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20.5k
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1.26k
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|---|---|---|---|---|---|---|---|---|---|
163,000 |
3760948-1
| 24,068,144 |
noncomm/PMC003xxxxxx/PMC3760948.xml
|
Dermatoscopic findings in telangiectasia macularis eruptiva perstans
|
A 59 year-old male patient reported the appearance of erythematous skin lesions on the\ntrunk and upper limbs 20 years ago, which regressed after a few months, leaving residual\nhyperchromic lesions. He denied any itching in the lesions. During the examination he\npresented with erythematous-brownish macules ranging from 0.5 to 5.0 cm in diameter,\nconfluent, distributed in the abdomen, chest, back and upper limbs, and residual\nhyperchromic macules ( and ). Darier sign was negative and on the dermoscopy of\nthe erythematous-brownish lesions, were observed thin and tortuous linear vessels, mild\nerythema and fine pigment network, compatible with the patient's skin type (). Histopathological examination showed\ndilated vessels with moderate inflammatory reaction around, mainly composed of mast\ncells, best visualized with Giemsa stain ( and ). The patient did not had\nlymphadenomegaly or bone changes, and laboratorial tests (blood count and chemistry)\nwere normal.
|
[[59.0, 'year']]
|
M
|
{'21844452': 1, '30484554': 1, '19668934': 1, '19060465': 1, '32055534': 1, '16922947': 1, '15096137': 1, '17537151': 1, '27613297': 1, '24068144': 2}
|
{}
|
163,001 |
3760951-1
| 24,068,147 |
noncomm/PMC003xxxxxx/PMC3760951.xml
|
Case for diagnosis
|
70-years-old white female presented a five-year evolution of recurrent and asymptomatic\ntense blisters with serous content on the second and third left fingers, which\ndisappeared without scarring. She denied triggering factors such as trauma.\nComorbidities, hypertension and type 2 diabetes mellitus for 20 years treated\nirregularly with antihypertensives and oral hypoglycemics.\nWe found on examination of the patient a tense blister with serous content, 2 cm in\ndiameter, located on the distal phalanx of the second left finger ( and ). There was\nevidence of distal hypoesthesia on the hands and feet associated with normal peripheral\npulses. No signs of local inflammation.\nHistologic examination revealed intraepidermal cleavage, reepithelialization and few\ninflammatory cells ().
|
[[70.0, 'year']]
|
F
|
{'19006577': 1, '1990993': 1, '373635': 1, '10759959': 1, '31497455': 2, '6067557': 1, '13974510': 1, '24068147': 2}
|
{'6716750-1': 1}
|
163,002 |
3760952-1
| 24,068,148 |
noncomm/PMC003xxxxxx/PMC3760952.xml
|
Case for diagnosis
|
Female patient, 42 years-old, without any noticeable personal or familial history, has\npresented, for the last four years, keratotic papules, some crusted, in a reddish-brown\ncoloration, linearly distributed along the left mammary region (). The patient presents similar lesions following the\nBlaschko lines from the left flank to the hypogastrium and also on the pretibial area of\nthe left leg (). These are pruriginous\nlesions that are exacerbated by the heat. There are no alterations to the palmar-plantar\nregions, mucosae or nails.\nThe histologic examination of an inter-mammary papule shows hyperkeratosis with areas of\nparakeratosis, acanthosis and suprabasal acantholysis associated to corps ronds and\ngrains, besides a superficial inflammatory perivascular infiltrate formed by lymphocytes\n().
|
[[42.0, 'year']]
|
F
|
{'30156633': 1, '17973816': 1, '11121153': 1, '12890216': 1, '10080178': 1, '24068148': 2}
|
{}
|
163,003 |
3760954-1
| 24,068,150 |
noncomm/PMC003xxxxxx/PMC3760954.xml
|
Do you know this syndrome?
|
A 10 year-old female patient presented with keratosis pilaris and characteristic facial anomalies. The prenatal history did not indicate any particular risk factors, the patient being born by normal delivery, without incidents and presenting with a good physical condition at the moment of birth (APGAR scores 9 and 10).\nPhysical examination showed signs of hypertelorism, down-slanting palpebral fissures, low set posteriorly rotated ears, palpebral ptosis, short neck, micrognathism and short stature ( and ). The mother reported some degree of learning disability and the need for special educational support in school.\nThe echocardiography demonstrated dilatation of the pulmonary artery and mitral regurgitation (although the patient did not have clinical symptoms). The jaw/ skull panoramic radiograph presented with bad dental occlusion.\nThe karyotype was 46 XX.
|
[[10.0, 'year']]
|
F
|
{'11080752': 1, '18797587': 1, '17515161': 1, '22494877': 1, '20876176': 1, '21396583': 1, '8001324': 1, '26075230': 1, '6696850': 1, '20464096': 1, '24068150': 2}
|
{}
|
163,004 |
3761125-1
| 24,010,083 |
noncomm/PMC003xxxxxx/PMC3761125.xml
|
Misdiagnosis of florid cemento-osseous dysplasia leading to unnecessary root canal treatment: a case report
|
In 2009, a 30-year-old woman was referred to our institution for the evaluation and further treatment of the persistent lesions after root canal treatment of the mandibular anterior teeth (#32, 33, and 42) at a private dental clinic. The patient's medical history was unremarkable. The patient had visited the private dental clinic because of aesthetic concerns caused by congenitally missing mandibular anterior teeth (#31, and 41). The patient decided to receive an orthodontic treatment for teeth alignment and an implant surgery in the missing space. During orthodontic procedure, apical radiolucencies were detected and root canal therapies on those three teeth (#32, 33, and 42) were performed by her previous dentist. Based on the patient's report, she had received endodontic treatments because the dentist had suspected periapical pathosis due to the increased orthodontic force on the treated teeth. However, according to the previous dentist's referring notes, all of the teeth were vital at the time of treatment. On comparing a 4-year series of panoramic radiographs taken from 2005 to 2008, the previous dentist had observed that the apical radiolucencies on these teeth appeared to enlarge (). The dentist was concerned about the persistent periapical pathosis and referred to our institution for apicoectomies of the affected teeth. Panoramic radiographs obtained in 2007 and 2008 showed additional radiolucencies in the apical area of the mandibular right second premolar and the first molar as well as the left first premolar ().\nPanoramic and periapical radiographs obtained at the initial visit (after the patient referral) showed mixed radiolucent and radiopaque areas in the mandibular anterior region (#32, 33, 42 and the implant between 32 and 42) and multiple radiolucent areas on the right lower posterior teeth ().\nA clinical examination revealed no swelling or bony expansion in the mandibular anterior region. None of the teeth were sensitive to percussion. The rest of the teeth except for #42, 43, and 32 responded normally to the thermal and electronic pulp tests. The patient experienced slight discomfort during palpation of the buccal mucosa of the mandibular incisors.\nIn the periapical areas of #32, 33, 36, 42, 43, 45, 46 and the implant, lobular-shaped radiolucencies that contained small radiopaque masses were revealed by computed tomography (CT, Somatom Sensation 64, Siemens, Munich, Germany, 120 Kvp, 90 mA). All of the lesions were related to the cortical plates, and perforation of labial and lingual cortical bones was observed on the mandibular lateral incisors. No cortical bony expansion was detected (). Periapicies of maxillary teeth were examined as normal condition.\nBased on the clinical and radiographic findings, the possibility of endodontic pathosis was excluded. An excisional biopsy was performed in the area of the mandibular incisors because the patient had experienced occasional discomfort in that area during palpation.\nWhen the periodontal flap was elevated, the soft tissue was exposed through the perforated cortical bone around the apices of #42 and 32. After removal of the soft tissue, a sand-like structure with a firm consistency was detected. Histological analysis of the specimen revealed multiple small fragments without any fibrous capsules (). Multiple trabeculae of cementum-like material were observed in a dense fibrous tissue, with no signs of inflammation (). The calcified material was associated with collagen fibres in the trabeculae and fibroblasts. No signs of free haemorrhage or osteoclastic activity were observed. A definite diagnosis of COD was established at the following histopathological examination. Combined with the radiographic findings that showed multiple radiolucent and radiopaque lesions in both right and left mandibular teeth and incisors, our definite diagnosis for this case was FCOD.\nThe patient did not report any moderate or severe postoperative pain or discomfort. At the one-year follow-up appointment, the patient did not report any experience of pain or discomfort. She was scheduled for annual routine check-ups.\nThe patient visited the hospital without an appointment 21 months after the biopsy because of discomfort in the mandibular anterior vestibule. Her chief complaint was pain on palpation, which had started 2 days prior to her visit. No signs of infection were detected. Cone-beam CT (CBCT, Pax-Zenith3D, Vatech, Hwaseong, Korea, 104 Kvp, 5.5 mA) radiograph was taken to assess any changes in lesion size and development (). Based on CBCT views, the apical lesions of madibular anterior teeth and the implant appeared to become more radiopaque. The patient was requested to return if she exhibited any signs of fever, swelling or pain. She did not experience any discomfort after the emergency visit. The patient was instructed to maintain annual routine check-ups.
|
[[30.0, 'year']]
|
F
|
{'18348379': 1, '33772568': 1, '15709105': 1, '9394387': 1, '7838469': 1, '9638705': 1, '14689960': 1, '18810917': 1, '12942053': 1, '7970604': 1, '21346079': 1, '10065652': 1, '3475289': 1, '25576510': 1, '29721232': 1, '1451083': 1, '21467823': 1, '29963485': 2, '9470284': 1, '21466999': 1, '30088561': 1, '31291935': 2, '16060474': 1, '34484583': 1, '9377196': 1, '12917278': 1, '9927089': 1, '18726126': 1, '24010083': 2}
|
{'6015922-1': 1, '6617922-1': 1}
|
163,005 |
3761126-1
| 24,010,084 |
noncomm/PMC003xxxxxx/PMC3761126.xml
|
Endodontic treatment of mandibular molar with root dilaceration using Reciproc single-file system
|
The patient, a 22-year old man, complaining of moderate pain in tooth #47 upon chewing, was referred to the Dental Clinic of the Federal University of Amazonas, Brazil. The patient did not have any systemic diseases and were not under any type of medication or drugs. Intraoral examination revealed the presence of a temporary restoration. The tooth was tested for pulp sensibility with Endo Frost spray (Roeko GmbH & Co., Langenau, Germany) and responded positively to the cold test, and negatively to the mobility test. The periapical radiographic examination revealed that the temporary restoration was extremely deep, since the tooth had already been submitted to pulpotomy procedure. Moreover, an accentuated dilaceration in the mesial root, a developmental anomaly characterized by an abrupt change in the axial inclination of the root, was observed. Also, no periapical lesions were observed ().\nThe tooth was diagnosed as asymptomatic irreversible pulpitis and endodontic treatment was instituted. After local anesthesia (Xylestesin 2%, Cristália Produtos Químicos Farmacêuticos Ltda., Itapira, SP, Brazil) and rubber dam isolation (Hygienic, Coltene/Whaledent AG, Alstatten, Switzerland) of the operative area, the temporary restoration was removed and pulp chamber access procedure using spherical burs No. 1013 (KG Sorensen, São Paulo, SP, Brazil) and tapered flame shaped burs No. 2200 (KG Sorensen) was performed. Next, the root canals orifices were located with the aid of a straight exploratory probe. The glide path was performed using #10 K-files (Dentsply Maillefer, Ballaigues, Switzerland) and Pathfile #13, #16 and #19 (Dentsply Maillefer) up the working length of 18 mm.\nBiomechanical preparation of the cervical and middle thirds was performed using the Reciproc system (VDW GmbH, Munich, Germany) coupled to the electric motor Silver Reciproc VDW handpiece (Sirona Dental Systems GmbH, Bensheim, Germany) with 6 : 1 reduction in the Reciproc ALL mode and a R25 file with 0.08 taper. When the cervical and middle thirds were finalized, the working length was measured with the aid of an electronic apex locator (Joypex 5, Denjoy Dental Co., Ltd., Changsha, China), which revealed that the real working length was 20 mm in the mesio-buccal and mesio-lingual canals, and 22 mm in the distal canal. To finalize and refine apical preparation, the R25 file of the Reciproc system was used again in the real working length. At each change of instrument, the canals were irrigated with 2.5 mL of 2.5% Sodium Hypochlorite solution (Biodinâmica, Ibiporã, PR, Brazil) using a disposable syringe and NaviTip needle (Ultradent, South Jordan, UT, USA). After complete instrumentation, 17% ethylenediaminetetraacetic acid (EDTA, Biodinâmica, Ibiporã, PR, Brasil) was used for smear layer removal. The canals were dried with absorbent paper points R5 (VDW GmbH) and filled using gutta-percha cones R25 (VDW GmbH) and AH Plus sealer (Dentsply Maillefer), by thermal compaction technique using McSpadden #50 (Dentsply Maillefer).\nNext, the pulp chamber was cleaned to remove the excess of gutta-percha and sealer. Glass-ionomer restorative cement (Vidrion R, SS White, Rio de Janeiro, RJ, Brazil) was used as temporary restoration due to its good sealing ability and fluoride release. After 2 weeks, the tooth was definitely restored with composite resin (Z250, 3M ESPE, Sumaré, SP, Brazil) (). Continued follow-up over 6 months has shown a successful outcome from endodontic perspective (). Clinically, the tooth presented no painful symptomatology, and radiographically, no signs of failure in root canal filling or periapical lesions were observed.
|
[[22.0, 'year']]
|
M
|
{'23240965': 1, '23321241': 1, '3858415': 1, '19133098': 1, '21080616': 1, '20416443': 1, '22414846': 1, '22595125': 1, '23430033': 1, '21409340': 1, '22498554': 1, '19249606': 1, '19840654': 1, '22188401': 1, '22515903': 1, '20877965': 1, '18081803': 1, '21902705': 1, '23493484': 1, '24010084': 2}
|
{}
|
163,006 |
3761127-1
| 24,010,085 |
noncomm/PMC003xxxxxx/PMC3761127.xml
|
Dilemmas pertaining to three canals in the mesiobuccal root of a maxillary second molar: a case report
|
A 36-year-old female came to the department with the chief complaint of dull spontaneous pain in the upper left posterior tooth for the previous 2 weeks. She reported a fractured restoration on the same tooth few months back. On examination, an open cavity with a dislodged restoration and exposed mesiobuccal pulp horn was seen with respect to the maxillary left second molar. An intraoral radiograph revealed the presence of radiolucency encroaching on the pulp horn with an apparently normal periapex. Thermal sensitivity tests elicited a lingering pain in the patient. Based on the clinical and radiographic findings, a diagnosis of irreversible pulpitis was formulated.\nSubsequent to anesthesia and rubber dam isolation, access cavity preparation was initiated and the mesiobuccal, distobuccal, and palatal canals were located. Anticipating the presence of extra canals, further exploration was carried out deliberately and two sticky points were located. This led to finding of two additional canals in the mesiobuccal root on the line connecting the mesiobuccal and palatal canal orifice (). Magnifying loupes (2.5X, ST250, STAC Dental Instruments Inc., Brampton, Canada), a DG 16 endodontic explorer, and sodium hypochlorite were the adjuncts used to locate the canals. After locating the orifices, an attempt was made to understand the internal anatomy of the mesiobuccal root using K files and intraoral periapical radiographs. While negotiating the canals individually in the mesiobuccal root, there was no hindrance in the movement of the #10 K file in any of the three canals. However, simultaneous insertion posed obstruction in the vertical movement of the files in the 2 extra canals. The above finding raised an element of doubt regarding the configuration of the canals. Intraoral periapical radiographs were taken from three different horizontal angulations (). However, all of the radiographs suffered from overlapping of the endodontic files radiopacity. Only a mesially angulated radiograph revealed limited information on where files associated with the second and third mesiobuccal canals were seen to be meeting in the middle third of the root approximately and continue to merge with the file in first mesiobuccal canal (). To avoid any missed canals, and for better understanding of the tooth's internal anatomy, a MDCT (Brilliance CT 64-channel, Philips Healthcare, Andover, MA, USA) scan was suggested because cone-beam computed tomography (CBCT) was not available in the set up or in the vicinity. The interpretation regarding the number of separate orifices and canals present in the coronal third or at the orifice level was inconsistent with the clinical or radiographic findings. In contrast to the 3 orifices and canals, clinically and radiographically, MDCT revealed only 1 large canal (). In the middle and apical third, 2 canals and 1 canal respectively could be distinguished in both radiographic and MDCT images ().\nThe configuration of the canals in the mesiobuccal root was perceived to be 3-2-1 () after correlating and computing the clinical, radiographic, and MDCT scan findings. Three separate coronal orifices extending apically to three separate canals were identified as mesiobuccal (MB), middle mesiobuccal (m-MB), and palatal mesiobuccal (p-MB) based on their anatomic positions. The m-MB and p-MB merged into one canal at a distance of approximately 5 mm from the orifice level. Following this, the canal joined the MB canal at a distance of approximately 9 mm from the orifice level. Finally, the canal ended with a single apical foramen at the apex. The distances mentioned above were calculated using the thickness of each slice of the MDCT scan images, which was 0.7 mm obtained using DentaScan software (GE Healthcare, Milwaukee, WI, USA). After understanding the anatomy of the mesiobuccal root and confirming the absence of extra canals in other roots, the treatment proceeded. The biomechanical preparation of MB, distobuccal, and palatal canals was completed using ProTaper NiTi rotary files (Dentsply Maillefer, Ballaigues, Switzerland). m-MB and p-MB canals were prepared with K-files using the step-back technique. Following one week of intracanal medication with calcium hydroxide, the canals were obturated using the cold lateral compaction technique ().
|
[[36.0, 'year']]
|
F
|
{'19712194': 1, '18265691': 1, '4500261': 1, '32382930': 1, '1917090': 1, '20478451': 1, '15551608': 1, '15833981': 1, '3482228': 1, '19410077': 1, '7673821': 1, '8886865': 1, '28179915': 1, '34475690': 2, '7714433': 1, '4508675': 1, '27195233': 1, '20416446': 1, '18805224': 1, '10530248': 1, '5262492': 1, '20433974': 1, '277575': 1, '7996086': 1, '22216031': 1, '21470249': 1, '15167464': 1, '15851938': 1, '16721471': 1, '20416435': 1, '18583372': 1, '15066504': 1, '5257186': 1, '12059921': 1, '4530549': 1, '2691624': 1, '12043874': 1, '4516749': 1, '15537976': 1, '15548270': 1, '20850665': 1, '4522570': 1, '6595621': 1, '19101482': 1, '18033942': 1, '24010085': 2}
|
{'8378491-1': 1}
|
163,007 |
3761128-1
| 24,010,086 |
noncomm/PMC003xxxxxx/PMC3761128.xml
|
Apexogenesis and revascularization treatment procedures for two traumatized immature permanent maxillary incisors: a case report
|
A 9-year-old boy was referred to the Department of Endodontics with pain on chewing and localized swelling on the anterior region of maxilla and a history of prior impact trauma three months previously. His medical history was non-contributory. Clinical examination showed complicated crown fracture on both maxillary central incisors. A large pulpal exposure, sensitivity to palpation and percussion and also localized swelling on the buccal mucosa of the right central incisor was observed. Cold thermal test elicited no response in this tooth. Left central incisor with a pinpoint pulpal exposure had no sensitivity in periapical tests and showed lingering painful response to cold test. Radiographic examination revealed that the fractured teeth had immature apices, and a radiolucent periapical lesion was observed adjacent to the right central incisor (). Based on clinical and radiographic examinations, the definitive diagnosis was irreversible pulpitis in the left central incisor and pulpal necrosis with symptomatic apical abscess in the right central incisor. Considering the immaturity of the teeth, the first treatment option was vital pulp therapy for the left central incisor and revascularization of the right one.\nUnder local anesthesia with 2% Lidocaine and 1 : 800,000 epinephrine (Xylocaine 2%, Dentsply, Addlestone, UK) and rubber dam isolation, an access cavity was prepared for the left central incisor. Coronal pulp tissues were removed by using a high-speed sterile long shank round diamond bur under copious water spray. The area was rinsed with normal saline solution and hemostasis was achieved by a cotton pellet moistened with 5% sodium hypochlorite (NaOCl). White Mineral Trioxide Aggregates (ProRoot MTA, Dentsply, Tulsa, OK, USA) powder was mixed with distilled water according to manufacturer's instructions and placed without pressure over the exposed clot-free pulpal wound (). The material was gently patted down with a moist cotton pellet. Then a moistened cotton pellet was placed over MTA and the tooth was temporarily filled with Cavit (Asia Chemi Teb Co., Tehran, Iran). One day later, the teeth were restored permanently with composite resin (Filtek Z350, 3M ESPE, St. Paul, MN, USA).\nAn access cavity was prepared for the right central incisor using the same procedure. On entering the pulp chamber, purulent drainage was observed. Length was estimated radiographically using a size #15 K-file (K-file, Mani Corp., Tokyo, Japan). The canal was passively irrigated with 20 mL of 5.25% NaOCl and gently dried with paper points. A creamy mixture of equal proportions of ciprofloxacin, metronidazole and minocycline, as described by Hoshino et al., was placed in the root canal with a #25 K-file up to 3 mm short of the radiographic apex. The access cavity was sealed temporarily with Cavit. After 3 weeks the patient was asymptomatic and the localized swelling had resolved. The tooth was anesthetized with a local injection of 3% plain Mepivacaine (Septodont, Cedex, France) without vasoconstrictor. After rubber dam isolation and removal of Cavit dressing, the antibiotic dressing material was removed by irrigation with 10 mL of 5.25% NaOCl and saline. The canal was then dried with paper points. A #40 K-file was used to irritate the apical tissues to create some bleeding into the root canal. The bleeding was allowed to reach the middle part of the canal. Ten minutes later, after the formation of a blood clot, white MTA was mixed and placed over the clot carefully (). A moistened cotton pellet was placed over MTA and the tooth was restored temporarily with Cavit. One day later the patient was referred for permanent restoration of this tooth.\nThe patient was recalled 6, 12 and 18 months after the treatment. In clinical examination, the teeth were asymptomatic. In radiographic examinations, both teeth showed increased root lengths and apical closure. Root wall thickness had also increased, but the left central incisor showed greater improvements. The radiolucent lesion adjacent to the right central incisor had healed ( and ).
|
[[9.0, 'year']]
|
M
|
{'4625987': 1, '17509406': 1, '24635197': 1, '34536210': 1, '18565368': 1, '18570985': 1, '28567136': 1, '10846265': 1, '20003936': 1, '12752531': 1, '25110649': 2, '19410097': 1, '4146883': 1, '15660748': 1, '16739540': 1, '28194367': 2, '24516822': 1, '18565373': 1, '25332909': 1, '21329828': 1, '20171379': 1, '12110105': 1, '15085044': 1, '9641130': 1, '20416538': 1, '14342926': 1, '9206436': 1, '16861071': 1, '1521505': 1, '18041512': 1, '26295020': 1, '10635232': 1, '14708648': 1, '15917683': 1, '24010086': 2}
|
{'5299758-1': 1, '4125589-1': 1}
|
163,008 |
3761948-1
| 24,027,744 |
noncomm/PMC003xxxxxx/PMC3761948.xml
|
Neck Swelling in a Newborn with Congenital Goiter
|
A 6-day-old male baby born to a 21 year old primigravida having normal antenatal course and clinically euthyroid with no past history of thyroid disease and not on any antithyroid medications, with normal thyroid levels in the present pregnancy, delivered by Cesarean section due to delayed progression of labor with birth weight of 2.5 kgs, presented to our hospital with delayed passage of meconium even after 5 days of birth, decreased activity, distension of abdomen, difficulty in latching onto breasts. On admission baby had stable vitals and general examination revealed midline swelling in the neck, which is soft, mobile, noncystic, without inflammatory signs and no bruits was audible. On per abdomen examination, there was soft distension, without hepatosplenomegaly or ascites. Rest of the systemic examination was normal except for the presence of generalised hypotonia.\nInvestigations revealed Hb 15.9 gm%, PCV 49.9, TC 3730, Platelet count 3.4, SBR 15.9/0.79, RBS 150 mg/dl, CRP negative, XR abdomen normal, free T3 <0.04 pg/ml (normal 147.8±50.1 ng/dl), free T4 0.18 ng/dl (normal 2.7±0.6 ng/dl), TSH >40 IU/ml (normal 2.6±1.8 IU/ml), X-ray of knee showing absence of the distal femoral epiphysis [], postnatal ultrasound of thyroid showed diffuse enlargement of thyroid gland. Hearing tests were normal. Further genetic tests were not done due to financial constrains and lack of genetic testing facility.\nA diagnosis of neonatal dysharmonogenitic goiter with hypothyroidism was made. Thyroxin started on 8th day of life at 15 mcg/kg/day and by 15th day decreased in the size of the goiter with regular passage of motions and good cry and activity was noticed. Baby was discharged on 16th day and is under follow-up regularly.
|
[[6.0, 'day']]
|
M
|
{'16740880': 1, '28491394': 2, '3674923': 1, '34063177': 1, '12530620': 1, '17510756': 1, '32166365': 1, '19606054': 1, '13297526': 1, '24027744': 2}
|
{'5362015-1': 1}
|
163,009 |
3761950-1
| 24,027,745 |
noncomm/PMC003xxxxxx/PMC3761950.xml
|
A Rare Case of Pyridoxine-dependent Seizures in Infancy
|
A 45-day-old male infant was brought to our hospital with complaints of frequent seizures. Birth history revealed that baby delivered by caesarean section and weighed 3.14 kg at birth. He was suspected of having perinatal asphyxia due to APGAR score and the need for ventilation for respiratory difficulty and neonatal seizures he developed. Baby developed respiratory distress and transferred to NICU. Baby required ventilatory support for 3 days. Baby had neonatal seizures which were treated with antiepileptics (levetiracetam and phenobarbitone). After discharge on fifteenth day of life baby developed seizures, readmitted and treated with antiepileptics (phenobarbitone, levetiracetam and phenytoin) and had temporary improvement. Baby was discharged with oral antiepileptics. On 45th day of life baby had seizures again and this time baby was brought to our hospital. Seizures were myoclonic jerks in type and multiple in episodes. Baby was started on antiepileptics after initial investigations. Blood sugar, serum calcium and septic screen were normal. In view of recurrent seizures despite antiepileptic medication we started on pyridoxine and seizures subsided. Ultrasound cranium was normal. Other investigations including MRI brain, Cerebrospinal fluid analysis and blood culture were normal. Baby remained seizure free and was discharged with advice to continue pyridoxine and phenobarbitone. Parents stopped pyridoxine ignoring medical advice. Baby developed seizures at three months of age after two days of stopping pyridoxine and was brought back to our hospital. After reinitiation of pyridoxine, seizures subsided dramatically. Baby was discharged on oral pyridoxine. All antiepileptic drugs were tapered off and stopped. Subsequently the baby remained seizure free on oral pyridoxine. Infant is currently six months old with age appropriate mile stones and neurological examination was normal by Amiel-Tison method. Parents were advised to come for regular follow-up for neurodevelopment assessment. Parents were counselled to continue pyridoxine indefinitely.
|
[[45.0, 'day']]
|
M
|
{'14580135': 1, '15032392': 1, '2356985': 1, '21397171': 1, '6859931': 1, '15851435': 1, '18094870': 1, '10448181': 1, '19770548': 1, '16225819': 1, '12881619': 1, '20887371': 1, '22529283': 1, '20031502': 1, '10519720': 1, '9627579': 1, '19588165': 1, '24027745': 2}
|
{}
|
163,010 |
3761953-1
| 24,027,746 |
noncomm/PMC003xxxxxx/PMC3761953.xml
|
A Huge Immature Cervical Teratoma; Antenatal Diagnosis, and its Management – An Unusual Entity
|
A 26-years-old second gravida female reported at 37th week with antenatal ultrasound of the fetus showing well-defined and hyperechoic solid mass of size of 5.5 × 6 centimeters in the anterior aspect of neck []. Associated findings included mild polyhydromnios and vertical lie. Guarded prognosis with conservative management till the birth of the fetus was advised. Mode of the delivery was to be decided by obstetric indications. Finally, the baby was born by cesarean section and had huge cervical mass. Baby cried immediately after birth and had respiratory distress of mild nature apparent only in supine position when the compression effect was maximum. The distress was relieved in lateral position, and baby was maintaining saturation with minimal oxygen support.\nOn initial assessment, the vitals of the baby were stable. Examination of respiratory system revealed equal air entry on both the side with mild conducted sounds and inspiratory stridor. Rests of the systemic examinations were within normal limits. On local examination, there was a neck mass which was solitary, oval, of size about 9 × 5 × 6 cms in midline anteriorly having firm consistency with moderate mobility in all the directions []. Swelling was non-pulsatile, and there were no skin changes.\nInitial imaging was done by X-ray neck and ultrasound. These were stipulated calcifications within the mass as shown by X-ray. Ultrasound showed the mass to be consisting of solid matrix with occasional cystic areas filled with hemorrhagic fluid having freckles of calcifications and well-defined capsules all around with neck vessels pushed laterally and some degree of tracheal displacement suggestive of the teratoma with mass effect. Computed tomographic scan was obtained to further rule out the organ of origin, vascular involvement, and thoracic extension of the mass lesion. CT showed the mass to be of size 8 × 6 × 5 cms and heterogeneous with scattered, nodular calcification extending superiorly into sub-mandibular and inferiorly up to supraclavicular region []. Invasive investigations like fine needle biopsy were not attempted due to the fear of hemorrhage within the tumor leading to further aggravation of respiratory distress and complicating the pre-operative clinical scenario. Corroborative evidences of the mass to be teratoma were obtained by means of tumor marker studies like estimation of alpha-fetoprotein and beta human chorionic gonadotropins. Alpha-fetoprotein level was significantly high in the range of 83,000 ng/ml though there was no rise in beta HCG. As the neck teratomas mostly arise from and completely replace the thyroid tissue, thyroid function test was also obtained, but T3, T4, and thyroid-stimulating hormone levels were within normal range.\nAfter pre-operative stabilization and investigations, patient was taken up for the surgical excision of the mass. General anesthesia with endotracheal intubation was done though securing the airway was difficult. Transverse incision directly over the mass was given. Below the platysma muscles, the well-encapsulated mass was lying above the strap muscles of the neck, attached only with the fibrous bands and few small caliber vessels feeding the mass. Complete enucleation of the mass without capsule rupture was attained, and specimen was sent for histopathological examinations. No ventilatory support was needed in post-operative period. Feeds were allowed in 2nd post-operative day, and patient was discharged on 4th day. Repeat alpha-fetoprotein and beta HCG at the end of 1 month, 3 months, and 1 year were within normal range.\nHistopathology report came out as lobulated grey-white mass predominantly solid with areas of cystic changes. Cysts were ranging from 1 mm to 1 cm and filled with mucinous material. The solid parts consisted of cartilages and bony spicules. Multiple sections studied from tumor showed mature as well as immature elements derived from all 3 germ layers. Mature elements comprised of nests of squamous cells, glands, mature cartilage, occasional bony tissue, neural tissue, and smooth muscle tissue. Immature elements included neuroepithelial elements, occasional group of blastemal cells, and immature cartilage in myxoid stroma. Mitosis was in the range of 2/10 HPF. Normal thyroid tissue was not seen in the section studied. Final diagnosis was immature cervical teratoma; grade II.
|
[[26.0, 'year']]
|
F
|
{'31571768': 1, '11877660': 1, '21493427': 1, '30851737': 2, '12163871': 1, '8520169': 1, '2425069': 1, '16001440': 1, '9483640': 1, '24027746': 2}
|
{'6409158-1': 1}
|
163,011 |
3761957-1
| 24,027,743 |
noncomm/PMC003xxxxxx/PMC3761957.xml
|
Congenital Giant Hydronephrosis: A Rare Cause for Upper Abdominal Mass in the Newborn
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A 20-year-old primigravida with no known co-morbidity was referred to the radiology department for a routine antenatal USG at 20 weeks 3 days of gestation by her last menstrual period. USG revealed appropriate fetal growth corresponding to gestational age. The left kidney of the fetus demonstrated dilated pelvis with antero-posterior (AP) dimension measuring 8.6 mm []. Follow-up USG was performed 1 month later, which revealed the progression of hydronephrosis with AP dimension of pelvis measuring 19 mm along with dilatation of calyces (SFU grade III, ]. Amniotic fluid was normal in quantity. No other congenital anomaly was detected at this point. She had a spontaneous preterm (at 35 weeks) vaginal delivery of a low-birth weight (1960 g) male baby. At birth, the neonate had mild respiratory distress, which settled over the next few hours with conservative treatment and did not require any active resuscitation. The baby was slightly irritable with visible distension of the upper abdomen []. There was a palpable lump across the entire upper abdomen (epigastric, supra-umbilical, both hypochondrium and both flanks). The neonate underwent an urgent USG, which revealed hydronephrotic left kidney (SFU grade IV) with grossly distended renal pelvis (40 mm × 65 mm × 72 mm, AP × TR × CC, ~187 cc) extending across the midline to reach the right hypochondrium and flank []. The right kidney and urinary bladder were normal on USG. Hematological parameters including blood urea, serum creatinine and electrolytes were within normal limits. Initially, the neonate was managed conservatively as the vital parameters, including urine output, were normal. Micturating cysto-urethrogram was performed at a later date, and was found to be normal. The child underwent a radionucleide dynamic renogram at 2 months of age, which revealed dilated obstructed pelvis with compromised function of the left kidney. The left kidney demonstrated reduced perfusion with glomerular filtration rate of 74% and a split function of 37%. No excretion was noted on the left side during the dynamic renogram. Prolonged excretion was noted on the right side. A dimercapto succinic acid renal scan revealed enlarged left kidney with markedly reduced tracer concentration and persistent excretion through the right kidney []. The child was operated (pyeloplasty done) at the end of the 4th month. Intraoperatively, the findings of antenatal as well as post-natal USG were confirmed. Left renal pelvis was ballooned out and was reaching to the right side across the midline with thinned-out renal parenchyma. The child has been followed-up for 18 months and has been doing well. Follow-up USG revealed postoperative status with residual dilated PC system of the left kidney.
