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13,732 | 118,004 | flow from the left upper extremity into the SVC excluding the left chest wall VM from causing any further PE. In order to maintain long-term patency of these stent-grafts, a small arterio-venous fistula was | order to maintain long-term patency of these stent-grafts, a small arterio-venous fistula | 21-year-old woman with a massive mediastinal–left chest wall VM, atresia of the left subclavian vein, and CTEPH was referred for evaluation primarily for PTE and secondarily for heart–lung transplantation. The patient was born with a compressible mass extending from the left neck, left chest, and left axillary areas. Six months prior to referral, she was diagnosed with an acute PE and treated with warfarin. She had not had an acute venous thromboembolic event prior to this and therefore was not previously on anticoagulation. She then reported progressive exercise intolerance progressing to severe dyspnea on exertion, ultimately becoming wheelchair-bound. Her pulmonary artery pressure was elevated and oral tadalafil |
30,960 | 26,774 | the emergency room on February 22, 2020, with complaints of subjective fever and cough productive of whitish sputum for three days prior to presentation. His symptoms were associated with generalized weakness, fatigue, and insomnia. He reported a history of an unintentional loss of 3 kg of weight secondary to decreased appetite over the past month. There were no symptoms of nausea, vomiting, shortness of breath, dysuria, or abdominal pain. There was no report of difficulty swallowing or coughing or regurgitation with food.\nHe was a poorly controlled type | with complaints of subjective fever and cough productive of whitish sputum for three days prior to presentation. His symptoms were associated with generalized weakness, fatigue, and insomnia. He reported a history of an unintentional loss of 3 | His last hospitalization was about three months earlier, where he was admitted for investigation of right upper quadrant pain and was found to have gallstone disease. His surgical history is inclusive of a transurethral resection of the prostate about a year earlier, which failed, and he has been on indwelling urinary catheter ever since. His medications are atorvastatin, aspirin, tamsulosin, and gliclazide. He has no known allergies. He has a history of smoking five cigarettes a day for 40 years, but he quit smoking three years ago. The patient denied alcohol consumption or illicit drug use.\nOn physical examination, he seemed to be uncomfortable and tachypneic with a respiratory |
21,228 | 89,981 | presented to our emergency department with chief complaint of right lower quadrant abdominal pain. The patient was referred with a 24 hour onset of colicky pain, of seven of ten in intensity. He denied bowel habit changes, fevers or chills, but he did complain of nausea, and postprandial fullness, but no vomiting. There was no history of weight loss over the last year and he denied any abdominal trauma or past surgeries. His family history was significant for colonic cancer in his father at age 47 | but no vomiting. There was no history of weight loss over the last year and | polyps, lesions or blood were appreciated. Tumor markers were drawn for CA-19-9, CA-125, beta-HCG, and alpha-fetoprotein. Only CA-123 was elevated at 128.\nThe patient was operated for resection of the mass. Upon gaining access to the peritoneal cavity, a moderate amount of serosanguinous fluid was evident and collected for cytology. A "muscular" mass was immediately apparent and occupied most of the peritoneal cavity (Fig ). The mass arose from the greater omentum, which was densely fused to it. On its inferior pole the mass was in close apposition to the sigmoid colon, |
15,947 | 50,590 | In this approach, immobilization is utilized when stretching of the FHL is too painful or when pain persists despite an adequate course of stretching.\nAfter two weeks, the pain persisted with weight-bearing and he was prescribed crutches by his PCP. The patient was referred for a second course of physical therapy two months post-injury. Under physical therapy guidance, the patient underwent a six-week rehabilitation program. The initial plan included reducing the use of crutches and boot along with instruction in a home exercise program consisting of | persisted with weight-bearing and he was prescribed crutches by his PCP. The patient was referred for a second course of physical therapy two months post-injury. Under physical therapy guidance, the patient underwent a six-week rehabilitation | to slowly increase his jogging distance with the goal of jogging two miles, a requirement to pass a physical fitness test. The patient was instructed to follow up if he experienced any recurrence in pain.\nTwo months later (four months after the initial evaluation), the patient re-injured his foot after running down a steep decline involving 1000 steps. The examination revealed pain along the navicular bone with pressure applied from a superior to inferior direction and pain along the plantar fascia. Navicular mobility was addressed with OMT, which immediate reduction in pain while |
14,298 | 78,578 | been presented to the hospital with exophthalmus and skin lesions, revealed that he had firstly undergone local excision due to basal cell skin carcinoma located on his face 12 years ago, that new lesions had formed 2 cm below the left oculonasal junction and in the left nasal root 6 years following the first diagnosis, and that the mass has been diagnosed to be a recurrence of BCC that indented medial wall of the left orbita and that expanded to close bones. The patient had undergone rhinectomy and reconstructive surgery. He had received radiotherapy. Six years after the completion of the therapy, he was presented with a lesion near | the left eye ().\nFacial MRI of the patient revealed a dense and large cystic mass lesion that led to an expansion of left frontal sinus by filling it and that destructed the anterior wall (). There were ovoid, dense cystic lesions with uniform contours in the central part and round, millimetric cystic lesions in the right of the mandibular corpus. A cystic lesion with uniform contours was observed in the contiguity of the retromolar dental roots in the left maxillar bone (Figures and ).\nIn the left, there were 2 contiguous cystic lesions with different sizes and contents and with regular | large cystic mass lesion that led to an expansion of left frontal sinus by filling it and that destructed the anterior wall (). There were ovoid, dense cystic lesions with uniform contours in the central part and round, millimetric cystic lesions in the right of the mandibular corpus. A cystic lesion with uniform contours was observed in the contiguity of the retromolar dental roots in the left maxillar bone (Figures and ).\nIn the left, there were 2 contiguous cystic lesions with different sizes and contents and with |
19,452 | 52,203 | and the mandible and maxilla bones appeared to be thin. A periapical radiographic examination showed severe absorption of the alveolar bone in | incisors. A periodontal examination revealed deep pockets and severe mobility in the maxillary right central incisor and mandibular left central incisor regions. In an orthopantomographic examination, all permanent teeth except for the mandibular left second premolar were identified, however, permanent tooth root formation was delayed, | Clinic of Osaka University Dental Hospital from the Pediatric Clinic of Osaka University Medical Hospital for consultation regarding oral management. Two mandibular primary incisors had spontaneously exfoliated at 1Y8M. Thereafter, the patient had been diagnosed with childhood-type HPP at the age of 2Y2M due to a low serum alkaline phosphatase (ALP) level (66 IU/I), as well as radiological examination findings of the lower extremities and hands, which revealed rickets, a metaphyseal irregularity. The obvious symptoms were localized |
24,391 | 85,690 | years, 3D printing technology has proven helpful not only to make an operation plan and simulate the operation in the preoperative stage but also for patients to learn more about their conditions and facilitate communication with doctors [, ].\nThe ganglioneuroma shows complete capsular and basal growth by expansive patterns. The most effective therapy is a surgical removal operation as soon as possible, which can reduce the | increase in enhancement on dynamic images; it presents as non-enhancement or mild enhancement in the arterial phase of CTs or MRIs and progressive mild enhancement in the delayed phase. If ganglioneuroma shows an atypical manifestation on a CT and an MRI, we consider the tumor to contain a malignant component []. In recent | in 13 papers. For details regarding age, position, clinical characteristics, and follow-up, see Table .\nNeurogenic tumors may be broadly classified as arising from nerve cells or nerve sheaths. The former group includes ganglioneuroma, ganglioglioma, ganglioneuroblastoma, and neuroblastoma, and the latter includes neurilemmoma, neurofibroma, and malignant schwannoma []. In 1941, Eden [] classified dumbbell-shaped tumors into four categories according to the anatomical relationship, that is, the spinal cord and vertebrae: intradural and extradural; intradural, extradural, and paravertebral; extradural and paravertebral; and foraminal and paravertebral. In this case, the tumor, which was located in the intraspinal region, passes through the intervertebral foramen to form a paravertebral mass resembling a dumbbell. |
38,321 | 25,115 | of Oral and Maxillofacial Surgery of Chonbuk National University Hospital with a complaint of pain and swelling in the left mandible that had appeared 10 days earlier. Eleven years ago, she was diagnosed with CFD (Fig. a, b) and had received bone contouring in the left zygomaticomaxillary complex and left mandibular region under general anesthesia in the same department (Fig. a, b). Postoperative healing was uneventful and 18 months postoperatively, there was no specific problem with the lesion (Fig. c). The patient had subsequently been lost to follow-up until November 2018.\nA review of medical history prior | Oral and Maxillofacial Surgery of Chonbuk National University Hospital with a complaint of pain and swelling in the left mandible that had appeared 10 | and 36. No evidence of gum inflammation, such as periodontal pockets or gingival sulcus swelling and bleeding, was found during the periodontal examination. Furthermore, in the panoramic view, the dental origin with the possible infection source was not observed (Fig. d).\nA well-defined multilocular radiolucent lesion in the left posterior mandibular region was identified on the panoramic radiograph, and the location of the lesion overlapped with the existing FD. In addition, amorphous calcified foci were observed inside the lesion (Fig. d).\nCone-beam computed tomography (CBCT) showed an expansive bone lesion with a ground-glass |
36,575 | 187,545 | spindle cells; some of which were arranged in vague storiform pattern and others in long fascicles. There were areas with epitheloid cells forming small anastomosing nests and cords. The areas in between these showed skenoid fibers along with focal areas of hemorrhage, | were arranged in vague storiform pattern and others in long fascicles. There were areas with epitheloid cells forming small anastomosing nests and cords. The areas | unavailability. A clinical diagnosis of acute appendicitis was made assigning an Alvarado score of 9/10. Laparotomy was performed using the Lanz incision in RIF. Intraoperatively appendix was found to be normal without evidence of inflammation or infection in RIF. In view of symptoms and signs, a possibility of other pathology was thought. Walking the bowel proximally up to 3 feet (1 m) did not show a Meckel's diverticulum or any other small bowel lesions. There were no obvious mesenteric lymph nodal enlargement and pelvic organs looked pristine. Approaching closure, just when |
5,527 | 141,380 | done for 12 years by the pediatrics department. During that time, there was no manifestation of abnormal neurological symptoms. The patient visited due to motor weakness. The computed tomography (CT) imaging scans showed intracerebral and intraventricular hemorrhage throughout left posterior frontal cortical area and left lateral ventricle. Under magnetic resonance image (MRI) gadolinum-enhanced T1 weighted image, partially high signal was detected in the cortical area of frontal lobe. Small inhomogenous high signal was also observed | at the pediatric department of our hospital. Under NCM impression at the time, serial follow-ups for clinical symptoms were | scans (). The mass on the left frontoparietal area was removed gross totally once again through surgery with same pathological findings. On the 3rd week following the second surgical treatment, the patient complained of back pain, voiding difficulty, left side motor weakness grade III and respiratory difficulty. So spinal MRI scans was done, and mass lesion with high signal at the T2 weighted image and inhomogenous high signal at gadolinum-enhanced T1 weighted image along the C5-T3 area were observed, and bilateral laminectomy with partial removal of the mass was |
40,130 | 81,215 | Department of Medical Genetics for growth and developmental delay. The parents were first cousins and he was the first child of the family. He was born at term by Cesarean section due to breech position. Bilateral congenital cataracts (operated on at age two years), cryptorchidism on the right side, hypertonia and seizures were observed after birth. However, no further seizures occurred for about twelve months. The patient was reported to have severe | developmental delay. He never learned to crawl or walk and did not say any words. He was fed by nursing bottle. His height and weight were within the normal range at birth, but below -2 standard deviations at all times after age 2 months.\nRhizomelic shortening of the arms, contractures at elbows and wrists, dolichocephaly, a flat occiput, maxillary hypoplasia, | level was 125.85 µmol/L (N: 0-9.88 µmol/L), a value which was very high. We elected to sequence the PEX7 gene in the patient and his parents. Ethylenediaminetetraacetic acid blood samples were sent to the Research Institute of the McGill University Health Centre in Montreal, Canada, in the context of a research protocol (). Molecular genetic analysis was performed by Sanger sequencing of polymerase chain reaction amplicons of all 10 PEX7 exons and flanking |
37,413 | 68,143 | (cell count, 36 /mm3; protein, 16 mg/dl; glucose, 113 mg/dl). C. neoformans was detected in CSF as well as in the surgical specimen of the cerebellum.\nHistopathologic examination of the surgical specimen revealed strong hyperplasia of the arachnoid mater (Fig. ). Fungi were mainly localized in the subarachnoid space and rarely in the parenchyma (Fig. ). Lymphocytes and multinucleated giant cells forming granulomata invaded the arachnoid and subarachnoid spaces and pia with heavy fibrosis (Fig. ). Small arteries were occasionally observed to be occluded with internal endothelial proliferation. While there were arteries in the sample, | Lymphocytes and multinucleated giant cells forming granulomata invaded the arachnoid and subarachnoid spaces and pia with heavy fibrosis (Fig. ). Small arteries were occasionally observed to be occluded with internal | count, 36 /mm3; protein, 16 mg/dl; glucose, 113 mg/dl). C. neoformans was detected in CSF as well as in the surgical specimen of the cerebellum.\nHistopathologic examination of the surgical specimen revealed strong hyperplasia of the arachnoid mater (Fig. ). Fungi were mainly localized in the subarachnoid space and rarely in the parenchyma (Fig. ). Lymphocytes and multinucleated giant cells forming granulomata invaded the arachnoid and subarachnoid spaces and pia with heavy fibrosis (Fig. ). Small arteries were occasionally |
29,229 | 33,383 | healthy disc, normal macular appearance, and normal horizontal corneal diameter.\nUnexpectedly, the ultrasound b-scan measured an axial length of 15.3 mm right eye and 15.7 mm left eye. This was supported by the MRI of the brain and orbits (Fig. ), which showed a longer globe length of the left compared to the right eye (Fig. b). It was concluded that the left eye was within the spectrum of microphthalmia with a cystic expansion of the posterior segment resulting in these similar axial lengths.\nThis MRI was undertaken at 10 weeks of age. The left optic nerve head was not evident on MRI (Fig. a). | with a cystic expansion of the posterior segment resulting in these similar axial lengths.\nThis MRI was undertaken at 10 weeks of age. The left | week of pregnancy; she did not suffer infection or nutritional deficiency. There was no history of medication use during pregnancy. The mother was monitored intensively during the third trimester for intrauterine growth retardation. The patient spent 3 weeks of the post-natal period in a special care baby unit for weight gain, requiring minimal respiratory support and an incubator for 3 days.\nAt term corrected age, her |
