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163,200 |
3772286-2
| 24,044,080 |
noncomm/PMC003xxxxxx/PMC3772286.xml
|
Evaluation of Probability of Survival Using Trauma and Injury Severity Score Method in Severe Neurotrauma Patients
|
Another example is seen in the case of a 51-year-old man sustaining traumatic brain injury combined multiple trauma in a pedestrian accident. Upon arrival at the emergency medicine department, the patient presented a systolic blood pressure of 140 mm Hg and a respiratory rate of 0. Because his eyes were closed and he was intubated, and showed no movement to pain, he was assigned a GCS of 3. His pupils were 6/6 mm in size and not responsive to light. Also, his corneal reflex disappeared. On brain CT, severe brain swelling and global hypoxic damaged brain parenchyme (the so-called, 'whole brain infarct') was revealed (). His blood pressure (RTS coded value=4), respiratory rate (RTS coded value=0), and GCS (RTS coded value=0) gave him an RTS of 2.93 (RTS=0.9368×0+0.7326×4+0.2908×0=2.93). His head and neck injuries, severe brain swelling and acute subdural hemorrhage (AIS=5) and liver injury of the abdomen (AIS=2) and clavicular fracture of extremity (AIS=2) were combined to give him an ISS of 33(ISS=1st AIS2+2nd AIS2+3rd AIS2=52+22+22=33). Thus, his calculated probability of survival by the TRISS methodology was 67.48%. If his AIS of the head and neck was given 6, his calculated probability of survival by the TRISS methodology would have decreased to 6.86%.
|
[[51.0, 'year']]
|
M
|
{'2231804': 1, '23025964': 1, '16759417': 1, '3123707': 1, '8576997': 1, '6623052': 1, '11003333': 1, '15179251': 1, '7745667': 1, '16766966': 1, '2020032': 1, '26393173': 1, '32201699': 1, '21274684': 1, '16508487': 1, '18646254': 1, '20220424': 1, '16688062': 1, '14759963': 1, '26816061': 1, '15454791': 1, '20386271': 1, '34834496': 1, '24044080': 2}
|
{'3772286-1': 2}
|
163,201 |
3772287-1
| 24,044,081 |
noncomm/PMC003xxxxxx/PMC3772287.xml
|
Isolated Lateral Sinus Thrombosis Presenting as Cerebellar Infarction in a Patient with Iron Deficiency Anemia
|
A 55-year-old man was admitted to the emergency department with a 15-day history of headache, nausea, and mild dizziness. The patient had no medication history and no underlying diseases including cancer, infection and hematologic disorder. In addition, he had not suffered from trauma. The patient was alert mentality and there were no abnormal neurologic findings for cranial nerves, muscle strength and deep tendon reflex. The cerebellar function test, however, showed a mild disturbance in tandem gait.\nVital signs at admission showed a body temperature 36.7℃, a blood pressure of 100/60 mm Hg, and a heart rate of 70 beats/minute. Laboratory findings were as follows : hemoglobin 7.2 g/dL, hematocrit 24.8%, white blood cell count 4600/µL, platelet count 130000/µL, erythrocyte sedimentation rate 12 mm/hr, and C-reactive protein 1.447 mg/L. Coagulation profiles demonstrated a prothrombin time of 82%, an international normalized ratio of 1.13, an activated partial thromboplastin time of 28.8 seconds, and a bleeding time of 3.00. The following laboratory examinations were done to evaluate his anemia : total iron-binding capacity 324 ug/dL, serum iron concentration 54 ug/dL, vitamin B12 294 pg/mL, and folate 11.4 ng/mL. Peripheral blood smear test showed normocytic normochromic anemia with anisopoikilocytosis. These findings were consistent with IDA. Magnetic resonance image (MRI) of the brain showed high signal intensity on the T2 weighted/FLAIR image and low signal intensity on the T1 weighted image of the right cerebellar hemisphere compressing the fourth ventricle (). There was multifocal petechial hemorrhage and irregular enhancement in the right cerebellar hemisphere on the gadolinium-enhanced T1 weighted image (). In addition, there was a high signal lesion on the junction of the right transverse sinus and proximal sigmoid sinus on the T2 weighted image and FLAIR image. To determine the malignant neoplasm, PET-CT scans and tumor markers were examined. PET-CT showed no hypermetabolic lesion in the cerebellar parenchyme. However, diffuse hypermetabolism was detected in bone marrow, which was probably a reactive change due to the patient's anemic condition. Tumor markers were normal : AFP 1.86 ng/mL, CEA 0.659 ng/mL, CA 19-9 1.32 U/mL, CA125 10.01 U/mL, and PSA 0.509 ng/mL. Cerebral angiography demonstrated a filling defect in the right side transverse sinus and proximal sigmoid sinus in the venous phase (). Some venous congestion along with collateral vessels was also developed in the right cerebellar region.\nThere were negative findings for antinuclear antibody, lupus anticoagulant, antiphospholipid antibody IgG/M, anticardiolipin antibody IgG/M, anti beta2 GPI antibody IgG/M, and PNH flowcytometry. In addition, no abnormality was found in the level of protein C and protein S : protein C antigen 55% and protein S antigen 52%. Thyroid function test was done as follows : T3 87.2 ng/dL, TSH 5.66 uIU/mL, and fT4 1.08 ng/dL.\nThe patient received mannitol to control the increased intracranial pressure, and ferrous sulfate 256 mg (80 mg as iron) was given daily for the IDA. For preventive purpose, aspirin and clopidogrel were also prescribed. Cerebellar edema was markedly improved on the follow-up CT scan (). Laboratory findings were also improved : hemoglobin 8.6 g/dL and hematocrit 29.0%. The patient was discharged with no neurologic deficits. After 1 month, the patient had no symptoms and anemia was completely recovered : hemoglobin 11.3 g/dL and hematocrit 35.8%.
|
[[55.0, 'year']]
|
M
|
{'21293023': 1, '16120838': 1, '20714964': 1, '20798372': 1, '18029905': 1, '18984440': 1, '19118248': 1, '19707002': 1, '15699061': 1, '17185884': 1, '14976332': 1, '22210158': 1, '12143279': 1, '17161294': 1, '24044081': 2}
|
{}
|
163,202 |
3772288-1
| 24,044,082 |
noncomm/PMC003xxxxxx/PMC3772288.xml
|
Solitary Ruptured Aneurysm of the Spinal Artery of Adamkiewicz with Subarachnoid Hemorrhage
|
A 45-year-old female patient was referred to our emergency department with a sudden burst headache and severe back pain, followed by nausea. On admission, she was alert, oriented, and cooperative. On neurological examination, she had moderate neck stiffness with mild lower limb motor weakness of IV/V. She had no predisposing clinical disease history and trauma history. Laboratory examinations showed no abnormal findings suggestive of inflammation or infection.\nNo abnormal findings were observed on brain computed tomography. However, brain magnetic resonance imaging (MRI) revealed thin SAH in right parietal lobe cortex. Whole spine MRI showed spinal SAH from T5 to sacrum with a small intradural extramedullary signal void lesion at the T12 level (). Spinal angiography revealed a small pearl and string-like aneurysm of a radiculomedullary branch of the left segmental artery (Adamkiewicz artery) originating on the left side at the L1 level (). Arteriovenous shunts or abnormal veins were not seen.\nThe findings and treatment options were discussed with the patient's family, and we refrained from performing operative clipping or endovascular coiling of the aneurysm because of the high risk of occlusion of the anterior spinal artery during the procedure.\nOver time, the patient improved gradually and was discharged without new neurological deficits.\nHowever, one month after onset, she complained aggravation of back pain and radiating pain of both legs, and follow-up lumbar MRI showed decreased hematoma and developed arachnoiditis of cauda equina ().\nTwo months after the initial onset, her symptoms improved completely, and follow-up lumbar MRI showed resolution of SAH with septated intradural fluid collection and remaining signal void lesion at the T12 level. The patient's subsequent clinical follow-up of five months was uneventful ().
|
[[45.0, 'year']]
|
F
|
{'21946730': 1, '15709145': 1, '571987': 1, '17542515': 1, '2689031': 1, '7099415': 1, '33535981': 1, '10369227': 1, '8971846': 1, '16219857': 1, '25496690': 1, '29159157': 2, '33505290': 1, '26627692': 1, '16331160': 1, '34541624': 1, '29030496': 1, '24044082': 2}
|
{'5680087-1': 1}
|
163,203 |
3772289-1
| 24,044,083 |
noncomm/PMC003xxxxxx/PMC3772289.xml
|
Primary Eosinophilic Granuloma of Adult Cervical Spine Presenting as a Radiculomyelopathy
|
A 29-year-old man had paresthesia on both arms and grasping weakness for 10 days. His cervical MRI showed diffuse marrow infiltration with pathologic fracture producing symmetrical collapse of the C7 vertebral body. In addition, epidural extension produced ventral cord compression without cord signal change (). On physical examination, he had mild weakness of grasping and elbow extension power on both arms (Grade IV). Laboratory tests were all within normal limits. 3D cervical CT scan revealed symmetrical collapse of C7 vertebral body and no involvement of posterior column (). Our first impression was tuberculous (Tb) spondylitis; as such, we did anti-Tb medication and Tb-related laboratory tests. However, his grasping power of both hands was worsened (Grade IV→III). Therefore, we performed C7 corpectomy and anterior plate fixation C6-T1 and iliac bone graft (). In the operative field, disc spaces above and below the level of lesion were not involved. After surgical management, motor weakness was improved (Grade III→IV) and paresthesia on both arms also got better. Pathological evaluation confirmed the diagnosis of eosinophilic granuloma. He was immobilized after surgery in a rigid cervical brace for 3 months. In the following outpatient clinic, positron emission tomography CT was conducted additionally, but no other lesions were found. Twelve months follow-up cervical MRI showed no recurrence () and his neurological deficits were fully recovered.
|
[[29.0, 'year']]
|
M
|
{'19844749': 1, '16013628': 1, '7334115': 1, '20396916': 1, '12131737': 1, '17021733': 1, '14676546': 1, '20042947': 1, '13057466': 1, '7304858': 1, '16891956': 1, '20617093': 1, '10472109': 1, '12662947': 1, '18338168': 1, '15289942': 1, '8570070': 1, '28247113': 1, '11039811': 1, '20669118': 1, '15120180': 1, '10326709': 1, '15076592': 1, '7030100': 1, '24044083': 2}
|
{}
|
163,204 |
3772290-1
| 24,044,084 |
noncomm/PMC003xxxxxx/PMC3772290.xml
|
Spinal Subarachnoid Hematoma as a Complication of an Intramuscular Stimulation : Case Report and a Review of Literatures
|
A 45-year-old man was hospitalized at a local clinic because of back pain. On the last day at the clinic, the patient underwent an IMS procedure and subsequently experienced severe headache and nausea. The patient underwent conservative management of the symptoms, but symptoms persisted. The patient was then referred to our hospital. Upon arrival, the patient had stable vital signs. A review of his medical history revealed a 5-year use of antihypertensive drugs, including daily aspirin (100 mg). Physical examination revealed neck stiffness without any other initial neurologic deficits. Clinical laboratory findings were all normal. Brain computed tomography (CT) was performed because the patient was suspected of having intracranial subarachnoid hemorrhage. But, this showed no abnormal findings. Because the patient continued to experience severe headache and nausea, he was admitted to the neurosurgical department for further evaluation and treatment. On the following day, the patient experienced severe back pain, decreased motor power of the lower extremities and constant headache. Based on these findings, the patient was suspected having intraspinal subarachnoid hematoma. The patient was interviewed in detail about the IMS procedure and its relatedness to the onset of headache. The patient stated that he had a history of severe radiating pain toward the lower extremities, while the IMS was directed toward the back. The severe headache and nausea occurred following the IMS procedure. We performed magnetic resonance imaging (MRI) of the thoracolumbar spine. But, the radiologic findings were suggestive of intraspinal subarachnoid hematoma (). The patient underwent an emergency exploratory laminectomy expecting to find a intradural hematoma. Then, we observed a solid hematoma compressing the cauda equina in the operative field (). The hematoma was completely evacuated. No evidence of tumor or vascular malformation was evident on histopathologic examination. Postoperatively, the patient's symptoms gradually improved. On postoperative week 3, the patient was discharged without any complications.
|
[[45.0, 'year']]
|
M
|
{'9357903': 1, '18534309': 1, '15711890': 1, '10417455': 1, '12520314': 1, '17596676': 2, '21943822': 1, '18275427': 1, '21082060': 1, '16190921': 1, '20544158': 1, '11569370': 1, '24044084': 2}
|
{'2693660-1': 1}
|
163,205 |
3772291-1
| 24,044,085 |
noncomm/PMC003xxxxxx/PMC3772291.xml
|
Disseminated Tuberculosis of Central Nervous System : Spinal Intramedullary and Intracranial Tuberculomas
|
A 66-year-old woman was admitted with bilateral lower extremity weakness and voiding difficulty for 2 weeks. Paraparesis with muscle power of the right lower extremity was grade 2/5 and the left lower extremity was grade 1/5, impaired sensations below the L1 level and decreased strength in the anal sphincter tone. Lower extremity reflexes including knee jerk and ankle jerk were absent. No evident upper extremity motor or sensory deficit was seen. Magnetic resonance imaging (MRI) of the thoracolumbar showed about 1.2×1×4 cm sized intramedullary enhancing lesion with central necrosis on conus medullaris at T12-L1 levels. The lesions were isointense on T1-weighted images and hyperintense on T2-weighted images, which were associated with diffuse edema of spinal cord on T7-T11 level. We presumed that this abscess might be closely related with tuberculous abscess. However, in laboratory, sputum, Cerebrospinal fluid (CSF) cultures and Acid-Fast bacilli stains were negative. A cerebrospinal fluid study showed glucose levels 55 mg/dL, protein 100 mg/dL, and 50 lymphocytes/mm3. Initial C-reactive protein (CRP) was 24. On review of her previous medical history, she was treated for pulmonary tuberculosis, diagnosed six months earlier. And 1 month ago, pus was found in the right kidney due to her flank pain, which was proved to be tuberculosis after drainage. She was also treated by rifampin, ethambutol, pyrazinamide at other hospital. Chest simple X-ray showed that features of bilateral pulmonary tuberculosis with multiple patchy consolidations. We took brain MRI in order to differentiate the brain lesion. MRI findings of brain showed multiple abscesses at the cerebrum and cerebellum. Results of a Tb INF-r were positive. Initially, we planed surgical treatment, however, we postponed the surgery due to her poor general condition and refusal of her family. Under the diagnosis of multiple CNS tuberculomas on spinal cord and brain, the anti-tuberculous drugs were started with rifampicin 600 mg, isoniazid 300 mg, pyrizinamide 1000 mg, ethambutol 800 mg. At 2 month later after medication, the muscle power in the both lower limbs had improved to grade 4/5, and voiding was also recovered. After 3 months of medical treatment, she could walk by herself. Follow up lab of CRP was reduced from 24 to 0.9 at 2 month later. Normalization of CRP was seen at 3 months of medication for tberculosis. After 6 months, the MRI of spine showed the markedly decreased size of intramedullary nodule at T12-L1 levels, which meaned improvement of tuberculous abscess, though perilesional edema of conus medullaris still remain. And MRI of brain showed that marked improvement of multiple nodular enhancing lesions at both frontoparietal lobe, right thalamus and both cerebellar hemisphere. Finally, we concluded these lesions were due to tuberculosis though we did not have the pathologic confirmation.
|
[[66.0, 'year']]
|
F
|
{'2193350': 1, '14652486': 1, '15235204': 1, '2070190': 1, '1590202': 1, '11641626': 1, '29114310': 2, '30645042': 1, '7969845': 1, '31649775': 2, '32548312': 1, '31121936': 1, '32099425': 1, '26217392': 2, '10879771': 1, '16793447': 1, '14705326': 1, '24044085': 2}
|
{'4513178-1': 1, '6798273-1': 1, '5652122-1': 1}
|
163,206 |
3772292-1
| 24,044,086 |
noncomm/PMC003xxxxxx/PMC3772292.xml
|
Symptomatic Epidural Pneumorrhachis : A Rare Entity
|
A 50-year-old man was admitted to our emergency department with blunt neck and thoracic trauma caused by a falling tree. On arrival, he was alert and his Glasgow Coma Scale point was 15. His vital signs were stable and electrocardiography, blood cell count, and serum biochemistry were unremarkable. He had full strength in his bilateral upper and lower extremities and he was able to move without limitation. However, he complained of intolerable, diffuse pain in his neck and back with reduced sensation to light touch in all extremities. There was decreased temperature and pinprick in his upper and lower extrimities bilaterally, below the C5 level. Brain computed tomography (CT) revealed no evidence of any abnormality. However, thoracic CT revealed a basal lung contusion and left pneumothorax with multiple fractures of third, fourth, fifth, and sixth ribs, and cervicothoracic spine CT showed extensive pneumorrhachis extending from C4 to T8 and compressing the spinal cord excessively (). Nonetheless, there was no evidence of fracture or subluxation within the spine. A thoracostomy tube was promptly inserted and he was transferred to our intensive care unit for close observation. Conservative treatment including bed rest, O2 inhalation, and medication for pain relief was administered for 7 days, when he was stable and able to tolerate an oral diet. On the 14th day after admission, CT of the cervicothoracic spine was normal and demonstrated complete resolution of the air within the spinal canal with no further complication (). The patient was discharged of 18 days after admission. At the time of discharge, his neurologic examination was unremarkable, and he had full strength in all extremities and an intact sensation to light touch without pain.
|
[[50.0, 'year']]
|
M
|
{'15993195': 1, '24623994': 2, '11509299': 1, '19384503': 1, '19096597': 1, '33643863': 1, '15824674': 1, '12779206': 1, '8141057': 1, '2913661': 1, '2322885': 1, '34790493': 2, '12913657': 1, '10889894': 1, '10195480': 1, '32307638': 1, '33389118': 1, '24044086': 2}
|
{'3949721-1': 1, '8588832-1': 1}
|
163,207 |
3772293-1
| 24,044,087 |
noncomm/PMC003xxxxxx/PMC3772293.xml
|
Spontaneous Spinal Subdural Hematoma Concurrent with Cranial Subdural Hematoma
|
A 39-year-old female presented with about a 10-days history of low back pain and pain radiating from both legs. She was transferred to our department under the diagnosis of spinal SDH. The patient had no history of antecedent head or back injuries, but had intermittent pulsatile headache for 2 weeks. Laboratory examinations eliminated the possibility of coagulopathy-related diseases. Neurologic examination showed no definite motor weakness and sensory change. Spinal MRI showed a diffuse mass encircling the thecal sac, leading to moderate to severe central spinal stenosis at the L4 to S2 vertebral levels. Axial MRI revealed that the hematoma was located between the epidural fat and cerebrospinal fluid space, indicating localization in the subdural space ().\nThe patient was treated conservatively because the pain was not severe. She refused surgery. One day after admission, the pre-existing headache (which had not been a complaint in the outpatient clinic) became aggravated, and nausea and vomiting developed. Computed tomography of the brain revealed a chronic cranial SDH associated with midline shift in the left hemisphere (). The cranial SDH was evacuated, which prevented brain herniation if lumbar decompression was necessary. Postoperatively, the headache gradually resolved (). We scheduled another evacuation of spinal SDH to be performed if neurologic deficit developed. However, low back pain and pain radiating from both legs gradually improved. Three months later, a lumbar MRI showed complete resolution of the spinal SDH ().
|
[[39.0, 'year']]
|
F
|
{'15070147': 1, '11218767': 1, '29899767': 2, '12486364': 1, '18301828': 1, '10419371': 1, '6879409': 1, '12886137': 1, '18262617': 1, '29479039': 1, '10918016': 1, '12520314': 1, '11428797': 1, '20505298': 1, '25349764': 1, '9322857': 1, '20828301': 1, '10996759': 1, '16377954': 1, '8837111': 1, '30235747': 2, '24044087': 2}
|
{'5982488-1': 1, '6160060-1': 1}
|
163,208 |
3772301-1
| 24,044,015 |
noncomm/PMC003xxxxxx/PMC3772301.xml
|
Acute Profound Thrombocytopenia after Using Abciximab for No-Reflow during Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction
|
A 65 year-old man with hypertension visited the local hospital with resting chest pain for 3 hours. He was transferred to our hospital due to the abnormal electrocardiogram (ECG) findings showing an elevated ST-segment in the inferior wall territory with a reciprocal change, which was suspicious of STEMI. In the emergency room, blood pressure was 140/80 mm Hg and chest radiography showed no definite abnormal findings, which was graded as Killip class 1. It was decided to have the patient undergo primary PCI for the treatment of STEMI. Conventional medical treatments that include a bolus injection of 5000 IU of heparin, a loading dose of aspirin (300 mg), and clopidogrel (300 mg) was applied before primary PCI. Coronary angiography (CAG) showed a totally occluded lesion of the proximal right coronary artery (RCA) with collateral flow grade 1 from the left anterior descending artery (). After predilatation with a 2.0×20 mm conventional balloon, a bare metal stent 5.0×24 mm Liberte® (Boston Scientific, Natick, MA, USA) was implanted in the proximal RCA lesion (). After implantation of a stent, no-reflow phenomenon developed () and blood pressure decreased with findings of a complete atrioventricular-block and re-elevation of the ST-segment on ECG monitoring. The patient was treated with intracoronary injection of nitrate and adenosine, and intravenous bolus consecutive injection of abciximab with maintenance (intravenous bolus of 0.25 mg/kg, 10 to 60 minutes during the procedure, followed by 0.125 µg/kg/min infusion for 12 hours). Although an improvement was observed in the Thrombolysis in Myocardial Infarction flow grade from grade 0 to grade 3 () and the patient returned to sinus rhythm, the hypotension was sustained. Therefore, an IABP was inserted into the left femoral artery. The patient was moved to the coronary care unit for intensive monitoring with maintenance of abciximab and IABP.\nAlthough the baseline platelet count was 167000/µL before PCI, a routine check determined a complete blood count showing a decreased platelet count of 6000/µL at 22 hours after bolus administration of abciximab, followed by a platelet count of 3000/µL 4 hours later. It was considered that the patient had acute, profound thrombocytopenia as a complication of abciximab. Heparin induced thrombocytopenia (HIT) was excluded because HIT typically develops after 6 to 10 days of heparin use with no previous exposure to heparin. In this case, the patient had no history of exposure to heparin. Therefore, the patient was started on clopidogrel 75 mg/day and aspirin 100 mg/day were started to prevent stent thrombosis. The patient was administered 4 units of platelet concentrates as a precaution. The patient was withdrawn from heparin treatment in consideration of additional hemorrhagic risk, but not HIT. The next followed count of platelet increased to 24000/µL without clinical evidence of stent thrombosis, such as chest pain and a change of ST-segment on ECG. Vital signs were stabilized the next day and IABP was removed successfully using the closing device, Perclose® (Abbott, Redwood City, CA, USA) due to the hemorrhagic risk of the access site and a decreased platelet count of 26000/µL. After additional transfusions of 4 units of platelet concentrates, the platelet count increased to 49000/µL without complications. Subsequently, the platelet count rose to 164000/µL on discharge (). A 1-year follow up of CAG showed good flow of RCA without chest pain or thrombocytopenia.
|
[[65.0, 'year']]
|
M
|
{'9672272': 1, '12525818': 1, '15117843': 1, '12752095': 1, '7717278': 1, '8121459': 1, '21664376': 1, '14517924': 1, '11711483': 1, '7586333': 1, '28710245': 1, '11113041': 1, '24044015': 2}
|
{}
|
163,209 |
3772302-1
| 24,044,016 |
noncomm/PMC003xxxxxx/PMC3772302.xml
|
Kounis Syndrome Presenting as Very Late Stent Thrombosis in an Everolimus-Eluting Stent Following Wasp Stings
|
A 56-year old man was referred by an emergency physician to our hospital with an impression of ST-segment elevation myocardial infarction (STEMI). The patient was stung on the arm, neck and head several times by wasps while working on his field about 7 hours prior to admission. He had a mild allergic reaction involving local pain and urticarial swelling immediately after the incident without signs of anaphylaxis or shock. Just a few minutes after being stung, he started complaining of chest pain and called the emergency service. His blood pressure was 120/80 mm Hg, pulse rate was 90 beats per minute and electrocardiogram revealed ST-segment elevation with Q wave formation in the anterior leads and reciprocal ST-segment depression in the inferior leads (). His troponin T level was elevated to 1.86 ng/mL. After being given intravenous dexamethasone and antihistamine, he was promptly transferred to our catheterization laboratory. He had undergone an everolimus-eluting 3.5×15 mm stent placement (Promus®, Boston Scientific, MN, USA) in the mid-left anterior descending (LAD) artery for stable angina 3 years prior in our hospital. Clopidogrel (75 mg/d) was withdrawn 24 months after stent implantation, while aspirin (100 mg/d) had been continued until that day. Coronary angiography demonstrated a thrombosis in the previous stent in the LAD artery, completely occluding the vessel (). The remaining vessels showed insignificant stenosis. The lesion was crossed with a Runthrough® NS guidewire (Terumo) and sequential inflations using Nimbus PICO® (BARD) 1.25×12 mm, followed by 2.0×12 mm balloons to disperse the thrombus. Next, thrombus aspiration with a thrombus aspiration catheter (Thrombuster II®, Kaneka Corp., Japan) was performed. Abciximab infusion was started, of which half of the initial bolus was given directly into the left coronary system. However, Thrombolysis in Myocardial Infarction flow 3 was not established despite these measures. In the end, an everolimus-eluting 3.5×15 mm stent (Promus Element™, Boston Scientific, MN, USA) was deployed with an excellent angiographic result (). We did not measure serum tryptase and histamine levels with a half life of 90 minutes and of less than 30 minutes respectively because 7 hours had passed after the onset of symptoms. He was discharged from the hospital 6 days after the index procedure with dual anti-platelet therapy (DAPT). The patient is currently doing well and is being followed up in the outpatient department.
|
[[56.0, 'year']]
|
M
|
{'10604922': 1, '16249041': 1, '21429602': 1, '16647768': 1, '28882939': 1, '19174317': 1, '19918484': 2, '24826269': 2, '19423176': 1, '20965463': 1, '20445180': 1, '14744976': 1, '19628178': 1, '20031696': 1, '23075822': 1, '18191745': 1, '19914724': 1, '21131075': 1, '20828286': 1, '18652940': 1, '18805597': 1, '24044016': 2}
|
{'4008356-1': 1, '2769374-1': 1}
|
163,210 |
3772303-1
| 24,044,017 |
noncomm/PMC003xxxxxx/PMC3772303.xml
|
A Case of Reversible Very Low Voltage Electrocardiogram in Fulminant Myocarditis
|
A 53-year-old Korean-Chinese woman was brought into the emergency department of our hospital by an ambulance, with complaints of progressive chest pain and dyspnea. She had a high fever, cough, and general fatigue over the three days. Upon arrival, she was fully conscious and had signs of cold sweating, cyanosis and general pallor. The initial creatine kinase (CK), CK-MB and Troponin-I levels were 626 U/L, 47.27 ng/mL, >50 ng/mL, respecitvely. Emergent coronary angiogram was performed because of low blood pressure (88/56 mm Hg), ST-segment depression in the precordial leads of ECG (), and systolic dysfunction with left ventricular wall motion abnormality on echocardiography. Coronary angiographic findings were normal, and an intra-aortic balloon pump (IABP) was immediately inserted for hemodynamic support (). On the basis of prodromal symptoms, elevated cardiac enzymes and normal coronary angiographic findings with ventricular wall motion abnormality, we contemplated acute decompensated heart failure due to clinical suspicion acute myocarditis. She was admitted to the coronary care unit, and mechanical ventilation and inotropic agents were started. Although aggressive supportive therapies were provided, her blood pressure continued to decline. We decided to support the patient with ECMO, which was inserted in a veno-arterial configuration by cannulation on both femoral vessels. We were able to reduce the amount of inotropic agents using mechanical circulatory support. However, ECG showed wide QRS tachycardia with left bundle branch block (), and echocardiography showed severe global hypokinesia (). The serum creatinine level was elevated, and the amount of urination was decreased. Soon after, pulmonary edema developed. Because of low blood pressure and the lack of diuretic effect, continuous renal replacement therapy was started using the ECMO circuit on day 1. Ventricular wall movement was gradually decreased, and ECG showed little or no electrical activity ( and ). On day 2, IABP had to be removed because of its malfunction. We continued intensive supportive care. However, the laboratory data and general medical conditions gradually deteriorated. ECG showed little or no electrical activity. On day 5, ECG revealed weak electrical activities (), and echocardiography showed a slight improvement of systolic function (). She gradually recovered, and her ECG showed sinus rhythm ( and ). Since then, her condition started to gradually recover. Mechanical ventilator was weaned off on day 18, and ECMO was weaned off on day 20. She underwent cardiac magnetic resonance imaging after making sure that she was medically stable, which showed diffuse wall thinning, decreased wall motion and delayed enhancement of diffuse ventricular wall sparing of the infero-septal wall (). During hospitalization, she was complicated with ischemic insult in the lower extremities, hepatitis with jaundice, and acute tubular necrosis. On day 76, she was discharged from the hospital. The ejection fraction on the echocardiogram before discharge was approximately 30%. She receives wound dressing once a day and maintains hemodialysis every other day.
