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| EN107405 |
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| EN107405 |
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] | A 37-year-old Arabian woman presented with 12 months of progressive Cushing's syndrome-like symptoms. Biochemical evaluation confirmed adrenocorticotropic hormone -dependent Cushing's syndrome. However, the anatomical site of her excess adrenocorticotropic hormone secretion was not clearly delineated by further investigations. Magnetic resonance imaging of our patient's pituitary gland failed to demonstrate the presence of an adenoma. Spiral computed tomography of her chest only revealed the presence of a non-specific 7 mm lesion in her left inferobasal lung segment. Functional imaging, including a positron emission tomography scan using 18-fluorodeoxyglucose and gallium-68-DOTA-D-Phe1-Tyr3-octreotide, also failed to show increased metabolic activity in the lung lesion or in her pituitary gland. Our patient was commenced on medical treatment with ketoconazole and metyrapone to control the clinical features associated with her excess cortisol secretion. Despite initial normalization of her urinary free cortisol excretion rate, levels began to rise eight months after commencement of medical treatment. Repeated imaging of her pituitary gland, chest and pelvis again failed to clearly localize a source of her excess adrenocorticotropic hormone secretion. The bronchial nodule was stable in size on serial imaging and repeatedly reported as having a nonspecific appearance of a small granuloma or lymph node. We re-explored the treatment options and endorsed our patient's favored choice of resection of the bronchial nodule, especially given that her symptoms of cortisol excess were difficult to control and refractory. Subsequently, our patient had the bronchial nodule resected. The histological appearance of the lesion was consistent with that of a carcinoid tumor and immunohistochemical analysis revealed that the tumor stained strongly positive for adrenocorticotropic hormone. Furthermore, removal of the lung lesion resulted in a normalization of our patient's 24-hour urinary free cortisol excretion rate and resolution of her symptoms and signs of hypercortisolemia.
| EN107405 |
Furthermore, removal of the lung lesion resulted in a normalization of our patient's 24-hour urinary free cortisol excretion rate and resolution of her symptoms and signs of hypercortisolemia. | [
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] | A 37-year-old Arabian woman presented with 12 months of progressive Cushing's syndrome-like symptoms. Biochemical evaluation confirmed adrenocorticotropic hormone -dependent Cushing's syndrome. However, the anatomical site of her excess adrenocorticotropic hormone secretion was not clearly delineated by further investigations. Magnetic resonance imaging of our patient's pituitary gland failed to demonstrate the presence of an adenoma. Spiral computed tomography of her chest only revealed the presence of a non-specific 7 mm lesion in her left inferobasal lung segment. Functional imaging, including a positron emission tomography scan using 18-fluorodeoxyglucose and gallium-68-DOTA-D-Phe1-Tyr3-octreotide, also failed to show increased metabolic activity in the lung lesion or in her pituitary gland. Our patient was commenced on medical treatment with ketoconazole and metyrapone to control the clinical features associated with her excess cortisol secretion. Despite initial normalization of her urinary free cortisol excretion rate, levels began to rise eight months after commencement of medical treatment. Repeated imaging of her pituitary gland, chest and pelvis again failed to clearly localize a source of her excess adrenocorticotropic hormone secretion. The bronchial nodule was stable in size on serial imaging and repeatedly reported as having a nonspecific appearance of a small granuloma or lymph node. We re-explored the treatment options and endorsed our patient's favored choice of resection of the bronchial nodule, especially given that her symptoms of cortisol excess were difficult to control and refractory. Subsequently, our patient had the bronchial nodule resected. The histological appearance of the lesion was consistent with that of a carcinoid tumor and immunohistochemical analysis revealed that the tumor stained strongly positive for adrenocorticotropic hormone. Furthermore, removal of the lung lesion resulted in a normalization of our patient's 24-hour urinary free cortisol excretion rate and resolution of her symptoms and signs of hypercortisolemia.
| EN107405 |
A 19-year-old healthy man was admitted to our cardiology department following a syncopal episode. | [
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] | A 19-year-old healthy man was admitted to our cardiology department following a syncopal episode. His past medical history was unremarkable. He no family history of heart disease or sudden death. Two-days prior the syncope, he developed chest pain and an influenza-like illness consisting of fevers, rhinorrhea, and sore throat. At the physical exam, the patient was febrile at 39°C. He had an inflamed throat, bradycardia at cardiac auscultation and there were no signs of heart failure. The electrocardiogram (EKG) showed grade III atrioventricular (AV) bloc with a ventricular rate of 38 beats per minute. Laboratory studies were remarkable for a HS-troponin level 181ng/L, a white blood cell count of 14270/mm³ with 48% lymphocytes, and elevated C-reactive protein at 90mg/L. Serum electrolytes, kidney and liver functions were within normal limits. A chest X-ray showed an appropriate cardiac size. The initial transthoracic echocardiography (TTE) showed a normal global left ventricular function (left ventricular ejection fraction (LVEF) 60%) and wall motion abnormalities (anteroseptal hypokinesia), with reduced left ventricular global longitudinal strain (LV GLS= -14.1%). Cardiac magnetic resonance (CMR) showed increased signal intensity at the mid-lateral wall on T2-weighted images. Late enhancement revealed a patchy subepicardial hyperenhancement of the medio-distal segments of the anterior and anterolateral walls which confirm the diagnosis of myocarditis. The patient was treated with cefotaxime and doxycycline. All serological tests (chlamydia, coxiella, mycoplasma, rickettsia, lyme and bartonella) obtained during the hospitalization were negative. Five days later, the patient was asymptomatic. The 24 hours ECG monitoring showed a sinus rhythm. The TTE revealed a normal LVEF and an improvement in the LVGLS with segmental reduced values concordant with the CMR abnormalities. At one-month follow-up the patient made a full recovery without any recurring cardiovascular symptoms or abnormal electrocardiographic or echocardiographic findings.
| EN100682 |
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] | A 19-year-old healthy man was admitted to our cardiology department following a syncopal episode. His past medical history was unremarkable. He no family history of heart disease or sudden death. Two-days prior the syncope, he developed chest pain and an influenza-like illness consisting of fevers, rhinorrhea, and sore throat. At the physical exam, the patient was febrile at 39°C. He had an inflamed throat, bradycardia at cardiac auscultation and there were no signs of heart failure. The electrocardiogram (EKG) showed grade III atrioventricular (AV) bloc with a ventricular rate of 38 beats per minute. Laboratory studies were remarkable for a HS-troponin level 181ng/L, a white blood cell count of 14270/mm³ with 48% lymphocytes, and elevated C-reactive protein at 90mg/L. Serum electrolytes, kidney and liver functions were within normal limits. A chest X-ray showed an appropriate cardiac size. The initial transthoracic echocardiography (TTE) showed a normal global left ventricular function (left ventricular ejection fraction (LVEF) 60%) and wall motion abnormalities (anteroseptal hypokinesia), with reduced left ventricular global longitudinal strain (LV GLS= -14.1%). Cardiac magnetic resonance (CMR) showed increased signal intensity at the mid-lateral wall on T2-weighted images. Late enhancement revealed a patchy subepicardial hyperenhancement of the medio-distal segments of the anterior and anterolateral walls which confirm the diagnosis of myocarditis. The patient was treated with cefotaxime and doxycycline. All serological tests (chlamydia, coxiella, mycoplasma, rickettsia, lyme and bartonella) obtained during the hospitalization were negative. Five days later, the patient was asymptomatic. The 24 hours ECG monitoring showed a sinus rhythm. The TTE revealed a normal LVEF and an improvement in the LVGLS with segmental reduced values concordant with the CMR abnormalities. At one-month follow-up the patient made a full recovery without any recurring cardiovascular symptoms or abnormal electrocardiographic or echocardiographic findings.
