, and he was transferred to the Neurology floor for further monitoring. Overnight, the patient continued to be agitated and was noted to have seizure-like activity in the bed. In the early morning, the patient was still experiencing visual and auditory hallucinations, was combative with house staff, and was requiring four-point restraints and intramuscular medications.\nWorkup for altered mental status\nThe main concern at this stage was a Jarisch Herxheimer reaction; however, other differentials at that time included neurosyphilis, metabolic encephalopathy secondary to hyponatremia, toxic encephalopathy from worsening PCP infection versus other viral or bacterial encephalitides, given HIV status. Magnetic resonance imaging (MRI) was performed, showing diffuse atrophy with non-specific enhancements (Figure ). He underwent an electroencephalogram (EEG), which revealed moderate diffuse encephalopathy without active seizures. Thyroid function tests were within normal limits, and a urine drug screen was negative. His transient altered mental status resolved within approximately 12 hours, and the patient was taken off of restraints. He was unable to recall any of the events over the last day and a half. The patient underwent a lumbar puncture (colorless, clear, RBC 91 mm3, WBC 9 mm3, non-xanthochrome, Glu 62 mg/dL, protein 36 mg/dL), and cerebrospinal fluid (CSF) was negative for toxoplasmosis, cryptococcus, CSF acid-fast bacilli, and CSF fungal culture. Silver stain cytology from an induced sputum culture was significant for bland appearing squamous cells and scattered pulmonary macrophages, without evidence of malignancy or PCP. The remainder of the workup resulted in a positive serum EBV and a positive CSF CMV, with a viral load of 12,400. The working diagnosis was CMV encephalitis in the setting of HIV-AIDS with a CD4 count of 145. The patient was started on IV foscarnet 6,500 mg twice daily and ganciclovir 365 mg twice daily. He completed a 21-day course of steroids with a taper as well as treatment for PCP. He also received IV penicillin G of four million units six times a day for two weeks. He clinically improved with decreasing oxygen requirements and was able to ambulate on room air. The patient was medically optimized for discharge with a plan for outpatient anti-retroviral treatment (Bictegravir 50 mg/Emtricitabine 200 mg/Tenofovir 25 mg) and further monitoring of his HIV-AIDS, suspected neurosyphilis, EBV, and CMV.", "age": [ [ 36.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC008xxxxxx/PMC8570985.xml", "relevant_articles": { "21675505": "0", "34246387": "0", "27159517": "0", "32765916": "123", "15336585": "123" }, "similar_patients": { "8349278-1": "123", "7032602-1": "0", "7772041-1": "13", "4528890-1": "0", "7500727-1": "0" } }, { "human_patient_id": "309", "human_patient_uid": "5566695-1-M", "PMID": "28868298", "title": "Case Report of Spontaneous Remission of Biopsy-Proven Idiopathic Immune Complex-Mediated Membranoproliferative Glomerulonephritis", "patient": "The patient is a 53-year-old woman, a registered nurse, who presented to the emergency department with a chief complaint of weakness, headache, and blurry vision. She reported a 15-pound weight loss over the past 4 months, which she attributed to nausea, anorexia, and intermittent vomiting. Serum chemistries revealed blood urea nitrogen (BUN) of 36 mg/dL and serum creatinine of 3.3 mg/dL. Electrolytes were normal as were her liver function tests. Complete blood count was normal and eosinophilia was absent. Initial urinalysis contained 3+ blood, 4+ protein, 32 RBC/HPF, 7 WBC/HPF, numerous hyaline casts, and no red blood cell casts. Renal ultrasonography demonstrated normal-size kidneys with increased echogenicity and no hydronephrosis.\nTwelve months prior to admission, chemistries revealed a BUN of 25 mg/dL and serum creatinine of 0.9 mg/dL, and 18 months prior to admission, BUN was 23 mg/dL with a serum creatinine of 1.0 mg/dL.\nHer past medical history included hypertension treated for the past 4 years with bisoprolol plus hydrochlorothiazide (Ziac). She had a history of pseudotumor cerebri treated with acetazolamide (Diamox). She was diagnosed with hyperlipidemia, but was not on treatment. Four years prior to admission, she underwent laparoscopic hysterectomy and sacrocolpopexy and colpoperineorrhaphy and cystoscopy. The surgery included use of RestorelleTM mesh and repair of a rectocele and enterocele. As a young adult, she underwent tonsillectomy and adenoidectomy and was involved in a motor vehicle accident with fracture of her left leg. The patient's maternal grandfather had diabetes, both parents have hypertension, and her one adult daughter is alive and well. She has no siblings. There was no history of autoimmune disease, glomerulonephritis, or chronic renal failure among her relatives. The patient had no history of international travel.\nReview of system was negative for fever, chills, or night sweats. She experienced occasional palpitations and nonexertional chest pain. She described the chest pain as \u201cacid reflux\u201d and wondered if this caused her nausea and vomiting as well. She denied diarrhea, melena, and hematemesis. She noted trace edema and occasional foamy urine on and off for the past 6 months but no flank pain, dysuria, or visible hematuria. She denied neurologic symptoms, specifically no headache, vision changes, ataxia, or incontinence. She denied dry eyes, dry mouth, joint swelling, skin rashes, sun sensitivity, easy bruising, pleuritic pain, cough, or hemoptysis.\nOn physical examination, she was a well-appearing woman of Anglo-European heritage. Neurologic examination was normal. Cardiac examination revealed normal S1 and S2 and no murmur. Pulmonary examination showed clear lungs. Abdomen was benign without guarding and no bruits. No lymphadenopathy was present. She had no joint effusions or signs of arthritis. Lower extremities edema was only 1+ bilaterally.\nDuring her hospital course, her bisoprolol and hydrochlorothiazide were discontinued and her hypertension was treated with carvedilol and amlodipine. She received intravenous fluids, but serum creatinine did not change. A 24-h urine collection contained a total volume of 1,450 mL, a total urine protein of 8,764 mg per 24 h, and total urine creatinine of 1,145 mg. Urine creatinine concentration was 79 mg/dL, with a serum creatinine of 3.5 mg/dL; thus, measured creatinine clearance was 22 mL/min.\nA renal biopsy was performed and revealed a MPGN pattern. Double contours and suspected subendothelial deposits were appreciated on light microscopy. No thrombi, necrosis, or crescents were present. There was mild diffuse mononuclear cell interstitial infiltration and tubulitis noted. The interstitium had mild fibrosis. There was mild intimal thickening of the small arteries. Electron microscopy confirmed electron-dense subendothelial deposits without substructure. Since no glomeruli were present in the specimen submitted for immunofluorescence, a pronase antigen retrieval technique was used on sections prepared from the paraffin block. It revealed granular capillary wall staining with 2\u20133+ IgG, 2\u20133+ C1q, and 2\u20133+ kappa light chain and 1\u20132+ lambda light chain positivity. There was trace IgM and no IgA staining (Fig. , , ).\nThe patient was discharged home on carvedilol and lisinopril in lieu of the amlodipine. Before she was able to return to the renal clinic, she was readmitted 1 week after discharge for intractable nausea and vomiting. Admission blood pressure was 206/110. This was attributed to her inability to take her antihypertensive medications. Despite this, her serum creatinine improved to 3.1 mg/dL with BUN 22 mg/dL. Albumin level remained 3.4 g/dL. Urinalysis documented 3+ blood and 4+ protein as on her prior admission with numerous hyaline and granular casts per low power field. A 24-h urine collection contained a total volume of 875 mL and total urine creatinine of 744 mg. The urine creatinine concentration was 85 mg/dL. Total urine protein was 4,148 mg per 24 h. At the time of the 24-h collection, her serum creatinine was 3.7 mg/dL and creatinine clearance was 18 mL/min. Upper endoscopy demonstrated gastritis. Biopsies of the esophagus and duodenum were normal. Helicobacter pylori testing was negative. She was treated with an aggressive regimen of sucralfate, proton pump inhibitor, and H2 blocker.\nUpon return to the clinic, 1 month after the biopsy, her blood pressure was reasonably controlled on lisinopril and carvedilol. Bone density was obtained and was normal. 25-hydroxyvitamin D was low at 19 ng/mL and ergocalciferol was started. By this time, a serologic search for an associated systemic disease included negative ANA, anti-double stranded DNA, HIV 1\u20132, anti-GBM, anti-neutrophil cytoplasmic antibodies (ELISA), and rheumatoid factor. The sedimentation rate was elevated at 75 mm/h, and repeat measurement was 111 mm/h. Complement levels were unremarkable with C3 120 mg/dL and C4 slightly high at 41 mg/dL. Serum protein immunoelectrophoresis demonstrated normal IgA, low IgG (287 mg/dL), low IgM (38 mg/dL), and no monoclonal spike. Urine protein immunoelectrophoresis was without monoclonal spike, and the kappa/lambda light chain ratio was 3.28 (normal 2.04\u201310.37). Hemoglobin A1c level returned at 5.8%. Treatment with antacids, Lisinopril, and carvedilol was continued, and she was instructed to start prednisone 60 mg daily.\nEight weeks after the biopsy, the patient was evaluated at a tertiary care center. She reported taking 3 doses of prednisone but stopped it completely after an episode of visible hematuria. Lisinopril was changed to irbesartan due to persistent dry cough. Laboratory values at this time included a 24-h urine collection with a total volume of 950 mL, total urine creatinine of 950 mg, and urine creatinine concentration of 100 mg/dL. Total urine protein was 2,812 mg per 24 h. A separate random urine sample for protein to creatinine ratio was 1.67 (239/143). Anti-scl-70 was negative. She was counseled to not restart prednisone.\nBy week 12, her blood pressure was moderately controlled at 150/90. Because of cost, irbesartan was discontinued and losartan 100 mg daily was started. Chlorthalidone 25 mg daily was added for her blood pressure control. Atorvastatin 40 mg once a day was started for hyperlipidemia. She continued on carvedilol and antacids. Examination revealed no edema.\nAt her tertiary clinic visit 44 weeks after the biopsy, she reported feeling well and examination revealed blood pressure of 106/70 and no edema. Laboratory testing in the clinic included serum creatinine 1.6 mg/dL, BUN 25 mg/dL, serum albumin 4.5 g/dL, and a protein to creatinine ratio of 0.06. Urinalysis registered trace blood and no protein. One week prior to this visit, micro-albumin assay contained 7.4 mg/g (normal <15 mg/g), and the protein to creatinine ratio was 0.06.\nTertiary clinic visit 82 weeks after the biopsy demonstrated well-controlled blood pressure of 117/85. Urinalysis was negative for blood, protein, cells, and casts. Remission was sustained at 92 weeks with stable serum creatinine at 1.2 mg/dL, normal serum albumin, and inactive urinalysis without proteinuria.\nHer serial serum creatinine, serum albumin, and urine protein to creatinine ratio values are listed in Table .", "age": [ [ 53.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5566695.xml", "relevant_articles": { "30504296": "0", "9198366": "123", "17128886": "123", "8570441": "0", "30504295": "0" }, "similar_patients": { "5968240-1": "123", "6647130-1": "123", "4964690-1": "123", "3712889-1": "123", "5733935-1": "13" } }, { "human_patient_id": "310", "human_patient_uid": "5465274-1-M", "PMID": "28649221", "title": "NOTCH 1 Mutation in a Patient with Spontaneous and Recurrent Dissections of Extracranial Arteries", "patient": "The patient is a 44-year-old female, with a medical history of migraines, mild arterial hypertension, and a left vertebral artery dissection in 2014, without brain infarction (Figures and ). She was using losartan and aspirin daily. The patient suffers from recurrent headaches related to the first 3 days of her menstruation cycle. Her 75-year-old mother was diagnosed with a thoracic aortic aneurysm 10 years previously.\nIn September 2016, she presented with oppressive headache with left predominance, photophobia and nausea, lasting for 6 days. The intensity of the pain was 8 out of 10 on a visual analog scale (VAS). She also complained of cervical discomfort. A computed tomography angiography (CTA) showed left internal carotid artery dissection extended between the upper cervical and supraclinoid segments (Figures and ). No ischemic brain damage was observed. Therefore, she was admitted to the emergency department, and aspirin orally was administered in doses of 250 mg at bed time. There were no focal neurological signs on physical examination. The patient had good spatial\u2013temporal orientation and was afebrile.\nWe attributed the headache to both the left internal carotid artery dissection and the migraine. There was an insufficient response to a combination of ketoprofen and metamizole i.v. Thus, intravenous betamethasone was added to the treatment regimen to provide a rescue medication for the refractory pain. However, the patient showed only a partial response after a 3-day course. She was then prescribed oral topiramate 50 mg two times a day as preventive therapy and naproxen sodium 550 mg as acute treatment option.\nOne week later, a new CTA was performed and showed no changes compared to the previous imaging.\nApart from hypertension and migraine, we did not identify other putative risk factors for dissections of extracranial arteries such as recent respiratory tract infection and hyperhomocysteinemia. There was no history of major or minor cervical trauma, chiropractic maneuver, or hyperextension injury. Infectious-inflammatory pathology of the paranasal sinuses was excluded with a computed tomography. The patient did not have signs of either hypermobility or dermic lesions. A dermatologist ruled out connective tissue disorders. Renal fibromuscular dysplasia was ruled out using non-invasive imaging duplex ultrasound. Transthoracic echocardiography revealed no abnormalities such as congenital heart defects and left ventricular outflow tract malformations. A computed tomographic scanning and aortography ruled out aortic aneurysm.\nTo determine the possible nature of this recurrent dissection, an aortopathy comprehensive panel was ordered with sequence analysis and exonic deletion/duplication testing of 25 genes (ACTA2, CBS, COL3A1, COL5A1, COL5A2, EFEMP2, FBN1, FBN2, FLNA; MAT2A, MED12, MYH12, MYH11, MYLK, NOTCH1, PLOD1, PRKG1, SKI, SLCA10, SMAD3, SMAD4, SMAD6, TGFB2, TGFB3, TGBR1, TGFBR2). This test is a comprehensive analysis of genes associated with inherited aortopathy and connective tissue disorders. We ordered it because of the antecedent of maternal thoracic aortic aneurysm (INVITAE, San Francisco, CA, USA; ).\nA heterozygous variant was identified in the NOTCH 1 gene (exon 34, c.6365C>T). This sequence replaces proline with leucine at codon 2122 of the NOTCH 1 protein (p.Pro2122Leu). Her mother was also tested, and she was positive for this variant in heterozygous state.\nThe patient was discharged without focal neurologic deficit with a National Institutes of Health Stroke Scale (NIHSS) of 0 (0\u201342). After 6 months, she was on aspirin 100 mg and topiramate 100 mg per day, remained with NIHSS 0 and was able to return to normal activities. There was a reduction in the headache days to about 1 day/month and in the headache severity (VAS = 2).", "age": [ [ 44.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5465274.xml", "relevant_articles": { "33876248": "12", "33603914": "123", "32026963": "123", "16619839": "12", "9206703": "12" }, "similar_patients": { "5715517-1": "0", "7327611-1": "1", "7544419-1": "0", "7073314-1": "0", "6417066-1": "0" } }, { "human_patient_id": "311", "human_patient_uid": "4084793-1-M", "PMID": "25002906", "title": "Necrotizing fasciitis in a young patient with acute myeloid leukemia \u2013 a diagnostic challenge", "patient": "A 30-year-old woman from Saudi-Arabia was admitted to our department of internal medicine with the strong suspicion of first manifestation of acute myeloid leukemia. Laboratory testing showed mild anemia and thrombocytopenia with normal leukocyte count. The differential blood cell count, however, showed 47% leukemic blasts. A bone marrow biopsy was performed immediately. With approximately 90% blasts the diagnosis of acute myeloid leukemia (AML) was confirmed. Flow cytometry showed an expression of CD34, HLA-DR, CD38 and cyMPO. A cross-lineage of CD56 was found, which correlates with a poor prognosis []. Cytogenetics and molecular analysis of the bone marrow cells revealed an ETV6-gen deletion in 12p13. According to the hematologic protocol intensive induction chemotherapy with HAM (high-dose Ara-C and Mitoxantron) was immediately initiated.\nOn day 8 after admission (2 days after the first cycle of chemotherapy was finished) the patient developed neutropenic fever up to a temperature of 39.4\u00b0C. The first laboratory testing showed a decrease in leukocytes down to 0.4 G/l with a C-reactive protein (CRP) less than 0.1 mg/dl. Escherichia coli with an extended-spectrum beta-lactamase (ESBL) was isolated from initially taken blood cultures, whereas all other clinical and diagnostic examinations (x-ray of the chest, urine, echocardiography and ultrasonography) were normal. Empirical broad-spectrum antibiotics was immediately initiated with Piperacillin/Tazobactam and switched to Meropenem after microbiologic testing confirmed ESBL sepsis. On that first day of fever, the patient told us, that she fell in the bathroom hurting her right knee two days before (day 6 after admission). There was no apparent injury on her leg. On further clinical examination, besides fever, her vital signs were always normal. In the course of the next 2 days neutrophils dropped below 0.1 G/l and CRP levels soared to a peak of 29.9 mg/dl. Highest procalcitonin level (PCT) measured was 1.7 ng/ml. Three days after the patient suffered from the minor injury to her lateral thigh, she suddenly presented a small hematoma with only little pain (day 9 after admission). There were no signs of superinfection of the hematoma explaining the clinical and laboratory signs of this unclear systemic infection. On that day, the patient was first presented to the surgical department. Within the next two days, the hematoma rapidly changed to a big untypical necrosis of the skin (day 11 after admission, see Figure ). Therefore, the patient was again presented to the surgical department. The patient was still in a good general condition with only little pain. A CT scan was initiated and showed entrapped air under the site of necrosis. Although the skin manifestation was not typical for a necrotizing soft tissue lesion, we considered the possibility of an untypical case of NF during severe neutropenia. Therefore, a surgical exploration was performed immediately (see Figure ). Macroscopically, subcutaneous tissue, fascia and muscle showed the typical characteristics of necrotizing fasciitis with grey necrotic tissue, facial edema, vessel thrombosis and non-contacting muscle. Intraoperative, there was only minimal resistance dissecting the subcutaneous fascia off the deep fascia, which is commonly described as positive \u201cfinger test\u201d []. The histological findings showed facial necrosis, vasculitis, thrombosis and suppuration of the veins and arteries coursing through the fascia. But, there were no signs of disease-causing bacteria or infiltration of polymorphonuclear leukocytes in the deep dermis and fascia as expected. First microbiological testing did not find any bacteria. The initial histopathological report could not confirm the typical picture of necrotizing fasciitis (see Figure ). In the further course of time, intensive care medicine was needed. After confirmation of adequate morphologic blast clearance in the bone marrow supportive treatment with granulocyte colony stimulating factor (G-CSF) was added on day 18 (after start of chemotherapy). Neutrophils eventually recovered on day 23 (>500/\u03bcl). After beginning to recover, histopathological analyses of additional specimen of surgical resections showed the expected typical pathological findings like inflammatory cells and bacteria. Furthermore, microbiological testing confirmed ESBL infection. A multiplicity of operations with extended debridement was performed in order to eradicate the infection using negative pressure wound therapy. After successful eradication the skin defect involved the complete lateral thigh including nearly the whole circumference of the lower leg. In the further course of time, the immense skin defects had to be prepared for further reconstructive surgery. Reconstructive surgery with mesh graft harvest was complicated by the limited residual skin available on the lower extremity and the delay on wound healing of the harvest sites. Due to unfavorable cytogenetics and the complicated course of treatment our patient was assigned to undergo allogeneic stem cell transplantation in first remission. But, the transplantation was only possible with wounds totally closed. It took another six surgical interventions and nearly eight months to finally close all wounds (see Figure ). After further recovery the patient underwent allogeneic stem cell transplantation as planned. Today, she is doing well and there is no evidence of disease.", "age": [ [ 30.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4084793.xml", "relevant_articles": { "25002906": "123", "23439752": "123", "29642157": "123", "19642531": "123", "9495377": "13" }, "similar_patients": { "8714340-1": "123", "4515430-1": "123", "3514080-1": "123", "3514080-2": "123", "6078673-1": "123" } }, { "human_patient_id": "312", "human_patient_uid": "7854425-1-M", "PMID": "32809062", "title": "Conservative management of abnormally invasive placenta complicated by local hyperfibrinolysis and beginning disseminated intravascular coagulation", "patient": "A healthy 37 year old IV gravida II para came to our hospital in 22 + 6 weeks of pregnancy for a second opinion with suspected placenta percreta. She has had two prior caesarean sections (the first one due to breech presentation, the second one planned repeated) and one early abortion followed by curettage. In ultrasound, the placenta praevia totalis of the anterior uterine wall showed distinct signs of placenta percreta with suspected bladder invasion. No myometrium between placenta and bladder and very irregular patterns of perfusion were observed, such as large lacunas and bridging vessels in the interface (Figs. and ). The MRI confirmed the suspected placenta percreta with no valid signs of invading other organs. She was counseled in detail about the serious risks of this diagnosis. Termination of the pregnancy was not an option for our patient. She had the urgent wish to preserve fertility due to unfinished family planning with a new partner. Segmental excision (if possible) or leaving the placenta in situ was planned. For the case of emergency, we also had her consent for hysterectomy, though. At 34 + 5 weeks of gestation, she presented with preterm contractions, secondary caesarean section through a fundal uterine incision after amniotic drainage and exteriorization of the gravid uterus [] was performed in combined neuraxial anesthesia and general anesthesia after birth without complications. Due to high risk of intraoperative bleeding, an arterial line and two 16 G peripheral vein cannulas were placed. Additionally, red blood cell concentrates as well as fresh frozen plasma were provided in theatre and cell savage, and norepinephrine was prepared in case of massive bleeding. Prophylactic tranexamic acid was applied continuously in a dosage of 15 mg/kg/bw during surgery without complications. A healthy boy of 2800 g, Apgar 8/8/8, NapH 7.31 was delivered, estimated blood loss was 500 ml. Due to extensive size of at least 10 \u00d7 8 cm of the percrete area, the placenta was left in situ. No transfusions of blood or hemostatic products were necessary and no further postpartum hemorrhage occurred.\nThe postoperative course remained without complications. She received an antibiotic prophylaxis with metronidazole and cefuroxime, regular blood tests for inflammation parameters and cervical swabs for bacteria were taken and showed no signs of infection, no vaginal hemorrhage occurred. She was discharged into ambulant care on day seven; weekly check-ups for infection and the antibiotic prophylaxis (400 mg of metronidazole two times a day, 500 mg of cefuroxime three times a day, oral application) were continued. Matching the antibiogram of bacteria from cervical swabs, the antibiotic therapy was changed to amoxicillin in the further course.\nOn day 54, she presented with vaginal bleeding. Blood tests still showed no signs of infection, in ultrasound, the placenta was in situ with reduced perfusion.\nThe different treatment options were discussed; embolism of the uterine arteries, hysterectomy vs. segmental uterine resection (if possible) or expectant management. On ultrasound examination, the uterus and also the percrete area presented significantly smaller, a surgical approach with uterine preservation (if possible) was planned. The preoperative blood work-up showed a reduced Quick value of 41%, increased d-dimere levels > 20 mg/l (normal range < 0.5 mg/l) and reduced fibrinogen levels of 0.59 g/l (normal range 1.6\u20134 g/l), so that 1 g of tranexamic acid was administered preoperatively. The hemoglobin level was 13.6 g/dl. Segmental uterine resection was performed and the uterus could be reconstructed. The bladder was not invaded as suspected in ultrasound, but surgical preparation and separation of the bladder wall from placental tissue resulted in a small bladder wall lesion which had to repaired (Figs. and ).\nRight from the beginning of the surgery, a diffuse bleeding tendency was observed. The thromboelastometric analysis (ROTEM\u00ae, TEM International, Munich, Germany) at the beginning of surgery showed a prolonged clotting time (CT: 126 s (46\u201383 s)) as well as reduced amplitudes of the fibrinogen related clot formation at different time points [A5: 3 (5\u201330) mm; A10: 4 (6\u201321) mm; A20: 4 (6\u201321) mm; A30: 4 (6\u201321) mm] in the FIBTEM\u00ae Test (Fig. ). These results are in line with the reduced fibrinogen levels of the preoperative blood work-up. Furthermore, the INTEM\u00ae and EXTEM\u00ae analysis with prolonged clot formation times [CFT INTEM\u00ae: 151 (62\u2013130) s; CFT EXTEM\u00ae: 178 (46\u2013149) s.], the reduced clotting amplitudes at all time points (A5\u2013A30; Fig. ) as well as the reduced Quick value of 41% in the preoperative blood work-up indicate an impaired coagulation due to fibrinogen consumption and a beginning DIC with a concomitant consumption of clotting factors (Fig. ) []. Hyperfibrinolysis could not be detected; TXA had been administered before, though (Fig. ). Nevertheless, an increased d-dimere level > 20 mg/l in the preoperative blood work-up suggests a sign of initially increased local hyperfibrinolysis before TXA was given. In consideration of the thromboelastometric analysis and the results of the blood work-up accompanied with ongoing intraoperative bleeding, two red blood cell concentrates (RBC) at a further decreasing hemoglobin level of 6.8 g/dl, three fresh frozen plasma units (FFP), prothrombin complex concentrate (PSSB, 1800 IE), 4 g of fibrinogen and tranexamic acid [15 mg/kg body weight (bw)] were administered until the bleeding could be controlled. A continuous application of norepinephrine in a dosage up to 0.2 \u03bcg/kg bw/min was temporally necessary for hemodynamic stabilization. Estimated blood loss was 3500 ml.\nAfter surgery, the patient was admitted to the intensive care unit for 24 h without any signs of recurrent bleeding or cardiorespiratory limitations. Coagulation parameters had already normalized 8 h after the operation (Quick value 87%, fibrinogen 2.41 g/l) and the hemoglobin levels remained stable (around 8 g/dl). On day seven, the cystogram showed no persistent bladder lesion, the catheter could be removed. The patient was discharged on the seventh postoperative day (day 62 postpartum) in good health condition. Due to segmental resection of the uterine wall, we did not recommend a pregnancy for the next two years.", "age": [ [ 37.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7854425.xml", "relevant_articles": { "32809062": "123", "30012037": "12", "17845337": "0", "19335802": "123", "29673673": "13" }, "similar_patients": { "5747084-1": "12", "6942409-1": "0", "4270707-1": "123", "5935985-1": "0", "7713836-1": "123" } }, { "human_patient_id": "313", "human_patient_uid": "3524240-1-M", "PMID": "23251253", "title": "Percutaneous vertebroplasty for Langerhans cell histiocytosis of the lumbar spine in an adult: Case report and review of the literature", "patient": "The 51-year-old male patient exhibited a 10-day history of low back pain, limited waist motion and right lower limb numbness. The patient reported no pain at other sites, exhibited no fever or night sweats and was unable to recall any recent injury. The patient\u2019s past medical history was unremarkable for trauma or other bone diseases. A physical examination demonstrated localized tenderness and percussion pain over the L4 spinous process, restricted waist motion and numbness of the right leg. Laboratory tests, including full blood cell count, serum electrolytes, renal and liver function tests, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), did not reveal any abnormalities. An X-ray revealed that the lesion was limited to the left lateral mass of the atlas, causing a potential instability (). Computed tomography (CT) revealed an osteolytic lesion in the right lateral mass of the L4 and accessories, accompanied by a paravertebral and intraspinal soft tissue extension (). Magnetic resonance imaging (MRI) revealed osteolytic destruction of the vertebral body associated with a mild compression fracture that exhibited hypointensity on T1-weighted (T1-W) images and hyperintensity on T2-weighted (T2-W) images (). On the basis of the radiological features of the lesion, there was a high possibility that the patient had a neoplastic lesion. However, the radiological features of the lesion were not sufficient to establish the diagnosis of LCH with certainty. A C-arm X-ray machine-guided needle biopsy of the vertebral body was performed and the histopathological diagnosis was LCH. Immunohistochemical staining was positive for CD1a and S-100 (). Further diagnostic evaluation included a bone scan, CT of the lungs, pituitary hormonal evaluation and brain CT and abdominal ultrasound evaluation. No other LCH infiltration was identified in the patient and the patient was treated as suffering from a single-system and single-site disease.\nThe patient underwent PVP (Stryker, Inc., Meyzieu, France) under local anesthesia in the prone position with the belly suspended in midair, under C-arm imaging guidance (). The amount of bone cement used to fill in the L4 was 3.6 ml. The blood loss during surgery was 5 ml. The spread of the cement was ideal with the exception of a small amount of paravertebral leakage of cement () which did not cause any symptoms. No complications were observed during the surgery or follow-up. After lying in bed for 6 h, the patient was able to sit freely and 24 h postoperatively, the patient was allowed to walk freely. Following the procedure, the low back pain was resolved completely and the patient\u2019s neurological symptoms were rapidly alleviated and then gradually continued to be alleviated. The patient required the use of a weak opioid prior to the PVP but did not receive an analgesic afterwards. Notably, CT revealed a significant decrease in the paravertebral and intraspinal soft tissue extension 5 days after the PVP ().\nThe patient received chemotherapy following PVP. The chemotherapy regime was 100 mg etoposide (days 1\u20133) and 60, 40 and 20 mg prednisone (days 1\u20137, 8\u201314 and 15\u201321, respectively) for 3 cycles. There were no serious side-effects of the chemotherapy. CT revealed that the paravertebral and intraspinal soft tissue extension disappeared after 3 cycles (). The height of the vertebral body remained stable without further collapse and lumbar kyphosis did not occur. There was no recurrence and no other complaints over a 6-month follow-up period ().", "age": [ [ 51.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3524240.xml", "relevant_articles": { "34169013": "123", "22097128": "0", "23218644": "123", "27073564": "0", "24161363": "123" }, "similar_patients": { "4994818-1": "123", "8046439-1": "123", "7811251-1": "0", "6393136-1": "123", "6735185-1": "13" } }, { "human_patient_id": "314", "human_patient_uid": "6015999-1-M", "PMID": "29942728", "title": "A Rare Case of Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia", "patient": "We present the case of a white, Hispanic, 58-year-old, non-smoker female. She has a past medical history of obstructive sleep apnea and chronic obstructive pulmonary disease (chronic bronchitis). Her travel history includes the Dominican Republic and Caribbean Islands. She worked for several years in an automobile repair shop and was exposed to lead and paint. Her current occupation is as a telephone operator in a call center, which requires her to speak continually.\nFifteen years ago, she developed a progressive cough. During the following four years, she was evaluated by more than eight pulmonologists who were unable to make a diagnosis. She developed a productive cough with white sputum and blood titer. Her alpha-1-antitrypsin serum, perinuclear anti-neutrophil cytoplasmic antibody (P-ANCA), cytoplasmic antineutrophil cytoplasmic antibody (C-ANCA), and rheumatoid factor were all within normal limits. Her purified protein derivative (PPD) and fungal infection tests were negative. Lung function tests revealed an obstructive pattern. Her forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) was 70% and total lung capacity (TLC) was 72%. A computed tomography (CT) scan showed mild ground glass infiltrates in the lung bases (Figure ).\nFinally, in December 2011, a lung biopsy via assisted thoracoscopic surgery (VATS) was performed, and she was diagnosed with constrictive bronchiolitis and diffuse idiopathic neuroendocrine cell hyperplasia with carcinoid tumorlets. She was treated with octreotide; however, the treatment was interrupted several times due to issues with insurance and difficulties visiting the medical center. Her treatment was restarted in our hospital after three years in May 2014. Since then, CT scans taken every six months show a stable disease. She currently has a stable radiographic disease with no new complaints during the over two years of follow-up.", "age": [ [ 58.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6015999.xml", "relevant_articles": { "17086001": "0", "15974215": "12", "9742863": "0", "10526946": "0", "33391903": "0" }, "similar_patients": { "4554223-1": "0", "4904559-1": "0", "5124667-1": "0", "6813980-1": "0", "5078134-1": "0" } }, { "human_patient_id": "315", "human_patient_uid": "5872675-1-M", "PMID": "29725546", "title": "Emergency Valve-in-Valve Transcatheter Aortic Valve Implantation for the Treatment of Acute Stentless Bioprosthetic Aortic Insufficiency and Cardiogenic Shock", "patient": "The patient is a 72-year-old female with a history of diabetes mellitus, hypertension, and bicuspid aortic valve status post aortic valve and root replacement using a 23 mm Freestyle (Medtronic, Minneapolis, MN) aortic valve and root bioprosthesis implanted by root inclusion method 12 years prior to admission. She was transferred from an outside hospital with acute-onset chest pain and shortness of breath. She denied fever and chills. Physical examination was notable for blood pressure 100/30 mmHg and hypoxia. Grade 3/6 systolic and diastolic murmurs were heard at the right 2nd intercostal space. Subsequently, she developed pulmonary edema and shock necessitating mechanical ventilation and vasopressor support. A transthoracic echocardiogram suggested flail aortic valve leaflet (), and transaortic Doppler signal was suggestive of wide-open aortic regurgitation ().\nDue to rapid deterioration of the patient, the heart team was immediately organized. Two cardiac surgeons deemed her unsuitable for redo surgical aortic valve replacement (Society of Thoracic Surgeons predicted operative mortality >50%). Therefore, valve-in-valve TAVI was considered. After review of the operative report and manufacturer product information, the inner diameter of the Freestyle valve was confirmed to be 20 mm. A 23 mm S3 valve (Edwards Lifesciences, Irvine, CA) was selected. Images from a remote contrast-enhanced CT scan suggested absence of peripheral arterial calcification and adequate caliber of iliofemoral arteries for large-bore sheath insertion.\nTransesophageal echocardiography (TEE) was used to guide the procedure. The etiology of valve deterioration was confirmed to be leaflet flail; no vegetations were identified. Arterial and venous access was obtained followed by placement of a transvenous pacemaker. Aortography was performed (), followed by insertion of a 14 F \u00d7 36 cm E sheath (Edwards Lifesciences, Irvine, CA). The 23 mm S3 valve was implanted during rapid pacing, using nominal inflation volume (). Of note, wide pulse pressure was observed even during pacing at 200 beats per minute. Pre-TAVI central aortic pressure was 114/30 mmHg, and left ventricular pressure was 120/30 mmHg (). Post-TAVI central aortic pressure was 90/40 mmHg with a left ventricular pressure of 90/13 mmHg (). The final TEE images and aortogram showed trivial aortic regurgitation (Figures \u2013). Blood cultures, which had been obtained at presentation, were negative. The patient was discharged home in stable condition after 7 days. At a 30-day postprocedure follow-up visit, she was asymptomatic and had returned to working as a teacher. An echocardiogram at that time revealed normal left ventricular size and function, no aortic insufficiency, mean transaortic gradient 12 mmHg, and calculated aortic valve area 1.0 cm2 (, ).", "age": [ [ 72.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5872675.xml", "relevant_articles": { "21793174": "0", "10770060": "3", "21087746": "0", "20824744": "123", "10770057": "123" }, "similar_patients": { "8238102-1": "0", "3049881-1": "0", "3069580-1": "0", "6787798-1": "0", "5977029-1": "0" } }, { "human_patient_id": "316", "human_patient_uid": "5380242-1-M", "PMID": "28353558", "title": "Transplanted lungs and the \u201cwhite plague\u201d", "patient": "A 41-year-old Caucasian woman underwent a primary double lung transplantation for cystic fibrosis in 2006. Her medical history was otherwise unremarkable and the patient had no known history of pulmonary tuberculosis or tuberculosis contact. On December 2015, she underwent retransplantation for chronic lung allograft dysfunction. During the month preceding retransplantation, 4 sputum specimens remained negative for acid-fast bacilli and specific M. tuberculosis culture and real-time polymerase chain reaction (PCR) testing. On postoperative day 42, deterioration of her respiratory status prompted a chest-computerized tomography (CT) scan revealing sub-centimeter bilateral nodules primarily located in the apical posterior lobes and a bilateral pleural effusion (Fig. ). The same day, a bronchoalveolar lavage (BAL) yielded a positive real-time PCR for rifampicin-susceptible M. tuberculosis, confirmed by culture on postoperative day 62. Tuberculin skin test (TST) or interferon-\u03b3 release assay (IGRA) test were not performed. All the BALs performed on postoperative period yielded no other pathogen except for the one performed on day 60 that cultured Pseudomonas aeruginosa; the adjunctive antibiotic therapy was imipenem-cilastatin, 3 g/d. Histological examination of a lung biopsy performed 6 weeks after retransplantation revealed a caseating granuloma and necrosis. Acid-fast bacilli were identified as rifampicin-susceptible M. tuberculosis by real-time PCR. On postoperative day 65, the patient's status worsened with severe hypoxemia, shock unresponsive to high dose cathecolamines, and multiorgan failure. The patient died on postoperative day 70, despite treatment combining isoniazid, rifampicin, ethambutol, and pyrazinamide. Retrospective real-time PCR testing of the explanted lung and BALs performed on postoperative days 1, 7, and 21 remained negative.\nThe organ donor died of posttraumatic intracerebral hemorrhage. He was a 47-year-old man with no history of lung disease or risk factors for tuberculosis other than chronic alcohol use and smoking. TST results were not available. During hospitalization, a lung CT-scan showed no signs of active or previous tuberculosis and no TST or IGRA test results were available. Routine cultures of per-transplantation right lung biopsy yielded Candida albicans. Retrospective M. tuberculosis real-time PCR yielded negative results on the left and right donor-lung biopsies. Both kidneys from the same donor were transplanted into 2 other recipients. Six months after transplantation, neither of the kidney recipients had developed any signs or symptoms suggestive of active tuberculosis.", "age": [ [ 41.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5380242.xml", "relevant_articles": { "28353558": "123", "21819571": "12", "17956503": "2", "20209770": "123", "21906490": "123" }, "similar_patients": { "2491651-1": "13", "5237312-1": "13", "6612222-1": "13", "3420530-1": "13", "2799965-1": "13" } }, { "human_patient_id": "317", "human_patient_uid": "4228646-1-M", "PMID": "25396134", "title": "Hutchinson \u2013 Gilford progeria syndrome: A rare case report", "patient": "A three-year-old boy presented with progressive loss of scalp hair, eyebrows, and eyelashes since six months of age along with stunted growth as a major complaint. The child's antenatal history was normal but was born to third-degree consanguineously married parents. On examination, he had a senile look with prominent eyes, sparse hair with patches of alopecia and visible veins over the scalp, beaked nose, and receded chin []. His voice was high pitched and growth was stunted as parameters were less than the third percentile. Teeth and genitals were normal and intelligence quotient (IQ) was corresponding to the age. Hands were short and clawed with thickening and hardening of the skin over the knuckles with racquet nails. The ribs were prominent and anterior fontanelle was open. There was mottled pigmentation and sclerodermatous changes over the trunk and lower limbs []. Lower limbs also had prominence of knees and slight valgus deformity [Figures and ].\nRoutine investigations were within normal limits. The serum lipid profile showed a decrease in high-density lipoproteins (HDL). X-ray of the chest showed a pyriform thorax, overcrowding of proximal ribs, and short clavicle with pointed lateral ends []. X-ray of the skull showed diastasis of the sutures and prognathism []. X-rays of hands and feet showed acro-osteolysis of phalanges and tarsals [].", "age": [ [ 3.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4228646.xml", "relevant_articles": { "25396134": "12", "24739722": "12", "10990576": "12", "21352287": "0", "16707821": "0" }, "similar_patients": { "4287574-1": "1", "5613360-1": "1", "3221230-1": "1", "3214428-1": "1", "3269350-1": "0" } }, { "human_patient_id": "318", "human_patient_uid": "3710195-1-M", "PMID": "23849585", "title": "Probable chronic renal failure caused by Lonomia caterpillar envenomation", "patient": "A 60-year-old black man \u2013 born in the Rio de Janeiro city and living in Teres\u00f3polis, RJ, Brazil \u2013 reported that when he was taking the mail from his mailbox, he accidentally put his left arm on six specimens of light green and brown caterpillars, which had about 5 cm length. The animals were crushed by the arm of the man, who, immediately, withdrawn it. He washed the arm using soap and water, applied alcohol to the affected area and also took an anti-allergy drug (could not say which).\nThe site affected by the caterpillars became swollen and after 20 minutes a burning sensation started. The victim also noticed a painful lymph node in the ipsilateral axilla, which disappeared spontaneously shortly after. In the same night, after dinner, he had abdominal distension associated with discomfort and vomiting. He did not take medicines to relieve the symptoms. As there was improvement, he laid down to sleep. After that, the man woke up at dawn feeling an intense abdominal pain (flank region) and arthralgia (upper and lower limbs), which became worse when he attempted to move.\nSubsequently, the patient looked for medical assistance and went to a local hospital. His clinical picture was described as pain associated with sudden anuria. He was admitted to the hospital to treatment. The man reported a previous history of nephrolithiasis and received treatment with saline solution, analgesics and urinary catheter to provide relief. He also received treatment for arterial hypertension with atenolol, 50 mg/day; until this time there was no evidence of kidney injury.\nDuring the hospitalization, the patient had developed diffuse edema, flank pain and the anuria remained, despite of use of intravenous hydration and furosemide infusion. Laboratory and imaging tests were performed (Tables and ).\nAfter two more days, the patient was transferred to the Hospital das Cl\u00ednicas de Teres\u00f3polis Costantino Ottaviano (HCTCO), where he remained for forty-five days due to hemodialysis treatment. Four days after the admission to HCTCO, he remembered the episode with the caterpillars in the morning before the painful crisis and anuria. That was the moment when the suspicion of erucism by Lonomia aroused (seven days after the accident).\nThe use of SALon was not indicated because the patient did not meet the criteria for it, particularly due to the time elapsed since the accident, hospital care for more than 10 hours and less than or equal to 36 hours []. During the admission the patient showed bruises scattered on upper and lower limbs and two voluminous cases of melena. After those events, there was no spontaneous recovery of renal function, which progressed to chronic renal disease (CRD), stage V \u2013 end-stage renal disease, when the glomerular filtration rate is below 15% of normal and the patient needs, invariably, renal replacement therapy.\nLonomia caterpillar has about six to seven centimeters long, and its color ranges from light brownish-green to yellowish-brown with three longitudinal stripes of dark-brown []. Its body is covered with bristles that contain toxins. The transformation to an adult moth occurs after a in ten weeks after three to six months of larval life [,].\nLonomia is found throughout Brazil, however, numerous registered cases of erucism occurred in the southern region, mainly in Rio Grande do Sul and Santa Catarina states, and were attributed to L. obliqua[,]. In recent years, there have been accidents in Minas Gerais, Goi\u00e1s, Maranh\u00e3o and Rio de Janeiro states [,,].\nErucism caused by Lonomia is uncommon in the state of Rio de Janeiro. Therefore, the present study is one of the first cases reported in the state. The increased rate of envenomations \u2013 especially in areas where they were not previously described \u2013 has been attributed to deforestation of indigenous trees, natural habitat of caterpillars, which are forced migrating to fruit trees in urban areas [,].\nThe symptoms of Lonomia envenomation range from local cutaneous manifestations to serious and potentially fatal systemic reactions []. General symptoms such as headache, unspecific indisposition, fever, nausea, vomit, arthralgia, myalgia, conjunctivitis and abdominal pain vary depending on the species involved, the intensity of the contact and the victim\u2019s response [,,,]. Hemorrhagic syndrome and acute renal failure (ARF) are unusual outcomes, but potentially fatal [,-].\nThe pathophysiological mechanisms of ARF in Lonomia envenomig are not clear yet. Probably, there is a relation between renal ischemia and systemic hypotension and/or fibrin deposition in glomerular capillaries [-]. Another hypothesis is that venom components may act directly on the kidneys [,].\nLonomia spp. venom is rich in several toxins that have procoagulant and fibrinolytic activities, which can significantly affect the blood coagulation process. For example, the enzyme lonofibrase is able to trigger a hemorrhagic syndrome similar to disseminated intravascular coagulation (DIC) by increasing fibrinogen degradation products and decreasing plasminogen, fibrinogen and factor XIII [,,,-]. Lonomia obliqua venom contains several lipocalins (protein group that transports hydrophobic molecules), among which is the Lonomia obliqua prothrombin activator protein (Lopap), involved in the increase of expression of adhesion molecules on cellular surface [-].\nErucism is diagnosed based on history of contact with the caterpillar and corroborated by data from laboratory tests. Laboratory abnormalities include slightly low platelet count, high urea and creatinine levels, slight increase of total bilirubin, and augmentation of indirect bilirubin, free hemoglobin and haptoglobin decrease in cases of hemolysis [].\nTreatment consists of washing the affected area with cold water, cold compresses, local anesthetic infiltration using lidocaine 2% and topical corticosteroids. In case of bleeding, the patient should be kept resting in order to avoid traumatic intervention [,]. The antilonomic serum (SALon) is indicated according to the severity of the accident, and its early administration prevents bleeding manifestations that start from one to ten days after the contact depending on its intensity and location [,,-].", "age": [ [ 60.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3710195.xml", "relevant_articles": { "23849585": "1", "28327855": "1", "16310819": "123", "15361962": "13", "30114211": "0" }, "similar_patients": { "7911769-1": "0", "5022210-1": "0", "5894131-1": "0", "5330040-1": "0", "5477873-1": "123" } }, { "human_patient_id": "319", "human_patient_uid": "6332561-1-M", "PMID": "30642394", "title": "The role of a sequencing-based clinical intestinal screening test in patients at high-risk for Clostridium difficile and other pathogens: a case report", "patient": "This patient is a 29-year-old white woman from the USA with a medical history significant for severe IBS-D (diagnosed at age 12) and anxiety disorder. In July 2015, she presented with severe bleeding hemorrhoids secondary to IBS, which required hemorrhoidectomy and anal sphincterotomy in August 2015. The week before the surgery she developed pharyngitis and was treated with azithromycin, which resulted in mucousy diarrhea and abdominal discomfort. She tested negative for C. difficile antigen and toxins at that time.\nA week after surgery, she developed a perirectal abscess that had formed at the site of the sphincterotomy and was prescribed orally administered ciprofloxacin. Despite moderate symptom improvement, in September 2015 she required an abscess incision and drainage procedure and Penrose drain insertion. Prior to the surgery she was given a single dose of clindamycin. An additional 2-week course of ciprofloxacin and metronidazole was then prescribed. In late September 2015 she was admitted to the hospital for two nights due to further complications related to the abscess and was then diagnosed as having a perianal fistula.\nIn November 2015, she was prescribed clindamycin for an episode of group C streptococcal-positive pharyngitis. In late November 2015, she was also diagnosed as having Ehlers\u2013Danlos syndrome, which according to her medical record may partially explain the poor wound healing from the perirectal abscess. In December 2015, her fistula required an anus seton placement. She was treated with multiple courses of ciprofloxacin and metronidazole off and on from December 2015 to January 2016.\nIn January 2016, following up on her recurrent pharyngitis, she was diagnosed as having chronic tonsillitis which led to tonsillectomy. In February 2016, 2 weeks after the surgery she was prescribed clindamycin. At the beginning of March 2016, she was diagnosed as having bacterial vaginosis and was prescribed orally administered metronidazole. A week later she was diagnosed as having vaginal candidiasis and was prescribed orally administered fluconazole. In April 2016, she complained of dysuria and was prescribed ciprofloxacin. After 2 days, when urine analysis results came back negative, she was asked by her physician to stop the treatment.\nIn June 2016, she presented for follow-up with ongoing diarrhea and abdominal pain. She was diagnosed as having C. difficile diarrhea, her antigen and toxins laboratory results were indeterminate, and a toxigenic strain was confirmed by polymerase chain reaction (PCR). She was prescribed a 6-week course of orally administered vancomycin. After a week of treatment her symptoms worsened, and following discussion with her gastroenterologist her treatment was switched to a 2-week course of metronidazole. Hours later, she was admitted to the hospital for a 4-day period for colitis. Her C. difficile antigen and toxin test returned negative during her admission. She received intravenously administered metronidazole treatment during her hospitalization. Her symptoms improved during her hospital stay, with 1\u20132 soft bowel movements a day. At discharge her metronidazole course was stopped and she was again prescribed vancomycin, which she took for over a month. She continued to experience GI irregularity (3\u20135 bowel movements a day) beyond what she had experienced secondary to her IBS prior to her surgeries. In March 2017, she was prescribed rifaximin for 2 weeks to treat chronic diarrhea.\nIn November 2017, she was prescribed a series of clinical intestinal tests (SmartGut\u2122, uBiome Inc., San Francisco, USA) with the instructions to administer the test at home whenever she was experiencing a noticeable change of GI symptoms, then follow-up with her health care provider to discuss the results. This sequencing-based test requires that patients use a sterile swab to transfer a small amount of fecal material from toilet paper into a vial containing a lysis and stabilization buffer that preserves the microbial DNA for transport by mail back to the laboratory for processing, which involves DNA extraction, 16S ribosomal RNA (rRNA) gene amplification, and sequencing []. She first used this test in November 2017, about a month after completing a 2-week course of rifaximin. The results revealed a number of microbial organisms that were outside the healthy reference ranges, but she was negative for all pathogenic organisms included in the test, including C. difficile (Fig. ).\nBetween November and December 2017, her GI symptoms worsened considerably; her daily bowel movements increased from 3\u20134 to 6\u201310, stool consistency became more mucous-like and gelatinous, and she was experiencing more pain with defecation. She re-tested with SmartGut\u2122 test again in January 2018. Her results continued to reveal a number of microbial organisms outside the healthy range and, this time, her sample also indicated the presence of C. difficile (Fig. ). She immediately contacted her primary care provider, who re-tested her for C. difficile and confirmed indeterminate CDI by antigen and toxins A and B. Additional PCR testing at a regional laboratory confirmed the sample was positive for a toxigenic C. difficile strain. As a result of testing, her clinician started her on fidaxomicin; her symptoms improved rapidly. By April 2018, she had returned to her baseline in regard to her IBS-related GI symptoms with no blood in her stools.\nIn addition, the second SmartGut\u2122 sample was tested for toxins A and B by sequencing at uBiome Inc. laboratory in San Francisco, USA, which resulted positive for both and confirmed the toxigenic nature of the C. difficile strain.", "age": [ [ 29.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6332561.xml", "relevant_articles": { "30998493": "0", "30642394": "12", "5197328": "0", "16318071": "0", "1068960": "0" }, "similar_patients": { "6639584-1": "0", "5924470-1": "12", "2698204-1": "123", "4820024-1": "0", "7846135-1": "0" } }, { "human_patient_id": "320", "human_patient_uid": "8553255-1-M", "PMID": "34722261", "title": "Case Report: Effective Treatment With Pyrotinib and Capecitabine in a Heavily Pretreated Locally Advanced Breast Cancer Harboring Both HER2 Overexpression and Mutant", "patient": "The 48-year-old woman unintentionally felt a painless mass of about 2 cm \u00d7 1 cm in the upper outer quadrant of her left breast in March 2017, which gradually enlarged due to her neglect. In September 2017, the mass rapidly enlarged to 7cm \u00d7 6 cm, and there was infiltrated erythema and ulceration on the skin of the breast. In October 2017, she was admitted to our hospital and received mammary magnetic resonance imaging (MRI) (), which showed a 91 mm \u00d7 55 mm \u00d7 87 mm mass with ill-defined margins and a heterogeneous internal enhancement in the left breast; breast imaging reporting and data system (BI-RADS) category was identified as 5. Additionally, enlarged lymph nodes in her left axilla were observed. Laboratory examinations presented normal carcinoembryonic antigen (CEA) level (0.926 ng/ml) and high cancer antigen 15-3 (CA15-3) level (61.4 U/ml). Subsequently, core needle biopsy was performed on October 28, 2017, and invasive ductal carcinoma was pathologically diagnosed, histological grade 2, with estrogen receptor (ER) negative and progesterone receptor (PR) negative, overexpression of HER-2 (+++), and high proliferation index Ki-67 (70%) (). The patient was in good health without any medical history of hypertension or diabetes and without smoking, drinking, and other bad habits. She had menarche at 13 years old, and the last menstrual period was October 11, 2017. Before any treatment, we offered a thorough examination and excluded any distant metastases. The clinical stage was cT4N2aM0 according to the 7th edition of American Joint Committee on Cancer (AJCC) staging manual ().\nAs pertuzumab and T-DM1 had not been approved in China at that time, after obtaining informed consent, we adopted a TCbH regimen (docetaxel, 75 mg/m2 d1; carboplatin, AUC = 6 d1; trastuzumab, 8 mg/kg for the first cycle and 6 mg/kg thereafter d1, 21 days/cycle) as first-line treatment according to the National Comprehensive Cancer Network (NCCN) guidelines. After five cycles (November 6, 2017\u2013January 30, 2018), reexamination of mammary MRI () showed the size of the mass shrank from 91 mm \u00d7 55 mm \u00d7 87 mm to 84 mm \u00d7 48 mm \u00d7 72 mm. According to the evaluation criteria of Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, we judged the therapeutic effect as stable disease (SD).\nBased on the NOAH test (), limited cycles of joint application of trastuzumab and anthracycline were effective and had controllable cardiac toxicity. Therefore, we choose ECH (epirubicin, 90 mg/m2 d1; cycloposphamide, 600 mg/m2 d1; trastuzumab, 6 mg/kg d1, 21 days/cycle) regimen as second-line treatment (February 27, 2018\u2013May 23, 2018). After four cycles, re-examined mammary MRI () showed that the tumor shrank from 84 mm \u00d7 48 mm \u00d7 72 mm to 66 mm \u00d7 29 mm \u00d7 56 mm. According to the evaluation criteria of RECIST v1.1, the therapeutic effect was still SD. There was no significant change in the appearance of the breast ().\nAs the efficacy still did not reach PR, the regimen was altered to nab-paclitaxel combined with trastuzmab. For metastatic breast cancer patients who had received prior taxanes, nab-paclitaxel plus still has the objective response rate of 54.2% (), and nab-paclitaxel plus traszumab to EC was superior to taxanes combined with trastuzumab to EC as neo-adjuvant therapy in GBG 69 trial (). Therefore, we choose nab-paclitaxel plus trastuzumab as the third-line treatment (nab-paclitaxel, 125 mg/m2 d1, d8; trastuzumab, 6 mg/kg d1, 21 days/cycle). The patient got PR after the first two cycles (), but two cycles later, the efficacy deteriorated to progressive disease (PD) ().\nAs the patient had developed acquired trastuzumab resistance after three lines of trastuzumab-based regimen, another regimen with distinct mechanism of anti-HER2 therapy was needed. To investigate the potential reason of drug resistance, a next-generation gene sequencing (NGS) of 425-gene panel was performed using the tissue repunctured from the tumor. According to the NGS report, persistent existence of ERBB2, CDK12, and MYC amplification with abundance of 15.7, 16.2, and 7.6 were detected, respectively. Meanwhile, there were mutations as p.R314H on IDH1 gene and p.H179R on TP53 gene. On ERBB2 gene, the patient had L755S () and K907R mutation. L755S mutation indicated resistance to trastuzumab and lapatinib (, ) and may be sensitive to neratinib (), an irreversible pan-HER TKI. At that time, neratinib had not been admitted to China, and a similar agent, pyrotinib, had just been approved by the China Food and Drug Administration (cFDA), whose phase II trial had indicated that for the treatment of advanced HER2-positive breast cancer patients, pyrotinib combined with capecitabine had better efficacy than lapatinib combined with capecitabine (). Thus, we selected pyrotinib plus capecitabine (pyrotinib, 400 mg/d d1\u201321; capecitabine, 1,250 mg/m2 bid d1\u201314, 21 days/cycle) as the fourth-line treatment regimen. After six cycles (August 28, 2018\u2013December 29, 2018), the patient got PR (), and the surface of the breast almost completely healed ().\nLeft breast cancer mastectomy and local rotation skin flap grafting were performed on the patient in January 16, 2019, and postoperative pathology report showed an invasive ductal carcinoma with changes in Miller\u2013Payne Grade 4 (), with a tumor size of 1.0 cm \u00d7 0.8 cm \u00d7 0.8 cm and lymph nodes negative (0/14). Immunohistochemistry indicated ER (\u2212), PR (\u2212), C-erbb-2 (+++), and ki-67 (70%+) ().\nThe patient continued to receive pyrotinib plus capecitabine (pyrotinib, 400 mg/day d1\u201321; capecitabine, 1,250 mg/m2 bid d1\u201314, 21 days/cycles) synchronous with radiotherapy (left chest wall plus left supraclavicular area, 5,000 cGy/25f), and pyrotinib plus capecitabine continued to be administrated for 1 year. There were no signs of metastasis or recurrence after an overall examination after 1 year of adjuvant therapy with pyrotinib plus capecitabine. The patient suspended capecitabin due to severe hand\u2013foot syndrome and took pyrotinib as single agent for another 1 year (), partially referred to ExteNET clinical trial (). By the time of contribution, the second (June 2019) and last regular follow-ups (March 2021) showed no signs of metastasis or recurrence ().", "age": [ [ 48.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC008xxxxxx/PMC8553255.xml", "relevant_articles": { "34722261": "123", "33581774": "123", "31430226": "123", "33065805": "123", "23463098": "123" }, "similar_patients": { "8257064-1": "123", "7748359-1": "123", "7936716-1": "123", "7310977-1": "123", "8161821-1": "123" } }, { "human_patient_id": "321", "human_patient_uid": "4195993-1-M", "PMID": "25317314", "title": "Non-Operative Treatment of a Fracture to the Coracoid Process with Acromioclavicular Dislocation in an Adolescent", "patient": "A 14-year-old boy sustained a direct impact to his left shoulder due to an ice-hockey body-check. He complained acute pain and loss of function of his left shoulder. Initially the shoulder was immobilized in a shoulder sling and the patient was introduced to our department for shoulder and elbow surgery 10 days after the injury. Clinically, he presented with a prominent left acromioclavicular (AC) joint with pain on horizontal and vertical manipulation of the lateral clavicle, as well as marked tenderness over the coracoid process. Functional evaluation of the AC joint revealed a moderate superoinferior (3-5 mm) but no anteroposterior instability. Active range of motion (ROM) was restricted in every direction [ab-/adduction (Abd/Add): 50-0-10\u00b0; flexion/extension (F/E): 60-0-30\u00b0; external/internal rotation (ER/IR): 40-0-85\u00b0], passive ROM was normal. There was no evidence for an injury of brachial plexus or vascular compromise. The patient\u2019s demands were complete and fast recovery with return to full sports as soon as possible, since he was playing ice-hockey in a first league team.\nComputed tomography (CT) showed an AC joint separation with elevation of the lateral clavicle of 5 mm () and a fracture at the epiphysis of the coracoid base with 3 mm dislocation medially (). The magnetic resonance imaging (MRI) revealed an AC joint sprain with intact AC capsule and ligaments as well as intact coracoclavicular ligaments (CCL) ().\nWe started non-operative treatment on first presentation with immobilization in a Camo\u00aeShoulder brace (OPED, Valley/Oberlaindern, Germany). This device allows resting of the 90\u00b0 flexed elbow on a pad, thereby partially unloading the shoulder girdle, with fixed abduction of 15\u00b0 and internal rotation of 45\u00b0 (). At clinical and radiological follow-up 2 weeks later, the patient presented with persisting tenderness over the coracoid process but less tenderness over the AC joint. Active ROM was still markedly restricted (Abd/Add: 60-0-10\u00b0; F/E: 60-0-30\u00b0; ER/IR: 40-0-80\u00b0). The radiographs ruled out a secondary dislocation of the coracoid process. Passive rotation of the shoulder within the dynamic brace was allowed between 30 and 60\u00b0 IR from week 4 and between 20 to 80\u00b0 IR from week 5 (). At 8 weeks follow-up the patient presented completely pain-free with full ROM () and without tenderness on palpation over the coracoid or the AC joint. Clinical tests for the AC joint, rotator cuff and long biceps tendon revealed to be normal. After week 8 the patient resumed ice-hockey training and regained sports activity on first league level after 12 weeks. After 5 months he presented with mild symptoms of subcoracoid impingement which was successfully treated with physiotherapy within 6 weeks. A MRI confirmed complete bony healing of the coracoid fracture without malalignement, a coracohumeral distance of 13mm and signs of a mild subcoracoid bursitis (,).", "age": [ [ 14.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4195993.xml", "relevant_articles": { "25317314": "123", "32991442": "12", "24924503": "1", "25994429": "12", "17063059": "1" }, "similar_patients": { "6813848-1": "12", "4410472-1": "12", "7674374-1": "123", "3878282-1": "12", "2964612-1": "12" } }, { "human_patient_id": "322", "human_patient_uid": "6087624-1-M", "PMID": "30108642", "title": "Trifascicular block as primary presentation of the cardiac amyloidosis; \nA rare case report", "patient": "A 70-year-old man patient weighing 55 kg was admitted to emergency department with a complaint of severe weakness, lightheadedness, and lower limb paresthesia. Before this admission, he also presented worsening of symptoms in the last two weeks. He had no family history of cardiovascular disease, sudden cardiac death, or syncope.\nOn admission, hemodynamic parameters were in acceptable condition. He had blood pressure of 79/99 mmHg, heart rate of 57 beats/minute, and respiratory rate of 20 breath/minute, and he was also afebrile. Oxygen saturation, at rest, with finger pulse oximeter in index finger was 95%.\nPrimary physical examination was also done and we found the S4 sound in the apex, in cardiac auscultation. He was in class 2 of the New York Heart Association (NYHA) Functional Classification. Laboratory findings showed a mild hypochromic microcytic anemia [hemoglobin = 10.9 g/dl, hematocrit = 30.3%, mean corpuscular volume (MCV) = 73.09 fl, and mean corpuscular hemoglobin (MCH) = 21.67 pg]. He had degrees of hypothyroidism with thyroid stimulating hormone (TSH) of 20 mU/l and serum thyroxine (T4) of 2.4 \u00b5g/dl.\nElectrocardiography (ECG) showed right bundle branch block (RBBB) with right axis deviation and complete atrioventricular block that diagnosed as a Trifascicular block ().\nThe patient referred to echocardiography unit and transthoracic echocardiography showed a moderate increase in thickness of left ventricular (LV) wall as a concentric pattern and LV diastolic dysfunction (grade 2). The ejection fraction of LV (LVEF) was 55%. Echocardiography revealed normal right ventricle size and function as well [tricuspid annular plane systolic excursion (TAPSE) = 1.9 cm] (). Cardiac biomarkers revealed that troponin I was negative with elevated N-terminal prohormone of brain natriuretic peptide (NT-ProBNP) equal to 288 pg/ml.\nRegard to severe weakness and paresthesia, he referred to neurology department for electrodiagnostic study. The electrodiagnostic evaluation revealed absent sensory nerve action potential (SNAP) with low amplitude compound muscle action potentials (CMAPs) of upper and lower limbs. These findings were compatible with chronic sensory-motor polyneuropathy with axonal features, and evidence of ongoing axonal loss.\nAccording to the sustained anemic situation and severe weakness, the patient underwent bone marrow aspiration. Microscopic evaluation of bone marrow aspiration revealed elevated cellularity with myeloid hyperplasia to erythroid hypoplasia ratio of 3:1, and complete maturation. Plasma cells were 22% of all nucleated cells. This finding was compatible with plasma cell myeloma.\nLaboratory investigations including serum and urine electrophoresis and serum free light chain examination as immunofixation assay were also done. The results showed that kappa (\u03ba) chains predominated over lambda (\u03bb) chains in a ratio of 3:2. The hepatic test showed elevated alkaline phosphatase value equal to 215 U/l.\nUltimately, by considering all clinical aspects and paraclinical investigations mentioned above, final diagnosis for the patient was amyloid light-chain (AL) cardiac amyloidosis.\nImmediately, the targeted therapy was established. Regarding clinical and paraclinical parameters, the patient received melphalan combined with high-dose dexamethasone. Concurrently, immunotherapeutic strategy with CPHPC and monoclonal antibodies were also prescribed. The patient closely monitored for 2 weeks and during this treatment period, he showed hematologic and organ response to the therapy. After this period, kappa to lambda ratio in urine immunofixation electrophoresis was normal, and serum level had a negative result. Heart response included no change in normal left ventricular ejection fraction (55 %), enhance the NYHA class of 2 to 1 without using any medications such as diuretic, and no wall thickness enhancement. NT-ProBNP was in normal range (100 pg/ml). The hepatic test revealed that alkaline phosphatase value had a dramatic decrease in 101 U/l (more than 50%).\nAfter completion of treatment, the patient was discharged and advised to follow his situation and disease by referring to heart clinic every 2 weeks until 6 months, and referring electrophysiologist to consult the indications of an implantable cardiac defibrillator.", "age": [ [ 70.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6087624.xml", "relevant_articles": { "30108642": "123", "26677890": "12", "25477986": "12", "31073350": "0", "34099054": "0" }, "similar_patients": { "5641517-1": "123", "4749759-1": "13", "6455992-1": "13", "6552948-1": "13", "5455328-1": "0" } }, { "human_patient_id": "323", "human_patient_uid": "5405476-1-M", "PMID": "28446143", "title": "IgG4-related membranous glomerulonephritis and generalized lymphadenopathy without pancreatitis: a case report", "patient": "A 40-year old male patient of Moroccan origin was admitted in 2012 for diffuse lymphadenopathy confirmed with ultrasound. Blood tests revealed renal insufficiency (serum creatinine: 1.6 mg/dL, eGFR: 48 ml/min/1.73 m2), low serum C3 and C4 levels and hypergammaglobulinemia (4250 mg/dL with oligoclonal banding). Anti-nuclear antibodies (ANA) were positive at 1/640. Anti-dsDNA were negative. Urine tests showed proteinuria (444 mg/L). A thoraco-abdominal computed tomography and positron-emission tomography/computed tomography (PET/CT) were performed. The images were compatible with a lymphoproliferative disorder. Heterogeneous uptake was also noticed in kidneys. Lymph node biopsy was performed and ruled out a hematologic malignancy. Immunohistochemistry showed more than 10 IgG4+ plasma cells per high powered field (HPF) of biopsy sample with more than 40% of IgG+ plasma cells being IgG4+ (Fig. ). Serum IgG4 level was then measured at 2790 mg/dL (N < 201 mg/dL).\nThis episode was not the first in patient\u2019s medical history. In 2004, the patient had been admitted for lower-limb edemas and diffuse lymphadenopathy. Renal insufficiency (serum creatinine: 3.51 mg/dL, eGFR: 24 ml/min/1.73 m2), low serum C3 and C4 levels and hypergammaglobulinemia (4590 mg/dL) had already been found. Urine tests showed high proteinuria (13800 mg/l) with hypoalbuminemia characteristic of a nephrotic syndrome. Renal ultrasound showed diffuse kidney enlargement. PET/CT showed the same results as the one performed in 2012. A lymphoproliferative disorder was excluded by whole skeleton X-Ray, bone marrow and lymph node biopsy. A renal biopsy was then performed and showed membranous glomerulonephritis (MGN) with IgG and C3d deposits (Fig. ). Severe tubulo-interstitial nephropathy (TIN) with lymphoplasmocytic infiltrate (CD20+, CD3+, CD5+) was associated. Secondary causes of MGN were rejected by appropriate tests. ANA were negative at the time. The proposed diagnosis was a dysimmune state of unknown origin with secondary MGN and reactive lymphadenopathy. Treatment with glucocorticoids (GC) was started with an excellent clinical and biological response.\nIn 2005, a cutaneous rash appeared on the left arm and was biopsied, showing IgG and C3d deposits. GC were stopped in 2006 given the recovery of renal function. A few months later, the patient started to complain of pain, redness and swelling in small joints of the feet and hands.\nIn 2008, the first relapse occurred with the same clinical picture that in 2004 (nephrotic syndrome and lymphadenopathy). Full assessment was repeated yielding similar results except for renal biopsy: MGN with IgG and C3d deposits was found again but chronic interstitial nephropathy replaced the severe TIN. Indeed, a mononuclear infiltrate was present in the interstitium without clear sign of tubular involvement. A severe thrombocytopenia (platelets: 8.103/mm3) developed a few weeks later with anti-dsDNA found on blood sample (1/80). Thrombocytopenia was refractory to perfusion of immunoglobulins, GC and cyclophosphamide (CYP). Plasmapheresis and splenectomy were then performed. CYP was next continued for 6 cycles (500 mg/cycle) with good efficacy. Relapsing thrombocytopenia was successfully treated by additional regiments of immunoglobulins and GC. The last cycle of CYP was completed at the end of 2008. Thereafter, the patient experienced a long period without any problem until the next hospitalization in 2012.\nIn 2012, a renal biopsy was not performed again despite a new relapse of nephrotic syndrome; indeed, the 2008 biopsy had led to a macroscopic urinary hemorrhage which had required embolization. MGN was assessed again and anti-phospholipase A2 receptor (PLA2R) antibodies were negative. Diagnosis of IgG4-RD was finally made on the basis of the lymph node biopsy, with IgG4-related generalized lymphadenopathy and IgG4-related MGN (associated with IgG4-related TIN in 2004). The patient was given GC again at high dose (methylprednisolone 96 mg daily) for 1 month followed by a progressive decrease of the dose. Rituximab use was discussed in 2013, due to a new relapse in spite of maintenance low dose GC therapy and development of side effects; unfortunately, the patient failed to obtain the reimbursement and the medication could not be given in this context. For now, the patient is well stabilized with low dose GC. Rituximab in compassionate use could be reconsidered in case of a new relapse. Figure shows the evolution of various biological markers and serum creatinine during 2013.", "age": [ [ 40.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5405476.xml", "relevant_articles": { "8346468": "123", "29388171": "123", "29765543": "123", "28446143": "123", "22445476": "123" }, "similar_patients": { "7802177-1": "123", "4360725-1": "123", "4616672-1": "123", "6689923-1": "123", "6868811-1": "123" } }, { "human_patient_id": "324", "human_patient_uid": "6830244-1-M", "PMID": "31723388", "title": "Use of nebulized naloxone to reverse methadone overdose \u2013 A case report and review of literature", "patient": "A 57 years old male with a past medical history significant for COPD, Hepatitis C, Opioid dependence on methadone maintenance therapy was brought to the emergency department by the emergency medical service personnel after ingesting double the quantity if his usual methadone. Upon initial encounter, the patient was found to be lethargic, unresponsive to pain and having poor respiratory efforts (GCS 6 E1V2M3). He was given intra-nasal naloxone in the field leading to some improvement in his mental status (GCS 13 E3V5M5). He revealed that he had taken twice as much as his usual maintenance dose of methadone (70 mg was ingested, he was on 35 mg daily per the methadone maintenance program). He had been dispensed a two-day dose for the weekend and took both doses simultaneously.\nUpon presentation to the Emergency Department (ED) vital signs included, pulse rate 84 beats/min, blood pressure 149/89 mmHg, respiratory rate 9 breaths/min, and SpO2 on 6L nasal cannula 73%. Physical examination showed a pale and lethargic gentleman with shallow respirations not responding to vocal commands or pain (GCS 8 E2V3M3). Pupils were 2mm bilaterally and sluggishly responsive to light bilaterally. Lung auscultation revealed coarse breath sounds on the right hemithorax; cardiac auscultation was unremarkable, and there were no focal neurologic deficits. The patient was oxygenated with a non-rebreather mask, with SpO2 only improving to 82%. An arterial blood gas sample was obtained and since opioid intoxication was evident, reversal with naloxone was attempted.\nInitially, IV access was unobtainable because of venous scarring. Due to deteriorating clinical status 2mg naloxone was added to 5ml normal saline and administered using a standard nebulizer mask (the side ports were partially occluded with tape to decrease the escape of nebulized naloxone) while continued attempts to obtain IV access were being made in addition to preparation for endotracheal intubation. The arterial blood gas obtained upon arrival showed a pH of 7.20, pCO2 87 mmHg (baseline of 55 mmHg), PaO2 44 mmHg. After 4 minutes of the nebulization the respiratory rate improved to 22 breaths/min, SpO2 increased to 100% on non-rebreather at 15 L/min and GCS improved to 15. After about 20 minutes of nebulization, the patient started yawning and became more alert, but no other signs of opioid withdrawal were observed. Repeat arterial blood gas showed pH 7.30, pCO2 60 mmHg, and PaO2 72 mmHg; EKG showed a QTc of 530 milliseconds, urine toxicology screen was only positive for methadone, chest X-ray, and other labs were unremarkable. After 50 minutes the SpO2 dropped to 85% and another dose of 2mg naloxone in 5ml of saline was administered via nebulization and the patient responded well. The patient was admitted to the ICU to obtain IV access and monitor for the next 24 hours, once in the ICU a peripherally inserted central catheter (PICC) was placed under ultrasound guidance and the patient was started on a naloxone infusion at a low dose rate (2 mg/hr) without any bolus dose to avoid precipitating acute opioid withdrawal. Within 10 minutes the patient was exhibiting signs of withdrawal and was agitated. Due to concerns for continued withdrawal and pulmonary edema the infusion rate was slowed to 1 mg/hr. After a few hours on (and off) the naloxone infusion, titrated per the RASS scale, the patient was eventually downgraded to the medicine telemetry unit and later discharged from the hospital without any complications.", "age": [ [ 57.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6830244.xml", "relevant_articles": { "33575513": "123", "12609650": "123", "23347721": "123", "26289651": "13", "9366459": "123" }, "similar_patients": { "8019539-1": "123", "6836333-1": "123", "7864128-1": "123", "7220329-1": "123", "3713675-1": "0" } }, { "human_patient_id": "325", "human_patient_uid": "5346373-1-M", "PMID": "28331646", "title": "Conversion of Low-Flow Priapism to High-Flow State Using T-Shunt with Tunneling", "patient": "The first case is a 24-year-old Caucasian male that sought medical attention for priapism 24 hours after his erection began. He has a past medical history of stuttering priapism and idiopathic thrombocytopenic purpura diagnosed three years earlier but in remission according to his hematologist. His only previous surgery was a splenectomy. He was taking no medications at the time.\nIn the emergency room he received an intracorporal aspiration and injection of phenylephrine (500 \u00b5g/mL) with no detumescence. A corporal blood gas was collected which showed the following: pCO2, 89 mmHg (normal = 32\u201343); pO2, 32 mmHg (normal = 83\u2013108); pH 7.20 (normal = 7.37\u20137.44). He was taken to the operating room where bilateral Al-Ghorab shunts were performed. In the recovery unit, he had recurrence of his erection. The patient was then transferred to our facility for further management.\nHis physical exam on arrival revealed a persistent erection and with pain and he was taken to the operating room. Dark venous blood was drained from his corpora. A corpora cavernosal shunt (T-shunt) with tunneling was performed using #8 Hegar dilators. Detumescence was obtained intraoperatively. The procedure was completed and the patient was transferred to the PACU without complication, yet immediately postoperatively he again became erect. A corporal blood gas was taken, with the values consistent with a high-flow state: pCO2, 47 mmHg (normal = 32\u201343); pO2, 106 mmHg (normal = 83\u2013108); pH 7.27 (normal = 7.37\u20137.44); and 98% 02 saturation. He was observed and discharged on post-op day 2, but he continued to have an erection for approximately three weeks without pain. He was seen at 6 weeks post-op and he was having normal erectile function.", "age": [ [ 24.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5346373.xml", "relevant_articles": { "33271660": "13", "26822610": "13", "26609335": "13", "32248201": "1", "12033473": "0" }, "similar_patients": { "5346373-2": "123", "4567212-1": "13", "6080740-1": "123", "3355694-1": "12", "4828374-1": "12" } }, { "human_patient_id": "326", "human_patient_uid": "5346373-2-M", "PMID": "28331646", "title": "Conversion of Low-Flow Priapism to High-Flow State Using T-Shunt with Tunneling", "patient": "The second patient is a 33-year-old African American male with sickle cell disease who presented to a referring emergency room in a methamphetamine-induced psychotic state. While on a psychiatric hold in the ER, he developed an erection with some associated discomfort. Besides sickle cell disease, the patient's medical history includes anxiety, depression, opioid dependence, marijuana, cocaine, amphetamine, benzodiazepine, and opioid abuse, splenic autoinfarction. He has a 16-pack year smoking history and used illicit drugs twice weekly. His surgical history includes 2 Winter shunts in 2010 and 1 T-shunt in 2012. The patient has suffered from episodes of stuttering and ischemic priapism one to two times monthly for the past two years but noted a higher frequency of episodes over the past three months. These have usually resolved with intracorporal injections of phenylephrine that were somewhat painful. He finally agreed to be treated almost 24 hours later and received intracorporal injections of phenylephrine (0.5 mg/mL) bilaterally every few minutes. After the injection, there was no improvement of his condition. A corporal blood gas was collected and the values were as follows: pCO2, 84 mmHg (normal = 32\u201343); pO2, 39 mmHg (normal = 83\u2013108); pH 7.21 (normal = 7.37\u20137.44).\nHe was taken to the operating room where a T-shunt was performed. There was minimal drainage on incision. A #8 Hegar dilator was used to dilate the corpora, irrigating a small volume of arterial blood with some mild improvement in his erection. Within 10 minutes of finishing the procedure the erection returned. A corporal blood gas was collected at that time and the values were as follows: pCO2, 45 mmHg (normal = 32\u201343); pO2, 105 mmHg (normal = 83\u2013108); pH 7.35 (normal = 7.37\u20137.44). The patient was observed in the hospital for a week while being treated for his other medical issues. His erection resolved after 10 days and he was still having erectile function at 6 weeks post-op. The patient was seen in another hospital 2 months later and had a T-shunt and tunneling for priapism and had a similar erection in the recovery unit and was taken back to the operating room without a repeat blood gas for a proximal shunt. He later developed a urethral injury from his proximal shunt.", "age": [ [ 33.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5346373.xml", "relevant_articles": { "33271660": "1", "27693479": "13", "26822610": "13", "24798364": "1", "18194188": "1" }, "similar_patients": { "5346373-1": "123", "4567212-1": "13", "6080740-1": "123", "8272654-1": "123", "3640157-1": "123" } }, { "human_patient_id": "327", "human_patient_uid": "2843709-1-M", "PMID": "20175900", "title": "Ten-year follow-up of giant basilar aneurysm treated by sole stenting technique: a case report", "patient": "A 43-year-old Mexican Hispanic man arrived in our hospital with a chronic headache. His neurological examination was unremarkable. The imaging workup showed a giant basilar artery aneurysm, dimensions 32 mm \u00d7 20 mm (Figure ), and that the lesion was located at an angled portion of the vessel. For the management of this aneurysm, we decided to place a stent at the aneurysm neck in order to: 1) straighten the shape of the parent vessel; 2) promote a shift in the pattern of the inflow into the sac and the outflow from the lesion; and 3) foster the thrombosis of the aneurysm.\nThe lesion was reached through a left vertebral approach with a 6F guiding catheter (Envoy, Cordis, Miami Lakes, FL). The medical periprocedural management at that time (1997) was empirical, as no rules for anticoagulation or antiplatelet treatment had been defined for intracranial stents. The vascular neurologist advised that the patient be placed under full anticoagulation without any antiplatelet drug. A 3.5 mm \u00d7 12 mm balloon-expandable stent (BES) (AVE Medtronic; Advanced Vascular Engineering, Santa Rosa, CA) was advanced and deployed at the neck of the lesion (Figures ).\nWhen trying to retrieve the balloon, the stent slipped backwards and its distal end tilted towards the sac. (Figures ). We therefore decided to carefully slip the stent forward into the aneurysm by inflating the balloon again and pushing the stent distally until the whole of it was floating within the aneurysm (Figures ). A 3.5 mm \u00d7 18 mm BES was advanced into the lesion and subsequently deployed within the parent artery to cover the full length of the diseased portion of the vessel, including the aneurysm neck (Figure ) In the immediate post-procedural angiographic runs, we observed a sluggish intra-aneurysmal vortex motion and a correction of the shape of the parent vessel to a 45-degree angle was conducted. The neurological status of the patient was unchanged and he was then discharged to the neurosurgical ward.\nA control digital subtraction angiography (DSA) performed four hours later to counter clinical deterioration showed thrombosis of the aneurysm along the basilar artery (Figure ). Rapid recanalization of the vessel was obtained through a mechanical procedure (balloon angioplasty) with the use of antiplatelet treatment (ticlopidine 250 mg and aspirin 100 mg) (Figure ). The patient subsequently recovered and this episode left a pontine stroke as a sequela (Figure ).\nAt ten years after the operation, the patient has a minor paresis, with a modified Rankin Scale of 2. A new imaging follow-up with DSA and three-dimensional reconstruction has been performed, which showed that the aneurysm remains occluded (no recanalization), the parent vessel is still patent, and no in-stent stenosis is present (Figure to ). The clinical evolution of the patient is described in Table 1.", "age": [ [ 43.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC002xxxxxx/PMC2843709.xml", "relevant_articles": { "23172541": "123", "26646176": "123", "15663225": "13", "23276034": "3", "34555247": "0" }, "similar_patients": { "3928345-1": "123", "3551501-2": "123", "3424179-1": "13", "3377880-1": "123", "5714937-1": "123" } }, { "human_patient_id": "328", "human_patient_uid": "6967357-1-M", "PMID": "32001911", "title": "A case of post-operative posterior reversible encephalopathy syndrome in children: A preventable neurological catastrophe", "patient": "A 12-year-old male child weighing 20 kg suffering from thalassemia major and immune thrombocytopenia presented with features of pancytopenia. His bone marrow examination showed red cell aplasia. The child was given steroid therapy in the form of oral prednisolone 1 mg/kg/day for 4 weeks.\nChild's haemoglobin was 9 g/dl and his platelet count was 30,000/mm3 despite steroid therapy. Ultrasound of the abdomen showed hepatosplenomegaly. The child had pancytopenia, hypersplenism and was posted for splenectomy. Splenectomy was done under general anaesthesia with endotracheal intubation (ETT). Stress dose of steroid hydrocortisone 25 mg was given perioperatively. Before extubation, ultrasound-guided bilateral single shot erector spinae block with 15 ml of 0.2% ropivacaine was given at T-8 level. The trachea was successfully extubated and the child was shifted to the post anaesthesia care unit (PACU).\nThe child was pain-free in the immediate postoperative period with a visual analog score (VAS) score of 1/10. The patient was discharged from PACU. On the second post-operative night, the child complained of severe pain at the surgical site with a VAS score of 8/10. Intravenous paracetamol 15 mg/kg was given for pain control but the pain was not relieved. The nonsteroidal anti-inflammatory drug was not given due to the risk of platelet dysfunction. The child had a heart rate of 120 beats/min and non-invasive blood pressure of 170/94 mmHg. The patient had continued pain and at midnight and he complained of a bilateral diffuse occipital headache followed by the blurring of vision and visual hallucinations. The symptoms worsened rapidly. Two hours later, the child had a generalised tonic-clonic seizure lasting for 2 min. Seizure episode was managed by intravenous (IV) midazolam 4 mg. A loading dose of IV phenytoin 20 mg/kg was given by slow infusion followed by 100 mg intravenous per day. The seizure was followed by postictal confusion. During this episode, blood pressure increased up to 180/96 mmHg, and the child was shifted to the intensive care unit (ICU).\nOn admission to the ICU, his Glasgow Coma Scale was 9/15 (motor 4, eyes 2, verbal 3). His blood pressure (bp) was 180/100 mmHg, heart rate 106 beats/min, body temperature 36.7\u00b0C and pupils were 2.5 mm in diameter, equal and reactive. The fundus examination was unremarkable. Blood glucose, arterial blood gases, serum osmolality and serum electrolytes were normal. The child maintained oxygen saturation throughout the whole event.\nThe patient had a recurrence of seizure after ICU admission, following which levetiracetam 20 mg/kg intravenous infusion was given. MRI brain showed T2-weighted-fluid-attenuated inversion recovery (T2 FLAIR) hyperintensities in the bilateral parieto-occipital region and bilateral cerebellar hemispheres with underlying cortical swelling [Figures and ]. Magnetic resonance venography (MRV) was also done to rule out venous sinus thrombosis. All clinical and radiological features were consistent with PRES.\nBlood-pressure monitoring showed wide fluctuations in reading hence left radial intra-arterial blood pressure monitoring was started in ICU. The systolic blood pressure of child ranged between 120\u2013190 mm of Hg, whereas diastolic blood pressure ranged between 70\u2013100 mm of Hg. The hypertension was managed with intravenous labetalol 0.4\u20131 mg/kg/hr intravenous infusion. Within 24 h, the blood pressure fluctuations resolved and oral prazosin tablet 0.5 mg once daily was started for maintenance. Oral phenytoin 150 mg and levetiracetam 400 mg were continued once daily. For analgesia paracetamol, 15 mg/kg was given intravenously every 6 h and intravenous fentanyl 1 \u03bc/kg bolus as per requirement. The dose of steroid was tapered to prednisolone 6 mg once daily. Headache and visual symptoms resolved gradually over 2 days. He did not have any recurrence of seizure and phenytoin was stopped while oral levetiracetam was continued. The patient was discharged on day 15.", "age": [ [ 12.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6967357.xml", "relevant_articles": { "23473460": "0", "8470788": "0", "23087458": "0", "2770185": "3", "1641854": "0" }, "similar_patients": { "4296369-1": "123", "4860235-1": "0", "4445157-1": "0", "3200050-1": "123", "4881719-1": "0" } }, { "human_patient_id": "329", "human_patient_uid": "4620347-1-M", "PMID": "26508941", "title": "A Case of Ectopic Adrenocorticotropic Hormone Syndrome in Small Cell Lung Cancer", "patient": "A 69-year-old male with underlying hypertension was admitted with a complaint of general weakness started 10 days ago. The patient had been taking irbesartan 150 mg and thiazide 12.5 mg for 3 years. He had 20 pack-year history of smoking. The initial blood pressure was 128/82 mm Hg, the respiratory rate 20 breaths per minute, and the temperature was 36\u2103. Chest auscultation revealed decreased breathing sound on the left upper area of chest wall.\nLaboratory findings were as follows: white blood cell count, 8,190\u00d7109/L; hemoglobin, 16.4 g/dL; platelet count, 170\u00d7109/L; glucose level, 235 mg/dL; sodium, 141 mEq/L; potassium, 1.7 mEq/L; chloride, 88 mEq/L; lactic dehydrogenase, 863 U/L; D-dimer, 0.08 \u00b5g/L; and C-reactive peptide, 2.30 mg/L. Arterial blood gas analysis was pH 7.574, pCO2 50.1 mm Hg, pO2 122 mmHg, HCO3 40 mmol/L, and oxygen saturation was 98.8% suggesting metabolic alkalosis.\nThe chest radiography taken on admission showed left upper lobe atelectasis and mass like lesion infiltrating the left upper bronchus (). Chest computed tomography (CT) scans revealed about 7\u00d75-cm-sized mass in left upper lobe showing invasion to the main pulmonary arterial trunk (). Biopsy was done with bronchoscopy and the pathology confirmed small cell carcinoma. Positron emission tomography CT showed hepatic and both adrenal gland metastases.\nOur primary impression was hyperaldosteronism or pseudohyperaldosteronism according to the lab finding of hypokalemia associated with hypertension. Aldosterone and renin level being normal, hypokalemia with metabolic alkalosis in patient with lung cancer infiltrating left upper lobe suggested Cushing syndrome due to ectopic ACTH secreting tumor. The ACTH level was elevated to 535.61 pg/mL and the cortisol level was elevated to 47.43 \u00b5g/dL. The level of cortisol was not suppressed with low dose and high dose dexamethasone suppression test and the 24-hour urinary free cortisol was still elevated to 1,796.93 \u00b5g/day. Brain magnetic resonance imaging showed normal pituitary gland and no cerebral metastases. The malignant tissue obtained with bronchoscopy was positive in ACTH marker stain. These finding were consistent with Cushing syndrome caused by ectopic ACTH production (). The patient had no cushingoid appearance such as moon face, skin change or central obesity, and hypokalemia was the only clinical feature to suspect diagnosis.\nTo reduce the high cortisol level before chemotherapy, ketoconazole (400 mg two times a day) and spironolactone were administered for EAS. As hypokalemia resolved, so did the metabolic alkalosis. It was not needed to maintain corticosteroid treatment after normalization of hypokalemia. Once ectopic ACTH production controlled, the patient was transferred to the oncology division to have systemic chemotherapy and survived for 15 months.", "age": [ [ 69.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4620347.xml", "relevant_articles": { "11273885": "123", "18091371": "123", "8840954": "12", "8622281": "123", "19388868": "0" }, "similar_patients": { "2740289-1": "123", "8040973-1": "0", "6984178-1": "123", "6220734-1": "123", "6106901-1": "13" } }, { "human_patient_id": "330", "human_patient_uid": "7271463-1-M", "PMID": "32493232", "title": "Disseminated Talaromyces marneffei infection presenting as multiple intestinal perforations and diffuse hepatic granulomatous inflammation in an infant with STAT3 mutation: a case report", "patient": "A 37-month-old male infant from Guangxi Province, China, with recurrent pneumonia since infancy exhibited recurrent pain in the right abdomen and fevers for 3 months. The abdominal pain was related to eating food, but not to physical activity and position. His maximum temperature was 40 \u00b0C. Physical examination revealed lymphadenopathy in the left neck and hepatomegaly. His abdomen was soft with normal bowel sounds; however, the liver and spleen were palpable 4 cm below his costal margins. The rest of the physical examination was unremarkable. Routine blood tests revealed 16.9 \u00d7 109/L leucocytes, 9.5 \u00d7 109/L neutrophils, 4.4 \u00d7 109/L lymphocytes, 0.22 \u00d7 109/L eosinophils, and 90 g/L hemoglobin. Blood was observed in his stool. The serum albumin and C-reactive protein levels were 29.0 g/L (40\u201360 g/L) and > 192 mg/L (< 10 mg/L), respectively. Erythrocyte sedimentation rate was 28 mm/h (\u226415 mm/h). Serum aspergillus galactomannan antigen was 0.826 (normal<0.5). His CD4+ T-cell count was 1078 cells/\u03bcL (normal: 410\u20131590 cells/\u03bcL), while the percentage of his natural killer cells was 18.10% (normal: 9\u201315%). Serum immunoglobulin (Ig) M was slightly elevated, while IgG and IgA were normal. Serum aspartate aminotransferase, alanine aminotransferase, and creatinine levels, as indicated by the blood test, were all normal. Anti-nuclear and anti-HIV antibodies and INF-\u03b3 autoantibody were all negative. Blood and stool cultures were negative. Chest computed tomography (CT) showed disseminated patchy exudates throughout the left upper and lower lobes of the right lung. Contrast-enhanced CT of the whole abdomen showed hepatomegaly, intestinal wall thickening in the ascending colon, and mesenteric lymphadenopathy in the cecum with (Fig. a-b). Colonoscopy showed a cobblestone pattern (non-ulcerated mucosa separated by ulcers) with erosion, ulcer, polypoid lesions, and lumen deformation from the colon to the cecum (Fig. a-b). Crohn\u2019s disease and intestinal tuberculosis were also considered based on the presence of multiple ulcers on colonoscopy and on the clinical manifestations. Therefore, the patient was treated with mesalazine and thalidomide for 1 week but without clinical improvement. After 5 days, the colon biopsy revealed mucosal ulceration and ulcers in the colon and massive infiltration of the mucosa and submucosa by the engorged macrophages. A large number of fungal spores were observed in the interstitial space and the macrophages (Fig. ). Subsequently, the patient underwent ultrasound-guided liver biopsy. Histopathological examination of the liver tissue revealed granulomatous inflammation (Fig. a), while periodic acid-Schiff staining revealed aggregates of macrophages engorged with numerous yeast-like organisms 2\u20134 \u03bcm in diameter. These yeast-like organisms were spherical to oval and had a transverse septum (Fig. b). After 2 weeks, the bone marrow culture confirmed T. marneffei, and the diagnosis of disseminated Talaromycosis involving the liver, colon, lymph nodes, and bone marrow was made. Intravenous voriconazole (12 mg/kg every 12 h) was administered for 4 weeks. Subsequently, the liver size reduced and was palpable 1 cm below the costal margin. Voriconazole was then administered orally (7 mg/kg twice a day). Unfortunately, 1 month later, his abdominal pain and fever recurred, and he presented with reduced urine output. Abdominal radiograph showed bowel perforation, pneumoperitoneum, and intestinal obstruction (Fig. ). Hence, an emergency exploratory laparotomy with intestinal resection, anastomosis, and a colostomy was performed. During the surgery, we observed the pebble sign with erosion in the ileocecal intestinal cavity. The lesion segment was approximately 8 cm long. The ileocolic junction was narrow and obstructed, and the adjacent intestinal ducts were edematous and thickened. Postoperative pathology indicated the presence of T. marneffei. Whole-exome sequencing was performed using the patient\u2019s and his parents\u2019 peripheral blood. A heterozygous missense mutation in exon 17 of the STAT3 gene (c.1673G>A, p.G558D) was found in the patient but not in his parents (Fig. ), indicating that the mutations were de novo.\nThe patient\u2019s condition improved after the administration of intravenous voriconazole and antibiotics for 10 days and oral voriconazole for 7 months. Seven months after the surgery, repeat colonoscopy showed good recovery of the stoma located at the ileocecum, within 35 cm from the anal verge (Fig. c). No relapse was observed during the 18-month period of antifungal treatment.", "age": [ [ 37.0, "month" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7271463.xml", "relevant_articles": { "32493232": "123", "32933586": "0", "25886601": "0", "30651958": "0", "16855414": "0" }, "similar_patients": { "7264840-3": "123", "7264840-1": "123", "7220345-1": "0", "8059157-1": "123", "7594432-1": "13" } }, { "human_patient_id": "331", "human_patient_uid": "7433964-1-M", "PMID": "32855952", "title": "Angioleiomyoma of the Lower Lip", "patient": "A 57-year-old male patient presented to the Department of Oral and Maxillofacial Surgery, of a dental institution with a swelling in the left lower lip region for about 6 months. Swelling was uniform in consistency and painless with no other signs of inflammation. Clinical examination revealed an exophytic, nodular, reddish-purple, well-outlined lesion measuring about 1 cm \u00d7 1 cm in diameter, located on the left lower lip []. The patient had no other dentoalveolar symptoms and no sign of local infection.\nSurgical excision under local anesthesia with diode laser (980 nm) was done. An elliptic incision was made to fully enucleate the lesion along with the overlying mucosa [Figure and ]. Antibiotic and analgesic therapy was given to the patient for 5 days. Antibacterial chlorhexidine gluconate rinse (0.12%) was prescribed for one week.\nThe specimen was fixed in 10% formalin solution. The histological examination made with hematoxylin and eosin [] and smooth muscle actin staining [] revealed the diagnosis of angioleiomyoma. The lesion was composed of large vascular channels of varying caliber, surrounded by thick walls of irregularly arranged, spindle-shaped cells []. The spindle-shaped cells showed elongated blunt-ended nuclei and eosinophilic cytoplasm-forming smooth muscle bundles showing interlacing patterns with collagen fibers between dilated and slit-like vascular spaces []. Whorled bundles of muscle fibers were seen fused with the vessel walls. Necrosis, atypical mitosis, and pleomorphism were not observed in the histological examination. The postoperative course of the patient was uneventful with 7 days of follow-up []. The tissue was completely healed and there was no sign of scar. There was no recurrence at 3 months of follow-up.", "age": [ [ 57.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC007xxxxxx/PMC7433964.xml", "relevant_articles": { "29780644": "123", "32855952": "123", "22165050": "0", "28603563": "0", "31359135": "0" }, "similar_patients": { "6415311-1": "123", "4860377-1": "123", "4860377-2": "123", "4687217-1": "0", "3830242-1": "123" } }, { "human_patient_id": "332", "human_patient_uid": "7052443-1-M", "PMID": "32108507", "title": "A Rare Case of Drug-Resistant Nocardia transvalensis\nInfection in a Renal Transplant Patient", "patient": "A 69-year-old male with past medical history of hypertension, asthma, coronary artery\ndisease, end-stage renal disease secondary to hypertensive glomerulosclerosis s/p\ndeceased donor kidney transplant 4 months back presented to the hospital with\nproductive cough, fever, and anorexia of 2 weeks duration. Vitals on presentation\nwere temperature of 38.5\u00b0C, heart rate of 72/min, blood pressure of 167/62 mm Hg,\nand respiratory rate of 22/min with oxygen saturation between 90% and 92% on room\nair. On physical examination, he had bibasilar crackles, more prominent on the left.\nLaboratory findings revealed an elevated white blood cell count of 15 100/\u00b5L, blood\nurea nitrogen of 21, and creatinine of 1.9 (baseline creatinine of 1.9-2.0).\nUrinalysis was unremarkable. Chest X-ray (CXR) showed a left lower lobe\nconsolidation. Pan cultures were obtained, and treatment was started with\nintravenous vancomycin and piperacillin/tazobactam for empiric coverage. His\nposttransplant immunosuppressive regimen of mycophenolate mofetil, tacrolimus, and\nprednisone was continued along with other supportive measures. His prophylactic\nmedications of nystatin, valganciclovir, and trimethoprim-sulfamethoxazole (TMP-SMX)\nwere discontinued 4 weeks prior to admission after completion of 3-month\nposttransplant prophylaxis course. On day 3, 1 out of the 4 blood cultures grew\ngram-positive bacilli for which ampicillin was added for better central nervous\nsystem (CNS) penetration to cover Listeria infection as well. The\ncomputed tomography (CT) scan of head and lumbar puncture ruled out any CNS\ninvolvement. On day 7, final report of the blood culture revealed weakly acid-fast\nfilamentous gram-positive bacteria. On further review of the gram stain and colony\nmorphology of the organisms, it was identified as Nocardia. The\ndiagnosis of disseminated nocardiosis secondary to pulmonary source (left lower lobe\npneumonia) was made. Treatment for Nocardia was initiated with\nimipenem/cilastatin, and initial antibiotics (vancomycin, piperacillin/tazobactam,\nand ampicillin) were discontinued. Despite changing the antibiotics, there was no\nsignificant improvement in his overall clinical condition, and the patient remained\nwith supplemental oxygen\u2013dependent, persistent cough and with productive phlegm.\nSpeciation of the organism was consistent with Nocardia\ntransvalensis, which was resistant to imipenem, bactrim, ceftriaxone,\naugmentin, and minocycline. It was reported to be sensitive to linezolid, amikacin,\nmoxifloxacin, clarithromycin, and tobramycin. Imipenem/cilastatin was discontinued,\nand linezolid along with moxifloxacin was initiated on day 14. Within the next 3\ndays, the patient started showing signs of improvement and was discharged home in a\nstable condition. He took linezolid 300 mg daily and moxifloxacin 400 mg daily for\n12 months and remained asymptomatic. His follow-up visits were uneventful, and the\npatient was asymptomatic. Repeat CXR at the follow-up visit showed resolution of the\npneumonia.", "age": [ [ 69.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7052443.xml", "relevant_articles": { "34372796": "123", "21249414": "12", "32146457": "12", "27900974": "12", "26867364": "12" }, "similar_patients": { "5764217-1": "123", "3432333-1": "0", "4414227-1": "12", "8279285-1": "123", "8375157-1": "1" } }, { "human_patient_id": "333", "human_patient_uid": "8706098-1-M", "PMID": "34947039", "title": "Malassezia restricta Pneumonia in Solid Organ Transplant Recipients: First Report of Two Cases", "patient": "A 43-year-old male with idiopathic pulmonary fibrosis underwent double-lung transplant (LT) at our institution in July 2014. His immunosuppressive regimen included tacrolimus, mycophenolate mofetil, and prednisone. His early post-LT course was complicated by one episode of humoral rejection (at 17 months post-LT) treated with high dose steroid therapy, one episode of acute cellular rejection (at 19 months post-LT) treated with thymoglobulin at the dosage of 125 mg per day for 6 days, and a persistent acute cellular rejection a month later treated with another course of thymoglobulin at the same dosage. During these treatments, he also received pre-emptive valganciclovir in consideration of minimal Cytomegalovirus (CMV) blood replication. Then, 22 months after-LT, he required admission for fever and bilateral pneumonia. A chest computed tomography (CT) showed persistent ground glass opacities, with tree-in-bud appearance, of the right middle and lower lobes (a). Laboratory results showed an elevated C-reactive protein of 78.8 mg/L (normal range 0\u20135 mg/L) and a normal white blood cells count. Blood cultures turned negative. The forced expiratory volume in one second (FEV1) was 1.73 L and the forced vital capacity (FEV1) of 2.16 L. Empirical antibiotic and antifungal therapy with meropenem, linezolid, and liposomal amphotericin B was started with mild clinical improvement. A broncho alveolar lavage (BAL) showed no growth on bacterial and fungal cultures, and galactomannan on BAL was negative. Lung transbronchial biopsy (TBB) showed no signs of acute rejection but was notable for acute bronchitis with aggregates of round and oval elements suggestive for fungi at the PAS staining. PCR 18S-sequencing was performed on the fresh tissue and identified Malassezia restricta. The patient was then started on voriconazole, with a significant progressive improvement in respiratory function, with an increase in both FEV 1 (2 L) and FVC (2.55 L). During the antifungal treatment, the tacrolimus dosage was adjusted according to the serum concentration and aimed at trough levels of 8\u201310 ng/mL. After 12 months, a new lung-TBB (36 months after-LT) showed the persistence of Malassezia restricta on PCR 18S-RNA molecular identification. At an 18-month follow up (42 months after-LT), both lipid-enriched culture and 18S-RNA on biopsy were negative for fungal pathogens, and the chest-CT-scan showed a notable improvement of radiographic findings (b). At a 2-year follow up (4 years after-LT), voriconazole was discontinued and the patient maintained a stable respiratory function. He had no infection recurrence at his 3-year follow up.", "age": [ [ 43.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC008xxxxxx/PMC8706098.xml", "relevant_articles": { "25344921": "1", "29884278": "12", "17292404": "1", "31926742": "12", "11927219": "12" }, "similar_patients": { "6431731-1": "123", "8411443-1": "0", "4446491-1": "13", "8589401-1": "123", "3504272-1": "1" } }, { "human_patient_id": "334", "human_patient_uid": "8706098-2-M", "PMID": "34947039", "title": "Malassezia restricta Pneumonia in Solid Organ Transplant Recipients: First Report of Two Cases", "patient": "A 52-year-old female presented with a lung nodule in the right lower lobe one year after living related donor kidney transplant (KT) for nail-patella syndrome in February 2020. Her post-KT course was uncomplicated, and her immunosuppressive regimen was based on tacrolimus, mycophenolate mofetil, and steroid. On a routine CT scan, a solitary pulmonary nodule with a small satellite lesion was accidentally found at 2 months post-KT (a). A positron emission tomography (PET) revealed high 18-Fluorodeoxyglucose-avidity with a value of standardized uptake value (SUV) of 12.3. The patient did not show any respiratory symptoms and the physical examination and laboratory results were unremarkable. Blood cultures were not performed as the patient was afebrile and the main diagnostic hypothesis was the neoplastic disease. To rule out a malignant aetiology, a CT guided transthoracic needle biopsy was performed. Histologic analysis of the specimen found granulomatous inflammation with multinucleated giant cells containing oval forms positive on PAS and Grocott staining. After deparaffination of the tissue section, we performed PCR 18S-RNA-sequencing. 