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He still had a partial right VI nerve palsy and a convergent squint . | [
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"text": "VI nerve palsy",
"type": "CLINENTITY"
},
{
"offsets": [
50,
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],
"text": "convergent squint",
"type": "CLINENTITY"
}
] |
His oedema resolved completely by day 10 of treatment , and he was discharged on day 18 . | [
{
"offsets": [
4,
10
],
"text": "oedema",
"type": "CLINENTITY"
}
] |
He continued prednisolone 60 mg daily for a total of 6 weeks , followed by a reduced dose of 40 mg on alternate days for 6 weeks . | [] |
At 12 weeks follow-up , his urinalysis showed a trace proteinurea but he remained in remission . | [] |
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 . | [
{
"offsets": [
138,
169
],
"text": "Ischaemic Heart Disease ( IHD )",
"type": "CLINENTITY"
}
] |
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 . | [
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"offsets": [
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"text": "IHD",
"type": "CLINENTITY"
},
{
"offsets": [
68,
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"text": "angina class III",
"type": "CLINENTITY"
}
] |
Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery ( LAD ) and the proximal Circumflex Coronary Artery ( Cx ) . | [
{
"offsets": [
51,
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],
"text": "lesions in the mid portion of the Left Descending Coronary Artery",
"type": "CLINENTITY"
}
] |
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 . 0 mm Bare Metal Stent . | [] |
The patient was angina-free for one year but represented in July 2010 again with angina class III . | [
{
"offsets": [
81,
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"text": "angina class III",
"type": "CLINENTITY"
}
] |
Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion . | [
{
"offsets": [
98,
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"text": "coronary lesion",
"type": "CLINENTITY"
}
] |
She was controlled on medical therapy . | [] |
However she presented again in November 2011 , this time with unstable angina . | [
{
"offsets": [
62,
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"text": "unstable angina",
"type": "CLINENTITY"
}
] |
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 . | [
{
"offsets": [
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"text": "stem stenosis",
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] |
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 32 kg / m 2 . | [
{
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"text": "obese",
"type": "CLINENTITY"
}
] |
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 . | [
{
"offsets": [
29,
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"text": "intermittent claudication",
"type": "CLINENTITY"
},
{
"offsets": [
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],
"text": "bilateral carotid bruits",
"type": "CLINENTITY"
},
{
"offsets": [
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"text": "diabetes mellitus",
"type": "CLINENTITY"
},
{
"offsets": [
172,
186
],
"text": "hyperlipidemia",
"type": "CLINENTITY"
}
] |
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 . | [
{
"offsets": [
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"text": "ventricular dysfunction",
"type": "CLINENTITY"
}
] |
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 . 5 mm vessel was snugged proximally and an arteriotomy performed in its mid-portion . | [] |
The arteriotomy site was kept bloodless with CO 2 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 . | [] |
A male patient , born in 1973 , fell off the balcony while on holidays in Crete in 1993 and developed complete tetraplegia at C- 5 level . | [
{
"offsets": [
102,
136
],
"text": "complete tetraplegia at C- 5 level",
"type": "CLINENTITY"
}
] |
In 1996 , deafferentation of sacral nerve roots 2 , 3 and 4 were carried out bilaterally . | [] |
Brindley sacral anterior root stimulator was implanted . | [] |
On eleventh post-operative day , blood stained fluid came out of sacral wound . | [
{
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"text": "sacral wound",
"type": "CLINENTITY"
}
] |
Microbiology of exudates showed growth of Pseudomonas aeruginosa , sensitive to gentamicin . | [
{
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"text": "Pseudomonas aeruginosa",
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}
] |
As discharge of serosanguinous fluid persisted , sacral wound was explored . | [
{
"offsets": [
49,
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"text": "sacral wound",
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}
] |
