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43,971 | 137,608 | paresthesia of lower extremities for 3 days. There was no underlying diseases or history of trauma. He went to the clinic and took home some medicine. Three days later, the patient developed dyspnea, generalized seizures, and subsequent loss of consciousness. He was sent to the emergency department of the local hospital and intubated promptly. A few minutes later, the patient had a cardiac arrest. Immediate cardiopulmonary resuscitation was performed nine times until the presence of vital signs. Computed tomography (CT) scan of the brain was obtained and showed a hyperdense lesion in the dorsal region of the left-sided | of the medulla oblongata, corresponding to medullary hemorrhage []. The patient was sent to the intensive care unit for close observation until clinical stable. Ten days later, the patient was sent to another larger local hospital. Following day, magnetic resonance imaging (MRI) of the brain revealed diffuse hyperintensity of the medulla oblongata on fluid-attenuated inversion recovery and T2-weighted sequences, corresponding to venous congestion or edema of the medulla. There were multiple dilated flow voids surrounding the medulla, more prominent |
21,963 | 104,989 | and Para II mother came to the outpatient clinic of the University of Gondar specialized hospital, North West Ethiopia, in January 2019 complaining of pruritus (mainly under the breasts, on the neck, palms of the hands and soles of the feet) along with jaundice at 24 weeks gestational age (GA). She had a history of antenatal care follow up at a nearby health center. She presented to us with singleton and intrauterine pregnancy.\nOn arrival, she was screened for both subjective and objective data for her current and past obstetric, medical, surgical, gynecological, social, personal and family history. | She had a history of early neonatal loss and one living child, her bilirubin value was elevated, she suffered pruritus and hepatomegaly in her previous pregnancies. She had a personal and family history of pruritus during pregnancy. From her previous personal history, she reported a history of |
2,074 | 46,231 | carefully divided, and the nerve was followed until it appeared healthy and branched into the extensor muscles of the forearm and thumb.\nDuring the course of his outpatient followup, the patient's left antecubital fossa demonstrated a well granulating wound; however, a contracture over this area limited the range of motion about his elbow to 25 degrees short of full extension. | posterior interosseous nerve extending beneath the supinator itself.\nThe recurrent radial artery and its accompanying veins were divided. The posterior interosseous nerve was then traced in its course and was found to be crushed with abundant scar tissue around it. The scar was |
4,541 | 6,869 | with biopsy was performed, which showed necrotic tissue with rare crushed degenerating atypical cells. A screening chest CT scan was also obtained which showed a small 3 mm nodule in the lower lobe of his left lung. A follow-up interventional radiology-guided left kidney biopsy showed a cellular neoplasm with sheets of pleomorphic round cells with hyperchromatic nuclei, irregular nuclear outlines, and inconspicuous nucleoli with scant and delicate cytoplasm which is consistent with SCC. The tumor cells were positive for the neuroendocrine markers synaptophysin and CD56 with focal staining for chromogranin and dot-like positive staining for cytokeratin (AE1/AE3), supporting the diagnosis of SCC (Fig. ). A | was admitted to the Emergency Department with nausea and vomiting. He was tachycardic to 110 beats per minute but maintained a normal blood pressure. His laboratory results were notable for hemoglobin to 12.1. His sodium was 134. At that time, a CT scan of his abdomen and pelvis showed interval enlargement of the left renal mass. An ureteroscopy |
23,036 | 28,560 | previous history of trauma was admitted to the hospital for intermittent claudication of the right lower limb for more than 1 month. The patient did not have resting pain or numbness in the lower extremities, and the claudication distance was about 100 m. The clinical history of acute myocardial infarction was evidenced by percutaneous coronary intervention (PCI) via the radial approach 6 months ago, and one stent was implanted. After the operation, the patient took aspirin and clopidogrel regularly. The | patient had a history of smoking and drinking but did not have hypertension, diabetes, and family genetic disease. Physical examination revealed that the right common femoral pulse was palpated, but popliteal pulse and anterior |
39,682 | 81,507 | eight hours. The ED team reported that a hyphaema was present with ‘bleeding through the pupil’. The patient described reduced vision after waking that morning, which progressed during the day. She reported severe pain (6/10) and aching in the right eye, which extended ipsilaterally down to her neck and was associated with dry retching every 30 min. She denied any previous similar episodes.\nShe was on Warfarin for recurrent pulmonary emboli and had recently been prescribed intravenous Ceftriaxone and subsequent oral Cefaclor for cellulitis of her right | leg. Her general health had been complicated by a cerebrovascular accident 30 years earlier following a ventriculoperitoneal shunt revision originally performed for pseudotumour cerebri. She had treated hypothyroidism and hypertension.\nHer right visual acuity was light perception and left was 6/9. The right pupil response to light was sluggish, but due to her long-standing |