|
[[53.0, 'year']]
|
F
|
{'24723087': 1, '11451278': 1, '19920051': 1, '1636589': 1, '18964254': 1, '11999637': 1, '31778001': 1, '10706898': 1, '11161940': 1, '11070105': 1, '24044017': 2}
|
{}
|
163,211 |
3772304-1
| 24,044,018 |
noncomm/PMC003xxxxxx/PMC3772304.xml
|
A Case of Cardiac Beriberi: A Forgotten but Memorable Disease
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A 72-year-old female presented at our emergency department with 1-week febrile sense, progressive dyspnea, and generalized edema. A few days prior to this presentation, she had experienced several loose stools with intermittent abdominal pain localized to the right upper quadrant for four months.\nShe denied smoking or using illicit drug use, but confessed excessive and protracted alcohol consumption and a dietary pattern restricted to intake of only carbohydrates; specifically, eating only cookies without any intake of essential nutrients.\nOn admission, she appeared to be chronically ill-looking, but alert with mild hyperventilation. Her vital signs were a blood pressure of 134/95 mm Hg, heart rate of 83 beats/min, and body temperature of 36.5℃. Peripheral oxygen saturation was approximately 100% without oxygen supplementation despite subjective dyspneic complaint. She had icteric sclera without evidence of anemia on physical examination. Her neck veins were not distended, and irregular heartbeats without a murmur were auscultated. A normal breathing sound was heard on whole lung field. There was a tender, enlarged and palpable liver below the right costal margin, but shifting dullness or visualized distended veins on the abdominal wall were not observed. The spleen was not palpable. Both lower extremities were warm to touch and showed minimal edema in a symmetrical fashion. Neurologic examination revealed no abnormalities. Electrocardiography demonstrated revealed premature atrial contraction with nonspecific ST-T segment change (). Her chest X-ray showed cardiomegaly with mild pulmonary congestion and pleural effusion (). Laboratory parameters included mild elevations in the level of liver enzymes, total bilirubin, and high sensitive-C reactive protein (hs-CRP); aspartate transaminase (AST) 44 IU/L (0-40), alanine transaminase (ALT) 64 IU/L (0-40), total bilirubin 1.7 mg/dL (0.2-1.2), and hs-CRP 0.7 mg/dL (<0.5). Results of the initial arterial blood gas analysis, electrolyte levels, thyroid function test and cardiac enzymes like creatinine kinase (CK), CK-MB, and troponin-I were all within the normal range. For further cardiac evaluation, echocardiogram and cardiac magnetic resonance imaging (CMR) were performed. Transthoracic echocardiography showed LV global hypokinesia with severe reduction in LV systolic function (as demonstrated by an LV ejection fraction of 20%), and dilated LV cavity (as shown by an LV end-diastolic dimension of 70 mm). In addition, functional mitral/tricuspid regurgitation in association with a moderate degree of pulmonary hypertension (estimated systolic pulmonary artery pressure of 60 mm Hg), and small amount of pericardial effusion were noted (). The CMR result allowed the exclusion of ischemic cardiomyopathy on the basis of the absence of myocardial delayed enhancement () and the lack of evidence of myocardial perfusion abnormality.\nBased on the patient's history of excessive alcohol consumption in combination with nutritional insufficiency, as well as cardiac imaging findings suggestive of dilated cardiomyopathy, cardiac beriberi was highly suspected. Intravenous thiamine administration was initiated for the next seven days, which was subsequently switched to oral vitamin B complex. With thiamine supplementation, the patient's condition steadily and gradually improved. Liver enzymes and total bilirubin were restored to normal levels a week later, and she was given permission to leave hospital two weeks after admission.\nFollow-up echocardiography performed six months later revealed that her cardiac condition had dramatically improved: LV end-diastolic dimension decreased from 70 mm to 61 mm with a concomitant increase in LV ejection fraction to 43%, systolic pulmonary artery pressure was significantly decreased to 38 mm Hg, and the pericardial effusion that was present before the initiation of treatment was gone (). The patient's subjective complaints of dyspnea and generalized edema were also no longer present.
|
[[72.0, 'year']]
|
F
|
{'27059308': 2, '2151336': 1, '22800868': 1, '28873391': 1, '29489643': 2, '20963443': 1, '2305319': 1, '28050289': 2, '22223666': 1, '25781926': 1, '13629790': 1, '21838901': 2, '31193878': 1, '19934228': 1, '15289782': 1, '12893406': 1, '18356241': 1, '13016605': 1, '3616806': 1, '33576090': 1, '18849553': 1, '24044018': 2}
|
{'5851725-1': 1, '5165147-1': 1, '3175447-1': 1, '4826515-1': 1}
|
163,212 |
3772305-1
| 24,044,019 |
noncomm/PMC003xxxxxx/PMC3772305.xml
|
Takotsubo Cardiomyopathy Associated with Severe Hypocalcemia Secondary to Idiopathic Hypoparathyroidism
|
A 69-year-old woman presented to the emergency department of our institution with a three-day history of exertional dyspnea and chest discomfort that had progressed to dyspnea at rest. She complained of a six-year history of numbness in both hands and leg cramps. She was diagnosed as having hypocalcemia secondary to idiopathic primary hypoparathyroidism and was treated with calcium lactate and calcitriol. One year earlier, she had suffered from intermittent cognitive dysfunction with memory loss and was diagnosed with senile dementia. Thereafter, she was irregularly given medication to treat hypoparathyroidism. One month before the present admission, calcium lactate and calcitriol had been discontinued. On arrival, physical examination revealed low blood pressure (90/60 mm Hg), tachycardia with a heart rate of approximately 102 beats per minute, and tachypnea with a respiration rate of 25 per minute. Her body temperature was 36.4℃ and oxygen saturation on room air was 90%. Chest auscultation revealed rales in the bilateral lung field without murmur. Spasm and cramps of both extremities were noted but the remainder of the physical and neurological examination yielded no remarkable results. Initial electrocardiogram showed sinus tachycardia, negative T waves in leads V 1-4 and a slightly prolonged QT interval (corrected QT interval=490 msec). Chest X-ray showed cardiac enlargement with pulmonary congestion and both pleural effusion. Laboratory testing indicated the following results: total serum calcium concentration, 5.0 mg/dL (reference range: 8.0-10.5 mg/dL), with free ionized calcium, 2.8 mg/dL (reference range: 4.0-4.5 mg/dL); serum phosphorous, 6.1 mg/dL; albumin, 3.7 g/dL; creatinine, 0.9 mg/dL; magnesium, 1.9 mg/dL; PTH, 170 pg/mL (reference range: 180-560 pg/mL); intact PTH, 10.7 pg/mL (reference range: 6.2-29.0 pg/mL) and 25-OH vitamin D, 9.3 ng/mL (reference range: 6.9-69.5 ng/mL). N-terminal pro-B-type natriuretic peptide was 12968 pg/mL; creatine phosphokinase, 1029 IU/L; Myoglobin, 91.78 ng/mL; Troponin-T, 0.234 ng/mL, and thyroid function was within the normal range. Initial echocardiography demonstrated a contractile pattern with preserved basal segment, akinesia of the apical segment and severe hypokinesia of the middle segment of the LV, compatible with takotsubo cardiomyopathy (). The ejection fraction was estimated to be 32%. Initial treatment with administration of furosemide, spironolactone, angiotensin II receptor blocker and intravenous calcium gluconate with close monitoring of serum free ionized calcium levels was started. On the fourth day of admission, we performed coronary angiography and a left ventriculogram. The former revealed normal coronary arteries () and the latter showed markedly improved LV contractility excluding residual localized akinesia of the mid to apical antero-septal wall, demonstrating the resolving course of the takotsubo cardiomyopathy (). The clinical symptoms and signs of congestive heart failure and the objective parameters of LV systolic function obtained by serial echocardiography improved rapidly after correction of the hypocalcemia (). On the twelfth day of admission, the echocardiographic findings showed complete resolution of the regional wall motion abnormalities of the LV with an ejection fraction of 65% () and the patient was discharged with no symptoms and signs of either heart failure or hypocalcemia. During the ensuing 18 month follow-up period, repeated echocardiograms showed normal ventricular contractility and there were no further episode of heart failure with the maintenance of daily alfacalcidol and calcium carbonate.
|
[[69.0, 'year']]
|
F
|
{'6259214': 1, '11451258': 1, '17651841': 1, '32393234': 1, '33117439': 1, '9541771': 1, '15703419': 1, '24903998': 1, '32243105': 2, '3340968': 1, '11965090': 1, '12628715': 1, '4014262': 1, '6448134': 1, '11868050': 1, '2310646': 1, '9292338': 1, '24044019': 2}
|
{'7261529-1': 1, '7261529-2': 1}
|
163,213 |
3772693-1
| 24,043,957 |
noncomm/PMC003xxxxxx/PMC3772693.xml
|
Ectopic lingual thyroid with vascular anomalies
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A 17-year-old female presented to our outpatient clinic complaining of a sensation of a lump in her throat and moderate dysphagia following an episode of acute rhinopharyngitis. Her height was 158 cm and weight was 63 kg. The patient had no family history of metabolic abnormalities. The ear, nose and throat examination identified a swelling of the base of the tongue. The swelling appeared round with an approximate diameter of 3 cm; it was near the foramen cecum; it had a reddish color; and it had an irregular nonulcerated surface. Fiberoptic endoscopy identified the swelling in the glossoepiglottic area (). It was mobile during deglutition. A thyroid scintigraphy, with technetium-99 pertechnetate, showed a single contrast enhancement in the sublingual region, instead of in the normal anatomical position of the thyroid (). Determination of blood levels of the thyroid hormones showed a free triiodothyronine (FT3) of 3.0 pg/mL (normal range: 2.4–4.2 pg/mL), a free tetraiodothyronine (FT4) of 1.0 ng/dL (normal range: 0.8–1.7 ng/dL), and TSH of 5 IU/mL (normal range 0.3–5.0 IU/mL).\nThe patient started medical suppressive therapy with levothyroxine 25 mcg/day for the first 2 weeks and 50 mcg/day for the next 9 months, but no reduction in either swelling or symptoms was observed, so she was scheduled for surgical treatment.\nA preoperative neck computed tomography (CT) identified an nonhomogeneous, hyperdense soft tissue with distinct margins and round shape at the base of the tongue, with a maximum diameter of 3 cm, and absence of the thyroid gland.\nThe vascularization of the mass was evaluated through carotid arteriography. The mass was vascularized by collateral branches of the lingual arteries in its anterior and posterior regions. The superior and inferior thyroid arteries were bilaterally absent ().\nSurgery was then performed using a transoral approach, under general anesthesia. The mass was removed, with an electrosurgical needle, along a cleavage plane from the foramen cecum backwards to the glossoepiglottic vallecula; hemostasis was adequate. A surgical reconstruction of the base of the tongue was performed by suturing the remaining area of the tongue, and a nasogastric tube was inserted. The nasogastric tube was removed 6 days after surgery, and the patient was discharged a day later with hormone replacement therapy, without deficiency in swallowing or speaking.\nThe hormone replacement therapy was based on thyroxine tablets 50 μg/day.\nHistologically, the mass was found to be “thyroid tissue with alternation of hyperplastic and colloid cystic areas, coated with a layer of squamous epithelium.” The surgical specimen measured 3 × 3 cm ().
|
[[17.0, 'year']]
|
F
|
{'22096763': 1, '12019490': 1, '16968815': 1, '3203989': 1, '13159105': 1, '17547972': 1, '26023300': 1, '2114758': 1, '22629516': 2, '2849171': 1, '12930606': 1, '18418276': 1, '24043957': 2}
|
{'3354857-1': 1}
|
163,214 |
3772751-1
| 24,043,944 |
noncomm/PMC003xxxxxx/PMC3772751.xml
|
Lumbar paravertebral blockade as intractable pain management method in palliative care
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A 71-year-old woman was referred to the palliative care unit of the Poznan Palium Hospice because of the poor pain control of her L-S (lumbar to sacral) backbone radiating to both legs. Just before the admission to the hospice, her severe pain (of bone and neuropathic origin) was poorly controlled despite having been treated with fentanyl TD 75 μg · hour−1, plus morphine sulfate (MF) subcutaneous (SC) (doses every 4 hours) 40 mg daily, and paracetamol 1,500 mg orally (po) On admission, the pain was assessed as 7–8/10 in rest, while the breakthrough pain equaled 10/10 according to verbal rating scale (VRS) (see Methods section). The physical findings during this hospice examination revealed skin and mucous membrane pallor, mycosis of the mucous membrane in the mouth, decreased muscle tone, and partial paresis of both legs, particularly escalated on the right side. presents clinical characteristics of the patient.\nThe primary site of cancer disease was the right breast. The patient had a mastectomy, followed by chemotherapy. Metastases to the lung led to a right, upper lobectomy with lymphadenotomy, and chemotherapy. Metastases to the bones (vertebral column: Th11–12, L5) and lymph nodes (of aortic arch and paratracheal lymph nodes) were detected and palliative radiotherapy to Th11–12, L5 region was performed. Extraspinal metastases were also detected (to the right and left hip bone shafts, right ilium, and hip joint cavity). Pathological fracture of right femoral neck had impaired pain control. For many years, the patient has been diagnosed with multiple degenerative changes in the Th12-L5 segment, essential hypertension (well controlled with pharmacotherapy), New York Heart Association (NYHA) class II heart failure (relative circulatory efficiency state), chronic kidney disease (CKD; stage 3, estimated glomerular filtration rate [eGFR] = 43 mL/min/1.73 m2), and depression (no written data/documentation available; history taking difficult due to patient’s confused state). The patient declared no drug allergies.\nThe results of laboratory investigations on the patient’s admission and during hospitalization are presented in . As a result of impaired renal function, the regular therapy with MF was switched to fentanyl 750–1,250 μg daily in constant SC infusion. Within 2 days, this improved the patient’s mental state incredibly but had a minor effect on the pain relief, despite repeated MF rescue doses (). Pamidronate was not introduced because of low calcium and high creatinine serum concentrations. Because of poor pain control, EDA was considered. However, the international normalized ratio (INR) value indicated an increased risk of bleeding or hematoma and was a contraindication to the EDA. Next, PVB with bupivacaine solution in boluses was performed with an excellent result. To lower the incidence of nursing procedures (waking up/disturbing/bothering the patient), the drug’s administration was switched into constant paravertebral infusion. The effect on pain was poorer and bupivacaine serum concentrations increased, in comparison to boluses. Thus, after one day, we decided to withdraw bupivacaine for the following 16 hours. Then, LA boluses were reintroduced with an excellent effect ( and ).
|
[[71.0, 'year']]
|
F
|
{'3706800': 1, '8017610': 1, '2910135': 1, '10947693': 1, '19680122': 1, '11251143': 1, '22581806': 1, '8435266': 1, '9605376': 1, '241197': 1, '19237975': 1, '6697648': 1, '10655907': 1, '19854794': 1, '12088961': 1, '7573876': 1, '18713924': 1, '25336967': 2, '22997447': 1, '10678727': 1, '8702049': 1, '11736777': 1, '1286056': 1, '9124680': 1, '9175963': 1, '2135017': 1, '21233114': 1, '16931684': 1, '7710020': 1, '8841863': 1, '16476698': 1, '3207539': 1, '9813528': 1, '17379131': 1, '1408293': 1, '8353663': 1, '19623887': 1, '18813048': 1, '3295762': 1, '8067221': 1, '19837806': 1, '8840066': 1, '14214487': 1, '3828165': 1, '1148097': 1, '7488477': 1, '7605766': 1, '9301381': 1, '9764965': 1, '1626675': 1, '8110587': 1, '10673888': 1, '568409': 1, '517716': 1, '12886912': 1, '8607299': 1, '20356808': 1, '24043944': 2}
|
{'4199793-1': 1, '4199793-2': 1}
|
163,215 |
3772759-1
| 24,043,928 |
noncomm/PMC003xxxxxx/PMC3772759.xml
|
Late vitreomacular traction in toxoplasma retinochoroiditis resolved by vitrectomy
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A 17-year-old female presented to our department with progressive blurring of vision in the left eye. She had been diagnosed with chronic inflammatory bowel disease 3 years earlier and was in remission on azathioprine and mesalazine. The patient underwent best-corrected visual acuity testing, full ophthalmic slit-lamp examination of the anterior and posterior segments, spectral-domain optical coherence tomography (SD-OCT), and fluorescein angiography at baseline. A complete serologic search was performed to detect an infectious cause, and active toxoplasma retinochoroiditis was diagnosed. A classic treatment regimen of pyrimethamine and sulfadiazine plus steroids was started.\nDuring the ensuing observation period, the patient was evaluated every 2 months and underwent the same examinations performed at baseline except for fluorescein angiography. When the clinical course suddenly evolved toward a significant vitreoretinal traction due to retraction of the retinal scar, pars plana vitrectomy was considered. After written informed consent was obtained from the patient’s parents, a three-port pars plana vitrectomy was performed with a 23-gauge transconjunctival approach. The posterior hyaloid was removed intraoperatively using forceps and no attempt was made to remove the inner limiting membrane.\nOn presentation, visual acuity was 20/20 in the right eye and 1/20 in the left eye, with a mild relative afferent pupillary defect in the second one. No other neurologic signs or symptoms were detected. Anterior segment examination in both eyes was unremarkable and intraocular pressure was 16 mmHg. On biomicroscopic examination, the vitreous of the right eye was clear whereas the left eye exhibited mild inflammation. Fundus examination of the left eye showed a whitish yellow inflammatory lesion temporal to the macula surrounded by retinal edema with foveal involvement (). The lesion was apparently located under the retinal pigment epithelium and there was mild dilation of the retinal vessels of the macula. No other retinal lesion was detected in the peripheral retina. Fluorescein angiography showed early hypofluorescence in the central part of the lesion with progressive hyperfluorescence of the margins due to leakage and pooling of the dye ( and ).\nA serologic search for Toxoplasma gondii infection was positive for immunoglobulin G (55.4 UI/mL, reference value <10 UI/mL), whereas immunoglobulin M levels were normal, indicating prior exposure to Toxoplasma. A syphilis screen and other tests, including for toxocariasis, and rheumatologic tests were all negative. A presumptive diagnosis of toxoplasma retinochoroiditis with macular involvement was made, and a regimen of pyrimethamine, sulfadiazine, and steroids was started.\nPrompt reduction of the retinal edema was followed by gradual flattening and pigmentation of the lesion, with a progressive increase in visual acuity from 20/200 after 4 days to 20/40 after 20 days. Medical therapy was stopped after 45 days. In the following months, no relapse of retinochoroidal inflammation or vitreitis was observed, and visual acuity remained stable during the first 6 months of observation. At month 2, a thickening of the vitreoretinal interface, interpreted as an initial epiretinal membrane, developed above the macula, without significant vitreoretinal traction or macular edema detectable by SD-OCT. However, this finding prevented complete recovery of visual function.\nBy the 8-month follow-up visit, visual acuity had declined to 20/200, with an increase in metamorphopsia. Clinical observation and SD-OCT revealed hyper-reflectivity of the vitreoretinal interface, suggesting a thickening of the posterior hyaloid strongly adherent to several areas of the macula, inducing elevation and marked distortion of the entire macular area (). These ocular clinical findings were suggestive of an inactive scar-like lesion without any inflammatory reaction in the vitreous and anterior chamber, but complicated by significant vitreoretinal traction.\nAfter written informed consent was obtained from the patient’s parents, a 23-G pars plana vitrectomy was performed. The posterior hyaloid was removed intraoperatively using forceps, without difficulty. After having accurately verified that no epiretinal membrane was detectable in the entire macular area, no attempt was made to remove the inner limiting membrane. Vitrectomy was completed without complication in a total surgical time of 20 minutes. Visual acuity improved soon after surgery and reached 40/60 after 10 days. The macula remained flat and free of any signs of traction in the following 10 months, with stabilization of visual acuity to 20/20 ().
|
[[17.0, 'year']]
|
F
|
{'19882570': 1, '17135336': 1, '12441842': 1, '20602328': 1, '30930669': 1, '14615644': 1, '22323888': 2, '21629569': 1, '24043928': 2}
|
{'3268171-1': 1}
|
163,216 |
3772870-1
| 24,043,950 |
noncomm/PMC003xxxxxx/PMC3772870.xml
|
Acute hemorrhagic edema of infancy: a worrisome presentation, but benign course
|
A 14 month old boy presented to our emergency department with intermittent low grade fever of 2 days duration associated with a rash, swelling of the left leg, and an inability to bear weight. The mother stated that the patient had a runny nose and a mild cough 1 week prior to admission.\nThere was no diarrhea, change in behavior, toxic ingestion, medication use, or any recent vaccinations. Past medical history and family history were unremarkable and immunizations were up to date. The patient was admitted to the ward for fever and rash. On admission, his temperature was 38°C, he had a respiratory rate of 25 breaths per minute, his heart rate was 110 beats per minute, and his blood pressure was 100/70 mmHg.\nOn examination, the patient was not looking toxic, his neck was supple, and the neurological exam was unremarkable. The skin showed ecchymotic, purpuric, targetoid plaques with oval and round shapes on the face and extremities (–). The right auricle of the ear was mildly edematous and purple in color. There was mild swelling on the hands and lower extremities without skin induration and the range of motion of all joints was normal. The rest of the physical exam was unremarkable. The complete blood count and urine analysis were both unremarkable.\nA decision was made to biopsy one of the lesions from the left forearm and it showed inflammatory infiltrate surrounding dermal blood vessels. The infiltrate was a mixture of neutrophils, lymphocytes, and scattered eosinophils with fragmented nuclei of neutrophils, and there was focal necrosis of the vessel wall. On direct immunofluorescence there was no immunoglobulin A (IgA) deposition. The patient was discharged after the diagnosis and the rash resolved spontaneously in 3 weeks.
|
[[14.0, 'month']]
|
M
|
{'17704952': 1, '17300653': 1, '32595402': 2, '33782070': 1, '21357201': 1, '19067875': 1, '18656284': 1, '23170985': 1, '18154430': 1, '18772356': 1, '21772612': 1, '23741666': 2, '34018831': 2, '31942241': 2, '23056774': 1, '26558246': 2, '22994202': 1, '24043950': 2}
|
{'8145611-1': 1, '7315089-1': 1, '7315089-2': 1, '4636105-1': 1, '6944248-1': 1, '3673373-1': 1}
|
163,217 |
3772920-1
| 24,194,972 |
noncomm/PMC003xxxxxx/PMC3772920.xml
|
Metformin induced acute pancreatitis
|
Nineteen year-old-man, known case of Type 2 Diabetes mellitus for 4 y on 1 g metformin twice daily since diagnosis of his diabetes. He was in his usual state of health till he presented to the emergency department reporting nausea, vomiting and epigastric pain for 3 d.\nOn physical examination, his height was 170 cm and body weight 99 kg; body mass index (BMI) 34.3 kg/m2, looked mildly dehydrated. Vitals signs were stable. Systemic examination was unremarkable, apart from mild epigastric tenderness.\nLaboratory investigations showed HbA1c 7.7%, Creatinine 58 µmol/L, Amylase 462 units/l (normal range < 100), Lipase 1378 units/l (0–60), white blood cells 16.8/mm3 (4–11) 80% of which was neutrophils, CRP 258 mg/l (0–5), Mg 0.76 mmol/l (0.7–1.05), Ca 2.17 mmol/l (2.2–2.6), AST 18 units/l (< 39), ALT 34 units/l (< 41), TG 0.95 mmol/l (< 2.3), Lactate 1.4 mmol/l (0.5–1.6). Abdominal Ultrasound and ERCP were done for the patient, results showed no gallstones and clear biliary tract, respectively. CT confirmed the diagnosis of acute pancreatitis, with no identifiable cause.\nThe patient was admitted to ICU for close monitoring and further investigation. Normalization of Amylase and Lipase was reached after Metformin cessation, and Supportive treatment in the form of IV insulin and IV fluids. Other potential causes of pancreatitis were excluded. Patient was discharged home in stable condition after 2 weeks.\nFew days later, after re-exposure to Metformin, he presented with recurrence of his previous symptoms, and elevation of Amylase and Lipase was documented.\nAs a result, Metformin was suspended with improvement of his symptoms and biochemical profile.
|
[[19.0, 'year']]
|
M
|
{'15082849': 1, '19561734': 2, '20531242': 1, '33375269': 1, '19552084': 1, '16644670': 1, '20087199': 1, '21238888': 1, '18259965': 1, '18081217': 1, '12000591': 1, '32302358': 1, '11824780': 1, '11095359': 1, '20227028': 1, '12930161': 1, '24194963': 1, '19281696': 1, '20181433': 1, '18067678': 1, '8726592': 1, '26170677': 2, '19379661': 1, '24194972': 2}
|
{'2672258-1': 1, '4489815-1': 1}
|
163,218 |
3773596-1
| 24,044,100 |
noncomm/PMC003xxxxxx/PMC3773596.xml
|
Squamous Cell Carcinoma of the Suprapubic Cystostomy Tract With Bladder Involvement
|
A 56-year-old male patient who had a suprapubic Foley catheter for 9 years after the formation of an urethrocutaneous fistula presented with a spontaneous suprapubic urinary leak from a well-healed suprapubic cystostomy tract scar. He originally had a urethral stricture that required multiple surgical corrections for 16 years beginning at the age of 28 years. Nineteen years later (at the age of 47 years), a urethrocutaneous fistula occurred spontaneously and a suprapubic cystostomy tube was eventually required for urinary diversion.\nPhysical examination revealed an erythematous lesion in the abdominal wall enveloping the suprapubic catheter. The result of ThinPrep smear urine cytology was suspicious of malignancy. Cystoscopy revealed a bladder mass in the dome. Ultrasound examination of the kidneys did not show any dilatation. On the computed tomographic (CT) scan of the abdomen, a tumor mass surrounding the suprapubic cystostomy tract was clearly visible (). Transurethral biopsy of the bladder mass was performed. Histological examination of the biopsy from the bladder mass revealed squamous cell carcinoma, moderately differentiated, probably originating from the vesicocutaneous fistula tract involving the bladder mucosa ().\nThe patient did not want to undergo aggressive surgical excision of the complete bladder and the abdominal wall and underwent radiation therapy. Although a CT scan of the abdomen after radiation therapy showed partial remission (), the patient died of lung metastasis and pneumonia at 6 months after the start of radiation therapy.
|
[[56.0, 'year']]
|
M
|
{'9146594': 1, '31240127': 1, '8001003': 1, '29492256': 2, '10925107': 1, '926277': 1, '3378221': 1, '1271546': 1, '26885141': 1, '29259836': 2, '7637064': 1, '712899': 1, '10369176': 1, '8516995': 1, '24044100': 2}
|
{'5702393-1': 1, '5824828-1': 1}
|
163,219 |
3773597-1
| 24,044,101 |
noncomm/PMC003xxxxxx/PMC3773597.xml
|
Isolated Renal Mucormycosis in a Healthy Immunocompetent Patient: Atypical Presentation and Course
|
A 30-year-old normotensive nondiabetic male presented with complaints of right flank pain on and off for the past 1 year. The pain had started as a sudden severe aching pain that was initially associated with painless hematuria, low-grade fever, and nausea. The patient was admitted to the hospital and was managed on parenteral antibiotics. His symptoms subsided on this conservative treatment, but he continued to have similar recurrent episodes over the past 1 year. He had no history of decreased appetite or weight loss. On evaluation, the patient was found to have a total leukocyte count of 9,700 cells/mm3 and serum creatinine of 0.88 mg/dL. Urine examination was unremarkable. Contrast enhanced computed tomography revealed a right upper polar heterogeneous nonenhancing mass about 8 cm×10 cm in size (). The right kidney was found to have a glomerular filtration rate of 7.4 mL/min on a technetium 99m-diethylene triamine pentaacetic acid scan. The patient underwent a right nephrectomy, and histopathology of the resected specimen revealed necrotizing granulomatous inflammation associated with mucormycosis and xanthogranulomatous pyelonephritis (). Inflammatory cells consisted of foamy histiocytes, few multinucleate giant cells, plasma cells, and lymphocytes. Large areas of necrosis were present along with palisading epithelioid cells and epithelioid cell granulomas at the periphery. Fungal elements were described as broad, aseptate fungi with right angled branching hyphae (). The patient had an uneventful postoperative course and recovery. Because the patient showed no signs of sepsis preoperatively or postoperatively, no antifungals were given and the patient was managed conservatively on that front.
