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Under spinal anesthesia, a tourniquet was applied to right lower extremity. | [
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] | A seventy two years old male presented to our clinic with swelling, pain, and limitation of movement at knee joint. The patient's history revealed swellings and pain at knee joint for nearly last 20 years. He was prescribed nonsteroidal anti-inflammatory drugs and rest. But pain didn't relieve and limitations in range of motion occurred at knee joint. Physical examination findings included a solid and semi-mobile mass at anterior knee region. Knee joint range of motion was 80 degrees flexion and 0 degrees extension. There wasn't any neurovascular pathology. Antero-posterior and lateral knee X-rays showed degenerative changes and a giant, irregular, calcific mass which started below patella and extended to suprapatellar area. Knee MRI revealed many loose bodies (consistent with synovial chondromatosis) isointense with fatty bone marrow at all sequences at the level of right knee joint. Scalloping was observed at tibial and femoral surfaces. Decision for a surgical intervention was made and after informing the patient, consent was taken. Under spinal anesthesia, a tourniquet was applied to right lower extremity. Right knee was entered with an anterior longitudinal incision. Cutaneous and subcutaneous tissues were passed. Quadriceps mechanism was opened with a medial parapatellar incision and patella was toppled to left side. Intraarticular mass was exposed. The mass was released from surrounding tissues by blunt excision and excised with enucleation. Then synovial tissue was excised with synoviectomy. Surgical area was irrigated using abundant isotonic solution. The excised mass was sent to pathology laboratory. Pathology evaluation showed that the mass was consistent with synovial chondromatosis. Active and passive exercises were started at an early period after surgery. Recurrence was not detected at his last control visit. Knee movements were at full range when compared with the other knee. There was no pain or other complaints.
| EN100247 |
Right knee was entered with an anterior longitudinal incision. | [
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| EN100247 |
Cutaneous and subcutaneous tissues were passed. | [
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] | A seventy two years old male presented to our clinic with swelling, pain, and limitation of movement at knee joint. The patient's history revealed swellings and pain at knee joint for nearly last 20 years. He was prescribed nonsteroidal anti-inflammatory drugs and rest. But pain didn't relieve and limitations in range of motion occurred at knee joint. Physical examination findings included a solid and semi-mobile mass at anterior knee region. Knee joint range of motion was 80 degrees flexion and 0 degrees extension. There wasn't any neurovascular pathology. Antero-posterior and lateral knee X-rays showed degenerative changes and a giant, irregular, calcific mass which started below patella and extended to suprapatellar area. Knee MRI revealed many loose bodies (consistent with synovial chondromatosis) isointense with fatty bone marrow at all sequences at the level of right knee joint. Scalloping was observed at tibial and femoral surfaces. Decision for a surgical intervention was made and after informing the patient, consent was taken. Under spinal anesthesia, a tourniquet was applied to right lower extremity. Right knee was entered with an anterior longitudinal incision. Cutaneous and subcutaneous tissues were passed. Quadriceps mechanism was opened with a medial parapatellar incision and patella was toppled to left side. Intraarticular mass was exposed. The mass was released from surrounding tissues by blunt excision and excised with enucleation. Then synovial tissue was excised with synoviectomy. Surgical area was irrigated using abundant isotonic solution. The excised mass was sent to pathology laboratory. Pathology evaluation showed that the mass was consistent with synovial chondromatosis. Active and passive exercises were started at an early period after surgery. Recurrence was not detected at his last control visit. Knee movements were at full range when compared with the other knee. There was no pain or other complaints.
| EN100247 |
Quadriceps mechanism was opened with a medial parapatellar incision and patella was toppled to left side. | [
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] | A seventy two years old male presented to our clinic with swelling, pain, and limitation of movement at knee joint. The patient's history revealed swellings and pain at knee joint for nearly last 20 years. He was prescribed nonsteroidal anti-inflammatory drugs and rest. But pain didn't relieve and limitations in range of motion occurred at knee joint. Physical examination findings included a solid and semi-mobile mass at anterior knee region. Knee joint range of motion was 80 degrees flexion and 0 degrees extension. There wasn't any neurovascular pathology. Antero-posterior and lateral knee X-rays showed degenerative changes and a giant, irregular, calcific mass which started below patella and extended to suprapatellar area. Knee MRI revealed many loose bodies (consistent with synovial chondromatosis) isointense with fatty bone marrow at all sequences at the level of right knee joint. Scalloping was observed at tibial and femoral surfaces. Decision for a surgical intervention was made and after informing the patient, consent was taken. Under spinal anesthesia, a tourniquet was applied to right lower extremity. Right knee was entered with an anterior longitudinal incision. Cutaneous and subcutaneous tissues were passed. Quadriceps mechanism was opened with a medial parapatellar incision and patella was toppled to left side. Intraarticular mass was exposed. The mass was released from surrounding tissues by blunt excision and excised with enucleation. Then synovial tissue was excised with synoviectomy. Surgical area was irrigated using abundant isotonic solution. The excised mass was sent to pathology laboratory. Pathology evaluation showed that the mass was consistent with synovial chondromatosis. Active and passive exercises were started at an early period after surgery. Recurrence was not detected at his last control visit. Knee movements were at full range when compared with the other knee. There was no pain or other complaints.
| EN100247 |
Intraarticular mass was exposed. | [
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] | A seventy two years old male presented to our clinic with swelling, pain, and limitation of movement at knee joint. The patient's history revealed swellings and pain at knee joint for nearly last 20 years. He was prescribed nonsteroidal anti-inflammatory drugs and rest. But pain didn't relieve and limitations in range of motion occurred at knee joint. Physical examination findings included a solid and semi-mobile mass at anterior knee region. Knee joint range of motion was 80 degrees flexion and 0 degrees extension. There wasn't any neurovascular pathology. Antero-posterior and lateral knee X-rays showed degenerative changes and a giant, irregular, calcific mass which started below patella and extended to suprapatellar area. Knee MRI revealed many loose bodies (consistent with synovial chondromatosis) isointense with fatty bone marrow at all sequences at the level of right knee joint. Scalloping was observed at tibial and femoral surfaces. Decision for a surgical intervention was made and after informing the patient, consent was taken. Under spinal anesthesia, a tourniquet was applied to right lower extremity. Right knee was entered with an anterior longitudinal incision. Cutaneous and subcutaneous tissues were passed. Quadriceps mechanism was opened with a medial parapatellar incision and patella was toppled to left side. Intraarticular mass was exposed. The mass was released from surrounding tissues by blunt excision and excised with enucleation. Then synovial tissue was excised with synoviectomy. Surgical area was irrigated using abundant isotonic solution. The excised mass was sent to pathology laboratory. Pathology evaluation showed that the mass was consistent with synovial chondromatosis. Active and passive exercises were started at an early period after surgery. Recurrence was not detected at his last control visit. Knee movements were at full range when compared with the other knee. There was no pain or other complaints.
| EN100247 |
The mass was released from surrounding tissues by blunt excision and excised with enucleation. | [
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| EN100247 |
Then synovial tissue was excised with synoviectomy. | [
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| EN100247 |
Surgical area was irrigated using abundant isotonic solution. | [
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| EN100247 |
The excised mass was sent to pathology laboratory. | [
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| EN100247 |
Pathology evaluation showed that the mass was consistent with synovial chondromatosis. | [
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| EN100247 |
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| EN100247 |
Recurrence was not detected at his last control visit. | [
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| EN100247 |
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] | A seventy two years old male presented to our clinic with swelling, pain, and limitation of movement at knee joint. The patient's history revealed swellings and pain at knee joint for nearly last 20 years. He was prescribed nonsteroidal anti-inflammatory drugs and rest. But pain didn't relieve and limitations in range of motion occurred at knee joint. Physical examination findings included a solid and semi-mobile mass at anterior knee region. Knee joint range of motion was 80 degrees flexion and 0 degrees extension. There wasn't any neurovascular pathology. Antero-posterior and lateral knee X-rays showed degenerative changes and a giant, irregular, calcific mass which started below patella and extended to suprapatellar area. Knee MRI revealed many loose bodies (consistent with synovial chondromatosis) isointense with fatty bone marrow at all sequences at the level of right knee joint. Scalloping was observed at tibial and femoral surfaces. Decision for a surgical intervention was made and after informing the patient, consent was taken. Under spinal anesthesia, a tourniquet was applied to right lower extremity. Right knee was entered with an anterior longitudinal incision. Cutaneous and subcutaneous tissues were passed. Quadriceps mechanism was opened with a medial parapatellar incision and patella was toppled to left side. Intraarticular mass was exposed. The mass was released from surrounding tissues by blunt excision and excised with enucleation. Then synovial tissue was excised with synoviectomy. Surgical area was irrigated using abundant isotonic solution. The excised mass was sent to pathology laboratory. Pathology evaluation showed that the mass was consistent with synovial chondromatosis. Active and passive exercises were started at an early period after surgery. Recurrence was not detected at his last control visit. Knee movements were at full range when compared with the other knee. There was no pain or other complaints.
