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31,160 | 23,782 | success rate and longevity, and a conventional prosthesis would not maintain the amount and quality of the bone in long-term. Furthermore, the slow mesial movement of the posterior teeth would have a beneficial effect over the bone graft on that region.\nThe treatment began at 10-years old with the installation of a quadrihelix appliance in the maxillary arch for slow expansion of the maxilla, with activation once a month, for 8 months. After expansion, the device | of a quadrihelix appliance in the maxillary arch for slow expansion of the maxilla, with activation once a month, for 8 months. After expansion, | disadvantage would be bone graft condition and the aesthetic and functional result of the rehabilitation, because an implant would have doubtful success rate and longevity, and a conventional prosthesis would not maintain the amount and quality of the bone in long-term. Furthermore, the slow mesial movement of the posterior teeth would have a beneficial effect over the bone graft on that region.\nThe treatment began at 10-years old with the installation of a quadrihelix appliance in the maxillary arch for slow expansion of the maxilla, with activation once a month, for 8 months. After expansion, the device was kept in position for another 12 months and during |
39,033 | 149,412 | tibial nerves. Temporal dispersion was not encountered in any of the studied nerves. Sensory nerve conduction studies revealed decreased Sensory nerve action potential (SNAP) amplitudes in both median and ulnar nerves while sural and superficial peroneal SNAPs, on both sides, were not recordable. However, dorsal ulnar cutaneous SNAPs were normally recorded. Needle Electromyography (EMG) revealed changes of chronic denervation in extensor digitorum brevis, and first dorsal interosseous, bilaterally. Grade one fibrillations were recorded from right Tibialis anterior and left Flexor digitorum sublimus. EMG of quadriceps, medial gastrocnemius, brachioradialis, pronator teres, biceps, deltoid, on both sides, was normal. The pattern evoked VEP revealed prolonged P100 latency (left: 137 ms; right: 144 ms.; normal, ≤104.5 ms) [Figure and | high.\nNerve conduction studies [] revealed prolonged distal latency in both common peroneal (CP) and posterior tibial (PT) nerves, decreased CMAP amplitude of left CP, and both PT nerves, and partial conduction block [distal/proximal amplitudes and % drop; Right CP: 6.7/3.2 mV (52.2%); Left PT: 3.0/1.5 mV (50.0%)] in right common peroneal and left posterior tibial nerves. There was slow conduction in both common peroneal and posterior tibial nerves. The F wave was prolonged in both lower limb nerves along with chronodispersion of 6. 7 ms [normal ≤6 ms], in bilateral posterior | working in the screen-printing industry for the last 4 years, presented with complaints of numbness in both feet and impaired ground sensations in both feet for one and a half years. Within 9 months of the onset, the numbness progressed up to the knees. After another 3 months, he developed numbness in both hands up to the wrist. For about a month prior to presentation, he started experiencing dizziness, diplopia on looking towards both side, and oscillopsia. He also had |
40,423 | 45,189 | polymer ligating clips. We extracted the resected specimen from the first trocar extending the skin incision to 30 mm using a 15 mm endocatch bag. The specimen weighed 576 g.\nThe total operative time was 262 minutes. Circumferential dissection of the left kidney in the right flank position took 129 minutes and resection of the distal ureter and removal of the specimen in a head-down position took 83 minutes. The total pneumoperitoneum time was 212 minutes. The estimated blood loss was minimal. The urine volume sucked from the inserted ureteral catheter was 900 mL.\nOperative and pathological findings showed that the kidney | to 30 mm using a 15 mm endocatch bag. The specimen weighed 576 g.\nThe total operative time was 262 minutes. Circumferential dissection of the left kidney in | nephroureterectomy was performed by an intraperitoneal approach. Prior to the laparoscopic procedure, an open-ended 6Fr left ureteral stent was placed. During surgery, the patient was initially positioned in the right flank position and four trocars were placed. The pneumoperitoneum pressure was 10 mmHg. The first 12 mm trocar (A: camera port) was inserted in the umbilicus. The second 12 mm trocar (B) was located in the anterior axillary line above the ilial crest. The third 5 mm trocar (C) was located in the midclavicular line on the left. The fourth 5 mm trocar (D) |
14,887 | 23,280 | nucleus, and prominent nucleolus (, panel F3). Both components were closely related to the smooth muscle fascicles of the bladder wall. Immunohistochemical analysis revealed diffuse strong S100 positivity in the plexiform neurofibroma, whereas ganglion-like cells were positive for synaptophysin and neuron specific enolase (NSE). Epithelial membrane antigen- (EMA-) positive perineurial cells were present around the neurofibromatous fascicles.\nTwo months after surgery, our patient still had high levels of Ct (52 ng/L), normal calcium levels on calcitriol therapy 0.25 μg/die (calcium 9.5 mg/dl; normal range: 8.6–10.2 mg/dl), normal PTH values (21 ng/L; normal range: 8–40 ng/L), and better values of both B-ALP and osteocalcin (75 μg/L and | specific enolase (NSE). Epithelial membrane antigen- (EMA-) positive perineurial cells were present around the neurofibromatous fascicles.\nTwo months after surgery, our patient still had high levels of Ct (52 ng/L), normal calcium levels on calcitriol therapy 0.25 μg/die (calcium 9.5 | only microfoci detected by neck ultrasound. A strong positive immunoreactivity to anticalcitonin (, panel A2) and negative immunoreactivity to antithyroglobulin (, panel A3) antibodies of the MTC tissue were shown. The largest microfocus of the tumor invaded the perithyroid soft tissue (, panels B and B1), and extensive neoplastic lymphangiosis and vascular embolization (, panel C) were present. In the perithyroid soft tissue, numerous neoplastic vascular emboli and tumoral deposits infiltrating an adjacent ganglioneuromatosis lesion were found (, panels B and B1). Multiple central compartment (5/10) and left laterocervical (5/32) lymph nodes that were removed were confirmed |
14,823 | 160,482 | for periodic monthly follow up for 4 month and 3 month follow up for next 2 years. At every recall, the teeth were clinically evaluated for vitality using an electric pulp tester (Digitest, Parkell, Farmingdale, NY, USA), thermal response to cold, pocket depth, percussion, mobility and occlusion, and periapical status with radiographs. After the | for periodic monthly follow up for 4 month and 3 month follow up for next 2 years. At every recall, the teeth were clinically evaluated for vitality | the upper lip. Horizontal fracture lines were radiographically evident between the middle third and the cervical third of the maxillary central incisors ().\nOtherwise, the status of the traumatized teeth was within normal limits in terms of periodontal pocket, vitality on thermal and electrical test. For the management of soft tissue injuries, analgesic (Ibuprofen 400 mg) and antibiotic (amoxicillin 500 mg) were prescribed to take 3 times a day for the period of 3 adjustment of the opposing mandibular incisors was carried out to eliminate interference on the traumatized incisors in maximum intercuspation. The patient was advised to have a |
22,321 | 19,575 | lower canaliculus without destruction. Probing was done and showed patent nasolacrimal duct, and mini Monoka stent was inserted through the right lower punctum, and the wall of the distended lower canaliculus was trimmed off and sutured over it. Inspection of the excised lesion was suggestive of cavernous hemangioma and the specimen was sent for histopathological examination. The patient tolerated the procedure well and was discharged the following day on topical medications (c). He shared the decision for the | of the distended lower canaliculus was trimmed off and sutured over it. Inspection of the excised lesion was suggestive of cavernous hemangioma and the specimen was sent for histopathological examination. The patient tolerated the | measured 2 × 1.8 × 0.4 cm. Cross sectioning revealed a solid and pale cut surface. Histopathologically, the conjunctival epithelium was thin and shows metaplasia with loss of goblet cells. The substantia propria showed diffuse infiltration mostly by mature neoplastic grade 1 cells resembling normal plasma cells with rare mitotic figures and few immature, binucleated and giant plasma cells (d). Immunohistochemical staining was done and showed expression of antibodies to CD38, CD 79a, CD138, and restricted kappa light chain (g). The tumor cells were negative for lambda light chain staining, and did not express the following markers: IgG4, CD3, CD56 and CD20. This concluded the diagnosis of a conjunctival plasmacytoma.\nMM |
38,129 | 146,321 | sensory and cerebellar examination were normal except for activated rigidity in the left upper limb at wrist joint and a reduced blink rate (10/minute). On the basis of history and clinical examination and presence of K-F ring, a diagnosis of isolated tongue involvement as a result of Wilson's disease was entertained.\nHemogram revealed hemoglobin concentration of 12.7 gm%. The white blood cell count was 3600 cells/cu.mm (neutrophil 50%, lymphocytes 39%, eosinophils 4% and monocytes 7%) and platelets count was 88,000/mm3. The serum electrolytes and kidney function tests were normal. Serum bilirubin (total) was 0.6 mg% (direct fraction 0.2 mg) and serum proteins were 6 gm% (with a serum albumin of 3.4 gm%), serum levels of AST, ALT and | normal. Serum bilirubin (total) was 0.6 mg% (direct fraction 0.2 mg) and serum proteins were 6 gm% (with a serum albumin of 3.4 gm%), serum levels of AST, ALT and | mental functions but Myerson's sign was positive. A Kayser-Fleischer ring (KF ring) was present in both the eyes [] and the cranial nerve examination (other than twelfth nerve) was normal. Tongue was normal in size without any evidence of atrophy or fasciculations but tone was increased on palpation []. All the movements of tongue including protrusion and side to side lateral movements were limited; and |
43,793 | 58,501 | Biosystems, Wetzlar, Germany). Histology showed that the gastric intramural lesion was ectopic pancreas measuring 35 × 25 × 17 mm which was located mainly in the proper muscular and subserosal layers (Fig. a, b). The lesion contained all the components of ducts, acini and islets of Langerhans (Heinrich type I), although the acini and islets were rare components (data not shown). IHC | Histology showed that the gastric intramural lesion was ectopic pancreas measuring 35 × 25 × 17 mm which was located mainly in the proper muscular and subserosal layers (Fig. a, b). The lesion contained all the components of ducts, acini and islets of Langerhans (Heinrich type I), although the | Tissues were embedded in paraffin and 3-μm-thick sections were cut. The sections were used for hematoxylin and eosin staining and IHC by detection system of BOND Polymer Refine Detection (Leica Biosystems, Wetzlar, Germany). Histology showed that the gastric intramural lesion was ectopic pancreas measuring 35 × 25 × 17 mm which was located mainly in the proper muscular and subserosal layers (Fig. a, b). The lesion contained all the components of ducts, acini and islets of Langerhans (Heinrich type I), although the acini and |
30,474 | 786 | deficiency. A trial vitamin supplement (500 mg administered intravenously three times a day and 1000 μg of cyanocobalamin administered intramuscularly daily) was given based on his alcohol abuse history, but no symptom improvements were seen during the following week. An inherited condition was thus suspected given the negative workup, the non-response to treatment, and the symmetric involvement in the brain MRI. This suspicion was validated by his peroxisomal fatty acid profile (Table ), and a diagnosis of X-ALD was confirmed according to the identification of a pathogenic mutation in the ABCD1 gene: c.1489 2A>G (g.153005544). Adrenocortical insufficiency | vitamin supplement (500 mg administered intravenously three times a day and 1000 μg of cyanocobalamin administered intramuscularly daily) was given based on his alcohol abuse history, but no symptom improvements were seen during | demyelinating white matter disease due to nutritional deficiency. A trial vitamin supplement (500 mg administered intravenously three times a day and 1000 μg of cyanocobalamin administered intramuscularly daily) was given based on his alcohol abuse history, but no symptom improvements were seen during the following week. An inherited condition was thus suspected given the negative workup, the non-response to treatment, and the symmetric involvement in the brain MRI. This suspicion was validated by his peroxisomal fatty acid profile (Table ), and a diagnosis of X-ALD was confirmed according to the identification of a pathogenic mutation in the ABCD1 gene: c.1489 2A>G |
21,252 | 37,297 | resection of the shoulder joint was performed, followed by total humerus placement on July 3, 2002. The humerus was entirely resected including parts of the deltoid and triceps brachii muscles and cuff, whereas the long head of the biceps brachii muscle, musculocutaneous nerve, and other neurovascular bundles were conserved. In reconstruction of the cuff, an artificial ligament | the long head of the biceps brachii muscle, musculocutaneous nerve, and other neurovascular bundles were conserved. In reconstruction of the | complaint of right upper arm pain. His past medical and familial histories were unremarkable. On February 5, 2002, severe pain occurred in the right upper arm while exercising with an iron bar, and he visited a physician. The patient was referred and admitted to our department for suspected pathological fracture associated with a metastatic bone tumor on February 20. Swelling and local heat were present in the proximal region of the right forearm, and tenderness and pain during motion were also present. No spontaneous pain was observed. The range of motion of the right shoulder joint could not be measured because of pain. On admission, alkalinephosphatase, at 442 and C-reactive |
6,532 | 94,683 | third metatarsal bone is intact.\nThe total-body bone scintigraphy showed high uptake of TC-99M in the left third toe and was suggestive of osteomyelitis. There were no other hotspots.\nThe clinical diagnosis was set at osteomyelitis and the patient was surgically treated as such. In august 2008 the proximal phalanx of the left third toe was surgically removed. Macroscopically there was a large mass in the surrounding soft tissue with calcifications. The findings were highly suggestive for a malignancy. Due do the initial diagnosis of osteomyelitis the surgical margins were intralesional.\nHistological examination | no other hotspots.\nThe clinical diagnosis was set at osteomyelitis and the patient was surgically treated as such. In august 2008 the proximal phalanx of the left third toe was surgically removed. Macroscopically there was a large mass in the surrounding soft tissue with calcifications. The findings were highly suggestive for a malignancy. Due do the initial diagnosis of osteomyelitis the surgical margins were intralesional.\nHistological | male presented with pain, swelling and redness in his left third toe. Radiological findings showed a pathological fracture of the proximal phalanx of the third toe on the basis of an intra-osseous lesion with a spotted and sclerotic aspect. An MRI was made showing a clear abnormality of the proximal phalanx of the third toe with oedema of the bone marrow and minimal reaction in the adjacent soft tissue. There was no extra-cortical expansion. Osteomyelitis or Ewing's sarcoma could not be excluded. (Fig. )\nIn January 2001 a biopsy was performed. |
12,651 | 50,610 | narrowing which improved with intra-arterial verapamil. DSE findings were suggestive of severe global hypokinesis (Video , Video ) and transthoracic echocardiogram (TTE) showed resolution of apical hypokinesis (Video ).\nThe patient was evaluated by Neurology and Neurosurgery and a decision was made to treat conservatively since there were no significant neurological symptoms and there was no aneurysm, arterio-venous malformation (AVM), or active bleed during cerebral angiography. Also, the distal LMCA branches showed some narrowing which improved with intra-arterial verapamil suggestive of reversible cerebral vascular syndrome (RCVS).\nThe | multifocal bilateral SAH, left frontal and right parieto-occipital ICH without midline shift. She was admitted to intensive care for ICH management. Her chest X-ray showed significant pulmonary edema (Figure ).\nNon-contrast CT head revealed acute multifocal bilateral SAH and left frontal and right parieto-occipital ICH without midline shift (Figure ).\nCT angiogram of head and neck followed by catheter-guided cerebral angiography showed no aneurysm, arteriovenous malformation (AVM); distal left middle cerebral artery (LMCA) branches showed some | than what she had in the days before the test. She also started to complain of severe dyspnea with increased oxygen requirement of up to 5 liters per nasal cannula. The patient was |
