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|---|---|---|---|---|---|---|---|---|---|
162,500 |
3730037-1
| 23,908,709 |
noncomm/PMC003xxxxxx/PMC3730037.xml
|
Cerebral Aspergillosis with Multiple Enhancing Nodules in the Right Cerebral Hemisphere in the Immune-Competent Patient
|
A 48-year-old man with diabetes mellitus, presented to the department of ophthalmology with the complaints of blurred vision that persisted for one month. There was defected visual accuracy in the left eye about 18 years ago. In ophthalmologic examination, there was no new lesion in the both eyes. The laboratory examinations were within normal range. The random blood glucose was 164 mmol/L and the glycosylated hemoglobin was 8.1%. Upon further evaluation, magnetic resonance imaging (MRI) of the brain showed a low-signal intensity on T1-wighted images and a high-signal intensity on T2-weighed images (). After gadolinium enhancement, multiple nodular enhancing lesions with or without a focal necrotic area were shown in the right frontotemporoparietal cortex and white matter (). The diffusion image appeared with high-signal intensity in these areas (). The magnetic resonance spectroscopy obtained from the right occipital region showed elevated lactate/lipid peaks, with mild decreased N-acetylaspartate and no elevation of choline, which suggested necrotic conditions. The lumbar-puncture examination cerebrospinal fluid did not show any infection signs. The body fluid parasite and anti-human immunodeficiency virus levels in the cerebrospinal fluid were negative.\nAn occipital craniotomy and biopsy was performed using the guidance of neuronavigation. In the operative field, there was a reddish color change of the cortex and the thickened arachnoid membrane had a yellowish color change (). There was no definitive mass lesion. By using grasping forcep, the biopsy was done in the yellowish white matter. The biopsy showed many inflammatory cells containing some hyphae with the positive periodic acid-shiff stain (). The pathology result showed a brain abscess caused by fungal infection that had the morphologically of aspergillus. Amphotericin B (50 mg/day) therapy was immediately started after the biopsy confirmation, but there were swelling, and skin eruptions at injection site, and fever. On the 3rd day of treatment, the antifungal agent was changed to ambisome (3 mg/kg/day). After 6 days, the serum creatinine level became elevated to 1.9 mg/dL and the antifungal agent was changed with voriconazole (400 mg/day). Voriconazole therapy was maintained for 3 months. The subjective visual symptom improved. There was no recurrence noted at the one year follow up MRI, but the remaining focal enhanced lesions were visible in the right temporal and occipital area ().
|
[[48.0, 'year']]
|
M
|
{'12167683': 1, '21537076': 1, '28053849': 1, '6353266': 1, '20800492': 1, '9564455': 1, '10941356': 1, '21516164': 2, '27097323': 1, '25870142': 1, '3174990': 1, '26392507': 1, '25981228': 1, '16739702': 1, '22022217': 1, '15814930': 1, '19325053': 1, '15124667': 1, '7793381': 1, '21716631': 1, '4020464': 1, '16844943': 1, '11918369': 1, '8273655': 1, '17245496': 1, '9113685': 1, '11170942': 1, '11732820': 1, '1414847': 1, '15285760': 1, '10543627': 1, '15480762': 1, '17630818': 1, '11058626': 1, '17894631': 1, '23908709': 2}
|
{'3074330-1': 1}
|
162,501 |
3730038-1
| 23,908,710 |
noncomm/PMC003xxxxxx/PMC3730038.xml
|
Neuromyelitis Optica Mimicking Intramedullary Tumor
|
This 20-year-old woman had no other medical history. The patient had been suffering motor weakness in both upper extremities and radiating pain in both hands since 3 weeks ago. She experienced progression of pain, sensory changes, and lopsided motor weakness to the left side of the body. At the initial physical examination, a motor grade of both upper extremities was determined as grade 4 and no weakness was found in lower extremities. She was generally mildly hypertonic, although there was no Babinski sign or clonus. She complained of mild radiating pain in both hands, which was not one-sided with inexplicit dermatome. The patient underwent brain and whole spine MRI, which revealed a heterogeneously enhancing mass in the central posterior aspect of the spinal cord at the C1-6 level (). Brain MRI showed no specific findings. She was suspected of a tumorous condition, particularly ependymoma. Following this, she was admitted to our hospital for further evaluation of neurologic change. On the second hospital day, her motor function in both upper extremities suddenly deteriorated from grade 4 to 3. Cervical MRI was performed again, which revealed further extension of the hyperintense lesion on T2 weighted image and more intramedullary enhancing lesion on the T1 weighted image than that on the initial MRI image (). We hypothesized that the origin of neurologic deterioration was spinal cord compression by tumor bleeding. We immediately started intravenous steroid therapy and carried out total laminectomy C2-6 for decompression with surgical biopsy.\nWe performed C2-6 laminectomy and after opening the dura, the spinal cord was edematous but otherwise normal (). In the operation field, there was no tumor like lesion, discoloration or hypervascularization. We obtained frozen biopsy from a site near the lesion which was obtained consistent with astrocystic cell proliferation. Due to the gross normal finding and no tumorous frozen biopsy, we stopped the removal procedure of the mass lesion to prevent another potential spinal injury. The operation was closed by lateral mass screw fixation and fusion C2-6.\nOn the first postoperative day, her vital signs were stable, and suffered from nuchal pain, but her motor weakness remained the same. However, from the second postoperative day, motor weakness in both upper extremities became gradually better along with improvement of other sensory symptoms. On the twelfth postoperative day, permanent biopsy revealed abundant histiocytic collection, perivascular lymphocytic inflammation and reactive astrocytic proliferation. There was no evidence of a neoplastic process and no oligoclonal bands. The pathologist strongly suggested the diagnosis of neuromyelitis optica. Only then did we investigate her ophthalmic symptoms with a suspicion of another disease. She recalled her visual disturbance 5 years ago. Since then, there was no symptom until visit our department. We referred her to ophthalmology and revealed optic atrophy with disc pallor with optic neuritis on her left eye. Finally, her diagnosis was determined on NMO.\nOn the fourteenth postoperative day, her motor grade was improved to grade 5 and the patient could perform her daily tasks including eating food. We continued postoperative steroid treatment and started rehabilitation. After rehabilitation, she regained most of her upper-extremity motor functions and her ability to walk. Her pain significantly disappeared. When she was discharged from the hospital, there remained only mild nuchal pain. After 3 month from surgical intervention, her follow-up cervical MRI showed dramatic improvement ().
|
[[20.0, 'year']]
|
F
|
{'8774400': 1, '12173580': 1, '17294622': 1, '16717206': 1, '12629245': 1, '17623727': 1, '18434643': 1, '9781568': 1, '19415287': 1, '12849268': 1, '34513162': 2, '20528913': 1, '11016744': 1, '25924171': 1, '14999489': 1, '9766305': 1, '9008495': 1, '18312402': 1, '10496275': 1, '19307541': 1, '1172207': 1, '18625858': 1, '16831965': 1, '17401734': 1, '18945724': 1, '9663311': 1, '34447017': 1, '18231705': 1, '21553012': 1, '15589308': 1, '19487655': 1, '23908710': 2}
|
{'8422470-1': 1}
|
162,502 |
3730072-1
| 23,908,576 |
noncomm/PMC003xxxxxx/PMC3730072.xml
|
Caruncular Abscess Due to Actinomycosis
|
A 47-year-old woman was a dmitted to o ur clinic for persistent purulent discharge from the left eye for a duration of six months. She had been diagnosed with chronic conjunctivitis at a private eye clinic. Despite conservative treatment, the symptom was persistent, leading to referral of this patient to our clinic. Her corrected visual acuity was 1.2, and no specific findings were noted in her past medical history. Slit lamp examination showed discharge via a fistula in the central part of the caruncle of the left eye, a red and swollen caruncle, and mild hyperemic conjunctiva (). Lacrimal drainage was patent to syringing and showed no reflux in the upper or lower canaliculus of the left eye. Computed tomography (CT) scan and magnetic resonance imaging (MRI) showed an elliptical hypo-dense lesion of about 1 cm in diameter in the medial portion of the left lower eyelid (). Caruncular abscess was diagnosed preoperatively, and excisional drainage and bacterial culture were performed. Intraoperative lacrimal probing and irrigation were performed to confirm that the abscess and canaliculus were not connected. Bacteria were not identified in the culture, but biopsy of the lesion confirmed a benign purulent cyst with 'sulfur granules' by histopathologic examination (). Postoperative oral and topical antibiotics were administered; the lesion resolved with no evidence of recurrence within four months, and the symptom significantly improved.
|
[[47.0, 'year']]
|
F
|
{'8190485': 1, '1987950': 1, '21750422': 1, '1390538': 1, '17413640': 1, '15221305': 1, '216128': 1, '3789057': 1, '23908576': 2}
|
{}
|
162,503 |
3730073-1
| 23,908,577 |
noncomm/PMC003xxxxxx/PMC3730073.xml
|
Contact Lens-associated Nocardial Necrotizing Scleritis
|
A 52 year-old male presented with four weeks of pain, photophobia and redness in the right eye. The patient had been evaluated by three different ophthalmologists prior to his presentation and was referred for further management of a steroid unresponsive scleritis. The patient had been treated with topical ciprofloxacin 0.3%, Predforte 1%, and 80 mg of oral prednisone without improvement over a two-week period.\nThe patient's past medical history was significant for gout and hypertension. The patient was diagnosed with gout 25 years previous, and he averaged 1-2 gouty attacks in his feet each year. He denied smoking or alcohol/drug use and any history of ocular surgery or trauma. The patient worked as a plumber and had worn soft disposable contact lenses for 20 years. He stated that he was compliant with proper contact lens care.\nOn examination, the patient's visual acuity was 20 / 100 in the right eye and 20 / 20 in the left eye. He had moderate right eyelid edema. Extraocular muscles and confrontation visual fields were normal in both eyes. His pupils reacted normally, and his intraocular pressure was 12 mmHg in the right eye and 14 mmHg in the left eye. On slit lamp examination with attention to the right eye, the conjunctiva was heavily injected. There was an 8 × 4 mm avascular patch of sclera at 9 o'clock with supprative inflammatory debris encasing the temporal conjunctiva. There were moderate Descemet's folds on the temporal cornea, but no evidence of either keratitis or an epithelial defect. There was neovascularization of the peripheral cornea at 10 o'clock. The anterior chamber was without cells or flare, and there were no keratic precipitates present. These negative findings are illustrated in . The posterior segment was within normal limits in both eyes.\nPreviously performed serology demonstrated a normal complete blood count, comprehensive metabolic panel, uric acid level, and urinalysis. Antinuclear antibodies, rheumatoid factor, antineutrophil cytoplasmic antibodies, and anti-double stranded DNA antibodies were also negative. The patient was diagnosed with necrotizing scleritis, poorly responsive to moderately high doses of oral steroids. Autoimmune, metabolic, and infectious causes were all considered. A swab culture of the supprative material coating the conjunctiva of the right eye was performed. A chest X-ray, lysozyme, rapid plasma reagin, venereal disease research laboratory, immunoglobulin A/immunoglobulin G for varicella zoster virus and herpes simplex virus, and thyroid-stimulating hormone tests were ordered. The patient was continued on the 80 mg of oral prednisone and referred to a rheumatologist for consideration of cyclophosphamide induction pending negative culture and laboratory results.\nAt five days follow-up from initial presentation, there was no significant change in the patient's symptoms or examination. The chest X-ray and the above mentioned labs were within normal limits. However, the culture came back positive for Nocardia asteroides, for which the patient was started on oral Bactrim DS twice daily and topical 2.5% amikacin every two hours. The prednisone dose was reduced to 40 mg, and a tapering schedule was implemented.\nAt one-week follow-up from the positive culture, there was significant improvement in the patient's symptoms and labs. His visual acuity improved to 20 / 40, and he was subjectively less photophobic and without significant pain. The culture results demonstrated that the Nocardia asteroides complex was sensitive to both amikacin and Bactrim, as shown in .\nAt one-month follow-up, the patient's visual acuity was 20 / 25 and he remained pain-free. The patient was tapered off the oral prednisone, and his topical amikacin was reduced to twice daily. At three months follow-up, the patient's right eye was refracted to 20 / 20 and he remained pain-free. The topical amikacin and oral Bactrim were discontinued. These results are illustrated in . The patient continued to be infection-free at his one-year follow-up examination.
|
[[52.0, 'year']]
|
M
|
{'1524135': 1, '18297243': 1, '18716947': 1, '8033581': 1, '2220994': 1, '17589714': 1, '10746462': 1, '33193422': 1, '11248825': 1, '29780901': 1, '9152089': 1, '15791166': 1, '11274691': 1, '23908577': 2}
|
{}
|
162,504 |
3730074-1
| 23,908,578 |
noncomm/PMC003xxxxxx/PMC3730074.xml
|
Full-thickness Sclerotomy for Uveal Effusion Syndrome
|
A 43-year-old man was referred to our retinal clinic due to decreased visual acuity in the left eye lasting for one month. He had been wearing glasses for hyperopia since he was younger than ten years. A gradual decrease in visual acuity led him to seek care at another hospital, where he was found to have a serous retinal detachment in the left eye. He was subsequently referred to our clinic.\nAt presentation, his best-corrected visual acuity (BCVA) was 0.3 and 0.01 logarithm of minimum angle resolution (logMAR), and spherical equivalents were +14.0 diopters (D) and +16.0 D in the right and left eyes, respectively. Fundus examination revealed nanophthalmic fundi in both eyes. In the left eye, there was uveal effusion involving the macula. The axial length was 16.41 mm in the right eye and 16.24 mm in the left eye on A-scan and B-scan ultrasonograms. Optical coherence tomography (OCT) showed a thickened sclera and retinal detachment (). Under general anesthesia, a drainage sclerotomy was conducted in all four quadrants of the left eye. One month postoperatively, a flat retina was seen on fundus examination and OCT (). The retina remained attached during the seven-month follow-up period, and an improved BCVA of 0.3 logMAR was achieved. We did not observe subretinal fluid or choroidal effusion in the fellow eye.
|
[[43.0, 'year']]
|
M
|
{'14060098': 1, '1200903': 1, '7177567': 1, '31651283': 2, '3549374': 1, '10606449': 1, '30564966': 1, '32765903': 1, '16692696': 1, '7436831': 1, '20159229': 1, '6676971': 1, '29133632': 1, '10711879': 1, '3047825': 1, '34663453': 2, '2374682': 1, '31081412': 2, '6635350': 1, '9186138': 1, '7150060': 1, '2379646': 1, '31077022': 1, '23908578': 2}
|
{'3730074-2': 2, '3730074-3': 2, '8525029-1': 1, '7512026-1': 1, '6814038-1': 1, '6814038-2': 1}
|
162,505 |
3730074-2
| 23,908,578 |
noncomm/PMC003xxxxxx/PMC3730074.xml
|
Full-thickness Sclerotomy for Uveal Effusion Syndrome
|
This case involved a 46-year-old man with blurry vision in the left eye for one week. For 15 years, he had receiving treatment with an intraocular pressure lowering medication at another hospital, and he was treated at our hospital with trabeculectomy one month prior to this second presentation under the diagnosis of congenital glaucoma. The refractive error was +3.5 D bilaterally, and BCVA was 0.4 logMAR before his experience with blurred vision. The anterior segment was normal with a proper filtering bleb, but examination of the posterior segment showed a total retinal and choroidal detachment (). Retinal detachment with choroidal effusion was confirmed on ultrasound examination. The scleral thickness and axial length in the left eye measured by ultrasound were 1.94 and 22.94 mm, respectively. Treatment with oral steroids (50 mg oral prednisolone per day) was ineffective. We performed three rounds of drainage sclerotomy. Sclerotomy was performed at the superonasal and inferonasal quadrants during the first surgery. An abnormally rigid and thick sclera was observed during surgery. The first surgery resulted in recurrence of uveal effusion three days postoperatively. During the second surgery, we added two drainage sclerotomies in the same quadrants as those of the first surgery. UES recurred eight weeks postoperatively, and then a third surgery was performed in the inferotemporal quadrant. After the final surgery, the subretinal fluid gradually resolved at one month postoperatively (). The final BCVA measured one month after the last surgery was 0.02 logMAR.
|
[[46.0, 'year']]
|
M
|
{'14060098': 1, '1200903': 1, '7177567': 1, '31651283': 2, '3549374': 1, '10606449': 1, '30564966': 1, '32765903': 1, '16692696': 1, '7436831': 1, '20159229': 1, '6676971': 1, '29133632': 1, '10711879': 1, '3047825': 1, '34663453': 2, '2374682': 1, '31081412': 2, '6635350': 1, '9186138': 1, '7150060': 1, '2379646': 1, '31077022': 1, '23908578': 2}
|
{'3730074-1': 2, '3730074-3': 2, '8525029-1': 1, '7512026-1': 1, '6814038-1': 1, '6814038-2': 1}
|
162,506 |
3730074-3
| 23,908,578 |
noncomm/PMC003xxxxxx/PMC3730074.xml
|
Full-thickness Sclerotomy for Uveal Effusion Syndrome
|
A 77-year-old man presented to the emergency room with a ten-day history of a shadow that affected the upper part of the vision in his left eye. He had no relevant ocular history, but had undergone cataract surgery in both eyes four years prior to presentation. BCVA without any refractive error was 1.0 and 0.4 logMAR in the right and left eyes, respectively. Fundus examination revealed marked shifting of the subretinal fluid underneath the retinal detachment of the left eye. On OCT examination, the retinal findings looked like an atypical central serous chorioretinopathy (). For further workup, ultrasonography, FAG, and ICGA were performed. The axial length was 21.74 mm in the right eye and 21.56 mm in the left eye, which was not compatible with nanophthalmos. There were no definite leaking points on ICG, but leopard-spot patterns were noted on FAG. On the basis of these findings, we diagnosed him with UES. Despite treatment with steroids (50 mg oral prednisolone per day), the retinal findings and vision did not improve. Drainage sclerotomy was conducted in the inferotemporal and inferonasal quadrants. External subretinal fluid drainage was also performed. Ten days later, only a small amount of subretinal fluid was noted on fundus examination. His visual acuity improved to 0.6 logMAR three months after surgery, and no subretinal fluid was noted on OCT (). His visual acuity improved to 0.9 logMAR, and the retina was stable at the last visit seven months postoperatively.
|
[[77.0, 'year']]
|
M
|
{'14060098': 1, '1200903': 1, '7177567': 1, '31651283': 2, '3549374': 1, '10606449': 1, '30564966': 1, '32765903': 1, '16692696': 1, '7436831': 1, '20159229': 1, '6676971': 1, '29133632': 1, '10711879': 1, '3047825': 1, '34663453': 2, '2374682': 1, '31081412': 2, '6635350': 1, '9186138': 1, '7150060': 1, '2379646': 1, '31077022': 1, '23908578': 2}
|
{'3730074-1': 2, '3730074-2': 2, '8525029-1': 1, '7512026-1': 1, '6814038-1': 1, '6814038-2': 1}
|
162,507 |
3730075-1
| 23,908,579 |
noncomm/PMC003xxxxxx/PMC3730075.xml
|
Regression of Iris Neovascularization after Subconjunctival Injection of Bevacizumab
|
A 62-year-old male presented with decreased visual acuity in his right eye. He was diagnosed with proliferative diabetic retinopathy with concurrent NVG. The best-corrected visual acuity (BCVA) was 20 / 200, OD and 20 / 63, OS. IOPs were 45 mmHg, OD and 14 mmHg, OS, with maximally tolerated medical treatment (topical brimonidine, topical dorzolamide/timolol fixed combination [DTFC], and oral acetazolamide [250 mg, three times a day]). Slit lamp examination revealed active neovascularization in the right eye (). The patient was offered a subconjunctival injection of bevacizumab (Avastin; Genentech Inc., San Francisco, CA, USA) in the right eye. A total of 2.5 mg/0.1 mL of bevacizumab was injected at two locations (7 and 9 o'clock, approximately 1.25 mg/0.05 mL each) using a 26-gauge needle. After the injection, a noticeable bleb was produced. Two days after the injection, the IOP in the right eye was decreased to 21 mmHg. Slit lamp examination revealed a substantial regression of previously visible iris neovascularizations (). On the fourth day after the bevacizumab injections, the IOP in the right eye was 23 mmHg. A remarkable regression of neovascularization was visible. The patient was further treated with three sessions of PRP. Two months after the bevacizumab injections, new vessels were not observed in either the iris or the angle (). However, the IOP was 28 mmHg in the right eye with medication, and Ahmed glaucoma implant surgery was subsequently performed. Two months after the surgery, the IOP was controlled at 12 mmHg without any IOP-lowering medication.
|
[[62.0, 'year']]
|
M
|
{'20689793': 1, '19826387': 1, '19324856': 1, '28272234': 1, '18929163': 1, '12036983': 1, '19826393': 1, '20577861': 1, '21526923': 1, '17415704': 1, '26586977': 1, '21845026': 1, '17157590': 1, '17700285': 1, '16854824': 1, '20702430': 1, '20458243': 1, '21878845': 1, '20847676': 1, '16815268': 1, '19074917': 1, '16508438': 1, '19606170': 1, '20148650': 1, '23908579': 2}
|
{'3730075-2': 2, '3730075-3': 2}
|
162,508 |
3730075-2
| 23,908,579 |
noncomm/PMC003xxxxxx/PMC3730075.xml
|
Regression of Iris Neovascularization after Subconjunctival Injection of Bevacizumab
|
A 63-year-old male who had been diagnosed with central retinal vein occlusion in the right eye visited the emergency room with ocular pain and decreased visual acuity. He had been using topical DTFC and brimonidine twice a day for three months because of the IOP elevation after intravitreal injection of triamcinolone acetonid to control the macular edema. With medication, the IOP, OD had been controlled below 20 mmHg for three months. At the time of the emergency room visit, the patient's vision was hand movement, and the IOP was 48 mmHg in the right eye. Slit lamp examination of the right eye disclosed corneal edema and gross hyphema. Iris neovascularization was suspected in the inferior iris although it could not be confirmed due to corneal edema (). Vitreous hemorrhage was also noted in the B-scan ultrasonograph. Subconjunctival injections, 3.75 mg/0.15 mL in total, were completed at the 5, 8, and 11 o'clock areas. One day later, IOP, OD decreased to 32 mmHg, and the cornea was much clearer. Two days after the injections, iris neovascularization was observed only on the margin of the pupil (). The IOP, OD was 29 mmHg.\nWith the conditions much more amicable for surgery, Ahmed glaucoma implant surgery was performed on the right eye on the fourth day after the subconjunctival injections. Preoperative IOP, OD was consistently 29 mmHg. Although the IOP was decreased to 15 mmHg at the next surgery, vigorous iris neovascularization was noted in the inferior iris (). Repeat subconjunctival injections of bevacizumab (1.25 mg/0.05 mL) were performed on this day. Five days after the second injection, the iris neovascularization disappeared completely. Three sessions of PRP were performed during the next three weeks. Three weeks after surgery, the IOP, OD was 17 mmHg, and no neovascularization was visible on the iris ().
|
[[63.0, 'year']]
|
M
|
{'20689793': 1, '19826387': 1, '19324856': 1, '28272234': 1, '18929163': 1, '12036983': 1, '19826393': 1, '20577861': 1, '21526923': 1, '17415704': 1, '26586977': 1, '21845026': 1, '17157590': 1, '17700285': 1, '16854824': 1, '20702430': 1, '20458243': 1, '21878845': 1, '20847676': 1, '16815268': 1, '19074917': 1, '16508438': 1, '19606170': 1, '20148650': 1, '23908579': 2}
|
{'3730075-1': 2, '3730075-3': 2}
|
162,509 |
3730075-3
| 23,908,579 |
noncomm/PMC003xxxxxx/PMC3730075.xml
|
Regression of Iris Neovascularization after Subconjunctival Injection of Bevacizumab
|
A 39-year-old male with type I diabetes, who had been previously diagnosed with bilateral proliferative diabetic retinopathy associated with NVG in his left eye, presented with visual disturbance in the left eye. Ophthalmic examination showed a BCVA of 20 / 25, OD, and 20 / 32, OS. The IOP was 11 mmHg, OD and 38 mmHg, OS despite treatment with both topical DTFC and brimonidine twice a day in the left eye. Slit lamp examination revealed neovascularization of the iris at the pupillary margin and neovascularization of the inferior, nasal, and temporal anterior chamber angle in the left eye (). A subconjunctival injection of bevacizumab (2.5 mg/0.1 mL) was performed in the left eye. In the following days after the injection, a significant regression of the neovascularization was observed in the angle (), and the IOP, OS was decreased to 19 mmHg. The patient was further treated with three sessions of PRP. Three months later, the IOP, OS was maintained at 14 mmHg with no neovascularizations visible in either the iris or angle.
|
[[39.0, 'year']]
|
M
|
{'20689793': 1, '19826387': 1, '19324856': 1, '28272234': 1, '18929163': 1, '12036983': 1, '19826393': 1, '20577861': 1, '21526923': 1, '17415704': 1, '26586977': 1, '21845026': 1, '17157590': 1, '17700285': 1, '16854824': 1, '20702430': 1, '20458243': 1, '21878845': 1, '20847676': 1, '16815268': 1, '19074917': 1, '16508438': 1, '19606170': 1, '20148650': 1, '23908579': 2}
|
{'3730075-1': 2, '3730075-2': 2}
|
162,510 |
3730076-1
| 23,908,580 |
noncomm/PMC003xxxxxx/PMC3730076.xml
|
Bupivacaine Injection to Lateral Rectus in Abducens Nerve Palsy
|
A 49-year-old female presented with esodeviation, which occurred one year after a traffic accident. Snellen visual acuity was 20 / 20 in both eyes. Bilateral abducens nerve palsies were diagnosed on neurological examination. The primary position deviation was 75 prism diopter (PD) esotropia on the alternate cover test (). The extraocular movement of the LR was -1 limitation for the right eye and -4 limitations for the left. No evidence of neurological impairment was present, and magnetic resonance imaging (MRI) of the brain was normal. After performing orbital MRI and discussing its experimental nature with the subject, informed consent was obtained for a BUP injection. A flaccid LR of the left eye was confirmed by exposing the muscle through a swan incision 8 mm from the limbus. Using a 30-gauge needle, 2 mL of BUP (5 mg/mL) was injected into the LR. One month after injection, there was no change in deviation, and a further orbital MRI was performed (). Subsequently, the recession of both medial rectus (6 mm) and resection of the left LR (9 mm) led to orthotropia until 18 months (). At the left LR resection, traction testing demonstrated restriction of the medial gaze compared to before BUP injection. The formerly-injected LR was 'stiff' on surgical observation.
|
[[49.0, 'year']]
|
F
|
{'8994117': 1, '11133843': 1, '20126486': 1, '27218062': 2, '3153651': 1, '19393509': 1, '5492943': 1, '7428022': 1, '8643247': 1, '4134570': 1, '23908580': 2}
|
{'4869415-1': 1}
|
162,511 |
3730077-1
| 23,908,581 |
noncomm/PMC003xxxxxx/PMC3730077.xml
|
Presence of Fusion in Albinism after Strabismus Surgery Augmented with Botulinum Toxin (Type A) Injection
|
Case 1 was an 18-year-old girl with refraction in her right and left eye of +4.0 / -1.5 × 180° and +4.0 / -2.0 × 180°, respectively, and a best-corrected visual acuity (BCVA) of 2 / 10 in both eyes. Examination showed 45Δ exotropia and 8Δ hypotropia in the left eye due to an overactive superior oblique muscle and no fusion. She underwent 8 mm bilateral lateral rectus recession, left superior oblique posterior tenotomy, and intraoperative bilateral 12.5 U BTA (Dysport; Ipsen Laboratories, Porton, UK) injection to these muscles with no complications. Follow-up examinations revealed 8Δ left esotropia at 2 weeks and 1 month, and 6Δ left exotropia at month 4, which remained constant up to 12 months. The patient demonstrated fusion on Bagolini test (). Before surgery, the patient had no perception in the Bagolini test; however, at 4 months after surgery, the patient was able to perceive the major parts of both arms of the X generated by Bagolini lenses, despite small areas of suppression around the fixation light.
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[[18.0, 'year']]
|
F
|
{'7696233': 1, '1925943': 1, '17070473': 1, '9418733': 1, '15629289': 1, '11304818': 1, '16678746': 1, '2635465': 1, '23908581': 2}
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{'3730077-2': 2}
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162,512 |
3730077-2
| 23,908,581 |
noncomm/PMC003xxxxxx/PMC3730077.xml
|
Presence of Fusion in Albinism after Strabismus Surgery Augmented with Botulinum Toxin (Type A) Injection
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Case 2 was a 16-year-old boy with refraction in his right and left eye of +3.5 / -1.75 × 20° and +3.25 / -2.0 × 155° and a BCVA 2 / 10 and 3 / 10, respectively. He had 50Δ left exotropia and no fusion. He underwent 9 mm bilateral lateral rectus recession, augmented with intraoperative bilateral 12.5 U BTA (Dysport) injection, with no complications. On week 2 and month 1 follow-ups, he had 10Δ left esotropia which decreased to 6Δ left exotropia from the 4th month postoperative follow-up onwards; fusion in the Bagolini test was also observed at 4 months after surgery ().
