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35,846 | 41,086 | extensive limb deformities reported to the department of Oral Medicine, Diagnosis, and Radiology with a chief complaint of unclear speech and difficulty in tongue movements.\nThe patient's medical history was | to the department of Oral Medicine, Diagnosis, and Radiology with a chief | But speech was affected minimally.\nMandibular anteriors were retroclined with congenitally missing right central incisor (). There was no radiographic evidence of impaction. Palate was V shaped, high arched, and narrow. Maxillary left lateral incisor was palatally positioned, thus blocking the regular alignment of mandibular anteriors. Anterior deep bite was observed (). Root stumps of maxillary left first premolar, mandibular first molars, and mandibular right second molar were present ().\nPresence of a small tongue in association with extensive limb deformities led to the diagnosis of |
838 | 88,647 | to provide the total daily calorie requirement.\nHypothermia was a major feature during this period and was treated with passive heating using an air heater and blankets to maintain temperature > 36°C. After ten days of somatic support, the patient developed ventilation-associated pneumonia, which was treated with ceftriaxone, and a tracheotomy was performed to facilitate bronchial hygiene and mechanical ventilation.\nFoetal well-being was thoroughly evaluated by electronic foetal heart rate monitoring, foetal Doppler velocimetry and biophysical profile. Betamethasone was used to accelerate foetal lung maturity. During a total of twenty-five days of prolongation, the maternal organism remained mostly stable. Nevertheless, in the last week of prolongation progressive oligohydramnios was detected in the | foetus and a Doppler test revealed centralization (brain sparring). Foetal status helped in reaching the decision to perform a Caesarean section at that moment. It is possible that, even at the low doses used, the vasoconstrictors may have | of epinephrine. Pressure-limited mechanical ventilation was used to manage mild respiratory alkalosis (CO2 = 32 mmHg) and an arterial oxygen saturation greater than 94%.\nBasal energy expenditure (BEE) was calculated using the Harris-Benedict formula (BEE = 655 + [9.6 × weight(kg)] + [1.8 × height(cm)] - [4.7 × age(yr)]), multiplied by 1.25 (stress factor for pregnancy), adding 300 Kcal for a single foetus and deducting 15% from the BEE to compensate for the reduction in metabolism associated with the state of brain death []. |
29,069 | 104,053 | the dispersion of chronic inflammatory infiltrates predominantly lymphocytes along with blood vessels and red blood cells in the connective tissue. With the above mentioned histopathological findings, it is suggestive of inflammatory fibrous hyperplasia.\nThe full-mouth gingivectomy was performed using an external bevel incision [Figure –]. Adequate amount of hemostasis was achieved, and a periodontal dressing (Coe-Pak) was given []. Amoxicillin 500 mg – 15 tablets for 5 days and analgesic (tramadol and acetaminophen) – 6 tablets | infiltrates predominantly lymphocytes along with blood vessels and red blood cells in the connective | vessels and red blood cells in the connective tissue. With the above mentioned histopathological findings, it is suggestive of inflammatory fibrous hyperplasia.\nThe full-mouth gingivectomy was performed using an external bevel incision [Figure –]. Adequate amount of hemostasis was achieved, and a periodontal dressing (Coe-Pak) was given []. Amoxicillin 500 mg – 15 tablets for 5 days and analgesic (tramadol and acetaminophen) – 6 tablets for 3 days were prescribed in reference with the physician's consent. Postoperative instructions were given. The patient was recalled after a period of 2 weeks and assessed. The |
34,218 | 36,572 | was free climbing with her boyfriend near Gunnison, Colorado. Both were wearing a helmet and a harness for safety. The girl had 20 years of experience of rock climbing, being taught early tricks by her father at the age of 8 years. The ascent consisted of three pitches of 90-100 feet (ca. 30 m) each. The climbing distance was defined by the climbing rope which had been fixed at a defined length. The girl took the lead on the third pitch, to a total height of 300 feet (ca. 90 m). After securing the anchor at that height, the rope - which was | lacking a security knot - slid through her harness. She then fell a total of 300 feet, with a first impact at 200 feet onto a flat rock surface, and a further fall for about 100 feet. | the L1 burst fracture which may have further complicated her bowel and bladder management. The applied spinal and pelvic fixation techniques facilitated her mobilization without adjunctive truncal bracing. The initial efforts for self-care and mobilization, however, were complicated by orthostatic hypotension, nausea and anxiety felt to be multi-factorial in etiology. The weight bearing precautions to the lower extremities were discontinued around 9 weeks post injury, based on progressive callus formation seen on follow-up X-rays (Figure ). The patient quickly progressed |
23,979 | 199,609 | titrated to 40 mg/day. The subject of seeing her father was closed. She stated that this made her feel good, and she registered for a painting course.\nWhile she was under follow-up in a child and adolescent psychiatry clinic, she was admitted to a paediatric gastroenterology clinic because of complaints of dysphagia with retrosternal pain, heartburn, involuntary vomiting of undigested food and weight loss. Oesophagogastrodu-odenoscopy showed retention of liquid in the oesophagus, so oesophageal manometry was quickly carried out, and the results were strongly consistent with achalasia | a child and adolescent psychiatry clinic, she was admitted to a paediatric gastroenterology clinic because of complaints of dysphagia with retrosternal pain, heartburn, involuntary vomiting of undigested food and weight loss. Oesophagogastrodu-odenoscopy showed retention of liquid in the oesophagus, so oesophageal manometry was quickly carried out, and the results were strongly consistent with achalasia | The subject of seeing her father was closed. She stated that this made her feel good, and she registered for a painting course.\nWhile she was under follow-up in a child and adolescent psychiatry clinic, she was admitted to a paediatric gastroenterology clinic because of complaints of dysphagia with retrosternal pain, heartburn, involuntary vomiting of undigested food and weight loss. Oesophagogastrodu-odenoscopy showed retention of liquid in the oesophagus, so oesophageal manometry was quickly carried out, and the results were strongly consistent with achalasia in the patient. After a joint meeting of the paediatric gastroenterology and paediatric surgery departments, a decision to operate was |
553 | 31,393 | in front of the colon, and portoenterostomy was performed. The jejunum was anastomosed to the\nporta hepatis\nusing 5–0 PDS II, which sufficiently covered the biliary outflow site (\n).\nThe biliary tract was reconstructed using the Roux-en-Y procedure, with the creation of a Nakajo-type enteric antireflux valve at a point 10 cm toward the liver from the Roux-en-Y limb and the Roux-en-Y limb was secured at an acute angle by suturing the seromuscular layer, to prevent food reflux. We performed an antireflux plasty using the intussuscepted valve Roux-en-Y procedure, according to the technique performed | outflow site (\n).\nThe biliary tract was reconstructed using the Roux-en-Y procedure, with the creation of a Nakajo-type enteric antireflux | cm in length was elevated in front of the colon, and portoenterostomy was performed. The jejunum was anastomosed to the\nporta hepatis\nusing 5–0 PDS II, which sufficiently covered the biliary outflow site (\n).\nThe biliary tract was reconstructed using the Roux-en-Y procedure, with the creation of a Nakajo-type enteric antireflux valve at a point 10 cm toward the liver from the Roux-en-Y limb and the Roux-en-Y limb was secured at an acute angle by suturing the seromuscular layer, to prevent food reflux. We performed an antireflux plasty using the |
35,291 | 11,652 | with bipolar resectoscope for recurrent left lateral bladder wall, bladder neck, and prostatic mass. The pathology again returned leiomyoma without sarcomatoid differentiation. A month after discharge the patient presented to an outside Emergency Room after developing gross hematuria. He was transferred for continuous bladder irrigation and refractory hematuria which required urgent TURBT to fulgurate bleeding vessels at the left lateral bladder neck and resect additional tumor regrowth.\nThe patient followed up in clinic 1 month later, and after an in-depth discussion of his | an outside Emergency Room after developing gross hematuria. He was transferred for continuous bladder irrigation and refractory hematuria which required urgent TURBT to fulgurate bleeding vessels at the left lateral bladder neck and resect additional tumor regrowth.\nThe patient | notable for bilateral pelvic adenopathy with lymph nodes greater than 2 cm and an interaortocaval lymph node of approximately 1.2 cm. Additionally, outside CT scan with IV contrast of abdomen pelvis showed large 6 cm heterogeneous soft tissue mass within the posterior left aspect of the bladder (). The mass was causing complete obstruction of the left ureterovesical junction (UVJ), which resulted in severe left sided hydronephrosis and hydroureter. Although the CT findings were highly concerning for metastatic process, the TURBT specimen did not support the diagnosis of metastatic disease from a bladder |
14,783 | 67,854 | the sensation over the rest of his face was normal. His corneal reflexes and his bite force were normal. Examination of other cranial nerves and limbs including motion, sensation, and reflex was normal.\nHemanalysis showed normal in full blood count, erythrocyte sedimentation rate, plasma glucose, urea and electrolytes, serum C reactive protein, creatinine, liver function, and immune indices. Syphilis antibody and tumor markers were all negative.\nAccording to the | reflex was normal.\nHemanalysis showed normal in full blood count, erythrocyte sedimentation rate, plasma glucose, urea and electrolytes, serum C reactive protein, creatinine, liver function, and immune indices. Syphilis antibody and tumor markers were all | conduit mouth was swollen. No enlarged lymph node was palpable.\nHe underwent a maxillofacial surgery and the tumor was resected. The histopathological examination showed infiltration of carcinoma cells with nest-like distribution in the fibrous tissue and bone (Figure ). The carcinoma cells, round and oval in shape and most in mitosis, were abundant of cytoplasm. The pathomorphological features revealed an epithelial malignant tumor, which was considered as a ductal adenocarcinoma derived from salivary gland with potentially low differentiation. Both of the two inferior alveolar nerves were invaded by tumor and metastases were discovered in the right submandibular lymph nodes.\nThe patient |
11,560 | 128,481 | to us. Investigation in the form of radiograph () depicted diffuse osteolysis and cortical destruction in lateral femoral condyle. Magnetic resonance imagingMRI of the lesion illustrated the heterogeneous decreased signals on T1 sequences and areas of hyperintensities on T2 sequences with overall picture suggestive of recurrence ( and ). Complete surgical excision of the tumor and articular surface reconstruction was planned as described by D’ Aubigne []. A 15-cm long vertical incision was made over anterolateral aspect of distal thigh and right knee and quadriceps tendon, patella and patellar tendon exposed. | sequences with overall picture suggestive of recurrence ( and ). Complete surgical excision of the tumor and articular surface reconstruction was planned as | Pre-operative and : 3-month post-operative radiograph). The patient did not relieve his pain in knee joint (which he had before surgery) throughout the course of the treatment. He consulted the primary surgeon for the same and advised active range of motion exercises. The pain kept on increasing, especially |
9,992 | 115,026 | uniform surface without stigma of hemorrhage or necrosis (Figure ). Histologically the polyp showed a central core of adipose and fibrovascular tissue surrounded by overlying squamous mucosa (Figure ). An immunohistochemical stain for MDM-2 supported the diagnosis of liposarcoma (Figure ). Focal areas of ossification were noted. In addition, there were scattered atypical cells with abundant eosinophilic cytoplasm, positive for desmin and also focally myogenin positive (Figure ). The rhabdomyomatous differentiation is considered a low grade lesion (Figure ).The final resection margin was uninvolved by the tumor. Patient recovered uneventfully and was discharged from the hospital on postoperative day 1. On follow | from the hypopharynx.\nPathology identified the 13.0 cm × 6.0 cm × 2.6 cm specimen as a well-differentiated liposarcoma arising in a giant fibrovascular polyp. Grossly the polyp had tan | without stigma of hemorrhage or necrosis (Figure ). Histologically the polyp showed a central core of adipose and fibrovascular tissue surrounded by overlying squamous mucosa (Figure ). An immunohistochemical stain for MDM-2 supported the diagnosis of liposarcoma (Figure ). Focal areas of ossification were noted. In addition, there were scattered atypical cells with abundant eosinophilic cytoplasm, positive for desmin and also focally myogenin positive (Figure ). The rhabdomyomatous differentiation is considered a low grade lesion (Figure ).The final resection margin was uninvolved by the tumor. Patient recovered uneventfully and was |
3,363 | 158,660 | remote possibilities of an infected joint. No organism grew on culture. Other than radiography and MRI, all the hematological investigations were within normal limits, on the basis of which syphilis and diabetes were ruled out. A purified protein derivative test was nonreactive. X-ray of right shoulder showed complete destruction of humeral head with fragmentation, which falls into the resorptive variant of Charcot shoulder []. X-ray of the left shoulder showed anterior dislocation of shoulder with fragmentation of head and heterotopic new bone formation []. No biopsy was performed. | was nonreactive. X-ray of right shoulder showed complete destruction of humeral head with fragmentation, which falls into the resorptive variant of Charcot shoulder []. X-ray of the left shoulder showed anterior | painful on terminal range of motions. His biceps strength was 4/5, triceps strength was 5/5 while motor strength in bilateral distal extremities was 5/5. There was decreased sensation involving the entire upper extremities bilaterally and healed trophic ulcers found on the fingers and dorsal and ulnar border of the hand and forearm . The biceps, triceps and brachioradialis reflex were |
23,454 | 14,340 | clindamycin 900 mg three times daily, gentamicin 240 mg once daily, and cefazolin 1 g three times daily. The patient continued to improve and repeat ultrasound showed a residual ovarian cyst of 3 cm with some heterogeneity within; thus, further surgical intervention as this stage was not considered necessary. The final histopathology report confirmed endometrioid cyst. As S. lugdunensis was deemed the causative organism and is associated with severe infection, these antibiotics were continued until discharge after 25 days of hospitalization. On discharge, the patient remained on a 7-day course of oral clindamycin 150 mg and cefalexin 500 mg, both three times daily. She remained under surveillance throughout pregnancy, without further sequelae.\nFollow-up ultrasound examination showed a | of the infected cyst, the patient improved and the WBC decreased to 16 000 per mm3. Microbiological cultures from the abdominal fluid were negative, but two bacterial organisms were detected in cultures obtained from the ovarian abscess: Staphylococcus lugdunensis (S. lugdunensis), and Peptoccocus anaerobius (P. anaerobius), both of which were sensitive to clindamycin and resistant to penicillin. Antibiotic therapy was, therefore, changed to intravenous | team. Upon entry into the peritoneal cavity, greenish free fluid and fibrin were observed in keeping with the clinical picture of generalized peritonitis. Microbiological cultures were taken from the peritoneal fluid. Exploration revealed that the abdominal organs, including the appendix stump, were normal. The right enlarged ovary, however, remained deeply adherent in the pouch of Douglas and |