27,931 | 169,832 | 44-year-old woman with no remarkable family history was admitted to our hospital with the following medical history: after undergoing modified radical mastectomy for cancer of the right breast (papillotubular carcinoma, T3N1M0) in March 2009 at another hospital, the patient received postoperative chemotherapy (4 courses of docetaxel+trastuzumab followed by 14 courses of trastuzumab). However, in March 2011, local excision was performed because of a recurrence that appeared at the site of the | surgery, and adjuvant chemotherapy was administered. No relapses were observed thereafter.\nWhen the patient was admitted to our hospital, the patient was of moderate build, was well nourished, had no yellowing of the bulbar conjunctiva, had no conjunctival pallor, and displayed no unusual finding in the heart or lungs. The abdomen was flat; the liver and spleen were not palpable. No remarkable finding was observed. An | lymph node metastasis was observed (Fig. ). Immunohistological staining revealed that hormone receptors were negative, with estrogen receptors (ERs) at ≤1% and progesterone receptors (PgRs) at ≤1%. The HER2 score was 1+ but is only a reference value.\nBased on the above findings, the final diagnosis was cancer of the |
28,632 | 49,001 | revealed elevated protein level 0.82 g/L (normal 0.15–0.45 g/L), increased white cell count 76 × 106/L (normal <5 × 106/L), and a composition that was 77.8% lymphocyte with normal glucose and chloride. CSF cultures and tests for infection, NMOSD including anti-aquaporin-4(AQP4) antibody and anti-myelin oligodendrocyte glycoprotein (MOG) antibody, MS (oligoclonal bands), autoimmune encephalitis, and paraneoplastic antibodies were all negative.\nA series of brain MRIs revealed small and scattered lesions distributed in the pons, presenting hypointensity | on T1-weighted, hyperintensity on T2-weighted images, high signals on the diffusion-weighted image (DWI), and slim contrast enhancement after Gd-DTPA injection (). Furthermore, the flow cytometry immunophenotype showed a normal percentage of CD3+ total T lymphocyte of 68.3% (normal 59.4–84.6%), | to 200 mg per day for maintenance (about 3 mg/kg/day), which is adequate for recommended dosage of azathioprine 2–3 mg/kg/day in NBD (). A total of 9 months later, the patient barely tolerated the side effects of prednisone and quickly withdrew after 1 month. |
24,366 | 43,396 | A 45-year-old male was found to have duodenal tumor by physical examination in Aug 2008. He was treated with partial duodenal resection together with tumor on Aug 19th, 2008 in a local hospital (Haining County People’s Hospital, Zhejiang Province). The tumor was 6 cm × 4 cm × 3 cm in size. Microscopical examination found non-mitotic, spindle cells with intersecting growth pattern. The tumor cells were positive for CD117 and CD34, but negative for α-SMA, desmin and S-100 by immunohistochemistry. He was diagnosed as GIST and classified into moderate risk level. The patient was not treated with any adjuvant therapy after the operation. Twelve months later, a solitary | and localized abdominal tumor with 4 cm in diameter was detected in the left upper abdominal cavity in routine CT scanning. The patient was reluctant to treatment. Six months later, the tumor was increased to 8 cm. He was initially treated with imatinib (400 mg daily) on Mar 28th, 2010 since the first clinical impression | mesenteric veins and adjacent to jejunum and colon, the ureter was also entrapped in it (Figures and ). Angiography showed a hypovascular tumor encroaching on superior mesenteric artery and vein, and their branches. Urography found the tumor obstructing the upper part of the left ureter, causing left side hydronephrosis. Furthermore, the primary duodenal GIST (Figure ) was reevaluated as borderline nature and no KIT and PDGFRA mutation was found in the tumor. Therefore, a MDT decision was made to resect the lesion surgically. Prior to surgery, detailed examinations were performed. On Nov. 11th, |
26,674 | 61,229 | girl born via normal vaginal delivery with no significant perinatal history developed increasing dyspnea, hoarseness, cyanosis with feeding, and lethargy. She was treated for respiratory syncytial virus (RSV) pneumonia and required supplemental oxygen and parenteral feeding. The feeding with cyanosis persisted after five days, prompting a visit to our hospital for a second opinion. Upon arrival, the patient had an oxygen saturation of 89% on room air and was admitted to the ward for further management. The oxygen saturation improved to 100% with supplemental oxygen. She was alert with no audible stridor at rest but had mild subcostal retractions. The heart and breath sounds were normal. Otolaryngology was consulted and bedside nasoendoscopy | reviewed a left vocal fold paralysis. The right vocal fold was mobile and the glottic gap was three millimeters. The remainder of the scope findings was normal. There were no palpable neck masses, and thorough examination of the ears and oral cavity was normal as well. Chest X-ray showed mild air space consolidation at the right perihilar region and possibly the left retrocardiac region, likely related to underlying pneumonia. The patient was treated presumably for aspiration pneumonia and was weaned off supplemental oxygen after a few days.\nTo evaluate the unilateral vocal fold paralysis, a magnetic resonance imaging | extension into the left parapharyngeal space and further extension superiorly into the skull base. Bilateral multiple enlarged enhancing cervical lymphadenopathy was also present, suggestive of metastasis. The tumor was staged as Stage 2B (International Neuroblastoma Staging System), and the patient was commenced on chemotherapy in view of progressive disease. The patient completed three cycles of OJEC, vincristine [O], carboplatin [J], etoposide [E], cyclophosphamide [C], and one cycle of OJE by six months of age. Post-chemotherapy scans showed a reduction in the size of the tumor. One year after treatment, the tumor has remained stable in size, |
6,609 | 120,395 | A 53-year-old man was referred to the oral surgery clinic affiliated to Isfahan University of Medical Sciences complaining of painful exposed oral lesion and bone extraction from right lower jaw in the mouth. He has declined any surgical or other dentistry procedure on his mouth recently. In his medical history, RCC with lung metastasis has been a diagnosis for | him in March 2016, and he underwent a left total nephrectomy on April 2016. For the previous 5 months, he has been treated with cycles of 50 | the left hemimandible [] on the contralateral side. The panoramic radiograph [] showed irregular sclerotic bone at these regions, and the fusion of computerized tomography (CT) scans and bone scans demonstrated locally elevated nucleotide activity there. Axial CT scan showed a single osteonecrotic process involving the mandible, associated with increased bone marrow density and initial signs of bone sequestration and |
21,062 | 62,325 | tests, and serum electrolytes were all unremarkable. A normal male karyotype of 46 XY was confirmed in chromosomal analysis. The result of bone age evaluation corresponded to the chronological age.\nNeedle aspiration was performed and yielded 5 mL whitish fluid. The fluid was positive for chyle. Biochemical tests of the fluid showed pH 7.5, triglycerides 39.2 mmol/L, cholesterol 4.5 mmol/L, protein 33 g/L, and glucose < 0.5 mmol/L. Slide review only showed presence of scanty lymphocytes with no malignant cell identified. | the chronological age.\nNeedle aspiration was performed and yielded 5 mL whitish fluid. The fluid was positive for chyle. Biochemical tests of the fluid showed pH 7.5, triglycerides 39.2 mmol/L, cholesterol 4.5 mmol/L, protein 33 g/L, and | half-year history of left breast mass. The boy was born at full term by normal vaginal delivery with an uneventful pregnancy. He was all along healthy until left breast enlargement was noticed since 9 months of age. Initially, parents thought that the breast problem was transient and did not pay attention to it. However, the mass gradually increased in size over a course of 6 months which prompted the parents to seek medical attention. There was no history of trauma or infection of the left breast. No medication was taken by the mother during or after the pregnancy. The boy was exposed to neither any medication nor |
17,448 | 162,780 | with two persons adequately we decided to give succinylcholine 1.5 mg/kg in order to facilitate the better visualization of the glottis on direct laryngoscopy. To facilitate the same we further decided to use McCoy blade of size 3. With all these precautions, our laryngoscopy with McCoy blade revealed CL grade IIIa.[] As there was no improvement in CL grading following relaxation and with McCoy blade, we decided to introduce the bougie and thread the tube over it and the same was accomplished with single attempt as in . Following uneventful intraoperative period, boy was extubated at the | direct laryngoscope as the left side of upper lip was involved by swelling. McIntosh laryngoscope with no. 3 blade was used through, which we could visualize only epiglottis with CL grading of III.[] As mask ventilation was achieved | we could visualize only epiglottis with CL grading of III.[] As mask ventilation was achieved with two persons adequately we decided to give succinylcholine 1.5 mg/kg in order to facilitate the better visualization of the glottis on direct laryngoscopy. To facilitate the same we further decided to use McCoy blade of size 3. With all these precautions, our laryngoscopy with McCoy blade revealed CL grade IIIa.[] As there was no improvement in CL grading following relaxation and with McCoy blade, we decided to introduce the bougie and thread the tube over it and the same was accomplished with |
26,778 | 80,146 | upper right mediastinum that measured 7.5×7 cm and was in close proximity to the superior vena cava (). The patient did not present with any respiratory symptoms, such as a cough or chest pain. Complete resection of the tumor was performed under general anesthetic in September 2011 (). During surgery, tumor cell invasion into the superior vena cava and left innominate vein, and pericardial adhesion were observed. The pathological evidence established a diagnosis of thymic squamous cell carcinoma | (), with positive lymph nodes under the clavicle. Treatment with GP (1.4 mg gemcitabine, days 1 and 8; 100 mg cisplatin, day 1; one cycle lasting 21 days) and GC (1.4 mg gemcitabine, days 1 and 8; 400 mg carboplatin, day 1; three cycles lasting 63 days). Subsequent to chemotherapy, the patient received post-operative radiotherapy to the mediastinum with a total | 28 days).\nAt the follow-up visit, the patient had no discomfort and the disease had not progressed. However, in late February 2013, thoracic CT revealed several unequal nodules in the right lung and under the pleura. The disease had recurred following 18 months of progression-free survival. Subsequent to two cycles of chemotherapy with DP (docetaxel, 100 mg on day 1; cisplatin, 100 mg |
9,802 | 63,053 | presented with abdominal pain from her recurrent nephrolithiasis. She had a right 2.1 cm partial staghorn calculus and 1 cm left lower pole calculus. She underwent right PCNL. Under fluoroscopic guidance, the right upper calix was accessed through an intercostal approach between the 11th and 12th ribs and had a right percutaneous nephrostomy tube placed at the end of the procedure to maintain percutaneous renal access for possible second look nephroscopy. Ureteral stent | was not placed as there was no indication for stent placement especially that nephrostomy tube was placed. There were no immediate postoperative complications, | ureteroscopy with minimal traumatization, there was no suspicion for any pleural injury at that time, and we did not want the patient to be bothered by having bilateral stents. The patient's pain improved and the patient was discharged from the hospital on POD 4 after removal of her right percutaneous nephrostomy tube. She was discharged with the indwelling left ureteral stent in place with removal planned in 1 week in clinic.\nThe patient was readmitted a day later for respiratory distress that required supplemental oxygen through a nonrebreather face mask. A CT scan of |
16,340 | 46,338 | light and accommodation with normal fundoscopy. She had impaired bilateral horizontal gaze secondary to bilateral CN VI paresis. The rest of cranial nerve examination was unremarkable. Motor exam revealed normal tone and power but her deep tendon reflexes were diminished and planters were down-going. Sensory exam was unremarkable. Bilateral upper limb dysmetria was noted with normal gait.\nConsidering her prior history of poor nutrition and acute neurological presentation following recurrent vomiting, the possibility of vitamin deficiency was considered. She was given IV thiamine 200 mg once daily for a week along with injectable Vitamin B12 1000 ugm and oral folic acid 5 mg once daily. Laboratory investigations revealed | paresis. The rest of cranial nerve examination was unremarkable. Motor exam revealed normal tone and power but her deep tendon reflexes were diminished and planters were down-going. Sensory exam was unremarkable. Bilateral upper limb dysmetria was noted with normal gait.\nConsidering her | for evaluation of recurrent vomiting of 3-week duration. Past medical history was noted for congenital multiple intestinal atresia and bilateral clubfeet. She had a prolonged hospitalization for multiple intestinal resections and she was on total parenteral nutrition for few months. She was followed by the pediatric gastrointestinal service and she was noticed to have failure to thrive. Her weight and height were below 3rd percentile throughout her childhood. She was on normal diet and was not compliant to her dietary supplements to increase her weight. She had normal cognitive function and attended ordinary schools. She had menarche in time. Her clubfeet, which was secondary to hereditary in nature |
42,996 | 31,015 | not change after commencement of the administration of cibenzoline.\nAfter she recovered almost fully without severe neurologic sequelae, a subcutaneous implantable cardioverter–defibrillator (S-ICD) was selected for second prevention as she was young and pacing therapy was thought as unnecessary. The surface ECG screening prior to the S-ICD implantation was performed. On the screening, the location of the surface electrodes was the fifth intercostal space along the left mid-axillary line (left leg, LL), 1 cm lateral | was selected for second prevention as she was young and pacing therapy was thought as unnecessary. The surface ECG screening prior to the S-ICD implantation was performed. On the screening, the location of the surface electrodes was the fifth intercostal space along the left mid-axillary line (left leg, LL), 1 cm lateral | with HCM based on the echocardiogram and cardiac biopsy 2 years prior, she had been free from any symptoms or arrhythmic events while taking a beta-blocking drug and ACE inhibitor. Both her father and grandfather had HCM, and her father died suddenly at 53 years old. Although she did not complain of anything, her BNP level was constantly high (500–970 pg/ml), so cibenzoline of 200 mg was added 3 months |
31,780 | 99,849 | reported isolated epistaxis denying hematemesis or melena other than distant episodes while in acute liver failure.\nCT of the sinuses revealed a large sinonasal mass with heterogeneous density in the left maxillary sinus, smooth bony destruction of the left medial and lateral maxillary sinus walls, extension into the nasal cavity, and erosion of the left inferior orbital wall (). MR imaging with gadolinium revealed a heterogeneously enhancing mass with foci of | large sinonasal mass with heterogeneous density in the left maxillary sinus, smooth bony destruction of the left medial and lateral maxillary sinus walls, extension into the nasal cavity, and erosion of the left | pathology, which remained inconclusive in ruling out malignancy. We thus proceeded under the premise of obtaining adequate margins for a presumed malignant sinonasal lesion. The tumor was debulked with mostly compressive findings on adjacent surfaces, other than the anterior inferior maxillary sinus and maxillary roof medial to V2. We dissected up to, but not within the pterygopalatine fossa. We used a 30k drill to polish irregular bony surfaces to arrive at normal appearing bone. The patient was observed overnight for additional bleeding and discharged in the morning.\nFinal pathology from the lesion was consistent |
