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162,400 |
3724297-2
| 23,914,095 |
noncomm/PMC003xxxxxx/PMC3724297.xml
|
Pitfalls associated with the diagnosis of herpes simplex encephalitis
|
An 84-year-old woman was found on the floor with altered mental status and myoclonic jerks. Some days earlier, levofloxacin was prescribed by her physician due to cystitis. On admission, the patient was somnolent and disorientated, but without meningeal irritation. On both arms, myoclonic jerks could be observed. The working diagnosis in the emergency room was quinolone associated delirium. In order to exclude other etiologies, a CCT was performed, revealing a hypodense lesion in the right temporal lobe []. The following CSF analysis showed elevated lymphocytic cell count (36/μL; normal < 4) and protein (961 mg/dl (normal < 450)); lactate and glucose were normal []. A therapy with acyclovir (10 mg/kg every 8 h for 14 days) was initiated. PCR assay for HSV-1 was found to be positive. Gradually the patient recovered and took part in a rehabilitation program. A year later, the patient was admitted due to a symptomatic seizure. At this time, she still showed marked neurocognitive impairment, needing moderate home care.
|
[[84.0, 'year']]
|
F
|
{'9710034': 1, '34692318': 1, '21941494': 1, '19751606': 1, '18582201': 1, '21470440': 1, '21686359': 1, '22067626': 1, '15033064': 1, '20122069': 1, '21068230': 1, '11787842': 1, '15804262': 1, '21483260': 1, '28502057': 1, '30352560': 2, '26243746': 1, '23914096': 1, '26770849': 2, '14978145': 1, '23914097': 1, '16675036': 1, '23914098': 1, '31528283': 1, '18380708': 1, '21585220': 1, '23914095': 2}
|
{'3724297-1': 2, '3724297-3': 2, '4681801-1': 1, '6198426-1': 1}
|
162,401 |
3724297-3
| 23,914,095 |
noncomm/PMC003xxxxxx/PMC3724297.xml
|
Pitfalls associated with the diagnosis of herpes simplex encephalitis
|
A 51-year-old diabetic woman was admitted to hospital with fever and acute confusion. In the emergency department, no signs of meningeal irritation and focal neurological signs were detected. A CCT was unremarkable [] and lumbar puncture showed 1 cell/μL (normal < 4) and slightly elevated protein 646 mg/dl (normal < 450) with normal glucose. As blood glucose was high (351 mg/dl), an infection triggered diabetic disorder was suspected. Therefore the patient was treated by the internist. The following day the patient suffered from aphasia. Since aphasia persisted, a stroke of the left temporal lobe was assumed next. However, as fever continued and confusional symptoms predominated, a second lumbar puncture was performed. The result, this time, showed elevated cell count (31 cells/μL, normal < 4) and elevated protein 1157 mg/dl (normal < 450). HSV was tested positive in the first and second CSF sample by PCR. Despite virostatic therapy with intravenous acyclovir (10 mg/kg every 8 h for 21 days), the patient's condition deteriorated, making mechanic ventilation and intensive care necessary. Furthermore neuroradiologically severe left-hemispheric encephalitic changes could be observed []. After a prolonged rehabilitation program, the patient is at home, but needs professional care.
|
[[51.0, 'year']]
|
F
|
{'9710034': 1, '34692318': 1, '21941494': 1, '19751606': 1, '18582201': 1, '21470440': 1, '21686359': 1, '22067626': 1, '15033064': 1, '20122069': 1, '21068230': 1, '11787842': 1, '15804262': 1, '21483260': 1, '28502057': 1, '30352560': 2, '26243746': 1, '23914096': 1, '26770849': 2, '14978145': 1, '23914097': 1, '16675036': 1, '23914098': 1, '31528283': 1, '18380708': 1, '21585220': 1, '23914095': 2}
|
{'3724297-1': 2, '3724297-2': 2, '4681801-1': 1, '6198426-1': 1}
|
162,402 |
3724301-1
| 23,914,099 |
noncomm/PMC003xxxxxx/PMC3724301.xml
|
Xanthogranulomatous colloid cyst of the third ventricle
|
A 30-year-old male presented with complaints of holocranial headache with transient episodes of blurring of vision for 1 month. His neurological examination was normal. Fundoscopy revealed bilateral florid papilledema.\nHe was investigated with MRI brain, which revealed a hyperintense (T1W and T2W) solid cystic lesion measuring 3 × 2.9 × 3 cm3 in the anterior third ventricle causing hydrocephalus with enhancement on contrast imaging. The solid portion was hypointense on T2W images and was nonenhancing on T1W-Gadolinium contrast images [Figure -]. The imaging differential diagnosis was colloid cyst with inspissated protein contents or craniopharyngioma.\nThe patient underwent right frontal craniotomy, and the lesion was approached through interhemispheric transcallosal interforniceal route as the lesion was large and would have been difficult to excise from transforaminal variation of the transcallosal approach. The lesion was solid cystic located in the third ventricle near the foramen of Monro and contained about 2-3 mL of machine oil like fluid which was drained. The solid part of the lesion was avascular, firm, and grayish black in color which was excised. The capsule was removed completely except for the part which was densely adherent to the floor of the third ventricle. An Ommaya reservoir was kept in the third ventricle for external ventricular drainage []. The external drain was removed on postoperative day 5, and a CT scan was repeated on day 7 to look for the residual blood in the ventricles. There was dilatation of the ventricles with periventricular lucency for which a right ventriculo-peritoneal shunt was performed. There was no residual tumor left in the third ventricle.\nHistopathological examination of excised specimen revealed all the typical diagnostic features of a colloid cyst except for certain parts of the cyst wall where the simple, compressed, ciliated, cuboidal lining lacked a brush border and was sometimes entirely missing. Moreover, the cyst wall was multilayered and thickened by granulomatous tissue which was composed of a potpourri of cells. There was a predominance of epithelioid cells and macrophages, many of which contained refractile material and hemosiderin. Polymorphonuclear leukocytes were diffusely scattered throughout the granuloma, and lymphocytes were seen in focal collections. Foreign body giant cells were not a conspicuous feature. Cholesterol clefts were also noted [Figure -].\nThe patient is under regular follow-up and doing well with no fresh neurological deficits at end of 1 year.
|
[[30.0, 'year']]
|
M
|
{'1168873': 1, '479942': 1, '7442988': 1, '22405542': 1, '2672396': 1, '4013683': 1, '4035556': 1, '4193921': 1, '20363554': 1, '8416224': 1, '28352831': 1, '2472473': 1, '12128295': 1, '8972153': 1, '1895117': 1, '10206164': 1, '14193250': 1, '632894': 1, '3244413': 1, '7931596': 1, '12066904': 1, '31583166': 2, '23914100': 1, '13273524': 1, '2716977': 1, '28578512': 1, '13795372': 1, '15570418': 1, '4159904': 1, '33207407': 1, '2505568': 1, '23914099': 2}
|
{'6763664-1': 1}
|
162,403 |
3724303-1
| 23,914,101 |
noncomm/PMC003xxxxxx/PMC3724303.xml
|
Cytologic diagnosis of undifferentiated high grade pleomorphic sarcoma of breast presenting with brain metastasis
|
A 60-year-old postmenopausal woman presented to the outpatient department with symptoms of headache and occasional dizziness for the last 2 months with one episode of generalized tonic clonic seizure 2 days back. The patient was of poor health status with mild pallor. The patient, on enquiry, also complained about a lump in her left breast for the last six months. There was no history of nipple discharge. On examination, a firm 6 × 4 cm swelling was palpated in the upper outer quadrant of the left breast. The swelling was non-tender and mobile with fixity to the overlying skin but not with the chest wall. There was no axillary lymphadenopathy; and the other breast was found normal on clinical examination. Clinical examination and history did not reveal any other abnormality. The patient underwent laboratory and imaging studies with fine needle aspiration of the breast lump. CT scan showed a heterogeneously enhancing hypodense infratentorial lesion measuring 6.3 × 5.7 cm in left cerebellar hemisphere and vermis compressing and displacing the fourth ventricle []. Laboratory tests showed hemoglobin of 9.8 gm/dl with microcytic, hypochromic anemia. The chest X-ray was normal. During FNAC, two passes were made. The smears were stained with Papanicolaou and May-Grunwald-Giemsa (MGG) stain and showed a dispersed population of malignant pleomorphic, sometimes bizarre, spindle cells and few multinucleated tumor giant cells. There was no epithelial component in the prepared smears. The background was hemorrhagic []. A cytologic diagnosis of malignant sarcomatoid spindle cell tumor was made. The differential diagnoses suggested were undifferentiated high grade pleomorphic sarcoma, malignant phyllodes tumor and metaplastic carcinoma (spindle/sarcomatoid variant). The patient underwent wide excision of the tumor. No axillary dissection was done. The histopathologic examination showed a high grade sarcoma composed of pleomorphic spindle cells arranged in fascicles and vague storiform pattern. There were bizarre and multinucleated tumor giant cells. The mitotic count was 15/10 HPF with atypical forms. There were foci of dystrophic calcification []. Immunohistochemistry for Cytokeratin (CK), Epithelial Membrane Antigen (EMA), Smooth Muscle Actin (SMA), desmin and S-100 protein were performed with adequate controls and showed no immunoreactivity indicating a lack of differentiation. A stereotactic biopsy from the cerebellar lesion showed similar histological and immunohistochemical pattern. A diagnosis of primary high grade undifferentiated pleomorphic sarcoma of breast with cerebellar metastasis was made. The patient in the post-operative period deteriorated quickly and developed progressive ataxia and headache. The patient died 3 weeks later.
|
[[60.0, 'year']]
|
F
|
{'22031808': 2, '10603190': 1, '23914102': 1, '2837374': 1, '21983422': 1, '15187996': 1, '23914103': 1, '2855511': 1, '17017451': 1, '16359532': 1, '23914101': 2}
|
{'3200522-1': 1}
|
162,404 |
3724306-1
| 23,914,104 |
noncomm/PMC003xxxxxx/PMC3724306.xml
|
Reversible diencephalic dysfunction as presentation of deep cerebral venous thrombosis due to hyperhomocysteinemia and protein S deficiency: Documentation of a case
|
A 45-year-old man, alcohol consumer, non-smoker, without co-morbidities, presented with abnormal behavior for 3 days and global headaches with vomiting for 6 days developing few hours after a cross-country run of 13 km at 7,000 ft. There was no seizure, loss of consciousness, fever or head injury. He was afebrile, conscious, abulic and uncooperative with normal vitals. Rest of the examination was normal.\nA non contrast computed tomography scan of head was normal. Magnetic resonance imaging (MRI) brain showed hyperintense signal in bilateral thalami, left basal ganglia and periventricular white matter on T1 and T2-weighted images (T1WI, T2WI) and fluid attenuated inversion recovery image (FLAIR), and hyperintense internal cerebral veins suggestive of subacute thrombosis [Figure and ]. DWI revealed heterogeneous signal intensity without hypointensity on ADC map corresponding to vasogenic edema [Figure and ]. Gradient echo image showed susceptibility artefacts compatible with hemorrhagic component of venous infarct []. Magnetic resonance venography (MRV) did not reveal the deep venous system, which was visualized on T1WI indicating thrombosis, while superior sagittal and lateral sinuses were patent [].\nHis condition steadily improved on low molecular weight heparin (LMWH) bridged with acitrom. Mini mental status examination improved from 20/30 to 29/30 by 3 weeks. At 2 months, he was asymptomatic with serum homocysteine of 31.51 μmol/l (5.46-16.2 μmol/l), and at this time, after discontinuation of acitrom for 2 weeks, the protein S was 49.00% (77-143.00%), and protein C 118.40% (70-140.00%); factor V Leiden mutation, methylene tetrahydrofolate reductase (MTHFR) gene mutation (C677T) and prothrombin gene G20210A mutation were not detected. Anti-phospholipid IgG antibody was 4.53 GPL U/ml (0.5-10.0) and IgM antibody was 2.77 MPL U/ml (0.5-10.0). Anti-neutrophil cytoplasmic antibody and rheumatoid factor were negative.\nHe was treated with methylcobalamin, pyridoxine and folic acid. Oral anticoagulation was continued for 1 year only. After 16 months, he remained asymptomatic with normal MRI brain [] and partially recanalized deep cerebral venous system on MRV, and serum homocysteine fell to 16.50 μmol/l (5.46-16.2 μmol/l).
|
[[45.0, 'year']]
|
M
|
{'21293023': 1, '9090411': 1, '31543733': 1, '11897316': 1, '7487562': 1, '17239803': 1, '11383943': 1, '25795155': 1, '29441008': 1, '14707415': 1, '25002759': 1, '9191776': 1, '23914105': 1, '32529307': 1, '33532137': 1, '11254226': 1, '10229757': 1, '12714502': 1, '23914104': 2}
|
{}
|
162,405 |
3724308-1
| 23,914,106 |
noncomm/PMC003xxxxxx/PMC3724308.xml
|
Genital self-mutilation in an attempt of suicide by a patient with a borderline personality
|
Our male patient was 25-years-old, he was hospitalized in March 2003 in the department of psychiatry of the university hospital of Fez (Morocco) for genital self-mutilation while attempting to suicide. The patient achieved the complete cutting of his genital organ using a razor cutter. This act was carried out during the incarceration stage in the civil prison of Fez. The patient was been jailed for a sentence following a premeditated murder.\nThe patient belongs to large family composed of 11 brothers and sisters; the family belongs to a low-income class of the rural area of Fez (Morocco). The patient received a severe family education from his father demonstrating a full use of authority, power and violence. The patient has spent seven years to learn the holly book of “Koran”. Then he practiced several jobs such agriculture and shoemaker at early age without achieving any professional stability.\nThe patient interpersonal relationships demonstrated instability and frequent ruptures. He believed that people do not try to understand him; they do not identify his concerns, issues and needs; and he believed that he might be rejected any time. The relationship of the patient with women was restricted and limited since he feared to be abandoned. Concerning the sexuality, the patient declared that he has had three successful sexual interactions before. However, the patient expressed that his not confident about his sexual identity and virility. Nonetheless, no physical or sexual abuse was revealed during his childhood. In addition, neither familial psychiatric history disorders or mood disorders nor suicidal behaviors or addiction behavior were recorded.\nThrough his 15 years old, a succession of various psychiatric symptoms occurred in the patient with collection of clinical aspects. Evermore, the patient reported episodically fluctuating anxiety in abandoned or accompanied contexts and sometimes-associating periods of depersonalization and derealization. The patient revealed also episodes of a permanent feeling of emptiness and lack of goals in life, with a frequent feeling of uselessness and underestimation. An excessive and abusive consumption of cannabis and alcohol was reported during episodes of anxiety and distress.\nDuring his 19-years old, the patient attempted to commit suicide using organo-phosphorics chemicals, this required hospitalization in the intensive care department along ten days. This suicidal behavior was considered secondary to a major depressive disorder. A year later, the patient demonstrated a brief psychotic disorder associating persecuting delusions, hypochondria and a diabolic possession. These disorders regressed after a three weeks of antipsychotic treatment.\nAt 21-years old, our patient committed a murder in an impulsive context. Thus, while he was walking with his girlfriend, two young men from his village tried to humiliate him and captivate the girl away with them. The patient could not control his aggressive behavior and he wounded one of his aggressors that died in the emergency department of the hospital. He was condemned guilty and sentenced for ten years of jail.\nSince his incarceration, the anxiety disorder, emptiness and abandon feelings were worsening. The patient was self-isolating in the prison cell and established very few relationships with the prison colleagues. The feeling of abandon has increased by the incarceration circumstances and the rare family visits.\nThe patient started the self-mutilation in the prison iteratively commencing with the left arm and the thorax [Figures and ]; these occurred in a context of infringement of impulsion, abandon and anxiety. He reported that these self-destructive acts allowed him to discard fear and tension feelings without being determined to suicide. Two weeks earlier the GSM, the patient has acquired a massive anxiety, a feeling of emptiness and uselessness. Accordingly, a strong desire to die was subsequent. Subsequently, he began to think ending his life. The patient decided to cut his genital organ since he always believes that this organ is the center of his existence. He started to organize the means to accomplish his act with a complete dissimulation of his suicidal intention. By the day of the GSM act, our patient borrowed a razor cutter from another detainee in the prison pretending that he wanted to shave. The patient took the opportunity of the absence of other detainees and prison guards who were in their morning break, he has hided himself in a corner of the prison cell and proceeded to completely cut his genital organ using the razor cutter around 10 AM [].\nThe patient was transferred to the surgical unit of the emergency department, where he immediately followed a re-implantation of the genital organ with a realignment of the urethra. However, necrosis was been noticed and treated during the control of the implant. Unfortunately, the necrosis caused tissues shrinking, and the urological surgery team removed the necrotized graft and proceeded to a plastic surgery of the remaining base of the genital organ []. However, the patient completely refused any surgery and therapeutical approach despite all explanations provided about the consequences including the vital prognosis.\nAfterward, the patient was hospitalized in the psychiatric department where he showed a clear depressive syndrome, a self-culpability regarding the execution and declared that he has lost his virility. Our case adopted a desperate vision of his future but he did not reveal any intention to recommit suicide. In addition, none of symptoms such disorganized speech, delusional, or perceptive disorders were noticed. The somatic examination was without particularity besides a routine biological assessment that was conducted and was negative.\nThe psychometric test DIBR (diagnostic interview for borderline-revised) revealed a borderline personality. During the admission in the psychiatry department, the patient demonstrated a progressive improvement of the symptomatology while using anxiolytic and antidepressant treatments including Clomipramine at 150 mg/day and Diazepam 20 mg/day. The patient showed an attenuation of the psychomotor reduction within 4 weeks of treatment. Additionally the desperate, hopeless and self-culpability feelings have decreased within 6 weeks. During the hospitalization stage, the patient developed washing compulsions, which regressed after one month of treatment. The patient left the hospital after the stabilization of his clinical state lasting 64 days of hospitalization.\nSix months later, the psychiatric test revealed a significant recovery of depressive disorder. In addition, the patient refused to talk about his self-destructive act and declared that he does not want to remember it again. One year later, the patient was examined in the jail and neither self-mutilation nor suicidal behavioral signs were recorded. Since he left hospital, he declared that his act was committed without his determination and God would forgive him. He superficially mentioned the self-mutilation with avoiding to talk about the circumstances again.\nIndeed, the GSM of a borderline personality diagnosis was evoked first considering the omnipresent fear of being abandoned, the permanent dysphoria, the instability characterizing the interpersonal relationship, the life sentimental, the recurrent suicidal behaviors, the psychiatric disorders alternation of varied categories and the significant values recorded in psychometric tests.\nVarious facts allowed suggesting recurrent major depressive disorders including the re-occurrence of episodic suicidal attempt during depressive state and the suicidal goal behind the genital self-mutilation. However, a combination of depressive episodes with fear of abandon and the occurrence of psychiatric disorders such psychotic, obsession, substance abuse and substance dependence disorders were not supporting this hypothesis. The atypical GSM of the borderline personality might suggest a schizophrenia diagnosis, which was discarded considering the absence of any element of disorganization and the preservation of a good lucidity toward reality. An antisocial personality diagnosis was also envisaged considering the relational and professional instability, the impulsivity of repetitive self-mutilations. However, the biographical data, the interaction of the patient with events and the prevalence of fear of separation allowed withdrawing this diagnosis.
|
[[25.0, 'year']]
|
M
|
{'18051812': 1, '16485555': 1, '15275800': 1, '11229984': 1, '10974364': 1, '8865356': 1, '19068333': 1, '17259032': 1, '20418647': 1, '19187711': 1, '22345848': 2, '17998964': 1, '21772655': 2, '18074964': 1, '12524634': 1, '16495110': 1, '15776908': 1, '16020029': 1, '18241308': 1, '12048941': 1, '22281435': 1, '23914106': 2}
|
{'3136025-1': 1, '3271498-1': 1}
|
162,406 |
3724309-1
| 23,914,107 |
noncomm/PMC003xxxxxx/PMC3724309.xml
|
Challenges in care of the child with special health care needs in a resource limited environment
|
We present a 10 year old male, who presented with a history of recurrent seizures and impaired speech development from the age of 6 months, hyperactivity, aggressive behavior and poor academic performance of 5 years duration. Informant was the mother. The seizures were described as afebrile and generalized tonic-clonic in nature. The child received several medications, from the hospital of his birth and other secondary health care facilities, for the seizures. Parents introduced traditional herbal oral medication at 2 years when seizures remained intractable, and which he continued till presentation at the CAMH unit. Speech has remained audible but incomprehensible since the 6th month of life till date and has not received any specific therapy for this. Though described as socially interactive with people he was observed to be hyperactive and aggressive in the past 5 years. These features, in addition to the recurrent seizures even in school had resulted in poor academic performance. Persistent complaints and rejection by schools culminated in complete withdrawal from school. Pregnancy and delivery were uneventful. Developmental motor milestones were described as normal until the 9th month of life when parents observed comparative weakness in the left upper and lower limbs. He started walking with a limp at 2 years. He developed a facial rash at 5 years which has increased in spread and defied repeated administration of a variety of topical skin creams. He was first diagnosed as having cerebral palsy at 2 years. It was at 5 years of age that a diagnosis of Tuberous Sclerosis was made in a tertiary health facility. After 2 years of several visits to this facility, the parents stopped attending due to lack of significant improvement in the child's condition and non availability of the special health services such as speech therapy. Currently he is at home and away from school. He is being tendered to by his mother, who had to relinquish her career pursuit, and two hired house helps. There was no family history of seizures. Father is a 37 year old salesman. The child has two younger siblings who have no growth or developmental challenges. Expenses incurred in the care of child were described as prohibitive and have been borne exclusively by the parents. On a monthly basis, his care is said to consume over a third of the family resources. Parents are not aware of any support group or supportive governmental program they can access. Increasing inappropriate hostility towards parents, relatives and other caregivers in addition to the associated difficulty in restraining him and the embarrassment the parents feel from his untoward activities informed his presentation to the CAMH Unit. On examination at presentation he was hyperactive but well kempt. He had Adenoma Sebaceum []. Weight, height and occipito- frontal circumference were appropriate for age. Other significant findings were expressive language disorder and left hemiplegia. Chest x-ray, abdominal ultra sonography and audiogram were normal. Electroencephalogram (EEG) indicated generalized tonic clonic-seizures. A CT-Scan showed intra-ventricular subependymal calcifications []. He had features of Attention Deficit Hyperactivity Disorder (ADHD). Outcome of draw-a-person test was very poor. Overall, a diagnosis of Tuberous Sclerosis with mental retardation, left hemiplegia and ADHD was made. Outlined management included parental counseling, physiotherapy for the hemiplegia, sodium valproate and methyl phenidate were prescribed for seizures and ADHD respectively. The frequency of the seizures and the degree of hyperactivity reduced with commencement of the drugs. The child and parents were subsequently introduced to a special education and rehabilitation facility in the community.
|
[[10.0, 'year']]
|
M
|
{'2726332': 1, '17089866': 1, '12160668': 1, '22346180': 1, '20587932': 1, '34557878': 1, '25878900': 1, '23914107': 2}
|
{}
|
162,407 |
3724310-1
| 23,914,108 |
noncomm/PMC003xxxxxx/PMC3724310.xml
|
Lumbar extradural dumbbell cavernous hemangioma: A rare lesion
|
A 52-year-old female presented with insidious onset progressive low backache with pain radiating to whole of left lower limb associated with paraesthesias for two months. She had difficulty in walking due to pain. There were no symptoms suggestive of bladder or bowel involvement. General examination was unremarkable. Upper limbs were normal with no sensorimotor deficits. Left lower limb power was 4/5 in hip flexion, extension, abduction and adduction, 4/5 in knee flexion and extension, subtle weakness in ankle flexion and extension and great toe extension with hypotonia. Right side lower limb power was normal. The reflexes of left lower limb were sluggish whereas on right side they were brisk (normal). Sensory examination revealed impairment of all the modalities of sensations (pin prick, touch, temperature, vibration- impaired upto anterior superior iliac spine) from L2 to S4 dermatomes on left side. There was no spinal tenderness or deformity. Rest of examination was unremarkable. Magnetic resonance imaging of lumbar spine revealed an irregularly shaped, well defined extradural lesion at L3 vertebral level indenting the body, displacing the thecal sac posterolaterally and extending into left paraspinal region through L3- 4 neural foramen. Lesion was isointense on T1W, hyperintense on T2W images with strong homogenous enhancement on Gadolinium contrast study []. Provisional preoperative diagnosis of schwannoma was considered. Though the clinical findings and radiology were not concordant, the patient was suggested surgical intervention for the presence of enhancing mass lesion noted on the imaging with guarded prognosis.\nThe patient underwent left hemilaminectomy from L2 to L4. There was an extradural, brownish red, highly vascular mass located anterolateral to thecal sac at L3 vertebral body with well defined capsule around it. It was extending into left paraspinal region through L3/4 neural foramen. Left L3 nerve root was pushed superiorly by the tumor and it was not arising from any neural tissue. It was highly vascular and bleeding heavily on taking a small biopsy. The capsule was then coagulated to control the haemorrhage. It was dissected clear from the L3 nerve and the dura keeping the dissection over the coagulated capsule. The spinal component of the lesion was excised in toto until the neural foramen, where it was coagulated and was cut sharply leaving behind the extra-foraminal portion. Perfect haemostasis was achieved using bipolar cauterisation, cross checked by Valsalva manoeuvre. Scalloping of L3 vertebral body was noted following tumor excision.\nMicroscopic examination revealed numerous dilated vascular channels of variable sizes lined by a single layer of flattened epithelial cells and filled with blood elements. Interspersed thick hyalinised blood vessels and mature adipose tissues were noted []. The histological picture was characteristic of cavernous hemangioma. Radiotherapy was administered to the residual paraspinal portion of tumor []. For radiotherapy, the patient was immobilised in a vacuum locking device and CT simulation was done in the treatment position. CT images were fused with the preoperative and post operative MR images. Margin of 1 cm was added to the post contrast T1W MRI to obtain the clinical target volume; planning target volume was obtained by adding a margin of 0.5 cm to the clinical target volume. Dose was prescribed to the planning target volume. Three dimensional conformal radiotherapy was planned on ECLIPSETM planning system (Varian Medical systems, Palo alto, CA) on linear accelerator (Clinac iX- 3665) using 6 MV X rays. The dose prescription was 40 Gy, 2 Gy per fraction, 20 fractions given five days a week over five weeks.
|
[[52.0, 'year']]
|
F
|
{'14620197': 1, '17498752': 1, '7280822': 1, '34211883': 2, '14689287': 1, '18654724': 1, '9974054': 1, '31358909': 1, '7163968': 1, '32922864': 1, '3941982': 1, '7838334': 1, '19487867': 1, '1919692': 1, '9391798': 1, '23914108': 2}
|
{'8202371-1': 1}
|
162,408 |
3724311-1
| 23,914,109 |
noncomm/PMC003xxxxxx/PMC3724311.xml
|
A rare case of an extra-axial cavernous angioma in the cerebellopontine angle
|
A 50-year-old male presented with a four-month history of dysarthria, dysphagia, and unsteady gait. Clinical examination revealed left lower cranial nerve palsy and cerebellar signs were positive on the left side; there was no facial palsy or decreased hearing in the left ear. Contrast enhanced computed tomography (CECT) images of the brain revealed an enhancing hyperdense mass lesion in the left CPA []. Widening of the CPA was noted with minimal perilesional edema. The lesion was extra-axial in location with a lobulated surface. No calcification was evident within the lesion.\nThe retrosigmoid suboccipital approach was used to operate on the patient in the supine position with head turned to the right side and fixed to the Sugita head frame. Intraoperatively, there was a lesion of 3 × 3.5 cm size in the left CPA, which was vascular and bled when attempts were made to separate it from the surrounding structures. It was adherent to the petrous dura and a thin tail of the lesion extended into the internal auditory canal. Small vessels connecting the cavernous angioma and surrounding tissues were coagulated and divided. Total excision of the lesion was done.\nHistopathological examination of the specimen showed a lobular arrangement of dilated and congested vascular spaces lined by a single layer of endothelial cells [Figures and ]. Intervening stroma was fibrocollagenous and devoid of nervous tissue. Postoperatively, there were no complications and the patient did not have further neurological deficits. He was discharged on the seventh day after the operation. The lower cranial nerve palsy recovered significantly in three months.
|
[[50.0, 'year']]
|
M
|
{'20174956': 1, '8210595': 1, '19240578': 1, '33408920': 2, '21429201': 2, '17308842': 1, '12172728': 1, '9149836': 1, '21499148': 1, '2502760': 1, '23914109': 2}
|
{'3070677-1': 1, '7771499-1': 1}
|
162,409 |
3724312-1
| 23,914,110 |
noncomm/PMC003xxxxxx/PMC3724312.xml
|
Infratentorial subdural empyemas mimicking pyogenic meningitis
|
A 17-year-old boy presented to our hospital with high spiking fever, chills rigors associated with vomiting and headache for the past 3 days. He also had a history of intermittent purulent right ear discharge since 6 years of age. There were no focal neurological signs or papilledema to suggest raised intracranial tension. A CT scan of the head done by the referring doctor was normal. Lumbar puncture showed increased proteins (210 mg/dL) with normal sugars. Cerebrospinal spinal fluid analysis (CSF) showed 3000 cells, 84% of them being neutrophils. Gram staining was negative for bacteria and CSF cultures were sterile. He was treated as pyogenic meningitis and was started on a combination of Ceftriaxone, Amikacin, and Tinidazole. His fever promptly responded to the antibiotics, but he repeatedly complained of a persistent headache. He was also diagnosed with bilateral atticoantral CSOM with a right-sided cholesteatoma. In view of the persistent headache, a contrast MRI study of the brain was obtained and it revealed a right-sided enhancing subtentorial subdural collection suggestive of a subdural empyema [].\nNeurosurgical consult was sought and the patient was transferred under our care for further management. As the boy was afebrile with no evidence of raised intracranial tension, he was initially managed conservatively with antibiotics. Over the next few days his headache and vomiting subsided, but he kept complaining of repeated episodes of severe neck pain every night at around 3 am.\nA repeat contrast-enhanced computed tomography scan (CECT) done 10 days later using a 64 slice scanner revealed that the collection had greatly increased in size and now measured 4.5 × 2.5 cm and was associated with secondary hydrocephalus []. The boy was taken up for a right retromastoid suboccipital craniectomy and about 15 ml of frank subdural pus was aspirated, and the subdural space gently washed out with antibiotic solution. Pus was sent for culture but later failed to show any bacterial growth.\nPost-operative period, he did well with no recurrence of fever or neck pain. Intravenous antibiotics were continued for the next 10 days. At the time of discharge he was afebrile and neurologically intact with no focal deficits. He was advised to attend the ENT outpatient department period for further management of his middle ear infection.
|
[[17.0, 'year']]
|
M
|
{'22194137': 1, '29930870': 2, '1968310': 1, '11564248': 1, '17664407': 1, '9402577': 1, '27057210': 2, '8095519': 1, '1967304': 1, '17328260': 1, '23914110': 2}
|
{'5991265-1': 1, '4802958-1': 1}
|
162,410 |
3724313-1
| 23,914,111 |
noncomm/PMC003xxxxxx/PMC3724313.xml
|
An unusual extra-axial hypodense lesion mimicking a chronic subdural haematoma
|
A 59-year-old man was found lying on the road with multiple facial and scalp lacerations well past midnight. He was assumed to have been involved in a road traffic accident and taken to hospital. At admission he was drowsy, disoriented but obeying verbal commands with a Glasgow coma scale (GCS) of E3V4M6. Computed tomography (CT) scan showed a thin hypo-dense extra-axial lesion in the left frontal region without mass effect and midline shift []. Patient was treated conservatively but was slowly deteriorating. A repeat CT scan [] showed some increase in the size of the hypodense lesion, so the attending surgeon decided to perform a frontoparietal craniectomy. During surgery no haematoma was seen but reddish thick fleshy tissue was seen. The trainee surgeon who operated unfortunately closed the incision without obtaining any biopsy. As there was no improvement, patient was taken to another centre where he was treated conservatively including steroids. The patient slowly improved, he was discharged, the steroids were made oral and tapered over one month.\nThe patient was brought to our centre, six weeks later with spikes of high fever. During inter-rogation it was understood that the patient has been slowly deteriorating a few days after discharge. At admission he was febrile, drowsy, GCS E2V2M5. CT scan showed a hypodense extra-axial lesion in the left fronto-temporal region with mass effect and midline shift [] with some enhancement on contrast CT. An incidental type 1 sylvian arachnoid cyst was also noticed on the right side. Magnetic resonance imaging (MRI) showed an isodense to hypo-dense lesion extra-axial lesion with a rim of cerebrospinal fluid (CSF) below [Figures and ]. The brain was seen fungating through the craniectomy site. An enplaque meningioma or an organized subdural haematoma was considered and surgery was planned.\nPatient underwent left front otemperoparietal craniotomy, during surgery there was a reddish fleshy vascular lesion just under the bone flap. Biopsy de-compression of the lesion was done. Patient was continued on steroids and improved dramatically only to deteriorate with features of increased intra-cranial pressure and papilloedema when steroids were tapered. The histo-pathology was Non-Hodgkin's lymphoma. Immuno histo-chemistry stains were positive for Cytokeratin and Leucocyte Common Antigen. The B-cell markers CD20 and CD79a were positive. Glial fibrillary acidic protein (GFAP) and Vimentin stains were negative. The Ki67 index was 8-10%. The blastic markers CD99 and Tdt were positive in focal areas. Biopsy obtained from brain tissue was reported normal. An extensive search for the primary including detailed clinical assessment, CT scans of abdomen and chest and bone marrow analysis were done but all these were negative. Immune status compromise and HIV were ruled out. The patient was referred to the oncologist but unfortunately deteriorated and died without the radio-therapy being completed.\nWhen the patient was with us he had a small swelling in the forehead which was reddish and firm and was attributed to the fall he had just before admission. During craniotomy a biopsy was taken from this site also and was suggestive of Non-Hodgkin's lymphoma.
|
[[59.0, 'year']]
|
M
|
{'10774950': 1, '17134121': 1, '894336': 1, '11079030': 1, '8990144': 1, '11883850': 1, '16334908': 1, '10965827': 1, '16769960': 1, '2300875': 1, '11451206': 1, '30725238': 1, '2689322': 1, '14571046': 1, '9832258': 1, '1985302': 1, '2677529': 1, '3286832': 1, '23914111': 2}
|
{}
|
162,411 |
3724314-1
| 23,914,112 |
noncomm/PMC003xxxxxx/PMC3724314.xml
|
Unilateral asterixis, thalamic astasia and vertical one and half syndrome in a unilateral posterior thalamo-subthalamic paramedian infarct: An interesting case report
|
A 42-year-old young lady presented with 3 days history of acute onset of dizziness, transient loss of consciousness, sudden drooping of left eyelid and binocular diplopia with difficulty in walking unassisted. She also had hypersomnolescence. There was history of hypertension and uncontrolled diabetes mellitus of 2 years duration. Her admission BP was 210/120 mm hg and her blood sugar was 283 mg/dl with urine acetone positive at admission. She had past history of migraine for several years. Systemic examination was normal. Higher mental functions were normal. She had complete ptosis with dilated 5 mm nonreactive pupil on left side. There was left internuclear ophthalmoplegia and skew deviation with left hypertropia. There was also bilateral up gaze palsy with monocular left down gaze palsy and the only possible vertical movement was downward movement of right eye suggestive of vertical one and half syndrome. There was bilateral horizontal gaze evoked nystagmus. Convergence was impaired. Bell's phenomenon and vertical oculocephalic movement was absent. The muscle strength, sensory system, finger nose and knee heel coordination were normal. Reflexes were normal and plantars flexors. She was not able to sit or stand without support. She had thalamic astasia, was leaning back while sitting and required support to walk. On outstretched prone arm, dorsiflexed wrist, she had right asterixis which comprised of semi rhythmic flexion movements at wrist and fingers.\nOn evaluation, biochemistry, lipid profile and blood counts were normal. Cardiac evaluation was normal. MRI imaging showed evidence of T1 hypo intense and T2, Flair hyper intense signal changes in left anterior thalamus, subthalamus, left midbrain including periaqueductal region []. There were also bilateral frontal caps, bilateral asymmetric fronto parietal sub cortical white matter and symmetric peritrigonal white matter signal changes. Magnetic Resonance angiogram was normal and diffusion studies showed restriction [Figures and ]. There were no hemorrhage or micro bleeds. Patient was started on anti-platelets, anti-edema measures, antihypertensive and insulin. Ptosis, diplopia, dizziness and ataxia started improving gradually over next 2 days.
