sentence
stringlengths 5
513
| entities
listlengths 0
26
| original_text
stringclasses 84
values | original_id
stringclasses 84
values |
|---|---|---|---|
A hypoxic coma occurred on day 4 leading to intubation and mechanical ventilation. | [
{
"id": "5513",
"offsets": [
10,
14
],
"role": "",
"semantic_type_id": "",
"text": "coma",
"type": "EVENT"
},
{
"id": "5528",
"offsets": [
44,
54
],
"role": "",
"semantic_type_id": "",
"text": "intubation",
"type": "EVENT"
},
{
"id": "5543",
"offsets": [
70,
81
],
"role": "",
"semantic_type_id": "",
"text": "ventilation",
"type": "EVENT"
},
{
"id": "5666",
"offsets": [
2,
14
],
"role": "",
"semantic_type_id": "C0559402",
"text": "hypoxic coma",
"type": "CLINENTITY"
},
{
"id": "5850",
"offsets": [
27,
32
],
"role": "",
"semantic_type_id": "",
"text": "day 4",
"type": "TIMEX3"
}
] | A 17 year-old woman with a history of moderate persistent allergic asthma has benefited from a first desensitization protocol at age 3. The protocol has been interrupted 4 years later because of a mild skin reaction. Her doctor decided to stop the specific immunotherapy. But another doctor restarted a new protocol of desensitization at age 16 against pollens because of a lack of control of his condition. She was never hospitalized, she was receiving no medication and she was doing well one year after she received a new regimen of pneumallergens (Alustal® Stallergenes SA, France). Indeed, 12 hours after initiation of treatment, she complained of abdominal pain, vomiting and diarrhea without fever. Several hours after, she consulted to the emergency department where a surgical emergency was ruled out. She was then admitted to the internal medicine ward. Two days later, she developed an acute respiratory failure and was referred to the intensive care unit where laboratory tests revealed multiorgan failure: liver enzymes, 5000U/L (normal level, 0-37U/L); creatine phosphokinase, 59000U/L (normal level, 10-200U/L); cardiac troponin T, 21ng/ml (normal level, under 0,01ng/ml); leucopenia, 2600/mm 3 (normal level, 4000-9000/ mm 3); thrombocytopenia, 13000/ mm 3 (normal level, 150000-400000/ mm 3); prothrombin time, 38% (normal level, 70-100%). Chest X-ray demonstrated bilateral interstitial markings with a normal cardiac silhouette. Viral serology was normal for hepatitis A, B, C, D, and E, Epstein-Barr virus and Cytomegalovirus. A skin morbilliform rash and facial edema appeared later. The patient received a fluid resuscitation, platelet and erythrocyte transfusion, steroids and antibiotics. A hypoxic coma occurred on day 4 leading to intubation and mechanical ventilation. Rapidly, she experienced intractable shock and acute renal impairment despite inotropic agents leading to death on day 5.
| EN100029 |
Rapidly, she experienced intractable shock and acute renal impairment despite inotropic agents leading to death on day 5. | [
{
"id": "5558",
"offsets": [
37,
42
],
"role": "",
"semantic_type_id": "",
"text": "shock",
"type": "EVENT"
},
{
"id": "5573",
"offsets": [
59,
69
],
"role": "",
"semantic_type_id": "",
"text": "impairment",
"type": "EVENT"
},
{
"id": "5588",
"offsets": [
106,
111
],
"role": "",
"semantic_type_id": "",
"text": "death",
"type": "EVENT"
},
{
"id": "5673",
"offsets": [
37,
42
],
"role": "",
"semantic_type_id": "C0036974",
"text": "shock",
"type": "CLINENTITY"
},
{
"id": "5680",
"offsets": [
47,
69
],
"role": "",
"semantic_type_id": "C1565662",
"text": "acute renal impairment",
"type": "CLINENTITY"
},
{
"id": "5771",
"offsets": [
9,
12
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "she",
"type": "ACTOR"
},
{
"id": "5859",
"offsets": [
115,
120
],
"role": "",
"semantic_type_id": "",
"text": "day 5",
"type": "TIMEX3"
}
] | A 17 year-old woman with a history of moderate persistent allergic asthma has benefited from a first desensitization protocol at age 3. The protocol has been interrupted 4 years later because of a mild skin reaction. Her doctor decided to stop the specific immunotherapy. But another doctor restarted a new protocol of desensitization at age 16 against pollens because of a lack of control of his condition. She was never hospitalized, she was receiving no medication and she was doing well one year after she received a new regimen of pneumallergens (Alustal® Stallergenes SA, France). Indeed, 12 hours after initiation of treatment, she complained of abdominal pain, vomiting and diarrhea without fever. Several hours after, she consulted to the emergency department where a surgical emergency was ruled out. She was then admitted to the internal medicine ward. Two days later, she developed an acute respiratory failure and was referred to the intensive care unit where laboratory tests revealed multiorgan failure: liver enzymes, 5000U/L (normal level, 0-37U/L); creatine phosphokinase, 59000U/L (normal level, 10-200U/L); cardiac troponin T, 21ng/ml (normal level, under 0,01ng/ml); leucopenia, 2600/mm 3 (normal level, 4000-9000/ mm 3); thrombocytopenia, 13000/ mm 3 (normal level, 150000-400000/ mm 3); prothrombin time, 38% (normal level, 70-100%). Chest X-ray demonstrated bilateral interstitial markings with a normal cardiac silhouette. Viral serology was normal for hepatitis A, B, C, D, and E, Epstein-Barr virus and Cytomegalovirus. A skin morbilliform rash and facial edema appeared later. The patient received a fluid resuscitation, platelet and erythrocyte transfusion, steroids and antibiotics. A hypoxic coma occurred on day 4 leading to intubation and mechanical ventilation. Rapidly, she experienced intractable shock and acute renal impairment despite inotropic agents leading to death on day 5.
| EN100029 |
A 45 year old Indian female of Nordic origin presented 5 years back with a lump in the right breast and the axilla. | [
{
"id": "3695",
"offsets": [
45,
54
],
"role": "",
"semantic_type_id": "",
"text": "presented",
"type": "EVENT"
},
{
"id": "3710",
"offsets": [
75,
79
],
"role": "",
"semantic_type_id": "",
"text": "lump",
"type": "EVENT"
},
{
"id": "4475",
"offsets": [
75,
114
],
"role": "",
"semantic_type_id": "C0238729",
"text": "lump in the right breast and the axilla",
"type": "CLINENTITY"
},
{
"id": "4482",
"offsets": [
75,
99
],
"role": "",
"semantic_type_id": "C2126187",
"text": "lump in the right breast",
"type": "CLINENTITY"
},
{
"id": "4580",
"offsets": [
83,
99
],
"role": "",
"semantic_type_id": "",
"text": "the right breast",
"type": "BODYPART"
},
{
"id": "4586",
"offsets": [
104,
114
],
"role": "",
"semantic_type_id": "",
"text": "the axilla",
"type": "BODYPART"
},
{
"id": "4670",
"offsets": [
0,
44
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "A 45 year old Indian female of Nordic origin",
"type": "ACTOR"
},
{
"id": "4734",
"offsets": [
55,
67
],
"role": "",
"semantic_type_id": "",
"text": "5 years back",
"type": "TIMEX3"
}
] | A 45 year old Indian female of Nordic origin presented 5 years back with a lump in the right breast and the axilla. She underwent modified radical mastectomy. Histophotomicrograph of the excised breast lesion showed a 2.1 cm duct carcinoma, positive for ER and PR with 1 out of 25 lymph nodes positive for metastasis. She received 6 cycles of chemotherapy with cyclophosphamide, epirubicin, and 5-fluorouracil. This was followed by tamoxifen 20 mg per day for five years. She was doing well on follow up until the completion of fifth year of her disease, when she presented with complaints of mild fever and weakness. Examination revealed generalized lymph node enlargement along with hepatomegaly. Hemogram showed mild anemia, normal platelet count and a leukocyte count of 1.2 x 10(11)/L. Peripheral blood examination revealed medium sized lymphoid cells, constituting almost 75% of total nucleated cell population. Immunophenotying, established a diagnosis of post thymic T-cell prolymphocytic leukemia. Contrast-enhanced computed tomography of the chest and abdomen was done which revealed an anterior mediastinal mass with destruction of sternum along with multiple small nodular shadows in bilateral lung fields suggestive of lung metastasis. Fine needle aspiration cytology of the mass showed atypical ductal cells with nuclear pleomorphism, which were positive for ER, PR and Her2neu protein. This confirmed a co-existent metastatic breast carcinoma. She was started on chemotherapy for T-PLL along with hormonal therapy with aromatase inhibitor. Unfortunately, both her malignancies progressed after an initial stable disease of two months.
| EN108139 |
She underwent modified radical mastectomy. | [
{
"id": "3725",
"offsets": [
31,
41
],
"role": "",
"semantic_type_id": "",
"text": "mastectomy",
"type": "EVENT"
},
{
"id": "4677",
"offsets": [
0,
3
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "She",
"type": "ACTOR"
}
] | A 45 year old Indian female of Nordic origin presented 5 years back with a lump in the right breast and the axilla. She underwent modified radical mastectomy. Histophotomicrograph of the excised breast lesion showed a 2.1 cm duct carcinoma, positive for ER and PR with 1 out of 25 lymph nodes positive for metastasis. She received 6 cycles of chemotherapy with cyclophosphamide, epirubicin, and 5-fluorouracil. This was followed by tamoxifen 20 mg per day for five years. She was doing well on follow up until the completion of fifth year of her disease, when she presented with complaints of mild fever and weakness. Examination revealed generalized lymph node enlargement along with hepatomegaly. Hemogram showed mild anemia, normal platelet count and a leukocyte count of 1.2 x 10(11)/L. Peripheral blood examination revealed medium sized lymphoid cells, constituting almost 75% of total nucleated cell population. Immunophenotying, established a diagnosis of post thymic T-cell prolymphocytic leukemia. Contrast-enhanced computed tomography of the chest and abdomen was done which revealed an anterior mediastinal mass with destruction of sternum along with multiple small nodular shadows in bilateral lung fields suggestive of lung metastasis. Fine needle aspiration cytology of the mass showed atypical ductal cells with nuclear pleomorphism, which were positive for ER, PR and Her2neu protein. This confirmed a co-existent metastatic breast carcinoma. She was started on chemotherapy for T-PLL along with hormonal therapy with aromatase inhibitor. Unfortunately, both her malignancies progressed after an initial stable disease of two months.
| EN108139 |
Histophotomicrograph of the excised breast lesion showed a 2.1 cm duct carcinoma, positive for ER and PR with 1 out of 25 lymph nodes positive for metastasis. | [
{
"id": "3740",
"offsets": [
0,
20
],
"role": "",
"semantic_type_id": "",
"text": "Histophotomicrograph",
"type": "EVENT"
},
{
"id": "3755",
"offsets": [
50,
56
],
"role": "",
"semantic_type_id": "",
"text": "showed",
"type": "EVENT"
},
{
"id": "3770",
"offsets": [
71,
80
],
"role": "",
"semantic_type_id": "",
"text": "carcinoma",
"type": "EVENT"
},
{
"id": "3785",
"offsets": [
95,
97
],
"role": "",
"semantic_type_id": "",
"text": "ER",
"type": "EVENT"
},
{
"id": "3800",
"offsets": [
102,
104
],
"role": "",
"semantic_type_id": "",
"text": "PR",
"type": "EVENT"
},
{
"id": "3815",
"offsets": [
147,
157
],
"role": "",
"semantic_type_id": "",
"text": "metastasis",
"type": "EVENT"
},
{
"id": "4489",
"offsets": [
36,
49
],
"role": "",
"semantic_type_id": "C0567489",
"text": "breast lesion",
"type": "CLINENTITY"
},
{
"id": "4496",
"offsets": [
66,
80
],
"role": "",
"semantic_type_id": "C1176475",
"text": "duct carcinoma",
"type": "CLINENTITY"
},
{
"id": "4503",
"offsets": [
122,
157
],
"role": "",
"semantic_type_id": "C0686619",
"text": "lymph nodes positive for metastasis",
"type": "CLINENTITY"
},
{
"id": "4592",
"offsets": [
36,
42
],
"role": "",
"semantic_type_id": "",
"text": "breast",
"type": "BODYPART"
},
{
"id": "4598",
"offsets": [
66,
70
],
"role": "",
"semantic_type_id": "",
"text": "duct",
"type": "BODYPART"
},
{
"id": "4604",
"offsets": [
110,
133
],
"role": "",
"semantic_type_id": "",
"text": "1 out of 25 lymph nodes",
"type": "BODYPART"
},
{
"id": "4698",
"offsets": [
59,
65
],
"role": "",
"semantic_type_id": "",
"text": "2.1 cm",
"type": "RML"
},
{
"id": "4704",
"offsets": [
82,
90
],
"role": "",
"semantic_type_id": "",
"text": "positive",
"type": "RML"
},
{
"id": "4710",
"offsets": [
134,
142
],
"role": "",
"semantic_type_id": "",
"text": "positive",
"type": "RML"
}
] | A 45 year old Indian female of Nordic origin presented 5 years back with a lump in the right breast and the axilla. She underwent modified radical mastectomy. Histophotomicrograph of the excised breast lesion showed a 2.1 cm duct carcinoma, positive for ER and PR with 1 out of 25 lymph nodes positive for metastasis. She received 6 cycles of chemotherapy with cyclophosphamide, epirubicin, and 5-fluorouracil. This was followed by tamoxifen 20 mg per day for five years. She was doing well on follow up until the completion of fifth year of her disease, when she presented with complaints of mild fever and weakness. Examination revealed generalized lymph node enlargement along with hepatomegaly. Hemogram showed mild anemia, normal platelet count and a leukocyte count of 1.2 x 10(11)/L. Peripheral blood examination revealed medium sized lymphoid cells, constituting almost 75% of total nucleated cell population. Immunophenotying, established a diagnosis of post thymic T-cell prolymphocytic leukemia. Contrast-enhanced computed tomography of the chest and abdomen was done which revealed an anterior mediastinal mass with destruction of sternum along with multiple small nodular shadows in bilateral lung fields suggestive of lung metastasis. Fine needle aspiration cytology of the mass showed atypical ductal cells with nuclear pleomorphism, which were positive for ER, PR and Her2neu protein. This confirmed a co-existent metastatic breast carcinoma. She was started on chemotherapy for T-PLL along with hormonal therapy with aromatase inhibitor. Unfortunately, both her malignancies progressed after an initial stable disease of two months.
| EN108139 |
She received 6 cycles of chemotherapy with cyclophosphamide, epirubicin, and 5-fluorouracil. | [
{
"id": "3830",
"offsets": [
25,
37
],
"role": "",
"semantic_type_id": "",
"text": "chemotherapy",
"type": "EVENT"
},
{
"id": "4684",
"offsets": [
0,
3
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "She",
"type": "ACTOR"
}
] | A 45 year old Indian female of Nordic origin presented 5 years back with a lump in the right breast and the axilla. She underwent modified radical mastectomy. Histophotomicrograph of the excised breast lesion showed a 2.1 cm duct carcinoma, positive for ER and PR with 1 out of 25 lymph nodes positive for metastasis. She received 6 cycles of chemotherapy with cyclophosphamide, epirubicin, and 5-fluorouracil. This was followed by tamoxifen 20 mg per day for five years. She was doing well on follow up until the completion of fifth year of her disease, when she presented with complaints of mild fever and weakness. Examination revealed generalized lymph node enlargement along with hepatomegaly. Hemogram showed mild anemia, normal platelet count and a leukocyte count of 1.2 x 10(11)/L. Peripheral blood examination revealed medium sized lymphoid cells, constituting almost 75% of total nucleated cell population. Immunophenotying, established a diagnosis of post thymic T-cell prolymphocytic leukemia. Contrast-enhanced computed tomography of the chest and abdomen was done which revealed an anterior mediastinal mass with destruction of sternum along with multiple small nodular shadows in bilateral lung fields suggestive of lung metastasis. Fine needle aspiration cytology of the mass showed atypical ductal cells with nuclear pleomorphism, which were positive for ER, PR and Her2neu protein. This confirmed a co-existent metastatic breast carcinoma. She was started on chemotherapy for T-PLL along with hormonal therapy with aromatase inhibitor. Unfortunately, both her malignancies progressed after an initial stable disease of two months.
| EN108139 |
This was followed by tamoxifen 20 mg per day for five years. | [
{
"id": "3845",
"offsets": [
9,
17
],
"role": "",
"semantic_type_id": "",
"text": "followed",
"type": "EVENT"
},
{
"id": "3860",
"offsets": [
21,
30
],
"role": "",
"semantic_type_id": "",
"text": "tamoxifen",
"type": "EVENT"
},
{
"id": "4743",
"offsets": [
37,
44
],
"role": "",
"semantic_type_id": "",
"text": "per day",
"type": "TIMEX3"
},
{
"id": "4752",
"offsets": [
49,
59
],
"role": "",
"semantic_type_id": "",
"text": "five years",
"type": "TIMEX3"
}
] | A 45 year old Indian female of Nordic origin presented 5 years back with a lump in the right breast and the axilla. She underwent modified radical mastectomy. Histophotomicrograph of the excised breast lesion showed a 2.1 cm duct carcinoma, positive for ER and PR with 1 out of 25 lymph nodes positive for metastasis. She received 6 cycles of chemotherapy with cyclophosphamide, epirubicin, and 5-fluorouracil. This was followed by tamoxifen 20 mg per day for five years. She was doing well on follow up until the completion of fifth year of her disease, when she presented with complaints of mild fever and weakness. Examination revealed generalized lymph node enlargement along with hepatomegaly. Hemogram showed mild anemia, normal platelet count and a leukocyte count of 1.2 x 10(11)/L. Peripheral blood examination revealed medium sized lymphoid cells, constituting almost 75% of total nucleated cell population. Immunophenotying, established a diagnosis of post thymic T-cell prolymphocytic leukemia. Contrast-enhanced computed tomography of the chest and abdomen was done which revealed an anterior mediastinal mass with destruction of sternum along with multiple small nodular shadows in bilateral lung fields suggestive of lung metastasis. Fine needle aspiration cytology of the mass showed atypical ductal cells with nuclear pleomorphism, which were positive for ER, PR and Her2neu protein. This confirmed a co-existent metastatic breast carcinoma. She was started on chemotherapy for T-PLL along with hormonal therapy with aromatase inhibitor. Unfortunately, both her malignancies progressed after an initial stable disease of two months.