| EN100682 |
He no family history of heart disease or sudden death. | [
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] | A 19-year-old healthy man was admitted to our cardiology department following a syncopal episode. His past medical history was unremarkable. He no family history of heart disease or sudden death. Two-days prior the syncope, he developed chest pain and an influenza-like illness consisting of fevers, rhinorrhea, and sore throat. At the physical exam, the patient was febrile at 39°C. He had an inflamed throat, bradycardia at cardiac auscultation and there were no signs of heart failure. The electrocardiogram (EKG) showed grade III atrioventricular (AV) bloc with a ventricular rate of 38 beats per minute. Laboratory studies were remarkable for a HS-troponin level 181ng/L, a white blood cell count of 14270/mm³ with 48% lymphocytes, and elevated C-reactive protein at 90mg/L. Serum electrolytes, kidney and liver functions were within normal limits. A chest X-ray showed an appropriate cardiac size. The initial transthoracic echocardiography (TTE) showed a normal global left ventricular function (left ventricular ejection fraction (LVEF) 60%) and wall motion abnormalities (anteroseptal hypokinesia), with reduced left ventricular global longitudinal strain (LV GLS= -14.1%). Cardiac magnetic resonance (CMR) showed increased signal intensity at the mid-lateral wall on T2-weighted images. Late enhancement revealed a patchy subepicardial hyperenhancement of the medio-distal segments of the anterior and anterolateral walls which confirm the diagnosis of myocarditis. The patient was treated with cefotaxime and doxycycline. All serological tests (chlamydia, coxiella, mycoplasma, rickettsia, lyme and bartonella) obtained during the hospitalization were negative. Five days later, the patient was asymptomatic. The 24 hours ECG monitoring showed a sinus rhythm. The TTE revealed a normal LVEF and an improvement in the LVGLS with segmental reduced values concordant with the CMR abnormalities. At one-month follow-up the patient made a full recovery without any recurring cardiovascular symptoms or abnormal electrocardiographic or echocardiographic findings.
| EN100682 |
Two-days prior the syncope, he developed chest pain and an influenza-like illness consisting of fevers, rhinorrhea, and sore throat. | [
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] | A 19-year-old healthy man was admitted to our cardiology department following a syncopal episode. His past medical history was unremarkable. He no family history of heart disease or sudden death. Two-days prior the syncope, he developed chest pain and an influenza-like illness consisting of fevers, rhinorrhea, and sore throat. At the physical exam, the patient was febrile at 39°C. He had an inflamed throat, bradycardia at cardiac auscultation and there were no signs of heart failure. The electrocardiogram (EKG) showed grade III atrioventricular (AV) bloc with a ventricular rate of 38 beats per minute. Laboratory studies were remarkable for a HS-troponin level 181ng/L, a white blood cell count of 14270/mm³ with 48% lymphocytes, and elevated C-reactive protein at 90mg/L. Serum electrolytes, kidney and liver functions were within normal limits. A chest X-ray showed an appropriate cardiac size. The initial transthoracic echocardiography (TTE) showed a normal global left ventricular function (left ventricular ejection fraction (LVEF) 60%) and wall motion abnormalities (anteroseptal hypokinesia), with reduced left ventricular global longitudinal strain (LV GLS= -14.1%). Cardiac magnetic resonance (CMR) showed increased signal intensity at the mid-lateral wall on T2-weighted images. Late enhancement revealed a patchy subepicardial hyperenhancement of the medio-distal segments of the anterior and anterolateral walls which confirm the diagnosis of myocarditis. The patient was treated with cefotaxime and doxycycline. All serological tests (chlamydia, coxiella, mycoplasma, rickettsia, lyme and bartonella) obtained during the hospitalization were negative. Five days later, the patient was asymptomatic. The 24 hours ECG monitoring showed a sinus rhythm. The TTE revealed a normal LVEF and an improvement in the LVGLS with segmental reduced values concordant with the CMR abnormalities. At one-month follow-up the patient made a full recovery without any recurring cardiovascular symptoms or abnormal electrocardiographic or echocardiographic findings.
| EN100682 |
At the physical exam, the patient was febrile at 39°C. | [
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| EN100682 |
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| EN100682 |
The electrocardiogram (EKG) showed grade III atrioventricular (AV) bloc with a ventricular rate of 38 beats per minute. | [
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| EN100682 |
Laboratory studies were remarkable for a HS-troponin level 181ng/L, a white blood cell count of 14270/mm³ with 48% lymphocytes, and elevated C-reactive protein at 90mg/L. | [
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| EN100682 |
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] | A 19-year-old healthy man was admitted to our cardiology department following a syncopal episode. His past medical history was unremarkable. He no family history of heart disease or sudden death. Two-days prior the syncope, he developed chest pain and an influenza-like illness consisting of fevers, rhinorrhea, and sore throat. At the physical exam, the patient was febrile at 39°C. He had an inflamed throat, bradycardia at cardiac auscultation and there were no signs of heart failure. The electrocardiogram (EKG) showed grade III atrioventricular (AV) bloc with a ventricular rate of 38 beats per minute. Laboratory studies were remarkable for a HS-troponin level 181ng/L, a white blood cell count of 14270/mm³ with 48% lymphocytes, and elevated C-reactive protein at 90mg/L. Serum electrolytes, kidney and liver functions were within normal limits. A chest X-ray showed an appropriate cardiac size. The initial transthoracic echocardiography (TTE) showed a normal global left ventricular function (left ventricular ejection fraction (LVEF) 60%) and wall motion abnormalities (anteroseptal hypokinesia), with reduced left ventricular global longitudinal strain (LV GLS= -14.1%). Cardiac magnetic resonance (CMR) showed increased signal intensity at the mid-lateral wall on T2-weighted images. Late enhancement revealed a patchy subepicardial hyperenhancement of the medio-distal segments of the anterior and anterolateral walls which confirm the diagnosis of myocarditis. The patient was treated with cefotaxime and doxycycline. All serological tests (chlamydia, coxiella, mycoplasma, rickettsia, lyme and bartonella) obtained during the hospitalization were negative. Five days later, the patient was asymptomatic. The 24 hours ECG monitoring showed a sinus rhythm. The TTE revealed a normal LVEF and an improvement in the LVGLS with segmental reduced values concordant with the CMR abnormalities. At one-month follow-up the patient made a full recovery without any recurring cardiovascular symptoms or abnormal electrocardiographic or echocardiographic findings.
