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3,878 | 33,202 | external rotation of the right hip and the psoas sign was positive. Cardiovascular and pulmonary examinations did not produce significant findings. Laboratory investigations showed white blood cells of 15 x 103/cu mm, hemoglobin 7.6 g/dL, MCV 73.5%, MCHC 32.0%, platelets 457 x 103/cubic mm, reticulocyte count 1.3%, ESR 118 mg/L, C-reactive protein (CRP) 58 mg/L.\nGiven the suspicion for psoas abscess, blood cultures were sent and the patient was started on ampicillin and sulbactam. CT of the abdomen with and without oral and intravenous contrast was performed. This | right lower quadrant, involuntary guarding, and hyperactive bowel sounds. Examination of the hip joint showed no redness, edema, or tenderness. No limitation in anterior hip flexion, lateral hip flexion, or internal rotation. Also, the costovertebral angle was not tender on percussion. Mild tenderness noticed on the |
20,580 | 12,631 | gestation of her second pregnancy was admitted to the Department of Emergency Medicine at the Medical University of Pecs with worsening hypoxia, dyspnea, hemoptysis and oliguria. The patient had a history of hypothyroidism and thromboembolic events: she suffered a pulmonary embolism at age 20, shortly after initiation of an oral contraceptive medication. Subsequent work-up identified no hypercoagulability risk factors and oral anticoagulation therapy was discontinued after a year. She then suffered a DVT at age 31 after lower extremity fracture and was subsequently restarted on anticoagulation therapy, which was switched from oral to low molecular weight heparin during | both her known pregnancies. Her previous pregnancy ended with intrauterine fetal demise 2 years prior at week 38. Her current pregnancy was unremarkable apart from occasional hemoptysis thought to be the side effect of anticoagulation therapy. Upon admittance, examination showed severe hypoxia (sO2 69%), maintained blood pressure, sinus tachycardia, peripheral edema and diminished urine output. Echocardiography confirmed severe right heart dilatation and failure (RV cross section 50 mm, TAPSE |
35,330 | 21,140 | 10 days of IV ampicillin-sulbactam and 8 days of enteral feeding.\nThe patient was successfully contacted 1 week after leaving the hospital and agreed to return for follow-up evaluation and another attempt to perform the procedure. One month later, the patient underwent fistulectomy, debridement of the previous fracture site, and removal and replacement of hardware after nasoendotracheal intubation without complication using a C-MAC video laryngoscope. Preoperative evaluation with awake nasolaryngoscopy performed by the otolaryngology service revealed a well-healed pyriform sinus. | Surgery was completed without incident, and the patient was extubated postoperatively without incident.\nThe patient was seen postoperatively 3 times in 1 month for |
18,690 | 174,882 | Finally, in February 2018, she was referred to our clinic and presented with a huge hemorrhagic draining cervical mass (Fig. ). Of interest, besides this finding, she did not have any other complaints other than a little dyspnea when lying down. Summing up all previous RAI treatments, cumulative 800 mCi RAI was given to her in the past 10 years; however, a physical examination and screening findings were not yet promising at the last follow-up (Fig. ). Eventually, considering her elderly age, harboring multiple metastases, and the absence of severe complaints, we planned radiotherapy to the giant mass on her neck. After applying radiotherapy, | ). However, a neck USG showed two solid thyroid nodules at the previous thyroid area and bilateral lung metastases were identified by thoracic CT. For the next 3 years, she was lost to follow-up, again. |
31,734 | 87,836 | experienced lancinating pain in her right leg and hot flashes. She did not report unintended weight loss, fatigue or fever. Previously, she had undergone body contouring plastic surgery after a weight loss of 35 kg. She carried a levonorgestrel-releasing intrauterine device (IUD) for several months. Computed tomography (CT) revealed a retroperitoneal mass adjacent to the right psoas muscle. Since a retroperitoneal sarcoma was suspected, the patient was referred to our institution. The laboratory test yielded normal blood levels of chromogranin A, neuron-specific enolase, CA15-3, and CA125. Urine and blood samples did not | show elevated production of catecholamines, vasoactive intestinal peptide or androgens. Gynaecological examination including transvaginal ultrasound showed normal findings and confirmed the correct position of the IUD. Magnetic resonance imaging (MRI) demonstrated a solid tumour (68 × 35 × 28 mm) |
10,356 | 156,670 | partial bed rest at home, the patient complained of severe headache, especially prominent in the area corresponding to the frontoparietal lobe.\nAs a work-up for headache, an initial computed tomography (CT) scan was performed which demonstrated hyperdense foci of the right frontoparietal lobe, typical signs of a right orbital anterior wall fracture implying right globe destruction. Then, a brain MRI with intravenous contrast was done. The MRI study revealed the intact right globe; its related optical nerve possessed normal diameter and signal also. The globe had only herniated through the bony defect of the right orbit roof into the floor | the orbit was irrigated and the upper eyelid repaired. Throughout the 7 days of hospitalization as well as for a further 7 days of |
34,414 | 89,344 | patient slept in a single room within the department, while controls slept in the hospital guest room. All participants were allowed to sleep as long as they wanted to. Recordings took place on an ambulatory basis; the participant had a portable recording device (Embla, Flaga hf, Reykjavik, Iceland) that was connected to the recording electrodes. The recordings were performed using the standard Rechtschaffen-Kales method []. The high-pass filter was 0.5 Hz and the low-pass filter 45 Hz, with a sampling rate of 100 Hz. Commercial software (Somnologica, version 2.0, Flaga hf, Reykjavik, Iceland) was used for scoring and calculation of sleep parameters. Sleep onset was defined as the first occurrence | of three consecutive epochs (90 sec) of stage 1 (S1) or other sleep stages. The following parameters were calculated: time in bed, |
10,752 | 74,166 | mmol/L. Electrocardiogram was significant for sinus tachycardia and left ventricular hypertrophy. After one liter of normal saline, the patient fully regained muscle strength, including the abilities to ambulate without difficulty, perform squats, single-leg stance and jumping jacks.\nGiven complete resolution of symptoms and abnormal thyroid function tests, the patient was discharged with a diagnosis of normokalemic, thyrotoxic periodic paralysis. In consultation, he was initiated on propranolol 10 mg three times daily and methimazole 20 mg daily. Outpatient follow-up with endocrinology was also secured, with subsequent testing demonstrating elevations in free triiodothyronine (FT3) at 12.2 pg/mL (1.7–3.7 pg/mL), thyroperoxidase antibody at 209 IU/mL (0–34 IU/mL), and percent thyroid-stimulating immunoglobulins of 294% (0–139%). A diagnosis of Graves’ disease was made | urine specific gravity of 1.032, a thyroid stimulating hormone level below assay detection, free thyroxine level of 18.8 ng/dL (0.7–1.9 ng/dl), creatine kinase of 501 U/L, aspartate aminotransferase of 55 U/L, alanine aminotransferase of 71 U/L, and phosphate level of 2.2 mg/dL. Importantly, his potassium level was normal at a level of 3.8 |
6,208 | 113,697 | were positive for valgus stress, with signs of posterior sagging in the posterior drawer test, and negative for the Lachman test, pivot shift test, extension recurvatum test, and dial test. A subsequent arthroscopic examination also revealed a complete midsubstance tear of the posterior cruciate ligament (PCL) () and a partial tear of the posterolateral bundle of the anterior cruciate ligament (ACL), which were not reconstructed (). A peripheral longitudinal tear of the lateral meniscus was repaired using the Fast Fix 360 Meniscal Repair System (Smith & Nephew, Andover, MA, USA) ().\nThereafter, a 7-cm medial longitudinal incision was made | to repair the medial collateral ligament (MCL). The medial retinaculum and capsule were |
17,855 | 34,607 | valve was present and compatible with a patent ductus arteriosus (PDA) with minimal right-to-left shunt associated with an estimated pulmonary arterial pressure of 55 mmHg.\nThe patient was admitted to the internal medicine department for further evaluation. She was initially managed with furosemide (20 mg three times a day) and supplemented oxygen with a 24% face mask. A therapeutic phlebotomy of one unit blood (500 mL) was performed resulting with significant symptoms improvement. A pulmonary test function (PTF) revealed a | relevant obstructive-restrictive pattern. A chest high-resolution computed tomography (HRCT) scan revealed hyperlucency and diminished vascularity in the right lower and middle lobe with hyperinflation of the pulmonary parenchyma (Figure ) which was confirmed by the computed tomography (CT) angiography (Angio-CT) to be a diffuse hypoplasia/agenesis of right superior and inferior branches of the pulmonary artery (Figure ), compatible with SJMS. The patient declined cardiac |
19,388 | 65,170 | cerebral palsy presented with walking crouch gait. He was born at full term normal delivery. The parents were not consanguineous. Both parents were normal. Mother did not take any medication before and during pregnancy for medical illness. No perinatal insult was noted. The developmental milestones were delayed. The child started standing around 1.5 years of age and walking around 2.5 years of age. No history of regression of developmental milestones was noted. The child was not on any treatment before presenting to us. He did not have any medical illnesses | and was not on any medication before the presentation. On examination, he had spasticity of all four limbs (lower limbs were involved more than the upper limbs). The diagnosis of cerebral palsy was made on clinical grounds.\nHe was able to crouch walk independently without walking aids. He had fixed flexion deformities (20 degrees) of both hips, and bilateral fixed flexion deformities of the knee (30 degrees) (, ). The popliteal angle was 60 degrees on |
41,015 | 56,716 | ultrasound showed no abdominal free fluid, no gallstones, and no other sonographic signs of cholecystitis.\nThe primary differential diagnosis considerations included hepatobiliary causes (such as biliary colic, choledocholithiasis, and acute cholecystitis), pancreatic causes (such as acute pancreatitis), and gastric causes (such as gastritis, gastric and duodenal ulcers) given the upper abdominal tenderness and vomiting. An atypical presentation of acute coronary syndrome was also considered, but was less likely given the history and physical examination findings. Similarly, thoracic and pulmonary diagnoses were entertained, but did not seem likely given the details of the case.\nThe patient’s point-of-care glucose testing was 9.3 mmol/L. His electrocardiogram showed normal sinus rhythm. The patient’s bloodwork on presentation to | the ED is shown in Table . The only significant abnormalities were an |