| EN108139 |
She was doing well on follow up until the completion of fifth year of her disease, when she presented with complaints of mild fever and weakness. | [
{
"id": "3875",
"offsets": [
14,
18
],
"role": "",
"semantic_type_id": "",
"text": "well",
"type": "EVENT"
},
{
"id": "3890",
"offsets": [
22,
28
],
"role": "",
"semantic_type_id": "",
"text": "follow",
"type": "EVENT"
},
{
"id": "3905",
"offsets": [
74,
81
],
"role": "",
"semantic_type_id": "",
"text": "disease",
"type": "EVENT"
},
{
"id": "3920",
"offsets": [
92,
101
],
"role": "",
"semantic_type_id": "",
"text": "presented",
"type": "EVENT"
},
{
"id": "3935",
"offsets": [
107,
117
],
"role": "",
"semantic_type_id": "",
"text": "complaints",
"type": "EVENT"
},
{
"id": "3950",
"offsets": [
126,
131
],
"role": "",
"semantic_type_id": "",
"text": "fever",
"type": "EVENT"
},
{
"id": "3965",
"offsets": [
136,
144
],
"role": "",
"semantic_type_id": "",
"text": "weakness",
"type": "EVENT"
},
{
"id": "4510",
"offsets": [
121,
131
],
"role": "",
"semantic_type_id": "C0239574",
"text": "mild fever",
"type": "CLINENTITY"
},
{
"id": "4517",
"offsets": [
136,
144
],
"role": "",
"semantic_type_id": "C3714552",
"text": "weakness",
"type": "CLINENTITY"
},
{
"id": "4691",
"offsets": [
88,
91
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "she",
"type": "ACTOR"
},
{
"id": "4761",
"offsets": [
56,
66
],
"role": "",
"semantic_type_id": "",
"text": "fifth year",
"type": "TIMEX3"
}
] | A 45 year old Indian female of Nordic origin presented 5 years back with a lump in the right breast and the axilla. She underwent modified radical mastectomy. Histophotomicrograph of the excised breast lesion showed a 2.1 cm duct carcinoma, positive for ER and PR with 1 out of 25 lymph nodes positive for metastasis. She received 6 cycles of chemotherapy with cyclophosphamide, epirubicin, and 5-fluorouracil. This was followed by tamoxifen 20 mg per day for five years. She was doing well on follow up until the completion of fifth year of her disease, when she presented with complaints of mild fever and weakness. Examination revealed generalized lymph node enlargement along with hepatomegaly. Hemogram showed mild anemia, normal platelet count and a leukocyte count of 1.2 x 10(11)/L. Peripheral blood examination revealed medium sized lymphoid cells, constituting almost 75% of total nucleated cell population. Immunophenotying, established a diagnosis of post thymic T-cell prolymphocytic leukemia. Contrast-enhanced computed tomography of the chest and abdomen was done which revealed an anterior mediastinal mass with destruction of sternum along with multiple small nodular shadows in bilateral lung fields suggestive of lung metastasis. Fine needle aspiration cytology of the mass showed atypical ductal cells with nuclear pleomorphism, which were positive for ER, PR and Her2neu protein. This confirmed a co-existent metastatic breast carcinoma. She was started on chemotherapy for T-PLL along with hormonal therapy with aromatase inhibitor. Unfortunately, both her malignancies progressed after an initial stable disease of two months.
| EN108139 |
Examination revealed generalized lymph node enlargement along with hepatomegaly. | [
{
"id": "3980",
"offsets": [
0,
11
],
"role": "",
"semantic_type_id": "",
"text": "Examination",
"type": "EVENT"
},
{
"id": "3995",
"offsets": [
12,
20
],
"role": "",
"semantic_type_id": "",
"text": "revealed",
"type": "EVENT"
},
{
"id": "4010",
"offsets": [
44,
55
],
"role": "",
"semantic_type_id": "",
"text": "enlargement",
"type": "EVENT"
},
{
"id": "4025",
"offsets": [
67,
79
],
"role": "",
"semantic_type_id": "",
"text": "hepatomegaly",
"type": "EVENT"
},
{
"id": "4524",
"offsets": [
21,
55
],
"role": "",
"semantic_type_id": "C0476486",
"text": "generalized lymph node enlargement",
"type": "CLINENTITY"
},
{
"id": "4531",
"offsets": [
67,
79
],
"role": "",
"semantic_type_id": "C0019209",
"text": "hepatomegaly",
"type": "CLINENTITY"
}
] | A 45 year old Indian female of Nordic origin presented 5 years back with a lump in the right breast and the axilla. She underwent modified radical mastectomy. Histophotomicrograph of the excised breast lesion showed a 2.1 cm duct carcinoma, positive for ER and PR with 1 out of 25 lymph nodes positive for metastasis. She received 6 cycles of chemotherapy with cyclophosphamide, epirubicin, and 5-fluorouracil. This was followed by tamoxifen 20 mg per day for five years. She was doing well on follow up until the completion of fifth year of her disease, when she presented with complaints of mild fever and weakness. Examination revealed generalized lymph node enlargement along with hepatomegaly. Hemogram showed mild anemia, normal platelet count and a leukocyte count of 1.2 x 10(11)/L. Peripheral blood examination revealed medium sized lymphoid cells, constituting almost 75% of total nucleated cell population. Immunophenotying, established a diagnosis of post thymic T-cell prolymphocytic leukemia. Contrast-enhanced computed tomography of the chest and abdomen was done which revealed an anterior mediastinal mass with destruction of sternum along with multiple small nodular shadows in bilateral lung fields suggestive of lung metastasis. Fine needle aspiration cytology of the mass showed atypical ductal cells with nuclear pleomorphism, which were positive for ER, PR and Her2neu protein. This confirmed a co-existent metastatic breast carcinoma. She was started on chemotherapy for T-PLL along with hormonal therapy with aromatase inhibitor. Unfortunately, both her malignancies progressed after an initial stable disease of two months.
| EN108139 |
Hemogram showed mild anemia, normal platelet count and a leukocyte count of 1.2 x 10(11)/L. | [
{
"id": "4040",
"offsets": [
0,
8
],
"role": "",
"semantic_type_id": "",
"text": "Hemogram",
"type": "EVENT"
},
{
"id": "4055",
"offsets": [
9,
15
],
"role": "",
"semantic_type_id": "",
"text": "showed",
"type": "EVENT"
},
{
"id": "4070",
"offsets": [
21,
27
],
"role": "",
"semantic_type_id": "",
"text": "anemia",
"type": "EVENT"
},
{
"id": "4085",
"offsets": [
45,
50
],
"role": "",
"semantic_type_id": "",
"text": "count",
"type": "EVENT"
},
{
"id": "4100",
"offsets": [
67,
72
],
"role": "",
"semantic_type_id": "",
"text": "count",
"type": "EVENT"
},
{
"id": "4538",
"offsets": [
16,
27
],
"role": "",
"semantic_type_id": "C1858586",
"text": "mild anemia",
"type": "CLINENTITY"
},
{
"id": "4610",
"offsets": [
36,
44
],
"role": "",
"semantic_type_id": "",
"text": "platelet",
"type": "BODYPART"
},
{
"id": "4616",
"offsets": [
57,
66
],
"role": "",
"semantic_type_id": "",
"text": "leukocyte",
"type": "BODYPART"
},
{
"id": "4716",
"offsets": [
29,
35
],
"role": "",
"semantic_type_id": "",
"text": "normal",
"type": "RML"
},
{
"id": "4722",
"offsets": [
76,
90
],
"role": "",
"semantic_type_id": "",
"text": "1.2 x 10(11)/L",
"type": "RML"
}
] | A 45 year old Indian female of Nordic origin presented 5 years back with a lump in the right breast and the axilla. She underwent modified radical mastectomy. Histophotomicrograph of the excised breast lesion showed a 2.1 cm duct carcinoma, positive for ER and PR with 1 out of 25 lymph nodes positive for metastasis. She received 6 cycles of chemotherapy with cyclophosphamide, epirubicin, and 5-fluorouracil. This was followed by tamoxifen 20 mg per day for five years. She was doing well on follow up until the completion of fifth year of her disease, when she presented with complaints of mild fever and weakness. Examination revealed generalized lymph node enlargement along with hepatomegaly. Hemogram showed mild anemia, normal platelet count and a leukocyte count of 1.2 x 10(11)/L. Peripheral blood examination revealed medium sized lymphoid cells, constituting almost 75% of total nucleated cell population. Immunophenotying, established a diagnosis of post thymic T-cell prolymphocytic leukemia. Contrast-enhanced computed tomography of the chest and abdomen was done which revealed an anterior mediastinal mass with destruction of sternum along with multiple small nodular shadows in bilateral lung fields suggestive of lung metastasis. Fine needle aspiration cytology of the mass showed atypical ductal cells with nuclear pleomorphism, which were positive for ER, PR and Her2neu protein. This confirmed a co-existent metastatic breast carcinoma. She was started on chemotherapy for T-PLL along with hormonal therapy with aromatase inhibitor. Unfortunately, both her malignancies progressed after an initial stable disease of two months.
| EN108139 |
Peripheral blood examination revealed medium sized lymphoid cells, constituting almost 75% of total nucleated cell population. | [
{
"id": "4115",
"offsets": [
17,
28
],
"role": "",
"semantic_type_id": "",
"text": "examination",
"type": "EVENT"
},
{
"id": "4130",
"offsets": [
29,
37
],
"role": "",
"semantic_type_id": "",
"text": "revealed",
"type": "EVENT"
},
{
"id": "4145",
"offsets": [
60,
65
],
"role": "",
"semantic_type_id": "",
"text": "cells",
"type": "EVENT"
},
{
"id": "4622",
"offsets": [
0,
16
],
"role": "",
"semantic_type_id": "",
"text": "Peripheral blood",
"type": "BODYPART"
},
{
"id": "4628",
"offsets": [
110,
114
],
"role": "",
"semantic_type_id": "",
"text": "cell",
"type": "BODYPART"
}
] | A 45 year old Indian female of Nordic origin presented 5 years back with a lump in the right breast and the axilla. She underwent modified radical mastectomy. Histophotomicrograph of the excised breast lesion showed a 2.1 cm duct carcinoma, positive for ER and PR with 1 out of 25 lymph nodes positive for metastasis. She received 6 cycles of chemotherapy with cyclophosphamide, epirubicin, and 5-fluorouracil. This was followed by tamoxifen 20 mg per day for five years. She was doing well on follow up until the completion of fifth year of her disease, when she presented with complaints of mild fever and weakness. Examination revealed generalized lymph node enlargement along with hepatomegaly. Hemogram showed mild anemia, normal platelet count and a leukocyte count of 1.2 x 10(11)/L. Peripheral blood examination revealed medium sized lymphoid cells, constituting almost 75% of total nucleated cell population. Immunophenotying, established a diagnosis of post thymic T-cell prolymphocytic leukemia. Contrast-enhanced computed tomography of the chest and abdomen was done which revealed an anterior mediastinal mass with destruction of sternum along with multiple small nodular shadows in bilateral lung fields suggestive of lung metastasis. Fine needle aspiration cytology of the mass showed atypical ductal cells with nuclear pleomorphism, which were positive for ER, PR and Her2neu protein. This confirmed a co-existent metastatic breast carcinoma. She was started on chemotherapy for T-PLL along with hormonal therapy with aromatase inhibitor. Unfortunately, both her malignancies progressed after an initial stable disease of two months.
| EN108139 |
Immunophenotying, established a diagnosis of post thymic T-cell prolymphocytic leukemia. | [
{
"id": "4160",
"offsets": [
0,
16
],
"role": "",
"semantic_type_id": "",
"text": "Immunophenotying",
"type": "EVENT"
},
{
"id": "4175",
"offsets": [
79,
87
],
"role": "",
"semantic_type_id": "",
"text": "leukemia",
"type": "EVENT"
},
{
"id": "4545",
"offsets": [
57,
87
],
"role": "",
"semantic_type_id": "C2363142",
"text": "T-cell prolymphocytic leukemia",
"type": "CLINENTITY"
}
] | A 45 year old Indian female of Nordic origin presented 5 years back with a lump in the right breast and the axilla. She underwent modified radical mastectomy. Histophotomicrograph of the excised breast lesion showed a 2.1 cm duct carcinoma, positive for ER and PR with 1 out of 25 lymph nodes positive for metastasis. She received 6 cycles of chemotherapy with cyclophosphamide, epirubicin, and 5-fluorouracil. This was followed by tamoxifen 20 mg per day for five years. She was doing well on follow up until the completion of fifth year of her disease, when she presented with complaints of mild fever and weakness. Examination revealed generalized lymph node enlargement along with hepatomegaly. Hemogram showed mild anemia, normal platelet count and a leukocyte count of 1.2 x 10(11)/L. Peripheral blood examination revealed medium sized lymphoid cells, constituting almost 75% of total nucleated cell population. Immunophenotying, established a diagnosis of post thymic T-cell prolymphocytic leukemia. Contrast-enhanced computed tomography of the chest and abdomen was done which revealed an anterior mediastinal mass with destruction of sternum along with multiple small nodular shadows in bilateral lung fields suggestive of lung metastasis. Fine needle aspiration cytology of the mass showed atypical ductal cells with nuclear pleomorphism, which were positive for ER, PR and Her2neu protein. This confirmed a co-existent metastatic breast carcinoma. She was started on chemotherapy for T-PLL along with hormonal therapy with aromatase inhibitor. Unfortunately, both her malignancies progressed after an initial stable disease of two months.
| EN108139 |
Contrast-enhanced computed tomography of the chest and abdomen was done which revealed an anterior mediastinal mass with destruction of sternum along with multiple small nodular shadows in bilateral lung fields suggestive of lung metastasis. | [
{
"id": "4190",
"offsets": [
27,
37
],
"role": "",
"semantic_type_id": "",
"text": "tomography",
"type": "EVENT"
},
{
"id": "4205",
"offsets": [
78,
86
],
"role": "",
"semantic_type_id": "",
"text": "revealed",
"type": "EVENT"
},
{
"id": "4220",
"offsets": [
111,
115
],
"role": "",
"semantic_type_id": "",
"text": "mass",
"type": "EVENT"
},
{
"id": "4235",
"offsets": [
121,
132
],
"role": "",
"semantic_type_id": "",
"text": "destruction",
"type": "EVENT"
},
{
"id": "4250",
"offsets": [
178,
185
],
"role": "",
"semantic_type_id": "",
"text": "shadows",
"type": "EVENT"
},
{
"id": "4265",
"offsets": [
230,
240
],
"role": "",
"semantic_type_id": "",
"text": "metastasis",
"type": "EVENT"
},
{
"id": "4552",
"offsets": [
90,
115
],
"role": "",
"semantic_type_id": "C0746454",
"text": "anterior mediastinal mass",
"type": "CLINENTITY"
},
{
"id": "4559",
"offsets": [
225,
240
],
"role": "",
"semantic_type_id": "C0153676",
"text": "lung metastasis",
"type": "CLINENTITY"
},
{
"id": "4634",
"offsets": [
45,
50
],
"role": "",
"semantic_type_id": "",
"text": "chest",
"type": "BODYPART"
},
{
"id": "4640",
"offsets": [
55,
62
],
"role": "",
"semantic_type_id": "",
"text": "abdomen",
"type": "BODYPART"
},
{
"id": "4646",
"offsets": [
136,
143
],
"role": "",
"semantic_type_id": "",
"text": "sternum",
"type": "BODYPART"
},
{
"id": "4652",
"offsets": [
199,
203
],
"role": "",
"semantic_type_id": "",
"text": "lung",
"type": "BODYPART"
},
{
"id": "4658",
"offsets": [
225,
229
],
"role": "",
"semantic_type_id": "",
"text": "lung",
"type": "BODYPART"
}
] | A 45 year old Indian female of Nordic origin presented 5 years back with a lump in the right breast and the axilla. She underwent modified radical mastectomy. Histophotomicrograph of the excised breast lesion showed a 2.1 cm duct carcinoma, positive for ER and PR with 1 out of 25 lymph nodes positive for metastasis. She received 6 cycles of chemotherapy with cyclophosphamide, epirubicin, and 5-fluorouracil. This was followed by tamoxifen 20 mg per day for five years. She was doing well on follow up until the completion of fifth year of her disease, when she presented with complaints of mild fever and weakness. Examination revealed generalized lymph node enlargement along with hepatomegaly. Hemogram showed mild anemia, normal platelet count and a leukocyte count of 1.2 x 10(11)/L. Peripheral blood examination revealed medium sized lymphoid cells, constituting almost 75% of total nucleated cell population. Immunophenotying, established a diagnosis of post thymic T-cell prolymphocytic leukemia. Contrast-enhanced computed tomography of the chest and abdomen was done which revealed an anterior mediastinal mass with destruction of sternum along with multiple small nodular shadows in bilateral lung fields suggestive of lung metastasis. Fine needle aspiration cytology of the mass showed atypical ductal cells with nuclear pleomorphism, which were positive for ER, PR and Her2neu protein. This confirmed a co-existent metastatic breast carcinoma. She was started on chemotherapy for T-PLL along with hormonal therapy with aromatase inhibitor. Unfortunately, both her malignancies progressed after an initial stable disease of two months.
| EN108139 |
Fine needle aspiration cytology of the mass showed atypical ductal cells with nuclear pleomorphism, which were positive for ER, PR and Her2neu protein. | [
{
"id": "4280",
"offsets": [
23,
31
],
"role": "",
"semantic_type_id": "",
"text": "cytology",
"type": "EVENT"
},
{
"id": "4295",
"offsets": [
44,
50
],
"role": "",
"semantic_type_id": "",
"text": "showed",
"type": "EVENT"
},
{
"id": "4310",
"offsets": [
124,
126
],
"role": "",
"semantic_type_id": "",
"text": "ER",
"type": "EVENT"
},
{
"id": "4325",
"offsets": [
128,
130
],
"role": "",
"semantic_type_id": "",
"text": "PR",
"type": "EVENT"
},
{
"id": "4340",
"offsets": [
135,
142
],
"role": "",
"semantic_type_id": "",
"text": "Her2neu",
"type": "EVENT"
},
{
"id": "4664",
"offsets": [
51,
98
],
"role": "",
"semantic_type_id": "",
"text": "atypical ductal cells with nuclear pleomorphism",
"type": "BODYPART"
},
{
"id": "4728",
"offsets": [
111,
119
],
"role": "",
"semantic_type_id": "",
"text": "positive",
"type": "RML"
}
] | A 45 year old Indian female of Nordic origin presented 5 years back with a lump in the right breast and the axilla. She underwent modified radical mastectomy. Histophotomicrograph of the excised breast lesion showed a 2.1 cm duct carcinoma, positive for ER and PR with 1 out of 25 lymph nodes positive for metastasis. She received 6 cycles of chemotherapy with cyclophosphamide, epirubicin, and 5-fluorouracil. This was followed by tamoxifen 20 mg per day for five years. She was doing well on follow up until the completion of fifth year of her disease, when she presented with complaints of mild fever and weakness. Examination revealed generalized lymph node enlargement along with hepatomegaly. Hemogram showed mild anemia, normal platelet count and a leukocyte count of 1.2 x 10(11)/L. Peripheral blood examination revealed medium sized lymphoid cells, constituting almost 75% of total nucleated cell population. Immunophenotying, established a diagnosis of post thymic T-cell prolymphocytic leukemia. Contrast-enhanced computed tomography of the chest and abdomen was done which revealed an anterior mediastinal mass with destruction of sternum along with multiple small nodular shadows in bilateral lung fields suggestive of lung metastasis. Fine needle aspiration cytology of the mass showed atypical ductal cells with nuclear pleomorphism, which were positive for ER, PR and Her2neu protein. This confirmed a co-existent metastatic breast carcinoma. She was started on chemotherapy for T-PLL along with hormonal therapy with aromatase inhibitor. Unfortunately, both her malignancies progressed after an initial stable disease of two months.
| EN108139 |
This confirmed a co-existent metastatic breast carcinoma. | [
{
"id": "4355",
"offsets": [
5,
14
],
"role": "",
"semantic_type_id": "",
"text": "confirmed",
"type": "EVENT"
},
{
"id": "4370",
"offsets": [
47,
56
],
"role": "",
"semantic_type_id": "",
"text": "carcinoma",
"type": "EVENT"
},
{
"id": "4566",
"offsets": [
29,
56
],
"role": "",
"semantic_type_id": "C4723838",
"text": "metastatic breast carcinoma",
"type": "CLINENTITY"
}
] | A 45 year old Indian female of Nordic origin presented 5 years back with a lump in the right breast and the axilla. She underwent modified radical mastectomy. Histophotomicrograph of the excised breast lesion showed a 2.1 cm duct carcinoma, positive for ER and PR with 1 out of 25 lymph nodes positive for metastasis. She received 6 cycles of chemotherapy with cyclophosphamide, epirubicin, and 5-fluorouracil. This was followed by tamoxifen 20 mg per day for five years. She was doing well on follow up until the completion of fifth year of her disease, when she presented with complaints of mild fever and weakness. Examination revealed generalized lymph node enlargement along with hepatomegaly. Hemogram showed mild anemia, normal platelet count and a leukocyte count of 1.2 x 10(11)/L. Peripheral blood examination revealed medium sized lymphoid cells, constituting almost 75% of total nucleated cell population. Immunophenotying, established a diagnosis of post thymic T-cell prolymphocytic leukemia. Contrast-enhanced computed tomography of the chest and abdomen was done which revealed an anterior mediastinal mass with destruction of sternum along with multiple small nodular shadows in bilateral lung fields suggestive of lung metastasis. Fine needle aspiration cytology of the mass showed atypical ductal cells with nuclear pleomorphism, which were positive for ER, PR and Her2neu protein. This confirmed a co-existent metastatic breast carcinoma. She was started on chemotherapy for T-PLL along with hormonal therapy with aromatase inhibitor. Unfortunately, both her malignancies progressed after an initial stable disease of two months.
