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29,052 | 83,398 | marrow transplant.\nThe contaminating donor was a 47-year-old male born in an endemic rural area near Santa Vitoria in Brazil, where he lived until the age of 23 before moving to São Paulo and then to Belgium when he was about forty. Shortly after implementation of T. cruzi blood screening in Belgium, he was found to be positive with four different serological assays that all remained reactive in another sample obtained three months later (). A | negative in the case of very low parasite burden. Extended follow-up with repeated testing is therefore planned to sustain long-term resolution of infection and absence of chronic complications. At present, more than two years after the contaminated transfusion occurred and one year after treatment completion, the child remained asymptomatic, and parasite DNA was undetectable in blood samples by PCR (as assessed in June 2015). He was still regularly receiving blood transfusion/manual partial exchanges, which are the only option in sickle-cell patients waiting for curative bone | The patient was a 7-year-old boy, born in Belgium from two parents of Burundi origin, who suffered from sickle-cell disease that was diagnosed during the neonatal period. He was undergoing manual recurrent partial exchange transfusion (roughly once a month since the age of four) in combination with medical treatment (hydroxyurea). Despite suitable therapy, he presented with some complications that mainly consisted of neurovascular malformations (Moyamoya disease). A look-back procedure, launched soon after an infected donor was |
36,458 | 16,245 | via computed tomography (CT), and the spinal cord was compressed by the posterior atlas arch (Fig. ).\nAfter failure of conservative treatment, we decided to perform surgical treatment on the patient to address the walking disorder. Preoperatively, we performed cervical CT angiography (CTA) to evaluate the relationship between the important blood vessels and bone in the cervical area. At the same time, 3D CT of the cervical region was performed to make a 3D print model of the patient's occipitocervical area (Fig. ). We simulated the depth and angle of cervical screw insertion according to the 3D print model, and finally determined | compressed by the posterior atlas arch (Fig. ).\nAfter failure of conservative treatment, we decided to perform surgical treatment on the patient to address the walking disorder. Preoperatively, we performed cervical CT angiography (CTA) to evaluate the relationship between the important blood vessels and bone in the cervical area. At the same time, 3D CT of the cervical region was performed | surgery to grade IV after surgery. Dexamethasone 5 mg/bid was administered twice a day for 5 days. Neurotrophic and anti-infective therapies were given at the same time. The wound healed at the first stage, and the stitches were removed at 14 days postoperatively. After removal of the stitches, 3D-CT was performed, which showed that the position of the pedicle screw was not significantly changed from that of the X-ray obtained 2 weeks prior (Fig. ). Postoperative |
35,351 | 49,270 | blade. The diseased tissue was peeled off with an electric knife in the cap aponeurosis layer. Then the subcutaneous tissue on both sides of the incision was separated to form two fascia tissue flaps. After using an electric knife to fully stop the bleeding and indwelling a negative pressure drainage tube, we pulled the bilateral fascia tissue flaps to the middle to suture the incision interruptly | cap aponeurosis layer. Then the subcutaneous tissue on both sides of the incision was separated to form two fascia tissue flaps. After using an electric knife to fully stop the bleeding and indwelling a negative pressure drainage | A 25 year-old male patient presented with a chief complaint of generalized hair loss in the scalp parietaloccipital region for a duration of 1 year, saying that hair loss started gradually and had worsened over time. In addition, this patient indicated that the alopecia area was occasionally accompanied by mild itching. He had scalp skin folds resembling the ridge and furrow of the cerebral cortex in the parietaloccipital region since birth. These were a small protuberant mass at first and had gradually increased in size and volume in proportion to his growth. He was of normal intelligence and denies neuropsychiatric diseases, eye diseases, scalp injuries, endocrine diseases, tumors, chronic dermatitis and similar family history. Physical examination at our |
24,153 | 30,868 | to percussion and palpation. No abnormal clinical signs or symptoms were observed in the adjacent or opposing teeth. The preoperative radiographical examination was based on periapical radiographs and CBCT scans. Periapical radiographs showed lateral and periapical radiolucent lesions on tooth #34, overlapping the apical third of the root structure and associated with inadequate root canal filling (Figure | ). A CBCT scan was obtained with a ProMax 3D MID (Planmeca Oy) operating at 90 kV and 10 mA with a small field of view (FOV) of 40 × 50 mm and a voxel size | length was determined using the apex locater (Root ZX; J. Morita) and was confirmed by the periapical radiograph (Figure ). The canal was shaped with a WaveOne GOLD file (Dentsply Sirona), size 45, taper 05, as the third instrument size after the removal of the gutta-percha. Copious irrigation of the canal was performed with 2.5% sodium hypochlorite (NaOCl; Clinix; Dental Sky) using a 27-gauge notched open-ended needle (Monoject® 3-mL endo syringes; Safco Dental Supply) and |
22,348 | 19,580 | rhabdoid variant.\nA radical resection was planned, and the patient was taken for surgical hip disarticulation. Following the surgery, adjuvant chemotherapy was done using Doxorubicin and Ifosfamide for 6 cycles. Then, the patient was referred to radiation oncology and underwent intensity-modulated radiation therapy at 6000 cGy to the left hip joint.\nThe patient had a slow yet uneventful postoperative recovery. On the | wide area of necrosis were present. Based on morphology, the tumor was assessed as epithelioid rhabdomyosarcoma with differential diagnosis of epithelioid sarcoma. Immunohistochemistry examination revealed vimentin () and CK positive expression (), while myogenin was negative (). Further immunostaining using CD34 () and HMB45 were also negative (). Thus, immunostaining profile was suitable as proximal epithelioid sarcoma, with the | using CD34 () and HMB45 were also negative (). Thus, immunostaining profile was suitable as proximal epithelioid sarcoma, with the rhabdoid variant.\nA radical resection was planned, and the patient was taken for surgical hip disarticulation. Following the surgery, adjuvant chemotherapy was done using Doxorubicin and Ifosfamide for 6 cycles. Then, the patient was referred to radiation oncology and underwent intensity-modulated radiation therapy at 6000 cGy to the left hip joint.\nThe patient had a slow yet uneventful postoperative recovery. On the most |
