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18,974 | 10,278 |
On examination, his higher functions were normal, and he had bilateral symmetrical upper and lower limb weakness with prominent lower limb involvement. His distal muscles were weaker (grade 3) than his proximal muscles (grade 4). His
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limbs were flaccid, and all the reflexes were absent with flexor plantar response. He did not demonstrate any abnormalities in sensory, sphincteric, and coordination examinations. Left-sided isolated partial ptosis was noted without associated ophthalmoplegia (Fig. ), and his pupils were of normal size, symmetric and reactive to light. He had no associated ataxia. He did not complain of any double vision and had no associated fatigability. His other cranial nerves were also normal. His cough reflex and neck muscle power were normal with
|
35,084 | 87,941 |
interval decrease in pleural thickening as described above. Despite the patient’s overall pronounced response to crizotinib, the treatment was eventually discontinued due to disease progression and gastrointestinal adverse events of Grade 3 nausea and vomiting.\nTreatment with orally administered ceritinib at a starting dose of 450 mg/day was initiated two months after crizotinib treatment ended. This ceritinib dose was administered with food; meals were generally relatively bland and small in size (taken three times a day), and red meat and
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spice-free. Ceritinib treatment is being well tolerated, and no gastrointestinal adverse events (nausea, vomiting, or related bowel problems) have been reported to date. Proactive treatment regimens have been reported as effective in the management of gastrointestinal AEs in patients taking ceritinib [], but regimens of this type were not required for this patient, who was treated with ceritinib 450 mg/day with food, and are not currently considered necessary for her future treatment. Overall, the
|
25,835 | 122,345 |
epinephrine). Laser safety protocols were strictly followed. Patient and the clinician were advised to put on the laser safety glasses specific to the wavelength of the laser.\nA diode laser (EZLASE, 940 nm, BIOLASE) was used for the procedure []. Initially, gingival recontouring was done to correct the gingival asymmetry of the maxillary right central incisor. A 400 μm fiber optic laser tip was used at an energy setting of 0.8W in continuous wave mode, with small paint brush-like strokes to ablate the marginal gingival tissue, to produce an ideal
|
surgery with gingival recontouring. Before the procedure, extraoral sepsis was carried out by swabbing with 5% povidone-iodine solution (Betadine, Win Medicare, India), and intraoral disinfection was performed with 10 ml of 0.2% chlorhexidine gluconate rinse (Hexidine 0.2%, ICPA, India). The surgical area was thoroughly anesthetized with a local anesthetic (2% lignocaine with 1:100,000
|
2,755 | 79,317 |
trauma to the arm. Physical examination revealed a firm, nontender swelling deep to the triceps just above the elbow. The function of the right upper limb was normal, with a full range of movements in all joints and without distal neurovascular deficit and no regional lymphadenopathy.\nPlain X-rays showed a dense sclerotic bony protuberance arising from the posterior cortex of
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the distal aspect of the humerus (). The MRI showed an exostosis measuring 6 cm in its long axis terminating immediately proximally to the level of the olecranon and with involvement of the underlying medulla (). Chest CT scan and whole body bone scan confirmed no evidence of disease elsewhere. A
|
24,404 | 54,533 |
with increased oncological surveillance.\nTemporary venoarterial extracorporeal membrane oxygenation support because of RV failure and hemofiltration was necessary for 3 days. The patient was extubated on day 6 and then transferred to the cardiology ward on day 9 post-operatively. He recovered quickly and
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Additional irrigation of the heart was performed to remove as many intravascular cells as possible. Implantation of the donor heart was uneventful. Immunosuppression was started as usual—tacrolimus, mycophenolate mofetil (MMF), and prednisolone—in combination
|
5,991 | 131,344 |
[]. After inspecting the site of tracheal narrowing externally, it was concluded that the extent of malacia might not be significant to warrant tracheal surgery. Postoperatively, the position of endotracheal tube was optimized with the help of chest X-ray. Postoperative respiratory management included lung toileting for retained secretions
|
favor the sternotomy approach. Once all the arch vessels were identified and looped, the right arch was divided from the dominant left arch, just proximal to the origin of the left common carotid artery
|
9,830 | 161,541 |
be used and excess solution should be dampened on gauze, e. Tweezers used to carry the cotton pellets must not be used for other purposes during the procedure.\nA reduction of the microhardness in both dentin and enamel has been reported following the use of trichloroacetic acid.[] Hence, restorations that will reinforce the weakened tooth structure are recommended. Chemical adhesion to tooth structure favours glass ionomer cement as the restorative material of choice.[] Recently a ‘reverse sandwich restoration’ comprising of microfilled resin composite and resin
|
thin glycerol impregnated cotton roll should be placed into the gingival sulcus for added protection, c. The cuff rubber dam technique should be employed to prevent slippage of the acid impregnated cotton pellets into the oral cavity, d. Very small cotton pellets or mini applicators must
|
12,857 | 150,222 |
was uneventful. After 1 week, skin wound showed dehiscence with purulent discharge and painful induration. Wound culture was done and antibiotics (ceftezol, amikacin, and metronidazole) were given. Careful wound dressing was performed twice daily. On postoperative day 9, debridement and closure of wound were done, however wound dehiscence was found again and pain was aggravated. The previous wound culture showed no growth of bacteria, but the clinician changed antibiotics to ertapenem and clindamycin.\nThe condition of wound did not appear to be improved and serial follow-ups of wound culture resulted in
|
no bacterial growth. Her vital signs including body temperature were normal. Wound dressing was done twice daily with saline irrigation. Wound tissue was obtained and the result of biopsy was supprative inflammation with fibrinoid vascular necrosis, consistent with abscess. The clinician changed antibiotics three times more and all the
|
30,895 | 156,814 |
CT of thorax which revealed cardiomegaly and dilated heart chambers [].\nWe started her on Tab carvedilol 6.25 mg OD, Tab frusemide –spironolactone (20/50 mg) OD and Tab enalapril 2.5 mg OD. Her pedal edema resolved after seven days and breathlessness on exertion after 14 days. She was
|
3 weekly injection. Her 7th dose was cancelled and she was referred to our center.\nChest X-ray PA view revealed cardiomegaly and straightening of left heart border. 2-D echocardiogram was done which revealed dilated left ventricle, global hypokinesia and left ventricular ejection fraction of 22%. On this basis, a diagnosis of dilated cardiomyopathy was made. To have objective assessment of the extent of cardio pulmonary involvement, we did a
|
27,480 | 138,209 |
Endarterectomy Trial classification (). The rest of extracranial cerebral arteries were normal. In addition, there was no baseline carotid dissection in axial CT imaging ().\nCAS was planned for the patient in index procedure. After 5000 units of heparin was given intravenously, the right common carotid artery was cannulated with a 5F Simmons catheter via the transfemoral approach. The external carotid artery
|
a severe stenosis in RICA, which was defined as 95% stenosis according to the North American Symptomatic Carotid
|
16,644 | 157,021 |
to supine. We approached the intra-abdominal space with a median laparotomy. The antral portion of the stomach was adhered to the diaphragm, liver, and surrounding structures. The cancer mass was not palpable. The whole gastric tube was resected. The length and vasculatures of the transverse and descending colon were considered to be suitable for an esophageal conduit. The left side of the colon with a pedicle of
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the left colic artery was prepared for esophageal reconstruction. The proximal sigmoid colon was connected (end to side) to the proximal part of the transverse colon with a 28 mm end-to-end anastomosis (EEA) stapler. After the left-sided colon conduit into the thoracic cavity in the isoperistaltic manner, esophago-colonostomy
|
29,751 | 36,216 |
bypass surgery, with exclusion of the aneurysm and mitral valve annuloplasty.\nMedian sternotomy was performed with subsequent pericardiotomy. The conduits (left internal mammary artery, left radial artery and right radial artery) were then harvested. After cardiopulmonary bypass was established, and cardioplegia administered, the conduits were grafted in place with the following configuration: left internal mammary artery to the first diagonal branch of his left anterior descending artery; left radial artery to his posterior descending artery; right radial artery to his left
|
The coronary angiogram (Figure ) illustrated the aneurysm, whose lumen appeared clear with no evidence of thrombus, in addition to left main disease. It was decided that our patient would undergo coronary artery
|
12,965 | 97,837 |
kept in a sealed container. The family member found a white powder and an open packet of calcium oxide food desiccant nearby, suggesting that the patient had accidentally ingested the food desiccant. The patient complained of severe pain in the oral cavity. Her family ensured that she expelled as much of the remaining calcium oxide as possible from her mouth. The patient was thereafter taken to the hospital by ambulance, and a physician observed the absence of calcium oxide-induced inflammation or ulcers in the esophagus and stomach.\nAfter the medical diagnosis, the patient was examined at our dental hospital to ascertain the cause of
|
her oral pain. During the oral examination, no symptoms of burns were observed on the palatal or buccal mucosae because these areas were protected by a complete denture in the maxilla. However, moderate erosion accompanied by ulceration and redness was present from the vestibular mucosa behind the lower lip and tip of the tongue to the left side and the sublingual mucosa; moreover, strong hyperpathia was observed (). Close inspection of the lower lip
|
9,344 | 109,246 |
in the right lower quadrant for approximately 2 years, and it occurred once or twice a month without precipitating factors. The abdominal pain lasted for approximately 30 minutes and was relieved without special treatment every time. She presented to our outpatient department because the abdominal pain had worsened and occurred weekly for 1 month. Her symptoms were not related to meals, bowel movements, or her menstrual cycle, which was normal. No
|
oral contraceptives or other medical history, recent pregnancy, or abdominal surgical history was noted, and she had a normal vaginal delivery 9 years previously. She had no identifiable pelvic inflammatory disease risk factors and no personal
|
20,001 | 99,191 |