| EN108139 |
She was started on chemotherapy for T-PLL along with hormonal therapy with aromatase inhibitor. | [
{
"id": "4385",
"offsets": [
8,
15
],
"role": "",
"semantic_type_id": "",
"text": "started",
"type": "EVENT"
},
{
"id": "4400",
"offsets": [
19,
31
],
"role": "",
"semantic_type_id": "",
"text": "chemotherapy",
"type": "EVENT"
},
{
"id": "4415",
"offsets": [
62,
69
],
"role": "",
"semantic_type_id": "",
"text": "therapy",
"type": "EVENT"
},
{
"id": "4573",
"offsets": [
36,
41
],
"role": "",
"semantic_type_id": "C2363142",
"text": "T-PLL",
"type": "CLINENTITY"
}
] | A 45 year old Indian female of Nordic origin presented 5 years back with a lump in the right breast and the axilla. She underwent modified radical mastectomy. Histophotomicrograph of the excised breast lesion showed a 2.1 cm duct carcinoma, positive for ER and PR with 1 out of 25 lymph nodes positive for metastasis. She received 6 cycles of chemotherapy with cyclophosphamide, epirubicin, and 5-fluorouracil. This was followed by tamoxifen 20 mg per day for five years. She was doing well on follow up until the completion of fifth year of her disease, when she presented with complaints of mild fever and weakness. Examination revealed generalized lymph node enlargement along with hepatomegaly. Hemogram showed mild anemia, normal platelet count and a leukocyte count of 1.2 x 10(11)/L. Peripheral blood examination revealed medium sized lymphoid cells, constituting almost 75% of total nucleated cell population. Immunophenotying, established a diagnosis of post thymic T-cell prolymphocytic leukemia. Contrast-enhanced computed tomography of the chest and abdomen was done which revealed an anterior mediastinal mass with destruction of sternum along with multiple small nodular shadows in bilateral lung fields suggestive of lung metastasis. Fine needle aspiration cytology of the mass showed atypical ductal cells with nuclear pleomorphism, which were positive for ER, PR and Her2neu protein. This confirmed a co-existent metastatic breast carcinoma. She was started on chemotherapy for T-PLL along with hormonal therapy with aromatase inhibitor. Unfortunately, both her malignancies progressed after an initial stable disease of two months.
| EN108139 |
Unfortunately, both her malignancies progressed after an initial stable disease of two months. | [
{
"id": "4430",
"offsets": [
24,
36
],
"role": "",
"semantic_type_id": "",
"text": "malignancies",
"type": "EVENT"
},
{
"id": "4445",
"offsets": [
37,
47
],
"role": "",
"semantic_type_id": "",
"text": "progressed",
"type": "EVENT"
},
{
"id": "4460",
"offsets": [
72,
79
],
"role": "",
"semantic_type_id": "",
"text": "disease",
"type": "EVENT"
},
{
"id": "4770",
"offsets": [
83,
93
],
"role": "",
"semantic_type_id": "",
"text": "two months",
"type": "TIMEX3"
}
] | A 45 year old Indian female of Nordic origin presented 5 years back with a lump in the right breast and the axilla. She underwent modified radical mastectomy. Histophotomicrograph of the excised breast lesion showed a 2.1 cm duct carcinoma, positive for ER and PR with 1 out of 25 lymph nodes positive for metastasis. She received 6 cycles of chemotherapy with cyclophosphamide, epirubicin, and 5-fluorouracil. This was followed by tamoxifen 20 mg per day for five years. She was doing well on follow up until the completion of fifth year of her disease, when she presented with complaints of mild fever and weakness. Examination revealed generalized lymph node enlargement along with hepatomegaly. Hemogram showed mild anemia, normal platelet count and a leukocyte count of 1.2 x 10(11)/L. Peripheral blood examination revealed medium sized lymphoid cells, constituting almost 75% of total nucleated cell population. Immunophenotying, established a diagnosis of post thymic T-cell prolymphocytic leukemia. Contrast-enhanced computed tomography of the chest and abdomen was done which revealed an anterior mediastinal mass with destruction of sternum along with multiple small nodular shadows in bilateral lung fields suggestive of lung metastasis. Fine needle aspiration cytology of the mass showed atypical ductal cells with nuclear pleomorphism, which were positive for ER, PR and Her2neu protein. This confirmed a co-existent metastatic breast carcinoma. She was started on chemotherapy for T-PLL along with hormonal therapy with aromatase inhibitor. Unfortunately, both her malignancies progressed after an initial stable disease of two months.
| EN108139 |
Our patient was an 87-year-old African-American woman who was a nursing home resident, with a history of diabetes mellitus type 2 and subarachnoid hemorrhage leading to aphasia, hemiplegia, seizures and dysphagia requiring percutaneous gastric feeds. | [
{
"id": "1539",
"offsets": [
94,
101
],
"role": "",
"semantic_type_id": "",
"text": "history",
"type": "EVENT"
},
{
"id": "1554",
"offsets": [
105,
113
],
"role": "",
"semantic_type_id": "",
"text": "diabetes",
"type": "EVENT"
},
{
"id": "1569",
"offsets": [
147,
157
],
"role": "",
"semantic_type_id": "",
"text": "hemorrhage",
"type": "EVENT"
},
{
"id": "1584",
"offsets": [
158,
165
],
"role": "",
"semantic_type_id": "",
"text": "leading",
"type": "EVENT"
},
{
"id": "1599",
"offsets": [
169,
176
],
"role": "",
"semantic_type_id": "",
"text": "aphasia",
"type": "EVENT"
},
{
"id": "1614",
"offsets": [
178,
188
],
"role": "",
"semantic_type_id": "",
"text": "hemiplegia",
"type": "EVENT"
},
{
"id": "1629",
"offsets": [
190,
198
],
"role": "",
"semantic_type_id": "",
"text": "seizures",
"type": "EVENT"
},
{
"id": "1644",
"offsets": [
203,
212
],
"role": "",
"semantic_type_id": "",
"text": "dysphagia",
"type": "EVENT"
},
{
"id": "1659",
"offsets": [
213,
222
],
"role": "",
"semantic_type_id": "",
"text": "requiring",
"type": "EVENT"
},
{
"id": "1674",
"offsets": [
244,
249
],
"role": "",
"semantic_type_id": "",
"text": "feeds",
"type": "EVENT"
},
{
"id": "1974",
"offsets": [
105,
129
],
"role": "",
"semantic_type_id": "C4014362",
"text": "diabetes mellitus type 2",
"type": "CLINENTITY"
},
{
"id": "1981",
"offsets": [
134,
157
],
"role": "",
"semantic_type_id": "C0038525",
"text": "subarachnoid hemorrhage",
"type": "CLINENTITY"
},
{
"id": "2044",
"offsets": [
4,
11
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "patient",
"type": "ACTOR"
},
{
"id": "2051",
"offsets": [
19,
53
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "87-year-old African-American woman",
"type": "ACTOR"
}
] | Our patient was an 87-year-old African-American woman who was a nursing home resident, with a history of diabetes mellitus type 2 and subarachnoid hemorrhage leading to aphasia, hemiplegia, seizures and dysphagia requiring percutaneous gastric feeds. While at the nursing home, she had recurrent aspiration pneumonia and large tube-feed residuals consistent with a diagnosis of underlying gastroparesis. Her management included metoclopramide and reduced tube-feeding rates, which improved her symptoms. However, within months the aspiration and increased residuals returned. After trials of different medication therapies without success, she started mirtazapine and her residual volume and aspirations decreased with a dose of 15mg nightly.
| EN106841 |
While at the nursing home, she had recurrent aspiration pneumonia and large tube-feed residuals consistent with a diagnosis of underlying gastroparesis. | [
{
"id": "1689",
"offsets": [
35,
44
],
"role": "",
"semantic_type_id": "",
"text": "recurrent",
"type": "EVENT"
},
{
"id": "1704",
"offsets": [
45,
55
],
"role": "",
"semantic_type_id": "",
"text": "aspiration",
"type": "EVENT"
},
{
"id": "1719",
"offsets": [
86,
95
],
"role": "",
"semantic_type_id": "",
"text": "residuals",
"type": "EVENT"
},
{
"id": "1734",
"offsets": [
114,
123
],
"role": "",
"semantic_type_id": "",
"text": "diagnosis",
"type": "EVENT"
},
{
"id": "1749",
"offsets": [
138,
151
],
"role": "",
"semantic_type_id": "",
"text": "gastroparesis",
"type": "EVENT"
},
{
"id": "2016",
"offsets": [
45,
65
],
"role": "",
"semantic_type_id": "C0032290",
"text": "aspiration pneumonia",
"type": "CLINENTITY"
},
{
"id": "2023",
"offsets": [
138,
151
],
"role": "",
"semantic_type_id": "C0152020",
"text": "gastroparesis",
"type": "CLINENTITY"
},
{
"id": "2058",
"offsets": [
27,
30
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "she",
"type": "ACTOR"
}
] | Our patient was an 87-year-old African-American woman who was a nursing home resident, with a history of diabetes mellitus type 2 and subarachnoid hemorrhage leading to aphasia, hemiplegia, seizures and dysphagia requiring percutaneous gastric feeds. While at the nursing home, she had recurrent aspiration pneumonia and large tube-feed residuals consistent with a diagnosis of underlying gastroparesis. Her management included metoclopramide and reduced tube-feeding rates, which improved her symptoms. However, within months the aspiration and increased residuals returned. After trials of different medication therapies without success, she started mirtazapine and her residual volume and aspirations decreased with a dose of 15mg nightly.
| EN106841 |
Her management included metoclopramide and reduced tube-feeding rates, which improved her symptoms. | [
{
"id": "1764",
"offsets": [
4,
14
],
"role": "",
"semantic_type_id": "",
"text": "management",
"type": "EVENT"
},
{
"id": "1779",
"offsets": [
43,
50
],
"role": "",
"semantic_type_id": "",
"text": "reduced",
"type": "EVENT"
},
{
"id": "1794",
"offsets": [
64,
69
],
"role": "",
"semantic_type_id": "",
"text": "rates",
"type": "EVENT"
},
{
"id": "1809",
"offsets": [
77,
85
],
"role": "",
"semantic_type_id": "",
"text": "improved",
"type": "EVENT"
},
{
"id": "1824",
"offsets": [
90,
98
],
"role": "",
"semantic_type_id": "",
"text": "symptoms",
"type": "EVENT"
}
] | Our patient was an 87-year-old African-American woman who was a nursing home resident, with a history of diabetes mellitus type 2 and subarachnoid hemorrhage leading to aphasia, hemiplegia, seizures and dysphagia requiring percutaneous gastric feeds. While at the nursing home, she had recurrent aspiration pneumonia and large tube-feed residuals consistent with a diagnosis of underlying gastroparesis. Her management included metoclopramide and reduced tube-feeding rates, which improved her symptoms. However, within months the aspiration and increased residuals returned. After trials of different medication therapies without success, she started mirtazapine and her residual volume and aspirations decreased with a dose of 15mg nightly.
| EN106841 |
However, within months the aspiration and increased residuals returned. | [
{
"id": "1839",
"offsets": [
27,
37
],
"role": "",
"semantic_type_id": "",
"text": "aspiration",
"type": "EVENT"
},
{
"id": "1854",
"offsets": [
52,
61
],
"role": "",
"semantic_type_id": "",
"text": "residuals",
"type": "EVENT"
},
{
"id": "1869",
"offsets": [
62,
70
],
"role": "",
"semantic_type_id": "",
"text": "returned",
"type": "EVENT"
},
{
"id": "2030",
"offsets": [
27,
37
],
"role": "",
"semantic_type_id": "C1963221",
"text": "aspiration",
"type": "CLINENTITY"
},
{
"id": "2072",
"offsets": [
16,
22
],
"role": "",
"semantic_type_id": "",
"text": "months",
"type": "TIMEX3"
}
] | Our patient was an 87-year-old African-American woman who was a nursing home resident, with a history of diabetes mellitus type 2 and subarachnoid hemorrhage leading to aphasia, hemiplegia, seizures and dysphagia requiring percutaneous gastric feeds. While at the nursing home, she had recurrent aspiration pneumonia and large tube-feed residuals consistent with a diagnosis of underlying gastroparesis. Her management included metoclopramide and reduced tube-feeding rates, which improved her symptoms. However, within months the aspiration and increased residuals returned. After trials of different medication therapies without success, she started mirtazapine and her residual volume and aspirations decreased with a dose of 15mg nightly.
| EN106841 |
After trials of different medication therapies without success, she started mirtazapine and her residual volume and aspirations decreased with a dose of 15mg nightly. | [
{
"id": "1884",
"offsets": [
37,
46
],
"role": "",
"semantic_type_id": "",
"text": "therapies",
"type": "EVENT"
},
{
"id": "1899",
"offsets": [
55,
62
],
"role": "",
"semantic_type_id": "",
"text": "success",
"type": "EVENT"
},
{
"id": "1914",
"offsets": [
68,
75
],
"role": "",
"semantic_type_id": "",
"text": "started",
"type": "EVENT"
},
{
"id": "1929",
"offsets": [
105,
111
],
"role": "",
"semantic_type_id": "",
"text": "volume",
"type": "EVENT"
},
{
"id": "1944",
"offsets": [
116,
127
],
"role": "",
"semantic_type_id": "",
"text": "aspirations",
"type": "EVENT"
},
{
"id": "1959",
"offsets": [
128,
137
],
"role": "",
"semantic_type_id": "",
"text": "decreased",
"type": "EVENT"
},
{
"id": "2037",
"offsets": [
116,
127
],
"role": "",
"semantic_type_id": "C1963221",
"text": "aspirations",
"type": "CLINENTITY"
},
{
"id": "2065",
"offsets": [
64,
67
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "she",
"type": "ACTOR"
},
{
"id": "2081",
"offsets": [
158,
165
],
"role": "",
"semantic_type_id": "",
"text": "nightly",
"type": "TIMEX3"
}
] | Our patient was an 87-year-old African-American woman who was a nursing home resident, with a history of diabetes mellitus type 2 and subarachnoid hemorrhage leading to aphasia, hemiplegia, seizures and dysphagia requiring percutaneous gastric feeds. While at the nursing home, she had recurrent aspiration pneumonia and large tube-feed residuals consistent with a diagnosis of underlying gastroparesis. Her management included metoclopramide and reduced tube-feeding rates, which improved her symptoms. However, within months the aspiration and increased residuals returned. After trials of different medication therapies without success, she started mirtazapine and her residual volume and aspirations decreased with a dose of 15mg nightly.
| EN106841 |
Here, we present a case of unicentric Castleman's disease in a 37-year-old woman without associated neoplastic, autoimmune or infectious diseases. | [
{
"id": "1435",
"offsets": [
9,
16
],
"role": "",
"semantic_type_id": "",
"text": "present",
"type": "EVENT"
},
{
"id": "1450",
"offsets": [
100,
110
],
"role": "",
"semantic_type_id": "",
"text": "neoplastic",
"type": "EVENT"
},
{
"id": "1465",
"offsets": [
137,
145
],
"role": "",
"semantic_type_id": "",
"text": "diseases",
"type": "EVENT"
},
{
"id": "1585",
"offsets": [
38,
57
],
"role": "",
"semantic_type_id": "C0017531",
"text": "Castleman's disease",
"type": "CLINENTITY"
},
{
"id": "1592",
"offsets": [
100,
145
],
"role": "",
"semantic_type_id": "C1882062",
"text": "neoplastic, autoimmune or infectious diseases",
"type": "CLINENTITY"
},
{
"id": "1599",
"offsets": [
112,
145
],
"role": "",
"semantic_type_id": "C0004364",
"text": "autoimmune or infectious diseases",
"type": "CLINENTITY"
},
{
"id": "1606",
"offsets": [
126,
145
],
"role": "",
"semantic_type_id": "C0009450",
"text": "infectious diseases",
"type": "CLINENTITY"
},
{
"id": "1716",
"offsets": [
6,
8
],
"role": "H-PROFESSIONAL",
"semantic_type_id": "",
"text": "we",
"type": "ACTOR"
},
{
"id": "1723",
"offsets": [
61,
80
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "a 37-year-old woman",
"type": "ACTOR"
}
] | Here, we present a case of unicentric Castleman's disease in a 37-year-old woman without associated neoplastic, autoimmune or infectious diseases. The lesion was located in the femoral region of the right lower extremity and surgically resected after radiographic workup and excisional biopsy examinations. The tumor comprised lymphoid tissue with numerous germinal centers with central fibrosis, onion-skinning and rich interfollicular vascularization. CD23-positive follicular dendritic cells were detected in the germinal centers and numerous CD138-positive plasma cells in interfollicular areas. The diagnosis of mixed cellularity type Castleman's disease was established and the patient recovered well.
| EN107424 |
The lesion was located in the femoral region of the right lower extremity and surgically resected after radiographic workup and excisional biopsy examinations. | [
{
"id": "1480",
"offsets": [
15,
22
],
"role": "",
"semantic_type_id": "",
"text": "located",
"type": "EVENT"
},
{
"id": "1495",
"offsets": [
89,
97
],
"role": "",
"semantic_type_id": "",
"text": "resected",
"type": "EVENT"
},
{
"id": "1510",
"offsets": [
117,
123
],
"role": "",
"semantic_type_id": "",
"text": "workup",
"type": "EVENT"
},
{
"id": "1525",
"offsets": [
146,
158
],
"role": "",
"semantic_type_id": "",
"text": "examinations",
"type": "EVENT"
},
{
"id": "1613",
"offsets": [
4,
10
],
"role": "",
"semantic_type_id": "C0221198",
"text": "lesion",
"type": "CLINENTITY"
},
{
"id": "1662",
"offsets": [
26,
73
],
"role": "",
"semantic_type_id": "",
"text": "the femoral region of the right lower extremity",
"type": "BODYPART"
}
] | Here, we present a case of unicentric Castleman's disease in a 37-year-old woman without associated neoplastic, autoimmune or infectious diseases. The lesion was located in the femoral region of the right lower extremity and surgically resected after radiographic workup and excisional biopsy examinations. The tumor comprised lymphoid tissue with numerous germinal centers with central fibrosis, onion-skinning and rich interfollicular vascularization. CD23-positive follicular dendritic cells were detected in the germinal centers and numerous CD138-positive plasma cells in interfollicular areas. The diagnosis of mixed cellularity type Castleman's disease was established and the patient recovered well.
