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25,612 | 184,087 | accident, anoxic brain injury with permanent percutaneous endoscopic gastrostomy (PEG) tube and tracheostomy to ventilator was noticed to have a high peak pressure on the ventilator on a routine check by the nursing home respiratory therapist. Suctioning was attempted but was unsuccessful. The tracheostomy tube was changed and during the process, increased resistance was felt. Soon thereafter it was noticed that blood was leaking from around the tracheostomy tube. Emergency medical services were called and the patient was brought to | to ventilator was noticed to have a high peak pressure on the ventilator on a routine check by the nursing home respiratory therapist. Suctioning was attempted but was unsuccessful. The tracheostomy tube was changed and during the process, increased resistance |
10,344 | 202,736 | until the dura was exposed (). A dense mass from T10 to T12 was palpable from the dura layer. After we exposed the lamina, we observed that the dura was tense from touch, and a solid mass underneath the dura was palpable from T10 to L2. Intradural tumor excision was performed by a sharp 3 mm incision in the midline of the dura and then continued with blunt dissection, opening the dura layer to caudal L2 and to cranial T10. Dura was then parted with stay thread until the vessel-rich tumor mass was exposed. The tumor mass was excised, and | was exposed (). A dense mass from T10 to T12 was palpable from the dura layer. After we exposed the lamina, we observed that the dura was tense from touch, and a solid mass underneath the dura was palpable from T10 to L2. Intradural tumor excision was performed by a sharp 3 mm incision in the midline of the dura |
15,936 | 27,737 | sonographic Murphy’s sign (Figure ). The common bile duct was prominent measuring seven millimeters in diameter. A follow-up magnetic resonance cholangiopancreatography did not reveal a common bile duct stone (Figure ). Initial laboratory investigations were unremarkable, except for a mildly elevated alanine aminotransferase level (Table ). Upon admission, he was initially started on intravenous antibiotics and underwent a laparoscopic cholecystectomy the next day. Post-procedure his pain improved and he was eventually discharged home. Pathological studies of the surgical specimen were reported as acute on chronic cholecystitis | reveal a common bile duct stone (Figure ). Initial laboratory investigations were unremarkable, except for a mildly elevated alanine aminotransferase level (Table ). Upon admission, he was initially started on intravenous antibiotics and underwent a laparoscopic cholecystectomy the next day. Post-procedure his pain |
42,194 | 86,032 | was performed on the patient to be assessed for any sinus disease and showed mucosal thickening in bilateral maxillary sinuses and sinus orifice obstruction consistent with chronic sinusitis. Additionally CT scan showed bony nasal septal deviation to the right.\nPrevious admission was on 2013 (2 years ago) for repeated faint attacks, palpitations, and mild anemia, with normal ECG findings.\nOn system review, patient denied fever, runny itchy nose, nasal discharge, red or painful eye, shortness of breath, cough, chest pain, palpitations, rash, joint pain, mouth ulcers, bleeding PR/urine, menorrhagia, abdominal pain or change in bowel habits, anorexia/recent weight lose, sensory loss or weakness, and lumps or bumps or | nasal septal deviation to the right.\nPrevious admission was on 2013 (2 years ago) for repeated |
20,554 | 94,415 | and lymph node lesions continued to progress slowly (Figure ). Three weeks after radiotherapy, the first systemic treatment was initiated, consisting of sunitinib 50 mg per day. After two weeks on sunitinib, the patient presented to the emergency room with chills and reduced general condition. Fever (38.7°C), elevated C-reactive protein (CRP) level (235 mg/L), leukopenia (3.2 × 109/L) and thrombopenia (73 × 109/L) were found. Blood- and urine cultures were negative. Chest X-ray showed a | weeks after radiotherapy, the first systemic treatment was initiated, consisting of sunitinib 50 mg per day. After two weeks on sunitinib, the patient presented to the emergency room with chills and |
29,870 | 12,299 | doses. His prolactin levels were still high at the time of his discharge from the hospital. Urology was consulted in the hospital, and an aggressive bladder program was initiated with close follow-up planned with his primary care, urologist, and psychiatrist.\nThe differential diagnoses of hyperprolactinemia clinically depend on the level of prolactin.\nLow levels of hyperprolactinemia have found to be due to medications, hypothyroidism, and kidney problems. Clinical judgment, when encountered with higher levels of hyperprolactinemia (>200 ng/mL), calls for ruling out pituitary adenoma. Our patient had many medications that could potentially interact with each | level of prolactin.\nLow levels of hyperprolactinemia have found to be due to medications, hypothyroidism, and kidney problems. Clinical judgment, when encountered with higher |
41,438 | 134,594 | in the inferior wall of the left ventricle. There was a 0.9 × 0.8 cm focus of intraventricular thrombus adherent to the inferior wall.\nFurther imaging with computed tomography (CT) scan revealed multilobulated, heterogeneous enhancement within the right trapezius muscle, indicative of intramuscular metastatic disease, which likely explained her right shoulder pain. There were lytic lesions within the right clavicle. Metastatic lesions were present in bilateral lung apices. There was interval development of a centrally necrotic 3.7 cm left adrenal mass, indicative of adrenal metastatic disease, which was not present on prior CT | with computed tomography (CT) scan revealed multilobulated, heterogeneous enhancement within the right trapezius muscle, indicative of intramuscular metastatic disease, which likely explained her right shoulder pain. There were lytic lesions within the right |
24,092 | 149,237 | the Department of Prosthodontics, MGV Dental College and Hospital complaining of pain on the right side of the face near the ear, headache in the right frontal region and worn out previous removable partial prosthesis.\nThe patient did not report any systemic illness and past major illness. Patient gave the past dental history of extraction of maxillary posterior teeth 3 years back followed by immediate replacement of teeth by a removable partial denture.\nExtra oral examination of the patient revealed pain and tenderness in right side TMJ, deviation of the mandible to the left side on opening and closing and clicking in TMJ on both sides. On palpation, there was tenderness in the masseter and temporalis | Department of Prosthodontics, MGV Dental College and Hospital complaining of pain on the right side of the face near the ear, headache in the right frontal region and worn out |
42,750 | 69,492 | male presented with a progressive intermittent claudication of his right leg of 2-month duration. He is a nonsmoker and occasionally consumes alcohol. He did not have a past history of diabetes mellitus, hypertension, or dyslipidaemia. His right lower limb claudication gradually became worse over one month and he experienced right leg pain even on minimal exertion in walking few meters. For the last four months, he had an evening low grade fever, profound myalgia with loss of appetite, and a gradual weight loss of 8 kg. Two weeks before the admission he noticed a weakness of his right ankle with a rash on his right leg. He had no history | a progressive intermittent claudication of his right leg of 2-month duration. He is a nonsmoker and occasionally consumes alcohol. He did not have a past history of diabetes mellitus, hypertension, or dyslipidaemia. His right lower limb |
42,475 | 105,034 | School of Stomatology, the Fourth Military Medical University for treatment, with the chief complaint of recurrent swelling of the gum in the anterior teeth region and occlusal pain. Intraoral clinical and X-ray examination showed that the neck of the crown oftooth 21 was broken at the 1/3 position, white filling was seen on the fracture surface, probing (–), knocking (+), and no obvious | anterior teeth region and occlusal pain. Intraoral clinical and X-ray examination showed that the neck of the crown oftooth 21 was broken at the 1/3 position, white filling was seen on the fracture surface, probing (–), knocking (+), and |
38,713 | 81,550 | experienced a mild non-pruritic rash on his torso after the second infusion, which lasted one week and resolved with topical steroids. The aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase were mildly elevated at baseline (Common Terminology Criteria for Adverse Events [CTCAE] v4.0 Grade 1) and remained stable throughout the course of treatment. Total bilirubin was within normal limits at baseline and remained normal throughout the | and resolved with topical steroids. The aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase |
27,176 | 39,792 | (13.67 WBC x103) and anemia (RBC 3.42 x106, Hb 10.4 g/dL, Ht 30.8%). An immediate abdominal sonography confirmed the clinical suspicion of spontaneous rupture of the spleen with massive hemoperitoneum (Figure\n). The patient immediately underwent an emergency laparotomy. Intraoperative findings have been massive hemoperitoneum (approximately 3 L of blood and coagula) due to a two-step rupture of the spleen, with subsequent subcapsular hematoma and complete decortication, that required a | massive hemoperitoneum (Figure\n). The patient immediately underwent an emergency laparotomy. Intraoperative findings have been massive |
