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162,900 |
3757777-1
| 24,014,947 |
noncomm/PMC003xxxxxx/PMC3757777.xml
|
Delayed hemolytic transfusion reaction with multiple alloantibody (Anti S, N, K) and a monospecific autoanti-JKb in intermediate β-thalassemia patient in Tabriz
|
A 37-year-old male with intermediate β-thalassemia syndrome was admitted to Ghazi Tabatabai Hospital. The patient’s blood type was O, Rh positive and his medical history included two previous transfusions. Throughout the past transfusions, not done in our center, he had unknown and unfamiliar transfusion reactions without any follow-up. At the time of admission to our center, laboratory data showed Hb 7.8 g/dl, RBC count 3.33×106/μL, White Blood Cell (WBC) count 4.33×103/μL, Hct 24.2% and serum Ferritin 840 ng/mL. The patient received two units of cross matched compatible and concentrated RBCs.\nEight days later a severe reaction was observed with clinical evidence which included tachycardia, fatigue, fever, back pain, chest discomfort, jaundice, nausea and anorexia. The patient was referred to an intensive care unit, and medication to modulate the immune system, including corticosteroid (Prednisolone 2 mg/kg) and high dose immunoglobulin (IV Immunoglobulin, 0.4 g/kg/day, for 7 days) were initiated.\nLaboratory data showed: Hb 4.8 g/dL, Hct 15.9%, Urea 40 mg/dL, creatinine 0.8 mg/mL; total billirubin 2.8 mg/dl, direct billirubin 0.5 mg/dl, and reticulocyte count 0.7%. He had a mild Hepatomegaly, and severe Splenomegaly (186 × 104 mm). DHTR was suspected. Coombs Test for antibodies against RBC Antibody Identification was performed. Laboratory tests showed the presence of three alloantibody: Anti-N, anti-S, anti-K, and a monospecific anti-JKb autoantibody, which is a warm auto antibody with single specific in the serum of patient, due to an autoimmune process.\nDAT was performed. Red cells from the EDTA tube were washed three times and a 3% cell suspension was made. A drop of cell suspension and the anti-Human Globulin (LORNE Laboratories Ltd, UK) was mixed in a tube and then centrifuged. The eluate was tested with panel cells by indirect antiglobulin test to know whether there were antibodies in patients’ serum which react with RBCs in vitro. Anti-Human Globulin reagents (LORNE Laboratories LTD., UK) and commercial panel cells (Iranian Blood and Transfusion Organization, Iran) were used.\nSeven days later, red cell units lacking anti-JKb, N, K, and anti-S antigens were transfused. He had mild reaction to these red cells, like mild pain in the back, fever, and hemoglobinuria. Further, RBC transfusions were stopped and the patient’s Hb stabilized at approximately 8 g/dL.
|
[[37.0, 'year']]
|
M
|
{'12777582': 1, '3439579': 1, '15064858': 1, '33983909': 1, '21330322': 1, '11035271': 1, '33275743': 1, '10029818': 1, '19788508': 1, '27561786': 1, '24014947': 2}
|
{}
|
162,901 |
3757778-1
| 24,014,948 |
noncomm/PMC003xxxxxx/PMC3757778.xml
|
Autoimmune hemolytic anemia in a patient with Malaria
|
A 20 year old male patient was admitted at our hospital with chief complaints of intermittent fever with chills since seven days and yellow discoloration of sclera and urine since five days. He was transfused three units of blood at a private clinic for anemia before one month. On Examination, relevant findings were pallor +++, icterus ++ and per abdomen examination showing palpable spleen. On admission, complete blood counts were as follows: Hemoglobin (Hb) 3.2 gm/dL, Mean Corpuscular Volume (MCV) 122 fL, Retic Count 7 %, Total and Differential Count in normal reference range, Platelet count 3.52 lacs/μL. In Peripheral Smear, ring forms of both Plasmodium vivax and P. falciparum were seen with Grade 4 parasitemia. Spherocytes were absent. Other relevant lab findings included Renal Function Tests (RFT): within normal reference range, S. Bilirubin 8.3 mg/dL (Indirect 4.7 mg/dL and Direct 3.6 mg/dL), serum Lactate Dehydrogenase (LDH) 355 U/L, Glucose 6 Phosphate Dehydrogenase (G6PD) enzyme activity: Present, Sickling test: Negative and NESTROFT (Naked Eye Single tube Red Cell Osmotic Fragility Test): Negative.\nBlood Bank Investigations: (On admission)\nCell grouping Serum grouping\nThis patient’s blood group was determined to be B +ve with positive autocontrol and no auto-clumps with saline. So, fresh sample was obtained which showed the duplicate results as above and further tested as follows:\nIndirect Antiglobulin Test (IAT) and Antibody screening with 3 cell panel (DiaMed) Antibody identification using 11 cell panel (DiaMed) was pan-positive (+4). Direct Antiglobulin Test (DAT) with Polyspecific and mono-specific Coomb’s sera Acid Elution of the patient’s sample was performed and the eluate was Pan-positive (+4) in the same 3 cell and 11 cell panels (DiaMed). On Major Cross Matching, multiple donor units (of the same group and ABO-Rh compatible group) were Grade 4 Incompatible.\nThese serologic findings are suggestive of auto-antibodies. On 2nd day of admission, Hb dropped further to 1.4 mg/dL.\nPatient was treated with intravenous Artesunate (2.4 mg/kg/day). Simultaneously, intravenous Methylprednisone 1 mg/kg/day for five days was started, followed by oral route and dose tapering. On 2nd and 3rd day, patient was transfused one unit O Neg and one unit B Neg Packed Red Cells respectively. Both the units were least incompatible and saline washed with uneventful post-transfusion period. On 4th day, Hb was raised to 6.1 mg/dL and Serum Bilirubin decreased to 4.3 mg/dL suggesting role of antimalarials in clearing parasitemia and steroids in reducing hemolysis by autoantibodies in this case. Patient was discharged on 9th day after admission with Hb 7.0 gm/dL and platelet count 2.5 lacs/μL with tapering dose of oral steroids. On routine follow-up after 15 days of discharge, patient had Hb of 8.1 gm/dL and was asymptomatic throughout this period.
|
[[20.0, 'year']]
|
M
|
{'31713516': 1, '26816452': 2, '34377668': 2, '16265890': 1, '15202694': 1, '27268491': 1, '22715566': 1, '28405337': 2, '4739592': 1, '24014948': 2}
|
{'5385069-1': 1, '5385069-2': 1, '4711211-1': 1, '8329521-1': 1}
|
162,902 |
3757780-1
| 24,014,950 |
noncomm/PMC003xxxxxx/PMC3757780.xml
|
Rhesus-D zygosity and hemolytic disease of fetus and newborn
|
A 30-year-old, AB negative pregnant woman without any blood transfusion record, with a history of two abortions (24th and 35th week) in two consecutive years and injection of Rh immune globulin (RhIG) after each abortion was referred to the Immunohematology Reference Laboratory of the Iranian Blood Transfusion Organization (IBTO) for further investigation. ABO-Rh was done by automated blood group analyzer (BIORAD Hemos SP Π Twinsampler, Bio_Rad Laboratories, 3, boulevard Raymond Poincare-B.P.3, 92430 Marnes_la_Coquette_France,). The antibody screening test and the antibody identification (ID) panel was performed by a patented and home-made “IBTO antibody Screen and ID panel” kit. By application of antibody screen panel, ID panel, and use of selected red blood cells with specific phenotype, she was found to be highly alloimmunized with RhD antigen of the fetuses from the previous pregnancies, having a titer of anti-D (IgG) equal to 1024. Her partner was also referred to Immunohematology Reference Laboratory of IBTO for further testing. The father had an Rh-positive blood group with a DcE phenotype of red blood cells. This would mean the father could have the possibility of Rh genotype homozygous Rh(D) DcE/DcE (R2R2) or heterozygous DcE/dcE (R2r”).[]\nPaternal D-zygosity based on the detection of the hybrid Rhesus-box was analyzed by using inno-train SSP-PCR Zygofast kit (Inno-TRΔ in Diagnostic GmbH Niederhochstadter Str.62 D-61476 Kronberg/Tanus Tel. +49[0]6173-607930 Germany,www.inno-train.de).[] The specimen requirements were 10 ml paternal whole blood collected in ethylene diaminetetraacetic acid. The term “SSP” describes a variant of PCR, in which only the sequence of the primer at the 3’ end is responsible for specification of the allele to be identified. The RhD gene is flanked by two highly homologous DNA segments of approximately 9kilobase(kb), the so-called upstream (5’ region) and downstream (3’ region) Rhesus-boxes.[] In haplotypes with a deletion of the RhD gene, the fusion of the two Rhesus-boxes generates the single hybrid Rhesus-box that is detected positively through amplification and zygosity testing. Therefore, the concept of a double-box detection is realized by performing 4 reactions: 2 upstream-box and 2 hybrid-box reactions [].\nIf no specific product is present after PCR, the amplificate of the positive control must be clearly detectable. The amplificate of the internal control sequence has a size of 434 base pair (bp) in all reaction mixes. Evaluation of the result was performed by agarose gel electrophoresis. Then, the bands were visualized by intercalating ethidiumbromide and photographed for documentation. At the end, the zygosity is obtained by entering the pattern of the specific bands in the result protocol. The father’s specimen was analyzed for D-zygosity by using inno-train D-zygofast kit. The PCR result showed that among 4 reaction mixes, only PCR products no. 3and 4 (937bp and 1527bp) are present. Thus,the genomic typing of the father was homozygous for RhD [].
|
[[30.0, 'year']]
|
F
|
{'17053461': 1, '19085963': 1, '17547570': 1, '8341334': 1, '12675718': 1, '24014936': 1, '9845707': 1, '24014950': 2}
|
{}
|
162,903 |
3757809-1
| 24,015,139 |
noncomm/PMC003xxxxxx/PMC3757809.xml
|
Bronchoscopy as a rescue therapy in patients with status asthmaticus: Two case reports and review of literature
|
A 43-year-old woman, known to have asthma for 5 years, is presented to the Emergency Department (ED) in a gasping state. Her clinical assessments include: heart rate, 140 bpm; blood pressure, 70/42 mmHg; respiratory rate, 35 per min; and SpO2 78% on plethysmography. Initial resuscitation was done with intubation and fluid management. Her initial arterial blood gases showed severe respiratory and metabolic acidosis (pH 6.90; PaCO2 114 mmHg; PaO2 30.0 mmHg; and HCO3 13.4 mEq/L). After securing the airway, the clinical exam revealed, tachycardia, unstable hemodynamics, peripherally mottled skin, and silent chest with no air entry. The case was diagnosed as a severe life-threatening asthma leading to type II respiratory failure and shock. Initial laboratory exams showed hemoglobin, 13.4 g/dL; hematocrit 40.8%; leukocyte count 15.7 × 109/L and platelet 225 × 109/L. Chest X-ray revealed hyper-inflated lung fields. The patient was sedated with ketamine and relaxed with rocuronium infusion. She was placed on mechanical ventilation (Draeger C500) in assist control mode, respiratory rate 12 per min; tidal volume 7 mL/kg (according to ideal body weight); inspiratory flow rate 70 L/min; Positive end expiratory pressure (PEEP) 5 cm H2O; and 1.0 FiO2. Lung mechanics revealed high-peak airway and plateau pressure (80 and 30 cm H2O respectively). The Intrinsic-PEEP (PEEPi) measured at that time was non-significant. The treatment was started with bronchodilators (salbutamol and ipratropium), inhaled and intravenous corticosteroids, and bolus of magnesium sulfate (2 g).\nSubsequently, the patient was treated with salbutamol infusion and intermittent doses of 0.5 mL (1:1000) subcutaneous adrenaline. Despite being on maximum support, the patient showed no significant improvement. Lung mechanics still displayed high peak and plateau pressures (75 and 35 cm H2O respectively). Bicarbonate infusion was started to maintain the pH near normal. The patient continued to have mixed acidosis with pH 7.01; PCO2, 71.8; PaO2 87; and HCO3 13.4. Urgent flexible bronchoscopy was performed for diagnostic purposes and removal of mucus plug as warranted. Bronchoscopy revealed hyperemic airways, purulent secretions in central airways. Lavage was done and mucus plugs were removed. The process of bronchoscopy was unremarkable.\nImmediately after bronchoscopy, the patient's respiratory condition began to improve. Acidemia improved from 7.01 to 7.24, PCO2 decreased from 72 to 32 mmHg and PaO2 improved from 87.2 to 186 mmHg []. FiO2 was also reduced from 1.0 to 0.4. Peak and plateau airway pressures decreased to 25 and 18 cm H2O respectively. Patient's severe bronchospasm had remarkably improved.\nAt the same time, the patient was also treated for sepsis. The presence of Gram-positive cocci in blood was noted in gram stains and vancomycin was started. Hematological assessment showed elevated leukocyte (21.2 × 109/L), low platelet (98 × 109/L) count, and normal hemoglobin.\nFurthermore, patient's sepsis worsened. Patient was resuscitated with fluids, vasopressor, and broad spectrum antibiotics. Despite improvement in respiratory status her course was complicated with septic shock and multi-organ failure. Patient expired after 5 days of admission.
|
[[43.0, 'year']]
|
F
|
{'5972524': 1, '4892038': 1, '16374178': 1, '30326585': 1, '11940264': 1, '10708200': 1, '22588986': 1, '12867228': 1, '17983880': 1, '13102418': 1, '18463203': 1, '25558218': 1, '21804120': 1, '11713143': 1, '24015139': 2}
|
{'3757809-2': 2}
|
162,904 |
3757809-2
| 24,015,139 |
noncomm/PMC003xxxxxx/PMC3757809.xml
|
Bronchoscopy as a rescue therapy in patients with status asthmaticus: Two case reports and review of literature
|
A 36-year-old male, who was asthmatic since childhood, presented in the ED with shortness of breath for 1 week. The patient also had a history of yellowish sputum with fever for 1 week. Clinical exam revealed bilateral wheeze with prolonged expiration throughout the chest and a roentgenogram showed hyper-inflated lungs and right lower lobe infiltrate. He was intubated in the ED in response to worsening respiratory failure. The initial diagnosis was exacerbation of asthma and community acquired pneumonia. Blood gases before (pH 7.01; PaCO2 108; PaO2, 106 HCO3 27.8) and after the intubation showed acute respiratory acidosis (pH 7.16; PaCO2 90.2; PaO2 110; HCO3 23.7). Initial treatment included inhaled bronchodilators, inhaled and intravenous steroids, antibiotics (ceftriaxone and azithromycin), and a bolus dose of magnesium sulfate. Patient was placed on mechanical ventilation (Draeger infinity 500) with settings of assist control, rate 12 per min; tidal volume 6-7 mL/kg; PEEP 05 cm H2O; inspiratory flow rate 70 L/min and FiO2 1.0. Lung mechanics revealed high peak and plateau pressures of 70 and 28 cm H2O respectively, whereas intrinsic PEEP (PEEPi) was measured 12 cm H2O. Inspiratory flow rate was increased to 80 L/min to reduce the PEEPi.\nIntravenous infusion of salbutamol and intermittent subcutaneous adrenaline 0.5 mL (1:1000) was started due to progressive worsening of clinical condition. PEEPi and peak airway pressure improved from 12 to 4 cm H2O and 70 to 56 cm H2O respectively. Arterial blood gases showed little improvement (pH 7.26; PaCO2 74.9; and PaO2 146). On 3rd day of hospital admission bronchoscopy was planned for bronchial toilet. It revealed inflamed airways and obstruction of middle-sized airways with mucus plugs []. Effective suction and lavage were done.\nThe patient's clinical condition and ventilator requirement were reduced and ABG was improved [] after therapeutic bronchoscopy. The patient was successfully weaned on the following day. Patient was discharged from intensive care 48 h after extubation.
|
[[36.0, 'year']]
|
M
|
{'5972524': 1, '4892038': 1, '16374178': 1, '30326585': 1, '11940264': 1, '10708200': 1, '22588986': 1, '12867228': 1, '17983880': 1, '13102418': 1, '18463203': 1, '25558218': 1, '21804120': 1, '11713143': 1, '24015139': 2}
|
{'3757809-1': 2}
|
162,905 |
3757810-1
| 24,015,140 |
noncomm/PMC003xxxxxx/PMC3757810.xml
|
Fatal pulmonary embolism subsequent to the use of Esmarch bandage and tourniquet: A case report and review of literature
|
Following a road traffic accident, a 30-year-old male developed right tibial plateau and fibular fracture. There were no other significant injuries. The limb was immobilized in a plaster cast for six days and he was planned for open reduction and internal fixation of the fracture. Due to the presence of limb edema, surgery could not be carried out till the sixth day after injury. Routine monitoring including noninvasive blood pressure, electrocardiography (ECG), and pulse oximetry were started. Spinal anesthesia was performed with 3.5 mL of hyperbaric bupivacaine 0.5%, along with buprenorphine 120 mcg. Block level of T4 was achieved and surgery was started. Approximately 40 minutes after spinal anesthesia, before starting open reduction of the tibia, exsanguination of the limb was carried out using Esmarch bandage and the tourniquet was inflated to a pressure of 300 mmHg. In the next three minutes, the patient suddenly became unconscious and his blood pressure dropped to 60/34 mmHg. Intravenous ephedrine 15 mg was given but the hypotension persisted. Endotracheal intubation was performed and full-support ventilation was initiated. Palpation of carotid artery pulsation and ECG revealed electromechanical dissociation. External cardiac compression was initiated and intravenous adrenaline of 1 mg was given every three minutes. For the brief duration of ventricular fibrillation which developed, defibrillation was done. It was suspected to be due to PE; hence, heparin 5,000 IU was given intravenously about 20 minutes after the arrest. After about 30 minutes of cardiopulmonary resuscitation (CPR), spontaneous circulation returned. Infusion of dopamine was started for hypotension. Surgery was abandoned and the patient was shifted to the intensive care unit (ICU) for further management. In the ICU, transthoracic echocardiography revealed right atrial and right ventricular dilatation and tricuspid regurgitation. Serum level of D-dimer was increased (>5,000 ng/mL), and Doppler study of the lower limb indicated the presence of thrombus in right femoral vein, confirming deep venous thrombosis (DVT) and PE as the diagnosis. Thrombolysis was started with intravenous streptokinase 500,000 IU. Intravenous infusion of heparinwas continued at 1,000 IU/hour to maintain activated partial thromboplastin time (aPTT) for around 90 seconds (three times control). Infusion of dopamine was stopped following normalization of blood pressure. Cerebral protective measures like mannitol, phenytoin, and dexamethasone were started from the second day. The patient never had a complete neurological recovery. Four days after the event, magnetic resonance imaging (MRI) of the brain revealed diffuse hyperintense signals in bilateral areas of the cerebral hemisphere, suggestive of diffuse cerebral edema. There was obliteration of the basal cistern and herniation of cerebellar tonsils. His neurological status deteriorated further in the next five days. The patient did not have a neurological recovery and died on the ninth day after the surgery.
|
[[30.0, 'year']]
|
M
|
{'2001041': 1, '7057471': 1, '1536398': 1, '17694688': 1, '10418649': 1, '19775066': 1, '21474320': 1, '6837977': 1, '30670004': 1, '7932344': 1, '3980509': 1, '9095615': 1, '19616954': 1, '15041624': 1, '11296445': 1, '6703361': 1, '12379384': 1, '29296053': 2, '8067569': 1, '21286468': 2, '9836044': 1, '24015140': 2}
|
{'5740697-1': 1, '3030064-1': 1}
|
162,906 |
3757812-1
| 24,015,142 |
noncomm/PMC003xxxxxx/PMC3757812.xml
|
Right hypoglossal nerve paralysis after tracheal intubation for aesthetic breast surgery
|
A 24-year-old female Caucasian patient, 171 cm tall and weighing 60 kg, was to undergo bilateral breast augmentation, exchange of implants, and mammaplasty for bilateral breast ptosis and capsular contracture. Past medical history included bilateral breast augmentation in 2008 and abdominoplasty in 2007 after 90 kg weight loss, lower Cesarean section in 2004, and tonsillectomy as a child. She was otherwise well and did not take any regular medication. The pre-operative physical examination showed good neck extension and mouth opening, and a straightforward endotracheal intubation was anticipated. Two hours before the induction of anesthesia, she received chlorazepam 20 mg orally as premedication. General anesthesia was induced with fentanyl 0.1 mg and 200 mg propofol, and atracurium 25 mg was used to prevent laryngospasm during insertion of the endotracheal tube. At intubation, the Cormack and Lehane grade was described as 1, using a standard size 3 Macintosh blade. A 7.5-mm Magill tube was used. After intubation, proper placement of the endotracheal tube was confirmed by bilateral breath sounds. The endotracheal tube cuff was inflated with air until the cuff pressure was 30 cm H2O. During surgery, the patient received intermittent positive pressure ventilation with 67% nitrous oxide in oxygen, 0.8-1.2% isoflurane, supplemented with fentanyl 0.15 mg. The maximum endotracheal tube cuff pressure did not exceed 34 cm H2O. The patient was placed in a 30° elevated supine position and the head was supported in position with a donut-type pillow. Surgery was completed uneventfully within 90 min, blood loss was minimal, and fluid replacement was done with 1000 ml of full electrolyte solution Jonosteril (Fresnius, Bad Homburg, Germany) and 500 ml of conventional 6% hetastarch 130/0.4 (Tetraspan, B. Braun, Melsungen, Germany). No significant changes in cardiovascular or respiratory parameters occurred during the operation. When spontaneous respiration and muscle tone were considered to be adequate, the endotracheal tube was carefully removed and transferred to the recovery unit. After 35 min, the patient was discharged to the ward.\nThe next morning, she complained of slight difficulty in swallowing solid foods but was able to drink water. On clinical examination, her tongue deviated to the right on protrusion and she was unable to move it to the left; there were no further detectable cranial nerve abnormalities. Magnetic resonance imaging of her brain did not demonstrate any evidence of an ischemic event or focal abnormality. A neurologist diagnosed an isolated paralysis of the right hypoglossal nerve. The neurologist recommended supportive treatment and did not prescribe any pharmacological therapy. Two weeks post surgery, the patient attended the neurology out-patient clinic; at this time, she had complete resolution of symptoms and had made a complete recovery.
|
[[24.0, 'year']]
|
F
|
{'9035668': 1, '7991825': 1, '17572589': 1, '5575191': 1, '31781403': 2, '174422': 1, '3422280': 1, '2354021': 1, '5564251': 1, '8505124': 1, '19116555': 1, '7654663': 1, '14410890': 1, '7924079': 1, '1734004': 1, '1903867': 1, '7567029': 1, '24876519': 2, '33680517': 2, '2140182': 1, '9082866': 1, '7873243': 1, '7098716': 1, '5522052': 1, '2030364': 1, '13262638': 1, '7978135': 1, '8505521': 1, '8042727': 1, '195702': 1, '2642137': 1, '19483548': 1, '30140523': 1, '2380737': 1, '22544135': 1, '1320348': 1, '6869781': 1, '9578251': 1, '16641750': 1, '22456359': 1, '2037480': 1, '8447578': 1, '7098741': 1, '24015142': 2}
|
{'6855057-1': 1, '6855057-2': 1, '6855057-3': 1, '4037807-1': 1, '7906798-1': 1}
|
162,907 |
3757813-1
| 24,015,143 |
noncomm/PMC003xxxxxx/PMC3757813.xml
|
A simple solution to unexpected kinking of endotracheal tube
|
A 2-month-old male baby, of weight 4 kg, was scheduled for emergency repair of bilateral inguinal hernia and right hernia was incarcerated. We planned general anesthesia with ET intubation, along with caudal block for this patient. The baby was placed over forced air warming blanket (Bair Hugger®) set at 40°C. Intravenous (i.v.) induction of anesthesia (modified rapid sequence) was done with propofol 2 mg/kg, fentanyl 3 μg/kg, and rocuronium 1.0 mg/kg. We accomplished ET intubation (oral) with 3.5-mm-internal diameter ET tube (Portex non-cuffed, PVC) and connected to anesthesia machine (Drager Zeus). The lungs of the baby were being ventilated with 2%-3% sevoflurane and 40% oxygen in air mixture. The mode of ventilation was volume control with tidal volume 20 ml and respiratory rate 30/min. Caudal block was placed with 4 ml of 0.25% bupivacaine. After the block, the baby was turned to supine position and handed over to surgical team which shifted the baby downward to middle of the operating table (as their final operating position). We re-confirmed neutral position of head, equal air entry, and fixed the breathing circuit on the supporting arm of the anesthesia machine. After 10 min of start of surgery, we heard an audible alarm from the anesthesia machine and noticed a decrease in expired tidal volume and rise in peak airway pressure. We checked the ET tube and found that it was kinked at a point between the angle of the mouth and the connector of the ET tube. We repositioned the support arm of anesthesia machine for breathing circuit close to the patient and placed some pieces of the cotton gauze under the tube to support it from below (arrow 1 in ) which resulted in straightening of the ET tube. We confirmed equal air entry on auscultation of chest, and measured expired tidal volume, and airway pressure returned to the previous readings. After a few minutes, we heard the same alarm again, with concomitant decrease of tidal volume and rise in peak airway pressure, and noted that the ET tube had kinked again at the same point. We manually supported the ET tube to straighten it and the chest expansion became adequate once again and ventilatory parameters also returned to acceptable range. To solve the problem of repeated kinking of ET tube, we wrapped an ordinary paper tape (Micropore 3M, 1 inch wide) around the ET tube (about 10 circles) at the point of frequent kinking (arrow 2 in ) and noted that there was no kinking during the rest of the procedure which lasted for more than 1 h after our reinforcement.
|
[[2.0, 'month']]
|
M
|
{'9389279': 1, '21211882': 1, '8273884': 1, '22134412': 1, '3829276': 1, '17122266': 1, '3627044': 1, '3605707': 1, '4033599': 1, '12775182': 1, '24015143': 2}
|
{}
|
162,908 |
3757814-1
| 24,015,144 |
noncomm/PMC003xxxxxx/PMC3757814.xml
|
Cardiopulmonary resuscitation in undiagnosed situs inversus totalis in emergency department: An intensivist challenge
|
A 34-year-old woman presented in our ED with chief complaints of severe acute epigastric pain referred to back, vomiting, and sudden onset breathlessness followed by Type I respiratory failure (arterial blood gas report). Somehow, intubation was delayed and she developed hypoxic cardiac arrest. Immediate critical care help was asked. After receiving initial 5 cycles of CPR she was intubated and mechanically ventilated with 100% oxygen and tidal volume and respiratory rate being 450 ml and 10, respectively. Adequate depth chest compression with full recoil and at a rate of hundred was performed at typically described on sternal position. Her carotid pulse was feeble and non-sustainable. ECG in monitor showed ventricular fibrillation (VF). 200 J Direct current (DC) shock was given in the conventional apex-sternal position (left antero-lateral) after 5 cycles of CPR. But even after DC shock, rhythm was not reverted into sinus. ABG showed severe acidosis with mild hyperkalemia. Intravenous adrenaline (ADR) 1 mg and sodium bicarbonate (8.4%) correction were given. Repeat DC shock after 1 minute of CPR and ADR failed to revert into sinus rhythm and no return of spontaneous circulation (ROSC). Then one intensivist continued CPR and other quick screened precordium with echocardiography (MicroMaxx Sonosite, Gurgaon, India) to see cardiac contractility if any. Intensivist found no heart chamber view in parasternal long axis, short axis, apical four chamber, and subcostal view as in all conventional site and surprisingly heart chamber was found visible in right side of the chest (CPR was stopped for few seconds only). We started CPR with slight modification. We place the heel of right hand on the right sternal margin (lower half of the sternum) and left heel of the other hand on top of the first (right handed) and tried to depress it 5 cm with each compression and allowing adequate chest wall relaxation. After 5 cycle effective CPR, we delivered DC shock again. During defibrillation, sternal paddle was on the right sterna margin and the apex paddle was under right breast tissue (right antero-lateral). This time rhythm reverted to sinus after defibrillation with 200 J (biphasic). We continued CPR for another few minutes and ultimately ROSC was achieved. ADR 0.1-0.5 mcg/kg/min was continued as infusion in titration. ROSC time was 8 minutes. She was shifted in ICU. Invasive monitoring lines were inserted under ultrasonography (USG) vision. There were no other features suggestive of Kartagenar syndrome in this patient or any congenital anomaly except this situs inversus and also had no other congenital structural heart disease. She was managed in ICU with mechanical ventilation, antibiotics, renal replacement therapy, and enteral-parenteral nutrition. Detailed radiological and cardiological evaluation and consultation were taken. Her brain MRI study was normal. Echocardiography (Echo) shown improved ejection fraction. Her pancreatitis required 40 days to resolve without any surgical intervention. She was then extubated uneventfully with intact neurological status and discharged from hospital next 5 days.
|
[[34.0, 'year']]
|
F
|
{'11732534': 1, '20956228': 1, '15025618': 1, '27216401': 1, '7574077': 1, '11471159': 1, '24015144': 2}
|
{}
|
162,909 |
3757815-1
| 24,015,145 |
noncomm/PMC003xxxxxx/PMC3757815.xml
|
Obstetric use of nitroglycerin: Anesthetic implications
|
The patient has consented for the clinical details of the case for publication in the journal for academic purpose.\nA 22-year old primigravida presented to obstetrics department with complaint of fever on sixth postpartum day after having undergone vaginal delivery elsewhere. Although the patient was febrile on presentation, the vital parameters were found to be normal. The per abdominal examination by the obstetrician revealed the uterine height of 24 weeks and abdominal ultrasonogram done showed placenta invading into the myometrium, short of serosa. The patient was scheduled to undergo manual removal of placenta. All the biochemical and hematological investigations were found to be normal. Airway was found to be normal. The patient was kept fasting and tablet ranitidine (150 mg) and alprozolam 0.25 mg was administered as premedication on the day of surgery.\nAn intravenous line was secured with 20 G cannula in the operating room. Standard noninvasive monitoring was done using anesthesia monitor (S/5™ critical care monitor, Datex Ohmeda, Helsinki, Finland). Induction was achieved with injection (inj.) fentanyl (100 μg), inj. propofol (100 mg) along with inj. atracurium (25 mg). Proseal laryngeal mask airway (PLMA) size 3 was inserted and the correct placement was confirmed by lube test and end tidal carbon dioxide tracing on monitor. Anesthesia was maintained with nitrous oxide –oxygen in 60:40 ratio and sevoflurane (1 MAC). Despite repeated attempts, the operating surgeon failed to gain access to the uterine cavity owing to the closed internal os. Therefore it was decided to administer NTG as a bolus in the dose of 50 μg to facilitate prompt cervico uterine relaxation. The desired relaxation and access to placenta was achieved in this manner. However a modest fall in arterial oxygen saturation (SpO2-94%) was noticed and N2O was discontinued to ascertain the cause of fall in saturation. The circuit disconnection, leaks, and soda lime exhaustion were ruled out. Chest auscultation revealed normal bilateral equal breath sounds. The oxygen saturation returned to normal (99%) after sometime. In the meantime, boluses of 50 μg and 100 μg of NTG were again repeated at the request of operating surgeon. The administration of second bolus led to significant fall in saturation with SpO2 falling to 89%. Along with, tachycardia was also witnessed with fall in both systolic and diastolic blood pressures. An arterial blood gas sample drawn during this time period revealed a paO2 of 56.4 mmHg and the difference from the baseline (ABG) arterial blood gas is shown in . However, this episode of desaturation too responded to volume resuscitation and discontinuation of nitrous oxide.\nPlacenta was completely removed following uterine relaxation achieved by the use of NTG without substantial hemorrhage. At the completion of procedure, inj. glycopyrrolate (0.5 mg) and inj. neostigmine (2.5 mg) was administered and PLMA removed with the assumption of spontaneous respiration and reflexes. The postoperative period was uneventful and the patient was subsequently discharged after 3 days.