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[[16.0, 'year']]
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M
|
{'7696233': 1, '1925943': 1, '17070473': 1, '9418733': 1, '15629289': 1, '11304818': 1, '16678746': 1, '2635465': 1, '23908581': 2}
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{'3730077-1': 2}
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162,513 |
3730472-1
| 23,919,053 |
noncomm/PMC003xxxxxx/PMC3730472.xml
|
Observance of Kassowitz law-late congenital syphilis: Palatal perforation and saddle nose deformity as presenting features
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A 9 year-old girl, born as the fourth child to non-consanguineous parents, was reported to our department with perforation of palate for routine Venereal Disease Research Laboratory (VDRL) screening from the ENT department. The patient had history of regurgitation of food and change of voice for the past 6 months. There was no history of trauma, loss of weight, skin lesions or fever. Also, there was no history suggestive of sexual abuse. Physical examination revealed saddle nose deformity [] and perforation of hard palate []. The size of perforation was 5-mm in diameter and the edges were regular. Ophthalmic and central nervous system examination were normal. VDRL was reactive in 1:8 dilutions and was later confirmed with Treponema pallidum hemagglutination (TPHA).\nHer parents and siblings (one elder and two younger) were screened for syphilis. Parents were VDRL reactive in 1:4 dilutions, elder sibling (female, 11 years old) was VDRL reactive in 1:8 dilutions and all were confirmed with TPHA. The two younger siblings were VDRL non-reactive. Patient's father gave a history of unprotected, premarital sexual contact, with an unknown female, 14 years back. Three weeks later he developed a genital ulcer for which he was treated and the ulcer healed without any scar. Patient's mother had six deliveries. Her first male baby was delivered 12 years back which died on the same day because of seizures. The second female baby was delivered 2 years later which also died on the 10 th day due to low birth weight. Her third female child (11 years old) is the elder sibling of the patient, who had non-development of upper central incisors []. Her fourth child was the patient. Fifth and sixth children were clinically and serologically normal []. All were home deliveries without any antenatal care.\nRoutine blood investigations, cerebrospinal fluid (CSF) analysis, Mantoux test, chest X-ray, X-ray skull and long bones were normal for the patient. Computed tomography (CT) scan of paranasal sinus (PNS) showed perforation of palate [] with bilateral maxillary and nasal polyps []. Her parents refused for biopsy of polyps. From the above history, clinical examination and investigations, diagnosis of late congenital syphilis with stigmata was made. The patient was treated with injection benzathaine penicillin 50,000 international units/kg body weight, deep intramuscular, once weekly, for 3 weeks, after test dose. The elder sibling and parents were also treated with injection benzathaine penicillin 24 lakh international units, once weekly, for 3 weeks. They were advised to come for regular follow-up.
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[[9.0, 'year']]
|
F
|
{'3284454': 1, '28400651': 1, '26770278': 1, '34433930': 1, '2061433': 1, '23919053': 2}
|
{}
|
162,514 |
3730473-1
| 23,919,054 |
noncomm/PMC003xxxxxx/PMC3730473.xml
|
Pseudoepitheliomatous keratotic and micaceous balanitis with malignant transformation
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A 40-year-old male presented with thick, hard lesions over the penis of 5 years duration, which were progressive in nature and associated with deviation of urinary stream. In some areas, yellowish white scales were seen with free edges. The scales were easily removable after rubbing, however, the scales recurred. He later developed phimosis for which he underwent circumcision. There was no history of sexually transmitted infection and diabetes mellitus. The patient gave history of use of anti-bacterial and keratolytic creams with no improvement.\nExamination revealed thick, non-tender, hard, keratotic yellowish plaques localized on the glans and partially obstructing the external urinary meatus, measuring about 2 cm × 1.5 cm in size with micaceous scaling and fissures at places []. The penile shaft and scrotum were normal. There was no inguinal or femoral lymphadenopathy. General and systemic examination revealed no abnormality.\nBlood counts and blood sugar levels were within normal limits. Tests for HIV antibodies, hepatitis B surface antigen were negative and Venereal Disease Research Laboratory test was non-reactive. Wedge biopsy from the glans revealed features of acanthosis, hyperkeratosis, parakeratosis with cellular atypia and abnormal mitosis suggestive of malignant transformation [].\nA diagnosis of PKMB of Civatte with carcinoma in situ was made and the patient underwent a partial penectomy []. He has been asked to follow-up every month to check for any new growths and lymphadenopathy.
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[[40.0, 'year']]
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M
|
{'7259225': 1, '8659009': 1, '30684817': 1, '10886158': 1, '20885051': 1, '14466728': 1, '591665': 1, '20826996': 1, '26557598': 1, '18549127': 1, '23919054': 2}
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{}
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162,515 |
3730474-1
| 23,919,055 |
noncomm/PMC003xxxxxx/PMC3730474.xml
|
Squamous cell carcinoma of penis with bullous pemphigoid masquerading as lymphogranuloma venereum
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A 60-year-old unmarried male, presented with a history of multiple ulcers over his right groin of 4 months duration. It started as a painless swelling over the right groin, which evolved into multiple ulcers with foul swelling discharge. One month later, he developed a similar swelling in the left groin. There was no history of trauma at the site. Patient denied history of sexual exposure and there was no history of genital ulcer. He does not give history of arthralgia, loss of weight, or loss of appetite. Bowel and bladder habits were normal.\nThe patient also gave history of multiple blisters over the trunk and extremities of 1 month duration. There was no history of oral erosions or drug intake prior to the onset of lesions.\nOn general examination, the patient was moderately built and nourished, there was no pallor, icterus, pedal edema, or generalized lymphadenopathy. His systemic examination was normal.\nExamination of the right inguinal region showed three tender excavating ulcers of sizes 6 × 8, 5 × 7, and 3 × 5 cm, respectively, located adjacent to each other with rolled out, everted edges, and foul smelling purulent, blood-stained discharge. Enlarged, grouped, and matted tender inguinal lymphnodes of sizes 5 × 7 cm were felt below the ulcer. Examination of the left inguinal region also revealed enlarged, grouped, tender inguinal nodes of size 8 × 6 cm present both above and below the inguinal ligament giving the appearance of “Groove sign of Greenblatt” []. External iliac lymph nodes were not palpable.\nGenital examination revealed phimosis. A firm, indurated, non tender mass of size 3 × 2 cm was felt through the prepucial skin on the glans penis, located on the 11’o-clock to 2’ o-clock position. There was no lymph edema of penis. Per-rectal examination was normal.\nMultiple tense bullae filled with clear fluid and erosions were present over upper limbs, lower limbs [], and trunk. A tense bulla was present over the shaft of penis, which eroded later. Nikolsky's sign and bulla spreading sign were negative. There were no oral erosions.\nWith the above clinical findings, a differential diagnosis of lymphogranuloma venereum (LGV) or SCC of penis with regional metastasis associated with bullous pemphigoid (BP) occurring as a para neoplastic phenomenon were considered.\nDark field smear was negative for Treponema pallidum. Tissue smear was negative for Donovan bodies. Gram's stain was negative for gonococci. IgG antibody for Chlamydia trachomatis (serovars L1, L2, L3) was negative. VDRL for syphilis and ELISA for human immunodeficiency virus (HIV) 1 and 2 were nonreactive. Mantoux was also negative. No abnormality was seen in his urine microscopy and pus culture reports. His laboratory investigations revealed anemia. Other blood counts, liver and renal function tests were normal. Tzanck smear taken from the bulla did not show acantholytic cells. His chest x-ray and ultra sound of the abdomen were normal.\nWedge biopsy of the ulcer in the right groin and from the penile growth showed ulcerated hyperplastic epidermis with severe dysplasia. The dysplastic epithelial cells invade the basement membrane forming nests with keratin pearls, consistent with keratinizing SCC of penis []. Skin biopsy taken from a tense bulla over the trunk, showed a sub epidermal bulla with mild lymphocytic infiltrate in the upper dermis consistent with BP.\nHence, a diagnosis of keratinizing SCC of penis with regional lymphnode metastasis and BP was confirmed. Patient was referred for surgical opinion and management.
|
[[60.0, 'year']]
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M
|
{'8874389': 1, '10624920': 1, '14690009': 1, '11410196': 1, '11735040': 1, '23919055': 2}
|
{}
|
162,516 |
3730475-1
| 23,919,056 |
noncomm/PMC003xxxxxx/PMC3730475.xml
|
Perianal pseudoverrucous papules and nodules
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A 14-year-old girl inmate of an orphanage with spina bifida at L3 level presented with complaints of multiple asymptomatic whitish-raised lesions on the inner aspect of thighs and labia majora since infancy. She had incontinence stool and urine excretion since birth. She had a history of using diapers since childhood, due to incontinency. She did not have any rash or constitutional symptoms. The patient was not sexually active. In the past, she had received topical antifungals, corticosteroids, and systemic antibiotics, without any improvement.\nSystemic examination, blood, and biochemical investigations were normal.\nCutaneous examination revealed multiple, flat-topped moist papules, 3-12 mm in size, few verrucous nodules; some of these lesions coalescing to form plaques at the perianal area, extending up to the labia majora [Figures and ]. Enzyme-linked immunosorbent assay (ELISA) for HIV, Venereal Disease Research Laboratory Test, and Treponema pallidum hemagglutination (TPHA) tests were negative/non-reactive. Polymerase chain reaction did not detect human papillomavirus.\nThe histopathological examination of a papule revealed irregular epidermal hyperplasia. There was marked acanthosis with pale keratinocytes in the upper epidermis. A mild lymphocytic infiltrate can be seen in upper dermis [].
|
[[14.0, 'year']]
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F
|
{'11324398': 1, '1739304': 1, '17052539': 1, '21285858': 1, '26392668': 1, '32317831': 1, '15086363': 1, '21938129': 2, '7996365': 1, '29204405': 1, '12224705': 1, '11122029': 1, '23919056': 2}
|
{'3168050-1': 1}
|
162,517 |
3730476-1
| 23,919,057 |
noncomm/PMC003xxxxxx/PMC3730476.xml
|
Late onset Warfarin induced skin necrosis in human immunodeficiency virus infected patient with pulmonary tuberculosis
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A 29-year-old female patient, referred from general medicine department was presented with asymptomatic purplish and black colored skin lesions over the face (around lips) and extremities since past 15 days. Patient was a known and treated case of pulmonary tuberculosis and had taken complete anti-tubercular treatment 2 years back. Three months back, before the development of skin lesions, patient came to our hospital with complains of continuous cough and heaviness in chest. 2 D echo was carried out, which showed blocking in left pulmonary artery due to thrombus with right ventricular enlargement. Patient was put-on oral Warfarin 2.5 mg once daily to dissolve the thrombus. At that time her sputum was negative for acid fast bacilli (AFB). Two and half months later the patient came back with worsening of her chest complaints and on investigation she was found to have reactivation of pulmonary tuberculosis (sputum positive for AFB). She also had the above mentioned skin lesions for which she was referred to skin out patient department (OPD). General examination revealed her poor general condition with multiple purple to black ecchymotic patches around mouth, upper, and lower extremities [Figures and ]. Skin over right knee revealed black eschar surrounded by ecchymotic patch and erythema []. She also had resolving grouped vesicular lesions involving right L3, 4 dermatome, and clinically, suggestive of Herpes zoster. Routine investigations were within normal limits. Prothrombin time international normalized ratio (PTINR) of patient was carried out, which initially was not recordable as it was very high. We advised enzyme linked immune sorbent assay (ELISA) for human immunodeficiency virus (HIV) antibodies taking in to consideration her reactivation of pulmonary tuberculosis, drug reaction, and herpes zoster. ELISA for HIV antibodies was reactive. Then the patient was admitted in medicine ward. Oral Warfarin was stopped and she was given two units of FFP on two alternate days. After giving one FFP, PTINR came down to 4 min, however, the patient died on the 4th day of admission.
|
[[29.0, 'year']]
|
F
|
{'12581084': 1, '7910706': 1, '33395867': 1, '5653634': 1, '11000083': 1, '10398319': 1, '9495376': 1, '1532830': 1, '20529438': 1, '12121399': 1, '6329108': 1, '7741443': 1, '29849320': 2, '29201953': 2, '7841299': 1, '10718793': 1, '14979401': 1, '23919057': 2}
|
{'5965214-1': 1, '5703748-1': 1}
|
162,518 |
3730478-1
| 23,919,058 |
noncomm/PMC003xxxxxx/PMC3730478.xml
|
Congenital syphilis, still a reality
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A three month old female child weighing 2 kg normally delivered at term presented with lesions all over the body with oro-genital erosions since 1½ month.\nOn examination, there were severe desquamating erythematous papulosquamous lesions over face, upper extremities, trunk, buttocks and legs. Multiple superficial erosions were present on palm, soles, genitals, buttocks and natal cleft [Figures –]. Moist erosive lesion with bleeding and crusting were present around oral cavity and nostrils. She had high arched palate without perforation which enables her to suck properly []. Syphilitic snuffles and rhagades were present. Epitrochlear and inguinal lymph nodes were enlarged and rubbery in consistency. Patient had moderate hepatosplenomegaly without cardiac, bone or joint involvement. X-ray of skull and long bones showed no abnormality. Ophthalmic examination including fundoscopy was normal.\nOn history, it was found that the baby was delivered at home and the mother had not taken any antenatal visits. Mother had a history of lesion over the genital area twice in the past i.e., two years and six month prior to the birth of the patient for which she has taken some treatment from local doctor. The records of the above-mentioned condition or any treatment taken were not available. She is second gravida with h/o of single second trimester abortion during last pregnancy. Father of the baby did not have any history of any sexually transmitted diseases (STDs) but had an h/o unprotected premarital exposure. Her parents had no overt signs of syphilis. Venereal disease research laboratory (VDRL) with dilution of patient was 1:512 while that of parents were 1:64. Parents as well as baby were non-reactive for HIV. Presumptive diagnosis of congenital syphilis was made based on four fold raise in patient titre. Parents were given benzathine penicillin G 2.4 MU, i.m. in single dose and patient was treated successfully with 1.5 lakh U/day i.m. Procaine penicillin G for 10 days.
|
[[3.0, 'month']]
|
F
|
{'26396451': 2, '2511408': 1, '12127355': 1, '21799574': 2, '17877837': 2, '23919058': 2}
|
{'4553844-1': 1, '2034583-1': 1, '3139286-1': 1}
|
162,519 |
3730510-1
| 23,619,488 |
noncomm/PMC003xxxxxx/PMC3730510.xml
|
Progressive atrophy of retinal pigment epithelium after trypan-blue-assisted ILM peeling for macular hole surgery
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A 68-year-old phakic Caucasian female presented with decreased central vision in the left eye for the past 18 months secondary to a large macular hole. She denied any prior history of trauma, high myopia, or any other ocular problems. Her presenting visual acuity was 20/200. A full-thickness stage-3 macular hole measuring 680μ in diameter on color photographs (OIS WinStation™ software, Ophthalmic Imaging Systems, Sacramento, CA) was diagnosed. []. An intravenous fluorescein angiogram showed mild hyperfluorescence at the base [], but no obvious atrophy of the retinal pigment epithelium was observed on clinical photographs. The right eye was 20/20, with normal appearing macula. A 20-g pars plana vitrectomy was performed using Accurus machine (Alcon, Fort Worth, TX) under local anesthesia. Halogen illumination at 100% intensity built into the Accurus was used for endoillumination. Posterior vitreous detachment was created by suction with the cutter nasal to the nerve and was confirmed by a visible Weiss ring in the vitreous cavity. After completion of vitrectomy, fluid air exchange was performed and 0.2 ml 0.06% TB (VisionBlue™, DORC Netherlands) was injected over the macular area. The sclerotomy sites were plugged and the microscope light was turned off during the staining period. After waiting for 2 min, air fluid exchange was performed. Process was repeated and TB was left for another 2 min because of poor staining of the ILM. Microforceps were used to remove the ILM completely for about 2 disk diameters around the hole. No subretinal TB was observed beyond the macular hole. Endoilluminator was kept as far away from the macular hole as possible during the ILM peel. Fluid air exchange was performed with a silicone-tipped cannula. Air pressure was set at 35 mm Hg during all fluid air exchanges. No attempt was made to drain through or near the macular hole at any time. Fourteen percent C3F8–air mixture was used for tamponade followed by face-down position for 2 weeks.\nA ring-shaped area of hypopigmentation corresponding to the edge of the macular hole was noted one month after surgery []. Seven months after surgery, atrophy of the RPE involved the entire base and edge of the macular hole []. Spectral domain optical coherence tomography (OCT) showed closed macular hole, defect in inner segment/outer segment junction, and increased transmission of light consistent with RPE atrophy []. Two years after surgery, area of RPE atrophy had increased in intensity and also showed slight enlargement in size to 790μ in diameter [], and spectral domain OCT demonstrated closed macular hole, defect in IS/OS junction, further attenuation of outer retinal layers, and increased transmission of light []. Her visual acuity was 20/200 3 months after surgery, but declined to counting fingers 2 years postoperatively with no improvement with refraction. She developed moderate nuclear sclerosis, which was not believed to be responsible for such a profound loss of vision. The right eye has remained 20/20 without any RPE atrophy, or changes of age-related macular degeneration. She denied history of chloroquine or hydroxychloroquine intake.
|
[[68.0, 'year']]
|
F
|
{'15548818': 1, '28050275': 1, '31061725': 1, '27536056': 1, '19174722': 1, '18398579': 1, '33888976': 1, '20150921': 1, '9307639': 1, '9591960': 1, '14644726': 1, '21713242': 1, '29850211': 1, '17292475': 1, '15834606': 1, '23619488': 2}
|
{}
|
162,520 |
3730512-1
| 23,571,266 |
noncomm/PMC003xxxxxx/PMC3730512.xml
|
Peripapillary retinal thermal coagulation following electrical injury
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A 20 year old boy presented to our department with decreased vision, redness and watering of both eyes following electrocution with overhead transmission wires six days ago. The electricity transmission wires were carrying a high voltage of approximately 20,000V. He had multiple eschars on the back, scalp and arms along with facial erythema []. His best-corrected visual acuity was light perception in the right eye and counting fingers in the left eye with normal intraocular pressures. There was a lid scaling and charring of the eyelashes. Anterior segment examination showed bilateral circumcorneal congestion, sluggish pupillary reactions, superficial punctate keratitis and cataract in the left eye. Fundoscopy revealed an area of peripapillary retinal opacification and a dull foveal reflex in both eyes [Figs. and ]. Fundus fluorescein angiogram showed a normal retinal circulation with late hyperfluorescence corresponding to the area of opacification. Optical coherence tomography (OCT) showed retinal thickening with few cystoid spaces in the right eye []. Similar changes were seen the left eye (not shown). Patient was started on oral corticosteroids (prednisolone 30 mg/day) and acetazolamide (750 mg/day in three divided doses). Steroids were given to control inflammation arising from the injury, if any, and oral carbonic anhydrase inhibitor were added to reduce cystic fluid collection by possible stimulation of the retinal pigment epithelium (RPE) pump.[] Acetazolamide was withdrawn after 1 month and oral steroids were discontinued after another month by gradual tapering. One month later, his best corrected visual acuity was counting fingers 1 meter in the both eyes with posterior subcapsular cataract and peripapillary retinal atrophy in both the eyes []. OCT of both the eyes showed retinal atrophy with disorganization of all retinal layers and the RPE []. Patient underwent cataract surgery after 6 months from the time of injury in both the eyes with no improvement in the visual acuity.
|
[[20.0, 'year']]
|
M
|
{'3692693': 1, '12394552': 1, '8848650': 1, '27994817': 1, '1752881': 1, '29133672': 2, '7085214': 1, '25390173': 1, '23571266': 2}
|
{'5700614-1': 1}
|
162,521 |
3731466-1
| 23,756,996 |
noncomm/PMC003xxxxxx/PMC3731466.xml
|
Parenteral ferumoxytol interaction with magnetic resonance imaging: a case report, review of the literature and advisory warning
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A 54-year-old male patient with nonalcoholic steatohepatitis (NASH) cirrhosis presented for surveillance with magnetic resonance imaging (MRI) of the liver to screen for hepatocellular carcinoma in the setting of a routine pre-transplant workup. The patient had iron deficiency anaemia and received parenteral ferumoxytol (second intravenous dose of 510 mg) 3 days prior to the MRI examination. MRI was performed using our institution’s standard high-risk liver protocol on a 3.0-T MRI scanner (Discovery 750w, General Electric Medical Systems, Milwaukee, WI). Pulse sequences included: axial and coronal T2-weighted single-shot fast spin echo (ssFSE), axial T2-weighted fast recovery fast spin echo (FRFSE), axial 3D in- and out-of-phase gradient recalled echo (GRE), B50 and B500 diffusion-weighted imaging with an apparent diffusion coefficient map, and pre- and dynamic post-contrast fat-suppressed 3D T1-weighted GRE sequences (LAVA), including arterial, portal venous and equilibrium phases. Gadobutrol (Gadovist, Bayer Inc., Toronto, ON) was administered to obtain the post-contrast imaging. The MRI study showed interval changes from the baseline examination performed 15 months prior. In the interval there was a marked reduction in signal intensity of the liver and spleen on T2 ssFSE sequences suggesting iron overload, which had not been present on the previous examination (Fig. ). Portahepatic lymph nodes also demonstrated low T2 signal intensity (Fig. ). Imaging findings of iron deposition in the bone marrow were revealed on T1 in-phase GRE imaging and also had not been present on the previous examination (Fig. ). Routine pre-contrast T1 GRE images demonstrated increased signal intensity in the blood pool and abdominal organs, which masked normal enhancement after gadolinium was administered (Fig. ). The constellation of findings was based on T1 and T2 shortening effects from ferumoxytol, which rendered the study non-diagnostic. The patient also had recently undergone unenhanced MRI of the brain to evaluate the progressive cognitive decline 1 day before the abdominal MRI, which demonstrated diffuse low signal intensity along the surface of the brain on T2* GRE images, findings also related to ferumoxytol administration that mimic superficial siderosis (Fig. ). The patient provided informed consent for publication.
|
[[54.0, 'year']]
|
M
|
{'26061331': 1, '29342861': 1, '33912328': 1, '23070094': 1, '22696123': 1, '27757917': 1, '25427433': 1, '32036485': 1, '31448157': 2, '22258974': 1, '33198376': 1, '25846288': 1, '18843256': 1, '20201089': 1, '26501808': 1, '28275562': 1, '23756996': 2}
|
{'6702869-1': 1}
|
162,522 |
3731623-1
| 23,914,203 |
noncomm/PMC003xxxxxx/PMC3731623.xml
|
Acute Kidney Injury due to Crescentic Glomerulonephritis in a Patient with Polycystic Kidney Disease
|
A 43-year-old man presented to the emergency department complaining of lower extremity edema for 2 weeks. The patient denied any pertinent past medical or family medical history; though he took metoprolol and hydrochlorthiazide for about 1 month a year earlier, he was not taking either of these agents at the time of presentation. He denied use of nonsteroidal anti-inflammatory agents and recreational drugs (including cocaine, heroin and phencyclidine). Initial physical examination was significant for elevated blood pressure (151/94 mm Hg) and pitting edema in both lower extremities. Initial laboratory analysis at presentation (table ) revealed renal failure (serum creatinine 2.6 mg/dl) and anemia (hemoglobin 10.8 g/dl, hematocrit 33.4% and mean corpuscular volume 85.4 fl). Urinalysis (random urine; table ) showed proteinuria, small blood and pyuria without bacteria. Proteinuria was confirmed on 24-hour urine collection that demonstrated nephrotic-range protein (25 g/24 h). Kidney ultrasound revealed enlarged kidneys bilaterally with multiple cysts and this was confirmed by computed tomography (CT) scanning (fig. ). A complete serologic evaluation, including hepatitis screen, was performed and was unrevealing (table ).\nInitially, the patient was empirically treated with intravenous steroid pulse (methylprednisolone, 1 g daily for 3 days) and then switched to prednisone orally (1 mg per kilogram daily). A CT-guided kidney biopsy was performed and revealed immune complex glomerulonephritis with features of membranous nephropathy with crescent formation (fig. ). Despite treatment with oral prednisone (1 mg/kg), the patient's renal function declined and he became oliguric. Intermittent hemodialysis was initiated. In addition to oral steroid, treatment with mycophenolate (500 mg twice daily; escalated to 1,500 mg twice daily over 2 weeks) was started. Over a 5-month period, urine output increased in association with improvement in kidney function. Concurrently, serum albumin recovered to normal values and proteinuria decreased from 25 to 3 g daily. Because of persistent nephrotic-range proteinuria, cyclosporine 75 mg twice daily was added to his medication regimen. Over the ensuing 3 months, the patient manifested further improvement in physiologic parameters. Accordingly, prednisone dosage was reduced (10 mg orally per day) and mycophenolate mofetil (MMF) was maintained at 1,500 mg orally twice daily and cyclosporine at 75 mg orally twice daily. Hemodialysis was subsequently discontinued and the patient has been off dialysis with stable chronic kidney disease stage 3 (creatinine clearance 45 ml/min by 24-hour urine studies). He continues to be monitored closely in an outpatient setting for any changes in renal function. Immunosuppressive agents are being tapered.
|
[[43.0, 'year']]
|
M
|
{'8589309': 1, '1528329': 1, '19342421': 1, '20429898': 2, '12191984': 1, '7206178': 1, '22218124': 1, '16791401': 1, '3218662': 1, '11286938': 1, '18776127': 1, '14872199': 1, '21552769': 1, '17429047': 1, '23914203': 2}
|
{'2873454-1': 1}
|
162,523 |
3731624-1
| 23,914,204 |
noncomm/PMC003xxxxxx/PMC3731624.xml
|
Intussusception Presenting with Malignant Hypertension and Lethargy
|
A 10-month-old boy with a body weight of 9.6 kg presented with progressive lethargy. His past medical history was unremarkable. He had suffered from gastritis 2 weeks before and started vomiting again 2 days before admission. The patient had no fever, excessive sweating or diarrhea, and his urine output was normal. Physical examination revealed a sleepy but easily arousable infant with a heart rate of 160 per minute, a respiration rate of 32 per minute and a body temperature of 37.7°C. On all four extremities, a blood pressure of 135/95 mm Hg was measured, a value above the 99th percentile (P) by age and height (e.g. P 95th is 103/56 mm Hg). There were no signs of meningitis or intracranial hypertension, no abnormalities in sensibility and strength, and reflexes were normal. Cardiopulmonary examination revealed no heart murmurs, and breath sounds were normal. The abdomen was not painful to palpation and there were no masses. No edema was found, and the skin was unremarkable. Based on the combination of hypertensive crisis and the neurological findings, the diagnosis of malignant hypertension was made and the patient was admitted to our pediatric intensive care unit for evaluation and intravenous antihypertensive therapy [, , ]. Nicardipine at 1 mcg/kg/min lowered his blood pressure to an acceptable level of 105/55 mm Hg (P 95th) within a few hours.\nLaboratory results showed a normal complete blood cell count, serum electrolytes (Na 137 mmol/l, K 4.1 mmol/l, Cl 104 mmol/l), creatinine 13 µmol/l, urea 3.6 mmol/l and glucose 5.6 mmol/l. Glomerular filtration rate was 118 ml/min, and blood lactate as well as ammonia levels were normal. An arterial blood gas analysis revealed a mild meta-bolic acidosis with respiratory compensation (pH 7.40, bicarbonate 17.7 mmol/l, pCO2 29 mm Hg).\nA computed tomography of the brain revealed no intracranial bleeding, no tumor and no signs of elevated intracranial pressure. An abdominal ultrasound showed normal kidneys without hydronephrosis, and Doppler studies were unremarkable. On the ultrasound, an abdominal mass with the characteristic ‘target sign’ of an ileocecal intussusception was visualized in the right lower quadrant (fig. ). Radiographically guided hydrostatic reduction with water-soluble contrast failed. Laparotomy was performed, which confirmed the diagnosis of intussusception. After repositioning, intestinal perfusion was adequate and bowel resection was not necessary. The anesthetics used during the surgery had no major influence on the blood pressure. Following surgery, the mental status returned to normal and antihypertensive medication could be discontinued. His blood pressure decreased to a normal level (P 50th 90/40 mm Hg).
|
[[10.0, 'month']]
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M
|
{'10701072': 1, '22512486': 1, '3829565': 1, '15286277': 1, '8488138': 1, '3068637': 1, '21415671': 1, '10342593': 1, '19673722': 1, '10394455': 1, '17848241': 1, '23914204': 2}
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{}
|
162,524 |
3731861-1
| 23,922,614 |
noncomm/PMC003xxxxxx/PMC3731861.xml
|
Pneumothorax, music and balloons: A case series
|
A 16-years-old man presented to our emergency department (ED) with a sudden onset of severe right sided chest pain while playing musical instrument. The pain was sharp and pleuritic in nature and there was no associated shortness of breath. As part of his studies, he has been playing trumpet. This activity results is generation of very high mouth pressures and possibly increased intra-thoracic pressure. He had never smoked and denied the use of illicit drugs and was not on any regular medications.\nOn physical examination, he was haemodynamically stable with oxygen saturations of 99% breathing room air with a respiratory rate of 16 per minute. The systemic examination including cardio-respiratory system was unremarkable. A chest radiograph showed a small right apical pneumothorax []. After a period of observation for few hours, he was discharged to have a follow up with the respiratory team. The pneumothorax resolved on follow up chest radiograph taken a week later.
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[[16.0, 'year']]
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M
|
{'2376165': 1, '10899243': 1, '20696690': 1, '8252960': 1, '26010886': 1, '3678419': 1, '8432133': 1, '7398388': 1, '18414772': 1, '15282396': 1, '19770136': 1, '22343477': 1, '23922614': 2}
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{'3731861-2': 2}
|
162,525 |
3731861-2
| 23,922,614 |
noncomm/PMC003xxxxxx/PMC3731861.xml
|
Pneumothorax, music and balloons: A case series
|
A 26-years-old painter and decorator presented with acute onset of severe right side chest pain and dyspnoea shortly after he blew 26 birthday balloons. He was a smoker with 11-pack-year history of smoking. He had no other significant past medical history and was not on any regular medications.\nOn examination, he had oxygen saturations of 97% while breathing room air and was haemodynamically stable. Respiratory system examination revealed decreased air entry on the right side. His chest radiograph showed a moderate right pneumothorax []. It was treated with simple needle aspiration with full expansion of the affected lung. However, he re-presented to ED with worsening dyspnoea on the next day and chest radiograph suggested a recurrence of pneumothorax. Hence an inter-costal chest drain was inserted and he was admitted to the respiratory ward. There was no resolution of his pneumothorax with a persistent air leak for the next 10 days. Therefore, a thoracic surgical intervention with video-assisted thoracoscopic surgery (VATs) was undertaken with a successful right apical bullectomy and pleurectomy.