| EN107424 |
The tumor comprised lymphoid tissue with numerous germinal centers with central fibrosis, onion-skinning and rich interfollicular vascularization. | [
{
"id": "1620",
"offsets": [
4,
9
],
"role": "",
"semantic_type_id": "C0027651",
"text": "tumor",
"type": "CLINENTITY"
},
{
"id": "1627",
"offsets": [
20,
35
],
"role": "",
"semantic_type_id": "C1400600",
"text": "lymphoid tissue",
"type": "CLINENTITY"
},
{
"id": "1634",
"offsets": [
80,
88
],
"role": "",
"semantic_type_id": "C0016059",
"text": "fibrosis",
"type": "CLINENTITY"
},
{
"id": "1641",
"offsets": [
90,
104
],
"role": "",
"semantic_type_id": "C1335112",
"text": "onion-skinning",
"type": "CLINENTITY"
},
{
"id": "1668",
"offsets": [
20,
35
],
"role": "",
"semantic_type_id": "",
"text": "lymphoid tissue",
"type": "BODYPART"
},
{
"id": "1674",
"offsets": [
50,
88
],
"role": "",
"semantic_type_id": "",
"text": "germinal centers with central fibrosis",
"type": "BODYPART"
},
{
"id": "1680",
"offsets": [
90,
104
],
"role": "",
"semantic_type_id": "",
"text": "onion-skinning",
"type": "BODYPART"
},
{
"id": "1686",
"offsets": [
114,
145
],
"role": "",
"semantic_type_id": "",
"text": "interfollicular vascularization",
"type": "BODYPART"
}
] | Here, we present a case of unicentric Castleman's disease in a 37-year-old woman without associated neoplastic, autoimmune or infectious diseases. The lesion was located in the femoral region of the right lower extremity and surgically resected after radiographic workup and excisional biopsy examinations. The tumor comprised lymphoid tissue with numerous germinal centers with central fibrosis, onion-skinning and rich interfollicular vascularization. CD23-positive follicular dendritic cells were detected in the germinal centers and numerous CD138-positive plasma cells in interfollicular areas. The diagnosis of mixed cellularity type Castleman's disease was established and the patient recovered well.
| EN107424 |
CD23-positive follicular dendritic cells were detected in the germinal centers and numerous CD138-positive plasma cells in interfollicular areas. | [
{
"id": "1540",
"offsets": [
46,
54
],
"role": "",
"semantic_type_id": "",
"text": "detected",
"type": "EVENT"
},
{
"id": "1648",
"offsets": [
0,
40
],
"role": "",
"semantic_type_id": "C2347252",
"text": "CD23-positive follicular dendritic cells",
"type": "CLINENTITY"
},
{
"id": "1692",
"offsets": [
0,
40
],
"role": "",
"semantic_type_id": "",
"text": "CD23-positive follicular dendritic cells",
"type": "BODYPART"
},
{
"id": "1698",
"offsets": [
62,
78
],
"role": "",
"semantic_type_id": "",
"text": "germinal centers",
"type": "BODYPART"
},
{
"id": "1704",
"offsets": [
83,
119
],
"role": "",
"semantic_type_id": "",
"text": "numerous CD138-positive plasma cells",
"type": "BODYPART"
},
{
"id": "1710",
"offsets": [
123,
144
],
"role": "",
"semantic_type_id": "",
"text": "interfollicular areas",
"type": "BODYPART"
}
] | Here, we present a case of unicentric Castleman's disease in a 37-year-old woman without associated neoplastic, autoimmune or infectious diseases. The lesion was located in the femoral region of the right lower extremity and surgically resected after radiographic workup and excisional biopsy examinations. The tumor comprised lymphoid tissue with numerous germinal centers with central fibrosis, onion-skinning and rich interfollicular vascularization. CD23-positive follicular dendritic cells were detected in the germinal centers and numerous CD138-positive plasma cells in interfollicular areas. The diagnosis of mixed cellularity type Castleman's disease was established and the patient recovered well.
| EN107424 |
The diagnosis of mixed cellularity type Castleman's disease was established and the patient recovered well. | [
{
"id": "1555",
"offsets": [
4,
13
],
"role": "",
"semantic_type_id": "",
"text": "diagnosis",
"type": "EVENT"
},
{
"id": "1570",
"offsets": [
92,
101
],
"role": "",
"semantic_type_id": "",
"text": "recovered",
"type": "EVENT"
},
{
"id": "1655",
"offsets": [
40,
59
],
"role": "",
"semantic_type_id": "C0017531",
"text": "Castleman's disease",
"type": "CLINENTITY"
},
{
"id": "1730",
"offsets": [
84,
91
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "patient",
"type": "ACTOR"
}
] | Here, we present a case of unicentric Castleman's disease in a 37-year-old woman without associated neoplastic, autoimmune or infectious diseases. The lesion was located in the femoral region of the right lower extremity and surgically resected after radiographic workup and excisional biopsy examinations. The tumor comprised lymphoid tissue with numerous germinal centers with central fibrosis, onion-skinning and rich interfollicular vascularization. CD23-positive follicular dendritic cells were detected in the germinal centers and numerous CD138-positive plasma cells in interfollicular areas. The diagnosis of mixed cellularity type Castleman's disease was established and the patient recovered well.
| EN107424 |
A 45 year old female with history of sickle cell disease presented with abdominal pain. | [
{
"id": "4189",
"offsets": [
49,
56
],
"role": "",
"semantic_type_id": "",
"text": "disease",
"type": "EVENT"
},
{
"id": "4204",
"offsets": [
57,
66
],
"role": "",
"semantic_type_id": "",
"text": "presented",
"type": "EVENT"
},
{
"id": "4219",
"offsets": [
82,
86
],
"role": "",
"semantic_type_id": "",
"text": "pain",
"type": "EVENT"
},
{
"id": "5134",
"offsets": [
37,
56
],
"role": "",
"semantic_type_id": "C0002895",
"text": "sickle cell disease",
"type": "CLINENTITY"
},
{
"id": "5141",
"offsets": [
72,
86
],
"role": "",
"semantic_type_id": "C0000737",
"text": "abdominal pain",
"type": "CLINENTITY"
},
{
"id": "5304",
"offsets": [
0,
20
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "A 45 year old female",
"type": "ACTOR"
}
] | A 45 year old female with history of sickle cell disease presented with abdominal pain. A CT scan revealed an exophytic renal mass measuring 2.9cm x 2.0cm x 2.1cm located on the antero-lateral aspect of her right kidney and an unremarkable spleen. She was evaluated by urology and a right partial nephrectomy was planned, however on the day of the procedure, the patient's preoperative pregnancy test was positive. The procedure was post postponed until after she delivered and interval ultrasounds were obtained throughout her pregnancy to monitor the renal mass. The lesion increased minimally in size. Two months after caesarian section delivery, patient underwent an unremarkable right laparoscopic partial nephrectomy with individual artery and vein vascular occlusion at the level of the renal hilum. A superficial liver laceration caused by the Veress needle was noted at the beginning of the procedure and effectively managed using bipolar cautery.
The patient's post-operative course was notable for marked thrombocytosis with her platelet count increasing for her baseline of 300,000 to a zenith of 1.3 million. She was started on aspirin therapy and splenomegaly was noted on abdomen ultrasound. Her platelet count normalized to 334,000. On pathology, the renal mass was classified as a papillary renal neoplasm consistent with a translocation carcinoma. There was no splenic tissue in the specimen. It was noted that the complete lack of staining of any keratins or epithelial membrane antigens was not consistent with a usual renal cell carcinoma and hence the diagnosis of a translocation tumor was made.
The patient was lost to follow up presenting 2 years later and a follow-up CT scan noted marked splenic atrophy with several splenules. The patient was completely asymptomatic and at the time received all the post-splenectomy vaccination and her platelet count remained within normal limits.
| EN100385 |
A CT scan revealed an exophytic renal mass measuring 2.9cm x 2.0cm x 2.1cm located on the antero-lateral aspect of her right kidney and an unremarkable spleen. | [
{
"id": "4234",
"offsets": [
5,
9
],
"role": "",
"semantic_type_id": "",
"text": "scan",
"type": "EVENT"
},
{
"id": "4249",
"offsets": [
10,
18
],
"role": "",
"semantic_type_id": "",
"text": "revealed",
"type": "EVENT"
},
{
"id": "4264",
"offsets": [
38,
42
],
"role": "",
"semantic_type_id": "",
"text": "mass",
"type": "EVENT"
},
{
"id": "4279",
"offsets": [
43,
52
],
"role": "",
"semantic_type_id": "",
"text": "measuring",
"type": "EVENT"
},
{
"id": "5148",
"offsets": [
32,
42
],
"role": "",
"semantic_type_id": "C0262613",
"text": "renal mass",
"type": "CLINENTITY"
},
{
"id": "5232",
"offsets": [
115,
131
],
"role": "",
"semantic_type_id": "",
"text": "her right kidney",
"type": "BODYPART"
},
{
"id": "5238",
"offsets": [
136,
158
],
"role": "",
"semantic_type_id": "",
"text": "an unremarkable spleen",
"type": "BODYPART"
},
{
"id": "5367",
"offsets": [
53,
74
],
"role": "",
"semantic_type_id": "",
"text": "2.9cm x 2.0cm x 2.1cm",
"type": "RML"
}
] | A 45 year old female with history of sickle cell disease presented with abdominal pain. A CT scan revealed an exophytic renal mass measuring 2.9cm x 2.0cm x 2.1cm located on the antero-lateral aspect of her right kidney and an unremarkable spleen. She was evaluated by urology and a right partial nephrectomy was planned, however on the day of the procedure, the patient's preoperative pregnancy test was positive. The procedure was post postponed until after she delivered and interval ultrasounds were obtained throughout her pregnancy to monitor the renal mass. The lesion increased minimally in size. Two months after caesarian section delivery, patient underwent an unremarkable right laparoscopic partial nephrectomy with individual artery and vein vascular occlusion at the level of the renal hilum. A superficial liver laceration caused by the Veress needle was noted at the beginning of the procedure and effectively managed using bipolar cautery.
The patient's post-operative course was notable for marked thrombocytosis with her platelet count increasing for her baseline of 300,000 to a zenith of 1.3 million. She was started on aspirin therapy and splenomegaly was noted on abdomen ultrasound. Her platelet count normalized to 334,000. On pathology, the renal mass was classified as a papillary renal neoplasm consistent with a translocation carcinoma. There was no splenic tissue in the specimen. It was noted that the complete lack of staining of any keratins or epithelial membrane antigens was not consistent with a usual renal cell carcinoma and hence the diagnosis of a translocation tumor was made.
The patient was lost to follow up presenting 2 years later and a follow-up CT scan noted marked splenic atrophy with several splenules. The patient was completely asymptomatic and at the time received all the post-splenectomy vaccination and her platelet count remained within normal limits.
| EN100385 |
She was evaluated by urology and a right partial nephrectomy was planned, however on the day of the procedure, the patient's preoperative pregnancy test was positive. | [
{
"id": "4294",
"offsets": [
8,
17
],
"role": "",
"semantic_type_id": "",
"text": "evaluated",
"type": "EVENT"
},
{
"id": "4309",
"offsets": [
49,
60
],
"role": "",
"semantic_type_id": "",
"text": "nephrectomy",
"type": "EVENT"
},
{
"id": "4324",
"offsets": [
65,
72
],
"role": "",
"semantic_type_id": "",
"text": "planned",
"type": "EVENT"
},
{
"id": "4339",
"offsets": [
100,
109
],
"role": "",
"semantic_type_id": "",
"text": "procedure",
"type": "EVENT"
},
{
"id": "4354",
"offsets": [
148,
152
],
"role": "",
"semantic_type_id": "",
"text": "test",
"type": "EVENT"
},
{
"id": "5311",
"offsets": [
0,
3
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "She",
"type": "ACTOR"
},
{
"id": "5318",
"offsets": [
115,
124
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "patient's",
"type": "ACTOR"
},
{
"id": "5373",
"offsets": [
157,
165
],
"role": "",
"semantic_type_id": "",
"text": "positive",
"type": "RML"
},
{
"id": "5397",
"offsets": [
85,
92
],
"role": "",
"semantic_type_id": "",
"text": "the day",
"type": "TIMEX3"
},
{
"id": "5406",
"offsets": [
125,
137
],
"role": "",
"semantic_type_id": "",
"text": "preoperative",
"type": "TIMEX3"
}
] | A 45 year old female with history of sickle cell disease presented with abdominal pain. A CT scan revealed an exophytic renal mass measuring 2.9cm x 2.0cm x 2.1cm located on the antero-lateral aspect of her right kidney and an unremarkable spleen. She was evaluated by urology and a right partial nephrectomy was planned, however on the day of the procedure, the patient's preoperative pregnancy test was positive. The procedure was post postponed until after she delivered and interval ultrasounds were obtained throughout her pregnancy to monitor the renal mass. The lesion increased minimally in size. Two months after caesarian section delivery, patient underwent an unremarkable right laparoscopic partial nephrectomy with individual artery and vein vascular occlusion at the level of the renal hilum. A superficial liver laceration caused by the Veress needle was noted at the beginning of the procedure and effectively managed using bipolar cautery.
The patient's post-operative course was notable for marked thrombocytosis with her platelet count increasing for her baseline of 300,000 to a zenith of 1.3 million. She was started on aspirin therapy and splenomegaly was noted on abdomen ultrasound. Her platelet count normalized to 334,000. On pathology, the renal mass was classified as a papillary renal neoplasm consistent with a translocation carcinoma. There was no splenic tissue in the specimen. It was noted that the complete lack of staining of any keratins or epithelial membrane antigens was not consistent with a usual renal cell carcinoma and hence the diagnosis of a translocation tumor was made.
The patient was lost to follow up presenting 2 years later and a follow-up CT scan noted marked splenic atrophy with several splenules. The patient was completely asymptomatic and at the time received all the post-splenectomy vaccination and her platelet count remained within normal limits.
| EN100385 |
The procedure was post postponed until after she delivered and interval ultrasounds were obtained throughout her pregnancy to monitor the renal mass. | [
{
"id": "4369",
"offsets": [
4,
13
],
"role": "",
"semantic_type_id": "",
"text": "procedure",
"type": "EVENT"
},
{
"id": "4384",
"offsets": [
23,
32
],
"role": "",
"semantic_type_id": "",
"text": "postponed",
"type": "EVENT"
},
{
"id": "4399",
"offsets": [
49,
58
],
"role": "",
"semantic_type_id": "",
"text": "delivered",
"type": "EVENT"
},
{
"id": "4414",
"offsets": [
72,
83
],
"role": "",
"semantic_type_id": "",
"text": "ultrasounds",
"type": "EVENT"
},
{
"id": "4429",
"offsets": [
113,
122
],
"role": "",
"semantic_type_id": "",
"text": "pregnancy",
"type": "EVENT"
},
{
"id": "4444",
"offsets": [
126,
133
],
"role": "",
"semantic_type_id": "",
"text": "monitor",
"type": "EVENT"
},
{
"id": "4459",
"offsets": [
144,
148
],
"role": "",
"semantic_type_id": "",
"text": "mass",
"type": "EVENT"
},
{
"id": "5325",
"offsets": [
45,
48
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "she",
"type": "ACTOR"
}
] | A 45 year old female with history of sickle cell disease presented with abdominal pain. A CT scan revealed an exophytic renal mass measuring 2.9cm x 2.0cm x 2.1cm located on the antero-lateral aspect of her right kidney and an unremarkable spleen. She was evaluated by urology and a right partial nephrectomy was planned, however on the day of the procedure, the patient's preoperative pregnancy test was positive. The procedure was post postponed until after she delivered and interval ultrasounds were obtained throughout her pregnancy to monitor the renal mass. The lesion increased minimally in size. Two months after caesarian section delivery, patient underwent an unremarkable right laparoscopic partial nephrectomy with individual artery and vein vascular occlusion at the level of the renal hilum. A superficial liver laceration caused by the Veress needle was noted at the beginning of the procedure and effectively managed using bipolar cautery.
The patient's post-operative course was notable for marked thrombocytosis with her platelet count increasing for her baseline of 300,000 to a zenith of 1.3 million. She was started on aspirin therapy and splenomegaly was noted on abdomen ultrasound. Her platelet count normalized to 334,000. On pathology, the renal mass was classified as a papillary renal neoplasm consistent with a translocation carcinoma. There was no splenic tissue in the specimen. It was noted that the complete lack of staining of any keratins or epithelial membrane antigens was not consistent with a usual renal cell carcinoma and hence the diagnosis of a translocation tumor was made.
The patient was lost to follow up presenting 2 years later and a follow-up CT scan noted marked splenic atrophy with several splenules. The patient was completely asymptomatic and at the time received all the post-splenectomy vaccination and her platelet count remained within normal limits.
| EN100385 |
The lesion increased minimally in size. | [
{
"id": "4474",
"offsets": [
4,
10
],
"role": "",
"semantic_type_id": "",
"text": "lesion",
"type": "EVENT"
},
{
"id": "4489",
"offsets": [
11,
20
],
"role": "",
"semantic_type_id": "",
"text": "increased",
"type": "EVENT"
},
{
"id": "5155",
"offsets": [
4,
10
],
"role": "",
"semantic_type_id": "C0221198",
"text": "lesion",
"type": "CLINENTITY"
}
] | A 45 year old female with history of sickle cell disease presented with abdominal pain. A CT scan revealed an exophytic renal mass measuring 2.9cm x 2.0cm x 2.1cm located on the antero-lateral aspect of her right kidney and an unremarkable spleen. She was evaluated by urology and a right partial nephrectomy was planned, however on the day of the procedure, the patient's preoperative pregnancy test was positive. The procedure was post postponed until after she delivered and interval ultrasounds were obtained throughout her pregnancy to monitor the renal mass. The lesion increased minimally in size. Two months after caesarian section delivery, patient underwent an unremarkable right laparoscopic partial nephrectomy with individual artery and vein vascular occlusion at the level of the renal hilum. A superficial liver laceration caused by the Veress needle was noted at the beginning of the procedure and effectively managed using bipolar cautery.
The patient's post-operative course was notable for marked thrombocytosis with her platelet count increasing for her baseline of 300,000 to a zenith of 1.3 million. She was started on aspirin therapy and splenomegaly was noted on abdomen ultrasound. Her platelet count normalized to 334,000. On pathology, the renal mass was classified as a papillary renal neoplasm consistent with a translocation carcinoma. There was no splenic tissue in the specimen. It was noted that the complete lack of staining of any keratins or epithelial membrane antigens was not consistent with a usual renal cell carcinoma and hence the diagnosis of a translocation tumor was made.
The patient was lost to follow up presenting 2 years later and a follow-up CT scan noted marked splenic atrophy with several splenules. The patient was completely asymptomatic and at the time received all the post-splenectomy vaccination and her platelet count remained within normal limits.
| EN100385 |
Two months after caesarian section delivery, patient underwent an unremarkable right laparoscopic partial nephrectomy with individual artery and vein vascular occlusion at the level of the renal hilum. | [
{
"id": "4504",
"offsets": [
35,
43
],
"role": "",
"semantic_type_id": "",
"text": "delivery",
"type": "EVENT"
},
{
"id": "4519",
"offsets": [
106,
117
],
"role": "",
"semantic_type_id": "",
"text": "nephrectomy",
"type": "EVENT"
},
{
"id": "5162",
"offsets": [
134,
168
],
"role": "",
"semantic_type_id": "C0264995",
"text": "artery and vein vascular occlusion",
"type": "CLINENTITY"
},
{
"id": "5169",
"offsets": [
150,
168
],
"role": "",
"semantic_type_id": "C1096458",
"text": "vascular occlusion",
"type": "CLINENTITY"
},
{
"id": "5244",
"offsets": [
134,
140
],
"role": "",
"semantic_type_id": "",
"text": "artery",
"type": "BODYPART"
},
{
"id": "5250",
"offsets": [
145,
149
],
"role": "",
"semantic_type_id": "",
"text": "vein",
"type": "BODYPART"
},
{
"id": "5256",
"offsets": [
185,
200
],
"role": "",
"semantic_type_id": "",
"text": "the renal hilum",
"type": "BODYPART"
},
{
"id": "5332",
"offsets": [
45,
52
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "patient",
"type": "ACTOR"
},
{
"id": "5415",
"offsets": [
0,
10
],
"role": "",
"semantic_type_id": "",
"text": "Two months",
"type": "TIMEX3"
}
] | A 45 year old female with history of sickle cell disease presented with abdominal pain. A CT scan revealed an exophytic renal mass measuring 2.9cm x 2.0cm x 2.1cm located on the antero-lateral aspect of her right kidney and an unremarkable spleen. She was evaluated by urology and a right partial nephrectomy was planned, however on the day of the procedure, the patient's preoperative pregnancy test was positive. The procedure was post postponed until after she delivered and interval ultrasounds were obtained throughout her pregnancy to monitor the renal mass. The lesion increased minimally in size. Two months after caesarian section delivery, patient underwent an unremarkable right laparoscopic partial nephrectomy with individual artery and vein vascular occlusion at the level of the renal hilum. A superficial liver laceration caused by the Veress needle was noted at the beginning of the procedure and effectively managed using bipolar cautery.