| EN100247 |
There was no pain or other complaints. | [
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] | A seventy two years old male presented to our clinic with swelling, pain, and limitation of movement at knee joint. The patient's history revealed swellings and pain at knee joint for nearly last 20 years. He was prescribed nonsteroidal anti-inflammatory drugs and rest. But pain didn't relieve and limitations in range of motion occurred at knee joint. Physical examination findings included a solid and semi-mobile mass at anterior knee region. Knee joint range of motion was 80 degrees flexion and 0 degrees extension. There wasn't any neurovascular pathology. Antero-posterior and lateral knee X-rays showed degenerative changes and a giant, irregular, calcific mass which started below patella and extended to suprapatellar area. Knee MRI revealed many loose bodies (consistent with synovial chondromatosis) isointense with fatty bone marrow at all sequences at the level of right knee joint. Scalloping was observed at tibial and femoral surfaces. Decision for a surgical intervention was made and after informing the patient, consent was taken. Under spinal anesthesia, a tourniquet was applied to right lower extremity. Right knee was entered with an anterior longitudinal incision. Cutaneous and subcutaneous tissues were passed. Quadriceps mechanism was opened with a medial parapatellar incision and patella was toppled to left side. Intraarticular mass was exposed. The mass was released from surrounding tissues by blunt excision and excised with enucleation. Then synovial tissue was excised with synoviectomy. Surgical area was irrigated using abundant isotonic solution. The excised mass was sent to pathology laboratory. Pathology evaluation showed that the mass was consistent with synovial chondromatosis. Active and passive exercises were started at an early period after surgery. Recurrence was not detected at his last control visit. Knee movements were at full range when compared with the other knee. There was no pain or other complaints.
| EN100247 |
A 31-year-old woman with no pathological history was admitted to our hospital for chest pain, bone and joint pain, hair loss and asthenia for the last 3 months. | [
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] | A 31-year-old woman with no pathological history was admitted to our hospital for chest pain, bone and joint pain, hair loss and asthenia for the last 3 months. On physical examination, we found fever at 38°C, polypnea at 32 cycles/min, arterial hypertension at 160/90 mmHg, malar rash, synovitis of wrists, elbows and ankles, and edema on both legs. Diagnostic assessment: laboratory tests disclosed the following values: Increase level of erythrocyte sedimentation rate 120 mm/1 st hour, C reactive protein was 20 mg/l. The blood count showed hemoglobin at 9g/dl, MCV at 85 µ 3, lymphopenia at 400/mm 3, while platelets were normal 450 000/mm 3. Direct coombs test was negative. Serum Albumin was 25g/l; proteins level was low at 50g/l and proteinuria at 3.2g/day. Creatinine was normal. Anti-nuclear antibody ANA were positive 1/320 with homogeneous pattern, anti-dsDNA level was 160U/ml. Anti-cardiolipin IgG antibodies were positive 25UGPL. Rheumatoid Factor was negative. C3 and C4 complement fractions were low (0.2 g/l and 0.05 g/l). Chest x-ray, electrocardiogram and echocardiography were normal. Chest computed tomography (CT) scan showed proximal pulmonary embolism. Renal ultrasound was normal. Renal biopsy reveals immunocomplex nephritis, lupus nephritis, segmental mesangial proliferation, mild activity lupus nephritis class III (A/C). Before starting corticosteroids, we analyzed electrolytes. Serum calcium was elevated 132 mg/l with hyper-calciuria 479 mg/24 h. 25 OHD was normal. Alcaline phosphatase was 420 UI/l. the patient did not have any symptoms of hypercalcemia. Serum protein Electrophoresis showed polyclonal hypergammaglobulinaemia. Serum and urine immunofixation as well as Bence-Jones proteinuria were negative. Intact parathyroid hormone (iPTH) was high 628 pg/ml. CT scan and ultrasound of parathyroid imaging revealed a lower left parathyroid nodule measuring 2cm x 1 cm. Femoral and lumbar bone mineral density (BMD) showed osteoporosis (T-score: -2.6). In addition, we found multiple pelvic osteolytic lesions at CT scan. Other causes of hypercalcemia and bone lysis were excluded. The diagnosis in this case was SLE with lupus nephritis class III and anti-phospholipid syndrome, complicated by pulmonary embolism associated to primary hyperparathyroidism causing severe hypercalcemia, osteoporosis. Therapeutic intervention: the patient was given a pulse of methyl-prednisolone 15 mg/kg/day for 3 days followed by oral prednisone 1 mg/kg/day, associated with intravenous cyclophosphamide 750 mg/m 2 /month for 6 months. Mycophenolate mofetil 2 g/day was prescribed as a maintenance therapy of lupus nephritis with hydroxychloroquine at a dose of 400 mg/day. Treatment of pulmonary embolism was initiated with subcutaneous low molecular weight heparin (enoxaparin 0.1 ml/10 kg/12h) followed by antivitamin K. For Hypercalcemia, patient has received intravenous fluid with furosemide. She also required Alendronate 70 mg/week with Vitamin D 400u/day for osteoporosis. The left parathyroid gland was surgically removed. Histopathological examination revealed parathyroid adenoma. Her immediate postoperative parathyroid hormone level was 64 pg/ml with a calcium level of 98 mg/l. Follow-up and outcomes: forty-eight hours after the surgery she developed oral paresthesia. She had hypocalcemia at 72 mg/l. She required oral supplementation for few months. Additional investigations for multiple endocrine neoplasia were negative. The patient remained asymptomatic. Her SLE was calm without any relapse. Control of proteinuria was negative. Corticosteroids was dropped. The follow-up was 4 years.
| EN100653 |
On physical examination, we found fever at 38°C, polypnea at 32 cycles/min, arterial hypertension at 160/90 mmHg, malar rash, synovitis of wrists, elbows and ankles, and edema on both legs. | [
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] | A 31-year-old woman with no pathological history was admitted to our hospital for chest pain, bone and joint pain, hair loss and asthenia for the last 3 months. On physical examination, we found fever at 38°C, polypnea at 32 cycles/min, arterial hypertension at 160/90 mmHg, malar rash, synovitis of wrists, elbows and ankles, and edema on both legs. Diagnostic assessment: laboratory tests disclosed the following values: Increase level of erythrocyte sedimentation rate 120 mm/1 st hour, C reactive protein was 20 mg/l. The blood count showed hemoglobin at 9g/dl, MCV at 85 µ 3, lymphopenia at 400/mm 3, while platelets were normal 450 000/mm 3. Direct coombs test was negative. Serum Albumin was 25g/l; proteins level was low at 50g/l and proteinuria at 3.2g/day. Creatinine was normal. Anti-nuclear antibody ANA were positive 1/320 with homogeneous pattern, anti-dsDNA level was 160U/ml. Anti-cardiolipin IgG antibodies were positive 25UGPL. Rheumatoid Factor was negative. C3 and C4 complement fractions were low (0.2 g/l and 0.05 g/l). Chest x-ray, electrocardiogram and echocardiography were normal. Chest computed tomography (CT) scan showed proximal pulmonary embolism. Renal ultrasound was normal. Renal biopsy reveals immunocomplex nephritis, lupus nephritis, segmental mesangial proliferation, mild activity lupus nephritis class III (A/C). Before starting corticosteroids, we analyzed electrolytes. Serum calcium was elevated 132 mg/l with hyper-calciuria 479 mg/24 h. 25 OHD was normal. Alcaline phosphatase was 420 UI/l. the patient did not have any symptoms of hypercalcemia. Serum protein Electrophoresis showed polyclonal hypergammaglobulinaemia. Serum and urine immunofixation as well as Bence-Jones proteinuria were negative. Intact parathyroid hormone (iPTH) was high 628 pg/ml. CT scan and ultrasound of parathyroid imaging revealed a lower left parathyroid nodule measuring 2cm x 1 cm. Femoral and lumbar bone mineral density (BMD) showed osteoporosis (T-score: -2.6). In addition, we found multiple pelvic osteolytic lesions at CT scan. Other causes of hypercalcemia and bone lysis were excluded. The diagnosis in this case was SLE with lupus nephritis class III and anti-phospholipid syndrome, complicated by pulmonary embolism associated to primary hyperparathyroidism causing severe hypercalcemia, osteoporosis. Therapeutic intervention: the patient was given a pulse of methyl-prednisolone 15 mg/kg/day for 3 days followed by oral prednisone 1 mg/kg/day, associated with intravenous cyclophosphamide 750 mg/m 2 /month for 6 months. Mycophenolate mofetil 2 g/day was prescribed as a maintenance therapy of lupus nephritis with hydroxychloroquine at a dose of 400 mg/day. Treatment of pulmonary embolism was initiated with subcutaneous low molecular weight heparin (enoxaparin 0.1 ml/10 kg/12h) followed by antivitamin K. For Hypercalcemia, patient has received intravenous fluid with furosemide. She also required Alendronate 70 mg/week with Vitamin D 400u/day for osteoporosis. The left parathyroid gland was surgically removed. Histopathological examination revealed parathyroid adenoma. Her immediate postoperative parathyroid hormone level was 64 pg/ml with a calcium level of 98 mg/l. Follow-up and outcomes: forty-eight hours after the surgery she developed oral paresthesia. She had hypocalcemia at 72 mg/l. She required oral supplementation for few months. Additional investigations for multiple endocrine neoplasia were negative. The patient remained asymptomatic. Her SLE was calm without any relapse. Control of proteinuria was negative. Corticosteroids was dropped. The follow-up was 4 years.
