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medical-triplet

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20,447	121,346	20 years ago, with smoking history of 15 pack-years) was referred to our outpatient clinic with NSCLC diagnosis to assess treatment options. The tumour was located in the right lung and spread to the mediastinal and supraclavicular lymph nodes. The lesion was detected in the chest CT (April, 2015) performed due to recurring mild exertional dyspnoea, decrease in exercise tolerance and dry paroxysmal cough. On histopathological examination of mediastinal lymph nodes biopsy obtained at mediastinoscopy and the right supraclavicular lymph nodes from fine-needle biopsy metastatic lung adenocarcinoma (TTF1+,	Napsin A+) was diagnosed (June, 2015). The patient denied any weight loss. His medical history included mild prostatic hyperplasia, past lithotripsy due to urolithiasis, and in his youth hepatitis A. He is a farm worker.\nThe results of	patient continued therapy for 12 months. The rash with no need of treatment persisted.\nIn August 2016 the patient experienced a pathological vertebral fracture with no evidence of lung cancer progression on chest imaging and no evidence of disease progression in the brain MRI. However, a few days later there appeared progressive paraparesis. The spine MRI revealed metastases in vertebral bodies of Th1, Th7 and Th8 with protrusion into the epidural space and spinal cord compression. The patient underwent neurosurgery (posterior decompression and C4-Th11 stabilisation), rehabilitation (physiotherapy and kinesitherapy) and
21,475	97,634	periapical radiograph of the concerned region revealed an ill-defined and non-corticated relatively low-density area with permeative changes, the adjacent teeth were removed, but the symptoms persisted after 2 weeks even though the bone healing was normal. The periapical radiograph taken after extraction exhibited an increased radiolucency in the area [].\nThe orthopantomograph showed a	revealed an ill-defined and non-corticated relatively low-density area with permeative changes, the adjacent teeth were removed, but the symptoms persisted after 2 weeks	low-density area with permeative changes, the adjacent teeth were removed, but the symptoms persisted after 2 weeks even though the bone healing was normal. The periapical radiograph taken after extraction exhibited an increased radiolucency in the area [].\nThe orthopantomograph showed a 2 cm diameter ill-defined and non-corticated slightly radiolucent osteolytic lesion with permeative changes of the right premolar region extending from the canine area to approximately the mesial aspect of the molar area, the lesion also appeared to be extending from the apical area within the alveolar crest to the
1,373	17,919	his left renal artery/in situ autotransplantation.\nAn occlusive 2 cm intra-arterial thrombus was removed, and a corresponding 2 cm damaged segment of the renal artery was excised. The kidney was flushed through the renal vein with histidine-tryptophan-ketoglutarate perfusion solution during the anastomosis of the renal artery. The left kidney was adequately perfused postreconstruction of the left renal artery ().\nDuring the two operations, the patient received a total of 7 units of packed red blood cells, 6 units of fresh frozen plasma, 2 units of cryoprecipitate, and 2 platelet transfusions. The patient was subsequently admitted to the Trauma Intensive Care Unit (TICU) for postoperative care.	His hospital course was significant for worsening azotemia in the setting of decreased kidney function and falling urine output with a	and urinary output increased. He exhibited hypertension 2-3 weeks postrenal artery repair, but his systolic blood pressures eventually stabilized between 110 and 130 mmHg. He recovered in our TICU after multiple episodes of fungemia and bacteremia, was transferred to the trauma floor, and was discharged two months after admission. He is currently being followed in an outpatient clinic. After 18
8,658	155,354	Chest X-ray showed total haziness in the left lung field and a chest CT showed successful stenting in the aortic arch aneurysm and total ateletasis of the left lung due to external compression of the left main bronchus by hematoma (). Therapeutic bronchoscopy was performed to remove a large amount of blood clots in the left bronchus. The left atelectasis improved on the	chest X-ray taken 5 days after a bronchoscopy procedure (). Follow up CT angiography of the aorta after 7 days showed successful stenting, no endoleak and	with a 7 cm sized aortic arch aneurysm 2 years earlier. He was recommended to undergo an operation for the aneurysm, but refused to do so. He also did not take his medicine and was without a follow up examination over that period.\nAt the time of admission, his blood pressure was 150/100 mmHg, pulse rate was 86 beats/min, respiratory rate was 20 breaths/min and body temperature was 36.5℃.