27,730 | 15,886 | were self-limiting and usually settling within one day. During these episodes, initially, the vomitus contained clear fluid; however, later it turned into coffee ground colour. In addition, he developed progressive abdominal distension. On examination, he was afebrile and not drowsy; however, he was mildly dehydrated. The child was in discomfort due to abdominal distension.\nInitial basic haematological investigations such as full blood count, C-reactive protein, | serum electrolytes, and urine full report did not reveal any significant derangements.\nInitially, the child was referred for an abdominal ultrasound scan. It revealed multiple echogenic foci in the portal vein suggestive of intravenous air. In addition, a small amount of free fluid was seen in the abdomen. The stomach was distended with echogenic foci within the gastric wall. Furthermore, distal small bowel loops were collapsed.\nA plain |
28,783 | 72,218 | continued extravasation. Protamine sulfate was given, and prolonged balloon inflation was then performed. Subsequent angiography showed that the circumflex artery was thrombosed.\nImmediate bedside transthoracic echocardiogram showed very small 4 mm pericardial effusion. Pericardiocentesis was attempted but was unsuccessful. The ejection fraction was normal, and there were no other echocardiographic features of cardiac tamponade.\nThe patient remained hemodynamically stable for about 20 minutes before developing progressive hypotension. The ECG showed fast atrial fibrillation with acute ST elevation in II, III and aVF (). He was supported with inotropes but developed pulseless ventricular tachycardia requiring cardioversion and 10 minutes of cardiopulmonary resuscitation. Venoarterial extracorporeal membrane oxygenation (VA ECMO) was inserted | for hemodynamic stabilization. Repeat assessment by echocardiogram showed no increase in pericardial effusion, but there was a new collection of fluid at the atrioventricular groove (), |
10,546 | 89,685 | about her pregnancy and had ambivalent feelings of love and hate towards the unborn child. There was no disorder of content or possession of thought. Physical examination was unremarkable except the patient was anaemic with haemoglobin of 8.5 mg/dl. Other routine investigations, including thyroid function tests, were normal. A | because of her "fear of God".\nThe patient was dressed appropriately and was well groomed. Her speech was coherent and relevant. Her complaints included insomnia, a general loss of interest, lack of concentration and a feeling of hopelessness. She was found tohave depressed mood but would occasionally smile while answering questions related to her symptoms because the "doctors wouldn't believe her". She had partial insight into her symptoms. She was not concerned |
1,015 | 86,024 | chin to chest deformity in February 2011. The deformity had progressed rapidly from mild difficulty in keeping the head up to head drop over a period of 5 months (). Upon admission, he could maintain his head up with extreme effort only for about five minutes. However, he was able to correct the deformity passively with his hands and the deformity could be relieved spontaneously in a supine position. He denied any other weakness in his extremities or difficulties in chewing and swallowing. The dropped head position had severely impaired the | patient's activities of daily living and withdrawn him from social contacts. He used to wear a collar for outdoor activities such as shopping but he preferred to stay home most of the times. For most of his activities and for having a meal, he used to hold his head with |
17,413 | 130,303 | There were no postoperative complications and the patient was discharged on day 5 after surgery. Pathology examination results showed a tumor measuring 31 × 21 × 8 cm, consisting of fatty tissue and thymic parenchyma []. There were also foci of collagenous fibrosis and accumulation of cholesterol crystals. No signs of malignant disease were observed. Final pathologist report revealed TL. The patient remains asymptomatic during the | section, it primarily consisted of mature-appearing adipose tissue with no area of hemorrhage or necrosis. |
32,399 | 142,368 | years older than herself.\nVital findings, neurological and other system examinations were all normal.\nLaboratory findings, hemogram, EFG, and brain magnetic resonance image (MRI) were also all normal.\nAt her first psychiatric appointment, the female patient, who looked older than her years, looked well groomed and behaved with respect. She kept looking around, didn’t speak spontaneously, and | replied hesitantly only when asked questions. During the interview she was agitated, her attention and concentration were poor, and she did not always seem to understand what was being asked of her. She showed no emotional response to the conversation |
18,786 | 160,829 | conjunctival and Tenon's capsule removal surgery on the right eye for cosmetic purposes at a local clinic 8 months prior to presentation, was referred to our University-associated tertiary-care eye center due to uncontrolled elevated IOP. She did not have any other significant past medical or social history. She did not take any systemic medications. Before conjunctival removal surgery, she had complained of redness in the right eye for 3 years, although she did not have ocular pain or irritation. The left eye did not show redness. Before surgery, IOP measurement was performed at two different visits. Goldmann applanation tonometry revealed that IOPs were | 19 and 13 mmHg at the first visit, and 19 and 12 mmHg at the second visit, in the right and left eye, respectively. The optic disc and visual field (VF) were apparently normal. Average retinal nerve fiber layer (RNFL) |
1,157 | 16,873 | of the excised mass was about 2 kilograms ().\nThe specimen showed lipoma in the left side of the abdomen, which consisted of an oriented fibrofatty tissue measuring 20 × 20 × 10 cm and elliptical skin measuring 22 × 14 cm.\nThe patient had an uneventful hospital course and was discharged on the first postoperative day in a stable condition.\nThe patient was seen in the clinic 2 days after discharge, 7 days later, and 2 months after surgery (). The drains were removed once the drainage output was less | was included and completely resected along with the excess abdominal skin. Hemostasis was secured, as two suction drains were inserted and brought out through the pubic area. Finally, the skin was approximated and closed in three layers using 0 vicryl for the Scarpas fascia, 2.0 vicryl for the deep dermal layer, and 3.0 monocryl for the subcuticular layer (). The wound was covered with a single layer of Dermabond and an abdominal binder was applied. The weight |
31,174 | 23,790 | the operation, the pacing threshold, impedance, and sensed parameters were repeatedly tested and deemed satisfactory.\nNext, we prepared the left bundle branch pacing for this patient as a backup lead. Under the 30° right anterior oblique projection position, another 3830 electrode was pushed to reach the RV septum, and was implanted into the position approximately | 1 cm away from the His bundle lead. The electrode lead was positioned vertically toward the spine, indicating that the electrode lead was located at the RV septum. After pacing, a complete left bundle branch block was observed: the V1 lead was QS type, and the |
41,876 | 99,085 | posterior tibial and dorsalis arteriosclerosis. Vibration perception threshold testing indicated severe peripheral neuropathy. Radiographic imaging of the left foot revealed changes in the distal part of the first and second metatarsal bones and abnormal bone morphology. MRI showed multiple bone marrow edema of metatarsal, navicular, cuboid, medial, and lateral cuneiform bones from the first to the fourth toes, indicating infectious disease. Doppler ultrasound results showed that the femoral, popliteal, anterior tibial, and posterior tibial arteries of both limbs were sclerotic, and that the | surface. The left foot was hypoesthesic and slightly swollen. Light touch sensation was intact in the left foot. The distal pulses, including pedal and posterior tibial pulses, of both feet were palpable.\nLaboratory investigation showed elevated random blood glucose of 14.3 mmol/L and hemoglobin A1c of 7%. The C-reactive protein level was 1.8 mg/L. The erythrocyte sedimentation rate was 17 mm/h. The ankle-brachial index greater than 1.3 in both legs suggested |
33,517 | 95,493 | 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 location to | the abnormalities visualized on MRI. Computed tomographic (CT) scanning of the thorax performed revealed no abnormalities. Laboratory test results were normal, left ventricular fraction ejection (FEV) was normal and equal to 69%.\nSurgical resection is the standard treatment of FS of bone. Early studies support the use of amputation []. At the Memorial Sloan-Kettering Cancer Center (MSKCC) more than 85% patients with histologically verified primary fibrosarcoma of bone, were treated by major amputation between 1918 and 1973. Nevertheless |
21,139 | 124,027 | II, female, 48 years old, presented with a tumor. On May 29, 2014, abdominal CT showed multiple space-occupying lesions in the pelvis, with the largest measuring 7.7×7.4×6.9 cm3 and elevated CA125 level of 1,191 U/mL. On June 3, 2014, the patient underwent cytoreductive surgery (total abdominal hysterectomy + bilateral adnexectomy + omentectomy). No residual lesions were detected in postoperative imaging. The patient was administered six cycles of chemotherapy with docetaxel combined with oxaliplatin from July 2014 to October 2014 and | her CA125 level returned to normal in October 2014. In June 2015, PET-CT showed that the FDG uptake of the nodules by the right iliac vascular region in the pelvis increased and was deemed metastatic; the FDG uptake of the lymph nodes by the abdominal aorta also increased and was deemed metastatic. CA125 level increased to 91.1 U/mL. The patient was administered six cycles of TP chemotherapy regimen from June 2015 to October 2015. The best therapeutic evaluation was PR during the treatment. Also, |
14,692 | 131,724 | have a renal transplant surgeon available during PTA so that, should a complication, such as dissection, arise with loss of the solitary kidney, then the kidney could be auto transplanted and re-anastomosed in the pelvis. Using a 6Fr sheath, an over-the-wire 3 mm × 15 mm cutting balloon (Boston Scientific) was used over a 0.014 wire () to relieve the stenosis. The stenosis was post dilated with 3.5 mm × 20 mm balloon with excellent angiographic results and release of the stenosis | made to stop and the use of a cutting balloon discussed in the paediatric urology meeting. A second attempt was scheduled for 3 months later. The MDT decision was to |