|
[[22.0, 'year']]
|
F
|
{'7519783': 1, '8019758': 1, '2030858': 1, '15758607': 1, '8701': 1, '7911801': 1, '12900527': 1, '32000415': 2, '16235461': 1, '18231892': 1, '24015145': 2}
|
{'7004715-1': 1}
|
162,910 |
3757840-1
| 24,015,346 |
noncomm/PMC003xxxxxx/PMC3757840.xml
|
Upper-body extracorporeal membrane oxygenation as a strategy in decompensated pulmonary arterial hypertension
|
A 23-year-old woman with PAH associated with an unrepaired 15-mm secundum atrial septal defect (ASD) with bidirectional shunting and WHO functional Class III symptoms on intravenous and oral PAH therapies presented with severe hypoxemia from decompensated PAH that was refractory to inhaled nitric oxide and inotropic agents (). ECMO was initiated as BTT. A bicaval dual-lumen cannula, designed to drain deoxygenated blood from the vena cavae and reinfuse oxygenated blood across the tricuspid valve, was inserted via the right internal jugular vein (RIJV; ).[] By directing reinfused blood across the ASD toward the left atrium, an oxygenated right-to-left shunt was created, effectively providing venoarterial ECMO with a single venous access site.[] The patient was extubated in the operating room. Pulmonary vasodilators were down-titrated both to divert oxygenated reinfusion flow away from the pulmonary vasculature and through the ASD, and to avoid systemic vasodilation which may occur with shunting of pulmonary vasodilators into the systemic circulation. On ECMO Day 7, the patient underwent successful lung transplantation and ASD closure, and was discharged home 20 days post-transplant.
|
[[23.0, 'year']]
|
F
|
{'19344471': 1, '22795457': 1, '22415051': 1, '19033774': 1, '12234951': 1, '30854311': 1, '34483506': 1, '12204511': 1, '29568657': 2, '25183571': 1, '31341752': 1, '25132984': 1, '24951763': 1, '22929897': 1, '22087681': 1, '19749199': 1, '21499077': 1, '32793679': 1, '22137803': 1, '27729704': 1, '22268135': 1, '21489818': 1, '20636463': 1, '19952734': 1, '26461241': 1, '29450594': 1, '21680644': 1, '31720177': 1, '24474528': 1, '32660492': 2, '19896387': 1, '34362109': 1, '24571627': 1, '24015346': 2}
|
{'3757840-2': 2, '3757840-3': 2, '5820626-1': 1, '7359482-1': 1}
|
162,911 |
3757840-2
| 24,015,346 |
noncomm/PMC003xxxxxx/PMC3757840.xml
|
Upper-body extracorporeal membrane oxygenation as a strategy in decompensated pulmonary arterial hypertension
|
A 22-year-old woman with PAH following an arterial switch operation as a newborn for transposition of the great vessels, stenting for left pulmonary vein stenosis, and WHO functional Class II symptoms, who had been well-controlled on oral PAH therapy presented with hypoxemic respiratory failure due to pneumonia. Despite noninvasive ventilation, inotropes, diuretics, and antibiotics, she had progressive right heart, respiratory, and renal failure, with supra-systemic pulmonary artery pressures on echocardiogram. She was intubated and placed on venoarterial ECMO as BTR. A drainage cannula was inserted through the RIJV and a reinfusion cannula was grafted to the right subclavian artery.[] She was started on intravenous epoprostenol and was extubated within 24 hours. She participated in physical therapy within 48 hours of extubation, ambulating 30 feet by ECMO Day 6. With up-titration of epoprostenol and volume removal with dialysis, ECMO was discontinued after eight days. Within two weeks, she was optimized on oral PAH therapy and iloprost, and epoprostenol was discontinued. She was discharged home 20 days post-ECMO, remaining off oxygen and on a stable PAH regimen.
|
[[22.0, 'year']]
|
F
|
{'19344471': 1, '22795457': 1, '22415051': 1, '19033774': 1, '12234951': 1, '30854311': 1, '34483506': 1, '12204511': 1, '29568657': 2, '25183571': 1, '31341752': 1, '25132984': 1, '24951763': 1, '22929897': 1, '22087681': 1, '19749199': 1, '21499077': 1, '32793679': 1, '22137803': 1, '27729704': 1, '22268135': 1, '21489818': 1, '20636463': 1, '19952734': 1, '26461241': 1, '29450594': 1, '21680644': 1, '31720177': 1, '24474528': 1, '32660492': 2, '19896387': 1, '34362109': 1, '24571627': 1, '24015346': 2}
|
{'3757840-1': 2, '3757840-3': 2, '5820626-1': 1, '7359482-1': 1}
|
162,912 |
3757840-3
| 24,015,346 |
noncomm/PMC003xxxxxx/PMC3757840.xml
|
Upper-body extracorporeal membrane oxygenation as a strategy in decompensated pulmonary arterial hypertension
|
A 34-year-old woman listed for lung transplantation with idiopathic PAH, status post-atrial septostomy, receiving sildenafil and intravenous treprostinil, with WHO functional Class III symptoms, presented with severe deconditioning, worsening right heart failure, and acute renal failure despite inotropes and diuresis, making her an inappropriate transplant candidate. Venoarterial ECMO was initiated to optimize her for transplantation, with the same configuration as in Case 2. The patient was extubated in the operating room, and all intravenous PAH therapies were discontinued within 24 hours. Her renal failure and anasarca resolved within 48 hours, enabling her to ambulate over 850 m daily. Low-grade bleeding from an arterial cannula defect, which caused a hematoma and brachial plexopathy, was repaired at the bedside. On ECMO Day 19, she underwent lung transplantation and septostomy closure. She was discharged home one month after transplantation and has been living independently.
|
[[34.0, 'year']]
|
F
|
{'19344471': 1, '22795457': 1, '22415051': 1, '19033774': 1, '12234951': 1, '30854311': 1, '34483506': 1, '12204511': 1, '29568657': 2, '25183571': 1, '31341752': 1, '25132984': 1, '24951763': 1, '22929897': 1, '22087681': 1, '19749199': 1, '21499077': 1, '32793679': 1, '22137803': 1, '27729704': 1, '22268135': 1, '21489818': 1, '20636463': 1, '19952734': 1, '26461241': 1, '29450594': 1, '21680644': 1, '31720177': 1, '24474528': 1, '32660492': 2, '19896387': 1, '34362109': 1, '24571627': 1, '24015346': 2}
|
{'3757840-1': 2, '3757840-2': 2, '5820626-1': 1, '7359482-1': 1}
|
162,913 |
3757841-1
| 24,015,347 |
noncomm/PMC003xxxxxx/PMC3757841.xml
|
A case of recurrent pericardial constriction presenting with severe pulmonary hypertension
|
A 78-year-old man was admitted to the pulmonary hypertension service at Stanford Hospital in December, 2010 with elevated pulmonary arterial pressures and progressive right-sided heart failure. He reported progressive shortness of breath over a period of two months, culminating in dyspnea at rest. This was associated with a 20-pound weight gain, abdominal bloating, and leg edema.\nHe was first evaluated for dyspnea several years prior to admission, where he was diagnosed with bilateral pleural effusions and extensive pericardial calcification on chest computed tomography (CT). Echocardiography and cardiac catheterization were consistent with constrictive pericarditis. He subsequently underwent uneventful complete pericardiectomy in 2008. The pericardium was stripped from phrenic nerve to phrenic nerve and the diaphragmatic and posterior pericardium was removed as well.\nThe patient enjoyed symptomatic improvement for approximately one year but then developed recurrent dyspnea. An echocardiogram demonstrated right ventricular (RV) pressure overload and a right ventricular systolic pressure of 66 mmHg. A trial of sildenafil was initiated but was discontinued after the patient developed a marked worsening of his dyspnea.\nHis medical history was remarkable for pericarditis diagnosed in 1978, which was presumed to be viral in origin. He had permanent atrial fibrillation/atrial flutter which did not respond to an attempted atrial flutter ablation in 2003. He had a history of chronic hypertension and gradually progressing stage 3-4 chronic renal impairment.\nOn admission, his jugular veins were distended to angle of his jaw when upright. Pitting edema was noted up to the mid thighs bilaterally. Crepitations were heard on auscultation of his lungs. N-terminal pro-brain natriuretic peptide was measured to be greater than 30,000 pg/mL. Chest x-ray showed blunting of the costophrenic sulci with coarse reticular linear basilar parenchymal opacities ().\nPrior to admission, ventilation-perfusion scan was low probability for pulmonary embolism. Neither pulmonary function tests nor screening blood work revealed any other potential cause for his pulmonary hypertension.\nEchocardiogram on admission was technically difficult. Moderate RV enlargement and dysfunction were identified. Right ventricular systolic pressure was severely elevated at 82 mmHg. No findings of pericardial constriction were reported.\nCardiac catheterization was performed two days post admission after the patient had received intravenous diuresis. Pulmonary artery pressures were elevated at 70/13 mmHg with a mean of 35 mmHg. The pulmonary capillary wedge pressure was 13 mmHg. Cardiac output as calculated by the Fick equation was preserved at 5.3 L/min and pulmonary vascular resistance was calculated to be 4.3 WU. The pulmonary pressures did not respond to vasodilator challenge with inhaled nitric oxide at a dose of 20 ppm. The right atrial pressure tracing () showed abrupt x and y descents, and no fall in right atrial pressure with inspiration (positive Kussmaul's sign). Simultaneous pressure measurements of the RV and left ventricle (LV) revealed an early diastolic “dip and plateau” and equalization of end diastolic pressures (). However, no evidence of discordant change in RV and LV pressures was seen with respiration. Thus, the catheterization was supportive but not diagnostic for pericardial constriction. Volume challenge was not performed. Cardiac biopsies were performed at the time of the catheterization and showed only nonspecific changes.\nCardiac magnetic resonance imaging (MRI) was performed on a 1.5 T GE scanner, with no contrast given secondary to the patient's renal insufficiency. The main pulmonary artery, inferior vena cava and right atrium were found to be dilated. Residual thickened pericardium was identified in the basolateral and basal posterolateral segments (), with adhesive segments, most prominent in the basal anterior segment of the RV and the basal posterolateral segment of the LV. Septal flattening occurred on inspiration () and resolved completely on expiration (), revealing heightened ventricular interdependence. These findings confirmed the diagnosis of recurrent pericardial constriction.\nGiven his significant comorbidity and the high-risk nature of repeat pericardiectomy, the patient was managed medically with diuresis. He responded well to furosemide and was clinically euvolemic with improvement in his dyspnea on discharge.
|
[[78.0, 'year']]
|
M
|
{'8640975': 1, '10326166': 1, '18206742': 1, '10500037': 1, '19433028': 1, '19130999': 1, '19394850': 1, '21875514': 1, '15120056': 1, '21835385': 1, '24015347': 2}
|
{}
|
162,914 |
3757885-1
| 24,015,012 |
noncomm/PMC003xxxxxx/PMC3757885.xml
|
Abberantly placed impacted mandibular canine
|
We are presenting a case of 22-year-old female patient who reported to the Department of Oral and Maxillofacial Surgery which was referred from the Department of Orthodontia with the impacted right mandibular canine in an aberrant position []. The type of this canine according to the classification is type 2 with the angulation of 90° which was detected accidently on a panoramic radiograph. The tooth was lying horizontally at the inferior border of the mandible below the apices of the lower incisors. The patient was planned for impaction. Patient's hematological investigations were within normal limits and had no past medical history.\nUnder strict aseptic conditions patient was painted with povidone iodine and draped. Right inferior alveolar nerve block was administered using 2% lignocaine with adrenaline. Incision was extended from right premolar to left premolar and two releasing incisions were given in the vestibule bilaterally. The mucoperiosteal flap was raised. Mandibular symphysis was exposed till the inferior border of mandible. This was a full bony impaction. Bone cutting was done using a number 8 stainless steel round bur; a window was made which was more widened by cutting the buccal cortical plate. This was followed by tooth sectioning below the cemento-enamel junction. The crown was separated from the root. It was removed with slight luxation []. Thorough irrigation was done with normal saline. The primary closure and hemostasis was achieved [].
|
[[22.0, 'year']]
|
F
|
{'14719741': 1, '28316943': 2, '26502299': 1, '31612084': 2, '11211293': 1, '3936805': 1, '26929701': 2, '4199159': 1, '14719743': 1, '12424633': 1, '8754465': 1, '24015012': 2}
|
{'4745244-1': 1, '6755289-1': 1, '5343688-1': 1, '5343688-2': 1, '5343688-3': 1}
|
162,915 |
3757886-1
| 24,015,013 |
noncomm/PMC003xxxxxx/PMC3757886.xml
|
Recurrent ameloblastoma in temporal fossa: A diagnostic dilemma
|
A 32-year-old Indian female reported to our institution in October 2010 with a painless swelling in the left temporal region. She had undergone a fine needle aspiration cytology (FNAC) which was reported elsewhere as “Chondromyxoid aspirate with atypical chondrocytes-suggesting malignancy.” Slides were not available for review. An orthopantomograph showed left hemimandibulectomy with disarticulation. She gave a history of prior surgery (2005) for the lower jaw swelling. No details were available.\nClinical examination showed a ~8 cm × 7 cm × 5 cm, soft, fluctuant, non-pulsatile, and non-tender swelling in left temporal fossa along with a 6 cm scar in the submandibular region. Cranial nerve examination was normal. There were no palpable neck nodes. Oral cavity examination was normal [Figure and ]. A computed tomography (CT) showed a well-defined, 8 cm × 6 cm, uniform, oval, cystic, homogenous lesion medial to the left zygomatic arch, infiltrating the pterygoid and temporalis muscles, abutting the deep lobe of the parotid gland, and causing erosion of the left zygomatic arch [Figure and ].\nOn FNAC, amber colored, non-purulent fluid showed inflammatory infiltrate of macrophages, occasional giant cells, atypical squamous cells with enlarged nuclei and keratinous cytoplasm. A core biopsy showed fibroadipose tissue with tiny focus of a tumor with squamoid differentiation infiltrating skeletal muscle. Squamous cell carcinoma was reported.\nHowever, clinical course and radiological features of the lesion were pointing toward a benign pathology. Case was discussed in tumor board and surgical excision was planned. After thorough work-up, patient underwent excision of left temporal mass with infratemporal fossa clearance via a combined temporal and cervical approaches under general anesthesia []. Reconstruction was carried out using the free anterolateral thigh flap to provide for oral cavity lining and bulk in the temporal area. Histopathological examination confirmed “ameloblastoma” []. Patient is disease free for last 1½ years [].
|
[[32.0, 'year']]
|
F
|
{'16487813': 1, '11893979': 1, '3802688': 1, '11815923': 1, '9269009': 1, '7633291': 1, '26261564': 1, '17056266': 1, '3135350': 1, '17881602': 1, '29682361': 2, '24015013': 2}
|
{'5841118-1': 1, '5841118-2': 1}
|
162,916 |
3757887-1
| 24,015,014 |
noncomm/PMC003xxxxxx/PMC3757887.xml
|
Management of anterior dental crossbite with removable appliances
|
An 8-year-old Turkish girl was referred to the pediatric dentistry clinic with the chief complaint of an unaesthetic appearance of the maxillary central incisors, which were located behind the lower anterior teeth. Her medical and dental history was non-contributory, and the patient did not have a family history of Class-III malocclusion. The permanent maxillary right and left central incisors were both in crossbite [], and maxillary lateral incisors had not yet fully erupted. The patient was in early-mixed dentition and had a Class-I molar relationship on both sides, with a 2 mm overjet and 100% overbite. The maxillary dental midline was coincident with the facial midline; however, the mandibular dental midline deviated approximately 2 mm to the left. Mild spacing was present in the maxillary arch, and there was sufficient mesiodistal distance to achieve labial movement of the maxillary central incisors. A panoramic radiograph showed no evidence of bone or dental pathology [] and lateral cephalometric radiographic view showed no evidence of basal problem between mandibular and maxillary arches [].\nThe treatment objectives for the patient were to correct the anterior crossbite, to establish normal overbite and overjet, to align the anterior teeth for ideal inclination and to improve the patient's facial and dental esthetics. The child was motivated to maintain good oral hygiene. To align the maxillary anterior teeth and correct the crossbite, a removable acrylic appliance with a posterior bite-opening platform was used [Figure and ]. A screw incorporated in the appliance platform was activated 0.25 mm every 4 days for 16 weeks. After 2 months, the maxillary and mandibular incisors displayed an edge-to-edge bite relationship, and the crossbite was corrected in an additional 2 months []. The posterior bite-opening platform was then removed, and screw activation continued every 7 days for another 2 months in order to establish a normal overjet. During the course of treatment (at 6 months), the permanent maxillary lateral incisors erupted, with the left lateral tooth in crossbite []. Accordingly, a new acrylic plate with a labiolingual spring was prepared, and the spring was activated every month for 2 months until this crossbite was resolved. At the end of 8 months of active treatment, the crossbite of all maxillary incisors was successfully corrected, and no problems were observed during 6 months of follow-up clinically and radiographically [Figure -].
|
[[8.0, 'year']]
|
F
|
{'19508256': 1, '16644418': 1, '9063206': 1, '11484470': 1, '3472894': 1, '1511366': 1, '29854482': 2, '33478458': 2, '29106299': 1, '29326528': 1, '19212539': 1, '1636634': 1, '3268900': 1, '24015014': 2}
|
{'7818763-1': 1, '7818763-2': 1, '5949202-1': 1, '5949202-2': 1, '5949202-3': 1}
|
162,917 |
3757888-1
| 24,015,015 |
noncomm/PMC003xxxxxx/PMC3757888.xml
|
Paget disease of bone: A classic case report
|
A 58-year-old male patient reported to the dental hospital with the complaint of difficulty in chewing food as his teeth were not in contact during mastication.\nHistory revealed that, there were swellings in the maxillary right and left posterior teeth region, which started 6 years back. Similar swellings were also seen bilaterally in the malar region and in the forehead of the right side. All swellings gradually increased in size.\nOn examination, extra-orally bilateral diffuse swellings were seen in the malar and zygomatic region bilaterally, obliterating the nasolabial sulcus and in the right frontal region [], which were bony hard in consistency on palpation. The swellings were immobile and attached to the underlying bone. Intra-orally, diffuse swelling of the maxillary alveolus was seen bilaterally, extending from 18 to 28 region [] with obliteration of the buccal sulcus. Bicortical expansion was seen in the maxillary premolar-molar region, which were non-tender and hard in consistency, attached to the underlying bone. The occlusion was deranged and on occluding, the teeth were not in contact.\nSince, the swellings were multiple, bilateral, gradually increasing in size, asymptomatic, and bony hard in consistency a provisional diagnosis of disorder of bone was made; radiologic, biochemical and histopathologic investigations were performed.\nPeriapical, occlusal, and panoramic radiographs reveal diffuse radiopacities and hypercementosis of roots of the maxillary teeth []. Postero-anterior and Lateral view of the skull reveal generalized flecks of irregularly shaped radiopacities involving the entire skull, giving a cotton wool appearance [].\nComputed tomography scan reveals osteosclerosis of right maxillary, ethmoid, frontal, and sphenoid sinuses with widening of diploic space with sclerotic and lytic areas involving inner and outer tables of bony calvarium []. There is an expansion, with sclerosis of all walls of right maxillary, right ethmoid, and floor of left maxillary sinuses.\nBiochemical tests revealed normal serum calcium: 9.2 mg/dL and serum phosphorus: 4 mg/dl, but markedly raised serum alkaline phosphatase (SAP): 1251 IU and urinary hydroxy-proline: Creatine ratio: 243.6 mmol.\nAn incisional biopsy of the swelling was carried out in the left maxillary alveolus. Histopathologic examination revealed a cellular proliferating inter-trabecular fibroblastic marrow with many clusters of osteoclasts separating spicules of bone, which appear lamellar in some of the bits with numerous cement lines forming a mosaic pattern. Trabecula of bone with basophilic reversal lines in connective tissue stroma are seen [].\nCorrelating the clinical, radiologic, biochemical, and histopathologic findings a final diagnosis of PDB was established. Patient was referred to the Rheumatologist for treatment.
|
[[58.0, 'year']]
|
M
|
{'31666998': 1, '20614314': 1, '29991249': 2, '19608727': 1, '20836245': 1, '22434946': 2, '21607019': 1, '27587747': 1, '22747870': 1, '28255281': 1, '33088752': 1, '21606236': 1, '24891879': 1, '15690073': 1, '19434273': 2, '24015015': 2}
|
{'3303501-1': 1, '2671770-1': 1, '6104730-1': 1}
|
162,918 |
3757889-1
| 24,015,016 |
noncomm/PMC003xxxxxx/PMC3757889.xml
|
Full mouth rehabilitation of a patient with mandibular implant screw retained Fp-3 prosthesis opposing maxillary acrylic removable over-denture
|
A 52-year-old white woman was initially seen with an existing maxillary tooth supported over-denture opposing edentulous mandibular arch []. The patient had initiated treatment previously with a general dentist, but decided to seek specialty care for the completion of her treatment. Fabrication of screw retained hybrid prosthesis was planned for the mandibular arch and a new over-denture for maxillary arch. The unfavorable sinus anatomy in the posterior maxilla and patient's unwillingness for bone grafting to facilitate implant placement precluded the placement of implants in the maxillary arch []. The treatment options presented to the patient also included the fabrication of an implant-supported over-denture, but the patient's desire was to eliminate a removable prosthesis in the mandible. The following clinical and laboratory procedures were performed.\nA full thickness mucoperiosteal flap was raised in the mandibular arch from distal to mental foramen on one side to mental foramen on the other side. In the right quadrant, implants (Tapered self-thread, Hi-Tech Implants, and Life care implant system) were placed in the 2nd premolar (4.2 mm × 10 mm), lateral incisor (4.2 mm × 10 mm) regions. In the left quadrant, implants were placed in 2nd premolar (4.2 mm × 10 mm), lateral incisor (4.2 mm × 10 mm) and regions. The implant dimensions were selected with the help of a computed tomography scan and 3D reconstructive image []. A total of four implants were placed in the mandibular arch with a help of surgical stent. The flap was closed using the horizontal interrupted sutures. After 1 week, the sutures were removed and an immediate denture was relined with a permanent soft denture liner (Permasoft, Dentsply, York, PA, USA) and inserted.\nAfter a waiting period of 4 months, an (Orthopantomograph 10E, Siemens) OPG was obtained to evaluate the bone to implant contact percentage [] and later stage II surgery was performed under local anesthesia cover screws were exposed and healing abutments were placed and the flap sutured.\nMaxillary and mandibular arch impressions were made using alginate (Tulip Alginate Impression Material, Cavex, Holland Bv, Haarlem, Holland). A conventional special tray was fabricated for the maxillary arch and a custom open tray was fabricated in acrylic resin (Autopolymerizing acrylic resin, ALIKE™; GC America, ALSIP, USA) for the mandibular arch. The open tray was verified in the patient's mouth. After 1 week, the healing abutments were removed, and impression copings were connected to the implants (Impression Coping Pick-up Type, 4 mm Profile; 3i Implant Innovations, Palm Beach Gardens, Fla.). These open tray impressions copings were stabilized with 23 gauge ortho wire and blocked out with acrylic resin (Autopolymerizing acrylic resin, ALIKE™; GC America, ALSIP, USA). The mandibular impression was made with monophase polyvinyl siloxane impression material (Aquasil Lv Ultra, Smart Wetting Impression Material, Dentsply, Detrey Gmbh, Konstanz, Germany). Border molding was completed with green stick compound and secondary impression was made using addition silicone impression material (Aquasil Lv Ultra, Smart Wetting Impression Material, Dentsply, Detrey Gmbh, Konstanz, Germany) for the maxillary arch. The impressions were poured in die stone (Ultrarock, Kalabhai Karson Pvt. Ltd., Mumbai, India) Master casts were recovered and trimmed and record bases and occlusion rims were fabricated. Patient returned for recording of maxillomandibular relations and tooth selection. Master casts were then mounted on a semiadjustable articulator (Hanau Modular Articulator System, Waterpik Technologies Inc., Fort Collins, Colo.). The path of insertion deviated considerably, so castable abutments were used to produce the optimal angulations. Wax up for framework fabrication was carried out. The framework was waxed, cast, recovered, and fitted on the master cast. Disclosing media (Kerr's Disclosing Wax; Kerr, Romulus, Mich. and Occlude; Pascal Co Inc., Bellevue, Wash.) were used to evaluate the fit of the framework and to guide adjustment procedures. The fit was refined until the framework seated passively on the master cast. The metal framework was tried in to evaluate and verify a passive fit intra-orally []. Disclosing media was used to discern any fit discrepancies. Adjustments were performed, and abutments were removed from the implant fixtures and healing abutments reconnected. The mandibular denture teeth were waxed to the hybrid framework, and a final wax try-in was performed to verify and correct maxillomandibular relations. At this appointment, the customized abutments along with the framework were connected to the implants for the final wax try-in. At this time an OPG was made to evaluate the fit between frameworks and implant interface []. The maxillary tooth supported over-denture was invested/flasked and processed by use of the maxillary master cast as any conventional complete denture. However, the mandibular hybrid prosthesis was invested without the master cast. The internal aspects of the casting that fit on the abutments were blocked out with the polyvinyl-siloxane impression material, and the prosthesis was invested directly into the lower half of the processing flask. The investing, flasking, and processing procedures were then completed. The prostheses were finished and polished, a clinical remount was performed to allow for refinement of occlusal contacts, the hybrid prosthesis was screw retained and provisional cement (Temp Bond; Kerr) was used to cover screw access hole. Maxillary over-denture and Mandibular hybrid prosthesis were inserted []. Hygiene techniques were reviewed, and patient was scheduled for recall and maintenance.\nOcclusion was evaluated using guided closure and was considered as: Good, if centric relation (CR) coincided with centric occlusion (CO); moderate, if minor (<0.5 mm) deviation was observed between CR and CO; poor, if clear (>0.5 mm) deviation was observed between CR and CO. Articulation was considered as good when it was fully balanced during lateral movements performed from CO, otherwise it was considered poor. Presence or absence of frontal contact in CO was also noted.[]\nRetention of the maxillary tooth supported over-denture was examined using the following scores: (1) good = good resistance to vertical pull, and sufficient resistance to lateral forces; (2) satisfactory = slight to moderate resistance to vertical pull, and little or no resistance to lateral forces; and (3) poor = no resistance to vertical pull and lateral forces; the denture falls out of place. Stability was determined with the following criteria: (1) good = slight or no rocking on denture-supporting structures when under pressure; (2) moderate = moderate rocking on supporting structures under pressure; and (3) poor = extreme rocking on supporting structures under pressure.[]
|
[[52.0, 'year']]
|
F
|
{'6352914': 1, '9878969': 1, '1289258': 1, '6576140': 1, '1800736': 1, '2202750': 1, '1494126': 1, '2202818': 1, '10220658': 1, '6352924': 1, '9474545': 1, '28713760': 1, '24015016': 2}
|
{}
|
162,919 |
3757890-1
| 24,015,017 |
noncomm/PMC003xxxxxx/PMC3757890.xml
|
Deep vein thrombosis: A rare complication in oral and maxillofacial surgery: A review of two cases
|
A 40-year-old woman presented with complaint of pain and swelling in left lower jaw and inability to open the mouth fully for about 6 days. History of trauma (self fall) 6 days ago and there was no history of loss of consciousness with no clinical and radiological evidence of brain injury. There was a history of childhood poliomyelitis. General examination revealed left lower limb paresis. Extra oral examination reveals tenderness in left condylar region, angle of mandible and along the lower border of mandible. Mouth opening was restricted. Intra-orally, occlusion was deranged. Sublingual ecchymosis was present. Left lower teeth were tender on percussion. Left mandibular third molar was fractured. Orthopantomogram revealed left angle and left parasymphysis fracture of mandible []. After thorough clinical and radiographical evaluation patient was diagnosed as suffering from fractured left angle and left parasymphysis of mandible. Routine blood investigations were done and patient was posted for open reduction and internal fixation (ORIF) under general anesthesia (GA). ORIF was done under GA by submandibular approach [] using two, 2 mm 4 hole with gap stainless steel plate and 7 nos. 2 × 8 titanium screws. Duration of surgery was about 45 min. On second post-operative day patient developed mild swelling in right leg which on examination was not tender but of pitting type []. On the 5th day after surgery, swelling became painful and reaches above the knee and calf muscle tenderness was elicited.\nColor duplex Doppler examination of both lower limbs-venous study was performed. Report revealed normal Doppler evaluation of veins of left lower limb and ilio-femoropopliteal deep venous thrombosis in right limb. Patient was referred to vascular surgery unit of higher institute for further management. Now patient is on oral anticoagulant.
|
[[40.0, 'year']]
|
F
|
{'18088814': 1, '7772581': 1, '10209995': 1, '15383478': 1, '10737280': 1, '24015017': 2}
|
{'3757890-2': 2}
|
162,920 |
3757890-2
| 24,015,017 |
noncomm/PMC003xxxxxx/PMC3757890.xml
|
Deep vein thrombosis: A rare complication in oral and maxillofacial surgery: A review of two cases
|
A 44-year-old man reported to our department with a compliant of restricted mouth opening and burning sensation inside the mouth for 6-month duration with history of areca nut chewing for 4 years. Patient was diagnosed as suffering from oral submucous fibrosis (Grade IV) and treated with release of fibrous bands [] and collagen grafting under GA. Operative time was 105 min. On the fourth post-operative day patient complained of calf muscle pain in the left limb and on examination severe localized calf muscle tenderness was elicited. Color Doppler reveals thrombosis in peroneal vein in left limb and popliteal and femoral veins are free of thrombus. Patient was referred to higher institute and anticoagulant therapy was started.
|
[[44.0, 'year']]
|
M
|
{'18088814': 1, '7772581': 1, '10209995': 1, '15383478': 1, '10737280': 1, '24015017': 2}
|
{'3757890-1': 2}
|
162,921 |
3757891-1
| 24,015,018 |
noncomm/PMC003xxxxxx/PMC3757891.xml
|
Intraosseous adenoid cystic carcinoma of maxilla: A rare case report
|
A 48-year-old female reported to the Department of Oral Medicine and Radiology with swelling over the left side of face since 4 years. There was history of swelling in the same region 5 years ago for which she was operated. The swelling recurred within a year, which gradually increased to attain the present size. Swelling was associated with dull and mild occasional pain on wide opening of the mouth. There was no history of pus/blood discharge, but had caused mild functional difficulty. There was no history of paresthesia, diplopia or change in resonance of the voice. Her past medical and personal histories were non-contributory.\nOn extra oral examination left side revealed gross facial asymmetry, with a diffuse swelling approximately 5 cm × 4 cm extending superoinferiorly from about 1 cm above the ala-tragus line up to the left angle of mouth and mediolaterally from philtrum up to the level of lateral canthus of left eye. Obliteration of left nasolabial fold and deviation of the left ala of the nose was noted. The overlying surface of the swelling was stretched and shiny but was normal in color. On palpation, no raise of local temperature was noted. Swelling was non-tender and firm in consistency with no pulsations evident. Examination of regional lymph nodes showed no evidence of lymphadenopathy [].\nOn intraoral examination an irregular, but well-defined swelling was noted involving the left vestibule and hard palate approximately measuring 7 cm × 6 cm extending anterio posteriorly about 2 cm from the maxillary anterior labial vestibule i.r.t 11.21 until the mesial aspect of 26 and medially crossing the mid palatine raphe on the right side approximately 1 cm away from the marginal gingiva of 13 and extending laterally into the left labial vestibule causing obliteration from 11 to 24. Overlying surface had areas of erythema interspersed with a bluish tint. Swelling was non-tender with firm consistency in the palate and cystic consistency in the left labial vestibule on palpation. Hard tissues in the region of complaint showed spacing in-between 21 and 22 and grade I mobility noted with 22, 23, and 24 [].\nOn correlating the history and clinical findings, a provisional diagnosis of low-grade minor salivary gland malignancy was rendered with mucoepidermoid carcinoma on top of the list followed by the ACC and others. Left maxillary antral malignancies and benign odontogenic tumors namely adenomatoid odontogenic tumor, squamous odontogenic tumor and others were considered in the differential diagnosis list.\nPanoramic image showed an irregular osteolytic lesion in maxillary anterior left region approximately 6 cm × 5 cm extending from mesial aspect of 12 up to the distal aspect of 26 anterio-posteriorly and superiorly had caused erosion and discontinuity of floors of the nasal fossa and maxillary sinus with soft-tissue density seen infiltrating into the respective structures and inferiorly up to interdental alveolus of 22, 23, 24, and 25. The lesion had an irregular moth-eaten internal architecture and had caused diversion of roots of 11, 21 and migration of 22. Intraoral periapical radiographs confirmed radicular findings along with multiplanar root resorptions seen with 21 and 23.\nTo assess the exact boundaries and invasion into the adjacent areas, computed tomography with contrast of mid-face was performed, which revealed a heterogeneous enhancing mass in the left maxilla. The lesion had caused bony destruction and erosions with the epicenter in the maxilla and the soft-tissue density was seen extending into the surrounding structures namely oral cavity, maxillary sinus, nasal cavity, buccal space, and upper lip equidistantly suggestive of intrabony origin [].\nRoutine hematological investigations were normal except erythropenia with microcytic, hypochromic anemia seen on peripheral smear.\nIncisional biopsy was performed from two separate locations namely, palate, and labial vestibule. On histopathological examination, hyperchromatic basaloid tumor cells were arranged in islands with interspersed multiple cystic areas showing eosinophilic material classically resembling cystic “Swiss-cheese pattern” was seen along with a solid pattern. Hence, diagnosis of ACC was rendered [].\nAs a part of metastatic work-up, clinical and imaging investigations were carried out including clinical examination of the oral cavity and neck, chest radiograms, and abdominal ultrasound were carried over, which showed no evidence of secondaries.\nThe patient was referred to higher regional oncology institute where surgery followed by the radiation treatment was planned. However, as the patient was reluctant to undergo surgery, lone radiation therapy with a total dose of 60 Gy was executed in the fractionation of 2 Gy/day for 5 days/week for a period of 6 weeks. As the treatment was incomplete and palliative, the prognosis was considered poor, nevertheless, follow-up of the case for 3 months after treatment showed no evidence of recurrence [].