18S-sequencing analysis was most consistent with the genus and species Malassezia restricta. After three-month antifungal therapy with itraconazole, a follow up CT scan showed a complete resolution of the lung nodule (b). Due to pharmacokinetic interaction between itraconazole and calcineurin inhibitors, frequent adjustments of tacrolimus dosage were needed based on through levels (max 19 ng/mL\u2013min 7.1 ng/mL) to avoid nefrotoxicity. Renal function remained constant without any rise of creatinine levels. Maintenance therapy with oral itraconazole was continued for a month further.", "age": [ [ 52.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC008xxxxxx/PMC8706098.xml", "relevant_articles": { "30879590": "12", "21766547": "12", "18655652": "0", "22129499": "0", "18695792": "0" }, "similar_patients": { "8706098-1": "123", "5609046-1": "0", "5841376-1": "0", "4400496-1": "123", "4283919-1": "123" } }, { "human_patient_id": "335", "human_patient_uid": "7450344-1-M", "PMID": "32908756", "title": "Mucosa-Associated Lymphoid Tissue Lymphoma of the Larynx", "patient": "A 78-year-old man presented with a six-month history of progressive hoarseness denying dysphagia, odynophagia, hemoptysis, otalgia, or dyspnea. He was initially treated for a marginal zone lymphoma of the right orbit 2 years prior. Given his concern for vision loss, a low-dose radiation strategy of 4 Gy over 2 fractions was used, and he had a complete clinical response. He had been doing well until his new onset of hoarseness.\nA CT with contrast was obtained showing a tumor involving the left larynx at the level of the anterior false vocal fold extending into the laryngeal ventricle, true cords, and with a mild subglottic component ().\nFurther evaluation was conducted with in-office flexible nasolaryngoscopy that confirmed a submucosal mass visible on the left false vocal cord. He then underwent microdirect laryngoscopy and biopsy of the mass ().\nAnalysis revealed small monocytoid B-cells positive for CD20 with aberrant CD43 expression and negative for CD3, CD5, CD10, and BCL-6, confirming a diagnosis of extranodal marginal zone B-cell lymphoma of MALT type.\nA staging FDG-PET scan did not show any sign of FDG avid malignancy, including at the primary site. Following multidisciplinary tumor board review, since he responded well to low-dose radiation to his orbit, he was again recommended to undergo low-dose radiation 4 Gy/2fx to his larynx. After completion of radiation treatment, he reported a resolution of his hoarseness and normalization of his voice. At four-month follow-up, repeat in-office flexible nasolaryngoscopy revealed a normal exam with fully mobile vocal folds bilaterally and no evidence of recurrence or persistence. He also had a PET-CT scan which confirmed he had no evidence of disease. Unfortunately, at 7 months following treatment, the patient died unexpectedly of unknown causes.", "age": [ [ 78.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7450344.xml", "relevant_articles": { "32908756": "123", "23341516": "0", "32252935": "0", "28644156": "0", "9396038": "0" }, "similar_patients": { "7450344-2": "13", "3539458-1": "0", "5379232-1": "0", "4284932-1": "0", "7394691-1": "0" } }, { "human_patient_id": "336", "human_patient_uid": "7450344-2-M", "PMID": "32908756", "title": "Mucosa-Associated Lymphoid Tissue Lymphoma of the Larynx", "patient": "A 60-year-old woman presented with one year of worsening throat discomfort, intermittent cough, and dyspnea with exertion. She denied any hemoptysis, otalgia, or odynophagia. She had no other significant past medical or social history including no history of tobacco use.\nA CT neck with contrast demonstrated a mass involving the anterolateral right subglottic larynx with extension along the upper cervical trachea ().\nIn-office flexible nasolaryngoscopy identified a fleshy pink-colored mass in the immediate right subglottis obstructing approximately 50% of the airway. She then underwent microdirect laryngoscopy and bronchoscopy for debulking and biopsy ().\nOperative findings were notable for extension of the mass approximately 1 cm below the true vocal fold.\nPathologic analysis noted small B-cells positive for CD19, CD20, and PAX5 and negative for CD5, CD10, and cyclin D21. FISH was negative for the 18q21 MALT1 gene. The combination of these findings confirmed the diagnosis of extranodal marginal zone B-cell lymphoma of MALT type was made.\nA staging CT neck/chest/abdomen/pelvis scan was negative for metastatic disease. Following multidisciplinary tumor board review, she was recommended low-dose radiation at 24\u201330 Gy in 2 Gy daily fractions for approximately 3 weeks contingent upon review of a bone marrow biopsy. Bone marrow biopsy was negative, and radiation treatment was finalized as 30 Gy in 15 fractions over the course of 1 month. Treatment was completed by May 2018. Following radiation treatment, she reported mild dysphagia and dysgeusia which has improved. Her breathing has improved, and she has returned to her normal exercise tolerance. At 21-month follow-up, there was no evidence of disease on exam or imaging; however, she continues to report a mild cough intermittently with no issues with eating, drinking, or breathing.", "age": [ [ 60.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7450344.xml", "relevant_articles": { "32908756": "123", "28448239": "12", "25022408": "123", "25031942": "0", "28483134": "0" }, "similar_patients": { "7450344-1": "13", "5253503-1": "123", "4861795-1": "12", "6959153-1": "132", "3424656-1": "0" } }, { "human_patient_id": "337", "human_patient_uid": "8435622-1-M", "PMID": "34527707", "title": "Acute Myocardial Infarction Followed by Cerebral Hemorrhagic Infarction in Polycythemia Vera: Case Report and Literature Review", "patient": "A 60-year-old man presented to the emergency department with chest pain lasting for 2 days. Electrocardiography revealed ST-segment elevation in leads V1\u2013V4 as well as elevated levels of serum troponin T (5.68 ng/mL; normal range, <0.14 ng/mL) and a creatine kinase-myocardial band (33.73 U/L; normal range, <25 U/L), indicating AMI. Routine blood tests showed a mildly increased erythrocyte level (6.05 \u00d7 109/L; normal range, 3.5\u20139.5 \u00d7 109/L) and a significantly increased leukocyte level (20.56 \u00d7 109/L; normal range, 3.5\u20139.5 \u00d7 109/L) and platelet count (643 \u00d7 109/L; normal range, 100\u2013300 \u00d7 109/L). However, his hemoglobin level was normal (171 g/L; normal range, 130\u2013175 g/L) (). Emergency coronary angiography showed total obstruction of the middle of the left anterior descending coronary artery (). Therefore, leukocyte elevation was initially considered to be caused by stress after myocardial ischemia. After receiving 300 mg aspirin and 180 mg ticagrelor, a stent was successfully placed, and antiplatelet therapy with oral aspirin (100 mg per day) and ticagrelor (90 mg twice daily) was administered. He had no conventional risk factors for cardiovascular disease. Twelve days later, the patient suddenly developed dizziness, diplopia, and visual distortion. Cerebral computed tomography (CT) revealed a hemorrhagic infarction in the right parieto-occipital lobe (). The craniocervical CT angiogram (CTA) was normal. Blood routine test indicated mildly increased levels of hematocrit (55.4%; normal range, 40\u201350%), leukocytes (12.12 \u00d7 109/L; normal range, 3.5\u20139.5 \u00d7 109/L), and hemoglobin (183 g/L; normal range, 130\u2013175 g/L) and significantly increased platelet count (1,128 \u00d7 109/L; normal range, 100\u2013300 \u00d7 109/L). A blood electrolyte test showed an elevated potassium concentration (5.9 mmol/L; normal range, 3.5\u20135.5 mmol/L), and intravenous calcium gluconate was used to reduce blood potassium. However, in the next few days, blood routine examinations showed significantly increased levels of erythrocytes, hemoglobin, hematocrit, and leukocyte and platelet count (). Thus, bone marrow biopsy was performed, which demonstrated the proliferation of all three cell lineages. Bone marrow aspirate smears revealed active hyperplasia of bone marrow, and the ratio of G/E (granulocytes to erythrocytes) was 1.65. The proportion of granulocyte was increased, accounting for 56%, and granulocytes account for 34%. There were > 200 megakaryocytes. There were no common risk factors of atherosclerotic vascular diseases for the patient, including smoking, hypertension, diabetes, hyperuricemia, hyperhomocysteinemia, hyperlipidemia, and atrial fibrillation, etc.\nSince hematocrit and hemoglobin levels were significantly increased and bone marrow biopsy showed proliferation of all three lineage cells, PV was strongly suspected. Gene testing confirmed a positive JAK2 mutation. The patient refused venous exsanguination. Patients with thrombosis aged >60 years should be treated with either hydroxyurea or interferon for descending cell therapy. He was then treated with hydroxyurea (500 mg) twice daily and interferon (30 \u03bcg) once daily. Since the patient was still required to take antiplatelet drugs to prevent thrombosis and myocardial and cerebral infarctions, the patient was only administered ticagrelor every 12 h. After 3 months of treatment, his blood routine returned to normal.", "age": [ [ 60.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC008xxxxxx/PMC8435622.xml", "relevant_articles": { "32637283": "12", "30564468": "12", "31607320": "0", "31318655": "0", "30410841": "0" }, "similar_patients": { "4574573-1": "123", "3861510-1": "123", "8610921-1": "0", "8191094-1": "0", "8416011-1": "0" } }, { "human_patient_id": "338", "human_patient_uid": "3590498-1-M", "PMID": "23509648", "title": "Posterior Reversible Leukoencephalopathy Syndrome in a Pre-Eclamptic Woman", "patient": "A 31-year-old primigravida in her 36 weeks of gestation came to our hospital with sudden dizziness, three episodes of seizure within 20 minutes followed by unconsciousness. Seizure was generalized tonic-clonic seizure (GTCS) type and each lasted for approximately 15 second. She was known case of gestational hypertension under medication of tablet Labetalol 5 mg daily. At presentation her blood pressure was 170/110 mm of Hg pulse rate 138/minute, bilateral pedal oedema with fetal heart sound 142/min. Immediately Injection Diazepam 10 mg and Magnesium sulphate 5 gm. Bolus dose followed by 2 gm. Over 40 minutes in i/v infusion was given. Patient was admitted and shifted to obstetrics Intensive Care Unit (ICU) with diagnosis of eclampsia and differential diagnosis of intracranial hemorrhage, PRES. Biochemical and laboratory tests were unremarkable except with 3+ proteinuria on urine deep stick test. Patient had recurrent seizure in ICU so, and urgent CT was advised. CT head showed low density shadow on bilateral parietal lobe, high density shadow near the top of the cerebral sulcus (shown in ). So with respect to the CT findings and clinical presentation, RPLS was diagnosed and prompt caesarian section was done without any complication. Post operatively patient had no episodes of seizures and blood pressure was controlled with medication. Repeat CT scan of head on 7th day of postoperative showed disappearance of low density and high density shadows. She was discharged after one week, with oral antihypertensive medication, and patient had no recurrences of symptoms after 2 months of discharge.", "age": [ [ 31.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3590498.xml", "relevant_articles": { "30631368": "123", "18415913": "0", "33911762": "123", "10750343": "12", "29451101": "12" }, "similar_patients": { "4563978-1": "123", "4493738-1": "123", "3190519-1": "123", "3751096-1": "123", "4200722-1": "123" } }, { "human_patient_id": "339", "human_patient_uid": "3343253-1-M", "PMID": "22563160", "title": "Fever, anemia, and splenomegaly: A rare presentation of splenic angiosarcoma", "patient": "A 60-year-old male presented with complaints of on and off fever and lump in left upper abdomen of 1 month duration. Physical examination revealed pallor. Abdomen was soft, with no venous engorgement. There was a 10 \u00d7 7 cm lump; 5 cm below left costal margin in midclavicular line. The lump was nontender with smooth surface and sharp margins. Bowel sounds were present. Laboratory evaluation showed anemia and leukocytosis; electrolyte and liver function tests were with in normal limits.\nGeneral blood picture was suggestive of hemolytic anemia with spherocytes, target cells, and Howell\u2013Jolly bodies. Chest X-ray, X-ray abdomen, and echocardiogram were unremarkable. Upper gastrointestinal endoscopy showed antral gastritis, suggesting segmental portal hypertension. Abdominal sonography and computed tomography (CT) showed splenomegaly with heterogeneous enlargement, subcapsular hematoma with multiple ill-defined nodules in the splenic parenchyma with minimal ascites, and left pleural effusion [].\nSuspecting a splenic trauma in a congested enlarged spleen, a laparotomy with splenectomy was performed. On gross examination, spleen was enlarged in size with cut surface showing a circumscribed grey white area with diffuse hemorrhagic areas and multiple ill-defined nodules []. Microscopic examination showed the replacement of whole of the spleen by a vascular neoplasm composed of anastomosing vascular channels lined by atypical endothelial cells. Tumor was composed of solid areas and papillary fronds. These papillary fronds were lined by pleomorphic endothelial cells with pleomorphic hyperchromatic nuclei showing mitotic figures [Figures and ]. Areas of necrosis were also noted. The staining for CD31 was performed, which showed diffuse membranous positivity []. Based on these findings the diagnosis of angiosarcoma was made.", "age": [ [ 60.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3343253.xml", "relevant_articles": { "17641924": "123", "28806241": "123", "24795063": "123", "26894076": "123", "28140311": "0" }, "similar_patients": { "5398021-1": "0", "6103999-1": "0", "5805425-1": "13", "3738355-1": "0", "2766879-1": "0" } }, { "human_patient_id": "340", "human_patient_uid": "4982061-1-M", "PMID": "27028387", "title": "Treatment of Spinal Tuberculosis by Debridement, Interbody Fusion and Internal Fixation via Posterior Approach Only", "patient": "A 68-year-old male patient was admitted to our hospital with chest pain for 6 months and lower limb fatigue for 1 month. There had been no obvious cause for the onset of back pain 6 months ago. This pain was particularly evident at night and had become more severe and accompanied by lower limb fatigue 1 month previously. He had received no anti-TB therapy before admission. X-rays, MRI and CT of spine, routine blood tests, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) concentrations and hepatorenal function were examined. He had a white blood cell count was 5.7 \u00d7 109/L, ESR 87 mm/1h, CRP concentration 21.4 mg/L and normal hepatorenal function.\nThe patient consented to publication of data concerning his case.\nPhysical examination showed hypesthesia below the rib arch, Grade 1 lower limb muscle strength and Frankel Grade C neurological function. It also showed increased muscular tone in the lower limbs, knee and ankle hyperreflexia and positive sign for ankle clonus.\nX-ray films showed collapse of the T8 vertebrae and T7\u20138 intervertebral space. CT scan showed destruction of T7, T8 and the intervertebral space and sequestrum formation, especially on the left side. A paravertebral abscess was limited to T7 and T8 without an obvious gravitation abscess. The height of the T8 vertebral body was markedly reduced and the dural sac and spinal cord severely compressed by an abscess posterior to the vertebral body.\nThe patient was administered the anti-TB drugs isoniazid, rifampicin, ethambutol and pyrazinamide prior surgery. He underwent surgical debridement, interbody fusion and internal fixation via a posterior approach 7 days after starting anti-TB therapy because his paralysis progressively worsened after commencing chemotherapy. He continued to receive anti-TB chemotherapy for 18 months postoperatively.\nThe patient was placed in a prone position under general anesthesia with somatosensory-evoked potential monitoring. Extraperiosteal dissection at both non-fusion and fusion levels was performed through a midline incision. The posterior spinal construction was exposed, including the spinous processes, lamina, facet joints and transverse processes and the range of exposure at the level of decompression expanded to include the costotransverse articulations and 3\u20135 cm of the medial ribs bilaterally. Pedicle screws or hooks were placed at one or two levels superior and inferior to the level of decompression under C-arm fluoroscopy guidance.\nOne side rod was fixed temporarily to avoid spinal cord injury during decompression and focal debridement. Lesion debridement to drain the prevertebral abscess and expose the diseased vertebral bodies was performed from the side with more bone destruction and a larger abscess (left). The facet joint was resected unilaterally and the lower costotransverse joints excised with a small fragment of adjoining rib if in the thoracic segment, retaining contralateral structural integrity (Figs , ), while protecting the spinal cord and nerve root. Spatulas of various sizes and angles were used from a posterior approach to remove all lesions, including sequestra, abscesses and granulation tissues. The abscesses were drained by suction and curettage as thoroughly as possible.\nAfter distracting the intervertebral space, specially constructed titanium mesh cages or bone blocks were implanted into the interbody (Fig. ). Both ends of the titanium mesh cages were filled with autologous bone with allograft or autogenous bone in the middle. Both side rods were then fixed and both sides compressed to tighten the mesh cages and bone blocks. After completion of internal fixation, debridement and interbody thoracic fusion were performed, and strip-sized autogenous or allograft bone imbedded in the posterior body to fuse the segments that had been subjected to decompression and focal debridement. Streptomycin (1.0 g) and isoniazid (0.3 g) were deposited locally. The debrided material underwent bacterial culture and histopathologic examination.\nAntibiotics were given i.v. injection during the first postoperative week. The drainage tube was removed when the drainage volume was less than 20 mL/24 h. The patient was asked to wear a brace as soon as possible and then for at least for 6 months. The patient received anti-TB chemotherapy with the four drugs mentioned above for at least 9 months and isoniazid, rifampicin and ethambutol treatment for another 3\u20136 months thereafter.\nThe patient was examined clinically and radiologically 3, 6 and 12 months after surgery and then at yearly intervals. X-rays and blood tests were examined. Bone graft fusion was assessed using Bridwell's radiologic criteria. The patient had significant improvement in back pain after surgery and had achieved bony spinal fusion 6 months after surgery. His ESR and CRP had recovered to normal values by 3 months postoperatively.", "age": [ [ 68.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4982061.xml", "relevant_articles": { "27028387": "13", "33579244": "123", "23844494": "123", "28407019": "123", "34941107": "13" }, "similar_patients": { "8701758-1": "123", "7278100-1": "123", "5779791-1": "123", "7501658-1": "123", "6775359-1": "0" } }, { "human_patient_id": "341", "human_patient_uid": "6743656-1-M", "PMID": "31528522", "title": "Electrical Cardioversion for Wide Complex Tachycardia", "patient": "A 55-year-old male with a past medical history of paroxysmal atrial fibrillation, hypertension, hyperlipidemia, and gastritis, presented to our emergency department via ambulance with a chief complaint of lightheadedness, associated with nausea and vomiting. The patient reported feeling lightheaded two hours prior to arrival, along with nausea and three episodes of non-bloody emesis. The patient underwent cardiac ablation one month prior for his paroxysmal atrial fibrillation. He denied chest pain, shortness of breath, abdominal pain, syncope, weakness, numbness, or tingling. He received 324 mg of aspirin en route. On physical exam, his heart rate was significantly elevated at 191 beats per minute, and he was hypotensive with a blood pressure of 61/57 mmHg. His pulse oximetry was 98% on room air, and he was afebrile.\nThe patient's electrocardiogram (EKG) showed wide complex tachycardia (WCT) (Figure ). Since the patient was hypotensive, and therefore hemodynamically unstable, the decision was made to cardiovert the patient with informed consent. The patient was successfully cardioverted with 100 joules (J) of electricity on a biphasic device.\nThe patient\u2019s heart rate improved to 89 beats per minute following the cardioversion, and his blood pressure normalized (Figure ). The patient was no longer lightheaded and nauseated. The patient\u2019s troponin came back at 0.01 ng/mL (normal), he did not have any electrolyte abnormalities or anemia. His thyroid-stimulating hormone level was also normal.\nThe patient was admitted for cardiac workup, and started on flecainide and nebivolol (a beta1 selective blocker) by the cardiologist then discharged home. The patient remained in normal sinus rhythm throughout his hospital stay.", "age": [ [ 55.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6743656.xml", "relevant_articles": { "10737566": "123", "20108823": "0", "25311462": "0", "34246387": "0", "28215710": "0" }, "similar_patients": { "6682223-1": "0", "8378286-1": "0", "8143831-1": "13", "7642508-1": "123", "8604421-1": "123" } }, { "human_patient_id": "342", "human_patient_uid": "7813077-1-M", "PMID": "33489144", "title": "Immunotherapy using Histobulin in atopic dermatitis", "patient": "A 19-year-old female patient visited the Department of Allergy and Clinical Immunology, Cheju Halla General Hospital, due to oozing and severe eczematous lesions mainly on the face with a history of atopic dermatitis. She had been treated with standard symptomatic therapy including antihistamines and steroids with persistent fluctuation of symptoms and signs. All patients in this report fulfilled the Haniffin and Rajka criteria. All four patients had no past medical history except atopic dermatitis from infancy. The clinical severity score was evaluated before and after treatment using SCORAD. The total score was 103 points. Basic allergic tests (blood tests and skin prick test) were conducted on all three patients before and after treatment. They received blood tests for a complete blood count with differential, serum eosinophil cationic protein, and serum total IgE and IgE levels for specific allergens using a multiple allergosorbent test (MAST, Green Cross PD). In the MAST test, the specific IgEs for 41 allergens were evaluated, including Dermatophagoides pteronyssinus (Dp), D farina (Df), cat, dog, egg white, milk, soybean, crab, shrimp, peach, mackerel, rye pollen, house dust mites, cockroach, Clasporium herbarum, Aspergillus fumigatus, Alternaria alternata, birch-alder mix, white oak, short ragweed, mugwort, Japanese hop, hazelnut, sweet vernal grass, Bermuda grass, orchard grass, timothy grass, reed, Penicillium notatum, sycamore, sallow willow, poplar mix, ash mix, pine, Japanese cedar, acacia, oxeye daisy, dandelion, Russian thistle, goldenrod, and pigweed. The test results show the level of specific IgE for each allergen, and a normal negative range is 0.000-0.349 IU/mL.\nA skin prick test was also performed for 53 allergens. The allergens tested by the skin prick test were A alternaria, A fumigatus, A nigre, Candida albicans, Cladosporium, P chrysogenum, German cockroach, Dp, Df, dog, cat, grey elder/silver birch, grass mix, mugwort, short ragweed, black willow pollen, orchard grass, Bermuda grass, timothy, English plantain, English rye grass, Holm oak, Japanese cedar, cotton flock, milk mix, egg mix, chicken, beef, pork, cod, oyster, salmon, prawn, mackerel, tuna, almond, peanut, bean, carrot, cabbage, walnut, maize, peach, tomato, black pepper, spinach, wheat flour, rabbit, kapok, hop, F acacia, pine, and poplar. Skin prick tests are performed on the upper back between the scapular spine and L1 spine. The area to be tested was cleaned with alcohol and coded with a skin marker pen corresponding to the number of allergens being tested. The marks were 2 cm apart. A drop of allergen solution is placed beside each mark. A small prick through the drop is made to the skin using a Morrow Brown Needle\u00ae (Morrow Brown\u00ae Allergy Diagnostics) by holding the needle perpendicular to the test site and punching firmly through testing extract and into epidermis. The drop was removed immediately after the skin has been pricked, and the used needle was discarded immediately. Histamine hydrochloride 1 mg/mL was used as a positive control, and physiologic saline was used as a negative control. The results were measured as the wheal size. Reactions were read after 15 minutes and described as negative (0, no reaction), 1+ (reaction greater than control reaction but smaller than half the size of histamine), 2+ (equal to or more than half the size of histamine), 3+ (equal to or more than the size of histamine), and 4+ (equal to or more than twice the size of histamine). The minimum size of a positive reaction is 3 mm.\nPatients received 2 mL of Histobulin (12 mg human immunoglobulin/0.15 \u03bcg histamine complex) by subcutaneous injection in the deltoid areas of upper arm every week for 24 or 36 times. All patients stopped to take antihistamine at least a week before Histobulin therapy.\nHer clinical severity was improved from 42.5 to 0 (points), and her atopic dermatitis was remitted clinically after 36 Histobulin injections. The clinical severity scores, laboratory test results, and skin test results before and after treatment are shown in Figure . Her atopic dermatitis was remitted after 36 Histobulin injections (Figure ). In the MAST, specific IgE for allergens was not detected, and in the skin prick test, only Japanese cedar was positive as 2 + before and after treatment. The URI frequency was decreased, and she did not suffer from URI for 1 year including the treatment period.", "age": [ [ 19.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7813077.xml", "relevant_articles": { "11089421": "12", "2649214": "2", "23369181": "2", "2192782": "2", "7039862": "2" }, "similar_patients": { "7869337-1": "123", "7813077-2": "123", "7813077-4": "123", "8588720-1": "123", "6509670-1": "12" } }, { "human_patient_id": "343", "human_patient_uid": "7813077-2-M", "PMID": "33489144", "title": "Immunotherapy using Histobulin in atopic dermatitis", "patient": "A 15-year-old male patient visited the clinic due to erythematous lesions on the face, neck, and elbow. He suffered from atopic dermatitis from infancy which had been more aggravated during the last year. He received standard treatment with persistent fluctuation. His clinical severity was improved from 29 to 16.5 (points) after 24 Histobulin injections. The laboratory and skin test results before and after treatment are shown in Figure . The severity score of atopic dermatitis was improved gradually with 24 Histobulin injections. The results of the MAST showed 10 positive allergens (Dp 100<, Df 100<, milk 1.0, Cladosporium 0.69, ragweed short 6.95, Bermuda grass 0.79, orchard grass 2.49, timothy grass 0.36, P notatum 0.56, and Japanese cedar 14.19) before treatment, and 9 allergens were positive (Dp 100<, Df 100<, C herbarum 0.65, ragweed short 1.37, Bermuda grass 1.30, orchard grass 2.85, reed 0.64, P notatum 0.57, and Japanese cedar 5.14) after treatment. In the skin test, six allergens (Dp 4+, Df 4+, grass mix 2+, orchard 3+, timothy 2+, and English rye grass 3+) showed positive reactions before treatment, and 7 allergens (Dp 4+, Df 4+, grass mix 3+, orchard 3+, timothy 2+, English rye grass 4+, and Japanese cedar 3+) were positive after treatment. Before treatment, the patient suffered from URI 4 times per year, but he did not experience URI during or after treatment for a year.", "age": [ [ 15.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7813077.xml", "relevant_articles": { "8258612": "0", "498489": "123", "17159431": "12", "20292294": "0", "1597349": "2" }, "similar_patients": { "7813077-1": "123", "7813077-4": "123", "7869337-1": "123", "7813077-3": "123", "2846738-1": "12" } }, { "human_patient_id": "344", "human_patient_uid": "7813077-3-M", "PMID": "33489144", "title": "Immunotherapy using Histobulin in atopic dermatitis", "patient": "A 15-year-old male patient visited the clinic due to vesiculopapular eruptions on the face and neck. He suffered from atopic dermatitis also from infancy, but it was abruptly aggravated during the past week. He received standard treatment thereafter showing persistent fluctuation. He received Histobulin therapy through 24 injections, and the clinical severity scores improved gradually from 26.1 to 14.2 after 24 Histobulin injections (Figure ). The MAST results showed that 2 allergens were positive (A alternata 100 95th percentile for his age and height) and pitting pedal edema.\nRoutine blood investigations, including renal and liver function tests were within normal limits. His baseline coagulation study and thyroid function test were normal. Urine analysis revealed nephrotic range proteinuria (4+ on dipstick and elevated protein creatinine ratio of 15.78) and microscopic hematuria. He also had hypoalbuminemia (1.4 g/dL) and hypercholesterolemia (1427 mg/dL). Ultrasound showed moderate pleural effusion, ascites and enlarged hyperechogenic kidneys. Suspecting SRNS, renal biopsy was performed, which revealed features of FSGS (). In view of severe anasarca and respiratory distress, he was initiated on albumin infusion with 20% albumin, 1 g/kg followed by diuretics, furosemide 1mg/kg/dose. After 2 sessions of combined albumin and diuretic therapy, edema settled and albumin level increased to 2 g/dL. Genetic study using targeted exome sequencing, revealed heterozygous missense mutation in exon 14 of ANLN gene that results in amino acid substitution of methionine for threonine at codon 821 (p.Thr 821Met;ENST00000265748.7). Currently, he is being treated with tacrolimus 0.1 mg/kg/day and enalapril 0.3 mg/kg/day, along with normal protein and no added salt diet. His parents have been counselled about the disease course, trial of immunosuppressive therapy and the need for renal transplantation in future.", "age": [ [ 2.0, "year" ], [ 6.0, "month" ] ], "geneder": "M", "file_path": "noncomm/PMC008xxxxxx/PMC8592633.xml", "relevant_articles": { "17384358": "12", "16501243": "0", "26908705": "0", "8990484": "0", "34342187": "12" }, "similar_patients": { "5998725-1": "123", "8593884-1": "1", "4544554-1": "12", "8632055-1": "12", "7398381-1": "123" } }, { "human_patient_id": "373", "human_patient_uid": "7031945-1-M", "PMID": "32075693", "title": "Primary aldosteronism concurrent with subclinical Cushing\u2019s syndrome: a case report and review of the literature", "patient": "A 54-year-old Chinese man of Han nationality, a retiree, went to a local hospital because of hematuria. He had an abdominal computed tomography (CT) scan showing right renal mass and bilateral adrenal nodules. He was referred to our hospital for further examination and treatment. He denied any medical history, except for a 4-year history of hypertension. He took 5 mg amlodipine besylate every day. He was married and living with his family; he had smoked tobacco for 30 years and denied alcohol consumption. Members of his family had no history of endocrine diseases or malignant tumors.\nAt the time of admission, his temperature was 37 \u00b0C, the pulse was 80 per minute, and his blood pressure was 161/75 mmHg. His height was 168 cm and weight 64 kg. There was no physical sign of Cushing\u2019s syndrome, such as central obesity, skin atrophy, buffalo hump, red striae of skin, or moon face. The results of his cardiovascular, respiratory, abdominal, and neurological examinations were all unremarkable. A laboratory examination (Table ) showed an electrolyte disturbance, in particular, a very low serum potassium level. His 24-hour urinary free cortisol was elevated. The function of his thyroid gland, parathyroid hormone, metanephrine, and normetanephrine were in normal range.\nThe endocrine findings (Table ) showed high plasma aldosterone level and low plasma renin concentration. He then underwent a captopril challenge test which did not show suppressed level of plasma aldosterone concentration. A diagnosis of PA was of no doubt. On the other hand, the circadian rhythm of cortisol disappeared, and his serum cortisol level was not suppressed by an overnight dexamethasone suppression test (ODST) and low-dose dexamethasone suppression test (LDDST). He was diagnosed as having SCS.\nAn abdominal CT scan revealed a mass in the parenchyma of his right kidney (Figs. and ) and there was a rounded, low-density mass in his right adrenal gland and a rounded, low-density mass in his left adrenal gland (Figs. , , , and ); the larger adrenal mass was approximately 2.6 cm \u00d7 2.3 cm on the left adrenal gland. These findings indicated the possibility of a renal tumor and bilateral adrenocortical adenomas.\nSequential adrenal venous sampling (AVS) without adrenocorticotropic hormone (ACTH) stimulation was performed next. The result of AVS (Table ) reminded us that the right adrenal gland was responsible for aldosterone hypersecretion, and, quite possibly, the left was responsible for hypercortisolism.\nRight nephrectomy and right partial adrenalectomy were performed first. The golden-yellow nodule in the right adrenal was approximately 2.5 cm \u00d7 2 cm \u00d7 0.8 cm macroscopically. The pathological diagnosis of the right adrenal nodule was adrenocortical adenoma. The right kidney tumor was proven to be a fibroma. Three days after operation, our patient\u2019s serum potassium was 4.5 mmol/L without any supplementary treatment. The hypertensive drug was changed to 2 mg terazosin every day.\nA laparoscopic left partial adrenalectomy was conducted 1 month later. When admitted to hospital, his blood pressure was 127/83 mmHg controlled by 2 mg terazosin every day, and his level of potassium was 4.9 mmol/L without any supplementary treatment. We examined his cortisol at 8 a.m. before operation, which was 344.81 nmol/L. The operation was successful and the level of cortisol at 8 a.m. had reduced to 192.01 nmol/L 2 days after operation. The nodule in the left adrenal was golden-yellow; it was approximately 3 cm \u00d7 2.5 cm \u00d7 2 cm. The pathological diagnosis of the left adrenal gland nodule was proven to be adrenocortical adenoma. After the second operation, doctors advised 30 mg hydrocortisone should be taken once a day with a weekly reduction of 10 mg until withdrawal, and 2 mg terazosin should be taken once a day.\nDuring postoperative follow-up, terazosin was gradually stopped, and blood pressure and serum potassium remained normal. Approximately 2 months later, his ACTH concentration was 98.73 pg/ml which was above the reference value. This meant our patient had adrenocortical insufficiency, and he continued to take hydrocortisone. Months later, hydrocortisone was stopped, the concentration of cortisol and ACTH were 233.46 nmol/L and 49.43 pg/ml, respectively. The plasma aldosterone concentration was 104 pg/ml and plasma renin concentration was 3.1 uIU/ml. Normalization of aldosterone-to-renin ratio (ARR), cortisol, and ACTH were reached and our patient did not complain of any discomfort.\nImmunohistochemistry (Fig. ) of the two adrenal nodules revealed that the right one had positive immunostaining for CYP11B2, which is essential to synthesize aldosterone, and the left one had positive immunostaining for CYP11B1, which is essential to synthesize cortisol. These results confirmed the right nodule was responsible for the secretion of aldosterone and the left nodule was responsible for the secretion of cortisol. Somatic KCNJ5 mutation (Leu168Arg) was found in the right adrenal tumor (Fig. ), and there was no KCNJ5 mutation in the left adrenal tumor.", "age": [ [ 54.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7031945.xml", "relevant_articles": { "11403095": "123", "34095465": "12", "20463748": "123", "16791399": "123", "26248855": "123" }, "similar_patients": { "5585945-1": "123", "5913873-1": "123", "6580498-1": "1", "4722418-1": "123", "6787834-1": "123" } }, { "human_patient_id": "374", "human_patient_uid": "6247715-1-M", "PMID": "30532787", "title": "Chorea Hyperglycemia Basal Ganglia Syndrome in a 63-Year-Old Male", "patient": "A 63-year-old Caucasian male presented with a one-week history of uncontrolled choreiform movements of his left upper extremity. As described by the patient, his left arm began \u201cjerking uncontrollably out of nowhere\u201d while working in his shed at home. Prior to this development, the patient stated he had one similar episode a year ago which lasted for two days and resolved spontaneously. He did not seek evaluation at that time. His past medical history consisted of uncontrolled insulin-dependent diabetes, hypertension, schizoaffective disorder, and polysubstance abuse in remission. He reported having diabetes mellitus for at least 10 years. Reviewing the medical records, his previous HbA1C readings ranged from 13.8% to 12.4% over a 12-month span prior to his admission. His average blood sugar readings over this time ranged from 300 to 350 mg/dl. BMI was 25.3 kg/m2. His home insulin regimen included 10 units of NovoLog three times a day with meals and Lantus 20 units every morning. He was not on any oral diabetic medications. The patient reported that he was not compliant with his home insulin medications. Notably for comparison, an MRI brain performed 5 months before for a fall did not reveal any abnormalities. He denied any recent medication changes, illnesses, or headaches. His ESR and CRP were elevated, and his initial glucose level was 339 mg/dl. HbA1C was 9.9% on the day of his admission. Vital signs were normal upon presentation, and physical exam was benign aside from the hemichorea movements of the left upper extremity. Our differential diagnosis included neoplastic disorders (metastatic brain disease and brain tumor), Huntington's disease, ischemic or hemorrhagic stroke, trauma, and drug or chemical toxicity (dopamine agonist or phenytoin). CT scan of the head showed areas of high density in the right lenticular nucleus and right caudate head. Subsequent precontrast MRI demonstrated T1 and T2 hyperintense abnormalities in the caudate nucleus portion of the right basal ganglia (). Postcontrast MRI of the brain showed no abnormal enhancement excluding the possibility of a mass lesion (). Diffusion-weighted MRI brain images did not reveal any abnormal restricted diffusion in the right basal ganglia which excluded ischemia (). All of these changes were consistent with the movement pattern he was displaying and with a diagnosis of CHBG. Other conditions that have been known to cause hyperintense imaging abnormalities on MRI such as this include various cellular respiratory toxins such as carbon monoxide, methanol, and cyanide. Leigh disease and hyperammonemia from chronic cirrhosis have also been known to cause this. Our patient did not have any history that would correlate with these alternative possibilities, and additionally, none of these alternatives have been known to present with hemichorea. Inpatient treatment consisted of restarting the patient's home insulin regimen with the addition of inpatient corrective coverage. This included Lantus 20 units every morning and 10 units of NovoLog 3 times a day with meals. The patient's symptoms eventually resolved with control of his blood sugar levels. Control was achieved over roughly 48 hours during which our patient's blood glucose levels dropped from an average of mid-300s to the 170\u2013200 mg/dl range. The choreoathetosis progressed from continuous movements to intermittent and then finally to resolution.\nEndocrinology was consulted for assistance with the patient's difficult glycemic control. During his posthospitalization outpatient course, our patient began to consistently adhere to his outpatient diabetic medications. Lantus was increased to 40 units every morning and NovoLog was increased 13 units 3 times a day with meals. His HbA1C 6 months after discharge had improved to 7.1%. There were no further occurrences of choreiform movements. This time course of events demonstrates how treatment of hyperglycemia can adequately treat and lead to complete resolution of hemichorea-hemiballismic movements in patients with CHBG. In this case, symptomatic improvement began being observed 48 hours after initiation of glucose control.", "age": [ [ 63.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6247715.xml", "relevant_articles": { "30532787": "123", "33307650": "123", "7605683": "12", "28943546": "12", "20108823": "0" }, "similar_patients": { "6570927-1": "12", "8614164-1": "12", "7335451-1": "12", "3970396-1": "123", "2621138-1": "123" } }, { "human_patient_id": "375", "human_patient_uid": "4320909-1-M", "PMID": "25685590", "title": "A Case of Primary Renal Carcinoid Tumor", "patient": "A 75-year-old man was referred to our institution after being diagnosed incidentally with a 3.0 cm, solid, right renal mass on computed tomography (CT) performed to assess thoracic trauma. He had no specific symptoms. The results of laboratory investigations were within normal limits. On abdominal CT, a renal mass was identified in the upper portion of the right kidney (). The mass measuring approximately 3.0 cm \u00d7 2.0 cm was well defined, and it consisted of a partial cystic mass within a mainly solid renal mass. The cystic component contained calcifications. No definite hydronephrosis or caliectasis was detected. The patient had no other abnormal findings, such as suspected distant metastasis or lymph node metastasis. At that time, we considered cystic renal cell carcinoma (RCC), oncocytoma, and adult-type cystic nephroma as the differential diagnosis of this mixed cystic and solid renal tumor. In May 2012, we planned an open partial right nephrectomy; however, during the operation, we noticed that the tumor had invaded the renal capsule. Therefore, we performed open right nephrectomy. After histopathological evaluation, the lesion was diagnosed as a primary renal carcinoid tumor (neuroendocrine tumor). The tumor met both the histological and immunochemical criteria for designation as a carcinoid tumor. Grossly, the resected tumor included a white-yellow soft mass attached to a cystic lesion (). On microscopic examination, the tumor consisted of a ribbon-like, trabecular, or rosette like pattern of cells with a high nucleus: cytoplasm ratio (). Immunohistologically, the tumor cells were positive for antibodies for the neuroendocrine markers, chromogranin A (), neural cell adhesion molecule (NCAM) (), and somatostatin receptor type 2 (SSTR2) (). The tumor cells had a mitotic count of 4 mitoses/10 high-power fields and the level of proliferation marker Ki-67 was 5%. The microscopic and immunohistological findings were compatible with the diagnosis of a primary renal neuroendocrine tumor (grade 2). No local recurrence or systemic metastasis was detected during the 18-month follow-up period.", "age": [ [ 75.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4320909.xml", "relevant_articles": { "25685590": "123", "24003360": "123", "24322410": "123", "26181565": "0", "22450836": "123" }, "similar_patients": { "4596506-1": "13", "3736966-1": "0", "6590521-1": "0", "7909218-1": "13", "4200141-1": "0" } }, { "human_patient_id": "376", "human_patient_uid": "7738091-1-M", "PMID": "33327331", "title": "Greenstick fracture of the ulnar shaft following physical therapy in an adult", "patient": "A 23-year-old man, without any past medical history, underwent open reduction, and internal fixation for a radial neck fracture and left olecranon fracture (Fig. ) sustained during a fall. He was referred to the rehabilitation department due to pain and a limited range of motion (ROM) of his left elbow 2 months following the injury. Physical examination of the left elbow in the clinic of the rehabilitation department revealed an active ROM of 40\u00b0 to 60\u00b0, passive ROM of 40\u00b0 to 60\u00b0, supination of 0\u00b0 to 20\u00b0, and pronation of 0\u00b0 to 30\u00b0. Physical therapy was arranged with therapeutic exercises including joint mobilization, stretch exercises to help increase elbow extension, as well as elbow flexion and extension with a sand bag and wrist supination and pronation with a stick following 15 minutes of infrared therapy.\nAfter approximately 6 months of physical therapy, the pain and ROM in the elbow improved, with an active ROM of 40\u00b0 to 100\u00b0, passive ROM of 5\u00b0 to 110\u00b0, supination of 0\u00b0 to 30\u00b0, and pronation of 0\u00b0 to 35\u00b0. He was admitted again 9 months after surgery to undergo removal of the internal fixation, and was discharged home after 2 days. During admission for removal, an X-ray taken showed bony union of the fracture site and smooth cortical bone without obvious fractures around the previous injury site or the drill holes (Fig. ). After discharge, the patient remained under the rehabilitation program at our department and the symptoms gradually improved.\nHowever, on 1 day, 5 months after removal of the internal fixation, the patient complained of left elbow tenderness with a \u201cbreaking\u201d sound occurring during physical therapy. He was promptly sent to emergency room in our hospital and the results of a subsequent X-ray revealed a greenstick fracture of the left ulnar shaft (Fig. ). After discussion with our orthopedic department, a cross-elbow splint was applied. Two months after splinting, the tenderness and numbness of the elbow was alleviated, and callus and increased density of the ulnar shaft was identified on subsequent X-rays (Fig. ).", "age": [ [ 23.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7738091.xml", "relevant_articles": { "33327331": "123", "33619861": "13", "28314869": "13", "23610759": "123", "18774042": "12" }, "similar_patients": { "4625882-1": "13", "7815679-1": "13", "8028123-1": "1", "6081541-1": "13", "5505878-1": "13" } }, { "human_patient_id": "377", "human_patient_uid": "3665142-1-M", "PMID": "23723589", "title": "Lytic and sclerotic (mixed) vertebral metastasis in ganglioneuroblastoma", "patient": "A 13-year-old girl presented with a history of abdominal distension, back ache, and loss of appetite and weight of 3 months\u2019 duration. Her medical history was otherwise unremarkable. On examination, an ill-defined mass of 10 cm \u00d7 8 cm size was palpable in the right hypochondrial region, extending 7 cm below the right costal margin and medially up to the umbilical region. Ultrasonography of the abdomen revealed a large, heterogeneous mass of 18 cm \u00d7 16 cm \u00d7 16 cm size arising from the right adrenal, infiltrating the right lobe of liver, and displacing the right kidney inferolaterally.\nFine-needle aspiration cytology (FNAC) of the adrenal mass showed clusters of malignant cells forming rosettes in an eosinophilic fibrillary background with high nuclear cytoplasmic ratio. In addition, scattered ganglion cells with eccentric-placed nuclei and prominent nucleoli were also present and features were consistent with ganglioneuroblastoma [].\nThe 24-h urinary vanillyl mandelic acid VMA level was 5.4 mg/24 h (normal is < 7 mg/24 h). Radiography of the lumbo-sacral spine showed mixed lytic and sclerotic lesion involving the L3 vertebrae [] and confirmed by computed tomography (CT) soft tissue with bone window []. To assess the extent of neuroblastoma and metastasis, PET-CT was done. It showed [Figures and ] increased uptake in the right adrenal and liver areas with metastatic involvement of L3 vertebrae. These imaging findings and FNAC reflected the diagnosis of ganglioneuroblastoma; stage IV (vertebral and liver metastasis). The patient was treated with intravenous zoledronic acid[] and carboplatin, vincristine, etoposide, and cyclophosphamide[] based chemotherapy regimen.", "age": [ [ 13.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC003xxxxxx/PMC3665142.xml", "relevant_articles": { "32975903": "0", "33292836": "0", "26036461": "12", "9756015": "0", "21938171": "0" }, "similar_patients": { "3518997-1": "13", "4715884-1": "13", "7093919-1": "13", "2788470-1": "0", "5398108-1": "0" } }, { "human_patient_id": "378", "human_patient_uid": "6087000-1-M", "PMID": "30097050", "title": "Wilms tumor, pleuropulmonary blastoma, and DICER1: case report and literature review", "patient": "A 3-year-old girl was admitted for fever and cough. She was diagnosed as having pleuresia and pleural drainage along with broad spectrum antibiotics was prescribed. Lack of improvement after a few days led to complete the work-up with a CT scan (Fig. a, b). The scan showed a tissular lesion of the left lower pulmonary lobe associated with a tumor of the right kidney. Lung biopsy showed blastema, without being able to distinguish whether its origin was WT or PPB despite multiple analyses by various pathological experts. Following the recommendations of the national panel of expert of both tumors, we decided to treat the patient as a metastatic WT following the International Society of Paediatric Oncology protocol (SIOP WT2001) []. A nephrectomy was thus performed after 6 weeks of chemotherapy (vincristine and actinomycin), with a good response in both sites (Fig. ).\nHistologic analysis confirmed the diagnosis of WT with an intermediate risk (epithelial type) which was classified as a stage IV. Lung surgery was scheduled several weeks later. During this period, using high-throughput sequencing of a panel of genes involved in endocrine tumor development, we identified a heterozygous pathogenic variant in exon 23 of the DICER1 gene (LRG_492). This variant c.4407_4410del, p.Ser1470Leufs*19, leading to loss of the RNase III active site, has been previously associated with pleuropulmonary blastoma [].The mutation was confirmed by Sanger sequencing (Fig. ). This led to a high suspicion of associated PPB. Pre-operative workup showed increase in tumor size, and chemotherapy was modified (by adding ifosfamide and doxorubicin) to try to reduce tumor volume and vascularization. After the first course of chemotherapy, the patient developed respiratory distress due to a massive increase in tumor size, leading to mediastinal compression. It was then decided to remove the left lung (Fig. e, f).\nA left pleuro-pneumonectomy with intra-pericardic ligature of the vessels and without cardiac assistance was performed. The early postoperative course was uneventful. The pathologist confirmed the diagnosis of type 3 PPB with R0 resection. Postoperative chemotherapy consisted of eight courses (27 weeks) of vincristine, actinomycin, and doxorubicin. After 1-year follow-up, the patient remains asymptomatic and is considered to be in remission.", "age": [ [ 3.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6087000.xml", "relevant_articles": { "28097783": "13", "34398502": "123", "12544779": "13", "18210767": "123", "16794508": "13" }, "similar_patients": { "7789227-1": "123", "8116104-1": "13", "4715884-1": "13", "8134796-1": "0", "8570905-1": "123" } }, { "human_patient_id": "379", "human_patient_uid": "4989059-1-M", "PMID": "27579204", "title": "Spinous Process Osteochondroma as a Rare Cause of Lumbar Pain", "patient": "A 70-year-old male, with history of hypertension, dislipidemia, and hyperuricemia, presented to our institution with a one-year long history of progressive and intense lower lumbar pain causing great limitation of daily activities. Physiotherapy or medication was ineffective. The patient reported a palpable mass on this region for years but with neither symptoms nor size progression. He had no constitutional or neurologic symptoms. On examination, there were tenderness over the central and left paraspinal area and a fixed palpable mass of size approximately 7 \u00d7 5 cm, hard in consistency, and no pulse. The pain aggravated with flexion, extension, and rotational trunk movements. Neurologic examination was normal. Radiographs showed a bony mass protruding posteriorly, apparently from the L5 vertebra. CT scan showed a 7 cm long well-limited mass with an apparent cartilage cap arising from the spinous process of L5. It was lateralized to the left with adjacent paraspinal muscle compression (). Under general anesthesia, the tumor was marginally resected along with the L5 spinous process through a posterior approach (). Histologic examination has shown a specimen composed of trabecular bone with focus on bone marrow covered by lobules of cartilaginous tissue, without cellular atypia, consistent with osteochondroma (). After surgery pain was completely relieved, and neurologic function was normal. At one-year follow-up there was no evidence of local recurrence or symptoms.", "age": [ [ 70.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4989059.xml", "relevant_articles": { "27579204": "123", "32872061": "0", "19968229": "123", "30280082": "123", "31356982": "123" }, "similar_patients": { "3530703-1": "123", "3707327-1": "0", "5867559-1": "123", "3845547-1": "0", "3162208-1": "0" } }, { "human_patient_id": "380", "human_patient_uid": "5040571-1-M", "PMID": "27703937", "title": "Mega Prosthetic Replacement of Elbow for Resistant Nonunion of Distal Humerus", "patient": "A 49-year-old male presented with a history of bomb blast injury to his left elbow 25 years back, when he had sustained an open and comminuted fracture of left distal humerus with extension into the elbow joint. The injury was treated with wound debridement and cast application for 6 weeks. Distal humerus progressed to atrophic non-union, with severe deformity and stiffness of the elbow. He also had partial involvement of radial and ulnar nerves with stiffness and deformities of the fingers of the left hand. He presented to us for correction of the elbow deformity and to gain reasonable elbow and hand function.\nOn local examination, there were multiple scars present medially, laterally and posteriorly around his left elbow suggestive of healed wounds by secondary intention after compound injury. There was fixed flexion deformity of the elbow of 900 with further flexion up to 120 degree was possible (, ). There was partial sensory loss in the little and ring fingers and the muscle power (as per MRC grading) of the finger flexors was 3/5; wrist and those of elbow flexors was 2/5. The motor power of left fingers, wrist and elbow extensors were 1/5.\nPlain radiographs revealed atrophic non-union of the supracondylar fracture along with the deformity at the distal humerus due to malunited distal humeral fracture (, ). CT scan confirmed these radiographic findings and demonstrated a significant gap at the fracture site with grossly rotated distal humeral condylar fragments and marked disuse osteopenia.\nIn view of grossly distorted anatomy of the distal humerus, poor bone stock, bone gap at the non-united fracture, severe elbow deformity and stiffness we preferred to go for a mega prosthetic replacement of the left elbow. Under general anaesthesia, elbow was approached posteriorly by \u2019Wadsworth approach\u2019 and the fracture site was exposed. Severe fibrosis was encountered between the fractured ends of the bone, which was excised. The distal humeral condylar fragments were found to be grossly mal-positioned, osteoporosed, destructed and were not amenable to osteosynthesis or conventional total elbow replacement. Hence, the distal humeral bone fragments were excised, leading to a large bone gap at the elbow. This gap was reconstructed by using elbow mega prosthesis. Preparation for mega prosthetic replacement was done by reaming the humeral and ulnar shafts. Cemented titanium prosthesis (XLO Tm) was used for reconstruction, with ulnar stem of 132 mm and humeral stem of 175 mm length. The implant had eyes in the ulnar component for the attachment of the triceps tendon. Common flexor tendons were attached on the medial side and the common extensor tendons were attached on lateral side of triceps tendon and finally the combined tendinous complex was attached at the eye of the prosthesis with the help of non-absorbable polyester suture (Ethibond\u2122 No. 5). Intra operatively, we could achieve good correction of the elbow deformity (with ROM of 10-1500) with stable elbow joint.\nThe patient was given i.v. third generation cephalosporin and aminoglycoside for a period of three days post operatively. The antibiotics were shifted to oral at the time of discharge and were continued for a period of two weeks till suture removal. The limb was kept in a splint for 2 weeks followed by physical therapy to regain the movements and function of the elbow and hand (, ). The post-operative recovery was satisfactory and uneventful. Post-operative X-ray showed good placement of the prosthesis with adequate cementation (, ).\nAt 12 months follow up, the the patient had significant improvement in the post-operative Mayo elbow score of 80 compared to pre-operative score of only 50. The patient could now do many of his activities of daily living with left hand, which were not possible before, apart from significant improvement in the cosmetic appearance.", "age": [ [ 49.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5040571.xml", "relevant_articles": { "27703937": "123", "16007382": "123", "20676822": "123", "21768901": "123", "20191963": "0" }, "similar_patients": { "8028123-1": "12", "4719359-1": "0", "3492012-1": "12", "3058185-1": "123", "8008461-1": "123" } }, { "human_patient_id": "381", "human_patient_uid": "7334765-1-M", "PMID": "32685229", "title": "High-Dose Inhaled Nitric Oxide as Adjunct Therapy in Cystic Fibrosis Targeting Burkholderia multivorans", "patient": "The patient is a 16-year-old female with CF (genotype: F508del/W1282X), CF-related diabetes requiring insulin, and CF-related liver disease after liver transplant, who experienced a precipitous decline in lung function over the prior year, requiring frequent- near monthly -hospital admissions for intravenous antibiotics targeting her primary respiratory pathogen, B. multivorans. The patient acquired this pathogen in her sputum six years before, and over time, it developed increasing antibiotic resistance (). Notably, the patient required long-term immunosuppressive therapy following liver transplant 21 months before. Her frequency of hospital admission for pulmonary exacerbations remained unchanged for the first year after liver transplant but doubled in the succeeding 9 months. Her pulmonary exacerbations would only briefly respond to a single antibiotic, intravenous meropenem-vaborbactam. Furthermore, the patient's weight remained stagnant at the 10th percentile.\nFemale sex, body mass index \u226418 kg/m2, CF-related diabetes requiring insulin, B. cepacia complex infection, and frequent pulmonary exacerbations have all been identified as risk factors for mortality in individuals with CF and low lung function []. Cystic fibrosis transmembrane conductance regulator (CFTR) modulators have been shown to increase lung function and decrease rates of pulmonary exacerbation in individuals with CF [, ]; however, the patient's genotype and history of liver transplantation precluded her from qualifying for any CFTR modulators available at the time or therapeutic trials, respectively. Lung transplantation was discussed though the patient's colonizing pathogen and adolescent age are controversially associated with poorer outcomes [, ].\nHigh-dose inhaled NO administration via a mechanical ventilator fitted with scavenging chambers was reviewed and approved under an institutional process called \u201cInnovative Diagnostics and Therapeutics,\u201d by which independent hospital leadership evaluate novel approaches to the care of individual patients. The patient assented, and her parents provided consent for this therapy.\nThe patient received a total of 46 intermittent inhalations of 160 ppm NO over a 28-day period during two separate hospital admissions: days 1\u201312 and days 16\u201328 (). During the first admission, inhaled NO was given over 30-minute intervals up to three times daily (27 total doses). In the second admission, the treatment interval was gradually increased to 60 minutes, two times daily (19 total doses), starting with 30-minute inhalations up to three times daily (9 doses), transitioned to 45-minute inhalations twice daily (2 doses), and ultimately 60-minute inhalations twice daily (8 doses). She concurrently received intravenous meropenem-vaborbactam (dose: 4 grams every 8 hours) on days 4\u201310 and 16\u201328.\nThe NO gas source was commercially available as 850 ppm nitric oxide in nitrogen tanks that meet the Environmental Protection Agency (EPA) traceability protocol requirements (Airgas Inc., Radnor Township, Pennsylvania, USA). Oxygen, medical air, and NO were blended and introduced through a ventilator (Puritan Bennett 980 Series, Medtronic, Minneapolis, Minnesota, USA) (). A target level of 160 ppm inhaled NO and 0.21 FiO2 were delivered via a tight-fitting noninvasive mask using a pressure support mode of 2 cmH2O driving pressure over a positive end-expiratory pressure of 5 cmH2O. Because the NO source of 850 ppm is mixed with nitrogen, the ventilator was set to a range of 0.25-0.26 FiO2, in order to deliver an FiO2 of 0.21 to the patient.\nNitric oxide and nitrogen dioxide (NO2) analyzers were attached to a sampling port proximal to the facemask and provided real-time measurements. Nitrogen dioxide, a potentially harmful gas that develops when oxygen and NO are mixed, was scavenged with calcium hydroxide chambers (Spherasorb\u2122, Intersurgical Ltd, Berkshire, UK), and levels remained less than 1.5 ppm in the circuit. Ambient NO and NO2 levels were intermittently measured in the patient's room and consistently remained below EPA recommendations [] at less than 4 parts-per-billion (ppb) and 12 ppb, respectively.\nThere were no serious adverse events, and inhalations were well tolerated. Echocardiograms were performed before, during, and after the first inhalation and demonstrated normal estimated pulmonary pressures. Heart rate, respiratory rate, oxygen saturation, and blood pressure were recorded at 5-minute intervals throughout inhalations and 30 minutes after cessation. The patient did not experience any hemodynamic instability or significant hypoxia with treatments. Nitric oxide oxidizes ferrous (Fe2+) hemoglobin into the ferric state (Fe3+), known as methemoglobin. Methemoglobin levels were continuously monitored during inhalations using a peripheral pulse co-oximeter (Masimo Rainbow SetTM Technology, Irvine, CA) and never surpassed our safety threshold of 5%. Specifically, at the end of the 30-minute and 60-minute inhalations, the highest recorded methemoglobin levels were 3.1% and 4.1%, respectively, and returned to baseline prior to subsequent treatments (). Additionally, the patient received 125 mg of ascorbic acid by mouth daily (on treatment days) to enhance methemoglobin reductase activity [].\nSputum was collected prior to (days 1 and 16), midcycle (days 3 and 23), and on completion (days 12 and 28) of each NO cycle (). Colony forming units (CFU) were calculated using sputum solubilized with Sputolysin\u00ae (MilleporeSigma) and plated on Burkholderia cepacia isolation agar. On days 1, 12, 23, and 28, B. multivorans grew from the patient's sputum, but the CFU count was low (). Early in therapy (day 3), the sputum culture yielded highly antibiotic-resistant B. multivorans, consistent with months before; however, by the end of the first week of therapy (day 16), isolated B. multivorans demonstrated susceptibility to trimethoprim-sulfamethoxazole and levofloxacin and intermediate susceptibility to ceftazidime, a susceptibility pattern not seen for months.\nFever, white blood cell count, and C-reactive protein all decreased with therapy (). The patient never manifested bacteremia or hemodynamic instability suggestive of cepacia syndrome\u2014a dreaded complication of B. cepacia complex infection primarily linked to Burkholderia cenocepacia though also associated with B. multivorans []. The patient's international normalized ratio (INR) remained consistently below 1.2, and she never demonstrated evidence of platelet dysfunction, hemoptysis, or other bleeding. Her lung function improved from her baseline. Specifically, on day 1\u2014before starting high-dose inhaled NO therapy and after recently completing a 16-day course of intravenous meropenem-vaborbactam two days before\u2014the patient's forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were 1.60 L (49% predicted) and 2.05 L (56% predicted), respectively. Both measurements improved at the end of the second admission to FEV1 1.72 L (52% predicted) and FVC 2.36 L (64% predicted). The patient's baseline weight in the prior 6 months remained at the 10th percentile, and her BMI was consistently below 18 kg/m2. Her weight at the start of inhaled NO therapy was 48.4 kg (22nd percentile). It rose to a maximum of 50.3 kg (30th percentile) on day 16 but decreased to 48.9 kg (24th percentile) by day 24.", "age": [ [ 16.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7334765.xml", "relevant_articles": { "32685229": "123", "18026162": "0", "12504610": "12", "7741300": "23", "16236892": "12" }, "similar_patients": { "5680511-1": "12", "6714384-1": "1", "6945791-2": "12", "5513036-1": "1", "3655929-1": "1" } }, { "human_patient_id": "382", "human_patient_uid": "5894316-1-M", "PMID": "29692524", "title": "Different etiologies of an unusual disease: Colouterine fistula \u2013 Report of two cases", "patient": "A 77-year-old female came to the hospital with complaints of lower abdominal pain localized particularly in the left iliac fossa. On initial examination, she was febrile (100.4\u00b0F). The abdomen was distended with ill-defined palpable mass in the left lower abdomen. The pelvic examination showed a spontaneous malodorous discharge in the vagina and cervical os. She had leukocytosis (14,500/mm3) and raised erythrocyte sedimentation rate (ESR) (40 mm/h).\nShe underwent contrast-enhanced computed tomography (CECT) scan which revealed a large collection adjacent to the sigmoid colon. The collection was seen abutting the uterus with air-fluid level within the uterine cavity []. Based on CT findings, possibility of sigmoid diverticular abscess and colouterine fistula was considered. The patient underwent abscess drainage, hysterectomy, and colostomy. About 2 cm defect was noted in the posterior uterine wall communicating with the abscess and sigmoid colon. The patient improved clinically following surgery.", "age": [ [ 77.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5894316.xml", "relevant_articles": { "23346512": "123", "24755749": "123", "12118927": "123", "26497865": "123", "25731327": "123" }, "similar_patients": { "3548148-1": "123", "5662985-1": "123", "2474575-1": "123", "5894316-2": "123", "8032511-1": "123" } }, { "human_patient_id": "383", "human_patient_uid": "5894316-2-M", "PMID": "29692524", "title": "Different etiologies of an unusual disease: Colouterine fistula \u2013 Report of two cases", "patient": "A 73-year-old female patient came to the outpatient department with complaints of lower abdominal pain, blood in stools, and whitish discharge through vagina for 10 days. On examination patient's vitals were stable. The patient underwent a CECT scan abdomen which revealed irregular wall thickening involving the rectosigmoid region for a length of ~ 7 cm, with wall thickness of ~ 18 mm. There was loss of fat plane between the uterus and the thickened rectosigmoid colon with air pockets within the endometrial cavity []. Mesocolic fat and perirectal fat stranding was also seen with multiple adjacent subcentimetric lymph nodes. Based on CT findings, possibility of rectosigmoid malignancy and colouterine fistula was considered. The sigmoidoscopy and biopsy of the lesion revealed infiltrating moderately differentiated adenocarcinoma of colon. The en bloc resection of the uterus and sigmoid colon with colostomy was performed on the patient and adjuvant chemotherapy started.", "age": [ [ 73.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5894316.xml", "relevant_articles": { "12144831": "0", "18705305": "1", "24365738": "123", "23346512": "123", "14507003": "123" }, "similar_patients": { "4970400-1": "0", "5894316-1": "13", "8032511-1": "13", "2967567-1": "13", "2515293-1": "13" } }, { "human_patient_id": "384", "human_patient_uid": "5741855-1-M", "PMID": "29302294", "title": "Severe tetracycline dental discoloration: Restoration with conventional feldspathic ceramic veneers. A clinical report", "patient": "A 46-year-old woman came to the dental practice in order to change her veneers to improve her smile. The patient had feldspathic ceramic veneers from 1.3 to 2.3 for 28 years. Clinical examination revealed intense tetracycline discoloration (grade IV), gingival retraction, color change of the veneers, the ceramic of 1.1 and 1.3 was cracked and incisal wear in antero-inferior teeth. Radiographic exploration, extraoral and intraoral photographs were performed and preliminary impressions were made for the preparation of the study models.\nTreatment plan consisted on veneers from 1.6 to 2.6. Premolars and first molars were included because its dark color intensifies the width buccal corridors. Besides, restorations with veneers from 3.3 to 4.3 were considered due to tetracycline stains and incisal wear.\nFirstly, the veneers were removed and the tooth color was selected from the Vitapan 3D Master guide (Vita Zahnfabrick, Bad S\u00e4ckingen, Germany). Mock up was made to evaluate aesthetic, phonetic and functional parameters. Teeth were prepared through the mock-up in order to reduce the minimal amount of dental tissue posible. (868B 314 020, 881 314 010 y 881 314 016, Komet, Germany). Then, opaque dentine mass of microhybrid composite (Esthet-X A2O, Dentsply Sirona, Konstanz, Germany) was placed to mask the most intense stains. This technique allows the reduction of hyperchromacity and gradually increase the color value of discolored teeth (). Afterwards, the final dental color was selected by the Vitapan 3D Master guide. The glycerine gel was placed to avoid the oxygen-inhaled layer of the composites. The definitive impressions were taken with silicone (Aquasil Ultra XLV, Dentsply Sirona, Konstanz, Germany) to fabricate conventional feldsphatic ceramic veneers (Noritake kisai Co, Ltd. Japan) by the parallel stratification masking technique. For cementing, an opaque cement was selected from the try-in tests (Calibra, Dentsply Sirona, Konstanz, Germany). The composite was silicatized by an air abrasion with a pressure of 2.5 bars from a distance of about 10 mm for 5 seconds. Next, enamel and dentin were etched with phosphoric acid (Detrey\u00ae Conditioner 36, Dentsply Sirona, Konstanz, Germany) and adhesive was applied (Prime & Bond\u00ae NT, Dentsply Sirona, Konstanz, Germany). On the other hand, the feldspathic veneers were prepared as follows: etched with 9% hydrofluoric acid for 2 minutes (Ultradent, Ultradent Products. Inc.), immersed in an ultrasonic bath with distilled water, silane (Calibra, Dentsply Sirona, Konstanz, Germany) for 2 minutes heated with a dryer and a thin layer of adhesive (Prime & Bond\u00ae NT, Dentsply Sirona, Konstanz, Germany). Finally, the cement was placed inside the veneers and placed on the teeth blandly. The palatal and buccal faces were polymerized for 40 seconds each one. The cement remnants were removed and the occlusion was checked, (Figs. -).", "age": [ [ 46.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5741855.xml", "relevant_articles": { "29302294": "123", "30627454": "3", "28074386": "3", "33047734": "3", "29379907": "3" }, "similar_patients": { "5741854-2": "0", "4799832-1": "0", "4609806-1": "0", "5030409-1": "0", "6305029-1": "123" } }, { "human_patient_id": "385", "human_patient_uid": "7879847-1-M", "PMID": "33627987", "title": "Complete Uterine Septum with Cervical Duplication and Longitudinal Vaginal Septum: An Anomaly Supporting Alternative Embryological Development", "patient": "A 32-year-old nulliparous married woman presents with complaints of chronic lower abdomen pain, dyspareunia, and infertility. Her general physical examination was normal with body mass index of 22 kg/m2. On speculum examination, a longitudinal vaginal septum was seen in the proximal portion of the vagina and the cervix was partially seen beyond the septum, at a high up position []. On vaginal examination, a single cervix was felt high up, slightly deviated to the right, and a normal anteverted uterus. An ultrasound showed a subseptate uterus with midline thick muscular septum and normal adnexa. MRI revealed septate uterus with septa extending till the cervix [Figures and ]. No anomaly was found in any other organ.\nTo complete the diagnosis, consent was taken for vaginal septum removal, followed by diagnostic hysterolaparoscopy. The couple was given the option of septoplasty in the same sitting or later in case of pregnancy complications. They chose to have it later.\nUnder anesthesia, the vaginal septum was held in between two alles forceps and divided in between the two with cautery. After the septum was removed, two dimples were seen high up in the vagina. They were double cervix confirmed by magnification with the hysteroscope. Two separate sounds could be inserted through the two cervices, ruling out any cervical atresia []. The uterocervical length in both sides was 3.5 inches. Hysteroscope was introduced through both the cervices. The septum was found to be complete till the level of the cervix delineating two separate cervical canals and two cavities. Cavities on both sides of the septum were found to be similar in size. The two ostia were visualized on the respective sides of the uterus. On introducing the laparoscope, the fundus was found to be smooth with a 2 cm fundal midline fibroid and with normal tubes and ovaries []. Thus, a diagnosis of complete uterine septum with two cervices and longitudinal vaginal septum was made. On chromopertubation spill was seen on both sides.\nAfter 6 weeks of the vaginal septum resection, she reported an improvement in the dyspareunia and the heaviness in the lower abdomen []. She is being kept under follow-up to look for pregnancy complications and manage accordingly.", "age": [ [ 32.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC007xxxxxx/PMC7879847.xml", "relevant_articles": { "17498712": "123", "15568409": "1", "11441691": "123", "16600229": "13", "16500341": "13" }, "similar_patients": { "2970785-1": "123", "7431203-1": "123", "8077801-1": "123", "7550037-1": "12", "3713583-1": "123" } }, { "human_patient_id": "386", "human_patient_uid": "6058169-1-M", "PMID": "29991545", "title": "When a patient with depression is feeling sleepy, be aware of sleep apnoea", "patient": "A 67-year-old man was referred to our outpatient clinic of geriatric psychiatry because of persistent affective symptoms for years. The onset of symptoms coincided with an unpleasant work situation that, after a year of sick leave, had led to demotion at 49 years of age. From that moment on, he suffered from depressed mood, anhedonia, loss of initiative, increased appetite, worrying, catastrophising, feelings of anxiety with excessive sweating, difficulties staying asleep, nightmares, increased need of sleep, loss of energy and tiredness. Symptoms fluctuated over the years but increased during autumn/winter, after life events and during vacation periods. Over the years, he had gradually withdrawn from social activities.\nHis general practitioner (GP) had prescribed benzodiazepine hypnotics, but without any improvement of symptoms. Six weeks prior to his referral, he was started on citalopram 20 mg one time a day, a first-line serotonergic antidepressant. He had lost 7 kg bodyweight due to nausea. This weight loss increased his physical fitness, which made him feel slightly better.\nHis medical history did not reveal other mental or physical symptoms.\nThe patient was monitored, but not treated, for mild hypertension by his GP. He had no other previous medical or psychiatric history. His family history revealed no psychiatric problems or neurodegenerative diseases like M. Parkinson, M. Alzheimer or M. Huntington. The patient did not smoke or drink alcohol. Besides citalopram, the patient used simvastatin 40 mg one time a day.\nHeteroanamnestic information of his wife and son revealed a change in character since the onset of his symptoms; he became more emotional and insecure about himself. Since his retirement, he tended to lose his temper over seemingly insignificant events. His wife explained that they slept apart for years because of his snoring. She nevertheless confirmed that his breathing paused regularly during sleep. Although they consulted their GP several times for his conspicuous sleepiness, they accepted the explanation that it was an inevitable part of his depression.\nAt psychiatric examination, we saw a tired man with bags under his eyes and reduced facial expression. Higher cognitive functions were intact. He had a depressed mood and flat affect, but denied suicidal ideation. Evaluation of his sleep pattern revealed a rapid sleep onset, but strikingly, he never woke up well rested, regularly dozed off during the day and he was often at risk of falling asleep while driving his car.\nA full physical and neurological examination was remarkable only for an overweight body mass index (28.9 kg/m2) and hypertension (130/100 mm Hg). Routine blood chemistry did not reveal any abnormalities.\nIn his next visits to our clinic, the patient repeatedly brought forward his work situation as being a traumatic event. This made him anxious in situations where he did not feel in control, like during his children\u2019s holiday. He did not meet DSM-5 criteria of post-traumatic stress disorder, but he met the criteria for a depressive disorder, partly seasonal, with a superimposed generalised anxiety disorder.\nThe patient scored 38 points on the 30-item Inventory of Depressive Symptomatology (IDS), which is indicative of a severe depression. The scores on the Mini-Mental State Exam (MMSE) and the Cambridge Examination for Mental Disorders of the Elderly/Cambridge Cognition test (CAMDEX/CAMCOG) were not indicative of cognitive problems (MMSE: 30/30, CAMDEX/CAMCOG 90/120). Based on his wife\u2019s information, he was additionally referred to a sleep clinic at our hospital. The score on the Epworth Sleepiness Scale was 16/24, which is indicative of excessive daytime sleepiness. Polysomnography showed 356 apnoeas in 6 hours of sleep and an Apnoea\u2013Hypopnoea Index (AHI) of 57. The arterial oxygen saturation varied between 76% and 95%. The sleep architecture was distorted, as no slow wave sleep was present. No significant periodic leg movements or other unusual movements were observed. The patient was diagnosed with severe OSA.\nDepressed mood, anhedonia, increased appetite, constant worrying, loss of initiative, withdrawal of social activities, sleeping problems, loss of energy, increasing symptoms during autumn/wintertime and lesser facial expression.\nFeelings of anxiety with excessive sweating, catastrophising, nightmares, withdrawal of social situations and constant worrying.\nAs a result of the unpleasant work situation, social withdrawal, nightmares and feelings of anxiety with excessive sweating.\nChange in character, mood disruptions and temper issues.\nSevere loss of energy/tiredness, falling asleep while driving, dozing off during daytime, wake up not fully rested, snoring, breathing pauses during sleep, irritability, change of character, obesity and hypertension.\nCitalopram, indicated for depressive as well as anxiety disorders, slightly improved his depressed mood and reduced anxiety symptoms over the course of 8 weeks. The patient accepted cognitive\u2013behavioural therapy (CBT), to improve coping with his work situation and to increase his self-esteem. Four weeks after starting CBT, the patient started with continuous positive airway pressure (CPAP) at night to treat his OSA.\nSince starting citalopram, the patient experienced a small improvement of his affective symptoms. With CBT, his self-image became more positive. Over the course of 3 months, prior to the start of CPAP, his affective symptoms further improved, without any effect on his sleep (related) problems and fatigue. After four nights of CPAP treatment, the patient felt more energetic and started rebuilding his life. Full recovery was achieved after 4 months of treatment. His IDS score decreased from 38 to 8 (no depression present).", "age": [ [ 67.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6058169.xml", "relevant_articles": { "24822091": "12", "20045725": "0", "29946274": "13", "25711117": "0", "11640447": "0" }, "similar_patients": { "6005892-1": "123", "3542016-1": "12", "7758532-1": "12", "6693215-2": "12", "7077860-1": "0" } }, { "human_patient_id": "387", "human_patient_uid": "2739969-1-M", "PMID": "19794952", "title": "Intravitreal Bevacizumab for the Treatment of Neovascular Glaucoma Associated With Central Retinal Artery Occlusion", "patient": "A 51-year-old man with known mild, bilateral nonproliferative diabetic retinopathy was referred for evaluation of CRAO that had developed in his left eye 72 hours prior to presentation. His past medical history included systemic arterial hypertension and diabetes mellitus for the past 15 years.\nOn examination, his best-corrected visual acuity was 0.6 in the right eye and hand motion in the left eye. Intraocular pressure (IOP) was 14 mmHg bilaterally by Goldmann applanation tonometry. Anterior segment evaluation showed no NVI in the left eye, and both eyes had open angles. Fundus examination showed midperipheral retinal hemorrhages in both eyes. In the left eye, the retina was pale with attenuated arteries and a cherry red spot at the posterior pole. An intravenous fluorescein angiogram showed a delayed arm-to-retina time of 25 seconds and incomplete retinal venous filling throughout the test (>6 minutes). Choroidal perfusion was normal. Noninvasive carotid examination delineated 70% stenosis in the left proximal internal carotid artery and plaques in both internal carotid arteries.\nFive weeks later, on routine follow-up examination, he returned complaining of ocular pain in his left eye for the previous three days. The visual acuity in the left eye had decreased to no light perception, and the IOP was 45 mmHg. Neovascularization of the iris and angle was noted in the left eye. The retinal whitening and cherry red spot were still present.\nDespite maximal tolerable medical therapy to control intraocular pressure, the patient experienced marked discomfort. Treatment options were explained in detail, and after the patient gave consent, an intravitreal injection of 0.75 mg (0.03 ml) of bevacizumab was performed in a sterile fashion without anterior chamber paracentesis. One week later, there was a complete regression of the NVI, and the IOP had decreased to 25 mmHg with two topical antiglaucoma medications (dorzolamide/timolol fixed combination and brimonidine). PRP consisting of a total of 1200 burns was administered in three sessions starting two weeks after the injection. Over the next three months, recurrent NVI developed, and the patient received another IVB injection and additional PRP. Over the course of treatment, the patient received 2000 burns in all. Two months after the additional combination therapy, there was no recurrence of NVI, and the IOP was 21 mmHg with the same medications.", "age": [ [ 51.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC002xxxxxx/PMC2739969.xml", "relevant_articles": { "29135355": "1", "34577819": "0", "19568367": "123", "19337482": "12", "26604668": "12" }, "similar_patients": { "2739969-2": "123", "2739969-3": "123", "7508140-1": "123", "8177024-1": "13", "3550317-1": "123" } }, { "human_patient_id": "388", "human_patient_uid": "2739969-2-M", "PMID": "19794952", "title": "Intravitreal Bevacizumab for the Treatment of Neovascular Glaucoma Associated With Central Retinal Artery Occlusion", "patient": "A 59-year-old man with a ten-year history of diabetes mellitus was referred for evaluation of decreased vision in the previous two weeks and ocular pain for three days. He was normally followed for mild diabetic retinopathy in both eyes for the past two years.\nOn examination, his best-corrected visual acuity was no light perception in the right eye and 0.8 in the left eye. IOPs were 40 mmHg in the right eye and 18 mmHg in the left eye by Goldmann applanation tonometry. Anterior segment evaluation revealed neovascularization of the iris and angle in the right eye. Fundus examination showed CRAO characterized by retinal whitening with attenuated arteries and a cherry red spot at the posterior pole in the right eye. Both eyes had midperipheral retinal hemorrhages. Fluorescein angiography showed normal choroidal filling. Retinal arterial filling began at 30 seconds after injection, and the retinal vein was not completely filled even late in the angiogram. A noninvasive carotid examination revealed 70% stenosis of the right internal carotid artery and 50% stenosis of the left internal carotid artery.\nAfter obtaining informed consent, bevacizumab (0.75 mg/0.03 ml) was injected. One week after the injection, the NVI had regressed, and the IOP was 18 mmHg/AT with two topical antiglaucoma medications (dorzolamide/timolol fixed combination and brimonidine). PRP was started two weeks after the injection. The patient received 1800 burns overfour sessions. Four months later, there was no recurrent neovascularization, and the IOP was 15 mmHg with one topical antiglaucoma medication (dorzolamide/timolol fixed combination).", "age": [ [ 59.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC002xxxxxx/PMC2739969.xml", "relevant_articles": { "19337482": "12", "23372385": "123", "34296045": "1", "31317095": "0", "16504960": "12" }, "similar_patients": { "2739969-1": "123", "2739969-3": "123", "3550317-1": "123", "7508140-1": "123", "5125125-1": "12" } }, { "human_patient_id": "389", "human_patient_uid": "2739969-3-M", "PMID": "19794952", "title": "Intravitreal Bevacizumab for the Treatment of Neovascular Glaucoma Associated With Central Retinal Artery Occlusion", "patient": "A 75-year-old woman presented with a ten-day history of decreased visual acuity in her right eye. Her past medical history included diabetes mellitus for the last five years.\nHer visual acuity was hand motion in the right eye and 0.9 in the left eye. IOPs were 14 mmHg in the right eye and 12 mmHg in the left eye by Goldmann applanation tonometry. There was no anterior chamber reaction or NVI in the right eye. The right fundus showed a CRAO characterized by retinal opacification of the posterior pole with a cherry red spot. No clinical evidence of diabetic retinopathy was present in either eye. Fluorescein angiography showed sluggish retinal arterial flow and delayed retinal venous filling. Noninvasive carotid examination showed no evidence of obstruction.\nTwo weeks later, the patient returned for a follow-up examination. Her visual acuity in the right eye remained hand motion. However, the right eye now exhibited NVI and had an IOP of 40 mmHg. The retinal opacification was still present. After obtaining informed consent, bevacizumab (0.75 mg/0.03 ml) was injected. One week after the injection, the NVI had regressed, and the IOP had decreased to 22 mmHg with two topical antiglaucoma medications (dorzolamide/timolol fixed combination and brimonidine). PRP was performed in the right eye two weeks after the injection. The patient received 1600 burns over four sessions. Four months after combination therapy, the visual acuity remained hand motion with no recurrent neovascularization. The IOP was 17 mmHg with one topical antiglaucoma medication (dorzolamide/timolol fixed combination).", "age": [ [ 75.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC002xxxxxx/PMC2739969.xml", "relevant_articles": { "23372385": "123", "19568362": "0", "24145559": "1", "31632158": "123", "31317095": "0" }, "similar_patients": { "2739969-2": "123", "2739969-1": "123", "3550317-1": "123", "7508140-1": "123", "8177024-1": "123" } }, { "human_patient_id": "390", "human_patient_uid": "4500843-1-M", "PMID": "26191518", "title": "Ultra-thin Rigid diagnostic and therapeutic arthroscopy during arthrocentesis: Development and preliminary clinical findings", "patient": "Twenty three year-old female was complained of mouth opening limitation, TMJ pain and sound. The mouth opening at initial examination was 32 mm (Fig. ). The patient has suffered from this problem, and experienced arthrocentesis before. Under diagnosing to chronic closed lock on both TMJ and anterior disk displacement without reduction in MRI (Fig. ), ultra-thin arthroscopic diagnosis and arthrocentesis was performed, and the adhesion was removed with trocar through the portal of Chung's needle (Figs. , ). After arthrocentesis, range of mouth opening was 45 mm, and symptom was disappeared (Fig. ).", "age": [ [ 23.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4500843.xml", "relevant_articles": { "15690292": "123", "24293928": "13", "15145035": "123", "23851804": "13", "33909828": "123" }, "similar_patients": { "6421772-1": "123", "4772573-1": "123", "8365916-1": "12", "4279969-2": "12", "5971088-1": "12" } }, { "human_patient_id": "391", "human_patient_uid": "4500843-2-M", "PMID": "26191518", "title": "Ultra-thin Rigid diagnostic and therapeutic arthroscopy during arthrocentesis: Development and preliminary clinical findings", "patient": "Twenty two year-old female was complained of habitual dislocation, articular sound and pain. The patient had prior history of TMJ dislocation 3 to 4 times in a week, and reduced by herself. Chung\u2019s needle introduced to the superior joint space of the TMJ, inserted the unltra-thin arthroscopy and RF surgery tip (Fig. ) and retrodiscal tissue was injured with RF surgery instrument through the Chung\u2019s needle and irrigated the joint space (Fig. ). The patient had no pain during mouth opening and no episodes of dislocation after treatment.", "age": [ [ 22.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4500843.xml", "relevant_articles": { "33041574": "1", "24951179": "1", "10628261": "1", "10870759": "1", "25737879": "1" }, "similar_patients": { "4772573-1": "0", "4617045-1": "12", "5494200-1": "0", "8365916-1": "0", "4319332-1": "0" } }, { "human_patient_id": "392", "human_patient_uid": "5851763-1-M", "PMID": "29489700", "title": "A new surgical treatment for abdominal wall defects: A vascularized ribs-pleural transfer technique that can be used with or without a thoracic umbilical flap a case report", "patient": "An 83-year-old male patient came to the Department of Hand and Reconstructive Surgery of the People's Hospital (Zhejiang Province, China) complaining of mild pain and swelling, and upon inspection a mass was found in his left upper abdomen. This mass had been slowly increasing in size for 2 years. Two years ago, the patient had undergone an operation to remove an abdominal soft tissue fibrosarcoma. The local general surgeon had used a mesh to repair the peritoneal defect and to close the abdominal wall directly. Unfortunately, the incision did not heal due to infection, and the mesh was soon taken out by operation. The incision resulted in a draining wound, and bacterial cultures eventually showed that the wound had a methicillin-resistant Staphylococcus aureus infection. The patient repeatedly came to the clinic to have his bandage replaced, but the masses in his abdomen gradually increased in size. The patient was referred to the Hand Department, and while laboratory tests were normal, further examination by computed tomography imaging revealed that the tumor had recurred, and that the patient also had a hernia in the upper abdomen along with the infected wound. Considering the patient's condition, the main purpose of the operation was to resect the tumor and treat the hernia. The surgical procedure was designed to resect the recurrent tumor using a left upper abdomen approach under general anesthesia, but a very large (15 \u00d7 8 cm) abdominal wall defect was found on peritoneum, which could not be directly sutured (Fig. ). In this case there was no obvious skin defect. Because of this defect, a right upper abdominal lateral approach for the operation was planned. The operation was planned to include a vascularized partial 9 to 10 ribs-pleural transfer (without a thoracic umbilical flap) by the vessel pedicle of the deep inferior epigastric artery (DIEA). The vascularized partial 9 to 10 ribs-pleural transfer material was first harvested so that it was connected only by the artery pedicle (Fig. ).\nThe vascularized partial 9 to 10 ribs-pleural transfer was translocated to the left abdominal wall defect site via subcutaneous tunnel. The composite tissue was used to fill in the abdominal wall defect (Fig. ). First, we sutured the broken peritoneum to the pleura, and then sutured the intercostal muscles to the abdominal muscles. Next, we closed the skin and the abdominal wall defect. Examinations after the surgery revealed that the right lung was not harmed. The right rib donor was wired closed using 1 mm steel wire, and the muscles, subcutaneous tissue, and skin were all sutured directly.\nThree days after the surgery, the patient's basal temperature returned to normal and he began to eat a full liquid diet. Six days after the surgery, we pulled out a subcutaneous drainage tube and the patient was able to eat half liquid diet. The patient had been given an infusion of Claforan for 1 week (4 g every 12 h; North China Pharmaceutical Co. Ltd, China). Ten days after the surgery, we removed the abdominal cavity drainage tube and the patient had recovered to the point where he could eat a normal diet. Two weeks after the surgery the incision healed, sutures were removed, and the patient was discharged. One year after the surgery, no masses in his abdomen were evident, and magnetic resonance imaging scans revealed no evidence of tumor recurrence. The patient also reported no abdominal pain or swelling symptoms. The patients\u2019 diet and breathing were normal and the patient was then able to be able to resume his daily activities. Nevertheless, we continued to observe and follow up with the patient (Fig. ).\nThese study protocols were approved by the medical ethics committee of the Zhejiang Provincial People's Hospital. Written informed consent for publication of clinical details and images was obtained from the patient. A copy of the consent form is available for review upon request.", "age": [ [ 83.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5851763.xml", "relevant_articles": { "29489700": "13", "30482184": "1", "32753929": "1", "34585097": "1", "21616228": "1" }, "similar_patients": { "6531267-1": "0", "2995941-1": "12", "7890968-1": "12", "4442005-1": "12", "6070448-1": "12" } }, { "human_patient_id": "393", "human_patient_uid": "5523475-1-M", "PMID": "28781920", "title": "Delayed presentation of spinal foreign body \u2013 Case report and review of literature", "patient": "A 31-year-old white male presented with a progressive spastic quadriparesis over 1-year duration. Four years previously, he had fallen from a horse into a tree called Mandacaru (Cereus jamaracu) in northeast Brazil. At the time of the injury, the patient had several skin wounds but no neurological symptoms or signs. Four years later, he presented with new onset of spastic tetraparesis characterized by motor 4/5 strength in the upper and lower limbs; he could only ambulate with assistance.\nWhile plain radiographs of cervical spine revealed upper cervical kyphosis, computed tomography (CT) scan [] demonstrated a foreign body resembling a needle that entered the spinal canal through the left C3-C4 foramen. Magnetic resonance imaging (MRI) [] demonstrated extensive edema in the cervical spinal cord and enhancement with gadolinium of tissue surrounding the foreign body.\nThe needle was removed utilizing a left side approach to the left C3-C4 foramen. (Hodgson-like approach[] posterior-lateral view).\nA 5-cm thorn was removed []; of interest, there was no cerebrospinal fluid (CSF) leak. The postoperative course was uneventful and he continued to improve over the next 6 months.", "age": [ [ 31.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5523475.xml", "relevant_articles": { "28033295": "123", "30105136": "123", "20506942": "12", "28053773": "123", "22389654": "123" }, "similar_patients": { "4423003-1": "13", "8035593-1": "123", "4483782-1": "123", "5857326-1": "123", "3377151-1": "123" } }, { "human_patient_id": "394", "human_patient_uid": "3102881-1-M", "PMID": "21655073", "title": "Synchronous Ectopic Pancreatoblastoma in a Child: A Case Report", "patient": "A 3-yr-old boy presented with abdominal pain was referred to our institution for the evaluation of a progressive bulge in his right abdomen that his mother had first noticed seven days previous on February 12, 2009. A biochemical evaluation revealed no significant abnormalities. Serum levels of tumoral markers (AFP, CA19-9, CA125 and CEA) were within reference limits. A physical exam revealed a mildly tender mass in the right hypochondrium extending to the epigastrium; however, two lesions were found after a dynamic computed tomography (). The primary lesion (8.5 \u00d7 4.3 cm) was located in the head of the pancreas and partly herniated into the abdominal wall. While the secondary lesion (1.8 \u00d7 2.1 cm) was in the left abdomen near the spleen and the tail of pancreas, and well demarcated from the surrounding structures, and no calcifications were evident within them (). They all showed well-defined margins and inhomogeneous attenuation due to the presence of cystic and solid areas, in the venous phase () and the delayed phase (), a continuous enhancement was observed with a parenchyma density that was higher than that of the arterial phase. In addition, a large and distorted vascular shadow () inside of the tumors in the arterial phase in the primary lesion. There was no radiological evidence of nodal or distant metastases; however, there was a local infiltration of the adjacent abdominal muscle that required a laparotomy.\nSurgery revealed the primary lesion was firmly adhered to the adjacent omental and abdominal muscle; in addition, a local infiltration of the liver and stomach were also noted. The head of the pancreas was compressed and could be separated from the tumor due to well-defined margins. The bile duct, portal vein, and the inferior vena cava were also compressed but patent. The gross specimen showed a resected mass measuring 8 \u00d7 4 \u00d7 4 cm that was well circumscribed and solid with areas of necrosis and hemorrhaging. No calcifications were evident within the mass. The secondary lesion was also adhered to the adjacent omentum and spleen; however, it was well demarcated from the surrounding structures with no evidence of originating from the pancreas. A histopathological analysis revealed a resected mass measuring 3 \u00d7 4 \u00d7 3 cm, which was well encapsulated by omentum with no calcifications within the mass. The surgical resection was difficult due to the extensive nature of the tumor, but the two lesions were completely resected without the pancreas being damaged. In the final pathology report following surgery, the diagnosis of pancreatoblastoma was confirmed with histopathological results, and the secondary lesion histology and immunohistochemistry was consistent with the findings of the primary lesion ().\nAfter surgery, the patient was treated with adjuvant chemotherapy (vincristine, cyclophosphamide, and epirubicin) regularly. At the time of this report, 18 months after complete tumor resection, the patient is currently in good condition and without radiological evidence of recurrent tumor or metastases () with normal levels of CA 125, CA 19-9 and AFP to date.", "age": [ [ 3.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3102881.xml", "relevant_articles": { "18604517": "0", "25943401": "123", "26943422": "123", "11702261": "123", "17205415": "123" }, "similar_patients": { "4015757-1": "123", "7666235-1": "123", "5731208-1": "123", "3488525-1": "0", "4652416-1": "13" } }, { "human_patient_id": "395", "human_patient_uid": "5847635-1-M", "PMID": "29532185", "title": "Polypoid pulmonary arteriovenous malformation causing hemothorax treated with thoracoscopic wedge resection", "patient": "A 64-year-old man was admitted to an outside hospital 6 months prior with a brain abscess and underwent surgery. He experienced recurrent epistaxis and was on anticoagulation therapy for chronic atrial fibrillation. During follow-up, he developed dyspnea, and chest CT showed a left-sided pleural effusion (Fig. a). Chest drainage revealed the collection to be a hemothorax, and the patient was referred to our hospital. Laboratory data showed slight anemia with a hemoglobin of 9.4 g/dl. Pulmonary function tests were within normal range. Chest CT after drainage revealed a solitary 15-mm nodule in the periphery of the left lower lobe, and identification of a feeding artery and draining vein on three-dimensional CT (3DCT) suggested that the node was a PAVM (Fig. b, c). The PAVM was adjacent to the diaphragm, and multi-detector CT (MDCT) and 3DCT demonstrated that the peripheral nodule slightly displaced the diaphragm, with the nodule protruding into the pleural cavity (Fig. ). After multidisciplinary conference, we believed that surgical therapy might be preferable to catheter embolization for the following reasons. Firstly, the patient had already developed a brain abscess and hemothorax, so definitive treatment without a chance for recurrence was paramount. The second reason was that the PAVM was a solitary, small nodule located in the periphery of the lung, with MDCT and 3DCT indicating that the nodule might be in close proximity to the visceral pleura protruding into the pleural cavity, making minimally invasive wedge resection straightforward.\nThe patient was placed in the right lateral decubitus position, and VATS with three ports was performed. The maximum incision length was 15 mm. The PAVM protruded from the periphery of the lung like a polyp, and wedge resection was easily performed after simple adhesiolysis (Fig. ). There were no complications, and the patient remained asymptomatic after 1-year of follow-up.", "age": [ [ 64.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5847635.xml", "relevant_articles": { "29532185": "123", "19637665": "0", "29552518": "23", "29299698": "0", "17996600": "2" }, "similar_patients": { "8272905-1": "0", "8424910-1": "123", "6082747-1": "0", "5371496-1": "0", "5518768-1": "12" } }, { "human_patient_id": "396", "human_patient_uid": "2740038-1-M", "PMID": "19829862", "title": "Right procedure, wrong organ, an unusual case report of aortic trauma in a multiple injured patient", "patient": "A 62-year-old, white, Caucasian, British-origin, male lorry driver was admitted to the hospital late on a Friday night after an unwitnessed single vehicle road accident. His lorry was by the side of the road and he was found unconscious in the vehicle and immediately transferred to the local District General Hospital. On admission, he had already fully recovered, being alert and orientated but he had no recollection of the accident. He was haemodynamically stable, with normal vital signs and no neurological deficit. He complained only at a moderate headache. Physical examination has revealed a bruise on the upper part of his left anterior chest wall, left shoulder and forehead. The rest of the examination was entirely normal. The radiological investigation that followed included cervical spine and left arm X-rays in which no fracture was noted. A mobile AP chest X-ray was also done on admission, in which it was demonstrated a dilated aortic arch (). A subarachnoid hemorrhage was found on a moderate quality brain CT-scan (), which was attributed to traumatic brain injury and the patient was transferred to the regional Neurosurgical centre as a post-traumatic subarachnoid hemorrhage for observation. During the next two days, the patient was well without any neurological defect and he has been gradually mobilized without any major complaint. On Monday however, brain CT interpretation by a more senior member of the medical staff suggested that this may not be a post-traumatic but rather an aneurismal subarachnoid hemorrhage (SAH). A CT angiogram confirmed that his SAH was of aneurismal origin, due to the rupture of an anterior communicating artery (Acom) aneurysm () which was the actual reason for his accident. As the patient was neurologically intact and stable, an embolisation procedure for endovascular treatment of this aneurysm was decided for the following day (day 5 since the SAH event). Under general anesthesia, the right common femoral artery was punctured and a 6F appropriate vascular sheath was placed following our protocol for endovascular procedures. During the first attempt to catheterize the aortic arch for the standard pre-embolisation angiogram, an unusual dilatation of the thoracic descending aorta was noted, just distal to the origin of the left subclavian artery. The combination of these findings with the bruise in the upper left chest, made us suspicious of an aortic injury. The embolisation procedure was abandoned and an aortogram revealed an aortic dissection just distal to the left subclavian origin (). The patient was woken up and a chest CT followed, which confirmed the diagnosis of a post-traumatic dissection of the descending aorta. Subsequently, he was transferred to the cardio-thoracic unit and an aortic stent was successfully deployed for endovascular repair of the dissection (). He had an uneventful recovery and two weeks later, endovascular treatment of his Acom aneurysm was performed with platinum coils (). At the same time, a posttraumatic dissection aneurysm of the right common carotid artery (CCA) at its cervical segment was also found (). This was clinically silent, treated conservatively at that stage [] and the patient was eventually discharged three weeks after the primary event. At the six month follow-up, the patient had made a very good recovery and returned to full activities. The aortic dissection was not visible anymore in imaging but there was a recurrence of the previous coiled Acom aneurysm due to coil compaction. Thus, a new embolisation procedure with platinum coils was performed to treat this aneurysm recurrence. At the same stage, the right CCA dissection aneurysm was endovascularly treated using platinum coils, as it showed no signs of regression [,].", "age": [ [ 62.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC002xxxxxx/PMC2740038.xml", "relevant_articles": { "28411526": "12", "31497447": "123", "22991520": "12", "19364031": "12", "22242293": "12" }, "similar_patients": { "4550747-1": "123", "5579789-1": "123", "3152739-1": "123", "6914354-1": "123", "3369966-1": "123" } }, { "human_patient_id": "397", "human_patient_uid": "7273010-1-M", "PMID": "32407609", "title": "De Novo Status Epilepticus in patients with COVID-19", "patient": "A 49-year-old right-handed AA woman with a past medical history of rheumatoid arthritis, schizoaffective, and conversion disorder presented to the UAB emergency room for evaluation of altered mental status after a witnessed seizure. There was no travel or contact exposure to COVID-19, and she had no symptoms of COVID-19. At presentation, she had an axillary temperature of 99.5F, respiratory rate of 16 breaths per minute, heart rate of 120 beats per minute, blood pressure of 180/95 mm Hg, and oxygen saturation of 94%. The neurologic exam revealed lethargy and disorientation to time and place. There was no meningismus. CT head was normal. Continuous video EEG monitoring was obtained to rule out subclinical seizures and status epilepticus. Scalp EEG showed severe background slowing in the delta range and the presence of multiple seizures (approx. 4-6 every hour over the next 8 hours) emanating from the midline and left fronto-central regions (Figs. , ). Initially, there was a clinical correlate of facial twitching, head version to the right followed by a bilateral tonic\u2013clonic seizure. In the latter half, there was electroclinical dissociation with the presence of only electrographic seizures. The patient was intubated and treated with multiple doses of lorazepam, levetiracetam, and propofol for sedation. Soon after arrival, the patient was tested for SARS-CoV-2 by reverse-transcriptase polymerase chain reaction (RT-PCR) through a nasal swab specimen, which returned negative. MRI brain without contrast was unrevealing for any definitive pathology. Her clinical course over the next 36 hours improved significantly with resolution in status epilepticus, and she was extubated within 48 hours. A lumbar puncture was not performed due to rapid improvement, and excellent response to levetiracetam. However, within 72 hours of the initial presentation, the patient developed fever, shortness of breath, myalgias, and nonproductive cough. A repeat nasal swab RT-PCR for SARS-CoV-2 returned positive. She remained stable with a mild cough and was eventually discharged home on levetiracetam and recommendation to self-quarantine.", "age": [ [ 49.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7273010.xml", "relevant_articles": { "33860395": "12", "24955075": "123", "33770609": "12", "34343115": "12", "34763960": "13" }, "similar_patients": { "7273010-2": "13", "7486016-1": "13", "7497292-1": "123", "7586424-1": "123", "8096577-1": "123" } }, { "human_patient_id": "398", "human_patient_uid": "7273010-2-M", "PMID": "32407609", "title": "De Novo Status Epilepticus in patients with COVID-19", "patient": "A 73-year-old right-handed AA woman with a known history of hypertension, diabetes mellitus, and chronic kidney disease presented to the UAB emergency room with shortness of breath, lower extremity edema, and confusion. There was no travel history, and contact exposure to COVID-19 was unknown. A significant past neurological history included surgical repair of left frontal skull base ethmoidal encephalocele and ventriculoperitoneal shunt for hydrocephalus. At presentation, she had an axillary temperature of 90.6 F, heart rate of 44 beats per minute, blood pressure of 86/71 mm Hg, and oxygen saturation of 100%. There was no focal neurological weakness or neck stiffness, but she had diminished level of consciousness. Chest X-ray demonstrated patchy bilateral opacities and serum procalcitonin (0.53 ng/mL) was elevated. She was admitted to the intensive care unit with the diagnosis of sepsis. The next morning, bedside nurses noticed persistent face and arm myoclonus with worsening altered mental status that was concerning for status epilepticus. Scalp EEG showed marked background voltage attenuation and slowing, continuous 0.5-0.75 Hz bilateral independent periodic discharges (BIPDs) over the left and right hemisphere that evolved to form recurrent (approx. 