| EN100653 |
Diagnostic assessment: laboratory tests disclosed the following values: Increase level of erythrocyte sedimentation rate 120 mm/1 st hour, C reactive protein was 20 mg/l. | [
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] | A 31-year-old woman with no pathological history was admitted to our hospital for chest pain, bone and joint pain, hair loss and asthenia for the last 3 months. On physical examination, we found fever at 38°C, polypnea at 32 cycles/min, arterial hypertension at 160/90 mmHg, malar rash, synovitis of wrists, elbows and ankles, and edema on both legs. Diagnostic assessment: laboratory tests disclosed the following values: Increase level of erythrocyte sedimentation rate 120 mm/1 st hour, C reactive protein was 20 mg/l. The blood count showed hemoglobin at 9g/dl, MCV at 85 µ 3, lymphopenia at 400/mm 3, while platelets were normal 450 000/mm 3. Direct coombs test was negative. Serum Albumin was 25g/l; proteins level was low at 50g/l and proteinuria at 3.2g/day. Creatinine was normal. Anti-nuclear antibody ANA were positive 1/320 with homogeneous pattern, anti-dsDNA level was 160U/ml. Anti-cardiolipin IgG antibodies were positive 25UGPL. Rheumatoid Factor was negative. C3 and C4 complement fractions were low (0.2 g/l and 0.05 g/l). Chest x-ray, electrocardiogram and echocardiography were normal. Chest computed tomography (CT) scan showed proximal pulmonary embolism. Renal ultrasound was normal. Renal biopsy reveals immunocomplex nephritis, lupus nephritis, segmental mesangial proliferation, mild activity lupus nephritis class III (A/C). Before starting corticosteroids, we analyzed electrolytes. Serum calcium was elevated 132 mg/l with hyper-calciuria 479 mg/24 h. 25 OHD was normal. Alcaline phosphatase was 420 UI/l. the patient did not have any symptoms of hypercalcemia. Serum protein Electrophoresis showed polyclonal hypergammaglobulinaemia. Serum and urine immunofixation as well as Bence-Jones proteinuria were negative. Intact parathyroid hormone (iPTH) was high 628 pg/ml. CT scan and ultrasound of parathyroid imaging revealed a lower left parathyroid nodule measuring 2cm x 1 cm. Femoral and lumbar bone mineral density (BMD) showed osteoporosis (T-score: -2.6). In addition, we found multiple pelvic osteolytic lesions at CT scan. Other causes of hypercalcemia and bone lysis were excluded. The diagnosis in this case was SLE with lupus nephritis class III and anti-phospholipid syndrome, complicated by pulmonary embolism associated to primary hyperparathyroidism causing severe hypercalcemia, osteoporosis. Therapeutic intervention: the patient was given a pulse of methyl-prednisolone 15 mg/kg/day for 3 days followed by oral prednisone 1 mg/kg/day, associated with intravenous cyclophosphamide 750 mg/m 2 /month for 6 months. Mycophenolate mofetil 2 g/day was prescribed as a maintenance therapy of lupus nephritis with hydroxychloroquine at a dose of 400 mg/day. Treatment of pulmonary embolism was initiated with subcutaneous low molecular weight heparin (enoxaparin 0.1 ml/10 kg/12h) followed by antivitamin K. For Hypercalcemia, patient has received intravenous fluid with furosemide. She also required Alendronate 70 mg/week with Vitamin D 400u/day for osteoporosis. The left parathyroid gland was surgically removed. Histopathological examination revealed parathyroid adenoma. Her immediate postoperative parathyroid hormone level was 64 pg/ml with a calcium level of 98 mg/l. Follow-up and outcomes: forty-eight hours after the surgery she developed oral paresthesia. She had hypocalcemia at 72 mg/l. She required oral supplementation for few months. Additional investigations for multiple endocrine neoplasia were negative. The patient remained asymptomatic. Her SLE was calm without any relapse. Control of proteinuria was negative. Corticosteroids was dropped. The follow-up was 4 years.
| EN100653 |
The blood count showed hemoglobin at 9g/dl, MCV at 85 µ 3, lymphopenia at 400/mm 3, while platelets were normal 450 000/mm 3. | [
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| EN100653 |
Direct coombs test was negative. | [
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] | A 31-year-old woman with no pathological history was admitted to our hospital for chest pain, bone and joint pain, hair loss and asthenia for the last 3 months. On physical examination, we found fever at 38°C, polypnea at 32 cycles/min, arterial hypertension at 160/90 mmHg, malar rash, synovitis of wrists, elbows and ankles, and edema on both legs. Diagnostic assessment: laboratory tests disclosed the following values: Increase level of erythrocyte sedimentation rate 120 mm/1 st hour, C reactive protein was 20 mg/l. The blood count showed hemoglobin at 9g/dl, MCV at 85 µ 3, lymphopenia at 400/mm 3, while platelets were normal 450 000/mm 3. Direct coombs test was negative. Serum Albumin was 25g/l; proteins level was low at 50g/l and proteinuria at 3.2g/day. Creatinine was normal. Anti-nuclear antibody ANA were positive 1/320 with homogeneous pattern, anti-dsDNA level was 160U/ml. Anti-cardiolipin IgG antibodies were positive 25UGPL. Rheumatoid Factor was negative. C3 and C4 complement fractions were low (0.2 g/l and 0.05 g/l). Chest x-ray, electrocardiogram and echocardiography were normal. Chest computed tomography (CT) scan showed proximal pulmonary embolism. Renal ultrasound was normal. Renal biopsy reveals immunocomplex nephritis, lupus nephritis, segmental mesangial proliferation, mild activity lupus nephritis class III (A/C). Before starting corticosteroids, we analyzed electrolytes. Serum calcium was elevated 132 mg/l with hyper-calciuria 479 mg/24 h. 25 OHD was normal. Alcaline phosphatase was 420 UI/l. the patient did not have any symptoms of hypercalcemia. Serum protein Electrophoresis showed polyclonal hypergammaglobulinaemia. Serum and urine immunofixation as well as Bence-Jones proteinuria were negative. Intact parathyroid hormone (iPTH) was high 628 pg/ml. CT scan and ultrasound of parathyroid imaging revealed a lower left parathyroid nodule measuring 2cm x 1 cm. Femoral and lumbar bone mineral density (BMD) showed osteoporosis (T-score: -2.6). In addition, we found multiple pelvic osteolytic lesions at CT scan. Other causes of hypercalcemia and bone lysis were excluded. The diagnosis in this case was SLE with lupus nephritis class III and anti-phospholipid syndrome, complicated by pulmonary embolism associated to primary hyperparathyroidism causing severe hypercalcemia, osteoporosis. Therapeutic intervention: the patient was given a pulse of methyl-prednisolone 15 mg/kg/day for 3 days followed by oral prednisone 1 mg/kg/day, associated with intravenous cyclophosphamide 750 mg/m 2 /month for 6 months. Mycophenolate mofetil 2 g/day was prescribed as a maintenance therapy of lupus nephritis with hydroxychloroquine at a dose of 400 mg/day. Treatment of pulmonary embolism was initiated with subcutaneous low molecular weight heparin (enoxaparin 0.1 ml/10 kg/12h) followed by antivitamin K. For Hypercalcemia, patient has received intravenous fluid with furosemide. She also required Alendronate 70 mg/week with Vitamin D 400u/day for osteoporosis. The left parathyroid gland was surgically removed. Histopathological examination revealed parathyroid adenoma. Her immediate postoperative parathyroid hormone level was 64 pg/ml with a calcium level of 98 mg/l. Follow-up and outcomes: forty-eight hours after the surgery she developed oral paresthesia. She had hypocalcemia at 72 mg/l. She required oral supplementation for few months. Additional investigations for multiple endocrine neoplasia were negative. The patient remained asymptomatic. Her SLE was calm without any relapse. Control of proteinuria was negative. Corticosteroids was dropped. The follow-up was 4 years.