5,353 | 62,979 | the adjacent soft tissues. After clinical and radiographic analysis by panoramic radiography (), poor bone availability in the maxilla and posterior mandible was observed and additionally a computed tomography was requested to plan the case in greater detail (). Due to the extreme maxillary atrophy in the right side (including a radiographic image suggesting oral-antral communication), the indication for reconstructive procedures did not have a favorable prognosis as it can be also observed in the 3D reconstruction image (). For this case, an anchoring technique combining conventional and zygomatic implants could be an alternative solution for rehabilitation; extraction of elements 25 and 26 was | patient's main complaint was the lack of stability, retention of the upper removable partial denture, the positioning of the lower third molars, the sensitivity of element 34 due to little bone support, and the difficulty of using the inferior prosthesis, which frequently injured | partial lower fixed dentures in acrylic resin were constructed. During the installation of the fixed dentures, periapical radiographs were performed in both sides and an occlusal adjustment was performed to establish simultaneous bilateral occlusal contacts in relation to the centric occlusion and the anterior guide. Procedures for the definitive lower prostheses were performed at the same time in both sides after three months and consisted of the following: obtaining a new impression, performing a radiographic test and evaluation of the metallic infrastructures, and registering the interocclusal record. Subsequently, a ceramic trial was performed and partial fixed denture prostheses (FDPs) were installed using a torque of |
14,075 | 97,214 | we present a case of PCG in a 12-year-old boy who presented with unusual gingival enlargement and erythema. The treatment outcome with a regular follow-up is also discussed. A 12-year-old boy reported to the Department of Oral Medicine and Radiology, Government Dental College Calicut (Kozhikode), North Kerala, with a chief complaint of painless swelling of gums in the upper and lower regions of teeth for 3 months with bleeding while brushing. The medical, dental, and personal histories of the patient were noncontributory. No history of any familial diseases was reported. Clinically no extra Oral anomaly detected [].\nIntraoral examination revealed a | diffuse severe gingival erythema and enlargement covering up to the cervical third of the clinical crown involving attached and | ]. Radiographic and hematologic investigations were carried out but did not reveal any significant finding [].\nAn incisional biopsy was performed from the gingiva, and the tissue specimen was sent for the histopathologic examination. The histopathologic examination revealed bits of the tissue covered by hyperplastic parakeratinized stratified squamous epithelium. The underlying connective tissue shows intense chronic inflammatory cells predominantly the plasma cells intermingled with numerous |
37,841 | 35,717 | As a result, the patient underwent a laparoscopic splenectomy in November 2009.\nThe patient was placed in the right lateral decubitus position, and 4 ports were placed in the left flank. The colonic attachments were divided, and the short gastric vessels were controlled with the Ligasure vessel sealing system (Covidien, Valleylab, Boulder, CO, US) to allow isolation of the splenic hilum (). The splenic artery was then dissected and ligated with a hemostatic clip (). Finally, the | splenic hilar vessels were dissected and divided using a vascular linear stapler (Ethicon Endo-Surgery, Inc. Cininnati, OH, US) (). Following complete splenic mobilisation (), the spleen was placed in a leak-proof bag and exteriorised to the abdominal wall. Histological analysis of the specimen confirmed a metastatic carcinoid tumour (chromogranin, cam 5.2, MFF116, synaptophysin, NSE and CD56 positive; no | history of left upper lobectomy in December 2000 for a primary carcinoid tumour of the lung (chromogranin positive; no mitotic activity; Ki67 labelling index of 2%; clear margins). The patient had been discharged from followup in 2005 with no evidence of recurrence. On representing in 2009, a CT scan showed evidence of local recurrence with left-sided pleural lesions and an enlarged left hilar lymph node, as well a solitary 4.7 cm splenic lesion (). The patient was further investigated with Octreotide SPECT and Gallium 68 whole body PET studies, which showed uptake in the pleural lesions, no |
11,923 | 117,018 | of the workup to determine the cause of his embolic stroke, the patient would have been sent for a trans-thoracic echocardiogram (TTE), but since he was recently worked up for a stroke just 2 months prior to this admission with a TTE, he was sent for | a transesophageal echocardiogram (TEE). The TEE showed a fairly large (12×3 mm), bulky, and highly mobile mass on the aortic aspect of the aortic valve, consistent with a fibroelastoma ( and ). After completing the rest of the workup, it was determined that this was likely the cause of his stroke. Cardiothoracic surgery was consulted for removal of the growth. Because of recent Plavix® (Clopidogrel; Bristol-Myers Squibb, New | imaging studies of the head. A computed tomography scan of the head without contrast showed no acute intracranial disease. Magnetic resonance imaging of brain showed multiple areas of restricted diffusion in the left middle cerebral artery territory in the medial and lateral left temporoparietal cortex and subcortical and periventricular white matter consistent with acute hemorrhagic infarcts, probably embolic. There |
23,341 | 186,944 | our patient was admitted due to ongoing lower abdominal and suprapubic pain and for intravenous antibiotics. A repeat FDG-PET-CT scan was conducted, revealing an intensely FDG avid mass in the midsigmoid colon (). The increase in size of the mass was concerning for a primary neoplasm or an extramural metastatic deposit from our patient's advanced lung cancer, given she had a colonoscopy which revealed no mucosal neoplasm.\nDespite these findings, it was still possible that this was secondary to an inflammatory rather than a neoplastic process. The patient was scheduled for a flexible sigmoidoscopy to evaluate the intracolonic foreign body. This | (). The increase in size of the mass was concerning for a primary neoplasm or an extramural metastatic deposit from our patient's advanced lung cancer, given she had a colonoscopy which revealed no mucosal neoplasm.\nDespite these findings, it was still | right hilar mass, necessitating a repeat diagnostic bronchoscopy and biopsy. This revealed a non-small-cell lung cancer (NSCLC) adenocarcinoma which was EGFR and ALK negative.\nBaseline staging imaging revealed that she had metastatic disease with a right lung primary lesion, mediastinal nodes, and adrenal, frontal skull bone, and left pelvic bone metastases (T4N2M1c). |
36,155 | 166,721 | eye and 21 mmHg in his right eye, but decreased within 5 min to 14 mmHg and 12 mmHg, respectively. Initial arterial blood gas analysis showed an Hct of 39%, a pH of 7.48, a PaCO2 of 34 mmHg, and a PaO2 of 240 mmHg. After changing the patient's position to left lateral decubitus, the IOP was 15 mmHg in his left eye and 14 mmHg in his right side, but increased to 20 mmHg and | 14 mmHg, respectively, after skin incision and arthroscopic insertion. The concentration of inhaled sevoflurane was adjusted in response to instantaneous IOP variation, and the occurrence of IOP surge was closely monitored. During the 210 min | was maintained with 2-2.5% sevoflurane in an oxygen-air mixture (FiO2 0.5). Immediately after tracheal intubation, IOP increased to 23 mmHg in his left eye and 21 mmHg in his right eye, but decreased within 5 min to 14 mmHg and 12 mmHg, respectively. Initial arterial blood gas analysis showed an Hct of 39%, a pH of 7.48, a PaCO2 of 34 mmHg, and a PaO2 of 240 mmHg. After changing the patient's position to left lateral decubitus, the IOP was 15 mmHg in his left eye and 14 mmHg in |
25,699 | 43,282 | general examination showed no other metastatic or primary lesions. A CT-guided puncture biopsy of the mediastinal mass failed to provide a pathological diagnosis. Based on the suspicion of a mediastinal tumor, thoracoscopic surgery | failed to provide a pathological diagnosis. Based on the suspicion of a mediastinal | 29-year-old female patient was admitted to Shandong Tumor Hospital and Institute (Jinan, China) on July 17, 2012, due to coughing that had lasted for one month and a fever that had been present for seven days. The patient had no history of any remarkable asbestos exposure. No abnormalities were noted upon physical examination and the patient exhibited no heart-involved symptoms. Furthermore, no heart abnormalities were detected by electrocardiogram and color ultrasonography studies. Laboratory tests showed that the leukocyte level was 7.8×109/l and the level of carcinoembryonic |
23,707 | 192,292 | neurologist and was managed with sumatriptan and Migraleve for her migraine and domperidone to prevent vomiting. She was also known to have an allergy to peanuts. She was a regular dental attendee and had experienced dental treatment and tooth extraction under local analgesia.\nHer dietary history showed that the patient consumed excessive quantities of acidic beverages: Coca-Cola, Irn-Bru and diluted fruit juice. The diluted juice was mixed with Maxijul and was taken to bed at night, and the mixed juice was sipped throughout the night.\nClinical examination | revealed generalised dental erosion that had severely affected the palatal surfaces of all the maxillary incisors and caused a fracture of the mesial surface of both the maxillary central incisors (). Several restorations were present on the posterior teeth.\nThe patient was very anxious | A1 with the used of celluloid crown forms (Frasaco®). Both the patient and her mother were happy with the results. Following that, the patient became more confident and displayed less anxiety. She was happy to proceed with the impression making procedures for the construction of the nickel-chromium palatal veneers for all the maxillary incisors, using heavy body polyvinyl siloxane impression material and light body polyvinyl siloxane impression material. The cementation of the nickel-chromium palatal veneers was done during the following visit using Panavia™ F2.0 resin cement (). The aesthetic and function were found to be satisfactory. |
9,495 | 38,915 | a history of unsuccessful surgery for otosclerosis in the right ear approximately 25 years ago. She says that she was told that the surgery did not work as expected, and she became deaf in that ear. At the time of surgery the surgeon reported high pressure and flow of perilymph that he characterized as a ‘gusher’. Her hearing in her left ear was already poor at the time of the operation on her right ear, and it had been deteriorating gradually. She was fitted with a hearing aid in her left ear soon after the surgery. There is no record of imaging or a | previous audiogram, and it is thought that an inadequate (unmasked) audiogram was used to formulate the initial diagnosis | from our patient’s family. They were made aware of the general risks involved in the surgery, in particular the potential for damage to her better ear from possible trauma associated with the extensive drilling during the procedure on her right ear. Our patient was implanted on 1 March 2011 using a CI24RE straight array |
12,960 | 156,432 | The longest length of the resected tracheal segment was 6.5 cm at the right posterolateral wall and the shortest length was 5.0 cm at the left anterolateral wall. In order to approximate both ends of trachea and minimize the tension of anastomosis, a proximal tracheal release was performed on the cricoid cartilage, and bilateral main bronchial release was performed under video-assisted mediastinoscopy (VAM). After dissection of the anterior and posterior wall of the trachea to the carina under direct vision, the anterior and posterior walls of both main bronchi were | dissected under VAM. The bronchi were released to the proximal part of the intermediate bronchus on the right and to the origin of the upper lobe bronchus on the left. The subcarinal lymph nodes were sampled. Both bronchial arteries were preserved. End-to-end anastomosis was performed by rotating the distal | rotating the distal end 90 degrees counter-clockwise and the proximal end 90 degrees clockwise. The pathologic diagnosis was adenoid cystic carcinoma. Both resection margins were clear. The mass had infiltrated into the paratracheal fibroadipose tissues. Cervical flexion was maintained for 10 days. Fiberoptic bronchoscopy on the 8th day revealed intact anastomosis. Computed tomography taken 12 months later revealed an approximately 3-cm elevation of the carina (). Fiber-optic bronchscopy revealed mild anastomotic stenosis at the cranial portion 5 cm from the carina (). Postoperative radiotherapy was performed because of the close radial margin. The patient |
27,711 | 86,453 | splenosis as the etiology of dry cough [, , ].\nBesides detailed medical history taking, proper physical examination can help us as well. Left upper quadrant scars should call our attention to possible history of splenic injury. Scars after upper midline laparotomy should be considered suspicious too, because midline laparotomy presents the common way for abdominal revision after gunshot or stab injury. In our case, the initial physical examination revealed only well-healed scar after midline incision; the patient had explained it as an old injury. Only with the histopathology report in hand, a more detailed physical examination revealed a small scar after a gunshot injury | call our attention to possible history of splenic injury. Scars after upper midline laparotomy should be considered suspicious too, because midline laparotomy presents the common way for abdominal revision after gunshot or stab injury. In our case, the initial | of functional splenic tissue (in patients after splenectomy). If splenosis is suspected, ferumoxide MRI is a helpful tool for diagnosis confirmation. Ferumoxide is a superparamagnetic MRI contrast medium consisting of small molecules of iron oxide which have an affinity for reticuloendothelial tissues – there is a signal loss on T2 sequences of MRI scans []. Thoracic splenosis can be confirmed accurately (without biopsy of surgery) by special radionuclide imaging examination. Scintigraphy with Tc-99m-labeled and heat-altered erythrocyte (combined SPECT/CT scanning) is the gold standard for splenic tissue confirmation based on labeled erythrocytes splenic uptake []. Radionuclide imaging with Tc-99m sulfur colloid and indium-111-labeled platelets presents an |
20,418 | 91,873 | child with poor interval growth. His mother has noticed that though he is thought to be breastfeeding appropriately, as defined by feeding 4 ounces of pumped breast milk every 2-3 hours, and has been meeting developmental milestones, his weight and height are not as expected. He has been exclusively breastfed and his mother has not introduced solid foods as of yet to his diet.\nHe was a full term, spontaneous vaginal delivery without complications during the pregnancy or labor. He was in the 50th percentile for both height and weight at his 2 month visit, but has fallen | to below the 3rd percentile for weight and is at the 3rd percentile for height. He is on no medications, there are no other siblings with failure to thrive and his mother has no post-partum depression | poor interval growth. His mother has noticed that though he is thought to be breastfeeding appropriately, as defined by feeding 4 ounces of pumped breast milk every 2-3 hours, and has been meeting developmental milestones, his weight and height are not as expected. He has been exclusively breastfed and his mother has not introduced solid foods as of yet to his diet.\nHe was a full term, spontaneous vaginal delivery without complications during the pregnancy or labor. He was in the 50th percentile for both height and weight at his 2 month visit, but has fallen to below the 3rd percentile for weight and is at the 3rd percentile for |