The patient's post-operative course was notable for marked thrombocytosis with her platelet count increasing for her baseline of 300,000 to a zenith of 1.3 million. She was started on aspirin therapy and splenomegaly was noted on abdomen ultrasound. Her platelet count normalized to 334,000. On pathology, the renal mass was classified as a papillary renal neoplasm consistent with a translocation carcinoma. There was no splenic tissue in the specimen. It was noted that the complete lack of staining of any keratins or epithelial membrane antigens was not consistent with a usual renal cell carcinoma and hence the diagnosis of a translocation tumor was made.
The patient was lost to follow up presenting 2 years later and a follow-up CT scan noted marked splenic atrophy with several splenules. The patient was completely asymptomatic and at the time received all the post-splenectomy vaccination and her platelet count remained within normal limits.
| EN100385 |
A superficial liver laceration caused by the Veress needle was noted at the beginning of the procedure and effectively managed using bipolar cautery. | [
{
"id": "4534",
"offsets": [
20,
30
],
"role": "",
"semantic_type_id": "",
"text": "laceration",
"type": "EVENT"
},
{
"id": "4549",
"offsets": [
31,
37
],
"role": "",
"semantic_type_id": "",
"text": "caused",
"type": "EVENT"
},
{
"id": "4564",
"offsets": [
63,
68
],
"role": "",
"semantic_type_id": "",
"text": "noted",
"type": "EVENT"
},
{
"id": "4579",
"offsets": [
76,
85
],
"role": "",
"semantic_type_id": "",
"text": "beginning",
"type": "EVENT"
},
{
"id": "4594",
"offsets": [
93,
102
],
"role": "",
"semantic_type_id": "",
"text": "procedure",
"type": "EVENT"
},
{
"id": "4609",
"offsets": [
119,
126
],
"role": "",
"semantic_type_id": "",
"text": "managed",
"type": "EVENT"
},
{
"id": "4624",
"offsets": [
141,
148
],
"role": "",
"semantic_type_id": "",
"text": "cautery",
"type": "EVENT"
},
{
"id": "5176",
"offsets": [
14,
30
],
"role": "",
"semantic_type_id": "C0347633",
"text": "liver laceration",
"type": "CLINENTITY"
},
{
"id": "5262",
"offsets": [
14,
19
],
"role": "",
"semantic_type_id": "",
"text": "liver",
"type": "BODYPART"
}
] | A 45 year old female with history of sickle cell disease presented with abdominal pain. A CT scan revealed an exophytic renal mass measuring 2.9cm x 2.0cm x 2.1cm located on the antero-lateral aspect of her right kidney and an unremarkable spleen. She was evaluated by urology and a right partial nephrectomy was planned, however on the day of the procedure, the patient's preoperative pregnancy test was positive. The procedure was post postponed until after she delivered and interval ultrasounds were obtained throughout her pregnancy to monitor the renal mass. The lesion increased minimally in size. Two months after caesarian section delivery, patient underwent an unremarkable right laparoscopic partial nephrectomy with individual artery and vein vascular occlusion at the level of the renal hilum. A superficial liver laceration caused by the Veress needle was noted at the beginning of the procedure and effectively managed using bipolar cautery.
The patient's post-operative course was notable for marked thrombocytosis with her platelet count increasing for her baseline of 300,000 to a zenith of 1.3 million. She was started on aspirin therapy and splenomegaly was noted on abdomen ultrasound. Her platelet count normalized to 334,000. On pathology, the renal mass was classified as a papillary renal neoplasm consistent with a translocation carcinoma. There was no splenic tissue in the specimen. It was noted that the complete lack of staining of any keratins or epithelial membrane antigens was not consistent with a usual renal cell carcinoma and hence the diagnosis of a translocation tumor was made.
The patient was lost to follow up presenting 2 years later and a follow-up CT scan noted marked splenic atrophy with several splenules. The patient was completely asymptomatic and at the time received all the post-splenectomy vaccination and her platelet count remained within normal limits.
| EN100385 |
The patient's post-operative course was notable for marked thrombocytosis with her platelet count increasing for her baseline of 300,000 to a zenith of 1.3 million. | [
{
"id": "4639",
"offsets": [
29,
35
],
"role": "",
"semantic_type_id": "",
"text": "course",
"type": "EVENT"
},
{
"id": "4654",
"offsets": [
40,
47
],
"role": "",
"semantic_type_id": "",
"text": "notable",
"type": "EVENT"
},
{
"id": "4669",
"offsets": [
59,
73
],
"role": "",
"semantic_type_id": "",
"text": "thrombocytosis",
"type": "EVENT"
},
{
"id": "4684",
"offsets": [
92,
97
],
"role": "",
"semantic_type_id": "",
"text": "count",
"type": "EVENT"
},
{
"id": "4699",
"offsets": [
98,
108
],
"role": "",
"semantic_type_id": "",
"text": "increasing",
"type": "EVENT"
},
{
"id": "5183",
"offsets": [
59,
73
],
"role": "",
"semantic_type_id": "C0836924",
"text": "thrombocytosis",
"type": "CLINENTITY"
},
{
"id": "5268",
"offsets": [
83,
91
],
"role": "",
"semantic_type_id": "",
"text": "platelet",
"type": "BODYPART"
},
{
"id": "5339",
"offsets": [
4,
13
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "patient's",
"type": "ACTOR"
},
{
"id": "5379",
"offsets": [
129,
136
],
"role": "",
"semantic_type_id": "",
"text": "300,000",
"type": "RML"
},
{
"id": "5385",
"offsets": [
152,
163
],
"role": "",
"semantic_type_id": "",
"text": "1.3 million",
"type": "RML"
},
{
"id": "5424",
"offsets": [
14,
28
],
"role": "",
"semantic_type_id": "",
"text": "post-operative",
"type": "TIMEX3"
}
] | A 45 year old female with history of sickle cell disease presented with abdominal pain. A CT scan revealed an exophytic renal mass measuring 2.9cm x 2.0cm x 2.1cm located on the antero-lateral aspect of her right kidney and an unremarkable spleen. She was evaluated by urology and a right partial nephrectomy was planned, however on the day of the procedure, the patient's preoperative pregnancy test was positive. The procedure was post postponed until after she delivered and interval ultrasounds were obtained throughout her pregnancy to monitor the renal mass. The lesion increased minimally in size. Two months after caesarian section delivery, patient underwent an unremarkable right laparoscopic partial nephrectomy with individual artery and vein vascular occlusion at the level of the renal hilum. A superficial liver laceration caused by the Veress needle was noted at the beginning of the procedure and effectively managed using bipolar cautery.
The patient's post-operative course was notable for marked thrombocytosis with her platelet count increasing for her baseline of 300,000 to a zenith of 1.3 million. She was started on aspirin therapy and splenomegaly was noted on abdomen ultrasound. Her platelet count normalized to 334,000. On pathology, the renal mass was classified as a papillary renal neoplasm consistent with a translocation carcinoma. There was no splenic tissue in the specimen. It was noted that the complete lack of staining of any keratins or epithelial membrane antigens was not consistent with a usual renal cell carcinoma and hence the diagnosis of a translocation tumor was made.
The patient was lost to follow up presenting 2 years later and a follow-up CT scan noted marked splenic atrophy with several splenules. The patient was completely asymptomatic and at the time received all the post-splenectomy vaccination and her platelet count remained within normal limits.
| EN100385 |
She was started on aspirin therapy and splenomegaly was noted on abdomen ultrasound. | [
{
"id": "4714",
"offsets": [
8,
15
],
"role": "",
"semantic_type_id": "",
"text": "started",
"type": "EVENT"
},
{
"id": "4729",
"offsets": [
27,
34
],
"role": "",
"semantic_type_id": "",
"text": "therapy",
"type": "EVENT"
},
{
"id": "4744",
"offsets": [
39,
51
],
"role": "",
"semantic_type_id": "",
"text": "splenomegaly",
"type": "EVENT"
},
{
"id": "4759",
"offsets": [
56,
61
],
"role": "",
"semantic_type_id": "",
"text": "noted",
"type": "EVENT"
},
{
"id": "4774",
"offsets": [
73,
83
],
"role": "",
"semantic_type_id": "",
"text": "ultrasound",
"type": "EVENT"
},
{
"id": "5190",
"offsets": [
39,
51
],
"role": "",
"semantic_type_id": "C0038002",
"text": "splenomegaly",
"type": "CLINENTITY"
},
{
"id": "5274",
"offsets": [
65,
72
],
"role": "",
"semantic_type_id": "",
"text": "abdomen",
"type": "BODYPART"
},
{
"id": "5346",
"offsets": [
0,
3
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "She",
"type": "ACTOR"
}
] | A 45 year old female with history of sickle cell disease presented with abdominal pain. A CT scan revealed an exophytic renal mass measuring 2.9cm x 2.0cm x 2.1cm located on the antero-lateral aspect of her right kidney and an unremarkable spleen. She was evaluated by urology and a right partial nephrectomy was planned, however on the day of the procedure, the patient's preoperative pregnancy test was positive. The procedure was post postponed until after she delivered and interval ultrasounds were obtained throughout her pregnancy to monitor the renal mass. The lesion increased minimally in size. Two months after caesarian section delivery, patient underwent an unremarkable right laparoscopic partial nephrectomy with individual artery and vein vascular occlusion at the level of the renal hilum. A superficial liver laceration caused by the Veress needle was noted at the beginning of the procedure and effectively managed using bipolar cautery.
The patient's post-operative course was notable for marked thrombocytosis with her platelet count increasing for her baseline of 300,000 to a zenith of 1.3 million. She was started on aspirin therapy and splenomegaly was noted on abdomen ultrasound. Her platelet count normalized to 334,000. On pathology, the renal mass was classified as a papillary renal neoplasm consistent with a translocation carcinoma. There was no splenic tissue in the specimen. It was noted that the complete lack of staining of any keratins or epithelial membrane antigens was not consistent with a usual renal cell carcinoma and hence the diagnosis of a translocation tumor was made.
The patient was lost to follow up presenting 2 years later and a follow-up CT scan noted marked splenic atrophy with several splenules. The patient was completely asymptomatic and at the time received all the post-splenectomy vaccination and her platelet count remained within normal limits.
| EN100385 |
Her platelet count normalized to 334,000. | [
{
"id": "4789",
"offsets": [
13,
18
],
"role": "",
"semantic_type_id": "",
"text": "count",
"type": "EVENT"
},
{
"id": "4804",
"offsets": [
19,
29
],
"role": "",
"semantic_type_id": "",
"text": "normalized",
"type": "EVENT"
},
{
"id": "5280",
"offsets": [
4,
12
],
"role": "",
"semantic_type_id": "",
"text": "platelet",
"type": "BODYPART"
},
{
"id": "5391",
"offsets": [
33,
40
],
"role": "",
"semantic_type_id": "",
"text": "334,000",
"type": "RML"
}
] | A 45 year old female with history of sickle cell disease presented with abdominal pain. A CT scan revealed an exophytic renal mass measuring 2.9cm x 2.0cm x 2.1cm located on the antero-lateral aspect of her right kidney and an unremarkable spleen. She was evaluated by urology and a right partial nephrectomy was planned, however on the day of the procedure, the patient's preoperative pregnancy test was positive. The procedure was post postponed until after she delivered and interval ultrasounds were obtained throughout her pregnancy to monitor the renal mass. The lesion increased minimally in size. Two months after caesarian section delivery, patient underwent an unremarkable right laparoscopic partial nephrectomy with individual artery and vein vascular occlusion at the level of the renal hilum. A superficial liver laceration caused by the Veress needle was noted at the beginning of the procedure and effectively managed using bipolar cautery.
The patient's post-operative course was notable for marked thrombocytosis with her platelet count increasing for her baseline of 300,000 to a zenith of 1.3 million. She was started on aspirin therapy and splenomegaly was noted on abdomen ultrasound. Her platelet count normalized to 334,000. On pathology, the renal mass was classified as a papillary renal neoplasm consistent with a translocation carcinoma. There was no splenic tissue in the specimen. It was noted that the complete lack of staining of any keratins or epithelial membrane antigens was not consistent with a usual renal cell carcinoma and hence the diagnosis of a translocation tumor was made.
The patient was lost to follow up presenting 2 years later and a follow-up CT scan noted marked splenic atrophy with several splenules. The patient was completely asymptomatic and at the time received all the post-splenectomy vaccination and her platelet count remained within normal limits.
| EN100385 |
On pathology, the renal mass was classified as a papillary renal neoplasm consistent with a translocation carcinoma. | [
{
"id": "4819",
"offsets": [
3,
12
],
"role": "",
"semantic_type_id": "",
"text": "pathology",
"type": "EVENT"
},
{
"id": "4834",
"offsets": [
24,
28
],
"role": "",
"semantic_type_id": "",
"text": "mass",
"type": "EVENT"
},
{
"id": "4849",
"offsets": [
33,
43
],
"role": "",
"semantic_type_id": "",
"text": "classified",
"type": "EVENT"
},
{
"id": "4864",
"offsets": [
65,
73
],
"role": "",
"semantic_type_id": "",
"text": "neoplasm",
"type": "EVENT"
},
{
"id": "4879",
"offsets": [
106,
115
],
"role": "",
"semantic_type_id": "",
"text": "carcinoma",
"type": "EVENT"
},
{
"id": "5197",
"offsets": [
49,
73
],
"role": "",
"semantic_type_id": "C1518879",
"text": "papillary renal neoplasm",
"type": "CLINENTITY"
},
{
"id": "5204",
"offsets": [
106,
115
],
"role": "",
"semantic_type_id": "C0007097",
"text": "carcinoma",
"type": "CLINENTITY"
}
] | A 45 year old female with history of sickle cell disease presented with abdominal pain. A CT scan revealed an exophytic renal mass measuring 2.9cm x 2.0cm x 2.1cm located on the antero-lateral aspect of her right kidney and an unremarkable spleen. She was evaluated by urology and a right partial nephrectomy was planned, however on the day of the procedure, the patient's preoperative pregnancy test was positive. The procedure was post postponed until after she delivered and interval ultrasounds were obtained throughout her pregnancy to monitor the renal mass. The lesion increased minimally in size. Two months after caesarian section delivery, patient underwent an unremarkable right laparoscopic partial nephrectomy with individual artery and vein vascular occlusion at the level of the renal hilum. A superficial liver laceration caused by the Veress needle was noted at the beginning of the procedure and effectively managed using bipolar cautery.
The patient's post-operative course was notable for marked thrombocytosis with her platelet count increasing for her baseline of 300,000 to a zenith of 1.3 million. She was started on aspirin therapy and splenomegaly was noted on abdomen ultrasound. Her platelet count normalized to 334,000. On pathology, the renal mass was classified as a papillary renal neoplasm consistent with a translocation carcinoma. There was no splenic tissue in the specimen. It was noted that the complete lack of staining of any keratins or epithelial membrane antigens was not consistent with a usual renal cell carcinoma and hence the diagnosis of a translocation tumor was made.
The patient was lost to follow up presenting 2 years later and a follow-up CT scan noted marked splenic atrophy with several splenules. The patient was completely asymptomatic and at the time received all the post-splenectomy vaccination and her platelet count remained within normal limits.
| EN100385 |
There was no splenic tissue in the specimen. | [
{
"id": "5286",
"offsets": [
13,
27
],
"role": "",
"semantic_type_id": "",
"text": "splenic tissue",
"type": "BODYPART"
}
] | A 45 year old female with history of sickle cell disease presented with abdominal pain. A CT scan revealed an exophytic renal mass measuring 2.9cm x 2.0cm x 2.1cm located on the antero-lateral aspect of her right kidney and an unremarkable spleen. She was evaluated by urology and a right partial nephrectomy was planned, however on the day of the procedure, the patient's preoperative pregnancy test was positive. The procedure was post postponed until after she delivered and interval ultrasounds were obtained throughout her pregnancy to monitor the renal mass. The lesion increased minimally in size. Two months after caesarian section delivery, patient underwent an unremarkable right laparoscopic partial nephrectomy with individual artery and vein vascular occlusion at the level of the renal hilum. A superficial liver laceration caused by the Veress needle was noted at the beginning of the procedure and effectively managed using bipolar cautery.
The patient's post-operative course was notable for marked thrombocytosis with her platelet count increasing for her baseline of 300,000 to a zenith of 1.3 million. She was started on aspirin therapy and splenomegaly was noted on abdomen ultrasound. Her platelet count normalized to 334,000. On pathology, the renal mass was classified as a papillary renal neoplasm consistent with a translocation carcinoma. There was no splenic tissue in the specimen. It was noted that the complete lack of staining of any keratins or epithelial membrane antigens was not consistent with a usual renal cell carcinoma and hence the diagnosis of a translocation tumor was made.
The patient was lost to follow up presenting 2 years later and a follow-up CT scan noted marked splenic atrophy with several splenules. The patient was completely asymptomatic and at the time received all the post-splenectomy vaccination and her platelet count remained within normal limits.
| EN100385 |
It was noted that the complete lack of staining of any keratins or epithelial membrane antigens was not consistent with a usual renal cell carcinoma and hence the diagnosis of a translocation tumor was made. | [
{
"id": "4894",
"offsets": [
7,
12
],
"role": "",
"semantic_type_id": "",
"text": "noted",
"type": "EVENT"
},
{
"id": "4909",
"offsets": [
39,
47
],
"role": "",
"semantic_type_id": "",
"text": "staining",
"type": "EVENT"
},
{
"id": "4924",
"offsets": [
104,
114
],
"role": "",
"semantic_type_id": "",
"text": "consistent",
"type": "EVENT"
},
{
"id": "4939",
"offsets": [
139,
148
],
"role": "",
"semantic_type_id": "",
"text": "carcinoma",
"type": "EVENT"
},
{
"id": "4954",
"offsets": [
192,
197
],
"role": "",
"semantic_type_id": "",
"text": "tumor",
"type": "EVENT"
},
{
"id": "5211",
"offsets": [
128,
148
],
"role": "",
"semantic_type_id": "C0007134",
"text": "renal cell carcinoma",
"type": "CLINENTITY"
},
{
"id": "5218",
"offsets": [
192,
197
],
"role": "",
"semantic_type_id": "C0027651",
"text": "tumor",
"type": "CLINENTITY"
},
{
"id": "5292",
"offsets": [
67,
86
],
"role": "",
"semantic_type_id": "",
"text": "epithelial membrane",
"type": "BODYPART"
}
] | A 45 year old female with history of sickle cell disease presented with abdominal pain. A CT scan revealed an exophytic renal mass measuring 2.9cm x 2.0cm x 2.1cm located on the antero-lateral aspect of her right kidney and an unremarkable spleen. She was evaluated by urology and a right partial nephrectomy was planned, however on the day of the procedure, the patient's preoperative pregnancy test was positive. The procedure was post postponed until after she delivered and interval ultrasounds were obtained throughout her pregnancy to monitor the renal mass. The lesion increased minimally in size. Two months after caesarian section delivery, patient underwent an unremarkable right laparoscopic partial nephrectomy with individual artery and vein vascular occlusion at the level of the renal hilum. A superficial liver laceration caused by the Veress needle was noted at the beginning of the procedure and effectively managed using bipolar cautery.
The patient's post-operative course was notable for marked thrombocytosis with her platelet count increasing for her baseline of 300,000 to a zenith of 1.3 million. She was started on aspirin therapy and splenomegaly was noted on abdomen ultrasound. Her platelet count normalized to 334,000. On pathology, the renal mass was classified as a papillary renal neoplasm consistent with a translocation carcinoma. There was no splenic tissue in the specimen. It was noted that the complete lack of staining of any keratins or epithelial membrane antigens was not consistent with a usual renal cell carcinoma and hence the diagnosis of a translocation tumor was made.