34,423 | 138,387 | unit with pain in the right lower back tooth region for 1 month. Pain was sudden in onset, throbbing in nature, and continuous in character. There was no history of fever, swelling, or paraesthesia associated with the pain.\nOn intraoral examination, pain seemed to be because of irreversible pulpitis with respect to 46. There was no sinus opening or tooth mobility present with respect to the same tooth. Electric pulp vitality | tooth region for 1 month. Pain was sudden in onset, throbbing in nature, and continuous in character. There was no history of fever, swelling, or paraesthesia associated with the pain.\nOn intraoral examination, pain seemed to be because of irreversible pulpitis with | graft placement. The lesion was approached by buccal crevicular incision. Full-thickness mucoperiosteal flap was raised. Surgical exploration revealed empty cavities with scarce amounts of tissue [Figures and ]. A diagnosis of multiple SBC was surgically confirmed. Thorough curettage of the internal walls of the cavities was carried out and bleeding was induced. The cavity was packed with chips of Perioglas allogenic bone graft and closure was done using 3–0 vicryl sutures [].\nHistopathological |
32,305 | 76,269 | no liver disease. The patient reported that he used to drink beer once a month and last consumed alcohol six months prior to admission. He also reported that he had consumed polished rice but had also been eating fruit and vegetables on a daily basis. The patient's family members endorsed his abstinence from alcohol and his daily fruit and vegetable consumption. The patient was not taking any vitamin supplements.\nAt the time of admission, he was in acute distress and was | orthopneic. He was well nourished with BMI of 29. His blood pressure was 103/52 mmHg, which was lower than his usual approximate blood pressure of 140/90 mmHg. He had a heart rate of 92 bpm, respiratory rate of 30/min, and oxygen saturation of 98% on room air. Physical examination revealed jugular venous distention, but the heart sounds and breath sounds were unremarkable. Bilateral pitting edema was present throughout | admission with a complaint of exertional dyspnea for one month. Chest X-ray showed cardiomegaly and pulmonary vascular congestion. Echocardiography revealed a preserved ejection fraction with no significant valve disease. He was diagnosed as having congestive heart failure with preserved ejection fraction, and treatment was initiated six months prior to admission with medications including furosemide 40 mg/day, trichlormethiazide 1 mg/day, methyldigoxin 0.1 mg/day, and losartan 50 mg/day. His symptoms gradually resolved over the next several weeks. He developed slight myalgia in both thighs two months after the initiation of diuretics. Two weeks prior to admission, his exertional dyspnea recurred with gradual exacerbation; the patient |
33,517 | 95,493 | on this data, we use the API combination (adriamycin 60 mg/m2 and cisplatin 100 mg/m2 on day 1 and ifosfamid 1.8 g/m2/d during 5 days with Uromi thexan (Mesna®) 1800 mg/m2/d during 5 days) as neo-adjuvant chemotherapy. G-CSF (filgastrim) was administrated from day 7 to day 14 of each cycle.\nHematologic and non hematologic tolerance to chemotherapy was evaluated after each cycle, and we showed two episodes of neutropenia (grade III and I) and 1 episode of | this data, we use the API combination (adriamycin 60 mg/m2 and cisplatin 100 mg/m2 on day 1 and ifosfamid 1.8 g/m2/d during 5 days with Uromi thexan (Mesna®) 1800 mg/m2/d during 5 days) as neo-adjuvant chemotherapy. G-CSF (filgastrim) was administrated from day 7 to day 14 of each cycle.\nHematologic and non hematologic tolerance to chemotherapy was evaluated after each cycle, and we showed two episodes of neutropenia (grade | into surrounding soft tissues. The shoulder and elbow appeared normal. There was no skip metastasis.\nA biopsy was performed. Microscopic examination showed fascicles of spindle cells with areas of collagen fibers, with an elevated mitotic index (Figure ). The microscopic aspect suggests the diagnosis of high grade FS of bone.\nA technetium-99 m labeled methylene diphosphonate radionucl ide (Tc 99 m/HMDP) bone scan revealed an area of increased uptake in the right proximal humerus, without other foci of abnormal isotope uptake that corresponded in |
19,675 | 79,704 | on the convexity of the brain and a glioma; pathologically, a transient area between the meningioma and astrocytoma was observed, and the two tumor types were mixed in some areas, supporting hypotheses (3) and (4) []. Drlicek et al. reported one case of the concurrence of a sphenoid ridge meningioma with a peripheral collision tumor. Pathological examination revealed that a meningioma was located within a glioma, also supporting hypotheses (3) and (4) []. Prayson et al. reported one case of a collision tumor comprising a meningioma in the sagittal sinus in the frontal lobe and a peripheral glioma; pathologically, the two tumors invaded each other, supporting | were mixed in some areas, supporting hypotheses (3) and (4) []. Drlicek et al. reported one case of the concurrence of a sphenoid ridge meningioma with a peripheral collision tumor. Pathological examination revealed that a meningioma was located within a glioma, also supporting hypotheses (3) and (4) []. Prayson et al. reported one case | with the surrounding brain tissues, was removed. Pathological examination after surgery confirmed that the cystic part of the tumor was a mixed glioma (oligodendrocytes-astrocytoma WHO class II) that tested positive for glial fibrillary acidic protein (GFAP) and oligodendrocyte lineage transcription factors (Oligo. The center of the lesion was a malignant meningioma (WHO class II) that exhibited 80% positive staining for both Ki-67 and epithelial membrane antigen (EMA). The two tumor types |
28,618 | 29,760 | was a 56-year-old male with a history of hypertension and dyslipidemia, in whom a CT scan performed 9 years earlier as part of a medical checkup had detected a 15-mm-diameter SMAA. He was referred to our institution, where it was found that the aneurysm had grown to 25 mm in diameter.\nThe SMAA was located 20 mm distal to the origin of the SMA and was dissected with a patent false lumen. The aneurysm and dissection longitudinally extended 3 cm distal to the origin of the aneurysm. The | a 15-mm-diameter SMAA. He was referred to our institution, where it was found that the aneurysm had | leg of the double-barrel graft in a side-to-end fashion. The ischemia time for the JAs was 32 min ().\nThe RCA was reconstructed with an end-to-end anastomosis to the branch of the GSV, which had been used for the external shunt. The ischemia time for the RCA |