|
[[20.0, 'year']]
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F
|
{'8255658': 1, '20713223': 1, '18947735': 1, '21765839': 1, '10792193': 1, '16362721': 1, '22350369': 1, '17511718': 1, '18708207': 1, '20395034': 1, '24027743': 2}
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{}
|
163,012 |
3761980-1
| 24,027,685 |
noncomm/PMC003xxxxxx/PMC3761980.xml
|
Umbilical Myiasis Associated with Staphylococcus Aureus Sepsis in a neonate
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An exclusively breast fed, 7-day-old, male baby, born at home out of nonconsanguineous marriage to a primi gravida mother with uneventful perinatal, from a flood-devastated remote village in West Bengal was admitted in our hospital with complaints of poor feeding and umbilical discharge. On physical examination the baby weighed 2.1 kg, temperature was 39°C, respiration were 47 breath/min and the heart rate was 170 beats/min. The anterior fontanel was soft and pulsatile. Abdomen was slightly distended; liver and spleen were palpable just below the costal margin. In addition to foul-smelling purulent discharge from umbilicus, mild omphalitis and cellulitis was noted. On close observation after removal of pus with sterile cotton swab, the tip of some white spindle-shaped mobile worm-like structures were noted []. These on pulling out with forceps proved to be a maggot. Blood, urine and cerebrospinal fluid (CSF) were sent for culture and sensitivity. Investigations revealed growth of Staphylococcus aureus on blood culture and the infant was treated accordingly. Urine and CSF analysis were negative. More than hundred maggots were removed within 24 hours of hospital admission following instillation of ether (repellent). Following removal, the maggots were preserved in ethyl alcohol and sent to Department of Parasitology, School of Tropical Medicine, Kolkata, for species identification. The dead maggots were examined microscopically and were identified as Chrysomya megacephala. Ultrasound scan of the umbilical area did not reveal any collection or abscess. As soon as all larvae were out of the epidermis, the periumbilical cellulitis rapidly resolved without any sequelae. The infant was discharged from the hospital on the 10th day after admission with satisfactory physical and clinical condition.
|
[[7.0, 'day']]
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M
|
{'8436455': 1, '17377609': 1, '20882424': 1, '32039212': 1, '7709854': 1, '26225352': 1, '21532102': 1, '7772491': 1, '15888968': 1, '24027685': 2}
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{}
|
163,013 |
3761996-1
| 24,027,402 |
noncomm/PMC003xxxxxx/PMC3761996.xml
|
Intratesticular Varicocele
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A 28-year-old male presented with a history of pain in the scrotal region for about 6 months. Surgical examination was negative. Patient was not seen by an urologist. His routine blood and urine test were within the normal limits. He was referred to our department for scrotal sonography to evaluate the cause of pain. Scrotal sonography revealed multiple dilated veins superior, lateral and inferior to the testis on left side. They ranged in size from 4 to 5 mm []. Color Doppler study confirmed the vascular nature []. The flow was sluggish and reflux noted on Valsalva manoeuvre for about 6 s. The left testis showed multiple anechoic tubular lesions spontaneously in mediastinal and subcapsular location []. Valsalva manoeuvre accentuated both intra- and extratesticular varicoceles. The right testis was normal in size, contour, and echo texture. Both epididymides appeared normal. Pampiniform plexus veins were normal in caliber on right side. The features were consistent with extratesticular and intratesticular varicocele on left side.
|
[[28.0, 'year']]
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M
|
{'15906796': 1, '10511183': 1, '16301727': 1, '6604430': 1, '11875994': 1, '1566668': 1, '24027402': 2}
|
{}
|
163,014 |
3762006-1
| 24,027,404 |
noncomm/PMC003xxxxxx/PMC3762006.xml
|
An Uncommon Cause of Acute Bowel Obstruction: The Left Para-Duodenal Hernia
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It's about a 77 year-old woman consulting for an acute bowel obstruction evolving since two days. Physical examination showed a discrete abdominal distension and slight tenderness in the epigastric and the left upper quadrant. The digital rectal examination found anempty rectal vault. The abdominal X-ray showed an air-fluid small bowel levels. The computed tomography (CT) showed the presence of a jejunal loop contained in a retroperitoneal sac interposed between the stomach pushed forward, the tail of the pancreas to the right and back and the left colon to the left and back []. The mesenteric vessels of these loops were stretched with displacement of the inferior mesenteric artery to the left. The diagnosis of a left PH complicated with acute bowel obstruction has been well discussed. The patient was operated emergency by median laparotomy. Surgical exploration found about 40 cm of proximal healthy small bowel in an internal left paradoudenal hernia. The neck hernia was 3 cm of diameter. After reduction of intestinal loops, the hernia orifice was sutured. The postoperative course was uncomplicated. The patient remained asymptomatic after 18 months of follow-up.
|
[[77.0, 'year']]
|
F
|
{'9419303': 1, '20054582': 1, '11431865': 1, '11510572': 1, '16847248': 1, '11152781': 1, '32938278': 2, '25174294': 1, '27530871': 1, '16794804': 1, '16948546': 1, '31006063': 1, '24027404': 2}
|
{'7503021-1': 1}
|
163,015 |
3762010-1
| 24,027,403 |
noncomm/PMC003xxxxxx/PMC3762010.xml
|
Diaphragmatic Hernia Masquerading as Pleural Effusion
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A 40-year-old man slipped and fell against the edge of his bath tub. He presented to a clinic where he was treated with analgesics and discharged after an apparently normal chest X-ray. After a year, he presented to the internal medicine department of another hospital with chest pain and shortness of breath. There was no history of cough or fever. On examination, he was afebrile with normal vital signs and oxygen saturation. Examination of the chest revealed dullness in the left infra-mammary and infra-scapular regions with markedly diminished breath sounds. X-ray chest was suggestive of left pleural effusion []. Ultrasound of the chest was reported as thick effusion and marked for thoracocentesis.\nA needle aspiration was attempted, but failed. Subsequently, a computerized tomography (CT) scan revealed a 2.5 cm defect in the anterior aspect of the left hemidiaphragm with herniation of omentum into the left chest []. The patient was then referred to our center for further management.\nAt thoracotomy, the omentum was found densely adherent to the diaphragm, left lung, pericardium, and chest wall []. There was no herniation of stomach, colon, or spleen. The adhesions were carefully released. An omentectomy [, inset] was done as it was not possible to reduce the entire herniated omentum into the abdomen. The defect in the diaphragm [] was closed with interrupted horizontal mattress sutures of 2-0 ethibond. Postoperative recovery was uneventful. He was asymptomatic at 1 year follow-up.
|
[[40.0, 'year']]
|
M
|
{'17186114': 1, '17382006': 1, '3280093': 1, '8526655': 1, '29056971': 2, '19779793': 1, '15351874': 1, '24027403': 2}
|
{'5625800-1': 1}
|
163,016 |
3762011-1
| 24,027,407 |
noncomm/PMC003xxxxxx/PMC3762011.xml
|
Intravenous Leiomyomatosis
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A 32-year-old woman was admitted with complaints of abdominal swelling and pain since 6 months. Pain abdomen was intermittent and confined to lower abdomen. She also had feeling of incomplete voiding of urine with overflow and stress incontinence since 3 months. Menstrual cycles were normal and there was no menorrhagia. She has one living child and underwent tubectomy 6 years ago. Abdominal examination revealed irregular, nontender uterine mass of 24 weeks pregnant size. Pelvic ultrasound showed bulky uterus measuring 9×6.8×4.3 cm, with multiple hypoechoic lesions in anterior and posterior myometrium, the largest one measuring 11×8.8×7 cm. Computed tomography (CT) scan was not done due to unavailability of the facility in the rural set-up as well as the unaffordability of the patient. As the mass was very big and the patient was symptomatic and had already completed her family, the decision of total abdominal hysterectomy was taken. Abdomen was opened by midline vertical incision. During surgery, multiple large subserosal, intramural, and submucosal fibroids ranging from 5×4 cm to 20×30 cm were seen. During surgical removal, the tumor showed worm-like projections into the pelvic veins []. A presumptive diagnosis of intravenous leiomyomatosis was made. Ovaries appeared healthy and were retained. There were no technical difficulties in removing the uterus. The tumor was very vascular; it started bleeding profusely from the cut margins. Bilateral hypogastric artery ligation was done which reduced uterine blood supply and enabled easy removal of the uterus. Hemostasis was well achieved. The tumor weighed 6.7 kg. The postoperative course was uneventful and she has been in good health for 16 months after the operation. Microscopic examination demonstrated the tumor cells invaginating the vascular tree with no evidence of atypia.
|
[[32.0, 'year']]
|
F
|
{'19729144': 1, '11904348': 1, '29904489': 1, '20492407': 1, '32337287': 1, '24027407': 2}
|
{}
|
163,017 |
3762013-1
| 24,027,714 |
noncomm/PMC003xxxxxx/PMC3762013.xml
|
A Severe and Rapidly Progressive Case of Proteus Syndrome in a Neonate Who Presented with Unilateral Hydrocephalus Apart from Other Typical Features of the Proteus Syndrome
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A 5-day-old male baby presented with enlarging head size and multiple physical abnormalities. He was the first child of nonconsanguineous parents. The pregnancy had been uneventful. He was born by caesarean section with birth weight of 2600 gm (5th centile), length 50 cm (50th centile), and head circumference 38 cm (>90th centile). The baby was on breast feeds. There was no relevant family history.\nOn physical examination, the baby had marked right-sided hemihypertrophy involving face and cranium. The facial hemihypertrophy included enlarged palpebral fissure, cheek, ear, and lip []. There was marked wasting of subcutaneous tissue of arms and thighs on both sides. Capillary hemangioma large in size was present in both flanks. There was venous prominence over scalp and trunk. Multiple subcutaneous masses were palpable over both thighs clinically appearing to be lipomas. The second and third toes of the left foot were significantly enlarged []. The head circumference has increased to 39.2 cm (95th centile).\nA cranial ultrasonogram (USG) was carried out which revealed selective dilatation of the right ventricle with partial occlusion of the right foramen of monro []. The brain parenchyma, left lateral ventricle, corpus callosum and cerebellum were normal. The cranial USG finding together with rapidly increasing head circumference in our patient indicated toward right-sided unilateral hydrocephalus. Computed tomography of the head was advised to confirm the USG finding and to detect any other associated CNS anomalies. But the baby became lethargic on day 7 of life. He developed marked respiratory distress. Examination revealed a bluish discoloration over anterior trunk and a large venous prominence visible over left side of chest and abdomen originating from mid axillae with flow from upward to downward []. The platelet count was 30×103/μl. Other parameters of hemogram and sepsis screen were normal. Duplex scan of chest and abdomen was advised but the baby died before the investigation. Parents refused to go for autopsy.
|
[[5.0, 'day']]
|
M
|
{'25654373': 1, '21793738': 1, '2325089': 1, '16702456': 1, '16525914': 1, '27274402': 1, '16010681': 1, '11140839': 1, '9613526': 1, '18816642': 1, '15313810': 1, '24027714': 2}
|
{}
|
163,018 |
3762022-1
| 24,027,711 |
noncomm/PMC003xxxxxx/PMC3762022.xml
|
Linear Nevus Sebaceous Syndrome in a Neonate Conceived by Intracytoplasmic Sperm Injection
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Full-term male neonate, conceived by ICSI, was born to a 21-year-old mother (gravida 1, para 1) at 39 weeks of gestation by caesarean delivery and resuscitation was assigned as uneventful. A prenatal sonogram at 32 weeks gestation revealed polyhydraminos as well as a well-defined hyperechoic mass 4.5×3 cm in the left lateral side of the face and neck with central cystic area.\nThe initial physical examination showed normal growth parameters with an evident cutaneous abnormality of the face consisted of linear, well-demarcated, raised, yellowish, fleshy and hairless plaques with velvety surface located on the left side of the forehead, the parietal region of the scalp, the face, chin, lower lip, and left ear with a smaller lesion on right side of face []. A similar, less well-formed lesion was present over the midline of the back at the lumbar and the sacral regions and scrotum. Also, a black nodule was noted over the medial canthus of the right eye. There were no other cutaneous manifestations, such as cafe-au-lait spots or hypo- or hyper-pigmentation lesions. The infant appeared healthy otherwise with no apparent neurologic deficit on physical examination.\nMagnetic resonance imaging (MRI) of his brain revealed an extra-axial CSF signal intensity lesion in the left side of the posterior fossa and the cistern magna suggesting arachnoid cyst with mild left cerebellar hypoplasia (Dandy Walker variant) []. Ophthalmologic examination showed bilateral posterior polar cataract. Abdominal sonogram, Doppler of renal vessels, bone survey and echocardiography revealed normal results. Also, serum calcium, phosphorus and urinary calcium were normal.\nHistopathology showed thick hyperplastic epidermis with underlying large immature sebaceous lobules and free cut margins with no evidence of cellular atypia.\nDuring hospitalization of the patient, no seizures occurred and no medication was prescribed. A chromosome study of peripheral blood showed a normal male karyotype.\nWritten informed consent was obtained from the parents of our patient for publication of this case report and any accompanying images. A copy of the written consent signed by the father of our patient is available for review by the Editor-in-Chief of this journal.
|
[[21.0, 'year']]
|
M
|
{'20542174': 1, '12224685': 1, '2918116': 1, '17055799': 1, '26557625': 1, '10770429': 1, '20888465': 1, '20110727': 1, '18230930': 1, '11882727': 1, '24027711': 2}
|
{}
|
163,019 |
3762023-1
| 24,027,712 |
noncomm/PMC003xxxxxx/PMC3762023.xml
|
Sirenomelia Apus: A Rare Deformity
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A 34-week, 1400-g preterm infant of unidentified sex was born to a 23-year-old primigravida mother with no significant past medical history. The infant was delivered by assisted breech vaginal delivery with an APGAR's score of 3 and 5 at 1 and 5 minutes, respectively. On physical examination of the infant showed single umbilical artery with multiple external deformities including a single lower tapering web like lower extremity with no feet and absence of external genitalia and anus. Additionally, Potter's facies i.e., prominent infraorbital folds, small slit like mouth, receding chin, downward curved nose, and low set soft dysplastic ears were seen [Figures and ]. Radiographic picture revealed single distal limb [Figures and ]. The infant expired after four hours due to severe respiratory distress. An autopsy was performed which showed severe bilateral lung hypoplasia, absence of the bladder, ureters, and bilateral kidneys. Uterus and vagina were atretic but ovaries and fallopian tubes were normal, rectum and anus were atretic. Death was attributed to pulmonary hypoplasia along with renal anomalies, and a diagnosis of sirenomelia was given.
|
[[23.0, 'year']]
|
F
|
{'10533025': 1, '21032381': 1, '26023366': 2, '8515529': 1, '17963219': 1, '25976191': 1, '12369674': 1, '19858681': 1, '27504380': 1, '11782287': 1, '11896526': 1, '9541120': 1, '12813764': 1, '16752437': 1, '3748679': 1, '24027712': 2}
|
{'4420302-1': 1}
|
163,020 |
3762025-1
| 24,027,716 |
noncomm/PMC003xxxxxx/PMC3762025.xml
|
Potter's Sequence
|
A 23-year-old woman, second gravida, of 35 weeks gestational age, delivered a stillborn male baby with spontaneous breech presentation. The baby weighed 1.5 kg. Placenta and membranes expelled with no liquor. Placenta was having marginal presentation, with normal fetal and maternal surfaces with complete cotyledons. Radiological examination of the baby revealed that there was absence of sacrum except first sacral vertebra, opaque lung fields, hypoplasia of right femur, absence of right fibula, and hypoplasia of right tibia with bowing []. Ultrasound examination showed non-visible kidneys, bladder, and severe oligohydramnios. Fetal autopsy was performed.\nOn autopsy, the following findings were noted. Typical Potter facies was noted which included flattened nose, recessed chin [], prominent bilateral epicanthal folds [], and low-set ears with wide pinna []. Umbilical cord showed only two vessels composed of single umbilical artery [].\nFurther examination revealed absence of anal opening and undeveloped genitalia []. There was also presence of short right lower limb, displacement of great toe, and congenital talipes equino varus (CTEV) []. Histopathologic examination of gonads showed hypoplastic gonads [Figure and ]. Lungs were hypoplastic and non-breathed [Figure and ]; heart, liver, and spleen were normal. Kidneys, urinary bladder, and rectum were not visualized.
|
[[23.0, 'year']]
|
M
|
{'3838659': 1, '32347825': 2, '6393764': 1, '32143317': 2, '16933729': 1, '31718018': 1, '34391013': 1, '17001905': 1, '28815206': 2, '24027716': 2}
|
{'5528912-1': 1, '7580308-1': 1, '7143793-1': 1}
|
163,021 |
3762041-1
| 24,027,416 |
noncomm/PMC003xxxxxx/PMC3762041.xml
|
Myxoid Neurothekeoma: A Rare Soft Tissue Tumor of Hand in a Male Toddler
|
A three-year-old boy presented with a nontender, left thumb swelling of four-week duration, without any history of trauma. Fine needle aspiration cytology of the mass revealed a few plump-to-oval spindle-shaped cells in a myxoid background. Subsequently, the lesion was surgically excised. Gross examination of the submitted specimen revealed a firm, elastic, tan-colored smooth nodule, measuring 10 × 8 × 6 mm with a solid homogeneous gray cut surface []. Histopathologic examination revealed a nonencapsulated dermal tumor, composed of multiple, closely situated medium-sized nodules with scattered spindle-shaped cells in a myxoid-rich stroma []. The tumor exhibited strong positivity for S-100 immunohistochemical stain [], and focal positivity for neuron-specific enolase (NSE). Based on the histopathologic and immunohistochemical results, the case was diagnosed as nerve sheath myxoma of classical type. The patient was followed up for 10 months with no reports of recurrence.
|
[[3.0, 'year']]
|
M
|
{'21297585': 1, '10597951': 1, '20049273': 2, '14699383': 1, '2154139': 1, '25462051': 1, '11495197': 1, '1587488': 1, '2277145': 1, '7446487': 1, '17592278': 1, '26023558': 1, '8676238': 1, '24027416': 2}
|
{'2800874-1': 1}
|
163,022 |
3762049-1
| 24,027,733 |
noncomm/PMC003xxxxxx/PMC3762049.xml
|
Pseudohypoaldosteronism Type 1: A Rare Cause of Severe Dyselectrolytemia and Cardiovascular Collapse in Neonates
|
A 7 day old male child was brought to emergency department with poor feeding for 72 h and progressive lethargy for 24 h. He was the second child of non-consanguineous parents and had a birth weight of 2.7 kg. There was no family history of sudden infant deaths or children on hormone replacement. At admission, he was pale and lethargic with poor capillary refill suggestive of shock. His weight was 2.1 Kg (weight loss of 22%). There was mild icterus. The heart rate was 160/min; respiratory rate was 60/min; and mean arterial pressure was 56 mm Hg. He was resuscitated with fluid boluses and phototherapy had begun. Meanwhile, wide QRS tachycardia was noticeable in the ECG tracings. Complete blood count, sepsis work up, blood culture, serum electrolytes, and serum bilirubin were sent. The serum level of potassium was reported to be very high (8.96 mEq/L). There was hyponatremia, acidosis, and hyperbilirubinemia. The test results are summarized in .\nBaby was immediately started on measures to reduce serum potassium like intravenous calcium, sodium bicarbonate, and insulin dextrose infusion. While arrangements were being made for dialysis, he developed ventricular arrhythmia and had cardiac arrest. He was revived with cardiopulmonary resuscitation and emergency peritoneal dialysis was instituted, after which the potassium level began to decline.\nWe thought of adrenal insufficiency in view of hyperkalemia, hyponatremia and acidosis. Appropriate hormonal studies were sent, and the results of which are presented in . The level of 17-OHP was normal, whereas serum aldosterone and plasma renin activity were raised, thereby excluding CAH. He had high urine spot sodium and low spot potassium. Urine culture was sterile and ultrasound abdomen excluded obstructive renal tract anomaly.\nAs the clinical course and investigations were suggestive of PHA type 1, hydrocortisone was stopped. Initially, the baby required parenteral rehydration, but subsequently oral rehydration with common salt (30 mEq/kg/day) added to breast milk was sufficient. Potassium level was kept under check with the use of potassium binding resin (kayexalate) in a dosage of about 2 to 3 g/kg/day, (dosage adjusted according to potassium level). Baby was discharged after his blood sodium and potassium levels were stable for 96 h without intravenous fluids, and there was consistent weight gain.\nDuring the initial follow period, baby developed recurrent skin infections with staphylococcus aureus which were treated with oral antibiotics. Baby had mildly elevated calcium: creatinine ratio (0.8), hence hydrochlorthiazide was added in the hope that it will protect against nephrocalcinosis as well as reduce the requirement of kayexalate. During the next 5 months, his requirement of salt supplementation decreased considerably. At 6 months of age, he was on 2 gram/day of common salt (6 mEq/kg/day), apart from the sodium present in kayexalate (10 mEq/kg/day). He weighs 5.8 kg and the development mile stones were appropriate for this age. He required one more hospital admission at 3 months of age for dehydration accompanying a respiratory illness during which he needed intravenous rehydration.
|
[[7.0, 'day']]
|
M
|
{'3962945': 1, '19571553': 1, '16611713': 1, '32840096': 1, '15853823': 1, '15179565': 1, '27335941': 1, '18424465': 1, '14745637': 1, '15491397': 1, '19031348': 1, '16444070': 1, '24027733': 2}
|
{}
|
163,023 |
3762050-1
| 24,027,729 |
noncomm/PMC003xxxxxx/PMC3762050.xml
|
Neonatal Mesenchymal Hamartoma of Liver: An Unusual Presentation
|
A 2-week-old boy, one of twins, presented with huge progressive abdomen distention, non bilious vomiting, and respiratory distress since birth. Antenatal ultrasound scan at the 5th month showed diamniotic dichorionic twin fetus. Abdominal examination revealed nontender, cystic mass occupying almost the whole of abdomen. Blood chemistry of serum electrolytes, coagulation screen and liver function tests were normal. Plain X-ray abdomen showed soft tissue homogenous opacity occupying the entire abdomen with displacement of bowel to left upper quadrant []. Ultrasound of abdomen revealed uniloculated, huge midline anechoic lesion extending on either side with clear fluid and of uncertain origin []. Neonate developed severe respiratory distress due to progressive abdominal distention. Hence he was posted for emergency laparatomy and 2000 ml of clear fluid was aspirated from the cyst. The cyst was found to be uniloculated peduncle swelling arising from the inferior surface of right lobe of liver [] and did not have any biliary communication. It was excised in toto. The cyst had displaced the malrotated bowel. Histopathology confirmed uniloculated cystic structure with wall containing proliferating bile ductules, lymphocytic infiltration, compressed hepatic cords, nodules, and no distinct lining suggestive of MHL []. Postoperative recovery was uneventful and at 1 year follow-up the child is thriving well.
|
[[2.0, 'week']]
|
M
|
{'18946110': 1, '16291152': 1, '10786986': 1, '26229397': 1, '16151789': 1, '1491920': 1, '15001128': 1, '7724278': 1, '11896953': 1, '18022426': 1, '24027729': 2}
|
{}
|
163,024 |
3763117-1
| 24,015,048 |
noncomm/PMC003xxxxxx/PMC3763117.xml
|
Single Nucleotide Deletion Mutation of KCNH2 Gene is Responsible for LQT Syndrome in a 3-Generation Korean Family
|
The proband who was admitted at the St. Mary's Hospital on May 29th, 2001 was a 39-yr-old female patient referred for the evaluation of intermittent palpitation and dizziness. Clinical evaluation including QT interval assessment and T-wave morphology through ECG, 24 hr Holter monitoring, treadmill exercise test, and coronary angiography was performed. Pedigree analysis was also carried out. The QT intervals were measured by Ashman method and corrected for heart rate (QTc) (). All the family members were also evaluated by ECG.\nThe patient complained severe dizziness and syncope with palpitation when she was under the stress or emotionally upset. Twenty-four hour Holter monitoring showed a few premature atrial or ventricular complexes. During treadmill exercise test, horizontal ST depressions were appeared on leads II, III, avF, V4-V5 with chest pain. While we are taking coronary angiography, the patient complained palpitation, dizziness, and loss of consciousness for a few seconds. Then the ECG showed typical 'Torsades de Pointes' with T wave alternans (). She was diagnosed as long QT syndrome and prescribed propranolol 40 mg bid. After medication, the symptom improved and she was discharged with good condition.\nshows the pedigree of this LQTS family. Five family members (I2, II2, II4, II7, and III1) were diagnosed with LQTS using the diagnostic scoring system (). The rest 4 members showed normal ECG patterns (I1, II6, II8, and III2) with normal QTc intervals (<450 ms) and the representative ECG is shown (). With exception of subject II4, all affected members showed prolonged QTc intervals ranged from 454 to 527 ms and the proband's ECG is shown in . Subject II4 was diagnosed as LQTS based on the non-specific T-wave abnormality despite of shorter QTc interval than normal one (). The clinical characteristics are summarized in .\nGenomic DNA was extracted from the peripheral blood of the participants using a Blood extraction kit (Qiagen) following the manufacturer's protocol. Genomic DNA was used as a template for PCR amplification of the individual exons of the KCNQ1, KCNH2, and KCNE1 genes. Gene-specific primer sequences were designed using genomic sequences of each gene (Genbank accession numbers; NG_008935.1 for KCNQ1, NG_008916.1 for KCNH2, and NG_009091.1for KCNE1). PCR primer sequences and conditions are shown in the . The purified PCR product was directly sequenced using ABI Prism 3730XL DNA Analyzer (Applied Biosystems, Foster City, CA, USA) and the sequences analyzed using BLAST program (). The putative mutation was further investigated in the family members to determine its familial transmission. And the general Korean population was also screened for the presence of this mutation.\nThe sequencing of the entire coding regions as well as the splicing junctions of the KCNQ1, KCNH2, and KCNE1 genes of the proband revealed a typical chromatogram of mixed samples in the sequence read of an exon (). Subcloning of the PCR products followed by sequencing of individual clones identified a mutant allele with a single nucleotide C deletion in exon 3 of KCHN2 gene. This C deletion at the nucleotide position of 453 of the KCNH2 mRNA presumably resulted in frameshift of the coding region thus introducing a premature termination codon after 15 miscoded amino acids (151Pfs+15X) (). This mutation co-segregated with LQTS in this family, thus I2, II2, II4, II7 (proband), and III1 were all heterozygotes for delC453fs (151Pfs+15X). This mutation was not detected in 100 chromosomes in general Korean population.
|
[[39.0, 'year']]
|
F
|
{'9845367': 1, '14613852': 1, '9753711': 1, '10828248': 1, '34801551': 1, '8339437': 1, '11334834': 1, '13435203': 1, '32311972': 1, '1884444': 1, '10728950': 1, '20541041': 1, '10973849': 1, '1519533': 1, '16075042': 1, '15176425': 1, '8995352': 1, '10532503': 1, '10862094': 1, '10187793': 1, '19862833': 1, '24015048': 2}
|
{}
|
163,025 |
3763118-1
| 24,015,049 |
noncomm/PMC003xxxxxx/PMC3763118.xml
|
An Infant with Prenatally Diagnosed Congenital Anaplastic Astrocytoma Who Remains Disease-Free after Proton Therapy
|
In January 2007, a 9-month-old boy with recurrent anaplastic astrocytoma of occipital lobe was transferred to our hospital for further management. On referral, he looked chronically ill but was adequate development for his age. Neurologically, he showed grade IV right sided weakness. He was born at 40 weeks of gestational age by normal vaginal delivery and the baby weighed 3.1 kg at birth. An obstetric ultrasound examination showed a huge mass in occipital lobe (64×46 mm) at the gestational age of 38 weeks. At birth, he had no other physical abnormalities (head circumference 34 cm, 50-75 percentile). A brain magnetic resonance imaging (MRI) () at 1 week of age revealed a huge lobulated, soft tissue mass on parietooccipital lobe. Subtotal resection of the mass done at 2 weeks after birth confirmed anaplastic astrocytoma (). At 1 month of age, he was treated with chemotherapy as per the Korean Society for Pediatric Neuro-Oncology (KSPNO) infant brain tumor protocol (vincristine, etoposide, cisplatin, cyclophosphamide, carboplatin, ifosfamide) for 4 months until a follow-up brain computed tomography (CT) showed progressive tumor of 35×34 mm-sized mass in the occipital lobe. At 5 months of age, he underwent 2nd tumor resection. The tumor histology was the same as before. Within 2 weeks after the surgery, he was placed on temozolomide with no avail. At 7 months of age, chemotherapy was changed to irinotecan, celecoxib, etoposide and thalidomide. At 9 months of age, upon showing further progression of tumor on brain MRI, he was finally referred for further management.\nUpon arrival, he underwent the 3rd gross tumor removal at the age of 11 months and had post-operative recovery for two months. He was able to walk holding with right side weakness (grade IV), make eye contact and have control over his head at that time. And treatment strategy was followed by proton therapy to tumor bed for a total dose 40 cobalt gray equivalent (CGE)/20 fractions (Fx) in 4 weeks (). At 20 months of age, he was able to walk without assistance. Neurologically, he continued to have limping gait on the right. Neurocognitive function test by Korean-Wechsler Preschool and Primary Scale of Intelligence (K-WPPSI) at 38 months of age showed verbal intelligence 109, performance intelligence 71 and total intelligence 88 and he showed adequate development and at 51 months of age showed verbal intelligence 133, performance intelligence 108 and total intelligence 125. Now at 53 months of age, he remains disease-free with adequate head size for his age and the height of 50 percentile. The most recent follow up of brain MRI (3 yr post-proton therapy) showed a large surgical defect at left parietooccipital operative bed without evidence of tumor recurrence ().
|
[[9.0, 'month']]
|
M
|
{'12663725': 1, '16165914': 1, '9647172': 1, '27568373': 1, '8869052': 1, '12426683': 1, '16168831': 1, '17184075': 1, '7121821': 1, '2167004': 1, '15050341': 1, '9697957': 1, '19581535': 1, '2550594': 1, '8033157': 1, '2340534': 1, '7799011': 1, '8823328': 1, '4796010': 1, '10613303': 1, '9241084': 1, '24015049': 2}
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{}
|
163,026 |
3763119-1
| 24,015,050 |
noncomm/PMC003xxxxxx/PMC3763119.xml
|
Muscular Sarcoidosis Detected by F-18 FDG PET/CT in a Hypercalcemic Patient
|
In November 2009, a 50-yr-old female was admitted to our hospital with idiopathic transient pulmonary edema. Her weight was 49 kg, creatinine clearance 33.8 mL/min and calcium 9.9 mg/dL. Her echocardiogram showed mild diastolic dysfunction with ejection fraction of 55%. Her pulmonary function was moderately restricted with 51% of forced vital capacity. Her pulmonary edema was rapidly improved with diuretics therapy. In August 2010, she was re-admitted with hypercalcemia. She had underlying diabetes for 20 yr. Her diabetes was complicated with proliferative retinopathy, chronic renal impairment, and a chronic foot ulcer. At the time of her recent admission, her weight was 37 kg and she appeared chronically ill and emaciated. She reported 2 weeks of general weakness. We could not find any abnormal mass or tenderness except generalized muscle atrophy at the beginning. Creatinine clearance was 19.4 mL/min, calcium 14.5 mg/dL, phosphate 5.0 mg/dL, and ionized calcium 1.78 mM/L. Her 24-hr urine calcium level was 186.2 mg/day, and intact parathyroid hormone (PTH) of 15.77 pg/mL. These ambiguous laboratory findings prompted further studies of non-parathyroid-related hypercalcemia. Her 25-hydroxy Vitamin D level was 21.3 ng/mL, 1,25-dihydroxy Vitamin D was 43.1 pg/mL (normal, 25.1-66.1), and parathyroid hormone related peptide (PTHrP) was under 1.1 pM/L. The thyroid hormone level, serum electrophoresis and tumor markers were normal. The angiotensin-converting enzyme (ACE) level was elevated to 353.1 IU/L (normal, 20-70), and muscle enzymes (CPK/LDH/AST) were normal. The chest radiograph, neck ultrasound, and whole body bone scan were unremarkable. F-18 FDG PET/CT was performed for the evaluation of possible hidden malignancy. The PET/CT showed increased uptake of small lymph nodes in the subcarina and both hila. In addition, multiple streaky and dotted muscular uptakes were noted along whole body including the back and extremities (). We reexamined her whole body and found a 2 cm-sized soft and non-tender mass in the left gastrocnemius muscle. Excisional biopsy was performed of the mass, and the microscopic finding demonstrated non-necrotizing granulomas with multinucleated giant cells and without acid-fast bacilli or fungi () consistent with muscular sarcoidosis. Imaging studies also revealed gallstones and bilateral renal stones, and we performed extracorporeal shock wave lithotripsy of the ureteral stone successfully. However, some renal stones remained.\nAcute severe hypercalcemia was relieved temporarily by hydration and furosemide. Prednisolone was started with 20 mg per day and then rapidly tapered to 5 mg per day within 1 week. The serum calcium level was normalized and maintained with prednisolone 5 mg a day, but ACE level continued to fluctuate. Her follow-up clinical data were laid out in the . Her glucose levels were controlled with insulin, and her weight increased to 50 kg with muscle gain. On follow-up PET/CT at one and half year later, muscular uptake was no longer seen. However, increased uptake in the mediastinal and hilar lymph nodes persisted ().