43,772 | 98,710 | aorta at the diaphragm level was 16.2 mm.\nDue to the normal functioning mitral valve and normal functioning bicuspid aortic valve, the normal size ascending aorta, and a significant aortic coarctation, the patient was scheduled for balloon dilatation and stenting.\nThe right femoral artery, right radial artery, and left femoral vein were punctured. One pigtail catheter was used in aortic arch through the right radial artery, and the gradient was measured between the pigtail and femoral artery, which was 70 mm | Hg. The coarctation stenosis was crossed by hydrophilic wire 0.035 through the multipurpose catheter and after that, the wire changed to Amplatz Super Stiff™, which was deployed at the aortic root. One pacemaker wire was positioned in RV through the femoral vein as a backup. The bare, self-expandable stent "Sinus-xl (OptiMed)” size 20 × 40 was deployed through | "Sinus-xl (OptiMed)” size 20 × 40 was deployed through the 10 French femoral sheath. Then, the stent was postdilated by balloon BIB®16 × 40 with proper final results and the gradient decreased to 5 mm Hg (Figure ).\nPostprocedural echocardiography showed that the gradient has decreased significantly (peak systolic gradient decreased to 4.5 mm Hg).\nThe patient was discharged in good condition. In follow-up visits in months 1 and 6, he had no complaints and had good functional activity. Follow-up echocardiography result after 6 months showed an ejection fraction of 60%, no AS, no AR, no MS, trivial MR, and peak systolic gradient of 3.6 |
10,476 | 18,588 | step, additional thyroid lesion workup such as a thyroid ultrasound, or measurement of her serologic thyroglobulin, anti-thyroglobulin, and calcitonin were not taken at this time. The patient then underwent a left neck dissection, and her left thyroid lobe and isthmus were resected. Additionally, the level 4 supraclavicular mass with multiple surrounding firm, enlarged nodes was resected en bloc. The right thyroid lobe and left central neck compartment contents | oncology team, the surgery team and the patient elected for surgical resection of the left neck mass for diagnostic purposes, as well as thyroid surgery for palliation, given the mass effect and tracheal deviation. With diagnostic surgery as the next | stain helped rule out a neuroendocrine or melanocytic origin. The workup for any lymphoid or histiocytic origin turned up negative, as the tumor cells did not stain for CD3, CD20, CD45, CD79a, CD138, or MUM-1. Additionally, there were areas of papillary thyroid carcinoma in both specimens collected (). Further genetic testing found that the lesion contained a BRAF (V600E) mutation. With these findings alongside the patient’s clinical presentation, we were able to conclude that the patient developed an aggressive anaplastic thyroid carcinoma with a plasmacytic |
20,350 | 138,133 | ().\nThe superior thyroid artery was connected to a descending branch of the lateral femoral circumflex artery by end-to-end anastomosis using nylon 10-0. Two venae comitantes were connected with a branch of the internal jugular vein and no name vein, respectively, on sternocleidomastoid muscle by end-toend anastomosis using nylon 10-0. After the anastomosis, flap blood flow was restored. The donor site was closed by primary closure using a split-thickness skin graft. The ALT flaps survived without problem. At 2 months | on the suprafascial plane, the proximal ALT flap was a musculocutaneous perforator flap and the distal ALT flap was a musculocutaneous flap. These ALT flaps were connected with the descending branch of the circumflex femoral artery. The length of pedicle was 6 cm. A vertical suture was placed on the upper ALT flap, which was used to reconstruct the esophagus. The lower ALT flap was used to reconstruct tracheostomy stroma | expected.\nTotal laryngopharyngectomy by ablative surgery and functional neck dissection were performed. After resection, a complete defect of the hypopharynx, upper esophagus, and tracheostomy stroma was observed (). The defect at the tracheotomy stromal site was 8×6 cm2. The initial reconstruction plan involved the use of two flaps, one for the hypopharynx and upper esophagus and the other for the tracheostomy stroma. Pulsation was present in the external carotid artery, but on resection the facial and lingual arteries and other branches of the external carotid artery (except the superior thyroid artery) were fibrotic with no pulsation or bleeding. The external jugular vein was normal. Because only the superior thyroid artery |
13,580 | 181,210 | truck was moving at low speed and he fell on muddy floor from a height of approximately 12 feet and sustained impact over abdomen. He was admitted in Nepalgunj medical college where contrast enhanced computed tomography of abdomen showed grade III liver | and sustained impact over abdomen. He was admitted in Nepalgunj medical college where contrast enhanced computed tomography of abdomen showed grade III liver | 12 feet and sustained impact over abdomen. He was admitted in Nepalgunj medical college where contrast enhanced computed tomography of abdomen showed grade III liver injury. He was managed conservatively with bed rest, 12 units of blood transfusion then discharged. He presented 15 days later to Alka Hospital emergency department with complaints of pain abdomen, excessive tiredness and vomiting of blood. His vitals in the emergency were pulse 100/min, blood pressure 90/60 mmHg, |
34,267 | 75,405 | skin flap, the tumor was found to invade through the frontal bone and to extend to the left frontal lobe (). The extra-cranial lesion was resected en bloc as widely as possible and the erosion of the frontal bone was extended by resection into the normal bones and dura, to remove a section 7×8 cm in diameter (). During the surgical procedure, the intra-cranial lesions invading the left frontal lobe, ethmoid sinus, superior sagittal sinus and the wall of the orbit were radically resected. The lesion in the ethmoid | of sinus cancer, was not taking any medication, did not smoke and did not drink alcohol. The erosion of the frontal bone gave rise to the suspicion of malignant disease or a metastatic tumor.\nA frontal craniotomy was performed with the aim of removing the tumor in December 2012. Subsequent to opening a | round cells with abundant cytoplasm (). The result of the histopathological examination was a diagnosis of SCC. Given that primary carcinomas of the frontal sinus are rare, the patient underwent further investigations, including chest and abdominal CT scans and a pelvic ultrasound. The results |
22,344 | 108,580 | with dosage of Aβ1–42, tau, phospho-tau, and 14-3-3 proteins.\nFurthermore, in February of the same year he underwent an electroencephalogram (EEG) which revealed minimal signs of encephalic suffering, represented by inscription of theta sequences within the alpha background rhythm. The patient was discharged with the diagnosis of “Rapidly evolving cognitive decline under investigation”. No treatment followed the hospital discharge. In February 2019, the patient underwent a 18F-FDG PET scan showing a markedly reduced uptake in the parietal, lateral temporal, and prefrontal regions bilaterally, greater in the right hemisphere. The uptake was also reduced in the precuneus especially on the right and less at the level of | with dosage of Aβ1–42, tau, phospho-tau, and 14-3-3 proteins.\nFurthermore, in February of the same year he underwent an electroencephalogram (EEG) which revealed minimal signs of encephalic suffering, represented by inscription of theta sequences within the alpha background rhythm. The patient was discharged with the diagnosis of “Rapidly evolving cognitive decline | Clinic due to the presence of cognitive changes and forgetfulness over the past two years, as well as recurrent and never-happened-before car accidents which occurred from October to December 2018. These events induced the man, married and father of an adolescent, to close the express courier business company he owned with a friend, remaining unemployed for a month. After starting to work again as an employee for another haul company, his forgetfulness and difficulties in driving the van persisted, to the extent |
5,595 | 141,296 | M was a 27-year-old single male, who had been working as an engineer in Germany for 15 months. He attended my outpatients’ clinic in Chennai with his brother and mother. He had returned suddenly from Germany the previous day, as he was convinced that his life was under threat from his work colleagues. When asked why he was being targeted, he said that he had developed | in Germany for 15 months. He attended my outpatients’ clinic in Chennai with his brother and mother. He had returned suddenly from Germany the previous day, as he was | to cooperate with the plan I suggested.\nA provisional diagnosis of an acute psychotic episode (International Classification of Diseases-10 category F23.3 – “other predominantly delusional psychotic disorders”) was made, on the basis of acute onset of delusions (mainly of a persecutory nature) within a period of <2 weeks. Isotretinoin was considered the likely precipitant as the onset of the symptoms followed its initiation. Although a functional origin of symptoms was possible (i.e. first episode of a functional mental illness like schizophrenia), absence of any prodromal symptoms, previous psychiatric history, or family psychiatric history |
8,594 | 44,642 | An abdominal CT revealed a large mass in the tail of the pancreas (10 × 14 cm) (Figure \n) without evidence of other peritoneal disease during staging investigation for a suspected carcinoma of the left breast. Two weeks previously, lumpectomy of a 3.5 cm tumor of the left breast had been performed by gynecologists. Sentinel lymph node examination was negative. Histology showed a primary poorly differentiated neuroendocrine carcinoma of the mammary gland. The patient’s medical history was significant for mediastinal sarcoidosis and a 0.7 × 0.9 cm | MCC removed from her left forearm 2.5 years previous, which was Merkel cell polyomavirus (MCV) DNA positive after quantitative PCR. No viral DNA was | containing areas of necrosis and hemorrhage. The spleen and four identified lymph nodes were negative for tumor as well as negative for the presence of MCV. Histological evaluation revealed a mitotic, highly active tumor (mitotic count 35 per high power field) with endocrine architecture of solid formations (regular, round nuclei with little cytoplasm). The tumor had immunohistochemically strong staining for synaptophysin, CD56, and in some areas, chromogranin. The tumor cells were strongly positive for cytokeratin 18 with |
21,449 | 188,602 | of neutrophils and plasma cells. Immunohistochemistry also showed expression of CD68, suggesting a significant histiocytic component to the lesion, but no true granulomata were identified. Focally the surface had a slightly palisaded appearance with necrotic debris on the surface, possibly representing an element of caseous necrosis. Staining with Ziehl-Neelsen () and Wade-Fite () showed numerous acid-fast bacilli.\nThe bland nuclear morphology, inflammatory cell infiltrate, and mycobacteria indicate an inflammatory pseudotumour secondary to mycobacteria infection. | The lack of epithelioid granulomata may be related to the underlying immunosuppression. The strong expression of desmin and the weaker smooth muscle actin, although slightly unusual, would be acceptable for a myofibroblastic proliferation.\nAfter confirmation of the histological diagnosis, the patient continued to show respiratory deterioration despite the surgical debulking and being started on broad-spectrum | tract infection 5 months prior to the latest admission with stridor. A sputum culture grew Haemophilus influenzae and Mycobacterium kansasii and the patient was advised 2 years of rifampicin, ethambutol, and clarithromycin by the respiratory team as per the British Thoracic Society recommendations []. Due to the duration of work-up of the diagnosis and need for 3 confirmatory sputum samples, the patient only had 6 weeks of triple therapy treatment prior to presenting with stridor.\nExamination of the patient during the acute admission using nasoendoscopy revealed a left anterior vocal cord granulation and an exophytic pedunculated lesion from the right vocal cord causing ball-valving of the glottic inlet |
29,443 | 122,135 | reported in basal ganglia. Occipital lobes were less hypometabolic in comparison to the other brain areas ( and ). These findings were more typical for PSP than MSA. Despite the MRI and FDG-PET findings, the diagnosis of probable MSA was confirmed on the basis of neurologic clinical findings and disease course. The patient developed rapid disease progression and died 5 months later due to multiple complications and cardiopulmonary insufficiency. Neuropathological postmortem examination was not performed because the family members denied permission for autopsy.\nWe confirm that written informed consent has been provided | Despite the MRI and FDG-PET findings, the diagnosis of probable MSA was confirmed on the basis of neurologic clinical findings and disease course. The patient developed rapid disease progression and died 5 months later due to multiple complications and cardiopulmonary insufficiency. Neuropathological | metabolic profile, complete blood count, tests for thyroid and liver functioning, vitamin B1, vitamin B12 and folate levels and erythrocyte sedimentation rate. Cerebrospinal fluid examination in terms of cell count, glucose and protein revealed no abnormalities. She was given levodopa, prescribed by a local neurologist for parkinsonism syndrome treatment, for more than 3 months, but there was no response to the treatment.\nMRI was repeated 29 months later. It revealed reduction of the anteroposterior diameter of midbrain at the superior collicular level from 15.5 mm on the first examination to 13.5 |
56 | 159,059 | as compared to the left. Radiographic analysis also revealed that all of the teeth on the right side had accelerated root formation relative to their counterparts on the left side. The condyle and the coronoid process on the right side were large with a prominent sigmoid notch. Multiple carious teeth were also noted ().\nMRI examination revealed the presence of a diffuse lipomatous tissue (which appeared bright or hyperintense on T1 weighted images) in the right | normal ().\nPanoramic radiograph showed that the right mandibular body and ramus were asymmetrically large in size. There was accelerated development of the maxilla and mandible on the right with advanced eruption of the teeth | with a complaint of pain in the region of the right posterior teeth of the lower jaw. Her mother also reported that her daughter had shown an asymptomatic swelling on the right side of her face since birth. The patient had undergone examination of this condition at 8 months of age. There was history of a gradual increase in the extent of the swelling with age, and the asymmetry of the face persisted. The child was born at full term with normal delivery and there was no history of consanguineous marriage in |
39,718 | 22,194 | 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 | was admitted to the neurosciences intensive care unit.\nHer initial laboratory tests showed respiratory alkalosis with an elevated | 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 |
41,293 | 86,521 | and fasten bone healing. Breastfeeding was not interrupted. Vitamin D was continued for a total of 4 months. One month later, patient symptoms started to improve gradually requiring less pain medications. Pain completely resolved and gait was restored around 6 months postpartum. No follow up MRI was performed and the patient was considered to have a healed fracture based on resolution of her symptoms.\nTo note, after 5 months of the diagnosis of sacral fractures, the patient underwent a follow | was continued for a total of 4 months. One month later, patient symptoms started to improve gradually requiring less pain medications. Pain completely | the immediate postpartum period and have already started to correct by the time the study was done. Another reason is that the follow up dual-energy X-ray absorptiometry that was performed 5 months later revealed an increase in the bone density at the spine and femur. Densitometry measurement of the forearm was not repeated. Another reason why this case can be regarded as a complication of pregnancy-associated osteoporosis is the timing of the event, which occurred in the immediate postpartum period; the affected skeletal |