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[[26.0, 'year']]
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M
|
{'2376165': 1, '10899243': 1, '20696690': 1, '8252960': 1, '26010886': 1, '3678419': 1, '8432133': 1, '7398388': 1, '18414772': 1, '15282396': 1, '19770136': 1, '22343477': 1, '23922614': 2}
|
{'3731861-1': 2}
|
162,526 |
3731862-1
| 23,922,615 |
noncomm/PMC003xxxxxx/PMC3731862.xml
|
Gastrobronchial fistula a rare complication post laparoscopic sleeve gastrectomy
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A 30-year-old male patient with morbid obesity underwent a laparoscopic sleeve gastrectomy in another hospital. During the post-operative course, the patient experienced abdominal pain and vomiting. An upper gastrointestinal contrast study was performed, which showed gastric leak and left subphrenic collection. The patient underwent percutaneous drainage of the left subphrenic collection, and was discharged home after improvement with oral antibiotic.\nAbout 4 months later, the patient was referred to our hospital. He had persistent cough with yellowish sputum, which aggravated with drinking, and on and off fever for 3 weeks. Physical examination was unremarkable. Chest radiograph was performed and showed elevated left hemidiaphragm with basal atelectasis otherwise unremarkable. An upper gastrointestinal contrast study was performed, which showed gastric leak, subphrenic collection, and gastrobronchial fistula [ and ].\nThe patient was managed conservatively with wide-spectrum antibiotic, CT-guided percutaneous drainage of the left subphrenic collection, endoscopic covered stent of gastric fistula and nasojejunostomy feeding. The patient was discharged home after clinical improvement, with a surgical outpatient clinic appointment.
|
[[30.0, 'year']]
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M
|
{'26224373': 1, '26464245': 1, '32257500': 2, '21643779': 1, '17982541': 1, '33815858': 2, '27449763': 1, '25948284': 1, '30617249': 1, '33517211': 1, '25276245': 2, '18696169': 1, '32518645': 2, '22977059': 1, '17669975': 1, '23922615': 2}
|
{'7272498-1': 1, '7102410-1': 1, '4166073-1': 1, '7990559-1': 1}
|
162,527 |
3731872-1
| 23,923,115 |
noncomm/PMC003xxxxxx/PMC3731872.xml
|
Ligation is Not Enough to Secure the Aortic End of the Anomalous Systemic Artery
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A 23-year-old non-smoking man was referred to our hospital because of recurrent hemoptysis that he began experiencing 2 years ago without any particular cause. Computed tomography (CT) scan revealed a few asymmetrical dilated vessels in the left lower lobe and the CT angiogram demonstrated an enlarged tortuous artery arising from the descending aorta and perfusing the left basal segments. He underwent a video-assisted thoracoscopy assisted operation to eliminate the symptoms. After dissection, the anomalous vessel was doubly ligated with No. 1 silk suture at the proximal end. A transfixation suture ligation was made between the two ligatures before division and then, the left lower lobe was removed. After the operation, the patient was transferred to intensive care unit ward. Two hours later, the massive blood, suddenly drained out (about 3000 ml) from the chest tube and the blood pressure dropped sharply to zero within several minutes. Emergency operation was performed promptly, revealing the ruptured aortic stump of the divided aberrant vessel. Although repair was accomplished with a continuous No. 4-0 Prolene suture, the patient died from the shock and the cardiac arrest unfortunately.
|
[[23.0, 'year']]
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M
|
{'11105720': 1, '11584238': 1, '20094717': 1, '20418461': 1, '10475391': 1, '16515937': 1, '23641375': 1, '19766847': 1, '11828210': 1, '23923115': 2}
|
{'3731872-2': 2}
|
162,528 |
3731872-2
| 23,923,115 |
noncomm/PMC003xxxxxx/PMC3731872.xml
|
Ligation is Not Enough to Secure the Aortic End of the Anomalous Systemic Artery
|
An 18-year-old nonsmoking man was referred to our hospital because of two episodes of hemoptysis within 1 month. The CT angiogram also confirmed an aberrant vessel rising from the descending aorta above the diaphragm, irrigating the left lower lobe []. Intraoperative exploration findings mimicked that was seen in case 1 [] and the same surgical method was performed: Aberrant artery division plus left lower lobectomy; however, with more cautions to the vessel handling. A 3-0 Prolene purse-string suture was placed on the aorta wall where anomalous vessel arose. Systolic arterial blood pressure (SBP) was set to 80 mmHg temporarily with intravenous nitroglycerin. Then, the vessel was divided, the proximal end was oversewn with 3-0 Prolene and the purse-string tied up. In the first post-operative 24 h, sedative was given to keep the patient calm and the SBP was kept within 90-110 mmHg. The patient's post-operative recovery was uneventful, and he was discharged on the 6th post-operative day. The patient has been followed uneventfully for 7 months and the complaints of hemoptysis and general fatigue disappeared.\nAnomalous systemic arterial (ASA) supply to apparently normal lung without sequestration is the rarest form of congenital abnormality of the pulmonary blood supply.[] The basal segments of the left lower lobe are more frequently involved and the most common pattern of anomalous systemic artery to the lung arises from the descending thoracic aorta.[] CT of the thorax is the most useful test in evaluation of suspected cases as it consistently demonstrates the key characteristics of ASA, both a normal bronchus branching pattern and the aberrant system-originating arteries to the lungs.[] Conventional aortography is usually unnecessary for proper diagnosis of this anomaly.[]\nAlthough transcatheter embolization of the aberrant vessel is an optional treatment, surgery remains the best for ASA patients.[] Post-operative massive hemorrhage from the aorta is devastating; however, scant archive underlined the importance of vessel handling techniques[] and perioperative managements. The aberrant arteries in this disease are distinct from bronchial arteries, histologically having an elastic-type (so-called pulmonary type) arterial wall.[] However, the pressure imposed on the misplaced “pulmonary artery” is much higher than pulmonary pressure. In the first case, even triple ligation could not prevent the accidental vessel stump laceration. In case 2, we ligated, divided the vessel under controlled hypotension and purse-sutured the stump carefully and furthermore post-operative sedation and the blood pressure control was warranted. That might be the key points for the patient's uneventful recovery.
|
[[18.0, 'year']]
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M
|
{'11105720': 1, '11584238': 1, '20094717': 1, '20418461': 1, '10475391': 1, '16515937': 1, '23641375': 1, '19766847': 1, '11828210': 1, '23923115': 2}
|
{'3731872-1': 2}
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162,529 |
3731971-1
| 23,946,747 |
noncomm/PMC003xxxxxx/PMC3731971.xml
|
The silent sinus syndrome
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Cone beam computed tomography was obtained from a 60-year-old female in order to assess implant insertion sites. In clinical examination, a mild facial asymmetry was detected and deviation of nasal septum to the left was apparent [Figures and ]. In regard to medical history, the patient was completely asymptomatic, with normal visual acuity, unaffected extraocular movements, no diplopia, and no obvious rhinitis. The patient reported recurrent and frequent sinusitis along with the difficulty in breathing during the last 5 years. Nasal septum deviation was diagnosed by an otolaryngologist as the main cause of the respiratory problem of the patient. The patient had no facial trauma, systemic infection, cranial malformation, or tumor. Computed tomography performed in the axial, sagittal, and coronal planes revealed a hypoplastic opacified left maxillary sinus with thinning and depression of the orbital floor and posterolateral sinus wall. The uncinate process appeared lateralized and adherent to the lamina papyracea, blocking the osteomeatal complex drainage [Figures –].
|
[[60.0, 'year']]
|
F
|
{'9041814': 1, '14143777': 1, '10631402': 1, '16754216': 1, '8849797': 1, '15909469': 1, '16219851': 1, '15161557': 1, '20096597': 1, '15019412': 1, '10604677': 1, '11804926': 1, '18260025': 1, '10969465': 1, '9439386': 1, '18082081': 1, '12689908': 1, '11001196': 1, '23946747': 2}
|
{}
|
162,530 |
3731972-1
| 23,946,748 |
noncomm/PMC003xxxxxx/PMC3731972.xml
|
Laterally positioned flap-revised technique along with platelet rich fibrin in the management of Miller class II gingival recession
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A 36-year-old male patient came to Department of Periodontia, Government Dental College and Hospital, Patiala with chief complaint of receding gums and sensitivity of lower teeth. On clinical examination a Miller class-II recession defect was present in 41 on buccal aspect along with shallow vestibule. There was clinical attachment loss of 7 mm. The distance between the cemento-enamel junction and gingival margin was 5 mm and the distance between the gingival margin and the base of the pocket was 2 mm. Base of the pocket was extending above the mucogingival junction [].\nA two stage treatment modality was contemplated. In the first stage, to increase the vestibular depth a vestibular extension (Fenestration technique)[] was planned. In the second stage, laterally positioned flap-revised technique[] along with PRF membrane was speculated to cover gingival recession.\nA general assessment of patient was made through history and routine laboratory investigations. The surgical procedure was explained to the patient and the informed consent obtained. Preparation of the patient included scaling and root planing and oral hygiene instructions. Modified Stillman's brushing technique was prescribed to the patient.\nParameters were assessed with UNC-15 periodontal probe. Following parameters were assessed at baseline and 6 months after the surgical procedure.\nClinical recession depth (RD) - distance between cemento-enamel junctions to the most apical point of gingival margin.\nPocket depth (PD) - distance between the gingival margin and the bottom of the gingival sulcus.\nClinical attachment level (CAL) - measured from the cemento enamel junction to the bottom of the pocket.\nStep 1: Vestibular extension procedure. After proper isolation of the surgical field, the operative sites were anesthetized using 2% xylocaine hydrochloride with adrenaline (1:200000). A horizontal incision was made using a #15 blade at the mucogingival junction retaining all of the attached gingiva. Flap was reflected sharply, dissecting muscle fibers. A rectangular periosteal strip measuring 2-3 mm width was then bluntly dissected at the level of mucogingival junction along the length of operative field, causing a periosteal fenestration []. Periodontal dressing (Coe pak) was placed over the wound. Post-operative instructions were given to the patient. Periodontal dressing was removed after 7 days. Patient was re-evaluated after 3 months [].\nStep 2: After 3 months, laterally positioned pedicle flap-revised technique along with PRF was done. After proper isolation of the surgical field, the operative sites were anesthetized using 2% xylocaine hydrochloride with adrenaline (1:200000). A collar of tissue was removed around the recession by two vertical incisions, which joined at one point apical to the base of the recession []. Then the donor site (right canine) was prepared by giving a vertical incision extending from gingival margin to the oral mucosa up to the level of the base of central incisor with a #15 blade. After that, thorough scaling and root planning was performed. The sliding flap detached as follows: First, the one-half of the flap away from the recession was reflected as a split thickness flap by giving sharp dissection using #15 blade, and then one half of the flap close to the recession was reflected as full thickness flap by giving blunt dissection using periosteal elevator [Figures and ]. The entire flap was finally released by performing an undermining incision through the periosteum at its apical base.\nThe 5 ml of blood was drawn in 10 ml test tube without an anticoagulant and centrifuged immediately. Blood was centrifuged in single step using a Bench top centrifuge (REMY Laboratories, Goregaon, Mumbai, India) for 10 min at 3000 rpm.[] The resultant product consisted of the following three layers: Top layer consisting of acellular platelet poor plasma, PRF clot in the middle, RBC's at the bottom []. The PRF membrane was obtained by squeezing out the fluids from the fibrin clot.[] The PRF membrane was placed over the denuded roots and stabilized []. The flap was then slided to completely cover the membrane and secured using sling sutures []. Periodontal dressing (Coe-pak) was used over the surgical site.\nAmoxicillin 500 mg thrice a day was prescribed for 5 days. Ibuprofen 400 mg thrice daily and vitamin-B complex, 1 capsule daily were also prescribed for 5 days. Patient was recommended to follow all the normal oral post-operative hygiene instructions. Patient should rinse the oral cavity with 0.12% chlorhexidine digluconate mouth rinse for two weeks. Patient was advised to avoid pulling on their lips to observe the surgical site. Both dressings and sutures were removed 12 days after surgery []. Post-operative follow-up was done for 6 months []. In this case, there was no post-operative complication and healing was satisfactory. The patients did not have any post-operative morbidity.
|
[[36.0, 'year']]
|
M
|
{'6954145': 1, '3288513': 1, '5270591': 1, '33802261': 1, '27783851': 1, '20376243': 1, '19186964': 1, '16504861': 1, '16504851': 1, '18245923': 1, '1625148': 1, '23946748': 2}
|
{}
|
162,531 |
3731973-1
| 23,946,749 |
noncomm/PMC003xxxxxx/PMC3731973.xml
|
Adenoid cystic carcinoma of palate: A case report and review of literature
|
A 60-year-old male patient reported to the Department of Oral and Maxillofacial Surgery with a chief complaint of pain and discharge in the upper left back region of the jaw since one and half years. According to the patient one year prior to our consultation, he got the maxillary molars extracted from a local dentist due to pain and mobility of the teeth in that area. Upon consultation patient revealed that the pain continued to exist even after the extraction.\nThe extra oral examination was within normal limits with no evidence of lymphadenopathy. The patient is a known hypertensive and is on medication since three years for the same. The patient had smoking habit, which he quit only a couple of years ago. Intraoral examination revealed a solitary erythematous swelling with diffuse borders involving the left posterior portion of hard palate and was also seen involving the soft palate on the same side. The swelling was seen extending from mesial aspect of first premolar to 1 cm posterior to tuberosity on left side, involving the palatal area but not crossing the midline []. An oro-antral communication was seen with purulent discharge. The remainder of the intraoral examination was within normal limits.\nThe swelling was nontender. The inspectory findings were confirmed on palpation. CT scan revealed complete obliteration of the left maxillary sinus []. The clinical differential diagnosis included a benign or malignant neoplasm of minor salivary glands, a neoplasm of maxillary sinus.\nAn incisional biopsy of palate and sinus lining was performed. Histopathological examination revealed fibrous stroma with areas of hyalinization. Islands of uniform cells arranged in cord-like pattern with hyperchromatic nuclei were seen enclosing round to oval pseudocystic spaces in the stroma. Few of these spaces showed eosinophilic coagulum []. The tumor cells are also seen arranged in the form of solid islands [] and ductal pattern []. The present case showed all the three histological types. There was no evidence of perineural invasion even on serial sectioning. Focal areas showed small cords and longitudinal tubules of isomorphic cells set in a background of densely hyalinized stroma [].\nA diagnosis of ADCC (cribriform pattern) was established. The patient was treated by wide surgical excision with clear margins and hemi-maxillectomy of left maxillary region with post-radiotherapy. The present case was staged as T4N0M0 based on American Joint Committee on cancer as a guide to prognosis. The patient was under regular follow-up and is free of the disease at one-year follow-up.
|
[[60.0, 'year']]
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M
|
{'6284339': 1, '31341457': 2, '12558867': 1, '186176': 1, '16043380': 1, '3002581': 1, '31523610': 1, '29093739': 2, '14690656': 1, '27408467': 1, '3002583': 1, '8018324': 1, '15529180': 1, '29491609': 2, '10458827': 1, '6088017': 1, '2982066': 1, '225961': 1, '17391298': 1, '199680': 1, '27226925': 1, '23946749': 2}
|
{'5824521-1': 1, '5637853-1': 1, '6619461-1': 1}
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162,532 |
3731974-1
| 23,946,750 |
noncomm/PMC003xxxxxx/PMC3731974.xml
|
Aggressive adenomatoid odontogenic tumor of mandible showing root resorption: A histological case report
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A 17-year-old-male patient reported to the Department of Dental Sciences with a gross asymmetry over the right anterior region of the mandible. The patient gave a history of loosening of teeth since 1 year. Intra-oral examination revealed a bony hard swelling in the right mandibular region extending from central incisor to first molar []. Right mandibular lateral incisor, canine, first premolar, and second premolar were mobile and gave no response on electrical pulp testing. On palpation the swelling was non-tender, irregular in shape, and measuring 2 cm × 3 cm. Orthopantomogram showed a large well-circumscribed radiolucency extending from right mandibular central incisor to the mesial root of first molar []. Due to the expansive growth there was deviation of the roots of right mandibular canine and first premolar. Root resorption was also evident in relation to the first premolar, second premolar, and mesial root of first molar on the right side. Based on these features, a differential diagnosis of odontogenic cysts and tumors (like odontogenic keratocyst, lateral dentigerous cyst, AOT, calcifying epithelial odontogenic tumor) was given. Other differential diagnosis included central giant cell lesions, lateral periodontal cyst, lateral radicular cyst, and the much rarer central benign mesenchymal neoplasms. The lesion was operated under local anesthesia and the specimen was sent for histopathologic examination. The mobile teeth, that is, mandibular lateral incisor, canine, premolars, and the first molar were removed along with the lesion []. Grossly, the lesion was white to tan, nodular tissue with cystic spaces containing yellowish brown semisolid material []. Microscopic examination revealed extremely vascular encapsulated lesion showing multivariate patterns of cellular arrangements ranging from sheets of polygonal cells arranged in ductal pattern, rossetes to solid sheets of cells []. In the center of these ducts, eosinophilic amyloid-like material was also seen. The solid lobular masses showed numerous spindle to columnar hyperchromatic cells with interspersed deposits of eosinophilic hyaline-like material. Mitotic figures were also seen in the lobules [Figures and ]. The above features were consistent with the diagnosis of AOT.
|
[[17.0, 'year']]
|
M
|
{'10435145': 1, '16816813': 1, '280645': 1, '12617250': 1, '29302284': 1, '12558960': 1, '2061853': 1, '29491597': 2, '5801660': 1, '163460': 1, '27857774': 2, '11793195': 1, '18888040': 1, '17617830': 1, '27642441': 1, '23946750': 2}
|
{'5824502-1': 1, '5091007-1': 1}
|
162,533 |
3731975-1
| 23,946,751 |
noncomm/PMC003xxxxxx/PMC3731975.xml
|
Primary tuberculous osteomyelitis of the mandible: A rare case report
|
A 13-year-old female of Asian Indian origin reported to our hospital for evaluation of swelling and pain on the right side submandibular region of the face. History obtained from the parents revealed that the swelling was present for past 2 months. The patient was prescribed multiple courses of antibiotics, but there was no significant improvement. The patient was moderately built, nourished, and afebrile at the time of examination. The patient gave a history of generalized weakness, weight loss for 2 months, and pain associated with the swelling.\nGeneral physical and systemic examinations did not give any significant diagnostic information. Extra oral examination revealed a unilateral diffuse solitary swelling over the right submandibular region of mandible measuring 2 × 3 cm in size. The overlying skin was normal in color, but swelling was tender on palpation with a discharging sinus []. On pressing the swelling, thick yellow pus discharge with blood was noticed. Margins of sinus opening were hyperemic. Multiple cervical lymph nodes on the right submandibular group of lymph nodes were enlarged and tender. A panoramic radiograph revealed an ill-defined, radiolucent, osteolytic lesion surrounding the developing right permanent second molar []. A provisional diagnosis of residual chronic dento alveolar abscess was made, while the differential diagnosis included tuberculous osteomyelitis of mandible or malignant bone tumor.\nHer chest radiograph did not reveal any evidence of TB []. Hematological finding included WBC counts of 8800 cells/mm3 and Hb of 11.50 gm/dl. Erythrocyte sedimentary rate raised to 38 mm and Mantoux test was 10 × 10 mm. Her serum HIV test was negative. Magnetic resonance imaging of neck showed evidence of osteomyelitis of right mandible involving the inferior margin of distal body of the mandible (from 2nd molar root abscess) [Figures –]. The length of the tract measured 2.34 cm and thickness was 0.6 cm. Computed tomography (CT) scan showed enlarged submandibular lymph nodes measuring 1 × 1 cm (nonspecific lymphadenitis).\nFine needle aspiration cytology of the swelling was also performed. A typical ceseous material with white cheesy appearance was aspirated, which on microscopic examination demonstrated necrotic calls, a large number of neutrophils, few lymphocytes, and few clusters of epitheloid cells, suggesting tuberculoid or caeseating granuloma. Right submandibular lymphadenopathy was also noted. Based on the above clinical findings, corroborated by history and various investigations, a diagnosis of primary tuberculous osteomyelitis of mandible was made.\nSinus tract excision with scooping of the cavity was done under local anesthesia. An extraoral submandibular incision was given to approach the mandible in the affected site. Necrotized bone was found distal to 46, involving the body of mandible with sequestrum formation in the angle area. The lesion was surgically drained and curetted and sent for histopathological examination.\nThe patient was started on standard antitubercular chemotherapy (2HRZE/4HR). The dosage was INH 75 mg, rifampicin 150 mg, ethambutol 275 mg, and pyrazinamide 400 mg. After 2 months of therapy, she improved markedly with decrease in swelling. Panaromic radiograph shows radio-opacity in relation to 47 (bone formation). She is under regular follow-up with continuation of AKT [].
|
[[13.0, 'year']]
|
F
|
{'18812606': 1, '8705586': 1, '1545958': 1, '33299618': 1, '15153873': 1, '32461909': 1, '11570448': 1, '17277438': 1, '27802849': 2, '23946751': 2}
|
{'5089153-1': 1}
|
162,534 |
3732352-1
| 23,922,529 |
noncomm/PMC003xxxxxx/PMC3732352.xml
|
Unusual Side Effects of Interferon Beta-1a in Patient with Multiple Sclerosis
|
A 30-year-old male, resident of Yazd, Iran, was referred to our emergency ward on April 23, 2011, because of massive epistaxis and ecchymosis on arms. He was known as a case of MS and he was getting Rebif (Ares-Serono, Geneva, Switzerland), three days a week, and each time 44mcg subcutaneous, for three months.\nHe had no history of trauma, hematuria, hematochezia, melena, hematemesis, diabetic mellitus, hypertension, ischemic heart disease and hyper lipidemia. The findings in his admission were blood pressure of 102/72 mmHg, pulse rate of 90 beat/min, axillary temperature of 37.2°C and respiratory rate of 24/min. He was oriented to time, place and person. In addition to abnormal CBC and kidney function tests, RBC 2.77mil/cu mm, Hemoglobin (Hgb) 8g/dl, Hematocrite (HCT) 25%, MCV 75fl, platelet count (PLT) 48000, plasma urea 91 mg/dl and creatinine 3.3 mg/dl. PT, PTT and INR were normal. When we hospitalized the patient, routine tests in our unit were checked for him, so they are summarized in Table . We checked retic count that was 0.3%. He didn’t have any significant data In his urine analysis and echocardiography. After that, liver function tests [SGOT (AST)-SGPT (ALT)-ALP], total and direct bilirubin were checked, they were normal. We checked LDH that was 1050 U/L. Infectious diseases such as HIV, HBV, HCV, HSV and EBV serology and ASO were negative. Blood and urine cultures, PPD test, Wright, 2ME were negative, too. Also Direct Coombs and Indirect Coombs were checked. They were negative, too. All investigations for probable malignancies were negative.\nThyroid function tests were normal. CBC, plasma urea and creatinine level were checked again two days later, yet his RBC, Hgb, HCT, MCV, PLT were low (i.e. under normal range) and his plasma urea and creatinine level were high (i.e. above normal range). 24 hours urine with a view to volume, creatinine, urea, uric acid and protein level was checked that was normal. Five days later, his CBC, plasma urea and creatinine level were checked again; RBC 2.88mil/cu mm, Hgb 8.4g/dl, HCT 26.2% and MCV 76fl, plasma urea 91 mg/dl and creatinine 3.2 mg/dl. He was treated with 50mg oral Prednisolone ½ Bid, 50mg Ranitidine IV Bid, one Folic acid tablet Bid, one Vitamin B12 tablet daily. He got 2 IU blood pack cell and Ringer serum 1000 cc/4hrs in the first admission. Peripheral blood smear had severe decrease in number of platelets. Erythrocytes were hypo-chromic severely with mild anisocytosis. White blood cell morphology and count were within normal limit and the most of them were nuetrophils. In bone marrow aspiration, cellularity appeared good (around 50%) and myeloid/erythroid (M/E) ratio was decreased. Blast count was less than 5% of nucleated cells. No dysplasia was detected. Megakaryocytes were increased. In bone marrow biopsy, megakaryocytes were increased. There was no evidence of malignancy. His chest radiograph, pelvic and abdominal sonography was normal. ANA, C3, C4, CH5, c and p ANCA and Anti-dsDNA and serum proteins electrophoresis were in normal range. His kidney biopsy had no significant thing. We consulted with neurologist and she proposed to disconnect interferon beta-1a (Rebif). After all of these investigations, we disconnected Rebif and after two days his CBC, plasma urea and creatinine level were checked again and their results were very fantastic. His RBC, Hgb, HCT, MCV and PLT had started to rise toward normal range, plasma urea and creatinine level had begun to fall. After seven days, they became normal.\nThey are summarized in Table .
|
[[30.0, 'year']]
|
M
|
{'12451188': 1, '11006371': 1, '30689655': 1, '15377168': 1, '7617182': 1, '8469318': 1, '9820297': 1, '9183256': 1, '8602746': 1, '9345462': 1, '8469319': 1, '23922529': 2}
|
{}
|
162,535 |
3732358-1
| 23,922,511 |
noncomm/PMC003xxxxxx/PMC3732358.xml
|
A Stent Thrombosis 1465 Days After Implantation
|
A 60-year-old man, a smoker presented with two hours after the beginning of chest pain. The patient had undergone PCI for the deployment of a SES (2.75mm diameter, 28 mm long) in the left anterior descending coronary artery (LAD) in 2006. He took clopidogrel for 6 months and continued taking aspirin. The physical examination was unremarkable. The ECG showed ST segment elevation in anterior leads. Coronary angiography elicited a total occlusion of the SES (Figure ). A loading dose of 600 mg clopidogrel, heparin (10.000IU) and a glycoprotein IIb/IIIa antagonist (tirofiban) were administered. After manually aspiration of the thrombus, a BMS (3.0 mm diameter, 32 mm long) was implanted at 14 atm. The chest pain resolved quickly and good TIMI3 flow in LAD was achieved (Figure ). The hospital course was uneventful and the patient was discharged four days later in good condition. He has been advised to continue on aspirin and clopidogrel indefinitely.
|
[[60.0, 'year']]
|
M
|
{'17296821': 1, '17296824': 1, '17224480': 1, '14523139': 1, '17470709': 1, '18804739': 1, '15870416': 1, '23922511': 2}
|
{}
|
162,536 |
3732890-1
| 23,930,251 |
noncomm/PMC003xxxxxx/PMC3732890.xml
|
An insight into genetics of non-syndromic cleft palate
|
Proband is a 29-year-old man who is affected with CP and was under treatment at Cleft Lip and Palate Clinic of Isfahan Medical University. Based on the medical interview, physical exams, echocardiogram, ophthalmologic evaluations, eudiometry test, and a routine blood examination, especially for checking if thyroid and parathyroid hormones were normal, the patient was diagnosed to have non-syndromic soft CP with hypernasality. He was born in a third-degree consanguineous marriage and was originally from Charmahal-Bakhtiyari province of Iran. He had a third-degree consanguineous marriage and has a 3-year-old healthy daughter, but his uncle IV-8 and nephew (VI-4) were affected by soft CP. Study of about six generations of this family pedigree showed that CP repeatedly occurred in males []. Another considerable point in this pedigree is that the sister of the proband (V-3) who has been affected with hypernasality disorder has an affected son. Regarding the occurrence of the disorder only in males who were born in consanguineous and non-consanguineous marriages in several successive generations, It seems that CP is a genetic disease in this family and its inheritance pattern is X-linked recessive.It seems that the sister of proband (V-3) is carrier of soft CP, leading to an affected son. Howevere, regarding the X-linked recessive inheritance pattern of the disorder, V-3 should not be affected phenotypically, like the other carrier females of the pedigree who have affected sons. But V-3 showed the mild form of disorder by just having hypernasality that is probably due to unusual inactivation of the X-chromosome, so that mutated copy of the gene is located on the X chromosome which is active in most of the cells.
|
[[29.0, 'year']]
|
M
|
{'3074911': 1, '8808277': 1, '2563677': 1, '18688869': 1, '5423440': 1, '457141': 1, '11401425': 1, '11499681': 1, '3728565': 1, '19881024': 1, '14994877': 1, '3812600': 1, '2563678': 1, '14722155': 1, '9445416': 1, '8045560': 1, '12412015': 1, '14729838': 1, '4825805': 1, '2881212': 1, '1570839': 1, '5057251': 1, '3812573': 1, '23930251': 2}
|
{}
|
162,537 |
3732911-1
| 23,930,127 |
noncomm/PMC003xxxxxx/PMC3732911.xml
|
Infectious endocardial intracardiac defibrillator lead, infectious pericarditis, and delayed constrictive pericarditis
|
A 62-year-old man with history of diabetes and opium addiction for 20 years was admitted in 2007 at Sina hospital, Isfahan, Iran, for evaluation of arrhythmia. Three brothers had sustained sudden death. Coronary angiography failed to reveal any significant coronary artery disease. However, left ventricular (LV) function was severely reduced with ejection fraction of 20%. There were no intracardiac clots. The patient was placed on anti-arrhythmia drugs (Amiodarone, 400 mg, orally, three times in day) and discharged.\nOne year later, the patient was admitted with Repeated VT with severe LV dysfunction arrhythmia which did not respond to medical therapy. Generator Medtronic maximo II Vr.\nLead Medtronic 6947-65 cm3 wires.\nCoronary sinus, Right ventricle, Right atrium (RA) ICD was implanted.\nOne year following the implantation, the patient was admitted with toe infection. TTE was unremarkable, TEE showed large vegetations on the ICD lead in RA and also vegetations on the anterior leaflet of tricuspid valve. Mild (Tricuspid regurgitation) TR was present. Left ventricular ejection fraction (LVEF) was 30% []. The result of the blood culture was positive for Staphylococcus aureus which was Methicillin sensitive.\nThe decision was made to remove the device surgically throw median sternotomy in February 2011. Pericardium was normal with no fluid collection or adhesions. The patient was placed on cardiopulmonary bypass. RA was opened. Large vegetations were seen on the anterior leaflet of the tricuspid valve. These were excised and the leaflet was repaired. ICD lead was completely removed. It was fully covered by vegetations. The generator was also removed by separate incision. The cultures of excised vegetations were positive for Staphylococcus aureus, e.g., Video 1, . The patient was discharged after two weeks of treatment with good general condition.\nOne month after the surgery, the patient returned to hospital with chest pain, malaise, and no fever. CT scan showed pericardial effusion, e.g., . Left thoracotomy was done and copious amounts of purulent fluid were drained. The culture was negative. He was discharged on 7th postoperative day.\nOne month later, the patient returned with severe lower extremity edema. CT scan revealed mild pericardial effusion with few gas bubbles. No evidence of mediastinitis was found. The sternum was stable. Echocardiography showed\nEcho findings were as follows:\nModerate pulmonary arterial hypertension (PAP = 45-50 mmhg), Moderate circumferential pericardial effusion with high-density material (18 mm) at pericardium [Figures -]. He was scheduled for surgery with diagnosis of constrictive pericarditis. Thick and fibrotic pericardium was resected. Purulent pericardial fluid was drained [].\nDuring ten months follow-up after pericardiotomy, dyspnea and edema improved significantly with no evidence of life-threatening arrhythmias.