17,798 | 165,819 | deformity and occupational dysfunction, but there was no active attempt.\nThe patient did have history of stammering since childhood, which exacerbated after his social anxiety increased. He has a history of alcohol and tobacco abuse. He is the first among his five siblings. His mother used to be very critical of his appearance from his childhood. There is family history of stammering, but there was no other significant mental illness in the family. He had difficult temperament from his childhood, although adequate information could not be got.\nAt the time of presentation to us, the patient had non pervasive sad mood, decreased concentration in | works involving social contact as a result of his ugly nose. He also started attributing his failures in academics and professional life to the imagined deformity in the nose. The patient did have recurrent suicidal ideation secondary to preoccupation with imagined | Mr. S is a 27-year-old male from middle socio-economic status. The patient was referred to psychiatry outpatient department from the plastic surgery department for clearance for rhinoplasty surgery. Patient was interviewed in detail and his history dated back to 17 years of age when he was in his final year of schooling. He started noticing pimples and acne on his face, which embarrassed him to face his peers. He observed that few of the acne cleared, but few on the face left black marks and those on the nose turned into comedones. Most of them cleared with the treatment from a dermatologist. But the patient's concern with the healed scars on the face and nose started increasing |
20,382 | 156,556 | for visiting his 8-year-old son. But according to the interview the patient did not feed him sufficiently due to her delusion and when despite of her mother's warnings, he had eaten something in the school the patient did not let him go to school anymore; so it was supposed that he was a case of delusional disorder by proxy. His condition was followed by a social worker. Regarding delusional disorder diagnosis, the patient was prescribed Olanzapine starting at 5 mg/day, and increased to 15 mg/day. The severity of delusions lessened after three weeks. Despite our plans for more sessions with the family, they refused to come to the hospital after | Her husband was a 55-year-old carpenter. He did not have good relationships with his family and didn’t care about them. He ate his food at work and in spite of the fact that he thought his wife's beliefs were ridiculous, when his family was starving he did not do anything. Unfortunately he did not give permission | neighbors were her husband's relatives she did not have any relationship with them and she thought they wanted to poison her and her children and they might do this in several ways such as injecting |
17,436 | 48,685 | a high-speed burr was used to enlarge the tumor cavity, allowing the removal of an additional 1–5 mm of the cavity lining. After repeated irrigation of the tumor cavity with povidone-iodine solution and isotonic saline, autologous iliac bone was harvested from the right ilium, followed by grafting in the focus (Fig. ) and suturing of the incisions in turn.\nThe reports for the intra-operative frozen section and postoperative pathological results revealed that the tumor tissues in the left patella were composed of osteoclast-like multi-nucleated giant cells and chondroid matrix. Accordingly, CB was considered (Fig. ).\nThe left knee joint was reviewed after the surgery, and the grafted | of the tumor cavity with povidone-iodine solution and isotonic saline, autologous iliac bone was harvested from the right ilium, followed by grafting in the focus (Fig. ) and suturing of the incisions in turn.\nThe reports for the intra-operative frozen section | with the small focus identified in the preoperative MRI raised difficulty in collecting sufficient samples.\nThe patient was made to lie in a supine position, and his left lower limb and right ilium were disinfected and draped. After approaching the lesion, a cortical window was created. Fresh blood was observed to be oozing out of the focus after the fenestration, and the focus had a multi-dividing shape |
38,056 | 28,076 | movements as well as short jerks. Speech was effortful and dysarthric. Even though there was no apparent facial palsy, voluntary control of facial mimics and tongue movement were impaired. Deep tendon reflexes were brisk, pyramidal signs were negative. Limb muscle tone was normal, muscle strength fulfilled 5/5 MRC (“Medical Research Council” Scale). During the exam, the movement disorder exacerbated for episodes of < 1 min duration | with dropped head was evident mainly when trying to stand up and during ambulation. She could stand unsupported for a few seconds. She would walk > 10 m without aid in a clumsy and dystonic manner. Perioral and tongue dyskinesia were nearly permanent and comprised slow choreatic | choreatic movements as well as short jerks. Speech was effortful and dysarthric. Even though there was no apparent facial palsy, voluntary control of facial mimics and tongue movement were impaired. Deep tendon reflexes were brisk, pyramidal signs were negative. Limb muscle tone was normal, muscle strength fulfilled 5/5 MRC (“Medical Research Council” Scale). During the exam, the movement disorder exacerbated for episodes of < 1 min duration without an obvious trigger. The patient was not taking any medication at that time.\nAt the age of 13, DBS |