28,760 | 159,502 | mg/L, and a sedimentation rate of 15 mm in the first hour. The radiographs showed a well circumscribed lytic lesion in the distal pole of the | and family history was unremarkable. Serologic workup performed showed a negative rheumatoid factor, a white blood cell count of 6000 cells/mm, a C-reactive protein of 0.6 |
34,913 | 20,485 | Scale III (WMS-III) []; the d2-R Test of Attention – Revised [, ]; the Processing Speed Index (PSI) of the Wechsler Adult Intelligence Scale IV (WAIS-IV) []; the Delis-Kaplan Executive Function System (D-KEFS) [], Verbal Fluency Test, Design Fluency Test and Trail Making Test; and the Wisconsin Card Sorting Test Revised and Expanded | given during each assessment.\nThe following validated neuropsychological tests were selected in cooperation with an experienced neuropsychologist to examine a wide range of cognitive functions: the Wechsler Memory |
22,607 | 90,620 | 70. During the first 10 months of treatment, he returned to his baseline weight. He was able to attend several university courses, to study and learn with regularity, and in 1 year of treatment he could pass 6 exams. He was feeling "..normal" and willing "...to manage life | without drugs". He decided to stop medication without doctor's consent. In the following two months, he experienced a relapse and gave his consent to restart aripiprazole. The drug was reintroduced at 10 mg/die, but it was deemed appropriate |
19,007 | 204,046 | a pseudo nodular structure composed of fibrous stroma axis which contained numerous glandular structures. An epithelial coating of variable histology was observed. Some mucosecretant glands suggested a digestive epithelium. Others had a cylindrical epithelium mucocilia, others a transitional or even squamous epithelium. There were | cm of larger diameter for a total height of 1.7 cm. The body showed two small protuberances measuring 0 .1cm larger diameter (Fig. ). Histopathology revealed fragments of |
38,336 | 138,105 | diagnosis of leiomyosarcoma was made. After receiving two units of packed red blood cells, the patient was posted for exploratory laparotomy.\nIntraoperatively, the mass was up to the umbilicus, adherent to the omentum and sigmoid colon. It had actually ruptured inside the abdomen with tumor tissue and necrosed material adherent to the bowel, abdominal wall, and | lateral pelvic wall []. Adhesiolysis was done. Total abdominal hysterectomy with bilateral salpingo-oophorectomy and infracolic omentectomy was done. The specimen was sent for histopathology.\nThe resected specimen measured 13 cm × 13 cm × 4 cm. The outer surface was congested |
17,447 | 51,280 | a height of 3 meters. After a primary survey, a computed tomography (CT) imaging revealed clavicle fracture, serial rib fractures associated with pulmonary contusion and hemopneumothorax on the left side, and non-displaced serial rib fractures on the right side.\nHe underwent surgery with surgical stabilization with plates of the clavicle and the ribs on the left side and was discharged home on the 19th postoperative day (POD).\nThree months later, he presented with a painful swelling on his right chest wall without a history of new trauma or surgery on that side. Physical examination showed a | large solitary swelling over the seventh/eighth rib, 3 × 5 cm in dimension. The lesion was soft, tender, fluctuating with defined margins, and not attached to underlying structures.\nIn order to determine the cause of the swelling, we performed an ultrasonography and a CT |
39,819 | 20,791 | 41-year-old woman, gravida 0. She had notable medical history. Laparoscopic right salpingo-oophorectomy and left cystectomy were performed for bilateral ovarian endometriomas, which were both pathologically diagnosed as benign. After surgery, she underwent regular outpatient treatment with dienogest. Six months later, she presented with left lower abdominal pain and expressive aphasia. A 7 cm diameter cyst had formed in the left ovary, with a solid ingredient and surrounding ascites. Contrast-enhanced computed tomography (CECT) revealed peritoneal dissemination, multiple | lymph node metastases, liver metastasis, pulmonary embolism, and deep venous thrombosis of the lower limbs. Brain magnetic resonance imaging (MRI) revealed that infarctions occurred at multiple locations in the bilateral cerebral hemisphere centered on the left frontal lobe |
8,967 | 98,756 | January 2017, a healthy, uniform granulation tissue bed had developed over the exposed bone (). To prevent osteomyelitis, we gave the patient antibiotics both locally and systemically.\nOn 20 February 2017, the patient underwent reconstructive surgery with a free full thickness skin graft to replace skin loss on the right calf. A 9 × 8 cm graft obtained from the right groin was fixed with suturing (). The wound was dried and covered with VSD dressings. After surgery, the patient was administered rivaroxaban and mucopolysaccharide polysulfate cream. Compression stockings were used to prevent the recurrence of varicose veins when the wound had been fully healed. The model of | the compression stockings is AD, 5 (Cizeta Surgical, Bologna, Italy), and the pressure was 30 mmHg. However, 2 |
28,522 | 162,233 | En bloc resection of the tumor and 15 cm of the small intestine with a side-to-side anastomosis was performed (fig. ). The postoperative course was uneventful and the patient could be discharged after 4 days.\nOn pathological examination the outer aspect of the tumor was smooth-walled with a good vascular support and partly multinodular (fig. ). It concerned a spherical cystic lesion filled with blood clots which was connected to the small intestine (fig. ). The diameter of the lesion was 11.0 cm. On microscopic examination radical resection was confirmed.\nImmunohistochemical stains showed that | tumor originating in the small bowel, 180 cm proximal to the ileocecal valve, on the antimesenteric side. There were some adhesions to the greater omentum, but there was no invasion into surrounding structures. On palpation there were no enlarged lymph nodes. There were no other lesions in the abdominal cavity. |
41,347 | 56,627 | algorithm because the detection zone for ventricular tachyarrhythmias for defibrillation or antitachycardia pacing had been programmed to over 150 beats per minute. From those observations, our initial speculation was that it was an accelerated idioventricular rhythm (AIVR) with VA dissociation. Then, we decided to attempt a catheter ablation procedure because the AIVR inhibited effective CRT | the absence of obvious P waves (A). The device interrogation demonstrated ventricular sensing without CRT pacing at a V-V interval of 700 ms, which was faster than the right atrial (RA) regular rhythm (B). The ventricular rhythm was not diagnosed as a tachycardia by the CRT-D detection |
14,322 | 80,806 | For about 3 years, she at times experienced being likely to faint upon standing and dimmed vision. However, she did not show neurological dysfunction; therefore, cerebral infarction was not suspected. When she was working in standing position for a long time in the middle of the night, she started experiencing dimmed vision, labile vertigo, and hindrance in the ability to stand at her workplace. Such episodes were associated with a following numbness and weakness in the lower extremities on the left half of her body. The estimated time from the onset of symptoms to hospital presentation was about 6 h. This consequently caused the delay | between neurologic symptoms onset and diagnostic of stroke in the patient. She was hospitalized in Jichi Medical University Hospital (Shimotuke, Japan) on the morning of the same day. Upon examination, her level of consciousness was alert, and she had a body weight of 47 kg, |
14,293 | 56,614 | the aorta being about 2.8 cm and the pulmonary artery at 3.0 cm. A mass of the size 3 × 3 × 2 cm was located on the right ventricular diaphragmatic surface, infiltrating the ventricular myocardium without a clear demarcation, which made excision impossible. The mass also involved the right atrium via the coronary sinus, forming another lesion of 4 × 3 | × 3 cm that was later removed.\nGrossly, the resected atrial lesion was soft and gray–red. Microscopically, neoplastic cells proliferated diffusely in the pattern of nests and sheets with fibrous separation (). Focal areas with remarkable cellular dyscohesion imparted a vague pseudopapillary pattern |
20,174 | 98,815 | travel abroad shortly after that, it was decided to inject the lumps with triamcinolone (40 mg/mL). Both lesions regressed in size within 2 weeks.\nHowever, after returning to the country at the end of September, they regained their original size. In October and November 2015, they were excised. By February 2016 there were already two lesions again, and by the end of 2016 she had undergone an additional three surgical procedures to remove chalazia. In December 2016 there were still two lesions in the upper lids of both eyes. The patient was very annoyed at this point and refused further invasive procedures. She decided to leave it as is and to continue | with hot compresses, however, without much success.\nIn a last attempt, the physician performed routine laboratory tests including a lipid profile and evaluation of the reproductive hormones (estrogen, progesterone, luteinizing hormone, follicle-stimulating hormone, prolactin, and testosterone) and thyroid-stimulating hormone (TSH). All results were well within the normal range. However, the TSH was 3.9 mIU/L, which was close to the upper limit. |
35,237 | 11,529 | resection of portions of segment IVb and V, en bloc with the cystic plate, was performed as well as a hepatoduodenal lymphadenectomy. Cystic duct margin, on frozen section, was negative for malignancy. Final pathology revealed a 2.7 cm T1b well-differentiated grade one papillary carcinoma of the gallbladder; no lymph nodes were found in the specimens (Figures -).\nThe liver mass was determined to be an anastomosing hemangioma with sharp | demarcation from the surrounding liver parenchyma, associated with a branching vascular pattern with mild |
34,445 | 162,273 | and mid chin to tragus of both right and left side []. The measurements showed hemifacial atrophy of the right side.\nThe intraoral examination revealed edentulous area in first quadrant []. The ridge in first quadrant was thin. Patient also gave history of absence of deciduous and permanent teeth in the first quadrant. Generalized periodontitis was seen with the remaining teeth. Patient also gives history | palpation, the ramus area and the depression below the zygomatic bone felt bony hard as there was absence of muscles. The skin on right side of the face was taut and not of the same texture when compared with the other side.\nLocal examination, measurements were taken from the nasion to the tragus, nasion to angle of mandible, |
