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Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy . | [
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"text": "lymphadenopathy",
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The patient was taken for surgical exploration and staging for ovarian malignancy . | [
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"text": "ovarian malignancy",
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] |
At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon . | [
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The right ovary was enlarged to about 10 cm diameter . | [] |
The left fallopian tube and ovary could not be distinguished and separated from the tumour . | [
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The rest of the abdominal organs and omentum looked grossly normal . | [] |
There was no ascites . | [
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Tumour was friable and was removed by blunt and sharp dissection . | [
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Total abdominal hysterectomy , bilateral adnexectomy and infracolic omentectomy were done . | [] |
The general surgeons were present and they did a sigmoidectomy and a Hartmann ' s procedure . | [] |
She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity . | [
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"text": "intraoperative bleeding",
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We had encountered significant bleeding from the friable tumor . | [
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Patient was sent to the high dependency unit where she recovered postoperatively . | [] |
Histology of the specimens showed a large B cell lymphoma . | [
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"text": "B cell lymphoma",
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A haematologist consulted and peripheral blood film and bone marrow aspirate were done . | [] |
Both results were normal , ruling out abnormal cells in both samples . | [
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"text": "abnormal cells",
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She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide , doxorubicin and vincristine . | [] |
She has also been initiated on highly active antiretroviral therapy . | [] |
A 23 - year-old previously healthy man , presented to the hospital ' s emergency department , with a 3 - day history of high-grade fever up to 40 ° C and upper right abdominal pain . | [
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"text": "upper right abdominal pain",
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The patient ' s past medical history was non-significant . | [] |
He was a student and had not received any medication . | [] |
He had a pet dog and reported no recent travel . | [] |
During physical examination on admission , vital signs were normal and he was febrile with a body temperature of 38 ° C . | [
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"text": "febrile",
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Abdominal examination revealed a tender palpable liver , with no signs of peritoneal irritation . | [
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"text": "peritoneal irritation",
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The remainder of physical examination was unremarkable . | [] |
Abnormal laboratory results on admission included a white blood cell count ( WBC ) of 20 . 830 ( 4-10 . 5 x 10 / L ) , elevated C-reactive protein ( CRP ) level ( 28 mg / dl , normal ≤ 0 . 5 mg / dl ) , slightly elevated alanine aminotransferase ( ALT ) of 56 IU / L ( normal 5-40 IU / L ) , and lactic dehydrogenase ( LDH ) of 255 IU / L ( normal < 225 IU / L ) . | [] |
Alkaline phosphatase ( ALP ) was normal . | [] |
Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable , hypoechoic lesions . | [
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Abdominal computed tomography ( CT ) scan revealed the 2 aforementioned lesions in diameter of 5 . 6 cm at the left liver lobe and 5 . 2 cm in the right lobe . | [
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The lesions were hypodense and presented peripheral enhancement after intravenous contrast , similar to the morphology of hepatic abscesses . | [
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{
"offsets": [
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"text": "hepatic abscesses",
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] |
The patient was admitted for further evaluation and treatment . | [] |
Culture guided antimicrobials and appropriate drainage was our first option . | [] |
Empiric antibiotic therapy with intravenous ciprofloxacin ( 400 mg every 12 hours ) , and metronidazole ( 500 mg every 8 hours ) was initiated . | [] |
All cultures resulted negative . | [] |
Initially , we performed percutaneous sonographic ( U / S ) guided aspiration into the left hepatic abscess cavity . | [] |
A thick , purulent material of 40 cc was drained and sent for culture . | [] |
Microbiology revealed a Gram-negative bacterium that presented slow growth . | [] |
On the 5 th and 8 th days of admission , we performed CT guided catheter drainage of both abscesses . | [
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"text": "abscesses",
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] |
Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted . | [
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{
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"text": "night sweats",
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] |
Ciprofloxacin discontinued and meropenem at a dose of 1 gr every 8 hours administered . | [] |
Thorough screening for other possible sources of infection , resulted negative . | [
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"text": "infection",
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] |
Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation . | [
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"text": "mild mitral regurgitation",
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] |
Entamoeba histolytica Abs , echinococcus Abs , leismania Abs , brucella Abs were negative . | [] |
Gastrointestinal endoscopic evaluation was unrevealing . | [] |
The patient was also HIV negative and no other immunodeficiency conditions were identified . | [
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"text": "HIV negative",
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] |