17,024	151,570	between visceral aspects of the liver and stomach were evident. After introducing a 32Ch gastric bougie, adhesiolysis was performed, and the gastrocolic and gastrosplenic ligaments were dissected from the greater curvature upstream until the fundus was fully exposed. Under the guidance of the gastric bougie, a pouch was created, similar to a gastric bypass pouch, using an Endo GIA (Medtronic-Covidien, Auto Suture) 60 mm stapler with Lila cartridges.	were evident. After introducing a 32Ch gastric bougie, adhesiolysis was performed, and the gastrocolic and gastrosplenic ligaments were dissected from the greater curvature upstream until the fundus was fully exposed. Under the guidance of the gastric bougie, a	weight reduction surgery, he received an laparoscopic adjustable gastric banding (LAGB) performed in 2005, which was revised in 2008 with a lesser curvature SG performed without a clear reason instead of the greater curvature resection or Roux-en-Y gastric bypass (RYGB) (). Probably technique selection was influenced by the following considerations: adhesions in gastric cardiac area, preserving blood supply in mentioned area and greater experience in esophageal resections than bariatric surgery. No improvement of
17,368	51,442	strength of both the upper and lower limbs was grade 3 following the Medical Research Council (MRC) grade. He was clinically diagnosed as ICU-acquired weakness because the MRC sum sore consisting of both wrist extension, elbow flexion, shoulder abduction, ankle dorsiflexion, knee extension, and hip flexion was 36 points, which was less than 48 points suggested by the guideline.[ Various types of rehabilitation exercises were carried out in a step-by-step manner	identified on chest radiography and computed tomography (Fig. ). After a month of mechanical ventilation, he was weaned off of the ventilator. However, critical illness and prolonged treatment in the ICU resulted in severe muscle wasting and deterioration of physical function.\nFor a comprehensive rehabilitation treatment, he was referred to the Department of Rehabilitation Medicine. During the initial assessment, he needed moderate support for static sitting balance and scored 0 on the Berg Balance Scale and 8 on the Modified Barthel Index. The	tube was continued, and the rehabilitative dysphagia treatment including chin tuck against resistance, thermotactile stimulation and electirical stimulation therapy was performed for 30 minutes daily.\nTwo weeks later, he was able to maintain sitting balance with supervision and static standing balance with moderate support. From this point on, the rehabilitation treatment consisted of standing balance training (step 3) and sit-to-stand training (step 4).\nAfter a total of 4 weeks of treatment,
25,404	78,322	analysis revealed a Class III skeletal pattern with severe mandibular prognathism and vertical excess (Figures –). Analysis of occlusion evidenced Class III interarch relationship and anterior and posterior crossbite with a negative overjet of 6 mm. Severe tooth compensation of mandibular teeth (lingual inclination of anterior and posterior teeth) and severe mandibular anterior crowding were observed (Figures –). The analysis of initial CBCT images (Figures –) showed very thin buccal and lingual bone plates in the maxillary and especially mandibular incisors. A CBCT exam was acquired before orthodontic treatment, replacing the conventional extraoral radiographs.\nThe combined orthodontic and surgical treatment was planned. The prognosis	was regular considering the magnitude of the skeletal discrepancy and the amount of required buccal movement of mandibular incisors in a thin mandibular symphysis.\nThe therapeutic goals were to give the patient a more balanced face and better esthetic and functional occlusion. For that purpose, the decompensation orthodontics intended to increase the negative overjet to an	with the chief complaint of facial disharmony. Facial analysis revealed a Class III skeletal pattern with severe mandibular prognathism and vertical excess (Figures –). Analysis of occlusion evidenced Class III interarch relationship and anterior and posterior crossbite with a negative overjet of 6 mm. Severe tooth compensation of mandibular teeth (lingual inclination of anterior and posterior teeth) and severe mandibular anterior crowding were observed (Figures –). The analysis
12,424	101,848	Plasma Reagin test, urine analysis, and chest X-ray). Two months later, a 1-mm-diameter thinned corneal ulcer was observed next to the neovascularization area, with 300 μm of depth (Fig. ). With the new diagnosis of PUK, a multilayer amniotic membrane graft was applied along with an intrastromal injection of antiangiogenic agents	An extensive workup undertaken to exclude an accompanying autoimmune or infectious disease yielded negative results (which included a blood test with complete blood count, C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor, antinuclear antibodies, antineutrophil cytoplasmic antibodies, complement, proteinogram, serology for infectious diseases, QuantiFERON, Rapid	corneal neovascularization area of 2 mm with mild stromal inflammation in the inferior part of the left eye. Neither endothelial deposits nor anterior chamber reaction were detected. Intraocular pressure was 19 mm Hg in both eyes, and fundoscopy showed no alterations. The initial diagnosis was bilateral scleritis with an exudative inflammatory keratitis in the neovascularization area in the left eye. Conjunctival exudate samples were taken and resulted negative for bacterial and fungal growth. Treatment included dexamethasone drops every 6 h and moxifloxacin drops every 8 h. The dexamethasone dose was reduced progressively during the next 7 months according to inflammation response.\nAfter the initiation of steroids and antibiotic drops
34,103	116,194	past medical history of morbid obesity (body mass index (BMI) of 41), osteoarthritis, a remote history of bilateral deep venous thrombosis, and severe chronic venous insufficiency (Clinical-Etiology-Anatomy-Pathophysiology (CEAP) Clinical Classification 6) presented to our clinic with refractory venous stasis ulcers of the bilateral lower extremities over the last 6 years. She was intermittently treated conservatively with PROFORE™ multi-layer compression bandaging system dressings (Smith and Nephew Inc., Andover, MA, USA) for 6-week periods with some improvement of the chronic venous stasis ulcers. A preoperative venous duplex scan demonstrated severe venous insufficiency of the superficial and deep systems of her bilateral lower extremities. Review of the preoperative duplex demonstrates an	ectatic right GSV at its origin; however, a diagnosis of a venous aneurysm was not made at that time based on the images that were available ().\nThe patient was recommended to undergo bilateral lower extremity radiofrequency ablation of the GSVs to facilitate wound healing and to reduce symptoms of her chronic venous insufficiency. Endovenous ablation of the left GSV was attempted; however, a post-procedure duplex scan indicated incomplete ablation of the left	at that time based on the images that were available ().\nThe patient was recommended to undergo bilateral lower extremity radiofrequency ablation of the GSVs to facilitate wound healing and to reduce symptoms of her chronic venous insufficiency. Endovenous ablation of the left GSV was attempted; however, a post-procedure duplex scan indicated incomplete ablation of the left GSV (). Failure of the radiofrequency ablation was attributed to the large size of the GSV (2.2 cm maximal diameter) and severe thickening of the vein from chronic inflammation. The patient was subsequently treated by open surgery with left GSV