|
[[62.0, 'year']]
|
M
|
{'18439181': 1, '23930196': 1, '19451366': 1, '20852296': 1, '12358163': 1, '20103204': 1, '21282681': 1, '17241309': 1, '19846629': 1, '23930127': 2}
|
{}
|
162,538 |
3732912-1
| 23,930,128 |
noncomm/PMC003xxxxxx/PMC3732912.xml
|
Osteoid osteoma of distal phalanx: A rare disorder and review of literature
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A 27-year-old right handed man refer to orthopedic uniclinic of Isfahan Al-zahra hospital on March 2011 with a 4 years history of gradual increase in size and deformity of the distal part of his left middle finger. Pain was a marked feature that disabled his life and was only relieved temporarily by analgesic and aggregated in nights. Twelve months earlier he had been treated for local infection, initially with a course of antibiotics. This treatment had been unsuccessful.\nOn examination, the finger was enlarged beyond the distal interphalangeal joint and clinically looked like an isolated clubbed digit. The pulp was big and there was increase in both longitudinal and transverse curvature of the nail-plate. The skin at the base of the nail-plate was swollen and shiny and there was a small amount of fluctuation. The nail-fold angle was obliterated. The patient did not report any previous trauma or infection; laboratory data, including laboratory tests for inflammation and rheumatic conditions, were normal, and CRP was negative. The middle finger was warm on palpation, and there were no evident superficial reticular veins. There was a slightly reduced range of motion in the distal interphalangeal joint compared to the contralateral hand. No satellite lymphadenopathy was observed.\nRadiographs revealed soft tissue edema on volar and dorsal side of finger. An oval shaped sclerotic mass in base of volar aspect of distal phalanx with tinny radiolucent border was seen []. In MRI, there was a 1.2 cm mass-like lesion in volar aspect of proximal half of the distal phalanx, being isosignal to muscles in T1W, and hyper in T2W images, causing saucerization of anterior surface of the bones. Nidus was not seen in plain radiography, but edema was obvious in MRI []. Unfortunately, we have no CT scan of finger in this patient.\nBased on clinical and radiographic findings, the presumptive diagnosis of osteoid osteoma was made (however other conditions, including infection and giant cell tumor were considered) and the patient underwent surgery. Through an approach on the volar side of the distal phalanx a hole was made in the area of osteosclerosis, thus revealing a small, less dense and relatively hyperemic area that flexor profundus tendon was attached to it. Then mass was removed en-block and Curettage was performed with a small curette and then tendon was attached to bone with tension suture, and specimen referred to pathology lab. Histological examination confirmed the diagnosis of osteoid osteoma, since the typical nidus was found in the histological specimen [].\nThe limb was immobilized with dorsal short splint for repair of tendon. In the first days following surgery, the pain with which the patient used to live with had already disappeared.\nThe patient, recently was seen 7 days after the operation, had no pain. Aspect and size of the finger and of the nail were similar to the contralateral one, having normalized a few months after surgery.
|
[[27.0, 'year']]
|
M
|
{'30621690': 2, '3225420': 1, '3437209': 1, '19052928': 1, '3325594': 1, '23329939': 2, '2738342': 1, '32109770': 2, '3325595': 1, '23930128': 2}
|
{'3522328-1': 1, '3522328-2': 1, '3522328-3': 1, '3522328-4': 1, '3522328-5': 1, '7044663-1': 1, '6323825-1': 1}
|
162,539 |
3733041-1
| 23,930,191 |
noncomm/PMC003xxxxxx/PMC3733041.xml
|
Close Contact Precautions Could Prevent an Outbreak of Crimean-Congo Hemorrhagic Fever: A Case Series Report from Southern Part of Tehran
|
On 25th June 2011 a 24-year-old female, pregnant with gestational age of 16 weeks, presented to the Loghman Hakim Hospital, Tehran, Iran, with chief complaint of hematemesis, petechia on upper extremities and palmar areas.\nShe denied history of vaginal bleeding, fever, myalgia, headache, arthralgia, diarrhea or rectorrhagia. She claimed to have a close contact with her husband who was a livestock-worker and had died the week before, with symptoms of bloody diarrhea and hematemesis. She also had a history of close contact with domestic animals as she worked with her husband.\nThe patient was immediately transferred to an isolated room and serum was obtained for CCHF virus serology and RT-PCR.\nHer laboratory studies revealed normal aminotransferases and PT, PTT. On baseline laboratory tests, anemia and thrombocytopenia were detected. urine analysis did not show hematuria. Obstetric examinations were normal and sonography showed normal alive twin fetuses. Because of her life-threatening condition, therapeutic ribavirin dose was administered to her.\nThe patient's condition was satisfactory after five days and she was discharged of hospital, with oral ribavirin.
|
[[24.0, 'year']]
|
F
|
{'19409826': 1, '17367225': 1, '14628945': 1, '113533': 1, '21887063': 1, '19815885': 1, '21362441': 1, '29869797': 1, '27809807': 1, '19249885': 1, '28249811': 2, '20626907': 1, '15827289': 1, '30916772': 1, '11422244': 1, '19301047': 1, '15307042': 1, '11170953': 1, '26770432': 1, '23544176': 1, '12802764': 1, '9033974': 1, '18395295': 1, '23930191': 2}
|
{'3733041-2': 2, '3733041-3': 2, '3733041-4': 2, '3733041-5': 2, '3733041-6': 2, '5421160-1': 1, '5421160-2': 1, '5421160-3': 1, '5421160-4': 1, '5421160-5': 1, '5421160-6': 1, '5421160-7': 1, '5421160-8': 1}
|
162,540 |
3733041-2
| 23,930,191 |
noncomm/PMC003xxxxxx/PMC3733041.xml
|
Close Contact Precautions Could Prevent an Outbreak of Crimean-Congo Hemorrhagic Fever: A Case Series Report from Southern Part of Tehran
|
On 29th June 2011, a 36-year-old male construction worker presented to the same hospital with chief complaint of fever, malaise, myalgia and headache, ecchymoses and hematemesis unresponsive to conservative managements. His symptoms were started 3 days prior to admission. There was no history of recent travel or direct contact with domestic animals, but a history of contact with his brother's blood and body fluid, who had worked in a live stock and died about 10 days before his admission.\nOn physical examination, the patient was hypotensive (mean arterial blood pressure: 80 mmHg), respiratory rate 36/min and pulse rate 100/min.\nThe patient had yellowish discoloration of sclera, a few petechiae on hard palate and multiple ecchymoses on extremities were detectable.\nLaboratory tests revealed leukocytosis, thrombocytopenia, increased PT, PTT, INR, aminotransferases, CPK and creatinine.\nFluid resuscitation and critical care managements were started. Ribavirin, loading and first doses were administered to him.\nSerum IgG, IgM ELISA tests and RT-PCR for CCHF virus were obtained.\nAfter a few hours of admission, the patient developed intractable hematemesis and epistaxis, not responding to medical managements; the patient's condition deteriorated and finally he died on 30th June, 2011. Surprisingly report of RT-PCR was negative for CCHF virus by reference laboratory.\nHis family members and all close contacts were informed to refer for evaluation. On 30th June, 13 suspicious cases were evaluated, 4 out of 13 were admitted to the hospital and the others who met the criteria for receiving prophylactic ribavirin were discharged with oral ribavirin. They advised to refer to the hospital in case of finding any sign or symptom of CCHF (temperature over 38.5 by mouth, headache, myalgia, petechia, arthralgia, or hemorrhagic manifestations.)\nshows the consanguinity of these cases.
|
[[36.0, 'year']]
|
M
|
{'19409826': 1, '17367225': 1, '14628945': 1, '113533': 1, '21887063': 1, '19815885': 1, '21362441': 1, '29869797': 1, '27809807': 1, '19249885': 1, '28249811': 2, '20626907': 1, '15827289': 1, '30916772': 1, '11422244': 1, '19301047': 1, '15307042': 1, '11170953': 1, '26770432': 1, '23544176': 1, '12802764': 1, '9033974': 1, '18395295': 1, '23930191': 2}
|
{'3733041-1': 2, '3733041-3': 2, '3733041-4': 2, '3733041-5': 2, '3733041-6': 2, '5421160-1': 1, '5421160-2': 1, '5421160-3': 1, '5421160-4': 1, '5421160-5': 1, '5421160-6': 1, '5421160-7': 1, '5421160-8': 1}
|
162,541 |
3733041-3
| 23,930,191 |
noncomm/PMC003xxxxxx/PMC3733041.xml
|
Close Contact Precautions Could Prevent an Outbreak of Crimean-Congo Hemorrhagic Fever: A Case Series Report from Southern Part of Tehran
|
This 41-year-old male construction worker, whose two brothers had died, denied any symptoms of fever, myalgia headache or abdominal pain, but on physical examination there were a few petechiae on buccal mucosa. He had neither close contact with his two dead brothers nor history of contact with domestic animals.\nLaboratory studies were within normal values. Empirical ribavirin was started for him with therapeutic dose.\nHis serum was obtained for evaluation of CCHF virus. He was discharged of hospital after 5 days without any complications, with oral ribavirin. His report of RT-PCR for CCHF virus was negative.
|
[[41.0, 'year']]
|
M
|
{'19409826': 1, '17367225': 1, '14628945': 1, '113533': 1, '21887063': 1, '19815885': 1, '21362441': 1, '29869797': 1, '27809807': 1, '19249885': 1, '28249811': 2, '20626907': 1, '15827289': 1, '30916772': 1, '11422244': 1, '19301047': 1, '15307042': 1, '11170953': 1, '26770432': 1, '23544176': 1, '12802764': 1, '9033974': 1, '18395295': 1, '23930191': 2}
|
{'3733041-1': 2, '3733041-2': 2, '3733041-4': 2, '3733041-5': 2, '3733041-6': 2, '5421160-1': 1, '5421160-2': 1, '5421160-3': 1, '5421160-4': 1, '5421160-5': 1, '5421160-6': 1, '5421160-7': 1, '5421160-8': 1}
|
162,542 |
3733041-4
| 23,930,191 |
noncomm/PMC003xxxxxx/PMC3733041.xml
|
Close Contact Precautions Could Prevent an Outbreak of Crimean-Congo Hemorrhagic Fever: A Case Series Report from Southern Part of Tehran
|
A 27-year-old male florist whose two brothers had died also was admitted with mild fever without any history of myalgia, arthralgia headache or bleeding. He did not recall close contact with his brothers or domestic animals.\nOn physical examination he showed mild fever and petechia on hard palate.\nLaboratory tests were all reported within normal values. RT-PCR was reported negative for CCHF virus. Ribavirin was administered to him and he was also discharged from hospital with satisfactory condition.
|
[[27.0, 'year']]
|
M
|
{'19409826': 1, '17367225': 1, '14628945': 1, '113533': 1, '21887063': 1, '19815885': 1, '21362441': 1, '29869797': 1, '27809807': 1, '19249885': 1, '28249811': 2, '20626907': 1, '15827289': 1, '30916772': 1, '11422244': 1, '19301047': 1, '15307042': 1, '11170953': 1, '26770432': 1, '23544176': 1, '12802764': 1, '9033974': 1, '18395295': 1, '23930191': 2}
|
{'3733041-1': 2, '3733041-2': 2, '3733041-3': 2, '3733041-5': 2, '3733041-6': 2, '5421160-1': 1, '5421160-2': 1, '5421160-3': 1, '5421160-4': 1, '5421160-5': 1, '5421160-6': 1, '5421160-7': 1, '5421160-8': 1}
|
162,543 |
3733041-5
| 23,930,191 |
noncomm/PMC003xxxxxx/PMC3733041.xml
|
Close Contact Precautions Could Prevent an Outbreak of Crimean-Congo Hemorrhagic Fever: A Case Series Report from Southern Part of Tehran
|
This 50-year-old female housewife, whose son-in-law (index case) had died, was admitted with suspicious symptoms and signs of CCHF. She claimed to have experienced myalgia, headache and fever. She had developed arthralgia, especially in both knees and shoulders a few days before admission. The patient had history of close contact with her daughter and her dead son-in-law.\nPhysical examinations revealed oral temperature of 38.5 and petechia on hard palate.\nLaboratory tests showed mildly increased PT, INR and creatinine. Anemia and leukopenia were notable in baseline tests.\nShe also received ribavirin and became afebrile after 4 days. Platelet levels came into normal limits after 4 days ELISA IgM antibody and RT-PCR for CCHF virus were reported as positive in this patient by reference laboratory. Her general condition showed improvement.\nThe patient preferred to leave out the hospital the sixth day of treatment, so oral ribavirin was prescribed for her for the rest of treatment period.
|
[[50.0, 'year']]
|
F
|
{'19409826': 1, '17367225': 1, '14628945': 1, '113533': 1, '21887063': 1, '19815885': 1, '21362441': 1, '29869797': 1, '27809807': 1, '19249885': 1, '28249811': 2, '20626907': 1, '15827289': 1, '30916772': 1, '11422244': 1, '19301047': 1, '15307042': 1, '11170953': 1, '26770432': 1, '23544176': 1, '12802764': 1, '9033974': 1, '18395295': 1, '23930191': 2}
|
{'3733041-1': 2, '3733041-2': 2, '3733041-3': 2, '3733041-4': 2, '3733041-6': 2, '5421160-1': 1, '5421160-2': 1, '5421160-3': 1, '5421160-4': 1, '5421160-5': 1, '5421160-6': 1, '5421160-7': 1, '5421160-8': 1}
|
162,544 |
3733041-6
| 23,930,191 |
noncomm/PMC003xxxxxx/PMC3733041.xml
|
Close Contact Precautions Could Prevent an Outbreak of Crimean-Congo Hemorrhagic Fever: A Case Series Report from Southern Part of Tehran
|
This 29-year-old pregnant female with gestational age of 32 weeks, whose two brothers-in-law had died, was admitted for better evaluation. She denied any history of bleeding, myalgia, arthralgia or fever. Physical examination and laboratory findings were all normal.\nObstetric examination and sonography showed normal alive fetus. The patient only was observed and was discharged after 3 days.\nHer RT-PCR was reported negative for CCHF virus.
|
[[29.0, 'year']]
|
F
|
{'19409826': 1, '17367225': 1, '14628945': 1, '113533': 1, '21887063': 1, '19815885': 1, '21362441': 1, '29869797': 1, '27809807': 1, '19249885': 1, '28249811': 2, '20626907': 1, '15827289': 1, '30916772': 1, '11422244': 1, '19301047': 1, '15307042': 1, '11170953': 1, '26770432': 1, '23544176': 1, '12802764': 1, '9033974': 1, '18395295': 1, '23930191': 2}
|
{'3733041-1': 2, '3733041-2': 2, '3733041-3': 2, '3733041-4': 2, '3733041-5': 2, '5421160-1': 1, '5421160-2': 1, '5421160-3': 1, '5421160-4': 1, '5421160-5': 1, '5421160-6': 1, '5421160-7': 1, '5421160-8': 1}
|
162,545 |
3733042-1
| 23,930,192 |
noncomm/PMC003xxxxxx/PMC3733042.xml
|
Wandering Ascaris Coming Out Through the Abdominal Wall
|
A 40-year-old female had undergone dilatation and curettage for missed abortion by a quack. On the second day she developed abdominal pain in the periumblical area which later on involved the whole abdomen. Pain was followed by abdominal distension and fever. There was no history of nausea, vomiting, hemetemesis, malena. There was history of anorexia.\nPhysical examination revealed an ill-looking female with pulse of 100 bpm, blood pressure of 100/60 and temperature of 100°F. Abdominal examination showed guarding and rebound tenderness all over. Chest and cardiovascular examination was essentially normal.\nChest X-ray of both domes of the diaphragm showed gas under the diaphragm. Abdominal sonography showed free fluid in the peritoneal cavity. A diagnosis of peritonitis was made and patient was explored. Operative findings were:\nFour perforations in the ileum in a segment of about 15 cm. About 300 ml of dirty bile-stained fluid in the peritoneal cavity. Pus flakes were present all over.\nResection anastomosis of the ileum was done and patient was put on Ryle's tube, IV fluids, and IV antibiotics (ceftrioxone salbactum and tinidazole). Ryle's tube was removed on the third postoperative day. Patient was shifted to liquid orals on the fifth postoperative day. Patient developed pus discharge from wound. Swab culture sensitivity was sterile. Skin sutures were removed and pus was drained. Wound was dressed daily and healing was achieved by secondary intention. On the 10th postoperative day patient developed a fistula just below the umbilicus which drained a small amount of bile-stained fluid, about 20 ml/day. On the 12th postoperative day a 10-cm-long worm was seen coming out through the fistulous tract. Discharge from the fistula decreased subsequently. Fistula closed of its own after three days. Wound healed completely by secondary intention. Patient was administered 400 mg of Albandazole for three consecutive days. Patient is on follow-up for the last six months.
|
[[40.0, 'year']]
|
F
|
{'34594431': 1, '751937': 1, '2031358': 1, '9775571': 1, '5769719': 1, '802797': 1, '4829790': 1, '10855079': 1, '15473279': 1, '14296775': 1, '5936979': 1, '23930192': 2}
|
{}
|
162,546 |
3733192-1
| 23,930,172 |
noncomm/PMC003xxxxxx/PMC3733192.xml
|
Bird Fancier's Disease Due to Exposure to Birds Via a Desert Cooler
|
A 57-year-old female referred to Imam Khomeini hospital with chief complaint of exertional dyspnea. She lived in the southern parts of Tehran. Her dyspnea which began about 4 months before her admission to hospital was gradually progressive and was accompanied by non-purulent cough. At the time of her admission she had some problems for performing activities of daily living. Dyspnea did not occur during resting and sleep and was not related to the time of eating. She didn't complain of orthopnea and paroxysmal nocturnal dyspnea (PND). The history of hemoptysis and exposure to tuberculous patients was negative.\nIn her past medical history, she was under treatment for hyperlipidemia (atorvastatine) and hypothyroidism (levothyroxine). She didn’t mention the history of any other respiratory or cardiovascular diseases. She didn’t have any hypersensitivity to drugs or nutritious substances and the history of seasonal allergy was negative as well.\nHer family history was negative for respiratory and cardiovascular diseases. History of smoking, alcohol consumption and drug abuse was negative. She was a housewife without any specific occupational exposures. Her husband was a farmer who had been died due to cardiovascular diseases 9 years ago. She lives in the first floor of a 3-storey buildingin Tehran (She didn’t use to live in her husband's farm). Her house was not near any industrial plants.\nIn the physical examination, she was completely alert. Her vital signs included: Pulse rate: 78/min, respiratory rate: 20/min, temperature: 37.1°C, blood pressure: 110/75 mmHg. Her body mass index was 35.5 kg/m2. Lung field auscultation revealed inspiratory crackles in the bases of both lungs, especially right lung and to a lesser intensity in the mid-zones of both lungs.\nIn arterial blood gas analysis, O2 saturation was 78%, and other parameters were normal. The results of complete blood count included:\nWBC: 10900/mm3\nRBC: 6.66 × 106 ml/mm3\nHemoglobin: 18.6 g/dl\nHCT: 58.9%\nMCV: 88 fl\nMCHC: 28 pg\nPlt: 230000/mm3\nMPV: 8.5 fl\nRDW: 15.1%\nPoly: 63.3%\nLymph: 28.3%\nMono: 4.6%\nEos: 3.3%\nBaso: 0.5%\nAnisocytosis: Slight\nThe result of spirometry showed a severe restrictive pattern (FVC = 1 L, 47.3% of predicted) which was approved by body plethysmography (TLC = 2.97 lit, 76% of predicted). Diffusing capacity (DLCO) was decreased (73.9%). She showed a significant response to bronchodilator administration hence a 21% and 17.7% increase in FVC and FEV1, respectively. The purified protein derivative (PPD) test for TB was negative.\nExercise stress test was performed but not completed because of her dyspnea. The result of transthoracic echocardiography was as following:\nPAPs: 40 mmHg, LVEF = 55%, Normal RV size and systolic function, diastolic dysfunction grade 2, trivial MR, and mild TR\nChest X ray showed reticulo-nodular pattern in both lower lung fields (despite a normal chest X ray 6 months before). shows two chest X rays before and after onset of disease.\nHigh-resolution computed tomography (HRCT) scan results in inspiration and expiration was as following: Generalized ground glass opacities in both lung fields and hypo-dense areas due to focal emphysema. Multiple lobular, patchily dispersed areas of air trapping throughout pulmonary fields, on expiratory views, mostly accompanied by mosaic perfusion on the corresponding inspiratory phase views. Interlobular septa were unremarkable. Neither bronchiectasis nor bronchiolectasis was noted, on either side. Interlobular and peribronchchovascular interstitium were ordinary depicted. The main pulmonary artery was dilated. Cardiomegaly was depicted [].\nAfter observing the results of paraclinic tests, because of high suspicion of hypersensitivity pneumonitis, another history with details was obtained from her. She mentioned that her son keeps a considerable number of birds (doves) on the roof of the building and their cage was beside the desert cooler of the building. So she fulfilled the criteria of HP and after removing the exposure her symptoms subsided and her pulmonary function improved significantly hence FVC = 1.79l, 82% of predicted and FEV1 = 1.42l, 79% of predicted.\nA written informed consent was obtained from patient to publish her case report with her radiographic images. This consent is available (in Persian) for the journal editorial.
|
[[57.0, 'year']]
|
F
|
{'10051719': 1, '16299091': 1, '4023982': 1, '18344808': 1, '3590053': 1, '11816827': 1, '8131466': 1, '12842854': 1, '7924510': 1, '4193468': 1, '24753784': 1, '5005677': 1, '11692086': 1, '15301309': 1, '23930172': 2}
|
{}
|
162,547 |
3733209-1
| 23,929,996 |
noncomm/PMC003xxxxxx/PMC3733209.xml
|
Efficacy of Āyurvedic treatment using Pañcakarma combined with balance exercises for disability and balance in progressive supranuclear palsy
|
A 55-year old lady already diagnosed with PSP presented at the Department of Pañcakarma in March 2012, with the chief complaints of inability to walk, falling over backward, memory loss (Smṛtikṣaya) and increased episodes of spontaneous laughing. Patient started complaining of memory loss since 2001 with minor incidents like: forgetting her keys, forgetting to mix salt in food etc., The memory loss gradually increased and by September 2010, she was not able to remember her signature. She also had complaints of falls along with balance and gait difficulties (Gati saṅga) since 2003. The problem persisted and the patient was referred to a neurologist where diagnosis of PSP was established. Past medical history included hypothyroidism and hypertension. Family history was not significant.\nOn observation, face was expressionless and mask-like. Patient had poor balance with the tendency to fall over backwards. On sitting, trunk deviation was seen towards right. She was able to walk only with support and gait was slow and wide based. Dysarthria (Vāk graha) was present but most of the words were comprehensible. Horizontal saccades were slow but vertical saccades were more affected. Downward gaze was hampered severely []. Neck rigidity was observed during extension. She used to fall abruptly on the chair while sitting down and was unable to get up from the chair without support. Postural stability was severely impaired with patient requiring assistance to stand still. Average sleep was less than 5 hours per day and patient complained of difficulty both in falling asleep and remaining asleep (Nidrā nāśa). Ocular examination revealed loss of upward and downward gaze. Blinking was severely affected with blink rate of less than one per minute. Patient was able to read, however the vision was blurred. Patient was assessed for cognitive impairment using Mini Mental Status Examination (MMSE) which showed mild deterioration of cognitive functions. Her ability to write was severely affected. Magnetic Resonance Imaging (MRI) revealed midbrain, frontal and cerebellar atrophy.\nAssessing subject on Āyurvedic parameters revealed her to be of Vāta-pittaja prakrti with madhyama samhanana (medium build) and normal Jatharāgni (appetite). History given by attendant was indicative of her anxious nature (Ati cintan) with habit of late night sleep (Rātri jāgarana). The symptoms observed like memory loss (Smritikshaya), spontaneous episodes of laughing and history as mentioned above were suggestive of Mano vāha as well as Rasa vāha srotas involvement.[]\nFor assessing disability, progressive supranuclear palsy rating scale (PSPRS) was used. It comprises of 28 items in six categories: daily activities (by history), behaviour, bulbar, ocular motor, limb motor and gait/midline. Scores range from 0 to 100. Inter-rater reliability is good, with intra-class correlation coefficient for the overall scale of 0.86 (95% CI 0.65-0.98).[] Balance was assessed by using Tetrax Interactive Balance System (IBS) posturography. It measures the anteroposterior and mediolateral sway of the patient under eight conditions (facing forwards eyes open, eyes closed; standing on foam with eyes open, eyes closed, stable standing eyes closed head rotated to right, left, back and forwards).\nAfter taking informed consent of the patient the treatment was started with Virecana karma (purgation). The classical process of Virecana was completed in 15 days. The allopathic treatment being taken by her then was stopped on the day of purgation and was restarted afterwards. From 16th day onwards, Mātrā basti, Śirobasti, and palliative treatment were started. Mātrā basti was given on alternate days for consecutive 3 months, while Śirobasti was given in two courses of three sittings each. Each session of Śirobasti comprises of 7 days. Between two sessions of Śirobasti, a compulsory break of seven days was given []. The palliative treatment was started in accordance with the treatment for Vāta vyādhi as described in classics and rejuvenation therapy[] []. Additional balance exercises were given to the patients under the supervision of physiotherapists[] [].
|
[[55.0, 'year']]
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F
|
{'18948373': 1, '10824045': 1, '9708960': 1, '31143747': 1, '12849397': 1, '19439847': 1, '17405767': 1, '22556488': 1, '10930594': 1, '23929996': 2}
|
{}
|
162,548 |
3734631-1
| 23,930,242 |
noncomm/PMC003xxxxxx/PMC3734631.xml
|
Posterior tracheal wall leading to life-threatening obstruction of tracheostomy tube
|
A 28-year-old male patient with severe traumatic brain injury (diffuse axonal injury with cerebral edema on magnetic resonance imaging) was admitted to the intensive care unit (ICU) in unconscious state Glasgow coma scale = 8: E2 M5 VT, with endotracheal tube in situ. In ICU, he was placed on mechanical ventilation (MV). Because of persistent poor neurological status, on the 5th day, a surgical tracheostomy was carried out with standard portex TT of 8.0 mm internal diameter. He was given daily intermittent spontaneous breathing trial by T-piece. On the 4th day of post-tracheostomy while the patient was on T-piece, he developed sudden tachypnea and tachycardia. With each inspiration and expiration an audible sound like vocalization was heard from inside the TT, which was heard despite fully inflated cuff. He was immediately placed on MV, which showed high peak inspiratory pressures (PIP) >40 cm H2O with every inspiratory effort. Positive pressure ventilation with Bain circuit was also not possible. Suction of the tracheostomy tube was carried out, which could be negotiated up to the carina with no secretions being aspirated. However, the high PIP with spontaneous inspiration did not subside and the audible sound continued. Immediate fiber optic bronchoscopy revealed indrawing of the posterior tracheal wall into the TT with each inspiratory effort causing almost complete closure of TT. This was causing a flap such as mechanism leading to audible sound and the high PIP. Ventilation with Bain was also not possible due to indrawing of the posterior tracheal wall and blockage of the TT during patient's own inspiration. Immediately, TT was removed over a bougie and replaced with 7.5 mm cuffed TT. Post-insertion, fiber optic bronchoscopy revealed patent tracheal lumen, PIP dropped and audible sound vanished. Inspection of TT cuff revealed elliptical deformity of the cuff leading to the lumen of TT facing posterior tracheal wall and deep inspiratory efforts lead to the indrawing of the posterior wall into the lumen causing airway blockade.