|
[[50.0, 'year']]
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F
|
{'29643679': 2, '17204697': 1, '15618571': 1, '21756234': 1, '22219622': 2, '21356398': 1, '20473167': 1, '6308066': 1, '27812958': 1, '20385567': 1, '17548505': 1, '17015889': 1, '22094184': 1, '12672326': 1, '10908687': 1, '21716006': 1, '22269612': 1, '5802453': 1, '32213991': 1, '15385292': 1, '9110911': 1, '26652015': 2, '18418595': 1, '26962842': 1, '24015050': 2}
|
{'3247783-1': 1, '4676867-1': 1, '5883436-1': 1}
|
163,027 |
3763677-1
| 24,015,161 |
noncomm/PMC003xxxxxx/PMC3763677.xml
|
The Unusual Chance Fracture: Case Report & Literature Review
|
A 30-year-old male was involved in an automobile accident. He was at the driver's seat and did not wear a seatbelt. During admission, his primary complain was back pain.\nUpon admission, palpation revealed tenderness at the thoracolumbar region. His neurologic examination was normal with no motor or sensory deficit of the lower and upper limbs. Ultrasonography was performed to exclude blunt abdominal concomitant injuries. Simple radiographic evaluation of the cervical spine, thorax and pelvis did not demonstrate associated injuries. Radiographs (Figs. , ) and CT scans (Fig. ) of the thoracolumbar spine revealed a transverse fracture at the level of T12. The CT scan further demonstrated a split of the posterior elements, progressing anteriorly into the vertebral body. Conservative treatment was decided and the patient, following an initial period of bed rest, was mobilized wearing a thoracolumbar orthosis. Appropriate antithrombotic prophylaxis with low molecular weight heparin was administered, until full ambulation was achieved. The patient was followed up with serial thoracolumbar radiographs for the first 6 weeks of ambulation and later on, in one month intervals. The thoracolumbar orthosis was applied for three months. At the 5th month follow-up, he was pain free with radiographic signs of mild vertebral kyphosis. Upon completion of treatment, he returned successfully to pre-injury levels of daily activity, without any impairment.
|
[[30.0, 'year']]
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M
|
{'29984023': 2, '19789468': 1, '19934698': 1, '16305094': 1, '4068070': 1, '5579406': 1, '33670128': 1, '25697298': 1, '14310340': 1, '18007230': 1, '20585301': 1, '4838388': 1, '5767317': 1, '16135975': 1, '3324066': 1, '18878306': 1, '28795268': 1, '3980716': 1, '30765994': 2, '1553330': 1, '4651929': 1, '24015161': 2}
|
{'6338003-1': 1, '6015715-1': 1}
|
163,028 |
3763753-1
| 24,015,158 |
noncomm/PMC003xxxxxx/PMC3763753.xml
|
Intrasynovial Tendon Graft for Chronic Flexor Tendon Laceration of the Finger: A Case Report
|
The patient was a 25-year-old, right-handed man presenting with limited flexion of his right ring finger. He had sustained a knife injury at the base of the right ring finger. He visited a surgeon at a local clinic, who sutured the wound; the patient was then informed that the flexor tendon was intact. However, since the limited flexion persisted even 4 months after the injury, he was referred to our hospital. On examination, the active ROM of the right ring finger was found to be 88°, 68°, and 12° of flexion and 0°, 10°, and 0° of extension for the metacarpophalangeal (MP) joint, proximal interphalangeal (PIP) joint, and distal interphalangeal (DIP) joint, respectively. The total active motion (TAM) was 168° (percent TAM, 62%) (Fig. ). Grip strength was 24 kg for the right hand and 41 kg for the left hand. The disabilities of the arm, shoulder, and hand (DASH) score was 31 points.\nThe patient was diagnosed with flexor digitorum profundus (FDP) tendon laceration at the A2 pulley level. Flexor tendon reconstruction from the palm to the fingertip was then performed using the left second-toe flexor tendon as a graft at 5.5 months after the injury, under general anesthesia. The left side was chosen because his right foot was dominant. Through a volar zigzag skin incision, the involved flexor system was exposed from the A2 to the A5 pulleys. All pulleys were intact. Frayed and degenerated distal stump and enlargement of the swollen proximal stump of the FDP tendon were noted (Fig. ). The flexor digitorum superficialis (FDS) tendon was found to have been transected and attached to the PIP joint volar plate. A separate skin incision was made over the A1 pulley to locate the proximal stump of the FDP tendon.\nThe left second-toe flexor tendon was harvested by the method described by Leversedge et al. []. Thereafter, the grafted tendon was advanced distally through a series of fibrous pulleys in the ring finger. Since the graft was not easily maneuvered through the A2 pulley with the FDS tendon attached to the volar plate, the FDS tendon was cut. The size and shape of the graft tendon were suitable for the ring finger synovial space. A distal juncture was created by a modification of the classic Bunnell tendon-to-bone pull-out technique. For the proximal juncture, 3 weaves of the grafted tendon were applied to the proximal stump of the FDP tendon (Fig. ).\nOn postoperative day 1, modified Kleinert’s early motion was initiated with a dorsal extension block splint, and active flexion was initiated 3 weeks after surgery. At 7 months after surgery, the TAM was 194° (percent TAM: 71%). Magnetic resonance imaging (MRI) of the ring finger revealed that the configuration of the grafted tendon was almost normal (Fig. ). Since the patient wished to gain further active flexion of the right ring finger, tenolysis was performed 7 months after surgery. The appearance of the graft tendon from the second toe was normal, without apparent degenerative findings (Fig. ). Adhesion was observed from the palm to the insertion point at the base of the distal phalanx, especially, at the proximal juncture site in the extrasynovial area. Release of the grafted tendon from the surrounding structures was easily accomplished. Immediate active ROM exercises were encouraged. At 1.5 years after tenolysis, the active ROM was 90° of flexion and 12° of extension for the MP joint, 100° of flexion and 16° of extension for the PIP joint, and 80° of flexion and -2° of extension for the DIP joint. TAM was 268° (percent TAM: 99%) (Fig. ). Grip strength was 46 kg for the right hand. The DASH score was 5.8 points. Although limited flexion of the second toe was evident, the patient’s gait was normal and he experienced no further morbidity at the donor site.
|
[[25.0, 'year']]
|
M
|
{'5114696': 1, '7086088': 1, '21282212': 1, '9052543': 1, '7602408': 1, '18070642': 1, '4152583': 1, '21123612': 1, '3171291': 1, '18762114': 1, '7642935': 1, '13295327': 1, '17996781': 1, '1470872': 1, '15054299': 1, '9052542': 1, '8335659': 1, '10913214': 1, '14213407': 1, '12132079': 1, '15882601': 1, '16618523': 1, '24015158': 2}
|
{}
|
163,029 |
3764261-1
| 24,019,847 |
noncomm/PMC003xxxxxx/PMC3764261.xml
|
A novel MLL2 gene mutation in a Korean patient with Kabuki syndrome
|
The male patient was born at 40 weeks gestation by spontaneous vaginal delivery to a 27-year-old G0P0 mother and a 29-year-old father. The parents were nonconsanguinous and healthy. The pregnancy and labor were uncomplicated. There was no history of fever, rash, spotting, tobacco, alcohol, illicit drug use, or X-ray exposure during pregnancy. At birth, the patient had microcephaly (<10th percentile) but no anatomical anomalies. He was admitted to a neonatal intensive care unit for 2 weeks due to transient respiratory difficulty. At 18 months of age, he first visited our clinic due to developmental delay. His height, weight, and head circumference were 77.4 cm (10-25th percentile), 11 kg (25-50 th percentile), and 43.4 cm (5-10th percentile), respectively. He could stand up with support at 15 months of age and walked alone at 25 months of age. His speech was delayed and at 27 months of age, he first said "mama". He showed long palpebral fissures with lateral eversion of the lower eyelid, long eyelashes, arched eyebrows with lateral thinning, and a depressed nasal tip. He had brachydactyly and prominent finger pads of bilateral third and fourth fingers. His intelligence quotient was estimated at 53 by Korean-Wechsler Preschool and Primary Scale of Intelligence, which meant moderate mental retardation (0.05th percentile). Spine X-ray showed butterfly vertebra at the 3rd thoracic spine, and echocardiography showed no cardiac anomalies except bicuspid aortic valve. Neurologic examinations showed no abnormal findings. He suffered from recurrent otitis media. At 11 years of age, his height, weight, and head circumference were 131.7 cm (<3rd percentile), 48.6 kg (75-90th percentile), and 55.5 cm (95-97th percentile), respectively. His chromosome was normal, 46, XY, and other laboratory findings including immunoglobulin, insulin, fasting glucose, cholesterol and thyroid hormone (TSH and free T4) were normal.\nAs our patient had typical facial features, skeletal anomalies and postnatal growth deficiency such as height 2 standard deviations, we diagnosed him as KS by clinical findings. After informed consent had been obtained, we performed molecular genetic testing for the MLL2 gene. A novel heterozygous MLL2 mutation (c.5256_5257delGA;p.Lys1753Alafs*34) was identified. However, no genetic mutations were detected in both parents ().
|
[[27.0, 'year']]
|
M
|
{'21607748': 1, '21411242': 1, '17178841': 1, '3067577': 1, '7277097': 1, '16086857': 1, '27573763': 1, '22197486': 1, '33552639': 1, '26512256': 1, '20711175': 1, '22126750': 1, '21461228': 2, '21658225': 1, '10409430': 1, '22840376': 1, '21671394': 1, '21280141': 1, '7277096': 1, '22437206': 1, '24739679': 1, '24019847': 2}
|
{'3060392-1': 1}
|
163,030 |
3764352-1
| 24,020,038 |
noncomm/PMC003xxxxxx/PMC3764352.xml
|
Adrenomyeloneuropathy Presenting With Adrenal Insufficiency
|
In January 2012, a 33-year-old man visited the Department of Rehabilitation Medicine in Seoul Medical Center with complaints of a 13-year history for bilateral, progressive weakness and spasticity in his lower extremities as well as gait disturbance, urge incontinence and impotence. He showed scissoring gait and dragged his feet during walking. He had no family history of neurological or autoimmune disorders and absences of any trauma to the spine. At the age of 15, he was diagnosed with primary adrenal insufficiency so-called Addison disease and has been taking daily Prednisolone of 5 mg.\nPhysical examinations showed hyperpigmentation, especially in gingiva, tongue, creases of hand, and areolae (). The respiratory, cardiovascular, and abdominal examinations were unremarkable but the muscle bulk in his lower extremities was diminished. On neurologic examination, there was decreased vibratory, pain and temperature sensation below the nipple. In a manual muscle test, flexion and extension of the hip and knee joint each showed 4/4, the ankle dorsiflexion III/III, and the ankle plantarflexion IV/IV under the Medical Research Council classification. He showed spastic gait pattern, with hyperactive deep tendon reflexes and positive Babinski sign. Each degree of spasticity of knees and ankles measured with Modified Ashworth Scale was grade 1. Intellectual and memory functions were within the normal range.\nIn laboratory findings, adrenocorticotropic hormone (ACTH) level was above 1,500 pg/mL (normally 10.60 pg/mL) and a short synacthen test showed adrenal failures with a baseline cortisol 0.9 µg/dL (normally 2.9.19.4 µg/dL), 0.7 µg/dL at 30 minutes and 0.6 µg/dL at 60 minutes. The serum testosterone level was 2.40 ng/mL (normally 2.41.8.17 ng/mL). VLCFAs were measured in the plasma. C26:0 levels were 2.969 µmol/L (normally <1.31 µmol/L), the C26:0/C22:0 was 0.083 µmol/L (normally <0.023 µmol/L), and the C24:0/C22:0 was 1.727 µmol/L (normally <1.39 µmol/L) ().\nIn electophysiologic studies, somatosensory evoked potentials (SEPs) showed no responses in posterior tibial nerve but normal in median nerve. Brainstem auditory evoked potentials (BAEPs) and visual evoked potentials (VEPs) did not demonstrate definite abnormal findings. Nerve conduction studies (NCS) and needle electromyographic examinations were within normal range.\nMagnetic resonance imaging showed intramedullary signal changes along entire thoracic cord, which were suggestive of myelopathy (). The diagnosis of AMN was confirmed by raising circulating concentrations of VLCFA.
|
[[33.0, 'year']]
|
M
|
{'16380594': 1, '19892975': 1, '7468762': 1, '15505272': 1, '8708687': 1, '7734032': 1, '29271619': 1, '2294415': 1, '24020038': 2}
|
{}
|
163,031 |
3764353-1
| 24,020,039 |
noncomm/PMC003xxxxxx/PMC3764353.xml
|
Multiorgan With Renal Infarction Following Treatment of Cerebral Infarction
|
A 72-year-old male patient visited the emergency department with a sudden weakness of the upper and lower left extremity and dysarthria. The patient had a history of diabetes, congestive heart failure and atrial fibrillation, and was currently taking 5 mg of warfarin, while maintaining an international normalized ratio (INR) of 2.0-2.5. The patient's blood pressure was 140/80 mmHg, heart rate 66 bits/min, respiratory rate 20 breaths/min, and body temperature 36.8℃. His mental state was clear with mild dysarthria by neurological exam. Manual Muscle Test grade (Medical Research Council of Great Britain) of his upper left extremity was 2, and lower left was 1. Patient's sensory examination showed normal findings, bilaterally. Brain magnetic resonance image showed that an acute cerebral infarction was recognized (), and low molecular weight heparin was used for 7 days, followed by oral administration of 3 mg warfarin after the 8th day.\nThirteen days after the occurrence of cerebral infarction, the patient complained of mild abdominal pains, nausea, vomiting and presented with paralytic ileus in a simple abdominal X-ray. For physical examination performed on the 14th day, the patient complained the tenderness of the costovertebral angle which persisted during percussion. The laboratory examination showed increased levels of lactate dehydrogenase (LDH) 549 IU/L (normal range, 100-450 IU/L); white blood cell (WBC) 21.58×103/µL; aspartate aminotransferase/alanine aminotransferase (AST/ALT) 191/133 IU/L; blood urea nitrogen (BUN)/Cr 41.4/1.43 mg/dL; C-reactive protein 65.6 mg/L; and procalcitonin 0.16 ng/mL, with INR 1.59. Urine analysis showed WBC 0-1/high power field (HPF), red blood cell 1-3/HPF and proteinuria. An abdominal computed tomogram (CT) showed a renal infarction with renal artery occlusion, multifocal splenic infarction and ischemic colitis on the rectum and sigmoid colon (). The patient could not be an indication for use of embolectomy and angiography after 24 hours since the abdominal pain and nausea. Low molecular weight heparin was administered intravenously for 10 days and followed by warfarin, maintaining a INR level of 2.0-3.0, with fluids and antibiotics for the accompanied ischemic colitis. A follow-up laboratory examination was performed after 25 days of occurrence, LDH levels normalized to 418, as well as normalization of AST/ALT 21/12 IU/L, BUN/Cr 16.0/1.02 mg/dL. A follow-up abdominal CT was performed after 43 days of occurrence. There was an improvement of the splenic infarction and ischemic colitis. However, signs of left renal infarction and atrophic change were observed (). During the 12-months follow-up after discharge, there was no symptom or sign of renal dysfunction, such as hypertension or renal failure.
|
[[72.0, 'year']]
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M
|
{'3385205': 1, '12389340': 1, '16706967': 1, '15342973': 1, '11401607': 1, '17229180': 1, '20152245': 1, '17379822': 1, '16903629': 1, '24020039': 2}
|
{}
|
163,032 |
3764354-1
| 24,020,040 |
noncomm/PMC003xxxxxx/PMC3764354.xml
|
Tuberculous Tenosynovitis and Ulnar Bursitis of the Wrist
|
A 65-year-old man presented with a 1-week history of an insidious flexor weakness of the right fifth finger. All traumatic causes were ruled out. Physical examination revealed paresthesia over the fifth finger and hypothenar region of the right hand. According to the Medical Research Council scale [], the strength of the right fifth finger flexor was grade 2, while the strengths of the fifth finger adductor and fourth finger flexor were both grade 3 (). The muscle strengths of the right upper extremity, including the first dorsal interosseous, abductor digiti minimi and flexor carpi ulnaris muscles, was all grade 5. No significant atrophy was identified on the right hand and forearm. Simple X-rays revealed no abnormal findings in bone, joint, and soft tissue ().\nThe patient had been treated for diabetes mellitus and hypertension over a period of 5 years at an outpatient clinic. A chest radiograph revealed tiny calcific nodules, suspicious for old tuberculous infection; however, no significant differences were found in patterns and sizes of these lesions when compared to previous films. There was no past or family history of tuberculosis. He did not have any complaints of respiratory symptoms, including cough, sputum, or chest discomfort. The levels of white blood cell count, erythrocyte sedimentation rate, and C-reactive protein were within normal range. However, plasma glucose level and glycosylated hemoglobin level were 477 mg/dL and 13.1%, respectively, which revealed poorly controlled diabetes mellitus.\nElectrodiagnostic studies were performed in the right upper extremity to rule out an atypical type of ulnar neuropathy. Nerve conduction studies of latency, amplitude, and conduction velocity exhibited normal findings in motor and sensory components. Abnormal needle electromyographic findings, including abnormal spontaneous activities and motor unit action potentials, were not observed.\nFor further evaluation, contrast-enhanced magnetic resonance imaging (MRI) of the right hand was performed, and this revealed a partial tear of the fifth finger flexor tendon with a fluid collection in the tendon sheath and in the flexor compartment along the ulnar side. This finding was suggestive of flexor tenosynovitis associated with ulnar bursitis (). There were no abnormal findings in bone, soft tissue, or neurovascular structure.\nBased on the spontaneous occurrence of flexor tenosynovitis along the ulnar side and tiny calcific nodules in chest radiographs, a decision was made for a PCR analysis to identify the potential infectious cause. Under ultrasound guidance, an 18-gauge needle was introduced into the hypoechoic area beneath the interrupted fifth flexor tendon (). From that point, 0.3 mL of synovial fluid, which was slightly turbid and yellowish, was aspirated. From the area, but did not contain loose bodies. Nested PCR analysis was positive for Mycobacterium tuberculosis gene probe in the aspirated fluid, confirming the diagnosis of tuberculous tenosynovitis (). A follow up serologic test was negative for human immunodeficiency virus (HIV) antibody.\nAlthough partial tear of fifth finger flexor tendon was highly suspected based on the MRI finding and motor weakness, a nonoperative medical treatment was preferentially followed due to the uncontrolled diabetes mellitus. The patient was started on combination chemotherapy of isoniazid, rifampin, pyrazinamide, and ethambutol along with additional hypoglycemic agents. Two weeks after the commencement of therapy, paresthesia along the ulnar side had begun to improve; however, there were no interval changes to the motor weakness of the fifth finger flexor. Extension block splint and range of motion exercise were maintained to support fourth and fifth finger flexor tendons. Three months later, sensory symptom disappeared and motor weakness had improved to grade 4.
|
[[65.0, 'year']]
|
M
|
{'25690847': 1, '25317223': 1, '16406184': 1, '1549632': 1, '15333346': 1, '8888250': 1, '30591871': 1, '21728152': 1, '30211389': 2, '15664569': 1, '22081281': 1, '24020040': 2}
|
{'6132321-1': 1}
|
163,033 |
3764355-1
| 24,020,041 |
noncomm/PMC003xxxxxx/PMC3764355.xml
|
Compressive Neuropathy of the Posterior Tibial Nerve at the Lower Calf Caused by a Ruptured Intramuscular Baker Cyst
|
A 49-year-old man with left sole paresthesia and calf pain for 2 weeks was admitted to the department of rheumatology. This pain had a sudden-onset and caused the excruciating calf pain at nights. His medical history was significant for rheumatoid arthritis diagnosed 6 months prior to this and significant also for intermittent low back pain. The patient had bilateral knee joint arthroscopic synovectomy at a local orthopedic clinic 3 months before to manage synovial hyperplasia caused by rheumatoid arthritis. Magnetic resonance imaging (MRI) study of the lumbar spine, at the time of admission, revealed bilateral foraminal spinal stenosis at L3-4 and L4-5 levels. Thus, he was referred to the department of anesthesiology and received diagnostic epidural steroid nerve block at the corresponding levels. However, the symptoms did not improved after the block, and the patient was referred to our physical medicine and rehabilitation department for electrodiagnostic study and further evaluation.\nNeurological examination at the time of referral visit showed no significant muscle atrophy but manual muscle test revealed a grade-IV muscle strength in left ankle plantar flexors and a grade-I muscle strength in left great and little toe abductors. Paresthesia was noted at the left sole area. Nerve conduction study showed significantly reduced amplitudes of compound muscle action potential in the left tibial nerve. Mixed nerve studies of the medial and lateral plantar nerves showed no sensory nerve action potential (SNAP) responses. Sural and superficial peroneal nerves showed normal latencies and SNAP amplitudes (). Denervation potentials were observed at the left abductor hallucis and abductor digiti minimi muscles with discrete recruitment patterns, but no denervation potentials were observed in the gastrocnemius or tibialis posterior muscles (). On the basis of these results, a preliminary diagnosis of posterior tibial entrapment neuropathy around the tarsal tunnel was made.\nTo rule out any structural lesion or mass at the tarsal tunnel, a musculoskeletal ultrasonography (US) was performed. However, this failed to identify any discrete mass around the tarsal tunnel area or any echo intensity change of the posterior tibial nerve. Additional proximal ultrasonography scans along the left tibial nerve from the proximal knee did identify a cystic anechoic compressible mass around the left posterior tibial nerve at the mid one-third area of the lower leg (). The cross-sectional area of the left posterior tibial nerve at the location of maximal nerve swelling measured 0.21 cm2. The cross-sectional area of the contralateral posterior tibial nerve at the same location measured 0.12 cm2. Subsequently, a MRI study of left lower leg revealed a Baker cyst with intermuscular and intramuscular dissection. The cystic lesion extended from the popliteal fossa, between the two heads of the gastrocnemius muscle to the deep posterior compartment of the middle one-third of the lower leg. Its longitudinal length was about 18.7 cm, and there was no connection with the intra-articular space. Upon gadolinium-infusion, deep flexor muscles near the cyst and at the periphery of the cyst were enhanced indicating rupture of the Baker cyst. Therefore, we concluded that posterior tibial neuropathy was caused by a direct compression from the ruptured intramuscular Baker cyst ().\nCareful re-examination of the leg muscle function showed mild weakness of the left great toe and digit flexor muscles. Additional needle electromyography study was performed, which showed denervation potentials in the left flexor hallucis longus and flexor digitorum longus muscles; however, no denervation potentials were observed in the left tibialis posterior, gastrocnemius, or soleus muscles. He was ultimately diagnosed with a posterior tibial entrapment neuropathy between the tarsal tunnel and popliteal space, distal to the tibialis posterior muscle branching site, secondary to a ruptured Baker cyst.\nThe patient was treated with a regiment consisting of gabapentin Neurontin cap 1,200 mg (Pfizer Korea Ltd., Seoul, Korea), transcutaneous electrical nerve stimulation, electrical stimulation therapy, and physical therapy. Additionally, a referral was made to the department of orthopedic surgery for possible surgical intervention. However, the patient's symptoms improved substantially after non-invasive treatment. There being no evidence of infection or other complications, and because the small cyst was located between the deep flexor muscles and blood vessels, the risk of an aspiration was deemed too great. Therefore, the department of orthopedic surgery and the patient decided to continue the non-operative course of management, and after two months of medical and physical therapy, the patient expressed significant improvement of symptoms.
|
[[49.0, 'year']]
|
M
|
{'30976834': 1, '31334050': 2, '9572709': 1, '20535511': 1, '11381504': 1, '21958564': 1, '837605': 1, '17300942': 1, '11590580': 1, '24020041': 2}
|
{'6625324-1': 1}
|
163,034 |
3764357-1
| 24,020,043 |
noncomm/PMC003xxxxxx/PMC3764357.xml
|
Treatment of Chronic Isolated Finger Flexor Tenosynovitis Through 50% Dehydrated Alcohol Installation
|
A 56-year-old man visited the rehabilitation department at our hospital with major complaints of painful swelling on his right forefinger. The patient was an office worker and had no history of external trauma. He indicated '2' on the visual analogue scale (VAS) in ordinary position but indicated '4' during finger extensions. On physical examination, tenderness-free edema was observed on his right forefinger, but there were no suspected infections e.g., localized burning sensation or redness. According to manual muscle testing using the Medical Research Council scale for muscular strength, the right forefinger measured 5 during both flexion and extension. Abnormalities were not observed in the metacarpophalangeal joint during the right forefinger extension, but its flexion angle did not exceed 30 degrees.\nThe patient had taken hypoglycemic drugs due to diabetes, but had no past medical histories related to gout, arthritis, and tuberculosis. He tested negative on a tuberculosis polymer chain reaction test and chest radiography performed at another hospital. He underwent a blood test after visiting this hospital, and white blood cells, red blood cells, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were all within normal levels. He was also tested negative for anti-cyclic citrullinated peptide, rheumatoid factor, and antinuclear antibodies.\nOn the longitudinal sectional image of his magnetic resonance imaging (MRI) scan performed at another hospital, synovial fluid retention was observed and the flexor tendon had increased in cross-sectional area, which was almost a positive proof of flexor tenosynovitis (). On the transverse image, the synovial cyst significantly increased in cross-sectional area (). He had had such symptoms for 9 months before visiting this hospital. Pharmacotherapy and physiotherapy were performed for 4 months and steroid was injected 3 times, but there were no improvements in symptoms.\nSimple radiography, performed at this hospital, did not show noteworthy abnormalities, but ultrasonography iU22 (Philips Medical System, Bothell, WA, USA) showed proliferations of blood cells in the right forefinger on both the longitudinal section and the transverse section. In addition, for hyperechoic characteristics, profuse synovial fluid retention and flexor thickening were noted through ultrasonography (). Power Doppler ultrasonography showed blood being supplied to the proliferated synovial cells ().\nUnder ultrasonography guidance, 1 mL of 50% ethanol was injected into the tendon sheath of the proximal interphalangeal joint of the forefinger where blood flow had increased. The patient did not show side effects excluding pain at the injection site.\nOn the second hospital visit (a month later), the VAS score fell to 1 even during joint movements and the range of joint motion approached 60 degrees. However, swelling remained.\nOn the third hospital visit (10 months later), the range of joint motion was the same as before. The VAS score had risen to 2 and edema was persistently visible. An additional alcohol injection was performed as before.\nOn the fourth hospital visit (12 months later), he indicated 'zero' on VAS during rest and during flexion and extension of the metacarpophalangeal joint of the right forefinger. On physical examination, the flexion angle approached 70 degrees and tenderness on the forefinger did not occur. In addition, edema had subsided significantly.\nOn the fifth hospital visit (22 months after the first alcohol injection), the VAS score was still 'zero' and edema had subsided remarkably from the previous 10 months (the fourth hospital visit). On physical examination, he did not show any pains during movement of the metacarpophalangeal joint of the right forefinger and could flex it 90 degrees.\nUltrasonography showed that synovial cells had proliferated and nutrition was being provided from blood vessels (). Two alcohol injections did not cause noteworthy complications during the follow-ups conducted for 22 months.
|
[[56.0, 'year']]
|
M
|
{'3693421': 1, '27152282': 1, '21764526': 1, '20569088': 1, '16172342': 1, '6392402': 1, '6725899': 1, '7553024': 1, '24020043': 2}
|
{}
|
163,035 |
3764358-1
| 24,020,044 |
noncomm/PMC003xxxxxx/PMC3764358.xml
|
Holmes Tremor After Brainstem Hemorrhage, Treated With Levodopa
|
A 70-year-old woman who had hypertension developed left side hemiparesis, right facial paralysis, severe dysarthria, and left hemiataxia. Physical examination revealed dysmetria and mildly increased deep tendon reflexes in the left upper and lower limbs. She did not show rigidity. Sensory examination demonstrated left hypesthesia. Brain magnetic resonance imaging showed an acute hemorrhage from the brachium pontis through the dorsal midbrain on the right side ().\nPrior to the tremor, her Modified Barthel Index (MBI), which was used to assess her activities of daily living, was 45 due to the left hemiparesis. At 6 months from the initial hemorrhage, the patient developed resting tremor of the head and left arm, which worsened progressively in the following days. As her motor function was impaired, it was difficult for her to sit up and hold a spoon, and this hindered eating independently. Her cognitive level was 26, which is considered within normal range based on the Mini Mental State Examination.\nThe patient's MBI score decreased to 30. Tremor continued with a sitting posture, particularly when her arms approached an object, and it was worsened by emotional distress, and ceased during sleep. The patient also developed a torticollis to the right and a regular dystonic head tremor, which was characterized by left chin rotation and right lateral head tilt. We measured the frequency of tremor using electromyography (EMG) equipment (VikingSelect; Nicolet, Madison, WI, USA). Recordings were made with a pair of surface EMG electrodes. The active (recording) electrode was placed over the bilateral sternocleidomastoid or the C7 paraspinal muscles. The reference electrode was positioned on the mastoid process of the temporal bone. The tremor of the head showed a slow (1.1 Hz), regular frequency at rest (). We prescribed propranolol (Indenol; DongKwang Pharm, Seoul, Korea), the first-line drug for essential tremor, at a dose of 120 mg per day and increased this to 240 mg per day for 2 weeks. However, her symptoms persisted. Next, she was recommended with other medications, namely, clonazepam and levetiracetam. She took several doses of clonazepam (Rivotril; Roche, Basel, Switzerland) from 0.5 to 1 mg; however, the tremor was unchanged. After administration of levetiracetam (Keppra; UCB, Slough, UK), from 500 to 1,000 mg per day for 2 weeks, her tremor showed some improvement. However, she complained of severe headache and mood changes; thus, she stopped taking levetiracetam. Next, she was treated with a levodopa-containing agent Stalevo (Novartis Korea, Seoul, Korea), starting at a dose of 200 mg once a day and progressively increasing over a period of 1 month to reach a final dose of 200 mg, three times a day. One week after beginning the medication, her tremor lessened gradually. At the final dose of the drug, her tremor was diminished and she was discharged from the hospital. We also observed an improvement in her motor function; she was able to sit up independently. In addition, her ability to perform activities of daily living improved; the functional levels for eating and dressing were enhanced, with her MBI score improving to 46.\nA month later, the patient returned to our outpatient clinic and the tremor was significantly improved. Six months later, the effect continued and the tremor was considered successfully controlled.