22,306	142,271	Tokyo, Japan). After achieving the patient's stabilization, 30 mm by 150 mm of thoracic stent graft was first deployed at the descending aorta. Then, a 34 mm by 200 mm of the stent graft was deployed at the aortic arch just distally to the left subclavian	mm of thoracic stent graft was first deployed at the descending aorta. Then, a 34 mm by 200 mm of the stent graft was deployed at the aortic	CEA and CA19-9 were within the normal value. A protein C antigen level of the patient was also normal, but the protein S antigen was lower at 44.2% (normal range; 60-150%). Since the size of the patient's aneurysm was very large despite the absence of any symptoms, there might have been a risk of aortic rupture. Therefore, we planned TEVAR for her aneurysm.\nA 300 mg of aspirin and the 600 mg of clopidogrel were administrated orally on the day of the procedure. A Rt. common femoral artery
12,334	84,385	for maternal IgA nephropathy. The obstetric examination at the time of admission revealed an 11-week gestation and a single live fetus was detected in utero. On the general physical examination, she appeared uncomfortable, but not acutely ill. She tended to keep her eyes closed. She did not have a history of an upper respiratory or gastrointestinal tract infection. She was fully alert with a normal mental status examination. Her eyes had dysconjugate gaze, with markedly restricted abduction of the left eye, and modest restriction of movement	trunk, or face. She had an unremarkable medical history and she had not been hospitalized. Her family history was significant	fetus was detected in utero. On the general physical examination, she appeared uncomfortable, but not acutely ill. She tended to keep her eyes closed. She did not have a history of an upper respiratory or gastrointestinal tract infection. She was fully alert with a normal mental status examination. Her eyes had dysconjugate gaze, with markedly restricted abduction of the left eye, and modest restriction
39,346	51,297	enlarged abdominal lymph nodes. There was no ascites. The visualized bones were normal with no focal bone lesion. The radiologic chest anatomy was normal (Fig. A–D). Histological examination of renal biopsy specimen was favorable for chemotherapeutic regimens.\nIn consultation with pediatric oncology tumor board, nephron-sparing surgery was deemed in appropriate given the poor long-term survival even in patients without distant metastasis. Our patient was commenced on combination chemotherapy (adriamycin and vincristine) with a palliative intent. The dose of vincristine was 1.5 mg/m2 body surface area administered as intravenous bolus injection and that of Adriamycin was 50 mg/m2 BSA	ureters and urinary bladder were normal. The portal vein, intrahepatic ducts and common bile ducts were normal. The abdominal aorta and inferior vena cava were normal. There were no	child was stable and active (Eastern Cooperative Oncology Group Functional Status 3). His vitals were within the normal limits. Conjunctivae was pink and Chest was essentially normal on physical examination. The abdomen was distended and had mild generalized tenderness. There was a palpable mass, approximately 7 finger breaths in the right upper quadrant, which was firm, non-tender, and not ballotable and did not cross the midline. The mass was dull to percussion and active bowel sounds appreciated. There were no enlarged peripheral lymph nodes.\nComplete blood count showed mild anemia with a hemoglobin level of 9.5 g/dl, while the other indices were normal. Renal function test and liver
16,097	145,045	and 6.5 mm on the long side (the left side). Bony interference between the fragments and flaring of the proximal segment on the right side would be anticipated if a BSSRO was performed. Therefore, we planned to use UIVRO on the short side and SSRO on the contralateral side of the mandible.\nDuring the maxillary surgery, a Le Fort I osteotomy was performed to correct the	canting and yawing of the maxilla in a standard fashion based on the intermediate surgical wafer. In the mandible, conventional SSRO was begun on the long side of the mandible (the left side) and then IVRO was performed on the short side (the right side).\nOn the left side a SSRO was	fixation of the condylar and proximal segments on the short side of the IVRO side. Additionally we did genioplasty for vertical reduction and advancement of the chin.()\nIntermaxillary wire fixations were maintained postoperatively for two weeks with the final surgical wafer to stabilize the occlusion and mandibular segments. After release of intermaxillary fixation at two weeks, two elastic bands were used for mouth opening exercises. The wafer was maintained for 6 weeks postoperatively for training and adaptation to
33,540	117,091	So the tumor was completely removed successfully. Tissue specimens obtained demonstrated monophasic SS with spindle-shaped mesenchymal cells (). Immunohistochemical stains were positive for vimentin, CD99, calponin, and Bcl-2 and negative for α-smooth muscle actin (α-SMA), muscle-specific actin (MSA), CD34, S-100, myeloperoxidase (MPO), epithelial membrane antigen (EMA), Hector Battifora mesothelial epitope-1, phosphoenolpyruvate carboxykinase (PCK), and cytokeratin 7 (CK7) (). After the right lateral orbital and right temporal tumor resection, the patient began postoperative chemotherapy with CVADIC (cyclophosphamide [CTX] 500 mg/m2 intravenously; d1, vincristine [VCR] 1.5 mg/m2 intravenously; d1-d5, adriamycin [ADM] 50 mg/m2 intravenously; d1, dacarbazine [DTIC] 200 mg/m2 intravenously; d1-d5, Q21d). She received 5 courses	lateral orbital wall was noted. It was located mainly in the lateral epidural and periorbital fascia with 4 cm × 3 cm × 3 cm in size. The boundary was clear and the blood supply was rich. No metastatic lesion was found.	abnormalities were detected on systemic examinations, including blood and urine tests, abdominal ultrasound, and chest CT.\nInformed consent was obtained from her parents. The plan was to remove the mass with the help of neurosurgeons followed by the chemotherapy. Intraoperatively, a soft tumor invading