|
[[48.0, 'year']]
|
F
|
{'3002581': 1, '29491606': 2, '15752085': 1, '18940488': 1, '18403891': 1, '32189902': 2, '24574668': 2, '29531857': 1, '16504862': 1, '11471650': 1, '15347297': 1, '24015018': 2}
|
{'5824518-1': 1, '3927351-1': 1, '7069154-1': 1}
|
162,922 |
3757892-1
| 24,015,019 |
noncomm/PMC003xxxxxx/PMC3757892.xml
|
Forced orthodontic eruption for augmentation of soft and hard tissue prior to implant placement
|
A 22-year-old woman was referred to the School of Dentistry at Araraquara, with the complaint of tooth mobility in the right maxillary lateral incisor. She was also disappointed with her prosthesis. Her medical history was non-contributory and her dental history revealed a root canal therapy and provisional restoration on the right maxillary lateral incisor. Clinical examination revealed that the tooth presented degree II of mobility, 5 mm probing depth in the interproximal surface and the gingival tissue surrounding the tooth was inflamed. The temporary acrylic resin crown presented some marginal infiltration, and after removing it, a cavity was found under the gingival tissue []. Periapical radiograph revealed bone resorption around the root, interproximal angular bone defects, and satisfactory canal treatment. Because it was impossible to obtain an adequate crown-root ratio after tooth treatment, it was decided with patient to extract the root orthodontically and to replace it by a dental implant.\nIt is important to note that this case report was planned with a multidisciplinary team, i.e., orthodontist, periodontist, and prosthodontist. The initial phase of treatment occurred with the reduction of control plaque accumulation and gingival inflammation. For this patient, the periodontal treatment and oral hygiene instruction were performed during 4 months, according to Gkanditis et al.[]\nAfter 4 months, a careful clinical examination was made, the cavity was treated, the excess of gingival tissue was removed, and the temporary crown was replaced. The orthodontic treatment was initiated using the brackets with Roth prescription and the right lateral incisor bracket was positioned more cervically than those on the other tissues, in order to allow the tooth extrusion with a 0.016″ Ni-Ti wire. To help prevent intrusion of the anchorage teeth, a 0.019″ × 0.025″ stainless steel auxiliary arch was used [Figure and ]. Patient was seen every 2 weeks for reduction of the incisal surface of the extruded tooth to prevent occlusal interferences during extrusive movement. Furthermore, the lateral incisor bracket was repositioned as close as possible to the gingival margin to allow a long extruding range. Periapical radiographs were taken monthly to monitor progress in the bone profile.\nAfter 12 weeks of orthodontic extrusion, the tooth was stabilized for 4 months in order to get a proper reorganization of the soft-tissue, and bone remodeling [Figure and ]. Before extraction of the maxillary right lateral incisor, it was possible to observe, clinical, and radiographically, a substantial interproximal and vertical bone formation and an increase in the amount of attached gingiva. After 15 months of orthodontic treatment, the lateral incisor was extracted [] and an implant (3.3 mm × 11 mm implant, Neodent, Curitiba, Brazil) was placed immediately, remaining unloaded for 6 months until the osseointegration period []. The periapical radiographic evaluation showed osseointegration around of the implant 6 months after its installation []. After this time, a provisional restoration was confectioned for allowed the gingival recontouring [].\nA definitive metal-ceramic crown was installed 1 year after implant placement []. After 5-year follow-up, the patient reported no complaints, and the dental implant was stable and healthy. Patient was very satisfied with the aesthetic result.
|
[[22.0, 'year']]
|
F
|
{'24966782': 2, '23083483': 1, '12498471': 1, '33299614': 2, '19835753': 1, '11799798': 1, '23338273': 1, '22509797': 1, '26877982': 1, '24872900': 2, '8300319': 1, '25133136': 1, '18302478': 1, '24523969': 2, '20113393': 1, '17936123': 1, '10229894': 1, '20202098': 1, '17243330': 1, '16000089': 1, '14579972': 1, '11432655': 1, '25202224': 2, '11450409': 1, '24955259': 2, '8670926': 1, '24015019': 2}
|
{'4020491-1': 1, '4054062-1': 1, '7704198-1': 1, '3913030-1': 1, '4052935-1': 1, '4144142-1': 1}
|
162,923 |
3757893-1
| 24,015,020 |
noncomm/PMC003xxxxxx/PMC3757893.xml
|
Facial pain due to elongated styloid process
|
A 45-year-old female patient reported to our maxillofacial unit with the chief complaint of pain on swallowing, a swelling in the throat, and vague facial pain over the right face and temple region. The pain never crossed midline. She also complained of pain on turning the head toward the left side and some unusual sensation in the tongue. These complaints, according to the patient, had been for 2 years. She had been administered non steroidal anti-inflammatory drugs, carbamazepine by some practitioners without any response.\nAfter a series of questioning and examination, a mass was palpable in the right tonsillar region. She did not have any extra-oral swelling or asymmetry. Her cervical lymph nodes were not palpable. All teeth were present and in good shape. It was easy on our part to rule out odontogenic pain. She neither had any history of tonsillar surgery nor could she remember any history of trauma. Her computed tomography (CT) scan revealed an elongated styloid process (33 mm) of the right side []. The temporomandibular joint appeared normal. She was planned for resection of the styloid process [Figure -]. An extraoral approach was carried out for the resection. She did not sustain any injury to the facial nerve or any vessels. The patient has been under regular follow-up and is free of the pre-operative symptoms.
|
[[45.0, 'year']]
|
F
|
{'856922': 1, '3998636': 1, '11815916': 1, '27544532': 1, '18894764': 1, '10958426': 1, '18131173': 1, '12457088': 1, '5442737': 1, '20339566': 1, '24015020': 2}
|
{}
|
162,924 |
3757894-1
| 24,015,021 |
noncomm/PMC003xxxxxx/PMC3757894.xml
|
Osteoradionecrosis of mandible: Case report with review of literature
|
A 65-year-old male patient reported to the dental out-patient department with a chief complaint of sharp bony projection in the mouth. The patient gave a history of exposed bony fragments since 7 months and history of pus discharge from the right side of check 2 months back. The patient finds difficulty in talking and eating since 1 week. He gives a history of a non-healing ulcer on right buccal mucosa diagnosed as squamous cell carcinoms 4 years back and had undergone surgery and radio therapy.\nOn extra oral examination, skin on lower right side of cheek showed scar of a healed sinus []. Intra oral examination was difficult due to limited mouth opening. There was depapillation of tongue and generalized mucositis. Exposed necrotic bone found from right lower retromolar area extending toward midline []. Provisional diagnosis of ORN was made and patient instituted conservative measures of antibiotics and the sequestrectomy was undertaken.
|
[[65.0, 'year']]
|
M
|
{'18562055': 1, '33341909': 1, '15122554': 1, '15641107': 1, '22668439': 1, '2240412': 1, '33642335': 1, '20843728': 1, '15542158': 1, '24015021': 2}
|
{}
|
162,925 |
3757895-1
| 24,015,022 |
noncomm/PMC003xxxxxx/PMC3757895.xml
|
Filariasis of the buccal mucosa: A diagnostic dilemma
|
A 54-year-old female school teacher reported with a complaint of intermittent swelling inside the mouth on the left side. Repeated exacerbations of the swelling occurred 4-5 times in a span of 8 months. Itching of the cheek always preceded the swelling, which got resolved within 1-2 days. There was no change in sensation over the affected area. She had consulted many clinicians prior to reporting to our hospital and had taken medications. However, the patient's symptoms had persisted. The detail of past consultations or medications regarding presenting complaint was obscure. She gave a medical history of hypertension and dyslipidemia for which she was on medication since 5 years. General physical examination did not show any relevant findings. No cervical or generalized lymphadenopathy was found.\nExtra-orally, diffuse swelling of left cheek was noted with no color changes. Intra-orally, examination of the left buccal mucosa revealed a hard movable mass of 1 cm × 0.5 cm anterior to the anterior border of ramus almost at the level of 27 []. Slight tenderness was present on palpation of the mass. Although the parotid papilla was prominent, it was not tender on palpation. Blood investigations were unremarkable. The erythrocyte sedimentation rates were mildly raised, Mantoux test was normal. Blood smear for staining malarial and filarial parasites were negative.\nAn occlusal radiograph placed vertically in the upper gingival sulcus in contact with the buccal mucosa to check for any soft-tissue calcifications did not reveal any findings.\nDifferential diagnoses of a parotid sialolith, minor salivary gland tumor, cysticercosis, calcified facial node, and lipoma were made.\nUltrasound scan of the cheek revealed a well-defined round hypo-echoic lesion in the muscular layer of the left cheek measuring 0.8 cm × 0.5 cm, with small specks of calcification. There were no obvious vascularity within the lesion and no perilesional edema []. The parotids appeared normal bilaterally. The probability of inflammatory pathology was considered.\nExcisional biopsy of the nodule was carried out. Histological examination revealed a dense fibrous capsule showing infiltrate of mixed inflammatory cells consisting of lymphocytes, macrophages, eosinophils, and neutrophils. Within the capsule, a single female filarial worm showing “double uterus” appearance containing numerous larval forms was seen []. Further, magnification revealed a thick layed cuticle with multiple longitudinal ridges and centrally placed intestinal tubule within the well-developed musculature [Figures and ]. A definitive diagnosis of Dirofilariasis repens was arrived at.\nPatient was treated with diethylcarbamazine (DEC) 100 mg tid for 3 weeks, albendazole 400 mg hs and cetrizine 5 mg Once daily for 5 days.\nFollowing medication, patient was reviewed regularly for 8 months and found to be completely asymptomatic.
|
[[54.0, 'year']]
|
F
|
{'1732496': 1, '8778658': 1, '9564568': 1, '12082307': 1, '18981515': 1, '8970844': 1, '30996536': 1, '12396323': 1, '12667230': 1, '9802095': 1, '16907864': 1, '10774712': 1, '16505560': 1, '12901735': 1, '30693219': 1, '24015022': 2}
|
{}
|
162,926 |
3757897-1
| 24,015,024 |
noncomm/PMC003xxxxxx/PMC3757897.xml
|
Triple tooth in primary dentition: A proposed classification
|
A 5-year-old boy presented to the Department of Pedodontics and Preventive Dentistry, with an abnormal upper front tooth. Past history and the family history were not relevant and there was no history of trauma. Examination revealed irregular morphology of teeth in the upper anterior region and there was fusion of left maxillary central incisor, lateral incisor and a supernumerary tooth and the fused teeth were free of caries []. The remaining primary teeth in both arches were normal. Occlusal radiograph revealed fusion of the central and lateral incisors to the supernumerary tooth with no clear distinction of root canal in the supernumerary tooth and agenesis of succedaneous upper left lateral incisor []. Parents were counseled regarding the anomaly and were made conscious about the concomitant problems expected with these anomalies. At 1-year follow-up, the succedaneous tooth germ of central incisor was found to be developing normally and he was advised regular follow-up.
|
[[5.0, 'year']]
|
M
|
{'6582168': 1, '5292961': 1, '5234679': 1, '18435724': 1, '5272471': 1, '28479704': 2, '26877735': 1, '14249184': 1, '15871454': 1, '17568838': 1, '11688820': 1, '6593362': 1, '14895778': 1, '25743857': 1, '27042600': 1, '10656127': 1, '3165989': 1, '32695375': 2, '11985191': 1, '20927417': 1, '25829699': 2, '24015024': 2}
|
{'7364066-1': 1, '5406797-1': 1, '4379660-1': 1}
|
162,927 |
3757898-1
| 24,015,025 |
noncomm/PMC003xxxxxx/PMC3757898.xml
|
Maturogenesis of non-vital immature permanent teeth
|
A 10-year-old girl with non-contributory medical history reported to the Department of Pediatric Dentistry, Government Dental College and Hospital, Nagpur for the treatment of pain and swelling in maxillary anterior region. History revealed trauma to maxillary anterior region 6 month back while playing in school. Clinical examination revealed fractured and discolored permanent maxillary right central incisor. Soft-tissue examination in relation to permanent maxillary right central incisor showed soft-tissue swelling of 1 × 1 cm. The tooth was tender to vertical percussion and showed negative response to thermal (cold test [Polfofluorange Pharma Dental Handelsges]) and electric pulp testing (Parkell Farmingdate). Intraoral periapical radiograph of permanent maxillary right central incisor revealed incompletely formed apex with periapical rarefaction []. The tooth was diagnosed with a pulpal necrosis and chronic periapical abscess. After rubber dam isolation and gaining access to the root canal system, the canal debris was loosen with minimal instrumentation and the root canal system was slowly irrigated with 0.5% sodium hypochlorite to prevent further damage to the survived apical papilla. Minimal instrumentation within the root canal system prevents further weakening of the root canal system. A light plain cotton pellet was placed in the pulp chamber for 48 h to facilitate purulent drainage. At the next visit working length was measured using diagnostic radiograph, followed by very minimal instrumentation and copious irrigation with normal saline and the canal was dried with sterile paper points. Mixture of ciprofloxacin, metronidazole and minocycline (3 Mix) was placed in the canal and coronal access was sealed with zinc oxide eugenol cement (Dentifiss India Ltd. Mumbai). Patient was recalled after 1 week, the tooth was asymptomatic and the canal was found to be dry.\nA 23 gauge sharp sterile needle was pushed with a sharp stroke beyond the working length of the canal into the periapical tissue to intentionally induce bleeding into the canal. When frank bleeding was evident at the cervical portion of the root canal system, a tight sterile dry cotton pellet was inserted at a depth of 3-4 mm into the canal and held there for 10 min to allow clot formation. Thick paste of calcium hydroxide base (Deepti Dental Product, Raigad) was placed over the clot and the excess opening was sealed with Zinc oxide eugenol cement (Dentifiss India Ltd. Mumbai). In the subsequent visit the excess cavity was sealed with glass ionomer cement.
|
[[10.0, 'year']]
|
F
|
{'32055296': 1, '26436090': 1, '17660916': 1, '14651290': 1, '9206435': 1, '12110105': 1, '18498881': 1, '32718044': 1, '18571000': 1, '11585146': 1, '19166764': 1, '6594274': 1, '15917683': 1, '24015025': 2}
|
{}
|
162,928 |
3757899-1
| 24,015,026 |
noncomm/PMC003xxxxxx/PMC3757899.xml
|
Orthodontic movement of a maxillary central incisor with a horizontal root fracture treated using an intra-radicular fibre splint
|
A 15-year-old boy with class II division 1 malocclusion was referred from the unit of Orthodontics for evaluation of a 2-year-old, asymptomatic, horizontal root fracture in the left maxillary central incisor, prior to undergoing fixed orthodontic treatment []. There was a history of trauma at the age of 13 years due to fall during play a recent intra-oral peri-apical radiograph revealed a horizontal root fracture at the junction of apical and middle-thirds of 21 showing a type 1 healing pattern with evidence of calcific nodules narrowing the pulp space []. On clinical examination, the tooth was found to be grade 1 mobile with no discoloration or tenderness to percussion. The electric pulp test showed the pulp of 21 to be vital. Three treatment options were considered for its management prior to orthodontic intervention (i) surgical removal of the apical fragment and endodontic treatment of the coronal segment, (ii) no treatment of the segments and observe the response to orthodontic forces and later carry out the above mentioned procedures, if required, (iii) endodontic treatment of both the fragments, if feasible and placement of a fiber post-splint. It was possible to negotiate both the fragments with the endodontic files, though with difficulty []. The apical 3 mm was sealed with mineral trioxide aggregate and a fiber post (3M, Rely X) measuring nearly 10 mm and at least 2-3 mm beyond the fracture site, was placed in the canal and sealed with resin modified light cure glass ionomer cement (3M) []. The coronal access was sealed with composite. Patient was then later subjected to orthodontic forces for correction of an over jet of nearly 7 mm, which involved both retraction and torque control, to which he responded favorably with both fragments moving as a unit [Figures -].
|
[[15.0, 'year']]
|
M
|
{'20238280': 1, '3864638': 1, '6573196': 1, '10673660': 1, '11475947': 1, '18352931': 1, '15876328': 1, '24015026': 2}
|
{}
|
162,929 |
3758170-1
| 22,455,975 |
noncomm/PMC003xxxxxx/PMC3758170.xml
|
Multimodal Imaging and Detection Strategy With 124 I-Labeled Chimeric\nMonoclonal Antibody cG250 for Accurate Localization and Confirmation of Extent of Disease\nDuring Laparoscopic and Open Surgical Resection of Clear Cell Renal Cell\nCarcinoma
|
A 60-year-old Caucasian male with a history of Ollier disease (a rare, nonhereditary,\nsporadic disorder characterized by multiple intraosseous benign cartilaginous tumors)\npresented with a right renal mass that was found at the time of a work-up for painless\nhematuria. CT scan of the abdomen showed a 10.3 cm × 7.6 cm × 6.7 cm mass in the superior\npole of the right kidney, with infiltration into the posterior hilum of the upper renal pole\n(). Retrograde cystoscopy\nwas completely negative.\n18F-FDG PET/CT imaging was performed during concomitant work-up of a suspicious\nleft femoral head/neck lesion related to the patient’s Ollier disease. 18F-FDG\nPET/CT imaging was performed 89 minutes following intravenous administration of 15.3 mCi of\n18F-FDG (). The\nattenuation correction non-contrast-enhanced CT portion of the 18F-FDG PET/CT\nimaging showed a large mass arising from the superior pole of the right kidney, with\n18F-FDG activity less than or equal to that of the normal 18F-FDG\naccumulation pattern within the remainder of either kidney. Mild, increased\n18F-FDG activity was seen in the left femoral head and neck region. No obvious\nsites of metastatic disease were originally identified in the initial interpretation of the\n18F-FDG PET/CT imaging.\n124I-cG250 PET/CT imaging was performed 4 days following intravenous\nadministration of 5.4 mCi of 124I-cG250 (). 124I-cG250 PET/CT imaging showed\nincreased 124I-cG250 activity within the renal mass in the superior pole of the\nright kidney, as well as increased 124I-cG250 activity within a retroperitoneal\nlymph node.\nThe patient was taken to the operating room and underwent a laparoscopic right radical\nnephrectomy with retroperitoneal lymph node dissection. Intraoperatively, a laparoscopic\ngamma detection probe (Neoprobe Model 2059, Neoprobe Corporation, Dublin, OH) was used to\nlocalize and identify all sites of 124I-cG250 uptake, to assist in the surgical\nresection, and for confirmation of complete removal of all sites of increased\n124I-cG250 activity. The laparoscopic gamma detection probe correctly identified\nincreased 124I-cG250 activity, both within the primary tumor of the right kidney\nand within the adjacent retroperitoneal lymph node tissues and provided confirmation of\nsuccessful laparoscopic surgical resection.\nThe intact right radical nephrectomy specimen and the intact retroperitoneal lymph node\ndissection specimen were imaged with 124I-cG250 PET/CT imaging and underwent\nsubsequent standard pathology processing and microscopic evaluation (). 124I-cG250 PET/CT imaging clearly\nidentified the sites of disease within the intact right radical nephrectomy specimen and the\nintact retroperitoneal lymph node dissection specimen. Histopathologic evaluation of the\nright nephrectomy specimen revealed an RCC (Fuhrman grade 3, 10.5 cm × 7.4 cm × 5.8 cm) of\nthe clear cell type with sarcomatoid features. It had surgical resection margins that were\nnegative, including Gerota’s fascia, the renal vessels, and the distal ureter. A total of 5\nregional lymph nodes were identified within the retroperitoneal lymph node dissection\nspecimen, with one lymph node metastasis identified and representing a lymph node nearly\ncompletely replaced by a tumor that was initially recognized on the preoperative\n124I-cG250 PET/CT imaging and resected with the assistance of the laparoscopic\ngamma detection probe.\nThe patient had a relatively uneventful postoperative course and was discharged to home on\npostoperative day 1. Two weeks later, the patient subsequently underwent an uneventful left\nproximal femur hemiarthroplasty, which showed a low-grade cartilaginous neoplasm, consistent\nwith his Ollier disease. The patient then went on to participate in the ASSURE (ECOG 2805)\nclinical trial, representing a randomized, double-blind, multi-institutional, phase III\nclinical trial comparing adjuvant sorafenib versus adjuvant sunitinib versus placebo in\npatients with resected RCC. At the time of this publication—30 months after the patient’s\nprevious laparoscopic right radical nephrectomy and retroperitoneal lymph node\ndissection—the patient is without evidence of disease.
|
[[60.0, 'year']]
|
M
|
{'15964127': 1, '29767327': 1, '22112047': 1, '23879552': 1, '11156414': 1, '25434612': 1, '17920348': 1, '17726663': 1, '23123291': 1, '29388770': 1, '17878667': 1, '12383210': 1, '18695901': 1, '18669472': 1, '17720652': 1, '16170161': 1, '4161094': 1, '2428759': 1, '13585339': 1, '29710858': 1, '10709109': 1, '17102051': 1, '4335980': 1, '14506194': 1, '18619378': 1, '8478666': 1, '12717246': 1, '15085295': 1, '18180227': 1, '17947723': 1, '10541374': 1, '18430115': 1, '23213092': 1, '12576453': 1, '9390023': 1, '15000251': 1, '19173715': 1, '14428164': 1, '16937302': 1, '9193349': 1, '11993941': 1, '18765154': 1, '11891480': 1, '8790218': 1, '17395103': 1, '11859199': 1, '8661007': 1, '18154677': 2, '17418153': 1, '21789055': 1, '14660102': 1, '25749808': 1, '32202104': 1, '7550393': 1, '21624561': 1, '19025340': 1, '17864425': 1, '17085101': 1, '20003888': 1, '23138852': 1, '18186915': 2, '20359812': 1, '9639291': 1, '33466827': 1, '19406595': 1, '18027053': 1, '9230182': 1, '9809561': 1, '22455975': 2}
|
{'3758170-2': 2, '2235860-1': 1, '2235860-2': 1, '2246138-1': 1}
|
162,930 |
3758170-2
| 22,455,975 |
noncomm/PMC003xxxxxx/PMC3758170.xml
|
Multimodal Imaging and Detection Strategy With 124 I-Labeled Chimeric\nMonoclonal Antibody cG250 for Accurate Localization and Confirmation of Extent of Disease\nDuring Laparoscopic and Open Surgical Resection of Clear Cell Renal Cell\nCarcinoma
|
A 39-year-old Caucasian female with a previous history of renal calculi presented for\nevaluation of right flank pain. Ultrasound of the abdomen showed a 1.9 cm × 1.6 cm × 1.4 cm\nsolid-appearing lesion in the inferior pole of the right kidney. CT of the abdomen showed a\n2.0 cm × 1.9 cm × 1.9 cm intraparenchymal mass within the posterior cortex of the inferior\npole of the right kidney ().\n124I-cG250 PET/CT imaging was performed 5 days following intravenous\nadministration of 5.2 mCi of 124I-cG250 (). 124I PET/CT imaging showed\nincreased 124I-cG250 activity within the renal mass in the inferior pole of the\nright kidney.\nThe patient was taken to the operating room and underwent an open right partial nephrectomy\nof the inferior pole of the right kidney. At the discretion of the surgeon, an\nintraoperative gamma detection probe was not used in this case.\nThe intact and bisected right partial nephrectomy specimens were imaged with\n124I PET/CT imaging (). 124I-cG250 PET/CT imaging clearly identified the tumor size and\nlocation within the intact and bisected specimens and the relationship of the tumor to the\nparenchymal surgical resection margin surface within the bisected specimen.\nThe right partial nephrectomy specimen underwent subsequent standard pathology processing\nand microscopic evaluation (). Histopathologic evaluation of the right partial nephrectomy specimen revealed an\nRCC (Fuhrman grade 2, 1.7 cm × 1.5 cm × 1.4 cm) of the clear cell type. It had negative\nsurgical resection margins, with the closest distance measuring 0.7 cm from the inked\nparenchymal surgical resection margin surface of the right partial nephrectomy specimen,\nwhich correlated well with the 124I-cG250 PET/CT image of the bisected right\npartial nephrectomy specimen.\nThe patient had a relatively uneventful postoperative course and was discharged to home on\npostoperative day 2. The patient required no postoperative adjuvant therapies. At the time\nof this publication—36 months after her previous open right partial nephrectomy—the patient\nis without evidence of disease.
|
[[39.0, 'year']]
|
F
|
{'15964127': 1, '29767327': 1, '22112047': 1, '23879552': 1, '11156414': 1, '25434612': 1, '17920348': 1, '17726663': 1, '23123291': 1, '29388770': 1, '17878667': 1, '12383210': 1, '18695901': 1, '18669472': 1, '17720652': 1, '16170161': 1, '4161094': 1, '2428759': 1, '13585339': 1, '29710858': 1, '10709109': 1, '17102051': 1, '4335980': 1, '14506194': 1, '18619378': 1, '8478666': 1, '12717246': 1, '15085295': 1, '18180227': 1, '17947723': 1, '10541374': 1, '18430115': 1, '23213092': 1, '12576453': 1, '9390023': 1, '15000251': 1, '19173715': 1, '14428164': 1, '16937302': 1, '9193349': 1, '11993941': 1, '18765154': 1, '11891480': 1, '8790218': 1, '17395103': 1, '11859199': 1, '8661007': 1, '18154677': 2, '17418153': 1, '21789055': 1, '14660102': 1, '25749808': 1, '32202104': 1, '7550393': 1, '21624561': 1, '19025340': 1, '17864425': 1, '17085101': 1, '20003888': 1, '23138852': 1, '18186915': 2, '20359812': 1, '9639291': 1, '33466827': 1, '19406595': 1, '18027053': 1, '9230182': 1, '9809561': 1, '22455975': 2}
|
{'3758170-1': 2, '2235860-1': 1, '2235860-2': 1, '2246138-1': 1}
|
162,931 |
3758708-1
| 24,014,971 |
noncomm/PMC003xxxxxx/PMC3758708.xml
|
Primary Pulmonary Poorly Differentiated Synovial Sarcoma: Transducer-Like Enhancer of Split 1 Immunohistochemistry as A Valuable Diagnostic Aid
|
A 26-year old male presented with an increasing breathlessness over the previous 15 days accompanied by an episode of hemoptysis. On examination, he was moderately built, had low grade fever and absent breath sounds in the right lower chest. On investigation, hemoglobin and the blood counts were in normal range. Chest radiograph revealed features suggestive of a mass lesion with well-defined margins within the right lower lobe. This was followed by a high resolution computerized tomogram, which further confirmed the presence of the mass and showed it to be pulmonary and not pleural in nature. A lobectomy resection was carried out as he was determined to have no other primary site of tumor.\nGross examination revealed a heavy boggy right lower lobe with a congested pleural surface. On sectioning, a well-defined fleshy mass (13 × 12 × 5 cm) with areas of necrosis and hemorrhage involving almost the entire lower lobe was present. The mass seemed to involve the medial aspect of the lobe including the hilar area with some residual remnant of parent lung in the periphery [].\nMicroscopy revealed a cellular unencapsulated neoplasm with tumor cells in vague lobulated sheets with pushing margins []. The compact spindle cells most characteristic of synovial sarcoma were largely absent. In most areas, the cells appeared small and round with round to ovoid nuclei and a small amount of eosinophilic cytoplasm []. In only a few areas was their some degree of spindling with cells growing in fascicular arrays []. In places, the cells were in nests separated by fine branching staghorn or hemangiopericytomatous type blood vessels []. Mitosis was brisk (10-14 mitosis/10 HPF). Large areas of geographic necrosis were also present. The differential diagnosis considered based on an initial histology included a neuroendocrine tumor, Ewing's sarcoma, peripheral neuroectodermal tumor (PNET), solitary fibrous tumor, and poorly differentiated synovial sarcoma.\nImmunoperoxidase studies on paraffin embedded tissue revealed the neoplastic cells to be focally reactive with antibodies to pancytokeratin along with reactivity for epithelial membrane antibody in approximately 25% of the cells. They failed to react with antibodies to thyroid transcription factor 1 (TTF-1), synaptophysin, smooth muscle actin, S100 protein, CAM5.2, CD99, chromogranin, CD45 and CD34. With the above IHC findings, a poorly differentiated synovial sarcoma was considered most likely and a TLE-1 stain was carried out, which revealed diffuse nuclear reactivity of the tumor cells []. This stain provided the definitive diagnosis of a synovial sarcoma. The patient was subjected to chemotherapy; however, over the next 4 months, he developed extensive metastatic disease and eventually succumbed to his illness.
|
[[26.0, 'year']]
|
M
|
{'22071579': 1, '7750931': 1, '11395555': 1, '15668648': 1, '9888710': 1, '21571956': 1, '11905413': 1, '20189377': 1, '16762837': 1, '15257548': 1, '24014971': 2}
|
{}
|
162,932 |
3758709-1
| 24,014,972 |
noncomm/PMC003xxxxxx/PMC3758709.xml
|
Iatrogenic Infection of Clostridium welchii Following Intramuscular Injection of Sodium Diclofenac
|
A 19-year-old male, presented to our hospital in September 2008, with severe pain in the right gluteal region. He gave the history of receiving an IM injection- diclofenac sodium from a local practitioner for viral fever and body ache. Within 7-8 h of receiving the injection, pain increased in intensity and radiated toward thigh, by 10-12 h he developed fever and pain increased in severity. He also had difficulty in walking. With the above features, he visited our hospital emergency department. On examination, patient had diffuse swelling with signs of inflammation in the upper posterior aspect of gluteal region there was no hematoma or local tissue damage and patient was febrile (102°F). Systemic examination was normal without other toxic symptoms at the time of admission. Various investigations showed Hb %-11g%, total WBC count-11,400 cells/mm3, Differential count-neutrophil-75%, lyphocytes-20%, monocyte-3%, and eosinophil-2%, ESR-35 mm/h. The diagnosis was injection site abscess and treated with systemic antibiotics (cephalosporin group) and antipyretics.\nWithin 24 h, patient developed toxic symptoms and had difficulty in moving the limb. Signs of inflammation spread to the lateral part of the thigh. On palpation, crepitus was present. Immediately X-ray of the part was taken which showed gas-filled sac near right hip joint []. Patient was immediately shifted to operation theater and wound debridement was done. Tissue bits were sent for Gram's stain and anerobic culture. Gram's stain revealed plenty of thick, Gram positive bacilli, and very few pus cells. Culture on Robertson's cooked meat media showed abundant gas which was foul smelling. Growth on neomycin blood agar showed grey colonies with swarming. Growth on egg yolk media showed opalescence around the colony. Nagler's reaction was positive which confirmed the organism as C. welchii.\nPostoperatively patient was started on systemic penicillin, ceftazidime, and metronidazole. Temperature and other vitals were regularly recorded which came to normal by the 8 postoperative day. Patient's general condition gradually improved and range of lower limb movements resumed thereafter. Patient went back home walking at the end of 30 days.