further conducted a computed tomography scan of the temporal bone. It was observed that the left IAC (2.8 mm in diameter) was relatively narrow as compared to the right IAC (3.9 mm in diameter) ().\nFrom these findings, we suspected that the developmental delay may be attributed to profound hearing loss on the left side. The hearing loss was, in turn, caused due to the anatomical anomalies elucidated in the images, including IAC stenosis with aplasia of cochlear nerve.\nAn otolaryngologist was
|
unable to detect any anatomical causes for the elevated ABR threshold of right side. Consequently, perinatal insult due to management in the NICU was presumed to be the cause, and a hearing aid was prescribed to preserve the residual hearing of right side.\nIn addition,
|
22,843 | 73,443 |
old, presented intense lower back pain. Lumbar spine CT revealed multiple osteolytic lesions in lumbar vertebrae. Further investigation by attending physicians ruled out neoplastic infiltration. Clinical and laboratory exams were normal, except for slightly decreased calcium levels of unknown origin, with normal levels of PTH, so the patient was treated conservatively with NSAIDs and careful medical advice.\nIn May of 2004, the patient discovered a nodule in left thyroid lobe, which gradually increased in size. Biopsy revealed follicular thyroid cancer, and a total thyroidectomy was performed. Histological exam showed papillary and
|
follicular thyroid cancer. Histological preparation did not consist of any parathyroid gland, although patient suffered from severe hypocalcaemia for many years postoperatively until utterly controlled by attending endocrinologist with administration of calcium and salmon calcitonin. In September of 2004, a large cystic mass was detected in anterior cervical surface, left of the clavicle. Ultrasound revealed a
|
35,499 | 120,033 |
(3 mm by 2 mm; Fig. ). The conjunctiva was freely mobile over the intrascleral portion of the cyst. The corneal cyst was filled with turbid fluid with multiple opaque particles floating in it. The surrounding stroma outside the cyst margin was clear. There was absence of corneal vascularization or any signs of trauma. The anterior chamber was well formed and clear. The rest of the anterior segment examination was normal along with a normal fundus.\nThe right eye had normal anterior and posterior segment on examination. BCVA in the right eye was 20/20, N6 and 20/200, N36 in OS. Based on the examination findings, a provisional diagnosis of
|
primary corneoscleral cyst was made.\nAfter obtaining informed consent from the parents, surgical intervention was planned as the cyst covered the pupillary axis. Localized peritomy was performed to expose the underlying scleral cyst. The anterior wall of the cyst was removed by excision of the scleral roof. There was a narrow passage through the limbus, connecting the scleral cyst to the corneal cyst. Fluid was drained from the intrastromal part of the cyst, and the cavity was repeatedly washed with balanced salt solution (BSS). After thorough wash
|
12,421 | 43,693 |
similar symptoms in the past. He reported poor appetite but no weight loss or strange craving. Other than the symptoms reported previously, the review of symptoms was negative, including neurological complaints. Complete blood count (CBC) was taken in the clinic and he was found to have hemoglobin (Hb) of 6.2 g/dL. The patient was subsequently admitted to the hospital
|
an ambulatory clinic complaining of fatigue and weakness for 2 weeks. The patient also complained of frequent epistaxis secondary to nose picking for 1 month. His fatigue was accompanied by dyspnea on exertion and lightheadedness which have increased in frequency in the last 4-5 days prior to the presentation. He denied
|
7,356 | 42,720 |
stenosis despite the use of dilators with increasing diameter over the guide-wire. Repeated punctures of the vein downstream and upstream of the stenosis were also unsuccessful. Consequently we decided to restore the abandoned unipolar CS lead which was disengaged from the surrounding scar tissue. The insulation was transected proximally to the fracture point and pulled back. The conductor was stretched out and exposed beyond the insulation for a 0.5 cm portion. A
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success. Then the bipolar CS lead was removed, leaving the guide-wire in the atrium via the subclavian vein. The insertion of an adequate size introducer for CS lead reimplant failed due to subocclusive vein
|
12,474 | 101,560 |
more frequent headaches, and the back of his neck grew increasingly more painful. A second brain CT scan showed a high-density area in the left posterior occipital region that was compatible with SAH (). Repeated blood tests revealed a PT of 21.3 s and INR of 1.86.\nIn view of the negative spinal CT results, we performed spinal angiography. Still, no arteriovenous malformation or other vascular abnormalities were found (). Considering the patient’s medical history and clinical manifestations, we temporarily stopped his anticoagulation treatment and administered vitamin K to reverse the anticoagulation, aminocaproic acid
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was 1.95 and that the prothrombin time (PT) was 1.96 s. On the second day, the patient’s brain CT results suggested SAH (). We performed another lumbar puncture, and bloody CSF was retrieved again in three test tubes, thus confirming SSH (). On the third day, the patient experienced
|
25,295 | 74,958 |
This showed a long, hypodense region in the right nasopharynx suspect for a hematoma as well as an aneurysmatic dilatation of the origin of the right internal maxillary artery (). The subsequently performed conventional angiography confirmed the presence of an internal maxillary artery pseudoaneurysm, approximately 2 cm after the bifurcation of the arteria carotis communis which was successfully coiled (). Two days later the Bellocq tampon was removed without problems, and a week after the initial fall, the patient could
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was to be removed 48 hours later. That night however, during routine endotracheal suctioning, the patient started to cough inducing pulsatile oral blood loss suspect for an arterial vascular injury. The bleeding was successfully controlled, and subsequently a CT angiography (CTA) of the head and neck was performed.
|
41,843 | 11,696 |
practice in 2010, with the complaint that she could not eat without discomfort in the mental foramen region due to the use of a mandibular complete denture. The patient had been using the same dentures for 30 years (Figures and ). On clinical examination, it was possible to feel the alveolar nerve on the crest of the mandible, and its compression during clenching usually caused the patient to feel pain. After imaging analysis (), a fixed full-arch rehabilitation on 3 straight immediately loaded implants was planned because the interforaminal distance limited the placement of four implants, according to the surgeon's experience.\nBefore the
|
surgery, a new complete denture had to be made, with better and adequate vertical dimension, centric relation, harmonious tooth positioning, and
|
23,731 | 136,371 |
carcinoma with cervical lymph nodes metastasis, who underwent total thyroidectomy with lymph nodes dissection few months earlier, presented with progressive left shoulder and arm pain associated with paresthesia. No other neurological symptoms were present. On physical examination, a few enlarged cervical lymph nodes were present. Neurological physical examination was normal with intact sensory and motor functions in both upper and lower limbs.
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Laboratory tests were normal. Serum thyroglobulin level was low. CT scan and MRI studies showed a left paraspinal mass, which was centered in the left side of C6 vertebral body with extension from C4 to C7. It was associated with a large
|
33,631 | 96,376 |
no ischaemic changes. Initial blood results shown in . Chest X-ray showed cardiomegaly with increased interstitial markings (). She deteriorated rapidly over the next hour with climbing oxygen requirements and hypotension and was investigated for pulmonary embolism (PE) and treated with morphine and enoxaparin. She was escorted to radiology from the neonatal ward for the CT pulmonary angiography (CTPA) which showed pulmonary oedema and no PE and was admitted to cardiovascular intensive care (CVICU). On arrival, she was intubated for respiratory distress and, as no transthoracic echocardiogram had been
|
performed, she had a transoesophageal echocardiogram. This demonstrated the posterolateral papillary muscle rupture and flail anterior leaflet with torrential MR and preserved left ventricular (LV) function (see ).\nShe proceeded to emergency mitral valve (MV) replacement, on transfer to the operating table she had a pulseless electrical activity (PEA) arrest, resuscitated with adrenaline and CPR before return of circulation and the start
|
39,479 | 57,238 |
treatment at our hospital almost 30 years ago after seeing a TV show about SAD. He argued being shy and reclusive since early childhood. Mr. A has always been ashamed of performing in front and interacting with other people. His symptoms progressively worsened as he grew up. By adolescence, he started presenting physical symptoms (like tremors, sweat, and heart palpitations) every time he exposed himself to social interactions. Mr. A had never dated until he was 31 years old when he had a brief romantic relationship strictly over the phone. He always lived with his mother.\nDespite his qualifications
|
and performance, Mr. A could not remain in the same job for more than 1 year,
|
4,097 | 151,796 |
pain during micturition, which persist for the last few months. In the regional medical institution treated as acute prostatitis. Good general condition, and the physical examination findings orderly. The laboratory findings of elevated CRP: 145mg / l, while the other parameters were of the reference values. On the ultrasound examination of the urinary tract, in the bladder was revealed tumor change the largest diameter to 70mm, which covers
|
the front wall of the bladder, and whose origin cannot be determined. Computed tomography revealed that in the pelvic there was edge well vascularised formation that covers the front wall of the bladder, with visible
|
17,745 | 65,433 |
findings were consistent with epidermotropic metastatic malignant melanoma. The patient was not only referred to a head and neck oncologic surgeon, but he was also presented at a multidisciplinary tumor board. Wide local excision with flap repair was recommended and performed.\nThe patient presented with multiple red nodules, ranging from 6 to 8 mm in diameter, in the same left parietal scalp region within three months (Figure ). A punch biopsy showed an aggregate of atypical melanocytes in a nodular configuration in the papillary and reticular dermis (Figures -). S100 stained positive to highlight cells comprising the proliferation. These findings established a diagnosis of metastatic malignant melanoma.\nThe patient received computerized tomography (CT) scans of the head,
|
neck, chest, abdomen, and pelvis that confirmed the scalp lesions; however, there were no other sites of metastatic disease. Pembrolizumab
|
20,584 | 69,334 |
worsening of the reticulonodular opacities previously visualized on the chest X-ray performed in the ED. A cardiac ECHO was ordered which was limited due to the patient developing tachycardia but showed normal EF and no signs of vegetations or valvular dysfunction. A repeat CT of the head was ordered as the patient's mental status continued to decline (). CT of the head showed new onset hydrocephalus,
|