6,747 | 82,940 | dorsal lateral prefrontal cortex (L-DLFC) []. Patient received high-frequency 6 Hz rTMS at 90% resting motor threshold, defined as the minimum amount of energy needed to induce a visible muscle twitch in the first dorsal interosseous muscle on more than 50% of the trials while the patient's hands are resting. Each session involved delivering 1200 pulses divided to several trains based on safety parameters built in to MAGSTIM Rapid2 machine (MAGSTIM, UK). In general, treatment was well tolerated except for some local scalp discomfort.\nPatient received one | received high-frequency 6 Hz rTMS at 90% resting motor threshold, defined as the minimum amount of energy needed to induce a visible muscle twitch in the first dorsal interosseous muscle | the recording of acceleration and deceleration phases. Participant performed 1 practice trial walking on the mat to familiarize himself with the protocol. Ambulation time (time elapsed between first contact of the first and the last footfalls, measured in seconds), gait velocity (cm/s), stride time (ms), cadence (number of full cycles taken by the pair of feet per minute), and stride time variability (percentage of coefficient of variation (%CoV)), the principal gait measures of interest, were measured over three trials which consisted of walking the length of the mat at a self-selected usual pace.\nA descriptive data analysis (means and proportions) was performed on quantitative |
7,586 | 102,520 | computed tomography (CT) (Figure ) and had undergone partial liver resection 7 years previously. Based on the 8th Union for International Cancer Control classification of | liver resection 7 years previously. Based on the 8th Union for International Cancer Control | per day. He had discontinued smoking and drinking alcohol 10 years previously. There was no history of cancer or liver disease in his family.\nThe height and weight of the patient at admission were 172 cm and 52 kg, respectively. There were no abnormalities in the vital signs. The abdomen was soft and slightly swollen. Tenderness was noted in the right lower abdomen.\nNo abnormal findings were found other than a high C-reactive protein level (4.95 mg/dL) in blood biochemical tests. Liver function tests revealed a class A Child-Pugh score.\nAbdominal contrast-enhanced CT |
6,031 | 39,663 | a characteristic feature of the lesion. The capsular surface was not involved with the tumor and a rim of residual thyroid tissue was observed in some peripheral areas. Immunohistochemically, neoplastic cells were strongly positive for CD31, CD34, and factor VIII-related antigen, showing evidence of their endothelial differentiation (Figure ). Diagnosis of this condition can be difficult as the histological features may mimic other malignant vascular lesions. In view of the clinical history and morphological and immunohistochemical findings, a diagnosis of primary angiosarcoma of the thyroid gland was made.\nAs regards adjuvant therapy, our patient has not been subjected to | any kind of special treatment because, even today, there are no guidelines and there are various schools of thought as to the best treatment options.\nThe prognosis was not favorable. The postoperative course was not simple: it was decided to admit the patient to our intensive coronary unit for precautionary reasons. After 3 days, due to an atelectasis of the | the right half, which was relatively easy, and the mass appeared well encapsulated and demarcated (Figure ).\nThe specimen was sent to surgical pathology for definitive diagnosis. The tissue samples were fixed in formalin, then routinely processed and embedded in paraffin. The sections were stained with hematoxylin and eosin. Additional 5-μm sections were cut and subjected to immunohistochemical studies using antibodies to the following antigens: CD34, CD31, factor VIII-related antigen, pan-cytokeratin (Pan-CK) and thyroglobulin. Grossly, the right thyroid lobe measured |
18,841 | 2,627 | fecal matter []. These findings indicate that the cyst communicated with the alimentary tract before being closed via an unknown mechanism. Our histological study revealed a focal discontinuity of the muscle layer in the cystic wall and a lining of mucosa through a defect in the muscle. Because these features of mucosa, also known as mucosal bridges, were sometimes seen after healing of an ulcer [, ] and because there was evidence of previous communication with the original bowel, our histological findings indicated a vestige of the opening site of cystic duplication. | healing of an ulcer [, ] and because there was evidence of previous communication with the original bowel, our histological findings indicated a vestige of the | closed during the healing process, resulting in a discontinuity in the muscular layer and the formation of a mucosal bridge after the stool poured into the cyst through an orifice and subsequently triggered intussusception in adulthood. In adults, intussusception is considered a rare condition and is observed in less than 5% of all cases []. More than 80% of these cases are caused by organic lesions, such as inflammatory |
17,532 | 53,921 | presented to our hospital with gradually worsening balance, ataxia, and dizziness for one year. Six months later she started having a new-onset headache which was progressively getting worse, was not relieved with over-the-counter medications. Headache was associated with loss of peripheral vision without any focal weakness, dysphagia, bladder or bowel incontinence, irritability, and apathy. She came to the emergency department for evaluation. Vital signs including body temperature, blood pressure, and heart rate were within normal limits. On neurological examination muscle strength was 4 out of 5 in all four extremities, gait was impaired, and rest examination was normal. Computed tomography (CT) scan of the brain demonstrated a hyperdense focus within the right | posterior parietal lobe (Figure and Figure ).\nThis was followed up with a magnetic resonance imaging (MRI) of the brain that demonstrated a new homogeneously enhancing lesion abutting the grey-white matter of the right parietal lobe concerning brain metastases versus primary brain neoplasm. Therefore, extensive imaging | was at baseline. Three days after the surgery she was discharged to a rehabilitation facility with a recommendation to continue dexamethasone 4 mg every 6 hours. Three weeks after surgery, she was seen by medical and radiation oncology team for discussion regarding the initiation of systemic therapy. On oncology evaluation she complained of persistent left-sided visual field deficits, however no further episodes of persistent headaches since her surgery. She continued to have quite a significant gait ataxia and was ambulating using a walker at home, and a wheelchair while going out of the home. On examination, she was ill-appearing, lethargic, minimally verbal, and wheelchair-bound.\nAs primary CNS lymphoma is an extremely rare |
32,578 | 79,360 | to be solid. During revision surgery, a total knee arthroplasty (Genesis II Total Knee System, Smith & Nephew®, Memphis, USA) with a femur size 7 posterior stabilized component was placed in combination with a tibia size 6, an insert size 15 and patella size 26. During surgery no complications were experienced. His range of motion after wound closure was 120 degrees of flexion and full extension with stable collateral ligaments. The postoperative X-rays revealed no abnormalities and a proper positioning of the total knee prosthesis.\nHis recovery | No other signs were found that could explain failure of the prosthesis. Cultures and biopsies of the medial femur condyle were taken for further examination; however, bacterial infection or osteonecrosis was not found. The tibial component was found | our out-patient department with symptomatic anteromedial osteoarthritis of his right knee. A physical examination revealed a full range of motion and stable collateral and cruciate ligaments. Plain radiography showed an anteromedial osteoarthritis grade III [] (Figure ). After an initial conservative approach, which included a 1-year period of physiotherapy, non-steroidal anti-inflammatory drugs and three hyaluronic acid injections, he was planned for a UKA (Oxford® Partial Knee).\nPreoperatively, a medium-size femoral component was templated. The surgery was performed by a specialist arthroplasty surgeon. During surgery, a femur of medium size, a tibia size C and an insert size 3 were placed and |
35,139 | 105,338 | and three with 90 mg oxaliplatin at three weekly intervals was instituted. She underwent six cycles of chemotherapy. She was doing well at six months post-surgery. Evaluation showed increased CEA level. Repeat CECT abdomen showed metastatic deposits over the small bowel. She was advised a folinic acid, fluorouracil, and irinotecan regimen but was lost to follow-up after six months. She also had an incisional hernia. The ileostomy was functioning well, and she enjoyed a good quality of | anastomosis was not done in view of the patient’s poor nutrition status.\nThe final histopathology report showed right and left ovarian lesions reported as mucinous ovarian neoplasm; colon showing adenocarcinoma in the rectum and sigmoid and multiple tubular adenomas (> 200) with omentum showing metastatic mucinous adenocarcinoma and uterus showing endometrioid carcinoma. She was started on adjuvant chemotherapy. A modified FOLFOX regimen with 750 mg 5-fluorouracil on days one, two, | pelvic region, not moving with respiration. There were no ascites. There was a family history of carcinoma rectum (the patient’s sister).\nContrast-enhanced computer tomography (CECT) of the abdomen reported ovarian mass (28 cm × 21 cm × 27 cm) with multiple polypoidal lesions within the bowel and omental deposits. Colonoscopy showed rectal ulcer with multiple polyps until the sigmoid colon, and the endoscope could not be negotiated further. Biopsy of |
21,959 | 82,913 | also complained of malaise, myalgia and arthralgia for the same duration but denied any urinary, respiratory or abdominal symptoms. Until he presented to us, he had obtained treatment froma local hospital for the illness with no clinical improvement. He had received co-amoxyclav, clarythromicin and paracetamol for 4 days. He had not been consuming any medication prior to the illness and had not received | in the Western Province of Sri Lanka presented with high fever associated with chills and rigors for 17 days. He | × 109/L (Neutrophils 43 %, Lymphocytes 56 %), Erythrocyte sedimentation rate was 80 mm/1st h and had a normal urine analysis, liver and renal function tests. The CT scan of the brain and the Electroencephalogram were normal. We did not perform a lumbar puncture or an Magnetic resonance image scan of the brain. He was positive for Immunofluoresence Assay (IFA)-IgM and IgG for O. tsutsugamushi on the 17th day of illness and the IFA-IgG titre using Orientia Karp antigen was 1:1024 which rose up to 1:16,384 after 2 weeks confirming scrub typhus. His fever settled with oral doxycycline and azithromycin within 48 h and |
5,214 | 100,718 | involved in a road traffic collision, after being dazzled by the sun, where she crashed into a parked vehicle and rolled her car twice. She was taken to her nearest emergency department and assessed following advanced trauma life support protocols. She was haemodynamically normal and had no neurological deficit. She complained of neck and left shoulder pain. Due to the mechanism of her injury and her complaint of neck pain, a CT scan of her cervical spine was performed along with an x-ray of | her left shoulder.\nThe left shoulder radiograph showed no abnormality. The sagittal images of the cervical spine CT scan are shown in and and . is the mid-sagittal slice of the CT scan at presentation and shows no obvious malalignment.\nThere is an acute fracture of the antero-superior osteophyte of the body of C7 (). There | presentation and shows no obvious malalignment.\nThere is an acute fracture of the antero-superior osteophyte of the body of C7 (). There is also opening of the cervical facet at C6/7 (). There were no fractures of the vertebral bodies. It can also be appreciated that there is significant degenerative change between C4 and C7.\nOn the basis of these imaging findings, the patient was reassured that no injury had been identified. Due to the COVID-19 pandemic, the patient was discharged home after this and no further follow up was arranged to ensure that both the patient and the hospital were protected from |
25,108 | 161,080 | hematuria on urine analysis; however, the other laboratory findings were within normal range. Cystoscopy showed diffuse erythematous mucosal thickening on the right side wall of the bladder dome (). However, there was no stool debridement no any fistulous opening in the bladder. A computed tomography (CT) scan showed that there was a tubular structure connected with the right side wall of the bladder, suggesting Meckel's diverticulum with fistula formation to the bladder as well as a mass-like bladder wall thickening ().\nWith an impression of Meckel's diverticulum with fistula with the bladder, a laparoscopic operation was performed through 3 abdominal ports (one 10 mm port placed | connected with the right side wall of the bladder, suggesting Meckel's diverticulum with fistula formation to the bladder as well as a | with 3-0 Vicryl (Ethicon). The total surgical time was 75 minutes and the estimated intraoperative blood loss was minimal.\nOn the 7th postoperative day, cystography was performed and no urinary leakage around the bladder was demonstrated. The urinary symptoms including gross hematuria, dysuria, and frequency improved and abdominal discomfort symptoms also subsided. The other laboratory findings were within normal range. The surgical specimen showed a 9.2×1.2 cm appendix attached to a 4.3×3.2 cm bladder with dense fibrotic change without any malignancy.\nAt 1 month postoperatively, he had no symptoms including frequency, urgency, sense of |
42,291 | 161,566 | left foot, as well as pitting edema in the right foot. A triple-phase bone scan revealed significant reuptake in the right foot, characteristic of CRPS.\nBy March of 2012, the patient’s requirements for the lower dose intravenous ketamine infusions were not as frequent (6 week intervals, pain spikes not as high). The patient recovered from CRPS flares more quickly, felt more energetic, and tolerated pain better. He became physically more | active, and his sleep improved significantly. Within 2 months after starting LDN, the patient’s dystonic spasms discontinued, although he still had moderate pain in both upper extremities. The patient was able to walk without a cane (Fig. ), which he | In 2010, he underwent a cardiac bypass surgery for coronary artery disease. His CRPS symptoms became widespread after this surgery, spreading to his upper chest, upper arms, and forearms. In 2011, the patient developed significant dystonic spasms to both upper extremities, resulting in hyperextension of his fingers. From 2008 to 2012, the patient underwent multiple treatments with anticonvulsants, antidepressants, physical therapy, psychotherapy, topical and systemic analgesics, including but not limited to opioids. The patient also currently has diabetes mellitus type II, hypertension, hyperlipidemia, as well as coronary artery disease.\nIn August of 2011, the patient began low-dose intravenous ketamine infusions. He reported a good initial response, but the relief was |