| EN100682 |
A chest X-ray showed an appropriate cardiac size. | [
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] | A 19-year-old healthy man was admitted to our cardiology department following a syncopal episode. His past medical history was unremarkable. He no family history of heart disease or sudden death. Two-days prior the syncope, he developed chest pain and an influenza-like illness consisting of fevers, rhinorrhea, and sore throat. At the physical exam, the patient was febrile at 39°C. He had an inflamed throat, bradycardia at cardiac auscultation and there were no signs of heart failure. The electrocardiogram (EKG) showed grade III atrioventricular (AV) bloc with a ventricular rate of 38 beats per minute. Laboratory studies were remarkable for a HS-troponin level 181ng/L, a white blood cell count of 14270/mm³ with 48% lymphocytes, and elevated C-reactive protein at 90mg/L. Serum electrolytes, kidney and liver functions were within normal limits. A chest X-ray showed an appropriate cardiac size. The initial transthoracic echocardiography (TTE) showed a normal global left ventricular function (left ventricular ejection fraction (LVEF) 60%) and wall motion abnormalities (anteroseptal hypokinesia), with reduced left ventricular global longitudinal strain (LV GLS= -14.1%). Cardiac magnetic resonance (CMR) showed increased signal intensity at the mid-lateral wall on T2-weighted images. Late enhancement revealed a patchy subepicardial hyperenhancement of the medio-distal segments of the anterior and anterolateral walls which confirm the diagnosis of myocarditis. The patient was treated with cefotaxime and doxycycline. All serological tests (chlamydia, coxiella, mycoplasma, rickettsia, lyme and bartonella) obtained during the hospitalization were negative. Five days later, the patient was asymptomatic. The 24 hours ECG monitoring showed a sinus rhythm. The TTE revealed a normal LVEF and an improvement in the LVGLS with segmental reduced values concordant with the CMR abnormalities. At one-month follow-up the patient made a full recovery without any recurring cardiovascular symptoms or abnormal electrocardiographic or echocardiographic findings.
| EN100682 |
The initial transthoracic echocardiography (TTE) showed a normal global left ventricular function (left ventricular ejection fraction (LVEF) 60%) and wall motion abnormalities (anteroseptal hypokinesia), with reduced left ventricular global longitudinal strain (LV GLS= -14.1%). | [
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| EN100682 |
Cardiac magnetic resonance (CMR) showed increased signal intensity at the mid-lateral wall on T2-weighted images. | [
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| EN100682 |
Late enhancement revealed a patchy subepicardial hyperenhancement of the medio-distal segments of the anterior and anterolateral walls which confirm the diagnosis of myocarditis. | [
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| EN100682 |
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| EN100682 |
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] | A 19-year-old healthy man was admitted to our cardiology department following a syncopal episode. His past medical history was unremarkable. He no family history of heart disease or sudden death. Two-days prior the syncope, he developed chest pain and an influenza-like illness consisting of fevers, rhinorrhea, and sore throat. At the physical exam, the patient was febrile at 39°C. He had an inflamed throat, bradycardia at cardiac auscultation and there were no signs of heart failure. The electrocardiogram (EKG) showed grade III atrioventricular (AV) bloc with a ventricular rate of 38 beats per minute. Laboratory studies were remarkable for a HS-troponin level 181ng/L, a white blood cell count of 14270/mm³ with 48% lymphocytes, and elevated C-reactive protein at 90mg/L. Serum electrolytes, kidney and liver functions were within normal limits. A chest X-ray showed an appropriate cardiac size. The initial transthoracic echocardiography (TTE) showed a normal global left ventricular function (left ventricular ejection fraction (LVEF) 60%) and wall motion abnormalities (anteroseptal hypokinesia), with reduced left ventricular global longitudinal strain (LV GLS= -14.1%). Cardiac magnetic resonance (CMR) showed increased signal intensity at the mid-lateral wall on T2-weighted images. Late enhancement revealed a patchy subepicardial hyperenhancement of the medio-distal segments of the anterior and anterolateral walls which confirm the diagnosis of myocarditis. The patient was treated with cefotaxime and doxycycline. All serological tests (chlamydia, coxiella, mycoplasma, rickettsia, lyme and bartonella) obtained during the hospitalization were negative. Five days later, the patient was asymptomatic. The 24 hours ECG monitoring showed a sinus rhythm. The TTE revealed a normal LVEF and an improvement in the LVGLS with segmental reduced values concordant with the CMR abnormalities. At one-month follow-up the patient made a full recovery without any recurring cardiovascular symptoms or abnormal electrocardiographic or echocardiographic findings.
| EN100682 |
Five days later, the patient was asymptomatic. | [
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] | A 19-year-old healthy man was admitted to our cardiology department following a syncopal episode. His past medical history was unremarkable. He no family history of heart disease or sudden death. Two-days prior the syncope, he developed chest pain and an influenza-like illness consisting of fevers, rhinorrhea, and sore throat. At the physical exam, the patient was febrile at 39°C. He had an inflamed throat, bradycardia at cardiac auscultation and there were no signs of heart failure. The electrocardiogram (EKG) showed grade III atrioventricular (AV) bloc with a ventricular rate of 38 beats per minute. Laboratory studies were remarkable for a HS-troponin level 181ng/L, a white blood cell count of 14270/mm³ with 48% lymphocytes, and elevated C-reactive protein at 90mg/L. Serum electrolytes, kidney and liver functions were within normal limits. A chest X-ray showed an appropriate cardiac size. The initial transthoracic echocardiography (TTE) showed a normal global left ventricular function (left ventricular ejection fraction (LVEF) 60%) and wall motion abnormalities (anteroseptal hypokinesia), with reduced left ventricular global longitudinal strain (LV GLS= -14.1%). Cardiac magnetic resonance (CMR) showed increased signal intensity at the mid-lateral wall on T2-weighted images. Late enhancement revealed a patchy subepicardial hyperenhancement of the medio-distal segments of the anterior and anterolateral walls which confirm the diagnosis of myocarditis. The patient was treated with cefotaxime and doxycycline. All serological tests (chlamydia, coxiella, mycoplasma, rickettsia, lyme and bartonella) obtained during the hospitalization were negative. Five days later, the patient was asymptomatic. The 24 hours ECG monitoring showed a sinus rhythm. The TTE revealed a normal LVEF and an improvement in the LVGLS with segmental reduced values concordant with the CMR abnormalities. At one-month follow-up the patient made a full recovery without any recurring cardiovascular symptoms or abnormal electrocardiographic or echocardiographic findings.