1,971 | 121,482 | read until he was calm enough to resume sleep. On a few occasions he took 0.25–0.5 mg of lorazepam, often with a glass of wine. The only other medications the patient used were fluticasone 100 mcg-salmeterol 50 mcg inhalation powder (Advair®, GlaxoSmithKline) and albuterol HFA, both for occasional asthma exacerbations. The anxiety symptoms occurred virtually every night by the fourth week of taking montelukast.\nThe patient reported that in the daytime he was also frequently overcome by morbid fears of such things as aging in loneliness, his children failing at life or worldwide economic collapse. At other times he would suddenly | feel extreme anxiety about expectations of him at his workplace, in which he experienced a wave of sympathetic arousal, mainly felt as flushing and an increased heart rate. Because of the night-time awakenings he was | out of bed and read until he was calm enough to resume sleep. On a few occasions he took 0.25–0.5 mg of lorazepam, often with a glass of wine. The only other medications the patient used were fluticasone 100 mcg-salmeterol 50 mcg inhalation powder (Advair®, GlaxoSmithKline) and albuterol HFA, both for occasional asthma exacerbations. The anxiety symptoms occurred virtually every night by the fourth week of taking montelukast.\nThe patient reported that in the daytime he was also frequently overcome by morbid fears of |
22,187 | 100,271 | who underwent delayed treatment for a missed Monteggia fracture dislocation after 9 years was referred to our clinic with complaints of an obvious left cubitus valgus deformity and snapping during wrist pronation–supination. In addition to movement limitations and cosmetic problems, the patient also had elbow arthralgia while lifting weights. The physical examination showed that the bony prominence of the radial head could be felt at the anteriolateral region of the elbow joint. No neurological complications, including tardy ulnar nerve palsy and posterior interosseous | obvious left cubitus valgus deformity and snapping during wrist pronation–supination. In | then attempted, but it failed. We then performed an oblique osteotomy at the proximal one-third of the ulna through the same incision. Angulation and elongation were temporarily maintained by an external fixator, and the interposed ligament was stretched from the joint space and was reduced around the radial head, as described in our previous study. Next, the osteotomy was fixed with a prebent plate in exchange of a temporary external fixator (). The stability of the radial head was assessed in flexion–extension under direct visualization, and the residual annular |
9,910 | 82,004 | lobe of lung without signs of neighboring pleura invasion (Fig. and ). There was no enlarged lymph node of the pleural cavity found. Whole body F18-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT study was not preformed at that time because there was no sign of tumor distant metastasis. Since the patient was a young adult, the preoperative impression of the lesion was a mesenchymal sarcoma of lung. The patient underwent a left lobe-ectomy of lung, and the mass was gross totally resected. Postoperative recovery was uneventful without surgical complications. After diagnosis, the patient received Crizotinib, an oral anaplastic lymphoma kinase inhibitor, at a dose of 250 mg twice daily. However, the patient rapidly | serum tumor markers and liver and renal function, were within the normal range. The CT images acquired at the local hospital showed a 10.0 × 8.0 cm well-circumscribed mass in the left lower | neighboring pleura invasion (Fig. and ). There was no enlarged lymph node of the pleural cavity found. Whole body F18-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT study was not preformed at that time because there was no sign of tumor distant metastasis. Since the patient was a young adult, the preoperative impression of the lesion was a mesenchymal sarcoma of lung. The patient underwent a left lobe-ectomy of lung, and the mass was gross totally resected. Postoperative recovery was uneventful |
40,066 | 14,564 | (Fig. B). The other half of the tissue was used to grow adherent CSCs, where the cells were cultivated on gelatin coated culture dishes in the medium described above supplemented with 10% fetal calf serum (Fig. A).\nAfter successful cultivation, cells were analyzed according to their expression profile of cancer stem cell and neuroendocrine specific markers, as well as their morphology. Immunocytochemical double staining of the lung cancer stem cell markers CD133 and CD44 confirmed the isolation of cancer stem cells (Fig. C). Additionally, cultivated cells | were positive for the neuroendocrine marker synaptophysin underscoring the establishment of the relevant cancer stem cells. Synaptophysin was especially | admitted to the hospital in November 2018. The clinical examination showed no abnormalities. Biochemical parameters in blood showed normal values apart from slightly elevated gamma-glutamyl-transferase (GGT) (160 U/l, normal up to 40U/l). She never smoked and had no family history of lung or gastrointestinal cancers. She developed dry cough over the last 6 weeks, which was resistant to treat. Therefore a chest X-ray was done, which showed an irregular left border of the heart. A subsequent chest CT-scan showed a paracardiac nodule with 2 × 1.8 cm in diameter (Fig. ), no mediastinal lymph nodes enlargement and no pleural |
7,229 | 114,371 | the patient history, in the evening of the first day of the onset of symptoms the patient reported a temperature of 40°C, pain in the lower limbs and muscular pain. The next day, the patient was without fever but developed a sore throat and had enlarged submandibular lymph nodes. The patient was consulted by her family doctor, who diagnosed a throat infection and prescribed second-generation cephalosporin (cefuroxime axetil) and ibuprofen. After a few days, the sore throat was relieved, although the fever remained. Five | days later, the patient went to a gynecologist with the symptoms of intense lower abdominal pain during her menses; a gynecological examination revealed no abnormalities. On the basis of her fever for the previous 8 days | again because of tonsillitis accompanied by another episode of edema of the joints. At the age of 14, the patient underwent tonsillectomy. The girl was then consulted by a rheumatologist – but the diagnosis of a connective tissue disease was not established. The consulting hematologist did not recommend bone marrow examination. The current process of diagnostic laboratory tests revealed elevated inflammatory markers: ESR, CRP, PCT. Serum ferritin concentration was slightly elevated, and serological markers indicated previous infection with Epstein-Barr virus (EBV), cytomegalovirus (CMV) and Mycoplasma pneumoniae. Immunoelectrophoresis showed increased concentrations of α-globulins. Both antinuclear antibodies (ANA) and anti-neutrophil cytoplasmic antibodies (ANCA) were negative. On three separate occasions, blood culture |
34,898 | 83,553 | the maxillary sinus. On the left sinus, the same image pattern, corresponding to a dental implant, was found; however, no sign of sinusitis was found. Computed tomography (CT) showed implants displaced into the maxillary sinus cavity with a significant opacification of the right maxillary sinus; however, the left sinus did not present the opacification; only the implant did (Figures and ).\nSurgical Procedure. The patient was operated under local anesthesia (Figures and ). An oral antibiotic prophylaxis (amoxicillin + | sinus, with no sign of oroantral fistula ().\nAfter examination of panoramic radiography, two similar images of dental implants were noted in the right maxillary sinus with evidence of sinusitis, including opacification of | with a nonsteroidal anti-inflammatory drug every 8 h for 7 days. Chlorhexidine mouthwashes were used along with usual oral hygiene for 7 days. The patient was instructed to avoid using a mucosupported prosthesis for 15 days to prevent suture dehiscence. The postoperative recovery was uneventful. After 7 days, the patient returned to the university for suture removal and clinical examination. Twelve months after the procedure, a CT scan showed the maxillary sinus without the opacification, with no sign of |
29,122 | 145,455 | poorly controlled hypertension and monoclonal gammopathy of undetermined significance (MGUS) was admitted to our hospital with right lower extremity cellulitis complicated by the hematuria, thrombocytopenia and acute kidney injury (AKI). He initially came to our institution for a consultation on his MGUS and what was described as a recurrent post-infectious GN. Two days after arrival, the patient developed cellulitis and was started on oral cephalexin within 24-h of the initial symptoms. On the next day, he felt no improvement. He began to notice amber-colored urine exactly as it happened in three previous episodes that resulted in acute renal failure and he was later diagnosed as having | recurrent post-infectious GN. This was his fourth episode (E4) of the recurrent GN, which prompted his admission to the hospital.\nThe patient suspected that his initial episode could have happened 8 years earlier after he went on a hunting trip and developed a viral syndrome. Within several weeks, he gained around 30 | hospital, his platelet count had dropped to 40 × 109/L, and his creatinine was up to 3.2 mg/dL (283 mcmol/L). Eventually, his creatinine reached 6.1 mg/dL (539 mcmol/L) and he developed nephrotic-range proteinuria with a urine protein/osmolarity ratio of 7.46 [(mg × kg H2O)/(mOsm × L)]. He was treated with high-dose intravenous (IV) steroids, which lead to resolution of the hematuria and improvement of the renal function and proteinuria. At admission, the patient’s antibiotic regimen was switched to vancomycin which improved the cellulitis symptoms. He was dismissed with the creatinine of 4.6 mg/dL |
15,744 | 48,849 | of the country and she did not possess any documentation. Symptoms had persisted postpartum until the current presentation.\nShe denied suffering from or being treated for a sexually transmitted infection earlier. She had one sexual partner and did not have evidence or suspicion that her husband had other sexual partners. The patient was not on treatment for any | being treated for a sexually transmitted infection earlier. She had one sexual partner and did not | undertaken or their results nor the names of antibiotics given during pregnancy were not available because care had been in a different hospital in a different part of the country and she did not possess any documentation. Symptoms had persisted postpartum until the current presentation.\nShe denied suffering from or being treated for a sexually transmitted infection earlier. She had one sexual partner and did not have evidence or suspicion that her husband had other sexual partners. The patient was not on treatment for any other chronic medical conditions and had not had |
5,280 | 23,051 | and was evident radiographically. On three years follow up, the patient complained of some growth without pain around the neck of the implants on the transplanted fibula. A biopsy was then performed that reported negative. On examination, it was observed that complete mucosalization of the skin graft had occurred with no observable distinction from the mandibular mucosa of the patient. It was concluded that the growth was the granulation tissue around the implants which was then excised by soft tissue 810 nm laser with 400 μm fibre. Presently, the patient | by carbide burs and all implants were checked for the stability. One loose implant was found to be in contact with the osteosysnthesis screws and thus failed to osseointegrate and was hence, removed. The prosthesis was refabricated keeping sanitary intaglio profile. Tissue around the implants were asymptomatic with no complaints from the patient. The surgeon was successful in achieving the union of the fibula to native mandible | and 23 mm. The ZDI® implant of 4.6 mm diameter and length 35 mm was angulated towards the left symphysis from the mesial aspect of fibula flapless and bended by AHB® adapter for the restorative acceptable position. The placement of implants were itself a challenging task as the implants were long |
32,083 | 113,990 | with a past medical history of hypertension and chronic obstructive pulmonary disease (COPD) presented to an outside hospital with altered mental status and acute renal failure 3 days after an uncomplicated right total hip arthroplasty performed for avascular necrosis of the femoral head secondary to chronic steroid use. Initial workup included computed tomography (CT) imaging of the chest, abdomen and pelvis and was significant only for aspirated material in the trachea. She was urgently transferred to our tertiary referral center | for further workup and management. On admission, she was obtunded, hypotensive, found to have a well-healing right hip wound, and her abdomen was noted | Blood cultures returned positive on HD2 for Pseudomonas aeruginosa and Klebsiella oxytoca. She had a mild leukocytosis and normal lactate. During the following week, she had continued need for critical care although she was weaned off of vasopressors and was tolerating enteral nutrition. Within that period, she was also started on a heparin drip for a questionable |
36,935 | 91,945 | the second twin born of in-vitro fertilized donor eggs to a 47-year-old nulliparous woman at 301/7 weeks gestation. The pregnancy was complicated by hypertension requiring 10 days of hospitalization prior to delivery for administration of labetolol. Her condition was associated with normal liver function tests and a platelet count of 150,000/ mcl. Prior to delivery, the mother received dexamethasone and ampicillin therapy because of the unknown status of her group B streptococcus cervical cultures. Premature spontaneous vaginal delivery (ascribed to hypertension and mild toxemia) was complicated with breech presentation and poor respiratory | effort requiring 30 seconds of positive-pressure ventilation. Apgar scores were 5 at one minute and 7 at five minutes. The infant was intubated for worsening respiratory distress at 20 minutes of life. Initial arterial blood gas demonstrated a pH of 7.35, carbon dioxide of 44 mmHg, PaO2 of 66 mmHg with a bicarbonate level of 23 mg/dl and a base deficit of -1.6. Beractant was delivered via endotracheal tube at 1.5 hours of life. Echocardiography revealed a 2 mm patent ductus arteriosis on the first day of life | were normal for gestational age. Chest X-Ray () was consistent with acute pulmonary hemorrhage.\nAfter placement on high frequency oscillatory ventilation (HFOV) as well as three rapid infusions of packed red blood cells, the infant stabilized. Treatment with vancomycin, cefotaxime and acyclovir were initiated. Blood culture and surface cultures for herpes simplex virus were negative. The possibility of RSV was entertained upon discussion with the nurse caring for the infant. She noted the patient's father |
36,025 | 124,442 | observed to confirm no obvious leakage after the reoperation (Fig. and Fig. ). The patient was returned to ICU ward after the second surgery, and was still given continuous conservative therapy. The next day after the reoperation, the drainage output diminished from about 9000 mL per day down to about 5000 mL per day. After a long | period of conservative treatment (lasting almost 7 months), the drainage gradually decreased to zero. Abdominal sonography on the eighth postoperative month revealed no fluid accumulation in abdominal cavity, especially in the right subhepatic space, and then the drain was removed. The patient was discharged | was returned to ICU ward after the second surgery, and was still given continuous conservative therapy. The next day after the reoperation, the drainage output diminished from about 9000 mL per day down to about 5000 mL per day. After a long period of conservative treatment (lasting almost 7 months), the drainage gradually decreased to zero. Abdominal sonography on the eighth |
27,048 | 12,698 | our department of radiation oncology from the department of urology for the purpose of palliative irradiation on March 1 of 20XX. She was followed up by the department of urology for nine years for a tumor in the right kidney (1.7 cm in size). The follow-up consisted of computed tomography (CT) without biopsy because of the stable nature of the tumor. She also received hemodialysis for six years because of chronic renal dysfunction.\nIn the summer of 20XX-1, the patient noticed a tiny tumor in her left cheek. After January of 20XX, the tumor showed rapid growth. On February | 21 of 20XX, the tumor was 2 cm in diameter with a violaceous appearance, and a biopsy of the tumor was performed. The immunohistochemical (IHC) analysis showed that the biopsy specimen was positive for chromogranin, synaptophysin, and CD56 and negative for thyroid transcription factor-1 (TTF-1), S-100, and human melanin black-45 (HMB-45). The pathologist reported it as | a violaceous appearance, and a biopsy of the tumor was performed. The immunohistochemical (IHC) analysis showed that the biopsy specimen was positive for chromogranin, synaptophysin, and CD56 and negative for thyroid transcription factor-1 (TTF-1), S-100, and human melanin black-45 (HMB-45). The pathologist reported it as a metastatic neuroendocrine tumor of unknown origin. Based on the pathology report, the urologist diagnosed the tumor as a metastatic tumor derived from the right kidney. The patient was referred to the departments of dermatology and plastic surgery. The dermatologist and the plastic surgeon agreed with the diagnosis made by the pathologist and the urologist and considered the tumor inoperable because of its extremely rapid-growing nature. The patient was referred |