|
[[19.0, 'year']]
|
M
|
{'1553607': 1, '33842680': 2, '17657062': 1, '21809721': 1, '21846405': 2, '5641440': 1, '5653039': 1, '1200501': 1, '24014972': 2}
|
{'8020469-1': 1, '3182882-1': 1}
|
162,933 |
3758710-1
| 24,014,973 |
noncomm/PMC003xxxxxx/PMC3758710.xml
|
Axillary Schwannoma with Extensive Cystic Degeneration
|
A 40-year-old female presented to orthopedics-out-patient department with complaints of shoulder pain for 6 months and treated for cervical spondylitis, shoulder arthritis and given short wave diathermy and physiotherapy. The pain only worsened. In due course of treatment, she noticed an axillary mass, which increased gradually and further referred to surgery out-patient department for further management. Local examination revealed a 6 × 4 cm oval tender, firm, mobile mass in the left axilla deeper to pectoralis major muscle. A provisional diagnosis of peripheral nerve sheath tumor was made and the case was subjected for fine needle aspiration cytology (FNAC).\nFine needle aspiration from the left axillary mass yielded 30 ml straw colored fluid. The size of the swelling markedly reduced after aspiration and no residual lump was palpated. The smears showed occasional lymphocytes in the proteinaceous background. The cytological diagnosis of benign cystic lesion possibly lymphatic cyst was made and the case was asked for biopsy.\nUltrasonogram showed a cystic lesion. On magnetic resonance imaging, a well-defined, oval shaped, hyperintense cystic lesion, of 6.6 × 4.8 cm in anterolateral compartment of arm was noted []. The lesion was parallel to long axis of neurovascular bundle predominantly in subcutaneous plane with an extension into the inter-muscular plane. The case underwent surgery and the excised mass was sent for the histopathological examination.\nGross examination revealed a cystic mass measuring 6.5 × 4.5 × 2 cm. External surface was smooth and grey white. Cut section revealed uniloculated cyst filled with gelatinous material and the inner lining of the wall was smooth []. Sections from the cyst wall showed hypocellular and hypercellular areas. Hypercellular areas show spindle shaped cells having wavy nuclei arranged in fascicles with focal palisading of nuclei []. Hypocellular areas showed large number of foamy macrophages and loose myxoid stroma []. There was mild nuclear pleomorphism, but no mitotic activity was noted. On IHC tumor cells showed diffuse cytoplasmic positivity for S-100 protein [] and was negative for KI67 []; confirming the diagnosis of schwannoma.
|
[[40.0, 'year']]
|
F
|
{'30431732': 1, '18989247': 1, '30316135': 2, '14859189': 1, '10962671': 1, '19472538': 1, '18453671': 1, '3317105': 1, '12401926': 1, '12646734': 1, '24014973': 2}
|
{'6187017-1': 1}
|
162,934 |
3758711-1
| 24,014,974 |
noncomm/PMC003xxxxxx/PMC3758711.xml
|
Melanoacanthoma of External Ear: Report of Two Cases
|
A fifty year old female presented with slow growing, non pruritic, elevated and solid pigmented growth 1.5 × 1 cm over the external ear noticed since last 1 year. Her general physical and systemic examination was within normal limits. The lesion was clinically suspected as melanoma. The histopathology of the excised specimen showed stratified squamous epithelium of the epidermis along with the elevated lesion with hyperkeratosis, acanthosis and papillomatosis. The spinous layer showed presence of round to oval cells and abundant brownish black pigment (melanin). In addition many horn cysts (both true and pseudo) were seen. There was no invasion of the surrounding tissue, lack of cellular atypia and infrequent mitoses. The dermis was unremarkable and a piece of cartilage of the concha was seen beneath it [Figures and ].\nThe second case was a 53 years old male who presented with similar type of pigmented lesion of 1 × 1 cm over external ear for past 1 and half year. Histopathologically there was presence of abundant melanin pigment containing cells in the spinous layer as seen in the previous case. In addition there were squamous eddies. Because of the clinical suspicion of malignancy and inadequate nature of the biopsy, repeat biopsy was advised. The second biopsy showed characteristic features of melanoacanthoma with adjacent normal epidermis. After 4 years of the initial diagnosis these 2 patients did not report any recurrence of the lesion.
|
[[50.0, 'year']]
|
F
|
{'17980780': 1, '20551567': 1, '14422903': 1, '21572799': 2, '15569024': 1, '22421661': 1, '11286615': 1, '24014974': 2}
|
{'3088943-1': 1}
|
162,935 |
3758712-1
| 24,014,975 |
noncomm/PMC003xxxxxx/PMC3758712.xml
|
Limb Body Wall Complex: A Rare Anomaly
|
A 42-year-old, G3P2 L0 presented to the obstetrics outpatient department in the second trimester of her third pregnancy for a routine antenatal check up. She had two still births in the past, the details of which are not known. She is not a hypertensive or diabetic. There was no history of any drug intake except for iron and folic acid supplementation. Her routine hematological and biochemical investigations were within normal limits. A routine anomalous scan done at 2nd trimester showed a fetus with features of intrauterine growth retardation along with a large fluid-filled sac in the abdominal region which was compressing the thorax. Both upper and lower extremities were visualized. However, due to oligohydraminos no further comment could be made upon the fetal anatomy. Color flow showed two umbilical arteries along the wall of the cyst. The intraabdominal unilocular cystic mass was assumed to be the urinary bladder and in conjunction with the presence of oligohydraminos and Intrauterine growth retardation a proposed diagnosis of congenital megacystitis or Prune Belly Syndrome was made [Figures and ]. The parents were informed about the diagnosis and after counseling, they opted for termination of pregnancy. The pregnancy was terminated after obtaining the consent, and the abortus was sent for pathological examination.\nAt autopsy, the fetus weighed 75 g and on external examination a number of anomalies were noted. The genitalia were ambiguous. Encephalocoele was seen over the head of the fetus in the occipital region. The most striking abnormality was a left sided anterior abdominal wall defect, from which gastrointestinal organs were protruding. The organs identified included the liver and the intestine. Although these organs were not encased by a membrane, a membrane like structure was present near the anterior abdominal wall opening [Figures and ]. A defect in the posterior abdominal wall was also noted. A number of skeletal abnormalities were noticed. There were scoliosis and amelia of the digits of the right upper limb. The lower limbs exhibited malrotation and were pushed to the right lateral side by the protruding abdominal organs []. The umbilical cord was short and was found in a membrane like structure that was partially covering some of the protruding organs. A radiological examination was also done, which confirmed the gross skeletal anomalies and the encephalocele []. On internal examination, there was agenesis of anal canal along with agenesis of genitourinary tract, and the lungs were hypoplastic. The remaining organs appeared normal on gross examination and congested on microscopy. In view of the above combination of malformations, a diagnosis of LBWC was offered.
|
[[42.0, 'year']]
|
F
|
{'30377551': 1, '14530552': 1, '2530150': 1, '18699998': 2, '14245093': 1, '24928524': 1, '17886024': 1, '8279488': 1, '18603699': 1, '2962493': 1, '27407587': 1, '32856427': 1, '24014975': 2}
|
{'2526069-1': 1}
|
162,936 |
3758736-1
| 24,019,631 |
noncomm/PMC003xxxxxx/PMC3758736.xml
|
Early diagnosis of co-existent ß-thalassemia and alkaptonuria
|
Our case was a 1-year 5-month-old male child, brought with complaints of reddish discoloration of the nappies and clothes and breath-holding spells. There was no abnormal odor of the skin or urine. There was no history of crying while passing urine, poor urinary stream or bleeding from skin or mucus membrane. There was no history of fever, rash, abdominal pain, constipation or alteration of sensorium. The mother of the baby was a known case of thalassemia trait; however, had never received transfusion. The baby’s parents were consanguineous cousins. The father’s thalassemia status could not be elicited.\nOn examination, the baby weighed 8.5 kg with head circumference 44 cm and length 81 cm and the baby was conscious and alert. There was no jaundice or dehydration or abnormal odor. Arterial oxygen saturation (SpO2) was 94%. The capillary refill time was between 3 s and 4 s. The heart rate was 146/min. The respiratory rate was 26/min. Non-invasive blood pressure was 73/44 (54) mm Hg. Respiratory system examination revealed normal chest movements with equal air entry on both sides. Abdomen was soft. The liver was palpable 1 cm below the costal margin. The spleen was not felt. There were no other masses felt. Examination of the cardiovascular system showed normal heart sounds. There were no added heart sounds, murmurs or rubs. Reflexes were normal, and he had hypotonia. There was no neck stiffness. The spine and gait were normal. The eyes, musculoskeletal system, skin, and cardiovascular systems were normal.\nThe baby was admitted for observation and investigations, and the initial differential diagnosis included alkaptonuria, myoglobinuria, hemoglobinuria, porphyria, and hemochromatosis. He had an under-current viral illness, which was managed symptomatically. The urine routine examination and ultrasound abdomen were normal.\nThe hemoglobin levels were low with microcytic hypochromic anemia. Hemoglobin was 10.2 g/dl (normal 10.5-14 g/dl), packed cell volume, mean corpuscular volume (MCV) and mean corpuscular hemoglobin were low at 31.9% (normal 32-42%), 68 fl (normal 72-88 fl), and 21.8 pg (normal 24-30 pg), respectively. MCV concentration was 32% (normal 31.5-34.5%) and red cell distribution width 17.1% (normal 11-16%). Serum iron, total iron binding capacity, and ferritin levels were within the reference range. Hemoglobin analysis by cation exchange high-pressure liquid chromatography (HPLC) revealed Hb A0 to be 80.4% and Hb A2 to be 6.1% (normal 2.40-3.60). The HPLC picture on correlation with the complete hemogram suggested β-thalassemia trait. DNA studies confirmed the beta globin gene defect of β-thalassemia.\nThe serum electrolytes and serum bicarbonate were normal. The renal function and liver function were within the reference range. The child’s urine porphyrin, estimations were within normal levels, and serum lead levels and δ-amino levulinic acid were not tested. Myoglobin and hemoglobin levels were undetected in urine. No abnormalities were detected on the electroencephalogram, leading us to believe that the breath holding spells were due to anemia.\nUrine was of normal color when voided but turned black over variable periods spontaneously; furthermore, turned black with Benedict’s reagent, strong alkali (filter paper impregnated with 10% sodium hydroxide turned black within 5 min when dipped into the urine) and ferric chloride (addition of dilute ferric chloride solution drop by drop showed an evanescent violet blue color). The urine of an alkaptonuric individual usually appears normal when passed. However, it starts to darken upon standing, and this is caused by oxidation and polymerization of the homogentisic acid, and it is enhanced with an alkaline pH.\nBenedict’s test was strongly positive with red brown precipitate at the bottom and black colored supernatant. Glucose oxidase test (with multistix) was negative excluding the role of glucose as reducing substance. For the qualitative assay of HA, to 0.5 ml of sample, a few drops of 10% ammonia was added followed by the addition of 3% silver nitrate solution. A greenish black color developed, signifying the presence of a substantial amount of HA. Quantitative examination of urine by tandem mass spectrometry revealed that concentration of HA in urine was 91 mg/dl (normally HA is not present in urine). Parents’ urine was negative for HA. Due to the financial constraints, confirmatory diagnosis by DNA mutation analysis could not be carried out.\nThe child was treated symptomatically, and he was given vitamin C (50 mg once a day for 3 months), low phenylalanine and tyrosine diet, and advised to monitor counts, get liver and renal function tests carried out every 2 weeks. On the request of his parents, the child was discharged after 3 days and advised to follow-up in the outpatient department (OPD). After 3 months post-therapy, his HA levels had not reduced. Currently, the baby is under follow-up every 6 months in the OPD.
|
[[5.0, 'month']]
|
M
|
{'19014543': 2, '3345345': 1, '28643719': 2, '18720640': 1, '16572955': 1, '26474772': 1, '33666743': 1, '6671941': 1, '24959026': 1, '20978599': 1, '8782815': 1, '4078344': 1, '16394410': 1, '12872815': 1, '24019631': 2}
|
{'2596114-1': 1, '5508465-1': 1}
|
162,937 |
3758737-1
| 24,019,632 |
noncomm/PMC003xxxxxx/PMC3758737.xml
|
Derivative chromosome 11 in a child resulting from a complex rearrangement involving chromosomes 3, 6 and 11 in father: Significance of parental karyotyping
|
The proband, a 3-year-old, morphologically normal male child born from full-term normal delivery to a phenotypically normal couple presented with a clinical history of mental retardation with convulsion, and was referred for cytogenetic analysis. The couple had a history of two first-trimester spontaneous abortions. However, there was no prior family history of congenital anomalies or other inherited disorders. The abortuses from earlier pregnancies were not subjected to cytogenetic analyses. Cytogenetic analysis was carried out on phytohemagglutinin stimulated peripheral blood lymphocytes, cultured in Roswell Park Memorial Institute (RPMI) 1640 medium, using modified standard protocol.[] Twenty G-banded metaphases were analyzed using Cytovision software, and designated as per ISCN (2009) nomenclature at 550 bands per haploid genome.\nThe karyotype of G-banded metaphase of the proband revealed derivative chromosome 11 arising from the presence of additional material of unknown origin on the short arm of chromosome 11 at band 11p15.2. To ascertain the origin of derivative chromosome identified in the child, the parental samples were requested for cytogenetic studies. Mother had an apparently normal karyotype (46, XX) reported earlier. The karyotype of father revealed a CCR involving chromosomes 3, 6, and 11, the breakpoints being 3p22, 6p22.1 and 11p15.2 respectively, with the karyotype representation as 46, XY, t(3;6;11) (p22;p22.1;p15.2) as depicted in []. This was an apparently balanced translocation since the father had no phenotypic features. Hence, the final karyotype of the child was designated as 46, XY, der(11) t(6;11)(p22.1;p15.2)pat, indicating partial trisomy for 6p22.1-pter and monosomy for 11p15.2-pter. The derivative chromosome 11 from father had directly passed to the child, resulting in unbalanced karyotype in child.
|
[[3.0, 'year']]
|
M
|
{'1437215': 1, '32577072': 2, '21890680': 1, '110670': 1, '11857547': 1, '3781562': 1, '13772379': 1, '24019632': 2}
|
{'7295250-1': 1}
|
162,938 |
3758738-1
| 24,019,633 |
noncomm/PMC003xxxxxx/PMC3758738.xml
|
A case of Kartagener’s syndrome: Importance of early diagnosis and treatment
|
A twelve year-old boy came to our institute with complaints of recurrent sore throat and cough with yellowish expectoration intermittently for past three to four years with episodes of fever; weight loss of about two to three kg over past one year; chronic wheezing; and chronic use of antibiotics for past two to three years with occasional steroids.\nThe patient was a moderately built fair young boy, who was dyspneic, coughing, and short of breath. He was febrile, conscious, and oriented. No pallor and no icterus. Clubbing grade 2 was present. JVP was not raised and no edema feet. A few submental lymph nodes were palpable, which were mildly tender. Auscultation of the chest revealed diffuse bilateral ronchi with scattered crepitations over both infrascapular regions. Chest expansion was reduced. Surprisingly, we could not hear his heart sounds on the left side, but they were appreciable over right side and those were normal cardiac sounds. Apex beat was palpable over the fifth intercostal space on the right side of chest. Rest of the physical and systemic examination were normal.\nWe did an electrocardiogram (ECG) on him with both right and left-sided chest leads, which revealed inverted “P” waves in L1 and AVL []. The ECG was normal on right-sided chest leads [Figures and ].\nThe ultrasonography of abdomen revealed situs inversus, but rest of the scan was normal. His high resolution computed tomography (HRCT) chest revealed bronchiectatic changes [] and CT abdomen again confirmed situs inversus []. X-ray and CT para nasal sinus revealed pansinusitis.\n2D echo was consistent with dextrocardia; all four chambers were normal. Doppler study confirmed situs inversus of aorta and inferior vena cava.\nHis hemogram revealed a total leucocyte count of 14700/cu.mm. erythrocyte sedimentation rate was 35 mm after 1st hour. Liver and renal functions were normal as was the urine examination.\nAnti nuclear antibody, anti nutrophilic cytoplasmic antibody, and human immunodeficiency virus serolgy were negative. Serum angiotensin converting enzyme levels and Serum Immunoglobulin E (IgE) were normal. Tuberculosis (TB) gold Quantiferon was negative. Sputum for acid fast bacilli did not reveal the tuberculosis bacilii. Gram stain of the sputum revealed numerous gram positive cocci in pairs and gram negative bacilli. Sputum culture was sterile.\nHe was operated for sinusitis (functional endoscopic sinus surgery) at the same institute by our ENT team. Bilateral middle turbinates were fused with the uncinate process. Fused portion was opened using microdibrider and frank pus was found in both bulla ethmoidalis. Bulla was opened and pus was removed. Bilateral inferior meatal antrostomy was done. Subsequently, he was advised vaccination for influenza and pneumococcal vaccine, inhaled steroid and bronchodilator, a mucolytic, and antibiotic course with regular follow-up in ENT, Pulmonology, and Internal Medicine OPD. After 2 months of follow-up, the patient is doing well, although he continues to have intermittent cough of mild intensity.
|
[[12.0, 'year']]
|
M
|
{'16428701': 1, '1081860': 1, '14392669': 1, '15486899': 1, '33646099': 1, '3498050': 1, '152870': 1, '1084576': 1, '15866661': 1, '24019633': 2}
|
{}
|
162,939 |
3758739-1
| 24,019,634 |
noncomm/PMC003xxxxxx/PMC3758739.xml
|
Sclerosterosis (Truswell-Hansen disease)
|
A 50-year-old man, diabetic for the past 10 years, presented with poorly controlled diabetes and cataract. Incidentally, he had coarse facial features with frontal bossing and congenital left facial nerve palsy with facial synkinesia []. He also had syndactyly of the left 3rdand 4thfingers and short right 4thfinger along with hypoplastic nails []. Radiographs showed dense skull [], pelvis [], lumbar spine, and fingers. Serum calcium, phosphorus, and alkaline phosphatase were normal.\nHe was born of a consanguineous marriage and the granddaughter of his elder brother was operated for syndactyly []. His family members could not be examined.
|
[[50.0, 'year']]
|
M
|
{'21471202': 1, '12694228': 1, '11181578': 1, '13539104': 1, '22084176': 1, '24019634': 2}
|
{}
|
162,940 |
3758994-1
| 24,009,910 |
noncomm/PMC003xxxxxx/PMC3758994.xml
|
Subtrochanteric Femoral Fracture during Trochanteric Nailing for the Treatment of Femoral Shaft Fracture
|
A 27-year-old woman (height 157 cm and weight 48 kg), with chronic renal failure and a previous complete lumbar spinal cord injury, sustained a femoral shaft fracture (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association [AO/OTA] classification 32B1) (). After reaming up to 13 mm, a 12 mm diameter, and 340 mm long nail was introduced manually. During the passage of the proximal metaphysis, resistance was felt. We then checked for evidence of fracture using an image intensifier, but no fracture was detected. Insertion of the IM nail was progressed with the image intensifier, focused around the fracture site. After inserting the nail, and while attempting to fix the proximal locking screw, a 7-8 cm long longitudinal fracture was observed along the lateral cortex from the vastus ridge to below the lesser trochanter. Due to severe osteoporosis (T score, -4.3), we believed that poor bone quality had caused the iatrogenic subtrochanteric fracture in this patient ().
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[[27.0, 'year']]
|
F
|
{'32443293': 2, '11602839': 1, '17805018': 1, '3506582': 1, '27115752': 1, '32296485': 2, '2737894': 1, '17106375': 1, '15607873': 1, '16118557': 1, '29326763': 1, '29386019': 1, '19411641': 1, '9892119': 1, '32774745': 1, '33283486': 1, '11741073': 1, '24009910': 2}
|
{'3758994-2': 2, '3758994-3': 2, '7156185-1': 1, '7253536-1': 1, '7253536-2': 1}
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162,941 |
3758994-2
| 24,009,910 |
noncomm/PMC003xxxxxx/PMC3758994.xml
|
Subtrochanteric Femoral Fracture during Trochanteric Nailing for the Treatment of Femoral Shaft Fracture
|
A 63-year-old man (height 169 cm and weight 72 kg) with multiple trauma injuries presented with a middle femoral shaft fracture (AO/OTA classification 32B1) (). After reaming up to 14 mm, a 13 mm diameter, and 360 mm long nail was inserted. However, when the targeting device was slowly rotated following the passage of the proximal metaphysis after confirming the central direction of nail's tip during insertion, resistance was felt, and cortical breakage along the lateral cortex in the subtrochanteric area was observed under an image intensifier. The newly developed fracture was on the lateral side and had a distance from the original fracture site; therefore, we considered it as a missed, concealed ipsilateral proximal femoral fracture rather than an iatrogenic fracture comminution. Accordingly, we continued the nail insertion (with gradual rotation) until a cracking sound was heard. The result was a displaced complete subtrochanteric fracture ().
|
[[63.0, 'year']]
|
M
|
{'32443293': 2, '11602839': 1, '17805018': 1, '3506582': 1, '27115752': 1, '32296485': 2, '2737894': 1, '17106375': 1, '15607873': 1, '16118557': 1, '29326763': 1, '29386019': 1, '19411641': 1, '9892119': 1, '32774745': 1, '33283486': 1, '11741073': 1, '24009910': 2}
|
{'3758994-1': 2, '3758994-3': 2, '7156185-1': 1, '7253536-1': 1, '7253536-2': 1}
|
162,942 |
3758994-3
| 24,009,910 |
noncomm/PMC003xxxxxx/PMC3758994.xml
|
Subtrochanteric Femoral Fracture during Trochanteric Nailing for the Treatment of Femoral Shaft Fracture
|
A 70-year-old man (height 160 cm and weight 63 kg) sustained a proximal femoral shaft fracture (AO/OTA classification 32A1) in a traffic accident (). No comminution was observed around the fracture surfaces. After reaming up to 12 mm, an 11 mm diameter, and 320 mm long nail was introduced manually. After the nail passed the proximal metaphysis, it was derotated gradually with successive mallet blows until it reached its intended location. When the proximal metaphysis was checked prior to proximal locking screw fixation, a newly developed proximal femoral fracture was observed under an image intensifier. This fracture started from the previous proximal fracture surface in the lateral aspect and propagated almost to the lesser trochanter, resulting in a proximal femoral shaft fracture with subtrochanteric extension ().
|
[[70.0, 'year']]
|
M
|
{'32443293': 2, '11602839': 1, '17805018': 1, '3506582': 1, '27115752': 1, '32296485': 2, '2737894': 1, '17106375': 1, '15607873': 1, '16118557': 1, '29326763': 1, '29386019': 1, '19411641': 1, '9892119': 1, '32774745': 1, '33283486': 1, '11741073': 1, '24009910': 2}
|
{'3758994-1': 2, '3758994-2': 2, '7156185-1': 1, '7253536-1': 1, '7253536-2': 1}
|
162,943 |
3759087-1
| 24,019,656 |
noncomm/PMC003xxxxxx/PMC3759087.xml
|
Association of non-traumatic complex regional pain syndrome with adenocarcinoma lung on 99mTc-MDP bone scan
|
A 56-year-old male, smoker since last 30 years presented to the physician with complaints of cough and hemoptysis since 3 weeks. A chest radiograph showed a right lung upper zone mass with surrounding consolidation []. There was no bone destruction. Non-contrast computed tomography scan of the chest showed a homogeneous mass with lobulated margins and surrounding consolidation in the right upper lobe. There was no calcification or cavitation seen in the mass. Mass showed a broad area of contact with the anterior chest wall, superior vena cava, and right brachiocephalic vein. No rib destruction or brachial plexus involvement were noted. Mass was not extending in to the paravertebral location where the stellate ganglion is located. There was no significant mediastinal adenopathy or lung metastasis seen []. A tru-cut biopsy revealed adenocarcinoma lung. The patient was referred for a bone scan to rule out metastases. The Nuclear Medicine physician observed swelling and redness in the right hand of the patient. The patient underwent a three phase 99mTc-MDP bone scan with intravenous administration of 20 mCi (740 MBq) radiotracer. Flow and pool phase study revealed diffusely increased tracer activity in the right hand and elbow []. Whole body anterior and posterior views taken 3 h later showed no evidence of metastases but right wrist joint and hand showed diffusely increased juxta-articular uptake consistent with CRPS. Also noted was increased uptake along long bones of the lower limbs especially in the tibiae, consistent with hypertrophic osteoarthropathy (HPOA) []. A radiograph of bilateral hands showed juxta-articular osteopenia consistent with CRPS and there was increased soft-tissue shadow in the right hand suggestive of subcutaneous edema. There was also periosteal reaction seen in the distal radius and ulna suggestive of HPOA []. Seven days after the diagnosis on bone scan, the patient developed pain in the affected hand. He was prescribed NSAIDS for these symptoms which did not relieve his symptoms appreciably. The patient was referred to the pain clinic of our institution for further management in addition to his oncologic treatment.
|
[[56.0, 'year']]
|
M
|
{'6739825': 1, '6368562': 1, '6192166': 1, '7156826': 1, '6487398': 1, '7455127': 1, '6747242': 1, '4038364': 1, '7065557': 1, '24019656': 2}
|
{}
|
162,944 |
3759088-1
| 24,019,657 |
noncomm/PMC003xxxxxx/PMC3759088.xml
|
Myocardial perfusion scintigraphy in a case of dextrocardia: Doing it “right”
|
A 54-year-old type 2 diabetic and hypertensive female patient with dextrocardia and situs inversus was referred for evaluation of coronary artery disease. The patient underwent treadmill test with Bruce protocol. The electrocardiogram with the leads placed conventionally [] shows P inversion in the lead 1 inverted QRS complexes in lead 1 with right axis deviation and equivocal and non-progressive R waves in the precordial leads. Reversal of the leads shows upright P and QRS in lead 1 with normal QRS progression in chest leads []. Chest X-ray also showed cardiac shadow on the right side []. At the peak stress, Tc99m-tetrofosmin (370MBq) was injected. Following the stress, tomographic imaging was carried out under a dual head gamma camera (Infinia hawkeye-4, General Electricals, Milwaukee, USA) with a low dose computed tomography (140 mV, 2 mA) for attenuation correction. Images were acquired in L mode over 180° starting from right posterior oblique to left anterior oblique projections instead of the standard right anterior oblique to left posterior oblique views. Rest images were acquired on the same day after reinjection of tracer. The images show findings of situs inversus and dextrocardia []. Reversible perfusion defect was also noticed in the free wall (antero-lateral segment as per conventional nomenclature). Attenuation correction in this case shows the severity and extent of defect to be less as compared to uncorrected images suggesting an attenuation artefact [].
|
[[54.0, 'year']]
|
F
|
{'17146108': 1, '31062220': 1, '14575388': 1, '19727926': 1, '27408900': 2, '19693317': 1, '18256560': 1, '12607878': 1, '24019657': 2}
|
{'4938873-1': 1}
|
162,945 |
3759089-1
| 24,019,658 |
noncomm/PMC003xxxxxx/PMC3759089.xml
|
Simultaneous occurrence of Graves’ disease in eutopic and ectopic thyroid tissues: A case report and review of literature
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A 35-year-old married woman presented to our department of Nuclear Medicine with chief complaints of palpitations, tremors, increased sweating, increased frequency of stools, and weight loss. The patient was non-smoker, had two children a male and a female aged 14 and 12 years respectively. At the time of presentation the patient was non-lactating and not pregnant. In drug history, patient gave history of treatment with anti-thyroid medication (Carbimazole and Propranolol). On her own, the patient discontinued these drugs 4 months before the current symptoms. At presentation, she had a regular pulse of 104/min. Her weight was 47 kg. She had only mild visible proptosis. There was a transverse surgical scar in the neck. Thyroid was not visible or palpable. There was no other swelling in the neck. There was an abdominal surgical scar on right side (post cholecystectomy) and rest of the general and systemic examinations were unremarkable. Her serum free tri-iodothyronine (FT3) was 3.98 pg/ml (normal, 1.7-4.2 pg/ml), and FT4 was 2.30 ng/dl (normal, 0.70-1.80 ng/dl). Her thyroid stimulating hormone (TSH) was less than 0.01 μIU/ml (normal, 0.30-5.5 μIU/ml). Anti TPO antibodies were 690 U/ml (0-60 U/ml). The 24 h radioactive iodine-131 uptake of thyroid was elevated at 72%. Her chest X-ray was reported normal. The Endocrinologist referred her for radioiodine treatment of her hyperthyroidism. A thyroid scan done 15 min after intravenous injection of 185 MBq of Technitium-99 m sodium pertechnetate revealed a eutopic thyroid gland with relatively smaller right lobe and a left lobe with marked tracer uptake. The salivary glands were suppressed. In addition to these findings an abnormal area of marked uptake was seen in the right upper mediastinum that appeared to be an ETT []. A non-contrast computed tomography (CT) scan revealed both lobes of a eutopic thyroid gland with an ectopic thyroid gland in the right superior aspect of anterior mediastinum []. A diagnosis of Graves’ disease involving the eutopic as well as the ectopic mediastinal thyroid was confirmed. The patient was subsequently administered 370 MBq (10 mCi) of Iodine-131 solution orally 5 weeks post I-131 therapy patient was cured of her thyrotoxic symptoms and complained of lethargy and puffiness of face. Her TSH levels were reported as 117.63 μIU/ml. A Tc-99m sodium pertechnetate thyroid scan confirmed thyroid ablation []. Her post Iodine-131 hypothyroid symptoms were controlled by replacement dose of oral thyroxine.
|
[[35.0, 'year']]
|
F
|
{'28658835': 1, '19092381': 1, '10670761': 1, '3018200': 1, '31293306': 2, '10646669': 1, '16889496': 1, '17179793': 1, '16613822': 1, '15648554': 1, '27029843': 2, '10807066': 1, '24019658': 2}
|
{'6593940-1': 1, '4815244-1': 1}
|
162,946 |
3759091-1
| 24,019,660 |
noncomm/PMC003xxxxxx/PMC3759091.xml
|
FDG PET/CT in a rare case of multiple cutaneous metastases in carcinoma larynx
|
A 65-year-old male smoker patient diagnosed to have SCC of larynx in year 2002 presented with complaints of change in voice, significant weight loss, difficulty in swallowing, reduced appetite, and gradual progressive random appearance of nodular cutaneous lesions. He also had past history of foreign body sensation associated with throat discomfort. Laryngoscopy in 2002 revealed a 1.5-cm mass arising from the undersurface of epiglottis on the left side. Biopsy of the mass confirmed moderately differentiated SCC. The patient did not take any standard treatment and remained on self medication with homemade remedies. He continued to have throat discomfort intermittently during this period. This patient reported to our hospital when he developed progressive and generalized skin lesion over the body. Clinically, the patient had a poor built and emaciated looks with tachycardia. He had multiple nodular lesions of varying sizes over trunk, chest, back, face, scalp, and extremities; some of these lesions were erythematosus and crusted [Figure and ]. The patient had a nasal twang in speech. Rest of the systemic examination and routine blood examination were apparently normal. Indirect laryngoscopy was done, which revealed a proliferative growth on the laryngeal surface of epiglottis. 18F-fluorodeoxyglucose positron emission tomography computed tomography (FDG PET/CT) was done that showed an irregular soft tissue thickening in the epiglottis, multiple FDG avid cutaneous deposits of varying sizes involving all extremities, trunk, neck, scalp, and face, multiple FDG avid pleural-based nodules FDG avid abdominal lymph nodes, and a solitary skeletal lesion in left scapula [Figures and ]. A representative lesion was excised and histopathology as well as immunohistochemistry confirmed the deposits of poorly differentiated carcinoma consistent with metastasis in a known case of carcinoma of larynx.
|
[[65.0, 'year']]
|
M
|
{'5030236': 1, '8643266': 1, '8676230': 1, '8335743': 1, '8727780': 1, '11275809': 1, '7934588': 1, '880547': 1, '8435173': 1, '9282208': 1, '3361016': 1, '3580159': 1, '24019660': 2}
|
{}
|
162,947 |
3759092-1
| 24,019,661 |
noncomm/PMC003xxxxxx/PMC3759092.xml
|
Recurrent giant cell tumor of foot detected by F18-FDG PET/CT
|
A 48-year-old female patient diagnosed to have GCT of right foot was subjected to excision, curettage and arthrodesis of ankle joint. Six months post-surgery she presented with increasing pain in right foot and recurrence was suspected. MRI could not be carried out due to surgical implant in situ. Total body F-18 FDG PET/CT acquired 60 min after intravenous injection of 10.2 mCi of F18-FDG was performed for detection of recurrence. Diagnostic quality CT images were acquired as part of the study. It showed intense uptake of FDG in soft-tissues in right hind foot along the anterior and medial surface of the right ankle joint. FDG uptake was also seen to involve the inferior surface of talus, cuboid, lateral and intermediate cuneiform, navicular, talus and calcaneum bones of the foot []. However, exact soft-tissue delineation was not possible due to surgical implant in situ leading to artefacts on CT. Later patient underwent biopsy from the suspected area, which confirmed recurrence. Patient was subsequently subjected to below knee amputation due to involvement of talar bone. Histopathologically the amputated specimen showed giant cell tumor of intermediate grade with involvement of inferior surface of talus, cuboid, lateral and intermediate cuneiform bones, navicular, and calcaneum correlating exactly with the F18-FDG PET/CT findings.