| EN100682 |
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] | A 19-year-old healthy man was admitted to our cardiology department following a syncopal episode. His past medical history was unremarkable. He no family history of heart disease or sudden death. Two-days prior the syncope, he developed chest pain and an influenza-like illness consisting of fevers, rhinorrhea, and sore throat. At the physical exam, the patient was febrile at 39°C. He had an inflamed throat, bradycardia at cardiac auscultation and there were no signs of heart failure. The electrocardiogram (EKG) showed grade III atrioventricular (AV) bloc with a ventricular rate of 38 beats per minute. Laboratory studies were remarkable for a HS-troponin level 181ng/L, a white blood cell count of 14270/mm³ with 48% lymphocytes, and elevated C-reactive protein at 90mg/L. Serum electrolytes, kidney and liver functions were within normal limits. A chest X-ray showed an appropriate cardiac size. The initial transthoracic echocardiography (TTE) showed a normal global left ventricular function (left ventricular ejection fraction (LVEF) 60%) and wall motion abnormalities (anteroseptal hypokinesia), with reduced left ventricular global longitudinal strain (LV GLS= -14.1%). Cardiac magnetic resonance (CMR) showed increased signal intensity at the mid-lateral wall on T2-weighted images. Late enhancement revealed a patchy subepicardial hyperenhancement of the medio-distal segments of the anterior and anterolateral walls which confirm the diagnosis of myocarditis. The patient was treated with cefotaxime and doxycycline. All serological tests (chlamydia, coxiella, mycoplasma, rickettsia, lyme and bartonella) obtained during the hospitalization were negative. Five days later, the patient was asymptomatic. The 24 hours ECG monitoring showed a sinus rhythm. The TTE revealed a normal LVEF and an improvement in the LVGLS with segmental reduced values concordant with the CMR abnormalities. At one-month follow-up the patient made a full recovery without any recurring cardiovascular symptoms or abnormal electrocardiographic or echocardiographic findings.
| EN100682 |
The TTE revealed a normal LVEF and an improvement in the LVGLS with segmental reduced values concordant with the CMR abnormalities. | [
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| EN100682 |
At one-month follow-up the patient made a full recovery without any recurring cardiovascular symptoms or abnormal electrocardiographic or echocardiographic findings. | [
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| EN100682 |
Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. | [
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
| EN100655 |
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| EN100655 |
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| EN100655 |
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
| EN100655 |
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| EN100655 |
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
| EN100655 |
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| EN100655 |
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| EN100655 |
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| EN100655 |
Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. | [
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| EN100655 |
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
| EN100655 |
An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. | [
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| EN100655 |
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
| EN100655 |
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
| EN100655 |
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
| EN100655 |
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
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| EN100655 |
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
| EN100655 |
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
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| EN100655 |
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
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| EN100655 |
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
| EN100655 |
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| EN100655 |
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
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| EN100655 |
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| EN100655 |
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| EN100655 |
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
| EN100655 |
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
| EN100655 |
At six months, radiographies showed that the lesion healed completely. | [
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
| EN100655 |
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
| EN100655 |
Their child acquired walking at the age of 14 months. | [
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
| EN100655 |
In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running. | [
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] | Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours. His parents had noted an ankle trauma in the previous week. The primary care physician had initially suspected a talus fracture. His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice. However, the child continued to experience ankle pain and fever. He was returned to the emergency room after two days. His symptoms were aggravated. The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation. His temperature was 39°C. Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h. Serum laboratory studies, including CBC count and inflammatory markers, were all elevated. An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint. However, the computed tomography (CT) scan findings revealed a talus fracture. A magnetic resonance imaging (MRI) was not done as it was not available. Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan. The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis. Therapeutic intervention: the patient was urgently taken to the operating room. During the operation, the ankle joint was explored through an anterior approach. There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus. The talar cartilage was regular and normal-looking. The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained. The biopsy specimens for the histopathological examination and culture were taken at that site. Curettage and irrigation were performed, and the joint was closed over suction drains. An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated. Follow-up and outcomes: febrile peaks persisted during the first three days. The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R. The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells. So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression. Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks. In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg. The patient's antibiotic was then substituted by oral pristinamycin for three weeks. In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively. At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle. The cast was removed six weeks after surgery. At six months, radiographies showed that the lesion healed completely. The parents were very satisfied. Their child acquired walking at the age of 14 months. In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.
| EN100655 |
We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. | [
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"text": "6 day old female neonate",
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] | We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. There was no use of instrumentation and she cried spontaneously at birth. Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. There were marked chemosis bilaterally worst in the right. Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. She was also reviewed by the pediatrician and no other abnormality was found. Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. Both eyeballs were normal.
| EN100090 |
The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. | [
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] | We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. There was no use of instrumentation and she cried spontaneously at birth. Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. There were marked chemosis bilaterally worst in the right. Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. She was also reviewed by the pediatrician and no other abnormality was found. Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. Both eyeballs were normal.
| EN100090 |
There was no use of instrumentation and she cried spontaneously at birth. | [
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] | We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. There was no use of instrumentation and she cried spontaneously at birth. Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. There were marked chemosis bilaterally worst in the right. Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. She was also reviewed by the pediatrician and no other abnormality was found. Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. Both eyeballs were normal.
| EN100090 |
Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. | [
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},
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],
"role": "",
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"text": "improvement",
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],
"role": "PATIENT",
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"text": "the child",
"type": "ACTOR"
},
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"id": "4869",
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166,
172
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"role": "",
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"text": "6 days",
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}
] | We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. There was no use of instrumentation and she cried spontaneously at birth. Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. There were marked chemosis bilaterally worst in the right. Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. She was also reviewed by the pediatrician and no other abnormality was found. Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. Both eyeballs were normal.
| EN100090 |
Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. | [
{
"id": "4322",
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],
"role": "",
"semantic_type_id": "",
"text": "Examination",
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},
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"role": "",
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"text": "revealed",
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},
{
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"role": "",
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"text": "bilateral complete eversion of the upper eyelids",
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},
{
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103,
116
],
"role": "",
"semantic_type_id": "",
"text": "upper eyelids",
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}
] | We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. There was no use of instrumentation and she cried spontaneously at birth. Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. There were marked chemosis bilaterally worst in the right. Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. She was also reviewed by the pediatrician and no other abnormality was found. Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. Both eyeballs were normal.
| EN100090 |
There were marked chemosis bilaterally worst in the right. | [
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],
"role": "",
"semantic_type_id": "",
"text": "chemosis",
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},
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18,
38
],
"role": "",
"semantic_type_id": "C2045790",
"text": "chemosis bilaterally",
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}
] | We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. There was no use of instrumentation and she cried spontaneously at birth. Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. There were marked chemosis bilaterally worst in the right. Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. She was also reviewed by the pediatrician and no other abnormality was found. Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. Both eyeballs were normal.
| EN100090 |
Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. | [
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"id": "4367",
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15,
29
],
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"text": "double-everted",
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},
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"text": "assess",
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"role": "",
"semantic_type_id": "",
"text": "Both eyes",
"type": "BODYPART"
},
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91,
103
],
"role": "",
"semantic_type_id": "",
"text": "two eyeballs",
"type": "BODYPART"
}
] | We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. There was no use of instrumentation and she cried spontaneously at birth. Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. There were marked chemosis bilaterally worst in the right. Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. She was also reviewed by the pediatrician and no other abnormality was found. Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. Both eyeballs were normal.