5,597 | 30,553 | to get his allergies controlled. A gentle exploration of psychotic symptoms was performed given his poor insight and reality testing. He denied any auditory or visual hallucinations as well as suicidal or homicidal intentions at the time. The patient denied feeling sadness, anhedonia, excessive guilt, hopelessness, worthlessness, or a decrease in concentration. The patient did not display any signs of grief during the interview sessions, stating he lives at home with his mother and referring to her in the present tense. The patient’s denial of his mother's | and cooperative. However, he displayed poor insight into his reason for hospital admission, stating he had been in the hospital | 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 |
8,891 | 80,277 | culture, were within normal range. Her past medical history included a rhabdomyosarcoma of the right buttock surgically treated at the age of six months and a germiline pathogenic p53 mutation (Li-Fraumeni syndrome). She did not take any regular medication and she was in good general health. An abdominal | ultrasound scan revealed two uncertain-in-nature lesions, one within the right part of liver and one within the upper pole of the right kidney.\nA subsequent MRI scan of liver and kidneys confirmed the presence of the two lesions that were shown at ultrasound scan. The lesion within segment 7 | of the right buttock surgically treated at the age of six months and a germiline pathogenic p53 mutation (Li-Fraumeni syndrome). She did not take any regular medication and she was in good general health. An abdominal ultrasound scan revealed two uncertain-in-nature lesions, one within the right part of liver and one within the upper pole of the right kidney.\nA subsequent MRI scan of liver and kidneys confirmed the presence of |
12,448 | 109,713 | surgery with ESR and CRP in normal range, the patient was operated in lateral position through posterior approach. The soft-tissue dissection and the dislocation of femoral head posed difficulty due to presence of soft-tissue contracture and fibrous tissue surrounding the hip joint. After acetabulum preparation, femoral canal preparation was done using small rasps and broaches and completed with no complications.\nUncemented total hip arthroplasty was done using Zimmer implant of acetabulum (Mallory head acetabulum shell 46 mm) with two self-tapping bone screws of size 6.5 mm, femoral component (uncemented Wagner cone prosthesis, 135°, size 16 with ceramic femoral head size of 28), and polyethylene liner of size 22. | of the contracted soft tissues. The patient was also started with physiotherapy to increase the strength in the affected muscles around the hip. As the patient’s X-ray showed hip with narrow femoral canal (champagne flute canal) (), templating for the hip was done and surgery was planned as total hip arthroplasty using a Wagner cone stem for the femoral component. After obtaining fitness for | no treatment taken for the same. The patient had no history of tuberculosis, weight loss, anorexia, morning stiffness, other joints involvement, or any history of drug abuse. The patient was not a known case of asthma, diabetes, and hypertension. The patient had no history of chronic alcohol consumption or tobacco smoking. Local examination revealed tenderness in the Scarpa’s triangle and over the greater trochanter. The movements at the hip were restricted in all planes |
2,955 | 173,006 | extending from the medial scapular border to the bony fragment, with a narrow gap between the protrusion and the fragment (Figures –).\nThe patient was instructed to avoid elevating the left arm for 2 months and then performed reinforcement exercises of the SA such as the scapular push-up and the bear hug using an elastic band for 2 months. At examination 4 months later, the periscapular pain and the winging of the scapula with the arm at the | side and in active flexion had resolved. The push-on-the-wall test at waist level was negative, and the range of motion of the left arm was the same as the unaffected side, except for a 15° limitation in | sling removal, the patient returned to basketball, which generated continuous dull pain around the left scapula. She presented at our clinic because her mother had noticed the deformity of her back.\nThe patient had no relevant family or medical history. There was no neurological deficit in the left shoulder and arm. The left scapula was slightly higher than the contralateral scapula and exhibited atypical medial winging with the arm at the side. The distance between the spinal process and medial scapular border was shorter on the left side than the right side at the inferior angle level, but these distances were almost the same at the scapular spine level (). Contraction of |
28,716 | 98,330 | of 50degree with further flexion up to 80degree was present. X-ray of the left hip showed bar of mature bone connecting the lateral part of superior pubic ramus to the lesser trochanter (). There was no bony destruction or periosteal reaction. Computed tomography (CT)angiography and three-dimensional reconstruction of CT images showed femoral artery tenting over the bony mass and complete extent of mass over left hip, respectively. Bony mass had dimensions of length 8.3 | (CT)angiography and three-dimensional reconstruction of CT images showed femoral artery tenting over the bony | deformity at ipsilateral knee. On examination of the left elbow, non-tender, and bony mass was present on anterior aspect of arm. Bony mass was fixed to underlying bone. Flexion deformity of 50degree with further flexion up to 80degree was present. X-ray of the left hip showed bar of mature bone connecting the lateral part of superior pubic ramus to the lesser trochanter (). There was no bony destruction or periosteal reaction. Computed tomography (CT)angiography and three-dimensional reconstruction of CT images showed femoral artery tenting over the bony mass and complete extent of mass over left hip, respectively. |
5,967 | 153,454 | control was achieved by coiling of the deep branch of the right superior gluteal artery (). The patient had well-controlled vital signs throughout the whole procedure. Post-operative AP, inlet/outlet and lateral pelvic radiographs confirmed proper-positioned iliosacral screws on both sides. No fracture displacement was seen (). In CT imaging, both iliosacral screws were not invading the first sacral foramen and were positioned in the safe area. Screws had passed the opposite side of the sacral fracture but | the right superior gluteal artery (), which was adjacent to the insertion site and the extension line of the right iliosacral screw. Arterial embolization and bleeding | screw. Arterial embolization and bleeding control was achieved by coiling of the deep branch of the right superior gluteal artery (). The patient had well-controlled vital signs throughout the whole procedure. Post-operative AP, inlet/outlet and lateral pelvic radiographs confirmed proper-positioned iliosacral screws on both sides. No fracture displacement was seen (). In CT imaging, both iliosacral screws were not invading the first sacral foramen and were positioned in the safe area. Screws had passed the opposite |
33,121 | 55,361 | The periapical area in relation to 41 and 42 was spared ().\nBased on the clinical and radiographic features, the provisional and differential diagnoses considered were of intraosseous carcinoma, ameloblastoma, central giant cell lesions, and lymphoma.\nHistopathological examination of the incisional biopsy from both right and left sides showed diffuse sheets of uniformly appearing plasma cells with eccentric nuclei and pale cytoplasm (). Nuclear hyperchromatism and pleomorphism of cells were suggestive of a malignancy (). Connective tissue stroma showed interstitial amorphous eosinophilic amyloid-like material in abundance, which was later confirmed with | ramus. Root resorption of involved teeth was noted. The right side showed a radiolucent lesion around the periapical area of 46 and the interdental area of 45 and 46 (). Cone-beam Computed Tomography (CBCT) revealed expansile lytic lesions with irregular borders. | of the opposing dentition.\nA right-side lesion presented as a gingival/alveolar mass on the buccal aspect of 45 to 47 measuring approximately 2 cm × 1.5 cm. The involved teeth were vital and free of any carious lesion. Growth was soft to firm in consistency with well-defined margins and an ulcerated surface.\nAn orthopantomograph revealed the presence of bilateral ill-defined radiolucent lesions. The left-side lesion showed the involvement of the entire mandible extending from tooth number 31 to the ramus. Root resorption of involved teeth was |
19,754 | 49,609 | was in 2011 and second time was 2014 where he did not meet the criteria for ADHD diagnosis. The third reference to the children and adolescent psychiatric outpatient clinic was in 2018. The reference from the | patient's family doctor was described concentration difficulties, difficulties with emotion regulation, impulse control, and regulation of activity and sleep. The patient met | children and adolescent psychiatric outpatient clinic with suspicion of ADHD. It is the third time reference with the same suspicion. First time reference was in 2011 and second time was 2014 where he did not meet the criteria for ADHD diagnosis. The third reference to the children and adolescent psychiatric outpatient clinic was in 2018. The reference from the patient's family doctor was described concentration difficulties, difficulties with emotion regulation, impulse control, and regulation of activity and sleep. The patient met the criteria for the diagnosis of ADHD at third control.\nThe patient was placed |
17,920 | 134,647 | in size and bled less (), which motivated him to pursue additional RT. The subsequent QUAD Shots were planned on new computed tomography (CT)-simulation scans and were given to gross residual diseases. He successfully completed the second and third QUAD Shot every 3–4 weeks resulting in continuous shrinkage of cSCC on the face ( and , | face to ensure the surface of the tumor would get the full prescription dose. Planning objectives required the planning target volume coverage of 95% to 110%. Radiation dose to the spinal cord, brain stem, and optic nerve/chiasm were limited to 9 Gy per QUAD Shot. For other organs at risk, the constraints were ‘as low as reasonably achievable’ ().\nTwo weeks after the first QUAD Shot, the patient noticed his cSCC on the right face became significantly decreased | male with history of non-compliance to medical advice presented in a hospital after recent multiple falls at home. At the hospital, he was found to have a huge, ulcerative and bleeding mass disfiguring the right side of his face (). The patient stated that he had the mass on the right side of his face for many years, had a biopsy on the mass showing cSCC three years ago at the other medical facility but declined surgery or any treatments at that time (data was not available). Subsequently, a surgery consultation was made for biopsy and to get a surgical opinion to manage this neglected |
169 | 81,763 | performed and immobilized for 9 months. A history of night bedwetting, up to the age of 11, due to urinary reflux evolving in the left renal regression and hypoplasia, accidentally revealed upon a renal infection and diagnosed by renal angiography at the age of 22. A problem of ingrown toe nail started from the age of adolescence with multiple recurrence after a surgical correction was noticed. Two attacks of the left ear Menier’s disease reported to be experienced at the age of 33 and 44 years, ended with the total hearing loss and a residual continuous tinnitus. The patient and family had a habit | of 22 to 27. An unsuccessful closed reduction of the left hip joint at the age of 11 put in spica cast from the tip of the toe up to the chest level was | neglected untreated history of DDH, who gradually developed severe bilateral hip joint arthritis. The chief complains included bilateral hips and knee joints pain on walking associated with a progressive limitation in the range of hip motion and walking ability distance day after day. The history of the present problem went back to the age 45 with an incident of the low back pain repeated at the ages 50 and 52; each time relieved by conventional bed rest and other conservative measures. The progressive changes in lumbar |
21,453 | 67,602 | to her cancer treatment which was consistent with PCOS-induced anovulation. Male factor workup was negative and she had attempted conception with the standard PCOS methods including timed intercourse after attempted medically induced ovulation without success. Weight loss did not result in conception. | factor workup was negative and she had attempted conception with the standard PCOS methods including timed intercourse after attempted medically induced ovulation without success. Weight loss did not result in conception. | acute inflammatory cells. Staging CT scans were performed and there was no evidence of distant metastasis. A positron emission tomography (PET) scan displayed hypermetabolic activity at the periphery of the mass. Four weeks after her initial presentation, she underwent an exploratory laparotomy and decompression of the pancreatic mass yielding 2 liters of fluid. An attempt was made to resect the body of the pancreas but significant adhesions were noted and surgery was abandoned. The final pathology report was MCN and low grade dysplasia. A postoperative CT scan 2 weeks after her surgery showed the mass had increased in size to 20.3×15.1 cm with multiple septations. On |
37,662 | 96,158 | had an enhanced neutrophil percentage with a value of 78.60%. The rest of the routine blood tests showed normal results.\nDuring admission, the patient developed an unexplained fever and his symptoms continued to worsen. Due to the patient's symptoms mentioned above, routine blood tests were performed again. The results of the examination showed that the patient had a white blood cell count of 17.86 × 109/l, a neutrophil count of 14.32 × 109/l and a neutrophil percentage of 80.20%. All routine blood test values were within normal limits except for the white blood cell | the patient's symptoms mentioned above, routine blood tests were performed again. The results of the examination showed that the patient had a white blood cell count of 17.86 × 109/l, a neutrophil count of 14.32 × 109/l and a neutrophil percentage of 80.20%. All routine blood test values were | puncture fluid was sent for cytoculture examination. The bacterial culture results showed Salmonella Dublin infection (). Following the CT-guided puncture of the right costophrenic angle abscess, the patient developed hypoproteinaemia, so they were administered 5g of hydrolyzed protein orally once daily for 1 day to improve their nutritional status. Then they were administered an additional |
8,123 | 20,626 | eating disorder about 4 months prior to symptom onset, requiring admission to the Adolescent Medicine service for malnutrition, orthostasis and bradycardia, which resolved with monitored feeding. Despite ongoing behavioral therapy following discharge, however, adequate intake with continued weight gain remained a challenge. Over the course of 6 weeks, he developed additive and persistent swelling of the right hand first and fourth digits, followed by the left fifth digit (Fig. ). The swelling was painful and unresponsive to nonsteroidal antiinflammatory drugs, there was no fever, and he identified no preceding trauma or illness. Physical exam was notable for fusiform swelling limited | bradycardia, which resolved with monitored feeding. Despite ongoing behavioral therapy following discharge, however, adequate intake with continued weight gain remained a challenge. | of symptoms.\nHand radiographs showed marrow and cortical erosive change with periosteal reaction and overlying soft tissue swelling of the involved phalanges (Fig. ). MRI of the right hand revealed signal abnormalities with surrounding soft tissue edema, but without arthritis, in these areas (Fig. ). These findings prompted concern for chronic noninfectious osteomyelitis (CNO) or an alternate noninfectious inflammatory entity, such as Langerhans Cell Histiocytosis (LCH). Subsequent whole body imaging did not identify any other areas of involvement. The isolation of the lesions to the hands was felt to be atypical for CNO and LCH, particularly without evidence of systemic inflammation |