The patient was lost to follow up presenting 2 years later and a follow-up CT scan noted marked splenic atrophy with several splenules. The patient was completely asymptomatic and at the time received all the post-splenectomy vaccination and her platelet count remained within normal limits.
| EN100385 |
The patient was lost to follow up presenting 2 years later and a follow-up CT scan noted marked splenic atrophy with several splenules. | [
{
"id": "4969",
"offsets": [
16,
20
],
"role": "",
"semantic_type_id": "",
"text": "lost",
"type": "EVENT"
},
{
"id": "4984",
"offsets": [
24,
30
],
"role": "",
"semantic_type_id": "",
"text": "follow",
"type": "EVENT"
},
{
"id": "4999",
"offsets": [
34,
44
],
"role": "",
"semantic_type_id": "",
"text": "presenting",
"type": "EVENT"
},
{
"id": "5014",
"offsets": [
78,
82
],
"role": "",
"semantic_type_id": "",
"text": "scan",
"type": "EVENT"
},
{
"id": "5029",
"offsets": [
83,
88
],
"role": "",
"semantic_type_id": "",
"text": "noted",
"type": "EVENT"
},
{
"id": "5044",
"offsets": [
104,
111
],
"role": "",
"semantic_type_id": "",
"text": "atrophy",
"type": "EVENT"
},
{
"id": "5225",
"offsets": [
96,
111
],
"role": "",
"semantic_type_id": "C0340987",
"text": "splenic atrophy",
"type": "CLINENTITY"
},
{
"id": "5353",
"offsets": [
0,
11
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "The patient",
"type": "ACTOR"
},
{
"id": "5433",
"offsets": [
45,
58
],
"role": "",
"semantic_type_id": "",
"text": "2 years later",
"type": "TIMEX3"
}
] | A 45 year old female with history of sickle cell disease presented with abdominal pain. A CT scan revealed an exophytic renal mass measuring 2.9cm x 2.0cm x 2.1cm located on the antero-lateral aspect of her right kidney and an unremarkable spleen. She was evaluated by urology and a right partial nephrectomy was planned, however on the day of the procedure, the patient's preoperative pregnancy test was positive. The procedure was post postponed until after she delivered and interval ultrasounds were obtained throughout her pregnancy to monitor the renal mass. The lesion increased minimally in size. Two months after caesarian section delivery, patient underwent an unremarkable right laparoscopic partial nephrectomy with individual artery and vein vascular occlusion at the level of the renal hilum. A superficial liver laceration caused by the Veress needle was noted at the beginning of the procedure and effectively managed using bipolar cautery.
The patient's post-operative course was notable for marked thrombocytosis with her platelet count increasing for her baseline of 300,000 to a zenith of 1.3 million. She was started on aspirin therapy and splenomegaly was noted on abdomen ultrasound. Her platelet count normalized to 334,000. On pathology, the renal mass was classified as a papillary renal neoplasm consistent with a translocation carcinoma. There was no splenic tissue in the specimen. It was noted that the complete lack of staining of any keratins or epithelial membrane antigens was not consistent with a usual renal cell carcinoma and hence the diagnosis of a translocation tumor was made.
The patient was lost to follow up presenting 2 years later and a follow-up CT scan noted marked splenic atrophy with several splenules. The patient was completely asymptomatic and at the time received all the post-splenectomy vaccination and her platelet count remained within normal limits.
| EN100385 |
The patient was completely asymptomatic and at the time received all the post-splenectomy vaccination and her platelet count remained within normal limits. | [
{
"id": "5059",
"offsets": [
27,
39
],
"role": "",
"semantic_type_id": "",
"text": "asymptomatic",
"type": "EVENT"
},
{
"id": "5074",
"offsets": [
56,
64
],
"role": "",
"semantic_type_id": "",
"text": "received",
"type": "EVENT"
},
{
"id": "5089",
"offsets": [
90,
101
],
"role": "",
"semantic_type_id": "",
"text": "vaccination",
"type": "EVENT"
},
{
"id": "5104",
"offsets": [
119,
124
],
"role": "",
"semantic_type_id": "",
"text": "count",
"type": "EVENT"
},
{
"id": "5119",
"offsets": [
148,
154
],
"role": "",
"semantic_type_id": "",
"text": "limits",
"type": "EVENT"
},
{
"id": "5298",
"offsets": [
110,
118
],
"role": "",
"semantic_type_id": "",
"text": "platelet",
"type": "BODYPART"
},
{
"id": "5360",
"offsets": [
0,
11
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "The patient",
"type": "ACTOR"
},
{
"id": "5442",
"offsets": [
73,
89
],
"role": "",
"semantic_type_id": "",
"text": "post-splenectomy",
"type": "TIMEX3"
}
] | A 45 year old female with history of sickle cell disease presented with abdominal pain. A CT scan revealed an exophytic renal mass measuring 2.9cm x 2.0cm x 2.1cm located on the antero-lateral aspect of her right kidney and an unremarkable spleen. She was evaluated by urology and a right partial nephrectomy was planned, however on the day of the procedure, the patient's preoperative pregnancy test was positive. The procedure was post postponed until after she delivered and interval ultrasounds were obtained throughout her pregnancy to monitor the renal mass. The lesion increased minimally in size. Two months after caesarian section delivery, patient underwent an unremarkable right laparoscopic partial nephrectomy with individual artery and vein vascular occlusion at the level of the renal hilum. A superficial liver laceration caused by the Veress needle was noted at the beginning of the procedure and effectively managed using bipolar cautery.
The patient's post-operative course was notable for marked thrombocytosis with her platelet count increasing for her baseline of 300,000 to a zenith of 1.3 million. She was started on aspirin therapy and splenomegaly was noted on abdomen ultrasound. Her platelet count normalized to 334,000. On pathology, the renal mass was classified as a papillary renal neoplasm consistent with a translocation carcinoma. There was no splenic tissue in the specimen. It was noted that the complete lack of staining of any keratins or epithelial membrane antigens was not consistent with a usual renal cell carcinoma and hence the diagnosis of a translocation tumor was made.
The patient was lost to follow up presenting 2 years later and a follow-up CT scan noted marked splenic atrophy with several splenules. The patient was completely asymptomatic and at the time received all the post-splenectomy vaccination and her platelet count remained within normal limits.
| EN100385 |
The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. | [
{
"id": "7394",
"offsets": [
12,
20
],
"role": "",
"semantic_type_id": "",
"text": "referred",
"type": "EVENT"
},
{
"id": "7409",
"offsets": [
78,
86
],
"role": "",
"semantic_type_id": "",
"text": "grafting",
"type": "EVENT"
},
{
"id": "7424",
"offsets": [
126,
133
],
"role": "",
"semantic_type_id": "",
"text": "managed",
"type": "EVENT"
},
{
"id": "7439",
"offsets": [
154,
161
],
"role": "",
"semantic_type_id": "",
"text": "Disease",
"type": "EVENT"
},
{
"id": "7454",
"offsets": [
163,
166
],
"role": "",
"semantic_type_id": "",
"text": "IHD",
"type": "EVENT"
},
{
"id": "8759",
"offsets": [
138,
167
],
"role": "",
"semantic_type_id": "C0151744",
"text": "Ischaemic Heart Disease (IHD)",
"type": "CLINENTITY"
},
{
"id": "8857",
"offsets": [
55,
70
],
"role": "",
"semantic_type_id": "",
"text": "coronary artery",
"type": "BODYPART"
},
{
"id": "8989",
"offsets": [
0,
11
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "The patient",
"type": "ACTOR"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. | [
{
"id": "7469",
"offsets": [
8,
17
],
"role": "",
"semantic_type_id": "",
"text": "presented",
"type": "EVENT"
},
{
"id": "7484",
"offsets": [
60,
63
],
"role": "",
"semantic_type_id": "",
"text": "IHD",
"type": "EVENT"
},
{
"id": "7499",
"offsets": [
68,
74
],
"role": "",
"semantic_type_id": "",
"text": "angina",
"type": "EVENT"
},
{
"id": "7514",
"offsets": [
144,
153
],
"role": "",
"semantic_type_id": "",
"text": "worsening",
"type": "EVENT"
},
{
"id": "7529",
"offsets": [
170,
177
],
"role": "",
"semantic_type_id": "",
"text": "therapy",
"type": "EVENT"
},
{
"id": "8766",
"offsets": [
60,
63
],
"role": "",
"semantic_type_id": "C0151744",
"text": "IHD",
"type": "CLINENTITY"
},
{
"id": "8773",
"offsets": [
68,
84
],
"role": "",
"semantic_type_id": "C0264677",
"text": "angina class III",
"type": "CLINENTITY"
},
{
"id": "8996",
"offsets": [
0,
3
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "She",
"type": "ACTOR"
},
{
"id": "9109",
"offsets": [
21,
30
],
"role": "",
"semantic_type_id": "",
"text": "July 2009",
"type": "TIMEX3"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). | [
{
"id": "7544",
"offsets": [
9,
20
],
"role": "",
"semantic_type_id": "",
"text": "angiography",
"type": "EVENT"
},
{
"id": "7559",
"offsets": [
26,
38
],
"role": "",
"semantic_type_id": "",
"text": "demonstrated",
"type": "EVENT"
},
{
"id": "7574",
"offsets": [
51,
58
],
"role": "",
"semantic_type_id": "",
"text": "lesions",
"type": "EVENT"
},
{
"id": "8780",
"offsets": [
51,
116
],
"role": "",
"semantic_type_id": "CUILESS",
"text": "lesions in the mid portion of the Left Descending Coronary Artery",
"type": "CLINENTITY"
},
{
"id": "8863",
"offsets": [
81,
116
],
"role": "",
"semantic_type_id": "",
"text": "the Left Descending Coronary Artery",
"type": "BODYPART"
},
{
"id": "8869",
"offsets": [
118,
121
],
"role": "",
"semantic_type_id": "",
"text": "LAD",
"type": "BODYPART"
},
{
"id": "8875",
"offsets": [
127,
166
],
"role": "",
"semantic_type_id": "",
"text": "the proximal Circumflex Coronary Artery",
"type": "BODYPART"
},
{
"id": "8881",
"offsets": [
168,
170
],
"role": "",
"semantic_type_id": "",
"text": "Cx",
"type": "BODYPART"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
The Right Coronary Artery was a dominant artery with some minor irregularities. | [
{
"id": "8887",
"offsets": [
0,
25
],
"role": "",
"semantic_type_id": "",
"text": "The Right Coronary Artery",
"type": "BODYPART"
},
{
"id": "8893",
"offsets": [
30,
78
],
"role": "",
"semantic_type_id": "",
"text": "a dominant artery with some minor irregularities",
"type": "BODYPART"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. | [
{
"id": "7589",
"offsets": [
35,
46
],
"role": "",
"semantic_type_id": "",
"text": "angioplasty",
"type": "EVENT"
},
{
"id": "8899",
"offsets": [
55,
62
],
"role": "",
"semantic_type_id": "",
"text": "the LAD",
"type": "BODYPART"
},
{
"id": "8905",
"offsets": [
67,
69
],
"role": "",
"semantic_type_id": "",
"text": "Cx",
"type": "BODYPART"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. | [
{
"id": "7604",
"offsets": [
44,
49
],
"role": "",
"semantic_type_id": "",
"text": "stent",
"type": "EVENT"
},
{
"id": "7619",
"offsets": [
73,
80
],
"role": "",
"semantic_type_id": "",
"text": "stented",
"type": "EVENT"
},
{
"id": "8911",
"offsets": [
50,
57
],
"role": "",
"semantic_type_id": "",
"text": "the LAD",
"type": "BODYPART"
},
{
"id": "8917",
"offsets": [
62,
68
],
"role": "",
"semantic_type_id": "",
"text": "the Cx",
"type": "BODYPART"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
The patient was angina-free for one year but represented in July 2010 again with angina class III. | [
{
"id": "7634",
"offsets": [
16,
27
],
"role": "",
"semantic_type_id": "",
"text": "angina-free",
"type": "EVENT"
},
{
"id": "7649",
"offsets": [
45,
56
],
"role": "",
"semantic_type_id": "",
"text": "represented",
"type": "EVENT"
},
{
"id": "7664",
"offsets": [
81,
87
],
"role": "",
"semantic_type_id": "",
"text": "angina",
"type": "EVENT"
},
{
"id": "8787",
"offsets": [
81,
97
],
"role": "",
"semantic_type_id": "C0264677",
"text": "angina class III",
"type": "CLINENTITY"
},
{
"id": "9003",
"offsets": [
0,
11
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "The patient",
"type": "ACTOR"
},
{
"id": "9118",
"offsets": [
32,
40
],
"role": "",
"semantic_type_id": "",
"text": "one year",
"type": "TIMEX3"
},
{
"id": "9127",
"offsets": [
60,
69
],
"role": "",
"semantic_type_id": "",
"text": "July 2010",
"type": "TIMEX3"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. | [
{
"id": "7679",
"offsets": [
16,
25
],
"role": "",
"semantic_type_id": "",
"text": "angiogram",
"type": "EVENT"
},
{
"id": "7694",
"offsets": [
41,
47
],
"role": "",
"semantic_type_id": "",
"text": "showed",
"type": "EVENT"
},
{
"id": "7709",
"offsets": [
70,
76
],
"role": "",
"semantic_type_id": "",
"text": "patent",
"type": "EVENT"
},
{
"id": "7724",
"offsets": [
107,
113
],
"role": "",
"semantic_type_id": "",
"text": "lesion",
"type": "EVENT"
},
{
"id": "8794",
"offsets": [
98,
113
],
"role": "",
"semantic_type_id": "C0010051",
"text": "coronary lesion",
"type": "CLINENTITY"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
She was controlled on medical therapy. | [
{
"id": "7739",
"offsets": [
8,
18
],
"role": "",
"semantic_type_id": "",
"text": "controlled",
"type": "EVENT"
},
{
"id": "7754",
"offsets": [
30,
37
],
"role": "",
"semantic_type_id": "",
"text": "therapy",
"type": "EVENT"
},
{
"id": "9010",
"offsets": [
0,
3
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "She",
"type": "ACTOR"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
However she presented again in November 2011, this time with unstable angina. | [
{
"id": "7769",
"offsets": [
12,
21
],
"role": "",
"semantic_type_id": "",
"text": "presented",
"type": "EVENT"
},
{
"id": "7784",
"offsets": [
70,
76
],
"role": "",
"semantic_type_id": "",
"text": "angina",
"type": "EVENT"
},
{
"id": "8801",
"offsets": [
61,
76
],
"role": "",
"semantic_type_id": "C0002965",
"text": "unstable angina",
"type": "CLINENTITY"
},
{
"id": "9017",
"offsets": [
8,
11
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "she",
"type": "ACTOR"
},
{
"id": "9136",
"offsets": [
31,
44
],
"role": "",
"semantic_type_id": "",
"text": "November 2011",
"type": "TIMEX3"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. | [
{
"id": "7799",
"offsets": [
19,
28
],
"role": "",
"semantic_type_id": "",
"text": "angiogram",
"type": "EVENT"
},
{
"id": "7814",
"offsets": [
41,
47
],
"role": "",
"semantic_type_id": "",
"text": "showed",
"type": "EVENT"
},
{
"id": "7829",
"offsets": [
84,
90
],
"role": "",
"semantic_type_id": "",
"text": "patent",
"type": "EVENT"
},
{
"id": "7844",
"offsets": [
121,
129
],
"role": "",
"semantic_type_id": "",
"text": "stenosis",
"type": "EVENT"
},
{
"id": "7859",
"offsets": [
153,
161
],
"role": "",
"semantic_type_id": "",
"text": "stenosis",
"type": "EVENT"
},
{
"id": "8808",
"offsets": [
116,
129
],
"role": "",
"semantic_type_id": "CUILESS",
"text": "stem stenosis",
"type": "CLINENTITY"
},
{
"id": "8923",
"offsets": [
149,
152
],
"role": "",
"semantic_type_id": "",
"text": "LAD",
"type": "BODYPART"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
She was subsequently referred for surgical revascularization. | [
{
"id": "7874",
"offsets": [
21,
29
],
"role": "",
"semantic_type_id": "",
"text": "referred",
"type": "EVENT"
},
{
"id": "7889",
"offsets": [
43,
60
],
"role": "",
"semantic_type_id": "",
"text": "revascularization",
"type": "EVENT"
},
{
"id": "9024",
"offsets": [
0,
3
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "She",
"type": "ACTOR"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. | [
{
"id": "7904",
"offsets": [
9,
20
],
"role": "",
"semantic_type_id": "",
"text": "examination",
"type": "EVENT"
},
{
"id": "7919",
"offsets": [
24,
33
],
"role": "",
"semantic_type_id": "",
"text": "admission",
"type": "EVENT"
},
{
"id": "7934",
"offsets": [
34,
42
],
"role": "",
"semantic_type_id": "",
"text": "revealed",
"type": "EVENT"
},
{
"id": "7949",
"offsets": [
82,
87
],
"role": "",
"semantic_type_id": "",
"text": "obese",
"type": "EVENT"
},
{
"id": "7964",
"offsets": [
105,
110
],
"role": "",
"semantic_type_id": "",
"text": "index",
"type": "EVENT"
},
{
"id": "8815",
"offsets": [
82,
87
],
"role": "",
"semantic_type_id": "C0028754",
"text": "obese",
"type": "CLINENTITY"
},
{
"id": "9031",
"offsets": [
43,
62
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "a middle aged woman",
"type": "ACTOR"
},
{
"id": "9073",
"offsets": [
114,
122
],
"role": "",
"semantic_type_id": "",
"text": "32kg/m 2",
"type": "RML"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
There were no significant physical findings. | [
{
"id": "7979",
"offsets": [
35,
43
],
"role": "",
"semantic_type_id": "",
"text": "findings",
"type": "EVENT"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. | [
{
"id": "7994",
"offsets": [
16,
23
],
"role": "",
"semantic_type_id": "",
"text": "factors",
"type": "EVENT"
},
{
"id": "8009",
"offsets": [
42,
54
],
"role": "",
"semantic_type_id": "",
"text": "claudication",
"type": "EVENT"
},
{
"id": "8024",
"offsets": [
71,
76
],
"role": "",
"semantic_type_id": "",
"text": "Index",
"type": "EVENT"
},
{
"id": "8039",
"offsets": [
118,
124
],
"role": "",
"semantic_type_id": "",
"text": "bruits",
"type": "EVENT"
},
{
"id": "8054",
"offsets": [
144,
152
],
"role": "",
"semantic_type_id": "",
"text": "diabetes",
"type": "EVENT"
},
{
"id": "8069",
"offsets": [
166,
180
],
"role": "",
"semantic_type_id": "",
"text": "hyperlipidemia",
"type": "EVENT"
},
{
"id": "8822",
"offsets": [
29,
54
],
"role": "",
"semantic_type_id": "C0021775",
"text": "intermittent claudication",
"type": "CLINENTITY"
},
{
"id": "8829",
"offsets": [
100,
124
],
"role": "",
"semantic_type_id": "C0694544",
"text": "bilateral carotid bruits",
"type": "CLINENTITY"
},
{
"id": "8836",
"offsets": [
144,
161
],
"role": "",
"semantic_type_id": "C0011849",
"text": "diabetes mellitus",
"type": "CLINENTITY"
},
{
"id": "8843",
"offsets": [
166,
180
],
"role": "",
"semantic_type_id": "C0020473",
"text": "hyperlipidemia",
"type": "CLINENTITY"
},
{
"id": "9079",
"offsets": [
93,
97
],
"role": "",
"semantic_type_id": "",
"text": "0.57",
"type": "RML"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
Her calculated euroscore was 6. | [
{
"id": "8084",
"offsets": [
15,
24
],
"role": "",
"semantic_type_id": "",
"text": "euroscore",
"type": "EVENT"
},
{
"id": "9085",
"offsets": [
29,
30
],
"role": "",
"semantic_type_id": "",
"text": "6",
"type": "RML"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. | [
{
"id": "8099",
"offsets": [
0,
11
],
"role": "",
"semantic_type_id": "",
"text": "Medications",
"type": "EVENT"
},
{
"id": "8114",
"offsets": [
15,
24
],
"role": "",
"semantic_type_id": "",
"text": "admission",
"type": "EVENT"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. | [
{
"id": "8129",
"offsets": [
0,
14
],
"role": "",
"semantic_type_id": "",
"text": "Investigations",
"type": "EVENT"
},
{
"id": "8144",