22,672 | 95,400 | Guinean male was diagnosed with hepatitis C, genotype II in 2007. He was given a 6-month trial of ribavirin and interferon without improvement in his viral load. Recently, the patient was found to have a liver mass on screening magnetic resonance imaging. The 4 cm mass was located in segment 6 and demonstrated hyperattenuation on arterial phase and hypoattenuation on venous phase, consistent with hepatocellular carcinoma (). The patient's past medical history is significant for hypertension and history of intermittent lower extremity skin lesions. previous biopsy of these skin lesions demonstrated leukocytoclastic vasculitis.\nWhen evaluated by | the surgical oncology service, the patient reported a recent weight loss of 10 lbs, occasional fevers, and decreased appetite. Physical examination was unremarkable, and there were no signs of ascites, malnutrition, or hepatomegaly. Liver transaminases were mildly elevated (aspartate aminotransferase 70 U/L, alanine transaminase 89 U/L) with a normal total bilirubin (0.7 mg/dL). Platelet count was 271 × 109/L, and albumin and coagulation factors were within normal limits.\nIn preparation for surgical resection, the patient underwent a right portal vein embolization with coils | demonstrated focal areas of small bowel thickening and splenic infarcts, which were suggestive of embolic disease. The patient underwent an emergent exploratory laparoscopy to rule out small bowel ischemia. Findings included diffuse patchy areas of hemorrhagic serositis along the small intestine; however, there was no evidence of bowel ischemia () and no bowel resection was performed. Cultures of the peritoneal fluid were negative for growth.\nGiven the patient's presentation with four sites of ischemic injury (small intestine, liver, spleen, skin), the diagnosis of embolic disease or systemic vasculitis was considered. Embolic work-up with transesophageal echocardiogram was negative, and computed tomography angiography revealed a patent abdominal aorta and major |
28,985 | 112,782 | 98 bpm. The dysrhythmia then changed to another form of VT. Lead Vl showed an rS pattern. RS moved to leads V3, I, and II. The lead aVL main wave was upward. The lead III and the aVF main wave were downward. The ventricular rate was 202 bpm, and the atrial frequency was 98 bpm. The two forms of tachycardia alternated. After being captured by a sinus heartbeat, sustained VT recurred spontaneously. The ECG indicated normal sinus node function | the QRS downloaded from S1. VT induced by S1S1 200 bpm stimulation showed patterns for blocks of the right bundle branch and left anterior branch. The ventricular rate was 187 bpm, and the atrial rate was | was normal. Palpation of the apex beat was normal with a heart rate of 179 per min, and the rhythm was irregular. No heart murmur was heard in each valve auscultation area, and there was no pericardial friction rub. There was no edema in the lower limbs.\nAll laboratory tests were normal, including liver and kidney function, electrolytes, myocardial enzymes, a routine hemogram, thyroid function, glycosylated hemoglobin level, and coagulation profile. Blood test results suggest dyslipidemia and cardiac insufficiency, as follows: Triglycerides, 1.99 |
31,517 | 150,991 | or NDI. There was also some bladder distension after his renal transplant (Figure ). A therapeutic trial of low-dose desmopressin (DDAVP; 0.1 mg orally) was performed. His weight, plasma sodium, plasma osmolarity, urinary sodium and urinary osmolarity were measured at the start of the test (0 h), shortly before DDAVP was administered. Fluid intake was not restricted. The various parameters were measured again at 2 and 4 h post-dose. The test resulted in urinary osmolality rising from 155 mOsmol/kg at 0 h to 400 mOsmol/kg at 4 h post-dose (normal average range 300–900 mOsmol/kg). Urinary sodium levels also increased from 35 mmol/L at 0 h to 78 mmol/L | (Figure ). A therapeutic trial of low-dose desmopressin (DDAVP; 0.1 mg orally) was performed. His weight, plasma sodium, plasma osmolarity, urinary sodium and urinary osmolarity were measured at the start of the test (0 h), shortly before DDAVP was administered. Fluid intake was not restricted. The various parameters were measured again at 2 and 4 h post-dose. The test resulted in urinary osmolality rising from 155 mOsmol/kg at 0 | of low-dose desmopressin (DDAVP; 0.1 mg orally) was performed. His weight, plasma sodium, plasma osmolarity, urinary sodium and urinary osmolarity were measured at the start of the test (0 h), shortly before DDAVP was administered. Fluid intake was not restricted. The various parameters were measured again at 2 and 4 h post-dose. The test resulted in urinary osmolality rising from 155 mOsmol/kg at 0 |
22,547 | 163,314 | grafting of the lesion was done at his hometown six months prior and was reported as acral lentiginous malignant melanoma on histopathological examination. He gave no history of abdominal pain, bony pain, vomiting, chest pain, convulsions or breathlessness. He had been operated for varicosities of left leg three years back and was a known hypertensive on treatment since two years.\nClinical examination of the patient revealed multiple, soft, friable, well defined, jet black colored, firm papulonodular lesions ranging in size from 3 mm to 6 cm in dimension. These lesions extended from dorsa of left foot up to the knee. Many of these papulonodular | left groin region since one month. A darkly pigmented scar was seen over the heel of left foot.\nOn enquiry, he gave history of single, small, dark colored pea sized raised lesion on the sole of left foot which over a period of two years gradually increased in size to ulcerate and form a non healing ulcer which would bleed occasionally. Complete excision with skin | which were responsible for the depigmented halo clinically [].\nUltrasonography of abdomen and pelvis showed normal sized liver with multiple hypo echoic lesions involving both lobes, measuring 2.3 by 2.2 cm in size suggestive of secondary metastatic deposits. Chest X ray was reported to be within normal limits. Fine needle aspiration cytology of the left inguinal lymph nodes confirmed metastasis. Reports of Positron emission tomography (PET) revealed presence of metastatic deposits in the lungs, liver, spleen, left para-aortic group of lymph nodes, left inguinal group of lymph nodes and in the subcutaneous tissue over left thigh |
36,453 | 176,241 | and correction of his INR to 1.2. Given his stable condition, he underwent a CT RIPIT (Rapid Imaging Protocol in Trauma) [] and CT angiogram (CTA) of the abdomen and pelvis. His imaging revealed pseudoaneurysms of the left gastric artery measuring up to 6 mm with another 9 mm rounded area of increased attenuation along the lesser curve of the stomach (, ). No extravasation was seen. Decision was made to monitor the patient closely with serial abdominal exams and repeat imaging in 72 h, or sooner if the patient exhibited any signs of deterioration.\nOver | (CTA) of the abdomen and pelvis. His imaging revealed pseudoaneurysms of the left gastric artery measuring up to 6 mm with another 9 mm rounded area of increased attenuation along the lesser curve of the stomach (, ). No extravasation was seen. | hospital in hemorrhagic shock with a blood pressure of 63/22 and heart rate of 118 beats/min. A primary survey was pertinently positive for hemodynamic instability and diffuse abdominal and lower thoracic spine tenderness.\nHe was resuscitated with 1 L of normal saline leading to an improvement of his pressure to 106/88. Initial laboratory investigations included a hemoglobin of 95 g/L, lactate of 6.1 mmol/L, creatinine of 129, and a supratherapeutic INR of 8.8. An initial non-contrast CT abdomen and pelvis showed moderate hemoperitoneum with sentinel clot in the left upper quadrant and pericolic gutter, as well as the area |
1,932 | 14,109 | the hospital for further care, whereupon a consult was placed for the reported presence of psychotic symptoms. As she did not meet the criteria for any psychiatric disorders at the time, psychiatry deemed her symptoms a manifestation of ictal episodes due to her temporal lobe epilepsy. Collateral information from the patient’s mother revealed that she began having seizures at 13 years of age, with increasing frequency of seizures during her pregnancy. The patient’s mother also noted that she | was poorly adherent to her then-current antiepileptic medications of valproic acid 250 mg and oxcarbazepine 600 mg. From the information given by the mother, it was unclear whether or not this regimen changed for the patient during pregnancy.\nThe psychiatry team encountered the patient two years later, the patient was brought to the emergency department on a 72-hour involuntary psychiatric hold for danger to self and danger to others. She | worsening psychosis and depression. During her psychiatric hospitalization, the patient suffered a witnessed tonic-clonic seizure lasting for at least a minute and a half after screaming and falling out of a chair; subsequent facial and cranial X-rays showed no fractures or apparent injury. According to the Diagnostic and Statistical Manual of Mental Disorders Four (DSM-IV) criteria, the patient was given an Axis I diagnosis of psychosis not otherwise specified (NOS), with ruling out of postpartum depression with psychosis. The patient was transferred to the medicine floor for the intravenous (IV) administration of antiseizure medication and further observation. EEG showed multiple sharp phases reversing in the left frontotemporal |
9,853 | 84,015 | during a soccer game. He reported a history of prior right leg fracture four years ago sustained while playfully wrestling with his younger brother. After the prior fracture healed, the patient noticed a bump at the level of his mid right shin, which corresponded to the site of the patient's current leg pain. He denied any pain in the right leg prior to sustaining the fracture, and he denied any other preexisting medical conditions.\nPresenting radiographs of the right tibia-fibula | in the right leg prior to sustaining the fracture, and he denied any other preexisting medical conditions.\nPresenting radiographs of the right tibia-fibula | Presenting radiographs showed a mildly displaced subacute fracture through the left olecranon (). There was early cortication along the fracture margins and more osteolysis than expected along the fracture line given the reported age of the fracture. Therefore, a bone biopsy of the fracture was performed, which was negative for neoplasm and infection. Tension band wiring of the olecranon fracture was subsequently performed (). Early remodeling without bridging bone formation was present on two-month follow-up radiographs (). The patient did not return for any additional follow-up of his elbow fracture.\nThe |
41,089 | 57,177 | unlike the previous episodes (). The patient remained febrile for 5 days into the antibiotic treatment and repeated cultures revealed persistent bacteremia. He underwent a follow-up abdominal CT, ocular examination, and echocardiography, which all excluded any possible sources of infection. On the 6th day after fever onset, a full physical examination led to the discovery of a chemoport that had not been used since HSCT but had been | tract during neutropenia. The patient was administered a prolonged 21-day course of susceptible antibiotics and was discharged.\nSeven weeks later, the patient visited the ED with a fever of 39.5 °C and no other symptoms. His CBC revealed no leukopenia or neutropenia, | and his general condition improved within 48 h. Immediate negative conversion of his blood cultures was observed at 24 h follow-up. However, within 96 h after negative conversion, his fever spiked to 39.7 °C, and his peripherally drawn blood cultures revealed a fifth episode of catheter-nonrelated K. pneumoniae bacteremia.\nA full physical examination revealed no rash, no abdominal tenderness, or any signs of focal infections. In order to find the source of K. pneumoniae causing recurrent sepsis, he was given echocardiography, revealing no vegetation or any other evidence of infective endocarditis. As he was neutropenic at all five episodes, the source was concluded to be bacterial translocation from his gastrointestinal tract during neutropenia. |
41,844 | 98,202 | and pus discharge in 44 regions and shedding of the tooth a few months back.\nDiscussion: Rootless teeth are seen in cases with dentin dysplasia and localized odontodysplasia. In dentin dysplasia the condition is generalized and teeth are characterized by pulpal obliteration, normal eruption, multiple periapical radiolucencies, and early exfoliation. In localized odontodysplasia, teeth demonstrate a lack of healthy dental tissues. However, in this case, enamel and dentin were healthy and the condition was localized. The possible explanation as seen from the oral health status of a child could be that the tooth erupted prematurely due to inflammation in overlying bone probably due to decayed primary tooth. | Camm and Shuler noted very early eruption of premolar in 5-6-year-old following early loss of abscessed primary molars.[] In these cases, erupted premolars showed mobility. Mulia et al. have stated that the rate of root resorption of the primary teeth affects the | the eruption rate but not the growth of the permanent teeth.[] Moreover, the acceleration of eruption occurs if there is extensive alveolar bone damage due to chronic inflammation originating from the primary teeth.\nThus, as seen in this condition, the tooth erupted prematurely but root was not formed.\nUnusual finding in this case as compared to other similar cases is the absence of abnormal mobility in spite of the absence of roots. A tooth crown |
32,537 | 53,422 | and the toe extensor muscles (MRC grade 4). The Gower’s sign test was positive and his tendon reflexes remained present but weak. There was no evidence of calf hypertrophy, scapular winging, or facial, and ocular impairment. Laboratory testing revealed slightly elevated creatine kinase levels (2× normal). Electromyography abnormalities of myopathic changes were found in both the vastus medialis and tibialis muscles. Echocardiograph and electrocardiogram results were normal. A magnetic resonance imaging (MRI) of the patient’s muscles revealed a preferential fatty infiltration in the posterior compartment of the patient’s thigh, with marked sparing in the gracilis, sartorius, and quadriceps muscles (). There was | There was no evidence of calf hypertrophy, scapular winging, or facial, and ocular impairment. Laboratory testing revealed slightly elevated creatine kinase levels (2× normal). Electromyography abnormalities of myopathic changes were found in both the vastus medialis and tibialis muscles. Echocardiograph and electrocardiogram results were | gene (). The presence of this homozygous deletion was confirmed with quantitative real-time polymerase chain reaction (). The patient’s parents were heterozygous for the mutation. This novel mutation was neither observed in 200 healthy Chinese controls, nor four public databases, including dbVar, ClinVar, the Database of Genomic Variants (), and the Leiden Open Variation Database ().\nAfter written informed consent was obtained |
7,520 | 141,592 | well groomed young man with normal psychomotor activity and speech. He was distressed by the sexual problems that he perceived he had, but denied suicidal ideation. He had a fixed belief that he attained penile erection whenever in an erect posture. This belief persisted despite evidence to the contrary. There were no other delusions or perceptual abnormalities. There were no obsessive compulsive symptoms or volitional abnormalities. He was alert and oriented with normal attention and concentration. His intelligence was estimated to be average; insight and judgment were poor.\nThe | sexual problems that he perceived he had, but denied suicidal ideation. He had a fixed belief that he attained penile erection whenever in an erect posture. This belief persisted despite evidence to the contrary. There were no other delusions or perceptual abnormalities. There were no obsessive compulsive symptoms or volitional abnormalities. He was alert and | a middle socioeconomic background. Over the previous year and a half, he firmly believed that every time he assumed an upright posture, he attained penile erection. He believed that others were able to identify his physiological state by the appearance of his groin and therefore were laughing at him and making derogatory comments. He had made attempts to mask these perceived bodily changes by changing the way he dressed. Secondary to these beliefs he had also become socially withdrawn, was frequently absent from class and had had significant academic decline. The patient had even shifted colleges because of the perceived ridicule by others. He also avoided situations, which required him |