|
[[70.0, 'year']]
|
F
|
{'8057126': 1, '7898699': 1, '26865524': 1, '17369598': 1, '9827589': 1, '27833521': 1, '25332842': 1, '25340035': 2, '22772877': 1, '12210864': 1, '17414941': 1, '11948754': 1, '15200125': 1, '24020044': 2}
|
{'4205259-1': 1}
|
163,036 |
3764359-1
| 24,020,045 |
noncomm/PMC003xxxxxx/PMC3764359.xml
|
Spontaneous Perirenal Hemorrhage in Cauda Equina Syndrome: A Case Report
|
A 57-year-old male patient with no specific medical history was admitted to University Hospital for paraparesis and sensory disturbances in both lower extremities, caused by a fall 3 months prior to admission. He was diagnosed with CES, due to a L3 burst facture and spinal canal compression. Thus, posterior lumbar interbody fusion was performed (). After surgery, paraparesis improved progressively and no specific symptoms were reported, except neuropathic pain. The patient was transferred to a rehabilitation hospital for conservative treatment of the neurogenic pain and gait training; no specific complication was found during treatment.\nThe patient was transferred to our emergency department with fever and general weakness for 7 days. A complete blood count indicated leukocytosis, and Klebsiella pneumoniae was isolated from blood and urine culture tests. By abdominal ultrasonography, edema was observed in the bilateral renal parenchyma with hyperechogenicity, indicating renal failure, caused by acute pyelonephritis. No local lesion in the renal parenchyma, decreased blood perfusion, or extension of the renal pelvis or renal calyx was observed. After diagnosing sepsis, caused by acute pyelonephritis, meropenem was administered intravenously. After antibiotic treatment for 13 days, vital signs were stable and laboratory findings returned to normal. Antibiotics were stopped on the 15th day.\nThe patient was transferred to the rehabilitation medicine department for comprehensive management of his CES on the 16th day of hospitalization. In the Medical Research Council Manual Muscle Test, muscular weakness was observed in both lower limbs, with hip flexor 4/4 (right/left), knee extensor 3/3, ankle dorsiflexor 3/3, hallucis extensor 3/3, and ankle plantar flexor 2/2 grades. The patient complained of tingling sensations, allodynia, hyperalgesia, and decreased sensations below the third lumbar segment.\nSitting and standing up could be performed independently according to the functional evaluation, but moderate assistance was necessary for balanced-level walking and the Modified Barthel Index was 76 points. The deep tendon reflex was decreased in both lower limbs, though no pathological reflex was observed. Anal sphincter tone and the bulbocavernosus reflex were decreased. An electrodiagnostic study revealed normal sensory nerve conduction in both lower limbs, but the conduction velocity for bilateral peroneal and tibial nerves was slow and the amplitude of the compound muscle action potential was decreased. The H-reflex showed delayed latency in the bilateral tibial nerves. Somatosensory evoked potential stimulating of the bilateral tibial nerves and the bulbocavernosus reflex, stimulating the pudendal nerves, revealed delayed latencies. In needle electromyography, increased insertional activity and abnormal spontaneous activity were observed in muscles innervated from L2 to S2. From these findings, bilateral lumbosacral polyradiculopathy, accompanied by a sacral reflex arc lesion, was diagnosed, and was clinically compatible with CES.\nAt the time of transfer to our department, the patient was voided with an indwelling catheter. The amount of self-voiding after removing the indwelling catheter was 100-200 mL and the residual urine volume was measured to be about 200-300 mL. Voiding sense and desire were normal, and no incontinence, feeling of residual urine or hesitancy was reported. However, timed intermittent catheterization was used for removal of residual urine after self-voiding.\nThe patient had sufficient improvements with walking independently on an even surface level through comprehensive rehabilitative managements, including drug therapy (tramadol 150 mg, gabapentin 900 mg) for neuropathic pains, muscle strengthening exercises, functional electrical stimulation for bilateral lower limbs, and gait training. On the 13th day after transfer, the patient was presented with chills and fever (38.5℃). In a complete blood count, leukocytes revealed 26,110/µL, hemoglobin was 9.3 g/dL, and platelets were 168,000/µL. Creactive protein and the erythrocyte sedimentation rate increased to 34.32 mg/L and 120 mm/h, respectively. In serum biochemical tests, the blood urea nitrogen (BUN)/creatinine ratio increased slightly, to 30.9/1.6 mg/dL, and no other specific finding was observed. A routine urinalysis showed a specific gravity of 1.016, pH 6.0, albumin (2+), glucose (3+), ketones (-), hemoglobin (1+), leukocyte (3+), nitrate (-), and red blood cell 1-4/high power field (HPF), and a white blood cell in excess of 5/HPF by high-resolution microscopy. After diagnosis of recurrent acute pyelonephritis, tazobactam, an empirical antibiotic drug, was administered intravenously. However, Klebsiella pneumoniae was isolated from blood and urine cultures, so the antibiotic was changed to meropenem.\nAfter 3 days, the patient suddenly complained of pain and tenderness on the left flank during voiding and a 10×20 cm-sized mass was palpated in the left abdomen. Vital signs at that time showed a blood pressure of 100/60 mmHg, a heart rate of 115 beats/min, a respiratory rate of 20 breaths/min, and an axillary temperature of 36.5℃. In a complete blood count, leukocytes were 28,900/µL, hemoglobin was 7.1 g/dL, and platelets were 158,000/µL, indicating a sharp decrease in hemoglobin; thus, an acute hemorrhage was suspected. In a coagulation profile test, the prothrombin time was 13.7 seconds, the international normalized ratio was 1.21, and the activated partial thromboplastin time was 35.7 seconds, indicating normal findings. In a serum biochemical test, the BUN/creatinine ratio had increased, to 43.1/3.5 mg/dL, but no other specific finding was observed. In contrast-enhanced abdominal computed tomography (CT), pyelonephritis with multifocal low-density lesions was observed in the left kidney and a perirenal hemorrhage of low density was found in the perinephric space. From the arterial to the delayed phase, active extravasation of contrast media was observed near the perinephric space and was thought to be a hemorrhage in a capsular artery outside the renal capsule.\nThe mass palpated in the left abdomen was found to be a retroperitoneal hematoma with low density in the left iliac fossa (). Systolic blood pressure had decreased by 90 mmHg with declined hemoglobin, thus, emergent transfusion and angiography were performed. No tumor or vascular malformation was found, but coil embolization was carried out due to suspicion of progressive hemorrhage in the left capsular artery (). After transferring the patient to the intensive care unit, conservative treatment for acute renal failure with acute pyelonephritis was performed. No more active bleeding was observed in a follow-up abdominal CT, and the embolized capsular artery was found around the anterior cortex of the left kidney, at the site of the acute pyelonephritis ().\nAfter coil embolization, the hemorrhage stopped, so, nephrectomy was not being considered. However, surgical hematoma removal was conducted, because of persistent abdominal pains. In voiding cystourethrography, the vesicoureteral reflux was not observed, and no voiding images were obtained because the patient failed to void after filling 450 mL of contrast medium even though he had voiding desire. In an urodynamic study, the patient had strong voiding desire when infused with 500 mL of saline, but failed to void due to detrusor areflexia.\nThe patient was administered oral medications, including an alpha blocker and a choline agonist, but intermittent self-catheterization was carried out five times per day due to urinary retention in excess of 500 mL. No additional UTIs or other complications occurred, so he was transferred to a rehabilitation hospital.
|
[[57.0, 'year']]
|
M
|
{'16670051': 1, '19104682': 1, '9376088': 1, '1159905': 1, '12384111': 1, '24020045': 2}
|
{}
|
163,037 |
3764366-1
| 24,020,024 |
noncomm/PMC003xxxxxx/PMC3764366.xml
|
Pinch-off syndrome
|
A 42-year-old woman with cancer of the left breast had undergone breast conservative surgery on January 4, 2011. An implantable venous port was inserted through the right subclavian vein for adjuvant chemotherapy, and the location was confirmed by chest radiography (). There was no problem with the catheter location, but a pinch-off sign showed as a catheter deviation between the clavicle and the first rib. After the initial injection of chemotherapeutic agent, the patient did not experience pain or swelling, and because there was no problem with blood aspiration or flushing, chemotherapy was administered 3 times under close observation. Three months after the port insertion, the patient was hospitalized for the fourth adjuvant chemotherapy. A chest radiograph showed that the transected catheter had embolized to the right atrium (). The patient was referred to an interventional radiologist, and the embolized catheter was successfully removed via the percutaneous approach through the right internal jugular vein under fluoroscopic guidance (). The remaining implantable venous port was removed surgically.
|
[[42.0, 'year']]
|
F
|
{'9310813': 1, '30002942': 2, '28812003': 1, '8024478': 1, '26770840': 2, '30948877': 1, '30402393': 1, '10205324': 1, '25692124': 1, '6496853': 1, '2217768': 1, '415566': 1, '30538396': 1, '17112371': 1, '27664131': 1, '26489636': 1, '4068197': 1, '15279190': 1, '24020024': 2}
|
{'3764366-2': 2, '3764366-3': 2, '4681828-1': 1, '5998163-1': 1}
|
163,038 |
3764366-2
| 24,020,024 |
noncomm/PMC003xxxxxx/PMC3764366.xml
|
Pinch-off syndrome
|
A 56-year-old woman with stomach cancer had undergone gastrectomy on December 31, 2007. After the operation, an implantable venous port was inserted through the right subclavian vein, and adjuvant chemotherapy was administered 6 times without any unusual complications. The patient had follow-ups on a regular basis, and the port was removed 18 months after its insertion. Part of the catheter was fractured and had embolized the right atrium and inferior vena cava, which was confirmed by chest radiography after the procedure (). In a retrospective review of the patient's chest radiographs, a pinch-off sign was noted in the chest radiograph taken immediately after the port insertion and the catheter's course was deviated by the clavicle (). During the adjuvant chemotherapy and outpatient follow-up observations, the patient did not complain of any pain or swelling, and there was no unusual problem with drug administration through the port. Transection of the catheter is assumed to have occurred at the end of the adjuvant chemotherapy, which was 6 months after the port insertion, but the exact time was impossible to confirm. The patient was referred to an interventional radiologist, and the embolized catheter was successfully removed by a percutaneous approach through the right internal jugular vein under fluoroscopic guidance ().
|
[[56.0, 'year']]
|
F
|
{'9310813': 1, '30002942': 2, '28812003': 1, '8024478': 1, '26770840': 2, '30948877': 1, '30402393': 1, '10205324': 1, '25692124': 1, '6496853': 1, '2217768': 1, '415566': 1, '30538396': 1, '17112371': 1, '27664131': 1, '26489636': 1, '4068197': 1, '15279190': 1, '24020024': 2}
|
{'3764366-1': 2, '3764366-3': 2, '4681828-1': 1, '5998163-1': 1}
|
163,039 |
3764366-3
| 24,020,024 |
noncomm/PMC003xxxxxx/PMC3764366.xml
|
Pinch-off syndrome
|
A 48-year-old man with rectosigmoid colon cancer had undergone low anterior resection on July 15, 2011. For adjuvant chemotherapy, an implantable venous port was inserted through the right subclavian vein, and its location was confirmed by chest radiography (). No associated complication with the location of the catheter, and no pinch-off sign was suspected. The patient had undergone adjuvant chemotherapy 4 times without any unusual problems, ended the therapy of his own accord, and was lost to follow-up. Six months after he terminated the therapy, the patient returned to the outpatient clinic. His test results indicated that his disease had aggravated; therefore, chemotherapy was initiated again with different medications. He had chemotherapy twice during 2 months without any unusual complications but the port became dysfunctional after he was hospitalized for the third cycle; therefore, the removal of the original venous catheter and reinsertion through the left subclavian route were conducted. In the chest radiograph taken immediately after the second cannulation, some parts of the catheter of the removed right subclavian venous port remained (). In a retrospective review of the patient's chest radiographs, we observed catheter's luminal narrowing, that was not present on the initial chest X-ray, in the chest radiograph that was taken 4 months after the insertion of the right subclavian venous port (). It is assumed that the weakened catheter was fractured by the force used during the removal. To find out the exact location of the catheter, pulmonary arteriography was performed (). The patient was referred to an interventional radiologist, and the embolized catheter was successfully removed by the percutaneous approach through the right common femoral artery ().
|
[[48.0, 'year']]
|
M
|
{'9310813': 1, '30002942': 2, '28812003': 1, '8024478': 1, '26770840': 2, '30948877': 1, '30402393': 1, '10205324': 1, '25692124': 1, '6496853': 1, '2217768': 1, '415566': 1, '30538396': 1, '17112371': 1, '27664131': 1, '26489636': 1, '4068197': 1, '15279190': 1, '24020024': 2}
|
{'3764366-1': 2, '3764366-2': 2, '4681828-1': 1, '5998163-1': 1}
|
163,040 |
3764367-1
| 24,020,025 |
noncomm/PMC003xxxxxx/PMC3764367.xml
|
Endovascular repair of bilateral iliac artery aneurysm with branched iliac stents: case report and review of the current literature
|
A 65-year-old man was admitted for iliac artery aneurysm, detected during coronary angiogram via femoral artery in another hospital. His electrocardiography and echocardiography were within normal range. Computed tomographic scan showed significant aneurismal dilatation of both iliac arteries and abdominal aorta (). The patient was asymptomatic and underwent elective repair without sign of rupture. The size of right and left CIA was 3.7 mm × 40 mm, 3.7 mm × 41 mm in maximal diameter and length, respectively. Left and right IIA was 36 mm, 15 mm in maximal diameter, respectively. The angulation between left and right CIA and IIA was 40° and 36° respectively. Calcification in both CIA and IIA was not significant. Size of AAA was 37 mm but in risk of further dilatation of the AAA and the difficulty of EVAR after both iliac artery graft stenting, we decided to perform branched iliac bifurcated stenting and EVAR simultaneously.\nInitially, a custom-made 15-Fr delivery right internal iliac branched device (IIBD, SEAL Bifurcated stent graft, S&G Biotech, Seoul, Korea) was introduced in right femoral artery and oriented under fluoroscopic guidance with the aid of the gold markers. The delivery sheath was withdrawn, and a 0.035-inch guidewire was reintroduced through the branched limb under fluoroscopic guidance from the contralateral femoral artery. After exchange for a stiff guidewire, an 8-Fr internal iliac stent-graft (IISG, SEAL Branched limb extension, S&G biotech, Seoul, Korea) was placed in the IIA to extend the IIBD into proximal IIA. The custom-made left IIBD was then placed from the ipsilateral femoral artery and IISG from the contralateral femoral artery same as above. Finally, conventional EVAR was performed successfully in AAA. The final aortogram showed abdominal and both iliac aneurysms were successfully sealed without any endoleak (). Procedure time was 325 minutes and dose of contrast dye was 160 g. The patient was discharged without complications. Follow-up computed tomography after 1 month showed patent stent but did not showed right renal artery. It might be caused by higher position or stent migration during or after EVAR. However, the patient did not express any discomfort and level of creatinine did not change ().
|
[[65.0, 'year']]
|
M
|
{'19394544': 1, '17600664': 1, '17664099': 1, '26131445': 2, '19329918': 1, '19962329': 1, '18338212': 1, '12844095': 1, '16928164': 1, '18378472': 1, '24020025': 2}
|
{'4481032-1': 1}
|
163,041 |
3764656-1
| 24,019,691 |
noncomm/PMC003xxxxxx/PMC3764656.xml
|
Primary posterior perineal herniation of urinary bladder
|
A 63-year-old multiparous lady presented with complaints of a bulge in the gluteal region that appeared while coughing. Physical examination revealed a visible bulge in the posterior perineal region that could be reduced to reveal a defect in the perineum with an expansile cough impulse []. Per rectal examination revealed a palpable defect in the pelvic floor muscles. Computed tomography (CT) scan and magnetic resonance imaging (MRI) of pelvis demonstrated a perineal hernia with herniation of a portion of the urinary bladder and rectal wall through pelvic floor [Figures –].\nShe underwent laparoscopic exploration, mesh repair of the hernial defect, and rectopexy. A defect was noticed in the levator ani on the right side, through which the urinary bladder and a portion of rectum was herniated. Herniated contents were dissected free, rectum was fully mobilized up to the pelvic floor, and a defect in the pelvic floor was displayed. A polypropylene mesh was deployed to cover the defect, mesh rectopexy was done using a polypropylene mesh [], and hitching of urinary bladder to the anterior abdominal wall was performed. At the time of writing this article, the patient is symptom free on follow-up of 22 months.
|
[[63.0, 'year']]
|
F
|
{'24010951': 1, '18830641': 1, '34457102': 2, '15838584': 1, '18267161': 1, '21895925': 1, '24019691': 2}
|
{'8377551-1': 1}
|
163,042 |
3764657-1
| 24,019,692 |
noncomm/PMC003xxxxxx/PMC3764657.xml
|
Laproendoscopic single site oesophageal diverticulectomy
|
The patient was a 57-year-old man with 6 months history of dysphagia and regurgitation. upper gastrointestinal (UGI) endoscopy was done which showed large wide mouthed diverticulum in lower oesophagus around 36 cm from the incisors. The mucosa within the lumen of diverticulum was normal and there was no other lesion in oesophagus, stomach or duodenum. Subsequently, barium swallow and Contrast Enhanced Computerised Tomography chest and abdomen were done which confirmed the diagnosis of epiphrenic diverticulum measuring 5 cm in maximum diameter arising from posterolateral wall of oesophagus around 4 cm above the Gastro Esophageal junction. Oesophageal manometry showed diffuse increase in pressure tracings with hypertensive Lower Esophageal Sphincter but normal peristalsis and LES relaxation with swallow. Twenty-four hour pH study did not reveal presence of preoperative reflux. The patient was taken up for surgery based on the severity of symptoms and objective findings. A laparoscopic transhiatal oesophageal diverticulectomy with myotomy through single incision was planned.\nPatient was kept on liquid diet 1 day prior to surgery and was fasting overnight. Operation was performed under general anaesthesia with patient supine and legs apart with steep reverse trendelenberg tilt. A Ryle's tube was placed before induction. The surgeon stood between the legs of the patient with a camera assistant to the left and scrub nurse to the right of the surgeon. A 4 cm transverse skin incision was made within the umblicus and deepened upto the anterior rectus sheath. Pneumoperitoneum was created using Veress needle and a 10 mm trocar for laparoscope was placed in the centre of the incision. Two 5 mm trocars were placed on either side for the working instruments creating a mini triangulation effect []. Initial peritoneoscopy was done and then left lobe of liver was retracted by placing heavy double armed silk onstraight needle through a corrugated plastic drain and brought out through the liver parenchyma and the anterior abdominal wall []. This suture was kept on traction with help of small artery forceps. The dissection started with opening up of the avascular gastrohepatic omentum and division of phrenoesophageal membrane and gastrophrenic attachments of the fundus. The right crus of diaphragm was identified and dissected and retroesophageal space created. An umbilical tape was placed and tied around the GE junction after this dissection and brought out through the right trocar for traction during circumferential mobilisation of the oesophagus. The hiatus was opened anteriorly and lower end of mediastinal oesophagus was dissected. The diverticulum was visualised and peridiverticular adhesions were released. The left mediastinal pleura was carefully stripped off the diverticulum. The diverticulum was freed upto its neck, 5 mm right lateral trocar was replaced by a 12 mm trocar and the diverticulum was then divided with two firings of 60 mm linear stapler with a blue cartridge []. Intra operative endoscopy confirmed mucosal integrity and adequacy of lumen of the oesophagus. An anterior oesophageal myotomy was done starting from 6 cm above GE junction and extending 2 cm into the stomach. The mucosal integrity was once again confirmed with endoscopy and air leak test was done. Finally, the specimen was placed in a plastic bag and extracted and drain was placed. Fascial incisions were closed with No 1 loop nylon and skin with subcuticular absorbable suture [].
|
[[57.0, 'year']]
|
M
|
{'6776641': 1, '8494418': 1, '10535377': 1, '16305847': 1, '19793475': 1, '21487878': 1, '26865897': 2, '29657705': 2, '18269655': 1, '9488513': 1, '24019692': 2}
|
{'5890487-1': 1, '4729731-1': 1}
|
163,043 |
3764658-1
| 24,019,693 |
noncomm/PMC003xxxxxx/PMC3764658.xml
|
Single incision laparoscopic distal pancreatectomy with splenectomy for neuroendocrine tumor of the tail of pancreas
|
A 46-year-old male patient presented with history of decreased appetite and diarrhea of 3 months duration. He gave a history of acute pancreatitis one year before at which time multi-detector computerized tomography (MDCT) imaging showed evidence of acute pancreatitis with no necrosis and a bulky tail of pancreas. A MDCT of the abdomen done now showed a well-circumscribed lesion in the tail of pancreas with infiltration into the splenic hilum []. The maximum diameter of the tumor was 3.5 cm. His Serum Chromogranin A level was 970ng/L. His rest of the lab parameters were within normal limits. He received pneumococcal and meningococcal vaccine two weeks before the planned surgery. A single incision laparoscopic distal pancreatectomy with splenectomy was performed.\nPatient was placed in the supine position with a 45 degree left up position. A 3 cm vertical incision was chosen at the umbilicus and subcutaneous tissue was dissected off from the sheath. CO2 pneumoperitoneum of 15 mm Hg was achieved using a veress needle. One 12 mm and two 5mm ports were inserted as previously described by us []. A 10 mm, 45 degree scope was used for camera vision. Hook cautery, Harmonic shears (Ethicon – Endo-surgery, Johnson and Johnson) and Enseal device (Ethicon – Endo-surgery, Johnson and Johnson) were used for avascular dissection. At first the splenic flexure of colon was mobilized completely. The lesser sac was entered and widely opened by dividing the gastro-colic omentum. A gastric traction suture was placed to retract the posterior wall of stomach to the right, thereby exposing the lesser sac widely by a suture technique previously described by us to facilitate SIL splenectomy.[] The short gastric vessels were divided with Enseal device. The inferior border of pancreas was defined. Next, the superior border of pancreas was defined in the proximal and mid-body region of the pancreas. The dissection was next carried out from inferior border onto the posterior surface of pancreas in an avascular plane. The body of pancreas in the midbody region including the splenic vein was looped with a ribbon tape and a surgeons knot loosely tied the same anteriorly. A 2-0 prolene suture was passed into the abdomen from the subcostal region in the left anterior axillary line, through the ribbon tape loop and then exited from an area close to its previous entry point. The ends of the prolene loop were held with a hemostat. Traction on the hemostat facilitated anterior displacement of the body of pancreas facilitating further dissection. The distal body and tail were mobilized from the retroperitoneum in a plane anterior to the kidney in view of intense desmoplasia encountered adjacent to the tumor. The lienorenal ligament was divided using Harmonic shears. At this stage the distal body of pancreas and spleen were completely freed of all attachments. The pancreatic transection plane was chosen 2 cm proximal to the tumor. A 5 mm laparoscope was used during this step with an Endo GIA linear cutter 60 mm, white cartridge (Autosuture), passed through the 12 mm port for stapled transection at the chosen site []. The splenic artery was separately clipped with hemlock clips and divided. The pancreatic stump was overseen with running 2-0 prolene sutures. Fibrin sealant (Tisseal, Baxter) was applied at the pancreatic transection site. A 20F drain tube was placed adjacent to the transected end and the same was exited subcostally at the posterior axillary line. Hemostasis was checked. Keeping anterior leaf of the bag open using two interrupted prolene sutures hitching it to the anterior abdominal wall facilitated bagging of specimen. The specimen was placed in an endobag and was retrieved through the umbilical incision by joining the three port sites []. Sheath was closed with no 1 PDS suture and skin was approximated with staples []. On opening pancreas along long axis, solid cystic tumor was noted in the tail region of pancreas with distance of 2 cm from transected pancreas margin [Figures and ]. The nasogastric tube was removed on postoperative day 1. Patient was started on oral liquids on day 2 and gradually increased to a solid diet. The surgical drain was removed on day 4 patient was discharged on day five after surgery. Wound healed and skin clips were removed on 9th postoperative day. Two weeks following surgery, patient presented with fever and leukocytosis and was readmitted. MDCT showed evidence of 20 cc collection in relation to the pancreatic stump, which was drained by percutaneous catheter. He was treated with culture sensitive antibiotics and discharged after removal of percutaneous catheter after seven days. Histopathology of the resected specimen showed a very well differentiated neuroendocrine carcinoma with negative resected margin of pancreas and no lymphnode metastasis. At a postoperative follow-up of 30 months he remains asymptomatic, has chromogranin A levels within normal limits, with hardly discernable scar [] and has no recurrence on MDCT imaging.
|
[[46.0, 'year']]
|
M
|
{'25339820': 1, '32377068': 1, '17876875': 1, '15962401': 1, '15674199': 1, '25494969': 1, '16327488': 1, '21197246': 2, '21814306': 1, '18345309': 1, '22002284': 1, '27891251': 1, '24019693': 2}
|
{'3002011-1': 1}
|
163,044 |
3764659-1
| 24,019,694 |
noncomm/PMC003xxxxxx/PMC3764659.xml
|
A case of complete transection of right main bronchus in a child: Role of thoracoscopy and bronchoscopy
|
We received a 5-year-old male child from a peripheral hospital to our emergency room, with a history of run over by a bullock cart. On arrival, the child was in severe respiratory distress with absence of peripheral pulses and air entry on the right side of chest as well as un-recordable blood pressure. The child was resuscitated with crystalloids and vasopressor support.\nAn immediate bedside chest X-ray showed massive tension pneumothorax on the right side and an intercostal drain (ICD) tube was inserted []. The child was stabilized for the next 24 h, but ICD showed continuous massive air leak and the child had persistent tachypnoea. A computed tomography (CT) scan image showed a collapse lung and massive pneumothorax with a suspicion of right main bronchus injury.\nThe child was taken to the operating room. After intubation with single lumen endotracheal tube, a fiber optic bronchoscopy showed right mainstem bronchus obliteration by hematoma just 1.5 cm from carina, and the endotracheal tube was guided into left main bronchus. A diagnostic thoracoscopy was done to reveal complete transection of the right main bronchus and no associated mediastinal injuries [].\nA right postero-lateral thoracotomy showed bronchial transection about 1.5 cm from the carina []. The distal end was dissected out from the hilar structures and bronchial continuity was established by an end-to-end anastomosis with 4-0 vicryl interrupted sutures. The child was extubated and was in intensive care unit (ICU) with oxygen support. Early postoperative chest X-ray showed features of pneumonitis, which resolved with intravenous (IV) antibiotics and chest physiotherapy, with complete lung expansion seen on chest X-ray [].
|
[[5.0, 'year']]
|
M
|
{'8639203': 1, '17257954': 1, '9332911': 1, '8845502': 1, '1812265': 1, '8020323': 1, '24019694': 2}
|
{}
|
163,045 |
3764660-1
| 24,019,695 |
noncomm/PMC003xxxxxx/PMC3764660.xml
|
Erosion of small intestine with necrotising fasciitis of over lying abdominal wall after expanded poly-tetrafluoroethylene mesh implantation: A rare complication after laparoscopic incisional hernia repair
|
A 45-year-old lady was admitted to the hospital with 2-day history of pain in abdomen and vomiting. Six years prior to admission, the patient had a caesarean section delivery. She subsequently developed an incisional hernia and underwent a LIHR by an experienced laparoscopic surgeon 6 weeks before. An ePTFE mesh was placed intraperitoneally and fixed with tackers and trans-abdominal polypropylene sutures. Patient was alright for up to 1 month till she started developing vomiting on and off. She was conscious, oriented. Pulse rate was 120/min and blood pressure was 50mm Hg (systolic). There were added sounds on chest auscultation and on abdominal examination, there was mild distension, tenderness, rigidity, guarding and a 7cm fluctuant swelling in right lumbar quadrant with blackish discoloration of overlying skin (the hernia site). Haematological values were Hb, 7.5 g/dl; Total Leucocyte Count, 5,840 cells/cmm; serum biochemical values showed as blood glucose (R), 66 mg/dl;serum creatinine, 1.4 mg/dl; serum albumin, 1.3 g/dl; serum sodium, 142.6 meq/l; and serum potassium, 3.1 meq/l. Ultrasonography abdomen showed: loculated collection in pelvis (~60cc), parietal wall collection (~100cc) in right lower abdomen at the site of previous surgical site communicating with peritoneal cavity and associated scar dehiscence; X-ray chest poster o anterior view showed: patchy-confluent consolidation in bilateral lung fields.\nPatient was admitted in intensive care unit (ICU). Intravenous fluids and inotropic drugs were given and eventually ventilatory support was given for difficulty in respiration and falling arterial oxygen saturation. On all life supports, patient was operated. Intraoperative findings were: necrotising fasciitis of overlying abdominal wall, infected mesh densely adhered to gut, feculent fluid, dense cohesive adhesions and two nearby small bowel perforations [Figures and ]. Liberal debridement of overlying anterior abdominal wall, maximum resection of implanted mesh, small bowel segmental resection and exteriorisation of bowel ends were done. Unfortunately, patient went into multiorgan dysfunction syndrome and expired on post-operative day 3.
|
[[45.0, 'year']]
|
F
|
{'33668318': 1, '12209305': 1, '27011528': 1, '18941863': 1, '14626400': 1, '17180562': 1, '15449157': 1, '26622118': 1, '30701369': 1, '24019695': 2}
|
{}
|
163,046 |
3764661-1
| 24,019,696 |
noncomm/PMC003xxxxxx/PMC3764661.xml
|
A simplified protocol of combined thoracoscopy and laparoscopic excision for large subdiaphragmatic hepatic hydatid cysts
|
A 30 year old lady presented with epigastric pain, dyspepsia and dyspnoea of 4 months duration. There was no history of jaundice or fever. On clinical examination there was moderate hepatomegaly. Routine blood investigations and liver function tests were normal. Ultrasonographic examination of abdomen was suggestive of a large cyst measuring 18 × 16 cm in the right lobe of liver with a typical rosette appearance. Computed Tomography (CT scan) of abdomen was suggestive of a 16x15 cm, hypodense space occupying lesion (SOL) in VII and VIII segments of liver and abutting the right dome of diaphragm []. Chest X-ray posterior-anterior view showed an elevated right dome of diaphragm. In view of the location and size of the hydatid cyst, we planned a combined thoracoscopy and laparoscopic approach for pericystectomy, to minimize the morbidity of thoraco-laparotomy\nPatient was treated with 2 weeks course of Albendazole 10 mg/kg/day and was then posted for surgery.\nUnder general inhalational anaesthesia in supine position, an umbilical 10 mm trocar was placed by open technique. Laparoscopy was done and whole of the abdomen was inspected. There was a solitary hydatid cyst, but only a crescent of it was visible posterosuperior to the right lobe of liver. One 10 mm epigastric and one 5 mm right sub-costal ports were placed under vision. Cyst was assessed for the feasibility of its dissection, but dense adhesions present between the dome of diaphragm and cyst wall, obliterated the subdiaphragmatic plane for dissection. [] At this stage we proceeded to thoracoscopy.\nA 10 mm port was placed in right 6th intercostal space (ICS) in mid-axillary line. Thoracoscopic inspection was done. There was tenting of right dome of diaphragm. A 5 mm working port in anterior axillary line in 5th ICS and 10 mm port in mid-axillary line in 7th ICS were placed. Port placements are shown in . Veress needle was passed through 7th ICS under vision and the cyst was punctured through diaphragm [Figures and ]. Diagnostic aspiration was done, which was suggestive of hydatid cyst as evidenced by clear fluid and daughter cysts in the aspirated content. 100 ml of fluid was aspirated and same quantity of 10% hypertonic saline was injected in to the cyst for its scolicidal effect for 15 minutes. The Verress needle was removed and replaced with a 10 mm trocar in to the cyst cavity. Cyst contents were aspirated with 10 mm suction cannula passed through the trocar. 10 % hypertonic saline and 10% povidone Iodine were alternatively used as scolicidal agents and instilled in to the cyst. Approximately 2 liters of the cyst fluid with daughter cysts was aspirated out. The inner wall of cyst was inspected with telescope passed through intracystic trocar, for any biliary communication, bleeding and residual contents. After ensuring the removal of cyst contents and inner wall; the rent in the diaphragm was sutured with prolene no 2-0 by intra-corporeal knotting. Inter-costal drain was placed. Then re-laparoscopy was done. Now it was possible to visualize most of the cyst wall as it was decompressed thoracoscopically. Also the cyst wall got separated substantially from the diaphragm, as few of the adhesions got divided after decompression facilitating easier liver mobilization. Partial cystectomy was done with monopolar hook. An endobag was introduced through 10 mm trocar in to the peritoneal cavity. The inner wall of cyst was scraped using gauze soaked in hypertonic saline. All the residual daughter cysts were collected in the endobag without spillage. Proper haemostasis was achieved at the edge of Cyst. The entire pericyst was removed. A tube drain was placed in the residual cyst cavity with an omental plug. All trocars were removed and port sites (thoracoscopic and laparoscopic) were closed. Post-operative period was uneventful. Inter-costal drain and abdominal drain were removed on 4th and 5th post-operative day respectively. Patient was treated perioperatively with broad spectrum antibiotics, analgesics, Albendazole and chest physiotherapy. Patient was discharged on 5th post-operative day and is asymptomatic at 9 months follow-up period.
|
[[30.0, 'year']]
|
F
|
{'16798482': 1, '27942301': 2, '21938199': 1, '22678325': 1, '12855097': 1, '33884226': 1, '7387376': 1, '17923196': 1, '3219540': 1, '11093502': 1, '1749287': 1, '16370523': 1, '24019696': 2}
|
{'5139739-1': 1}
|
163,047 |
3764686-1
| 24,019,670 |
noncomm/PMC003xxxxxx/PMC3764686.xml
|
Post meningitis subdural hygroma: Anatomical and functional evaluation with 99mTc-ehylene cysteine dimer single photon emission tomography/computed tomography
|
An 8-year-old boy presented to the neurology department. The parents complained that the child was becoming quieter. In addition, he was having difficulty in walking. This was associated with unsteady gait. There was no history of trauma. The child had a history of bacterial meningitis 2 year back for which he was treated and declared cured. Clinical examination was unremarkable except for reduced power (4/5) in both legs. CSF biochemistry, microscopy, and culture were within the normal limits. Magnetic resonance imaging (MRI) findings revealed bilateral frontal subdural CSF collections, suggestive of hygroma, more marked on the left side []. Similar collection was also noted in relation to the right cerebellum [Figure and ]. As subdural hygroma are known to resolve spontaneously and there was no associated hydrocephalus, the clinician decided for a conservative medical management. Because of the parents concern the child was referred to Department of Nuclear Medicine for evaluation of cerebral perfusion. The child was injected 185 MBq (5 mCi) of 99mTc-ECD intravenously and rested in a quiet room. SPECT/CT of the brain was performed under oral sedation 30 min later. The SPECT/CT images confirmed the subdural hygroma [Figure –]. In addition, it also revealed hypoperfusion in bilateral frontal, parietal and temporal cortices [Figure –]. In contrast to the hygroma, hypoperfusion was more marked on the right side. The occipital cortex and cerebellum showed preserved perfusion while the basal ganglia showed relative hyperperfusion. Based on the combination of SPECT/CT findings and clinical signs, the patient underwent drainage of the subdural hygroma with significant clinical improvement.
|
[[8.0, 'year']]
|
M
|
{'33623260': 1, '21923656': 1, '20019068': 1, '23255125': 1, '8124669': 1, '33393068': 1, '19485721': 1, '7857535': 1, '23290122': 1, '1414825': 1, '16619648': 1, '22044363': 1, '24019670': 2}
|
{}
|
163,048 |
3764687-1
| 24,019,671 |
noncomm/PMC003xxxxxx/PMC3764687.xml
|
Dual ectopic thyroid in the presence of atrophic orthotopic thyroid gland in a patient with acquired hypothyroidism: Evaluation with hybrid Single-Photon Emission Computed Tomography/Computed Tomography
|
A 13-year-old boy presented with stunted growth and poor school performance. A thorough clinical history revealed that initial motor and social developments as a child were within limits. However, the boy was stunted. Local examination of the neck was unremarkable. His Thyroid-stimulating hormone (TSH) was >100 IU/ml. Thyroid antibodies was significantly elevated. His serum free T3 and free T4 were low. An ultrasonogram (USG) of the neck was performed which showed atrophic orthotopic thyroid gland.\nTechnetium thyroid scan [] was performed to evaluate the functional status of the orthotopic thyroid gland. Planar image anterior view (a) and face turned to the right (b) shows 2 foci of tracer uptake in the upper part of the neck. No tracer uptake was noted in the expected location of orthotopic thyroid gland. SPECT CT showed atrophic thyroid gland without any technetium uptake (c) and localized the ectopic thyroid tissues (ETT) to the sub-hyoid location (d) and suprahyoid locations (e). The patient is being managed with thyroxine replacement.