|
[[30.0, 'year']]
|
M
|
{'18626171': 1, '15134995': 1, '2033702': 1, '11545569': 1, '29049207': 1, '30524710': 1, '10534520': 1, '30652661': 1, '2682947': 1, '3557325': 1, '18695332': 1, '19701078': 1, '24044101': 2}
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{}
|
163,220 |
3774952-1
| 24,049,579 |
noncomm/PMC003xxxxxx/PMC3774952.xml
|
Minimally invasive treatment for esthetic enhancement of white spot lesion in adjacent tooth
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A 22-year-old woman who lost her maxillary right central and lateral incisor prosthesis presented to the Gangneung-Wonju National University Dental Hospital for treatment (). The prosthesis was lost with severe secondary caries around the metal post. Each root canal was incompletely filled with a radiopaque resinous hard material, and the right lateral incisor root had apical rarefying osteitis (). Extraction was necessary due to the large extent of secondary caries and the nonremovable canal filling material. A white spot was found in the maxillary left central incisor with poor oral hygienic control.\nBecause the patient refused tooth preparation, restoring the teeth with an implant prosthesis was planned. A diagnostic waxing of the teeth determined the installing site of implants to meet the esthetic needs and to fabricate a radiographic stent and a surgical stent. Six weeks after extraction, severe bone loss of the buccal plate was confirmed (). In view of the insufficient implant primary stability, guided bone regeneration was performed as defects were filled with a xenograft material (Bioss; Geistlich Pharma AG, Wolhusen, Switzerland) and covered with a resorbable bilayer collagen membrane (Bio-gide; Geistlich Pharma AG) (). Four months after guided bone regeneration, sufficient hard and soft tissue volume was acquired. A tapered internal hex titanium implants (Implantium; Dentium, Seoul, Korea) were installed, oriented by a surgical guide. An acrylic resin RPD was fabricated to replace the missing tooth during the healing period.\nSix month after implant placement, a tissue-punch technique was used to place a screw-retained provisional restoration with a provisional plastic abutment (Plastic temporary abutment, Dentium). The treatment for the white spot of the left maxillary central incisor was also needed. Diagnosis for the white spot was performed with visual-tactile inspection evaluating change of the surface gloss and color after dessication. The lesion surface was hard and shiny, it was diagnosed as an inactive ICDAS (International Caries Detection and Assessment System) code 2 which requires esthetic improvement only. Regenerating the white spot on the prosthesis was not esthetic and removal of the white spot lesion was thus required. Gingival recession after a surgical procedure highlights the white spot in the cervical area (). Furthermore, bandlike whitish discoloration along the perikymata in the middle third coronal area also needed esthetic enhancement. The proposed minimally invasive technique is based on a combined approach of bleaching, resin infiltration and composite resin bonding. In-office bleaching treatment was applied according to the manufacturer's (Lumawhite; Luma Lite, Spring Valley, CA, USA) recommendations. After gingival tissues were isolated using a light-polymerized resin dam (Opal Dam; Ultradent Products Inc., South Jardan, UT, USA), 35% hydrogen peroxide (Lumawhite) was applied onto the left maxillary incisor with consistent coverage of 2 to 3 mm thickness for 8 minutes, for a total of 3 times (). Two weeks after treatment, the white spot lesion was still apparent though bleaching became effective on the normal tooth structure, requiring more effective treatment ().\nConsequently, the decision was made to conduct the resin infiltration technique as it was more preservative than microabrasion or macroabrasion. On the enamel surface, careful application of 15% hydrochloric acid gel (ICON-Etch; DMG, Hamburg, Germany) was performed for 120 seconds to remove the surface layer less than 30 to 40 µm (). The acid gel was suctioned and washed away thoroughly. The lesions were desiccated using ethanol (ICON-Dry; DMG) for 30 seconds. At the moment of applying ethanol, the color change in the white spot lesion was confirmed with ethanol penetration. After thorough dessication with ethanol, an infiltrant resin (ICON-Infiltrant; DMG) was placed on the tooth surface for 3 minutes for inside penetration. Excessive resin was wiped away from the surface and the proximal spaces. Light polymerizing was performed for 40 seconds. Applying the infiltrant resin was repeated to compensate for the shrinkage after polymerization. The tooth surface was polished with polishing discs (Sof-lex disk; 3M ESPE, Saint Paul, MN, USA). After resin infiltration, some of the cervical white spot and bandlike whitish discoloration along the perikymata in the middle third coronal area disappeared (). However, resin infiltration in some parts of the cervical white spot lesion was ineffective, requiring an advanced approach.\nThe limited, unchanged white spot lesion was removed with a carbide bur (Carbide Burs Round; Mani Inc., Tochigi, Japan). The tooth structure was etched with 38% phosphoric acid (Scotchbond Etchant; 3M ESPE) for 15 seconds. The etching gel was washed away and dried. A bonding agent (Adper Single Bond Plus adhesive, 3M ESPE) was applied to the preparation area and light polymerized for 10 seconds. Composite resin (Filtek Supreme XT; 3M ESPE) was placed and polymerized for 40 seconds. Finally, polishing the restoration surface was performed with polishing discs (Sof-lex disk; 3M ESPE) ().\nA complete maxillary arch impression was made with a silicone impression material (Exafine, GC, Tokyo, Japan). A customized abutment (Direct Casting Abutment; Dentium) was fabricated. Shade information was transferred to the dental laboratory after taking clinical photos with a shade guide (VitaLumin shade guide; VidentInc, Brea, CA, USA) and a detailed shade map (). A metal ceramic fixed dental prosthesis was cemented with implant cement (Premier Implant Cement; Premier Products Co., Plymouth Meeting, PA, USA) ().\nThe patient was followed for oral hygiene instruction and no complications were found after 6 months (). However, due to insufficient long term clinical research on color stability for resin infiltration treatment, continuous post-treatment monitoring should be followed. It is also important to monitor the maintenance of proper surface gloss, oral hygiene and health of peri-implant soft and hard tissue.
|
[[22.0, 'year']]
|
F
|
{'26877590': 1, '16329421': 1, '11699174': 1, '31496574': 1, '17823680': 1, '10860340': 1, '19029077': 1, '21172402': 1, '28512540': 1, '21401750': 1, '19862396': 1, '17333980': 1, '31496570': 1, '9304185': 1, '14969374': 1, '26330939': 1, '1067529': 1, '30271637': 2, '7562731': 1, '17886464': 1, '17586715': 1, '17001829': 1, '6749694': 1, '15286119': 1, '24049579': 2}
|
{'6146902-1': 1}
|
163,221 |
3774953-1
| 24,049,580 |
noncomm/PMC003xxxxxx/PMC3774953.xml
|
The evaluation of maximum bite force in the occlusal rehabilitation of patient with Angle Class III malocclusion: a case report
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A male patient aged 33 years old was self-referred to the Faculty of Dentistry at University of Gazi. The main complaints of patient were difficulty in masticatory function and poor esthetic. The patient's medical history was reviewed and it was decided to be non-contributory. An extensive clinical examination was also made. On extraoral clinical examination, retruded upper lip with prominent lower lip was noted as usually seen in Class III malocclusion (). Cephalometric analysis of patient revealed that patient had Angle Class III malocclusion (ANB = -5). In dental examination, it was detected that Class III cuspidfirst molar relationship and anterior crossbite with the negative horizontal overjet in centric relation, diastemas in anterior teeth, and missed three molar teeth number of 17, 26 and 47 (). There was no caries, wear or restoration on teeth. The periodontal examination showed the presence of plaque and generalized staining. In the evaluation of temporomandibular joint, no history of dysfunction was reported and, no joint sound and pathology was revealed. Masticatory muscles, head and neck muscles were normal to palpation. The mandibular range of the motion and jaw opening were within the normal limits.\nBefore the treatment, maximum bite forces were measured from each side of the dental arch using two miniature strain-gauge transducers with stainless-steel cases (Model VLPB, Load Cell Central, Monroeton, PA, USA). Each transducer had a height of 4 mm and a diameter of 12 mm. The bite force was detected as a two-channel signal from each side with a biosignal acquisition device designed by Kardiosis (Tepa, Kardiosis, Ankara, Turkey). The force signals were monitored online and then measured on a PC screen, using a specific software program developed by the same company. Two transducers were placed bilaterally in contact with maxillary first molar teeth over metal plate. The transducers fixed with plaster (Betasan, Kocaeli, Turkey) to the metal plate. Then, metal plate and transducers were covered with a disposable latex finger coating to avoid contamination. During measurement, the subject was asked to clench teeth as forcefully as possible three times. The highest value of each clenching was recorded as kilogram (kg), and the mean value of the three highest clenching was considered as the subject's maximum bite force. The sum of the right and left bite force values was considered to be the maximum bite force of the subject. Maximum bite force of patient was measured as 42 kg before treatment.\nTwo following treatment options were discussed with the patient; (1) Orthodontic treatment and following surgical treatment, (2) Restorative treatment with increasing of OVD. The patient was informed about all the advantages, disadvantages and possible risks of both treatment options. In that patient, even if the orthodontic treatment is accomplished, the shape, size and color of present teeth would remain the same. Also orthodontic and surgical treatment would also require extended treatment time. On the other hand, as another option, restorative treatment would involve the preparations of all maxillary and mandibular teeth for improving occlusal relationships and also increasing of OVD. The patient's expectations from the treatment were a good esthetic and masticatory function with a less invasive way in a relatively short time. Therefore, increasing of OVD and then restoring the maxillary and mandibular teeth was decided to be chosen as the treatment option of patient. Full mouth rehabilitation with metal ceramic restorations was suggested to patient.\nAt first, periondontal treatment was performed and oral hygiene instructions were given. Then, irreversible hydrocolloid impressions (Hydrocolor 5, Zhermack, Zhermack SpA., Badia Polesine, Italy) of maxillary and mandibular teeth were made to obtain diagnostic casts. A face bow record (UTS Face-bow, Ivoclar Vivadent, Austria) and an interocclusal record in centric relation were completed and diagnostic casts were mounted in a semi-adjustable articulator (Stratos 300, Ivoclar-Vivadent, Austria). The new OVD was established using Niswonger method and facial measurements. Patient had increased interocclusal rest space (7 mm in the anterior teeth), therefore 3 mm rest space was pretended and actual increase were determined as 4 mm in the anterior teeth and 2 mm in the posterior teeth and the incisal guidance pin of the articulator was set.\nDiagnostic casts were evaluated and wax up of all anterior teeth with final contour and position was accomplished at the new OVD. Then an auto-polymerized acrylic resin (Panacryl, Arma Dental, İstanbul, Turkey) occlusal splint was provided to evaluate the adaptation of the patient to altered OVD. The splint was adjusted intraorally to ensure bilateral anterior and posterior simultaneous contacts in centric relation. Anterior region of splint prevented occlusion of splint, therefore excess of acrylic resin was removed from anterior region of splint (). Patient was instructed to wear splint during 24 hours, for 4 weeks. In clinical examination after the first week, no muscle tenderness and temporomandibular discomfort was found.\nAfter the verification of functional adaptation to new OVD, anterior teeth were prepared for definitive treatment. In this session occlusal splint was used to check the preparation amount of anterior teeth and to take bite registration by placing the splint into mouth. Posterior teeth were occluded and anterior part of splint was supported with wax. Then posterior teeth were prepared. At this time anterior part of occlusal splint was occluded and posterior part was supported with wax. After preparation of all anterior and posterior teeth (), final impressions were made with polyvinylsiloxane impression material (Optosil Comfort/Xantopren VL Plus, Heraeus Kulzer, Hanau, Germany) and provisional restorations were fabricated using an auto-polymerized acrylic resin. The provisional restorations were used for one month, as a guide for the definitive restoration. During this period, the patient's condition and functions, such as muscle tenderness, temporomandibular joint discomfort, range of the mandibular movements, masticatory function, swallowing and speech were evaluated. Improvement in masticatory function, speech, and dentofacial esthetics affirmed the patient's tolerance to the new OVD. In the following session, metal substructures (Kera N, Germany) of restoration were adjusted. After the adaptation of metal substructure, the trial of ceramic restoration (Ceramco 3, Dentsply, Dreieich, Germany) were accomplished with minor occlusal adjustments. The occlusal sheme of definitive restoration was designed as mutually protected occlusion. During excursive mandibular movements the anterior teeth protected the posterior teeth from excursive force and posterior teeth supported the bite force in the maximum intercuspal position. Then definitive restorations were glazed and cemented with zinc polycarboxylate cement (Adhesor-Carbofine, Spofa-Dental, Germany) (). Oral hygiene instruction and regular check-up were administered.\nOne week later cementation of definitive restoration, maximum bite force was remeasured and recorded as 106 kg (). Patient reported increased masticatory efficiency with treatment.
|
[[33.0, 'year']]
|
M
|
{'11890069': 1, '17317862': 1, '11843269': 1, '28077971': 1, '22369551': 1, '11807475': 1, '6574243': 1, '6573373': 1, '10462736': 1, '18330194': 1, '21165279': 2, '22885032': 1, '3455969': 1, '21521921': 1, '15743864': 1, '15994982': 1, '22565523': 1, '18992566': 1, '11203936': 1, '24049580': 2}
|
{'2994694-1': 1}
|
163,222 |
3775019-1
| 24,049,352 |
noncomm/PMC003xxxxxx/PMC3775019.xml
|
Tracheobronchomalacia Post-Pneumonectomy: A Late Complication
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An 83-year-old male presented with barking cough with greenish expectoration, shortness of breath (grade III MMRC) and wheezing for 3 days. For last 3 years he has been under treatment for recurrent exacerbations of bronchial asthma, required multiple admissions at various hospitals and was suspected to have brittle asthma. He was a diabetic and hypertensive and a lifelong non-smoker. He had undergone left pneumonectomy 40 years ago for pulmonary tuberculosis. On general examination he was conscious, alert, afebrile, pulse was regular, 120 per minute, BP was 130/80 mm Hg. He had tachypnoea with respiratory rate of 28/min and had hypoxia with SpO2 of 89% on room air. Examination of respiratory system revealed shift of trachea to left, audible stridor which increased on lying down, absent air entry on the left side and conducted sounds on the right side. Arterial Blood Gas analysis showed; pH–7.28, pCO2–53 mm Hg, pO2–75.1 mm Hg, HCO3–22.1.\n2D Echocardiography showed normal LV function, Mild RV dysfunction, dilated RA/RV (TAPSE: 1.24 cm), mild TR and plethoric IVC. CBP, Serum sodium, potassium, and magnesium, were normal. Serum calcium-6.8 mg/dl, phosphate-2.7 mg/dl, parathyroid hormone-179.4 pg/ml, Vit D-3.58, and serum albumin-2.7 mg/dl.\nPatient was given intravenous hydrocortisone, calcium gluconate infusion, and NIV-BiPAP support. CT scan of Neck and Chest were done which showed left post-pneumonectomy status, thickening and calcification of left pleura, tortuous trachea with acute angulation at the thoracic inlet, gross shift of mediastinum to the left, multiple spiculated lesions with surrounding fibrosis (granulomas) in anterior and posterior segments of RUL, multiple calcified pretracheal lymph nodes and compensatory hyperinflation of right lung []. In view of worsening of arterial blood gas values and respiratory failure, he was intubated and mechanically ventilated. Fibreoptic bronchoscopy showed severe narrowing of trachea during inspiration and near total closure during expiration suggestive of tracheomalacia []. Similar dynamic airflow obstruction was visualized up to segmental bronchi, though of progressively lesser severity. Patient was considered unsuitable for invasive surgical procedures in view of poor general condition, high risk for anesthetic complications, and generalized debility. He was unsuitable for placement of stent due to long segment tracheobronchial involvement. He refused further invasive procedures. Long length tracheostomy tube (Portex 8.0) was placed with tip of tracheostomy tube 2 - 3 cm from the level of carina as checked with FOB post-placement. Patency of lower trachea was maintained and chest radiography showed well-aerated right lung. He was discharged with tracheostomy used as interface for BiPAP ventilator with no requirement of supplemental oxygen.
|
[[83.0, 'year']]
|
M
|
{'30863517': 1, '16771908': 1, '24413710': 1, '1555444': 1, '9872215': 1, '16608964': 1, '24049352': 2}
|
{}
|
163,223 |
3775021-1
| 24,049,354 |
noncomm/PMC003xxxxxx/PMC3775021.xml
|
Gall Bladder Carcinoma Presenting with Spinal Metastasis: A Rare Phenomenon
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A 50-year-old lady presented to out-patient orthopedic clinic with pain in the neck since 3 months and weakness in her right upper limb of 2 months duration. The general physical examination was normal; she had tenderness over C4 and C5 vertebra with sensory and motor deficit (power 3/5) in right upper limb. A right upper quadrant abdominal lump was also discovered during the examination. The patient was put on a hard cervical collar and analgesics were advised. Orthopedicians planned a magnetic resonance imaging (MRI) scan of cervico-dorsal spine and a bone scan. An ultrasound scan of the abdomen was also done to evaluate the incidentally found abdominal lump.\nThe MRI scan showed altered marrow signal intensity in right half of C4 vertebra and posterior neural arch with paravertebral soft tissue thickening plugging the right C3/C4 neural foramen and encasing vertebral artery []. The bone scan showed an osteolytic lesion in right side of C4 vertebra with increased uptake over mid cervical vertebra. In addition, there was increased focal uptake on the left side of manubrium sterni. Ultrasound scan of the abdomen revealed a large ill-defined heterogeneous mass lesion in the area of gall bladder, which was infiltrating into adjacent liver; the gall bladder was not separately visible. A diagnosis of metastatic lesion in the sternum and C4 vertebra causing cord compression was made and a general surgeon's opinion was sought for the ultrasound findings.\nThe history was reviewed; she complained primarily of neck pain with weakness in her right upper limb of 3 months duration which was increasing progressively from 2 months. As we were biased by the ultrasound findings, some direct questions were asked to which she responded by stating some discomfort in her left upper abdomen from last 7 months and decreased appetite from last 4 months. There were no complaints on the right side of abdomen. She related her symptoms to ‘indigestion’. On re-examination, we found her to be of medium built with average nutrition. The general physical examination was essentially normal. Abdominal examination revealed mildly tender, irregular, and hard lump measuring 5 × 4 cm in her right upper abdomen, which was moving well with respiration with surrounding hepatomegaly. A clinical diagnosis of carcinoma of gall bladder was made and a contrast enhanced computed tomography (CECT) scan of abdomen was advised for staging. The CT scan showed a poorly differentiated heterogeneous mass lesion replacing gall bladder with extension into the segment 4 and 5 of liver []. For histological confirmation, an ultrasound (USG)-guided fine needle aspiration cytology (FNAC) was performed from the mass which showed well-differentiated adenocarcinoma of the gall bladder. The patient and her relatives were explained about the nature, stage and likely poor outcome of the disease. She was offered chemotherapy and local radiotherapy for the painful spinal lesion but she opted for ‘no treatment’, left the hospital, and was subsequently lost to follow-up.
|
[[50.0, 'year']]
|
F
|
{'9114585': 1, '19139691': 1, '15966303': 1, '23133106': 1, '33090880': 1, '7875728': 1, '20529758': 1, '25432582': 1, '9870740': 1, '24049354': 2}
|
{}
|
163,224 |
3775022-1
| 24,049,355 |
noncomm/PMC003xxxxxx/PMC3775022.xml
|
Pericardial-Peritoneal Window: A Novel Palliative Treatment for Malignant and Recurrent Cardiac Tamponade
|
A 61-year-old male had presented to the hospital with symptoms of chronic cough with expectoration and hemoptysis since 6 months. He complained of sudden onset breathlessness since last few days. On evaluation, conventional radiographs of the chest demonstrated an enlarged cardiac silhouette []. Contrast-enhanced computerized tomography (CECT) revealed disseminated lung cancer, bilateral pleural effusion, and massive pericardial effusion []. An echocardiogram was performed which had features of massive pericardial effusion (6 cm space between the two layers of pericardium) and right ventricle diastolic collapse. Pericardial fluid was aspirated thrice before a definitive surgical procedure was planned. Cytology of the peritoneal fluid showed signs of malignancy. Patient was diagnosed to have recurrent cardiac tamponade secondary to disseminated lung malignancy.\nIn view of recurrent cardiac tamponade and patient being in an already compromised state dying of disseminated disease, a definitive surgical procedure was planned. Surgical pericardial-peritoneal window was planned through a subxiphoid approach under local anesthesia.\nAfter the pericardial sac was exposed and the fluid evacuated, the diaphragmatic surface of the pericardium was examined. An opening of (4 × 4 cm) was created to join the pericardial and peritoneal cavities []. The cut edges of the pericardium, diaphragm, and peritoneum were sutured together with a few interrupted sutures. The dome of the liver prevents any abdominal viscera from herniating into the pericardial cavity. No drainage tubes are needed. The linea alba, subcutaneous tissues, and skin were closed in the usual manner. No complications were encountered and patient was discharged in 2 days. Patient experienced significant symptom amelioration after undergoing pericardioperitoneal fenestration.
|
[[61.0, 'year']]
|
M
|
{'6207601': 1, '4272474': 1, '15487259': 1, '1118576': 1, '2205162': 1, '4690501': 1, '8431079': 1, '4067615': 1, '7728571': 1, '707539': 1, '4046619': 1, '8311586': 1, '20503838': 1, '2648048': 1, '24049355': 2}
|
{}
|
163,225 |
3775054-1
| 24,049,233 |
noncomm/PMC003xxxxxx/PMC3775054.xml
|
Sexual Abuse in 8-year-old Child: Where Do We Stand Legally?
|
DB, a 8-year-old girl, studying in fourth grade and from the Wardha District, was brought in April 2012. Her mother reported change in behavior in form of irritability, withdrawn behavior, sleep disturbance, decreased appetite, using abusive language toward parents and younger brother for the past 1 month. These symptoms succeeded the sexual abuse by a 60-year-old local milkman from the same village a couple of days back. Her mother accidently noticed a 20 rupees note in her school bag and during enquiry incidence of sexual abuse was revealed. The milkman used to tie her hands and gag her mouth and lured her by giving her money and abused her. The family lodged a police complaint and brought the girl to us for assessment and management. Police undertook medico-legal formalities prior to bringing her to us.\nShe was retained as a patient for 2 weeks. The girl has normal developmental history with well-adjusted premorbid temperament. After the incidence, her scholastic performance had deteriorated.\nOn examination, the girl was hiding herself behind her mother. She was well dressed, quiet, and had reasonable eye contact. She was frightened, hesitant, and anxious. She was hyper-vigilant and irritable. She was diagnosed with post-traumatic stress disorder. Family members were counseled regarding her condition and rehabilitation. In follow-up, we noticed difficulty in speech, nightmares, withdrawn behavior, anger, and outbursts. She was counseled. In subsequent assessment, we found that her family was boycotted by villagers. The social agency of the district with the help of police department relocated the family in a different village.\nIn a follow-up, her mother reported improvement. We continued with counseling and psychotherapy. At present, she is undergoing court proceedings, the case will come for hearing in a couple of year's time.
|
[[8.0, 'year']]
|
F
|
{'25657958': 1, '34380802': 1, '24459299': 1, '24049233': 2}
|
{'3775054-2': 2}
|
163,226 |
3775054-2
| 24,049,233 |
noncomm/PMC003xxxxxx/PMC3775054.xml
|
Sexual Abuse in 8-year-old Child: Where Do We Stand Legally?
|
RH, a 8-year-girl, studying in fourth grade, the lone child of her parents was referred to us for psychiatric assessment by local police with a history of sexual abuse by her landlord's 17-year-old son. She presented with complaints of fearfulness, palpitation, breathlessness, anxiety, nightmares, and school avoidance.\nWhen her mother was bathing her, she noticed whitish discharge on her under garments. On enquiry, the girl narrated with fearfulness the whole incidence of sexual abuse by the landlord's son in her house under threat and coercion. Most traumatic aspect was that mother of child would keep the victim in protection of accuser's mother, as the parents were laborer. The police undertook medico-legal formalities prior to coming to us.\nOn examination, she was quiet, perplexed, anxious, and, at times, unhappy. A rapport was gradually established with her. Initially, she used to sit on mother's lap and cling to her. Gradually, she settled down. She looked very traumatic emotionally, a bit fearful, and her anxiety levels increased when she started narrating the incidence. While describing the incidence, she drew two figures lying down on cot, labeled them as herself and the accused on the top. She was so scared that she stopped going to school and out of home. She was diagnosed as having acute stress reaction.\nA report was submitted to the police for court purposes. The Child and Women Welfare Officer was involved. She was counseled along with her mother.
|
[[17.0, 'year']]
|
F
|
{'25657958': 1, '34380802': 1, '24459299': 1, '24049233': 2}
|
{'3775054-1': 2}
|
163,227 |
3775055-1
| 24,049,234 |
noncomm/PMC003xxxxxx/PMC3775055.xml
|
Electro Convulsive Therapy in Psychiatric Manifestations in Wilson's Disease
|
A Hindu male patient aged 22 years diagnosed with Wilson's disease attended our psychiatry out patient department (OPD) with chief complains of wandering behavior from home multiple times since past 6 months, inappropriate giggling, muttering to self, poor self-care, social withdrawal, and emotional blunting. The patient had occasional anger outbursts with irritability and beating parents whenever he was asked to take proper self-care or eat food. Over and above these psychiatric symptoms, the patient had severe extra pyramidal symptoms like drooling of saliva, rigidity in muscles of bilateral upper limbs, festinate gait, and masking of face. There was history of discontinuation to the prescribed doses of penicillamine 8 months ago, i.e., 2 months before the initiation of the current symptoms. Following this, psychotic symptoms were the first to develop, followed by fever, severe anemia, and extrapyramidal symptoms (without antipsychotic medication) about 1 month ago.\nInvestigations of haematology in current exacerbation depicted Hb of 10.9 g/dl, platelet count of 1,06,000/mm3, WBC of 2840/mm3, serum bilirubin of 1.5 mg/dl, serum ceruloplasmin of 3.60 mg/dl (20-60) mg/dl, and serum copper of 68 mcg/dl (80-155), 24-hour urine copper excretion of 95 (20-50) mcg/dl. On ophthalmologic examination, bilateral Kayser–Fleischer rings were visible, MRI findings showed hypo echoic regions in basal ganglia and the ultrasonography of abdomen showed hepato-spleenomegaly.\nPatient was currently on zinc acetate 250 mg/d, penicillamine 600 mg/d, olanzapine 5 mg/d, and trihexyphenydyl 4 mg/d. In the current episode, the neurologist had tried to treat the psychotic symptoms with 6 mg of risperidone with 4 mg of trihexyphenydyl; however, the patient had an episode of severe neck dystonia after which he was shifted to 10 mg of olanzapine, which was reduced to 5 mg after disturbances experienced by patient due to the extrapyramidal symptoms.\nThe patient was diagnosed with Wilson's disease 4 years ago after confirmation by laboratory investigations and ophthalmological examination by a neurologist and treatment with penicillamine. The first symptoms to develop were drooling of saliva with rigidity of limbs and withdrawn behavior and wandering aimlessly. The patient was managed by neurophysician with penicillamine 500 mg/d in divided doses and control over both neurological and psychiatric symptoms was obtained by it. No psychiatric liaison was required.\nThe dilemma was that, presently, there was exacerbation of psychiatric symptoms; however, poor control by antipsychotic medications and worsening of extrapyramidal symptoms on olanzapine even at low dose of 5 mg/day with 4 mg of trihexyphenydyl. It was decided to treat the current psychiatric manifestations with electro convulsive therapy (ECT) and discontinue all antipsychotics. He was referred to the medical side and a high-risk consent from the family members was obtained to start ECT in the patient. A course of 6 ECT was planned and administered in the patient. The patient showed 25-30-sec seizure response in all ECT sessions which were delivered as per the calculated dose of ECT, administered thrice weekly on alternate days. No prolonged seizure or post-ictal confusion as mentioned in previous case reports was observed. Later, the patient was given 4 ECTS, twice weekly, and 4 ECT once a week, as maintenance ECTs and, with complete resolution of psychiatric manifestations, ECTs were discontinued without starting any antipsychotic medication. The patient was continued on penicillamine and zinc for control of neurologic and other manifestations of Wilson's disease.\nIt has been reported that, in Wilson's disease, the psychiatric manifestations may precede neurological signs in the early stages of Wilson's disease. This patient had consulted us after being a defaulter in the treatment of Wilson's disease from a neurologist. The current scenario had more of psychiatric problems than neurologic. The visible extrapyramidal symptoms were worsened with antipsychotics. However, by discontinuing the antipsychotic treatment, there was an exacerbation of the neuropsychiatric symptoms. With references to case reports from previous data, it was decided to start a course of 6 ECTs in the patient, which is a routine course of therapy followed in our hospital for psychotic patients. We also went a step ahead to continue with the maintenance ECTs in this patient and preferred not to stabilize him on any oral antipsychotic drug due to poor outcomes in the past 6 months. The patient was followed-up regularly and, after omission of ECTs and continuing regular treatment from neurologist, the patient showed no active symptoms either from psychiatric side or any other domain of Wilson's disease. ECT in control of acute psychosis of Wilson's disease is an encouraging option, especially in patients who have extrapyramidal symptoms along with psychosis as neuropsychiatric symptoms of Wilson's disease. This adds to the long list of managing psychosis of non-psychiatric origin by ECT: intractable epilepsy, multiple sclerosis, parkinson's disease, dementia, neuroleptic malignant syndrome, space occupying lesions, movement disorder, normal pressure hydrocephalus, and encourages us to increase the use of ECT and refrain from any hesitation and stigma related to this time tested therapy.[] Treating psychosis of organic origin with ECTs is a safer and better option whenever there is poor response to antipsychotics.