40,674 | 28,326 | peri-operative complications.\nThe patient progressed well on the ward following surgery. Healthcare professionals wore enhanced PPE, including FFP3 masks, face shield, fluid-resistant gowns and gloves when carrying out AGPs (e.g. suctioning and stoma care). On morning ward rounds, he was reviewed by a senior member of the medical team who wore a fluid-resistant surgical mask, face shield, apron and gloves. There were no post-operative complications and the patient was safely discharged two weeks after his surgery.\nThe patient was reviewed in | and stoma care). On morning ward rounds, he was reviewed by a senior member of the medical team who wore a fluid-resistant surgical mask, face shield, apron | fluid-resistant gown and gloves. There were no surgical or anaesthetic-related peri-operative complications.\nThe patient progressed well on the ward following surgery. Healthcare professionals wore enhanced PPE, including FFP3 masks, face shield, fluid-resistant gowns and gloves when carrying out AGPs (e.g. suctioning and stoma care). On morning ward rounds, he was reviewed by a senior member of the medical team who wore a fluid-resistant surgical mask, face shield, apron and gloves. There were no post-operative complications and the patient was safely discharged two weeks after his surgery.\nThe patient was reviewed in clinic one month post-operatively; his wounds were healing well and he was eating and |
5,569 | 77,228 | was made. The patient was advised to discontinue propolis use and was prescribed tetracycline mouthwash three times daily for 3 days and Doloneurobion twice daily for 7 days to manage the | patient was advised to discontinue propolis use and was prescribed tetracycline mouthwash three times | the patient was healthy and was not under any medication. A clinical examination revealed multiple shallow and irregular ulcerations on the right buccal mucosa, the right hard palate mucosa, and the gingival area surrounding tooth 17. The size of the ulcers ranged from 0.3 to 1.5 cm in diameter (). Tooth 17 was in the middle of endodontic treatment for wide and deep caries lesion, and the radiograph showed no periapical lesion (). Palpation and percussion |
15,556 | 38,410 | muscle flap. The post-operative anti-coagulation regime was as follows: dextran 40 (500mL) twice a day for seven days; aspirin (100mg) orally three times a day for three days; narceine (30mg) four times a day for seven days; and tolazoline (25mg) | muscle flap. The post-operative anti-coagulation regime was as follows: dextran 40 (500mL) twice a day for | leg were anastomosed to the amputated lower right leg structures. The anterior tibial artery and posterior tibial artery were anastomosed crosswise, and the ends of the great saphenous vein, small saphenous vein and four deep veins were anastomosed without crossover. The sural nerve and saphenous nerve were anastomosed crosswise, and the anterior and posterior tibial nerves were anastomosed without crossover. Heterotopic replantation of her right lower leg to the left leg stump was thus completed. A stump was created on the right side at her hip joint. Routine antibiotic, anti-coagulant, and anti-angiospasm |
8,803 | 12,141 | The patient's parvovirus B19 serological test (IgM and IgG) results were negative. A computed tomography (CT) scan of the abdomen was performed to rule out other causes of anemia. CT revealed a herniation of stomach and spleen into the thoracic cavity the posteromedial aspect of left hemidiaphragm, and the patient was therefore diagnosed with Bochdalek hernia (Fig. ). No foci of bleeding and other abnormalities were detected in the CT scan. The bone marrow study | (105.9 fL; NR: 70–90 fL). The total white blood cell and platelet count were normal. On hemoglobin electrophoresis, hemoglobin F level was found to be elevated (12.1%; NR: <1%), along with an increase in the erythrocyte adenosine deaminase level (60.2 IU/L; NR: 8–19 IU/L). | delivered at 39 + 4 weeks’ gestational age via a vaginal delivery. As a newborn delivery, the patient had cried weakly and had a pale appearance and was consequently diagnosed with respiratory distress syndrome and anemia. He was treated with a surfactant and underwent 6 packed red blood cell (PRBC) transfusions in the neonatal intensive care unit within the first month of his birth. Subsequently, he continued |
16,385 | 21,914 | the brackets were removed, maxillary and mandibular lingual fixed retainers were placed and Hawley retainers were given to the patient for both the maxillary and mandibular arches.\nThe post-treatment facial and intraoral photographs and dental casts illustrate the significant improvement in the patient’s smile (, and ). The posttreatment orthopantomogram showed the achievement of good root parallelism in the absence of root resorption (). The post-treatment cephalometric analysis illustrates the changes achieved with the treatment (). The post-treatment dental casts and intraoral photos show a Class I canine occlusion with normal | casts illustrate the significant improvement in the patient’s smile (, and ). The posttreatment orthopantomogram showed the achievement of good root parallelism in the absence of root resorption (). | 0.019 × 0.025 SS. The use of this archwire sequence allowed us to obtain the alignment, leveling and coordination of the maxillary and mandibular arches. The use of thermal archwires during the initial stage of the treatment allowed us to move the teeth through the expression of low force, achieving the correction of the dentoalveolar discrepancy without iatrogenic injuries [,,].\nDuring each appointment, low-level laser therapy (LLLT) was administered using a Diode laser emitting infra-red radiation at 980 nm (Wiser, Doctor Smile—Lambda Spa, Brendola, VI, Italy) in order to accelerate the orthodontic movement, in particular during the |
25,942 | 3,760 | but the stromal cells were negative. The Ki-67 (MIB-1, BioGenex, diluted 1:30) labeling index of the tumor was as high as 90%, while the degenerated necrotic tumor cells showed decreased staining properties. Nephrogenic rest, a precursor lesion of NB, was not | identified in the remaining renal parenchyma. The clinical stage classification of the Japanese Wilms Tumor Study (JWiTS) group was 3. The patient | staining of peritoneal fluid confirmed three components of blastemal, stromal, and epithelial cells. The findings were interpreted on-site as NB (Fig. ).\nCytologically, the blastemal cells were dyshesive, exhibiting naked nuclei with scant to absent cytoplasm and were the most predominant cell type. The spindle-shaped stromal cells were arranged in fascicles, showing a fibroblast-like configuration. And epithelial cells formed tubular structures. Macroscopically, the resected cystic tumor measured 80 mm in maximum |
12,318 | 142,645 | probing, marginal gingiva and tooth mobility assessment was done. Tooth mobility was classified as grade I — slightly more than normal, grade II — moderately more than normal, grade III — severe mobility facio-lingually and mesio-distally combined with vertical displacement.[] Radiographic examination is done in 1, 3 and 6 months and additional sensitivity test to cold in 6 months post-operation.\nThe survival rate was 87% because two patients had lost their transplants. One failure occurred, 2 weeks after | additional sensitivity test to cold in 6 months post-operation.\nThe survival rate was | cold was similar to neighboring teeth. In 9 months follow-up, patients had no discomfort or any complaints about their transplants. Objectively, teeth that were positioned in occlusal level during operation (with root development ¾ or full length []) were fully functional with correct contacts when checked with marking paper in 1 month post-operation after splint and temporal bite-raise on neighboring teeth were removed. Teeth that were positioned in slight infra-occlusion during operation had minimal contacts with opposing tooth in 3 and fully contacted in 6 months |
24,035 | 34,213 | a vacuum drainage system was applied, and the patient started a course of intravenous antibiotics based on the antibiogram (S. aureus and Enterococcus spp). Although his vital signs returned to normal levels immediately after the surgery, one month postoperatively, the CRP level remained at a plateau level (110), and the toes presented ischemic lesions. After an extensive conversation with the patient, we proposed a below-knee amputation as the most reliable option in this phase. The patient underwent a below-knee amputation without any complication, and three weeks | course of intravenous antibiotics based on the antibiogram (S. aureus and Enterococcus spp). Although his vital signs returned to normal levels immediately after the surgery, one month postoperatively, the CRP level remained at a plateau level (110), and the toes presented ischemic lesions. After an extensive conversation with the patient, we proposed a below-knee amputation as the most reliable option in this phase. The patient underwent a below-knee amputation without any | an ankle joint injury twenty days before. Initially, he had swelling and no pain and walked normally. As the swelling did not get better, he decided to visit an orthopedic surgeon elsewhere. The surgeon diagnosed an ankle sprain and gave him instructions without radiographic investigations. Some days later, the patient noted a leg malalignment and discomfort during walking |
1,848 | 36,437 | the source of bleeding, bilateral ureteroscopy was performed. The right ureter and renal pelvis were found to be unremarkable. The left ureter also appeared to be free of pathology. However, at approximately the level of the ureteropelvic junction, a papillary mass was noted that appeared to extend into the left renal pelvis. A biopsy was unable to be obtained due to significant bleeding. After | the blood clots were evacuated, and taking into account the past history of hematuria with a small, atretic kidney, it was deemed necessary to pass a stent into the left ureteral pelvis. The patient tolerated the procedure well. The results of | deemed necessary to pass a stent into the left ureteral pelvis. The patient tolerated the procedure well. The results of the cystoscopy were discussed with the patient, and a nephrectomy was being considered to remove the tumor. However, after cystoscopy the patient developed an ileus. She was also very malnourished. Once her bleeding and ileus resolved, the decision was made to allow her to be discharged home to recuperate in order to better tolerate the nephrectomy. The patient was for a followup appointment two weeks later to evaluate for a nephrectomy. The patient did not show up for her appointment and was lost to |
41,457 | 134,486 | posterior face of the pancreas. For a better characterization, a pancreatic magnetic resonance imaging (MRI) was performed, showing a nodular lesion of the pancreatic body with 2.8 × 2.5 cm causing pancreatic tail atrophy and distal dilation of Wirsung's duct (Fig. ). These findings were mostly compatible with a neoplastic lesion. A thoracic CT was performed and was negative for metastatic pulmonary lesions.\nThe patient's clinical case was discussed in a multidisciplinary meeting, and she was proposed for a surgical procedure with the diagnosis of pancreatic neoplasia clinically staged as T2 N0 M0 (Stage IB – AJCC 8th edition) [].\nShe was submitted to a | were within normal ranges. The referral ultrasound result reported a nodular hypoechogenic lesion with 4 × 3 × 3.3 cm in the pancreas tail, suspicious of an expansive process. An abdominal computed tomography (CT) revealed a globular shaped pancreatic body and a loss of cleavage plane between the splenic vein and the | and distal dilation of Wirsung's duct (Fig. ). These findings were mostly compatible with a neoplastic lesion. A thoracic CT was performed and was negative for metastatic pulmonary lesions.\nThe patient's clinical case was discussed in a multidisciplinary meeting, and she was proposed for a surgical procedure with the diagnosis of pancreatic neoplasia clinically staged as T2 N0 M0 (Stage IB – AJCC 8th edition) [].\nShe was submitted to a left subcostal |
24,621 | 142,711 | neuroblastoma stage IV two years previously with no evidence of brain metastasis on initial cerebrospinal fluid study, and he received treatment 6 times with chemotherapy, as well as auto peripheral blood stem cell transplantation (auto PBSCT), therapeutic metaiodobenzylguanidine for residual tumor, and unrelated PBSCT for tumor relapse. When he was discharged from the hospital after successful unrelated PBSCT, he experienced increased nausea and vomiting, and poor oral intake. He was subsequently admitted to receive intravenous amino acid resuscitation (Trophamine) and total parenteral nutrition (TPN). When he was admitted, jitteriness on bilateral upper extremities was observed for a brief time while he was receiving intravenous amino acid resuscitation and TPN therapy. Under the | on initial cerebrospinal fluid study, and he received treatment 6 times with chemotherapy, as | gait, and bilateral jerky type multidirectional nystagmus, but his mental status was alert and he did not show sensory changes in his extremities. On the evaluation of dizziness, neurological evaluation and consultation to Otolaryngology Department was done. His dizziness was not associated with spinning sensation, and it was nontrue vertigo type. He had no ear fullness or tinnitus, and his ear drums and hearing function were all intact. On neurological examination, his cranial nerve |
25,236 | 19,308 | proved effective. She developed a realistic idea of what caused her stress, how she reacted situationally and improved her awareness that she tends to have control over everything. Her parents were involved in helping her developing control coping skills and checking on achievements. Because of this insight, she succeeded in maintaining her diet less strictly and experimenting with behaving differently without alcohol or drugs. Her parents saw that she was doing better and were able to release her a bit more. This increased | had not sufficiently developed social learning strategies in her early school years. In addition, there appeared to be an issue of individuation and separation problems. These problems got worse because it was almost impossible for her parents to let her develop in her own way due to the stress they had over her suicidal thoughts, drug use, and worsening physical condition due to bad eating habits. We decided on an additional family counseling approach to address these issues.\nThe integrated treatment modality approach | school dropout. We added medication in order to try to stabilize her mood with fluoxetine, an SSRI, which might also modulate stress. The medication initially seemed to have some effect but after two months there was a sharp mood drop, increased suicidality and aggravation of eating disorder symptoms. Eventually she had a body mass index of 16 kg/m2. The eating problems were mapped and analysed by an eating disorder specialist. The latter used a problem-solving approach and focused on both directive counseling and emotional support. The eating disorder specialist |
19,793 | 48,281 | low absorption areas displayed lower CT values than the gallbladder lumen (A). In addition, the presence of stones (about 15 mm in diameter) in the gallbladder was detected by drip infusion cholecystocholangiography-CT (DIC-CT) imaging. No contrast medium was observed in the suspected cyst area (B). Abdominal ultrasonography revealed the presence of bile sludge, but no abnormalities in the gallbladder wall other than the cysts and the stone were noted. Laparoscopic cholecystectomy was performed and the patient was diagnosed with cholecystocholedocholithiasis. No adhesions in the surrounding tissues of the gallbladder were observed during intraoperative examination. A whitish region different from the original color of the wall was observed at the | the hepatobiliary enzymes. The levels of the tumor markers carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 were within the normal ranges. Abdominal computed tomography (CT) showed a low absorption zone in the gallbladder wall suggestive of a cyst. The | a woman in her seventies and had a history of appendectomy, hypothyroidism, and cataracts. She had undergone endoscopic papillary balloon dilatation for choledocholithiasis about 2 years ago. Thereafter, the choledocholithiasis recurred and endoscopic sphincterotomy was performed. Subsequently, the patient visited Saiseikai Toyama Hospital for surgery due to symptoms of recurrence. No findings of jaundice or anemia were noted; the abdomen was flat and soft without tenderness and peristaltic sounds of the bowel were regular. Laboratory findings revealed no inflammation or increases in the levels of the hepatobiliary enzymes. The levels of the tumor markers carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 were within the normal ranges. |