|
[[13.0, 'year']]
|
M
|
{'21713222': 1, '18175113': 1, '22614198': 1, '24761065': 2, '17179793': 1, '21765986': 1, '19232175': 1, '22064096': 1, '27358692': 1, '24761074': 1, '16951442': 1, '15978895': 1, '24019671': 2}
|
{'3996763-1': 1}
|
163,049 |
3764688-1
| 24,019,672 |
noncomm/PMC003xxxxxx/PMC3764688.xml
|
Solitary sternal metastasis from hepatocellular carcinoma detected by F-18 FDG PET/CT
|
A 65-year-old male presented with pain abdomen, progressive deepening jaundice, weight loss of 15 kg and anorexia over last 6 months. Hepatitis B surface antigen was negative. Computed tomography (CT) scan of the abdomen in arterial phase showed a heterogeneously enhancing hypodense lesion in the left lobes and segment VIII of the right lobe of liver. Fine needle aspiration cytology (FNAC) was consistent with primary HCC. F-18 FDG PET/CT performed for visualizing the extent of tumor and metastatic work-up showed solitary sternal metastasis []. He was started on chemotherapy but later on died due to progression of the disease.
|
[[65.0, 'year']]
|
M
|
{'12571212': 1, '16250051': 1, '17504862': 1, '17516087': 1, '11592607': 1, '8741556': 1, '28018100': 1, '15549449': 1, '10845666': 1, '11343235': 1, '19208034': 1, '28874904': 1, '10945530': 1, '11564960': 1, '24019672': 2}
|
{}
|
163,050 |
3764689-1
| 24,019,673 |
noncomm/PMC003xxxxxx/PMC3764689.xml
|
Autoimmune pancreatitis: An incidental detection on FDG PET/CT with response to steroid therapy
|
A 72-year-old gentleman, a diagnosed case of small cell lung cancer stage IIIA, was referred for a whole body 18F-FDG PET/CT study, for pre-treatment staging. Patient was breathless, but had no abdominal complaints. Maximum intensity projection (MIP) image showed intense mediastinal tracer concentration at the site of primary [-arrow]; however also seen was moderately increased tracer uptake in the mid-abdomen [-arrow head]. On axial CT [-arrow] and PET/CT [-arrow] image, a large enhancing FDG avid mediastinal mass was seen, predominantly to the right, encasing the right main bronchus and causing vascular compression. Also, PET/CT image showed diffusely increased tracer uptake in the pancreas [-arrow]. Axial contrast enhanced CT image revealed featureless pancreas with diffuse, homogenous, sausage-shaped enlargement, with minimal post-contrast enhancement, associated with diffuse narrowing of main pancreatic duct [-arrow]. No focal lesion or mass was noted in the pancreas. No calcification, peripancreatic fluid or perilesional adenopathy was seen. Liver function tests and CA-19.9 levels were normal. Though, patient was asymptomatic, based on the imaging features, a suspicion of AIP was raised. This was confirmed by raised serum lipase and amylase levels, and raised IgG4 titer (230 mg/L, normal value < 135 mg/L). Small cell lung cancer was managed with a chemotherapy regimen of four cycles of cisplatin with etoposide (Cisplatin 60-80 mg/m2 on day 1 and etoposide 80-120 mg/m2 on days 1-3, every 21 days). Oral corticosteroid (prednisolone 40 mg/week for 4 weeks, tapering by 5 mg/week for 12 weeks) was given for AIP and thereafter, a follow-up PET/CT study was performed. MIP image showed a significant reduction in mediastinal tracer uptake [-arrow] suggestive of response to chemotherapy, with no tracer uptake in the mid-abdomen. Axial PET/CT [-arrow] and CT image [-arrow] showed no pancreatic tracer uptake, with restoration of normal size and architecture of pancreas. Also normal levels of serum amylase, lipase, and IgG4 were seen. These findings, in retrospect, confirmed the presence of AIP.
|
[[72.0, 'year']]
|
M
|
{'17153461': 1, '20060066': 1, '18430876': 1, '19620430': 1, '24019673': 2}
|
{}
|
163,051 |
3764690-1
| 24,019,674 |
noncomm/PMC003xxxxxx/PMC3764690.xml
|
Left is right and right is wrong: Fluorodeoxyglucose uptake in left hemi-diaphragm due to right phrenic nerve palsy
|
A 36-year-old Indian male, underwent whole body FDG PET/CT for staging of recently diagnosed right lung carcinoma. He complained of cough and difficulty in breathing since last 3 weeks. The PET/CT scan showed increased FDG uptake in right perihilar lung lesion [black arrow in and red arrows in ] compatible with known lung neoplasm. There was no abnormal FDG uptake in the mediastinal lymph nodes. Maximum intensity projection image also showed increased FDG uptake in accessory muscles of respiration-bilateral sternocleidomastoid and inter coastal muscles [blue arrows in ] and unilateral, intense FDG uptake in left hemi-diaphragm [red arrows in Figure and ]. On CT, there was no morphological abnormality in any of the above-mentioned muscles with FDG uptake. Coronal CT image revealed elevated right hemi-diaphragm [arrow in ], suggestive of right diaphragmatic paralysis. Fused PET/CT image [coronal slice, arrow in ], shows intense FDG uptake in left hemi-diaphragm. The maximum standardized uptake value of this uptake was 6.1 (normalized for body surface area). These FDG PET/CT findings suggested a cause-effect relationship, indicating right phrenic nerve palsy caused by the lung neoplasm resulting in right diaphragmatic paralysis. This possibly resulted in asymmetric, intense FDG uptake in the left hemidiaphragm and accessory muscles of respiration, due to compensatory increased workload related to contralateral right diaphragmatic paresis.
|
[[36.0, 'year']]
|
M
|
{'23174735': 1, '9935060': 1, '12122141': 1, '11138567': 1, '15722818': 1, '6292583': 1, '9619304': 1, '10444433': 1, '16517966': 1, '14530472': 1, '24019674': 2}
|
{}
|
163,052 |
3764691-1
| 24,019,675 |
noncomm/PMC003xxxxxx/PMC3764691.xml
|
Skeletal muscle metastases as the initial manifestation of an unknown primary lung cancer detected on F-18 fluorodeoxyglucose positron emission tomography/computed tomography
|
A 65-year-old male presented with pain and swelling of the right forearm. Fine needle aspiration cytology of the swelling showed metastatic squamous cell carcinoma. The patient underwent a whole body F-18 FDG PET/CT to identify the site of the primary malignancy. Increased FDG avidity (standardized uptake value [SUVmax] 9.0) was detected in an irregular heterogeneously enhancing soft-tissue mass in the right paravertebral region in the upper lobe of the right lung with a focus of calcification within the mass [Figure and , white arrow]. Abnormal FDG uptake was also noted in a presacral mass [Figure and ], the bulky left adrenal gland, several dorsal vertebrae and multiple lesions in the trapezius [Figure and , red arrow], right brachioradialis [], deltoid, and right external oblique muscles [], suggestive of metastatic involvement. A diagnosis of primary squamous cell carcinoma of the lung was pathologically confirmed. The patient was treated with 4 cycles of chemotherapy, after which significant decrease in FDG uptake (SUVmax = 5.1) was seen in the primary as well as the right brachioradialis muscle lesion (not shown here).
|
[[65.0, 'year']]
|
M
|
{'15276559': 1, '20698137': 1, '21119274': 1, '30123594': 2, '18092026': 1, '19077783': 1, '15121758': 1, '19358412': 1, '18806583': 1, '21285692': 1, '27651747': 2, '24019675': 2}
|
{'6079606-1': 1, '5020800-1': 1}
|
163,053 |
3764692-1
| 24,019,676 |
noncomm/PMC003xxxxxx/PMC3764692.xml
|
F18 FDG positron emission tomography revelation of primary testicular lymphoma with concurrent multiple extra nodal involvement
|
A 48-year-old male presented with progressive enlargement of right testis of 3 weeks duration. There was associated dragging sensation in the right testicular region and in the lower abdomen. No associated urinary symptoms, fever or weight loss. No medical history of diabetes or hypertension and no family history of any solid or hematological cancers. Physical examination revealed a large right testicular swelling of 10 cm × 8 cm size, firm in consistency with mild pain on palpation, testicular sensation was preserved. There was no accompanying palpable inguinal adenopathy. Contra lateral testis was normal in size and unremarkable on physical examination. Systemic examination was unremarkable. Initial laboratory data revealed mild normocytic normochromic anemia with hemoglobin of 10.2 g/dL, platelet count of 2.9 lakhs/cu mm, lactate dehydrogenase of 369 U/L. Chest radiograph was normal. Patient underwent a computed tomography (CT) scan of the abdomen and pelvis, which revealed an enlarged right testis of uniform density with no retroperitoneal lymphadenopathy and right adrenal was mildly enlarged. FNAC of right testis showed provisional possibility of poorly differentiated carcinoma. Positron emission tomography/CT (PET/CT) was performed for initial assessment and staging, which revealed a markedly enlarged right testis showing intense metabolic activity with standardized uptake value (SUV) max of 35.5. Normal sized left testis also showed intense Fluoro deoxy glucose uptake with SUV max of 15.9. Hyper metabolic activity was also noted in loco regional small volume inguinal nodes bilaterally with SUV max of 15.5. There were additional areas of hyper metabolic activity noted in extra testicular extra nodal sites such as, contra lateral testis, adrenals, and small bowel loops []. Metabolically active area of a CT based hypo dense area encircling the superior vena cava right atrial junction []. Hyper metabolic nodule was noted in the subcutaneous planes of right thigh []. Patient underwent a right inguinal orchidectomy. Histopathology showed enlarged testis measuring 9.5 cm × 6 cm × 6 cm. Cut section was fleshy and grey white. Normal testicular tissue was not evident. Microscopy showed entrapped seminiferous tubules in sheets of monomorphic dyscohesive cells. These cells are large and show vesicular pleomorphic nuclei, clumped chromatin, small nucleoli, and a minimal amount of cytoplasm. Mitosis is increased. Surgical margin of the spermatic cord was free of tumor. Tunica was not infiltrated with tumor []. Immuno histo chemistry was carried out for further typing which showed diffuse membranous CD-20 positivity with increased Ki67 index of 85-90%. CD10 was negative. Findings were consistent with primary testicular diffuse large B cell lymphoma, Post surgery chemotherapy with Cyclophosphamide, Hydroxydaunorubicin, Oncovin (Vincristine), Prednisolone regimen was followed by an interim PET after four cycles of chemotherapy, which showed complete morphological and metabolic regression of all the lesions [].
|
[[48.0, 'year']]
|
M
|
{'3543244': 1, '5007387': 1, '4873149': 1, '12506165': 1, '3529957': 1, '20818615': 1, '10375083': 1, '7037154': 1, '29889027': 1, '23087799': 1, '8917708': 1, '10724045': 1, '10618618': 1, '24019676': 2}
|
{}
|
163,054 |
3764693-1
| 24,019,677 |
noncomm/PMC003xxxxxx/PMC3764693.xml
|
Dual tracer functional characterization of metastatic gastric carcinoid
|
A 32-year-old man presented with features of abdominal pain and enlargement of 6 months duration. Clinical examination revealed a massively enlarged liver reaching up to the umbilicus with no other positive clinical findings. Biochemical examination, liver function tests, and viral markers were within normal limits except for an elevation of serum alkaline phosphatase. A preliminary high-resolution dual phase computed tomography (CT) revealed a grossly enlarged liver with multiple enhancing hypodense lesions suggestive of hypervascular secondaries and thickening of the greater curvature of the stomach []. An upper gastrointestinal (UGI) endoscopy done during the same time revealed a 3 cm × 2 cm ulcer with rolled up edges along the greater curvature of the stomach. FNAC from one of the liver SOL revealed features of neuroendocrine tumor (NET) with positive immunohistochemistry and a Ki-67 index of 40-50%, following which the patient underwent positron emission tomography/CT (PET/CT) using two different radiotracers with differing imaging perspectives: 18F-fluorodeoxyglucose (18F-FDG) (a metabolic tracer) and 68Gallium-DOTA-NOC (somatostatin receptor expressing tumor seeking tracer).\n18F-FDG PET/CT revealed multiple hypodense lesions in liver with focally increased radiotracer uptake, suggestive of poorly differentiated secondaries with high metabolic activity, which was earlier proven on FNAC from a liver SOL [] while foci of increased tracer uptake in a soft-tissue mass at the greater curvature of the stomach was seen on a 68Ga-DOTA-NOC PET/CT scan suggesting a well-differentiated primary somatostatin receptor expressing NET in addition to regional lymph node involvement while the liver lesions showed no tracer uptake []. A gastric biopsy later confirmed this finding (well-differentiated NET; Ki-67 index-2%) []. Based on a combination of these findings the patient was deferred from surgery and instead underwent chemotherapy protocol with etoposide and cisplatin, following which he went into a near total clinical and radiological remission []. The patient however had recurrence later on and despite aggressive treatment even including a bone marrow transplant, he succumbed to his disease.
|
[[32.0, 'year']]
|
M
|
{'8661813': 1, '3227292': 1, '9574618': 1, '7872269': 1, '9024720': 1, '11762349': 1, '9396878': 1, '10418942': 1, '8404961': 1, '1157019': 1, '11216519': 1, '10029611': 1, '9484822': 1, '24019677': 2}
|
{}
|
163,055 |
3764694-1
| 24,019,678 |
noncomm/PMC003xxxxxx/PMC3764694.xml
|
Radionuclide cisternography: A prudent investigation in diagnosing spontaneous intracranial hypotension
|
A 31-year-old male presented to us with the chief complaints of headache and diplopia. The symptoms presented 15 days back when he suddenly developed occipital headache with neck stiffness followed by multiple episodes of vomiting occurring in the next 24 h. The pain was relieved within 15 min of lying down and recurred after 15 min of upright posture. This was followed by complaints of tinnitus and hyperacusis. A day later he also developed diplopia on looking to the left side. There was no history of fever, limb weakness, associated ear or nasal discharge, any trauma or prior lumbar puncture.\nA lumbar puncture revealed low CSF opening pressure and on analysis, normal sugar, high protein content of 200 mg/dl with 10 cells (all lymphocytes) was seen. No organisms were seen on microscopy and culture was negative. A Magnetic resonance imaging (MRI) brain with gadolinium contrast was performed, which showed diffuse pachymeningeal enhancement []. SIH was suspected and the patient was referred to the Department of Nuclear Medicine for radionuclide cisternography (RNC).\nAfter explaining the procedure, a written consent was obtained from the patient and 10 mCi of 99m Technetium Diethylenetriaminepenta acetic acid was injected via a lumbar puncture into the sub-arachnoid space. Serial images were obtained (Philips Precedence 16 single-photon computed emission tomography — computed tomography [SPECT-CT]) in anterior, posterior, and lateral views with the patient in supine position at 1 h, 2 h, 4 h and 24 h. Gradual ascent of tracer was seen along the spinal axis. There was early visualization of the kidneys and bladder on the 1 h delayed image []. Subtle extra-dural tracer accumulation of radiotracer was noted in the region of upper thoracic spine on the right side in the 2 h anterior and posterior delayed images []. Inadequate ascent of tracer over the higher cerebral convexities was noted in the 24 h delayed image [].\nPatient started recovering with bed-rest and good hydration, and was discharged after full recovery with conservative management.
|
[[31.0, 'year']]
|
M
|
{'12122194': 1, '14159070': 1, '27169059': 1, '9146681': 1, '9069493': 1, '15557521': 1, '1549206': 1, '16705110': 1, '8492946': 1, '32646948': 1, '14979299': 1, '11087775': 1, '24019678': 2}
|
{}
|
163,056 |
3764695-1
| 24,019,679 |
noncomm/PMC003xxxxxx/PMC3764695.xml
|
Enterogastroesophageal reflux detected on 99m-technetium sestamibi cardiac imaging as a cause of chest pain
|
A 71-year-old woman with complaints of precordial pain for 2 years was referred to our department for the evaluation of ischemic heart disease. The patient had a history of weight loss, decreased appetite, fatigue, chronic hepatitis C, and cholecystectomy. The patient underwent dipyridamole pharmacological stress test using a 4-min infusion of 0.142 mg/kg/min dipyridamole and subsequently 370 MBq (10 mCi) Tc-99m MIBI was injected intravenously. After 60 minutes, radiotracer injection, stress single photon emission tomography (SPET) imaging with a dual head gamma-camera (GE, Infinia), which was fitted with a low-energy, high resolution, parallel-hole collimator, was performed. Stress MPI showed normal perfusion findings []. SPET images (short-axis, horizontal, and vertical) were reconstructed using a low-pass filter, using no attenuation correction. The images were also evaluated using three-dimensional localization with the standard tomographic sections of the body (sagittal, coronal and transaxial) and then displayed in static slices for further assessment. On the raw projection images, cineloop views and reconstructed slices, radiotracer concentration was seen in the stomach secondary to enterogastric reflux and retrocardiac intense linear activity was seen throughout the esophagus in the midline of the thorax, retromedial to the cardiac activity secondary to gastroesophageal reflux (GER) []. In addition, hepatic clearance was considered very rapid because of there was a little hepatic accumulation during the study.\nAfter stress MPI, immediately, a Tc-99m MIBI whole-body scan performed, no pathologic accumulation of the radiotracer was detected and there was no tracer retention in the esophagus and stomach [].\nFollowing exclusion of a cardiac cause of chest pain, the patient underwent a scintigraphic evaluation for GER and GER observed on the acquired dynamic images. GER was interpreted by three methods: Visual interpretation, time activity curve and condensed image. According to the number of episodes (grade 0: No reflux, grade 1: 1-3 episodes, grade 2: ≥4 episodes) the scintigraphic findings were interpreted as grade 1, according to the location (distal, middle or proximal esophagus) GER was reached proximal 1/3 of the esophagus, and according to intensity (low, moderate or high) interpreted as high [Figure –]. Dynamic images were acquired for 16 min. The patient requested the acquisition be stopped due to patient's discomfort at 16th min and no delayed images of thorax provided. Upper gastrointestinal endoscopic examination of the patient revealed minimal inflammation in the distal part of the esophagus and hyperplastic polyp in the gastric antrum and confirmed pathologically [Figure and ], and there was no evidence of esophageal neoplastic pathology. Antireflux medication (lansoprazole) started by gastroenterologist and symptoms of the patient were improved.
|
[[71.0, 'year']]
|
F
|
{'8708757': 1, '19081872': 1, '10375665': 1, '17146108': 1, '16891012': 1, '14569242': 1, '1595759': 1, '1931549': 1, '19037727': 1, '9087653': 1, '5942973': 1, '9227591': 1, '15724135': 1, '18852377': 1, '9059318': 1, '15052249': 1, '2140856': 1, '11353306': 1, '24019679': 2}
|
{}
|
163,057 |
3764696-1
| 24,019,680 |
noncomm/PMC003xxxxxx/PMC3764696.xml
|
Fluorodeoxyglucose positron emission tomography-computed tomography findings in a case of xanthogranulomatous pyelonephritis
|
A 60-year-old Indian man underwent 18-FDG PET/CT for evaluation of pyrexia and weight loss of 9 kg in 2 months. His blood examination revealed anemia, leukocytosis, and high erythrocyte sedimentation rate. Patient's serum creatinine was found to be raised (1.9 mg%, normal up to 1.4 mg%). His chest X-ray was normal. He was found to have multiple calculi in left kidney on ultrasonography (USG). USG also demonstrated multiple hypo echoic masses; thinned out parenchyma; and a dilated collecting system suggesting a chronically obstructed kidney. Suspicion of pyelonephritis was raised in the USG report and rest of the abdominal organs were unremarkable. Urinalysis showed pyuria and Escherichia coli was detected in urine culture. Antibiotic therapy was instituted for treatment of the urinary tract infection. Even after extensive antibiotic therapy, the fever remained unresolved and weight loss continued. Before invasive diagnosis, patient was referred for a whole body 18-FDG PET/CT to confirm kidney as the sole site of active disease and rule out any extra-renal pathology as the cause of symptoms.\nFor PET/CT, 10 mCi of FDG was injected intravenously to patient after 6 h of fasting. After 1 h of injection, patient was scanned on dedicated 16 slice PET – CT (GE – STE 16). Whole body CT scan was obtained as part of PET/CT protocol on a multi-slice CT with 3.5 mm slice thickness without contrast injection. Contrast administration was withheld considering the increased serum creatinine level. Standardized uptake value (SUV) of FDG was normalized to body weight obtained over lesions.\nThe maximum intensity projection (MIP) image [Figures and , arrows] revealed intense FDG uptake in cortex of grossly enlarged hydronephrotic left kidney. SUV max of uptake was 14.1. Multiple calculi were seen in pelviureteric junction and in pelvi-calyceal system [Figure red arrows]. Extensive perinephric fat stranding and mild FDG uptake in perinephric, retroperitoneal lymph nodes was seen with SUV max of 4.1 [Figure and white arrows]. The findings were reported as possible XGNP. In addition to these findings diffuse FDG uptake was seen in bone marrow [black arrow in ]. This could be due to anemia or the pyrexic state. Left nephrectomy was performed and histopathology confirmed XGNP. Post-nephrectomy, patient's fever resolved and he reported gradual weight gain over last 4 months.
|
[[60.0, 'year']]
|
M
|
{'17418153': 1, '6609582': 1, '17054551': 1, '22105452': 1, '23365780': 2, '16237295': 1, '16160116': 1, '1852939': 1, '34522121': 1, '24019680': 2}
|
{'3556416-1': 1}
|
163,058 |
3764698-1
| 24,019,681 |
noncomm/PMC003xxxxxx/PMC3764698.xml
|
Ventilation/Perfusion scan aids in the diagnosis of diabetes mellitus induced trepopnea due to isolated right phrenic nerve palsy
|
A 27-year-old female with a 3 year history of diabetes mellitus presented with sudden onset dyspnea of 2 weeks duration. Patient is on 5 units of regular human insulin subcutaneously per day and was otherwise asymptomatic. Clinically, patient was conscious, well-oriented with preserved higher functions and intact cranial nerves. No sensory motor deficit was elicited. Patient was well-nourished, afebrile, with a pulse of 84 beats/min, a blood pressure of 120/80 mmHg (right arm; sitting position), a respiratory rate of 20/min and oxygen saturation of 96% on room air. Patient showed no jugular venous distension and cardiovascular examination revealed no abnormality. Trachea was situated in the midline. Patient showed reduced chest expansion and dullness to percussion on the right side and decreased breath sounds in the right posterior lower lung field. Her basic biochemical investigations were negative including D-dimer test. Recent chest X-ray was non-contributory [].\nPatient was referred to Nuclear medicine to rule out pulmonary embolism given the sudden onset of symptoms. 99mTc DTPA (Di ethylene triamine penta acetic acid) aerosol lung ventilation scintigraphy [] was performed followed by 99mTc MAA (Macro aggregared albumin) lung perfusion scintigraphy []. Both sets of images revealed no segmental or sub segmental ventilation — perfusion (V/Q) defects. However, elevation of right hemidiaphragm was noticed in both scans. A fluoroscopic sniff test showed paradoxically moving right diaphragm confirming the diagnosis of unilateral diaphragmatic paralysis that was attributed to isolated phrenic neuropathy caused by diabetes mellitus. Patient was treated with parenteral immunoglobulins.
|
[[27.0, 'year']]
|
F
|
{'13855425': 1, '12127363': 1, '12535814': 1, '18431352': 1, '17294337': 1, '24019681': 2}
|
{}
|
163,059 |
3764699-1
| 24,019,682 |
noncomm/PMC003xxxxxx/PMC3764699.xml
|
Extensive tumor thrombus of hepatocellular carcinoma in the entire portal venous system detected on fluorodeoxyglucose positron emission tomography computed tomography
|
A 50-years-old male, a case of hepatocellular carcinoma (HCC) was referred for a fluorodeoxyglucose (FDG) positron emission tomography (PET) computed tomography (CT) scan for a pre trans arterial radio embolization (TARE) evaluation. He was positive for hepatitis B virus infection. His alpha feto-protien levels were significantly elevated at 34,700.50 ng/ml (normal values 0-15 ng/ml). His scan revealed a moderately hypermetabolic mass in the right lobe of liver, which was the site of the primary HCC. In addition to the primary mass there was extensive hypermetabolic thrombus involving the portal vein and its branches, the splenic vein and the superior mesenteric vein. The maximum intensity projection image shows hypermetabolic thrombus involving the right and left branches of the portal vein (thin arrows), the main portal vein (block arrow), splenic (arrow head) and superior mesenteric (curved arrow) veins []. The CT images show a filling defect completely occluding the lumen of the right and left portal veins and the main portal vein. All these vessels were expanded and were enhancing when compared with the plain baseline images. The mass in the right lobe of liver directly invades the portal vein branches and shows attenuation characteristics same as that of the tumor [, left panel]. The fused PET CT image shows the hypermetabolic tumor thrombus in the branches of portal and in the main portal vein [, right panel]. Hypermetabolic filling defects were also seen in superior mesenteric vein [, upper panel] and splenic vein [, lower panel]. These characteristics of an expanded filling defect in the vessels, enhancing on post contrast images with intense FDG avidity and more over being directly invaded by the tumor itself led to the diagnosis of tumor thrombus over a bland thrombus. Though the patient was referred for a pre TARE evaluation, with such large tumor with extensive malignant thrombus, the patient opted against any invasive treatment option and the patient was put on oral Tyrosine kinase inhibitor.
|
[[50.0, 'year']]
|
M
|
{'16110108': 1, '32215762': 1, '8017372': 1, '17394062': 1, '19933628': 1, '6295617': 1, '20032150': 1, '27408876': 1, '18300346': 1, '17724816': 1, '9057522': 1, '19330189': 1, '17449777': 1, '24019682': 2}
|
{}
|
163,060 |
3764712-1
| 24,049,274 |
noncomm/PMC003xxxxxx/PMC3764712.xml
|
Successful treatment of verruca vulgaris with Thuja occidentalis in a renal allograft recipient
|
A 34-year-old male, a clerk by profession underwent a living donor renal transplantation in 2006 and was maintained on cyclosporine (150 mg daily), prednisolone (10 mg daily), and mycophenolate mofetil (1500 mg daily). He did not receive lytic induction. He was anti-HCV positive and received a 6-months course of interferon alpha 2b before transplantation. During early post-transplant period, he had acute cellular rejection Banff type II A, requiring three doses of methyl prednisolone. There were no opportunistic infections or reactivation of HCV during the 1st year of follow-up.\nA year after transplantation, he developed multiple warty lesions on the dorsum of the fingers of both hands suggestive of verruca vulgaris. These lesions were treated with cryotherapy, cauterization, and radiosurgery with marginal improvement. However, 4 months later, the distal end of the right middle finger revealed ischemic changes and necrosis, needing amputation of distal two phalanges []. Histology of the amputated finger showed nests of malignant squamous cells with keratin pearls infiltrating the dermis []. He returned to our center where excisional biopsies of few existing warts were done. Histology showed hyperkeratosis, parakeratosis, acanthosis and prominent giant eosinophilic keratohyalin granules and eosinophilic intranuclear inclusions with viral cytopathic effect, and mild dysplasia consistent with verruca vulgaris []. Human papillomavirus (HPV) genotype Ia was identified from the specimen. Having lost part of the finger on the right hand, the patient had crippling anxiety and fear that the remaining warts would claim his other fingers and his livelihood. Cyclosporine was replaced with everolimus. Ketoconazole augmentation was given for cost reduction. Cryotherapy and cauterization failed over the next 6 months. At this time, the patient was treated with Thuja occidentalis (T. occidentalis) extract, orally and topically for a period of 7 days at his native place. For external applications, he received mother tincture and as oral preparation he was given potentized medium (power 1m= 1000 times) T. occidentalis as 2 globules thrice a day. By the end of 3rd week of therapy, the warts dropped off leaving only small superficial scars []. The allograft function remained unaffected at creatinine of 1.5 mg/dl. He has been followed up for one year and has not had any recurrence.
|
[[34.0, 'year']]
|
M
|
{'12142612': 1, '12487324': 1, '34285446': 1, '2576234': 1, '16855978': 1, '10630107': 1, '17456615': 1, '24049274': 2}
|
{}
|
163,061 |
3764713-1
| 24,049,275 |
noncomm/PMC003xxxxxx/PMC3764713.xml
|
Percutaneous stent-in-stent placement for renal artery stenosis of a solitary functioning kidney
|
A 37 year old male presented with a history of hypertension for the last 3 years. He was not a smoker and had no family history of hypertension. The blood pressure was 220/120 mm of Hg despite being on nifedipine 20 mg thrice daily, prazosin 5 mg twice daily and clonidine 0.1 mg 3 times daily. He was found to have severe renal insufficiency (serum creatinine: 8.9 mg/dl), hypokalemia (serum potassium 2.9 meq/l), bland urine sediment, contracted left kidney (6.3 cm × 3.4 cm) and normal sized right kidney (9.4 cm × 4.0 cm) with increased echotexture. The cardiac evaluation showed concentric left ventricular hypertrophy with good LV function (EF: 71%) and mild diastolic dysfunction. Color Doppler showed high resistive indices (RI > 1.0) and peak systolic velocity (>180 cm/sec) in both main renal arteries suggesting ostial stenosis. Renal arteriogram showed hemodynamically significant ostial stenosis on both sides. Renal angioplasty and stenting was carried out on the right side with balloon expandable chromium cobalt stent. He received 5000 units of unfractionated heparin in the post procedure period and was started on anti-platelet agents. His serum creatinine decerased to 1.5 mg/dl over the next 4 weeks. The blood pressures were within the normal range on 40 mg of nifedipine daily. He continued to use anti-platelet agents (aspirin 150 mg and clopidogrel 75 mg daily).\nHe presented with flash pulmonary edema after 1½ years of initial stent placement. When his follow-up visits with the local physician were reviewed it revealed a slowly rising blood pressure levels for which an angiotensin converting enzyme inhibitor (ramipril 5 mg) was added in the last 2 weeks. Re-evaluation showed severe renal insufficiency (serum creatinine 10.2 mg/dl). Color Doppler showed no flow across the stent. Renal arteriogram showed near total stent occlusion with no collateral flow into the kidney [].\nRamipril was discontinued and he was given two sessions of hemodialysis. A percutaneous balloon dilatation and stent-in-stent (Medtronic racer: 5.0 mm × 18 mm, cobalt chromium) was placed [Figures and ]. On the 2nd day of stent placement his urine out put improved and serum creatinine started to decline and reached a nadir of 1.5 mg/dl on the 7th day.