35,631 | 65,963 | patient was an 81-year-old Caucasian woman with a history of persistent right-sided flank pain with no associated symptoms including dysuria, hematuria, frequency, or urinary retention. She had no history of prior abdominal surgery, trauma, or congenital defects. Given the unclear etiology, we obtained cross-sectional imaging which demonstrated a right-sided Bochdalek diaphragmatic hernia incarcerating her proximal ureteral segment (Fig. ). Initially, she was managed conservatively with surveillance monitoring since her pain was tolerable and her renal function was preserved. Although her kidney function remained unchanged, follow-up imaging at the next visit surprisingly demonstrated an interval increase in hydroureteronephrosis (Fig. ). Additionally, the entrapped ureteral portion had progressed with now obvious hydronephrosis | was an 81-year-old Caucasian woman with a history of persistent right-sided flank pain with no associated symptoms including dysuria, hematuria, frequency, or urinary retention. She had no history of prior abdominal surgery, trauma, or congenital defects. Given the unclear etiology, we obtained cross-sectional imaging which demonstrated a right-sided Bochdalek diaphragmatic hernia incarcerating her proximal ureteral segment (Fig. ). Initially, she was managed | our suspicion – she had moderate obstruction of the right kidney. This study also demonstrated an asymmetric split function with 64% left and 36% right in the setting of a stable baseline creatinine (0.7mg/dL).\nIn attempt to reduce the entrapped ureter and unobstruct the right kidney, a double-pigtail ureteral stent was endoscopically placed. We were able to reduce the herniation with the use of a super stiff wire and a standard soft stent was placed in the usual retrograde fashion. During her stent exchanges, it became apparent that the herniated ureteral segment was enlarging as the curl of the double-J stent retracted into the distal ureter requiring ureteroscopy to visualize and |
37,634 | 27,618 | weeks and 4 days, the fetuses developed Stage I TTTS. Fetoscopic-guided laser photocoagulation of placental anastomoses and amnioreduction (1L) was performed with survival of both fetuses. The patient was discharged home post-operative day 3.\nDue to the anticipated complexity of patient delivery and that this was a unique case to our institution, we conducted a multidisciplinary, table-top simulation at 27 weeks gestation. This included orientation to simulation processes such as confidentiality, mutual respect, suspension of disbelief, and debriefing principles. The simulation facilitators were trained in debriefing with good judgment | Stage I TTTS. Fetoscopic-guided laser photocoagulation of placental anastomoses and amnioreduction (1L) was performed with survival of both fetuses. The | fetuses demonstrated growth restriction with greater growth restriction in twin B.\nAt 28 weeks and 6 days, twin B was noted to have intermittent, severe decelerations with increase in painful maternal contractions refractory to magnesium sulfate. The decision to perform the EXIT procedure urgently was made. In the operating room, ultrasound demonstrated both |
22,520 | 163,291 | was extremely high (). Bone matrix was present outside of these cells in some areas. No metastasis was found in 25 lymph nodes.\nGross pathologic examination of the mass from the lower right quadrant of the abdomen showed a tumor measuring 14.0 cm in length, 12.0 cm in width, and 7.0 cm in height with gray capsule wall. The thickness of the capsule wall was 0.2–0.5 cm. Fatty tissues and hairs were prevalent in the tumor. Microscopically, the capsule wall contained squamous epithelium. Skin appendages such as sweat and sebaceous glands were found under the epithelium. There were | lower right quadrant of the abdomen showed a tumor measuring 14.0 cm in length, 12.0 cm in width, and 7.0 cm in height with gray capsule wall. The thickness of the capsule wall was 0.2–0.5 cm. Fatty tissues and hairs were prevalent in the tumor. Microscopically, the capsule wall contained squamous epithelium. Skin appendages such as | pathologic examination of the mass from the lower right quadrant of the abdomen showed a tumor measuring 14.0 cm in length, 12.0 cm in width, and 7.0 cm in height with gray capsule wall. The thickness of the capsule wall was 0.2–0.5 cm. Fatty tissues and hairs were prevalent in the tumor. Microscopically, the capsule wall contained squamous epithelium. Skin appendages such as sweat and sebaceous glands were found under the epithelium. There were also some ovarian tissues. Keratinized tissues, which were stained in red, |
16,490 | 176,768 | isolated and deflated, and the surgeon proceeded to place ports to facilitate the robotic resection as follows: the sixth intercostal space in the anterior axillary line, the third intercostal space in the anterior axillary line, and the ninth intercostal space in the posterior axillary line. The surgical procedure continued uneventfully from an anesthesia perspective with level 7 and 10 lymph node dissections, extensive lysis of adhesions and pericardial and pleural fat to facilitate visualization, and a left lower lobectomy. Surgical blood loss was estimated at less than 50 cc. Chest tubes were placed through the sixth and ninth | isolated and deflated, and the surgeon proceeded to place ports to facilitate the robotic resection as follows: the sixth intercostal space in the anterior axillary line, the third intercostal space in the anterior axillary line, and the ninth intercostal space in the posterior axillary line. The surgical procedure continued uneventfully from | testing was performed. The hemoglobin was resulted at 6.5 g/dL, and transfusion was initiated while awaiting a confirmatory hemoglobin sent to the lab, which was resulted at 7.4 g/dL (preoperative hemoglobin 13. 5 g/dL). The chest radiograph did not show any areas suspicious for bleeding. The double-lumen endotracheal tube was removed and replaced with a single-lumen endotracheal tube to facilitate transport and the potential for prolonged mechanical ventilation, and the patient was transported urgently to the computed tomography (CT) scanner for chest, abdomen, and pelvis imaging. Upon review with the radiologist, the diagnosis was made of a subcapsular splenic hematoma with fluid extending |
5,857 | 98,338 | cefazolin 2 g, were given before incision. The patient was prepped and draped in the typical sterile fashion, and a 2 cm midline incision over the proximal aspect of the fluid collection was made that extended through the subcutaneous tissue, opening the superficial fascia. At this time, a large amount of serosanguinous fluid began exuding from the incision. No purulence noted or obvious necrotic tissue. The fluid obtained was sent for | culture and cell count. In total 900 ml of serosanguinous fluid was evacuated. On intraoperative examination of the lesion, it was felt that the fluid collection demonstrated a defined walled-off lesion. The cavity | a large fluctuant mass in the lumbar region, measuring approximately 20 cm×20 cm. No overlying erythema, warmth, or ecchymosis noted. Diffuse tenderness to palpation of the mass was noted. The patient exam was otherwise unremarkable.\nThe patient was informed of the presence of a persistent fluid collection and given that the patient would likely benefit from operative evacuation, she was offered an open incisional drainage. Treatment options were discussed with the patient and family, and after explaining the risks, benefits, and alternatives to surgery, the patient elected to procedure with surgical irrigation and debridement of the persistent fluid collection. Pre-operative testing was performed with basic |