|
[[42.0, 'year']]
|
F
|
{'8301291': 1, '3699071': 1, '16434643': 1, '2682933': 1, '15106015': 1, '6716110': 1, '21601072': 1, '1866011': 1, '21917272': 1, '29264041': 1, '14597795': 1, '3946109': 1, '2841901': 1, '16966933': 1, '2424153': 1, '27089111': 1, '18232338': 1, '3715958': 1, '23914112': 2}
|
{}
|
162,412 |
3724315-1
| 23,914,113 |
noncomm/PMC003xxxxxx/PMC3724315.xml
|
Lower motor neuron facial palsy in cerebral venous sinus thrombosis
|
A 30-year-old lady congenitally deaf and mute presented with history of headache since one month and right LMN facial palsy since last 20 days. Using the sign language, she indicated that at the onset headache was predominantly over the anterior part of head and within few days it became diffuse. It was pressing in character, present throughout the day and associated with vomiting on increased severity. Ten days after the onset of headache she noticed difficulty in closing her right eyelid and three days later deviation of angle of mouth to left. There was no history of fever, ear discharge, weakness of limbs, seizures, diplopia, blurring of vision, ataxia, tinnitus or recent worsening of deafness. Physical examination showed presence of pallor, no organomegaly, external ear, mastoid and eardrum were normal. She was conscious, alert and oriented. Her visual acuity was 6/9 on both sides. Examination of the optic fundi revealed presence of bilateral papilledema. Eye movements and pupillary reactions were normal. She had right LMN facial palsy with absent taste and tearing ipsilaterally with bilateral sensory neural deafness as evidenced by tuning fork tests. Rest of the cranial nerves, motor, sensory and cerebellar examinations were normal. Clinically she was diagnosed as a case of raised intracranial pressure (ICP) with right LMN facial palsy with congenital deaf mutism.\nInvestigations revealed hemoglobin of 7.1 gm%, microcytic hypochromic blood picture with normal white blood cells and platelets. Serum biochemistry and electrolytes were normal. Rheumatoid factor and antinuclear antibodies were negative. Serum antiphospholipid antibodies, homocysteine levels, angiotensin converting enzyme levels and chest X-ray were normal. Computerized tomography (CT) scan of the brain showed posterior empty delta sign in the superior sagittal sinus. Temporal bone and middle ear cavity were normal. MRI and MRV [] showed thrombosis of superior and right lateral sinus, with no parenchymal lesions. Lumbar puncture was normal except with raised opening pressure. Audiometry showed bilateral profound sensory neural hearing loss. Brain stem auditory evoked responses were absent bilaterally. She was diagnosed as a case of CVT (superior and right lateral sinus) with ipsilateral LMN facial palsy with congenital deaf-mutism. She was started on parenteral followed by oral anticoagulation (prothrombin time, international normalization ratio maintained at about two), hematinics, anti edema measures. Over the next one month her symptoms of headache and facial palsy improved and at 4 months after her symptom onset, she was asymptomatic.
|
[[30.0, 'year']]
|
F
|
{'3789675': 1, '9549513': 1, '5573820': 1, '10884485': 1, '25969481': 1, '25988013': 2, '23914113': 2}
|
{'4369979-1': 1}
|
162,413 |
3724378-1
| 23,914,220 |
noncomm/PMC003xxxxxx/PMC3724378.xml
|
Convulsive syncope as presenting symptom of carotid body tumors: Case series
|
A 78-year-old woman was admitted to Al-Zahra Hospital, Isfahan, Iran, in December 2010, because of episodic vertigo and attack of loss of consciousness when she was in a sitting position. These attacks were accompanied with perspiration, pallor and bradycardia and after a few seconds followed with colonic movement of left extremities. She regained consciousness after taking supine posture.\nThe past medical history was negative except for the history of toxoplasmosis 7 years ago; drug and family history were unremarkable. Neurological examination was normal in a lying position but when she was sitting she became pale, lost her consciousness and convulsive syncope happened. Electroencephalography (EEG) did not show any abnormal discharges, Brain magnetic resonance imaging (MRI) and computed tomography scan, Holter monitoring, echocardiography and coronary angiography were normal. Cervical MRA and digital subtraction angiography (DSA) revealed CBT [].\nClassic resection of the CBT was performed and a 3 cm × 4 cm mass in the carotid bifurcation was removed. The post-operative period was uneventful, and the patient became completely symptom free.
|
[[78.0, 'year']]
|
F
|
{'18298303': 1, '9046120': 1, '8053660': 1, '20864295': 1, '13975591': 1, '20016787': 1, '20045781': 1, '34248304': 1, '21262948': 1, '21747190': 1, '26722157': 1, '7103429': 1, '21187865': 1, '19563966': 1, '6583549': 1, '18417602': 1, '33598293': 1, '23914220': 2}
|
{'3724378-2': 2, '3724378-3': 2}
|
162,414 |
3724378-2
| 23,914,220 |
noncomm/PMC003xxxxxx/PMC3724378.xml
|
Convulsive syncope as presenting symptom of carotid body tumors: Case series
|
A 65-year-old woman has referred to Al-Zahra Hospital, Isfahan, Iran, in September 2011, because of recurrent episodes of loss of consciousness since 10 months ago, the first one occurred when she was standing for a long time; her relatives described this attack as a fit of falling, loss of consciousness, and tonic movements that took 1-2 min; she was treated with antiepileptic drugs, but her attacks continued and repeated more and more. She has been treated as a case of intractable epilepsy. Her attacks began with the rotation of neck as focal seizure, too.\nDrug history was negative except for phenytoin and carbamazepin that started from 10 months ago. The neurological examination was normal but in the general examination during carotid auscultation suddenly the patient became pale and impaired her consciousness as well as, adversive head movement and then tonic movement of limbs. This event continued for 1-2 min and then she became conscious. Gentle examination revealed painless, oval shape, mobile, 2 cm × 3 cm mass in the right mandibular ankle.\nCervical magnetic resonance imaging (MRA) and computed tomography (CT) angiography showed separation between the right internal and external carotid arteries on left-side []. Cervical Doppler color sonogeraphy showed soft-tissue, hypo echo mass at carotid bifurcation. Electrocardiography (ECG), echocardiography and exercise test were in normal category. The patient was referred to the vascular surgeon and excision of CBT and lymphadenectomy was done. Report of pathology confirmed carotid body of three rather firm, tan colored tissue fragments measuring 5.5 cm × 5.2 cm that on section were solid with homogenous features.\nAfter surgery, the patient did not experience another attack of syncope and anticonvulsive drugs discontinued.
|
[[65.0, 'year']]
|
F
|
{'18298303': 1, '9046120': 1, '8053660': 1, '20864295': 1, '13975591': 1, '20016787': 1, '20045781': 1, '34248304': 1, '21262948': 1, '21747190': 1, '26722157': 1, '7103429': 1, '21187865': 1, '19563966': 1, '6583549': 1, '18417602': 1, '33598293': 1, '23914220': 2}
|
{'3724378-1': 2, '3724378-3': 2}
|
162,415 |
3724378-3
| 23,914,220 |
noncomm/PMC003xxxxxx/PMC3724378.xml
|
Convulsive syncope as presenting symptom of carotid body tumors: Case series
|
A 37-year-old woman was admitted to our hospital because of repeated attack of loss of consciousness for the last 3 months without any predisposing factor, aura and postictal period with duration of some seconds; her relative said that she became pale and unresponsive and sometimes ending to clonic movements of limbs when she did not have a recombinant position. She was healthy otherwise. The drug history and family history of epilepsy was negative; neurological examination was unremarkable but general examination revealed bilateral non tender, mobile, well defined masses in her neck.\nEEG did not show any epileptic discharges. ECG showed sinus rhythm at a rate of 70 beats/min, other cardiac investigation, including echocardiography and treadmill exercise test were in a normal range. Brain MRI showed no abnormality. Because of the neck masses multi slice CT angiography of the neck was done and revealed enhanced mass lesions on the carotid bifurcation bilateraly. Common carotid arteries, internal carotid arteries, vertebrobasilar arteries and thyroid glands were normal; these findings were mostly consistent with CBT. Cervical MRA and Doppler sonograghy confirmed this diagnosis.\nSurgery was performed for neck mass on the both sides. A 4 cm × 5 cm mass was removed from right carotid bifurcation and 3 cm × 4 cm mass from left side too. The patient passed post-operative period successfully and in the follow-up work up she became free from her pervious symptoms.
|
[[37.0, 'year']]
|
F
|
{'18298303': 1, '9046120': 1, '8053660': 1, '20864295': 1, '13975591': 1, '20016787': 1, '20045781': 1, '34248304': 1, '21262948': 1, '21747190': 1, '26722157': 1, '7103429': 1, '21187865': 1, '19563966': 1, '6583549': 1, '18417602': 1, '33598293': 1, '23914220': 2}
|
{'3724378-1': 2, '3724378-2': 2}
|
162,416 |
3725012-1
| 23,898,284 |
noncomm/PMC003xxxxxx/PMC3725012.xml
|
Multifocal Central Serous Chorioretinopathy Associated with Steroids in a Patient with Myasthenia Gravis
|
A 40-year-old white male was referred to our clinic due to a 15-day history of bilaterally blurred vision and metamorphopsia. He had a history of myasthenia gravis for which he had been treated with oral prednisolone and azathioprine during the last 2 years. His best-corrected visual acuity (BCVA) was 8/10 in the right eye (OD) and 9/10 in the left eye (OS).\nFundoscopy revealed a few small, yellow-whitish circumscribed macular elevations and one larger, irregularly shaped parafoveal elevation in OD (fig. ). Similar small macular lesions were also noted in OS. Fluorescein angiography showed multiple areas of early hyperfluorescence and late leakage in OD (fig. ). Similar but less pronounced angi-ography findings were seen in OS (fig. ). Optical coherence tomography (OCT) revealed RPE detachment, elevation of the neurosensory retina and highly reflective subretinal fluid mostly in OD (fig. ).\nThe diagnosis of multifocal CSCR was made. As the patient's myasthenia could not be optimally controlled at the time, the treating neurologist advised against prednisolone discontinuation. Unfortunately, we noticed further deterioration of the BCVA and subfoveal expansion of the subretinal fluid in OD, so it was decided to administer an intravitreal injection of ranibizumab in this eye. One month later, his BCVA had deteriorated to 3/10 in OD and 7/10 in OS. Fundoscopy revealed that the area below the fovea in OD was enlarged with the deposition of material presumed to be fibrin in the subretinal space. OCT demon-strated further elevation of the neurosensory retina and a more irregular subretinal accumulation of highly reflective material (fig. ). Indocyanine green angiography excluded neovascularization and polyp-like vascular abnormalities. Low-fluence photodynamic therapy (PDT) was performed. We administered verteporfin i.v. at a dose of 6 mg/m2 over 10 min, waited for 5 min and then directed the diode laser at the larger lesion of leakage in OD, using a wavelength of 689 nm and laser energy of 25 mJ/cm2. After the first application, the laser spot was directed at the second and the third lesion of leakage in OD (fig. ). As the patient's myasthenic symptoms improved, it became possible for the attending neurologist to reduce the dose of prednisolone, increase the dose of azathioprine and add neostigmine. One month later, and while undergoing prednisolone tapering, his BCVA in OD had improved to 6/10 with no subretinal fluid, while the area with the fibrin deposition had nearly disappeared (fig. ). The BCVA in OS improved to 10/10 over the next couple of months. To date, 1 year after treatment, the patient's BCVA remains stable at 6/10 in OD and 10/10 in OS with no signs of active disease. The patient's myasthenia is currently well controlled with azathioprine and neostigmine.
|
[[40.0, 'year']]
|
M
|
{'9121756': 1, '12431693': 1, '9202960': 1, '26638151': 2, '15019370': 1, '18214491': 1, '20930852': 1, '14660450': 1, '3306853': 1, '19041477': 1, '16732205': 1, '21475646': 1, '19184311': 1, '21427570': 1, '21668499': 1, '16877418': 1, '23898284': 2}
|
{'4670548-1': 1, '4670548-2': 1, '4670548-3': 1}
|
162,417 |
3725016-1
| 23,898,291 |
noncomm/PMC003xxxxxx/PMC3725016.xml
|
Advanced Ethmoid Sinus Adenocarcinoma Presenting as Temporary Exudative Retinal Detachment
|
A 70-year-old Caucasian man was referred with a 2-week history of reduced vision in the right eye. He had no past ocular or medical history and reported no systemic or neurologic symptoms. On examination, corrected visual acuity was 1/10 in the right eye and 20/20 in the left eye. Ocular motility and the anterior segment examination were normal. There was no proptosis. Intraocular pressures were 14 mm Hg in the right eye and 12 mm Hg in the left eye. The mode B ocular ultrasound detected a localized ERD involving temporal superior (fig. ). Examination of the posterior segment of the left eye was unremarkable.\nTwo weeks after presentation, the patient reported mild pain, and no vision in the right eye. On examination, visual acuity was no light perception in the right eye and 20/20 in the left eye. A right relative afferent pupillary defect and an external deviation of the right globe were noted (fig. ). The ERD had completely resolved (fig. ), and mottling of the retinal pigment epithelium was evident. Computed tomographic scan of the brain and orbits demonstrated a space-occupying lesion in the right ethmoid (fig. ). An excisional biopsy of the ethmoid lesion revealed an adenocarcinoma (fig. ). After stereotactic radiotherapy and chemotherapy, tumour recurrence occurred during the 10 months of follow-up. The patient died 2 months later.
|
[[70.0, 'year']]
|
M
|
{'21616740': 1, '9484939': 1, '15064075': 1, '19363711': 1, '6717909': 1, '14335138': 1, '20157059': 1, '12211046': 1, '14531627': 1, '23898291': 2}
|
{}
|
162,418 |
3725021-1
| 23,898,287 |
noncomm/PMC003xxxxxx/PMC3725021.xml
|
Atypical Presentation of a Pigmented Oncocytoma of the Caruncle: A Case Report
|
A 69-year-old woman was referred to the Ocular Oncology Service for the evaluation of a pigmented mass in the caruncular region of the right eye. The patient was regularly followed for chronic blepharoconjunctivitis in both eyes and dry eye syndrome, treated with lubricant eye drops. There was no history of eye surgery or trauma. The patient took daily medications for hypertension and was suspected to have rosacea. Aside from this, her personal medical history and family history were unremarkable.\nThe patient complained of a tan-colored lesion on her right caruncle, but denied symptoms of bleeding, discharge, an increase in size, or a color change of the lesion. On ocular examination, visual acuity was 20/20 and intraocular pressure was 16 mm Hg in both eyes. Slit lamp biomicroscopy revealed a well-circumscribed, partially pigmented lesion in the caruncle of the right eye. The lesion had a slightly lobulated surface with visible superficial vessels (fig. ). No involvement of the lacrimal system was noted, and the dilated fundus examination of both eyes was unremarkable. The patient was diagnosed with conjunctival nevus of the right caruncle.\nDue to the lesion's unfavorable location, the patient was advised to undergo complete surgical excision of the caruncular mass. The excised specimen was submitted for histo-pathological evaluation.\nHistopathological examination disclosed a benign, cystic, tubular, well-circumscribed lesion composed of tall, columnar, granular eosinophilic cells (fig. ). A thin fibrous tissue capsule penetrating the tumor from the periphery was also present. The pigmented macroscopic appearance of the lesion was thought to be due to concretions within the tumor (fig. ).\nA diagnosis of oncocytoma of the caruncle was made.
|
[[69.0, 'year']]
|
F
|
{'17519627': 1, '843279': 1, '1476982': 1, '7887854': 1, '9790111': 1, '29344489': 1, '21522047': 1, '28053800': 2, '14711437': 1, '7448149': 1, '8199108': 1, '21956543': 1, '12090093': 1, '23898287': 2}
|
{'5178330-1': 1}
|
162,419 |
3725023-1
| 23,898,269 |
noncomm/PMC003xxxxxx/PMC3725023.xml
|
Metastatic Castration-Resistant Prostate Cancer: Two Case Reports of Dramatic Response with Abiraterone Acetate in Patients Heavily Pretreated with Chemotherapy
|
In April 2004, a 58-year-old male presented with a PSA of 17.9 ng/ml, T3 and Gleason 7 (3 + 4) prostate adenocarcinoma. He underwent pelvic lymph node ablation, showing an invasion of the right ilio-obturatory nodes. A bone scan as well as a thoraco-abdominal CT were normal. The patient was treated with prostatic (70 G) and pelvic (50 G) radiation therapy, followed by gosereline acetate (10.8 mg every 3 months for 6 months). His post-treatment PSA nadir was 1 ng/ml in July 2004.\nIn October 2007, progression occurred with an increase in PSA, CT showing enlarged lumbo-aortic nodes as well as lumbar bone metastases. The patient began ADT with gosereline acetate (10.8 mg every 3 months) and bicalutamide 50 mg/day from June 2007 to December 2007, followed by spine radiation therapy. In January 2008, as PSA progressed, docetaxel (75 mg/m2 every 3 weeks with prednisone 10 mg daily/6 cycles) was started. A partial response was obtained, and ADT was resumed after chemotherapy. In January 2009, while PS was 1, a new progression occurred with bone pain, radiographic progression (bone, liver, hydronephrosis) as well as PSA increase. A mitroxantrone/prednisone treatment was proposed (10 mg/m2, 3 cycles), but treatment was poorly tolerated and the disease continued to progress.\nFrom 2009 through 2011, the patient received a total of 5 separate regimens for his progressing metastatic disease: zoledronic acid, stilboestrol, oral vinorelbine (80 mg weekly, 6 cycles), docetaxel (60 mg/m2, 3 cycles), and carboplatin/VP16 (3 cycles: carboplatin AUC 4 and VP16 100 mg/m2 for C1, carboplatin AUC 4 and VP16 80 mg/m2 for C2 and carboplatin AUC 3.75 and VP16 75 mg/m2 for C3). However, the disease progressed and PS deteriorated to 3.\nIn March 2011, a named-patient treatment with abiraterone was started at a dose of 1,000 mg/day together with prednisone 10 mg/day. Before abiraterone, PSA was 504 ng/ml and PS was 3; main metastatic lesions were located in the bones, lumbo-aortic nodes, liver, urinary tract (hydronephrosis) and lungs. Moreover, the patient had ascite and lower limb edema.\nQuickly after abiraterone initiation, the patient had a sharp clinical improvement (PS 1). Biological response (PSA decrease at 281 ng/ml) was obtained after 1 month of treatment. No side effects were attributed to abiraterone treatment. After 3 months of treatment, radiological partial response was achieved (fig. ) and PSA was 54 ng/ml with PS 1.\nIn August 2011, PS deteriorated, lower limb edema increased, and the patient died.
|
[[58.0, 'year']]
|
M
|
{'18519708': 1, '21612468': 1, '22995653': 1, '21859989': 1, '25057438': 1, '7608911': 1, '22170708': 1, '16287438': 1, '32743362': 2, '16278481': 1, '22373539': 1, '23898269': 2}
|
{'3725023-2': 2, '7292117-1': 1}
|
162,420 |
3725023-2
| 23,898,269 |
noncomm/PMC003xxxxxx/PMC3725023.xml
|
Metastatic Castration-Resistant Prostate Cancer: Two Case Reports of Dramatic Response with Abiraterone Acetate in Patients Heavily Pretreated with Chemotherapy
|
In 2000, a 49-year-old man presented with prostate adenocarcinoma with PSA at 6 ng/ml and Gleason score of 7 (3 + 4). He underwent a radical prostatectomy with pelvic lymph node ablation. After radical prostatectomy, the patient was staged pT2N0, but surgical margins were positive and intraprostatic lymphovascular invasion was diagnosed with no invasion of capsule or seminal vesicles. Gleason score was confirmed.\nIn September 2007, PSA monitoring showed an increase at 57 ng/ml. A CT showed enlarged iliac lymph nodes without metastases. Bicalutamide was started and PSA decreased to 1.2 ng/ml. In August 2008, upon increase in PSA, the patient began ADT (leuprolide 45 mg every 6 months). PSA dropped, but 1 year later, in August 2009, PSA was at 122 ng/ml and a CT showed retroperitoneal node enlargement. The patient began chemotherapy with docetaxel (75 mg/m2 every 3 weeks with prednisone 10 mg daily − 10 cycles). Partial node response was obtained and PSA dropped to 15 ng/ml after 10 cycles of docetaxel. In September 2010, progression was evident with bone and lung metastases and PSA at 666 ng/ml. Zoledronic acid was given and a second line of chemotherapy was proposed with cisplatin + VP16 (CDDP 75 mg/m2 and VP16 100 mg/m2 for C1, CDDP 67.5 mg/m2 and VP16 90 mg/m2 from C2/6 cycles). Stabilization was obtained until May 2011 when PSA rose to 1,069 ng/ml together with bone pain. PS was good at 0. A named-patient treatment with abiraterone was started at a dose of 1,000 mg/day together with prednisone 10 mg/day. After 1 month of abiraterone, PSA dropped to 143 ng/ml. Abiraterone was well tolerated. In December 2011, the patient remained in very good shape (PS 0, and PSA 14.8 ng/ml). A CT showed response of lung lesions (fig. ). Then, the disease remained stable until May 2012 with a bone scan indicating progressive bone metastases, while CT lung and node lesions remained stable. In August 2012, PSA was at 2,025 ng/ml and abiraterone was stopped. Chemotherapy was resumed with cabazitaxel (25 mg/m2 − 3 cycles). Tolerance was good and PSA dropped to 1,208 ng/ml after C2.
|
[[49.0, 'year']]
|
M
|
{'18519708': 1, '21612468': 1, '22995653': 1, '21859989': 1, '25057438': 1, '7608911': 1, '22170708': 1, '16287438': 1, '32743362': 2, '16278481': 1, '22373539': 1, '23898269': 2}
|
{'3725023-1': 2, '7292117-1': 1}
|
162,421 |
3725024-1
| 23,898,288 |
noncomm/PMC003xxxxxx/PMC3725024.xml
|
Management of Pediatric Traumatic Macular Holes – Case Report
|
A 12-year-old boy presented with sudden unilateral visual loss following a blunt trauma with a bottle cork in a mildly amblyopic left eye. At presentation, the initial visual acuity (iVA) was hand motion in the left eye and 20/20 in the right eye. Anterior segment examination revealed hyphema, corneal edema and red fundus reflex absence. The patient underwent an ocular ultrasound which excluded the presence of a retinal detachment. Eight days later the child was reassessed: no hyphema was identified, visual acuity (VA) remained hand motion and a macular hole was detected on fundus biomicroscopy (fig. ). An OCT was performed which confirmed a full-thickness macular hole (fig. ) with posterior vitreous attachment. One day later the patient underwent surgery as described above. One month after surgery, the OCT confirmed closure of the macular hole and VA had improved to 20/50, which remained stable until the end of the follow-up.
|
[[12.0, 'year']]
|
M
|
{'11508892': 1, '11320012': 1, '12834697': 1, '18797673': 1, '9339035': 1, '9754166': 1, '9098285': 1, '12208244': 1, '17870044': 1, '28239490': 1, '11812427': 1, '12383820': 1, '9535631': 1, '10546935': 1, '17056374': 1, '10546953': 1, '8912978': 1, '15751261': 1, '34408388': 1, '9355183': 1, '5772720': 1, '11475397': 1, '10546936': 1, '18464183': 1, '12652242': 1, '21733168': 2, '23898288': 2}
|
{'3725024-2': 2, '3725024-3': 2, '3725024-4': 2, '3224546-1': 1}
|
162,422 |
3725024-2
| 23,898,288 |
noncomm/PMC003xxxxxx/PMC3725024.xml
|
Management of Pediatric Traumatic Macular Holes – Case Report
|
A 10-year-old girl was hit by a soccer ball followed by sudden visual loss in the left eye. At that time the VA was 20/400 in the left eye and 20/20 in the right eye. Anterior segment examination was unremarkable. Fundus biomicroscopy revealed a lamellar hole, confirmed by OCT (fig. ), which turned into a full-thickness macular hole identified 8 days after trauma (fig. ). Surgery was performed the following day. One week after surgery, fundus examination revealed closure of the macular hole, and by the end of the first month, the best corrected VA (BCVA) was 20/50. One year later the VA was 20/30, with maintenance of macular hole closure (fig. ).
|
[[10.0, 'year']]
|
F
|
{'11508892': 1, '11320012': 1, '12834697': 1, '18797673': 1, '9339035': 1, '9754166': 1, '9098285': 1, '12208244': 1, '17870044': 1, '28239490': 1, '11812427': 1, '12383820': 1, '9535631': 1, '10546935': 1, '17056374': 1, '10546953': 1, '8912978': 1, '15751261': 1, '34408388': 1, '9355183': 1, '5772720': 1, '11475397': 1, '10546936': 1, '18464183': 1, '12652242': 1, '21733168': 2, '23898288': 2}
|
{'3725024-1': 2, '3725024-3': 2, '3725024-4': 2, '3224546-1': 1}
|
162,423 |
3725024-3
| 23,898,288 |
noncomm/PMC003xxxxxx/PMC3725024.xml
|
Management of Pediatric Traumatic Macular Holes – Case Report
|
A 9-year-old boy was hit by a soccer ball with sudden visual loss in the left eye. iVA was 20/400 in the left eye and 20/20 in the right eye. Anterior segment examination showed no lesions. Fundus biomicroscopy revealed a macular hole, confirmed by OCT (fig. ). Surgery was performed the following day. One week later, OCT confirmed closure of the macular hole. One month later, the BCVA was 20/50. After 6 months of follow-up, the VA was 20/40, with maintenance of macular hole closure (fig. ).
|
[[9.0, 'year']]
|
M
|
{'11508892': 1, '11320012': 1, '12834697': 1, '18797673': 1, '9339035': 1, '9754166': 1, '9098285': 1, '12208244': 1, '17870044': 1, '28239490': 1, '11812427': 1, '12383820': 1, '9535631': 1, '10546935': 1, '17056374': 1, '10546953': 1, '8912978': 1, '15751261': 1, '34408388': 1, '9355183': 1, '5772720': 1, '11475397': 1, '10546936': 1, '18464183': 1, '12652242': 1, '21733168': 2, '23898288': 2}
|
{'3725024-1': 2, '3725024-2': 2, '3725024-4': 2, '3224546-1': 1}
|
162,424 |
3725024-4
| 23,898,288 |
noncomm/PMC003xxxxxx/PMC3725024.xml
|
Management of Pediatric Traumatic Macular Holes – Case Report
|
A 15-year-old boy was hit on his left eye by a soccer ball. At presentation, iVA of the affected eye was hand motion. The adnexa and anterior segment were unremarkable. Fundoscopy showed little intraretinal hemorrhages, commotio retinae in the posterior pole, and the presence of a macular hole. The OCT revealed a full-thickness macular hole with hyaloid still attached (fig. ). The patient underwent surgery 2 days later. Five days after surgery, the OCT confirmed macular hole closure (fig. ) and the VA was counting fingers. Follow-up observations showed sustained heterogeneous areas of retinal pallor mingled with hyperpigmentation zones and maintenance of macular hole closure. The OCT revealed disorganization of the retinal layers with foveal atrophy and disruption of the photoreceptor layer. The VA remained in counting fingers until the end of the follow-up.\nVery little can be found in the literature regarding pediatric TMH management and its results compared to adult population.\nWu et al. [] presented a case series with TMH in which 13 pediatric patients (1–15 years old) were submitted to plasmin-assisted vitrectomy, membrane peeling and gas or silicone oil injection, followed by prone position for 7 days. The macular hole closed in 12 (92%) patients. fVA could be measured only in 12 of 13 patients. From those, 11 (92%) patients had VA improvement of 2 or more lines and six (50%) achieved vision of 20/50 or better; all patients achieved a vision better than 20/200.\nWachtlin and associates [] reported a case series of four pediatric patients with TMH (10–15 years old). All patients underwent pars plana vitrectomy with platelet concentrate, internal limiting membrane (ILM) peeling, and gas tamponade for stage 3 TMH repair. Primary closure was achieved by a single intervention in all patients, with a visual improvement of three to seven lines after surgery. The surgically achieved visual improvement remained stable during the follow-up and no complications were reported.\nIn 2007, Brasil and Brasil [] reported a single case of a 9-year-old boy with a TMH who gained vision from 20/300 to 20/70 after surgery with ILM peeling and silicone oil tamponade, which remained stable one year after the silicone oil removal.\nOn the other hand, the surgical outcomes of TMH in adults have been analyzed in multiple retrospective case series. Closure rate varies from 92 to 100% and fVA <20/40 from 38 to 48% [, , , , , ].\nRubin et al. [] presented a case series of 12 consecutive patients with TMH who underwent vitrectomy, fluid-gas exchange and instillation of bovine or recombinant transforming growth factor beta-2. The closure rate was 92%, repeated surgery having been necessary in 3 patients. The BCVA improved by at least 2 lines in 8 (67%) of 12 eyes. Six (50%) of 12 eyes improved to 20/40 or better.\nAnother reference of the use of platelet concentrate was reported by García-Arumí and associates [] who presented the surgical outcomes of 14 eyes with full-thickness TMH submitted to pars plana vitrectomy with posterior hyaloid dissection, followed by complete fluid-gas exchange, and instillation of 0.1 ml of platelet concentrate just over the macular hole. Closure rate was 93% (13 of 14 eyes), with a vision improvement of at least 4 Snellen lines in every closed hole. The mean fVA was 20/30, and two patients had a fVA of 20/20. No intra- or postoperative complications were noted.\nSeveral studies have demonstrated the benefits of vitrectomy without adjunctive therapy, but almost exclusively in adults.\nIn the series of Amari et al. [] and Chow and associates [] the final closure rate of 96 and 94%, respectively, and a VA improvement of at least two lines in more than 70% of patients were obtained without any adjunctive therapy.\nIn 2001, Kuhn et al. [] reported the benefits of ILM removal in a case series of 17 consecutive TMH patients. All patients were submitted to vitrectomy and ILM removal with no adjuvant therapy. Results showed 100% closure rate. Vision improved by at least 2 Snellen lines in 16 (94%) eyes.\nMore recently, a multicenter case series of 25 TMH cases was published, and the authors observed a 96% closure rate and a vision of 20/50 or better in 64% of the eyes [].\nSome cases of TMH spontaneous resolution have also been published. In total we found 37 cases of spontaneous TMH closure and the majority of them occurred in children [, , , , , , , , , , ]. All the holes closed within up to one year, and 55% within up to three months of trauma [, , , , , , , , , , ]. Therefore, some authors advocate at least an initial period of observation instead of an early intervention []. Although our series is too small to postulate the benefits of an early intervention some features should be highlighted. The iVA in the eyes with spontaneously closed TMH was 20/400 or better in 70.3%, the size of the hole was equal to or less than 0.2 disk diameter (DD) in at least 75.7% of the eyes and 40.5% of the patients were more than 15 years old. On the contrary, all our patients had iVA of 20/400 or worse, the macular hole size was superior to 0.3 DD and our oldest patient was 15 years old. Therefore, spontaneous closures of TMH described are mostly in patients with small holes and VA above 20/400. Larger holes seem to result from higher kinetic energy which causes more severe retinal edema, RPE damage, subretinal bleeding with its possible photoreceptor toxicity, and retinal necrosis with tissue loss. These factors may contribute to inability to reappose the retinal edges by the contracting fibroglial tissue, limiting the reparative process to flattening of the retinal edges surrounding the hole []. From the 37 cases described, only 11 had fluid cuff described, and all but one had the posterior hyaloid attached, thus having a higher probability to spontaneously close. Also the patients that ended up with a BCVA ≥20/25 (12 patients] had holes ≤0.2 DD, initial BCVA between 20/200 and 20/40, and only two had fluid cuff present.\nRegarding only the case series that reported a spontaneous closure rate of TMH [, , ] one can say that most of them did not close spontaneously: only 13 of 34 (38.2%) TMH resolved spontaneously. Few data is found regarding the numbers of non-closing TMH managed with an observational attitude. What size were they? What were their anatomical features? How old were the patients? What was the initial BCVA? And most of all, what was the final BCVA on holes that remained unclosed? Would these patients benefit in the same way with surgery after waiting so long?\nTMH are less frequent than idiopathic ones, have a different pathogenesis and do not have a well-established management guideline, especially in pediatric patients. However, several well-documented retrospective case series have actually shown very similar surgical outcomes for idiopathic and TMH [, , ]. The use of platelet concentrate and autolo-gous plasmin has been described, although more studies are necessary.\nSome authors claim that an observation period of 3 to 6 months is advised, especially in young patients with small holes, good iVA and posterior vitreous adhesion to the TMH edges due to the higher possibility of spontaneous resolution. In the remaining cases the possibility of spontaneous closure is low [, , , , , , ].\nThe photoreceptor damage is more likely, the longer the delay. The consequences of a long period of waiting for the spontaneous closure of the macular hole have not been clarified. Few series have been published concerning this matter, all of them with few cases and controversial results. Many questions remain controversial and unanswered. Until when should we wait? Authors have reported the enlargement of macular hole during the follow-up [] with unclear consequences. Which is the best timing to intervene? Which TMH are more suitable to spontaneously close? Is the probability the same regardless of the child's age? Should we wait in patients in amblyopic ages, in patients with only one eye, or in patients with previous low vision? What impact could this situation have in the psychomotor development in these ages?\nIn conclusion, early pars plana vitrectomy with ILM peeling and gas tamponade seems to be a safe and effective choice for the therapy of TMH in pediatric patients. When compared to spontaneous closure results found in the literature, the surgical closure rate is higher and the fVA is slightly better after vitrectomy. We believe that early vitrectomy could facilitate and accelerate the closure process, preventing irreversible structural changes and consequent permanent damage.\nHigh-resolution cross-sectional retinal images provided by OCT add new data to the understanding of pathogenesis of TMH and may help in management decisions.
|
[[15.0, 'year']]
|
M
|
{'11508892': 1, '11320012': 1, '12834697': 1, '18797673': 1, '9339035': 1, '9754166': 1, '9098285': 1, '12208244': 1, '17870044': 1, '28239490': 1, '11812427': 1, '12383820': 1, '9535631': 1, '10546935': 1, '17056374': 1, '10546953': 1, '8912978': 1, '15751261': 1, '34408388': 1, '9355183': 1, '5772720': 1, '11475397': 1, '10546936': 1, '18464183': 1, '12652242': 1, '21733168': 2, '23898288': 2}
|
{'3725024-1': 2, '3725024-2': 2, '3725024-3': 2, '3224546-1': 1}
|
162,425 |
3725026-1
| 23,898,273 |
noncomm/PMC003xxxxxx/PMC3725026.xml
|
The Role of Radical Surgery in the Management of Acquired Uterine Arteriovenous Malformation
|
A 32-year-old G3P2012 presented with sonographic findings indicating a cesarean scar ectopic pregnancy. The lower uterine segment was 6 mm thick, incorporating the bladder, uterine serosa, myometrium, decidua and trophoblast. She consented to undergo diagnostic laparoscopy, dilation and curettage. Laparoscopically, the uterine serosa appeared normal. During the curettage she had a 1.5-liter postpartum hemorrhage, which stopped after placement of an intrauterine compression balloon as a tamponade.\nThe patient subsequently presented with profuse vaginal bleeding requiring a blood transfusion. Ultrasound revealed a multicystic structure with low-resistance arterial flow on Doppler, inseparable from the anterior lower uterine segment (fig. ). MRI demonstrated multiple, enlarged vessels extending from the myometrium to the left broad ligament, which raised suspicion of an AVM (fig. ). A pelvic and selective bilateral uterine arteriography was performed. The left uterine arteriography suggested the presence of a large, high-flow arteriovenous fistula (AVF), with drainage through the left internal iliac vein and left gonadal vein. The lesion was successfully embolized with coils, and an angiogram confirmed cessation of the flow. Other multiple, small AVFs supplied by both uterine arteries were considered clinically insignificant given the occlusion of the larger AVF.\nFour days following coil placement, the patient experienced acute vaginal hemorrhage. Repeat angiography demonstrated a hypervascular midline mass arising from the anterior division of the internal iliac arteries bilaterally, without a dominant feeding artery. Angiographically, these represented multiple, small AVFs, which were larger and more numerous than those previously noted, consistent with acquired AVM (fig. ). Given her recurrence of symptoms despite vascular embolization with coils, a step-wise procedure was planned: Gelfoam (Pfizer, New York, N.Y., USA) bilateral embolization of the internal iliac arteries, followed by a hysterectomy.\nGelfoam embolization of the internal iliac arteries resulted in a 40–60% reduction in vascularity of the uterine AVM (fig. ). Grossly, the AVM originated from the prior hysterotomy site and extended into the left parametrium. The right uterine vessels and cardinal ligaments were found to have compensatory engorgement. The AVM extended into the left parametrium and left pelvic sidewall. This anatomy necessitated a radical hysterectomy for complete excision. Dissection of the potential spaces of the pelvis was undertaken, and the bladder and left ureter were dissected away from the AVM.