In March 1997 , induration and craggy swelling were noted at the site of receiver . | [
{
"offsets": [
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"text": "induration",
"type": "CLINENTITY"
},
{
"offsets": [
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],
"text": "swelling",
"type": "CLINENTITY"
}
] |
There was discharge from the surgical wound in the back . | [] |
Wound swab grew Pseudomonas aeruginosa . | [
{
"offsets": [
16,
38
],
"text": "Pseudomonas aeruginosa",
"type": "CLINENTITY"
}
] |
The receiver was taken out . | [] |
Cables were retrieved and tunnelled in left flank . | [] |
Laminectomy wound was left open . | [] |
In May 1997 , cables were removed from left flank through the laminectomy wound . | [] |
Grommet was sliced down as much as possible without producing leak of cerebrospinal fluid . | [
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"text": "Grommet",
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},
{
"offsets": [
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"text": "leak of cerebrospinal fluid",
"type": "CLINENTITY"
}
] |
Histoacryl glue was used over the truncated grommet as a sealing agent . | [] |
Microbiology of end of S- 2 and S- 3 cables showed growth of Pseudomonas aeruginosa , which was sensitive to gentamicin . | [
{
"offsets": [
61,
83
],
"text": "Pseudomonas aeruginosa",
"type": "CLINENTITY"
}
] |
End of S- 4 cable showed scanty growth of Pseudomonas aeruginosa and Klebsiella aerogenes . | [
{
"offsets": [
42,
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"text": "Pseudomonas aeruginosa",
"type": "CLINENTITY"
},
{
"offsets": [
69,
89
],
"text": "Klebsiella aerogenes",
"type": "CLINENTITY"
}
] |
Review of this patient in January 1999 revealed presence of sinuses in dorsal wound exuding purulent material . | [
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"text": "sinuses",
"type": "CLINENTITY"
},
{
"offsets": [
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"text": "wound exuding purulent material",
"type": "CLINENTITY"
}
] |
The wound was explored ; grommet and electrodes were removed . | [] |
The consequences of failed implantation were severe constipation and loss of reflex penile erection and bladder emptying . | [
{
"offsets": [
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"text": "constipation",
"type": "CLINENTITY"
},
{
"offsets": [
69,
120
],
"text": "loss of reflex penile erection and bladder emptying",
"type": "CLINENTITY"
}
] |
This patient had to spend increasing amount of time for bowels management . | [] |
Faecal incontinence limited his mobility . | [
{
"offsets": [
0,
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"text": "Faecal incontinence",
"type": "CLINENTITY"
}
] |
The problem with his bowels was affecting his confidence in doing anything , as the slightest movement could cause his bowels to work . | [] |
The inconvenience and embarrassment of a bowel accident caused distress to the patient and to his mother . | [] |
A 38 - year-old man presented with a seven month history of progressively worsening bilateral knees pain with associated swelling . | [
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"text": "knees pain",
"type": "CLINENTITY"
},
{
"offsets": [
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"text": "swelling",
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] |
The pain was present when the patient was at rest , and worsened when the legs was bearing weight , thus restricting his walking to short distances . | [
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"offsets": [
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"text": "pain",
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] |
His knees had become increasingly swollen . | [] |
He was otherwise fit and well . | [] |
His medical history was unremarkable and he was only taking a paracetamol , codeine and anti-inflammatory drugs for the pain . | [] |
Upon examination , the patient was seen to have visibly swollen popliteal fossa and marked quadriceps wasting of his right lower limb . | [
{
"offsets": [
56,
79
],
"text": "swollen popliteal fossa",
"type": "CLINENTITY"
}
] |
On palpation , the masses was hard , mobile , well defined , and measured 0 . 5 - 04 cm . | [] |
The swelling was non-tender and there were no associated skin changes . | [
{
"offsets": [
4,
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],
"text": "swelling",
"type": "CLINENTITY"
}
] |
He could fully extend his knee , but flexion was restricted to only 110 degrees . | [] |
There was a McMurray test proved equivocal and no ligamentous instability . | [] |
An examination of the patient ’ s hip revealed no abnormality . | [] |
A plain radiograph of the patient ’ s knees revealed multiple calcific densities within the soft tissues surrounding it on the right one . | [] |