20,899 | 40,960 | up to his umbilicus and difficulty in walking for the previous 15 days. He had fallen from a tree 2 months earlier and had no bleeding fraction and an unremarkable shoulder X-ray. He experienced mild pain in his right shoulder and neck after the trauma, which was relieved through medication, and was sent home.\nA physical examination displayed a good physique and a normal body mass index. There was no visible or palpable stepoff in the spine, and no tenderness was observed around the area of fracture. A detailed neurological examination revealed that his upper limbs were | the trauma, which was relieved through medication, and was sent home.\nA physical examination displayed a good physique and a normal body mass index. There was no visible or palpable stepoff in the spine, and no tenderness was observed around the area of fracture. |
1,722 | 85,571 | were also performed (). Hematoxylin and eosin stain histological slide demonstrates characteristic giant cells ().\nApproximately 3 months after the giant tumor curettage and cementation, MRI and CT were obtained as a baseline. These studies demonstrated a new area of uncemented intramedullary cavity anterior to the cement (). Given the short interval since prior MRI (), findings are clinically thought to represent postoperative inflammatory change. Subsequent follow-up radiograph, which is approximately 4 months after the curettage and packing surgery, shows stable surgical change | a baseline. These studies demonstrated a new area of uncemented intramedullary cavity anterior to the cement (). Given the |
38,813 | 155,997 | Endodontics because of swelling in his left mandibular region. His medical status was noncontributory. According to the patient's clinical records, he reported a history of pain in the lower left side 1 month back. He consulted a general dentist, where caries excavation in the left mandibular first molar | patient's clinical records, he reported a history of pain in the lower left side 1 month back. He consulted a general dentist, where caries |
31,267 | 157,930 | increased to twice daily after 5 days and then three times daily after 10 days of initiation. She tolerated the treatment well until 19th day when she returned with high-grade fever, redness of eyes, swelling all over body, eruptions on lips, face in | 10 days of initiation. She tolerated the treatment well until 19th day when she returned with high-grade fever, redness of eyes, swelling all over body, eruptions |
39,696 | 46,153 | the canine fossa. Pathological examination revealed a highly malignant anaplastic tumor. Under hematoxylin-eosin stain, two components could be observed in the lesions: SqCC and small cells containing chromatin-rich nuclei with scanty cytoplasm undergoing apoptosis and mitosis (). To characterise the cells, an immunohistochemical examination was performed. On evaluation of specimens from the right maxillary sinus, small cells were positive for the epithelial marker cytokeratin CAM5.2 (), and | small cells containing chromatin-rich nuclei with scanty cytoplasm undergoing apoptosis and |
21,785 | 47,429 | I malformation presented to the emergency department with right elbow pain and deformity after a fall. He had tripped while coming down the stairs and had landed on his right elbow in a flexed position. Prior to this injury, he had full range of flexion–extension and pronation–supination movements of his right elbow. There was no prior elbow injury.\nOn examination, he had normal vital signs. A right elbow joint effusion was present, and he was | range of flexion–extension and pronation–supination movements of his right elbow. There was no prior elbow injury.\nOn examination, he had normal vital signs. A right |
31,895 | 96,347 | jejunal segment was mobilized by preserving the arcades and placed in the bed of the duodenum []. An end-to-end anastomosis between the jejunum and duodenal cuff was performed using a single layer of interrupted absorbable polyfilament 3/0 sutures []. A transmural incision (1 cm) was made at the optimal site on the jejunal wall facing the ampulla patch (5 cm distal to the pylorojejunostomy). The ampulla and its surrounding mucosal patch were anastomosed end-to-side to the jejunal segment by absorbable polyfilament 5/0 interrupted sutures [Figures and | sutures []. A transmural incision (1 cm) was made at the optimal site on the jejunal wall facing the ampulla patch (5 cm distal to the pylorojejunostomy). The ampulla |
24,863 | 64,165 | of lipoproteins did not reveal any pathological results either.\nOne sample of serum was collected and serum was isolated by centrifugation (2500 x g/ 10 min) and kept at −80 °C until completion of recruiting phase. Serum was subsequently sent for diagnostic workup to the authors’ lab (Luebeck, Germany), and tested for the presence of antineuronal antibodies by means of a commercial immunofluorescence assay (Autoimmune Encephalitis Mosaic, Euroimmun, Luebeck, Germany).\nSlides were incubated with patient samples at a starting dilution of 1:10. After incubation for 30 min at room temperature, the slides were rinsed with | sent for diagnostic workup to the authors’ lab (Luebeck, Germany), and tested for the presence of antineuronal antibodies by means of a commercial immunofluorescence assay (Autoimmune Encephalitis Mosaic, Euroimmun, Luebeck, Germany).\nSlides were incubated with |
18,576 | 83,314 | and both lower extremity weakness. The patient had a limping gait due to the pain in her right thigh, which had persisted for 4 months without direct traumatic episodes. It had aggravated 3 months previously due to slipping in her bathroom. Motor weakness of her right thigh was apparent. The sensation of her lower extremities was normal. Her deep tendon reflexes seemed to be hypoactive, and there was no muscular atrophy.\nWe initially assumed that the | The patient had a limping gait due to the pain in her right thigh, which had persisted for 4 months without direct traumatic episodes. It had aggravated 3 months previously due to slipping in her bathroom. Motor weakness of her right thigh was apparent. The sensation of |
32,319 | 73,253 | ketamine before surgery for a broken leg. Four hours after drug administration, and after eating lunch, H.C.'s symptoms of nausea, faintness, dissociation, and auditory, visual, and perceptual alterations had almost completely subsided. Five hours after drug administration, he appeared more alert and was able to complete all study-related tasks.\nAt the end of the experimental session, H.C. was prompted to recount his experience. He reported feeling overwhelmed that it was an uncomfortable, scary, and unpleasant experience akin to what he would expect an overdose or anxiety attack may feel like, and he indicated he never wanted to have the | subsided. Five hours after drug administration, he appeared more alert and was able to complete all study-related tasks.\nAt the end of the experimental session, H.C. was prompted to recount his experience. He reported feeling overwhelmed that it was an uncomfortable, scary, and unpleasant experience akin to |
2,933 | 202,433 | was secured in situ, an occlusion plug (10mmx7mm) (AMPLATZER ™ Vascular Plug II, Abbott) was advanced through a 6F sheath and deployed across the fistula (Fig. ). This led to good embolic occlusive result with subsequent angiography showing no flow across the previous fistula (Fig. – (a) pre occlusion | (AMPLATZER ™ Vascular Plug II, Abbott) was advanced through a 6F sheath and deployed across the fistula (Fig. ). This led to good embolic |
11,489 | 80,048 | with an export catheter. A Liberte bare metal stent (5.0/12) was inserted and expanded to 16 atm. It was postdilated with a noncompliant balloon to 20 atm and proximal stent edge was flared in the aorta. Multiple injections of isosorbide dinitrate were given (total of 15 mg). IVUS was performed after stenting which revealed appropriate stent size and expansion with good angiographic result (). A fractional flow reserve (FFR) wire was used to measure the gradient across the ostial right renal artery which showed a maximum gradient of 10 mmHg. This | a noncompliant balloon to 20 atm and proximal stent edge was flared in the aorta. Multiple injections of isosorbide dinitrate were given (total of 15 mg). IVUS was performed after stenting which revealed appropriate stent size and expansion with good angiographic result (). A fractional flow reserve (FFR) wire was used to measure the |
11,070 | 66,947 | overhead sports in basketball and baseball, and clinical outcome allowing the patient to return to activity without pain and restricted function. The operative treatment agreed upon was reduction of the fracture and placement of an elastic intramedullary clavicle nail. Informed consent was signed by the parents and the patient.\nAt the time of the surgery, a trial of closed reduction revealed an unstable fracture. Subsequently, an incision was made centered over the fracture site. Exposure of the fracture site confirmed complete displacement with the lateral end of the clavicle anterior to the medial end. A | upon was reduction of the fracture and placement of an elastic intramedullary clavicle nail. Informed consent was signed by the parents and the patient.\nAt the time of the surgery, a trial of closed reduction revealed an unstable fracture. |