|
[[32.0, 'year']]
|
F
|
{'19513893': 1, '16738166': 1, '26413002': 1, '11796896': 1, '19452327': 1, '29628618': 1, '26929872': 1, '32756152': 2, '14605105': 1, '7860055': 1, '22106189': 1, '23898273': 2}
|
{'7402736-1': 1}
|
162,426 |
3725027-1
| 23,898,276 |
noncomm/PMC003xxxxxx/PMC3725027.xml
|
Radiation-Induced Esophagitis Exacerbated by Everolimus
|
A 63-year-old man was diagnosed with RCC (papillary cell carcinoma) and underwent a nephrectomy in December 2006. Four years later, lung metastases were found and a lung metastasectomy was performed. However, the lung metastases recurred in June 2011, and sunitinib therapy was initiated. The lung metastases improved, and the sunitinib treatment was continued for 12 months. In July 2012, the patient complained of back pain, and magnetic resonance imaging and a technetium bone scintigraphy examination revealed multiple vertebral metastases. Treatment with everolimus (10 mg daily) was initiated as second-line systemic therapy, and nonsteroidal anti-inflammatory drugs as well as oxycodone analgesics were also administered. One week later, the patient's back pain persisted, and we temporarily discontinued the everolimus treatment and initiated irradiation to the T6–10 vertebrae at 30 Gy in 10 fractions over a 2-week period. Everolimus (10 mg daily) was reinitiated immediately after the completion of the radiotherapy. One week after receiving the everolimus, the patient complained of dysphagia, nausea and vomiting. An endoscopic examination of the esophagus showed erosive esophagitis in the middle to lower portions of his thoracic esophagus (fig. ), corresponding to the irradiation field (fig. ). Everolimus was discontinued, and his symptoms gradually resolved. One month later, a repeat endoscopy showed a remarkable improvement in the esophageal erosions (fig. ).\nWritten informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent form is available for review by the editor of this journal.
|
[[63.0, 'year']]
|
M
|
{'15940265': 1, '20921209': 1, '21268715': 1, '21278224': 1, '20864273': 1, '8778606': 1, '23335087': 1, '12499272': 1, '16168567': 1, '17396045': 1, '19147764': 1, '23898276': 2}
|
{}
|
162,427 |
3725029-1
| 23,898,289 |
noncomm/PMC003xxxxxx/PMC3725029.xml
|
A Case of Dengue Maculopathy with Spontaneous Recovery
|
A 25-year-old female with good past health presented to a general hospital in Hong Kong with a 2-day history of fever, headache and retro-orbital pain preceded by papular rash over both hands and both feet. She had recently travelled to Indonesia. Her vital signs were stable, and her body temperature was 39°C. No lymphadenopathy was noted clinically. Systemic workup revealed lymphopenia, neutropenia, thrombocytopenia and a negative culture for sputum, blood and stool, and the patient was negative for anti-HIV antibodies, malaria, leptospira and rickettsial antibodies. Immunoglobulin M for dengue virus was negative at the time of presentation. Real-time PCR for dengue virus type 1 was positive so that the diagnosis of dengue fever was confirmed. The patient received supportive treatment for her systemic disease.\nFour days after admission, the patient complained of a paracentral absolute scotoma in her left eye. On examination, the Snellen visual acuity in her right and left eye was 20/25 and 20/60, respectively. There was no relative afferent pupillary defect or loss of colour perception on Ishihara test plates. Amsler chart testing showed a round, absolute scotoma inferotemporal to the fixation point in her left eye. Intraocular pressure was normal, and anterior segment examination was unremarkable. Fundal examination showed an area of retinal infiltrate and a haemorrhage superonasal to the fovea in her left eye and some retinal pigment epithelium (RPE) changes in her right eye (fig. ). There were no signs of vitritis or vasculitis.\nSpectral-domain optical coherence tomography (OCT) was performed and showed retinal thickening corresponding to the area of retinitis and haemorrhage. There was no foveolitis (fig. ). Multifocal electroretinogram (ERG) showed a reduction in first-order kernel responses at the central maculae of both eyes (more severe in the left eye) (fig. ). The working diagnosis was dengue maculopathy. The option of steroid treatment was discussed with the patient. In view of leucopenia secondary to dengue fever and the absence of a proven benefit of steroid treatment, the patient opted for observation.\nOne week after the onset of visual symptoms, the vision of her left eye deteriorated to 20/250. There was suspicion of other viral retinitis secondary to her immunocompromised state. Aqueous tapping with an aseptic technique was performed and sent for PCR for cytomegalovirus, herpes simplex and varicella zoster viruses. The patient opted for empirical treatment with oral valganciclovir 900 mg bid for a few days until the results of the PCR were negative.\nEleven days after visual symptom onset, the patient's condition started to improve with less retinal haemorrhage and resolving retinitis. One week later, her vision returned to normal. After 9 months, her Snellen best-corrected visual acuity was stable at 20/20, but there were a persistent reduction in retinal responses on multifocal ERG and a persistent paracentral scotoma.
|
[[25.0, 'year']]
|
F
|
{'15522372': 1, '17030709': 1, '18617754': 1, '16494756': 1, '11549879': 1, '12686878': 1, '19800610': 1, '15890137': 1, '20094013': 1, '17561258': 1, '12089096': 1, '17638819': 1, '12436482': 1, '23898289': 2}
|
{}
|
162,428 |
3725030-1
| 23,898,272 |
noncomm/PMC003xxxxxx/PMC3725030.xml
|
An Unusual Location of Extraosseous Ewing's Sarcoma
|
An 18-year-old female presented with a painful swelling in the left upper quadrant of her abdomen. She became aware of this problem 4 days before presentation. There was no history of previous illness, nor did she take any medication. Physical examination revealed a tender, painful spot and palpable mass in the left upper quadrant of the abdomen.\nBiochemistry indicated an elevated C-reactive protein value (14 mg/dl, normal <1). Tumor marker carbohydrate antigen (CA) 125 was within normal range and the lactate dehydrogenase value was not elevated.\nUltrasonographic evaluation revealed a structure in the left upper quadrant, inferior to the left kidney measuring 7 × 9.5 cm. There were calcifications visible and the study in Doppler mode revealed no apparent blood flow.\nSubsequent abdominal computed tomography (CT; fig. , fig. ) confirmed a nodular mass in the left upper quadrant measuring 6.5 × 7.5 × 10 cm. The mass was partially solid, partially cystic and had some calcifications. This mass was situated inferior to the left kidney. The spleen and pancreas were situated superior to this structure, the descending colon was posterior to this lesion and was closely related to it. The medial border of this mass was in close contact with the distal part of the transverse colon and the stomach. There was also contact with the jejunal part of the small intestine and a diffuse infiltration of the surrounding fatty tissue. There was no obvious lymphadenopathy and there were no intra-abdominal metastases.\nA CT scan of the thorax did not detect thoracic metastases. Colonoscopy was normal except for a small nodule at the cecum, which anatomopathological investigations confirmed to be a submucosal lymphoid nodule.\nExcisional surgery was planned and median laparotomy was performed. Exploration revealed that the tumor was located partially in the omentum majus and partially fixed in the retroperitoneum inferior to the spleen. There was no evidence of peritoneal or hepatic metastases during surgery, nor a connection with the small or large intestine. A wide excision of the lesion with a surrounding envelope of fatty tissue was performed. Perioperative frozen section after resection suggested the presence of a mesenchymal tumor.\nThe specimen weighted 260 g. It consisted of omental fat and peritoneum with a well-defined, encapsulated multinodular mass of 9 × 5.5 × 5.5 cm. Cross-section revealed a solid washed-out lesion with inlying yellow zones and a macroscopic aspect of necrosis.\nThe tumor was well defined with large inlying islands of necrosis. The tumor cells were monotonous and were closely packed together. The nuclei were of oval shape, irregular and had a notch. There was a moderate mitotic activity. The cytoplasm was vacuolated or lucid. Some cells were separated by connective tissue. Some tumor cells contained periodic acid-Schiff (PAS)-positive granules in the cytoplasm (fig. ).\nThe tumor that was resected during the laparotomy was positive for vimentin (fig. ) and CD99 (fig. ) (membranous) and negative for keratin, S-100, WT1, neuroendocrine marker (synaptophysin), inhibin, CD45, calretinin, CD117, CD34 and muscle markers (smooth cell actin and desmin). The morphologic and immunophenotype was consistent with ES. Molecular analysis by fluorescent in situ hybridization (FISH) confirmed an ES gene (EWS) rearrangement.\nThere were no postoperative complications. The patient was discharged from the hospital in good health on the 4th postoperative day. A whole-body positron emission tomography (PET)/CT scan was performed 4 weeks after surgery, which revealed no evidence for hypermetabolic activity.\nTwo months after treatment, the patient underwent laparoscopic resection of the left adnexa for cryopreservation. During this laparoscopy, 2 lesions of endometriosis were discovered and excised. The adjuvant chemotherapy regimen consisted of a 3-drug regimen including vincristine, ifosfamide and doxorubicin. There were 8 cycles planned every 3 weeks. After the first cycle, the patient had neutropenic fever which necessitated intravenous antibiotics. The subsequent second cycle was given in combination with neurokinine-1 receptor antagonist and granulocyte colony-stimulating factor (pegfilgrastim).\nA CT scan of the thorax and abdomen 3 months after surgery revealed no recurrence.\nAfter the third cycle, the patient had neutropenic fever and severe thrombopenia. The patient received intravenous antibiotics and a pool of thrombocytes. There were no other problems reported during the last 5 cycles of chemotherapy. The 6th cycle was one with a dose reduction of doxorubicin and ifosfamide (80%). During this regimen, she received intramuscular injections of luteinizing hormone releasing hormone to protect the right ovary.\nThe PET/CT scan performed 6 months after chemotherapy revealed no evidence for local, lymphatic or hematogenic recurrence. Ultrasound evaluation of the abdomen and X-ray of the chest revealed no recurrence 14 months after surgery.
|
[[18.0, 'year']]
|
F
|
{'17487851': 1, '21292083': 1, '10385445': 1, '18525337': 1, '17541349': 1, '20478118': 1, '19834301': 1, '11481351': 1, '29904480': 1, '11878783': 1, '21753790': 1, '25608963': 2, '4751919': 1, '8683375': 1, '16317751': 1, '1522903': 1, '9747829': 1, '15838394': 1, '19533369': 1, '11573731': 1, '8387809': 1, '21603018': 2, '1384659': 1, '30544742': 1, '10963639': 1, '27186040': 1, '8428791': 1, '16411206': 1, '15465200': 1, '12400989': 1, '1283315': 1, '11285617': 1, '5334502': 1, '26280743': 1, '16544300': 1, '14687792': 1, '21518191': 1, '17334332': 1, '14871959': 1, '17898809': 1, '33552288': 1, '17924404': 1, '8022439': 1, '34307115': 2, '17572479': 1, '12504050': 1, '23898272': 2}
|
{'3095240-1': 1, '4307901-1': 1, '8299103-1': 1}
|
162,429 |
3725033-1
| 23,898,290 |
noncomm/PMC003xxxxxx/PMC3725033.xml
|
Intraocular Surgery in Kyphosis: An Easier Approach
|
A 49-year-old obese male with controlled secondary glaucoma needed cataract surgery in the right eye. He had ankylosing spondylitis-related extreme kyphosis and a neck in fixed flexion. His pulmonary reserve was also very low. The past ocular history was positive for recurrent uveitis and glaucoma shunt surgery in the right eye. The pupil was small and fixed from posterior synechia. Cataract density was +4, and the best-corrected visual acuity was 20/200. The anterior chamber was shallow and the glaucoma shunt tube was visible at the 11 o'clock position. The patient was planned for pupillary dilation using iris retraction hooks, lens capsule staining with trypan blue and phacoemulsification with intraocular implantation under local anesthesia. The anesthesiologist was reluctant to use general anesthesia because of the patient's disability and poor health.\nIn the operating room, the patient could only recline to about 40° from the vertical axis despite maximal reverse Trendelenburg position and a number of pillows under his back, neck, head and legs (fig. ). With the surgeon at the temporal side of the patient, the eye was also seen reclining at 40° (fig. ). While trying to focus the microscope, it became evident that by grasping the eye at the inferior limbus with a fine forceps and pulling it upwards, it could be moved to a more desirable horizontal position. A single 7/0 VicrylTM (polyglactin) corneal retraction suture was placed at the limbus at the 6 o'clock position to achieve the desired view (fig. ). The assistant surgeon was able to rotate the eye to the desired positions during the whole procedure by relaxing or pulling the suture. There were no intraocular complications, and the postoperative recovery was uneventful. The final best-corrected visual acuity was 20/30.
|
[[49.0, 'year']]
|
M
|
{'4448534': 1, '8064616': 1, '16246791': 1, '9051493': 1, '7722903': 1, '11008060': 1, '7791042': 1, '8523272': 1, '23898290': 2}
|
{}
|
162,430 |
3725034-1
| 23,898,271 |
noncomm/PMC003xxxxxx/PMC3725034.xml
|
Voltage-Gated Potassium Channel Antibody Paraneoplastic Limbic Encephalitis Associated with Acute Myeloid Leukemia
|
In December 2009, a 79-year-old man was diagnosed with an AML with minimal maturation (AML 1), normal karyotype, activating mutation of the FMS-like tyrosine kinase-3 internal tandem duplication (FLT3-ITD), and no mutation of NPM1, CEBPα1, or CEBPα2.\nThe patient had neither prior health problems nor cognitive disturbances. He received induction treatment with idarubicin and cytarabine, achieving complete response.\nInduction was followed by consolidation treatment: six courses of daunorubicin and cytarabine, the last one performed in July 2010.\nIn March 2011, anemia, thrombocytopenia and hyperleukocytosis recurred, leading to the diagnosis of relapsed AML 1 with persistence of FLT3-ITD. The patient received an oral FLT3 inhibitor, achieving complete response. He was treated with 10 mg of amlodipine and 16 IU of insulatard.\nIn June 2011, evolution occurred with onset of confusion. He lost orientation to place and time, and his nycthemeral rhythm was disturbed expressing agitation in the night and vigilance disturbances. Neurological examination found no motor/sensitive deficiency, the reflexes were not perceived but an extrapyramidal rigidity was noted. Basic blood laboratory tests revealed an isolated hyponatremia (125 mmol/l). No evident etiology was found to explain this disturbance. Laboratory examination of the cerebrospinal fluid revealed an elevated protein concentration (0.69 g/l), normal cell count and no malignant cells, normal lactate, normal glucose, negative 14.3.3 protein, negative screening for herpes simplex virus and HHV6 by polymerase chain reaction, and sterile bacterial, viral or fungal cultures. Brain magnetic resonance imaging (MRI), 2 months after the onset, was considered normal. An electroencephalogram (EEG) showed non-specific bilateral slow waves. Serum evaluation for antithyroid antibodies was negative. Screening for plasmatic antinuclear antibodies and antineutrophil cytoplasmic antibodies was negative. There was no vitamin deficiency. Despite stopping all treatments and natremia correction, the patient presented with a rapidly progressive dementia with hallucinations, extrapyramidal and pyramidal rigidity affecting the limbs and the axis, without seizures or myoclonus, resulting in death in September 2011. The family refused an autopsy.\nWe received the results of the blood screening of neuronal autoantibodies after the patient's death and detected the presence of anti-VGKC antibodies at 102 pmol/l (normal at <30 pmol/l), on a radioimmunoassay. Anti-Lgi1 and anti-Caspr2 antibodies were both negative. All other tested neuronal antibodies remained negative. The diagnosis of postmortem anti-VGCK paraneoplastic limbic encephalitis was finally made.
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[[79.0, 'year']]
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M
|
{'25648431': 2, '20724950': 1, '18339348': 1, '19996080': 1, '19235472': 1, '18668637': 1, '31941873': 1, '25520958': 1, '25574194': 1, '22223504': 1, '18930300': 1, '22136379': 1, '15258215': 1, '21777830': 1, '27439460': 2, '23898271': 2}
|
{'4320461-1': 1, '4955157-1': 1}
|
162,431 |
3725351-1
| 23,901,314 |
noncomm/PMC003xxxxxx/PMC3725351.xml
|
Diagnosis of a Malignant Intramammary Node Retrospectively Aided by Mastectomy Specimen MRI-Is the Search Worth It? A Case Report and Review of Current Literature
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A 61-year-old female was presented to the breast clinic with complaints of a lump in the right breast since the past 3 months. On examination, a lump was palpated in the right upper-outer quadrant without any palpable axillary nodes. The contralateral breast and axilla were clear. Mammography showed a high density lesion in the upper outer quadrant of the right breast with perilesional architectural distortion and spiculations (). The MRI showed a soft tissue mass showing irregular spiculated margins in the upper outer quadrant of the right breast which was hypointense on T1W images and hyperintense on Short Tau (t) (inversion time) Inversion Recovery (STIR) images; further, it showed areas of restricted diffusion at the periphery. Another similar appearing nodular lesion was noted at the right 12 o'clock position measuring approximately 5 mm (). It showed a homogeneous contrast enhancement with rapid increase in signal intensity on the postcontrast scan, followed by a washout-type II signal intensity curve favoring a malignant lesion. A second-look ultrasound examination was performed, presenting a tiny hypoechoic nodule (). With the lesion being small, an ultrasound-guided FNAC was attempted in the same sitting, which was negative for malignancy. The lesion was classified as indeterminate and the patient underwent modified right radical mastectomy with axillary node sampling. Sentinel lymph node biopsy and lymphoscintigraphy are not routinely performed at out institution. The final histopathology was reported as infiltrating ductal carcinoma; grade II without nodal involvement as the axillary nodes were negative. The smaller lesion was not evaluated in pathological grossing owing to its size. As the lesion was highly suspicious for malignancy, the resected pathology specimen was subjected to an MRI examination .The specimen MRI confirmed the STIR hyperintense lesion observed previously (). The lesion was then localized under MR guidance and methylene blue was injected at the site (). The specimen was sent back for regrossing and pathology examination. Additional sections were taken from the marked region, which showed intramammary node with metastasis from ductal carcinoma without perinodal extension (). Thus, the disease was then labeled as follows: carcinoma with axillary node-negative but metastatic intramammary node, which upgraded the disease to stage II. The patient was placed on adjuvant systemic therapy and close follow-up, as the presence of intramammary node correlates with poorer overall prognosis.
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[[61.0, 'year']]
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F
|
{'8240892': 1, '19800463': 1, '6701374': 1, '3000154': 1, '16449185': 1, '9114083': 1, '15316905': 1, '16978960': 1, '18248563': 1, '18066627': 1, '21788008': 1, '19171479': 1, '23901314': 2}
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{}
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162,432 |
3725358-1
| 23,901,321 |
noncomm/PMC003xxxxxx/PMC3725358.xml
|
Fluoroscopic Guided Fogarty Embolectomy for an Angio-Seal Embolism in the Popliteal Artery
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A 47-year-old man underwent percutaneous coronary intervention (PCI) secondary to unstable angina. The right common femoral arterial puncture site was closed with an Angio-Seal. There was no definite immediate complication, and the patient was discharged from the hospital.\nTwo days after the PCI, he presented pain and numbness of the right calf. Symptoms were progressively aggravated in the following week. He revisited the hospital eight days after the procedure. Upon physical examination, there was no evidence of hematoma or pseudoaneurysm at the puncture site. Ultrasonography showed presumed aggregated collagen with bright echogenic anchor of the Angio-Seal device in the right popliteal artery ().\nA left femoral artery puncture was made, and right lower extremity angiography was performed with a 5 Fr catheter. Total occlusion of the distal popliteal artery was observed in angiography (). Correlating with ultrasonography, a right popliteal artery occlusion due to the Angio-Seal that had broken away from its original location was diagnosed. The arteries distal to the occlusion were reconstituted by collateral vessels, showing reduced but persistent lumens.\nUnder local anesthesia, the right common femoral artery was exposed by a cardiothoracic surgeon. An 8 Fr long vascular sheath was inserted antegrade into the right superficial femoral artery. A 4 Fr Fogarty balloon catheter (Edwards Lifesciences, Irvine, CA, USA) was introduced into the vascular sheath, then inserted into the arterial lumen until the balloon was located distal to the embolus over an 0.018 wire (Terumo, Tokyo, Japan). The balloon of the Fogarty catheter was inflated and pulled back toward the femoral artery cutdown site (). While performing the procedure, we could recognize the location of the embolus in angiography, which was seen as a filling defect between the balloon. Contrast was made by injecting a small amount of contrast material through the sheath (). The embolus was successfully removed through the incision site of the femoral artery. It consisted of the Angio-Seal sponge with anchor, and had accumulation of acute thrombus proximally ().\nAfter a 12-month follow-up, the patient was pain free, and his post-interventional course was uneventful.
|
[[47.0, 'year']]
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M
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{'15224459': 1, '11146512': 1, '16586517': 1, '14734598': 1, '16478672': 1, '10642760': 1, '17292986': 1, '17145443': 1, '10527441': 1, '15364320': 1, '29181220': 2, '20146317': 1, '18230871': 1, '23901321': 2}
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{'5664249-1': 1}
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162,433 |
3725359-1
| 23,901,322 |
noncomm/PMC003xxxxxx/PMC3725359.xml
|
Rapid Intra-Hepatic Dissemination of Hepatocellular Carcinoma with Pulmonary Metastases Following Combined Loco-Regional Therapy
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An 83-year-old man with alcoholic liver cirrhosis was treated with microwave ablation of a solitary HCC in segment 4A (2.8 cm in size), and developed tumor recurrence at the ablation site 5 months later (, white arrow), with the recurrent tumor measuring 3.5 cm in size. Given the early recurrence with microwave ablation, the decision was made to perform combination therapy, using TACE and RFA. TACE was performed using a single vial of 100-300 um of DC Beads (Biocompatibles, Surrey, England, UK) loaded with 50 mg of doxorubicin. During arteriography, variant hepatic arterial anatomy was noted. The right lobe was supplied by a replaced right hepatic artery arising from the superior mesenteric artery, a replaced left hepatic artery arising from the gastrohepatic trunk to supply the segment II and III and the middle hepatic artery arising from the gastroduodenal artery supplied only segment 4 and the tumor. No other hypervascular tumors were detected on angiography in the rest of the liver. Cone-beam CT was performed following infusion of the DC beads from the middle hepatic artery (segmental TACE), showing good tumoral uptake of the DC beads (, white arrow). While RFA was scheduled for the next day, it was delayed for 2 weeks for the patient to recover from a urinary tract infection following TACE.\nRadiofrequency ablation was performed with Cool-tip RF system (Valleylab, Boulder, CO, USA), utilizing a switch-box with three active electrodes. Probe placement was performed under combined US and cone-beam CT guidance with no transgression of vascular structures. Active ablation was performed for a total of 16 minutes per device protocol, achieving tip temperature of 70-82 degrees Celsius in the electrodes. Track ablation was performed on completion of the ablation cycle and the patient tolerated the procedure well. The immediate post ablation contrast enhanced CT confirmed adequate ablation margins, with no evidence of disease in the lung bases and rest of the liver ().\nFour weeks after ablation, the patient complained of mild epigastric discomfort and on examination was found to have hepatomegaly. This was associated with close to 10 times elevation of serum alpha-fetoprotein levels from the pre-TACE/RFA level of 2662 ng/L to 24734 ng/L. Contrast enhanced MRI showed multiple (> 15), new 1-1.5 cm rim enhancing nodules around the ablation site and scattered in the left lobe (segment IV, II and III) (). Additionally, tumor thrombus was also present in the inferior vena cava (, curved white arrow) and the left portal vein (, curved white arrow). Several new pulmonary nodules had developed, consistent with pulmonary metastases (). The patient declined systemic therapy, received symptomatic treatment, and died 3 months later from diffuse metastatic disease.
|
[[83.0, 'year']]
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M
|
{'34983650': 1, '32153726': 1, '19669252': 1, '15249243': 1, '28349677': 1, '30940322': 1, '16425391': 1, '32691543': 1, '33530676': 1, '15069713': 1, '23901322': 2}
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{}
|
162,434 |
3725363-1
| 23,901,326 |
noncomm/PMC003xxxxxx/PMC3725363.xml
|
Inflammatory Pseudotumor in the Mediastinum: Imaging with 18F-Fluorodeoxyglucose PET/CT
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A 25-year-old male had a chest X-ray taken as part of a routine health examination; the results showed a large mass in the right paratracheal space (). He had had acute lymphoblastic leukemia 11 years earlier but was in complete remission. He was asymptomatic, had no pain, cough, or dyspnea. His physical examination was normal, and all laboratory tests were within normal limits except mild leukocytosis (12.1 × 103/µL, normal range 3.9-9.7). Contrast-enhanced chest CT and 18F-FDG PET/CT were performed to rule out malignant lymphadenopathy (). The mass showed mild homogeneous enhancement with a longitudinal dimension of approximately 8.0 cm in the right paratracheal space in the transaxial view on contrast-enhanced chest CT (Brilliance CT 16-slice, Philips Medical Systems, Cleveland, OH, USA). No abnormality was observed in the lung parenchyma (). The patient underwent 18F-FDG PET/CT (Discovery STe scanner, GE Healthcare, Milwaukee, WI, USA) after fasting for at least 6 hours. Unenhanced CT was performed by a continuous spiral technique using a 16-slice helical CT (120 KeV, 80-200 mAs with AutomA mode, a section width of 3.75 mm) 60 minutes after injection of 370 MBq 18F-FDG. After CT scan, an emission scan was obtained from the thigh to the head for 3 minutes per frame in the 3-dimensional (3D) mode. Attenuation-corrected PET images using CT data were reconstructed by a 3D ordered-subsets expectation maximization algorithm (20 subsets, 2 iterations). A huge mass with lobulated borders was found in the right paratracheal space; the mean Hounsfield unit of the mass was 36 on unenhanced CT of 18F-FDG PET/CT. On PET images, the mass showed heterogeneous 18F-FDG uptake, with the maximum standardized uptake value (SUVmax) of 5.0 (). No 18F-FDG uptake suggesting metastases was observed on PET/CT.\nThese clinical and radiological findings suggested malignant lymphadenopathy associated with recurrent leukemia. The patient underwent mediastinoscopic biopsy. Histopathology suggested an inflammatory pseudotumor. The mass was removed via thoracotomy. The tumor was a multinodular mass, measuring about 8 × 6 × 5 cm. On the cut section, the mass was lobulated by intervening fibrous tissue, showing a yellow-brown or yellow-white color with a myxoid character. Histopathologically, the tumor contained multifocal patchy infiltration of B and T lymphoid cells, plasma cells, histiocytes, and fibroblastic cells in a fibrocollagenous stroma (). The final diagnosis was an inflammatory pseudotumor, fibrohistiocytic type.
|
[[25.0, 'year']]
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M
|
{'12740472': 1, '10228516': 1, '18805199': 1, '20572593': 1, '17905469': 1, '16549957': 1, '33841908': 2, '15193246': 1, '24900079': 1, '30007906': 1, '22358018': 1, '22055682': 1, '23901326': 2}
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{'8008462-1': 1}
|
162,435 |
3725366-1
| 23,901,329 |
noncomm/PMC003xxxxxx/PMC3725366.xml
|
Uncommon of the Uncommon: Malignant Perivascular Epithelioid Cell Tumor of the Lung
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A 63-year-old male nonsmoker with chest radiograph's abnormality was referred to our hospital. He was asymptomatic and denied any weight loss, cough, wheezing or hemoptysis. Physical examination and laboratory results were unremarkable.\nThe chest radiograph showed a large mass in the left lower lung zone, abutting the mediastinal structures (). On computed tomography, a 9 × 12-cm-sized, well-circumscribed, and solid mass was located in the posteromedial aspect of the left lower lobe with wide pleural attachment. There was no displacement of bronchovascular bundles in adjacent lung parenchyma and bone remodeling. Close observation disclosed air-bronchograms in the peripheral portion of the tumor. For these reasons, this tumor seemed to be originated from the lung parenchyma rather than the posterior mediastinum or pleura. The mass contained curvilinear calcifications and showed heterogeneous enhancement (solid portion showed strong contrast enhancement; 37 HU on pre-contrast image and 115 HU on post-contrast image) with contrast-medium injection. On the lung window image, several discrete subcentimeter nodules were also noted in both lungs, raising the possibility of lung-to-lung metastases. There was no significant mediastinal or hilar lymph node enlargement. Our final radiological differential diagnosis included lung cancer or malignant sarcoma of the lung. 18F-FDG PET CT depicted a hypermetabolic mass with SUVmax of 4.4 in the left lower lobe and several small nodules with faint uptake.\nThe patient underwent left lower lobectomy. Video-Assisted Thoracoscopic Surgery resection was planned initially but was converted to an open thoracotomy due to severe adhesion and large mass size. On the surgical field, the tumor appeared to be a lung parenchymal lesion, probably originating from the lung parenchyma near to the left lower lobar bronchus. On gross pathologic examination, the tumor appeared as a yellow-tan, well-demarcated mass with internal hemorrhage. The left lower lobar bronchus and the visceral pleura were involved with the tumor.\nMicroscopic examination showed sheets of round to polygonal cells with little clustering. The tumor cells had abundant clear to eosinophilic cytoplasm with oval nuclei (). Histopathologic differentiation included clear cell pulmonary carcinoma, metastasis from renal cell carcinoma, malignant form of paraganglioma, and PEC tumor. The tumor cells were immunoreactive for SMA, S-100 and CD56, but were nonreactive for cytokeratin AE1/AE3, HMB45, CD10, CD34, chromogranin and synaptophysin. According to these results, other histopathologic differential diagnoses other than the PEC tumor were excluded. Thus, the histopathologic diagnosis was reported as the clear cell (sugar) tumor of the lung (i.e., PEC tumor), low grade malignancy. The Ki-67 score was 10% and there was no vascular, lymphatic or perineural invasion. Tumor resection margin was negative for malignancy. At ultrastructural analysis using electron microscopy (not shown), PECs contained microfibrillar bundles with electron-dense condensation.\nA follow up CT obtained 4 months after the operation revealed enlarged metastatic nodules in both lungs. Compared with the pre-operation CT, the lesion in RLL increased in diameter from 3.8 mm to 7.3 mm within 6 months and then to 9.4 mm within another 6 months. Multifocal wedge resection for the several nodules was performed after 1 year from the initial operation and led to the diagnosis of metastatic lesions from the PEC tumor. However, there are still remaining metastatic lesions, gradually enlarging in size on a serial follow up CT.
|
[[63.0, 'year']]
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M
|
{'5578741': 1, '18080139': 1, '30876389': 2, '19391667': 1, '16327428': 1, '3190399': 1, '27895874': 2, '27537571': 1, '26039123': 1, '30038969': 1, '17670735': 1, '20805446': 1, '21323971': 1, '26171053': 1, '20048174': 1, '19119463': 2, '31579733': 1, '16845532': 1, '21272348': 2, '23901329': 2}
|
{'5117114-1': 1, '6419825-1': 1, '3042371-1': 1, '2610653-1': 1}
|
162,436 |
3726797-1
| 23,904,959 |
noncomm/PMC003xxxxxx/PMC3726797.xml
|
A Case of Incidentally Discovered Subclinical Cushing Syndrome in a Patient with Chronic Fatigue and Anxiety
|
A 51-year-old woman visited the department of family medicine, Pusan National University Yangsan Hospital, Yangsan, Korea, complaining of a 2-year history of anxiety and fatigue. She had previously visited a cardiologist and was diagnosed with early-stage diabetes with known hypertension, and prescribed alprazolam and lorazepam. However, her symptoms were not alleviated, and fatigue, weakness, and dizziness developed. She also visited a neurologist and rehabilitation specialists, but these symptoms persisted. Her underlying diseases included 10 years of hypertension, 2 years of diabetes, and lumbar neuropathy following surgery for spinal stenosis 2 years ago. She was also a chronic hepatitis B carrier. Her family history did not yield any remarkable findings, and she had no history of smoking or drinking. On physical examination, her blood pressure was 149/91 mm Hg; pulse, 74 beats/min; temperature, 36.5℃; and respiratory rate, 20 breaths/min. Her weight was 47.9 kg, and her body mass index was 19.8 kg/m2. The patient was in good condition and her chest and abdomen were normal. There was no peripheral edema. The results of her neurological examination were normal.\nThe results of routine laboratory blood tests and thyroid function tests were normal. Routine urine analysis revealed microscopic hematuria (red blood cell [RBC] > 30/HPF) and rechecked value was RBC 3-5/HPF. Abdominal ultrasonography revealed no specific findings except for mild fatty liver. Computed tomography (CT) was performed for the unexplained hypertension and differential diagnosis of hematuria. CT showed a right renal stone, and a well-circumscribed and homogeneous 2.7 cm-sized mass containing a fatty component in the left adrenal gland on a non-contrast-enhanced CT, suggesting adrenal adenoma (). There was no specific finding on endoscopy except for erosive gastritis. Dual-energy X-ray absorptiometry revealed osteopenia.\nThe patient received endocrine evaluation for the differential diagnosis of adrenal incidentaloma. Baseline serum cortisol at 8:00 a.m. (17.17 µg/dL) was normal but the 24-hour excretion of urinary free cortisol (UFF) (100.54 µg) and serum basal 17-hydroxyprogesterone (19.0 mg/d) were elevated. A low-dose dexamethasone suppression test (DST) (0.5 mg orally, 4 times a day for 2 days, with measurement of serum cortisol and other steroids at 8:00 a.m. the following morning, and determination of UFF) failed to suppress the serum cortisol level (14.78 µg/dL) and the 24-hour UFF (282.56 µg). High-dose DST (2 mg, 4 times a day for 2 days) also failed to suppress the serum cortisol level (16.82 µg/dL) and the 24-hour UFF (186.62 µg). The 24-hour urinary excretion of catecholamines and metanephrine, measured to rule out pheochromocytoma, showed normal results (epinephrine 1.0 µg/d, norepinephrine 54.5 µg/d, and metanephrine 0.672 mg/d). Renin plasma activity was 0.26 ng/mL/h, aldosterone was 9.63 pg/mL, and the aldosterone renin activity ratio was normal (0.96), excluding an aldosterone-producing adenoma. Therefore, the adrenal mass on CT was diagnosed as a cortisol-producing tumor. The tumor was surgically removed by left laparoscopic adrenalectomy. The pathological diagnosis was adrenocortical adenoma, 3 × 2 cm in size, without any evidence of malignancy.\nAfter the resection of the adrenal adenoma, the patient's general condition improved and self-reported anxiety and dizziness disappeared. Her blood pressure stabilized with fewer antihypertensive medications, and her hemoglobin A1c level decreased to 5.3% after 5 months. She was followed up with supplemental prednisolone 5 mg/d to treat a suppressed hypothalamic pituitary axis (baseline serum cortisol at 8:00 a.m., 2.78 µg/dL; adrenocorticotropic hormone, 11.1 pg/mL).