15,431 | 34,759 | in question was a 45-year-old Hispanic female who had lived in Canada for the previous 11 years. She reported a long history of manual labour and subsisted on similar occupations since arriving in Canada. At the time of her presentation, her occupation required prolonged periods of standing. The patient's chief complaint was chronic low back pain. There was no antecedent trauma, bone surgery, or history of cancer. The onset of low back pain was described as insidious, with constant achy pain of at least two years duration which was progressively worsening. The pain remained localised to the central lower back in the area of the lumbosacral | junction. The pain was rated at 3/10 (verbal scoring) at its best and 8/10 (verbal scoring) at its worst. An increase in pain was associated with an increased level of physical activity during the day, with the pain | do not examine patients who are referred into an imaging department for investigation. As such, no physical examination was performed in this case. Permission was granted after the images were interpreted only to interview the patient for this case report.\nA three-phase bone scan was performed with 99 mTc(Technetium)-MDP (methylene diphosphonate) including blood flow and blood pool imaging followed by a delayed whole-body scan. SPECT/CT imaging centered over the lumbar spine was subsequently performed on a Symbia T6 (Siemens), a dual-head gamma-camera incorporating a low-dose 6-slice non-contrast enhanced CT (12 mAs, 130 kVp, |
38,960 | 150,947 | Caucasian, who was an anesthesiologist, from São Paulo in Brazil, identified symptoms like gingival recession, dentine hypersensitivity and mobility in teeth 31 and 41, greater than its original physiology, went to a general dental practitioner for dental health care. The professional carried out an extra-coronal splinting in the lower anterior teeth, and gave him a referral to consult the Periodontology Department of the UNESP- Araçatuba, São Paulo, Brazil. In the anamnesis questionnaire, the patient informed that there was no previous specific periodontal treatment, neither was he taking any medication for at least | 3 months prior to this study, and denied any pre-existing systemic conditions or significant history of harmful habits.\nHowever, the patient revealed a nasal obstruction and chronic mouth breathing condition, which induced an altered maxillary arch development with a high narrow vault. Clinical and radiographic assessments were obtained, with a similar protocol used by Page et al. (2002) [] and Repeke | symptoms like gingival recession, dentine hypersensitivity and mobility in teeth 31 and 41, greater than its original physiology, went to a general dental practitioner for dental health care. The professional carried out an extra-coronal splinting in the lower anterior teeth, and gave him a referral to consult the Periodontology Department of the UNESP- Araçatuba, São Paulo, Brazil. In the anamnesis questionnaire, the patient informed that there was no previous specific periodontal treatment, neither was he taking any |
42,192 | 86,032 | adenoids, hypertrophied bilateral inferior turbinates, and mild periorbital tenderness. Complete blood count (CBC), renal function test (RFT), liver function test (LFT), and coagulation profile were all normal.\nThe secretion at the corner of the eye was collected during an episode of bleeding and we did blood smear examination on the sample. The results showed plenty of red blood cells, and no abnormal cells.\nHematology, dermatology, ophthalmology, ENT, and immunology were consulted to further evaluate and assess the patient, and cause of bleeding. All consults returned inconclusive of any identifiable source or cause of bleeding.\nThe only significant finding on past medical history included menarche at age of 10 years | that was regular for four months, then spontaneously stopped for around two years, and returned spontaneously for unknown cause, with no medical attention. Last few menstruations however were regular and of normal flow and no clots or dysmenorrhea.\nPatient is not on any medications and not on over-the-counter drugs. However patient describes allergy to eggs or egg-containing products and sugar candy, where a steak line rash appears on | was admitted to the hospital as a case of unusual painless bleeding from the left side of the face (), left eye, and tear duct of two-week duration. The bleeding was described to be spontaneous, unpredictable, and intermittent, with no specific patterns, and it stopped spontaneously. There was no association with mood, activity, or sleep. The bleeding occurred mostly around the orbital regions, the tear ducts, and the face, with intact skin, and no blood or redness, or visual disturbance of the eyes, except |
15,814 | 56,001 | the posterior aspect of the right frontal lobe and T2 FLAIR high signal intensity in the left side of the optic chiasma and bilateral optic tracts with heterogeneous enhancement in the left side of optic chiasma, features suggesting demyelinating changes with active phase in the left side of the optic chiasma (Figures –). Based on these findings, she | and bilateral optic tracts with heterogeneous enhancement in the left side of optic chiasma, features suggesting | left eye, respectively. She also had headache with painful eyes on movement. The vision was fully recovered after fifteen days of medication then. The second episode was two years ago when she had sudden blurring of vision with a visual acuity of 6/18 and 6/12 in the right and left eye, respectively. There was no headache or painful eye-movements then. She was discharged in 5 days of admission with visual acuity of 6/9 in both eyes. Our patient is a regular smoker, 4–6 |
29,722 | 12,108 | until 2012 when patient had disease progression with development of diffuse lymphadenopathy and increasing splenomegaly and was treated with bendamustine and rituximab. He was then treated with ibrutinib in 2014. He presented in February 2017 to University of Michigan Hematology Clinic for a consult with a 2-month history of neck and face swelling, | cough, dysphagia, and night sweats. The patient was admitted to a local hospital prior to this consult and underwent fine needle aspiration (FNA) of the left neck mass with pathology report showing persistent CLL. Given the rapid disease progression which was not consistent with CLL, the decision was made to get a positron emission tomography (PET)/computed tomography (CT) scan and excisional biopsy of the presumed cervical lymph node with the highest 18F-fluorodeoxyglucose (FDG) metabolic activity (standardized | with chronic lymphocytic leukemia (CLL) in 2009 when lymphocytosis was noted. Interphase fluorescence in situ hybridization (FISH) studies performed on peripheral blood at that time confirmed the presence of abnormalities including homozygous deletion of chromosome 13q. Flow cytometric evaluation of peripheral blood demonstrated positivity for ZAP70 in 13% of the CD19-positive B cells. His CLL was monitored until 2012 when patient had disease progression with development of diffuse lymphadenopathy and increasing splenomegaly and was treated with bendamustine and rituximab. He was then treated with ibrutinib in 2014. He presented in February 2017 to University of Michigan Hematology Clinic for a consult with a 2-month history of neck and |