42,007 | 139,834 | and interpreted using CLSI guideline M24-A2 []. The organism was susceptible to all antibiotics tested with minimum inhibitory concentrations (MICs) of trimethoprim/sulfamethoxazole ≤ 0.25/4.75 µg/mL, ciprofloxacin ≤ 0.12 µg/mL, moxifloxacin ≤ 0.25 µg/mL, amikacin ≤ 2 µg/mL, doxycycline ≤ 0.5 µg/mL, clarithromycin ≤ 2 µg/mL, linezolid ≤ 1 µg/mL, imipenem ≤ 2 µg/mL, cefepime ≤ 1 µg/mL, amoxicillin/clavulanate ≤ 2/1 µg/mL, ceftriaxone ≤ 4 µg/mL, minocycline ≤ 1 µg/mL, cefoxitin ≤ 8 µg/mL, tigecycline ≤ 0.5 µg/mL, and tobramycin ≤ 1 µg/mL.\nFor a few days before | linezolid ≤ 1 µg/mL, imipenem ≤ 2 µg/mL, cefepime ≤ 1 µg/mL, amoxicillin/clavulanate ≤ 2/1 µg/mL, ceftriaxone ≤ 4 µg/mL, minocycline ≤ 1 µg/mL, cefoxitin ≤ 8 µg/mL, tigecycline ≤ 0.5 µg/mL, and tobramycin ≤ 1 µg/mL.\nFor a few days before |
9,457 | 42,759 | verotoxin type 2 and was eae-gene negative. Blood analysis of Adamts-13 protein activity showed normal levels and antibodies against the protein were not observed. Signs of multiple small ischaemic fronto-temporal cortical lesions were noted on an MRI scan, as well as lesions in the circulus Willisi and the basilar artery with narrowing and more distal dilatations of | negative. Blood analysis of Adamts-13 protein activity showed normal levels and antibodies against the protein were not observed. Signs of multiple small ischaemic fronto-temporal cortical lesions were noted on an MRI scan, as well as lesions in the circulus Willisi and the basilar artery |
6,313 | 89,724 | A diagnosis of anterior mediastinal teratoma with cervical extension was made.\nThe patient was operated upon through a neck crease and median sternotomy incision under general anesthesia with endotracheal intubation. The posterior wall of the mass in the neck was adherent to the strap muscles. A solid mediastinal tumour with areas of necrosis, which seemed to be arising from the thymus gland, was found on sternotomy. The tumor derived its blood supply from the thoracic vascular channels as direct branches from aortic arch and the subclavian artery. There were no vessels feeding or draining the tumor in the neck. | through a neck crease and median sternotomy incision under general anesthesia with endotracheal intubation. The posterior wall of the mass in the neck was adherent to the strap muscles. A solid mediastinal tumour with areas of necrosis, which seemed to be arising from |
27,487 | 17,036 | peripheral blood smear showed normocytic normochromic anemia, serum bilirubin-1.2mg/dl, aspartate aminotransferase 18 U/L, alanine aminotransferase 16 U/L, serum alkaline phosphatase 76 U/L, serum protein- 5.1 g/dl with albumin- 2.3 g/dl, serum creatinine- 1.7 mg/dl, blood urea- 130 mg/dl. Urine examination showed 4+ protein, 50–60 red cells per high power field (HPF), 40–50 white cells/HPF, erythrocyte sedimentation rate 123 mm/hr, serum C-reactive protein 1.90mg/dl. Antinuclear antibody (ANA) by immunofluorescence was 4+ homogenous (1:80 dilution), anti-double stranded deoxyribonucleic acid (dsDNA) antibodies were elevated (>300 IU/ml), serum complements were low (C3- 39.3 mg/dl [60–120], C4 9.5 mg/dl [15–25]). Lupus anticoagulant was positive, however, anti- β2 glycoprotein, IgG & IgM anti-cardiolipin antibodies were negative. Coomb’s test (direct and | (1:80 dilution), anti-double stranded deoxyribonucleic acid (dsDNA) antibodies were elevated (>300 IU/ml), serum complements were low |
32,171 | 81,432 | the serosal surface and peristalsis looked good, so it was observed. On the next day, contrast-enhanced CT revealed improvement of blood flow of the SMA () and enhancement of the intestinal tract (). It was confirmed that the color of the terminal ileum became better by laparoscopy. Furthermore, this CT revealed the aortic dissection changed to a type A dissection, and total aortic arch replacement was performed immediately after the laparoscopy. Heparin (15000 units per day) was injected for 7 days, and thereafter two antiplatelet drugs (200 mg cilostazol and 200 mg | and enhancement of the intestinal tract (). It was confirmed that the color of the terminal ileum became better by laparoscopy. Furthermore, this CT revealed the aortic dissection changed to a type A |
16,829 | 165,066 | the OR on the same day for decompressive craniotomy and placement of external ventricular drains (EVD) for monitoring intracranial pressure (ICP). The patient then came from OR ventilated and sedated with fixed dilated pupils (right pupil 4 mm in size, and left was 7 mm in size) with no cough or gag reflexes and an ICP monitor reading of less than 10 mmHg. On the fifth | for monitoring intracranial pressure (ICP). The patient then came from OR ventilated and sedated with fixed dilated pupils (right pupil 4 mm in size, and left was 7 |
9,730 | 44,615 | week following the increased cyclosporine dose she presented with a further deterioration of her vision with 6/18 vision in the left eye and non-useful vision in the right eye. Acetazolamide dose was increased to 90 mg/kg/d and therapeutic LPs were reinstituted to bring pressures to between 200–250 mmH2O. There was an improvement in the visual acuity in her left eye following CSF drainage. Due to the clinical presentation and reported association of cyclosporine therapy and IIH, her immunomodulation therapy was converted to mycophenolate mofetil (1200 mg/m2/day). As the improvement of her vision was not sustained and her intracranial pressures remained elevated, she underwent an urgent surgical cerebrospinal fluid diversion procedure.\nOver the next few months, | association of cyclosporine therapy and IIH, her immunomodulation therapy was converted to mycophenolate mofetil (1200 mg/m2/day). As the improvement of her vision was not sustained and her intracranial pressures remained elevated, she underwent an urgent surgical cerebrospinal |
34,709 | 22,288 | deficiencies in the anterior capsule of the lens. The lens appeared wrinkled and had a diameter of approximately 3 mm (Fig. ). Substantial integration of vascular tissue was observed in the posterior capsule of the cataractous lens. Following posterior capsulotomy, the red light reflex disappeared. We then performed anterior vitrectomy.\nPathological examination revealed that the right lens and capsule contained little connective tissue. We also observed fibrous tissue | and had a diameter of approximately 3 mm (Fig. ). Substantial integration of vascular tissue was observed in the posterior capsule of the cataractous lens. Following posterior capsulotomy, the |
2,459 | 21,599 | that was involved in a head on collision approximately four hours prior to time of presentation.\nThe patient came in complaining of mild epigastric pain for 4 h. He was examined using the ATLS protocol. He was talking on presentation and he had no neck pain but still | patient came in complaining of mild epigastric pain for 4 h. He was examined using the ATLS protocol. He was talking on presentation and |
2,343 | 57,267 | revealed a fusiform-type aneurysm with a diameter of 56 mm in the distal aortic arch. Aneurysmal change extended to the aortic arch around the origin of ARSA and the left subclavian artery. The patient was found to also have a common carotid trunk and an ARSA independently originating from the back of the aortic arch distal to the left subclavian artery. This artery passed behind the esophagus and trachea and connected the axillary artery through the right side of the thoracic vertebra (). Bilateral vertebral arteries ordinarily arose from the superior | the origin of ARSA and the left subclavian artery. The patient was found to also have a common carotid trunk and an ARSA independently originating from the back of the aortic arch distal to the left subclavian artery. This artery passed behind the esophagus and |
6,234 | 14,708 | six straight wires were inserted into the calcaneus and attached to the distal foot ring. In addition, six straight wires were inserted into the distal tibia for strong fixation ().\nThe total operative time for the combined procedure was 152 minutes. The hemoglobin concentration decreased from 13.9 mg/dL preoperative1y to 9.8 mg/dL on postoperative day 1, but the patient was not transfused. On postoperative day 3, knee drainage material was removed, oral antiplatelet administration was resumed, and walking with full weight-bearing was permitted. Hospitalization was prolonged for 14 days. The ankle fusion appeared to have | but the patient was not transfused. On postoperative day 3, knee drainage material was removed, oral antiplatelet administration was resumed, and walking with full weight-bearing was permitted. Hospitalization was |
40,086 | 178,824 | 100 beats per minute. Physical examination was unremarkable with a normal sensation on right leg and foot. He was admitted to cardiac intensive care unit for further workup due to elevated troponin.\nSalient laboratory values and electrocardiogram\nThe patient’s initial complete blood count was remarkable for white blood cell of 28,800/ul with eosinophil count of 12,960/ul (45%) in spite of the use of low-dose oral corticosteroids for a few days prior to admission. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were both elevated at 35 and 4.14, respectively. His admission troponin was 16.28. His initial electrocardiogram (ECG) showed atrial fibrillation with a heart rate of 161 beats per minute, non-diagnostic Q | and electrocardiogram\nThe patient’s initial complete blood count was remarkable for white blood cell of 28,800/ul with eosinophil count of 12,960/ul |
24,201 | 30,801 | measured 13 × 8 cm (Fig. b). The lesion also contained a well-differentiated neuroendocrine tumor (0.4 cm) (Fig. c), which was synaptophysin and chromogranin positive and with Ki67 < 3% (Fig. d). Pathologists also noted the presence of marked secondary inflammatory and degenerative changes, with prominent necrotizing pancreatitis, fat necrosis, hemorrhage, and fibrosis, accompanying all three lesions. 18 lymph nodes were evaluated, all of which were negative for metastatic | × 8 cm (Fig. b). The lesion also contained a well-differentiated neuroendocrine tumor |