|
[[51.0, 'year']]
|
F
|
{'8521790': 1, '12466342': 1, '10787080': 1, '21011882': 1, '16927063': 1, '2164335': 1, '10770179': 1, '17287480': 1, '15082524': 1, '11889151': 1, '12414841': 1, '10732270': 1, '14706419': 1, '16132200': 1, '542586': 1, '7135206': 1, '15850851': 1, '14514341': 1, '3978579': 1, '10732263': 1, '9062506': 1, '9435416': 1, '11751069': 1, '14599113': 1, '10022410': 1, '12614096': 1, '11475942': 1, '3202603': 1, '23904959': 2}
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{}
|
162,437 |
3726849-1
| 23,904,941 |
noncomm/PMC003xxxxxx/PMC3726849.xml
|
Successful tracheal intubation using fiberoptic bronchoscope via an I-gel™ supraglottic airway in a pediatric patient with Goldenhar syndrome -A case report-
|
A 4-year-old boy (55 months, 16.3 kg, 102 cm) was diagnosed with chronic hypertrophic tonsillitis and adenoid vegetation due to severe stertorous breathing and sleep apnea, and he was hospitalized in the otorhinolaryngology department for tonsillectomy and adenoidectomy. Preoperative laboratory tests, electrocardiogram, and chest radiology were unremarkable. However, the patient had severe stertorous breathing and recently developed mild dry coughing two days prior to surgery. According to the preoperative interview with the guardian one day before the surgery, the patient was born via cesarean section due to breech presentation weighing at 3.5 kg and had no specific medical history. An intramuscular injection of 0.25 mg atropine was given as premedication 30 minutes prior to entering the operating room. The patient's guardian was in attendance in the waiting room for psychological stabilization.\nWhen we approached the patient for induction of anesthesia, malformation was found on the right side of the patient's face. When asked once again about the patient's medical history, it was found that the patient was diagnosed with congenital auricular atresia after birth, and hearing test conducted 3 months after birth confirmed hearing loss of the right ear. Later, the patient was diagnosed with Goldenhar syndrome accomopanying partial loss of the right auricle, conjunctival dermoid, and oral atresia. The right side of the patient's face was less developed compared with the left, thus making his face asymmetric. The auricle was undeveloped, with only a partial earlobe remaining in his right ear (). The Mallampati oral opening view was unavailable due to agitation of the patient, and the patient presented irregular dentition. The patient was sitting on the bed due to dyspnea that occurs in a lying position. While the guardian remained to help stabilize the patient, ketamine (2 mg/kg) was administered to induce anesthesia. With spontaneous breathing intact, the patient was taken to the operating room.\nIn the waiting room, pulse oxygen saturation was measured at 98% in a sitting position. However, after ketamine was given for induction of anesthesia, pulse oxygen saturation fell to 94% in the operating room with the spontaneous breathing intact. Other vital signs showed blood pressure of 125/85 mmHg and heart rate of 170 beats/min. Preoxygenation was performed, and 0.6 mg/kg of rocuronium and 1 µg/kg of fentanyl were administered intravenously. Manual ventilation was attempted using a mask, but the mask did not fit due to facial deformity. For effective manual ventilation, gauze was filled in the buccal area to achieve the best possible fit for the mask. Oral airway was inserted and an open airway was maintained using both hands, and then manual ventilation was attempted with the help of an assistant.\nA skilled anesthesiologist used a #2 Macintosh curved laryngoscope blade to lift the epiglottis with an assistant manipulating the larynx, but failed to check the glottic opening. With a 4.5 mm cuffed tube (Mallinckrodt, Covidien, Ireland) and a stylet, the authors used blind technique for intubation, but it was unsuccessful. A video laryngoscope (GlideScope & GVL 4, Verathon Medical, Canada) was used in the following attempt, but even entering the glottis was difficult due to the narrow oral cavity. Thus, a supraglottic airway device (I-gel™ size 2, Intersurgical, Lithuania) was inserted for proper ventilation. Then a bronchoscope (LF-DP, Olympus, Tokyo, Japan) was inserted through I-gel™ for visualization of the glottic opening, a part of which was shown on the upper side of a the bronchoscopic view. By lifting the mandible and applying pressure on the cricoid cartilage, the authors moved the glottic opening to the center of the the bronchoscopic view. After deciding to attempt fiberoptic bronchoscopic intubation, adequate ventilation was performed. A cuffed 4.5 mm tube was covered with lubricant, and fiberoptic bronchoscopic intubation was performed through a laryngeal mask airway. The tube was placed in a proper depth by checking the carina (). In order to remove the I-gel™ while maintaining the tube, first, the connecting part at the proximal end of the tube was removed. Then, a tube exchanger (Airway exchanger catheter, Cook, Canada), which was thicker than the tube, was used to secure the tube in place. Finally, the I-gel™ was removed (). After cuff ballooning, the tube's connecting part and the respiratory circuit were connected. The authors checked the depth of the tube through a stethoscope and conducted mechanical ventilation.\nDuring the surgery, 1.5 and 2.5 L/min of O2 and air were administered, respectively. Anesthesia was maintained with sevoflurane 2.0-2.5 vol%. Vital signs were maintained, as follows: blood pressure 115-130/70-85 mmHg, heart rate 140-170/min, pulse oxygen saturation 98-100%, and capnogram 32-41 mmHg. The operation was finished after 75 minutes. After the spontaneous breathing of the patient was recovered, 0.004 mg/kg glycopyrrolate and 0.2 mg/kg pyridostigmine was injected intravenously. Then, the patient was extubated and moved to the recovery room. Severe stridor and even transient apnea occurred while the patient was lying in the recovery room. When 5 L/min of oxygen was supplied by a mask, pulse oxygen saturation was up to 98%, but it fell to 84-88% during room air respiration. The patient did not feel much discomfort because he had long been adapted to low oxygen saturation. After being stabilized for 2 hours in the recovery room, the patient was supplied with 2 L/min of oxygen through a nasal cannula and transferred back to the patient's room. Total operative time and anesthesia time were 75 minutes and 105 minutes, respectively, and 80 ml of Hartman solution was administered. On the fourth day following the surgery, the patient was discharged without any further problems.
|
[[4.0, 'year']]
|
M
|
{'22474556': 2, '19520483': 1, '15910358': 1, '626178': 1, '28913445': 1, '25394762': 1, '22354398': 1, '12717151': 1, '8210026': 1, '18502367': 1, '23059523': 1, '29176148': 1, '2316841': 1, '18613937': 1, '27482318': 2, '26702197': 1, '20337959': 1, '17381591': 1, '23904941': 2}
|
{'3315659-1': 1, '4967636-1': 1}
|
162,438 |
3726850-1
| 23,904,942 |
noncomm/PMC003xxxxxx/PMC3726850.xml
|
Atropine injection followed by coronary artery spasm with ventricular tachycardia during spinal anesthesia -A case report-
|
A 44-year-old female, height and weight of 158 cm; 53 kg, was scheduled for a varicosectomy and a communicating vein ligation of the bilateral varicose veins.\nThe patient's family history, past history, obstetric history, and social history were unremarkable.\nUpon admission, vital signs were stable with a normal physical examination. The electrocardiogram (ECG) displayed a normal sinus rhythm at 57 beats per minute at normal intervals ().\nThe patient's vital signs on arrival to the operation room showed a blood pressure of 134/72 mmHg and heart rate of 90-93 beats/min.\nWith the patient in the lateral decubitus position, spinal anesthesia was administered using a 25-gauge Quincke-type needle with 12 mg of bupivacaine (Marcaineheavy®) at the L3-L4 interspace.\nThe patient was placed in the supine position for 10 minutes, where the blood pressure lowered to 120/70 mmHg and the heart rate decreased to 82-85 beats/min. The maximal level of the sensory block to cold temperature was T8.\nThereafter, 2.5 mg of midazolam were given intravenously\nfor the sedation and resolution of anxiety.\nThe patient's blood pressure was then stabilized to 110-90/65-45 mmHg. After one hour since the start of the operation, the patient's heart rate began to gradually decrease. However, since the patient's blood pressure was stable and she was successfully sedated, we decided to observe and no supplementary evaluation of block level was performed. Two hours after the administration of the spinal anesthesia, the heart rate dropped to 42-45 beats/min, and 0.5 mg of atropine was injected intravenously. The patient's heart rate rose to 60 beats per minute within 5 minutes. Shortly after, premature ventricular contraction occurred in the ECG followed by ventricular tachycardia, where the patient's heart rate increased to 140 beats per minute and the blood pressure to 120/60 mmHg ( and ). The patient complained of chest discomfort, but was capable of communication and cooperation. At that time, the upper sensory block level to cold temperature was T10. The patient was given 10 mg of esmolol intravenously. After 2-3 minutes, the patient's ECG presented an elevation in the ST with a heart rate of 62 beats/min (). After the termination of the operation, the patient was transferred to the intensive care unit. Laboratory tests at the moment of ventricular tachycardia were nonspecific. The CPK-MB was 19.7 ng/ml; and Troponin I peaked at 6.38 ng/ml, where both subsequently returned back to normal within 2 days. Thyroid function test and fasting lipid profile were within normal limits.\nCoronary angiography (CAG) that was performed after the operation showed luminal stenosis of up to 40% at the middle left anterior descending coronary artery (mLAD), while left circumflex artery (LCX) and right coronary artery (RCA) showed no significant signs of luminal stenosis. Ultrasonic cardiography (UCG) that was performed after the operation showed an ejection fraction of 40%, akinesia at the LCX territory with mild left ventricle (LV) systolic dysfunction, and impaired relaxation. According to the CAG and UCG results that were obtained by the consultation of the department of cardiology, the patient was diagnosed with VT due to vasospasm. After the administration of calcium channel blockers, the patient was discharged 3 days later without any further symptoms.
|
[[44.0, 'year']]
|
F
|
{'9358475': 1, '7341405': 1, '10669271': 1, '7437231': 1, '19535970': 1, '13626971': 1, '26185447': 2, '5041702': 1, '1599111': 1, '23904942': 2}
|
{'4500618-1': 1}
|
162,439 |
3726851-1
| 23,904,943 |
noncomm/PMC003xxxxxx/PMC3726851.xml
|
Pericardial tamponade caused by massive fluid resuscitation in a patient with pericardial effusion and end-stage renal disease -A case report-
|
A 73-year old male patient of 173 cm height and 52 kg weight visited hospital. The chief complaint was cellulitis in right ankle. He was under medication after being diagnosed with diabetes, hypertension, congestive heart failure, and left chronic tuberculous empyema ten years ago. He was undergoing hemodialysis three times a week after diagnosis of end-stage renal disease eight years previously. There were no specific findings during the hospital stay. He maintained normal blood pressure of 130/80 mmHg and heart rate of 65-80 beats per minute. Atrial fibrillation, normal left ventricular function, moderate concentric left ventricular hypertrophy, moderate pulmonary hypertension, severe tricuspid regurgitation, moderate mitral regurgitation, aortic regurgitation, and moderate pericardial effusion were observed in echocardiography () performed during his hospital stay. Left lung empyema, right pleural effusion, pericardial effusion were confirmed by chest CT scans () and simple chest X-rays () and pulmonary function test showed a moderate restrictive pattern. Hemodialysis was performed the day before the operation and the result of the complete blood count before hemodialysis were hemoglobin level 8.8 g/dl.\nOn the fourth day of his in-hospital stay, sudden respiratory distress occurred after performing needle aspiration test of the right pleural effusion. Despite taking a simple chest X-ray immediately, our medical staff could not find any cause and observed him with oxygen therapy via nasal cannula. Respiratory distress got worse at a respiratory rate of 30 times per minute and an oxygen saturation level of 85% with changing mental status. Our staff inserted right chest tube 2 hours 30 minutes after performing needle aspiration biopsy. Approximately 1,500 ml of blood was drained for about 10 minutes after chest tube insertion, with blood pressure of 90/40 mmHg, heart rate of 66 beats per minute, respiratory rate of 22 times per minute, and body temperature of 36.4℃. Rapid fluid replacement with 1L of normal saline via central venous catheter placed in the right internal jugular vein was performed and an emergency operation was decided upon. The patient's electronic medical record (EMR) was unidentifiable by anesthesiologists because of computer network error at that time. Hence, the emergency operation was began only by acknowledging that the patient with diabetes and hypertension was receiving hemodialysis and massive bleeding occurred during needle aspiration test at right pleura.\nHe was transferred to the operating room without any preoperative medication 20 minutes after chest tube insertion. At that time, his vital signs were blood pressure of 130/50 mmHg, heart rate of 60 beats per minute, respiratory rate of 22 times per minute, and body temperature of 34.9℃. He was stuperous and his skin was cold but other physical examination could not be performed. Preoxygenation was attempted with 100% oxygen at 8 L/min via mask and warm Voluven® (6% hydroxyethyl starch, Fresenius Kabi, Germany) was rapidly administered. In addition, non-invasive blood pressure, oxygen saturation, and electrocardiogram (ECG) were monitored. An arterial catheter for continuous hemodynamic monitoring was placed via the right femoral artery and a central venous catheter via the right femoral vein and 500 ml of Voluven® was rapidly administered. After IV administration of 90 mg ketamine and 50 mg rocuronium for induction, endotracheal intubation was performed with a 35 Fr left-sided double lumen endotracheal tube (Broncho-Cath®, Mallinckrodt Medical Athlone, Ireland) and flexible fiberoptic bronchoscope (LF-GP, Olympus, Japan) was used for confirmation of proper placement. During lung ventilation, tidal volume of 100-120 ml, a peak inspiratory pressure of 40 cmH2O, blood pressure of 130/50 mmHg, a heart rate of 65 beats per minute, and a central venous pressure of 17-18 mmHg in supine position was checked. We attempted to maintain anesthesia with 1.5 L/min of oxygen, 1.5 L/min of nitrous oxide, and 2 vol% of sevoflurane. However, inspired oxygen concentration was changed to 100%, sevoflurane administration was stopped, and 1 mg of midazolam was administered intravenously every 15 minutes after oxygen saturation fell to 84%. After the patient was changed to left-sided lateral position, the location of tube was confirmed by a flexible fiberoptic bronchoscope with a central venous pressure of 21 mmHg. Left one-lung ventilation (OLV) was performed five minutes after changing the position to left-sided lateral position. Tidal volume and oxygen saturation decreased to 170-180 ml and 80% respectively. Peak inspiratory pressure increased up to 38 cmH2O.\nImmediately on opening the right pleural cavity via right posterolateral thoracotomy, blood pressure decreased catastrophically and 1,500 ml of blood gushed out of the pleural cavity followed by about additional 1,200 ml of blood loss. Arterial blood gas analysis was performed 25 minutes after the beginning of surgery (). Subsequently, 3 L of Voluven® and 1 L of normal saline were administered rapidly during the half an hour after the beginning of surgery. At half an hour after the beginning of surgery, our hospital computer network was restored; packed red blood cells and fresh frozen plasma were administered. Then central venous pressure increased up to 38 mmHg with decreased active bleeding, fluid administration was minimized for concern about volume overload. Oxygen saturation level decreased continuously even though peak inspiratory pressure was above 40 cmH2O during one-lung ventilation. One-lung and two-lung ventilation were performed in turn along with manual and mechanical ventilation by maintaining tidal volume of 120 ml, respiratory rate of 60-70 times per minute, peak inspiratory pressure of 22 cmH2O, inhaled oxygen concentration of 100%, and oxygen saturation of 91-93%. Although fluid administration was minimized, central venous pressure increased up to 50 mmHg, blood pressure and heart rate were maintained at 120/60 mmHg and 67 beats per minute respectively and there were no abnormal ECG finding. Initial blood loss via chest tube before surgery was 1,500 ml, estimated blood loss during operation was 2,700 ml for 40 minutes and there was no urine output. The patient was administered 4,000 ml of Voluven®, 2,000 ml of normal saline, 5 pints of packed RBCs, and 5 pints of fresh frozen plasma. At 45 minutes after the beginning of surgery, central venous pressure suddenly increased up to 58 mmHg with falling in blood pressure of 70/40 mmHg, bradycardia of 25-30 beats per minute. 0.5 mg of atropine and 0.5 mg of epinephrine were administered immediately through a central line and the pericardium was checked by the surgeon for suspected pericardial tamponade while resuscitation was being prepared. The surgeon confirmed pericardial expansion and made a pericardial window immediately. After approximately 800 ml of yellow serous fluid with no blood was drained from the pericardial space, vital signs stabilized with recovering heart rate 60 beats per minute. Thereafter, blood pressure of 115/50 mmHg and heart rate of 65 beats per minute were maintained and central venous pressure was reduced to 45 mmHg. To maintain blood pressure, 20 mg of ephedrine and 1 g of calcium gluconate were administered divided. Arterial blood gas analysis was performed 30 minutes after pericardial window (). Although no active bleeding focus was found in the surgical field, blood leak continued under the damaged diaphragm. It was decided to observe the patient in the intensive care unit after primary closure. Flexible fiberoptic bronchoscopy was performed postoperatively and a small fresh blood clot was detected at the right bronchus. The patient was transferred to the ICU while maintaining a double lumen endotracheal tube from concern about failure of finding the bleeding focus and the risk of rebleeding. The total amount of fluid administrated during surgery was 4,100 ml of Voluven®, 3,000 ml of normal saline, 7 pints of packed RBCs, and 5 pints of fresh frozen plasma. Blood loss before surgery was 1,500 ml and intraoperative blood loss was 2,700 ml. Upon arrival on the ICU, the patient was stable with blood pressure of 97/72 mmHg, heart rate of 74 beats per minute and a tympanic membrane temperature of 35.7℃. No pulmonary edema was observed on postoperative chest X-ray (). Hemoperitoneum was confirmed on abdominal CT scan but we decided to observe carefully because there was no active bleeding focus in the abdominal cavity on the celiac artery angiogram. The patient exhibited stable vital signs after continuous renal replacement therapy during follow-up period and about 900 ml of bleeding via chest tube occurred on the first postoperative day. However, the chest tube was removed and hemoperitoneum was resolved as bleeding diminished 10 days postoperatively. Moderate pericardial effusion was detected again on echocardiography. The patient is currently admitted to the intensive care unit under mechanical ventilation due to respiratory failure.
|
[[73.0, 'year']]
|
M
|
{'21789738': 1, '19451153': 1, '3716989': 1, '12478050': 1, '8356985': 1, '9639014': 1, '3768818': 1, '30093469': 1, '1282555': 1, '18332261': 1, '21666814': 1, '12917306': 1, '637968': 1, '23904943': 2}
|
{}
|
162,440 |
3726852-1
| 23,904,944 |
noncomm/PMC003xxxxxx/PMC3726852.xml
|
Massive hemothorax immediately after removal of central venous catheter -A case report-
|
A 29-year-old woman with Marfan's syndrome was scheduled to undergo the elective Bentall's operation and thoracic aortic replacement with artificial graft. There were no abnormal findings or special histories on the preoperative evaluations.\nOn patient's arrival at the operating room, standard monitoring devices were applied including the left radial arterial cannulation. Anesthesia was induced and maintained according to institutional guidelines. After anesthetic induction, the right subclavian vein was cannulated with MAC™ Multi Access Catheter (ARROW international Inc., PA, USA) using the infraclavicular Seldinger technique. During this attempt to cannulate the subclavian vein, there was neither air aspiration nor arterial puncture. After ensuring the aspiration of dark and nonpulsatile blood, a guidewire was introduced without any resistance. This was followed by sliding the catheter over the guidewire, and the wire was withdrawn without apparent resistance. Thus, the catheter was placed without any difficulty during catheterization. After that, the patient received standardized management according to institutional guidelines including mechanical ventilation and cardiopulmonary bypass during intraoperative period.\nThe operation was performed uneventfully. The patient was transferred to the intensive care unit (ICU) and was very stable in vital signs and laboratory tests. On postoperative day 1, the patient was successfully weaned from mechanical ventilation. There was no evidence of hemorrhage including the volume of blood drained to chest bottles and follow-up chest X-ray (). On postoperative day 3, the patient was transferred to the general ward and the central venous catheter was removed. Ten minutes after the removal of the catheter, the patient complained of dyspnea and pleuritic pain on right side, at which time approximately 1,700 ml of blood was abruptly drained to chest bottles and the patient's chest X-ray confirmed a hemothorax on the same side as the cannulation. Although the blood pressure was stable with administration of intravenous fluid and norepinephrine, hematocrit values dropped from 32.0% to 22.6%.\nThe patient promptly underwent emergent thoracotomy and approximately 2,500 ml of clotted blood was evacuated during operation. The patient was maintained hemodynamically stable with infusion of 0.05 mcg/kg/min of norepinephrine, 3,500 ml of crystalloid and 4 units of packed red blood cell. There was an injury site by the central venous catheterization on the right side of superior vena cava, which was 3 cm distant from the junction of the right atrium and superior vena cava without any other injuries and reinforced by hemostatic materials. After transfer to the ICU, vital signs and other laboratory findings such as arterial blood gas analysis were stable without any pharmacologic supports. The patient was transferred to the general ward after a 4-day ICU stay and discharged on the 15th day after the thoracotomy without any complications.
|
[[29.0, 'year']]
|
F
|
{'8037017': 1, '2930292': 1, '20958959': 2, '432797': 1, '841527': 1, '3094927': 1, '33585687': 1, '1600785': 1, '8968276': 1, '7984193': 1, '12646670': 1, '11990937': 1, '7170906': 1, '23904944': 2}
|
{'2974744-1': 1}
|
162,441 |
3726873-1
| 23,918,997 |
noncomm/PMC003xxxxxx/PMC3726873.xml
|
Pseudolymphomatous Folliculitis: A Distinctive Cutaneous Lymphoid Hyperplasia
|
A 45-year-old married male presented to us with a red raised lesion on the right side of forehead. The lesion has started 2 months back as single papule and gradually progressed to present size. Recently, he also noticed development of new papules around it and some pustules on it []. There was no history of any drug intake, insect bite or any local trauma prior to lesions. Before presenting to us, patient was treated with various topical and oral antibiotics like amoxicillin-clavulanic acid combination, azithromycin and linezolid etc., but lesions kept on increasing without any improvement.\nCutaneous examination erythematous indurated minimally tender plaque of 2 cm × 4 cm on the right side of the forehead topped with few pustules and brownish crust at places. Furthermore, there were two discrete erythematous papules of recent onset developing around it. There was no any lymph node swelling noted. Rest of his cutaneous and systemic examination was unremarkable. Ophthalmic examination revealed no abnormality.\nA diagnosis of fixed cutaneous leishmaniasis, deep fungal infection and pseudolymphoma was thought. Pus swab from lesion showed no growth. A biopsy of the lesion revealed dense lymphocytic infiltrate extending from upper dermis to lower dermis []. Involvement of subcutis was not seen. Infiltrate also contained numerous histiocytes, few neutrophils and occasional plasma cells that surrounded and infiltrated hypertrophic hair follicles with dilated sebaceous glands (so called activated pilosebaceous units). Some lymphocytes infiltrated into the hair follicles leading to its destruction and ultimately effacement by infiltrate []. Infiltrated cells were medium to large sized lymphocytes with hyperchromatic nuclei, high nuclear/cytoplasmic ratio, and prominent nucleoli accompanied by numerous histiocytes, netrophils, and few plasma cells []. No any bacterial or fungal elements were identified. On clinicopathological correlation a diagnosis of PLF was made. Due to economic constraints, immunohistochemistry for T- and B-cell markers or cluster designation 1a could not be done. Patient was advised topical clobetasol and fusidic acid combination in a cream form. Also oral prednisolone 40 mg per day with antacids and oral calcium supplement which was tapered over 40 days. Intra-lesional triamcinolone injection (20 mg/ml) was given after 7 days of starting oral steroids. Remarkable improvement was seen after 4 days of single injection [].
|
[[45.0, 'year']]
|
M
|
{'19213656': 1, '11937751': 1, '33910788': 2, '10554999': 1, '16441647': 1, '22493580': 1, '23918997': 2}
|
{'8094362-1': 1}
|
162,442 |
3726875-1
| 23,918,999 |
noncomm/PMC003xxxxxx/PMC3726875.xml
|
Unilateral Nevus of Ota with Bilateral Nevus of Ito and Palatal Lesion: A Case Report with a Proposed Clinical Modification of Tanino's Classification
|
A 24-year-old Indian male patient born out of non-consanguineous marriage, presented with bluish gray asymptomatic mottled pigmented patch on his right side of the face along with bluish discoloration of the upper part of the right eye since his infancy. He also complained of a similar pigmented lesion affecting both of his shoulder regions from his early days of life, though the lesion on the right shoulder started earlier. The discoloration became more prominent with the onset of puberty. He also reported that the intensity of the discoloration of all the lesions aggravates during the summer months. He does not have any complain about his problem except his concern for the cosmetic appearance. On enquiry he told that none of his family members have any such lesion. He did not give history of any major illness including any ophthalmological or auditory complaint.\nOn examination the lesion on the face was found to be distributed on the right side extending from temple to malar and mandibular regions []. Sclera of the ipsilateral side was also involved. He too had a large gray-bluish speckled pigmented lesion on his right and left shoulder regions [Figures and ]. The lesion on the right side was bigger in size and the deltoid and scapular areas were more affected than the supraclavicular region []. Few bluish pigmented patches were also found in the right side of the hard palate [].\nRoutine examinations of the blood, X-ray of the chest and CT scan of the brain revealed no abnormality. Ophthalmologic and ENT examines were normal. Histopathlogic examinations of the skin from the affected area of the face and shoulders showed the presence of heavily pigmented, elongated, dendritic dermal melanocytes. The overlying epidermis was normal.
|
[[24.0, 'year']]
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M
|
{'12399743': 1, '1743382': 1, '18388370': 1, '17640235': 1, '20944262': 1, '15308859': 1, '22567445': 2, '11295763': 1, '18625388': 1, '17642580': 1, '18712021': 1, '3378374': 1, '20074832': 1, '13696097': 1, '27293272': 1, '20300349': 1, '6018994': 1, '23918999': 2}
|
{'3335646-1': 1}
|
162,443 |
3726906-1
| 23,919,029 |
noncomm/PMC003xxxxxx/PMC3726906.xml
|
Bitemporal Scalp, Lip and Tongue Necrosis in Giant Cell Arteritis: A Rare Presentation
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A 74-year-old man was presented with high-grade fever, sudden onset bilateral temporoparietal headache, jaw claudication, and diminished vision in both eyes for last 7 days. On examination, he had bilateral scalp, lip, and tongue necrosis [Figures and ]. On clinical examination, the temporal arteries were palpable tender and nonpulsatile. In addition, he had exposure keratopathy and diminished corneal reflexes.\nRoutine hematological and biochemical investigations revealed raised erythrocyte sedimentation rate (ESR: 132 mm at the end of 1 h), anemia (hemoglobin: 8.6 g/dl), leukocytosis (total leukocyte count: 19,700/mm3), thrombocytosis (platelet count: 9, 94,000/mm3), and raised C-reactive protein level (10 mg/L). ANA was negative and the bone marrow examination was normal. The temporal artery biopsy was compatible with giant cell arteritis and showed infiltration of media tunica by lymphocytes and giant cells []. There was a focal destruction of internal elastic lamina and narrowing of the lumen due to fibrin deposition. Ultrasonography and color Doppler was not performed as the patient was bedridden, and we felt it was unnecessary at that given point of time.\nWe have treated this patient with systemic corticosteroids (oral prednisolone: 1 mg/kg body weight per day). After an initial improvement in headache and scalp necrosis (within 24-36 h of initiation of therapy), there was no improvement for another 2-3 days, neither it was deteriorating. The patient's relatives decided to take him home against the medical advice. Therefore, further follow-up could not be possible.
|
[[74.0, 'year']]
|
M
|
{'19577329': 1, '20500172': 1, '20799290': 1, '8478767': 1, '30315264': 1, '22285588': 1, '21460132': 1, '9255121': 1, '21885526': 1, '8024610': 1, '21455737': 1, '25318611': 1, '21216207': 1, '33790612': 1, '12086271': 1, '28424735': 2, '973648': 1, '26069840': 2, '12140303': 1, '7898257': 1, '19277817': 1, '23919029': 2}
|
{'5382308-1': 1, '4455788-1': 1}
|
162,444 |
3726907-1
| 23,919,030 |
noncomm/PMC003xxxxxx/PMC3726907.xml
|
Tender Skin Nodules in a Newborn
|
A 9-day-old male baby presented to us with an inconsolable cry. He was a full-term singleton delivered by cesarean section with a history of birth asphyxia. His mother had an uneventful antenatal period. Early postnatal events were otherwise normal, and the baby had been feeding well. The baby's crying aggravated on being handled or kept in the supine position. On examination, we found numerous tender purple-colored plaques and nodules over the back, buttocks, and upper thigh []. No other systemic abnormality that explained the crying was found on detailed examination. Routine blood, urine, and stool examinations were normal. Hypercalcemia was found, which persisted in spite of proper hydration and administration of frusemide in a dose of 1 mg/kg/body weight daily. A punch biopsy was done from a plaque over the back. Histology showed a normal epidermis. Lobular panniculitis was seen with a dense infiltrate of lymphocytes, histiocytes, and multinucleate giant cells [].\nWe started corticosteroid in the form of prednisolone (Dose-1 mg/kg/day in 2 divided doses orally). To relieve the pain, we prescribed acetaminophen (15 mg/kg/dose 4 times daily) and triclofos (50 mg/kg/dose). Breastfeeding was continued, and hydration was maintained. The baby gradually became symptom-free after 8 days of admission. Serum calcium level which was initially 12.4 mg/dl persisted for a week at that level before decreasing to 12 mg/dl at the end of 2 weeks and 11.4 mg/dl at the end of 4 weeks. The dose of prednisolone was gradually tapered over a period of 2 weeks, and the baby was discharged. Regular follow-up and routine check of serum calcium levels was done thereafter. The serum calcium levels decreased to 9.4 mg/dl at the end of 6 months and remained stable at that level thereafter. We followed him up for the next 18 months, and there was no recurrence till then.
|
[[9.0, 'day']]
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M
|
{'17493069': 1, '20178707': 1, '26734138': 1, '20072856': 1, '7792219': 1, '33944856': 2, '20713821': 1, '16743644': 1, '21284334': 1, '34065153': 2, '18811689': 1, '10571840': 1, '8071923': 1, '23919030': 2}
|
{'8151818-1': 1, '8142782-1': 1}
|
162,445 |
3726908-1
| 23,919,031 |
noncomm/PMC003xxxxxx/PMC3726908.xml
|
Cutis Laxa: A Report of Two Interesting Cases
|
A 14-year-old Hindu female presented to us with complaint of ‘loose skin’ on the neck. An itchy eruption had developed on the anterior neck 5 years ago, and it lasted for about a month. Several months later, she noticed that the skin of that area was becoming wrinkled and loose. The wrinkling and looseness progressed for 4 to 5 months after which it became stable. She was otherwise well and had no history of dyspnoea, chest pain, palpitation or visual problems. She was not taking any medication. No similar changes were noted in any other part of her body. Family history of similar skin lesion was absent. Physical examination revealed a circumscribed palm sized area of lax, extensible, wrinkled skin localized to the anterior part of the neck []. Stretching of the skin produced delayed recoil []. No induration was noted. There was no hyper-extensibility of the joints and systemic examination was normal. Slit-lamp examination of the eyes revealed no angioid streaks.
|
[[14.0, 'year']]
|
F
|
{'28128165': 1, '26189148': 1, '102106': 1, '3708900': 1, '19467378': 1, '4064367': 1, '32180869': 1, '92145': 1, '5555855': 1, '2298964': 1, '5835325': 1, '30745636': 2, '23919031': 2}
|
{'3726908-2': 2, '6340237-1': 1}
|
162,446 |
3726908-2
| 23,919,031 |
noncomm/PMC003xxxxxx/PMC3726908.xml
|
Cutis Laxa: A Report of Two Interesting Cases
|
A 40-year-old Muslim male presented to us with a complaint of loose skin all over his body for last 10 years. He was well till the age of 30, when he noticed that his skin was gradually becoming wrinkled and loose. It started from forehead and progressed slowly downwards over a couple of years after that the process stabilized. At the time of presentation, he was suffering from hypertension and cervical and lumbar spondylosis. He was having beta-blockers for hypertension. He had no episodes of dyspnoea, chest pain or palpitations. His family history was non-contributory. On examination, the patient appeared much older than his age. The skin of his forehead [], neck, abdomen and back [] was diffusely wrinkled and it hung in folds. There was blepharochalasis but no hyper-extensibility of joints. Eye examination did not reveal any angioid streaks.\nIn both the cases investigations revealed normal values for complete blood count, erythrocyte sedimentation rate, routine urine analysis, blood biochemistry, hepatic enzymes and serum electrophoresis. Chest X-ray, electrocardiography and gastroscopy were normal. Biopsy specimens taken from the involved area were stained with Hematoxylin-eosin (H and E), Von Kossa and Verhoeff-van Gieson stain. Histopathological findings were similar in both cases. H and E staining revealed normal epidermis with diminished elastic fibres and mild non-specific chronic lymphohistiocytic infiltrate in upper dermis []. The elastic fibres present were fragmented, stained uneven and showed granular appearance, as evidenced in Verhoeff-van Gieson stain []. Von-Kossa stain did not show any calcification.
|
[[40.0, 'year']]
|
M
|
{'28128165': 1, '26189148': 1, '102106': 1, '3708900': 1, '19467378': 1, '4064367': 1, '32180869': 1, '92145': 1, '5555855': 1, '2298964': 1, '5835325': 1, '30745636': 2, '23919031': 2}
|
{'3726908-1': 2, '6340237-1': 1}
|
162,447 |
3726909-1
| 23,919,032 |
noncomm/PMC003xxxxxx/PMC3726909.xml
|
Ganglion cell like cells, diagnostic dilemma
|
A 41 year old man, otherwise healthy, presented with an asymptomatic, painless, solitary, nontender, cutaneous swelling over the left anterior axillary fold []. It was measuring 2 cm in size. There were no local inflammatory changes. The nodule was firm with relatively well defined borders. Regional lymphnodes were not palpable. The patient had no constitutional symptoms. An excision biopsy was performed without any complications. The specimen was sent for histopathologic examination.\nGross examination revealed a relatively well circumscribed mass measuring 2 × 1.5 × 1.5 cm with a solid grey white glistening appearance on the cut surface []. Microscopy showed a relatively well circumscribed tumor composed of spindle cells arranged in whorls and fascicles with thin elongated nuclei interspersed with few blood vessels lined by plump endothelial cells. There were numerous large ganglion-like mononuclear rounded basophilic cells with prominent nuclei and nucleoli. Compressed fibro-adipose tissue and blood vessels were seen outside the margin of the tumor []. Based on these histologic features a diagnosis of ganglioneuroma was made. However, immunohistochemical studies showed strong positive staining for vimentin and negative for smooth muscle actin, CD34, S100 protein and chromogranin []. Based on these immunohistochemistry finding a final diagnosis of fibromatosis with ganglion cell like cells was offered.