1,324 | 77,045 | by his relatives, bleeding from the oral cavity, and with a blood stained knife in his hand. He was urgently transferred to the hospital, where he received the appropriate resuscitation treatment. Examination of the oral cavity revealed extensive trauma to the soft and hard palate, without any other lesions to be seen in the head and neck region. Following stabilization of his condition the patient | and with a blood stained knife in his hand. He was urgently transferred to the hospital, where he received the appropriate resuscitation treatment. Examination of the oral cavity revealed extensive trauma to the soft and hard | 93-year-old male was admitted to the 1st University Department of Otorhinolaryngology via the Accident and Emergency Department due to trauma to the oral cavity. He was found unconscious, by his relatives, bleeding from the oral cavity, and with a blood stained knife in his hand. He was urgently transferred to the hospital, where he received the appropriate resuscitation treatment. Examination of the oral cavity revealed extensive trauma to the soft and hard palate, without any other lesions to be seen in the head and neck region. Following stabilization of his condition the patient reported that he repeatedly stabbed his palate due to the intolerable character of the ongoing |
35,433 | 92,361 | she was 22 years old, after a bus accident while she was going to work. The bus crashed into a motorcycle, with no loss of awareness. Once outside the bus, she remembered her face was covered with blood and having seen the motorcycle rider being thrown from his motorcycle. After the accident she was admitted at an intensive care unit for a few days and was studied for the THI. During the recovery period it was very difficult for her to walk, and because of continuing lack of sensitivity in both legs she underwent electromyogram (EMG) three months after the | accident. The EMG results were normal.\nFour months, from the accident seizures began, were characterized by paroxysmal behavioral and motor episodes with a frequency of two to three seizures in a week. She also had absences (lack of response) and sometimes got lost in the street (compatible with dissociative fugue). She received a diagnosis of posttraumatic epilepsy and was treated with antiepileptic drugs like phenytoin, carbamazepine and diazepam. Despite this medication, seizures continued. At this point she was | at the Epilepsy Monitoring Unit in July 2005 and underwent Video-EEG. Neurologic examination was normal, as were an MRI of the brain, interictal SPECT, and interictal electroencephalogram (EEG). Video-EEG monitoring data were obtained with a digital system through 24 hour continuous scalp recordings, with electrodes placed according to the 10–20 international system. The patient was |
42,360 | 42,079 | man with a 5-year history of maintenance hemodialysis for diabetic nephropathy presented with spikes of fever every few months accompanied by the appearance and regression of multiple painful subcutaneous nodules over his legs and feet. These were diagnosed as erythema nodosum by a biopsy examination. Investigations showed had high levels of C-reactive protein (150 to 200 mg/L), a hemoglobin level of 146 g/L, a white blood cell count of 7.0 × 109/L, with 92% neutrophils and a platelet count of 2.2 × 1011/L, indicating a lack of anemia in spite of chronic inflammation. Administration of broad-spectrum antibiotics failed to generate a response. Peripheral lymph nodes were not palpable. | presented with spikes of fever every few months accompanied by the appearance and regression of multiple painful subcutaneous nodules over his legs and feet. These were diagnosed as erythema nodosum by a biopsy | was maintained at 50–150 ng/mL. The patient at this stage needed Epo infusions to maintain hemoglobin levels (target hemoglobin between 100 and 120 g/L). The strong association between the excision of the tubercle and the drop in Epo levels made us examine the granuloma for Epo expression. The tubercle granuloma was found to be positive for Epo on in situ hybridization (Figure A). Methods of in situ hybridization are described in the Additional file . We further validated this by immunohistochemical staining, wherein strong cytoplasmic staining for Epo was |
39,647 | 173,452 | follow-up has included the following: Initial chest CT scan was carried out 2 months after surgery. Parathyroid hormone (PTH) and prolactin levels were within normal limits 1 year after surgery. The following investigations were carried out at 6 months and then every 6 months for the first 5 years: Chest CT scan, abdominal ultrasound, chromogranin A measurement and standard laboratory testing including complete blood count, renal function, liver function, calcium and glucose. Abdominal CT scan and fiberoptic bronchoscopy were | hormone (PTH) and prolactin levels were within normal limits 1 year after surgery. The following investigations were carried out at 6 months and then every 6 months for the first 5 | middle and lower lung fields, hyperinflation of the right lung and deviation of the trachea to the left (Fig. ). A computerized tomography (CT) scan of the chest showed complete left lung atelectasis due to a mass obstructing the left main bronchus and excessive mediastinal deviation to the left with substantial herniation of the hyperdistended right lung into the left |
28,218 | 103,118 | or goals of care.\nThe ethical principle of autonomy underlies the ethical and legal basis which supports patients' (who have decisional capacity), or their legally designated surrogate, and after an informed discussion) right to refuse/decline any medical or device treatment including those that may be considered life-sustaining such as dialysis in a patient with end-stage renal disease. Furthermore, this right, upheld by the US court system, holds even if the patient is not "terminally ill, "and | ethical and legal basis which supports patients' (who have decisional capacity), or their legally designated surrogate, and after an informed discussion) right to refuse/decline any medical or | dual-chamber implanted cardioverter defibrillator (ICD) placed 5 years ago (he later became pacemaker dependent) presents after a recent diagnosis of stage Ⅳ colon cancer with widespread metastases to liver and bone. After appointments with Oncology and Palliative care, a collective decision was made to forgo any cancer treatment (e.g., chemotherapy, radiation, surgery) in favor of comfort-oriented measures. On the advice of his oncologist he is in clinic to discuss management of his ICD.\nAlthough it would appear obvious that patients with significant cardiovascular disease, especially those requiring CIED therapy, should |
9,220 | 35,144 | necrosis (AVN) and to determine the safety of a possible clearance for return-to-play. An increased signal was observed in a well-localized area in the superior anterior aspect of the femoral head near the fovea on the T2-weighted images []. The location was atypical for AVN, but the lack of edema in the same area immediately post injury made these changes worrisome. The differential diagnosis was atypical AVN (by location) or an atypical femoral head bone bruise (by the lack of edema on the initial MRI). On account | for AVN, but the lack of edema in the same area immediately post injury made these changes worrisome. The differential diagnosis was atypical AVN (by location) or an atypical femoral head bone bruise (by the lack of edema | hip []. The radiographs did not reveal any fracture or dislocation. With his persistent symptoms and continued pain with rotation, magnetic resonance imaging (MRI) was obtained to rule out an occult fracture within three hours of the initial injury. The MRI revealed a small hemarthrosis and a posterior labral tear, but there was no iliofemoral ligament tear or bone edema in the acetabulum or femoral head []. The patient was discharged with instructions to not bear weight on the right hip, and use crutches.\nThe athlete was re-evaluated the next day and found to have continued tenderness with |
25,568 | 139,318 | but he was fully coherent. He had extensive grandiose and persecutory delusions about which he had no insight.\nAfter consultation with several experts he was given a diagnosis of paranoid schizophrenia.\nThe patient's wife was a | oriented to time and place, able to communicate normally, and appeared of normal intelligence. There were no obvious hallucinations or perceptual distortions. His mood was stable but his emotional reactions were somewhat inappropriate to the content of his speech and to the surrounding environment. His thinking was slightly disorganized | VIP, but the person stopped after being warned. The son was actively involved in his father's petition in 2007 to build a house and considered his and his family's rights had been violated, so he had made a petition about this to a Japanese news agency in Shanghai, the ‘Asahi Shimbun Digital’. He firmly believed that his father was treated unfairly at work and that there were issues with his father's food at work. He thought that the fight at work was understandable because co-workers had made trouble.\nDuring the first week after admission, medical staff observed his behavior |
3,785 | 157,975 | removal was started from below where the exophytic portion was tackled first between the roots [], and as we moved up the cord the left DREZ [] was incised to approach the upper intramedullary component. Piecemeal excision was done with the help of ultrasonic surgical aspirator and tumor forceps [] and gross total excision was possible. The histopathology was pilocytic astrocytoma (grade I). The postoperative MRI revealed complete excision without any contrast-enhancing areas []. The patient had a good recovery with grade III power in the left upper limb which gradually improved with time.\nThis 8-year-old | thus modified our approach and used the DREZ approach from the left side for this particular case. Midline durotomy was made and the cord was seen rotated to the opposite side which was further helped by cutting the dentate ligaments and rotating it further. The tumor | nocturnal nuchal pain and few episodes of vomiting for last 2 months. He also had occasional difficulty in swallowing and recent change in his voice. On examination, he had weakness (grade IV) and wasting in the left upper limb flexors, while power in the rest of the muscle groups was normal. The reflexes in the lower limbs were brisk and the gag reflex was depressed on the left side. There was some hypesthesia in the left C8 dermatome and the gait was normal with no other signs of myelopathy (McCormick grade I). The sagittal magnetic resonance imaging (MRI) revealed a cervicomedullary lesion with an exophytic portion in the lower |
36,928 | 123,636 | pain, mainly localized in the lumbar region for 1 week. He was tossing on bed due to backache. He was unable to bear weight on his lower limbs. There were symptoms of bladder and bowel dysfunction for the last 3 days.\nHe was a resident of an ongoing dengue-outbreak area. He had a recent history of high-grade fever 28 days back with chills, generalized myalgia, arthralgia, headache, and petechial rash, which was diagnosed as dengue fever by serological tests. His previous records included blood investigation reports positive for nonstructural protein 1 (NS1) antigen test of dengue virus | as well as decreased platelet counts documented on serial complete blood counts. HIV test was performed, which turned out to be negative.\nThe patient was fully conscious and oriented with preserved higher mental functions. On neurological examination, there was flaccid paralysis involving bilateral lower limbs. Muscle power in the lower limbs was 3/5 (distal more prominently involved | of an ongoing dengue-outbreak area. He had a recent history of high-grade fever 28 days back with chills, generalized myalgia, arthralgia, headache, and petechial rash, which was diagnosed as dengue fever by serological tests. His previous records included blood investigation reports positive for nonstructural protein 1 (NS1) antigen test of dengue |
12,107 | 128,968 | and ptosis on the right caused by right oculomotor nerve palsy. Head T2-weighted magnetic resonance (MR) imaging disclosed a large intracavernous ICA aneurysm, and cerebral digital subtraction angiography revealed a large aneurysm at the ICA-PTA bifurcation with a maximum diameter of 18 mm [Figure –]. | PTA originated at cavernous portion of ICA and terminated at basilar artery, below the level of the superior cerebral artery and above the union. Because she refused to undergo an operation, follow-up examination was continued.\nThree years later, she complained of a headache in addition to the | PTA, and the PTA was occluded using a PRESIDIO Spherical 10 CERECYTE 4 mm × 11.5 cm coil, and two ULTIPAQ Helical 10 CERECYTE 2 mm × 8 cm coils (Johnson and Johnson). Throughout the procedure, care was taken to prevent coil protrusion into the aneurysm, ICA, and basilar artery. After tight packing of the PTA was obtained, the procedure was ended.\nOn the next day, |
25,020 | 15,145 | bleeding, the patient did not develop any major complications during the operation and the postoperative period. The patient was discharged after 14 days of hospital admission with a good overall condition and was referred to the surgery clinic for postoperative visits. Moreover, the patient was given adjuvant chemotherapy for a total of 6 weeks.\nDuring a 2.5 year follow-up the patient showed lymph nodes in the hilum of the liver in imaging, for which he underwent laparotomy, and three lymph nodes were removed. | the operation and the postoperative period. The patient was discharged after 14 days of hospital admission with a good | patient underwent laparotomy and exploration was done which showed a large mass (20 cm) in the left lobe of the liver and in the caudate lobe with involvement of IVC and involvement of left and middle hepatic veins.\nHepatectomy was done using a standard technique with extensive lymph node dissection around the superior mesenteric artery and celiac |
28,682 | 81,646 | of one of the policemen and shot him on the left side of his chest. The bullet came out through the back of the policeman and entered through the open mouth of the patient, who was standing behind him. The policeman died on the way to the hospital. The patient became unconscious and was admitted to the nearby hospital. After initial treatment, the patient was referred to a Medical College and was admitted there. He was given supportive treatment including blood transfusion and | he regained his consciousness in the next morning.\nOn examination, there was a huge haematoma over the left side of the face. The entry wound () was found in the inner aspect of the cheek adjacent to the left lower third molar. There was dental malocclusion. | The flap was elevated at the subplatysmal level. The main trunk of the facial nerve was identified first. The parotid gland along with the ramus of the mandible was retracted anterosuperiorly and the sternomastoid muscle was retracted posteriorly. Blunt dissection was carried out very carefully up to the carotid sheath but the bullet could not be found. Bimanual palpation was done with the left index finger in the dissected area and the right middle finger in the pharynx. The bullet |
40,883 | 151,087 | metacarpophalangeal joint. After the debridement and thumb amputation, multiple lacerated wounds on the volar and dorsal aspect were closed in layers, whereas the wound on the dorso-radial surface of the wrist and hand was left open for regular dressing as it was not possible to close it primarily. This was followed by stabilization of the fractures, by application | of the wrist and hand was left open for regular dressing as it was not possible to close it primarily. This was followed | from the wound, whereas surprisingly the ulna was felt intact. The wound was grossly contaminated. Surprisingly all active finger movements were present though reduced, in all four fingers except the thumb. Ulnar pulse was palpable whereas radial pulsations were absent |
24,083 | 34,170 | was 41 mm/h. The aCLs IgG was at 57 (normal < 22), IgM was at 24 (normal < 10). Anti-neutrophil cytoplasmic antibody (pANCA) and anti-β2GPI antibody were tested positive. In addition, some other autoimmune antibodies were also tested positive: ANA (1:100, granular); dsDNA: +; nucleosome: ++; histone: +; mitochondrial M2: +. Other examinations including liver and kidney function tests were unremarkable.\nColor doppler ultrasonography of lower extremity vessels revealed deep venous thrombosis in his left lower leg, accompanied by soft tissue edema and superficial lymphangiectasia. Vascular CT scan of left lower extremity showed extensive mural thrombosis (Fig. ).\nHe was then | diagnosed HIV complicated with thrombotic antiphospholipid syndrome. He was initially treated with low molecular weight heparin (LMWH) calcium 3000 IU every 12 h for 6 weeks followed by warfarin (1.25 mg/day) for long-term anticoagulant therapy at a target INR of 2.0–3.0. Besides, | + NVP) since last 4 years when his CD4+ T lymphocyte cell count had reached 346 cells/μL at that time. The plasma HIV RNA was undetectable after half a year of ART.\nHis mother was HIV seropositive person. The child had no personal and/or family history of thrombotic diseases. There was no history of any prior surgery, trauma, prolonged bed rest, obesity, smoking and any other common risk factors of thromboembolic events.\nOn physical examination during hospital admission, the maximum circumference of his left thigh was 38 cm and |