15,793 | 36,967 | source of vitamin A was natural fish liver oil (NOW® Foods, 25,000 IU softgels, Manufacturer SKU: 733739003409). A needle was used to puncture the softgels and the oil was applied topically to the warts every night prior to sleep. The oil was allowed to soak into the tissue before the excess oil was removed with a dry towel. Soap was not used to wash the | applied topically to the warts every night prior to sleep. The oil was allowed to soak into the tissue before the excess |
28,624 | 36,042 | subject is a 47-year-old woman. When her younger sister developed chronic myeloid leukemia, she was 27 years old and living in the United States with her husband and their two children, apart from her parents and her younger sister since her marriage. The subject shared information on the treatment of leukemia with her sister at the disease onset and learned about allo-HSCT for the first time. She had a positive sense of allo-HSCT; however she did not match with her younger sister for human leucocyte antigen (HLA). Thus, she was not selected as a donor and the bone marrow transplantation was performed with her mother as the donor. Twenty years | time. She had a positive sense of allo-HSCT; however she did not match with her younger sister for human leucocyte antigen (HLA). Thus, she was not selected as a donor and the bone marrow transplantation was performed |
17,590 | 155,565 | placed as in the routine procedure. Generally, 45 ± 3 × 4 mm screw is suitable. In our opinion, this technique may provide better outcome in anteriorly displaced oblique fractures. If the fracture is displaced, it must be reduced with an manuel reduction manevuer of intraoperative manipulation. Then, contralateral entry point is drilled at a point 2-mm lateral and 1-mm inferior compared with the first one []. This change in the entry point | 3 × 4 mm screw is suitable. In our opinion, this technique may provide better outcome in anteriorly displaced |
7,528 | 135,041 | bilateral headache involving frontal and temporal lobes, accompanied by nausea, vomiting, left upper extremity numbness and weakness, left-sided tongue and perioral numbness, and involuntary movements of the left upper extremity. There were five episodes with complete recovery in the last 3 weeks, of which two episodes were without any neurologic deficit and three episodes were preceded by transient symptoms. The numbness and weakness lasted for about 10 to 20 mins and were ensued by headache and involuntary movements of the left upper extremity. The headache lasted approximately 2–9 | and perioral numbness, and involuntary movements of the left upper extremity. There were five episodes with |
38,965 | 110,640 | cytomegalovirus (CMV)-IgG positive (+), Rub-IgG positive (+), herpes simplex virus (HSV)I-IgG positive (+), the others were negative. Serum tumor marker results showed no abnormalities.\nAfter admission, she was treated with antiviral therapy (ganciclovir), nerve nutrition, dehydration, decreasing intracranial pressure therapy (mannitol, glycerol fructose, albumin, and furosemide), electrolyte supplementation and nutritional support. On the second day of admission, the patient’s vision dropped to a sense of no light, and she could not distinguish day from night. For the patient’s vision loss, we consulted the ophthalmology. Examination of the ophthalmoscope found that the edge of the nipple was | were negative. Serum tumor marker results showed no abnormalities.\nAfter admission, she was treated with antiviral therapy (ganciclovir), nerve nutrition, dehydration, decreasing intracranial pressure therapy (mannitol, glycerol fructose, albumin, and furosemide), electrolyte supplementation and nutritional support. On the second day of admission, the patient’s vision dropped to a sense of no light, and she could not distinguish day from night. For the |
626 | 162,406 | and poor academic performance of 5 years duration. Informant was the mother. The seizures were described as afebrile and generalized tonic-clonic in nature. The child received several medications, from the hospital of his birth and other secondary health care facilities, for the seizures. Parents introduced traditional herbal oral medication at 2 years when seizures remained intractable, and which he continued till presentation at the CAMH unit. Speech has remained audible but incomprehensible since | when seizures remained intractable, and which he continued till presentation at the CAMH unit. |
28,241 | 44,972 | across the stenosis measured 11 mm Hg. The stenosis was sequentially dilated with a 12 mm × 40 mm Conquest balloon (Conquest angioplasty balloon: C. R. Bard, Inc.) and a 16 mm × 40 mm Atlas balloon (Atlas angioplasty balloon: C. R. Bard, Inc.). Postangioplasty venography each time demonstrated no significant improvement in stenosis. The stenosis was then angioplastied with an 18 mm × 40 mm XXL balloon (XXL angioplasty balloon: Boston Scientific Corporation). Postangioplasty venography demonstrated moderate improvement in the stenosis ().\nThe pressure gradient remained 11 mm Hg. At this point, the etiology of the stenosis was unknown and reevaluation with | × 40 mm Conquest balloon (Conquest angioplasty balloon: C. R. Bard, Inc.) and a 16 mm × 40 mm Atlas balloon (Atlas angioplasty balloon: C. R. Bard, Inc.). Postangioplasty venography each time |
4,395 | 45,948 | the antenatal care providers [,]. Several symptoms have been established to suggest the presence of abdominal pregnancy. These symptoms include recurrent abdominal pain, painful fetal movements, and easily palpable fetal parts. Difficulty in establishing fetal lie and presenting part is another sign which should raise suspicion for abdominal pregnancy. Signs and symptoms of peritoneal irritation can be an additional indicator, as this can suggest hemoperitoneum as in our patient [,,,].\nIt is vital for the diagnosis of abdominal pregnancy to be made early in pregnancy. Morbidity and mortality are largely due to massive hemorrhage that may arise from complete or partial placental | an additional indicator, as this can suggest hemoperitoneum as in our patient [,,,].\nIt is vital |
26,133 | 81,652 | dressing was applied over donor site for 5 days and antibiotic therapy was recommended for 5 days.\nClinical assessment was subsequently performed after surgical procedure at 5 and 14 days and 1, 3, and 6 months. During all clinical follow-ups, we observed a progressive release of scar retraction together with an important improvement of pain symptoms. Therefore, we proposed a | was recommended for 5 days.\nClinical assessment was subsequently performed after surgical procedure at 5 and 14 days and |
27,830 | 86,508 | to manage severe bradyarrhythmias as doses of glycopyrrolate and atropine (aliquots of 0.2 mg IV doses) were ineffective. Cardiac workup, including electrocardiogram, cardiac enzymes, and echocardiogram, was all within normal limits. Episodes of bradycardia and SVT occurred daily, until twenty days after the first episode of bradycardia, when a permanent pacemaker was placed. A snapshot of the episodes of autonomic instability is outlined in .\nThe patient received multiple therapies including high dose methylprednisolone and IVIg, immunotherapy with rituximab, intrathecal methotrexate, and an extended course of electroconvulsive therapy (ECT) for her profound catatonia. A visual snapshot of treatments offered is outlined in .\nThe patient was discharged initially to a skilled nursing facility and then home. She made a | until twenty days after the first episode of bradycardia, when a permanent pacemaker was placed. A snapshot of the episodes of autonomic instability is outlined in .\nThe patient received multiple therapies including high dose methylprednisolone and IVIg, immunotherapy with rituximab, intrathecal methotrexate, and an extended course of electroconvulsive therapy (ECT) for her profound catatonia. A visual snapshot of treatments offered is outlined in .\nThe patient was discharged initially to a skilled nursing facility and then home. She made a |
38,848 | 47,398 | resorption parameters were within the normal range ().\nThe number of osteocytes and empty lacunae in the fracture site specimen (cortex) was measured. The osteocyte density (394.2 N/mm2) was remarkably higher than the empty lacunar density (8 N/mm2; ). Seven microcracks were found in the | of osteocytes and empty lacunae in the fracture site specimen (cortex) was measured. The osteocyte density (394.2 N/mm2) was remarkably higher than the |
36,987 | 94,325 | of psoriatic arthritis therefore treatment with Efalizumab was interrupted after 9 months. In addition during the 9 months of efalizumab therapy his platelets count rose substantially (Figure ). Then, etanercept (Enbrel) 50 mg twice weekly was started. After an initial flare of his | interrupted after 9 months. In addition during the 9 months of efalizumab therapy his platelets count rose substantially (Figure ). Then, etanercept (Enbrel) |
38,003 | 63,879 | Babinski sign. Senses of vibration and proprioception could not be assessed. Cerebellar examination indicated an abnormal finger-to-nose test and an abnormal shin-to-heel test with dysdiadochokinesia. The patient had a score of 8/30 on the Mini Mental State Examination. The rest of the examination was unremarkable.\nThe patient's initial laboratory investigations indicated a normal white blood cell count, mildly decreased hemoglobin (12.4 g/dL), elevated mean corpuscular volume (MCV) (102 fL), and normal platelet count (212 × 103 U/L). There were undetectable levels of vitamin B12 (less than 83 pg/mL). His aspartate aminotransferase (AST) and alanine aminotransferase (ALT) | an abnormal shin-to-heel test with dysdiadochokinesia. The patient had a score of 8/30 on the Mini Mental State Examination. The rest of the examination was unremarkable.\nThe patient's initial laboratory investigations indicated a normal white blood cell count, mildly decreased hemoglobin (12.4 g/dL), elevated mean corpuscular volume (MCV) (102 fL), and normal platelet count (212 × 103 U/L). There were undetectable levels of vitamin B12 (less than |