|
[[28.0, 'year']]
|
M
|
{'12377868': 1, '14535219': 1, '23930242': 2}
|
{}
|
162,549 |
3734632-1
| 23,930,243 |
noncomm/PMC003xxxxxx/PMC3734632.xml
|
Intermittent left bundle branch block caused by coronary vasospasm
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A 53-year-old African American female with past medical history of diabetes mellitus, hypertension and dyslipidemia, presented to the hospital with 3 days history of intermittent chest pain. She described the pain as severe retrosternal, non-exertional, radiating to the left arm lasting for 20-30 min and is associated with severe diaphoresis and shortness of breath. It used to occur 3-5 times a day and relieved spontaneously or by sublingual Nitroglycerin (NTG). The patient had 15 pack year's history of smoking, occasional alcohol intake and no illicit drug use.\nOn physical examination, she was hemodynamically stable, blood pressure of 115/52 mmHg, pulse of 78 bpm, with normal saturation on room air. The pain quickly resolved by sublingual nitroglycerin and IV morphine, cardiac exam showed 2/6 systolic ejection murmur at aortic area with no radiation, heart sounds were normal with regular rate and rhythm, there was no jugular venous distention, lungs were clear, pulses were strong and equal in all limbs and there was no edema in the lower extremities. Serial EKG/ECG were obtained, it consistently showed (LBBB) during chest pain episodes [], and resolution of the LBBB pattern with deep T wave inversion in Leads V1-V4 during chest-pain-intervals [].\nPatient was started on aspirin 325 mg, loading dose of clopidogrel 600 mg, heparin drip, and was subsequently taken for emergent coronary angiogram. By the time, she arrived to Cath Lab, the chest pain was substantially improved. The coronary angiogram showed clean coronary arteries except of 80% LAD vasospasm, which was relieved by intravenous nitroglycerin. Cardiac enzymes were negative. Echocardiogram showed normal left ventricular ejection fraction without any regional wall motion abnormalities. The diagnosis of coronary vasospasm was made and the patient was started on calcium channel blocker (Diltiazem) daily, which provided symptomatic relief. Patient did well during 10 months follow-up period with further chest pain episodes.
|
[[53.0, 'year']]
|
F
|
{'18838725': 1, '32410837': 1, '14434946': 1, '34189004': 2, '17467642': 1, '18068830': 1, '3859197': 1, '19376525': 1, '17418437': 1, '20830663': 1, '27752273': 2, '27562181': 1, '15788845': 1, '2532074': 1, '8522709': 1, '11526352': 1, '2909157': 1, '27296905': 1, '23930243': 2}
|
{'8232976-1': 1, '5055374-1': 1}
|
162,550 |
3734633-1
| 23,930,244 |
noncomm/PMC003xxxxxx/PMC3734633.xml
|
Alcoholic leukopenic pneumococcal sepsis
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Alcohol abuse and subsequent leukopenia led to a significant and devastating illness in a 55-year-old man. The patient presented with 2 day history of shortness of breath, cough, fever, chills, confusion, and altered mental status. The patient was found unconscious at the day of admission by a friend and there was no witnessed seizure or trauma. The patient was last seen conscious was 12 h before this presentation. The patient had a significant history of alcohol abuse with the multiple admissions to the hospital due to alcohol withdrawal.\nOn examination, he was unconscious. The patient was intubated on arrival and placed on assist- control mechanical ventilation. Vitals were significant for sinus tachycardia and hypotension that mandated the use of vasopressors. The chest shows right-sided decreased air entry with diffuse crackles. The rest of examination was unremarkable. Initial work-up revealed complete blood count shows white blood cells 0.8 × 109/L (reference range 4.5-11.0), absolute neutrophil count 360 mm3, hemoglobin 8.1 g/L (14.0-17.5), and platelets 109,000 and creatinine 3.5 mg/dl, potassium 4.5 meq/L. Chest X-ray showed right lower lobe consolidation with the right costophrenic angle obliteration suggestive of right pleural effusion []. Computed tomography - Angiography of the chest confirmed the findings of right lower lobe consolidation with no pleural effusion on both lung window [ transverse cut and b coronal cut] and mediastinal window [ transverse cut and b coronal cuts]. Bronchial secretions culture grows gram-positive diplococci (Streptococcus pneumoniae). Given the radiographic and microbacterial findings along the history of alcohol abuse and leukopenia, the diagnosis of “ALPS” syndrome was made. The patient initially was admitted to the intensive care unit and started on vancomycin and piperacellin/tazobactam antibiotics. Few days later, he made remarkable recovery and was discharged in stable condition.
|
[[55.0, 'year']]
|
M
|
{'8531287': 1, '7813281': 1, '14960971': 1, '16272341': 1, '363086': 1, '15252285': 1, '4051312': 1, '12119223': 1, '10798593': 1, '16877635': 1, '23930244': 2}
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{}
|
162,551 |
3734640-1
| 23,930,033 |
noncomm/PMC003xxxxxx/PMC3734640.xml
|
Can yoga be used to treat gastroesophageal reflux disease?
|
A 62-year-old male presented with history of heart burn followed by dysphagia. An endoscopy showed a large hiatal hernia with a nonobstructing peptic stricture proximal to the gastroesophageal junction due to erosive esophagitis. The esophagogastroduodenoscopy (EGD) revealed presence of gastritis and duodenitis. The patient had Grade D esophagitis according to Los Angeles (LA) classification of esophagitis []. Initially the patient was started on a high-dose PPI. After 6 months of continuous treatment, repeat EGD showed LA Grade C esophagitis and persistence of a large hiatal hernia. We used Bravo (Bravo is a pH recording capsule used to measure acidity levels in the esophagus) study to accurately measure acid reflux and correlate it with clinical symptoms by keeping the patient off the PPI regimen temporarily. On a Bravo study, the patients DeMeester score on the 1st day was 81.1 and on 2nd day was 35.1, indicating severity of acid reflux.\nThe patient was advised to continue treatment of high dose of PPI. In conjunction with PPI the patient began practicing Yoga daily for symptomatic alleviation of his GERD. Regular Yoga exercises included a Kapalbhati Pranayama and an Agnisar Kriya. After 6 months follow-up EGD revealed hiatal hernia and a nonobstructing peptic stricture just proximal to the gastroesophageal junction but his esophagitis grade improved to Grade A from initial Grade D esophagitis according to LA classification. To confirm these findings we did Bravo study and a repeat EGD after 5 weeks. The Bravo study showed a significant improvement in DeMeester scores; the day one score improved from 81.1 to 12 and the day two score improved from 35.1 to 17. These finding of EGD indicates that the patient had significant symptomatic improvement after 6 months of combined regimen of Yoga and PPI, which were refractory to high dose of PPI alone. His heart burn and dysphagia symptoms improved significantly in terms of both severity and frequency. He did not have nausea, diarrhea, constipation, postprandial fullness, bloating, and any other additional complaints. He had normal bowel movements. All of his blood tests were within normal limits. A follow-up Barium Swallow study was performed and showed normal oral transit time, pharyngeal transit time, reflex time and reflex strength. Biopsies of the stomach and duodenum demonstrated normal results except for chronic gastritis.\nThis patient has shown the effect of regular practice of a Kapalbhati Pranayama and Agnisar Kriya on severe GERD. After adding regular Yoga exercises to the ongoing treatment of high dose PPI, he had dramatic clinical improvement evidenced by both the reduction of Bravo scores and improvement in esophagitis grading.
|
[[62.0, 'year']]
|
M
|
{'22844607': 1, '31879617': 1, '13948775': 1, '28744059': 1, '11879596': 1, '22618308': 1, '19705417': 1, '2653945': 1, '23930033': 2}
|
{}
|
162,552 |
3736370-1
| 23,956,968 |
noncomm/PMC003xxxxxx/PMC3736370.xml
|
Autoerythrocyte sensitization syndrome presenting with general neurodermatitis
|
A 70-year-old woman had recurrent episodes of painful bruising on the back, abdomen, and four extremities for 5 years (). The patient complained that the bruises appeared after scratching the skin to relieve pruritus. The patient had a 5-year history of general chronic neurodermatitis without any bleeding manifestations, such as melena, hematuria, and menorrhagia. The neurodermatitis had usually recurred approximately every 4-6 months with severe itching over the lesions, and the last relapse was approximately 3 months prior to the study. Symptoms of itching could be relieved by oral antihistamines or corticosteroids; however, the ecchymosis was unaffected.\nPhysical examination at the time of bruising revealed scattered ecchymosis with lesions varying in size. The lesions were tender, without bleeding, ulceration, or scarring. Dispersive, noticeable excoriation could be seen on the same regions especially on the trunk. Laboratory tests showed normal values for complete blood cell count, platelet count and coagulation panels. There were no detectable autoimmune abnormalities that would explain the lesions. Punch biopsies of the skin lesions revealed scant superficial perivenular lymphocytic infiltration.\nAn intradermal test for autoerythrocyte sensitization was performed, with 0.1 mL of the patient's washed red blood cells, whole blood, plasma, and normal saline injected in an inaccessible area of the back, lateral to thoracic spine. Approximately 24 hours later, the patient developed a painful ecchymotic reaction on the washed red blood cell (RBC) and whole blood injection site, while no reaction was observed on the plasma and normal saline injection site ().\nPsychiatric evaluation of the patient revealed depression with anxiety features. The patient was empirically given oral antihistamines, steroids and anxiolytics. The ecchymosis reduced and finally diminished approximately 4 weeks later, with a follow-up of stationary phase for more than 3 months.
|
[[70.0, 'year']]
|
F
|
{'17656998': 1, '14389381': 1, '6887489': 1, '7897725': 1, '12838436': 1, '910012': 1, '20883407': 1, '10966177': 1, '23956968': 2}
|
{}
|
162,553 |
3736966-1
| 23,986,857 |
noncomm/PMC003xxxxxx/PMC3736966.xml
|
Primary hepatic neuroendocrine tumor: gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging
|
A 71-year-old man presented to our outpatient clinic 3 years ago for the evaluation of metastasis with documented prostate cancer, which was diagnosed elsewhere. The patient reported no clinical symptoms, such as flushing, fever, or abdominal pain. A physical examination revealed no abnormal findings. The results of other laboratory evaluations, including liver tests and blood level of tumor markers (i.e. alpha-fetoprotein, CA-19–9, and carcinoembryonic antigen), were within normal limits. An ultrasound examination revealed a heterogeneous mixed echoic solid mass in the left lateral segment of the liver that was approximately 3.7 cm in maximal diameter (Fig. ). Abdominal multidetector CT revealed a well-circumscribed, heterogeneous, and hypodense mass, with mild peripheral constant enhancement during the arterial, portal, and equilibrium phases (Fig. ). The liver background was not cirrhotic. MR images (Fig. ) were obtained with a 1.5 T unit using a liver-specific contrast agent (gadoxetic acid disodium [Gd-EOB-DTPA], Primovist®, Bayer Healthcare, Berlin, Germany). On T2-weighted fast spin-echo MR (TR/TE, 3646.3/107.0) and diffusion images (diffusion b-factor, 800), the mass was mainly with mild high signal intensity correlated with normal liver parenchyma with several foci of hyperintense foci. This mass demonstrated hypointensity on T1-weighted gradient echo images (TR/TE, 3.6/1.4), and the previously highly hyperintense foci on T2-weighted images showed also slightly hyperintense on T1-weighted image, suggesting a hemorrhagic component. Gadoxetic acid-enhanced T1-weighted MR images demonstrated peripheral enhancement of the solid tumor portion on early arterial phase, contrast wash-out pattern on portal venous phase and definite defect on 20 min delayed hepatobiliary phase. The patient underwent ultrasound-guided biopsy of the hepatic mass, and histology suggested a malignant neoplasm that originated from a neuroendocrine cell (well-differentiated neuroendocrine carcinoma, Grade 2). After a meticulous examination for the primary origin, including positron emission tomography-computed tomography (18F-FDG-PET/CT), colonoscopy, gastroscopy, and chest CT, there was no evidence of a primary focus. On 18F-FDG-PET/CT, there was no definite increase of glucose metabolism in the hepatic tumor (Fig. ). Although grade 2 neuroendocrine tumors demonstrate slow growth, surgical resection is the treatment of choice. Based on this pathologic diagnosis, a left hemihepatectomy was performed. During the operation, no evidence of ascites or liver cirrhosis was found. The gross features of the tumor appeared approximately 3.3 cm in size with well-defined margins and a pink-yellowish appearance. The tumor consisted of multiple small hemorrhagic vascular lakes with old blood. Microscopic examination revealed that the neoplasm comprised cell atypia and mitotic activity (8/10 HPF, Fig. ). Small-intermediate-sized tumor cells demonstrated uniformly round nuclei with abundant cytoplasm and vesicular nuclei chromatin. Immunohistochemical studies were performed (Fig. ), and the tumor cells were strongly positive for the neuroendocrine marker synaptophysin, focally positive for neural adhesion molecule (CD56)/chromogranin and negative for cytokeratin 7 (a marker for cholangiocarcinoma). Ki-67 proliferative index is positive in 5% of cells. Microscopic and immunohistochemical findings were compatible with a well-differentiated G2 neuroendocrine carcinoma based on the WHO 2010 criteria (). Based on this finding, we performed a more thorough study to rule out the possibility that the liver tumor was a metastatic NET during the 3-year follow-up period. This work-up included multiple upper gastrointestinal endoscopies, colonoscopy, abdominal ultrasound examination, chest and abdominal CT scans, 123I-MIBG scan, and 123I-Octreotide SPECT-CT. All imaging findings were normal, except mild duodenitis. Thus, we concluded that the final diagnosis in this case was primary hepatic NET.
|
[[71.0, 'year']]
|
M
|
{'17374863': 1, '27574614': 1, '31412920': 1, '34630876': 1, '21915659': 1, '10365076': 1, '34152286': 1, '15153441': 1, '9024720': 1, '16762613': 1, '29962820': 2, '34584804': 2, '22984220': 1, '11433205': 1, '1729316': 1, '30213016': 2, '11536403': 1, '3354510': 1, '19014620': 2, '34435011': 2, '11756710': 1, '31852101': 2, '26064749': 2, '8661810': 1, '23986857': 2}
|
{'6021771-1': 1, '8362580-1': 1, '6922538-1': 1, '6155964-1': 1, '2596793-1': 1, '4439501-1': 1, '8457678-1': 1}
|
162,554 |
3736967-1
| 23,986,856 |
noncomm/PMC003xxxxxx/PMC3736967.xml
|
Slow-growing primary marginal zone B-cell lymphoma arising in the chest wall in a patient without a history of tuberculosis
|
A 57-year-old man had noticed a right chest wall mass lesion for 15 years, but had ignored the lesion in the 5 years before presentation. He was admitted to our hospital without significant symptoms and with no history of tuberculosis. Magnetic resonance imaging (MRI) was performed, and a 5-cm-diameter lesion was found. The signal was isointense on T1-weighted imaging (T1WI) and hyperintense on T2-weighted imaging (T2WI) (Fig. ). Needle biopsy was performed, and histopathology showed lymphocyte infiltration with no evidence of malignancy. The patient was followed up for the next 7 years, and during that interval he had no significant symptoms.\nOn MRI after 7 years of follow-up, the primary chest wall mass lesion was without any significant change, but a small subcutaneous mass lesion was found nearby. The MRI signal of this subcutaneous mass was almost identical with the original mass (Fig. ). Diffusion-weighted imaging (DWI) was performed and both lesions exhibited high signal on DWI and a low apparent diffusion coefficient (ADC) (about 0.5) on the ADC map (Fig. ). In light of the MRI findings, hypercellular malignant tumors (including melanoma and lymphoma), atheroma, and nodular fasciitis were suspected. Excisional biopsy was not performed since that would make definitive re-excision more extensive due to the contamination of surrounding tissue planes. Therefore an open biopsy of both lesions was performed. The mass lesions were both found to be marginal zone B-cell lymphomas (Fig. ).\nIn this case, no other tumors were found, so radiation therapy only (36 Gy/20 French) was given. The patient was discharged, and follow-up found the patient in good condition with no apparent signs of recurrence after 2 years.
|
[[57.0, 'year']]
|
M
|
{'18716129': 1, '12499440': 1, '29066707': 1, '16564245': 1, '19136410': 1, '15563266': 1, '19114192': 1, '19716671': 1, '23986856': 2}
|
{}
|
162,555 |
3736968-1
| 23,986,858 |
noncomm/PMC003xxxxxx/PMC3736968.xml
|
Fatal intra-abdominal hemorrhage as a result of avulsion of the gallbladder: a postmortem case report
|
A man in his 40s with a history of chronic alcohol abuse and mental illness was found dead at home. His brother alleged that he hit the deceased's head and face while under the influence of alcohol, but in a deposition he denied hitting the deceased in the abdomen. During the police investigation, the veracity of the brother's account could not be determined because he was intoxicated at the time of the incident. He also had a mental illness. Therefore, the body was transported to our institution for a forensic autopsy in order to clarify whether the death was the result of a crime or an accident.\nPostmortem CT for pre-autopsy screening was performed with an eight-channel multislice scanner (Aquilion; Toshiba Medical Systems, Tokyo, Japan). Images were reconstructed with soft tissue, lung, and bone kernels to provide 2.0 mm slices each. MSCT data were sent to a digital imaging and communication in medicine (DICOM) server (POP-Net Server; ImageONE, Tokyo, Japan) and a three-dimensional workstation (ziostation ver. 2.1.0.3; Ziosoft, Tokyo, Japan). All CT images were evaluated by an experienced radiologist.\nOn postmortem CT, a moderate amount of blood was identified in the right perihepatic and perisplenic spaces, respectively (Fig. a). The gallbladder could not be visualized in situ (Fig. b). It was lying in a high-attenuation material (suspected to be blood) in the inferior abdomen, detached from its liver bed and filled with a large amount of bile, some gallstones, and biliary sludge (Fig. c, d, e). Its fundus was at the lower pole of the right kidney (Fig. d). Clotted blood was evident in the liver bed (Fig. b). No other hepatic parenchymal injuries were visible on CT. Other CT findings included fatty liver, fractures of the fourth to ninth left ribs, and cerebral edema. Pneumothorax and hemothorax were not found.\nFollowing MSCT scanning, forensic autopsy was performed with the guidance of radiologic findings. The cadaver was 170 cm long and weighed 92 kg. The subcutaneous tissue of the head was edematous. The brain weighed 1200 g, with slight swelling of the surface. No intracranial bleeding was identified. Slight amounts of subcutaneous hemorrhage were widespread in the upper abdomen. Massive subcutaneous hemorrhage was seen around the left thoracic and left hip region. The eighth right costal cartilage and the fifth and sixth left costal cartilages were fractured. The multiple bilateral rib fractures were found without pleural injury. There were no lacerations and hemorrhage in both lungs. The distended gallbladder was completely stripped from its liver bed (Fig. ) and hanging from an intact cystic duct with adherent coagulated material. The gallbladder was filled with dark green bile (110 mL) and three gallstones, and associated with massive intra-abdominal bleeding (900 mL). There was no extrahepatic bile duct injury or evidence of bile leak. The presence of clotted blood was confirmed on the liver bed. The liver weighed 1580 g; the appearance of its external surface was irregular, nodular, and yellow. The cut surface also had a yellow granular appearance suggestive of cirrhosis. No other pathological abnormalities were found in the abdomen.\nThe blood alcohol concentration was 0.8 mg/mL. As mentioned above, we confirmed that the brain and lungs showed no significant pathological alteration, and therefore concluded that the cause of death was hemorrhagic shock due to intra-abdominal bleeding from avulsion of the gallbladder.
|
[[45.0, 'year']]
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M
|
{'7006529': 1, '7473927': 1, '9242765': 1, '21498285': 1, '13149107': 1, '30788563': 1, '15732423': 1, '10505132': 1, '21851630': 2, '23986858': 2}
|
{'3169498-1': 1}
|
162,556 |
3737615-1
| 23,986,616 |
noncomm/PMC003xxxxxx/PMC3737615.xml
|
Congenital duplication of mastoid segment of facial nerve: A rare case report
|
A 15-year-old female presented to the ENT department at our hospital with history of progressive hearing loss detected at school age. There was no history of either pus discharge or ear pain. Also, there was no history of any congenital infection, trauma, or any surgery. Clinical examination showed well-formed pinna with atresia of external auditory canal. There was conductive type of hearing loss. No facial nerve abnormalities were detected. Audiometry study showed low-frequency hearing loss in the right ear up to 60 dB. Patient underwent high-resolution computed tomography (HRCT) of temporal bone in our department.\nHRCT temporal bone showed atresia of the right external auditory canal. Middle ear ossicles were dysplastic with hypoplastic malleus which was fused with deformed incus []. Stapes was absent. The inner structures, cochlea, vestibule, and semicircular canals, were unremarkable. We traced the course of facial nerve and found duplication of mastoid segment of facial nerve with two stylomastoid foramina on the right side []. Mastoid segment of the facial nerve divides into lateral and medial segments with larger lateral segment branch which carries enlarged chorda tympani branch and medial segment branch continues as tympanic branch of the facial nerve []. There was no duplication of tympanic and labyrinthine segments of the facial nerve [].
|
[[15.0, 'year']]
|
F
|
{'15592859': 1, '8797901': 1, '12917123': 1, '30324041': 1, '7668738': 1, '1902944': 1, '13701069': 1, '3202133': 1, '10774379': 1, '32209522': 1, '13865573': 1, '15100137': 1, '9692640': 1, '23986616': 2}
|
{}
|
162,557 |
3737620-1
| 23,986,620 |
noncomm/PMC003xxxxxx/PMC3737620.xml
|
Multiphasic contrast-enhanced CT and MRI findings of adult mesoblastic nephroma: A report of two cases
|
A 47-year-old woman presented with an incidentally detected renal mass on a routine physical exam. The results of the laboratory examination were unremarkable. Ultrasound examination of the kidneys detected a 5.5-cm, well-delineated, partly cystic mass located in the middle polar of the left kidney (not shown). T2-weighted imaging (T2WI) demonstrated a heterogeneous predominantly hypointense mass with interspersed stellate-like hyperintensity []. Mass was isointense relative to renal parenchyma on T1-WI with areas of low signal intensity []. The lesion presented mild patchy enhancement on the corticomedullary phase (CMP) [] and progressive heterogeneous enhancement on the nephrographic phase (NP) and pyelographic phase (PP) [Figure and , respectively]. Multiphasic images consisting of CMP (20-30 sec), NP (80 sec) and PP (120 sec) phases were acquired after the administration of contrast material. There was no suggestion of lymphadenopathy or renal vein involvement on any of the sequences. The patient was diagnosed as renal cell carcinoma and underwent radical left nephrectomy. The pathologic diagnosis was an MN []. The patient was free of disease on the 1-year follow-up examination.
|
[[47.0, 'year']]
|
F
|
{'10466454': 1, '9669345': 1, '10782473': 1, '17414095': 1, '4355052': 1, '4378178': 1, '15288147': 1, '20845287': 1, '10895818': 1, '18006141': 1, '19818075': 1, '8396855': 1, '18592471': 1, '23986620': 2}
|
{'3737620-2': 2}
|
162,558 |
3737620-2
| 23,986,620 |
noncomm/PMC003xxxxxx/PMC3737620.xml
|
Multiphasic contrast-enhanced CT and MRI findings of adult mesoblastic nephroma: A report of two cases
|
A 46-year-old man with a history of intermittent gross hematuria for 1 year was admitted to our hospital. Ultrasound examination of the kidneys detected a 12-cm, well-delineated, partly cystic mass herniating into the right renal pelvis (not shown). A CT scan revealed a well-defined, solid and cystic, mixed attenuation renal mass bulging into the renal pelvis []. The mass was ovoid and mainly solid, showing heterogeneous attenuation with moderate prolonged enhancement on CMP and NP [Figure and , respectively]. The highest CT value of the tumor was 46 HU, 120HU and 135HU on plain scan, CMP and NP, respectively. There was no enhancement seen in the hypoattenuation area of the mass corresponding to the cystic area described on ultrasound. The tumor was bulging out of the renal parenchyma without peri-nephric infiltration. A radical nephrectomy of the right kidney was performed because of the diagnosis of renal cell carcinoma on CT scan. Microscopically, the tumor was composed of spindle-shaped cells showing both fibroblastic and muscle differentiation admixed with entrapped clusters of tubular epithelium. The epithelial component showed large foci of proliferating tubules. There was no cytologic atypia in either the mesenchymal or the epithelial component. On histological examination, the tumor was composed mainly of proliferating spindle cells, which stained strongly with smooth muscle actin, with variable cellularity and epithelial tubular cells scattered amid the spindle cells []. Although the tumor was well circumscribed, it lacked a true capsule. The patient was free of disease on the 2-year follow-up examination.
|
[[46.0, 'year']]
|
M
|
{'10466454': 1, '9669345': 1, '10782473': 1, '17414095': 1, '4355052': 1, '4378178': 1, '15288147': 1, '20845287': 1, '10895818': 1, '18006141': 1, '19818075': 1, '8396855': 1, '18592471': 1, '23986620': 2}
|
{'3737620-1': 2}
|
162,559 |
3737622-1
| 23,986,621 |
noncomm/PMC003xxxxxx/PMC3737622.xml
|
Appearances of the circumcaval ureter on excretory urography and MR urography: A single-center case series
|
A 34-year-old man presented with intermittent right flank pain for 6 months. Preliminary ultrasound for suspected calculus disease showed right hydroureteronephrosis with a dilated proximal ureter but no evidence of calculi. Excretory urography showed right-sided grade 4 hydroureteronephrosis, the ureter being dilated up to the L4 vertebral level, with a tapered segment seen coursing superiomedially. A diagnosis of circumcaval ureter was suggested, and MRU was performed. MRU showed grade 4 hydronephrosis with the medialized segment of the ureter coursing around the IVC, and axial sections clearly depicted the anatomy [].
|
[[34.0, 'year']]
|
M
|
{'2117354': 1, '11893643': 1, '12751873': 1, '2016790': 1, '3257616': 1, '18463916': 1, '33851303': 1, '26848379': 1, '104583': 1, '20166394': 1, '32337857': 2, '8033691': 1, '16534551': 1, '27186038': 1, '23986621': 2}
|
{'3737622-2': 2, '3737622-3': 2, '3737622-4': 2, '3737622-5': 2, '3737622-6': 2, '3737622-7': 2, '7397898-1': 1}
|
162,560 |
3737622-2
| 23,986,621 |
noncomm/PMC003xxxxxx/PMC3737622.xml
|
Appearances of the circumcaval ureter on excretory urography and MR urography: A single-center case series
|
A 20-year-old man presented with intermittent right flank pain for 1 year and dysuria for 1 week. Sonography revealed right-sided hydronephrosis, and excretory urography showed a mid-ureteric medialization with grade 4 hydronephrosis and the rest of the ureter was not visualized. MRU was subsequently performed, which showed the right upper ureter conically dilated and tapering into a normal caliber ureter that made an S-shaped curve around the IVC.
|
[[20.0, 'year']]
|
M
|
{'2117354': 1, '11893643': 1, '12751873': 1, '2016790': 1, '3257616': 1, '18463916': 1, '33851303': 1, '26848379': 1, '104583': 1, '20166394': 1, '32337857': 2, '8033691': 1, '16534551': 1, '27186038': 1, '23986621': 2}
|
{'3737622-1': 2, '3737622-3': 2, '3737622-4': 2, '3737622-5': 2, '3737622-6': 2, '3737622-7': 2, '7397898-1': 1}
|
162,561 |
3737622-3
| 23,986,621 |
noncomm/PMC003xxxxxx/PMC3737622.xml
|
Appearances of the circumcaval ureter on excretory urography and MR urography: A single-center case series
|
A 12-year-old boy was incidentally found to have right hydronephrosis on routine sonography, and the left kidney was not visualized. An excretory urogram showed grade 3 hydronephrosis on the right, with a dilated proximal ureter and a short distal medialized segment. There was no excretion on the left side. MRU confirmed a solitary right kidney with grade 3 hydronephrosis, and the acute medialization was seen to be due to the ureter winding around the IVC at L3 vertebral level. The patient, being asymptomatic, was not operated, and is on regular sonographic follow-up.
|
[[12.0, 'year']]
|
M
|
{'2117354': 1, '11893643': 1, '12751873': 1, '2016790': 1, '3257616': 1, '18463916': 1, '33851303': 1, '26848379': 1, '104583': 1, '20166394': 1, '32337857': 2, '8033691': 1, '16534551': 1, '27186038': 1, '23986621': 2}
|
{'3737622-1': 2, '3737622-2': 2, '3737622-4': 2, '3737622-5': 2, '3737622-6': 2, '3737622-7': 2, '7397898-1': 1}
|
162,562 |
3737622-4
| 23,986,621 |
noncomm/PMC003xxxxxx/PMC3737622.xml
|
Appearances of the circumcaval ureter on excretory urography and MR urography: A single-center case series
|
A 40-year-old woman presented with right flank pain and fever for 2 weeks. Ultrasound showed right hydronephrosis with moving internal echoes, suggesting pyonephrosis. Urine culture was positive for gram-negative bacilli. Excretory urography done after treatment of the infection showed right-sided grade 3 hydronephrosis with a “reverse J” configuration of the dilated system. MRU images and MIP reconstructions showed a similar appearance, but axial sections clearly depicted a circumcaval course of the ureter.
|
[[40.0, 'year']]
|
F
|
{'2117354': 1, '11893643': 1, '12751873': 1, '2016790': 1, '3257616': 1, '18463916': 1, '33851303': 1, '26848379': 1, '104583': 1, '20166394': 1, '32337857': 2, '8033691': 1, '16534551': 1, '27186038': 1, '23986621': 2}
|
{'3737622-1': 2, '3737622-2': 2, '3737622-3': 2, '3737622-5': 2, '3737622-6': 2, '3737622-7': 2, '7397898-1': 1}
|
162,563 |
3737622-5
| 23,986,621 |
noncomm/PMC003xxxxxx/PMC3737622.xml
|
Appearances of the circumcaval ureter on excretory urography and MR urography: A single-center case series
|
A 25-year-old man presented to the emergency department with acute severe right flank pain for a day and history of similar milder pain for the last year. Ultrasound revealed right hydroureteronephrosis with proximal ureteric calculus. IVU showed right grade 4 hydronephrosis with a calculus overlying the pedicle of L3 vertebra. CT showed right hydronephrosis with renal and proximal ureteric calculi, but the intimate relation of ureter and IVC raised the possibility of a circumcaval ureter. MRU unequivocally depicted the circumcaval course of the ureter and two calculi proximal to the obstruction [].