25,136	166,914	In response to these adverse effect, the CsA concentration was controlled in the range from 75 to 100 ng/ml, which maintained blood pressure within the normal range and a glomerular filtration rate over 50 ml/min. After 7 years, a follow-up MRI was performed and the AChR antibody titer was 5.0 μmol/l. The CsA concentration was kept in the range from 75 to 100 ng/ml, and the tumor was maintained at a size	adverse effect, the CsA concentration was controlled in the range from 75 to 100 ng/ml, which maintained blood pressure within the normal range and a glomerular filtration rate over 50 ml/min. After 7 years, a follow-up MRI was performed and the	of a thymoma detected by routine chest X-ray examination. At the time of the thymoma detection, she had not shown any abnormal neurological symptoms. However, she has been suffering from symptoms such as moderate bilateral ptosis, severe diplopia, and muscle weakness after 10 years of thymoma operation, despite no recurrence of the thymoma. The affected muscles were the bilateral external ocular muscles, pharyngeal musculature, neck extensor muscle, deltoid, biceps, triceps, and iliopsoas. In particular, her left eye movement was limited in all directions. The diplopia developed at approximately the same time as the onset of the ptosis, and the extremity muscle weakness occurred
12,058	133,125	28 years of age, suffered sudden loss of consciousness in March 2004, when she was 15 years old. When she reached the hospital, she was scored in Glasgow Coma Scale 3; computed tomography (CT) scan showed a large intraparenchymal cerebellar hemorrhage from rupture of an arteriovenous malformation supplied by the posterior circle. The patient underwent surgery to remove the hematoma and malformation. The operation was complicated by	March 2004, when she was 15 years old. When she reached the hospital, she was scored in Glasgow Coma Scale 3; computed tomography (CT) scan showed a large intraparenchymal cerebellar hemorrhage from rupture of an arteriovenous malformation supplied by the posterior circle. The patient	in vegetative state with eyes fixed in central position, showing severe spasticity and repeated generalized epileptic seizures. The extent of the disorder of consciousness (DoC) was confirmed by the scores attributed to the patient through the assessment scales used in Italy in those years: Los Amigos Levels of Cognitive Functioning (LCF), Level II, Disability Rating Scale (DRS), Score 25, Glasgow Outcome Scale: vegetative state, Modified Barthel Index (MBI) Score 0/100, Category 1.\nFor about 7 years, she stayed in a
23,537	7,887	the case of a 53-year-old Japanese male with schizophrenia who had been hospitalized at Takano Hospital from the age of 29. Haloperidol was continuously prescribed, and he was mentally stable before the disaster. His parents died during his hospitalization, and he did not have any social or financial support from other family members, which was one reason for his long-term hospitalization. This type of long-term hospitalization of psychiatric patients is relatively common in Japan []. His right eyesight and hearing were impaired. He had chronic constipation and took purgative medicines, yet no other abnormalities were noted in terms of his physical condition. Although he maintained positive relationships with the hospital staff, few	been hospitalized at Takano Hospital from the age of 29. Haloperidol was continuously prescribed, and he was mentally stable before the disaster. His parents died during his hospitalization, and he did not have any social or financial support from other family members, which was one reason for his	the chaotic postdisaster situation. On March 19, 2011, the number of staff who remained at the hospital dropped to 13, compared to the predisaster baseline of 88. Following the hospital director's decision to evacuate relatively stable patients, the patient in question was transferred to Hospital A (), which specializes in psychiatric care, in Saitama Prefecture, 250 km away from Takano Hospital, together
30,840	204,892	from diabetes. He had sustained a minor head trauma 3 years prior with no concussion; however, his scan was reported to have shown “scattered areas of bleeding” in his brain. He otherwise maintained a healthy life and never required a hospital visit for any medical issues. His family reported the patient had normal cognitive function, especially as someone who ran his own business.\nThe patient was lethargic upon arrival to the accident and emergency department. Given the apparent risk of airway obstruction, the emergency physician intubated the patient. On general examination, we found no facial phakomas. While the patient was sedated, we found tonic eye deviation with nystagmoid-like eye movement	was reported to have shown “scattered areas of bleeding” in his brain. He otherwise maintained a healthy life and never required a hospital visit for any medical issues. His family reported the patient had normal cognitive function, especially as someone who ran his own business.\nThe patient was lethargic upon arrival to the accident and emergency department. Given the apparent risk of airway obstruction, the emergency physician intubated the	Saudi man with diabetes mellitus was admitted to the Neurology Department with an unremitting headache lasting 5 days, episodic confusion, and visual disturbances. According to his family, the headache started gradually over the left side of his head and then became holocephalic and moderate to severe in intensity. The patient reported feelings of nausea and 2 episodes of vomiting. Moreover, his family stated the patient was often seen “bumping” into surrounding objects while ambulating. The patient reported experiencing some visual disturbance during this period. The patient's family felt he appeared confused at times and
39,941	79,281	with Sjögren syndrome and systemic lupus erythematosus at the Department of Dermatology of our hospital in 2006, and oral treatment with 20mg of prednisolone was initiated. She felt right coxalgia with no inducer in 2007, and was diagnosed with ION of the right femoral head at our department, but the pain was transient and remitted. Periodic follow-up was continued thereafter, but pain in her right hip joint over the gluteal region started upon sitting	systemic lupus erythematosus at the Department of Dermatology of our hospital in 2006, and oral treatment with 20mg of prednisolone was initiated. She felt right coxalgia with no inducer in 2007, and was	change suggesting a cam lesion was not noted in the femoral neck. No irregular joint surface was noted (Figure \n). T1-weighted imaging of magnetic resonance imaging (MRI) showed the band sign, which is the characteristic MRI finding of ION of the femoral head. The MRI findings also demonstrated that the patient had type B of the femoral head according to the Nishii et al. classification and stage 1 of the femoral head according to the Association Research Circulation Osseous classification\n[,]. On MRI T2 short-tau inversion recovery a high intensity was noted in the acetabular
38,317	143,494	attached to the spinous processes and laminae, and no jolting movement of the SML was elicited by shaking with Kelly clamps. The SML could not be rotated or bent with several kinds of clamps, so the arms of the SML were drilled down with a diamond burr under microscopic vision (). The lower ends of the bilateral limbs of the SML could be pushed out after the drilling.\nHowever, the upper ends that were hooked in the upper L4 laminae could not be extracted manually	of the previous operation site, the paraspinal muscles and fascia were dissected and retracted. The adhesions along the SML were carefully divided and the SMLs were exposed (). It seemed that the SMLs were firmly	SML was elicited by shaking with Kelly clamps. The SML could not be rotated or bent with several kinds of clamps, so the arms of the SML were drilled down with a diamond burr under microscopic vision (). The lower ends of the bilateral limbs of the SML could be pushed out after the drilling.\nHowever, the upper ends that were hooked in the upper L4 laminae could not be extracted manually and