| EN100653 |
Serum Albumin was 25g/l; proteins level was low at 50g/l and proteinuria at 3.2g/day. | [
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] | A 31-year-old woman with no pathological history was admitted to our hospital for chest pain, bone and joint pain, hair loss and asthenia for the last 3 months. On physical examination, we found fever at 38°C, polypnea at 32 cycles/min, arterial hypertension at 160/90 mmHg, malar rash, synovitis of wrists, elbows and ankles, and edema on both legs. Diagnostic assessment: laboratory tests disclosed the following values: Increase level of erythrocyte sedimentation rate 120 mm/1 st hour, C reactive protein was 20 mg/l. The blood count showed hemoglobin at 9g/dl, MCV at 85 µ 3, lymphopenia at 400/mm 3, while platelets were normal 450 000/mm 3. Direct coombs test was negative. Serum Albumin was 25g/l; proteins level was low at 50g/l and proteinuria at 3.2g/day. Creatinine was normal. Anti-nuclear antibody ANA were positive 1/320 with homogeneous pattern, anti-dsDNA level was 160U/ml. Anti-cardiolipin IgG antibodies were positive 25UGPL. Rheumatoid Factor was negative. C3 and C4 complement fractions were low (0.2 g/l and 0.05 g/l). Chest x-ray, electrocardiogram and echocardiography were normal. Chest computed tomography (CT) scan showed proximal pulmonary embolism. Renal ultrasound was normal. Renal biopsy reveals immunocomplex nephritis, lupus nephritis, segmental mesangial proliferation, mild activity lupus nephritis class III (A/C). Before starting corticosteroids, we analyzed electrolytes. Serum calcium was elevated 132 mg/l with hyper-calciuria 479 mg/24 h. 25 OHD was normal. Alcaline phosphatase was 420 UI/l. the patient did not have any symptoms of hypercalcemia. Serum protein Electrophoresis showed polyclonal hypergammaglobulinaemia. Serum and urine immunofixation as well as Bence-Jones proteinuria were negative. Intact parathyroid hormone (iPTH) was high 628 pg/ml. CT scan and ultrasound of parathyroid imaging revealed a lower left parathyroid nodule measuring 2cm x 1 cm. Femoral and lumbar bone mineral density (BMD) showed osteoporosis (T-score: -2.6). In addition, we found multiple pelvic osteolytic lesions at CT scan. Other causes of hypercalcemia and bone lysis were excluded. The diagnosis in this case was SLE with lupus nephritis class III and anti-phospholipid syndrome, complicated by pulmonary embolism associated to primary hyperparathyroidism causing severe hypercalcemia, osteoporosis. Therapeutic intervention: the patient was given a pulse of methyl-prednisolone 15 mg/kg/day for 3 days followed by oral prednisone 1 mg/kg/day, associated with intravenous cyclophosphamide 750 mg/m 2 /month for 6 months. Mycophenolate mofetil 2 g/day was prescribed as a maintenance therapy of lupus nephritis with hydroxychloroquine at a dose of 400 mg/day. Treatment of pulmonary embolism was initiated with subcutaneous low molecular weight heparin (enoxaparin 0.1 ml/10 kg/12h) followed by antivitamin K. For Hypercalcemia, patient has received intravenous fluid with furosemide. She also required Alendronate 70 mg/week with Vitamin D 400u/day for osteoporosis. The left parathyroid gland was surgically removed. Histopathological examination revealed parathyroid adenoma. Her immediate postoperative parathyroid hormone level was 64 pg/ml with a calcium level of 98 mg/l. Follow-up and outcomes: forty-eight hours after the surgery she developed oral paresthesia. She had hypocalcemia at 72 mg/l. She required oral supplementation for few months. Additional investigations for multiple endocrine neoplasia were negative. The patient remained asymptomatic. Her SLE was calm without any relapse. Control of proteinuria was negative. Corticosteroids was dropped. The follow-up was 4 years.
| EN100653 |
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] | A 31-year-old woman with no pathological history was admitted to our hospital for chest pain, bone and joint pain, hair loss and asthenia for the last 3 months. On physical examination, we found fever at 38°C, polypnea at 32 cycles/min, arterial hypertension at 160/90 mmHg, malar rash, synovitis of wrists, elbows and ankles, and edema on both legs. Diagnostic assessment: laboratory tests disclosed the following values: Increase level of erythrocyte sedimentation rate 120 mm/1 st hour, C reactive protein was 20 mg/l. The blood count showed hemoglobin at 9g/dl, MCV at 85 µ 3, lymphopenia at 400/mm 3, while platelets were normal 450 000/mm 3. Direct coombs test was negative. Serum Albumin was 25g/l; proteins level was low at 50g/l and proteinuria at 3.2g/day. Creatinine was normal. Anti-nuclear antibody ANA were positive 1/320 with homogeneous pattern, anti-dsDNA level was 160U/ml. Anti-cardiolipin IgG antibodies were positive 25UGPL. Rheumatoid Factor was negative. C3 and C4 complement fractions were low (0.2 g/l and 0.05 g/l). Chest x-ray, electrocardiogram and echocardiography were normal. Chest computed tomography (CT) scan showed proximal pulmonary embolism. Renal ultrasound was normal. Renal biopsy reveals immunocomplex nephritis, lupus nephritis, segmental mesangial proliferation, mild activity lupus nephritis class III (A/C). Before starting corticosteroids, we analyzed electrolytes. Serum calcium was elevated 132 mg/l with hyper-calciuria 479 mg/24 h. 25 OHD was normal. Alcaline phosphatase was 420 UI/l. the patient did not have any symptoms of hypercalcemia. Serum protein Electrophoresis showed polyclonal hypergammaglobulinaemia. Serum and urine immunofixation as well as Bence-Jones proteinuria were negative. Intact parathyroid hormone (iPTH) was high 628 pg/ml. CT scan and ultrasound of parathyroid imaging revealed a lower left parathyroid nodule measuring 2cm x 1 cm. Femoral and lumbar bone mineral density (BMD) showed osteoporosis (T-score: -2.6). In addition, we found multiple pelvic osteolytic lesions at CT scan. Other causes of hypercalcemia and bone lysis were excluded. The diagnosis in this case was SLE with lupus nephritis class III and anti-phospholipid syndrome, complicated by pulmonary embolism associated to primary hyperparathyroidism causing severe hypercalcemia, osteoporosis. Therapeutic intervention: the patient was given a pulse of methyl-prednisolone 15 mg/kg/day for 3 days followed by oral prednisone 1 mg/kg/day, associated with intravenous cyclophosphamide 750 mg/m 2 /month for 6 months. Mycophenolate mofetil 2 g/day was prescribed as a maintenance therapy of lupus nephritis with hydroxychloroquine at a dose of 400 mg/day. Treatment of pulmonary embolism was initiated with subcutaneous low molecular weight heparin (enoxaparin 0.1 ml/10 kg/12h) followed by antivitamin K. For Hypercalcemia, patient has received intravenous fluid with furosemide. She also required Alendronate 70 mg/week with Vitamin D 400u/day for osteoporosis. The left parathyroid gland was surgically removed. Histopathological examination revealed parathyroid adenoma. Her immediate postoperative parathyroid hormone level was 64 pg/ml with a calcium level of 98 mg/l. Follow-up and outcomes: forty-eight hours after the surgery she developed oral paresthesia. She had hypocalcemia at 72 mg/l. She required oral supplementation for few months. Additional investigations for multiple endocrine neoplasia were negative. The patient remained asymptomatic. Her SLE was calm without any relapse. Control of proteinuria was negative. Corticosteroids was dropped. The follow-up was 4 years.
| EN100653 |
Anti-nuclear antibody ANA were positive 1/320 with homogeneous pattern, anti-dsDNA level was 160U/ml. | [
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] | A 31-year-old woman with no pathological history was admitted to our hospital for chest pain, bone and joint pain, hair loss and asthenia for the last 3 months. On physical examination, we found fever at 38°C, polypnea at 32 cycles/min, arterial hypertension at 160/90 mmHg, malar rash, synovitis of wrists, elbows and ankles, and edema on both legs. Diagnostic assessment: laboratory tests disclosed the following values: Increase level of erythrocyte sedimentation rate 120 mm/1 st hour, C reactive protein was 20 mg/l. The blood count showed hemoglobin at 9g/dl, MCV at 85 µ 3, lymphopenia at 400/mm 3, while platelets were normal 450 000/mm 3. Direct coombs test was negative. Serum Albumin was 25g/l; proteins level was low at 50g/l and proteinuria at 3.2g/day. Creatinine was normal. Anti-nuclear antibody ANA were positive 1/320 with homogeneous pattern, anti-dsDNA level was 160U/ml. Anti-cardiolipin IgG antibodies were positive 25UGPL. Rheumatoid Factor was negative. C3 and C4 complement fractions were low (0.2 g/l and 0.05 g/l). Chest x-ray, electrocardiogram and echocardiography were normal. Chest computed tomography (CT) scan showed proximal pulmonary embolism. Renal ultrasound was normal. Renal biopsy reveals immunocomplex nephritis, lupus nephritis, segmental mesangial proliferation, mild activity lupus nephritis class III (A/C). Before starting corticosteroids, we analyzed electrolytes. Serum calcium was elevated 132 mg/l with hyper-calciuria 479 mg/24 h. 25 OHD was normal. Alcaline phosphatase was 420 UI/l. the patient did not have any symptoms of hypercalcemia. Serum protein Electrophoresis showed polyclonal hypergammaglobulinaemia. Serum and urine immunofixation as well as Bence-Jones proteinuria were negative. Intact parathyroid hormone (iPTH) was high 628 pg/ml. CT scan and ultrasound of parathyroid imaging revealed a lower left parathyroid nodule measuring 2cm x 1 cm. Femoral and lumbar bone mineral density (BMD) showed osteoporosis (T-score: -2.6). In addition, we found multiple pelvic osteolytic lesions at CT scan. Other causes of hypercalcemia and bone lysis were excluded. The diagnosis in this case was SLE with lupus nephritis class III and anti-phospholipid syndrome, complicated by pulmonary embolism associated to primary hyperparathyroidism causing severe hypercalcemia, osteoporosis. Therapeutic intervention: the patient was given a pulse of methyl-prednisolone 15 mg/kg/day for 3 days followed by oral prednisone 1 mg/kg/day, associated with intravenous cyclophosphamide 750 mg/m 2 /month for 6 months. Mycophenolate mofetil 2 g/day was prescribed as a maintenance therapy of lupus nephritis with hydroxychloroquine at a dose of 400 mg/day. Treatment of pulmonary embolism was initiated with subcutaneous low molecular weight heparin (enoxaparin 0.1 ml/10 kg/12h) followed by antivitamin K. For Hypercalcemia, patient has received intravenous fluid with furosemide. She also required Alendronate 70 mg/week with Vitamin D 400u/day for osteoporosis. The left parathyroid gland was surgically removed. Histopathological examination revealed parathyroid adenoma. Her immediate postoperative parathyroid hormone level was 64 pg/ml with a calcium level of 98 mg/l. Follow-up and outcomes: forty-eight hours after the surgery she developed oral paresthesia. She had hypocalcemia at 72 mg/l. She required oral supplementation for few months. Additional investigations for multiple endocrine neoplasia were negative. The patient remained asymptomatic. Her SLE was calm without any relapse. Control of proteinuria was negative. Corticosteroids was dropped. The follow-up was 4 years.