37,109 | 125,109 | In addition, an investigation was carried out due to proteinuria which was concluded to be caused by a mild chronic kidney insufficiency. The cardiac and kidney affection was treatment related.\nIn April 2014, a mutation analysis was performed on archived material from the primary tumour from 2005 which revealed a deletion in exon 18 of PDGFRA involving c.2527_2538delATCATGCATGAT, p.Ile843_Asp846del (p.I843_D846del), and wild-type c-KIT. At primary diagnosis in 2005, mutation analysis was not part of daily practice.\nIn September 2017, a recurrence of GIST in relation to the ileum was discovered on CT imaging which retrospectively could be detected already in August 2016, | chronic kidney insufficiency. The cardiac and kidney affection was treatment related.\nIn April 2014, a mutation analysis was performed on archived material from the primary tumour from 2005 which revealed a deletion in exon 18 of PDGFRA involving c.2527_2538delATCATGCATGAT, p.Ile843_Asp846del (p.I843_D846del), and wild-type c-KIT. At primary diagnosis in 2005, mutation analysis was not part of daily practice.\nIn September 2017, a recurrence of GIST in relation to the ileum was discovered on CT imaging |
18,079 | 79,906 | SMA phenotype with cardiac involvement in Germany []. For those reasons we added sequence analysis of LMNA gene, and a novel nonsense mutation p.Q353X (c.1057C > T) in exon 6 of LMNA was detected (Figure a). Exon 6 encodes the rod domain of lamin A and lamin C, which results in truncated lamin A protein lacking tail domain including nuclear localization signal (NLS) site (Figure b). The genetic analysis was limited to the proband, as we could not get a permission from other family members.\nThe molecular mechanisms of autosomal | gene, and a novel nonsense mutation p.Q353X (c.1057C > T) in exon 6 of LMNA was detected (Figure a). Exon 6 encodes the rod domain of lamin A and lamin C, which |
10,734 | 78,170 | α-inhibin, and human placental lactogen (HPL). Multiple biopsies collected at colonoscopy and esophagogastroduodenoscopy showed a poorly differentiated adenocarcinoma in the lamina propria of the stomach fundus positive for AEI/3, CD7, CK20 and CEA (Figure ). The esophageal biopsy showed atypical cells with necrotic exudates and the colon biopsy showed no malignancy. The patient | a poorly differentiated adenocarcinoma in the lamina propria of the stomach fundus positive for AEI/3, CD7, CK20 and CEA (Figure ). The esophageal biopsy showed atypical cells with |
1,527 | 73,548 | parents regarding the diagnosis, risks, and treatment.\nUpon review after 1 week, his parents reported further improvement in his irritability and overactivity and he was continued on the same medication. He was reviewed every 2 weeks for the next month and continued to show improvement in mental state. However, he showed significant weight gain while on treatment. Metabolic screen was done at 4 weeks and investigations were normal. Dietary advice was provided and physical activities were encouraged. Switching to aripiprazole was discussed; however it is not available in the public hospitals in Sri Lanka and parents were not able to afford | significant weight gain while on treatment. Metabolic screen was done at 4 weeks and investigations were normal. Dietary advice was provided and physical activities were encouraged. Switching to aripiprazole was discussed; however it is not available in |
6,802 | 37,544 | a result, her warfarin dosage was gradually increased accordingly. During this time our patient experienced a few occasional bouts of mild bleeding from the surgical site that were easily stopped with 5% tranexamic acid mouthwash. Ecchymosis later appeared over the | result, her warfarin dosage was gradually increased accordingly. During this time |
37,465 | 12,347 | mass was excised and the auriculectomy incision was closed with three mattress sutures with pledgets using 4-0 polypropylene over-sewn with a simple continuous pattern using 3-0 polypropylene. Five small dark round masses ranging from 5 mm to 12 mm in diameter were adhered to the visceral surface of the parietal pericardium and were suspected to represent locoregional metastasis. They | polypropylene. Five small dark round masses ranging from 5 mm to 12 mm in diameter were adhered to the |
26,407 | 30,641 | stroma. Corneal nerves within the Bowman layer were present, but the visibility of the layer was disrupted by optical shadows from the cysts, hyperreflective structures at the centre of basal cells, and increased density of the Langerhans cells. Posterior corneal stroma and endothelium presented normal morphology ().\nThe patient also underwent basic laboratory analysis including morphology with a microscopic smear, C-reactive protein, Bence–Jones protein in the urine, and a proteinogram. All results were normal.\nAcute microcystic keratitis was diagnosed based on slit-lamp examination and AS-OCT and IVCM results.\nThe patient was treated with topical 0.1% dexamethasone in both eyes 7 times a day along with lubricating | was disrupted by optical shadows from the cysts, hyperreflective structures at the centre of basal cells, and increased density of the Langerhans cells. Posterior corneal stroma and endothelium presented normal morphology ().\nThe patient also underwent basic laboratory analysis including morphology with a microscopic smear, |
23,618 | 56,608 | in Patient I:1 identified a chromosome 2q34 deletion of 276.5 kilobases (kb) encompassing exon 1 (numbered as in NM_005235.3 and demarcated from g.213403173_213403565 in GRCh 37) of ERBB4 (NC_000002.11:g.(213170347_213255794)_(213532234_213581360)del) (DECIPHER ID: 271941). Further array-CGH and fluorescent in situ hybridisation (FISH) studies showed that the deletion was present in all affected individuals and absent in all unaffected individuals who were tested (Fig. ). The LOD score for the association of the deletion with the phenotype in this family was calculated as 1.81 (recombination factor (ϴ) = 0; the number of informative meiosis/individuals (N) = 6, and | demarcated from g.213403173_213403565 in GRCh 37) of ERBB4 (NC_000002.11:g.(213170347_213255794)_(213532234_213581360)del) (DECIPHER ID: 271941). Further array-CGH and fluorescent in situ hybridisation (FISH) studies showed that the deletion was present in all affected individuals and absent in all unaffected individuals who were tested (Fig. ). The LOD score for the association of the deletion with the phenotype in this family was calculated |
3,911 | 163,737 | disc while checking the tip position with the AP and lateral fluoroscopic images. After penetrating the disc, the 20 g Chiba needle was advanced up to the predetermined depth, which was 2/3 of the AP diameter of the vertebral body from the anterior margin of the vertebral body. Frequent fluoroscopic images for both the AP and lateral views were used to guide the needle when advancing it in the correct plane. While advancing the needle, we checked the loss of resistance | up to the predetermined depth, which was 2/3 of the AP diameter of the vertebral body from the anterior margin of the vertebral body. Frequent fluoroscopic images for both the AP and lateral views were used |
7,895 | 16,906 | the 3-month follow-up in this patient, as indicated by the computed tomographic scans shown in Fig. . After 3 months of treatment, there was a significant reduction in lymphedema in the left arm, a partial response of the lymph nodes according to Lugano criteria [], and clearance of pleural effusion. At 6 months, the remaining lymphedema in the left arm | to Lugano criteria [], and clearance of pleural effusion. At 6 |
22,838 | 35,174 | the right side and the inferior vena cava. As the thrombus was refractory to thrombolysis therapy, a surgical embolectomy of the pulmonary embolism was attempted, the histopathological examination of which revealed a chondrosarcoma (Figure ).\nThe postoperative period was uneventful, and his symptoms subsided gradually. Because we suspected a tumor embolism, his lower-back ache and paresthesia were evaluated in detail. A magnetic resonance imaging (MRI) scan of his spine and pelvis showed a large, destructive mass lesion arising from the right iliac wing with permeative lytic areas involving the right iliac vein and a tumor embolus within | a surgical embolectomy of the pulmonary embolism was attempted, the histopathological examination of which revealed a chondrosarcoma (Figure ).\nThe postoperative period was uneventful, and his symptoms subsided gradually. Because we suspected a tumor embolism, his lower-back ache and |
31,624 | 83,037 | terminal ileum, with speckled calcifications, adjacent lymphadenopathy, and a small amount of dense fluid in the pelvis (). No hepatic abnormalities were visualized. Colonoscopy demonstrated a 4-5 cm friable mass in the terminal ileum | small amount of dense fluid in the pelvis (). No hepatic abnormalities were visualized. Colonoscopy demonstrated a 4-5 cm friable |