leading to a consult being placed with neurosurgery. Due to the new findings on CT scan an MRI was ordered, which showed subtle increased T2/flair signal interdigitating between the gyri, concerning for leptomeningitis (). Neurosurgery
|
17,079 | 133,087 |
was performed under laparoscopy in October 13, 2017. Histopathology showed that the mass was an adrenal metastatic PCCCL based on its pathological characteristics demonstrated by H&E () and immunohistochemical staining, which exhibited the high expression of hepatocytes and glypican ().\nThe patient had multiple metastases and is in complete response (CR) state until now. He is considered as clinically cured. From the initial diagnosis of PCCCL, the
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size reduction of the adrenal gland nodule (2.3 cm maximum diameter) in August 5, 2016.\nThe maximum diameter of the right adrenal mass decreased to 1.5 cm in March 2, 2017 () and slightly increased to 2.1 cm in September 20, 2017. Because of the enlargement, right adrenal mass resection
|
37,866 | 35,014 |
and torso. Positive findings from these studies revealed multiple bilateral rib fractures with associated hemothoraces (Figure ). He also sustained fractures and subluxation at the third and fourth thoracic levels (Figure ). The patient was started on spinal dose steroids and strict spine precautions were maintained for anticipated surgical
|
stabilization. Bilateral chest tube thoracostomies were placed for the hemothoraces and a arterial blood gas was then obtained which documented adequate oxygenation and ventilation given this patient's significant pulmonary injury; (pH 7.33 pCO2 42 PaO2 91 HCO3 21, O2 saturation 97 BD-4, 2 liters nasal cannula).\nThe initial drainage from the left chest tube was 500 milliliters (ml)
|
12,565 | 23,570 |
of plasmapheresis and withdrawal of CNI, the patient’s labs did not improve. ADAMTS13 activity was 91%. CH50 complement was low. Due to lack of response to plasmapheresis, this was not believed to be TTP and with lack of improvement despite withdrawing CNI, CNI-induced TMA seemed less likely. The diagnosis of aHUS was made, and the patient was started on eculizumab. She was started on an induction dose of 900 mg weekly for four weeks and then maintenance with 1,200 mg at week 5 and every two weeks thereafter.\nEncapsulated organism prophylaxis was
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followed. Meningococcal vaccination was given. After the first dose of eculizumab, the patient's hemolysis parameters began to improve and creatinine took about three weeks to return to baseline of 0.7-0.9.\nEculizumab was stopped after three months of therapy due to difficulties getting it covered by
|
5,436 | 84,883 |
to our emergency department. She had massive rectal bleeding.\nShe had an iron deficiency anemia. She did not complete the investigations so the cause was not yet diagnosed. She had no chronic bleeding, neither gynecologic nor digestive. She was treated by oral iron with no regular follow up. She had no past surgical interventions, and no other medical condition. She had no contact with animals. There were no medical conditions in her family, no cancers and no current infections. No one in her family or neighborhood was diagnosed with tuberculosis.\nIn our admission unit, her hemodynamic parameters
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showed that she was in shock: her blood pressure was 80/40 mmHg and her pulse was up to 120 beats per minute. She was pale, her conjunctivas were discolored and her limbs were cold. While examining her, we found profuse rectal bleeding with clots. A quick abdominal and pelvis examination including proctologic examination appeared normal. She
|
41,284 | 121,765 |
from the Department of Orthodontics, Department of Endodontics, Department of Oral Surgery, and Department of Prosthodontics for complete rehabilitation of the patient. Teeth with hopeless prognosis were identified. Implants were planned for the upper anteriors.\nQuadrant-wise full-mouth flap surgery was done, except on the upper anterior region. Kirkland flap was raised; with respective bone surgery was done. Extraction of root stumps in relation to 16 and 26 was done. Interrupted silk sutures were placed and co-pak was given.\nSutures were removed after 10
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and the patient was recalled after 14 days for review and subgingival scaling.\nAt the second visit subgingival scaling was completed. The patient was advised to continue chlorhexidine mouthwash, and oral hygiene maintenance was reinforced, with additional use of interdental cleaning with an interdental brush. Two weeks after subgingival scaling, there was marked a reduction in pocket depth and no bleeding on probing was present.\nOverall treatment was planned with a multidisciplinary approach, with consultations
|
29,861 | 100,029 |
respiratory rate 18/minute, and temperature 100.2 F. Physical examination revealed an alert gentleman with impaired short-term memory. His neurological exam did not reveal any cranial nerves or other motor or sensory deficits. A complete blood count, comprehensive metabolic panel were unremarkable. The patient was evaluated by neurology and empiric meningitis coverage was initiated after a lumbar puncture. His cerebrospinal fluid (CSF) analysis revealed 4 nucleated cells, 0 RBCs, protein 44 mg/dl, and glucose 88 mg/dl. HSV 1/2 PCR came back negative and CSF cytology was negative for any malignant cells.
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had trouble remembering recent things and following directions while driving. He had had no weight loss or appetite changes. During his outpatient workup, an MRI of his head, delayed for 10 days due to insurance issues, showed bilateral hippocampal edema (). His memory loss progressed, and he developed fever with chills for which he was referred to the emergency department (ED).\nIn the ED, his vital signs included: heart rate 95/minute, blood pressure 158/76,
|
3,473 | 125,198 |
ipsilateral thoracodorsal perforator flap was designed and elevated. After flap transfer, we performed arterial microanastomosis first between the radial collateral artery and thoracodorsal artery. Finally, we did venous anastomosis between each of vena commitantes.\nOne week postoperatively, permanent pathology with Gomori methenamine silver (GMS) and periodic acid-Schiff (PAS) staining confirmed chronic active inflammation and extensive necrosis with numerous fungal hyphae showing septation and branching consistent with Aspergillus species (, ). Tissue
|
cultures grew A. fumigatus. After surgery, the patient was started on amphotericin B (20 mg/day) IV for 5 days and switched to oral itraconazole (200
|
20,483 | 71,510 |
surgery, but 2 weeks after starting cefotaxime, follow-up MRI showed a left sided psoas abscess (Fig. ). We performed CT-guided biopsy and debridement, which led to no exacerbation in symptoms and laboratory data afterward. Cefotaxime was administered for a total of 4 weeks, and after making sure that he remained afebrile and CRP remained within the normal range, we switched the antibiotics to oral trimethoprim-sulfamethoxazole which the organism was susceptible to. He was discharged and finished taking trimethoprim-sulfamethoxazole for a total of 2 weeks. The radiograph and MRI at the point of 6 months follow-up after discharge revealed improvement of vertebral bodies alignment, and no
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and performed surgical drainage, and transplantation of iliac crest graft following curettage of the vertebral disc. During and after the surgery, we used sulbactam cefoperazone empirically. Tissue, wound and abscess cultures from the surgical specimens grew Salmonella Saintpaul which was sensitive to cefotaxime, therefore we changed the antibiotic to cefotaxime. His fever reduced and CRP began to decline soon after the
|
28,664 | 49,047 |
On HD11, she first noticed bilateral foot drop and numbness, which were attributed to critical illness. Arm and proximal leg strength were normal. A follow-up CT chest/abdomen/pelvis performed several days later showed stability of the retrouterine hemorrhagic fluid collection. On HD20, worsening hypotension prompted a repeat CT that showed interval development of a large right-sided pelvic retroperitoneal hematoma associated with contrast extravasation and mass effect on the bladder (Fig. ) and small bowel wall thickening concerning for ischemic bowel. An exploratory laparotomy was performed during which small bowel resection and hemoperitoneum evacuation were performed. Interventional radiology addressed the intercurrent
|
pelvic retroperitoneal hematoma by stenting an identified right external iliac artery pseudoaneurysm and embolizing the source of the hemorrhage, an irregular distal branch of the right internal iliac artery. Since the stability of the pelvic retroperitoneal hematoma was confirmed with repeat imaging, surgical evacuation of the hematoma was not pursued. On HD37,
|
4,892 | 95,774 |
connected to the left wall of the uterus just above the cervix by a thick fibrous band and the ipsilateral tube and ovary were stretched over the horn []. The fallopian tube and ovary of the right side were healthy. A live 950 g male fetus was extracted from the horn and handed over to the pediatrician. The rudimentary horn and ipsilateral tube and ovary were removed. Left sided kidney and ureter were found to be absent. Abdominal cavity was washed with saline and closed. Patient received two units of packed cells during the operation.\nHer
|
postoperative course was uneventful. Pathological evaluation of the specimen confirmed the presence of placenta percreta invading the serosal layer. Microscopic examination confirmed the lack of any communication in the fibrous band connecting the rudimentary horn with the uterus. The neonate was
|
11,646 | 32,765 |
picking when he applied topical over the counter antibiotic and antiseptic creams. However, he could not resist picking the scars over these wounds and the wounds would never heal. Over time, he reported that “he gave up” on his skin picking behavior as he noticed that the left leg wound was gradually getting worse. Due to the worsening pain and foul-smelling discharge from the wound, he decided to come to the emergency room (ER).\nWhen he presented to the ER, he was found to have an extensive wound on distal left foot with exposure of the underlying muscle tissue, oozing of blood and surrounding
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whenever he gets nervous and anxious. He described his picking as constant on a daily basis, sometimes that episode could last for minutes. This compulsive behavior started off with picking the skin around his nail beds and slowly got worse. He reported few occasions of having painful sores and wounds due to the skin
|
13,057 | 157,151 |
female presented to the emergency department secondary to an accident involving her wheelchair. Earlier that day she had been seen by her family physician regarding a subcutaneous abscess located on her abdomen and was on her way to see a general surgeon when she had an accident, whereby she was flung from her wheelchair. She was fully immobilized and on a backboard. She was later taken off the backboard after passing Nexus criteria for cervical spine immobilization, with no complaints of pain other than in her left lower quadrant. After being taken off the backboard, a full physical examination was
|
performed. The patient's vital signs were blood pressure of 124/59, heart rate of 107, respiratory rate of 18, temperature of 97.5°F, and a pulse oximetry of 95% on room air.