18,917	160,177	was performed.\nOn opening of the thorax, a bilateral brownish pleural effusion of 300 mL was observed, and clear effusion of 100 mL was present in the pericardial sac. The thyroid gland and all of the four parathyroid glands were found to be normal and not enlarged. Enlarged mediastinal lymph nodes and periaortic lymph nodes were observed,	with conglomeration up to 10 mm. The cut surfaces of the bilateral lungs were found to be heavy, firm, and brittle (). On opening of the peritoneal cavity, accumulated brownish ascites was	the bilateral kidneys was brittle and showed no demonstrable hemorrhage or necrosis. Careful examination of the pelvic and abdominal cavity, including the gastrointestinal tract, found no gross abnormalities.\nHistologically, near complete destruction of the pulmonary architecture caused by calcium deposits (), which were stained using a von-Kossa stain, was observed. Calcification was observed in the alveolar septa, bronchus, bronchioles, and blood vessels. Diffuse calcific deposits, mainly in the glomeruli and interstitial spaces, were observed in the parenchyma of the kidney (). The skin necropsied from the violaceous extremity was characterized by total epidermal necrosis and calcification (calciphylaxis) was observed in small and medium-sized
7,857	63,792	clinic by the pediatrics department for consultation regarding a suspected upper respiratory tract infection and rhinosinusitis and also to exclude the possibility of a hidden foreign body. History obtained from his mother revealed that he had purulent nasal discharge for about three weeks, with intermittent low grade fever since two weeks. This was associated with an occasional cough and the child had recently started refusing food. His parents consulted the local practitioner who prescribed antibiotics suspecting the condition to be a respiratory tract infection. However, although the fever subsided for the time being, the nasal purulence continued.\nUpon initial examination	in our out-patients’ department, the child was playful, afebrile, with no apparent sign of respiratory distress, although there was copious amount of mucopurulent discharge in the nasal cavity as evident on anterior rhinoscopy. Examination of the oral cavity and oropharynx revealed postnasal drip and slight bulging of the soft palate.\nAfter interrogating the child’s mother it was made known that the child had been observed puting the cap of a small plastic bottle in his mouth about a month back. Immediately thereafter he had difficulty in swallowing and pain	be swallowed. It was only when the sick child was referred by the general practitioner to the pediatrics department of our institute that the clinical presentation mimicking upper airway infection was considered to be caused by a probable hidden foreign body. Leading questions to his parents further strengthened the suspicion. A formal referral to the otolaryngology department was made.\nConsidering the localized nature of the infection and mild bulging of the soft palate, we conjectured that the symptoms were more corroborative of a hidden foreign body that could have possibly been lodged in the nasopharynx. At the same time, we were also
26,211	20,621	pills on the room floor next to the patient. Furthermore, the family detected the pacemaker and electrode lines outside the window (Fig. ). Therefore, they assumed that the patient had removed the pacemaker and taken drugs to commit suicide. The patient’s medical history indicated that she had a history of coronary heart disease for 16 years and depression for 4 years. She had implanted two stents separately and has a long-term used aspirin, atorvastatin, and metoprolol sustained-release tablets to treat heart disease. She usually took alprazolam and paroxetine for relieving depression.\nTwo months earlier, the patient was admitted to another hospital due to syncope. The echocardiography was	her low blood oxygen saturation. Her other vital signs were stable. Electrocardiogram (ECG) showed sinus rhythm with heart rate at 70 bpm, and the blood pressure (BP) was around 130/70 mmHg. There was a self-inflicted wound on her left upper chest, and two silicone-caps were found in the injury. According to the patient family members, two hours before, they suddenly discovered the patient unconscious on the bedroom floor with severe trauma on her left upper chest (Fig. ). They also found an empty packet of sleeping	the doctor since she was last discharged from the hospital. On the day of admission to our hospital, she cut the pacemaker pocket with a knife, extracted the pacemaker by hand, and then she attempted to kill herself with 80 alprazolam tablets. As the patient and her family members refused to continue treatment in the cardiology department, they immediately left the hospital upon the improvement of the patient’s condition. Considering the particularity of this patient’s
15,520	35,918	duct or lingual nerve injury as evidenced by the patient's symptoms and post-operative evaluations. Final histopathology was benign sublingual gland ranula on both sides.\nThe transoral resection of the ranula was performed using the da Vinci Si Surgical System. The oral cavity and surgical site were exposed using a self-retaining retractor (Jennings's mouth gag) and a Sweetheart tongue retractor. The robotic arms of the da Vinci Si-System were placed	into position in the patient's mouth, while the surgeon controlled the instruments from the control console within the room. The robotic arm controlled by the surgeon's left hand contained	Head and Neck Center at Our Lady of the Lake Regional Medical Center in Baton Rouge, LA and to the Department of Otolaryngology Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA to be evaluated for a right floor of mouth swelling (Figure ). The swelling was associated with progressive discomfort in speech. There were no symptoms suggestive of an infective or obstructive process within the submandibular system such as