"offsets": [
43,
57
],
"role": "",
"semantic_type_id": "",
"text": "echocardiogram",
"type": "EVENT"
},
{
"id": "8159",
"offsets": [
64,
70
],
"role": "",
"semantic_type_id": "",
"text": "showed",
"type": "EVENT"
},
{
"id": "8174",
"offsets": [
102,
110
],
"role": "",
"semantic_type_id": "",
"text": "fraction",
"type": "EVENT"
},
{
"id": "8189",
"offsets": [
119,
127
],
"role": "",
"semantic_type_id": "",
"text": "evidence",
"type": "EVENT"
},
{
"id": "8204",
"offsets": [
143,
154
],
"role": "",
"semantic_type_id": "",
"text": "dysfunction",
"type": "EVENT"
},
{
"id": "8850",
"offsets": [
131,
154
],
"role": "",
"semantic_type_id": "C0242973",
"text": "ventricular dysfunction",
"type": "CLINENTITY"
},
{
"id": "9091",
"offsets": [
71,
75
],
"role": "",
"semantic_type_id": "",
"text": "good",
"type": "RML"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. | [
{
"id": "8219",
"offsets": [
6,
15
],
"role": "",
"semantic_type_id": "",
"text": "radiogram",
"type": "EVENT"
},
{
"id": "8234",
"offsets": [
25,
42
],
"role": "",
"semantic_type_id": "",
"text": "electrocardiogram",
"type": "EVENT"
},
{
"id": "8249",
"offsets": [
66,
71
],
"role": "",
"semantic_type_id": "",
"text": "tests",
"type": "EVENT"
},
{
"id": "8929",
"offsets": [
0,
5
],
"role": "",
"semantic_type_id": "",
"text": "Chest",
"type": "BODYPART"
},
{
"id": "9097",
"offsets": [
77,
83
],
"role": "",
"semantic_type_id": "",
"text": "normal",
"type": "RML"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
All blood parameters were within acceptable limits. | [
{
"id": "8264",
"offsets": [
10,
20
],
"role": "",
"semantic_type_id": "",
"text": "parameters",
"type": "EVENT"
},
{
"id": "8935",
"offsets": [
4,
9
],
"role": "",
"semantic_type_id": "",
"text": "blood",
"type": "BODYPART"
},
{
"id": "9103",
"offsets": [
33,
43
],
"role": "",
"semantic_type_id": "",
"text": "acceptable",
"type": "RML"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. | [
{
"id": "8279",
"offsets": [
10,
16
],
"role": "",
"semantic_type_id": "",
"text": "review",
"type": "EVENT"
},
{
"id": "8294",
"offsets": [
51,
60
],
"role": "",
"semantic_type_id": "",
"text": "scheduled",
"type": "EVENT"
},
{
"id": "8309",
"offsets": [
79,
87
],
"role": "",
"semantic_type_id": "",
"text": "grafting",
"type": "EVENT"
},
{
"id": "8324",
"offsets": [
114,
123
],
"role": "",
"semantic_type_id": "",
"text": "procedure",
"type": "EVENT"
},
{
"id": "8941",
"offsets": [
91,
98
],
"role": "",
"semantic_type_id": "",
"text": "the LAD",
"type": "BODYPART"
},
{
"id": "9038",
"offsets": [
43,
46
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "she",
"type": "ACTOR"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
Surgery was performed in November 2011. | [
{
"id": "8339",
"offsets": [
0,
7
],
"role": "",
"semantic_type_id": "",
"text": "Surgery",
"type": "EVENT"
},
{
"id": "9145",
"offsets": [
25,
38
],
"role": "",
"semantic_type_id": "",
"text": "November 2011",
"type": "TIMEX3"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
The cardiopulmonary bypass circuit was not primed. | [
{
"id": "8354",
"offsets": [
43,
49
],
"role": "",
"semantic_type_id": "",
"text": "primed",
"type": "EVENT"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. | [
{
"id": "8369",
"offsets": [
17,
27
],
"role": "",
"semantic_type_id": "",
"text": "sternotomy",
"type": "EVENT"
},
{
"id": "8384",
"offsets": [
32,
42
],
"role": "",
"semantic_type_id": "",
"text": "harvesting",
"type": "EVENT"
},
{
"id": "8399",
"offsets": [
140,
144
],
"role": "",
"semantic_type_id": "",
"text": "used",
"type": "EVENT"
},
{
"id": "8414",
"offsets": [
148,
158
],
"role": "",
"semantic_type_id": "",
"text": "immobilize",
"type": "EVENT"
},
{
"id": "8429",
"offsets": [
201,
214
],
"role": "",
"semantic_type_id": "",
"text": "visualization",
"type": "EVENT"
},
{
"id": "8947",
"offsets": [
46,
78
],
"role": "",
"semantic_type_id": "",
"text": "the Left Internal Mammary Artery",
"type": "BODYPART"
},
{
"id": "8953",
"offsets": [
80,
84
],
"role": "",
"semantic_type_id": "",
"text": "LIMA",
"type": "BODYPART"
},
{
"id": "8959",
"offsets": [
159,
190
],
"role": "",
"semantic_type_id": "",
"text": "the anterior myocardial surface",
"type": "BODYPART"
},
{
"id": "8965",
"offsets": [
218,
225
],
"role": "",
"semantic_type_id": "",
"text": "the LAD",
"type": "BODYPART"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. | [
{
"id": "8444",
"offsets": [
37,
44
],
"role": "",
"semantic_type_id": "",
"text": "snugged",
"type": "EVENT"
},
{
"id": "8459",
"offsets": [
63,
74
],
"role": "",
"semantic_type_id": "",
"text": "arteriotomy",
"type": "EVENT"
},
{
"id": "8971",
"offsets": [
0,
7
],
"role": "",
"semantic_type_id": "",
"text": "The LAD",
"type": "BODYPART"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. | [
{
"id": "8474",
"offsets": [
4,
15
],
"role": "",
"semantic_type_id": "",
"text": "arteriotomy",
"type": "EVENT"
},
{
"id": "8489",
"offsets": [
30,
39
],
"role": "",
"semantic_type_id": "",
"text": "bloodless",
"type": "EVENT"
},
{
"id": "8504",
"offsets": [
49,
61
],
"role": "",
"semantic_type_id": "",
"text": "insufflation",
"type": "EVENT"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
The LIMA to LAD anastomosis was performed with 6-0 prolene suture. | [
{
"id": "8519",
"offsets": [
16,
27
],
"role": "",
"semantic_type_id": "",
"text": "anastomosis",
"type": "EVENT"
},
{
"id": "8977",
"offsets": [
4,
8
],
"role": "",
"semantic_type_id": "",
"text": "LIMA",
"type": "BODYPART"
},
{
"id": "8983",
"offsets": [
12,
15
],
"role": "",
"semantic_type_id": "",
"text": "LAD",
"type": "BODYPART"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. | [
{
"id": "8534",
"offsets": [
4,
13
],
"role": "",
"semantic_type_id": "",
"text": "procedure",
"type": "EVENT"
},
{
"id": "8549",
"offsets": [
18,
28
],
"role": "",
"semantic_type_id": "",
"text": "uneventful",
"type": "EVENT"
},
{
"id": "8564",
"offsets": [
49,
60
],
"role": "",
"semantic_type_id": "",
"text": "transferred",
"type": "EVENT"
},
{
"id": "8579",
"offsets": [
109,
116
],
"role": "",
"semantic_type_id": "",
"text": "support",
"type": "EVENT"
},
{
"id": "9045",
"offsets": [
33,
44
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "the patient",
"type": "ACTOR"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. | [
{
"id": "8594",
"offsets": [
8,
14
],
"role": "",
"semantic_type_id": "",
"text": "weaned",
"type": "EVENT"
},
{
"id": "8609",
"offsets": [
62,
69
],
"role": "",
"semantic_type_id": "",
"text": "support",
"type": "EVENT"
},
{
"id": "8624",
"offsets": [
74,
86
],
"role": "",
"semantic_type_id": "",
"text": "discontinued",
"type": "EVENT"
},
{
"id": "9052",
"offsets": [
0,
3
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "She",
"type": "ACTOR"
},
{
"id": "9154",
"offsets": [
40,
47
],
"role": "",
"semantic_type_id": "",
"text": "4 hours",
"type": "TIMEX3"
},
{
"id": "9163",
"offsets": [
93,
101
],
"role": "",
"semantic_type_id": "",
"text": "24 hours",
"type": "TIMEX3"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
Postoperative recovery was delayed by the need to achieve glycaecmic control. | [
{
"id": "8639",
"offsets": [
14,
22
],
"role": "",
"semantic_type_id": "",
"text": "recovery",
"type": "EVENT"
},
{
"id": "8654",
"offsets": [
27,
34
],
"role": "",
"semantic_type_id": "",
"text": "delayed",
"type": "EVENT"
},
{
"id": "8669",
"offsets": [
50,
57
],
"role": "",
"semantic_type_id": "",
"text": "achieve",
"type": "EVENT"
},
{
"id": "8684",
"offsets": [
69,
76
],
"role": "",
"semantic_type_id": "",
"text": "control",
"type": "EVENT"
},
{
"id": "9172",
"offsets": [
0,
13
],
"role": "",
"semantic_type_id": "",
"text": "Postoperative",
"type": "TIMEX3"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
She was discharged home 2 weeks postoperatively. | [
{
"id": "8699",
"offsets": [
8,
18
],
"role": "",
"semantic_type_id": "",
"text": "discharged",
"type": "EVENT"
},
{
"id": "9059",
"offsets": [
0,
3
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "She",
"type": "ACTOR"
},
{
"id": "9181",
"offsets": [
24,
47
],
"role": "",
"semantic_type_id": "",
"text": "2 weeks postoperatively",
"type": "TIMEX3"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
She has been reviewed in clinic and remains free of angina. | [
{
"id": "8714",
"offsets": [
13,
21
],
"role": "",
"semantic_type_id": "",
"text": "reviewed",
"type": "EVENT"
},
{
"id": "8729",
"offsets": [
44,
48
],
"role": "",
"semantic_type_id": "",
"text": "free",
"type": "EVENT"
},
{
"id": "8744",
"offsets": [
52,
58
],
"role": "",
"semantic_type_id": "",
"text": "angina",
"type": "EVENT"
},
{
"id": "9066",
"offsets": [
0,
3
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "She",
"type": "ACTOR"
}
] | The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos. She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy. Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx). The Right Coronary Artery was a dominant artery with some minor irregularities. Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done. A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent. The patient was angina-free for one year but represented in July 2010 again with angina class III. Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion. She was controlled on medical therapy. However she presented again in November 2011, this time with unstable angina. An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis. She was subsequently referred for surgical revascularization. Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2. There were no significant physical findings. Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia. Her calculated euroscore was 6. Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate. Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction. Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal. All blood parameters were within acceptable limits. Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure. Surgery was performed in November 2011. The cardiopulmonary bypass circuit was not primed. Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD. The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion. The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister. The LIMA to LAD anastomosis was performed with 6-0 prolene suture. The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support. She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours. Postoperative recovery was delayed by the need to achieve glycaecmic control. She was discharged home 2 weeks postoperatively. She has been reviewed in clinic and remains free of angina.
| EN100024 |
A 65 year-old woman with hypertension and Parkinson's disease presented with sudden onset severe chest pain. | [
{
"id": "1510",
"offsets": [
25,
37
],
"role": "",
"semantic_type_id": "",
"text": "hypertension",
"type": "EVENT"
},
{
"id": "1525",
"offsets": [
54,
61
],
"role": "",
"semantic_type_id": "",
"text": "disease",
"type": "EVENT"
},
{
"id": "1540",
"offsets": [
62,
71
],
"role": "",
"semantic_type_id": "",
"text": "presented",
"type": "EVENT"
},
{
"id": "1555",
"offsets": [
103,
107
],
"role": "",
"semantic_type_id": "",
"text": "pain",
"type": "EVENT"
},
{
"id": "1802",
"offsets": [
42,
61
],
"role": "",
"semantic_type_id": "C0030567",
"text": "Parkinson's disease",
"type": "CLINENTITY"
},
{
"id": "1809",
"offsets": [
97,
107
],
"role": "",
"semantic_type_id": "C0008031",
"text": "chest pain",
"type": "CLINENTITY"
},
{
"id": "1869",
"offsets": [
0,
19
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "A 65 year-old woman",
"type": "ACTOR"
}
] | A 65 year-old woman with hypertension and Parkinson's disease presented with sudden onset severe chest pain. Electrocardiogram showed ischemic ST-segment elevation in inferior and lateral leads. Urgent cardiac catheterization revealed focal dissections in four small caliber coronary arteries in right and left coronary systems including right posterior decending, posterolateral, obtuse marginal and septal arteries. Angiography demonstrated no significant atherosclerotic coronary artery disease. The patient was medically managed with Eptifibatide, Aspirin, Clopidogrel and beta blocker since dissected vessels were not technically suitable for percutaneous coronary intervention. Antiparkinson medications were held as a potential cause of dissection. She responded well to medical management.
| EN108055 |
Electrocardiogram showed ischemic ST-segment elevation in inferior and lateral leads. | [
{
"id": "1570",
"offsets": [
0,
17
],
"role": "",
"semantic_type_id": "",
"text": "Electrocardiogram",
"type": "EVENT"
},
{
"id": "1585",
"offsets": [
18,
24
],
"role": "",
"semantic_type_id": "",
"text": "showed",
"type": "EVENT"
},
{
"id": "1600",
"offsets": [
45,
54
],
"role": "",
"semantic_type_id": "",
"text": "elevation",
"type": "EVENT"
},
{
"id": "1816",
"offsets": [
34,
54
],
"role": "",
"semantic_type_id": "C0520886",
"text": "ST-segment elevation",
"type": "CLINENTITY"
},
{
"id": "1851",
"offsets": [
58,
84
],
"role": "",
"semantic_type_id": "",
"text": "inferior and lateral leads",
"type": "BODYPART"
}
] | A 65 year-old woman with hypertension and Parkinson's disease presented with sudden onset severe chest pain. Electrocardiogram showed ischemic ST-segment elevation in inferior and lateral leads. Urgent cardiac catheterization revealed focal dissections in four small caliber coronary arteries in right and left coronary systems including right posterior decending, posterolateral, obtuse marginal and septal arteries. Angiography demonstrated no significant atherosclerotic coronary artery disease. The patient was medically managed with Eptifibatide, Aspirin, Clopidogrel and beta blocker since dissected vessels were not technically suitable for percutaneous coronary intervention. Antiparkinson medications were held as a potential cause of dissection. She responded well to medical management.
| EN108055 |
Urgent cardiac catheterization revealed focal dissections in four small caliber coronary arteries in right and left coronary systems including right posterior decending, posterolateral, obtuse marginal and septal arteries. | [
{
"id": "1615",
"offsets": [
15,
30
],
"role": "",
"semantic_type_id": "",
"text": "catheterization",
"type": "EVENT"
},
{
"id": "1630",
"offsets": [
31,
39
],
"role": "",
"semantic_type_id": "",
"text": "revealed",
"type": "EVENT"
},
{
"id": "1645",
"offsets": [
46,
57
],
"role": "",
"semantic_type_id": "",
"text": "dissections",
"type": "EVENT"
},
{
"id": "1823",
"offsets": [
40,
57
],
"role": "",
"semantic_type_id": "",
"text": "focal dissections",
"type": "CLINENTITY"
},
{
"id": "1857",
"offsets": [
61,
132
],
"role": "",
"semantic_type_id": "",
"text": "four small caliber coronary arteries in right and left coronary systems",
"type": "BODYPART"
},
{
"id": "1863",
"offsets": [
143,
221
],
"role": "",
"semantic_type_id": "",
"text": "right posterior decending, posterolateral, obtuse marginal and septal arteries",
"type": "BODYPART"
}
] | A 65 year-old woman with hypertension and Parkinson's disease presented with sudden onset severe chest pain. Electrocardiogram showed ischemic ST-segment elevation in inferior and lateral leads. Urgent cardiac catheterization revealed focal dissections in four small caliber coronary arteries in right and left coronary systems including right posterior decending, posterolateral, obtuse marginal and septal arteries. Angiography demonstrated no significant atherosclerotic coronary artery disease. The patient was medically managed with Eptifibatide, Aspirin, Clopidogrel and beta blocker since dissected vessels were not technically suitable for percutaneous coronary intervention. Antiparkinson medications were held as a potential cause of dissection. She responded well to medical management.
| EN108055 |
Angiography demonstrated no significant atherosclerotic coronary artery disease. | [
{
"id": "1660",
"offsets": [
0,
11
],
"role": "",
"semantic_type_id": "",
"text": "Angiography",
"type": "EVENT"
},
{
"id": "1675",
"offsets": [
12,
24
],
"role": "",
"semantic_type_id": "",
"text": "demonstrated",
"type": "EVENT"
},
{
"id": "1690",
"offsets": [
72,
79
],
"role": "",
"semantic_type_id": "",
"text": "disease",
"type": "EVENT"
},
{
"id": "1830",
"offsets": [
25,
79
],
"role": "",
"semantic_type_id": "",
"text": "no significant atherosclerotic coronary artery disease",
"type": "CLINENTITY"
}
] | A 65 year-old woman with hypertension and Parkinson's disease presented with sudden onset severe chest pain. Electrocardiogram showed ischemic ST-segment elevation in inferior and lateral leads. Urgent cardiac catheterization revealed focal dissections in four small caliber coronary arteries in right and left coronary systems including right posterior decending, posterolateral, obtuse marginal and septal arteries. Angiography demonstrated no significant atherosclerotic coronary artery disease. The patient was medically managed with Eptifibatide, Aspirin, Clopidogrel and beta blocker since dissected vessels were not technically suitable for percutaneous coronary intervention. Antiparkinson medications were held as a potential cause of dissection. She responded well to medical management.
| EN108055 |
The patient was medically managed with Eptifibatide, Aspirin, Clopidogrel and beta blocker since dissected vessels were not technically suitable for percutaneous coronary intervention. | [
{
"id": "1705",
"offsets": [
26,
33
],
"role": "",
"semantic_type_id": "",
"text": "managed",
"type": "EVENT"
},
{
"id": "1837",
"offsets": [
97,
114
],
"role": "",
"semantic_type_id": "",
"text": "dissected vessels",
"type": "CLINENTITY"
},
{
"id": "1876",
"offsets": [
0,
11
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "The patient",
"type": "ACTOR"
}
] | A 65 year-old woman with hypertension and Parkinson's disease presented with sudden onset severe chest pain. Electrocardiogram showed ischemic ST-segment elevation in inferior and lateral leads. Urgent cardiac catheterization revealed focal dissections in four small caliber coronary arteries in right and left coronary systems including right posterior decending, posterolateral, obtuse marginal and septal arteries. Angiography demonstrated no significant atherosclerotic coronary artery disease. The patient was medically managed with Eptifibatide, Aspirin, Clopidogrel and beta blocker since dissected vessels were not technically suitable for percutaneous coronary intervention. Antiparkinson medications were held as a potential cause of dissection. She responded well to medical management.