| EN100653 |
Anti-cardiolipin IgG antibodies were positive 25UGPL. | [
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| EN100653 |
Rheumatoid Factor was negative. | [
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| EN100653 |
C3 and C4 complement fractions were low (0.2 g/l and 0.05 g/l). | [
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| EN100653 |
Chest x-ray, electrocardiogram and echocardiography were normal. | [
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| EN100653 |
Chest computed tomography (CT) scan showed proximal pulmonary embolism. | [
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] | A 31-year-old woman with no pathological history was admitted to our hospital for chest pain, bone and joint pain, hair loss and asthenia for the last 3 months. On physical examination, we found fever at 38°C, polypnea at 32 cycles/min, arterial hypertension at 160/90 mmHg, malar rash, synovitis of wrists, elbows and ankles, and edema on both legs. Diagnostic assessment: laboratory tests disclosed the following values: Increase level of erythrocyte sedimentation rate 120 mm/1 st hour, C reactive protein was 20 mg/l. The blood count showed hemoglobin at 9g/dl, MCV at 85 µ 3, lymphopenia at 400/mm 3, while platelets were normal 450 000/mm 3. Direct coombs test was negative. Serum Albumin was 25g/l; proteins level was low at 50g/l and proteinuria at 3.2g/day. Creatinine was normal. Anti-nuclear antibody ANA were positive 1/320 with homogeneous pattern, anti-dsDNA level was 160U/ml. Anti-cardiolipin IgG antibodies were positive 25UGPL. Rheumatoid Factor was negative. C3 and C4 complement fractions were low (0.2 g/l and 0.05 g/l). Chest x-ray, electrocardiogram and echocardiography were normal. Chest computed tomography (CT) scan showed proximal pulmonary embolism. Renal ultrasound was normal. Renal biopsy reveals immunocomplex nephritis, lupus nephritis, segmental mesangial proliferation, mild activity lupus nephritis class III (A/C). Before starting corticosteroids, we analyzed electrolytes. Serum calcium was elevated 132 mg/l with hyper-calciuria 479 mg/24 h. 25 OHD was normal. Alcaline phosphatase was 420 UI/l. the patient did not have any symptoms of hypercalcemia. Serum protein Electrophoresis showed polyclonal hypergammaglobulinaemia. Serum and urine immunofixation as well as Bence-Jones proteinuria were negative. Intact parathyroid hormone (iPTH) was high 628 pg/ml. CT scan and ultrasound of parathyroid imaging revealed a lower left parathyroid nodule measuring 2cm x 1 cm. Femoral and lumbar bone mineral density (BMD) showed osteoporosis (T-score: -2.6). In addition, we found multiple pelvic osteolytic lesions at CT scan. Other causes of hypercalcemia and bone lysis were excluded. The diagnosis in this case was SLE with lupus nephritis class III and anti-phospholipid syndrome, complicated by pulmonary embolism associated to primary hyperparathyroidism causing severe hypercalcemia, osteoporosis. Therapeutic intervention: the patient was given a pulse of methyl-prednisolone 15 mg/kg/day for 3 days followed by oral prednisone 1 mg/kg/day, associated with intravenous cyclophosphamide 750 mg/m 2 /month for 6 months. Mycophenolate mofetil 2 g/day was prescribed as a maintenance therapy of lupus nephritis with hydroxychloroquine at a dose of 400 mg/day. Treatment of pulmonary embolism was initiated with subcutaneous low molecular weight heparin (enoxaparin 0.1 ml/10 kg/12h) followed by antivitamin K. For Hypercalcemia, patient has received intravenous fluid with furosemide. She also required Alendronate 70 mg/week with Vitamin D 400u/day for osteoporosis. The left parathyroid gland was surgically removed. Histopathological examination revealed parathyroid adenoma. Her immediate postoperative parathyroid hormone level was 64 pg/ml with a calcium level of 98 mg/l. Follow-up and outcomes: forty-eight hours after the surgery she developed oral paresthesia. She had hypocalcemia at 72 mg/l. She required oral supplementation for few months. Additional investigations for multiple endocrine neoplasia were negative. The patient remained asymptomatic. Her SLE was calm without any relapse. Control of proteinuria was negative. Corticosteroids was dropped. The follow-up was 4 years.
| EN100653 |
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| EN100653 |
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| EN100653 |
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| EN100653 |
Alcaline phosphatase was 420 UI/l. the patient did not have any symptoms of hypercalcemia. | [
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| EN100653 |
Serum protein Electrophoresis showed polyclonal hypergammaglobulinaemia. | [
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| EN100653 |
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| EN100653 |
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| EN100653 |
CT scan and ultrasound of parathyroid imaging revealed a lower left parathyroid nodule measuring 2cm x 1 cm. | [
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| EN100653 |
Femoral and lumbar bone mineral density (BMD) showed osteoporosis (T-score: -2.6). | [
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| EN100653 |
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| EN100653 |
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| EN100653 |
The diagnosis in this case was SLE with lupus nephritis class III and anti-phospholipid syndrome, complicated by pulmonary embolism associated to primary hyperparathyroidism causing severe hypercalcemia, osteoporosis. | [
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| EN100653 |
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| EN100653 |
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| EN100653 |
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| EN100653 |
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| EN100653 |
She also required Alendronate 70 mg/week with Vitamin D 400u/day for osteoporosis. | [
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| EN100653 |
Histopathological examination revealed parathyroid adenoma. | [
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| EN100653 |
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| EN100653 |
Additional investigations for multiple endocrine neoplasia were negative. | [
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| EN100653 |
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] | A 31-year-old woman with no pathological history was admitted to our hospital for chest pain, bone and joint pain, hair loss and asthenia for the last 3 months. On physical examination, we found fever at 38°C, polypnea at 32 cycles/min, arterial hypertension at 160/90 mmHg, malar rash, synovitis of wrists, elbows and ankles, and edema on both legs. Diagnostic assessment: laboratory tests disclosed the following values: Increase level of erythrocyte sedimentation rate 120 mm/1 st hour, C reactive protein was 20 mg/l. The blood count showed hemoglobin at 9g/dl, MCV at 85 µ 3, lymphopenia at 400/mm 3, while platelets were normal 450 000/mm 3. Direct coombs test was negative. Serum Albumin was 25g/l; proteins level was low at 50g/l and proteinuria at 3.2g/day. Creatinine was normal. Anti-nuclear antibody ANA were positive 1/320 with homogeneous pattern, anti-dsDNA level was 160U/ml. Anti-cardiolipin IgG antibodies were positive 25UGPL. Rheumatoid Factor was negative. C3 and C4 complement fractions were low (0.2 g/l and 0.05 g/l). Chest x-ray, electrocardiogram and echocardiography were normal. Chest computed tomography (CT) scan showed proximal pulmonary embolism. Renal ultrasound was normal. Renal biopsy reveals immunocomplex nephritis, lupus nephritis, segmental mesangial proliferation, mild activity lupus nephritis class III (A/C). Before starting corticosteroids, we analyzed electrolytes. Serum calcium was elevated 132 mg/l with hyper-calciuria 479 mg/24 h. 25 OHD was normal. Alcaline phosphatase was 420 UI/l. the patient did not have any symptoms of hypercalcemia. Serum protein Electrophoresis showed polyclonal hypergammaglobulinaemia. Serum and urine immunofixation as well as Bence-Jones proteinuria were negative. Intact parathyroid hormone (iPTH) was high 628 pg/ml. CT scan and ultrasound of parathyroid imaging revealed a lower left parathyroid nodule measuring 2cm x 1 cm. Femoral and lumbar bone mineral density (BMD) showed osteoporosis (T-score: -2.6). In addition, we found multiple pelvic osteolytic lesions at CT scan. Other causes of hypercalcemia and bone lysis were excluded. The diagnosis in this case was SLE with lupus nephritis class III and anti-phospholipid syndrome, complicated by pulmonary embolism associated to primary hyperparathyroidism causing severe hypercalcemia, osteoporosis. Therapeutic intervention: the patient was given a pulse of methyl-prednisolone 15 mg/kg/day for 3 days followed by oral prednisone 1 mg/kg/day, associated with intravenous cyclophosphamide 750 mg/m 2 /month for 6 months. Mycophenolate mofetil 2 g/day was prescribed as a maintenance therapy of lupus nephritis with hydroxychloroquine at a dose of 400 mg/day. Treatment of pulmonary embolism was initiated with subcutaneous low molecular weight heparin (enoxaparin 0.1 ml/10 kg/12h) followed by antivitamin K. For Hypercalcemia, patient has received intravenous fluid with furosemide. She also required Alendronate 70 mg/week with Vitamin D 400u/day for osteoporosis. The left parathyroid gland was surgically removed. Histopathological examination revealed parathyroid adenoma. Her immediate postoperative parathyroid hormone level was 64 pg/ml with a calcium level of 98 mg/l. Follow-up and outcomes: forty-eight hours after the surgery she developed oral paresthesia. She had hypocalcemia at 72 mg/l. She required oral supplementation for few months. Additional investigations for multiple endocrine neoplasia were negative. The patient remained asymptomatic. Her SLE was calm without any relapse. Control of proteinuria was negative. Corticosteroids was dropped. The follow-up was 4 years.