5/hour) discrete seizures emanating from either right or left fronto-central-parietal regions (Figs. , ). Myoclonic status epilepticus with coma (MSE) was diagnosed and treated with intravenous levetiracetam, lacosamide, phenytoin, and midazolam to achieve burst suppression for 48 hours. Four days later, the EEG improved significantly with the cessation of epileptiform activity. However, clinically she worsened with multi-organ failure requiring blood transfusions and hemodialysis. Tracheal aspirate tested positive for SARS-CoV-2 by RT-PCR. Due to a strict isolation policy to minimize the spread of COVID-19, the MRI brain was not obtained. Instead, a CT brain and perfusion study were performed a day after the MSE ceased, and it did not reveal any abnormality that could explain the etiology of MSE. For the next 3 weeks, multiple attempts to arouse or extubate failed after sedatives were held. Care was withdrawn, and the patient expired.", "age": [ [ 73.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7273010.xml", "relevant_articles": { "33944850": "123", "32837729": "123", "31372926": "12", "29851670": "123", "33784269": "123" }, "similar_patients": { "7273010-1": "13", "5832162-1": "123", "8531578-1": "0", "8551889-1": "13", "8142772-1": "13" } }, { "human_patient_id": "399", "human_patient_uid": "2740084-1-M", "PMID": "19829813", "title": "Late presentation of a paranasal sinus glass foreign body: a case report", "patient": "A 47-year-old Caucasian man presented with forehead swelling and puffiness around the eyes. The swelling had gradually increased over a period of two months. The patient had purulent nasal discharge and no visual symptoms. Sixteen years ago, he was involved in a road traffic accident in which he sustained a laceration on his forehead as he collided with the windscreen of the car. He attended his local accident and emergency department and the laceration was treated by primary suturing under local anaesthesia (LA). No Plain radiographs were carried out. The wound healed well and the patient had no problems.\nOn examination, a 5 cm linear scar was noted over the forehead swelling. The swelling measured 6 cm x 3 cm and was mildly tender. The patient underwent a complete ear nose throat examination. The nasal speculum examination showed sinusitis of the left paranasal sinuses which was confirmed by endoscopy. The CT (computed tomography) scan of paranasal sinuses () showed a radio-opaque foreign body (FB) in the left ethmoid sinus with opacification of all sinuses on the left side.\nThe patient underwent functional endoscopic sinus surgery with removal of glass fragment and draining of the sinuses. His symptoms resolved completely following the procedure. At 12 months follow-up, the patient has had no similar problems and remains asymptomatic.", "age": [ [ 47.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC002xxxxxx/PMC2740084.xml", "relevant_articles": { "9280420": "0", "16010108": "0", "10077255": "0", "10209625": "13", "10767468": "0" }, "similar_patients": { "5652117-1": "0", "4800463-1": "0", "6339757-1": "123", "3423774-1": "0", "2993987-1": "123" } }, { "human_patient_id": "400", "human_patient_uid": "4274482-1-M", "PMID": "25568763", "title": "Late Differentiation Syndrome in Acute Promyelocytic Leukemia: A Challenging Diagnosis", "patient": "The first patient, a 53 years old man, was diagnosed of high risk microgranular variant APL, presenting gingivorrhagia and fever. Anemia (Hb: 7.8 g/dL), more than 10\u00d7109/L leucocytes (11.8\u00d7109/L), and thrombocythopenia (platelets: 2.75\u00d7109/L) were present as well as coagulopathy (prothrombine time: 54%; fibrinogen: 114 mg/dL). The bone marrow aspirate showed infiltration by 93% of promyelocytes, and 80% of them were hypogranular. The diagnosis was confirmed by conventional cytogenetic, FISH and molecular studies, identifying the t(15,17) and PML/RAR (bcr3) isoform.\nThe patient was included in the LPA 2005 PETHEMA protocol and received idarrubicin, 12 mg/m2 on days 2, 4, 6 and 8 and ATRA, 45 mg/m2 since day 1. According to the protocol, the patient received dexamethasone at dose of 5 mg/12 hours during 15 days as DS prophylaxis because of leucocytes count at diagnosis was >5\u00d7109/L.\nTwenty-four hours after stopping dexamethasone, when he had just recovered from neutropenia (neutrophils: 1.2\u00d7109/L), the patient developed fever without any clinical focus or microbiological documentation. Although wide spectrum antibiotics (piperazilin-tazobactam and teicoplanin) were administered, febrile syndrome was maintained. Six days later, on day 22, with neutrophil counts of 2.8\u00d7109/L, the patient developed hemodynamic instability with maintained hypotension, tachycardia, tachypnea and oliguria with fluid retention, respiratory insufficiency and evidence of hepatic failure. The chest radiography showed bilateral alveolar infiltrates and venocapillary hypertension signs. The patient was admitted to the Intensive Care Unit (ICU), requiring invasive mechanical ventilation and vasoactive drugs. At that moment, in absence of any microbiological documentation, late DS was suspected and ATRA was discontinued. Dexamethasone was administered and significant clinical and radiological improvement was observed 4 days after initiation. After complete recovery, ATRA was reintroduced without further complications. Eight months after achieving molecular complete remission (CR), the patient relapsed with central nervous system involvement, and promyelocytic infiltration was detected in the cerebrospinal fluid analysis. Rescue therapy, that included arsenic trioxide (ATO) plus intrathecal liposomal cytarabine, leaded to achievement of molecular remission and the patient received allogeneic stem cell transplantation. At the present time, he remains and disease free, 20 months after transplantation. The second patient was a 56 years old lady, diagnosed of low risk APL based on laboratory investigation due to hemorrhagic diathesis and fever. At diagnosis she presented anemia (Hb: 7.8 g/dL), leucopenia (0.4\u00d7109/L) and thrombocytopenia (platelets: 46\u00d7109/L). The bone marrow aspirate showed 38% of blasts, all of them abnormal promyelocytes, and the diagnosis was confirmed by cytogenetic and molecular analysis, detecting t(15,17) and PML/RAR (bcr1) isoform, respectively.\nShe was also included in the LPA 2005 PETHEMA protocol and received idarrubicin 12 mg/m2 days 2, 4, 6 and 8 and ATRA 45 mg/m2 since day 1. Since it was classified as of low risk, no DS prophylaxis was required.\nSeventeen days after treatment initiation, the patient developed fever with no clinical focus and no microbiologic documentation. Wide spectrum antibiotics (piperacilin/tazobactam, teicoplanin and amikacin) were administered without improvement. At day +22, when granulocyte count started to recover (0.350\u00d7109/L), the patient evidenced crepitants on right pulmonary base, without dyspnoea or cough. Bilateral pulmonary infiltrates were observed in thorax X-ray and the computerized tomography reported the presence of bilateral pulmonary opacities, with areas of unpolished glass. This was radiologically suggestive of fungal infection and empiric treatment with B-amphotericin, cotrimoxazol and oseltamivir was given together with enlarged spectrum antibiotics.\nSeven days later, on day +28, the patient developed respiratory failure with dyspnea, requiring large debit oxigenotherapy. Intensive care unit admission was required, requiring non-invasive mechanical ventilation. At that time, DS was suspected and ATRA was discontinued starting treatment with dexamethasone at dose of 10 mg twice per day. Forty-eight hours later, significant improvement was observed, with disappearance of fever and respiratory symptoms. ATRA was reintroduced during the consolidation without any further complications.", "age": [ [ 53.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4274482.xml", "relevant_articles": { "16858973": "123", "20670478": "123", "24385831": "123", "9856675": "13", "7645395": "13" }, "similar_patients": { "5649878-1": "123", "5412762-1": "13", "6684484-1": "13", "8577590-1": "13", "2843861-1": "123" } }, { "human_patient_id": "401", "human_patient_uid": "5265797-1-M", "PMID": "27442680", "title": "Rhabdomyolysis associated with single-dose intravenous esomeprazole administration", "patient": "A 45-year-old male patient visited the emergency room (ER) because of lower chest discomfort starting 6 hours earlier. He also complained of thirst and limb numbness. His medical history included diabetes mellitus, bronchial asthma, and unstable angina for 4 years, 2 years, and 1 year, respectively. He had been taking aspirin (100 mg/d), clopidogrel (75 mg/d), atorvastatin (10 mg/d), and candesartan (8 mg/d) for 1 year without changes. He took those medicines on the morning of his admission. He regularly used a Symbicort Turbuhaler\u00ae (AstraZeneca Korea, Seoul, Republic of Korea) (160/4.5 \u03bcg) for asthma management. One month before the present admission, he discontinued the oral hypoglycemic agents prescribed by his primary physician. He denied recent alcohol consumption and had quit smoking 1 year earlier. Except for these symptoms, he initially had no complaints, such as muscular pain, fever, upper respiratory symptoms, or signs, on visiting the ER. He had no history of excessive physical activity or recent trauma.\nOn initial physical examination in the ER, his vital signs were as follows: blood pressure, 100/60 mm Hg; heart rate, 71 beats/min; respiratory rate, 20 times/min; and body temperature, 36.6 \u00b0C. On chest auscultation, no abnormal sounds, such as rales or wheezing, were audible, and his heartbeat was regular without murmur. His general skin turgor was decreased, and his tongue was dry. His conjunctivae were not anemic and sclerae were not icteric. There were no palpable lymph nodes in the head or neck area. Organomegaly was not seen in the abdomen. No pretibial pitting edema, muscular swelling, or skin color changes were detected on either lower extremity. There was no tenderness in the upper or lower extremities. His muscle power was within normal limits.\nCompared with a previous ECG, the rhythm and voltage were unchanged. His initial troponin-I was less than 0.1 ng/mL, creatinine kinase (CK) was 144 U/L (0\u2013190 U/L), lactate dehydrogenase (LDH) was 220 U/L (135\u2013225 U/L), and CK-MB, subunit of CK, was 3.5 ng/mL. Other initial laboratory data were hematocrit 45% (39%\u201352%), hemoglobin 14.5 g/dL (13\u201317 g/dL), white blood cell count 11,280/mm3 (4000\u201310,000/mm3, neutrophils: 68.2%, lymphoid cells: 25.6%, and monocytes: 4.5%), and platelet count 256,000/mm3 (130,000\u2013400,000/mm3). Liver function tests were as follows: alkaline phosphatase 84 IU/L (35\u2013130 IU/L), aspartate aminotransferase (AST) 21 IU/L (0\u201337 IU/L), alanine aminotransferase (ALT) 42 IU/L (0\u201341 IU/L), and glucose 696 mg/dL. Hemoglobin A1c (HbA1c) was 9.3% (4.2%\u20135.9%). Blood urea nitrogen (BUN) and creatinine were 19.9 mg/dL (6.0\u201320.0 mg/dL) and 1.11 mg/dL (0.6\u20131.2 mg/dL), respectively. Electrolyte results were sodium 123 mmol/L (135\u2013145 mmol/L), potassium 4.7 mmol/L (3.3\u20135.1 mmol/L), and chloride 80 mmol/L (98\u2013110 mmol/L). Serum osmolality was 296 mOsm/kg. Urinalysis with micro revealed no protein or blood on a dipstick and red blood cell 1 to 4/high-power field.\nContinuous intravenous insulin and hydration with normal saline were started. In addition, 40 mg of esomeprazole was infused intravenously under a suspicion of GERD. Glucose levels, measured by a blood sugar meter, decreased to 240 mg/dL and chest discomfort improved 6 hours after this management. In the mean time, there were no other oral, intramuscular, and intravenous drug therapies except for oral lactulose for his constipation. He felt mild discomfort in the right buttock at that time but did not complain to the medical team. However, he complained of severe right buttock pain 12 hours after the esomeprazole infusion. Tender muscle swelling of 8 cm in diameter was seen in the right buttock area and a reddish skin color change was noted (Fig. ). Serum CK and LDH levels increased to 40,533 and 1326 U/L, respectively, and AST and ALT levels also increased to 320 and 83 IU/L, respectively. BUN and creatinine levels were 23.9 and 1.49 mg/dL, respectively. We started vigorous hydration through isotonic saline infusion and urine alkalinization by intravenous bicarbonate infusion. Another 40 mg of esomeprazole was administered because we did not regard esomeprazole as the causative agent of the rhabdomyolysis at that time. Serum CK, LDH, AST, and ALT levels were 84,226, 1943, 603, and 171 IU/L, respectively, 24 hours later. On the third day in hospital, he was admitted to the nephrology ward. Esomeprazole was ended, and hydration and alkalinization were continued. Serum CK and LDH levels decreased gradually (Fig. A and B), and his muscular symptoms and swelling in the buttock area improved gradually. A bone scan using 20 mCi of 99mTc-hydroxymethylene diphosphonate was performed on the seventh day in hospital and revealed multiple and diffuse uptake in the soft tissues of the right buttock and both lower legs (Fig. ). His clinical manifestations and laboratory findings improved, so he was discharged on the 12th day. We added oral hypoglycemic agents, linagliptin 5 mg and metformin 500 mg, to his previous drugs (aspirin, clopidogrel, candesartan, and atorvastatin). He is being followed in our outpatient department with no recurrence of rhabdomyolysis at 6 months.", "age": [ [ 45.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5265797.xml", "relevant_articles": { "27442680": "123", "26521193": "123", "12894392": "12", "11766073": "12", "31875741": "123" }, "similar_patients": { "5708908-1": "12", "4901012-1": "13", "3230026-1": "13", "5934790-1": "0", "8543899-1": "12" } }, { "human_patient_id": "402", "human_patient_uid": "7981744-1-M", "PMID": "33768855", "title": "Paraneoplastic giant cell arteritis and prostate cancer: A case report of a not common association", "patient": "The authors report a case of a 73-year-old Caucasian male with background history of type 2 diabetes and arterial hypertension diagnosed with prostatic adenocarcinoma in December 2018. Radical prostatectomy was performed, and the patient was started on hormone therapy with cyproterone and adjuvant radiotherapy (March 2019). He had 1-month history of night sweats and headache and 1-week history of moderate, nonirradiating pain in the anterior thighs and low-grade fever. At examination, the patient was pale, sweaty and had a grade 2/5 panfocal heart murmur. Laboratory tests revealed normocytic normochromic anemia, erythrocyte sedimentation rate (ESR), transaminases, C-reactive protein (CRP), and procalcitonin. Cultures were drowned, and empirical antibiotics were started. The head CT scan and lumbar CT scan were unremarkable. Blood cultures and serologic tests for atypical agents were negative. A transthoracic echocardiogram was performed and showed no valvular vegetations. A thoracic-abdominal-pelvic CT scan was performed and showed only moderate hepatomegaly. After ten days of empirical antibiotic with doxycycline and gentamicin, the patient maintained low-grade fever and pain in the anterior thighs with worsening of anemia, SR, and transaminases. The CRP and procalcitonin remained unchanged, and the multidisciplinary team decided to suspend local radiotherapy.\nA bone scintigram was performed and suggested the hypothesis of aseptic femoral head necrosis that was excluded with hip MRI. With development of mandibular claudication during the hospital stay, a Doppler ultrasound of the temporal arteries was performed and revealed periluminal hypoechogenic halo reflecting arterial wall edema more pronounced in the left temporal artery (Figure ).\nThe patient was started on 1 mg/kg of prednisolone with clinical improvement at the first 48 hours and resolution of laboratory abnormalities. It was not possible to perform the temporal artery biopsy until the 10th day of therapy, and it showed only slight lymphocytic infiltration.\nLocal radiotherapy was restarted, and the patient was discharged home.\nThree months later, the patient restarted bilateral hip pain and a lumbosacral spine MRI was performed and revealed new osteoblastic lesions in S1, S2, and S3 compatible with bone metastasis.", "age": [ [ 73.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC007xxxxxx/PMC7981744.xml", "relevant_articles": { "31744808": "0", "26184358": "12", "2085934": "0", "12808546": "12", "10391074": "0" }, "similar_patients": { "4789417-1": "123", "8718965-1": "13", "6305016-1": "0", "3679761-1": "123", "7851335-1": "0" } }, { "human_patient_id": "403", "human_patient_uid": "6600096-1-M", "PMID": "31275487", "title": "Embolization of a Bronchial Artery\u2013Pulmonary Artery Arterio\u2013Venous Malformation", "patient": "A 63-year-old man presented with exertional dyspnea in the background of normal cardiac evaluation, and computer tomography (CT) findings of a vascular malformation in the posterior mediastinum (). The malformation was supplied by 4 arteries (right bronchial artery and three intercostals) arising from the thoracic aorta with a large vascular mass in the posterior mediastinum and single drainage vessel into the right upper lobe pulmonary artery (). The appearance was consistent with a BP-AVM.\nIn view of the size and the risk of hemoptysis, the patient was referred for embolization. Through a left common femoral vein access, the right upper lobe pulmonary was accessed. The drainage vessel arising the superior segmental artery of the right upper lobe was first cannulated. However, due to the angulation of the artery with sheath instability, a tri-axial system was needed to allow deep catheterization required for vascular plug embolization (). This consisted of an 8.5F Agilis NxT (St Jude Medical, Minnetonka, MN, USA) steerable sheath positioned in the ostium of the segmental artery, followed by an 8F Mach 1 guiding catheter (Boston Scientific, Natick, MA, USA) and a 5F 125 cm long Ultimate 1 diagnostic catheter (Merit Medical Systems, Inc., South Jordan, UT, USA) inserted co-axially. In a telescoping fashion, the guiding catheter was advanced over the diagnostic catheter and guidewire to reach a stable position within the segmental pulmonary artery, and a 16 mm Amplatzer AVP II vascular plug (St Jude Medical) was deployed, occluding the solitary drainage pulmonary artery ().\nThrough a right common femoral artery access, aortography demonstrated the 4 feeding arteries as seen on CT (). The plan was for staged coil/plug embolization (without particulate embolics) of the feeding arteries (2 arteries in a single sitting) due to the difficulty in resolving any potential spinal supply. If needed, we would return for an interval embolization of the remaining two vessels. The largest supplying artery (intercostal artery) was first cannulated and a 6F Brite-tip sheath (Cordis, Miami, FL, USA) was used to deliver a 12 mm AVP II plug successfully deployed (). The hypertrophied right bronchial artery was then accessed using a Progreat microcatheter and embolized using a total of 8 Interlock coils ranging from 5 to 12 mm in size (Boston Scientific) (). Completion angiography showed complete embolization of the two vessels with significant slow flow into the malformation through the remaining two untreated arteries ().\nThe immediate post-embolization CT at day 1 showed significant thrombosis of the BP-AVM () and the patient was discharged well. At 6 months follow-up CT, complete thrombosis with a significant reduction in size of the BP-AVM was demonstrated (). The patient reported improvement in effort tolerance from previous modified Medical Research Council score (mMRC) of 3 to 1 over the same period and remained so at 1 year.", "age": [ [ 63.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6600096.xml", "relevant_articles": { "18440451": "0", "21364243": "13", "34570294": "13", "21812957": "0", "27617047": "123" }, "similar_patients": { "7500744-1": "123", "4531447-1": "123", "3487018-1": "123", "6966339-1": "0", "4923520-1": "0" } }, { "human_patient_id": "404", "human_patient_uid": "7714748-1-M", "PMID": "33282586", "title": "Coronavirus-Associated Coagulopathy: Lessons From SARS-CoV1 and MERS-CoV for the Current SARS-CoV2 Pandemic", "patient": "A 64-year-old female nursing home medical technician presented to the emergency department with fever and nonproductive cough of one-week duration. Her medical history was notable for venous insufficiency, vertigo, migraine headaches, hypothyroidism, and remote tobacco abuse. In the emergency department, she was febrile (38.2\u2103), with an otherwise preserved heart rate, blood pressure, and respiratory rate. Her oxygen saturation was 92% on ambient air. Initial, basic laboratory diagnostics were unremarkable, and SARS-CoV2 nasopharyngeal PCR was negative. Chest radiograph demonstrated patchy infiltrates in the right mid and lower lung fields. She was discharged home with recommendations for self-isolation. Over the course of the next 48 hours, she noted ongoing fevers and worsening shortness of breath, prompting a return to the emergency department where she was noted to be febrile (39.5\u2103) and hypoxic (90% on room air) requiring supplemental nasal cannula. Physical examination was unremarkable except for occasional, generalized scattered crackles and wheezes on lung auscultation. Laboratory diagnostics demonstrated a preserved white blood cell count (5.8 k/uL) with neutrophilic predominance (82.6%) and lymphopenia (13.4%), with an absolute neutrophil count (4.8k/uL) to absolute lymphocyte count (0.8 k/uL) ratio of 6, a preserved hemoglobin (14.1 gm/dL), and mild thrombocytopenia (142 k/uL). The metabolic panel demonstrated mild hyponatremia (130 mmol/L), a preserved creatinine (0.90 mg/dL), and mild elevation of the AST (56 units/L) with a preserved ALT (27 units/L). Inflammatory markers were remarkable for an elevated CRP (118 mg/L), LDH (460 units/L), ferritin (1,962.5ng/mL), and D-dimer (3.38 mcg/mL). Repeat SARS-CoV2 testing on re-presentation as well as one additional test during the course of her hospitalization were negative. Computed tomography was ordered in the setting of her worsening hypoxia and elevated D-dimer and demonstrated bilateral ground-glass opacities with crazy paving patterns worse on right than left, consistent with SARS-CoV2 infection, a left upper lobe pulmonary embolism with associated right heart strain, and an enlargement of the main pulmonary artery (Figure ). She was initiated on therapeutic anticoagulation with low molecular weight heparin (LMWH). Unfortunately, despite continued management of her pulmonary embolism and conservative management for presumed SARS-CoV2 infection, her clinical condition was complicated by progressive tachypnea and associated hypoxia, necessitating endotracheal intubation and mechanical ventilation. She received three doses of hydroxychloroquine and seven days of azithromycin. Antibiotics were discontinued as she had no evidence of secondary superinfection. Intriguingly, despite initially negative nasopharyngeal swabs, endotracheal sampling demonstrated SARS-CoV2 positivity. She remained on mechanical ventilation was subsequently extubated after seven days. She was transferred to the medical service where her clinical course remained stable and subsequently discharged home on apixaban.", "age": [ [ 64.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7714748.xml", "relevant_articles": { "33282586": "123", "32645300": "123", "32687485": "123", "32426242": "1", "32923288": "1" }, "similar_patients": { "7563040-1": "123", "7370682-1": "12", "7500727-1": "1", "7364429-1": "12", "8087949-2": "1" } }, { "human_patient_id": "405", "human_patient_uid": "5107433-1-M", "PMID": "27847753", "title": "Apicoectomy of maxillary anterior teeth through a piezoelectric bony-window osteotomy: two case reports introducing a new technique to preserve cortical bone", "patient": "A 48 year old male patient was referred to a private endodontic practice for evaluation and treatment of a maxillary left lateral incisor. He complained of pain on biting and palpation in the area. Medical history was non-contributory. In his dental history, he reported that the tooth had been treated non-surgically 12 months earlier. Clinical examination revealed moderate percussion sensitivity. Periodontal probing and mobility were within normal limits when compared to contralateral and adjacent teeth. The radiographic examination revealed periapical radiolucency 7 - 8 mm in diameter along the distal surface of the root, indicative of either an accessory canal or a possible apical fracture (). The radiograph also showed a titanium screw that was used for fixation of the membrane during a previous implant placement procedure performed two years before presentation. The tooth had porcelain fused to a metal crown with good margins and esthetics. On the basis of the history and clinical and radiographic examination, a diagnosis of a previous root canal treatment with symptomatic apical periodontitis was established. The patient was offered all treatment options; he opted for microsurgical retreatment. Written consent was obtained.\nThe micro-surgical technique, as suggested by Kim and Kratchman, was performed in addition to creation of a bony window osteotomy. After rinsing with 0.12% chlorhexidine solution (Peridex, Zila Pharmaceuticals Inc., Phoenix, AZ, USA) for 60 seconds, the patient was administered 2 carpules of 4% articaine with 1:100,000 epinephrine (3M ESPE, Seefeld, Germany) buccal and palatal infiltration. After ensuring profound anesthesia, a full thickness sulcular flap was elevated, with one release incision distal to the left canine. The exposed site was considered a candidate for the bony window osteotomy as the cortical plate was found to be intact. The osteotomy was performed using a piezoelectric device (Piezotome 2, Acteon Satelec, Acteon Germany GmbH, Mettmann, Germany). The BS5 Tip (Acteon Satelec, Acteon Germany GmbH) was used to make an outline on the exposed cortical plate based on the measurement made on the digital radiograph and the topography of the exposed bone. Two vertical and two horizontal grooves were joined to create a bony window of approximately 6 mm by 12 mm, at the recommended setting mode of 3 with 60 mL/minute irrigation of sterile saline (). The average width of the cut was approximately 1 mm. The carved bony window was lifted off with a curved osteotome (). The bone block was stored in Hanks Balanced Salt Solution (Life Technologies, Grand Island, NY, USA) in order to keep it hydrated. The granulation tissue at the surgically exposed site was removed by curettage with bone and curved periodontal curettes until healthy bone margins were encountered and the root tip was clearly visible. A biopsy sample was sent for histologic evaluation. The denuded root was stained with methylene blue and inspected under high magnification (\u00d716) with a surgical operating microscope (Carl Zeiss OPMI Pico, Carl Zeiss, Oberkochen, Germany) for a vertical root fracture or perforation. Upon curettage, the root presented with a fracture line extending from the root tip to about 4 mm along the length on the distal surface. The fractured portion of the root was eliminated during apical resection with a high-speed carbide Lindemann surgical bur (Hu-Friedy, Chicago, IL, USA) at a zero degree bevel. The resected root surface was then stained again for inspection under high magnification (\u00d716). The root-end preparation was achieved using ultrasonic surgical JetTips (B&L Biotech USA Inc., Fairfax, VA, USA), and the root-end cavity was filled with white mineral trioxide aggregate (MTA, ProRoot MTA, Dentsply Tulsa Dental, Tulsa, OK, USA) (). The bony window was repositioned (). Care was taken not to depress it into the osteotomy site but instead place it in alignment with the remaining bone in its original alignment. As the insert used with the piezoelectric to create the bone window was very thin, the bone flap was re-approximated firmly. 6-0 propylene nylon sutures (Supramid, S. Jackson Inc., Alexandria, VA, USA) were used for suturing the soft tissue. A postoperative radiograph was taken (). The patient was prescribed an oral analgesic (ibuprofen 600 mg) and instructed to rinse twice daily with a 0.2% chlorhexidine mouth rinse for 1 week. The sutures were removed 7 days after surgery.\nThe patient presented for follow-up at 9 () and 18 () months with radiographic signs of complete healing and no clinical signs or symptoms.", "age": [ [ 48.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5107433.xml", "relevant_articles": { "27847753": "13", "20726915": "12", "12710819": "0", "26197881": "12", "25799535": "12" }, "similar_patients": { "7431938-1": "123", "5107433-2": "123", "4520127-1": "123", "8223161-1": "123", "5107434-1": "123" } }, { "human_patient_id": "406", "human_patient_uid": "5107433-2-M", "PMID": "27847753", "title": "Apicoectomy of maxillary anterior teeth through a piezoelectric bony-window osteotomy: two case reports introducing a new technique to preserve cortical bone", "patient": "A 16 year old male patient with a history of dental trauma 4 years prior was referred for treatment of the maxillary right lateral incisor. Mild percussion and pain on palpation was observed during clinical examination. The radiographic examination revealed a previously treated root canal with an 8 - 9 mm periapical radiolucency, extending apically and along the distal surface of the incisor with signs of a disto-lateral resorptive defect at the mid-root (). On the basis of a history, clinical examination, and radiograph, a diagnosis of a previous root canal treatment with symptomatic apical periodontitis was established. The previous operator had restored the access with radiolucent flowable composite, the coronal portion of which was removed and light cure composite (Filtek Supreme XT, 3M ESPE, St Paul, MN, USA) was placed. In discussion with the patient, apicoectomy was selected as the treatment of choice. Upon flap elevation, as the cortical plate was found to be intact, the surgical procedure as described above was implemented (). The bone window measured about 9 mm horizontally and 18 mm vertically. The lesion in this case was found to have a cyst-like appearance, which was confirmed by histopathological evaluation of the biopsy sample sent to the laboratory. Other than the apical root-end preparation, the lateral perforation was also exposed after curettage. Both areas were carefully prepared with JetTips ultrasonic tips (B&L Biotech USA Inc.) and sealed with white MTA (ProRoot MTA, Dentsply Tulsa Dental) (, ). Upon completion of the microsurgery, the bone flap was replaced and held in position with some CollaCote collagen material (Zimmer Dental, Carlsbad, CA, USA), as there was a break seen along the approximated bone margins (). The flap was sutured with 6-0 propylene nylon sutures (Supramid, S. Jackson Inc.) and the surgical procedure was completed. The patient presented for follow-up at 12 months with radiographic signs of complete healing and no clinical signs or symptoms ().", "age": [ [ 16.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5107433.xml", "relevant_articles": { "18602298": "123", "21206171": "12", "22041013": "13", "28119787": "123", "25799535": "123" }, "similar_patients": { "5107433-1": "123", "4520127-1": "123", "5299758-1": "123", "4812223-1": "123", "8223161-1": "123" } }, { "human_patient_id": "407", "human_patient_uid": "6609340-1-M", "PMID": "31321115", "title": "A Paratesticular Angiolipoma: A Case Report of a Rare Benign Scrotal Mass and Review of Literature", "patient": "A 21-year-old male with a history of one episode of right orchitis well treated with antibiotics two years ago presented to the urology outpatient department with a painless swelling of the right hemiscrotum without any associated other symptoms. Local examination revealed a palpable firm right testicular mass with atrophy of the whole testis. The left testis was palpated in the scrotum and is of normal size with no suspicious mass. His laboratory findings including Germ Cell Tumour serum markers were within the normal range (Alpha-fetoprotein (AFP): 0,86 \u03bcg/L, Beta human chorionic gonadotrophin (\u03b2-HCG) < 0,5 mIU/mL, and lactate dehydrogenase (LDH): 241 UI/ml).\nScrotal ultrasound () demonstrated a suspicious solid well-defined mass within the right epididymis, measuring 21 x 14 mm. The mass was slightly heterogeneous with hyperechoic appearance and regular smooth contour. Distinct from the lesion, the right testis appeared smaller in size measuring 23 x 12 x 15 mm. Imaging of the contralateral scrotum revealed no anomaly. A radical right orchiectomy was performed via an inguinal incision. Recovery was uneventful. The surgical specimen consisted of the right testis measuring 3.5x2.5x1 cm in size and of the spermatic cord measuring 5 cm in length. Sectioning of the specimen () revealed a single well circumscribed nodular tissue with multiple foci of hemorrhage. Microscopic examination of the nodular tissue () showed an admixture of mature lobulated adipose tissue and numerous dilated and thicken walled blood vessels with no signs of malignancies such as germ cell atypia or intraepithelial germ cell neoplasm. Thus a diagnosis of paratesticular angiolipoma was made.", "age": [ [ 21.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6609340.xml", "relevant_articles": { "31807430": "123", "6098178": "123", "8578983": "123", "29070743": "12", "25356877": "123" }, "similar_patients": { "8164541-1": "1", "2566564-1": "13", "3296444-1": "13", "5971421-1": "13", "7986722-1": "13" } }, { "human_patient_id": "408", "human_patient_uid": "4465739-1-M", "PMID": "26114007", "title": "Unusual Variant of Coronal Bladder Duplication Associated with Glans Diphallia: A Case Report and Review of the Literature", "patient": "A 6-year-old boy was referred with double stream urination. Physical examination revealed the presence of the double glans accompanied by second urethral meatus positioned dorsally (). Further evaluation by voiding cystourethrogram (VCUG) showed duplex bladders in the coronal plane (). The accessory bladder lies anterior to the main bladder with no evidence of vesicoureteral reflux. Dimercaptosuccinic acid (DMSA) scan showed horseshoe kidney with acceptable cortical function in the right kidney (60%) and diffuse decrease in the cortical function of the left kidney (40%). Cystoscopy was performed and the cystoscope easily passed through the ventral meatus unlike the dorsal orifice due to severe stenosis. The right ureteral orifice drained at the entrance of the accessory bladder to the main bladder while the left orifice entered the main bladder at its normal position. However, both urethral orifices originated from the main bladder. Further study by spinal magnetic resonance imaging revealed butterfly vertebrae in L1, L2, and L3 (). Overall, the patient had bladder duplication in the coronal plane with two distinct urethras, both originating from the main bladder, accompanied by glans diphallia with dorsal stenotic urethra (). The patient was taken to surgery and the bladder was exposed through a lower midline incision. The main and accessory bladders were separated by adjacent fascia. After opening the main bladder, the septum between the two bladders was resected and the two lumens were anastomosed (). Due to the patent ventral urethra and stenotic dorsal urethra, the closure of dorsal urethra was planned. A catheter was placed in the stenotic dorsal urethra to demonstrate the orifice, and the orifice was subsequently ligated and cauterized. The biopsy of the intravesical septum revealed a muscular tissue lined by a transitional epithelium with congestion and hemorrhage. Postoperatively, the patient had good caliber urination at ventral orifice with no stream at dorsal orifice and he was discharged with good condition. The patient has no complication after 1 year follow-up.", "age": [ [ 6.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4465739.xml", "relevant_articles": { "21547464": "123", "26114007": "13", "3776767": "123", "27127361": "123", "18697498": "123" }, "similar_patients": { "4745289-1": "12", "5905857-1": "123", "6986538-1": "123", "3983764-1": "12", "3160051-1": "123" } }, { "human_patient_id": "409", "human_patient_uid": "6425334-1-M", "PMID": "30949369", "title": "Development of Multiple Myeloma of the IgA Type in a Patient with Cold Agglutinin Disease: Transformation or Coincidence?", "patient": "A woman in her late 60s was transferred in July 2012 from her local hospital because of anemia of at least one and a half year duration. She had no relevant family history, but had been treated for diabetes type 2 and hypertension for decades and paroxysmal atrial fibrillation for a few years. She had suffered from recurrent urinary tract infections, several times with fever and once with verified urosepsis. A concrement had been removed from her right ureter a few months ago.\nHer history of anemia started gradually with fatigue in 2010-11. Her hemoglobin (Hb) level was 8.9 g/dL in February 2011, as compared to 13.4 at the last known previous assessment in 2008. She had received an erythrocyte transfusion at her local hospital without any transfusion reaction or other problems, and she had already suffered several exacerbations of anemia during febrile infections. There was no history of acrocyanosis or Raynaud phenomena.\nOn admission, she was in good general condition and did not present any pathological findings by physical examination. In particular, there was no acrocyanosis, lymphadenopathy, or splenomegaly. Chest radiography and abdominal ultrasonography were unremarkable. Hb was 8.2 g/dL, leukocytes 7.8 \u00d7 109/L with normal differential count, platelets 263 \u00d7 109/L, mean corpuscular volume (MCV) 99 fL, reticulocytes 88 \u00d7 109/L, and C-reactive protein (CRP) 11 mg/L. Serum levels of iron, transferrin, cobalamin, and folic acid as well as transferrin saturation were within the reference range, however, with elevated ferritin at 1257 \u03bcg/L. Genetic screening for hemochromatosis showed no HFE gene abnormalities. Concentrations of electrolytes, calcium, creatinine, and liver transaminases were normal. Lactate dehydrogenase (LDH) was elevated at 544 U/L, bilirubin elevated at 43 \u03bcmol/L, while haptoglobin was undetectable (less than 0.1 g/L). Her urine was negative for hemoglobin and protein. Serum albumin was 41 g/L with normal immunoglobulin levels (IgG 7.0 g/L, IgA 3.2 g/L, and IgM 0.69 g/L). Serum electrophoresis identified a small spike of monoclonal IgA\u03bb. Free \u03bb chains in serum were slightly elevated at 53 mg/L, however, with a \u03ba/\u03bb ratio within the reference range. The direct antiglobulin test (DAT) was strongly positive for C3d and negative for IgG, IgM, and IgA. CA titer at 4\u00b0C was 128. Serum erythropoietin was slightly elevated at 36 IU/L.\nBased on these findings, she was diagnosed with CA-mediated AIHA. With a chronic course, no signs of malignancy so far, and no recent specific infection, this AIHA was further classified as primary CAD. A bone marrow trephine biopsy showed erythroid hyperplasia and small lymphocytic infiltrates interpreted as lymphoplasmacytic lymphoma (LPL). Flow cytometry in bone marrow aspirate revealed two small, clonal populations: one of B-lymphocytes that displayed a \u03ba phenotype and the other one of \u03bb positive plasma cells.\nThe further development in Hb and IgA levels is shown in . During the next couple of years, Hb ranged from 9.0 to 10.0 g/dL; she had only mild fatigue and no transfusion requirement. Management consisted of regular follow-up, avoidance of cold exposure, and prompt antibiotic therapy in case of febrile bacterial infection but no CAD-directed pharmacological therapy. By 2014, a second bone marrow biopsy showed erythroid hyperplasia and lymphoid infiltrates, now interpreted as probable CAD-associated LPD []. Flow cytometry in bone marrow aspirate again demonstrated 2 pathological clones of \u03ba positive B-lymphocytes (approximately 5%) and \u03bb positive plasma cells (0.7%), respectively.\nHer condition remained stable until late spring 2016, when she deteriorated. Her fatigue worsened, her atrial fibrillation relapsed more frequently, and her Hb level declined to 8.5 g/dL. The reticulocyte count was now elevated at 191 \u00d7 109/L, LDH was 303 U/L, bilirubin 96 \u03bcmol/L, haptoglobin <0.1 g/L, while IgA had increased to 12.5 g/L and CA titer to 512. The DAT findings were unchanged. We decided to give her rituximab monotherapy [], four weekly doses of 375 mg/m2, which she received from August 2016. Hb rose to 12.5 g/dL by December 2016, while bilirubin and LDH normalized. Unexpectedly, however, her IgA level continued to increase from 12.5 g/L immediately before rituximab treatment to 19.6 g/L by January 2017.\nFrom June 2017, Hb started again to decline and IgA continued to increase. In January 2018, she experienced severe lumbar pain after having removed snow from her courtyard, which can be heavy work in Norway. One month later, Hb was 9.5 g/dL, while the absolute reticulocyte count was 153 \u00d7 109/L and the levels of LDH, bilirubin, and haptoglobin had not changed significantly. The IgA level was 24.5 g/L and \u03b22-microglobulin 3.5 mg/L. A new trephine biopsy showed hypercellular bone marrow affected by 20% infiltration of monoclonal, \u03bb positive plasma cells, and some small lymphocytic infiltrates. A CT scan showed osteolytic lesions of the skull but no relevant pathological findings in her spine, pelvis, or femora. She was diagnosed with development of MM.\nIn February 2018, a local visiting hematologist initiated a cycle of melphalan and prednisolone. During the next couple of weeks, Hb declined further to 8.0 g/dL, however, without any neutropenia or thrombocytopenia. Concomitantly, a rise in bilirubin and LDH was observed, and she was diagnosed with an exacerbation of CAD. Melphalan and prednisolone were discontinued after the first cycle.\nHoping to induce remission of both MM and CAD, we decided in March 2018 to offer her bortezomib-based therapy [] with the addition of dexamethasone and rituximab [, , ]. She received four cycles at four weeks' interval of bortezomib (1.3 mg/m2 weekly for 3 weeks), rituximab (375 mg/m2 once per treatment cycle), and dexamethasone (20 mg on days 1, 2, 8, 9, 15, and 16). She tolerated this combination well; her Hb level increased from 8.0 g/dL to 13.6 g/dL following the first cycle and reached 14.4 g/dL after the second one. Bilirubin and LDH normalized within a couple of weeks, and reticulocyte count declined to the normal range (65 \u00d7 109/L). IgA had declined to 3.8 g/L by the start of the second cycle. Her back pain improved. Ten weeks after start of therapy, Hb was 13.2 g/L, bilirubin 7 \u03bcmol/L, LDH 247 U/L, haptoglobin 0.24 g/L, and CA titer 64. IgA remained in plateau at 3.9 g/L, while serum electrophoresis did not show any monoclonal spike. DAT was still positive for C3d.\nThe lymphoma pathologist in our group (U.R.) did a centralized, parallel review of all three bone marrow samples based on extensive experience with CAD-associated bone marrow pathology []. The 2012 biopsy shows, in addition to erythroid hyperplasia, intraparenchymatous, \u03ba positive B-cell infiltrates consistent with CAD-associated LPD. There are scattered \u03ba positive plasma cells, more of them near the lymphocytic infiltrates, and one distinct infiltrate of \u03bb positive plasma cells. In the 2014 biopsy, the picture has not changed significantly. The trephine biopsy from February 2018 shows an IgA\u03bb positive plasma cell population that has expanded, but IgM\u03ba positive B-cell infiltrates can still be seen. In retrospect, therefore, all three biopsies show two clones; and in the 2018 sample, the CAD-associated IgM\u03ba plasma cell population seems \u201chidden\u201d among the expanding, myeloma-associated IgA\u03bb plasma cells ().", "age": [ [ 67.5, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6425334.xml", "relevant_articles": { "30504296": "12", "30504295": "12", "32645300": "12", "1880946": "12", "25749330": "123" }, "similar_patients": { "7956980-1": "123", "3655493-1": "0", "4142660-1": "123", "8517987-1": "12", "5472347-1": "12" } }, { "human_patient_id": "410", "human_patient_uid": "5385992-1-M", "PMID": "28444079", "title": "Use of noninvasive ventilation in severe acute respiratory distress\nsyndrome due to accidental chlorine inhalation: a case report", "patient": "A 55-year-old man accidentally inhaled a chlorine cloud when cleaning the swimming\npool at his home, evolving to a clinical picture of mild dyspnea, cough with mucoid\nsputum, and epigastric pain. He sought emergency care (after 30 minutes), where he\nwas initially evaluated for respiratory symptoms and received venous hydration,\nbronchodilators, and oxygen therapy. However, he presented progressive clinical\nworsening over a 3-hour period, with increased expectoration, arterial oxygen\nsaturation (SpO2) (from 95% to 60%), and cyanosis and was referred to the\nreference emergency room, where he was seen in the emergency department. At that\ntime, he already had signs of acute respiratory failure, associated with intense\nburning chest pain and cough with blood-tinged sputum. There was no history of\nsmoking, respiratory diseases, and other comorbidities.\nAt admission, the patient was afebrile, tachycardic (heart rate 110bpm), and\ntachypneic (respiratory rate 34bpm), with a blood pressure of 134/82mmHg and an\nSpO2 of 86% during oxygen macronebulization at 10L/minute. Chest\nexpandability was decreased due to pain, and respiratory auscultation detected the\npresence of generalized decreased vesicular murmur and crackling rales mainly on the\nlung bases. No other changes were detected on physical examination. Noninvasive\nventilation with 60% FiO2, 7cmH2O support pressure (SP), and\n10cmH2O positive end expiratory pressure (PEEP) was started.\nArterial blood gas analysis revealed a pH of 7.41, a partial carbon dioxide pressure\n(PaCO2) of 39.1mmHg, a partial oxygen pressure (PaO2) of\n59.5mmHg, an oxygen saturation (SO2) of 87.4%, a bicarbonate level of\n29mEq/L and a base excess of +0.7mmol/L. The patient had leukocytosis (leukocyte\ncount of 27,840 thousand/mm3 with 94% segmented). Electrolytes,\ncoagulation tests, and liver and canalicular enzymes were normal. Chest X-ray\nrevealed bilateral alveolar infiltrate in the lower third (). Chest tomography showed consolidation in the\nposterior region of the lower lobes and discrete in the upper lobes, associated with\nareas of diffuse ground-glass opacity in the upper lobes, in addition to an increase\nin the diameter of the pulmonary arterial trunk (3.8cm), indicating hypertension of\nthe same ().\nIn the intensive care unit, antibiotic therapy with cefepime (2g every 8 hours),\nintravenous corticosteroid (methylprednisolone 125mg every 6 hours), and\nnebulization with a beta-agonist and an anticholinergic were started, with\nprogressive clinical improvement and noninvasive mechanical ventilation (NIV)\nmaintained intermittently for 4 days. A Dixtal\u00ae 3010 mechanical\nventilator with a full face mask interface was used in SP mode, using SP for a\ntarget tidal volume of approximately 6 to 8mL/kg predicted weight and a PEEP ranging\nfrom 5 to 10cmH2O, in addition to an FiO2 required to maintain\nan oxygen saturation above 88%. On the first day, the patient remained on a zero\ndiet and remained on NIV for 24 hours; the PaO2/FiO2 ratio was\n99. On the second day, pauses were taken for oral feeding; the\nPaO2/FiO2 ratio was 150. On the third day, most NIV shifts\nwere maintained but with larger pauses; the PaO2/FiO2 ratio\nwas 230. On the fourth day, NIV was performed intermittently; the\nPaO2/FiO2 ratio was 350. On the fifth day, the patient was\nkept on oxygen macronebulization. On the sixth day and following until hospital\ndischarge, which occurred on the seventh day, the patient was spontaneously\nventilated with room air. He remained hemodynamically stable throughout his hospital\nstay, without organ dysfunctions. He was discharged on the seventh day of\nhospitalization and was given an oral corticosteroid and a bronchodilator. In his\noutpatient follow-up, he underwent a chest X-ray, showing dense striae in the right\nupper lobe (), with no other\nalterations. Spirometry was also performed but did not show alterations.", "age": [ [ 55.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5385992.xml", "relevant_articles": { "33575513": "123", "34412752": "12", "25006313": "123", "17988390": "2", "34963717": "123" }, "similar_patients": { "8059757-1": "123", "6314689-1": "123", "4832462-1": "12", "1090580-1": "13", "3401823-1": "123" } }, { "human_patient_id": "411", "human_patient_uid": "4118546-1-M", "PMID": "25097291", "title": "Olanzapine-induced restless leg syndrome: A case report and review of literature", "patient": "A 38-year-old married female without any past or family history of psychiatric or neurological illness and with good premorbid functioning. She was harboring delusion of infidelity against her husband along with disturbed socio-occupational and biological functioning for the past 6 years. There was no history of substance use disorders, except excessive caffeine use, or any high risk sexual behavior. Organic psychiatric disorder or symptoms of schizophrenia were not evident. Detailed general physical examination including neurological evaluation did not reveal any abnormality except mild pallor. She reported regular menstruation and the last childbirth was 10 years back. Mental status examination revealed that she was having an uncooperative and aggressive attitude, delusion of infidelity, impaired judgment, and lack of insight. So, she was admitted to psychiatry ward with a diagnosis of persistent delusional disorder as per International Classification of Diseases, 10th edition. She was started on intramuscular olanzapine 10 mg/day. On investigation, her complete hemogram revealed a Hb of 11.5 gms/dL and a serum ferritin level of 30.2 ngm/ml (normal value for females is 10-291 ng/mL). Other routine hematological and biochemical parameters including blood sugar, renal, liver, and thyroid function were within normal limits. We also planned a vitamin B12 and folic acid estimation which could not be done due to lack of resources.\nWithin 4-5 days of starting olanzapine, there was a decrease in her aggression and she became cooperative for interviewing. However, she would report that she was having sleeping difficulty due to an itching sensation in both upper and lower limbs at night. She would rub her legs against bedclothes, tie pieces of cloth around her limbs, and ask for limb massage to get relief from such a discomfort. She would have such symptoms for hours after lying down at night. During daytime, she would, however, feel comfortable, relaxed, and was able to sleep. She was evaluated for sleep disorder-before this she never had any sleep complaint, neither was there any family history of sleep disorder. During sleep, there was no history of snoring, no abnormal limb or breathing movements. Ear, nose, throat examination was also noncontributory. She was having a thin built and a body mass index of 15.56. As she became cooperative, she was shifted to oral psychotropics (olanzapine 15 mg/day + clonazepam 1 mg at bedtime). Also oral iron supplementation in the form of ferrous fumarate 350 mg, vitamin B12, and ascorbic acid was started. To improve her sleep, general sleep hygiene practices were initiated, she was prohibited from taking any caffeine beverages at night and the clonazepam was further increased up to 2 mg at bedtime. But there was no improvement in her nighttime symptoms.\nIn view of her above symptoms and investigations, she was diagnosed to have RLS with an International Restless Legs Scale Score (IRLS) of 24 indicating high severity and olanzapine was considered to be the probable cause. Hence, the olanzapine was decreased to 10 mg/day and oral risperidone 2 mg was added at bedtime. On the next day, the severity of symptoms decreased to a RLS score of 12. No other change in medication was done during this period. So, after 2 days, olanzapine was stopped and risperidone was increased to 6 mg at bedtime. Thereafter, her troublesome symptoms ceased completely. Though she still harbored the delusions yet the conviction decreased and she became more cooperative with her husband and the treating clinician. Then after about a week of uneventful ward stay, she was discharged free of her sleep-related difficulties on risperidone 6 mg and clonazepam 1 mg at bedtime with the plan to continue her antipsychotic drugs and iron supplementation on an outpatient basis.", "age": [ [ 38.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC004xxxxxx/PMC4118546.xml", "relevant_articles": { "31279381": "1", "22481958": "1", "20672499": "1", "26703328": "0", "7640726": "1" }, "similar_patients": { "5968651-1": "0", "3746308-1": "0", "3579060-1": "12", "5968651-2": "0", "4481805-1": "0" } }, { "human_patient_id": "412", "human_patient_uid": "7909122-1-M", "PMID": "33663129", "title": "Use of venovenous extracorporeal membrane oxygenation for perioperative management of acute respiratory distress syndrome caused by fat embolism syndrome", "patient": "A 24-year-old man riding a motorcycle collided with a car while turning to the right. He fell off the motorcycle after the collision, and was injured by another car. He had no previous medical history. When he was brought to our emergency department in an ambulance, his airway was patent, he was tachypneic, hypotensive, tachycardic, and his Glasgow coma scale score was 7 (E1V2M4). Intubation, bilateral chest drainage, and blood transfusion were performed. Following assessment by whole-body computed tomography (CT), he was diagnosed with bilateral pneumothorax, liver and spleen injuries, fractures of the left acetabulum, right patella and tibial plateau, with open fractures of the shaft of the right femur and distal third of the left femur (Fig. ). External fixation and irrigation of both thighs were performed in the operating room. The liver and spleen injuries were treated conservatively. After surgery, his consciousness disorder persisted. Initially, hypoxia was not accompanied by significant changes in chest radiographs; however, serial chest radiographs showed progressive bilateral pulmonary opacities consistent with ARDS (Fig. A and B). Contrast-enhanced CT also showed bilateral patchy gland glass opacity and consolidation matching chest radiographs, and there was no filling defect in pulmonary artery. Arterial blood gases on the 4th day of admission showed a PaO2/FiO2 (P/F) ratio of 100 mmHg under 10 cm H2O of positive end-expiratory pressure (PEEP). In addition, the patient developed subconjunctival, abdominal, and precordial petechiae (Fig. ). He remained tachycardic, febrile with a body temperature >38\u00b0C, and was jaundiced. Laboratory data showed exacerbation of anemia (hemoglobin, 9.1 \u00d7 10 g/L), decreased platelet count (88 \u00d7 109 /L), and elevated total bilirubin levels (8.9 \u00d7 10 \u03bcmol/ L). Gurd and Wilson criteria (3 major and 5 minor criteria) and Schonfeld scoring system were used for the diagnosis of FES. The criteria of both scoring systems were met, thereby supporting the positive diagnosis of FES (Table ).[\nThe patient had type 1 respiratory failure which gradually worsened with conventional lung-protective ventilation. Due to a persistent consciousness disorder, prophylactic antiepileptic drug administration, anticerebral edema therapy, and targeted temperature management using an intravascular temperature control catheter were performed.[ On the 6th day of admission, the Murray score was 3.5 indicating severe lung injury: P/F ratio of 81 mmHg (4 points), pulmonary edema in all lung fields on chest X-ray (4 points), PEEP of 14 cm H2O (3 points), compliance of 23.3 ml/cm H2O (3 points). Because his cardiac function was not reduced and hemodynamic status was maintained, we chose VV-ECMO over venoarterial-ECMO.[ A 23 French multi-stage drainage cannula was inserted from the left femoral vein to the inferior vena cava, and a 17 French single-stage return cannula was cannulated from the right internal jugular vein to the superior vena cava. The ECMO rotation speed was 3300 r/minute and the flow rate was 4.5 L/minute with 100%FiO2 and 4.5 L/minute sweep gas flow. Under the condition, his peripheral oxygen saturation was maintained >95% and blood gas analysis showed a pH of 7.42, PO2 of 95 mmHg, and PCO2 of 46.6 mmHg. Although lung protection management was continued with high PEEP and low tidal volume after VV-ECMO introduction, improvement in respiratory condition was not observed. Therefore, we decided to convert the external fixation to internal fixation to begin prone position therapy. Osteosynthesis was performed on the 9th day of admission under VV-ECMO. In the supine position a tourniquet was applied on the left side. The lateral parapatellar approach was used to reduce the fracture and fix the screws and lateral locking plate (Fig. A). The tourniquet was released to place the screws in the proximal holes of the plate, following which there was continued congestive bleeding. Heparin had been introduced into the circuit at the beginning of the operation, but due to a large amount of blood loss, protamine sulfate, an antagonist for heparin, was administered midoperation. The bleeding was controlled by closing the left knee wound and inserting a drain. Osteosynthesis of the right femur was then performed using a retrograde intramedullary nail (Fig. B) without any serious complications. The total operation time was 4 hours and 29 minutes and the total blood loss amounted to 3800 g. Sixteen units of red blood cell transfusion, 20 units of platelet transfusion, and 16 units of fresh frozen plasma were needed. The ECMO circuit was run heparin free for 2 days postsurgery.\nProne-position ventilation was initiated on the second day postsurgery after the hemodynamics became stable. The patient was placed in the prone position for 16 hours a day. Low tidal volume ventilation (6 ml/kg) and an infusion of neuromuscular blockade was introduced. To address severe acute kidney injury due to hemolysis, we also started continuous renal replacement therapy on the 14th day. For 4 days, the patient was managed in the prone position. His respiratory condition and chest radiographs improved steadily over the 8 days following osteosynthesis, and VV-ECMO was discontinued on the 17th day (Fig. C). The ventilator was removed on the 28th day. At that time, his respiratory status improved to P/F ratio: 370, and multiple petechiae disappeared. His conscious level normalized without residual central nervous system complications.", "age": [ [ 24.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7909122.xml", "relevant_articles": { "33663129": "13", "31014372": "123", "26538308": "123", "8779403": "123", "33834969": "123" }, "similar_patients": { "6849020-1": "123", "6501329-1": "123", "7488892-1": "123", "4336281-1": "13", "3766782-1": "13" } }, { "human_patient_id": "413", "human_patient_uid": "2803898-1-M", "PMID": "20062678", "title": "Spontaneous bowel perforation due to norovirus: a case report", "patient": "An 83 year old retired Caucasian lady was admitted to a UK hospital with a recent history of back pain without any trauma. She had no significant past medical history of note and her only regular medication included a statin for cholesterol. She was a non-smoker and drunk only minimal amounts of alcohol. X-rays on admission demonstrated severe osteoporosis with multiple collapsed lumbar vertebrae. Whilst awaiting a brace and social support she developed diarrhoea and vomiting. An initial stool sample was negative for clostridium difficile serotoxin. Over the next few days her clinical condition deteriorated and by day 6 her C-reactive protein was 357. She developed abdominal distension, pain and a plain x-ray showed centralised dilated small bowel loops. A subsequent CT scan of her abdomen revealed small bowel obstruction together with mural thickening of the distal ileum (see Figure ).\nFollowing CT the patient developed signs of localised peritonitis and underwent a laparotomy. At surgery necrosis and ischaemia was seen in a large portion of mid-ileum together with large quantities of pus and a localised perforation. A small bowel resection of 60 cm was performed. Histology revealed an acute gangrenous ileitis. Blood, urine and stool cultures were all negative but reverse transcription polymerase chain reaction (RT-PCR) of stool cultures revealed Norovirus genogroup II. Immunoassay of the stool was negative for rotavirus and adenovirus. No specific testing for astrovirus was performed. Immunological testing of the histological specimens was not performed.\nThe patient had no prior history of vascular disease to suggest the cause of the ileitis was ischaemic enterocolitis. Furthermore despite the patient's back pain she had been mobilising around her bed in the hospital therefore it is unlikely that the cause of the ileitis was paralytic ileus secondary to immobility. The patient received only as required opiate analgesia and this was co-administered with appropriate laxative cover to avoid constipation. A diagnosis of acute gangrenous ileitis secondary to Norovirus was therefore made. It was postulated that the virus had triggered a localised inflammatory response leading to necrosis which had continued despite clearing of the virus by host immune responses. The virus was thought to be a nosocomial infection as there was no recent history of foreign travel or contact with individuals demonstrating the symptoms of gastro-enteric disease prior to admission. However antibody testing for IgG and IgM was not performed therefore the length of infection with the virus was unclear.\nFollowing surgery the patient developed a pelvic collection requiring CT guided drainage which matured into an enterocutaneous fistula. The fistula was treated conservatively and sealed spontaneously at 10 weeks at which point she was discharged.", "age": [ [ 83.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC002xxxxxx/PMC2803898.xml", "relevant_articles": { "30018843": "0", "32879725": "0", "15952487": "0", "31337629": "0", "23345475": "1" }, "similar_patients": { "6823019-1": "1", "2613894-1": "0", "7389872-1": "1", "3816040-2": "1", "7433370-1": "0" } }, { "human_patient_id": "414", "human_patient_uid": "4016293-1-M", "PMID": "24597740", "title": "Endovascular aneurysm repair in emergent ruptured abdominal aortic aneurysm with a \u2018real\u2019 hostile neck and severely tortuous iliac artery of an elderly patient", "patient": "A 79-year-old woman was admitted to the emergency department of Peking Union Medical College Hospital complaining of severe abdominal pain with unknown causes for 4 hours. The pain got worse after 2 hours with an acute hypotension (blood pressure drop from 106/79 mmHg to 61/44 mmHg), heart rate elevation (from 80 beats/min to 100 beats/min) and blunted. Laboratory investigation noted a decrease of hemoglobin from 119 g/dL to 62 g/dL in half an hour. Emergent computed tomographic angiography (CTA) showed the presence of a very tortuously ruptured AAA that now was 10.33 cm in diameter with a 90\u00b0 neck angle (Figure A). The rupture, which extended from 2.5 cm below the opening of bilateral renal arteries down to the celiac artery and elongated to both common iliac arteries, involved the inferior mesenteric artery. Although the two iliac arteries were unobstructed with a 2.1 cm and 1.8 cm diameter of the right and left respectively, the right iliac artery was severely tortuous with a \u2018S\u2019 appearance (Figure B and C).\nPrevious medical history was normal except that she had a hypertension for more than 10 years with a maximum blood pressure of 160/90 mmHg, and was diagnosed of AAA by CTA with a maximum diameter of 6 cm in 2009. She refused to follow up because of no abdominal symptoms since then. She had no surgical history. Given the age of the patient and the emergent status, an endovascular approach was conducted despite the hostile neck. The time of door-to-cath lab was about 70 minutes. After local anesthesia, a 6-F, 11 cm-long introducer sheath (Cordis, Johnson & Johnson, NJ, USA) was placed percutaneously through the left groin for the diagnostic angiography, which confirmed the existence of an unfavorable aneurysm inferior to the renal artery (Figure A and Additional file : Movie S1). An 18-F, 30-cm-long sheath (W.L. Gore & Associates, Flagstaff, AZ, USA) was introduced and a 28-12-160-mm Excluder aortic main body (W.L. Gore &Associates) was deployed below the origin of the bilateral renal arteries (Additional file : Movie S2). Another 18-F, 30-cm-long sheath (W.L. Gore & Associates, Flagstaff, AZ, USA) was used, and two iliac legs of 20\u2013120 and 20\u2013100 (W.L. Gore & Associates, Flagstaff, AZ, USA) were placed superior to the opening of the right hypogastric respectively.\nThe guidewire was hard to enter the iliac leg due to the severely tortuous right iliac artery (Additional file : Movie S3), and therefore balloon-assisted technique was designed. The balloon was deployed in the proximal part of the main body and then inflated, thus keep the stiff wire in place which allowing the positioning of the guidewire (Figure B and Additional file : Movie S4).\nIn order to avoid the type Ib endoleak, we deployed a 26\u201330 cuff above the bifurcation of the iliac artery (W.L. Gore & Associates, Flagstaff, AZ, USA) (Figure C). A 20\u2013140 iliac leg was placed above the bifurcation of the left iliac artery (Figure D). The stent-grafts were dilated using balloons (CODA, COOK, USA). The following angiography showed a severe Ia endoleak in the proximal neck (Figure E and Additional file : Movie S5), and therefore, a 32\u20134.0 Cuff (W.L. Gore & Associates, Flagstaff, AZ, USA) was deployed distal to opening of the left renal artery with off-the-shelf solution [] (Figure F).\nFinal angiography confirmed successful sealing of the rAAA with continued perfusion of both celiac and right renal arteries, and the aortic body pulsation disappeared accordingly (Figure G, H and Additional file : Movie S6). The patient had an uneventful recovery and was discharged home after 6 days. She is well and symptom-free 6 months later. Follow-up CT at 6 months demonstrated fluent celiac and bilateral renal arteries (Figure ).", "age": [ [ 79.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4016293.xml", "relevant_articles": { "24597740": "123", "25887163": "123", "32827677": "123", "33034266": "123", "18845097": "123" }, "similar_patients": { "4357166-1": "123", "8054837-1": "123", "6180878-1": "123", "4927212-1": "123", "5991240-1": "12" } }, { "human_patient_id": "415", "human_patient_uid": "6366367-1-M", "PMID": "30775656", "title": "Early Identification of Central Retinal Artery Occlusion Using Point-of-care Ultrasound", "patient": "A 69-year-old woman presented to the ED with painless vision loss in her left eye. She stated that over the course of minutes, she completely lost vision in that eye, with onset approximately six hours prior to evaluation. Initially, there was concern for posterior circulation arterial stroke, as the patient had elected to stop taking her antihypertensive medications one year prior. A computed tomography (CT) of the head showed no evidence of intracranial hemorrhage, and a magnetic resonance imaging (MRI) evaluation of the brain showed no evidence of acute stroke. The patient\u2019s fundoscopic exam was limited by constricted pupils, and she was transferred to a tertiary care academic medical center for ophthalmologic evaluation.\nOn arrival to the tertiary care center, the ED team performed a POCUS, linear probe, 12 MegaHertz (MHz) of the patient\u2019s eye to evaluate for retinal detachment. No evidence of retinal detachment, vitreous detachment, or massive vitreous hemorrhage was found. However, the study demonstrated a widened and irregular optic nerve sheath, which measured over the normal limit of five millimeters (mm). Additionally, an area of hyperechoic signal was noted in the distal aspect of the optic nerve, raising concern for embolic event (). Additional radiologist review of the patient\u2019s MRI showed no evidence of embolism in that area. Ophthalmology was consulted and performed a dilated fundoscopic exam, with direct visualization of a pale, occlusive object within the central retinal artery.\nThe patient was admitted to the neurology service for monitoring of permissive hypertension initially, and then resumption of an antihypertensive medication regimen. The timing of symptom onset was a contraindication for thrombolytic treatment. Rapid stroke-risk stratification demonstrated no echocardiographic evidence of cardiac source of her embolus, no right-to-left cardiac shunt, and no significant carotid stenosis on CT angiography. She was re-initiated on her outpatient antihypertensive medications, and on two-month follow-up she had no significant return of vision in her left eye and had no evidence of further embolic events.", "age": [ [ 69.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6366367.xml", "relevant_articles": { "33794992": "12", "33028264": "0", "34158954": "12", "30775656": "12", "26879704": "12" }, "similar_patients": { "8212687-1": "1", "5965109-1": "0", "7198085-1": "12", "8017636-1": "1", "7008758-1": "0" } }, { "human_patient_id": "416", "human_patient_uid": "7675892-1-M", "PMID": "33240400", "title": "Olaparib is effective for recurrent urothelial carcinoma with BRCA2 pathogenic germline mutation: first report on olaparib response in recurrent UC", "patient": "Here, we report a 60-year-old Chinese woman, presenting to a local hospital due to hematuria and diagnosed with left upper tract UC in March 2018. She had a left laparoscopic radical nephroureterectomy in the same month. Postoperative pathological examination confirmed invasive high-grade UC. Immunohistochemistry showed GATA-3 (+), CKH (+), CK7 (+), CK20 (\u2013), P63 (+), CgA (\u2013), Syn (\u2013), CKL (weak +), \u03b2-Catenin (+), Ki-67 (+, 25%), CK18 (+), and P40 (+). She was discharged and recovered well after surgery, and had gemcitabine and cisplatin (GC) combined chemotherapy for four cycles. In November 2019, the patient came to hospital with left back and abdominal pain. Computed tomography (CT) examination showed a slightly high-density soft tissue mass shadow of 3.2 \u00d7 3.1 cm on the posterior wall of the left abdomen, a dense soft tissue mass shadow on the left internal iliac lymph nodes (3.2 \u00d7 4.2 cm, thick-walled annular enhancement in contrast-enhanced CT), and multiple enlarged lymph nodes to the left of the abdominal aorta (maximum diameter of about 1.5 cm) ( before therapy). All masses and enlarged lymph nodes were highly suspected to be metastatic lesions. The patient\u2019s left back pain later worsened, accompanied by a loss of appetite, and a \u201cgoose egg\u201d size mass was found at the left waist ( before therapy). In order to identify potential targets for systematic treatment, blood samples were collected from the patient, and the germline DNA was tested with a next-generation sequencing (NGS)-based 605-gene panel and the status of 58 hereditary cancer related genes were reported (), and the somatic circulating tumor DNA (ctDNA) was tested with the same NGS-based 605-gene panel (). The test results suggested that the patient carried a novel germline BRCA2 nonsense mutation p.L557* (c.1670T>A), as well as somatic INDEL mutations, including BRCA1 p.Y1845Pfs*34 (c.5533_6634del), RB1 p.E554Gfs*6 (c.1661_1695del), JAK2 p.M84Vfs*6 (c.250_251.del), and somatic SNV mutations in TP53, KMT2D, MET, ROS1 and IL7R (). Among them, the germline BRCA2 c.1670T>A mutation was discovered for the first time (list of all germline mutations for this patient is provided in ). Based on the above test results, the patient started taking Olaparib orally (300 mg/tablet, bid, po). At 3 months after the initiation of Olaparib therapy, CT reexamination revealed a reduction of the left lumbar mass ( after therapy) and a reduction of the abnormal enhanced mass in the original left kidney area ( after therapy). Multiple enlarged lymph nodes to the left of the abdominal aorta became smaller or disappeared. The overall response achieved partial response (PR). The repeated ctDNA test after 3 months of treatment showed reduction in mutation allele frequency in BRCA1 (from 13.42% to 0.25%), TP53 (from 12.26% to 0.54%), and KMT2D (from 10.21% to 0.21%). The remaining somatic mutations were not detected in the second test (). The tumor mutational burden (TMB) decreased from 6.11 Muts/Mb to 0.76 Muts/Mb. These observations suggested that Olaparib treatment successfully controlled the tumor development and reduced the tumor burden. At the time of submission of this article, the patient has been receiving Olaparib treatment for more than 4 months with continued response.", "age": [ [ 60.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC007xxxxxx/PMC7675892.xml", "relevant_articles": { "33240400": "123", "31577767": "123", "30333000": "123", "32884538": "123", "32668858": "123" }, "similar_patients": { "8075353-1": "123", "8636970-1": "123", "8024449-1": "13", "8116796-1": "13", "8254587-1": "123" } }, { "human_patient_id": "417", "human_patient_uid": "2629922-1-M", "PMID": "19096248", "title": "A Case of an Asymptomatic Intralenticular Foreign Body", "patient": "A 66-year-old male visited our ophthalmology department because of decreased visual acuity in his left eye of 10 days duration. The patient had a past history of ocular trauma to the left eye while mowing his lawn 6 months before his visit. He had not been treated because he did not feel any discomfort. On presentation, his best-corrected visual acuities (BCVAs) were 1.0 and 0.4 in the right and left eye, respectively. The intraocular pressure was 11 mmHg in the right eye and 14 mmHg in the left eye. In the right eye, the anterior segment did not show any obvious abnormalities. In the left eye, corneal opacity, which did not involve the visual axis, an incidental intralenticular metallic foreign body, and lens opacity were found. The posterior lens capsule was intact (). There was no inflammation in the cornea or anterior chamber. Funduscopy showed no definite abnormalities in either eye. Emergent surgical removal was performed. Under local anesthesia, capsulorrhexis of the anterior lens capsule and hydrodissection and hydrodelineation of the lens were performed via a corneal incision site. With viscoelastic aid, the intralenticular foreign body was elevated into the anterior chamber. The foreign body was then removed with foreign body forceps. Phacoemulsification and posterior chamber intraocular lens implantation was then performed. The implanted IOL was an AcrySof\u2122 (SA60AT, Optic 6.0 mm, Length 13.0 mm, Alcon, USA). The diameter of the removed foreign body was about 1 mm and it was identified to be metallic by a magnet. It was thought to be a part of the lawn mower blade (). At 3 days postoperatively, the BCVA of the left eye was 1.0. There were no specific findings except trace cell reactions in the anterior chamber. At 17 days postoperatively, the BCVA of the left eye was 1.0. There was no inflammation in the anterior chamber and the IOL was well-seated ().", "age": [ [ 66.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC002xxxxxx/PMC2629922.xml", "relevant_articles": { "19096248": "123", "8985549": "123", "27625956": "123", "34160455": "123", "11838993": "1" }, "similar_patients": { "2813589-1": "123", "4535674-1": "123", "4240328-1": "0", "2955278-1": "123", "5348785-1": "12" } }, { "human_patient_id": "418", "human_patient_uid": "8278592-1-M", "PMID": "34256709", "title": "Campylobacter fetus bacteremia and meningitis in an acute lymphoblastic leukemia patient undergoing maintenance therapy: a case report", "patient": "A 33-year-old woman, who was on maintenance chemotherapy for acute lymphoblastic leukemia (ALL), presented to our clinic with chief complaints of severe headache and nausea. She had been diagnosed with ALL 2 years before this event and was in the process of receiving maintenance treatment under the Japan Adult Leukemia Study Group ALL202-U protocol []. Her headache and nausea had started after receiving an intrathecal chemotherapy (methotrexate, cytarabine, and prednisolone) 2 weeks before; thus, she initially interpreted the headache as post-lumbar-puncture pain and consumed painkillers (loxoprofen and tramadol) that partially relieved her symptoms. However, her symptoms continued, and by the time of her visit to our clinic, she also developed other symptoms, such as photosensitivity, appetite loss, left temporal and eye pain, and tinnitus. She had no gastrointestinal symptoms or fever during the 2 weeks. She had no medical history before her diagnosis of ALL and had only one episode of septic shock with lung abscess during her course of chemotherapy, which was caused by Klebsiella pneumoniae. She was on prophylactic antimicrobials, including atovaquone (leukopenia due to trimethoprim-sulfamethoxazole), fluconazole, and acyclovir. Notably, she had eaten undercooked beef 2 days prior to admission. On admission, the patient experienced acute distress, had a body temperature of 36.2 \u00b0C, blood pressure of 130/88 mmHg, pulse rate of 87/min, respiratory rate of 18/min, and oxygen saturation measured by pulse oximetry of 100% on room air. The patient did not have neck stiffness, jolt accentuation, or any other neurologic deficits, such as cranial nerve abnormality, ataxia, or muscle weakness in her extremities. She had no abdominal tenderness or normoactive bowel sounds. Laboratory findings were the following: white blood cell count, 2400/\u03bcL (neutrophils, 58%; lymphocytes, 27.5%; monocytes, 11.5%); hemoglobin level, 11.5 g/dL; platelet count, 336,000/\u03bcL; blood urea nitrogen level, 10.2 mg/dL; creatinine level, 0.48 mg/dL; and C-reactive protein level, 3.74 mg/dL. Computed tomography of the brain did not reveal any abnormalities. Incidentally, her neutrophil count had been hovering around 1000/\u03bcL, a month prior to her admission. Her headache was so intense that we started intravenous patient-controlled analgesia with fentanyl.\nOn day 2, her temperature rose to 38.0 \u00b0C and jolt accentuation was observed. Lumbar puncture was performed, and CSF analysis showed a cell count of 71 (polymorphonucleocytes 59.2% and mononucleocytes 40.8%), protein level of 87 mg/dL, and glucose level of 82 mg/dL (serum glucose 124 mg/dL). No bacteria were observed under gram staining. We empirically initiated ampicillin 2 g intravenously (IV) every 4 h and ceftriaxone IV 2 g every 12 h. Her symptoms gradually improved. On day 4, spiral gram-negative rods were detected in blood cultures obtained on admission, and ampicillin was discontinued. On day 6, blood and CSF cultures revealed C. fetus, which was identified by an aerobic bottle, BacT/ALERT (bioM\u00e9rieux, Inc., Durham, NC). The minimum inhibitory concentrations (MICs) of this strain measured by E-test (bioM\u00e9rieux) were as follows: meropenem, 0.064 \u03bcg/mL and cefotaxime, 16 \u03bcg/mL. Stool cultures were negative on day 9, and we switched from ceftriaxone to meropenem 2 g IV every 8 h (Fig. ). We excluded other metastatic foci, such as infective endocarditis, splenic or renal abscess, septic pulmonary emboli, or infected aneurysm. We continued meropenem for 3 weeks, and she was discharged without neurological sequelae.", "age": [ [ 33.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC008xxxxxx/PMC8278592.xml", "relevant_articles": { "34256709": "123", "7873285": "0", "32998485": "0", "9198101": "0", "16408432": "0" }, "similar_patients": { "7670619-1": "0", "8461981-1": "0", "7670619-2": "0", "8252270-1": "123", "5735542-1": "123" } }, { "human_patient_id": "419", "human_patient_uid": "4521112-1-M", "PMID": "26240588", "title": "Constrictive Pericarditis Long after a Gunshot Wound", "patient": "A 69-year-old man visited our hospital for palpitation and dyspnea on exertion. The symptoms began four months prior to his visit to the hospital. On physical examination, a rapid heartbeat and friction rub were audible, and a 6-cm linear scar was observed on the right upper chest. Edema of both lower extremities was observed. At the age of 6 in 1950, he was wounded in the chest during a shooting spree by North Korean soldiers during the Korean War. However, at that time he could not visit a hospital and was treated with folk remedies. On the chest X-ray, a bullet adjacent to the right cardiac border and bilateral pleural effusion was noted (). On electrocardiography, he had typical atrial flutter with 2-to-1 atrioventricular conduction, and his heart rate was 150 bpm (). An axial computed tomographic image () showed that the bullet was likely located in the right atrium. Thickening of the pericardium was also observed. A long axis reformatted image () and a three-dimensional volume-rendered image () confirmed that the bullet was located in the epicardial fat and abutted the right atrium at an acute angle. Transthoracic echocardiography during the atrial flutter and sinus rhythm revealed bi-atrial enlargement, thickened pericardium, septal bouncing motion, and significant respiratory variations of the mitral inflow velocity, which were compatible with constrictive pericarditis (). The E/A and E/e' ratios were 4.4 and 8, respectively. The septal e' was higher than the lateral e' (12 cm/sec and 10 cm/sec, respectively). To rule out lead poisoning from the bullet, the patient's blood lead level was checked and lead was undetectable. Atrial flutter and constrictive pericarditis were the suspected causes of the palpitation and dyspnea on exertion. An electrophysiological study confirmed that the atrial flutter was cavotricuspid isthmus-dependent: during the electrophysiological study, fluoroscopy showed that the bullet moved primarily with respiratory movements and partially with heart-beating movements. Moreover, pericardial calcification was also observed adjacent to the coronary sinus. Radiofrequency catheter ablation for ty-pical atrial flutters was performed by a bidirectional conduction block of the cavotricuspid isthmus. One week after radiofrequency catheter ablation, surgical extraction of the bullet and pericardiectomy were performed. In the surgical field, the pericardium was th-ickened and the bullet was severely adhered to the adjacent epicardial tissue (). There were scattered substances around the bullet, which were presumed to be gunpowder. Due to the gunpowder, the pericardium was thickened and stiffened. The rusted bullet was extracted 63 years after the initial gunshot wound. The pathology of the adjacent epicardial tissue showed dystrophic calcification (). After surgery, the patient recovered without complications and there was no echocardiographic evidence of constrictive physiology.", "age": [ [ 69.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4521112.xml", "relevant_articles": { "26240588": "123", "11139955": "1", "18754936": "123", "9755533": "1", "10604888": "1" }, "similar_patients": { "2771803-1": "1", "4391184-1": "123", "3443881-1": "1", "6601183-1": "12", "3863515-1": "13" } }, { "human_patient_id": "420", "human_patient_uid": "3108471-1-M", "PMID": "21660274", "title": "Bilateral Giant Juvenile Fibroadenomas of Breasts:A Case Report", "patient": "A 12-year-old premenarche girl presented with bilateral, rapidly enlarging breast lumps for three months (). There was history of dull ache in the breasts. There was no family history. History of trauma, nipple discharge, fever, anorexia, or weight loss was absent. On local examination bilateral slightly tender, huge, well-circumscribed masses in both the breasts were seen, which were firm in consistency. The overlying skin was tense and shiny with prominent superficial veins. The right breast lump measured 15 \u00d7 12 cms and left breast lump measured 17 \u00d7 15 cms. On both the sides, the lumps were not fixed to underlying structures. There was no discharge from the nipple, and axillary lymphadenopathy was absent. Routine hematological and biochemical examinations were within normal limits. Chest-X ray was normal. Ultrasonography was carried out which showed heterogenous parenchymal pattern suggestive of bilateral fibroadenoma. The patient was subjected to fine-needle aspiration cytology (FNAC) of bilateral breast lumps which revealed cellular smears comprising of many branching monolayer sheets along with myoepithelial cells ().\nBackground showed bare nuclei and myxoid stromal fragments. Based on the cytological findings, diagnosis of benign proliferative lesion without atypia suggestive of bilateral fibroadenomas was given. The patient underwent total excision of bilateral breast lumps conserving the normal breast tissue, nipple, and areola by the plastic surgeon. The two resected specimens were sent for histopathological study in the department of pathology. The right-sided excised lump measured 15 \u00d7 12 \u00d7 6.5 cms and weighed 800 gms. The left-sided excised lump measured 17 \u00d7 15 \u00d7 5 cms and weighed 950 gms. Overlying skin was unremarkable. External surface was bosselated, and both the lumps were well circumscribed and encapsulated (). Cut sections from both the lumps showed multiple gray white nodules showing myxoid, gray white appearance along with occasional slit-like spaces and tiny cysts ().", "age": [ [ 12.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3108471.xml", "relevant_articles": { "27872544": "0", "24653651": "0", "88619": "2", "30868011": "123", "3208039": "12" }, "similar_patients": { "2905535-1": "123", "6402743-1": "123", "3643372-1": "123", "3806122-1": "0", "3097716-1": "0" } }, { "human_patient_id": "421", "human_patient_uid": "4913998-1-M", "PMID": "27366094", "title": "1p/19q codeletion and RET rearrangements in small-cell lung cancer", "patient": "The first patient was a 46-year-old male heavy smoker whose chief complaint was pain in his left shoulder and back for 3 months. A chest computerized tomography (CT) revealed a mass in his left upper lung lobe with mediastinal lymph node metastasis. The patient received two cycles of chemotherapy with gemzar and cisplatin followed by radical resection of the left upper lung cancer. His pathological diagnosis was SCLC and immunohistochemical stains revealed that his specimen was positive for synaptophysin and carcinoembryonic antigen and negative for chromogranin A and neuron-specific enolase. The size of the resected tumor was 5\u00d74\u00d7 3.5 cm, and his pathological TNM stage was T2aN2M0 (IIIA). After surgery, he received two cycles of chemotherapy (gemzar and cisplatin) and thoracic radiotherapy (planning target volume 56Gy/28F). The patient was followed up for 58 months and is still alive with no recurrence.", "age": [ [ 46.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4913998.xml", "relevant_articles": { "14750327": "123", "17876154": "123", "22202282": "0", "33371055": "123", "25963779": "123" }, "similar_patients": { "4913998-2": "123", "4913998-3": "123", "5944445-1": "123", "5709029-1": "123", "6031552-1": "13" } }, { "human_patient_id": "422", "human_patient_uid": "4913998-2-M", "PMID": "27366094", "title": "1p/19q codeletion and RET rearrangements in small-cell lung cancer", "patient": "The second patient was a 61-year-old male heavy smoker who reported a cough and sputum with blood for over 10 days. A chest CT revealed a mass (5.5\u00d74 cm) in his left upper lung lobe. The patient underwent a left total pneumonectomy. His pathological diagnosis was SCLC, and his specimen stained positive for CD56, neuron-specific enolase, and carcinoembryonic antigen, and negative for chromogranin A and synaptophysin. His pathological TNM stage was T2bN1M0 (IIB). He received six cycles of chemotherapy (etoposide and cisplatin), thoracic radiotherapy, and prophylactic cranial irradiation. The patient was followed up for 50 months and is still alive with no recurrence.", "age": [ [ 61.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4913998.xml", "relevant_articles": { "25806349": "123", "33371055": "123", "1648333": "123", "25963779": "123", "26767023": "123" }, "similar_patients": { "4913998-1": "123", "4913998-3": "123", "5709029-1": "123", "5058936-1": "123", "8360407-1": "13" } }, { "human_patient_id": "423", "human_patient_uid": "4913998-3-M", "PMID": "27366094", "title": "1p/19q codeletion and RET rearrangements in small-cell lung cancer", "patient": "The third patient was a 58-year-old male moderate smoker. A mass (3.1\u00d72.5 cm) was found in his right upper lung lobe during a physical examination. The patient received two cycles of chemotherapy with etoposide and cisplatin followed by a right upper lobectomy with systematic mediastinal lymphadenectomy. His pathological diagnosis was SCLC and his tumor stained positive for chromogranin A, synaptophysin, and CD56, and negative for TTF-1 and CK5/6. His pathological TNM stage was T2aN0M0 (IB). He received two cycles of chemotherapy with etoposide and cisplatin and prophylactic cranial irradiation (25Gy/10F) after surgery. The patient was followed up for 30 months and is still alive with no recurrence.", "age": [ [ 58.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4913998.xml", "relevant_articles": { "2321985": "3", "14750327": "123", "8538096": "123", "26767023": "123", "1648333": "123" }, "similar_patients": { "4913998-2": "123", "4913998-1": "123", "5672992-1": "123", "5709029-1": "123", "4706535-1": "123" } }, { "human_patient_id": "424", "human_patient_uid": "7583397-1-M", "PMID": "33078648", "title": "Internal carotid artery rupture successfully rescued after resection of locally advanced mucosal malignant melanoma of the eustachian tube: a case report", "patient": "A 62-year-old woman complained of persistent nasal discharge with nose bleeding accompanied by right tinnitus for 2 years. A nasopharyngeal mass was found on a nasopharyngeal endoscopic examination at another hospital. Histopathology of the biopsy specimen showed nasopharyngeal malignant melanoma. After taking six cycles of temozolomide at another hospital, the nasopharyngeal mass did not decrease in size. Therefore, conventional segmentation radiotherapy was performed 20 times.\nFinally, the patient was admitted to our hospital. A specialist examination showed a mass in the nasopharyngeal cavity with pigmentation on the surface and growth into the right nasal cavity. Enhanced magnetic resonance imaging (MRI) () showed masses in the right lateral wall of the nasopharyngeal cavity, which involved the nasal cavity and was consistent with melanoma. The masses showed high-signal intensity on T1-weighted images and low-signal intensity on T2-weighted images. Non-enhanced computed tomography (CT) () showed an irregular mass in the nasopharyngeal cavity with an unclear boundary with the lateral nasopharynx wall. After excluding distant metastases, such as to the chest and abdomen, the operation plan of partial resection was selected. The operation process was divided into two parts. First, surgery was performed to open the whole group of bilateral sinuses. The tumour was found at the centre of the eustachian tube, and extended forward to the nasal cavity and sinuses, and invaded the ethmoid roof and meningeal tissue. Second, the diseased meningeal tissue was removed and cerebrospinal fluid rhinorrhoea was repaired.\nTwo weeks later, subtotal resection of the right temporal bone with the Fisch type B posterior auricular approach and of the lateral cranial base lesions was performed in the second stage. Intraoperatively, the lesion was found to be located inferomedially to the cartilaginous portion of the eustachian tube. The cartilage and lesion were removed together up to the foramen lacerum and down to the pharyngeal orifice of the eustachian tube. The ICA was exposed and properly protected. Three days after the second operation, the patient developed sudden massive oral and nasal bleeding with a volume of approximately 300 mL. Therefore, nasal endoscopic probing was performed after endotracheal intubation under general anaesthesia at the site of haemorrhage on the right side of the nasopharynx. Because of continuous bleeding, we performed emergency cerebrovascular angiography and balloon (Cordis 6 \u00d7 20 mm; Johnson & Johnson, New Brunswick, NJ, USA) embolization of the ICA. The specific process was as follows. Super selective arteriography of the bilateral common carotid arteries, internal carotid artery, and left vertebral artery was performed, and contrast media leakage was observed in the temporal segment of the right ICA (). Cerebral angiography showed that the anterior communicating artery was open and the bilateral anterior cerebral arteries, middle cerebral arteries, and their branches were well developed. The balloon was placed at the distal and proximal ends of the orifice of the fistula to block the blood vessel. Postoperative angiographic results are shown in . The patient developed transient myocardial ischaemia postoperatively, and 4 days after the treatment, the patient returned to the local hospital for medical treatment. No abnormalities were found on brain CT at discharge. After discharge, the patient did not receive any other comprehensive treatment. At the 6-month follow-up, the patient showed multiple bone and kidney metastases. She died of systemic metastases 1.5 years later.", "age": [ [ 62.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC007xxxxxx/PMC7583397.xml", "relevant_articles": { "33078648": "123", "1950553": "2", "30035522": "123", "1399302": "2", "15143448": "123" }, "similar_patients": { "4278099-1": "13", "7758204-1": "1", "7837894-1": "13", "8590532-1": "13", "5652126-1": "13" } }, { "human_patient_id": "425", "human_patient_uid": "6616428-1-M", "PMID": "31208005", "title": "Spontaneous Subdural Hematoma and Behavioral Changes Due to a Dural Arteriovenous Fistula. A Case Report and Literature Review", "patient": "A 23-year-old male with a history of migraine headaches for over 10 years was studied. The headaches responded favorably to usual analgesic treatment and worsened with physical exercise.\nThe patient looked for medical attention due to sudden and intense headaches in the occipital region with no evident cause, whose characteristics differed from the previous ones. An emergency computed tomography (CT) scan was performed, revealing the presence of a right occipital intracerebral hematoma that required immediate hospitalization and treatment for a month until resolution of the clot. One year after being symptom-free, he began to experience a mild to moderate oppressive headache in the right temporal region, which improved with analgesics for approximately 15 days. After that, the oppressive headache restarted with more intense hemicrania, accompanied by fatigue, short episodes of altered consciousness, sweating, multiple instances of projectile vomiting, and blurred vision of the left eye. General physical and neurological exams did not show any positive data, nor was there evidence of triggering events, such as traumatic brain injury, hematologic disorders, previous surgeries, or infections of the central nervous system (CNS).\nMood changes, including permanent irritability, aggressiveness, anxiety, diminished ability to think or concentrate, and temporo-spatial time disorientation, appeared during the follow-up period and a second CT-scan was performed.\nLaboratory tests included the following: hemoglobin 133 g/L; leucocytes 8.1 \u00d7 103, platelets 373 u/L. A coagulogram indicated the following: suitable platelets, bleeding time 1.30 s, coagulation time 8 min, prothrombin time 15.2 s (control 13 s \u00b1 3), and activated thromboplastin time 30 s; glycemia 4.83 mmol/L; glutamic oxaloacetic transaminase (GOT) 42.51 U/L; glutamic oxaloacetic transaminase (GPT) 42.29 U/L; cholesterol 4.24 mmol/L; triglycerides 0.90 mmol/L; creatinin 82.81 \u03bcmol/L; uric acid 280 \u03bcmol/L; total protein 72.15 g/L; albumin 41.30 g/L; negative human immunodeficiency virus (HIV) and non-reactive Venereal Disease Research Laboratory (VDRL).\nUrgent multislice tomography showed a laminar SDH in the right fronto-parietal region, a posterior interhemispheric fissure at the level of the tentorium, and ipsilateral occipital intracerebral hematoma (2.2 \u00d7 2.3 cm in axial section), with a volume of 7 mL. These lesions produced a slight mass effect on the neighboring structures, and the midline was displaced 0.5 cm ().\nBoth hematomas were reabsorbed gradually (), with satisfactory clinical evolution after a two-month follow-up period. shows the increased frontal subdural hematoma and its extension to parietal and frontal lobes. Angiography revealed ecstatic cortical veins, one of them with saccular dilatation adjacent to the IPH (). For this reason, we decided to perform cerebral angiography, which confirmed the dural arteriovenous fistula. It connected the artery, a branch of the external carotid artery, with cortical veins in the superior sagittal sinus drainage (). After endovascular therapy, the evolution of the patient was satisfactory ( and ). Two years later, no bleeding had appeared, and the subsequent angiographic studies were negative.", "age": [ [ 23.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6616428.xml", "relevant_articles": { "11449719": "12", "18975568": "12", "3841193": "12", "24505966": "123", "31208005": "123" }, "similar_patients": { "4859945-1": "0", "4031834-1": "12", "5883424-1": "12", "6935788-1": "12", "6014500-1": "0" } }, { "human_patient_id": "426", "human_patient_uid": "5702755-1-M", "PMID": "29201854", "title": "Traumatic Intracerebral and Subarachnoid Hemorrhage Due to a Ruptured Pseudoaneurysm of Middle Meningeal Artery Accompanied by a Medial Sphenoid Wing Dural Arteriovenous Fistula", "patient": "A 69-year-old male patient presented with stuporous mentality after fall from 2-meter height. On admission, the patient's Glasgow Coma Scale (GCS) score was 7/15. Neurological exam revealed no further abnormalities. Brain computed tomography (CT) scan revealed an ICH in the left temporal lobe with diffuse SAH and subdural hemorrhage (). A brain CT angiography revealed a pseudoaneurysm of MMA (). Sequentially, the patient was submitted to cerebral angiography and the left external carotid angiogram revealed a pseudoaneurysm arisen from the anterior branch of the MMA accompanied by dAVF at the middle segment of sphenoid ridge (). Through the right common femoral artery, a guiding catheter (Envoy 6 Fr; Cordis/Johnson & Johnson, Miami, FL, USA) was positioned in the left external carotid artery. We carefully naviated a microcatheter pre-shaped 45 degrees (Excelsior SL-10; Stryker Neurovascular, Fremont, CA, USA) under the guidance of a 0.014-inch microguidewire (Synchro 14; Stryker Neurovascular) to reach the juxtaproximal to the pseudoaneurysm via MMA. After the confirmation of the appropriate position of the microcatheter via repetitive superselective angiography (), embolization of a pseudoaneurysm and MMA was performed using 25% n-butyl cyanoacrylate (NBCA) (Hystoacryl; B. Braun, Melsnagen, Germany) mixed with iodized oil (Lipiodol; Guerbet, Aulnay-sous-Boid, France). We achieved angiographically complete occlusion of a pseudoaneurysm and dural AVF (). Follow-up brain CT scan showed no significant hematoma enlargement and well penetrated glue cast at the all the vascular lesions ().\nThe patient presented an improvement in consciousness for GCS score 15 after 12 days. However, at the 18-day after the procedure, the right side weakness and dysarthria were developed. Brain CT angiography and subsequent left internal carotid angiography revealed cerebral vasospasm at the distal segment of MCA with multiple low densitied at the left MCA territories (). Cerebral vasospasm was treated using intra-arterial (IA) nimodipin infusion, and it was improved. At discharge, dysarthria was improved, but right side weakness was remained (Grade 3).", "age": [ [ 69.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5702755.xml", "relevant_articles": { "32360920": "12", "17323900": "12", "26862457": "12", "11098228": "12", "29354334": "12" }, "similar_patients": { "4847511-1": "13", "4323506-1": "13", "8213310-1": "13", "7307609-1": "13", "2892657-1": "13" } }, { "human_patient_id": "427", "human_patient_uid": "5100305-1-M", "PMID": "27821092", "title": "Human meningitis due to Streptococcus suis in Lom\u00e9, Togo: a case report", "patient": "A 32-year-old man working as a carpenter in Lom\u00e9, Togo, was admitted in August 2015 to the University Hospital Campus of Lom\u00e9 for a 3 day history of severe headaches, vomiting, fever, and intense agitation (Table ). He had no particular medical history and no risk factors for immunodeficiency. At admission, the body temperature was of 36.4 \u00b0C, and the general state was acceptable, with a correct conservation of consciousness. The neurological examination did not show any sign of motor or sensitive defect, of cranial nerve dysfunction or cerebellar symptoms. There was no hearing or skin abnormalities, no obvious neck stiffness, and the rest of the clinical examination was normal. Acute meningeal hemorrhage was evocated as the initial diagnosis. Cranial computed tomography could not be performed and a symptomatic treatment associating antalgic, antipyretic, and anticonvulsant medication was initiated. At the second day of admission, the patient was febrile, agitated, and still suffered from severe headaches and vomiting. The neck had become stiff, and Kernig and Brudzinski signs were positive. The meningeal signs led to the realization of a lumbar puncture, which yielded a turbid cerebrospinal fluid (CSF) concluding to the diagnosis of bacterial meningitis. An empiric intravenous antibiotic treatment associating ceftriaxone (2 g, 2\u00d7/d for 24 h then 1 g, 2\u00d7/d), ofloxacin (200 mg, 3\u00d7/d), and metronidazole (500 mg, 2\u00d7/d) was started.\nCSF analysis showed 2,800 leukocytes/mm3 (65 % lymphocytes and 35 % neutrophils), a protein concentration of 1.8 g/L, and a glucose concentration of 0.47 g/L (2.6 mmol/L) with a plasma glucose concentration of 1.41 g/L (7.8 mmol/L; ratio = 0.33). Gram staining did not reveal any microorganism. Blood and CSF cultures, after 48 h and 24 h of incubation, respectively, grew small beta-hemolytic colonies on horse blood agar plates. The bacteria were catalase negative, gram-positive cocci, in chains or in pairs. They were identified as S. suis (score 2.56) by MALDI-TOF (Matrix Assisted Laser Desorption Ionisation Time Of Flight) spectrometry (BrukerTM) and as S. suis serotype 1 (97 % probability) by VITEK 2 Gram-positive card system (bioM\u00e9rieux, Marcy l\u2019Etoile, France). Slide agglutination with type-specific hyperimmune serum and specific multiplex PCR identified the isolate as S. suis serotype 2, indicating a serotype misidentification by the automated card system, and concluding, together with Multi-Locus Sequence Typing [\u2013], to an infection due to S. suis serotype 2, Sequence-Type (ST) 1, one of the most virulent and frequently isolated clone all over the world [, ]. Antimicrobial drug-susceptibility testing performed according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) recommendations characterized the strain as susceptible to penicillin (Minimum inhibitory concentration (MIC) < =0.25 mg/L), erythromycin, clindamycin, levofloxacin, and linezolid and resistant to tetracycline.\nAfter S. suis was identified, the patient reported working as a pork butcher every week-end. The patient did not have any sign or symptoms of endocarditis, and the antibiotic treatment was replaced by ampicillin (2 g, 3\u00d7/d) and gentamicin (80 mg, 2\u00d7/d) for 7 days. While the patient was receiving treatment for 1 day, vertigo and tinnitus developed, for which he received adjunctive corticoid therapy and the treatment was completed with no particular adverse events. Hearing disorders, especially hearing loss, are the most common sequelae of S. suis infections and affect more than 50 % of patients who survive meningitis []. In that case, hearing disorders evolved into severe hearing loss in the left and right ears (80 dB), and the patient was still suffering from tinnitus 9 months after the diagnosis. One year later, tinnitus had disappeared and the patient\u2019s auditory function had improved from severe to moderate hearing loss.", "age": [ [ 32.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5100305.xml", "relevant_articles": { "9378053": "123", "21779197": "123", "12884827": "123", "27821092": "123", "29429850": "123" }, "similar_patients": { "5336690-1": "13", "3325437-1": "123", "7351979-1": "13", "3129354-1": "123", "7570012-1": "13" } }, { "human_patient_id": "428", "human_patient_uid": "3354430-1-M", "PMID": "22624132", "title": "Crohn's disease of the appendix with enterocutaneous fistula post-appendicectomy: An approach to management", "patient": "A 24-year-old unmarried female patient presented to us with a persistent fistula in the right iliac fossa following an appendicectomy done in another hospital 6 weeks previously. On further questioning, she informed us that she had presented to this hospital with a 2-week history of abdominal pain, confined to the right lower abdomen. She complained of general ill health and occasional altered bowel habits for 6 months prior to this acute episode.\nAn enquiry with the doctors who had initially seen her revealed that at the time of presentation for acute appendicitis she was quite unwell with fever, tachycardia, and dehydration. Her abdomen was tender all over with guarding, more pronounced over the right lower half. Her white cell count was 24 \u00d7 109/L. An X-ray of her abdomen showed a few fluid levels and an ultrasound scan revealed free fluid in the abdomen with an associated right iliac fossa mass.\nA diagnosis of pelvic peritonitis secondary to acute appendicitis was made by the physicians, and she was taken up for surgery after adequate resuscitation. The abdomen was approached through a right McBurney's incision. There was pus in the abdomen with an appendicular mass, and the appendix appeared oedematous, thickened, and congested. An appendicectomy was carried out followed by a thorough irrigation of the abdominal cavity. The abdomen was closed after placing a drain, which was removed on the 3rd post-operative day. In spite of antibiotic administration, she developed a wound infection and persistent pyrexia. She was managed conservatively with antibiotics and anti-inflammatory medication and eventually improved, except for a persistent purulent discharge from the wound. She then decided to seek our opinion and was admitted under our care for further investigation and management.\nThe appendicular histopathology was retrieved from the previous hospital and revealed transmural inflammation with granulomas suggestive of Crohn's disease. A computerized tomography (CT) scan of the abdomen carried out in our hospital showed pericaecal collection with an inflammatory mass in front of the caecum ().\nThe abdomen was surgically explored through the previous incision after excising the fistula leading into the caecum. An inflammatory mass associated with the caecum was noted. The appendicular stump had not healed, and was draining into a cavity which was communicating with the wound, indicating a complex enterocutaneous fistula. A limited right hemicolectomy was carried out and continuity established with a primary anastomosis of macroscopically-appearing healthy bowel of the ascending colon and terminal ileum. A specimen of the resected caecum revealed the cobblestone appearance of the mucosa, strongly suggesting the possibility of underlying caecal Crohn's disease (). The histology was reported as inflammatory bowel disease (IBD) consistent with Crohn's disease (). The patient's post-operative recovery was uneventful. She was referred to a gastroenterologist and was being treated with mesasalazine and a regular annual colonoscopy. When last seen at two years post-surgery she continued to remain in good health.", "age": [ [ 24.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC003xxxxxx/PMC3354430.xml", "relevant_articles": { "22624132": "123", "24469845": "123", "30918739": "123", "32368212": "123", "31337629": "0" }, "similar_patients": { "3983759-1": "123", "6815536-1": "123", "3253676-1": "123", "555568-1": "123", "3014788-1": "0" } }, { "human_patient_id": "429", "human_patient_uid": "3171650-1-M", "PMID": "21863273", "title": "Variable phenotypes in a family with mitochondrial encephalomyopathy harboring a 3291T > C mutation in mitochondrial DNA", "patient": "Figure a shows the pedigree of our patients. A 70-year-old woman (II-4) was admitted to our hospital due to a 6-year history of progressive gait disturbance. At the age of 45 years, she developed bilateral hearing deficits, and at 64 years, she underwent surgery to correct cataracts and glaucoma. Neurological examination of the patient revealed mild external ophthalmoparesis, nystagmus, sensory neural hearing loss, dysarthria, and severe cerebellar ataxia. There was mild proximal muscle weakness of the limbs. Tendon reflexes were reduced generally. Electroencephalogram (EEG) assessment showed diffuse paroxysmal slow activity (3\u20136 Hz), which was induced by photo-stimulation. No epileptic discharge was found. Needle electromyography showed low amplitude and short motor-unit potential in the proximal extremities. Brain magnetic resonance imaging (MRI) showed atrophy of frontal lobe and cerebellar cortex (Fig. ). There was no lactate peak on brain magnetic resonance spectroscopy in a voxel placed over a lateral ventricle. Laboratory test results revealed normal lactate levels and slightly increased pyruvic acid levels. Cerebrospinal fluid analysis was normal. The psychometric test showed impaired intelligence, memory, and frontal function.\nThe proband\u2019s mother (I-2) suffered from hearing loss and glaucoma. Since the age of 80, she had slowly become progressively bedridden. She died at the age of 84.\nThe proband\u2019s first daughter (III-2) is 41 years old and has had palindromic rheumatism since the age of 14 years. She has not experienced convulsion, myoclonic event or stroke-like episodes, but has had recurrent migraine attacks. Brain MRI showed multiple, small hyper-intense areas in subcortical white matter of the cerebrum on a T2-weighted sequence. Her neurological examination showed no abnormalities.\nThe proband\u2019s second daughter (III-3) is 39 years old and has experienced photo-induced myoclonus since the age 36 years. At that time, atrophy of the cerebellum was noted on MRI. At the age of 38 years, she started taking anticonvulsant medication due to negative myoclonus and photo-induced myoclonus on EEG examination. Her neurological examination showed an absence of tendon reflexes in all limbs and mild truncal ataxia. Muscle strength and mental status were normal.\nThe proband\u2019s first granddaughter (IV-1) is 17 years old. She was delivered with the aid of a vacuum extractor at 37 gestational weeks. At the age of 15 years, loss of consciousness lasting a few seconds and myoclonic jerks in her upper extremities and trunk appeared. Two years later, she experienced her first generalized seizure with an abnormal EEG record and started taking antiepileptic drugs. School records indicated below average academic performance. Her neurological examination showed an absence of tendon reflexes in all four limbs and slight cognitive decline. Coordination and muscle strength were normal.", "age": [ [ 70.