| EN100090 |
Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. | [
{
"id": "4397",
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24
],
"role": "",
"semantic_type_id": "",
"text": "repositioning",
"type": "EVENT"
},
{
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],
"role": "",
"semantic_type_id": "",
"text": "unsuccessful",
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},
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],
"role": "",
"semantic_type_id": "",
"text": "chemosis",
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},
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],
"role": "",
"semantic_type_id": "C2045790",
"text": "chemosis",
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},
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"id": "4763",
"offsets": [
29,
36
],
"role": "",
"semantic_type_id": "",
"text": "eyelids",
"type": "BODYPART"
}
] | We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. There was no use of instrumentation and she cried spontaneously at birth. Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. There were marked chemosis bilaterally worst in the right. Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. She was also reviewed by the pediatrician and no other abnormality was found. Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. Both eyeballs were normal.
| EN100090 |
The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. | [
{
"id": "4442",
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],
"role": "",
"semantic_type_id": "",
"text": "admitted",
"type": "EVENT"
},
{
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],
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"text": "monitoring",
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9
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "The child",
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}
] | We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. There was no use of instrumentation and she cried spontaneously at birth. Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. There were marked chemosis bilaterally worst in the right. Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. She was also reviewed by the pediatrician and no other abnormality was found. Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. Both eyeballs were normal.
| EN100090 |
She was also reviewed by the pediatrician and no other abnormality was found. | [
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],
"role": "H-PROFESSIONAL",
"semantic_type_id": "",
"text": "the pediatrician",
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}
] | We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. There was no use of instrumentation and she cried spontaneously at birth. Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. There were marked chemosis bilaterally worst in the right. Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. She was also reviewed by the pediatrician and no other abnormality was found. Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. Both eyeballs were normal.
| EN100090 |
Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. | [
{
"id": "4502",
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],
"role": "",
"semantic_type_id": "",
"text": "shield",
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},
{
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],
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"text": "applied",
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},
{
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"offsets": [
60,
64
],
"role": "",
"semantic_type_id": "",
"text": "eyes",
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}
] | We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. There was no use of instrumentation and she cried spontaneously at birth. Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. There were marked chemosis bilaterally worst in the right. Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. She was also reviewed by the pediatrician and no other abnormality was found. Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. Both eyeballs were normal.
| EN100090 |
She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. | [
{
"id": "4532",
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"role": "",
"semantic_type_id": "",
"text": "commenced",
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},
{
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],
"role": "",
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"text": "saline",
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},
{
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],
"role": "",
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"text": "placed",
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},
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],
"role": "",
"semantic_type_id": "",
"text": "prolapsed chemosed palpebral conjunctivae",
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},
{
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],
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"text": "She",
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},
{
"id": "4878",
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],
"role": "",
"semantic_type_id": "",
"text": "4 hourly",
"type": "TIMEX3"
},
{
"id": "4887",
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],
"role": "",
"semantic_type_id": "",
"text": "3hours",
"type": "TIMEX3"
},
{
"id": "4896",
"offsets": [
170,
183
],
"role": "",
"semantic_type_id": "",
"text": "once in a day",
"type": "TIMEX3"
}
] | We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. There was no use of instrumentation and she cried spontaneously at birth. Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. There were marked chemosis bilaterally worst in the right. Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. She was also reviewed by the pediatrician and no other abnormality was found. Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. Both eyeballs were normal.
| EN100090 |
She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. | [
{
"id": "4577",
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13,
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"text": "commenced",
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},
{
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"role": "",
"semantic_type_id": "",
"text": "USP",
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},
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],
"role": "",
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"text": "2 hourly",
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},
{
"id": "4914",
"offsets": [
129,
134
],
"role": "",
"semantic_type_id": "",
"text": "night",
"type": "TIMEX3"
}
] | We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. There was no use of instrumentation and she cried spontaneously at birth. Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. There were marked chemosis bilaterally worst in the right. Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. She was also reviewed by the pediatrician and no other abnormality was found. Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. Both eyeballs were normal.
| EN100090 |
On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. | [
{
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"role": "",
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"text": "chemosis",
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},
{
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"role": "",
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"text": "resolved",
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],
"role": "",
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"text": "opening",
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{
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],
"role": "",
"semantic_type_id": "C2045792",
"text": "chemosis on the right",
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},
{
"id": "4781",
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],
"role": "",
"semantic_type_id": "",
"text": "right lid",
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},
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"id": "4923",
"offsets": [
7,
14
],
"role": "",
"semantic_type_id": "",
"text": "3rd day",
"type": "TIMEX3"
}
] | We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. There was no use of instrumentation and she cried spontaneously at birth. Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. There were marked chemosis bilaterally worst in the right. Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. She was also reviewed by the pediatrician and no other abnormality was found. Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. Both eyeballs were normal.
| EN100090 |
However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. | [
{
"id": "4652",
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],
"role": "",
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"text": "chemosis",
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"text": "resolved",
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23
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"text": "5th day",
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] | We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. There was no use of instrumentation and she cried spontaneously at birth. Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. There were marked chemosis bilaterally worst in the right. Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. She was also reviewed by the pediatrician and no other abnormality was found. Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. Both eyeballs were normal.
| EN100090 |
Both eyeballs were normal. | [
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"role": "",
"semantic_type_id": "",
"text": "Both eyeballs",
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] | We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth. The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route. There was no use of instrumentation and she cried spontaneously at birth. Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral. Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids. There were marked chemosis bilaterally worst in the right. Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal. Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis. The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring. She was also reviewed by the pediatrician and no other abnormality was found. Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae. She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day. She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night. On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening. However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening. Both eyeballs were normal.
| EN100090 |
A 33-year man working in Gulf, presented with hemetemesis 15 days ago in the month of February this year. | [
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"text": "15 days ago in the month of February this year",
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] | A 33-year man working in Gulf, presented with hemetemesis 15 days ago in the month of February this year. This was preceeded by low grade fever, bone pain, generalised bodyache, low back ache and generalised macular skin rashes. There was no history of abdominal pain, jaundice or features of chronic liver disease. He gave history of intake of analgesics for backache. After symptomatic treatment he returned back. He came to our OPD with Complete blood count which showed a haemoglobin of 8g/dl, total count 6700/mm3 platelet count 24000/mm3 and ESR 55mm/hr. On examination patient was pale with non pruritic macular rashes and mild splenomegaly. Residing in Middle East with background history of fever, backache, skin rash, splenomegaly and a low platelet count possibility of atypical infection like Brucellosis with NSAID induced gi bleed was considered. He was admitted for further evaluation and endoscopy done showed a nodular ulcerative lesions in the antrum of stomach and histopathologic examination confirmed adenocarcinoma of stomach. Liver function tests showed a high ALP (1536 U/l), elevated INR (2.15) though bilirubin, transaminases and serum proteins were normal. Brucella agglutination test was negative. Xray Chest was normal. Ultrasound of abdomen showed normal echotexture of liver, no SOL, normal portal vein and no IHBRD. CT scan of the abdomen revealed gross pylorus thickening with regional lymphadenopathy and skeletal metastasis with sclerotic foci involving vertebrae and pelvic bones and lytic areas in bilateral iliac blades with no liver metastasis or ascites. A skeletal survey was done which showed lytic lesions in the iliac and femoral bones. Bone marrow aspirate showed decreased red cells and platelets and marrow biopsy done was reported as metastasis from adenocarcinoma. Coagulation profile done was suggestive of DIC due to the raised levels of FDP (5,170 ng/dl) and a low fibrinogen \(152mg/dl). He was transferred to Medical Oncology department for subsequent management and was treated with chemotherapy. He succumbed to his illness within 10 months of diagnosis.