|
[[25.0, 'year']]
|
M
|
{'2117354': 1, '11893643': 1, '12751873': 1, '2016790': 1, '3257616': 1, '18463916': 1, '33851303': 1, '26848379': 1, '104583': 1, '20166394': 1, '32337857': 2, '8033691': 1, '16534551': 1, '27186038': 1, '23986621': 2}
|
{'3737622-1': 2, '3737622-2': 2, '3737622-3': 2, '3737622-4': 2, '3737622-6': 2, '3737622-7': 2, '7397898-1': 1}
|
162,564 |
3737622-6
| 23,986,621 |
noncomm/PMC003xxxxxx/PMC3737622.xml
|
Appearances of the circumcaval ureter on excretory urography and MR urography: A single-center case series
|
A 41-year-old man presented with dysuria of 6 months duration. Ultrasound showed right-sided hydronephrosis with a prominent pelvis, the ureter not traceable. IVU showed right grade 2 hydronephrosis, and the “reverse J” shape of the collecting system suggested circumcaval course of the ureter. MRU showed grade 2 obstruction due to hooking of the proximal ureter around the IVC []. This was well made out on both coronal MIP images and axial source images.
|
[[41.0, 'year']]
|
M
|
{'2117354': 1, '11893643': 1, '12751873': 1, '2016790': 1, '3257616': 1, '18463916': 1, '33851303': 1, '26848379': 1, '104583': 1, '20166394': 1, '32337857': 2, '8033691': 1, '16534551': 1, '27186038': 1, '23986621': 2}
|
{'3737622-1': 2, '3737622-2': 2, '3737622-3': 2, '3737622-4': 2, '3737622-5': 2, '3737622-7': 2, '7397898-1': 1}
|
162,565 |
3737622-7
| 23,986,621 |
noncomm/PMC003xxxxxx/PMC3737622.xml
|
Appearances of the circumcaval ureter on excretory urography and MR urography: A single-center case series
|
A 43-year-old man presented with flank pain for 2 months. Sonographically, there was right-sided hydronephrosis. IVU showed a dilated pelvis and proximal ureter, with grade 3 hydronephrosis. Retrograde Pyelogram (RGP) was performed, which showed only the distal normal ureter, up to L4 vertebral level, the tip of the catheter being more medial than expected, causing circumcaval ureter to enter the differential. CT was performed to exclude radiolucent calculus, and the proximity of the ureter and IVC was noted, though there was no retrocaval segment. MRU was performed, and though the procedure had to be terminated prematurely owing to the patient's claustrophobia, the obtained sections excluded a circumcaval course of the ureter and were suggestive instead of a crossing vessel []. The latter was proven intraoperatively a week later.
|
[[43.0, 'year']]
|
M
|
{'2117354': 1, '11893643': 1, '12751873': 1, '2016790': 1, '3257616': 1, '18463916': 1, '33851303': 1, '26848379': 1, '104583': 1, '20166394': 1, '32337857': 2, '8033691': 1, '16534551': 1, '27186038': 1, '23986621': 2}
|
{'3737622-1': 2, '3737622-2': 2, '3737622-3': 2, '3737622-4': 2, '3737622-5': 2, '3737622-6': 2, '7397898-1': 1}
|
162,566 |
3737670-1
| 23,956,516 |
noncomm/PMC003xxxxxx/PMC3737670.xml
|
Partial reimplantation of Tenckhoff catheter for channel perforation and aneurysm: A case series
|
A 60-year-old female, who was on CAPD for 7 years, presented with channel perforation of the Tenckhoff catheter. She had no mechanical or infective complication earlier. At presentation, she complained of leak from a perforation of Tenckhoff catheter. She was afebrile with stable vitals. On examination, there was a 2 mm longitudinal crack, 2 cm distal to the skin exit site of the catheter with stenosed distal channel. Peritoneal fluid leak was easily discernible at the site of the crack. There was no pericatheter leakage, edema, or induration at the exit site. Leukocyte count of catheter fluid was within normal limits and culture was sterile. Based on the clinical diagnosis of Tenckhoff catheter's crack, we planned for partial reimplantation. The surgical procedure was performed under local anesthetic 1% lignocaine. We placed the skin incision over the previous scar of catheter insertion. Dissection was carried out along the proximal normal portion of catheter so as to gain adequate length from the looped internal part, which was then exteriorized along with outer Teflon cuff superior to the incision line. This partial replantation was accomplished by excision of catheter proximal to the crack site and fitting the tungsten adapter at the cut end []. Immediately following the procedure, CAPD was re-started and she is undergoing regular dialysis for last 6 months without any complications.
|
[[60.0, 'year']]
|
F
|
{'25074998': 1, '8829126': 1, '27891387': 1, '8865910': 1, '16865213': 1, '19325058': 1, '11379858': 1, '23956516': 2}
|
{'3737670-2': 2, '3737670-3': 2, '3737670-4': 2}
|
162,567 |
3737670-2
| 23,956,516 |
noncomm/PMC003xxxxxx/PMC3737670.xml
|
Partial reimplantation of Tenckhoff catheter for channel perforation and aneurysm: A case series
|
The second case was a 41-year-old male patient who was on CAPD for 2 years. He presented with perforation in the catheter due to accidental injury by a surgical blade while removing the dressing. This was managed in a similar manner to that mentioned earlier. He was on regular dialysis for next 3 years without any catheter-related complication.
|
[[41.0, 'year']]
|
M
|
{'25074998': 1, '8829126': 1, '27891387': 1, '8865910': 1, '16865213': 1, '19325058': 1, '11379858': 1, '23956516': 2}
|
{'3737670-1': 2, '3737670-3': 2, '3737670-4': 2}
|
162,568 |
3737670-3
| 23,956,516 |
noncomm/PMC003xxxxxx/PMC3737670.xml
|
Partial reimplantation of Tenckhoff catheter for channel perforation and aneurysm: A case series
|
The third case was a 45-year-old male, who presented after 15 months of CAPD catheter insertion, with perforation in the Tenckhoff catheter. The cause of the perforation was frequent cleaning of catheter with spirit. Partial reimplantation was performed. He was advised to avoid any alcoholic antiseptic for catheter care and he continued dialysis from the same catheter for the next 4 years.
|
[[45.0, 'year']]
|
M
|
{'25074998': 1, '8829126': 1, '27891387': 1, '8865910': 1, '16865213': 1, '19325058': 1, '11379858': 1, '23956516': 2}
|
{'3737670-1': 2, '3737670-2': 2, '3737670-4': 2}
|
162,569 |
3737670-4
| 23,956,516 |
noncomm/PMC003xxxxxx/PMC3737670.xml
|
Partial reimplantation of Tenckhoff catheter for channel perforation and aneurysm: A case series
|
The fourth case was a 50-year-old female patient who reported with aneurysmal dilatation and kinking of the Tenckhoff catheter at the exit site after 3 years of CAPD insertion []. The cause of the problem was not known. Due to very short length of the normal proximal part of the catheter, it required not only partial reimplantation but also attachment of the extension channel to the catheter in situ. In the follow-up at 6 months, she was not suffering from any CAPD-related problems.\nThe clinical summary of the cases is given in .
|
[[50.0, 'year']]
|
F
|
{'25074998': 1, '8829126': 1, '27891387': 1, '8865910': 1, '16865213': 1, '19325058': 1, '11379858': 1, '23956516': 2}
|
{'3737670-1': 2, '3737670-2': 2, '3737670-3': 2}
|
162,570 |
3737671-1
| 23,956,517 |
noncomm/PMC003xxxxxx/PMC3737671.xml
|
Robotic repair of a rare case of symptomatic “Ureterosciatic Hernia”
|
A 75-year-old Caucasian woman was referred to us with chronic left-sided flank pain for the past several years. She had a history of an uneventful abdominal hysterectomy performed 6 years back. At presentation, she was afebrile and her general examination was unremarkable, her urine analysis, blood biochemistry including blood urea and serum creatinine were also within normal limits. A plain X-ray KUB did not show any evidence of nephrolithiasis and an ultrasound-KUB revealed left gross hydroureteronephrosis (HDUN). Based on this, we entertained an initial empirical diagnosis of left obstructive uropathy possibly due to a left ureteric stricture/stone. Subsequently, she was planned for a renogram and computed tomography (CT). The radioisotope renogram revealed high-grade obstruction with a compromised left renal function of 17%. The plain CT scan of the abdomen and pelvis (without contrast) done was suggestive of left HDUN with a grossly dilated convoluted ureter till the level of S2-3 vertebra seen on longitudinal cuts [], with protrusion outside the bony pelvis above the piriformis seen on transverse cuts []. Based on the CT, a diagnosis of internal herniation of the ureter was speculated. The retrograde urography study revealed a normal caliber distal left ureter with an abnormal lateral protrusion and looping (curlicue) beyond the bony pelvic margin at the level of the sciatic foramina []; this confirmed the diagnosis of an USH. The obstructed left renal unit was drained with a percutaneous nephrostomy (PCN) as prior multiple attempts at retrograde placement of a left guide-wire across the looped and partially obstructed left ureter had been unsuccessful. Subsequently through this PCN, an antegrade guide wire was passed which depicted a fixed kinking of the ureter [] and ureteric stenting was successfully performed. She initially elected to remain on observation, though complaining of severe discomfort with the stent. Her pre-stent renal function was 17% in the left kidney. A second renal scan was done after six weeks of stenting and the left renal function was now up to 38% (post-endourological stenting with the stent in situ). Later, at six weeks, the stent became so intolerable that she elected to have it removed and decided for a definitive surgery. After discussing the various surgical options with the patient, she elected to undergo a robot-assisted laparoscopic repair of her left USH.\nThe robot-assisted laparoscopic procedure was initiated under general anesthesia with the patient in steep trendelenburg position, pneumoperitoneum, and four ports. A robot-assisted meticulous laparoscopic reduction of the left USH (at the point where the distal ureter was identified entering the sciatic foramen) and ureterolysis (releasing from surrounding adhesions) were carried out successfully. The released ureter from hernial sac appeared well vascularized; thus, we decided not to excise the ureter and employ ureteroneocystostomy. A ureterotomy was made for retrograde insertion of a 26 cm/6Fr JJ stent, which was done successfully, and the ureterotomy was closed using 5-0 polyglactin absorbable suture. The hernial defect was repaired in two layers with a 3-0 nonabsorbable polypropylene suture in a running manner. The patient made an uneventful rapid recovery and the operating time, blood loss, and hospital stay were 90minutes, <50 ml, and 18 hours, respectively. At the 10th week of follow-up, her JJ-stent was removed in our outpatient clinic. Later at 3 months follow-up, her renogram left renal function improved to 43%; currently, the patient is doing well [].
|
[[75.0, 'year']]
|
F
|
{'4773699': 1, '34926163': 1, '34742226': 2, '25849669': 2, '17535604': 1, '17124625': 1, '10510938': 1, '31041589': 1, '18818145': 1, '17958996': 1, '23956517': 2}
|
{'4294447-1': 1, '8572418-1': 1}
|
162,571 |
3737672-1
| 23,956,518 |
noncomm/PMC003xxxxxx/PMC3737672.xml
|
Spontaneous transvaginal bowel evisceration
|
A 51-year-old postmenopausal female presented to the emergency department with complaints of continuous, dull aching pain in the lower abdomen and an irreducible mass protruding per vagina for the past 6 hours. Patient's past history was significant for high-grade muscle invasive transitional carcinoma of bladder. She underwent anterior pelvic excentration with ileal conduit 3 months back. Histopathology reported high-grade papillary urothelial carcinoma with muscle and urethral invasion without involvement of the ureters. There was no lymph node metastasis. Postoperative period was uneventful.\nAt the current visit, general survey showed features suggestive of dehydration with pulse rate of 94/min and blood pressure recording of 130/88 mm of Hg. On examination, about 30 cms of small bowel was found protruding through the vaginal introitus []. The bowel loops were congested and a small defect was palpable in the pelvic floor communicating with the peritoneal cavity. Systemic examination was completely normal. Abdominal examination showed ileostomy site draining clear urine, midline incision healed by primary intension. Hematological and biochemical investigations were normal. Exploratory laparotomy was done after stabilizing the patient which showed 30 cms of jejunal and ileal loops prolapsing through pelvic floor and vaginal introitus. Bowel loops were congested but found to be viable after reduction into peritoneal cavity. Full-thickness tear was present in jejunal loop 25 cms from duodeno-jejunal flexure; resection anastamosis was hence performed. Pelvic floor was repaired with prolene mesh and vagina closed from the perineum. Postoperatively patient had uneventful recovery. Follow-up after 1 month was normal.
|
[[51.0, 'year']]
|
F
|
{'8784315': 1, '27843219': 2, '25738028': 1, '11933691': 1, '5445007': 1, '26832349': 1, '9653870': 1, '34755053': 2, '18958482': 1, '12798729': 1, '31076491': 1, '2302281': 1, '12004225': 1, '16021065': 1, '23956518': 2}
|
{'8560436-1': 1, '5054667-1': 1}
|
162,572 |
3737673-1
| 23,956,519 |
noncomm/PMC003xxxxxx/PMC3737673.xml
|
Cloacal anomaly with bladder tumor
|
A 36-year-old married female having two children, both delivered by caesarian section, presented to us with complaints of urinary frequency, urgency, and urge incontinence associated with low-grade fever. She had history of recurrent urinary tract infections (UTI) since childhood and had received multiple courses of antibiotics. She had been diagnosed as having a persistent cloaca and had undergone multiple cutback procedures at birth. On pelvic examination, a single short common channel opening in the perineum was found. All preoperative blood investigations including renal function were normal.\nUltrasound abdomen showed a mass lesion in urinary bladder []. Computed tomography (CT) abdomen and pelvis with three dimensional reconstruction confirmed the presence of persistent cloaca, a large mass in the bladder with infiltration into the pubic bones [] with uterus didelphys and rectum crossing between the two uteri and opening into the bladder base []. Cystoscopy revealed a large solid, sessile growth arising from dome and anterior wall of urinary bladder, rectum opening just distal to bladder neck and two cervical openings posteriorly. Cold cup biopsy from growth revealed a moderately differentiated squamous cell carcinoma (SCC).\nWith a diagnosis of squamous tumor with persistent cloaca, radical cystectomy and urinary diversion were planned. Intraoperatively, we found a 15 cm pouch colon along with a large tumor involving anterior wall of bladder, infiltrating the pubic bones. Two uteri were lying on either side of the bladder []. Pelvic exenteration, standard bilateral pelvic lymph node dissection, pubectomy, and wet colostomy were performed. Operative time was 6 hours with 1200 cc blood loss and the patient received 2 units of packed cell transfusion. Postoperative course was uneventful except for a small incision disruption which was managed with secondary suturing. Histopathologic findings confirmed the presence of squamous cell carcinoma. Resected margins were free of tumor and 50% of pelvic nodes showed tumor metastases. She was started on adjuvant methotrexate and platin-based combination chemotherapy but finally lost to follow up.
|
[[36.0, 'year']]
|
F
|
{'16032273': 1, '19878548': 1, '6711540': 1, '9742916': 1, '26109625': 1, '11531187': 1, '2661802': 1, '666378': 1, '23956519': 2}
|
{}
|
162,573 |
3737674-1
| 23,956,520 |
noncomm/PMC003xxxxxx/PMC3737674.xml
|
Primary renal angiosarcoma
|
A 67-year-old gentleman presented with dull aching left loin pain since the last two months. He also had malaise, loss of appetite and significant loss of weight. There was no hematuria, headache, hemoptysis or bone pain. There was no history of previous exposure to radiation or agents like thorotrast and vinyl chloride but he had a sixty pack year history of smoking. Physical examination revealed pallor and a large ballotable mass in the left flank.\nOn evaluation, his hemoglobin was 5.7 gm% and creatinine was 1.72 mg%. Liver function tests and chest X-ray were normal. Contrast-enhanced computed tomogram revealed a 13 × 12 × 10 cm, predominantly hypodense left upper and inter-polar renal mass with few areas of enhancement, abutting the posterior abdominal wall, psoas and spleen []. After optimization, he underwent open radical nephrectomy through a subcostal transperitoneal approach. Intraoperatively, the left renal mass was seen to involve the entire kidney and infiltrate the splenic capsule, diaphragm and the psoas muscle.\nGrossly, the tumor measured 13 × 10 × 7 cm. Sectioning revealed a hemorrhagic surface admixed with areas of necrosis. The posterior aspect showed a raw area with breach of capsule and attachment to remnants of diaphragm. The tumor was not seen to infiltrate the renal sinus or hilum [].\nMicroscopy showed renal parenchyma infiltrated by an extensively hemorrhagic and focally necrotic tumor []. Scanty viable tumor, composed of clusters of spindle to polygonal-shaped cells with moderately pleomorphic and mitotically active nuclei was seen. Some tumor cells were seen to line small spaces containing RBCs []. On immunohistochemistry, the tumor cells were diffusely positive for CD31, CD34 and vimentin and were negative for pancytokeratin and EMA [Figures and ]. These features are consistent with angiosarcoma. Ki proliferative index was high (>80%).\nHe had an uneventful postoperative recovery and was started on paclitaxel-based chemotherapy. Paclitaxel was given in a dose of 115 mg intravenously, weekly for 3 weeks, followed by one week rest. The next cycle was started on day 28 and a total of 3 cycles are planned.
|
[[67.0, 'year']]
|
M
|
{'21989448': 1, '25120734': 1, '26842370': 2, '29383452': 1, '31410364': 1, '17681076': 1, '16903939': 1, '30305861': 1, '19711281': 1, '26816844': 1, '25789072': 2, '16818182': 1, '23956520': 2}
|
{'4356396-1': 1, '4739400-1': 1}
|
162,574 |
3737675-1
| 23,956,521 |
noncomm/PMC003xxxxxx/PMC3737675.xml
|
Traumatic rectourethral fistula repair: A potential application of porcine small intestinal submucosa
|
A 45-year-old male met with road traffic accident a year ago and sustained pelvic fracture with urethral injury and traumatic rectourethral fistula. He underwent diversion loop colostomy and suprapubic cystostomy elsewhere immediately after injury. Six months later, he came to us for further management. He had mild difficulty in squatting and complete loss of penile erection. Clinical examination revealed normally functioning pelvic loop colostomy, well-positioned functioning suprapubic cystostomy and an indurated opening of 1 cm × 1 cm size in the anterior wall of rectum, 6 cm above the anal verge. Opposing cystourethrography revealed complete obliterative stricture at the level of proximal bulbar urethra and extravasation of contrast into rectum from bulbomembranous urethra [Panel A, ]. MR urethrogram showed a 6 cm long distraction defect with callous tissue. His blood and urine investigations were normal. Anastomotic urethroplasty by progressive perineal approach (upto inferior pubectomy) was done. The fistulous communication between the posterior aspect of membranous urethra and rectum was disconnected. Rectum was closed in 2 layers with 3-0 polydiaxonone absorbable sutures. Bulboprostatic anastomotic urethroplasty was done by the parachute technique. Porcine small intestinal submucosal graft (Biodesign™ (Surgisis®) 4-Layer Tissue Graft, Cook Medical Inc. Bloomington, USA) was used for interposition between the repaired ends of urethra and rectum []. He was on continuous per urethral catheter for 8 weeks. After catheter removal, he voided well with a peak flow of 36 ml/s at a voided volume of 560 ml. Post-operative voiding cystourethrogram [Panel B, ] revealed well-healed bulboprostatic urethral anastomosis and absence of contrast extravasation. Subsequently he had loop colostomy closure 6 months later. At follow-up of 1 year, he is voiding well.
|
[[45.0, 'year']]
|
M
|
{'16148682': 1, '12115437': 1, '21992771': 1, '34447650': 2, '19830143': 2, '18604462': 1, '14154543': 1, '9224315': 1, '11992915': 1, '9124629': 1, '11890446': 1, '31008987': 1, '23956521': 2}
|
{'8381446-1': 1, '2726482-1': 1, '2726482-2': 1}
|
162,575 |
3737677-1
| 23,956,523 |
noncomm/PMC003xxxxxx/PMC3737677.xml
|
Bilateral vesical inguinal hernia: A perineal ‘Mickey mouse’
|
A 50-year-old gentleman presented with dull right flank pain since three months. There was no hematuria, weight loss or lower urinary tract symptoms (LUTS). Physical examination was unremarkable. Contrast enhanced computed tomogram (CECT) revealed a right interpolar hypervascular renal mass suggestive of renal cell carcinoma.\nThe CECT incidentally picked up bilateral inguinal hernias with bladder protruding anteroinferiorly on both sides. The herniating bladder was seen as a fluid-filled structure contiguous with the rest of the bladder bilaterally, which was easily demonstrated on the axial images [] with further confirmation of the same on reformatted sagittal and coronal sections []. There was no evidence of bowel or any other structure in the hernia. This gave the appearance of a ‘Mickey mouse’, with the bladder protrusion into bilateral hernias mimicking its ears and rest of the bladder resembling its face.
|
[[50.0, 'year']]
|
M
|
{'24960133': 1, '15671377': 1, '16302332': 1, '33381349': 2, '21344035': 2, '30631632': 2, '28469311': 2, '31485328': 2, '30487042': 1, '23956523': 2}
|
{'6304920-1': 1, '6717051-1': 1, '5396411-1': 1, '7748886-1': 1, '7748886-2': 1, '3037511-1': 1}
|
162,576 |
3737698-1
| 23,956,722 |
noncomm/PMC003xxxxxx/PMC3737698.xml
|
Successful retrieval of a knotted pulmonary artery catheter trapped in the tricuspid valve apparatus
|
A 64-year-old man with a 20-month history of exertional chest pain presented for elective myocardial revascularization. Past medical history included hypertension, type 2 diabetes mellitus, and hypercholesterolemia. The patient underwent coronary angiogram, which revealed extensive diffuse 3 vessel disease and very poor left ventricular function with an ejection fraction of about 25%. Trans-thoracic echo showed dilated left ventricle with severe left ventricular dysfunction. Recent MRI showed extensive regional wall motion abnormalities, but no late gadolinium enhancement despite wall thinning, suggestive of viable and hibernating myocardium. Preoperative vital signs, physical examination, electrocardiogram, chest X-ray results, and laboratory values were consistent with the patient's underlying conditions and revealed no acute changes in his condition.\nInvasive monitoring was inserted in the anesthetic room. This consisted of a brachial arterial line, a right internal jugular central venous catheter, and a sheath for a PAC. A PAC was passed into the pulmonary artery. Attempts to wedge the PAC were unsuccessful and when we tried to withdraw the PAC we found that it was tethered. A transesophageal echocardiography (TOE) confirmed that the PAC was tangled in the tricuspid valve apparatus []. TOE of the knotted PAC in the tricuspid valve apparatus.\nThe help of an interventional radiologist was sought. Under fluoroscopy the PAC was wired and using traction over the wire the knot was worked along to the end of the catheter and released. This allowed the PAC to be re-floated with a satisfactory pulmonary wedge pressure in the right pulmonary artery. The patient's postoperative course was entirely uneventful. He made good progress in the ward and was discharged home [Figure and ]. X-ray of the knotted PACs.
|
[[64.0, 'year']]
|
M
|
{'510002': 1, '18179002': 1, '7418424': 1, '2315639': 1, '15122422': 1, '20927274': 2, '15251992': 1, '6884097': 1, '7214940': 1, '7984193': 1, '23956722': 2}
|
{'2945509-1': 1}
|
162,577 |
3737699-1
| 23,956,723 |
noncomm/PMC003xxxxxx/PMC3737699.xml
|
Esophageal misplacement of a single-lumen tube after its exchange for a double-lumen tube despite the use of an airway-exchange catheter
|
A 22-year-old male victim of a traffic accident presented with dyspnea, and was diagnosed with right hemothorax and pneumothorax. He was intubated and chest tube drainage (CTD) was performed, after which he was transferred to our emergency room (ER) for further evaluation and management. On arrival, he had decreased mental status, and his initial vital signs were as follows: Blood pressure (BP): 80/50 mmHg, heart rate (HR): 124 beats/minute, respiratory rate (RR): 28 breaths/minute, oxygen saturation: 90%, and arterial blood gas analysis (ABGA) values of pH: 7.28, PaCO2: 31, PaO2: 60 mmHg, HCO3: 14.6 mEq/dL, and Hb: 10.9 g/dL. The patient was placed on mechanical ventilation (continuous mandatory ventilation (CMV) mode, fraction of inspired oxygen (FiO2): 100, tidal volume: 500 mL, respiratory rate: 15/minute, positive end-expiratory pressure (PEEP): 5 mmHg), and a central catheter and arterial catheter were inserted into the right subclavian vein and left femoral artery, respectively. Chest X-ray showed right pulmonary hemorrhage [], and computed tomography (CT) revealed a 9 cm radiopacity in the right upper hemithorax which suggested hematoma (hemothorax) as well as minor pneumothorax.\nSoon after undergoing CT, the patient stopped responding to mechanical ventilation. At that time, ABGA showed pH: 7.03, PaCO2: 42, PaO2: 43 mmHg, HCO3: 10.8 mEq/dL, oxygen saturation: 58%, and Hb: 7 g/dL. The patient was transferred to the angiography room for extracorporeal membrane oxygenation (ECMO), where a 21 Fr venous cannula (DLP®, Medtronic Inc., Minneapolis, MN, USA) was inserted into the right atrium, and a 24 Fr venous cannula (RMI®, Edward's Life Science LLC, Irvine, CA, USA) was inserted into the inferior vena cava via both femoral veins using the Seldinger technique, and venous ECMO was begun at 4 L/minute.\nNext, the patient was transferred to the operating room, where general anesthesia was induced with a bolus of rocuronium 50 mg for muscle relaxation. Then, a 37 Fr left DLT was inserted following removal of the single-lumen tube, and the correct position of the DLT was confirmed by fiberoptic bronchoscopy, both before and after positioning in the lateral decubitus position. A right anterolateral thoracotomy via the fifth intercostal space was performed, which revealed 3 L of blood in the extrapleural space as well as a blood clot due to a right subclavian artery injury. The blood and blood clot were removed and the damaged subclavian artery was repaired. During the surgery, which lasted approximately two hours, five pints of packed red cells were transfused. At the end of the operation, the DLT needed to be exchanged for a single-lumen tube. Using the AEC as a guidewire, a 12 F, 80 cm AEC with a flexible tip (METTI, VBM, Germany) was inserted 25 cm from the lip through the DLT, which we then tried to remove over the AEC. The DLT was removed stiffly, and the AEC remained in situ 25 cm from the lip following its removal. Subsequent intubation was performed through the AEC using a 7.5 Fr single-lumen tube. The tube was inserted smoothly, and fixed at 22 cm. We assumed that the ETT had been placed correctly into the trachea, although its position was not confirmed by auscultation or end-tidal carbon dioxide. Then, the patient was transferred to the intensive care unit (ICU) with Ambu bagging under ECMO. Immediately after arrival in the ICU, portable chest X-ray revealed esophageal misplacement of the ETT []. The patient was successfully reintubated using laryngoscopy, then extubated a week later. The ECMO was stopped 10 days later.
|
[[22.0, 'year']]
|
M
|
{'17905282': 1, '16645477': 1, '1824555': 1, '21257702': 1, '10443594': 1, '17898417': 1, '21831436': 1, '3813082': 1, '10625008': 1, '23956723': 2}
|
{}
|
162,578 |
3737700-1
| 23,956,724 |
noncomm/PMC003xxxxxx/PMC3737700.xml
|
Child with bilateral pheochromocytoma and a surgically solitary kidney: Anesthetic challenges
|
A 14-year-old boy, weighing 44 kg presented with complaints of excessive sweating since childhood, with recent onset fever, pedal edema, blurring of vision, easy fatigability, and Grade 2 dyspnea (NYHA). Four years ago, he underwent left nephrectomy in view of PUJ obstruction and a non-functioning kidney. His pulse rate was 102/min and blood pressure (BP) of 160/110 mm Hg. Adequate control of BP was achieved with tab. prazosin 7.5 mg tds, tab. nicardipine 40 mg bd, tab. propranolol 80 mg bd, and a combination of HCT-spironolactone 50 mg bd. A diagnosis of bilateral pheochromocytoma was made by raised levels of urinary catechol amines, ultrasound, and CT scan. CT scan showed bilateral adrenal masses with right adrenal mass measuring 5.8 × 4.1 × 4.3 cm and left mass was 6.4 × 2.9 × 3.8 cm []. 24-hour urine samples showed false-negative levels of HVA-14.3 mg/g (3-28 mg/g creatinine), VMA-8.6 mg/vol (2-8 mg/vol), but the ratio of VMA: Creatinine-38 mg/g of creatinine was elevated.[] Creatinine level was 224 mg/vol (800-1 500 mg/vol). 24-hour urinary catechol amines was done which showed levels of adrenaline - 0.6 μg (<20 μg) and noradrenaline - 359.1 μg (<90 μg). Other laboratory parameters were within normal limits. Echocardiography showed an ejection fraction of 51%, concentric LVH, and fair LV systolic function. Renal artery Doppler was normal on right side. Ophthalmological evaluation showed Grade 4 hypertensive retinopathy, resolving papilledema and signs of optic atrophy. Child was posted for bilateral adrenalectomy following initial therapy with a BP of 140/80 mm Hg and no postural hypotension. Oral antihypertensives were continued as per schedule with preoperative anxiolysis. Maintenance fluid was started overnight at 2 ml/kg/hr. Left radial artery was cannulated under local anesthesia. An epidural catheter was secured in right lateral position, in the T8-T9 space with careful positioning. 5 ml of 0.25% bupivacaine was administered. General anesthesia was induced using fentanyl 2 μg/kg and titrated doses of propofol. After adequate depth of anesthesia, gentle laryngoscopy was done and pharynx, epiglottis, and vocal cords were sprayed with 10% lignocaine. Right internal jugular cannulation was then performed (initial CVP was 15 mm of Hg). Intraoperative BP fluctuations during dissection and tumor manipulation of both sides were controlled with infusion of nitroglycerine (2-8 μg/kg/min) titrated to effect, MgSO4 – 25 mg/kg, dexmedetomidine – 1 μg/kg, and boluses of esmolol 5-10 mg. Analgesia was provided with epidural infusion of 0.25% bupivacaine. IV hydrocortisone 100 mg was given. After excision of the second tumor, precipitous fall in BP was managed with an infusion of noradrenaline, dopamine, crystalloid, and colloid. Estimated blood loss was 300 ml. Urine output was maintained at 0.5-1 ml/kg/hr. Blood sugar was monitored. At the end of procedure, child was extubated. The gross specimen showed a single mass on the right and lobulated tumor on the left []. Postoperatively, child required noradrenaline 100 ng/kg/min for maintenance of BP temporarily. IV hydrocortisone 20 mg 8th hourly was started and tapered off in 18 days. Also, oral fludrocortisone 0.1 mg once daily was simultaneously put on. Child had uneventful postoperative period and was discharged on 12th postoperative day.