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC003xxxxxx/PMC3171650.xml", "relevant_articles": { "9234257": "1", "1300261": "12", "9311007": "0", "7729099": "1", "9125748": "0" }, "similar_patients": { "5473401-1": "1", "6882281-1": "1", "7548920-1": "0", "6984135-1": "1", "5097349-1": "1" } }, { "human_patient_id": "430", "human_patient_uid": "5268061-1-M", "PMID": "27977615", "title": "Total revascularization for an epsilon right coronary artery and severe left main disease combined with profound cardiogenic shock", "patient": "A 67-year-old man presented with non-ST-elevation myocardial infarction (NSTEMI) and cardiogenic shock. His heart rate was around 120 to 130/min, and his systolic blood pressure was around 70 to 80 mm Hg even though vasoactive agent use. The patient developed pulmonary edema and progressed to profound cardiogenic shock status within 2 hours. Electrocardiography showed diffuse ST-segment depression in precordial leads and Q-wave in inferior leads. His coronary risk factors include hypertension, diabetes mellitus, hyperlipidemia, and smoking. He received intubation and ventilator support due to impending respiratory failure. IABP was set before diagnostic coronary angiography (CAG). CAG revealed severe calcified RCA subtotal occlusion at middle portion, with retrograde collaterals from the distal portion of the left anterior descending artery (LAD) (Fig. A). From the distal LM to the mid LAD, there was a long tubular severe calcified 80% stenosis (Fig. B) and concomitant hypoplastic left circumflex artery (LCX) chronic total occlusion (CTO) without significant collaterals from LAD or RCA (Fig. C). Transthoracic 2-dimensional echocardiography revealed poor left ventricular performance and global hypokinesis with LVEF of 23%. His SYNTAX score (synergy between percutaneous coronary intervention with TAXUS and cardiac surgery) was 43, and the EuroScore (European System for Cardiac Operative Risk Evaluation) was 20 (estimated perioperative mortality rate 20%\u201338%). The patient and his family refused coronary artery bypass grafting (CABG). Due to unstable hemodynamic condition, ECMO were set up immediately.\nCoronary intervention was performed via right transradial (TR) approach because both femoral arteries were used for ECMO and IABP. A 6-French (Fr.) Ikari IL 3.5 guiding catheter (Terumo, Tokyo, Japan) was used for engaging the left main ostium. Tirofiban was used for intracoronary bolus and intravenous maintenance. After advancing a 0.014 Runthrough Floppy wire (Terumo, Tokyo, Japan) to the distal LAD, sequential dilatation was performed using Maverick 2.5 \u00d7 20 mm (Boston Scientific, New York, USA) up to 18 atm, NC Sprinter 2.75 \u00d7 12 mm (Medtronic, Minneapolis, MN) up to 18 atm, NC Sprinter 3.0 \u00d7 12 mm (Medtronic) up to 20 atm, and Quantum 3.5 \u00d7 8 mm (Boston Scientific, USA) up to 28 atm. All of these balloons ruptured and long linear dissection occurred. Two drug-eluting stents (DES) Taxus Liberte (Boston Scientific, USA) 2.75 \u00d7 28 mm and 3.0 \u00d7 32 mm were deployed at mid LAD to distal LM, and subsequently, postdilatation of the in-stent portion up to 30 atm by Quantum (Boston Scientific, USA) 3.0 \u00d7 8 mm, 3.25 \u00d7 8 mm, and 3.5 \u00d7 8 mm balloons. Intra-vascular ultrasound (IVUS) and angiography (Fig. D) revealed that 2 stents were well deployed and well apposed to the vessel wall (Fig. E\u2013H) with retrograde collaterals to the distal RCA.\nWe performed PCI for the difficult lesion of RCA to complete revascularization due to cardiogenic shock. A hydrophilic wire Pilot 50 (Abbott, Chicago, IL) was successfully advanced to the distal posterior descending artery with a 6 Fr. Ikari IL 3.5 guiding catheter (Terumo, Tokyo, Japan) via the right TR approach. An Ottimo 1.5 \u00d7 10 mm balloon (Kaneka, Osaka, Japan) and a Maverick 2.0 \u00d7 20 mm balloon (Boston Scientific, USA) were used for dilatation of the lesions from mid RCA to proximal RCA up to 18 atm. Because the RCA was much angulated with an epsilon shape (Fig. A) and linear dissection occurred after balloon angioplasty, we tried to deploy stents from the distal to the ostium RCA but failed. Even though we employed methods such as 2 guidewire technique, balloon anchoring technique, 5-in-6 technique using 5Fr. ST01 catheter (Terumo, Tokyo, Japan), and deep-seating technique to deploy stents (including one drug-eluting stent), but all were unsuccessful when applied separately. Therefore, we proceeded to apply 3 techniques in combination (balloon anchoring technique, 5-in-6 technique, and deep-seating technique) to deploy the first stent Vision 2.75 \u00d7 18 mm (short stent) (Abbott) at the most angulated portion (Fig. B) which attributed the success of deploying other 4 stents from the distal to the ostium RCA: pixel 2.5 \u00d7 23 mm (Abbott), micro-Driver 2.5 \u00d7 24 mm (Medtronic, USA), Vision 3.0 \u00d7 28 mm, and Vision 3.5 \u00d7 12 mm. After high-pressure dilatation of the in-stent portion, IVUS and angiography (Fig. C) revealed that the 5 stents were well deployed and well apposed to the vessel wall (Fig. D\u2013H).\nWe removed IABP and ECMO until cardiac contractile function improved to left ventricular ejection fraction over 40 percentage after 1 week. The patient was discharged after 2 months and had survival for 5 years.", "age": [ [ 67.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5268061.xml", "relevant_articles": { "34467428": "123", "27964934": "123", "22930372": "123", "24122502": "123", "29921223": "123" }, "similar_patients": { "2933466-1": "123", "3958605-1": "123", "7360218-1": "123", "7026705-1": "123", "8123955-1": "13" } }, { "human_patient_id": "431", "human_patient_uid": "4124073-1-M", "PMID": "25114596", "title": "Idiopathic CD4+ lymphocytopenia in Hispanic male: case report and literature review", "patient": "A 20-year-old Hispanic male with no past medical history presented to our institution complaining of generalized weakness for 4 weeks, progressive cough with yellowish sputum, as well as persistent shortness of breath for 3 weeks, and intermittent fever and chills for 3\u20135 days prior to admission. Family history was remarkable only for coronary artery disease in his father. He denied smoking, alcohol, and using illegal drugs. He had lived with his girlfriend for 2 years and stated to be monogamous over this period. He reported a total of two sexual partners in his life. He was born in Texas and had not traveled outside the US for the last 12 years. Physical examination revealed a cachectic and tachypneic patient in no acute distress with bilateral diffuse crackles and rhonchi. The initial laboratory workup was within normal limits. Computed tomography of the chest () showed diffuse tree-in-bud nodularity, bronchiectasis, and thick-walled cavities in the upper lobes and moderate right simple pleural effusion. The HIV-rapid enzyme-linked immunosorbent assay test was reactive. The acid-fast bacilli sputum test was positive, and the patient was started on combination treatment for tuberculosis. The patient improved clinically over the next 3 days. The HIV Western blot test was negative; the viral load was undetectable. The CD4+ and CD8 counts were low (124 and 185, respectively) with a low CD4:CD8 ratio of 0.7. Further workup including immunoglobulin A, immunoglobulin G, and immunoglobulin M levels, urine protein electrophoresis, and serum protein electrophoresis was unremarkable. The pleural fluid cytology revealed atypical lymphocytes consistent with the established diagnosis of pulmonary tuberculosis. Further imaging of the abdomen and pelvis showed no abnormalities.\nIn addition, 8 weeks after discharge the patient was seen in clinic. He was taking his medication to treat tuberculosis and had regular health care follow-up. He was found to be completely asymptomatic with a CD4+ count of 188 cells/mm3. The repeated HIV test was negative, and the viral load was undetectable. After finishing his treatment for tuberculosis, he was evaluated in clinic, had a CD4+ count of 212 cells/mm3, and remained asymptomatic.", "age": [ [ 20.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4124073.xml", "relevant_articles": { "30560051": "123", "25114596": "123", "7837723": "123", "34079652": "12", "31885960": "12" }, "similar_patients": { "4156626-1": "123", "8097161-1": "12", "6252309-1": "1", "8308763-1": "12", "4269629-1": "12" } }, { "human_patient_id": "432", "human_patient_uid": "6868556-1-M", "PMID": "31090849", "title": "SELLA TURCICA 3T MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF\nCUSHING\u2019S DISEASE IN CHILDREN: TWO CASE REPORTS", "patient": "Black female patient; nine years and three months old. She had progressive weight\ngain and a decrease in growth velocity, which had been observed since the age of\n5 years old. Height1.14 m, Z score -3.24 (below the percentile <2.5); weight\n37 kg, Z score 1.33 (>P97); Body Mass Index (BMI) 28.6 kg/m2, Z\nscore 3.2 (>P97); acanthosis nigricans, hypertrichosis, hunch back, globular\nabdomen without purplish stretch marks. Developmental stage in puberty according\nto the Tanner Scale M3 P5. Bone age of six years and ten months old, with a\nchronological age of nine years and three months old. No history of\nglucocorticoid use.\nLaboratory tests () showed that she\nhad \u00adACTH-dependent hypercortisolism and no apparent pituitary adenoma in three\n1.5 MRI studies. Additionally, the patient participated in a dynamic study when\nshe was 9, 10 and 12 years old. Bilateral inferior petrosal sinus sampling\n(BIPSS) was indicated. The exam was performed three years after the first\nconsultation, and the result was unclear due to technical problems. At 12 years\nof age, the patient was submitted to a 3-RM MRI in the dynamic study. In the\npost-contrast (gadolinium) sequence, the sagittal section, and the T1 sequence,\na contrasting hypocaptive image was found. It was located in the adenohypophysis\non the left side\u2019s cavernous sinus. It measured 2.9 \u00d7 2.6 \u00d7 2.5 mm, which is\ncompatible with microadenoma ().\nDetails of this technique can be found in . A transsphenoidal surgery was performed on the patient when she\nwas 12 years and 11 months old and because she had enough adrenal to be\ndiagnosed with hypercortisolim, she took prednisone for two years. Even after\nshe was cured of hipercortisolism, she did not grow enough. Recombinant growth\nhormones were then prescribed, even though the growth hormone test was\nresponsive after glucagon stimulation (). She thus became officially defined as having idiopathic short\nstature. The patient\u2019s final height was 1.41 m, which did not reach the family\ntarget of 1.61 m.", "age": [ [ 9.0, "year" ], [ 3.0, "month" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6868556.xml", "relevant_articles": { "9545099": "0", "9125748": "0", "27104179": "123", "21344737": "0", "6858682": "0" }, "similar_patients": { "6868556-2": "123", "6813230-1": "13", "4217336-1": "13", "4208257-1": "13", "8505036-1": "13" } }, { "human_patient_id": "433", "human_patient_uid": "6868556-2-M", "PMID": "31090849", "title": "SELLA TURCICA 3T MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF\nCUSHING\u2019S DISEASE IN CHILDREN: TWO CASE REPORTS", "patient": "White female patient; nine years and nine months old. She had been overweight\nsince the age of six, and her mother noticed a decrease in growth one year\nbefore the consultation. She also exhibited depression and anxiety. She used\nprednisone until she was seven years old because of bronchial asthma. Height\n1.34 m, Z score -0.49 (=P31); weight 59 kg, Z score 3.18 (>P97); BMI 32.9\nkg/m2, Z score 3.54 (=P99); Moon facies, Tanner development stage\nof M2 P3, generalized obesity with fat deposition in supraclavicular fossa,\ncervical acanthosis nigricans, fine axillary hairs, thin purplish stretch marks\nin abdomen and breasts. Bone age of a nine or ten-year-old, with a chronological\nage of nine years and six months old.\nACTH-dependent hypercortisolism was confirmed (). The 1.5T MRI with a dynamic study did not demonstrate the\npresence of adenoma at the age of 9 years and 10 months, but in the 3T MRI with\na dynamic study performed at age 10 years and 3 months, the sagittal cut in the\nT1 TSE sequence after the administration of (gadolinium) contrast, demonstrated\nthe contrast-enhanced, oval-shaped image of the anterior adiphyophysis measuring\n3 \u00d7 2.3 \u00d7 2.1 mm. Details of the examination technique are described in . The patient underwent\ntranssphenoidal surgery at ten years of age. She continued to grow with\ntransient diabetes insidious and central permanent hypothyroidism. She presented\ninsufficient adrenal in the postoperative period, which is compatible with the\ncure for hypercortisolism. She used prednisone for two years. She showed\nprogressive weight loss. Her final height was 1.51 m, with a family target of\n1.59 m. She presented new weight gain without the recurrence of\nhypercortisolism.", "age": [ [ 9.0, "year" ], [ 9.0, "month" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6868556.xml", "relevant_articles": { "9545099": "0", "7546942": "0", "9125748": "0", "33372011": "0", "17075602": "0" }, "similar_patients": { "6868556-1": "123", "6813230-1": "123", "4666013-1": "123", "6110164-1": "0", "8152328-1": "123" } }, { "human_patient_id": "434", "human_patient_uid": "6417341-1-M", "PMID": "30937053", "title": "Aggressive Primary Pediatric Intracranial Malignant Melanoma: Sphinx of the Tissue Diagnosis", "patient": "A16-year-old male patient was presented with headache and vomiting for 2 months. He developed left upper and lower limb weakness for 15 days. There was no history of immune suppression, family history of melanoma, or nevus or sunburns. His general examination did not reveal any nevus. Neurological examination revealed bilateral papilledema and Grade 4 power in the left upper and lower limb.\nComputed tomography (CT) plain imaging showed cortical based hyperdense lesion measuring 26 mm \u00d7 26 mm in the right parietal region. It was associated with bleed measuring 48 mm \u00d7 38 mm. [] Magnetic resonance imaging (MRI) showed well-circumscribed, lobulated, cortical-based lesion with bleed in the right parietal region. It measured 26 mm \u00d7 26 mm \u00d7 18 mm in size. It was isointense to gray matter on both T1, T2W images and mildly hyperintense on fluid-attenuated inversion recovery images. Diffusion-weighted images (DWI) showed irregular peripheral restriction of the lesion and susceptibility on susceptibility-weighted images. Heterogeneous enhancement on contrast images was noted. The lesion was associated with varying ages of bleed measured 48 mm \u00d7 42 mm \u00d7 34 mm. The bleed showed intense hyperintensity on T1W images and iso- to hyper-intense on T2W images. There was perilesional edema with midline shift of 5 mm. Magnetic resonance (MR) angiography showed normal flow signals within the intracranial arteries. No other abnormality was seen [Figure \u2013]. Based on imaging findings, we considered hemorrhagic mass lesions such as high-grade glioma or metastatic lesions as possibilities. He underwent a right parietal craniotomy and total excision of the lesion and evacuation of hematoma. Intraoperatively, hematoma was seen on the pia. The lesion was soft to firm, fleshy reddish dark brown, and vascular. Apart from the blood, there was no pigmentation of the meninges. There were no areas of pigmentation in the inner surface of the dura mater [Figure and ] Postoperative period was uneventful. Postoperative CT and MRI showed total excision of lesion with bleed [Figure \u2013].\nHistopathology from paraffin blocks showed interesting features. Sections examined from the tumor showed cellular neoplasm composed of large cells with abundant eosinophilic cytoplasm, arranged in perivascular papillary pattern and in sheets. Tumor cells had coarse chromatin with brisk mitotic activity (8\u201310/10 hpf). At places, the tumor cells exhibited nuclear atypia. Focally, the tumor cells had intracytoplasmic brownish pigment along with hemosiderin-laden macrophages. Necrosis and thrombosed vessels were noted. The differential diagnoses considered based on these histological features were a high-grade glioma and a papillary meningioma.\nImmunohistochemistry for epithelial membrane antigen (EMA), glial fibrillary acidic protein (GFAP), IDH-1 (R132H), cytokeratin, CD34, chromogranin, and synaptophysin was negative and strongly positive for S-100 protein. INI-1 showed retained expression. MIB-1 labeling index was15%\u201320%. In view of diffuse and strong S-100 immunohistochemistry (IHC), further IHC with human melanin black-45 (HMB-45) antibody was performed. The tumor showed strong HMB-45 immunopositivity and the final diagnosis of MM was offered [Figure \u2013]. BRAF mutations analysis could not be done in this patient as our laboratory was not equipped with the facilities for doing it.\nThe patient underwent screening to look for the primary site for melanoma. A thorough search was made for a primary lesion in the other probable sites such as skin, mucus membrane, eyes, and lower gastrointestinal tract, which yielded negative results. CT scans of the thorax and abdomen yielded normal findings with no evidence of primary lesion. We confirmed that the intracranial lesion was a PMM. He was referred to oncologist for further treatment. Four months following surgery, he completed intensity-modulated radiotherapy 60 Gy in 30 fractions. He did not receive any chemotherapy. He again developed headache and vomiting immediately after completion of the radiation therapy. CT brain showed right parietooccipital bleed [Figure and ]. MRI done showed a tentorial-based recurrent tumor in the right parietooccipital region. It was measuring 1.5 cm \u00d7 1.3 cm size. It was heterogenous intense in both T1 and T2W sequences with contrast enhancement. Gliotic area was seen in the previously operated cavity. Imaging confirmed a recurrent tumor remote from the previously operated site and away from the leptomeninges [Figure \u2013]. He underwent a right parietooccipital craniotomy and total excision of the tumor. Tumor was soft and suckable mixed with blood clots [Figure and ]. Falx and tentorium were seen and brain was lax at the end. The patient had a normal postoperative course without any complications. Postoperative CT confirmed total excision [Figure and ] and histopathology confirmed HMB-45 strongly positive recurrent melanoma. Five months following second surgery, the patient eventually succumbed to recurrence and expired.", "age": [ [ 16.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6417341.xml", "relevant_articles": { "23346671": "12", "27073564": "0", "20069660": "0", "29689399": "123", "26601100": "123" }, "similar_patients": { "5705934-1": "13", "4849329-1": "13", "4040033-1": "13", "4078611-1": "13", "4532938-1": "123" } }, { "human_patient_id": "435", "human_patient_uid": "6402280-1-M", "PMID": "30836958", "title": "Treatment of aortic thrombosis with retrievable stent filter and thrombolysis: a case report", "patient": "A 47-years-old woman with diabetes mellitus presented to our department with severe abdominal pain and fever. The local hospital\u2019s computed tomography showed massive mural thrombosis in the thoracic and abdominal aorta from the level of the diaphragmatic muscle to the superior mesenteric artery (Fig. ). The spleen had a large area of infarction complicated by portal venous thrombosis. This patient underwent amputation three years ago due to extensive thrombosis of the left upper extremity artery. Further examination in our hospital showed thrombosis in the portal vein, the superior mesenteric vein and the splenic vein. Laboratory examination showed the following: prothrombin time 10.9 s, D-Dimer 1.030 \u03bcg/mL, C-reactive protein > 200 mg/mL, erythrocyte sedimentation rate 99 mm/h, NH3 73.5 \u03bcmol/L. Rheumatic immune tests, liver function, kidney function and electrolytes were normal, except for an albumin of 25.6 g/L.\nPreoperative preparation and intraoperative procedures were carefully performed to improve the success rate and to reduce the risk of thrombus shedding during intervention. The catheter and guide wire was placed in the mesenteric artery and left renal artery via left femoral artery puncture, so that balloon angioplasty or stent implantation could be performed immediately once those branch vessels were blocked by shedding thrombus. Written informed consent was obtained from the patient for the use of RFS and the right femoral artery was incised to implant the RSF. The aortic thrombus was successfully compressed and fixed without thrombosis during intervention (Fig. a, b). A transjugular intrahepatic portosystemic stent shunt (TIPSS) procedure was conducted and a thrombolytic catheter was inserted in the portal vein for thrombolysis (Fig. a, b). Urokinase 100,000 units (Lizhu pharmaceutical Co., Ltd., Guangdong, China) was dissolved in 50 ml of normal saline, and given by microinfusion pump every 8 h. Warfarin sodium tablets 3.75 mg (Qilu pharmaceutical, Shangdong, China) were taken orally once a day after the procedure. In addition, 1000 units of heparin sodium (Fengyuan pharmaceutical co., Ltd., Anhui, China) and 0.6 mg of octreotide (Chinese medicine & pharmaceutical co., Ltd., China) were dissolved in 50 ml of normal saline and given by microinfusion pump every 12 h. Omeprazole 40 mg (Changchun Fuchun Pharmaceutical Co., Ltd., Changchun, China) and levofloxacin 0.6 mg (Yangzijiang Pharmaceutical Group Co., Ltd., Jiangshu, China) were administrated intravenously once a day.\nRelief of the patient\u2019s abdominal pain was evident 3 days after the interventional procedure, and pain resolved completely after 15 days. Angiography showed that the abdominal aortic thrombus was mostly dissolved, with only a few residual thrombi. A 12 F sheath was introduced through the guide wire and the RSF was retrieved (Fig. c, d). Catheter angiography confirmed an recovery of portal vein thrombosis via indwelling catheter. Portal vein thrombosis almost completely disappeared and the patient was discharged after 16 days (Fig. c). She received oral warfarin sodium 100 mg per day for anticoagulation with an international normalized ratio of 2\u20133. One month later, the bilateral renal artery, superior mesenteric artery, lower extremity artery and portal vein were well visualized, without thrombosis. The upper abdominal aorta was normal with a small amount of residual thrombus. The patient appears normal and no complications have occurred after 14 months.", "age": [ [ 47.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6402280.xml", "relevant_articles": { "31743781": "12", "11851847": "12", "30836958": "123", "22944028": "123", "16468535": "12" }, "similar_patients": { "4062453-2": "12", "5266015-1": "12", "5944500-1": "12", "4062453-1": "12", "8016758-1": "0" } }, { "human_patient_id": "436", "human_patient_uid": "3792540-1-M", "PMID": "24167751", "title": "Extraosseous Intra-Articular Osteochondroma", "patient": "A-52-year old woman presented with 3-year history of fullness and dull pain involving the left knee. She had been aware of a mass in the knee joint that had been progressively increasing in size. She was unable to flex her knee, sit cross-legged, or squat. There was no history of trauma or constitutional symptoms.\nOn physical examination, there were fullness on the medial aspect of left knee and palpable nodular mass of approximately 6 \u00d7 4 cm over the infrapatellar region medial to the patellar tendon (). The mass was nontender with no local warmth, bony hard in consistency, and immobile. The mass was more prominent on flexion than on extension of knee. The range of motion of the knee joint was limited to 100\u00b0 of active flexion. Neurovascular examination was normal. Plain radiographs of the knee revealed a mineralized mass situated between the anterior tibial tubercle and the patella. The mass appeared to occupy the entire region of the infrapatellar fat pad. The femoral condyles and tibial plateau were normal (Figures and ). Subsequently an MRI was performed. MRI revealed a large mineralized mass lying in the Hoffa body with no attachment to the skeletal tissue (). It was decided to perform an excision biopsy.\nUnder regional anaesthesia with the patient supine in a bloodless field furnished by a pneumatic tourniquet, a 7 cm longitudinal incision was made medial to the patellar tendon. The mass was lying medially and behind the patellar tendon in Hoffa's fat pushing the tendon laterally () and impinging on medial femoral condyle and intercondylar notch (). It was dissected and excised in toto (Figures and ). The medial tibial plateau, patella, menisci, and the patellar tendon were not involved in the process. The mass did not involve the joint space or synovium and was not continuous with femur, tibia, or patella but rather originated from joint capsule and was completely intra-articular. The capsule and the subcutaneous tissue were sutured with 1/0 vicryl and skin with 2/0 ethilon. 12 G drain was kept. Compression dressing was applied. Weight bearing was allowed in the immediate postoperative period.\nPostoperative recovery was uneventful. Sutures were removed on the 12th postoperative period. The patient returned to her daily activities regaining full flexion within two weeks after surgery. She was on regular followup. When last reviewed 24 months after excision, she was asymptomatic with no clinical and radiographic signs of recurrence of the lesion (Figures , (1), and (2)).\nGrossly, the resected specimen measured 7 \u00d7 6 \u00d7 5 cm with a large cartilaginous cap and was surrounded by adipose tissue and a fibrous capsule. Histologically, the cut sections showed numerous lamellar bony trabeculae with mature cartilaginous cap. Fibrofatty tissue was seen at the periphery (). There were foci of active endochondral ossification without any evidence of malignancy. No mitotic figures were seen.", "age": [ [ 52.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3792540.xml", "relevant_articles": { "17681220": "123", "17898923": "2", "20086668": "0", "32125441": "2", "26726983": "123" }, "similar_patients": { "1534046-1": "123", "5690290-1": "123", "6727461-1": "12", "6145751-1": "123", "5974668-1": "0" } }, { "human_patient_id": "437", "human_patient_uid": "6716303-1-M", "PMID": "31516285", "title": "Exercise-induced syncope and Brugada syndrome", "patient": "An 18-year-old previously healthy male presented to cardiology clinic after experiencing syncope while running laps. He experienced loss of consciousness for a few minutes but was successfully resuscitated with cardiopulmonary resuscitation. Initial workup including electrolytes and toxicology screen was normal. However, his ECG showed the typical coved-type ST-segment changes in V1 and V2 consistent with BrS []. Since the syncope was triggered by exercise, he underwent a treadmill stress test, during which he became near syncopal and his rhythm degenerated to a wide complex tachycardia consistent with ventricular tachycardia []. His symptoms self-resolved shortly after exercise was stopped. A cardiac magnetic resonance imaging did not demonstrate any pathologic findings.\nGenetic testing was done and the patient was found to have a pathogenic disease-causing mutation in the SCN5A gene consistent with BrS. The c. 4140_4142delCAA variant that was identified is located in coding exon 22 of the SCN5A gene and has been associated with varying degrees of cardiac conduction disorders, as well as a family history of sudden death in several studies.[] Additional testing including ECGs and genetic testing for the same mutation in his brother and parents came back negative. The patient underwent an electrophysiology study, which showed easily inducible, hemodynamically unstable polymorphic ventricular tachycardia at 260 bpm, requiring DC cardioversion for conversion to sinus rhythm. The patient was started on nadolol 40 mg daily and a transvenous dual-chamber implantable cardiac defibrillator was implanted. The patient underwent a subsequent exercise test that showed no ventricular tachycardia on beta-blockers.", "age": [ [ 18.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6716303.xml", "relevant_articles": { "22396703": "12", "30116135": "123", "22584762": "123", "33651170": "123", "19279983": "12" }, "similar_patients": { "8664766-1": "123", "5538234-1": "123", "7793045-1": "123", "2761048-1": "123", "3582081-1": "123" } }, { "human_patient_id": "438", "human_patient_uid": "7484498-1-M", "PMID": "32953098", "title": "Unusual location and complication of a cystic lymphangioma: A case report", "patient": "A 25-year-old man with no past medical or drug history, presented to the emergency room with an acute pain of the right upper quadrant and flank evolving for three days associated with fever. The patient reported no chronic abdominal pain or transit disorders.\nPhysical examination showed that the patient had fever 39 \u00b0c. The abdominal examination revealed the presence of a 10 cm - regularly shaped, soft, and fixed mass in the right hypochondria and flank. The rest of the abdomen revealed no remarkable abnormalities.\nLaboratory tests showed a high c-reactive protein level (173.5mg/l) but a normal white blood cell count (7553/\u03bcl). No anemia nor hemostasis disorders were noticed. Furthermore, urine culture was normal.\nFirstly, we decided to perform an abdominal ultrasound that showed a cystic formation of the right pericolic gutter with a thick wall and several septa within. The mass had close relationships with the sixth liver segment and the ascending colon. At first, we suspected a hydatid cyst of the liver because Tunisia is an hydatid endemic area. However, a malignant tumor of the colon could not be ruled out.\nTherefore, we indicated an abdominal CT scan to characterize the mass and determine its exact location. It revealed a regular 10-cm- intraperitoneal cystic mass independent from the liver but repressing the ascending colon with heterogonous internal density. Moreover, the mass was multilocular edged by thick walls showing low contrast enhancement after intravenous injection. Peritoneal effusion was detected on CT scan in the pericolic gutter and douglas pouch, to boot (, ).\nAn infected cystic lymphangioma was then suspected besides the diagnosis of intraperitoneal hydatid disease or infected malignant tumor of the colon. We decided then to perform open surgery for diagnostic and therapeutic purpose.\nWe found a 10-cm-cystic-mass containing a serous bloody fluid in the right pericolic gutter depending from the ascending colon. The colon was not distended. No liver metastasis nor peritoneal carcinosis were noticed. An ileocolic en bloc -resection was performed with an immediate ileocolic anastomosis. ().\nMacroscopically, the 10 \u2013cm colonic cystic mass had many septas and contained serous fluid. It was obviously arising from the ascending colon. In addition, histopathological examination revealed dilated lymphatic and vascular components lined with attenuated endothelial cells. These findings were consistent with the diagnosis of a cystic lymphangioma. The patient's post-operative course was uneventful. He was discharged on the 5th post-operative day. A 6-months clinical and radiological follow-up showed no symptoms or recurrence with good tolerance to regular diet.", "age": [ [ 25.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7484498.xml", "relevant_articles": { "14673727": "0", "21205508": "123", "25344823": "123", "19915308": "0", "21829771": "0" }, "similar_patients": { "3981227-1": "0", "4444522-1": "0", "5209321-1": "13", "4844871-1": "0", "7718357-1": "0" } }, { "human_patient_id": "439", "human_patient_uid": "5073084-1-M", "PMID": "27812456", "title": "Endoscope-assisted resection of cavernous angioma at the foramen of Monro: a case report", "patient": "A 65-year-old woman with a history of hyperlipidemia had experienced headache and vomiting for 10 days before admission to another hospital. Magnetic resonance imaging (MRI) showed enlargement of both lateral ventricles and a mass at the foramen of Monro. The patient was then referred to our hospital.\nNeurological examination on admission to our hospital showed memory disturbance (Mini-Mental State Examination 20/30) and a wide-based gait disturbance. Computed tomography (CT) showed a 16 mm mildly hyperdense mass with no calcification at the foramen of Monro, and the mass was causing obstructive hydrocephalus. MRI revealed a well-delineated mass at the foramen of Monro with heterogeneous signal intensity on both T1- and T2-weighted images; the mixed-signal core appeared as a popcorn-like lesion typical of cavernous angioma (Fig. ). Gadolinium-enhanced T1-weighted imaging revealed mild enhancement of the mass (Fig. ). There were no vascular abnormalities on CT angiography or CT venography. We considered a colloid cyst, central neurocytoma, subependymoma, ependymoma, low grade astrocytoma, and arteriovenous malformation as differential diagnosis; however, despite the unusual location of the mass, a diagnosis of intraventricular cavernous angioma was made because of its typical appearance on MRI.\nWe performed endoscope-assisted transcortical removal of the mass (Fig. ). The entry point was made using the StealthStation S7 navigation system (Medtronic Inc., Louisville, CO), and a flexible videoscope (VEF-V, Olympus Corporation, Tokyo, Japan) was inserted. Intraoperative neuroendoscopic imaging revealed a reddish lobular mass with a hematoma and obstruction of the foramen of Monro. We observed the cavum septum pellucidum because of the high intracranial pressure associated with hydrocephalus. After right frontal mini-craniotomy, the Viewsite Brain Access System (Vycor Medical Inc., Boca Raton, FL) was inserted (Raza et al. ); we used the 17 mm wide retractor in the 7 cm length. Endoscope-assisted surgery with the Viewsite was performed with technique similar to microsurgery. A 2.7 mm rigid endoscope (Karl Storz, Tuttlingen, Germany) fixed by UniArm (Mitaka Kohki, Tokyo, Japan) was inserted. The working ambience was air because of its advantages over fluid ambience especially when dealing with a relatively vascularized pathology. Other microsurgical instruments were used parallel to the endoscope. The endoscope served only as an optic apparatus. We used the Viewsite as an access port to enable dual instrumentation (endoscope and microsurgical instrumentation). The tumor was bluntly dissected from the ventricle wall, and total en bloc resection of the lesion was performed by one surgeon using the two-handed technique. Bleeding was well controlled with irrigation and bipolar coagulation.\nThe resected tumor was reddish and consisted mainly of clotted blood vessels and xanthochromic tissue. Histological examination revealed a cavernous angioma with evidence of large vascular spaces filled with an organized thrombus (Fig. ).\nPostoperative MRI confirmed complete removal of the tumor, and a return to normal ventricular size (Fig. ). The patient\u2019s symptoms resolved immediately, and there were no postoperative complications. She was discharged without any neurological deficit. No complications or neurological impairment were observed at the 1-year follow-up.", "age": [ [ 65.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5073084.xml", "relevant_articles": { "27812456": "123", "17124371": "12", "15916846": "12", "25883855": "123", "16283212": "123" }, "similar_patients": { "3467373-1": "12", "3513852-1": "123", "3843325-1": "13", "7398264-1": "123", "3512334-1": "123" } }, { "human_patient_id": "440", "human_patient_uid": "6159178-1-M", "PMID": "30363204", "title": "Use of single photon metal artefact reduction in the detection of an impacted capsule endoscope", "patient": "An 80-year-old male was being investigated at a tertiary hospital for iron deficiency anaemia. His medical history, symptomology and physical examination did not indicate a cause. After gastroscopy and colonoscopy were also unremarkable he was referred for capsule endoscopy. The delivery of the capsule in the morning was routine; however, review of the images 8 hlater showed a static picture and no evidence the capsule had entered the stomach. The patient was clinically stable and contacted to present to the emergency department with a suspicion of capsule impaction.\nA chest radiograph demonstrated a metallic object at the level of the second thoracic vertebra to the left of the trachea (). The patient had no known oesophageal or tracheal diverticulum and expressed no symptoms of dysphagia. To pinpoint the exact anatomical location of the foreign body a non-contrast CT scan of the neck () was performed. The effective dose of CT was 0.81 mSv. This confirmed the object was the capsule endoscope lying to the left of the hypopharynx. The adjacent soft tissue was obscured by aliasing metal artefacts arising from the capsule. A single photon metal artefact reduction (MAR) software technique (O-MAR; Philips Healthcare, Cleveland, OH) was applied which successfully removed most of the metallic artefacts. It revealed the capsule was impacted in an oesophageal diverticulum.\nThe capsule was successfully endoscopically removed under a general anaesthetic and the patient\u2019s recovery was uncomplicated. A follow-up barium swallow study confirmed the presence of a Zenker\u2019s diverticulum which the patient opted not to surgically repair as he was asymptomatic. He was also offered endoscopic insertion of the capsule endoscope to bypass the diverticulum; however, the patient refused. His anaemia resolved with iron transfusions but no definitive cause was found. He was discharged from the clinic.", "age": [ [ 80.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6159178.xml", "relevant_articles": { "27112247": "123", "16197536": "123", "17120692": "2", "18513723": "2", "33678788": "2" }, "similar_patients": { "3813457-1": "0", "6202987-1": "0", "4649712-1": "0", "8647053-1": "12", "4083553-1": "12" } }, { "human_patient_id": "441", "human_patient_uid": "6824397-1-M", "PMID": "31102204", "title": "Real-World Outcomes with Lomitapide Use in Paediatric Patients with Homozygous Familial Hypercholesterolaemia", "patient": "This is 13-year-old girl with a homozygous LDLR c.313+5G>A mutation and evidence of an aortic root plaque. Her parents are first-degree cousins, both with heterozygous FH (HeFH).\nThis patient was initially treated with statins, ezetimibe and biweekly LA but the patient remained with increased LDL-C and evidence of atherosclerotic disease in the form of an aortic root plaque. Evolocumab was tried, but only for 3 months because of lack of response. With a background therapeutic regimen of atorvastatin 40 mg/day, ezetimibe 10 mg/day and biweekly (Q2W) LA, mean interval LDL-C levels were 263 mg/dL. The patient was commenced on lomitapide 5 mg/day. The patient initially suffered from nausea, occasional vomiting, reduced appetite and increased stool frequency; however, these symptoms became tolerable and no other adverse events were observed. Liver enzymes remained within normal limits. The patient was gradually escalated to lomitapide 20 mg/day and atorvastatin 40 mg/day with cessation of LA. Mean interval LDL-C levels are now maintained at 72 mg/dL (76% decrease) without the need for LA (Fig. ). The patient has been treated for over 18 months with no alteration in liver enzymes (Fig. ).", "age": [ [ 13.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC006xxxxxx/PMC6824397.xml", "relevant_articles": { "31102204": "123", "34238445": "12", "18484971": "12", "34692794": "12", "29306853": "123" }, "similar_patients": { "6824397-6": "123", "6824397-2": "123", "6824397-3": "123", "6824397-9": "123", "6824397-5": "123" } }, { "human_patient_id": "442", "human_patient_uid": "6824397-2-M", "PMID": "31102204", "title": "Real-World Outcomes with Lomitapide Use in Paediatric Patients with Homozygous Familial Hypercholesterolaemia", "patient": "This is a 12-year-old boy with a homozygous LDLR c.682G>T mutation. Both parents have HeFH. The patient has left ventricle dilatation, mild aortic regurgitation and atherosclerotic plaques (1.5\u20132.1 mm thick) in both carotid bulbs, and in the common and internal carotid arteries. Imaging revealed diffuse atherosclerotic involvement of all coronary arteries, but this was not clinically significant.\nThe patient was treated with rosuvastatin 20 mg/day, ezetimibe 10 mg/day, LA Q2W, but mean interval LDL-C levels remained increased at approximately 300 mg/dL. The patient was commenced on lomitapide 5 mg/day following a normal FibroScan test. Rosuvastatin 20 mg/day, ezetimibe 10 mg/day and LA Q2W were maintained.\nMean interval LDL-C levels decreased modestly over 2 months (Fig. ). The patient then took a vacation with no LA, and experienced an increase in LDL-C levels that was gradually brought under control with escalating doses of lomitapide. Overall, LDL-C levels decreased by 50\u201370%. There has been no evidence of adverse events to lomitapide, and liver function tests (LFTs) remain normal (Fig. ). Gastrointestinal (GI) complaints were only present when dietary advice was not followed. The patient achieved an LDL-C nadir of 98 mg/dL (70% reduction). LA intervals have been gradually extended to Q4W with a modest increase in LDL-C levels to 184 mg/dL (44% reduction from baseline).", "age": [ [ 12.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6824397.xml", "relevant_articles": { "31102204": "123", "24053480": "12", "29306853": "123", "34971394": "123", "28154305": "123" }, "similar_patients": { "6824397-3": "123", "6824397-6": "123", "6824397-1": "123", "6824397-9": "123", "6824397-5": "123" } }, { "human_patient_id": "443", "human_patient_uid": "6824397-3-M", "PMID": "31102204", "title": "Real-World Outcomes with Lomitapide Use in Paediatric Patients with Homozygous Familial Hypercholesterolaemia", "patient": "This is a 16-year-old boy diagnosed with HoFH at the age of 10 months on the basis of development of xanthomas, LDL-C levels 981 mg/dL, and LDLR genotyping with the finding of homozygosity for the LDLR mutation c.119_1207del. Both parents have HeFH, and the patient has a right coronary lesion evident on computed tomography, which has been treated with percutaneous revascularisation (at the age of 14 years). The patient was commenced on statins at the age of 2 years, which was gradually escalated to rosuvastatin 20 mg/day, ezetimibe 10 mg/day and colesevelam 3250 mg/day. At the age of 5 years, weekly LA was commenced, which resulted in regression of xanthomas by the age of 10 years, but without complete control of LDL-C levels (mean interval LDL-C 168 mg/dL).\nIn 2016, at age 14 years, the patient was commenced on evolocumab 420 mg QW with no effect on LDL-C levels. The following year, lomitapide was commenced at 5 mg/day, and gradually escalated to 40 mg/day. Mean interval LDL-C levels were reduced to 75\u201383 mg/dL, which represents a greater than 60% reduction in LDL-C (Fig. ).\nThe patient began to have some recurrent issues with elevated liver enzymes, possibly related to rosuvastatin, which had caused this in the past. Lomitapide dose was reduced to 30 mg/day, and rosuvastatin briefly stopped while the LFTs resolved. Eventually, LA intervals were extended to every 2\u20133 weeks and rosuvastatin was permanently stopped. The patient remained on lomitapide 40 mg/day. Increasing lomitapide dose to 45 mg/day was associated with an increase in LFTs that was brought under control with dose reduction and gradual re-escalation. The patient is now doing well on lomitapide 60 mg/day with an LDL-C level of just 90.8 mg/dL and LA Q2W. There has been no evidence of GI adverse events apart from mild flatulence.", "age": [ [ 16.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6824397.xml", "relevant_articles": { "24053480": "12", "31102204": "123", "28154305": "123", "33023859": "123", "30688048": "12" }, "similar_patients": { "6824397-6": "123", "6824397-2": "123", "6824397-9": "123", "6824397-4": "123", "6824397-8": "123" } }, { "human_patient_id": "444", "human_patient_uid": "6824397-4-M", "PMID": "31102204", "title": "Real-World Outcomes with Lomitapide Use in Paediatric Patients with Homozygous Familial Hypercholesterolaemia", "patient": "This patient is a 7-year-old boy with compound heterozygote mutations in LDLR c.666C>A and c.1646C>A. The patient has a sister with HoFH who is on LA and not part of this patient series. Both parents have HeFH. The patient has a large aortic plaque extending the length of the thorax with 25\u201350% narrowing of the lumen.\nBefore lomitapide, the patient was treated with rosuvastatin 40 mg/day, ezetimibe 10 mg/day and colesevelam 625 mg/day. No LA was used as a result of venous access issues. LDL-C levels were increased at 866 mg/dL. The patient underwent dose reduction of rosuvastatin (20 mg) and was commenced on lomitapide 2.5 mg/day, which was gradually escalated to 30 mg/day in 5-mg increments. LDL-C levels reduced by 78% to 360 mg/dL (Fig. ). Notably, this patient has been treated for over 18 months and has not experienced any side effects of lomitapide.", "age": [ [ 7.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6824397.xml", "relevant_articles": { "24053480": "12", "31102204": "123", "28154305": "123", "32906018": "123", "28432645": "123" }, "similar_patients": { "6824397-3": "123", "6824397-6": "123", "6824397-2": "123", "6824397-5": "123", "6824397-8": "13" } }, { "human_patient_id": "445", "human_patient_uid": "6824397-5-M", "PMID": "31102204", "title": "Real-World Outcomes with Lomitapide Use in Paediatric Patients with Homozygous Familial Hypercholesterolaemia", "patient": "This patient is an 11-year-old girl with a homozygous duplication spanning the promoter region to exon 6 of LDLR (c.-187-? 940+? Dup) []. Family history includes sudden death in an older brother aged 17. Another brother has HoFH with aortic stenosis and a non-critical obstruction of the right coronary artery. The patient presented with non-critical aortic stenosis/supra aortic stenosis, and non-obstructive plaques in the carotid arteries. Her computed tomography angiography showed no signs of coronary artery disease.\nThe patient commenced LLT at the age of 2 years when LDL-C levels were 1009 mg/dL. Up until the age of 7, she was treated with atorvastatin 40 mg/day and ezetimibe 10 mg/day and her LDL-C level was 453 mg/dL. LA is not available in the patient\u2019s home country.\nAt age 7, atorvastatin dose was decreased to 10 mg/day, and lomitapide was commenced at a dose of 5 mg/day. Over the next year, lomitapide was escalated to 30 mg/dL but this dose was reduced back to 20 mg/day as a result of diarrhoea. LDL-C levels were effectively reduced with treatment (nadir 231 mg/dL; 40.7% reduction) with no elevations in LFTs (Fig. ). A trip to a remote region of Brazil led to brief discontinuation of lomitapide with a consequent increase in LDL-C levels. Following resolution of the issues, reintroduction of lomitapide resulted in the expected decrease in LDL-C levels.\nThe patient is now maintained on atorvastatin 60 mg/day, ezetimibe 10 mg/day and lomitapide 20 mg/day and has been treated with lomitapide for 4.5 years. She continues to develop normally and had her menarche at the age of 11 years. LDL-C levels are 266 mg/dL (38% reduction from pre-lomitapide values). A routine check-up revealed no calcification in the coronary arteries; however, there were signs of aortic stenosis and supra aortic stenosis, and some non-obstructive plaques in the carotid arteries, but these are not considered to be life-threatening. There were no elevations of liver enzymes during treatment. A detailed history of this patient has been published by Chacra et al. [].", "age": [ [ 11.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC006xxxxxx/PMC6824397.xml", "relevant_articles": { "28154305": "123", "33023859": "123", "31102204": "123", "32906018": "123", "32128483": "123" }, "similar_patients": { "6824397-3": "123", "6824397-8": "123", "6824397-2": "123", "6824397-9": "123", "6824397-6": "123" } }, { "human_patient_id": "446", "human_patient_uid": "6824397-6-M", "PMID": "31102204", "title": "Real-World Outcomes with Lomitapide Use in Paediatric Patients with Homozygous Familial Hypercholesterolaemia", "patient": "This is a 16-year-old boy with compound heterozygote mutations LDLR c.131G>A and c.2043C>A and a history of HeFH in both parents (LDL-C levels at 271 mg/dL and 387 mg/dL). The patient has carotid plaques occluding 25\u201330% of the carotid lumina, but with no impairment of perfusion. The patient was diagnosed with HoFH at the age of 9 years with Achilles\u2019 xanthomata and LDL-C levels at 900 mg/dL. LLT with rosuvastatin 20 mg/day, ezetimibe 10 mg/day and weekly apheresis was started, with dietary modifications to reduce fat intake to 15% of total energy. On this regimen, mean interval LDL-C levels reduced to 206 mg/dL.\nAs the patient got older, issues with schooling meant that there was a desire to extend the LA interval to biweekly. This change was made, and evolocumab 420 mg Q2W was added to the background LLT. However, as a result of the mutation profile of the patient, evolocumab did not work (mean interval LDL-C 329 mg/dL), and the decision was taken to prescribe lomitapide. The patient was commenced on lomitapide at 5 mg/day with escalation to 15 mg/day over 3 months (Fig. ). Apheresis was stopped, lomitapide was increased to 20 mg, rosuvastatin was increased to 40 mg and ezetimibe doses were maintained. LDL-C levels remained at approximately 190 mg/dL for more than 6 months and therefore lomitapide was increased to 30 mg/day and rosuvastatin reduced to 35 mg/day. Figure shows that LDL-C levels continued to rise after commencement of lomitapide, followed by a subsequent marked decrease. There is no direct explanation for this other than the cessation of apheresis.\nMean interval LDL-C levels are now at 34.8 mg/dL (a remarkable 85.7% decrease), with no LA currently ongoing. Early GI issues resolved. There were no other adverse events, other than slightly depressed alkaline phosphatase levels. Alanine aminotransferase briefly increased by more than three times the upper limit of normal (ULN) on two occasions, and reduced to less than three times the ULN without intervention. All other laboratory parameters remain normal and there is no evidence of hepatic steatosis.", "age": [ [ 16.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6824397.xml", "relevant_articles": { "28154305": "123", "24053480": "12", "31102204": "123", "34971394": "123", "29925433": "123" }, "similar_patients": { "6824397-3": "123", "6824397-2": "123", "6824397-9": "123", "6824397-1": "123", "6824397-4": "123" } }, { "human_patient_id": "447", "human_patient_uid": "6824397-7-M", "PMID": "31102204", "title": "Real-World Outcomes with Lomitapide Use in Paediatric Patients with Homozygous Familial Hypercholesterolaemia", "patient": "This is a 4-year-old girl with a homozygous c.2043C>A mutation who presented at the age of 3 with an LDL-C level of 739 mg/dL. Her father has a severe form of HeFH. At diagnosis, the patient had normal echocardiography; but, by 2016, she had mild aortic thickening and some mild aortic valve regurgitation. There was evidence of a pedunculated atheroma at the aortic arch that had potentially embolised as it was no longer apparent on a later scan. For this reason, the treating physician decided that the patient was a candidate for aggressive LLT, but low body weight meant that LA was not suitable. LDL-C levels were reduced very slightly to 685 mg/dL with atorvastatin 10 mg/day and ezetimibe 10 mg/day, and the decision was taken to intensify LLT with lomitapide. Doses were escalated gradually from 2.5 mg/day in 2.5-mg increments given the young age of the patient and low body weight, and LDL-C levels became reduced. By the time the dose was escalated to 15 mg/day in August 2018 (patient now 5 years old), LDL-C had reached a nadir of 235 mg/dL (Fig. ). There have been no side effects in this patient apart from one episode of a loose stools when pancakes were eaten. No liver pathology is evident on ultrasound. The patient has recently had a significant reduction in triglycerides to 21 mg/dL, and so the levels of fat-soluble vitamins are being checked prior to any further dose increase given the young age of the child.", "age": [ [ 4.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC006xxxxxx/PMC6824397.xml", "relevant_articles": { "24053480": "12", "34238445": "12", "18484971": "12", "34692794": "12", "33463677": "2" }, "similar_patients": { "6824397-5": "123", "6824397-6": "123", "6824397-3": "123", "6824397-1": "123", "6824397-2": "123" } }, { "human_patient_id": "448", "human_patient_uid": "6824397-8-M", "PMID": "31102204", "title": "Real-World Outcomes with Lomitapide Use in Paediatric Patients with Homozygous Familial Hypercholesterolaemia", "patient": "This is a 14-year-old boy with an extensive family history of HeFH and a brother with HoFH. The boy has a compound heterozygous for the LDLR mutations c.1846-? 2311+?del and c.1895A>T (variant of unknown significance). The boy presented with xanthomas and hypercholesterolemia at 4.8 years of age. High dose (for age) statins and ezetimibe were started (atorvastatin 20\u201330 mg/day; ezetimibe 10 mg/day). At the age of 8 years, mild aortic regurgitation was evident. Treatment with plasma exchange (PE) was commenced every 15\u201320 days. Three years later, the patient required composite graft replacement of the aortic valve, aortic root and ascending aorta, with re-implantation of the coronary arteries (Bentall procedure).\nAt this point, lomitapide was initiated as add-on to the previous treatment regimen, escalating from 5 to 10 mg/day. LDL-C levels decreased to almost 100 mg/dL (Fig. ). Lomitapide dose was increased to 15 mg/day and then briefly escalated to 20 mg, but the patient experienced elevated transaminases, so the dose was reverted with consequent normalization of LFTs. The LA frequency was altered a number of times in this patient (Q2W\u2013Q6W), and was eventually stopped once the patient was on the 15 mg dose of lomitapide. The response to lomitapide was a 66.4% reduction, and apheresis has been discontinued, apart from two emergency sessions when an insurance issue interrupted the lomitapide dosing (Fig. ).", "age": [ [ 14.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6824397.xml", "relevant_articles": { "32906018": "123", "33023859": "123", "28154305": "123", "34316840": "13", "24734312": "123" }, "similar_patients": { "6824397-3": "123", "6824397-9": "123", "6824397-5": "123", "6824397-2": "123", "6824397-6": "123" } }, { "human_patient_id": "449", "human_patient_uid": "6824397-9-M", "PMID": "31102204", "title": "Real-World Outcomes with Lomitapide Use in Paediatric Patients with Homozygous Familial Hypercholesterolaemia", "patient": "This is a 15-year-old boy with compound heterozygous LDLR c.313+1G>A and a deletion spanning exon 1\u20136. Both parents have HeFH with no evidence of cardiovascular disease (CVD). The patient was diagnosed at the age of 2 years old as a result of the presence of xanthomas. LDL-C levels were found to be elevated to 982 mg/dL, and diagnosis was confirmed via genetic testing. Asymptomatic aortic insufficiency was evident. Medication was commenced with atorvastatin 40 mg/day plus ezetimibe 10 mg/day. The patient received once-weekly lipoprotein apheresis, but LDL-C levels remained elevated (mean interval LDL-C 197 mg/dL). At the age of 8.5 years, chest pain led to a diagnosis of angina and a coronary bypass operation. LA was intensified to two times per week.\nAt 13.5 years of age, prior to the initiation of lomitapide, mean interval LDL-C levels were at 85 mg/dL with LA twice weekly, and therefore well below current treatment target. Unlike the other patients in this case series, the treatment plan for this patient was to attempt to maintain the LDL-C levels at target but to reduce the apheresis burden. Lomitapide was commenced at a dose of 5 mg/day and apheresis was decreased to once weekly. After 6 months, the lomitapide dose was intensified to 10 mg/day followed by 15 mg/day and after an additional 5 months, apheresis was reduced to Q2W. Through these modifications, LDL-C levels remained under control (nadir 62 mg/dL) (Fig. ).\nNo adverse events have been reported for lomitapide, liver enzymes and imaging are normal, and the patient has reported improved quality of life due to less disruption from apheresis sessions resulting in less time away from school, sports and other leisure activities. As a result, the LDL-C target levels have been maintained despite reducing apheresis burden by 75%.", "age": [ [ 15.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6824397.xml", "relevant_articles": { "1751669": "123", "31102204": "123", "34496902": "123", "32128483": "123", "31753721": "123" }, "similar_patients": { "6824397-6": "123", "6824397-3": "123", "6824397-8": "123", "6824397-2": "123", "6824397-1": "123" } }, { "human_patient_id": "450", "human_patient_uid": "1868024-1-M", "PMID": "17448227", "title": "Single left coronary artery with separate origins of proximal and distal right coronary arteries from left anterior descending and circumflex arteries \u2013 a previously undescribed coronary circulation", "patient": "A 57 year old male presented with unstable angina. Risk factors included hypertension and hypercholesterolaemia. Significant past history included multiple episodes of deep vein thrombosis and pulmonary embolism. Coronary angiography demonstrated a single coronary artery arising from left coronary sinus (fig ) which divided into a normal sized left anterior descending artery (LAD) and a circumflex (Cx) artery. LAD had a 99% stenotic lesion beyond the first septal and was a good sized vessel going just beyond the left ventricular apex (Fig ). From its proximal segment, beyond the origin of first diagonal and prior to the origin of first septal artery, arose 3 right ventricular branches, the largest of which crossed the right ventricular outflow tract (RVOT), 2 centimetres below the pulmonary valve, to gain the anterior right atrioventricular groove (Fig , ), descended in the groove to anastomose with the distal right coronary artery (Fig ), which arose as a continuity of the circumflex artery (Fig ), as described below. The second right ventricular branch crossed the RVOT below the first but petered out well before it could gain the anterior right AV groove. The third branch supplied the right ventricle and followed a course close to the LAD (fig ). The diagonal artery was a large bifurcating artery with significant proximal stenosis. The circumflex artery had severe stenosis proximally after which it gave a large obtuse marginal branch and then the PDA in the posterior interventricular groove and thereafter continued in the AV groove as the right coronary artery (Fig ). This right coronary artery then gave off a ventricular branch to the inferior surface of the right ventricle and thereafter anastomosed with the proximal RCA arising anomalously from the LAD as described above (Fig ). There was no stenotic lesion in this composite, anomalously arising proximal and distal right coronary arterial system.\nPatient was taken to theatre for urgent CABG. Operative findings confirmed the following: Proximal RCA was arising as a branch from the proximal LAD after the first diagonal, crossed the RVOT and gained the anterior aspect of the right AV groove to anastomose with the distal RCA which arose as a continuity of circumflex artery. LAD gave off two further branches to supply the right ventricle (Fig ). The distal circumflex continued to the crux of the heart, gave off PDA in the posterior interventricular groove (Fig ) and thereafter continued as RCA till just above the acute margin of right ventricle. This distal RCA also gave off a right ventricular branch to the inferior right ventricular surface below the acute margin of the heart (Fig ). Employing cardiopulmonary bypass, with antegrade cold blood cardioplegic arrest, quadruple coronary artery bypass grafting was performed. Left internal mammary artery (LIMA) graft was anastomosed to LAD and separate saphenous vein bypass grafts were constructed to Dx, OM Cx and PDA from Cx. Bypass was discontinued easily in sinus rhythm, without ionotropes and patient transferred to ICU in a satisfactory haemodynamic condition. He was transferred to ward on first postoperative day and home 8 days after surgery.", "age": [ [ 57.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC001xxxxxx/PMC1868024.xml", "relevant_articles": { "26702699": "12", "23044526": "12", "7714389": "123", "21646836": "12", "16816453": "12" }, "similar_patients": { "2104526-1": "123", "4115355-1": "12", "4930572-1": "123", "4931778-1": "1", "4370000-1": "1" } }, { "human_patient_id": "451", "human_patient_uid": "7929523-1-M", "PMID": "33665366", "title": "Syncope Associated with Sinus Nodal Dysfunction in a COVID-19 Patient: A Case Report and Review of the Literature", "patient": "An 84-year-old female with PMHx significant for HTN, IDDM, HFpEF, CAD s/p PCI w/DES, CKD, presented to the hospital with syncope. There was no head trauma, seizure activity, tongue biting or urinary/fecal incontinence per daughter, who witnessed the episode. At baseline, the patient has dyspnea on exertion, orthopnea, PND and lower extremity swelling bilaterally. She had endorsed abdominal discomfort for multiple days prior to the event. There were no recent sick contacts or recent travel and she denied cough, fever, chills or diarrhea.\nIn the Emergency Department (ED), initial blood pressure was stable with a HR of 50 bpm. Her cardiovascular exam was unremarkable and the respiratory exam was notable for inspiratory crackles at the bases bilaterally. Initial labs were pertinent for mildly elevated inflammatory markers (). She received IV lasix and required 2 L/min of nasal cannula to maintain adequate SpO2. A chest radiograph showed a small left-sided pleural effusion. Nasopharyngeal PCR was positive for COVID-19.\nAn electrocardiogram (EKG) confirmed sinus bradycardia, HR 45 bpm with no AV-node dysfunction (). Transthoracic echocardiogram (TTE) on admission demonstrated an ejection fraction (EF) of 60%, no wall motion abnormalities and mild aortic stenosis (AS). Cardiac enzymes negative x2. Coronary angiogram from 2014 showed single vessel thrombotic occlusion of the marginal branch of the right coronary artery (mRCA).\nOn day 3 of hospitalization, she developed worsening renal failure and hypoxemia, requiring 6L of oxygen via nasal cannula to maintain O2 saturation. Telemetry monitoring continued to show persistent sinus bradycardia with a nadir of 40 bpm. At this time, the patient remained afebrile, hemodynamically stable. Electrolytes and thyroid stimulating hormone (TSH) were within normal limits. All atrioventricular (AV) nodal blocking agents were held. No ST segment changes or T-wave abnormalities were identified on serial EKGs and cardiac biomarkers remained negative.Additionally, the patient never endorsed any chest pain or pressure during the hospital course.\nGiven the persistent sinus bradycardia recorded on cardiac telemetry, a decision was made to undergo an electrophysiology (EP) study which revealed a delayed sinus node recovery time (), confirming SND. Subsequently, a dual chamber permanent pacemaker (PPM) was successfully placed without complications. Upon further evaluation, she was recommended for subacute rehab (SAR) with outpatient cardiology follow up.", "age": [ [ 84.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7929523.xml", "relevant_articles": { "31695976": "123", "26885932": "12", "20602800": "13", "28197257": "0", "31214395": "0" }, "similar_patients": { "8420262-1": "123", "7929522-1": "123", "8059417-1": "123", "8292066-1": "123", "8559582-1": "123" } }, { "human_patient_id": "452", "human_patient_uid": "5644329-1-M", "PMID": "29089684", "title": "Prenatal diagnosis of nail patella syndrome: A case report", "patient": "A 21-year-old primigravida underwent an anomaly scan at 19 weeks of gestation. Her medical and surgical history was unremarkable. Her husband had NPS which was proven by mutation study. He was visually challenged secondary to congenital glaucoma and had undergone renal transplantation for end-stage renal disease due to focal segmental glomeruloscelrosis. He had antecubital pterygium; difficulty in abducting the shoulders; bilateral small and dislocatable patella; swan neck deformity of fingers; triangular lunules in the thumbs; dystrophy and longitudinal ridging in both thumb nails and absent skin creases on distal interphalangeal joints of the second, third and fourth fingers, and bilateral iliac horns.\nUltrasound evaluation showed a single live fetus with parameters corresponding to 19 weeks of gestation. The orientation of the long bones of the lower limbs was abnormal. There was rotational defect at the knee joint in both the lower limbs and feet were pointing towards the gluteal region. The extension at the knee joints was restricted [ and Videos , ]. Throughout the examination both the upper limbs were flexed at the elbow joint with limited extension in between []. A three-dimensional (3D) ultrasound scan was undertaken to better delineate the extent of the limb anomaly, which showed a clearer picture of the abnormal position of the limbs. The upper limb was kept flexed at the elbow and in the lower limbs the feet were pointing towards the gluteal region [Figures and ]. Based on these ultrasound findings the clinical diagnosis was NPS. When counseled regarding the findings, the couple opted for termination.\nPost-abortal examination and infantogram confirmed the antenatal findings. In the lower limbs, there was a rotational defect at the knee joint and the feet were pointing posteriorly. The elbows could not be extended beyond 90\u00b0 due to soft tissue contracture. In the infantogram, the tibia was seen laterally with a medial fibula due to torsion at the knee joint [].", "age": [ [ 21.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5644329.xml", "relevant_articles": { "26544544": "0", "7927962": "0", "20013463": "0", "16024481": "0", "8162466": "0" }, "similar_patients": { "4701366-1": "0", "3722620-1": "0", "5498117-1": "0", "2373302-1": "0", "5830815-1": "1" } }, { "human_patient_id": "453", "human_patient_uid": "3424817-1-M", "PMID": "22919561", "title": "Endovascular Management of Fusiform Superior Cerebellar Artery Aneurysms: A Series of Three Cases with Review of Literature", "patient": "A 42-year-old man with no past significant medical illness presented with headache. CT scan done showed subarachnoid hemorrhage (SAH) predominantly in the perimesencephalic cisterns []. Magnetic resonance imaging T1 gradient sequence also showed the hypointense signal suggestive of blood products in the perimesencephalic cisterns []. Fetal posterior cerebral arteries are seen on both the sides arising from the internal carotid artery [Figures and ]. DSA (digital subtraction angiogram) done subsequently revealed fusiform bulbous dilation involving both the cisternal and cortical segments of the left SCA []. Endovascular treatment in the form of parent artery occlusion was done under general anesthesia, with complete exclusion of the aneurysm from the circulation as seen on post-coiling angiogram []. Standard heparin protocol was followed and activated clotting time greater than 250 s was maintained during the procedure. Six-French (6F) Envoy (cordis) guiding catheter was placed in the distal vertebral artery. A combination of echelon-10 microcatheter (ev3) and transcend 0.014 microwire (Stryker) were used to access the aneurysms. Multiple Axium (ev3) coils were used to occlude the aneurysm. There were no intra- and periprocedural complications and patient was discharged on the 5th day after operation. The post-operative course was uneventful. The patient's neurological examination after 1 month was completely normal. Control angiogram done after 1 year showed stable occlusion of the aneurysm with endovascular coil in place [].", "age": [ [ 42.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3424817.xml", "relevant_articles": { "27847774": "13", "21716902": "123", "34918697": "123", "10660030": "123", "17356193": "123" }, "similar_patients": { "3424817-2": "123", "3424817-3": "123", "3551501-1": "123", "3988606-1": "123", "3551501-2": "123" } }, { "human_patient_id": "454", "human_patient_uid": "3424817-2-M", "PMID": "22919561", "title": "Endovascular Management of Fusiform Superior Cerebellar Artery Aneurysms: A Series of Three Cases with Review of Literature", "patient": "A 50-year-old lady, who had a history of hypertension, presented with severe headache and ataxia. CT scan done at admission showed acute right cerebellar hematoma []. DSA done subsequently revealed fusiform aneurysm of the cisternal segment of the SCA []. Endovascular treatment was done under general anesthesia with inside out coiling of the aneurysm with platinum coils []. Standard heparin protocol was followed and an activated clotting time greater than 250 s was maintained during the procedure. 5F Envoy (cordis) guiding catheter was placed in the distal vertebral artery. A combination of echelon-10 micro-catheter (ev3) and transcend 0.014 micro-wire (Stryker) were used to access the aneurysms and multiple axiom (ev3) coils were used to occlude the aneurysm. Post-coiling angiogram showed complete exclusion of the aneurysm from the circulation. The post-operative period was uneventful. The patient's neurological examination done after 1 month was completely normal. Control angiogram done at the end of 1 year showed stable occlusion with no re-canalization of the aneurysm [].", "age": [ [ 50.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC003xxxxxx/PMC3424817.xml", "relevant_articles": { "27847774": "13", "12080516": "12", "15663225": "123", "33316814": "123", "18677524": "123" }, "similar_patients": { "3424817-1": "123", "3424817-3": "123", "3551501-2": "123", "3551501-1": "123", "3988606-1": "123" } }, { "human_patient_id": "455", "human_patient_uid": "3424817-3-M", "PMID": "22919561", "title": "Endovascular Management of Fusiform Superior Cerebellar Artery Aneurysms: A Series of Three Cases with Review of Literature", "patient": "A 64-year-old man, who had a history of hypertension, presented with headache and vomiting. CT scan showed SAH in the superior cerebellar cisterns []. DSA done revealed a fusiform aneurysm of the distal SCA, predominantly involving the branch of the cortical segment [Figures and ]. Standard heparin protocol was followed and an activated clotting time greater than 250 s was maintained during the procedure. 5F Envoy (cordis) guiding catheter was inserted in the distal vertebral artery. The aneurysm was accessed with a combination of micro-catheter (echelon-10) and micro-wire (traxcess12). Meticulous pre-shaping of the micro-catheter according to the shape of the target aneurysm aided in proper positioning of the micro-catheter in the aneurysm which was subsequently packed densely with the platinum micro-coils. Post-procedure angiogram showed complete exclusion of the aneurysm along with the branch of the cortical segment and preservation of the flow in the superior cerebellar artery (SCA) []. There were no untoward events in the post-procedure hospital stay and patient was discharged after 1 week. No neurological deficit was seen during the clinical follow-up after 1 month. Control angiogram carried out after 1 year showed stable occlusion of the aneurysm with preservation of the ante-grade flow in the SCA [].", "age": [ [ 64.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3424817.xml", "relevant_articles": { "27847774": "13", "7873281": "12", "11678406": "12", "32434031": "12", "8133972": "12" }, "similar_patients": { "3424817-2": "123", "3424817-1": "123", "3551501-1": "123", "3551501-2": "123", "3988606-1": "123" } }, { "human_patient_id": "456", "human_patient_uid": "5965116-1-M", "PMID": "29849242", "title": "Spontaneous Spinal Epidural Hematoma from Rivaroxaban", "patient": "A 74-year-old man on rivaroxaban for paroxysmal atrial fibrillation presented with the gradual onset of neck pain. The pain started while he was walking in the woods and was associated with progressive weakness and numbness from the clavicles downward. He was able to walk back to his cabin, but upon arrival he was unable to maintain his balance and fell forward striking his head. He denied any loss of consciousness. He was unable to move for about 45 minutes. Emergency medical services was called and they noted the patient to be completely paralyzed with fecal incontinence. He also had shortness of breath. During his transport to the emergency department (ED) he started to regain strength and feeling in his arms and legs and improvement of his shortness of breath. He denied any recent fevers, upper respiratory infection, rash or tick bites. All other review of systems was negative. Past medical history was significant for hypertension, atrial fibrillation, and coronary artery disease.\nOn initial examination, the patient was alert and oriented to person, place, and time. Temperature was 92.0 degrees Fahrenheit tympanic, pulse 56 beats per minute, respiratory rate 20 breaths per minute, blood pressure 122/56 mmHg, oxygen saturation 100% on four liters nasal cannula. Lungs were clear to auscultation bilaterally without wheezes, rhonchi, or rales. Heart was regular rate and rhythm, without any murmurs. Abdomen was soft, non-tender, non-distended with normal bowel sounds. Back had no evidence of trauma or deformity, non-tender to palpation. On extremity exam he had 4/5 strength in all extremities. After 20 minutes in the ED, he developed flaccid paralysis of all extremities with 0/5 strength. His voice also became softer and he developed shortness of breath. After five minutes he was able to wiggle his left toes. Over the next hour he slowly regained strength in his right lower extremity and his voice returned to normal. After another 40 minutes the patient was able to move his right upper and lower extremity and wiggle his toes on his left lower extremity. He was still unable to move his left upper extremity.\nA computed tomography angiography (CTA) of the chest, abdomen, and pelvis was performed and did not show any evidence of aortic dissection. MRI of the cervical spine showed a prominent epidural hematoma, primarily dorsal, that extended from the foramen magnum down to cervical vertebra C7 and contributed to severe mass effect on the thecal sac (). Findings were the worst at C2\u2013C3, where the hematoma measured 7\u20138 mm in width with compression of the cervical spinal cord and associated cord signal abnormality. In retrospect, findings were also visible on the preceding CTA. Patient was taken emergently to surgery for evacuation of the hematoma.", "age": [ [ 74.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5965116.xml", "relevant_articles": { "28045690": "0", "20108823": "0", "20164075": "1", "29930019": "0", "2927616": "123" }, "similar_patients": { "7434283-1": "13", "5965191-1": "0", "8143822-1": "1", "6497200-1": "0", "5965200-1": "13" } }, { "human_patient_id": "457", "human_patient_uid": "5749288-1-M", "PMID": "29410929", "title": "A Case of Midgut Volvulus Associated with a Jejunal Diverticulum", "patient": "The patient is an 80-year-old female with a history of recurrent abdominal pain. Permission was obtained from the patient to allow discussion and publication of his case. The patient had a history of coronary artery disease, atrial fibrillation (on anticoagulation), multiple cerebral vascular accidents, chronic obstructive pulmonary disease, an aortic and mitral valve replacement, and a prior hysterectomy. The patient was noted to have presented to the hospital three times in the prior month with similar complaints of vague, diffuse abdominal pain that would last a few hours and resolve. The patient did note nausea and vomiting with these episodes. The patient re-presented to the emergency room, where a CAT scan was performed () which showed mesenteric swirling secondary to possible internal hernia. The patient underwent a small bowel follow through with gastrografin, which demonstrated no abnormalities. The patient then underwent an obstructive series that was also noted to be normal. The patient's symptoms, however, did not subside. Due to the chronicity and the unresolving symptoms, the patient was brought to the operating room after a long discussion of possible outcomes with the patient.\nThe operation was started laparoscopically but was soon converted to an open laparotomy due to a large mass of small bowel swirled onto itself that was adhered together (). In mobilizing the small bowel, blunt dissection was used to lyse adhesions and untwist the mesentery. The small bowel mesentery was observed, and no mesenteric defects were noted. It was seen that the mesentery had swirled and twisted upon itself (). While running the bowel, a large, proximal jejunal diverticulum was present. The diverticulum was excised using a 60 mm stapler. The bowel was run from the ligament of Treitz down to the ileocecal valve with no mesenteric defects noted, and all bowel was viable. The small bowel was returned to the abdomen. The patient did well postoperatively and was seen in follow-up without complication.", "age": [ [ 80.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5749288.xml", "relevant_articles": { "30697414": "0", "22696674": "0", "27303459": "0", "30115714": "0", "24454405": "123" }, "similar_patients": { "6031059-1": "123", "6794980-1": "0", "8450547-1": "0", "6368202-1": "123", "7338329-1": "123" } }, { "human_patient_id": "458", "human_patient_uid": "8311943-1-M", "PMID": "34304737", "title": "Mechanic\u2019s hand; is it a prodromic sign of disease relapse of anti-synthetase syndrome; a case report", "patient": "A 45-year-old South Asian woman presented with a progressively worsening of proximal muscle weakness. Initially there was a mild pain in her thighs and arms which was followed by a difficulty getting up from the seated position and inability of raising her arms. There was no dysphagia, regurgitation or difficulty in breathing. During this particular presentation there was no dermatological manifestations suggestive of dermatomyositis or mechanic\u2019s hands. There was no history suggestive of Raynaud\u2019s phenomenon or any joint pains. There was a mild nonproductive cough which developed a few weeks after the onset of the muscle symptoms without any notable shortness of breath of exertion or wheezing. There was no other evidence of any connective tissue diseases.\nThere was no ptosis, double vision or fatiguability to suggestive myasthenia. Patient appeared to be clinically euthyroid without any overt features of hypothyroidism. There was no history of statin use at the time of the presentation or prior to that. Patient denied any similar history previously nor was there a history of a similar disease among her family members.\nExamination revealed bilateral symmetrical proximal muscle weakness with a muscle power of 4/5 in all four limbs. Reflexes were intact without any muscle wasting. There were no overt features of dermatomyositis. Auscultation of the lungs revealed a few bilateral basal fine end inspiratory crepitations suggestive an interstitial lung disease. Second heart sound was of normal intensity. A diagnosis of inflammatory myositis was considered with a concurrent interstitial lung disease. With this clinical text she was thoroughly investigated.\nCreatinine phosphokinase levels were elevated with a value of 1435 u/l. Inflammatory markers were elevated with a ESR of 54 though the CRP was only slightly elevated. ANA was negative. Findings on electromyography was consistent with an inflammatory myositis. Muscle biopsy which was carried out revealed inflammatory cells in between the muscle fibers causing complete necrosis of some of the muscle fibers. Anti Jo-1 antibody was positive. HRCT revealed bilateral homogenous sub pleural basal ground glass opacification suggestive of non-specific interstitial pneumonitis (Fig. ). She was started on oral prednisolone 1 mg/kg/day with azathioprine 50 mg per day which was later increased to 100 mg per day. Subsequently her muscle power improved, CPK levels normalized and the cough which was present improved.\nShe attended her follow up clinic visits and was compliant with her medication. She was in remission for 2 years with low dose prednisolone and azathioprine. She was asymptomatic with no muscle pains, proximal muscle weakness and CPK levels were within normal range. She continued to be free from any cough or shortness of breath. ESR was persistently normal with values in the mid 20\u2019s.\nFollowing a period of unsatisfactory compliance of 4 weeks, she presented with fissuring and cracking of the fingers suggestive of mechanic\u2019s hands (Fig. ) without any muscle pain or weakness. She denied any recurrence of the cough which she had during the initial disease presentation and did not have any shortness of breath. Her CPK was within normal limits at that time. Though there was no evidence of a systemic relapse, the steroid dose was up titrated while continuing azathioprine. However, the mechanic\u2019s hands did not improve and subsequently in the following month she started to complain of a pain in her thighs and arms with a subtle weakness. Her CPK had risen to 1427 u/L and ESR risen to 47. Given the overall clinical picture it was decided that she required escalation of her immunosuppressive therapy. She was started on IV cyclophosphamide 500 mg every 2 weekly and after 3 doses the skin manifestations started to resolve and CPK had normalized (Fig. ). Hydroxychloroquine 200 mg daily was added as patient had prominent dermatological manifestations with photosensitivity (Table ).\nRepeat HRCT revealed stable nonspecific interstitial pneumoniae without any radiological progression. Lung function tests revealed a restrictive lung disease with a FVC of 78% of predicted, FEV1 of 94% of predicted with FEV1/FVC of 124%. DLCO was 49%.", "age": [ [ 45.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC008xxxxxx/PMC8311943.xml", "relevant_articles": { "34304737": "123", "29665800": "123", "20340018": "12", "33740993": "123", "22491200": "0" }, "similar_patients": { "8093052-1": "123", "4890335-1": "123", "5905122-1": "13", "8147826-1": "13", "7046003-1": "123" } }, { "human_patient_id": "459", "human_patient_uid": "5467274-1-M", "PMID": "28634489", "title": "A Study of Patients with Primary Mediastinal Germ Cell Tumors Treated Using Multimodal Therapy", "patient": "A previously healthy 22-year-old Japanese man without a medical or surgical history presented to Anjo Kosei Hospital with complaints of fever and dyspnea. Physical examination revealed a temperature of 37.8\u00b0C and tachycardia. CT scans revealed a 14.4 \u00d7 9.8 \u00d7 10.0 cm mass in the anterior mediastinum with compression of the heart. Pertinent laboratory values included an AFP level of 31,536 ng/mL and an LDH level of 604 IU/L. His hCG level was within the normal range. Physical examination of the testes showed no neoplastic parenchymal involvement. A needle core biopsy revealed a malignant germ cell tumor, and immunohistochemical staining was positive for AFP. From these data, the patient was finally diagnosed with a yolk sac tumor.\nThe patient received combination chemotherapy consisting of BEP every 3 weeks for a total of 3 cycles. After that, an additional 2 cycles of EP chemotherapy were administered in order to normalize his serum tumor marker levels. His AFP level decreased to 46 ng/mL after 3 cycles of BEP and further normalized after 2 cycles of EP. After 5 courses of preoperative chemotherapy, resection of the tumor was performed, resulting in a complete pathologic response (). The patient is alive and in CR without any evidence of recurrence.", "age": [ [ 22.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5467274.xml", "relevant_articles": { "21384681": "123", "2475556": "123", "7525792": "123", "14978917": "123", "31950009": "123" }, "similar_patients": { "5467274-2": "123", "3804737-1": "13", "4239375-1": "123", "8460974-1": "13", "3499222-1": "13" } }, { "human_patient_id": "460", "human_patient_uid": "5467274-2-M", "PMID": "28634489", "title": "A Study of Patients with Primary Mediastinal Germ Cell Tumors Treated Using Multimodal Therapy", "patient": "A previously healthy 25-year-old Japanese man was admitted to our hospital with complaints of chest pain. His history was unremarkable. Physical examination did not reveal any significant findings. A CT scan revealed a 7.6 \u00d7 6.5 \u00d7 3.5 cm mass in the anterior mediastinum and no metastases at the initial diagnosis. His laboratory values included an AFP level of 3,034 ng/mL and an hCG level of 20.6 ng/mL. Ultrasonography of the testes revealed a uniform pattern without any findings suggestive of malignancy. Needle core biopsy was not performed. Based on suspicion for PMGCT, the patient was referred for thoracic surgery. The tumor was histopathologically diagnosed as a yolk sac tumor. After the operation, the patient received 4 total courses of BEP and EP chemotherapy. Upon completion of the chemotherapy, his serum tumor marker levels normalized (). The patient is alive and in CR without any evidence of recurrence after 3 years.", "age": [ [ 25.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5467274.xml", "relevant_articles": { "7525792": "123", "16281866": "123", "14978917": "123", "2475556": "123", "32483951": "123" }, "similar_patients": { "5467274-1": "123", "8476321-1": "13", "4265396-1": "123", "4239375-1": "123", "2893319-1": "123" } }, { "human_patient_id": "461", "human_patient_uid": "2783048-1-M", "PMID": "19946585", "title": "Vertebral artery dissection presenting as a Brown-S\u00e9quard syndrome: a case report", "patient": "A 35-year-old right-handed man who worked in a bank was admitted to hospital with complaints of neck pain and left-sided weakness. The patient had developed a sharp pain in the left side posterior aspect of his neck and occiput after a 4-hour flight, 4 weeks before presentation. At the time he felt nauseated but did not vomit, and he was treated conservatively with ultrasound and massage. The weakness began acutely after he had turned his head to one side and rapidly progressed from his left leg to his left arm. He was immediately unable to walk and subsequently began to experience tingling sensations in his right arm and leg.\nThere was no history of head trauma or neck manipulation, no past medical or surgical history, and no previous use of medications or previous infectious symptoms. The patient was a non-smoker, did not have diabetes and was normotensive. There was no family history of thrombophilia or venous throboembolism. Both his father and uncle had suffered from ischemic strokes in their late forties. He was born in the Philippines and had lived in Canada since early childhood.\nOn examination, level of consciousness, cognition and speech were normal. His blood pressure was 144/96 mmHg. The cranial nerve examination was normal. There was Medical Research Council (MRC) grade 4 out of 5 weakness affecting the left arm and left leg, with active movement possible against gravity and minimal resistance. Pinprick and temperature sensation were diminished on the right side from the second cervical vertebra (C2). Vibration and joint position were diminished on the left side below C2. The left plantar reflex was equivocal and the right was flexor. The remainder of the physical examination was normal. The results of the examination were consistent with a Brown-S\u00e9quard syndrome on the left at the level of C1-C2.\nHematologic, biochemical and immunologic investigations were normal and electrocardiogram and chest radiography were unremarkable. The lumbar puncture cerebrospinal fluid (CSF) protein was 0.22 g/l and glucose was 4.9 mmol/l (blood glucose 8.8 mmol/l). There was one white cell, two red cells, no oligoclonal banding and no xanthrochromia in 10 ml of CSF.\nT2-weighted magnetic resonance (MR) imaging performed 2 days after presentation revealed a hyperintense signal associated with restrictive diffusion from the left inferior medulla and obex to the level of C2-C3, consistent with infarction (Figure ). Three-dimensional time-of-flight MR angiography showed narrowing of the left vertebral artery over the arch of C1 with a high signal parallel to the narrowed lumen, consistent with intramural hematoma and dissection (Figure ).\nThe patient was started on anticoagulation therapy with heparin and bridged to warfarin as secondary prevention. When the patient was discharged one month later, he was doing well, with improving, although not yet normal, strength in his left arm and leg.", "age": [ [ 35.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC002xxxxxx/PMC2783048.xml", "relevant_articles": { "7669422": "0", "28045690": "0", "26741691": "0", "9046857": "0", "20108823": "0" }, "similar_patients": { "6907223-1": "123", "3766176-1": "1", "7608839-1": "12", "5591917-1": "12", "7747072-1": "0" } }, { "human_patient_id": "462", "human_patient_uid": "7249747-1-M", "PMID": "32467790", "title": "Severe Kidney Injury After a 110-km Trail Race", "patient": "We present a case of severe AKI with rhabdomyolysis in a 49-year-old, experienced, competitive male trail runner (weight 66 kg, height 183 cm, body mass index 19.7 kg/m2, running 5-6 times/ week, training load 70-100 km/week) who presented six days after a 110-km trail race to the accident and emergency department. He participated in one of Europe\u2019s toughest ultra-trail race, the Grossglockner Ultra-Trail, a 110-km trail race with 6.500 m positive climb and an average elevation higher than 2,000 m for at least half of the course, including technically difficult terrain and trails. He finished the race in a time of approximately 18 hours (overall winning time of 14:40:14 hr:c). Prior to the event, he was free of injury, otherwise fit and healthy, non-smoker, with no other past medical history of note. Blood tests approximately six months before the event showed a normal renal function (creatinine 1 mg/dL, glomerular filtration rate [GFR] >90 mL/min/1.73 m2). Immediately prior to the event, he ingested 500 mg of naproxen and 20 mg of esomeprazole. Throughout the race, he consumed little oral fluids (approximately 4 litres of fluids in total, during approximately 18 hours of running). There was no urination throughout the race. Immediately after crossing the finish line, he started to re-hydrate and increased his fluid intake ad libitum and shortly thereafter had one episode of chocolate brown urination. He felt fine, with some post-race fatigue and subsequently returned home. The following day he noticed some mild generalised swelling with oliguria, despite regular food and fluid intake. After two days, urination returned to normal, but the generalised oedema increased over the following days with a combined weight gain of approximately 10 kg. Subsequently, he felt generally tired and fatigued, and at this stage he presented to the local accident and emergency department six days post-event. Biochemically the diagnosis of severe AKI with rhabdomyolysis was made. Conservative measures with intravenous and oral fluid therapy were instigated, and renal replacement therapy was contemplated. However, his kidney function gradually improved, as well as elevated potassium levels, with conservative measures; therefore renal replacement therapy was not required. Further investigations included abdominal radiographs (due to abdominal extension), ultrasounds of both kidneys, urine analysis (dip stick and microscopic) and serial laboratory blood tests, as well as cardiac assessment, including ECG. Radiological imaging and cardiological assessment were unremarkable, as well as blood gas analysis, without signs of metabolic acidosis. The patient remained hospitalised for two weeks, and on discharge his renal function and clinical symptoms had improved considerably. Subsequent regular blood test demonstrated a gradual return of his creatinine levels after approximately six months. Estimated laboratory GFR remained reduced, with no evidence of microproteinuria (albumin-to-creatinine ratio) (Table ). At this point, he was allowed to return to gradual aerobic activity under close supervision of his sports physician.", "age": [ [ 49.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7249747.xml", "relevant_articles": { "32467790": "123", "26840437": "0", "29070954": "0", "2287252": "123", "31875741": "12" }, "similar_patients": { "8582916-1": "123", "3289185-1": "0", "8299420-1": "123", "8412848-1": "12", "7746474-1": "12" } }, { "human_patient_id": "463", "human_patient_uid": "2844739-1-M", "PMID": "20351985", "title": "Primary laryngeal tuberculosis mimicking laryngeal carcinoma: CT scan features", "patient": "A 36-year-old-man without a medical history of pulmonary tuberculosis or BCG vaccination was admitted for dysphonia and dysphagia for 6 months. Laryngoscopic examination revealed thickening of the left vocal cord and the ventricular strip, with edema. Laryngeal CT scan [Figures and ] revealed a localized, regular thickening of the left vocal cord, associated with irregular thickening of the posterior laryngeal wall. The anterior commissure and sub-glottic region were normal. There were neither any cartilaginous abnormalities nor any cervical adenopathy. A biopsy was performed, which revealed caseo-follicular tuberculosis laryngitis. The chest radiograph and abdominal USG were normal. On further interrogation and investigations, it was found that the patient was negative for the human immunodeficiency virus and his sputum was negative for acid-fast bacilli.", "age": [ [ 36.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC002xxxxxx/PMC2844739.xml", "relevant_articles": { "20351985": "12", "26557293": "12", "8553964": "12", "29202349": "0", "11068416": "12" }, "similar_patients": { "6710967-1": "0", "3249944-1": "1", "4326367-1": "1", "2803812-1": "1", "5569942-1": "0" } }, { "human_patient_id": "464", "human_patient_uid": "2783122-1-M", "PMID": "19946477", "title": "Acute free perforation of gall bladder encountered at initial presentation in a 51 years old man: a case report", "patient": "A 51-years-old Pakistani male, without any known medical co-morbidity, presented to the emergency department at our institution with a 1 day history of sudden-onset and severe abdominal pain along with abdominal distension. The pain had started after a long drive of 12 - 14 hours. It was initially localized to the right upper quadrant and right lumbar region but had evolved to a more generalized distribution over time. The pain was aggravated on movement and relieved by rest. There were no other associated symptoms. His past surgical history was significant for a repaired left sided inguinal hernia 10 years back.\nThe patient was in obvious anxiety and distress when first encountered in the emergency room. His vital signs were stable except for an increased pulse of 105 beats per minute. Examination of his respiratory system revealed vesicular breathing with decreased intensity of breath sounds in the right lung base as well as dullness on percussion on the right side of the chest. His abdomen was distended with generalized tenderness on palpation and minimal movement with respiration. No organomegaly was appreciated on the physical examination. His bowel sounds were sluggish.\nThe laboratory tests done at the time of admission are shown in table . The patient had mild anemia, mildly reduced hematocrit, leukocytosis with neutrophilia and hyponatremia. His serum amylase, lipase and random blood sugar levels were all within normal limits. His abdominal x-ray showed sub-optimal inspiration with minimal right sided pleural effusion. However, there were no signs of intestinal obstruction or pneumoperitoneum noted. Subsequently, computed tomography (CT) scan of the abdomen was done. Gallbladder margins were not very clearly identifiable; there was significant pericholecystic fat stranding with pericholecystic fluid. A circular high density focus in the proximity of gallbladder was identified which was thought to be representing a gallstone. Mild ascites was also present. These features were collectively suggestive f gallbladder perforation. (Figures and )\nThe patient's emergent management included nothing per oral status, regular vitals and input/output charting, insertion of nasogastric tube, administration of intravenous fluids, narcotic analgesics, proton pump inhibitors, metochlopramide, ceftriaxone, metronidazole, and ampicillin.\nThe patient was then taken to the operating room and a diagnostic laparoscopy was performed. It revealed free yellowish green fluid, most likely bilious, in the peritoneum. As the triangle of Calot could not be identified on laparoscopy, the procedure was converted to an open laparotomy. Intra-operative findings included presence of frank bile in the abdomen and a thick walled gall bladder. Dense adhesions of the gall bladder with surrounding structures were observed. A small perforation was visible near the neck of gall bladder in association with a large gall stone. The anatomy of the Calot's triangle was still obscure. A near-total or partial cholecystectomy including the perforated area was performed and a single large gall stone measuring around 2 \u00d7 1 cm was retrieved. The peritoneal cavity was washed with copious amounts of normal saline and a drain was placed. The rectus sheath was closed with loop polydioxanon (PDS) but the wound was kept open for healing by delayed primary closure.\nHistopathology of the specimen showed full thickness gallbladder wall lined by mucosa with focal ulceration. Rokitansky aschoff sinuses were also seen. A pathological diagnosis of acute on chronic cholecystitis was made.\nThe patient's hospital course was uneventful. His symptoms significantly improved and he was discharged from the hospital on the third post-operative day. He returned to the clinic after one week when his drain was removed and his wound closed.", "age": [ [ 51.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC002xxxxxx/PMC2783122.xml", "relevant_articles": { "19946477": "123", "20580518": "123", "3826818": "12", "34235016": "123", "18029515": "12" }, "similar_patients": { "2995940-1": "123", "7654559-1": "123", "7440013-1": "123", "4940531-1": "13", "7666622-1": "12" } }, { "human_patient_id": "465", "human_patient_uid": "6039681-1-M", "PMID": "29952988", "title": "Uncommon foreign body in the hypopharynx", "patient": "A 9-month-old boy presented to Department of Otolaryngology for an hour of crying associated with having congee. He was suspected of foreign body aspiration. However, there were no suggestive symptoms, such as dyspnea, stridor, croupy cough, hoarseness, or vomiting. In physical examination, no foreign body was found in the oropharynx. Differences in the intensity, phase, and quality of bilateral breath sounds were uncertain for disturbance of baby crying. Therefore, cervicothoracic computed tomography (CT) scan with virtual endoscopy was taken for excluding foreign bodies of the pharynx, larynx, trachea, bronchi, and esophagus. However, no abnormality was revealed in the CT scan, as shown in Fig. . Then, flexible laryngoscopy was applied for viewing the hypopharynx and larynx. A transparency film, exhibited in Fig. , was visualized on the posterior hypopharyngeal wall, as shown in Fig. . The removal of the foreign body was proceeded immediately. The tongue was depressed for better exposure of the foreign body. Under direct visualization it was removed with forceps.", "age": [ [ 9.0, "month" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6039681.xml", "relevant_articles": { "29952988": "123", "1952042": "123", "14680912": "12", "3380739": "12", "23169095": "123" }, "similar_patients": { "7533046-1": "123", "7487441-1": "123", "8684363-1": "123", "8591057-1": "12", "5902111-1": "12" } }, { "human_patient_id": "466", "human_patient_uid": "6579323-1-M", "PMID": "31249745", "title": "A Unique Association of Osteogenesis Imperfecta with Bilateral Renal Osteodystrophy and Gastroenteritis in a Three-year-old Boy", "patient": "A three-year-old male child was admitted to the pediatric ward of Dr. Ruth KM Pfau, Civil Hospital Karachi (CHK) with a one-year history of generalized weakness, loose motions, decreased appetite and intermittent fever not associated with rigors, chills or night sweats, an eight-month history of inability to walk and sit, polydipsia, polyurea, abdominal distention and loss of neck holding for 14 days. He had a previous history of hospitalization six months ago due to the same complaints. The patient was accompanied by his mother. He weighed 6 kg, is the 7th born child to his parents and was delivered at term to a 37-year-old G7P7 mother via normal vaginal delivery. The mother did not report any complications or illnesses during pregnancy. He cried immediately after birth, and there were no complications during or after birth. There is no consanguinity between mother and father. The child was vaccinated but was malnourished, with an unremarkable family history.\nThe patient also developed diarrhea which was bulky in consistency, green in color with seven episodes per day after every meal intake. Diarrhea was associated with abdominal distention and vomiting. The mother then started giving him a combination of trimethoprim-sulfamethoxazole, after which diarrhea subsided. The child developed neck holding at four years of age, he started sitting at eight months and started walking with support at 12 months of age. The child was first breastfed within three hours of delivery and was exclusively breastfed up to six months. Complimentary feeding was started after six months with pulses, mashed potatoes, porridge and chicken. Breastfeeding was continued up to two years. Currently, the child takes 1-2 feeds per day. The personal history revealed that the patient was sleeping normally, but the appetite was decreased. The mother also noticed a weight loss, altered bowel habits, and micturition was normal.\nOn examination (O/E), the patient was lying on the bed irritated, severely wasted and emaciated with visible bony deformities. Initial vitals included blood pressure (BP) 110/70 mmHg, a regular pulse of 90 beats/min, a respiratory rate of 20 breaths/min, and a low-grade fever of 100\u00b0 F. The patient was anemic and dehydrated, while, there was no presence of edema, clubbing, cyanosis, and lymphadenopathy. On further examination, parietal and frontal bossing, rachitic rosary (Figure ), widening of wrists and knock knees (it's a valgus deformity in which legs curve inwards so that the feet are apart when the knees are touching) were found as well. On abdominal examination, it was soft, non-tender, distended with mild tenderness on both flank regions, with a centrally placed umbilicus. The liver was palpable three fingers below the right costal margin. Gut sounds were audible 3-4 sounds/min. All other systems were unremarkable.\nThe anthropometric measures of the child are as follows: weight = 6.5 kg, occipitofrontal circumference = 49.5 cm, height = 72.5 cm, mid-upper arm circumference = 8 cm, upper segment = 45 cm, lower segment = 27.5 cm, weight for height = 6.5/9 *100 = 72.2 (moderately low) and height for age = 72.5/94.6*100 = 76.6 (severely low).\nOn investigations performed, complete blood count (CBC) showed a hemoglobin (Hb) of 5.4 gm/dl, mean corpuscular volume (MCV) of 82 fl and a platelet count of 187,000/mL. The total leukocyte count (TLC) was 10.6 x 109/L, including 39% neutrophils and 48% lymphocytes. His inflammatory markers were raised with a C-reactive protein (CRP) of 23 mg/L [Normal (N) = 3] and an elevated erythrocyte sedimentation rate (ESR) of 115 mm/hr (N = 0-22) for men and (N = 0-29) for women. The clotting profile showed an international normalized ratio (INR) of 1.01, while prothrombin time (PT) was 10.6 seconds.\nThe urea creatinine electrolytes (UCE) were within normal range except decreased potassium levels of 2.8 mEq/L. The levels of calcium, magnesium and phosphate in blood were 15.1, 1.9 and 4 mg/dL, respectively. The blood culture showed a growth of Burkholderia species. The urinalysis showed a pH of 5.0, specific gravity of 1.025, with the presence of protein and blood. Additionally, numerous red cells were seen along with yeast and 4-6 pus cells per high power field (HPF). The urine culture showed growth of Candida species. The stool analysis showed that the stool was hard, acidic, brown in color with 1-2 pus cells per HPF. His vitamin D levels came out to be 54.29 ng/mL, and parathyroid levels were 8.36 pg/ml. Liver function tests showed a total bilirubin of 0.28 mg/dL, direct bilirubin of 0.21 mg/dL and levels of alkaline phosphate alanine aminotransferase were 368 and 3 units per liter, respectively.\nThe X-rays of the chest (Figure ), skull (Figure ) and femur (Figure ) are attached below. Additionally, ultrasound of kidney ureters and bladder (KUB) showed an incidental finding of bilateral renal calculi (right kidney at lower pole measuring 0.7 cm, in the left kidney at mid pole measuring 0.7 cm), along with bilateral grade 2 renal parenchymal changes. The urinary bladder was normal in thickness with no presence of focal mass, calculus or diverticulum.\nConsidering the diagnosis of OI, an ophthalmology review was done to look for lens dislocation and blue sclera, but neither was present in both eyes. However, the left eye showed a corneal thinning nasally, temporally and inferiorly.\nDuring the hospital stay, the patient was intravenously given cefotaxime 220 mg, piperacillin-tazobactam 700 mg, and meropenem three times a day. Additionally, linezolid 70 mg was injected every eight hours, along with injections of bisphosphonate 7 mg for three days, amikacin 55 mg twice a day for 14 days and fluconazole 85 mg loading dose, 45 mg once a day for 10 days. The patient was also given a teaspoon of the combination (artemether and lumefantrine) once a day. Three pints of red blood cells were transfused as well, after which his Hb became 10.6 mg/dL. During the stay, the child had a prolonged course of fever with pancytopenia, which improved on injections of meropenem, amikacin, and fluconazole.", "age": [ [ 3.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6579323.xml", "relevant_articles": { "10809979": "0", "28644156": "0", "26908705": "0", "17618180": "0", "31249745": "12" }, "similar_patients": { "6823080-1": "0", "6464487-1": "0", "6834089-1": "0", "6830538-1": "0", "7430660-1": "0" } }, { "human_patient_id": "467", "human_patient_uid": "5107239-1-M", "PMID": "27872789", "title": "Malignant Peripheral Nerve Sheath Tumor of Prostate: A Rare Case Report and Literature Review", "patient": "A 44-year-old man without systemic underlying disease suffered from painless gross hematuria combined with urine retention for days. He had LUTS for years and became worse recently. Stony-hard prostate with markedly enlarged size was found during digital rectal examination, but the PSA level was detected within the normal range (total PSA: 0.42 ng/mL). Transrectal ultrasonography (TRUS) revealed multiple nodules in the prostate. The largest nodule is 6.3 cm and the whole prostate measures about 300 grams. Architecture derangement of prostate, possible central necrosis with hemorrhage, and enlarged right internal iliac lymphadenopathy were found on prostate magnetic resonance imaging (MRI) (). No bony metastasis was detected on the bone scan. We performed TRUS-guided prostate biopsy but massive gross hematuria attacked days after the procedure. Thus, cystoscopy for checking bleeding was done and the specimen resected from prostate was reported as malignant peripheral nerve sheath tumor (). For further staging, we arranged chest computed tomography (CT), which revealed a solitary 0.9 cm nodule in the right upper lobe.\nConsidering the difficulty of radical surgery due to huge size of prostate, we prescribed neoadjuvant chemotherapy (5-Fluorouracil + Cisplatin + Ifosfamide) for 5 cycles. Regression of previous lung nodule was found on follow-up chest CT. Pelvic MRI revealed residual tumor lesion within the visible prostate gland, whose size regressed to 83 grams. The radical cystoprostatectomy was performed, and tumor invasion to bladder was found during operation. Bilateral pelvic lymph node dissection was also done and no metastasis was found. The pathologic diagnosis reported was consistent with MPNST.\nAfter the operation, we prescribed adjuvant concomitant chemoradiation therapy (Cisplatin + 5-Fluorouracil + Ifosfamide with external beam radiation therapy 6600 cGy, 33 fractions). Follow-up abdominal CT done in postoperative 3 months showed multiple ill-defined poorly enhanced nodules in the liver and a 3.5 cm gallbladder mass. The target therapy, Pazopanib 400 mg per day, was given for palliative treatment due to suspect disease progression. However, his clinical condition went downhill and he expired three months later.", "age": [ [ 44.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5107239.xml", "relevant_articles": { "32316705": "123", "27872789": "123", "33776718": "123", "30278486": "123", "28567329": "123" }, "similar_patients": { "4165926-1": "123", "4165926-2": "13", "7787201-1": "1", "8093112-1": "1", "3162226-1": "13" } }, { "human_patient_id": "468", "human_patient_uid": "4747944-1-M", "PMID": "26943378", "title": "A case of giant ileal duplication in an adult, successfully treated with laparoscope-assisted surgery", "patient": "A 60-year-old male was admitted to our hospital with a complaint of right lower abdominal pain. The patient did not have same symptoms before, and he only had a medical history of asthma. The laboratory data on admission showed a slightly elevated WBC count of 9,300/\u03bcl and a CRP level of 1.0 mg/dl, but the tumor marker levels (CEA, CA19-9) were almost within the normal limits. Abdominal computed tomography (CT) demonstrated a 15-cm large cystic mass, like a dilated intestine, and fluid collection was observed inside.\nThe cystic mass was adhered to the ileum, but there was no definite communication to the ileum. The feeding arteries of the cyst were communicating branches from the upper mesentery artery, and the lymph nodes around the cyst were slightly swollen (Figure a,c). At the small-bowel follow-through exam, the cyst did not come out, but it did exclude normal intestine (Figure b). There were not significant findings during a colonoscopic examination.\nBased on these findings, we diagnosed the cyst as an ileal duplication and decided to perform surgery in order to prevent a recurrence of abdominal pain and lethal complications, such as bleeding or perforation.\nWe employed a four-port laparoscope-assisted resection of the duplicated ileum and segmental resection of the normal ileum. An umbilical port was used for a mini-laparotomy with a zigzag skin incision (Figure a). The cyst\u2019s stalk was attached to the base of the mesentery of the terminal ileum, approximately 40 cm from the ileocecal junction (Figure b,c). After resection of the cyst, a side-to-side anastomosis of the ileum was made with a stapler.\nThe resected specimen showed an ileal duplication of 18 \u00d7 7 cm in diameter, filled with purulent matter with some ulcers inside (Figure a). The histological findings showed that it had a mucus gland inside, like intestinal epithelium, and was covered with two layers of smooth muscle. There was no communication between the duplication and normal ileum, but they had a common muscle layer (Figure b,c).\nThe postoperative period was uneventful without any asthma attack, and the patient was discharged on the 13th postoperative day.", "age": [ [ 60.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4747944.xml", "relevant_articles": { "24115964": "123", "30510947": "123", "29607390": "123", "20011941": "12", "31555466": "123" }, "similar_patients": { "4158108-1": "123", "3326825-1": "123", "6139107-1": "123", "2952782-1": "123", "6536564-1": "123" } }, { "human_patient_id": "469", "human_patient_uid": "7775664-1-M", "PMID": "33390940", "title": "Acute Digital Ischemia After Arterial Injection of Crushed Zolpidem Tablets: Role of Microcrystalline Cellulose? A Case Report", "patient": "A 31-year-old female patient was admitted to the vascular medicine department of the H\u00f4pital Europ\u00e9en Georges-Pompidou for an acute ischemia of the left hand. She presented with necrosis of the intermediate and distal phalanges of the second, third, fourth and fifth fingers of her left hand.\nThree days earlier, the patient turned up at the primary care center close to her home for a sudden and constant pain in her left hand. She was discharged within 2 h with painkillers. After 72 h, cyanosis and coldness of the intermediate and distal phalanges of the fingers of the left hand appeared. She then decided to consult at the H\u00f4pital Europ\u00e9en Georges-Pompidou emergency department.