|
[[37.0, 'year']]
|
M
|
{'10887230': 1, '11022901': 1, '17377375': 1, '10088889': 1, '17721946': 1, '10326075': 1, '24049275': 2}
|
{}
|
163,062 |
3764714-1
| 24,049,276 |
noncomm/PMC003xxxxxx/PMC3764714.xml
|
Post-infectious glomerulonephritis following infective endocarditis: Amenable to immunosuppression
|
An 11-year-old boy, a known case of acyanotic heart disease since infancy, was admitted with high-grade fever for 15 days. He had cough, respiratory distress, and chest pain for 1 day. On examination, he was conscious but sick looking and had pallor. His pulse rate was 140/min, with all peripheral pulses well palpable. His respiratory rate was 76/min and he had subcostal and intercostal recessions. The blood pressure was 102/60 mmHg. On examination of the chest, the child had bilateral fine crepts. The cardiovascular examination was suggestive of cardiomegaly. A grade 3/6 systolic murmur was heard all along the left sternal border. The second heart sound was loud and palpable. The liver was palpable 5.0 cm below the costal margin and the spleen was palpable 3 cm below the costal margin. A provisional diagnosis of congestive heart failure with a possibility of IE was made.\nThe investigations revealed a hemoglobin concentration of 5.6 g/dL with a microcytic and hypochromic picture. The total leucocyte count was 18,650 (polymorphs 70, lymphocytes 25, eosinophils 2, monocytes 2) and the platelet count was 102,000/mm3. All the three blood cultures sent were sterile. A chest X-ray showed cardiomegaly with congested lung fields. An urgent echocardiogram revealed an atrial septal defect (7 mm) and a restrictive perimembranous ventricular septal defect (5 mm) with multiple vegetations in the right ventricle at the site of impingement of jet and near the ventricular septal defect. A urine examination revealed 2+ proteinuria and 15-20 RBCs/hpf (40% dysmorphic). The kidney function tests showed urea of 64 mg/dl and creatinine of 0.8 mg/dl. A fundus examination revealed bilateral Roth’s spots. A diagnosis of IE with congestive heart failure was made. The child was started on furosemide and intravenous ceftriaxone, vancomycin, and gentamicin. The child received packed cell transfusion. After 5 days his renal functions worsened (urea 58 mg/dl and creatinine 1.7 mg/dl). The antibiotics were changed to piperacillin-tazobactam, teicoplanin and gentamicin in view of renal dysfunction and persistence of fever. Subsequently, the antibiotics were upgraded to meropenem and teicoplanin in view of non-response. The child received antibiotics for a total duration of 6 weeks. The fever subsided but the patient developed periorbital puffiness and his proteinuria increased to 3+ and renal functions continued to be deranged (urea 114 mg/dl, creatinine 1.2 mg/dl). The urinalysis after 6 weeks of antibiotic therapy showed 2+ proteinuria, 18-20 RBC/hpf and 20-25 casts/hpf (both fine and course).\nA renal biopsy done at this time showed moderate degree of chronic parenchymal damage in the form of tubular atrophy and interstitial fibrosis on Masson’s Trichrome stain []. There were 19 glomeruli, of which four were globally sclerosed. The viable glomeruli showed increase in mesangial matrix and cellularity with focal endocapillary proliferation [ and ]. Two glomeruli showed partial cellular to fibrocellular crescents [-]. The basement membrane was unremarkable on silver methenamine stain.\nImmunofluorescence showed fine granular deposition of C3, C1q and IgM in the glomerular capillary walls and mesangium []. Two crescents were positive for fibrinogen stain. A diagnosis of a receding phase of immune complex-mediated proliferative glomerulonephritis with crescents was made.\nThe anti-nuclear antibody was negative and antistreptolysin (ASLO) titers were normal, and C3 complement levels were 117 mg/dl. The serology for hepatitis B surface antigen and anti-HCV were negative. The child continued to have protienuria and also developed edema, while his heart failure was controlled. His total serum proteins were 6.0 g/dl and he had a serum albumin level of 2.8 g/dl. His cholesterol was 190 mg/dl. In view of persistent proteinuria, the child was started on oral prednisolone 2 mg/kg/day for 4 weeks. The child continued to have proteinuria and edema persisted. In view of a proliferative glomerulonephritis on renal biopsy, oral cyclophosphamide was added in doses of 2 mg/kg/day for 8 weeks with alternate-day steroids. At the end of treatment, the child became edema free. His urine protein was negative and his kidney functions had normalized (urea 27 mg/dl and creatinine 0.8 mg/dl). The child has been on follow-up for the last 1.5 years, and has continued to be well. He is off all medications at present.
|
[[11.0, 'year']]
|
M
|
{'10452634': 1, '11071965': 1, '25120306': 1, '32489865': 1, '6702824': 1, '32849876': 2, '2403898': 1, '27891383': 1, '29043144': 2, '16703379': 1, '33078666': 2, '24049276': 2}
|
{'7583404-1': 1, '5438014-1': 1, '7441411-1': 1}
|
163,063 |
3764715-1
| 24,049,277 |
noncomm/PMC003xxxxxx/PMC3764715.xml
|
An unusual cause of gross hematuria and renal dysfunction in a young male
|
A 31-year-old male presented with 1 week history of anorexia, headache, and gross hematuria. He did not have history of fever, urinary tract infection, stone disease, rash, arthralgia, night sweats, and weight loss, nor was there any significant past history. He was a non-smoker and non-alcoholic, and family history was not contributory. On examination, his blood pressure was 180/100 mmHg, heart rate was 100/min and he had mild pallor. Systemic examination was normal and fundus examination did not reveal any changes of hypertensive retinopathy.\nInvestigations revealed normal hemoglobin (11.5 g/l), total leukocyte count (9500/dl) and platelet count (2.4 × 106/dl), but increased serum creatinine (4.8 mg/dl). Urine examination revealed proteinuria (4+) and dysmorphic RBCs (>80% of RBCs), and his 24-h urine protein excretion was 3.8 g. For evaluation of gross hematuria, he underwent cystoscopic examination, ultrasonography and non-contrast computerized tomography of the genitourinary tract, which were normal. Anti-nuclear antibodies, anti-neutrophil cytoplasmic antibodies, anti-glomerular basement membrane antibodies and serum cryoglobulins were negative, so were hepatitis B surface antigen, anti-hepatitis C antibody and human immunodeficiency virus. His renal function further deteriorated, requiring initiation of hemodialysis, and subsequently, a kidney biopsy was performed. The kidney biopsy specimen contained nine glomeruli, and consisted of both cortex and medulla. Light microscopy examination of the biopsy revealed that all the glomeruli showed mesangial expansion, hypercellularity and mesangial nodules. Cellular crescents were present in two glomeruli along with focal glomerular basement membrane thickening. The tubulointerstitial compartment showed fibrosis and atrophy involving <30% of the biopsy area, while the blood vessels were normal []. The mesangial nodules were periodic acid-schiff (PAS) positive but Congo red negative. Immunofluorescence examination revealed 2+ to 3+ diffuse linear staining for kappa light chains in mesangium and tubular basement membrane []. Electron microscopy examination showed powdery electron-dense material in the lamina rara interna of the glomerular basement membrane as well as on the outer aspect of the tubular basement membrane [ and ]. With these findings, a diagnosis of LCDD was made and he was investigated further.\nSerum electrophoresis was performed, which revealed a monoclonal band in the gamma region that, on immunofixation, was confined to the kappa and IgG regions. Serum kappa free light chain level was elevated and bone marrow examination revealed 8% plasma cells. Thus, the LCDD was thought to be non-myeloma related. He was started on bortezomib, thalidomide and dexamethasone regimen. After four cycles, his hematuria settled; however, renal functions did not improve. Repeat serum immunofixation was negative. He was initiated on maintenance hemodialysis on which he is doing well since the last 3.5 years and is planned for deceased donor renal transplantation.
|
[[31.0, 'year']]
|
M
|
{'22096039': 1, '18300034': 1, '22156754': 1, '11423577': 1, '19066331': 1, '21944962': 1, '14712438': 1, '15696120': 1, '8321932': 1, '7917761': 1, '17699367': 1, '11423587': 1, '1621676': 1, '10626147': 1, '24049277': 2}
|
{}
|
163,064 |
3764716-1
| 24,049,278 |
noncomm/PMC003xxxxxx/PMC3764716.xml
|
Severe hypercalcemia unmasked by Vitamin D in a patient with sarcoidosis
|
A 53-year-old lady, detected to be diabetic and hypertensive for 7 years presented with h/o generalized weakness, poor appetite, and constipation of 1 month. She had lost about 1-2 kgs in the preceeding month. There was no h/o fever, night sweats, proximal or distal muscle weakness, arthralgia, or rash. She was post-menopausal and had undergone total abdominal hysterectomy for dysfunctional uterine bleeding 8 years earlier. She denied any respiratory symptoms. Her medications included insulin, glimeperide, atenolol, and multivitamin. She had received two injections of Vitamin D 60,000 International Units (IU) 1 week apart for about a month before presentation elsewhere for suspected osteomalacia. On examination, she was thin built, had a blood pressure of 130/90 m of Hg, pulse rate of 86/min, and respiratory rate of 18/min. General physical examination was non-contributory and no peripheral lymphadenopathy could be appreciated. Systemic examination of the cardiac, respiratory, and abdominal evaluations was normal. Her investigations are summarized in . A thorough work-up was done to investigate the cause of hypercalcemia.\nUltrasound examination of the neck did not reveal any thyroid or parathyroid nodule. Serum electrophoresis was normal and mammogram was negative. Computed tomography abdomen was negative and did not show any lymphadenopathy. High resolution computerized tomography chest revealed reticulonodular shadows in both lung fields, one small paratracheal lymph node and two isolated pleural nodules. With clinical suspicion of sarcoidosis with associated renal failure, a renal biopsy was done and this revealed non-caseating granulomatous interstitial nephritis with features of acute tubular injury []. Patchy chronic interstitial nephritis was also noted. She was initially treated before the biopsy diagnosis with intravenous hydration, furosemide to increase renal calcium excretion, and one dose of calcitonin. A temporary reduction in serum calcium was noted to 13.4 mg/dL. Following the diagnosis of sarcoidosis, she was then started on betamethasone followed by oral prednisone at 1 mg/kg for 1 week, tapered to 0.5 mg/kg at discharge. This led to a gradual fall in calcium levels and some improvement in renal functions. Serum creatinine at last follow-up was stable at 1.5 mg/dL.
|
[[53.0, 'year']]
|
F
|
{'22955801': 1, '18032765': 1, '21209801': 2, '21629348': 1, '15373321': 1, '16694702': 1, '22826146': 1, '20665397': 1, '29285441': 1, '14733420': 1, '17365920': 1, '21282814': 1, '18408317': 1, '22177616': 1, '23109211': 1, '16276266': 1, '22639294': 1, '312811': 1, '29884710': 1, '18021432': 1, '25285443': 1, '33244491': 1, '24049278': 2}
|
{'3014744-1': 1, '3014744-2': 1}
|
163,065 |
3764717-1
| 24,049,279 |
noncomm/PMC003xxxxxx/PMC3764717.xml
|
Non-O1, non-O139 Vibrio cholerae sepsis in a patient with nephrotic syndrome
|
A 33-year-old lady presented with a history of recurrent episodes of headache, myalgia, and occasional episodes of nausea and vomiting for 5 months duration. She was evaluated elsewhere and was treated for migraine, without relief. She had intermittent episodes of hypotension with persistent leucocytosis, for which she was treated with multiple courses of empirical broad-spectrum antibiotics. She developed anasarca 1 month prior to visiting our centre. There was no history of hematuria or reduction in urine output.\nOn examination, she was afebrile; blood pressure (BP) was 110/70 mmHg without postural hypotension. Systemic examination was unremarkable. Investigations revealed nephrotic range proteinuria (14.3 g/day), microscopic hematuria (10-12 red blood corpuscle/high power field), hypoalbuminemia (0.8 g/dl), hypercholesterolemia (455 mg/dl), hypertriglyceridemia (352 mg/dl), and a serum creatinine of 1.08 mg/dl. She also had leucocytosis (15,500 cells/mm3) with a differential count of neutrophil 71%, lymphocyte 19%, eosinophil 3%, monocyte 6%, and basophil 1%. Anti-nuclear antibody (ANA) and anti-double stranded deoxyribonucleic acid antibody (anti-dsDNA) were negative; Complement C3c and C4 levels were normal.\nShe was started on diuretics and intravenous albumin for edema. Blood culture, performed in view of leucocytosis at admission, did not grow any pathogen. Renal biopsy revealed six glomeruli displaying mild increase in mesangial matrix with hypercellularity []. Immunofluorescence study was negative. A diagnosis of idiopathic unsampled focal and segmental glomerulosclerosis was made and she was started on prednisolone at a dose of 120 mg every alternate day. Subsequently, electron microscopy revealed mesangial proliferative glomerulonephritis with few small mesangial electron dense deposits. She was discharged to follow-up as an out-patient.\nFive days after starting oral steroids, she presented to the emergency department with myalgia, giddiness, and weakness. There was no history of fever. On examination, she had tachycardia, tachypnea, and hypotension. Systemic examination was unremarkable. Investigations revealed worsening leucocytosis (15,900 cells/mm3) with neutrophilic predominance (89%) and markedly elevated serum procalcitonin levels (144.5 ng/ml), suggesting possible bacterial sepsis with septic shock. After drawing blood for culture, she was started on broad-spectrum antibiotic coverage with intravenous meropenem. The total leucocyte count increased to 53,500 cells/mm3 the next day. Imaging of chest and abdomen did not reveal any focus of sepsis. The patient was managed in the intensive care unit with meropenem and inotropic support. Clinical improvement started after 72 hours of antibiotics with reduction of inotropic requirement and normalization of the total leucocyte count by the fourth day. Her blood culture grew non-O1, non-O139 V. cholerae, which was sensitive to ampicillin, tetracycline, cotrimoxazole, cefotaxime, ofloxacin, and meropenem. In view of V. cholerae sepsis, a stool culture was done, which did not grow any pathogen.\nOn further questioning, she recalled that 16 weeks before the onset of nephrotic syndrome, she had visited a beach for swimming and bathing. She did not consume any sea-food. The patient completed 2 weeks of meropenem, following which a repeat blood culture was documented to be sterile. She was then discharged in stable condition with advice to continue prednisolone for nephrotic syndrome.
|
[[33.0, 'year']]
|
F
|
{'8852924': 1, '34194844': 1, '8501234': 1, '1311706': 1, '407543': 1, '6980586': 1, '1079322': 1, '26543710': 2, '26825075': 2, '32869555': 2, '8508394': 1, '11682534': 1, '20616193': 1, '9798033': 1, '15582302': 1, '24049279': 2}
|
{'4771811-1': 1, '4771811-2': 1, '8258294-1': 1, '4627963-1': 1}
|
163,066 |
3764718-1
| 24,049,280 |
noncomm/PMC003xxxxxx/PMC3764718.xml
|
Isolated cavitary lung disease in a renal allograft recipient: A rare manifestation of cryptococcus
|
A 38-year-old male, carpenter by occupation received renal allograft in 2004 for end stage renal disease due to chronic glomerulonephritis. The renal donor was his mother. He was not given induction therapy. He received triple drug immunosuppression that included prednisolone, mycophenolate mofetil, and tacrolimus in therapeutic doses. Mycophenolate mofetil was replaced with azathioprine after 3 months due to financial constraints. He maintained good graft function.\nAfter 8 years of renal transplantation, he presented with non-pleuritic chest pain on the right side and breathlessness of 2 days duration. There was no history of fever, cough, or hemoptysis.\nThe examination was essentially, unremarkable except for an area of bronchial breathing over his right mammary region. His hemogram showed hemoglobin of 10.5 g/dL, and normal total and differential leukocyte and platelet counts. Urine examination was normal. The blood urea and serum creatinine were 50 mg/dL and 1.5 mg/dL respectively. The liver function tests were within normal limits. His HBsAg, anti-hepatitis-C virus, anti-human immune deficiency virus, cytomegalovirus IgM antibodies tests were negative. Chest X-ray revealed right mid-zone cavitary lesion with a fluid level []. High resolution computerized tomography showed area of cavitation with nodular density and fibrotic bands suggesting infective pathology.\nBronchoscopy revealed multiple small papillomatous nodules in the tracheobronchial tree. Bronchoalveolar lavage (BAL) was negative for microbial gram stain and culture, nocardia, acid fast bacilli, pneumocystis jiroveci, and malignant cells. Endobronchial biopsy showed pseudostratified ciliated columnar epithelium with squamous metaplasia. Spores of cryptococcus were seen in focal areas in the epithelium. Periodic acid-Schiff stain highlighted the fungus spores []. Although, clinically, there were no signs and symptoms of meningitis, cerebrospinal fluid analysis was done and it was negative for cryptococcal meningitis. He was treated with fluconazole 200 mg twice a day for 6 months and the dose of tacrolimus was decreased keeping the blood tacrolimus levels in the therapeutic range and showed clinical and radiological improvement []. Before starting fluconazole, he was receiving tacrolimum 2 mg twice a day that had to be decreased to 0.5 mg twice a day.
|
[[38.0, 'year']]
|
M
|
{'22167400': 1, '17927804': 1, '18840080': 1, '17262720': 1, '19352182': 1, '16519251': 1, '20047480': 1, '16278598': 1, '8665468': 1, '12201357': 1, '24049280': 2}
|
{}
|
163,067 |
3764719-1
| 24,049,281 |
noncomm/PMC003xxxxxx/PMC3764719.xml
|
Fulminant hepatic failure following marijuana drug abuse: Molecular adsorbent recirculation system therapy
|
A 23-year-old male college student presented to the emergency department with a history of malaise, fatigue and vomiting of 1 week duration. He also had a history of yellowish discoloration of the sclera and breathlessness of 3 days and developed altered sensorium a day prior to presentation. There was no history of oliguria, hematuria, dysuria or graveluria. There was no history of focal weakness of limbs or seizures and bleeding manifestations. He had no significant past medical, surgical or family history. He had no drug allergy. His father gave a history of marijuana abuse for the past few months and denied history of smoking and alcohol. On examination, he was irritable pale and icteric, blood pressure was 130/80 mmHg. Cardio-respiratory examination was unremarkable. Abdomen was soft and showed no evidence of hepatosplenomegaly. Neurological examination revealed no evidence of focal neurological deficit or meningeal signs of irritation. His laboratory parameters are given in .\nTests for hepatitis A, hepatitis B, hepatitis C and E, human immunodeficiency virus, cytomegalovirus, parvovirus, Wilson’s disease, autoimmune hepatitis and acetaminophen induced hepatitis were all negative. Chest radiograph and ultrasonogram of the abdomen were normal. Blood and urine culture were sterile. Peripheral smear for malaria parasite, anti-dengue antibodies and leptospira serology were all negative. Cerebrospinal fluid analysis was unremarkable. Blood and urine for tetrahydrocannabinol (THC) were positive. The diagnosis of acute fulminant hepatitis secondary to marijuana abuse was considered as other causes of fulminant hepatic failure were all ruled out and blood and urine were positive for THC. He was given supportive care and antibiotics. His condition worsened over the next 2 days and developed respiratory distress requiring intubation and ventilator support. Sequential laboratory reports are shown in . On the 3rd day, he was initiated on extra-corporal liver-purification system; MARS. After three sessions of MARS, each lasting 8 h, there was a remarkable improvement in level of sensorium and biochemical parameters. He was extubated on the 6th day and by 10th day his liver parameters came down remarkably. He was discharged after 3 weeks. On follow-up, his biochemical parameters were normal.
|
[[23.0, 'year']]
|
M
|
{'8268613': 1, '15448809': 1, '31294362': 1, '4106633': 1, '10226696': 1, '10980060': 1, '7562536': 1, '15112883': 1, '14689190': 1, '22077243': 1, '24049281': 2}
|
{}
|
163,068 |
3764726-1
| 24,049,297 |
noncomm/PMC003xxxxxx/PMC3764726.xml
|
Four rare extranodal sites seen on FDG PET/CT in a single patient of disseminated lymphoma
|
A 25-year-old gentleman, on anti-retroviral treatment for immunopositivity for HIV, since two years, presented to our institution 4 months back, with history of unexplained fever, weight loss and bilateral axillary swellings. On examination he had palpable bilateral axillary nodes. Recent CD4 count was 550 cells/mm3. A biopsy from the left axillary node confirmed it to be Non-Hodgkin's lymphoma (NHL) B cell type. Patient was then referred for a baseline whole body 18-F Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) study. Maximum intensity projection (MIP) images [] revealed multiple foci of increased tracer uptake in bilateral cervical, axillary, mediastinal and retroperitoneal regions. In addition, there were foci of intense uptake on the left side of abdomen (arrow) and in the pelvis (arrow head), which appeared to be due to physiological tracer excretion into the urinary bladder. Axial fused PET/CT images revealed multiple enlarged FDG avid bilateral axillary and mediastinal nodes. In addition, FDG uptake was seen in enlarged bilateral adrenal glands, left being more than right [, arrows]. There was focal FDG uptake seen in the body of pancreas on axial-fused PET/CT images [, arrow]. FDG uptake in the retroperitoneal region corresponded on CT and fused PET/CT images to exiting nerve roots from lumbar vertebrae [Figure and , arrow]. Also, the FDG uptake in the pelvis which appeared to be excreted tracer in bladder, was in fact seen in the enlarged prostate gland on CT and fused PET/CT images [Figure and , arrow]. Patient received two cycles of intravenous bolus chemotherapy regimen, R-EPOCH (Rituximab with etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone) with methotrexate, after which he was referred for a FDG PET/CT study for treatment response assessment. Post-treatment FDG PET/CT study revealed no abnormal focus of FDG uptake in the entire body, suggestive of complete metabolic and morphological response to treatment [, MIP image].
|
[[25.0, 'year']]
|
M
|
{'16823555': 1, '12672282': 1, '17828824': 1, '3400147': 1, '15764875': 1, '20083598': 1, '15613109': 1, '12075752': 1, '24049297': 2}
|
{}
|
163,069 |
3764727-1
| 24,049,298 |
noncomm/PMC003xxxxxx/PMC3764727.xml
|
Subcutaneous panniculitis-like T-cell lymphoma in a case of carcinoma cervix
|
A 42-year-old lady, presented with two indurated and painful patches in the lower part of her anterior abdominal wall, the right hypochondriac and lumbar regions. This was three months after completing chemotherapy and radiotherapy for a squamous cell carcinoma of the cervix for which she had been operated five months prior to the present complaint. She had received treatment at another hospital.\nOn local examination, there was an ill-defined, diffuse thickening and hardening of the abdominal wall. FNAC was attempted but yielded scanty material, hence was inconclusive. An incisional biopsy was performed and submitted for histopathology.
|
[[42.0, 'year']]
|
F
|
{'25755768': 1, '15482305': 1, '9563791': 1, '9176382': 1, '8178765': 1, '9473239': 1, '9669350': 1, '15166664': 1, '24049298': 2}
|
{}
|
163,070 |
3764728-1
| 24,049,299 |
noncomm/PMC003xxxxxx/PMC3764728.xml
|
Oral submucous fibrosis at pediatric age, now time to think: Series of two cases
|
In 2009, a 11-year-old Indian Muslim girl was referred to the Oral Medicine Clinic, CSM Medical University, Lucknow, India by Public Health Dentist during “School oral health care program”, with a complaint of reduced mouth opening, discomfort and a burning sensation particularly when eating spicy foods.\nPatient showed history of areca nut chewing since seven year; the reduced mouth opening was noticed from past one year, with discomfort and a burning sensation particularly when eating hot and spicy foods.\nIntraoral examination revealed that her entire oral mucosa was pale, especially the buccal mucosa, which does not show areas of erosion and the hard palate, which was completely blanched or opaque. Her tongue, uvula and soft palate were normal.\nDental examination reveals carious lesion in posterior tooth and poor oral hygiene.\nPhysical examination reveals a mouth opening of 14 mm and absence of fibrotic bands.
|
[[11.0, 'year']]
|
F
|
{'12354270': 1, '31057961': 1, '25516862': 1, '11964056': 1, '5660202': 1, '11236919': 1, '28050496': 1, '34824517': 2, '32346505': 1, '28144089': 1, '8327363': 1, '19157321': 1, '26473161': 1, '413949': 1, '7553382': 1, '24049299': 2}
|
{'3764728-2': 2, '8585908-1': 1}
|
163,071 |
3764728-2
| 24,049,299 |
noncomm/PMC003xxxxxx/PMC3764728.xml
|
Oral submucous fibrosis at pediatric age, now time to think: Series of two cases
|
In 2011, another 10-year-old Indian Muslim boy who had not been attending school at all was referred to the Oral Medicine Clinic, CSM Medical University, Lucknow, India by Public Health Dentist during the “Community oral health screening program”, with a complaint of reduced mouth opening, discomfort and a burning sensation particularly when eating spicy foods.\nPatient showed history of areca nut chewing since six year; the reduced mouth opening was noticed from past eight month, with discomfort and a burning sensation particularly when eating hot and spicy foods and loss of gustatory sensation.\nClinical examination of soft tissue of oral cavity reveals blanched or opaque appearance of mucosa, reduced mobility of the soft palate and tongue, loss of tongue papillae and dryness of the mouth.\nDental examination reveals dental fluorosis in the anterior teeth, carious lesion in posterior tooth and a poor oral hygiene.\nPhysical examination reveals mouth opening is 13 mm, with presence of palpable fibrous band especially in the retro molar area but does not involve the uvula and tonsil.
|
[[10.0, 'year']]
|
M
|
{'12354270': 1, '31057961': 1, '25516862': 1, '11964056': 1, '5660202': 1, '11236919': 1, '28050496': 1, '34824517': 2, '32346505': 1, '28144089': 1, '8327363': 1, '19157321': 1, '26473161': 1, '413949': 1, '7553382': 1, '24049299': 2}
|
{'3764728-1': 2, '8585908-1': 1}
|
163,072 |
3764729-1
| 24,049,300 |
noncomm/PMC003xxxxxx/PMC3764729.xml
|
Management of isolated recurrence of extramedullary myeloid tumor at a single site
|
A 9-year-old male child presented with fever, weakness, and easy fatiguability for 1 month. There was no history of cough, chest pain, and bleeding manifestations. Family history was insignificant and there was no other significant past medical history. Physical examination was significant for pallor, bilateral subcentrimetric cervical, axillary and inguinal lymphadenopathy, and hepatomegaly. Investigations revealed hemoglobin of 8.6 gm%, leukocyte count 22.40 × 109/L and platelet count of 78 × 109/L. Peripheral blood examination showed 84% myeloblasts which were myeloperoxidase (MPO) positive. Bone marrow was hypercellular with 58% blasts that showed auer rods and were MPO positive. On flow cytometry, the blasts were positive for CD 13, CD 33, CD117, CD34, CD38, CD15, and CD19 and negative for CD11b and CD64. Fluorescent in situ hybridization (FISH) analysis of the bone marrow revealed the presence of t (8,21) translocation. The patient was classified as having good-risk AML and was treated with standard 3+7 induction with daunorubicin 60 mg/m2 iv push for 3 days and cytarabine 100 mg/m2 continuous 24-h infusion for 7 days. Day 10 marrow was dilute with no excess of blasts, suggestive of good response to therapy. Marrow examination done on day 30, after the recovery of counts, was in morphologic and cytogenetic remission. He was planned for consolidation with three cycles of cyatrabine at 18 g/m2. Following the 1st consolidation, he was detected to have a single hard 1 cm × 2 cm right cervical lymph node. Excisional biopsy of the lymph node revealed the presence of extramedullary myeloid tumor / granulocytic sarcoma. Cytogenetic evaluation showed the presence of translocation t (8, 21) in the aspirate from the lymph node. Imaging failed to reveal any other sites of lymphadenopathy. Bone marrow continued to be in morphological and cytogenetic remission by FISH. He was treated with salvage chemotherapy with two cycles continuous infusion cytarabine (500 mg/m2), Day 1-5, along with cladribine (9 mg/m2) Day 2-6.[] Following two cycles, patient continued to be in both clinical and hematological remission. Though allogenic stem cell transplant was considered as an option, the patient did not have a HLA-matched sibling and matched unrelated transplant was not financially feasible. Further consolidation was given with one cycle of mitoxantrone 8 mg/m2 for 1 day, cytarabine 75 mg/m2 for 5 days and etoposide 75 mg/m2 for 5 days. Maintenance was with six cycles of oral 6-TG 40 mg/m2 for 21 days of 28 days, oral etoposide 50 mg/m2 for 21 days of 28 days, and oral sodium valproate 500 mg twice daily. Following the oral maintenance, the patient was treated with external beam radiotherapy to the right hemi-neck at a dose of 25.2 Gy in 14 fractions. Presently, the child is disease-free and is doing well 18 months post-diagnosis of relapse and 6 months of completing chemotherapy.
|
[[9.0, 'year']]
|
M
|
{'10091734': 1, '21948298': 1, '19717379': 1, '15289011': 1, '7602369': 1, '18592470': 1, '8733701': 1, '17169797': 1, '21200413': 2, '7512442': 1, '21109304': 1, '18076637': 1, '19242495': 1, '24049300': 2}
|
{'2997500-1': 1}
|
163,073 |
3764730-1
| 24,049,301 |
noncomm/PMC003xxxxxx/PMC3764730.xml
|
A diagnostic dilemma in a patient with lymphoma
|
A 49-year-old man, with no significant co morbidities and no history of smoking or alcohol use, presented with upper abdominal pain and flatulence since 3 months. Upper GI scopy was suggestive of ulceroproliferative lesion in the gastric fundus and body. Lactate dehydrogenase (LDH) was elevated at 501 U/L. Gastric biopsy revealed lymphoma with LCA and CD20 positive. Thus, the patient was diagnosed with diffuse large B cell NHL (NHL – DLBCL) of the stomach stage I-EA. He received three cycles of cyclophosphamide, vincristine, epirubicin, and prednisolone (CEOP) chemotherapy. Following three cycles, upper GI endoscopy revealed an ulcerative lesion involving incisura and distal part of lesser curvature and part of antrum, indicative of progressive disease. He then received four cycles of salvage MINE (mitoxantrone, ifosfamide, and etoposide) following which he achieved complete remission. Patient declined further chemotherapy; therefore, he received consolidation radiation therapy with 45 GY/25# over 5 weeks to stomach and perigastric nodes.\nThe patient presented 2 months later with a 1-week history of malena. Examination was unremarkable. Stool occult blood was positive. Upper GI endoscopy revealed gastritis. Gastric biopsy showed chronic inflammation. Bone marrow aspiration and biopsy was normal. As there was no concrete evidence of recurrent disease, no further systemic therapy was given.\nPatient again presented 3 months later with 15-day history of persistent dull aching epigastric pain. Examination was normal. Abdominopelvic computed tomography (CT) scan showed pyloric wall thickness of 1.1 cm, wall thickening around lesser curvature up to 6 mm, tiny sized perigastric nodes, and enlarged left para-aortic nodes in retroperitoneum as well as mesentery. Upper GI scopy showed mucosal thickening in the distal body and antrum of stomach, extending till pyloric rim, with the differential diagnoses being post-treatment changes or residual disease []. Stomach biopsy showed gastric mucosa with acute and chronic inflammation accompanying S. stercoralis larvae [].\nThe patient was treated with ivermectin 10 mg (200 g/kg) daily on two consecutive days.\nAfter 1 month, the patient became asymptomatic. Follow-up upper GI scopy showed erosions in the distal body and antrum of stomach. Biopsy showed no organisms, parasites, or Helicobacter pylori, with no evidence of lymphoma.\nThe patient currently is disease free and asymptomatic over 2 years after completing treatment.
|
[[49.0, 'year']]
|
M
|
{'8879813': 1, '14726461': 1, '9988339': 1, '8254165': 1, '11559724': 1, '32318369': 2, '2646009': 1, '16679166': 1, '24049301': 2}
|
{'7114037-1': 1, '7114037-2': 1}
|
163,074 |
3764732-1
| 24,049,303 |
noncomm/PMC003xxxxxx/PMC3764732.xml
|
Stage IV lung cancer: Is cure possible?
|
A 53-year-old male, chronic smoker, presented with history of left-sided dull aching chest pain for 1 month and significant weight loss of 5 kg in 1 month. There were no symptoms of breathing difficulty, hemoptysis, bony pains, or lumps noticed anywhere in body. Evaluation included a contrast-enhanced computed tomography (CT) of thorax which revealed a left upper lobe peripherally situated mass of size 2 × 2 cm involving chest wall, enlarged pretracheal, prevascular, and aortopulmonary window nodes, and mild left pleural effusion.\nThe common differential diagnoses for weight loss and lung mass with lymphadenopathy in a male smoker in our country are chronic obstructive lung disease, chronic bronchitis, tuberculosis, pneumonia, and lung cancer. Clinical history and thorough examination should be made with careful palpation of the neck for lymphadenopathy and chest auscultation. A chest radiograph is the basis of imaging and is complemented by a contrast-enhanced CT scan of the chest, which should include the liver and the adrenal glands. Tissue diagnosis is mandatory if the clinicoradiological suspicion of malignancy is high and a biopsy should be performed either by bronchoscopy or with CT guidance. If confirmed to be malignant, further staging workup would be required if the chest CT scan shows non-metastatic disease. A metastatic workup would include a positron emission tomography (PET)-CT scan and a magnetic resonance imaging (MRI) scan of the brain.\nOur patient presented to us with a CT scan showing a left upper lobe mass with ipsilateral mediastinal lymphadenopathy and a small pleural effusion. His vitals were normal, physical examination was unremarkable, and ECOG performance status was 1. Fiber optic bronchoscopy showed no endobronchial growth. Diagnostic thoracentesis was performed. Pleural fluid cytology was positive for metastatic squamous cell carcinoma.\nConventional cytologies such as sputum examination, bronchial lavage, bronchial brushings, fine-needle aspiration biopsy have played an important role in the diagnosis of primary and metastatic lung cancers. Immunohistochemical stains can be applied on cytological material. The immunohistochemical markers such as TTF-1, CK7, CK20, 4A4, 34 E12, and p63 help to classify further subtypes in Non-small cell lung cancer (NSCLC). In addition, epidermal growth factor receptor (EGFR) gene mutation studies can also be done on the blocks prepared from cytological material, which helps in choosing appropriate targeted therapy. Thus, cytology plays an important role not only to subclassify tumors but also to individualize treatment strategy with the advantage of easy availability and minimum invasiveness.[]\nThus, the patient was diagnosed with squamous cell carcinoma of the lung, T3N2M1a, stage IV.
|
[[53.0, 'year']]
|
M
|
{'13982100': 1, '20537426': 1, '11569782': 1, '21515066': 1, '7484585': 1, '10487566': 1, '9341895': 1, '1651993': 1, '26835190': 2, '21616674': 1, '16505394': 1, '15158627': 1, '8787451': 1, '8678651': 1, '16580442': 1, '14571170': 1, '33543315': 1, '11713138': 1, '8691861': 1, '4473261': 1, '15405683': 1, '26094729': 1, '21623384': 1, '17825950': 1, '16192576': 1, '11505288': 1, '17225705': 1, '18263769': 1, '30643546': 1, '24049303': 2}
|
{'4725754-1': 1}
|
163,075 |
3764734-1
| 24,049,305 |
noncomm/PMC003xxxxxx/PMC3764734.xml
|
Stomach metastasis of breast carcinoma mimicking primary gastric neoplasm on fluorodeoxy glucose–positron emission tomography–computed tomography
|
We present fluorodeoxy glucose positron emission tomography–computed tomography (FDG-PET/CT) findings in a 53-year-old woman, a case of ductal breast carcinoma, post-modified radical mastectomy status. Six years after surgery, she was found to have skeletal metastases and PET/CT was performed to evaluate baseline pre-chemotherapy disease status. PET/CT, along with skeletal metastases, revealed a hypermetabolic stomach thickening [], which was reported as a possible primary gastric neoplasm. The patient had no abdominal symptoms. Endoscopic biopsy of this lesion demonstrated presence of breast carcinoma metastasis with estrogen receptor positivity []. Stomach metastasis of breast carcinoma is very rare.[] Our case suggests that it is difficult to distinguish a stomach metastasis of breast cancer from a primary gastric cancer on the basis of clinical and imaging features. However, this differential diagnosis must be kept in mind, and it is important to make such distinction because of its implications on patient management.\nPhotomicrograph of the pathology slides (A) shows ductal carcinoma of the breast. The neoplastic cells marked with arrows in B and C demonstrate positive staining for cytokeratin-7 (CK-7) and estrogen receptors (ER), respectively. Final diagnosis of stomach metastasis of breast carcinoma was made and the patient was started on hormonal therapy.