| EN100046 |
This was preceeded by low grade fever, bone pain, generalised bodyache, low back ache and generalised macular skin rashes. | [
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"semantic_type_id": "",
"text": "skin rashes",
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] | A 33-year man working in Gulf, presented with hemetemesis 15 days ago in the month of February this year. This was preceeded by low grade fever, bone pain, generalised bodyache, low back ache and generalised macular skin rashes. There was no history of abdominal pain, jaundice or features of chronic liver disease. He gave history of intake of analgesics for backache. After symptomatic treatment he returned back. He came to our OPD with Complete blood count which showed a haemoglobin of 8g/dl, total count 6700/mm3 platelet count 24000/mm3 and ESR 55mm/hr. On examination patient was pale with non pruritic macular rashes and mild splenomegaly. Residing in Middle East with background history of fever, backache, skin rash, splenomegaly and a low platelet count possibility of atypical infection like Brucellosis with NSAID induced gi bleed was considered. He was admitted for further evaluation and endoscopy done showed a nodular ulcerative lesions in the antrum of stomach and histopathologic examination confirmed adenocarcinoma of stomach. Liver function tests showed a high ALP (1536 U/l), elevated INR (2.15) though bilirubin, transaminases and serum proteins were normal. Brucella agglutination test was negative. Xray Chest was normal. Ultrasound of abdomen showed normal echotexture of liver, no SOL, normal portal vein and no IHBRD. CT scan of the abdomen revealed gross pylorus thickening with regional lymphadenopathy and skeletal metastasis with sclerotic foci involving vertebrae and pelvic bones and lytic areas in bilateral iliac blades with no liver metastasis or ascites. A skeletal survey was done which showed lytic lesions in the iliac and femoral bones. Bone marrow aspirate showed decreased red cells and platelets and marrow biopsy done was reported as metastasis from adenocarcinoma. Coagulation profile done was suggestive of DIC due to the raised levels of FDP (5,170 ng/dl) and a low fibrinogen \(152mg/dl). He was transferred to Medical Oncology department for subsequent management and was treated with chemotherapy. He succumbed to his illness within 10 months of diagnosis.
| EN100046 |
There was no history of abdominal pain, jaundice or features of chronic liver disease. | [
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"text": "liver",
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] | A 33-year man working in Gulf, presented with hemetemesis 15 days ago in the month of February this year. This was preceeded by low grade fever, bone pain, generalised bodyache, low back ache and generalised macular skin rashes. There was no history of abdominal pain, jaundice or features of chronic liver disease. He gave history of intake of analgesics for backache. After symptomatic treatment he returned back. He came to our OPD with Complete blood count which showed a haemoglobin of 8g/dl, total count 6700/mm3 platelet count 24000/mm3 and ESR 55mm/hr. On examination patient was pale with non pruritic macular rashes and mild splenomegaly. Residing in Middle East with background history of fever, backache, skin rash, splenomegaly and a low platelet count possibility of atypical infection like Brucellosis with NSAID induced gi bleed was considered. He was admitted for further evaluation and endoscopy done showed a nodular ulcerative lesions in the antrum of stomach and histopathologic examination confirmed adenocarcinoma of stomach. Liver function tests showed a high ALP (1536 U/l), elevated INR (2.15) though bilirubin, transaminases and serum proteins were normal. Brucella agglutination test was negative. Xray Chest was normal. Ultrasound of abdomen showed normal echotexture of liver, no SOL, normal portal vein and no IHBRD. CT scan of the abdomen revealed gross pylorus thickening with regional lymphadenopathy and skeletal metastasis with sclerotic foci involving vertebrae and pelvic bones and lytic areas in bilateral iliac blades with no liver metastasis or ascites. A skeletal survey was done which showed lytic lesions in the iliac and femoral bones. Bone marrow aspirate showed decreased red cells and platelets and marrow biopsy done was reported as metastasis from adenocarcinoma. Coagulation profile done was suggestive of DIC due to the raised levels of FDP (5,170 ng/dl) and a low fibrinogen \(152mg/dl). He was transferred to Medical Oncology department for subsequent management and was treated with chemotherapy. He succumbed to his illness within 10 months of diagnosis.
| EN100046 |
He gave history of intake of analgesics for backache. | [
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] | A 33-year man working in Gulf, presented with hemetemesis 15 days ago in the month of February this year. This was preceeded by low grade fever, bone pain, generalised bodyache, low back ache and generalised macular skin rashes. There was no history of abdominal pain, jaundice or features of chronic liver disease. He gave history of intake of analgesics for backache. After symptomatic treatment he returned back. He came to our OPD with Complete blood count which showed a haemoglobin of 8g/dl, total count 6700/mm3 platelet count 24000/mm3 and ESR 55mm/hr. On examination patient was pale with non pruritic macular rashes and mild splenomegaly. Residing in Middle East with background history of fever, backache, skin rash, splenomegaly and a low platelet count possibility of atypical infection like Brucellosis with NSAID induced gi bleed was considered. He was admitted for further evaluation and endoscopy done showed a nodular ulcerative lesions in the antrum of stomach and histopathologic examination confirmed adenocarcinoma of stomach. Liver function tests showed a high ALP (1536 U/l), elevated INR (2.15) though bilirubin, transaminases and serum proteins were normal. Brucella agglutination test was negative. Xray Chest was normal. Ultrasound of abdomen showed normal echotexture of liver, no SOL, normal portal vein and no IHBRD. CT scan of the abdomen revealed gross pylorus thickening with regional lymphadenopathy and skeletal metastasis with sclerotic foci involving vertebrae and pelvic bones and lytic areas in bilateral iliac blades with no liver metastasis or ascites. A skeletal survey was done which showed lytic lesions in the iliac and femoral bones. Bone marrow aspirate showed decreased red cells and platelets and marrow biopsy done was reported as metastasis from adenocarcinoma. Coagulation profile done was suggestive of DIC due to the raised levels of FDP (5,170 ng/dl) and a low fibrinogen \(152mg/dl). He was transferred to Medical Oncology department for subsequent management and was treated with chemotherapy. He succumbed to his illness within 10 months of diagnosis.