\nLeft hand examination revealed the following injuries: cyanosis and coldness of the intermediate and distal phalanges of the fifth finger, necrosis of the distal phalanges of the second, third and fourth fingers, phlyctens of the intermediate phalanges of the second, third and fourth fingers and the proximal phalanges of the fourth finger (,). The hand was still painful with paresthesia, but without fingers paralysis. Upper limb pulses were present and symmetrical. Injection marks were noted at the bend of the right and left elbows. Cardiac auscultation was normal without any bruit that could evoke an infective endocarditis, and she had no fever. Electrocardiogram showed a sinus rhythm without any abnormalities.\nIn her medical history, she had no cardiovascular history but active smoking, as her only cardiovascular risk factor. Spontaneously, she mentioned being a drug addict, but weaned off ectasy, codein, and cannabis, and currently in a weaning off program for heroin. She had been prescribed tapered doses of buprenorphine but still used to take bromazepam and zolpidem off the counter.\nThe continuous Doppler confirmed the presence of flow in the left radial, ulnar and palmar arteries. A digital subtraction angiography was rapidly performed which demonstrated no run-off in the digital arteries of the second, third and fourth left fingers (). No thromboaspiration could be performed on these too small arteries. Anticoagulation with unfractionated heparin was started.\nThe patient was transferred to the vascular medicine department for medical therapy and further investigations. As the patient denied any recent intravenous drug injection, a complete screening for acute limb ischemia etiology was performed.\nHuman Immunodeficient Virus and Hepatitis B Virus serology were negative, whereas Hepatitis C Virus serology came back positive. Several analyses to find a cryoglobulinemia returned negative.\nArterial thrombophilia has been investigated in vain, with normal prothrombin time and activated partial thromboplastin time, absence of anti-cardiolipin antibodies, anti-beta2GPI antibodies, lupus anticoagulant, antinuclear antibodies, anti-double stranded DNA antibodies, anti polymorphonuclear cytoplasm antibodies. There was no antithrombin or protein S or protein C deficiency and no hyperhomocysteinemia. There was no argument for a myeloproliferative syndrome in the absence of a clinical call point (especially no mass or lymphadenopathy), the blood count was unspecialized and JAK2 mutation V617F was absent.\nWe also looked for an embolic arterial cause. The trans-thoracic echocardiography did not find any thrombus or any argument for an infectious endocarditis. The 24 h Holter-ECG was normal. The computed tomography performed at the emergency room did not show any atheroma on the aortic arch or atheromatous plaque on the left upper limb arteries.\nOnce she was arrived in our department, we started a daily treatment with iloprost, an arterial vasodilator, as well as pain medication, and local care with a protective dressing. Treatment with iloprost allowed delineation of necrosis at the intermediate and distal phalanges of the three fingers involved, and cyanosis of the fifth finger and the proximal phalanx of the fourth finger resolved. Management by an orthopedic surgical team specialized in the upper limb and hand was required for the amputation of the intermediate and distal phalanges of the three fingers involved ().\nFinally, the patient acknowledged she had injected herself, 3 days before her admission, just below the fold of her left elbow with one and a half crushed tablet of zolpidem 10 mg mixed with contact lens cleaning fluid. The patient intended to do an intravenous injection, but it turned out to be an accidental brachial intra-arterial injection. The 3 days delay corresponded to the beginning of the pain and to her first consultation at the local medical center.\nAntithrombotic therapy by anticoagulants was changed for antiplatelet therapy and the patient was then transferred to a vascular rehabilitation unit for complete healing of the amputation wounds. presents a timeline summary. After her discharge, the patient did not come back at follow-up consultations and was lost to follow-up despite several reminders.", "age": [ [ 31.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7775664.xml", "relevant_articles": { "33390940": "123", "10412358": "123", "12099143": "123", "24486016": "0", "2596899": "1" }, "similar_patients": { "5052832-1": "123", "5714986-1": "123", "5498117-1": "12", "8312813-1": "12", "7577353-1": "123" } }, { "human_patient_id": "470", "human_patient_uid": "2585102-1-M", "PMID": "18957112", "title": "Giant fibrovascular polyp of the oesophagus: a case report and review of the literature", "patient": "A 65-year-old Greek man presented with a 9-month history of gradually progressive intermittent dysphagia. He also reported significant weight loss but no haemetemesis or melaena. The rest of his medical history was not significant. No specific abnormality was revealed during the physical examination.\nRadiologic work-up with oesophagogram showed a dilated oesophagus, air bubbles with a mottled appearance, and contrast-filling defects from the cervical oesophagus to the upper body of the stomach (Figure ). The computed tomography (CT) scan revealed a soft-tissue lesion in the oesophagus, extending from the level of the cervical oesophagus to the level of the upper body of the stomach (Figure ). The lesion appeared as a relatively smooth, sausage-shaped intraluminal mass with bulbous distal tip.\nCT with multiplanar reformatting provided valuable information regarding the location of the lesion as well as the size and anatomical attachment proximally, which was pivotal in directing surgery (Figure ). The intraluminal polyp showed soft tissue densities and a central area with attenuation identical to that of fat (Figure ). Endoscopy revealed a smooth submucosal mass occluding the oesophageal lumen. Endoscopic ultrasound-guided fine-needle aspiration was performed and cytological examination revealed benign fibro-fatty elements. The lesion was diagnosed as a submucosal FVP of the oesophagus, originating from the cervical oesophagus.\nA biapproach surgical technique was selected. The origin of the pedicle was attached to the anterior wall of the hypopharynx. The broad base of the stalk was divided by performing cervical vertical oesophagostomy. However, the head of the polyp was too large to be removed through pharyngotomy; therefore, the entire polyp was removed via gastrostomy (Figure ). The length of the tumour was 16 cm and histopathology revealed an oesophageal mucosa-covered polypoidal lesion composed of lymphocytes and plasma cells interspersed with fibroblasts and blood vessels. No hyperplasia of the mucosal epithelium was evident. The final diagnosis was FVP of the proximal oesophagus. The patient recovered uneventfully and was cured of his dysphagia.", "age": [ [ 65.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC002xxxxxx/PMC2585102.xml", "relevant_articles": { "18957112": "123", "19457898": "123", "15627161": "123", "22040665": "123", "11215563": "123" }, "similar_patients": { "6806403-1": "123", "2729903-1": "123", "1180860-1": "123", "6582405-1": "123", "6875686-1": "1" } }, { "human_patient_id": "471", "human_patient_uid": "3467881-1-M", "PMID": "23066250", "title": "Nifedipine-induced gingival enlargement: Correlation with dose and oral hygiene", "patient": "A 65-year-old male reported to the clinic with a complaint of enlarged gums in relation to the right side upper and lower jaw for the past 2 years. His past medical history revealed that he was hypertensive and was taking Tab. nifedipine 30 mg BID for the past 3 years, as prescribed by his physician. History of the presenting illness revealed that the patient noticed the swelling which started before 2 years and progressed to the present stage. On intraoral examination, there was bulbous enlargement of the gingival mucosa in relation to 13, 14, 44, and 45; surface was lobulated and reddish pink in color []. On palpation, it was nontender and firm in consistency. Assessment of plaque accumulation was done using Silness and Loe plaque index (1964) which gave in a score of 3 (marking abundance of soft matter within the gingival pocket and/or on the tooth and gingival margin). Assessment of gingival inflammation was made using gingival index of Silness and Loe (1963), which gave a score of 1 (which includes mild inflammation, slight change in color, slight edema, and no bleeding on palpation). The gingival hyperplasia was graded by using Angelopoulos and Goaz (1972) criteria, which was graded as grade I (which presents with hyperplastic gingiva extending to the cervical third or less of the anatomic crown).", "age": [ [ 65.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3467881.xml", "relevant_articles": { "1452797": "0", "9650873": "0", "9863337": "12", "15853970": "0", "8436633": "0" }, "similar_patients": { "6077973-1": "1", "4095636-1": "1", "7307469-1": "1", "3276876-1": "1", "4771055-1": "1" } }, { "human_patient_id": "472", "human_patient_uid": "8469300-1-M", "PMID": "34576773", "title": "Infection of Cronobacter sakazakii ST1 Producing SHV-12 in a Premature Infant Born from Triplet Pregnancy", "patient": "A thirty-six year-old woman became pregnant after infertility treatment consisting of ovulation stimulation and intrauterine insemination. Pregnancy was complicated by a history of cervical insufficiency (cervical cerclage in 30th week of pregnancy) and cervical infections (Klebsiella pneumoniae, Enterococcus foecium\u2014both widely susceptible) successfully treated with antibiotics.\nAt 34 weeks and 3 days, a gestational age premature baby girl was born by caesarean section as a first of the triplets, with birth weight 1720 g and Apgar score of 9, 8, and 9 at 1, 5, and 10 min, respectively. After delivery room stabilization, she was placed into an incubator with passive oxygen therapy. The newborn received total parenteral nutrition and trophic feeding of expressed mother\u2019s colostrum in the first day of life, then was supported with donor human milk from the Human Milk Bank through orogastric feeding tube. On the second day of life, patient received phototherapy due to abnormal total serum bilirubin concentration (10.2 mg/dL). At the end of the third day, the infant\u2019s health suddenly deteriorated, requiring intubation and ventilation. From the first symptoms and abnormal infections markers (high CRP\u2014247.5 mg/L, PCT\u201417.14 ng/mL, low leukocyte\u20143.4 G/L, and platelet count\u201429 g/L) she was treated with meropenem (40 mg/kg/dose twice a day) and vancomycin (15 mg/kg/dose twice a day). Blood culture was positive and C. sakazakii NMI5563_17 isolate had been identified on the sixth day of life. Phenotypic detection of ESBL was carried out by the ESBL double-disc synergy test (DDST) as described previously []. The antibiotic susceptibility testing was evaluated using gradients tests and broth microdilution method for colistin (; accessed on 1 June 2021). Isolate showed resistance to ampicillin, piperacillin, ceftazidime, cefotaxime, and aztreonam ().\nOn the fifth day of life, the platelet transfusion was performed. The culture of cerebrospinal fluid was negative. Despite appropriate antimicrobial treatment with meropenem (according to the susceptibility profile of the bacteria), the infant had developed sepsis with multiorgan failure and meningitis with multiple brain abscesses. Cerebral ultrasound showed multiple brain abscesses with disintegration tendency and complete obliteration of brain structures. The electroencephalography examination showed low voltage signal. After discussion with her parents, care was redirected to palliation, and the infant died at 12 days of age.\nThe other triplets (II-female 1500 g and III-male 1430 g) have been fed in the same way (orogastric tube and own mother\u2019s breastmilk supplemented by donor milk) and were in good condition with no symptoms of infection. They were discharged after 27 days of hospitalization.\nIn the course of epidemiological investigation, mother\u2019s skin (axillary and inguinal regions), hospital surfaces, and equipment were swabbed, milk samples (from mother\u2019s breastmilk and Human Bank Milk) together with milk expressing devices including breast pump kits, underwent microbiological examination. The analysed surfaces, devices, and milk did not show Cronobacter contamination.", "age": [ [ 36.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC008xxxxxx/PMC8469300.xml", "relevant_articles": { "29280369": "0", "20835550": "0", "714536": "0", "32214387": "0", "1941407": "0" }, "similar_patients": { "3872106-1": "13", "7727064-1": "13", "8495192-1": "13", "7825155-1": "0", "6588903-1": "0" } }, { "human_patient_id": "473", "human_patient_uid": "2803834-1-M", "PMID": "20062740", "title": "Lipoprotein glomerulopathy treated with LDL-apheresis (Heparin-induced Extracorporeal Lipoprotein Precipitation system): a case report", "patient": "We describe the case of a 60-year-old Caucasian woman with a positive familial history for dyslipidemia and nephropathy.\nThe patient was first hospitalized in February 2001 with: hypertension (160/100 mmHg), high lipidic values (cholesterol 372 mg/dl, LDL cholesterol 267 mg/dl, triglycerides 239 mg/dl), creatininemia within the standard limits (0.9 mg/dl), a corresponding GFR of 63 ml/min calculated according to Cockroft and Gault, albuminemia of 3.15 gr/dl, total proteins of 5.7 g/dl, and a micro-hematuria, proteinuria (200 mg/dl) and proteinuria and/or albuminuria ratio of 2 g/g. The main immunological studies, ASO, rheumatoid factor, C3-C4, VDRL, serum immuno-fixation and serum immunoglobulin were normal. The serum markers for HBV, HCV and HIV were negative. The leucocyte formula was normal.\nA physical examination ruled out the presence of xanthelasma and corneal arc in the absence of edemas. An ultrasound revealed kidneys which were regular in dimension and structure.\nA renal biopsy showed the presence of lipid deposits in the glomerular lumens under the optical microscope after staining with Red-O oil. The interstitium showed a diffuse fibrous edema and tubular atrophy in the areas of fibrosis with a moderate infiltration of inflammatory cells. An arteriole showed hyaline deposits. An immunofluorescence revealed the presence of deposits of IgM and C3 in the sub endothelial seat. An electronic ultrastructural analysis confirmed the presence of thrombi in the lumen of the glomerular capillary loops. The histopathological diagnosis suspected LPG, but ApoE typing identified the polymorphism (E2/2) with a diagnosis of familial type III dyslipoproteinemia.\nThe patient started treatment with atorvastatin 40 mg/day. We did not use fibrates in association with statin to avoid possible side effects. After one year of therapy we observed a good control of lipid values (cholesterol 250 mg/dl, LDL cholesterol 114 mg/dl) and a reduction of the proteinuria (120 mg/dl). Hypertension was controlled (145/90 mmHg) by means of ACE-inhibitors (irbesartan 300 mg/day, ramipril 5 mg/day), beta-blockers (carvedilole 25 mg/day) and Ca antagonists (nifedipine 60 mg/day).\nFour years later in April 2005, the patient was again hospitalized for clinically overt nephrotic syndrome with proteinuria (5 g/24 h) and renal failure (creatinine 2.2 mg/dl). Arterial hypertension (180/100 mmHg) was hardly responsive to treatment. The patient had a low response (cholesterolemia 445 mg/dl, LDL 318 mg/dl, triglycerides 292 mg/dl) to lipid-lowering drugs (atorvastatin 40 mg/day + cholestyramine 4 g/day + Omega3 fatty acids 2 g/day) with the presence of periocular thelasmas.\nA renal biopsy revealed the presence of lipids with a fibrous growth of the interstitium and a percentage increase of sclerotic glomeruli with a diagnosis of LPG evolved into nephrotic syndrome (histology will be published in a manuscript in preparation and when published the reference will be provided).\nIn view of the patient's poor response to pharmacological treatment alone, in July 2005 we decided to associate for the first time in a patient with LPG an LDL-Apheresis protocol (three aphereses in the first two weeks, then one weekly session for two months followed by one apheresis every 15 days) with dextran sulfate columns on the basis of the evidence present in literature for the treatment of the steroid-resistant nephrotic syndrome. [-]\nDuring the first LDL-apheresis (July 2005) with dextran sulphate columns (Liposorber System - Kaneka\u2122), an anaphylactoid reaction occurred. This complication, as described by Olbricht in 1992 in patients undergoing treatment with ACE inhibitors and an LDL-apheresis regimen with dextran sulphate columns, is due to the inhibition of kininases that metabolize bradikynin [].\nTo avoid stopping the anti-hypertension treatment with ACE-inhibitors we decided to use another LDL-apheresis procedure: the extracorporeal precipitation of LDL-cholesterol induced by heparin in acid pH (HELP System, B. Braun Avitum\u2122 Melsungen Germany). This procedure does not involve complications linked to the use of ACE-inhibitors, following the same protocol previously described.\nThe effects of a single HELP-apheresis on vascular homeostasis is a simultaneous, drastic reduction within two hours of cholesterol (-52%), LDL-cholesterol (-56%), VLDL-cholesterol (-52%), oxLDL (-47%), Lp(a) (-55%), triglycerides (-50%), fibrinogen (-56%), thrombin (-55%), von Willebrand factor (-56%), factor V (-57%), factor VII (-35%), PCR (-56%), plasma viscosity (-14%), erythrocyte aggregability (-60%), and thrombocyte aggregability (-60%). Also reported in the long-term treatment was an increase of HDL-cholesterol (+14%), peripheral muscle oxygenation (+33-50%), coronary flow reserve (+14%), and cerebral CO2 reactivity (+14%) [].\nIn the LDL/fibrinogen apheresis procedure (HELP-apheresis), the plasma is obtained by filtration of the whole blood through a 0.55 \u03bcm pore-size filter and then mixed continuously in a 1:1 ratio with a solution of a 0.2 M sodium acetate buffer (pH 4.85) containing 100 IU/ml (300,000 UI) of heparin. The pH of the plasma-buffer solution reaches 5.12 and, at this value, the heparin binds the LDL-cholesterol, Lp(a), fibrinogen and triglycerides forming aggregates. These aggregates precipitate and are retained by the precipitate filter. Precipitate filter is a 0.4 \u03bcm pore-size polycarbonate filter from which plasma free from LDL-cholesterol, Lp(a) and fibrinogen is obtained and then passed through an anion exchange filter (heparin absorber) to adsorb excess heparin. The last stage of the system (dialysis filter) restores the physiological pH of the plasma and the balance of the liquids, removing excess fluid by ultrafiltration. The liquid used for dialysis is a sterile solution with a bicarbonate concentration of 35 mmol/l. After the dialysis process, the plasma, purified of lipids and fibrinogen, is returned to the patient mixed with the haematic cell components.\nWe processed 3000 ml of plasma. That means about 1.4 patient plasma volumes in two hours, with HELP machine (Plasmat Futura\u00ae, B. Braun Avitum, Melsungen Germany) and a disposable kit. There were no side effects with the HELP. method, except that the patient had problematic vascular accesses leading to flow problems, So, it became necessary to modify some software parameters (most notably the \"PA minimum\" threshold; software version 2.06.01) to be able to use a 17G fistula needle for the blood withdrawal and a 20G cannula needle for the blood reinfusion during the procedure. With this configuration, the flows were relatively moderate for an LDL-apheresis (blood flow of 50 ml/min and plasma flow of 20 ml/min), to complete the treatment target of 3000 ml. After some procedures we proceeded with the use of an 18G fistula needle in re-entry, maintaining a 17G fistula needle for drawing, obtaining flows that were definitely higher (blood flow of 80-100 ml/min and plasma flows of 25-30 ml/min). By increasing the flows, there was a marked reduction in the duration of the individual procedure, super-imposable to that of a patient with good vascular accesses.\nAfter two months of treatment with LDL-apheresis (10 procedures), the laboratory data showed a progressive increase of albuminemia (from 3.39 to 3.70 g/dl) with partial remission of proteinuria (from 3.3 to 2 expressed as urine protein to creatinine ratio. A ratio of 0.1 is normal - protein and creatinine are expressed in mg/dl); and a progressive decline in creatininemia (from 1.9 to 1.6 mg/dl). The patient's anemia was improving and her arterial pressure was well under control with a reduction of the pharmacological dose, compared to two months earlier. There was also a significant drop in the mean values of TG (from 285 to 231 mg/dl) and LDL-Cholesterol (from 178 to 158 mg/dl) with reduction of xanthelasma. Pre-apheresis fibrinogen and Lp(a) mean values did not show a significant reduction. Considering the patient's clinical condition improvement, we decided to reduce the statins dosage (from 40 to 20 mg/die) continuing LDL-apheresis protocol of one session every two weeks.\nFour months after aphaeretic treatment (15 procedures), the patient's albuminemia values were maintained (3.70 g/dl), her creatinine (1.3 mg/dl) and proteinuria (ratio 1.3) were reduced and her arterial pressure was stabilized (120-80 mmHg). There was a further reduction of LDL-cholesterol (105 mg/dl) and TG (134 mg/dl) mean values, with a suspension of cholestyramine and Omega-3 fatty acids treatment and a further reduction of the xanthelasmas. The LDL-Apheresis session was reduced to one session every three weeks.\nAfter ten months (25 procedures) the laboratory data were as follows: creatinine 1.6 mg/dl, albuminemia 4.30 g/dl, proteinuria (ratio 0.13), LDL-cholesterol 106 mg/dl and TG 154 mg/dl. The values of Lp(a) and fibrinogen are unchanged (Figure , ).\nAfter two years of follow up, with a maintenance treatment of one LDL-apheresis session every three weeks in the last period, the mean biochemical values were: cholesterol 199 mg/dl, LDL-cholesterol 110 mg/dl, HDL-cholesterol 76 mg/dl, TG 112 mg/dl, fibrinogen 381 mg/dl, creatininemia 1.5 mg/dl, Proteinuria ratio 0.9, arterial pressure 120-80 mmHg. The pharmacological therapy is unchanged.\nThe sequence of the ApoE gene made in 2007 showed that the patient was homozygous for epsilon-2 allele (polymorphism E2/2 with Cys112 and Cys158 in the mature protein) and heterozygous for a novel mutation in exon 4: c.502 C>T [Arg 150>Cys of mature protein]. The mutant Apo E (ApoEMODENA) expresses a new residue of Cys in place of an Arg. This new cysteine residue could form a disulphide bridge with the other Cys residue of the E2 isoform resulting in ApoE polymerization (dominant negative effect). This phenomenon is probably the cause of both dyslipidemia and lipid thrombi in the glomerular capillaries [].", "age": [ [ 60.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC002xxxxxx/PMC2803834.xml", "relevant_articles": { "7890009": "123", "10146336": "123", "8159304": "123", "1936104": "123", "1751248": "123" }, "similar_patients": { "5345283-1": "123", "3917403-1": "1", "3598816-1": "1", "8294436-1": "123", "6693054-1": "123" } }, { "human_patient_id": "474", "human_patient_uid": "2671755-1-M", "PMID": "19434263", "title": "Bilateral Pneumothorax and Pneumomediastinum Following Total Thyroidectomy with Central Neck Dissection", "patient": "A 60-year-old woman admitted for elective excision of a right thyroid papillary carcinoma. She had complained of hoarseness and aspiration while swallowing for several months. Rigid endoscopy confirmed paramedian vocal cord fixation with large glottic chink. Preoperative computed tomography (CT) detected a solid thyroid mass invading the perithyroid tissue with suspicion of right tracheoesophageal groove invasion. Total thyroidectomy with central neck dissection was carried out via transcervical incision. Intraoperatively, the tumor was found to invade the right recurrent laryngeal nerve and along the right tracheoesophageal groove (). The right recurrent laryngeal nerve was sacrificed and the tumor invading the tracheoesophageal groove was shaved off the trachea and esophagus. After tracheal shaving, a small perforation (0.5\u00d70.5 cm) was noticed in the posterior membranous portion of first tracheal ring (). The pleura of the lung and mediastinum were intact. The perforation was repaired primarily with No. 4-0 Vicryl suture and reinforced with Surgicel\u00ae and tissue glue. The trachea did not leak by underwater testing during positive anesthetic ventilation and the operation was completed.\nOne day after surgery, the patient developed dyspnea, cervical emphysema, and ecchymosis over the neck after an episode of vigorous coughing. With the impression of a postoperative hematoma an emergency neck exploration was performed under general anesthesia. A small hematoma was found beneath the platysma and strap muscles, No obvious bleeding point was evident and the reconstructed trachea portion was relatively intact. Postoperatively, while still in the recovery room, the patient showed signs of acute respiratory failure. A chest radiograph revealed bilateral pneumothorax, pneumomediastinum, and massive subcutaneous emphysema (). Her dyspnea and cyanosis were relieved after an emergency chest tube was inserted. Over the next week, the pneumomediastinum and pneumothorax resolved gradually. The patient discharged without any problems.", "age": [ [ 60.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC002xxxxxx/PMC2671755.xml", "relevant_articles": { "33331204": "0", "34095490": "123", "2072583": "0", "31233256": "1", "2519187": "12" }, "similar_patients": { "8014238-1": "12", "7850071-1": "13", "5156893-1": "123", "2671752-1": "123", "3437421-1": "12" } }, { "human_patient_id": "475", "human_patient_uid": "7067370-1-M", "PMID": "32190530", "title": "The Management of an Intraperitoneal Leak Following Transgastric Stenting of a Pancreatic Pseudocyst", "patient": "A 68-year-old male presented to the outpatient endoscopy unit for a repeat EUS drainage of a PP.\nThe patient has a background history of necrotising gallstone pancreatitis that was treated supportively. A subsequent laparoscopic cholecystectomy was performed. Unfortunately, he developed a PP that required EUS-guided drainage approximately 12 months following his index presentation. A surveillance CT abdomen demonstrated a large recurrence of his PP (approximately 13 cm in largest diameter); thus, a decision for repeat drainage was made. His other comorbidities include chronic obstructive pulmonary disorder, hypertension, and a solitary kidney (donor nephrectomy).\nA linear echoendoscope was advanced to the second part of the duodenum. External compression of the posterior gastric wall was observed endoscopically. Endosonographically, the PP measured 13 x 10 cm and was punctured using a 19-gauge access needle. Approximately 10 ml of clear fluid was aspirated, and then injected with 20 ml of contrast. A 450-mm Jagwire was passed through the needle into the pseudocyst under fluoroscopy. The access needle was exchanged for a cystotome. A cystpogastrostomy was performed using the cystotome, and a second 450-mm Jagwire was inserted. The cystotome was removed, and two 7 French plastic double pigtail stents were introduced into the PP over the two guidewires under direct fluoroscopy. Both stents appeared to have been positioned satisfactorily, and were draining clear fluid into the stomach (Figure ).\nThe patient developed severe abdominal pain in the recovery bay. An urgent CT abdomen demonstrated free fluid and gas in the upper abdomen especially anterior to the liver (Figure ). A decision was made to proceed to the operating theatre given concerns for a perforated hollow viscus.\nA midline laparotomy was performed. Significant amounts of gastric and pancreatic juices were found throughout the entire peritoneal cavity and evacuated. The gastrocolic ligament was taken down with the harmonic scalpel to allow access to the pancreas. The cystogastrostomy tract and stents were found to have inadvertently entered the peritoneal cavity (Figure ), and thus were removed.\nA decision was made to surgically decompress the PP given the high likelihood of recurrence. An anterior longitudinal gastrotomy was performed. There was difficulty locating the PP through the posterior stomach wall as it had collapsed, having spilled its contents into abdominal cavity. The PP cavity was not identifiable despite using an intraoperative ultrasound (IOUS). An 8-French infant feeding tube was inserted through the peritoneal defect caused by the transgastric stent, and placed into the PP cavity. The feeding tube was subsequently injected with saline (Figure ).\nA subsequent attempt at transgastric localisation of the PP was successful using IOUS given the re-expansion of the PP. A seeking needle was then used to confirm the location of the PP. A 45-mm Endo-GIA (Medtronic plc, Minneapolis, MN) stapler was used to complete the cystogastrostomy, and the edges oversewn with 3-0 prolene (Figure ). The anterior gastrotomy wound was closed with 3-0 PDS. The PP defect and corresponding gastrotomy defect were closed with 3-0 PDS. A feeding jejunostomy was fashioned. The abdomen was washed with saline and two drains placed: one on the anterior stomach and one on the closed pseudocyst defect.\nThe patient recovered well postoperatively. A CT contrast swallow was organised on day 10 after the operation, which demonstrated no evidence of any leak. The abdominal drains were removed after drain amylase levels were found to be normal. The patient was initially supported with postpyloric feeds through his feeding jejunostomy, and then slowly transitioned back into a regular diet. He was discharged from hospital two weeks after his operation. He remains free from any recurrence 13 months after his surgery.", "age": [ [ 68.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7067370.xml", "relevant_articles": { "32190530": "13", "23533390": "123", "32078121": "123", "23752005": "123", "29703250": "123" }, "similar_patients": { "7646684-1": "13", "4288835-1": "13", "5040526-3": "13", "6163145-1": "123", "7945647-2": "123" } }, { "human_patient_id": "476", "human_patient_uid": "5209593-1-M", "PMID": "28096817", "title": "Heralding Extramedullary Blast Crisis: Horner's Syndrome with Brachial Plexopathy in a Patient with Chronic Myelogenous Leukemia", "patient": "A 36-year-old African American male diagnosed with Philadelphia chromosome positive CML two years ago presented to the emergency room for the second time with a history of a one-month progressively worsening weakness involving his left upper extremity, along with numbness and severe pain. His symptoms during the previous hospital evaluation were attributed to musculoskeletal causes after stroke was ruled out. Although he was unsure, he was reported by family members to have developed some facial asymmetry during this time. He had been noncompliant with his treatment with dasatinib, being irregular and casual in his approach to prescribed medication intake, and his primary oncologist was concerned with CML progression at an accelerated phase after having undergone a bone marrow biopsy. He was meanwhile awaiting the results of a recent cervical lymph node biopsy.\nOn neurological examination the patient was noticed to have left-sided ptosis, miosis, enophthalmos (), and reported facial anhidrosis on the left side, alongside ipsilateral weakness predominantly involving his intrinsic hand muscles, long finger flexors, and numbness involving the medial border of his arm, hand, and little finger (see Video 1 in Supplementary Material available online at ). The rest of his motor power was 5/5 throughout, with restriction of an accurate evaluation of his left upper extremity, due to exquisite pain-limited range-of-motion of the whole limb. Deep tendon reflexes were 2+ throughout. Plantar reflexes were down going bilaterally and no sensory level was appreciated. His findings were concerning for left Horner's syndrome and lower trunk brachial plexopathy, while the rest of his general physical examination was significant for scattered, nontender cervical lymphadenopathy.\nHis blood count revealed marked leukocytosis with a total leukocyte count of 102 \u00d7 109/L, predominated by myeloid precursors, 4% promyelocytes, 3% myelocytes, and 12% metamyelocytes. An electrodiagnostic study was deferred due to lack of patient cooperation from the pain. An MRI of the cervical spine and brachial plexus with and without contrast was performed. This revealed the presence of a bulky left paraspinal soft tissue mass (), extending from the C6 to T3 level, measuring 3.9 \u00d7 6.8 \u00d7 7.8 cm, anteroposterior, transverse, and cephalocaudad dimensions, respectively. This also involved the left C6 to T1 nerve roots and extended into the supraclavicular and retroclavicular segment of the left brachial plexus over approximately 6.8 cm in length, most consistent with leukemic infiltration. Extension into the spinal canal on the left was noted from C6/7 to the bottom of the T1 level without cord compression, along with abnormal bone marrow signal intensity involving the posteromedial first rib and left anterior scalene muscle, all again consistent with leukemic infiltration. Extensive lymphadenopathy was noted on imaging studies (), particularly involving the submandibular, left, and right internal jugular lymph nodes. The excisional biopsy of right cervical lymph node, meanwhile, confirmed myeloid sarcoma or chloroma with immunophenotyping revealing 32% blasts displaying myeloid-associated antigen expression and aberrant expression of CD5, CD7, and CD 117 (). In view of the collateral histological findings, his neurological presentation was attributed to a paraspinal chloroma with regional leukemic infiltration of the left lower brachial plexus, and a final diagnosis of CML with extramedullary myeloid blast crisis was made. He was started on aggressive induction chemotherapy with a 7 + 3 regimen (7 days of cytarabine at 100 mg/m2 plus 3 days of idarubicin at 12 mg/m2) in addition to resuming dasatinib. He was also initiated on radiotherapy of 10 fractionations to a total of 3000 centigray (cGy) for the paraspinal chloroma. Bone marrow biopsy on Day 14 was hypocellular with no blasts identified or evidence of residual leukemia. Repeat Computed Tomography of soft tissue neck showed interval decrease in size of his cervical lymphadenopathies and paraspinal soft tissue mass. His postchemotherapy, inhospital course was complicated with neutropenic fever, clostridium difficile diarrhea, and multifocal pneumonia with pleural effusion from which he gradually recovered. At the time of hospital discharge, his neurological deficits continued to persist. Allogeneic bone marrow transplantation and prophylactic intrathecal liposomal cytarabine (given his high risk for CNS involvement) were discussed as part of the postremission treatment plan.", "age": [ [ 36.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5209593.xml", "relevant_articles": { "33214938": "123", "10390894": "0", "25529640": "1", "22612514": "12", "9046857": "0" }, "similar_patients": { "2997500-1": "1", "3854546-1": "13", "3660492-1": "13", "5043162-1": "123", "8379434-1": "13" } }, { "human_patient_id": "477", "human_patient_uid": "4771996-1-M", "PMID": "26933001", "title": "SVC obstruction and stridor relieved by nasogastric tube insertion", "patient": "An 81-year-old woman with a background of asthma, ischaemic heart disease and achalasia presented to hospital with a 2-h history of worsening shortness of breath. On examination, she was in visible respiratory distress and was tachypnoeic at 24 breaths per minute, with oxygen saturations of 93% on room air. Examination of the chest revealed diffuse bilateral wheeze. She was tachycardic at 130 beats per minute and hypotensive. There was no specific trigger apart from the patient eating her lunchtime meal. She was also noted to have noisy inspiratory stridor. Furthermore, she had bilateral neck swelling which moved with expiration, and her neck veins were visibly distended. High-flow oxygen was administered, and an arterial blood gas revealed a respiratory acidosis with pH 7.19, p02 15.7 (on 15 l of oxygen), PC02 8.6 and a lactate of 2.9. A provisional differential diagnosis of infective exacerbation of asthma was made with stridor of unknown cause. She was given intravenous fluids and nebulized steroids, intravenous steroid and nebulized adrenaline.\nA plain chest radiograph was taken demonstrating a massively dilated air and fluid-filled oesophagus, with no visible intraparenchymal lung abnormality. A 16-French gauge nasogastric tube was immediately placed into the oesophagus with aspiration of air, fluid and food debris. This resulted in almost immediate relief of the patient's respiratory distress, and she clinically improved.\nAfter decompression of the oesophagus, a computed tomography (CT) scan of the chest confirmed the diagnosis of megaoesophagus causing tracheal compression. The patient, now stabilized, was referred for oesophago-gastro-duodenoscopy (OGD) with a view to Botulinum toxin treatment for underlying achalasia (Figures \u2013).", "age": [ [ 81.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC004xxxxxx/PMC4771996.xml", "relevant_articles": { "27147631": "12", "18363027": "12", "34277314": "0", "29255644": "0", "10928442": "123" }, "similar_patients": { "3085971-1": "123", "8128534-1": "13", "4200884-1": "12", "7816791-1": "0", "2584089-1": "0" } }, { "human_patient_id": "478", "human_patient_uid": "3514818-1-M", "PMID": "23227409", "title": "Lobular Capillary Hemangioma in the Posterior Trachea: A Rare Cause of Hemoptysis", "patient": "A 22-year-old male presented to our clinic with recurrent episodes of hemoptysis over a 4-week period with 3 distinct events. He stated that this started with an incidence of heavy coughing. He then would cough up to 2\u20134 tablespoons of blood. After presentation to the emergency room, it was initially thought this was related to epistaxis, and he was sent home with treatment for allergic rhinitis. He had no other symptoms, denying fever, weight loss or gain, chest pain, easy bruising, dyspnea, or rash. He did complain of chronic postnasal drip, nasal congestion, and occasional pruritis, which he attributed to allergies. He had a past medical history of eosinophilic colitis, obsessive-compulsive disorder, history of an aneurismal bone cyst status post-removal, and allergic rhinitis. He had also been recently diagnosed with hypogonadism over the last 5 months, and was on injectable testosterone supplementation. He denied smoking, alcohol, and illicit drug use and had no known inhalant exposures and trauma to the airway that he could recall. His family history included a brother with eosinophilic colitis and his mother had vascular ectasias of her spinal cord. He did note that these episodes seemed to occur 5 days after his dose of intramuscular testosterone. Physical exam was otherwise unremarkable and laboratory values were unrevealing. Computed tomography did not reveal any notable lesion of the upper airway or lung parenchyma.\nUpon flexible bronchoscopic evaluation, the following lesion was seen in the distal trachea (). The purple, vascular lesion was approximately 1\u20131.5 cm in size located 3 cm from the carina at the 5 o'clock position along the posterior wall attached by a short pedicle. A biopsy was taken at that time which only showed fibrin products and inflammatory cells. Hemostasis was difficult to obtain without use of cold saline, several injections of topical epinephrine and Argon Plasma Coagulation. Due to unavailability of pathology and the location of the lesion, the patient was taken to the operating suite where a therapeutic flexible bronchoscope was used with utilized. The lesion was obtained by electrocautery loop snare and endoscopic basket. The pathology revealed the diagnosis of lobular capillary hemangioma (Figures and ). The superficial portions of the lesion had undergone secondary, nonspecific changes including stromal edema, capillary dilation, inflammation, and a granulation tissue reaction. It demonstrated diagnostic, lobular arrangements of capillaries at its base, which consisted of discrete clusters of endothelial cells. The cellular architecture was made up of an inflammatory infiltrate of neutrophils and monocytes.\nUpon followup, the patient had no hemoptysis episodes and has subsequently stopped his testosterone therapy.", "age": [ [ 22.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3514818.xml", "relevant_articles": { "34872678": "0", "12033473": "0", "28644156": "0", "34625182": "0", "26741691": "0" }, "similar_patients": { "5147552-1": "0", "6000843-1": "0", "1257651-1": "0", "4694660-1": "0", "7948695-1": "0" } }, { "human_patient_id": "479", "human_patient_uid": "6967109-1-M", "PMID": "32025942", "title": "Implantation of ventricular assist device for systemic right ventricular failure in a patient with transposition of the great arteries and post-Mustard procedure: a case report", "patient": "The patient was a 41-year-old man (height 174.2 cm, body weight 60 kg) with dextro-TGA who underwent balloon atrioseptostomy treatment at birth because of desaturation. He also had a Mustard procedure (interatrial baffle) at 10 months of age and required surgical repair for pulmonary vein stenosis at 2 years of age. At 41 years of age, he developed severe systemic RV failure and pulmonary edema (Fig. ). He was treated with inotropic agents, mechanical ventilation, intra-aortic balloon pumping, and continuous hemodiafiltration. His hemodynamic status was stabilized with these treatments, but he remained inotrope-dependent, and his condition gradually worsened despite optimal medical therapy. After a medical team preoperative meeting, he was scheduled for a VAD implantation of the RV as a bridge to orthotropic cardiac transplantation.\nPreoperative cardiac catheterization indicated elevated pulmonary arterial wedge pressure and severely impaired systemic RV function with infusion of dobutamine (3 \u03bcg/kg/min) and carperitide (24 ng/kg/min), a recombinant atrial natriuretic peptide with vasodilating and diuretic activity (Table ). Echocardiography identified the dilated RV, preserved pulmonary ventricle (morphological left ventricle), and increased baffle flow velocity (Table ). Chest radiography and computed tomography scan showed a severely dilated RV (Figs. and ).\nIn the operating room, a continuous monitoring of electrocardiography, SpO2, systemic arterial pressure via a right radial artery catheter, bispectral index (BIS; Medtronic, Minneapolis, MN), and regional cerebral oxygen saturation at the right and left forehead (INVOS\u2122 5100C, Somanetics, USA) was initiated before anesthesia induction. After administration of 100% oxygen, general anesthesia was induced slowly by intravenous administration of 3 mg of midazolam, 0.5 mg of fentanyl, and 50 mg of rocuronium. Additionally, dobutamine (3.3 \u03bcg/kg/min), nicorandil (1.1 \u03bcg/kg/min), which has the dual properties of a nitrate and a potassium channel opener, and carperitide (33 ng/kg/min) were continuously administered to minimize anesthetic-induced cardiac depression. During anesthesia induction and tracheal intubation, his circulatory and respiratory status remained stable. After tracheal intubation, a transesophageal echocardiography probe was inserted. Then, a central venous catheter and right heart catheter were inserted via the right internal jugular vein. The latter catheter (Swan Ganz catheter) was guided to the right pulmonary artery under fluoroscopic control because of his unique anatomy with interatrial baffle.\nHis anesthesia depth was controlled at a BIS of 40\u201360 by a continuous infusion of propofol (3\u20135 mg/kg/h), remifentanil (0.2\u20130.3 \u03bcg/kg/min), and rocuronium (7 \u03bcg/kg/min).\nA standard median sternotomy was performed. Because his heart was heavily adherent, the cardiac surgeons had difficulty in adhesiolysis. The systemic aorta and systemic atrium were cannulated, and cardiopulmonary bypass (CPB) was instituted. At first, the patient\u2019s aortic valve was replaced with a bioprosthetic valve for moderate aortic valve regurgitation. Subsequently, the trabeculae carneae of the RV, which could disturb the flow to the inflow cannula, were resected via the RV apex; the inflow cannula was positioned at the apex of the RV. The outflow cannula graft was anastomosed to the ascending aorta, and then a Jarvik 2000 VAD (Jarvik Heart, Inc., New York, NY, US) was implanted.\nAt the weaning of the CPB, infusion of dobutamine (3.3 \u03bcg/kg/min) and inhalation of nitric oxide (20 ppm), to decrease afterload of the pulmonary LV, was started. The CPB weaning was not difficult, and the VAD was successfully commenced at a pump speed of 10,000 rpm (3\u20135 L/min). The aortic cross-clamping, CPB, surgery, and anesthesia lasted 200, 296, 628, and 807 min, respectively. Estimated blood loss and urine output were 2051 and 2390 mL, respectively. Overall, 900 mL of crystalloid, 900 mL of colloid, 960 mL of packed red blood cells, 560 mL of fresh frozen plasma, and 200 mL of platelet concentrate were administered. After completion of operation, the patient was transferred to the intensive care unit with ventilator support under propofol sedation.\nOn postoperative day (POD) 2, the patient was weaned from mechanical ventilation. On POD 5, after our surgeons decreased the VAD dial from 3 to 2, the patient developed pulmonary congestion with respiratory distress, decreased arterial oxygen saturation, and elevated pulmonary artery pressure (PAP) (Table ). Noninvasive positive-pressure ventilation (NPPV) was adopted, and intensified diuretic therapy was started. Additionally, the intensivists returned the VAD dial from 2 to 3. A few days later, he recovered from congestive heart failure, and then, NPPV was stopped. Following this, the patient did well hemodynamically and had good VAD performance. Another important point for postoperative management of VAD implantation is to prevent thrombosis. In this case, continuous infusion of heparin was administered for anticoagulation. The heparin infusion adjusted to an activated partial thromboplastin time (APTT) ration of 1.5\u20132.0 (or 40\u201350 s). Actually, the infusion rate or heparin was 15,000\u201320,000 units per day.\nThe patient was discharged from the hospital on POD 60. He is now eagerly awaiting heart transplantation. Table shows his hemodynamic data, and Fig. shows his chest radiography on POD 90.", "age": [ [ 41.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6967109.xml", "relevant_articles": { "32025942": "13", "30379462": "12", "8038979": "0", "9187994": "0", "25175520": "0" }, "similar_patients": { "3927005-1": "123", "6972011-1": "123", "5813737-1": "13", "7441615-1": "0", "5818770-1": "0" } }, { "human_patient_id": "480", "human_patient_uid": "5063496-1-M", "PMID": "27784979", "title": "Central cortical cleanup and zonular deficiency", "patient": "This 92-year-old lady had advanced coronary artery disease and visual loss to finger counting bilaterally from ultra-brunescent cataract () and pseudo-exfoliation. Under pure (no sedation) topical anesthesia, the right eye underwent attempted phacoemulsification. There was excessive wrinkling and mobility of the anterior capsule. Extracapsular cataract extraction was done, and the capsule was spontaneously expressed. An anterior chamber implant was placed. Under topical anesthesia also, the left eye underwent phacoemulsification of the very dense nucleus. The cortex was aspirated from the center as described in the technique. A CTR was not placed as its insertion would traumatize the loose zonules. One day postoperatively the cornea was clear, and uncorrected visual acuity was 20/25. The implant was well centered. At the 1-month follow-up, moderate capsular phimosis () was observed with preservation of the central visual axis and absence of implant-donesis. This persisted at the last follow-up 6 months postoperatively.", "age": [ [ 92.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5063496.xml", "relevant_articles": { "12776905": "123", "17534813": "123", "8729839": "123", "8551445": "123", "33413210": "123" }, "similar_patients": { "3998858-2": "123", "2908861-1": "12", "6167652-2": "0", "6501317-1": "0", "5657170-1": "123" } }, { "human_patient_id": "481", "human_patient_uid": "5107867-1-M", "PMID": "27872648", "title": "A 58-Year-Old Female with Progressive Cough and Right Shoulder Pain", "patient": "A 58-year-old female after allogeneic stem cell transplant (SCT) for acute myelogenous leukemia (AML) presented with cough productive of brown sputum and right shoulder pain. Her symptoms progressed over the course of 2 weeks. She did not have fever, chills, or shortness of breath. She denied chest pain, vomiting, or diarrhea and she did not report headache, loss of consciousness, or seizures.\nShe was diagnosed with AML 2 years ago for which she underwent allogeneic SCT. Thereafter she developed chronic graft versus host disease (cGVHD), which was treated with steroids and mycophenolate mofetil. Her home medications included prednisone, mycophenolate mofetil, and dapsone.\nOn examination, she was afebrile with a heart rate of 57, blood pressure of 150/74, and oxygen saturation of 93% on room air. Lung examination revealed reduced air entry and rhonchi over the right upper lung zone. Heart exam revealed regular heart sounds without murmurs and her abdomen was soft without tenderness or organomegaly.\nLaboratory tests showed white blood cell count of 7.6 \u00d7 109 cells/L (88% neutrophils), hemoglobin of 94 g/L, platelets of 34 \u00d7 109 cells/L, and creatinine of 70 \u03bcmol/L. Chest computed tomography (CT) scan was done and is shown in . Bronchoalveolar (BAL) stains and cultures were negative for bacteria, mycobacteria, and fungi. Serum as well as BAL galactomannan and serum cryptococcal antigen were negative. Her prednisone dose was reduced and she was discharged home on ertapenem and voriconazole that were given on empirical basis.\nThe patient's symptoms persisted, so a follow-up chest CT scan was done 2 weeks into treatment (). She was readmitted to the hospital and started on broad-spectrum antibiotics: linezolid, imipenem, amikacin, and liposomal amphotericin B. Her vital signs on admission were stable with an oxygen saturation of 93% on room air. Labs were within her baseline. A repeated BAL was performed.\nWhat is your diagnosis?\nBAL stains were negative but bacterial cultures grew few branching gram-positive rods that were identified to be N. farcinica. Susceptibility testing was not performed. Liposomal amphotericin B and amikacin were stopped and she continued taking linezolid and imipenem. Trimethoprim/sulfamethoxazole (TMP/SMX) could not be used because she was allergic to sulfa drugs and, unfortunately, sulfa desensitization was not considered. Head CT scan was done and was negative for any brain lesions. Her cough and chest pain worsened and she developed progressive shortness of breath and fevers. Amikacin was added to the regimen without significant improvement in symptoms. She elected to pursue comfort care measures and was discharged to hospice.", "age": [ [ 58.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5107867.xml", "relevant_articles": { "28483134": "12", "21344737": "0", "30452335": "0", "34505493": "0", "32654737": "0" }, "similar_patients": { "3785346-1": "13", "3432333-1": "13", "4561337-1": "123", "4908945-1": "123", "7066410-1": "123" } }, { "human_patient_id": "482", "human_patient_uid": "5301116-1-M", "PMID": "28203169", "title": "Recurrent Malignant Melanoma Presenting as Isolated Pleural Metastases in a Patient with Chronic Lymphocytic Leukemia", "patient": "A 65-year-old Caucasian woman presented in March 2007 with a 3-month history of painless left-sided cervical lymphadenopathy. She denied any associated fevers, chills, loss of weight, dyspnea, dysphagia, or any other symptoms. The patient's surgical history was pertinent for a completely resected stage IA melanoma over the left shoulder 16 years before this presentation. Physical exam revealed enlarged and non-tender cervical and axillary lymph nodes without splenomegaly. A skin survey did not reveal any new nevi or concerning lesions. A complete blood picture showed a white blood cell count of 14.7 \u00d7 103/\u03bcL, an absolute lymphocyte count of 7.35 \u00d7 103/\u03bcL, hemoglobin of 13.8 g/dL, a platelet count of 258 \u00d7 103/\u03bcL, and lactate dehydrogenase of 291 U/L. Flow cytometry of the peripheral blood demonstrated a monoclonal lymphocyte population expressing CD5, CD19, CD20, CD24, CD43, and CD52 with lambda light chain restriction and no increase in CD34-positive blasts. The cells were negative for CD38 and ZAP-70. Based on the above findings, the patient was diagnosed with Rai Stage I CLL and placed under observation.\nTwo years after her initial diagnosis, the patient presented with progressive dyspnea, associated with pleuritic chest pain and a 20 lbs weight loss over a period of 3 months. Physical examination revealed increased axillary and cervical lymphadenopathy and decreased breath sounds over the right lung. Chest X-ray revealed a large right-sided pleural effusion (Fig. ). White blood cell count was noted to be 53.4 \u00d7 103/\u03bcL, and she had an absolute lymphocyte count of 40.7 \u00d7 103/\u03bcL. The pleural fluid analysis was consistent with an exudative effusion, with increased atypical lymphocytes. Flow cytometry demonstrated a 12% clonal population consistent with the pleural involvement of CLL. The majority of the lymphocytes were CD4+ T-lymphocytes (CD4:CD8 in a ratio of 15: 1), but polymerase chain reaction failed to show any clonal T-cell receptor-\u03b3 or T-cell receptor-\u03b2 gene rearrangements.\nSecondary to rapid reaccumulation of pleural fluid, increasing lymphadenopathy, and rapid doubling time of lymphocyte count, the decision to treat symptomatic CLL was made. Chemotherapy with pentostatin, cyclophosphamide, and rituximab did not result in any meaningful clinical response. As the patient's pleural effusion was refractory to CLL treatment, video-assisted thoracoscopic surgery was performed, which demonstrated diffuse nodular thickening of both visceral and parietal layers of the pleura (Fig. ). A biopsy of these lesions revealed enlarged cells with an increased nuclear-cytoplasmic ratio and pleomorphic nuclei with occasional cherry red nucleoli (Fig. ). Immunohistochemistry studies demonstrated positive staining with HMB-45 (Fig. ) and S-100 protein. Electron microscopy revealed type II melanosomes with cross-striated lattice in an enclosed membrane (Fig. ), type III melanosomes with increased deposition of electron-dense melanin, and type IV melanosomes with highly electron-dense melanin (Fig. ). Based on the above findings, a diagnosis of malignant melanoma was made. Computed tomography of the chest revealed extensive lobulated tumor lining the entirety of the right parietal pleural surface without any evidence of parenchymal involvement. The patient's medical condition rapidly declined, and she ultimately succumbed to death before initiation of any therapy.", "age": [ [ 65.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5301116.xml", "relevant_articles": { "26271927": "0", "2556591": "0", "31519718": "0", "33578518": "0", "21239776": "12" }, "similar_patients": { "6881765-1": "13", "4498862-1": "123", "5582220-1": "13", "2923171-1": "1", "3204301-1": "13" } }, { "human_patient_id": "483", "human_patient_uid": "5796812-1-M", "PMID": "29410943", "title": "Thrombotic Paradox: Ischaemic Stroke in Immune Thrombocytopaenia. A Case Report and Review", "patient": "A 68-year-old woman presented with increased right upper limb weakness for one week's duration. There were no sensory symptoms. Her vital signs were normal. Examination showed slurring of speech with decreased power in the right upper limb proximal muscle strength (Medical Research Council (MRC) score of 4) compared to the left (MRC 5). Muscle power in the distal upper limbs was equal. Power was also decreased in the right proximal lower limb compared to the left. The patient had a past medical history of old ischaemic stroke in 2006, hypertension, dyslipidaemia, Graves\u2019 disease, and immune thrombocytopaenia (ITP), which was diagnosed incidentally in 2008. There was no bleeding manifestation of the ITP on diagnosis; her platelet was repeatedly below 100 x 109/L at that time. There were no immature or abnormal white cells, no schistocytes, and no abnormal platelet morphology on blood film. Coagulation tests were not prolonged. Antiphospholipid antibodies (lupus anticoagulant and anticardiolipin), anti-double-stranded DNA, and anti-Smith antibodies were negative. Complements (C3 and C4) were normal. Human immunodeficiency virus (HIV) and hepatitis C antibodies were not detected. Helicobacter pylori screening was not done.\nComputed tomography (CT) of the brain showed hypodensity in the left corona radiata and old infarcts with a background of small vessel disease (Figure ). A decision was made by the neurologists not to proceed with magnetic resonance imaging (MRI) of the brain in view of the multiple old strokes. A diagnosis of right ataxic hemiparesis was made. An ultrasound of her carotid arteries showed moderate left and mild right carotid artery stenosis. Platelet level at the onset of stroke was 119 x 109/L (reference range 150-400 x 109/L). Total white cells were 6.98 x 109/L and haemoglobin 14.4 g/dL. Thrombophilia screenings revealed levels of Factor V Leiden, proteins C and S, and antithrombin were not deficient. She was not on prednisolone. After consultation with a haematologist, the decision was made to start clopidogrel. She underwent a one-month duration of rehabilitation. While on clopidogrel, her platelet count dropped to a nadir of 59 x 109/L. There were no clinical symptoms or signs of bleeding manifested. Antiplatelet therapy was continued. She was discharged ambulant with a walking frame.\nTwo months later, she presented with acute right-sided lower limb weakness and difficulty in walking, which was new to her. CT brain did not show any acute haemorrhage. Multiple chronic lacunar infarcts were seen in bilateral thalami, internal capsules, corona radiata, and pons. MRI with diffusion-weighted imaging (DWI) did not show the presence of an acute infarct. There were multiple chronic infarcts. Multiple microhaemorrhages were also seen. Magnetic resonance angiography (MRA) showed diffuse flow irregularities in the anterior and posterior circulations due to atherosclerosis without significant flow-limiting stenosis. She was diagnosed with right ataxic hemiparesis and DWI-negative stroke with microhaemorrhages. Her platelet count was 41 x 109/L, and the clopidogrel was suspended. She was started on prednisolone, 60 mg daily, as advised by the haematologist. Subsequent platelet counts were 43 x 109/L and 51 x 109/L before the clopidogrel was restarted with esomeprazole. Her platelet remained stable at 88 to 126 x 109/L during the course of rehabilitation, and her prednisolone was gradually tapered to 20 mg daily upon discharge.\nThree weeks after discharge from above-mentioned admission, she was admitted for non-specific breathlessness. Initial investigations showed that her blood gases and chest x-ray were normal. A CT scan was performed because the patient complained of right-sided weakness with deconditioning of her activities of daily living, to the point where she needed a wheelchair for ambulation. CT showed no acute intracranial haemorrhage or territorial infarct. A 0.4 cm hyperdense lesion was noted in the left corona radiata that corresponded to a prior punctate haemorrhage (Figure ). Her platelet count was 127 x 109/L. She was discharged uneventfully with clopidogrel and same previous prednisolone dose of 15 mg daily.", "age": [ [ 68.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5796812.xml", "relevant_articles": { "29410943": "123", "7546929": "123", "34804744": "0", "28331021": "0", "34543144": "0" }, "similar_patients": { "7714735-1": "13", "8086049-1": "123", "4370012-1": "12", "7188982-1": "123", "4628357-1": "123" } }, { "human_patient_id": "484", "human_patient_uid": "7716066-1-M", "PMID": "33312008", "title": "Isolated Neck Extensor Myopathy Associated With Cervical Spondylosis: A Case Report and Brief Review", "patient": "A 72-year-old Chinese man with chronic nuchal pain complained of progressive difficulty in lifting the head over the last 2 years. He also developed difficulty walking due to the loss of horizontal gaze. Past history was notable for hypertension under control. The patient reported no history of trauma and no known neurological deficits. Prior workup by an orthopedic surgeon and a neurologist excluded the diagnosis of any cranial, neurological or autoimmune diseases. A muscle biopsy from the left trapezius muscle demonstrated nonspecific myopathic features. Cervical collar, oral non-steroidal anti-inflammatory medication and exercise rehabilitation were ineffective in correcting his posture for the past 1 year. The patient then sought chiropractic care for his condition.\nUpon examination, the patient ambulated with a cane to maintain balance. Gaze was down at the floor, instead of forward. Pronounced head drop with neck flexion caused the chin to rest on the chest in standing or sitting. The center of gravity plumb line (COG PL, red dashed line) is considered a virtual gravity line of the entire body (). Measurements of cervical range of motion (ROM) showed restriction of active motions, where active versus passive extension ROM (normal range: 70\u00b0) was 10\u00b0/54\u00b0, and active versus passive rotation ROM (normal range: 90\u00b0 to both sides) was 58\u00b0/72\u00b0 each side. The head was able to be passively raised up by hands and the neck deformity resolved when lying supine. Pain intensity of the neck was rated 3-4/10 on an 11-point numeric pain rating scale, where 0 means no pain and 10 means the worst imaginable pain. Motor strength measurement of the cervical extensors with a handheld dynamometer was graded at 4+/5. The patient could maintain the head up with extreme effort only for a couple of minutes. EOS\u00ae radiographies ( and ) revealed reverse lordosis (CobbC2-C7 \u221216\u00b0), cervical disc space narrowing with grade 1 anterolisthesis at C3/4 and C4/5 levels (red arrows), and C5-C6 ankylosis (hollow arrow). COG-C7 sagittal vertical axis (SVACOG-C7) \u2a7e30 mm (red solid line) is regarded as occiput-trunk discordance and SVAC2-C7 \u2a7e40 mm (purple solid line) is considered to be cervical sagittal imbalance. Needle electromyography revealed myopathic changes in the cervical muscles. Clinical pictures and histological findings were consistent with INEM associated with cervical spondylosis.\nThe chiropractic regimen consisted of upper thoracic spine manipulation, electrical muscle stimulation (EMS), cervical extension exercises and cervical collar. The splenius capitis, semispinalis capitis, semispinalis cervicis, and trapezius are the key muscles for cervical extension. In order to correct dropped head posture and relieve neck pain, these muscles need to be strengthened specifically. In the presence of instability at C3/4 and C4/5 levels, cervical manipulation was contraindicated. An upper thoracic manipulation was cautiously delivered instead. An inflatable air pump cervical collar was prescribed to maintain neck posture and to relieve neural compression when patient was at home. Greater functional range of active cervical motion was obtained after 2 weeks of treatment 5 times per week. Subsequently, in addition to manipulative therapy, EMS of the neck extensors and cervical extension exercises for muscle strengthening were added in each treatment session. Treatments were delivered 3 times weekly for further 3 months. Dropped head state was almost corrected and neck pain was fully resolved near the completion of treatment. The patient resumed normal daily activities and continued monthly follow-ups. At the 6-month follow-up, he regained upright posture of the head and global sagittal balance (). Repeat standing full-spine EOS\u00ae ( and ) depicted substantial improving of most of the radiographic parameters except SVAC7-S1. The C7 plumb line (white dashed line) should fall within 30 mm, either anterior or posterior, to the posterosuperior endplate of the S1. His SVAC7-S1 moved posteriorly (from \u221237 to \u221266 mm), indicating negative sagittal balance.", "age": [ [ 72.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC007xxxxxx/PMC7716066.xml", "relevant_articles": { "21945295": "12", "28570930": "0", "10626704": "0", "33585691": "0", "25692364": "0" }, "similar_patients": { "1363725-1": "0", "4808527-1": "0", "8636150-1": "0", "7787856-1": "123", "8577610-1": "0" } }, { "human_patient_id": "485", "human_patient_uid": "8308763-1-M", "PMID": "34203265", "title": "Immune Reconstitution Inflammatory Syndrome with Recurrent Paradoxical Cerebellar HIV-Associated Progressive Multifocal Leukoencephalopathy", "patient": "A 34-year-old Haitian man with no past medical history presented with initial complaints of ataxia. He reported an unprotected sexual encounter 4 years ago with a suspected HIV-positive partner and was subsequently newly diagnosed with acquired immune deficiency syndrome (AIDS). CD4 cell count was 37.56 cells/mm3 [6.83%], CD8 357.82 cells/mm3, CD4/CD8 ratio 0.1 and plasma HIV viral load 459,020 copies/mL.\nBrain magnetic resonance imaging (MRI) on admission showed increased T2 FLAIR in the brainstem and cerebellum, as well as bilateral, but asymmetrical involvement of the cerebellar peduncles, not consistent with intracranial mass or acute stroke (). Lumbar puncture (LP) showed: white blood cells 2/\u03bcL, red blood cells 140/\u03bcL, glucose 51 mg/dL, total protein 48 mg/dL, lymphocytes 94/\u03bcL, monocytes 6/\u03bcL. The cerebrospinal fluid (CSF) polymerase chain reaction (PCR) for JC virus returned as 6400 copies/mL, suggestive of PML. Other CSF studies were unremarkable, including: Cryptococcus neoformans antigen, venereal disease research laboratory test (VDRL), Toxoplasma gondii PCR, meningoencephalitis panel, Mycobacterium tuberculosis PCR, Epstein Barr virus (EBV) PCR, cytomegalovirus (CMV) PCR, herpes simplex virus (HSV)-1 and -2 (PCR), varicella zoster virus (VZV) PCR, adenosine deaminase (ADA), angiotensin converting enzyme (ACE) and acid-fast bacilli culture and smear. Serum serological testing was positive for Toxoplasma gondii, but otherwise negative. Other negative blood tests include EBV PCR, CMV PCR, hepatitis panel, and interferon gamma release assay. CSF cytology and flow cytometry were negative for malignancy including B- or T-cell lymphoma.\nHigh concern for PML was raised; less likely toxoplasmosis or IRIS, as the patient was not on ART at the time. Differential considerations for his imaging appearance included CNS lymphoma, neurosarcoidosis, and cerebritis-meningitis among others. The patient was initiated on bictegravir 50 mg/emtricitabine 200 mg/tenofovir alafenamide 25 mg and prophylaxis against opportunistic infections notably Pneumocystis carinii pneumonia. After 2 weeks of ART, the viral load decreased significantly to 1400 copies/mL.\nTwo months after the initial presentation and despite compliance to ART, the patient was re-admitted for progressive neurological complaints, including worsening ataxia, now unable to stand or walk without assistance. The physical exam was notable for right facial droop, decreased sensation over the right face, marked dysmetria with finger-to-nose testing, and dysdiadochokinesia. He had significant ataxic gait but full muscle strength and negative pronator drift or nuchal rigidity. Repeat CSF studies were unrevealing. Brain MRI was concerning for worsening of previous PML lesions with multifocal brainstem and cerebellar T2/FLAIR hyperintense lesions, new extensive leptomeningeal and perivascular enhancement, and mass effect (). Repeat T- lymphocyte subsets/HIV studies at this time showed: CD4 cell count 252 cells/mm3 [7.94%], CD8 2430.4 cells/mm3, CD4/CD8 ratio 0.1 and plasma HIV viral load decreased to 106 copies/mL. In the setting of radiologic and clinical progression of disease with recently diagnosed AIDS and ART initiation 1 month prior, paradoxical cerebellar PML-IRIS was diagnosed. While ART was continued, he was also started on an adjunctive intravenous methylprednisolone course 1 g daily for 5 days, followed by an oral prednisone taper 60 mg per day, with taper over 6 weeks and close outpatient follow up. The patient was discharged after 5 days of hospital stay.\nPatient did not return to receive care at our institution, but had 2 readmissions at an outside hospital within 20 miles to our hospital facility. The first readmission after discharge from our institution occurred within one week with symptoms of nausea, vomiting and gait dysfunction. Brain MRI again showed right cerebellar vasogenic edema with enhancing lesions in the left cerebral peduncle and extension to the pons, left cerebellar peduncle and right medullary edema. Repeat LP studies at this time was positive for JC virus PCR. He was treated again with a course of intravenous corticosteroids. Follow up CD4 count was 101 cells/mm3 and sulfamethoxazole/trimethoprim was continued for opportunistic infection prophylaxis. The patient was subsequently discharged to a rehabilitation treatment center after 4 weeks hospital stay.\nOne month after leaving the rehabilitation program, the patient was readmitted again with symptoms of nausea, vomiting and blurry vision. Repeat brain MRI showed a new 6 mm enhancing focus in the medulla in addition to imaging findings very similar to his last hospital stay. Work up for lymphoma and other malignancy was negative even though CSF studies were positive for EBV PCR in addition to JC virus. Patient again got a course of intravenous steroids. A repeat MRI performed after completion of intravenous steroids showed significant improvement of lesions. He was discharged home with outpatient physical therapy and his functional status continues to improve as of the time of this report.", "age": [ [ 34.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC008xxxxxx/PMC8308763.xml", "relevant_articles": { "34589769": "123", "11218704": "123", "32381752": "123", "28095350": "123", "24097317": "123" }, "similar_patients": { "3578199-1": "13", "2529329-1": "123", "8474382-1": "13", "7343350-1": "123", "8569688-1": "123" } }, { "human_patient_id": "486", "human_patient_uid": "7385612-1-M", "PMID": "32775393", "title": "Multiple recurrent cystic echinococcosis with abdominal aortic involvement: A case report", "patient": "A 60-year-old male with the chief complaints of progressive abdominal pain and poor appetite was admitted to our department.\nHe previously underwent surgery for a splenic CE lesion. There was no other relevant personal or familial history.\nPhysical examination upon admission revealed a mass in the left upper quadrant of the abdomen.\nLaboratory examinations (routine blood tests, routine urine tests and urinary sediment examination, routine fecal tests and occult blood test, blood biochemistry, immune indices, and infection indices) showed no apparent abnormalities.\nImaging examination with computed tomography and angiography revealed two irregular CE2 lesions (approximately 10.0 cm \u00d7 14.0 cm \u00d7 13.6 cm and 12.5 cm \u00d7 11.2 cm \u00d7 5.8 cm), respectively, located in the left upper retroperitoneal cavity and the abdomen, according to World Health Organization (WHO) classification (Figure and )[,]. The lesions mainly invaded the liver-spleen-gastric gap, superior section of the spleen, left retro-renal cavity and the abdominal aortic wall (Figure and ). There was no other abdominal organ involvement.\nThe patient was finally diagnosed with recurrent abdominal/retroperitoneal active CE with aortic involvement. After preoperative evaluation, abdominal hydatid excision combined with abdominal aortic stent implantation was planned and surgical treatment was performed on October 12, 2017.\nSurgery was performed under general anesthesia. Following an upper abdominal incision, two round-shaped hard lesions were found. Firstly, a lesion within the abdominal cavity was carefully removed from the gastrocolic space by total cystectomy. Another retroperitoneal lesion was then observed. Considering that the retroperitoneal lesion was huge and involved the aorta, sub-total cystectomy was performed in order to protect the aorta from possible injury. The outer capsule area was exposed as much as possible and the surrounding tissues were protected by 10% saline. The capsule of the retroperitoneal lesion was opened from the left side where it could be easily operated without affecting the aorta. The inner contents were then extracted under full vision. The residual cavity was then washed with 10% saline. Aneurysmal inflammatory granulation tissue was detected on the right capsule wall adjacent to the aortic wall. During the third saline washing of the cavity, the aortic wall suddenly ruptured. Massive bleeding suddenly occurred, accompanied by a drop in blood pressure and an increase in heart rate. The bleeding section of the abdominal aorta was immediately clamped and pressed. Blood loss was estimated to be 2500 mL. The upper end of the abdominal aorta was immediately separated and blocked intermittently for 30 min each time. Hemostasis attempts were conducted to deal with this emergency situation and maintain circulation. The rupture site was at the celiac trunk level and was sutured with 3-0 proline lines in the setting of interrupted blockage of the superior and inferior sections of the aorta. A small amount of bleeding was found in the surgical area. The patient then underwent digital subtraction angiography (DSA), which showed an ulcer on the left posterior wall of the abdominal aorta (0.5 cm above the celiac arteries) and no obvious contrast agent overflow. A covered stent (VAMF2828 C150 TE, Medtronic Inc., United States) was placed in the aortic wall after angiography of the aortic section. No active bleeding was observed. Blood flow in the aorta and main branches were confirmed to be normal (Figure ). During surgery and DSA, a total of 11.5 units of erythrocyte suspension was transfused and vital signs and hemoglobin levels were maintained within normal levels. Thereafter, he was transferred to the intensive care unit, then to a general ward after 3 d, and discharged on day 13 following DSA. Postoperative pathological evaluation of the lesion was consistent with CE.\nAfter surgery, the patient was administered albendazole 10 mg/kg/day according to expert consensus[,]. The patient was followed-up for the next two years by abdominal ultrasound examination. No abnormalities were observed during the 2-year-follow-up.", "age": [ [ 60.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC007xxxxxx/PMC7385612.xml", "relevant_articles": { "9480573": "123", "17853717": "123", "16010502": "123", "1675485": "123", "16765229": "0" }, "similar_patients": { "5815701-1": "13", "6380711-1": "123", "8167463-1": "123", "7751079-1": "123", "7708907-1": "0" } }, { "human_patient_id": "487", "human_patient_uid": "5925835-1-M", "PMID": "29736261", "title": "Choroidal infarction following ophthalmic artery chemotherapy", "patient": "Patient one was a 52-month old male with bilateral RB at the time of infarct diagnosis in his right eye. He was homozygous for the C677T polymorphism, and experienced choroidal ischemia after his seventh dose of OAC (carboplatin, topotecan, and melphalan) to the right eye only. His prior six OAC doses were unremarkable except for vasospasm of the ophthalmic artery during the fifth dose, which limited the ability for simultaneous bilateral chemotherapy infusion. The seventh dose, however, was his first administration of nitrous oxide during the procedure; he received 24 min of nitrous oxide induction anesthesia with a maximum end tidal nitrous oxide (ET N2O) of 60.2% (higher ET N2O percentage correlates to higher nitrous oxide concentration in the blood). He experienced no intra-procedural complications. One month later, new choroidal ischemia was identified in the right eye, presumed to be due to an infarction.", "age": [ [ 52.0, "month" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5925835.xml", "relevant_articles": { "29736261": "12", "20605391": "0", "2521436": "0", "3310725": "0", "1532895": "0" }, "similar_patients": { "5925835-4": "1", "5925835-3": "1", "5925835-2": "1", "7379369-1": "0", "4546078-1": "0" } }, { "human_patient_id": "488", "human_patient_uid": "5925835-2-M", "PMID": "29736261", "title": "Choroidal infarction following ophthalmic artery chemotherapy", "patient": "Patient two was a 13-month old female with bilateral RB when she experienced ischemia of her left choroid. She was heterozygous for the A1298C polymorphism and experienced an infarction after her third cycle of carboplatin OAC to the left eye only, anesthetically induced by nitrous oxide. Two prior OAC infusions were done with sevoflurane induction alone. She received 47 min of nitrous oxide, with 65.6% max ET N2O, and the procedure was without acute complications. Follow-up 1 month later revealed infarction of the lateral half of the posterior choroid.", "age": [ [ 13.0, "month" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5925835.xml", "relevant_articles": { "29736261": "12", "30872294": "0", "9197295": "0", "27854092": "0", "10597552": "0" }, "similar_patients": { "5925835-1": "1", "5925835-3": "1", "5925835-4": "1", "7289942-1": "0", "2518154-1": "0" } }, { "human_patient_id": "489", "human_patient_uid": "5925835-3-M", "PMID": "29736261", "title": "Choroidal infarction following ophthalmic artery chemotherapy", "patient": "Patient three was a 25-month old male with unilateral RB when he experienced choroidal infarction in the treated eye. His infarction was diagnosed at the one-month follow-up appointment after his second dose of OAC with melphalan and carboplatin. He was heterozygous for two polymorphisms: C677T and A1298C. While he did not receive nitrous oxide during his first OAC session, he did receive 58 min of nitrous oxide with max ET N2O 31.9% during this second session of OAC.", "age": [ [ 25.0, "month" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5925835.xml", "relevant_articles": { "29736261": "12", "20605391": "0", "33722915": "0", "10710958": "0", "31772134": "0" }, "similar_patients": { "5925835-1": "123", "5925835-4": "123", "5925835-2": "123", "3765988-1": "1", "4546078-1": "0" } }, { "human_patient_id": "490", "human_patient_uid": "5925835-4-M", "PMID": "29736261", "title": "Choroidal infarction following ophthalmic artery chemotherapy", "patient": "Patient four was a 58-month old female when her right eye experienced a choroidal infarction following OAC for her bilateral RB. Her genetic testing showed heterozygosity for the C677T polymorphisim. The infarct occurred after her eighth dose of OAC with carboplatin, topotecan, and melphalan to the right eye (tenth treatment of OAC for this patient, two treatments only to left eye). This was her first time receiving nitrous oxide (duration 21 min, max ET N2O 60.5%) during OAC for the right eye. This patient\u2019s choroidal ischemia was identified by RetCam images at her one-month follow-up appointment.", "age": [ [ 58.0, "month" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5925835.xml", "relevant_articles": { "29736261": "1", "25606040": "0", "22855935": "0", "34481477": "0", "34221526": "0" }, "similar_patients": { "5925835-1": "1", "5925835-3": "1", "5925835-2": "1", "8219460-1": "0", "3765988-1": "0" } }, { "human_patient_id": "491", "human_patient_uid": "5471592-1-M", "PMID": "28656118", "title": "Pediatric Ovarian Growing Teratoma Syndrome", "patient": "A 12-year-old female patient presented from a referring institution in November 2015 for evaluation of 1-month history of an enlarging abdominal mass. The patient reported a 4.5 kg weight loss with increased lethargy. The physical examination was normal except for a large abdominal solid mass. Pelvic CT () revealed a large pelvic mass. Tumor markers were significant for alpha fetoprotein (AFP) 656 ng/mL (nml \u2264 7 ng/mL), CA-125 401 U/mL (nml < 35 U/mL), and CEA 6.7 ng/mL (nml \u2264 3.5 ng/mL). Inhibin A/B and \u03b2-HCG levels were normal. She underwent an exploratory laparotomy, right salpingoophorectomy, omentectomy, peritoneal washings, diaphragmatic/peritoneal/pelvic biopsies, and periaortic lymph node biopsy. Intraoperative findings were significant for a distinct right ovarian mass with evidence of prior rupture. Ascites was noted and aspirated. There was peritoneal seeding along the pelvis and right pericolic gutter and along the right hemidiaphragm. Gross residual disease remained consisting mostly of the peritoneal seeding despite removal of all gross abdominal disease. The cytology examination of the peritoneal fluid demonstrated no malignant cells. Histologically, all the pathology specimens returned with high grade immature teratoma (). She was diagnosed as grade 3, FIGO stage IIIC. Chromosome analysis returned trisomy 3 in four of her autosomal cells, consistent with the diagnosis of immature teratoma. Since there is currently no \u201cstandard of care\u201d for pediatric grade immature teratoma FIGO stage IIIC, we elected to follow tumor markers closely. Following tumor markers, her AFP fell by approximately 50% every week almost normalizing over the course of three months from diagnosis (from 656 ng/mL to 9.78 ng/mL). In January 2016, repeat tumor marker labs demonstrated that AFP levels increased to 28.3 ng/mL and CA-125/\u03b2-HCG were within normal limits (18 units/mL CA-125, <3 units/mL). Repeat CT of chest, abdomen, and pelvis revealed that, in the abdomen and pelvis, she now had enlarged peritoneal implants, as large as 3.5 \u00d7 1.5 cm, but no other masses, and, in the chest, she had a 1.3 \u00d7 2 \u00d7 0.3 cm left anterior pleural nodule, as well as bilateral diaphragmatic lesions, 2.5 \u00d7 2.1 \u00d7 1.8 cm on right and 2.1 \u00d7 3 \u00d7 1.5 cm on left. She subsequently underwent chemotherapy with bleomycin, etoposide, and cisplatin (BEP) between February and May 2016 for high risk malignant ovarian germ cell tumor. After 4 cycles, her AFP was 0.84 ng/mL.\nAfter 4 cycles, she underwent interval radiologic evaluation in preparation for second look surgery. The CT scan of the chest, abdomen, and pelvis in May 2016 revealed a significant increase in the size of the thoracic masses, as well as the size and a number of abdominal and pelvic masses (). The largest mass was 7.9 \u00d7 7.7 \u00d7 8.7 cm in the rectouterine pouch with evidence of fat and calcification. There was also a 4.4 \u00d7 7.2 \u00d7 6.6 cm peritoneal implant superior to the liver that also had similar visual findings. There were also findings of bilateral cardiophrenic masses, with the largest measuring 2.1 \u00d7 1.3 \u00d7 1.1 cm. In June 2016, she underwent a second debulking procedure consisting of complete infracolic omentectomy, para-aortic lymph node dissection, hepatic mass resection, and pelvic tumor removal on the right side. Gross residual disease remained in her abdomen and pelvis, since she had innumerous peritoneal studding, and thus her thoracic tumors were not removed. A total of 5 pelvic masses and 3 liver masses were excised, and pathologic analysis indicated mature teratoma (). At the time of surgery her liver masses were found to compress the parenchyma of the liver and were not invasive.\nDue to the massive growth of tumor in 4 months, as well as recently undergoing 2 major surgical debulkings, and still being unable to completely resect her tumors, medical treatment was discussed with the patient and her parents. In an attempt to prevent regrowth of her tumors, in August 2016, the patient was started on experimental protocol #009 of the Neuroblastoma and Medulloblastoma Translational Research Consortium (NMTRC). This treatment regimen consists of temozolomide 40 mg/m2 PO daily (days 1\u201328), tretinoin 25 mg/m2/day PO BID (days 1\u201314), and sorafenib 150 mg/m2 PO BID (days 1\u201328). Thalidomide was started during cycle 2. This protocol was chosen as this study tests the feasibility of experimental technologies to determine a tumor's molecular makeup. This technology includes a genomic report based on DNA exomes and RNA sequencing that will be used to discover new ways to understand cancers and potentially predict the best treatments for patients with cancer in the future. Prior to the experimental therapeutics, a CT scan was obtained to evaluate disease progression. She is currently without new tumor growths.", "age": [ [ 12.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5471592.xml", "relevant_articles": { "20613905": "123", "34314853": "123", "23984130": "123", "25620216": "123", "16515629": "123" }, "similar_patients": { "6327407-1": "13", "8271255-2": "123", "5815738-1": "123", "6015461-1": "13", "3152755-1": "123" } }, { "human_patient_id": "492", "human_patient_uid": "2788476-1-M", "PMID": "20011497", "title": "Accessory thymus in posterior mediastinum", "patient": "A 20-month-old male child was admitted with complaints of dry cough, dysphagia, and low-grade fever of one-month duration. There was no abnormality detected on clinical examination. On investigating the child, his Hb was 10.8g%, WBC \u2013 9,700, S. LDH \u2013 356, LFT and RFT were normal. An x-ray chest revealed superior mediastinal widening []. HRCT chest showed a lesion in the posterior mediastinal region with mass effect on the esophagus and trachea and a normally placed thymus which was enlarged but normal for age. The most common differential diagnosis of this mass \u2013 neuroblastoma was suspected and child investigated for the same. All investigations including MIBG, Urinary VMA, and serum alpha-fetoproteins were normal. In view of the obstructive symptoms excision of the mass was planned. At right posterolateral thoracotomy through fourth intercostal space, a nodular mass was found behind the trachea extending up to the carina not communicating with any other structure. A normal thymus was found in the anterior mediastinum. The posterior mediastinal mass was completely excised after careful dissection of the trachea, esophagus and the nerves and sent for histopathology, which revealed normal thymic tissue.\nPost-operatively, the child developed right phrenic nerve neuropraxia causing asymptomatic right eventration of diaphragm. The child was followed up for 4 years. An x-ray chest done 1 year later showed complete resolution of the eventration and the latest x-ray 6 months ago was also normal.", "age": [ [ 20.0, "month" ] ], "geneder": "M", "file_path": "comm/PMC002xxxxxx/PMC2788476.xml", "relevant_articles": { "2072583": "12", "22699472": "123", "12677581": "123", "20011497": "123", "9136545": "123" }, "similar_patients": { "3446191-1": "123", "3826527-1": "123", "6333069-1": "123", "4050947-1": "123", "2902217-1": "123" } }, { "human_patient_id": "493", "human_patient_uid": "4062198-1-M", "PMID": "24949336", "title": "Rupture of a duodenal stromal tumor during EUS-FNA: A case report", "patient": "A 71-year-old female presented with abdominal pain, for which esophagogastroduodenoscopy (EGD) was performed. Subsequently, a smooth, protuberant mass of descending duodenum was found (). By endoscopic ultrasound (EUS), performed at Shengjing Hospital, the lesion was homogeneous and hypoechoic, and measured approximately 36 mm \u00d7 35 mm (). No internal vessels or blood flow was detectable. Due to its size and indistinct margins, the site of origin was also difficult to ascertain. EUS-FNA was thus elected.\nA linear echo endoscope (EG3630, Pentax, Tokyo, Japan) and a 22-gauge needle (Echo Tip Ultra, Cook Endoscopy, Winston-Salem, North Carolina, USA) were used to access the mass. After lesion the needle was inserted (under EUS guidance) into the targeted tissue (), the stylet was completely withdrawn by carefully retracting the plastic hub housed in the needle handle. A syringe (prepped in advance) was attached by way of Luer lock to the fitting on the needle handle, and its stopcock was turned to the \u201copen\u201d position (aligned with the syringe),10 cc of negative pressure was allowed in the syringe for aspiration of cells. Guided by EUS, the needle handle was moved back and forth gently in small increments. The tissue had been penetrated several times, when a hyperechoic line was noted in the needle track (). Thereafter, a 10 mm \u00d7 7 mm cystic area materialized within the mass, and hyperechoic flow was noted (). In a matter of seconds, the cystic zone grew to roughly 25 mm \u00d7 20 mm, and the entire mass expanded to 62 mm \u00d7 40 mm (). Because hemorrhage within the mass was likely, the procedure was halted, and the patient was hospitalized.\nTwo hours afterwards the patient complained of severe abdominal pain, later developing diffuse abdominal rigidity and guarding. Non-coagulated blood was withdrawn by abdominocentesis. By contrast-enhanced computed tomography (CT), the mass of descending duodenum was now measured 81 mm \u00d7 62 mm. Its appearance bordered on high-density, with a low-density mass inside (). Findings were suggestive of rupture, accompanied by hematocele, accumulated exudate, and ascites.\nFour hours following EUS-FNA, emergency surgery was performed, and the clinical impressions were confirmed. The abdominal cavity contained approximately 1000 ml of blood. Consequently, the tumor was completely resected.\nImmunohistochemical staining of the lesion was positive for CD-117, CD-34, and DOG-1 markers, as well as for smooth muscle actin. Positivity of Ki67 was <5%, and staining for Desmin was negative. A diagnosis of high-risk duodenal stromal tumor was ultimately rendered.", "age": [ [ 71.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC004xxxxxx/PMC4062198.xml", "relevant_articles": { "26190124": "2", "28540094": "2", "12145615": "2", "27092323": "2", "33886105": "2" }, "similar_patients": { "5603504-1": "0", "4568640-1": "13", "7220736-1": "13", "5579914-1": "0", "3572357-1": "0" } }, { "human_patient_id": "494", "human_patient_uid": "7008393-1-M", "PMID": "32104038", "title": "Classical Dermatomyositis: A Case Report", "patient": "A 44-year-old female patient living in Purano-baneshwor, Kathmandu, Nepal was referred from the National Center for Rheumatic disease (NCRD) for laboratory investigation in the Modern Diagnostic Laboratory and Research Center on 24 July 2019, presenting with hyperpigmented erythematous rash all over her body along with V-shaped rashes on the neckline since 2 months. Initial symptoms as mentioned by the patient included itchy rashes and photosensitivity. She had no history of headache, fever, and weight loss with a normal vital test. In addition, she had no surgical as well as medical history of chronic disease. She had progressed symptoms like muscle pain (especially in the left arm and thigh), unable to walk upstairs, inability to stretch hands, unable to turn neck, and difficulty in swallowing food.\nPhysical examination showed signs of inflammation supported by laboratory findings, i.e. erythrocyte sedimentation rate (ESR) done by Wintrobe\u2019s method found to be 30 mm/1st hour (normal 0\u201320 mm/1st hour), leukocytosis (14,920 cells/\u00b5L) with neutrophilia 13,080 cells/\u00b5L (normal range 2500\u20138000 cells/\u00b5L), and carbohydrate reactive protein (CRP) done by nephelometry found to be 25.3 mg/L (normal <3 mg/L). Hematological parameters were measured using Sysmex XN-350 and are presented in . Biochemical parameters () were measured by a fully automated Dimension RxL Max integrated chemistry analyzer that revealed an elevated level of serum creatinine kinase 17,160 IU/L (normal 26\u2013192 IU/L), and normal plasma glucose level and renal function test. Her liver enzymes revealed an elevated level of alanine aminotransferase (ALT), i.e. 370 IU/L (normal 5\u201345 IU/L), and aspartate aminotransferase (AST) 616 IU/L (normal 5\u201345 IU/L). Nailfold capillaroscopy of 8 fingers findings showed variant and simple Raynaud's. Urine analysis, chest X-ray, and thyroid function test were normal. Serum lactate dehydrogenase (LDH) 1657 IU/L (reference 25\u2013250 IU/L), Jo-1 antibodies, and dsDNA antibodies were negative while anti-Mi-2 antibody was positive. Raynaud\u2019s phenomenon and anti-Mi-2 antibody are highly specific to dermatomyositis. Based on the above findings, a diagnosis of dermatomyositis was made.\nShe was administered with 50 mg prednisolone with a significant improvement of muscular activities within a month; with a modest fall in serum creatinine kinase level as shown in and 25 mg azathioprine once a day as immunosuppressive drugs. At present, she is orally administered 50 mg prednisolone therapy for maintenance therapy and still being followed up.", "age": [ [ 44.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC007xxxxxx/PMC7008393.xml", "relevant_articles": { "21969283": "0", "16603844": "123", "1604420": "12", "21816012": "123", "22190579": "0" }, "similar_patients": { "3424642-1": "123", "8057120-1": "0", "3183691-1": "13", "8255573-1": "0", "8243539-1": "123" } }, { "human_patient_id": "495", "human_patient_uid": "3047774-1-M", "PMID": "21430848", "title": "Perforation into gut by ventriculoperitoneal shunts: A report of two cases and review of the literature", "patient": "A 9-month-old male had undergone the right-sided VP shunt (Chhabra-slit-in-spring silicone shunt) procedure 7 months back for congenital hydrocephalus. He presented to us with complaints that the child protruded a white tube per anus on defecation for past 15 days with clear fluid dripping from it. On examination, the child was afebrile, alert and had no neck rigidity, and the abdomen was soft. On rectal examination, there was a white tube coming from beyond the reach of finger. Total leukocyte count (TLC) was 7200/cumm. An ultrasonography (USG) abdomen was normal. The sigmoidoscopy showed VP shunt protruding into the colon at 18 cm from the anal verge. The child was operated and the shunt was cut at abdominal surface through a small incision. The rest of the distal tube was extracted per rectum. The proximal tube was taken out as external drainage. On antibiotics, the child improved. The cerebrospinal fluid (CSF) culture done after 1 month was sterile and so a revision of shunt was done on the left side. The child was asymptomatic at 3 years follow-up.", "age": [ [ 9.0, "month" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3047774.xml", "relevant_articles": { "28553391": "1", "32157451": "123", "21887196": "123", "15641223": "123", "24665288": "1" }, "similar_patients": { "5982498-1": "123", "5898128-1": "123", "3505339-3": "123", "3047774-2": "123", "3505339-1": "123" } }, { "human_patient_id": "496", "human_patient_uid": "3047774-2-M", "PMID": "21430848", "title": "Perforation into gut by ventriculoperitoneal shunts: A report of two cases and review of the literature", "patient": "A 3-year-old male, who underwent VP shunt 1 year ago for congenital hydrocephalus presented with similar complaints as the above patient []. On examination, the child was stable except that proctoscopy showed VP shunt protruding into the rectum at about 12 cm from anal verge. TLC was 6400/cumm, CSF was sterile and the USG abdomen was normal. The child was operated and managed similarly as the above patient with successful outcome and is on regular follow-up.", "age": [ [ 3.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3047774.xml", "relevant_articles": { "26613270": "13", "17154033": "13", "26848430": "13", "11981631": "13", "3399007": "13" }, "similar_patients": { "3047774-1": "123", "3505339-2": "1", "4155640-1": "123", "5898128-1": "123", "5982498-2": "123" } }, { "human_patient_id": "497", "human_patient_uid": "4314867-1-M", "PMID": "25657500", "title": "Coexistence of JAK2 and BCR-ABL mutation in patient with myeloproliferative neoplasm", "patient": "A 60-year-old male retired soldier presented with a 4-month history of recurrent low-grade fever, cough, abdominal distention and remarkable weight loss. He was chronically ill looking, wasted, moderately pale, splenomegaly of 16 cm, and hepatomegaly of 6 cm. Haematological investigation showed packed cell volume (PCV) of 21.7% (37.0-53.0%), total white blood cell (WBC) count of 30.5 \u00d7 109/L (3.0-13.2 \u00d7 109/L) with differentials of granulocyte of 36.3%, lymphocyte 53.6%, medium sized (MID) 10.1%. Platelet count was 324 \u00d7 109/L. Other investigations revealed erythrocyte sedimentation rate (ESR) \u02c380 mm in the first hour. Chest radiograph (hilar opacities), mantoux test (negative) and sputum acid bacilli (negative). The patient was then classified as smear-negative tuberculosis. He was then placed on empirical anti tuberculosis therapy according to the Nigerian national guideline for tuberculosis therapy. However, there was no clinical response after 4 weeks.\nOn haematological review he was found to be emaciated, mildly pale, mildly dehydrated without significant peripheral lymphadenopathy. The chest was clinically clear, and the cardio-vascular system was stable. He has an enlarged spleen measuring 24 cm below the left coastal margin. Repeat haematological investigations revealed a PCV of 20.8%, WBC count of 48.8 \u00d7 109/L differentials were neutrophils 70%, lymphocyte 8%, monocyte 4%, band forms 2%, metamyelocyte 10% and myelocyte 6%. The platelet count was 769 \u00d7 109/L. The peripheral blood film showed 416 nucleated red blood cells (NRBC) per 100 WBC, macrothrombocyte, leuco-erythroblastosis, tear drop poikilocytes, target cells, fragment cells and hypogranular granulocyte with bizarre segmentation. Bone marrow aspiration (BMA) revealed myeloid:Erythroid reversal and increased megakaryocytopoiesis. Biopsy findings were consistent with increase dysplastic megakaryocyte and moderate fibrosis.\nThese laboratory and clinical findings led to a diagnosis of CML (accelerated phase) to rule out cellular phase of myelofibrosis (MF); thus, cytoreductive therapy was started with hydroxyurea (HU) for 3 months while awaiting results of molecular biologic test. The test turned out positive for BCR-ABL1 (e14a2/e13a2) 61.6%. The patient was then commenced on Imatinib at 400 mg once daily. However, response to Imatinib was sub-optimal; thus, JAK2 analysis was requested on the same sample, and it turned out to be positive for the JAK2 mutation (exon14V617F). He was then maintained on Imatinib, blood transfusion support, erythropoietin and regular follow-up, but the patient died in a peripheral hospital about 10 months after diagnosis.", "age": [ [ 60.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4314867.xml", "relevant_articles": { "23233636": "12", "32002188": "123", "30564468": "12", "25737999": "12", "30305076": "0" }, "similar_patients": { "6754873-1": "13", "7388081-1": "13", "6249888-1": "123", "4594041-1": "123", "6633400-1": "1" } }, { "human_patient_id": "498", "human_patient_uid": "5051059-1-M", "PMID": "27722118", "title": "A case of a pseudo colonic mass causing gastrointestinal bleeding in a patient with a left ventricular assist device", "patient": "RF is a 66-year-old male with a history of ischemic cardiomyopathy. The patient had a HeartMate II LVAD placed 3 years prior to presentation for medically refractory heart failure. He was on warfarin and aspirin for his LVAD with goal INR of 1.5\u20132.0. He presented to the emergency department with light-headedness and hematochezia for several days. He had no prior history of GIB. His physical examination and vital signs were unremarkable. His INR was 2.8, creatinine was 2.3 mg/dl, and hemoglobin was 10.4 from baseline of 12 to 13 g/dl. His last screening colonoscopy was 4 years prior and was reportedly unremarkable. He was admitted for close monitoring, serial laboratory testing, and gastroenterology consultation. He underwent esophagogastroduodenoscopy revealing a gastric ulcer with a clean base with no evidence of active bleeding. A colonoscopy revealed a likely malignant tumor in the cecum, diverticulosis, and nonbleeding colonic angiodysplastic lesions []. The cecal mass was biopsied; it appeared to be actively bleeding and uncontrollable endoscopically. These findings were relayed to the emergency general surgery team.\nHe was taken emergently to the operating room. A midline laparotomy was undertaken and he was found to have a cecal mass that was perforated into a retroperitoneal abscess. The right colon was mobilized to the hepatic flexure and the abscess cavity was debrided. A right colectomy was performed with a stapled side-to-side ileocolonic anastomosis. A drain was placed in the abscess cavity, fascia was closed, and the skin and subcutaneous tissues were packed with gauze.\nFinal pathology showed no evidence of malignancy. It revealed a transmural defect of 1.0 cm \u00d7 0.5 cm with organizing hematoma and acute on chronic inflammation. Cytomegalovirus testing was negative. There was focal re-epithelialization, thus making bleeding diverticulum a possible diagnosis.\nThe patient's postoperative course was complicated by prolonged ileus necessitating total parenteral nutrition and pelvic abscess that required percutaneous drain placement. The patient additionally had bacteremia and fungemia. The patient's postoperative complications eventually resolved, and he was discharged to home with home health.", "age": [ [ 66.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5051059.xml", "relevant_articles": { "24916983": "123", "27127437": "0", "21392850": "0", "15678643": "123", "30844969": "0" }, "similar_patients": { "8256897-1": "0", "4531180-1": "123", "3350215-1": "123", "7389889-1": "123", "8462868-1": "0" } }, { "human_patient_id": "499", "human_patient_uid": "3829108-1-M", "PMID": "24165224", "title": "Subtenon injection of natural leukocyte interferon \u03b1-2a in diabetic macular edema: a case report", "patient": "A 66-year-old man, affected by type II DM for 4 years and arterial hypertension for 10 years, developed severe non-proliferative diabetic retinopathy without macular edema just 2 years after DM diagnosis. The patient was treated with panretinal photocoagulation (PRP), because he had a poor glycometabolic control and was unable to adhere to a close follow-up. One year after PRP, he developed severe visual loss due to diffuse non tractional bilateral DME. Thus, the two eyes were treated with an IV triamcinolone injection 1 month apart (the right eye [RE] before the left eye [LE]) and laser grid photocoagulation was performed in both eyes 2 weeks after IV injection. After no visual recovery for over 2 months due to the persistence of macular edema in both eyes, an IV injection of bevacizumab was given in the RE, where a larger amount of intraretinal fluid and subfoveal neural detachment were observed. However, 1 week after the injection, anterior ischemic optic neuropathy (AION) with a residual visual acuity of hand motion was observed. During the entire period, the patient had poor glycometabolic control (glycated hemoglobin >9%, high hypertension, and hypercholesterolemia) and poor adherence to therapy. This fact could have influenced the patient\u2019s poor response to therapy and the development of AION.\nAs a result of this unfortunate adverse event, the patient refused an IV injection of bevacizumab in his LE. After informing the patient about the risks and benefits of different treatment options such as observation, off-label IV injections of steroids, and subtenon injections of IFN\u03b1, the patient signed an informed consent for a cycle of subtenon injections of IFN\u03b1.\nBefore the treatment, the BCVA in the LE was 20/200. The patient received posterior subtenon injections of IFN\u03b1 (1\u00d7106 IU/ml) three times (on Monday, Wednesday, and Friday) for a week in his LE, according to the following procedure: after the administration of topical 0.4% oxybuprocaine surface anesthesia, 1 ml of IFN\u03b1 was slowly injected into the inferotemporal quadrant under the Tenon\u2019s capsule, using a 27-gauge needle on a 2.5-ml syringe. The needle was moved toward the macular area, until the hub was firmly pressed against the conjunctival fornix. After the first injection, topical 0.3% netilmicin eye drops were prescribed three times a day for 7 days. During the period of IFN-\u03b1 therapy, the patient had a good systemic condition and a good glycometabolic control (glycated hemoglobin = 6.9%).\nA complete ophthalmic examination including BCVA, indirect ophthalmoscopy, and SD-OCT of the macular region was conducted several times throughout the period of IV injection and laser grid therapy and, specifically, preoperatively, as well as at 1 week, 1 month, 4 months, and 1 year after the last injection of INF\u03b1. SD-OCT images were obtained using Spectralis OCT spectral-domain (Heidelberg Engineering GmbH, Heidelberg, Germany) and the baseline macular scan was set as the reference (Figure \n). Fifteen months after the treatment, the BCVA in the LE was 20/40, with reduced cystoid macular edema but the SD-OCT highlighted the persistence of the photoreceptor inner segment/outer segment (IS/OS) disruption already highlighted at the baseline (Figure \n). The patient gives his written consent for the use of his data and any accompanying images.", "age": [ [ 66.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3829108.xml", "relevant_articles": { "24165224": "123", "25232337": "12", "26154736": "12", "23974665": "12", "23901262": "12" }, "similar_patients": { "5288508-2": "12", "5604409-1": "12", "4960716-1": "12", "7036532-1": "12", "6557065-1": "12" } }, { "human_patient_id": "500", "human_patient_uid": "3364478-1-M", "PMID": "22670198", "title": "Seminal Vesicle Involvement by Urothelial Carcinoma in Situ of the Bladder with Mucosal Spread Pattern: A Case Report", "patient": "A 75-year-old man was referred to Chungbuk National University Hospital owing to urinary frequency. He had a history of transurethral resection of the bladder for invasive urothelial carcinoma 8 years previously. The tumor was of a low grade and invaded the subepithelial connective tissue. However, proper muscle involvement was not evaluable because the specimen had no proper muscle component. The patient had been treated with Bacillus Calmette-Guerin (BCG) and had lived without recurrence. The patient underwent a transurethral biopsy under the clinical impression of recurrent urothelial cancer. There was widespread urothelial carcinoma in situ; therefore, radical cystoprostatectomy with orthotopic bladder substitution (Ghoneim) was carried out. Grossly, the mucosal surface of the urinary bladder showed multifocal flat erythematous lesions, and there were no remarkable lesions in the remainder. The microscopic findings showed multiple urothelial carcinoma in situ lesions throughout the mucosa of the urinary bladder and both ureters (). The left seminal vesicle was covered by large polygonal tumor cells, which were confined to the mucosa in single to several layers (). The tumor cells had large and hyperchromatic nuclei with distinct nuclear membranes and relatively abundant eosinophilic cytoplasm. In addition, bizarre-shaped tumor cells showing irregular hyperchromatic or smudged nuclei were occasionally identified. The tumor cells mostly involved the mucosa between the epithelial cells and the basal lamina of the seminal vesicle, a feature that is referred to as pagetoid spread. In some areas, the entire thickness of the mucosa was replaced by tumor cells. The mucosa of the ejaculatory duct and adjacent prostatic acini and duct were also scattered with tumor cells (). On the basis of the overall findings, we considered that the urothelial carcinoma in situ of the urinary bladder revealed mucosal spread to the seminal vesicle along the ejaculatory duct. In addition, there was an incidental prostatic adenocarcinoma, which was a small, solitary lesion with a Gleason score of 6. At the time of the surgery, the patient's serum prostate-specific antigen level was 0.87 ng/ml. The patient had no evidence of disease for 5 months after surgery.", "age": [ [ 75.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3364478.xml", "relevant_articles": { "22670198": "123", "32192274": "123", "11199158": "0", "18536309": "123", "25124389": "123" }, "similar_patients": { "3118316-1": "13", "7577816-1": "123", "3920611-3": "13", "6626396-1": "13", "3920611-4": "13" } }, { "human_patient_id": "501", "human_patient_uid": "7607043-1-M", "PMID": "33163444", "title": "Rapidly Progressive Atypical Vertebral Hemangioma: A Case Report", "patient": "A 57-year-old male patient was admitted to our department with continuous back pain without any traumatic episode. The pain persisted for several months but progressively worsened with activity or while in the standing position with relief when lying down. A computed tomography (CT) scan and magnetic resonance imaging (MRI) was performed to rule out a compression fracture. The CT revealed a characteristic \u2018polka dot\u2019 pattern of the trabecular thickening involving the whole T12 vertebral body. The MRI showed the mass was high signal intensity on the T2 weighted images and low signal intensity on the T1 weighted images without epidural extension (). These findings resulted in the diagnosis of a vertebral hemangioma. Conservative treatment, including analgesic and anti-inflammatory drugs, physiotherapy, and epidural steroid injections, was performed. However, the patient complained of progressively worsening back pain over the following 2 months and re-visited our institute.\nThe CT and MRI took 2 months later, demonstrated an expansile mass involving the vertebral body and the posterior element with epidural extension and cord compression at the T12 (). A preoperative embolization and vertebrectomy with reconstruction are recommended for aggressive vertebral hemangiomas. However, given the patient's intact motor power, a less invasive procedure was performed. The patient underwent intraoperative vertebroplasty and percutaneous screw fixation.\nThe patient received about 4 mL's of polymethylmethacrylate injected into the T12 vertebral body, followed by percutaneous screw fixation to prevent tumor growth and to enhance stability (). The pathological diagnosis was consistent with epithelioid hemangioendothelioma, which is an aggressive vertebral hemangioma (). After surgery, the patient's back pain improved dramatically, and he was transferred to the hemato-oncological department for low-dose radiotherapy. No further tumor growth was observed over 4 years after the procedure.", "age": [ [ 57.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC007xxxxxx/PMC7607043.xml", "relevant_articles": { "33163444": "123", "33598343": "123", "34897610": "123", "22071649": "123", "22828699": "0" }, "similar_patients": { "4518427-1": "123", "7397391-1": "12", "3550428-1": "123", "6504302-1": "123", "2826736-1": "0" } }, { "human_patient_id": "502", "human_patient_uid": "7683915-1-M", "PMID": "33213249", "title": "Compound heterozygosity for hemoglobin variant Hb-Broomhill and the Southeast Asian \u03b1-thalassemia deletion does not worsen outcome: a case report of two unrelated patients", "patient": "Case 1 is a 32-year-old woman originating from Yunfu City in Guangdong Province, China. She was referred to our hospital for a routine prenatal examination at the 18th week of gestation and then underwent thalassemia screening. Case 2 is a 51-year-old man from Guangzhou City in Guangdong Province. He attended our hospital for routine partner testing for thalassemia. These two cases were from unrelated families. Both agreed to participate in our study and signed informed consent forms. All studies were approved by the Ethics Committee of Guangdong Women and Children Hospital.