Although some of these appeared to lie within the capsule , the majority appeared to be outside of it , and a solitary image on the left knee . | [] |
These appearances were thought to be consistent with idiopathic tumoral calcinosis . | [
{
"offsets": [
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],
"text": "tumoral calcinosis",
"type": "CLINENTITY"
}
] |
However , to further scrutinize these calcifications , a magnetic resonance imaging ( MRI ) scan was recommended . | [
{
"offsets": [
38,
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"text": "calcifications",
"type": "CLINENTITY"
}
] |
It showed an extensive thickening of the patient ’ s synovium , multiple intraarticular calcific and ossific loose bodies , and large calcified bursal extensions . | [] |
These findings were thought to be consistent with very extensive bilateral synovial chondromatosis . | [
{
"offsets": [
75,
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],
"text": "synovial chondromatosis",
"type": "CLINENTITY"
}
] |
The patient ’ s blood tests were normal : C-reactive protein 5 mg / l and the phosphate calcium balance without errors . | [] |
A two-stage procedure was planned following the findings of the MRI scan . | [] |
The first stage was arthroscopy , which was able to note Grade IV osteoarthritis alongside florid synovial chondromatosis in the lateral compartment of the right knee . | [
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"text": "osteoarthritis",
"type": "CLINENTITY"
},
{
"offsets": [
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],
"text": "synovial chondromatosis",
"type": "CLINENTITY"
}
] |
There were multiple loose bodies within this compartment and nodules were fixed to the synovium . | [] |
On the left one , we found an isolated synovial metaplasia in the subvastus quadriceps-sparing . | [
{
"offsets": [
39,
58
],
"text": "synovial metaplasia",
"type": "CLINENTITY"
}
] |
A synovectomy with debridement and excision of these bodies was thus performed . | [] |
The second stage involved an open exploration of the patient ’ s popliteal fossa . | [] |
Multiple calcified masses were found , all enclosed in bursal sacs . | [] |
They were lateral to the semimembranosus at the level of the oblique popliteal ligament . | [] |
All the masses were excised . | [] |
A histological review confirmed our diagnosis of synovial chondromatosis . | [
{
"offsets": [
49,
72
],
"text": "synovial chondromatosis",
"type": "CLINENTITY"
}
] |
The sections showed nests of chondrocytes with focal ossification and focally attenuated synovium overlying the nodules . | [] |
After the operation , the patient underwent functional rehabilitation sessions focusing on quadriceps strengthening , with a daily exercise regime to supplement this . | [] |
He recovered well and ten weeks after the operation , has regained his right knee ’ s full range of movement with flexion increased to 130 degrees , which is equal to that of his left knee . | [] |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy ( AIDP ) variant of Guillain-Barr syndrome 12 years back presented with acute , ascending symmetrical flaccid quadriparasis extending to bulbar muscles , bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation . | [
{
"offsets": [
91,
138
],
"text": "acute inflammatory demyelinating polyneuropathy",
"type": "CLINENTITY"
},
{
"offsets": [
141,
145
],
"text": "AIDP",
"type": "CLINENTITY"
},
{
"offsets": [
159,
181
],
"text": "Guillain-Barr syndrome",
"type": "CLINENTITY"
}
] |
Nerve conduction study revealed AIDP variant of Guillain-Barr syndrome . | [
{
"offsets": [
32,
36
],
"text": "AIDP",
"type": "CLINENTITY"
},
{
"offsets": [
48,
70
],
"text": "Guillain-Barr syndrome",
"type": "CLINENTITY"
}
] |
Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation . | [] |
She was treated with intravenous immunoglobulin resulting in a remarkable recovery . | [] |
Both episodes had a complete clinical recovery in three and four months ' time respectively , rather a faster recovery than usually expected . | [] |
A 61 - year-old woman , gravida 3 para 3 , presented with an increased size of ovarian cyst . | [
{
"offsets": [
79,
91
],
"text": "ovarian cyst",
"type": "CLINENTITY"
}
] |
Her history revealed a diagnosis of left ovarian cyst 3 cm in diameter 3 years previously . | [
{
"offsets": [
41,
53
],
"text": "ovarian cyst",
"type": "CLINENTITY"
}
] |
Her serum cancer antigen ( CA ) 125 and CA 19-9 levels were within the normal ranges , and she was followed up at 6 - month intervals at a private hospital . | [] |
The ovarian cyst size had not changed in size and structure on biannual transvaginal ultrasound ( TVS ) . | [
{
"offsets": [
4,
16
],
"text": "ovarian cyst",
"type": "CLINENTITY"
}
] |
Subsets and Splits