11,486 | 148,383 | primary airway control. Alternatives in case of failure to negotiate the growth were also kept in mind. Therefore, a set of graduated rigid bronchoscopes with the presence of an experienced otorhinolaryngologist was ensured until the primary control of airway was attained.\nStandard noninvasive monitoring was done using anesthesia monitor (S/5™ critical care monitor, Datex Ohmeda, Helsinki, Finland). An arterial cannula was placed in the left radial artery for invasive blood pressure monitoring and arterial gas analysis. Awake fiberoptic intubation was done after topical anesthesia of the upper airway in a position in which patient reported least discomfort that is, 30° head up and slight right up tilt. | Under fiberoptic guidance, a 5.5 mm ID MLS tube was placed distal to the growth but proximal to carina. After confirming the placement through fiberoptic bronchoscope (FOB), the patient was anesthetized and paralyzed with injection propofol 2 mg/kg, fentanyl 2 μg/kg and vecuronium 0.1 mg/kg. Prior to the positioning, patient started desaturating |
28,050 | 174,254 | to IgA nephropathy, who underwent a living related kidney transplantation in 1995, presented to our hospital with generalized malaise, dyspnea on exertion, and cough which started 6 months prior. Her other past medical history included type 2 diabetes mellitus and chronic kidney allograft dysfunction due to recurrent IgA nephropathy. Immunosuppressive regimen included cyclosporine 100 mg every 12 hours, azathioprine 50 mg daily, and prednisone 5 mg daily. On arrival to the hospital, the patient was hypotensive with a blood pressure of 75/48 mmHg and febrile with a temperature of 100.6 F. Norepinephrine drip and broad-spectrum antibiotics were initiated, although a source of infection was not obvious at | that time. Laboratory testing was notable for anemia, thrombocytopenia, and elevated lactate dehydrogenase (LDH) and C-reactive protein (CRP). CMV viral load was positive with a titer of 3.6 log10 IU/ml and valganciclovir therapy was initiated as a result. Morning cortisol level was substantially suppressed at 0.6mcg/dL, and, due to concern for |
37,961 | 128,371 | dilated inferior alveolar canal on left side, which cannot be traced anteriorly was also noticed [].\nUltrasonography of face and neck was done using 12-MHz transducer which revealed the increased vascularity in the course of left facial artery anterior to left masseter in color flow Doppler imaging []. Increased vascularity also was noticed over the vessels of left submandibular gland [].\nContrast-enhanced CT of mandible revealed large expansile lesion on left body of the mandible with brilliant | enhancement after intravenous contrast and minimal rarefaction of lingual and labial cortex with very rich vascularity. Prominent serpiginous nidus of vessels seen at left half of mandible and adjacent subcutaneous compartment supplied through branches of external carotid arteries such as lingual, facial, and superficial temporal arteries representing AVM of the left mandible [].\nUnder local anesthesia through left femoral arterial approach, left external carotid angiogram was done, which revealed evidence of AVM in the left side mandible with feeding arteries from branches of left external carotid |
29,574 | 86,149 | involvement of a new group of lymph nodes on the other side of the diaphragm (left inguinal) without development of B symptoms. This was a rare presentation which raised the suspicion of the oncologist, prompting a second excisional biopsy. Specific to this case of Hodgkin’s lymphoma with synchronous rhabdomyosarcoma (alveolar type), overlapping treatment is available, thus making treatment options less cumbersome. Margin negative (R0) resection is the goal for the rhabdomyosarcoma. Given its aggressive histology and the possibility of incomplete resection, chemoradiation will likely be pursued. The CHOP induction chemotherapeutic regimen for Hodgkin’s lymphoma has some degree of overlap with the VAC protocol for rhabdomyosarcoma (vincristine being | dactinomycin, and cyclophosphamide (VAC) protocol with the addition of radiation therapy [].\nSpecifically relevant to this case, our patient initially presented with two groups of enlarged lymph nodes on the same side of the diaphragm and did not present with B symptoms. He subsequently developed |
36,285 | 87,300 | basilar trunk be occluded by coils, if not, a superficial temporal artery to PCA bypass surgery is needed preceding BA occlusion.\nThe procedure was performed under general anesthesia. The patent portion of aneurysm is 39.7*20.8 mm (Fig. –). First, an attempt was made to catheterize the distal BA and left PCAs with a microcatheter (Headway 17, MicroVention, Inc. 75 Columbia, Ste A. Aliso Viejo, California 92656, USA) through the aneurysm, but this proved impossible because of the volume of the aneurysm and the pulsations in the sac. Therefore, bilateral carotid compression test was performed separately. A retrograde filling of | the left posterior communicating artery (PCoA) and internal carotid artery was seen on the vertebral artery (VA) injection and left carotid compression, proving the functionality of the circulus of Willis on the left (Fig. –). Then, we decided to partially embolize the patent portion of aneurysm and occlude the BA above both anterior inferior cerebellar arteries. Assistance with temporal occlusion of the proximal BA by Hyperform 7*7 mm balloon (ev3 Inc. 9600 54th Avenue N.Plymouth, MN |
39,794 | 206,178 | timely and was said to be taking a nutritionally adequate diet. As per the parents, all his vaccinations were complete and the past medical history was clear.\nOn general examination, the patient was well oriented in time, place, and person with his vitals, height, | and weight all within the normal ranges. Regarding system-wise examination, the central nervous system examination showed no signs of wasting or abnormal tone |
32,153 | 63,074 | outside hospital for complaints of a lump in her right breast of three months duration. She also had severe bone pains and numbness in her chin, since the last one month. She was diagnosed to have metastatic breast cancer. Biopsy was suggestive of high grade infiltrating duct carcinoma which was further characterised as being estrogen, progesterone receptor positive and | Her 2 neu 3+ by immunohistochemistry. Contrast Enhanced Computerised Tomography scans (CECT scans) of the chest and abdomen and Magnetic Resonance Imaging (MRI) of the brain, head and neck region revealed multiple lung, liver and bone metastases including the right acromion as well as parameningeal and right mandibular bony infiltration |
6,856 | 29,852 | with dyspnea underwent computed tomography (CT) angiography to rule out pulmonary embolism in October 2017. There was only arterial hypertension, bilateral hip arthroplasty, and laparoscopically assisted cholecystectomy in the patient’s history. A mass on the right adrenal gland was incidentally detected on the CT scan. With this finding, the patient was referred to a urological department in a tertiary medical center. A lesion of the right adrenal gland was confirmed on the subsequent abdominal CT, and in addition, another incidental lesion was found on the right kidney. A tumor on the lower pole of the right kidney measured 45 × 38 × 34 mm, with significant heterogeneous enhancement; it was interpreted | as a suspected renal cell carcinoma (). The mass on the right adrenal gland had dimensions of 41 × 38 × 24 mm (); its attenuation was 41 Hounsfield units (HU) in the unenhanced phase, 71 HU in the venous phase, and 64 HU in |
22,258 | 18,800 | host as human immunodeficiency virus (HIV) screen and viral load were negative, and the immunoglobulin and T-lymphocyte counts were within normal limits. Bacterial cultures remained negative, and all antibiotics were subsequently discontinued.\nThe patient underwent daily dressing changes, as per the orthopedic team, and had reaccumulation of the abscess twice, requiring drainage each time. He was discharged on IV amphotericin B for a total of four weeks and was counseled on smoking cessation. All other cultures and infectious workup, including HIV and hepatitis C, remained negative. The patient was able to ambulate and physical therapy was ordered on an | ongoing basis upon discharge.\nAfter discharge, the patient continued to recover well, receiving daily IV amphotericin B infusions. His treatment was complicated by low potassium and magnesium levels, getting as low as 2.1 mmol/L (normal: 3.5 - 5.0 mmol/L) and 1.2 mmol/L (normal: 0.62 - 0.99 mmol/L), respectively, and the patient was started on daily supplementation.\nThe patient |
12,384 | 143,051 | the meta-diaphysis of the left femur (). A provisional diagnosis of osteogenic sarcoma was made based on the radiograph and CT scan findings.\nA magnetic resonance imaging (MRI) examination of the thigh was performed to evaluate the local disease. MRI revealed altered marrow signal intensity in the proximal meta-diaphysis of the left femur with a circumferential soft tissue mass. Hypointensity was seen in the radial distribution on gradient echo sequences, corroborating the "sunburst" calcification noted on the radiograph and CT | of the left femur with spiculated periosteal reaction (). The patient underwent a computed tomography (CT) study of the pelvis and the proximal lower limbs, which showed a lytic lesion with a circumferential spiculated sunburst type of periosteal reaction and an ill-defined associated vascular soft tissue component in the proximal third of |
43,682 | 136,037 | erythrocytes from A1, A2, B, and O blood groups. Reaction with anti-H lectin was negative. The blood group was finally interpreted as the Bombay blood group with naturally occurring anti-H antibodies in the plasma ().\nThe molecular basis of LAD II was demonstrated to be the deficient expression of the CD15 adhesion molecules on the surface of the leukocytes. The expression of LFA-1 (CD11a/CD18), Mac-1 (CD11b/CD18), and p150/95 (CD11c/CD18) was not absent (). CD18 expression could not be determined due to the lack of a CD18 kit.\nBecause the patient’s haemoglobin level was not low enough for erythrocyte transfusion, we started iron therapy. The patient’s haemoglobin level then elevated, so | reverse grouping on the tube revealed the blood group to be O Rh D positive. It was found to be incompatible with a strength of 4+ agglutination in all cross-matches using reverse analysis conducted with |
6,102 | 23,140 | after the initial visit to our hospital, the patient provided written informed consent for surgery and for the publication of her anonymized images in this case report.\nTo eliminate the deformity and to achieve painless functional recovery of the wrist, the patient underwent opening wedge osteotomy of the distal radius with an iliac bone graft followed by distal ulnar shortening osteotomy. Briefly, the patient was placed in the supine position with | variance of the affected wrist vs the contralateral wrist were 10° vs 28°, 35° vs 12°, and +12 mm vs 0 mm, respectively. Three-dimensional computed tomography revealed volar angulation of the distal radius, dorsal protrusion of the distal ulna and radius, and a radioulnar length discrepancy (Fig. A–D). Six months |