|
28,256 | 34,792 |
lymphocytic infiltration was noted. Additionally, there was associated dilatation, congestion and hemorrhage of surrounding blood vessels which corroborated with a diagnosis of radiation induced TLN (Figure ). Fortunately, her symptoms relieved significantly after resection of the right lesion. Postoperative MRI revealed a big cavity in the lower portion of right temporal lobe with surrounding edema, and several minor enhanced lesions in the counterpart of the left temporal lobe (Figure ). She presented to our department to seek medical opinion about further treatment for the minor lesions in the left temporal lobe.
|
attending neurosurgeon performed a maximal surgical resection of the lesion in the right temporal lobe on May 18th, 2010. However, histological examination confirmed the absence of neoplastic cells in the resected brain tissues. Instead, partial liquefactive necrotic tissue with
|
24,391 | 85,690 |
years, 3D printing technology has proven helpful not only to make an operation plan and simulate the operation in the preoperative stage but also for patients to learn more about their conditions and facilitate communication with doctors [, ].\nThe ganglioneuroma shows complete capsular and basal growth by expansive patterns. The most effective therapy is a surgical removal operation as soon as possible, which can reduce the
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increase in enhancement on dynamic images; it presents as non-enhancement or mild enhancement in the arterial phase of CTs or MRIs and progressive mild enhancement in the delayed phase. If ganglioneuroma shows an atypical manifestation on a CT and an MRI, we consider the tumor to contain a malignant component []. In recent
|
18,284 | 75,125 |
the normal range but had missed several doses over the preceding three days in addition to a decrease in the number of bowel movements. On initial exam the patient was normotensive and oxygenating well on room air with mild encephalopathy. A chronic ventral hernia displayed no signs of peritonitis. Labs on admission were significant for an ammonia level of 87 μmol/L (18–72 μmol/L), platelet level of 96
|
abuse in remission who was admitted to our hospital with a three-day history of worsening abdominal pain and confusion. She was prescribed lactulose for the hepatic encephalopathy, which kept her ammonia in
|
34,053 | 202,625 |
bone trabeculae of the mandible had been resorbed and replaced by fibrous connective tissue. This tissue contained a few nests of squamous cell carcinoma, composed mainly of necrotic tissue with a small number of viable cancer cells and remnants of keratin pearls. The surgical margins were free from tumor. Metastatic disease was detected in five cervical lymph nodes, including one left submandibular aggregated-node, three left upper jugular nodes, and one left middle jugular node. No metastatic nodes revealed extra-nodal extension. Metastasis to BN was also present (Fig. ). These metastatic regions contained few viable cancer cells and consisted primarily of necrotic tissue.\nFollowing surgery, the patient was treated with adjuvant radiotherapy (50 Gy/25 fractions) with
|
dissection (levels I–II) on the right side, classical radical neck dissection (levels I–V) on the left side, segmental mandibulectomy, and oromandibular reconstruction with a scapular osteocutaneous flap. The primary tumor and buccinator space including BN were dissected in continuity with neck dissection. Histopathological examination of the segmental mandibulectomy specimens showed that the alveolar bone and part of the
|
18,795 | 132,065 |
to ten episodes of watery blood-stained stools per day over this period.\nOver the preceding thirteen months the patient had presented nine times to hospital with the same symptoms but of lesser severity. Upon closer questioning he admitted to experiencing altered bowel habits (alternating constipation and diarrhoea) for up to one month before presentation but denied any
|
abnormalities in bowel habit frequency during childhood or adolescence.\nHis past medical history included an episode pericarditis of unknown aetiology 8 years prior and recurrent left shoulder dislocations. He had not previously undergone any prior abdominal operations or endoscopies. He had no known allergies. He was a previous habitual methamphetamine user but stated he had not used illicit substances for four years and was not taking any regular prescription medications.\nHis mother had been diagnosed with colorectal
|
14,338 | 19,019 |
with K-wires, followed by definitive fixation with a lateral distal femoral locking plate (Figure ).\nThe postoperative period was uneventful. The wound healed, and the sutures were removed. The patient was kept on an aggressive physiotherapy protocol, and knee range of motion (ROM) and isometric quadriceps were started on the
|
second day post-surgery. A continuous passive motion (CPM) machine was employed to start a passive movement of the knee joint, and by the end of the first week, 90 degrees of passive motion was achieved while
|
32,946 | 82,203 |
performed. Articles were included in this review if 10 or more patients were investigated retrospectively or prospectively, patients suffered of metastases to pancreas (no infiltrative involvement) and only the pancreas was affected by metastases, patients received resection of pancreas metastases in curative intension and different tumor entities were included in each study. Four retrospective studies [–] summerized in Table met the inclusion criteria with a total of 92 patients. Median age of patients ranged from 59 to 64 years. Most frequent origin of
|
pancreatic metastases was the kidney in 46 % of the cases followed by melanoma in about 10 % of the cases. Rectal and Colon carcinomas
|
16,978 | 60,892 |
MTB was positive, which suggested a mycobacterial and non-BCG infection.\nThis was followed by further imaging to exclude extrapulmonary involvement including MRI head and spine, which showed no features of TB. She had an ultrasound of the abdomen and pelvis, which showed hypoechoic rounded lymph nodes throughout the abdomen. Further immunophenotyping of PB revealed no detectable aberrant expression or maturation asynchrony on B cell, T cell, or natural killer (NK) cell.\nShe was commenced on quadruple antitubercular treatment: isoniazid, rifampicin, ethambutol hydrochloride and Zinamide. During her time at the tertiary centre, her inflammatory markers (CRP) peaked at 220 mg/L and she developed fever and required piperacillin/tazobactam, which was later switched
|
(Fig. ).\nZiehl–Neelsen staining was negative, though mycobacterial PCR was positive for Mycobacterium tuberculosis (MTB) target. Early secreted antigenic target of 6 kDa (ESAT-6) of
|
12,916 | 97,791 |
at week 11 and reported an episode of tachycardia with a heart rate of 130 beats/min, after which he self-increased his total daily dose of clonazepam back to 1.5 mg (0.5 mg in the morning and 1 mg at night). He stated that his symptoms of worsened anxiety and tinnitus had not resolved but had been ameliorated since increasing his dose. The tinnitus was no longer interfering with his sleep. Due to the intensity of these symptoms experienced at the 1 mg total daily dose, the current 1.5 mg daily dose was continued, and the plan was to reevaluate in 1 month.\nAt visits occurring at weeks 15 and 23 of the taper,
|
but take 0.5 mg in the morning and 0.5 mg at bedtime to allow for more consistent levels throughout the day.\nHe presented to the clinic at week 9 endorsing continued tinnitus and worsened anxiety. As a result, clonazepam was maintained at the current dose. The patient returned
|
35,532 | 121,897 |
(lisinopril). The physical exam suggested euvolemic hyponatremia, with urine and electrolyte studies confirming SIADH of unknown etiology. In following the management guidelines, she was fluid restricted to 1000 mL/day. After three days, sodium chloride (NaCl) pills three times daily (TID) were added as her sodium levels and symptoms were minimally improved with fluid restriction, alone.\nTo evaluate her muscle weakness, she was seen by nephrology and neurology. Magnetic resonance images of head, spine and brachial plexus were unrevealing. Lyme screening was performed
|
or other abnormalities.\nLab values obtained during her hospitalization are displayed in and .\nThere were two problems we faced: hyponatremia and muscle weakness. To evaluate her hyponatremia, thyroid stimulating hormone, cortisol and computed tomography (CT) head were evaluated and found to be within normal limits. Medications which could have contributed to hyponatremia were discontinued
|
29,623 | 43,478 |
did reveal bilateral lower lobe consolidation. Shortly after the completion of the CT angiogram, he developed acute worsening of his respiratory distress requiring intubation. A previously ordered MRI was unable to be performed due to the unavailability of an MRI compatible ventilator. After intubation and stabilization, a contrast-enhanced CT of the cervical spine revealed a 3.7 by 1.4 cm low-density oval lesion displacing the thecal sac and extending from the C2 to the C4 vertebrae ().\nBased on the imaging results, the patient was emergently taken to the operating room where he underwent laminectomy
|
of C2–C5 for debridement of the epidural abscess, with the surgical wound left open for negative pressure wound vacuum therapy. He was also begun on intravenous vancomycin therapy. During postoperative day 1, due to the dense consolidation seen on chest CT, he underwent fiberoptic bronchoscopy with bronchial
|
27,604 | 41,326 |
duodenal and upper jejunal mucosa. Multiple biopsies taken at different sites were within normal histological limits. The HIV screen was negative and the thyroid hormone profile was also normal.\nAt this point it was noted that the patient was avoiding food. He constantly complained of food causing uncomfortable abdominal distention, epigastric pain and shortness of breath. He was then referred to the University Psychiatry Unit of the National Hospital of Sri Lanka for further assessment for an underlying psychiatric morbidity.\nOn the initial psychiatric interview it became clear that these recent constellation of symptoms had started three months back
|
the ultrasound scan of abdomen. An upper gastrointestinal endoscopy was arranged and revealed a normal oesophagal, gastric,
|
24,378 | 35,228 |
decubital lesions remained at Wagner grade II. In parallel, his general condition deteriorated, and vascular surgery was contraindicated.\nGiven the lack of response, risk of amputation, and general deterioration in this patient's condition, bosentan was initiated on a compassionate use basis, with informed consent, three months after his hospitalization. Antibiotic therapy was discontinued and not reinstated during the course of treatment with bosentan. Bosentan has been shown to prevent the occurrence of new digital ulcers in patients with systemic sclerosis and a history of digital ulceration at a dose of 62.5 mg twice daily and titrated up to 125 mg twice daily after