1,331 | 56,583 | presentation along with the progression of the symptoms.\nDiagnostic challenges\nHereditary neuropathies are divided into four major subcategories: hereditary motor and sensory neuropathy, hereditary sensory neuropathy, hereditary motor neuropathy, and hereditary sensory and autonomic neuropathy. The most common type is Charcot-Marie-Tooth disease, one of the hereditary motor and sensory neuropathies. Symptoms of the hereditary neuropathies vary according to the type and may include sensory symptoms such as numbness, tingling, and pain in the feet and hands, or motor symptoms such as weakness and loss of muscle bulk, | sensory symptoms such as numbness, tingling, and pain in the feet and hands, or motor symptoms such as weakness and loss of muscle bulk, |
13,120 | 25,927 | the time measured 6.5 × 5.1 × 5.0 cm (). Repeat metabolic testing was again negative. Surgical treatment was recommended, and the patient underwent left open adrenalectomy. Laparoscopic/robotic adrenalectomy was not considered because of the suspicion of adrenal cortical carcinoma and the data that has been presented regarding the increased risk of peritoneal dissemination with laparoscopic surgery in these cases []. The intraoperative findings included limited access to the mass due to the proximity of | × 5.1 × 5.0 cm (). Repeat metabolic testing was again negative. Surgical treatment was recommended, and the patient underwent left open adrenalectomy. Laparoscopic/robotic adrenalectomy was not considered because of the suspicion of adrenal cortical carcinoma and the data that has been presented regarding the increased risk of peritoneal dissemination |
36,052 | 33,821 | neck region, which the mass had been detected during a routine medical check-up. FNA were performed twice prior to the visit to our hospital, but the results of the cytological evaluations at both instances were atypia of undetermined significance (AUS). The patient had no clinical symptoms and the laboratory results were in normal range. Ultrasonography, performed at our hospital, revealed the presence of a relatively well circumscribed mass (2.2 cm in diameter) with microcalcifications on the right lobe of the thyroid gland (Fig. a). Additionally, another FNA conducted at our | cm in diameter) with microcalcifications on the right lobe of the thyroid gland (Fig. a). Additionally, another FNA conducted at our |
6,963 | 72,875 | For further diagnosis, we discussed with the patient pulmonary wedge resection, vertebral biopsy, or cholecystectomy. With the two unsuccessful attempts in mind, she chose the latter procedure, suggesting the highest probability to finally reach a diagnosis. This intervention was then performed without complications and provided the following findings.\nMacroscopically, the gall bladder specimen was 9 cm long and 3 cm in diameter. In the lumen, a friable broad based papillary nodule in the fundus (5 cm maximum diameter) and two polypoid satellite nodules in the neck (1 cm maximum diameter) were present. In the cystic duct, a small gallstone was identified. Histopathologically, surprisingly, the | patient pulmonary wedge resection, vertebral biopsy, or cholecystectomy. With the two unsuccessful attempts in mind, she chose the latter procedure, suggesting the highest probability to finally reach a diagnosis. This intervention was then performed without complications and |
5,294 | 44,920 | knee and was tender over his patella. Radiographs showed no displacement in the fracture. He was kept in his Richard splint for a further two weeks but allowed to be partial weight bearing.\nAt four weeks after injury, the patient was mobilising using his crutches. On examination, only a small residual effusion was noted and radiographs revealed though no further displacement, and the fracture line was still visible. He was able raise his leg straight but flexion was limited | weeks but allowed to be partial weight bearing.\nAt four weeks after injury, the patient was mobilising using his crutches. On examination, only a small residual effusion was noted and radiographs revealed though no further displacement, and the fracture line was |
7,258 | 13,112 | showed extensive soft tissue calcifications surrounding the hip joint associated with erosion of the femoral neck and mild left hip degenerative changes. The radiographic differential diagnoses included synovial chondromatosis and synovial chondrosarcoma.\nHe subsequently underwent a CT scan, which demonstrated extensive calcifications adjacent to the left hip with asymmetric soft tissue enlargement and mild degenerative changes of the hip joint (Figure ). The masses were mostly anterior | soft tissue calcifications surrounding the hip joint associated with erosion of the femoral neck and mild left hip degenerative changes. The radiographic differential diagnoses included synovial chondromatosis and synovial chondrosarcoma.\nHe |
4,516 | 72,132 | sign was observed due to dilation of the renal calyces on CT of the abdomen (). Complex cystic renal mass or renal malignancy and cystic degeneration were mentioned as a probable diagnosis.\nIn addition, chest X-ray revealed mild pleural effusion and a soft tissue density pleural based lesion in right hemithorax. A thoracic CT scan with and without contrast medium injection was advised to investigate the latter findings further ().\nThoracic CT revealed bilateral smaller than 2 cm irregular bordered nodules in both lung fields. | density pleural based lesion in right hemithorax. A thoracic CT scan with and without contrast medium injection was advised to investigate the latter findings further ().\nThoracic CT revealed |
3,160 | 31,596 | failed to find anything significant, and upon removal of the rectal tube, the patient once again relapsed.\nAt this point, the patient was referred to the colorectal team for ongoing consultation.\nFlexible sigmoidoscopy was performed to exclude any evidence of mechanical obstruction, and a lengthy discussion | to find anything significant, and upon removal of the rectal tube, the patient once again relapsed.\nAt this point, the |
18,723 | 34,849 | and onychogryphosis and had not been cut. The deep cotton bandages were intact but appeared soiled on removal of the cast. The exposed leg was covered in thick yellow skin scales (Figure ) which were easily exfoliated by hand (Figure ). There were no significant areas of skin loss with integument intact over bony protuberances. Dense heel callosities were removed with a sharp blade. Closer inspection of the skin surface revealed small pitted ulcers 1-2 mm in diameter replacing the normal skin pores. Healthy pink granulation tissue was seen | cut. The deep cotton bandages were intact but appeared soiled on removal of the cast. The exposed leg was covered in thick yellow skin scales (Figure ) which were easily exfoliated by hand (Figure ). |
39,141 | 137,053 | internal echo and had a relatively smooth surface, suggesting UT3N1. Neoadjuvant therapy was performed with 25 times of radiotherapy and two courses of capecitabine and oxaliplatin (XELOX) regimen. A review of rectal cavity ultrasound showed that the original lesion size was 2.42 cm × 0.68 cm, suggesting UT3N1. Therefore, laparoscopic radical resection of rectal cancer and transverse colostomy was performed between the navel and xiphoid. Post-operative pathology showed slightly poorly differentiated residual adenocarcinoma in the intestines, which invaded into the deep muscular layer. In the intestinal wall, a large number of foam cells with calcification were present, as well as multinucleated | between the navel and xiphoid. Post-operative pathology showed slightly poorly differentiated residual adenocarcinoma in the intestines, which invaded into the deep muscular layer. In the intestinal wall, a large number of |
33,717 | 142,417 | loss was not particularly bad and transfusion was not needed. Frozen intraoperative pathology was reported as metastatic carcinoma. As the amount of bone and tumor removed was likely destabilizing and the bone quality found to be poor at these levels, a posterolateral pedicle screw fusion was performed from T12 through L4 [].\nFinal histopathologic analyses revealed abundant tissue necrosis with an estimated live tumor cell presence of only 5-10% []. Immunohistological analysis indicated | amount of bone and tumor removed was likely destabilizing and the bone quality found to be poor at these levels, a posterolateral pedicle screw fusion was performed |
17,013 | 143,676 | treatment () revealed that the size of the mass was slightly decreased and that the osteolytic lesion was localized. However, osteolytic lesions are not reversible in subjects with GSS. Therefore, sternal instability and the possibility of pathologic fracture remained. Therefore, we decided to resect the involved bone.\nEn bloc resection was performed. The sternum was exposed by making a midline incision on the anterior chest. The manubrium and the sternal body were involved, and they displayed a mesh-like appearance (). The 2nd to 7th rib cartilages as well as the sternum and the | the osteolytic lesion was localized. However, osteolytic lesions are not reversible in subjects with GSS. Therefore, sternal instability and the possibility of pathologic fracture remained. Therefore, we decided to resect |
26,668 | 152,720 | the fornices evaluated. The contour of the pattern was adjusted to match the contralateral eye []. Upon satisfactory carving of the wax pattern, the challenge is to replicate the position of the iris. Fabrication of a custom painted iris is painstaking and technique demanding. Hence, a color matched iris was retrieved from a stock prosthesis []. The location of the iris was marked on | technique demanding. Hence, a color matched iris was retrieved from a stock prosthesis []. The location of the iris |