1,477 | 76,750 | day two with no issues noted before discharge.\nThe patient was seen in clinic on postoperative day four for a blood pressure check and complained of difficulty ambulating since delivery, requiring assistance for walking, and mild bilateral lower extremity edema. Upon reviewing her delivery and hospital course, the patient did report that she had some weakness when walking prior to hospital discharge but her symptoms had progressed to the point of needing ambulatory assistance. On examination, she was noted to have a steppage gait, decreased strength of the left lower extremity, and intact sensation to the | bilateral lower extremities with bilateral foot drop. The patient also complained of right-sided lower back and buttock pain with movement and intermittent “lightning bolt” sensation to thighs.\nShe was readmitted on postoperative day four for hypertensive control as well as additional evaluation of her lower extremity neuropathy. Anesthesiology and neurology were also consulted given her neuropathy | in her bilateral lower extremities.\nThe patient was evaluated on postoperative day 7 reporting significant improvement in pain and ambulation since hospital discharge and declined physical therapy at that time. On postoperative day 14, the patient was again seen in clinic and reported no change in symptoms or gait and a physical therapy consult was ordered |
42,931 | 167,861 | infection diagnosis, treatment with oral immunoglobulin was started. An intravenous immunoglobulin solution (Privigen®) was given orally at a dose of 1250 mg (25 mg/kg body weight) four times daily for 2 days (altogether eight doses). The immunoglobulin solution did not bypass the gastric barrier. Tacrolimus trough levels during the preceding 4 months had been stable above 10 ng/L (range 11.5–18.3 ng/L), and the patient had received triple immunosuppression therapy with | needed repeated episodes of hospitalization due to dehydration. Norovirus PCR from the stools remained repeatedly positive, and the norovirus infection was considered a cause for the chronic diarrhea. Endoscopy findings were unchanged. Nearly 3 months after the initial norovirus | chronic diarrhea. Endoscopy findings were unchanged. Nearly 3 months after the initial norovirus infection diagnosis, treatment with oral immunoglobulin was started. An intravenous immunoglobulin solution (Privigen®) was given orally at a dose of 1250 mg (25 mg/kg body weight) four times daily for 2 days (altogether eight doses). The immunoglobulin solution did not bypass the gastric barrier. Tacrolimus trough levels during the preceding 4 months had been stable above 10 ng/L (range 11.5–18.3 ng/L), and the patient had received triple immunosuppression therapy with MPA 360 mg twice daily and methylprednisolone 6 mg daily.\nFour days after the end of the immunoglobulin treatment, the |
30,678 | 24,654 | DF and low platelet count. On the sixth day, the platelet count again started to fall. Serum glutamic pyruvic transaminase (SGPT) was found to be above normal (82 U/L; reference range = up to 31 U/L). Again, platelets were infused to the patient. An automatic call counting test was then performed, which revealed no sign of lymphopenia and leukocytopenia but showed the development of thrombocytopenia with abnormal platelet distribution (Figure | sixth day, the platelet count again started to fall. Serum glutamic pyruvic transaminase (SGPT) was found to be above normal (82 | the platelet level dropped to 31 x 10^9/L and the patient experienced bleeding from the nose with a mild earache. Tranexamic acid 100 mg/ml was administered to reduce the bleeding, which stopped completely after two days. An ultrasonogram of the whole abdomen revealed mild hepatomegaly with infiltration of the liver, splenomegaly, abdominal ascites, and right-sided pleural effusion (Figure ).\nThe patient’s earache gradually intensified. CBC |
15,652 | 65,977 | typical findings for these entities. However, extensive testing yielded negative results (Table ). Autoimmune diseases and primary immunodeficiencies were ruled out by these investigations. Primary dermatologic disorders such as congenital or acquired epidermolysis bullosa, bullous pemphigoid diseases and other blistering skin diseases were ruled out by skin biopsy. In total, six skin biopsies were performed over a time span of 2 years. All biopsies showed faint perivascular lymphocytic infiltrates associated with rare infiltrates of polymorphonuclear granulocytes, possibly caused by mechanical or medical irritation of the skin. Several imaging studies were performed including abdominal ultrasound, brain MRI and echocardiography, all with normal results. Eye exams did not show any inflammatory changes | who had no apparent psychiatric abnormalities.\nA diagnosis of SAID was one of the first diagnoses suspected, and was first proposed by the dermatologists, as fever and skin symptoms are | age of 5 months (Fig. ). A skin biopsy was performed, showing faint polymorphonuclear granulocytic infiltrates; a histopathologic diagnosis of probable autoinflammatory skin disease was made, which prompted further diagnostic evaluations into SAIDs (s. Table ). At 8 months of age, macroscopic haematuria, bloody diarrhoea and epistaxis were reported by the mother. Shortly after, recurrent episodes of |
42,682 | 105,768 | these, the preceding potentials were considered to be potentials of an epicardial interatrial connection. Ablation began with 35 W of radiofrequency using an irrigated catheter (ThermoCool SmartTouch™ Surround Flow, Biosense Webster) on the epicardial interatrial connection with a conduction delay from the endocardial side (Figure ). After 17 s of ablation, BiAT was terminated and sinus rhythm (SR) was restored without pause (Figure ). Additional burns at the area near the successful site of ablation were applied; subsequently, pulmonary vein isolation and LA roof ablation were also performed using a 28-mm cryoballoon (Arctic Front Advance, Medtronic, Minneapolis, | atrial septums (Figure ). On the ripple map of both atriums, a propagation reciprocating near the assumed high-septum interatrial connection was visualized (Video 3), and clear double potentials were recorded near the site (Figure ). The preceding potentials were considered to be far field potentials due to amplitude lower than the following potentials, and the TCL (304 ms) was completely covered by adding the activation time of the preceding potentials (36 ms) to the activation time of the endocardial potentials of both atriums (268 ms). Given | ms). Given these, the preceding potentials were considered to be potentials of an epicardial interatrial connection. Ablation began with 35 W of radiofrequency using an irrigated catheter (ThermoCool SmartTouch™ Surround Flow, Biosense Webster) on the epicardial interatrial connection with a conduction delay from the endocardial side (Figure ). After 17 s of ablation, BiAT was terminated and sinus rhythm (SR) was restored without pause (Figure ). Additional burns |
12,301 | 38,059 | language . If it was not, as in the majority of cases, this area would have also roles related with receptive language but in a subordinated way, leading to a bilateral dissociation design . This seems to be the case with functions related to lexical ambiguity resolution, where left and right Wernicke’s areas function as processors of dominant and subordinated meanings of ambiguous words, respectively.\n100 days | and 10.9% of the Brodmann area 22 (reference 4). If the dominant cerebral hemisphere were the right one, this area would be part of the Wernicke’s area, fully related to auditory comprehension of | associated with some motor responses to vibrotactile digit stimulation and to spoken language . Brodmann area 13 belongs to the insular cortex, that is reported to participate in somatosensory , olfaction and taste , and verbal memory functions , among others. Finally, Brodmann area 39 is also part of the Wernicke’s area or its contralateral homologous. In the right hemisphere, it is generally associated to visuospatial processing and music reading . predicts that, at |
41,339 | 114,169 | months. Poor appetite with a weight loss of 2–3 kg in 1 month was also noted. Hemoptysis, hoarseness, fever, chillness, chest pain, shortness of breath, acid regurgitation, and bone pain were denied. As a common housewife with hypertension on | regular medical control, she did not smoke cigarettes, nor indulge in alcohol drinking.\nDespite no significant findings on physical examination, her chest X-ray film revealed a mass shadow in the right middle lung field just adjacent to the hilum. | 40 mg afatinib since March 20, 2015. Her devastating disease status resolved quickly, and a stable condition was well maintained until April 27, 2016. At that time, she was admitted to the neurology ward of that hospital for impairment of memory, attention, calculation ability, as well as gait and movement disturbance. Frequent episodes of dizziness, vertigo, and falling were also notable. These symptoms had developed progressively in the previous 3 months according to her family. Evident paranoid delusion and depressed mood were detected during hospitalization. However, there was |
43,462 | 62,804 | since the age of 13. It was then treated with Methotrexate with poor response, and thus it was substituted for combination of Cyclosporine and Azathioprine which achieved a better control. A year ago, Azathioprine was suspended for a while because of the political situation and Adalimumab was initiated. Few days following the second dose of Adalimumab, the patient | substituted for combination of Cyclosporine and Azathioprine which achieved a better control. A year ago, Azathioprine was suspended for a while because of the political situation and Adalimumab was initiated. Few days following the | study was reviewed and showed normal ordinary labs including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Antinuclear antibodies (ANA), rheumatic factor (RF), and antineutrophil cytoplasmic antibodies C-ANCA and P-ANCA were all negative. Human leukocyte antigen (HLA) analysis revealed HLA-B27. CSF analysis showed acellular fluid with immunoglobulin G (IgG) index of 0.53, normal protein, lactate dehydrogenase (LDH), and glucose levels. Despite the lack of enhancement, diagnosis of Adalimumab induced MS was suspected in this patient with HLAB-27 associated uveitis |
13,493 | 62,483 | the arytenoids. Selective venous sampling showed increased PTH levels in this area.\nA third parathyroid exploration was undertaken for elective resection of the suspicious area shown on PET-CT. Frozen section pathology results suggested the presence of inflammatory tissue secondary to a suture granuloma from the previous neck exploration. Intraoperative PTH levels continued to remain elevated. An exhaustive search of the neck was then undertaken, including skeletonization of the carotid artery to the level of the bifurcation, mobilization of the jugular vein, identification of the course of the vagus nerve | for elective resection of the suspicious area shown on PET-CT. Frozen section pathology results suggested the presence of inflammatory tissue secondary to a suture granuloma from the previous neck exploration. Intraoperative PTH levels continued to remain elevated. An exhaustive search of the neck was | Although subsequent MRI and CT scans remained negative, PET-CT scanning showed a 3 cm region of uptake in the right parapharyngeal region behind the thyroid cartilage at the level of the arytenoids. Selective venous sampling showed increased PTH levels in this area.\nA third parathyroid exploration was undertaken for elective resection of the suspicious area shown on PET-CT. Frozen section pathology results suggested the presence of inflammatory tissue secondary to a suture granuloma from the previous neck exploration. Intraoperative PTH levels continued to remain elevated. An exhaustive search of the neck was then undertaken, including skeletonization of the carotid artery to the level of the bifurcation, mobilization of the |
31,005 | 104,809 | important to acknowledge the limitations of our review. It is possible that some reports did not specify the urinary bladder as an involvement site, so we cannot exclude the possibility of missing a significant number of cases. This is a retrospective study, and patients have not been studied and treated uniformly; therefore, it is impossible to draw a definitive conclusion regarding the pathogenesis of MALT lymphoma of the urinary bladder.\nThe patient we report has a history of rheumatoid arthritis (RA). The relationship between RA and MALT lymphoma in this patient remains unclear. An increased risk of malignant lymphoma has been reported in | while second case showed translocation t(11;18)(q21;q21), trisomy 3, and trisomy 18.\nTreatment approaches were variable including surgical excision, antibiotics, chemotherapy, radiation, or combined modality. Six patients were successfully treated with antibiotics.,, Eight patients had some surgical procedures with or without consequent radiotherapy and/or chemotherapy.,,,,,,, Hughes and colleagues reported one patient who was successfully treated by diathermy. Majority of the patients (24) were treated with chemotherapy either alone (16) or in combination with radiation (8) (). Three cases did not have any information about therapeutic approach. Overall the outcome of the treatment was good with median follow-up time of 64.5 months (from 3 to 156 months).\nIt is | established. No additional molecular studies were performed.\nThe patient received 4 cycles of Rituximab and achieved complete remission seen on the pelvic computed tomography (CT) (). The patient showed no signs of disease with the last follow-up more than 10 years after original diagnosis.\nThe literature review was initiated starting with 1990 when Kuhara and colleagues reported what was eventually called “the first definitive report of a MALT lymphoma of the urinary bladder”., After a systemic search of the PubMed database for primary MALT lymphoma involving urinary bladder, |
25,034 | 10,759 | it was decided that she would undergo R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone) chemotherapy for her lymphoma prior to definitive management of her breast cancer. She has currently completed 4 cycles of chemotherapy and positron emission tomography demonstrates complete disease response (Fig. ). Following completion of her chemotherapy, she is planned to undergo breast surgery followed by adjuvant therapy. At the time of this report, the patient states that | she has had minimal return of sensation to the left tongue and mandibular area to her face; however, she has had complete resolution of the left-sided facial pain | to hematology and general surgery for management of both primaries. After a multidisciplinary discussion, it was decided that she would undergo R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone) chemotherapy for her lymphoma prior to definitive management of her breast cancer. She has currently completed 4 cycles of chemotherapy and positron emission tomography demonstrates complete disease response (Fig. ). Following completion of her chemotherapy, she is planned to undergo breast surgery followed by adjuvant therapy. At the time of this report, the patient states that she has had minimal return of sensation to the left tongue and mandibular area to |
2,853 | 54,776 | parenteral nutrition and gastronomy tube placement. Mr. X then suffered from paralytic ileus, followed by severe bacterial pneumonia. As a result, Mr. X had to be admitted and discharged repeatedly from multiple hospitals and skilled nursing facilities (SNF). During one of his stays at an SNF, he refused to take his clozapine; over time, he became agitated, aggressive, and began physically assaulting the nursing home staff and his family caretakers.\nMr. X then demonstrated both disorganized speech and thought, ultimately declaring | procedure with right colectomy en bloc resection, he was hospitalized for eight days. The psychiatric consultation-liaison team worked closely with the surgical team to help Mr. X maintain psychiatric stability. In the months after discharge, Mr. X suffered physical complications from his surgery. These complications included severe malnutrition that led to total | his psychosis and disorganized thought. Due to the severity of his mental illness, his sister is his conservator, which means that she makes all of his legal and medical decisions. Mr. X has a family history of colon cancer, where his mother was diagnosed with colon cancer in her 60s. The course of his disease started with symptoms of recurrent diarrhea and right lower quadrant abdominal pain. Since Mr. X is conserved, Mr. X’s sister gave informed consent for Mr. X to undergo an initial colonoscopy. Mr. X |