|
four weeks []. However, given our patient's age and history of cardiopathy, bosentan was initiated at a dose of 62.5 mg once daily for one week and titrated up to a maintenance dose of 62.5 mg every 12 hours twice daily thereafter. Following a two-week treatment period at the maintenance dose, all ulcers had improved and marked granulation tissue was apparent on the heel ulcer (Figure ) and the ulcer on the flexure of the right ankle. The sacral and external malleolar ulcers had both healed rapidly. The
|
30,668 | 33,819 |
among the incriminated objects being projectile fragments, catheter fragments, Kirschner wires, or acupuncture needles [–]. However, when aiming to identify the cause of intrapericardial bleeding in a patient with a history of previous surgical interventions, the possibility of a migrating foreign body should be taken into account. In uncommon cases, foreign bodies have been reported to migrate through tissues []. A possible explanation of this phenomenon is that suppuration causes the foreign bodies
|
in both children and adults [–]. Similarly, accidental or iatrogenic foreign body injuries to the heart have also been described as a possible cause of PT,
|
27,437 | 86,701 |
UKA had delaminated from the underlying subchondral bone and easily yielded to pressure. Softening of the subchondral bone at the affected site was observed. Osteotomy of the MFC and MTP resulted in complete excision of the lesions. Histological examination of both specimens showed a subchondral crack, fibrous granulation, and osteoid formation, but no evidence of antecedent
|
osteonecrosis (). These findings were consistent with those of subchondral fractures. The articular surface of the MFC lesion was smooth, whereas the cartilage of the MTP lesion showed superficial irregularities and degenerative changes. Three
|
8,465 | 65,344 |
the area of necrotic temporal bone developed into penetrating osteomyelitis that lead to the formation of a 2 cm3 cerebellar abscess abutting the area of infected bone. The initial presentation was one of worsening headaches and an urgent MRI head revealed the presence of the abscess. In addition, the MRI revealed the sequestrum within the temporal bone opacification of the temporal bone adjacent to the abscess. No mass lesions were noted on imaging. The patient had no other features of raised intracranial pressure. The temporal bone osteomyelitis and cerebellar abscess were treated with broad-spectrum IV antibiotics
|
and surgical drainage and irrigation through a burr hole. Local wound cultures and peripheral blood cultures were negative but local wound cultures grew fully sensitive Pseudomonas aeruginosa. The procedure was uneventful and the patient made a full recovery
|
12,390 | 152,014 |
predominantly of histiocytes and plenty of eosinophils. Hemosiderin-laden macrophages and multinucleated giant cells with areas of necrosis were also noted. The neoplastic histiocytes showed kidney-shaped and elongated nuclei with a longitudinal groove (coffee beans like), consistent with Langerhans histiocytes []. Immunohistochemistry revealed strong staining to S100, CD1a and CD68 in those Langerhans histiocytes confirming the diagnosis of Langerhans histiocytosis. There was no organisms’ growth on culture of the fluids obtained during surgery from the cyst or
|
extradural space.\nThe child had an uneventful postoperative period with complete recovery of his left hemiparesis and discharged home in a good condition.\nHe was regularly followed up
|
28,661 | 81,898 |
with abundant mucin (Fig. ). The minor duodenal papilla was normal in size and ERP via the minor papilla was not possible. The diagnosis based on pancreatic juice cytology was “highly suspicious for adenocarcinoma,” suggestive of an intraductal papillary mucinous carcinoma (IPMC) arising in the ventral pancreas of pancreas divisum. The patient underwent a pylorus-preserving pancreaticoduodenectomy (PPPD) with regional lymphadenectomy. The postoperative course was uneventful, except for a Grade A pancreatic fistula (staged
|
at the head of the pancreas (Fig. ). The major duodenal papilla was enlarged and the orifice was filled
|
40,605 | 153,873 |
man presented with a one-week history of pain in the right TMJ area, especially during eating, and a restricted range of jaw motion. The patient’s previous medical/dental history was unremarkable. No history of parafunction was present, and the patient had not experienced any TMJ pain prior to the presently reported experience. An examination revealed no deviation in the opening path and no noise in the TMJ.\nThe maximum unassisted opening distance was 40 mm. The patient reported pain upon palpation of the right TMJ (lateral pole, inside ear), but had no extraoral or intraoral muscle tenderness. Twenty-eight teeth were present, and the occlusion was anatomically normal. TMJ tomography showed no evidence
|
of degeneration (Fig. ), and a diagnosis of temporomandibular arthralgia was made based on the Research Diagnostic Criteria for TMD (RDC/TMD) []. Since an anterior flat
|
23,288 | 95,567 |
groove in extension, it laterally dislocated with the knee in flexion beyond 45° (Figure ). She complained slight discomfort by an apprehension test. The passive lateral patellar tilt test was negative since the soft tissue attachment to the lateral border of the patella was diffusely stiff and tight, but no cord-like band was palpable. The patella could be easily displaced laterally due to medial parapatellar instability, but was not so painful even when dislocated. The range of motion at the knee
|
or Kabuki make-up syndrome [,]. She also denied any history of injections into the quadriceps muscle.\nPhysical examination did not reveal general joint laxity or macroscopically apparent malalignment of the lower extremity. Although the patella was in the femoral trochlear
|
36,784 | 88,780 |
initiated. Mr. A was admitted to the general medicine service, where overnight he had another acute episode of agitation, becoming increasingly argumentative with the staff. Intramuscular haloperidol was administered to treat his acute psychotic agitation.\nMr. A was transferred to the medical psychiatry inpatient unit with the DSM-IV-TR diagnosis of Psychotic Disorder, Not Otherwise Specified. His vital signs remained stable. Rapid plasma reagin test, cobalamin and folate levels, liver transaminase levels, and thyroid stimulating hormone levels were within normal limits. Mr. A complained of intense anxiety with no identifiable precipitant on the first day of his hospital course. He demonstrated paranoid behaviour and was highly suspicious of the
|
were remarkable for a blood pressure of 157/97, and physical examination was significant only for altered mental status. Serum electrolytes, renal function, and cell blood count were within normal limits. Blood glucose was mildly elevated at 146 mg/dL. Urine drug screen was negative. Urinalysis was positive for bacteriuria, and a course of levofloxacin was
|
29,441 | 122,135 |
before admission, the patient noticed gradually increasing difficulty to find the right words and respond to questions, and her sentences became disjointed and less clear. Besides dysphasia and mild limb ataxia, her neurologic status was normal. She also had moderate orthostatic hypotension with no falls and mild urinary incontinence. Mental status was without cognitive impairment with a Mini-Mental State Examination (MMSE) score of 25. Polysomnography was not performed because the patient had no clinical signs of sleep-related disorder either in the disease manifestation or in the disease course. Her medical history was remarkable for hypothyroidism and episodic supraventricular tachycardia, and these disorders were
|
treated with levothyroxine and beta blockers. There was nothing special in her family history. The first MRI was performed during the first hospitalization period. Mild brain atrophy and small vascular lesions were seen. Based on anamnesis, MRI, ultrasound investigations and laboratory findings, chronic cerebral ischemia was diagnosed.\nThe patient was admitted to our clinic for the second time only 2 years later. The clinical examination revealed global aphasia, bulbar syndrome, hypomimia, symmetrical bradykinesia with rigidity, hyperreflexia, bilateral Babinski sign, gait and limb ataxia
|
39,020 | 107,129 |
the Medical Research Council scale) in proximal upper and lower limb muscles, with normal distal strength. He had reduced vibration sensation at the big toes, which normalized by the ankle. Joint position sense was normal and sensation to pinprick was normal throughout. Nerve conduction studies and electromyography demonstrated a mixture of a diffuse predominantly axonal, but mixed axonal and demyelinating, sensory-motor peripheral neuropathy, along with evidence of a proximal myopathy (small motor unit potentials with early recruitment in proximal muscles).\nHe saw his gastrointestinal specialist and additional bloodwork including those measuring vitamin levels was performed. He was found to be anemic with a hemoglobin of 129 g/L (normal 140–180 g/L) and deficient in magnesium at 0.40 mmol/L (normal
|
upper and lower limbs with relative sparing of his distal leg, forearm, and hand muscles. There was moderate weakness (4/5 on
|
40,746 | 51,483 |
Mycoplasma or Ureaplasma infection and she was started on levofloxacin and doxycycline. Culture growth morphologically consistent with Mycoplasma species was recovered from all 9 intraoperative specimens (brain tissue, scalp, fluid aspiration) submitted for culture on readmission, and Mycoplasma hominis was eventually identified using 16 s ribosomal DNA sequencing. Susceptibility testing was requested, but unable to be obtained.\nHer aphasia improved significantly 2 days after starting appropriate therapy. She was ultimately sent home to complete an 8-week course of levofloxacin 750 mg daily and doxycycline 100 mg every 12 h, and a 6 week course of daptomycin 10 mg/kg IV via PICC line. A follow-up MRI brain 1 month after completion
|
cultures (CDC anaerobic agar), however Gram staining of the possible colonies was negative. Colonies on CDC anaerobic agar from approximately day 6 of culture are shown in . Upon further review of cultures from the previous admission (collected 1 week prior), these pinpoint colonies were also identified. These findings of fastidious growth and inability to stain organisms with Gram stain raised suspicions for
|
37,380 | 32,256 |
(HIV), not on highly active antiretroviral therapy (HAART) for the last two years, presented to an outside emergency department with a three-week history of subjective fever, arthralgias, myalgias, and a diffuse painful papular upper body rash. The rash had progressed from his trunk to involve his face, arms, and upper legs. He reported painless genital lesions preceding the diffuse rash, as well as two unprotected sexual encounters approximately one month prior. The patient took no home medications and had no known medication allergies. In the emergency department, he was found to have