| EN100653 |
Her SLE was calm without any relapse. | [
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] | A 31-year-old woman with no pathological history was admitted to our hospital for chest pain, bone and joint pain, hair loss and asthenia for the last 3 months. On physical examination, we found fever at 38°C, polypnea at 32 cycles/min, arterial hypertension at 160/90 mmHg, malar rash, synovitis of wrists, elbows and ankles, and edema on both legs. Diagnostic assessment: laboratory tests disclosed the following values: Increase level of erythrocyte sedimentation rate 120 mm/1 st hour, C reactive protein was 20 mg/l. The blood count showed hemoglobin at 9g/dl, MCV at 85 µ 3, lymphopenia at 400/mm 3, while platelets were normal 450 000/mm 3. Direct coombs test was negative. Serum Albumin was 25g/l; proteins level was low at 50g/l and proteinuria at 3.2g/day. Creatinine was normal. Anti-nuclear antibody ANA were positive 1/320 with homogeneous pattern, anti-dsDNA level was 160U/ml. Anti-cardiolipin IgG antibodies were positive 25UGPL. Rheumatoid Factor was negative. C3 and C4 complement fractions were low (0.2 g/l and 0.05 g/l). Chest x-ray, electrocardiogram and echocardiography were normal. Chest computed tomography (CT) scan showed proximal pulmonary embolism. Renal ultrasound was normal. Renal biopsy reveals immunocomplex nephritis, lupus nephritis, segmental mesangial proliferation, mild activity lupus nephritis class III (A/C). Before starting corticosteroids, we analyzed electrolytes. Serum calcium was elevated 132 mg/l with hyper-calciuria 479 mg/24 h. 25 OHD was normal. Alcaline phosphatase was 420 UI/l. the patient did not have any symptoms of hypercalcemia. Serum protein Electrophoresis showed polyclonal hypergammaglobulinaemia. Serum and urine immunofixation as well as Bence-Jones proteinuria were negative. Intact parathyroid hormone (iPTH) was high 628 pg/ml. CT scan and ultrasound of parathyroid imaging revealed a lower left parathyroid nodule measuring 2cm x 1 cm. Femoral and lumbar bone mineral density (BMD) showed osteoporosis (T-score: -2.6). In addition, we found multiple pelvic osteolytic lesions at CT scan. Other causes of hypercalcemia and bone lysis were excluded. The diagnosis in this case was SLE with lupus nephritis class III and anti-phospholipid syndrome, complicated by pulmonary embolism associated to primary hyperparathyroidism causing severe hypercalcemia, osteoporosis. Therapeutic intervention: the patient was given a pulse of methyl-prednisolone 15 mg/kg/day for 3 days followed by oral prednisone 1 mg/kg/day, associated with intravenous cyclophosphamide 750 mg/m 2 /month for 6 months. Mycophenolate mofetil 2 g/day was prescribed as a maintenance therapy of lupus nephritis with hydroxychloroquine at a dose of 400 mg/day. Treatment of pulmonary embolism was initiated with subcutaneous low molecular weight heparin (enoxaparin 0.1 ml/10 kg/12h) followed by antivitamin K. For Hypercalcemia, patient has received intravenous fluid with furosemide. She also required Alendronate 70 mg/week with Vitamin D 400u/day for osteoporosis. The left parathyroid gland was surgically removed. Histopathological examination revealed parathyroid adenoma. Her immediate postoperative parathyroid hormone level was 64 pg/ml with a calcium level of 98 mg/l. Follow-up and outcomes: forty-eight hours after the surgery she developed oral paresthesia. She had hypocalcemia at 72 mg/l. She required oral supplementation for few months. Additional investigations for multiple endocrine neoplasia were negative. The patient remained asymptomatic. Her SLE was calm without any relapse. Control of proteinuria was negative. Corticosteroids was dropped. The follow-up was 4 years.
| EN100653 |
Control of proteinuria was negative. | [
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] | A 31-year-old woman with no pathological history was admitted to our hospital for chest pain, bone and joint pain, hair loss and asthenia for the last 3 months. On physical examination, we found fever at 38°C, polypnea at 32 cycles/min, arterial hypertension at 160/90 mmHg, malar rash, synovitis of wrists, elbows and ankles, and edema on both legs. Diagnostic assessment: laboratory tests disclosed the following values: Increase level of erythrocyte sedimentation rate 120 mm/1 st hour, C reactive protein was 20 mg/l. The blood count showed hemoglobin at 9g/dl, MCV at 85 µ 3, lymphopenia at 400/mm 3, while platelets were normal 450 000/mm 3. Direct coombs test was negative. Serum Albumin was 25g/l; proteins level was low at 50g/l and proteinuria at 3.2g/day. Creatinine was normal. Anti-nuclear antibody ANA were positive 1/320 with homogeneous pattern, anti-dsDNA level was 160U/ml. Anti-cardiolipin IgG antibodies were positive 25UGPL. Rheumatoid Factor was negative. C3 and C4 complement fractions were low (0.2 g/l and 0.05 g/l). Chest x-ray, electrocardiogram and echocardiography were normal. Chest computed tomography (CT) scan showed proximal pulmonary embolism. Renal ultrasound was normal. Renal biopsy reveals immunocomplex nephritis, lupus nephritis, segmental mesangial proliferation, mild activity lupus nephritis class III (A/C). Before starting corticosteroids, we analyzed electrolytes. Serum calcium was elevated 132 mg/l with hyper-calciuria 479 mg/24 h. 25 OHD was normal. Alcaline phosphatase was 420 UI/l. the patient did not have any symptoms of hypercalcemia. Serum protein Electrophoresis showed polyclonal hypergammaglobulinaemia. Serum and urine immunofixation as well as Bence-Jones proteinuria were negative. Intact parathyroid hormone (iPTH) was high 628 pg/ml. CT scan and ultrasound of parathyroid imaging revealed a lower left parathyroid nodule measuring 2cm x 1 cm. Femoral and lumbar bone mineral density (BMD) showed osteoporosis (T-score: -2.6). In addition, we found multiple pelvic osteolytic lesions at CT scan. Other causes of hypercalcemia and bone lysis were excluded. The diagnosis in this case was SLE with lupus nephritis class III and anti-phospholipid syndrome, complicated by pulmonary embolism associated to primary hyperparathyroidism causing severe hypercalcemia, osteoporosis. Therapeutic intervention: the patient was given a pulse of methyl-prednisolone 15 mg/kg/day for 3 days followed by oral prednisone 1 mg/kg/day, associated with intravenous cyclophosphamide 750 mg/m 2 /month for 6 months. Mycophenolate mofetil 2 g/day was prescribed as a maintenance therapy of lupus nephritis with hydroxychloroquine at a dose of 400 mg/day. Treatment of pulmonary embolism was initiated with subcutaneous low molecular weight heparin (enoxaparin 0.1 ml/10 kg/12h) followed by antivitamin K. For Hypercalcemia, patient has received intravenous fluid with furosemide. She also required Alendronate 70 mg/week with Vitamin D 400u/day for osteoporosis. The left parathyroid gland was surgically removed. Histopathological examination revealed parathyroid adenoma. Her immediate postoperative parathyroid hormone level was 64 pg/ml with a calcium level of 98 mg/l. Follow-up and outcomes: forty-eight hours after the surgery she developed oral paresthesia. She had hypocalcemia at 72 mg/l. She required oral supplementation for few months. Additional investigations for multiple endocrine neoplasia were negative. The patient remained asymptomatic. Her SLE was calm without any relapse. Control of proteinuria was negative. Corticosteroids was dropped. The follow-up was 4 years.