41,267 | 89,118 | The prognosis is usually poor.\nCCAM is most commonly found in the neonatal period and up to 90% of diagnoses are made within the first two years of life [,].\nThe adult form of CCAM shows a wide radiological expression with extreme difficulty of preoperative diagnosis []. Some authors reported very unusual findings like the involvement of an entire lung lobe [] or the presentation as a single large well defined cyst of more than 5 cm in diameter []. The disease may be asymptomatic, diagnosed by means of a routine chest radiograph [], may be a surgical chance finding in | the study of an extrapulmonary disease [] or may be revealed by a lung inflammatory process [,]. The histological description lacks in almost all the reported cases in the literature, and the lesion is |
27,890 | 133,327 | excess alcohol consumption (more than 100 g of alcohol daily) for over 20 years. He had been hospitalized 4 times in a 7-year period for symptoms of heart failure. He presented with dyspnea and azotemia and was managed with a continuous infusion of dobutamine and milrinone, along with continuous renal replacement therapy. On hospital day 33, he experienced cardiac arrest due to ventricular fibrillation and returned to spontaneous circulation after 4 minutes of cardiopulmonary resuscitation.\nTransthoracic echocardiography | showed decreased left and right ventricular systolic function (left ventricular ejection fraction, 30%; tricuspid annular plane systolic excursion, 8.5 mm). Severe mitral and tricuspid regurgitation were present. The inferior vena cava was dilated, with a diameter of 3.1 cm and associated plethora, and his right ventricular systolic pressure was 44.3 mm Hg. He also had severe cardiomegaly with pericardial effusion (). Because |
25,053 | 132,634 | 21-year-old man from the Indian Subcontinent experienced right sided, painless, sudden visual loss. He presented on the same day and his best-corrected visual acuity (BCVA) was 6/60 in the right eye and 6/6 in the left. His anterior segment examination was unremarkable and his intraocular pressure was 17 OD and 15 OS. On fundoscopy, we found a recent cilioretinal artery occlusion on the right and a normal left fundus. White retinal oedema was present along the artery course leading into the fovea. No thrombi were seen within the artery lumen. The optic discs were healthy bilaterally and there were no other peripheral retinal or vascular lesions. No signs of | inflammation were found in the anterior or posterior chamber.\nHe had normal eye movements and a neurological examination did not reveal any other signs of stroke. The patient was otherwise well with no other medical history. He was not taking any regular medication and there was no significant family history. He admitted to smoking |
22,050 | 24,349 | presented with pain (2–4 NRS scores) and difficulty in moving his left lower limb after a fall. He was diagnosed with a left femoral neck fracture, and surgery for the fixation of the left lower extremity with an intramedullary nail was planned. Preoperative interview revealed a history of tuberculosis and a subsequent pulmonary CT revealed severe tuberculous damage in left lung and diffuse lesions in right lung (Fig. ). Echocardiography showed significant pulmonary arterial hypertension (109 mm Hg). The patient was classified as American Society of Anesthesiologists (ASA) class III. Ultimately, we performed an ultrasound-guided SIFI block combined with a sacral plexus block. After | obtaining preoperative informed consent, sedation was initiated using an infusion of dexmedetomidine (1 μg/kg maintenance). Using all aseptic precautions, the anterior superior iliac spine (ASIS) was first palpated and a high frequency linear ultrasound transducer (UMT-400, Mindray, |
36,763 | 132,522 | man was admitted because of memory impairment. His past medical history included hypertension and angina of ten years duration, for which he had been placed on regular antihypertensive medication. The patient denied a history of diabetes mellitus, episodes of stroke, or neuropsychological symptoms. He had been educated for 12 years and had learned Hanja at school. His wife said he had no problems reading or writing Hanja before admission. During neurological examinations, he was fully conscious and had a Korean Mini-Mental State Examination score of 22/30. Deficits were observed | mainly in the domains of attention, calculation, and immediate memory recall. Interestingly, we found that he was unable to read or write Hanja, but could read Hangul. Hangul writing was partially impaired. In his wife's |
31,860 | 99,883 | weeks of gestation (only 15 weeks after surgery), the patient gave birth by cesarean delivery to a healthy baby with no signs of skin pathology.\nOne month after delivery and with no signs of recurrence of the primary lesion, the physical examination revealed the growth of the previously detected axillary mass. The positron emission tomography–computed tomography (PET–CT) demonstrated a hypercaptant lymph node conglomerate highly suggestive of metastatic disease (). Thus, 7 weeks after delivery the patient underwent complete right axillary lymph node dissection without intercurrences. Pathological examination of the specimen revealed metastases of SCC in four of the excised lymph nodes, with evidence of perineural invasion.\nDespite | of small lymphocytes and histiocytes, suggestive of reactive lymphadenopathy.\nThe case was discussed at the oncology multidisciplinary group, whose decision was amputation by the middle third of the forearm. The surgery was performed at 21 weeks of pregnancy and underwent without intra- or post-operative complications, with no signs of fetal distress. The histopathological examination of the surgical specimen showed a moderately differentiated SCC with invasion of muscle and tendon sheaths and signs of perineural invasion. The excision was complete.\nThe next few weeks were uneventful. Prenatal testing was performed and no genetic anomalies were found. At 36 |