|
a temperature of 100.9°F, a heart rate of 130 beats per minute, and a respiratory rate of 22 breaths per minute. Urinalysis was not suggestive of infection, and chest radiograph demonstrated no infiltrate. Blood and urine
|
25,606 | 53,229 |
status, and the patient was thus continued with the original management plan and was asked to visit hospital if there was any aggravation of symptoms. Through the fourth week of illness, there was aggravation of clinical features with frequent drops in oxygen saturation noted overnight and generalized weakness, and cramps especially in the lower limbs. By the end of the first month of illness, the patient was afebrile with resolution of most of the symptoms including improvement of appetite and return of sense of smell and taste, but the body aches and muscle weakness further aggravated. This was when serological tests were performed for SARS-CoV-2 that showed strong IgG positivity
|
with negative reaction for IgM, presented in Table . The patient had normal d-dimer, elevated C-reactive protein (23 mg/L), normal liver enzymes, and normal renal profile.\nAs presented in Table , in a span of 5 days, the patient’s condition deteriorated with development of flaccidity in all of the upper and lower limb muscles, demonstrating 1/5 power
|
19,080 | 1,782 |
was made, tumor was identified which was light silver in color and attached to the spinal cord (Fig. ). A careful microsurgical dissection was done to separate the tumor from the spinal cord. There was an identifiable plane between tumor and the cord which facilitated safe removal of the tumor, with the exception of certain areas
|
laminectomy for partial excision of the tumor was done for tissue diagnosis. Once the lesion was determined to be a pilocytic astrocytoma, a decision was made to proceed with an extensive resection of the tumor. The residual tumor was removed in two stages. In the first surgery a multilevel laminectomy was done from T4-T10. After a midline dural opening
|
15,572 | 141,113 |
moderate respiratory embarrassment in the form of using of intercostal muscles of respiration along with subphrenic recession. Bowel sounds were absent. His pulse rate was 122 per min and blood pressure was 90 mm Hg systolic, which improved to 110/80 mm Hg after fluid resuscitation in the emergency room. His respiratory rate was 34–36 per min and pulse oximetry saturation was 92–94%.\nBlood investigations were unremarkable. Blood gas analysis showed mild hypoxemia (paO2 72 mm Hg on a fractional inspiratory oxygen concentration
|
was unable to pass stool or flatus and had several episodes of non-bilious vomiting. There was no referral note with the patient, hence further details of clinical findings and treatment were not available.\nOn examination, he was febrile but hemodynamically stable. There were two left ICDs in the left hemithorax draining turbid, foul-smelling contents. Air entry was decreased on the left side of the lung, which was radiologically found to be due to the presence of abdominal viscera and fluid in the left hemithorax. There was abdominal tenderness with guarding and rigidity and
|
4,236 | 50,156 |
days she developed refractory respiratory failure and VV-ECMO was initiated. Consecutive CT scans showed a large bronchopleural fistula of the right lung, multiple abscesses and lung parenchyma which at that time was regarded as being destroyed (Fig. a). The patient continued to deteriorate and due to the ongoing septic profile, she was referred to our center where the proposal was made to perform a bilateral pneumectomy and then clear the infection, whilst keeping the patient on ECMO until such time
|
as bilateral lung transplantation was possible [].\nAt the time of admission to our ICU, 35 days after intubation, the patient was in respiratory
|
19,074 | 63,277 |
walking due to dizziness and visual impairment as well as difficulties concentrating during the interview. A neurological evaluation revealed vertical gaze palsy, extrapyramidal type increased right body side muscle tonus, involuntary stereotypical movements (purposeless raising and lowering of the left hand), weaker reflexes on the left side and ataxic gait. Arterial blood pressure was 160/90 mmHg. Ophthalmologic examination revealed severely impaired vision, a disability to distinguish between light and darkness, without any congestive changes in the retina. The evaluation of mental state revealed typical symptoms of organic brain disease: disorientation in time, slower thought processing, concentration difficulties and disturbed short-term memory. Mini-Mental State Examination score 20/30 revealed dementia with moderate cognitive decline, two in date and two
|
dizziness, impaired memory, insomnia, emotional lability, the possible causes were differentiated among cerebrovascular and somatoform/conversion disorder. As the symptoms progressed significantly, on the 7th week after the onset of symptoms, the patient was referred to the University Hospital. Clinical course of the disease and the major diagnostic tests are presented in Fig. .\nDuring the hospital admission the patient complained of weakness, difficulties standing up and
|
20,865 | 203,139 |
styloid processes, which was ~6.3 cm in length on the right side and 6.1 cm on the left side ().\nSubsequently, CDFI depicted a long hyperechoic bony structure on the right side of the neck (), located between the base of skull and the ICA compressing the ipsilateral ICA causing visible artery stenosis (). Blood flow velocity in the ICA dramatically increased when the patient slowly turned his head to the right (), which was significantly altered compared with the normal position ().\nTCD was then used to monitor
|
hemodynamic changes of the bilateral middle cerebral artery (MCA) in real time. Even when the patient was in a normal position, blood flow velocity in the right MCA was lower than in the left, but, nevertheless, remained in the normal range (). When the patient turned his head to the right, blood flow
|
15,019 | 52,830 |
girl was referred to our center with an Ewing sarcoma of the proximal humerus. Initially, she underwent curettage and cementation at an outside center for a pathological fracture of what was thought to be a benign cyst. The tumor progressed, and a biopsy showed Ewing sarcoma, which was confirmed by FISH for EWSR1 rearrangement, involving the proximal humeral metaphysis and epiphysis (Figure ). She was treated with neoadjuvant chemotherapy consisting of vincristine, cyclophosphamide, doxorubicin, ifosfamide and etoposide, and proton radiation therapy because of the soft-tissue contamination. A FVET was planned supplemented with a fresh frozen allograft and
|
rotator cuff.\nThe proximal humerus was approached using an extended deltopectoral approach, and an intra-articular resection of the
|
36,423 | 58,808 |
of the cervix showed a benign tumor (Figure ). Plasma cells were infiltrating the leiomyoma, indicating an inflammatory reaction. These findings were like the lymph node findings, indicating a relationship between the two disease processes.\nTwo weeks postoperatively, the results of the amyloid confirmatory tests returned. The lymph node specimens were evaluated with Congo red Staining to confirm the diagnosis of amyloid deposits. However, the results were inconclusive due to the limited tissue quantity. Light chain testing revealed a polyclonal B cell population
|
with no atypia or abnormal mitoses.\nUpon follow-up several days later, the patient returned to the clinic for removal of skin staples and review of pathological findings. One month
|
12,320 | 108,954 |
was performed through the anterolateral “soft spot” arthroscopic portal site4, and fluid was seen extravasating from the wound after 30cc of normal saline was injected ().\nHe was admitted overnight for continued antibiotics (IV Ancef 40 mg/mL every 8 h) and surgical arthroscopic irrigation and debridement the next morning. For the procedure, the patient was positioned supine with the elbow
|
across the chest. The posterior arthroscopic portal was established as well as the anterolateral arthroscopic portal with 2.7 mm cannulas []. Three liters of normal saline irrigation were run through the joint and the wound with gentle curettage debridement. The small bony fragment was deemed non-viable and excised. The wound was
|
30,080 | 38,832 |
32-year-old African American male presented to our hospital with a generalized skin rash for the past 3 days. He developed a productive cough, sore throat, and fever one week prior to developing this rash. He also noted rhinorrhea and pink eyes with visual blurring and was prescribed erythromycin eye ointment by a physician. The rash appeared one day using the ointment and was described as a nonpruritic,
|
painless eruption of “bumps” starting on his back and rapidly spreading over his chest and hands. The rash progressed over 3 days and he experienced swelling of both eyelids along with blistering and crusting
|
41,765 | 11,726 |
high fever and subcutaneous abscess of the same limb suddenly developed again.\nAs a result of this puzzling clinical course, especially the fact that multiple species, including oral indigenous bacteria with a polymicrobial pattern, were detected in cultures of blood and the wound abscess (Fig. ), we finally suspected the possibility of self-injury. A psychiatrist was consulted and gave sufficient explanation to our patient and her family to persuade them to cooperate in diagnosing
|
such as acute fever and extensive skin eruption, occurred, so we switched to minocycline instead. Hyperbaric oxygen therapy was also performed nine times against the refractory soft tissue infection to improve neutrophil functions []. At the end, these multidisciplinary treatments allowed her to consider discharge, however,
|
43,581 | 115,097 |
(until the cement-enamel junction). For the supragingival zone, after etching with phosphoric acid (37%) and adhesive application (Scotchbond®, St. Paul, USA), a microhybrid composite (Spectrum®, Dentsply, USA) was used []. Special burrs and micro
|
discs were used for polishing, and the flap was sutured [].\nRecall visits were scheduled at different intervals. Satisfactory periodontal healing was observed on the buccal site. Gingival inflammation and food impaction have disappeared 1 month after surgery [];
|
40,772 | 23,553 |
endotracheal tube was advanced past the resection site into the caudal segment. The preplaced 4-0 prolene appositional sutures were tightened and were tied off in order to obtain tracheal segment apposition. 4-0 polypropylene sutures were used in a simple interrupted pattern to complete the anastomosis. The dorsal tracheal membrane was friable and did not hold sutures well creating a small tracheal tear. A 1 × 2.5
|
cm segment of the sternohyoid muscle was harvested and placed over the dorsal aspect of the trachea to reconstruct this defect. This was sutured in place using simple interrupted 4-0 polydioxanone. The endotracheal tube was deflated, repositioned cranial to the tracheal incision, and reinflated.