|
[[53.0, 'year']]
|
F
|
{'19650900': 1, '11147591': 1, '12938796': 1, '24049305': 2}
|
{}
|
163,076 |
3764752-1
| 24,049,295 |
noncomm/PMC003xxxxxx/PMC3764752.xml
|
Long-term survivor of human immunodeficiency virus-associated plasmablastic lymphoma
|
A 10-year-old male child presented to our center 7 years ago with a history of swelling of the right side of the face and intermittent fever of 2 months duration. On examination, he had pallor, palatal and upper alveolar mass, bilateral cervical adenopathy and hepatosplenomegaly. Baseline investigation showed Hb–7.3g/dL, TLC − 5.6 × 109/L, platelet count of 181 × 109/L. There was reversal of A: G ratio. Biopsy from oral mass was suggestive of PL. Bone marrow was not involved. ELISA for HIV-1 was reactive. Computed tomography, scan of the face, neck, chest, and abdomen showed a large oral cavity mass lesion with an extensive local spread and bony destruction, retroperitoneal adenopathy, multiple hypo-dense masses in both lobes of liver, with the hepatosplenomegaly. Serum protein electrophoresis showed no M band. Biopsy from oral mass showed sheets of small round cells with eccentric nuclei, vesicular nuclei and prominent nucleoli with plasmacytoid appearance. These cells were immunopositive for leucocyte common antigen (LCA), CD 79a, kappa light chain, epithelial membrane antigen (EMA) and CD138 and immunonegative for CD 20, CD3, MPO, and CD56 [Figures and ].\nFinal diagnosis of HIV associated high-grade lymphoma, plasmablastic type Stage IV was made.\nHe was treated with the high grade NHL protocol (MCP 842 protocol) that included – cyclophosphamide, vincristine, adriamycin, high-dose ara C, ifosfamide, etoposide along-with the central nervous system (CNS) prophylaxis.[] He was simultaneously started on HAART with lamivudine, stavudine and nevirapine. He completed the chemotherapy in 2003 and is in remission until last follow-up about 3 months ago. He is continuing HAART with same medicines and his latest CD4 cell count is 280 cells/mm3.
|
[[10.0, 'year']]
|
M
|
{'26108914': 1, '11555712': 1, '9028965': 1, '26188739': 1, '14616390': 1, '11755827': 1, '26357515': 1, '9358941': 1, '11023505': 1, '15322522': 1, '20418245': 1, '16327436': 1, '15223650': 1, '17094093': 1, '16374212': 1, '11999580': 1, '24049295': 2}
|
{}
|
163,077 |
3764753-1
| 24,049,296 |
noncomm/PMC003xxxxxx/PMC3764753.xml
|
Acute visual loss as the initial presentation in a child with systemic Burkitt lymphoma
|
We report a case of a 3-year-old boy with acute visual loss in both eyes, who had been diagnosed with stage IV NHL with bone marrow, abdominal and CNS involvement. The child was admitted with complaint of acute blindness in both eyes without a remarkable past medical history. In funduscopy, his pupils were fixed at 6 mm in diameter without light perception. Cranial magnetic resonance imaging (MRI) demonstrated masses arising within the sphenoid sinus and invading the orbits and ethmoidal sinuses causing bilateral compression on optic nerves [] The diagnosis of B-NHL was defined cytologically and immunologically in the bone marrow aspirates and cerebrospinal fluid (CSF). Abdominal computed tomography also depicted tumoral infiltration of the kidneys and abdominal lymphadenopathy. His acute blindness was attributed to optic nerve compression in addition to the high proliferation rate characteristic to Burkitt lymphoma. Once the diagnosis was established, he started therapy according to the UKCCSG 9003 protocol. Response to chemotherapy was monitored by appropriate restaging investigations after COP and CYVE II. The boy did not show any visual improvement but some slight light perception despite his partial remission after CYVE II as depicted in restaging investigations. Unfortunately, he relapsed in the CNS and died secondary to neutropenic septicemia 6 months after diagnosis before his scheduled radiotherapy without ever achieving complete remission.
|
[[3.0, 'year']]
|
M
|
{'9649146': 1, '12867117': 1, '17914740': 1, '22398118': 1, '8457514': 1, '11884882': 1, '11369626': 1, '8606720': 1, '1379833': 1, '24049296': 2}
|
{}
|
163,078 |
3764757-1
| 24,023,436 |
noncomm/PMC003xxxxxx/PMC3764757.xml
|
Body Hair Transplantation in Vitiligo
|
A 28-year-old male presented with multiple focal depigmented macules varying from 1 × 1 to 4 × 6 cm in size on the left shin, calves and both ankles [] since past 2 years. Leukotrichia was present. He had applied some Ayurvedic preparation (content not known), which led to phototoxicity resulting in focal scarring on shin. No new lesions were seen elsewhere in the body and the size of the lesions had remained stable for the past 1 years. No history of Koebner’s phenomenon was noted. A diagnosis of vitiligo was made based on the clinical findings. The patient was first started on phototherapy with good improvement, but the areas of scarring [] were not improving despite treatment for 6 months. Body hair transplant was suggested in the areas of scarring. Informed consent was taken. Donor hairs were harvested under aseptic conditions from the right upper thigh by follicular unit extraction (FUE) method [] using 0.8-mm punch under local anaesthesia. A total of 52 intact follicular units were extracted. Follicular units were simultaneously transplanted in directions of existing hairs [] using 19-g needle in the depigmented macules with 5-mm gap between the follicles. After implantation, the hair density was roughly 6-8 FU/cm2. Phototherapy was restarted in the recipient area after 1 week of the procedure. Perifollicular repigmentation in the vitiligo patch was seen at the end of weeks by the patient [], and complete pigmentation was achieved at 12 weeks with partial reversal of leukotrichia []. Colour matching was good, but superficial atrophy was still left because of previous scarring. There was no recurrence after 3 months of follow-up.
|
[[28.0, 'year']]
|
M
|
{'7351492': 1, '9555797': 1, '33034877': 1, '21275943': 1, '24023436': 2}
|
{}
|
163,079 |
3764758-1
| 24,023,437 |
noncomm/PMC003xxxxxx/PMC3764758.xml
|
Body Hair Transplantation: Case Report of Successful Outcome
|
A 63-year-old male presented with extensive baldness. Further, he gave history of previous punch transplantation 18 years back, which had failed to give satisfactory results. Occipital scalp examination showed multiple punch scars and poor density, of only 41 follicular units/sq cm. He was counselled about the poor donor area on scalp and was advised against a transplantation. He was determined to have a transplantation and requested for body hair transplantation, as he had good body hair and had read about the procedure on internet. Detailed counselling was done about body hair transplantation, detailed history taken, general examination performed to rule out any contraindications for the surgery. Investigations including blood counts, sugar, liver and renal function tests, electrocardiogram were within normal limits. Informed consent was obtained and preoperative photography performed. A test graft session by FUE technique was performed to determine its feasibility with 400 units from chest []. The hairs showed satisfactory growth after 5 months and after detailed counselling, larger sessions were planned.\nInitially, the procedure was planned under local cream anaesthesia, using eutectic mixture of lignocaine and prilocaine. However, this proved inadequate in relieving intraoperative pain and it was therefore decided to use tumescent anaesthesia, which was administered as per standard guidelines.[] FUE was performed by using a automated extractor with 0.9-mm punches. Sessions were performed from different areas, such as chest and abdomen [], arms, and thighs on different dates as shown in . shows characters of body hair, such as density and length from different areas. Rate of transection during extraction from different body parts is shown in .\nExtracted grafts were kept in ringer lactate solution [] and then transplanted in to the frontal, parietal, and vertex scalp []. Donor sites healed quickly in 2 days []. The grafts started growing on recipient area from fourth month onwards and reached a length of 3–4 cms by 8 months []. shows length of the grafted hairs after transplantation in to scalp from different areas. Yield (ratio of hairs growing after transplantation and the number of grafted hairs) after grafting from different body areas is shown in .\nPatient was satisfied with the results. The patient has been followed up for a period of 24 months after the first session and 8 months after the last session. The patient’s appearance has altered so much that he has had to change his passport!
|
[[63.0, 'year']]
|
M
|
{'18363725': 1, '18688105': 1, '28584752': 1, '21872192': 1, '31413480': 1, '15544779': 1, '20418979': 1, '12269871': 1, '33911407': 1, '34984086': 1, '24023437': 2}
|
{}
|
163,080 |
3764759-1
| 24,023,438 |
noncomm/PMC003xxxxxx/PMC3764759.xml
|
Successful Treatment of Laser Induced Hypopigmentation with Narrowband Ultraviolet B Targeted Phototherapy
|
A 29-year-old male patient of Fitzpatrick skin type V approached us for tattoo removal treatment. He had a 6-month-old black tattoo of size 3 × 7 cm on the dorsum of his left hand []. He was treated with Qs 1064 nm Nd: YAG () (Dual- pulsed Q-switched Nd: YAG SPECTRA Laser, Lutronic Corporation) laser machine. The parameters used were 3 mm spot size, 2 Hz pulse rate and 3J fluence in the first session. The subsequent sessions were scheduled at 1 month interval and the fluence was gradually increased to 8J. Patient had a very good response to the treatment with 85% clearance of the tattoo but reported to us with depigmentation at 4 weeks after the 6th session of laser treatment []. Patient was then subjected to targeted UVB phototherapy twice a week starting on the same day, using TPT device (Lumera: Targeted Phototherapy, Daavlin Company), which delivered UVB radiations at a dosage of 100 mJ/s, at a full lamp output of 100 mW/cm2. The starting duration of therapy was 4 s and gradually increased by 1 s at every session, depending on the response to previous session. Patient started showing re-pigmentation after two sessions and a very good response was seen after six sessions at 9 s duration of phototherapy []. The energy delivered at 9 s with the Lumera system was 275 mJ/cm2.
|
[[29.0, 'year']]
|
M
|
{'2746004': 1, '10816644': 1, '19293497': 1, '7594638': 1, '15024471': 1, '21061766': 1, '17338685': 1, '24023439': 1, '11442585': 1, '19293495': 1, '16265659': 1, '18637814': 1, '24023438': 2}
|
{}
|
163,081 |
3764887-1
| 24,049,411 |
noncomm/PMC003xxxxxx/PMC3764887.xml
|
Efficacy of traditional treatment regimen on Kati Shoola with special reference to lumbar spondylolisthesis
|
A 59-year-old woman, who attended the Outdoor Patients Department of Ayurvedic Teaching Hospital, Borella, for treatment of her lower back pain, was selected and admitted to the ward. She had a 9-month history of progressively increasing pain in left lower back and both buttocks, but no pain in both legs. She was an otherwise healthy farmer, capable of doing heavy work. She had no history of trauma and her symptoms have increased gradually.\nOn physical examination, prominence of the upper posterior border of the sacrum was observed on the lower back. Patient had little discomfort in buttocks on turning to the lateral side. Straight leg raising test was negative in both legs. She could flex the body forward up to 5°. Motor and sensory functions were normal in right and left legs and both deep and superficial reflexes were also normal.\nAll details of the patient including present history, past history, treatment history, dietary habits, lifestyle, and addictions were recorded before the treatment. Necessary examinations and X-rays in lumbo sacral region were done and findings were recorded. Patient was kept on a normal diet without any specific restrictions and was advised not to lift any weights. The patient was treated with four treatment regimens for 65 days. Details are as below.\nThe patient was treated for 10 days with 120 ml of decoction of Eranda Saptaka with Rasona Methi Abhaya and 30 ml of Punarnawasawaya twice a day before meals. She was also given two pills of Chandraprabha each weighing 250 mg with lukewarm water and 5 g of powder of Safufe Surinjan with honey twice a day after meals. Thirty milliliters of Nirgundi oil was applied on Kati Pradesha (lumbar region).\nDuring the next 10 days, the patient was treated internally with 120 ml of decoction of Madhu Yashtee Nisha Yugma, and 5 g each of paste of Nawarathna and Thripala Churna twice a day before meals.\nSiddhartha Taila Pichu was also carried out by soaking 20 g of cotton in 60 ml of Siddhartha Taila and keeping over Kati Pradesha for 60 minutes in the morning at 10.00 a.m. Then, in the afternoon at 2.00 p.m., 30 g of paste of Ankenda paste was applied on the lumbar region and kept on for 120 minutes.\nFor the third regimen of the treatment, patient was treated internally and externally as mentioned in the second treatment regimen. Additionally, 120 ml of decoction of Dashamula Wenivelgeta was given twice a day before meals from day 21 to day 40.\nFrom day 41 to 65, the patient was treated internally with 120 ml each of decoction of Dashamula Wenivelgeta and decoction of Punarnawashtaka twice a day before meals. Siddhartha Taila Pichu was performed as described in the second treatment regimen. Thirty grams of paste of Wellangiriya was applied on lumbar region in the afternoon at 2.00 p.m. and kept on for 120 minutes.\nAll medicines were prepared at the Pharmacy, Ayurveda Teaching Hospital, Borella, Sri Lanka, according to the Ayurvedic Pharmacopoeia, Department of Ayurveda, Sri Lanka. Decoction of Punarnawashtaka, Punarnawasawaya, pills of Chandraprabha, Thripala Churna, and Nirgundi oil were prepared according to the methods given in the classical text.[] Bhaishayja Ratnavali.\nPreparation of decoction of Dashamula Wenivelgeta\nFive grams each of roots of Dashamula, seeds of Coriandrum sativum (Dhanyaka) and stem of Coscinum fenestratum are boiled together in 1920 ml of water until the final volume is reduced to 240 ml.\nPreparation of decoction of Eranda Saptaka with Rasona Methi Abhaya\nSix grams of each of the ingredients of decoction of Eranda Sapthaka, pericarp of Terminalia chebula (Abhaya), seeds of Trigonella foenum (Methika), and bulb of Allium sativum (Rasona) are boiled together in 1920 ml of water until the final volume is reduced to 240 ml.\nPreparation of decoction of Madhu Yashtee Nisha Yugma\n8.5 g each of roots of Glycyrrhiza glabra (Madhuyashti) and Stereospermum suaveolens (Patala), stem of Coscinum fenestratum, rhizomes of Curcuma longa (Haridra), tubers of Cyperus rotandus (Mustaka), stem bark of Azadirachta indica (Nimba), and Cassia fistula (Vyadighata) are boiled together in 1920 ml of water until the final volume is reduced to 240 ml.\nPreparation of paste of Nawaratna\nFive grams of each of finely powdered seeds of Cumminum cyminum (Jeeraka), Nigella sativa (Krishna Jeeraka), Carum copticum (Ajamoda), Vernonia anthelmintica (Atavi jeeraka), Myristica fragrance (Jatiphala), fruits of Piper longum (Pippali), mace of the fruits of M. fragrance, calyx of Eugenia caryophyllus (Lavanga), stem of the G. glabra, roots of Piccorrhiza curroa (Tikta), rhizomes of Zingiber officinalis (Shunti), resins of Ferula foetida (Hingu), 130 g of finely powdered pericarp of T. chebula (Abhaya), and 65 g of finely powdered pericarp of Terminalia bellirica (Bibhitaka) are ground well, adding honey, till it becomes a fine paste.[]\nPreparation of powder of Safufe Surinjan\nForty-eight grams of roots of Colchicum luteum (Surinjan), 12 g each of seeds of C. cumminum, leaves of Cassia angustifolia (Swarnapatrika), Mentha viridis (Pudina), 36 g of pericarp of T. chebula, and 144 g of sugar candy are powdered together.\nPreparation of Safufe Surinjan\nFive hundred grams of each of the roots of Aegle marmelos (Bilva), Premna intergrifolia (Agnimantha), Oroxylum indicum (Shyonaka), Stereospermum suaveolens (Patala), Gmelina aborea (Kashmarya), Solonum melongena (Vruhathi), and Ricinus communis (Eranda), and entire plant of Alysicarpus Vaginalis (Bhumi Shalaparni), Aerava Lanata (Astmabayda), Solanum Xanthocarpum (Kantakari), Tribulus terrestris (Gokshura), and Sida cordifolia (Bala) are boiled in 92.16 l of water until the volume is reduced to 23.04 l and then filtered. 23.04 l each of extract of rhizomes of Asparagus racemosus (Shatawari), fresh cow's milk, and 5.76 l sesame oil are mixed with the above decoction and heated. Sixty grams of each of finely powdered seeds of Peucedanum graveolens (Shatapushpa), Eletteria cardamomum (Ela) and Carum copticum (Ajamoda); rock salt, stems of Santalum album (Shwetha Chandana), Pterocarpus santalinus (Rakta Chandana), and Coscinum fenestratum, roots of Withania somnifera (Vaji Gandha) and Nardostachys jatamansi (Jatamansi), rhizomes of Acorus calamus (Vacha), Alpinia galanga (Rasna), and Zingiber officinalis, entire plant of Rubia cordifolia (Manjishta), fruits of P. longum (Pippali) and Saussurea lappa (Kushta), purified Shilajatu, and rock alum (Sinhala name: Galmada) are added to the above solution. The whole mixture is heated while stirring continuously, and when it reaches “Samapaka” stage, the medicated oil is taken out from the fire, allowed to cool down, and filtered.[]\nPreparation of paste of Ankenda\nSixty milliliters of juice is extracted from leaves of Acronychia pedunculata (Ankota). Ten grams of finely powdered alum sulfate (Sphaticari) is added to it and heated until a semi-solid paste is obtained.\nPreparation of paste of Wellangiriya\nForty grams of leaves of Paramignya monophylla is ground with 5 g of rhizomes of Curcuma longa and 5 g of common salt (Samudra Lawana), till it becomes a fine paste.
|
[[59.0, 'year']]
|
F
|
{'30595629': 1, '25018032': 1, '24049411': 2}
|
{}
|
163,082 |
3764903-1
| 24,049,385 |
noncomm/PMC003xxxxxx/PMC3764903.xml
|
Challenges on percutaneous nephrolithotomy in pregnancy: Supine position approach through ultrasound guidance
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A 24-year-old female patient, in her 22th week of pregnancy, presented with severe flank pain secondary to a 2.7 cm urinary stone located in the right renal pelvis that was detected by US []. Despite attempts at conservative management, with optimal analgesic treatment, a retrograde placement of a ureteral stent was necessary due to intractable pain []. However, 1 week later, the patient returned with flank pain refractory to analgesics, when she was submitted to ureteroscopy, but with no success.\nPNL was performed with US guidance (without fluoroscopy) and in a supine position [Figure and ]. Fast and safe stone fragmentation through pneumatic energy and removal was possible [Figure and ]. The patient was released from the hospital on the first postoperative day with no tube and pregnancy curse and labor occurred with no complications.
|
[[24.0, 'year']]
|
F
|
{'11972502': 1, '7179620': 1, '27042176': 1, '40462': 1, '2926891': 1, '29560029': 1, '16153221': 1, '19996751': 1, '26751955': 1, '27720776': 1, '9817303': 1, '32134719': 1, '7855714': 1, '30364569': 1, '11890444': 1, '11108925': 1, '24049385': 2}
|
{}
|
163,083 |
3764904-1
| 24,049,386 |
noncomm/PMC003xxxxxx/PMC3764904.xml
|
Angiomatous leiomyoma of the urachus: A rare entity masquerading as extraluminal gastrointestinal stromal tumor
|
A 45-year-old lady came with a gradually increasing painful mass in the lower abdomen for the past six months with recent onset of increased frequency of micturition. There was no history of vomiting, weight loss or alteration in the bowel habits. She was a known case of diabetes mellitus well controlled on insulin, and had undergone tubal ligation 15 years back. There was no significant family history. Her general physical examination was unremarkable. On per abdominal examination, there was tenderness in the right iliac fossa with a mobile palpable mass measuring 5 × 3 cm in size. There was no regional lymphadenopathy. Her routine biochemical and hematological investigations were within normal limits, but she was found to be HBsAg positive. Computed tomography (CT) scan of the abdomen and pelvis revealed a well-defined heterogeneous, mildly enhancing, predominantly hypodense lesion measuring 5.8 × 3.6 cm lying anterosuperior to the bladder on the right side and in close proximity to the right rectus muscle []. It was thought to be an extraluminal GIST arising from the terminal ileum. The patient was undertaken for diagnostic laparotomy. A lower midline abdominal incision was given. The abdomen was opened in layers. A fibrous band was seen extending between the anterior dome of the urinary bladder and the anterior abdominal wall at the umbilicus, which in its central portion showed a 5 × 3 cm well-circumscribed lesion. It was thought to be an urachal remnant and was excised by ligating both its ends and was sent for histopathological examination.\nThe specimen consisted of a well-encapsulated nodular mass measuring 6 × 5 × 3.5 cm. The external surface was smooth with few congested blood vessels. The cut surface was solid homogeneous with gray-white appearance []. Microscopic examination revealed a well-circumscribed smooth muscle tumor comprising of spindle-shaped cells arranged in interlacing fascicles and whorls. The cells had long slender bipolar cytoplasmic processes and cigar-shaped nucleus. The stroma showed myxoid and hyaline change at places. Numerous thick-walled blood vessels were evident with their inner muscle layer arranged circumferentially and outer layer blending with the less well-ordered smooth muscle of the tumor []. Immunohistochemically, the tumor cells were positive for smooth muscle actin (SMA) and desmin; and negative for CD117 (to differentiate from GIST). The vessels showed immunoreactivity for CD34 []. The patient is symptom free with no residual disease or recurrence after a follow-up period of 6 months.
|
[[45.0, 'year']]
|
F
|
{'29796699': 1, '16381359': 1, '1417101': 1, '15245952': 1, '16823045': 1, '12752081': 1, '12629346': 1, '11694966': 1, '16826585': 1, '9634059': 1, '17718222': 1, '11728666': 1, '18097457': 1, '11259707': 1, '24049386': 2}
|
{}
|
163,084 |
3764905-1
| 24,049,387 |
noncomm/PMC003xxxxxx/PMC3764905.xml
|
Paraurethral Skene's duct cyst in a newborn
|
A healthy 12-day-old female infant was referred with interlabial mass. In patient's history, cystic mass was noticed soon after birth and its size did not change during this period. On examination, she had a soft, ovoid cystic mass, approximately 15 mm in diameter. It was located on the right side of the urethral meatus and the urethra was deviated to the left side []. Vaginal patency was also verified. Laboratory investigations included renal function tests, urinalysis, and complete blood count which were all normal. Urinary and pelvic ultrasounds and voiding cystourethrography were normal. Examination under anesthesia was performed. A Skene's duct cyst was identified. Urethral catheterization was done and the cyst was treated by incision and drainage []. Biopsy was not made. The remainder of the examination was normal. The microscopic evaluation of the fluid was normal and no bacterium was detected on culture. The postoperative course was uneventful. No recurrence was observed within 9 months after drainage.
|
[[12.0, 'day']]
|
F
|
{'4002010': 1, '839610': 1, '28551690': 1, '1552435': 1, '27797876': 1, '29264050': 1, '19232290': 1, '18918954': 1, '13457666': 1, '27074810': 1, '24049387': 2}
|
{}
|
163,085 |
3764906-1
| 24,049,388 |
noncomm/PMC003xxxxxx/PMC3764906.xml
|
Feasibility of renal transplantation after unroofing of a large renal cyst in an expanded criteria donor
|
The patient was a 61-year-old male with a history of high blood pressure, who subsequently developed renal failure, and had been undergoing hemodialysis for 3 years before he received a renal transplant. The deceased donor was a 62-year-old male with a 2-year history of hypertension, and cerebrovascular accident was the cause of death. The deceased donor kidney was noted to have a large cyst abutting the main renal artery [].\nThe allograft essentially met the expanded criteria for renal transplantation.[] There was a 1-antigen match in the HLA-DR locus. T and B-lymphocyte crossmatches were negative. The allograft was then prepared for transplantation; the large cyst was unroofed []. The frozen section revealed a benign simple cyst. The graft kidney weighed 340 g with very mild arteriosclerosis and fibrosis, and 3% glomerulosclerosis. The edges were oversewn with a 4-0 PDS suture material; Evicel™ was applied to the base, and the two biopsy sites were oversewn with 5-0 Prolene sutures. The allograft was then transplanted in the usual fashion uneventfully: the renal artery to the external iliac artery and the vein to the external iliac vein.\nThe patient was induced with thymoglobulin and daclizumab. Thymoglobulin (1 mg/kg) was given intraoperatively, with similar additional postoperative doses on days 3 and 5. The first dose of daclizumab (1 mg/kg) was also given intraoperatively, with one additional dose 14 days later. Tacrolimus was initiated at a dose of 0.1 mg/kg twice daily after the renal function had improved, i.e. the serum creatinine concentration decreased to <4 mg/dl in the absence of dialysis. The target (12 h) trough level of tacrolimus was 4-6 ng/ml. The target mycophenolatemofetil dose was 1 g twice daily. Methylprednisolone was given intravenously at 500 mg per day for 3 days postoperatively, with subsequent weaning to complete withdrawal after the first postoperative week; steroid avoidance.[]\nThe postoperative course was uneventful. The patient was discharged with excellent urine out, and at 22 months, the serum creatinine level was 1.4 mg/dl.
|
[[61.0, 'year']]
|
M
|
{'18725015': 1, '11277055': 1, '15082973': 1, '11743266': 1, '18622280': 1, '12694055': 1, '18555108': 1, '10580071': 1, '9075855': 1, '12591293': 1, '19154478': 1, '24049388': 2}
|
{}
|
163,086 |
3764907-1
| 24,049,389 |
noncomm/PMC003xxxxxx/PMC3764907.xml
|
Pure primary small cell carcinoma of urinary bladder: A rare diagnostic entity
|
A 59-year-old male presented in the outpatient department of Urology, R G Kar Medical College and Hospital, Kolkata with the chief complaint of mild hematuria, particularly at the end of the micturition. Patient was a builder by profession and a chronic smoker. His past and family history was insignificant.\nThe patient's urine examination was positive for occult blood with microscopic presence of 3-6 RBC/hpf and negative growth on culture. Ultrasonograph of the urinay bladder revealed a large papillomatous mass measuring 5 × 4 cm arising from left superalateral wall of urinary bladder with no evidence of calculi. Contrast-enhanced computed tomography scan confirmed the anatomical location of the mass along with involvement of the adjacent musculature []. Patient underwent cystoscopy with biopsy of mass, which on histopathological examination was reported as poorly differentiated urothelial carcinoma.\nRadical cystoprostatectomy with pelvic lymphadenectomy along with Studer's neobladder reconstruction was done with ileal wall and the specimen was sent to the Department of Pathology for histopathological examination. Postoperative period was uneventful. Combined ascending and micturating cystourethrography done 4 weeks postsurgery, showed normal flow of contrast through penile urethra in ascending urethrogram along with normal outline of neobladder exhibiting feathery pattern of small intestine [].
|
[[59.0, 'year']]
|
M
|
{'16813945': 1, '26271292': 1, '14644119': 1, '25436014': 2, '1713277': 1, '17270661': 1, '17008012': 1, '11173944': 1, '28115940': 2, '15329903': 1, '15217423': 1, '15855652': 1, '24049389': 2}
|
{'5237721-1': 1, '4246694-1': 1}
|
163,087 |
3764908-1
| 24,049,390 |
noncomm/PMC003xxxxxx/PMC3764908.xml
|
Holmium:YAG laser ablation of upper urinary tract transitional cell carcinoma with new Olympus digital flexible ureteroscope
|
A 62-year-old male with a history of tuberculosis and left nephroureterectomy in 1992 because mastic kidney was admitted to our hospital presenting repeated microscopically haematuria.\nInitially, IVU and CT were performed, without conclusive findings in the collecting system. Due to higher resolution image and diagnostic ability, endoscopy is commonly used to diagnose upper urinary tract tumors by our group in selected cases. Then, using an access sheath 12/14 Flexor TM (Cook) and with the help of a hydrophilic guide wire (Terumo 0.035"), we performed a flexible ureteroscopy, revealing a small papillary tumor in the right kidney middle calyx. A biopsy of the tumor was obtained by 2.4 Fr tipless nitinol basket. The result of the biopsy was a low-grade urothelial tumor. Cytology was negative.\nAfter discussion regarding ureteroscopic treatment of this lesion, including the theoretical risk of tumor recurrences we decided ureteroscopic management of the tumor using Holmium:YAG laser ablation.\nA new 8.5 F Olympus® digital ureteroscope (ODF-URS): URF-V was used to locate the urothelial tumor [] and ablation of the tumor was performed by 200 μm laser Stone Light 15 W Ho: YAG fiber [Figures and ] set at 1.0 J and 10 Hz.\nThe procedure was completed in 30 min, and the estimated blood loss was less than 50 mL. A Foley catheter was placed after surgery up to 12 h.\nPatient hospital stay was 24 h without any post-operative complication. The patient has been followed for 6 months without evidence of recurrence on surveilance ureteroscopy, cytology, cystoscopy or IVU.
|
[[62.0, 'year']]
|
M
|
{'17632132': 1, '20201842': 1, '16190841': 1, '19148506': 1, '11489692': 1, '18578656': 1, '19108945': 1, '15725931': 1, '24049390': 2}
|
{}
|
163,088 |
3764909-1
| 24,049,391 |
noncomm/PMC003xxxxxx/PMC3764909.xml
|
Anterior bladder flap neo urethra as treatment for stress urinary incontinence due to developmental urogenital anomaly
|
A 15 year old girl was referred to urogynecology department (April’08) with severe urinary incontinence since childhood.\nCloacal anomaly was detected soon after birth (March’93) which was managed successfully by the paediatric surgeon with colostomy, anal transposition and colostomy closure. In view of non visualisation of vaginal opening, vaginoplasty at a later date was suggested by the paediatric surgeon.\nA complete workup was done in the urogynecology department. Local examination under anaesthesia showed a very wide and patulous urethra with urinary leakage. A narrow vaginal opening was lying lateral to the urethral orifice (instead being inferior) with a bridge of tissue separating the two []. The vaginal opening could be dilated to expose a normal cervix and adequate vaginal length that did not require vaginoplasty. Radiological imaging (Ultrasonography, Computed Tomography imaging, Micturating Cystourethrogram, intravenous urogram) confirmed normal upper urinary tract. Bladder appeared normal in capacity as well as contour. Features of stress urinary incontinence with markedly decreased valsalva leak point pressure were depicted in the urodynamic assessment. There were no features of bladder outlet obstruction or detrusor overactivity. Cystourethroscopy confirmed patulous short urethra with significant sphincter deficiency.\nDevelopmental urethral anomaly as part of urogenital sinus maldevelopment was the cause of her incontinence so reconstruction of urethra and augmentation of urethral sphincter with autologous fascia lata as pubovaginal sling was done on 11.1.10. During the procedure the dense fibrous scar tissue between urethra and vagina was dissected. After mobilizing the remaining urethra vaginal wall flap was used to lengthen the urethra and reconstruct the external urethral meatus. A harvested strip of fascia lata was laid under the proximal urethra as pubovaginal sling.\nPersistence of significant urinary incontinence was observed in the post operative period. Re-evaluation was done after six months and confirmed persistent short (approximately one cm) urethra with sphincter deficiency. A second reconstruction was planned to form a neourethra. Continent diversion was also an available option but was deferred considering her age and child bearing prospective. Restoring continence with a near normal functional anatomy remained the prime objective.\nOn 21.01.11 examination revealed a nonexistent urethra and bladder neck and the only opening discharging urine was identified as bladder. It was decided to reconstruct the urethra from tubularised anterior bladder wall (modified Tanagho flap). Parallel incisions were made in the anterior wall of the bladder to form a 5 cm × 2 cm rectangular bladder flap preserving its proximal attachment. Scarring around the bladder opening due to previous surgery demanded abdominal mobilization of the bladder. Further extraperitoneal mobilization of the bladder made the anterior wall flap tension free which was then tubularised to create the neourethra. The distal end was brought down at the expected site of meatus to form the external urethral meatus.\nLaparotomy also revealed a lateral fusion defect that included a relatively well developed communicating left horn, rudimentary right horn and a right endometriotic cyst of 4 cm × 5 cm which was drained.\nUrinary drainage was ensured by suprapubic and urethral catheter post operatively. Continuous periurethral leak (leak around the catheter) was observed in second post operative week which was treated with antimuscarinics. Menstrual suppression was given for six months in view of endometriotic cyst.\nInitially frequency, urgency and urge incontinence was significant which improved with antimuscarinics and bladder training. Four months following the surgery, patient has achieved a continent period of 2 hours which is socially acceptable to her and is likely to improve further with bladder training. A normal urinary flow rate and no residual urinary volume excluded bladder outlet obstruction. However, regular and longer follow up with symptomatic and functional assessment is required.