43,508 | 140,453 | construction field, as a head of the household of a multicultural family, had been steadily gaining weight since his 30s. The patient suffered from a herniated disc, gonarthritis, and sleep apnea as his weight reached 106 kg. He lost approximately 13 kg through exercising during 1 year prior to the surgery. When the weight loss slowed down, he visited the Bariatric Surgery Center at Soonchunhyang University at Bucheon Hospital in June 2013 for a surgical consult. At the time of the surgery, his weight was 93.0 kg and BMI was 35.8 kg/m2, which was corresponding to severe morbid obesity. Medical | the household of a multicultural family, had been steadily gaining weight since his 30s. The patient suffered from a herniated disc, gonarthritis, and sleep apnea as his weight reached 106 kg. He lost approximately 13 kg through exercising during 1 year prior to the surgery. When the weight loss slowed down, he |
33,029 | 131,106 | sometimes headache, symmetric numbness in her face and arms and/or sensation of imminent fainting. The reported episodes resolved spontaneously after a few minutes, tended to occur after the main meals and had increased in frequency over the last 5 years. Following advice from relatives and her own personal research, the patient performed blood sugar measurements during the episodes, which yielded results between 40 and 60 mg/dL. She consulted her general practitioner 2 years before, and | arms and/or sensation of imminent fainting. The reported episodes resolved spontaneously after a few minutes, tended to occur after the main meals and had increased in frequency over the last 5 years. Following advice from relatives and her own personal research, the patient performed blood sugar measurements during the episodes, which yielded results |
10,057 | 151,006 | preserved. Fracture repositioning and external fixation was applied bilaterally. On the second day after admission, the patient suffered lung emboli that required treatment with anticoagulants, and, therefore, delayed the definitive reconstruction.\nIn the next three weeks, the patient underwent serial revisions of necrotic tissues. On the right side, a large portion of the skin from the thigh to the distal third of the lower leg as well as the gastrocnemius and soleus muscles were debrided, resulting with a large circular defect of the leg with exposure of the posterior tibial neurovascular pedicle and the tibia bone. On the left side, after debridement, the soft tissue defect measured 18 × 16 cm on the | lung emboli that required treatment with anticoagulants, and, therefore, delayed the definitive reconstruction.\nIn the next three weeks, the patient underwent serial revisions of necrotic tissues. On the right side, a large portion of the skin from the thigh to the distal third of the lower leg as well as the gastrocnemius and soleus muscles were debrided, resulting with a large circular defect |
17,188 | 162,631 | (Dentsply, Maillefer). Since the perforation was very small it was decided not to place a matrix. A wet cotton pellet was placed on this and the access was temporarily sealed with MD Temp (Meta Biomed Ltd, Choenju city, Chungbuk, Korea). An immediate postoperative radiograph was taken to confirm a satisfactory filling of the resorptive defect []. Fourty-eight hrs later after checking the set of MTA the access cavity was finally sealed with light cure composite resin (Tetric Ceram, Ivoclare, and Vivadent). Finally, porcelain fused to metal fixed partial denture was placed after 4 weeks.\nThe patient was recalled after 3 months and | MD Temp (Meta Biomed Ltd, Choenju city, Chungbuk, Korea). An immediate postoperative radiograph was taken to confirm a satisfactory filling of the resorptive defect []. Fourty-eight hrs later after checking the set of MTA the access cavity was finally sealed with light cure composite resin (Tetric Ceram, Ivoclare, and Vivadent). Finally, porcelain fused to metal fixed |
42,787 | 50,231 | and another heterozygous start-loss variation in exon 1 (p.Met1). Hence, on combining the clinical phenotype with the genetic test result, a final diagnosis of PYCR2 gene-related hypomyelination and microcephaly syndrome (also known as hypomyelinating leukodystrophy 10) was established (Figure ). Parents were explained about the diagnosis, course, and progression of the disorder, as well as the poor outcome. The patient was given pharmacotherapy for spasticity, and physiotherapy and occupational therapy were recommended. In view of the progressive neurological condition, severe wasting, and feeding difficulties, a percutaneous endoscopic gastrostomy (PEG) tube feeding was recommended but parents were not keen on it. As genetic counseling was not available | diagnosis, course, and progression of the disorder, as well as the poor outcome. The patient was given pharmacotherapy for spasticity, and physiotherapy and occupational therapy were recommended. In view of the progressive neurological condition, severe wasting, and feeding difficulties, |
2,778 | 16,792 | second day of hospitalization, the swelling in his left ankle burst and thick masses containing blood, debris, and white crystalized materials were observed.\nThe patient was born to healthy non-consanguineous parents with no family history of HPRT deficiency (). At the age of 1 day, the patient developed stiffness in both hands. When he was 2 months old, he was diagnosed with severe psychomotor retardation and could only lie down. A pediatric neurologist diagnosed | day, the patient developed stiffness in both hands. When he was 2 months old, he was diagnosed with severe psychomotor retardation and could only lie down. A pediatric neurologist |
7,041 | 138,434 | in this study for the first time, and an attending colorectal surgeon with more than 6 years of experience performed the procedure.\nThe follow-up visits were scheduled for 1 week, 1 month, 3 months, 6 months, and 12 months after the surgery in the colorectal surgery clinic.\nThe duration of surgery was 124 minutes for patient 1 and 142 minutes for patient 2. After the surgery, colostomy functioned properly in both patients. The length of hospital stay for patient 1 was 5 days and for patient 2 was 4 | 1 week, 1 month, 3 months, 6 months, and 12 months after the surgery |
9,559 | 164,485 | dissection acuity and indicates predisposition toward progressive extension of dissection into adjacent vessels. The abdominal aorta and its other major branches were normal with no stenosis or aneurysm or dissection. There was no evidence of organ or bowel infarction. Subsequent Digital subtraction angiogram performed with therapeutic intent confirmed the CT findings []. Also, superior mesenteric artery injection showed retrograde filling of the hepatic and splenic arteries via the anterior, posterior pancreaticoduodenal arcades and the gastroduodenal artery | and indicates predisposition toward progressive extension of dissection into adjacent vessels. The abdominal aorta and its other major branches were normal with no stenosis or aneurysm or dissection. There was no evidence of organ or bowel infarction. Subsequent Digital |
3,824 | 117,204 | bearing and physiological range of motion was reached 10 weeks after the surgery. Radiological assessment showed proper consolidation of the fracture (). A full recovery and resumption of regular activities of the daily life and sport was accomplished 4 months after surgery.\nWe recommend to place a sterile pillow under | consolidation of the fracture (). A full recovery and resumption of regular activities of the daily life and sport was accomplished 4 months after |
8,518 | 70,997 | was uneventful, and the patient returned to his activities of daily living, and qualified as a surveyor. He returned to play competitive basketball in 1989 for 2 seasons.\nIn 1993, the patient started to complain of mild dysphagia, but all the physicians attributed this to post-surgery and post-irradiation adherences.\nIn July 1998, the patient underwent fluoroscopy for the diagnosis of the dysphagia, showing the second screw of the anterior plate being partially extruded (Fig. ). One month later, in August 1998, the patient complained of complete inability to swallow. Radiographs showed the absence of the mobilized screw in the | patient started to complain of mild dysphagia, but all the physicians attributed this to post-surgery and post-irradiation adherences.\nIn July 1998, the patient underwent fluoroscopy for the diagnosis of the dysphagia, showing the second screw of the anterior plate being partially extruded (Fig. ). One month later, in August 1998, the patient complained of complete inability to swallow. Radiographs showed the absence of the mobilized screw |
31,031 | 44,237 | with betadine and sterile drapes applied. A skin wheal was raised with 1% lidocaine over the posterolateral part of the transducer for an in-plane approach. Under ultrasound guidance, a 3.5 inch, 25 G needle was advanced to approximately 2-3 cms during attempts to visualize the needle tip (). The patient experienced severe paraesthesia in the arm which necessitated immediate removal of the needle. Following recovery from the paraesthesia, in approximately five minutes, the needle was reintroduced at a different angle. Only portions of the needle were visualised along with tissue movement. As the needle tip could not | (). The patient experienced severe paraesthesia in the arm which necessitated immediate removal of the needle. Following recovery from the paraesthesia, in approximately five minutes, the needle was reintroduced at a different angle. Only portions of the needle were visualised along with tissue movement. As |