36,790 | 203,678 | in a construction field. Physical examination revealed a male patient with a body mass index in the normal range and an acutely ill looking appearance. His right lower leg and ankle were swollen and bruised, and he had a 2 cm laceration wound on the plantar aspect of his right foot. The patient's right ankle had limited range of motion due to pain. The patient had tenderness at the right anterolateral aspect of the mid lower leg and anterior aspect of the ankle. There was grade 1 anterolateral instability of the left ankle. The neurologic examination | was normal. Based on the patient's clinical history and physical examination, the orthopedic surgeon suspected a fracture of the right fibular diaphysis and ligament injury of the right anterolateral ankle.\nInitial radiographs of the ankle in the anteroposterior and lateral views showed fractures at the diaphysis at the fibula and anterior lip of the tibial plafond (Fig. ). The patient was not |
41,502 | 25,679 | mood (see Fig. ). AA scored 23 on the []. Such a score implied the presence of moderate depressive symptoms.\nOlanzapine (5 mg)—an antipsychotic—was instituted once every day to which she was deemed to be compliant. The clinical team noted that the severity of her distress significantly receded but still manifested in episodes of screaming and lability and, as often the case, dissipated upon the start of menstrual bleeding. As the symptoms | the second half of her menstrual cycle. Overall, she expressed foggy awareness of her recurring distress.\nPhysical examination was unremarkable and her medical workup—hormonal study, brain computerized tomography (CT) scan, and electroencephalogram (EEG)—was inconclusive. She was also subjected to neuropsychological testing and evaluation of |
2,490 | 44,911 | of PDB were identified (Figures and ).\nPostoperatively, the patient did extremely well with complete resolution of her symptoms. Given the pathologic diagnosis, she was referred to a rheumatologist for further evaluation for PDB. A whole-body bone scan with (single-photon emission computed tomography) SPECT demonstrated abnormal bony uptake in the left frontal bone in keeping with postsurgical changes (). An alkaline phosphatase level was drawn and it was within normal limits. The staff rheumatologist's impression was monostotic | PDB of the skull inactive and no additional therapy was indicated. The patient is now 8 months postoperatively and |
3,420 | 108,293 | stage of the operation was performed 14 days later for definitive closure of the surgical wound. The interval between the stages of surgery provided adequate time to assess the viability of the SA flap and the sufficiency of space obliteration, as well as to confirm a negative microbiology report to ensure that there would be no local recurrence of infection. Here, a pedicled vertical rectus abdominis myocutaneous (VRAM) flap was utilized to fill in | the right anterior chest wall soft tissue and skin defect from the first exploratory thoracotomy |
36,884 | 166,627 | rectum. There was no pelvic lymphadenopathy. A transrectal biopsy of the mass was performed which was reviewed at several different institutions, though it was considered indeterminate. A second transrectal biopsy of the periprostatic/seminal vesicle soft tissue mass was performed, which was reviewed at our institution and found to be a grade 4 (of 4) epithelioid angiosarcoma. Immunohistochemical stains showed the tumor cells reacted strongly and diffusely with antibodies to CD31 and vimentin, but did not react to antibodies to keratin (Cam 5.2, 7, 20 and wide spectrum), prostate specific antigen, actin, desmin, melanin A, S-100, CD117 (C-kit), synaptophysin, and chromogranin, supporting the diagnosis.\nThe patient | was referred to our institution for further evaluation and management. Digital rectal examination revealed a normal anal sphincter tone and a large, firm, fixed mass in the left lateral |
10,329 | 123,379 | or substance-use disorders. She belongs to the low socioeconomic status, with a family history of mental illness in the first- and second-degree relatives, suggestive of a depressive disorder.\nOn mental status examination, she was adequately groomed with normal psychomotor activity. Her talk was increased in tone, tempo, and content, but there were no formal thought disorders. Her mood was euphoric and there were no ideas of guilt, depressive ideas/death wishes, or psychotic symptoms. Her abstract ability was impaired, and her insight was grade 2.\nHer physical examination and vital signs revealed no abnormalities. Laboratory investigations on the day of admission including hemoglobin, total and differential count, platelet count, serum | episode being 10 years back. She is off medication for the past 7 years as per her previous therapist's advice following absence of any psychiatric symptoms for 2 years after treatment of the second episode. She presented with symptoms of elevated mood, increased talk, overfamiliarity, and decreased need for sleep for 5 days following a financial stressor. There was no history of aggression or psychotic symptoms and the symptoms did not affect her work or conflicted with her family members or colleagues. There is no history of any medical illness, use of other medications, |
36,183 | 29,333 | underwent a clinical and radiographic follow-up evaluation, which showed an implant with good grip and a reduction of the fracture abutments. The patient underwent new clinical and radiographic checks two months and three months after his surgery (). The multi-fragmentation of the fracture still showed no stable consolidation during these controls, with poor presence of bone callus; conversion to intra-medullary nailing had been planned at soft tissue healing.\nThree months after surgical treatment, the patient suffered a new motorcycle accident in which he reported the refracture and decomposition of the anatomical axis and the abutments, deformity of the anatomical profile, and damage to the soft tissues and external fixation system ().\nA new surgical treatment was performed. | The external fixator was removed, the fracture abutments were reduced, and a long cast with a trans-calcaneal traction was performed. The cast was anteriorly open because the tibial fracture focus was prominent at the level of the soft tissue, encompassing the trans-calcaneal traction bracket |
28,603 | 181,098 | difficulty clearing secretion, and she had an intact gag reflex. Extraocular movements were intact with no ptosis, and pupils were reactive to light. The patient’s tongue projected midline, and speech was at baseline per parents. There was no lymphadenopathy in the head or neck. The patient’s lungs were clear. The remainder of the exam was notable only for diffuse symmetrical muscle spasticity in the upper and lower extremities. A chest radiograph showed no consolidation or evidence of foreign body.\nAfter careful clarification of the time course of the patient’s gagging episodes, it was suggested to the patient and her parents that she might have been having | 71 beats per minute, a blood pressure of 115/78 millimeters of mercury, a respiratory rate of 14 breaths per minute, and an oxygen saturation of 100% on room air. The oropharynx was clear. Oral mucosa was moist without any obvious lesions. There was no drooling or |
43,493 | 36,838 | Global Impression - Severity and Improvement scales (CGI-S and CGI- I) are clinician-rated instruments to assess the baseline severity and improvement in a psychiatric disorder []. Presence of depression was assessed with the Hospital Anxiety Depression Rating Scale - Depression subscale (HADS-D) [].\nOur patient was initially started on fluoxetine 20 mg/day (gradually increasing the dose up to 80 mg/day by week eight), clonazepam 0.5 mg/day (tapered off by week three) and continuous cognitive behavior therapy (CBT). By week eight, despite the reasonably adequate dose and treatment duration, there | was minimal improvement in hair-pulling behavior. Hence, at week eight, bupropion sustained release (bupropion-SR) was initiated at 150 mg/day, and increased to 300 mg/day at week 10. Fluoxetine was tapered off by week 11. By week |
22,495 | 35,058 | abduction separately. However, 45° of this combined motion was predicted to lead to impingement (see Figure ). Internal rotation at 90° of flexion was limited to 15°, compared to 35° (±12°) in healthy hip joints as found by Tannast et al. [].\nWe agreed upon a second arthroscopy of the affected hip. During this procedure, the remaining osseous rim on the femoral head was shaved off. At six months after this procedure, our patient is almost pain free and has regained a pain-free functional ROM. His limp has | order to gain insight in the kinematics of the joint. Using Articulis (Clinical Graphics, Delft, The Netherlands), a system for the simulation of bone-determined ROM, the CT scan of the hip joint was analyzed. Articulis uses a collision detection algorithm and a kinematic model to describe the ROM of spherical joints such as the hip joint [].\nAccording to the simulations the risk of impingement was small in flexion and |
40,562 | 13,445 | of calcification and frequent formation of concentric lamellae (Fig. c, d). Eosinophilic and amorphous deposits were present but negative for Congo red stain. The tumor was well-circumscribed with pushing borders and showed evidence of focal involvement of the gingival mucosa (Fig. e). An odontogenic cyst lined by ciliated columnar epithelium with stratified squamous epithelial component was seen near the developing third molar tooth consistent with a dentigerous cyts (Fig. f, g). Immunohistochemical stains for cytokeratins (AE1/AE3 and Cam 5.2) were used to confirm the epithelial origin of the tumor (picture not shown). The diagnosis of CEOT with extraosseous soft tissue involvement was made. All surgical margins were negative. The patient was followed up for | and prominent nucleoli and abundant eosinophilic cytoplasm (Fig. c, d). Malignant features including nuclear pleomorphism, increased mitoses, necrosis and desmoplastic tissue reaction were not identified. The stroma was myxoid or mucinous with islands |