4,369	110,523	showed mild improvement with a small mucosal tear. The scope was able to be passed to the stomach and duodenum which were found to be normal mucosa with unremarkable findings.\nAfter the procedure, the patient failed to regain conscious and was intubated for airway protection and kept on mechanical ventilation in the intensive care unit. An urgent head computed tomography (CT) showed multiple foci of intraparenchymal air suggestive of air emboli as well as visualization of small infarcts in the left frontal lobe (). Transthoracic echocardiogram was performed, which showed no evidence of patent foramen ovale or atrial	unit. An urgent head computed tomography (CT) showed multiple foci of intraparenchymal air suggestive of air emboli as well as visualization of small infarcts in the left frontal lobe (). Transthoracic echocardiogram was performed, which showed no evidence of patent foramen ovale	medical history of hypertension, previous stroke and Schatzki rings treated with dilation 7 years ago presented with progressive dysphagia to solid food. The patient reported the sensation of food getting stuck in her throat with associated coughing and choking spells. Seven years ago, she had similar symptoms and was treated with endoscopy and esophageal balloon dilation, which was complicated by a stroke resulting in left-sided weakness. No clear cause of the stroke was found at that time. Eventually her weakness improved with physical and occupational therapy.\nDuring this admission, a conventional video-endoscopy was performed
8,663	71,682	these findings, the composition of the preparation was modified, and a PTS combination of herbal medicines was introduced instead of StPT. Shortly, after introducing PTS and increasing dexamethasone doses, the patient felt an improvement that mainly manifested by a higher mobility of the limbs. The control NMRI from 21 May 2013 (Fig. ) showed a reduction of the tumor from 60 to 50 mm, and the scan from 01 October 2014 showed that the tumor radius was 45 mm (Fig. ). Further	and treatment with corticosteroids was urgently introduced. A daily dose of dexamethasone of 8 mg/day was introduced, and it was quickly raised to 16 mg/day. MRI imaging of 22 February 2013 showed the progression of the tumor, whose radius was 60 mm and which was surrounded by a large perifocal edema that was completely compressing the right lateral cerebral ventricle (Fig. ). Following	6 MW. A therapeutic dose of 46 Gy was administered in 23 fractions, followed by radiation of the tumor base with a therapeutic dose of 8 Gy in 4 fractions. With this, the oncological treatment was completed. In August 2012, the patient’s condition deteriorated. At an emergency MRI imaging on 23 August 2012, the progression
16,326	60,097	when the MT stopped playing or changed instruments, he also focused on what the MT asked him to do and did himself. He was able to remember as he could repeat his MT’s name and play the instruments; if he could not play a given instrument, he had the capacity to learn. Creative behaviour was observed. For example, if he dropped the drumstick, he continued playing with his hand.\nHis mother said that she had seen a great change in her son A. since he had started going to the Music Therapy	and played the drum, for example, he did not move his legs. Both verbal and non-verbal communication (sounds) increased when he was stimulated through songs and sounds. At the social-emotional level, positive emotions were strongly expressed and he smiled when he played. Cognitively, his attention was focused on each instrument, and	a month the mother refers that he goes to energy-based therapies, like energetic kinesiology which focuses on the energetic processes in the body.\nThis section analyses the calculations related to the variables observed in A.’s seven sessions through the registration template. This was later converted into means and deviations, resulting in the findings shown in Fig. . As can be seen, there is a slight clinical improvement in all the post-evaluation carried out, including physical, communication, social, emotional and cognitive variables.\nThe researcher’s qualitative observations for the physical, communicative, emotional and cognitive dimensions are described below. A.
7,910	135,722	The implants and the implant prosthesis were removed under local anesthetic using gauze and hemostats. Given the substantial bone loss, multiple grafting procedures were planned and the same was discussed with the patient. The autogenous iliac grafting was performed first. After 9 months of healing, radiographic evaluation was carried out to document the vertical and horizontal bone gain. In the second grafting procedure, a 20 mm × 20 mm titanium mesh was fixed with 6- and 8-mm bone screws on the buccal and lingual sides of the ridge with a 0.5 cc of Geistlich Bio-Oss (Geistlich Pharma, Wolhusen, Switzerland) bovine bone, 0.5 cc Puros cortical particulate allograft (Zimmer	Biomet Dental, Palm Beach Gardens, FL, USA) and a small amount of recombinant human bone morphogenetic protein-2 combined with an absorbable collagen sponge (INFUSE Bone Graft, Medtronic Sofamor Danek, Memphis, TN, USA). After 1 year of healing, radiographic evaluations were done [], and the titanium mesh was surgically removed. At this stage, alginate impressions were obtained for both arches, and a diagnostic wax-up was achieved to evaluate the prosthetic space. The radiographic template was fabricated, and a cone-beam computed tomography scan	grafting procedures were planned and the same was discussed with the patient. The autogenous iliac grafting was performed first. After 9 months of healing, radiographic evaluation was carried out to document the vertical and horizontal bone gain. In the second grafting procedure, a 20 mm × 20 mm titanium mesh was fixed with 6- and 8-mm bone screws on the buccal and lingual sides of the ridge with a 0.5 cc of Geistlich Bio-Oss (Geistlich Pharma, Wolhusen, Switzerland) bovine bone, 0.5 cc Puros cortical particulate allograft (Zimmer Biomet Dental, Palm Beach Gardens, FL, USA) and a small
43,975	97,719	right lower abdominal pain. His past history included prostate carcinoma with bone metastasis at 60 years of age, and type 2 diabetes mellitus diagnosed at 62 years of age with poor control of the hemoglobin A1c (HbA1c) level measuring 8.0%. Family history revealed that his siblings had type 2 diabetes mellitus and his uncle had gastric cancer. He had a personal history of social alcohol drinking of less than	and type 2 diabetes mellitus diagnosed at 62 years of age with poor control of the hemoglobin A1c (HbA1c)	by abdominal sonography, CT, or magnetic resonance imaging, a diagnosis of ectopic HCC was determined. Additional laboratory tests showed an elevated serum AFP level and PIVKA-II level, and liver biopsy revealed slight inflammatory infiltrates in the portal area with mild to moderate fibrosis and slight fatty change in liver cells.\nThe patient received 400 mg of sorafenib per day for ectopic HCC. Two months later, CT imaging showed a significant increase in the tumor size, and blood tests showed increased levels of serum AFP and