|
[[41.0, 'year']]
|
M
|
{'15684358': 1, '11684963': 1, '18373875': 2, '22438620': 2, '13199773': 1, '12775986': 1, '1577976': 1, '23919032': 2}
|
{'2359765-1': 1, '3307455-1': 1}
|
162,448 |
3726910-1
| 23,919,033 |
noncomm/PMC003xxxxxx/PMC3726910.xml
|
A Generalized, Non-Pruritic Variant of Lichen Amyloidosis: A Case Report and a Brief Review
|
A 62-year-old man presented with complaints of multiple dark eruptions involving his lower limbs, back, chest, and parts of the upper extremities. The lesions appeared 10 years ago on the lower limbs and progressed to involve the other parts of the body over the past 3 years. There was no history of itching, trauma, chronic scratching or friction, no systemic symptoms and no similar complaints in other family members. On examination, multiple, discrete, hyperpigmented, papules were present on the shins, [] and similar smaller papules were seen on the upper back, chest, abdomen, upper arms and few on the thigh and gluteal region [Figure and ]. Histopathological examination revealed a hyperplastic epidermis and globular masses in the dermal papillae []. Congo red staining revealed amorphous, eosinophilic deposits in the papillary dermis []. Routine laboratory investigations including complete blood count, blood sugar levels, renal, hepatic, urinary analysis, and thyroid function tests were within normal limits.\nA diagnosis of lichen amyloidosis was made on the basis of clinicopathological findings, and the patient was given topical clobetasol propionate and salicylic acid combination along with oral acitretin 25 mg/day.
|
[[62.0, 'year']]
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M
|
{'458190': 1, '6987109': 1, '9704823': 1, '8586756': 1, '19663869': 1, '6983598': 1, '4100068': 1, '2573304': 1, '10901719': 1, '3279077': 1, '7759242': 1, '16625072': 1, '21669474': 1, '1399213': 1, '8869690': 1, '13039576': 1, '19788854': 1, '10733268': 1, '10391881': 1, '12890114': 1, '3279082': 1, '18547301': 1, '17106614': 1, '1559750': 1, '2666799': 1, '11122031': 1, '15319161': 1, '405983': 1, '2475535': 1, '12920377': 1, '15569021': 1, '9217811': 1, '12890115': 1, '9418758': 1, '1700757': 1, '23919033': 2}
|
{}
|
162,449 |
3726911-1
| 23,919,034 |
noncomm/PMC003xxxxxx/PMC3726911.xml
|
Case Reports of Incontinentia Pigmenti in Males
|
A 5-years-old Muslim male child presented with cutaneous hyperpigmentation on trunk, extremities, and face.\nThe boy was an only child, born to third degree consanguineous parents with full-term normal delivery. There was no history of abortion or death of a male child previously. Family history was non-conclusive.\nAs informed by mother, the skin lesions started appearing at 1 week of age in the form of vesicular lesions on the lower extremities, which gradually spread onto the trunk. These were followed by crusted plaques, which healed with hyperpigmentation.\nOn examination, the child had slate brown hyperpigmented macules on face and lower limbs in linear distribution. Widely distributed areas of pigmentation in whorled pattern were seen on trunk []. Oral cavity showed hypodontia with peg-shaped teeth []. The physical and intellectual development of boy was considered subnormal for age by pediatrician. His developmental milestones were delayed for age, and he had complaints of primary nocturnal enueresis. Systemic examination including ocular, central nervous system (CNS), and skeletal systems revealed nothing abnormal. Hair and nails were normal. Hematological tests showed peripheral blood eosinophilia. CT scan brain was normal. 2D Echo revealed patent ductus arteriosus.\nHistopathological examination revealed mild epidermal hyperplasia (acanthotic) with dyskeratotic cells with few whorls of squamous cells with central keratinization. Dermis reveals infiltrates of eosinophils and mononuclear cells.
|
[[5.0, 'year']]
|
M
|
{'13250108': 1, '8423608': 1, '30009071': 1, '12140463': 1, '8004094': 1, '23919034': 2}
|
{'3726911-2': 2}
|
162,450 |
3726911-2
| 23,919,034 |
noncomm/PMC003xxxxxx/PMC3726911.xml
|
Case Reports of Incontinentia Pigmenti in Males
|
A 20-days-old male child, second in order, born to non-consanguineous parents, with an uneventful normal vaginal delivery, was brought with the complaints of vesiculobullous eruptions on both lower limbs [Figures ] and ] and right arm since birth. The other sibling was a male child who expired at 7 months of gestational age due to hydrops fetalis. On examination, the child had vesiculo-bullous lesions on both lower limbs. Hair and nails were normal.\nThe infectious causes were excluded (Tzanck test showed no giant cells, and test for antibodies for HSV, VZV was negative). Systemic examination including that of eyes, CNS, and skeletal system revealed nothing abnormal. Routine blood, urine, and stool examinations did not show any abnormality, except for raised eosinophils on differential leukocyte count. VDRL of mother and the child was non-reactive, and a skin biopsy was performed, which revealed spongiotic intra-epidermal vesicles with a rich eosinophil infiltrate [].
|
[[20.0, 'day']]
|
M
|
{'13250108': 1, '8423608': 1, '30009071': 1, '12140463': 1, '8004094': 1, '23919034': 2}
|
{'3726911-1': 2}
|
162,451 |
3728137-1
| 23,904,814 |
noncomm/PMC003xxxxxx/PMC3728137.xml
|
Atypical chronic myeloid leukemia with t(9;22)(p24,11.2), a BCR-JAK2 fusion gene
|
In April 2010, a 54-year-old male patient presented with fatigue, abdominal pain and splenomegaly. A blood count revealed leukocytosis (93.38 x 109/L) with a predominance of neutrophils and a shift to the left. Hypercellular bone marrow with granulocytic and erythroid dysplasia was described. Conventional cytogenetic analysis was performed and a 46,XY,t(9;22) (p24;q11.2) karyotype was found in 90% of the metaphases examined ( 1) In view of the clinical picture, the result was interpreted as indicative of the presence of a BCR-ABL1 fusion gene, but this was not detected by reverse transcription polymerase chain reaction (RT-PCR). The presence of a BCR-ABL rearrangement was also ruled out by fluorescence in situ hybridization (FISH) using a BCR-ABL probe. In addition, no BCR/PDGFR FIP fusion gene or JAK2 V617F mutation were detected by RT-PCR. Therefore, the case was classified, according to the latest World Health Organization Classification, as BCR-ABL1-negative atypical CML.\nThe patient was treated with imatinib at a dose of 400 mg/day because of the involvement of the BCR gene. After three months of treatment, he presented weight loss, progressive splenomegaly and no hematologic response. His medication was changed to dasatinib (150 mg/day) plus hydroxyurea (3 g/day). In August 2011, given the absence of a hematologic response, the dasatinib treatment was discontinued.\nConventional karyotyping was performed again and the 46,XY,t(9;22)(p24;q11.2) karyotype was observed in all metaphases examined.\nIn October 2012, the patient had not achieved complete hematologic remission with hydroxyurea. However, in the meantime, his sister had been identified as an HLA-fully matched donor and he was presenting a 90% Karnofsky score. Thus, he was referred for an allogeneic bone marrow transplant. Fifty-three days after the transplantation he died due to acute graft-versus-host disease affecting his gastrointestinal tract and skin.
|
[[54.0, 'year']]
|
M
|
{'18537978': 1, '12023981': 1, '22384256': 2, '25789185': 2, '11746971': 1, '26341525': 1, '20594592': 1, '18503828': 1, '16001431': 1, '27664113': 1, '31533510': 2, '11739186': 1, '25833723': 1, '22549126': 1, '34367701': 2, '23904814': 2}
|
{'4348613-1': 1, '7583391-1': 1, '8337103-1': 1, '3288102-1': 1}
|
162,452 |
3728450-1
| 23,908,671 |
noncomm/PMC003xxxxxx/PMC3728450.xml
|
Polyclonal gammopathy related to renal bleeding in a peritoneal dialysis patient
|
A-15-year-old girl was admitted with left flank pain and gross hematuria for several days. Four years ago, she was diagnosed as end-stage renal disease due to dysplastic kidneys which was multicystic dysplastic kidney in right side and was dysplastic kidney with severe hydronephrosis in left side. She underwent cadaveric kidney transplantation. However, because chronic allograft dysfunction has occurred, she has been undergoing peritoneal dialysis for 3 months. She had received oral immunosuppressant therapy during kidney transplantation state, and it was stopped when the peritoneal dialysis was started. Her blood pressure was 147/104 mmHg, heart rate was 112 beats/min and respiratory rate was 22 beats/min. She looked acutely ill and physical examination revealed severe tenderness on the left costovertebral angle, but no pitting edema. The laboratory findings on admission were hemoglobin 6.3 g/dL, hematocrit 18.7%, white blood cell count 5,640/µL (lymphocyte 78% neutrophil 17%) and platelet 144,000/µL. The blood chemistry showed total protein/albumin 6.8/2.6 g/dL, sodium/potassium 132/4.0 mmol/L, calcium/phosphorus 7.3/3.5 mg/dL, blood urea nitrogen/creatinine 43/13.1 mg/dL, erythrocyte sedimentation rate 53 mm/hr, and C-reactive protein 2.2 mg/dL. Coagulation blood test was prothrombin time 105%, partial thromboplastin time 30.5'', international normalized ratio 1.0. Her urine showed gross hematuria with blood clots and protein (4+) occult blood (3+) on dipstick. The analysis of dialysate was normal. Computerized tomography of her abdomen revealed encapsulated intrapelvic hematoma in the left kidney (). She was given red blood cell transfusion and with conservative therapy, flank pain and gross hematuria were improved. Follow-up serial hemoglobin level was remained and her blood pressure was maintained within the normal range. Follow-up abdominal computerized tomography showed as renal pelvic hematoma of the same size. She was discharged with improved condition. At the outpatient department, she had neither fever nor pain, but complained of intermittent gross hematuria with blood clot and her anemia was not improved. Ten days after discharge, follow-up laboratory findings showed a reversed albumino-globulin ratio (total protein, 6.6 g/dL; albumin, 1.9 g/dL; globulin, 4.7 g/dL; albumin/globulin ratio, 0.4) and this finding was sustained for two months in spite of no evidence of infection or inflammation. Serum electrophoresis was compatible with polyclonal gammopathy, which showed an increased component with alpha-1 and gamma fraction (). Thereafter, a massive gross hematuria was recurred and anemia was persisted. We performed the embolization of the left renal artery, two months after when the renal cystic hemorrhage began. The continuous bleeding was solved and also, albumino-globulin dissociation was normalized a month after renal artery embolization was done ().
|
[[15.0, 'year']]
|
F
|
{'21082932': 1, '15663032': 1, '10050783': 1, '11357794': 1, '19712843': 1, '2660357': 1, '19648385': 1, '9017623': 1, '23908671': 2}
|
{}
|
162,453 |
3728451-1
| 23,908,672 |
noncomm/PMC003xxxxxx/PMC3728451.xml
|
Severe hypermagnesemia presenting with abnormal electrocardiographic findings similar to those of hyperkalemia in a child undergoing peritoneal dialysis
|
An 11-year-old boy on CCPD was admitted to the emergency room (ER) after 1 week of lethargy, decreased oral intake and poor function of CCPD. He had a medical history of mild cerebral palsy and steroid resistant focal segmental glomerulosclerosis leading to end stage renal disease. He had been managed with CCPD for 5 months. His medications included 4 types of antihypertensive drugs (nifedipine, enalapril, losartan, and amlodipine), 3 types of antiepileptic drugs (oxcarbazepine, clobazam, and lamotrigine), iron, calcium, and vitamin supplementation for chronic renal failure. Additionally, as a laxative for chronic constipation, lactulose had been administered for 5 months. Since lactulose didn't improve his symptom much, magnesium oxide was administered for 2 weeks prior to admission.\nAt admission, his blood pressure was 112/75 mmHg, his heart rate was 135 bpm, and his respiratory rate was 32 breaths/min. Physical examination revealed no specific abnormalities. Laboratory tests showed a leukocyte count of 7,900/mm3, a hemoglobin concentration of 10.7 g/dL, a serum sodium concentration of 132 mmol/L, a serum potassium concentration of 7.2 mmol/L, a blood urea nitrogen concentration of 53 mg/dL, a serum creatinine concentration of 9.3 mg/dL and a C-reactive protein concentration of 1.1 mg/dL. His dialysate fluid was clear. While in the ER, his temperature rose to 38.4℃ and his lethargy persisted. He was diagnosed with a viral infection and hyperkalemia and was admitted for general supportive care. After admission, an electrocardiography (ECG) revealed a tall T wave, a wide QRS complex and irregular conduction. CCPD was much frequently performed every 1 hour and he was administered intravenous calcium gluconate and regular insulin with glucose to correct his supposed hyperkalemia. Follow-up laboratory tests from blood drawn 4 hours later showed that his potassium concentration had decreased to 6.3 mmol/L, but his ECG findings did not improve and even became aggravated to wide QRS complex with irregular conduction abnormalities (). At that time, we found that his serum concentration of magnesium was markedly elevated, to 8.9 mg/dL (7.4 mEq/L), and he was diagnosed with symptomatic severe hypermagnesemia.\nThe patient was transferred to the pediatric intensive care unit and emergently hemodialyzed for hyperkalemia and hypermagnesemia. The patient underwent hemodialysis for three hours with dialysate containing 2.0 mEq/L (2.4 mg/dL) of magnesium, without heparin treatment. His serum concentration of magnesium decreased to 5.7 mg/dL (4.7 mEq/L) after 30 minutes. An ECG performed during the dialysis revealed a normal sinus rhythm with mild T wave changes (). The patient tolerated hemodialysis well and showed no hemodynamic instability. After 3 hours of hemodialysis, his serum concentrations of magnesium and potassium had decreased to 3.7 mg/dL and 4.8 mmol/L, respectively. On the following day, he was transferred to a general ward and continued CCPD every 2 hours. After two days, however, his serum magnesium concentration rose slightly, to 4.7 mg/dL. A repeat session of hemodialysis reduced his serum magnesium concentration to 3.17 mg/dL, which was thereafter maintained within a normal range with CCPD. At the time of discharge, his serum electrolytes and ECG findings were within the normal range.
|
[[11.0, 'year']]
|
M
|
{'20951915': 1, '25949041': 2, '33612659': 1, '11858925': 1, '11535863': 1, '24563801': 1, '19274487': 1, '8740750': 1, '14523145': 1, '10654978': 1, '18568054': 1, '30510660': 2, '12766548': 1, '15942092': 1, '16543690': 1, '11049902': 1, '12837909': 1, '23908672': 2}
|
{'4411570-1': 1, '6230454-1': 1}
|
162,454 |
3728465-1
| 23,908,982 |
noncomm/PMC003xxxxxx/PMC3728465.xml
|
Nutritional Support Process for a Patient with Short Bowel Syndrome in Conjunction with Panperitonitis: A Case Report
|
A 35-year-old man was admitted to the surgical ward through the Emergency Room (ER) at Gangnam Severance Hospital on May 20, 2011. He had no notable medical history except a laparoscopic appendectomy for acute appendicitis on May 4, 2011 at a local hospital. He was readmitted to the same hospital 8 days later on May 12 for complication-related reoperation and was under the observation when he developed acute abdominal pain, fever, surgical wound infection and both pulmonary effusions. The patient was immediately transferred to the Gangnam Severance Hospital and was diagnosed with panperitonitis. The X-ray result showed free air in the abdomen, which required him to undergo emergency reoperation. During the operation, perforation was found 50 cm above the terminal ileum and the patient had to undergo small bowel resection and anastomosis. He underwent an emergency exploratory laparotomy, irrigation and drainage, jejunostomy, and percutaneous endoscopic jejunostomy. An endto- end anastomosis at the resection site was difficult; thus, the surgeons performed jejunostomy at the proximal jejunum and inserted a feeding tube at the distal jejunum to attach the distal jejunum to the right anterior peritoneum ().\nAt the initial nutrition assessment upon admission, the patient was categorized as 'patient at high-risk of malnutrition' with serum albumin of 1.8 g/dL, lymphocytes of 0.73 × 103/µL and body mass index of 17.6. And also, before admittance to the Gangnam Severance Hospital, he had already experienced severe weight loss from 55 kg to 50.9 kg (7.5% weight loss) after the appendectomy. To correct his serum albumin level, the medical team injected seven packs of 20% albumin infusion and was able to recover the patient's serum albumin level to 3.6 g/dL; the patient had been receiving 50% of the minimum nutrition requirement through total parenteral nutrition (TPN) during early intensive care unit (ICU) days. The patient was referred to the nutrition support team on hospital stay day 5 and taking everything into consideration, he was classified as 'moderate malnutrition'.\nThe nutrition support team recommended the use of TPN given that enteral feeding was not a feasible option due to the surgery. Therefore, the patient received parenteral nutrition (2,180 kcal, 260 g of carbohydrate, 58 g of protein, 100 g of fat and 20 g of glutamine per day) through the right jugular line for 15 days after the surgery ().\nThe patient started oral feeding on hospital stay day 8 but nutrients were not properly absorbed because most of them were lost through the proximal jejunostomy.\nEnteral nutrition started on hospital stay day 22 through the jejunal feeding tube. Standard enteral nutrition formula (MediWell RTH has 1,000 kcal per 1,000 ml containing 140 g of glucose, 46 g of protein, and 30 g of fat) was provided. The amount of formula administered gradually increased from 300 kcal/300 ml to a maximum of 1,700 kcal/1,700 ml but the infusion rate and volume had to be frequently adjusted to address abdominal discomfort and frequent diarrhea but such changes did not fully improve the patient's condition ().\nMeanwhile, on hospital stay day 20, the medical and nutrition support team decided to re-administer the bolus that was lost through the proximal jejunostomy back into the jejunal feeding tube, which was expected to extend the contact time between the nutrients and shortened small intestine, thereby increasing absorption. This procedure was employed until the final surgery.\nAs the amount of standard enteral nutrition provided increased, there was an increase in diarrheal episodes. Following the recommendation of the nutrition support team, the patient started receiving hydrolyzed nutrition formula (MonoWell: 400 kcal per packet containing 50 g of glucose, 16 g of protein and 15 g of fat) on hospital stay day 55 that contains amino acids, which are more easily absorbed than intact proteins.\nTaking hypertonicity of the standard enteral nutrition formula into consideration, the hydrolyzed nutrition formula was given in lower concentration (0.5 kcal/ml) and was administered over 15 hours. This adjustment made a significant improvement in reducing diarrheal episodes. The volume was then gradually increased over a month and reached a daily average of 1,000 kcal and 40 g of protein. To complement the inadequacy of the enteral nutrition, a 1,000 kcal peripheral intravenous nutrition, containing 50 g of protein, vitamins and minerals, was provided until the final surgery.\nOn hospital stay day 66, the medical team desired to readminister standard enteral nutrition formula to stimulate normal digestive function of the small bowel but the patient continued to show maladjustment signs like diarrhea. Thus, the team provided continuous but a small volume of the standard enteral nutrition until the final surgery.\nDespite the administration of TPN after the initial surgery, the patient experienced rapid weight loss of about 3 kg over 3 weeks since the admission to the hospital. By the 21st day of hospitalization at Gangnam Severance Hospital, the patient weighed approximately 47 kg. However, through enteral and parenteral nutrition support, his weight stabilized and his blood lab values also returned to normal figures ().\nAt the final surgery on hospital stay day 85, the medical team removed the jejunal feeding tube, repaired the jejunostomy, eliminated a section of the edematous distal jejunum by 50 cm, and performed anastomosis of the distal jejunum and the healthy proximal jejunum. The patient switched from parenteral nutrition to liquid diet on hospital stay day 89 and was discharged on hospital stay day 97 when he was completely able to eat a regular meal instead of a liquid diet.
|
[[35.0, 'year']]
|
M
|
{'3011582': 1, '3134973': 1, '21621693': 1, '37887': 1, '11873098': 1, '23690158': 1, '15330926': 1, '23761561': 1, '21378253': 1, '8389406': 1, '16837533': 1, '23264168': 1, '20713204': 1, '23908982': 2}
|
{}
|
162,455 |
3728466-1
| 23,908,983 |
noncomm/PMC003xxxxxx/PMC3728466.xml
|
Changes in Dietary Intake, Body Weight, Nutritional Status, and Metabolic Rate in a Pancreatic Cancer Patient
|
A 42-year-old man diagnosed with pancreatic head cancer at another hospital was referred to our hospital for a second opinion. For further evaluation, the patient underwent a biopsy that yielded positive results for malignant cells. The patient was in good health except for hypercholesterolemia. However, the patient complained of fatigue, dyspepsia, and nausea and developed jaundice. The patient's total bilirubin level was 10.6 mg/dL. Other blood test indices were as follows: albumin, 4.0 g/dL; total cholesterol, 288 mg/dL; and glycosylated hemoglobin (HbA1c), 6.1% ().\nNutrition consultation was regularly provided by a registered dietitian. Nutritional status was assessed using the scored Patient-Generated Subjective Global Assessment (PG-SGA) at diagnosis, as well as at 2 and 3 months after the diagnosis. Dietary intake was evaluated using 3-day food records. Measured resting energy expenditure (measured REE) was assessed using indirect calorimetry (TrueOne2400; Parvo Medics, Utah, USA), while predicted resting energy expenditure (predicted REE) was calculated using the Harris-Benedict equation at the time of diagnosis and 2 months later. To increase the accuracy of the food records, a trained registered dietitian confirmed all of the records written by the caregiver using face-to-face interviews. The daily intakes of energy and nutrients were calculated using the CAN-pro 3.0 (Korean Nutrition Society, Korea). The main caregiver was a family member (a sister) who assisted with the nutritional assessment by recording the patient's dietary intake.\nThe patient's height was 161 cm and usual body weight was 70 kg. At diagnosis, the patient's measured REE was 1,707 kcal/day (24.4 kcal/kg/day), while the predicted REE was 1,545 kcal/day (22.1 kcal/kg/day). The patient usually consumed 3 meals a day and sometimes had constipation, but this had no effect on the patient's dietary intake. The mean energy intake was 1,887 kcal/day (27.0 kcal/kg/day), and the mean protein intake was 56 g/day (0.8 g/kg/day). Because the patient was an outpatient at this time, no parenteral nutrition was provided. The ratio of carbohydrates to proteins to lipids was 70:12:18. The patient's weight was stable at 70 kg. According to the PG-SGA, the patient was classified as well nourished (SGA-A) with a PG-SGA score of 2. Physical examination of the subcutaneous fat, muscle mass, and fluid balance did not reveal any depletion in the subcutaneous fat or muscle ().\nThe patient was encouraged to divide his daily energy intake over 6 meals: 3 main meals and 3 snacks between meals that included various food items for a well-balanced diet. No strict rules or prohibitions with respect to dietary intake were imposed. The patient received pancreatic enzyme replacement therapy in combination with dietary counseling to maintain his weight and improve the QOL. The patient received concurrent chemo-radiation therapy (CCRT) with 5-fluorouracil (5-FU) after he recovered from hyperbilirubinemia. The patient's weight was stable during the first CCRT.\nAt the 2-month follow-up after diagnosis, the patient's weight was almost stable at 69 kg. However, the patient reported having a poor appetite and epigastric pain. At this time, the patient intended to reduce his food intake as a result of decreased physical activity. The patient's energy intake decreased to 1,060 kcal/day (15.4 kcal/kg/day), and the protein intake also decreased to 30 g/day (0.44 g/kg/day). Because the patient was an out-patient at this time, no parenteral nutrition was provided. The ratio of carbohydrates to proteins to lipids was 78:11:11. Conversely, the measured REE of the patient increased to 2,416 kcal/day (35.0 kcal/kg/day), while the predicted REE remained stable (1,531 kcal/day). There was no depletion in the subcutaneous fat or muscle. The patient's daily functioning was also good, and the patient was still considered as well nourished (SGA-A), but the PG-SGA score increased to 8. Nutritional education was conducted to encourage dietary intake in order to prevent further deterioration of his nutritional status.\nAt the 3-month follow-up after diagnosis, the patient was readmitted for a pancreatectomy and was classified as being moderately malnourished or with suspected malnutrition (SGA-B). The PG-SGA score was 8. The patient's weight decreased to 68 kg, and the serum albumin level was 4.1 g/dL. After the total pancreatectomy, the patient was diagnosed with diabetes mellitus and received insulin therapy along with diet education for blood glucose control. The patient reported symptoms such as constipation, poor appetite, and abdominal pain. The frequency of the patient's dyspepsia also increased, which contributed to a decrease in food intake to 500-1,000 kcal/day. A dietitian advised the patient and his caregiver to consume frequent small meals and provided tips for the treatment and prevention of hypoglycemia.\nWhen the patient was discharged, the patient could only consume a very minimal amount of solid food, as the patient was experiencing severe pain and dyspepsia. The patient had several hypoglycemic events; hence, the insulin dosage was reduced. Dietary intake, especially of solid food, continued to decrease. A dietitian provided detailed explanations on food preparation skills to the caregiver in order to increase the nutrition density in food and to prepare a balanced liquid diet.\nAt the 8-month follow-up after diagnosis, positron emission tomography (PET) findings suggested a recurrence around the superior mesenteric artery with aortocaval lymph node metastasis. While chemotherapy commenced, the patient continued to have poor oral intake, and a dietitian met the patient's caregiver to introduce an oral nutrition supplement. However, the patient's weight was 55 kg and continuously decreased to 49 kg at the last chemotherapy treatment.\nAt the 11-month follow-up after diagnosis, the patient could not meet the dietitian due to his poor health. Medical care for the patient focused on supportive care due to the advanced stage of the disease and treatment-refractory disease progression. The last weight measurement showed a 15 kg weight increase over a 2-week period due to the accumulation of ascites. The patient was referred to a hospice for end-of-life care.
|
[[42.0, 'year']]
|
M
|
{'7512810': 1, '21926936': 1, '31164144': 1, '20440279': 1, '22684989': 1, '23400555': 1, '9000606': 1, '6692317': 1, '11433403': 1, '20967470': 1, '10731472': 1, '15030964': 1, '28912804': 1, '14730120': 1, '9824858': 1, '23908983': 2}
|
{}
|
162,456 |
3728598-1
| 23,904,852 |
noncomm/PMC003xxxxxx/PMC3728598.xml
|
Vertebral Artery Dissection Associated with Generalized Convulsive Seizures: A Case Report
|
An otherwise healthy 46-year-old male engineer, with juvenile myoclonic epilepsy, was admitted to our department following convulsive seizures 1 month after discontinuation of lamotrigine. He was diagnosed with juvenile myoclonic epilepsy at the age of 39 after having 3 generalized convulsive seizures over 3 months. An EEG and brain CT were both normal. He was started on valproic acid 900 mg and was shifted to lamotrigine 200 mg daily 3 years later. After a 5-year period without seizures, lamotrigine was slowly tapered off and the patient completely stopped the intake 1 month before the present admission. He was admitted to hospital with a right-sided hemiparesis with Babinski sign, a right-sided central facial palsy and an ataxic finger-nose test on the left side, which developed following a generalized convulsive seizure 1 day prior to admission. He had no neurological or other complaints up to the seizure. Brain CT was normal, but an MRI scan showed an infarct in the left cerebellar hemisphere (fig. ) and a left-sided pontine infarction (fig. ). Subsequent MR angiography showed a right VAD (fig. ).\nIn addition, the blood samples for kidney and liver function, haemoglobin and coagulation factors were all in the normal range of reference. However, there was a high leucocyte count with an overabundance of neutrophils. Moreover, the patient's blood pressure at the time of admission was normal (127/87 mm Hg), and he was afebrile. The patient was started on heparin and the oral anticoagulant warfarin, which he continued for 6 months (from January 10 until June 21). The treatment with lamotrigine was also resumed. Recovery of neurologic function was excellent, and he was discharged after 14 days. A control MR angiography 6 months later showed a normal vertebral artery (fig. ). The patient still continued treatment with aspirin and dipyridamole.
|
[[46.0, 'year']]
|
M
|
{'15573213': 1, '5000418': 1, '25883815': 2, '22290060': 1, '20935331': 1, '10707232': 1, '18309177': 1, '21923248': 1, '16511634': 1, '22301716': 1, '9118849': 1, '20661402': 1, '17523124': 1, '20544651': 1, '18574926': 1, '1905346': 1, '16488240': 1, '17046478': 1, '11259724': 1, '18990128': 1, '19165955': 1, '23904852': 2}
|
{'4391316-1': 1}
|
162,457 |
3728599-1
| 23,904,841 |
noncomm/PMC003xxxxxx/PMC3728599.xml
|
Feasible Isolated Liver Transplantation for a Cirrhotic Patient on Chronic Hemodialysis
|
The recipient was a 63-year-old Japanese male who had been suffering from hepatitis C cirrhosis since the age of 37 years. He had undergone endoscopic variceal ligation for esophageal varices at the age of 58 years. His liver function had gradually become decompensated and he had developed hepatic encephalopathy 5 months before admission. He had had cryptogenic chronic nephritis from the age of 19 years and started hemodialysis at the age of 60 years. He had no other complications such as diabetes, hypertension or hemodialysis-related complications. His height was 159 cm and his weight was 53 kg before hemodialysis and 51 kg after hemodialysis. His Child-Pugh score was 10 (grade C) with a total bilirubin level of 0.9 mg/dl, an albumin level of 3.4 g/dl and a prothrombin time of 68% (international ratio 1.25). He was seropositive for hepatitis C virus (HCV) antibodies but seronegative for HCV RNA. The levels of blood urea nitrogen and creatinine were 61 and 9.01 mg/dl, respectively. His model for end-stage liver disease score was 22. A computed tomography scan revealed the presence of liver cirrhosis, splenomegaly and developed collateral vessels such as splenorenal shunt, recanalized paraumbilical vein and gastric varices. No definite hepatocellular carcinomas were detected (fig. ). The bilateral kidneys were very atrophic, which was consistent with irreversible renal failure (fig. ). In summary, he had decompensated hepatitis C cirrhosis without serum HCV RNA. He had non-diabetic renal failure after 3 years on hemodialysis. He showed good general function except for the liver and kidney failure. Therefore, the patient was expected to have a good prognosis after LDLT.\nThe donor was his healthy 58-year-old wife with identical blood type to the recipient. The right lobe graft was procured using a typical method described elsewhere [, , , , ]. The actual graft weight was 546 g, which accounted for 50.4% of the recipient's standard liver volume.\nIn the recipient, intraoperative continuous hemodiafiltration (CHDF) without water removal was started immediately via the right femoral vein after laparotomy. The CHDF provided a stable acid-base and electrolyte balance. A total hepatectomy and implantation were performed under stable hemodynamics using an extracorporeal veno-venous bypass. The V5, right inferior hepatic vein and right hepatic vein of the right lobe graft were reconstructed to have a co-orifice using the left internal jugular vein and explanted portal vein grafts of the recipient at the backtable according to our usual method [, ]. Operative time was 14 h 22 min. The anhepatic, cold ischemic and warm ischemic times were 140, 169 and 65 min, respectively. The blood loss was 2,000 g, for which 10 units of red cell concentrate, 10 units of fresh-frozen plasma and 30 units of platelet concentrate were transfused.\nThe postoperative courses of the recipient and the donor were uneventful. CHDF was continued until postoperative day 4, at which point CHDF was converted to hemodialysis. The amount of water removal was appropriately adjusted according to blood pressure, central venous pressure and body weight. The drained ascites was below 500 ml/day and all abdominal drains were removed by postoperative day 6 except for the biliary stents (table ). Other than the renal replacement therapy and dose modulation of renal excretory drugs such as acyclovir, the perioperative management of the recipient was typical, as previously described [, , , , ]. Immunosuppression was induced with intravenous methylprednisolone and then switched to oral prednisolone, cyclosporin A and mycophenolate mofetil. He left the intensive care unit on postoperative day 5 and was discharged on postoperative day 36 with good hepatic function.
|
[[63.0, 'year']]
|
M
|
{'27500264': 1, '19202452': 1, '12591446': 1, '12682898': 1, '18433050': 1, '11391230': 1, '22203391': 1, '21447144': 1, '18808402': 1, '18589127': 1, '17984835': 1, '21542128': 1, '16025497': 1, '12937310': 1, '17532752': 1, '11981768': 1, '16611337': 1, '10030332': 1, '11209015': 1, '8516873': 1, '23904841': 2}
|
{}
|
162,458 |
3728603-1
| 23,904,847 |
noncomm/PMC003xxxxxx/PMC3728603.xml
|
Breast Osteosarcoma 29 Years after Radiation Therapy for Epithelial Breast Cancer
|
We present the case of an 87-year-old African American female with a past medical history of right breast adenocarcinoma diagnosed in 1989. At that time, the patient underwent partial mastectomy, axillary lymph node dissection and radiation therapy. The patient had yearly surveillance and diagnostic mammograms with no evidence of disease recurrence. Her past medical history is also significant for hypertension and type 2 diabetes mellitus. The patient's family history is significant for breast cancer in her sister at the age of 40 years and hypertension in both of her parents. The patient was using metformin, low-dose aspirin, lisinopril and hydrochlorothiazide.\nIn October 2011, a 10-cm tender right breast mass was noted by the patient. She subsequently underwent modified radical mastectomy of the right breast after thorough medical evaluation of the mass (fig. ). The pathology report was consistent with chondroblastic osteosarcoma (fig. ). The tumor stained positive for vimentin and negative for cytokeratin.\nEight months later, the patient had a recurrence of the lesion and a re-excision was performed with clear margins. A pathology report of the recurrent breast mass was consistent with breast osteosarcoma. Eight months after the second surgery, the patient started having fatigue and dry cough. A computed tomography of the chest was performed and showed bilateral pulmonary nodules suspicious for a malignancy (fig. ). A biopsy of the nodules revealed metastatic osteosarcoma (fig. ). The patient was started on liposomal doxorubicin chemotherapy. Transthoracic echocardiography was performed prior to doxorubicin initiation, given potential cardiotoxic effects of doxorubicin. Transthoracic echocardiography showed a normal heart function. The patient tolerated chemotherapy well and is scheduled for the next visit in 2 months.
|
[[87.0, 'year']]
|
F
|
{'12206600': 1, '10661345': 1, '22334455': 1, '22688473': 1, '26870284': 1, '19526590': 1, '19935795': 1, '19996729': 1, '20555081': 1, '10571202': 1, '12393820': 1, '23904847': 2}
|
{}
|
162,459 |
3728604-1
| 23,904,848 |
noncomm/PMC003xxxxxx/PMC3728604.xml
|
Aggressive Angiomyxoma with Diffusion-Weighted Magnetic Resonance Imaging and Dynamic Contrast Enhancement: A Case Report and Review of the Literature
|
In July 2011, a 51-year-old woman presented to her general practitioner with an incidentally discovered renitent mass in the internal part of the left buttock. Initial ultrasound (US) showed a well-circumscribed mass initially evoking a lipoma. Due to the large volume of the mass, the patient was referred to our hospital.\nThe patient did not have any specific medical, personal, or familial history. Her treatment included hormone replacement therapy. Rectal examination palpated the renitent mass. She was otherwise asymptomatic with a performance status score of 0 on the WHO scale. Laboratory findings were unremarkable. US showed a superficial, soft, hypoechoic, well-limited, solid mass. US-guided biopsy showed mature adipocytes associated with nonatypical fibroblast-like cells. Endorectal US showed a 39-mm hypoechoic lesion distant from the internal and external sphincters.\nMRI showed a bulky perineal and intrapelvic tumour displacing rather than infiltrating the vagina, anal canal, and rectal structures. The mass was well limited, hourglass-shaped and had a maximum diameter of 11 cm (fig. ). On T1-weighted imaging, the tumour was isointense relative to muscle. T2-weighted imaging showed typical high signal intensity with layered strands of lower signal intensity and swirled architecture. Finger-like projections into the underlying adipose tissue were observed. A fat linear structure of high signal intensity on T1- and T2-weighted images was present inside the mass. Its significance was unknown, perhaps representing neighbouring tissues trapped when the tumour was growing. After intravenous contrast injection, the mass was greatly and heterogeneously enhanced, exhibiting a layered pattern (fig. ). The tumour's DCE analysis showed a progressive curve without plateau or washout. Regions of interest located in the layers demonstrated the same profile curves of progressive enhancement with variable intensity.\nDW-MRI sequences (fig. ) showed heterogeneous high signal intensity on b0 and b1000 sequences. Typical architecture was only observed on b0 sequences. Apparent diffusion coefficient (ADC) mapping showed a high value in the tumour, estimated at 2 × 10−3 (±0.15) mm2/sec.\nThus, MRI was highly suggestive of AA. It also showed disease extension, notably through the pelvic diaphragm, which made a combined transperineal and laparoscopic abdominopelvic approach necessary. Before surgery, the examination under general anesthesia showed that the mass was soft, renitent, and seemed to come from the pelvic cavity through the levator ani muscles. Tumour excision was monobloc and macroscopically complete, without any rectal or vaginal resection or tumour capsular rupture. The postoperative course was uneventful.\nMacroscopic examination of the surgical specimen showed a firm, partly circumscribed tumour measuring 16 × 12 × 6.5 cm. A cut section showed a homogeneous, glistening, and gelatinous appearance without any hemorrhagic or necrotic areas. Microscopic analysis showed a monotonous hypocellular proliferation of small nonatypical stellate-shaped cells arranged in a myxoid stroma, along with numerous, variably sized vessels. No mitosis or necrosis could be seen. In its periphery, the proliferation infiltrated the nontumour adipose tissue, and resection margins were focally involved by the tumour cells. Immunohistochemical analysis showed strong expression of CD34, and estrogen and progesterone receptors by tumour cells, without expression of desmin, CD117, β-catenine, and MDM2, nor epithelial (pancytokeratin, EMA), smooth muscle (α-smooth actin, H-caldesmon), and Schwann cell (PS100) markers. The final diagnosis was pelvi-perineal AA.\nAfter surgery, no adjuvant treatment was given, and the patient was regularly monitored clinically and radiologically. At her last visit, in October 2012, more than 1 year after the diagnosis, the patient was alive with an excellent performance status and without any recurrence of the disease on pelvic DW-MRI.