37,349 | 11,254 | recent escalation in the doses and addition of other antidepressants (SSRI) and benzodiazepines with concomitant intake of drugs like metoprolol, pantoprazole and some herbal medications associated with typical features, presumptive diagnosis of SS was made as per Hunters criteria. All antidepressants were stopped. Sedation using titrated doses of propofol (10 mg/hr) to maintain Ramsay | score of 2–3 was started to alleviate the symptoms and allow the complete excretion of drugs. Patient received oxygen by face mask and was monitored continuously. Over the next 24 hours his agitation subsided and patient was awake and started responding to commands. Later propofol sedation was gradually tapered off. Thereafter, patient was discharged from | 117/K+ 3.9/iCa+2 3.55/glucose 90 mg/dL/Cl− 83 mEq/L. In view of the recent escalation in the doses and addition of other antidepressants (SSRI) and benzodiazepines with concomitant intake of drugs like metoprolol, pantoprazole and some herbal medications associated with typical features, presumptive diagnosis of SS was made as per Hunters criteria. All antidepressants were stopped. Sedation using titrated doses of propofol (10 mg/hr) to maintain Ramsay score of 2–3 was started to alleviate the symptoms and allow the complete excretion of drugs. Patient received oxygen by face mask and was monitored continuously. Over the next 24 hours his agitation subsided and patient was awake and started responding to commands. Later propofol sedation was gradually tapered off. Thereafter, |
22,460 | 31,712 | anastomotic site in the lumen of the jejunal limb (Fig. a). CT revealed that one of the metastases in the pancreatic tail had markedly enlarged compared with previous CT. PM-RCC invaded the jejunal limb and extended into the lumen. A tumor thrombus completely filled the jejunal limb, increasing its diameter to 7 cm. The proximal side of the jejunal limb had also expanded, with the tumor thrombus causing bowel occlusion (Fig. b–f). Although preoperative biopsy of the tumor was not performed because of concern about hemorrhagic complications, based on CT findings and course of tumor growth, jejunal | enlarged compared with previous CT. PM-RCC invaded the jejunal limb and extended into the lumen. A tumor thrombus completely filled the jejunal limb, increasing its diameter to 7 cm. The proximal side | detected.\nPalliative surgery was considered as means of ameliorating the patient’s symptoms. However, because the tumor thrombus was located at a site immediately distal to the esophagojejunal anastomosis, bypass surgery would have been difficult. To remove the bowel occlusion, distal pancreatectomy with concomitant resection of the jejunal limb and re-anastomosis were considered to be necessary. Although the patient had multiple RCC metastases, his general condition remained fairly good, and tumor progression was |
20,070 | 157,826 | pursestring suture at the mouth of the bag was tightened. Under laparoscopic guidance, the pursestring suture was held and the mouth of the bag was delivered through the umbilical port site. The umbilical port was extended to 3 cm. The hemangioma was morselled within the bag and retrieved []. The retrieval bag with the gall bladder was finally removed. Re-laparoscopy was performed, hemostasis was ensured, a subhepatic 24 F tube drain was placed and ports were withdrawn.\nThe operative time was 220 min and the blood loss was around 50 cc. The | open end of the bag. This suturing technique facilitated in bagging the large specimen comfortably. The cystic duct was clipped, the gallbladder was dissected off from the liver bed, placed in the same endobag and the | a 12-mm port to facilitate the use of the 4× Habib laparoscopic probe. RF generator (Habib™ 4X, Generator 1500X, RITA Medical Systems, Inc. California, USA), 60 Watts setting, was used during liver parenchymal transection with the laparoscopic 4× Habib probe by choosing a 2 cm depth of application of RF prongs along the line of transection with parenchymal division performed with straight scissors []. To prevent injury to the retroperitoneal structures, the hemangioma was lifted in an anterior direction with a 10 mm fan retractor. The posterior 1 cm depth of the parenchymal division was achieved by two firings of an endo GIA stapler with 60 mm, white reloads (Autosuture) []. Hemostasis |
18,150 | 79,512 | angle area and grafted below the osteotomized segment (Figure ). Then, the segment was reinserted into the condylar fossa. The distal segment of the mandible was positioned as guided by the final splint, and both sides of the mandible were fixed with an absorbable mesh and screws (Osteotrans-MX®; Takiron, Osaka, Japan).\nOn histological examination, a chondroid mass was found on the capsule of the mandibular condyle, which was extended into underlying trabecular bones. The chondroid tissue showed many hyperplastic chondrocytes, which were mostly surrounded by hyalinized matrix and subsequently underwent ossification to produce trabecular bones. The underlying trabecular bones were irregular in shape and anastomosed each other, resulting in | positioned as guided by the final splint, and both sides of the mandible were fixed with an absorbable mesh and screws (Osteotrans-MX®; Takiron, Osaka, Japan).\nOn histological examination, a chondroid mass was found on the capsule of the mandibular condyle, which was extended into underlying trabecular bones. The chondroid tissue showed many hyperplastic chondrocytes, which were mostly surrounded by hyalinized matrix and subsequently underwent ossification to produce | (Figures ; A1, A2). On immunohistochemical staining, the chondroid tissue was conspicuously positive for BMP-4 (bone morphogenetic protein-4; antibody was from Santa Cruz Biotechnology, Santa Cruz, CA, USA) (Figures ; B1, B2) and the trabecular bones were slightly positive for BMP-2 (bone morphogenetic protein-2; antibody was from Santa Cruz Biotechnology) (Figure ; C). This tumor was finally diagnosed as osteochondroma, and the entire tumor tissue examined was rarely positive for PCNA (proliferating cell nuclear antigen; antibody was from DAKO, Glostrup, Denmark) (Figure ; D).\nThe post-operative course was uneventful. Intermaxillary fixation was performed to stabilize the jaws for 2 weeks. The patient performed jaw movement exercises for 3 months after removal of intermaxillary fixation. |