17,190 | 162,631 | and swelling in the right mandibular posterior region. The medical history was non-contributory. She had no history of traumatic injury or orthodontic treatment. Clinical examination showed small intraoral swelling with relation to 45. The tooth was slightly tender to percussion and served as an abutment to a long span bridge extending upto 48. The probing depths were within normal limits.\nIntraoral periapical radiographic examination revealed a well-circumscribed, fairly round radiolucency in the cervical third of the root with diffuse periapical rarefaction []. Clinical symptoms and radiographic examination suggested a diagnosis of internal resorption and pulp necrosis. The Bridge was cut and removed to preserve the | integrity of tooth with resorption and endodontic treatment was scheduled. It was decided not to include 44 as the patient was reluctant to sacrifice a healthy tooth and was ready to wear a partial denture in case of future loss of tooth. Implant was not considered due to financial constraint of the patient. As the conventional | specialities, Ballaigues, Swizterland) accompanied by copious irrigation with 2.5% sodium hypochlorite (Dentpro, Chandigarh, India). A calcium hydroxide paste dressing (Metapex; Meta Biomed Ltd, Choenju city, Chungbuk, Korea) was placed to alkalinize the environment and control bleeding at the perforation. The calcium hydroxide dressing was changed twice every 15 days. Master cone radiograph was taken [] and the canal below the resorptive defect was obturated with gutta percha (Dentsply, Maillefer) and AH Plus sealer (Dentsply, Maillefer, Konstanz, Germany) using a combination of cold lateral condensation and vertical |
42,602 | 82,210 | breathing and noticeably reduced urine output. He was transferred to our tertiary care unit for further management of progressive multi organ involvement.\nOn general examination he was alert and coherent with Glasgow coma scale score of 15. There were multiple ulcerations in his mouth and oropharyngeal region. Nasogastric tube contents revealed coffee ground aspirate. Respiratory examination revealed rapid shallow breathing with a respiratory rate of 40 per minute. Auscultation of the lungs was unremarkable and oxygen saturation was 99 % on room air on pulse oxymetry. He was tachycardic (heart rate:104 beats per minute) with normal blood pressure and adequate peripheral perfusion. Severe guarding and tenderness over the epigastrium was present in examination of the abdomen. Bowel | rapid shallow breathing with a respiratory rate of 40 per minute. Auscultation of the lungs was unremarkable and oxygen saturation was 99 % on room air on pulse oxymetry. He was tachycardic (heart rate:104 beats per minute) with normal blood pressure and adequate peripheral perfusion. Severe guarding and tenderness over the epigastrium | a neutrophil leukocytosis (Table ). Arterial blood gas analysis showed a high anion gap metabolic acidosis with a pH of 7.21. Serum potassium was elevated at 6.4 mmol/L, which persisted through the first week of hospital stay. Ultrasound scan of the abdomen showed normal sized kidneys with evidence of acute renal failure. Subsequent complete blood counts showed a reducing trend in hemoglobin and platelets. Bite cells, Heinz bodies and fragmented red cells were also seen. Serum lactate dehydrogenase level was elevated. Direct Coombs test was negative. The reticulocyte count was 1.5 % showing an inadequate bone marrow response. Hemolysis settled by the second week |
11,230 | 60,086 | was electrodiagnostic evidence of a generalized length-dependent sensorimotor polyneuropathy which was predominantly axonal in nature. There was also a superimposed tibial mononeuropathy on the right, likely localizing just proximal to the tibial take-off branches to the soleus muscle. The findings were consistent with the patient's report of recent severe pain involving the right foot accompanied by ankle plantarflexion and toe flexion weakness.\nThe patient was subsequently referred for a right sural nerve biopsy (). Biopsy confirmed the presence of chronic and ongoing small-vessel vasculitis with associated axonopathy. She underwent treatment | severe pain involving the right foot accompanied by ankle plantarflexion and toe flexion weakness.\nThe patient was subsequently referred for a right sural nerve biopsy (). Biopsy confirmed | no evidence of axonal continuity to the intrinsic musculature of the forefoot.\nTaken together, there was electrodiagnostic evidence of a generalized length-dependent sensorimotor polyneuropathy which was predominantly axonal in nature. There was also a superimposed tibial mononeuropathy on the right, likely localizing just proximal to the tibial take-off branches to the soleus muscle. The findings were consistent with the patient's report of recent severe pain involving the right foot accompanied by ankle plantarflexion and toe flexion weakness.\nThe patient was subsequently referred for a right sural nerve biopsy (). Biopsy confirmed the presence of chronic and ongoing small-vessel vasculitis |
21,392 | 159,675 | history of hypertension, and he had been taking oral antihypertensives. He had no history of diabetes. However, at the time of admission, his serum glucose was 491 mg/dL and other laboratory findings were unremarkable. There was no history of other systemic disease. On postoperative day one, the patient's visual acuity was HM, and the suture site was clear. A small amount of viscoelastics materials remained in the anterior chamber, along with some floating vitreous fibers (). The lens surgery was postponed due to the corneal edema. He was | serum glucose was 491 mg/dL and other laboratory findings were unremarkable. There was no history of other systemic disease. On postoperative day one, the patient's visual acuity was HM, and the suture site was clear. A small amount of viscoelastics materials remained | the time of admission, his serum glucose was 491 mg/dL and other laboratory findings were unremarkable. There was no history of other systemic disease. On postoperative day one, the patient's visual acuity was HM, and the suture site was clear. A small amount of viscoelastics materials remained in the anterior chamber, along with some floating vitreous fibers (). The lens surgery was postponed due to the corneal edema. He was discharged a week after the primary suture. |
4,191 | 25,157 | of uptake with previous bone scintigraphy studies is important to determine loosening. A higher intensity around the prosthesis compared with the previous studies may raise the suspicion of aseptic loosening. Conversely, should no increased uptake on delayed bone scintigraphy exist, significant loosening is unlikely. Furthermore, acute fractures or unstable and unfused old fractures were reported to show increased uptake on bone scintigraphy. Furthermore, we examined her right thigh with [18F] NaF PET/CT to investigate | suspicion of aseptic loosening. Conversely, should no increased uptake on delayed bone scintigraphy exist, significant loosening is unlikely. Furthermore, acute fractures or unstable and unfused old fractures | reperformed NaF PET/CT scan again, and it showed a markedly reduced NaF uptake at the lateral cortex near the distal stem tip (Figure ). Unexpectedly, the high intensity around the distal screws was observed in contrast to low uptake along the distal stems. In addition, anteroposterior radiography of the right femur performed simultaneously, also showed radiolucent zones around the distal screws (Figure ). These findings indicated that hardware micromotion may have induced high bone metabolic activity, resulting in |
7,422 | 142,541 | the wire against the LV apex, and oriented the device using the left coronary cusp as the reference. Pushing on the wire resulted in its being oriented against the greater curvature of the aorta (Fig.). Following partial deployment, we noted that the device was relatively deep with respect to the non- and right coronary cusps, but was ideally oriented to the deformed left | against the LV apex, and oriented the device using the left coronary cusp as the reference. | had endocarditis and he was treated and followed up. In 2000, his symptoms worsened and he underwent aortic valve replacement with a St. Jude Toronto stentless porcine valve (Fig.). Despite his young age, he refused a mechanical valve prosthesis since he wished to avoid anticoagulation so he could continue active military |
29,756 | 26,940 | operative day 12, he started to have a fever, and his respiratory frequency increased. His blood pressure decreased and was maintained by norepinephrine, while his cardiac troponin (cTnI) was 35.59 ng/ml and B-type natriuretic peptide (BNP) was greater than 5000 pg/ml, suggesting heart failure. Because of the complex situation, the patient was placed under the care of a MDT and was diagnosed by severe pancreatitis with multiple organ damage. Because his condition was too severe and conservative treatment was ineffective, he received exploratory laparotomy | on postoperative day 18 that found extensive intraperitoneal pus, pancreatic swelling, and peripancreatic necrosis with hematocele. After debridement | on day 5. In the ICU, he received artificial liver treatment, ventilatory support, continuous renal replacement therapy and norepinephrine to maintain vital sign stability; he also received a routine orthotopic liver transplantation from a non-heart-beating donor with an incompatible blood type (AB to O) on day 6.\nIntraoperatively, liver atrophy with little as cites and swelling of the pancreas were observed, confirming acute pancreatitis and the anhepatic time was 52 minutes. The donors liver was suitable for the patient, and the surgery was |
17,331 | 147,774 | reddish brown, soft, and glistening with multifocal hemorrhage (). Microscopically, the tumor showed a diffuse solid sheet pattern with congestion. The tumor cells had epithelioid features, with round to oval nuclei and abundant eosinophilic cytoplasm. Some lymphocytes were scattered throughout the tumor. The borders of the tumor cells were clear. Multinucleated giant cells could occasionally be identified in the background of the dilated vessels. IHC of the resected specimen yielded results consistent with those of the needle biopsy sample. IHC with anti-CD34 antibody showed increased vascularity (). Mitotic activity was one per ten high-power fields. No | tumors had not infiltrated into adjacent organs, whether these tumors had been completely resected microscopically was uncertain due to their diffuse and amorphous nature. The patient's recovery was uneventful.\nThe resected specimen appeared as a solid, disrupted mass with cystic changes and hemorrhage and measured 13 cm × 11 cm × 9 cm in size. The cut surface of the mass was | high signal intensity on T2-weighted images (). The CT and the MRI results suggested a sarcoma of unknown origin, a mesothelioma, a hemangioma, or a desmoid tumor. A needle biopsy revealed that the tumor was an epithelioid mesenchymal neoplasm with hypervascularity.\nThe results of immunohistochemical (IHC) staining of the needle biopsy sample are shown in . The Ki-67 labeling index was less than 5%. The IHC results excluded the lesion from being a perivascular epithelioid cell tumor (PEComa), gastrointestinal stromal tumor, neuroendocrine carcinoma, adrenal cortical neoplasm, hepatocellular carcinoma, renal cell carcinoma, rhabdomyosarcoma, desmoplastic round cell tumor, hemangioendothelioma, or epithelioid |
4,078 | 13,454 | man with a history of leukoplakia underwent biopsy of his oral mucosa in 2010; it revealed moderate to severe dysplasia. He remained asymptomatic until 2014 when he felt a mass in his tongue. A computed tomography (CT) scan of the head and neck showed a density in the right tongue with no cervical lymphadenopathy. Biopsy of the tongue revealed moderately differentiated squamous cell carcinoma (SCC). A staging positron emission tomography (PET) scan demonstrated evidence of ipsilateral cervical lymph node involvement. He underwent tracheostomy, right neck dissection, right tongue cancer resection, and reconstruction with a free flap graft from his right forearm. Pathology revealed a | leukoplakia underwent biopsy of his oral mucosa in 2010; it revealed moderate to severe dysplasia. He remained asymptomatic until 2014 when he felt a mass in his tongue. A computed tomography | remission.\nA surveillance CT scan done 1 year later, in May 2016, showed left lung lesions suspicious for metastatic disease, and bronchoscopy confirmed SCC of these lung lesions. He then underwent chemotherapy with 2 cycles of paclitaxel, carboplatin, and radiation. A repeat PET scan in September 2016 showed complete response, and the patient decided to proceed with observation. Another surveillance CT scan in December 2016 showed a cardiac lesion in the left ventricular (LV) apex (). The patient was referred to our specialized cardiomyopathy clinic. In the clinic, the patient's physical examination |
26,845 | 94,203 | and vomiting. On readmission through the emergency department, she had normal vital signs and her exam was notable for tenderness over the right upper quadrant. Laboratory values were notable for AST 810 U/L, ALT 772 U/L, alkaline phosphatase 227 U/L, bilirubin 1.8 mg/dL, prothrombin (PT) INR 1.0, hemoglobin 14.6 g/dL, hematocrit 41.3%, platelets 109,000/UL, BUN 18 mg/dL, and creatinine 0.7 mg/dL. No free air was noted on plain abdominal X-rays. A computerized tomography (CT) scan of the abdomen revealed a hyperdense mass within the right lobe of | the liver, measuring 7.7 × 5.7 cm in diameter, traversing segments 6 and 7 and bordering on segment 8. | her exam was notable for tenderness over the right upper quadrant. Laboratory values were notable for AST 810 U/L, ALT 772 U/L, alkaline phosphatase 227 U/L, bilirubin 1.8 mg/dL, prothrombin (PT) INR 1.0, hemoglobin 14.6 g/dL, hematocrit 41.3%, platelets 109,000/UL, BUN 18 mg/dL, and creatinine 0.7 mg/dL. No free air was noted on |
14,624 | 109,913 | bone over the transverse and sigmoid sinuses. The mastoid air cells were covered with bone wax to avoid postoperative CSF leakage. The dura was then opened and reflected over the transverse and the sigmoid sinuses, and CSF was drained from the lateral cerebellomedullary cistern to relax the cerebellum.\nInitial inspection of the cerebellopontine angle showed the seventh and eighth nerve complex. More CSF drainage was attempted to provide additional working space and the trigeminal nerve was subsequently localized and freed from the surrounding arachnoid adhesions. A whitish tubular structure that resembled an empty vessel was noticed crossing and abutting the trigeminal nerve root entry zone []. After | thorough inspection of the area, it was identified as the previously embolized SCA. As no other obvious vessel loop was noted, we considered this empty vessel as the offending structure causing the trigeminal neuralgia.\nThe SCA was hence carefully dissected off the trigeminal nerve root entry zone and the brain stem, creating space for two small pieces of Teflon sponges which were inserted to separate the vessel from the mentioned structures it was compressing []. The dura and the | other obvious vessel loop was noted, we considered this empty vessel as the offending structure causing the trigeminal neuralgia.\nThe SCA was hence carefully dissected off the trigeminal nerve root entry zone and the brain stem, creating space for two small pieces of Teflon sponges which were inserted to separate the vessel from the mentioned structures it was compressing []. The dura and the muscle fascia were thereafter closed tightly and the procedure was completed.\nThe patient did well postoperatively and left the hospital 2 days later with no reported hemifacial |
31,584 | 167,095 | 5 gtt in order to reduce musculoskeletal pain. The reason for choosing a drug such as tramadol rather than any other pharmacological option lies in the fact that the pain was so intense that it affected the patient’s relationships []. We therefore opted for a drug that would have an immediate effect, so as to be able to undertake the acupuncture course. Subsequently, in the first two sessions, after careful disinfection of the skin with 2% chlorhexidine, and using the appropriate needles | in the meantime it was recommended to administer oral tramadol (100 mg/mL), 5 gtt in the morning and | interfered with her regular attendance at school, generating social withdrawal phenomena, which are unfortunately very frequent in patients with chronic pain.\nPain began three months before the consultation, after an accidental fall with trauma to the left wrist. It gradually increased and did not respond to either NSAIDs or limb immobilization. The diagnostic tests performed at the time (X-ray, Doppler ultrasound and magnetic resonance imaging) were negative, as were the blood chemistry tests ( and ).\nFrom the age of 8, the girl was followed by a pediatrician in our hospital for a history of cramps and pain in the lower limbs, especially |