|
[[51.0, 'year']]
|
F
|
{'16317491': 1, '30510948': 2, '31019700': 2, '17255431': 1, '16870390': 1, '19954923': 1, '14608546': 1, '30363609': 2, '16515622': 1, '12972531': 1, '12623047': 1, '8646730': 1, '32698271': 2, '21997994': 1, '15157218': 1, '15564405': 1, '33329983': 2, '24293303': 1, '31934004': 1, '10716303': 1, '27571990': 1, '9930798': 1, '34790299': 1, '18334016': 1, '23904848': 2}
|
{'6264985-1': 1, '6264985-2': 1, '6264985-3': 1, '6264985-4': 1, '6264985-5': 1, '6264985-6': 1, '6264985-7': 1, '6264985-8': 1, '6180818-1': 1, '6463328-1': 1, '7734890-1': 1, '7322231-1': 1}
|
162,460 |
3728605-1
| 23,904,853 |
noncomm/PMC003xxxxxx/PMC3728605.xml
|
Delayed Liver Function Impairment Secondary to Interferon β-1a Use in Multiple Sclerosis
|
A 56-year-old Taiwanese woman was diagnosed as having multiple sclerosis in May 2000. Her first attack presented as left optic neuritis in December 1998. Her second attack, with brain stem encephalitis, developed in May 2000. Cranial MRI studies showed T2-weighted hyperintense lesions in the inferior medulla and upper cervical spinal cord at C1 level at that time. Her IgG index was 0.77 (reference <0.5), but oligoclonal bands were not found in the cerebrospinal fluid. Autoimmune factors such as anti-SSA/SSB antibody, antinuclear antibody, and rheumatoid factor were within the normal ranges. She was diagnosed as having multiple sclerosis and received interferon β-1a (Rebif 44 μg subcutaneous injection 3 times a week) starting in October 2002. She had sensations of chill after interferon use at first, but could tolerate it. The results of liver function tests in March 2005 were still within the normal range: alanine transaminase (ALT) 13 U/l [upper limit of normal (ULM) <36 U/l]. Recurrent thoracic myelopathy developed in March 2006. The thoracic MRI studies showed T2-weighted hyperintense lesions in the central gray matter around the T5–T6 level (two segments). However, her anti-aquaporin 4 (AQP4) antibody test result was negative (the manufacturer's recommended level for seropositivity was ≥5 U/ml; assessed by Elisa RSR AQP4 Ab kits; provided by Kronus, Ltd.). She was still diagnosed as having multiple sclerosis rather than neuromyelitis optica (NMO) according to Wingerchuk et al.'s [] criteria for NMO in 2006 and McDonald's diagnostic criteria for multiple sclerosis in 2010 [], and she continued to receive interferon therapy. After the thoracic myelitis, mycophenolate prednisolone and cyclophosphamide were also used to control her disease. However, she could not tolerate the side effects of these medications. Her medications were changed to azathioprine 50 mg daily in December 2006. During this period, she also received carbamazepine 100 mg twice a day. Follow-up liver function tests in October 2007 then showed impaired liver function: aspartate transaminase (AST) 93 U/l [2.7 × ULM (<34 U/l)] and ALT 100 U/l (2.8 × ULM). She only had mild general malaise without other symptoms such as jaundice. She did not consume any alcohol and denied taking any over-the-counter medication. However, she took some Chinese herbs with unknown content sometimes. Initially, azathioprine was suspected to induce liver function impairment, and the dose was reduced to 25 mg daily in December 2007 and further reduced to 25 mg every other day in January 2008. However, her liver function gradually worsened in the next few months. In May 2008, the results of her liver function tests were as follows: AST 213 U/l (6.3 × ULM); ALT 282 U/l (7.8 × ULM); alkaline phosphatase (ALK-P) 145 U/l [1.5 × ULM (<94 U/l)]; total bilirubin 0.7 mg/dl (ULM <1.3 mg/dl). Detailed hepatological evaluation was started. Results of hepatitis markers (HBsAg and anti-HCV antibody) and autoimmune titers (antinuclear antibody, anti-smooth muscle antibody, and anti-mitochondrial antibody) were all within the normal ranges. In addition, she did not have any other drug reactions such as renal insufficiency, hemolytic anemia, leucopenia, and thrombocytopenia besides liver function impairment. Drug-induced hepatitis was highly suspected. Interferon β-1a was reduced to 44 μg twice a week; carbamazepine and azathioprine were discontinued in May 2008. She also stopped taking Chinese herbs after that time. Her liver function improved after reducing the interferon dose and discontinuing other concomitant medications [July 2008: AST 51 U/l (1.5 × ULM); ALT 80 U/l (2.2 × ULM); r-glutamyl transpeptidase (r-GT) 110 U/l (ULM <71 U/l)]. Then, her liver function returned into normal ranges after interferon was discontinued in August 2008 [January 2009: AST 23 U/l; ALT 27 U/l; r-GT 75 U/l (1.06 × ULM)]. After a period of follow-up, interferon β-1a (22 μg twice a week) and carbamazepine (100 mg twice a day) were added again in March 2009. However, her liver enzymes were elevated again [April 2009: AST 43 U/l (1.3 × ULM); ALT 69 U/l (1.9 × ULM); r-GT 436 U/l (6.1 × ULM)] a month later. So, interferon was discontinued, while carbamazepine treatment was continued (100 mg twice daily). Her liver enzymes returned to normal ranges [AST 24 U/l; ALT 31 U/l; r-GT 150 U/l (2.1 × ULM)] again in May 2009. The results of her liver function test remained in the normal ranges at follow-up (November 2010: AST 18 U/l; ALT 19 U/l). The Roussel Uclaf Causality Assessment Method (RUCAM) scale for this patient after receiving interferon treatment is 8 [].
|
[[56.0, 'year']]
|
F
|
{'15090564': 1, '15794390': 1, '16531969': 1, '12908850': 1, '17030771': 1, '15742101': 1, '21387374': 1, '8229110': 1, '9820297': 1, '16717206': 1, '11425926': 1, '21148660': 1, '19465443': 1, '14631124': 1, '23904853': 2}
|
{'3728605-2': 2}
|
162,461 |
3728605-2
| 23,904,853 |
noncomm/PMC003xxxxxx/PMC3728605.xml
|
Delayed Liver Function Impairment Secondary to Interferon β-1a Use in Multiple Sclerosis
|
A 43-year-old Taiwanese woman had right optic neuritis in 2001. Her second attack, with brain stem encephalitis, developed in April 2007. Cranial MRI studies at that time showed multiple periventricular and right paramedian pontine white matter lesions which fitted the criteria of dissemination in space according to the McDonald criteria []. Her IgG index was 0.65; oligoclonal bands were not found in the cerebrospinal fluid. Autoimmune factors such as anti-SSA/SSB antibody, antinuclear antibody, and rheumatoid factor were within the normal ranges. Since she did not have acute myelitis, which is one of the absolute diagnostic criteria of NMO [], she did not receive an anti-AQP4 antibody test. She received interferon β-1a (Rebif 44 μg subcutaneous injection 3 times a week) under the diagnosis of multiple sclerosis starting in January 2007. Results of liver function tests in November 2007 were within the normal ranges: ALT 33 U/l and AST 22 U/l. Concomitant medications during this period were baclofen 10 mg twice a day and zolpidem 10 mg before sleep. However, follow-up liver function tests in July 2012 showed impaired liver function: AST 93 U/l (6.8 × ULM); ALT 251 U/l (7.4 × ULM); amylase 636 [6.4 × ULM (<100 U/l)]; r-GT 73 U/l, and total bilirubin 0.8 mg/dl. She did not have any clinical symptoms like malaise or jaundice. She also denied any alcoholic intake and taking any other medication during this period. Rebif was reduced to 22 μg 3 times a week. Detailed hepatological evaluation was also started. Results of hepatitis markers (HBsAg and anti-HCV antibody) and autoimmune titers (antinuclear antibody and anti-mitochondrial antibody) were within normal ranges. She only had mild elevated anti-smooth muscle antibody tilter (1:80). Further abdominal computed tomography scan studies only showed a slight predominance of periportal fat raising suspicion of inflammatory change. Her liver function improved a little after reducing the interferon dose [November 2012: AST 84 U/l (2.5 × ULM); ALT 92 U/l (2.6 × ULM)]. Interferon was discontinued in January 2013 due to the persistently elevated liver function tests. The results of her liver function test then returned into normal ranges (February 2013: AST 35 U/l; ALT 36 U/l), and interferon treatment was not resumed this time. The RUCAM scale for this patient after receiving interferon treatment is 7.
|
[[43.0, 'year']]
|
F
|
{'15090564': 1, '15794390': 1, '16531969': 1, '12908850': 1, '17030771': 1, '15742101': 1, '21387374': 1, '8229110': 1, '9820297': 1, '16717206': 1, '11425926': 1, '21148660': 1, '19465443': 1, '14631124': 1, '23904853': 2}
|
{'3728605-1': 2}
|
162,462 |
3728606-1
| 23,904,849 |
noncomm/PMC003xxxxxx/PMC3728606.xml
|
A Case of Panitumumab-Responsive Metastatic Rectal Cancer Initially Refractory to Cetuximab
|
A 64-year-old man was initially diagnosed with rectal cancer and liver metastasis. He underwent rectal amputation and partial hepatectomy, and pelvic node metastasis was pathologically diagnosed. Two months after the resection, he received first-line adjuvant chemotherapy comprising 5-flurouracil, leucovorin and oxaliplatin (mFOLFOX6). One year and 9 months later, computed tomography with contrast enhancement revealed multiple pulmonary and right femoral lymph node metastases. Second-line chemotherapy comprising 5-flurouracil, leucovorin and irinotecan (FOLFIRI) plus bevacizumab was begun, and he was free from progression for 2 years and 11 months. At that point, imaging studies revealed progressive disease (PD) as evidenced by metastatic lesions. Third-line chemotherapy comprising cetuximab combined with CPT-11 was then begun. The lesions showed a partial response after 3 months, and the patient was free from progression for 1 year and 6 months.\nThe metastatic lesions then showed gradual growth and the patient again developed PD. He began to suffer from severe right femoral pain, and panitumumab therapy was begun. After 2 months, the femoral pain had diminished, the multiple pulmonary lesions had been markedly reduced and a portion of the lesions had disappeared (fig. ).\nThe patient's partial response status was maintained for 6 months. Although the pulmonary lesions began to progress again, the patient has been alive for 5 years and 6 months since the first operation (fig. ).
|
[[64.0, 'year']]
|
M
|
{'19114683': 1, '20921465': 1, '22270724': 1, '20921462': 1, '18316791': 1, '22586653': 1, '21900593': 1, '19339720': 1, '18946061': 1, '17332301': 1, '18422755': 1, '23904849': 2}
|
{}
|
162,463 |
3728608-1
| 23,904,845 |
noncomm/PMC003xxxxxx/PMC3728608.xml
|
Primary Dermal Melanoma in a Patient with a History of Multiple Malignancies: A Case Report with Molecular Characterization
|
A 72-year-old Caucasian woman came to our attention for a right paravertebral purplish-red nodular lesion on the back, with a few focal pigmentations and a small semilunar perinodular area of brownish pigmentation (fig. ). The patient could not report the onset of the lesion. The differential diagnosis included, in this case, basal cell carcinoma, malignant melanoma, vascular lesions, epidermoid carcinoma and dermatofibroma.\nThe patient's clinical history was characterized by multiple tumours, including bilateral metachronous breast cancer for which she had undergone bilateral mastectomy and axillary lymphadenectomy, clear cell renal cell carcinoma, uterine fibromatosis and intestinal polyposis with low- and high-grade dysplasia. Despite the macroscopic aspect which suggested pigmented basal cell carcinoma, the possibility of the lesion being melanocytic made us opt for an excisional biopsy with a 2-mm margin.\nThe skin lesion specimen showed a poorly differentiated neoplastic dermal infiltration with morphological aspects of melanocytic proliferation (fig. ). The tumour cells displayed round or oval shapes with brisk mitotic activity, and they were arranged in a nodular architecture with rounded margins. Lymphocytic and plasmacellular infiltration of the lesion was observed, without formation of lymphoid nodules. An intraepidermal component, ulceration and regression aspects were not evident, even with an examination of multiple sections; a preexisting nevus, spindle neoplastic cells or bands of mature intercellular collagen were also not found. A distinct grenz zone was appreciable between the dermal neoplasm and the overlying epidermis. The neoplastic cells demonstrated melanocytic-type immunohistochemistry (S100 protein and HMB-45 positive). The proliferative index evaluated with Mib-1 was 25%.\nThe histopathological report was summarized as ‘malignant melanoma (thickness 2 mm); the absence of intraepidermal atypical melanocytes is compatible with metastatic malignant melanoma or PDM’. Desmoplastic melanoma was excluded on the basis of cytology and because of the lack of a desmoplastic reaction, while nodular melanoma was excluded due to the absence of an intraepidermal component. With the aim of identifying a possible primary lesion, the following tests were performed: dermatological examination; total body CT; ophthalmologic examination; pancolonoscopy; ear, nose and throat examination; esophagogastroduodenoscopy, and gynaecological examination. No evidence of another primary melanoma was found; however, a parallel finding of frontal meningioma was noted. The absence of another primary lesion led us to make the diagnosis of PDM per exclusionem.\nThe second surgical step included the excision of the biopsy scar with 2-cm margins and sentinel lymph node biopsy. The preoperative lymphoscintigraphy showed 3 areas of uptake − 2 of them involving the soft tissue at the level of the posterior pillar of both the axillae, and the remaining 1 in the left paravertebral area, adjacent to the previous surgical site. However, only a single sentinel node presenting micrometastasis of melanoma was found in the latter area.\nA bilateral axillary ultrasound examination was performed to investigate the areas of lymphoscintigraphic uptake; subsequently, the patient underwent an additional surgical procedure for the removal of a lymph node with ambiguous ultrasonographic features found within the residual left axillary fatty tissue (the patient had had ipsilateral axillary lymphadenectomy several years before for breast cancer). The histological examination of the specimen revealed adipose tissue and a lymph node with reactive patterns. The patient is currently alive and free of disease 14 months since her diagnosis.
|
[[72.0, 'year']]
|
F
|
{'22622578': 1, '18209168': 1, '23331971': 1, '15286780': 1, '16609049': 1, '16410786': 1, '26630911': 1, '11074704': 1, '19799798': 1, '32740808': 1, '17289871': 1, '14732666': 1, '31280224': 1, '17113518': 1, '19130137': 1, '12789286': 1, '19828018': 1, '19500183': 1, '22080950': 1, '16291983': 1, '23904845': 2}
|
{}
|
162,464 |
3728609-1
| 23,904,850 |
noncomm/PMC003xxxxxx/PMC3728609.xml
|
High-Grade Glioma: Refined Diagnostics Steering Stratified Therapy
|
A 30-year-old female presented at our clinic with moderate aphasia of a few weeks’ duration 14 days after she had been diagnosed with anaplastic astrocytoma based on an open biopsy of her left temporal lobe at an external hospital. She had a 2-year history of complex focal epileptic seizures prior to diagnosis. Due to a substantial mass effect of the remaining tumor, an interdisciplinary consensus was followed, and part of the remaining tumor was resected with a substantial relief of the mass effect (fig. ) and almost complete recovery of aphasia, with a Karnofsky performance score of 90%. The diagnosis of anaplastic astrocytoma was confirmed by the local neuropathologist, taking into consideration that some of the reactive and regressive changes (fig. ) were attributable to the preceding biopsy. The presence of a mutation of isocitrate dehydrogenase (IDH1), a marker of grade II and III gliomas and secondary glioblastomas, substantiated the diagnosis []. After central review of the histology by 2 reference neuropathologists, randomization into an international clinical trial for anaplastic gliomas was rejected due to the fact that necrosis in the histological samples obtained during the second surgery qualified, in the view of the reference neuropathologists, as glioblastoma. At that point, considering the size of the residual tumor mass and in view of the clinical history and an MRI suggestive of a rather aggressive high-grade glioma, we decided to start the patient on radiochemotherapy with temozolomide according to the Stupp protocol [].
|
[[30.0, 'year']]
|
F
|
{'18669428': 1, '15758009': 1, '27868022': 1, '19228619': 1, '23095825': 1, '23904850': 2}
|
{}
|
162,465 |
3728610-1
| 23,904,844 |
noncomm/PMC003xxxxxx/PMC3728610.xml
|
Severe Acute Pancreatitis with Complicating Colonic Fistula Successfully Closed Using the Over-the-Scope Clip System
|
A 44-year-old man presented to the emergency room with continuous abdominal pain and met the diagnostic criteria for systemic inflammatory response syndrome (39°C, 130 beats/min, 20 breaths/min). Laboratory tests showed elevation of leukocyte count (WBC) and levels of C-reactive protein (CRP), transaminase, amylase, pancreatic amylase and triglyceride (table ). Two of Ranson's criteria were positive (WBC > 16,000 cells/mm3; blood glucose > 200 mg/dl) []. Contrast-enhanced computed tomography (CT) revealed necrotizing pancreatitis and a diagnosis of hyperlipidemic acute pancreatitis was made. Although extrapancreatic progression of inflammation extended to the anterior pararenal space, there were hypoenhanced lesions in two segments of the pancreas.\nConservative treatment including high-volume infusion, prophylactic antibiotic (meropenem), protease inhibitors and intravenous immune globulin were started immediately. Follow-up CT revealed massive peripancreatic fluid collection and an abscess in the left abdominal cavity (fig. ). CT-guided percutaneous drainage was performed for the pancreatic abscess. No improvement was seen and a 7-Fr pig-tail drainage catheter was placed on hospital day 22. Abscess culture was positive for extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and methicillin-resistant Staphylococcus aureus (MRSA). The cavity was lavaged of debris and purulent material.\nA 12-Fr silicon catheter was subsequently placed on day 34, 8-Fr and 7-Fr pig-tail catheters were placed on day 48, and the catheter was dilated gradually. Immediately after irrigation of a temporary drain, high fever developed, so we switched to continuous drainage. A 16-Fr drainage catheter inserted on day 69 achieved good drainage. Maroon-colored fluid from the abscess drainage changed to clear fluid on day 78. The volume of fluid drained did not decrease, however, and remained between 200 and 400 ml per day. The fluid was high in amylase and as pancreatic duct disruption was strongly suspected, endoscopic retrograde cholangiopancreatography (ERCP) was performed on day 90. The results showed disruption on the tail of the main pancreatic duct with contrast extravasation. An endoscopic nasopancreatic drainage (ENPD) tube was therefore placed at the tail. With the aim of achieving fistula closure and reduction of output, octreotide (300 μg/day) was used concurrently.\nAs the volume of fluid drained did not decrease below 50 ml/day, octreotide was increased to 600 μg/day on day 105. To increase drainage volume, a 7-Fr pancreatic stent was placed endoscopically on day 111 and dilated to 8.5 Fr on day 133. Fluid volume decreased for around 2 weeks but thereafter increased gradually, so we discontinued octreotide on day 130. We had reached the limit of conservative management at this point and explored the indications for surgical therapy. However, as the abscess culture was still positive for ESBL-producing E. coli and MRSA, surgical treatment was postponed. CRP and WBC were stable and the patient had no abdominal complaint, so a liquid diet was started on day 138. The patient ran a fever ≥38°C the following day, diet was stopped and radiography was performed on day 140 for pyrexia. Drainage tubography showed a small fistula of the colon at the splenic flexure (fig. ); the diagnosis was thus amended to colonic fistula complicated by severe acute pancreatitis. Drainage was effective and therefore the cause of the colonic fistula was suspected to be protraction of the pancreatic fistula.\nTo investigate the communication of fistulas, colonoscopy was performed (CF H-260 AI; working channel of 3.7 mm; Olympus Medical Systems, Tokyo, Japan). After indigo carmine injection, the fistula into the splenic flexure of the colon showed blue staining (fig. ). The fistula was a small erosion and endoscopic treatment appeared feasible. An attempt to seal the perforation endoscopically was performed using the OTSC system (fig. ). Once the colonoscope had been removed, the OTSC applicator was mounted on the tip of the endoscope and reinserted. The tissue edges, including the fistula, were gently pulled inside the cap while continuous suction was applied. The OTSC clip (type T, 10 mm diameter) was released and the fistula was sealed. A Gastrografin enema performed on day 151 showed complete sealing of the leak and improved clinical course.\nA liquid diet was restarted after ENPD tube exchange on day 159 and was smoothly upgraded to a full diet. However, a 7-Fr endoscopic pancreatic stent (EPS) was placed for internal drainage on day 175 because of an increase in the volume of percutaneous drainage. After removing the EPS on day 180, drainage volume immediately decreased. CT on day 189 showed no exacerbation of the abscess and the patient was discharged on day 194.\nFollow-up CT and colonoscopy of the pancreatic and colonic fistulas were performed on day 221. CT showed improvement of the abscess, colonoscopy indicated the clip was in situ and scarred and the perforation site was sealed with no signs of inflammation or ulceration. ERCP performed on day 223 revealed no pancreatic duct disruption. The patient's clinical course was good and he is now receiving outpatient therapy for hyperlipidemia.
|
[[44.0, 'year']]
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M
|
{'22430616': 1, '20594223': 1, '485850': 1, '7632140': 1, '29785309': 2, '25893120': 2, '19953707': 1, '12120252': 1, '12960726': 1, '19533550': 1, '14703889': 1, '11442530': 1, '34497676': 1, '31632570': 1, '17032204': 1, '26587229': 1, '10714629': 1, '11878789': 1, '17591492': 1, '23904844': 2}
|
{'4381724-1': 1, '5892304-1': 1}
|
162,466 |
3728612-1
| 23,904,842 |
noncomm/PMC003xxxxxx/PMC3728612.xml
|
Successful Endoscopic Resection of Large Pedunculated Brunner's Gland Hamartoma Causing Gastrointestinal Bleeding Arising from the Pylorus
|
A 45-year-old man presented with a 4- or 5-day history of melena. He also presented nausea lasting for 10 days. His medical history was not significant for hypertension or diabetes. On physical examination, he was afebrile with normal vital signs. His abdomen was soft and nontender. Laboratory tests showed his hemoglobin to be 10.2 g/dl. Esophagogastroduodenoscopy showed a pedunculated ulcerated mass about 50 mm large arising from the pyloric ring (fig. ). We tried to pull the tumor into the stomach with a snare to prevent loss of the tumor after resection because the tumor head was located in the bulb of the duodenum. However, the tumor was too big to pass the pyloric ring. Therefore, endoscopic piecemeal mucosal resection was performed in the bulb of the duodenum for pulling out the specimen after resection; it was successfully removed by snare. A snare polypectomy was performed and secured with a clip. The lesion was a well-circumscribed mass of 48 × 32 mm, with an ulcerated surface and yellowish core (fig. ). Histological examination of the mass showed Brunner's glands with ducts separated by fibromuscular stroma (fig. ). After 5 months, follow-up esophagogastroduodenoscopy was performed; there was no evidence of recurrence.
|
[[45.0, 'year']]
|
M
|
{'23422840': 2, '19245812': 1, '27737521': 2, '22303509': 1, '28584807': 2, '33914269': 1, '10894601': 1, '18204775': 1, '16610009': 1, '16928936': 1, '7847303': 1, '12447318': 1, '28203131': 2, '30515293': 1, '21960922': 1, '27994010': 2, '30918195': 1, '32377490': 2, '16083227': 1, '15300922': 1, '31443637': 2, '18025785': 1, '23904842': 2}
|
{'5453661-1': 1, '6708166-1': 1, '5301130-1': 1, '3572344-1': 1, '5165059-1': 1, '7198079-1': 1, '5152786-1': 1}
|
162,467 |
3728615-1
| 23,904,846 |
noncomm/PMC003xxxxxx/PMC3728615.xml
|
Antiphospholipid Syndrome Complicated by Unilateral Pleural Effusion
|
A 75-year-old Japanese man was admitted to our hospital for spreading erythema on his trunk and extremities, as well as dyspnea. One year prior to admission, he visited us with a 1-year history of erythema and purpura on his legs, accompanied by intermittent fever. Results of laboratory examinations for antiphospholipid antibodies, lupus anticoagulant (using the phospholipid neutralization test), and anticardiolipin antibody had been positive 12 weeks apart. In addition, he showed positive antinuclear antibody (1:80, homogeneous pattern), but was negative for anti-dsDNA antibody, anti-Sm antibody, anti-RNP antibody, anti-SS-A antibody, anti-SS-B antibody, antitopoisomerase I antibody, and anticentromere antibody. MPO-ANCA, PR3-ANCA, and cryoglobulin were negative. Given the diagnosis of APS, we initiated combination therapy with aspirin (100 mg daily) and warfarin (target international normalized ratio, 2.0–3.0), but the skin lesions continued to gradually worsen. Violaceous erythema, purpura, and pigmentation were widely noted on his trunk and extremities (fig. ); they were associated with low platelets (93,000/μl) and elevated partial thromboplastin time (48.4 s). A biopsy specimen revealed marked thrombosis in the dermal and subcutaneous small vessels (fig. ). There were interface changes of the dermo-epidermal junction and mild inflammatory infiltrates in the perivascular area of the dermis, but mucin deposition and thickening of the basal layer of the epidermis were not apparent. In addition, a chest X-ray and computed tomography demonstrated a large pleural effusion in the left lung (fig. ), without evidence of large vessel thrombus. Electrocardiogram and echocardiogram were normal. Despite serial thoracenteses, effusion recurred. Thoracoscopy and parietal pleura biopsy showed only marked lymphocytic infiltration without evidence of malignancy. An analysis of the pleural fluid also indicated a benign exudative effusion. Bacterial and fungal cultures, as well as cytology analyses for malignant cells, were all negative. After excluding infectious diseases, malignancies, pulmonary thrombosis, and heart failure, we added oral prednisolone (30 mg daily) to his prior anticoagulant regimen. The skin lesions and the pleural effusion improved rapidly, eventually disappearing without complication (fig. ). On follow-up clinical examinations, no symptoms related to SLE or other collagen diseases were noted.
|
[[75.0, 'year']]
|
M
|
{'19935226': 1, '16010207': 1, '9106577': 1, '18190884': 1, '11830421': 1, '8304360': 1, '23235100': 1, '10852175': 1, '19449189': 1, '23904846': 2}
|
{}
|
162,468 |
3728616-1
| 23,904,843 |
noncomm/PMC003xxxxxx/PMC3728616.xml
|
Usefulness of Pure Laparoscopic Hepatectomy for Hepatocellular Carcinoma in a Severely Cirrhotic Patient
|
A 55-year-old Japanese woman had been observed at a local hospital for 10 years for liver cirrhosis of unknown cause. A 20-mm tumor was found in liver segment III (S3), and she was referred to our hospital for surgery. Her laboratory data on admission were as follows: platelet count 7.8 × 104/dl (normal 13.0-36.0), total bilirubin 1.4 mg/dl (normal 0.2-1.1), albumin 3.3 g/dl (normal 3.8-5.3), prothrombin time 88% (normal 70-140), and ammonia 95 μg/dl (normal 30-86). Her hepatic functional reserve was as follows: indocyanine green retention rate at 15 min 72.7% (normal 0-10) and galactose tolerance test 40 min (normal ≤20 min). Abdominal enhanced computed tomography (CT) showed a 20-mm tumor that was heterogeneously enhanced during the early phase (fig. ) and washed out during the late phase (fig. ) on the surface of S3. Gd-EOB-DTPA-enhanced magnetic resonance imaging showed a hypointense region in S3 as seen on CT in the hepatocyte phase (fig. ). Although the patient's hepatic functional reserve was poor, the tumor was located in the edge of the liver and we thus considered percutaneous ablation therapy, such as radiofrequency ablation, to be unsuitable because of concern about hemorrhage, tumor dissemination and injury to adjacent organs. Therefore, we performed pure laparoscopic partial hepatectomy of S3.\nThe patient was placed supine, in the head-up tilt position, with the primary surgeon on the right side of the patient. Five ports were placed including 12-mm ports for the camera and intraoperative ultrasonography (fig. ). Intra-abdominal pressure was maintained at 10-12 mm Hg. Operative findings revealed that a 20-mm white tumor protruding outside the liver was present in S3 (fig. ). A Cavitron ultrasonic surgical aspirator and saline-enhanced coagulation were used to perform partial hepatectomy of S3 with a margin of 1 cm without vascular inflow occlusion. Operative time was 170 min and operative blood loss was 350 ml. A 20-mm, comparatively well-demarcated, septate white tumor was present in the resected specimen (fig. ). Histopathologically, the lesion was identified as moderately differentiated HCC without vascular invasion, and the surgical margin was negative for cancer (fig. ).\nThe patient's postoperative course was extremely uneventful. Her drain discharge was serous, with a volume of around 100 ml until postoperative day 3; the drainage decreased to 30 ml on day 4. The drain was therefore removed on day 5. There was no subsequent ascites retention, edema or weight gain. Her serum liver enzyme levels were transiently elevated postoperatively, but rapidly decreased again. There was no rise in total bilirubin or ammonia levels postoperatively. The patient was discharged on postoperative day 8 with no other complications (fig. ). As of the time of this writing (10 months postoperatively), the patient is doing well clinically with no signs of recurrence.
|
[[55.0, 'year']]
|
F
|
{'19280110': 1, '16552201': 1, '15754094': 1, '31612396': 1, '22776279': 1, '12860758': 1, '19458892': 1, '25309070': 1, '26316115': 1, '10898182': 1, '9347849': 1, '17705086': 1, '18791368': 1, '23904843': 2}
|
{}
|
162,469 |
3728617-1
| 23,904,854 |
noncomm/PMC003xxxxxx/PMC3728617.xml
|
Eccrine Hidrocystoma Arising at the Tarsal Plate during Childhood
|
A 5-month-old boy was referred to us for further examination of his right upper-eyelid tumor. The tumor was 8 mm in diameter and observed in the upper eyelid (fig. ). According to his parents, the tumor was first noticed at the child's birth. As the patient could open his eye, it was assumed that the tumor most likely would not affect the visual development in his right eye. Therefore, at that time, we decided that a follow-up examination was the best option for the patient. However, due to a gradual enlargement of the tumor, the patient returned 2 years later and underwent further evaluation (fig. ). At the time of the follow-up examination, the tumor exhibited a distinct boundary and was 12 mm in size. Physical examination revealed that there was no pain or any inflammatory reaction in the lid. When observed from the side of the palpebral conjunctiva, the tumor was found to be buried beneath a portion of the tarsal plate and showed a translucent configuration (fig. ). A T2-enhanced magnetic resonance imaging (MRI) examination demonstrated that the tumor was well demarcated from the surrounding tissue. This uniformly high-intensity lesion was 12 mm (height) × 12 mm (width) × 8 mm (depth) in size, with the lesion observed to be in direct contact with the tarsal plate (fig. ). Since the tumor caused blepharoptosis in the patient's right eye, this subsequently led to oblique astigmatism. Therefore, 2 months later, it was decided to surgically remove the mass lesion. The wall of the tumor was easily separated from the surrounding connective tissues, with the exception of the portion where the tarsal plate was attached. As a result, the tumor was completely removed along with a round defect of the tarsal plate (fig. ). Pathological examination showed that the tumor was composed of a thin wall and contained a transparent liquid. The wall consisted of a single cuboidal epithelium that covered the inner luminal surface without decapitation. An area of papillary process proliferation was also observed (fig. ). Based on these findings, the tumor was diagnosed as eccrine hidrocystoma. Although there was obvious improvement in the blepharoptosis after the surgery, his best-corrected visual acuities remained at 0.2 OD and 1.2 OS due to the refractive astigmatic amblyopia that was present at 2 weeks after the procedure. Thus, the patient was provided with a prescription for glasses and, with the help of his parents, began a training program designed for the visual recovery of his right eye. Two years later, his best-corrected visual acuities recovered to 1.0 OD (fig. ).
|
[[5.0, 'month']]
|
M
|
{'6217229': 1, '20548887': 1, '15205675': 1, '28979020': 1, '1583183': 1, '17406184': 1, '31788577': 1, '23904854': 2}
|
{}
|
162,470 |
3728618-1
| 23,904,851 |
noncomm/PMC003xxxxxx/PMC3728618.xml
|
Pleuropulmonary and Lymph Node Progression after Docetaxel – Benefits from Treatment with Cabazitaxel in Metastatic Prostate Cancer
|
A 74-year-old male with performance status 0 presented with a prostate specific antigen (PSA) level of 51.2 ng/ml in August 2001. After biopsy, computed axial tomography (CT) and bone scan, prostate adenocarcinoma T2bN0M0, Gleason 6 (2 + 4), was diagnosed and considered an intermediate risk. The patient was treated with radical prostate-bed radiotherapy and full androgenic block with oral (PO) bicalutamide 50 mg/24 h and subcutaneous goserelin 10.8 mg quarterly until March 2002, when it was decided to remove the blockade after reaching an almost undetectable PSA level.\nHe was asymptomatic with a stable PSA level less than 0.07 ng/ml until March 2003, when the PSA level started increasing until reaching its highest level (7.27 ng/ml) in May 2005. Because of this biochemical relapse, antiandrogenic treatment was initiated with PO tamoxifen 10 mg/12 h and PO bicalutamide 50 mg/24 h, progressively reducing the PSA level (reaching its nadir of 0.66 ng/ml in September 2006). The blockade was suspended and a quarterly subcutaneous treatment with leuprorelin acetate was initiated. In September 2009, the PSA level rose to 47.53 ng/ml along with a clinical picture of weakness of the lower limbs, ambulatory difficulty and mechanical lumbar pain.\nA thoracic-abdominal-pelvic CT scan was requested; it focused on adenopathies between 1 and 2 cm in the upper and middle mediastinum and the left infrarenal para-aortics, as well as diffuse bone lesions in the lumbar vertebral bodies. Abnormal deposits of diffuse-shaped tracer were detected in the bone scan. Magnetic resonance imaging showed a mass of soft tissue at the spinal level causing a spinal stenosis, maximum T7 level, without compromising the spinal cord, so it was treated with palliative intent radiotherapy (fig. ).\nDue to the hormonal refractoriness, first-line chemotherapy treatment was started with intravenous docetaxel 75 mg/m2 and PO prednisone 5 mg/12 h. The first cycle was given on October 21, 2009. The patient's PSA level at this time was 47.53 ng/ml. He completed 9 cycles of treatment (the last in April 2010) with excellent tolerance. His PSA analytical nadir reached 19.81 ng/ml after chemotherapy was completed. A further evaluation in May 2010 gave a partial response, continuing only with luteinizing hormone-releasing hormone analogues.\nIn April 2011, pulmonary progression with right pleural effusion and pathological size increase in paratracheal adenopathies and the aortopulmonary window were observed on a CT scan and histologically confirmed. Due to this situation and the good overall condition of the patient, it was decided to initiate intravenous treatment with cabazitaxel 25 mg/m2 and PO prednisone 10 mg continuously. At the beginning of the treatment, his PSA level was 120.62 ng/ml, reaching 64 ng/ml after the third cycle in June 2011.\nAfter 6 cycles of chemotherapy, a reduction of mediastinal adenopathies and infrarenal para-aortic stable bone involvement and an absence of pleural effusion were observed. The patient's PSA level was 48.58 ng/ml. Given the good response and the absence of toxicity, it was decided to continue with 2 more cycles. After 8 cycles, the last of which was in September 2011, treatment was discontinued as it was considered that the therapeutic plan had been fulfilled without having relevant toxicity at any time.\nIn February 2012, his PSA level increased to 94 ng/ml. A thoracic-abdominal-pelvic CT scan was requested, which showed stability of the infradiaphragmatic and supradiaphragmatic gland injuries, as well as diffuse bone metastasis. To date, the patient remains asymptomatic. Since February 2012, a progressive PSA increase without clinical deterioration has been noted. In January 2013, the PSA level was 191 ng/ml (fig. ). Should further symptoms occur, a new treatment will be proposed. The reintroduction of cabazitaxel treatment would be our first choice given the clinical benefit and the important targeted radiological and biochemical responses. Currently, there is a treatment-free interval following the end of the 16-month cabazitaxel treatment and a 6-month period free of biological progression.