2,485 | 148,878 | syndrome following two cervical spine surgeries with no significant medical problems. The pain was not responsive to conservative medical management including oral opioid therapy. The patient underwent a successful intrathecal opioid trial followed by Intrathecal drug delivery system (IDDS) implantation (Medtronic Synchromed II 40 ml pump) in August 2007. The patient had a history of PDPH following the intrathecal opioid trial before permanent placement and was treated with epidural blood patch to control the headache after failed conservative management. He was followed by his pain physician for intrathecal pump refills and management without problems with good pain control. In December 2013, the | elective replacement indicator (ERI) showed 4 months remaining, and non-critical alarm (single tone) started in January 2014. The patient was scheduled for | for the subsequent four weeks because of bad weather and lack of symptoms.\nSix weeks following the IDDS replacement, the patient woke up in the morning complaining of headache, photophobia, and nausea. He also observed redness and warmth over the left lower abdominal incision site. He denied any drainage or fever. The patient presented to the pain clinic later that day. On examination, patient had localized erythema over the left abdominal wall over the surgical area. There were no signs of tracking of redness over flank or paraspinal |
23,123 | 18,207 | in territories scarcely congruent with the rest of the examination, at the level of the thigh in the L4 dermatome, and then at the level of the leg and foot in the L5 and S1 dermatomes. These findings were most consistent with a diagnosis of L4 neuropathy. These symptoms remitted within 48 hours and given that the patient had no other complications, she was discharged on the eighth postoperative day. Because blockade was established at the T9 level, away from the affected area, and | at the level of the leg and foot in the L5 and S1 dermatomes. These findings were most consistent with a diagnosis of L4 | a supra and infraumbilical middle laparotomy for hysterectomy, right adnexectomy, pelvic and aortocaval lymphadenectomy, and sigmoid resection and colostomy.\nGiven the patient's history, we decided on a combined approach to intraoperative analgesia using a bilateral erector spinae plane block (ESP block) and the placement of catheters for postoperative pain control, together with an opioid-free analgesic (OFA) technique. We chose this approach because the invasiveness of the surgical procedure and the patient's history of scoliosis |
28,852 | 66,495 | and dyspnoea and was found to have a left lower lobe collapse on a chest X-ray. Her past medical history was significant for a 19-year history of recurrent pulmonary lobar collapse from mucus plugs with cultures positive for Aspergillus and thus bore a diagnosis of CPA. She had no documented history of wheezing, peripheral eosinophilia or obvious clinical response to oral steroids, and thus was deemed unlikely to have allergic bronchopulmonary aspergillosis (). Although she had previously been treated intermittently with itraconazole, the patient had not been on any antifungal therapy for 6 weeks prior to presentation due to difficulty | history of recurrent pulmonary lobar collapse from mucus plugs with cultures positive for Aspergillus and thus bore a | to have a left lower lobe collapse on a chest X-ray. Her past medical history was significant for a 19-year history of recurrent pulmonary lobar collapse from mucus plugs with cultures positive for Aspergillus and thus bore a diagnosis of CPA. She had no documented history of wheezing, peripheral eosinophilia or obvious clinical response to oral steroids, and thus was deemed unlikely to have allergic bronchopulmonary aspergillosis (). Although she had previously been |
14,096 | 24,904 | for further resuscitation and hemodynamic stabilization. Continuous venovenous hemofiltration was started via a dialysis catheter due to anuria. During the placement of this dialysis catheter in the left jugular vein, another foreign body was diagnosed by ultrasound that looked like possible remnants of the same intravenous catheter. The hypothesis was that the CVC remnant became dislodged during removal from the insertion site at the jugular vein and split in two different | due to anuria. During the placement of this dialysis catheter in the left jugular vein, another foreign body was diagnosed | long-ICU admission in another hospital in 1989. Paramedics stated that patient was feverish for a couple of days and was found confused and sweating severely. No trauma had occurred. No further anamnesis was possible because of the current mental state. On physical examination, a very ill, pale, untended patient was seen with a tachycardia of |
21,575 | 20,570 | melena and was scheduled to undergo laparoscopic colectomy. His height was 166 cm and his weight was 57 kg. At the age of 17 years, a scaly erythema rash appeared on the front of his lower leg and gradually spread throughout his body. He visited a dermatologist at the age of 19 years and was diagnosed with psoriasis vulgaris. He received topical therapy (He could not remember what drugs were used.) and systemic therapy with betamethasone at 1 mg/day for treatment of psoriasis vulgaris. However, the treatment was discontinued at his discretion several months ago. He has been aware of right knee pain for 3 years, but he | and gradually spread throughout his body. He visited a dermatologist at the age of 19 years and was diagnosed with psoriasis vulgaris. He received topical therapy (He could not remember what drugs | mouth in the past a few years. Drinking water was possible with no problem, but he had to eat his food in small portions. However, he did not visit a hospital and his TMJ had not been evaluated by a dentist. Preoperative airway evaluation by an anesthesiologist included multiple difficult airway predictors: limited mouth opening (1.5 transverse fingers), presence of teeth, limited thyromental distance (thyroid incision distance of 4.5 cm), limited neck |
41,779 | 87,160 | A 26-year-old man was admitted with a 6-hour history of rapidly developing erythematous, severely painful, mildly to moderately edematous skin rash. The rash started from his right lower back and spread within hours to include the right hip, abdomen, and groin, and down to the proximal third of the anterior lateral aspect of right thigh. At the time of initial infectious diseases consultation, the skin lesion had further spread from the upper third of his right thigh to the upper edge of his right knee over the course of 40 minutes. The patient complained of extreme fatigue; however, he denied any fever, nausea, vomiting, coughing, shortness of breath, dysuria, or | the anterior lateral aspect of right thigh. At the time of initial infectious diseases consultation, the skin lesion had further spread from the upper third of his right thigh to the upper edge of his right | His medical history revealed a history of a mixed connective tissue disease (limited systemic sclerosis overlapping with polymyositis and SLE which had been diagnosed one month previously). He was currently being treated with intravenous immune globulin (IVIG) every three months and prednisone 40 mg daily. He had received a pulse infusion of 1 gram of cyclophosphamide 18 days prior to the current presentation.\nHis initial vital signs were stable, with temperature of 36.2°C, blood pressure of 123/82 mmHg, heart rate of 114/min, respiratory rate of 22/min, and oxygen saturation of 92% on room air. The patient was alert and oriented. Further physical examination |
24,110 | 21,579 | to acute gastroenteritis. His initial laboratory findings are summarized in Table .\nCT of the abdomen and pelvis with intravenous contrast showed mild intrahepatic biliary duct distention, chronic portal venous thrombosis, and cavernous transformation of the portal vein (Figure ), extensive collateral vessels in the mesentery, mild ascites, splenomegaly (spleen size was 18.6 x 7.4 x 14.5 cm), and signs of acute enteritis and colitis. He was treated symptomatically for acute gastroenteritis most likely viral in nature due to the fact that stool studies showed no white blood cells, red blood cells, ova or parasites in microscopy exam, and the patient had negative | His initial laboratory findings are summarized in Table .\nCT of the abdomen and pelvis with intravenous contrast showed mild intrahepatic biliary duct distention, chronic portal venous thrombosis, and cavernous transformation of the portal vein (Figure ), extensive collateral vessels in the mesentery, mild ascites, | physical exam was within normal limits. Initial laboratory investigations revealed white blood count of 7.4 x 109/L with a left shift (93.2% neutrophils), hemoglobin level of 14.1 g/dL, platelet count of 138 x |
42,548 | 67,411 | the proximal humeral head was debrided. The quality of the cuff tissue was poor. The Achilles tendon allograft with attached calcaneus was then prepared (Fig. a). The calcaneus was shaped to fill proximal humeral head defect. The Achilles tendon was then split longitudinally, with the deep layer used to reinforce the rotator cuff repair and the superficial | was then prepared (Fig. a). The calcaneus was shaped to fill proximal humeral head defect. The Achilles tendon | avulsion of the greater tuberosity, as described by Mutch et al. []. Open reduction and internal fixation of the fracture were performed with a tension band technique, using an anchor screw and nonabsorbable sutures []. The functional outcome was poor. The patient was painful and had marked weakness in external rotation and abduction. Active forward flexion and abduction were 40° with full passive motion, and active external rotation was 30°. Her single assessment numeric evaluation score [] was of 40 %. Past medical history was significant for noninsulin-dependent diabetes mellitus and obesity (BMI 42). Radiographic |
34,351 | 115,893 | were found simultaneously (Fig. ) which suggested that the patient was in a sideropenic and megalobastic anemia stage. Protein electrophoresis and immunofixation electrophoresis showed that there were no definitive monoclonal immunoglobulin protein bands in her serum.\nGastrointestinal endoscopy was completed then. Duodenal and ileac biopsies revealed atrophy and blunting villi (Fig. ). The bowel lamina propria was infiltrated with slightly increased intraepithelial lymphocytes and mainly with diffuse plasma cells (Fig. A). The following enzyme labeling immunohistochemistry results were strongly positive to alpha-heavy-chain (Fig. B), but negative to lambda and | we completed the bone marrow aspiration and found no evidences to diagnose the patient with lymphoma, plasmoma, multiple myeloma, and so on. The percentage of mature and immature plasma cells in the smear of bone marrow were about 3% and 2.5% (normal ratio) and a lot of megacaryocytes with many small round nuclei | anemia. She had been diagnosed with suspected celiac disease and chronic bacterial intestinal infection in other hospitals and then been treated with gluten-free diet for more than 6 months, some antibiotics such as tetracycline, metronidazole, and ampicillin for more than 1 month, |
40,491 | 1,103 | by brain biopsy as part of clinical care. All samples were obtained with appropriate consent.\nA biopsy of the mass was performed and revealed extensive parenchymal lakes and vascular and perivascular deposition of amorphous, amyloid like material (). Congo-red positive staining and apple-green birefringence (not shown) of the amorphous material upon polarization confirmed that the amorphous material was amyloid (). Also present in the resected tissue were a number of small intraparenchymal blood vessels with perivascular lymphoplasmacytic infiltrates (). The initial histologic differential diagnoses included cerebral amyloid angiopathy-inflammatory type (CAA-I) and lymphoma associated amyloidoma. | extensive parenchymal lakes and vascular and perivascular deposition of amorphous, amyloid like material (). Congo-red positive staining and apple-green birefringence (not shown) of the amorphous material upon polarization confirmed that the amorphous material was amyloid (). Also present in the resected tissue were a number of small intraparenchymal blood | a lymphoplasmacytic appearance (). Immunohistochemical analysis demonstrated that the lymphoid cells were CD20 positive (). Tumor cells were negative for CD3, CD5, BCL1, and CD23. The tumor Ki67 proliferation index was low (3%). The more plasmacytoid appearing cells were CD138 positive and were shown to be lambda light chain restricted by kappa and lambda chromogenic in situ analysis (Figures and ). An immunoglobulin heavy chain (IgH) gene rearrangement analysis |
33,840 | 127,272 | the operating room for further debridement due to possible necrotizing skin infection. Necrotic mesh was removed and after adequate tissue debridement, an open abdomen negative pressure therapy system (ABTHERA) was placed over the abdomen.\nPatient subsequently returned to the operating room on two additional occasions for further | tissue debridement, an open abdomen negative pressure therapy system (ABTHERA) was placed over the abdomen.\nPatient subsequently returned to the operating room on | with a wound vacuum assisted closure (VAC) over it. Patient was then transferred to the post anesthesia care unit in stable condition.\nThe histopathology of the bladder revealed stage IIIA (T3b) invasive and poorly differentiated urothelial cell carcinoma (Fig. ) |
15,105 | 28,203 | our department after she requested surgical treatment for a tumor located near the gastric fornix. She underwent a preventive esophagogastroduodenoscopy 2 years and 7 months prior to the referral. The examination had revealed a submucosal tumor-like lesion in the fornix, which measured 10 mm. After this diagnosis, she was referred to her previous physician. Contrast enhanced computed tomography (CT) revealed a low density, round mass, measuring approximately 20 mm that was | years and 7 months prior to the referral. The examination had revealed a submucosal tumor-like lesion in the fornix, which measured 10 mm. After this diagnosis, she was referred to her previous physician. Contrast enhanced computed tomography (CT) | of the tumor showed a tan or yellow solid component (Fig. b) and cystic abnormalities. On microscopic examination, it was found that the tumor was surrounded by a pink fibrous capsule with a cystic area (Fig. c). Under low magnification power, the tumor showed a pattern of alternating highly cellular Antoni type A and less cellular Antoni type B areas (Fig. d). The tumor was composed of spindle cells with bland, twisted nuclei and indistinct cytoplasmic border arranged in short bundles or interlacing fascicles (Fig. d). In the Antoni type A |
26,259 | 62,913 | medical history and additional physical examination and laboratory tests were normal. The patient case was further discussed in a multidisciplinary meeting and a solid pseudopapillary neoplasm (Hamoudi or Frantz tumor) with past haemorrhage was considered as the most likely diagnosis based on clinical and radiological findings. Owing to the low malignant potential of the suspected solid pseudopapillary neoplasm in the tail of the pancreas, a robot-assisted spleen preserving distal pancreatectomy was advised. In addition, a cystic neuroendocrine tumor and mucinous cystadenoma were in the differential diagnosis. Due to questionable sensitivity, endoscopic ultrasound is not | were normal. The patient case was further discussed in a multidisciplinary meeting and a solid pseudopapillary neoplasm (Hamoudi or Frantz tumor) with past haemorrhage was considered | isolated and left intact. Taking sufficient margin, the pancreatic tail was transected with a stapler device and extracted from the abdominal cavity in an endobag. The total operation time was 2 hours and 4 minutes, with a total blood loss of 20 mL.\nMacroscopically, the specimen showed a well-demarcated and encapsulated dark-red lesion with a diameter of 26 mm harbouring a 16 mm cyst (). Microscopically, the lesion consisted of normal splenic tissue with alternating red and white pulp surrounded by a thin fibrous capsule (). A cystic space lined by stratified squamous epithelium without atypia was present within the splenic |