11,722	73,838	Caucasian male patient aged 34 without an irrelevant past medical history that presented with unexplained weight loss. Imaging studies revealed the presence of a left renal mass of 10 × 12 cm (Fig. ). The patient underwent a left radical nephrectomy and the pathology was consistent with an EAML (Fig. ) with poor prognosis features (size > 7 cm, vascular and renal sinus invasion, necrosis, and severe atypia). Immunohistochemical profile revealed diffuse and intense expression of HMB-45 and Melan A (Fig. ), along with expression of smooth muscle actin and CD68 (KP-1, Ventana), and negativity for CD-31, CEA, CK-pan, desmin, EMA, Ki-67,	myogenin and S-100. After nephrectomy the patient did not receive adjuvant therapy and started follow up in urology clinics. Seven months after primary surgery the patient developed 3 liver metastases (two in segment VIII of 6 cm and 1.5 cm, respectively, and one in segment IV of 2 cm). All these lesions were completely resected through a right partial hepatectomy with extension to segment IV through a split in situ technique. Again,	liver metastasis and the blood were successfully sequenced by NGS, with a mean coverage of 184× and 1643×, respectively, and single nucleotide variants and indels were identified. One TSC2 variant resulting in a premature stop codon (c.2739dup; p.K914*) was found in heterozygosity in the metastasis while it was absent in blood (Fig. ). Sanger sequencing validated this finding, and detected the TSC2 mutation also in the primary tumor (Fig. ). IHC revealed absence of TSC2 expression in the liver metastasis (Fig. ), in agreement with
32,338	77,437	contouring workstation for TomoTherapy Hi · Art System®. Set up was based on fiducial markers and tattoo aligned with a room laser system before treatment.\nThe gross target volume (GTV) was considered as right gluteal region outlined based on the depth of involvement and the extent of disease. Clinical target volume (CTV) was created adding a margin of 3 mm at GTV. Doses to organs at risk (rectum, bladder, right and left femur, right and left kidney, pubis, bowel) were defined in accordance with dose	(CTV) was created adding a margin of 3 mm at GTV. Doses to organs at risk (rectum, bladder, right and left femur, right and left	for contouring, a new treatment plan was elaborated at 30 Gy according with volumetric reduction of lesion. The time of delivery (around 10 minutes for fractions) were well tolerated by the patients. At the end of the combined radio target therapy, Cetuximab treatment continued for the following 10 months.The patient achieved complete response, confirmed at imaging evaluation, and
19,159	36,363	male with uncontrolled type 2 diabetes mellitus was admitted to a community hospital with sudden onset of pain in his left thigh associated with swelling. His past medical history included stage IV chronic kidney disease, background retinopathy, peripheral vascular disease requiring below the knee amputation of his left lower extremity, severe peripheral neuropathy, uncontrolled hypertension, and a prior history of tobacco use.\nHe denied any trauma or administering insulin injections into his left thigh. He was noted to have an elevated creatine kinase of 1670 U/L (reference range, 32–294) and found to be severely anemic requiring transfusion with 4 units of packed red blood cells (PRBC). CKMB and troponin	levels were 0.31 ng/mL (reference range, 0–5 ng/mL) and 0.02 ng/mL (reference range, 0–012 ng/mL), respectively. EKG demonstrated normal sinus rhythm	male with uncontrolled type 2 diabetes mellitus was admitted to a community hospital with sudden onset of pain in his left thigh associated with swelling. His past medical history included stage IV chronic kidney disease, background retinopathy, peripheral vascular disease requiring below the knee amputation of his left lower extremity, severe peripheral neuropathy, uncontrolled hypertension, and a prior history of tobacco use.\nHe denied any trauma or administering insulin injections into his left thigh. He was noted to have an elevated creatine kinase of 1670 U/L (reference range, 32–294) and found to be severely anemic requiring transfusion with 4 units of packed red blood cells (PRBC). CKMB and troponin levels were 0.31 ng/mL (reference range, 0–5 ng/mL) and
90	117,267	the fascia on the left side of the abdomen. The perforator vessel passing through the right rectus sheath, which had been confirmed by color Doppler ultrasound on the day before surgery, was secured and dissected to the right deep inferior epigastric vessels. As the shunt tube was placed on the left side, we prepared the pedicle of the DIEP flap on the right side. Although we could have	on the left side of the abdomen. The perforator vessel passing through the right rectus sheath, which had been confirmed by color Doppler ultrasound on the day before surgery, was secured and	for immediate breast reconstruction. She had a history of subarachnoid hemorrhage and a lumbar peritoneal shunt tube had been implanted in her abdomen to treat hydrocephalus. She had no other obvious sequelae from the subarachnoid hemorrhage and her medical condition was quite stable with the shunt. Her breasts were large and drooping (), and left nipple areola sparing mastectomy was scheduled. A preoperative computed tomography scan showed the shunt tube, which pierced the intervertebral lumbar and traveled through the subcutaneous layer of the left trunk () and entered into the
22,420	85,419	posterior capsule was removed and the remainder of the anterior rim of the cup was exposed. Tissue samples were sent for frozen section.\nThe top of the fractured femoral stem was then located (). The soft tissues were removed from the area of the greater trochanter and the cement around the posterior shoulder and around the collar of the prosthesis was removed. A carbide punch was used to drive the prosthesis out of the cement mantle. Examination of the cement mantle after removal of the prosthesis showed a small crack proximally which was suspected	tissues were dissected, and the plane beneath the tensor fascia lata was elevated. The sciatic nerve was identified and noted to be in its normal position. The short external rotators were scarred and adhered to the joint capsule. This layer was dissected as a full thickness flap. The quadratus femoris muscle appeared healthy distally. The capsule was then incised, revealing a small amount of serous fluid within the joint. The	in her knee and underwent exchange arthroplasty later that same year. Only the total knee implant had been affected and revised, whereas the total hip implant was unaffected. The patient subsequently underwent successful rehabilitation and had been an independent community ambulator thereafter.\nUpon presentation, the patient denied shortness of breath, chest pain, fevers, chills, night sweats, or recent travel. Five month prior to presentation, the patient had dental work with appropriate antibiotic prophylaxis. The critical event most likely occurred several days prior to presentation when the patient slipped and fell in
8,752	93,052	transferred to a medical emergency department with marked dyspnoeic symptoms and tachycardia, where an acute coronary syndrome was diagnosed. After laboratory testing and an electrocardiogram a non-ST elevation myocardial infarction (NSTEMI) was diagnosed. The following coronary angiography (an intervention that was endured by the patient with enormous dread), revealed severe three-vessel disease.\nThe patient was informed of the urgent indication of a bypass operation, which was planned as an emergency intervention on the same day. At the end of the	angiographic intervention, this information caused a severe panic reaction with hyperventilation, tachycardia and the feeling of loss of control, which was successfully treated with benzodiazepines. He described an intensely irrational and unavoidable fear of putting himself in the hands of	years. With regard to childhood and adolescence, he described fear symptoms while knocking on or opening 'foreign' doors. Though the patient showed avoidant personality traits, no personality disorder could be diagnosed.\nThe psychopathological findings at the time of psychiatric exploration were limited to intense fear in relation to the forthcoming surgical procedures and interventions. During the psychiatric exploration, the patient was polite, friendly, and honest. Compulsive symptoms were limited to the repeated checking of electric appliances. As a consequence of his lifelong avoidance strategies he seemed not to feel