|
[[22.0, 'year']]
|
M
|
{'2597916': 1, '8628467': 1, '1527540': 1, '3830328': 1, '13797909': 1, '19634211': 1, '2589927': 1, '9812135': 1, '7872138': 1, '11941067': 1, '1635439': 1, '7850400': 1, '9034700': 1, '24049234': 2}
|
{}
|
163,228 |
3775056-1
| 24,049,235 |
noncomm/PMC003xxxxxx/PMC3775056.xml
|
Wires in the Body: A Case of Factitious Disorder
|
Ms. S, a female aged 16 years, hailing from rural background in northern India, with lower socio-economic status, presented with recurrent spontaneous extrusion of copper wires from all of her limbs for the past 1½ years. The patient initially reported pain and development of pustules in the posterior aspect of the left hand which took a long time to heal when an X-ray revealed thin metallic wires in the muscle bulk. These wires were removed by a surgeon, but the problems recurred after a couple of days. Subsequently these wires would be removed every week or two at a clinic in a nearby town, but they would soon recur. The copper wires extracted from the patient surgically would be entrusted to the family members, who would dispose them off near home. The patient and the family members sought treatment at many places in nearby towns but there would be recurrence in a few days. The family members had also taken her to many faith healers for cessation of extrusion of these wires, who told them that she was afflicted by a powerful jinn causing the presence of the wires. Faith healers had suggested rituals which the patient did not follow meticulously. She had also received brief media attention for her symptoms, which she liked and the family members would often talk about it with pride during the interview. The patient presented to our center after she was refused surgery for extraction of wires by local surgeons, who referred her to a tertiary care center. She was admitted in the psychiatry ward for management. In past history, the family members reported that the patient had difficulty with affect regulation since childhood. She would be stubborn and inconsiderate toward younger siblings, would get angry easily, and refuse food. She would refuse to do the delegated household chores, sought attention of others and would go out of the house without informing the family members. Physical examination of the patient revealed multiple scars and wounds bilaterally, in the forearms, arm, thighs and knees. However, no scars or wounds were present in any inaccessible areas like back. On interview the patient was guarded. She appeared tidy and kempt with normal speech, had euthymic affect and no perceptual and thought abnormalities. Higher mental functions were within normal limits. She expressed displeasure on being asked about any psychological stressors and focused primarily on her physical complaints. When asked nonjudgmentally about the possible source of such wires in the body she became verbally aggressive and assumed a challenging stance toward the ward team. Engaging her into a therapeutic relationship was very difficult. She refused psychometric and personality testing and did not cooperate for the same on repeated attempts. X-rays of multiple body areas were obtained [Figures and ] and a surgery consultation was sought. The surgical team decided against operation as it was considered unnecessary with risk of further tissue scarring, and advised regular dressing of the wounds.\nThe diagnosis of factitious disorder was made due to the presentation of repeated healthcare seeking for metallic wires in the body parts. Malingering was ruled out due to absence of a definite external incentive occurring from the act. Repeat X-rays confirmed the diagnosis as no new wire formation occurred during the ward stay.\nThe patient became disappointed when surgery was refused and started requesting for discharge. When all attempts to gain confidence of the patient failed, the patient was confronted in a supportive manner in a way that redefines the patient's illness from that of a physical disease to that of psychological distress, and with the assurance that the information will not be communicated to any family member. However, the patient became aggressive, and stopped communicating altogether with the treating team. Family intervention also failed as family members vehemently declined the possibility of the patient inserting the wires herself and were quite insistent that it be due to supernatural powers. Understanding the plurality of the belief system of the family, where they believed that the causation was by “jinn” but the treatment needed was surgical, the family was also allowed to visit faith healers during hospitalisation. Ultimately a therapeutic contract was drafted between the family members, the psychiatry team and the surgical team, whereby it was agreed that all wires from one limb will be removed by surgery, and a soft bandage with tamper protection seal will be made in the same limb. If no new wires developed in the protected limb after a month, family members will come back for psychiatric treatment. Although family members initially agreed, they refused the contract subsequently fearing that the “jinn” will be angered and may cause further damage, and left the hospital against medical advice
|
[[16.0, 'year']]
|
F
|
{'1757950': 1, '12777276': 1, '9279713': 1, '9498978': 1, '18418027': 1, '2247566': 1, '24049235': 2}
|
{}
|
163,229 |
3775057-1
| 24,049,236 |
noncomm/PMC003xxxxxx/PMC3775057.xml
|
Zolpidem-induced Hallucinations: A Brief Case Report from the Indian Subcontinent
|
A 20-year-old female patient visited our psychiatric clinic with sadness of mood and irritable behavior for 4 months. The onset of illness was subacute without any precipitating factors. Her family members also noticed a change in her behavior. Now she would remain worried and preoccupied with thoughts of her marital life most of the time in a day with gradual loss of interest in pleasurable as well as routine activities. She would feel low, gloomy, and fatigued all the day. She had to push herself to go to office and would not take much interest in grooming herself now. She would become easily irritable and falls into arguments frequently. Many a times she would become abusive-aggressive and had harmed herself. Once she attempted suicide after having an argument with her husband. Her biological functions were disturbed and her risk assessment for suicide revealed a high score.\nHer detailed routine and special investigations ruled out any organicity. She was diagnosed as a case of major depressive disorder and was put on paroxetine 12.5 mg twice a day and zolpidem 10 mg at bed time for sleep. Next day, she reported with complaints of experiencing dream-like pleasurable state in which there was Lilliputian like visual and elementary auditory hallucinations after half an hour of ingestion of zolpidem. She slept comfortably 15-20 minutes after the episode. She had partial memory for this phenomenon in the morning.\nThe patient was thoroughly assessed and was advised for hospitalization. Her treatment modalities were altered. Zolpidem was replaced with alprazolam 0.25 and the rest of the medications were unchanged. She remained free of any psychotic phenomenon in further nights. She underwent four psychoeducation sessions and was provided supportive psychotherapy. She showed improvement with treatment and her depressive symptomatology was lessened. The mood disturbances observed in the patient slowly over the next 3-month treatment were replaced by euthymia most of the time. The patient started doing her routine activities and no any hallucinations were reported by the patient in her follow-up.
|
[[20.0, 'year']]
|
F
|
{'33762791': 1, '16990083': 1, '30891388': 1, '29489694': 1, '17026779': 1, '9656974': 1, '14677799': 1, '15027567': 1, '16517453': 1, '21565448': 1, '24049236': 2}
|
{}
|
163,230 |
3775058-1
| 24,049,237 |
noncomm/PMC003xxxxxx/PMC3775058.xml
|
Delusional Procreation Syndrome: Report from TURUVECARE Community Intervention Program
|
A 40-year-old never married male, studied till class VII, presented with diagnosis of paranoid schizophrenia (International Classification of Diseases (ICD)-10) of 2 years duration. In his psychopathology, he had a delusion that he has a 10-year-old royal looking son by name ‘Vikramanka’. He also falsely believes that Vikramanka is a topper in his class and is studying in a government run school; he is living in his friend's house. Patient has not revealed any further information about his wife. The dominant psychopathology in this patient was ‘delusion of paternity’ (father of a son).
|
[[40.0, 'year']]
|
M
|
{'15192320': 1, '14451599': 1, '25336783': 2, '2513079': 1, '23051198': 1, '22135449': 2, '22311536': 1, '25133144': 1, '9730787': 1, '24049237': 2}
|
{'3775058-2': 2, '3775058-3': 2, '3775058-4': 2, '4201803-1': 1, '3221187-1': 1}
|
163,231 |
3775058-2
| 24,049,237 |
noncomm/PMC003xxxxxx/PMC3775058.xml
|
Delusional Procreation Syndrome: Report from TURUVECARE Community Intervention Program
|
A 25-year-old separated female, studied till class VII, presented with diagnosis of undifferentiated schizophrenia (ICD-10) of 6 years duration. Patient had a delusion that she delivered a baby girl 1 year back and is yet to have a name for her baby. She gives an interesting description of delivery of this baby girl: Labor pain started when all her family members had gone out of the house. She also reports that the labor process got completed spontaneously without any complication and that soon after the delivery, the child was kept in an orphanage for children which no family member was aware of. Additionally, patient reports that her girl is growing in that ashrama and has been studying in primary school. However, she has not revealed any other information. Delusion of delivery (labor and childbirth) was concluded to be present.
|
[[25.0, 'year']]
|
F
|
{'15192320': 1, '14451599': 1, '25336783': 2, '2513079': 1, '23051198': 1, '22135449': 2, '22311536': 1, '25133144': 1, '9730787': 1, '24049237': 2}
|
{'3775058-1': 2, '3775058-3': 2, '3775058-4': 2, '4201803-1': 1, '3221187-1': 1}
|
163,232 |
3775058-3
| 24,049,237 |
noncomm/PMC003xxxxxx/PMC3775058.xml
|
Delusional Procreation Syndrome: Report from TURUVECARE Community Intervention Program
|
An 18-year-old never married female, educated up to class X, presented with a diagnosis of schizophrenia NOS (ICD-10) of 1 month duration. In her psychopathology, patient had a delusion that she has a 7-year-old daughter by name ‘Kavya’ who is going to pre-school. Patient did not reveal any information on Kavya's father except the information that he works in a garment factory. Patient also claims that she is taking care of Kavya's day-to-day activities such as bathing, dressing, feeding, and dropping, and picking from her school. When asked about the name of the school, she says that she does not know about it. Patient wishes that her daughter should become a good teacher and serve in her hometown. ‘Delusion of maternity’ (mother of a daughter) was present in this patient.
|
[[18.0, 'year']]
|
F
|
{'15192320': 1, '14451599': 1, '25336783': 2, '2513079': 1, '23051198': 1, '22135449': 2, '22311536': 1, '25133144': 1, '9730787': 1, '24049237': 2}
|
{'3775058-1': 2, '3775058-2': 2, '3775058-4': 2, '4201803-1': 1, '3221187-1': 1}
|
163,233 |
3775058-4
| 24,049,237 |
noncomm/PMC003xxxxxx/PMC3775058.xml
|
Delusional Procreation Syndrome: Report from TURUVECARE Community Intervention Program
|
A 47-years-old never married male without any formal education presented with a diagnosis of undifferentiated schizophrenia (ICD-10) of 16 years duration. In his psychopathology, patient had a delusion that he had a wife by name “Lavanya”, married a year back against the wishes of his family in a temple called as Ram Mandir in the presence of some of his friends and villagers. He also reported that he used to work as a daily wage labourer before his marriage. After marriage, he and his wife started business of selling coconut which is running successfully with huge profits. He is planning to purchase jewelry for his wife from the profit of their business. With this, he believes that he will gain respect from his family and society. ‘Delusion of having spouse’ was present in him.
|
[[47.0, 'year']]
|
M
|
{'15192320': 1, '14451599': 1, '25336783': 2, '2513079': 1, '23051198': 1, '22135449': 2, '22311536': 1, '25133144': 1, '9730787': 1, '24049237': 2}
|
{'3775058-1': 2, '3775058-2': 2, '3775058-3': 2, '4201803-1': 1, '3221187-1': 1}
|
163,234 |
3775059-1
| 24,049,238 |
noncomm/PMC003xxxxxx/PMC3775059.xml
|
Disulfiram Induced Reversible Hypertension: A Prospective Case Study and Brief Review
|
A 39-year-old married adult male, from urban and middle socio-economic background, presented with a history of daily alcohol consumption (92-123 g of ethanol/day) and chewing of tobacco (15-20 packets) since 10 years with the dependence pattern since 4 years. He was diagnosed as alcohol dependence syndrome, and tobacco dependence syndrome in uncomplicated withdrawal state as per ICD-10 diagnostic criteria.[] He had no prior medical history of hypertension, diabetes, heavy metal exposure, epilepsy, neurological deficits, or any drug intake. Family history of alcoholism, but not hypertension was noted in his father and brother.\nOn admission, vital parameters showed marginal alcohol withdrawal sympathetic activity with pulse rate of 96 beats/min and BP of 140/90 mm of Hg. His general physical and the systemic examination revealed no other abnormal findings, except for fine tremors of both hands and mild hepatomegaly. Patient had pre-occupations with alcohol, anxious mood with preserved cognitions, and grade-4 insight. After alcohol detoxification, his BP had stabilized to 120/84 mm of Hg on day-8 of admission. Electrocardiograph revealed no abnormalities. Hematological and biochemical investigations such as complete blood count, blood glucose (105 mg/dl), blood urea (25 mg/dl), and serum creatinine (1.0 mg/dl) were within normal limits. Liver function tests were normal except for elevated liver enzymes (gamma-glutamyl transferase 96 units/L; serum glutamic oxaloacetic transaminase 120 units/L; serum glutamic pyruvic transaminase 56 units/L). His ultrasound abdomen showed mildly enlarged liver with grade-2 fatty infiltration. Considering frequent relapses, patient, and spouse were explained about the nature of illness, and its various treatment modalities available including DSF. Written informed consent for DSF therapy was taken and a dose of 500 mg/day was initiated. Patient was discharged with DSF (500 mg/ day), and multi-vitamin supplementation. At discharge, his vital parameters were stable with pulse of 86 beats/min, and BP of 130/80 mm of Hg.\nCompliance with medications was ensured and supervised by his spouse. A fortnight later, patient complained of gradual onset occipital headache and giddiness with pulse rate of 86 bpm and BP of 146/100 mm of Hg. Life style modifications and dietary measures along with above prescribed medications were advised. On week-4 of DSF therapy, his complaints of headache, giddiness worsened, and BP increased to 170/110 mm of Hg. In view of recent inclusion of DSF, with the absence of prior medical illnesses or drug history contributing to hypertension, possibility of drug induced (DSF) hypertension was suspected. Subsequently, DSF was reduced to 250 mg/day and BP reduced to 150/96 mm of Hg a week later. DSF was further reduced to 125 mg/day following this observation and antihypertensive agents such as telmisartan 40 mg and hydrochlorothiazide 12.5 mg/day were also initiated on the physician's advice. A month later (week-8), patient reported with increased giddiness and physical fatigue with BP of 90/60 mm of Hg despite abstinent. Anti-hypertensive agents were withdrawn and DSF was discontinued completely. Fortnight later (week-10), patient had reached his premorbid levels of BP to 110/70 mm of Hg. Psycho education about medical illness, life style modifications such as regular exercises and dietary measures were advised. Six months later, patient had maintained complete abstinence from alcohol as well as tobacco, and his BP was 130/80 mm of Hg [].
|
[[39.0, 'year']]
|
M
|
{'16702894': 1, '20640061': 1, '25336781': 1, '15156245': 1, '920841': 1, '26664087': 1, '21584118': 1, '17164822': 1, '10348093': 1, '1422404': 1, '106999': 1, '6732388': 1, '7028794': 1, '24049238': 2}
|
{}
|
163,235 |
3775085-1
| 23,925,335 |
noncomm/PMC003xxxxxx/PMC3775085.xml
|
Topography-guided custom ablation treatment for treatment of keratoconus
|
A 22-year-old male patient presented to us with keratoconus both eyes, intolerant to contact lens. His right eye UCVA was 6/18 and BCVA was 6/9 with a spectacle correction of −1.0 DS/−3.5DC@70°. His pre-operative pentacam map is shown in which shows an early keratoconus with a partially inferiorly decentred cone. The pre-operative Q measured by Topolyser was −0.67 which also suggests a mild decentration of the cone and it was retained unchanged.\nHe underwent T-CAT with CXL for his right eye. T-CAT was performed with a refractive correction-1.25DS/-2DC@70° after Zernike optimization, maintaining the maximum central ablation to be less than 40 microns.\nPost-operatively his UCVA was 6/12, BCVA was 6/6 with a spectacle correction of +1.00DS/−1.50DC@20°. His pentacam post-operatively [] revealed regularization of the cornea with flattening of the K-values at various points on the sagittal curvature map.
|
[[22.0, 'year']]
|
M
|
{'15523954': 1, '20954679': 1, '17544782': 1, '26366293': 1, '11383766': 1, '14518740': 1, '21117539': 1, '15523987': 1, '25686063': 1, '32656290': 1, '19772257': 1, '10857834': 1, '25302296': 1, '11425683': 1, '14640438': 1, '28356712': 1, '11713074': 1, '33229651': 1, '15126143': 1, '29042747': 1, '11535475': 1, '12160150': 1, '32494120': 1, '14739922': 1, '2076422': 1, '33229704': 2, '15030830': 1, '33229657': 2, '28513495': 1, '19772256': 1, '12699174': 1, '17667633': 1, '14640439': 1, '21794846': 1, '18500099': 1, '26904679': 1, '23925335': 2}
|
{'3775085-2': 2, '7856944-1': 1, '7856960-1': 1, '7856960-2': 1}
|
163,236 |
3775085-2
| 23,925,335 |
noncomm/PMC003xxxxxx/PMC3775085.xml
|
Topography-guided custom ablation treatment for treatment of keratoconus
|
A 28 year-old male patient with keratoconus presented with UCVA of 6/60 and BCVA of 6/9 with a spectacle correction −5.5DC@30°. His pre-operative pentacam [] revealed grade 2 keratoconus. His pre-operative Q as measured by Topolyzer was −0.54 which suggests a more decentred cone. The Q value was retained unchanged during the planning for T-CAT. The refractive power treated was +0.75DS/−3DC@6° after Zernike optimization.\nPost-operatively his UCVA improved to 6/24p and BCVA TO 6/6p with a spectacle correction of −1DS/−2.25DC@30°. His pentacam revealed good centration of the cone post-operatively, with relative flattening of the cornea [].
|
[[28.0, 'year']]
|
M
|
{'15523954': 1, '20954679': 1, '17544782': 1, '26366293': 1, '11383766': 1, '14518740': 1, '21117539': 1, '15523987': 1, '25686063': 1, '32656290': 1, '19772257': 1, '10857834': 1, '25302296': 1, '11425683': 1, '14640438': 1, '28356712': 1, '11713074': 1, '33229651': 1, '15126143': 1, '29042747': 1, '11535475': 1, '12160150': 1, '32494120': 1, '14739922': 1, '2076422': 1, '33229704': 2, '15030830': 1, '33229657': 2, '28513495': 1, '19772256': 1, '12699174': 1, '17667633': 1, '14640439': 1, '21794846': 1, '18500099': 1, '26904679': 1, '23925335': 2}
|
{'3775085-1': 2, '7856944-1': 1, '7856960-1': 1, '7856960-2': 1}
|
163,237 |
3775144-1
| 24,049,752 |
noncomm/PMC003xxxxxx/PMC3775144.xml
|
Salmonella Paratyphi B septicemia in a Neonate
|
A 6-day-old baby girl presented with fever and blood in stools and vomitus since 1 day. She was a term, small for gestational age, delivered by normal vaginal delivery with a birth weight of 1.55 kg in a private hospital born to a economically poor and severely anemic mother. She was supplemented with top up feeds along with breast milk and was discharged on 3rd day. Antenatal and perinatal history was uneventful. Her Apgar score was not available. On examination she was febrile (101°F), pulse rate 160 beats/min and respiratory rate 50 breaths/min. She appeared dehydrated. Her systemic examination was unremarkable. A diagnosis of neonatal sepsis was made and baby was started empirically on intravenous piperacillin/tazobactam 80 mg/kg body weight 8th hourly and cefotaxime 60 mg/kg body weight 8th hourly. The drug was chosen based on the sensitivity pattern of the prevalent bacteria usually causing sepsis in the hospital nursery.\nScreening for sepsis was done. Laboratory investigations revealed increased C-reactive protein-169.8 mg/L, serum urea 227 mg/dl and serum creatinine was 3.6 mg/dl. Hemogram showed Hb 15.7 gm%, white blood cell count on admission was 24,200/cumm with 54% neutrophils and 40% lymphocytes 6% monocytes and platelet count of 92,000/mm3 suggesting sepsis and prerenal failure. Blood collected at the time of admission flagged positive after 8 hours by BD BACTEC 9120 (Becton Dickinson). The isolate, Gram-negative bacilli is identified as Salmonella enterica serotype Paratyphi B (Agglutinating serum, Remel Europe, Ltd) which was sensitive to ampicillin, ceftriaxone, co-trimoxazole, ciprofloxacin, cefotaxim, ceftriaxone and piperacillin/tazobactam. Stool culture was negative. CSF culture was not done as there were no symptoms of meningeal irritation. Treatment was continued with same antibiotics. Baby's condition improved with 5 days of treatment and was discharged on 9th day. Subsequently, the mother gave history of typhoid fever 3 years back. Mother's stool was cultured to rule out carrier state. Mother's stool culture yielded Salmonella enterica serotype Paratyphi B with the same antibiotic sensitivity pattern. Blood culture and Widal test were negative. Mother was advised to take treatment for carrier state and repeat stool culture after treatment. But she did not turn for follow-up.
|
[[6.0, 'day']]
|
F
|
{'17785907': 1, '29255611': 2, '19801808': 1, '19605582': 1, '16505567': 1, '24049752': 2}
|
{'5729899-1': 1}
|
163,238 |
3775145-1
| 24,049,753 |
noncomm/PMC003xxxxxx/PMC3775145.xml
|
Pentalogy of Cantrell: An Extremely Rare Congenital Anomaly
|
A baby boy weighing 2,390 gm was born to a 39-year-old primigravida mother at 33 weeks of gestation. The maternal antenatal care was transferred to a tertiary setting following the detection of multiple fetal anomalies at 14 weeks of gestation in a polyclinic. Her medical and obstetric histories were unremarkable. Parents were non-consanguineous. A detailed anomaly scan showed a live fetus with EC [] and omphalocele. Fetal echocardiography revealed atrial and ventricular septal defects. The pericardium was not visualized.\nParents were counseled regarding the fetus possibly having a severe form of PC and an amniocentesis was offered. However, they denied amniocentesis and decided to continue with the pregnancy due to religious beliefs. At parental request the perinatal team agreed to deliver the baby at term with a standby multidisciplinary team for surgical intervention, if feasible after assessment.\nWhile on follow-up, mother was admitted with preterm labor at 33 weeks of pregnancy. At parental request, cesarean section was done. A live male infant was born with poor Apgar scores requiring intubation at two minutes of life. On examination there was a large anterior thoraco-abdominal wall defect, ectopic contractile heart and an edematous liver with loops of small intestine and colon outside the abdominal cavity []. Spleen and splenunculi were seen. The face was dysmorphic with bilateral cleft lip. The thoraco-abdominal wall defect was extending from the umbilicus to the upper third of the body of the sternum. The cord was distorted at the umbilicus due to omphalocele. The liver was enlarged with a prominent caudate lobe and the gall bladder appeared normal. A large defect in the diaphragm extending from the sternum to the spine posteriorly was noted. Lungs could be visualized through the defect. Lower half of the body of the sternum and the xiphisternum were absent. The spine was showing severe scoliosis and the abdominal cavity was contracted. All the four limbs were normal. Both kidneys were small and were noted in the pelvis. The external genitalia showed a normal male phenotype. Birth weight, length and head circumference were in the 10-50th percentile.\nAn echocardiogram confirmed the atrial and ventricular septal defects and patent ductus arteriosus. The pericardium was absent. Cranial ultrasonographic scan was unremarkable.\nParents were updated and they requested for comfort care. The ventilatory support was withdrawn and the baby died at three hours of life. The parents consented only for partial autopsy. The biopsy of the skin surrounding the anterior abdominal wall defect was done to rule out amniotic bands and was reported as normal. A biopsy was obtained from the base of the heart and confirmed the absence of the pericardium. Karyotyping showed a normal male infant.
|
[[39.0, 'year']]
|
M
|
{'28503337': 1, '10921692': 1, '9244119': 1, '9564963': 1, '28770129': 2, '17674044': 1, '31072457': 1, '21098854': 1, '34306788': 2, '25404984': 1, '12691294': 1, '8901716': 1, '1308371': 1, '30972230': 1, '4263752': 1, '23804974': 1, '14694384': 1, '13592660': 1, '24049753': 2}
|
{'5538598-1': 1, '8282392-1': 1}
|
163,239 |
3775175-1
| 24,049,624 |
noncomm/PMC003xxxxxx/PMC3775175.xml
|
Kikuchi-Fujimoto Disease in 21-Year-Old Man
|
The patient was a 21-year-old man with chief complaints of chills, fever, cervical lymphadenopathy and myalgia. On admission vital signs were as: T = 39°C, PR = 90/min, RR = 15/min, BP = 100/60 mmHg. The patient was conscious and orient. Physical examination of chest, heart, abdomen, extremities and neurologic examination were normal. He had swelling and tenderness of cervical area and multiple enlarged lymph nodes were palpable. Examination of pharynx revealed no erythema or exudation. Tonsils were normal. Laboratory findings were as follow:\nCBC: WBC = 15700, Hb = 13.6 g/dl, Plt = 209,000, ESR = 92 mm, CRP = 24 mg/l, BUN = 18 mg/dl, Cr = 1 mg/dl, Na = 143 meq/dl, K = 4.5 meq/dl, FBS = 78 mg/dl. ALT = 25 U/L, AST = 33 U/L, PT = 12.5 s, PTT = 28 s, ALP = 278 U/L, LDH = 1398 U/L, CPK = 52 IU/L, INR = 1. Urine analysis and peripheral blood smear were normal. Wright, widal, HBs-Ag and HIV-Ab were negative. EBV, CMV and toxoplama antibodies (IgM and IgG) were negative.\nCervical soft tissue sonography showed multiple lymph nodes with different size. The largest was 9 * 15 mm.\nCeftriaxone and azithromycin was started for him. Cervical lymph node excisional biopsy was performed. Microscopic examination showed reactive follicular hyperplasia and some areas of monocytoid lymphoid cells hyperplasia with vast areas of necrosis without neutrophilic infiltration. No sign of malignancy was seen. Final diagnosis was Kikuchi-Fujimoto necrotizing lymphadenitis. Prednisolone 25 mg daily was started for him. Fever disappeared and general condition improved gradually. The patient was discharged with good condition and outpatient follow-up.
|
[[21.0, 'year']]
|
M
|
{'19180344': 1, '14608843': 1, '25199195': 1, '15043495': 1, '16722618': 1, '17611068': 1, '28052948': 1, '14521458': 1, '16275413': 1, '12494869': 1, '24049624': 2}
|
{}
|
163,240 |
3775176-1
| 24,049,625 |
noncomm/PMC003xxxxxx/PMC3775176.xml
|
Kerathocyst Odontogenic Tumor: Importance of Selection the Best Treatment Modality and A Periodical Follow-up to Prevent from Recurrence: A Case Report and Literature Review
|
A 22-year-old male presented to the clinic of oral and maxillofacial radiology of Isfahan dental school for evaluation of a gradually enlarging hard mass in the right mandible on January, 2013. He reported that the swelling had gradually increased in size over a period of 2 years. He has not any other symptoms such as pain, drainage and neurosensory deficit associated with right inferior alveolar nerve. He has a history of surgery on the right side of the mandible at molar region due to the KCOT in this region 5 years ago with the size of 2.5 × 2.5 cm. Unfortunately, all the patient previous documents except the pathological report were lost.\nClinical evaluation showed a slight swelling along all the right mandibular body, second premolar and first molar teeth in this region were extracted. The cone beam computed tomography was performed by Gallileos unit (Sirona dental systems GmbH, Germany, Hessen, Bensheim) with slice thickness and slice interval of 2 mm. Evaluation of coronal, axial and cross-sectional views exhibits a large multilocular radiolucency from the angle of mandible to the symphysis [].\nThe lesion expands the inferior border of the mandible and displaced the inferior alveolar canal inferiorly [].\nIn the right parasymphis region, the buccal cortical plate of the mandible was perforated in some regions [].\nFinally, due to the patient's past history and radiological findings, the temporary diagnosis was recurrence of KCOT that was proved by incisional biopsy and the patient referred for surgical treatment. Surgical resection of the right side of the mandible from an angle to the right parasymphis region was done under the general anesthesia and reconstruction with autologous graft was done. The histhopathologic examination confirmed the diagnosis of recurrent KCOT [.
|
[[22.0, 'year']]
|
M
|
{'18088693': 1, '30895141': 1, '33110304': 1, '23691729': 1, '19158536': 1, '4505406': 1, '1550808': 1, '8113423': 1, '16243184': 1, '16413905': 1, '8727585': 1, '5270271': 1, '12167890': 1, '18088687': 1, '18801672': 1, '18088689': 1, '18088694': 1, '7443696': 1, '28446856': 1, '6172530': 1, '16487797': 1, '18088690': 1, '11077375': 1, '12892445': 1, '18088691': 1, '22144832': 2, '18587212': 1, '24049625': 2}
|
{'3227256-1': 1}
|
163,241 |
3775182-1
| 24,049,555 |
noncomm/PMC003xxxxxx/PMC3775182.xml
|
Brain herniation induced by drainage of subdural hematoma in spontaneous intracranial hypotension
|
A 36-year-old male with intermittent history of headache since 4 weeks presented with acute onset excruciating headache to our emergency department. The headache was generalized, continuous, squeezing with no relief, or aggravation on lying down. Past history was unremarkable, and there was no history of head trauma. On examination he was alert with no neurological deficit. No nuchal rigidity was noted. Blood examination revealed a normal hemoglobin and coagulation profile. Computed tomography (CT) scan findings of bilateral chronic subdural hematoma (SDH) collection with increased attenuation along basal cistern raised the possible diagnosis of acute subarachnoid hemorrhage (SAH) []. Intracranial angiography revealed no evidence of aneurysm or vascular malformations. Conservative treatment including bed rest and careful observation was done. Until then, the diagnosis of SIH was not made, and follow-up intracranial angiography was planned after a week considering the possibility of concealed aneurysm. In subsequent days, the patient's consciousness deteriorated progressively to be lethargic which was interpreted as a sign of increased intracranial pressure due to bilateral chronic SDH. After confirming no aneurysm on follow-up CT angiogram, the patient underwent emergency bilateral burr hole drainage of hematoma. The intraoperative course was unremarkable. Immediate postoperative CT scan demonstrated poor visualization of posterior fossa cisterns [, left] with large pneumocephaly in both cerebral hemispheres [, right]. After the recovery period, the patient did not regain consciousness; instead, there was progressive worsening of consciousness. The 2-h follow-up CT scan revealed a huge epidural hematoma on the left side []. An emergency craniotomy and hematoma evacuation was performed. After the second surgery, the patient was deeply stuporous without any clinical improvement. The 2-day follow-up diffusion weighed magnetic resonance imaging (MRI) evidenced acute cerebral infarction on bilateral territories of posterior cerebral artery and CT scan showed poor visualization of the fourth ventricle [, left] with supratentorial pneumocephalus and subdural fluid collection [, right]. Unusual rapid clinical deterioration despite prompt hematoma evacuation, poor visualization of the fourth ventricle, and pneumocephalus on imaging were now interpreted as the result of downward displacement of the brain, and an underlying spinal CSF leak was suspected. The patient was placed in the Trendelenburg position and an empirical epidural blood patch was applied using a 10 ml autologous blood, one each for a cervico-thoracic and thoraco-lumbar junction. A rapid improvement in consciousness (from Glasgow coma scale score 7-11) was noted over the period of 3 days after the procedure and the CT scan showed well visualization of the fourth ventricle []. The patient demonstrated full clinical recovery, 4 weeks after the epidural blood patch. A complete spine CT myelography performed to evaluate the possibility of remaining CSF leak demonstrated small leaks at cervical C4-5 level []. Because the patient was alert and had no symptoms associated with SIH, no further intervention was performed. The patient was discharged and the 4-month post-operative follow-up brain MRI showed no evidence of subdural fluid collection [] or brain herniation. Bilateral cortical blindness due to bilateral occipital infarction and mild cognitive deficit gradually improved 8 months after the surgery.