\nBlood samples were collected and hematological parameters were determined using a Sysmex XN5000 automated hematology analyzer (Sysmex Corporation, Kobe, Japan). Hb analysis was conducted with an automated capillary 2 electrophoresis system (Sebia, Lisses, France). Genomic DNA was extracted from peripheral blood leukocytes using the Lab-Aid 820 automation system (Zee San Biotech Company, Fujian, China). Twenty-three mutations common in individuals from southern China were routinely measured in our laboratory by a suspension array system, as previously described. \u03b11-, \u03b12-, and \u03b2-globin genes were independently amplified by PCR using previously described primer pairs, then PCR products were purified and sequenced by Sangon Biotech Co., Ltd. (Shanghai, China). The sequences were compared with National Centre for Biotechnology Information reference sequences (HBA1: NC_000016.10: 176680-177522; HBA2: NC_000016.10: 172876-173710; HBB: NC_000011.10: 5225464-5227071) using Sequence Scanner software (Applied Biosystems).\nHematological indices and genotypes are summarized in . Both samples showed characteristics of microcytic and hypochromic erythrocytes. Iron deficiency was excluded (data not shown). In both cases, capillary electrophoresis (CE) revealed an abnormal Hb X fraction which was close to the Hb A peak and easily identified, even if partial overlap persisted (). The suspension array system determined that both cases carried heterozygous (- - SEA/) deletions for \u03b1-thalassemia and were negative for \u03b2-thalassemia (data not shown). DNA sequencing detected a substitution (HBA1: c.343C>G) at codon 114 of HBA1 that was previously reported as Hb Broomhill (), which was consistent with CE results. No other mutation with clinical significance was observed in either of the cases. Eventually, the two patients were diagnosed with compound heterozygosity for Hb Broomhill and the (- - SEA/) \u03b1-thalassemia deletion.", "age": [ [ 32.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC007xxxxxx/PMC7683915.xml", "relevant_articles": { "33213249": "12", "28945175": "12", "26193976": "12", "21250886": "12", "32986258": "12" }, "similar_patients": { "8326627-1": "1", "6378710-1": "1", "8194298-1": "1", "8281434-1": "1", "5613431-1": "1" } }, { "human_patient_id": "503", "human_patient_uid": "6220751-1-M", "PMID": "30498606", "title": "Gastrointestinal Bleeding Secondary to Portal Hypertensive Duodenopathy in a Patient with Decompensated Liver Cirrhosis", "patient": "A 46-year-old male with a history of alcoholic liver cirrhosis complicated by small esophageal varices after banding and moderate ascites was awaiting liver transplant (MELD 24, Child-Pugh class B). He presented with a 3-day history of abdominal pain. He described the pain as sharp and located around the periumbilical area with notable suprapubic discomfort. He also reported associated symptoms of nausea, hematochezia, and general malaise. On further review of systems, he reported chills, increased fatigue, shortness of breath, lightheadedness, and decreased appetite 4 days prior to presentation. He reported compliance at home with a sodium-restricted diet and medications. Physical exam was significant for abdominal distension with positive fluid wave, generalized abdominal tenderness, and splenomegaly. Scant blood was noted on the rectal exam. Laboratory studies revealed stable hemoglobin of 12.4 g/dL, hematocrit of 36.8%, platelet of 83 K/UL, leukocytosis of 15.4 K/UL with 78% neutrophils and 16% bands, sodium of 130 mmol/L, ammonia of 83 Umol/L, ALT of 40 U/L, AST of 42 U/L, and alkaline phosphatase of 127 U/L. International normalized ratio (INR) was 2.02. Diagnostic paracentesis revealed serosanguinous fluid and ascitic fluid polymorphonuclear neutrophils (PMN) count of 686 cells/mm3, consistent with culture negative neutrocytic ascites. Blood cultures revealed no growth of organisms. The patient was started on intravenous (IV) ceftriaxone, IV pantoprazole infusion, and an IV bolus of octreotide followed by continuous infusion. He completed a 5-day course of IV ceftriaxone therapy.\nThe patient underwent an esophagogastroduodenoscopy (EGD) which showed ulcerations in the distal esophagus from prior banding of small esophageal varices and diffuse portal hypertensive gastropathy (). Mucosal edema and erythema with an area of oozing of blood were identified in the duodenum bulb and between proximally located duodenal folds with no specific identifiable lesion. These findings correlated with a diagnosis of portal hypertensive duodenopathy (). Colonoscopy was performed, and it showed no active bleeding. However, there were old blood clots in the terminal ileum in addition to mild inflammation in the terminal ileum near the ileocecal valve. Video capsule endoscopy was also performed, and it revealed no active bleeding. Because of the concern of the possible failure of the patient on medical therapy for portal hypertension while awaiting liver transplant, the patient was referred for evaluation by a transjugular intrahepatic portosystemic shunt (TIPS). The patient successfully underwent the TIPS procedure. Follow-up occurred one month later in clinic. At this time, the patient reported resolution of the hematochezia.", "age": [ [ 46.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6220751.xml", "relevant_articles": { "33381333": "123", "21371340": "123", "15447756": "12", "8549262": "123", "19673028": "12" }, "similar_patients": { "8454251-1": "12", "8175418-1": "12", "8605961-1": "12", "6197016-1": "0", "6497512-1": "1" } }, { "human_patient_id": "504", "human_patient_uid": "6346692-1-M", "PMID": "30673931", "title": "Left colic artery aneurysm rupture after stent placement for abdominal aortic aneurysm associated with neurofibromatosis type 1", "patient": "A 67-year-old female with NF1 presented with lumbago, cold sweats, and sudden onset weakness, which necessitated an emergency transfer to our institution. She had no significant past medical history, was negative for hypertension, and was on no regular medications. She was hypotensive (systolic blood pressure = 60 mmHg) and tachycardic on arrival. An abdominal contrast computed tomography (CT) scan showed a rupture of an abdominal aortic aneurysm (AAA) with communication between the aneurysm and the inferior vena cava (IVC) (Fig. a, b). The maximum dimensions of the ruptured AAA and IVC were 34 mm and 37 mm, respectively. The aortic rupture was located 7.5 cm distal to the renal artery and 2.5 cm proximal to the bifurcation of the aorta (Fig. c). Due to the difficulty of primarily closing the ruptured IVC, we planned an endovascular treatment to control the bleeding from the IVC by exclusion of the ruptured AAA. The diameter of normal proximal aorta was 16 mm, which was too narrow to place a normal Y-shaped graft. Moreover, there was insufficient time to prepare another stent in emergency. Therefore, we instead deployed an ENDURANTII (Medtronic Vascular, Santa Rosa, CA, USA) iliac extension proximal to the terminal aorta that was long enough to insert three or more stents (Fig. d). As the bleeding from the AAA and the communication between the aneurysm and the IVC were not well controlled, we placed an EXCLUDER (W.L. Gore & Associates, Flagstaff, AZ, USA) cuff in the ENDURANTII iliac extension. Although a type IV endoleak was detected on angiography, the patient\u2019s hemodynamics stabilized. We therefore decided to conclude the operation at this point and re-assess the endoleak in a few days.\nAn abdominal contrast CT performed 3 days after the operation showed a type Ib endoleak and injury to the distal abdominal aorta (Fig. a). This led to a redo-EVAR 4 days after operation. This included deploying an AFX (Endologix, Inc., Irvine, CA, USA) graft, as well as an infrarenal cuff, as the AFX head did not fit exactly within the stent placed in the primary operation. We also performed coil embolization treatment of the left internal iliac artery aneurysm (Fig. b), which was identified initially (Fig. b). We confirmed no endoleak at the final angiography. An abdominal contrast CT performed 18 days after the primary operation showed two new sequential aneurysms of the LCA, which were not previously detected. Coil embolization was planned to address these new aneurysms.\nTwenty-two days after primary operation, however, the patient presented with new onset nausea, left abdominal pain, and hypotension. Her systolic blood pressure was 50 mmHg. She was resuscitated and required vasopressor support. Laboratory tests, including leukocyte count and electrolytes, were normal. The serum C-reactive protein and D-dimer were elevated to 0.37 mg/dl (normal range 0.01\u20130.30) and 6.8 \u03bcg/ml (normal range 0.0\u20131.0), respectively. We considered potential bleeding from nearby arteries, including the inferior mesenteric artery (IMA) and lumbar artery [, ]. An abdominal contrast CT showed enlargement of LCA aneurysms and surrounding hematoma (Fig. a\u2013c), establishing the diagnosis of rupture of the LCA aneurysms. Emergency exploratory surgery was performed.\nWe gained access through a midline abdominal incision. Active bleeding was encountered intraperitoneally and controlled with compression. As a result of the patient\u2019s initial AAA rupture, residual hematoma was present, which extended along the entire left abdomen and retroperitoneum (Fig. a). In addition, the AAA stent endograft had resulted in a left laterally displaced aorta, narrowing our operative field. Due to her distorted anatomy, active bleeding, and clinical condition, we elected to perform a left hemicolectomy. We divided the inferior mesenteric artery (IMA) 3 cm distal to the IMA root to not to injure the recently repaired aorta. We divided the colon at the rectosigmoid junction. Proximally, we divided the colon at the middle of the transverse colon (Fig. b). The mesentery was divided to include the LCA aneurysms. Given her clinical condition, we elected to not perform a colorectal anastomosis, but instead performed a Hartmann\u2019s procedure with an end transverse colon colostomy. The surgery took 145 min, and the estimated blood loss was 4.5 L. Packed red blood cell transfusion volume was approximately 1.96 L, and fresh frozen plasma volume was 1.44 L.\nIn reviewing the specimens, a 2-cm aneurysmal sac and 1-cm aneurysmal sac were identified in the LCA. No thrombus was identified (Fig. a, b). No ischemic changes and no tumor were observed in the excised colon (Fig. c). Interestingly, fibrous tissue around the left colic artery stained positive for S-100 protein, suggesting that neurofibroma from NF1 might have been associated with the rupture of these aneurysms due to weakened integrity of the vascular walls (Fig. a\u2013e). A follow-up abdominal CT showed no recurrence of the endoleak. The patient was discharged 37 days after the last operation without any other post-operative complications.", "age": [ [ 67.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6346692.xml", "relevant_articles": { "30673931": "13", "32827677": "13", "14723567": "13", "14670014": "123", "20413255": "123" }, "similar_patients": { "5684157-1": "123", "4797187-1": "123", "7991712-1": "123", "6741388-1": "123", "8349994-1": "123" } }, { "human_patient_id": "505", "human_patient_uid": "4274717-1-M", "PMID": "25511019", "title": "Kimura\u2019s disease of the lacrimal gland mimicking IgG4-related orbital disease", "patient": "A 47-year-old Chinese man presented to our department of ophthalmology with a 26-month history of left upper eyelid painless swelling and redness. The patient was initially treated with a course of intravenous penicillin, which resulted in temporary regression of the lesion. There had been no similar family history of this appearance to date.\nPhysical examination revealed that the left lacrimal gland was obviously swelling, which presented with a soft, non-tender and smooth-surfaced. Slit lamp examination was otherwise unremarkable aside from bilateral mild cataract. Laboratory testing revealed a white blood cell count of 9.8 \u00d7 10-9/L with 15.91% eosinophils(normal range: 0.05-0.5 \u00d7 10-9/L). Serum concentration of immunoglobulin E was elevated at 469.3 IU/ml, and immunoglobulin G4 was 295 mg/dL (normal range less than 135 mg/dL). Magnetic resonance imaging (MRI) examination of the orbit showed that the left lacrimal gland was lobulated with a distinct margin and was predominantly isointense on T1-weighted images. Isointense on T2-weighted images and an obvious heterogeneous enhancement on contrast-enhanced MRI images are shown in Figure . The chest radiograph was normal and no cervical lymph nodes were palpable.Next, we advised the patient to be hospitalized and the patient underwent an orbital biopsy. Intraoperative frozen sections were reported as being consistent with a benign tumor. Therefore, a complete resection was undertaken. Perioperatively, it was noted that the mass had a smooth and homogeneous grey appearance. There was no evidence of haemorrhage or cystic change and borders were indistinct. A definite diagnosis of KD was made by histopathology and immunohistochemical examinations of representative resected specimens after surgery. Histopathological examination demonstrated follicular hyperplasia with evidence of reactive germinal centres. Eosinophilic infiltration, involving the interfollicular areas, and proliferation of post capillary venules were observed. These features enabled a diagnosis of KD to be made (Figure A). Further analysis, including immuohistochemistry, was undertaken, demonstrating positive staining for CK, Vimentin, CD3, CD4, CD20, CD21, CD117, CD5, CD8, CD23, IgG and IgG4 (30 per high-power field) and negative staining for CD10 and CD34 (Figure B), the ratio of IgG4 to IgG positive cells was about 35%. The pathological diagnosis, which was also the final diagnosis, was KD. However, some ophthalmologists questioned whether the histological and immunohistochemical findings were also had common features with IgG4-related disease, which is a newly recognized fibro-inflammatory condition characterized by tumefactive lesions, a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis, and elevated serum IgG4 concentrations.\nThe patient was discharged following his surgery and treated with prednisone 25 mg/day for four weeks and then reduce by 5 mg/day every two weeks. His symptoms gradually improved. Serum immunoglobulin E (IgE) levels dropped to 125.9 IU/mL and eosinophil\u2019s decreased to 0.69 \u00d7 109/L after 2 months. There was no sign of recurrence in twelve months of regular follow-up.", "age": [ [ 47.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4274717.xml", "relevant_articles": { "25511019": "0", "21757831": "123", "28367391": "123", "33108358": "12", "22827716": "12" }, "similar_patients": { "8130254-1": "123", "3080319-1": "0", "6868811-1": "123", "5446720-1": "0", "5086477-1": "123" } }, { "human_patient_id": "506", "human_patient_uid": "5314602-1-M", "PMID": "28209139", "title": "Stroke caused by an inflammatory thrombus: a case report", "patient": "A 46-year-old male visited the emergency department of our hospital on April 23, 2015 due to fever and headache for three days and impaired memory for half a day. The patient had experienced fever three days before, with a peak body temperature of 38.5 \u00b0C. No other discomfort was described. He had visited other hospitals before and was diagnosed with an upper respiratory infection based on haematological findings. However, his condition did not improve after treatment with intravenous levofloxacin. Within a half a day, he developed impaired memory, concomitant with speech disturbance, poor response, no significant limb movements and convulsions before being referred to the emergency department of our hospital. The patient had no medical history. No histories of food and drug allergies were obtained. The patient denied any prior history of smoking, heavy drinking or drug abuse. On arrival, the initial physical examination revealed the following: body temperature 38.0 \u00b0C, pulse 100 beats/min, respirations 26 breaths/min, blood pressure 144/76 mmHg, delirium, speech disturbance, equal size and round shape of bilateral pupils with diameters of approximately 3.0 mm, sensitive to light reflex, basically normal cranial nerve examination, limb muscle strength Grade V, negative bilateral pathological signs, and no ataxia. The patient\u2019s neck was soft, and there were no signs of meningeal irritation. No significant findings were found on the cardiopulmonary and abdominal examinations. No skin rashes or bleeding sites were observed after examining the entire body. The laboratory test results were the following: haematology: white blood cells (WBC), 12.5 \u00d7 109/L, neutrophil percentage, 87.6%; C-reactive protein (CRP), 56 mg/L; procalcitonin (PCT), 2.8 ng/mL; and D-dimer, 3.2 \u03bcg/mL. A chemistry panel and screens for infectious diseases and cardiac markers were generally normal. No abnormal findings were observed on chest X-ray or electrocardiogram. Brain computed tomography (CT) showed a curved high-density mass at the left sylvian fissure area and an ischemic lesion of the left temporal lobe (Fig. ).\nAs an emergency diagnosis, massive cerebral infarction (probable atherosclerosis of the left internal carotid artery system) was considered, and intracranial infection could not be excluded; appropriate treatments included aspirin for anti-platelet aggregation, atorvastatin for lipid regulation and plaque stabilization, and cefuroxime and acyclovir for anti-infection.\nThe patient experienced aggravated unconsciousness after two hours of admission, and physical examination showed the following: lethargy, aphasia, equal size and round shape of bilateral pupils with diameters of approximately 3.0 mm, sensitive to light reflex, shallow right nasolabial folds, immobilization of right limbs upon orbital pressure, movable left limbs, positive right pathological signs and negative left pathological signs. Further revascularization therapy was considered, and the patient was immediately transferred to undergo brain magnetic resonance imaging (MRI). On the way to the radiology department, the patient experienced further aggravation of unconsciousness and entered a light coma, concomitant with limb seizure, gazing to the left of bilateral eyes, equal size and round shape of bilateral pupils with diameters of approximately 2.0 mm, and disappearance of the light reflex. Appropriate treatments included midazolam for epilepsy, mannitol for dehydration and intracranial hypotension. After termination of the seizure, re-examination of the brain CT showed a curved high-density mass at the left sylvian fissure area and a massive low-density area in the left temporal lobe with many high-density plot areas scattered within it. CT images also showed compressed deformation of the left ventricle and a shift of the brain midline to the right (Fig. ). Considering that the patient developed haemorrhagic transformation, he was admitted to the emergency intensive care unit for further management.\nEighteen hours after admission, the patient experienced further aggravation of unconsciousness and entered a moderate coma, concomitant with high fever (body temperature 39.9 \u00b0C), bilateral pupils: left versus right = 5.0 mm versus 3.0 mm, respectively, disappearance of the light reflex, increased muscle tone of the right limbs, and positive pathological signs of bilateral limbs. The brain CT re-examination showed expansion of the bleeding area, with overt signs of brain herniation. The patient underwent emergency left frontal temporal craniotomy, removal of the intracranial hematoma and a decompressed craniotomy performed by neurosurgeons. The intraoperative findings were as follows: dark red appearance of the left temporal brain tissue, concomitant with subarachnoid haemorrhage (SAH); an ostomy of approximately 0.2 cm was created along the left temporal sulcus; a visible purple blood clot was observed, concomitant with surrounding contused brain tissues; and a large vascular embolization could be observed in the hematoma cavity. Approximately 10 mL of the hematoma and contused brain tissues were removed and sampled for pathological evaluation. Histopathological examination showed haemorrhage, oedema and inflammatory changes in brain tissues, neutrophil infiltration into the vascular walls and surrounding tissues, and microvascular purulent thrombosis (Figs. \u2013). The patient was transferred to the neurologic intensive care unit for further treatment after the operation. During the course of the treatment, negative findings were found for Chlamydia pneumoniae, mycopsslasma, influenza, tuberculosis, the TORCH panel, hepatitis B, hepatitis C, syphilis and human immunodeficiency virus (HIV); the sputum culture was negative, and the blood culture suggested Staphylococcus aureus. No abnormal findings were found on chest X-ray or ultrasound. In addition, two transthoracic echocardiography (TTE) examinations were normal, and there were no observations of valvular dysfunction or neoplasm. The following final diagnosis was considered: massive cerebral infarction, consistent with haemorrhagic transformation (the left internal carotid artery system, inflammatory thrombus), Staphylococcus aureus sepsis and symptomatic epilepsy. After two months of vancomycin anti-infective treatments and supportive and symptomatic treatment, the consciousness of the patient improved gradually, and several blood cultures were negative. He underwent rehabilitation and was discharged from the hospital on the 72nd postoperative day (POD). At discharge, his Glasgow Coma Scale (GCS) was E4V4M6, and the modified Rankin scale score was 3.", "age": [ [ 46.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5314602.xml", "relevant_articles": { "10689697": "12", "6752743": "0", "29245300": "123", "7150452": "0", "33505277": "12" }, "similar_patients": { "7187894-1": "13", "6799848-1": "13", "7723034-1": "0", "8383711-1": "0", "3638277-1": "123" } }, { "human_patient_id": "507", "human_patient_uid": "4196304-1-M", "PMID": "25328316", "title": "Parotid angiofibroma", "patient": "A 54-year-old male reported to our department with history of swelling over the right side of face since 5 years. The patient reported insidious onset of swelling with a gradual progress to the present size. He also reported mild, intermittent, and dull pain in the region of swelling.\nClinical examination confirmed a solitary, oval, well-defined swelling measuring approximately 7 \u00d7 5 cm in the preauricular region []. The surface over the swelling was smooth without any secondary changes. It extended superioinferiorly from the level of outer canthus of the eye to inferior border of mandible and anterioposteriorly extended from 2 cm in front of anterior border of ramus to the mastoid notch []. On palpation, the swelling was firm, non-tender, free from skin, and mobile over the underlying structures. Mild pulsations could be appreciated from the swelling. There was no weakness of facial muscles or enlargement of swelling during mastication.\nUltrasonography revealed a large lobulated solid mass of 6 \u00d7 4 cm in the right parotid region with multiple vessels with low velocity flow and without any areas of calcification or cystic changes. Findings were suggestive of a low-grade vascular tumor.[] Computed tomography scan with contrast medium revealed a large well-circumscribed, solitary isodense lesion measuring 6.36 \u00d7 4.39 cm []. It was observed to be extending anteriorly over the superficial lobe of the parotid gland, with anterior displacement of parotid gland. A diagnosis of mixed parotid tumor was made.[] FNAC revealed numerous vascular channels with occasional singly scattered and single cluster of plump spindle cells. Based on these findings, a lesion of vascular origin was suggested.\nClassical superficial parotidectomy was performed under general anesthesia using a modified Appiani incision. Tumor mass was dissected anteriorly and excised along with the superficial lobe of parotid gland []. Facial nerve was located using the anterograde method and all the branches of facial nerve were preserved. Post-operative recovery was uneventful. Upon six months of follow up, facial nerve function was intact and no sign of reoccurrence was observed.\nHistopathological sections revealed connective tissue with numerous vascular spaces of variable sizes ranging from small capillary-like vessels to partly lined vessels. Around the endothelial cells, few vascular spaces showed a rim of circumscribed smooth muscle cells. The supporting connective tissue stroma appeared immature and fibromyxoid with sparse cellularity. Cells were plump or stellate-shaped with mild inflammatory cell response and composed predominantly of plasma cells and a few lymphoid follicles []. Immunohistochemistry revealed strong uptake of CD34 in the endothelial cells [].[] Findings were suggestive of a vascular lesion compatible with diagnosis of ENA.", "age": [ [ 54.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4196304.xml", "relevant_articles": { "30034966": "123", "12498313": "123", "12753995": "123", "18985000": "123", "29184599": "123" }, "similar_patients": { "4989566-1": "123", "7481918-1": "123", "6327801-1": "123", "4451658-1": "123", "4687212-1": "123" } }, { "human_patient_id": "508", "human_patient_uid": "3069581-1-M", "PMID": "21468269", "title": "A Case of Sheehan's Syndrome that Manifested as Bilateral Ptosis", "patient": "The patient was a 51-yr-old woman with swelling of the extremities and bilateral ptosis on March 8, 2010. She complained of exertional dyspnea and weakness. She married at the age of 25. After that time, she developed drooping of her eyes, with the left eye drooping more than the right eye. Her symptoms persisted and they had gradually increased during about the last 10 yr. About 8 yr ago, she underwent a ptosis repair operation at a local clinic, but her symptoms were not improved. She denied a history of loss of consciousness, headache, dysphagia, dysarthria and myalgia. There was no family history of similar symptoms and no history of trauma. There was no previous history of diabetes and hypertension.\nOn examination, she was determined to be 151 cm in height and 48 kg in weight. The initial vital signs were a blood pressure of 140/80 mmHg, a pulse rate of 68 beats/min and a respiratory rate of 20/min. She was lethargic and had facial puffiness and no goiter. The lung and heart examinations were unremarkable. All the extremities showed pitting. She had marked bilateral ptosis, while the external ocular movements were normal (). The other cranial nerve examinations were unremarkable.\nThe laboratory findings were a total leucocyte count 4.75 \u00d7 103/\u00b5L with 61.6% polymorphs, a hemoglobin level of 9.0 g/dL, the random blood glucose was 124 mg/dL, the serum sodium was 130 mM/L, the potassium was 3.7 mM/L, the blood urea nitrogen (BUN) was 13 mg/dL, the creatinine was 0.8 mg/dL, the aspartate transaminase (AST) was 81 IU/L, the alanine transaminase (ALT) was 29 IU/L, the total bilirubin was 0.93 mg/dL, the creatine kinase (CK) was 1,195 IU/L (normal reference: 20-180 IU/L ), the lactate dehydrogenase (LDH) was 517 IU/L (normal reference: 101-218 IU/L), the total cholesterol was 256 mg/dL, the triglyceride was 121 mg/dL, the high density lipoprotein cholesterol (HDL-C) was 40 mg/dL and the low density lipoprotein cholesterol (LDL-C) was 196 mg/dL. The urinary analysis was negative for blood and protein with using a dipstick. As the clinical findings suggested hypothyroidism and myasthenia gravis, a thyroid function test and acetylcholine receptor binding antibody test were done. The serum T3 was 0.195 ng/mL (normal reference: 0.86-2.02 ng/mL), the free T4 was 0.08 ng/dL (normal reference: 0.93-1.705 ng/dL), the thyroid-stimulating hormone (TSH) was 2.08 \u00b5IU/mL (normal reference: 0.27-4.2 \u00b5IU/mL), the antimicrosomal antibody was 17 IU/mL (normal reference: 0-34 IU/mL), the antithyroglobulin antibody was 20.1 IU/mL (normal reference: 0-114 IU/mL) and the acetylcholine receptor binding antibody was negative.\nSecondary hypothyroidism was suspected. We performed a careful history taking and other pituitary hormone evaluations. At the age of 26 the patient delivered her daughter and she had a history of massive postpartum vaginal bleeding. Thereafter she not resumed menses. The basal levels of other hormones were a serum cortisol of 4.03 \u00b5g/dL, the adrenocorticotropic hormone (ACTH) was 29.64 pg/mL, the growth hormone (GH) was 0.06 ng/mL, the IGF-1 was 25 ng/mL (normal reference: 71-263 ng/mL), the prolactin was 1.59 ng/mL, the luteinizing hormone (LH) was 1.49 IU/L, the follicle-stimulating hormone (FSH) was 4.91 IU/L, the E2 was 17.29 pg/mL and the testosterone was 0.02 ng/mL. The combined pituitary stimulation test, including the insulin tolerance test, the thyrotropin-releasing hormone (TRH) stimulation test and the gonadotropin-releasing hormone (GnRH) stimulation test showed panhypopituitarism (). Brain magnetic resonance imaging (MRI) showed a finding of an empty sella turcica and there was no evidence of an intracranial mass, hemorrhage and aneurysm ().\nNerve conduction study (NCS) and electromyography (EMG) of the limbs reveled normal results with the exception of incidentally detected carpal tunnel syndrome. Needle EMG of the orbicularis oculi showed no evidence of dysfunction of the neuromuscular junction.\nWe diagnosed her as having Sheehan's syndrome, bilateral ptosis and subclinical myopathy caused by secondary hypothyroidism. Replacement with prednisolone of 10 mg/day and thyroxine (T4) 100 \u00b5g/day was started. The dose of prednisolone was decreased to 5 mg/day after 4 weeks. At 3 months follow-up, she had become euthyroid with normalized muscle enzymes. She recovered from her presenting symptoms and the bilateral ptosis was much improved ().", "age": [ [ 51.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC003xxxxxx/PMC3069581.xml", "relevant_articles": { "23329774": "0", "19099165": "123", "28357106": "0", "17724362": "0", "15927337": "123" }, "similar_patients": { "3443729-1": "123", "4027082-1": "123", "4504997-1": "123", "3992346-1": "123", "3461311-1": "123" } }, { "human_patient_id": "509", "human_patient_uid": "4746356-1-M", "PMID": "26925283", "title": "Foreign Accent Syndrome, a Rare Presentation of Schizophrenia in a 34-Year-Old African American Female: A Case Report and Literature Review", "patient": "The patient was a 34-year-old African American US-born single female. At the time of the investigation she was unemployed and lived temporarily with her mother, who had a history of paranoid schizophrenia. The patient was brought to the psychiatry emergency room by ambulance for evaluation of aggression. Upon presentation, the patient described an altercation with her mother's landlady, hitting her numerous times in the face with a closed fist. The patient started the altercation because she felt that the landlady practiced voodoo and had cursed her, causing her hair to fall off. She described an overwhelming rage prior to the physical assault. The patient did not show any remorse for her actions: \u201cI hate her,\u201d \u201cI did the right things,\u201d and \u201cShe is evil\u201d are examples of statements made by the patient. Collateral information from the patient's mother revealed that the patient had not been compliant with her medications. She refused to follow up with outpatient care after the last inpatient admission ten months previously. The patient denied auditory hallucinations but appeared to be internally preoccupied. She denied visual and tactile hallucinations, thought insertion, and thought broadcasting. She reported an unchanged pattern of sleep and appetite, which she described to be \u201cgood.\u201d Prior to this episode, the patient had been under economic and emotional stress. She lost her job as a nurse aide five months earlier and had not been able to secure another job since then. The patient broke up with her fianc\u00e9e ten months previously after cutting her fianc\u00e9e's stepfather's face following verbal altercation. There was no symptom suggestive of mania, seizure disorder, head trauma, loss of consciousness, cerebrovascular accident, Parkinson's disease, anxiety, or other organic brain disorder. The patient denied use of nicotine, alcohol, and other psychoactive substances currently or in the past. The patient had her first inpatient psychiatry admission for acute exacerbation of paranoid schizophrenia and FAS ten months earlier. She was then treated with risperidone tablets with improvement including change in accent on discharge, when she was less psychotic. The patient had a family history of sickle cell disease (brother had sickle cell disease) and schizophrenia (brother, mother, and uncle had schizophrenia). Birth and developmental history were unremarkable. There were no reported behavioral or learning disabilities, and the patient denied being a victim of emotional, physical, or sexual abuse. She had some college education and worked as a nurse aide up till five months prior to presentation to the hospital.\nMental status examination showed a middle-aged, well-groomed, dark-haired woman with poor eye contact and in no apparent distress. The patient was tangential and preoccupied with \u201cvoodoo\u201d and was deeply paranoid of her neighbors and her mother's landlady. Auditory hallucinations were not elicited, and she denied suicidal ideation at the time of evaluation. The patient continued to endorse homicidal ideation towards her mother's landlady. She was awake, alert, orientated in time, place, and person, and attentive and had good concentration but had poor impulse control. Her insight and judgment were impaired. Immediate recall and short- and long-term memory were intact.\nThe physical examination of the patient showed no significant pathological findings. Laboratory investigations were unremarkable. Electroencephalogram showed no seizure activity. Structural magnetic resonance imaging (MRI) and MR angiography of the head were both unremarkable.\nThe patient presented with a British-like accent, despite never having lived in Britain, and was therefore investigated by a speech therapist. There was no phonetic problem or grammatical errors, but there was a problem with prosody, including prominence of the pitch of the words and syllables. The patient's pitch range was narrow, as she sparingly expressed any emotions during speech. Her speech was monotonous, hesitant, and of low volume. She substituted \u201cth\u201d for \u201cf\u201d and \u201cw\u201d for \u201cwh\u201d as well as \u201ct\u201d for \u201cd\u201d and \u201cai\u201d for \u201cei.\u201d\nThe patient was diagnosed according to DSM-V criteria with paranoid schizophrenia, chronic condition with acute exacerbation, and in addition FAS. The diagnosis of schizophrenia was made based on disorganized speech, specifically tangentiality, paranoid delusions, and grossly disorganized behavior, which lasted for more than ten months and affected the level of functioning, specifically with regard to interpersonal relations and occupation. This was determined not to be due to illicit drug use or known medical illness.\nThe patient was discharged from the previous hospitalization ten months earlier with a prescription of disintegrating tablets of risperidone. However, she was not compliant with this compound after discharge and also refused to take it during the second hospital admission described here. The patient agreed to take olanzapine tablets to address her psychosis. She was offered a readily dissolvable formula, as we had concern she was \u201cchecking\u201d her medications to spit out after administration. However, the patient refused to take any other medication than conventional olanzapine tablets. The olanzapine serum concentration could not be controlled, because the patient became more delusional and refused further blood work. The patient continued to have psychotic symptoms and her foreign accent remained unchanged. She refused augmentation with any other antipsychotic medication because of paranoia. In the course of treatment, the patient continued to endorse homicidal ideation, paranoid ideation towards her mother's landlady, and still spoke in a British accent. In view of unremitting psychotic symptoms, she was transferred to a long-term psychiatric inpatient facility.", "age": [ [ 34.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4746356.xml", "relevant_articles": { "26703328": "0", "34223460": "123", "27141698": "0", "21660520": "0", "12690544": "0" }, "similar_patients": { "5316453-1": "0", "6970483-1": "0", "7993062-1": "13", "8286638-1": "13", "4585446-1": "13" } }, { "human_patient_id": "510", "human_patient_uid": "8579914-1-M", "PMID": "34786254", "title": "Acute Intestinal Invagination: An Exceptional Method of Revealing Crohn\u2019s Disease", "patient": "This is a 57-year-old male patient from eastern Morocco, followed up for 10 years for ankylosing spondylitis and admitted to the emergency room for an occlusive syndrome and abdominal pain. The symptomatology goes back two years with the onset of intermittent postprandial abdominal pain in the right iliac fossa which worsened on the day of his admission to the hospital. The clinical examination of our patient revealed tenderness in the right iliac fossa with palpation of a mobile mass measuring about 4 cm and free hernial orifices. The standard biological assessment carried out in the emergency room had objectified an inflammatory syndrome with a CRP increased to 60 mg/L and the CT scan had objectified a cockade image next to the last ileal handle. This image, which is probably related to an ileo-ileal invagination, is also the site of a circumferential thickening, regular symmetrical, measuring 14 mm in maximum thickness with respect for the adjacent fat and without individualization of peri-lesional lymphadenopathy (Figure ).\nAfter multidisciplinary discussion and discussion with the patient, we opted for surgical exploration performed under general anesthesia which had demonstrated an intussusception 50 cm from the last intestinal loop on an intraluminal process with mesenteric lymphadenopathy. Bowel resection with lymphadenectomy involving intussusception with manual anastomosis was performed (Figures , ).\nThe pathological study noted the presence of an inflammatory pseudo-polyp integrating into chronic inflammatory bowel disease Crohn's type (Figures , ). The patient's postoperative progress course was uneventful, our patient was satisfied with the overall care and the discharge was carried out for five days under specific medical treatment for Crohn's disease. Follow-up after two years was without abnormalities with control of rheumatological and digestive manifestations.", "age": [ [ 57.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC008xxxxxx/PMC8579914.xml", "relevant_articles": { "22571080": "123", "18689187": "123", "25246840": "123", "20804544": "123", "33127722": "0" }, "similar_patients": { "8572057-1": "0", "7981728-1": "123", "4064808-1": "12", "3113992-1": "123", "4980778-1": "123" } }, { "human_patient_id": "511", "human_patient_uid": "5569394-1-M", "PMID": "28868199", "title": "Intradural angiomatous meningioma arising from a thoracic nerve root", "patient": "Over 8 months, a 40-year-old male presented with gait instability, numbness, progressive lower extremity weakness. His neurological examination revealed reduced sensation below the T10 level, and urinary hesitancy. A magnetic resonance image (MRI) of the thoracic spine demonstrated a 3 \u00d7 1.4 \u00d7 1.5cm lesion compressing the spinal cord at the T3\u2013T4 level []. It markedly enhanced with contrast, but showed no classical signs of a \u201cdural tail.\u201d It was presumed to be a spinal schwannoma.\nA T3\u2013T4 laminectomy was performed. Upon opening the dura, a reddish encapsulated tumor was observed []. Progressive debulking of the lesion showed no dural attachment, but firm adhesion of the lesion to the lateral aspect of a spinal nerve; the tumor resembled a schwannoma []. To avoid a neural deficit, a marginal resection was performed, leaving the spinal nerve intact. The postoperative course was uneventful, and the patient was discharged home on the 4th postoperative day. Fourteen months postoperatively, the patient remained asymptomatic, without any motor or radicular thoracic sensory impairment. The follow-up contrast enhanced MRI was normal, and there was no residual/recurrent tumor at the T3\u2013T4 level [].\nHistopathology of the tumor revealed proliferation of meningothelial cells characterized by round-to-oval nuclei, small nucleoli, occasional pseudoinclusions, and abundant eosinophilic cytoplasm. Cells were arranged in cords and small nests, and they appeared to grow around/intermingled with numerous blood vessels [] that were of variable calibre. There was also marked hyalinization. Histologically, the tumor was considered an AM. Meningiomas are defined as \u201cangiomatous\u201d (vascular) when at least 50% of the tumor mass is composed of blood vessels. Mitotic figures were not found, and special studies were not needed to confirm the meningothelial nature of the neoplasia.", "age": [ [ 40.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5569394.xml", "relevant_articles": { "26014023": "123", "34221582": "123", "15371721": "123", "34754547": "123", "24418789": "123" }, "similar_patients": { "5518430-1": "123", "8571252-1": "123", "8645484-1": "13", "3172008-1": "123", "4421966-1": "123" } }, { "human_patient_id": "512", "human_patient_uid": "6677049-1-M", "PMID": "31332139", "title": "The ocular surface after simple limbal epithelial transplant (SLET): A high-resolution OCT study of the early postoperative period", "patient": "The patient, a 26-year-old male, with a history of acid injury in the right eye 3 months prior had been variously treated with symblepharon release, hAM transplantation, and BCL insertion in the acute phase followed by lid reconstruction, symblepharon release, and an Ahmed glaucoma valve (AGV) for uncontrolled intraocular pressure (IOP). At presentation, he had a total LSCD with total conjunctivalization of the cornea []. There were symblephara of the upper and lower lids [Fig. and ]. Vision was perception of light with inaccurate projection of rays. Digital tension was higher than normal. The left, unaffected eye was within normal limits with a healthy limbus. B-scan ultrasound of the affected eye revealed an attached retina. The technique of SLET used was as described by Sangwan et al.[] \u2013 blunt dissection of the pannus from the corneal surface, release of all symblephara, gluing of an hAM (non-cryopreserved, fresh), and fixation of limbal explants from the contralateral eye with fibrin glue (Tisseel Kit from Baxter AG, Vienna, Austria). At the end of the procedure, a BCL was placed. Tissue harvested from the healthy eye was approximately 2 mm wide and was divided into 11 bits which were placed in two concentric circles on the right eye []. shows the slitlamp photograph of the operated eye on post-operative day 2.\nThe patient was followed up daily for the first 6 days and subsequently on days 8, 10, and 14. At each visit, besides a full clinical evaluation, slit lamp photographs were taken and anterior segment OCT was done on a Cirrus\u2122 HD-OCT (Carl Zeiss Meditec AG, Goeschwitzer Strasse 51\u201352, 07745 Jena, Germany), spectral-domain OCT with an axial resolution of 5 \u03bcm and a transverse resolution of 15 \u03bcm.\nFor the purpose of the study, three explants were identified on a clinical photograph [] and labelled as 1, 2, and 3. Serial OCT was done along a radial axis for each explant reaching up to the limbus, as shown in by a single investigator (MS) at each follow up day on each of the three explants. Quality of all OCT images achieved was satisfactory. The best images were obtained for explant 2 and are reproduced here.\nPostoperative regime followed was prednisolone acetate drops 6 times a day, moxifloxacin drops 6 times a day, and carboxy-methyl cellulose drops 2 hourly. The BCL was retained in the operated eye for the entire duration of the study.\nThere was rapid resolution of conjunctival congestion and good mobility of the globe with release of the symblephara. Lid closure was good. Digital IOP was normal. Anterior chamber details could be made out hazily through the translucent cornea, with the pannus removed. Vision remained perception of light with inaccurate projection of rays. The donor fellow eye had rapid closure of the epithelial defect at the donor site.\nThe hAM remained of even density (OCT reflectivity) and thickness throughout the study duration []. Sub-hAM space increased from day 3 and resolved completely by day 10. There was thinning of the explants from day 3 which corresponded to the sub-hAM space expansion, which may have been compressing the explants against the BCL. Fibrin around the explants started decreasing from day 2 onwards and disappeared by day 4. The hAm, even though glued to the corneal surface with fibrin glue, was not absolutely stable in the early days after SLET. The fibrin glue beneath the hAM appeared to swell, displacing the hAM anteriorly. However, this settled by day 10, and thereafter the hAM was adherent to the cornea. There were no changes in the consistency (reflectivity) and thickness of the hAM. The fibrin around the explants developed optically hollow spaces immediately adjacent the explants and started decreasing from day 2 and disappeared by day 4. Comment regarding the thinning rate of the explants is difficult as it is impossible to ensure that the OCT section is being taken at exactly the same site of the explants on each occasion. Further, the thinning of the explants appear to correlate with the initial bulging of the sub-hAM space and continued even as the hAM settled down and adhered to the cornea. There was no evidence of epithelialization up to day 8. By day 14, there was complete epithelialization on the limbal side, in contrast centripetally directed epithelialization was poor extending only about 0.24 mm on day 14. The nature of the epithelium was boggy and not the crisp reflective layer that is seen in OCT of normal corneas. There was little change in the corneal stromal thickness and lucidity on OCT.", "age": [ [ 26.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6677049.xml", "relevant_articles": { "31332139": "123", "33683425": "123", "21117604": "12", "20436366": "0", "1923286": "0" }, "similar_patients": { "8632734-1": "123", "6734731-1": "123", "8482941-2": "123", "3120246-1": "123", "3129758-1": "0" } }, { "human_patient_id": "513", "human_patient_uid": "6424056-1-M", "PMID": "30875526", "title": "An unusual site of gallstones five years after laparoscopic cholecystectomy", "patient": "We present the case of a 70 year old male who had an elective right inguinal hernia repair. He reported a longstanding history of a right inguinal lump which had been causing increasing discomfort over the previous 12 months. His past medical history included an emergency laparoscopic cholecystectomy 5 years prior, as well as atrial fibrillation. On examination, the patient had a mildly tender right inguinoscrotal hernia. Despite being tender, the hernia was reducible and there were no overlying skin changes. Abdominal and testicular examinations were otherwise unremarkable.\nOpen right inguinal hernia repair was performed using a modified Kugel technique. Intraoperative findings validated clinical examination and a large indirect hernia was reduced. Upon reduction, the hernia sac was found to have multiple 5 mm foreign bodies embedded into the wall. On closer inspection these foreign bodies were macroscopically consistent with gallstones (see , ). The hernia sac and foreign bodies were sent to the pathologist who confirmed the foreign bodies to be cholesterol gallstones.\nThe immediate post-operative recovery was uneventful and the patient was discharged home the following day. He was reviewed four weeks later in the outpatient surgical clinic where he reported a good recovery.", "age": [ [ 70.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6424056.xml", "relevant_articles": { "31874379": "123", "31694829": "123", "32500655": "123", "23519856": "123", "24141115": "123" }, "similar_patients": { "6931096-1": "123", "5786248-1": "123", "2626576-1": "123", "8421327-1": "123", "7781570-1": "123" } }, { "human_patient_id": "514", "human_patient_uid": "8382542-1-M", "PMID": "34434584", "title": "A Case of Myxoma Arising in the Buccal Mucosa", "patient": "An 86-year-old male was referred to Saitama Medical University Hospital (Moroyama, Saitama, Japan) from a local dentist in July 2015 due to the presence of an intraoral mass. The patient had not noticed the mass until the dentist brought it to his attention. His previous history included transitional cell cancer of the bladder, but his family history was unremarkable. The round mass, measuring 12 mm in diameter, was located in the left buccal mucosa (). The mass was soft, nontender, and nonadherent to the surrounding tissue, and the surface exhibited normal mucosa. Magnetic resonance imaging (MRI) of the left buccal region showed a mass with intensity lower than that of skeletal muscle tissue on T1-weighted imaging () and with intensity higher than that of adipose tissue on T2-weighted imaging (). This was diagnosed as a benign buccal tumor and was subsequently resected under local anesthesia. The tumor was easily dissected from the surrounding tissue and appeared to be covered with a thin fibrotic capsule. The resected specimen measured 2 cm at its largest diameter () and was filled with glossy, mucoid, and milky white materials (). Microscopically, the tumor cells in the sparse mucoid matrix () exhibited a spindle or stellate shape without nuclear atypia (data not shown). The tumor matrix had abundant collagen fibers and was strongly stained with alcian blue, indicating the presence of acidic polysaccharides (data not shown). On immunohistochemistry, the tumor cells were negative for S-100 protein, ASMA, and CD3 (data not shown). The final histopathological diagnosis was a myxoma. The tumor was completely resected, and five years later, the patient exhibited no recurrence or distant metastasis.", "age": [ [ 86.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC008xxxxxx/PMC8382542.xml", "relevant_articles": { "8007631": "123", "24285986": "123", "26236522": "0", "34624834": "123", "22843913": "123" }, "similar_patients": { "2626811-1": "123", "4639648-1": "123", "4581409-1": "0", "4440942-1": "123", "6425529-1": "123" } }, { "human_patient_id": "515", "human_patient_uid": "8289685-1-M", "PMID": "34295972", "title": "Gastric Neuroendocrine Tumor", "patient": "A 38-year-old man presented to the surgery clinic with complaints of upper abdomen pain for 1 year. The pain was dull aching with episodes of increased severity lasting for 1 to 2 hours. The pain was relieved with oral analgesics. This was associated with occasional black tarry stools. The patient also complained of easy fatigability, breathlessness, and palpitations. He had a history of repeated blood transfusions for severe anemia. He was a chronic smoker and tobacco chewer.\nHis clinical examination revealed pallor. The rest of the examination was unremarkable.\nThe patient had severe anemia with hemoglobin of 5.7 g/dL for which he was transfused with two units of packed cells. Subsequently, his hemoglobin improved to 8.3 g/dL.\nUGIE showed a 1 \u00d7 1 cm polyp with central umbilication along the greater curvature of the body of the stomach. There was no active bleeding. The mucosa of the rest of the stomach appeared normal. An impression of a gastrointestinal stromal tumor or NET was kept. The serum chromogranin A (CgA) level was 304 ng/L (normal value = 28\u201394 ng/mL).\nContrast enhanced computed tomography (CECT) showed evidence of a hyperenhancing polypoidal lesion along the greater curvature measuring 1.1 \u00d7 0.7 cm (\n). There were no enlarged lymph nodes visualized. Gd-68 DOTATATE scan showed a somatostatin receptor (SSTR) expressing small polypoidal soft tissue density in the body of the stomach along the greater curvature (\n).\nSubsequently, the patient underwent resection of the polyp under a second endoscopy (\n) which was sent for histopathological examination (HPE).\nHPE showed a polypoidal structure lined by gastric mucosa (\n). The mucosa and submucosa were infiltrated by a tumor that was arranged in an acinar pattern. The tumor cells were monomorphic with a moderate amount of cytoplasm and salt and pepper nuclear chromatin. Occasional mitotic figures were seen. The base of the polyp was free of tumor cells. The tumor was diffusely positive for synaptophysin and CgA on immunohistochemistry (\n). Ki-67 index was 3%. The impression made from the above findings was NET of the World Health Organization (WHO) grade II.\nThe patient was immediately relieved of symptoms following polypectomy and was discharged 2 days later. His hemoglobin after 2 weeks on follow-up was 10.5 g/dL. He is currently asymptomatic.", "age": [ [ 38.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC008xxxxxx/PMC8289685.xml", "relevant_articles": { "19023173": "123", "30692484": "123", "33887847": "123", "22096700": "12", "26805228": "12" }, "similar_patients": { "3487888-1": "123", "5586883-1": "1", "8172005-1": "123", "3764693-1": "1", "5846865-1": "123" } }, { "human_patient_id": "516", "human_patient_uid": "4197919-1-M", "PMID": "24876400", "title": "Anterior knee pain: an unusual presentation of renal cell carcinoma", "patient": "We present the case of a 74-year-old Caucasian male presenting with a 2-year history of left knee pain. He described difficulty kneeling and descending stairs. On examination, a tender and mildly diffuse swelling was present over the left patella associated with mild erythema. The patient was able to perform a straight leg raise test and had full range of movement of the left knee. Ligamentous and meniscal testing was unremarkable as was examination of the ipsilateral hip.\nNineteen months earlier the patient had consulted his general practitioner complaining of left knee pain. Radiographs performed at that time were reported to show joint space narrowing within the patello-femoral compartment as well as early joint space narrowing within the medial compartment. A subchondral lucency was also noted within the patella which was described as a subarticular cyst secondary to the previously mentioned patello-femoral degeneration (Figs \u2013).\nThe patient had a past history of prostate cancer, diagnosed in October 2005. He had been successfully treated and discharged from follow-up. In August 2007 he underwent excision of a basal cell carcinoma and had a permanent pacemaker for bradyarrhythmia. His only regular medication was a statin. Overall, he enjoyed good health and considered himself very active. There were no symptoms or signs of systemic disease.\nRepeat radiographs performed by his general practitioner 19 months after initial presentation (Figs \u2013) revealed a large lucency within the patella and a discontinuity in the anterior cortex of the inferior pole suggesting pathological fracture. A bone scan was arranged and demonstrated isolated abnormal tracer activity around the left patella (Fig. ). Due to the pacemaker a computed tomography (CT) scan was performed to further characterize the lesion. This confirmed a large lucent area occupying most of the patella with multiple areas of cortical disruption along its anterior border (Fig. ). Since the exact nature of the lesion could not be determined an ultrasound-guided biopsy was suggested but ultrasound screening revealed the lesion to be highly vascular (Fig. ). In view of this the radiologist performed a renal ultrasound, which revealed a large mass arising from the superior pole of the left kidney. Subsequent CT of the chest, abdomen and pelvis followed demonstrating the extent of disease. There was a large (13 \u00d7 8.5 \u00d7 9 cm) mass arising from the superior pole of the left kidney (Fig. ), the appearances of which were consistent with a primary RCC. Metastases were found in both adrenals and lungs, but no other bone metastases. Since diagnosis, the patient has had a left nephrectomy and is currently receiving radiotherapy and zolendronic acid treatment for the patella metastasis. At the time of writing this report the patient's patella lesion continues to be managed non-operatively.", "age": [ [ 74.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4197919.xml", "relevant_articles": { "17525717": "0", "11413886": "12", "28507960": "0", "31192948": "0", "22800460": "0" }, "similar_patients": { "3939934-1": "0", "4689044-1": "0", "3161952-1": "0", "7859265-1": "0", "7271459-1": "0" } }, { "human_patient_id": "517", "human_patient_uid": "7783446-1-M", "PMID": "33414756", "title": "Case Report: Local Anesthesia Round Window Plugging and Simultaneous Vibrant Soundbridge Implant for Superior Semicircular Canal Dehiscence", "patient": "A 78-year-old woman was referred to our clinic with bilateral hearing loss with sound distortion, tinnitus and auditory hypersensitivity, recurrent vertigo/dizziness induced by loud noises (Tullio phenomenon), and a diagnosis of bilateral SSCD at the temporal bone HRCT performed in the emergency room (Figures 2a\u2013c).\nPreoperative audiometry indicated severe mixed hearing loss in the right ear, with moderate conductive hearing impairment in the left ear (). A pure tone sound of 110 dB at 500 and 1,000 Hz in the right ear, and pneumatically increasing external auditory canal pressure induced dizziness without detectable nystagmus on video-oculographic (or Frenzel goggles) examination. Her tympanogram was bilaterally normal. A stapedial reflex could not be performed due to patient intolerance (dizziness). Mastoid vibration elicited dizziness without detectable nystagmus on video-oculographic (or Frenzel goggles) examination. A temporal bone 1.5-T MRI with 3D reconstruction performed two months before did not show the bilateral dehiscence (). Air conduction cervical VEMPs (cVEMPs) demonstrated a threshold of 85 dB HL on the right side and 100 dB HL on the left side. The cVEMPs were recorded from both ears using 500 Hz short tone-bursts (STBs). A video head impulse test for horizontal and vertical canals, including both dehiscent SSC, showed normal vestibulo-ocular reflex gain bilaterally ().\nPossible surgical procedures (superior canal plugging or resurfacing either through a middle fossa approach or via a transmastoid route, or RW niche plugging) were discussed with the patient. Comorbid cardiopulmonary conditions represented major contraindications for general anesthesia, so the latter procedure was the only possible option to pursue.\nSince the patient did not show bilaterally any benefit from an air conduction hearing aid but rather had deteriorating auditory and vestibular symptoms on the right, we decided to perform the surgical procedure in the right ear as it had worse vestibular and auditory symptoms, a poorer hearing threshold, and greatly altered HRCT and VEMPs findings.\nWith local-assisted anesthesia, we performed a transcanal approach with elevation of the tympanomeatal flap and preservation of the chorda tympani nerve with a minimally invasive retroauricular incision. Ossicular mobility and continuity were assessed, we excluded the stapedial fixation, and no cerebrospinal fluid (CSF) leak was observed during the surgical procedure. After identification and reshaping of the RW niche, a vibroplasty was performed paying particular attention to correctly plugging the round window and coupling it with the floating mass transducer (FMT) of the VSB (). We opted to couple the FMT with the RW because concomitant RW plugging was performed and from previous studies it seemed to provide a more stable coupling over time than incus (). No ossicular chain abnormalities or perilymphatic fistula were observed intraoperatively.\nThe plugging of the round window was achieved using cartilage and perichondrium (tragus). This autologous tissue also helped to seal off the FMT in the round window niche. Furthermore, VSB hearing outcomes were monitored with electrocochleography using a cotton-wick recording electrode placed on the hypotympanum () ().\nThe wire of the VSB was housed in a canal tunnel drilled up to the tympanic attic. Minimal drilling of the cortical temporal bone posterosuperior to the external auditory meatus was necessary to house the implant receiver and extra wire (). The ear canal tunnel was covered with autologous cartilage and external auditory meatus packing was performed.\nThis study received an exemption from the ethics committee of the University Hospital of Siena (Comitato Etico Regione Toscana, area vasta Sud Est\u2013AOU Senese, Usl Toscana Sud Est) on 10/21/2019 for publication.\nSurgery was uncomplicated, the patient did not complain of any post-operative vestibular symptoms. Sutures and external meatus packing were removed on the 10th postoperative day. At the 1-month follow-up, the patient underwent VSB activation and hearing and vestibular examination. She reported a significant improvement in auditory hypersensitivity and reduced sound distortion although tinnitus remained unchanged. No disabling vestibular symptoms were reported. Neither dizziness nor nystagmus could be observed in response to loud sounds or increased external ear pressure on the right side. The postoperative pure tone audiogram revealed a mild increase at 500, 1,000, and 2,000 Hz and a mild decrease at 250 and 4,000 Hz for bone conduction thresholds (). An improvement to moderate hearing loss in the VSB-aided hearing threshold was confirmed at 3 months (). The maximum speech recognition score of bysillabic words at 65 dB HL improved from 10% preoperatively to 70% at the last follow-up. The improvement of hearing and vestibular symptoms was confirmed subjectively by the patient on the right side. Discomfort and mild dizziness associated with loud sounds on the left side remained unchanged. Using a visual analog scale (0\u201310), the patient reported an improvement in symptoms from 10 to 4 and from 9 to 2, respectively, for hearing and vestibular complaints (3-month follow-up). Left side mild symptoms related to dehiscence remained unchanged. No short-term surgical complications such as device extrusion or external or middle ear canal infection/inflammation were identified at the 3-month follow-up (). Control HRCT was not performed since correct positioning of the FMT and plugging of the RW were confirmed by improvements in symptoms and stability of VSB-aided hearing. Air conduction VEMPs were not performed for safety reasons due to the risk of mobilizing the plugging or FMT from the RW.", "age": [ [ 78.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7783446.xml", "relevant_articles": { "33414756": "123", "21131892": "123", "34374862": "123", "22935810": "123", "32986504": "0" }, "similar_patients": { "5461570-1": "123", "4627111-1": "123", "7758672-1": "123", "4491948-1": "0", "4181057-1": "123" } }, { "human_patient_id": "518", "human_patient_uid": "3004882-1-M", "PMID": "21143844", "title": "Heart echinococcus cyst as an incidental finding: early detection might be life-saving", "patient": "A 46-year-old female smoker was admitted to the emergency department of our hospital due to cough with blood-tinged sputum for the last four days before admission. She did not complaint of any other symptom. Her past medical history was unremarkable. She denied any exposure to toxic substances and gave no history of handling dogs or having ever reared sheep. The physical examination revealed no specific findings and there was no sign of respiratory or cardiovascular dysfunction. Lung auscultation revealed a mild decrease in the intensity of breath sounds, whereas heart examination was completely normal, without extra sounds or murmurs. The electrocardiogram (ECG) was lacking remarkable findings. The patient had negative reaction of the Mantoux tuberculin skin test. Moreover, all routine laboratory test results, including liver and kidney function tests, serum proteins and urinanalysis were normal. The erythrocyte sedimentation rate was normal (ESR 12 mm/hr). Sputum specimens for mycobacteria and other pathogens were smear and culture negative. Serological tests for cancer or virus were negative but serology for echinococcosis showed an indirect immunohemagglutination test positive. Other autoimmune markers were negative. Chest x-ray depicted multiple calcified cystic formations (Figure ). A Multi-Detector Computed Tomography (MDCT) of the chest [] and abdomen identified localized bronchiectatic lesions of the right upper lobe, calcified spots at both the lung fields, probably from previous disease (chickenpox, tuberculosis or occupational disease), a low density solitary lesion with peripheral calcification located at the myocardium of LV (compatible with calcified echinococcus cyst) (Figure ) and other three similar but smaller findings were located at the liver. The CT scan of the brain showed no disease. No lung disease was diagnosed with the bronchoscopy. Transthoracic contrast echocardiography revealed a cyst-like echoluscent structure 5 \u00d7 2 cm, occupying the Posterior Wall of Left Ventricle (PWLV). It gave the impression of endomyocardial localization due to the decreased thickness of the PWLV (Figure ). The rest of examination was normal with an estimated ejection fraction of 60%, without regional wall motion abnormalities. Coronary angiography revealed normal coronary arteries.\nExcision of the cardiac cyst was planned by using cardiopulmonary bypass and the patient received perioperative chemotherapy with albendazol 10 mg/kg. After a median sternotomy the patient was connected to the cardiopulmonary bypass by cannulating the ascending aorta and right atrium. The pericardial cavity was free of adhesions. Under condition of normothermic cardiopulmonary bypass the aorta was crossclamped and the heart was arrested with a dose of antegrade cold blood-based cardioplegia. The heart was lifted and the free surface of the cyst was seen as a white tense mass in the lateral wall of left ventricle (Figure ). By palpation, it was partially calcified. The lateral wall of the left ventricle was localized by gauzes irrigated by 10% NaCl solution. A small incision was made into the cyst corresponding its free wall, and a viscous sub-yellow fluid was aspirated. The sub-epicardial wall of the cyst was then excised and its contents were completely aspirated (Figure ). The cyst was then injected, first with 10 ml of 10% NaCl solution and then with 5 ml of povidone iodine solution, which was left inside for 3 min and then aspirated. The resultant cavity was then obliterated by a continuous 4-0 prolene suture (Figure ). To complete this obliteration, we avoided to use any prosthetic material such as pledgets, to prevent possible postoperative infection. After de-clamping of the aorta and de-airing of the heart, the patient was easily weaned off bypass with no inotropic support. Cytology of the aspirated cyst fluid and histology of the cyst wall was consistent with the diagnosis of hydatid cyst (Figure ). The patient had an uneventful recovery and at the fifth postoperative day she discharged from the hospital with a normal echocardiographic examination which confirmed preserved function of the mitral valve apparatus, with only minimal regurgitation.\nFollow up at 6 and 12 months, with echocardiography (Figure ) and CT scan, which confirmed the excellent post-surgery result without complications or recurrence of the disease. The findings of the liver were stable and brain CT was clear.", "age": [ [ 46.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3004882.xml", "relevant_articles": { "6820265": "123", "30279818": "123", "8211934": "123", "21358231": "123", "16318934": "123" }, "similar_patients": { "8370852-1": "123", "4000877-1": "123", "3639073-1": "123", "7495958-1": "123", "5621715-1": "123" } }, { "human_patient_id": "519", "human_patient_uid": "8326001-1-M", "PMID": "34345404", "title": "Rhabdomyosarcoma in the maxillary gingiva of a child patient", "patient": "A 12-year-old girl presented to our clinic with a chief complaint of trismus. A few months ago, she noticed a bulge in the left maxillary gingiva and trismus. There was no spontaneous pain, but pressure pain was felt. She was afebrile, had no history of trauma or medications. During her first medical examination at our clinic, she was 164 cm tall, weighed 54 kg. Extraoral examination revealed a slight bulge in the left cheek with countenance, right and left asymmetry and trismus. The range of mouth opening was 18 mm, and there were no swollen lymph nodes that I could feel in the neck. Intraoral findings revealed a neoplastic lesion extending from the left maxillary first molar to the maxillary tuberosity (). It interfered with the occlusion on that side.\nPanoramic radiography showed impaction of the left maxillary second molar and resorption of alveolar bone between the left maxillary molar area and the maxillary tuberosity ().\nComputed tomography (CT) images showed a mass that extended from the left masticator space to the buccal space and the alveolar regions of the maxilla and mandible and pressure resorption of the anterior border of ramus, rear wall of the maxillary sinus and lateral plate of the pterygoid process. Involvement of the maxillary sinus was also suspected. Contrast-enhanced T1-weighted magnetic resonance imaging (MRI) showed a high signal in a range similar to CT (). Contrast-enhanced effects in the left cervical and retropharyngeal (Rouviere) lymph nodes were also detected. 18F-fluorodeoxyglucose (18FDG)-positron emission tomography/CT showed a mass measuring 63 \u00d7 38 \u00d7 45 mm (long axis \u00d7 minor axis \u00d7 height) located in the left maxillary gingiva, accompanied by abnormal accumulation of 18FDG (standardized uptake value [SUV] max, 8.3), and left cervical lymphadenopathy, accompanied by abnormal accumulation of 18FDG (SUVmax, 41.72), which was suspected as metastasis. Abnormal accumulation was not observed in the other organs.\nThe differential diagnosis for a malignant tumor of oral soft tissue includes squamous cell carcinoma, sarcoma and salivary gland malignant tumor. Ameloblastoma is considered in the differential diagnosis for a maxillary tumor with trismus. Ameloblastoma is a benign tumor that presents as a bulge on the jawbone and causes bone resorption. It has included extraosseous/peripheral ameloblastoma [].\nThree days after the first medical examination, a biopsy of the lesion was performed in the left maxillary gingiva with the consent of the patient and parents to obtain a definitive diagnosis. The sectioned surface was milky-white with enhancing characteristics (). Histopathological examination showed proliferation of oval to spindle-shaped cells, with hyperchromatic nuclei and a high nuclear-cytoplasmic ratio, arranged in a fascicular pattern (). Mitotic figures were frequently observed. Focally, the tumor cells were arranged in small nests and in a pseudo-capillary pattern in the sclerotic collagenous stroma (). Immunohistochemical examination revealed that the tumor cells were positive for desmin, myoD1, myogenin, mammary serum antigen and glial fibrillary acidic protein (). The Ki67 proliferation index was ~30% per HPF (). The details of immunostaining are shown in . The patient was diagnosed with RMS classified as Group III according to the Intergroup Rhabdomyosarcoma Study (IRS) grouping system []. The left maxillary gingiva RMS was treated via proton beam irradiation at 59.4 Gy and with vacuum-assisted wound closure therapy with 14 cycles of vincristine, actinomycin D and cyclophosphamide. After chemoradiotherapy, a complete response was documented via image evaluation.", "age": [ [ 12.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC008xxxxxx/PMC8326001.xml", "relevant_articles": { "17760557": "123", "34345404": "123", "28724861": "123", "22090771": "123", "12953782": "123" }, "similar_patients": { "4474970-1": "123", "4247009-1": "13", "3303510-1": "123", "4246683-1": "13", "3652139-1": "123" } }, { "human_patient_id": "520", "human_patient_uid": "7447456-1-M", "PMID": "32846802", "title": "Combined bursal aspiration and corticosteroid injection for rotator cuff tear patients unresponsive to conservative management", "patient": "Patient I was a 73-year-old man who experienced right shoulder pain for >2 months without any history of trauma. His pain progressively worsened with a waxing and waning course, despite use of nonsteroidal anti-inflammatory drugs and supportive physical therapy. There was no obvious improvement after injection of intra-articular corticosteroids from another hospital in the previous month. He subsequently experienced limitation of activities of daily living and night pain that worsened over time and made it impossible to sleep at night. Shoulder pain on the Visual Analogue Scale (VAS) was 5 at rest and 7 during motion. There was no history of trauma, known chronic diseases, or alcohol and drug abuse.\nOn physical examination, the skin over the shoulder joint was normal, and gentle palpation around the shoulder joint did not elicit pain. There was no loss of passive motion of his shoulder joint. However, the empty-can, Neer, and Hawkin's tests were positive. All laboratory results were within normal limits. Plain radiographs revealed a hooked acromion in the supraspinatus outlet view. US revealed marked SASD bursal effusion with a full-thickness tear of the supraspinatus tendon (Fig. A). To ensure an accurate diagnosis, he underwent magnetic resonance imaging (MRI) that revealed a full-thickness tear along the supraspinatus tendon with SASD bursitis.\nBecause the symptoms failed to resolve with conservative management, including corticosteroid injection, the authors attempted to aspirate fluid from the SASD bursa to the greatest extent possible (Fig. B). Under US guidance, 8 mL of clear bursal fluid was aspirated, and the specimen was sent for analysis. US-guided intra-articular corticosteroid injection was administered by penetrating the posterior joint capsule. A mixture of 0.5% lidocaine and 40 mg triamcinolone was injected into the shoulder joint space by visualizing the posterior intra-articular space.[ Distension of the joint cavity and SASD bursa after injection was checked to confirm that the procedure was accurate.\nBursal fluid analysis revealed normal white cell counts without crystals. Acid-fast bacillus stain and gram stain were negative. Fluid culture grew no microorganisms.\nAfter aspiration and intra-articular injection, the symptoms abated. One month later, his pain score on VAS decreased from 5 to 2 at rest and from 7 to 3 during motion. Upon recheck 2 months after the combined procedure, patient I was satisfied with the pain relief; therefore, surgical management was not indicated.", "age": [ [ 73.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7447456.xml", "relevant_articles": { "32846802": "123", "15695959": "123", "27847713": "123", "11935203": "0", "25322742": "12" }, "similar_patients": { "7447456-3": "123", "7447456-2": "123", "7717826-1": "12", "7869743-1": "123", "8604749-1": "123" } }, { "human_patient_id": "521", "human_patient_uid": "7447456-2-M", "PMID": "32846802", "title": "Combined bursal aspiration and corticosteroid injection for rotator cuff tear patients unresponsive to conservative management", "patient": "Patient II was a 65-year-old man who experienced right shoulder pain for >1 month with no history of trauma and known left-sided weakness after right cerebral infarction 15 years before. He complained of unbearable pain despite corticosteroid injection 3 weeks before. Subjective pain on the VAS was 7 at rest, 9 during motion. On physical examination, empty-can and Hawkin's tests were positive. US demonstrated substantial effusion of the long biceps tendon and SASD bursa with a full-thickness tear of the supraspinatus and a partial thickness tear of subscapularis tendon. He did not want MRI for economic reasons. Under US guidance, 7 mL of the clear bursal fluid was aspirated, and a triamcinolone mixture was injected in the same way. All laboratory results, including bursal fluid, were within normal limits. Compared with the scores after 1 month, his pain score on the VAS slightly decreased from 7 to 4 at rest, from 9 to 6 during motion. Although pain abated, an additional 3 mL of bursal fluid was aspirated, and triamcinolone injected again. Upon review 3 months after the repeat procedure, his pain score on the VAS decreased from 4 to 2 at rest, from 6 to 4 during motion.", "age": [ [ 65.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7447456.xml", "relevant_articles": { "29533161": "12", "24068062": "12", "34362697": "12", "32846802": "123", "29181986": "12" }, "similar_patients": { "7447456-3": "123", "7447456-1": "123", "7714298-1": "123", "7869743-1": "123", "8081110-1": "123" } }, { "human_patient_id": "522", "human_patient_uid": "7447456-3-M", "PMID": "32846802", "title": "Combined bursal aspiration and corticosteroid injection for rotator cuff tear patients unresponsive to conservative management", "patient": "Patient III was a 70-year-old man who experienced right shoulder pain for >3 months with no history of trauma. There was no noticeable improvement following intra-articular corticosteroid injection 1 month before. Subjective pain on the VAS was 5 at rest and 8 during motion. On physical examination, the empty-can test was positive. US demonstrated substantial effusion of the long biceps tendon and SASD bursa with a full-thickness tear of the supraspinatus and subscapularis tendon (Fig. C). MRI revealed a full-thickness tear along the supraspinatus and subscapularis tendon with SASD bursitis. With US guidance, 9 mL of clear bursal fluid was aspirated, and a triamcinolone mixture was injected. All laboratory results, including bursal fluid levels were within normal limits. At 1 month, his pain score on the VAS decreased from 5 to 3 at rest and from 8 to 4 during motion; follow-up US revealed diminution of the previously noted bursal distension (Fig. D). His pain scores at 2 months were approximately at the same level as that at 1 month; follow-up US revealed increased bursal distension compared to the previous US finding but fluid accumulation was slightly decreased compared to the initial US finding (Fig. E).", "age": [ [ 70.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7447456.xml", "relevant_articles": { "32846802": "123", "14695399": "12", "24068062": "1", "29181986": "12", "33816641": "12" }, "similar_patients": { "7447456-2": "123", "7447456-1": "123", "8081110-1": "123", "7869743-1": "123", "7714298-1": "123" } }, { "human_patient_id": "523", "human_patient_uid": "6283093-1-M", "PMID": "30508908", "title": "Mesalazine-related lung disease in a patient with ulcerative colitis", "patient": "A 75-year-old nonsmoking woman presented to our emergency department due to progressive shortness of breath for 3 days. She denied fever, abdominal pain, diarrhea, bloody stool, or tenesmus. She had been diagnosed with ulcerative colitis at our hospital and received mesalazine 2 g per day for 2 years and 8 months.\nHer initial vital signs were a blood pressure of 131/79mm Hg, pulse rate of 80 bpm, respiratory rate of 28/min and body temperature of 36.0\u00b0C. On physical examination, chest auscultation revealed coarse breathing sounds with bilateral crackles. Laboratory investigations revealed a white blood cell count of 10,600/\u03bcL with 79% neutrophils, hemoglobin level of 9.7 g/dL, and platelet count of 464,000/\u03bcL. Biochemistry profile showed an elevated level of C-reactive protein (79.7 mg/L), mildly impaired renal function (blood urea nitrogen level of 21.2 mg/dL and creatinine level of 1.23 mg/dL), and a normal alanine aminotransferase level (13 U/L).\nElectrocardiography showed a normal sinus rhythm, and echocardiography of her heart was normal (left ventricular ejection fraction of 77%). Chest radiography revealed increased infiltration with patchy consolidations in both lungs and lower lobe predominance (Fig. A). She was then given oxygen via a nasal cannula. Under the impression of community-acquired pneumonia, she received antibiotic treatment and was admitted to our chest ward.\nEpisodic high fever was noted since admission, and chest radiography showed progression of bilateral infiltrates. Further investigations were thus warranted, and a computed tomography (CT) scan showed diffuse peribronchial and subpleural consolidations in bilateral lungs with minimal interstitial thickening. The differential diagnosis included cryptogenic OP, acute interstitial pneumonia, and metastasis (Fig. A). In the following days, her respiratory condition deteriorated, and she was given noninvasive ventilator support (bi-level positive airway pressure, BiPAP) (Fig. B). Under the consideration of mesalazine-induced OP, mesalazine was discontinued on the 8th day of admission, and intravenous hydrocortisone 100 mg Q6H was started. She was then transferred to our medical intensive care unit.\nWe performed infection surveys for viruses, fungi, and mycobacteria. Due to positive cytomegalovirus (CMV) serologic tests including both IgM and IgG, intravenous ganciclovir was given for 7 days until the results of CMV antigenemia assays and qualitative CMV polymerase chain reaction (PCR) assays were negative. We also surveyed her autoimmune condition and vasculitis markers, and positive results of antinuclear antibodies and p-ANCA (antineutrophilic cytoplasmic antibodies, perinuclear pattern) were attributed to ulcerative colitis.\nHer respiratory condition improved in the following days, although only a mild improvement was shown on serial chest plain films (Fig. C). Hydrocortisone 100 mg Q6H was maintained for 8 days and then tapered. BiPAP was shifted to an oxygen mask in the 2nd week of ICU admission.\nBronchoscopy with bronchoalveolar lavage (BAL) was performed, and a specimen was sent for bacterial, fungal, and viral cultures, PCR testing of tuberculosis and Pneumocystis jirovecii, galactomannan, total and differential cell counts, CD4/CD8 ratio, and cytology. The results showed 81% macrophages, 10% lymphocytes, 8.2% neutrophils, and 0% eosinophils, with CD4 and CD8 counts of 24.6% and 22.7%, respectively (CD4/CD8 ratio: 1.08). The BAL culture showed growth of Actinomyces odontolyticus, which may have been caused by aspiration of oropharyngeal secretion. A transbronchial lung biopsy was done, and the pathology report showed mild chronic inflammation with OP (Fig. ). There was no evidence of granuloma, malignancy, or vasculitis.\nThe patient was discharged on the 28th day of hospitalization with oral prednisolone 20 mg per day. She was regularly followed up at our chest out-patient department. One month after discharge, she had greatly reduced exertional dyspnea, and a chest plain film showed substantial improvements (Fig. D). A follow-up chest CT scan 3 months after disease onset showed resolution of most of the infiltration (Fig. B).", "age": [ [ 75.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6283093.xml", "relevant_articles": { "30508908": "123", "11855087": "123", "15581755": "123", "11398337": "0", "16050472": "0" }, "similar_patients": { "3564029-1": "0", "4939210-1": "123", "4512086-1": "0", "5106782-1": "0", "4694600-1": "0" } }, { "human_patient_id": "524", "human_patient_uid": "7987922-1-M", "PMID": "33786319", "title": "Epi-endocardial asynchrony during atrial flutter followed by atrial fibrillation", "patient": "A 77-year-old man with severe aortic stenosis and persistent AFL was admitted for elective aortic valve replacement and concomitant surgical AFL ablation. Written informed consent for cardiac mapping (MEC-2015-274) was obtained prior to surgery.\nBefore induced cardiac arrest, a mapping array of 128 electrodes (interelectrode distance: 2 mm) was used to cover the epicardial atrial surface of Bachmann's bundle (BB), the right atrium (RA), anterior LA including the left atrial appendage (LAA), and pulmonary vein area. In addition, recordings of the endocardial right atrial septum were obtained.\nU-EGMs, sampled at a frequency of 1000 Hz, were automatically analyzed offline and manually checked using customized software. Local activation times were defined as the steepest negative deflection of U-EGM potentials and used to reconstruct wavemaps during 10 seconds of AFL.\nSubsequently, distribution of AFL cycle length (AFL-CL) and AFL-CL variability were assessed at all locations. Variability of AFL-CL is defined as standard deviation of the AFL-CL histogram.\nIn line with prior mapping studies, the proportion of lines of CB was calculated as the number of lines of CB (interelectrode conduction time > 11 ms) relative to the total number of interelectrode connections. A cut-off value of >11 ms was derived from prior mapping studies in which this degree of delay was associated with reversal of wavefront direction at the other side of the line of CB. Beat-to-beat consistency in patterns of activation was evaluated by comparing entry sites of the AFL wave and main direction of propagation in consecutive wavemaps for each location. Frequency of fractionated potentials, defined as electrogram potentials consisting of 2 or more negative deflections, were quantified as the number of fractionated potentials relative to the total number of potentials. As we previously demonstrated that fractionated unipolar potentials are caused by remote, asynchronous activation of the atrial wall,, , all deflections of fractionated potentials were annotated in a separate analysis to identify electrical asynchrony in deeper tissue layers.", "age": [ [ 77.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7987922.xml", "relevant_articles": { "20814733": "123", "33963960": "123", "33355964": "123", "12370221": "12", "11139956": "123" }, "similar_patients": { "4443606-1": "13", "7411197-2": "13", "7496276-1": "13", "7954256-1": "13", "6009767-1": "13" } }, { "human_patient_id": "525", "human_patient_uid": "5579934-1-M", "PMID": "28859624", "title": "Living kidney transplantation between brothers with unrecognized renal amyloidosis as the first manifestation of familial Mediterranean fever: a case report", "patient": "A 31-year-old man, originally from Morocco, was admitted to Leiden University Medical Center (LUMC, The Netherlands) complaining of leg edema in February 2000. The patient had a history of recurrent episodes of inflammation, fever and serositis. The patient was diagnosed with nephrotic syndrome due to amyloidosis secondary to FMF. His family had 7 siblings with consanguineous parents. At that time, no genetic mutations were found. After another episode of FMF in 2009, the patient presented with renal failure and nephrotic syndrome that did not respond to conservative therapy (angiotensin-converting-enzyme inhibitors, diuretics, nonsteroidal anti-inflammatory drugs, cyclosporine and colchicine). He was suspected not to be compliant with treatment. A bilateral nephrectomy was performed to halt the progressive catabolism due to unrestrained renal protein loss. The patient, a Dutch resident, required chronic dialysis. At this time, there was no evidence of clinical cardiac involvement by amyloidosis. In 2011, he received a left kidney transplant from his elder brother, a resident of Spain, who had no medical history of note (the preoperative evaluation of his clinical status and renal function were unremarkable). The kidney donation and transplantation were performed in the Netherlands. The recipient received a standard immunosuppression protocol (cyclosporine, mycophenolic acid and prednisolone). After transplantation, the recipient\u2019s postoperative course was unsatisfactory, with a 10% decrease in serum creatinine levels on 3 consecutive days during the first postoperative week. His renal function subsequently improved, although slowly, and he developed massive proteinuria (18 g/day) and elevated serum amyloid A levels and was diagnosed with nephrotic syndrome. A graft transplant biopsy showed extensive amyloid deposition. The patient underwent treatment with colchicine (0.5 mg/12 h, adjusted for renal function), anakinra (100 mg/day), prednisolone (10 mg/day), mycophenolic acid (540 mg/12 h) and cyclosporine (150 mg/12 h). After 6 months, the patient presented a serum creatinine level of 2.10 mg/dL (185.6 \u03bcmol/L) and proteinuria of 0.25 g/day. After 20 months, the graft was functioning well, with a serum creatinine level of 2.40 mg/dL (212.1 \u03bcmol/L), undetectable serum amyloid A levels and proteinuria of 0.20 g/day. After 62 months and at the time of this report, his serum creatinine was 2.05 mg/dL (182 \u03bcmol/L), Modification of Diet in Renal Disease (MDRD) value of 35 mL/min/1.73 m2 and proteinuria of 0.44 g/day.\nAn apparently healthy 45-year-old man, originally from Morocco and a resident of Spain for 12 years, was considered a living kidney donor for his younger brother. His medical history and examination was compatible for a living related kidney donation procedure. A thorough physical examination showed no abnormalities, and the laboratory work-up included urine analysis, urine culture, blood test and liver function, the results of which were all within normal ranges. Other studies revealed a serum creatinine level of 1 mg/dL (88.4 \u03bcmol/L), creatinine clearance of 113 mL/min/1.73 m2, a 24-h urine protein level of 100 mg and a C-reactive protein (CRP) level of 6 mg/dL (normal range < 5 mg/dL). A computed tomography (CT) angiography of his abdomen showed both kidneys had a perfect configuration with a single renal artery and vein, a normal excretory system and normal appearance of the bladder. After the kidney donation in 2011, the patient presented nausea, vomiting and diarrhea and developed an erysipelas-like erythema of the lower legs. On the fifth postoperative day, he presented a serum creatinine level of 2.08 mg/dL (184 \u03bcmol/L). With the diagnosis of prerenal renal failure, the patient was started on IV fluids, which resulted in partially improved renal function. He was released from hospital on the seventh day after the kidney transplantation and was readmitted 3 days later for dyspnea and chest pain. At that time, his serum creatinine level had increased to 2.20 mg/dL (197 \u03bcmol/L). Nineteen days after the transplantation, the patient presented a serum creatinine level of 4.80 mg/dL (424.3 \u03bcmol/L), proteinuria of 25 g/day and a serum amyloid A level of 85 mg/L. A renal biopsy showed 8 glomeruli, one of which was globally sclerosed and all were pathological. There was extensive expansion of the mesangium, with periodic acid-Schiff (PAS)-positive eosinophilic material, which also caused occlusion of the glomerular capillaries. The eosinophilic material also invaded the blood vessels and was stained with Congo Red. The interstitium presented fibrosis and a diffuse lymphocytic infiltrate. There was also a component of acute tubular necrosis with regeneration. The patient underwent treatment with colchicine (0.5-1 mg/12 h, adjusted for renal function) and anakinra (100 mg/day). After 4 weeks, the patient presented a serum creatinine level of 3.80 mg/dL (339 \u03bcmol/L), proteinuria of 16 g/day and an undetectable serum amyloid A level. Treatment with candesartan (2 mg/day) was then started. Fourteen weeks after the kidney donation, the patient had a serum creatinine level of 1.93 mg/dL (171 \u03bcmol/L) and proteinuria of 7.5 g/day. He remained on regular colchicine (0.5 mg/12 h), anakinra (100 mg/48 h), candesartan (4 mg/day) and enalapril (5 mg/day) for 4 months. After 20 months, the patient was in good clinical condition. The serum creatinine level had stabilized at 1.50 mg/dL (132.6 \u03bcmol/L), creatinine clearance was 61 mL/min/1.73 m2 (MDRD of 53.3 mL/min/1.73 m2), and proteinuria was 2.6 g/day. An echocardiogram revealed an ejection fraction of 60%. Although the possibility of anakinra withdrawal was considered, we decided on indefinite therapy with anakinra and colchicine due to the satisfactory response. After 62 months and at the time of this report, the patient was taking colchicine (0.5 mg/12 h), anakinra (100 mg/48 h) and atorvastatin (40 mg/day). His serum creatinine level was 1.40 mg/dL (123.7 \u03bcmol/L), his creatinine clearance was 67.4 mL/min/1.73 m2 (MDRD of 55.7 mL/min/1.73 m2) and his proteinuria was 1.1 g/day.\nAn initial genetic study on the recipient was conducted in 2000 with negative results. A second genetic analysis was performed in 2011 after the living transplantation on both brothers. Briefly, genomic DNA was prepared from 200 \u03bcL of whole blood, using a commercial kit. Hot spot testing for exons 2 (c.278 to c.910) and exon 10 (c.1900 to c.2346) of the FMF gene (MEFV), as well as exons 3, 4-5, 6-7 including introns 2,4 and exons 6 9, 11, by direct PCR and automated sequencing revealed homozygosity in the MEFV gene (c.2082G > A; p.M694I; National Amyloidosis Centre, University College London Medical School, London, UK). The reason p.M694I was not found in 2000 is not known, given that this founder mutation had been already described in 1998 [, ]. This missense mutation has a founder effect in the African Mediterranean population (Lebanon 12.6%; Tunisia; 13%, Syria 4.8%; Egypt 20.6%), and dates back more than 8500 years (Lebanon) (Mediterranean Founder Mutation Database). This change has been established as a pathogenic variant (Clin Var: RCV000220431.2) in a recessive condition.", "age": [ [ 31.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5579934.xml", "relevant_articles": { "18790261": "123", "16860177": "123", "34580924": "12", "34967975": "12", "18853664": "123" }, "similar_patients": { "5348144-1": "12", "4400500-1": "123", "5010548-1": "12", "6441500-1": "123", "4421672-1": "123" } }, { "human_patient_id": "526", "human_patient_uid": "5851743-1-M", "PMID": "29489640", "title": "A rare case report of a saddle pulmonary embolism presenting with high grade fevers, responsive to anticoagulation", "patient": "A woman in her 40s, presented to the emergency department with complains of nausea, vomiting, and dizziness for the last 2 days. She was experiencing non-bilious, non-bloody, and non-projectile vomiting associated with diffuse abdominal pain and non-bloody watery diarrhea. Patient reported subjective fever associated with rigors and chills but denied diurnal variation, any sick contacts, uncooked/stale food consumption, recent travels, or any urinary symptoms. Her comorbid conditions included human immunodeficiency virus (HIV) infection with a recent CD4+ count of 810 cells/\u03bcL (acquired through unknown source, compliant on antiretroviral therapy), subclinical hypothyroidism, hypertension, and diabetes mellitus. She had tubal ligation done 5 years ago and did not report any family history of cancers, heart, or lung diseases. She was non-smoker, non-alcoholic, and had never used recreational drugs or herbal medications. She worked as a home attendant and had 3 children, lived in United States for the past 15 years with last travel to Africa 6 years ago.\nOn presentation to the emergency department, patient was found to be febrile with a temperature of 38 \u00b0C (Fig. ), tachycardia of 112 beats/min, blood pressure of 125/75 mmHg, and an oxygen saturation of 100% on room air. She was lethargic but alert and oriented and not in an acute distress. Cardiovascular exam was unremarkable except for tachycardia. Rest of the physical examination was unremarkable. Initial laboratory findings are shown in Tables and . Patient was started on intravenous fluids and intravenous antibiotics for suspected acute cholangitis. Computed tomography (CT) scan of the abdomen was performed to discern cause of sepsis, results of which were inconclusive. Advance imaging including magnetic resonance cholangiopancreatography (MRCP) was negative for any intrahepatic, biliary, or pancreatic ductal pathology. She continued to have persistent fevers despite sufficient antibiotics, and all cultures remained negative. Her liver function tests normalized within 3 days, without any intervention. Extensive work up for fever including testing for legionella, mycoplasma, leptospirosis, herpes simplex, Cytomegalovirus (CMV), strongyloides, stool ova and parasites were negative.\nOn day 7 of Intensive Care Unit (ICU) stay, patient became tachypneic and hypotensive, with oxygen saturation dropping to 88%. She was started on supplemental oxygen via nasal cannula and a bedside goal-directed echocardiography was performed by the ICU team. Echocardiography was significant for a right ventricular strain pattern. An emergent CT angiogram of the chest was done, eliciting a large saddle embolus (Fig. ). Ultrasound of the lower extremities showed right sided superficial femoral and popliteal vein deep vein thrombosis (DVT). Intravenous tissue plasminogen activator (t-PA) was administered and later the patient was started on intravenous heparin infusion. On day 9, Gallium scan was done (Fig. ) that showed uptake exclusively in the lungs, and confirmed suspicion of pulmonary embolism as the sole cause of her fever. All antibiotics were discontinued and patient eventually became afebrile on day 11 of ICU stay (3 days after initiation of anticoagulation). She was observed for continued stability and transferred to the floor for further care.", "age": [ [ 45.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5851743.xml", "relevant_articles": { "34349095": "0", "29719745": "0", "32645300": "123", "29489640": "123", "34972223": "0" }, "similar_patients": { "8570451-1": "0", "7916640-1": "0", "3651076-1": "0", "7891250-1": "1", "7198072-1": "0" } }, { "human_patient_id": "527", "human_patient_uid": "6069878-1-M", "PMID": "30083353", "title": "Identification of a novel mutation in the factor VIII gene causing severe haemophilia A", "patient": "A 68-year-old male was diagnosed with severe HEMA in early childhood, with less than 0.001% factor VIII activity. The brother of the proband also suffered from severe HEMA, thus the mother must have been carrier of the causative mutation. The children of the proband were male, and consequently, in this part of the family the mutation has not been passed on. Due to the distant past of the diagnosis, no genetic tests had been performed to identify the causative mutation. Around 30% of patients with severe HEMA develop inhibitors during their treatment with factor VIII, especially patients with large deletions and intron inversions. Thus, genetic factors can influence inhibitor development, and different treatment approaches are chosen according to risk of inhibitor development []. However, the proband never developed factor VIII inhibitors, possibly suggesting a smaller and less frequent mutation in F8 than the large intron inversion. Following blood transfusion, the proband was tested positive for HIV-1 and hepatitis C virus in the late 1980s and early 1990s, respectively. The patient was cured for his Hepatitis C infection, but never received any treatment for his HIV-1 infection, since he remained with normal CD4 T cell count over time and was considered an HIV long-term non-progressor (LTNP).\nTo identify the HEMA causative mutation (as well as possible mutations explanatory for his HIV LTNP phenotype), a blood sample was drawn in EDTA tubes (FLUKA), and peripheral blood mononuclear cells (PBMCs) were isolated over ficoll gradient (GE-healthcare). Integrating HIV DNA in CD4 T cells might result in false positive (somatic mosaic) mutations, or disturb the quality of sequencing. Therefore, CD4 T cells were depleted by magnetic purification (miltenyi biotec). DNA from non-CD4 T cells was purified using allprep DNA/RNA mini kit (Qiagen). Whole exome sequencing (WES) was performed employing Kapa HTP Library preparation and Nimblegen SeqCap EZ MedExome Plus kit and analysed using Nextseq v2 chemistry (2 \u00d7 150 bp). SNPs were called relative to hg19. Variant call files (VCF) were uploaded to Ingenuity Variant Analysis (IVA, Qiagen) and variants were compared to population frequencies of variants in the Allele Frequency Community (AFC) database and to frequencies in the 1000 Geneomes project. One hundred thirty thousand six hundred eighty-seven variants were identified in 16,957 genes in the patient, of which seven were located in the F8 gene. Two variants did not pass quality control, thus five variants could be possibly causative (see Table ). Four of the remaining variants had an allele frequency much higher than the disease frequency and were therefore judged as being irrelevant. Therefore, one variant (c.5411_5412delTCT, p.F1804del) remained a potential cause of disease (Fig. ). The mutation was verified in the raw BAM file (Additional file : Figure S1). Ingenuity did not provide any dbSNP ID or frequency for this variant, which is thus denoted as novel. Moreover, the variant was not reported in Coagulation Factor Variant Databases EAHAD.CFDB (), which provides all 5418 known transcript variants in the F8 gene, confirming that the c.5411_5413delTCT, p.F1804del must indeed be novel.", "age": [ [ 68.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6069878.xml", "relevant_articles": { "30083353": "12", "25617427": "12", "32078252": "12", "26897466": "12", "31975530": "0" }, "similar_patients": { "7499997-1": "0", "8353764-1": "0", "7379893-1": "0", "3851682-1": "0", "6525401-1": "0" } }, { "human_patient_id": "528", "human_patient_uid": "5415937-1-M", "PMID": "28663815", "title": "Rhizobium radiobacter peritonitis: the first case report from India and review", "patient": "A 54-year-old male with end-stage renal disease (ESRD) secondary to chronic, long-standing type II diabetes mellitus presented in January 2011 with decreased urine output and swelling over the whole body for 3 months. He was trained for CAPD in a stable state of health. The patient was compliant with medical care and had been free from peritonitis to date. However, he presented to the nephrology outpatient department in January 2013 with complaints of fever, abdominal pain and cloudy PD effluent. As the abdominal pain worsened, the patient was admitted to the hospital. The patient denied any contact with soil or plant material. His past medical history was uneventful except for diabetes mellitus for the past 11 years. On physical examination, his blood pressure was 140/80 mm Hg\u22121, temperature 100.8 \u00b0 F, pulse 72 min\u22121 and respiration rate 18 min\u22121. His head, eyes, ears, nose and throat examination was unremarkable. There was no clubbing, cyanosis, lymphadenopathy or icterus. His lungs were clear and no cardiac murmur was heard. His abdomen was tender in all quadrants with rebound tenderness. Bowel sounds were present and active. Pertinent laboratory values were Hgm (Hemoglobin) 7.2 gm dl\u22121, white blood cells (WBCs) 24000 mm\u22123, platelets 2.28\u00d7105 \u00b5l\u22121, serum creatinine 9.3 mg dl\u22121, serum blood urea nitrogen 45 mg dl\u22121, serum uric acid 4.9 mg dl\u22121, serum sodium 131 mmol l\u22121, serum potassium 3.5 mmol l\u22121, serum albumin 3.3 g dl\u22121, serum bilirubin (total) 0.45 mg dl\u22121, serum aspartate transaminase 19 U l\u22121, serum alanine aminotransferase 13 U L\u22121, serum alkaline phosphatase 105 U l\u22121, serum amylase 29 U L\u22121, serum calcium 8.9 mg dl\u22121, serum phosphorus 5 mg dl\u22121 and serum lactate dehydrogenase 514 U l\u22121. PD fluid was sent for cell count, Gram stain and culture. The WBC count in PD fluid was 6400 mm\u22123 with 82% neutrophils. Gram staining of the fluid showed plenty of Gram-negative bacilli. A presumptive diagnosis of CAPD peritonitis was made and empiric intraperitoneal cefazolin and tobramycin were started. PD fluid culture yielded catalase-positive, oxidase-positive, non-spore-forming and non-fermenting Gram-negative bacilli. The isolate was positive for urea hydrolysis and nitrate reduction. Negative reactions were found for the production of H2S, indole, lysine decarboxylase and ornithine decarboxylase for the hydrolysis of gelatin. The identity of the isolate was confirmed as R. radiobacter sensitive to trimethoprim/sulfametoxazole, ceftazidime, ceftriaxone, ampicillin-sulbactam, cefoperazone-sulbactam, piperacillin-tazobactam, amikacin, gentamicin, tobramycin, ciprofloxacin, imipinem and meropenem. It was resistant only to aztreonam. Empiric antibiotic therapy was continued and the patient\u2019s abdominal pain subsided and the peritoneal fluid counts decreased to 50 WBCs mm\u22123 on day 4. However, on the eighth hospital day, the patient again complained of abdominal pain and the PD fluid count increased to 300 WBCs mm\u22123. The catheter was therefore surgically removed and the tip sent for culture. The tip yielded growth of R. radiobacter.", "age": [ [ 54.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5415937.xml", "relevant_articles": { "28663815": "123", "15366644": "123", "34246387": "0", "29685363": "0", "14655075": "0" }, "similar_patients": { "3193673-1": "13", "6913050-1": "13", "6942743-1": "13", "4161764-1": "13", "7146884-1": "13" } }, { "human_patient_id": "529", "human_patient_uid": "7188374-1-M", "PMID": "32362983", "title": "Prolonged Remission by Pembrolizumab and Brentuximab-Vedotin Combination Therapy in Heavily-Pretreated Relapsed/Refractory Hodgkin\u2019s Lymphoma", "patient": "A 27-year-old male presented with multiple cervical and mediastinal lymphadenopathies. The excisional biopsy disclosed classical HL, nodular sclerosis subtype, characterized by architectural effacement by nodular collagenous bands, and a mixed-population inflammatory background including numerous eosinophils admixed with Hodgkin and Reed-Sternberg (HRS) cells. Computed tomography (CT) scan of chest and pelvis revealed lymphadenopathies in bilateral neck and superior mediastinum; multiple bone lesions in T1, 2, 12, and L4 vertebrae and right ischium. Whole-body positron emission tomography (PET) scan revealed multiple sites of bone and liver involvement. The diagnosis was classical HL, nodular sclerosis type, Ann Arbor stage IVEB (stage IV: diffuse or disseminated foci of involvement of one or more extralymphatic organs or tissues; E: extranodal organ involvement; B: presence of systemic symptoms like fever and loss of weight), with liver and bone metastasis. He experienced a short remission after 12 cycles of primary chemotherapy with ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) and then relapsed in para-aortic lymph nodes. After ESHAP (etoposide, methylprednisolone, cytarabine, and cisplatin) salvage chemotherapy, he received subsequent high-dose BEAM (carmustine, etoposide, cytarabine, and melphalan) chemotherapy conditioning and autologous peripheral blood stem cell transplantation. However, his disease relapsed 5 months thereafter. Subsequent chemotherapeutic regimens of vinorelbine + gemcitabine and DVIP (dexamethasone, etoposide, ifosfamide, and cisplatin) only achieved a limited period of partial clinical response. Re-biopsy of the chest wall soft-tissue mass confirmed classical HL with cluster of differentiation 30 (CD30) expression. BV was then administered, but after three cycles of treatment, rapid progression occurred (). The patient experienced a severe skin reaction to subsequent lenalidomide treatment. Immunotherapy with pembrolizumab was then initiated, and his disease responded well for 16 months () until the PET scan showed progression with recurrent bony involvement and relapse (). Because of the limited options for subsequent treatment and the patient being medically unfit for allogeneic stem cell transplantation, a combination of BV and pembrolizumab was initiated, and remission was achieved for > 15 months ().", "age": [ [ 27.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC007xxxxxx/PMC7188374.xml", "relevant_articles": { "22034208": "123", "26467917": "12", "33988076": "123", "22448704": "123", "19899733": "123" }, "similar_patients": { "6458937-1": "12", "7944653-4": "12", "5036553-1": "12", "7230437-1": "0", "4307131-1": "12" } }, { "human_patient_id": "530", "human_patient_uid": "6245346-1-M", "PMID": "30532602", "title": "Severe neutropenia in a breastfed infant: a case report and discussion of the differential diagnosis", "patient": "An 8 days old exclusively breastfed female infant was referred to our hospital because of an infection of the umbilicus without fever. She was the second child of nonconsanguineous parents, both of Arab-Berber descent, born after 39 weeks of pregnancy, complicated by intrauterine growth restriction. Birth weight 2.570 kg (SD \u20131.6), length 48 cm (SD \u20130.8), and head circumference 32 cm (SD \u20131.7). The mother was known to have Crohn\u2019s disease, treated with oral methylprednisolone, in a gradually reducing dose with a maximum of 32 mg daily, and adalimumab, 40 mg subcutaneously every 2 weeks for up to 3 months before delivery. Additional investigations revealed a latent tuberculosis (positive interferon gamma release assay), for which she used INH 300 mg once a day, in combination with pyridoxine 125 mg, which both were started immediately after delivery. Family history is negative for hematologic diseases, syndromes, or early unexplained death.\nPhysical examination of the neonate was, besides a local infection of the umbilicus, normal for her age. No (skeletal) malformations, cutaneous, or nail abnormalities; hepato-splenomegaly; or hypotonia were noted. However, complete blood count showed a picture of severe isolated neutropenia (hemoglobin 18.2 g/dL, mean corpuscular volume 97, plate-lets 254\u00d7109/L, leukocytes 7.56\u00d7109/L, and absolute neutrophil count [ANC] 0.04\u00d7109/L; C-reactive protein 73.1 mg/L). The child was admitted and broad-spectrum intravenous antibiotic treatment (ampicillin and cefotaxime) was started. Cultures of the umbilicus revealed the growth of Staphylococcus aureus. Urine and blood cultures remained negative.\nThe infection improved; however, the isolated neutropenia persisted. No viral etiology (TORCH, which includes Toxoplasmosis, Other [syphilis, varicella-zoster, parvovirus B19], Rubella, cytomegalovirus, and herpes infections, [para] influenza, respiratory syncytial virus, adenovirus) could be demonstrated. Testing for antineutrophil antibodies was not done, as the tests often show false-positive and false-negative results. Bone marrow aspiration revealed a severe dysgranulopoiesis, characterized by a maturation stop after meta-/myelocyte stage (), indicating severe congenital neutropenia. Maternal usage of adalimumab during pregnancy can cause neutropenia because it can cross the placenta from the maternal circulation into the fetal circula tion. Also, agranulocytosis due to INH, used by the mother while breast-feeding, could not be excluded. Tuberculosis was excluded in the child, and the complete blood count of the mother did not show neutropenia. As a probability scale, we use the Naranjo algorithm, and this case was scored for both medications separately. INH was scored \u201c3,\u201d while adalimumab was scored \u201c4,\u201d both as a \u201cpossible\u201d likelihood to be responsible for the neutropenia (Naranjo scores: 9 or 10 indicate \u201cdefinitely\u201d; 5\u20138 rate the likelihood as \u201cprobable\u201d; 1\u20134 \u201cpossible\u201d; <1 \u201cdoubtful\u201d).