| EN100653 |
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] | A 31-year-old woman with no pathological history was admitted to our hospital for chest pain, bone and joint pain, hair loss and asthenia for the last 3 months. On physical examination, we found fever at 38°C, polypnea at 32 cycles/min, arterial hypertension at 160/90 mmHg, malar rash, synovitis of wrists, elbows and ankles, and edema on both legs. Diagnostic assessment: laboratory tests disclosed the following values: Increase level of erythrocyte sedimentation rate 120 mm/1 st hour, C reactive protein was 20 mg/l. The blood count showed hemoglobin at 9g/dl, MCV at 85 µ 3, lymphopenia at 400/mm 3, while platelets were normal 450 000/mm 3. Direct coombs test was negative. Serum Albumin was 25g/l; proteins level was low at 50g/l and proteinuria at 3.2g/day. Creatinine was normal. Anti-nuclear antibody ANA were positive 1/320 with homogeneous pattern, anti-dsDNA level was 160U/ml. Anti-cardiolipin IgG antibodies were positive 25UGPL. Rheumatoid Factor was negative. C3 and C4 complement fractions were low (0.2 g/l and 0.05 g/l). Chest x-ray, electrocardiogram and echocardiography were normal. Chest computed tomography (CT) scan showed proximal pulmonary embolism. Renal ultrasound was normal. Renal biopsy reveals immunocomplex nephritis, lupus nephritis, segmental mesangial proliferation, mild activity lupus nephritis class III (A/C). Before starting corticosteroids, we analyzed electrolytes. Serum calcium was elevated 132 mg/l with hyper-calciuria 479 mg/24 h. 25 OHD was normal. Alcaline phosphatase was 420 UI/l. the patient did not have any symptoms of hypercalcemia. Serum protein Electrophoresis showed polyclonal hypergammaglobulinaemia. Serum and urine immunofixation as well as Bence-Jones proteinuria were negative. Intact parathyroid hormone (iPTH) was high 628 pg/ml. CT scan and ultrasound of parathyroid imaging revealed a lower left parathyroid nodule measuring 2cm x 1 cm. Femoral and lumbar bone mineral density (BMD) showed osteoporosis (T-score: -2.6). In addition, we found multiple pelvic osteolytic lesions at CT scan. Other causes of hypercalcemia and bone lysis were excluded. The diagnosis in this case was SLE with lupus nephritis class III and anti-phospholipid syndrome, complicated by pulmonary embolism associated to primary hyperparathyroidism causing severe hypercalcemia, osteoporosis. Therapeutic intervention: the patient was given a pulse of methyl-prednisolone 15 mg/kg/day for 3 days followed by oral prednisone 1 mg/kg/day, associated with intravenous cyclophosphamide 750 mg/m 2 /month for 6 months. Mycophenolate mofetil 2 g/day was prescribed as a maintenance therapy of lupus nephritis with hydroxychloroquine at a dose of 400 mg/day. Treatment of pulmonary embolism was initiated with subcutaneous low molecular weight heparin (enoxaparin 0.1 ml/10 kg/12h) followed by antivitamin K. For Hypercalcemia, patient has received intravenous fluid with furosemide. She also required Alendronate 70 mg/week with Vitamin D 400u/day for osteoporosis. The left parathyroid gland was surgically removed. Histopathological examination revealed parathyroid adenoma. Her immediate postoperative parathyroid hormone level was 64 pg/ml with a calcium level of 98 mg/l. Follow-up and outcomes: forty-eight hours after the surgery she developed oral paresthesia. She had hypocalcemia at 72 mg/l. She required oral supplementation for few months. Additional investigations for multiple endocrine neoplasia were negative. The patient remained asymptomatic. Her SLE was calm without any relapse. Control of proteinuria was negative. Corticosteroids was dropped. The follow-up was 4 years.
| EN100653 |
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| EN100653 |
Forty year old male presented with a huge mass in this left arm. | [
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] | Forty year old male presented with a huge mass in this left arm. The same patient apparently was admitted three years back for excision of the arm swelling which was relatively small that time. However the patient did not undergo surgery and was takin treatment from local bone setters during the last three years and tumor grew to a larger size during this period. The current dimensions of tumor was 32x28 cms with circumference of 87 cms. X-ray showed complete destruction of the upper humerus with central calcification. Biopsy releveled a chondrosarcoma. Skeletal survey and bone scan did not reveal any other lesion in the body. A forequarter amputation was done and a 16 kg tumor mass was excised. At three years follow up, the patient has no complains with no recurrence of the tumor.
| EN104179 |
The same patient apparently was admitted three years back for excision of the arm swelling which was relatively small that time. | [
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] | Forty year old male presented with a huge mass in this left arm. The same patient apparently was admitted three years back for excision of the arm swelling which was relatively small that time. However the patient did not undergo surgery and was takin treatment from local bone setters during the last three years and tumor grew to a larger size during this period. The current dimensions of tumor was 32x28 cms with circumference of 87 cms. X-ray showed complete destruction of the upper humerus with central calcification. Biopsy releveled a chondrosarcoma. Skeletal survey and bone scan did not reveal any other lesion in the body. A forequarter amputation was done and a 16 kg tumor mass was excised. At three years follow up, the patient has no complains with no recurrence of the tumor.
| EN104179 |
However the patient did not undergo surgery and was takin treatment from local bone setters during the last three years and tumor grew to a larger size during this period. | [
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] | Forty year old male presented with a huge mass in this left arm. The same patient apparently was admitted three years back for excision of the arm swelling which was relatively small that time. However the patient did not undergo surgery and was takin treatment from local bone setters during the last three years and tumor grew to a larger size during this period. The current dimensions of tumor was 32x28 cms with circumference of 87 cms. X-ray showed complete destruction of the upper humerus with central calcification. Biopsy releveled a chondrosarcoma. Skeletal survey and bone scan did not reveal any other lesion in the body. A forequarter amputation was done and a 16 kg tumor mass was excised. At three years follow up, the patient has no complains with no recurrence of the tumor.
| EN104179 |
The current dimensions of tumor was 32x28 cms with circumference of 87 cms. | [
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] | Forty year old male presented with a huge mass in this left arm. The same patient apparently was admitted three years back for excision of the arm swelling which was relatively small that time. However the patient did not undergo surgery and was takin treatment from local bone setters during the last three years and tumor grew to a larger size during this period. The current dimensions of tumor was 32x28 cms with circumference of 87 cms. X-ray showed complete destruction of the upper humerus with central calcification. Biopsy releveled a chondrosarcoma. Skeletal survey and bone scan did not reveal any other lesion in the body. A forequarter amputation was done and a 16 kg tumor mass was excised. At three years follow up, the patient has no complains with no recurrence of the tumor.
| EN104179 |
X-ray showed complete destruction of the upper humerus with central calcification. | [
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] | Forty year old male presented with a huge mass in this left arm. The same patient apparently was admitted three years back for excision of the arm swelling which was relatively small that time. However the patient did not undergo surgery and was takin treatment from local bone setters during the last three years and tumor grew to a larger size during this period. The current dimensions of tumor was 32x28 cms with circumference of 87 cms. X-ray showed complete destruction of the upper humerus with central calcification. Biopsy releveled a chondrosarcoma. Skeletal survey and bone scan did not reveal any other lesion in the body. A forequarter amputation was done and a 16 kg tumor mass was excised. At three years follow up, the patient has no complains with no recurrence of the tumor.
| EN104179 |
Biopsy releveled a chondrosarcoma. | [
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] | Forty year old male presented with a huge mass in this left arm. The same patient apparently was admitted three years back for excision of the arm swelling which was relatively small that time. However the patient did not undergo surgery and was takin treatment from local bone setters during the last three years and tumor grew to a larger size during this period. The current dimensions of tumor was 32x28 cms with circumference of 87 cms. X-ray showed complete destruction of the upper humerus with central calcification. Biopsy releveled a chondrosarcoma. Skeletal survey and bone scan did not reveal any other lesion in the body. A forequarter amputation was done and a 16 kg tumor mass was excised. At three years follow up, the patient has no complains with no recurrence of the tumor.
| EN104179 |
Skeletal survey and bone scan did not reveal any other lesion in the body. | [
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] | Forty year old male presented with a huge mass in this left arm. The same patient apparently was admitted three years back for excision of the arm swelling which was relatively small that time. However the patient did not undergo surgery and was takin treatment from local bone setters during the last three years and tumor grew to a larger size during this period. The current dimensions of tumor was 32x28 cms with circumference of 87 cms. X-ray showed complete destruction of the upper humerus with central calcification. Biopsy releveled a chondrosarcoma. Skeletal survey and bone scan did not reveal any other lesion in the body. A forequarter amputation was done and a 16 kg tumor mass was excised. At three years follow up, the patient has no complains with no recurrence of the tumor.
| EN104179 |
A forequarter amputation was done and a 16 kg tumor mass was excised. | [
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] | Forty year old male presented with a huge mass in this left arm. The same patient apparently was admitted three years back for excision of the arm swelling which was relatively small that time. However the patient did not undergo surgery and was takin treatment from local bone setters during the last three years and tumor grew to a larger size during this period. The current dimensions of tumor was 32x28 cms with circumference of 87 cms. X-ray showed complete destruction of the upper humerus with central calcification. Biopsy releveled a chondrosarcoma. Skeletal survey and bone scan did not reveal any other lesion in the body. A forequarter amputation was done and a 16 kg tumor mass was excised. At three years follow up, the patient has no complains with no recurrence of the tumor.
| EN104179 |
At three years follow up, the patient has no complains with no recurrence of the tumor. | [
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] | Forty year old male presented with a huge mass in this left arm. The same patient apparently was admitted three years back for excision of the arm swelling which was relatively small that time. However the patient did not undergo surgery and was takin treatment from local bone setters during the last three years and tumor grew to a larger size during this period. The current dimensions of tumor was 32x28 cms with circumference of 87 cms. X-ray showed complete destruction of the upper humerus with central calcification. Biopsy releveled a chondrosarcoma. Skeletal survey and bone scan did not reveal any other lesion in the body. A forequarter amputation was done and a 16 kg tumor mass was excised. At three years follow up, the patient has no complains with no recurrence of the tumor.