|
[[36.0, 'year']]
|
M
|
{'26923835': 1, '15926018': 1, '28180623': 1, '14718728': 1, '16009901': 1, '11087775': 1, '19242563': 1, '14676045': 1, '20063129': 1, '8913082': 1, '20211844': 1, '25255993': 1, '33213246': 2, '25598907': 1, '18325294': 1, '25969682': 2, '16266041': 1, '33093993': 2, '12754345': 1, '17257233': 1, '33163434': 2, '24049555': 2}
|
{'7568103-1': 1, '4427154-1': 1, '7683931-1': 1, '7683931-2': 1, '7683931-3': 1, '7607012-1': 1}
|
163,242 |
3775190-1
| 24,049,553 |
noncomm/PMC003xxxxxx/PMC3775190.xml
|
Idiopathic spinal cord herniation: Clinical review and report of three cases
|
A 66-year-old previously well man presented with an 18-year history of upper thoracic spine pain. The pain was initially intermittent and mild, but in the 14 months prior to presentation, it had gradually increased in severity and persistence. The pain radiated to the left side of the neck, and when severe, spread around both sides of the chest. The patient reported two episodes of left arm weakness lasting a few hours with spontaneous resolution, but denied paresthesia, sensory loss, or sphincter disturbance. There was no history of spinal surgery, trauma, or spinal disorders. Clinical examination demonstrated an upper thoracic spine gentle kyphosis. There were no abnormal findings on neurological motor, sensory, and reflex examination. A suboptimal quality MRI of the thoracic spine performed at a different institution was interpreted as an intradural mid-thoracic lesion, with a described intradural extramedullary mass indenting the dorsal aspect of the spinal cord. These findings were initially thought to be a dorsal arachnoid cyst. Repeat MRI at our institution demonstrated findings consistent with the characteristic features of ISCH. T2-weighted images showed anterior kinking and mild flattening of the spinal cord at T5, with widening of the subarachnoid space posterior to the cord and pulsation artifact within the CSF space []. The patient was treated with conservative management, with clinical and radiological surveillance. The patient remained neurologically stable at 4 months after presentation.
|
[[66.0, 'year']]
|
M
|
{'10908944': 1, '11598531': 1, '11599832': 1, '8272972': 1, '17443054': 1, '8880706': 1, '11437295': 1, '20730456': 1, '11760388': 1, '28593382': 1, '22290791': 1, '9726479': 1, '15347010': 1, '15200221': 1, '7299475': 1, '16729448': 1, '12546398': 1, '25336997': 1, '1758609': 1, '17048765': 1, '8839477': 1, '16924199': 1, '30870118': 1, '14767711': 1, '15327225': 1, '18204810': 1, '10834646': 1, '32181298': 1, '7791969': 1, '12792347': 1, '27190115': 1, '1870677': 1, '10664429': 1, '8692427': 1, '15300464': 1, '24871148': 1, '16284547': 1, '11337631': 1, '19513134': 1, '11243773': 1, '12408396': 1, '16770516': 1, '16635036': 1, '12021877': 1, '15687862': 1, '32363061': 1, '22470690': 1, '28955299': 2, '10526071': 1, '18976174': 1, '26539277': 2, '9377512': 1, '16483712': 1, '19264054': 1, '19190439': 1, '7964829': 1, '16708343': 1, '10690740': 1, '12498498': 1, '15261515': 1, '11396743': 1, '20593998': 1, '19769512': 1, '9452246': 1, '10232549': 1, '12924599': 1, '4424434': 1, '10369369': 1, '18207514': 1, '11979181': 1, '29713402': 1, '9038133': 1, '19240564': 1, '32101990': 1, '8692428': 1, '31118170': 1, '16506460': 1, '15984404': 1, '19353449': 1, '7815118': 1, '18552662': 1, '12792345': 1, '9726480': 1, '31448173': 2, '10690741': 1, '18501612': 1, '16769517': 1, '8692429': 1, '18538639': 1, '15967323': 1, '24049553': 2}
|
{'3775190-2': 2, '3775190-3': 2, '5601982-1': 1, '5601982-2': 1, '6702865-1': 1, '6702865-2': 1, '6702865-3': 1, '4630365-1': 1}
|
163,243 |
3775190-2
| 24,049,553 |
noncomm/PMC003xxxxxx/PMC3775190.xml
|
Idiopathic spinal cord herniation: Clinical review and report of three cases
|
A 51-year-old female presented with a 3-year history of thoracic back pain. Her medical history included diabetes, rheumatoid arthritis, and Sjögren's syndrome. The pain, when severe, was associated with nausea and vomiting. The patient reported longstanding reduced sensation bilaterally, in the L5 and S1 distribution, secondary to chronic lumbar spondylosis. There was no change in her lower limb neurological symptoms, specifically, no radicular pain or sphincter disturbance. There was no history of spinal trauma. Upon clinical examination, there was mild mid-thoracic tenderness. Lower limb neurological examination was complicated by leg stiffness related to the Sjögren's syndrome. There was global mild weakness Medical Research Council (MRC) grade 4/5 in bilateral lower limbs, and reflexes were normal. There was reduced sensation in the L5 and S1 distribution, which was a longstanding finding. MRI of the thoracic spine demonstrated features consistent with ISCH. T2-weighted images showed anterior deviation and flattening of the spinal cord at the T7 vertebral body level, with a small ventral dural defect and mild cord herniation []. The patient was treated conservatively, and at 4-year follow-up, her neurological condition remained stable.
|
[[51.0, 'year']]
|
F
|
{'10908944': 1, '11598531': 1, '11599832': 1, '8272972': 1, '17443054': 1, '8880706': 1, '11437295': 1, '20730456': 1, '11760388': 1, '28593382': 1, '22290791': 1, '9726479': 1, '15347010': 1, '15200221': 1, '7299475': 1, '16729448': 1, '12546398': 1, '25336997': 1, '1758609': 1, '17048765': 1, '8839477': 1, '16924199': 1, '30870118': 1, '14767711': 1, '15327225': 1, '18204810': 1, '10834646': 1, '32181298': 1, '7791969': 1, '12792347': 1, '27190115': 1, '1870677': 1, '10664429': 1, '8692427': 1, '15300464': 1, '24871148': 1, '16284547': 1, '11337631': 1, '19513134': 1, '11243773': 1, '12408396': 1, '16770516': 1, '16635036': 1, '12021877': 1, '15687862': 1, '32363061': 1, '22470690': 1, '28955299': 2, '10526071': 1, '18976174': 1, '26539277': 2, '9377512': 1, '16483712': 1, '19264054': 1, '19190439': 1, '7964829': 1, '16708343': 1, '10690740': 1, '12498498': 1, '15261515': 1, '11396743': 1, '20593998': 1, '19769512': 1, '9452246': 1, '10232549': 1, '12924599': 1, '4424434': 1, '10369369': 1, '18207514': 1, '11979181': 1, '29713402': 1, '9038133': 1, '19240564': 1, '32101990': 1, '8692428': 1, '31118170': 1, '16506460': 1, '15984404': 1, '19353449': 1, '7815118': 1, '18552662': 1, '12792345': 1, '9726480': 1, '31448173': 2, '10690741': 1, '18501612': 1, '16769517': 1, '8692429': 1, '18538639': 1, '15967323': 1, '24049553': 2}
|
{'3775190-1': 2, '3775190-3': 2, '5601982-1': 1, '5601982-2': 1, '6702865-1': 1, '6702865-2': 1, '6702865-3': 1, '4630365-1': 1}
|
163,244 |
3775190-3
| 24,049,553 |
noncomm/PMC003xxxxxx/PMC3775190.xml
|
Idiopathic spinal cord herniation: Clinical review and report of three cases
|
An 82-year-old man presented with a 10-day history of progressive bilateral lower limb weakness and generalized numbness in his thorax and lower limbs. He reported a 3-week history of worsening gait ataxia, on a background history of 5 years of mild gait disturbance. On admission, the patient denied having problems with defecation, but had acute difficulty with micturition which resulted in catheter insertion. There was no history of spinal surgery, trauma, or spinal disorders. His medical history included ischemic heart disease, stroke, prostate cancer, and Paget's disease. Clinical examination was significant for a T4 sensory level, with reduced sensation to pin prick and light touch. Motor assessment revealed reduced power in bilateral lower limbs, with the following MRC grades: 1+/5 proximal and 3/5 distal. MRI was diagnostic for ISCH. T2-weighted images demonstrated ventral displacement of the thoracic spinal cord with moderate flattening, focal atrophy, and anterior herniation through the dura at T3-5 []. The CSF flow pattern dorsal to the cord at that level was preserved, but ventral to the cord, the CSF flow pattern was absent. Following a full discussion of the options with the patient, the decision was made for non-operative management. At 3 months after presentation, the patient remained neurologically stable.
|
[[82.0, 'year']]
|
M
|
{'10908944': 1, '11598531': 1, '11599832': 1, '8272972': 1, '17443054': 1, '8880706': 1, '11437295': 1, '20730456': 1, '11760388': 1, '28593382': 1, '22290791': 1, '9726479': 1, '15347010': 1, '15200221': 1, '7299475': 1, '16729448': 1, '12546398': 1, '25336997': 1, '1758609': 1, '17048765': 1, '8839477': 1, '16924199': 1, '30870118': 1, '14767711': 1, '15327225': 1, '18204810': 1, '10834646': 1, '32181298': 1, '7791969': 1, '12792347': 1, '27190115': 1, '1870677': 1, '10664429': 1, '8692427': 1, '15300464': 1, '24871148': 1, '16284547': 1, '11337631': 1, '19513134': 1, '11243773': 1, '12408396': 1, '16770516': 1, '16635036': 1, '12021877': 1, '15687862': 1, '32363061': 1, '22470690': 1, '28955299': 2, '10526071': 1, '18976174': 1, '26539277': 2, '9377512': 1, '16483712': 1, '19264054': 1, '19190439': 1, '7964829': 1, '16708343': 1, '10690740': 1, '12498498': 1, '15261515': 1, '11396743': 1, '20593998': 1, '19769512': 1, '9452246': 1, '10232549': 1, '12924599': 1, '4424434': 1, '10369369': 1, '18207514': 1, '11979181': 1, '29713402': 1, '9038133': 1, '19240564': 1, '32101990': 1, '8692428': 1, '31118170': 1, '16506460': 1, '15984404': 1, '19353449': 1, '7815118': 1, '18552662': 1, '12792345': 1, '9726480': 1, '31448173': 2, '10690741': 1, '18501612': 1, '16769517': 1, '8692429': 1, '18538639': 1, '15967323': 1, '24049553': 2}
|
{'3775190-1': 2, '3775190-2': 2, '5601982-1': 1, '5601982-2': 1, '6702865-1': 1, '6702865-2': 1, '6702865-3': 1, '4630365-1': 1}
|
163,245 |
3775200-1
| 24,049,255 |
noncomm/PMC003xxxxxx/PMC3775200.xml
|
Spontaneous resolution of post-traumatic pulmonary artery pseudoaneurysm: Report of two cases
|
A 32-year-old male patient presented in casualty with a history of assault and civilian, high velocity gunshot injury on the right side of the chest. He developed gradually progressive shortness of breath. On clinical examination, chest compression test was positive with reduced air entry on the right side with dullness on percussion. Small penetrating wound was present over the right chest with lacerated wound in scalp. Focused assessment with sonography for trauma (FAST) scan was positive. Intercostal drainage tube (ICD) was placed and it drained about 1 L of blood. Patient was sent for CECT chest and abdomen.\nOn computed tomography (CT) scan, there was right sided hemothorax with ICD tube in situ, fracture of right 6th rib with laceration and contusion of lower lobe of the right lung. There was rounded hyperdense lesion of attenuation similar to that of the vessel and measuring 1.3 cm in the right lower lobe in continuity with a branch of descending right pulmonary artery suggesting a pseudoaneurysm [Figure and ]. Both entry and exit wound were well seen on CT images. This pseudoaneurysm was in the track of bullet and there was associated liver laceration with minimal hemoperitoneum.\nBecause of small size of pseudoaneurysm, absence of hemoptysis and stable clinical condition of patient, conservative management was planned. Follow-up CT pulmonary angiography was performed 1 week later, which revealed a significant reduction in size of pseudoaneurysm (0.7 cm) and surrounding lung contusion []. Patient was discharged on conservative treatment and was kept on clinical follow-up.
|
[[32.0, 'year']]
|
M
|
{'3053058': 1, '13979783': 1, '21769223': 1, '7922906': 1, '20838148': 1, '31811096': 1, '6884097': 1, '34556926': 1, '16612316': 1, '24049255': 2}
|
{'3775200-2': 2}
|
163,246 |
3775200-2
| 24,049,255 |
noncomm/PMC003xxxxxx/PMC3775200.xml
|
Spontaneous resolution of post-traumatic pulmonary artery pseudoaneurysm: Report of two cases
|
A 58-year-old female patient presented in casualty with complaints of right chest pain and difficulty in breathing following road traffic accident. On clinical examination, chest compression test was positive with bilateral basal reduced breath sounds. Chest radiograph revealed blunting of the left costophrenic (CP) angle. FAST scan was positive with fluid in bilateral CP angles. ICD was put in bilateral pleural space and patient was subjected to CECT chest and abdomen, which revealed bilateral basal lung contusion (left more than right) and hemothorax (left more than right). Patient was kept on conservative management. Patient developed gradual respiratory distress for which a repeat CECT chest was carried out at 1 week interval, which revealed a 2.5 cm pseudoaneurysm in the right lower lobe []. The surrounding lung parenchyma showed cavitary changes. Because of large size of pseudoaneurysm, thrombin injection within pseudoaneurysm was planned. After 1 week, pulmonary angiography was performed for injecting thrombin, but there was no opacification of aneurysmal sac []. CECT chest was repeated at the same time, which revealed hypodensity at the site of sac suggesting spontaneous thrombosis of pseudoaneurysm []. She was kept on follow-up and remained asymptomatic.
|
[[58.0, 'year']]
|
F
|
{'3053058': 1, '13979783': 1, '21769223': 1, '7922906': 1, '20838148': 1, '31811096': 1, '6884097': 1, '34556926': 1, '16612316': 1, '24049255': 2}
|
{'3775200-1': 2}
|
163,247 |
3775201-1
| 24,049,256 |
noncomm/PMC003xxxxxx/PMC3775201.xml
|
Plastic bronchitis in beta thalassemia minor
|
A 33-year-old woman with beta thalassemia minor was hospitalized with productive cough, dyspnoea with wheezing, and chest pain predominantly in interscapular area, ongoing since six months. There were no symptoms of asthma since childhood, or atopy in self or family. The patient was treated with empirical anti-tuberculous treatment without any relief, and then was referred to our side. The patient was previously diagnosed case of beta thalassemia minor as a part of workup done for her daughter who has Thalassemia major. General examination was normal. Respiratory system examination showed movements reduced on left with signs of volume loss, dull note on percussion, and reduced intensity of breath sounds over left hemi thorax. Blood hemogram was within normal limit. Sputum for acid fast bacilli smear and culture was negative. Chest radiograph [] showed left lung collapse which was confirmed on computed tomography []. Bronchoscopy showed stenosed left mainstem bronchus just distal to carina with viscid secretions. The secretions were successfully aspirated. Her bronchial washings and post-bronchoscopy sputum for cytology were negative for malignant cells. Histopathology of the biopsied stenosed site was suggestive of respiratory epithelium with mucous. The patient was treated with oral corticosteroids, bronchodilators, N-acetyl cysteine nebulization, and vigorous chest physiotherapy for 3 months. In the mean time the patient continued to expectorate bronchial casts []. Post-treatment there was evidence of response noted clinically by improvement in intensity of breath sounds, radiologically by re-expansion of base of left lung confirmed on computed tomography [] which showed aeration of upper and lower lobe with persistent post-obstructive collapse of the lingula.
|
[[33.0, 'year']]
|
F
|
{'34373673': 1, '3871286': 1, '20492708': 1, '9001337': 1, '16298313': 1, '9200374': 1, '11502666': 1, '16385370': 1, '12654082': 1, '20113579': 1, '24669101': 1, '24669100': 1, '24049256': 2}
|
{}
|
163,248 |
3775202-1
| 24,049,257 |
noncomm/PMC003xxxxxx/PMC3775202.xml
|
Pancoast syndrome: A rare presentation of non-Hodgkin's lymphoma
|
A 16-year-old female presented with a painful swelling on the left side of the neck for 2 months, and gradually increasing weakness and numbness of left upper limb with drooping of the left an upper eye lid for 1 month. She had sharp, shooting pain in the neck and left shoulder, radiating along the inner aspect of the left arm, associated with tingling and numbness of her left forearm extending to the tips of her fourth and fifth fingers, ulnar aspect of the forearm and hand. The pain was not relieved by simple analgesic and her sleep was disturbed because of intense pain. Neck swelling was irregular in shape and progressively increasing in size; initial size was 2 cm × 3 cm. There was no history of fever, weight loss, and anorexia. She was normotensive and non-diabetic. There was no past history of the tuberculosis.\nOn general examination, there was a firm, tender, irregular swelling of 4 cm × 4 cm size in the left side of the neck extending to left supraclavicular area. The swelling was fixed to underlying structures and lower margin was not delineated. Temperature was not raised and overlying skin was normal. Fluctuation was absent and transillumination test was negative. There was no other peripheral swelling in the body. Clubbing and anemia were absent and her axillary temperature was 97°F, pulse rate 100 beats/min, respiratory rate 20 breaths/min, and the blood pressure was 110/70 mmHg.\nOn examination of the respiratory system, the movement of the chest wall was restricted over left supraclavicular and infracalvicular areas along with fullness in the same areas. There was no venous engorgement over the chest wall. Trachea was shifted to the right without shifting of cardiac apex. Percussion note was dull over left second and third intercostal spaces and sternal percussion was also dull. Diminished vesicular breath sound and decreased vocal resonance were noted over left supraclavicular and infraclavicular areas.\nEye examination revealed the partial ptosis of left upper eye lid with ipsilateral miosis, but the vision was preserved with normal light and accommodation reflexes. Ocular movement was normal in all directions.\nOn neurological examination of upper extremity, the hypothenar muscles of the left hand were wasted. There was a decrease in power of all muscle groups in this hand (grade 2/5). Fine touch and pain sensation were decreased in the C8 and T1 segmental distribution in his left hand and arm. Triceps jerk was diminished.\nComplete hemogram and blood biochemistry were normal, except elevated serum lactate dehydrogenase level (340 U/L). Chest X-ray (P.A. view) showed a huge anterior mediastinal mass, compressing left lung and extending to the thoracic inlet, but no rib erosion. Sputum smear for acid fast bacilli was negative. Incisional biopsy from the neck swelling was inconclusive. Contrast enhanced computed tomography (CT) thorax showed heterogeneous huge anterior mediastinal necrotizing mass extending through thoracic inlet to the neck, but no rib erosion []. CT guided fine needle aspiration cytology (FNAC) was inconclusive. Excision biopsy from the left supraclavicular swelling revealed malignant round cell tumor involving lymph nodes. Histopathological examination of CT guided tru-cut biopsy of mediastinal mass showed effacement of normal architecture of lymph gland, which was replaced by sheets of atypical large lymphoid cells admixed with the histiocytes and plasmacytoid cells. Scattered immunoblasts were present. No Reed Sternberg cell or its variant was found []. Hence, histopathology ultimately confirmed the tissue diagnosis of NHL. Immunohistochemistry further substantiated the diagnosis of diffuse large B-cell phenotype of NHL, as the tumor cells expressed CD20 and CD10, but were immunonegative for CD3, CD5, CD23, and CD30 []. Bone marrow biopsy was within normal limit. Ultrasound of whole abdomen was normal. Hence, he was finally diagnosed as a case of diffuse large B-cell phenotype of NHL. The size of the lesion regressed following six cycles of combination chemotherapy, comprising of cyclophosphamide, doxorubicin, vincristine, and prednisolone.
|
[[16.0, 'year']]
|
F
|
{'6204740': 1, '5348167': 1, '760938': 1, '1570995': 1, '1661891': 1, '4693591': 1, '11336324': 1, '5093260': 1, '3704984': 1, '262110': 1, '20385989': 1, '24049257': 2}
|
{}
|
163,249 |
3775203-1
| 24,049,258 |
noncomm/PMC003xxxxxx/PMC3775203.xml
|
Reversible interstitial lung disease with prolonged use of nitrofurantoin: Do the benefits outweigh the risks?
|
A 70-year-old man was admitted for the evaluation of dry cough and progressive shortness of breath of 8 weeks duration. His past medical history was remarkable for diabetes mellitus, hypertension and benign hyperplasia of prostate (BHP). He underwent trans-urethral resection of the prostate 1 year back for BHP. He had recurrent urinary tract infections and was on nitrofurantoin, 100 mg at night, for 6 months preceding the onset of symptoms. There was no significant work place exposure, previous lung disease or significant smoking history. Physical examination revealed a respiratory rate of 20 breaths/min, blood pressure of 140/90 mmHg, pulse of 100/min and a saturation of 93% while room air. Respiratory system revealed bibasilar fine end-inspiratory, velcro crackles. Rest of the physical examination was unremarkable. His routine biochemistry and hemogram were normal. Arterial blood gas analysis while breathing room air showed a pH of 7.43, PaO2 of 64 mm Hg, PaCO2 of 37 mm Hg, and bicarbonate of 25 mEq. Chest radiograph carried out revealed bilateral lower zone reticulo-nodular opacities []. He was euthyroid and enzyme-linked immuno sorbent assay for human immunodeficiency virus was negative. Antinuclear antibody, antineutrophil cytoplasmic antibody and rheumatoid factor were normal. Computed tomography of the chest demonstrated symmetric bilateral reticulation, architectural distortion, and honeycombing involving mainly the subpleural lung regions and lower lobes []. Pulmonary function tests showed moderate restrictive defect (forced vital capacity was 58% predicted) with severe reduction carbon monoxide diffusion capacity (DLCO 48%, diffusing capacity corrected for alveolar volume (DLCO/VA), 49% predicted). Electrocardiograph and echocardiography were normal. Open lung biopsy was offered to the patient, but he didn’t agree to it. Nitrofurantoin-induced lung disease was suspected and the drug was discontinued and prednisone 40 mg daily was initiated. Follow chest radiograph [] and computed tomography [] at 1 month showed significant improvement.
|
[[70.0, 'year']]
|
M
|
{'7031172': 1, '18392467': 1, '16212142': 1, '21292654': 1, '4720696': 1, '17618765': 1, '3896715': 1, '34295398': 1, '18495029': 2, '7308333': 1, '24049258': 2}
|
{'2408600-1': 1}
|
163,250 |
3775204-1
| 24,049,259 |
noncomm/PMC003xxxxxx/PMC3775204.xml
|
Congenital cystic adenomatoid malformation of lung: Report of two cases with review of literature
|
A 30-year-old G2 P1 L1, of nonconsanguineous marriage, had a normal antenatal course until 20.5 weeks of gestation, when she presented with history of per vaginal bleeding and abdominal pain since three days. Her past medical history and family history were unremarkable. On examination uterus was of 24 weeks and fetal heart sounds were not localized. Routine blood and biochemical investigations were within normal limits. Subsequently; she delivered a stillborn fetus, clinically it was concluded as inevitable abortion and after informed consent the fetus was sent for pathological examination.\nOn autopsy, it was a male fetus weighing 1,450 g. External examination did not reveal any anomaly. On internal examination all organs were in situ. The right lung was enlarged (7 × 5 × 3 cm) cut-section showed cysts of varying sizes majority of them were < 2 cm. The left lung was normal (3.5 × 2 × 1 cm). On histology, right lungs showed multiple cysts relatively uniform in size resembling bronchioles, lined by stratified columnar epithelium, and having thin fibromuscular septa. Mucus production was not evident on periodic acid Schiff (PAS) staining [Figure -]. All other visceral organs were congested, but well-developed and revealed no anomalies. With the above features, a pathological diagnosis of CCAM Stocker type II was offered.
|
[[30.0, 'year']]
|
F
|
{'21838200': 1, '27051113': 2, '18855054': 1, '20551549': 1, '29681956': 1, '21292076': 1, '30210243': 1, '28658850': 1, '17906087': 1, '856714': 1, '22866187': 1, '22472365': 2, '27408162': 1, '18941042': 1, '16319347': 1, '15074892': 1, '24049259': 2}
|
{'3775204-2': 2, '4797444-1': 1, '3349468-1': 1, '3349468-2': 1}
|
163,251 |
3775204-2
| 24,049,259 |
noncomm/PMC003xxxxxx/PMC3775204.xml
|
Congenital cystic adenomatoid malformation of lung: Report of two cases with review of literature
|
A 29-year-old female G4 P3 L2, with history of 24.6 weeks of amenorrhea sought routine antenatal check-up. She gave history of second degree consanguineous marriage. Her third baby girl died 3 days after birth, details of which was not available. Her blood and biochemical investigations were within normal limits. Routine anomalous scan revealed polyhydramnios along with features of congenital diaphragmatic hernia (CDH). The parents were counseled and they opted for termination. Pregnancy was terminated after informed consent and the fetus was sent for pathological evaluation.\nOn autopsy, it was a female fetus. External examination revealed low set ears, short neck, and subcutaneous edema. On internal examination all organs were in situ. The left lung was enlarged (8 × 6 × 4 cm), and cystic in consistency. It was occupying most part of the thorax. Right lung, heart, and thymus were pushed posteriolaterally. Right lung was hypoplastic (3 × 2 × 1 cm). The enlarged left lung was pushing the diaphragm inferiomedially; hence, the spleen was found in umbilical region [Figure -]. Cut-section of the left lung revealed multiple cysts, the larger one was occupying whole of the upper lobe []. On histology, left lung revealed cysts of varying sizes dominated by larger cysts accompanied by smaller cysts. The cysts were lined by flattened cuboidal epithelial cells having fibromuscular septa [Figure -]. Focally, few of the cysts showed mucin production which was evident on Periodic acid-Schiff (PAS) staining [Figure and ]. Cartilage was not seen. All other visceral organs were congested, but well developed and revealed no anomalies. With the above features a pathological diagnosis of CCAM Stocker type I was offered.
|
[[29.0, 'year']]
|
F
|
{'21838200': 1, '27051113': 2, '18855054': 1, '20551549': 1, '29681956': 1, '21292076': 1, '30210243': 1, '28658850': 1, '17906087': 1, '856714': 1, '22866187': 1, '22472365': 2, '27408162': 1, '18941042': 1, '16319347': 1, '15074892': 1, '24049259': 2}
|
{'3775204-1': 2, '4797444-1': 1, '3349468-1': 1, '3349468-2': 1}
|
163,252 |
3775225-1
| 24,049,604 |
noncomm/PMC003xxxxxx/PMC3775225.xml
|
Reactive Arthritis Induced by Bacterial Vaginosis: Prevention with an Effective Treatment
|
A 42-year-old woman presented with a history of pain and swelling of her several joints. At first, she complained of tenderness and pain and warm swelling of her right ankle and after two days she also had a similar problem in her left ankle. Her ankle swelling was reduced by ibuprofen. After that, she had arthralgia in the knees and her right elbow and then swelling of the metarsal joints have developed within two weeks. She claimed that resting and ibuprofen could reduce, but not cure her swelling and pain. She hasn’t had a history of diarrhea or dysuria or vaginal secretion, or sexually transmitted infections (STIs). She has been married and living with her husband. On physical examination, she had difficulty walking due to heel pain, a fever (38.8 C), swelling of her right ankle and right metatarsophalangeal joints. She had tenderness on both of achilles tendons attachments, the base of her right fifth metacarpal, and both patellar tendon insertions. There was no rash or vision problem. Laboratory data were normal for hemoglobin, leukocytes, erythrocyte, serum electrolytes, chemistry studies, and urine analysis except for erythrocyte sedimentation rate (ESR) which was 42 and C-reactive protein (CRP) was slightly elevated. Tests for human immunodeficiency virus (HIV) antibody, hepatitis B and C, brucellosis antibody, Chlamydia trachomatis antibody, cold agglutination test, rheumatic factor, lupus erythematosus (LE) cells, Antinuclear antibody (ANA) and Anti double stranded (ds) DNA were negative. She was advised to continue taking ibuprofen. Therapy with non-steroidal anti-inflammatory drugs wasn’t effective completely. These tests were repeated after four weeks and no new change has been observed. Her joints problem lasted more than three months. Her pelvic examination revealed homogeneous white grey and malodorous vaginal discharge on the vaginal wall. Her Pap smear and Gram-stained smear of vaginal swab showed benign cellular changes, predominance of Gram-variable coccobacilli consistent with shift in vaginal flora, mild inflammation. Treatment with metronidazole resulted in resolution of the symptoms.