|
[[14.0, 'year']]
|
M
|
{'14046640': 1, '6141233': 1, '11035703': 1, '3539166': 1, '5918098': 1, '7559889': 1, '15317907': 1, '10927994': 1, '7411363': 1, '6149463': 1, '23956724': 2}
|
{}
|
162,579 |
3737701-1
| 23,956,725 |
noncomm/PMC003xxxxxx/PMC3737701.xml
|
Anesthetic management of a child with corrected transposition of great vessels undergoing non-cardiac surgery
|
A 14-year-old girl weighing 30 kg presented with deformity of right foot following trauma and gait abnormality for 3 years. During childhood she suffered frequent from respiratory tract infections. Further assessment revealed her to have TGA for which she underwent pulmonary artery banding twice followed by a double switch procedure in childhood. Currently, she was on tablets, ramipril 2.5 mg and hydrochlorothiazide 12.5 mg for afterload reduction.\nPre-anesthetic check-up showed stable vitals except for mild peripheral cyanosis with SpO2 90% on room air. Cardiovascular evaluation revealed sternotomy scar, apex beat on right 5th intercostal space lateral to midclavicular line. No raised jugular venous pressure or parasternal heave was evident. Heart sounds were heard on the right chest and there was no murmur. She had a good effort tolerance.\nLaboratory investigations including haematocrit and electrolytes were normal. Electrocardiogram (ECG) showed heart rate 84 per minute, T wave inversion in V1, V2, and V3. Chest X-ray revealed dextrocardia. 2-D echocardiogram showed dextrocardia, situs inversus, atrioventricular-ventriculoatrial concordance, mild atrioventricular valve regurgitation on both left and right side. A 2.5 mm size ostium secundum atrial septal defect with bidirectional shunt, normal biventricular systolic function, and intact interventricular septum was found. Arterial blood gas on room air revealed pH 7.48, PaCO2 26 mmHg, PaO2 59 mmHg, and HCO3 19 mEq/L. Tab ramipril was continued and hydrochlorthiazide were skipped in the morning during surgery. Once the child was on operating table, baseline monitoring established (NIBP, SpO2, ECG on right side). Intravenous (IV) access 20 G canula left hand and left radial artery cannulated with 22 G canula and hep-locked with precautions not to inject/avoid air-bubbles. Infective endocarditis prophylaxis given with IV ampicillin 1.5 G and gentamycin 40 mg. Induction involved pre-oxygenation, fentanyl 50 μg, etomidate 8 mg, and sevoflurane 2-2.5% in O2. A proseal LMA (PLMA) size 2.5 was inserted following atracurium 15 mg. Controlled ventilation was initiated with tidal volume 250 mL, respiratory rate 13/min, and anesthesia maintained with sevoflurane 1.5-2%, air: O2 mixture with FiO2 40%. The procedure involved repair of tendoachillis tendon under tourniquet. Throughout the procedure (50 min) patient remained stable, maintaining SpO2 94-96%. The patient received 375 mL crystalloids. At the end of the procedure, the neuromuscular blockade was antagonized with neostigmine 1.5 mg and glycopyrrolate 0.3 mg. PLMA was removed once the patient was awake. The postoperative course was uneventful.
|
[[14.0, 'year']]
|
F
|
{'3877300': 1, '20730397': 1, '10585044': 1, '3259092': 1, '9659025': 1, '17823484': 1, '7853883': 1, '19933174': 1, '15679130': 1, '16115962': 1, '17446442': 1, '23956725': 2}
|
{}
|
162,580 |
3737702-1
| 23,956,726 |
noncomm/PMC003xxxxxx/PMC3737702.xml
|
Pourfour Du Petit syndrome after interscalene block
|
A 24-year-old male with fracture upper third shaft of left humerus was posted for open reduction and internal fixation. Patient had an insignificant post-anesthetic exposure for left inguinohernioplasty under spinal anesthesia. Patient was explained about the option of regional anesthesia for the above surgery and also about the possible complications. He agreed for the brachial plexus block. Patient was 152 cm tall, weighed 70 kg with no coexisting disease, and had normal physical examination and routine investigation.\nA left brachial plexus block was performed under aseptic precautions by interscalene approach using a 22-guage, 2-inch insulated needle with extension tube assembly (Stimuplex®, B Braun, Melsungen AG, 34209, Melsungen, Germany) after localizing the plexus with the help of the nerve stimulator by eliciting motor response at shoulder and upper arm at 0.5 mA. With all standard monitors, 40 ml of local anesthetic solution containing 200 mg of lignocaine with 50 μg adrenaline and 50 mg of bupivacaine was injected slowly over 5 min. Adequate sensory and motor block was achieved. But within 10 min after injection of local anesthetic solution, patient complained of increased sweating in the face and diminished vision in the left eye. On examination, sweating was confined to the left half of the face with widened palpebral fissure of the left eye and the left pupil was dilated in comparison to the right pupil (4 mm/2 mm). Patient was reassured and the surgery was completed successfully. These symptoms resolved when the plexus functions returned to normal.
|
[[24.0, 'year']]
|
M
|
{'3715780': 1, '6742547': 1, '17513685': 1, '8923075': 1, '1023346': 1, '9608222': 1, '5534420': 1, '19091709': 1, '2178179': 1, '12706784': 1, '5439369': 1, '6689890': 1, '23000183': 1, '7294419': 1, '21045936': 1, '4890046': 1, '23956726': 2}
|
{}
|
162,581 |
3737703-1
| 23,956,727 |
noncomm/PMC003xxxxxx/PMC3737703.xml
|
Posterior leukoencephalopathy syndrome: Postpartum focal neurologic deficits: A report of three cases and review of the literature
|
A 29-year-old woman, G2 P1, at the 35th week of gestation with a history of pregnancy-induced hypertension, was admitted to the emergency department due to two generalized seizures episodes at home without prodromal symptoms. According to the patient's husband, the patient has presented malaise and headache during the past week.\nThe patient's blood pressure was 180/100 mmHg at admission. Obstetric ultrasound was normal. The laboratory test concerning renal and liver function was normal, except for the presence of 2 + proteinuria. The electrocardiogram showed sinus tachycardia. Emergency cesarean delivery was indicated due to eclampsia. Rapid sequence induction with 200 mg of propofol and 100 mg of succinylcholine was administered and anesthesia was maintained with oxygen and nitrous oxide at a concentration of 50%. 1.5% of sevofluorane and 150 mcg of fentanyl were administered after the umbilical cord was clamped. After induction and during surgery, systolic blood pressure was between 140 mmHg and 130 mmHg. A 2000 g male infant with Apgar scores of 7 at 10 min was delivered. The scalp pH was 7.17 and appropriate resuscitation was performed. The patient was admitted extubated at the Post Anesthesia Care Unit (PACU) with blood pressure over 170/110 mmHg, conscious, hemodynamically stable and disoriented, with a coherent conversation but with blurred vision. No focal neurological symptoms were seen at this time. Her blood pressure decreased from 170/110 mmHg to 140/100 mmHg after an intravenous administration of magnesium sulfate first bolus of 4 gr followed by an infusion of 1 g/24 h associated with intravenous infusion of labetalol and nitroglycerin according to our protocol. The laboratory test in the Intensive Care Unit (ICU) was normal. After surgery, a cranial computerized tomography (CT) and magnetic resonance imaging (MRI) scans were performed because the patient was still Hypertensive and had headache and confusion. The CT scan showed findings consistent with posterior reversible encephalopathy in the context of eclampsia, and brain MRI confirmed these findings []. Ophthalmological examination was requested showing moderate hypertensive retinopathy. An echocardiogram was also performed showing slight pericardial effusion, normal left ventricular size and normal systolic function, moderate functional mitral regurgitation and pulmonary artery pressure slightly elevated. Three days after the seizures, her neurologic examination became normal. Her blood pressure gradually normalized but laboratory values still showed slight anemia and mild proteinuria. She was treated orally with amlodipino 10 mg/day and labetalol 200 mg bid from the second day of stay at the ICU. One week later, the MRI was repeated and results were normal. Nine days later, the patient was discharged home without any neurological sequel.
|
[[29.0, 'year']]
|
F
|
{'16215360': 1, '29849324': 2, '16945518': 1, '12057549': 1, '10954269': 1, '21911199': 1, '19566552': 1, '7705536': 1, '14747815': 1, '16258402': 1, '16855969': 1, '12811718': 1, '8559202': 1, '16497761': 1, '30809401': 1, '21333604': 1, '11376265': 1, '15705136': 1, '22341535': 1, '23956727': 2}
|
{'3737703-2': 2, '3737703-3': 2, '5965172-1': 1}
|
162,582 |
3737703-2
| 23,956,727 |
noncomm/PMC003xxxxxx/PMC3737703.xml
|
Posterior leukoencephalopathy syndrome: Postpartum focal neurologic deficits: A report of three cases and review of the literature
|
A 45-year-old woman, G1 P0, at the 39th week of gestation, was admitted to the emergency department after a generalized seizure at home without prodromal symptoms. After seizure, she presented drowsiness. According to the patient's husband, the patient was presenting progressive and widespread edema in the prior weeks but she did not suffer any hypertensive episode or neurologic symptom. Cesarean section was indicated due to eclampsia 1 h from the admission. General anesthesia was performed with rapid intubation sequence using 100 mg of succinylcholine and 200 mg of propofol and 150 ug of fentanyl after the umbilical cord was clamped, without any complications. She maintained systolic blood pressure between 110 mmHg and 80 mmHg during anesthesia. An intravenous administration of magnesium sulfate first bolus of 4 gr followed by a infusion of 1 g/24 h was started. A live male infant with significant clinical deterioration was delivered. The newborn umbilical cord pH was 6.75 and he was transferred to the pediatric ICU for appropriate resuscitation. Emerge from anesthesia in the operating room was delayed for no apparent reason, and once the patient was awake, she was stirred and confused without apparent focal neurological deficit. The patient was admitted extubated to the PACU, conscious, with agitation, disorientation, incoherent speech, exaltation of the patellar reflexes and blurred vision. No neurological focal deficit at that time of clinical assessment was found. The patient presented obesity and foveal edema. The administration of magnesium sulfate was continued and an intravenous infusion of labetalol was added. Despite this treatment, her blood pressure remained high. Dexamethasone 4 mg was added to the treatment. The laboratory test at admission was altered with creatinine 2.12 mg/dL, potassium 5.1 mEq/L, magnesium 5.88 mg/dL and sodium 130 mEq/L, pH 7.26 and HCO3 13 mEq/L, elevated LDH and 3 + proteinuria.\nSix hours after surgery, a cranial CT, brain MRI, electroencephalogram and angioresonance were performed. The cranial CT scan was normal. The brain MRI showed subcortical hyperintense lesions, on T2-weighted sequences, with different characteristics []. The electroencephalogram showed signs of brain involvement lateralized in the right hemisphere and the angioresonance was normal. In the PACU, her blood pressure remained high. Creatinine values increased to 3.2 mg/dL; however, these values normalized within 2 days and the creatinine clearance at discharge was 155 mL/min, with persistence of proteinuria 305 mg/mL and albumin 1.4 g/dL. Intravenous infusion of antihypertensive drugs was removed and she was treated orally with amlodipine 10 mg/day, labetalol 200 mg tid, irbesartan 300 mg/day and enalapril 10 mg bid. Because of persistent high blood pressure and renal impairment, a renal Doppler ultrasound was also performed, which showed good bilateral arterial and venous supply. The resistance indices and acceleration, as well as the morphology of the wave, were normal. Due to the patient's improvement, she was transferred to the gynecology ward. The patient was discharged without any neurological deficits.
|
[[45.0, 'year']]
|
F
|
{'16215360': 1, '29849324': 2, '16945518': 1, '12057549': 1, '10954269': 1, '21911199': 1, '19566552': 1, '7705536': 1, '14747815': 1, '16258402': 1, '16855969': 1, '12811718': 1, '8559202': 1, '16497761': 1, '30809401': 1, '21333604': 1, '11376265': 1, '15705136': 1, '22341535': 1, '23956727': 2}
|
{'3737703-1': 2, '3737703-3': 2, '5965172-1': 1}
|
162,583 |
3737703-3
| 23,956,727 |
noncomm/PMC003xxxxxx/PMC3737703.xml
|
Posterior leukoencephalopathy syndrome: Postpartum focal neurologic deficits: A report of three cases and review of the literature
|
A 35-year-old woman, G2 P1, at 39 weeks’ gestation, was admitted to the emergency department with labor work. Her medical record showed no significant disease and her prenatal history was unremarkable. An epidural catheter was placed and epidural analgesia was administered. The blood test was normal. During labor, her systolic blood pressure remained high, with values of 170/90 mmHg being recorded. This blood pressure persisted and intravenous 5 mg hydralazine was administered. A 2700 g newborn was delivered alive with Apgar scores of 7 at 10 min. The umbilical cord pH was 7.26. He was transferred to a pediatric clinic where appropriate resuscitation was performed.\nThe patient was transferred to the obstetric ward 2 h after delivery, with persisting high blood pressure and headache. Alphamethyldopa 500 mg orally was administered to control arterial pressure, but, 20 min later, the patient had a seizure and intravenous 10 mg of diazepam was administered to control the same. The patient recovered, presenting confusion, and was then admitted to the PACU with stupor, without focal neurological and mild lower limb edema. A cranial CT scan was performed, which showed findings consistent with posterior reversible encephalopathy []. In the laboratory blood test, the hemoglobin, platelet count and prothrombin activity were 11.7 mg/dL, 67,000 × 109/L and 60%, respectively. The patient also presented elevated liver enzymes and proteinuria. Elevated blood pressure persisted, requiring intravenous infusion of labetalol (25 mg bolus dose over 2-5 min). An intravenous infusion of magnesium sulfate was also initiated for 24 h. At 48 h, the intravenous infusions were suspended and oral treatment was initiated with amlodipine 10 mg/day and irbesartan 300 mg/day.\nBecause of the improvement of patient, she was transferred to the gynecology ward on the third day. Five days later, an MRI was performed. Results were normal. The patient was discharged without any neurological deficits.
|
[[35.0, 'year']]
|
F
|
{'16215360': 1, '29849324': 2, '16945518': 1, '12057549': 1, '10954269': 1, '21911199': 1, '19566552': 1, '7705536': 1, '14747815': 1, '16258402': 1, '16855969': 1, '12811718': 1, '8559202': 1, '16497761': 1, '30809401': 1, '21333604': 1, '11376265': 1, '15705136': 1, '22341535': 1, '23956727': 2}
|
{'3737703-1': 2, '3737703-2': 2, '5965172-1': 1}
|
162,584 |
3737704-1
| 23,956,728 |
noncomm/PMC003xxxxxx/PMC3737704.xml
|
Anaesthetic challenges in a patient presenting with huge neck teratoma
|
A 3 year old girl, weighing 12 kg, presented to the out-patient department with a massive neck mass enlarging gradually over the past two year. She tends to fall forwards in upright position and had difficulty in breathing/strider in lying down posture. The base of the mass extended vertically from lower border of mandible up to clavicle inferiorly (approx. 18 × 12 cm in size) and on both sides approaching posterior triangle of neck (more towards left side). The mass was firm in consistency, non-translucent, non-tender with a shallow ulcer (2 × 2 cm size) at most dependent part []. Systemic examination/routine haematology was within normal limits. Skiagram and CECT of the neck/chest showed a soft tissue mass involving major vessels of neck with extra-thoracic extension up to the lower end of sternum and marked trachea deviation towards the right side (C4-T2 vertebral level) []. Cytology (FNAC) report was suggestive of teratoma. At the preoperative visit, her airway examination revealed Mallampatti grade III with restricted neck movements. She was graded as ASA II according to American Society of Anaesthesiologists risk classification.\nAs a part of pre-anaesthetic preparation, availability of adequate blood and difficult airway cart was ensured in the operation theatre. Patient was pre-medicated with glycopyrrolate 0.01 mg/kg IV, ondansetron 0.15 mg/kg IV. After pre-oxygenation, inhalational anaesthesia was induced with incremental doses of halothane (0.5% increment after every five breaths up to 3.0%) with 100% oxygen until intubating conditions were achieved. A cushion was placed under the shoulder to provide better laryngoscopic view. Two experienced anaesthesiologist participated in the procedure, one for holding the tumour mass and other for intubation. In the first attempt using Macintosh blade, intubation failed due to marked laryngeal deviation towards the right side (Cormach-Lehane grade 3). In the second attempt, using Magill blade, a 4.5 mm uncuffed endotracheal tube slided over the vocal cords but after that resistance was encountered. Immediately, a smaller size (4 mm) endotracheal tube was exchanged over the suction catheter (8.0 mm size) and trachea was now intubated, with confirmed bilateral air entry. Neuromuscular blockade was then facilitated with rocuronium (0.6 mg/kg IV) and a triple lumen central venous cannulation was done into right subclavian vein. Surgery was allowed to commence and anaesthesia was maintained with halothane, nitrous oxide/oxygen combination (60%/40%) and rocuronium (0.1 mg/kg IV) throughout surgery. The vitals remained stable throughout the operation and no major blood loss was there. A soft tissue mass weighing 2.75 Kg was excised during this procedure that lasted for about 2 hrs. At the end of surgery, after confirming adequate breathing efforts, neuromuscular block was reversed with neostigmine (0.05 mg/kg IV), glycopyrrolate (0.01 mg/kg IV). The patient was extubated and transferred to PACU. The patient remained stable throughout the postoperative period with no further complications.
|
[[3.0, 'year']]
|
F
|
{'21735298': 1, '2331412': 1, '6620078': 1, '11149469': 1, '16250313': 1, '22869931': 1, '23956729': 1, '23956728': 2}
|
{}
|
162,585 |
3738318-1
| 24,175,058 |
noncomm/PMC003xxxxxx/PMC3738318.xml
|
A case of tricuspid regurgitation and congestive cardiac failure presenting with orbital pulsation
|
A 74-year-old lady presented to our Medical Assessment Unit with two weeks’ history of increasing orthopnoea, ankle swelling and abdominal distension. Past medical history included ischaemic heart disease and atrial fibrillation. She also had a history of normocytic normochromic anaemia of unknown cause. Her regular medications included aspirin 75 mg (once daily); simvastatin 40 mg (once per night); sotalol 160 mg (once daily); doxazosin 4 mg (once daily); and lisinopril 20 mg (once daily).\nOn examination, her pulse was 80 per minute, irregularly irregular and blood pressure was 180/80 mmHg. Normal heart sounds were heard throughout the praecordium. The jugular venous pressure (JVP) was grossly elevated up to the earlobes causing them to pulsate with an indiscernible waveform, even with the patient sitting fully upright. The external jugular veins were filled, consistent with increased venous pressure. There was pitting ankle and sacral oedema. Diffuse crackles were heard throughout both lungs. There was gross, tense ascites, but no signs of chronic liver disease. Neurological examination was normal. On fundoscopy, the optic discs appeared normal with characteristic venous pulsation.\nOf note, there was bilateral forward systolic eyeball displacement of up to 5 mm at all angles of incline of the patient when viewed from the side (Figure ). There was no visual disturbance associated with the pulsation. The patient was asymptomatic and was not aware of any orbital movement.\nThe admission electrocardiogram showed atrial fibrillation. A chest X-ray showed cardiomegaly, alveolar oedema and bilateral pleural effusions. Admission bloods revealed a normocytic anaemia with low white cell count but a normal platelet count. Urea and electrolytes, liver function tests and bone profile were unremarkable.\nThe clinical impression at this stage was that of congestive cardiac failure with severe venous hypertension. The increasing ascites and generalized pitting oedema was likely to be secondary to congestive cardiac failure, on a background of ischaemic heart disease.
|
[[74.0, 'year']]
|
F
|
{'8409071': 1, '11529211': 1, '11492984': 1, '10452461': 1, '4005756': 1, '8438758': 1, '34737541': 1, '17167622': 1, '5474495': 1, '24175058': 2}
|
{}
|
162,586 |
3738330-1
| 23,986,821 |
noncomm/PMC003xxxxxx/PMC3738330.xml
|
Bilateral multiple extraocular muscle metastasis from hepatocellular carcinoma
|
A 44-year-old man presenting with diplopia of three months' duration was admitted to our hospital in August 2011. A detailed history revealed that he had undergone partial resection for HCC in the S7 segment in March 2010.\nThree months before his visit to us, he developed rapidly progressive proptosis and double vision. In addition, he reported a 7-kg weight loss within the past month. Ophthalmologic examination disclosed that his visual acuity was normal in both eyes with normal anterior and posterior segments. Motility examination of the right eye revealed severe limitation of adduction and depression, and moderate limitation of elevation and abduction. The left eye revealed severe limitation of adduction and abduction.\nOrbital MRI showed nodular enlargement of the bilateral multiple EOMs, including the right superior oblique muscle, lateral rectus and inferior rectus, and the left lateral and medial rectus. The enlarged EOMs exhibited isointensity to cerebral white matter on T1-weighted images (Fig. ) and heterogeneous intermediate-to-high signal intensity to cerebral white matter on T2-weighted images (Fig. ). The muscle borders were well-defined, and there was mild-to-significant heterogeneous contrast enhancement with gadolinium (Fig. ). The tendons were seen to be spared, and there was no evidence of orbital bone marrow involvement. Orbital echography revealed multiple enlarged EOMs with low internal reflectivity.\nBiopsy of the right superior oblique muscle was performed by a lid crease incision. Microscopic examination revealed a diffuse infiltration of atypical polygonal cells, which contained hyperchromatic nuclei in the eosinophilic cytoplasm. Immunohistochemically, the tumor cells were positively stained for AFP (Fig. ). These features were consistent with metastatic HCC with moderate differentiation. The patient received external beam radiation therapy to the orbit, which led to significant improvement of his bilateral proptosis and ocular motility.
|
[[44.0, 'year']]
|
M
|
{'28839518': 2, '7522316': 1, '15590527': 1, '16139041': 1, '9682712': 1, '16924330': 1, '8183505': 1, '7807727': 1, '9227204': 1, '2771351': 1, '7845650': 1, '19264688': 1, '5562786': 1, '11213742': 1, '10643005': 1, '23986821': 2}
|
{'5550763-1': 1}
|
162,587 |
3738331-1
| 23,986,822 |
noncomm/PMC003xxxxxx/PMC3738331.xml
|
Mixed epithelial and stromal tumor of the kidney with polypoid component extending into renal pelvis and ureter
|
A 61-year-old postmenopausal woman presented with gross hematuria for two weeks. The physical examination was unremarkable. She had no relevant family history or medical history other than mild obesity. Her routine blood investigation was normal with no elevated serum tumor marker. Ultrasonography revealed the presence of a left renal mass in the interpolar region extending into the renal pelvis. Exfoliative urine cytology was class 3. Excretory phase contrast-enhanced CT (Fig. ) showed a well-circumscribed multiseptate cystic mass of 44 × 40 × 45 mm in the interpolar region of the left kidney with a polypoid solid component protruding into the renal pelvis and proximal ureter. Calcification was identified within the solid component. Retrograde ureterography (Fig. ) showed mild hydronephrosis due to the polypoid part of the tumor in the ureter. Dynamic MRI study (Figs. and ) demonstrated delayed contrast enhancement of the solid polypoid component and multiple septa.\nSince the tumor was consistent with a Bosniak category IV cystic mass, we performed a laparoscopic left nephro-ureterectomy. Gross examination showed a well-marginated multilocular cystic mass with a polypoid solid component protruding into the renal pelvis and ureter (Fig. ). Histopathological analysis revealed an intermixture of epithelial elements consisting of varying sized glands and a proliferation of spindle cells resembling ovarian stroma. The polypoid lesion was superficially covered with normal urothelium. Complex glands with a single layer of flattened, cuboid or hobnail-appearing epithelium and a mild cellular atypia of swollen nuclei were marked in the cystic lesion. The tumor was well-marginated but no capsule was found histologically. No malignant cells were found. Immunohistochemically, spindle cells expressed vimentin and alpha smooth muscle actine, and were partially positive for progesterone receptor, bcl-2, CD99, and desmin. Epithelial cells were positive for cytokeratin and epithelial membrane antigen, partially positive for vimentin, bcl-2 and negative for CD99, alpha smooth muscle actine, desmin, or progesterone receptor. The estrogen receptor was negative in both. On the basis of the morphologic and immunohistochemical findings a pathologic diagnosis of MEST was achieved.\nThe postoperative course of the patient was uneventful. There was no local recurrence or metastasis during 10-month follow-up.
|
[[61.0, 'year']]
|
F
|
{'14987239': 1, '18313107': 1, '33552340': 1, '21071374': 1, '16390243': 1, '17414095': 1, '9689654': 1, '19133001': 1, '17707262': 1, '15581546': 1, '16272852': 1, '11764393': 1, '15322873': 1, '10895818': 1, '18971776': 1, '18094306': 1, '19818075': 1, '18261632': 1, '23986822': 2}
|
{}
|
162,588 |
3738332-1
| 23,986,823 |
noncomm/PMC003xxxxxx/PMC3738332.xml
|
A new diffusion metric, diffusion kurtosis imaging, used in the serial examination of a patient with stroke
|
A 40-year-old woman complained of headache and speech disturbance without motor dysfunction for the previous two weeks. An interview revealed that she had no history of disease. Brain MRI demonstrated multiple cerebral infarctions and a more subacute infarcted lesion in the right frontal deep white matter on DWI and the calculated ADC map (Fig. a and b). A corresponding mean DK image showed the peripherally high intensity and dark dot in the stroke lesion (Fig. c). Infarction in the left temporal cortex was also observed, which was thought to be the cause of the speech dysfunction (not shown). Moreover, MR angiography poorly depicted the bilateral middle and anterior cerebral arteries (not shown). The patient was ultimately diagnosed with Moyamoya disease. Two weeks later, repeated MR scanning revealed a homogenous high signal on both DWI and the ADC map (Fig. d and e) and partially normalized mean DK (Fig. f) in the corresponding ischemic lesion. In the FLAIR image taken 6 months later (Fig. g), the stroke lesion displayed a low signal in the central cystic portion with peripheral high intensity, as reflected in the DK image.
|
[[40.0, 'year']]
|
F
|
{'21640304': 1, '29393531': 1, '29213008': 1, '22933581': 1, '24414884': 1, '15906300': 1, '26937016': 1, '20960579': 1, '21419670': 1, '23086313': 1, '28484279': 1, '23986823': 2}
|
{}
|
162,589 |
3738333-1
| 23,986,824 |
noncomm/PMC003xxxxxx/PMC3738333.xml
|
Urachal carcinoma: imaging findings
|
A 46-year-old woman presented at our hospital with recurrent pelvic pain and frequent daytime urination of three months duration. Her medical history was unremarkable.\nDespite suprapubic tenderness on palpation, physical examination was normal.\nComplete blood count revealed marked increase in CEA to 1603 ng/mL (reference value <4 ng/mL) and slight increase in CA 125 to 46.5 U/mL (reference value <35 U/mL).\nPelvic ultrasound revealed a supravesical complex cystic mass with foci of increased echogenicity, suggestive of calcifications (Fig. ).\nOn contrast-enhanced CT it was seen a heterogeneous mass, of approximately 12.5 cm, extending through the anterosuperior wall of the bladder to the right flank. The lesion revealed low-attenuation and multiple dystrophic calcifications, suggestive of mucinous adenocarcioma. There was no evidence of local or distant metastases (Fig. ).\nMR was performed to better characterize the lesion and revealed a large inhomogeneous mass in contact with the dome and superior wall of the bladder and occupying the right flank. The lesion showed high signal intensity on T2-weighted images and intermediate signal on T1-weighted images. After intravenous contrast administration the mass enhanced slightly peripherally (Fig. ).\nOpen laparotomy revealed that the lesion was strongly adhered to the wall of the bladder and partial cystectomy with en-bloc resection of the mass was performed. Histologic analysis revealed an urachal mucinous adenocarcinoma.
|
[[46.0, 'year']]
|
F
|
{'33013244': 1, '29682385': 2, '29721106': 1, '25295114': 1, '24556377': 1, '27429672': 1, '16549617': 1, '31283453': 1, '19448126': 1, '16826585': 1, '11867795': 1, '11259707': 1, '8256396': 1, '23986824': 2}
|
{'5851316-1': 1}
|
162,590 |
3738334-1
| 23,986,825 |
noncomm/PMC003xxxxxx/PMC3738334.xml
|
Bilateral thalamic infarction and DSA demonstrated AOP after thrombosis
|
A 61-year-old woman was admitted to the emergency room with sudden onset of unconsciousness. CT showed no acute hemorrhage or infarctions. She received thrombolysis (rt-PA) within 6 h and Glasgow Coma Scale (GCS) score was back to 15 right after. However, she still complained of drowsiness and mild memory deficit. Diffusion-weighted imaging (DWI) the next day showed symmetrical paramedian thalamic high signal intensity (Fig. ). The patient was then transferred to our hospital after 20 days. On admission she was somnolent and disoriented to time and place. Neurological examination showed vertical gaze palsy and upgoing plantar reflexes bilaterally.\nShe had no history of diabetes, hypertension, hyperlipidemia, or atrial fibrillation. Laboratory investigations were unremarkable. An MRI after three weeks showed symmetric enhanced signals in the paramedian thalamus (Fig. ). Digital subtraction angiography (DSA) showed that the P1 segment of the right PCA was absent. The P2 segment was supplied by the right posterior communicating artery (PcomA). A stenotic AOP originated from the left P1 segment was also visualized (Fig. ).\nShe was discharged 2 weeks later with full consciousness but severe cognitive impairment.