| EN104179 |
It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. | [
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] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. | [
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] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. | [
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] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. | [
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"text": "the loins",
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] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. | [
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"text": "30 days",
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] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
She has never practiced contraception. | [
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"text": "contraception",
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3
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"text": "She",
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}
] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
She has been adequately treated for acute pelvic inflammatory disease five years earlier. | [
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88
],
"role": "",
"semantic_type_id": "",
"text": "five years earlier",
"type": "TIMEX3"
}
] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
Her only child is a girl born vaginally seven years ago. | [
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"text": "seven years ago",
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] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
Her blood group is B rhesus positive and she has never undergone surgery. | [
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"text": "she",
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] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. | [
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"text": "positive",
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] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. | [
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"text": "bleeding",
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},
{
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"text": "nausea",
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},
{
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{
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"text": "vomiting",
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{
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"semantic_type_id": "C2979982",
"text": "vaginal bleeding",
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],
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"semantic_type_id": "C0027497",
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},
{
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"semantic_type_id": "C0042963",
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{
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41,
52
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "the patient",
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}
] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. | [
{
"id": "8299",
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"text": "good",
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"text": "pressure",
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{
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],
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"text": "rate",
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"text": "temperature",
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{
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"text": "blood",
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{
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111
],
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"text": "110/70 millimeters of mercury",
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{
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135,
153
],
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"text": "20 cycles / minute",
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191
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"role": "",
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"text": "70 pulsations/minute",
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213,
232
],
"role": "",
"semantic_type_id": "",
"text": "37.3 degree Celsius",
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}
] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
The conjunctivae were pink and the tongue was clean and moist. | [
{
"id": "8404",
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"text": "pink",
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"text": "clean",
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"text": "moist",
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{
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0,
16
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"role": "",
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"text": "The conjunctivae",
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{
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31,
41
],
"role": "",
"semantic_type_id": "",
"text": "the tongue",
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}
] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
There were no cervical adenopathies. | [
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23,
35
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"role": "",
"semantic_type_id": "",
"text": "adenopathies",
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}
] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
The breast and cardiopulmonary examination revealed no abnormalities. | [
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10
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"text": "breast",
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}
] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
The abdomen was flat, and mobile with respiration. | [
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11
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"role": "",
"semantic_type_id": "",
"text": "The abdomen",
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] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. | [
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"text": "palpation",
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"text": "the left iliac fossa",
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{
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73,
78
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"role": "",
"semantic_type_id": "",
"text": "bowel",
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] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. | [
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35,
69
],
"role": "",
"semantic_type_id": "",
"text": "normal gravid external cervical os",
"type": "BODYPART"
}
] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. | [
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"text": "exploration",
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],
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153
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"role": "",
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"role": "",
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"text": "the cervix",
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},
{
"id": "9464",
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],
"role": "",
"semantic_type_id": "",
"text": "the uterus",
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143
],
"role": "",
"semantic_type_id": "",
"text": "eight weeks",
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}
] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. | [
{
"id": "8794",
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],
"role": "",
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"text": "mass",
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},
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"role": "",
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"text": "The left adnexae",
"type": "BODYPART"
},
{
"id": "9668",
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68,
85
],
"role": "",
"semantic_type_id": "",
"text": "seven centimeters",
"type": "RML"
}
] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
The posterior cervico-vaginal fornix was neither tender nor bulging. | [
{
"id": "8824",
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],
"role": "",
"semantic_type_id": "",
"text": "tender",
"type": "EVENT"
},
{
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"role": "",
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"text": "bulging",
"type": "EVENT"
},
{
"id": "9476",
"offsets": [
0,
36
],
"role": "",
"semantic_type_id": "",
"text": "The posterior cervico-vaginal fornix",
"type": "BODYPART"
}
] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. | [
{
"id": "8854",
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3,
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"role": "",
"semantic_type_id": "",
"text": "suspected",
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},
{
"id": "8869",
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],
"role": "",
"semantic_type_id": "",
"text": "pregnancy",
"type": "EVENT"
},
{
"id": "8884",
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],
"role": "",
"semantic_type_id": "",
"text": "pregnancy",
"type": "EVENT"
},
{
"id": "8899",
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],
"role": "",
"semantic_type_id": "",
"text": "torsion",
"type": "EVENT"
},
{
"id": "8914",
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172,
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],
"role": "",
"semantic_type_id": "",
"text": "bleeding",
"type": "EVENT"
},
{
"id": "9617",
"offsets": [
0,
2
],
"role": "H-PROFESSIONAL",
"semantic_type_id": "",
"text": "We",
"type": "ACTOR"
}
] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). | [
{
"id": "8929",
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],
"role": "",
"semantic_type_id": "",
"text": "investigations",
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},
{
"id": "8944",
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],
"role": "",
"semantic_type_id": "",
"text": "revealed",
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},
{
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],
"role": "",
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"text": "level",
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},
{
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89,
146
],
"role": "",
"semantic_type_id": "",
"text": "96 702 milli International Units per milliliter of plasma",
"type": "RML"
}
] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. | [
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"id": "8974",
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"role": "",
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"text": "Ultrasonography",
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{
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"text": "revealed",
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{
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{
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"role": "",
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"text": "effusion",
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},
{
"id": "9482",
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"role": "",
"semantic_type_id": "",
"text": "an empty uterus",
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},
{
"id": "9680",
"offsets": [
61,
75
],
"role": "",
"semantic_type_id": "",
"text": "82 millimeters",
"type": "RML"
}
] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
This comforted our first diagnosis. | [
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"text": "comforted",
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] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. | [
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] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. | [
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"role": "",
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"role": "",
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"text": "normal right adnexae",
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"semantic_type_id": "",
"text": "normal uterus",
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}
] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
There was no hemoperitoneum. | [
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"id": "9139",
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13,
27
],
"role": "",
"semantic_type_id": "",
"text": "hemoperitoneum",
"type": "EVENT"
}
] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. | [
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"text": "the ovarian capsule",
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{
"id": "9530",
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61,
80
],
"role": "",
"semantic_type_id": "",
"text": "the gestational sac",
"type": "BODYPART"
}
] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. | [
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{
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"role": "",
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"text": "trophoblastic tissue",
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{
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],
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"role": "H-PROFESSIONAL",
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"text": "the pathologist",
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}
] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
Post operative course was uneventful and the patient was discharged six days after surgery. | [
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"role": "",
"semantic_type_id": "",
"text": "six days",
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] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
The ? | [] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
hCG level decreased and disappeared 25 days after surgery. | [
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"text": "25 days",
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] | It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy. She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission. A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic. The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation. She had first menses at 14 and her menstrual cycle is regular with a length of 30 days. She has never practiced contraception. She has been adequately treated for acute pelvic inflammatory disease five years earlier. Her only child is a girl born vaginally seven years ago. Her blood group is B rhesus positive and she has never undergone surgery. She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done. On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting. On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius. The conjunctivae were pink and the tongue was clean and moist. There were no cervical adenopathies. The breast and cardiopulmonary examination revealed no abnormalities. The abdomen was flat, and mobile with respiration. On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation. Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge. On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy. The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal. The posterior cervico-vaginal fornix was neither tender nor bulging. We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy. Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml). Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion. This comforted our first diagnosis. After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia. The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus. There was no hemoperitoneum. We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis. The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy. Post operative course was uneventful and the patient was discharged six days after surgery. The ?hCG level decreased and disappeared 25 days after surgery.
| EN100068 |
We report the case of a 15-year-old Caucasian girl who was diagnosed with Silver-Russell syndrome at the age of four and a half years. | [
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"text": "syndrome",
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"semantic_type_id": "C0175693",
"text": "Silver-Russell syndrome",
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"text": "a 15-year-old Caucasian girl",
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] | We report the case of a 15-year-old Caucasian girl who was diagnosed with Silver-Russell syndrome at the age of four and a half years. Recombinant growth hormone was administered for 18 months without an appropriate increase in growth velocity. At the age of seven years, her serum growth hormone levels were high, and an insulin-like growth factor 1 generation test did not increase insulin-like growth factor 1 levels (baseline insulin-like growth factor 1 levels, 52 μg/L; reference range, 75 μg/L to 365 μg/L; and peak, 76 μg/L and 50 μg/L after 12 and 84 hours, respectively, from baseline). The genetic analysis showed that the patient was homozygous for the R217X mutation in the growth hormone receptor gene, which is characteristic of Laron syndrome. On the basis of these results, the diagnosis of primary growth hormone insensitivity syndrome was made, and recombinant insulin-like growth factor 1 therapy was initiated. The patient's treatment was well tolerated, but unexplained central hypothyroidism occurred at the age of 12.9 years. At the age of 15 years, when the patient's sexual development was almost completed and her menstrual cycle occurred irregularly, her height was 129.8 cm, which is 4.71 standard deviations below the median for normal girls her age.
| EN107465 |
Subsets and Splits