|
[[48.0, 'year']]
|
F
|
{'17110693': 1, '19958849': 1, '15347720': 1, '8625607': 1, '10813712': 1, '8574373': 1, '15960914': 1, '26579486': 1, '24019661': 2}
|
{}
|
162,948 |
3759093-1
| 24,019,662 |
noncomm/PMC003xxxxxx/PMC3759093.xml
|
Incidentally detected grade 3 cystocele on FDG PET/CT in a case of suspected malignancy
|
A 65-year-old lady presented to our institution with non resolving pneumonia. She had severe cough with expectoration since 2 months, which aggravated over last one month. She also complained of significant weight loss during that period. Posteroanterior chest radiograph showed consolidation involving the lower lobe of left lung, following which she was treated with broad spectrum antibiotics. Since there was no improvement in her symptoms and her radiographic findings, lung malignancy was suspected. She was referred for a whole body 18 Fluoride fluorodeoxyglucose positron emission tomography/computed tomography (18 F FDG PET/CT), for further evaluation of a possible malignant etiology. Maximum Intensity Projection (MIP) images revealed low grade FDG uptake in left lung [-arrowhead], corresponding to the consolidation and ground glass opacification seen on the CT component of the study. Physiological tracer distribution was seen in the heart, brain, liver and urinary bladder. However, a distinct focus of intense FDG uptake was seen inferiorly, separate from the urinary bladder [-arrows]. The intense nature of the FDG concentration was similar to that of urinary tracer accumulation in the bladder. Axial CT images showed that the uptake corresponded to a well defined rounded lesion, which was protruding out from the introitus and had a fluid density -arrow]. Sagittal fused PET/CT images revealed that there was definite communication with the bladder, suggesting the possibility of herniated bladder [-arrows]. Subsequent clinical evaluation confirmed that the intensely tracer concentrating structure at the introitus was a grade 3 cystocele.
|
[[65.0, 'year']]
|
F
|
{'9925392': 1, '15371617': 1, '20513451': 1, '32715003': 1, '11896220': 1, '24019662': 2}
|
{}
|
162,949 |
3759094-1
| 24,019,663 |
noncomm/PMC003xxxxxx/PMC3759094.xml
|
Duplicated gall bladder detected on 99m Tc HIDA hepatobiliary scintigraphy: A report of two cases
|
A 15 year old boy presented with intermittent pain in right hypochondrium for a week. Physical examination revealed no local tenderness. Liver function parameters were normal. Ultrasonography (USG) of the abdomen revealed two cystic formations in the gall bladder (GB) fossa with no distinct visualisation of cystic duct. No GB wall thickening was noted, thus ruling out GB diverticula. Differential diagnosis of choledochal cyst and duplicated GB was given. Patient was then referred for a 99m Tc hepatobiliary scintigraphy. After fasting for 6-8 hours, 5 mCi of 99m Tc mebrofenin (HIDA) was injected intravenously and dynamic images were acquired for 1 hour, at a frame rate of 1 minute/second. Images revealed normal hepatocellular tracer extraction with visualization of the hepatic and common bile ducts at 10 minutes. Two foci of tracer uptake were seen in the region of GB fossa [-arrows] at 15 minutes, which persisted till the end of the study. Anterior static pre fatty meal image showed two intense foci of tracer uptake in GB fossa [-arrow]. Patient then consumed a fatty meal. Post fatty meal anterior static image showed reduction in size and counts in both structures in GB fossa [-arrows]. Detection of two globular structures in GB fossa, which contract after fatty meal, is specific for duplicated GB. It was further confirmed by drawing regions of interest (ROIs) on GB moieties, on pre and post meal images, which showed reduction in counts by more than 50%. Since GB visualization was within normal time range, with preserved contractile function post fatty meal, patient was kept on medical therapy, low fat diet and antibiotics, and follow up was recommended.
|
[[15.0, 'year']]
|
M
|
{'19205686': 1, '15889262': 1, '1740714': 1, '19879969': 1, '1663130': 1, '3895856': 1, '6884716': 1, '21861996': 1, '24019663': 2}
|
{'3759094-2': 2}
|
162,950 |
3759094-2
| 24,019,663 |
noncomm/PMC003xxxxxx/PMC3759094.xml
|
Duplicated gall bladder detected on 99m Tc HIDA hepatobiliary scintigraphy: A report of two cases
|
An 8-year-old boy presented with recurrent abdominal pain and occasional vomiting since a few months. Liver function tests were normal. USG of the abdomen showed two pear shaped structures in the GB fossa, seen as two adjacent anechoic structures oriented in the same plane [-arrows]; consistent with duplicated GB, with separate cystic ducts. Coronal Magnetic Resonance Imaging (MRI) showed the duplicated GB [-arrows]. After adequate preparation, serial static 99m Tc mebrofenin hepatobiliary study was performed; images being acquired in anterior, right lateral and right anterior oblique views every 2-5 minutes. Static anterior images showed two distinct moieties in GB fossa [-arrow and arrowheads], confirming the diagnosis on USG and MRI, of duplicated GB. Post meal static image [] was compared with pre meal static image [], latter showed significant reduction in GB counts (arrows), suggesting normal contraction of the GB, thus ruling out obstruction.
|
[[8.0, 'year']]
|
M
|
{'19205686': 1, '15889262': 1, '1740714': 1, '19879969': 1, '1663130': 1, '3895856': 1, '6884716': 1, '21861996': 1, '24019663': 2}
|
{'3759094-1': 2}
|
162,951 |
3759095-1
| 24,019,664 |
noncomm/PMC003xxxxxx/PMC3759095.xml
|
Incidental detection of a bleeding gastrointestinal stromal tumor on Tc-99m red blood cell scintigraphy
|
A 40-year-old man presented with a history of rectal bleeding for two days, with a reported loss of more than 1 liter of fresh blood. Despite intensive fluid management with whole blood and normal saline, his hemoglobin dropped to 4.2 mg/dl and he lapsed into delirium. Since oxygen saturation of blood was low, he was ventilated through endotracheal intubation. Colonoscopy was not attempted because of continuous bleeding. Tc-99m labeled red blood cell (RBC) scintigraphy [] showed accumulation and movement of tracer in the mid-abdomen, corresponding to the region of the jejunal loops. A diagnosis of active gastro-intestinal bleed (likely to be from the jejunum) was made, and the patient taken up for exploratory laparotomy. A polypoidal exophytic mass about 4 cm in size was found in the jejunal wall, 40 cm from the duodeno-jejunal junction. The mass along with the adjoining jejunal loops was resected, followed by end-to-end anastomosis. Gross examination of the specimen [Figure and ] showed a polypoidal mass (measuring 3.2 cm in its largest dimension) arising from the serosal aspect, producing a bulge in the central part of the mucosa, which was ulcerated and could be the possible source of bleeding. Microscopic examination [] showed a well-circumscribed tumor in the submucosa. The mass showed a spindle cell tumor arranged in long interlacing fascicles with characteristic perivascular arrangement of tumor cells. The tumor cells were moderately pleomorphic with mitotic rate of 2/50 high power field (HPF). Focally the tumor was infiltrating mucosa causing ulceration. However, the resection limits were free of tumor. Immunoperoxidase staining [] confirmed a GIST. Following surgery, the patient made a satisfactory recovery and was discharged on the seventh post-operative day.
|
[[40.0, 'year']]
|
M
|
{'14657591': 1, '17193820': 1, '8957633': 1, '15764876': 1, '9707037': 1, '14726714': 1, '16999158': 1, '18431163': 1, '14625841': 1, '24019664': 2}
|
{}
|
162,952 |
3759106-1
| 23,571,267 |
noncomm/PMC003xxxxxx/PMC3759106.xml
|
The association of carotid cavernous fistula with Graves’ ophthalmopathy
|
A 72-year-old woman who was diagnosed with Graves’ disease and mild bilateral ophthalmopathy 1 year ago and treated with propylthiouracil was admitted to our hospital because of grittiness, eye discomfort, proptosis, and swelling of both eyes; exophthalmos, eye pain, visual disturbance, conjunctive congestion and chemosis in the right eye []. She had progressive visual disturbance on the right eye. The patient had undergone corticosteroid treatment with 16 mg/day methylprednisolone for 1 month and than 30 mg/day deflazacort for 2 months for the opthalmopathy. Her laboratory results were as follows fT4: 1.19 ng/dl (0.7-1.7), TSH: 2.24 mU/l (0.4-4), TSH receptor antibodies and thyroid peroxidase antibodies were positive. The orbital MRI images revealed exophtalmos in the right eye, an enlargement in the right extraocular muscle and in the right retro-orbital fatty tissue. The right optic nerve diameter was less than the left one. The patient's ophthalmopathy was diagnosed as asymmetrical thyroid ophthalmopathy but also, carotico-cavernous fistula was considered in differential diagnosis. A cerebral angiography was performed and a dural carotid cavernous fistula was observed on the right side []. This dural CCF was draining through the right superior opthalmic vein as well as the left superior opthalmic vein via posterior intercavernous sinus connection. Endovascular treatment of the right-sided superior opthalmic vein drainage was accomplished by closing the right cavernous sinus with platinum coils. However, although the small left-sided drainage was persisted since then, there was no left-sided superior opthalmic vein drainage and therefore right-sided drainage was decided to be left untreated. After 2 months, the symptoms regressed, a full vision of right eye was obtained and radiological improvement was noted [].
|
[[72.0, 'year']]
|
F
|
{'34179589': 2, '12615754': 1, '30045703': 2, '7673432': 1, '19491222': 1, '17577868': 1, '32340153': 2, '15317547': 1, '12915622': 1, '8413459': 1, '18299459': 1, '23571267': 2}
|
{'6060543-1': 1, '8207854-1': 1, '7230325-1': 1}
|
162,953 |
3759107-1
| 23,548,317 |
noncomm/PMC003xxxxxx/PMC3759107.xml
|
Localized bi-nasal macular edema in optic chiasmal syndrome
|
A 28-year-old healthy male was seen in our clinic complaining of vision loss in his right eye (OD). Best-corrected visual acuity (BCVA) was OD: 20/200 and left eye (OS): 20/20. Anterior segment examination revealed a relative afferent pupillary defect in the OD. Fundus examination disclosed localized bilateral temporal pallor in the optic nerve. The rest of the ophthalmologic examination was found to be within normal limits. Fundus pictures and fluorescein angiogram (FA) were performed during the first visit. Mild vascular abnormalities were detected in the temporal aspect of right optic nerve, but no conclusive information was obtained. The OS was deemed to be normal. OCT using the Stratus OCT 3 model (Carl Zeiss Meditec, Jena, Germany) was indicated for the evaluation of the macular areas, RNFL thicknesses, and optic nerves. The fast macular protocol revealed subtle macular thickness beyond normal in the superior and nasal quadrants of both maculae. No visible alterations in the internal microarchitecture of the retina were observed using several retinal lines and optic disc protocols. The RNFL thickness was near the superior normal limit in OD. A slight incremental thickening of the RNFL was observed in the superior and nasal quadrants of the OS.\nIn order to evaluate the patient's visual field (VF) and retinal sensitivities, a frequency doubling technology perimetry (FDT), using the commercially available (Matrix®) device, was performed in both eyes. The threshold 30-2 strategy revealed the presence of junctional scotoma composed by a central scotoma in OD associated with superior temporal quadrantanopia in the fellow eye. The pattern detected in the VF suggested the presence of an expansive mass at the level of the optic chiasm []. Magnetic resonance imaging (MRI) was performed which disclosed the presence of a tumor, compatible with the diagnosis of pituitary adenoma []. After a complete neurological evaluation, medical treatment with Cabergoline (a dopamine agonist), once a week, was recommended. After 8 months, a significant reduction of tumor volume was achieved. Moreover, the patient experienced a full recovery of BCVA and VF []. Functional normalization was accompanied with restoration of macular thickness.
|
[[28.0, 'year']]
|
M
|
{'14615635': 1, '15377539': 1, '12488259': 1, '17353405': 1, '15652827': 1, '15205233': 1, '12788124': 1, '23548317': 2}
|
{}
|
162,954 |
3759108-1
| 23,571,237 |
noncomm/PMC003xxxxxx/PMC3759108.xml
|
Different treatment modalities for choroidal neovascularization in two eyes of one patient with bilateral type 2A parafoveal telangiectasia
|
A 60-year-old man presented with a history of decrease in vision in the left eye (LE) for last 15 days. He was a known diabetic on treatment since past 10 years. On examination, his best corrected visual acuity (BCVA) in the right eye (RE) was 20/30 and that in LE was 20/80. Anterior segment examination was unremarkable except nuclear sclerosis grade 1 in both eyes (BE). Fundus examination RE revealed grayish retina temporal to fovea, about 500 μm wide, with multiple yellowish crystalline deposits and pigments. The left fundus examination showed the presence of subretinal fluid with subretinal hemorrhage measuring about 400 μm in width. A clinical diagnosis of RE type 2A stage 4 IMT and LE type 2A stage 5 IMT was made. The clinical findings were confirmed on optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) []. The patient underwent PDT (greatest linear dimension of 1310 μm, a spot size of 2310 μm) as per the standard protocol.\nAt 1 month of follow-up, LE BCVA was maintained at 20/80 with resolution of subretinal fluid and hemorrhage on fundus examination. FFA showed no signs of activity in the LE. The patient was on regular follow-up with stable findings []. At 4 years of follow-up, he presented with complaints of decrease in vision in RE since the past 4 weeks. The BCVA in the RE was 20/80 and in the LE was 20/40. RE fundus examination revealed the presence of subretinal hemorrhage temporal to the fovea about 300 μm in size and LE scarred membrane. FFA confirmed the activity in RE and scarring in LE []. The patient received two consecutive monthly intravitreal ranibizumab (Lucentis) injections 0.5 mg/0.05 ml in RE. At 1-month follow-up following the second injection, his RE BCVA improved to 20/40 with decrease in retinal thickness on OCT. Improved visual acuity and clinical findings including bilateral macular scar with a vision of 20/40 was maintained till the 6th month follow-up [].
|
[[60.0, 'year']]
|
M
|
{'16606869': 1, '18577646': 1, '7082207': 1, '24492507': 1, '30788805': 1, '19668526': 1, '18193448': 1, '23571237': 2}
|
{}
|
162,955 |
3759109-1
| 23,571,238 |
noncomm/PMC003xxxxxx/PMC3759109.xml
|
Conjunctival erosion after glaucoma drainage device surgery: A feasible option
|
A 69-year-old male, known case of chronic angle closure glaucoma with advanced glaucomatous neuropathy, was on medical management for his raised intraocular pressures. He was highly noncompliant with his medications and subsequently went on to develop vascular occlusions (superotemporal branched retinal vascular occlusion in the right eye and central retinal vascular occlusion in the left eye) due to sustained high intraocular pressures in both his eyes in a sequential manner followed by NVG in the left eye.\nThe patient had undergone phacotrabeculectomy with Mitomycin C MMC in both the eyes for chronic angle closure glaucoma 6 months back. There was a diffuse functional bleb with an intraocular pressure of 12 mmHg in right eye. The bleb was flat and vascularized in the left eye and intraocular pressure in the left eye was 36 mmHg. Ahmed Glaucoma Valve with donor scleral patch graft was implanted along with intravitreal Inj Avastin for NVG in the left eye. One month postoperative follow-up of the patient revealed a well-functioning implant with an exposed scleral graft and overlying conjunctival melt []. The patient was put on Cap Doxycycline (100 mg bd) orally, eye drop Prednisolone acetate 8 times/day, E/D Tear substitute 8 times/day and continued eye drop Moxifloxacin 4 times/day, with a review on alternate days. After 2 weeks, there was complete epithelial healing over the exposed scleral graft [], anterior chamber was deep and the tube was functioning well. Doxycycline was continued once daily orally further for a period of 4 weeks and then stopped. During the 4 months follow-up period, the tube remained covered by intact conjunctival epithelium. On the last follow-up visit, the patient had a visual acuity of 6/18 in the left eye, the tube remained covered by intact conjunctival epithelium, and intraocular pressure was 13 mmHg on eye drop Brimonidine and the patient was advised a 3-monthly review [].
|
[[69.0, 'year']]
|
M
|
{'8216025': 1, '27616909': 1, '11438047': 1, '15774923': 1, '25480142': 1, '9493112': 1, '10577604': 1, '15021228': 1, '10537766': 1, '4900144': 1, '18303385': 1, '27703872': 1, '3627691': 1, '27195095': 2, '23571238': 2}
|
{'4860976-1': 1}
|
162,956 |
3759110-1
| 23,548,316 |
noncomm/PMC003xxxxxx/PMC3759110.xml
|
Distant metastatic retinoblastoma without central nervous system involvement
|
A 5-year-old boy presented with prominence of the right eyeball since the past 5 months. There was a past history of the parents noticing whitish reflex in the right eye since past 1 year. There was no positive family history. Examination under anesthesia revealed the right eye to have proptosis of more than 8 mm with extraocular mass, and anterior segment details were all obscured []. The left eye anterior segment was normal and the fundus showed a 4 × 3 × 2 mm partly calcified tumor in the supero-nasal periphery and a 1 × 1 × 1 mm fully calcified regressed tumor in the infero-temporal periphery. Computed tomography (CT) scans were classical of a bilateral retinoblastoma with right eye extraocular and optic nerve extension. However, there was no intracranial extension []. A systemic workup including bone marrow biopsy and cerebrospinal fluid (CSF) analysis was done. Bone marrow was positive for tumor deposits of malignant round cells. The cells were small with scant rim of cytoplasm and a round hyperchromatic nucleus with prominent nuclear molding. The CSF cytology was within normal limits. Based on this, a diagnosis of metastatic retinoblastoma stage IV a (distant metastatic retinoblastoma without CNS involvement) was made. The patient was started on a 3-weekly high-dose chemotherapy protocol with vincristine, etoposide and carboplatin (VEC regime). Following four cycles, the right eye proptosis resolved and there was atrophic bulbi with total vascularized corneal scar. The left eye tumor regressed completely.\nThe patient was then lost to follow-up and again presented with mild proptosis in the right eye. Examination under anesthesia revealed right eye upper periocular edema and numerous firm and tender swellings on the forehead and scalp [] with large areas of thin scleral ectasia. Left eye was found to have regressed tumors. CT scans showed the right eye to have similar findings as noted in the initial visits, but in addition, there was diffuse heterogeneous mass involving the frontal bones and the superior orbits with diffuse, irregular bony erosions []. Fine needle aspiration cytology (FNAC) of the forehead lesion, bone marrow biopsy and CSF analysis were done. Bone marrow biopsy and FNAC were positive for tumor deposits of malignant round cells []. The systemic condition of the child was poor. An impression of extensive skeletal metastasis was made and the patient is currently on a palliative chemotherapy with high dose of vincristine, etoposide and carboplatin. At current follow-up of 4 months following palliative therapy, the patient is stable.
|
[[5.0, 'year']]
|
M
|
{'1145423': 1, '19556217': 1, '20486171': 1, '14707710': 1, '16828510': 1, '15763192': 1, '10845413': 1, '29197363': 2, '26063518': 1, '26089630': 1, '11801265': 1, '34784412': 1, '23548316': 2}
|
{'5712193-1': 1}
|
162,957 |
3759111-1
| 23,571,253 |
noncomm/PMC003xxxxxx/PMC3759111.xml
|
Pseudoexfoliation on pseudophakos
|
A 70-year-old man presented in January 2011 to our OPD with poor vision in both eyes (BE). He had extracapsular cataract extraction with implantation of a polymethylmethacrylate intraocular lens (PMMA IOL) in left eye (LE) in June 2007 for nuclear cataract. There was no record of PXF noted on the lens surface or pupillary ruff before cataract surgery. On examination, the best-corrected visual acuity (BCVA) was 20/200 in right eye (RE) and no perception of light in LE. The intraocular pressure (IOP) was 42 and 17 mm Hg in RE and LE, respectively. Examination of RE revealed dense nuclear cataract with no PXF and a cup/disc ratio of 0.9. Gonioscopy showed open angles with patchy peripheral anterior synechiae (PAS). In LE, the pupil was dilated and fixed with frosted granular material similar to PXF over the anterior surface of IOL and new vessels on iris were present []. Fundus examination revealed ischemic central retinal vein occlusion and a total cup. Gonioscopy revealed open angles with no new vessels but heavy pigmentation.
|
[[70.0, 'year']]
|
M
|
{'24722276': 1, '17889784': 1, '34634862': 1, '19882560': 1, '9930277': 1, '11581041': 1, '1565458': 1, '8534654': 1, '28112147': 1, '959998': 1, '17889788': 1, '14609823': 1, '28112146': 1, '23571253': 2}
|
{'3759111-2': 2, '3759111-3': 2}
|
162,958 |
3759111-2
| 23,571,253 |
noncomm/PMC003xxxxxx/PMC3759111.xml
|
Pseudoexfoliation on pseudophakos
|
A 65-year-old male presented in May 2008 with a 1-year history of decreased vision in BE. He had primary open angle glaucoma (POAG) and dense cataract. There was no PXF in either eye. Patient had manual small incision surgery with trabeculectomy in BE the same year. The posterior capsules were intact, and rigid PMMA IOL was placed in sulcus. He next turned up in May 2011 for decreased vision in BE. Following dilatation, PXF material was seen on the IOL in LE. This was distributed in a concentric ring as radial striations and on the posterior surface of the IOL where it appeared as multiple granular spots [Figs. and ]. Gonioscopy of LE showed open angles with patchy PAS in the inferior angle and darkly pigmented trabecular meshwork. The IOP was 18 mmHg and the cupping was 0.8. RE had edematous cornea, visual acuity of light perception, and the IOP was 28 mmHg. No other details could be made out.
|
[[65.0, 'year']]
|
M
|
{'24722276': 1, '17889784': 1, '34634862': 1, '19882560': 1, '9930277': 1, '11581041': 1, '1565458': 1, '8534654': 1, '28112147': 1, '959998': 1, '17889788': 1, '14609823': 1, '28112146': 1, '23571253': 2}
|
{'3759111-1': 2, '3759111-3': 2}
|
162,959 |
3759111-3
| 23,571,253 |
noncomm/PMC003xxxxxx/PMC3759111.xml
|
Pseudoexfoliation on pseudophakos
|
A 62-year-old male with air-borne contact dermatitis had cataract surgery 10 years ago in BE in our hospital. There was no PXF noted at the time of extracapsular cataract extraction in BE. On examination, BCVA was 20/30 in BE, PXF was noted in LE in pupillary ruff, and on IOL placed in sulcus. PXF was radially distributed nasally on the IOL and as granular dots on the posterior surface [Figs. and ]. RE did not show PXF on pupillary ruff or IOL surface. The IOP in BE were 14 and 12 mmHg, respectively. Fundus examination revealed a cupping of 0.8 and 0.6 in RE and LE, respectively.
|
[[62.0, 'year']]
|
M
|
{'24722276': 1, '17889784': 1, '34634862': 1, '19882560': 1, '9930277': 1, '11581041': 1, '1565458': 1, '8534654': 1, '28112147': 1, '959998': 1, '17889788': 1, '14609823': 1, '28112146': 1, '23571253': 2}
|
{'3759111-1': 2, '3759111-2': 2}
|
162,960 |
3759637-1
| 24,009,633 |
noncomm/PMC003xxxxxx/PMC3759637.xml
|
Rhabdoid Colorectal Carcinomas: Reports of Two Cases
|
A 62-year-old man was admitted to Konkuk University Medical Center due to occult blood in his stool. He had a six-year history of hypertension and cerebrovascular attacks. Colonoscopic examination revealed a huge mass in the sigmoid colon. Abdominal computed tomography (CT) revealed an ulcerofungating mass in the sigmoid colon and multiple enlarged pericolic lymph nodes. There was no evidence of distant metastasis on chest CT and positron emission tomography-computed tomography (PET-CT). The serum level of cancer antigen 19-9 (CA19-9) was within the normal range (15.75 U/mL). Low anterior resection was performed on a 4.5×4.0×1.2 cm sized ulcerofungating mass in the sigmoid colon (). Microscopically, most of the tumor was composed of sheets of large round and polygonal nuclei with vesicular chromatin along with abundant acidophilic cytoplasm which often contained hyaline-like inclusions. A poorly differentiated adenocarcinoma component was found in the peripheral portion of the tumor, located in the mucosa and submucosa, taking up 5% of the tumor. A transitional area from the poorly differentiated adenocarcinoma to the rhabdoid tumor was noted (). The tumor invaded into the pericolic adipose tissue and 10 out of 24 regional lymph nodes showed metastases. Adenocarcinoma cells were positive for mixed cytokeratin (CK), CK20, and epithelial membranous antigen (EMA), but focally positive for vimentin (). The rhabdoid tumor cells were positive for mixed CK, but focally positive for CK20 and EMA. In addition, the rhabdoid tumor cells were diffusely positive for vimentin, but negative for desmin (). E-Cadherin immunoreactivity was attenuated in the adenocarcinoma cells and negative in the rhabdoid tumor cells (). Immunohistochemical stains for MLH1, MSH2, MSH6, and PMS2 were positive in both types of tumor cells, while the stains for p53 were negative in both types of tumor cells. Immunohistochemical stains for smooth muscle actin (SMA), CD45, CD99, CD117, synaptophysin, neuron-specific enolase (NSE), and human melanoma black 45 (HMB45) were also negative in both types of tumor cells. The patient was treated with 12 cycles of adjuvant chemotherapy (FOLFOX: folinic acid, fluorouracil, oxaliplatin) and was alive without evidence of recurrence or distant metastasis for 36 months after surgery.
|
[[62.0, 'year']]
|
M
|
{'17913953': 1, '10809224': 1, '33903966': 2, '7848396': 1, '7682022': 1, '31455041': 1, '21791485': 1, '19430801': 1, '7275104': 1, '10554335': 1, '21651356': 1, '2916901': 1, '8918447': 1, '19189669': 1, '21315413': 1, '26064731': 2, '29452605': 2, '206343': 1, '8545590': 1, '19369011': 1, '10355971': 1, '32748092': 2, '25788994': 2, '6310357': 1, '24009633': 2}
|
{'3759637-2': 2, '4431317-1': 1, '8076409-1': 1, '5816521-1': 1, '4356266-1': 1, '7399011-1': 1}
|
162,961 |
3759637-2
| 24,009,633 |
noncomm/PMC003xxxxxx/PMC3759637.xml
|
Rhabdoid Colorectal Carcinomas: Reports of Two Cases
|
An 83-year-old woman with a history of hypertension was admitted to Konkuk University Medical Center for the further evaluation of rectal cancer. Colonoscopic examination revealed a huge mass in the rectum. Abdominal, chest CT and PET-CT revealed an ulcerofungating mass in the rectum with multiple metastatic lesions in the liver, lung, perirectal, para-aortic and left common iliac lymph nodes. The serum level of CA19-9 was elevated (60.50 U/mL). Lower anterior resection was performed. The tumor was an ulcerofungating mass, measuring 6.5×4.3×4.0 cm, in the rectum (). Microscopically, the tumor composed of sheets of rhabdoid cells, which comprised 70% of the tumor. The remaining portion of the tumor consisted of gland forming adenocarcinoma cells with villous adenoma. The tumor invaded into the mesosalpinx. Although there was no metastasis in 7 regional lymph nodes, 4 out of 4 omental lymph nodes showed metastases. Adenocarcinoma cells were positive for mixed CK, CK20, and EMA, but focal positive for vimentin (). The rhabdoid tumor cells were positive for mixed CK, but negative for CK20 and EMA. In addition, the rhabdoid tumor cells were diffusely positive for vimentin, but negative for desmin (). E-Cadherin immunoreactivity was attenuated in the adenocarcinoma cells and negative in the rhabdoid tumor cells. Immunohistochemical stains for MLH1, MSH2, MSH6, and PMS2 were positive in both types of tumor cells, while the stains for p53 was negative in the adenocarcinoma cells and focal positive in the rhabdoid tumor cells. Immunohistochemical stains for SMA, CD45, CD99, CD117, synaptophysin, and HMB45 were negative in both types of tumor cells, while the stains for NSE was weakly positive in the rhabdoid tumor cells. Unfortunately, the patient died a month after surgery.
|
[[83.0, 'year']]
|
F
|
{'17913953': 1, '10809224': 1, '33903966': 2, '7848396': 1, '7682022': 1, '31455041': 1, '21791485': 1, '19430801': 1, '7275104': 1, '10554335': 1, '21651356': 1, '2916901': 1, '8918447': 1, '19189669': 1, '21315413': 1, '26064731': 2, '29452605': 2, '206343': 1, '8545590': 1, '19369011': 1, '10355971': 1, '32748092': 2, '25788994': 2, '6310357': 1, '24009633': 2}
|
{'3759637-1': 2, '4431317-1': 1, '8076409-1': 1, '5816521-1': 1, '4356266-1': 1, '7399011-1': 1}
|
162,962 |
3759638-1
| 24,009,634 |
noncomm/PMC003xxxxxx/PMC3759638.xml
|
A Giant Peritoneal Loose Body
|
A 50-year-old man underwent a routine medical examination, at which time multiple gallstones and an incidental pelvic mass were detected on computed tomography (CT) scanning of the abdomen and pelvis. An ovoid, well-defined mass in the pelvic cavity was detected consisting of central dense, heterogeneous calcifications and peripheral soft tissue (). The mass compressed the bladder wall (). There was a distinct fat plane around the mass, which did not appear to originate from or invade any of the adjacent organs. The patient denied any symptoms and the presence of any past medical problems. Laboratory tests were all within the normal range. Based on the radiologic findings, a preoperative diagnosis of peritoneal calcifying fibrous pseudotumor was suggested. On laparoscopic exploration, a well-circumscribed, fist-sized, hard, and free mass was found in the pelvic cavity. In addition, some of the epiploic appendices attached to the sigmoid colon were calcified with constricted stalks and were on the verge of becoming detached. All other abdominal and pelvic viscera were unremarkable. Laparoscopic cholecystectomy and pelvic mass removal were performed.\nGrossly, the pelvic mass measured 7.5×7.0×6.8 cm and weighed 160 g; it was a white-to-pale yellow, hard, glistening concretion that looked like a boiled egg with the shell removed (). The cut surface of the concretion revealed a central 1.5 cm-diameter nucleus of a creamy, cheese-like material surrounded by white-to-yellow lamellar structures (). Microscopically, the concretion consisted of central necrotic fatty tissue () surrounded by many layers of concentrically laminated, eosinophilic, acellular, fibrous material () with scattered blue-to-black lakes of microcalcifications (). Masson's trichrome stained the fibrous material blue, indicating an abundance of collagen (). There were variable-sized vacuoles and empty clefts interspersed among the laminated material that could have represented vestiges of aged fat necrosis. The surface was partially lined by mesothelial cells. No inflammatory or foreign body reactions, parasites, polarizable substances, or identifiable tumor tissues were present in the specimen. These histopathological findings were characteristic of a giant PLB. The patient had an uneventful recovery. He was discharged from the hospital five days after surgery.