32,595 | 118,344 | a perforation in the central portion of the resected appendix and a thick scar obstructing the appendiceal orifice that did not allow the passage of a probe (Fig. ). Microscopic examination revealed no residual tumor and identified a broad band of fibrotic tissue adjacent to the appendiceal orifice consistent with a scar | and swelling, an intraluminal fecal calculus, and fluffing of the surrounding fat tissue. The patient was diagnosed with acute appendicitis and underwent emergency surgery. Because the surgeon suspected that her appendicitis was associated with residual tumor, the patient underwent a laparoscopic cecectomy. Intraoperatively, the appendix was firmly adherent to the terminal ileum and retroperitoneum, and the root of the appendix was intussuscepted into the cecal lumen.\nMacroscopic examination of the resected specimen revealed |
21,177 | 15,197 | agents (NSAIDs). Therefore, a close follow-up was suggested.\nIn February 2018, 3 months after the lung biopsy, the patient complained about cough and lumbago. The chest CT manifested that the mass in the right middle lobe of the lung enlarged to 6.2 cm × 3.8 cm (Fig. A), and new diffused nodules appeared. At the same time, thoracic vertebra metastasis was also indicated by the chest CT (Fig. C). Then multiple bone metastases were proved by an emission | CT for bones. An intra-abdominal mass near porta hepatis that indicated metastasis was showed in further the abdominal CT and MRI (Fig. C). So the nature of the tumor was suspectable. Subsequently, the re-biopsy of the lesion in the right lung was conducted, and the pathological result was totally consistent to the previous |
13,778 | 123,461 | warm and painful, and there was evidence of necrosis and ulceration of two of the mammary glands (). The testes were symmetrical and appeared normal, and moved freely into the scrotum. No additional checks had been performed during previous veterinary visits.\nOwing to the extent and severity of injuries, mammary neoplasia was also considered when making the differential diagnosis, as reported in the classification of the main mammary masses in cats.\nThe acute mastitis could be a secondary pathology of a form of mammary hyperplasia, considering that these diseases can occur | simultaneously. Although rare in feline species, adrenal and hormone-secreting testicular tumours must be considered in the differential diagnosis, as well as the possible presence of functional ovarian tissue in the abdominal cavity.\nGeneral screening of the patient involved a |
30,810 | 5,500 | any of the previous therapies suggested the possibility of Melkersson–Rosenthal syndrome []. Thus, the patient was referred to the Dental Clinic, where a mucosal biopsy of the affected lower lip was performed (Fig. ). Histopathological examination showed non caseating granulomas (Miescher’s cheilitis), consistent with a diagnosis of MRS. The two aggregates of non-caseating granulomatous inflammation consisted of lymphocytes and epithelioid histiocytes, and few multinucleated giant cells, clustered around scattered vessels (Fig. ). Special staining for identification of fungal microorganisms and acid-fast bacteria were negative. No foreign material could be detected even at polarization. One month of oral steroid (prednisone, 25 mg qd, gradually tapered to | found along with antiphospholipid antibodies (lupus anticoagulants; anti-cardiolipin, anti-β2-glycoprotein IgM), possibly related to complement consumption [].\nAs ultrasound scan detected only a subcutaneous, hypoechogenic thickening of the inferior lip and we did not find any further clinical or laboratory sign of systemic inflammation, recurrent swelling was interpreted as a form of idiopathic angioedema and treated with tranexamic acid after a thrombophilia screen testing negative for further risk factors [, ]. Both this antifibrinolytic drug and a following, therapeutic course with the leukotriene receptor antagonist montelukast [] failed to solve the edema. Finally, clinical picture, blood analyses, and lack of response to |
37,036 | 72,540 | and orbit with contrast study showed an asymmetrical deformity of the skull and left cerebral hemisphere which was bulging towards the left orbit, causing extrinsic pressure resulting in proptosis of the eyeball (Figure ). It also showed widened cortical sulci due to decreased volume. There was indirect evidence of widening of left lateral ventricle and Sylvian fissure due to hemi-atrophic changes. Contrast studies did not elucidate any abnormal enhancement. Right orbit, right | hemisphere, brainstem, and cerebellum appeared normal. There was no evidence of demyelination or any intracranial mass. The affected orbit was larger and downwards than normal. There was an absence of floor and roof of the left orbit.\nWith this information, a working diagnosis of orbital meningoencephalocele was made and a maxillofacial consult was taken. The patient and her family were counseled regarding the condition |
34,276 | 157,422 | the patient's vital signs were stable and there was no evidence of acute retroperitoneal hemorrhage. We decided to perform an open surgical repair of the recurrent aortic aneurysm based on the relatively young age of the patient and the uncertain aortic pathology due to his underlying NF-1. We removed the aortic and iliac stent grafts and reconstructed the aorta using a Dacron graft (Boston Scientific Inc., Natick, MA, USA). Intra-operatively, | easy bleeding from the retroperitoneal periaortic tissue due to increased vascularity was observed. A 2 × 3 cm pseudoaneurysm was identified at the anterolateral aspect of the terminal abdominal aorta at the level of aortic bifurcation.\nOn histologic examination (), the |
25,932 | 19,118 | with complaint of a narrowing in the caliber of the stool without obvious cause for about 1 year. Otherwise, he had no history of asbestos exposure, hematochezia, diarrhea, constipation, abdominal pain and distention. He had a history of prostatectomy due to benign prostatic hyperplasia and he denied recent weight loss. Digital examination of rectum showed the lower boundary of a mass in the rectum was 2 cm from the anal margin, and the upper boundary could not be palpated. Therefore, the patient underwent colonoscopy | endoscopic electrocoagulation resection.\nA soft tissue shadow was occasionally found by pelvis CT examination in the right pelvic wall. The mass had well-defined boundary and was oval shape with size of 7.3 × 5.3 cm. No calcification was found within the mass. On unenhanced CT images, the mass was heterogeneous with suspected |
29,502 | 57,146 | ). Given encouraging signs of radioiodine uptake, she underwent 131I treatment with 216 mCi in late December 2020. The post-therapy scan showed radioiodine uptake within the left level 2 cervical lymph node, left paratracheal soft tissue, as well as a now-demonstrated 7 mm left lower lobe nodule (Figure ). Dabrafenib and trametinib were held | dabrafenib/trametinib therapy. The pre-therapy scan showed radioiodine uptake in a left level-2 cervical lymph node and a soft tissue nodule in the left lower neck (Figure |
6,041 | 160,991 | to our department with the complaint of pain and swelling in the left mandibular region since two years. During systemic history, patient revealed low back pain, hypertension and diabetic mellitus Type 2 since 10-11 years. She underwent surgery of the maxillary sinus region which as per her previous records was treated with FESS (functional endoscopic sinus surgery), left conchaplasty with widening of maxillary sinus. The biopsied tissue of the ophthalmic and maxillary region showed inflammatory cells and was not suggestive of any malignancy. During course of time patient underwent root canal treatments of mandibular molars, premolars and incisors for her dental pain. However, the pain did | not subside and patient referred to our department. On examination pain was mild, dull, and localized in nature. The family history of the patient was not contributory. Physical examination showed facial asymmetry attributable to diffuse swelling of the left mandibular region. Mouth opening and sensation over the distribution of the left inferior alveolar nerve was |
21,687 | 108,435 | in his problem solving capacity and frustration tolerance. There was also a history of low mood, loss of confidence, unable to enjoy even positive events, preoccupation with his illness, and apprehensiveness about another breakthrough seizure. The patient denied any substance use on regular basis though he occasionally consumed alcohol on social occasions. There was no past or family history of any psychiatric or any other physical disorder.\nOn physical examination, vitals were stable. | know next morning due to the pain. Once he had also bitten his wife's hand at night. He reported having irresistible urge to bite his body whenever under stress. Whenever he was under stress he could not control himself. On seeing blood from the skin, he would get relaxed a little bit giving rise to tension relief cycle. There is no intent of dying during any of these times. He had problems in domestic sphere due to his symptoms. He reported decrease |
1,254 | 90,188 | presented to the maxillofacial department at a district general hospital with a 6-week history of difficulty in swallowing solids together with pain in his pharynx.\nOn examination, he was noted to have a 3 × 2 cm solitary pedunculated lesion on the right side of the anterior two-thirds of his tongue crossing the midline. His tongue mobility was normal and there was no palpable cervical lymphadenopathy.\nSystematic examination of chest, abdomen and heart were normal. The lesion was biopsied and initially reported as a primary squamous cell carcinoma with some clear cell changes. His blood tests including renal functions were normal. His case was discussed in the head and | neck cancer multidisciplinary team (MDT) meeting and subtotal glossectomy was planned after a staging MRI (magnetic resonant imaging) scan followed by adjuvant radiotherapy to the head and neck region. While awaiting an MRI, he presented to the hospital with severe pain in his oral cavity and difficulty in swallowing. His tongue lesion had doubled in size in a matter of two weeks and was now protruding outside the mouth (Figure ). It was considered unusual for primary squamous cell carcinoma of tongue to behave like that. The pathology |
10,408 | 88,524 | (Prempak-C).\nApproximately 48 hours after the overdose, on examination of her eyes, she was found to have left subhyaloid and retinal hemorrhages. After 72 hours, the visual acuity in the right eye was 6/9 and hand movements in the left eye. The intraocular pressures were reasonably controlled and she had bilateral Yag laser iridotomies. Subsequently, she was discharged to the local psychiatric unit as she continued to express suicidal thoughts and was low in mood. Apart | from receiving treatment for her eye problems at the general hospital, she was commenced on a reducing regime of chlordiazepoxide for her alcohol dependence. On discharge from the general hospital, she was advised to continue on Timolol, pilocarpine and dexamethasone eye drops for further 14 days.\nShe remained free of anti-depressants and her mood improved gradually in the absence of alcohol. After 14 days, her visual acuity was noted to be 6/18 |