|
2,800 | 16,609 |
childhood. She complained of shoulder pain and restriction of activity in daily life (ADL) during shoulder movement due to shoulder instability. There was no abnormal finding from radiological examination. There were no psychiatric diseases. She could dislocate her bilateral shoulder joint voluntarily. Her chief complaint was the bilateral shoulder discomfort and instability during writing motion. On her first examination by a doctor, she was treated conservatively, using the exercise program for 6 months []. On her second examination by a doctor at another hospital, she was also treated conservatively, adding an orthosis for MDI to the
|
exercise program (intervention A) []. The patient received an explanation about this report and provided informed consent that complied with the Declaration of Helsinki.\nThe patient had a slight build with a height of 156 cm and weight of
|
16,228 | 19,824 |
The antibiotic course was converted to intravenous ertapenem for one week. MRI of the cervical spine following the full seven-week course of antibiotics showed spinal cord myelomalacia and cord atrophy from C4 to C7 without further evidence of fluid collection or cord compression (Figure ).\nAt this time, the erythrocyte sedimentation rate (ESR) was noted to have decreased to 32 millimeters per hour, down from 41 millimeters per hour and the C-reactive protein (CRP) to 7.8 milligrams per liter, down from 208.9 milligrams per hour. Dental surgery was consulted during the hospital course who recommended multiple dental extractions in an outpatient setting. The patient was discharged to physical medicine and
|
and metronidazole, the patient developed a skin rash consistent with drug eruption with biopsy showing evidence for leukocytoclastic vasculitis.
|
11,936 | 60,080 |
other urinary or gastrointestinal symptoms. On retrospective review, she admitted to experiencing skin flushing once a week and palpitations and hot sweats but denied diarrhoeal symptoms. She was otherwise fit and well, and her only past medical history was of long-standing migraines for which she took zolmitriptan. She had never smoked and had no family history of renal or other neuroendocrine tumours. On examination, she had a palpable and minimally tender right-sided mass.\nAn ultrasound and subsequent
|
computed tomography (CT) scan were arranged, which revealed a 14 cm mass arising from the upper pole of the right kidney (Fig. ). The tumour was abutting, but not invading the liver, and no evidence of metastatic spread was seen, either in the liver or elsewhere. Pre-operative blood workup revealed normal renal and liver function and mild
|
3,897 | 118,013 |
oral orifice of the FS by bending up a curve. At that point of time, the oral part of the FS was still outside the body. By bending the FS outward at the level of percutaneous stoma and pulling the jagwire at both ends – one end was below the level of percutaneous stoma, the other was beyond the mouth – the FS flipped with its upper part over the soft-tip stiff DLET into the upper
|
membrane of the cut FS behind. Over this jagwire, this above-mentioned soft-tip stiff DLET was introduced for more stability and dragged out of the new stoma of the cut FS. Then, the distal jagwire was introduced into the
|
11,448 | 125,359 |
three-month-old boy was admitted to our department with a three-week history of easy irritability and poor oral intake. He had an uneventful vaginal delivery in August 2005. However, there was a mild scalp bulge, suspicious of a cephalhematoma. A computed tomography (CT) scan of the head showed a widened foramen rotundum and an abnormal density in the right cavernous sinus (). The boy was discharged home since he did not exhibit any abnormal neurologic signs. Two months later, the boy presented again with poor oral intake, easy irritability, and insomnia during the night. An MRI scan of the head showed a large cystic lesion filling the entire middle
|
cranial fossa, compressing the right temporal lobe. There was also evidence of a relatively small solid portion of varying signal intensity; this area enhanced heterogeneously after the administration of intravenous contrast medium. The
|
42,919 | 81,838 |
device did not open in the mitral chordal apparatus (). It was then withdrawn toward the interventricular septum. After further satisfactory echocardiographic evaluation of septal alignment, the RV disc was also deployed and the device was released from the delivery cable ().\nBoth TEE () and left ventriculography () confirmed good placement of the device with no detectable residual shunt, demonstrating good device size selection. The patient showed immediate significant symptomatic improvement. He was transferred to the coronary care unit, and discharged seven days later. As of the date of this case report, the patient is alive and feeling well with no residual shunt detected by transthoracic echocardiography. No procedure-related complications have
|
the LV cavity over the wire and the dilator and the wire was carefully removed. A 20-mm Amplatzer PIMVSD device (AGA Medical) was used. The occluder device was then delivered to the LV. The device was extruded from the sheath until the LV disc was opened under echocardiographic guidance to ensure that the
|
34,629 | 93,700 |
examination did not reveal any crackles or wheezing. The remainder of the examination was also within normal limits. Spirometric assessment revealed an FEV1 of 2.59 liters (104% of predicted) and FVC of 3.83 liters (113% of predicted). However FEV3/FVC ratio was reduced suggesting mild obstruction in the mid-flow range. His chest radiograph (CXR) showed a pattern
|
having fevers, night sweats, chest pain, shortness of breath, orthopnea or unintentional weight loss. On physical examination, his vitals revealed a blood pressure of 123/73, pulse of 68/minute, respiratory rate of 17/minute and temperature of 97.8 Fahrenheit. Pulmonary
|
33,658 | 52,983 |
These findings were thought to be an aneurysmal bone cyst, mucocele, mucopyocele, or other sinonasal tumors.\nHowever, upon careful study of the imaging, AFS was considered due to the heterogeneous nature of the content, the bony expansion of the lesion in the CT scans, the low signal intensity on T2-weighted images, and the heterogeneous high signals on T1-weighted images (Figures -).\nShe was then assured and counseled for surgery. The patient had a routine and unremarkable preoperative assessment and then underwent functional endoscopic sinus surgery, polypectomy, and septoturbinoplasty (resecting whole middle turbinate) under general anesthesia.\nIntraoperatively,
|
of the paranasal sinuses. These reports commented on a bony nasal lesion measuring 1.7 × 3.7 × 3.0 cm and arising from the left skull base. The lesion was obstructing all ipsilateral paranasal sinuses with complete opacification and displacing the nasal septum to the contralateral side. Fortunately, there was no intracranial or orbital extension. No comments were made regarding heterogeneous opacification.