41,155 | 69,584 | for treatment of breast cancer several years ago. The patient was placed on pulsed erlotinib therapy with dose adjustments depending on toxicity. The patient derived her own optimal dosage of 600 to 750 mg daily for 3 days on and 2 days off resulting in a total dose of 2,550 mg per week. The patient noticed complete resolution of neurological symptoms in about a week and has remained symptom free at the time of this report more than 12 months after diagnosis of LC. The patient is symptomatic only in terms of grade 1 dermatologic toxicity and grade 1 diarrhea secondary to erlotinib. Results of spinal fluid analysis continue to show adenocarcinoma cells; however, | with decrease in size of the lung mass to 6 mm without increased metabolic activity, resolution of pleural effusion and sclerosis of bone metastasis without increased metabolic activity.\nA diagnosis of LC was made and treatment options including intrathecal chemotherapy and cranial or craniospinal radiation were discussed. The patient refused these treatments mainly because of the death of her daughter who had LC related to an Ommaya reservoir | the ribs, sacrum and the right scapula. A right scapular lesion had an SUV of 10.6. Magnetic resonance imaging (MRI) of the brain did not show any evidence of parenchymal or leptomeningeal metastatic disease.\nThe patient started oral erlotinib, 150 mg daily, and subcutaneous denosumab, 120 mg monthly, in addition to daily subcutaneous low molecular weight heparin. The patient rapidly became asymptomatic and significant decrease in the lung mass, improvement of pleural effusion and resolution of pulmonary emboli were noted on chest CT 3 months after diagnosis.\nIn July 2013, |
20,239 | 140,487 | oculomotor nerve symptomatology[] and one case had an optic nerve deficit in addition to ophthalmic and oculomotor nerve involvement.[] In two cases, despite the fact that the CA location was proven to be on the third cranial nerve intraoperatively, no oculomotor nerve deficit was found at presentation: One had only ipsilateral trigeminal symptoms[] | and the other had pituitary dysfunction with ipsilateral optic nerve deficit.[]\nIn the six patients with oculomotor nerve palsy, three cases presented acutely with | of symptoms revealed a partial third cranial nerve palsy on the left side. Initial cerebral magnetic resonance imaging (MRI) demonstrated an 8 mm oval lesion in the anterior left interpeduncular cistern that was hyperintense on T1 and heterogeneous on T2-weighted images [ and ]. On the computed tomography angiography (CTA), the lesion enhanced but did not correspond to an intracranial aneurysm []. The patient was observed. Over the following week, the left third cranial nerve deficit worsened significantly. The ipsilateral pupil was fully dilated and unreactive. Complete ptosis and paralysis of the oculomotor nerve-related muscles |
19,515 | 144,302 | hospital for routine antenatal checkup. Physical examination revealed distended abdomen with fundal height corresponding to 30–32 weeks of gestation. Multiple fetal parts were felt and a single fetal heart sound was auscultated below the umbilicus toward the left of midline. On per vaginal examination, the os was found to be closed with uneffaced cervix. Three months earlier, her first ultrasound scan taken at a peripheral hospital was misdiagnosed as a single live intrauterine fetus of 18 weeks gestational age. Later she was referred to the Department of Radiology, and the ultrasound images showed twin | antenatal checkup. Physical examination revealed distended abdomen with fundal height corresponding to 30–32 weeks of gestation. Multiple fetal parts were felt and a single fetal heart sound was auscultated below the umbilicus toward the left of midline. On per vaginal examination, the os was found to be closed with uneffaced cervix. Three months earlier, | A 22-year-old, 7-months pregnant primigravida visited the Department of Obstetrics and Gynecology of our hospital for routine antenatal checkup. Physical examination revealed distended abdomen with fundal height corresponding to 30–32 weeks of gestation. Multiple fetal parts were felt and a single fetal heart sound was auscultated below the umbilicus toward the left of midline. On per vaginal examination, the os was found to be closed with uneffaced cervix. Three months earlier, her first |
42,437 | 36,654 | least 10, 000 nuclei were plotted. The DNA-diploid cell population corresponding to surrounding normal tissue from the same location was used as an internal reference standard for the identification of DNA-aneuploid clones. The percentages of the cell cycle phases as well as the DNA indices of the aneuploid clones were calculated using the Modfit 5.2 software package. DNA histograms were classified as diploid if there was a single G0-G1 peak and | location was used as an internal reference standard for the identification of DNA-aneuploid clones. The percentages of the cell cycle phases as well as the DNA indices of the aneuploid clones were calculated using the Modfit 5.2 software package. DNA histograms | ).\nGroup 3 samples exhibited an unusual histological pattern. These hypercellular areas were composed of blocks of round to ovoid epithelial cells without the 'reminiscent' myoepithelium. The epithelial cells were round with pale eosinophilic cytoplasm and round to oval nuclei. Nuclear pleomorphism or atypia, malignant luminal cells and necrotic foci were not observed (Figure ). The immunohistochemical study showed strong expression of CKs AE1/AE3 and CK 8 in most of the epithelial cells (Figure ). p63 and α-SMA staining were seen to a lesser degree than in the Group 1 and 2 samples |
1,930 | 71,603 | and magnetic resonance imaging (MRI) were performed. There were no hematomas and no abnormality or deformation of the radial artery and carpal bones on contrast-enhanced CT. There was an enlargement of the median nerve at the pisiform bone level on fat suppression T2-weighted MRI (Fig. ). There was no thickening of the flexor tendon, but there was fluid stagnation in the deep part of the bursa and intense signals around the flexor tendon; these are typical findings in carpal tunnel syndrome even though the patient has no past medical history of carpal tunnel syndrome. During interviews, some ICU nurses recalled that his wrist-extension split had | been fixed in a relatively hyperextended position for 4 days to obtain a good arterial pulse waveform.\nNeurological diagnosis revealed iatrogenic carpal tunnel syndrome due | radial artery catheter was removed when he was transferred to a general ward. He experienced numbness and a tingling sensation in his left palm during his ICU stay that he considered transient and insignificant and did not report it to the ICU staff. This continued after ICU discharge. On the 10th postoperative day, he complained about his numbness to the physician in charge. The physician consulted a pain specialist, and the medical examination revealed that numbness and paresthesia were present in the left thumb, the second and third fingers, and the |
39,716 | 22,194 | The CSF glucose was elevated at 91 units. The CSF white blood cell count was 3/μL. Further studies on CSF for ruling out meningitis were done, and they included Cryptococcus neoformans/gattii, Cytomegalovirus, Enterovirus CSF, E. coli K1, Hemophilus influenzae, Human Parechovirus, Listeria monocytogenes, Neisseria meningitidis, Streptococcus agalactiae, Streptococcus pneumoniae, varicella-zoster, and herpes simplex virus 1, 2, and 6, which were negative; details are shown in .\nThe infectious disease team was consulted, and doxycycline was added due to the high prevalence of typhus in the area. Febrile agglutinins, West Nile virus, and fungal serologies were also negative ().\nCSF studies for | meningitis were done, and they included Cryptococcus neoformans/gattii, Cytomegalovirus, Enterovirus CSF, E. coli K1, Hemophilus influenzae, Human Parechovirus, Listeria monocytogenes, Neisseria meningitidis, Streptococcus agalactiae, Streptococcus | white blood cell count at 11.6 th/μl with 76.5% of neutrophils. Her complete metabolic panel showed hypokalemia. Her urine toxicology, serum alcohol levels, and urine analysis were unremarkable. C-reactive protein was 3.3 mg/dL, and her lactic acid was 1.2 mmol/L. Blood tests |
18,667 | 72,123 | dorsal incision was performed and an osteotomy of the distal part of the radius was made 1 cm proximal from the epiphysis to preserve the joint with securing the bony margin according to the preoperative planning using MRI gadolinium enhancement analyses (Fig. ). The osteotomy of the proximal part of the radius was made 2 cm proximal from the tumor on the basis of the preoperative MRI and an intercalary resection of the tumor-bearing bone was performed (Fig. ). The soft tissue, including the complete pronator quadratus muscle, intraosseous membrane, and periosteum of the ulna where the soft-tissue extension of the tumor originally existed before chemotherapy, was peeled from the ulna and excised with the tumor | made 1 cm proximal from the epiphysis to preserve the joint with securing the bony margin according to the preoperative planning using MRI gadolinium enhancement analyses (Fig. ). The osteotomy of the proximal part of the radius was made 2 cm proximal from the tumor on the basis of the preoperative MRI and an intercalary resection of | diagnosis from the open biopsy was conventional osteosarcoma (Fig. ), and six courses of neoadjuvant chemotherapy with intravenous cisplatin (120 mg/m2) and doxorubicin (30 mg/m2/day × 2 days) were administered according to our chemotherapy regimen []. As chemotherapy progressed, the swelling and restricted range of motion (ROM) of the forearm was reduced, with the difference between the left and right wrists disappearing completely after six courses. Preoperatively, the extraosseous lesion appeared greatly shrunken, represented by only a slight signal contrast within the intraosseous membrane. This was confirmed by CT (Fig. ) |
24,599 | 142,931 | oral and cutaneous vesicles revealed only a few neutrophils.\nA skin biopsy drawn from an intact vesicle showed a subepidermal plane of cleavage with a perivascular lymphocytic infiltrate. A direct immunofluorescence (DIF) study on a perilesional biopsy demonstrated linear deposits of immunoglobulin G (IgG) and C3 along the dermoepidermal junction. The blood vessels also showed C3 (2+) deposits. A repeat DIF study using salt split skin revealed complete separation of the epidermis from the dermis, with linear staining of the basement membrane zone with IgG and C3. The band was seen mainly on the epidermal side of the split | × 0.7 cm in the oral cavity at the junction of the hard and soft palate []. There was no erythema at the base of the lesions. No other areas were involved.\nResults of laboratory investigations including total hemogram, blood sugar levels, liver and renal function tests, human immunodeficiency virus antibody test, chest radiograph and urinalysis were all within normal limits. A Tzanck smear from fresh | right hand, right leg, and ankle of three months duration, and painful oral ulcers of three years duration. She had been diagnosed with poorly differentiated squamous cell carcinoma of the hypopharynx four years earlier (T2 N1 M0), and had been treated with radiotherapy in a dose of 60 Gy for 26 days, with complete resolution of the lesion. In addition, she had filarial lymphedema of the right hand and the right lower limb, diagnosed 40 years earlier, and treated with diethylcarbamazine citrate. Her subsequent history was uneventful, except for rare |
4,666 | 100,869 | suffered from transient chest pain, dyspnoea, and paroxysmal neck swelling irrespective of emotional stress for ∼15 years (). Since the attacks often developed after meals, especially at full stomach, she took care not to eat too much. At the age of 44, she was admitted to the emergency department for the first time due to acute pulmonary oedema following the aforementioned attacks. Urgent cardiac catheterization showed no significant coronary stenosis and typical apical LV ballooning (), and finally she was diagnosed as having TTS. Later, at the age of 45 | At the age of 44, she was admitted to the emergency department for the first time due to acute pulmonary oedema following the aforementioned attacks. Urgent cardiac catheterization showed no significant coronary stenosis and typical apical LV ballooning (), and finally she was diagnosed as having TTS. Later, at | A 50-year-old woman with no coronary artery disease risk factors had suffered from transient chest pain, dyspnoea, and paroxysmal neck swelling irrespective of emotional stress for ∼15 years (). Since the attacks often developed after meals, especially at full stomach, she took care not to eat too much. At the age of 44, she was admitted to the emergency department for the first time due to acute pulmonary oedema following the aforementioned attacks. Urgent cardiac catheterization showed no significant coronary stenosis and typical apical LV ballooning (), |
27,971 | 160,305 | with breathlessness and productive cough of one week duration. She was referred to our institute as a case of non-resolving left pneumothorax. Significant history included open heart surgery for ventricular septal defect closure at 4 years of age and spinal instrumentation for correction of kyphoscoliosis at the age of 15 years. On examination, she was emaciated, weighing 35 kg, and had severe thoracic kyphoscoliosis and generalized muscle wasting. Airway evaluation revealed limited mouth opening with inter-incisor distance of 1 cm, Mallampati Score was IV, and Atlanto-occipital joint extension was grade | IV (<12). Respiratory system examination revealed a decreased air entry on the left chest. Chest radiography and computed tomography displayed a large pneumothorax with complete atelectasis of the left lung and airway distortion with deviated trachea and bilaterally | monitoring guidelines, the right radial artery was cannulated under topical anesthesia for invasive arterial pressure monitoring. Despite topicalization of the upper airways with local anesthetic, the patient remained uncooperative for any kind of airway instrumentation. After further sedation with intravenous fentanyl (50 μg) and midazolam (1 mg), general anesthesia was induced with titrated concentrations of sevoflurane taking care to maintain spontaneous breathing. A lubricated nasopharyngeal airway was inserted in the left nostril to administer oxygen and sevoflurane. A 7.0-size cuffed endotracheal tube was successfully introduced into the patient's trachea through the right nostril under the guidance of a 4.0-mm diameter fiberoptic scope (LF-1 Olympus).\nOnce airway control was achieved, |
13,136 | 78,784 | community he used intravenous amphetamine and occasionally intravenous heroin with shared needles for several years in addition to cannabis and infrequent ecstasy use. He has had a long history of alcohol abuse with periods of proactive abstinence.\nAn examination revealed right foot drop, bilateral leg weakness, some quadriceps wasting, bilateral hypertonicity of his lower limbs with sensory impairment reaching his upper thoracic region, and bilateral tingling and numbness in his upper limbs. Urinary incontinence was found to be due to neurogenic bladder dysfunction. Nerve conduction studies ruled out peripheral neuropathy and myopathy. His cranial nerve function was normal. His spinal cord magnetic resonance imaging (MRI) was normal, showing no | to 5 years with them. HTLV-1 infection is typically endemic in these Aboriginal populations. He was significantly integrated into the community, undertaking initiation practices such as circumcision and distal urethral hypospadic incision and had unprotected sexual relationships with Aboriginal women. In the Aboriginal | presented with a 2-week history of urinary incontinence and the inability to walk. Difficulty climbing stairs and occasional foot drop had been present for approximately 3 years prior to presentation. He was also found to have Pseudomonas pneumonia, chronic sinusitis, and a small scrotal abscess. Since 1995 he had spent an extensive period in an Aboriginal community in the Great Sandy Desert and was in contact for a total of 4 to 5 years with them. HTLV-1 infection is typically endemic in these |