\nBreast-feeding was terminated, and filgrastim (Neupogen\u00ae, Amgen Inc., Thousand Oaks, CA, USA) 5 \u00b5g/kg subcutaneously was started. A very slow increase of ANC was seen, and so filgrastim dose was increased to 10 \u00b5g/kg subcutaneously, with good improvement. ANC increased to a maximum of 35.85\u00d7109/L. Two months after birth, filgrastim was terminated which, initially, led to a decrease of ANC, before it stabilized in the normal range (). Two weeks after terminating, the filgrastim a new bone marrow aspiration () and a complete blood count was repeated. Both were normal, which excluded severe congenital neutropenia.", "age": [ [ 8.0, "day" ] ], "geneder": "F", "file_path": "noncomm/PMC006xxxxxx/PMC6245346.xml", "relevant_articles": { "30532602": "123", "22170976": "123", "18194172": "123", "8970682": "123", "12555210": "12" }, "similar_patients": { "6612131-1": "13", "8607801-1": "123", "5075604-1": "12", "8222900-1": "12", "7036529-1": "12" } }, { "human_patient_id": "531", "human_patient_uid": "5266031-1-M", "PMID": "27930559", "title": "Sofosbuvir and ribavirin in acute hepatitis C\u2013infected patient with decompensated cirrhosis", "patient": "A 65-year-old woman had been diagnosed with overlap syndrome (autoimmune hepatitis and primary biliary cirrhosis) for 14 years. Initially, she was prescribed ursodeoxycholic acid and prednisone, and refused immunosuppressive drugs. However, due to the presence of gastric ulcer and economic reasons, she stopped taking these medications. When liver test results were abnormal, she would take compound glycyrrhizin tablets to treat the disease. In September 2013, due to hematemesis and melena, rupture and hemorrhage of the esophagofundal varices was found. Computed tomography revealed cirrhosis of the liver, splenomegaly, and ascites. The disease progressed to Child\u2013Pugh C decompensated cirrhosis. The patient received endoscopic therapy, and began taking prescribed ursodeoxycholic acid 750 mg daily. From September 2013 to August 2015, her alanine aminotransferase (ALT) level fluctuated between 27 and 91 U/L, aspartate aminotransferase between 33 and 94 U/L, \u03b3-glutamyl transpeptidase between 73 and 240 U/L, alkaline phosphatase between 130 and 260 U/L, total bilirubin (TBIL) between 39.3 and 74.05 mol/L, direct bilirubin between 17.6 and 34.24 mol/L, albumin between 30 and 35 g/L, antinuclear antibody (ANA) titer between 1:1000 and 1:3200, and antimitochondrial II antibody (AMA-M2) between (+) and (++). In September 2015, the patient consulted her physician in our department for significant jaundice and weakness. Physical examination revealed yellow pigmentation of the skin and sclerae, positive liver palms, spider angioma on the chest, and positive shifting dullness. Results of liver function tests showed the following: ALT, 499.9 U/L; aspartate aminotransferase, 686.8 U/L; albumin, 27.02 g/L; \u03b3-glutamyl transpeptidase, 87.2 U/L; alkaline phosphatase, 225.6 U/L; TBIL, 329.6 mol/L; direct bilirubin, 272.91 mol/L; cholinesterase, 2156.4 U/L; prothrombin time, 17.7 seconds; percentage prothrombin time activity, 60; and platelet count, 45 \u00d7 109/L. The anti-HCV antibody test result was positive and the quantitative HCV RNA test result was 6.1 \u00d7 105 IU/mL (genotype 1). The ANA titer was 1:3200, and the AMA-M2 was (+). Epigastric enhanced magnetic resonance imaging identified cirrhosis, splenomegaly, ascites, and collateral circulation in the esophagus, fundus of the stomach, and splenic hilum. Magnetic resonance cholangiopancreatography did not detect any abnormality in the intrahepatic and extrahepatic bile ducts. Initially, the treatment included ursodeoxycholic acid at the previous dosage, glycyrrhizinate, human serum albumin, furosemide, spironolactone, lactulose oral solution, and platelet and clotting factor transfusion. However, after 1 week, weakness and jaundice were exacerbated. Liver function test results were significantly abnormal with a TBIL of 417.6 mol/L, prothrombin time of 23.5 seconds, percentage prothrombin time activity of 46, albumin of 23.1 g/L, cholinesterase of 1789.7 U/L, and platelet count of 14 \u00d7 109/L. After ruling out other possible causes of acute hepatitis, we thought that the cause of the acute exacerbation of hepatic damage was AHC infection, as liver function was decreased by HCV activity. After discussing the risks and benefits with the patient, we started her on an IFN-free combination therapy of SOF and weight-based RBV for 12 weeks. Gilead-brand SOF (400 mg/d) was used. SOF cannot be bought in China; the patient acquired the medication through her relative who works abroad. The patient was reviewed at treatment weeks 1, 2, 3, 4, 8, and 12 and at posttreatment weeks 4, 12, 24, and 36. At the beginning of SOF and RBV treatment, the HCV RNA viral load was 4.8 \u00d7 106 IU/mL. At week 1, the HCV RNA viral load was reduced to 4330 IU/mL; at week 2, 1790 IU/mL; and at week 3, 750 IU/mL. At weeks 4, 8, 12, 16, 24, 36, and 48 (posttreatment week 36), the HCV viral load was undetectable (Fig. ). By week 4, the patient's symptoms alleviated. By week 8, liver function returned to baseline levels with TBIL of 85.35 mol/L, prothrombin time of 17.0 seconds, albumin of 29.5 g/L, and platelet count of 53.2 \u00d7 109/L (Fig. ).", "age": [ [ 65.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5266031.xml", "relevant_articles": { "18293283": "12", "16677548": "12", "16163639": "123", "16880138": "0", "26192239": "0" }, "similar_patients": { "6750843-1": "123", "6750843-3": "13", "6313026-1": "12", "5498963-1": "13", "8544910-1": "123" } }, { "human_patient_id": "532", "human_patient_uid": "8086522-1-M", "PMID": "33948400", "title": "Wernicke Encephalopathy in an Elderly Patient Due to Chronic Malnutrition From an Atypical Diet", "patient": "The patient is a 75-year-old Caucasian female with a past medical history of major depressive disorder who presented to the emergency department for altered mental status. She was brought in by ambulance after the patient developed acute aphasia and was unresponsive to verbal commands. She had developed generalized weakness, decreased oral intake, and recurrent falls over the past several weeks. Over the previous year, she had been increasingly developing abnormal dietary habits, including obsessively eating canned peaches, dairy products such as milk and cheese, and refusing to eat any leafy green vegetables. However, her mentation remained sharp, as she was able to have meaningful and in-depth conversations, up to until her recent symptoms had developed. Her initial vital signs indicated a temperature of 86.7 degrees Fahrenheit via rectal thermometer, hypertensive at 154/60 mmHg, bradycardic at 48 beats/minute, respiratory rate of 18 breaths/minute, and saturating 99% on room air. On physical exam, she was responsive only to painful stimulation, with a Glasgow Coma Score (GCS) of 8. However, she was able to spontaneously move all of her extremities and intermittently opened her eyes. Initial laboratory values were significant for hyponatremia of 120 mmol/L (reference range 135 - 145 mmol/L), glucose of 69 mg/dL (reference range of 74 - 106 mg/dL), white blood cell (WBC) count of 1.22 1000/uL (reference range of 4.50 - 10.50 1000/uL), ammonia was within normal limits as was the thyroid-stimulating hormone (TSH) (Table ).\nInitial CT scan of the head revealed a questionable hypodensity in the left middle cerebral artery (MCA) distribution in the temporal region. She was started on a forced-air warming blanket and admitted to the intensive care unit for concern for a cerebral vascular accident and hypothermia. Subsequent MRI of the brain revealed no acute intracranial findings, including no acute infarct. Mild fluid-attenuated inversion recovery (FLAIR) hyperintense foci within the supratentorial white matter was noted. Electroencephalogram (EEG) revealed continuous generalized slowing that was suggestive of moderate encephalopathy (Figure ).\nLumbar puncture revealed a mildly elevated cerebrospinal fluid total protein of 53 mg/dL (reference range of 15-45 mg/dL) and glucose of 71 mg/dL (reference range of 40-70 mg/dL). Her hypothermia resolved and she was transferred to the general medicine wards, however, her mentation did not improve. She remained unresponsive to verbal commands, responded only to painful stimuli, and appeared to develop nuchal rigidity, with a flat affect. Lorazepam was administered to treat for possible catatonia, however, her symptoms did not improve. Given her previous history of malnutrition, she was administered intravenous high-dose thiamine (Vitamin B\u2081). The following day, the patient\u2019s mentation had improved significantly. She was able to answer questions and hold conversations. She still had partial confusion, but was alert and oriented to person and time. Her family confirmed that her improvement was closer to how she was behaving prior to admission. Subsequently, she suffered a series of mechanical falls as a consequence of persistent gait ataxia. Following her falls, her level of alertness and speed of cognition continued to improve. As her cognition returned she began to question the daily plans told to her by her physicians, physical therapists, and even her family. While some of what she said included confabulation, she rapidly became more oriented to the events around her. By the time she was deemed stable for discharge, she was able to clearly explain why she was in the hospital, as well as her post-discharge plan, but she was not able to recall events that took place during the three weeks leading up to her admission. Afterward, she was discharged home.", "age": [ [ 75.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC008xxxxxx/PMC8086522.xml", "relevant_articles": { "30998493": "0", "5197328": "0", "16318071": "0", "1068960": "0", "6570608": "0" }, "similar_patients": { "7954516-1": "0", "7980951-1": "0", "7901574-1": "0", "7189311-1": "0", "5938807-1": "0" } }, { "human_patient_id": "533", "human_patient_uid": "5299834-1-M", "PMID": "28074828", "title": "Three-dimensional Transesophageal Echocardiography-guided Transcathetar Closure of Ruptured Noncoronary Sinus of Valsalva Aneurysm", "patient": "A 44-year-old male presented with a 3-month history of atypical chest pain, palpitation, and exertional dyspnea. Cardiac auscultation revealed a Grade III/IV to-and-fro murmur. Electrocardiography showed normal sinus rhythm.\nTransthoracic echocardiography (TTE) revealed an aneurysm of the noncoronary cusp of sinus of Valsalva rupturing into the RA. Transesophageal echocardiography (TEE) and three-dimensional (3D) images were taken before the procedure. In the midesophageal right ventricle (RV) inflow view, they clearly showed ruptured sinus of Valsalva [RSOV] into RA.\nThe procedure was performed under general anesthesia with TEE guidance. Seldinger technique was used to achieve percutaneous access to the right femoral artery (RFA) and vein so that two hemostatic sheaths were inserted. Intravenous heparin (200 IU/kg) and cefazolin were given.\nFrom RFA approach, right and left heart pressures and saturations were obtained, and aortic root angiography was performed. The RSOV was measured at its aortic end as well as at the rupture site on TEE. RSOV was tried crossing with terumo wire under real time-TEE guidance. However, we were not able to pass through RSOV. Hence, we took use of 3D imaging available in our TEE machine and tried passing terumo wire across RSOV and position in SVC under the guidance of midesophageal aortic valve long axis at 120\u00b0 and other real time-3D video images and Aortography, and we succeeded in passing the guide wire across RSOV. It was then snared from venous end, and an arteriovenous loop was established. The defect was measured 5.5 mm at its aortic end as measured by TEE and 8 mm when measured in 3D images. According to the measurement in the 3DTEE and aortogram, a patent ductus arteriosus (PDA) occluder 2\u20134 mm larger than the narrowest diameter of the ruptured site was chosen to close most of the lesions. An 8F PDA delivery sheath then placed in the descending aorta and 10 mm \u00d7 8 mm RSOV PDA occluder device (life tech) was placed in the sac of RSOV noncoronary cusp after checking for aortic regurgitation (AR). The entire assembly was pulled back until the disk blocked the aortic end of the ruptured site without slipping into the aneurysm.\nTEE images and aortogram after releasing of the device showed minimal residual shunt across RSOV and no AR. Subsequent echocardiography (echo) next day showed no residual flow [ and Video \u2013].", "age": [ [ 44.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5299834.xml", "relevant_articles": { "17869060": "123", "20824737": "13", "25788785": "1", "24088421": "123", "11720146": "12" }, "similar_patients": { "4276590-1": "123", "4782474-1": "123", "7034198-1": "123", "8133107-1": "0", "3017926-1": "123" } }, { "human_patient_id": "534", "human_patient_uid": "5861962-1-M", "PMID": "29588907", "title": "Disseminated toxoplasmosis in a patient with advanced acquired immunodeficiency syndrome", "patient": "A 46-year-old male with a history of drug, alcohol and tobacco abuse was admitted to the emergency department with altered level of consciousness. At admission, no close companion was present to provide a detailed medical history. A complete clinical examination and various laboratory tests were performed, and uremia was diagnosed. The lab tests showed a serum creatinine level of 17.2 mg/dL (reference range [RR] = 0.7-1.2 mg/dL); serum urea 318 mg/dL (RR = 10-50 mg/dL); hemoglobin 4.8 g/dL (RR: 13-18g/dL) with intense poikilocytosis; peripheral white blood cell count 5,220 cells/mm3 (RR = 4,000-11,000 cells/mm3); total peripheral lymphocyte count 400 cells/mm3 (RR = 900-3,400 cells/mm3); arterial pH 7.208 (RR: 7.37-7.44) and serum bicarbonate 6.1 mmol/L (RR: 23-29 mmol/L). A head computed tomography (CT) and a lumbar puncture were also carried out, both of which showed normal results. Dialytic treatment and adjuvant measures were then initiated, and the patient\u2019s mental and general condition improved progressively over the next few days. The serology panel requested at admission showed two ELISA positives for HIV antibodies, non-immunization for HBV, a positive Toxoplasma immunoglobulin (Ig)G (by electrochemiluminescence, with 650.0 IU/mL [RR \u2265 3 IU/mL]) and a positive HVA IgG. Other serologic tests, including anti-hepatitis C virus (HCV) and anti-T. cruzi antibodies were negative. The HIV infection was then confirmed by Western blotting. However, the patient was not aware of his HIV status. The TCD4+ peripheral count was 74 cells/\u00b5L, TCD8+ peripheral count was, 171 cells/ \u00b5L (TCD4+/TCD8+ ratio = 0.43) and the HIV-1 RNA viral load in the blood was 66,309 copies/mL (branched DNA) or 4.82 Log. The blood cultures were negative.\nOn the 28th day of hospitalization, the patient manifested acute hepatitis, with significant elevation of serum canalicular enzymes (direct bilirrubin (DB) = 2.63 mg/dL [RR < 0.3 mg/dL], alkaline phosphatase (AP) = 1,248 U/L [RR: 40-129 U/L]) and liver enzymes (AST = 172 U/L [RR < 37 U/L], ALT = 447 U/L [RR < 41 U/L]) attributed to trimethoprim/sulfamethoxazole (TMP/SMX) prescribed to prevent opportunistic infections. The detection of HCV RNA by the real-time polymerase chain reaction assay was negative in the blood. These antibiotics were discontinued for 2 weeks, when the canalicular enzyme levels returned to the reference range. Combined antiretroviral therapy (ART) was not prescribed during hospitalization due to the patient\u2019s liver dysfunction. On the 55th day of hospitalization, the patient developed refractory shock attributed to nosocomial pneumonia as he presented cough, fever, and thoracic rales (see chest x-ray and chest CT in ). Bronchoalveolar lavage (BAL) was not performed due to the poor clinical condition of the patient.\nBroad-spectrum antibiotics and vasoactive drugs were prescribed associated with dialysis and mechanical ventilation, but the patient did not respond favorably and died. The blood cultures were negative, and the microscopic analysis and culture of the sputum were negative. The autopsy was requested and was performed with the agreement of the patient\u2019s relatives.\nThe corpse weighed 65 kg and measured 177 cm (body mass index 20.74). The external examination was unremarkable. The lungs were heavy (the right lung weighed 1,126 g and the left lung 936.0 g [RR = 400-800 g]), congested, and showed signs of anthracosis. The parenchymal cut surface was violaceous, friable, with diffuse consolidation (lung hepatization), associated with abundant purulent secretions draining from the airways. Microscopic examination revealed significant congestion and pneumonia characterized by scattered foci of necrosis, a variable number of mononuclear and polymorphonuclear inflammatory cells () associated with granular eosinophilic cysts and free arc-shaped structures with eccentric nuclei (measuring 7 \u00b5m) compatible with Toxoplasma gondii cysts and tachyzoites, respectively ().\nThe cysts were periodic acid Schiff (PAS) positive and the immunohistochemistry (IHC) for the T. gondii antigen (Rabbit Polyclonal Antibody, Cell Marque\u2122) was positive in both cysts and tachyzoites ().\nThe liver weighed 1,570 g (RR: 1,400-1,600 g), was extremely congested, and had a finely granular capsule. The histology demonstrated cirrhosis with dense mononuclear inflammatory infiltrates in the portal tracts, focal steatosis, centrilobular congestion, and necrosis of hepatocytes. The spleen weighed 268.0 g (RR; 100.0 -150.0 g), and the red pulp was friable. Microscopic analysis showed that the red pulp exhibited splenitis and hemorrhagic foci, and that the white pulp had an intense lymphocytic depletion. The kidneys were both atrophic, with a granular external surface. Microscopic examination revealed diffuse glomerular hyalinization, some glomeruli with collapse of the glomerular tuft (collapsing glomerulopathy), cystic dilatation of the renal tubules, chronic interstitial nephritis associated with interstitial fibrosis, and tubular atrophy ().\nThe bone marrow was hypercellular due to increased granulocytic-lineage cells, and numerous plasmacytes and micromegakaryocytes. The brain weighed 1,302 g (RR: 1,200-1,600 g) and was congested and edematous. Microscopy showed sparse areas of necrosis associated with congestion, edema, and discrete interstitial and perivascular lymphohistiocytic infiltrate. The T. gondii antigen was detected by immunohistochemistry in the cytoplasm of inflammatory cells, confirming central nervous system involvement (). The heart weighed 512 g (RR: 200-350 g) and had concentric left ventricular hypertrophy, with no signs of T. gondii infection at the microscopic level. The eyes were not examined, and other organs had no significant histological features. The Grocott\u2019s, Gram, and Ziehl-Neelsen stains were negative in the lungs, brain, heart, and bone marrow. Tissues were not collected for postmortem microbiological analysis.", "age": [ [ 46.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5861962.xml", "relevant_articles": { "32025418": "0", "34260522": "0", "25886601": "0", "22947348": "0", "26110300": "0" }, "similar_patients": { "8015031-1": "0", "8510663-1": "0", "5295150-1": "0", "7703462-1": "0", "8478360-1": "0" } }, { "human_patient_id": "535", "human_patient_uid": "6319102-1-M", "PMID": "30662200", "title": "Isolated spontaneous cerebrospinal fluid rhinorrhoea as a rare presentation of idiopathic intracranial hypertension: Case reports with comprehensive review of literature", "patient": "A 38-year-old female presented with acute onset of spontaneous CSF rhinorrhoea, which started a month ago. The patient disregarded the symptom and related it to rhinosinusitis. However, she again had episodes of intermittent nasal discharge on left side. She denied history of headache, vomiting, blurring, visual disturbance, or head injury. The ophthalmoscopic examination revealed papilledema [] with normal visual acuity and field charting. The laboratory analysis of nasal discharge tested positive for beta-2 transferrin. The magnetic resonance imaging (MRI) cisternography was requested to demonstrate site of leakage. The patient was advised to get MRI on the day of active nasal discharge. The MRI was acquired in prone position with a dry cotton pledget placed in the left nasal opening. A tiny focus of CSF leakage was identified in the left cribriform plate [; zoomed up ], which was seen continuing posteroinferiorly into the nasal cavity []. The dry cotton pledget got soaked with CSF and appeared hyperintense on T2 weighted images []. In addition, MRI demonstrated perioptic CSF distension [], vertical tortuosity of the optic nerves [Figure and ], empty sella [], and very prominent CSF distended bilateral Meckel's cave []. No intracranial mass was noted. Moreover, MR venography showed bilateral distal transverse sinus stenosis []. Imaging diagnosis of IIH was suggested.\nLumbar puncture was performed 2 weeks later at the time of absence of CSF rhinorrhoea, which demonstrated increased opening pressure of 30 cm of H2O (normal 10\u201318 cm of H2O) with normal CSF composition on laboratory analysis. This confirmed imaging diagnosis of IIH. The patient was offered computerized tomography (CT) scan, which she denied. The patient was treated medically and was offered endoscopic surgical repair. Eventually, patient was lost to follow-up.", "age": [ [ 38.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC006xxxxxx/PMC6319102.xml", "relevant_articles": { "9406210": "12", "23616328": "123", "30363286": "12", "32757674": "123", "12080608": "123" }, "similar_patients": { "6319102-2": "13", "6526667-1": "13", "7749803-1": "1", "7677777-1": "1", "7852283-1": "1" } }, { "human_patient_id": "536", "human_patient_uid": "6319102-2-M", "PMID": "30662200", "title": "Isolated spontaneous cerebrospinal fluid rhinorrhoea as a rare presentation of idiopathic intracranial hypertension: Case reports with comprehensive review of literature", "patient": "A 55-year-old female presented with sudden onset of copious spontaneous CSF rhinorrhoea, which started 3 weeks ago noted on the right side. She denied history of headache, vomiting, blurring, visual disturbance, or head injury. The ophthalmoscopic examination revealed normal fundus exam, visual acuity, and field charting. The laboratory analysis of nasal discharge tested positive for CSF. The MRI cisternography was requested. The MRI was acquired in prone position. A moderate sized focus of CSF leakage was identified in the right cribriform plate [], which was seen continuing posteroinferiorly into moderate amount of CSF in the right ethmoid air cells []. The MRI also demonstrated a ballooned empty sella [], perioptic CSF distension [], and vertical tortuosity of the optic nerves [Figure \u2013]. No intracranial mass was noted. Imaging diagnosis of IIH was suggested. CT scan showed a corresponding defect in the right cribriform plate []. The patient was referred for endoscopic/neurosurgical surgical repair. Surgery confirmed the site of leakage noted on MRI/CT and was repaired with fascia lata patch.", "age": [ [ 55.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC006xxxxxx/PMC6319102.xml", "relevant_articles": { "9406210": "12", "7811408": "12", "23616328": "123", "14615855": "12", "26878002": "123" }, "similar_patients": { "6319102-1": "123", "8330654-1": "123", "6526667-1": "123", "6399895-1": "123", "8015513-1": "123" } }, { "human_patient_id": "537", "human_patient_uid": "5476656-1-M", "PMID": "28652823", "title": "Optic perineuritis: a retrospective case series", "patient": "A 60-year-old man developed pain in the left eye 3 days prior to his first visit. At the ophthalmological consultation, he negated any previous disorders, except a history of migraine, and was not taking any prescription medication. The patient displayed a slight exophthalmos of the left eye. BCVA was 0.8 in the right eye and 1.0 in his left eye. A fundus examination revealed a normal optic disc and retina in both eyes. The patient did not receive any treatment except tear substitution eye drops. Laboratory testing included determination of hemoglobin (HGB), glucose, C-reactive protein (CRP), thyroid-stimulating hormone (TSH), thyroxine (T4), and erythrocyte sedimentation rate (ESR), and results from all tests were normal. An orbital MRI with and without intravenous contrast carried out 3 weeks later revealed moderately increased signal intensity in the optical nerve sheaths, especially on the left side, in line with what is seen in OPN. The MRI also showed increased signaling in the retrobulbar fat. No swelling of the extraocular muscles was evident.\nThe eye pain had subsided at a new visit 2 months after the initial consultation. Visual acuity was measured 2, 5, and 12 months after the first visit; corrected visual acuity was 1.0 in both eyes on these examinations. Visual field and color vision tests were normal on all three follow-up examinations. Fundus examinations were performed on all three visits and did not reveal anything abnormal.", "age": [ [ 60.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5476656.xml", "relevant_articles": { "23931468": "2", "32588162": "0", "24987363": "0", "19568362": "0", "25915492": "0" }, "similar_patients": { "5476656-2": "12", "5476656-7": "12", "5476656-6": "12", "5476656-3": "12", "5476656-5": "12" } }, { "human_patient_id": "538", "human_patient_uid": "5476656-2-M", "PMID": "28652823", "title": "Optic perineuritis: a retrospective case series", "patient": "A 60-year-old male experienced dimmed vision in his left eye for 3 days prior to his first visit. The patient negated any other symptoms, including pain and diplopia. He had a history of two previous occurrences of possible ON \u2013 30 years ago in his left eye and some 10 years later in his right eye. The patient had a history of hypertension and was currently on antihypertensive drugs. No relative afferent pupillary defect (RAPD) was present at his first examination. BCVA was 0.65 in the right eye and 0.5 in his left eye. A fundus examination revealed an atrophic and excavated disc in his right eye. An optic disc edema was present in his left eye. Retina was normal in both eyes. Laboratory tests for sarcoidosis, syphilis, and giant cell arteritis were analyzed, including determination of HGB, blood count, serum calcium, ESR, angiotensin-converting enzyme (ACE), Venereal Disease Research Laboratory (VDRL), and Wassermann reaction (WR). All tests were normal or negative. Visual field and color vision were analyzed 3 days later; visual field test showed arcuate inferior defects in both eyes, with equivalent neural capacity of 67% in his right eye and 58% in his left eye. A Sahlgren\u2019s saturation test (SST) color vision test revealed a more defective color vision in his left (20) than in his right (15) eye.\nAn orbital MRI carried out 1 week later revealed increased signal intensity in the parts of the left optical nerve sheath, possibly indicating OPN. The MRI also showed increased signaling in the retrobulbar fat of the left eye. No increased swelling of the extraocular muscles was evident.\nThe patient received a course of prednisone, 60 mg/day, which was tapered over 1 month, at which time he was examined again. BCVA was 1.0 in the right eye and 0.65 in his left eye. The optic disc edema had subsided substantially since the last fundus examination 1 month earlier. He received a new course of prednisone, starting with 25 mg/day, which was tapered to 7.5 mg/day until his next visit 2 months later. His BCVA was 1.0 in his right eye and 0.65 in his left eye.\nVisual field testing again showed arcuate inferior defects in both eyes and abnormal thresholds, with equivalent neural capacity of 69% in his right eye and 61% in his left eye. A new MRI showed a slight regression of the enhancement around the left optical nerve since the last MRI. The results of a fundus examination revealed a pale papilla in both eyes. He remained on 7.5 mg/day prednisone, which was tapered over 14 weeks. At a new consultation 4 months later, BCVA was 1.0 in the right eye and 0.5 in his left eye.", "age": [ [ 60.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5476656.xml", "relevant_articles": { "34292301": "0", "33011753": "0", "32675127": "0", "3960484": "123", "27486810": "123" }, "similar_patients": { "5476656-7": "123", "5476656-3": "123", "5476656-6": "123", "5476656-1": "12", "5476656-4": "12" } }, { "human_patient_id": "539", "human_patient_uid": "5476656-3-M", "PMID": "28652823", "title": "Optic perineuritis: a retrospective case series", "patient": "A 58-year-old woman experienced sudden deterioration of vision in her right eye, 2 weeks prior to her first visit. The patient negated any other symptoms related to her eyes, including pain and diplopia. The patient had a history of pain-related symptoms in her arms and negated taking any medicines regularly.\nAn initial eye examination determined BCVA to be 1.0 in her left eye, whereas she was only able to distinguish hand movement in her right eye. No RAPD was evident at this first examination. No proptosis or enophtalmus was present. A fundus examination revealed that both eyes had vital optic discs and normal retinas. Initial laboratory tests revealed a high ESR (22 mm/h), a slightly increased CRP (8 mg/L), and normal HGB and creatinine. The patient negated head pain, scalp tenderness, and jaw pain.\nAn orbital MRI was carried out 3 weeks after her initial visit and showed a suspected increase in fluid around the distal part of the optical nerve of the right eye, along with increased signaling. The pituitary gland also displayed increased signaling. The results were interpreted as being suggestive of OPN. The patient received a course of prednisone, starting with 60 mg/day for 5 days, 50 mg/day for 10 days, and 40 mg/day until her next appointment 3 months after her initial examination.\nAt the follow-up, an examination determined BCVA to be 1.3 in her left eye and <0.5 in her right eye. Because of severe side effects, the prednisone was tapered to 5 mg/day at her next visit 6 weeks later. BCVA was determined to be 1.0 in her left eye and 0.5 in her right eye. Color vision was assessed and found to be defective in her right eye (red light seen as pink). Prednisone was tapered out completely during the next 10 days. A new MRI showed increased signaling in the right optic nerve and right nerve sheath.\nAt a new examination 4 months later (8 months after her first visit), BCVA was unchanged. A visual field test of her right eye revealed a lower arcuate scotoma (Humphrey field test, visual field index [VFI] of 94%). Fundus examination revealed a pale papilla in her right eye compared to the left. The macula appeared to be normal.\nA MRI of the sella turcica area and a chest x-ray was conducted. No pathological changes were observed. Further laboratory tests included markers for sarcoidosis (ACE), syphilis (WR, VDRL), and inflammation. Besides a slightly elevated haptoglobin, results did not support any increase in inflammatory activity.\nHer symptoms were unchanged at her next ophthalmologic examination 10 months later (one and a half years after her first visit), once again showing a paler papilla in her right eye compared to her left. A RAPD was present in her right eye.\nAt her last eye examination, 18 months after the initial contact, the optic disc in her right eye was found to be pale and slightly atrophic compared to the left eye. BCVA was unchanged at 1.0 in her left eye and 0.5 in her right eye. RAPD was present.", "age": [ [ 58.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5476656.xml", "relevant_articles": { "19568362": "0", "22855935": "0", "25498110": "0", "26055592": "0", "20456768": "0" }, "similar_patients": { "5476656-7": "123", "5476656-2": "123", "5476656-6": "123", "5476656-4": "123", "5476656-5": "13" } }, { "human_patient_id": "540", "human_patient_uid": "5476656-4-M", "PMID": "28652823", "title": "Optic perineuritis: a retrospective case series", "patient": "A 26-year-old woman presented with a 2-week history of cold-like symptoms prior to her first visit. She described having had 5 days of movement-associated eye pain and 3 days of dimmed vision in her left peripheral visual field. The patient also stated having a headache. No previous history of eye disorders was acknowledged. She was taking antibiotics (phenoxymethylpenicillin and chloramphenicol eye drops) for her symptoms.\nNo RAPD was present at the initial examination. BCVA was 1.3 in the right eye and <1.0 in her left eye. The results of a fundus examination showed a normal retina, papilla, and macula in both eyes. An SST color vision test did not reveal any abnormalities (0p). A confrontation visual field exam revealed a possible inferior temporal defect in the left eye. The overall lack of findings in the examination did not lend support for any medical treatment.\nTwo weeks later, her vision deteriorated during a trip abroad. She could only perceive hand waving on her right eye and finger counting on her left. An MRI scan of the spinal cord, brain, and orbita revealed increased signal intensity in the optical nerve sheaths of both eyes, suggesting OPN. There was no evidence of any other abnormalities in the brain or spinal cord. She was being treated with methylprednisone 1 g/day for 5 days and prednisone 50 mg until her next examination 2 weeks later.\nAt this visit, the patient reported that her vision had normalized and that the pain had disappeared. BCVA was 1.3 in the right eye and 1.6 in her left eye. No RAPD was present. A visual field test did not demonstrate any irregularities on either eye (Humphrey field test, VFI was 100% in right eye and 98% in left eye). An SST color vision test suggested slightly more defective color vision in her right (15) than in her left (10) eye. As was the case at her first visit, a fundus examination showed a normal retina, papilla, and macula in both eyes. Except a small bulge on her left iris, possibly an iris cyst, nothing abnormal was found. Her prednisone treatment was tapered out during a period of 1 month.\nFive weeks later, the woman contacted the hospital and described similar symptoms as earlier, including a severe headache coupled with eye movement. Her steroid treatment had been completed 1 week earlier. No RAPD was present. A visual field test revealed a defect in the lower quadrants of her right eye (Humphrey field test, VFI was 96% in the right eye and 98% in the left eye). A fundus examination again showed a normal retina, macula, and papilla. Steroid treatment was reinstated with 40 mg/day of prednisone.\nThree weeks later, the patient was recuperating and reported that her eye sight had improved. A fundus examination revealed nothing abnormal. Her prednisone dose was slowly tapered. Seven months after her first visit, BCVA was 1.3 in her right eye and 1.6 in the left eye. An eye examination revealed nothing abnormal except for a persisting visual field defect in her left eye.", "age": [ [ 26.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5476656.xml", "relevant_articles": { "19568362": "0", "25498110": "0", "16263371": "0", "8810853": "0", "24145559": "0" }, "similar_patients": { "5476656-3": "123", "5476656-7": "123", "5476656-2": "123", "5476656-6": "123", "5476656-5": "12" } }, { "human_patient_id": "541", "human_patient_uid": "5476656-5-M", "PMID": "28652823", "title": "Optic perineuritis: a retrospective case series", "patient": "A 58-year-old male presented with a 2-day history of dimmed vision on his left eye. He reported having had headaches and swollenness behind his left eye during the last week. The patient had undergone heart surgery after a myocardial infarction 9 months prior to his first visit. He was taking several prescription medications because of hypertension and stent implants in his heart. These included aspirin, ticagrelor, bisoprolol, candesartan, and atorvastatin. Except for a pollen allergy, he negated other disorders.\nAn eye examination revealed free eye motility in all directions and slight movement-associated pain in his left eye. BCVA was 1.0 in the right eye and 0.1 in his left eye. There was no diplopia. A RAPD was present in his left eye at the same examination. Color vision was affected in the left eye. The results of a fundus examination revealed a normal optic disc in the right eye, except adjacent ectopic myelin in the lower portion. Retina and macula were without signs of disease. Examination of the left eye revealed papillary edema. Macula and retina were normal except for small hemorrhage from a vessel in the lower fundus. Blood pressure was 150/90. Initial laboratory tests that included ESR, CRP, serum calcium, ACE, anti-nuclear antibodies (ANAs), anti-neutrophil cytoplasmic antibodies (ANCA), and syphilis screen were normal, except for a slightly elevated IgA test.\nAn MRI of the orbita was performed a week after his first visit to the clinic and revealed a slight edema surrounding the left optical nerve, fitting with OPN. At this time, the patient reported that his vision had normalized. Steroid treatment was therefore not initiated. Since his first visit, he reported having three episodes of lost vision in his previously unaffected right eye a few days earlier. Also present was minor pain in his left eye and a few shorter episodes of blurred vision.\nAt a new visit, 3 weeks after his first, vision had improved further. A slight RAPD was present in his left eye. A fundus examination revealed no edema on either eye. Two months after his initial visit, BCVA was 0.8 in his right eye and 1.0 in the left eye. A visual field test conducted at the same time revealed a small isolated central scotoma with a slightly elevated threshold in his left eye (Humphrey field test, VFI was 100% in right eye and 99% in left eye).", "age": [ [ 58.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC005xxxxxx/PMC5476656.xml", "relevant_articles": { "34292301": "0", "26392445": "0", "15078843": "0", "3960484": "0", "9362922": "0" }, "similar_patients": { "5476656-7": "12", "5476656-4": "12", "5476656-2": "12", "5476656-3": "12", "5476656-6": "12" } }, { "human_patient_id": "542", "human_patient_uid": "5476656-6-M", "PMID": "28652823", "title": "Optic perineuritis: a retrospective case series", "patient": "A 64-year-old woman experienced gradual visual loss for several months prior to her first examination. The woman had a 15-year history of systemic lupus erythematosus (SLE). In addition, she suffered from hypertension, hyperlipidemia, chronic obstructive pulmonary disease (COPD), sleep apnea, and a sense of unsteadiness, which had worsened during the last months. She was on several medications (aspirin, omeprazole, simvastatin, atenolol, ramipril, amlodipine, albuterol inhalation, budenoside, and formoterol inhalation). She negated eye pain. BCVA was 0.8 in both eyes. Both visual fields exhibited temporal defects (Humphrey field test). A fundus examination showed peripapillary atrophy in both eyes, but no sign of edema. An MRI with and without intravenous contrast performed 1 week later revealed an increased volume of fluid surrounding both optical nerves as well as increased signal intensity in the optical nerve sheaths, as seen in OPN. The MRI also showed increased signaling in the retrobulbar fat of the left eye and possible subcortical vasculitis. At a consultation, 1 week after the first visit, BCVA was unchanged since the last visit. Laboratory testing was done for sarcoidosis (ACE), syphilis (WR, VDRL), and neuromyelitis optica (NMO). In addition, ESR, CRP, HGB, and blood count were determined. Results showed a high or abnormal ESR, serum lysozyme, polyclonal IgG, and creatinine. Results for NMO antibodies, syphilis, and sarcoidosis markers were normal or negative. A chest X-ray did not find any sign of sarcoidosis. However, a slightly enlarged heart was observed, suggesting a developing heart failure. The woman was later administered intravenous corticosteroids (1 g \u00d72) and cyclophosphamide to treat her SLE. Shortly after, the woman was hospitalized due to cardiac arrhythmia. Warfarin and digoxin were prescribed, and the woman was discharged from the hospital some days later. Because of her arrhythmia, future treatment with corticosteroids was restricted.\nAt a new examination 3 months after her first visit, BCVA was unchanged. Results from eye field tests were still abnormal, with no certain change since the last examination. An SST color vision test showed more defective color vision in the left eye (80 p), compared to the right (30 p). Fundus examination showed no optic disc edema in either eye.\nAt a new consultation 2 months later, BCVA was still unchanged at 0.8 in both eyes. She was on prednisone (5mg/day) in addition to methotrexate (5 mg/week) and levetiracetam, which had been prescribed since her last visit. A fundus examination revealed peripapillary atrophy, but no signs of disc edema in either the left or the right eye. Visual field tests were abnormal (Humphrey field test, VFI was 61% in right eye and 71% in left eye). One month later, she was given injections of rituximab.\nAt the final eye examination 10 months after her first visit, BCVA was 0.8/0.65. A slight improvement of visual test results was observed (Humphrey field test, VFI was 83% in right eye and 74% in left eye). As noted previously, color vision was more defective in the left eye (35 p) compared to the right (20 p), although some improvement was seen since the last examination.", "age": [ [ 64.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5476656.xml", "relevant_articles": { "25246764": "0", "25606038": "0", "19568362": "0", "26055592": "0", "2186292": "0" }, "similar_patients": { "5476656-7": "123", "5476656-2": "123", "5476656-3": "123", "5476656-4": "123", "5476656-5": "12" } }, { "human_patient_id": "543", "human_patient_uid": "5476656-7-M", "PMID": "28652823", "title": "Optic perineuritis: a retrospective case series", "patient": "A 56-year-old woman with a history of diabetes, hypertension, and heart failure developed a gradual decrease in vision in her left eye over a 2-month period prior to her first examination. Two weeks prior to her first visit, she developed left eye pain, radiating upward. She negated headaches, diplopia, or problems with her right eye. She was currently on insulin, antihypertensive medication, and aspirin. The results of the first ophthalmologic examination revealed optic disc edema and RAPD in the left eye. Visual acuity was 0.8 in the right eye and 0.13 in the left eye.\nInitial laboratory testing included syphilis serology, Lyme disease (Borrelia antibodies), determination of HGB, electrolyte status, ACE, blood count, CRP, and ESR. The results of all the tests were negative or normal except Lyme disease serology (IgG 239 (pos), IgM 9 (neg)), low ACE (2 U/L), and eosinophilic cells (high).\nAn MRI performed 1 week later revealed enlargement and enhancement in the left nerve sheath from the eye to the chiasma, in line with the findings seen in OPN ( and ).\nAt a new consultation 1 month after her first visit, BCVA was unchanged. A visual field test revealed a general constriction of the visual field of the left eye, with equivalent neural capacity of 99% in his right eye and 33% in his left eye. Fundus examination showed progression of the left optic disc edema (). RAPD was still present. New laboratory tests that included ESR, CRP, ACE, and sarcoidosis revealed nothing abnormal.\nOne month later, 2 months after her first examination, the left optic disc edema had regressed but an RAPD was still present. Visual acuity was unchanged since her last visit. Treatment with prednisone was initiated, 60 mg/day, which was tapered to 25 mg/day over 4 weeks when she was examined again.\nAt a fourth consultation, 3 months after her first visit, visual acuity was 0.8 in both eyes. A SST color vision test revealed that the patient had more defective color vision in her left eye (35 p), compared to the right (15 p). The optic disc edema was reduced. The steroid dose was tapered to 5 mg/day during 3 weeks. At this point, the patient suffered her first relapse with dimmed vision in her left eye. Fundus examination 1 week later revealed a pale papilla. BCVA was now 0.8 in her right eye and 0.4 in her left eye. Steroid dose was increased to 30 mg/day and tapered to 20 mg/day until the next appointment 2 weeks later. Some days later, the patient was hospitalized with arrhythmia due to hypercalcemia and hyperkalemia. At the new consultation, visual acuity was 0.8 in her right eye and 0.5 in her left eye.\nThe steroid dose was lowered with 2.5 mg per week. At 10 mg/day, she suffered a second relapse and received intravenous steroids. Her corticosteroid dose was increased to 30 mg/day in addition to azathioprine (150 mg/day). A fundus examination 3 months later revealed a normal optic disc with no edema. One month later, the steroid dose had been tapered to 17.5 mg/day. BCVA was 0.8 in both eyes. An SST color vision test revealed defective color vision in both the right (30 p) and the left eye (40 p). The fundus examination showed no sign of optic disc edema.\nFour months later, it was suspected that the patient was suffering from sarcoidosis. Liver and spleen biopsies were positive for granulomas.\nFour months later, she had a third relapse. She was taking 150 mg azathioprine and no corticosteroids at this time. Both eyes were affected; BCVA was 0.4 in her left eye and 0.65 in her right eye. A fundus examination revealed blurred borders of the optic discs in both eyes.\nAt a new consultation 2 months later, she remained on azathioprine, 150 mg/day, and was taken off corticosteroids. BCVA was 0.5 in her right eye and 0.65 in her left eye. Fundus examination showed no optic disc edema. A new MRI added support to the OPN diagnosis.", "age": [ [ 56.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5476656.xml", "relevant_articles": { "25606038": "0", "19568362": "0", "26240107": "0", "26055592": "0", "20157417": "12" }, "similar_patients": { "5476656-6": "123", "5476656-2": "123", "5476656-3": "123", "5476656-4": "123", "5476656-5": "13" } }, { "human_patient_id": "544", "human_patient_uid": "8516024-1-M", "PMID": "34660155", "title": "Xanthogranulomatous Breast Mass: An Unusual Presentation", "patient": "An elderly 92-year-old female noticed a palpable mass in the lower inner quadrant of her right breast for several months. The patient reported occasional palpable tenderness but no skin changes, nipple retraction, or discharge. She denied any family history of breast cancer.\nA mammogram was performed and demonstrated a suspicious right breast mass (Figure ). It was followed up with ultrasound-guided core-needle breast biopsy, which further showed a large, lobulated mass corresponding to the mammographic findings suspicious for a malignant neoplasm, Breast Imaging-Reporting and Data System (BI-RADS) category 4 [].\nSurgery was consulted, subsequent right breast lumpectomy and sentinel lymph node biopsy were performed. Pathology reports demonstrated malignant tumor cells with unknown etiology most likely consistent with a soft tissue mass and no lymph node involvement. She underwent a positron emission tomography (PET) scan that showed no distant metastases or axillary uptake. The patient declined any further treatment and continued to follow up with oncology with consideration for bilateral mammograms in the future.", "age": [ [ 92.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC008xxxxxx/PMC8516024.xml", "relevant_articles": { "16264937": "123", "34660155": "123", "19122965": "12", "33708564": "123", "33790180": "123" }, "similar_patients": { "6024341-1": "13", "7968522-1": "0", "7029571-1": "13", "6480983-1": "0", "3424916-1": "13" } }, { "human_patient_id": "545", "human_patient_uid": "7703459-1-M", "PMID": "33344305", "title": "Primary Ewing sarcoma/primitive neuroectodermal tumor of the lung", "patient": "A 42-year-old previously healthy male was referred to our tertiary center complaining of high-grade fever accompanied by chills over the last 20 days. He also complained of progressively increasing breathlessness, nonproductive cough, and right-sided chest pain. There was no history of weight loss or abdominal pain. He denied smoking tobacco. On arrival at our center, he was found to be febrile and dyspneic. His pulse was 120/min, respiratory rate 28/min, and SP02 was 95% at room air. The systemic examination of the chest revealed decreased breath sounds in the right lower zone and coarse crackles in the right infrascapular region. No peripheral or deep chain lymphadenopathy was detected on physical or imaging examinations. The hematological workup showed a leukocyte count of 18,000/\u00b5l (reference range [RR]; 4000-12000/\u03bcL) with 80% polymorphs. Liver and renal function tests were within normal limits. The serum lactate dehydrogenase (LDH) was 1650 U/L (RR; 150-250U/L). The chest X-ray revealed a heterogeneous opacity in the right pulmonary lower lobe and pleural effusion, which showed to be hemorrhagic after diagnostic thoracocentesis (A). The computed tomographic (CT)-guided Tru-cut biopsy attempted in the original-attending hospital showed necrotic tissue. The thoracic CT scan after the second hospitalization revealed a well-defined irregularly, marginated, complex, non-enhancing mass in the right lung, likely pleural based with thickened visceral pleura causing collapse and consolidation of the right lung (B). The radiological differentials comprised malignant mesothelioma versus a synovial sarcoma.\nA new CT-guided biopsy was attempted and showed atypical cells consistent with an underlying malignant lesion (A). The thoracocentesis revealed an exudative and hemorrhagic pleural effusion without malignant cells.\nMeanwhile, the patient\u2019s clinical condition deteriorated, he became tachypneic and developed puffiness of the face and altered sensorium and a clinical diagnosis of superior vena cava obstruction was made. He was kept on an antibiotic regimen with Piperacillin-Tazobactam, corticosteroids and controlled ventilation. Bedside 2D echocardiogram failed to evidence a pericardial tamponade, but the mass was seen compressing the right atrium and superior vena cava. On the eighth day of hospitalization, his general condition suddenly worsened, and he expired. Immediately. the autopsy was performed with the working diagnosis of a right lung mass with SVC syndrome, probably due to malignant mesothelioma or a high-grade sarcoma.\nExternal examination revealed proptosis of eyes and midline shift of trachea to the left. On the opening of the chest cavity, the right hemithorax was replaced by a massive hemorrhagic and necrotic tumor mass, which was adherent to the chest wall. In comparison, on the left side, there were 25 ml of straw-colored pleural fluid noted with pleural sheen (A). The right lung weighed 1200 g (RR; 360-570 g), and Left lung weighed 550 g (RR; 325-480 g). The right lung was replaced by a large tumor, which was chiefly necrotic, hemorrhagic, and pulpy. Only a portion of the posterior segment of the middle lobe was noted to be intact. The tumor mass pushed the trachea to the left. The left lung was boggy and was oozing frothy blood-stained fluid. The cut section did not show any cavities, abscesses, or tumor deposits (B).\nThe liver was enlarged and weighed 1800 g (RR:1500-1800 g). The external surface was smooth and glistening. No nodularity was noted. The cut surface showed a nutmeg appearance suggestive of passive venous congestion. No mass lesion was identified.\nThe spleen was enlarged, and weighed 230 g (RR:150-200 g). External and cut surface showed congestion. Both kidneys, pancreas, stomach, intestines, heart and brain were externally and on cut sections unremarkable.\nHistological examination of the lung depicted tumor cells in cohesive sheets, having a peritheliomatous arrangement amidst predominantly necrotic areas. The tumor cells were round to oval, had coarsely stippled chromatin with scant to mildly eosinophilic cytoplasm. Nucleoli were inconspicuous, and mitosis was brisk. Numerous apoptotic bodies were also noted (2C).\nIHC reactions showed the tumor cells to be diffusely positive for Vimentin (strong cytoplasmic positivity), CD99 (strong membranous positivity), and FLI 1(strong nuclear positivity). The tumor cells were diffusely negative for calretinin, WT1, D240, synaptophysin, CD56, TTF1, Tdt, S-100, desmin, myogenin, BCL-2, LCA, and EMA. On Periodic Schiff stain (PAS), the cytoplasm of tumor cells showed strong magenta cytoplasmic positivity (AD). Sections from the left upper and lower lobe showed normal air-filled alveoli lined by type II pneumocytes.\nNo tumor deposits were seen. Sections from the right and left lobe of the liver showed features of passive venous congestion. No tumor deposits were noted. Sections from the spleen showed expansion of red pulp with attenuation of the white pulp. Final diagnosis was primary Ewing sarcoma of right lung causing SVC syndrome.", "age": [ [ 42.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7703459.xml", "relevant_articles": { "17419436": "12", "33344305": "12", "26881550": "12", "28599947": "12", "20684215": "0" }, "similar_patients": { "4967471-1": "0", "4142470-1": "1", "8061173-1": "1", "6613054-1": "12", "6360822-1": "12" } }, { "human_patient_id": "546", "human_patient_uid": "8380169-1-M", "PMID": "34434672", "title": "Atypical Subacute Cutaneous Lupus in a Patient on Apixaban Anticoagulation Therapy: A Case Report and Review of the Literature", "patient": "A 37-year-old African American female with a history of two unprovoked deep venous thromboses (DVT) treated with apixaban was evaluated for a pruritic rash of two weeks' duration. She had started apixaban two months prior to the rash onset; there were otherwise no changes in her medication regimen. The exam showed hyperpigmented brown scaly plaques with central atrophic patches on the conchal bowl of the ears (Figure ), violaceous nodules, and indurated plaques with scattered flaccid vesicles on the medial thighs, knees, and antecubital fossae (Figures , ), and eroded plaques with dry, serosanguinous crust on the elbows. Vesicles were not appreciated on non-lesional skin and there was no mucosal involvement. She endorsed hematuria and weight loss but denied lesion photosensitivity. Laboratory analysis was significant for leukopenia (WBC of 3.4 thousands/\u03bcL), anemia (hemoglobin of 5.6 g/dL), and proteinuria. Serology was positive for antinuclear antibodies (ANA) (>1:160), anti-double-stranded DNA (anti-dsDNA), anti-Smith, anti-Ro/SSA, cardiolipin antibody, beta2 glycoprotein antibody, and low C3 and C4 complement.\nA 4-mm punch biopsy of a representative lesion from the medial knee was performed. Histopathologic findings suggested early SCLE and consisted of basilar vacuolar degeneration with scant dermal perivascular lymphocytic infiltrate (Figure ). Colloidal iron staining highlighted mucin deposition throughout the superficial and deep dermis (Figure ). Apixaban was discontinued and warfarin initiated. Triamcinolone 0.01% was used as needed for her skin. She remains in remission at her three-month follow-up, treated with hydroxychloroquine (200 mg BID), mycophenolate mofetil (1 gm BID), and prednisone (40 mg daily) for her SLE and lupus nephritis, respectively.", "age": [ [ 37.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC008xxxxxx/PMC8380169.xml", "relevant_articles": { "14576650": "123", "25958415": "0", "30996845": "0", "15365271": "123", "12100703": "123" }, "similar_patients": { "7199909-1": "123", "4738507-1": "123", "7505537-1": "123", "3546453-1": "13", "6509922-1": "123" } }, { "human_patient_id": "547", "human_patient_uid": "5817355-1-M", "PMID": "29535884", "title": "Free Intraperitoneal Gallstone: An Unusual Case of Small Bowel Obstruction from Extrinsic Compression", "patient": "An 83-year-old man presented to the emergency department (ED) with upper abdominal chest pain with newly deranged liver function tests (LFTs) and raised inflammatory markers. On examination, he was found to be tender in the right upper quadrant as well as in the epigastrium. His LFTs were as follows: unconjugated and conjugated bilirubin were both 26 and 14 \u00b5mol/L, respectively; ALP, GGT, ALT, and AST were 333, 557, 194, and 158 U/L, respectively. His white cell count was 13.9 \u00d7 109/L, and CRP was 105 mg/L. A computed tomography (CT) scan was performed due to his atypical presentation to the emergency department, which showed cholecystitis with a distended gallbladder containing a 21 mm solitary lamellated calcified calculus. This was then confirmed on abdominal ultrasound, which, in addition to the above findings, showed that there was no evidence of choledocholithiasis or biliary duct dilatation.\nThe patient underwent LC, performed by a senior surgical trainee with an intraoperative cholangiogram showing no filling defects in the biliary ducts and free flow of contrast into the duodenum. During the operation, the gallbladder was inadvertently opened whilst dissecting it from the liver bed, resulting in spillage of the large calculus. While retrieving the gallbladder specimen in an endoscopic bag, the spilled calculus was left inadvertently in the peritoneal cavity. The operator did not realize that the spilled stone was unretrieved. The patient made an uneventful, gradual recovery and was discharged on postoperative day 1. Macroscopic histopathology report revealed a partially opened gallbladder with no gallstone within the lumen, suggesting that the spilled large calculus was not retrieved from the peritoneal cavity. Microscopically, it was consistent with acute and chronic cholecystitis with muscle hypertrophy and fibrosis of the wall.\nThe patient re-presented to the emergency department 3 weeks after discharge with central abdominal pain, anorexia, and vomiting. He had been experiencing these symptoms since day 3 of discharge, and they had been getting worse until the time he re-presented. In spite of these symptoms, he was systemically well. Examination of the abdomen revealed minimally distended abdomen with tenderness in the periumbilical region. These symptoms and signs suggested that he had small bowel obstruction. However, in the setting of recent cholecystectomy, we wanted to rule out the possibility of a biliary injury. His LFTs and inflammatory markers were normal. His symptoms were further evaluated with a CT scan, which showed evidence of SBO with transition point in the right iliac fossa. The obstruction was from a laminated calcified structure applying extrinsic compression on a loop of small bowel. With the knowledge of the index operation and the pathology report of the retrieved specimen, it was suspected that this structure was the unretrieved gallstone. This calculus was associated with a surrounding phlegmon, evidenced by intense inflammatory change on the CT scan ().\nThe patient underwent laparoscopy in view of the CT scan findings. Laparoscopy identified a large phlegmon compressing on the distal ileum causing obstruction with distended proximal and collapsed distal small bowel loops (). Dissection of the phlegmon revealed a small abscess cavity and the unretrieved gallstone at its center (). The abscess was drained and the gallstone retrieved (), which resulted in a resolution of the small bowel obstruction. The patient made a gradual recovery and was subsequently discharged on postoperative day 4, at which point he was tolerating solid diet with return of normal gastrointestinal function.", "age": [ [ 83.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC005xxxxxx/PMC5817355.xml", "relevant_articles": { "25391822": "123", "29092966": "123", "27898351": "0", "34754862": "0", "31337629": "0" }, "similar_patients": { "6159182-1": "123", "8544619-1": "123", "3907196-1": "123", "3016474-1": "0", "6439269-1": "0" } }, { "human_patient_id": "548", "human_patient_uid": "7220766-1-M", "PMID": "32332657", "title": "Tracheoesophageal fistula associated with bevacizumab after thoracic radiotherapy in non-small cell lung cancer", "patient": "A 54-year-old male was referred to local hospital with cough and expectoration in April 2018. Chest computed tomography (CT) revealed a mass in the left of the lung, with multiple mediastinal lymph node metastases (4L, 5 and 6 region). Endobronchial ultrasound-guided transbronchial needle aspiration result was consistent with adenocarcinoma. Staging evaluation in Cancer Hospital, Chinese Academy of Medical Sciences (Beijing, China) with CT, positron emission tomography- CT, and magnetic resonance imaging of the brain conformed stage IIIB (T3N2M0) according to the UICC 7th edition TNM classification. The patient was given concurrent chemotherapy, consisting of 500 mg/m2 pemetrexed and 75 mg/m2 cisplatin on day 1 every 3 weeks for 2 cycles, and definitive thoracic radiotherapy of volumetric modulated arc therapy (95%PGTV 60.2Gy in 28 fractions. 95%GTV 50.4Gy in 28 fractions). The isodose lines of radiation dose distribution are showed in Figure . A CT scan of the chest indicated a partial response. Grade I esophageal toxicity, Grade II gastrointestinal toxicity, Grade I dermatological toxicity and Grade I myelotoxicity (Common Terminology Criteria for Adverse Events Version 4.0; CTCAE v4.0) were the side effects of the concurrent chemoradiotherapy.\nHowever, 2 months after completing concurrent chemoradiotherapy, he developed progressive disease with enlargement of right inguinal lymph node. Biopsy of the inguinal lymph node was consistent with adenocarcinoma and the patient was administered docetaxel 75 mg/m2 on day 1, carboplatin AUC 5 on day 2 plus bevacizumab 7.5 mg/kg on day 1 once every 3 weeks.\nEighteen days after 4 cycles, the patient presented a sudden onset of acute cough after drinking. Esophageal Barium meal revealed a TF. Gastroscopy showed an esophageal mucosa erosion to be 28 to 36 cm from the nostrils, in which a deep hole was observed (Fig. ). Then a jejunal feeding tube was placed for nutrition (Fig. ). Forty days after the placement, the patients suffered from lung infections by an unclosed TF and a covered esophageal stent was placed in the esophagus (Fig. ). The TF was managed with stents. Until now, 6 months after the event of TF, the patient was still in follow-up care without any complication related to the stent placement.", "age": [ [ 54.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7220766.xml", "relevant_articles": { "32332657": "123", "28868011": "123", "19327900": "0", "30805810": "0", "8055441": "0" }, "similar_patients": { "6145360-1": "0", "8493187-1": "123", "4595409-1": "0", "4846625-1": "0", "8161821-1": "0" } }, { "human_patient_id": "549", "human_patient_uid": "7886949-1-M", "PMID": "33591403", "title": "Descending aortic transection for recurrence of a pseudoaneurysm previously treated with a stent graft after extra-anatomical bypass for aortic coarctation: a case report", "patient": "The patient in our case was a 51-year-old man who had been treated 20 years ago with ascending-to-descending EABG using a 22-mm Dacron graft for CoA. Moreover, he had anatomical anomalies of the right aortic arch with Kommerell\u2019s diverticulum. Eight years ago, the patient experienced hemoptysis due to a PA on the distal anastomosis site and was treated by TEVAR using the GORE TAG Stent Graft System (34 mm \u00d7 20 cm) (W.L. Gore & Associated, Inc., Flagstaff, AZ, USA). After TEVAR, the size of the PA decreased, and the patient did not experience hemoptysis.\nHowever, due to a recurrence of hemoptysis, the patient was admitted to a hospital. On admission, contrast-enhanced computed tomography (CT) revealed the presence of a PA in the distal anastomotic site of the graft, which appeared to be the cause of hemoptysis (Fig. ). The stent graft was observed in the distal anastomotic site, as was massive blood flow from the descending aorta. Therefore, the patient was transferred to our institution. Blood pressure was normal on examination, and we initially planned to treat the patient using TEVAR. The stent graft is ideally deployed from a site distal to the coarctation to cover the PA, but in this case, it could not be placed proximally to the PA owing to the anatomical form. Thus, we decided to replace the descending aorta and subsequently performed end-to-side anastomosis of the replaced descending aorta with the graft that was surgically constructed 20 years ago.\nThe patient underwent a right third intercostal thoracotomy. Because large portions of the lung had adhered to the ascending-to-descending EABG and PA, we modified the initial surgical plan to perform replacement of the descending aorta, followed by end-to-side anastomosis of the graft to the newly replaced descending aorta. The native descending aorta proximal to the anastomosis site was accessible; therefore, we decided to completely transect the descending aorta for decompression of the PA (Fig. ). The descending aorta was clamped between the coarctation and PA and transected. Both sides were closed using 4-0 polypropylene with pledget (ETHICON\u00ae). Postoperative contrast-enhanced CT showed the complete disappearance of the diseased aortic arch, including the ruptured PA (Fig. ). The postoperative course was uneventful, and the patient was transferred back to the previous hospital on the 13th postoperative day to continue rehabilitation. The patient is doing very well at 5 months after the surgery.", "age": [ [ 51.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7886949.xml", "relevant_articles": { "33591403": "123", "10554491": "123", "30480385": "13", "8037522": "13", "11509272": "13" }, "similar_patients": { "5579796-1": "13", "8241557-1": "13", "6094031-1": "123", "6434357-1": "123", "4981234-1": "123" } }, { "human_patient_id": "550", "human_patient_uid": "7024078-1-M", "PMID": "32082535", "title": "Acute abdomen due to an infarction of wandering spleen: case report", "patient": "A 13-year-old girl presented to the emergency room with generalized, acute abdominal pain (worst in the hypogastric region) with fever 38.9\u00b0, anorexia and vomiting started 2 days prior to presentation.\nThe parents mentioned that they brought her 5 months ago with mild pain and abdominal mass; an ultrasonography showed no splenic tissue in upper left quadrant, which suggested a wandering spleen and a CT scan was ordered, but the parents ignored. She did not have history of trauma or any remarkable past medical history.\nOn examination, the abdomen was rigid with generalized tenderness and rebound tenderness. There was an evident mass bulging under the umbilicus. Heart rate was 123 bpm with otherwise normal cardiorespiratory function.\nOn admission, her hemoglobin was 11.3 g/dL, white cell count 19.6 \u00d7 109/L, granulocytes 78.1% and CRP 21.6 mg/L. Her renal, liver function, amylase and lactate were within normal limits.\nA Doppler ultrasonography showed that the spleen was in the hypogastric region with a diameter of 14 cm and a very low perfusion. The abdominal radiograph and the chest radiograph were normal.\nShe was prepared for an emergency laparotomy; the spleen was infarcted without any ligamentous attachments. The hilar vessels of the spleen were within a long mesentery. The splenic vessels were twisted three rounds around themselves. The other organs in the abdomen were normal (). A splenectomy was performed and the splenic vessels were ligated and then cut.\nHer recovery was uneventful, and she took vaccines dedicated for splenectomy patients.", "age": [ [ 13.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC007xxxxxx/PMC7024078.xml", "relevant_articles": { "33041134": "123", "28140311": "123", "24426389": "123", "22514765": "123", "17384868": "123" }, "similar_patients": { "4031896-1": "123", "2553057-1": "123", "3325069-1": "123", "3336896-1": "123", "4747945-1": "123" } }, { "human_patient_id": "551", "human_patient_uid": "2868038-1-M", "PMID": "20416096", "title": "Fluvoxamine for blonanserin-associated akathisia in patients with schizophrenia: report of five cases", "patient": "The patient was a 40-year-old man who met the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for schizophrenia. Onset of schizophrenia occurred in his early twenties. The typical antipsychotic drug haloperidol was administered for some time. After he stopped the medication (haloperidol 2 mg) because of tremor, he jumped from a second floor window due to delusions and hallucinations. He was then admitted to the hospital's emergency medical center with a right calcaneal fracture. His right leg joint was fixed in a plastic cast, and he was admitted. Treatment with blonanserin (8 mg) and flunitrazepam (2 mg, at night) was initiated for auditory hallucination. At 1 week later, the blonanserin was increased to 16 mg because his persecutory delusions and auditory hallucinations persisted. After the increase in dose (16 mg), the patient complained of leg restlessness. His global score on the Barnes Akathisia Scale [] was 3 ('moderate akathisia'). Substantial relief of akathisia was noted on the next day of fluvoxamine (50 mg) treatment, at which point his global score on the Barnes Akathisia Scale was 0. At 1 week later, the dose of blonanserin was increased to 24 mg since he still had psychotic symptoms. Fluvoxamine (50 mg) continued to be administered. He had no recurrence of the akathisia. After 1 month, he was discharged home because his psychotic symptoms were improved.", "age": [ [ 40.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC002xxxxxx/PMC2868038.xml", "relevant_articles": { "20416096": "123", "16240977": "12", "30300293": "12", "33328211": "0", "21652784": "12" }, "similar_patients": { "2868038-2": "123", "2868038-4": "123", "2868038-5": "123", "2868038-3": "123", "2847563-1": "123" } }, { "human_patient_id": "552", "human_patient_uid": "2868038-2-M", "PMID": "20416096", "title": "Fluvoxamine for blonanserin-associated akathisia in patients with schizophrenia: report of five cases", "patient": "The patient was a 48-year-old woman who met the DSM-IV criteria for schizophrenia. The onset of schizophrenia occurred in her late twenties, and 10 years previously she had been admitted to a hospital emergency medical center with delusions and hallucinations. She was treated for this previous episode with haloperidol (6 mg), but she had stopped the medication due to EPS. She was admitted to the hospital emergency medical center with a recurrence of psychosis, including delusions and hallucinations. Treatment with blonanserin (8 mg), flunitrazepam (2 mg, at night), and levomepromazine (50 mg) was initiated. At 3 days later, the patient complained of leg restlessness. Her global score on the Barnes Akathisia Scale [] was 3. Substantial relief of akathisia was noted on the next day of fluvoxamine (50 mg) treatment, at which point her global score on the Barnes Akathisia Scale was 0. The dose of blonanserin was increased to 24 mg due to an abnormal experience. Fluvoxamine (50 mg) continued to be administered. After 3 weeks, she was discharged home because she had no recurrence of the akathisia.", "age": [ [ 48.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC002xxxxxx/PMC2868038.xml", "relevant_articles": { "20416096": "123", "21652784": "12", "32373382": "12", "18073258": "1", "32165917": "1" }, "similar_patients": { "2868038-1": "123", "2868038-4": "123", "2868038-3": "123", "2868038-5": "123", "2847563-1": "123" } }, { "human_patient_id": "553", "human_patient_uid": "2868038-3-M", "PMID": "20416096", "title": "Fluvoxamine for blonanserin-associated akathisia in patients with schizophrenia: report of five cases", "patient": "The patient was a 63-year-old man who met the DSM-IV criteria for schizophrenia. The onset of schizophrenia occurred in his early twenties. He had been treated with olanzapine (10 mg) for the last 4 years, but he had a tendency to stop the medication due to appetite and body weight. He was admitted to the hospital due to delusions and hallucinations at his older brother's funeral. Treatment with blonanserin (8 mg) and etizolam (1 mg, at night) was initiated for auditory hallucinations and delusions. At 2 weeks later, the patient complained of leg restlessness. His global score on the Barnes Akathisia Scale [] was 2. Substantial relief of akathisia was noted after 14 days of fluvoxamine (50 mg) treatment. His global score on the Barnes Akathisia Scale was 0.", "age": [ [ 63.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC002xxxxxx/PMC2868038.xml", "relevant_articles": { "20416096": "123", "15572272": "12", "14870947": "12", "16240977": "1", "30013866": "1" }, "similar_patients": { "2868038-1": "123", "2868038-2": "123", "2868038-4": "123", "2868038-5": "123", "2847563-1": "123" } }, { "human_patient_id": "554", "human_patient_uid": "2868038-4-M", "PMID": "20416096", "title": "Fluvoxamine for blonanserin-associated akathisia in patients with schizophrenia: report of five cases", "patient": "The patient was a 36-year-old man who met the DSM-IV criteria for schizophrenia. The onset of schizophrenia occurred in his early twenties. He was admitted to the hospital's emergency medical center with a cut to the right of the neck from an unsuccessful suicide attempt. Treatment with blonanserin (8 mg) and flunitrazepam (2 mg, at night) was initiated for auditory hallucinations. At 2 days later, the patient complained of leg restlessness. His global score on the Barnes Akathisia Scale [] was 3. Substantial relief of akathisia was noted on the next day of fluvoxamine (50 mg) treatment. His global score on the Barnes Akathisia Scale was 0. Blonanserin (8 mg), fluvoxamine (50 mg), and flunitrazapam (2 mg) continued to be administered. After 2 weeks, he was discharged home because he had recovered.", "age": [ [ 36.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC002xxxxxx/PMC2868038.xml", "relevant_articles": { "20416096": "123", "15572272": "12", "14870947": "12", "30300293": "12", "21652784": "12" }, "similar_patients": { "2868038-1": "123", "2868038-2": "123", "2868038-5": "123", "2868038-3": "123", "2847563-1": "123" } }, { "human_patient_id": "555", "human_patient_uid": "2868038-5-M", "PMID": "20416096", "title": "Fluvoxamine for blonanserin-associated akathisia in patients with schizophrenia: report of five cases", "patient": "The patient was a 42-year-old man who met the DSM-IV criteria for schizophrenia. The onset of schizophrenia occurred in his early twenties. He had been treated with haloperidol (18 mg), chlorpromazine (150 mg), biperiden (6 mg), and haloperidol decanoate (100 mg) for some time. He tended to drink a lot of water due to mouth dryness. He was admitted to the hospital's emergency medical center because he had fallen at home. He was diagnosed with low sodium blood syndrome due to water intoxication, and he was treated with intravenous nutrition. After recovery, he was treated with blonanserin (16 mg) and flunitrazapam (2 mg, at night). At 2 days later, the patient complained of leg restlessness after the increase in blonanserin (24 mg). His global score on the Barnes Akathisia Scale [] was 3. Substantial relief of akathisia was noted on the next day of fluvoxamine (50 mg) treatment, at which point his global score on the Barnes Akathisia Scale was 0. After 1 week, he was discharged home because she had no psychotic symptoms.", "age": [ [ 42.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC002xxxxxx/PMC2868038.xml", "relevant_articles": { "16240977": "12", "20416096": "123", "26783874": "0", "31142911": "0", "12033473": "0" }, "similar_patients": { "2868038-1": "123", "2868038-4": "123", "2868038-2": "123", "2868038-3": "123", "2847563-1": "123" } }, { "human_patient_id": "556", "human_patient_uid": "7581145-1-M", "PMID": "33120729", "title": "Use of steroids to treat anti-tumor necrosis factor \u03b1 induced tuberculosis-associated immune reconstitution inflammatory syndrome", "patient": "A 32-year-old man who had been diagnosed with Crohn disease 7 years previously was admitted to our hospital with TB. Since diagnosis, his Crohn disease had been managed with infliximab. Before starting infliximab, he had tested negative for M. tuberculosis using an interferon-\u03b3 release assay. He visited a clinic complaining of persistent fever and cough that had started one week previously. His most recent infliximab injection had been administered 14 days before the visit. A chest X-ray revealed a left pleural effusion, and he was admitted to a local hospital. A computed tomography (CT) scan of his chest revealed miliary pulmonary nodules; acid-fast bacilli were found in a sputum smear and a urine sediment sample; and polymerase chain reaction confirmed the presence of M. tuberculosis in both his sputum and the pleural effusion. He was diagnosed with miliary TB and was started on antituberculous therapy (isoniazid, rifampicin, pyrazinamide, and ethambutol). Six days after starting antituberculous therapy, he was transferred to the University of the Ryukyus Hospital in Okinawa, Japan, for further management.\nThe patient's clinical course and chest X-ray findings are shown in Figure . His symptoms initially improved after starting antituberculous therapy, but his high fever recurred within 2 weeks of starting treatment, and his cough recurred within 3 weeks. Initially, his fever was thought to be a reaction to the antituberculous drugs, so his TB treatment regimen was changed to a combination of streptomycin, ethionamide, and levofloxacin on Day 15. However, his clinical condition continued to deteriorate. A repeat chest CT scan, done on Day 23, revealed enlarged miliary pulmonary nodules, extensive ground-glass opacities, and an increased volume of his pleural effusion (Fig. ). This paradoxical exacerbation was diagnosed as anti-TNF\u03b1-induced TB-IRIS, associated with infliximab, and a systemic corticosteroid was initiated [prednisolone 25 mg/day (0.5 mg/kg/day)] on Day 24. After starting corticosteroid treatment, his radiological findings improved immediately, and his fever and cough disappeared within a few days. He was discharged on Day 41.\nAfter discharge, the M. tuberculosis strain that had been cultured from a sputum sample was found to be fully susceptible to the antituberculous drugs that were being administered. Prednisolone was tapered off over the course of 10 weeks, and he completed a 9-month course of antituberculous therapy uneventfully. Infliximab was withdrawn at the initiation of antituberculous therapy and had not been restarted at the time of his most recent follow-up, 14 months after his discharge.", "age": [ [ 32.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7581145.xml", "relevant_articles": { "33120729": "123", "33685105": "12", "32321232": "0", "8107348": "12", "8089560": "12" }, "similar_patients": { "2726479-1": "12", "8044679-1": "1", "6598396-1": "1", "3268750-1": "12", "4050074-1": "12" } }, { "human_patient_id": "557", "human_patient_uid": "5559925-1-M", "PMID": "28852580", "title": "Incidental Finding of Dual Ectopic Thyroid on Computed Tomography Angiography", "patient": "A 72-year-old female patient, with a symptomatic carotid stenosis previously identified by ultrasonography, has come to our attention to perform a CT angiography of the neck vessels. CT angiography examination showed the presence of a severe degree of carotid stenosis (equal to about 85% calculated with the North American Symptomatic Carotid Endarterectomy Trial method); therefore, the patient was candidate to perform a carotid endarterectomy (CEA).\nHowever, the CT angiography has identified some significant incidental findings that have profoundly changed the patient management.\nCT angiography identified an oval soft-tissue mass, well circumscribed with regular margins, with size of 34 mm \u00d7 28 mm \u00d7 23 mm, localized at the base of the tongue along the midline, with avid and inhomogeneous enhancement. This mass changed the aspect of the base of the tongue showing a major bulging on the lumen of the oropharynx, with a significant reduction of the caliber of the air column. More inferiorly, just above the geniohyoid muscle on the midline and in proximity to the hyoid bone, we detected another oval, soft-tissue mass with the same characteristics previously described, and a size of 12 mm \u00d7 22 mm \u00d7 22 mm. Finally, CT angiography revealed the absence of thyroid tissue in its normal position [].\nThe knowledge of the embryologic thyroid course, the absence of thyroid gland in its normal position, the location of the two masses along the midline, and their appearance on CT-scans suggest a dual ectopic thyroid, a lingual thyroid (in the base of the tongue) and suprahyoid thyroid (just above the geniohyoid muscle on the midline, in close proximity to the hyoid bone), respectively.\nThe ultrasound evaluation of the sublingual mass, performed by a linear array transducer (10\u201315 MHz), documented the typical ultrasound characteristics of the thyroid tissue [].\nThe patient was then evaluated by otorhinolaryngology and the diagnosis of lingual thyroid was clinically confirmed. Thyroid function tests were found in the normal range.\nThis patient was originally scheduled for CEA which is effective in preventing ipsilateral ischemic events in patients with symptomatic moderate and high-grade stenosis. The radiological detection and subsequently clinical confirmation of lingual thyroid addressed the patient to an endovascular procedure, by carotid angioplasty and stenting. This alternative approach was chosen to minimize the risks of an endotracheal intubation, such as hemorrhage and compromised airway. In particular, the large blood vessels on the surface of the lingual thyroid could be traumatized by the insertion of any instruments during intubation, with potential onset of hemorrhage and compromised airway.[]", "age": [ [ 72.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5559925.xml", "relevant_articles": { "27747110": "12", "28852580": "12", "23397793": "12", "22040768": "12", "16155337": "12" }, "similar_patients": { "4282920-1": "0", "4288225-1": "1", "6146113-1": "1", "4826937-1": "1", "3580922-1": "0" } }, { "human_patient_id": "558", "human_patient_uid": "4245354-1-M", "PMID": "25469349", "title": "Rectouterine fistula after laparoscopic ultrasound-guided radiofrequency ablation of a uterine fibroid", "patient": "A 36-year-old, nulligravida, unwanted for pregnancy was referred to our hospital due to persistent dysmenorrhea and lower back pain following a bilateral uterine artery embolization and intrauterine device (Mirena) insertion at a local clinic. A pelvic magnetic resonance imaging showed a 5-cm-heterogeneous mass on the posterior uterine wall, which appeared to be an intramural fibroid. After thorough counseling on the potential risks and benefits of the procedure and the possible alternative surgical treatments was the laparoscopic ultrasound-guided RFA performed under general anesthesia. A dense adhesion was found in the right cul-de-sac between uterus and colon. Adhesiolysis and biopsies were performed of the adhesive band and peritoneum and an endometriosis was later confirmed. A 16-gauge RFA needle was percutaneously inserted and placed within the target fibroid under laparoscopic video and transvaginal ultrasound guidance. The RF delivery system (M1004, RF Medical Co., Seoul, Korea) was applied twice with a maximum power of 120 watt and a maximum temperature of 85\u2103 for 5 minutes. The patient was discharged without any complications. However, she visited the hospital for bloody anal discharge and vaginal leakage of stool after two weeks of discharge. During her visit were the vital signs stable, but a leukocytosis (white blood cell 12,820/\u00b5L) and an elevation of C-reactive protein (1.4 mg/dL) were observed. The colonoscopy showed a white, marginal protruding mucosal defect about 9 cm above the anal verge (). A pelvic computed tomography and a hysterosalpingogram revealed a fistula between the posterior uterine wall and the rectum (). The patient underwent a rectal fistula wedge resection and ileostomy and total abdominal hysterectomy due to severe inflammation and necrosis in the uterine cavity. Two months later, the fluoroscopic examination of the pouchgram showed an improved rectouterine fistula and no leakage of contrast media, thus a take-down of the ileostomy was performed. There was no further clinical problem afterward for one year of follow-up.", "age": [ [ 36.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC004xxxxxx/PMC4245354.xml", "relevant_articles": { "25469349": "123", "22159908": "123", "34012498": "12", "27104158": "1", "29478113": "0" }, "similar_patients": { "6927061-1": "0", "1315324-1": "123", "5621082-1": "123", "6076194-1": "123", "4105790-1": "0" } }, { "human_patient_id": "559", "human_patient_uid": "4857572-1-M", "PMID": "27186000", "title": "Delayed diagnosis of endobronchial mucoepidermoid carcinoma in a 29-year-old male", "patient": "A 29-year-old never smoker male patient was referred to the Pulmonary Medicine Outpatient Clinic for evaluation of possible drug resistant TB. The patient had received more than 1 year of anti-TB medications with no symptomatic improvement. Patient history and records were reviewed.\nTwo years ago, the patient developed insidious onset right sided pleuritic chest pain associated with a dry cough. It was associated with on and off fever with evening rise of temperature. There was a history of intermittent wheezing without any seasonal worsening and patient had noted 3\u20134 episodes of streaky hemoptysis. There was no history of anorexia or weight loss. The patient was evaluated at a local health care facility wherein based on the findings of a right sided chest radiographic opacity and thoracic ultrasound demonstrating mild right side pleural effusion, a possibility of pleuro-pulmonary TB was considered, and four-drug anti-TB treatment (directly observed treatment regimen) with first-line drugs was initiated. The patient was reassessed after initial regimen, but there was no radiological response. Sputum smear examination for acid-fast bacilli was negative on multiple occasions. Despite 12 months of regular treatment, there was no improvement in symptoms and cough persisted. The patient was initiated on treatment with an intensified anti-TB regimen (Cat II drugs administered on daily basis for 9 months) along with streptomycin and referred to our center.\nGeneral physical examination was normal. On chest examination, crackles were audible in the right infrascapular area, and breath sounds were reduced in the lower right hemithorax. Routine blood investigations were normal. Sputum cytology was negative for malignant cells. A thoracic computed tomography (CT) scan followed by flexible bronchoscopy was planned.\nContrast-enhanced CT thorax demonstrated a mass lesion measuring 5 cm \u00d7 7.5 cm \u00d7 4.5 cm in relation to the bronchus intermedius causing its significant luminal compromise with resultant atelectasis and bronchiectatic changes in middle lobe and lower lobe of the right lung [Figure and ]. No significant mediastinal/axillary lymphadenopathy or pleural effusion was noted. Findings were suggestive of a primary endobronchial mass with parenchymal extension with post obstructive pneumonitis changes. Flexible fiberoptic bronchoscopy showed a lobulated endobronchial growth in proximal right intermediate bronchus completely occluding the middle and lower lobe []. Endobronchial biopsy showed a malignant neoplasm comprising squamoid cells and mucin-secreting cells showing mild to moderate cytological atypia. Few mucin-secreting cells were seen lining glandular structures and foci of extracellular mucin were noted []. Occasional mitotic figure was seen, and necrosis was absent. Immunohistochemistry revealed CK5 and CK7 positivity, whereas, CK-20, S-100, and SMA were negative. A diagnosis of MEC (low grade) was given. Positron emission tomography-CT scan showed no significant uptake apart from the right lung mass. The patient underwent right middle and lower lobectomy and his postoperative period was uneventful. The final histopathology report was consistent with the result of the bronchoscopic biopsy. Follow-up bronchoscopy performed after 1 year showed an intact suture line with no tumor recurrence.", "age": [ [ 29.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4857572.xml", "relevant_articles": { "34616821": "12", "30205116": "123", "34649627": "0", "34667620": "0", "18574289": "123" }, "similar_patients": { "2876700-1": "123", "4370018-1": "123", "7280025-1": "0", "5152778-1": "0", "3276037-1": "13" } }, { "human_patient_id": "560", "human_patient_uid": "3429963-1-M", "PMID": "23346342", "title": "Bilateral Mandibular Supernumerary Canines: A Case Report", "patient": "A 25-year-old female patient was referred to the Department of Orthodontics, Dental School, Shahed University of Medical Sciences, Tehran, Iran. Past medical history revealed a kidney cyst, but the patient did not suffer from any systemic disease. Clinical examinations eliminated the possibilities of any developmental disorders and syndromes. Extra-oral examination did not reveal any abnormality. In intraoral examination, mild spacing in both of dental arches was noted. Her upper left lateral incisor, second premolar and first molar were in dental crossbite without any functional shift. She had class III occlusal relationships and cephalometric evaluation revealed a class III skeletal pattern (). In her panoramic radiograph, four impacted third molars were present (Figure 2). Significant root dilaceration of maxillary lateral incisors and right first premolar was evident. Surprisingly, an impacted supernumerary canine was noted on the right side of the mandible and a primary canine accompanied by two impacted teeth, both resembling a canine, was present on the left side of the mandible. All of the three impacted teeth had fully-developed roots, and showed the configuration, size and root length of a permanent canine (Figures & ). Occlusal radiograph revealed the impacted tooth on the right was lingual and both of impacted teeth on the left were buccal (). According to the patient, there was no history of tooth extraction. The parents did not have supernumerary teeth; the patient had no siblings.\nFixed orthodontic treatment started for the patient. After six months of treatment including leveling and aligning, the right canine and first premolar were not properly aligned because of the impacted supernumerary canine; therefore, surgical removal of the supernumerary tooth was carried out.\nAnother surgical session was planned for the left side, in which the distal impacted canine was removed after extraction of the ankylosed primary canine, and a bracket was placed on the mesial canine for forced eruption because of its longer root. Both of the extracted teeth had the size and anatomy of a normal canine ().", "age": [ [ 25.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3429963.xml", "relevant_articles": { "33628523": "12", "17846674": "123", "17458091": "123", "288671": "1", "26629478": "0" }, "similar_patients": { "5090803-1": "13", "3304190-1": "13", "4960832-1": "13", "4072348-1": "13", "4041113-1": "13" } }, { "human_patient_id": "561", "human_patient_uid": "3102826-1-M", "PMID": "21655048", "title": "Conventional Epi-LASIK and Lamellar Epithelial Debridement in Myopic Patients with Dermatologic Keloids", "patient": "A 25-year-old woman was evaluated for refractive surgery. She was noted to be susceptible to keloid scarring, as demonstrated by the presence of scars on both ears. Preoperative best-corrected visual acuity (BCVA) was 20 / 16 in both eyes. Preoperative spherical equivalent (SE) was -6.5 diopters (D) in the right eye (OD) and -6.25 D in the left eye (OS). Ophthalmic examination was unremarkable except for moderate myopia. Preoperative characteristics and demographics are shown in .\nThe uncorrected visual acuity (UCVA) was 20 / 32 (OD) and 20 / 20 (OS) one day postoperatively. At 3 days, 1 week, 1 month, 3 months, and 6 months postoperatively, the UCVA was 20 / 100, 20 / 20, 20 / 20, 20 / 12.5 and 20 / 12.5 (OD) and 20 / 20, 20 / 20, 20 / 16, 20 / 12.5, and 20 / 12.5 (OS), respectively. The patient was invited to a re-examination 21 months after the surgery, when the SE was -0.125 D (OD) and -0.25 D (OS). No adverse events, including corneal haze, were observed in this patient, and her visual acuity remained at 20 / 12.5 in both eyes.", "age": [ [ 25.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC003xxxxxx/PMC3102826.xml", "relevant_articles": { "21655048": "123", "32941339": "0", "7473109": "123", "19683145": "0", "17124886": "123" }, "similar_patients": { "3102826-2": "123", "3102828-1": "12", "5216245-1": "12", "5372330-1": "0", "5657171-1": "0" } }, { "human_patient_id": "562", "human_patient_uid": "3102826-2-M", "PMID": "21655048", "title": "Conventional Epi-LASIK and Lamellar Epithelial Debridement in Myopic Patients with Dermatologic Keloids", "patient": "A 28-year-old woman was examined for refractive surgery. Her general history revealed a tendency to form keloids, as demonstrated by a scar on her left shoulder (). Preoperative BCVA was 20/16 in both eyes, and preoperative SE was -5.25 D (OD) and -6.00 D (OS). Ophthalmic examination was normal except for moderate myopia. Preoperative characteristics and demographics are shown in .\nOne day postoperatively, the UCVA was 20 / 25 in both eyes. At 3 days, 1 week, 1 month, 3 months, and 6 months postoperatively, the UCVA was 20 / 20, 20 / 20, 20 / 16, 20 / 12.5, and 20 / 12.5 (OD) and 20 / 25, 20 / 20, 20 / 16, 20 / 12.5, and 20 / 12.5 (OS), respectively. At her final examination, the SE was -0.50 D (OD) and -0.25 D (OS). There were no postoperative complications such as corneal haze ().", "age": [ [ 28.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC003xxxxxx/PMC3102826.xml", "relevant_articles": { "21655048": "123", "28880335": "0", "32941339": "0", "7473109": "123", "20095518": "123" }, "similar_patients": { "3102826-1": "123", "5372330-1": "0", "7508138-1": "0", "5216245-1": "12", "5657171-1": "0" } }, { "human_patient_id": "563", "human_patient_uid": "3102826-3-M", "PMID": "21655048", "title": "Conventional Epi-LASIK and Lamellar Epithelial Debridement in Myopic Patients with Dermatologic Keloids", "patient": "A woman 32 years of age was referred for refractive surgery. She had a tendency for keloids, which was indicated by the existence of an over-exuberant scar on her lower abdomen (). Preoperative BCVA was 20/16 in both eyes. Preoperative SE was -4.50 D (OD) and -2.00 D (OS). Her ophthalmic examination was normal except for mild to moderate myopia. Preoperative characteristics and demographics are shown in .\nOne day postoperatively, the UCVA was 20 / 50 (OD) and 20/40 (OS). At 3 days, 1 week, 1 month, 3 months and 6 months postoperatively, the UCVA was 20 / 40, 20 / 25, 20 / 20, 20 / 12.5 and 20 / 12.5 (OD) and 20 / 32, 20 / 25, 20 / 20, 20 / 12.5 and 20 / 12.5 (OS), respectively. At the final follow-up, the SE was -0.25 D (OD) and -0.50 D (OS), and no postoperative adverse events occurred ().", "age": [ [ 32.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC003xxxxxx/PMC3102826.xml", "relevant_articles": { "21655048": "123", "32941339": "0", "22562297": "0", "28880335": "0", "20672763": "123" }, "similar_patients": { "3102826-2": "123", "3102826-1": "123", "3862735-4": "123", "5216245-1": "123", "5372330-1": "0" } }, { "human_patient_id": "564", "human_patient_uid": "4173618-1-M", "PMID": "25886239", "title": "Ischemic pain mandating unconventional position for epidural placement", "patient": "The case we present here is about a 40-year-old man who was referred to our pain clinic with severe ischemic pain of right lower limb. The pain started gradually 10 months back and became very severe for the last 1 month. The intensity of pain was increasing in both the sitting and lying down positions and decreasing in a standing position. Many non-steroidal anti-inflammatory drugs were tried earlier without much benefit. Over the last 1 month, the severity of the pain was so bad that the patient had to stand all the time and sitting or decubitus position was not tolerable even for 1 min. His sleep was so miserable that he had been taking small naps in that standing position leaning onto some support. He had carcinoma rectum for which he underwent abdominoperineal resection 8 years ago. There was history of smoking prior to that. After the surgery, he had been leading a near normal life driving auto rickshaw for a living until he developed the present problem. There were many gangrenous ulcers over his right thigh and leg. A computed tomography-angiogram was done previously that showed a thrombus in the right common iliac artery measuring about 9.5 cm extending up to the right superficial femoral artery with a near total occlusion of the lumen and poorly developed collaterals. He was scheduled for a conventional peripheral angiogram for deciding on the further plan. However, he could not lie down in the catheterization laboratory due to severe pain and was referred to our Department of Pain Management. We initially tried a conservative approach with a combination of oral pregabalin, diclofenac, paracetamol, and tramadol as per the standard dosage protocol for 2 days. When there was no satisfactory pain relief, we planned epidural analgesia. However, the problem here was the positioning. Patient was not able to tolerate either sitting or lateral decubitus position even for 1 min. He was somewhat comfortable only in the standing position. Considering the special situation, though not conventional, we decided to place the epidural catheter in that standing position. An intravenous line was started using an 18G venous cannula. Electrocardiogram, pulse oximeter, and non-invasive blood pressure monitors were connected. Patient was made to stand besides the operating table holding on to it for support. He was also supported by a technician from the front []. After painting and draping the back, L 4-5 inter-space was identified and local anesthesia was given with 2% lidocaine. Epidural space was engaged with 18G Tuohy needle using loss of resistance to air technique. The epidural catheter was carefully threaded and placed such that the length of the catheter was 5 cm in the epidural space. Catheter was gently aspirated to check for blood and cerebro-spinal fluid and was fixed after subcutaneous tunneling for about 5 cm []. Patient was reassured and gently placed on the operating table in the supine position. A quick test dose was given with 3 ml of 2% lidocaine with 15 mcg adrenaline confirming the epidural placement followed by a bolus of 10 ml of 1% lidocaine along with 1 ml of 7.5% sodium bicarbonate. The pain was relieved within 1 min and the vital signs were stable. Epidural infusion was maintained thereafter with a solution of 0.125% bupivacaine and dexmedetomidine 2 mcg/ml at the rate of 5 ml/h. Patient was very comfortable and slept peacefully. Next day peripheral angiogram was performed, which confirmed the findings of CT-angiogram. Balloon angioplasty was attempted after 2 days, but was not successful and an above knee amputation was performed subsequently. Epidural catheter was removed after 2 days and further pain control was achieved satisfactorily with oral medications.", "age": [ [ 40.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC004xxxxxx/PMC4173618.xml", "relevant_articles": { "25886239": "123", "11840667": "0", "14531260": "123", "10399520": "123", "8368470": "123" }, "similar_patients": { "4478830-1": "1", "4671810-1": "0", "4383118-1": "1", "6966728-1": "1", "4155296-1": "0" } }, { "human_patient_id": "565", "human_patient_uid": "3945949-1-M", "PMID": "24627803", "title": "Cerebral venous thrombosis in post-lumbar puncture intracranial hypotension: case report and review of literature", "patient": "A 31-yr-old female with pregnancy-induced hypertension (PIH) underwent caesarean section (CS) at 35 weeks of pregnancy (due to fetal growth retardation). Spinal anesthesia was used for the procedure. On the second day post-partum, she noticed diffuse occipital headache and neck pain when she tried to get off the bed, which improved on lying down. This postural headache was persistent over next 8 days following which it changed character and became continuous. A diagnosis of PL headache was made and she was discharged on Ibuprofen 400mg thrice daily. On 12\nth post-partum day she had a generalized tonic clonic seizure and had persistent drowsiness. She was taken to local hospital for seizure; there she received lorazepam 4mg slow IV bolus followed by phenytoin 900mg IV infusion over 60 minutes. After stabilization of vitals she was transferred to our comprehensive stroke care center. Prior to this episode she had been detected to have PIH in two earlier pregnancies and the first pregnancy had resulted in intrauterine death. During the present pregnancy she received dalteparin 5000 IU/day subcutaneous injection from 6 weeks pregnancy from local maternity centre with suspicion of anti-phospholipid syndrome; it was continued until the 8\nth post-partum day. There was no past history of abortions or deep vein thrombosis.\nOn examination in the emergency room after 12 hours of seizure she was conscious and oriented. She had no papilledema and her visual acuity and visual field were normal. She had weakness and appendicular ataxia of the left upper limb and mild dysarthria. Her National Institute of Health Stroke Scale on admission was 3.\nShe was investigated with a CT scan of the head (\n) after 8 hours of ictus at a local hospital; this showed a right high parietal hemorrhagic infarct. MR imaging of the brain (\n) and spine (\n) (sequences: T1 Weighted, T2 Weighted, fluid attenuated inversion recovery (FLAIR), susceptibility weighted imaging (SWI), diffusion weighted imaging (DWI), apparent diffusion coefficient (ADC) and MR venography (MRV) was done after 14 hours of seizure ictus. This showed a right posterior high parietal lobe hematoma with mass effect and right side superficial cortical veins and partial sagittal sinus thrombosis. In addition there was evidence of intracranial hypotension with CSF leakage at the lumbar puncture site, as evidenced by corpus callosum sagging, pachymeningeal enhancement, and diffuse prominence of the cortical vein and rim of CSF seen in the epidural space from the D10 to the L3 vertebra. Her routine blood investigations, including a haemogram, liver function test and renal function test, were within normal limits. Erythrocyte sedimentation rate was elevated with 40 mm/hour. Her coagulation parameters including prothrombin time and antithromboplastin time were normal. Prothrombotic (etiological) work-up sent prior to starting of heparin therapy revealed reduced Protein C and Protein S activity of 31% (normal range 67\u2013195%, plasma-clotting time based assay) and 26% (normal range 55\u2013123%, plasma-clotting time based assay), respectively. Antithrombin III antigen level was normal at 209 mg/l (normal range: 170\u2013300 mg/l, chromogenic assay). Factor V Leiden mutation (real time PCR method) was not detected. The vasculitic work up (antineutrophil antibody, ANA, double stranded DNA, dsDNA, antiphospholipid antibody, APLA, IgG and IgM and antineutrophil cytoplasmic antibody, ANCA) was negative.\nUnfractionated heparin was started (16 hours after time of onset) at 800 units/hour to maintain plasma thromboplastin time between 75\u201390 seconds along with bed rest and caffeine immediately after the MRI venography. She responded early and was discharged after 6 days on warfarin 4mg once daily and optimized international normalized ratio (INR) of 2.1. On discharge she did not have any headache and neurological deficit had subsided, with NIHSS of 0 and modified Rankin Scale (mRS) of 0. On follow-up after 3 months, she had no further recurrences or new symptoms.", "age": [ [ 31.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3945949.xml", "relevant_articles": { "23115432": "12", "24627803": "123", "29556650": "123", "12512125": "1", "31616131": "0" }, "similar_patients": { "4493738-1": "123", "3428826-1": "123", "7304224-1": "123", "6126002-1": "0", "4200722-1": "12" } }, { "human_patient_id": "566", "human_patient_uid": "7607849-1-M", "PMID": "33143669", "title": "Central retinal artery and vein occlusion as a complication of persistent hyaloid artery \u2013 a case report", "patient": "In August 2019, a six-year-old male patient manifested right eye (RE) excessive tearing, conjunctival injection and pain. Family history was unremarkable. The child was born after uncomplicated twin pregnancy, in 37th gestational week, but ultrasound assessment was consistent with 34th maturity week. Birth weight was 2100 g and Apgar score 9/10. Photographs before the event depicted isocoria without anterior segment asymmetry.\nOn examination, RE demonstrated visual acuity of light perception and intraocular pressure (IOP) of 36 mmHg. Left eye showed no abnormalities. The diagnoses of neovascular glaucoma, CRVO and CRAO were established as affirmed with fluorescein angiography (FA). Extensive systemic work-up was performed. Neurological and cardiologic examinations were unremarkable. Laboratory tests for tuberculosis, Epstein-Barr virus, cytomegalovirus, Toxoplasma gondii, rubella, herpes simplex virus type 1 and 2, and HIV were negative, as well as factor V Leiden (FVL) mutation, MTHFR gene, anticardiolipin antibodies, and lupus anticoagulant. PHA was not reported in any of the findings. The child\u2019s condition was perceived as idiopathic CRAO and CRVO, which led to the development of neovascular glaucoma. The patient was treated with antiglaucoma drugs topically (dorzolamide + timolol 20 mg/L + 5 mg/L drops b.i.d., latanoprost 50 \u03bcg/mL drops q.d., and acetazolamide 250 mg q.d.), panretinal photocoagulation, ranibizumab intravitreally and cyclophotocoagulation.\nIn December 2019, the child was referred to our Centre for second opinion. Clinical examination showed no light perception. The slit-lamp indirect lateral illumination revealed fully dilated, non-reactive RE pupil (Fig. a). Retroillumination verified blood cells in the HA lumen and anterior vitreous (Fig. b). RE IOP was 38 mmHg. Br\u00fcckner\u2019s transillumination revealed dim red reflex and tubular remnant of HA freely rotating in the anterior vitreous (Additional file 1). Closed angle and clear lens were depicted using ultrasound biomicroscopy (Fig. c). Extensive subhyaloid and intravitreal haemorrhages obscured visualization of fundus periphery and posterior pole (Fig. d). Thus, RE optical coherence tomography (OCT) angiography could not be performed. Ultrasound B-scan affirmed low reflective membranous tubular structure of the persistent hyaloid artery extending freely into the vitreous demonstrating substantial after-movements (Fig. e). It originated within the optic nerve head measuring 4.92 \u00d7 1.08 mm (Fig. f).\nVascular occlusion incident was discerned as a consequence of the existence of patent HA in the highly mobile Cloquet\u2019s canal. No therapeutic intervention was currently indicated, but only close follow-up because the patient did not complain of any eye pain.", "age": [ [ 6.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7607849.xml", "relevant_articles": { "33143669": "123", "18425438": "12", "24311934": "0", "18672609": "12", "34248588": "0" }, "similar_patients": { "5125125-1": "12", "7457306-1": "1", "5643585-1": "0", "5731101-1": "1", "6125994-1": "0" } }, { "human_patient_id": "567", "human_patient_uid": "5391161-1-M", "PMID": "28435274", "title": "Hashimoto encephalopathy with high plasma monoamine metabolite levels: a case report", "patient": "A 52-year-old woman with faithful and mild personality who has never had medical or psychiatric history and drug/alcohol abuse and dependence was admitted to orthopedic hospital for neck pain after a traffic accident. She was diagnosed with contusion of neck and received painkillers. Three days after the traffic accident, she developed delusions, visual and auditory hallucinations, and her speech became incoherent. Although she was voluntarily discharged from the hospital after 5 days of admission, hallucinations and delusions lasted and she became agitated and violent. She was admitted to the psychiatric ward of our hospital due to psychotic state with disorientation and agitation, 6 days after the traffic accident. On admission (day 1), her physical and neurologic examinations (brain computed tomography, usual blood tests including levels of serum electrolytes, fasting blood glucose, and renal and liver function) showed no remarkable findings. But considerable changes were observed in the plasma levels of HVA and MHPG on admission; the level of HVA was 66.5 ng/mL (normal range for 50\u201360-year-old subjects, 4.0\u201315 ng/mL) and the level of MHPG level was 41.8 ng/mL (normal range, 4.0\u20137.0 ng/mL). Brain magnetic resonance imaging and whole-body computed tomography, electrocardiogram, and chest X-ray were all normal. Thyroid stimulating hormone and free T3 were normal, but free T4 was slightly elevated with 1.79 ng/mL (normal range, thyroid stimulating hormone: 0.50\u20135.00 \u03bcIU/mL; free T3: 2.30\u20134.00 pg/mL; free T4: 0.90\u20131.70 ng/mL). Thyroid autoantibodies tests indicated normal titrates of antithyroid peroxidase antibodies 7.7 IU/mL (normal range, 0.0\u201315.9 IU/mL), but elevation in titrates of antithyroglobulin antibodies (anti-TG) 92.3 IU/mL (normal range, 0.0\u201327.9 IU/mL).\nThe clinical course after admission is summarized in . A diagnosis of HE was suspected because of the extensive negative work-up, disturbance of consciousness and psychotic symptoms, and positive anti-TG. On day 16, oral prednisolone (PSL) 50 mg/day was administered. Disorientation, hallucinations, and delusions dramatically improved after the administration of PSL, and plasma levels of HVA and MHPG decreased to 7.2 and 9.9 ng/mL, respectively, on day 19. On day 27, hallucinations and delusions appeared again, and plasma levels of HVA and MHPG increased to 33.1 and 22.4 ng/mL, respectively, on day 33. After that, since a diagnosis of steroid psychosis was suspected, the dosage of PSL was decreased to 45 mg/day and risperidone was started at 2 mg/day. Subsequently, her hallucinations and delusions were alleviated. PSL was tapered, and her psychiatric symptoms gradually improved. On day 82, plasma levels of HVA and MHPG were 17.9 and 7.7 ng/mL, respectively.", "age": [ [ 52.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5391161.xml", "relevant_articles": { "28435274": "123", "32595319": "123", "25787102": "0", "23107155": "0", "20384190": "0" }, "similar_patients": { "4442283-1": "0", "7989680-1": "0", "3224772-1": "12", "5330085-1": "0", "8647114-1": "0" } }, { "human_patient_id": "568", "human_patient_uid": "7470353-1-M", "PMID": "32974493", "title": "A case of primary bacteraemia caused by Salmonella enterica serovar Corvallis in an immunocompetent adult after travel to Southeast Asia", "patient": "A 24-year-old native Japanese man presented to our hospital after developing high-grade fever. He had travelled to Vietnam and Cambodia for 14 days. After leaving Japan, he visited the beach in Halong Bay, the forest region near the border of China, and Siem Reap in Cambodia. During his stay, he had participated in forest trekking tourism and had stayed in a youth hostel. For dietary intake, he ate home-cooked food and drank beverages with ice, in a similar manner to local people. Fourteen days after he returned to Japan, he developed a mild headache, chills and malaise, and 2 days later, he developed a high fever with chills and rigors. He did not have any abdominal pain or diarrhoea. His past medical history, family history and social history were unremarkable. On examination, his temperature was 39 \u2103, his blood pressure was 128/68 mmHg, his pulse was 101 beats per minute, his respiratory rate was 18 breaths per minute and his oxygen saturation was 98 % with room air. He did not present a rash, lymph node swelling, abdominal tenderness, or hepatosplenomegaly. His laboratory examination demonstrated elevated serum C-reactive protein (5.1 mg dl\u22121; normal range, 0\u20130.3 mg dl\u22121). The blood cell counts and the other biochemical tests were normal (WBC 6900 \u00b5l\u22121, AST 20 U l\u22121, ALT 19 U l\u22121). The HIV test result was negative, while contrast-enhanced computed tomography (CT) revealed ileocecal lymphadenopathy. We did not detect enterocolitis, arthritis, or abscesses. We also did not detect an aneurysm or abscess via brain magnetic resonance imaging (MRI).