|
[[42.0, 'year']]
|
F
|
{'20044862': 1, '15073605': 1, '12412212': 1, '3665689': 1, '11830436': 1, '1994931': 1, '10968604': 1, '21160459': 1, '2668431': 1, '19306788': 1, '1734908': 1, '10990232': 1, '6610806': 1, '9751477': 1, '17127200': 1, '9437781': 1, '1706728': 1, '583074': 1, '17953762': 1, '9229179': 1, '2085058': 1, '1525841': 1, '11840434': 1, '9085451': 1, '17466304': 1, '17360026': 1, '24049604': 2}
|
{}
|
163,253 |
3775226-1
| 24,049,605 |
noncomm/PMC003xxxxxx/PMC3775226.xml
|
A Rare Clinicopathological Presentation of the Breast Carcinoma; Implications and Outcome
|
A 45-year-old woman was admitted with complaint of lump in the left breast for 3 months. Blood discharge was present from the lump from 3 months. Physical examination revealed a hard, tender lump of size 8 × 7 cm in upper and outer quadrant in the left breast. Axillary lymph nodes were present of left side. Right side of the breast region was normal.\nRoutine blood tests were within normal limits. To rule out another primary site, chest radiograph, ultrasonography of the abdomen, computed tomography of the thorax, and gynecological examination were performed. No other primary site was detected. On fine needle aspiration cytology carcinoma of the breast was diagnosed. According to all these findings, the patient underwent modified radical mastectomy with axillary lymph node clearance was performed []. Primary closure of the skin was done.\nOn microscopic examination, tumoral structure composed of large hyperchromatic nuclei with abundant cytoplasm, along with multiple foci of keratin pearl in different sizes and marked increase in mitotic activity [Figures and ] was observed. There was no origin from the surface epithelium and no different tumoral components were seen. No axillary lymph node deposits were seen. With these entire findings, the lesion was accepted as keratinizing (large cell) SCC. The patient was started with adjuvant 6 cycles of CAP (cyclophosphamide, adriamycin, and cisplatinum) chemotherapy. The patient is alive and disease-free, 8 months follow-up after the diagnosis.
|
[[45.0, 'year']]
|
F
|
{'7609529': 1, '19099605': 2, '22368697': 1, '2041612': 1, '10808370': 1, '16137440': 1, '8638180': 1, '16497446': 1, '12711295': 1, '21954743': 1, '8111712': 1, '14663374': 1, '24049605': 2}
|
{'2626594-1': 1}
|
163,254 |
3775621-1
| 24,049,444 |
noncomm/PMC003xxxxxx/PMC3775621.xml
|
Coronary anomaly: anomalous right coronary artery originates from the left sinus of Valsalva and coursing between the pulmonary artery and aorta
|
A 64-year-old woman complained of gradually progressive exertional angina pectoris for 3 months. Electrocardiogram was normal. Coronary angiogram was performed through a trans-radial approach. Coronary angiogram demonstrated the left main coronary artery (LMCA) and LAD were normal, but there was mild stenosis in the middle of the LCX segment (). Repeated attempts to cannulate the RCA were not successful (). A nonselective injection into the left coronary sinus with a pigtail catheter demonstrated an anomalous RCA arising from the left sinus. In order to confirm the anomalous origin and course of RCA, a 64-slice MSCT detection of the heart was performed on a 64-slice machine (Philips 64 Slice, Philips, Amsterdam, The Netherlands). The results showed the anomalous RCA originating from the left sinus of Valsalva, anteriorly, then taking an acute bend to course between the aorta and pulmonary artery trunk. The anomalous RCA was classified as type L-II B subtype ( and ). The patient was treated medically.
|
[[64.0, 'year']]
|
F
|
{'3946238': 1, '17353457': 1, '25489331': 1, '2208265': 1, '19038677': 1, '7064835': 1, '12021235': 1, '1512344': 1, '24049444': 2}
|
{'3775621-2': 2, '3775621-3': 2}
|
163,255 |
3775621-2
| 24,049,444 |
noncomm/PMC003xxxxxx/PMC3775621.xml
|
Coronary anomaly: anomalous right coronary artery originates from the left sinus of Valsalva and coursing between the pulmonary artery and aorta
|
A 60-year-old woman presented with dyspnea after physical exertion for more than 2 months. Electrocardiogram showed ST depression in inferior leads II, III, aVF. Coronary angiogram was performed through trans-femoral approach. Coronary angiogram demonstrated the LMCA was normal, there was borderline narrowing in the proximal segment of LAD, and the LCX was small and patent. Repeated attempts to cannulate the RCA were successful and the result showed that the anomalous RCA originated from the left sinus of Valsalva and there was severe narrowing in the posterior descending coronary artery (PDA). Reconstructed three-dimensional images were performed to verify the course of the anomalous RCA. The results showed the anomalous RCA originating from the left sinus anterior to the left coronary artery ostium, then taking an acute bend to course between the aorta and pulmonary artery. The right coronary artery anomaly was classified as type L-II B subtype ( and ). Neither percutaneous coronary intervention (PCI) nor coronary artery bypass grafting (CABG) was performed, and the patient was only treated medically.
|
[[60.0, 'year']]
|
F
|
{'3946238': 1, '17353457': 1, '25489331': 1, '2208265': 1, '19038677': 1, '7064835': 1, '12021235': 1, '1512344': 1, '24049444': 2}
|
{'3775621-1': 2, '3775621-3': 2}
|
163,256 |
3775621-3
| 24,049,444 |
noncomm/PMC003xxxxxx/PMC3775621.xml
|
Coronary anomaly: anomalous right coronary artery originates from the left sinus of Valsalva and coursing between the pulmonary artery and aorta
|
A 66-year-old man presented with an acute anterior myocardial infarction and had reperfusion therapy with thrombolytic agent. Electrocardiograms showed ST segment elevation in precordial leads V1–3 with normal creatininase values and troponin T concentration of 0.02 μg/L. The patient underwent cardiac catheterization because of post-infarct unstable angina. Angiography demonstrated that the right coronary artery and left main coronary arteries were originating from the same ostium of the left sinus (). The left main stem was patent, the LAD artery had 90% stenosis in the proximal segment, and the LCX artery was patent and non-dominant. The anomalous RCA had a high-grade 90% stenosis in the proximal (). A 6-F left Amplatz 1.5 guiding catheter was used to engage the left coronary system to perform PCI to the anomalous RCA and LAD, one stent was implanted at the proximal of the RCA segment and another stent deployed in the proximal of the LAD segment. The final angiographic result was excellent (). In order to confirm the origin and course of anomalous RCA, a 64-slice MSCT detection of the heart was performed on a 64-slice machine (Philips). The results showed the anomalous RCA originating from the left sinus of Valsalva, anteriorly, then taking an acute bend to course between the aorta and pulmonary artery trunk. The anomalous coronary artery was classified as type L-II B subtype.
|
[[66.0, 'year']]
|
M
|
{'3946238': 1, '17353457': 1, '25489331': 1, '2208265': 1, '19038677': 1, '7064835': 1, '12021235': 1, '1512344': 1, '24049444': 2}
|
{'3775621-1': 2, '3775621-2': 2}
|
163,257 |
3775671-1
| 24,049,461 |
noncomm/PMC003xxxxxx/PMC3775671.xml
|
Chronic idiopathic axonal neuropathy and pain, treated with the endogenous lipid mediator palmitoylethanolamide: a case collection
|
An 81-year-old female patient (born in 1932) started to suffer from pain in both feet in 2003; pain was progressive in nature. We saw this patient first in 2013; her pain score was 8 over 10 on the numeric rating scale (NRS) when she visited our clinic. The pain was located in both legs from the knees downwards, and the patient experienced subjective feelings as if walking on a pillow. Clinical examination showed absence of Achilles tendon reflex and absence of vibration sense in the feet up to the knee. Previous neuropathic pain treatments did not result in any pain reduction, neither amitriptyline 50 mg nor duloxetine 30 mg. The diagnosis axonal polyneuropathy was confirmed by electrophysiological examination in 2008. Symptoms grew worse, and increasingly she complained about strange feelings in both feet, as if walking on a ball, dead feelings of toes, and difficulty walking due to pain. She did not wish to be treated with pregabalin or opioids. We started treating with palmitoylethanolamide (PeaPure), 400 mg three times daily. Within 7 days, pain scores were reduced by 50%, and after 2 weeks the patient reported absence of pain. No side effects were reported.
|
[[81.0, 'year']]
|
F
|
{'27220803': 1, '6330306': 1, '28631063': 1, '19765362': 1, '18602217': 1, '24066256': 1, '19615459': 1, '7505999': 1, '17715764': 1, '15963531': 1, '25874232': 1, '24647619': 1, '22697514': 1, '23166447': 1, '20731707': 1, '26664738': 1, '23121724': 1, '20634621': 1, '6280652': 1, '7783666': 1, '14088962': 1, '21284955': 1, '22013720': 1, '23204246': 1, '22703530': 1, '30177906': 1, '26039098': 1, '22972997': 1, '22548623': 1, '34062792': 1, '7798984': 1, '15106203': 1, '24049461': 2}
|
{'3775671-2': 2, '3775671-3': 2, '3775671-4': 2, '3775671-5': 2, '3775671-6': 2, '3775671-7': 2}
|
163,258 |
3775671-2
| 24,049,461 |
noncomm/PMC003xxxxxx/PMC3775671.xml
|
Chronic idiopathic axonal neuropathy and pain, treated with the endogenous lipid mediator palmitoylethanolamide: a case collection
|
A 55-year-old Caucasian male (born in 1957) started to suffer from pain in both feet around 20 years ago, which was initially treated by a podologist. Some years later, numbness started, especially noticeable during bursts of activity, and playing tennis became impaired. In 2008, neurologists diagnosed the patient as suffering from CIAP, based on an electrophysiological examination. Analgesic treatment with gabapentin was suggested, but the patient declined treatment due to the side effect profile. In a few years, pain grew worse up to 8 over 10 on the 11-point NRS (0–10), and treatment was started with pregabalin, 75 mg bid. This gave a reduction of pain of around 40%, with the NRS score decreasing from 8 to 5. However, the patient was unsatisfied due to side effects, especially drowsiness, difficulties concentrating, and an inability to drive a car. However, after stopping pregabalin, pain grew again in intensity to a score of 8 on the NRS. He then visited our clinic. We started treatment with PEA, 400 mg three times daily. After 2–3 weeks on PEA, pain scores were down to 4 on the NRS. The patient’s quality of life improved, as did his sleep pattern, and he remained stable until we discharged him several months later. No side effects were reported.
|
[[55.0, 'year']]
|
M
|
{'27220803': 1, '6330306': 1, '28631063': 1, '19765362': 1, '18602217': 1, '24066256': 1, '19615459': 1, '7505999': 1, '17715764': 1, '15963531': 1, '25874232': 1, '24647619': 1, '22697514': 1, '23166447': 1, '20731707': 1, '26664738': 1, '23121724': 1, '20634621': 1, '6280652': 1, '7783666': 1, '14088962': 1, '21284955': 1, '22013720': 1, '23204246': 1, '22703530': 1, '30177906': 1, '26039098': 1, '22972997': 1, '22548623': 1, '34062792': 1, '7798984': 1, '15106203': 1, '24049461': 2}
|
{'3775671-1': 2, '3775671-3': 2, '3775671-4': 2, '3775671-5': 2, '3775671-6': 2, '3775671-7': 2}
|
163,259 |
3775671-3
| 24,049,461 |
noncomm/PMC003xxxxxx/PMC3775671.xml
|
Chronic idiopathic axonal neuropathy and pain, treated with the endogenous lipid mediator palmitoylethanolamide: a case collection
|
A 66-year-old Caucasian male (born in 1947) suffered from chronic idiopathic axonal polyneuropathy, and showed a mean pain score of 8 on the NRS. The diagnosis was supported by EMG analysis in 2011, showing signs of a severe axonal neuropathy, without any sign of demyelinization. The complaints started in 2000, with burning and tingling in both feet. Neuropathic pain started after walking 10 miles and more. Being an enthusiastic walker, he started to feel very annoyed by the symptoms. He refused to take analgesics such as amitriptyline and pregabalin because of much-feared side effects. We started treatment with PEA according to our protocol, and month-by-month his pain decreased. After 2–3 months, pain was reduced to NRS 1–2, and the patient was able to start walking long distances again. Side effects were not reported.
|
[[66.0, 'year']]
|
M
|
{'27220803': 1, '6330306': 1, '28631063': 1, '19765362': 1, '18602217': 1, '24066256': 1, '19615459': 1, '7505999': 1, '17715764': 1, '15963531': 1, '25874232': 1, '24647619': 1, '22697514': 1, '23166447': 1, '20731707': 1, '26664738': 1, '23121724': 1, '20634621': 1, '6280652': 1, '7783666': 1, '14088962': 1, '21284955': 1, '22013720': 1, '23204246': 1, '22703530': 1, '30177906': 1, '26039098': 1, '22972997': 1, '22548623': 1, '34062792': 1, '7798984': 1, '15106203': 1, '24049461': 2}
|
{'3775671-1': 2, '3775671-2': 2, '3775671-4': 2, '3775671-5': 2, '3775671-6': 2, '3775671-7': 2}
|
163,260 |
3775671-4
| 24,049,461 |
noncomm/PMC003xxxxxx/PMC3775671.xml
|
Chronic idiopathic axonal neuropathy and pain, treated with the endogenous lipid mediator palmitoylethanolamide: a case collection
|
A 73-year-old Caucasian female (born in 1941) suffering from burning pains since 2003 was diagnosed with sensory axonal neuropathy as confirmed by EMG in 2003. Pain scores when we first saw her in 2011 were 8 out of 10 on the NRS. TENS (transcutaneous electrical nerve stimulation) and amitriptyline 30 mg before sleep did not result in pain reduction, tramadol 100 mg bid did help to bring down peak pain effects. Treatment was started using 1200 mg PEA per day, and this reduced the burning pain from NRS score 8 to 6. The patient stopped tramadol, and this resulted in a relapse of pain. Tramadol was reinitiated, and PEA dose was increased to 2000 mg daily. Pain intensity decreased, and within 14 days, all burning sensations vanished; the patient spoke of “a miracle.” The situation remained stable for months, and side effects were not reported.
|
[[73.0, 'year']]
|
F
|
{'27220803': 1, '6330306': 1, '28631063': 1, '19765362': 1, '18602217': 1, '24066256': 1, '19615459': 1, '7505999': 1, '17715764': 1, '15963531': 1, '25874232': 1, '24647619': 1, '22697514': 1, '23166447': 1, '20731707': 1, '26664738': 1, '23121724': 1, '20634621': 1, '6280652': 1, '7783666': 1, '14088962': 1, '21284955': 1, '22013720': 1, '23204246': 1, '22703530': 1, '30177906': 1, '26039098': 1, '22972997': 1, '22548623': 1, '34062792': 1, '7798984': 1, '15106203': 1, '24049461': 2}
|
{'3775671-1': 2, '3775671-2': 2, '3775671-3': 2, '3775671-5': 2, '3775671-6': 2, '3775671-7': 2}
|
163,261 |
3775671-5
| 24,049,461 |
noncomm/PMC003xxxxxx/PMC3775671.xml
|
Chronic idiopathic axonal neuropathy and pain, treated with the endogenous lipid mediator palmitoylethanolamide: a case collection
|
A 42-year-old Caucasian female (born in 1969) visited our clinic in 2011, mainly because of severe burning pains and paresthesia due to an axonal neuropathy, diagnosed via EMG in 2011 and 2012. She had also been suffering from numbness in feet and fingers for many years. Although treated with 1200 mg gabapentin daily, her pain score on the NRS was 8 out of 10 when we first saw her. We added 1200 mg PEA daily, and within some weeks, pain was reduced to an NRS score of 3. She started physiotherapy and was able to start running again. Side effects were not reported.
|
[[42.0, 'year']]
|
F
|
{'27220803': 1, '6330306': 1, '28631063': 1, '19765362': 1, '18602217': 1, '24066256': 1, '19615459': 1, '7505999': 1, '17715764': 1, '15963531': 1, '25874232': 1, '24647619': 1, '22697514': 1, '23166447': 1, '20731707': 1, '26664738': 1, '23121724': 1, '20634621': 1, '6280652': 1, '7783666': 1, '14088962': 1, '21284955': 1, '22013720': 1, '23204246': 1, '22703530': 1, '30177906': 1, '26039098': 1, '22972997': 1, '22548623': 1, '34062792': 1, '7798984': 1, '15106203': 1, '24049461': 2}
|
{'3775671-1': 2, '3775671-2': 2, '3775671-3': 2, '3775671-4': 2, '3775671-6': 2, '3775671-7': 2}
|
163,262 |
3775671-6
| 24,049,461 |
noncomm/PMC003xxxxxx/PMC3775671.xml
|
Chronic idiopathic axonal neuropathy and pain, treated with the endogenous lipid mediator palmitoylethanolamide: a case collection
|
A 44-year-old Caucasian female (born in 1967) visited our clinic in 2011. Her medical history included two operations for a Morton’s neuroma (1997, 2008). EMG findings supported an axonal neuropathy. Her pain score on the NRS was 6–8, despite 20 mg amitriptyline and 150 mg pregabalin daily. We added 1200 mg PEA daily, and this resulted in a gradual pain reduction over some weeks, until an NRS score of 2–3. She was then able to wean-off from pregabalin and amitriptyline, without pain relapses. The patient has remained stable since, and side effects were not reported.
|
[[44.0, 'year']]
|
F
|
{'27220803': 1, '6330306': 1, '28631063': 1, '19765362': 1, '18602217': 1, '24066256': 1, '19615459': 1, '7505999': 1, '17715764': 1, '15963531': 1, '25874232': 1, '24647619': 1, '22697514': 1, '23166447': 1, '20731707': 1, '26664738': 1, '23121724': 1, '20634621': 1, '6280652': 1, '7783666': 1, '14088962': 1, '21284955': 1, '22013720': 1, '23204246': 1, '22703530': 1, '30177906': 1, '26039098': 1, '22972997': 1, '22548623': 1, '34062792': 1, '7798984': 1, '15106203': 1, '24049461': 2}
|
{'3775671-1': 2, '3775671-2': 2, '3775671-3': 2, '3775671-4': 2, '3775671-5': 2, '3775671-7': 2}
|
163,263 |
3775671-7
| 24,049,461 |
noncomm/PMC003xxxxxx/PMC3775671.xml
|
Chronic idiopathic axonal neuropathy and pain, treated with the endogenous lipid mediator palmitoylethanolamide: a case collection
|
A 63-year-old Caucasian female (born in 1948) visited our clinic in 2011. She was diagnosed as suffering from a severe sensory and motor axonal neuropathy, based on EMG findings. Her medical history included an L5 discus prolapse that was operated upon. Apart from sensory complaints, there was a severe burning pain and instability, as well as drop feet and pareses of feet extensors and toe extensors (Medical Research Council grade 4). We started treating with 1200 mg PEA daily, and pain decreased from 7 on the NRS score to a mean score of 3, with peaks up to NRS score of 5. Side effects were not reported.
|
[[63.0, 'year']]
|
F
|
{'27220803': 1, '6330306': 1, '28631063': 1, '19765362': 1, '18602217': 1, '24066256': 1, '19615459': 1, '7505999': 1, '17715764': 1, '15963531': 1, '25874232': 1, '24647619': 1, '22697514': 1, '23166447': 1, '20731707': 1, '26664738': 1, '23121724': 1, '20634621': 1, '6280652': 1, '7783666': 1, '14088962': 1, '21284955': 1, '22013720': 1, '23204246': 1, '22703530': 1, '30177906': 1, '26039098': 1, '22972997': 1, '22548623': 1, '34062792': 1, '7798984': 1, '15106203': 1, '24049461': 2}
|
{'3775671-1': 2, '3775671-2': 2, '3775671-3': 2, '3775671-4': 2, '3775671-5': 2, '3775671-6': 2}
|
163,264 |
3775673-1
| 24,049,455 |
noncomm/PMC003xxxxxx/PMC3775673.xml
|
Meningitis and stridor in advanced Human immunodeficiency virus/acquired immune deficiency syndrome
|
A 37-year-old female with retroviral disease was brought to casualty by caregivers because she was confused. The confusion was preceded by severe headache for 3 weeks. She had no history of vomiting or neck stiffness. She had started antiretroviral drugs 2 months earlier and subsequently defaulted.\nOn initial clinical examination, the patient was confused (not orientated to time, place, or person), pyrexial, and pale. She was normotensive (108/80 mmHg) but had a tachycardia of 107 beats per minute. The cardiac examination was otherwise normal. She was tachypneic with a respiratory rate of 22 breaths per minute and crackles throughout both lung fields. Neurologic examination identified neck stiffness without localizing signs.\nBlood tests, microbiology, lumbar puncture analysis, and a chest film were done (– and ). The patient had normocytic normochromic anemia, hyponatremia, and a slightly raised alanine transaminase. Her viral load was raised (678,233 copies/mL) and her CD4 count was low (155.28 × 106/L). Cerebrospinal fluid analysis showed an increase in lymphocytes, a raised protein level, and decreased glucose (). India ink staining and a Cryptococcus latex antigen test were both negative (). Sputum analysis and blood cultures were negative for Mycobacteria ().\nThe anterior-posterior supine chest film with the patient rotated to the right () showed bilateral nodular infiltrates with hilar and mediastinal lymphadenopathy not excluded. A veiling pleural effusion was noted on the left, and the left cardiac border was obscured by confluent opacification in the lingular segment of the left upper lobe.\nThe patient was initially assessed as having disseminated tuberculosis with central nervous system involvement, specifically meningitis. She was admitted to the medical ward and started on antituberculosis therapy, glucocorticosteroids, and supportive care.\nOn day 2, the patient developed both inspiratory and expiratory stridor and her initial respiratory distress worsened, with the respiratory rate increasing to 46 breaths per minute. The patient was started on adrenalin nebulization. The patient was intubated in theater and then transferred to the high care ward with a T-piece attached to the endotracheal tube. The glottis appeared normal during endotracheal intubation. At this point she was normotensive (113/73 mmHg), tachycardiac (152 beats per minute), and tachypneic (54 breaths per minute). Her oxygen saturation was 94% on 40% oxygen via a T-piece. A computed tomography (CT) scan of her brain and chest were requested. Unfortunately, the CT scanner at the base hospital was not working and the patient was deemed too unstable for transport to a CT scanner 2 hours away. High-dose cotrimoxazole, piperacillin/tazobactam, and amikacin were initiated. The patient remained pyrexial with a temperature of 38°C.\nOn day 4, the patient’s oxygen saturation dropped to 92% and her arterial oxygen was 59 mmHg on 40% oxygen. Her chest film suggested a left-sided pleural effusion. Her blood pressure was also decreasing and central venous pressure was low (0 cm H2O). The central venous pressure was optimized and inotropic cardiac support was initiated. The patient’s level of consciousness improved.\nOn day 7, she developed worsening hepatic impairment so her treatment was changed to a “liver-friendly” tuberculosis regimen. Clinical improvement was noted (improved level of consciousness, pulse 104 per minute, blood pressure 94/68 mmHg, oxygen saturation 100% on 60% T-piece oxygen, central venous pressure 8 cm H2O, respiratory rate 36 breaths per minute) and it was decided to taper her inotropic support.\nOn day 12, the patient extubated herself. Her vitals at this point were as follows: pulse 102 per minute, oxygen saturation 98% on 40% face mask oxygen, respiratory rate 30 breaths minute, and blood pressure 147/71 mmHg. Vesicular lesions with a dermatomal distribution were noted on her buttock and the patient developed diarrhea. The endotracheal tube and stool were sent for microbiologic analysis (). Approximately 9 hours later, the patient desaturated and was reintubated. The patient then underwent a tracheostomy.\nThe following day she suffered a cerebrovascular accident with left hemiplegia. The patient died later that day, approximately 2 weeks after admission.
|
[[37.0, 'year']]
|
F
|
{'23493162': 1, '3800488': 1, '21961543': 1, '1095695': 1, '12677581': 1, '14679472': 1, '10448488': 1, '20605462': 1, '3833332': 1, '21272895': 1, '7803014': 1, '23425167': 1, '17198106': 1, '24049455': 2}
|
{}
|
163,265 |
3776072-1
| 23,572,332 |
noncomm/PMC003xxxxxx/PMC3776072.xml
|
Coronary and cerebral air embolism: a rare complication of computed tomography-guided transthoracic lung biopsy
|
A 71-year-old man with a history of excessive smoking was evaluated for an abnormal chest X-ray. He had no angina and no risk factors for coronary artery disease. Considering a high probability of lung cancer in this patient, computed tomography-guided transthoracic lung biopsy was performed by an experienced radiologist. A co-axial 18-gauge needle system was used to enter the lung and two core biopsy samples were obtained. During the procedure the patient was asked to inhale in order to reach the lesion. After the biopsy he developed mild haemoptysis followed by rapid loss of consciousness. After a couple of seconds the patient regained consciousness, was asymptomatic and did not show any signs of respiratory or haemodynamic complications. However, the ECG showed ST-segment elevation in leads I, II, aVL, aVF and V3-6 without reciprocal ST-segment depression suggestive of an acute myocardial infarction involving the distributions of more than one coronary artery (Fig. ). Review of the multi-slice CT images showed a mild pneumothorax, pulmonary haemorrhage, and air bubbles in both the circumflex coronary artery and descending aorta, diagnostic of an air embolism of the arterial system (Fig. ). He was placed in a mild Trendelenburg position and was administered 100 % high-flow non-rebreathing oxygen. Anticoagulation therapy was not initiated due to the pulmonary haemorrhage. Electrocardiography showed complete resolution of the ST-segment elevation after 20 min. However, 3 h later he developed seizures likely due to air embolisation to the cerebral circulation. A subsequent blood test showed cardiac troponin I elevation of 11.0 μg/l, whereas echocardiography demonstrated hypokinesis in the distal inferior and anteroseptal regions. The patient was eventually discharged after 1 week without any cardiac, pulmonary or neurological symptoms.
|
[[71.0, 'year']]
|
M
|
{'22322584': 1, '21584800': 1, '25431666': 2, '22309812': 1, '30221455': 1, '33051730': 1, '19156246': 1, '22083429': 1, '23090421': 1, '8571428': 1, '22371385': 1, '21556914': 1, '21606253': 1, '30201067': 1, '17699141': 1, '23572332': 2}
|
{'4241573-1': 1}
|
163,266 |
3776468-1
| 24,052,791 |
noncomm/PMC003xxxxxx/PMC3776468.xml
|
Recurrent Strokes due to Transient Vasospasms of the Extracranial Internal Carotid Artery
|
In July 1999, a previously healthy 34-year-old female patient was admitted to our hospital for the first time with an acute left-sided brachiofacial hemiparesis. She reported that similar symptoms had occurred several times in the previous 10 years but had regressed spontaneously. Aside from regular nicotine consumption, she had no other cardiovascular risk factors. In addition, she had no history of migraine headaches.\nMagnetic resonance imaging (MRI) showed an internal middle cerebral artery (MCA) territory watershed infarct, probably of hemodynamic origin. Duplex sonography on admission revealed proximal occlusions of both ICAs and retrograde flow in both supratrochlear arteries (STA). Three days later, a digital subtraction angiography showed a recanalization of the left ICA and a persistent occlusion of the right ICA at the origin, which subsequently never recanalized. On axial T1-weighted fat-suppressed images, the presence of intramural hematomas and thus arterial dissections as a cause of the bilateral ICA occlusions could be ruled out. A cerebrospinal fluid analysis was unremarkable.\nUnder the assumption of vascular spasms, the patient was treated with the calcium antagonist nimodipine (240 mg/day) and was heparinized with an aim for a partial thromboplastin time of >60 s. Despite this treatment, a transient occlusion of the left ICA, confirmed with repeated ultrasound and magnetic resonance angiography (MRA), occurred again during this first admission. The patient was discharged receiving nimodipine, and an oral anticoagulation with phenprocoumon was begun.\nIn February 2004, she was readmitted due to a short episode with paresis of the right hand and aphasia. While MRI including diffusion-weighted imaging showed no new infarction, an initial occlusion and subsequent reopening of the left ICA was documented with ultrasound and MRA. During the course of this admission, oral anticoagulation was discontinued and the patient was discharged with Aspirin and nimodipine.\nIn March 2010, February 2011 and May 2011, the patient experienced recurrent episodes with transient right-sided hemiparesis and aphasia. In all three instances, MRI revealed new small infarcts in the left MCA territory. Extensive laboratory investigations were performed twice (including virology, bacteriology and tests for thrombophilia and vasculitis), but revealed no pathological results. Likewise, 2 chest X-rays and an ultrasound of the abdomen were normal.\nSimilar to the findings in 2004, MRA and ultrasound repeatedly revealed an initial occlusion and subsequent reopening of the left ICA (fig. , fig. ) without nimodipine administration. During the episodes of left ICA occlusion, a reduced pulsatility in the left MCA, a collateralization via the posterior communicating arteries and a retrograde flow within the ipsilateral STA were observed with ultrasound. After recanalization, ultrasound showed an antegrade flow within the ipsilateral STA and a completely normalized MCA flow.\nSince May 2011, the patient has had no further ischemic symptoms. A coincidence with smoking was presumed during the first stays, but attacks appeared also after she quit smoking.