41,881 | 158,203 | to treat by either a surgical or endovascular approach.\nHydrocephalus was diagnosed with computed tomography (CT) and treated with surgical placement of a ventriculoperitoneal shunt system in our hospital, and an uneventful follow-up period of 31 months. After the Enterprise stent system (Codman Neurovascular, Miami Lakes, FL, USA) became available, which is easier to deliver through the tortuous anatomy than other available stents, we planned a stent-assisted coil embolization of the PICA aneurysm. A follow-up cerebral angiography demonstrated a wide-necked aneurysm with a medially directed distal lobule (). The aneurysm measured 6.1 mm in the long-axis diameter, 2.7 mm in the short-axis diameter, and 3.3 mm in height. There was no significant interval change | in aneurysm size and shape. Because the left PICA coursed inferiorly, forming an acute angle with the proximal V4 segment of VA, it was decided that the Enterprise stent should be placed retrogradely with a contralateral (right) VA approach and coils should be placed into the aneurysm through the ipsilateral VA.\nThe patient was premedicated with 75 mg clopidogrel and 100 mg aspirin 72 hours before treatment. Under general anesthesia, we performed bilateral common |
30,587 | 205,171 | of fever and chills, as well as tachycardia and episodic hypotension. She was noted to have mild epigastric tenderness. There was no surrounding erythema, discharge, or tenderness noted around the tunneled dialysis catheter on the right anterior chest. Initial workup showed elevated troponin and procalcitonin. Chest X-ray findings were suggestive for left lower lobe pneumonia. Within the ER, the patient's hypotension resolved with fluid resuscitation and intravenous levofloxacin therapy was started with blood cultures drawn.\nCardiology was consulted for persistent elevation of troponins and it was presumed secondary | to impaired clearance in ESRD. Transthoracic echocardiography (TTE) was done to evaluate for endocarditis given the presentation of bacteremia and fevers. TTE revealed artifact noted on an abandoned ICD lead in the right heart concerning for possible |
6,774 | 56,830 | of 21, she was diagnosed as having major depressive disorder with psychotic features and controlled on citalopram and quetiapine. At the age of 22, the patient presented to the emergency department (ER) complaining of dizziness after suddenly losing consciousness lasting about 30 seconds noticed by her mother; she had up rolling eyes with muscular rigidity. There was no urine incontinence, memory loss, or salivation, and she was seizure-free for the past three years until one month before this visit as when she again experienced one episode of seizure. Furthermore, the patient gave a history of multiple teeth loss throughout her life, and | the age of one year, then tapered and discontinued at age of four years. During her childhood, she only had mild learning difficulties started at intermediate school, her school performance was challenging compared to her colleagues; however, she was able to finish high school and did not pursue higher education. Brain CT was normal initially. At the age |
7,785 | 172,429 | the stent graft, an attempt was made to access the internal iliac artery via the buttock. Direct sac puncture was not possible as the endoleak was located within the pelvis and surrounded by bony structures and pelvic viscera. The intention was to puncture the posterior division of the IIA but visualisation with ultrasound was limited and a vessel was punctured, which on subsequent angiography | was shown to be the anterior division of the left IIA (Fig. ). The left IIA was embolised using Spirali (Pyramed) coils in a retrograde manner. Due to the absence of a solid structure which to compress the access vessel against, especially as the anterior division of the |
41,812 | 98,010 | suffered from numbness and weakness of the limbs. She had no abnormalities on blood tests or physical examination and was accordingly suspected of having a psychological disorder. On the same day, she was examined at a psychiatric clinic. She was diagnosed with a functional neurologic disorder triggered by psychological stress, such as conflicts with her supervisor at her workplace and her parents. She was treated with the anxiolytic alprazolam (1.2 mg). She then developed symptoms such as numbness of the tongue, headache, and difficulty opening her eyes. She also complained that her vision was unfocused and | that she had noticed circular eye motions (nystagmus) in the mirror. The next day, she suddenly felt exhausted and was unable to walk unaided, whereupon she presented at the Department of Psychiatry. On |
7,852 | 47,100 | and tongue brushing three times a day followed by chlorhexidine mouthwash. The patient was then asked about whether she had prior history of allergic reactions in relation to the use or consumption of beehive products such as honey, bee pollen, or propolis. She confirmed that she never had any allergic reaction to any beehive product. The patient was then instructed to also apply the commercially available hydroglyceric propolis extract to the surgical wound three times a day for a week. In addition, the patient | were placed (Figure ). During the surgical procedure, minimal amount of bleeding from the site was observed. The specimen was then sent for a histopathological examination. After the surgery, the patient was instructed to keep the oral cavity clean by teeth |
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