6,702 | 89,461 | as routine follow-up. His initial symptoms had completely resolved and a repeat chest radiograph on that day showed clear lungs with no evidence of metastatic deposits (figure ). Although no histological confirmation of the metastatic nature of the lung lesions was obtained, it is highly likely that his pulmonary metastases had regressed spontaneously as the patient had not received any immunotherapy in the meantime. The patient remains well five months after the operation.\nRenal cell cancer accounts for 2% of all | resolved and a repeat chest radiograph on that day showed clear lungs with no evidence of metastatic deposits (figure ). Although no histological confirmation of the metastatic nature of the lung lesions was obtained, it is highly likely that his pulmonary metastases had regressed spontaneously as the patient | Histology revealed clear cell renal cell carcinoma. Six weeks following the operation, just prior to commencing immunotherapy, he attended the haematology clinic as routine follow-up. His initial symptoms had completely resolved and a repeat chest radiograph on that day showed clear lungs with no evidence of metastatic deposits (figure ). Although no histological confirmation of the metastatic nature of the lung lesions was obtained, it is highly likely that his pulmonary metastases had regressed spontaneously as the patient had not received any immunotherapy in the meantime. The patient remains well five months after the operation.\nRenal cell cancer accounts for 2% of all cancers and its |
28,071 | 112,530 | and the apparatus was further reinforced with two long extension plates. Weight-bearing was encouraged with shoe raise. Two cycles of Accordion maneuver (AM) as per Baruah and Patowary protocol [] were done at the hyporegenerate site. The wires were tightened in each follow-up. The distraction rate was slowed down to half a millimeter a day in the initial period when bone failed to appear in the beginning.\nOnce the docking site was reached further distraction was continued to get few millimeters of invagination into distal fragment to improve stability at the docking site. Slowly the bone started showing in the regenerate | in follow-up X-rays. After docking was achieved, further distraction was continued to gain the length of the limb by external bone transport. Apparatus was kept twice the period of distraction to consolidate the regenerate. It was removed when clinically there was no pain, abnormal mobility, and tenderness, and the X-ray showed three cortices | to the family. The guardians were true to their thinking that no modern science could salvage her limb. They started believing that amputation would be a viable option and with that feeling in mind, they approached us. The clinical setting was also conducive, in general for such an action. We knew that still a modern orthopedic technology called Ilizarov could settle down the morbidities in her favor. However, it was difficult to make them believe that a miracle might still be happening. After few sittings of counseling, they somehow agreed to give it a try.\nAfter improving the general condition of the patient, extensive debridement was done. All |
43,918 | 88,677 | with approximately five pre-school aged children, none of whom had recently had any serious illnesses.\nOn initial presentation to the Emergency Department, M.J. had no elevation in temperature. She had a mild frontal headache. Her vital signs were otherwise within normal limits. Her physical exam showed her to be alert and oriented, but with mild dysnomia on questioning. She did not have meningeal signs, but appeared mildly dehydrated. An initial computed tomography scan of the head | within normal limits. Her physical exam showed her to be alert and oriented, but with mild dysnomia on questioning. She did not have meningeal signs, but appeared mildly dehydrated. An initial computed tomography scan | are caused by HSV-1, with 10% having HSV-2 as the etiologic factor. An MRI is abnormal in the majority of PCR-positive cases []. PCR itself has a reported sensitivity of 98% and a specificity of 94% for the detection of HSV in the CSF []. In general, the treatment for HSV encephalitis is to initially treat with intravenous acyclovir for 21 days [,], with a further period of oral antiviral medication as clinically indicated. Untreated, this |
40,056 | 64,275 | was partially resected due to extension into the right thorax. Pathology from the lesion revealed a poorly differentiated adenocarcinoma with enteric histomorphology and >5 positive lymph nodes demonstrating extranodal extension with prominent lymphovascular invasion. No residual thymic tissue was identified. The pathologists subjected the specimen to various immunophenotypic stains (). The adenocarcinoma of the anterior mediastinum was diffusely positive for CDX2, CK20, and β-catenin in addition to CK7 positivity. The tumor was negative for TTF-1, PAX8, cKIT, and SALL4, markers | from the lesion revealed a poorly differentiated adenocarcinoma with enteric histomorphology and >5 positive lymph nodes demonstrating extranodal | uncomplicated laparoscopic right hemicolectomy () by Colorectal Surgery with an uneventful recovery. Final pathology of the colonic specimen revealed an invasive, poorly differentiated, adenocarcinoma arising from a tubular adenoma with high grade dysplasia and thirteen of twenty-eight lymph nodes positive for metastatic adenocarcinoma. Despite aggressive en bloc resection of the pericolonic |
14,698 | 141,280 | and imaging specialists evaluated the case and approved TAVI for this patient.\nThe procedure was carried out in a hybrid operating room under general anesthesia. The vascular access for the CoreValve delivery catheter was obtained in the left common femoral artery with standard percutaneous access techniques. The "Preclose" technique using two suture-based closure devices (Abbott Vascular, Redwood City, CA, USA) was applied before insertion of the sheath in order to prepare pre-tied knots | in a hybrid operating room under general anesthesia. The vascular access for the CoreValve delivery catheter was obtained in | inch wire was passed through the aortic valve using a 5 Fr AL1 catheter and exchanged with a pre-shaped 0.035 inch superstiff wire. A delivery sheath loaded with a 26 mm CoreValve was inserted through the aortic valve without predilation. The position of the CoreValve was adjusted within the aortic valve, avoiding contact with the prosthetic mitral valve, and was slowly deployed under angiographic and transesophageal echocardiography probe (TEE) guidance (). TEE after the valve deployment revealed a moderate degree of paravalvular leak. Therefore, postdilation using a |
27,487 | 17,036 | normochromic anemia, serum bilirubin-1.2mg/dl, aspartate aminotransferase 18 U/L, alanine aminotransferase 16 U/L, serum alkaline phosphatase 76 U/L, serum protein- 5.1 g/dl with albumin- 2.3 g/dl, serum creatinine- 1.7 mg/dl, blood urea- 130 mg/dl. Urine examination showed 4+ protein, 50–60 red cells per high power field (HPF), 40–50 white cells/HPF, erythrocyte sedimentation rate 123 mm/hr, serum C-reactive protein 1.90mg/dl. Antinuclear antibody (ANA) by immunofluorescence was 4+ homogenous (1:80 dilution), anti-double stranded deoxyribonucleic acid (dsDNA) antibodies | normal.\nInvestigations revealed anemia (hemoglobin 5.9g/dl), total leucocyte count 8000/mm3, differential leucocyte count – neutrophils 81%, lymphocytes 12% (absolute lymphocyte count-960/mm3), platelets- 209,000/mm3, reticulocyte count- 3%, peripheral blood smear showed normocytic | when she developed migratory arthritis involving the left knee joint at first followed by the right knee, right elbow and left shoulder. The pain and swelling lasted for 7–10 days before involving the other joints. She had been diagnosed to have acute rheumatic fever and started on analgesics and penicillin prophylaxis. The joint symptoms subsided in three months. For the past 4 months, she had history of fever (documented to be around 101–102° F) occurring |
42,923 | 167,846 | and mirtazapine were discontinued. Given the MRI findings, she was treated for ongoing inflammation associated with IRIS versus a possible exacerbation of her underlying MS with high-dose intravenously administered methylprednisolone (IVMP) 1500 mg daily for 3 days. She was then transitioned from glatiramer acetate to ocrelizumab for treatment of MS. Six months following her diagnosis she reported changes in left hand dexterity and right upper extremity phasic spasms. A repeat lumbar puncture was performed and JCV PCR remained undetectable. | was then transitioned from glatiramer acetate to ocrelizumab for treatment of MS. Six months following her diagnosis she reported changes in | with no significant medical history was diagnosed as having MS in 2013 at age 22 and experienced ongoing radiologic activity on both glatiramer acetate and dimethyl fumarate. She transitioned to natalizumab in July 2014 to stabilize disease activity, and her JCV antibody index was positive at 3.58 prior to starting natalizumab. She became clinically and radiologically stable with the initiation of natalizumab until November 2016 when a surveillance |
20,589 | 29,716 | to exclude a cardiac origin of the thrombus. We observed two minor Dukes criteria, i.e. the presence of an aortic graft after a David procedure and an arterial embolus. Because the patient had already been discharged he was contacted for further analysis. Since he was already on rivaroxaban for persistent atrial fibrillation and | he reported no further complaints (e.g. no dyspnea or fevers), it was decided to perform ambulatory transthoracic echocardiography, possibly followed by transesophageal echocardiography, within two to three days to exclude a cardiac origin for his arterial embolus, such as infective | was 144/89 mmHg. Saturation was 97%. Auscultation of heart and lungs was not documented. Also, there was no documentation on the presence of endocarditis stigmata. Laboratory investigations showed elevated inflammatory parameters (see Table ). An electrocardiogram (ECG) was not performed. No blood cultures were taken. After a CT-scan had revealed a thrombus in his right brachial artery the care of the patient was swiftly transferred to a vascular surgeon. Surgical embolectomy was performed within short notice. Elevated inflammatory parameters were attributed to ischemia in his arm and he was discharged the next day. A few days after discharge, it was realized that a source for his peripheral |
3,281 | 15,505 | tectal plate of the midbrain and subjacent aqueduct, which was resulting in obstructive hydrocephalus. To further evaluate, we obtained serum beta-hCG and alpha-fetoprotein to distinguish if the mass was a pure extragonadal germ cell tumor or NGGCT. Patient's serum alpha-fetoprotein levels were elevated to 215.8 ng/mL (normal range of 0-8 ng/mL), and beta-hCG level was noted to be 35 mIU/mL (normal range of 0-3 mIU/mL). Given the elevations of the tumor markers, this patient likely had an | NGGCT; however, a definite diagnosis biopsy was needed. On day three of his admission, the patient received an endoscopic third ventriculostomy to improve the obstructive hydrocephalus and help in the drainage of the cerebrospinal fluid through the cerebral | The patient also had an episode of seizure in the emergency department and was administered a loading dose of Keppra 1000 mg and a maintenance dose of 500 mg twice a day intravenously. The patient was then admitted to the neurological critical care unit for further monitoring.\nNeurosurgery evaluated the patient and recommended to bolus 10 |
10,462 | 41,898 | malignant transformation is low. Based on the medical history, probably an adequate pathology diagnosis at the moment of the second procedure would have saved the second ovary. Yet, the pathological exam is difficult and the pre-operative computed tomography showed a very large tumor. Also, at that moment the immunohistochemistry was not routinely performed. The long medical history of this case highlights that even in rare situation like this the clinical | pathological exam is difficult and the pre-operative computed tomography showed a very large tumor. Also, at that moment the immunohistochemistry was not routinely | histories were all unremarkable. At the age of 16 she was accidently (at a routine abdominal ultrasound) diagnosed with a right ovarian tumor. The tumor has been removed because of suspected malignant risk. Pathologic examination showed an immature teratoma with glial cells. (Figure a) Six years she was asymptomatic then a left ovarian tumor was found because she accused unspecific pelvic pain which was controlled under usual analgesics. The tumor was evidenced by computed tomography and it was completely removed based on |
20,457 | 66,797 | of brain activity was thus considered low. Accordingly, we suspected that the patient’s consciousness disorder was caused not by an exacerbation of the psychiatric disorder, but rather by some functional cerebral disorder. After hospital day-19, the patient’s state of consciousness improved, and he regained the ability to speak. His muscle stiffness and sweating were also reduced.\nOn hospital day-29, a repeat EEG showed decreases in diffuse slow wave activities, and a moderate amount of | α-waves was observed. It appeared that this reflected an improvement in the patient’s state of consciousness. However, brain MRIs performed on hospital day-17, day-36, and day-54 demonstrated persistent findings of a high-intensity signal in bilateral VPL, and this was | change was observed in his state of consciousness.\nStarting on hospital day-6, the patient developed a fever of ≤38 °C and muscle stiffness associated with elevated creatine kinase values. Muscle stiffness and excessive sweating were observed on hospital day-8. However, the C-reactive protein (CRP) value was approx. 0.4 mg/dL, and no infectious disease symptoms were observed. All oral antipsychotic agents were discontinued when the patient was admitted to the emergency hospital. Taking this into consideration, |
38,253 | 86,354 | to detect early stage colon cancer which can be treated by endoscopic submucosal dissection in preventing surgical resection of reconstructed colon.\nDGE is one of the major postoperative complications after PpPD, and the incidence has been reported to be 22–45 % []. The main pathogenesis of DGE after PpPD has been thought to be preservation of the pylorus ring without innervation. Conventional PD and subtotal stomach-preserving pancreatoduodenectomy (SSPPD), in which the pylorus and duodenum are removed and more than 90 % of the stomach is preserved, has recently been reported to reduce the incidence of DGE compared with PpPD [–]. In this patient, | has been reported to be 22–45 % []. The main pathogenesis of DGE after PpPD has been thought to be preservation of the pylorus | the H2 blocker due to the decreased numbers of white blood cells to less than 2000/μl from the 141th POD. The number of white blood cells recovered to normal level soon. Severe extensive stricture remained observed. We suspected that this patient had resistance to PPI; thus, we performed simultaneous 24-h pH and bilirubin monitoring to estimate the extent to which gastric acid secretion was inhibited by omeprazole (20 mg/drip/twice a day). Proximal and distal pH sensors were positioned in the narrow lesion and in the stomach, respectively, and a bilirubin sensor was positioned just beyond the narrow lesion. In the stomach, a pH < |
33,915 | 141,244 | There were multiple areas of necrosis and the cells localized around vessels were generally preserved (). Scattered mitotic figures were identified, Homer-Wright- or Flexner-type rosettes were absent, and the periodic acid-Schiff preparation was negative in the cytoplasm of these cells. There was an interface, which consisted of spindle cells and necrotic tissue, between the GCT and the small, rounded, and basophilic component. Immunohistochemistry was negative for CD99, cytokeratin, and leukocyte common antigen, and was only positive for Vimentin. Due to the unusual histology, we consulted two bone tumor experts to discuss about this case. Their opinion was that this case | mitotic figures were not observed. The giant multinucleated cells were similar to osteoclasts, but with more nuclei arranged towards the center of the cell (). The remainder of the radial tumor was composed of a monotonous proliferation of small cells with rounded and basophilic nuclei and scant cytoplasm. The nuclei exhibited a finely-dispersed chromatin pattern. | The mass was painful, non-mobile, and attached to the deep planes corresponding to the proximal radial head. There was hypoesthesia and the flexion/extension and prono-supination movements of the patient’s right arm were limited.\nX-ray revealed a lytic lesion localized in the proximal meta-epiphysis of the radius with ill-defined |