| EN108055 |
Antiparkinson medications were held as a potential cause of dissection. | [
{
"id": "1720",
"offsets": [
14,
25
],
"role": "",
"semantic_type_id": "",
"text": "medications",
"type": "EVENT"
},
{
"id": "1735",
"offsets": [
31,
35
],
"role": "",
"semantic_type_id": "",
"text": "held",
"type": "EVENT"
},
{
"id": "1750",
"offsets": [
60,
70
],
"role": "",
"semantic_type_id": "",
"text": "dissection",
"type": "EVENT"
},
{
"id": "1844",
"offsets": [
60,
70
],
"role": "",
"semantic_type_id": "",
"text": "dissection",
"type": "CLINENTITY"
}
] | A 65 year-old woman with hypertension and Parkinson's disease presented with sudden onset severe chest pain. Electrocardiogram showed ischemic ST-segment elevation in inferior and lateral leads. Urgent cardiac catheterization revealed focal dissections in four small caliber coronary arteries in right and left coronary systems including right posterior decending, posterolateral, obtuse marginal and septal arteries. Angiography demonstrated no significant atherosclerotic coronary artery disease. The patient was medically managed with Eptifibatide, Aspirin, Clopidogrel and beta blocker since dissected vessels were not technically suitable for percutaneous coronary intervention. Antiparkinson medications were held as a potential cause of dissection. She responded well to medical management.
| EN108055 |
She responded well to medical management. | [
{
"id": "1765",
"offsets": [
4,
13
],
"role": "",
"semantic_type_id": "",
"text": "responded",
"type": "EVENT"
},
{
"id": "1780",
"offsets": [
30,
40
],
"role": "",
"semantic_type_id": "",
"text": "management",
"type": "EVENT"
},
{
"id": "1883",
"offsets": [
0,
3
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "She",
"type": "ACTOR"
}
] | A 65 year-old woman with hypertension and Parkinson's disease presented with sudden onset severe chest pain. Electrocardiogram showed ischemic ST-segment elevation in inferior and lateral leads. Urgent cardiac catheterization revealed focal dissections in four small caliber coronary arteries in right and left coronary systems including right posterior decending, posterolateral, obtuse marginal and septal arteries. Angiography demonstrated no significant atherosclerotic coronary artery disease. The patient was medically managed with Eptifibatide, Aspirin, Clopidogrel and beta blocker since dissected vessels were not technically suitable for percutaneous coronary intervention. Antiparkinson medications were held as a potential cause of dissection. She responded well to medical management.
| EN108055 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. | [
{
"id": "6062",
"offsets": [
24,
33
],
"role": "",
"semantic_type_id": "",
"text": "presented",
"type": "EVENT"
},
{
"id": "6077",
"offsets": [
133,
139
],
"role": "",
"semantic_type_id": "",
"text": "squint",
"type": "EVENT"
},
{
"id": "6092",
"offsets": [
149,
155
],
"role": "",
"semantic_type_id": "",
"text": "vision",
"type": "EVENT"
},
{
"id": "7224",
"offsets": [
144,
155
],
"role": "",
"semantic_type_id": "C3665347",
"text": "poor vision",
"type": "CLINENTITY"
},
{
"id": "7329",
"offsets": [
52,
55
],
"role": "",
"semantic_type_id": "",
"text": "eye",
"type": "BODYPART"
},
{
"id": "7449",
"offsets": [
0,
23
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "An eleven year old girl",
"type": "ACTOR"
}
] | An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
| EN100184 |
Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. | [
{
"id": "6107",
"offsets": [
15,
22
],
"role": "",
"semantic_type_id": "",
"text": "noticed",
"type": "EVENT"
},
{
"id": "6122",
"offsets": [
25,
37
],
"role": "",
"semantic_type_id": "",
"text": "misalignment",
"type": "EVENT"
},
{
"id": "6137",
"offsets": [
98,
109
],
"role": "",
"semantic_type_id": "",
"text": "complaining",
"type": "EVENT"
},
{
"id": "6152",
"offsets": [
130,
136
],
"role": "",
"semantic_type_id": "",
"text": "vision",
"type": "EVENT"
},
{
"id": "7231",
"offsets": [
116,
136
],
"role": "",
"semantic_type_id": "C0042798",
"text": "poor distance vision",
"type": "CLINENTITY"
},
{
"id": "7335",
"offsets": [
41,
49
],
"role": "",
"semantic_type_id": "",
"text": "the eyes",
"type": "BODYPART"
},
{
"id": "7456",
"offsets": [
0,
10
],
"role": "OTHER",
"semantic_type_id": "",
"text": "Her mother",
"type": "ACTOR"
},
{
"id": "7463",
"offsets": [
77,
88
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "the patient",
"type": "ACTOR"
},
{
"id": "7555",
"offsets": [
50,
72
],
"role": "",
"semantic_type_id": "",
"text": "three years previously",
"type": "TIMEX3"
},
{
"id": "7564",
"offsets": [
147,
153
],
"role": "",
"semantic_type_id": "",
"text": "a year",
"type": "TIMEX3"
}
] | An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
| EN100184 |
There was no history of antecedent trauma to the head or face. | [
{
"id": "6167",
"offsets": [
35,
41
],
"role": "",
"semantic_type_id": "",
"text": "trauma",
"type": "EVENT"
},
{
"id": "7341",
"offsets": [
45,
53
],
"role": "",
"semantic_type_id": "",
"text": "the head",
"type": "BODYPART"
},
{
"id": "7347",
"offsets": [
57,
61
],
"role": "",
"semantic_type_id": "",
"text": "face",
"type": "BODYPART"
}
] | An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
| EN100184 |
There was no history of double vision (diplopia) or pains on ocular movements. | [
{
"id": "6182",
"offsets": [
31,
37
],
"role": "",
"semantic_type_id": "",
"text": "vision",
"type": "EVENT"
},
{
"id": "6197",
"offsets": [
39,
47
],
"role": "",
"semantic_type_id": "",
"text": "diplopia",
"type": "EVENT"
},
{
"id": "6212",
"offsets": [
52,
57
],
"role": "",
"semantic_type_id": "",
"text": "pains",
"type": "EVENT"
},
{
"id": "7238",
"offsets": [
24,
37
],
"role": "",
"semantic_type_id": "C0012569",
"text": "double vision",
"type": "CLINENTITY"
},
{
"id": "7245",
"offsets": [
39,
47
],
"role": "",
"semantic_type_id": "C0012569",
"text": "diplopia",
"type": "CLINENTITY"
}
] | An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
| EN100184 |
There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. | [
{
"id": "6227",
"offsets": [
24,
32
],
"role": "",
"semantic_type_id": "",
"text": "headache",
"type": "EVENT"
},
{
"id": "6242",
"offsets": [
34,
39
],
"role": "",
"semantic_type_id": "",
"text": "fever",
"type": "EVENT"
},
{
"id": "6257",
"offsets": [
41,
49
],
"role": "",
"semantic_type_id": "",
"text": "vomiting",
"type": "EVENT"
},
{
"id": "6272",
"offsets": [
57,
62
],
"role": "",
"semantic_type_id": "",
"text": "pains",
"type": "EVENT"
},
{
"id": "6287",
"offsets": [
71,
77
],
"role": "",
"semantic_type_id": "",
"text": "rashes",
"type": "EVENT"
},
{
"id": "6302",
"offsets": [
78,
85
],
"role": "",
"semantic_type_id": "",
"text": "lesions",
"type": "EVENT"
},
{
"id": "7252",
"offsets": [
24,
32
],
"role": "",
"semantic_type_id": "C0018681",
"text": "headache",
"type": "CLINENTITY"
},
{
"id": "7259",
"offsets": [
34,
39
],
"role": "",
"semantic_type_id": "C0015967",
"text": "fever",
"type": "CLINENTITY"
},
{
"id": "7266",
"offsets": [
41,
49
],
"role": "",
"semantic_type_id": "C0042963",
"text": "vomiting",
"type": "CLINENTITY"
},
{
"id": "7273",
"offsets": [
66,
85
],
"role": "",
"semantic_type_id": "C0037284",
"text": "skin rashes/lesions",
"type": "CLINENTITY"
},
{
"id": "7280",
"offsets": [
66,
77
],
"role": "",
"semantic_type_id": "C0015230",
"text": "skin rashes",
"type": "CLINENTITY"
},
{
"id": "7353",
"offsets": [
66,
70
],
"role": "",
"semantic_type_id": "",
"text": "skin",
"type": "BODYPART"
}
] | An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
| EN100184 |
The review of systems was essentially normal and she had enjoyed good health since early childhood. | [
{
"id": "6317",
"offsets": [
4,
10
],
"role": "",
"semantic_type_id": "",
"text": "review",
"type": "EVENT"
},
{
"id": "6332",
"offsets": [
70,
76
],
"role": "",
"semantic_type_id": "",
"text": "health",
"type": "EVENT"
},
{
"id": "7470",
"offsets": [
49,
52
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "she",
"type": "ACTOR"
},
{
"id": "7519",
"offsets": [
38,
44
],
"role": "",
"semantic_type_id": "",
"text": "normal",
"type": "RML"
}
] | An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
| EN100184 |
Her pregnancy and delivery were uneventful; and her development was normal. | [
{
"id": "6347",
"offsets": [
4,
13
],
"role": "",
"semantic_type_id": "",
"text": "pregnancy",
"type": "EVENT"
},
{
"id": "6362",
"offsets": [
18,
26
],
"role": "",
"semantic_type_id": "",
"text": "delivery",
"type": "EVENT"
},
{
"id": "6377",
"offsets": [
32,
42
],
"role": "",
"semantic_type_id": "",
"text": "uneventful",
"type": "EVENT"
},
{
"id": "6392",
"offsets": [
52,
63
],
"role": "",
"semantic_type_id": "",
"text": "development",
"type": "EVENT"
},
{
"id": "6407",
"offsets": [
68,
74
],
"role": "",
"semantic_type_id": "",
"text": "normal",
"type": "EVENT"
}
] | An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
| EN100184 |
All other family members were well and there was no family history of squint. | [
{
"id": "6422",
"offsets": [
30,
34
],
"role": "",
"semantic_type_id": "",
"text": "well",
"type": "EVENT"
},
{
"id": "6437",
"offsets": [
59,
66
],
"role": "",
"semantic_type_id": "",
"text": "history",
"type": "EVENT"
},
{
"id": "7287",
"offsets": [
70,
76
],
"role": "",
"semantic_type_id": "C0038379",
"text": "squint",
"type": "CLINENTITY"
},
{
"id": "7477",
"offsets": [
0,
24
],
"role": "OTHER",
"semantic_type_id": "",
"text": "All other family members",
"type": "ACTOR"
}
] | An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
| EN100184 |
Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. | [
{
"id": "6452",
"offsets": [
15,
21
],
"role": "",
"semantic_type_id": "",
"text": "acuity",
"type": "EVENT"
},
{
"id": "6467",
"offsets": [
52,
60
],
"role": "",
"semantic_type_id": "",
"text": "counting",
"type": "EVENT"
},
{
"id": "6482",
"offsets": [
70,
72
],
"role": "",
"semantic_type_id": "",
"text": "CF",
"type": "EVENT"
},
{
"id": "7359",
"offsets": [
34,
47
],
"role": "",
"semantic_type_id": "",
"text": "the right eye",
"type": "BODYPART"
},
{
"id": "7365",
"offsets": [
61,
68
],
"role": "",
"semantic_type_id": "",
"text": "fingers",
"type": "BODYPART"
},
{
"id": "7371",
"offsets": [
77,
89
],
"role": "",
"semantic_type_id": "",
"text": "the left eye",
"type": "BODYPART"
},
{
"id": "7525",
"offsets": [
26,
30
],
"role": "",
"semantic_type_id": "",
"text": "6/24",
"type": "RML"
}
] | An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
| EN100184 |
During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. | [
{
"id": "6497",
"offsets": [
7,
17
],
"role": "",
"semantic_type_id": "",
"text": "refraction",
"type": "EVENT"
},
{
"id": "6512",
"offsets": [
30,
36
],
"role": "",
"semantic_type_id": "",
"text": "acuity",
"type": "EVENT"
},
{
"id": "6527",
"offsets": [
37,
45
],
"role": "",
"semantic_type_id": "",
"text": "improved",
"type": "EVENT"
},
{
"id": "7377",
"offsets": [
65,
88
],
"role": "",
"semantic_type_id": "",
"text": "the right and left eyes",
"type": "BODYPART"
},
{
"id": "7531",
"offsets": [
49,
52
],
"role": "",
"semantic_type_id": "",
"text": "6/9",
"type": "RML"
},
{
"id": "7537",
"offsets": [
57,
61
],
"role": "",
"semantic_type_id": "",
"text": "6/60",
"type": "RML"
}
] | An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
| EN100184 |
The refractive error was a hypermetropia of +4.50 diopters in each eye. | [
{
"id": "6542",
"offsets": [
15,
20
],
"role": "",
"semantic_type_id": "",
"text": "error",
"type": "EVENT"
},
{
"id": "6557",
"offsets": [
27,
40
],
"role": "",
"semantic_type_id": "",
"text": "hypermetropia",
"type": "EVENT"
},
{
"id": "7294",
"offsets": [
27,
40
],
"role": "",
"semantic_type_id": "C0020490",
"text": "hypermetropia",
"type": "CLINENTITY"
},
{
"id": "7383",
"offsets": [
62,
70
],
"role": "",
"semantic_type_id": "",
"text": "each eye",
"type": "BODYPART"
},
{
"id": "7543",
"offsets": [
44,
58
],
"role": "",
"semantic_type_id": "",
"text": "+4.50 diopters",
"type": "RML"
}
] | An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
| EN100184 |
Examination revealed normal anterior and posterior segments bilaterally. | [
{
"id": "6572",
"offsets": [
0,
11
],
"role": "",
"semantic_type_id": "",
"text": "Examination",
"type": "EVENT"
},
{
"id": "6587",
"offsets": [
12,
20
],
"role": "",
"semantic_type_id": "",
"text": "revealed",
"type": "EVENT"
},
{
"id": "7389",
"offsets": [
21,
59
],
"role": "",
"semantic_type_id": "",
"text": "normal anterior and posterior segments",
"type": "BODYPART"
}
] | An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
| EN100184 |
There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. | [
{
"id": "6602",
"offsets": [
42,
52
],
"role": "",
"semantic_type_id": "",
"text": "hypotropia",
"type": "EVENT"
},
{
"id": "6617",
"offsets": [
144,
151
],
"role": "",
"semantic_type_id": "",
"text": "posture",
"type": "EVENT"
},
{
"id": "7301",
"offsets": [
42,
52
],
"role": "",
"semantic_type_id": "C0152208",
"text": "hypotropia",
"type": "CLINENTITY"
},
{
"id": "7395",
"offsets": [
139,
143
],
"role": "",
"semantic_type_id": "",
"text": "head",
"type": "BODYPART"
},
{
"id": "7484",
"offsets": [
110,
113
],
"role": "PATIENT",
"semantic_type_id": "",
"text": "she",
"type": "ACTOR"
}
] | An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
| EN100184 |
Her palpebral fissures were normal and equal on both sides in the primary position of gaze. | [
{
"id": "6632",
"offsets": [
28,
34
],
"role": "",
"semantic_type_id": "",
"text": "normal",
"type": "EVENT"
},
{
"id": "6647",
"offsets": [
39,
44
],
"role": "",
"semantic_type_id": "",
"text": "equal",
"type": "EVENT"
},
{
"id": "6662",
"offsets": [
74,
82
],
"role": "",
"semantic_type_id": "",
"text": "position",
"type": "EVENT"
},
{
"id": "7401",
"offsets": [
0,
22
],
"role": "",
"semantic_type_id": "",
"text": "Her palpebral fissures",
"type": "BODYPART"
}
] | An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
| EN100184 |
Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. | [
{
"id": "6677",
"offsets": [
0,
11
],
"role": "",
"semantic_type_id": "",
"text": "Examination",
"type": "EVENT"
},
{
"id": "6692",
"offsets": [
35,
43
],
"role": "",
"semantic_type_id": "",
"text": "elicited",
"type": "EVENT"
},
{
"id": "6707",
"offsets": [
51,
61
],
"role": "",
"semantic_type_id": "",
"text": "limitation",
"type": "EVENT"
},
{
"id": "6722",
"offsets": [
96,
103
],
"role": "",
"semantic_type_id": "",
"text": "looking",
"type": "EVENT"
},
{
"id": "6737",
"offsets": [
124,
133
],
"role": "",
"semantic_type_id": "",
"text": "elevation",
"type": "EVENT"
},
{
"id": "6752",
"offsets": [
161,
165
],
"role": "",
"semantic_type_id": "",
"text": "full",
"type": "EVENT"
},
{
"id": "7407",
"offsets": [
78,
90
],
"role": "",
"semantic_type_id": "",
"text": "the left eye",
"type": "BODYPART"
},
{
"id": "7413",
"offsets": [
137,
149
],
"role": "",
"semantic_type_id": "",
"text": "the same eye",
"type": "BODYPART"
}
] | An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
| EN100184 |
The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. | [
{
"id": "6767",
"offsets": [
4,
13
],
"role": "",
"semantic_type_id": "",
"text": "movements",
"type": "EVENT"
},
{
"id": "6782",
"offsets": [
36,
42
],
"role": "",
"semantic_type_id": "",
"text": "normal",
"type": "EVENT"
},
{
"id": "6797",
"offsets": [
73,
80
],
"role": "",
"semantic_type_id": "",
"text": "changes",
"type": "EVENT"
},
{
"id": "6812",
"offsets": [
131,
140
],
"role": "",
"semantic_type_id": "",
"text": "movements",
"type": "EVENT"
},
{
"id": "7419",
"offsets": [
17,
30
],
"role": "",
"semantic_type_id": "",
"text": "the right eye",
"type": "BODYPART"
},
{
"id": "7425",
"offsets": [
84,
119
],
"role": "",
"semantic_type_id": "",
"text": "the palpebral fissures of both eyes",
"type": "BODYPART"
},
{
"id": "7431",
"offsets": [
127,
130
],
"role": "",
"semantic_type_id": "",
"text": "eye",
"type": "BODYPART"
}
] | An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
| EN100184 |
Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. | [
{
"id": "6827",
"offsets": [
15,
19
],
"role": "",
"semantic_type_id": "",
"text": "test",
"type": "EVENT"
},
{
"id": "6842",
"offsets": [
37,
45
],
"role": "",
"semantic_type_id": "",
"text": "sedation",
"type": "EVENT"
},
{
"id": "6857",
"offsets": [
64,
72
],
"role": "",
"semantic_type_id": "",
"text": "revealed",
"type": "EVENT"
},
{
"id": "6872",
"offsets": [
80,
91
],
"role": "",
"semantic_type_id": "",
"text": "restriction",
"type": "EVENT"
},
{
"id": "7437",
"offsets": [
116,
128
],
"role": "",
"semantic_type_id": "",
"text": "the left eye",
"type": "BODYPART"
},
{
"id": "7549",
"offsets": [
51,
59
],
"role": "",
"semantic_type_id": "",
"text": "positive",
"type": "RML"
}
] | An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
| EN100184 |
Her systemic examination was completely normal. | [
{
"id": "6887",
"offsets": [
13,
24
],
"role": "",
"semantic_type_id": "",
"text": "examination",
"type": "EVENT"
},
{
"id": "6902",
"offsets": [
40,
46
],
"role": "",
"semantic_type_id": "",
"text": "normal",
"type": "EVENT"
}
] | An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
| EN100184 |
A diagnosis of congenital left Brown syndrome with severe amblyopia was made. | [
{
"id": "6917",
"offsets": [
37,
45
],
"role": "",
"semantic_type_id": "",
"text": "syndrome",
"type": "EVENT"
},
{
"id": "7308",
"offsets": [
15,
45
],
"role": "",
"semantic_type_id": "C3805227",
"text": "congenital left Brown syndrome",
"type": "CLINENTITY"
},
{
"id": "7315",
"offsets": [
58,
67
],
"role": "",
"semantic_type_id": "C0002418",
"text": "amblyopia",
"type": "CLINENTITY"
}
] | An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
| EN100184 |
Subsets and Splits