28,428 | 151,724 | block was effective only for several hours.\nConsidering the chronicity and severity of neuropathic pain, a temporary trial of SCS was performed (approximately 10 weeks after onset of pain) with a cylindrical electrode (Octrode®, Plano, TX, USA) at the level of C3-5 (). The severe dull, crushing and deep pressure-like spontaneous pain and | SCS was performed (approximately 10 weeks after onset of pain) with a cylindrical electrode (Octrode®, | temporary trial of SCS was performed (approximately 10 weeks after onset of pain) with a cylindrical electrode (Octrode®, Plano, TX, USA) at the level of C3-5 (). The severe dull, crushing and deep pressure-like spontaneous pain and the evoked pain (mechanical allodynia) in the arm and hand was alleviated for about 50% (contact polarity 3-4+, 100 usec, 100 Hz, 1.5 mA). She assessed the effect of SCS as fairly successful and expressed the pain intensity (4-5/10, |
35,551 | 98,114 | ng/mL) and hypersensitive troponin T (142.9 ng/L), were increased. Her plasma N-terminal pro-B-type natriuretic peptide level (> 35000 pg/mL) was significantly high. Autoimmune profiles showed hypocomplementemia with C3 of 36 mg/dL and C4 of 13.7 mg/dL, positive antinuclear antibodies with a titer 1:1000 (speckled nuclear pattern), positive SS-A antibodies (+++), positive SS-B antibodies (++) and positive Ro-52 antibodies (+++). An arterial blood gas on admission to ICU revealed a pH of 7.46, PaCO2 of 21 | high. Autoimmune profiles showed hypocomplementemia with C3 of 36 mg/dL and C4 of 13.7 mg/dL, positive antinuclear antibodies with a titer 1:1000 (speckled nuclear pattern), positive SS-A antibodies | the liver and spleen were not palpable. She had joint line tenderness in both knees and mild edema in both lower extremities.\nThe initial laboratory tests are shown in Table . Blood tests revealed mild leukocytosis 10.71 × 109/L with moderate anemia (hemoglobin 71 g/L) and severe thrombocytopenia (platelet count 33 × 109/L). Alanine aminotransferase (98 IU/L) and aspartate aminotransferase (301 IU/L) were increased, which may have been attributed |
40,207 | 206,231 | cell carcinoma of the left kidney metastatic to the bony pelvis, lungs, mediastinum, and spleen presented to the emergency department with shortness of breath, pleuritic chest pain, and left scapular pain. She presented to the same emergency department one week prior with pleuritic chest pain but was discharged home after pulmonary embolism was ruled out.\nShe was diagnosed with renal cell carcinoma of the left | kidney five years prior after presenting with gross hematuria. At that time, she underwent left radical nephrectomy. One year later, she developed a metastatic lesion in the bony pelvis for which she underwent radiation therapy. She as treated with pazopanib for | following week, further CT imaging was obtained, revealing a gastro-pleural fistula (via the left diaphragm and superior posterolateral stomach) with associated complex pleural effusion containing contrast material and gas (Figure ). This process abutted the known splenic metastases.\nAn esophagogastroduodenoscopy (EGD) revealed a 1.5-cm fistula in the posterolateral stomach that opened |
19,046 | 1,717 | next 2 years she lost 60 kg and underwent SPK during which the donor duodenal segment was diverted to a bowel loop distal to her Roux loop implant site into the common channel. Induction immunosuppression with alemtuzumab was followed by maintenance with tacrolimus (trough levels 5-7 ng/mL), mycophenolate-mofetil (2 g daily), and a steroid taper. She was CMV seronegative and received a graft from a CMV positive donor and received standard prophylaxis with | SPK. At this point it was decided to offer her bariatric surgery, and, after extensive discussion, it was felt that a RYGBP was the best option for her in terms of weight loss. At the age of 32 years, she underwent uneventful robotic-assisted surgery; the stomach remnant was attached to the abdominal wall for potential future access.\nOver the | found to have skin lesions on her right leg, which were diagnosed as calciphylaxis. Her serum calcium at that time was 14 mg/dl and the diagnosis of tertiary hyperparathyroidism was made. A three-and-a-half-gland resection together with subtotal thymectomy was done without any complications; the left lower parathyroid gland was the only normal appearing and half of it was preserved taking care that blood supply remained intact. Intraoperative parathyroid hormone levels dropped from >1500 to 150. Calcium serum levels within 24 hours postoperatively were 9 mg/dl with ionized calcium of 3.5 mg/dl. She was discharged in good condition within 24 hours postoperatively with daily calcium supplementation of 4.5 g/day divided into |
1,371 | 134,364 | radiating to bilateral lower limbs, aggravated on any movement of both lower limbs or turning sideways, decreased on restand medications. History of rest pain was present but no history of night cries or diurnal variations. He was mobilizing with walker during the first few years of pain but he developed complete inability to | but no history of night cries or diurnal variations. He was mobilizing with walker during the first few years of pain | back when he developed pain over the lower back which was insidious in onset, gradually progressive, intermittent in nature, radiating to bilateral lower limbs, aggravated on any movement of both lower limbs or turning sideways, decreased on restand medications. History of rest pain was present but no history of night cries or diurnal variations. He was mobilizing with walker during |
16,576 | 121,693 | well within the true pelvic cavity, lying just medial to the left obturator foramen (). Computerized tomogram images with three-dimensional reconstruction were obtained to accurately locate the needle position inside the true pelvis ().\nWe decided to operate and retrieve the needle from the pelvis due to 3 reasons. First, | the needle was in close proximity to the urinary bladder and obturator neurovascular bundle, and chances of further migration of the needle could not be ruled out completely [, ]. For the same reason, minimally invasive computed tomography (CT)-guided removal of needle also was not considered safe by the radiologist. Second, the needle could act as | radiographs of the pelvis including an antero-posterior view, Judet views, pelvis inlet, and outlet views were obtained to ascertain the current position of the needle. The needle was located well within the true pelvic cavity, lying just medial to the left obturator foramen (). Computerized tomogram images with three-dimensional reconstruction were obtained to accurately locate the needle position inside the true pelvis ().\nWe decided to operate and retrieve the needle from the pelvis due to 3 reasons. First, the needle was in close proximity to the urinary bladder and obturator neurovascular |
24,982 | 38,835 | There were many small lymph nodes in St. 5, 7, 9 and 10. A harmonic scalpel and an endoscopic dissector used to dissect the lymph nodes. This whole procedure took approximately 2.5 hour to complete. At the end of the procedure, we placed one Fr.24 chest tube in the pleural cavity (Figure ) and it was fixed in the single port wound. The estimated blood loss was approximately 50 ml, and forty-eight hours after the procedure, the chest tube was removed. Seventy-two hours after | one Fr.24 chest tube in the pleural cavity (Figure ) and it was fixed in the single port | outpatient department and complained of mild chest discomfort. She reported that she had not had any systemic disease in the past and that she was a non-smoker. She also had not had any noticeable weight loss. Subsequent chest radiograph showed a faint opacity in left middle lung field. Therefore, she was admitted for further survey. Chest computed tomographic( CT) scan showed a lesion with features of air-bronchogram and a minimal solid component in the superior segment of the left lower lobe and a tiny nodule near the primary lesion. Preoperative survey, including sputum cytology, bronchoscopy and chest ultrasound, failed to yield a definitive |
42,661 | 30,825 | occipitoparietal craniotomy. The hematoma consisted of one part that could be easily evacuated and another part, located mainly on the deep side, that was solid and bled easily. The surgery was terminated after confirming that a large amount of the hematoma had been debulked, leaving a portion in which hemostasis was difficult. Histological examinations of the solid part revealed a meningioma with massive hemorrhage within the tumor and many irregular vessels, including softened thin-walled vessels, closed vessels, etc., | confirming that a large amount of the hematoma had been debulked, leaving a portion in which hemostasis was difficult. Histological examinations of the solid part revealed a meningioma with massive hemorrhage within the tumor and many irregular | was initially treated in the intensive care unit. Prior to this event, she had been in good health except that she often experienced migraine-like headaches. On admission, she was assessed as Glasgow Coma Scale 4 (E1V1M2), and her blood pressure was 125/84 mmHg, heart rate was 67/min (regular in rhythm), respiratory rate was 16/min, body temperature was 36.2oC, and routine laboratory blood tests showed no remarkable abnormalities. Her pupils were 2.5-mm prompt when reacting to direct light on the right side and 3.0-mm sluggish when reacting to direct light on the left side. Non-contrast computed tomography (CT) of |
23,547 | 56,955 | of ipsilateral talus fracture trail closed has been achieved and insertion of two partially threaded screws posterior to anterior was done.\nPost-operative management and follow-up\nThe patient recovered well, tolerated the procedure, and the patient's mother was instructed by the medical team on the specifics of spica care. The patient was scheduled to be discharged two days after the surgery. Then, | the patient returned for follow-up after two weeks with a foul smell from the spica (Figure ). Thus, she was taken again to the operation room for | bear her body weight when standing and complained of left hip pain. The Advanced Trauma Life Support (ATLS) protocol was completed. She was conscious and alert with normal and stable vital signs. A full head-to-toe examination showed superficial bruising over the dorsal aspect of the left foot. Locally, there was tenderness over the left hip on deep palpation associated with lateral and posterior bruises, but there were no open wounds or visible swelling. Her range of motion of the left hip was restricted due to |
42,294 | 11,140 | contaminated transverse laceration over the anterior aspect of his knee exposing a comminuted fractured patella and radiographs further revealed a bicondylar Hoffa (AO 33-B3) fracture ( and ). He had no distal neurovascular deficits.\nHe underwent emergency debridement and removal of the loose patella fragments. The laceration was extended and the distal femur | revealed a bicondylar Hoffa (AO 33-B3) fracture ( and ). He had no distal neurovascular deficits.\nHe underwent emergency debridement and removal of the loose patella fragments. The laceration was extended | three years following union of the fracture. He was very compliant and was on regular visits. At latest follow-up (15 years since the trauma), he was asymptomatic, although there were Kelgren-Lawrence grade 2 osteoarthritic changes of the right knee visible on radiographs ( and ). The gait was normal and both knees were in alignment (). He had no pain or extensor lag and his knee was clinically stable with a flexion of 130° which was 5° short of the normal side ( and ). He could squat, sit cross-legged ( and |
32,622 | 56,956 | recurrent vaginal bleeding presented to the ED with an episode of acute heavy vaginal bleeding. The patient reported soaking through multiple sets of clothes and passing golf ball-sized clots. The patient’s vital signs on presentation showed a blood pressure of 116/70 mmHg, pulse of 100 beats per minute, respiratory rate of 18 breaths per minute, and temperature of 37°C. The patient denied any episodes of lightheadedness, dizziness, or syncope. Pertinent laboratory values on presentation are illustrated in Table .\nPhysical examination revealed | mild tenderness along the midline and both the right and left lower quadrants. On pelvic examination, there was active bleeding from the cervical os, which was closed. The patient experienced a significant drop in hemoglobin from her previous ED visit four days prior | supply to the AVM via the left uterine artery.\nAngiography of the right internal iliac artery was performed, which showed persistent flow to the AVM from the right uterine artery. Selecting the right uterine artery was extremely difficult, and distal selection was not possible. Hence, embolization of the right uterine artery was performed with gel foam. The final pelvic angiography showed good perfusion of the uterine body and |
16,153 | 138,197 | 130/85 mmHg, his pulse rate as 130 beats per minute. No free fluid were detected in focused assessment with sonography for trauma (FAST) scan. His body mass index (BMI) as 36.3, suggesting morbid obesity. No tenderness to palpation on his spinal column, no symptoms of laceration in his chest and abdomen and no abdominal guarding and tenderness were detected. The results of his perineal and pelvic examinations were also normal. Although his distal pulses were normal, a | deformity was observed in the distal third of his left forearm. He had a left lower extremity crash injury. His left leg was nearly amputated below the knee, with severe muscle and skin damage, and the nerves and vessels were all cut. He reported a history of committing suicide, although he had no history of diseases except for psychological disorders treated with valproate.A nasogastric tube (NGT) and a foley catheter were inserted. His chest x-ray (), pelvic radiographand | had a left lower extremity crash injury. His left leg was nearly amputated below the knee, with severe muscle and skin damage, and the nerves and vessels were all cut. He reported a history of committing suicide, although he had no history of diseases except for psychological disorders treated with valproate.A nasogastric tube (NGT) and a foley catheter were |
12,339 | 161,297 | was occupied by the foreign body, suggesting ICA encroachment. Delayed time to peak of the right side was noticed on perfusion CT suggesting right carotid artery occlusion (). Progressive left side weakness developed after admission. Because of the patient's critical condition, we needed prompt management to restore blood flow without digital substraction angiography (DSA). Emergency skull base surgery was planned to unblock the cavernous sinus. And then we considered extracranial to intracranial high flow arterial bypass in case of flow decrement on the | right ICA. Conventional craniotomy was performed on the right pterional area. After extradural removal of the anterior clinoid process, micro-Doppler revealed restoration of carotid flow to the paraclinoid segment (). Intradural inspection revealed displacement of the carotid artery due to the foreign body (). The carotid artery was found to | an industrial grinder while doing demolition work. He was transferred to the emergency room with fading mental awareness. The facial laceration was 15 cm in length from nose to right cheek (). A piece of the broken blade was observed in the deep portion of the facial wound. Facial bone CTs revealed a blade fragment in the anterior skull base from his nose to the dorsum sellae area (). Brain CTs demonstrated the involvement of the right temporal lobe, cavernous sinus, paraclinoid segment of the carotid artery (). Also there were traumatic subarachnoid hemorrhage, pneumocephalus without |
40,286 | 13,363 | extension, and finger extension. He was right-handed. One year earlier, his right limb was caught in machinery. The forearm was pulled forward by a conveyor belt, and his distal clavicle hit a metal pole. Since rupture of the right axiallary artery and pectoralis major muscle and fractures of the clavicle and scapula were diagnosed, revascularization and open reduction with internal fixation of the clavicle were performed immediately. However, the right upper limb palsy remained.\nThe skin scar was on the anterior side of the shoulder from the coracoid process to the axilla. The British Medical Research Council (BMRC) grading | scale was 1 for biceps, 3 for triceps, 1 for brachioradialis, 1 for wrist extensors, 1 for finger extensors, and 5 for deltoid. Active range of motion (ROM) of the right shoulder was nearly full flexion and abduction | started. Active elbow flexion was 130 degrees after 5 months.\nTendon transfer based on the method of Riordan with a slight modification was performed for the wrist and finger reconstruction as secondary surgery 5 months after primary surgery.\nAfter splint fixation in the extension position of the wrist and finger for 3 weeks, active and passive ROM training began.\nOne and a half years after the primary surgery, the BMRC grade was 4 for elbow flexion, 4 for wrist extension, and 4 for finger extension. The active ROM of the right elbow was 0/135 (, which displays active motion of the elbow, wrist, and fingers at one and |