Eventually , the isolate identified by the Vitek 2 automated system and classified as A . aphrophilus . | [] |
To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry ( MALDI-TOF MS ) . | [
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"text": "strain",
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The sensitivity test was performed with minimal inhibitory concentration ( MIC ) test strips ; the isolate ' s susceptibility was to ceftriaxone ≤ 0 . 125 ( S ) , cefepime ≤ 0 . 5 ( S ) , ciprofloxacin ≤ 0 . 125 ( S ) , gentamycin ≤ 0 . 5 ( S ) , amikacin ≤ 0 . 125 ( S ) and to meropenem ≤ 0 . 032 ( S ) . | [] |
Percutaneous drainage of both abscesses , combined with antimicrobial treatment , was successful and the patient ' s clinical condition improved . | [
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Thankfully , no surgical procedure was required . | [] |
The drains were removed immediately the fluid from the abscess cavities became clear . | [
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"text": "abscess",
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] |
Meropenem was administered for a total of 2 weeks . | [] |
Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital , in full recovery . | [] |
Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities . | [] |
An 80 year-old Caucasian male was diagnosed at an outside institution with Barrett ' s esophagus with high grade dysplasia and presented to our institution for therapy . | [
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The patient underwent endoscopic mucosal resection using a band ligation technique of an area of nodularity within the Barrett esophagus . | [
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Microscopic examination demonstrated extensive Barrett esophagus with high-grade dysplasia as well as a second tumor which was morphologically different from the surrounding high-grade dysplasia and which was positive for S- 100 , HMB 45 and Melan-A on immunohistochemistry , consistent with melanoma . | [
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"text": "Barrett esophagus with high-grade dysplasia",
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"text": "high-grade dysplasia",
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"text": "melanoma",
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Further workup of the patient demonstrated multiple radiologic lesions consistent with metastases . | [
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"text": "metastases",
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Molecular studies demonstrated that the melanoma was positive for the 1799 T > A ( V 600 E ) mutation in the BRAF gene . | [
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The overall features of the tumor were most consistent with metastatic melanoma occurring in a background of Barrett esophagus with high-grade dysplasia . | [
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"offsets": [
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"text": "Barrett esophagus with high-grade dysplasia",
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}
] |
A 22 - year-old woman , without any formerly diagnosed diseases , presented to the emergency department with a 3 day history of dyspnea , fatigue and central chest pain . | [
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She reported increasing dyspnea that developed in the previous month . | [
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She also had intermittent pain in the small joints for several months . | [
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There was no family history of SLE . | [
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"text": "SLE",
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On examination , she had a temperature of 38 . 2 ° C , a heart rate of 115 beats / minute , blood pressure of 90 / 60 mmHg , respiratory rate of 25 breaths / minute , muffled heart sounds and jugular distention . | [
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"text": "jugular distention",
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The electrocardiogram showed sinus tachycardia and low voltage . | [
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The chest radiograph showed an enlargement of the cardiac silhouette with a right-sided pulmonary effusion . | [
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The echocardiography revealed a large circumferential pericardial effusion , with diastolic collapse of the right atrium , dilated inferior vena cava and 30 % respiratory variation of the Doppler mitral valve , confirming the diagnosis of cardiac tamponade . | [
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"text": "diastolic collapse of the right atrium",
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"text": "cardiac tamponade",
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] |
Initial workup showed normochromic normocytic anemia with hemoglobin at 8 . 5 g / dl , CRP : 75 mg / L , renal and liver function tests were normal . | [
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"offsets": [
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"text": "normochromic normocytic anemia",
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] |
Emergency pericardiocentesis was indicated but could not be performed because of the incapability to place the guidewire into the pericardial cavity . | [] |
So , urgent surgical pericardiectomy with window procedure was realized , 1200 of clear fluid was evacuated . | [] |
The pericardial fluid contained 2900 white blood cells / mm , 100 red blood cells / mm , bacteriological culture and cytologic examinations yielded negative results . | [] |
The pericardial biopsy showed features of nonspecific inflammation , malignancy and tuberculosis were ruled out . | [
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"text": "malignancy",
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{
"offsets": [
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"text": "tuberculosis",
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}
] |
Further investigations were accomplished to determine the etiology . | [] |
Immunological workup revealed antinuclear antibodies titer of 1 : 1280 , positive anti-SSA and anti-SM antibodies and hypocomplementemia . | [] |
The coombs test was positive . | [] |
The diagnosis of systemic lupus erythematosus was established based on hemolytic anemia , serositis , arthralgia , positive anti nuclear and anti SM antibodies and low complement . | [