43,857 | 135,914 | anchors loaded with FiberTape (Arthrex, Naples, Florida [FL]) were placed just lateral to the articular margin, one anterior and one posterior on the footprint. The tape-type sutures were passed in a horizontal mattress fashion through the tendon. An additional FiberLink (Arthrex, Naples, FL) was passed through the most posterior aspect of the infraspinatus tendon. The lateral row was then created with two additional 4.75 mm SwiveLock anchors (Arthrex, Naples, FL). Visualization from the | sutures were passed in a horizontal mattress fashion through the tendon. An additional FiberLink (Arthrex, Naples, FL) was passed through the most posterior aspect of the infraspinatus tendon. The lateral row was then created with two additional 4.75 mm SwiveLock anchors | no appreciable signs of instability on examination. Plain radiographs including anteroposterior, axillary lateral, and outlet views of the shoulder were obtained in office and demonstrated no evidence of acute fracture or dislocation. There was no evidence of Hill-Sachs deformity. The patient was sent for magnetic resonance arthrogram (MRA) to further evaluate his injury. MRA (Figs. and ) demonstrated a full-thickness tear of the infraspinatus with minimal |
24,598 | 142,931 | oral and cutaneous vesicles revealed only a few neutrophils.\nA skin biopsy drawn from an intact vesicle showed a subepidermal plane of cleavage with a perivascular lymphocytic infiltrate. A direct immunofluorescence (DIF) study on a perilesional biopsy demonstrated linear deposits of immunoglobulin G (IgG) and C3 along the dermoepidermal junction. The blood vessels also showed C3 (2+) deposits. A repeat DIF study using salt split skin revealed complete separation of the epidermis from the dermis, with linear staining of the basement membrane zone with IgG and C3. The band was seen mainly on the epidermal side of the split | involved.\nResults of laboratory investigations including total hemogram, blood sugar levels, liver and renal function tests, human immunodeficiency virus antibody test, chest radiograph and urinalysis were all within normal limits. A Tzanck smear from fresh | right hand, right leg, and ankle of three months duration, and painful oral ulcers of three years duration. She had been diagnosed with poorly differentiated squamous cell carcinoma of the hypopharynx four years earlier (T2 N1 M0), and had been treated with radiotherapy in a dose of 60 Gy for 26 days, with complete resolution of the lesion. In addition, she had filarial lymphedema of the right hand and the right lower limb, diagnosed 40 years earlier, and treated with diethylcarbamazine citrate. Her subsequent history was uneventful, except for rare |
35,192 | 40,189 | surgery and at this stage the clinical examination revealed inadequate space for the unerupted second premolar. The panoramic view (OPG) showed a favorable change in the position of the impacted premolar with increased\nradiopacity of cystic lesion, suggesting osteogenesis\n(). A fixed orthodontic appliance was fitted in the lower arch without further delay with the aim of reopening the lost space for the impacted premolar and preventing mesial migration of the permanent first molar. The space was opened with the help of an open coil spring and the permanent first molar was held in position by a mesial stop in the archwire. The impacted premolar | of the impacted premolar with increased\nradiopacity of cystic lesion, suggesting osteogenesis\n(). A fixed orthodontic appliance was fitted in the lower arch without further delay with the aim of reopening the lost space for the impacted premolar and preventing mesial migration of the permanent first molar. The space was opened with the help of an open coil spring and the permanent first molar was held in position by a mesial stop in the archwire. | vertically impacted second premolar. The root of the impacted second bicuspid was developed approximately up to half of its usual length and the apex was quite wide open. The cystic structure appeared to have originated from the second bicuspid with inferior and distal displacement of the same tooth. The corresponding deciduous tooth (second molar) was still present with normal crown and roots\n().\nA clinical diagnosis of a dentigerous cyst involving the crown of the impacted left mandibular second bicuspid was made with the differential diagnosis of an inflammatory cyst, a keratocyst and a unilocular ameloblastoma.\nAims and objectives\nConsidering the age of the patient, her occlusal status, size of the cyst, position, and |
19,621 | 141,783 | curiously reticent to use a wheelchair. There had never been any problems with gait initiation nor any signs of parkinsonism.\nApproximately nine years after the anoxic insult, he began to develop problems with gait initiation, characterized by taking multiple stuttering in-place | years after the anoxic insult, he began to develop problems | to be unable to shift his center of gravity forward, and he bore his weight on his heels; he ultimately fell backward a few times while trying to start. Once he began walking, his gait was otherwise unchanged from the baseline pattern. There were no other new neurologic signs or symptoms, no signs of parkinsonism and |
10,155 | 128,184 | tachycardia, atrial premature beats, and ventricular premature beats. A cardiac B-mode ultrasound showed mild aortic valvular regurgitation and left ventricular diastolic dysfunction. Coronary artery CT found stenosis of the left anterior descending artery (50%). Laboratory findings, including blood chemistry and myocardial enzymes, were normal. The patient was prescribed 100 mg aspirin once a day for 2 months by another center. We decided to continue this existing treatment and add metoprolol 47.5 mg/day for her symptoms. Before our treatment, no examination for sense of smell or | taste was performed, and the patient did not report any abnormalities in her ability to smell or taste.\nAfter 2 weeks of metoprolol therapy, the patient reported decreased chest distress and palpitations. She reduced her metoprolol dose to 23.75 mg/day without reporting to the clinic her dose alteration. At the third week | compliant of an olfactory disorder. No abnormalities were found during the endoscopic nasal examination, with normal color. No gland or turbinate hypertrophy was found. No obstruction or excess secretion was noted in the nasal passages, and the olfactory epithelium showed no signs of congestion or inflammation. It was determined that the olfactory dysfunction was an adverse effect of metoprolol. Considering her better initial symptoms and repeated DCG result, the metoprolol was tapered. The patient recovered from the olfactory dysfunction 3 weeks later, as determined by her ability to once again perceive the smell of soap. By the second month after discharging metoprolol, the patient's ability |
10,564 | 14,280 | Dx Series Genetic Analyzer (ThermoFisher Scientific, USA) at Beijing Shengguzhi Medical Laboratory (Beijing, China) following the manufacturer’s instructions. It was found that a deletion mutation (Fig. ) occurred in the patient’s VHL gene at the c530-536delGACTGGA region in exon 3. This deletion caused a change in the amino acid at position 177 (Arg-177, Fig. ). Based on the results of genetic tests, the patient was diagnosed with VHL syndrome with renal carcinoma, bilateral lung metastases, multiple nephrotic | his relatives did not agree to perform further pathological diagnosis by renal biopsy. After a comprehensive analysis, it was thought that the patient might have VHL syndrome. Genomic DNA was extracted from the patient’s peripheral blood leukocytes using a DNA extraction kit, and VHL gene coding sequence analysis was performed by direct sequencing of PCR-amplified products using Sanger sequencing technology with an Applied Biosystems 3500 | examination of the cranial and thoracoabdominal regions showed multiple lacunar infarctions in the basal ganglia, bilateral softening lesions in the cerebellar hemispheres, multiple space-occupying lesions in both kidneys, bilateral polycystic kidney disease, multiple hepatic cysts and pulmonary nodules (Fig. ). The patient’s father was dead, the cause of death was unknown, his mother was alive, and the patient was |
35,170 | 148,328 | smoke.\nOn examination, her temperature was 38.9℃, her blood pressure 136/66 mmHg, and her pulse 84 beats per minute. The respiratory rate was 20 breaths per minute, and the oxygen saturation 96% when ambient air was breathed. She appeared tired when the fever spiked, but otherwise did not appear to be ill. Her heart and breathing sounds were normal. Neither the liver nor spleen was palpable and no palpable lymph node could be found. The peripheral pulse was intact, palpable, and present bilaterally at the carotid, brachial, radial, popliteal, and dorsalis pedis artery. No | 84 beats per minute. The respiratory rate was 20 breaths per minute, and the oxygen saturation 96% when ambient air was breathed. She appeared tired when the fever spiked, but otherwise did not appear to be ill. | was observed for some time with prescription of antipyretics. The fever did not subside after 1 month and she was admitted to another hospital.\nThe patient had been generally well despite her fever and chills. Her blood pressure and pulse were normal. No bacteria were cultured from blood. Extended spectrum beta lactamase-negative Escherichia coli was isolated from the initial urine culture, but the fever did not subside after administration of appropriate |
30,734 | 36,742 | []. However, none of these were present in our patient. Imaging such as computed tomography, echocardiography and coronary catheterization aided on the diagnosis and establishment of complications.\nIntensive medical treatment has been one possible approach for PA aneurysms with clinical improvement of signs and symptoms [,,] and so treatment for PH was started. However, despite being responsive to therapy with calcium channel blockers and near normalization of pulmonary vascular resistance, the aneurysm showed no size reduction after 20 months of | treatment, suggesting that PH and PA aneurysms progress independently. Boerrigter et al have described that the normally observed progressive dilatation of PA is independent of hemodynamic changes in PH, such as, PA pressure and cardiac output. Rather, it can be related to changes on the vessel wall [].\nAlthough other authors have reported such giant | 3/6 systolic murmur and a 2/6 diastolic murmur at the lower and upper left sternal border, respectively. Her chest radiography showed cardiomegaly and dilation of the main pulmonary artery and its branches (Figure ).\nSecondary causes |
25,998 | 190,488 | for CD10, while stains for inhibin, CD34, WT-1, S-100, MART1, and HMB-45 were negative. The epithelial component was positive for CK7 (), for PAX-8, and, focally, for CD10. Immunostains for ER and PR were negative in stromal and epithelial components. The ki-67 index was low (<2%).\nThe tumor pedicle extending into the inferior vena cava showed similar morphology except for some edema and a focal procedure-related hemorrhage. Specifically, no epithelioid morphology and no tumor necrosis or mitoses were seen despite | extensive sampling. The pedicle appeared to be floating in the vascular lumen without attachment to, or invasion of, the vascular wall (). The outer surface of the tumor pedicle was covered by endothelial (CD31/CD34 positive) cells (not shown).\nFISH studies for ETV6 rearrangement by an ETV6 break-apart probe on chromosome 12 at 12p13.2 and for SS18 by a synovial sarcoma break-apart probe on chromosome 18q11.2 were negative.\nA diagnosis of “mixed epithelial and stromal tumor (MEST) of the kidney with extension into IVC” was rendered. After surgery, the patient recovered uneventfully and no recurrences have been reported at | male presented with a 1-day history of intermittent gross painless hematuria. His past medical history included herniated lumbosacral disk with radiculopathy, otherwise unremarkable. Social history included current smoking, 6 pack/year, and occasional EtOH. The patient was single and had no children; family history was negative for genitourinary malignancies. Physical examination was unremarkable with BMI 23 and BP 120/86 and no prescribed medicines or drug use. Laboratory tests showed normal CBC, normal coagulation profile, and normal renal function.\nAxial, contrast-enhanced CT demonstrated a centrally located, 4 x 4 x 4.6 cm, lobulated mass invading the renal vein and extending into the lumen of the infrahepatic inferior vena cava (). CT angiography of the |
22,372 | 102,753 | for analgesia in the possibility of pain during the next 48 h. First bowel movement occurred 30 h after the surgery without bleeding, with a slight discomfort, yet without any difficulty. During the follow-up visit that took place a week later, the reported pain dropped to 2/10 (VAPS), without any discomfort. On the second follow-up, 15-days post-op, physical examination confirmed that the hemorrhoidal piles have been substantially shrunk and the healing process was normal. Next follow-up visits took place on the 6th, 12th | after the surgery and returned to daily activities after 5 days; he was prescribed only with paracetamol 500 mg as needed | with the placement of three stents 6 years ago. As a result, he was on anticoagulation protocol with 75 mg clopidogrel and 75 mg aspirin. There were no other medications and no known drug allergies. Furthermore, the patient has never had any similar symptoms and neither |
9,520 | 42,920 | 3D CT findings, we concluded that rupture of the subclavian artery pseudoaneurysm had occurred owing to injury, and emergency surgery was performed (Figure ). From a supine position, under general anesthesia, the right clavicle was removed to expose the subclavian artery. However, the subclavian artery could not be properly exposed owing to a massive surrounding hematoma and large pseudoaneurysm; in addition, a thrill was felt around the pseudoaneurysm | rupture of the subclavian artery pseudoaneurysm had occurred owing to injury, and emergency surgery was performed (Figure ). From a supine position, under general anesthesia, the right clavicle was removed to | felt, but the bleeding continued. Subclavian vein exposure was difficult, and we could not identify the venous connection site. During compression of the lesion, we decided to perform a median sternotomy for cardiopulmonary bypass and total circulatory arrest.\nThe aorta and right atrium were cannulated to perform conventional cardiopulmonary bypass while lowering the body temperature to 20°C, and the aneurysmal sac was then opened. |
1,488 | 129,475 | at that time showed no notable abnormalities. He was, therefore, diagnosed with schizophrenia and treated with risperidone at a maximal dosage of 6 mg per day for 12 weeks. The patient did not respond, and he was discharged with a weight of 59 kg and body mass index (BMI) of 20.41 kg/m2.\nAfter discharge, the patient presented with | the same symptoms and he was taken by his parents to our outpatient department 1 year before he was admitted to our hospital. The outpatient physicians diagnosed him with schizophrenia and treated him for 10 weeks with a maximal dose of olanzapine of 20 mg per day. He responded poorly, so he was admitted to our hospital at the request of his parents. The patient reported never | 0–5 pg/mL); soluble interleukin-2 receptor (sIL-2R), 812 U/mL (223–710 U/mL); IL-6, 10 pg/mL (0–7 pg/mL); IL-8, 51 pg/mL (0–62 pg/mL); IL-10, 8.8 pg/mL (0–9.1 pg/mL); tumor necrosis factor-α (TNF-α), 8.7 pg/mL (<8.1 pg/mL); and CRP, 5.5 mg/L (<5 mg/L). Electroencephalography, electrocardiography, and transcranial Doppler ultrasound results were normal. The patient and his family members denied any abuse of illicit substances. The patient’s weight was 66 kg and BMI was 22.84 kg/m2.\nThe patient was diagnosed with schizophrenia based on the Structured Clinical Interview for the fourth edition |
13,837 | 154,788 | boy complained of chest tightness and dizziness immediately after an intravenous meperidine injection for pain control before a colonoscopy.\nHe had a history of generalized tonic-clonic seizure at the age of thirteen and had been taking valproate. His brain MRI was normal and his EEG showed generalized spike waves, implying generalized epilepsy. Otherwise, he was healthy and had no family history of syncope or sudden death. As he had complained of cramping abdominal pain with diarrhea 2-3 times per week for one year before this event, he was scheduled | for a colonoscopy under the suspicion of inflammatory bowel disease. Initially, his vital signs were stable and his heart rate was 72 beats/min. After a meperidine injection for pain control before the colonoscopy, | infusion (0.1 µg/kg/min) (). The steady state QTc was 425 msec. Both the treadmill exercise test and 24-hour holter monitoring were normal, and there were no cardiac abnormalities seen on the echocardiogram. We performed a genetic analysis for 3 genes encoding essential channel subunits, including KCNQ1 (LQT1), KCNH2 (LTQ2), and SCN5A (LQT3). There was no related mutation, but 12 single nucleotide polymorphisms (SNPs), including H558R in SCNA5A and K897T in KCNH2, were reported in these genes. |
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