|
[[50.0, 'year']]
|
M
|
{'28854406': 1, '16504897': 1, '9014730': 1, '25888737': 2, '20862998': 1, '24995211': 1, '17939421': 1, '22864137': 1, '9739786': 1, '32874380': 1, '34589611': 2, '15614509': 1, '16721225': 1, '28550786': 1, '34815978': 1, '19121315': 1, '27277860': 1, '14513332': 1, '1734482': 1, '5243178': 1, '22606651': 2, '30030420': 1, '5798342': 1, '26901087': 1, '31598532': 1, '29760921': 2, '21736712': 2, '8331268': 1, '33100091': 2, '19394607': 1, '21415299': 1, '24009634': 2}
|
{'7607142-1': 1, '3146931-1': 1, '8435557-1': 1, '4381450-1': 1, '3349808-1': 1, '5946589-1': 1}
|
162,963 |
3759639-1
| 24,009,635 |
noncomm/PMC003xxxxxx/PMC3759639.xml
|
Sebaceous Carcinoma Arising in Mature Cystic Teratoma of Ovary
|
A 69-year-old gravida 4, para 4 Korean woman visited our hospital with a two week history of pelvic pain. Ultrasonography and computed tomography of the abdomen demonstrated a large pelvic mass measuring 22.0 cm in maximal diameter and with a small amount of ascites. Her preoperative serum cancer antigen 125 level was elevated at 430.5 U/mL. Together, these findings were suggestive of malignancy. A total abdominal hysterectomy with bilateral salpingo-oophorectomy and partial omentectomy were performed. A massive left ovarian mass and omental cake were noted in the pelvic cavity, and numerous nodules (1-2 cm in size) were scattered in the peritoneum and along the intestinal serosal surface. A neoplastic implant measuring 1.5 cm in diameter was also observed at the posterior portion of the uterine body. The right ovary was unremarkable. The resected left ovary measured 22.0 cm in diameter and weighed 2,180 g. The outer, capsular surface of the ruptured left ovary appeared ragged with scattered tumor implants measuring up to 1.2 cm in diameter. On the cut section, the left ovary was replaced by a unilocular cyst filled with keratin-like material and brownish-serous fluid. The luminal surface of the cyst was smooth, but a luminally-protruding and outer expanding mass measuring 6.0 cm in diameter was noted. The cut surface of the mass was relatively grayish-white in color and firm in the luminal portion and was tan-colored and friable with hemorrhagic necrosis in the outer, expanding portion (). Microscopically, the smooth cystic wall was lined by stratified squamous epithelium with underlying sebaceous glands and other skin adnexal structures, findings consistent with a typical mature cystic teratoma. Benign squamous epithelium was abruptly replaced by a nodular arrangement of germinative cells with a pushing border, which protruded into the cyst lumen (). The nodular portion showed an alternatively dark and white area, which corresponded to generative cells (dark) and sebaceous cells (light) with cytoplasmic lipid vacuoles. There was no cytologic atypia or sparse mitosis. Taken together, these findings led to a diagnosis of sebaceous adenoma. Beneath the nodular portion, infiltrating trabeculae or nests of atypical cells were noted. The infiltrating portion was mostly separated but was focally contiguous with the sebaceous adenoma (). Infiltrating cells exhibited conspicuous vacuoles in the cytoplasm and remarkable nuclear pleomorphism, prominent nucleoli, and frequent abnormal mitoses (). There was no peripheral nuclear palisading or cleft-like spaces between the lobules. Tumor cells were immunohistochemically positive for cytokeratin (CK) 7 (), CK19, high molecular weight CK, epithelial membrane antigen (EMA) (), carcinoembryonic antigen (CEA) (), and p63 (), but stains were negative for CK20, p53, vimentin, human placental alkaline phosphatase, α-inhibin, S100 protein, c-erbB-2, estrogen receptor, and progesterone receptor. Periodic acid-Schiff (PAS) was negative in the large, cytoplasmic inclusion. The uterine myometrium showed direct infiltration of the sebaceous carcinoma, and the omental mass also revealed the same histology. The patient developed sepsis two weeks after diagnosis and was discharged home with palliative care.
|
[[69.0, 'year']]
|
F
|
{'8669530': 1, '30165878': 2, '6723706': 1, '1774106': 1, '12836022': 1, '2044057': 1, '12352193': 1, '11578458': 1, '11068992': 1, '8160548': 1, '30225334': 1, '8134074': 1, '30775330': 2, '12439559': 1, '11531299': 1, '10690674': 1, '8632066': 1, '12440821': 1, '8503739': 1, '19521124': 1, '24009635': 2}
|
{'6116445-1': 1, '6360825-1': 1}
|
162,964 |
3759640-1
| 24,009,636 |
noncomm/PMC003xxxxxx/PMC3759640.xml
|
Spindle Cell Rhabdomyosacoma of Uterus: A Case Study
|
A 76-year-old woman, gravida 3, para 2, presented with intermittent lower abdominal pain of increasing severity. The patient reported a 10 kg weight loss with associated anorexia and constipation for approximately six months. Physical examination revealed abdominal tenderness and a fixed lower abdominal mass at roughly six months in gestational size. Abdominal and pelvic ultrasonography showed a multilobulated solid and cystic mass in the pelvic cavity. A computerized tomography scan of the abdomen and pelvis demonstrated a 16×10×8 cm lobulating-contoured and heterogeneously-enhanced mass occupying the lower abdomen and pelvic cavity. Neither the uterus nor both ovaries were identified (). Serum levels of tumor markers, with normal values in parentheses, were as follows: cancer antigen 125, 101.2 U/mL (<35 U/mL); cancer antigen 19-9, 4.8 U/mL (<30 U/mL). An exploratory laparotomy was performed given the high-suspicion for an ovarian tumor. Intraoperatively, a yellowish, hard, friable, 20×15×7 cm mass had replaced the right lateral uterine wall and had adhered to the colon, rectum, and appendix. The right ovary was not recognized, but the left ovary and both fallopian tubes appeared normal. Tumor debulking and subtotal hysterectomy with bilateral salpingo-oophorectomy were performed. The tumor grossly occupied the entire right myometrium and was bulging into the endometrial cavity. The cut surface of the tumor had a variegated appearance, including components of greyish soft, whitish fish-flesh, and yellowish myxoid with small cystic changes (). Wide areas of hemorrhagic necrosis were also noted. Microscopic findings exhibited highly cellular and necrotic tumor consisting of bundles or fascicles of spindle cells in a myxoid stroma (). Rare rhabdomyoblasts containing eccentric nuclei and deeply eosinophilic cytoplasm were observed (). Pleomorphic tumor cells were mixed with spindle cells in small areas. Mitotic figures were frequently counted with more than 100 mitotic figures per 10 high power fields. Right ovarian tissue was identified in the fibrous tumor capsule without direct invasion of tumor cells. Immunohistochemical staining showed diffuse positivity of tumor cells with myoglobin (), myo-D1, desmin, and vimentin. No stains for smooth muscle actin, pan-cytokeratin, epithelial membrane antigen, or estrogen receptor were postive. The patient refused further treatment and died of disease three months after diagnosis.
|
[[76.0, 'year']]
|
F
|
{'11860548': 1, '9537474': 1, '20173498': 1, '17013628': 1, '26983595': 1, '16006807': 1, '26082937': 2, '17325479': 1, '34017064': 1, '1599014': 1, '3910785': 1, '24009636': 2}
|
{'4458748-1': 1}
|
162,965 |
3759641-1
| 24,009,637 |
noncomm/PMC003xxxxxx/PMC3759641.xml
|
Micronodular Thymoma with Lymphoid Stroma in a Multilocular Thymic Cyst: A Case Study
|
A previously healthy 73-year-old male presented with an acute onset of chest pain for one month in duration. Chest computed tomography showed a heterogeneously enhancing mass in the right anterior mediastinum approximately 5.1 cm in size, most likely representing an intermediate-grade thymic epithelial tumor (). Trans-sternal extended thymectomy was performed. Upon gross examination, the external surface of the thymus was smooth and micronodular in appearance (). Upon opening, the thymus was completely replaced by a yellowish brown ovoid mass that was solid and cystic in appearance, and yellowish turbid fluid was expelled from the cystic portions. The largest cyst measured 2.5×2.0×2.0 cm (). Prominent macro- and microcystic changes were observed, and the cystic spaces were lined by flattened cuboidal cells (, inset) with occasional mucinous epithelium (, inset). Microscopically, the mass consisted of two components: a nodular epithelial component and mature lymphoid cells with prominent germinal centers (). Of the nodular structures, the epithelial cells had a spindle to round appearance, with bland euchromatic nuclei and plump cytoplasm. Occasional bluish mucin was observed in the tumor. At the subepithelial area, accumulation of foamy macrophages was also observed as well as infiltrating spindle- to round-shaped epithelial cells. Some areas of the cyst wall showed extensive fibrosis. The patient was diagnosed as having a micronodular thymoma with lymphoid stroma accompanied by a pre-existing multilocular thymic cyst.\nPreoperatively, the patient showed an uneventful course for twelve months. Symptoms such as myasthenia gravis were not observed before or after removal of the mass.
|
[[73.0, 'year']]
|
M
|
{'23026930': 1, '16711400': 1, '15800684': 1, '2006719': 1, '8333562': 1, '28941195': 1, '26360499': 1, '11173341': 1, '22388764': 1, '31934213': 1, '27486334': 2, '25400824': 1, '17393994': 1, '29945642': 1, '25812662': 2, '24009637': 2}
|
{'4357414-1': 1, '4958359-1': 1}
|
162,966 |
3759642-1
| 24,009,638 |
noncomm/PMC003xxxxxx/PMC3759642.xml
|
Fine Needle Aspiration Cytology of Hepatic Hydatid Cyst: A Case Study
|
A 28-year-old man presented with abdominal pain that had persisted for the past three months. The patient was a foreign worker from Uzbekistan. Physical examination revealed no abdominal mass. He had undergone partial hepatic resection due to a hydatid cyst 14 years ago. Abdominal computed tomography scan revealed a cystic mass in the right hepatic lobe (). Serologic testing for hydatid cysts was not performed. However, the clinical impression was a hydatid cyst. A right hemihepatectomy was performed, and the resected specimen was sent for intraoperative consultation. FNAC of the cystic mass was performed. The aspirated fluid was clear. Both smears and a cell block preparation were carried out. The smears were stained using Papanicolaou and hematoxylin and eosin stains.\nThe smears showed many protoscolices in the shape of a mushroom, with hooklets (). Amorphous necrotic debris and inflammatory cells were present in the background. Degenerated protoscolices were also found. Detached hooklets with refractile structures were seen. Fragments of laminated membranes stained pinkish-red on hematoxylin-eosin stain. Therefore, the diagnosis of a hydatid cyst was made.\nOn gross examination, the right hemihepatectomy specimen measured 15.3×14.8×8.5 cm in size. A 6.5×5.0×4.5 cm hepatic cyst was present (). The cyst contained multiple daughter cysts of variable sizes. The wall of the cyst was grayish white. Histologic examination revealed that the cyst wall was composed of an outer laminated membrane and an inner germinal layer (). Protoscolices and a brood capsule were seen. The laminated membrane was acellular and the germinal layer contained nuclei. The surrounding liver parenchyma showed a fibrinous wall and inflammatory cells infiltration including lymphocytes, eosinophils, and histiocytes. The patient has been alive for 16 months following this surgery without evidence of recurrence.
|
[[28.0, 'year']]
|
M
|
{'2220255': 1, '2458514': 1, '18855888': 1, '20585534': 1, '2781968': 1, '18540313': 1, '9167677': 1, '23008130': 1, '18973124': 1, '1954835': 1, '31533411': 1, '12789911': 1, '12789941': 1, '8575282': 1, '22509076': 1, '22689886': 1, '8807252': 1, '24009638': 2}
|
{}
|
162,967 |
3759643-1
| 24,009,639 |
noncomm/PMC003xxxxxx/PMC3759643.xml
|
Pleomorphic Adenoma of the Trachea: A Case Report
|
A 59-year-old male was referred to our hospital due to a three-month history of dyspnea on exertion. He was a current smoker with a 45-year history of smoking 2 packs of cigarettes per day. He had no past medical history except for pulmonary tuberculosis two years prior. On physical examination, the sound of his right lung was decreased with crackles but he did not have lymphadenopathy or weight loss. Laboratory findings were unremarkable except that the pulmonary function test revealed a moderately obstructive lung defect. Chest X-ray showed reactivation of pulmonary tuberculosis in the upper lung field and a round mass shadow in the mid-tracheal area (). A computed tomography (CT) scan showed a 2.2 cm-sized homogenous mass originating from the left lateral inner wall of the trachea, and active pulmonary tuberculosis with cavitation in the right upper lobe and in the superior segment of the right lower lobe (). Flexible bronchoscopy revealed a broad-based, polypoid mass obstructing 75% of the lumen in the left lateral wall. The mass was 5 cm above the carina, without endobronchial lesion (). We decided to surgically remove the lesion after initial management for pulmonary tuberculosis since airway obstrucion could occur during the bronchoscopic procedure owing to rich vascularity on the tumor surface.\nThe patient underwent right thoracotomy with segmental resection and end-to-end anastomosis. Four tracheal rings were excised along with the tumor. The excised tumor appeared as a single well-demarcated solid, polypoid mass, measuring 2×2 cm in size. The mass was completely covered by intact mucosa without any visible sign of hemorrhage or necrosis. On microscopic examination, the mass was composed of epithelial and myoepithelial cells in the chondromyxoid stroma (). There was no definitive cellular pleomorphism and mitotic figures. The surgical margins of the resected trachea were free of tumor. Immunohistochemically, the epithelial cells were positive for cytokeratin, cytokeratin 19 and epithelial membrane antigen (EMA). The myoepithelial cells were immunoreactive for cytokeratin, S100 protein, and p63 (). Overall, these findings were suggestive of a pleomorphic adenoma involving the mid trachea. The postoperative course was uneventful, and the patient has been asymptomatic and in good health for 5 years after the surgery.
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[[59.0, 'year']]
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M
|
{'31620581': 2, '17522768': 1, '9443098': 1, '6323791': 1, '12582787': 1, '21597416': 1, '33176739': 2, '33344601': 2, '2853932': 1, '14274349': 1, '16863832': 1, '30334948': 1, '7513602': 1, '10963381': 1, '24009639': 2}
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{'6784665-1': 1, '7723722-1': 1, '7661225-1': 1}
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162,968 |
3759688-1
| 24,010,072 |
noncomm/PMC003xxxxxx/PMC3759688.xml
|
Pseudomyxoma Peritonei: A Rare Cause of Oliguric Acute Kidney Injury
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A 53-year-old man presented to the emergency department with poor oral intake and abdominal distension. He had been admitted to other hospitals with abdominal distention twice over the previous year, at which time abdominal CT had shown moderate ascites. He underwent gastroduodenoscopy and colonoscopy to rule out gastrointestinal malignancy, but the results were unrevealing. He refused further evaluation at that time and had stopped seeking conventional medical care in favor of alternative medicine. At the present admission, he complained of a 5-kg weight loss over the previous month and intermittent vomiting for several weeks. The physical examination revealed a tense, distended abdomen with no palpable mass. His blood pressure was 110/70 mmHg and his pulse was 92 beats/minute. His mucous membranes were dry, his skin turgor was poor, and his initial urine output was less than 10 ml/hour for 12 hours. Laboratory evaluation showed severe azotemia (blood urea nitrogen, 66.3 mg/dl [normal range, 3-23 mg/dl]; creatinine, 2.86 mg/dl [normal range, 0.3-1.6 mg/dl]), decreased serum sodium and chloride (Na, 130 mmol/L [normal range, 133-146 mmol/L]; Cl, 85 mmol/L [normal range, 99-110 mmol/L]), and decreased urine sodium and chloride (Na<10 mmol/L, Cl<10 mmol/L). The fractional excretion of sodium was reduced to 0.1%. Tumor markers were elevated: CEA was 25.0 ng/ml (normal range, 0-5 ng/ml) and CA 19-9 was 142.6 IU/ml (normal range, 0-37 IU/ml). Other biochemical findings were normal. A chest x-ray showed subsegmental atelectasis of both lower lungs. His creatinine level was markedly elevated compared with the last level of 0.9 mg/dl measured 9 months previously and continued to rise steadily up to 3.4 mg/dl at 48 hours after admission. The findings were consistent with AKI as defined by the Acute Dialysis Quality Initiative group.\nOwing to the patient's volume depletion, we initiated volume resuscitation with normal saline (4 L/day). His urine output did not improve, however, so we obtained a non-contrast CT of the abdomen, which revealed massive ascites of the abdomen and pelvis, diffuse peritoneal thickening, infiltration of the greater omentum, and hydronephrosis and hydroureter of the right kidney without an obstructing lesion in the urinary tract (). Ultrasound-guided paracentesis yielded thick mucoid pus. A pigtail catheter was placed but was unable to drain the extremely thick fluid. Owing to the progression of azotemia and metabolic acidosis, a right percutaneous nephrostomy was performed, yielding urine amounts of less than 100 ml per day, which had no effect on the progressive kidney injury. The following day, after several attempts to irrigate, the pigtail catheter allowed nearly 4 L of thick ascites to drain, after which urine output increased to 2.7 L in 24 hours () and creatinine dropped to 1.16 mg/dl. The follow-up CT with contrast is shown in . Unfortunately, the patient's symptoms did not improve along with restoration of his renal function. Accordingly, gastroduodenoscopy and colonoscopy were performed, which showed chronic gastritis and several colon polyps that were biopsied and found to be tubulovillous adenomas with high-grade dysplasia. Exploratory laparoscopy confirmed massive mucin-rich ascites suggestive of PMP.\nDebulking surgery was performed to remove the mucinous ascites. Histopathologic findings of samples from the cystic wall and peritoneum of the ascending colon confirmed the diagnosis of PMP and mucinous cystadenoma. The findings of the surface encased with mucus and mucinous epithelium with minimal atypia indicated low-grade PMP () and immunohistochemistry was positive for cytokeratin 20 and negative for cytokeratin 7, which suggested an origin of the lower gastrointestinal tract ().
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[[53.0, 'year']]
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M
|
{'2057120': 1, '22074643': 1, '14567019': 1, '15312219': 1, '7125746': 1, '18726894': 1, '15285293': 1, '22662781': 1, '18248391': 1, '17182192': 1, '24010072': 2}
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{}
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162,969 |
3759689-1
| 24,010,073 |
noncomm/PMC003xxxxxx/PMC3759689.xml
|
Stress Cardiomyopathy Associated with Diffuse Alveolar Hemorrhage after Colonoscopy
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A 37-year-old woman was transferred from a primary clinic to our emergency department because of chest pain and shortness of breath. She had undergone gastroscopy and colonoscopy in the left lateral decubitus position at the clinic that day to evaluate her complaint of constipation. During the examination, she aspirated some gastric contents with residual PEG. Although she received immediate first aid, her hypoxia did not resolve fully and her chest pain gradually worsened. At the time of her arrival at the emergency department, she complained of chest pain, shortness of breath, and blood-tinged sputum. She had no significant past medical history or medication history. Her initial vital signs were as follows: blood pressure, 80/50 mm Hg; heart rate, 114 beats/minute; respiration rate, 22 breaths/minute; body temperature, 37.2℃; and saturation, 95% in FiO2 0.32 by pulse oxymetry. Laboratory tests revealed a white blood cell count of 13,280/µl with 94.3% neutrophils and 0.3% eosinophils, hemoglobin of 13.0 g/dl, platelet count of 182,000/µl, activated partial thromboplastin time of 30.9 s, prothrombin time of 14.2 s, C-reactive protein of 2.10 mg/dl, significantly elevated troponin-I of 3.07 ng/ml, and elevated creatine kinase-MB of 15.7 ng/ml. The total creatine kinase level was not elevated at 194 U/L, but the creatine kinase-MB/creatine kinase ratio was markedly elevated at 8%. The electrocardiogram revealed sinus tachycardia without significant ST segment abnormality or T-wave inversion. A chest radiograph showed alveolar infiltration in the left upper lung field (). Chest computed tomography showed ground-glass opacities and multiple low attenuation areas in the bilateral dependent portions, especially in the left upper lobe (). The transthoracic echocardiogram revealed global hypokinesia, especially in the basal and midportions of the LV (). The LV ejection fraction was estimated to be approximately 30% by the A/L method, and there was no LV outflow tract obstruction, pulmonary hypertension, or mitral regurgitation. Initial pharmacologic management included aspirin, clopidogrel, and antibiotics based on the suspicion of acute coronary syndrome with aspiration pneumonia. The patient subsequently underwent cardiac catheterization. Coronary angiography revealed no significant stenosis of the major epicardial coronary arteries (). Although left ventriculography and ergonovine provocation tests were not conducted, the typical echocardiography findings without significant coronary artery lesions were sufficient to confirm the diagnosis of SCM.\nAfter the patient was transferred to the cardiac intensive care unit, her symptoms of hypoxia and dyspnea gradually worsened and fresh hemoptysis accompanied this worsening. While she was on 80% oxygen, her arterial blood gas measurements were as follows: pH, 7.306; PCO2, 26.7 mm Hg; PO2, 58.4 mm Hg; HCO3, 13.0 mmol/L; and SaO2, 88.2%. Ultimately, the patient was intubated, ventilator care was begun, and fiberoptic bronchoscopy was performed. No bronchial mucosal lesion was identified, but five sequential aliquots of bonchoalveolar lavage (BAL) fluid with a progressively bloody appearance were observed in the airway of the left upper area. Analysis of the BAL fluid revealed a red blood cell count of 28,000/mm3 and a white blood cell count of 100/mm3 with 40% neutrophils and 44% macrophages, consistent with alveolar hemorrhage. The patient received ventilator care for 3 days and was treated with methylprednisolone (starting dose of 1 mg/kg and tapering for 7 days to stop) and antibiotics. Seven days into her hospitalization, her symptoms of dyspnea, hemoptysis, and chest discomfort had fully resolved. Follow-up measurements of creatine kinase and creatine kinase-MB were normalized, and troponin-I was decreased to 0.13 ng/ml. The haziness on her chest radiograph had also disappeared (). She was discharged without any further complications. Six months after her discharge from the hospital, a follow-up transthoracic echocardiogram revealed a 60% improvement in LV ejection fraction by the A/L method without regional wall motion abnormality ().
|
[[37.0, 'year']]
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F
|
{'17651841': 1, '7559221': 1, '12204858': 1, '7485041': 1, '8219434': 1, '11327218': 1, '19129275': 1, '12883308': 1, '22732314': 1, '16788218': 1, '22095654': 1, '20442117': 1, '16741637': 1, '24010073': 2}
|
{}
|
162,970 |
3759767-1
| 24,009,457 |
noncomm/PMC003xxxxxx/PMC3759767.xml
|
Endoscopic ultrasound-guided fine needle aspiration of solid pseudopapillary tumors of the pancreas: a report of three cases
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A 31-year-old female was diagnosed with a pancreatic mass, which was found on an abdominal computed tomography (CT) scan performed during an examination for chronic liver disease. The physical examination was unremarkable. On admission, laboratory results were all within the normal reference ranges: white blood cell (WBC) count, 5.68 × 103/µL; hemoglobin, 11.8 g/dL; platelets, 188 × 103/µL; total bilirubin, 0.4 mg/dL; aspartate aminotransferase (AST)/alanine aminotransferase (ALT), 37/19 U/L; amylase/lipase, 84.0/84.6 U/L; carbohydrate antigen (CA) 19-9, 7.59 U/mL.\nAn abdominal CT scan showed an ovoid, slightly hypoattenuating, 2.4-cm mass with accompanying distal pancreatic duct dilatation in the body of the pancreas. Magnetic resonance imaging (MRI) demonstrated a well-circumscribed, round mass with mild upstream duct dilatation. Hypervascularity then delayed enhancement was noted during the arterial phase, which was interpreted as suspicious for SPT. During the EUS exam, an approximately 3-cm, well demarcated, homogenously isoechoic mass was observed in the neck of the pancreas. The tumor compressed the pancreatic vein and pancreatic duct but there was no evidence of invasion into the surrounding tissues.\nEUS-FNA was performed three times using a 25-gauge needle without complications. Materials were smeared on glass slides, and then fixed immediately in 95% alcohol for hematoxylin and eosin (H&E) and Papanicolaou stains. Additional aspirate materials were used for preparation of the cell block, which was fixed in formalin.\nThe samples showed some cell nests with branching papillary features composed of fibrovascular cores and microadenoid structures ( and ). These findings were strongly suggestive of SPT. We recommended surgery, but the patient rejected surgical resection before being discharged.
|
[[31.0, 'year']]
|
F
|
{'16193376': 1, '21157561': 1, '11023097': 1, '12451561': 1, '16698596': 1, '11731417': 1, '17876886': 1, '15922212': 1, '21098190': 1, '24009457': 2}
|
{'3759767-2': 2, '3759767-3': 2}
|
162,971 |
3759767-2
| 24,009,457 |
noncomm/PMC003xxxxxx/PMC3759767.xml
|
Endoscopic ultrasound-guided fine needle aspiration of solid pseudopapillary tumors of the pancreas: a report of three cases
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A 40-year-old female was diagnosed with a mass in the pancreatic body that was detected incidentally by abdominal ultrasonography during a general examination. All laboratory values were within normal levels: WBC, 5.32 × 103/µL; hemoglobin, 13.7 g/dL; platelets, 228 × 103/µL; AST/ALT, 16/9 U/L; amylase/lipase, 78.3/38.4 U/L; and CA 19-9, 28.6 U/mL. Abdominal CT showed no definite pancreatic lesion. MRI revealed a 1-cm sized, delayed enhancing lesion in the body of the pancreas. The tumor was a morphologically well-defined, hypoechoic mass by EUS imaging.\nEUS-FNA was performed five times using a 25-gauge needle via a transgastric approach without complications. Specimens were prepared for cytologic smears and cell blocks using the same method as described above. The initial impression based on the imaging studies was pancreatic SPT or pancreatic neuroendocrine tumor.\nCytologic smears and cell blocks showed hypercellular sheets or nests of atypical ductal epithelial cells with papillary features and a vascular core and some discohesive cell nests. Based on the characteristic histology, no immunostaining was performed. We interpreted the mass as a SPT.\nThe patient underwent laparoscopic pancreatic mass excision. We conducted immunohistochemical staining on the surgical specimen. Immunostaining was positive for vimentin, CD10, and β-catenin (), with focal positivity for synaptophysin (), and were negative for CD99, Ki-67, and CK19.
|
[[40.0, 'year']]
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F
|
{'16193376': 1, '21157561': 1, '11023097': 1, '12451561': 1, '16698596': 1, '11731417': 1, '17876886': 1, '15922212': 1, '21098190': 1, '24009457': 2}
|
{'3759767-1': 2, '3759767-3': 2}
|
162,972 |
3759767-3
| 24,009,457 |
noncomm/PMC003xxxxxx/PMC3759767.xml
|
Endoscopic ultrasound-guided fine needle aspiration of solid pseudopapillary tumors of the pancreas: a report of three cases
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A 33-year-old male visited our hospital for evaluation of an adrenal mass, which was suspected in abdominal ultrasonography during a general examination. An abdominal CT scan revealed a mass in the tail of the pancreas, not the adrenal gland. The physical examination was unremarkable. Laboratory studies revealed slightly increased AST and ALT: WBC, 6.49 × 103/µL; hemoglobin, 14.3 g/dL; platelets, 269 × 103/µL; AST/ALT, 66/101 U/L; amylase/lipase, 78.9/45 U/L; CA 19-9, 28.7 U/mL. The CT scan showed a 4-cm heterogeneous low-attenuation mass with a smooth margin in the tail of the pancreas. The lesion demonstrated iso-enhancement relative to the surrounding pancreas in the adrenal enhancement phase. MRI demonstrated a 4.2-cm, well-demarcated cystic mass involving the tail of the pancreas. In the MR arterial phase, the lesion showed a relatively low enhancement pattern. EUS showed that the 5-cm cystic mass consisted of numerous tiny cysts ().\nEUS-FNA and TCB were performed. We used a 25-gauge needle for FNA and a 19-gauge needle for TCB and approached the pancreas using a transgastric pathway. Both cell aspirates and tissue sections were obtained.\nSmear and cell block sections showed hypercellularity and sheets and clusters of monotonous small cells with round nuclei. The tissue sections did not display typical pseudopapillary features. We performed immunohistochemical staining to identify other cystic lesions in the pancreas. Immunostaining was positive for β-catenin and CD10, whereas staining was negative for neuroendocrine markers, such as synaptophysin and chromogranin. These immunohistochemical features implied that the mass would be a SPT. A laparoscopic spleen-preserving distal pancreatectomy was performed. The resected specimen showed a round solid mass, measuring 5 cm, with some cystic change due to necrosis. Microscopically, the tumor was composed of round tumor cells with numerous pseudopapillae and multifocal necrosis. The immunoprofile was consistent with the biopsy specimen. The final histopathologic diagnosis was SPT of the pancreas.
|
[[33.0, 'year']]
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M
|
{'16193376': 1, '21157561': 1, '11023097': 1, '12451561': 1, '16698596': 1, '11731417': 1, '17876886': 1, '15922212': 1, '21098190': 1, '24009457': 2}
|
{'3759767-1': 2, '3759767-2': 2}
|
162,973 |
3759768-1
| 24,009,458 |
noncomm/PMC003xxxxxx/PMC3759768.xml
|
Reversible dilated cardiomyopathy caused by idiopathic hypoparathyroidism
|
A 50-year-old female suffering from dyspnea (New York Heart Association class IV) and orthopnea was admitted to our cardiology clinic at Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea. She had been treated with neurotonics due to dizziness for 2 months, and dyspnea had developed 5 days before admission.\nOn admission, the patient's blood pressure was 100/60 mmHg, and her pulse rate was 82 beats per minute. No heart murmur was detected, but rales were heard on both sides of the lung field. Physical examination did not reveal neurological dysfunction with regard to muscle tone and sensitivity. Neither pitting edema nor neck vein distension was observed. Electrocardiography showed a prolonged QT interval (432 ms) with nonspecific ST-T changes. Chest X-ray revealed prominent cardiomegaly with pulmonary congestion (). Echocardiography indicated decreased left ventricular function.\nThe ejection fraction of the left ventricle (LV) was 36.5%, and the diastolic and systolic dimensions of the LV were 59 and 47 mm, respectively. Moderate mitral and tricuspid valvular regurgitations were identified with global hypokinesia. Serum levels of creatine kinase-MB and troponin-I were within the respective normal ranges, whereas the brain natriuretic peptide level was 1,855.1 pg/mL (reference range, 0 to 100).\nBased on her symptoms and the results of several previous studies, we made a diagnosis of congestive heart failure and began initial treatment with furosemide injection. The patient had no history of hypertension, diabetes mellitus, or smoking. In addition, we could not find any influence of neurotonics taken before admission on the patient's heart.\nAdditional studies were performed to determine the etiology of congestive heart failure. Laboratory studies revealed reduced total serum calcium of 3.7 mg/dL (reference range, 8.4 to 10.2), magnesium of 1.7 mg/dL (reference range, 1.9 to 2.5), and ionized calcium of 0.6 mmol/L (reference range, 1.12 to 1.3). The phosphorus and creatinine levels were 8.5 mg/dL (reference range, 2.5 to 4.6) and 1.5 mg/dL (reference range, 0.6 to 1.2), respectively. Hormone analysis was performed and showed free T4 and thyroid stimulating hormone to be within the respective normal ranges, while intact parathyroid hormone (PTH-intact, terminal) level was 8.17 pg/mL (reference range, 15 to 68). The vitamin D level was 10.1 ng/mL (reference range, 11 to 70). Coronary angiography did not detect significant stenotic lesions on the coronary arteries.\nWe made a diagnosis of DCM caused by severe hypocalcemia, and treatment was started with intravenous calcium and oral vitamin D3 and calcitriol. Concurrently, we sought to determine the cause of severe hypocalcemia, and a neck sonogram was ordered to rule out parathyroid infiltrating disease. However, no abnormalities were observed. Rheumatoid factor and fluorescent antinuclear antibody test were also assessed to rule out autoimmune disease; their serum levels were within the respective normal ranges ().\nThe patient was finally diagnosed with idiopathic hypoparathyroidism-induced DCM, and the treatment described above was continued in addition to conventional heart failure management. The patient responded to this regimen with remarkable improvement of dyspnea, and chest X-ray showed a reduction of cardiomegaly with clearance of pulmonary edema (). Calcium levels reached the normal range; the initial ionized calcium level was 0.6 mmol/L, and increased to 0.89 mmol/L after 5 days of calcium supplementation. The prolonged QT interval was also reduced (). Discharge treatment included oral calcium, vitamin D3, and congestive heart failure medications.\nFollow-up visits revealed progressive improvement of myocardial function; the LV ejection fraction was 46% by the first month and 51% by the third month. In addition, the LV diastolic and systolic dimensions were decreased to 53 and 37 mm, respectively (). Calcium and vitamin treatments were maintained, and aspirin, an angiotensin receptor blocker and statin medications were added. The patient is currently well on this therapy.