|
[[15.0, 'year']]
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F
|
{'21353080': 1, '985889': 1, '29692510': 2, '5765877': 1, '28352341': 1, '24049391': 2}
|
{'5894289-1': 1, '5894289-2': 1}
|
163,089 |
3764910-1
| 24,049,392 |
noncomm/PMC003xxxxxx/PMC3764910.xml
|
Urothelial carcinoma of the bladder with asynchronous metastases to both testes
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A 71-year-old male presented with clot retention, with a large bladder mass consistent with UC identified by cystoscopy and subsequently fully resected via transurethral resection of bladder tumor (TURBT). Histology confirmed invasive (G3T2) UC with squamous differentiation. CT staging at the time [] revealed a right upper lobe pulmonary nodule of 15 × 15 mm, and a fine needle aspirate confirmed malignant cells. A fluorodeoxyglucose (FDG) study demonstrated uptake only within the pulmonary lesion.\nTreatment was initiated using 66 Gy radiotherapy plus gemcitabine-based chemotherapy. A reduction in the size of the lung metastasis was noted on subsequent FDG PET (PET: Positron emission tomography) scanning.\nApproximately one year after his initial presentation, the patient noted painless swelling of his left testicle. Ultrasound [] confirmed a mixed solid cystic lesion, which was treated by a left inguinal orchidectomy. Histology revealed metastatic UC. At that time, the right testis was normal; however, nine months later, he re-presented with a similar painless swelling in the other testicle and later went on to have a right inguinal orchidectomy. Serum tumor markers at both presentations were negative. Histology again confirmed metastatic UC, with squamous differentiation. The patient thereafter received three-monthly testosterone replacement. On repeat staging computerized tomography (CT), mediastinal lymphadenopathy was noted, but there was no other evidence of metastasis [].\nSubsequently, four-month surveillance CT revealed that the patient's disease had progressed with metastatic disease developing in pulmonary and paratracheal tissue. Ultrasound-guided biopsy confirmed urothelial origin. Despite further systemic chemotherapy, the patient died approximately two years after his initial presentation.
|
[[71.0, 'year']]
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M
|
{'2677407': 1, '33489703': 1, '19157687': 1, '12107023': 1, '16903948': 1, '21178055': 1, '7721183': 1, '15491734': 1, '25120937': 2, '6733686': 1, '11012739': 1, '21603207': 2, '24049392': 2}
|
{'4120918-1': 1, '3095414-1': 1}
|
163,090 |
3764940-1
| 24,019,770 |
noncomm/PMC003xxxxxx/PMC3764940.xml
|
Familial Adenomatous Polyposis and Crohn's Disease in One Patient: Dilemmas and Concerns
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A 29-year-old man presents with bloody diarrhea, progressive asthenia and weight loss (8% of his usual weight in 6 months). Physical examination was unremarkable and laboratory tests showed iron deficiency anemia (hemoglobin 8.5 g/dl, mean corpuscular volume 72 fl, serum iron 8 μg/dl and serum ferritin 5 ng/ml). He was a smoker of 10 cigarettes per day.\nThe patient was followed in our family cancer risk clinic because he belonged to a family with FAP. At the age of 16 colonic phenotype became evident and genetic testing was performed at age 18. Prophylactic proctocolectomy with J-ileal pouch and ileo-anal anastomosis was performed when he was 26 years old and he maintained sphincteric tone with good continence and about 4 bowel movements per day. Annual physical examination, laboratory screening and endoscopic evaluation of the pouch was performed as well as upper gastrointestinal endoscopy as dictated by the Spigelman score (last upper gastrointestinal endoscopy performed 3 months before symptoms).\nOne year before bloody diarrhea and weight loss were noted, multiple ulcers were seen on a routine pouch evaluation. At that time he was completely asymptomatic, hemoglobin levels were normal, and he mentioned a 7-day course of nonsteroidal anti-inflammatory drugs for dental pain. Biopsies showed subacute inflammation. Nonsteroidal anti-inflammatory drugs enteropathy was assumed at that time.\nInvestigation consisted of upper gastrointestinal endoscopy with findings of mild esophagitis and duodenal polyposis (Spigelman II), and pouch endoscopy showed no abnormal features. Stool cultures were negative. Small bowel capsule endoscopy showed multiple deep ulcers, some of them >2 cm long, and a hyperemic and congestive surrounding mucosa (fig. ). Ileoscopy up to 60 cm from the anal verge was performed and multiple biopsies were taken from the ulcerated surface (fig. ). Histology showed ulceration, regenerative changes, inflammation with lymphoid follicle formation and numerous polymorphonuclear cells infiltrating the submucosa. CD was assumed. MRI enterography showed no abnormal findings other than mucosal uptake in the jejunum and ileum.\nWe considered him to be a high-risk patient as he was a young smoker, with severe small bowel involvement from CD including the upper gastrointestinal tract (jejunum), already submitted to small bowel surgery (ileal pouch). After the mandatory viral serology tests and latent tuberculosis screening, 60 mg of oral prednisolone was started, with slow tapering during 12 weeks, while azathioprine was escalated up to 2.5 mg/kg. Iron supplementation was started. One year after diagnosis of CD the patient is symptom-free, has gained back 8 kg and has a normal hemoglobin level with replenished iron reserve.
|
[[29.0, 'year']]
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M
|
{'7851206': 1, '21708105': 1, '22237781': 1, '21602529': 1, '8199592': 1, '20556747': 1, '29670872': 2, '19755972': 1, '18194984': 1, '16009685': 1, '22081510': 1, '16775703': 1, '24019770': 2}
|
{'5893786-1': 1}
|
163,091 |
3764942-1
| 24,019,775 |
noncomm/PMC003xxxxxx/PMC3764942.xml
|
Diphenylcyclopropenone-Induced Vitiligo in a Patient with Alopecia Universalis
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A 52-year-old, diabetic, white male presented with an 18-year history of generalized hair loss. The patient was diagnosed as having AU. Upon examination, there was a universal loss of hair on the whole scalp, the face, the eyebrows and eyelashes, the arms, the axilla, the moustache and the beard areas. Dermoscopy did not show any cicatrization, but extensive areas of yellow dots and small areas with black dots and fine, small exclamation-mark hairs were noticed. There were no signs of regrowth in any of the affected areas. Nails and mucous membranes were normal. He had a positive family history of alopecia areata, but no family or personal history of vitiligo. Laboratory investigations showed an elevation of antithyroid peroxidase and antinuclear antibody (1:160) speckled pattern. Antiparietal cell antibody and anti-intrinsic-factor antibody were negative. Thyroid function test, homocysteine and vitamin B12 showed normal levels. Before attending our OPD clinic, the patient underwent topical and intralesional steroid therapies at another hospital without improvement. In January 2011, we decided to initiate DCP therapy on the scalp only. Following the classic sensitization regimen, we started with one 2% application, followed by 0.0001% after 2 weeks, and then a weekly dose escalation guided by the appearance of erythema and the contact dermatitis reaction. The scalp showed erythema and crusts formation during therapy with no signs of hair regrowth. In July 2011, after 6 months of therapy and when we had reached a concentration of 0.01%, the patient presented with multiple white patches on the occipital and parietal areas of the scalp, diagnosed clinically and by Wood's light examination as vitiligo (fig. ). We discontinued DCP and from July 2011 to April 2012, we administered a combined therapy of monochromic excimer laser radiation (308 nm; XTRAC, Photomedex, USA) in 3 sessions weekly (total dose 18.3 J/cm2) combined with topical pimecrolimus 1% cream twice daily. Depigmented areas showed a mild improvement, but this combined therapy had no effect on hair regrowth. The patient discontinued both lines of treatment. In September 2012, we started a low-pulse prednisone therapy, administering 80 mg prednisone per day on weekends (2 days of therapy and 5 days off treatment) for 4 months (until January 2013). In conjunction with prednisone, we prescribed topical prostaglandin E2 solution (Latisse: bimatoprost 0.03%) for the eyebrows and eyelashes. The hair regrowth was significant. After years, he at last achieved hair regrowth on his scalp, even though the vertex showed a moderate, androgenic, permanent loss of hair. His eyebrows recovered, but his eyelashes showed no response. He also experienced considerable though incomplete repigmentation of areas of skin with vitiligo. Oral pulse prednisone therapy was tapered and then discontinued after 4 months. Potent topical clobetasone propionate 0.05% ointment was applied once daily to the scalp in addition to topical pimecrolimus 1% cream twice daily to the moustache and beard areas. Topical prostaglandin E2 solution was continued for the eyebrows and eyelashes. The topical therapies were continued for the next 16 weeks (until May 2013). The improvement was satisfactory for the patient, although tiny residual patches of colocalized alopecia and vitiligo can still be seen on the vertex and occipital areas (fig. ). Regrowth of his facial hair is almost complete, especially his moustache. There has been no relapse and hair growth has continued. A maintenance therapy consisting of a topical weekend application of local agents is being continued with no intention of interruption. A spontaneous regression of both conditions cannot be ruled out.
|
[[52.0, 'year']]
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M
|
{'1580660': 1, '20055821': 1, '9649675': 1, '21839315': 1, '3169339': 1, '21712899': 2, '22458952': 1, '23760330': 1, '22215015': 1, '19347085': 1, '22811720': 2, '20585597': 1, '8170863': 1, '8547018': 1, '20747100': 1, '10571834': 1, '22881476': 1, '21057754': 1, '14870990': 1, '20596022': 1, '2206982': 1, '19989979': 1, '24019775': 2}
|
{'3395361-1': 1, '3395361-2': 1, '3107954-1': 1}
|
163,092 |
3764943-1
| 24,019,773 |
noncomm/PMC003xxxxxx/PMC3764943.xml
|
Signet-Ring Cutaneous Squamous Cell Carcinoma Arising on the Back of the Finger
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An 83-year-old man presented with a skin lesion on his left hand. He had no medical history of note. He first noticed the skin lesion 3 years ago and it had gradually enlarged. Physical examination revealed a 31 × 21 mm, reddish-brown, erosive macule on the back of the left fourth finger (fig. ). Medical imaging, including PET/CT, could not detect any other neoplastic lesions on the body. A biopsy taken from the lesion showed a thickened epidermis with parakeratosis, but no granular layer. We also observed an abnormal stratified arrangement, cytologically atypical keratinocytes (fig. ) and an inflammatory cell infiltrate in the dermis. Notably, numerous signet-ring cells with crescentically compressed nuclei were seen extending to the cellular border (fig. ). The results of mucicarmine and periodic-acid Schiff staining were both negative. Based on these findings, a histological diagnosis of solar keratosis, which was expected to advance to SCC, was made. The lesion was therefore excised with a 5-mm margin and the wound was covered by a skin graft.\nHistological examination of the whole tumor revealed irregular masses of proliferating tumor cells with invasive, atypical epidermal keratinocytes. Horn pearl cells and cells with individual keratinization were also present. The border of the lesion showed focal parakeratosis and a loss of normal epidermal stratification. Signet-ring cells were present, both at the border and throughout the tumor (fig. ). Immunohistochemistry revealed that the tumor cells were negative for CK20, carcinoembryonic antigen, vimentin, HMB45, Melan A and desmin. A final diagnosis of signet-ring SCC was made. The patient has been monitored for 3 years, but no recurrence has been noted to date.
|
[[83.0, 'year']]
|
M
|
{'19751229': 1, '22559018': 1, '9550318': 1, '32675973': 1, '26155484': 1, '27066782': 2, '2467552': 1, '10495385': 1, '24019773': 2}
|
{'4827219-1': 1}
|
163,093 |
3764944-1
| 24,019,776 |
noncomm/PMC003xxxxxx/PMC3764944.xml
|
Subacute Cutaneous Lupus Erythematosus Triggered by Radiotherapy
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A 72-year-old woman underwent breast cancer surgery and received adjuvant systemic treatment with the estrogen receptor antagonist tamoxifen 20 mg/day, which was discontinued after the patient developed a generalized skin rash about two weeks after the initiation of tamoxifen. This rash was clinically and histologically diagnosed as erythema exsudativum multiforme, which rapidly resolved under systemic treatment with prednisolone. Tamoxifen was discontinued. The patient afterwards received radiotherapy of the left breast. A cumulative dose of 40 Gy in 15 fractions was administered and was initially well tolerated by the patient. After finishing radiotherapy, our patient developed a painless maculopapular erythema on the left breast limited to the irradiated area.\nHistology of a skin biopsy taken from the left breast showed an acute interface dermatitis with vacuolization of the dermo-epidermal junction, apoptotic keratinocytes in the basal epidermis and a mild, predominantly lymphocytic, infiltrate within the superficial dermis and with few admixed neutrophils and eosinophilic granulocytes.\nThese histological changes were consistent with subacute cutaneous lupus erythematosus (SCLE). Because of the presence of eosinophilic granulocytes in the inflammatory infiltrate, a fixed drug eruption was considered a differential diagnosis. An allergic reaction to tamoxifen was ruled out by a negative scratch-patch test.\nSerology revealed elevated titers for antinuclear antibodies 1:2,560, anti-SS-A at >3,400 U/ml, anti-SS-B at >3,400 U/ml and rheumatoid factor at 41 IU/ml. Complement components (C3 and C4) were within normal limits and urine analysis was unremarkable.\nBased on the patient's history, the clinical presentation of the skin lesions, serologic results, histopathology and allergy testing, a diagnosis of SCLE – presumably triggered by radiotherapy – was made.\nThe administration of topical corticosteroids and systemic hydroxychloroquine at 400 mg/day led to a total disappearance of the lesions on the left breast within 6 weeks.
|
[[72.0, 'year']]
|
F
|
{'22577279': 1, '9390351': 1, '6982644': 1, '8133066': 1, '11423840': 1, '16384753': 1, '12081934': 1, '15785062': 1, '533284': 1, '34401433': 1, '15990071': 1, '2777673': 1, '34458649': 2, '24019776': 2}
|
{'8377432-1': 1}
|
163,094 |
3764945-1
| 24,019,764 |
noncomm/PMC003xxxxxx/PMC3764945.xml
|
Extraperitoneal Fluid Collection due to Chronic Pancreatitis
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A 39-year-old man was referred to our hospital for the investigation of abdominal fluid collection. He had no symptoms before this admission, but he was pointed out to have alcoholic chronic pancreatitis with calcification and multiple pseudocysts by medical checkup. Laboratory data on admission showed high levels of C-reactive protein at 12.4 mg/dl (normal <0.3), a white blood cell count at 20 × 103/mm3 (normal 3.9–9.3 × 103), direct bilirubin at 2.2 mg/dl (normal 0.2–1.0), amylase at 185 IU/l (normal 36–120), low levels of red blood cells at 176 × 104/mm3 (normal 400–540 × 104) and hemoglobin at 6.7 g/dl (normal 12–16). Abdominal computed tomography demonstrated huge fluid collection pressing on the visceral organs, multiple pancreatic pseudocysts and pancreatic calcification (fig. ). The fluid showed a high level of amylase at 4,490 IU/l. Under the diagnosis of pancreatic ascites, at first conservative therapy and continuous fluid drainage was done, but reduction of discharge was not observed. Endoscopic pancreatic stent insertion was attempted but was unsuccessful. Under the diagnosis of pancreatic ascites caused by disruption of the pancreatic duct and rupture of a pancreatic pseudocyst, surgical treatment was attempted. At laparotomy, a huge amount of fluid containing bile acid (amylase at 1,474 IU/l and bilirubin at 13.5 mg/dl) was found to exist in the extraperitoneal space (over the peritoneum) (fig. ), but no fluid was found in the abdominal cavity. Extraperitoneal fluid collection due to chronic pancreatitis was diagnosed, and Frey procedure, cystojejunostomy, cholecystectomy and T tube placement in the common bile duct were performed. His postoperative course was uneventful and he has shown no recurrence of the fluid for 2 years.
|
[[39.0, 'year']]
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M
|
{'6402923': 1, '4704038': 1, '7622943': 1, '618422': 1, '4825832': 1, '8509046': 1, '9659142': 1, '14818413': 1, '16943673': 1, '16724995': 1, '31522387': 1, '970546': 1, '1259581': 1, '6177058': 1, '5414267': 1, '984927': 1, '24019764': 2}
|
{}
|
163,095 |
3764946-1
| 24,019,772 |
noncomm/PMC003xxxxxx/PMC3764946.xml
|
Acral Peeling Skin Syndrome Resembling Epidermolysis Bullosa Simplex in a 10-Month-Old Boy
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Here, we report on a 10-month-old boy with a history of skin peeling limited to the hands and feet since 2 months of age. His mother noticed worsening of the condition with heat and humidity but not by mechanical trauma. The baby was born from a normal pregnancy and delivery and has non-consanguineous parents. The family history was negative. Clinical examination showed erythematous erosions with desquamation at the periphery on both palms and soles as well as a flaccid blister on the finger of the right hand (fig. , fig. ). The mycological examination of the palms and soles was negative. The baby's mother refused a skin biopsy from the edge of a fresh blister for histological examination. DNA mutation analysis was performed in the 10-month-old boy as well as in his mother and father. From the extracted DNA of the index case, the entire coding region and the flanking intronic regions of the TGM5 gene (Genbank NM_201631.3, NC_000015.9) were analyzed using the PCR followed by DNA sequencing as described []. In the parents, only the coding exons 1 and 3, and the flanking intronic regions were analysed. In the index patient, we detected two heterozygous TGM5 mutations: c.2T>C, p.M1T in exon 1 and c.337G>T, p.G113C in exon 3. The father is a heterozygous carrier of the mutation c.2T>C, p.M1T and the mother is a heterozygous carrier of the mutation c.337G>T, p.G113C (fig. ). No other mutations were disclosed in the analyzed regions.\nThe baby's parents have been advised to communicate with a human geneticist or a genetic counselor. They were informed about preventive measurements: avoid heat and humidity by using shoes made from breathing textile materials and leather as well as to use topical emollient application.
|
[[10.0, 'month']]
|
M
|
{'22622422': 1, '21944047': 1, '25549719': 1, '16709496': 1, '25785582': 1, '22066523': 1, '23534700': 1, '20164844': 1, '19440220': 1, '16380904': 1, '24019772': 2}
|
{}
|
163,096 |
3764948-1
| 24,019,778 |
noncomm/PMC003xxxxxx/PMC3764948.xml
|
Severe Acute Rhabdomyolysis Induced by Multi-Agent Chemotherapy for Alveolar Rhabdomyosarcoma in a 15-Year-Old Female: A Case Report
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A previously healthy, 15-year-old Japanese female presented with right nasal congestion and a right submandibular mass. On admission, physical examination revealed only a submandibular mass (approximately 2 cm in diameter), which was solid, painless and immovable; no other remarkable abnormalities were found. Laboratory findings were all within normal limits: blood urea nitrogen (BUN) 10 mg/dl, creatinine 0.58 mg/dl, aspartate aminotransferase (AST) 34 U/l, alanine aminotransferase (ALT) 16 U/l, lactate dehydrogenase (LDH) 533 U/l, C-reactive protein (CRP) 0.02 mg/dl, and creatine kinase (CK) 92 U/l. Magnetic resonance imaging showed a mass in the right maxillary sinus with hyperintensity on T1- and T2-weighted images, which were enhanced by gadolinium. FDG-positron-emission tomography and bone and Ga scintigraphy revealed multiple metastases in the right submandibular and bilateral cervical lymph nodes, and bones (thoracic and lumbar vertebrae, right humerus and right sacroiliac region). Bone marrow metastasis was not detected. Histological examination showed monotonous proliferation of small round tumor cells, which were positive for desmin and HHF35. PAX3-FKHR gene alteration was positive in real-time polymerase chain reaction. These findings indicated a diagnosis of alveolar rhabdomyosarcoma (stage 4 of the IRS-V TNM staging classification, group IV of the IRS clinical grouping classification).\nShe received etoposide, cyclophosphamide, pirarubicin, vincristine and cisplatin as her first cycle of chemotherapy without any adverse effects. Her CK level was within normal range during this cycle of therapy. The second cycle of chemotherapy consisted of etoposide (100 mg/m2 intravenously for 5 days), ifosfamide (1,800 mg/m2 intravenously for 5 days), actinomycin-D (0.015 mg/kg intravenously for 5 days) and vincristine (1.5 mg/m2 intravenously on days 1 and 8). Twenty-four hours after the end of chemotherapy, she developed a high fever, generalized myalgia and pigmenturia. After 4 days, her condition deteriorated rapidly. She suffered from disturbance of consciousness, respiratory failure, ARF, acute liver dysfunction and disseminated intravascular coagulation. She was treated with mechanical ventilation and fluid replacement. The laboratory examination showed; CK 114,268 U/l (CK-MB 0.16%), BUN 41 mg/dl, creatinine 3.01 mg/dl, total bilirubin 7.8 mg/dl, AST 1,187 U/l, ALT 204 U/l, LDH 4,330 U/l, CRP 22.13 mg/dl, fibrin degradation products 10.6 μg/ml and D-dimer 3.1 μg/ml. These findings were consistent with rhabdomyolysis. The estimated glomerular filtration rate (eGFR) using serum creatinine was 27.1 ml/min/1.73 m2. Even after extubation, she remained in an oliguric state and was bedridden due to severe muscle atrophy. She was treated with continuous hemodiafiltration or continuous ambulatory peritoneal dialysis (CAPD).\nIn order to search for the cause of rhabdomyolysis, we performed magnetic resonance imaging, evoked electromyography, nerve conduction study, a muscle biopsy from the right musculus quadriceps femoris, bacterial cultures and additional laboratory tests. Evoked electromyography and nerve conduction study showed no indication of neuropathy. The biopsy section showed marked size variation of muscle fibers with occasional central nuclei. There were basophilic muscle fibers, suggestive of regeneration of damaged fibers in the frozen sections. Small angular fibers and a nuclear clamp were also seen. A mild endomysial mononuclear cell infiltrate was noted. Necrotic muscle fibers were not evident. These histological features of the muscle biopsy were compatible with the regenerative process of rhabdomyolysis. A high CRP level suggested severe infection, although all bacterial cultures were negative. The final diagnosis was nontraumatic rhabdomyolysis, and anticancer drugs were thought to be responsible for rhabdomyolysis because other possible causes were unlikely. However, the particular causative drug was unclear.\nAfter discontinuing CAPD, the patient's conditions improved slowly, and low-dose chemotherapy (vincristine, actinomycin D and cyclophosphamide) and local radiation therapy were started 5 months after the episode of rhabdomyolysis. Forty-eight months after the initial presentation, she maintained complete remission. Her renal function has improved to the latest eGFR of 96.5 ml/min/1.73 m2, although it still takes some effort for her to walk and she continues to receive rehabilitation.
|
[[15.0, 'year']]
|
F
|
{'18650507': 1, '11807638': 1, '16574552': 1, '6416944': 1, '17079586': 1, '3967373': 1, '77729': 1, '10221868': 1, '19571284': 1, '10870133': 1, '11793103': 1, '25432075': 1, '7078398': 1, '3382301': 1, '21249398': 1, '1545444': 1, '8832525': 1, '2654542': 1, '19481857': 1, '12210815': 1, '17611408': 1, '24019778': 2}
|
{}
|
163,097 |
3764949-1
| 24,019,774 |
noncomm/PMC003xxxxxx/PMC3764949.xml
|
Hepatitis and Lupus-Like Syndrome during Infliximab Therapy for Psoriasis
|
A 23-year-old female presented with generalized plaque psoriasis of 10 years duration. She was married and using an intrauterine device for contraception. Her quality of life was severely affected (dermatology life quality index = 16), body surface area involvement was 17%, and her body mass index was 28 (overweight). Scalp, nails and flexures were involved, while the palms, soles and joints were spared at that time. The patient had received different systemic and topical conventional therapeutic modalities including methotrexate (cumulative dose of 430 mg) with variable responses. She had no history of alcohol consumption or smoking and no history of other drugs that may exacerbate or induce hepatitis or lupus erythematosus. Infliximab was initiated in February 2010 at a dose of 5 mg/kg per infusion session on 0, 2 and 6 weeks and then every 8 weeks. The patient responded nicely to therapy, but after the fifth injection session in July 2010, she noticed dark urine and lethargy. Liver function tests showed a marked elevation in liver enzymes and total bilirubin. The level of immunoglobulin G was 2,100 mg/dl, i.e. about 130% of the upper limit (normal 700–1,600 mg/dl); other immunoglobulins (IgM and IgA) showed normal findings, while anti-nuclear antibodies (ANAs) turned positive with a titer of 1:320 (speckled). The laboratory results are displayed in table . Screening for viral hepatitis (A, B, C and E) showed negative result. Anti-microsomal antibodies, anti-mitochondrial antibodies, anti-soluble liver antigen, anti-smooth-muscle antibody, anti-liver-kidney microsomal antibodies, prothrombin time and international normalized ratio were all within normal ranges or negative. Anti-soluble liver antigen/liver-pancreas antibodies and pANCA were not done. Liver ultrasound was normal, showing normal hepatic size and echogenicity as well as normal gallbladder and bile ducts.\nThe patient did not give consent for liver biopsy. She was diagnosed as suffering from AIH and given corticosteroids; the following dose of infliximab was suspended. Her liver function test improved dramatically within the first 4 weeks. She was given etanercept 50 mg bi-weekly for 12 weeks, which unfortunately showed primary lack of response and injection site hypersensitivity. Her liver function test returned to baseline after 2 months. Under care by a hepatologist and with consent of the patient, infliximab therapy was resumed with great caution due to flare-up of the skin condition.\nThe patient received three re-initiation doses with good response and no changes in liver function tests. This was followed by five doses over a year. In January 2012 she was admitted to hospital with fever (39°C), severe arthralgia, myalgia, lethargy and depression. Erythrocyte sedimentation rate and C-reactive protein were highly elevated. On examination there were severe symmetrical peripheral arthritis lesions with swelling, effusion and mobility problems involving the knees, elbows and proximal small joints of both hands and feet. There was no axial joint involvement. There was an ANA titer of 1:1,280 (homogenous), positive anti-Sm, positive anti-histone antibodies, negative anti-double-stranded DNA (anti-dsDNA) antibodies, negative rheumatoid factor and normal serum complement. No malar rash, photosensitivity, mouth ulceration, visceral organ involvement, serositis, renal involvement, proteinuria, cytopenia or any other manifestations of lupus erythematosus were observed. The patient was diagnosed as having lupus-like syndrome due to infliximab therapy. Infliximab was eventually discontinued. The condition was controlled by corticosteroids, leflunomide and azathioprine. Her general condition and arthritis improved within 2 months, liver function tests remained within normal limits, and anti-Sm and anti-histone antibodies returned to normal values. Her ANA titer went down to 1:160 (homogenous); 24 months later the condition remained stable with no relapse or recurrence of drug-related symptoms (table ). Corticosteroids were stopped 7 months later; she is maintained on sulfasalazine, hydroxychloroquine and ustekinumab injections. The main complaint of the patient during the latest period was worsening of the joint condition, especially in the small joints of the hands that started to show erosive arthritis and minor deformities.
|
[[23.0, 'year']]
|
F
|
{'23547416': 1, '19880688': 1, '23114587': 1, '17929297': 1, '17223874': 1, '17097378': 1, '22937775': 1, '23333219': 1, '20338127': 1, '23651182': 1, '29063464': 1, '24019774': 2}
|
{}
|
163,098 |
3764950-1
| 24,019,768 |
noncomm/PMC003xxxxxx/PMC3764950.xml
|
A Phrygian Cap
|
An 81-year-old man visited the gastroenterologist because he had been suffering from iron deficiency anaemia without obvious blood loss for a few months. Apart from intermittent pain in the right upper abdominal region, there were no other symptoms. His weight remained constant and he did not lose his appetite. Defecation was regular, once a day. His medical record consisted of diabetes mellitus type II, hypertension, impaired renal function and an ear operation many years before. He had no history of gastrointestinal problems. Family history revealed two brothers who had died of colorectal cancer at old age. With a body mass index of 28 he was overweight. Examination of the abdomen did not reveal any unusual findings. No abnormality was palpated during digital rectal examination. A complete blood count revealed anaemia (Hb 6.7 mmol/l) and iron deficiency (9 µmol/l).\nThe patient underwent colonoscopy. Diverticulosis was seen in the sigmoid. Three polyps were removed during the colonoscopy. A bleeding tumour was found in the ascending colon, 80 cm from the anal sphincter. Definitive pathology revealed an adenocarcinoma in the ascending colon. An abdominal CT scan confirmed the presence of a process in the ascending colon. It also showed a liver lesion with a diameter of 9 mm, suspicious of liver metastasis. The CT scan did not reveal any other unusual findings. Ultrasonography of the upper abdomen confirmed a liver lesion, with a diameter of 13 mm, suspicious of liver metastasis with an atypical hepatic haemangioma in the differential diagnosis. MRI scan showed a liver lesion in segment V, suspicious of liver metastasis.\nThe patient underwent simultaneous right hemicolectomy and wedge resection of the liver lesion. During perioperative inspection of the upper abdomen, a gallbladder deformity was seen (fig. ). The fundus of the gallbladder was folded like a cap. The patient underwent cholecystectomy to make the wedge resection of the liver metastasis in segment V easier to perform. The surgery proceeded without complications. Pathological examination confirmed the presence of both an adenocarcinoma in the ascending colon and a liver metastasis. There were slight inflammatory changes in the gallbladder, but it did not show stones or a tumour. The patient recovered from surgery without any problems and was discharged after 12 days. The deformity of the gallbladder was, in retrospective, detected on the preoperative MRI scan (fig. ).
|
[[81.0, 'year']]
|
M
|
{'32064443': 2, '11301462': 1, '6538468': 1, '12585795': 1, '30310714': 1, '32864277': 1, '34966602': 2, '1950867': 1, '416045': 1, '5575887': 1, '24716073': 2, '25302235': 1, '8466463': 1, '24019768': 2}
|
{'8710038-1': 1, '7012564-1': 1, '3971497-1': 1}
|
163,099 |
3764954-1
| 24,019,771 |
noncomm/PMC003xxxxxx/PMC3764954.xml
|
Coxsackievirus A6 and Hand, Foot and Mouth Disease: Three Case Reports of Familial Child-to-Immunocompetent Adult Transmission and a Literature Review
|
Case 1: A 35-year-old man, computer technician, with irrelevant past medical history, was admitted to our outpatient clinic at the beginning of October 2012 with a 2-day history of papular and vesicular skin rash. He complained of fever with chills, malaise and sore throat 1 day before the onset of cutaneous symptoms. Moreover, the patient reported close contact with a child suffering from HFMD, during a family party, 1 week before symptoms developed.\nPhysical examination revealed erythematous papulovesicular lesions on the posterior oropharyngeal structures and multiple erythematous papules followed by vesicular lesions on his palms, soles and perioral zone (fig. , fig. ). A complete blood count revealed no abnormalities. The erythrocyte sedimentation rate was increased to 20 mm/h. Blood chemistry tests were normal, except for the level of C-reactive protein (CRP), which was elevated to 12 mg/l. Syphilis, HIV and hepatitis B and C serologies were negative. The pattern of serum protein electrophoresis was normal, and the initial chest X-ray and ECG demonstrated no pathologic findings.\nViral ribonucleic acid was extracted from vesicular fluid samples (both from the throat and skin) and from plasma. Afterwards, it was amplified with reverse transcription-seminested polymerase chain reaction (PCR) assay as described elsewhere [], using primers that allow amplification of all known human enteroviruses and identification of the serotypes by amplicon sequencing. The primers used for the seminested step amplified a 376-bp portion of the capsid viral protein 1 (VP1) gene. The amplicon sequencing and comparison to gene database identified Coxsackievirus A6, both from vesicles and plasma.\nHistological examination of the skin biopsy from a palmar papule showed orthokeratotic hyperkeratosis with areas of confluent parakeratosis and presence of singular basal and suprabasal keratinocyte necrosis. Moreover, a lymphocytic inflammatory infiltrate was present in the superficial dermis up to dermo-epidermal junction. The histological features were consistent with a viral infection.\nThe patient was diagnosed with HFMD based on characteristic clinical manifestations, positive results of enterovirus PCR analysis, molecular typing for Coxsackievirus A6 and histological findings. Symptomatic treatment with oral paracetamol and lidocaine oral spray was introduced. During a 7-month follow-up, no complications were observed. Skin and mucosal lesions resolved completely. No nail changes have been observed so far, but the child who infected the patient with Coxsackievirus A6 developed onychomadesis 2 months later (fig. ).
|
[[35.0, 'year']]
|
M
|
{'28413820': 1, '33574876': 1, '10568570': 1, '33101238': 1, '25636654': 1, '25742504': 1, '23800163': 1, '8133108': 1, '14722149': 1, '28168168': 1, '16891480': 1, '33274234': 1, '25774239': 2, '20189452': 1, '26203408': 2, '30760232': 2, '22762340': 1, '22456122': 1, '12643822': 1, '10720980': 1, '19788821': 1, '28352303': 1, '5694203': 1, '30425589': 1, '23732432': 1, '33743167': 1, '20548919': 1, '26975350': 1, '11760019': 1, '26155357': 2, '24019771': 2}
|
{'3764954-2': 2, '3764954-3': 2, '4483348-1': 1, '4333364-1': 1, '4504872-1': 1, '4504872-2': 1, '4504872-3': 1, '4504872-4': 1, '4504872-5': 1, '4504872-6': 1, '4504872-7': 1, '4504872-8': 1, '6373151-1': 1}
|
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