|
[[74.0, 'year']]
|
M
|
{'19380444': 1, '16533874': 1, '11125382': 1, '17925542': 1, '21612468': 1, '15150570': 1, '18813832': 1, '19380448': 1, '12359855': 1, '20888992': 1, '21455038': 1, '12351594': 1, '23904851': 2}
|
{}
|
162,471 |
3728740-1
| 23,919,072 |
noncomm/PMC003xxxxxx/PMC3728740.xml
|
Unusual presentation of oesophageal carcinoma with adrenal metastasis
|
A 55-year-old male was diagnosed to have poorly differentiated squamous cell carcinoma of oesophagus 1 year back. An initial staging computed tomography (CT) scan showed nodal involvement in the celiac, peri-oesophageal and along the gastro-hepatic ligament. A baseline fluorine-18 fluoro-2-deoxyglucose (F-18 FDG) positron emission tomography (PET/CT) scan demonstrated hypermetabolism in the gastro-oesophageal junction growth along with focal areas of hypermetabolism in the liver and lymph nodes. The patient subsequently received six cycles of cisplatin based chemotherapy.\nA repeat endoscopy done after the completion of the chemotherapy showed a small 1.0 × 1.0 cm growth at 30 cm and few small satellite nodules of 0.5 × 0.5 cm size indicating submucosal spread. A repeat PET/CT scan did not show any definite evidence of hypermetabolism in the gastro-oesophageal junction [Figure , ]. However, the left adrenal gland showed a focal area of increased FDG uptake []. The patient was non-compliant to another cycle of chemotherapy. Another PET/CT [] repeated at 3 months showed definite increase in the size of the adrenal lesion [Figure , ]. No FDG avidity was noticed in the image at gastro-oesophageal (GE) junction level [] while the endoscopy revealed subcentimetric nodule in the mucosa. The GE junction growth now showed distinct hypermetabolism []. Multiple liver metastasis [Figure , ] and hypermetabolic foci in the brain were also identified.
|
[[55.0, 'year']]
|
M
|
{'25273320': 1, '19340526': 1, '19304700': 1, '17949483': 2, '11849252': 1, '16518827': 1, '17227316': 1, '23919072': 2}
|
{'2100056-1': 1}
|
162,472 |
3728741-1
| 23,919,073 |
noncomm/PMC003xxxxxx/PMC3728741.xml
|
Hypermetabolic subcutaneous fat in patients on highly active anti-retroviral therapy treatment: Subtle finding with implications
|
A 34-year-old gentleman, on anti-retroviral therapy since 3 years was treated for lymphoblastic lymphoma. He was referred for fluorine-18 FDG positron emission tomography/computed tomography (PET/CT) study for follow-up evaluation. The scan revealed hypermetabolism in the mid thorax corresponding to esophageal candidiasis []. With a history of HAART therapy of 3 years duration, the scintigraphic findings of increased FDG uptake in the subcutaneous adipose tissue was suggestive of LD. He was treated with antifungal medications. To arrest the progression of LD, stavudine was replaced by tenofovir and diet modification was advised.
|
[[34.0, 'year']]
|
M
|
{'20145581': 1, '19561519': 1, '18936624': 1, '19893417': 1, '12620736': 1, '20706598': 1, '15622321': 1, '19082590': 1, '19350235': 1, '21674240': 1, '11832679': 1, '19306513': 1, '18240864': 1, '23919073': 2}
|
{}
|
162,473 |
3728742-1
| 23,919,074 |
noncomm/PMC003xxxxxx/PMC3728742.xml
|
Primary extradural non-hodgkin's lymphoma
|
A 67-year-old male first presented with back pain and progressive weakness of both lower limbs of 3 months duration with loss of bowel and bladder control since 1 month. On examination, patient was in poor general condition. There was no peripheral lymphadenopathy and was normalon systemic examination. There was a laminectomy scar in dorsal region. Central nervous systemic examination revealed decreased power in both lower limbs with decreased sensation over both feet. Patient was with indwelling Foley's catheter. The whole body positron emission tomography (PET)/CT was performed, which showed an Fluorine18 Fluorodeoxyglucose (FDG) avid soft-tissue lesion in the spinal canal extending from D4 to D12 level causing cord compression []. Whereas, magnetic resonance imaging spine showed a large extradural soft-tissue mass in the spinal canal from D4 to D11/D12 level compromising and deforming cord and causing significant canal stenosis. Bone marrow examination revealed no Infiltration with NHL.
|
[[67.0, 'year']]
|
M
|
{'5007387': 1, '4928162': 1, '3949570': 1, '1260667': 1, '991100': 1, '8437651': 1, '6892659': 1, '23919074': 2}
|
{}
|
162,474 |
3728743-1
| 23,919,075 |
noncomm/PMC003xxxxxx/PMC3728743.xml
|
Diffusely increased thyroidal uptake of F-18 fluorodeoxyglucose in a patient with non-Hodgkin's lymphoma and Graves’ disease
|
A 63-year-old female patient with non-Hodgkin's lymphoma in remission for the last 2 years after chemotherapy was referred to our department for a whole body FDG-positron emission tomography (PET)/computed tomography scan to assess for disease recurrence after recent onset of diplopia and raised β2-microglobulin levels. Multiple lymph nodes in the cervical, mediastinal and right axillary regions showed increased metabolic activity, suggestive of recurrence. In addition, diffusely increased FDG uptake was seen in both lobes of the thyroid gland on the whole body PET image [], with a standardized uptake value of 12.3. On clinical examination, she was found to have bilateral exophthalmos and the biochemical profile showed high T3 and T4 and low thyroid stimulating hormone values, suggestive of hyperthyroidism. Subsequently, a 99mTcO4 (pertechnetate) scan [], also showed diffusely increased tracer uptake in the thyroid gland; uptake at 20 min was 6.1%. A diagnosis of Graves’ disease was made and treatment with Carbimazole was started.
|
[[63.0, 'year']]
|
F
|
{'15488560': 1, '17885368': 1, '9925392': 1, '17504869': 1, '15154698': 1, '9777746': 1, '9609903': 1, '10478760': 1, '17179794': 1, '9393189': 1, '23919075': 2}
|
{}
|
162,475 |
3728744-1
| 23,919,076 |
noncomm/PMC003xxxxxx/PMC3728744.xml
|
Disseminated metastatic penile squamous cell carcinoma detected by fluorodeoxyglucose PET/computerized tomography
|
We report a case of a 57-year-old male demonstrated inguinal metastases with biopsy then underwent amputation and recognized histopathological grade 2 (moderately differentiated) penile SCC. The patient was referred to our PET/CT department to search for possible further metastatic disease. Following 10 h fasting (serum glucose level 126 mg/dl), the patient was injected with 14.5 mCi F-18 of fluorodeoxyglucose(FDG) intravenously. After 1 h waiting period, whole-body images were obtained on the Siemens HI-REZ PET/CT System. Fused images of metabolic (PET) and anatomic (CT) information were reviewed. PET/CT study showed that intense accumulation of FDG on inguinal lymph nodes. Additionally, increased FDG uptake was detected on multiple lymphadenomegalies in abdomen-pelvis and the left-inferior jugular region, the left supraclavicular fossa and the mediastinal lymph nodes [Figures and ]. Also, PET images demonstrated a few uptakes in the left axilla and left parasternal lymph nodes. The lung parenchyma, liver and skeletal system demonstrated a physiological distribution of the tracer. Histopathological results showed primary penile SCC carcinoma [] and metastatic inguinal lymph nodes [].
|
[[57.0, 'year']]
|
M
|
{'15825185': 1, '8158767': 1, '17296384': 1, '18268397': 1, '20163910': 1, '27385892': 2, '19477581': 1, '20022269': 1, '29184780': 1, '18502024': 1, '18120502': 1, '11144896': 1, '23919076': 2}
|
{'4918485-1': 1}
|
162,476 |
3728746-1
| 23,919,078 |
noncomm/PMC003xxxxxx/PMC3728746.xml
|
Promising role of single photon emission computed tomography/computed tomography in Meckel's scan
|
A 10-year-old male presented on 16/02/12 with 3 months history of abdominal pain and episodes of bleeding (P/R). Upper upper gastrointestinal (GI) endoscopy (UGIE) and colonoscopy was carried out and was normal. Routine blood investigation revealed anemia (Hb = 7.9 Gm%). He was hospitalized for recurrent symptoms. His presentation suggested an obscure-overt source of GI bleeding. Meckel's scan was carried out and dynamic as well as static images were acquired. Initial images does not reveal any abnormal focus of tracer uptake, However, in view of clinical presentation strongly suggesting heterotopic gastric mucosal location, delayed static views at 60 min were acquired, which showed a focus of tracer uptake in the mid line of lower abdomen []. Furthermore, fused SPECT-CT imaging showed focal uptake in the distal ileum [Figures and ]. The patient underwent Meckel's diverticulectomy with sparing of adjacent bowel. Histopathology confirmed the heterotopic location of gastric mucosa [].
|
[[10.0, 'year']]
|
M
|
{'9708529': 1, '24554052': 1, '8744187': 1, '20706827': 1, '21490844': 1, '6603248': 1, '23919078': 2}
|
{'3728746-2': 2}
|
162,477 |
3728746-2
| 23,919,078 |
noncomm/PMC003xxxxxx/PMC3728746.xml
|
Promising role of single photon emission computed tomography/computed tomography in Meckel's scan
|
A 3.5-year-old male presented on 18/05/12 with complaints of two episodes of passage of clots in stools in past 7 days associated with episodic colicky pain abdomen and vomiting. There was similar episode of bleeding P/R in Feb 2012, which was treated as dysentery. Complete blood count showed anemia (Hb = 5.1 Gm%). Patient was hospitalized and 2 units of blood were transfused. Colonoscopy revealed blood clots until the splenic flexure of colon and no other pathology. Meckel's scan was carried out and dynamic as well as static images were acquired. A focus of intense tracer uptake in the right paramedian lower abdomen was seen. Fused SPECT/CT images showed malrotated ectopic kidney in the same location [Figures and ]. Thus, the study was negative for Ectopic gastric mucosa. Video colonoscopy commented a doubtful lesion in the terminal ilieum,? Koch's. ultrasongraphy abdomen was normal, except malrotated left kidney. Patient was advised review after 3 months.
|
[[3.5, 'year']]
|
M
|
{'9708529': 1, '24554052': 1, '8744187': 1, '20706827': 1, '21490844': 1, '6603248': 1, '23919078': 2}
|
{'3728746-1': 2}
|
162,478 |
3728747-1
| 23,919,079 |
noncomm/PMC003xxxxxx/PMC3728747.xml
|
Sacrococcygeal chordoma: Increased 99mTc methylene diphosphonate uptake on single photon emission computed tomography/computed tomography bone scintigraphy
|
A 37-year-old female patient with non-traumatic back pain for the last 2 months was found to have a soft tissue mass in the sacral region on magnetic resonance imaging, with destruction of the sacrum and coccyx, heterogeneous enhancement of L3-L5 vertebrae and invasion of both iliac bones. A chordoma was diagnosed on ultrasound guided fine needle aspiration. 99mTc MDP whole body bone scintigraphy [] showed increased tracer uptake in the sacrum, L5 vertebra and both iliac bones. Hybrid single photon emission computed tomography/computed tomography (SPECT/CT) images of the pelvis showed increased tracer uptake in the sacrum and L5 vertebra with bilateral iliac involvement and extensive corresponding osteolysis [].
|
[[37.0, 'year']]
|
F
|
{'3712078': 1, '18034341': 1, '6873104': 1, '33392355': 1, '11227920': 1, '1611792': 1, '15311125': 1, '10091765': 1, '23919079': 2}
|
{}
|
162,479 |
3728748-1
| 23,919,080 |
noncomm/PMC003xxxxxx/PMC3728748.xml
|
Touraine-Solente-Gole syndrome: The complete form needs to be recognized
|
A 44-year-old male presented with complaints of generalized itching for past 5 years. He also had swelling and pain in both knees ankles and small joints of hands with worsening of symptoms following exercise. Fever or other associated rheumatological symptoms were denied. No relevant family history. He also had troublesome dyspepsia for past 6 months with no relief in spite of medications. Physical examination revealed greasy and coarse skin with deep furrowed forehead skin. Examination revealed ptosis of both eyelid, hyperhydrosis of both palms and soles, generalized seborrheic dermatitis and multiple folliculitis in both lower limbs []. The patient showed pandigital clubbing and bulbous deformity of all digits of hand and feet [Figures , and ]. Laboratory work up of routine blood and urine investigations including S. VDRL (venereal disease research laboratory) were unremarkable.\nRadiograph of both hands and wrists showed increase in soft-tissue around terminal phalanges with hypertrophy of distal tufts and periosteal thickening in all metacarpals including proximal and middle phalanges []. Radiograph of both feet revealed similar changes. X-ray of both forearm showed symmetric exuberant irregular sub-periosteal bone formation with cortical thickening in both radius and ulna. There was interosseus membrane ossification in Lt fore-arm []. X-ray of both tibia and fibula showed gross irregularities and intense periosteal proliferation throughout the shaft including epiphysis and resultant broadening of the epiphysis []. Lateral radiograph of skull revealed normal sella turcica and hyperostosis of skull bones. Chest radiograph was taken to rule out pulmonary causes of HOA which was found to be normal. 99mTc MDP (methylene diphosphonate) bone scintigraphy was performed following standard protocols after i.v administration of 20 mCi activity Figure and shows diffusely increased and almost symmetrical peri-cortical uptake in the entire skeletal system prominently involving the shaft of all long bones. In view of his troublesome dyspepsia, upper gastro intestinal endoscopy carried out showed hypertrophied mucosal folds involving the entire stomach and antrum. CECT abdomen with negative contrast revealed uniform increase in stomach wall thickness >1 cm.\nHis skin biopsy showed thickening and packing of collagen fibres in dermis – Features suggestive of pachydermia. Based on the clino-radiological correlation and after ruling out other secondary causes the diagnosis of Touraine-Solente-Gole syndrome or primary HOA was made.
|
[[44.0, 'year']]
|
M
|
{'1623673': 1, '935484': 1, '29643673': 2, '28851954': 1, '6825994': 1, '23919080': 2}
|
{'5883430-1': 1}
|
162,480 |
3728749-1
| 23,919,081 |
noncomm/PMC003xxxxxx/PMC3728749.xml
|
Non-osseous uptake on Tc99m methylene diphosphonate in multiple muscles confirmed on SPECT/computed tomography
|
A 55-year-old female presented to the physician with complaints of pain in the left hip radiating to the left lower limb since 1 year, gradually increased to unbearable leading to inability in walking since 1 month. She was a known case of rheumatoid arthritis since 2004, under treatment on phenylbutazone and steroids. On physical examination, we noted mild tenderness in anterior thigh muscles of left lower limb, restriction of movements in the left lower limb. No significant joint deformities. Blood investigations and biochemistry revealed hemoglobin of 12.9 g/100 ml, white blood cell: 23,000, erythrocyte sedimaentation rate (ESR): 44 mm/h (0-20), lactate dehydrogenase LDH: 521 mU/ml (100-190), serum creatine: 0.7 mg% (0.6-1.3), serum phosphate: 7.0 (2.5-4.5), uric acid: 18.9 (2.6-7.2), creatinine phosphokinase CPK: 6592 mU/ml (21-232), serum calcium: 8.9 (8.8-10.5). CT abdomen and pelvis revealed bony destruction of pubic symphysis with associated soft-tissue component suspicious of infective or metastatic etiology, diffuse osteoporotic changes, and insufficiency fracture of sacrum. Magnetic resonance imaging Lumbo-sacral spine performed later revealed altered bone marrow signal in sacral 1-3 vertebrae, grade 1 forward spondylolisthesis L5 over S1, degenerative spondylitic and disc changes with facet joint involvement of L4/L5 vertebrae. Subsequently, patient was referred for a bone scan to look for bone metastases. Whole body bone scan with 25 mCi of Tc-99m MDP was performed, which revealed multiple skeletal metastases []. In addition, extraosseous soft-tissue uptake was seen involving multiple muscles. We performed SPECT-CT images to precisely delineate the muscle involved, i.e., right adductor magnus muscle, left rectus femoris muscle and right gastrocnemius muscle. We noted calcification on CT images in right adductor magnus muscle at site of Tc-99m MDP uptake, no definite calcification was note in the left rectus femoris muscle and right gastrocnemius muscle. Subsequently, biopsy was performed from left rectus femoris muscle, which mentioned suspicion of adenocarcimatous cells. Left rectus femoris muscle did not show visible calcification radiologically (CT images) however, abnormal micro calcification was shown in muscle biopsy evaluation by electron microscopy. Myeloma profile was negative. Thus, the final diagnosis was multiple skeletal metastasis with metastatic calcification in multiple muscle from an unknown primary.
|
[[55.0, 'year']]
|
F
|
{'31286350': 1, '1194959': 1, '3581604': 1, '2217976': 1, '1177017': 1, '162951': 1, '5086568': 1, '2166666': 1, '10795688': 1, '6502253': 1, '8356264': 1, '23919081': 2}
|
{}
|
162,481 |
3728750-1
| 23,919,082 |
noncomm/PMC003xxxxxx/PMC3728750.xml
|
Lymphoscintigraphy with single-photon emission computed tomography/computed tomography is useful for determining the site of chyle leakage after esophagectomy
|
A 59-year-old woman was diagnosed with esophageal carcinoma of the lower intrathoracic esophagus and radical esophagectomy was performed. After surgery, more than 1 L of chylous fluid was drained via a chest tube daily for more than a week. It was expected that the patient's nutritional condition would become worse if chyle, which contains lipids, proteins, electrolytes, lymphocytes, and various other elements, leaks continuously for a long period. Therefore, we performed lymphoscintigraphy with Tc-99m-human serum albumin-diethylenetriaminepentaacetic acid (HSA-D) to identify chyle leakage site. The imaging protocol for the lymphoscintigraphy was following that after 185 MBq of Tc-99m-HSA-D was subcutaneously injected between the first and second toes of each foot, we began temporal imaging from 0 to 60 min and SPECT/CT at the time when an abnormal accumulation of the radioisotope (RI) appeared. In this case, by 10 min after the injections, lymphatic fluid in each foot flows through the lymphatic vessel of the lower limb to the lumbar lymphatic trunk. At 10 min after the injections, planar imaging revealed cisterna chyli joined by right and left lumbar lymphatic trunks and the thoracic duct above. An abnormal accumulation of the RI was observed on the left side of the thoracic duct at 10 min and it appeared to be distributed over the left thoracic cavity as time passed, which suggested chyle leakage into the left thoracic cavity []. SPECT/CT was performed to identify the accurate site of chyle leakage into the left thoracic cavity at 30 min after the injections. SPECT/CT revealed a hot spot directly on the site at which the thoracic duct was ligated during surgery, which was the suggested site of chyle leakage []. Although we considered surgical treatment for chyle leakage, it gradually decreased following conservative treatment with octreotide, a somatostatin analog,[] and did not increase again after restarting meals.
|
[[59.0, 'year']]
|
F
|
{'20182712': 1, '25320629': 2, '2059813': 1, '25080863': 1, '25829744': 2, '12045448': 1, '16220303': 1, '8993881': 1, '12708946': 1, '23919082': 2}
|
{'4197361-1': 1, '4379685-1': 1}
|
162,482 |
3728873-1
| 23,919,200 |
noncomm/PMC003xxxxxx/PMC3728873.xml
|
Coexistence of Pheochromocytoma with Abdominal Aortic Aneurysm: An Untold Association
|
A 45-year-old woman was admitted with complaints of headache, sweating, anxiety, dizziness, nausea and vomiting. She also had dull aching abdominal pain, which was poorly localized, non-radiating and not associated with any nausea, vomiting or altered bowel habits. She was a non-smoker with no significant family history. The patient was 168 cm tall and weighed 61 kg. On physical examination, there were no cafe au lait spots or neurofibromas. Her resting pulse rate was 100 beats/min. The patient's blood pressure was 230/140 mmHg without any asymmetry between the limbs. Abdominal examination revealed mild lower abdominal tenderness without any hepatomegaly and ascitis. There was a palpable, pulsatile, expansile and non-tender mass in the epigastric region. Rest of the systemic examination was unremarkable.\nThe patient's hemogram and blood biochemistry, including potassium, sodium, bicarbonate, calcium, phosphorus, alkaline phosphatase and creatinine levels, and liver function tests were normal. The electrocardiogram revealed left ventricular hypertrophy. No alterations in cardiac as well as renal function were observed. Thus, the presence of pheochromocytoma was suspected. The endocrinological evaluation was planned to measure the levels of catecholamines, steroids and the renin-angiotensin system parameters. The catecholamines and their metabolites were measured by performing high-performance liquid chromatography–electrochemical detection by using Biorad variant D 10. Automated enzyme immunoassay was used for the assessment of plasma cortisol. Adrenocorticotropic hormone (ACTH), plasma renin activity and plasma aldosterone were estimated by radioimmunoassay methods by using the Roche E 601 analyzer. This battery of tests revealed increase in plasma metanephrines, 24-h fractionated metanephrines and VMA and supine plasma renin activity, and that plasma aldosterone concentrations were increased []. Plasma cortisol and hormone ACTH levels were within normal ranges [].\nAbdominal CT revealed a large, well-defined, heterogenous para-aortic mass (6 cm × 3 cm) with attenuation score of 35 hounsfield units (HU) at the upper pole of the right kidney without any calcification []. Further work up to establish the etiology of the abdominal pain included MRI of the abdomen, which demonstrated a 4.5 cm AAA with 3 cm lumen []. A diagnosis of right pheochromocytoma was made, and surgical treatment was recommended to her. Alfa receptor blocking therapy with prazosin was instituted, followed by β-blocker after adequate α-blockade. After 2 weeks, hypertension was well controlled and the remaining symptomatology disappeared. With adequate blood pressure control, laparoscopic adrenalectomy was performed on the patient. Light microscopy of the specimen showed characteristic organoid or zellballen nest of cells, confirming the diagnosis of pheochromocytoma, with no cytoplasmic inclusion, pleomorphism, cytological alterations or necrosis; the mitotic index was low []. Because of the asymptomatic 4.5 cm aneurysm, our patient was advised for periodic follow-up of the lesion.\nDuring the post-operative period, the blood pressure was normal and the patient's convalescence was uncomplicated. She was discharged on the 7th post-operative day. During the next 12 months, the patient's blood pressure remained normal and the size of the aneurysm did not change. A 24-h urine sample was collected for analyzing the levels of metanephrines and VMA, which were found to be within the normal ranges. At present, the patient is asymptomatic and requires no medications.
|
[[45.0, 'year']]
|
F
|
{'10601965': 1, '17548742': 1, '11903030': 1, '12756363': 1, '22629039': 2, '9853436': 1, '23226643': 1, '16926569': 1, '9149678': 1, '22346144': 2, '15610701': 1, '10407524': 1, '16865521': 1, '22128043': 1, '30517262': 2, '1969422': 1, '15671003': 1, '15684209': 1, '2806578': 1, '10893569': 1, '23919200': 2}
|
{'6257529-1': 1, '3271680-1': 1, '3354464-1': 1}
|
162,483 |
3728874-1
| 23,919,201 |
noncomm/PMC003xxxxxx/PMC3728874.xml
|
Pediatric Precursor B-cell Lymphoblastic Lymphoma Presenting with Extensive Skeletal Lesions
|
A 3-year-old girl presented with right knee pain and swelling of 3 months duration. She had a fracture of the left femoral diaphysis 6 weeks prior to presentation. There was no history of any constitutional symptoms. Radiograph revealed expansile lytic lesion at the right supracondylar region and multiple lytic areas in the diaphyseal and metaphyseal regions of both femora and tibia []. She had been treated with antibiotics for suspected osteomyelitis. In view of non-response to antibiotics, possibility of malignancy was considered. Biopsy revealed a small round cell tumor. When she presented to us, she had mild pallor, but no icterus, rash, hemorrhagic manifestations, edema, lymphadenopathy or organomegaly. Her investigations revealed hemoglobin 105 gm/L, white blood cell count 7.4 × 109/L, platelet count 445 × 109/L, neutrophils 52%, lymphocytes 33%, monocytes 5% and bands 10%. Peripheral smear examination did not reveal blasts. Serum uric acid level was 350 μmol/L and lactate dehydrogenase level was 368 U/L. Urinary vanillylmandelic acid was not increased. Bone scan revealed foci of patchy radiotracer concentration in the proximal shaft of the bilateral tibia, distal shaft of the bilateral femur, proximal shaft and head of the right femur and proximal shaft of the left femur. Increased radiotracer concentration was seen in the right superior pubic ramus. Computerized tomography scan revealed multiple, well-defined expansile lytic lesions of varying sizes without sclerotic rim involving the bilateral femoral heads and femoral shafts, bilateral iliac blades, bilateral ischial tuberosity, right ilio-pubic ramus, vertebral body of D9 vertebrae, bilateral scapulae, bilateral humeral head and humeral shafts. Multiple hypodense focal lesions were seen in both the kidneys, the largest measuring 15 × 16 mm in size in the right lower pole [; panel A]. A hypodense, poorly enhancing lesion measuring 3.1 cm × 3.0 cm × 2.2 cm was seen in the left adnexal region [; panel B]. Bone marrow aspiration revealed occasional abnormal cells. Bilateral bone marrow biopsy could not reveal any abnormal cells.\nRight supracondylar biopsy review from an apex oncology institute revealed a high-grade hematolymphoid malignancy with blastic morphology. On immunohistochemistry, tumor cells were positive for leucocyte common antigen, CD79a, CD10 and terminal deoxynucleotidyl transferase, while being negative for CD20, CD3, CD5, c-kit and desmin, suggestive of precursor B-cell lymphoblastic lymphoma. Unfortunately, the parents refused treatment for socioeconomic reasons. The rate of refusal of treatment is about 20% in our unit.
|
[[3.0, 'year']]
|
F
|
{'16353078': 1, '25006054': 1, '15700250': 1, '12170455': 1, '8113359': 1, '10587707': 1, '23919201': 2}
|
{}
|
162,484 |
3728876-1
| 23,919,203 |
noncomm/PMC003xxxxxx/PMC3728876.xml
|
A Synchronous Presentation of Two Different Ovarian Tumors: A Rare Occurrence
|
A 29-year-old lady P1L1 presented to the gynecology outpatient department with chief complaints of pain abdomen off and on since the last 1 year. The pain was predominantly in the right iliac fossa region. She kept taking medication for the pain until recently in January 2012, when she developed acute pain also on the left side of the abdomen for which she was admitted. She also complained of one episode of vomiting. Ectopic pregnancy was ruled out by urine pregnancy test. Abdominal examination did not reveal any mass and no abnormality was detected on per speculum examination. Bimanual examination revealed a normal-sized uterus and a cystic mass felt laterally near the posterior fornix that was approximately 4 cm in diameter. An ultrasound examination and CA-125 were requested. Ultrasonography revealed normal uterus with enlarged right ovary with a cyst measuring 46 mm × 36 mm × 55 mm showing internal echoes with volume of 50 cc, the left ovary was also enlarged with multiple well-defined cysts measuring 34 mm × 44 mm × 69 mm with volume of 55 cc and the largest cyst measured 37 mm []. The serum CA-125 level was 38 U/mL. Diagnostic laparoscopy followed by laparotomy with bilateral ovarian cystectomy was performed, followed by chromopertubation under general anesthesia. Intraoperative findings-adhesions present with omental and fat adhesions with the abdominal wall. The right cyst was approximately 5 cm in diameter with smooth surface and surface papillary excrecences and containing straw-colored fluid. The left ovarian cyst was approximately 5 cm × 4 cm, with a bosselated surface. Cut-surface revealed multiloculated cyst with thick walls. Omentum was healthy. On chromopertubation, bilateral tubes were patent. Bilateral ovarian cystectomy specimens were received in the Department of Pathology. On gross examination, the right ovary revealed an opened up cystic structure approximately 6 cm in diameter. The inner surface of the wall revealed multiple papillary excrescences. The left ovary was 7 cm in diameter, with the cut surface revealing multiloculations with solid and cystic areas. Microscopic examination of the right ovary revealed cyst wall lined by simple columnar lining with papillary proliferations at places, and the left cyst revealed a thick-walled cyst with endocervical like mucinous cell lining [Figure -]. Thus, a diagnosis of right ovarian serous cystadenoma with left ovarian mucinous cystadenoma was made.
|
[[29.0, 'year']]
|
F
|
{'2685680': 1, '431978': 1, '1311984': 1, '18828427': 1, '1644430': 1, '29744056': 2, '7184889': 1, '8420674': 1, '14055739': 1, '29162960': 1, '25068699': 2, '23919203': 2}
|
{'5930217-1': 1, '4159786-1': 1}
|
162,485 |
3728877-1
| 23,919,204 |
noncomm/PMC003xxxxxx/PMC3728877.xml
|
Twin Tooth on Either Side: A Case Report of Bilateral Gemination
|
A 25-year-old male patient reported to our clinic with the complaint of decay in the right back region of the upper jaw. On clinical examination, dentinal caries was observed on the occlusal surface of upper right first molar. Macrodontia was observed in relation to the maxillary central incisors. The central incisors were larger in the mesiodistal dimension. There was a notching present in relation to the incisal edge of the macrodonts. On the right central incisor, the notch continued cervically as a shallow groove [], whereas on the left central incisor, the groove continued only till the middle third of the crown. The lateral incisors were placed palatally. The patient had normal compliment of teeth for his age. The intra-oral periapical radiograph of the maxillary anterior region revealed large crowns of the central incisors bilaterally. A radiolucent notch was observed in relation to the incisal edges of the central incisors []. Relatively large pulp chambers and root canals were observed in relation to the central incisors, which suggestive of bilateral gemination.\nSince the patient was not concerned about the esthetic problems due to macrodontia, only composite restoration in relation to the right maxillary first molar was done.
|
[[25.0, 'year']]
|
M
|
{'26904551': 1, '19212565': 1, '18167487': 1, '17418718': 1, '11398389': 1, '10529873': 1, '3856006': 1, '34658379': 1, '28384987': 1, '26002668': 1, '15272664': 1, '10815574': 1, '23919204': 2}
|
{}
|
162,486 |
3728878-1
| 23,919,205 |
noncomm/PMC003xxxxxx/PMC3728878.xml
|
An Unusual Presentation of Perforated Intrauterine Contraceptive Device
|
Mrs SA was a 35-year-old housewife with three living children, who was referred from a peripheral hospital to the accident and emergency department of Abuja Clinics Ltd. on the 5th of July 2010 with a 6-h history of lower abdominal pain. The pain was of sudden onset, sharp and radiated to the anal region. It was aggravated by movement but relieved by lying still. There was associated weakness and dizziness, but there was no fainting sensation. There was no bleeding per vaginum and no constitutional or urinary symptoms. Her last menstrual period was about 5 weeks prior to presentation. She claimed to have had a regular 28-day cycle with 4 days menstrual flow. She had right ectopic pregnancy and salpingectomy in 1997 and a miscarriage in 1998. She had spontaneous vaginal deliveries in 1999, 2001 and 2005. She wore an IUCD in between the pregnancies for an average of 13 months. She had Cu T IUCD in June 2005, about 6 weeks after her last confinement. She experienced pain during the Cu T IUCD insertion, which prompted an ultrasound scan to be done the same day. The ultrasound scan suggested that the IUCD was in situ and normally placed. She was reassured and was given paracetamol tablets for 2 days and the pain stopped.\nExamination on presentation revealed a young woman in painful distress, pale, anicteric and not dehydrated. Her pulse rate was 88 bpm while her blood pressure was 120/80 mmHg. Her abdomen was generally tender, but the tenderness was more marked at the right iliac fossa. Vaginal speculum examination showed the tail of her IUCD protruding from the external cervical Os. There was cervical excitation, tenderness and a bulging pouch of Douglass on digital vaginal examination. Rectal examination revealed no abnormality. An impression of acute abdomen due to ectopic pregnancy or acute appendicitis was made. Her packed cell volume (PCV) was 34%, genotype AA and blood group A rhesus D positive. Blood beta-HCG test was negative. The emergency ultrasound scan report showed a normal sized, anteverted uterus containing only part of an IUCD, while the remaining part of the device protruded through the fundus of the uterus. There was a thick-walled complex cystic mass in the right adnexium that was difficult to differentiate from the right ovary. The mass had an irregular outline and was sonoluscent. It measured 2.1 cm in diameter. These features were in keeping with the “adnexal ring sign.” This complex cystic mass was surrounded by a hematoma. Probe tenderness was marked over this mass. The left adnexium showed normal sonographic features. Moderate echo-rich fluid was present in the pouch of Douglas. Impression: these features were in keeping with a right ruptured ectopic pregnancy and a displaced IUCD.\nEmergency exploratory laparotomy, adhesiolysis [], Cu T 360 IUCD removal [] and intestinal repair were performed through the previous sub-umbilical midline incision. Intraoperative findings included a hemoperitoneum (approximately 700 ml), a normal sized uterus, adhesions involving the intestines, omentum and the fundus of the uterus, tangential laceration of the omental surface of the terminal ileum about 2-3 inches from the ileocaecal junction, normal ovaries and left fallopian tube. The right fallopian tube was absent. The horizontal arm of the Cu T 360 IUCD was inside the terminal ileum while the vertical arm was inside the myometrium, with the string still protruding in the vagina. The skin was closed sub-cortically using braided, coated and absorbable polyglycolic acid suture. She did not receive any blood transfusion. She received antibiotics, intravenous fluids and analgesics. She commenced oral intake on the fifth day and was discharged the next day in a stable condition.