7,051 | 138,714 | showed spindle-shaped fibroblastic cells with well-differentiated trabeculae of woven bone with an osteoblastic rim on its surface. The fibroblasts showed minimal cytological pleomorphism and small nucleoli. Focal islands of irregular primitive bone formation were visible between the lamellar trabeculae. No vascular invasion of the tumor was seen, and no dedifferentiated areas were identified (). Regarding the histological features, the lesion was identified as a grade | I parosteal osteosarcoma of the humerus.\nA pathologist re-reviewed the tissue samples that had been examined in December 1982 and concluded that the initial lesion that had been diagnosed as calcified hematoma with benign characteristics should have | working as a professional welder, was admitted in our hospital in January 2004 after experiencing swelling and vague diffuse pain in his right shoulder for several weeks. The patient denied a history of trauma or previous fracture of the upper extremity in the humerus. His recent medical history was unremarkable and he denied any constitutional symptoms such as weight loss, fever, or malaise. He had been treated at our institution at the age of 11, in December 1982, due to an ossification on the proximal |
12,534 | 53,542 | olfactory groove in contact with the base of the sphenoid, with a mass effect on adjacent structures and significant compression of the optic chiasm, with characteristics suggestive of a benign meningioma (Fig. ). He was referred to the neurosurgery department where a partial tumor resection was carried out by craniotomy with the confirmation of the pathology report of a benign meningioma (WHO Grade | effect on adjacent structures and significant compression of the optic chiasm, with characteristics suggestive of a benign meningioma (Fig. ). He was referred to the neurosurgery department where a partial | is worth mentioning that he was fully aware that this phenomenon was not real and he referred to it as part of a disease, however, it caused him discomfort and sometimes agitation.\nAfter the complete vision loss he initiated with depressive symptoms which consisted of sadness, anhedonia, fatigue, weight loss and low self-esteem, later adding recurrent thoughts of death. Family members mentioned that he began with personality changes such as constant irritability, impulsivity and behavioral changes regarding personal hygiene and dressing, lasting weeks without taking a bath, a situation that had never happened before. For this |
7,432 | 43,220 | to break the mass.\nThe appendix was swollen with a 60-mm cyst with a glossy white surface. No rupture of the mass was observed ().\nThe mass wall was thickened on the appendicular ostium and accompanied by enlarged nuclei and pseudostratified cells, leading to the diagnosis of adenocarcinoma. The protrusion on the appendicular ostium was located inside the thickened wall and composed of granulation tissue with proliferating capillaries. The protrusion on the appendicular tip was composed of mucus, and part of the | via the cubital vein. Contrast enhancement was observed in the thickened wall of the mass on the appendicular ostium and in the projection on the same side; however, not in the projection on the appendicular tip ().\nBased on the thickened and contrast-enhanced wall of the mass on the appendicular ostium on abdominal CT and US, as well as contrast enhancement of the projection on the appendicular ostium on US, the mass was diagnosed as mucinous cystadenocarcinoma of the appendix and ileocecal resection was performed on day 10. The mass was excised with surrounding connective tissue with care taken not | felt in the right lower quadrant that resembled the one felt previously and tenderness was experienced at the same site. The patient was then admitted for workup. The patient had no history of alcohol or smoking and the prior medical history included surgery for internal hemorrhoids at the age of 59 years. |
20,888 | 12,410 | nodes was observed. The patient was conscious and coherent, but with panic gait and few facial expressions. Limb muscle strength was normal, limb muscular tension was increased, and resting tremor of the limbs could be observed. Breast physical examination revealed no obvious mass. The modified Rankin score (mRS) was four. Blood routine, urine routine, fecal routine, liver and kidney functions, and electrolyte were all within the normal ranges. Serum anti-HIV antibody, antibodies against Treponema pallidum, hepatitis C antibody, and TORCH virus antibody were negative. Thyroid function, tumor markers, and immune indicators were normal. Urinary cadmium, arsenic, manganese, mercury, chromium, and strontium, and blood lead were normal. Serum anti-CV2 antibody was positive. Anti-Hu, anti-Ri, anti-Amphiphysin, anti-Tr, anti-GAD, anti-Yo, anti-Ma2, | within the normal ranges. Serum anti-HIV antibody, antibodies against Treponema pallidum, hepatitis C antibody, and TORCH virus antibody were negative. Thyroid function, tumor markers, and immune indicators were normal. Urinary cadmium, arsenic, manganese, mercury, chromium, and strontium, and blood lead were normal. Serum anti-CV2 antibody was positive. Anti-Hu, anti-Ri, anti-Amphiphysin, | the nodule were unclear, and the internal echoes were uneven with rich strip-like blood flow signals. The BI-RADS classification was 4b.\nAt this point, the diagnoses was anti-CV2 autoimmune encephalitis and breast cancer. The patient was transferred to the Breast Surgery Department and underwent modified radical mastectomy under general anesthesia. Postoperative pathology revealed the presence of an invasive ductal carcinoma. Tumor heterogeneity was obvious under the fluorescence microscope. TNM staging was pT1cN0M0. The cancer was |
31,104 | 161,841 | no history of pruritis during and after the recovery from hepatitis. There was no past or family history of any neurological, psychiatric, endocrinal, chronic, or allergic illness. He consumed alcohol occasionally. There was no history of any other substance abuse. Physical examination on admission did not reveal any feature of active hepatitis or thyromegaly. Systemic examination was within normal limit. Skin examination revealed itch marks and skin excoriations both the limbs and on other accessible parts of the body. Mental status examination revealed anxious and depressed affect, | delusion of parasitosis, tactile hallucination, impaired insight, and reduced biodrives in a clear sensorium. He was admitted in the psychiatry ward for inpatient management. Serial evaluation and ward observation revealed persistent | 36-year-old male was apparently asymptomatic until August 16, 2011, when, in the background of vague sensation of something crawling under his skin, he developed a sudden onset belief that he has been infested by worms that crawl under his skin as well as travel throughout his body. Over next few days, he experienced these sensation again with which he reinforced his belief to an unshakeable level of delusion, although there were no |
4,060 | 22,700 | Computed tomography showed lymphadenopathy of the mediastinal and subcarinal lymph nodes. Coronary angiography revealed that feeding vessels of the tumor extended from the circumflex artery (). Thoracentesis and pericardiocentesis were performed; however the signs/symptoms of tamponade remained. Cytological findings of the pericardial fluid specimen was grade II and was negative for malignant cells. After a preoperative discussion, our team decided upon a surgical intervention for the definitive diagnosis and to reduce the tumor mass as much as possible to improve the patient’s symptoms. A median sternotomy and pericardiotomy were performed, and the bloody pericardial effusion was removed. The | showed lymphadenopathy of the mediastinal and subcarinal lymph nodes. Coronary angiography revealed that feeding vessels of the tumor extended from the circumflex artery (). Thoracentesis and pericardiocentesis were performed; however the signs/symptoms of tamponade remained. Cytological findings of the pericardial | it into sections. The weight of the resected tumor was 480 g (B). The histopathological diagnosis of the resected tumor specimen was malignant mesothelioma, sarcomatoid type (). The pericardial fluid obtained at surgery showed grade V cytology. It showed irregularly shaped nuclei and numerous mitotic divisions, and the cells were identified as malignant cells. The patient’s symptoms improved and his early postoperative course was uneventful. Postoperative computed tomography showed reduction of the tumor mass (A). We recommended adjuvant therapy for the patient because of his young age and he and his family agreed to proceed. At 3 weeks after surgery, he was administered carboplatin and pemetrexed; however, the tumor progressed. The tumor was irradiated, |
5,598 | 30,553 | proved a childish regression in his understanding of various topics. The patient was asked to assess his current situation of whether or not it was appropriate to treat someone with an allergy on the psychiatric ward versus the medical ward. The patient hesitated at first but eventually said the medical floor was better, however, “The medical floor has the medical tape that grows trees with soaked detergent for the nostrils” perhaps an elaboration of his delusions on the treatment of allergies.\nIn the second week of hospital admission, denial intensity decreased and no signs of anger or depression were shown. The | has the medical tape that grows trees with soaked detergent for the nostrils” perhaps an elaboration of his delusions on the treatment of allergies.\nIn the second week of hospital admission, | his PANSS score was 10 on the positive scale and 23 on the negative scale. He remained focused on the hope that his brother will pick him up at discharge and he will go back to living his life with his brother and neighbors, gardening, and playing video games. Upon the conclusion of our CBT, the patient’s final statement when asked who was taking care of his garden, was “whoever my mother left in charge. She died so she can reincarnate |
33,297 | 18,073 | On physical examination, the patient exhibited marked periorbital swelling unilaterally and a full-thickness, oblique laceration on the right lower eyelid. Upon retraction of the right eyelid, marked conjunctival edema and hemorrhage were noted, and no globe was found on visual inspection. The patient had a Glasgow coma score of 15 with no evidence of any neurological dysfunction. No cerebrospinal fluid (CSF) leakage was noted. A computed tomography (CT) scan revealed that the slightly compressed, deformed globe had extruded into the anterior cranial fossa through | large fractures in the orbital roof, accompanied by cerebral contusion (Fig. a, b). No fractures were noted in the optic canal, but the optic nerve appeared kinked (Fig. b).\nFollowing the diagnosis, the patient was immediately | slight hyphema.\nAfter removing the globe, CSF leakage was noted. Debridement and irrigation were performed at the wound tract. Some bone fragments were placed back at the bone-defective region. The dura was sutured as naturally as possible. Periosteal flaps with pedicles were then transferred to the anterior cranial fossa to cover the dural defect. Biomedical fibrin glue was injected into the flaps to enable adherence. Next, an artificial duramater was used to reinforce the repair. Finally, the wound was closed and a dressing was applied.\nThe patient received intravenous antibiotics and a high dose of corticoids. Tropical steroid drops were used as |
31,683 | 33,349 | acute abdomen was made at this point. As initial treatment she was given intravenous fluids (Ringer’s lactate solution) 1-L bolus, as well as intravenous paracetamol and ondansetron for pain and vomiting, respectively.\nThe initial investigations included a full blood count, which revealed a normal hemoglobin level of 13.2 g/dl, slightly elevated white cell count of 12.28 × 109 cells/L, and normal platelet count of 314 × 109 | paracetamol and ondansetron for pain and vomiting, respectively.\nThe initial investigations included a full blood count, which revealed a normal hemoglobin level of 13.2 g/dl, slightly elevated white | peritoneal lavage were performed, and hemostasis was confirmed (Fig. ). The specimen was retrieved through the 12-mm port and taken for histology. There was no sign of uterus perforation. The pouch of Douglas and rectum appeared normal. All trocars were removed under vision.\nThe postoperative recovery of the patient was unremarkable. She was debriefed about the surgery and discharged |
26,716 | 93,254 | had been diagnosed with prostate cancer one year previously and was on hormone therapy. Three months after diagnosis, he was found to have a rising PSA (prostate specific antigen) and ALP (alkaline phosphatase) as well as pain in his right hip. A bone scan revealed bone metastases. Radiotherapy made no difference to the hip pain. He then tried a variety of analgesics from the family doctor including a NSAID (non-steroidal anti-inflammatory drug) and oral morphine but adequate dosing was hindered by nausea and vomiting.\nHe was eventually referred to a palliative care physician who commenced him on a subcutaneous | therapy. Three months after diagnosis, he was found to have a rising PSA (prostate specific antigen) and ALP (alkaline phosphatase) as well as pain in his right hip. A bone scan revealed bone metastases. Radiotherapy made no difference to the hip pain. He then tried a variety of analgesics from the family | British Caucasian gentleman, had been diagnosed with prostate cancer one year previously and was on hormone therapy. Three months after diagnosis, he was found to have a rising PSA (prostate specific antigen) and ALP (alkaline phosphatase) as well as pain in his right hip. A bone scan revealed bone metastases. Radiotherapy made no difference to the hip pain. He then tried a variety of analgesics from the family doctor including a NSAID (non-steroidal anti-inflammatory drug) and oral morphine but adequate dosing was hindered by nausea and vomiting.\nHe was eventually referred to a palliative care physician who commenced him on a subcutaneous infusion of diamorphine 20 mg and cyclizine 15 0 mg over 24 hours. This controlled |
29,013 | 50,332 | a GT. At the next step, the excision of the mass was planned. We approached the tumor through the mid-axillary longitudinal incision. The previous incision for biopsy was included in the surgical approach. During the operation, the lesion was observed to be an encapsulated mass situated between the scapular body and chest wall. There was no gross adhesion between | mass was planned. We approached the tumor through the mid-axillary longitudinal incision. The previous incision for biopsy was included in the surgical approach. During the operation, the lesion was observed to be an encapsulated mass situated between the | to our clinic for further evaluation.\nUpon physical examination, his lump was revealed to be a fixed and painful mass located at the patient's left chest wall (in the mid-axillary line). No enlarged axillary lymph nodes were detected. His left shoulder's passive motion was in full range, but his active range of motion, especially active forward elevation, was limited.\nThe chest X-ray and shoulder X-ray of our patient were insignificant. His left shoulder magnetic resonance |
32,994 | 61,494 | to the emergency room of our institution complaining of disorientation, restlessness, palpitations, vomiting, abdominal pain, and fever (not quantified) that had begun over 48 hours prior. Worsening symptoms, including right-sided weakness and difficulty understanding verbal language and communication with his spouse in the previous 24 hours, prompted the patient's assistance to our institution. Upon evaluation by the emergency room physician, the patient had a decreased neurological status with poor response to pain and verbal stimuli, for which he was endotracheally intubated to secure his airway. A head computed tomography (CT) scan without intravenous contrast revealed a gross acute | begun over 48 hours prior. Worsening symptoms, including right-sided weakness and difficulty understanding verbal language | the Japanese Thyroid Association criteria for thyroid storm, this case met the criteria for definitive diagnosis of TS1-grade thyroid storm [].\nOur patient was treated aggressively for thyroid storm upon arrival to our institution. Successful extubation was achieve on day 6 following admission. When the patient's mental status recovered, he confirmed that his fever palpitations and nausea preceded the paralysis, confirming that the events of thyrotoxicosis leaded to the stroke. In addition, his sinus rhythm returned to normal after completed hyperthyroidism treatment and his pedal edema improved. The patient was transferred |