| EN100046 |
After symptomatic treatment he returned back. | [
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] | A 33-year man working in Gulf, presented with hemetemesis 15 days ago in the month of February this year. This was preceeded by low grade fever, bone pain, generalised bodyache, low back ache and generalised macular skin rashes. There was no history of abdominal pain, jaundice or features of chronic liver disease. He gave history of intake of analgesics for backache. After symptomatic treatment he returned back. He came to our OPD with Complete blood count which showed a haemoglobin of 8g/dl, total count 6700/mm3 platelet count 24000/mm3 and ESR 55mm/hr. On examination patient was pale with non pruritic macular rashes and mild splenomegaly. Residing in Middle East with background history of fever, backache, skin rash, splenomegaly and a low platelet count possibility of atypical infection like Brucellosis with NSAID induced gi bleed was considered. He was admitted for further evaluation and endoscopy done showed a nodular ulcerative lesions in the antrum of stomach and histopathologic examination confirmed adenocarcinoma of stomach. Liver function tests showed a high ALP (1536 U/l), elevated INR (2.15) though bilirubin, transaminases and serum proteins were normal. Brucella agglutination test was negative. Xray Chest was normal. Ultrasound of abdomen showed normal echotexture of liver, no SOL, normal portal vein and no IHBRD. CT scan of the abdomen revealed gross pylorus thickening with regional lymphadenopathy and skeletal metastasis with sclerotic foci involving vertebrae and pelvic bones and lytic areas in bilateral iliac blades with no liver metastasis or ascites. A skeletal survey was done which showed lytic lesions in the iliac and femoral bones. Bone marrow aspirate showed decreased red cells and platelets and marrow biopsy done was reported as metastasis from adenocarcinoma. Coagulation profile done was suggestive of DIC due to the raised levels of FDP (5,170 ng/dl) and a low fibrinogen \(152mg/dl). He was transferred to Medical Oncology department for subsequent management and was treated with chemotherapy. He succumbed to his illness within 10 months of diagnosis.
| EN100046 |
He came to our OPD with Complete blood count which showed a haemoglobin of 8g/dl, total count 6700/mm3 platelet count 24000/mm3 and ESR 55mm/hr. | [
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] | A 33-year man working in Gulf, presented with hemetemesis 15 days ago in the month of February this year. This was preceeded by low grade fever, bone pain, generalised bodyache, low back ache and generalised macular skin rashes. There was no history of abdominal pain, jaundice or features of chronic liver disease. He gave history of intake of analgesics for backache. After symptomatic treatment he returned back. He came to our OPD with Complete blood count which showed a haemoglobin of 8g/dl, total count 6700/mm3 platelet count 24000/mm3 and ESR 55mm/hr. On examination patient was pale with non pruritic macular rashes and mild splenomegaly. Residing in Middle East with background history of fever, backache, skin rash, splenomegaly and a low platelet count possibility of atypical infection like Brucellosis with NSAID induced gi bleed was considered. He was admitted for further evaluation and endoscopy done showed a nodular ulcerative lesions in the antrum of stomach and histopathologic examination confirmed adenocarcinoma of stomach. Liver function tests showed a high ALP (1536 U/l), elevated INR (2.15) though bilirubin, transaminases and serum proteins were normal. Brucella agglutination test was negative. Xray Chest was normal. Ultrasound of abdomen showed normal echotexture of liver, no SOL, normal portal vein and no IHBRD. CT scan of the abdomen revealed gross pylorus thickening with regional lymphadenopathy and skeletal metastasis with sclerotic foci involving vertebrae and pelvic bones and lytic areas in bilateral iliac blades with no liver metastasis or ascites. A skeletal survey was done which showed lytic lesions in the iliac and femoral bones. Bone marrow aspirate showed decreased red cells and platelets and marrow biopsy done was reported as metastasis from adenocarcinoma. Coagulation profile done was suggestive of DIC due to the raised levels of FDP (5,170 ng/dl) and a low fibrinogen \(152mg/dl). He was transferred to Medical Oncology department for subsequent management and was treated with chemotherapy. He succumbed to his illness within 10 months of diagnosis.
| EN100046 |
On examination patient was pale with non pruritic macular rashes and mild splenomegaly. | [
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] | A 33-year man working in Gulf, presented with hemetemesis 15 days ago in the month of February this year. This was preceeded by low grade fever, bone pain, generalised bodyache, low back ache and generalised macular skin rashes. There was no history of abdominal pain, jaundice or features of chronic liver disease. He gave history of intake of analgesics for backache. After symptomatic treatment he returned back. He came to our OPD with Complete blood count which showed a haemoglobin of 8g/dl, total count 6700/mm3 platelet count 24000/mm3 and ESR 55mm/hr. On examination patient was pale with non pruritic macular rashes and mild splenomegaly. Residing in Middle East with background history of fever, backache, skin rash, splenomegaly and a low platelet count possibility of atypical infection like Brucellosis with NSAID induced gi bleed was considered. He was admitted for further evaluation and endoscopy done showed a nodular ulcerative lesions in the antrum of stomach and histopathologic examination confirmed adenocarcinoma of stomach. Liver function tests showed a high ALP (1536 U/l), elevated INR (2.15) though bilirubin, transaminases and serum proteins were normal. Brucella agglutination test was negative. Xray Chest was normal. Ultrasound of abdomen showed normal echotexture of liver, no SOL, normal portal vein and no IHBRD. CT scan of the abdomen revealed gross pylorus thickening with regional lymphadenopathy and skeletal metastasis with sclerotic foci involving vertebrae and pelvic bones and lytic areas in bilateral iliac blades with no liver metastasis or ascites. A skeletal survey was done which showed lytic lesions in the iliac and femoral bones. Bone marrow aspirate showed decreased red cells and platelets and marrow biopsy done was reported as metastasis from adenocarcinoma. Coagulation profile done was suggestive of DIC due to the raised levels of FDP (5,170 ng/dl) and a low fibrinogen \(152mg/dl). He was transferred to Medical Oncology department for subsequent management and was treated with chemotherapy. He succumbed to his illness within 10 months of diagnosis.
| EN100046 |
Residing in Middle East with background history of fever, backache, skin rash, splenomegaly and a low platelet count possibility of atypical infection like Brucellosis with NSAID induced gi bleed was considered. | [
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| EN100046 |
He was admitted for further evaluation and endoscopy done showed a nodular ulcerative lesions in the antrum of stomach and histopathologic examination confirmed adenocarcinoma of stomach. | [
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] | A 33-year man working in Gulf, presented with hemetemesis 15 days ago in the month of February this year. This was preceeded by low grade fever, bone pain, generalised bodyache, low back ache and generalised macular skin rashes. There was no history of abdominal pain, jaundice or features of chronic liver disease. He gave history of intake of analgesics for backache. After symptomatic treatment he returned back. He came to our OPD with Complete blood count which showed a haemoglobin of 8g/dl, total count 6700/mm3 platelet count 24000/mm3 and ESR 55mm/hr. On examination patient was pale with non pruritic macular rashes and mild splenomegaly. Residing in Middle East with background history of fever, backache, skin rash, splenomegaly and a low platelet count possibility of atypical infection like Brucellosis with NSAID induced gi bleed was considered. He was admitted for further evaluation and endoscopy done showed a nodular ulcerative lesions in the antrum of stomach and histopathologic examination confirmed adenocarcinoma of stomach. Liver function tests showed a high ALP (1536 U/l), elevated INR (2.15) though bilirubin, transaminases and serum proteins were normal. Brucella agglutination test was negative. Xray Chest was normal. Ultrasound of abdomen showed normal echotexture of liver, no SOL, normal portal vein and no IHBRD. CT scan of the abdomen revealed gross pylorus thickening with regional lymphadenopathy and skeletal metastasis with sclerotic foci involving vertebrae and pelvic bones and lytic areas in bilateral iliac blades with no liver metastasis or ascites. A skeletal survey was done which showed lytic lesions in the iliac and femoral bones. Bone marrow aspirate showed decreased red cells and platelets and marrow biopsy done was reported as metastasis from adenocarcinoma. Coagulation profile done was suggestive of DIC due to the raised levels of FDP (5,170 ng/dl) and a low fibrinogen \(152mg/dl). He was transferred to Medical Oncology department for subsequent management and was treated with chemotherapy. He succumbed to his illness within 10 months of diagnosis.