26,283 | 125,714 | intubated and ventilated. Pulse rate and blood pressure were 68 beats per minute and 130/80 mm Hg, respectively. There was no history of diabetes mellitus, hypertension, heart disease, stroke, or cancer. On neurological examination, she was semicomatose with flexion to painful stimulation. Both pupils appeared centrally fixed, dilated (6 mm), and nonreactive to direct or indirect light stimuli. Computed tomographic (CT) scanning demonstrated extensive subarachnoid hemorrhage spreading around the both Sylvian, basal, and interhemispheric cistern (). Emergency extraventricular drainage (EVD) was performed. Initial intracranial pressure (ICP) was 45 mm Hg, and subsequently, the pressure remained between 15 and 25 mm Hg after intermittent cerebrospinal fluid (CSF) | drainage. Seven hours after EVD, the right pupil became reactive to light, but left pupil was nonreactive to light with 4 mm in size. A digital subtraction angiogram revealed a saccular aneurysm on the AComA (). The patient underwent an operation on the next day via left pterional approach. After opening the Sylvian fissure, it was observed | She was intubated and ventilated. Pulse rate and blood pressure were 68 beats per minute and 130/80 mm Hg, respectively. There was no history of diabetes mellitus, hypertension, heart disease, stroke, or cancer. On neurological examination, she was semicomatose with flexion to painful stimulation. Both pupils appeared centrally fixed, dilated (6 mm), and nonreactive to direct or indirect light stimuli. Computed tomographic (CT) scanning demonstrated extensive subarachnoid hemorrhage spreading around the both Sylvian, basal, and interhemispheric cistern (). Emergency extraventricular |
24,170 | 150,132 | the patient was disqualified from surgical intervention. The following therapy was targeted at optimal medical management of arterial systemic hypertension. Future control tests after 6 and 10 months were planned.\nAfter six months control echocardiography showed a proximal MPA diameter of 28 mm with enlargement progression of the distal segment to 51 mm and RPA to 31 mm. Right ventricule diastolic diameter was also enlarged to 41 mm with preserved contractility. Computed tomography study revealed progression of MPA diameters to 52 × 45 mm, | CT scan was performed and showed no signs of left coronary artery compression with MPA aneurysm (, ). Additional laboratory studies excluded inflammatory and collagen disorders. According to the gathered data a diagnosis of idiopathic dilatation of the main pulmonary artery (IDPA) was stated. At that time | for a further therapy decision to be made. His first hospitalisation due to congenital heart disease suspicion was at the age of 18. At that time there were no clinical symptoms besides the presence of protomezosystolic murmur over the left sternal edge and cardiac apex. In chest X-ray tomography performed at that time enlargement of the left pulmonary artery was |
42,298 | 54,452 | the lesion appearance, the patient had no discomfort, thus she did not pay attention to the skin lesion, and had not used other external medicines or ask for help from professionals. Until nearly a month, she found that the lesion was prone to bleed after friction, thus she came to our hospital for treatment. The lesion was removed surgically | nodes. She had no significant history of medicine, surgery, irritation, and trauma. Before | January 17, 2020. Detailed information was shown below.\nThe dermoscopic images showed the dark red background, covering a thick yellow-and-white crust, with spot-shaped and polymorphic vascular structures which focally distributed. In some areas, white homogeneous structures could be seen, as well as dark red clumps. No typical pigment structure was seen (Fig. a, b). The skin lesions were considered as the diagnosis of skin tumors using dermoscopy.\nThe excisional biopsy was carried out, and the specimen tissue was fixed in formalin, and embedded in paraffin. The histological examination showed: the skin lesion at the left side of mons pubis was spindle-shaped, the lesion size was 2.2 × 1.8 × 0.5 cm. There were gray-brown |
32,136 | 74,227 | then, the seizures have stopped for 3 years even after sodium valproate was stopped 2 years after the start of prescription. At the age of 12 months, he started holding up his head on his own, and, at 16 and 20 months, he started pulling up on things and walking along against a wall, respectively. Magnetic resonance imaging (MRI) performed at 8 months of age revealed delayed myelination of the frontal lobe on both T1- and T2-weighted imaging (Fig. and ). However, follow-up MRI performed at 18 months of age demonstrated almost normal myelination (Fig. and | ).\nGenomic DNA was extracted from whole blood and subjected to whole exome sequencing analysis using SureSelect Human All Exon V5 (Agilent Technologies, CA, USA). The captured DNA was subjected to the massively parallel sequencing system (HiSeq2000, Illumina, CA, USA). Paired-end read sequences were mapped and quality-checked with StrandNGS (Strand Genomics, CA, USA) using the reference sequence hg19/GRCh37. Among 88,273 variants detected in the patient and parents, 263 variants predicted to affect amino acid residues and | variants detected in the patient and parents, 263 variants predicted to affect amino acid residues and detected in the patient with minor allele frequency (MAF) < 0.5% in public databases [–] were extracted and proceeded for segregation analysis within the family. Finally, eight variants of seven genes were selected as possible pathogenic mutations (Additional file ). Of these, the SOX10 mutation (c.652G > T, |
23,778 | 81,074 | head and aponeurosis []. Once the main trunk of the radial nerve was found, the surrounding branches were carefully isolated and dissected. The inferior lateral cutaneous branch was found subcutaneously and traced back to its origin (Figure ). This origin was noted to be a very proximally branching variant of the inferior lateral cutaneous branch, which is typically found at the inferior/distal end of the spiral groove, near the metadiaphyseal junction of the distal third of | traced back to its origin (Figure ). This origin was noted to be a very proximally branching variant of the inferior lateral cutaneous | emergency department with a coaptation splint. She had sustained a closed injury and remained neurovascularly intact. Initial management consisted of conversion over to a fracture brace and close follow-up. However, six weeks from injury, the patient endorsed continued pain. Examination revealed tenderness and movement through the fracture site; radiographs revealed unacceptable angulation and minimal callus formation (Figure ). With persistent pain, movement through the fracture and minimal healing, the patient was indicated for operative fixation.\nThe |
11,507 | 155,782 | The endoscopic finding revealed a 2.5 cm-sized SMT which involved the GEJ (), and this tumor was originated from the proper muscle layer by the finding of EUS (). The EUS-guided FNAB failed to get enough specimen for diagnosis, and a homogeneously enhanced SMT around the GEJ was observed by abdominal computed tomography (CT) | proper muscle layer by the finding of EUS (). The EUS-guided FNAB failed to get enough specimen | male patient was admitted to Incheon St. Mary's Hospital, The Catholic University of Korea to undergo surgery under diagnosis of SMT of GEJ by screening endoscopy. There was no symptom related to the tumor and there was no abnormality in physical examination and laboratory tests. The endoscopic finding revealed a 2.5 cm-sized SMT which involved the GEJ (), and this tumor was originated from the proper muscle layer by the finding of EUS (). The EUS-guided FNAB failed to get enough specimen for diagnosis, and a homogeneously enhanced SMT around the GEJ was observed by abdominal computed |
3,758 | 34,822 | of chronic illness, pulmonary or otherwise. All three patients exhibited severe hemoptysis, ranging from 300 to 700 mL/day, with multiple episodes. They also had hypoxemia, anemia and low blood pressure. They were admitted to the intensive care unit for close monitoring and treatment.\nTwo of our patients received blood | transfusions because of a rapid fall in hemoglobin levels (e.g. patient 1 had a hemoglobin level of 15.2% on admission, which had dropped to 8.7% two days later) and fear of severe hemodynamic instability,. All three of our patients were managed according to a standard hemoptysis protocol. They underwent emergency bronchoscopy and computed tomography (CT) of the thorax to identify the site of bleeding. | instability,. All three of our patients were managed according to a standard hemoptysis protocol. They underwent emergency bronchoscopy and computed tomography (CT) of the thorax to identify the site of bleeding. The bronchoscopy did not allow identification of the bleeding lobe or any other significant abnormality in any of our patients. Blood trails and clots were seen in both the left and right bronchial systems, but provided no conclusive evidence as to the origin of |
11,262 | 81,120 | revealed a large, nontender, and fixed left-sided abdominal mass and a normal neurovascular examination except an isolated reduction in light touch sensation in the L2-L3 dermatomes of his left leg only.\nAn abdominal and pelvic magnetic resonance imaging (MRI) and computed tomography (CT) demonstrated a large, 19 × 16 × 11 cm mass arising from the anterolateral aspect of the L3 pedicle with peripheral calcification, completely obliterating the distal psoas | the L2-L3 dermatomes of his left leg only.\nAn abdominal and pelvic magnetic resonance imaging (MRI) and computed tomography (CT) demonstrated a large, 19 × 16 × 11 | (Figures and ).\nCT guided biopsy of the left abdominal mass confirmed the diagnosis of a low-grade chondrosarcoma arising from an osteochondroma from the lateral body of the L3 vertebrae. The difficult anatomical location and the large size of the lesion greatly increased the complexity and risks of any surgical approach. In order to improve the chances of surgical success and reduce and prepare for possible risks and complication such as catastrophic haemorrhage, spinal instability, and paralysis/neurological deficit, a two-stage surgical procedure and a multidisciplinary |
31,145 | 152,069 | hemangioblastoma, vascular malformation, and other neonatal tumor types, such as soft-tissue sarcoma.[] In addition, meningioma could not initially be definitively excluded because of the dural attachment.\nOwing to the compressive nature of the lesion and the progressive hydrocephalus, the infant was taken to the operating room for resection of the posterior fossa lesion. | definitively excluded because of the dural attachment.\nOwing to the compressive nature of the lesion | estimated total circulating blood volume was only 230 ml and urine output was 50 ml.\nPostoperative imaging revealed gross total resection of the mass and significant decompression of the brainstem and cerebellum []. The immediate postoperative course was complicated by seizures and thrombosis of the right transverse sinus, for which therapy with levetiracetam and Lovenox (Sanofi-Aventis, Bridgewater, New Jersey) was started. Initially, intracranial pressures were normal and a several-day trial of EVD clamping was successful, allowing the removal of the EVD. Unfortunately, during the follow-up period, the patient |
5,176 | 22,197 | The robotic software converts CT images to a virtual model where a surgeon can plan on implant size, positioning, and joint alignment. As demonstrated from images, this patient had a distal femur fracture, which had resulted in malunion. Because of malalignment, the patient had recurvatum deformity. The use of the anatomical axis and jig-based technique would have resulted in the positioning of the knee implant into hyperextension. Also, it would have been difficult to use the jig-based technique in the setting of severe deformity of the distal femur. Also, deformity in the proximal tibia due to a previous high tibial osteotomy would have resulted in difficulties in establishing the mechanical axis. Because of robotic software, we | MAKO-Stryker surgical arthroplasty system was advised as the surgical method in order to plan for implants that would better fit this patient's specific geometric bony anatomy with the plans of bringing the mechanical axis within 3 degrees of neutral biomechanical alignment. A thorough discussion of the risks and benefits of the surgical procedure and preoperative 3-D computed tomographic images of his knee was performed.\nThe surgical planning included obtaining a MAKO protocol CT scan. | enough to accommodate an at least 9 mm poly liner. However, in flexion, this gap was 12 mm and 15 mm on the lateral and medial side, respectively. But often, making a cut on the tibia removes the tight PCL and opens up the flexion gap. Also, we all know that tibial cut symmetrically affects the flexion and extension gap. So, we decided to proceed with this tibial cut first.\nNext, appropriate tibial cut was made. The previous existing hardware was removed. |
18,219 | 113,177 | later admitted and anemia was corrected with blood transfusion. She received 3 units of sedimented cells (1 unit daily) and post transfusion hemoglobin level was 10.2 g/dL.\nShe later had open abdominal myomectomy through a vertical midline incision on the anterior abdominal wall under combined spinal and epidural anesthesia. The uterus was riddled with multiple fibroids. Tourniquet was applied with size 22 Foley catheter at the base of the broad ligament, below | the fallopian tubes and ovaries. Then fibroid masses were enucleated through three anterior incisions and one posterior incision on the uterus. The tourniquet was released every 20–30 minutes for 10–30 seconds to allow for revascularization of the uterus. The incision sites were closed with size 1 Monolus® suture on a round body needle (Poliglecaprone-25) on the myometrium | a private hospital where clinical diagnosis of uterine fibroids was made 3 years prior to presenting to Life International Hospital. At the initial private hospital, she was evaluated, counseled and was booked for open myomectomy but she declined. She was afraid that she may lose her “womb” after the surgery or it may affect her fertility. She subsequently presented to Life International Hospital when her abdominal swelling condition got worse, and |
14,195 | 165,406 | region. She was referred to the Department of Rehabilitation for electrodiagnostic examinations. According to the patient's past history, she had undergone right carpal tunnel release 8 months before she visited our hospital. However, this did not relieve the complaint of right finger numbness that she had before the surgery. Therefore, she had undergone the surgery again one month earlier. The symptoms in the medial antebrachial region occurred thereafter. During the surgery, she was anesthetized by axillary brachial plexus block using ultrasound guidance. First, in | a supine position, her arm was externally rotated by 90°, her elbow joint | mg, and tramadol 50 mg were orally administered as drug treatment, and stellate ganglion block was performed. However, the patient's symptoms were not relieved. We decided to conduct outpatient follow-ups and periodic electrodiagnostic examinations. Eight weeks after the onset of the symptoms, the patient's pain was relieved slightly. In follow-up sensory nerve conduction study of the right MABC nerve, |
1,779 | 39,471 | pen tip was attached to the superior orbital roof, and after removal, CSF leakage and minimal purulent discharge were noted. The dura was opened, and the pen tip penetrated the frontal lobe inferior surface. Ink from the pen was noted on the brain and orbital muscles. Debridement and irrigation were performed at the tract of the penetrating wound. A small piece of surgical patch was placed between the bone and | she underwent foreign body removal and debridement of the brain abscess. Transcutaneous upper eyelid surgery was carried out by a team that included both oculoplastic and neurological surgeons. Upper eyelid skin crease was opened exploring the superior subperiosteal space, exposing the proximal end of the foreign body that comprised the pen's metallic tip and pieces of glass from the pen's shaft (). The | abscess formation surrounded by cerebral edema (). Her laboratory investigations did not reveal any leukocytosis in the blood, and the result of the blood culture was negative. The patient was kept on an antibiotic regiment of vancomycin, ceftazidime, and metronidazole.\nAfter one day of being admitted to our hospital, she underwent foreign body removal and debridement of the brain abscess. Transcutaneous upper eyelid surgery was carried out by a team that included both oculoplastic and neurological surgeons. |