|
[[50.0, 'year']]
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F
|
{'7969328': 1, '10862601': 1, '6806669': 1, '25785137': 1, '10744351': 1, '28465969': 1, '15765137': 1, '12234765': 1, '32243105': 2, '11965090': 1, '8616918': 1, '32700587': 2, '24009458': 2}
|
{'7261529-1': 1, '7261529-2': 1, '7378728-1': 1}
|
162,974 |
3759769-1
| 24,009,459 |
noncomm/PMC003xxxxxx/PMC3759769.xml
|
Gestational hyperlipidemia and acute pancreatitis with underlying partial lipoprotein lipase deficiency and apolipoprotein E3/E2 genotype
|
A 28-year-old female patient presented to the hospital at 21 weeks of her second pregnancy. Her weight and height were 75 kg and 163 cm, respectively. She exhibited no clinical signs suggestive of hyperlipidemia such as tendon xanthomata, eruptive xanthomata, or other skin lesions. According to her family history, her mother had diabetes mellitus, and her father also had diabetes mellitus with hyperlipidemia. Her first pregnancy 1 year prior was influenced by gestational diabetes mellitus (GDM) and severe hyperlipidemia. Her first pregnancy progressed uneventfully, and other antenatal obstetrical examinations throughout her pregnancy were within normal limits. Labor was induced at the 38 weeks of gestation, and a healthy male infant weighing 4,050 g was delivered.\nDuring the laboratory examination of her first pregnancy, functional tests of her liver, kidney, and thyroid were normal. At gestational week 25, she underwent a 50-g oral glucose tolerance test (OGTT) for screening of GDM; after 1 hour, her plasma glucose was 198 mg/dL. Next, 100-g OGTT was administered to the patient, and her plasma glucose levels at 0, 1, 2, and 3 hours were 79, 145, 175, and 169 mg/dL, respectively. Therefore, GDM was diagnosed by the Carpenter and Coustan criteria. Lipid levels indicated that her total cholesterol was 451 mg/dL, low density lipoprotein cholesterol (LDL-C) was 154 mg/dL, high density lipoprotein cholesterol (HDL-C) was 60 mg/dL, triglyceride was 1,128 mg/dL, and β-lipoprotein was 1,421 mg/dL. Supernatant samples exhibited a turbid, cloudy appearance. GDM and hyperlipidemia were managed by strict dietary control and the administration of omega-3 acid ethyl ester, which was started at 1 g/day. At 35 weeks of gestation, her lipid levels had increased with a cholesterol level at 622 mg/dL and triglyceride level at 3,360 mg/dL. Therefore, the omega-3 acid ethyl ester dose was doubled to 2 g/day. After delivery, the patient's medication was switched to fenofibrate (130 mg/day) at 6 weeks after delivery, her total cholesterol and triglyceride levels decreased to 195 and 413 mg/dL, respectively ().\nAt 21 weeks into her second pregnancy, extreme hyperlipidemia and GDM recurred with more severe laboratory findings. Upon administration of 100-g OGTT, her plasma glucose levels at 0, 1, 2, and 3 hours were 101, 158, 197, and 166 mg/dL, respectively. And lipid profile showed total cholesterol 693 mg/dL, LDL-C 99 mg/dL, HDL-C 42 mg/dL, triglyceride 3,108 mg/dL, β-lipoprotein 3,066 mg/dL, apo A1 188 mg/dL, and apo B 105 mg/dL, respectively. The patient was managed by strict dietary control and omega-3 acid ethyl esters at 2 g/day until labor. Her pregnancy progressed uneventfully, and labor was induced at the 38th week of gestation; a healthy male infant weighing 3,650 g was delivered. On the following day, she complained of epigastric pain. Peripheral blood tests showed that her cholesterol level was 1,137 mg/dL, triglyceride level was 6,600 mg/dL, amylase level was 179 U/mL (compared with normal ranges, 25 to 115), and lipase level was 133 U/L (compared with normal ranges, 13 to 60). Enhanced abdominal computed tomography revealed swelling of the pancreas with adjacent fluid collection consistent with acute pancreatitis (). After 4 days of complete parenteral nutrition and fluid therapy, her amylase and lipase levels were normalized. She was discharged 7 days after labor, with improved status of lipid levels with cholesterol 489 mg/dL and triglyceride 702 mg/dL ().\nThe patient experienced recurrent severe hyperlipoproteinemia limited to the gestational period. We performed lipoprotein electrophoresis, apoE genotyping and LPL gene analysis. Furthermore, we measured postheparin plasma LPL activity to elucidate the underlying etiology of the extreme gestational hyperlipidemia. Lipoprotein electrophoresis showed the increase of pre-β region and the decrease of β region (), and her apoE genotype was E3/2. We evaluated the LPL gene on chromosome 8q22, and detected no gene mutation. This test analyzed the entire exon, and the adjacent intron of the LPL gene was amplified using polymerase chain reaction (Model 9700, Applied Biosystems, Foster City, CA, USA), with direct gene sequencing using an automatic nucleotide sequencer (ABI 3130xl, Applied Biosystems). LPL activity was measured using an LPL enzyme-linked immunosorbent assay kit (American Diagnostica GmbH, Mannheim, Germany), performed in her nonpregnant state. A blood sample was collected from the patient after overnight fasting, and an intravascular injection of heparin was given (30 U/kg), with 5 mL of postheparin blood samples obtained 15 minutes after the injection []. LPL in samples was trapped on the plate due to the antigen-antibody reaction with the antibovine milk LPL mouse monoclonal antibody (anti-LPL monoclonal antibody) that was coated on the plate. Subsequently, antibovine milk LPL chicken serum (anti-LPL serum) was added, with horseradish peroxidase-labeled antichicken immunoglobulin G goat serum (enzyme-labeled antibody) applied to initiate the antigen-antibody reactions in each sample. The substrate o-phenylenediamine was then added for color development. The absorbance of the developed color was measured to determine LPL levels, which indicated an LPL activity level of 152 ng/mL (compared with normal values, 164 to 284).\nAfter treatment for pancreatitis, her medication was switched to fenofibrate (130 mg/day), and her cholesterol level normalized, ranging from 130 to 200 mg/dL. In contrast, her triglyceride levels were mildly elevated, ranging from 139 to 567 mg/dL.
|
[[28.0, 'year']]
|
F
|
{'12836860': 1, '27512474': 1, '18187065': 1, '1388198': 1, '19233944': 1, '8222262': 1, '8077845': 1, '17441893': 1, '3479440': 1, '7455696': 1, '6277903': 1, '24009459': 2}
|
{}
|
162,975 |
3759770-1
| 24,009,460 |
noncomm/PMC003xxxxxx/PMC3759770.xml
|
A rare cause of dysphagia: compression of the esophagus by an anterior cervical osteophyte due to ankylosing spondylitis
|
A 48-year-old male, who was being followed up for AS, visited our hospital complaining of progressive dysphagia. Difficulty swallowing solid foods started ~4 years prior, and for the last year, he suffered from dysphagia when swallowing both solid and liquid foods. The patient had no pain while swallowing, but did experience coughing, and had lost ~16 kg in the last 4 years.\nUpon physical examination, cervical motion was limited in all directions; the occiput-wall distance was 12 cm and chin-manubrium sterni distance was 7 cm. The patient had dorsal kyphosis with a Schober test score of 1 cm. A SI compression test was bilaterally positive; the Bath AS disease activity index was 4.7; and Bath AS functional index was 3.9. Laboratory tests showed that the whole blood count was within normal limits. Erythrocyte sedimentation rate was 25 mm/hour, and C-reactive protein was 19.8 mg/L (normal range, ≤ 5). Blood levels of urea, creatinine, transaminases, calcium, and alkaline phosphatase were all within normal limits. While he was negative for antinuclear antibody and rheumatoid factor, he was positive for HLA-B27.\nImaging studies revealed SI joint ankylosis and whiskering sign in pubic bones with simple pelvic radiography (). A bamboo spine appearance was present with simple thoracolumbar radiography (). Osteophytes were observed at the anterior corners of vertebra corpuses at C4-5 and C7-T1 levels with lateral cervical radiography (). Esophagography with barium revealed compression of the esophagus due to osteophytes. Cervical computed tomography, performed to localize the osteophytes and for differential diagnosis, revealed fusion between the C5-C6-C7 corpuses with prominent osteophyte formation anteriorly on the left at the C7-T1 level. This formation compressed the esophagus (). Cervical magnetic resonance imaging (MRI) was performed to rule out factors originating from soft tissues as causes of dysphagia. A large osteophyte formation on anterior vertebra corpuses at the C7-T1 level, which caused compression on esophagus, was defined in the cervical MRI ().\nThe patient was diagnosed with severe dysphagia because he could not swallow small solid foods and he complained of coughing when swallowing liquid and solid foods []. After consultation with an orthopedic surgeon, an operation for osteophyte excision was proposed, but the patient refused. Diet modification, antireflux and swallowing therapy were prescribed. However, after 6 months, dysphagia had not improved.
|
[[48.0, 'year']]
|
M
|
{'14800245': 1, '4123836': 1, '1749474': 1, '935390': 1, '10748839': 1, '30783344': 1, '33728307': 2, '19772795': 1, '31485696': 1, '16803720': 1, '7782829': 1, '10474677': 1, '28119739': 2, '19714374': 1, '12381506': 1, '18646336': 1, '18290747': 1, '24009460': 2}
|
{'5227134-1': 1, '7942043-1': 1}
|
162,976 |
3760296-1
| 24,019,746 |
noncomm/PMC003xxxxxx/PMC3760296.xml
|
Sleep disorders and depression: brief review of the literature, case report, and\nnonpharmacologic interventions for depression
|
A 65-year-old Caucasian woman was referred to our Psychiatry Unit for consultation. She told us\nthat since childhood, every year in spring and in the evening towards bedtime, she suffered from\nmental illness with feelings of guilt about her daily activities. Awareness of the recurrence of\nthese periods meant that, since she was young, she feared the month of April because it coincided\nprecisely with her subjective and objective behavioral disorder. At school, she often felt so ill\nand impatient that one day she obtained the teacher’s permission to go home before the end\nof the lesson. This made her feel guilty. On another occasion, again in spring, she recalled that\nwhile she was walking along the main road, she suddenly experienced a strong “sense of\nloss” and was nearly run over by a car. She also remembered having often felt envious of a\nclassmate who always had lots of sweets and coins. Indeed, on one occasion, she tried to steal a few\ncoins from her school friend because of a strong desire to buy sweets. The girl was therefore\nscolded by the teacher in front of the whole class and this provoked a deep sense of guilt and\nshame. These episodes of guilt and awkwardness in interpersonal relationships associated with\ndepressive feelings were present every spring. Indeed, she remembered having suffered from severe\npain in her eyes and having feared becoming blind; this discomfort disappeared alone after a few\nweeks. At the age of 40 years, the patient reported her problems to her general practitioner who\nprescribed paroxetine, but the patient refused it.\nThis peculiar pathologic phenomena continued to occur until the discomfort perceived by the\npatient obliged her to contact our Unit. We decided to adopt a psychoeducational approach because of\nher refusal to take drugs. We advised her to get out of bed immediately, and go to a secluded area\nof her house and do some housework if she were to wake up in the middle of the night with negative\nthoughts. She usually woke up between 2 am and 4 am, and as soon as she left her bed, the negative\nthoughts vanished and were replaced by her household duties. After performing these activities, she\nwas able to go to work and be productive. She returned home at 2.30 pm, and after lunch had a nap.\nOnce she was in bed, she plunged into a deep sleep and woke up around 6.30 pm, still feeling drowsy.\nThis feeling disappeared after about 15 minutes. In the following days, at times she would wake up\nduring the night, while other nights she slept peacefully. In any case, whenever she woke up in the\nmiddle of the night, she performed some domestic activities.\nThis patient, even though she felt different from other people because of the peculiarities in\nher sleep-wake cycle, did not complain of any depressive symptoms. In this case the wakefulness by\nitself (accompanied by some goal-directed activities such as washing, cooking, and ironing) probably\nimproved her mood. It is well known that if a patient with major depression is stimulated to be\nactive, their mood can improve at least for a short period. That said, the emerging hypothesis is that “the early morning\nawakening” is a form of biological remedy against depression. Hence, sleep deprivation could\nbe a strategy to apply, especially in senile depression. In the elderly, sleep is frequently\npolyphasic. Finally, given that the clinical value of insomnia should not be underestimated, it\nwould be natural to question whether the aim to treat insomnia with the objective to observe a\nsocially agreed circadian rhythm is correct or whether insomnia should be “accepted”\nand considered a spontaneous expression of a biological remedy against depression.
|
[[65.0, 'year']]
|
F
|
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{}
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162,977 |
3760309-1
| 24,019,642 |
noncomm/PMC003xxxxxx/PMC3760309.xml
|
Giant anterior urethral diverticulum with a calculus masquerading as left inguinal hernia: A missed diagnosis, a lesson to learn
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A 3-year-old boy presented with a large left-sided hemi-scrotal swelling and a history of urine discharge from the suture line of left inguinal herniotomy []. The urinary leak was exacerbated during and immediately after micturition.\nOn detailed evaluation, it was elicited that the boy had a history of poor urinary stream since birth, which was neglected. Three months back, an intermittent swelling was observed in the left inguino-scrotal region. The fluctuation in size of the swelling was related to micturition and not to cough impulse. However, the condition was misdiagnosed as left inguinal hernia, and left-inguinal herniotomy was performed by another surgeon. Urine discharge from the surgical site was noted from the first post-operative day. He also had recurrence of scrotal swelling. The swelling was tense, non-tender, with limited mobility and involved the upper half of left hemi-scrotum and reached up to the midline, base of penis, extending cranio-laterally up to the pubic tubercle. On exerting pressure, the swelling disappeared with dribbling of urine from the external meatus and from the inguinal wound and reappeared at the next act of micturition. A hard oval structure resembling a calculus could be palpated within the swelling once deflated.\nSonography revealed dilatation of both the ureters in the lower half. Voiding cystourethrogram (VCUG) revealed the presence of a urethral diverticulum arising from the bulbar urethra with bilateral Grade IV vesicoureteric reflux []. The posterior urethra was also mildly dilated. Urinary bladder was normal. The typical description of an acute angle forming between the proximal part of dilated portion and the ventral floor was conspicuous by its presence.\nA midline incision was made from the mid-penile region to the middle of the scrotal raphe []. A thick-walled diverticulum with a contained stone was appreciated in close proximity to the penile urethra. The diverticulum was extending beyond the confines of the corpus spongiosum into the left inguinoscrotal region. The diverticulum was canulated with an infant feeding tube to facilitate dissection and skeletonised along with the cutaneous fistulous tract communicating with the herniotomy incision []. On opening the diverticulum, an elliptical mustard-colored calculus about 1 × 0.8 × 0.7 cm was identified []. The diverticulum was opening into the ventral surface of the bulbar urethra with a narrow mouth (0.7 × 0.6 cm). A lip of tissue was appreciated along the mouth of the diverticulum. The fistula was disconnected from the inguinal region and the wound was repaired. The diverticulum was divided at its neck and the bulbar urethra was repaired with 5-0 vicryl over a no. 8 silicone catheter. The postoperative recovery was uneventful. The urinary catheter was removed on 7thpostoperative day. Postoperative urinary stream was good.\nHistopathology of the diverticulum wall revealed all the layers of the urethra (true diverticulum) with mucosal ulcerations and chronic inflammatory cell infiltrates and congested blood vessels in the muscular layer. The sections from the portion of the diverticulum extending into the inguinal region revealed a fibrous wall lined by ulcerated squamous epithelium (pseudodiverticulum) with features of chronic inflammation.
|
[[3.0, 'year']]
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M
|
{'22866225': 2, '15685649': 1, '22084741': 2, '16534177': 1, '19661640': 1, '16734857': 1, '24019642': 2}
|
{'3406200-1': 1, '3195389-1': 1}
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162,978 |
3760313-1
| 24,019,646 |
noncomm/PMC003xxxxxx/PMC3760313.xml
|
Aortoesophageal fistula in a child
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A 10-year-old boy presented to the pediatric emergency with bouts of massive hematemesis, passage of fresh blood per rectum, and melena for 2 h. There was a previous history of massive hematemesis 2 weeks back, which resolved spontaneously after 2 units of blood transfusion. He had a history of anorexia and weight loss over the last 1 month. There was no history of trauma, foreign body, or corrosive ingestion. On examination, the child was restless and irritable. He had marked pallor, a low volume pulse, and a pulse rate of 140 per minute and blood pressure of 100/60 mmHg. Systemic examination was unremarkable. The child was resuscitated with fluids and packed red blood cells (PRBCs). However, massive hematemesis and melena continued resulting in progressive worsening of hemodynamic status over the next few hours. Resuscitation was stepped up with transfusion of multiple PRBC units to make up for the ongoing blood loss, and the child was intubated for prevention of aspiration and put on support. The preliminary reports revealed hemoglobin of 2.5 g/dl, platelet count of 200,000/mm3, and a normal prothrombin time. Upper GI endoscopy showed active esophageal bleeding and a pale esophageal mucosa with an ulcerated lesion of around 1 cm in diameter with overturned margins and a clot over it, in mid-esophagus at 25 cm from the incisors. Rest of the esophagus was unremarkable. Hemostatic procedures in the form of sclerotherapy around the lesion were tried, but re-bleeding occurred during the procedure. Child was shifted to pediatric intensive care unit, where resuscitative measures were continued and ionotropes were started. Imaging with contrast enhanced computed tomography (CT) scan thorax showed multifocal parenchymal consolidation and marked soft tissue thickening in mediastinal planes with esophageal mural and periesophageal thickening. The intravenously administered contrast was seen filling the esophageal lumen with a linear track extending from medial aortic border to the esophagus []. Based on clinical, endoscopic, and imaging findings, a diagnosis of AEF was made and the child was taken up for emergency thoracotomy. On exploration by left thoracotomy, mediastinum was studded with multiple necrotic nodes and inflammatory soft tissue. Mid esophagus and the aorta were encased in dense inflammatory tissue preventing separation of the esophagus from the aorta. Therefore, the aorta was transected between clamps to approach the AEF [], which was then dissected off the posterior wall of the aorta. Damaged segment of the aorta was resected and continuity restored using Dacron graft within 20 minutes without cardiopulmonary bypass. A partial esophagectomy of the densely inflamed esophagus, closure of distal esophageal stump, and cervical esophagostomy was performed. A gastrostomy and feeding jejunostomy were also placed. In the post-operative period, the inotropes were gradually tapered and stopped, and the child was weaned of the ventilator over the next few days. The histopathological examination of lymph nodes, aortic wall, and esophagus showed presence of necrotizing epithelioid cell granulomas compatible with tuberculosis []. The Mantoux test done in postoperative period was strongly positive (18-mm induration). There was global neurological impairment with poor recovery secondary to neurological injury as a result of massive preoperative blood loss and hypoxemia. However, the child could be discharged home on anti-tubercular drugs and enteral nutrition through the feeding jejunostomy, pending an esophageal replacement.
|
[[10.0, 'year']]
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M
|
{'10830043': 1, '21298926': 1, '8801321': 1, '21271572': 1, '22152890': 1, '11961316': 1, '3767615': 1, '3337583': 1, '1765917': 1, '7633134': 1, '7807347': 1, '8947363': 1, '17670036': 1, '11605901': 1, '15852296': 1, '15991162': 1, '17264556': 1, '24019646': 2}
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{}
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162,979 |
3760366-1
| 24,019,811 |
noncomm/PMC003xxxxxx/PMC3760366.xml
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Scurvy-scorbutic siderosis of gingiva: A diagnostic challenge - A rare case report
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A 32-year-old male, farmer by occupation, presented to Dept of Periodontics ACPM Dental College and Hospital, Dhule district of Maharashtra, India, with severe pain and bleeding gums since 1 month.\nAccording to the patient, bleeding gums were associated with severe enlargement and pain that caused difficulty in speech, inability to eat, chew and carry out his routine oral hygiene practice. He also revealed that he had literally stopped consuming his regular diet and was only on liquids for the past 15 days owing to pain. Severe halitosis was noticed as he conversed about his problem.\nMedical history revealed that he was not on any medication known to induce gingival hyperplasia, but he admitted of having been hospitalized few years back owing to severe joint pain involving knees and elbows which had caused limitation of movements. Presently there were no medical reports available regarding it.\nFrom his diet history, he appeared to be a heavy tea drinker, consumed around 8-10 glasses of tea per day. His main diet included bread and milk.\nGeneral physical examination revealed some skin lesions resembling keratotic patches on the temple of face, abdomen and back of neck. His palms too revealed small red dots resembling petechiae, for which he had not consulted any dermatologist [Figures –].\nClinical examination of the periodontium revealed generalized intense dark red colored, painful gingiva with severe inflammation, involving mainly interdental papilla and the margins extending up to mucogingival junction. The gingiva appeared shiny bulbous with soft and spongy consistency [Figures and ]. There appeared whitish pseudo membranous slough over the cervical and interdental regions, revealing either poor oral hygiene or negligence. There appeared spontaneous bleeding on slightest provocation which persisted for few minutes (3-5 min). With these presenting features, a provisional diagnosis of necrotizing ulcerative gingivitis was thought of until there happened to appear a blackish discoloration at the provocated sites []. This observation stopped us from further detailed periodontal examination. The patient was advised for medical referral with complete blood examination and an orthopantomogram (OPG). The hemogram report, showed all the clinical parameters to be within normal limits except for platelet count which was 80,000/cu mm. After obtaining consent from the physician, a gingival biopsy was planned.\nThe next day, under the cover of antibiotics, anti inflammatory and vitamin C supplements, (Antibiotics - Amoxicillin 500 mg, Metronidazole 400 mg, and anti-inflammatory Ibuprofen-400 mg for five days, along with vitamin C supplements-250 mg q.i.d for 2 weeks) slow and gentle removal of necrotic slough with cotton swabs soaked in 3% hydrogen peroxide solution, was carried out, after application of topical anesthesia []. This was followed by irrigation with solution containing povidone and iodine. The superficial accretions were slowly removed with curettes without hurting the gingiva. An incisional biopsy was taken under local anesthesia. Further, a venous blood sample was drawn and sent to the laboratory to detect the neutrophil function. The patient was discharged with the advice of adequate rest and inclusion of a variety of nutritional supplements in his diet.\nMeanwhile, histopathological examination of the biopsy specimen confirmed it to be a case of scorbutic gingivitis. It showed presence of intra-epidermal vesicles and spongiosis in the squamous epithelium. The superficial areas of squamous epithelium show koilocytic change. The deeper connective tissue revealed marked vascularity and acute or chronic inflammatory exudates. Few of the areas also revealed subepithelial hemorrhages and capillaries revealed fibrin thrombi [Figures and ].\nA confirmed diagnosis of scorbutic siderosis of gingiva was made based on the collected information regarding clinical, histopathological, and medical examination.\nMeanwhile the neutrophil defect assay showed reduced chemotaxis and reduced phagocytosis activity. Phagocytic activity was depicted by reduced mean particle number of ingested Candida (Most probable number (MPN)-3). Neutrophil chemotaxis response towards N-formyl-methionyl-leucyl-phenylalanine was −1.1 mm in the present case. The values for the respiratory burst activity and intracellular killing activity by NBT (Nitroblue Tetrazolium) assay and candid cidal assay were within normal limits [].\nAfter 1 week, the patient returned and there was marked improvement at the site of the gingiva and at this time blood examination revealed the platelet count to be 1,30,000/cu.mm. Now a detailed periodontal examination was carried out, which revealed, grade three mobility with 31 and grade two mobility with 41. OPG revealed mild to moderate generalized bone loss []. The patient was advised for extraction of 31 for which he did not agree and insisted on retaining the teeth, therefore, a partial supragingival scaling was carried out. The patient was recalled after one week for subgingival scaling and root planning. At this time provisional splinting of the lower anterior teeth was carried out. The patient was counseled for proper oral hygiene maintenance and the importance of inclusion of fruits and vegetables in his diet were once again stressed. The clinical picture of the gingiva at the end of 2 weeks [Figures and ].\nThe patient returned after 3 months and there was remarkable improvement at the site of gingiva [Figures and ]. Bleeding on probing was minimal with no discoloration at the provocated site. Meanwhile the skin disorder was diagnosed as hyperkeratosis with ringworm infection (Tinea corporis), by the dermatologist and was advised vitamin C supplements, topical application of a steroid ointment and an antifungal cream. The patient is being followed up regularly for 1 year with no recurrence of the lesion so far.
|
[[32.0, 'year']]
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M
|
{'6374927': 1, '7330838': 1, '9673175': 1, '17616774': 1, '10972636': 1, '20684188': 1, '22163038': 1, '24019811': 2}
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{}
|
162,980 |
3760367-1
| 24,019,812 |
noncomm/PMC003xxxxxx/PMC3760367.xml
|
Submental intubation
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A 38-year-old male patient with panfacial trauma was planned for open reduction and internal fixation under General Anesthesia. Nasotracheal intubation was ruled out due to the presence of nasal fractures. Oral intubation was also ruled out due to the need to establish occlusion by intermaxillary fixation (IMF). Initially, a tracheostomy was planned, but in the operation theatre itself it was decided to intubate this patient through the sub-mental route as described by Mac Innis and Baig. After normal oral intubation using a tube (such as a mallinkrodt tube, US), which allows the connector to be removed, an incision measuring 2 cm was marked in the midline of the chin just anterior to the sub-mental crease close to the lower border of the mandible by the maxillofacial surgeon. Local anesthetic was infiltrated, and a 20 mm incision was made, enough to admit a size 8 tube. Blunt dissection was carried out as close as possible to the lingual aspect of the mandible into the floor of the mouth. A longitudinal incision was then made in the floor of the mouth, in the midline between the submandibular ducts at the base of the tongue, just enough to allow the passage of the tube so as to protect the facial nerve, lingual nerve and submandibular duct []. Artery forceps were passed from the extraoral to the intraoral incision and the existing flexometallic orotracheal tube drawn through the incision after grasping with the artery forceps []. This maneuver took approximately, 6 min for the maxillofacial surgeon to do. Correct tube position was confirmed with capnography and lung auscultation by the anesthetist. The cuff of the tube was inflated and the throat packed by the anesthetist. Temporary black silk sutures were placed to secure the tube extraorally, one on either side of the tube and around it by the surgical team.\nThe patient was painted and draped as usual, with full access to the facial bones and occlusion. Upon open reduction and internal fixation, which was now conveniently done in a single stage surgery, when the patient was ready to be extubated, the anchoring sutures were cut. The tube was removed extraorally and an oropharyngeal airway placed. 3-4 black silk sutures were placed in the skin extraorally. There was no need for intraoral sutures. If required, the tube can be kept in situ for a day or two. However, in this case the IMF was removed first, and then the throat-pack. The throat was suctioned thoroughly, and the tube was removed in the operation theatre through the sub-mental incision. The wound was closed with three interrupted sutures of 3-0 ethilon.
|
[[38.0, 'year']]
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M
|
{'8819724': 1, '10535533': 1, '18571024': 1, '11465141': 1, '12369093': 1, '9014636': 1, '23482892': 1, '12562424': 1, '3456416': 1, '8142106': 1, '10625008': 1, '24019812': 2}
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{}
|
162,981 |
3760368-1
| 24,019,813 |
noncomm/PMC003xxxxxx/PMC3760368.xml
|
Oral malignant melanoma: A case report of an unusual clinical and histologic presentation
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A 60-year-old female patient reported with the complaint of a growth on the palate and inability to wear the denture since 3 months. On clinical examination, the lesional mass was seen involving the entire hard palate as a pedunculated mass, measuring approximately 3 cm × 3 cm, attached to the palatal mucosa with a narrow stalk. The base of the pedunculated mass, the palatal mucosa and the surrounding alveolar mucosa showed areas of brownish black pigmentation. The mucosa on the oral side of the lesion showed a pale whitish color []. On palpation the lesion was smooth, non-tender, well defined, firm to hard in consistency with induration of the posterior margins.\nOn computed tomography an enhancing, infiltrative soft tissue mass arising from the hard palate with subtle bony erosion noted over the mid portion of the hard palate [] and bilateral submandibular lymphadenopathy were evident.\nA provisional diagnosis of malignant melanoma was considered and an incisional biopsy was performed which confirmed the diagnosis. The patient underwent total maxillectomy with neck dissection.\nThe histopathological examination of the excised tissue revealed cells with a clear cytoplasm and hyper chromatic nuclei resembling atypical melanocytes seen proliferating from dermal-epidermal junction into the connective tissue. The atypical melanocytes were epitheloid in the superficial region [], and spindle shaped in the deeper regions of the connective tissue. The spindle cell type predominated showing an irregular branching pattern with intervening fibrous septae [], these cells appeared fusiform to round in different orientations []. Atypical features like mitosis, multi-nucleation, pleomorphism, hyper chromatism, increased nuclear cytoplasmic ratio and prominent nucleoli were seen []. Pigmented nests of atypical melanocytes along with melanophages were seen in the superficial region. The tumor-stroma interface showed a marked inflammatory response and dense fibrosis. The evaluation the harvested submandibular lymph node showed metastatic involvement. The histopathology confirmed the diagnosis of malignant melanoma with metastatic level I nodes. The spindle cell predominance with collagenous stroma was suggestive of desmoplastic malignant melanoma.\nThe patient underwent reconstruction, prosthetic rehabilitation, and has been on regular follow with no recurrence till date.
|
[[60.0, 'year']]
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F
|
{'20936153': 1, '29732311': 1, '16170181': 1, '14561964': 1, '23087745': 2, '20585483': 1, '9613519': 1, '9070205': 1, '8136216': 1, '21603499': 1, '10745167': 1, '23087742': 2, '24019813': 2}
|
{'3469903-1': 1, '3469903-2': 1, '3469903-3': 1, '3469903-4': 1, '3469906-1': 1}
|
162,982 |
3760701-1
| 24,010,117 |
noncomm/PMC003xxxxxx/PMC3760701.xml
|
A Case of Rapunzel Syndrome
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An 8-year-old girl was referred to our pediatric clinic with a 3-month history of palpable abdominal mass, epigastric pain, and intermittent vomiting that worsened after meals. Her mother reported several episodes of vomiting, which consisted of undigested recently eaten food. There was no history of recent illness, fever, diarrhea, or ingestion of toxic substances. Physical examination of her abdomen revealed hyperactive bowel sounds and a palpable firm mass in the epigastric region (approximately 15×10 cm). No acute peritoneal signs were evident. The patient had long hair, and no erythema, scaling, or scalp edema was present. The rest of the physical examination was unremarkable.\nLaboratory findings were all within normal limits, including complete blood cell counts, serum electrolyte levels, liver and renal function tests, complete metabolic panel, and pancreatic enzyme levels. Plain radiograph of the abdomen revealed an unusual gas pattern in the left upper quadrant with a rim of air inside. Abdominal computed tomography (CT) scan revealed a huge free-floating heterogeneous solid mass with a mottled gas pattern in the markedly distended stomach (). The diagnosis of gastric trichobezoar was made, and removal through an upper gastrointestinal endoscopy was considered. Upper gastroscopy revealed a huge gastric trichobezoar mixed with undigested food material occupying almost the entire gastric cavity. A long hairy tail was exiting the pylorus and extending into the duodenal bulb; the gastric mucosa appeared normal without evidence of ulceration (). An attempt to remove the trichobezoar using foreign body forceps failed because of its extensive size. Consequently, surgical laparotomy was performed. A gastrostomy was made in the anterior wall of the stomach, and the huge trichobezoar was subsequently identified and extracted. The stomach-shaped mass measured 14.0×10.0×5.5 cm, weighed 407 g, and had a long tail of hair extending through the pylorus into the middle portion of the jejunum ().\nThe patient had an uneventful postoperative course and was discharged and returned home 7 days later. During her admission, a psychiatric consultation with a review revealed a history of trichotillomania and trichophagia 4 years ago. However, we failed to find the fundamental causes of stress or anxiety disorder associated with her trichotillomania and trichophagia. Her parents were advised to visit a pediatric psychiatrist for further psychiatric intervention. However, they refused further psychiatric treatment, and the patient was lost to follow-up.
|
[[8.0, 'year']]
|
F
|
{'23583142': 1, '20932380': 1, '25540542': 2, '18286701': 1, '5638179': 1, '9569269': 1, '16227005': 1, '27671985': 1, '34221745': 2, '17476105': 1, '10830041': 1, '16080951': 1, '19405804': 1, '26457086': 2, '3540541': 1, '19625498': 1, '10328129': 1, '24010117': 2}
|
{'4271385-1': 1, '4589580-1': 1, '8237910-1': 1}
|
162,983 |
3760702-1
| 24,010,116 |
noncomm/PMC003xxxxxx/PMC3760702.xml
|
Co-Infection with Cytomegalovirus and Helicobacter pylori in a Child with Ménétrier's Disease
|
A 3-year-old boy visited the emergency department with an 11-day duration of anorexia, vomiting, and facial and peripheral edema. He had no previous history of medical problems, surgeries, medication use, or allergies. Family history was not notable. His body temperature was 36.6℃, heart rate was 72 beats/min, respiratory rate was 24/min, and blood pressure was 88/68 mmHg. Physical examination revealed swelling of the face, lower extremities, and scrotum. Breathing sounds were clear bilaterally without crackles or wheezing. His bowel sounds were normoactive and abdominal palpation showed no tenderness or hepatosplenomegaly. Initial complete blood cell count, electrolytes, blood urea nitrogen, creatinine, transaminases and cholesterol were unremarkable. But, serum protein and albumin were decreased (2.9 g/dL and 1.9 g/dL, respectively). The patient displayed no laboratory evidence of acute or chronic inflammation (erythrocyte sedimentation rate 2 mm/hr; C-reactive protein 0.08 mg/dL). No urinary protein was detected in urinalysis. At the second day of admission, esophagogastroduodenoscopy with gastric biopsy was performed, which revealed enlarged erythematous gastric folds in the entire stomach (). The diagnosis was protein-diminishing gastropathy with giant rugae (i.e., Ménétrier's disease). Along with the gastric biopsy and in-situ hybridization of specific viruses including CMV, Epstein-Barr virus and herpes simplex virus, we also performed an 13C urea breath test. The 13C urea breath test was positive(>2.0‰: cut-off value 2.0‰), prompting a 2-week regimen of lansoprazol, amoxicillin, and clarithromycin for Helicobacter pylori eradication. During the treatment, we noted the expected positive finding of recent CMV infection. Serologically, CMV immunoglobulin M was positive (IgM 1.19). A subsequent blood CMV polymerase chain reaction was positive and CMV antigenemia also was positive (18/200,000 white blood cells). Histologically, a gastric biopsy showed the proliferation of the gastric glands and cystic dilatation without increase of granulocytes or eosinophils, consistent with common histologic findings of Ménétrier's disease (). In addition, CMV intranuclear inclusions were detected from gastric tissue using in-situ hybridization (). H. pylori was not detected in Giemsa-stained sections. Although not totally normalized, the patient's appetite, peripheral edema, and hypoalbuminemia improved sufficiently to allow discharge after 8 days of supportive care such as fluid restriction, albumin infusion, diurectics, high-protein diet. Seven weeks after discharge, follow-up esophagogastroduodenoscopy with biopsy and 13C urea breath test were done. The patient did not complain of any notable symptoms and endoscopy was nearly normalized, both grossly and microscopically (). But the 13C urea breath test was still positive despite 2 weeks of H. pylori eradication treatment.