| EN100046 |
Liver function tests showed a high ALP (1536 U/l), elevated INR (2.15) though bilirubin, transaminases and serum proteins were normal. | [
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] | A 33-year man working in Gulf, presented with hemetemesis 15 days ago in the month of February this year. This was preceeded by low grade fever, bone pain, generalised bodyache, low back ache and generalised macular skin rashes. There was no history of abdominal pain, jaundice or features of chronic liver disease. He gave history of intake of analgesics for backache. After symptomatic treatment he returned back. He came to our OPD with Complete blood count which showed a haemoglobin of 8g/dl, total count 6700/mm3 platelet count 24000/mm3 and ESR 55mm/hr. On examination patient was pale with non pruritic macular rashes and mild splenomegaly. Residing in Middle East with background history of fever, backache, skin rash, splenomegaly and a low platelet count possibility of atypical infection like Brucellosis with NSAID induced gi bleed was considered. He was admitted for further evaluation and endoscopy done showed a nodular ulcerative lesions in the antrum of stomach and histopathologic examination confirmed adenocarcinoma of stomach. Liver function tests showed a high ALP (1536 U/l), elevated INR (2.15) though bilirubin, transaminases and serum proteins were normal. Brucella agglutination test was negative. Xray Chest was normal. Ultrasound of abdomen showed normal echotexture of liver, no SOL, normal portal vein and no IHBRD. CT scan of the abdomen revealed gross pylorus thickening with regional lymphadenopathy and skeletal metastasis with sclerotic foci involving vertebrae and pelvic bones and lytic areas in bilateral iliac blades with no liver metastasis or ascites. A skeletal survey was done which showed lytic lesions in the iliac and femoral bones. Bone marrow aspirate showed decreased red cells and platelets and marrow biopsy done was reported as metastasis from adenocarcinoma. Coagulation profile done was suggestive of DIC due to the raised levels of FDP (5,170 ng/dl) and a low fibrinogen \(152mg/dl). He was transferred to Medical Oncology department for subsequent management and was treated with chemotherapy. He succumbed to his illness within 10 months of diagnosis.
| EN100046 |
Brucella agglutination test was negative. | [
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] | A 33-year man working in Gulf, presented with hemetemesis 15 days ago in the month of February this year. This was preceeded by low grade fever, bone pain, generalised bodyache, low back ache and generalised macular skin rashes. There was no history of abdominal pain, jaundice or features of chronic liver disease. He gave history of intake of analgesics for backache. After symptomatic treatment he returned back. He came to our OPD with Complete blood count which showed a haemoglobin of 8g/dl, total count 6700/mm3 platelet count 24000/mm3 and ESR 55mm/hr. On examination patient was pale with non pruritic macular rashes and mild splenomegaly. Residing in Middle East with background history of fever, backache, skin rash, splenomegaly and a low platelet count possibility of atypical infection like Brucellosis with NSAID induced gi bleed was considered. He was admitted for further evaluation and endoscopy done showed a nodular ulcerative lesions in the antrum of stomach and histopathologic examination confirmed adenocarcinoma of stomach. Liver function tests showed a high ALP (1536 U/l), elevated INR (2.15) though bilirubin, transaminases and serum proteins were normal. Brucella agglutination test was negative. Xray Chest was normal. Ultrasound of abdomen showed normal echotexture of liver, no SOL, normal portal vein and no IHBRD. CT scan of the abdomen revealed gross pylorus thickening with regional lymphadenopathy and skeletal metastasis with sclerotic foci involving vertebrae and pelvic bones and lytic areas in bilateral iliac blades with no liver metastasis or ascites. A skeletal survey was done which showed lytic lesions in the iliac and femoral bones. Bone marrow aspirate showed decreased red cells and platelets and marrow biopsy done was reported as metastasis from adenocarcinoma. Coagulation profile done was suggestive of DIC due to the raised levels of FDP (5,170 ng/dl) and a low fibrinogen \(152mg/dl). He was transferred to Medical Oncology department for subsequent management and was treated with chemotherapy. He succumbed to his illness within 10 months of diagnosis.
| EN100046 |
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| EN100046 |
Ultrasound of abdomen showed normal echotexture of liver, no SOL, normal portal vein and no IHBRD. | [
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| EN100046 |
CT scan of the abdomen revealed gross pylorus thickening with regional lymphadenopathy and skeletal metastasis with sclerotic foci involving vertebrae and pelvic bones and lytic areas in bilateral iliac blades with no liver metastasis or ascites. | [
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| EN100046 |
A skeletal survey was done which showed lytic lesions in the iliac and femoral bones. | [
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| EN100046 |
Bone marrow aspirate showed decreased red cells and platelets and marrow biopsy done was reported as metastasis from adenocarcinoma. | [
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] | A 33-year man working in Gulf, presented with hemetemesis 15 days ago in the month of February this year. This was preceeded by low grade fever, bone pain, generalised bodyache, low back ache and generalised macular skin rashes. There was no history of abdominal pain, jaundice or features of chronic liver disease. He gave history of intake of analgesics for backache. After symptomatic treatment he returned back. He came to our OPD with Complete blood count which showed a haemoglobin of 8g/dl, total count 6700/mm3 platelet count 24000/mm3 and ESR 55mm/hr. On examination patient was pale with non pruritic macular rashes and mild splenomegaly. Residing in Middle East with background history of fever, backache, skin rash, splenomegaly and a low platelet count possibility of atypical infection like Brucellosis with NSAID induced gi bleed was considered. He was admitted for further evaluation and endoscopy done showed a nodular ulcerative lesions in the antrum of stomach and histopathologic examination confirmed adenocarcinoma of stomach. Liver function tests showed a high ALP (1536 U/l), elevated INR (2.15) though bilirubin, transaminases and serum proteins were normal. Brucella agglutination test was negative. Xray Chest was normal. Ultrasound of abdomen showed normal echotexture of liver, no SOL, normal portal vein and no IHBRD. CT scan of the abdomen revealed gross pylorus thickening with regional lymphadenopathy and skeletal metastasis with sclerotic foci involving vertebrae and pelvic bones and lytic areas in bilateral iliac blades with no liver metastasis or ascites. A skeletal survey was done which showed lytic lesions in the iliac and femoral bones. Bone marrow aspirate showed decreased red cells and platelets and marrow biopsy done was reported as metastasis from adenocarcinoma. Coagulation profile done was suggestive of DIC due to the raised levels of FDP (5,170 ng/dl) and a low fibrinogen \(152mg/dl). He was transferred to Medical Oncology department for subsequent management and was treated with chemotherapy. He succumbed to his illness within 10 months of diagnosis.
| EN100046 |
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