22,588 | 127,891 | A 74-year-old man presented to the Eye Emergency Department of Galway University Hospital complaining of a gradual decrease in visual acuity and foreign body sensation in his right eye 8 days post uncomplicated phacoemulsification cataract surgery and intraocular lens insertion. His preoperative assessment was routine with no specific preoperative concerns and he had a normal Schirmer test and normal corneal sensation. He had no relevant medical or surgical history and was not currently taking any medication. Postoperatively, the patient was placed on a regimen which consisted of G. Maxitrol (dexamethasone, polymyxin B sulfate, neomycin sulfate and benzalkonium chloride), one drop four times a day for 2 weeks post procedure and G. Yellox (bromfenac) one drop two | times a day for 3 days before and 11 days post procedure. The patient stated | and the anterior chamber depth fluctuated. Secondary to the fact that it was a non-healing defect in the inferior cornea, a decision was made that the patient undergo a corneal graft. He subsequently had an uneventful slightly eccentric full-thickness tectonic corneal transplant due to the inferior site of the corneal melt and perforation. The patient was placed on 2 hourly preservative-free prednisolone 0.5% and 4 hourly preservative-free chloramphenicol 0.5% drops. His vision improved to 6/36 4 days post transplant. Re-epithelisation was slow but was complete 21 days post operation ().\nDirect questioning revealed that this patient had |
24,022 | 199,543 | patient's head revealed a hypodensed mass with the size of 3 × 3 × 2.4 cm of the right temporal lobe. He was then admitted, and the magnetic resonance imaging (MRI) of his brain showed cystic astrocytoma in the right parietal lobe without midline shifting. A craniotomy was performed, and the pathology showed astrocytoma (World Health Organization | (WHO) grade III). After operation, he received 2-dimensional conformal RT with a total dose of 45 Gy in 25 fractions to the whole brain. Mild skin erythematous change was noted after the completion of RT.\nDuring a | years, MRI of brain showed worsening recurrent tumor in the right frontal lobe and the body of right caudate nucleus. Fourth craniotomy was performed. The pathology revealed anaplastic oligodendroglioma (WHO grade III). The latest follow-up brain image revealed that the disease is under control (Fig. ). He receives regular follow-ups at our outpatient department. Currently, he has survived for more than 26 years since his initial diagnosis of anaplastic |
4,448 | 124,617 | hip in his sleep. He was evaluated in the Emergency Room where a magnetic resonance imaging (MRI) scan was ordered due to the lack of clinical suspicion for hip dislocation. It showed the left hip to be dislocated posteriorly with the ligamentum teres absent (). The hip was reduced with closed reduction techniques, and he was instructed to follow-up with our clinic. Radiographic evaluation in our clinic showed a non-arthritic joint with reasonable lateral coverage and a lateral centre edge angle of 32 degrees with no crossover sign. | hip stabilization and gluteus medius activation. He was also given standard instructions for posterior hip precautions to limit flexion to 90 degrees, adduction to neutral and to limit internal rotation. He was not braced, and the risks of avascular necrosis were discussed. He was instructed to follow-up with our clinic in 6–8 weeks.\nApproximately 4 weeks after his clinical evaluation, he dislocated his | no pertinent orthopaedic past medical or surgical history. He sustained an initial injury to his left hip six weeks prior to presentation following a direct lateral impact during a lacrosse match. The patient felt pain but was able to return to play. Two weeks later, he was running in a lacrosse match and sustained a non-contact left hip injury. He was unable to ambulate and was taken by ambulance to the emergency room, where he was diagnosed with a posterior hip dislocation. He underwent uncomplicated closed reduction within two hours of the injury and was referred for follow-up to the senior author’s practice. Upon examination, his left hip had good |
25,532 | 33,164 | hospital for the transvaginal evisceration of bowel through the vagina. Four days before, when she was 10 weeks pregnant she underwent a uterine dilatation and curettage (D and C) performed by a non-certified health care personnel in an infrastructure that was not a health facility and neither equipped for this procedure. After the D and C was carried out she was sent back home. A few hours later a painful protrusion of her bowels out of the vagina till the vulvar region occurred while she was | defecating. She immediately sought consult in another primary healthcare facility where she was administered analgesics, antibiotics, and a wet sterile drape was applied | Para 0, a refugee residing in Northern Cameroon. She was admitted for protrusion of intestines out of the vagina that occurred 6 h ago following an unsafe D and C intended for termination of her pregnancy when she was at 12 weeks of gestation. On admission, she had a good general condition. There were signs of acute intestinal obstruction. Hemodynamic parameters were normal, as well as other vital signs. The gynecological examination showed a loop of viable small bowel protruding through |
31,700 | 43,866 | and vision loss in the right eye. The patient had been diagnosed with proliferative diabetic retinopathy (PDR) 1 year earlier. The patient provided written informed consent. The patient underwent pars plana vitrectomy combined with retinal photocoagulation and pan retinal photocoagulation in the right and left eyes, respectively. The individual had also undergone Ahmed glaucoma valve implantation 8 months earlier due to NVG. A general history revealed that diabetes mellitus type 2 had been diagnosed 10 years previously and that the patient was treated with subcutaneous insulin injections. The patient’s best-corrected visual acuity (BCVA) was 20 letters [Early Treatment Diabetic Retinopathy Study (ETDRS) chart] in the | left eyes, respectively. The individual had also undergone Ahmed glaucoma valve implantation 8 months earlier due to | BCVA was now 22 letters in the right eye and 25 letters in the left eye. The IOP was 30 mmHg in the right eye and 14mm Hg in the left eye. The rubeosis of the iris had disappeared and the vitreous hemorrhage was slightly improved. However, the retina was still invisible in the right eye. A biomicroscopic examination of the left eye revealed a swollen optic disk with unclear boundaries, several retinal hemorrhages and thinning retinal vessels (). The central retinal |
27,504 | 136,952 | A” QAV) with well-balanced, comparable aortic cusp sizes [], mild-to-moderate aortic regurgitation was confirmed [], and no doming of the cusps was documented in TEE long-axis view [].[]\nThe patient underwent submaximal, fatigue limited, ergometer stress test that revealed no angina-like symptoms neither ECG alterations. High-sensitivity troponin I remained within the normal range limits on several determinations during the hospital stay.\nAs isolated systolic hypertension was diagnosed during hospitalization, a mild | dosage of angiotensin-converting enzyme inhibitor was prescribed.\nConsidering the current clinical condition not suitable for any surgical or invasive treatment, the patient was selected for medical treatment only and regular | arch congenital anomaly and cleft palate and the other one was in good health status. Patient's father died from myocardial infarction at the age of 55, and her mother was affected by systemic hypertension.\nAt admission to our unit, the clinical examination revealed regular heartbeat and 2/6 levine diastolic murmur; blood pressure was 140/80 mmHg and SpO2 was 98% breathing room air. The ECG showed sinus rhythm, and no abnormal findings were detected: the ECG pattern was overall normal |
9,471 | 165,747 | with several episodes of transient weakness involving left lower extremity that lasted for 6 months. Each episode occurred once a week, and lasted approximately for 10-20 seconds. The initial magnetic resonance imaging (MRI) from another hospital revealed multifocal stenosis of cerebral artery including left proximal internal carotid artery (ICA), right proximal external carotid artery (ECA), right middle cerebral artery (MCA) at the M1 segment, and occlusion of right ACA at the A2 segment without any evidence of cerebral infarct in the diffusion weighted imaging. Despite | The initial magnetic resonance imaging (MRI) from another hospital revealed multifocal stenosis of cerebral artery including left proximal internal carotid artery (ICA), right proximal external carotid artery (ECA), right middle cerebral artery (MCA) at the M1 segment, and occlusion of right ACA | oxime was performed to evaluate the patient's hemodynamic status. Brain SPECT showed decreased perfusion and decreased vascular reserve in the right frontal lobe ().\nOral anticoagulant and antiplatelet agent were discontinued 1 week prior to surgery. After 2 months from experience of cerebral infarct, revascularization surgery was performed. After confirmation of sufficient length and integrity of parietal branch of the STA in preoperative ECA angiography, we planned end-to-side anastomosis between ipsilateral STA and distal ACA. Under general anesthesia, curvelinear skin incision was made along the parietal branch of the |
17,318 | 61,637 | lower limbs followed by weakness of lower limbs, involving both distal and proximal muscle groups. Weakness was progressive and ascending, involving both upper limbs and neck muscles by day 6 of the illness. There was no dysphagia, dysphonia, respiratory difficulty or bladder/bowel involvement. There was no significant medical history suggestive of preceding infection, toxin ingestion or similar disease in the past. On examination, there was flaccid quadriparesis (muscle power grade - 3/5) with | areflexia in all 4 limbs. There were no cranial nerve palsies or features suggestive of autonomic involvement. | of 13 years, patient had noticed tingling sensation of distal upper and lower limbs followed by weakness of lower limbs, involving both distal and proximal muscle groups. Weakness was progressive and ascending, involving both upper limbs and neck muscles by day 6 of the illness. There was no dysphagia, dysphonia, respiratory difficulty or bladder/bowel involvement. There was no significant medical history suggestive of preceding infection, toxin ingestion or similar disease in the past. On examination, there was flaccid quadriparesis (muscle power grade - 3/5) with areflexia in all 4 |
6,382 | 14,537 | made, and approximately 50 mL of pus was released. Antibiotics were administered intravenously, and his body temperature returned to normal the next day. Since then, the dressing was changed every day, but the amount of pus drained daily did not decrease, and occasionally, it appeared that gas was emanating from the wound; gradually, a sinus tract was formed. Even after treatment for nearly 3 months, the sinus tract did not heal.\nAfter admission, the patient showed good appetite, stool, urine, good nutritional status, and no fever. Surgical incision scars were observed on | extracted; the pus had a foul odor and was considered to be indicative of abscess formation. One 1 cm incision was | the plain mesh was closely attached to the transverse abdominal fascia and adhered to the mesh plug below. An abscess cavity had formed around the mesh plug from which thin pus was extracted. The area surrounding the mesh plug was relaxed, but the basilar part of the mesh plug was attached to the small intestine, where a small amount of digestive fluid was intermittently discharged. An EF was confirmed intraoperatively (Fig. 2A: The hole probed with forceps was perforated, and a thickened intestinal wall with adhesion to the mesh plug was observed). |
34,643 | 68,295 | patient referred for invasive coronary angiography was a 42-year-old male, active duty US Army soldier, without significant cardiac history, admitted to Brooke Army Medical Center with chest pain. On the day of admission, the patient noted severe substernal chest pain along with lightheadedness, flushing, and nausea. Symptoms persisted for approximately 45 minutes and resolved spontaneously soon following presentation. Electrocardiogram obtained on arrival revealed diffuse ST segment depressions with an initial serum troponin T reported at 0.02 ng/mL. The patient was hemodynamically stable and free from chest pain at the time of admission. The patient was admitted to | substernal chest pain along with lightheadedness, flushing, and nausea. Symptoms persisted for approximately 45 minutes and resolved spontaneously soon following presentation. Electrocardiogram obtained on arrival revealed diffuse ST segment depressions with an initial serum troponin T reported at 0.02 ng/mL. | Center with chest pain. On the day of admission, the patient noted severe substernal chest pain along with lightheadedness, flushing, and nausea. Symptoms persisted for approximately 45 minutes and resolved spontaneously soon following presentation. Electrocardiogram obtained on arrival revealed diffuse ST segment depressions with an initial serum troponin T reported at 0.02 ng/mL. The patient was hemodynamically stable and free from chest pain at the time of admission. The patient |
35,392 | 25,988 | tenderness with superficial palpation with no rebound or guarding. We noted no jaundice, and she had a preserved mental status. Additional blood work revealed elevated lipase (>600 U/L). Routine management for pancreatitis was started with intravenous fluids. Biochemical studies obtained two hours before finalizing the fourth NAC infusion are detailed in Table .\nOn hospital day 3, the patient’s blood work was significant for a marked increase in AST/ALT levels. We contacted the Center for Poison Control again, and they suggested contacting the hepatic transplant team for transfer and further management of the patient. Finally, the patient was transferred to | or guarding. We noted no jaundice, and she had a preserved mental status. Additional blood work revealed elevated lipase (>600 U/L). Routine management for pancreatitis was started with intravenous fluids. Biochemical studies obtained two hours before finalizing the fourth NAC infusion are detailed in Table .\nOn hospital day 3, the patient’s blood work was significant for a marked increase in AST/ALT levels. We contacted the Center for Poison Control | no rebound or guarding. We noted no jaundice, and she had a preserved mental status. Additional blood work revealed elevated lipase (>600 U/L). Routine management for pancreatitis was started with intravenous fluids. Biochemical studies obtained two hours before finalizing the fourth NAC infusion are detailed in Table .\nOn hospital day 3, the patient’s blood work was significant for a marked increase in AST/ALT levels. We contacted the Center for Poison Control again, and they suggested contacting the hepatic transplant team for transfer and further management of the patient. Finally, the patient was transferred to an external institution for |
30,231 | 15,443 | my classmates laughed and looked at me in disgust. At that time, I was crying in secret”.\nAs an adult, Sara continued keeping her secrets, hiding her suffering of an unhappy marriage, and other consequences from her choices. Sara mentioned that she was very slim, and had a great body when she was young, but in order to relieve anxiety she would eat compulsively, ultimately leading to her to obesity. “When I was compulsive, | on her legs which she tried to hide with socks, and which, in turn, resulted in blood stains. “My parents never cared, but | from the need to constantly organize the house and that she had “some manias”, such as positioning the tablecloth and having a specific order to prepare her breakfast, which she hid from her family, so they would not judge her as “an unreasonable person”.\nSara gradually began to reveal facts about her past in a quest to finding the reasons for her symptoms and suffering. Sara’s childhood was marked by a |