28,946 | 47,972 | any traumatic lesions of her left hip or pelvis. While the MRI showed no traumatic lesion, it revealed a tumor of her left iliopubic ramus infiltrating the anterior acetabular wall, evoking a chondrogenic tumor (). The tumor had started to invade the soft tissue on the anterior aspect of the iliopubic ramus. The patient was then referred to our sarcoma center. A surgical biopsy revealed a low-grade chondroid tumor. Given the particular situation of a pelvic low-grade chondrosarcoma in | tumor (). The tumor had started to invade the soft tissue on the |
29,965 | 55,774 | tissue.\nDefinitive surgery was done 2 weeks later via complete excision of the lesion. We debrided and resected an irregular and gray tumor of 4.3 × 3 × 0.4 cm (Figure ) located on the neurovascular bundle of the ulnar side of the proximal phalanx of the middle finger (Figure ). The bone had a gray-like color on the dorsal part of the proximal phalanx and a 1-mm focal discontinuity of the cortical bone (Figure ). A 20 × 10 mm window was created to observe the medullary canal, which had a yellowish and gray-like tissue that was removed. The medullary canal was obliterated in the proximal region. Finally, the bone window | proximal phalanx and a 1-mm focal discontinuity of the cortical bone (Figure ). A 20 × 10 mm window was created to observe the |
3,259 | 86,911 | noticed in the vicinity of the septal mass. The LVOT gradient was further evaluated by an exercise stress echocardiography which demonstrated a resting LVOT gradient of 10 mmHg that significantly increased to 69 mmHg at 79% of maximal predicted heart rate and returned to baseline at a heart rate of 88 bpm. It also showed a significant bileaflet systolic anterior motion of mitral valve at peak heart rate as compared to the baseline without any significant mitral regurgitation. No intervention was performed due to lack symptoms and good functional capacity. He was followed up with a CMR every other year, which | to baseline at a heart rate of 88 bpm. It also showed a significant bileaflet systolic anterior motion of mitral valve at peak heart rate as compared to the baseline without any significant mitral regurgitation. No intervention was performed due to lack symptoms and |
34,295 | 88,896 | Preoperative CA125 was the only tumor marker examined and it was within normal limits. A presumptive diagnosis of ovarian cancer was made and she underwent exploratory laparotomy which revealed macroscopic peritoneal metastases to ovaries, omentum and pelvic peritoneum. At that time total abdominal hysterectomy, bilateral salpingoopherectomy, pelvic lymph node sampling, partial omentectomy, appendectomy and evacuation of mucinous ascites was performed. Final pathology revealed low grade mucinous adenocarcinoma in all specimens, arising from an appendiceal primary. The patient received no | omentum and pelvic peritoneum. At that time total abdominal hysterectomy, bilateral salpingoopherectomy, pelvic lymph node sampling, partial omentectomy, appendectomy and evacuation of mucinous |
30,463 | 22,124 | diagnosed with VM per Bárány Society criteria. Treatment options were discussed, including both pharmacologic and non-pharmacologic paradigms. Due to the severity of symptoms, she elected to do both. A standard handout was provided with recommendations on migraine trigger avoidance, including stress reduction, sleep hygiene, and a migraine elimination diet. The diet change was suggested to avoid any food triggers of her migraines. In addition, medications were discussed with her, and she elected to try venlafaxine 37.5 mg by mouth daily. At first, she reported feeling increased brain | her migraines. In addition, medications were discussed with her, and she elected to try venlafaxine 37.5 mg by mouth daily. At first, she reported feeling |
17,867 | 38,406 | discs appeared degenerated at various levels but otherwise appeared intact (Figure C, D).\nTransoral fine needle aspiration cytology of the lesion yielded caseous material on cytology but did not show any acid-fast bacilli. Our patient was given antitubercular treatment with a four-drug regimen (rifampicin, isoniazid, ethambutol, pyrazinamide) for two months followed by a two-drug regimen (rifampicin, isoniazid) for a period of four months. His cervical spine was protected by a Philadelphia collar. On follow-up radiographs, the fracture in his C2 vertebra was found to be united by the end of 16 weeks and the prevertebral soft tissue shadow returned to its normal limits (Figure | appeared degenerated at various levels but otherwise appeared intact (Figure C, D).\nTransoral fine needle aspiration cytology of the lesion yielded caseous material on cytology but did not show any acid-fast bacilli. Our patient was given |
35,044 | 171,587 | so annoying,” and the “echoing tinnitus” that was the cause of the patient’s discomfort at the time of the initial visit disappeared. Only the pulsatile tinnitus, which seemed to be related to palpitations, remained.\nOne year and seven months after the initial visit, palpitations and pulsatile tinnitus, as well as anxiety and insomnia, were aggravated due to | remained.\nOne year and seven months after the initial visit, palpitations and pulsatile tinnitus, as well as anxiety and insomnia, were aggravated |
23,517 | 111,684 | amikacin qd by intravenous drip. One week later, her symptoms of low back pain were relieved. This effective treatment further confirmed the diagnosis of M. chelonae spondylitis. After communication with the patient, this anti-NTM treatment regimen was further adjusted for 1 month. Levofloxacin was stopped and switched to moxifloxacin (400 mg qd by intravenous drip). The amikacin dose was increased to 600 mg qd by intravenous drip, and linezolid injection 600 mg qd by intravenous drip was started. Two weeks later, the patient experienced no adverse reactions and she was discharged for outpatient treatment. The post-discharge medication plan was 300 | symptoms of low back pain were relieved. This effective treatment further confirmed the diagnosis of M. chelonae spondylitis. After communication with the patient, this anti-NTM treatment regimen was further adjusted for 1 month. Levofloxacin was stopped and switched to moxifloxacin (400 mg qd by intravenous drip). The amikacin dose was increased to 600 mg qd by intravenous drip, and linezolid injection 600 |
12,644 | 89,995 | although she could read the figures on car registration plates, she had lost the ability to understand words and sentences seen on window stickers or roadside advertisements. Other than this deficit, she had not noticed any alteration in her vision.\nHer medical history revealed that the patient had suffered an ischaemic stroke 15 months previously, causing temporary weakness in the right hand. Subsequently, she was | to understand words and sentences seen on window stickers or roadside advertisements. Other than this deficit, she had not noticed any alteration in her vision.\nHer |
28,567 | 81,852 | FDG uptake within the sternum, thoracic, lumbar, and pelvic bones. The pulmonary nodules identified on CT imaging were also found to be FDG-avid, right middle lobe (SUV 11.5), two left upper lobe nodules (SUV 6.4 and 5.1), and right upper lobe (SUV 5.0) (). Flexible bronchoscopy with biopsy was performed and demonstrated malignant spindle cell tumors with geographic necrosis consistent with metastatic | 11.5), two left upper lobe nodules (SUV 6.4 and 5.1), and right upper lobe (SUV 5.0) (). Flexible bronchoscopy with biopsy was performed and demonstrated malignant spindle cell tumors with geographic necrosis consistent |
7,715 | 37,368 | hypertension and dyslipidemia presented with nausea, vomiting, and epigastric pain for 7 days. She admitted to a history of multiple drug intolerances. A few days prior to the presentation, the patient was started on oral rosuvastatin 10 mg daily for dyslipidemia at the discretion | She admitted to a history of multiple drug intolerances. A few days prior to the presentation, the patient was started on oral rosuvastatin 10 mg daily for dyslipidemia at |
23,527 | 57,054 | the patient was in good clinical condition, in absence of drug therapy.\nA coronary computed tomography (CT), 10 days after the onset of the clinical manifestations, excluded any lumen obstruction, dissection or other anatomical variants of the aorta and coronary arteries. However, it was clearly observed myocardial bridge of a tract of the left anterior descending (LAD) coronary artery (). As a precaution, it | onset of the clinical manifestations, excluded any lumen obstruction, dissection or other anatomical variants of the aorta and coronary arteries. However, it was clearly observed myocardial bridge of a tract of the left anterior descending (LAD) coronary artery (). As a |
25,715 | 54,505 | on. So she recognized the existing association between physical activity and fatigue. However, she felt she was able to manage this by herself, using the tools for gradually increasing activity levels she had received during treatment. In agreement with the patient, treatment was ended. In total, treatment consisted of 12 sessions (face-to-face or online, no use of additional video sessions) spread over 21 weeks. After completing treatment, patient A completed the Checklist Individual Strength (CIS) once again. She still had a score of 16 on the subscale fatigue severity of the Checklist Individual Strength (CIS) (see ), | sessions (face-to-face or online, no use of additional video sessions) spread over 21 weeks. After completing treatment, patient A completed the Checklist Individual Strength (CIS) once again. She still had a score of 16 on |
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