|
[[34.0, 'year']]
|
F
|
{'27348139': 1, '9596258': 1, '16788018': 1, '21864073': 1, '33336087': 1, '22622856': 1, '16809567': 1, '1258110': 1, '20040009': 1, '2406221': 1, '8374945': 1, '3039441': 1, '27325355': 1, '21481904': 1, '15782597': 1, '22687799': 1, '21116906': 1, '24052791': 2}
|
{}
|
163,267 |
3777162-1
| 23,649,801 |
noncomm/PMC003xxxxxx/PMC3777162.xml
|
Successful treatment of nonunion with teriparatide after failed ankle arthrodesis for Charcot arthropathy
|
A 25-year-old Japanese woman sustained a right femoral shaft fracture while climbing the stairs in May 2012 (Fig. ). She denied any abuse or accident such as falling down the stairs. She had a history of Type 1 diabetes mellitus, which was poorly controlled with insulin therapy (HbA1c, 16.7 %), and Charcot arthropathy of the ankle due to peripheral nerve disorder. An ankle arthrodesis had been performed at another clinic 15 months ago, but union was not achieved, and therefore, she underwent further surgery 12 months ago to fix her ankle. This treatment also failed resulting in nonunion, and so the woman was instructed to wear a patellar tendon-bearing brace for her ankle instability and pain (Fig. ). Her laboratory data, including serum levels of alkaline phosphate, parathyroid hormone, calcium, and phosphorus, were normal, but her level of 1.25 vitamin D3 was low, and her left femoral bone density was extremely low (0.54 mg/cm2) and 2.0 standard deviations below the normal value for her age (Table ).\nWe treated the femoral shaft fracture with intramedullary nail fixation 29 days after the fracture occurred, because her chronic heart failure was too poor to allow for immediate surgery. We initiated teriparatide (20-μg subcutaneous injection daily) and alfacalcidol (1-μg oral administration daily) immediately after surgery because of severe osteoporosis and in an attempt to accelerate healing of the femoral fracture. There was no immobilization of the femur, but a non-weight-bearing period of 4 weeks was implemented postoperatively. From 2 weeks after the initiation of teriparatide therapy, plain radiography began showing callus formation on the femoral shaft fracture, and after 12 weeks, almost complete healing of the fractured bone was observed (Fig. ). We therefore allowed the woman to walk with full weight bearing. We noticed that her ankle pain disappeared once she had resumed walking. Radiography and computed tomography images revealed that union of the ankle had been achieved (Fig. ). No side effects attributable to the drug were observed during treatment, and her subsequent laboratory findings continued to be normal. At 6 months, the patient could walk without a brace and without any pain. Plain images taken at this time revealed complete healing of the fractured and nonunion sites.
|
[[25.0, 'year']]
|
F
|
{'27891497': 1, '27400961': 1, '31844831': 1, '33559713': 1, '34434361': 2, '32911581': 1, '19010455': 1, '14606504': 1, '31332508': 1, '28630836': 2, '27668112': 2, '23076681': 1, '27429980': 1, '33748330': 2, '9531204': 1, '20051918': 1, '25138261': 1, '26205360': 1, '15382326': 1, '18182890': 1, '17003188': 1, '19859645': 1, '17383486': 1, '19290582': 1, '20846618': 1, '31038646': 1, '28377962': 1, '9463765': 1, '32870946': 1, '19594305': 1, '12030541': 1, '31992929': 1, '10901308': 1, '23649801': 2}
|
{'5458694-1': 1, '8383629-1': 1, '7939565-1': 1, '5030418-1': 1}
|
163,268 |
3777285-1
| 24,082,644 |
noncomm/PMC003xxxxxx/PMC3777285.xml
|
Cutaneous mercury granuloma
|
A 23-year-old male patient presented to dermatology out-patient department with chief complaints of nodular, erythematous lesions over the left forearm, and anterior chest wall below the left nipple, of 4 months duration. There was a past history of injury to the chest wall and forearm 5 months back. Injury was in the form of abrasions and ulceration over the chest wall and forearm. Patient applied some ointment over the wounds. Details of the ointment were unknown to the patient. The lesions became itchy with raw ulcerated areas. The size and nodularity of the lesions increased in last 4 months. Physical examination revealed a thin built male with stable vital signs. The general examination was unremarkable. Patient did not give history of nausea, vomiting or diarrhea. On systemic examination, no abnormality was detected. On local examination, there were irregular, nodular, erythematous lesions with induration, scarring and discoloration of the overlying skin on the left forearm and anterior chest wall region below the nipple [Figures and ]. Neuropsychiatric evaluation was carried out. Neurological examination was normal except mild tremors and the clinical depression. There was no lymphadenopathy. Patient was not giving any history of self-injection or ingestion of mercury. Gold-lysis test, blood, and urine mercury levels, energy-dispersive X-ray analysis and scanning electron microscopy were not carried out in our case.\nRoutine hemogram and biochemical investigations were within normal limits. X-ray showed diffuse deposition of metallic material (mercury) in the soft-tissue upto subcutaneous plane in the left forearm and chest wall [Figures and ]. The patient underwent surgical excision of the areas of skin discoloration and soft-tissue induration. The specimen was sent for the histopathological examination to pathology department.\nGross–Multiple, irregular, brownish tissue bits, total measuring 3.2 cm × 2 cm × 2 cm. Few bits were skin covered. After minute observation some shiny material was seen in the few tissue bits []. Microscopy-Hematoxylin and Eosin stained sections revealed stratified squamous epithelium showing hyperkeratosis and epitheliomatous hyperplasia. Subepithelial tissue showed multiple granulomas composed of central spherical dark, black colored opaque globules, surrounded by foreign-body type of multinucleate giant cells, histiocytes, and inflammatory infiltrate composed of lymphocytes, plasma cells, and few eosinophils []. For further confirmation of the shiny material seen on gross examination and spherical bodies seen on microscopy, small amount of tissue was sent for chemical analysis. Chemical analysis reported that material to be mercury. Histopathological diagnosis of mercury granuloma was given. Subsequently, patient has been lost to follow-up.
|
[[23.0, 'year']]
|
M
|
{'12879712': 1, '10863229': 1, '15830714': 1, '11519542': 1, '3882785': 1, '22106728': 1, '11165836': 1, '24082644': 2}
|
{}
|
163,269 |
3777313-1
| 24,082,685 |
noncomm/PMC003xxxxxx/PMC3777313.xml
|
Primary spinal intradural extramedullary lymphoma causing cauda equina syndrome
|
This 11-year-old boy presented with 3 days history of progressively increasing radicular pain over the sacrogluteal region bilaterally; left side more than the right side, along with lower limb weakness and sensory impairment in both lower limbs. He also developed urinary retention and was catheterized elsewhere 1 day prior to his presentation. On examination, his cranial nerves and upper limbs were normal. He had asymmetrical lower limb weakness with the left side worse than the right. His sensory examination also revealed an asymmetrical sensory impairment in the lower limbs with the upper limit being D12 dermatome. Both knee jerk and ankle jerk were absent with plantars not being elicitable. His muscle tone and bulk were normal. He did not have any neurocutaneous markers, palpable lymph nodes or spinal deformity. With this presentation and neurological examination, a diagnosis of spinal cord pathology with clinical localization to cauda equina was made. An emergency magnetic resonance imaging (MRI) of the lumbosacral spine with screening was performed, which showed a well-defined sausage shaped intradural lesion at L2, L3 level, without evidence of any other central nervous system (CNS) lymphomas. The lesion was iso-intense in T1- and T2-weighted images []. He underwent emergency L2, L3 laminectomy and excision of intradural extramedullary lesion. The lesion was removed piecemeal. Intra-operatively the lesion had some attachment to the anterior dura. Total removal was carried out, with coagulation of the anterior dura.\nPost-operatively he had total relief of pain and his motor power improved by one Medical Research Council grade and sensations were slowly improving. Histoplathological examination of the tumor revealed a dense infiltration of round cells admixed with cells with a large eosinophilic cytoplasm and vesicular nucleus with prominent nucleolus, which was consistent with non-Hodgkin's lymphoma []. The diagnosis was confirmed by immunohistochemistry showing CD20 positivity. Detailed investigation was carried out to stage the disease, which included complete hematological examination, including bone marrow aspiration and computerized tomography of the chest and abdomen. All the above investigations were normal.\nOn follow-up after 1 month he had received radiotherapy to the local area of 32 Gy in 20 fractions and was on chemotherapy; cyclophosphamide, hydroxydaunomycin, oncovin-vincristine, and prednisone regimen. Post-operative MRI showed total excision of the lesion []. At 1 year follow-up, he was having near normal power, normal sensations, and normal bladder control.
|
[[11.0, 'year']]
|
M
|
{'20367381': 1, '34221843': 1, '25741044': 1, '27769981': 1, '32042476': 1, '28810339': 1, '16542791': 1, '7246286': 1, '16850958': 1, '22013369': 1, '20631485': 1, '29928449': 1, '3756827': 1, '34321945': 2, '33408533': 2, '24082685': 2}
|
{'8312505-1': 1, '7781032-1': 1}
|
163,270 |
3777314-1
| 24,082,686 |
noncomm/PMC003xxxxxx/PMC3777314.xml
|
C1-C3 lateral mass fusion for type IIa and type III Hangman's fracture
|
A 36-year-old female who was the unrestrained passenger in a vehicle, which was involved in a collision and roll over and she lost consciousness briefly and on regaining consciousness, she complained of neck pain. She was transferred to a nearby medical facility where radiographs revealed Hangman's fracture and the patient was subsequently transferred to our department for surgical management. On admission, she was noted to have no neurological deficits, but had tenderness over the cervical spine. Her cranial computed tomography (CT) examination was normal. Her radiographs of the cervical spine revealed Levine and Edwards type IIa Hangman's fracture []. Magnetic resonance imaging (MRI) of the spine revealed evidence of hematoma extending from clivus to C4 anteriorly and from occiput to C7 posteriorly []. There was also evidence of anterior translation and mild angulation at C2-C3 suggestive of type IIa Levine and Edwards Hangman's fracture. In view of the unstable nature of the fracture and the presence of angulation, it was believed immobilization with external orthosis will not be effective and hence, surgical fixation was opted for. Pre-operative traction was not attempted as the patient was not willing for the same. CT studies of the spine showed that the fracture fragments were displaced [] and hence, direct fixation of the pars fracture with pars screws as suggested by Bristol et al. and Dalbayrak et al. was not considered safe or feasible.[] Hence, C1-C3 lateral mass fusion was planned. With the patient kept under skeletal traction in the prone position, proper alignment was achieved under fluoroscopic control and then the region from C1 to C3 was exposed. The C2 root and ganglion were sectioned on either side and the C1 lateral mass was exposed. The C3 lateral masses were exposed on either side or 3.5 mm × 28 mm polyaxial titanium screws were inserted into the C1 lateral masses on either side followed by insertion of 3.5 mm × 14 mm polyaxial screws into the lateral masses of C3. For insertion of C1 lateral mass screw, the entry point was the middle of the lateral mass with 10* medial angulation aiming for the anterior tubercle of atlas and for C 3 lateral mass screw, the entry point was 1mm medial to the center of the lateral mass with 30* lateral and 15* rostral angulation. The exposed posterior surfaces of C1, C2, and C3 were decorticated and autologous grafts obtained from posterior iliac crest was applied as onlay graft and the wound was closed in layers. Post-operative radiographs showed good alignment with proper placement of screws []. Post-operatively, when examined 3 months later, there was no change in the patient's clinical condition except for numbness in the occipital region due to sectioning of C2 root.
|
[[36.0, 'year']]
|
F
|
{'9508111': 1, '7998495': 1, '20679925': 1, '21099568': 1, '16925087': 1, '24744563': 1, '16235100': 1, '12445339': 1, '19929332': 1, '11034656': 1, '20401619': 1, '10505495': 1, '20173530': 1, '17224812': 1, '10078131': 1, '25558315': 1, '19431128': 1, '2809718': 1, '9280020': 1, '7263741': 1, '32873313': 1, '15799815': 1, '24082686': 2}
|
{'3777314-2': 2}
|
163,271 |
3777314-2
| 24,082,686 |
noncomm/PMC003xxxxxx/PMC3777314.xml
|
C1-C3 lateral mass fusion for type IIa and type III Hangman's fracture
|
A 22-year-old male was the unrestrained passenger in a vehicle involved in road traffic accident. Shortly, after the accident, he complained of severe neck pain. When examined in the hospital, he had no neurological deficits, but had severe pain and tenderness in the neck. His radiographs showed a type III Levine and Edwards Hangman's fracture []. His MRI of the spine showed hematoma extending from the clivus to C4 along with anterior translation and angulation of C2 over C3 along with disruption of the C2-C3 disc []. CT of the spine showed bilateral pars fracture of C2 with significant displacement []. In view of these findings, anterior approach with C2-C3 discectomy and plating was planned. With the patient under traction, the C2-C3 region was exposed through the anterolateral approach and discectomy and grafting of C2-C3 was carried out. However, attempt to plate C2 and C3 was not successful as the diameter of the available plate was greater than the diameter of the base of C2 body as was cautioned by Traynelis and Fontes.[] Hence, grafting alone was carried out. However, post-operative radiographs on day 2 revealed dislodgment of the graft with recurrence of subluxation. Hence, patient was taken up for posterior C1-C3 lateral mass fusion. The same approach as mentioned for case 1 was carried out uneventfully []. Post-operative radiographs showed good alignment with appropriate position of the screws []. Three months later, patient had no neurological deficits, but had a small trophic ulcer in the occipital region owing to numbness in the area and wearing of Philadelphia collar.
|
[[22.0, 'year']]
|
M
|
{'9508111': 1, '7998495': 1, '20679925': 1, '21099568': 1, '16925087': 1, '24744563': 1, '16235100': 1, '12445339': 1, '19929332': 1, '11034656': 1, '20401619': 1, '10505495': 1, '20173530': 1, '17224812': 1, '10078131': 1, '25558315': 1, '19431128': 1, '2809718': 1, '9280020': 1, '7263741': 1, '32873313': 1, '15799815': 1, '24082686': 2}
|
{'3777314-1': 2}
|
163,272 |
3777315-1
| 24,082,687 |
noncomm/PMC003xxxxxx/PMC3777315.xml
|
Giant cell tumor of dorsal vertebral body
|
A 30-year-old female patient presented with complaints of backache, progressive weakness of both lower limbs and bladder and bowel incontinence of 4 months duration. On examination, she had tenderness over lower dorsal region and power of grade 2-3 in the right lower limb and grade 1-2 in the left lower limb. Magnetic resonance imaging (MRI) was suggestive of osteolytic lesion involving tenth dorsal vertebral body and left neural arch with extension into posterior mediastinal space []. A thin rim of anterior vertebral body was spared [] and there was marked anterior compression on the dorsal cord from the tumor mass. Left anterolateral approach with excision of left tenth rib was used to excise the soft moderately vascular osteolytic tumor. Reconstruction was done using expandable cage and pedicular screw and rod fixation in ninth and eleventh dorsal vertebrae [Figures ]. Histopathological examination of the tumor was suggestive of GCT [Figures ]. Patient improved in power in both lower limbs after surgery. Radiation therapy was not given in the present case due to fear of osteoradionecrosis and myelitis. After more than 1 year of follow-up patient is doing well without any evidence of local and distant tumor recurrence.
|
[[30.0, 'year']]
|
F
|
{'9152458': 1, '18461324': 1, '16462511': 1, '3805057': 1, '11276839': 1, '31529151': 1, '24082687': 2}
|
{}
|
163,273 |
3777316-1
| 24,082,688 |
noncomm/PMC003xxxxxx/PMC3777316.xml
|
Intraosseouss degenerative cyst of the axis approached via transcervical extrapharyngeal avenue
|
A 43-year-old man came to our clinic with a history of significant chronic neck pain. He was referred to us due to a lesion in the axis seen on magnetic resonance imaging (MRI). The neurological examination was normal. The computed tomography showed a lytic lesion with sclerotic margins in C2. The MRI showed a lesion hypointense in T1 and hypeintense in T2-signal intensity []. The angiography of the cervical region was normal, as well as cintilography. Functional plain film of the cervical spine showed no instability. Based on the cervical pain and the necessity to perform a diagnosis the patient the lesion was approached. It was used an anterior transcervical extrapharyngeal approach. The anterior part of C1, C2, and C3 was exposed. A cavity within C2 was identified, and a soft material was removed. The cavity was completed with iliac bone graft. In the post-operative, the patient showed a tongue deviation to the opposite side of the approach (hypoglossal nerve alteration). Histopathological examination showed a dense fibrous tissue with no synovial layer. It was not indicated cervical instrumentation because there was no cervical instability The patient had improvement cervical pain and is being monitoring in the last three years with cervical MRI and plain films [].
|
[[43.0, 'year']]
|
M
|
{'8893718': 1, '2450093': 1, '2353265': 1, '8178245': 1, '4729015': 1, '15534401': 1, '20515343': 1, '24082688': 2}
|
{}
|
163,274 |
3777317-1
| 24,082,689 |
noncomm/PMC003xxxxxx/PMC3777317.xml
|
Lumbosacral arachnoid cyst with tethered cord: A rare case report
|
A 6-year-old boy presented to us with complaints of recent onset difficulty in walking and dribbling of urine. On examination he had grade 3/5 power in both lower limbs and absent reflexes. An MRI spine was performed which revealed a clearly defined intradural cystic lesion extending from L2 to S2 which was hypointense on T1-weighted images [] and hyperintense on T2-weighted images [] with tethering of cord. A syrinx was also noted in the cervicodorsal spine []. A tentative diagnosis of lumbosacral arachnoid cyst was made and the patient was taken up for surgery. Multiple level laminectomies were performed and on opening the dura a tense cyst was found [] along with short and thickened filum terminale. There were no other associated lesions. No communication was found between the cyst contents and the subarachnoid space. The lesion was incised and clear fluid contents were let out. The walls were marsupialized and the dura was closed primarily. Detethering of cord was done by transection of thickened filum terminale. Postoperatively the child's motor power began to improve though his bladder was kept catheterized. Postoperative MRI was done which showed complete resolution of cyst []. At follow-up of 2 months patient could walk independently and had regained bladder control.
|
[[6.0, 'year']]
|
M
|
{'12679678': 1, '15454723': 1, '11305773': 1, '10735434': 1, '11694795': 1, '11012061': 1, '11508539': 1, '15068166': 1, '16925076': 1, '11960242': 1, '3612266': 1, '24082689': 2}
|
{}
|
163,275 |
3777318-1
| 24,082,690 |
noncomm/PMC003xxxxxx/PMC3777318.xml
|
Spinal hydatid with meralgia paresthetica in a female: A rare case report
|
A 45-year-old female presented with swelling in the thoraco-lumbar region which had been present for last 1 year but had enlarged rapidly over the last 3 months. She denied any recent weight loss or pain associated with the mass. She also denied any fever or blunt trauma to the area. Apart from its size, it did not give any problem except that since the last few weeks she had started experiencing tingling sensation over her anterior-lateral aspect of left thigh and slight weakness in her left lower limb resulting into a limp. She was otherwise in good health except for mild hypertension for which she took no medication. On general examination, she was afebrile and hemodynamically stable. Local examination, revealed a large swelling, of size 30 × 25 × 25 cm in the thoraco-lumbar region which was soft, lobulated and non tender. Its border was well defined. It extended proximally upto the 8th thoracic vertebrae and distally upto 5th lumbar vertebrae. There were no signs of inflammation. The overlying skin was freely mobile with no venous engorgement. The mass was mobile in all directions []. Other systemic examination was normal. Neurological examination did not reveal any significant finding except for sensory loss over the antero-lateral aspect of left thigh and grade 3 power in the flexors of left hip joint. Straight leg raising test was negative. An initial diagnosis of lipoma was considered and radiological investigations were planned. Local USG of swelling was suggestive of hydatid cyst in subcutaneous tissue with membranes, septations and daughter cysts within the cystic cavity. No primary in abdomen or lungs was found. X-ray lumbo-sacral spine anteroposterior (AP) view was suggestive of destruction of spinous process and left pedicle of L1-L2 vertebrae []. Further Magnetic resonance imaging (MRI) of thoraco-lumbar spine was planned which revealed a well defined lesion with daughter cyst involving subcutaneous tissue of back, paraspinal muscle, post neural arch segment of D12-L2 with extradural extension into spinal canal at D12-L2 level [].\nThe patient underwent T12 to L2 laminectomy with total cyst excision with membrane. Extradural space showed multiple pearly white cysts compressing the dural sac. All the cysts were extirpated without rupture. The operative field was soaked with hydrogen peroxide wetted patties for a few minutes and then washed with normal saline. Histopathological examination confirmed the diagnosis of hydatid cyst []. Postoperative period was uneventful. Albendazole was given for a period of three months. There was no further weakness and tingling sensation over the lower extremity after 1 month of treatment. Also, there was no recurrence during the follow-up period of two years.
|
[[45.0, 'year']]
|
F
|
{'21124688': 2, '20082420': 1, '12865531': 1, '21294431': 1, '24082690': 2}
|
{'2981901-1': 1}
|
163,276 |
3777325-1
| 24,082,480 |
noncomm/PMC003xxxxxx/PMC3777325.xml
|
Cystic adventitial disease of popliteal artery with significant stenosis
|
A 40-year-old male patient presented with complaints of intermittent claudication in the right lower limb for past 6 months. There was no history of fever, trauma, diabetes mellitus, or hypertension. He was an occasional smoker. There were no other significant associated complaints. Physical examination revealed diminished pulses in right lower limb arteries, for which Doppler USG (ultrasound) examination was requested. Doppler study revealed multiloculated cystic lesion in relation to the popliteal artery, causing significant luminal narrowing with dampened low resistance flow in distal arteries []. It was also causing focal narrowing of popliteal vein. Subsequently, the patient underwent computed tomography angiography (CTA) on 128-slice multidetector computed tomography (MDCT) scanner (Ingenuity CT, Philips Healthcare, Cleveland, OH, USA). CTA revealed multiloculated cystic lesion in relation to right popliteal artery, with mild peripheral enhancement. There was significant focal eccentric narrowing of popliteal artery. Distal vessels were normally opacified. It was also causing narrowing of popliteal vein []. Based on the characteristic imaging findings, diagnosis of cystic adventitial disease of popliteal artery was made. Patient underwent surgery with partial resection of the cysts and the diagnosis was confirmed on histopathology. Patient improved symptomatically. Postoperative CTA revealed significant reduction of cystic disease and reduction of popliteal artery stenosis [].
|
[[40.0, 'year']]
|
M
|
{'22284772': 1, '14749403': 1, '20039232': 1, '2231973': 1, '22336642': 1, '20413777': 1, '9719314': 1, '20247247': 1, '17696086': 1, '24082480': 2}
|
{}
|
163,277 |
3777326-1
| 24,082,481 |
noncomm/PMC003xxxxxx/PMC3777326.xml
|
Embolization of a large high-flow renal arteriovenous fistula using 035″ and 018″ detachable coils
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A 45-year-old man with a past medical history of refractory hypertension presented with a progressively enlarging right renal AVF, which was incidentally discovered a year prior on a computed tomography (CT) scan of the abdomen, and demonstrated interval growth on the follow-up CT scan from a maximum diameter of 21 mm to 33 mm. Considering the increase in size, the patient's team decided to treat this AVF. However, the poor general medical condition secondary to non-ischemic cardiomyopathy precluded the option of total nephrectomy. CT angiogram (CTA) showed an enlarged main renal and posterior segment artery which fed a tortuous fistulous tract having many fusiform dilatations; the maximum diameter of the tract measured 33 mm []. Following an angiogram performed for selective embolization of the renal AVF, access to the right common femoral artery was obtained and a 5-French (F), 45-cm arterial sheath (Ansel sheath, Cook, Bloomington, IN, USA) was placed with its tip in the infrarenal aorta. The right renal angiogram revealed a large posterior segment branch, measuring up to 8 mm in diameter, supplying a tortuous fistulous tract and arising distal to the origin of the segmental branches []. This tortuous fistulous tract had multiple saccular aneurysms []. The maximum diameter of the aneurysmal portion of the fistulous tract measured 33 mm and was situated immediately distal to the arteriovenous communication. The posterior segment artery was selected using a Cobra catheter over a 035″ glide wire. The arterial sheath was further advanced over a super stiff wire into the main right renal artery for better support. A 3-F microcatheter having an inner diameter of 0.021 inches (Renegade, Boston Scientific Corporation) was advanced coaxially through the Cobra catheter over a 018″ wire (Transcend wire, Boston Scientific Corporation) into the fistula. Initially, a 018″ 14 mm × 30 cm IDC, which was the largest coil available at the time, was advanced through the microcatheter and partially deployed in the feeding artery. However, the coil was unstable in its position and prolapsed into the aneurysmal fistulous tract; the coil was subsequently withdrawn. The microcatheter was removed and a 035″ 50 mm × 40 cm IDC was advanced through the Cobra catheter into the feeding artery while maintaining a saline flush. The coil was deployed cautiously over 5 min. Once the loops were stable, the IDC was detached []. This initial coil served as a scaffold for the other coils. The 3-F microcatheter was reinserted coaxially through the Cobra catheter over a 018″ Transcend wire into the feeding artery. Then, a 018″ 10 mm × 30 cm fibered IDC was advanced through the microcatheter, and loops of the coil were deployed proximally in the feeding artery using the previously deployed coil as an anchor. Further coiling of the feeding artery was performed by a 018″ 10 mm × 30 cm and followed by seven 018″ 10 mm × 20 cm. Final angiogram demonstrated non-filling of the AVF with preservation of the remaining segmental branches. A nephrogram was noted in the final angiogram, which was not present in the initial angiogram, indicating redirected arterial flow from the AVF toward the renal parenchyma []. There were no complications during the procedure. Follow-up CTA obtained 6 months after the embolization demonstrated occlusion of the fistulous tract. Focal parenchymal atrophy in the posterior cortex corresponded to the vascular territory of the occluded segment.
|
[[45.0, 'year']]
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M
|
{'16517784': 1, '30652152': 2, '12720244': 1, '22365298': 1, '15184996': 1, '17225970': 1, '16517785': 1, '11357984': 1, '19560942': 1, '21326487': 1, '27904109': 1, '17494851': 1, '31193393': 1, '31745170': 1, '20390272': 1, '24082481': 2}
|
{'6319512-1': 1}
|
163,278 |
3777327-1
| 24,082,482 |
noncomm/PMC003xxxxxx/PMC3777327.xml
|
Neuroenteric cysts of the brain-comprehensive magnetic resonance imaging
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A 17-year-old female patient presented with neck pain since two weeks which was aggravated by exercise and neck movements. She developed weakness of limbs for one week which started in left upper limb and then evolved to involve all four limbs. She also complained of numbness in both upper limbs and urgency of micturation. On neurological examination, tone was mildly decreased in both upper limbs and increased in both lower limbs. Power was 2/5 in left upper limbs and 4/5 in other limbs. Deep tendon reflexes were absent in upper limbs and exaggerated in lower limbs. Pain and touch sensation decreased by 30% below C2 level and vibration sense lost below T2 level.\nMRI [] showed a well circumscribed extra-axial cystic lesion of 3 × 1.8 × 2.4 cm size noted anterior and to the right of medulla extending through foramen magnum into upper cervical canal. It was hyperintense on T1 and T2 weighted images with no diffusion restriction. On right side hypoglossal nerve was displaced laterally by lesion.\nShe underwent suboccipital craniectomy and total excision of the lesion via right lateral approach. Histopathology showed a cyst wall is lined by cuboidal and columnar epithelium with goblet cells (arrow) suggestive of a neuroenteric cyst.\nPostoperatively, patient's power improved to 4/5 in all 4 limbs.
|
[[17.0, 'year']]
|
F
|
{'16775266': 1, '28553375': 2, '17987286': 1, '19277673': 1, '11237972': 1, '2654696': 1, '18518701': 1, '15200128': 1, '3113198': 1, '20890417': 1, '12182790': 1, '9930826': 1, '15507425': 1, '15340855': 1, '1546383': 1, '34401938': 1, '24082482': 2}
|
{'3777327-2': 2, '3777327-3': 2, '3777327-4': 2, '3777327-5': 2, '5437783-1': 1}
|
163,279 |
3777327-2
| 24,082,482 |
noncomm/PMC003xxxxxx/PMC3777327.xml
|
Neuroenteric cysts of the brain-comprehensive magnetic resonance imaging
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A 28-year-old lady presented with headache and vomiting since 11/2 years. She complained of difficulty in gripping objects with left upper limb, gait unsteadiness with tendency to sway to the left side, dysarthria and nasal regurgitation on swallowing fluids. On examination, bilateral gaze evoked downbeat nystagmus was present. Gag reflex was sluggish bilaterally but uvula was central. There was drooping of right shoulder and weakness of right sternocleidomastoid. Left cerebellar signs were present with ataxic gait. Bulk and tone of muscles was normal.\nCT [] showed a hyperdense extraxial lesion in left side posterior fossa, compressing brainstem and distorting the 4th ventricle with obstructive hydrocephalus. On MRI [], it appeared iso- to mildly hypointense on T2 weighted images and hyperintense on T1 weighted images without suppression of signal on fat saturated images. The lesion measured 5.4 × 4.2 × 5.34 cms. There was no obvious enhancement on administration of contrast. There was no restriction diffusion. On the anterior aspect of the lesion, just to the left of midline, there was a T1- and T2 hypointense focus that corresponded with slightly increased density on plain CT and showed blooming on SWI (likely calcification). The lesion showed facilitated diffusion. MRS showed a large NAA like peak at 2.02 ppm.\nShe underwent midline suboccipital craniectomy and near total excision of the lesion. Histopathology showed a cyst wall composed of pseudostratified ciliated columnar epithelium (black arrow) with extensive areas of squamous metaplasia suggestive of neuroenteric cyst.