36,849 | 159,667 | and consolidation of the left lung were also evident. Contrast injection through the chest tube confirmed its presence in the left main pulmonary artery []. Plans were made for surgical removal of the tube, possibly requiring cardiopulmonary bypass. It was noteworthy that each attempt to unclamp the chest tube resulted in frank hemorrhage through the tube. Preparations were | made and the patient was taken to the operating room. Pump standby was used. The patient was then prepared, with multiple monitoring lines placed, and was placed in semi-right lateral decubitus position. A left lateral thoracotomy was performed, | given to dissection around the lung to obtain vascular control of the hilum, this did not seem feasible, given dense adhesions and consolidation of the left lung. Therefore, purse string sutures of Prolene were placed around the entrance of the tube into the lateral portion of the lower lobe of the left lung. The tube was then quickly withdrawn while the purse string sutures, placed on the lung tissue were tied, and hemorrhage controlled. Bleeding from the orotracheal tube, which had been positioned in the right main stem bronchus, was noted and required suctioning. This seemed to be controlled with limited suctioning. Postoperatively the patient was followed in |
38,895 | 18,308 | with closed kinetic chain activities. Patient B presented to therapy with no reported pain, no joint line swelling, knee range of motion lacking seven degrees of extension to 134 degrees of flexion, 3+/5 hip abduction left lower extremity MMT, 5/5 upper abdominal and 3+/5 lower abdominal testing, and required moderate | verbal and tactile cueing to increase spine and lower extremity proprioception during closed kinetic chain activities. Both patients finished therapy with pain-free, normal knee range of motion, no swelling, excellent activation of quadriceps, repetitive straight leg raises without an extensor lag, and the ability to perform pain-free repetitive squats without any corrective cueing. Due to anticipated surgical intervention, quadriceps isokinetic testing was not performed to reduce the risk of effusion.\nBoth patients started postoperative physical therapy within one week of their respective surgeries with the same physical therapist as pre-rehabilitation. The identical | post-injury. Patient B underwent left knee arthroscopy with ACL reconstruction using a hamstring autograft two weeks and five days post-injury. Although both twins sustained similar tears in their ACLs, Patient A struggled more with obtaining a full range of motion and swelling control following the injury. It was for this reason that her surgery was after her sister’s despite her injury occurring two days earlier.\nBoth patients began pre-rehabilitation within one week of injury to improve outcomes following ACL reconstruction []. Patient A presented to therapy |
43,070 | 123,236 | in the outpatient clinic because of weight loss, fatigue, and abdominal discomfort. Current height was 175 cm, weight 67 kg, with an unintended weight loss of 6 kg over the last few months. There had been symptoms of fatigue, which the patient attributed to increased workload. The abdominal discomfort included distention without pain or nausea. There were normal and unchanged stools and no icterus.\nThe patient had no other symptoms at presentation and showed a good performance | The abdominal discomfort included distention without pain or nausea. There were normal and unchanged stools and no icterus.\nThe patient had no | scan, ultrasound of the abdomen, and a plain thoracic X-ray. Blood tests were normal apart from a moderate thrombocytopenia at 90–125 × 109/L (150–450). Radiographically, there were venous collaterals at the level of the previous inferior vena cava thrombosis. In addition, ultrasound showed slowly progressive splenomegaly to 16 cm developing over the years, which was not further investigated. Five years after treatment, an abnormal ultrasound pattern was observed in the liver parenchyma without signs of cirrhosis and normal flow in the portal and liver veins; no further action was taken. At the age of 18, after 10 years of follow-up, the patient was discharged |
31,762 | 41,331 | diagnosed with breast cancer by mammography and underwent breast-conserving surgery and axillary lymph node biopsy for node-negative breast cancer in December 2011. The patient recovered without postoperative sequelae via conventional treatment, including antibiotics and exercise, during the postoperative period.\nDuring the breast-conserving surgery, we performed cavity margin assessments to achieve margin clearance []. However, on the 17th day after the first surgery, the patient had to undergo secondary breast surgery on only the breast, without lymph-node dissection, to achieve negative margins by excising seven margins. This was because the postoperative pathology report indicated a diagnosis of ductal carcinoma in situ; however, only two of the five margins excised in | underwent breast-conserving surgery and axillary lymph node biopsy for node-negative breast cancer in December 2011. The patient recovered without postoperative sequelae via conventional treatment, including antibiotics and exercise, during the | by mammography and underwent breast-conserving surgery and axillary lymph node biopsy for node-negative breast cancer in December 2011. The patient recovered without postoperative sequelae via conventional treatment, including antibiotics and exercise, during the postoperative period.\nDuring the breast-conserving surgery, we performed cavity margin assessments to achieve margin clearance []. However, on the 17th day after the first surgery, the patient had to undergo secondary breast surgery on only the breast, without lymph-node dissection, to |