37,742 | 15,173 | probe.\nSuction Procedure: In this phase, the alternate compression and release of the syringe plunger have been applied so that the physiological solution was injected and resuctioned inside it. This impulse was applied until the calcific amorphous material was completely aspirated inside the syringe, which will result in a modification of the color of the physiological solution due to the presence of calcium fragments. Such process may be repeated with different syringes, but | without removing the needle from inside the joint, until the calcific content is totally expelled.\nTreatment with cortisone: Without |
30,543 | 100,263 | statutory health insurance refused to reimburse the cost of PBT, the patient deliberately declined a concurrent chemotherapy, in order to demonstrate afterwards that he was exclusively cured by PBT alone.\nOutcome and follow-up: Generally, the patient tolerated PBT well and drove 300 km daily between our center and his home. At the beginning of the treatment, he complained of intumescence of the nose, with boring pain in the evening, that was mitigated by anti-edematous medication (dexamethasone 8-16 mg per day) and analgesics. In the further course, he developed increasing radiation dermatitis with superinfection in the middle face, | both eyeballs was reduced because of incipient tumor shrinkage, noticed by weekly-performed low-dose CT scans, as well as for the purpose of better eye sparing (Figure ). Since the |
6,155 | 154,222 | to the operation. With the patient in the prone position, the T9/10 interspace was checked under C-arm guidance and the puncture point was marked at the center line. After the skin around the puncture point was disinfected with a betadine solution, we carried out local anesthesia with 1% mepivacaine 3 ml and used an 18-gauge Tuohy needle to make the initial puncture. Applying the loss of resistance technique via imaging and normal saline, the epidural space was verified. After checking that there was | and a dorsal spine epidural block was performed after obtaining her consent |
32,969 | 131,276 | with minimal pleomorphism, cytoplasmic pigmentation and a low mitotic index (<1/50 high power fields). Immunohistochemistry showed that the tumour was strongly positive for HMB-45, weakly positive for Melan-A, and negative for S100. The differential diagnosis of the cervical punch biopsies based on the cytological and immunohistochemical characteristics was between primary or secondary cervical melanoma and cervical PEComa. However, the low degree of pleomorphism and the low mitotic count favoured PEComa over melanoma (Fig. ). The endometrial tissue specimen was negative for any endometrial pathology.\nOn ultrasound scanning of the cervix, a 3.4 × 2.1 cm2 hypoechoic mass was | noted in the proximal endocervical region with some internal colour flow Doppler signals. The MRI imaging of the pelvis showed a 3 cm endocervical mass with an intermediate signal intensity. PET-CT scan imaging of the pelvis demonstrated a 4.5 |
31,184 | 173,410 | His symptoms became exacerbated, and he required intensive therapies including high-dose steroid and catecholamine administration.\nDespite the continuous therapeutic support mentioned above, he abruptly developed hypotension following diarrhea, fever, and abdominal distension on day 41 after admission. Metabolic acidosis (pH 7.34, base excess − 7.0 mmol/L) was confirmed by blood gas analysis, and highly elevated CPK 11800 U/L, AST 461 U/L, ALT 201 U/L, and LDH 1034 U/L values were revealed by a blood chemistry | and indistinct consciousness. He was diagnosed with limbic encephalitis, which is an autoimmune disorder characterized by inflammation of the limbic area in the brain. |
20,152 | 134,178 | obviously enlarged and that the myocardial radioactivity was not uniform in each wall of the left ventricle, but there was no obvious radiation reduction or defect area. Because the patient had no surgical contraindications, corrective surgery of ALCAPA was performed. An autologous pericardial patch was used to implant the coronary artery into the aorta. During this procedure, mechanical aortic valve replacement, mitral valve plasty, and tricuspid valve plasty were also performed. The results of transesophageal echocardiography were normal after cardiac rebeating. Echocardiography after this operation showed that the inner diameter | with no obvious stenosis and adequate provision of collateral circulation to the LCA, and origination of the LCA from the PA; pulmonary angiography did not show the LCA (). The PA pressure was 77/31 mmHg, and the mean PA pressure was 46 mmHg.\nThe patient later sought surgical treatment at Fuwai Hospital (National Center of Cardiovascular Disease of China). Before surgery, myocardial perfusion imaging was performed to assess the myocardial viability. This examination showed that the left ventricular cavity was |
27,538 | 112,034 | year prior) and nasal septal perforation repair (two months prior). After septoplasty, she had recurrent epistaxis episodes for six months which were treated with nasal packings when needed. She eventually had a nasal septal perforation and was referred to another tertiary care hospital by her primary surgeon. There she underwent her second surgery under general anesthesia which involved septal perforation repairment. After this | surgery she started having epistaxis episodes which were treated with cauterization and nasal packing.\nOne month following the septal perforation repairment surgery, the patient suffered her first episode of subcutaneous emphysema on her left arm, chest, and neck. The chest computed tomography (CT) revealed pneumothorax and subcutaneous emphysema. The pneumothorax was treated with chest tube insertion. The patient underwent an endoscopic examination of head and neck, as well as bronchoscopy to discover the etiology of pneumothorax and |
14,474 | 142,991 | was irregular, and there was a subchondral cyst seen in the medial aspect. The lesion was reported as an osteochondroma of the right mandibular condyle associated with remodeling deformities and degenerative change in the right temporomandibular joint. The patient was planned for a condylectomy to resect the lesion and correct the right mandibular ramus height and simultaneous orthognathic surgery to resolve the other asymmetry problems. In this case, a 3D stereolithographic model was printed using the Z Printer 450 system. The surgery was simulated on the model to achieve the optimal treatment plan for the patient.\nThe patient was operated | the right and crossbite on the left side.\nComputed tomography showed an expansion of the right mandibular condyle, and there was an abnormal bird beak like tapering in the anterior aspect due to the lesion. The articular surface of the right condyle |
3,978 | 52,489 | the following weeks, there was modest clinical improvement of the surgical site wound. The patient’s renal function returned to baseline with complete resolution 17 days post-discontinuation of colistin therapy. The patient reported no drug-related effects or infusion site reactions and weekly monitoring of bloods showed no untoward effects. Thirteen days after initiation of cefiderocol, the renal function had sufficiently improved to allow the dose of cefiderocol to be increased to 2 g/q8h. Cefiderocol and ciprofloxacin were both discontinued after completing | 28 days of treatment, 60 days after he was initially admitted to hospital, and he was discharged home once medically stable.\nHe was reviewed in an outpatient clinic 3 months later and there was no evidence of persistence or relapse of infection. The patient reported significant improvement in pain and swelling following the surgery and completion of antibiotic therapy. The post treatment X-ray showed improved bony remodelling over the tibia and fibula with good bony alignment and no adverse features. Physiotherapy |
34,937 | 77,183 | nitinol self-expanding stents. The procedure was complicated by diplopia caused by occipital infarction, despite intraoperative heparinisation and immediate postoperative readministration of anticoagulant therapy (coumarin and clopidogrel). Postoperative serum creatinine remained unchanged. Three weeks after surgery, clopidogrel was discontinued because of side effects. Follow-up CT-angiography 6 weeks after discharge showed adequate position of the aortic branch graft (), patency of the visceral side branches, and target vessels without kinking of the (covered) stents. However, a mass in the left mamma was found. Additional diagnostic tests showed an invasive ductal carcinoma. Subsequently the patient was planned for mastectomy with sentinel node procedure. | was performed with an aortic branch graft including side branches for the celiac trunk, superior mesenteric artery (SMA), and the right renal artery. Covered stents were placed through the side branches in the target vessels and these were relined with |
23,801 | 34,578 | packing of the petrous portion of the temporal bone was performed. As a precaution, we had exposed and slinged the ICA at the level of the CCA bifurcation to allow for possible ICA occlusion in the neck, should the packing | down parts of the orbital apex and sphenoid wing around the metal fragment, which reached the floor of the middle cranial fossa, it was possible to mobilize and retrieve the entire foreign body in one single piece via the transorbital route[] []. Simultaneous |
27,618 | 160,722 | the popliteal fossa was found on magnetic resonance imaging (MRI) to have a thrombus-containing popliteal aneurysm. The patient had history of coronary artery disease for which percutaneous coronary intervention with single bare metal stent placement was done. Patient also suffered from hypertension, obstructive sleep apnea, paroxysmal atrial fibrillation, and a small infrarenal abdominal aortic aneurysm. Angiography demonstrated complete occlusion of the right popliteal artery caused by the aneurysm. Review of a recent 2D transthoracic echocardiography revealed normal left ventricular wall motion with ejection fraction (EF) of 55% and mild mitral regurgitation. He had completed a one-month course of | clopidogrel therapy following bare metal coronary artery stent placement and was currently on aspirin 325 mg daily, which he discontinued 72 hours prior to surgery. Pre-operative laboratory tests were unremarkable including a hematocrit of 41%, platelet count of |
13,144 | 128,852 | tests showed normal white blood cells count of 10.6 × 109/L (normal range: 4.5 to 11.0 × 109/L), Alkaline phosphatase (ALP), Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and bilirubin levels with a mild increase in γ-glutamyl transpeptidase (147 IU/L). Upper abdominal ultrasound revealed a fatty liver and 2 gallstones measuring 8mm in diameter in the dependent portion of the gallbladder with acoustic shadowing and normal wall thickness (4 mm). No distension of the gallbladder was seen. Because of the patient’s morbid obesity there was a sonographic suggestion of early acute cholecystitis. Since he showed no clinical symptoms of acute | no palpable mass. summarizes the time line of the case, interventions given, and the progress of procedure conducted on the patient.\nLaboratory |