|
[[35.0, 'year']]
|
F
|
{'19320421': 1, '16304473': 1, '2782133': 1, '3898848': 1, '6378687': 1, '19521707': 1, '18949478': 1, '8736720': 1, '15697109': 1, '17241837': 1, '28572893': 2, '20120941': 1, '21333209': 1, '12521659': 1, '23919205': 2}
|
{'5451451-1': 1}
|
162,487 |
3728879-1
| 23,919,206 |
noncomm/PMC003xxxxxx/PMC3728879.xml
|
Prosthodontic Management of Hypohidrotic Ectodermal Dysplasia with Anodontia: A Case Report in Pediatric Patient and Review of Literature
|
An eight-year-old male patient reported to the Rural Dental Hospital with the complain of missing teeth causing difficulty in mastication and speech. He was accompanied by his father who gave the history of missing teeth of his son since infancy. He mentioned that child was intolerant to heat and prefers to be in cold environment. Patient also reported about absence of sweating. Family history revealed that he was the second kid of parents with non consanguineous marriage and none of the other members or relatives had similar condition.\nThe boy was moderately built and poorly nourished with BMI value of 12.5 kg/m2. His skin was dry with scanty body hair. The nails were not affected. Extraoral examination revealed the typical features of ectodermal dysplasia like sparse scalp hair, frontal bossing, absent eyebrows, loss of eyelashes, hyper pigmentation around the eyes and mouth, saddle nose and protuberant lips. A diminished lower facial height contributed to a senile facial expression [].\nIntraoral examination revealed thin, atrophic and complete edentulous maxillary and mandibular alveolar ridges []. Anodontia as well as underdevelopment of alveolar ridges was also confirmed by panoramic radiography []. Correlating clinical, radiographic and skin biopsy findings, the boy was diagnosed with hypohidrotic ectodermal dysplasia with complete anodontia.\nTreatment plan was discussed with patient and his father. Informed consent was obtained for the agreed treatment. The child was rehabilitated with removable maxillary and mandibular complete dentures. Routine procedures were followed for the construction of the complete dentures which included preliminary impressions with irreversible hydrocolloid [], fabrication of special trays using autopolymerizing acrylic resin after applying spacers, border-molding with low fusing compound, final impression with zinc oxide non eugenol impression paste [], recording of maxillomandibular relations and mounting the casts on semi adjustable articulator []. Rather than primary tooth forms, permanent tooth forms were selected in order to provide better static and dynamic occlusion. Teeth arrangement was done and bilateral balanced occlusion was given. Trial dentures were checked for retention, phonetics, occlusion and esthetics. The denture base was processed through compression molding using heat cure fiber reinforced acrylic material (DPI, Mumbai, India) for stability and longevity. The processed dentures were finished and polished. Occlusal equilibrium was confirmed. After the insertion of dentures [], postplacement instructions were given to child and his parents. The facial profile and expression improved significantly with complete dentures [].\nPatient was very cooperative throughout the clinical procedures. Recall appointments were scheduled after 24 hours, 1 week, and 4 weeks. After 4 weeks the patient was able to function well with both maxillary and mandibular dentures. In order to accommodate growth and development, the patient was scheduled for ongoing follow up visits every 6 months. At recall appointments, good retention was observed and the parents reported a significant improvement in terms of speech and mastication.
|
[[8.0, 'year']]
|
M
|
{'17224035': 1, '21891912': 1, '10442937': 1, '8933447': 1, '15867750': 1, '19008629': 1, '8531147': 1, '8218745': 1, '12239475': 1, '7856640': 1, '34931149': 2, '32440077': 2, '9200202': 1, '8150513': 1, '26321846': 1, '23919206': 2}
|
{'8684530-1': 1, '7229389-1': 1}
|
162,488 |
3728880-1
| 23,919,207 |
noncomm/PMC003xxxxxx/PMC3728880.xml
|
Mycobacterium Tuberculosis Pyomyositis in an Infant
|
A previously healthy 9 month old boy, who was up to date on immunizations, was found to have an area of swelling and firmness on his right thigh noted by mom while bathing him. The induration increased over the following week, but there was no associated fever, pain, or history of trauma. Parents recalled routine immunizations given in both thighs three months ago. Children in Dubai receive Bacille Calmette-Guérin (BCG) vaccine in the deltoid at birth; followed by diphtheria/tetanus/acellular pertussis (DTaP), inactivated polio (IPV), hemophilus influenza B (HiB) and hepatitis B (HepB) vaccines given at 2-months, 4-months and 6-months in the thighs. His initial blood work revealed a CRP of 30 mg/L (normal: <6 mg/L); ESR 29 mm/hr (normal: <10 mm/hr) and normal complete blood count, AST, ALT and alkaline phosphatase.\nAn ultrasound of the right thigh showed a 6 cm × 4 cm deep abscess in its anterolateral aspect. The abscess was drained under general anesthesia and 15 ml of purulent material was evacuated; he was discharged home on oral cefuroxime pending culture results. Gram stain of abscess fluid showed gram positive cocci and gram negative rods; bacterial cultures remained negative. He completed 10 days of oral cefuroxime post-drainage without any improvement in thigh induration or swelling; hence he was referred for pediatric infectious diseases consultation.\nOn examination in the pediatric infectious disease clinic, he was a very well-appearing infant with normal vital signs, weight at 50% ile and length at 90% ile for age. The anterolateral right thigh was indurated and swollen, without any overlying erythema or tenderness, and a 3 cm incisional scar was noted to be healing well. He did not bear weight on his legs when placed in standing position, and did not crawl. There was no systemic lymphadenopathy, and the remainder of his physical examination was normal. An MRI scan with contrast obtained after abscess drainage and completion of oral antibiotic therapy showed extensive inflammatory granulation tissue involving the right lateral thigh compartment, without any evidence of underlying femoral osteomyelitis. The involved muscles, especially vastus intermedius and vastus lateralis were noted to have undergone significant fatty replacement [Figures and ].\nMycobacterial PCR on the abscess fluid was reported as positive; this PCR detects Mycobacterium tuberculosis (M. TB), Mycobacterium avium (M. avium), Mycobacterium bovis (M. bovis), and Mycobacterium microti (M. microti). Due to his unusual clinical presentation, and hence concerns about a false-positive test, the TB PCR was repeated on the sample fluid and was again highly positive. In addition, Ziehl-Neelsen and auramine-rhodamine staining of the pus sample demonstrated a large number of acid fast bacilli (AFB). After 6 weeks, the mycobacterial culture grew a pan-sensitive isolate of M. TB.\nThis was a previously healthy child who was born in Dubai, United Arab Emirates. He had received the BCG vaccine on his deltoid at birth, a routine practice in this region. He had travelled within the Middle East; there were no family pets; and no unpasteurized milk consumption was reported. He had no known exposures to tuberculosis or human immunodeficiency virus (HIV); and he had demonstrated no systemic symptoms i.e., fever, night sweats or weight loss prior to his presentation to the pediatrician for this complaint. Tuberculin skin test (TST) was not done; and a TB interferon gamma release assay (IGRA) was negative. A chest X-ray was normal. TSTs placed on all household contacts were negative.\nHe was empirically started on 4-drug anti-TB therapy with isoniazid, rifampin, ethambutol, pyrazinamide and pyridoxine pending AFB culture results, and followed clinically. He tolerated the medications very well; within one month of initiating therapy he started to bear weight on his legs, the thigh induration improved, and his ESR and CRP normalized. Once culture/sensitivity data were available, and after 2 months of receiving 4-drug therapy, he was continued on isoniazid and rifampin for the remainder of his treatment. A repeat MRI obtained after 6 months of starting anti-TB therapy showed significant resolution of the prior inflammatory changes; however, a residual 8 mm cystic area with an enhancing wall was noted between the vastus medialis and vastus lateralis muscles. Hence the anti-TB therapy was continued for an additional three months. An MRI obtained at the conclusion of 9 months of treatment showed no active inflammation, and treatment was stopped. On follow-up, one year after completing his treatment, he remains a very active two-year old with normal gait and physical activity; without evidence of disease recurrence.
|
[[9.0, 'month']]
|
M
|
{'12506952': 1, '11721168': 1, '2327761': 1, '34542327': 1, '19371548': 1, '6550577': 1, '24609759': 1, '10809836': 1, '9502442': 1, '11816427': 1, '17339619': 1, '6353528': 1, '11181357': 1, '16601088': 1, '7548524': 1, '18593687': 1, '16714724': 1, '2069387': 1, '7433925': 1, '1317144': 1, '14727228': 1, '23919207': 2}
|
{}
|
162,489 |
3728881-1
| 23,919,208 |
noncomm/PMC003xxxxxx/PMC3728881.xml
|
Compound Odontoma in Deciduous Dentition
|
A 4-year-old female patient visited the department of Oral Medicine and Radiology, Yenepoya Dental College, Yenepoya University, Mangalore with a complaint of swelling over the maxillary anterior region since 3½ years. Her parents noticed the swelling when she was 6 months old. Initially it was small in size and then gradually increased to the present size. It was not associated with pain or discharge. She gave a history of delayed eruption of primary teeth and no history of trauma has been reported. Her medical and family history was noncontributory. Extraoral examination showed no abnormality. Intraoral examination revealed a diffuse swelling in the maxillary anterior region [] measuring approximately 1 × 2 cm in size that extends from the midline located above the gingival margin with respect to maxillary primary central incisor, lateral incisor and canine. The swelling was nontender and bony hard in consistency, thus came to a provisional diagnosis of bony exostosis.\nIntraoral periapical radiograph in relation to right maxillary primary teeth revealed multiple radiopacities in irregular fashion with densities equal to or greater than that of tooth, separated and surrounded by a thin radioluscent capsule [] above which there is presence of developing permanent tooth bud. On the basis of history, clinical and radiographic examination a final diagnosis of compound odontoma was made. In the present case seeing the extent of the lesion a surgical excision was planned. Surgical removal of the odontoma was performed and the specimen was sent for histopathological examination []. Histologically, foci of odontogenic tissues comprising dentin and pulp tissue were found to be distributed in fibrous stroma []. These features were suggestive of compound odontoma. The patient was then reevaluated after 2 months.
|
[[4.0, 'year']]
|
F
|
{'15573658': 1, '23019505': 2, '20533004': 1, '19212497': 1, '18784868': 1, '12752922': 1, '18192989': 1, '16224136': 1, '24383013': 2, '6935141': 1, '11340730': 1, '23919208': 2}
|
{'3429986-1': 1, '3870643-1': 1}
|
162,490 |
3728882-1
| 23,919,209 |
noncomm/PMC003xxxxxx/PMC3728882.xml
|
Juvenile Aggressive Ossifying Fibroma of the Maxilla: A Case Report and Review of the Literature
|
A 7-year old female child presented to the pediatric unit of our institution with a 9-month history of right maxillary tumor. A clinical assessment of Burkitt's lymphoma was made, and the child was subjected to several courses of chemotherapy without adequate histologic confirmation. The child was later referred to the maxillofacial unit after about 2 months of unsuccessful management by the pediatricians.\nOn presentation, there was an expansile lesion, measuring about 12 cm by 8 cm in its greatest diameter, involving the right maxilla with proptosis of the right eye and moderate hypertelorism. Vision was, however, intact in the associated right eye. The right nostril was completely obstructed by an exophytic growth, and thus patient had to breathe via the left side []. Intra-orally, the lesion had involved the whole of the right hemipalatal region with a little extension to the contralateral side. The associated teeth had little or no displacement but with grade 1 mobility. On general examination, there was mild palor and weight loss, but there was no difficulty in swallowing.\nComputerized tomographic findings showed a well-delineated osteolytic lesion, which had destroyed the right maxilla and with extension into the maxillary antrum []. Incisional biopsy was done, and the histopathologic analysis confirmed a diagnosis of juvenile aggressive ossifying fibroma of the trabecular variety [].\nA hemi-maxillectomy was planned. A Weber-Feguson incision was used to expose the lesion, which was excised. The lesion was well-defined, and some areas of cystic degeneration were encountered. The lesion was excised along the line of cleavage. Gross examination of the specimen showed multiple gray-white, soft to firm fragments measuring 5.5 × 4.0 × 3.0 cm in largest dimension. The whole specimen was sent for histopathologic diagnosis. Slides from the initial biopsy were reviewed and compared. The initial histologic diagnosis of trabeculae juvenile ossifying fibroma was confirmed. The nasal lesion was found to be in isolation from the maxillary lesion and was excised, labeled separately, and sent for histopathologic diagnosis. The result came out as nasal polyp.\nThe patient was rehabilitated by fabrication of an obturator to cover the surgical defect. Post-operative recovery was uneventful, and patient was discharged after 1 week following surgery.
|
[[7.0, 'year']]
|
F
|
{'3864113': 1, '18445542': 1, '29152441': 2, '16321450': 1, '24421970': 1, '11925539': 1, '20953744': 1, '25395805': 1, '8630892': 1, '28210024': 2, '12823062': 1, '8246661': 1, '31380504': 1, '1451083': 1, '28588818': 2, '30232767': 1, '1899514': 1, '21596643': 1, '18206279': 1, '27833246': 1, '7823298': 1, '23919209': 2}
|
{'5458042-1': 1, '5685647-1': 1, '5292216-1': 1}
|
162,491 |
3728883-1
| 23,919,210 |
noncomm/PMC003xxxxxx/PMC3728883.xml
|
Joubert Syndrome: The Molar Tooth Sign of the Mid-Brain
|
A 1 year and 4 month-old male baby was admitted in our department with history of delayed developmental milestone, mental retardation, abnormal limb movement, generalized hypotonia and abnormal head movements with nystagmus. There was also history of abnormal breathing pattern with episodes of alternate rapid breathing and normal breathing. There was history of feeding difficulties on and off and frequent chest infection from the early months of life.\nPast history revealed that the child was born by normal vaginal delivery in a hospital at term pregnancy, with history suggestive of birth asphyxia. The birth weight of the baby was 3 kg. His parents had a consanguineous marriage. From the early days of life, his mother noticed feeding difficulties and frequent chest infections of her baby. She also noticed abnormal movement of his head and peculiar eye movement with deviation of the eyes, but relative paucity of movement of the limbs. There was history of episodic rapid breathing lasting for 2-3 min with frequent opening of the mouth and protrusion of the tongue interspersed with normal breathing. There was weak cry and floppiness of all the muscles from the first few months of life. But, no convulsion was noted. Hearing was normal as the child was able to turn the head toward the source of sound. Symptoms were progressively increasing. Prenatal history was uneventful. No similar illness in any siblings in the family was reported. Immunization was incomplete. There was gross delay in development of mental and motor milestones.\nPhysical examination revealed a hypotonic child with constant efforts of abnormal head movement sideways and limb movements, opened mouth with protruded tongue [], and the child showed abnormal breathing pattern with hyperpnea and tachypnea. Head circumference and other anthropometric examinations were normal. No morphological abnormality was detected. Cardiovascular and respiratory system examinations were normal. No organomegaly was present. Ocular examinations revealed bilateral divergent squint, inability to follow moving object, restricted upward gaze of eye and bilateral horizontal gaze-evoked nystagmus. Retinoscopy revealed refractory error of both eyes. Ophthalmoscopic examination was normal and no pigment changes in the retina were detected; optic disc was also normal. Complete blood count, renal function test and liver function test were normal.\nAxial T1- and T2-weighted magnetic resonance imaging (MRI) images showed hypoplastic cerebellar vermis with hypoplasia of the superior cerebellar peduncle resembling the “Molar Tooth Sign” in the mid-brain [Figures and ]. MRI sagital T1-weighted image revealed partial agenesis of cerebellum agenesis and hypoplasia of the superior cerebeller peduncle was noted []. MRI axial (at the level of post-fossa) T2-weighted image revealed hyperintensity of basal cisterns communicating with the fourth ventricle suggestive of vermian agenesis []. Renal ultrasound showed no abnormality.
|
[[1.0, 'year'], [4.0, 'month']]
|
M
|
{'33004012': 2, '12169461': 1, '19461662': 1, '1341417': 1, '10749289': 1, '17377524': 1, '19129991': 1, '19876931': 1, '15689444': 1, '15966043': 1, '16619384': 1, '10488903': 1, '18164675': 1, '31114663': 1, '30518138': 1, '20615230': 1, '23919210': 2}
|
{'7531107-1': 1}
|
162,492 |
3729993-1
| 23,908,967 |
noncomm/PMC003xxxxxx/PMC3729993.xml
|
Inflammatory myofibroblastic tumor mimicking hepatocellular carcinoma with dense lipiodol uptake
|
A 60-year-old woman was admitted at our hospital for evaluation and management of liver tumor. Two months ago, she felt general weakness. She had weight loss, 5 kg/2 wk. She visited a local hospital due to the above problems. She was checked by abdominal sono whereby a liver tumor was identified. Laboratory results at that time were not available. The impression was HCC at that time. Thus, she was treated with transhepatic arterial chemoembolization (TACE) by using adriamycin (50 mg), lipiodol and gelfoam. Two weeks after TACE, she visited our hospital for operation. She felt general weakness and had no other symptoms. She had diabetes mellitus that was treated with oral hypoglycemic agents. She had no history of hepatitis B or C. Blood pressure was 120/70 mmHg. Pulse rate was 76/min. Temperature was 36.0℃. She was not icteric. Neither abdominal mass nor liver were palpable.\nAbnormal laboratory results were decreased hemoglobin, 10.0 g/dL (reference range, 12.0 to 16.0 g/dL); elevated erythrocyte sedimentation rate, 122 mm/hr (reference range, 0 to 22 mm/hr); and elevated gamma-glutamic transpeptidase, 81 IU/L (reference range, 7 to 32 IU/L). Hepatitis B surface antigen was negative and surface antibody was positive. Hepatitis C antibody was negative. Tumor markers were all nor mal; alpha-fetoprotein, 3.2 ng/mL (reference range, 0 to 10 ng/mL); carcinoembryonic antigen, 0.4 ng/mL (reference range, 0 to 5 ng/mL); carbohydrate antigen 19-9, 10.2 U/mL (reference range, 0 to 37 U/mL).\nAbdomen CT checked prior to TACE showed a gross 5 cm spherical tumor in Segment VII (Couinaud's segment) and Segment VI of the liver. The tumor showed slight low attenuation on precontrast scan (). On arterial phase, this tumor showed general high attenuation with central stellate slight low attenuation (). On portal phase, a major portion of the tumor showed remarkable low attenuation with irregular septa-like and peripheral thick rim-like high enhancement (). Hepatic artery angiogram showed spherical tumor stain with no remarkable hypervascularity (). Lipiodol CT, which was taken 14 days following TACE, revealed a 4.3 cm densely lipiodol uptaken spherical mass in segment S6 and S7 of the liver (). Right post sectionectomy was done with the diagnosis of HCC.\nIn the specimen, the tumor was 5.2 cm×4.5 cm×4.2 cm in size. It was spherical, well-defined and had smooth contour without capsule. The color of tumor was grayish white to yellow tan (). High power view demonstrates interlacing bundles of myofibroblasts and fibroblasts in a collagenous stroma, with an admixture of polymorphic inflammatory cells, including plasma cells, lymphocytes and eosinophils (). Immunohistochemical stain revealed positive activity of vimentin (diffuse +), smooth muscle actin (mainly +) and desmin (focal +). The final diagnosis was IMT.\nThe patient recovered well without any complication. Regular follow-up studies including abdomen CT showed no recurrence of tumor for 5 years after operation.
|
[[60.0, 'year']]
|
F
|
{'2173643': 1, '18031372': 1, '11054708': 1, '17522777': 1, '15633215': 1, '16998295': 1, '6196102': 1, '11490814': 1, '26578495': 1, '1311116': 1, '26767012': 1, '7976880': 1, '23908967': 2}
|
{}
|
162,493 |
3729994-1
| 23,908,968 |
noncomm/PMC003xxxxxx/PMC3729994.xml
|
Open surgical decompression of celiac axis compression by division of the median arcuate ligament
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A 37-year-old female patient presented with chronic epigastric pain lasting 6 months, food phobia and weight loss of 10 kg during the previous 4 months. The pain was cramping aggravated after meals, and persisted for 20-30 minutes after meals. There were no other gastrointestinal symptoms such as diarrhea, constipation, gastrointestinal bleeding and nausea or vomiting.\nAs past history, she underwent coil embolization of the bilateral ovarian veins at another hospital 2 months before visiting us under the impression of pelvic congestion syndrome, which did not improve her abdominal symptoms.\nPhysical examination showed mild abdominal tenderness at both lower quadrants without muscle rigidity. Laboratory test showed normal range including serum amylase, liver enzyme and complete blood cell count. There was also no abnormality in fluorescent antinuclear antibody and antineutrophil cytoplasm antibody. Gastro-duodenoscopy showed chronic atrophic gastritis and 18-fluorodeoxyglucose positron emission tomography-CT showed no spe cific lesion with abnormal hot uptake.\nAbdominal CT angiography () showed downward angulation of CA and superior mesenteric artery (SMA) close to their origins by the compression.\nTo decompress CA, we approached through the upper mid line incision and lesser sac. We found CA was tightly compressed by MAL with poststenotic dilatation (). After division of the fibrous structure, we found that arterial blood flow increased significantly and recovered without bruit.\nPostoperatively, epigastric postprandial pain was resolved and the patient could return to a normal diet. On a follow-up abdominal CT angiography (), we found patent CA with mild residual stenosis.
|
[[37.0, 'year']]
|
F
|
{'20630683': 1, '27744644': 2, '21536596': 1, '17911551': 1, '6108704': 1, '11887094': 1, '5844938': 1, '14083857': 1, '19128929': 1, '17863663': 1, '23908968': 2}
|
{'5065883-1': 1}
|
162,494 |
3730031-1
| 23,908,703 |
noncomm/PMC003xxxxxx/PMC3730031.xml
|
Ruptured Saccular Aneurysm Arising from Fenestrated Proximal Anterior Cerebral Artery : Case Report and Literature Review
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A 59-year-old woman was admitted with complaints of a sudden onset of dysarthria and left side weakness. Computed tomography revealed an intracerebral hemorrhage in the right basal ganglia and frontal lobe. Subarachnoid hemorrhage was also identified in the anterior falx and sulci of medial frontal lobes (). Cerebral angiography demonstrated a saccular aneurysm which arised from the proximal end of the right fenestrated A1 segment. The A2 segment of ACA was only visible from the right internal carotid artery. There was another saccular aneurysm at the right middle cerebral artery (MCA) bifurcation which was considered as an unruptured one because of the long distance from co-existing intracerebral hematoma ().\nUnder general anesthesia, the aneurysms were surgically clipped via right pterional craniotomy. A ruptured saccular aneurysm with broad neck was identified on the proximal end of fenestrated A1 segment intraoperatively. An aneurysm was projected anteriormedially and was occluded by Yasargil mini clip. An unruptured MCA bifurcation aneurysm was also treated by surgical clipping and the intracerebral hematoma was removed ().\nThe postoperative course was uneventful, and the patient was discharged without any neurologic deficits.\nIn the literature review, we found 18 cases of aneurysms arising from the fenestrated A1 segment. Characteristics of 19 cases (including present case)-,,,-,-, are summarized in . There were 9 males and 9 females (1 case, not recorded) with a mean age of 49.7 years (range 33-78 years). The sizes of aneurysms were recorded in 7 out of 19 cases, and the mean aneurysm size was 5.05 mm (range 2.9-7.0 mm). Twelve aneurysms were developed at the right side while seven were located at left side. All 19 aneurysms were saccular type and 15 cases (79%) were ruptured. Three among the aneurysms were treated by endovascular interventions, while the other aneurysms except for those three were treated by aneurysm clipping.\nWe could classify the aneurysms into three types based on the arising point of the aneurysm (). Of the 17 cases in which exact location of the aneurysm was described on the original article (including the present case), 14 (82%) aneurysms developed on the proximal end of the fenestrated A1 segment, which was classified as type I. Two cases (12%) were classified as type II which represent the aneurysm located on the midportion of the fenestrated A1. One case (6%) which demonstrated multiple aneurysms including one at the proximal end and another at the posterior aspect of the fenestrated artery was classified as type III. Of the nine reports in which the presence of azygos ACA has been investigated azygos ACA was noted in 3 cases (33%). Hypoplastic A1 or aplasia of A1 was demonstrated in 4 cases (31%) out of 13 cases in which the status of A1 hypoplasia or aplasia were described. In one case, the ipsilateral A1 was hypoplastic while the other three cases represented contralateral hypoplastic A1. Finally, multiple aneurysms were found in 3 cases (16%) including the present case.
|
[[59.0, 'year']]
|
F
|
{'7464862': 1, '7143067': 1, '30022945': 2, '12790284': 1, '4012555': 1, '19686315': 1, '6836482': 1, '10690739': 1, '21748037': 2, '6618896': 1, '31497139': 2, '9745246': 1, '4023910': 1, '6495158': 1, '19669689': 1, '3599873': 1, '1545903': 1, '2460786': 1, '29987435': 1, '4009274': 1, '8613864': 1, '11311909': 1, '15200058': 1, '23908703': 2}
|
{'3130439-1': 1, '6703010-1': 1, '6703010-2': 1, '6047555-1': 1, '6047555-2': 1}
|
162,495 |
3730032-1
| 23,908,704 |
noncomm/PMC003xxxxxx/PMC3730032.xml
|
Pituitary Stalk Hemangioblastoma in a von Hippel-Lindau Patient : Clinical Course Follow-Up Over a 20-Year Period
|
A 15-year-old boy was admitted to our hospital in 1990 with an one year history of intermittent headache and vomiting. A solitary hypervascular mass was demonstrated at the right cerebellum and was removed completely. Histologic finding was consistent with HB. There was no recurrence during a few years of follow-up. However, 7 years following the initial surgery, brain magnetic resonance image (MRI) showed a cystic mass with a mural nodule in the right cerebellar hemisphere and several small masses at the right cerebellopontine angle and left cerebellar vermis representing recurrence. Resection of the lesion was achieved, using suboccipital craniectectomy, and gamma-knife therapy was performed. Seventeen years following the initial surgery (2007), he developed progressive headache, dizziness and diplopia. At that moment, brain MRI revealed a homogeneous enhancing suprasellar mass () and enlarged edematous optic chiasm (). Additionally, he was clinically diagnosed with VHL disease with numerous enhancing nodules and syringomyelia along the cervical and thoracic spine, multiple cysts in the both kidneys and the pancreas, and renal cell carcinoma in the lower pole of the right kidney. His endocrinological profile was normal. He subsequently received gamma-knife radiosurgery for pituitary and other residual lesions in the brain. Twenty-two years following the initial surgery (2012), he complained recurred dizziness and progressive diplopia. Brain MRI revealed an increased size of the pituitary mass (from 4.3×5 mm to 7×11.5 mm) and cerebellar masses, despite treatment. After the cerebellar lesion has been removed surgically, he was discharged and scheduled for further follow-up imaging and gamma-knife therapy because the patient's symptoms were subsided and the surgeon opted for observation.
|
[[15.0, 'year']]
|
M
|
{'12814730': 1, '19654966': 2, '15081659': 1, '15937651': 1, '26847309': 2, '18834262': 1, '20647972': 1, '12546356': 1, '26180617': 2, '23908704': 2}
|
{'4740549-1': 1, '2719216-1': 1, '4502246-1': 1}
|
162,496 |
3730033-1
| 23,908,705 |
noncomm/PMC003xxxxxx/PMC3730033.xml
|
Treatment of a Traumatic Leptomeningeal Cyst in an Adult with Fibrinogen-Based Collagen
|
A 28-year-old man presented with a growing soft mass on the vertex of his head; it had developed 5 months earlier. Sixteen months prior to this, the patient had been involved in an incident in which he had received a blow to the head. Initially, he had a small subgaleal hematoma but it disappeared by the following day. Patient did not visit hospital for the head trauma; thus, head computed tomography (CT) and X-rays were not performed at that time.\nTwo years ago, the patient was diagnosed with bipolar disorder, and it was because of this that he underwent a physical examination and EEG for evaluation of his psychological state one month after the incident. At this time, no mass was detected on his scalp. Also, he did not feel the mass on the scalp. It was not until 8 months later that a mass developed, which continued to grow. The patient experienced no associated symptoms, and the mass was not tender to touch. A plain X-ray revealed a round 5×5 cm area of lucency in the posterior parietal bone with adjacent skull erosion. Upon enhanced CT examination of the head, a bony defect involving both the inner and outer table of the cranium was observed close to the superior sagittal sinus. A well-defined mass, 5 cm in diameter, was nested within the defect (). There were no enhancing lesions inside the cyst, and the rest of the brain parenchyma was free from notable anomalies. Magnetic resonance imaging (MRI) of the lesion was hypointense on T1-weighted images and hyperintense on T2-weighted images, indicating that a cystic lesion was propagating through the defect and slightly compressing the adjacent brain.\nFollowing this, the patient underwent surgery. A skin flap was created close to the lesion by making an incision down to the galea. The underlying lesion was pulsatile. The galeal layer was then dissected from the cyst, which exposed the cystic membranes. These membranes protruded through the bone defect and contained a clear fluid. The dura around the bone defect was thin and fragile.\nUsually, dura is sutured in a watertight manner with artificial dura, such as lyophilic dura. However, due to the close proximity of the defect to the sagittal sinus, we chose instead to place fibrinogen-based collagen fleece (TachoComb®) over the dural defect in order to reduce the risk of injuring or perforating the sinus. Six pieces of fibrinogen-based collagen fleece, cut to a size of 1×3 cm, were thus placed over the dural defect in a partially overlapping manner. The gluing surface of the fibrinogen-based collagen fleece was attached to the dural defect, exceeding the margins by about 0.5 cm. A wet patty was then applied over the defect and gently compressed. After the patty was removed, any extra seepage of blood was prevented by the application of an additional layer of fibrinogen-based collagen fleece on top of the existing layer (). The outer table of the skull was reconstructed.\nThe day after surgery, the patient remained asymptomatic and displayed good cosmetic results. Histologic findings revealed that the cyst was lined by meningothelial cells resting on a layer of supporting fibrous tissue. The walls of the cyst were infiltrated with mild chronic inflammatory cells and displayed vascular congestion. The cyst surface was focally lined with flattened epithelial cells, and the underlying brain tissue had become gliotic. The presence of chronic inflammatory cells and hemosiderin-containing macrophages suggested traumatic etiology (). Thirteen months later, a follow up brain CT scan of the patient revealed no recurrent cystic mass ().
|
[[28.0, 'year']]
|
M
|
{'17171003': 1, '6228744': 1, '3321930': 1, '28744690': 1, '11786702': 1, '19246866': 1, '25227164': 1, '19556133': 1, '12217685': 1, '16385319': 1, '11956939': 1, '16249888': 1, '23908705': 2}
|
{}
|
162,497 |
3730034-1
| 23,908,706 |
noncomm/PMC003xxxxxx/PMC3730034.xml
|
Fatal Rhabdomyolysis in a Patient with Head Injury
|
A previously healthy 42-year-old man was referred to our emergency department due to a deteriorating mental status after a car accident. Emergency services reported decreased mental status and a Glasgow Coma Scale score of 7. There were no associated systemic injuries, muscle contusions, internal organ damage or swelling of the extremities. However, he showed decerebrated rigidity at both arms and legs. On admission, sodium, potassium, and osmolarity were 143 meq/L, 3.5 meq/L, and 335 mmol/L, respectively. Computed tomography (CT) showed diffuse cerebral swelling consistent with hemorrhagic contusion and epidural hematoma at right temporoparietal area (). 150 mL of mannitol solution (20%) every 4 hours was prescribed. However, despite treatment to lower intracranial pressure (ICP), that is, mannitol, mild hyperventilation, and extraventricular drainage (EVD), his mental status remained semicomatose and recurrent convulsive generalized tonic-clonic seizures developed, and thus, he was admitted to the neurosurgical intensive care unit for adequate hydration, anticonvulsant and correction of the metabolic derangement. Unfortunately, myoglobinuria developed 3 days after admission with a high serum creatine kinase (CK) level up to 48, 837 IU/L (normal 55-215 IU/L). At this time, his serum sodium, potassium, and osmolarity were 152 meq/L, 3.0 meq/L and 352 mmol/L. Acute renal failure developed 3 days after admission despite intensive fluid replacement and diuresis. CK level peaked at 52, 825 IU/L on day 5, and serum myoglobin exceeded 25 mg/dL (normally <2.5 mg/dL). Despite intensive supportive treatment, the patient became anuric 5 days after admission and required hemodialysis. No source of muscle breakdown was evident, but his condition deteriorated rapidly, culminating in cardiorespiratory arrest with dilated non-reactive pupils. He died 8 days after admission.
|
[[42.0, 'year']]
|
M
|
{'15774072': 1, '3748364': 1, '1520370': 1, '431646': 1, '135855': 1, '9218322': 1, '25620985': 2, '8242960': 1, '2294777': 1, '19096594': 1, '564002': 1, '23908706': 2}
|
{'4303285-1': 1}
|
162,498 |
3730035-1
| 23,908,707 |
noncomm/PMC003xxxxxx/PMC3730035.xml
|
Non-Traumatic Myositis Ossificans in the Lumbosacral Paravertebral Muscle
|
A 42-year-old man presented with a 4-month history of low back pain and pain in the left posterolateral part of the buttock and thigh. The patient appeared healthy and had no history of previous trauma or musculoskeletal disease. On physical examination, a slightly tender, hard, and fixed mass was palpated in the left PVM at the L5 level. Complete blood cell count, erythrocyte sedimentation rate, and blood chemistry values including serum calcium, phosphate, C-reactive protein, and alkaline phosphatase were all within normal limits.\nLateral lumbosacral spine X-ray showed calcific density near the spinous process of L5 and S1 (). T2-weighted sagittal magnetic resonance imaging (MRI) showed heterogeneous high signal intensity at the PVM from L5 to S2 (). Axial MRI showed a heterogeneous high signal intensity mass in T1- and T2-weighted image in the left PVM, and no enhancement of the mass was found in the Gadolinium-enhanced T1-weighted MRI (). Findings on computed tomography revealed an inhomogenously calcified mass, and the mass was in continuity with or eroding the left-sided lamina, facet joint of the L5, and the sacrum ().\nThe lack of typical imaging features required an open biopsy, which showed no evidence of malignancy and confirmed MO (). The patient was followed up for 6 months after the biopsy and the patient's pain had been reduced gradually. However, a follow-up image could not be obtained, because of the patient's refusal due to financial difficulties.
|
[[42.0, 'year']]
|
M
|
{'1950874': 1, '19404167': 1, '22081461': 1, '28795074': 1, '25983509': 1, '15278779': 1, '25210536': 1, '12407551': 1, '12475528': 1, '30459985': 2, '26264943': 1, '16133463': 1, '25685123': 1, '16932921': 1, '10864118': 1, '34458184': 2, '20704714': 2, '21102285': 1, '10354880': 1, '23908707': 2}
|
{'6243371-1': 1, '8387081-1': 1, '2928249-1': 1}
|
162,499 |
3730036-1
| 23,908,708 |
noncomm/PMC003xxxxxx/PMC3730036.xml
|
Bilateral Thoracic Ganglion Cyst : A Rare Case Report
|
A 53-year-old female suffered from severe bilateral groin pain and dysesthesia for three months. She had this intermittent pain for 12 years, but the symptoms became worsening in the last three months. The visual analog scale score for pain was 8 out of 10. The pain was not relieved by conservative treatment. Her medical history was unremarkable. Her neurological examination was normal but she was suffering so much groin pain while walking. Thoracic magnetic resonance imaging (MRI) revealed bilateral, well circumscribed extradural, intraforaminal masses in continuity with the right and left apophyseal joints at Th12-L1 level (). Sagittal T2-weighted thoracolomber MRI revealed the bilateral roots compression caused by this cystic lesion cystic lesions at Th12-L1 level (). The patient underwent bilateral hemi-laminectomy and flavectomy at the Th12 level. Using the operative microscope, following exposure the foramens, bilateral cystic masses, emerging from the facet joints and compressing the dural sac and nerve roots were removed. The cysts were adhered tightly to the first lumbar dorsal root ganglion. The histopathological findings were consistent with ganglion cyst (). The patient made an excellent post-operative recovery with full resolution of preoperative symptoms.
|
[[53.0, 'year']]
|
F
|
{'7134440': 1, '20461173': 1, '27606282': 2, '21607185': 1, '11013623': 1, '6621847': 1, '3629450': 1, '2147482': 1, '15291021': 1, '1485209': 1, '2512789': 1, '29082053': 2, '30313106': 2, '14968402': 1, '14609693': 1, '19927101': 1, '5673315': 1, '1321700': 1, '18389295': 1, '15124052': 1, '11755976': 1, '23908708': 2}
|
{'6203516-1': 1, '5610893-1': 1, '5012987-1': 1}
|
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