\nBased on his travel history and clinical findings, we suspected primary bacteraemia from typhoid fever. He was admitted to our hospital for observation and treated with antibiotics. On the day of admission, ceftriaxone (2 g/day) and minocycline (200 mg/day) were administered. On hospital day two, the initial blood cultures yielded Gram-negative bacilli, which were identified as by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The bacterial subspecies could not be identified by biochemical testing at our hospital. Antibiotic susceptibility testing revealed that the organism was not resistant to the following antibiotics: ampicillin, piperacillin, cefotiam, cefotaxime, ceftizoxime, ceftazidime, cefepime, imipenem, meropenem, azythromycin, levofloxacin, ciprofloxacin and fosfomycin. Only minomycin had an MIC90 value of >8 \u00b5g ml\u22121.\nAfter 1 day of ceftriaxone and minocycline, his fever, malaise and headache remitted. We discontinued minocycline, and ceftriaxone was continued for 14 days. The patient was discharged on day 10 and had an uneventful recovery with no recurrence of fever.\nFurther testing using commercial O and H antisera (Denka Seiken Co. Ltd, Tokyo, Japan) according to the Antigenic Formulae of the (9th ed.) [] identified the organism as serovar Corvallis (at Hokkaido Institute of Public Health, Sapporo, Japan). Thus, serovar Corvallis was likely to have caused the primary bacteraemia in this patient, as described.", "age": [ [ 24.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7470353.xml", "relevant_articles": { "32974493": "123", "28991941": "0", "33322867": "0", "32321232": "123", "26741691": "0" }, "similar_patients": { "8466638-1": "123", "6388674-1": "123", "7367316-1": "123", "2649872-1": "123", "6136621-1": "123" } }, { "human_patient_id": "569", "human_patient_uid": "7982115-1-M", "PMID": "33767883", "title": "Spontaneous cervical epidural hematoma: Insight into this occurrence with case examples", "patient": "We present a 52-year-old right-handed Caucasian male with a medical history of HIV, hepatitis C, hypertension, and type II diabetes with a chief complaint of sudden onset severe upper back pain. The patient stated that the upper back pain started while he was conducting a Zoom lecture as a math teacher. He denied any trauma or injuries. He also denied any regular use of anticoagulant medications, but did take aspirin 81 mg daily for general cardiovascular health. He also denied any subjective fever or chills. He stated that the pain was 8/10 in severity. Within hours, he started to notice weakness in his right and right hand which prompted him to call the ambulance and was brought to the hospital. As the weakness became more severe, he began to develop numbness in the right hand and right leg. The patient was admitted and a magnetic resonance imaging (MRI) of the cervical spine was performed.\nRadiographically, MRI of the cervical spine without contrast revealed an epidural fluid collection identified posterior to the cord at the C4-C7 levels measuring up to 1 cm thick []. The cord appeared compressed and was most pronounced at the C6 and C7 levels with mild increased cord signal. The signal characteristics were compatible with epidural hematoma.\nThe patient was emergently taken to the operating room for posterior C5-C7 decompressive laminectomy and evacuation of intra-SEH. On removal of the lamina and ligamentum flavum, there was visualization of epidural hematoma. The purple, clotted, thick, gelatinous material was completely evacuated and sent to pathology for confirmation. There was no obvious vascular malformation noted and there did not appear to be any trauma in the adjacent soft tissues. There did not appear to be any unusual bleeding problems intraoperatively. Complete evacuation of hematoma and decompression was achieved. The histopathological specimen consisted of a 2 \u00d7 2 \u00d7 1 cm aggregate of dark brown-purple clotted blood fragments. The pathological diagnosis confirmed SHE with no malignancy cells. The patient was returned to his hospital room for continued recovery and physical therapy rehabilitation. He was subsequently discharge to acute rehabilitation facility. The above patient represents a case of idiopathic SSEH.", "age": [ [ 52.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC007xxxxxx/PMC7982115.xml", "relevant_articles": { "18310978": "123", "2245080": "12", "10973117": "12", "19128914": "123", "17657280": "123" }, "similar_patients": { "7982115-2": "13", "7434283-1": "13", "6805498-1": "13", "3604222-1": "13", "6213806-1": "13" } }, { "human_patient_id": "570", "human_patient_uid": "7982115-2-M", "PMID": "33767883", "title": "Spontaneous cervical epidural hematoma: Insight into this occurrence with case examples", "patient": "We present a 72-year-old right hand dominant Caucasian female transferred from outside hospital status \u2013 post sudden onset severe left neck pain and left arm pain. She stated that her neck pain started the night prior and suddenly started radiating into her left shoulder and arm which was associated with progressive weakness. Her pain was made worse by any movement. She denied any preceding trauma. She denies any medical history other than hypertension. Of note, she stated that she does take 325 mg aspirin daily for joint pain. She denies having any known bleeding disorder but stated that she tends to bruise easily. Her coagulation laboratories indicated aspirin therapeutic response causing platelet dysfunction: platelet EPI >300 (normal 72\u2013184) and platelet function aspirin 560 (normal 570\u2013675). Her platelet count was 400 and other laboratory work noncontributory. Her physical examination was significant for having motor deficits as follows: left upper extremity: 4/5 deltoid, 4/5 bicep, 3/5 triceps, 2/5 wrist extension, 2/5 wrist flexion, 4/5 handgrip, and 2/5 interosseous muscles, left lower extremity: 4+/5 hip flexion, 5/5 knee flexion, 5/5 knee extension, 4+/5 dorsiflexion, 5/5 plantar flexion, and 5/5 extensor hallucis longus. She also had sensory deficits in the left upper extremity which displayed decreased sensation to pinprick in a nondermatomal distribution.\nRadiographically, MRI of the cervical spine showed an epidural hematoma dorsal to the cord at the C3-T2 levels measuring up to 6 mm thick []. It lied eccentric toward the left with mild-to-moderate compression on the cord. There was no definite cord edema, abnormal enhancement, or major ligamentous injury. MRA of the neck was negative for any abnormal vascularity.\nShe was taken to surgery within hours of presentation for emergent posterior C3-C7 decompressive laminectomies and evacuation of intra-SEH. There were findings of dorsal purple clotted epidural hematoma that was eccentric to the left. Operatively, there was complete decompression achieved and hematoma was entirely evacuated. Baseline intraoperative neuromonitoring showed decreased motor signals in bilateral upper extremities, left worse than right. The SSEP sensory signals were normal and stable throughout the surgery. After decompression and evacuation, there was identifiable improvement in bilateral upper extremity motor signals on intraoperative neuromonitoring.\nPostoperatively, within the first 24 h period, she had near resolution of her weakness with only residual weakness of 4+/5 wrist extension, 4+/5 wrist flexion, 4/5 handgrip, and 4/5 interosseous muscle. She continued to have left upper extremity decreased sensation to pinprick testing in nondermatomal fashion that was stable. She worked with the physical and occupational therapy teams and was subsequently discharged home with outpatient physical therapy and recommendations to discontinue her daily aspirin use. The above case represents SSEH likely resultant from daily aspirin usage.", "age": [ [ 72.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC007xxxxxx/PMC7982115.xml", "relevant_articles": { "27796190": "0", "28045690": "0", "32351744": "123", "33102899": "0", "33327287": "0" }, "similar_patients": { "7732784-1": "123", "7732784-2": "13", "6830539-1": "0", "8412216-1": "123", "8288909-1": "0" } }, { "human_patient_id": "571", "human_patient_uid": "6323576-1-M", "PMID": "30688936", "title": "Difficult management of a patient presenting with recurrent syncope caused by diffuse vasospasm", "patient": "A 57-year-old male was admitted to our hospital with chest pain followed by loss of consciousness. It was stated that loss of consciousness was not related to the patient\u2019s position, and according to the eyewitness\u2019 statement, the patient\u2019s eyes were open at that time. Episodes lasted for approximately 2\u20133 min. During the episode, fecal and urinary incontinence, tongue-biting, and tonic\u2013clonic seizures were not observed. The medical history revealed that the patient was taking 5 mg amlodipine and 50 mg metoprolol succinate due to hypertension; there was no history of alcohol or cigarette consumption. The patient was then hospitalized and admitted to the cardiology department. Sinus bradycardia (45/min) was detected on electrocardiogram (ECG) at admission, and the patient\u2019s blood pressure was 165/63 mmHg. Then, beta blocker treatment was stopped. There were also no electrolyte disturbances on admission. No other pathology except sinus bradycardia was detected during 24-h ambulatory rhythm monitoring. On the third day of hospitalization, ST segment elevation at DII-DIII as well as aVF derivations and complete atrioventricular (AV) block were detected on ECG (). Emergency coronary angiography was performed, and diffuse spasm was detected at the left anterior descending, circumflex, and right coronary arteries (). After intracoronary administration of 300 mcg nitrate, vasospasm disappeared and ST elevation and AV block regressed (Figs. , ). Because the patient had bradycardia, diffuse spasm, and life-threatening ventricular arrhythmia during ischemic episodes, dual implantable cardioverter-defibrillator (ICD) was implanted. Then, 50 mg isosorbid 5-mononitrate and 90 mg diltiazem 2\u00d71 po treatment was initiated. Episodes of syncope continued, and ventricular fibrillation reoccurred during an ischemic episode because of vasospasm. During follow-up, the diltiazem dose was increased up to 480 mg, and episodes were taken under control. In the sixth-month follow-up, the patient had no complaints of angina and syncope and his vasospastic episodes were under control with treatment.", "age": [ [ 57.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC006xxxxxx/PMC6323576.xml", "relevant_articles": { "30688936": "123", "17517803": "123", "11573452": "123", "21899184": "123", "18297382": "123" }, "similar_patients": { "7495811-1": "123", "6669425-1": "123", "3816167-1": "0", "8464441-1": "0", "4720840-1": "0" } }, { "human_patient_id": "572", "human_patient_uid": "4336244-1-M", "PMID": "25705419", "title": "A validation of presepsin levels in kidney dysfunction patients: four case reports", "patient": "Case 1: an 83-year-old man was admitted to the ICU in order to manage postoperative respiratory failure with AKI. He had previously undergone resection of rectal cancer and ileal conduit replacement. Clinical data from his ICU stay are shown in Table (case 1). On his 1st day in the ICU, Escherichia coli (E. coli) was isolated by urine culture and normal florae were isolated by oral culture (Table (case 1)). PSP measured on the 2nd day was 2,745 without PCT or CRP elevation. However, on the 6th day, severe sepsis set in and E. coli was isolated by blood culture. PSP was elevated to 3,977, and PCT and CRP had also increased. The patient\u2019s kidney function recovered gradually with continuous hemodiafiltration; however, PSP rose to 6,051 on the 9th day, along with high SIRS and APACHE II values. The patient did not survive on the 13th day due to multiple organ failure.", "age": [ [ 83.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4336244.xml", "relevant_articles": { "25705419": "123", "33897779": "12", "7745298": "12", "33413183": "12", "28711593": "12" }, "similar_patients": { "4336244-2": "13", "4336244-4": "1", "4336244-3": "13", "5509818-1": "1", "8417974-1": "1" } }, { "human_patient_id": "573", "human_patient_uid": "4336244-2-M", "PMID": "25705419", "title": "A validation of presepsin levels in kidney dysfunction patients: four case reports", "patient": "Case 2: a 78-year-old woman with CKD on hemodialysis (HD) was admitted to the ICU after a coronary artery bypass graft under cardiopulmonary pump. Continuous HD was undergone postoperatively, and PSP ranged from 1,473\u20131,870 without sepsis symptoms. Clinical data from her ICU stay are presented in Table (case 2). Temporary elevation of CRP or PCT was observed; however, SIRS and APACHE II values gradually decreased postoperatively. Bacteria were not isolated in blood culture, and normal florae were isolated in oral culture (Table (case 2)). Postoperative complications were not observed, and the patient\u2019s clinical prognosis was good.", "age": [ [ 78.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4336244.xml", "relevant_articles": { "25705419": "12", "18292722": "0", "23466483": "0", "18820863": "0", "9071130": "0" }, "similar_patients": { "4336244-3": "123", "4336244-4": "123", "4336244-1": "13", "8417974-1": "0", "4973043-1": "0" } }, { "human_patient_id": "574", "human_patient_uid": "4336244-3-M", "PMID": "25705419", "title": "A validation of presepsin levels in kidney dysfunction patients: four case reports", "patient": "Case 3: a 74-year-old woman with CKD on HD was admitted to the ICU after surgical clipping for intracranial arterial aneurysm. Intermittent HD was undergone postoperatively, and PSP ranged from 1,240\u20131,935 without sepsis symptoms. Clinical data from her ICU stay are listed in Table (case 3). Temporary elevation of CRP or PCT was also observed, while SIRS and APACHE II values did not change postoperatively (Table (case 3)). Bacteria were not isolated in blood culture, and normal florae were isolated in oral culture (Table (case 3)). Postoperative complications were not observed, and the patient\u2019s clinical prognosis was good.", "age": [ [ 74.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC004xxxxxx/PMC4336244.xml", "relevant_articles": { "25705419": "123", "28711593": "0", "33072496": "0", "9559770": "0", "25324976": "0" }, "similar_patients": { "4336244-2": "123", "4336244-4": "123", "4336244-1": "13", "8417974-1": "0", "5884756-1": "0" } }, { "human_patient_id": "575", "human_patient_uid": "4336244-4-M", "PMID": "25705419", "title": "A validation of presepsin levels in kidney dysfunction patients: four case reports", "patient": "Case 4: a 62-year-old man with CKD was admitted to the ICU in order to control gastrointestinal bleeding. Initial PSP was 606 without infection. Clinical data on his 1st day in the ICU are presented in Table (case 4). His CRP was not elevated and PCT was elevated only slightly, while low SIRS and APACHE II values were observed. Bacteria were not isolated in blood culture, and normal florae were isolated in oral culture (Table (case 4)). No signs of infection were observed, and the patient\u2019s clinical prognosis was good.", "age": [ [ 62.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4336244.xml", "relevant_articles": { "25705419": "12", "11089747": "2", "34641661": "0", "32164551": "0", "27738486": "0" }, "similar_patients": { "4336244-3": "123", "4336244-2": "123", "4336244-1": "13", "8417974-1": "0", "7745708-1": "0" } }, { "human_patient_id": "576", "human_patient_uid": "8040088-1-M", "PMID": "33854344", "title": "Possible Prosthetic Valve Endocarditis by Pandoraea pnomenusa and Specific Virulence Mechanisms", "patient": "A 37-year old male injecting drug user (IDU) with recurrent biological PVE resided in a cardiac rehabilitation clinic after valve re-replacement surgery for an episode of Enterococcus faecalis and Candida dubliniensis endocarditis. Two days after completion of his six-week antibiotic treatment with intravenous amoxicillin/clavulanic acid and whilst still under isavuconazole treatment, he developed fever accompanied by elevated inflammatory markers. Subsequently, two blood culture bottles yielded growth of P. pnomenusa drawn simultaneously from his peripherally inserted central venous catheter (PICC) and from his elbow vein. The patient was started on empirical treatment with tigecycline. Upon suspicion of a central venous catheter-associated bloodstream infection (CLABSI), the patient was readmitted to the University Hospital of Zurich on day 6 of the current episode. Blood cultures drawn upon admission showed a marked difference in time to positivity of 9h between the PICC (14 hours) and the peripherally drawn blood cultures (23 hours), indicative of CLABSI. The central line was removed immediately without showing any growth microbiologically. Initial testing demonstrated susceptibility towards piperacillin/tazobactam but resistance to tigecycline when interpreted according to Pseudomonas clinical breakpoints. Accordingly, therapy was switched to piperacillin/tazobactam on day 8 of the current episode. Three days after initiation of targeted therapy, a new PICC was inserted until novel blood cultures on day 22 yielded growth of P. pnomenusa again, which led to another change of the PICC. At the same time, transesophageal echocardiography (TOE) demonstrated filiform, floating structures on the central catheter without valve vegetation, whereas the positron emission computed tomography (PET/CT) did neither show a metabolic activity of the prosthetic valve nor of the catheter tip. A small echo-dense structure at the anterior pocket of the annulus had already been described in earlier investigations. Based on suggestive clinical and microbiological criteria (fever, persistent positive blood cultures not meeting major criteria, predisposing heart condition and IDU) a treatment duration of six weeks for possible PVE was determined. After a three-week course of piperacillin/tazobactam, therapy was switched to trimethoprim/sulfamethoxazole. To date, P. pnomenusa was not isolated in the patient again.", "age": [ [ 37.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC008xxxxxx/PMC8040088.xml", "relevant_articles": { "27826374": "0", "31970514": "0", "33633889": "12", "16324966": "123", "16815193": "0" }, "similar_patients": { "6580457-1": "12", "7669802-1": "123", "3892611-1": "123", "7793199-1": "123", "8468436-1": "1" } }, { "human_patient_id": "577", "human_patient_uid": "8573376-1-M", "PMID": "34765838", "title": "Rubber band-assisted closure of a mucosal defect following duodenal EMR", "patient": "We demonstrate this technique in a 72-year-old woman who was referred for evaluation of iron deficiency anemia. EGD was performed for evaluation and revealed a 3-cm \u00d7 3-cm flat polyp (Paris classification 0-IIa) in the second portion of the duodenum, sparing the ampulla. Capsule endoscopy and colonoscopy were subsequently performed and revealed no other polyps or etiology for anemia. The decision was made to proceed with EMR. The polyp was lifted using a mixture of 6% hetastarch and methylene blue. Complete piecemeal EMR was performed using snare cautery.\nAfter resection, post-EMR defect margins were prophylactically treated with snare tip soft coagulation to help prevent recurrence., To reduce the risk of delayed AEs, closure of the EMR defect with endoscopic clips was attempted. Because of the large size of the resection bed, complete apposition of the 2 edges of the mucosal defect using standard endoscopic clips was not feasible. The decision was made to proceed with rubber band\u2013assisted closure. As described, a small rubber band was attached to the first clip. The clip was then placed on the proximal edge of the lesion at the area of maximal width, fixing the rubber band in place. A second clip was used to grasp the rubber band and was then attached to the opposite edge of the defect, approximating both edges. This allowed for subsequent closure of the remaining mucosal defect by easily adding additional clips at the now approximated edges.\nA total of 8 endoclips were used, achieving excellent closure. The patient was discharged home the same day. There were no AEs, including bleeding or delayed perforation. Final pathology revealed a tubulovillous adenoma with no high-grade dysplasia. Surveillance EGD 6 months later revealed no evidence of recurrent adenomatous tissue.", "age": [ [ 72.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC008xxxxxx/PMC8573376.xml", "relevant_articles": { "34765838": "123", "26364966": "123", "33291159": "123", "30296436": "12", "31362007": "123" }, "similar_patients": { "5721481-1": "123", "7205367-1": "13", "7370691-1": "123", "4627350-1": "0", "7808504-1": "123" } }, { "human_patient_id": "578", "human_patient_uid": "6955129-1-M", "PMID": "31976093", "title": "A Rare Etiology of Abnormally Large Gastric Folds: Menetrier's Disease", "patient": "A 58-year-old male with comorbidities of hypertension, chronic obstructive pulmonary disease, benign prostatic hyperplasia, and gastro-esophageal reflux disease was initially referred to the gastroenterology clinic by primary care physician for the surveillance colonoscopy, and evaluation of dark colored stools.\nPatient noted dark colored stools during the Christmas weekend associated with nausea, vomiting, and abdominal pain. The abdominal pain was epigastric, gradual onset, severe in intensity, nonradiating, aggravated with emesis with no specific relieving factors. Denies any hematemesis. He had colonoscopy 10 years ago and had history of colonic polyps. At the time of assessment in the clinic he denied any nausea, vomiting, and worsening abdominal pain or other symptoms.\nPhysical examination of cardiovascular, respiratory, gastrointestinal, and neurological system was unremarkable. Vitals were within normal limits. Recent laboratory workup showed hemoglobin of 14.7 g/dl with normal renal and hepatic parameters including normal albumin levels. He has past medical history of anemia and esophagogastroduodenoscopy (EGD) and Colonoscopy which revealed arteriovenous malformations (AVMs). He also has history of Alcoholic pancreatitis, alcohol dependence, smoking but no history of any drug abuse. Family history was negative for the colon cancer and stomach cancer. For gastroesophageal reflux disease, he was prescribed PPIs as needed but he was not taking it regularly due to little or no relief from them.\nFor the evaluation of GI bleed, he underwent colonoscopy in January 2016 which showed normal ileum, few 2\u20134 mm hyperplastic polyps in the sigmoid colon, and few 3 mm polyps in the rectum which had reactive lymphoid aggregate and focal epithelial hyperplasia on biopsy. Other findings included diverticulosis in the sigmoid colon and in the descending colon and nonbleeding internal hemorrhoids. In January 2016 an EGD showed normal esophagus but enlarged gastric folds and erythematous mucosa in the antrum and stomach biopsy showed gastric antral mucosa with focal mild increase of eosinophils and congestion. Three nonbleeding angioectasias were seen in the duodenum which were treated with argon plasma coagulation (APC). Mucosa biopsies were negative for H. pylori infection. For evaluation of the AVMs, Small bowel enteroscopy was done on February 2016 which showed mucosal changes in the jejunum and biopsy revealed small bowel mucosa with dilated lymphatics. EGD was repeated for polypectomy in February 2016 which showed enlarged gastric folds and were ligated. There was normal duodenal bulb and mucosal resection was successfully performed. The biopsy was consistent with fundic gland polyps.\nHe was referred to the gastroenterology clinic after eighteen months for abnormal abdominal computerized tomography findings of gastric wall thickening which he had for abdominal pain. This epigastric pain was gradual in onset, severe in intensity, radiating to right upper quadrant, and progressively worsened. To rule out gastric malignancy, EGD and EUS were done. EGD in September 2017 showed giant gastric folds, much larger than seen on the prior endoscopies. This is shown in . The biopsied enlarged gastric folds revealed gastric fundic mucosa with foveolar hyperplasia, dilated fundic glands and chronic gastritis which is shown in . Another gastric fundus nodule biopsy revealed gastric fundic mucosa with foveolar hyperplasia and mild chronic inflammation.\nWith the background of thickened gastric folds and episodes of recurrent pancreatitis, the patient underwent upper endoscopy ultrasound for the evaluation of the pancreas as well as the stomach on March 2018 which showed wall thickening in the body of the stomach. The thickening appeared to be primarily within the submucosa (Layer 3) of the stomach (). There was no sign of significant pathology in the common bile duct, gall bladder, and the main pancreatic duct.\nStomach biopsy results were consistent with Menetrier disease. Patient was followed in the clinic and explained the risks of adenocarcinoma associated with this disease. Our patient has worsening of the disease in one and half years.", "age": [ [ 58.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6955129.xml", "relevant_articles": { "31976093": "123", "29742955": "0", "2754838": "0", "30043121": "0", "30692472": "0" }, "similar_patients": { "5827909-1": "0", "5606985-1": "0", "5638174-1": "0", "7592548-1": "0", "7198079-1": "0" } }, { "human_patient_id": "579", "human_patient_uid": "7333553-1-M", "PMID": "32676548", "title": "Occipital Hemangiopericytoma 10 Years after Initial Manifestation", "patient": "A 54-year-old woman was referred to our hospital for occipital soft tissue swelling and headache. The patient\u2019s history was remarkable for resection and radiation therapy for a hemangiopericytoma (HPC) in the left gluteal musculature 10 years previously. The patient had also undergone multiple pulmonary metastases resections. An ultrasound of the occipital region revealed a heterogeneous soft tissue mass with destruction of the occipital bone of up to 6 cm (Figure ). Computed tomography (CT) of the brain showed an extra-axial mass in the fossa posterior extending through the tentorium and lysis of the overlying occipital bone (Figure ). On MRI the mass was isointense to grey matter on both T1- and T2-weighted images (WI), flow voids were noted (Figure , arrowheads). The lesion demonstrated mildly heterogenous, avid contrast enhancement (Figure ). There was no restricted diffusion. The patient underwent selective intra-arterial embolization before surgical resection to minimize blood loss. Afterwards the patient received adjuvant radiotherapy.", "age": [ [ 54.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7333553.xml", "relevant_articles": { "2234296": "123", "18055104": "123", "20438488": "123", "33913268": "123", "32780654": "123" }, "similar_patients": { "7657444-1": "123", "5485299-1": "13", "4395944-1": "13", "5059891-1": "1", "3730196-1": "123" } }, { "human_patient_id": "580", "human_patient_uid": "6447140-1-M", "PMID": "30989012", "title": "Feasibility of Transoral Approach to Accessory Parotid Tumors", "patient": "A 43-year-old woman presented with a chief concern of painless swelling in the right cheek, which she had first noticed two years ago. On examination, we noted a 1 cm x 1 cm painless, firm mass in the patient\u2019s right cheek area (Figure ).\nThe rest of the examination revealed no pathologic alterations in the head and neck area. Ultrasonography showed a round tumor under the skin, outside of the buccinator muscle and around the anterior edge of the masseter muscle. Furthermore, this tumor was separated from the main parotid gland (Figure ).\nThe patient underwent fine-needle aspiration cytology and was diagnosed with a pleomorphic adenoma originating from an accessory parotid gland. After we discussed the risks of the procedure and the possibility of avoiding a scar with the patient, she provided informed consent to undergo surgery via a transoral approach. Transoral excision of the tumor was performed with assistance from an endoscopy for improved visualization (Figure ). Frozen section was not performed in view of preoperative benign cytology report as well as no perioperative clinical suspicion. No intraoperative complications were encountered such as excessive bleeding. Postoperatively, the patient had minimal parotid swelling which was treated conservatively. Post surgery histopathology showed a benign pleomorphic adenoma. We monitored the patient via follow-up for eight months and found no postoperative complications, including pain, facial or auricular nerve weakness, salivary fistula, infection, tumor recurrence, Frey\u2019s syndrome or depression deformity (Figure ).", "age": [ [ 43.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC006xxxxxx/PMC6447140.xml", "relevant_articles": { "33168293": "123", "34759162": "123", "27538561": "12", "18637446": "12", "12926606": "12" }, "similar_patients": { "6615422-1": "12", "6015682-1": "12", "4545910-1": "12", "4361912-1": "12", "8025948-1": "12" } }, { "human_patient_id": "581", "human_patient_uid": "4365775-1-M", "PMID": "25884938", "title": "A rare desmoid tumor arising from the manubrium", "patient": "A 64-year-old man was referred to our hospital with bulging of the sternal manubrium. He was otherwise asymptomatic. There was no antecedent history of Gardner syndrome, trauma or surgery. Physical examination revealed a firm, 3\u00d7 3 cm palpable sternal mass. The contrasted computed tomography (CT) scan of the chest showed a 4\u00d7 4 cm mass based on the sternal manubrium, with no apparent involvement of the mediastinal structures (Figure A and B). 18F-fluorodeoxyglucose\u2013positron emission tomography (FDG-PET) revealed metabolically active areas around the manubrium, both sternoclavicular joints, and bilateral first sternocostal joints, which was suggestive of malignant tumor of the sternal manubrium. The patient refused to undergo preoperative fine-needle aspiration of the lesion. Thus the patient underwent a radical en bloc resection of the tumor and sternal reconstruction with autogenous rib grafts. At surgery, an expansile lesion involving the entire manubrium, both sternoclavicular joints, and bilateral first sternocostal joints was found. En bloc radical manubriectomy was performed including portions of the bilateral clavicles and first ribs. The specimen was removed 4 cm beyond the margin of the lesion. Then through a left anterior lateral incision, about 10 cm of the left fifth rib was harvested from the subperiosteum and carved into two parts with preservation of intact periosteum and pleura. Slots were cut into the ends of the two rib clips, bilateral clavicles, and the edge of the sternum using an electric drill. The two rib grafts were placed to form a T shape between the edges of the residual sternum and bilateral clavicles using rib nails, and then fixed with stainless steel wires. Histopathological examination revealed long fascicles of spindle-shaped cells with slight atypia arranged in a collagenous stroma, indicating a diagnosis of desmoid tumor (Figure A and B). The resection margins did not show any signs of neoplastic infiltration. Postoperative recovery was unremarkable and there were no complications. Three months postoperatively, computed tomography scan of the reconstructed chest showed neither instability of the chest wall nor evidence of tumor recurrence (Figure C). The patient has been free of disease for 46 months after surgery without any other treatment.", "age": [ [ 64.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4365775.xml", "relevant_articles": { "33213427": "123", "25199477": "123", "25589989": "123", "28860818": "12", "18788370": "12" }, "similar_patients": { "8214899-1": "123", "4663035-1": "123", "5566894-1": "123", "4186566-1": "123", "8548202-1": "123" } }, { "human_patient_id": "582", "human_patient_uid": "5894144-1-M", "PMID": "29651227", "title": "A case of atopic dermatitis caused by Ascaris lumbricoides infection", "patient": "The patient was a 12-year old female suffering since early infancy from atopic dermatitis and asthma. Both skin and respiratory symptoms were perennial, with worsening in spring and autumn. Allergy testing, performed at the age of 18 months, resulted positive to Dermatophagoides pteronyssinus and farinae. In addition, tomato, hen\u2019s egg and cow milk were positive to skin prick tests. Following environmental measures to reduce house dust mite exposure and the elimination of tomato, egg and milk from the diet, there was an improvement of the patient\u2019s asthma condition but not in atopic dermatitis. At 3 and 6 years of age, there was a worsening of dermatitis with modest response to topical corticosteroids, while asthma was no longer present. A further worsening of atopic dermatitis occurred at 9 years of age, which was treated with oral bethametasone and topical pimecrolimus. In September 2014, the patient was referred to our Unit; we found peripheral eosinophilia of 14.4% and, suspecting parasitic infections, we evaluated specific IgE for A. lumbricoides, which had a value of 32.50 kU/L. Anthelmintic therapy was prescribed using mebendazole (one 100 mg 1 tablet b.i.d. for 3 days), repeated after 20 and 50 days. Table shows patient data. One month after the first two cycles of therapy, the patient showed progressive improvement of symptoms (Fig. ), and eosinophilia was 12%. Six months after the end of therapy, the skin was free from dermatitis and a further decrease was observed for eosinophilia (11.20%) and Ascaris-specific IgE (23.90 kU/L).", "age": [ [ 12.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5894144.xml", "relevant_articles": { "29651227": "123", "18837422": "12", "23283060": "1", "4085965": "12", "8023005": "12" }, "similar_patients": { "6073181-1": "12", "5831961-1": "12", "7907169-1": "12", "6332555-1": "12", "7869337-1": "12" } }, { "human_patient_id": "583", "human_patient_uid": "3857899-1-M", "PMID": "24349817", "title": "Nutcracker Syndrome Complicated by Left Renal Vein Thrombosis", "patient": "We present the case of a 24-year-old newly married woman, who was admitted to our hospital from the Emergency Department complaining of acute and constant left flank pain for 3 days with macroscopic haematuria.\nThis pain was nonradiating, was not related to meals, did not respond to over-the-counter analgesics, and was not associated with anorexia, nausea, vomiting, or fever. This pain was preceded by macroscopic haematuria that appeared for 2 months before.\nPersonal and family history was noncontributory; especially she denied any history of surgeries, chronic illness, recent immobilisation, recent prolonged travel, or trauma or oral contraceptives. She was not pregnant. No thrombogenic factors were identified.\nShe reported no change in her bowel habits.\nThe patient's vitals were stable and exam revealed isolated left costovertebral angle tenderness. Physical examination revealed also a height of 172 cm and weight of 51 kg with a lower BMI at 17.2.\nHer initial labs revealed only haemoglobin at 9.0 mg/dL.\nComputed tomographic angiography (CTA) was performed demonstrating left renal vein thrombosis (), regardless of renal tumor or hydronephrosis. The CTA also showed a compression of the left renal vein (LRV) between the aorta and the superior mesenteric artery (SMA), SMA angle (the angle between aorta and SMA) was approximately 10\u00b0, the posteroanterior diameter of the hilar portion and that of the aorticomesenteric stenotic portion of the LRV were 9.9 mm and 1.0 mm, respectively (), and the diagnosis of anterior nutcracker syndrome leading to left renal vein thrombosis was confirmed.\nWhen we asked her again, she reported a long history of various symptoms including intermittent macroscopic haematuria and chronic moderate left lumbar pain aggravated by physical activity, associated with systemic signs dominated by chronic fatigue and headache, which lasted for his childhood, despite a long investigational history combined with several imaging examinations and laboratory tests. Urinalysis revealed 4+ proteinuria, and 24 hour urine collection analysis showed 2 g of proteinuria.\nBased on clinical presentation, urinary and systemic symptoms, laboratory reports, and computed tomographic angiography finding, a diagnosis of anterior nutcracker syndrome leading to left renal vein thrombosis was confirmed.\nAnticoagulation was started by a low molecular weight heparin bridge to warfarin. Three weeks later, CTA showed complete disappearance of the renal vein thrombosis ().\nThe patient was informed of her diagnosis and there was a discussion about possible treatment options. We proposed transposition of left renal vein that the patient consented to.\nSince she was newly married, it was decided to initially bridge her to warfarin with plans for 6 months of anticoagulation followed by repeated imaging. Need for additional management would be decided at that time.", "age": [ [ 24.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3857899.xml", "relevant_articles": { "31488449": "12", "24349817": "123", "24564080": "12", "32246272": "123", "19216958": "12" }, "similar_patients": { "4216544-1": "1", "5413680-1": "13", "8364742-1": "1", "6343343-1": "1", "4374268-1": "1" } }, { "human_patient_id": "584", "human_patient_uid": "5795688-1-M", "PMID": "29403139", "title": "Quetiapine-induced Diabetic Ketoacidosis", "patient": "A 40-year-old woman on treatment for bipolar depression attended the psychiatry outpatient department on May 10, 2014. She complained of excessive tiredness for the past few days and was admitted for evaluation in view of her multiple admissions in the past. She was afebrile with normal vitals and Glasgow Coma Scale of 15. Her psychiatric history revealed bipolar depression for the past 5 years with an episode of depression in 2013. She was on tablet quetiapine 400 mg and tablet valproate 500 mg for July 15, 2013. There was no medical history of diabetes in her or her first-degree relatives. Ten months after the initiation of medication, her weight was 231 lbs (105 kg) with body mass index of 40.92 kg/m2 (height 5 feet 3 inches) indicating class III obesity.\nLaboratory investigations revealed an elevated random blood sugar (RBS) value of 443 mg/dl. Urine acetone was positive (+++). Arterial blood gas analysis revealed pH 7.1 and bicarbonate 10.54 mEq/L (normal 22\u201326 mEq/L) and PaCO230 (normal 35\u201345) revealing a picture of uncompensated metabolic acidosis. Next day fasting lipid profile was done which showed elevated total cholesterol 509 mg/dl (normal <190 mg%) and triglyceride 2871 mg/dl (normal <150 mg/dl). Glycated hemoglobin was 9.2% (normal 4\u20136.4%) indicating poor glycemic control. Serum pancreatic amylase was 104 U/L (normal 0\u2013137 U/L), and lipase was 114U/L (normal 0\u2013160 U/L). Other investigations such as hemoglobin, total and differential count, platelet count, erythrocyte sedimentation, renal and liver function tests, lipid profile, serum sodium, and potassium were within the normal limits.\nDiagnosis of DKA was made. After consultation with the physician, the patient was aggressively managed with 10 units regular insulin as bolus injection followed by 15 units plain insulin in 500 ml of 0.9% saline given as intravenous infusion at the rate of 15 drops per minute. She was also given intensive fluid management with normal saline and dextrose normal saline. When her blood glucose became 261 mg/dl, the insulin infusion was stopped, and plain insulin 8 units was given eighth hourly subcutaneously. Her fasting and postprandial blood sugars remained high on the consecutive days, and the insulin therapy was stepped up to 14 units in morning, 14 units in afternoon and 10 units at night(14-14-10) on May 17, 2014. Tablet atorvastatin 20 mg once daily was initiated in view of her deranged lipid profile. The dose of quetiapine was stepped down (18th - 300 mg, 20th - 250 mg, and 21st - 100 mg) and stopped on May 22, 2014. The RBS values on 22nd and 23rd were 76 and 90 mg%, respectively, and the patient was discharged with tablet amisulpride 200 mg twice daily and tablet metformin 1000 mg once daily.", "age": [ [ 40.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5795688.xml", "relevant_articles": { "18691993": "0", "19934390": "0", "22164402": "0", "9533062": "0", "22261942": "0" }, "similar_patients": { "5461850-1": "0", "8123093-1": "123", "7891158-1": "123", "5363110-1": "123", "4992786-1": "123" } }, { "human_patient_id": "585", "human_patient_uid": "3424655-1-M", "PMID": "22928130", "title": "Degenrative Fibroid and Sclerosing Peritonitis", "patient": "A 66-year-old lady presented to the general surgeons with a history of diarrhoea and abdominal distension. Examination revealed ascites and a CT scan was organised; this showed gross ascites with small pleural effusions, bulky ovaries, a fibroid uterus, and multiple peritoneal and mesenteric deposits. Tumour makers were within normal limits with Ca 125 17, CEA 2.1, and Ca19 9 6.2. A gynaecological oncology opinion was sought and an ascitic drain sited for symptom relief and to obtain possible cytological diagnosis. Histological analysis of ascitic fluid on two separate occasions revealed leukocytes, mesothelial cells, and scattered histiocytes with no malignant cells present. Further immunohistochemistry was performed confirming the cells to be lymphoid in origin.\nShe continued to be symptomatic with abdominal distension and vomiting and therefore, a diagnostic laparoscopy was performed by the general surgeons. Laparoscopy confirmed gross ascites with what appeared to be widespread carcinomatosis with peritoneal and omental seedlings, bulky uterus and ovaries. Omental biopsies that were taken revealed an inflammatory process suggestive of possible sclerosing peritonitis. Histology showed omental fat with fibrous proliferation at the surface infiltrated by inflammatory cells and nodules of mesothelial proliferation, with no evidence of neoplastic infiltration. Immunohistochemical analysis was negative.\nHer clinical condition remained unchanged, and she required further ascitic drains for symptom relief. An MRI scan confirmed CT findings, and her case was discussed in detail at the Gynaecology and Colorectal MDT.\nAs extensive investigation failed to establish a definitive diagnosis. In view of the small possibility of the fibroid uterus being responsible for her condition the decision was taken to perform a total abdominal hysterectomy, bilateral Salpingo-ophrectomy, omental biopsy, and serosal bowel biopsy. The gynaecological procedure was completed without difficulty with note only of an enlarged fibroid uterus. The peritoneal cavity was generally fibrosed extending throughout the bowel surface. Macroscopically the bowel was firm, solid with no obvious peristalsis due to the serosal fibrosis explaining the symptoms of obstruction. The bowel was inspected by the bowel surgeon and a number of biopsies were taken.\nHistological analysis from the peritoneal fluid showed mixed inflammatory cells and markedly reactive mesothelial cells. Interestingly, the ovaries were normal and the uterus contained an infracted ischaemic fibroid. Sections from the omentum and small bowel showed a fibrous process with spindle cells and inflammation. Overall this indicated diffuse sclerosing peritonitis.\nHer postoperative recovery was uneventful and at her six-week follow-up she had made an excellent recovery. She remained asymptomatic at her six-month follow-up. A CT that was performed at the time when compared to previous imaging showed complete resolution of her ascites and a normal appearance of the bowel.", "age": [ [ 66.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC003xxxxxx/PMC3424655.xml", "relevant_articles": { "31217214": "123", "22928130": "123", "16983950": "123", "28638005": "12", "8279621": "123" }, "similar_patients": { "3970332-1": "13", "8427934-1": "123", "6792242-1": "13", "3599504-1": "123", "6151194-1": "123" } }, { "human_patient_id": "586", "human_patient_uid": "3638553-1-M", "PMID": "23653873", "title": "Not Just Another Cause of Dyspnea: Common Complaint Leads to a Rare Diagnosis", "patient": "A 62-year-old male with past medical history of type 2 DM (DM-2) and hypertension of 20 years presented to our emergency room with progressive dyspnea that had worsened gradually over the last three months. He was being treated in another facility with questionable diagnosis of congestive heart failure with incomplete response to diuretic therapy. There was no history of chest pain, cough, orthopnea, or paroxysmal nocturnal dyspnea. He was a nonsmoker and had used alcohol occasionally. There was no recent viral or flu-like illness. On careful questioning, he complained of difficulty in walking and weakness in his legs. The patient denied any back pain, fever, weight loss, bladder involvement, or pain and paresthesias in his extremities. Neurological examination revealed bilateral symmetric muscle weakness with power of 4/5 in upper proximal and distal extremities and 3/5 in lower proximal and distal extremities. There was no ptosis or gaze paresis. Cranial nerves I\u2013XII were grossly intact. There was no evidence of atrophy of the hand muscles and fasciculations. Sensory exam revealed decreased pinprick sensation distal part of extremities. Deep tendon reflexes were graded one in both upper and lower extremities. His blood pressure on admission was 161/106 mm Hg. A fasting blood glucose done at emergency room triage was 229 mg/dL. The clinical and functional examinations did not correlate with the severity of dyspnea. Arterial blood gas (ABG) revealed respiratory insufficiency (pO2 of 60 mm Hg, pCO2 of 58 mm Hg, and SaO2 of 89%).\nInitially, chest radiograph was obtained which revealed normal lung fields with no evidence of fluid overload. Serum electrolytes and thyroid panel were found to be normal. \u03b2-natriuretic peptide level and 2-D echocardiogram results were inconsistent with heart failure. Adequate glycemic control was achieved with insulin, and serial ABGs remained unchanged on day 1. As the diagnosis leaned towards neuromuscular involvement, bilevel positive alveolar pressure (BiPAP) was started which was followed by serial vital capacities and negative inspiratory pressure (NIP). CSF analysis narrowed the differential to demyelinating neuropathy, which proved to be inconsistent with Gullian-Barr\u00e9 syndrome. EMG analysis revealed sensorimotor polyneuropathy that was predominantly axonal and demyelinating in nature (). In the meantime, the patient's vital capacity dropped to 0.7 liters with NIP of \u221226 cm H2O. Anti-paraneoplastic antibody screening with ANA and anti-MAG levels were noncontributory. On day 4, the CSF culture was negative. As diabetic polyradiculopathy was considered the most likely diagnosis, intravenous immunoglobulin IVIg 0.4 g/kg/day was started for five days. The patient tolerated the treatment well and showed both subjective and objective improvement as assessed by serial ABGs, vital capacity, and NIP assessment (). The patient was discharged to a rehabilitation center in stable respiratory condition with intermittent nasal oxygen insufflation and overnight BiPAP ventilation.", "age": [ [ 62.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3638553.xml", "relevant_articles": { "34366049": "0", "33965153": "0", "8797213": "0", "15336585": "0", "8268041": "0" }, "similar_patients": { "4236670-1": "123", "4015480-1": "12", "5011863-1": "123", "7545753-1": "123", "8462911-1": "123" } }, { "human_patient_id": "587", "human_patient_uid": "6406221-1-M", "PMID": "30899476", "title": "Pulmonary alveolar proteinosis developing during steroid treatment in a patient with organizing pneumonia in association with atypical chronic myeloid leukemia", "patient": "The patient was a Japanese 72-year-old man, who had been diagnosed with atypical chronic myeloid leukemia (aCML) in 2014. He was an ex-smoker who did not regularly consume alcohol. In September 2015, treatment with oral cytarabine ocfosfate hydrate was initiated. After four cycles, he developed pneumonia, and treatment was terminated in February 2016. In April 2016, although he had no complaints, his serum C-reactive protein level was found to have re-increased to 4.6 mg/dL, and a chest X-ray and high-resolution computed tomography (HRCT) revealed scattered small nodular shadows and patchy consolidation (Figure A,B). The radiological findings did not improve despite the administration of antibiotics and antifungal drugs.\nWe performed bronchoscopy in May 2016. Bronchoalveolar lavage performed in the right upper lobe recovered 90 mL of 150 mL (60%) with 1.3 \u00d7 105/mL cells (neutrophils: 26%, lymphocytes: 36%, eosinophils: 1%, and macrophages: 37%). The histological examination of a specimen obtained from the right upper lobe via transbronchial lung biopsy revealed findings consistent with OP (Figure A). On immunofluorescence testing, the patient's antinuclear antibody titer was <40, and no other autoantibodies, including anti-SS-A, anti-aminoacyl tRNA synthetase antibody, rheumatoid factor, and anti-cyclic citrullinated peptide antibody, were detected. We diagnosed the patient with secondary OP associated with aCML. Treatment with prednisolone (30 mg, daily) was initiated, which resulted in the improvement of the laboratory and radiological findings, and the dose of prednisolone was then gradually tapered (Figure ). In September 2016, the patient developed general fatigue while under treatment with prednisolone (17.5 mg, daily). Chest CT revealed diffuse ground-glass opacities (GGOs). We considered the possibility of a recurrence of OP, and therefore increased the dose of prednisolone to 30 mg, daily; however, the patient's condition did not improve.\nThe patient was admitted to our hospital due to dyspnea on effort in November 2016. On admission, a physical examination revealed the following findings: respiratory rate, 15 breaths per minute; heart rate, 80 beats per minute; blood pressure, 106/60 mm Hg; and body temperature, 37.3\u00b0C. Chest auscultation revealed no abnormalities.\nThe laboratory tests performed on admission included an arterial blood gas analysis under ambient air, which showed the following findings: partial pressure of oxygen, 60.3 Torr; partial pressure of carbon dioxide, 30.4 Torr; and pH, 7.446. A blood analysis revealed the following findings: white blood cell count, 41 900/\u03bcL (neutrophil, 88.0%; lymphocytes, 5.0%; monocytes, 2.0%; promyelocytes, 1.0%; and myelocytes, 3.0%; metacytes, 1.0%); hemoglobin, 7.8 g/dL; platelet count, 34.2 \u00d7 104/\u03bcL; lactate dehydrogenase, 564 IU/L, Krebs von den Lugen-6, 2826 U/mL; and carcinoembryonic antigen, 15.6 ng/mL. The patient was negative for \u03b2-D glucan and cytomegalovirus antigen. HRCT showed diffuse GGOs in both lung fields (Figure C,D).\nOn the following day, we performed bronchoscopy with bronchoalveolar lavage in the right middle lobe. The bronchoalveolar lavage fluid showed a light milky appearance (Figure B) and was periodic acid-Schiff (PAS)-positive. Transbronchial lung biopsy revealed the precipitation of dense, homogenous, eosinophilic material, which had a fine granular appearance, and which filled the alveoli (Figure C); however, no evidence of OP was found. Based on these findings, he was diagnosed with PAP. Although the granulocyte/macrophage colony-stimulating factor autoantibody level was not measured, the diagnosis of sPAP was confirmed by compatible radiological findings and a pre-existing diagnosis of aCML.,\nHe gradually developed respiratory failure with the progression of PAP; whole-lung lavage was subsequently performed. Unfortunately, the patient died of acute enteritis within 1 month of whole-lung lavage.", "age": [ [ 72.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6406221.xml", "relevant_articles": { "9465620": "123", "24334588": "0", "17929470": "0", "1289640": "0", "8976082": "0" }, "similar_patients": { "8339249-1": "13", "7132862-1": "13", "3537559-1": "13", "7220071-1": "123", "4818583-1": "13" } }, { "human_patient_id": "588", "human_patient_uid": "8481101-1-M", "PMID": "34646624", "title": "A Unique Case of Sporadic Optic Pathway Glioma in an Infant With Acute Nystagmus", "patient": "A six-month-old Caucasian male with no significant past medical history presented to the pediatric emergency department for a chief complaint of frequent unusual eye movements as reported by the parents. The patient began having intermittent rotary nystagmus approximately three weeks ago, and since then it progressed and became more continuous, worsened by changes in position or flashing lights from toys brought in his visual field. The parents also noticed the patient sleeping more than usual, only staying awake for an hour at a time, and had a subsequent severe regression in milestones, with an inability to roll over or sit unsupported.\nInitial workup in the emergency department included a CT brain without contrast, which showed evidence of thickening of the bilateral optic nerves with associated masses and diffuse bilateral ventriculomegaly (Figure ). This finding was concerning for possible bilateral optic pathway gliomas, at which point a dedicated MRI of the brain and orbits was recommended, along with further genetic workup for possible neurofibromatosis I.\nMRI of the brain and orbits confirmed these findings, showing diffuse enlargement of the optic tracts extending from the lateral geniculate nuclei to the optic chiasm and into the bilateral optic nerves, with a mass demonstrating 270\u00ba encasement of the bilateral supraclinoid internal carotid arteries and near circumferential encasement of the bilateral A1 segments of the anterior cerebral arteries (Figures , ).\nThese imaging findings confirmed the suspicion of bilateral optic pathway glioma, and as a result, the patient was admitted to the hospital and evaluated by both neurosurgery and pediatric hematology-oncology. Neurosurgery did not recommend any surgical intervention at the time, and the hematology-oncology team recommended proceeding with chemotherapy. His genetic testing results showed no evidence of clinically significant variants of neurofibromatosis I or II, suggesting a sporadic bilateral optic pathway glioma. The patient was then discharged and was followed up on an outpatient basis by both ophthalmology and pediatric hematology-oncology for maintenance chemotherapy with carboplatin and vincristine.", "age": [ [ 6.0, "month" ] ], "geneder": "M", "file_path": "comm/PMC008xxxxxx/PMC8481101.xml", "relevant_articles": { "10772434": "13", "3724975": "12", "1448196": "12", "33655935": "123", "19726946": "0" }, "similar_patients": { "7434372-1": "0", "4730700-1": "0", "8405252-1": "0", "5468056-1": "0", "6884947-1": "0" } }, { "human_patient_id": "589", "human_patient_uid": "3139287-1-M", "PMID": "21799575", "title": "Genital lesions: An indication for changing ART regimen", "patient": "Thirty-five year old unmarried male, known positive for HIV infection and on highly active antiretroviral therapy (HAART) since 2001, presented with genital ulcers for a prolonged duration of 16 months. He gave past history of recurrent genital ulcers which were responded to acyclovir. He had undergone circumcision because of recurrent herpes ulcers in 2005. He was initiated on NNRTI containing ART (AZT + 3TC+NVP) in 2001. His CD4 cell count improved in the years 2002\u20132006 and subsequently in late 2006 he had a decline in CD4 to 140. He underwent genotyping and found to have NRTI and NNRTI mutations. He was switched to boosted indinavir-containing second line HAART regimen in late 2006. His CD4 count improved to 290, 354, 405 and 398 cells/microliter in the follow-up visits. In spite of his improvement in CD4 he developed genital ulcers in 2007 [], which were not responding to the usual line of management with acyclovir and antibiotics. The imprint cytology and scrapings from the lesions showed degenerated and mature squamous cells in an inflammatory background and the patient did not give consent for biopsy. Since the patient was known to have recurrent herpes genitalis, and was responding to acyclovir in the past, we diagnosed it as HSV and his VDRL was non-reactive on four repeated attempts. Dark-field examination for Treponema pallidum was negative on repeated attempts. He was on acyclovir and antibacterial for a prolonged period with some improvement on the genital lesions but genital lesions did not heal fully. In July 2008, to avoid indinavir toxicity he was substituted with boosted atazanavir containing PI regimen. His genital lesions healed completely [] in 15 days with no recurrence for more than two months and his current CD4 count is 437 cells/microliter.", "age": [ [ 35.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3139287.xml", "relevant_articles": { "27890958": "123", "3912973": "13", "1668960": "123", "11311761": "12", "8390630": "123" }, "similar_patients": { "2827172-1": "0", "7449072-1": "0", "5389221-1": "13", "4710108-1": "123", "3335519-1": "123" } }, { "human_patient_id": "590", "human_patient_uid": "3169362-1-M", "PMID": "21991486", "title": "Multiple Stafne Bone Defects: A Rare Entity", "patient": "The asymptomatic patient, a 60-year-old man, was referred to a radiology clinic to undergo examination for the purpose of implant planning. The panoramic radiograph revealed no important alterations in the mandible (). The patient underwent multidetector computed tomography (MDCT) (Synergy Helicoidal, General Electric Company, Milwaukee, WI), with slices and intervals of 0.625 mm, field of view 15.8 cm, matrix 512 \u00d7 512, standard filter, 120 kV and 200 mA.\nThe tomographic images clearly showed multiple cavitary defects, two in the anterior region (anterior variant) and one in the posterior region (posterior variant) (Figures , , and ). Intracavitary tomographic density (Hounsfield units) suggested glandular tissue in the anterior defects and fat in the posterior defect.", "age": [ [ 60.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC003xxxxxx/PMC3169362.xml", "relevant_articles": { "21119418": "12", "33901545": "0", "3484573": "0", "26983816": "0", "28559005": "0" }, "similar_patients": { "6018268-1": "0", "4262880-1": "0", "5974821-1": "0", "7429597-1": "0", "5370248-1": "0" } }, { "human_patient_id": "591", "human_patient_uid": "8525669-1-M", "PMID": "34692331", "title": "Acute Psychosis and COVID-19 Infection: Psychiatric Symptoms in Hospitalized Patients", "patient": "A 49-year-old woman with no past medical or psychiatric history was admitted to the inpatient psychiatric unit with suicidal ideation. For the past two weeks, the patient's family members reported that the patient expressed thoughts that the world was ending. She was not sleeping, was increasingly agitated and not eating, and had an 8-pound weight loss. She had expressed thoughts of wanting to jump in front of the train, feeling morbidly guilty and hopeless. She also reported feeling helpless with multiple deaths in the city due to COVID-19, and the situation reminded her of her grandmother's death due to cancer. She also had paranoid delusions with nightmares and felt responsible for her grandmother's death due to cancer about 40 years ago.\nShe was a high school graduate and worked as a hairdresser and cleaner in a hair salon for 15 years. She stopped working a month ago due to COVID-19 and reported being stressed about this. She lived in an apartment with her three children, a 25-year-old son, a 22-year-old son, and a 12-year-old daughter. She had periodic contact with the father of her children, who lives in a different state. She also broke off a one-year romantic relationship with her boyfriend about two months ago. She denied a history of sexual or physical abuse as a child. She had no past psychiatric history or suicide attempts or substance use or criminal history and no family history of depression.\nShe also had a three-week history of on and off cough with a reduced appetite and anosmia but denied fever, malaise, and body aches. On examination, she was guarded, withdrawn, disheveled, and depressed with constricted affect. She was alert and oriented to time, place, and person with no focal neurological deficits. Besides, her memory and concentration were intact with a goal-directed thought process, however, with limited insight and judgment. Bloodwork showed normal white cell and platelet count, hemoglobin and hematocrit, and normal glucose and electrolytes, kidney, liver, and thyroid function tests. Urinalysis showed moderate leucocytes, trace blood, trace protein, positive for ketones and negative for nitrite and glucose. Urine microscopy showed few bacteria, 25-50 white cells, 5-10 red cells, moderate epithelial cells, and moderate mucus threads. Drug toxicology screen and lithium, carbamazepine, and valproic acid levels were negative. She tested positive for SARS-CoV-2 on admission. Oral aripiprazole 5 mg was started for psychotic symptoms, and the dose was titrated up to 7 mg. She was also started on oral escitalopram 10 mg for depressed mood, lorazepam 2 mg for anxiety, and oral mirtazapine 15 mg for poor sleep and poor appetite. Oral azithromycin and oral Hydroxychloroquine were started for SARS-CoV-2 infection for five days. Chest x-ray, EKG, and CT head were unremarkable.\nOn day four of hospital admission, she continued to express suicidal ideation and wanted to starve herself. She remained withdrawn, guarded, with poor appetite and sleep. She also had a brief catatonic episode of muteness for less than a minute. Subsequently, she got up from her bed, was agitated, and tried to run out of her isolation room. Repeat blood work showed normal white count, normal hemoglobin, platelets, electrolytes, and renal and liver function tests. She was given haloperidol, diphenhydramine, and lorazepam. Aripiprazole was discontinued and she was started on oral metoprolol for hypertension and oral olanzapine 7.5 mg for psychosis, poor sleep, and poor appetite, and the dose was slowly titrated up to 20 mg. With this regimen, clinical improvement was noted from admission days four to 15, and the patient\u2019s depression, appetite, and behavior improved, with no suicidal ideation. There was a plan to send the patient home on day 16. However, on the scheduled discharge day, she reported a loss of appetite with paranoid behavior and she complained that she would be investigated and arrested if she left the hospital because she had COVID-19, so she did not want to leave the hospital. On examination, the patient was alert and oriented but showed guarded behavior and limited judgment. Subsequently, the olanzapine dose was increased to 25 mg, and oral aripiprazole 2 mg was re-started. From days 17 to 21, she showed clinical improvement, mood improvement, and improvement in her thoughts with no more paranoid behavior and no suicidal or homicidal ideation. She was subsequently discharged home on day 21 on olanzapine 25 mg, escitalopram 20 mg, and mirtazapine 15 mg, and metoprolol 25 mg. She had outpatient follow-ups with a psychiatrist after discharge and did not exhibit paranoid behavior or manic episodes. Olanzapine was stopped two months later due to akathisia as an adverse effect. Eight months after initial hospitalization, she was re-admitted to the inpatient psychiatric unit for grandiose, erratic, disorganized behavior at home, verbal aggression at work, and violently confronting strangers on the street. She was treated for 20 days in the inpatient psychiatric unit and diagnosed with bipolar disorder (current episode manic) with psychosis. She was then discharged on oral risperidone 3 mg twice daily, valproate 500 mg twice daily for mood, and metoprolol 25 mg once daily for hypertension.", "age": [ [ 49.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC008xxxxxx/PMC8525669.xml", "relevant_articles": { "26703328": "123", "21344737": "0", "27938775": "123", "29553939": "0", "22977365": "0" }, "similar_patients": { "8525047-1": "123", "8525669-2": "13", "7993062-1": "0", "8040443-2": "123", "5669522-1": "123" } }, { "human_patient_id": "592", "human_patient_uid": "8525669-2-M", "PMID": "34692331", "title": "Acute Psychosis and COVID-19 Infection: Psychiatric Symptoms in Hospitalized Patients", "patient": "A 56-year-old African American woman with a history of hypertension and not on any medications at home with no past psychiatric history was admitted to the hospital with acute hypoxic respiratory failure secondary to COVID-19 pneumonia.\nOn arrival to the emergency room, she was noted to be hypoxic on room air and required high flow oxygen therapy, and tested positive for SARS-CoV-2 infection. She reported symptoms of shortness of breath, chills, cough for two weeks. Her husband was sick at home for two weeks, and her boss was also ill at work. Physical examination revealed the patient was in acute distress with labored breathing and was speaking in short sentences. She was alert and oriented with a normal neurological exam with no focal neurological deficits. Urinalysis was not performed. Inflammatory markers including ferritin, C-reactive protein, sedimentation rate, and D-dimer were elevated. Chest x-ray showed extensive airspace consolidation throughout both lungs, consistent with extensive bilateral pneumonia. Chest CT angiogram revealed bilateral diffuse pulmonary infiltrate with mild cardiomegaly, no pulmonary embolus, and no pleural effusion.\nShe was then admitted to the inpatient unit for acute hypoxic respiratory failure and treated with vitamin C, vitamin D, zinc, one dose of monoclonal antibody, tocilizumab, dexamethasone for 10 days, and remdesivir for five days. In addition, she was treated with full-dose of enoxaparin for elevated D-dimer levels. She was also diagnosed with new-onset type 2 diabetes mellitus with a hemoglobin A1C of 14.4 and was started on insulin. Throughout this hospital admission, her oxygen requirement progressively decreased as she was weaned off from high flow nasal cannula to nasal cannula and then room air.\nShe exhibited altered mental status with bizarre delusions and agitated behavior during this hospital admission. She claimed that her boss had poisoned her and that the blood work would prove it. Her son provided collateral history and mentioned that her boss gave her antibiotics, possibly azithromycin and ivermectin, supposedly obtained from Tanzania. She took the antibiotics for a week and stopped a few days ago. Few days before the hospital admission, she experienced hallucinations and bizarre delusions and talked about \"numbers on the wall.\" There was no prior history of psychiatric illness, no history of similar complaints in the past, no history of suicidal/homicidal ideations, no family history of mental illness, no family history of suicide, no drug use, and no other instances of paranoid behavior. She is a teacher at a daycare and the primary caregiver for her boyfriend and lives with her boyfriend and has three children, two sons and one daughter.\nShe mentioned that the board of education sent her as an undercover to observe and investigate and shut down this hospital. She also reported visual and auditory hallucinations, seeing numbers all over the walls, and the spirit of God was talking to her. She also reported mania-like symptoms with inflated self-esteem, easy distractibility, circumstantial thought process, rapid speech, racing thoughts, poor sleep at night, and despite minimally sleeping, she felt energetic before coming to the hospital. The plan was to start the patient on antipsychotics for her acute psychosis; however, these were initially placed on hold due to a prolonged QT interval of 550 milliseconds on EKG on admission. Urine drug screen, rapid plasma reagin (RPR) test for syphilis, and HIV testing were negative. Two samples of blood culture showed no growth after five days of incubation. CT head was normal. She exhibited paranoid behavior, believing that she was raped during this hospital stay. She thought the hospital had killed the patient next to her bed, and the staff was laughing at her. She was given oral aripiprazole 5 mg and intramuscular olanzapine 5 mg and was then discharged to an outside facility for further psychiatric management due to COVID-19. There was no follow-up after discharge.", "age": [ [ 56.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC008xxxxxx/PMC8525669.xml", "relevant_articles": { "34765363": "123", "27938775": "1", "26703328": "0", "31140247": "0", "8279734": "0" }, "similar_patients": { "8525047-1": "13", "8525669-1": "13", "8437203-1": "13", "7913998-1": "13", "7993062-1": "0" } }, { "human_patient_id": "593", "human_patient_uid": "6081099-1-M", "PMID": "30075560", "title": "Successful management of perivascular epithelioid cell tumor of the rectum with recurrent liver metastases", "patient": "A 28-year-old male was transferred to our hospital in November 2006 because of a sudden onset of cramping and abdominal pain and intermittent melena for 4 days. Initially, he exhibited symptoms including generalized weakness, dizziness, and massive bloody stool passage. There was no significant past medical history of recent infection, inflammatory bowel disease, bleeding disorders, changes in bowel habits, significant weight loss, or tuberous sclerosis complex. The patient had no previous surgeries, and the family history was unremarkable. The patient's height was 180.2 cm, weight was 78.5 kg, blood pressure was 74/39 mm Hg, pulse rate was 122 beats/min, and temperature was 36.4\u00b0C. The physical examination revealed moderate distention and tenderness in the left lower quadrant with associated defense. On digital rectal examination, there was some gross blood mixed with soft stool and an empty ampulla. Laboratory data showed a white blood cell count of 17,120/mm3, hemoglobin level of 7.4 g/dL, hematocrit of 23.9%, and platelet count of 162,000/mm3. Other biochemical tests were normal. The serum carcinoembryonic antigen level was normal.\nThe gastroscopic evaluation was normal. The full colonoscopy revealed a greater than 4.0 cm in diameter, large ulceration with an easy bleeding mass of the rectum lying beneath the mucosa but protruding into the lumen 15 cm from the anal verge (Fig. ). This tumor could not be classified by biopsy. However, on the basis of the immunohistopathological features, carcinoma and malignant lymphoma could be excluded. An abdominal enhanced CT scan revealed a heterogeneous mass lesion of approximately 8.9 x 7.2 cm in the pelvic floor at approximately the level of the rectum (Fig. ). A technetium-99m red blood cell scan showed no significant findings. Repeated attempts at endoscopic revaluation resulted in profuse bleeding requiring blood transfusions. A diagnostic biopsy failed before the surgical treatment due to bleeding from a light touch of the mass lesion\nGiven the difficulty of obtaining a diagnostic specimen, surgical resection and lower anterior resection were performed. On gross examination, the resected specimen was an 8.8 x 5.5 x 4.5 cm, tan, gray-white, soft, and well-circumscribed transmural mass of the rectum, mainly involving the muscularis propria and protruding into the tunica adventitia. The mucosa and submucosa were intact (Fig. ). The tumor protruded into the lumen, and the overlying mucosa showed ulceration. The tumor had a dark, red-grey, solid parenchyma with irregular cystic spaces with colorless serous liquid (Fig. ). The cut surface showed a yellowish-tan to gray-red solid parenchyma with focal irregular cystic spaces containing colorless serous fluid (Fig. ). All surgical margins were macroscopically free of tumor. No separate polyps were identified. Microscopically, the foci of hemorrhage and necrosis were present. The tumor extended through the muscularis propria into the subserosa tissue with lymphatic invasion. The colon mucosal tissue was composed of sheets with atypical glands with spindle-to-epithelioid cells and nuclear abnormalities in a tubular arrangement (Fig. ). Perivascular hyalinization was noted (Fig. ). Most tumor nuclei showed clear to granular, light, eosinophilic cytoplasm, and round to oval nuclei with distant small nucleoli pleomorphism (Fig. ). Less than 50% of the tumor area was necrotic. The mitotic rate was low. One of 27 accompanying serosal lymph nodes contained metastatic tumors that distended the subcapsular sinus. All of the surgical margins were free of tumor. Immunohistochemically, the tumor cells were positive for melanoma-associated antigen (HMB-45) (Fig. ) but negative for cytokeratin, c-kit, synaptophysin, S-100, and actin. A diagnosis of metastatic PEComa was made after examination of the resection material.\nUnfortunately, the patient did not complete the follow-up in the outpatient department after surgery because he relocated to another city to seek work. At the 49th month (2010) postoperatively, the patient returned to the clinic upon our scheduled request. An abdominal CT scan showed a 0.6 cm hypodense mass over the liver. He refused further evaluation and treatment. In July 2014, during the course of a required physical health check, he received an abdominal CT that showed that the original mass had increased from 0.6 to 1.5 cm and that the number of tumors had increased from 1 to 3 compared with the previous CT image in 2010. We noted that the distant liver metastasis progressed very slowly during the 4 years of follow-up. The liver function and the other serum tumor markers were normal upon examination. In August 2014, he underwent segmental hepatectomy (S3, S4A, S5, and S6) combined with wedge resection. The pathology report of segmental hepatectomy was metastatic PEComa.\nThis patient underwent 2 different surgical resections at 2 different times. He underwent the lower anterior resection of the PEComa of the rectum in 2006 and received the segmental hepatectomy in 2014. He is currently undergoing regular surveillance and has remained free of disease 28 months after the second operation. At the follow-up examination, the patient felt well, and the general clinical examination, subsequent colonoscopies, and abdominal CT scan once every 3 months revealed no significant findings after second operation in 2014. Since the primary surgery in 2006, there was also no recurrence of the PEComa of the rectum according to the general clinical examination, subsequent colonoscopies, and abdominal CT scan at the 120-month follow-up of the very first instance back in 2006.", "age": [ [ 28.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC006xxxxxx/PMC6081099.xml", "relevant_articles": { "30075560": "123", "17455882": "123", "19399284": "123", "34392019": "123", "8726838": "123" }, "similar_patients": { "4909687-1": "13", "5591109-1": "123", "3896964-1": "123", "3012279-1": "123", "4014137-1": "123" } }, { "human_patient_id": "594", "human_patient_uid": "8559745-1-M", "PMID": "34733039", "title": "Massive Cerebral Air Embolism Causing Stroke Secondary to Pulmonary Tuberculosis", "patient": "A 55-year-old man with a weight of 76 kg and height of 178 cm, suddenly experienced a nontraumatic loss of consciousness after a cough attack at an upright position as reported by a witness. Two months prior, he was diagnosed with pulmonary tuberculosis and had been receiving antituberculosis treatment. On arrival, the patient was unconscious with a Glasgow coma scale score of 6, blood pressure of 169/89 mm Hg, regular heart rate of 85 beats/minute, respiratory rate of 18/minute, body temperature of 36.5\u00b0C, SaO2 of 82% at room air, and capillary blood sugar of 110 mg/dL. Auscultation of the lungs revealed an inspiratory crackle at the left lung field. After rapid intravenous access and oxygenation, the patient was sedated, the trachea was intubated, mechanical ventilation was initiated, and conservative treatment was maintained in the intensive care unit. Urgent computed tomography (CT) of the brain was performed and showed multiple air shadows in both hemispheres and the right cerebral vessels (). These lesions suggest air embolism. Twelve hours later, a magnetic resonance imaging (MRI) of the head was performed and showed a diffuse ischemic stroke in the right and left frontoparietal cortical areas and multiple hypointense signals, which were consistent with cerebral air embolism ().\nThe brain perfusion images were normal. The chest CT performed at the emergency department showed pulmonary tuberculosis cavity associated with the destruction of parenchyma in the left upper lobe (). There was no evidence of cerebral hemorrhage. The diagnosis of cerebral gas embolism after sudden cough was retained, and immediate treatment was started including 100% oxygen and cardiovascular support while the patient was placed in a supine position. The transthoracic echocardiography was performed, and no patent foramen ovale was found. A lumbar puncture was performed to seek for tuberculous meningoencephalitis. The cerebrospinal fluid analysis was normal. Hyperbaric oxygen therapy was considered, but the patient\u2019s condition was too unstable to support transfer to the hyperbaric oxygen center. One day later, his neurological status deteriorated. The patient died on the fourth day with multiple organ failure. No autopsy was performed based on his family\u2019s wishes.", "age": [ [ 55.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC008xxxxxx/PMC8559745.xml", "relevant_articles": { "18677615": "12", "28607332": "123", "21841875": "123", "15574583": "123", "11782337": "123" }, "similar_patients": { "3695312-1": "123", "5691610-1": "12", "2946670-1": "123", "8202586-1": "1", "6116308-1": "1" } }, { "human_patient_id": "595", "human_patient_uid": "5465588-1-M", "PMID": "28595573", "title": "A novel KCNQ1 nonsense variant in the isoform-specific first exon causes both jervell and Lange-Nielsen syndrome 1 and long QT syndrome 1: a case report", "patient": "The proband (II-2 in Fig. ) is a 45-year old woman, who first presented to our university hospital at the age of 35 and was referred to us because of her pregnancy. She has congenital deafness, first experienced syncope at the age of 3, and was diagnosed with epilepsy. She was treated with anti-epilepsy medications; however, she subsequently experienced several instances of syncope. At the age of 13, she had a syncope event, and was suspected of having JLNS because of her congenital deafness and prolonged QT interval. Her syncope was diagnosed as an arrhythmic episode when she was aware of tachycardia and as epilepsy when she was not. She also had a subarachnoid hemorrhage at the age of 29.\nWhen she first presented at our hospital, she was not taking beta-blockers, because of a history of asthma, but was taking mexiletine in addition to phenytoin. Her QTc was found to be prolonged (584 ms) at presentation and administration of atenolol was initiated. She delivered her baby (III-1 in Fig. ) through Caesarean operation at our hospital at the age of 35. At 37, she delivered her second baby (III-2 in Fig. ) through Caesarean operation at our hospital. Despite administration of beta-blockers, her QTc remained prolonged (600 msec at the age of 37, 780 msec at 44) (Figs. and ), which is not unexpected because treatment with beta-blockers in LQTS1 is not expected to overtly reduce QTc []. However, she continued to experience occasional syncope and finally underwent an implantable cardioverter defibrillator (ICD) operation at 38 years of age. Subsequently, she is in a stable clinical condition. Because the proband was suspected of JLNS and both infants had a measured QTc of 500 ms or greater within 1 month after birth, beta blockers were initiated and both children remain in stable condition at ages 10 and 8 (Figs. and ). QTc of the son (III-1 in Fig. ) was measured as 500 ms one month after birth, while the QTc of his sister (III-2) was 530 ms at birth.\nThe father (I-1) and mother (I-2) of the proband were first cousins. There is no history of sudden unexplained syncope or death of children or adults in the immediate family members, despite the prolonged QTc of the children.\nClinical evaluation and consultation of the proband and her family members were performed at Chiba University Hospital. Clinical phenotypes were deduced from the clinical history, physical examinations, and ECG. Blood samples were collected from the proband and her family members following genetic counseling, and written informed consent was obtained prior to sample collection.\nGenomic DNA was isolated from peripheral blood lymphocytes according to established protocols at our laboratory []. Entire coding exons, including the intronic boundaries of the genes, of KCNQ1 (NCBI ref: NM_000218) and other LQT causative genes (KCNH2, SCN5A, KCNE1, KCNE2, KCNJ2, SCN4B, KCNJ5) were amplified by polymerase chain reaction (PCR), according to established protocols in our laboratory. Briefly, 30\u2013100 ng of genomic DNA was subjected to PCR amplification with DNA polymerase (PrimeSTAR GXL DNA Polymerase; Takara Bio Inc., Kusatsu, Japan) and primer sets.\nThe amplicons were subjected to conventional sequencing with Sanger sequencers (Applied Biosystems 3730/3130 DNA analyzers; Thermo Fisher Scientific, Waltham, MA, USA). The sequence data were processed with Gene Codes Sequencher Software (Takara Bio Inc.) and mapped to the human genome sequence (build GRCh37/hg19).\nGenetic analysis was performed to screen all coding exons and the exon\u2013intron boundaries of the KCNQ1 gene (NCBI ref: NM_000218.2, NP_000209.2) with concurrent screening of other LQT causative genes (KCNH2, SCN5A, KCNE1, KCNE2, KCNJ2, SCN4B, KCNJ5). We detected a novel homozygous nonsense variant, NM_000218.2:c.115G > T (p.Glu39X, in exon 1a), in the KCNQ1 gene of the proband, as well as a homozygous common variant (NM_000218.2:c.1343C > G, p.Pro448Arg) (Additional file : Table S1). Genetic screening of her mother (I-2) and children (III-1 and III-2) revealed that they were heterozygous for the nonsense variant (Fig. ). Her husband (II-3) was also screened and found to be heterozygous for the common variant (NM_000218.2:c.1343C > G, p.Pro448Arg). The proband is a child from a first-cousin marriage, and we have concluded the homozygous nonsense variant in the proband is the cause of her JLNS1. The proband was negative for pathogenic variants in other LQT causative genes, including the KCNE1 gene (Additional file : Table S1).", "age": [ [ 45.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC005xxxxxx/PMC5465588.xml", "relevant_articles": { "23400408": "123", "26022593": "123", "12085742": "123", "32071644": "123", "24573873": "12" }, "similar_patients": { "3763117-1": "123", "5644177-2": "123", "8353764-1": "0", "5376485-1": "12", "5644177-1": "123" } }, { "human_patient_id": "596", "human_patient_uid": "5806422-1-M", "PMID": "29497567", "title": "C1-C2 arthrodesis after spontaneous Propionibacterium acnes spondylodiscitis: Case report and literature analysis", "patient": "A 43-year-old female had received both local and oral corticosteroid treatment for facial acne 1 month before presenting with neck/pharyngeal pain and progressive dysphagia. Magnetic resonance imaging (MRI) showed a T2-hyperintense signal involving the dens (C2), accompanied by an extensive inflammatory reaction involving the retropharyngeal space []. Computed tomography (CT) scan also documented early dens erosion [Figure and ]. Although blood cultures were negative, the C-reactive protein (CRP) level was elevated (29.3 mg/dl), and erythrocyte sedimentation rate (ESR) was 120 mm/h. The patient was afebrile on steroids, but was not on any antibiotics.\nA biopsy was performed of the C1-C2 level through the posterior oral pharynx. Although the histological finding was consistent with inflammation, cultures remained negative (e.g., for common aerobic and anaerobic pathogens). Ten days later, however, the cultures grew P. acnes, sensitive to linezolid. A second confirmatory biopsy confirmed this diagnosis.\nThe patient was treated for 20 days with linezolid 600 mg, and was placed in a Halo-vest for atlantoaxial instability. Three months later, although laboratory tests documented resolution of the infection, both the MRI [] and CT scans [Figure and ] confirmed marked erosion of left C1-C2 joint/dens that required a transarticular C1-C2 posterior arthrodesis (Magerl's technique in combination with Gallie fixation with heterologous bone graft, Organizzazione Toscana Trapianti OTT). Three and 6 months later, the CT scan showed fusion [], the patient was clinically improved, and both CRP and ESR laboratory studies were normal.", "age": [ [ 43.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC005xxxxxx/PMC5806422.xml", "relevant_articles": { "9696080": "123", "18638878": "123", "20110831": "0", "32355621": "0", "23032595": "123" }, "similar_patients": { "4537593-1": "123", "7837991-1": "123", "6287336-1": "123", "6431363-1": "123", "8493043-1": "123" } }, { "human_patient_id": "597", "human_patient_uid": "4063595-1-M", "PMID": "24959293", "title": "Obstructive jaundice due to von Hippel-Lindau disease-associated pancreatic lesions: A case report", "patient": "In 1998, a 20-year-old male was admitted to the General Hospital of Tianjin Medical University (Tianjin, China) with symptoms of dizziness, unsteadiness and nausea for three weeks, as well as vomiting for one week. Magnetic resonance imaging (MRI) revealed a mass in the cerebellar vermis and surgery was performed to excise the tumor. The pathological examination identified a hemangioblastoma. Three years later, the patient was readmitted to hospital due to dizziness lasting for one week. An MRI examination showed recurrence of the hemangioblastoma in the cerebellum and the patient underwent surgery to resect the tumor. In April 2012, the patient was readmitted to hospital for the third time due to jaundice. An enhanced computed tomography (CT) scan of the abdomen revealed multiple RCCs in the kidneys, and a nodule with a rich blood supply in the pancreatic head. In addition, numerous cysts were identified throughout the pancreas (). These observations were confirmed by magnetic resonance cholangiopancreatography, which revealed that the nodule in the pancreatic head was ~2.9\u00d72.2 cm in size and possibly a NET. Due to the size and location of the tumor, the bile duct in the pancreas was compressed and the upper parts of the common bile and hepatic ducts were dilated. Since it was not possible to excise the RCCs, the patient also refused surgery to resect the pancreatic head mass. A metallic stent was placed at the stenosis site of the common bile duct, which alleviated the jaundice ( and ). Nine months later, the patient returned to the hospital with a fever, abdominal pain and jaundice. An enhanced abdominal CT was performed, which revealed no change in the size of the pancreatic head mass. The patient\u2019s symptoms were relieved following anti-inflammatory therapy for one week. However, the patient continued to suffer the same symptoms every two months, and gradually, anti-inflammatory therapy failed to alleviate the symptoms. Radiography tests revealed complete blockage of the stent and thus, percutaneous transhepatic cholangiography (PTCD) surgery was performed.\nGenomic DNA was extracted from the peripheral blood leukocytes and polymerase chain reaction was performed. Direct sequencing revealed a known mutation of a base pair change at nucleotide 473 in exon 3 (T473T/C) of the VHL gene, resulting in the amino acid change Leu158Pro.\nThere was a recorded family history of VHL disease, with the patient\u2019s mother, grandmother, two uncles and three aunts also suffering from the disease. Additionally, one uncle had succumbed to RCC and five other individuals in the family had succumbed to cerebral hemangioblastomas.", "age": [ [ 20.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4063595.xml", "relevant_articles": { "24959293": "123", "23047639": "12", "22236871": "123", "18219881": "123", "22233949": "12" }, "similar_patients": { "5287970-1": "12", "5155187-1": "123", "7528461-1": "0", "6902464-1": "0", "4009261-1": "123" } }, { "human_patient_id": "598", "human_patient_uid": "3283793-1-M", "PMID": "22379608", "title": "A Case of Korean Ginseng-Induced Anaphylaxis Confirmed by Open Oral Challenge and Basophil Activation Test", "patient": "A 44-year-old man developed anaphylaxis after an oral intake of fresh ginseng. He complained of rhinorrhea and nasal stiffness, followed by respiratory difficulty and abdominal pain 10 minutes after ingestion. He had suffered from seasonal allergic rhinitis during the spring season for several years. Upon presentation, a physical examination, chest radiography, and routine laboratory tests were unremarkable, with normal serum IgE levels. To confirm the causal relationship, ginseng extracts were prepared and used for SPT, as well as for enzyme-linked immunosorbent assay (ELISA) and BAT. The SPT results (A/H ratio) showed positive responses to ginseng extract (2+ with 1:500 w/v) and fresh ginseng (3+) as well as to alder pollens (4+) and birch pollens (4+). The methacholine bronchial challenge test produced a positive result at 5.83 mg/mL. The open oral challenge was performed using 50 g of fresh ginseng, and the patient showed immediate onset of facial flushing, cough, respiratory difficulty with wheeze, and abdominal pain. The patient's blood pressure was 140/90 mmHg, respiration rate was 22 breaths/minute, pulse rate was 66/minute, and body temperature was 36.6\u2103. His oxygen saturation decreased to 90% from a baseline value of 96%, with a significant decrease of FEV1 (54% from baseline). The patient was treated with nasal oxygen, IV steroids and salbutamol nebulization leading to a rapid recovery. Serum-specific antibodies were detected by ELISA, and BAT was performed using flow cytometry, according to previously described methods., Serum-specific IgE and IgG4 were not detected, but a higher level of serum-specific IgG1 was noted in the patient samples, as compared to the control samples. BAT showed a dose-dependent increase in the expression of CD203c and CD63 on the basophils of the patient in response to ginseng extracts, while no changes were observed in the controls ().", "age": [ [ 44.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3283793.xml", "relevant_articles": { "22379608": "123", "18437005": "12", "32070136": "12", "28701878": "0", "30410551": "12" }, "similar_patients": { "2846738-1": "12", "2831573-1": "11", "6215653-1": "123", "3121064-1": "123", "3242061-1": "1" } }, { "human_patient_id": "599", "human_patient_uid": "7706144-1-M", "PMID": "33269145", "title": "An Atypical Presentation of Heroin Inhalation Induced Leukoencephalopathy (Chasing the Dragon)", "patient": "A 60-year-old Caucasian female with the unknown past medical history presented to the emergency department via her sister for evaluation of altered mental status. The patient was a poor historian, and most of the history was obtained from the patient's sister. As per collateral, the patient had been behaving \"differently\" for the past month. The patient was unaware of why she was in the hospital. She replied, 'does not know' to almost every question. She denied fever, headache, dizziness, nausea, vomiting, muscle weakness, sensory deficit, gait abnormality, hallucination, homicidal or suicidal ideation. She also denied smoking or any illicit drug use; however, her sister reported the patient has been inhaling heated vapours of heroin for an unknown duration.\nOn examination, she looked confused and restless, was alert and oriented to person and place but not to time, and intermittently laughing throughout the interview. CNS examination revealed normal strength and sensation in all extremities, including proprioception. No gait abnormalities or nystagmus was observed.\nLaboratory investigations done on admission, including complete blood count and metabolic panel, were unremarkable; WBC 8.3 k/ul, Hb 13.3 g/dl, platelets 392 k/ul, creatinine (Cr) 0.7 mg/dl, sodium (Na) 135 mmol/l, potassium (K) 4.8 mmol/l. The urine drug screen was negative. The CT head was unremarkable. MRI brain without contrast showed diffuse symmetric increased intensity signals throughout the white matter (Figures and ). Lumbar puncture was also done, which was unremarkable. EEG revealed mild diffuse slowing with no lateralization.\nThe patient was started on Vitamin E 400 IU twice daily and was transferred to a rehab facility with following up neurology as an outpatient. She was counselled regarding abstaining from heroin.", "age": [ [ 60.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7706144.xml", "relevant_articles": { "25489012": "0", "9789311": "0", "7612389": "0", "9311007": "0", "33269145": "123" }, "similar_patients": { "8115684-1": "0", "8642152-1": "1", "8038922-1": "0", "8086522-1": "0", "7935071-1": "13" } }, { "human_patient_id": "600", "human_patient_uid": "2844756-1-M", "PMID": "20352000", "title": "Paradoxical hepatic tumor: Undifferentiated embryonal sarcoma of the liver", "patient": "A 7-year-old girl presented with a 2-week history of shoulder-tip pain, progressive fever and right upper quadrant pain. She had no history of vomiting, diarrhea or weight loss.\nOn examination, she was febrile and had a palpable, firm mass in the right upper quadrant. She had a temperature of 38\u00b0C, heart rate of 145/min and respiratory rate of 28/ min. Blood culture was negative and did not grow any organism. Serology for cytomegalovirus (CMV), Ebstein-Barr virus, hepatitis B surface antigen, hepatitis C and hydatid was negative. Serum \u03b1-fetoprotein levels of 0 and serum HCG <2 were recorded.\nUSG of the abdomen [] showed a large, mixed, complex solid-cystic lesion, which was predominantly a solid lesion with a heterogenous cystic component, within the right lobe of the liver with no flow or increased vascularity on color Doppler examination. CT scan revealed a well-defined, solitary, cyst-like hepatic mass []. No definite solid mass-like component, enhancing nodule or calcification/fat was appreciated. A few hyperdense areas were seen within this cystic-looking lesion. No vascular compromise or invasion was seen. No contrast enhancement was seen. Subsequently, an MRI of the abdomen was also performed [], which revealed the hepatic lesion to be predominantly hyperintense on the T2W images, but with central areas of low signal intensity. The T1W axial images [] revealed the lesion to be iso to heterogeneously hypointense and did not show any enhancement after intravenous contrast administration []. There was thus a discordance between the predominantly solid appearance on USG and the predominantly cystic appearance on CT scan and MRI.\nShe underwent surgical biopsy. Immunohistochemistry was performed, which revealed that tumor cells were positive for \u03b1-1-antitrypsin and \u03b1-1-antichymotrypsin and some cells were also positive for cytokeratosis. No positivity was seen for CD10 or desmin. Several CD68-positive macrophages were found. The myxoid morphology of the lesions, the presence of eosinophilic hyaline bodies and the immunohistochemical spectrum were typical for UES of the liver []. Rhabdomyosarcomatous differentiation was not seen. Based on these findings, we arrived at a final diagnosis of UES of the liver.\nThis patient is presently on chemotherapy (ifosfamide, doxorubicin and ondansetron) and follow-up imaging (CT scan) has revealed mild reduction in size. Future plans include surgery, if feasible, followed by radiation and postoperative chemotherapy. This is the currently accepted clinical practice.", "age": [ [ 7.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC002xxxxxx/PMC2844756.xml", "relevant_articles": { "20615364": "123", "10510898": "0", "25352388": "12", "33408948": "0", "17984611": "0" }, "similar_patients": { "8424748-1": "13", "6142750-1": "12", "3415884-1": "1", "5285294-1": "1", "4154933-1": "1" } }, { "human_patient_id": "601", "human_patient_uid": "7861960-1-M", "PMID": "33543880", "title": "A Unique Mode of Failure in the Noncontact Bridging Periprosthetic Plating System", "patient": "An 85-year-old woman with a history of dementia and previously treated osteoporosis presented for the treatment of a right proximal femur Vancouver B1 periprosthetic fracture after sustaining a mechanical ground level fall (Figure ). She had a remote history of a stroke with associated residual right-sided weakness and used a walker with ambulation at baseline. On admission, she was diagnosed with a urinary tract infection and appropriate antimicrobial therapy was initiated. Blood cultures were negative. She was medically optimized and taken to the operating room the following day for open reduction and internal fixation (Figure ). A subvastus approach to her femoral shaft was used, and after placing one cerclage wire around the fracture, a titanium alloy NCB Periprosthetic Plate (Zimmer Biomet) with a greater trochanteric attachment was placed. Fixation was obtained via the placement of an additional cerclage wire around the bone and NCB plate, several 3.5 mm and 4.0 mm titanium alloy proximal locking screws, and three 5.0 mm titanium alloy standard screws distal to the fracture. She was discharged on postoperative day 4 back to her assisted living facility. She was allowed to participate in the range of motion as tolerated but was limited to toe-touch weight bearing for 6 weeks. Before discharge, she was evaluated by our endocrinology team who obtained laboratory test results including comprehensive metabolic panel, vitamin D 25 hydroxy, and inorganic phosphate. Several laboratory values were found to be abnormal, and the patient was ultimately started on calcium, vitamin D, and nutritional supplements.\nGiven the patient's notable commute to our facility, her sutures were removed by her primary care provider and radiographs obtained approximately 7 weeks postoperatively were sent to the operating surgeon for review (Figure ). At that time, the patient was reported to be doing well. Radiographs demonstrated appropriate fracture healing without evidence of implant failure. Approximately 11 weeks after surgery, she again presented to our emergency department for right lower extremity pain after sustaining an additional mechanical ground level fall. Discussion with family noted that the patient had overall seemed to be recovering well from her previous injury and had recently started painless partial weight bearing activities. Radiographs at that time unfortunately revealed an acute right distal femur fracture and fretting of the distal-most screw through the plate (Figure ). Standard preoperative laboratory studies were obtained and found to have values within normal limits with the exception of a mild anemia. The patient again underwent open reduction and internal fixation of her acute fracture after medical optimization. She was discharged on postoperative day 6 back to her assisted living facility. The patient was ultimately lost to further follow-up because she entered hospice care on postoperative day 12.", "age": [ [ 85.0, "year" ] ], "geneder": "F", "file_path": "comm/PMC007xxxxxx/PMC7861960.xml", "relevant_articles": { "34141659": "0", "10497859": "123", "20461434": "0", "33194238": "0", "28164053": "123" }, "similar_patients": { "7861960-2": "123", "6530233-1": "0", "5288625-1": "13", "5831315-1": "0", "8152131-1": "0" } }, { "human_patient_id": "602", "human_patient_uid": "7861960-2-M", "PMID": "33543880", "title": "A Unique Mode of Failure in the Noncontact Bridging Periprosthetic Plating System", "patient": "A 73-year-old man with multiple medical comorbidities including multiple myeloma after chemotherapy, diabetes, and coronary artery disease presented for the treatment of a comminuted right periprosthetic supracondylar distal femur fracture after sustaining a mechanical ground level fall (Figure ). Before this injury, he was able to ambulate two blocks without difficulty but did use a stair lift at home secondary to chronic left lower extremity weakness, which he attributed to his previous multiple myeloma treatment. He was medically optimized and taken to the operating room the following day for open reduction and internal fixation (Figure ). After achieving adequate reduction of the fracture through indirect reduction techniques, a limited lateral approach to the distal femur was performed and the proximal end of a titanium alloy NCB Periprosthetic Plate (Zimmer Biomet) was placed submuscularly. Three titanium alloy 5.0 mm standard screws were placed in a percutaneous manner proximal to the fracture and multiple titanium alloy 5.0 mm locked screws were placed in the distal segment. Postoperatively, he was placed in a knee immobilizer to be worn at all times for 3 weeks, at which time the range of motion exercises were initiated. He was limited to toe-touch weight bearing for 8 weeks. Before discharge, he was evaluated by our endocrinology team who obtained laboratory test results including comprehensive metabolic panel, vitamin D 25 hydroxy, and inorganic phosphate. Several of these laboratory values were found to be abnormal, and he was ultimately started on calcium and vitamin D supplements.\nThe patient was discharged to a skilled nursing facility on postoperative day 5. At his 8-week postoperative appointment, new radiographs were obtained (Figure ). Adequate callous formation was noted, and no concerns for complications were noted. At that time, he did have notable quadriceps atrophy but denied pain with passive or active range of motion. He was advanced to weight bearing as tolerated and given home quadriceps strengthening exercises.\nAt his 14-week postoperative appointment, it was noted that the patient had not been compliant with his home strengthening exercises, and he reported 75% weight bearing with continued use of a walker for all ambulation. He endorsed stiffness in his right knee and intermittent mild pain described as muscle soreness in his distal thigh. Radiographs were obtained, which demonstrated slight varus malalignment of the fracture and fretting of the distal-most screw placed proximal to the fracture site (Figure ). He was referred to physical therapy but was unfortunately lost to further follow-up.", "age": [ [ 73.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC007xxxxxx/PMC7861960.xml", "relevant_articles": { "24876402": "0", "29985903": "123", "12033473": "0", "33339718": "12", "21410116": "0" }, "similar_patients": { "7861960-1": "13", "6530233-1": "13", "6664517-1": "0", "3863509-1": "0", "2887894-1": "0" } }, { "human_patient_id": "603", "human_patient_uid": "3276918-1-M", "PMID": "22345792", "title": "DRESS SYNDROME WITH SEPSIS, ACUTE RESPIRATORY DISTRESS SYNDROME AND PNEUMOMEDIASTINUM", "patient": "A 10-year-old girl presented with high-grade intermittent fever with cough for 20 days and a generalized rash for 15 days following ingestion of phenobarbital for 6 weeks. There was h/o seizures with fever from the age of 18 months, but the severity and frequency of seizures started increasing, occurring even without fever for which she was put on oral phenobarbital.\nOn admission, we found that the girl was toxic, febrile, icteric, with tachypnea, tachycardia, conjunctival congestion, stomatitis, and cervical, axillary and inguinal lymph node enlargement. There was a diffuse erythematous, maculopapular rash without vesiculation or blistering []. There were bilateral diffuse crepitations over the chest and tender hepatomegaly.\nInitial investigations showed leukocytosis, eosinophilia (absolute eosinophil count: 1586/dl), high bilirubin, elevated liver enzymes, microscopic hematuria and minimal pyuria. Imaging studies revealed hepatomegaly with features of hepatitis, mild pericardial effusion on echocardiography, and features of diffuse pneumonitis. Initial blood culture and urine culture were negative.\nThe patient was put on empirical antibiotics and other supportive measures. Antibiotics were changed and steroid (i.v. dexamethasone) was added on persistence of fever and dyspnea, following which there was a short period of improvement. But after a few days, the girl again complained of sudden onset exacerbation of respiratory distress and we found that she had developed subcutaneous emphysema and pneumomediastinum []. The patient had intermittent high spiking fever. A repeat blood culture showed growth of Acinetobacter baumanii and we switched over to sensitive antibiotics. But the general condition deteriorated and the patient developed ARDS for which she was ventilated. She improved dramatically and was extubated after 6 days. The girl again developed fever and dyspnea 2 days postextubation. There were findings of ARDS and pneumothorax on chest X-ray. She was ventilated again but succumbed after 5 days.", "age": [ [ 10.0, "year" ] ], "geneder": "F", "file_path": "noncomm/PMC003xxxxxx/PMC3276918.xml", "relevant_articles": { "34972223": "0", "22345792": "123", "18253750": "123", "23485263": "123", "21262091": "123" }, "similar_patients": { "3980093-1": "13", "3250000-1": "1", "7694938-1": "13", "7047308-1": "13", "6983282-1": "13" } }, { "human_patient_id": "604", "human_patient_uid": "4181003-1-M", "PMID": "25253623", "title": "Orbital rhabdomyosarcoma with skin metastasis: a case report", "patient": "A previously fit and well 20-year-old Moroccan man presented with a right orbital tumor measuring 2 cm in diameter that had been rapidly increasing in volume. A complete resection of the tumor was made. The diagnosis was made on histological examination, confirming the orbital tumor to be an embryonal rhabdomyosarcoma.\nThe patient received six cycles of adjuvant chemotherapy with alternating vincristine, adriablastine and cyclophosphamide(VAC). One year later, the patient developed a local recurrence. Exenteration was performed,followed by treatment with six cycles of ifosfamide plus etoposide (IE); local radiotherapy was also given at a dose of 45 Gy. However, after 6 months, the patient developed a cutaneous mass in the right lumbar region, which was resected. A computed tomography - scan of the thorax, abdomen and pelvis did not reveal any metastasis. Macroscopically, the tumor size was 4 \u00d7 4 \u00d7 2.2 cm; the cut surfaces were nodular and fleshy; there was no necrosis and the edges showed an infiltrative pattern. Histologic sections with microscopy showed a proliferation of undifferentiated round cells arranged in sheets with some tapered eosinophilic cytoplasm. High mitotic rate was seen. The tumor cells infiltrating the subcutaneous tissue. Hematoxylin and eosin stained sections revealed loosely arranged round cells with large hyperchromatic nuclei and rare strap cells with eosinophilic cytoplasm (Figures and ). Immunohistochemical studies were performed using antibodies directed against desmin,myogenin, cytokeratin and leukocyte common antigen(LCA).\nPhotomicrographs showing a sheet of undifferentiated round cells. The tumour cells were immunopositive for desmin (Figure ) and myogenin (Figure ), and negativity for cytokeratin and LCA. A final diagnosis of cutaneous RMS metastasis was made. The patient then was treated by chemotherapy with 6 cycles of IE. He is still living 9 months after the initial diagnosis of skin metastasis with no recurrence.", "age": [ [ 20.0, "year" ] ], "geneder": "M", "file_path": "comm/PMC004xxxxxx/PMC4181003.xml", "relevant_articles": { "25253623": "123", "16945640": "0", "25404964": "0", "27755831": "0", "30195334": "0" }, "similar_patients": { "3963119-1": "13", "4274531-1": "13", "5043172-1": "13", "5008524-1": "0", "3800372-1": "0" } }, { "human_patient_id": "605", "human_patient_uid": "3284290-1-M", "PMID": "22396812", "title": "Combined circular external fixation and open reduction internal fixation with pro-syndesmotic screws for repair of a diabetic ankle fracture", "patient": "A 67-year-old male presented to the outpatient clinic with a chief complaint of ambulatory difficulty and a history of an ankle fracture and deformity. The patient's daughter reported that her father sustained an ankle fracture 6 weeks ago and was hospitalized. The history revealed that the patient was placed in a short-leg cast and surgery was considered but not performed since the ankle mortise was reduced at that time and the patient's ankle displayed multiple fracture blisters. The patient was discharged to a rehabilitation facility during which time the cast was removed secondary to non-compliance and skin compromise. The patient's daughter stated that her father was fully ambulatory at 2 weeks after the initial injury despite medical advice. Unfortunately, he was unaware of his ankle fracture since he suffered from dementia and Alzheimer's disease. His medical history was also significant for poorly controlled diabetes mellitus, peripheral neuropathy, peripheral vascular disease, prior alcohol abuse, seizures, aortic stenosis, meningioma, and hypertension. A physical examination revealed a well-nourished individual who was in no acute distress and was alert but not oriented to time, person, or place. His vital signs were stable. The left lower extremity was edematous with a non-infected necrotic wound over the medial malleolus. The ankle and rearfoot displayed severe valgus deformity with the medial malleolus causing pressure necrosis to the overlying soft tissue. He had weakly palpable pulses and loss of protective sensation when examined with a 5.07 Semmes-Weinstein monofilament. Radiographic evaluation revealed a displaced fibula fracture with significant ankle joint subluxation and widening of the medial clear space (). The patient was admitted to the hospital and stratified as moderate risk for surgical intervention after optimized by both internal medicine and cardiology.\nNon-invasive vascular studies that consisted of ankle-brachial index, toe-brachial index, and pulse volume recordings demonstrated moderate arterial occlusive disease with a falsely elevated ankle-brachial index secondary to calcified vessels. The patient was then evaluated by vascular surgery and after angiography was performed, adequate collateral circulation was present and their recommendation was to proceed with appropriate surgical intervention. The patient was brought to the operating room after obtaining informed consent from his daughter, as he was deemed not competent to make his own medical decisions. The patient underwent operative intervention that consisted of ORIF of his fibula fracture with placement of multiple pro-syndesmotic screws and application of a multi-plane circular external fixator. Postoperatively, the patient was permitted to fully weight-bear with the external fixator and discharged to a rehabilitation facility. The patient developed a postoperative infection that was evident 3 weeks after surgery, as wound dehiscence and drainage were apparent. The patient was readmitted to the hospital for inpatient care. The patient was brought back to the operating theater during this admission for an incision and drainage of the ankle wound with collection of deep intra-operative soft tissue cultures and reclosure of the wound over a drain. The drain was removed at 72 h and then wet to dry dressings were applied daily until the wound was healed. Deep intra-operative cultures grew methicillin-resistant Staphylococcus aureus. The patient was initially placed on parenteral administration of Vancomycin but was switched to oral administration of Zyvox after the first week as the patient continued to remove his peripherally inserted central catheter line. His antibiotic regimen was continued 6 weeks for treatment of deep infection with retained hardware. The patient healed his wound at 6 weeks postoperatively and was full weight-bearing with the external fixator for 12 weeks total time.\nThe external fixator was removed and the patient was placed into a walking total contact cast for a total of 6 weeks with cast changes performed at 2 week intervals. The patient was able to resume full ambulatory status with prefabricated extra-depth diabetic shoes with soft inlays at 18 weeks postoperatively. The patient continued to maintain an ambulatory status with no further complications at his 8-month follow-up ().", "age": [ [ 67.0, "year" ] ], "geneder": "M", "file_path": "noncomm/PMC003xxxxxx/PMC3284290.xml", "relevant_articles": { "25103697": "123", "24032619": "123", "23756596": "123", "23623627": "123", "24736016": "123" }, "similar_patients": { "2831018-1": "123", "3284275-1": "123", "3284265-1": "123", "3284265-2": "123", "6957040-1": "123" } } ]