22,432 | 119,966 | (0.625% for 5 min) patch of autologous pericardium was then used to reconstruct the anterior wall of the neo RPA. This created a wide stoma of the RPA from the main pulmonary artery. The transected aorta was reanastomosed. The perfusate was rewarmed and the child was weaned off CPB uneventfully. CPB and aortic cross clamp (ACC) times were 280 and 180 min respectively. The antegrade cerebral perfusion time was similar to the CPB time since the cannula in the innominate artery was used for arterial perfusion for the entire duration of the procedure. Irradiated blood was not used despite the child having proven DiGeorge syndrome due to restrictions in blood | RPA using 7 0’ polypropylene, thereby creating the posterior wall of the neo RPA. The anterior wall of the distal RPA was then incised longitudinally into the hilar portion to gain the widest caliber. A previously harvested and glutaraldehyde-treated |
43,030 | 150,850 | pulsus paradoxus. Routine blood investigations were normal. Abdominal ultrasound showed free fluid, hepatomegaly, single left sided spleen, and no other abnormality. Her chest X-ray [] showed cardiomegaly and pulmonary venous hypertension. Electrocardiography showed ectopic atrial rhythm, first-degree atrioventricular block, and poor R wave progression but was unchanged from the previous recording.\nEchocardiography showed features of congestion such as dilated inferior vena cava and lack of inspiratory collapse. There | was no pericardial effusion. Biatrial enlargement was also present. There was no significant atrioventricular valve regurgitation, and systemic ventricular function was normal. Respiratory variation in inflow velocities across the atrioventricular valves or septal bounce were |
32,784 | 148,059 | lower back pain accompanied by mild fever. Despite a lack of neurological manifestations, the patient underwent several investigations including brain computerized tomography (CT) and MRI, which surprisingly showed a mass-like lesion in the right temporal lobe with cystic and infiltrative portions that partially enhanced following intravenous (IV) gadolinium administration. Additionally, a smaller lesion was detected in the hypothalamus ( and ). Glioma was suspected based on the imaging results, and stereotactic biopsy of | the lesion was performed. Histological analyses revealed granular, foamy, periodic acid–Schiff (PAS)-positive macrophages with no signs of tumor. WD was suspected and then confirmed at a referential histopathological laboratory (Bonn, Germany) using PAS staining technique. For WD confirmation, the patient underwent a thorough gastroenterological evaluation including repeated duodenal biopsy; all biopsies were deep; histology was done with correct PAS staining and the specimens examined by experienced pathologists were found to be negative. The diagnosis of primary |
18,322 | 111,795 | and caused loss of hypoglycaemia awareness.\nGiven the deterioration in LV function in the context of a persistent atrial tachycardia and the previous cardiomyopathy during her first pregnancy, treatment to rate control the arrhythmia was mandated; however, options in this circumstance were limited by the safety profile of commonly used antiarrhythmic drugs. Ivabradine was discussed considering the higher incidence of autonomic FATs during pregnancy and the recent evidence of its efficiency in this particular subset of arrhythmias. In view of the limited available data regarding the teratogenic risk of ivabradine, this option was reviewed with the Pregnancy Heart Team and pharmacists, as well as the patient. It was felt that the benefits would outweigh the risks | and ivabradine was started at a dose of 5 mg twice daily. A three-lead 24 h Holter ECG was fitted and recording started parallel to commencing the treatment. The effect was observed ∼6 h after the first dose with a successful reduction of the average heart rate to ∼100 b.p.m. (). Ivabradine was further increased to the target dose of 7.5 mg twice |
3,512 | 35,585 | showed no distinct lesions, which was confirmed by magnetic resonance imaging (MRI). The following day, the patient regained consciousness and complained of burning pain and severe allodynia localized in her left upper limb; subsequently, there was a recurrence of other CRPS symptoms (swelling, skin temperature escalation, and paleness). Despite regular intravenous administration of phenytoin, seizures occurred several times over the following 3 days, which occasionally required additional administrations of intravenous diazepam or thiamylal, and | diminished. Additionally, her upper limb motor disturbance was significantly improved.\nOne hour after the 18th Bier block, the patient suddenly experienced a major epileptic seizure and lost consciousness during physiotherapy. This was the first time in the patient's life that a seizure episode had occurred. Intravenous administration of diazepam followed by thiamylal was used to control the seizure. An emergency CT scan of the brain |
22,391 | 18,894 | (ROM) after being fixed, the articular surface had recovered its smoothness under arthroscopy, and the PCL reattachment held tension on testing (Fig. E). A posterior draw-sign was attempted, which showed a negative result. No major perioperative complications were reported | during the study period.\nAt 1 month postoperative, the pain and claudication symptoms had completely disappeared. Flexion of the knee was approximately 110° at 1 month (Fig. A), 125° at 2 months (Fig. B), 140° |
24,442 | 72,931 | murmur was heard in the aortic area. A low-pitch murmur (grade 3/6) was heard in the right axillary region, at the intersection of the midaxillary line and the fourth and fifth intercostal space. There were no crepitations on lung auscultation. There were no clinical signs of deep venous thrombosis nor signs of right ventricular failure. The rest of the clinical examination was unremarkable. The diagnosis of pulmonary embolism was made based on an intermediate | of apnea. This murmur was not heard beyond this intersection. There was no radiation of the murmur to the back. No systolic |
37,316 | 92,673 | breath, and productive cough. Her background included heavy smoking, heavy ethanol use, and two prior hospital admissions for pneumonia and exacerbation of chronic obstructive airways disease.\nAt presentation she was febrile, delirious, and tachypneic with low oxygen saturations, relative hypotension, and new onset atrial fibrillation with a rapid ventricular response. Her chest X-ray revealed dense right upper and middle lobe consolidation. Initial treatment consisted of oxygen therapy, intravenous fluid resuscitation, noninvasive ventilation, and antibiotics (ceftriaxone and azithromycin) for her community acquired pneumonia. She reverted to sinus tachycardia after treatment with digoxin. She was prescribed benzodiazepines for apparent alcohol withdrawal agitation.\nShe | was transferred to our institution after two days in established multiorgan failure with shock, respiratory failure, coagulopathy. Invasive organ support was initiated with intubation, mechanical ventilation, vigorous fluid resuscitation, vasopressors, and inotropes. Blood and sputum cultures taken at the time of her initial presentation grew Klebsiella pneumoniae sensitive to all antibiotics except amoxicillin. |
34,991 | 93,844 | be vimentin positive, but negative for cytokeratin, desmin, CD117, Melanin, CD45, CD3 and CD20—further supporting the diagnosis of EOO (). The patient underwent bronchoscopy showing multiple endobronchial masses; biopsies were taken and again showed pleomorphic spindle cells. The patient also had a palpable lymph node in his right supraclavicular region; this was biopsied, and pathology results were consistent with EOO. A PET/CT revealed an extensive, calcified, lobulated esophageal mass () with intense FDG avidity extending from T1 to T8, approximately 16 cm in length. In addition, he had bilateral FDG-avid level VI cervical lymph nodes, | FDG-avid lymphadenopathy in the mediastinum, multiple bilateral pulmonary nodules, and calcified FDG-avid gastrohepatic lymph nodes.\nThe patient underwent placement of an esophageal stent, which helped relieve his dysphagia. Medical oncology was consulted to determine the role of systemic therapy. The patient was seen, evaluated, and scheduled to receive 4 cycles of |
36,068 | 33,339 | resistant intracytoplasmic granules were present (Figure ).\nImmunohistochemical studies ruled out mimickers (Figure ). Tumor cells were negative for Desmin, SMA, S100, CD34, Myo-D1, Myogenin, PAN CK, Synaptophysin, Chromogranin, CD56, Melan A, and HMB45. A diagnosis of primary lingual Alveolar Soft Part Sarcoma was confirmed. Molecular studies were performed. Interestingly, FISH analysis molecular analysis was negative for TFE3 rearrangement. Therefore, a variant TFE3 fusion type or a fusion involving a related gene such as TFEB were suspected.\nAs the histopathology report showed involved surgical margin, patient | agreed to have further resection of the lesion through partial glossectomy. Further excision revealed multiple residual foci of ASPS and a close deep resection margin. Left hemiglossectomy plus reconstruction of the left side of the tongue and the floor of the mouth with radial forearm free flap were |
33,550 | 19,448 | ear hearing loss of 3 months duration. He did not experience earache or discharge before the hearing loss. He; however, experienced visual acuity and dizziness. General physical examination did not yield much. Cranial nerve examinations were unremarkable. We did not observe any cerebellar signs and symptoms. We did not observe any discharges from the ear and otoscopic examination did not reveal same. Rinne and Weber tests demonstrated sensorineural hearing loss. Fundoscopic examination did not yield much. Routine laboratory investigations were within normal rangers.\nCT revealed a cystic-solid mass at right CPA measuring about 5.3 × 4.3 cm with slightly dense regions. | We noticed right auditory canal expansion (Fig. A). Enhanced CT demonstrated partial heterogeneous enhancement. We noticed thick and enlarged blood vessels |
29,303 | 124,675 | in a bigeminal pattern. The 12-lead ECG (Fig. ) shows sinus bradycardia at a rate of 36 beats/min with a P–P interval of 1840 ms. Each P wave is followed by a QRS complex with a PR interval of 200 ms. The P waves (green arrows) are best seen in lead II. A junctional escape rhythm is seen interrupting each sinus | cycle at a constant escape interval of 1360 ms.The junctional escape beats are followed by regular sinus beats at intervals of 480 ms. Laboratory data including thyroid stimulating hormone, electrolytes and serial cardiac markers (troponin I) were within |
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