17,600 | 123,835 | [] and an apparent right frontoparietal cerebral arteriovenous malformation. MR angiography was performed and confirmed a large saccular aneurysm of the right middle cerebral artery []. Three days after collection of the CSF, Candida lusitaniae was isolated, and the blood culture identified methicillin-resistant Staphylococcus epidermidis. Antimicrobial coverage was changed from cefepime to vancomycin and amphotericin B. For a suspected large mycotic aneurysm of the right middle cerebral artery, neurosurgery was consulted. During the period of surgical consideration, the infant abruptly experienced severe apnea, hypotonia, and lethargy with aggressive attempts | [] and an apparent right frontoparietal cerebral arteriovenous malformation. MR angiography was performed and confirmed a large saccular aneurysm of the right middle cerebral artery []. Three days after collection of the CSF, Candida lusitaniae was isolated, and the blood culture identified methicillin-resistant Staphylococcus epidermidis. Antimicrobial coverage was changed from cefepime to vancomycin and amphotericin B. For a | However, after 3 days, blood cultures were negative, and the clinical condition had improved. Therefore, the antibiotics were discontinued.\nOn the day of life three, a routine cranial ultrasound was found to be normal. Echocardiogram was also normal with no structural abnormalities. The initial cranial circumference was 31 cm, and the neurological examination after resolution of hypotension was normal with no |
30,247 | 92,385 | 59.9 IU/mL (normal <40). Blood and urine cultures were both sterile and she was admitted for intravenous antibiotic treatment and insulin control of her diabetes. Treatment with ceftriaxone, amoxicillin and clavulanic acid was started and over a six-day period she continued to have temperature spikes with fever up to 39ºC. She eventually became afebrile on day seven and after two additional days of antibiotics, she was sent home with oral antibiotic treatment and her oral antidiabetic medications were restarted. | The patient was discharged with good diabetic control and was feeling much better.\nDuring her admission, a repeat ultrasound scan revealed a large heterogeneous mass with central cystic areas intimately related to the uterus with a diagnosis of possibly uterine fibroids. A computed tomography (CT) scan was also done with and without intravenous contrast | days and again improved with reduction in her spiking fever and improvements in her blood sugars. She was then scheduled for staging laparotomy and discharged home.\nOne month later, she was admitted for staging laparotomy and found to be ill-looking with pallor, fever and abdominal tenderness. Her Hb was 7.6 g/dL (normal range 11-15 g/dL), WBC 11 × 109/L (normal range 4-11 × 109/L). The anaemia was confirmed as anaemia of |
4,502 | 152,622 | measures proved ineffective, the Acute Pain Medicine Service was consulted.\nPhysical examination of our patient revealed an anxious woman in moderate distress. Her right lower extremity was cool to the touch from the toes to the ankle. There was dry gangrene on the second and third toes with dusky discoloration. Limitation of plantar flexion and dorsiflexion was observed secondary to pain and prolonged immobility. On the left | touch from the toes to the ankle. There was dry gangrene on the second and third toes with dusky discoloration. Limitation of plantar flexion and dorsiflexion was observed | on the soles of her feet in order to promote vasodilation and reduce cyanosis. When these measures proved ineffective, the Acute Pain Medicine Service was consulted.\nPhysical examination of our patient revealed an anxious woman in moderate distress. Her right lower extremity was cool to the touch from the toes to the ankle. There was dry gangrene on the second and third toes with dusky discoloration. Limitation of plantar flexion and dorsiflexion was observed |
10,441 | 1,272 | who presented to our Emergency Department 6 hours after he had fallen approximately 6 meters from a rambutan tree where his left arm hit the tree trunk on his way down to the ground. Post trauma, he complained of pain and swelling over his left antecubital fossa. There was no wound over his left upper limb. He had no history of trauma to his left upper limb and no significant past medical history. He did not take any medications. He was an army officer and had been an army officer for 16 years. Two years prior to the current | to our Emergency Department 6 hours after he had fallen approximately 6 meters from a rambutan tree | a small suburban home. He was an active tobacco smoker with a 20 pack year smoking history. Currently he smoked 10–15 cigarettes a day. He did not consume alcohol.\nIn our Emergency Department, his vital signs were stable with blood pressure 132/80, pulse rate 79/minute, and temperature 37 °C. A physical examination |
29,566 | 70,700 | CLL/SLL via lymph node biopsy that was diagnosed three months prior to admission. At the outside facility, he was noted to be hypoxic and required four liters of oxygen/minute to maintain oxygen saturation above 85%. An arterial blood gas (ABG) was performed demonstrating a pH of 7.53, pCO2 of 32 mmHg, and a PaO2 of 550 mmHg | arterial blood gas (ABG) was performed demonstrating a pH of 7.53, pCO2 of 32 mmHg, and a PaO2 of | with very dark urine. In light of his elevated carboxyhemoglobin and methemoglobin levels, we asked him social and exposure questions. He denied smoking, recent exposure to exhaust or fire, local anesthetics, and topical or oral numbing medications. Interestingly, he noted that he had a very similar episode four months prior after receiving an IV dose of vitamin C for his rheumatoid arthritis that had been uncontrolled with biologics. At that time, he received a single dose of packed red blood cells and demonstrated clinical improvement. He was discharged |
37,206 | 93,297 | and his eyes open and rolled back. This lasted for approximately 1 minute and was followed by restless thrashing movements and awkward attempts to get up. There was some foaming at the mouth.\nOn admission there was some residual disorientation but no lateralizing symptoms or signs. The patient had been previously well, | although one week prior he had had flu-like symptoms, including loss of appetite and general myalgia, as well as a swelling on the right side of his neck which had resolved on its own.\nThere was no history of previous seizures, meningitis, encephalitis, blackouts, loss of consciousness, head injuries, or febrile seizures. The patient reported no use of recreational drugs. Neither the patient nor his family members had a history of | speaking or swallowing. There was no abnormality in bowel or bladder function. Gait was normal, and the patient's neurological exam was unremarkable except for gaze evoked nystagmus, thought to be a side effect of the phenytoin. Following the procedure, the patient reported feeling better and his wife reported that conversation with him was more normal, although he had forgotten details of events up to a week prior.\nThe same morning, however, the patient |
Subsets and Splits