|
31,891 | 101,886 |
citrulline while awaiting results (, ).\nTargeted DNA Sequencing looking for SLC7A7 gene variants was ordered, and was negative for any pathogenic mutations. However, deletions, duplications and intronic variants will not be detected by this testing. LPI can be caused by deletion or duplication of SLC7A7 in approximately 15–20% of patients; however, a deletion/duplication assay could not be obtained []. Biopsies of the middle and distal esophagus, stomach, duodenum, terminal ileum and ascending and transverse colon were significant only for a focal increase in lamina propria eosinophils in the duodenum. Liver biopsy was significant for moderate to severe steatosis of the parenchyma, focal mild cholestasis, mild inflammatory infiltrate with scattered eosinophils and fibrosis. Both an upper GI series
|
distension and pain following an additional episode of rectal prolapse. The 60 most common CFTR mutations were tested at this time and were all negative. Plasma and urine amino acids were collected and the patient was started on empiric
|
26,302 | 46,638 |
the patient displayed flexion deformity in all fingers at the distal interphalangeal joint. The skin of the hands and knuckles was hyperpigmented. Both elbow joints and the third and fourth fingers on the right side had subcutaneous nodules on the dorsum ().\nThe X-rays showed loss of bone mineralization of the involved joints, decrease in joint space and resorption of
|
phalanges. Cortical thinning and expansion of the phalangeal and metacarpal bones was a distinct finding. The rest of the skeleton showed a lesser degree of osteopenia. The immunological and hematological reports were normal except for a high erythrocyte sedimentation rate (20 mm at 1 hour). Phenotypic characteristics and biochemical values are depicted in and .\nAbdominal ultrasonography (US) was unremarkable except for a small-sized uterus (21.4 x 12.1 x 6.4 mm). The ovaries were slightly enlarged and measured as:
|
8,458 | 23,063 |
for any brainstem lesions and was unrevealing. The levels of thyroid stimulating hormone and skeletal muscle enzymes were normal. She was diagnosed with right BP and started on acyclovir and steroids, and discharge orders were placed.\nBefore being discharged, she began to develop slurred speech, hoarseness, and an increase in her right facial weakness which was now accompanied by mild ptosis. She was admitted and underwent a bedside swallowing evaluation, which was abnormal. A
|
diplopia or ophthalmoparesis, even after sustained upward gaze. The computerized tomography (CT) angiogram of the head and neck along with the remainder of her stroke work-up were also unremarkable. A magnetic resonance imaging (MRI) of the brain was performed with and without contrast to evaluate
|
18,820 | 34,254 |
examination revealed the presence of an elongated hard mass, located on the proximal medial side of the right upper arm. There was also right thenar eminence atrophy, defective apposition of the right thumb and incomplete flexion of the index and middle fingers. The patient underwent a full-body PET-CT scan. This revealed abnormal FDG-avid activity in the anatomical location of the median nerve in the right upper arm (Fig. a i, ii). No other lesions were identified. MRI revealed enlargement of the median nerve with abnormal signal intensity after IV contrast administration (Fig. b i, ii). Cerebral spinal fluid (CSF) examination showed normal protein and
|
time. The patient was treated with a methotrexate-free regimen consisting of six cycles of R-CHOP and achieved a complete remission (CR). Three months post-CR, the patient presented with pain in the right axilla, extending to the thumb, index, middle fingers and median half of the ring finger. Hyperesthesia was present in the palm of the right hand, along the sensory distribution of the median nerve. The pain rapidly worsened and hampered daily activities involving the right upper limb. Clinical
|
2,752 | 79,317 |
bearing bone, extracorporeal irradiation of excised bone segment to eradicate the tumoral cells, and reimplantation of the autograft with preservation of the elbow joint. We resected 10 cm of the humerus, stopping 2 cm from the elbow joint and dividing the bone a further 10 cm proximal to this. We then stripped the tumor from the bone surface and underlying intramedullary canal using osteotomes, curettes, and a burr. Samples were sent for histology and microbiology. The humerus segment was wrapped in a sterile moist swab immersed in saline containing 2 grams of vancomycin and placed in a sterile bag. This was placed in another sterile bag
|
and was securely packed in a sterile container. This container was taken to the radiotherapy suite, where the segment bone was irradiated with 90 Gy, and the container was returned to the operation theater. Transport and irradiation took about one hour, during which time the host bone was prepared for reconstruction. The irradiated humeral segment was reimplanted, inserting a nonvascularised fibular autograft
|
8,886 | 176,442 |
treated with pulse methylprednisolone (250 mg/day for three days) and then with maintenance dose prednisone (50 mg/day). Serum creatinine decreased in a few days and so did his serum calcium. Since the episode of acute kidney injury the patient has been followed at our unit and at the unit of Cardiology. Renal function returned to normal (serum creatinine 1.1 mg/dl, eGFR 91 ml/min/1.73 m2) and heart function markedly improved over the following two years (EF 49% vs 37% vs 32% vs 23%). The diuretic and cardiologic therapy was significantly
|
within the granulomas. A diagnosis of granulomatous interstitial nephritis due to sarcoidosis was made.\nWhen the patient was called to discuss his kidney biopsy, his serum creatinine had further increased (3.5 mg /dl), eGFR 22 ml/min/1.73 m2 and so had his serum calcium (13.3 mg/dl), serum albumin 4.06 g/dl. For this reason, he was hospitalized again and
|
11,783 | 191,392 |
second week, she complained of nonradiating chest pain located at the midsternal region, shortness of breath, and worsening fatigue. She went to a hospital where she was admitted. Her initial vitals were significant for low to normal blood pressure and a persistent tachycardia of up to 110. EKG was negative for any acute changes and a CT-PE was also negative for pulmonary embolism but showed a
|
moderate size pericardial effusion. She was given fluids with no change in the blood pressure, and she continued to remain hypotensive and tachycardic and was eventually transferred to another hospital for concerns of a cardiac tamponade. At the other hospital,
|
16,625 | 140,095 |
Mitosis and necrosis were present. The immunohistochemistry results of neoplastic cells revealed positive for CD117 and placenta alkaline phosphatase [], but negative for CD3, CD20, and synaptophysin immunostains. Germinoma was diagnosed based on the morphology of the tumor cells and the result of immunohistochemical stains. Based on the histological diagnosis of the tumor, whole spine MRI was checked, which disclosed no evidence of abnormal enhancing mass lesion. Although her immediate postoperative brain MRI showed no evidence of abnormal enhancing mass lesion, or abnormal
|
this tumor was removed in piece-meal fashion with the aid of Cavitron Ultrasonic Surgical Aspirator (CUSA). Intraoperative frozen section of the specimen reported “malignant tumor”, therefore, we tried to achieve maximum tumor resection. Histology examination showed that the specimen composed of sheets of large anaplastic cells divided by delicate fibrovascular septa with small lymphocytes [].
|
12,274 | 54,350 |
in Cranial software, we used the Spine software to allow an automated registration of the O-arm images.\nThe intraoperative imaging was done with O-arm (Medtronic Inc., Louisville, CO, USA) and 3D images (slice thickness was 0.833 mm, tube voltage 100 kV, tube current 80 mA and imaging time 13 s) were automatically transferred into navigation system.\nThe patient was set in a prone position
|
with his head fixated using the carbon fibre frame (Fig. ). After the O-arm imaging and navigation (Fig. ), an L-shaped skin opening was made in the midline extending to the right side. After opening of the soft tissues, the lambdoid suture and the bullet were located using navigation
|
27,340 | 98,804 |
g/L) were within normal limits.\nUpper gastrointestinal endoscopy was performed and revealed an ulcero-infiltrative growth in the antrum occluding the pylorus. There were no esophageal or gastric varices. Histopathologic examination showed poorly differentiated adenocarcinoma. There were no Helicobacter pylori or intestinal metaplasia.\nFor staging purposes, an abdominal CT scan was performed and showed irregular wall thickening of the antral wall and the pyloric channel associated with lymph nodes along the lesser curvature of the stomach (Fig. ). There was a hypervascular mass lesion in the hepatic segment VIII (50 × 30
|
mm) with enhancement during the arterial phase and washout during the venous phase, adjacent to the hepatic veins and the inferior vena cava, suggesting the diagnosis of HCC with no imaging features of livercirrhosis.CT scan of the chest
|
1,139 | 87,906 |
all five lobes (). Extensive microbiological studies were performed with no positive bacteriologic, viral, or fungal isolates. The only positive test was a mildly increased DNA load of Epstein-Barr virus (EBV) in blood with 0.5 copies per microliter detected by a quantitative PCR assay. EBV capsid IgG and nuclear antigen/antibody were positive. Peripheral blood smear showed mild normocytic anemia with moderate thrombocytopenia. White cells count was within the normal range with absolute lymphopenia and no atypical lymphocytes or lymphoma cells.\nAs his condition deteriorated, he developed signs of cardiac tamponade. Pericardial effusion was drained and sent to the pathology laboratory. He developed uncontrollable ventricular fibrillation with subsequent cardiac arrest, which could
|
sphenoid and left maxillary sinuses. A nasoenteric tube was in place in nasal cavity. There was no mass lesion, erosion, or bone destruction. These finding were most consistent with mild inflammatory changes ().\nSepsis was suspected and he was given antibiotics without improvement of his clinical condition. His condition rapidly deteriorated with progressive dyspnea and pulmonary infiltrates which by X-ray examination involved
|
1,474 | 71,828 |
case of hypercapnic respiratory distress and loss of consciousness resulting from transient phrenic nerve palsy associated with supraclavicular brachial plexus block. Interscalene brachial plexus block almost invariably causes ipsilateral phrenic nerve palsy []. However, it is thought to occur less frequently with brachial plexus block via the supraclavicular approach, depending on the amount of local anesthetic used and the techniques employed (e.g., nerve stimulator or ultrasound guidance).
|
Respiratory symptoms are uncommon during the brachial plexus block irrespective of the approaches [].\nWe detected hemidiaphragmatic paralysis in this patient with hypercapnic respiratory distress by means of bedside ultrasonography. There
|
21,358 | 75,918 |
woman was admitted to the hospital after experiencing acute visual deficits. Her symptoms resolved within 24 hours and were consistent with a transient ischemic attack (TIA). The patient's past medical history was significant for paroxysmal atrial fibrillation, migraines, and hypertension. Prior medical records indicated that she was taking 325 mg of aspirin once a day for paroxysmal atrial fibrillation. The patient did not take any additional medications. Her family and social history were unremarkable. On physical exam, her blood pressure was 170/116 mmHg and heart rate was 88 bpm with a respiratory rate of 20 and oxygen saturation of 98%. The patient had an irregularly irregular heart rate
|
and rhythm with a soft midpeaking systolic murmur best appreciated at the right upper sternal border. No carotid bruits were appreciated. An electrocardiogram showed atrial fibrillation with a ventricular rate of
|
34,771 | 113,035 |
in the posterior and outer basal segments of the lower lobe of the right lung were slightly smaller on May 16. A percutaneous lung biopsy was performed on May 21, 2018. The right lower lung biopsy showed a chronic inflammatory lesion but no granuloma or neoplastic lesion. Immunohistochemistry with PAS and acid-fast staining showed that the chronic inflammatory lesions were negative. After the admission of the patient and after considering an infection in the lung, the dosage of prednisone was
|
171.23 mg/L, the erythrocyte sedimentation rate was 70 mm/h, and serum procalcitonin was 0.707 ng/mL. The serum was positive for AIGAs. His plasma HIV antibody, blood culture, beta-D-glucan, GM and Cryptococcus latex agglutination tests were all negative. The lesion in the right upper lobe was still present, and the high-density lesions
|
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