7,855 | 47,100 | dorsal surface of the tongue, which caused the difficulty in chewing and speaking. The lesion was of the size of a pea when the patient first noticed it but had grown to attain the size of 8 × 7 × 3 mm over a period of 2 weeks. The lesion had started to bleed when she was presented to the clinic. The patient's medical history was unremarkable. She mentioned that she previously went to a general practitioner and was prescribed amoxicillin, dexamethasone, and mefenamic acid. She consumed the medications for 5 days and reported no improvement. Intraoral examination | lesion was of the size of a pea when the patient first noticed it but had grown to attain the size of 8 | history of allergic reactions in relation to the use or consumption of beehive products such as honey, bee pollen, or propolis. She confirmed that she never had any allergic reaction to any beehive product. The patient was then instructed to also apply the commercially available hydroglyceric propolis extract to the surgical wound three times a day for a week. In addition, the patient was prescribed 500 mg mefenamic acid |
22,129 | 54,762 | performed with ABTHERA (total surgical time was 65 minutes). The patient was admitted to the intensive care unit (ICU) after the surgery.\nOn day 3, we tried to perform ERP again before the second surgery. A 5 Fr ENPD tube was successfully placed in the distal pancreatic duct from accessory ampulla passing through the injured part (Fig. ). Simultaneously, a 5 Fr EPST was inserted right next to the injured main | pancreatic duct from the ampulla of Vater. Then, a second operation was performed. We confirmed that the bleeding from pancreatic injury had stopped, and the tissue damage around the pancreatic head was very partial and limited to a small area when the gauze was removed. The gauze packing played an important role | on her right anterior chest and lower abdomen. Voluntary guarding and rebound tenderness were observed on her abdomen. She had marked spontaneous pain and tenderness in the upper lumbar spine, but had no abnormal neurological findings. There were no obvious abnormal findings on her extremities. Focused assessment sonography for trauma (FAST) revealed no hemoperitoneum. A whole-body contrast-enhanced CT was performed as her vital signs were stable. On abdominal CT, the head and body |
3,234 | 121,774 | try-in was done for the patient []. During the try-in stage, orthodontic face bow was inserted into orthodontic buccal tubes which in turn is inserted into the trial denture [Figure and ]. The outer arc is inserted into head gear that gains retention from the scalp []. The retention of the denture was verified during this procedure. The aim of the prosthesis was to help in enhanced feeding and to prevent regurgitation of fluids into the oro-nasal cavity. The patient was given fluids to verify regurgitation. After satisfactory intake of fluids, the patient's comfort was evaluated. The denture | the trial denture [Figure and ]. The outer arc is inserted into head gear that gains retention from the scalp []. The retention of the denture was verified during this procedure. The aim of the prosthesis was to help | upper jaw. The detailed history revealed total maxillectomy was done to resect sarcoma 1 month ago []. The patient was on Ryle's feed. Surgical reconstruction was attempted with the right side of the face as donor site, but was unsuccessful []. On examination, the oral nasal communication was evident []. Healing mucosa with no clinical evidence of recurrence of the lesion, loss of soft tissue support, were noted. The goal of the treatment was not only to provide |
31,959 | 12,897 | of neurological issues or allergies. Her medications were prenatal vitamins and Metamucil. On physical examination, she exhibited the normal physical changes of pregnancy. Her prenatal laboratory values were unremarkable. Her vital signs were within normal limits, with a blood pressure of 130/98, heart rate (HR) of 22 and a temperature of 98.6° Fahrenheit. She was 5 feet 4 inches tall and weighed 88.4 kg.\nThe patient requested an epidural for labor pain | positive for asthma, which was stable throughout the pregnancy. The patient did not report any prior history | be in the 80s to 90s. During the seizure, the fetal heart tones increased to 130, then further increasing to 170s and 180s after the seizure. Due to the fetal heart tones, the surgeon proceeded with the cesarean section.\nThe patient was taken to the operating room for an emergency cesarean section under general anesthesia. The maternal vital signs remained relatively stable throughout the operation, |
35,650 | 19,882 | baby was born at 40 weeks of gestation. Her birth weight was 2820 g, height was 49 cm, head circumference (HC) was 31.5 cm, and Apgar score was 10; all parameters were in normal range.\nAfter delivery, however, due to “poor response”, the infant was transferred to the neonatal intensive care unit. After a routine blood test showed that the white blood cells (WBC) increased to 33.7 × 109/L and granulocytes were at 72.8%, antibiotic treatment was given. Physical examination showed that the anterior fontanelle was 2.5 × 2.5 cm, | and Apgar score was 10; all parameters were in normal range.\nAfter delivery, however, due to “poor | referred to the genetic clinic for aniridia and an enlarged anterior fontanel during November 2019. She was the first child of non-consanguineous parents, both of whom are now 33 years old. The mother underwent surgical tumor removal due to mucinous cystadenoma of the right ovary at the age of 27. Simultaneously, she suffered from polycystic ovarian syndrome (PCOS) and subclinical hypothyroidism. Because of the PCOS, the infant was conceived through in vitro fertilization and embryo transfer (IVF-ET). Euthyrox was given orally before pregnancy, and thyroid function was well-controlled. A genetic karyotype analysis of both parents was done prior |
2,003 | 116,094 | with an inflammatory and ulcerative mass in her right breast that had been there since 2011. The mass had grown rapidly over the past 3 months and it was extremely painful with a huge ulcerative wound (). Breast ultrasonography and a core needle biopsy were performed initially in an outside breast clinic and the biopsy result was a diagnosis of invasive carcinoma of no specific type. She was referred to Korea University Medical Center, Ansan in January 2016, 2 weeks after being diagnosed.\nAdditional imaging workup was performed to check the primary breast mass and metastatic lesion, including a MRI of the breast; a CT scan of the chest and abdomen; a bone scan; | in her right breast that had been there since 2011. The mass had grown rapidly over | abdominis myocutaneous (TRAM) flap were performed (). The right breast mass weighed 2,212 g at the time of excision.\nThe final pathology confirmed a malignant phyllodes tumor measuring 125 mm × 120 mm. The tumor showed brisk stromal overgrowth with lymph and vascular tumor emboli, and the mitotic count was 46 per 10 high power fields. All resection margins were negative and we obtained margins of more than 10 mm except for the deep resection margin which was less than 1 mm. Immunohistochemical staining for estrogen receptor (ER) and progesterone receptor (PR) were positive, but for human epidermal growth factor receptor 2 was |
23,254 | 117,208 | patient was followed with approximately monthly brain MRI scans. Two months after stopping treatment, brain MRI showed that the left frontal abscess was enlarging again and had not responded to treatment. At this point, the patient was re-admitted to the hospital and a bifrontal craniotomy was performed for internal debridement of the left-side | was discharged on oral voriconazole and continued intracavitary aspiration with amphotericin B injections on an outpatient basis 3 times/week. This regimen was continued for a further 3 months at which point the lesions appeared stable. All medications were then stopped and the | Bantiana on cultures. The dose of intracavitary amphotericin treatment was then increased to 1 mg every other day. After 1 week in the hospital, he was discharged home on oral voriconazole and intracavitary aspiration and amphotericin B instillation 3 times/week in the clinic. Later, he was transitioned to weekly aspiration/injections that were continued for another 5 months, during which findings on periodic MRI remained stable [].\nFrom the last surgical debridement onward, analysis of aspirated material from the persistent left-side lesion continued to show septate hyphae on smear with no fungal growth on culture. Then, in September 2014 (13 months after |
20,479 | 94,473 | was 33% and there was a total urine output of 1000 ml. During closure of the surgical wound she gradually developed hypotension with a systolic BP 80 mm Hg.\nA fluid challenge of 500 ml Ringer Lactate was given without much benefit and the SBP decreased to 70 mm Hg. Mephenteramine 6 mg intravenous bolus was given and dopamine 10 mcg/kg/min infusions started. Noradrenaline infusion | was started when the BP continued to be low despite the dopamine infusion. Hydrocortisone 200 mg was administered for a possible adrenal insufficiency. In spite of dopamine (up to 10 mcg/kg/min) and noradrenaline (up to 20 mcg/min) infusions, SBP remained below 60 mm Hg over the next 30 minutes. Adrenaline infusion | L5-S1 spondylolisthesis was scheduled for L5 laminectomy, reduction and instrumentation. She was a known hypertensive for nine years and her blood pressure (BP) was controlled on amlodipine 5 mg and atenolol 50 mg orally, once daily. On the preoperative visit, her BP and HR were found to be 130/80 mm Hg and 78 beats per minute respectively. All other investigations were normal. She had no clinical evidence of any end organ dysfunction or limitation of physical activity.\nThe patient received diazepam 5 mg per orally, the night before surgery, atenolol 50 mg, amlodipine 5 mg, per |
11,805 | 94,994 | two painful, small flat-based ulcers with erythematous halos and a white ulcer bed were detected, localized on the right and left buccal mucosa.\nCultures from the plaques on the tongue and oral cavity were all negative for bacteria and fungi. The biopsies were obtained from the tongue, buccal mucosa and retromolar trigon. Secondary amyloidosis (AA type), was diagnosed by histological and immunohistochemical findings (Figure ).\nOur patient received comprehensive periodontal therapy, which | left buccal mucosa.\nCultures from the plaques on the tongue and oral cavity were all negative for bacteria and fungi. The biopsies were obtained from the tongue, buccal mucosa and retromolar trigon. Secondary amyloidosis (AA type), was diagnosed by histological and immunohistochemical findings (Figure ).\nOur patient received comprehensive periodontal therapy, | after minor trauma. The enlarged tongue has interfered with speech and swallowing, and caused sleep apnea. In addition, two painful, small flat-based ulcers with erythematous halos and a white ulcer bed were detected, localized on the right and left buccal mucosa.\nCultures from the plaques on the tongue and oral cavity were all negative for bacteria and fungi. The biopsies were obtained from the tongue, buccal mucosa and retromolar trigon. Secondary amyloidosis (AA type), was diagnosed by histological and immunohistochemical findings (Figure ).\nOur patient received comprehensive periodontal |
11,204 | 145,011 | canal and the superior orbital fissure, probability of fungal etiology was also detected [Figure and ]. Exploration of the ulcer and debridement of necrotic tissue were done under local anesthesia and sent for histopathology, culture analysis. Histopathological examination of the debrided tissue showed elongated, broad, nonseptate hyphae, marked areas of necrosis with giant cells, thrombosis of vessels, diffused infiltration of lymphocytes, eosinophils and few plasma cells [Figure -]. The Grocott-Gomori's methanamine silver staining showed nonseptate, twisted, ribbon-like hyphae of zygomycetes []. Rhino-orbito-cerebral zygomycosis was suspected and partial surgical debridement of | of paranasal sinuses and the brain showed right maxillary and ethmoidal sinusitis with deviation of the bony nasal septum to the left, mild erosion of bony nasal septum and bone destruction. Widening of the optic nerve | The patient approached a local physician where he was put on antibiotics, anti-inflammatory drugs and was also referred to a dentist to rule out dental infections. The dental infection was ruled and he was asked to continue the prescribed medications, but there was no relief and the condition deteriorated with increased ocular discomfort, severe headaches, sloughing of the ulcer which extended rapidly and involving nose, both the orbits with gradual loss of vision in next 2 weeks. The patient was admitted to the hospital due to repeated seizures, altered sensorium, non-coherence and was uncooperative. Clinical examination showed large irregular ulcer approximately 12 × 10 cm in size on the |
368 | 73,178 | no apparent lucencies (). Additionally, AP and lateral views of the entire tibia and fibula did not reveal any fractures, and the patient did not complain of any discomfort or tenderness to palpation outside of the ankle. Closed reduction was attempted in the emergency department; the talus was relocated, but the fibula was lodged in place and unable to be reduced. Understanding that repeated | attempts at closed reduction most likely be unsuccessful and to minimize the risk of articular damage, iatrogenic fracture, or skin breakdown, the decision was made to proceed with open reduction. The patient consented to open reduction and internal fixation of the fibular dislocation and was taken to the operating room the same day. The time that elapsed from injury to operation start was just under 5 hours. From the time the patient had been seen in the emergency department to operation start was | of a right tibial stress fracture with intramedullary nail fixation 14 months before presented to the emergency department after jumping into a shallow lake and immediately suffering severe right ankle pain and inability to bear weight. He had had the proximal intramedullary nail screw removed 3 months prior to presentation due to discomfort but reported no other medical problems. On exam, there was significant swelling of the ankle, with global tenderness to palpation. The fibula was noted to be displaced, as palpation of the lateral aspect of the ankle resulted in contact with the tibia, and palpation at the normal region of the peroneal groove revealed the distal fibula. |
27,472 | 32,174 | ). The readings of CT and MRI showed total necrosis of the maxilla, and osteomyelitis was extended to the sphenoid body, sinus, right greater wing, pterygoid process, and the clivus. PET-CT showed irregular hypermetabolic lesion involving the skull base, posterior nasopharyngeal wall, and both maxillary areas, indicating possible malignancy (Fig. ). Tentative initial treatment plan included total maxillectomy with reconstruction, but radiologic exam indicated a need for pathologic confirmation before proceeding with any definitive treatment.\nOne week following admission, an incisional biopsy of the necrotic bone in the posterior right and left maxilla was | extended to the sphenoid body, sinus, right greater wing, pterygoid process, and the clivus. PET-CT showed irregular hypermetabolic lesion involving the skull base, posterior nasopharyngeal wall, and both maxillary areas, indicating possible malignancy (Fig. ). Tentative initial treatment plan included total maxillectomy with reconstruction, but radiologic exam indicated a need | controlled hypertension and diabetes mellitus. After radiographic and clinical evaluation, he was shown with extensive osteonecrosis of the entire maxilla (Fig. ) and was hospitalized under the department of oral and maxillofacial surgery. He was immediately prescribed with prophylactic antibiotics in preparation for surgery. On admission, the patient had unremarkable vital signs and no abnormalities in neurologic examination. Laboratory studies showed normal white blood cell count (7080 cells/μl, normal erythrocyte sedimentation rate (14 mm/h), and normal serum C-reactive |
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