|
[[3.0, 'year']]
|
M
|
{'11519296': 1, '17533897': 1, '8200570': 1, '20958864': 1, '8522306': 1, '18773679': 1, '16858581': 1, '8229553': 1, '8229556': 1, '31013510': 1, '32803424': 1, '32041355': 1, '33505900': 1, '25687706': 1, '8956179': 1, '3514352': 1, '18651176': 1, '28607327': 2, '15492913': 1, '199063': 1, '3285309': 1, '4357211': 1, '24010116': 2}
|
{'5806914-1': 1}
|
162,984 |
3760704-1
| 24,010,118 |
noncomm/PMC003xxxxxx/PMC3760704.xml
|
A Case of Cecal Volvulus Presenting with Chronic Constipation in Lissencephaly
|
A 19-year-old male (height, 145 cm; weight, 34 kg), who was treated for cerebral palsy and refractory epilepsy due to lissencephaly, visited our hospital (Yeungnam University Medical Center, Daegu, Korea) because of severe abdominal distension and vomiting. Also, this patient was not able to perform independent daily living without any assistance because of mental disability. The patient had been treated with an anti-epileptic agent such as lamotrigine, phenobarbital, leviteracetam, rivotril, and ativan for epilepsy since he was a neonate and had visited our hospital several times for rectal decompression because of chronic constipation. The patient, suffered from chronic constipation over 3 years, had history of ≤2 bowel movements per week with hard large stool, necessitating rectal stimulation for defecation. Two months prior to admission, the patient had experienced a 3.0 kg weight loss and sleep disturbance with irritability.\nUpon admission, the patient was lethargic with dried lips. Abdominal examination showed epigastric and lower abdominal distension with decreased bowel sounds, which had mild rigidity. We could not check the site of pain and tenderness due to impaired communication with the patient. Laboratory findings showed leukocytosis with a white blood cell count of 45,690/µL, increased C-reactive protein at 15.14 mg/dL (reference range <0.5 mg/dL), and increased blood urea nitrogen/creatinine at 33.15/1.91 mg/dL. The patient had an electrolyte imbalance consisting of hyponatremia (124 mmol/L Na+) and hyperkalemia (5.9 mmol/L K+). Intravenous antibiotics of 3rd cephalosporin (50 mg/kg/day) and metronidazole (15 mg/kg/day) were administrated.\nAn initial abdominal x-ray showed a markedly distended stomach and a huge quantity of gas in right lower abdomen (). We performed continuous suction with a naso-gastric and rectal tube for decompression and observed the patient. The next day, abdominal distension progressively deteriorated and a follow-up laboratory examination revealed uncontrolled inflammation. A follow-up supine abdominal x-ray 24 hours after the decompression revealed fixed haustral gas formation despite decompression with gastric and rectal tube insertion (). Leukocytosis was improved, but C-reactive protein levels increased markedly to 34.11 mg/dL. An abdominal computed tomography scan without contrast enhancement scan showed dilated small bowel in the abdomen but no 'while' or 'bird peak' sign ().\nWe suspected intestinal obstruction as the primary cause of the symptoms and planned an explorative laparotomy. During the laparotomy, ischemic changes were seen throughout the cecum and part of the ascending colon. The cecum, which was not fixed at the retro-peritoneum, was dilated and twisted around the terminal ileum () and an approximately 20 cm length segmentectomy of the proximal ascending colon was completed with preserved ileocecal valve.\nThe patient was admitted to the intensive care unit and hospital ward for >2 months due to post-operative ileus. Approximately 3 months after the laparotomy, previous ileus signs had nearly disappeared and the patient's symptoms were much improved.
|
[[19.0, 'year']]
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M
|
{'8034456': 1, '22901919': 1, '6781272': 1, '23027907': 1, '19469008': 1, '11440107': 1, '20376252': 1, '3322151': 1, '3540707': 1, '7949792': 1, '17653554': 1, '24010118': 2}
|
{}
|
162,985 |
3760936-1
| 24,068,132 |
noncomm/PMC003xxxxxx/PMC3760936.xml
|
Linear IgA Dermatosis associated with ulcerative colitis: complete and\nsustained remission after total colectomy
|
A 13-year-old boy sought dermatological consultation because of itching skin lesions\nlasting one month. He had had UC diagnosed 11 months earlier and was in continuous use\nof adalimumab, mesalazine and prednisone (10mg/d). On physical examination, erosions\nwith some peripherally disposed vesicles over a reddish background on the forehead and\nglabella were seen (). Some impetigo-like\npustular lesions were found on the chin and around the nose. There was also oral\ninvolvement, some crusted clustered papules in the precordium, and some large erosions\nwith hemorrhagic exudate in the back, lumbar region and buttocks ( and ). In the\nintergluteal region, a large eroded plaque covered by a whitish membrane was observed\n(). The patient denied use of any\nmedication previously associated to drug induced-LAD such as vancomycin, penicillin,\nceftriaxone, metronidazole, captopril, phenytoin, diclofenac, somatostatin, amiodarone,\nlithium, cefamandole, cyclosporin, interleukin-2, interferon-γ etc. Histopathology revealed a subepidermal\nblister and a superficial inflammatory infiltrate consisting of neutrophils arranged in\ncollections on dermal papillae ( and\n). Direct immunofluorescense of perilesional\nskin depicted a strong linear deposition of IgA along the basement membrane and a focal\ngranular positiveness of C3 (non-specific finding) (). IgG, IgM and fibrinogen were negative. The diagnosis of LAD was\ntherefore established and treatment with dapsone 50 mg/day started. In two weeks there\nwas regression of all the skin lesions, leaving only erosions inside the mouth, which\nwere handled with triancinolone acetonide 0.1% ointment. At this point in time oral\nprednisone was suspended. One month later there was a relapse of perineal and\nintergluteal lesions, with bleeding. Oral prednisone was reinitiated in the dose of\n20mg/day. A new attempt of tapering prednisone resulted again in a worsening of the skin\nlesions and the dose of dapsone was increased to 100mg/d. LAD remained partially but\nunsatisfactorily controlled over the next 2.5 months, when the patient underwent total\ncolectomy with ileorectal anastomosis for UC and experienced a substantial improvement\nof skin lesions, allowing reduction of prednisone and dapsone to 10 mg and 50 mg every\nother day, respectively. After 3 months, the patient returned with complete remission of\nboth LAD and UC and all medications were suspended. There was no relapse in two years of\nfollow-up.
|
[[13.0, 'year']]
|
M
|
{'10233655': 1, '19399380': 1, '28300887': 1, '16225624': 1, '31555959': 1, '19726277': 1, '7917982': 1, '12741472': 1, '19023862': 1, '17229615': 1, '9205518': 1, '3721124': 1, '7500294': 1, '10209920': 1, '10052419': 1, '11122060': 1, '3280383': 1, '6228498': 1, '9649655': 1, '10583613': 1, '8415303': 1, '24068132': 2}
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{}
|
162,986 |
3760937-1
| 24,068,133 |
noncomm/PMC003xxxxxx/PMC3760937.xml
|
Involucrin in the differential diagnosis between linear psoriasis and\ninflammatory linear verrucous epidermal nevus: a report of one case
|
A 4-year-old girl presented with numerous confluent verrucous papules, either\nhypochromic or erythematous, linearly distributed, some along the Blaschko's lines, on\nthe trunk, upper and lower limbs, since birth (). No other skin lesions, or ungueal, scalp or mucosal lesions were detected.\nLesions were located initially in the back of the patient's right hand, with\ndissemination to the rest of trunk and limbs over the years. The lesions were pruritic.\nHer medical history suggested substantial reaction to food allergies. She had a twin\nsister without skin lesions and there was no family history of psoriasis or of any other\nskin disorder. Given the clinical aspect, the diagnostic hypotheses were ILVEN,\nichthyosis hystrix, linear psoriasis, incontinentia pigmenti and lichen striatus.\nHistopathologic examination revealed a psoriasiform dermatitis, consistent with the\nclinical hypothesis of ILVEN and linear psoriasis, and it was not possible to\ndifferentiate between the two (). Results\nof immunohistochemical staining for involucrin revealed that this protein expression was\nincreased in the orthokeratotic regions but deficient in the parakeratotic regions\n(). The patient received topical\ntreatment with keratolytics and steroids, as well as systemic treatment with\nantihistaminic drugs. The treatments resulted in moderated improvement of the lesions\nand pruritus.
|
[[4.0, 'year']]
|
F
|
{'1158005': 1, '443842': 1, '31181689': 1, '29166506': 1, '14871332': 1, '21152805': 1, '1723870': 1, '10738637': 1, '15319153': 1, '3668277': 1, '29606943': 2, '5114412': 1, '1718120': 1, '15191537': 1, '3890921': 1, '2869777': 1, '4750212': 1, '737873': 1, '29230331': 2, '24068133': 2}
|
{'5869485-1': 1, '5688342-1': 1}
|
162,987 |
3760938-1
| 24,068,134 |
noncomm/PMC003xxxxxx/PMC3760938.xml
|
Breast carcinoma en Cuirasse - Case report
|
About a year ago a 78-year-old black woman, housewife, born and resident in São Vicente,\nSP, presented with papulonodular lesions, scaly and confluent in the right breast,\nprogressing to edema and skin infiltration, with marked reduction in breast volume, like\na cuirasse (). Four\nmonths ago she showed signs of contralateral breast and abdomen involvement, with\nenlarged, hardened and palpable lumps in the left breast. There was also gradual weight\nloss of 10 kg in the previous year, anterior cervical and axillary lymphoadenopathy,\nassociated with lymphedema of the right arm. She denied any dermatological diseases and\nher personal history was unremarkable ().\nHistological examination showed epidermis infiltration with pagetoid neoplastic cells,\nsome of them with clear cytoplasm and tumor emboli in lymphatic vessels (, and\n). The diagnosis was invasive ductal breast\ncarcinoma with Paget-like foci, cutaneous metastases and lymphatic embolization.
|
[[78.0, 'year']]
|
F
|
{'30287992': 1, '32606879': 2, '20551556': 1, '19557891': 1, '14756657': 1, '33869701': 1, '33633892': 2, '26312696': 2, '27284253': 2, '34745972': 2, '24068134': 2}
|
{'4883816-1': 1, '7899250-1': 1, '4540530-1': 1, '7308115-1': 1, '8566709-1': 1}
|
162,988 |
3760939-1
| 24,068,135 |
noncomm/PMC003xxxxxx/PMC3760939.xml
|
Protein contact dermatitis - Case report
|
A 37-year-old female, with a personal history of intrinsic asthma, treated with\nsalbutamol, and who worked as a cook, was referred to our Center for evaluation of skin\nlesions on the dorsum of the hands and forearms, which had started 2 years before. On\nphysical examination eczematous plaques were observed on the dorsal aspect of both\nforearms and hands, including fingers and interdigital surfaces, with the presence of\nfissures (). She had previously been\ntreated with moderate potency topical corticosteroids without improvement.\nThe patient worked as a cook at a Japanese restaurant, and daily handled food based on\nfish and vegetables (). She used\nprotective latex gloves during her daily routine and reported that during vacations or\nrest days she experienced major improvement, as well as worsening when she returned to\nwork.\nGiven the clinical aspect, location of the lesions and the patient's occupation, we\ndecided to conduct patch testing with the baseline series of the Spanish Group for\nResearch of Allergy and Contact Dermatitis and the rubber series (True Test and\nChemotechnique Diagnostics), in addition to prick-by-prick tests with all the raw food\nthat the patient handled daily at her workplace. All patch tests were negative.\nRegarding the prickby-prick tests, positive results were observed to crab, tuna fish,\nsalmon, scallop, eel, shrimp and butterfish (). Additionally IgE levels were measured in serum, with high levels of total\nIgE (326 IU / ml), shrimp IgE (0.52 KU / L) and crab IgE (0.52 KU / L).\nWith the diagnostic test results and the patient's clinical and occupational history,\nthe diagnosis of protein contact dermatitis was established. The patient was advised to\navoid contact with prawns, shrimp and crab, both handling and ingestion, and to wear\nprotective plastic gloves. Prompt improvement was observed.
|
[[37.0, 'year']]
|
F
|
{'8365175': 1, '8455408': 1, '8368462': 1, '7756118': 1, '28203266': 1, '20732848': 1, '145923': 1, '24068135': 2}
|
{}
|
162,989 |
3760940-1
| 24,068,136 |
noncomm/PMC003xxxxxx/PMC3760940.xml
|
Dermatofibroma in a black tattoo: report of a case
|
An otherwise healthy 24-year-old male presented with an erythematous nodule involving a\ntattoo on his right lower leg. The eruption began two months after the placement of\nblack ink within a previously existing tattoo. He denied similar changes in previous\ntattoos. Clinical examination revealed an erythematous, freely movable nodule overlying\na black pigment zone on the right lower leg, with slight tenderness on pressure ().\nExamination of the hematoxylin-eosin stained histological sections of an excisional\nbiopsy revealed nodular dermal proliferation of fibroblast-like cells embedded in a\ndense collagen matrix. These cells displayed an irregular arrangement, but no\ncytological atypia. The overlying acanthotic epidermis showed basal hyperpigmentation.\nIn addition, extracellular deposits of coarse black pigment were observed, particularly\nabove the spindlecell proliferation (,\n and ).
|
[[24.0, 'year']]
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M
|
{'18582244': 1, '25328722': 2, '17040267': 1, '17052538': 1, '18174803': 1, '18053037': 1, '21152800': 1, '21496711': 1, '19175704': 1, '10971696': 1, '26940693': 1, '14226967': 1, '27721753': 2, '24068136': 2}
|
{'5043227-1': 1, '4190120-1': 1}
|
162,990 |
3760941-1
| 24,068,137 |
noncomm/PMC003xxxxxx/PMC3760941.xml
|
Fixed drug eruption caused by tadalafil - Case report
|
A 30-year old man referred to City Institute for Skin and Venereal Diseases complaining\nof recurrent red spots on the skin and genitalia. They appeared on the same skin sites\nand resolved three times consecutively during 6 months. The subjective symptom was only\nmild pruritus. Physical examination during the first visit revealed a solitary\nerythematous patch, 2cm in diameter, on the penile shaft. Treatment with topical\ncorticosteroid cream resulted in complete resolution of the lesion in a few days. Apart\nfrom the clinically suggestive patch, at first visit the diagnosis of erythema\nfixum could not be complemented with the appropriate anamnestic data since\nthe patient denied oral ingestion of any drug preceding the onset of the lesion. He was\nadvised to carefully look for skin and genital lesions if using oral antibiotics or\nnonsteroid anti-inflammatory drugs. The next episode of disseminated patches developed\nsuddenly on the penis, right forearm and left periorbital region, nevertheless the\npatient did not come to the clinic for examination. Instead, he applied topical\ncorticosteroid cream on his own, for a couple of days. Few weeks after the complete\nresolution of all patches they reappeared on identical sites of the skin, with one new\nlesion on the buccal mucosa. Upon referral, the third episode clinically presented with\nmultiple erythematous violaceous disseminated patches on the penile shaft, right elbow,\nleft periorbital region as well as patches and erosions on buccal mucosa and hard palate\n(, and ). The patient was worried and\nmotivated for cooperation so his thorough medical history revealed that each episode was\nelicited by the same event - recreational use of tadalafil for enhancement of coital\nexcitement and pleasure, approximately once every 3 months during the previous year. The\npatient denied any other concurrent symptoms and diseases; complete blood count,\nbiochemical parameters, serum aminotransferase values and urine analysis were all within\nnormal physiological ranges.\nA short course of topical corticosteroid therapy once again resulted in complete\nresolution of all lesions leaving residual hyperpigmentation of the involved skin sites.\nMucosal oral lesions were effectively treated with gingival hyaluronic acid 0.2%\ngel.
|
[[30.0, 'year']]
|
M
|
{'28392662': 1, '9865869': 1, '17241588': 1, '19911677': 1, '20722788': 1, '15866997': 1, '11702319': 1, '12605242': 1, '24068137': 2}
|
{}
|
162,991 |
3760942-1
| 24,068,138 |
noncomm/PMC003xxxxxx/PMC3760942.xml
|
Extensive hydroa vacciniforme
|
An 18-year-old female student reported that since the age of 5 she has been suffering\nfrom necrotic lesions and vesicles in exposed areas that leave asymptomatic\nvarioliform scars, which worsen in summer.\nSkin examination showed that the nose and ears were covered with hemorrhagic/yellow\ncrusts and erosions (). The dorsal\nsurfaces of hands were also strongly involved with hemorrhagic crusts and vesicles\n(). There were also lesions on other\nareas that were unprotected from the sunlight, such as the ankles and the presternal\nregion ().\nLight microscopy showed epidermal necrosis with lymphocytic infiltration (). Laboratory tests for lupus erythematosus\n(ANA) and uroporphyrines were normal. There are no similar cases in her family. There\nwas little improvement with the use of highly protective sunscreens (SPF 45), with onset\nof new lesions. Topical antibiotics were prescribed for secondary infection.
|
[[18.0, 'year']]
|
F
|
{'20814626': 1, '21442060': 1, '20523790': 1, '10642674': 1, '19688153': 1, '20711268': 1, '20837686': 1, '24068138': 2}
|
{}
|
162,992 |
3760943-1
| 24,068,139 |
noncomm/PMC003xxxxxx/PMC3760943.xml
|
Circumscribed palmoplantar hypokeratosis: report of two Brazilian\ncases
|
Case 1: Female patient, 68 years old, white, had had lesions on the palms for 30 years.\nThere was no history of trauma or local infection. The dermatological exam showed two\nreddish plaques of approximately 5x5mm on the right palm and 5x10mm on the left palm.\nThe lesions were circumscribed, nummular, depressed and located symmetrically over the\nthenar regions ( and ). Her soles were not involved. The general clinical examination\nwas not significant. Direct mycological examination was performed with negative results,\nand histopathological aspects of skin biopsy showed a focus of sharp decrease in the\nstratum corneum thickness, mild acanthosis and no change in the basal layer ().\nThe one year follow-up showed no change of clinical lesions.
|
[[68.0, 'year']]
|
F
|
{'12077576': 1, '18399810': 1, '16635682': 1, '18818675': 1, '15987302': 1, '19955702': 1, '19171227': 1, '17412452': 1, '16625071': 1, '17553594': 1, '24068139': 2}
|
{'3760943-2': 2}
|
162,993 |
3760943-2
| 24,068,139 |
noncomm/PMC003xxxxxx/PMC3760943.xml
|
Circumscribed palmoplantar hypokeratosis: report of two Brazilian\ncases
|
Case 2: Female patient, 84 years old, white, had had a single lesion on the left palm\nfor over 24 years. The patient had no history of trauma or local infection. The physical\nexamination revealed a reddish, nummular, depressed and circumscribed patch, about 5 mm\nin diameter, located over the thenar eminence of the left palm ( and ). There were\nno lesions on contralateral palm or on soles.\nDirect mycological examination was performed with negative results. Histologically, it\nshowed an abrupt, well-demarcated decrease in the thickness of the stratum corneum and a\ndiminished granular layer ().
|
[[84.0, 'year']]
|
F
|
{'12077576': 1, '18399810': 1, '16635682': 1, '18818675': 1, '15987302': 1, '19955702': 1, '19171227': 1, '17412452': 1, '16625071': 1, '17553594': 1, '24068139': 2}
|
{'3760943-1': 2}
|
162,994 |
3760944-1
| 24,068,140 |
noncomm/PMC003xxxxxx/PMC3760944.xml
|
Ichthyosis associated with widespread tinea corporis: report of three\ncases
|
An 87-year-old female patient with congenital ichthyosiform erythroderma had been\nfollowed since 1976. Over the years she presented with erythematous-scaling patches,\nwith peripheral activity and central clearing. The diagnosis of chronic\ndermatophytosis had been established for more than 30 years. The patient underwent\nseveral treatments with systemic antifungal agents, including griseofulvin and azoles\nfor periods of 3 to 12 weeks. In addition, topical creams were used with temporary\nimprovement. In 2006 she accepted treatment with Acitretin. Partial improvement of\nerythema and desquamation was seen within 2 months; however, arciform lesions were\noccasionally seen. In September 2011, she showed signs of clinical deterioration with\nwidespread lamellar scaling on the limbs and trunk, ectropion and multiple bilateral\nerythematous round patches on the lower limbs (). Direct examination demonstrated hyaline septate hyphae with a positive\nculture for T. rubrum. Association with dermatophytosis was\ndiagnosed. Thirty days after prescription of terbinafine 250 mg qd the patient showed\ndramatic improvement of the lesions ().
|
[[87.0, 'year']]
|
F
|
{'9691500': 1, '19595270': 1, '10495665': 1, '17714134': 1, '25322706': 1, '17714151': 1, '9594935': 1, '32547912': 1, '1287487': 1, '11531856': 1, '9460252': 1, '24068140': 2}
|
{'3760944-2': 2, '3760944-3': 2}
|
162,995 |
3760944-2
| 24,068,140 |
noncomm/PMC003xxxxxx/PMC3760944.xml
|
Ichthyosis associated with widespread tinea corporis: report of three\ncases
|
A 73-year-old male patient was diagnosed with ichthyosis linearis circumflexa in\n1999. Disseminated arciform and round patches had been seen since his first\ndermatology visit. Previous empiric treatment to rule out coincident fungal infection\nincluded ketoconazole, topical terbinafine, ketoconazole or ciclopirox olamine. This\ntherapy had no impact.\nDuring one of his regular visits in July 2011, he presented ill-defined erythematous\nscaly papules and plaques on the trunk and upper limbs (). Onycholysis, distal leukonychia, subungual\nhyperkeratosis and onychorrexis on the toenails were also evident. A mycological\nexamination demonstrated septate hyaline hyphae, and a positive culture for\nT. rubrum. Skin biopsy presented several hyphae within the\nstratum corneum, suggesting the diagnosis of dermatophytosis (). A subungual sample also demonstrated T. rubrum.\nPatient was treated with terbinafine 250 mg qd for 120 days, with significant\nimprovement of skin scaling and nail dystrophy ( and ).\nAfter this treatment, features of ichthyosis linearis circumflexa\nwere no longer observed. Lamellar desquamation, skin thinning and a discrete\nectropiun suggested lamellar ichthyosis as a primary diagnosis.
|
[[73.0, 'year']]
|
M
|
{'9691500': 1, '19595270': 1, '10495665': 1, '17714134': 1, '25322706': 1, '17714151': 1, '9594935': 1, '32547912': 1, '1287487': 1, '11531856': 1, '9460252': 1, '24068140': 2}
|
{'3760944-1': 2, '3760944-3': 2}
|
162,996 |
3760944-3
| 24,068,140 |
noncomm/PMC003xxxxxx/PMC3760944.xml
|
Ichthyosis associated with widespread tinea corporis: report of three\ncases
|
A 27-year-old female patient, with Sjögren Larsson Syndrome (congenital ichthyosis\nassociated to spasticity), had been followed since 2003. She was on Acitretin since\n2004 and presented with sudden worsening. From 2008 on, she had onycholysis and\nsubungual hyperkeratosis on toenails. She was on ciclopirox olamine nail lacquer and\nketoconazole cream for more than 2 years with mild improvement. In September 2011 her\nmother reported severe worsening of ichthyosis, despite regular use of Acitretin.\nClinical examination demonstrated lamellar desquamation of the lower limbs,\nill-defined erythematous patches, and round scaly lesions on trunk and left leg\n(). Direct mycological examination\nshowed hyaline septate hyphae and the culture was positive for T. rubrum\n(). Skin biopsy\ndemonstrated several hyphae within the stratum corneum. Terbinafine 250 mg qd for 30\ndays led to clearance of the erythematous lesions, slight scaling persisted due to\nbaseline ichthyosis ().
|
[[27.0, 'year']]
|
F
|
{'9691500': 1, '19595270': 1, '10495665': 1, '17714134': 1, '25322706': 1, '17714151': 1, '9594935': 1, '32547912': 1, '1287487': 1, '11531856': 1, '9460252': 1, '24068140': 2}
|
{'3760944-1': 2, '3760944-2': 2}
|
162,997 |
3760946-1
| 24,068,142 |
noncomm/PMC003xxxxxx/PMC3760946.xml
|
Cutaneous mucinosis in mixed connective tissue disease
|
CASE 1: A female patient, 44-years-old, diagnosed with MCTD (Kasukawa's\nclassification criteria) for eight years. She had Raynaud's phenomenon, swollen hands,\npolyarthritis, photosensitivity, esophageal ectasia, leukopenia, lymphopenia,\npredominantly axonal peripheral sensorimotor polyneuropathy, sensorineural hearing loss\nand anterior uveitis. Anti-RNP antibodies titers were 1/1200 (haemaglutination). The\npatient remained stable for over one year taking azathioprine (1.5 mg/ kg / day) and\nwhen joint activity initiated was treated with prednisone 10 mg/ day and leflunomida,\nwith improvement (). A month later she\nnoticed papules on the neck, back and face, which were biopsied. The histopathology\nanalysis revealed a mild lymphocytic infiltrate in lymphocytic perivascular and\nperiadnexal areas in the superficial dermis, with some melanophages and collagen fibers\ndissociation (). The PAS showed focal\nincrease of the basal layer of the epidermis. The deposition of mucin was confirmed by\nAlcian-Blue staining. The epidermis was normal. Immunofluorescence\nshowed no deposition of C3, anti-IgM, anti-IgG or anti-IgA antibodies. Histopathological\nfindings were therefore consistent with cutaneous papular mucinosis. The appearance of\nthis skin condition occurred independently of other manifestations of MCTD. The dose of\nazathioprine was increased to 2mg/kg/day. This led to an improvement of the lesions.
|
[[44.0, 'year']]
|
F
|
{'21690534': 1, '1517494': 1, '2007673': 1, '28300913': 1, '21378287': 1, '15243538': 1, '21848686': 1, '11328393': 1, '17300236': 1, '22607617': 1, '24068142': 2}
|
{'3760946-2': 2}
|
162,998 |
3760946-2
| 24,068,142 |
noncomm/PMC003xxxxxx/PMC3760946.xml
|
Cutaneous mucinosis in mixed connective tissue disease
|
CASE 2: A 42-year-old male, diagnosed with MCTD (Kasukawa's classification\ncriteria) for eight years. He had Raynaud's phenomenon, hand swelling, pleurisy,\nlymphadenopathy, arthritis, myopathy and anti-RNP antibodies titers 1/6400\n(haemaglutination. The patient remained clinically stable for more than seven months\nwith prednisone 15mg/day and azathioprine 2.0 mg/ kg / day when he presented\nerythematous-violaceous indurated mildly pruritic and painless lesions in the face,\ntrunk and upper limbs (). As there were no\nother signs of MCTD disease activity, the dose of prednisone was reduced to 7.5 mg/ day\nand azathioprine was discontinued. Histopathological analysis of papules of the trunk\nshowed epidermal parakeratosis and hyperorthokeratosis. Perivascular, interstitial and\nperiadnexal lymphocytic inflammatory infiltrate appeared in the dermis (predominantly\nthe former). The alcian-blue and the PAS staining revealed interstitial\nmucinosis in the reticular dermis. Chloroquine diphosphate was introduced (250 mg/ day)\nand the prednisone dose was increased to 20 mg/ day, with improvement of the\nlesions.
|
[[42.0, 'year']]
|
M
|
{'21690534': 1, '1517494': 1, '2007673': 1, '28300913': 1, '21378287': 1, '15243538': 1, '21848686': 1, '11328393': 1, '17300236': 1, '22607617': 1, '24068142': 2}
|
{'3760946-1': 2}
|
162,999 |
3760947-1
| 24,068,143 |
noncomm/PMC003xxxxxx/PMC3760947.xml
|
Severe Multi-Resistant Pemphigus vulgaris: prolonged remission with a\nsingle cycle of Rituximab
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Male patient, 33 years-old, without any morbid antecedents of notice, was admitted to\nthe hospital with a history of painful bullous lesions on the scalp and oral cavity\nsince two months before, with subsequent dissemination to the entire body. Physical\nexamination showed flaccid blisters, mostly with serous content, besides exulcerated\nlesions covered in honey-colored crusts. () The diagnostic hypothesis was pemphigus vulgaris, later confirmed by skin\nbiopsies and direct immunofluorescence. Treatment with prednisone 1mg/Kg/day and\nantibiotics to address the secondary infection was then started. The patient was\nreleased 15 days later, with a slightly improved clinical condition.\nHe returned 10 days later, due to the appearance of new blisters, worsening of the pain\nand odynophagia. The dose of corticoid was increased to 1.5mg/Kg/day, and both sulfone\n100 mg/day and systemic antibiotics were added to the treatment. As the patient's\nclinical condition rapidly deteriorated, sulfone was replaced by azathioprine 150 mg/day\nand the dose of prednisone was once again increased to 2mg/Kg/day. Despite these\nactions, there was a decline in the patient's general condition, and a worsening of the\ncutaneous lesions, accompanied by the development of thrombocytopenia secondary to the\nuse of azathioprine. In a period of 20 days, the patient had almost 100% of his body\nsurface stricken by the disease, including all mucosae (oral, nasal, ocular, penile,\nanal) and the periungual regions of all fingers and toes. He was then submitted to\nintravenous methylprednisolone pulse therapy in a dose of 1g/day for 5 days. A week\nafter the pulse therapy, new lesions were still appearing, leading to the introduction\nof five cycles of intravenous immunoglobulin at 400mg/Kg/per cycle. After 75 days of\nhospitalization, the patient was discharged with an improved clinical condition.\nOne month after being discharged, the patient had a clinical relapse, with the\nappearance of new bullous lesions despite the daily use of prednisone 2mg/Kg. A new\ncycle of intravenous immunoglobulin was performed, followed by a second pulse therapy\nwith methylprednisolone and the addition of mycophenolate mofetil 3g/day for 30 days.\nHowever, mycophenolate mofetil was suspended due to Kaposi varicelliform eruptions,\nwhich were treated with intravenous acyclovir ().\nThe persisting lack of clinical response resulted in the use of cyclophosphamide pulse\ntherapy at 250mg/day, associated to dexamethasone 100 mg/day for 3 days. As the patient\nwas still unresponsive, weekly intravenous treatment with rituximab 375mg/m2 (4 cycles)\nwas started. The patient presented with improvement of the cutaneous lesions after the\nfirst cycle and a complete remission in 20 days, being discharged with a prescription of\nprednisone 2 mg/Kg/day and cyclophosphamide 50 mg/day (). These medications were progressively withdrawn and the patient was\nasymptomatic for 23 months using only low dosage corticoids (5mg/day). After this period\nthere was a slight clinical relapse, which was controlled with prednisone 120 mg/day,\nresulting in rapid regression of the disease. Presently, after 34 months of follow-up,\nthe patient is being treated only with prednisone 20 mg/day ().
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[[33.0, 'year']]
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M
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{'21925000': 1, '26417354': 1, '18201220': 1, '17709662': 1, '14616397': 1, '33489386': 2, '17687130': 1, '17460396': 1, '17957371': 1, '17687137': 1, '22351790': 1, '18563177': 1, '24068143': 2}
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{'7790587-1': 1}
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