|
[[61.0, 'year']]
|
F
|
{'30706382': 1, '27003984': 2, '12933968': 1, '20299438': 1, '3368064': 1, '1908474': 1, '25436032': 2, '4126735': 1, '23986825': 2}
|
{'4245066-1': 1, '4780158-1': 1}
|
162,591 |
3738335-1
| 23,986,826 |
noncomm/PMC003xxxxxx/PMC3738335.xml
|
Unusual cause of neuropathy: extensive dural spread of primary cervical osteosarcoma
|
The patient was a 62-year-old woman brought in to the hospital by her daughter who said that the patient had complained of several swellings in her neck region over a period of 4 months.\nAll the swellings had progressively increased in size and the patient indicated that she had pain upon flexion, extension, and rotation of the neck. The pain was associated with hoarseness and a lowering in pitch of the voice. She had significant weight loss (approximately 30% reduction) over the past 4 months. The patient also complained of some weakness of the right upper limb and numbness of the right hand.\nUpon examination, the patient was cachexic with significant muscle wasting especially in the supraclavicular fossae. Examination of the neck revealed three swellings as follows: swelling 1: Posterior neck: swelling measured 7 × 8 cm, round, well-defined margins, firm, rubbery, not attached to the superficial fascia but fixed to the muscle, not mobile, and mildly tender to palpation; swelling 2: Right level V(B) lymph node measuring 3 × 2 cm, well-defined borders, firm, rubbery, not mobile, not fixed to the superficial fascia, and mildly tender to palpation; and swelling 3: Left level III lymph node measuring 2 × 2 cm, well-defined borders, firm, rubbery, not attached to the superficial fascia, not mobile, and mildly tender to palpation.\nThe following investigations were carried out:\nAn excision biopsy of the right neck level V (B) lymph node showed a high grade sarcoma, consistent with osteosarcoma. The histopathological examination showed cells having osteoid deposition (osteoblastic variant of osteosarcoma) (Fig. ) and staining positively with vimentin and smooth muscle actin but not with S100 protein; Magnetic resonance imaging (MRI) of the neck showed a 5 × 4 cm posterior neck tumor, centered around the spinous processes of C2–C4, with bony destruction. The tumor also enveloped the posterior elements and wrapped around them. Anteriorly, the tumor extended up to the spinal canal, compressing the spinal cord but without any abnormal cord signal. There was enhancement of the posterior dura and body of C2 and C3 suggesting dural and bony involvement. There were also multiple enhancing neck nodes; Computed tomography (CT) of the chest and abdomen showed pleural and lung nodules most likely metastasis, in view of the history; Contrast-enhanced CT (CECT) of the neck, thorax, and abdomen after the patient had received three cycles of chemotherapy with IV Doxorubin 20 mg/m2 and IV Cisplatin 25 mg/m2 showed tumor progression with worsening of lung metastases and cervical lymph node involvement; extensive intradural involvement from C2 to C4 (Figs. and ) was seen as well.\nDue to these findings a decision was made to stop chemotherapy and start radiotherapy. The patient underwent one session of radiotherapy and was to continue with this treatment when she suddenly became paraplegic. The patient refused any further treatment.
|
[[62.0, 'year']]
|
F
|
{'8641093': 1, '17138225': 1, '1067250': 1, '6930985': 1, '17267328': 1, '15667972': 1, '6585007': 1, '3459729': 1, '2326708': 1, '15850902': 1, '14749514': 1, '23986826': 2}
|
{}
|
162,592 |
3738336-1
| 23,986,827 |
noncomm/PMC003xxxxxx/PMC3738336.xml
|
Hepatic encephalopathy due to intrahepatic portosystemic venous shunt successfully treated by balloon occluded retrograde transvenous embolization with GDCs
|
A 65-year-old man was referred with a history of repeated episodes of unconsciousness. The patient had no history of trauma, liver biopsy, or liver disease. Gastrectomy had been performed for gastric cancer 3 years previously, and at the time of admission the patient was free from tumor. A review of the entire family tree revealed no inherited disorder. Laboratory studies showed no liver dysfunction with the exception of a mild increase in the serum ammonia level (147 μg/dl; normal range, <79 μg/dl). Contrast-enhanced multidetector-row CT revealed a large abnormal vessel in communication with a peripheral right portal branch and the right hepatic vein, which suggested the existence of an IPSVS. The shunt was 15 mm in diameter. These findings confirmed that a hepatic encephalopathy caused by an IPSVS was responsible for the repeated episodes of unconsciousness. Therefore, we attempted embolization of the IPSVS.\nAfter the patient provided written informed consent, the following procedures were performed with the patient under local anesthesia. First, a 5-F cobra-shaped catheter (Terumo Clinical Supply, Gifu, Japan) was inserted from the right femoral artery. Then, superior mesenteric arterial portography was performed, which confirmed the presence of an IPSVS forming a communication between the right portal vein and the right hepatic vein. Next, a 6-F sheath introducer (Medikit, Tokyo, Japan) was inserted from the right femoral vein after which a 6-F hook-shaped guiding catheter (Terumo Clinical Supply) was advanced to the right hepatic vein. Subsequently, a 3.3-F micro-balloon catheter (Fuji Systems, Fukushima, Japan) with a balloon 10 mm in diameter was advanced through the guiding catheter into the right hepatic vein. Third, a 5-F sheath introducer (Medikit) was inserted from the right femoral vein to accommodate a 5-F hook-shaped catheter (Terumo Clinical Supply). The 5-F hook-shaped catheter was inserted into the right hepatic vein, followed by coaxial passage by a 0.018-inch micro-catheter (Renegade; Boston Scientific, Watertown, MA, USA) through the IPSVS into the portal vein (Fig. a). Fourth, the balloon of the micro-balloon catheter was inflated to decrease hepatofugal blood flow in the intrahepatic portosystemic venous shunt and to avoid migration of the coils to the systemic venous site. Injection of the contrast medium via the micro-catheter advanced into the portal vein showed stasis of hepatofugal blood flow in the IPSVS. Fifth, the micro-catheter was re-positioned in the IPSVS, and 11 GDCs (GDC-18, 360°; diameter, 10–16 mm; length, 30 cm; and GDC-18 fibered-Vortx, diameter 4–6 mm) were placed in the IPSVS from the micro-catheter. Superior mesenteric arterial portography obtained after the balloon was deflated showed sufficient embolization of the IPSVS (Fig. b). Finally, all catheters were withdrawn. There were no procedural complications, and liver function was consistently normal after embolization. The serum ammonia level had normalized to 66 μg/dl the day following the procedure. Enhanced multidetector row CT obtained 1 week after the procedure revealed sufficient embolization of the IPSVS.\nCurrently, 14 months after this interventional procedure, the patient has no symptoms of hepatic encephalopathy and his clinical condition is good.
|
[[65.0, 'year']]
|
M
|
{'22325417': 1, '8089327': 1, '9455737': 1, '1920910': 1, '15387347': 1, '3757427': 1, '2117349': 1, '8662164': 1, '14072076': 1, '27990104': 2, '12818832': 1, '23986827': 2}
|
{'5156888-1': 1}
|
162,593 |
3738337-1
| 23,986,828 |
noncomm/PMC003xxxxxx/PMC3738337.xml
|
Transcatheter arterial embolization with trisacryl gelatin microspheres (Embosphere®) leads to life-threatening tumor lysis syndrome in a rectal carcinoid patient with hepatic metastases
|
A 34-year-old man was admitted to our hospital for treatment of multiple hepatic metastases from a rectal carcinoid tumor. He had been treated with local extirpation of a rectal tumor 4 years previously. Abdominal computed tomography (CT) 25 months later revealed multiple liver metastases. The diagnosis was confirmed by liver biopsy, and the tumor cells were immunoreactive to synaptophysin. The patient was then treated with Yttrium-90 selective internal radiation therapy about 1 year and 7 months before this admission. Yttrium-90 resin microspheres (SIR-spheres; Sirtex Medical, Sydney, Australia) mounted with a radioactive load of approximately 50 Bq per sphere were used for radioembolization. One year and 2 months after the Yttrium-90 therapy, a follow-up abdominal CT showed liver metastases in progression. Therefore, further embolization with Embosphere® (BioSphere Medical, Inc., Rockland, MA, USA) was performed.\nThe patient had no past medical history of serious illness such as hypertension, diabetes mellitus, or chronic kidney disease, nor any hospitalization other than treatment for the carcinoid tumor.\nOn physical examination, a huge mass was palpable in the upper abdomen. There was no ascites or signs of encephalopathy. On the day of admission, laboratory results showed hemoglobin 11.3 g/dL, platelet count 207000/mm3, alanine aminotransferase (ALT) 37 IU/L, aspartate aminotransferase (AST) 35 IU/L, albumin 3.9 g/dL, total bilirubin 0.57 mg/dL, lactate dehydrogenase (LDH) 402 IU/L, creatinine 0.8 mg/dL, potassium 4 mmol/L, and prothrombin time 13.5 s. The Child-Pugh class was A.\nOn unenhanced and contrast-enhanced CT, there were more than 20 hepatic tumors in both lobes, with the largest being > 18 cm in diameter (Fig. a and b). Hepatic angiography was performed via a right femoral artery approach (Fig. a and b). A 4-French catheter and a 2.7-French microcatheter were used for celiac trunk and superselective hepatic (segmental and subsegmental) angiography, respectively, revealing multiple tumor stains in both hepatic lobes. TAE was performed by injection of 2 mL 100–300 μm Embosphere® particles in the left hepatic artery's supplying branches and 2 mL 100–300 μm, 2 mL 300–500 μm Embosphere® particles injection in the right hepatic artery's supplying branches until there was sluggish hepatic arterial flow. The coil shown in the picture (Fig. ) was placed during the procedure of Yttrium-90 therapy. Coil embolization of the right gastric artery and gastroduodenal artery could avert reflux and thereby decrease the risk of gastric ulcer during Yttrium-90 therapy.\nThree days after TAE, the patient complained of general fatigue and poor appetite. He also became oliguric. Laboratory tests showed ALT 430 IU/L, AST 1910 IU/L, total bilirubin 7.63 mg/dL, LDH 16300 IU/L, creatinine 6.54 mg/dL, potassium 7 mmol/L, phosphorous 10.7 mg/dL, calcium 6.2 mg/dL, and uric acid 13.4 mg/dL. As the patient developed hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia, and acute renal failure, the diagnosis of acute tumor lysis syndrome was made. He was first treated with 0.9% saline hydration, then alkalinization of urine with sodium bicarbonate, allopurinol for hyperuricemia, kalimate, and calcium gluconate for hyperkalemia were applied 3 days after TAE. However, anuria developed and he received emergency hemodialysis. Rasburicase was applied for hyperuricemia on the fifth day after TAE.\nAfter intensive care, the patient gained satisfactory recovery of both renal and hepatic functions on day 68 after TAE. Laboratory tests showed ALT 16 IU/L, AST 16 IU/L, total bilirubin 0.58 mg/dL, creatinine 0.79 mg/dL, BUN 12 mg/dL, potassium 3.9 mmol/L, and prothrombin time 12.6 s. Follow-up unenhanced CT scan on day 34 after TAE showed large areas of necrosis (Fig. ).\nBecause of disease progression 1 year later, TAE was performed once more with Embosphere® after prevention for tumor lysis syndrome (adequate hydration and the usage of rasburicase). Neither tumor lysis syndrome nor acute renal failure occurred after this procedure. Finally, the patient died of progressive disease 4 months after the second TAE.
|
[[34.0, 'year']]
|
M
|
{'16891885': 1, '12704055': 1, '15886943': 1, '12569593': 1, '17354139': 1, '14706584': 1, '16772882': 1, '15063817': 1, '18177818': 1, '19787837': 1, '21561350': 1, '12399054': 1, '2424291': 1, '23986828': 2}
|
{}
|
162,594 |
3738338-1
| 23,986,829 |
noncomm/PMC003xxxxxx/PMC3738338.xml
|
Polyarteritis nodosa with uterine involvement
|
A 78-year-old woman with a history of hepatitis B and Sjögren syndrome was admitted to a local clinic near her house experiencing prolonged fever and leg pain. After being transferred to our hospital, a complete physical examination revealed leg livedo. She did not notice atypical genital bleeding. Laboratory tests showed high levels of C-reactive protein, a high white blood cell count and a high erythrocyte sedimentation rate. The patient's tumor markers were normal, except for high CA-125. In order to exclude aortitis, focal infection, or malignancy, a whole-body contrast-enhanced multidetector-row computed tomography (MDCT) examination was performed and three-dimensional CT angiography (3-D CTA) was reconstructed. Transaxial images and maximum intensity projection (MIP) of the MDCT showed multiple microaneurysms in the liver (Fig. a and b) and irregularity and ectasia of the celiac and renal arteries (Fig. c). Multiple microaneurysms in the liver and irregularity and ectasia of the renal arteries were seen with 3-D CTA (Fig. d). Transaxial images of the MDCT showed that the patient's uterus was large for her age (Fig. ). In order to rule out endometrial cancer, pelvic MRI was performed. T2-weighted imaging (WI) and diffusion-weighted imaging (DWI) showed the thickness of the endometrium and uterine muscle. T2-WI and DWI (Fig. a and b) also showed high signal intensity in part of the parametrium. However, MRI did not show disarray of the uterus' structure or a tumor. A pathological examination of the endometrium performed to rule out the presence of endometrial cancer showed significant infiltration of neutrophils with no malignancy. Hence, she and her condition were carefully followed.\nBased on physical findings (leg pain, livedo, elevated C-reactive protein, and fever) and the microaneurysms found in her liver by 3-D CTA, systemic polyarteritis nodosa (PAN) was diagnosed and methylprednisolone was administered. Two months later, her fever and leg pain had disappeared. Follow-up whole-body CT with 3-D CTA and pelvic MRI were then performed. Follow-up 3-D CTA showed that the multiple microaneurysms in her liver had completely disappeared, although irregularity and ectasia of the celiac and renal artery had remained (Fig. ). Follow-up pelvic MRI showed that the thickness of both the uterine endometrium and muscle had diminished, and the signal intensity on both DWI and T2-WI in the parametrium had decreased (Fig. ).
|
[[78.0, 'year']]
|
F
|
{'20112401': 1, '17912548': 1, '11158650': 1, '19440120': 1, '2882678': 1, '23986829': 2}
|
{}
|
162,595 |
3738339-1
| 23,986,830 |
noncomm/PMC003xxxxxx/PMC3738339.xml
|
Embolization of pulmonary AVMs of feeding arteries less than 3 mm: reports of two cases and an 8-year follow-up without embolization
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The first case report concerns a 40-year-old woman with hereditary hemorrhagic telangiectasia (HHT). Her father died from a probable cerebral attack. At screening of families with HHT the patient was discovered with PAVMs eight years previously. PaO2 was then 9.7 kPa (72.8 mmHg), the contrast echocardiography showed a shunt of grade 4 (maximal), and the shunt was estimated to 24%. One big simple PAVM and two small PAVMs were visualized by pulmonary angiography (Fig. a and b). The big PAVM in right middle lobe was embolized with one detachable silicone balloon (Target Therapeutics, Fremont, CA, USA) (Fig. ) while the two small ones were left untreated because of small feeders <3 mm.\nAt follow-up 3 months later the PaO2 had increased to 13.0 kPa (97.5 mmHg), the oxygenation was 98%, the contrast echocardiography shunt had decreased to 3, and the shunt was estimated to 7%. The patient felt better performance. In the following years there were no occurring problems, especially no neurologic events, but the patient experienced periodic headaches.\nAt follow-up 8 years later the CT scan showed that the big PAVM was occluded with a residual scar at the place of the former PAVM. At pulmonary angiography the balloon was invisible, but the embolized PAVM was without flow. The feeders of the other two PAVMs had since the initial pulmonary angiogram 8 years earlier grown from 1.6 mm to 2.7 mm (right lower lobe) (Fig. ) and from 1.5 mm to 2.0 mm (left upper lobe) (Fig. a). The right sided PAVM was embolized using two vortexes – 35, 3–5 mm, 0.035 coils (Boston Scientific/Target Vascular, La Garenne-Colombes, Cedex, France) (Fig. b and c), and the left with one 3/30 mm coil (MR eye, non-ferro-magnetic standard embolization coil 0.035, Cook, Bjaeverskov, Denmark) (Fig. b).
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[[40.0, 'year']]
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F
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{'3738339-2': 2, '6319526-1': 1, '6319526-2': 1, '6319526-3': 1, '6319526-4': 1, '4790420-1': 1}
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162,596 |
3738339-2
| 23,986,830 |
noncomm/PMC003xxxxxx/PMC3738339.xml
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Embolization of pulmonary AVMs of feeding arteries less than 3 mm: reports of two cases and an 8-year follow-up without embolization
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A 37-year-old woman, who was a member of a HHT family, had by screening been diagnosed with a PAVM in left lower lobe. At pulmonary angiography it appeared to be a complex PAVM (Fig. ) with two feeding arteries: one was 4.4 mm in size (Fig. ) and the other was 2 mm (Fig. ). It was decided to embolize both, the larger one with an Amplatzer vascular plug 4 (AGA Medical Corporation/St Jude Medical Inc., St Paul, MN, USA) and the small one with deployment of one 3/50 mm MR eye coil (COOK, Bjaeverskov Denmark). The patient had a little pleurisy for two days after the embolizaton but was well at 3-month follow-up and with a negative contrast echocardiography. Embolization of the bigger feeding artery only would have resulted in an insufficient embolization of this complex PAVM.
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[[37.0, 'year']]
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F
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{'27027094': 2, '11061251': 1, '30652150': 2, '8951745': 1, '16195839': 1, '8311636': 1, '15037468': 1, '19118276': 1, '4075342': 1, '34882285': 1, '3186989': 1, '19376841': 1, '16415131': 1, '8184034': 1, '20858807': 1, '10971793': 1, '6601370': 1, '15126654': 1, '19683942': 1, '23986830': 2}
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{'3738339-1': 2, '6319526-1': 1, '6319526-2': 1, '6319526-3': 1, '6319526-4': 1, '4790420-1': 1}
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162,597 |
3738340-1
| 23,986,831 |
noncomm/PMC003xxxxxx/PMC3738340.xml
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Successful treatment of ruptured duodenal varices with dual balloon-occluded embolotherapy
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The Human Subjects Research Review Board at our institution approved the interventional protocol; patient consent for inclusion in this retrospective study was waived.\nThis 60-year-old man suffered from chronic hepatitis due to hepatitis C virus infection since undergoing a right hepatic lobectomy for hepatocellular carcinoma 5 months earlier. Blood transfusions, because he had become anemic with melena and abdominal pain starting approximately one week earlier, failed to improve his symptoms. On the day of the procedure hematemesis developed. Laboratory examinations revealed anemia (hemoglobin 4.7 mg/dl); liver function was graded as Child-Pugh B (total bilirubin 1.8 mg/dl, albumin 2.2 g/dl, prothrombin time 52%, ascites).\nContrast-enhanced computed tomography (CT) scans obtained with a 64-row multidetector CT instrument (Brilliance-64, Philips Medical Systems, Best, The Netherlands) revealed duodenal varices fed from the posterior inferior pancreaticoduodenal vein; drainage was into the right gonadal vein. Esophagogastroduodenoscopy detected active bleeding from ruptured duodenal varices. Conservative management with fasting did not improve his progressive anemia and melena, nor did endoscopic injection sclerotherapy (Fig. ). Prior written informed consent was obtained for angiography and BRTO or dual balloon-occluded embolotherapy (DBOE) and for entry into this study.\nA 5-F guiding sheath (Flexor Tuohy-Borst Side-Arm Introducer; Cook, Bloomington, IN, USA) was inserted from the right femoral vein; to assist in placement we used a 0.035-inch diameter torque Radifocus guidewire (Terumo-Clinical Supply Co., Tokyo, Japan). A 3-F occlusion balloon catheter with an 8-mm diameter balloon (Attendant; Terumo-Clinical Supply Co., Tokyo, Japan) was wedged into the right gonadal vein to introduce a Syncro 2 guidewire (outside diameter 0.014 inch) with a free transformation tip (Boston Scientific Corp., Watertown, MA, USA). We manually injected 10 mL of iomeprol (Iopamiron 300 [300 mg I/mL]; Bayer, Osaka, Japan), inflated the balloon, and obtained right gonadal venography. No opacified duodenal varices were detected (Fig. ). Subsequently, we used the percutaneous transhepatic approach to insert a 7-F vascular sheath (Medikit Co. Ltd., Tokyo, Japan) and a 5-Fr balloon catheter (Terumo-Clinical Supply Co.) into the posterior inferior pancreaticoduodenal vein. Venography revealed well-opacified duodenal varices (Fig. ).\nWe then injected 10 mL of a 70% glucose solution into the gastric varices before injecting 5% ethanolamine oleate (EO) (Odamin; Mochida Pharmaceutical, Tokyo, Japan). The sclerosing agent was a mixture of 10% EO and the same dose of a non-ionic contrast medium (Iopamiron 300) (EOI); this yielded radio-opacity. To prevent hemolysis and subsequent renal failure () during the procedure we intravenously delivered 4000 units of human haptoglobin (Green Cross, Osaka, Japan); 1 unit binds 1 mg of hemoglobin. The sclerosing agent was injected slowly under fluoroscopic monitoring until the duodenal varices were completely filled. The injected 5% EOI remained in the varices for 1 h during balloon occlusion. During DOBE we monitored his blood pressure, pulse rate, urine volume, arterial oxygen saturation status (pulse oximeter), and obtained electrocardiograms. We terminated DOBE after 1 h; at that time, test injection of contrast medium showed clot formation in the varices. Lastly a portography was performed. As it revealed marked dilation of the coronary vein compared to pre-DOBE findings we performed microcoil-embolization of this vessel using interlocking detachable coils (Boston Scientific).\nAfter the procedure his hematemesis improved and the hemoglobin increased from 3.6 to 9.7 mg/dl. Esophagogastroduodenoscopy 1 week post-DOBE detected no active bleeding from duodenal varices. On endoscopic images there was a change in the color tone (Fig. ). Although he died from hepatic failure 2 months later, there was no hemorrhage and the hemoglobin did not decrease during that period.
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[[60.0, 'year']]
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{'8813517': 1, '10228513': 1, '18360078': 1, '19119491': 1, '9715401': 1, '18839245': 1, '19902296': 1, '17597405': 1, '19629586': 1, '1951242': 1, '23986831': 2}
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{}
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162,598 |
3738341-1
| 23,986,832 |
noncomm/PMC003xxxxxx/PMC3738341.xml
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Successful closure of intractable tracheoesophageal fistula using a combination of a modified silicon stent and metallic stents
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A 70-year-old man with hepatocellular carcinoma (HCC) underwent surgical resection, transarterial chemoembolization (TACE), percutaneous ethanol injection therapy (PEIT), and radiofrequency ablation (RFA). Although the primary tumor responded well, follow-up computed tomography (CT) scan demonstrated new pulmonary nodules.\nCT-guided biopsy confirmed pulmonary metastases from the HCC. Surgical treatment and radiotherapy was precluded by the multiple metastases within the right lung. Thus, local treatment was performed with bronchial arterial infusion (BAI) of epirubicin (30 mg), mitomycin (6 mg), and cisplatin (25 mg) via the right bronchial artery. One month later, a second BAI was given. Measurement of “protein induced by vitamin K absence or antagonist-II” (PIVKA-II) levels showed a decrease in the normal range.\nOne week after the second BAI, the patient developed back pain, chest pain, sputum production, and paroxysms of coughing after eating or drinking. Chest CT scan revealed a TEF between the mid-esophagus and the tracheal carina, and bronchoscopy demonstrated a fistula 1 cm in diameter located at the membranous portion of the carina (Fig. ).\nThe patient was established on total parenteral nutrition (TPN) and treated conservatively. Repeat examination revealed that the wall of the fistula had completely epithelialized. The patient declined surgical management, and thus, a silicon tracheobronchial tube stent (Dumon Y-stent, Novatech, La Ciotat, France; 110 mm in length and 16 mm in outer diameter [OD] for trachea, 50 mm in length and 13 mm in OD for each bronchus, cut to 30 mm for trachea and 20 mm for right bronchus and 30 mm for left bronchus in length) was placed in the carina using a rigid scope under general anesthesia on four months after the final diagnosis. However, the stent did not fit the carina adequately, and the fistula remained patent.\nAfter retrieving the tracheobronchial stent, further treatment was attempted through the use of metallic coils and cyanoacrylate glue (n-butyl cyanoacrylate [NBCA], Histoacryl-Blue, Braun, Melsungen, Germany), but these measures were also unsuccessful because the esophagus had dilated focally with a large diverticulum communicating directly with the carina without having a defined tract (Fig. ). Thus, application of any occlusive or adhesive would subsequently fall into the bronchial or esophageal lumen.\nFifteen months after the final diagnosis, the next attempt at treatment consisted of a retrievable and fully covered esophageal stent (16 × 140 mm Niti-S Esophageal Covered Stent; Taewoong Medical, Seoul, Korea) which was fixed externally to prevent migration. This was achieved by a transcervical approach in which the stent was fixed into place by tying the distal end of the stent to the dermis of the neck. Again, the fistula remained patent because of a gap between the stent wall and the dilated diverticulum-like esophageal wall. During these failures to close the fistula, the patient experienced recurrent aspiration pneumonia.\nTwo years after the final diagnosis, the esophageal stent was retrieved, and airway stenting was attempted using a combination of a modified silicon stent (TM Y-stent, Fuji Systems, Tokyo, Japan; 100 mm in length and 16 mm in OD for the trachea; 50 mm in length and 13 mm in OD for each bronchus, cut to 30 mm for trachea and 20 mm for right bronchus and 30 mm for left bronchus in length) and two bare metallic stents (Gianturco Z-stent, Cook Inc., Bloomington, IN, USA; 20 mm in diameter). A modified Y-shaped silicon stent was constructed by creating a longitudinal center cut to fit the tracheal and the bronchial lumens. The tube stent was introduced into the trachea by a rigid scope under general anesthesia and was placed at the carina so that the center cut faced forward. Next, two bare metallic stents were placed within the tube stent to expand its lumen (Fig. ). This technique resulted in close approximation between the silicone tube stent wall and the tracheobronchial wall, successfully covering the fistula. No immediate or short-term complications were noted.\nFollowing this procedure, aspiration remitted, and there was no leakage through the fistula by esophagography. Following swallowing-training by a qualified therapist, the patient began to eat a soft diet and was discharged. However, he died of HCC four months after the final procedure. During the follow-up period, there were no findings of aspiration pneumonia.
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[[70.0, 'year']]
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M
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{'8629986': 1, '1288228': 1, '9884667': 1, '15868255': 1, '18984818': 1, '16010516': 1, '27999779': 1, '15905351': 1, '12755313': 1, '507984': 1, '6526631': 1, '17062286': 1, '27222792': 1, '27134746': 1, '23986832': 2}
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{}
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162,599 |
3738343-1
| 23,986,834 |
noncomm/PMC003xxxxxx/PMC3738343.xml
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Massive retroperitoneal hemorrhage from a giant renal angiomyolipoma treated by selective arterial embolization with an Amplatzer Vascular Plug II
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A 36-year-old Caucasian woman fell on her left side during a parking maneuver with her motor scooter. Shortly after the incident, the patient developed acute left flank pain and hematuria associated with tachycardia, hypotension, and diaphoresis. The pain worsened and she was brought to the emergency department of our institution.\nOn physical examination the patient was in acute distress with a tenderness of palpation of the left flank. The patient was otherwise healthy with no know history of benign or malignant medical conditions. On laboratory analysis, hemoglobin (Hb 9.8 mg/dL) and hematocrit (HCT 36%) were reduced. Conventional CT with i.v. contrast injection (Figs. and ) demonstrated a left renal mass containing fat with an extended retroperitoneal hematoma. The diagnosis of a massive retroperitoneal hemorrhage from a ruptured AML was made. Furthermore, CT revealed a duplicated left renal artery.\nAfter initial stabilization of the patient, she was then referred to our interventional radiology department for SAE. Using a right common femoral artery approach a diagnostic flush aortogram was performed to exclude extrarenal feeders to the tumor. A selective catheterization of the upper and lower pole left renal artery revealed that the upper renal artery was exclusively supplying the renal parenchyma not affected by the AML with no significant feeding of the tumor (Fig. ) whereas the lower renal artery solely supplied the giant AML (Fig. ). The diameter of the lower left artery was 6.5 mm. Embolization of the tumor-feeding lower left renal artery was performed with an 8-mm Amplatzer Vascular Plug (AVP; AGA Medical, Golden Valley, MN, USA). The AVP was deployed through a long 6-F envoy-guiding catheter (Codman & Shurtleff, Raynham, MA, USA) with 0.070” ID (1.8 mm). An instant and complete occlusion of the lower left renal artery was achieved (Fig. ).\nImmediately after embolization the patient complained of left-sided abdominal pain, which was treated with a single dose of 50 mg pethidine i.v. As a consequence of tumor devascularization the patient developed post-embolization syndrome characterized by acute pain, malaise, nausea, severe night sweats, and temperatures of up to 39°C 10 days following the procedure. A follow-up CT scan showed necrosis of AML with signs of abscess formation (Fig. ) 14 days post embolization. A nephron-sparing surgical resection of the residual AML was performed, preserving the healthy upper pole of the left kidney, which was supplied by the separate upper renal artery. The patient was discharged from hospital 4 days later.
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[[36.0, 'year']]
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F
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{}
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