8,313	107,979	proteins 100mg/dl and a white cell count of 10. MRI brain and spine was also done which shows re-demonstration of atrophic left hippocampus with abnormal T2 and Flair hyperintense signals due to mesial temporal sclerosis ( and ). Levels of anti-ganglioside antibodies were: Anti-GD1b 198, Anti-GD1a 175, Anti-GM1 154, Anti-GM2 41 and Anti-GQ1b <30. Reference range for all these antibody is less than 30. Since the antibody tests were strongly positive electrophysiological studies were not	36.9°c. On neurologic examination he had ophthalmoplegia, finger to nose dysmetria, dysdiadochokinesia, abnormal heel to shin test, generalized areflexia and difficulty in standing and needed full support to stand up. The rest of the neurologic examination was unchanged from his baseline examination. The patient underwent a lumbar puncture and a CSF analysis showed	this case because all measures to prevent aspiration were taken including a semi-recumbent position, surveillance of enteric feeding and use of promotility drugs. Diagnosis of VAP was made based on the development of pneumonia that occurred more than 48 hours after he was intubated and mechanically ventilated. He improved clinically so he was extubated. He stayed in ICU for 5 days and then was transferred back to a ward. He again became febrile and hypotensive on the second day
37,279	170,198	clumsiness. He had wrist drop and was unable to grip with the fingers. He complained of no sensory loss or numbness. His past medical history included long-term oral anticoagulation due to recurrent lower extremity deep vein thrombosis, glaucoma, and a non-significant aortic valve stenosis, with vascular risk factors including a 5-year history of treated hypertension, hypercholesterolemia, and a history of non-significant stenosis of the left	anterior descendent coronary artery. On admission, no abnormality could be detected by physical examination, apart from the neurological signs, which included a wrist drop on the left side with decreased grip strength (Fig. ). Pronation and wrist dorsiflection were lost, as	upper extremity were slightly brisk, with not pathological reflexes present and no sensory deficits. Laboratory parameters were without abnormal findings except for a slightly elevated fasting blood glucose level. Cranial CT revealed contrast-enhancing, irregularly shaped lesions with diameters of 7, 10, and 9 mm (in the temporal, parietal, and frontal
20,493	10,922	bulb and could easily be traversed with a 5.8 mm upper slim scope (Figure ).\nThe patient's clinical condition was tenuous, and it was felt that he would likely not be able to tolerate a major surgical intervention such as a Billroth II reconstruction since he was deemed to be an ASA class 4	ulcer. The perforation was measured at about 1.5 cm in size. An 18 French drain with low active pressure (suction) was left in the abdominal cavity. Postoperatively, there was a persistent leakage of about 1000 mL per day. On the ninth postoperative day, he underwent an upper endoscopy. The perforation was visualized in the duodenal	The abdominal drain was removed 10 days after the stent placement. A subsequent CT scan with oral contrast performed 3 weeks after the stent placement showed no leakage into the abdominal cavity (Figure ). The stent was easily removed after 28 days using gastroscopy with a mild form of anesthesia. The position of the stent was unchanged when it was removed after 4 weeks, which we believe is a sufficient time for the perforation to heal. The patient was discharged from our hospital 2 weeks later with a prescription for oral pantoprazole 20 mg two
2,043	152,603	blood decreased with rest, but massive hemoptysis occurred on day 16. Despite bronchial artery embolization, a second massive hemoptysis occurred and the patient died on day 21. The final day of voriconazole administration was day 20.\nAt autopsy, the pulmonary bullae were filled with blood. A macroscopic examination showed a hole in the aortic wall into the bullae (). This hole was unlikely to have been a consequence of the autopsy procedure because a microscopic examination of the tissue around the hole showed extensive accumulation of inflammatory cells (a–c). This microscopic examination also revealed small fungal lesions in the pulmonary bullae adjacent to the aortic	wall (a–c). The diameters of these lesions were approximately 4 mm. The fungal hyphae were	our hospital for hemoptysis in July 2011 (day 0). Before admission, pulmonary emphysema and multiple pulmonary bullae were detected on a chest computed tomography (CT) scan, and we also discovered that the patient had hypertension. He had a history of lobectomy of the left lower lobe for lung cancer in 1993, with no recurrence; two episodes of bacterial pneumonia; gastrectomy for gastric cancer in August 2010; right spontaneous pneumothorax that required tube drainage in November 2010; and hospitalization for dyspnea in February 2011, at which time chest radiographs showed left lung opacity and a chest CT scan showed consolidation
24,265	53,720	cm; weight, 56 kg; body mass index, BMI 23.0). The patient was a clerical worker who complained of working in a sitting position for a long time (6 h) a day, four times a week. The patient was informed that data from the case would be submitted for publication, and she gave her consent for publication of this report.\nThe patient was diagnosed with low back pain (LBP) and sciatica (lumbar disc herniation was not observed on magnetic resonance imaging). The patient experienced moderate dull pain from the right lower back to the hip and severe radiating pain in the right lower extremity of the lateral side for a	week before her visit to the clinic (- day 7). In addition to the two types of pain, the patient also experienced numbness in the lower extremities. The chief complaint was radiating pain and insufficient sleep due to numbness; thus, the patient hoped that the pain would be relieved and she could sleep well. Another	times per week. Furthermore, the patient was instructed to increase physical activity as much as possible to prevent pain catastrophizing and fear-avoidance beliefs by disuse and enhancement of the descending pain inhibitory system [].\nThe results of all assessments are shown in . A remarkable point about the pain was that there was an incongruency between each dimension of pain. By day 15, symptoms of sciatica disappeared according to the orthopedic tests (i.e., SLR test and Bragard test), and the severity of the S–D dimension in the MPQ, and the degree of dull pain, radiating