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"text": "hemolytic anemia",
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"text": "serositis",
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"offsets": [
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"text": "arthralgia",
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] |
The patient was started on intravenous therapy with methylprednisolone followed by prednisone 60 mg by mouth daily with hydroxychloroquine . | [] |
She had a good clinical response and control echocardiography showed complete resolution of the pericardial effusion without recurrence . | [
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"text": "pericardial effusion",
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] |
A 14 - year old boy with no significant past medical history presented to a small district hospital in southern Sierra Leone with a 4 day history of facial puffiness , peripheral pitting oedema , abdominal pains , and reduced urine output . | [
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"text": "pitting oedema",
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"text": "abdominal pains",
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},
{
"offsets": [
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"text": "reduced urine output",
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] |
On examination he was afebrile , BP 150 / 110 , heart rate 70 . | [] |
He had significant periorbital and facial oedema , pitting oedema from the feet to the knees , a distended abdomen , ascites , and tender hepatomegaly . | [
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"text": "pitting oedema",
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"text": "distended abdomen",
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"text": "ascites",
"type": "CLINENTITY"
},
{
"offsets": [
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"text": "hepatomegaly",
"type": "CLINENTITY"
}
] |
Lab results showed haemoglobin 10 . 9 g / dl , packed cell volume 35 % , and positive malaria parasites . | [] |
Urea ( 14 mg / dl ) , creatinine ( 1 . 0 mg / dl ) , sodium ( 137 mmol / L ) , and potassium ( 3 . 7 mmol / L ) were normal . | [] |
Urinalysis , using a urine dipstick , revealed three pluses of proteinurea , which equates to ≥ 3 g urinary protein per day . | [] |
Lab facilities for the measurement of serum albumin were not available . | [] |
The diagnosis of nephrotic syndrome was made and the patient was started on a course of prednisolone 60 mg / day , Enalapril 2 . 5 mg daily , anti-malarial treatment , and empirical broad spectrum IV antibiotics to cover bacterial infections , in addition to a salt-restricted diet . | [
{
"offsets": [
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"text": "nephrotic syndrome",
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] |
On day 3 of admission he showed a clinical response to treatment , as the facial oedema , ascites , and BP had reduced . | [
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"text": "facial oedema",
"type": "CLINENTITY"
},
{
"offsets": [
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"text": "ascites",
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}
] |
Urinalysis showed two pluses of proteinurea ( 0 . 5-1 . 0 gram per day per day ) . | [] |
The child complained of a moderate headache , but had no fever , meningism , or focal neurological signs . | [
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"text": "fever",
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"text": "meningism",
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},
{
"offsets": [
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"text": "focal neurological signs",
"type": "CLINENTITY"
}
] |
He was started on oral paracetamol . | [] |
The next morning ( day 4 of admission ) his symptoms evolved : his headache became severe , he had pain behind both eyes , and he was vomiting . | [
{
"offsets": [
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"text": "headache",
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"text": "pain behind both eyes",
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},
{
"offsets": [
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"text": "vomiting",
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}
] |
Examination showed a right VI nerve palsy , diplopia , and tinnitus in the right ear , with some hearing loss . | [
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"text": "diplopia",
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{
"offsets": [
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"text": "tinnitus in the right ear",
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},
{
"offsets": [
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"text": "hearing loss",
"type": "CLINENTITY"
}
] |
He later became drowsy and had a generalised seizure . | [
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},
{
"offsets": [
33,
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"text": "generalised seizure",
"type": "CLINENTITY"
}
] |
Diagnosis and commencement of treatment was delayed due to the absence of CT / MRI brain imaging facilities in the local district . | [] |
In the context of the child ' s nephrotic status and focal neurological signs , we had a high suspicion of cerebral venous thrombosis , and made a presumptive diagnosis . | [
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},
{
"offsets": [
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"text": "cerebral venous thrombosis",
"type": "CLINENTITY"
}
] |
The child was started on high dose subcutaneous unfractionated heparin daily . | [] |
This decision was made cautiously , but it was felt that the advantages surpassed the risks . | [] |
He also received dexamethasone , high flow oxygen , and elevation of the head to 45 degrees , in order to treat features of raised intracranial pressure . | [
{
"offsets": [
124,
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],
"text": "raised intracranial pressure",
"type": "CLINENTITY"
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] |
On day 6 of admission his headache had improved and his focal neurological signs began to resolve . | [
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"offsets": [
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],
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},
{
"offsets": [
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],
"text": "focal neurological signs",
"type": "CLINENTITY"
}
] |
Subsets and Splits