26,742 | 72,705 | Slight weakness of the extensor digitorum communis and extensor carpi radialis brevis muscles was detected. Adson's test for TOS was positive with loss of radial pulse and numbness in the left arm and hand, and Wright's hyperabduction test was negative. Plain radiographs of the left shoulder showed that the bony mass adjacent to the clavicle had markedly increased compared with 8 years previously (Figures and ). Computed tomography of the left shoulder showed a bony lesion involving the left clavicle protruding in the posteroinferior direction, adhering to the coracoid process of the scapula; the subclavian artery was located under the | pulse and numbness in the left arm and hand, and Wright's hyperabduction test was negative. Plain radiographs of the left shoulder showed that the bony mass adjacent to the clavicle had markedly increased compared with 8 years previously (Figures and ). Computed tomography of the left shoulder showed a bony lesion involving the left clavicle protruding in the posteroinferior direction, | the arm. Slight weakness of the extensor digitorum communis and extensor carpi radialis brevis muscles was detected. Adson's test for TOS was positive with loss of radial pulse and numbness in the left arm and hand, and Wright's hyperabduction test was negative. Plain radiographs of the left shoulder showed that the bony mass adjacent to the clavicle had markedly increased compared with 8 years previously (Figures and ). Computed tomography of the left shoulder showed a bony lesion involving the left clavicle protruding in the posteroinferior direction, adhering to the coracoid |
41,325 | 97,515 | bowel obstruction. Due to persistent and severe GI symptoms, the patient underwent a second colonoscopy with mucosectomy for deeper tissue studies. The pathology sections showed colonic tissue with normal mucosa, intact muscularis mucosa, and mildly | mucosectomy for deeper tissue studies. The pathology sections showed colonic tissue with normal mucosa, intact muscularis mucosa, | the pulmonary function test, done to assess the function of the patient's lungs, were in favor of a mild restrictive lung disease. An audiogram was also performed to assess the patient's complaints of hearing loss, and it showed bilateral sensorineural hearing loss, while the electromyography showed severe neuropathy with demyelination suggestive of associated myopathy.\nFor the evaluation of the GI symptoms, the patient underwent stool analysis and an esophagogastroduodenoscopy with gastric, duodenal, and ileal biopsies, all of which returned |
3,448 | 128,637 | specific cause related treatment was initiated. Her baseline hematological work-up and vitals including blood pressure were within the normal limits during the antenatal and natal periods.\nThere was no past as well as antenatal history of trauma, fever, fits, or blurring of vision. Her past medical history did not reveal any comorbid medical conditions and she had not | vitals including blood pressure were within the normal limits during the antenatal and natal periods.\nThere was no past as well as antenatal | sort of addictions. On examination, she had a pulse of 80 beats per minute, mildly elevated blood pressure of 140/90 mm of mercury, respiratory rate of 22 breaths per minute. Her blood parameters were within normal limits too, hemoglobin level was measured to be 14 gm/100 mL. A fundoscopic examination was within normal limits. Neurological examinations revealed that the patient had developed left-sided hemiparesis and aphasia and was managed with conservative medical therapy.\nFollowing seizure and loss of consciousness, a preliminary baseline noncontrast CT [] scan of head was performed, it showed changes of early infarct involving bilateral cerebral hemispheres, with the infarct being randomly interspersed and not belonging to any specific vascular territory. |
19,341 | 15,081 | used as the surgical landmark on the posterior side ().\nSecond, the external iliac vein was exposed and the obturator nerve and vessels were preserved. The left ureter was mobilized and divided at the oral side of the tumor. The left internal iliac artery was exposed and the umbilical artery and inferior vesical vessels were divided. At the distal side of | the sigmoid colon was mobilized medially-to-laterally and the root of the inferior mesenteric artery was divided. Subsequently, we mobilized the rectum to the bottom of the pelvic floor on the right and posterior sides while completely preserving the right nerve plexus; this point was | and histopathological examination revealed moderately differentiated adenocarcinoma. Enhanced computed tomography (CT) and magnetic resonance imaging (MRI) showed a large tumor directly invading into the urinary bladder and the left ureter. Besides, an abscess was formed between the tumor and the urinary bladder (Figures and ). Cystoscopy showed no definitive tumor exposed in the mucous membrane, and urine cytology was also negative for cancer. Preoperative staging was cT4bN0M0 |
23,947 | 80,602 | disease (CLD). A computerized tomography (CT) of the abdomen revealed a 9 × 5 cm mass in the right iliac fossa, matted gut loops, enlarged lymph nodes, and splenomegaly. The patient did not improve despite conservative management and an explorative laparotomy was performed five days after admission.\nPeroperatively, it was found that a dense membrane had enclosed the whole of the abdominal contents against the posterior abdominal wall to form three cocoons (). A large cocoon was found extending from the left hypochondrium to the epigastric region (cocoon 1), a second large cocoon was extending from the epigastric region to the pelvis (cocoon 2), and a third smaller cocoon was | in the right iliac fossa (cocoon 3). There was also a moderate amount of purulent ascites found within the abdomen. The cocoons | and so an extensive adhesiolysis of the gut was done from the duodenojejunal flexure to the ileocaecal junction and was found to be wholly viable (). The abdomen was closed after saline irrigation and placement of drain.\nThe samples taken during the surgical exploration were later found to be negative for MTB DNA by PCR and the histopathological report of the encasing membrane revealed fibrosis and chronic inflammation, negative for granulomatous |
35,693 | 111,948 | painful and gradually increasing in size for past 8-weeks ().\nShe had undergone coronary artery bypass grafting (CABG) along aortic valve replacement 2 months earlier at a private centre for which coronary angiogram was performed preoperatively through right transradial route. She was receiving aspirin-325 mg, warfarin-5 mg, frusemide-40 mg, and rosuvastatin- 20 mg.\nAfter few days following angiography, small swelling was noted at the radial puncture site for which she consulted her physician. According to her, manual compression | coronary angiogram was performed preoperatively through right transradial route. She was receiving aspirin-325 mg, warfarin-5 mg, frusemide-40 mg, and rosuvastatin- | Japan) was parked into distal branch of radial artery. 3.5x18-mm Graftmaster covered stent (Abott Vascular, USA) was positioned over the neck of pseudoaneurysm (C).\nThe stent was slowly deployed over one minute time at 14-atm pressure (A). Subsequent angiogram demonstrated complete exclusion of pseudoaneurysm without any spillage of contrast into the sac (B).\nThe sheath was removed after 6 hours of keeping the activated clotting time < 180 seconds and replaced by light pressure bandage using dynaplast, which was removed next day. Ultrasonography on the |
31,873 | 38,644 | gentleman was presented in April 2008 with a mild left hemiparesis and slurred speech. An MRI of the brain showed a 25 × 24 mm mass lesion in the deep right hemisphere area adjacent to the thalamus, which was well defined and of low-signal intensity on T1-weighted images and high-signal intensity on T2 with some low-signal septations within it. There was significant perilesional oedema, and following gadolinium there was ring | enhancement and some enhancement within the septations. Appearances were therefore in keeping with a high-grade glioma ().\nThe patient went on to have a CT-guided biopsy (Medtronic Stealth™), and the histology confirmed GBM multiforme, WHO grade 4. | presented in April 2008 with a mild left hemiparesis and slurred speech. An MRI of the brain showed a 25 × 24 mm mass lesion in the deep right hemisphere area adjacent to the thalamus, which was well defined and of low-signal intensity on T1-weighted images and high-signal intensity on |
7,987 | 78,312 | dialogue; language disorder, especially in expressive language; deficit in motor skills and difficulties in the understanding and execution of tasks and games. With respect to activities of daily living, he showed autonomy in eating and dressing.\nAt 6 years and 10 months of age, he measured 125 cm in height (50th – 75th percentile), weighed 26 kg (50-75th percentile) and had an occipital frontal circumference (OFC) of 52 cm (25th – 50th percentile). Dysmorphological examination revealed low-set ears with prominent helices | 10 months of age, he measured 125 cm in height (50th – 75th percentile), weighed 26 kg (50-75th percentile) and had an occipital frontal circumference (OFC) of 52 cm (25th | 4 years of age, despite having communicative intent, language expression was quite restricted. He also had deficits in psychomotor and cognitive executive function that improved with time, especially regarding sensory integration, and he presented an attention deficit. At 5 years of age, an evaluation of language and cognitive development was performed using the Protocol of Observation Behavioral []. The examinations revealed the following: limited |
4,936 | 118,581 | surgery and anesthesia. The patient gave a history of having undergone a cataract surgery under peribulbar block using bupivacaine and lignocaine 10 months back and a laparoscopic surgery for ligation of fallopian tubes 20 years back under local anesthesia and sedation. She was a diabetic well controlled on oral hypoglycemic drugs. There was a history of back pain since 2 years. There was no history of asthma or any other drug or food allergy. There was no other significant finding on history, examination, and investigations.\nThe patient was | a laparoscopic surgery for ligation of fallopian tubes 20 years back under local anesthesia and sedation. She was a diabetic well controlled on | hemodynamically stable in ICU. She did not require any inotropes and by morning swelling over her face and body had completely subsided. She maintained SpO2 of 97–98% on room air. She was shifted to the ward by afternoon. There was no mention of serum tryptase levels in the notes. She was sent for skin prick test and intradermal test after 6 weeks to an allergy clinic both of which were positive and confirmed IgE-mediated immune |
6,758 | 27,281 | malformation noted at birth. The lesion was centered around the left axilla as well as chest wall and also involved significant areas of the neck and posterior trunk (Figure , ). The patient also had lesions on bilateral posterior scapular regions and the left breast. At the age of two, she underwent combined surgery with pediatric and plastic surgery where the axillary/chest wall lesion was resected | centered around the left axilla as well as chest wall and also involved significant areas | as well as chest wall and also involved significant areas of the neck and posterior trunk (Figure , ). The patient also had lesions on bilateral posterior scapular regions and the left breast. At the age of two, she underwent combined surgery with pediatric and plastic surgery where the axillary/chest wall lesion was resected along with significant neurolysis off the brachial plexus and flap closure.\nSurgical pathology of the mass revealed a 25.5 cm x 17.5 cm x |
35,890 | 133,146 | positive staining for synaptophysin, chromogranin, CAM5.2, and AE1/AE3. She was subsequently followed regularly until March 2014, when repeat imaging showed her tumor had recurred in the sella turcica with asymptomatic invasion into the left cavernous sinus. The patient underwent a debulking resection of the sellar component of the tumor. Upon pathologic review, the recurrence specimen was found to now stain positively for ACTH as well as contain some atypical features including nuclear | CAM5.2, and AE1/AE3. She was subsequently followed regularly until March 2014, when repeat imaging showed her tumor had recurred in the sella turcica with asymptomatic | with our institution in December 2015 to discuss repeat irradiation for her recurrent pituitary macroadenoma and undergo a full endocrine evaluation. At that time, her salivary cortisol levels were found to be approximately four times the upper limit of normal though she remained clinically asymptomatic. She initiated treatment with pasireotide 0.6 mg/mL subcutaneously twice a day and cabergoline 0.5 mg twice a week for this clinically-silent, ACTH-secreting pituitary adenoma with the intent to slowly titrate up her cabergoline dose to 2 mg twice a week. Repeat brain MRI two months later showed |
18,039 | 100,736 | mg IV every 2 hours. About 24 hours later, she had the same severe “mirror image” pain in her left ankle. Some providers questioned the validity of the symmetrical pain in the left ankle due to the unlikely possibility of having vaso-occlusion in such a symmetrical pattern. Physical exam, however, revealed the presence of similar swelling and tenderness over both ankles. Better pain relief was achieved by increasing the dose of morphine to 8 mg IV every 2 hours. She continued to improve gradually and was discharged with her infant ten days after admission.\nThis patient illustrates two important issues in SCD: postpartum | morphine to 8 mg IV every 2 hours. She continued to improve gradually and was discharged with | of pathology. Shunting of the blood away from the bone marrow, the steal syndrome, is another possibility. Another explanation of bilaterality is that it is due to central sensitization at the level of the spinal cord, as described by Woolf in rats. The convergence of nerve fibers from two different sites at the same level in the spinal cord is perceived |
4,362 | 113,482 | for his baclofen pump refill as well as increasing discomfort from spasticity. He was being treated with baclofen administered via an intrathecal baclofen pump that had been originally placed in subfascial position more than 20 years ago. His pump had been replaced twice previously. Specifically, he had undergone one previous end-of-service pump replacement and one revision to replace a fractured catheter, and the patient had not experienced any complications with any of his prior pump refills.\nBecause the patient’s baclofen pump could not be palpated in the created pocket and he continued to have signs of spasticity, | an X-ray was performed, during his referral appointment at the clinic. The X-ray demonstrated a subcostal location of his baclofen pump, but | posterior aspect of the subfascial pump pocket. For this reason, a smaller (20 mL) baclofen pump was filled and inserted instead subcutaneously.\nFollowing the removal of his migrated baclofen pump and its replacement with a subcutaneous one, the patient was discharged home on postoperative day 7 only to return on postoperative day 9 with constipation and abdominal pain. Subsequently, he was readmitted and placed on a strict bowel regimen with milk of molasses enema treatments. As his diet was slowly advanced, he was monitored for any evidence |
25,556 | 153,477 | of general weakness and poor oral intake. She had an underlying disease of diabetes and hypertension for 10 years and had been treated with medications at the local clinic, which included metformin, glimepiride, hydrochlorothiazide, losartan, and atorvastatin. She also had severe osteoarthritis at both knee joints and had multiple steroid injections at the local orthopedic clinic. Approximately 2 weeks before admission, she had been admitted for treatment of urinary tract infection (UTI). At that time, blood culture and urine culture showed growth of Escherichia coli and was treated with ceftriaxone and tazobactam. She was not on any antihypertensive medication for 2 weeks.\nPhysical examination showed the | following findings: height 152 cm, body weight 57 kg, blood pressure 70/50 mmHg, heart rate 70 beats per minute, and respiratory rate 20 per minute, with body temperature 36.5°C. Decreased skin and tongue turgor were observed. Pulmonary, cardiac, abdominal, and neurologic examinations were unremarkable.\nshows the laboratory data at admission and those 2 | tongue turgor were observed. Pulmonary, cardiac, abdominal, and neurologic examinations were unremarkable.\nshows the laboratory data at admission and those 2 weeks before admission. Her outpatient laboratory data checked at 2 weeks prior to admission showed normal levels of serum creatinine and calcium. Serum magnesium level decreased to a lower limit of normal range at admission. Fractional excretion of sodium was 1.0%.\nHaving pyuria and hypotension, with a previous history of UTI, she was first diagnosed as UTI sepsis. She was admitted |
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