|
[[28.0, 'year']]
|
F
|
{'16775266': 1, '28553375': 2, '17987286': 1, '19277673': 1, '11237972': 1, '2654696': 1, '18518701': 1, '15200128': 1, '3113198': 1, '20890417': 1, '12182790': 1, '9930826': 1, '15507425': 1, '15340855': 1, '1546383': 1, '34401938': 1, '24082482': 2}
|
{'3777327-1': 2, '3777327-3': 2, '3777327-4': 2, '3777327-5': 2, '5437783-1': 1}
|
163,280 |
3777327-3
| 24,082,482 |
noncomm/PMC003xxxxxx/PMC3777327.xml
|
Neuroenteric cysts of the brain-comprehensive magnetic resonance imaging
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A 7 month old girl presented with complaints of poor feeding, excessive crying and downgaze preference since 1 month. MRI [] showed a CSF-intensity cystic lesion of 7 × 5.7 × 5.8 cm size in left side of posterior fossa compressing the brainstem and cerebellar hemisphere to right with obstructive hydrocephalus and periventricular hyperintensities. The child underwent midline suboccipital craniotomy and decompression of cyst. On histopathology, the cyst wall was lined by pseudostratified ciliated cuboidal to flattened epithelium (black arrow) with a subepithelium composed of fibrocollagenous tissue with dilated vascular channels. On microscopic examination, the findings were suggestive of a neuroepithelial cyst, but based on the immunohistochemical properties, a final diagnosis of neuroenteric cyst was made.
|
[[7.0, 'month']]
|
F
|
{'16775266': 1, '28553375': 2, '17987286': 1, '19277673': 1, '11237972': 1, '2654696': 1, '18518701': 1, '15200128': 1, '3113198': 1, '20890417': 1, '12182790': 1, '9930826': 1, '15507425': 1, '15340855': 1, '1546383': 1, '34401938': 1, '24082482': 2}
|
{'3777327-1': 2, '3777327-2': 2, '3777327-4': 2, '3777327-5': 2, '5437783-1': 1}
|
163,281 |
3777327-4
| 24,082,482 |
noncomm/PMC003xxxxxx/PMC3777327.xml
|
Neuroenteric cysts of the brain-comprehensive magnetic resonance imaging
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32-year-old lady presented with complaints of oligomenorrhoea since 9 years; tremor of both hands since 9 months; intermittent right frontal headache, drop attacks, urinary incontinence, somnolence and irrelevant laughing since 6 months. On examination, there was bilateral secondary optic atrophy. No other cranial nerve involvement. Power was grade 3/5 in both upper limbs and grade 4+/5 in both lower limbs. Deep tendon reflexes were brisk. Bilateral cerebellar signs were present.\nMRI [] showed a suprasellar lesion elevating the floor of the fourth ventricle and extending into the interpeduncular fossa posteriorly. It appeared iso- to mildly hyperintense on T1 weighted images and hyperintense on T2 weighted images. There was facilitated diffusion in the lesion with high ADC values. There was no blooming on gradient echo images. There was no obvious enhancement on administration of contrast. On MR spectroscopy, there was a prominent peak at 2.02 ppm corresponding to NAA like compound. The third and lateral ventricles were dilated with periventricular hyperintensities suggestive of transependymal seepage of CSF.\nThe patient underwent right frontotemporal craniotomy, single peice orbitozygomatic osteotomy and subtotal excision of the lesion. Histopathology showed ciliated columnar, pseudostratified columnar, stratified squamous, mucosal glands, clusters of Rosenthal fibres suggestive of neuroepithelial cyst. Based on the immunohistochemical properties, a final diagnosis of neuroenteric cyst was made.
|
[[32.0, 'year']]
|
F
|
{'16775266': 1, '28553375': 2, '17987286': 1, '19277673': 1, '11237972': 1, '2654696': 1, '18518701': 1, '15200128': 1, '3113198': 1, '20890417': 1, '12182790': 1, '9930826': 1, '15507425': 1, '15340855': 1, '1546383': 1, '34401938': 1, '24082482': 2}
|
{'3777327-1': 2, '3777327-2': 2, '3777327-3': 2, '3777327-5': 2, '5437783-1': 1}
|
163,282 |
3777327-5
| 24,082,482 |
noncomm/PMC003xxxxxx/PMC3777327.xml
|
Neuroenteric cysts of the brain-comprehensive magnetic resonance imaging
|
A 17-year-old female patient presented with occasional headache since two years increased since the last three months. On examination, bilateral papilledema was present. No other focal neurological deficits were present.\nMRI [] showed a well-defined CSF-intensity cystic lesion in the region of the fourth ventricle with obstructive hydrocephalus. There were no enhancing solid components. The lesion showed facilitated diffusion. The patient underwent midline suboccipital craniotomy and deroofing of the cyst. Histopathology showed cuboidal or columnar epithelium (pseudostratified at some foci). Based on the immunohistochemical properties, a final diagnosis of neuroenteric cyst was made. Patient did well in the post-operative period with reduction of the hydrocephalus.
|
[[17.0, 'year']]
|
F
|
{'16775266': 1, '28553375': 2, '17987286': 1, '19277673': 1, '11237972': 1, '2654696': 1, '18518701': 1, '15200128': 1, '3113198': 1, '20890417': 1, '12182790': 1, '9930826': 1, '15507425': 1, '15340855': 1, '1546383': 1, '34401938': 1, '24082482': 2}
|
{'3777327-1': 2, '3777327-2': 2, '3777327-3': 2, '3777327-4': 2, '5437783-1': 1}
|
163,283 |
3777328-1
| 24,082,483 |
noncomm/PMC003xxxxxx/PMC3777328.xml
|
Acute Wallerian degeneration of middle cerebellar peduncles due to basilar artery thrombosis
|
A 59-year-old male patient with known arterial hypertension, hypercholesterolemia, and diabetes mellitus came to our hospital with accentuated dysarthria, skew deviation, double vision, and right hemisyndrome since 2 days. Before that the patient had acute vertigo for 9 days as the initial symptom and he went to a local hospital where MRI of the brain was performed, which showed acute tegmental infarction of left paramedian pons.\nUpon admission, the patient was drowsy and markedly dysarthric. Neurological examination showed abnormal horizontal movements of the extraocular muscles and spontaneous nystagmus; however, vertical gaze was maintained. Left facial palsy as well as weakness in the upper and lower extremities on both sides was noted. The total National Institute Health Stroke Scale (NIHSS) score was 8/42.\nMRI at this time [] revealed small bilateral foci of restricted diffusion in the ventral pons. The central paramedian pons and the midbrain showed lesser hyperintense signal on DWI and contrast enhancement suggestive of subacute infarct. MR angiography (MRA) revealed no flow void in intracranial right vertebral artery and basilar artery [], suggesting thrombosis. Consensus decision was taken to avoid catheter cerebral angiography and thrombolysis, as the patient had history of bleeding per rectum 1 month prior. Intravenous unfractionated heparin was administered. Extensive work-up to rule out any cause of vasculitis was done; however, these were normal. Four days later, he was in full control of his spaciotemporal orientation; however, he developed new ataxia on the left side. The oculomotor and motoric deficits were unchanged. Intravenous heparin was continued and the patient was managed conservatively. On day 12, he further developed diminished facial sensation in trigeminal distribution, dysmetria, and dysdiadokinesia of the lower left extremity and the NIHSS score was 5/42.\nMRI [] performed at this time (day 12) revealed restricted diffusion in both the MCPs with hyperintense signal on fluid-attenuated inversion recovery (FLAIR) images symmetrically. The new lesions were interpreted as WD due to bilateral paramedian pontine infarction following the basilar artery thrombosis. No new focus of acute infarct was seen. At this time, intravenous heparin was stopped and prophylactic aspirin 100mg daily was considered. Patient was transferred to neurorehabilitation clinic and gradually regained power in extremities.\nLast follow-up MRI [] was done 12 weeks after the onset showed gliosis in midbrain and ventral pons. Persistent T2-hyperintense signal was noted in both the MCPs with decreased fractional anisotropy. Paucity of fibers of MCP and transverse pontine fibers was also seen. Presently, the patient has persistent mild dysarthria, dysmetria, and inability to converge eyes, but otherwise there are no motor or sensory defects.
|
[[59.0, 'year']]
|
M
|
{'14962648': 1, '14625215': 1, '14991261': 1, '15891160': 1, '14561611': 1, '1374872': 1, '10589585': 1, '11566246': 1, '12942223': 1, '11018710': 1, '31828281': 1, '29521288': 1, '15526095': 1, '2740501': 1, '26751508': 1, '24082483': 2}
|
{}
|
163,284 |
3777329-1
| 24,082,484 |
noncomm/PMC003xxxxxx/PMC3777329.xml
|
Esophagobronchial fistulae: Diagnosis by MDCT with oral contrast swallow examination of a benign and a malignant cause
|
A 15-year-old male presented with cough, mucopurulent expectoration, and dyspnea since 3 months. There was history of exacerbation of cough after swallowing. This finding of swallow–cough sequence has been referred to as Ono's sign.[] A chest radiograph revealed complete opacification of the right hemithorax with volume loss suggesting complete collapse of the right lung with mediastinal shift to the right []. A plain and intravenous contrast-enhanced CT study with oral contrast swallow was performed on a 128-slice MDCT scanner (Siemens Somatom Definition AS, Erlangen, Germany). The study revealed complete collapse of the right lung with irregular dilated ectatic bronchi in the right lower lobe []. There was stenosis and diffuse narrowing of the right mainstem bronchus with nodularity of the mucosa seen best on the virtual bronchoscopy []. The right main pulomanary artery (MPA) was narrow in caliber. There was a resultant significant shift of the mediastinum and heart to the right. An air-filled tract was noted extending from one of the right lower lobar bronchi toward the posterior mediastinum with ill-defined soft tissue around it. The possibility of an esophagobronchial fistula was suspected, and we did a CT oral contrast swallow study to detect it. Oral contrast swallow study performed with the patient in right decubitus position using diluted non-ionic iodinated contrast medium (1:20 dilution of iohexol with normal saline). It depicted the site and the fistula tract between the right lateral wall of the esophagus and one of the ectactic bronchi in the right lower lobe of the lung. Thick MIP images and VRT processing demonstrated the fistula site and tract [Figures and ]. Right adrenal gland calcification was also noted. These imaging findings led us to conclude that these changes were most likely the sequelae of chronic tuberculosis. The patient underwent an open right pneumonectomy with repair of the fistula. Histology of the lung specimen revealed distorted bronchioles with diffuse and focal dense infiltration by mononuclear cells and giant cells. Lymph nodes with prominent germinal centers were also seen.
|
[[15.0, 'year']]
|
M
|
{'18678504': 1, '16572873': 1, '15905619': 1, '507984': 1, '21264171': 2, '19188476': 1, '5348488': 1, '11834036': 1, '29363017': 1, '7893888': 1, '2241331': 1, '11044052': 1, '27303515': 1, '4918289': 1, '3490162': 1, '11028712': 1, '20165591': 1, '6773373': 1, '12376614': 1, '18559902': 1, '1308667': 1, '24082484': 2}
|
{'3777329-2': 2, '3023871-1': 1}
|
163,285 |
3777329-2
| 24,082,484 |
noncomm/PMC003xxxxxx/PMC3777329.xml
|
Esophagobronchial fistulae: Diagnosis by MDCT with oral contrast swallow examination of a benign and a malignant cause
|
A 65-year-old male presented with progressive dysphagia to solids over the past 2 months. An ultrasound of the neck revealed few enlarged lymph nodes which on fine needle aspiration (FNA) revealed neoplastic squamous cells. A plain and intravenous contrast-enhanced CT study with CT oral contrast swallow was performed. There was moderate irregular enhancing wall thickening of the upper and mid thoracic esophagus. There was a loss of fat plane between the esophagus and the carina, left mainstem bronchus, and aorta. A defect was seen in the posterior wall of the proximal left mainstem bronchus suggesting formation of a fistula with the esophagus []. A CT oral contrast swallow study performed in prone position with diluted non-ionic contrast (1:20 dilution of iohexol in normal saline) revealed a small fistula tract between the esophagus and the proximal left mainstem bronchus just distal to the carina []. Post-processing of this contrast swallow study with volume rendering depicted the fistulous communication in 3D [].
|
[[65.0, 'year']]
|
M
|
{'18678504': 1, '16572873': 1, '15905619': 1, '507984': 1, '21264171': 2, '19188476': 1, '5348488': 1, '11834036': 1, '29363017': 1, '7893888': 1, '2241331': 1, '11044052': 1, '27303515': 1, '4918289': 1, '3490162': 1, '11028712': 1, '20165591': 1, '6773373': 1, '12376614': 1, '18559902': 1, '1308667': 1, '24082484': 2}
|
{'3777329-1': 2, '3023871-1': 1}
|
163,286 |
3777354-1
| 24,082,253 |
noncomm/PMC003xxxxxx/PMC3777354.xml
|
A case of Zolpidem dependence successfully detoxified with gabapentin
|
Mrs. M.C., 72-year-old female, received a prescription for Tab Zolpidem 10 mg per day as a treatment for insomnia. She gradually increased the number of tablets and would take Zolpidem even during the day as it increased her efficiency to carry out work done earlier. Over an 8 month period, the use escalated to 300 mg per day following which she was noted to be sleeping most of the time during the day, and would not attend to her routine household chores. If she was denied the tablets, she would become irritable on minimal provocation, would complain of feeling weak, along with decreased energy and ability to carry out work done earlier and would also develop tremulousness of hands and feet along with craving for Tab. Zolpidem. In view of the above symptoms, patient was taken to a private psychiatrist. She was initiated on 6 mg of Tab Clonazepam per day and the dose of Zolpidem was reduced to 150 mg per day over a period of 28 days. However, the craving persisted and hence she was referred to this hospital.\nOn mental status examination at admission, patient was found to be anxious with increased psychomotor activity, ill-sustained concentration, and dysphoric mood along with tremors of outstretched hands.\nOn physical examination, no gross abnormality was noted except for pallor and blood pressure of 180/110 mm Hg. Routine blood investigations and chest X-ray were within normal limits. ECG showed evidence of right bundle branch block.\nShe was started on a daily dose of Cap Gabapentin which was initiated at 300 mg one in the morning and two tablets at night, and gradually increased by 100 mg every fifth day to the dose of 1200 mg per day and Tab Zolpidem was reduced by 15 mg every third day. Patient was successfully detoxified over a period of 30 days. At discharge, the dose of Gabapentin was reduced to 600 mg per day which was tapered over a month. The patient was followed up after a fortnight of stopping Tab Gabapentin and was found to be asymptomatic.
|
[[72.0, 'year']]
|
F
|
{'25012623': 2, '16399882': 1, '10221362': 1, '18085123': 1, '17250613': 1, '33888666': 2, '10435388': 1, '9768560': 1, '11448723': 1, '11235923': 1, '17049955': 1, '11320686': 1, '12766380': 1, '8521677': 1, '14519173': 1, '11097986': 1, '24082253': 2}
|
{'4230342-1': 1, '8077048-1': 1, '8077048-2': 1, '8077048-3': 1, '8077048-4': 1, '8077048-5': 1, '8077048-6': 1, '8077048-7': 1, '8077048-8': 1}
|
163,287 |
3777355-1
| 24,082,254 |
noncomm/PMC003xxxxxx/PMC3777355.xml
|
A patient with Tramadol dependence and predictable provoked epileptic seizures
|
The patient was a 24-year-old high school educated, married male farmer by occupation, who initially started chewing tobacco at the age of 17 years in the company of his friends. He developed dependence in the form of tolerance, withdrawal, and craving over a period of 6-8 months. At the age of 18 years, he took 2-3 tablets of Tramadol (as a combination preparation of 37.5 mg with Paracetamol 375 mg) on the advice of some friends who used the same to allay fatigue after working in the fields. These were freely available without prescription at the neighborhood pharmacy. The patient found it beneficial to allay fatigue and felt elated after its use and started to take it on a regular basis. Over the next 6-8 months, he developed tolerance and had to take 5-6 tablets/day to derive the same benefit and he experienced a craving to consume these tablets and would often start his day with these tablets. He also started to experience symptoms, of that he claimed were non-specific such as headache and fatigue when he did not take the regular dose of these tablets. This would be relieved on taking the tablets. Over the next 4-6 months, he also started to consume Alprazolam at the dose of 1-2 mg/day, again on the advice of friends who claimed it would help him relax. This too was available freely locally. Over a period of 1 year, he developed dependence to Alprazolam as well. After about 3 years of regular use of Tramadol and Paracetamol combination tablets, he once consumed 15-16 tablets on advice of a friend who claimed it would enable him to sustain an erection for longer duration sexual intercourse. His usual dose was 7-8 tablets of Tramadol–Paracetamol and 2 mg/day of Alprazolam. After about 1h of intake, the patient had an episode of unresponsiveness characterized by tonic–clonic movement of both upper and lower limbs for about 1 min, associated with clenching of teeth and frothing from mouth, following which he remained confused for about half an hour. He was at home at this time and did not take any particular treatment for the same. Gradually, however, he started to notice that whenever he took a higher than usual dose of Tramadol–Paracetamol combination, he would feel jittery and uncomfortable and then he would have an epileptic seizure. This, however, he could prevent by taking a higher than normal dose of Alprazolam at the dose of about 3-4 mg, which he would take concurrently with Tramadol–Paracetamol. He also observed that he could sustain an erection and withhold ejaculation for longer than was usual for him during intercourse whenever he took this higher than usual dose of Tramadol–Paracetamol. Therefore, whenever he planned for having sex, he would use a higher than usual dose of Tramadol–Paracetamol and then prevent the expected seizure with a higher than usual dose of Alprazolam. Whenever he got this combination wrong, he would either be dissatisfied with his sexual experience or have a seizure. Eventually, he was persuaded by family members to seek treatment for his drug taking and seizures. He took treatment from some private de-addiction centers without much relief. His usual pattern was to take 7-8 tablets of Tramadol–Paracetamol in the morning and 3-4 tablets in evening, which he would increase to 13-15 tablets in case he had to perform sexual intercourse and 7-8 tablets of 0.5 mg of Alprazolam daily in two divided doses. On admission and on quitting from his usual drugs, he complained of premature ejaculation and headache. His withdrawal symptoms were largely non-specific and the typical opioid withdrawal symptoms were not observed. His ward stay was essentially uncomplicated and a non-contrast computed tomography (CT) scan of the head and electroencephalography (EEG) were reported normal.
|
[[24.0, 'year']]
|
M
|
{'10617309': 1, '25489425': 1, '20196795': 1, '26913261': 1, '16615669': 1, '12167549': 1, '15651948': 1, '19874162': 1, '12378844': 1, '21467190': 1, '24082254': 2}
|
{}
|
163,288 |
3777374-1
| 24,082,617 |
noncomm/PMC003xxxxxx/PMC3777374.xml
|
Paraquat - A deadly poison: Report of a case and review
|
A 16-year-old female patient was admitted to emergency department of our tertiary care hospital with history of alleged consumption of paraquat poison, 13 days before at 19.00 hours at her residence due to failure in matriculation examination. History revealed that after consumption of the poison, she was taken to the local hospital after ½ an hour. Meanwhile, she was reported to have 6 episodes of vomiting. She was treated conservatively; gastric lavage followed by activated charcoal 1 gm/kg was given as an adsorbent and discharged after 6 days from a local hospital. Since then, she was suffering from fever and cough without shortness of breath, orthopnea, chest, and abdominal pain. After 1 week at 21.00 hours, she was brought to our hospital. Her O2 saturation was 40% on room air, pulse rate was 78 beats/minute, respiratory rate 28 beats/minute, and blood pressure was 100/60 mmHg. Respiratory examination revealed bilateral crepitation. Patient was administered O2 by 60% venturi, and her saturation picked up to 95%.\nLaboratory tests showed leukocytosis, neutrophilia, elevated ESR, and metabolic acidosis with normal renal and liver function. On the second day, she was shifted to ICU due to increasing breathlessness. Empirical antibiotic therapy was started with intravenous piperacillin-tazobactam 4.5 gm stat and continued 8th hourly. Antioxidant therapy was initiated on the same day with vitamin E and C. Detoxifying agent N-Acetyl cysteine 600 mg was given orally thrice-daily from second day onwards. In view of persistence hypoxia, she was intubated and put on mechanical ventilator on the 3rd day. Midazolam and Morphine were started on same day and continued for 1 week. She was treated with oral cyclophosphamide 50 mg once-daily on 3rd day till 12th day, and steroid dexamethasone 4 mg i.v. 6 hourly was started on 6th day and stopped after one week. Subsequently, she was treated with linezolid and piperacillin-tazobactam when she developed ventilator-associated pneumonia (VAP). Piperacillin-tazobactam was changed to cefoperazone-sulbactum based on culture and sensitivity of endotracheal aspirate, which grew Klebsiella pneumoniae and Acinetobacters pecies. The serial chest X-rays done are shown in the Figures -. Patient could not afford to continue the treatment; hence, she was discharged against medical advice in a critical condition.
|
[[16.0, 'year']]
|
F
|
{'34384262': 2, '17497456': 1, '28798883': 1, '19837651': 1, '16871121': 1, '17139398': 1, '34212926': 1, '33810013': 1, '18588370': 1, '27042505': 1, '11141378': 1, '30809298': 1, '33959562': 2, '18161502': 1, '29417032': 2, '17975689': 1, '24082617': 2}
|
{'5787979-1': 1, '8366112-1': 1, '8095252-1': 1}
|
163,289 |
3777376-1
| 24,082,619 |
noncomm/PMC003xxxxxx/PMC3777376.xml
|
Bronchial asthma with ABPA presenting as PTE
|
A 9-year-old boy presented with bluish discoloration of the nails and lips since last one year andanasarca (generalized swelling), worsening cough, respiratory distress, and periumbilical pain abdomen since 20 days previously. He had past history suggestive of asthma (recurrent episodes of cough and respiratory distress since the first year of life), for which he had received irregular treatment. He was not receiving any regular inhaled steroids. He had no significant febrile illnesses and loose stools in the past. His sibling had bronchial asthma. There was no history of tuberculosis or sibling death in family. On admission, patient found to have central cyanosis, tachycardia, marked respiratory distress with normal blood pressure. The child had anasarca, grade III clubbing, and raised jugular venous pressure. His weight and height both were below the third percentile. Examination revealed a hyper-resonant chest with generalized crepts and rhonchi. The second heart sound was loud, but no murmur was detected. He had tender hepatomegaly.\nInvestigations showed hemoglobin of 150 g/L, total leukocyte count 12.8 × 109/L with neutrophils 80%, lymphocytes 18%, monocytes 1%, and eosinophils 1%. Arterial blood gas analysis on 100% oxygen showed pH of 7.36, pCO2 59.5 mm of Hg, pO2 116 mm of Hg, HCO3 32.6 mmol/L, base excess 5.2 and oxygen saturation 98.3%, suggesting chronic respiratory acidosis. Tubercular workup was negative. Sweat chloride level (pilocarpine iontophoresis method) was 42 meq/L (borderline). HIV was non-reactive. Chest x-ray revealed cardiomegaly and bilateral lung infiltrates. Electrocardiography revealed right axis deviation and p-pulmonale. HRCT chest showed central bronchiectasis [], minimal right pleural and pericardial effusion, and gross cardiomegaly. Chest angiography revealed dilated main pulmonary artery and filling defect in right branch of pulmonary artery []. Echocardiography finding were: Dilated right-sided heart, right ventricular dysfunction, severe pulmonary artery hypertension, and right atrial clot. Lung ventilation-perfusion scan was suggestive of pulmonary thrombo-embolism. Serum IgE levels were 1100 IU/ml (normal 50-100 IU/ml). Immediate skin hypersensitivity to Aspergillus fumigatus was positive. Serum precipitants against aspergillus and candida were negative. Coagulogram revealedPprothrombin time index of 82%, APTT 33 seconds, INR 1.2 and presence of fibrin degradation products.\nThe patient was managed with salbutamol (0.15 mg/kg/dose) and ipratropium bromide (0.5 mg/dose) nebulization and intravenous hydrocortisone (10 mg/kg stat followed by 2 mg/kg every 6 hourly) for exacerbation of asthma. For congestive heart failure, digoxin (3 μg/kg/day) and furosamide (2 mg/kg/day) was given. He received injection ceftriaxone (100 mg/kg/day) for 14 days. Low molecular weight heparin (1.0 mg/kg 12 hourly for 5 days) followed by warfarin (0.1 mg/kg/day) was administered for thrombo-embolism after chest angiography. He improved and was discharged on request on warfarin, home oxygen therapy, oral steroids (prednisolone 2 mg/kg/day), and inhaled steroids (budesonide 400 μg/day) after three weeks of admission. He didn’t return for follow-up, and on enquiry, we came to know that he expired after few days of discharge.
|
[[9.0, 'year']]
|
M
|
{'13667335': 1, '15969680': 1, '20697704': 1, '19317361': 1, '30381560': 1, '15884287': 1, '20675033': 1, '24082619': 2}
|
{}
|
163,290 |
3777377-1
| 24,082,620 |
noncomm/PMC003xxxxxx/PMC3777377.xml
|
Successful resuscitation after suspected carbon dioxide embolism during laparoscopic ureteric reconstructive surgery
|
A 35-years-old female, weighing 42 kg was posted for transperitoneal laparoscopic Boari's ureteric reimplantation. She had undergone. cesarean section 6 months back. Her, physical examination and routine investigations were unremarkable.\nWith routine monitoring, balanced general anesthesia was given. Patient was positioned supine with 20° trendelenberg tilt. CO2 Pneumoperitoneum was created uneventfully using open insufflation technique and sustained with pressure of 14 mm Hg. Patient was hemodynamically stable. After 2 h, when the surgeon was dissecting the ureters, there was a sudden drop in ETCO2 (8 mm Hg), tachycardia (130/min) followed by multiple ventricular premature beats (VPBs) with blood pressure (BP) 110/72 mm of Hg and SaO2-98%. Surgical bleeding and endotracheal tube blockage were ruled out, and gas embolism was suspected. No drug was being administered intravenously. Infusion tubing was patent. Pneumoperitoneum was terminated immediately and the patient was placed in 45° trendelenberg position. Injection lignocaine 80 mg intravenously was given for VPBs, and the regular rhythm was restored with the heart rate of 42/min. Injection atropine 0.6 mg intravenously was given. At this point, the SaO2 decreased from 98% to 77% while the breath sounds were normal with no adventitious sounds. Also, the patient was cyanosed with non-recordable BP and heart sounds. ECG monitor suggested complete heart block with pulseless electrical activity. One liter of crystalloid was infused. We could not appreciate a “mill wheel” murmur on auscultation. Patient was manually ventilated with 100% O2. Injection atropine, totally 1.8 mg intravenously was given. Cardiopulmonary resusicitation was commenced and injection adrenaline 1 mg intravenously was given. Since there was no response to these measures, injection dopamine 20 ug/kg/min and nor-adrenaline 0.36 ug/kg/min were infused. Multiorifice central venous catheter with its tip at the superior vena cava -right atrium (SVC-RA) junction was inserted via right internal jugular vein but air could not be aspirated. The central venous pressure (CVP) was 15 mm of Hg. After 20 min, resuscitative efforts were successful, patient had pulse rate of 120/min, BP 100/54 mm/Hg, SaO2 100%, ETCO2 30 mm/Hg and ECG showed sinus rhythm with right ventricular strain pattern.At this time the CVP was found to be 10 mm of Hg. ABG analysis was normal. Surgery was abandoned. After ½ h, adrenaline was stopped. Two-dimension echocardiography (2-D Echo) showed no patent ductus arteriosus or any other congenital defects. She was shifted to intensive care unit with dopamine 5 ug/kg/min. which was tapered and stopped after ½ h. The patient did not receive hyperbaric oxygen as we did not have the facility. She regained consciousness after 2 h without neurological deficit and was extubated.
|
[[35.0, 'year']]
|
F
|
{'18729315': 2, '19879638': 1, '10444005': 1, '12015619': 1, '34552832': 2, '7978402': 1, '24082620': 2}
|
{'8449495-1': 1, '2615299-1': 1}
|
163,291 |
3777448-1
| 22,854,062 |
noncomm/PMC003xxxxxx/PMC3777448.xml
|
Metaplastic carcinoma of the right breast and simultaneous giant ovarian teratoma: a case report
|
A 55-year-old woman (married, having 3 children) presented with a painless mass in the right breast discovered by self-examination one year before reporting it. She had no other symptoms or previous breast problems and no family history of breast cancer.\nOn clinical examination, palpation of the right breast revealed a painless, mobile, hard mass at the 1-o'clock position (upper inner quadrant) that measured 5.0 cm in width and 4.0 cm in height. There was no tethering of the skin or peau d' orange, and there were no enlarged lymph nodes in the axillary region. The opposite breast and the axilla were normal. Hematological investigation results were within normal limits, and chest X-ray, electrocardiogram showed the heart and lung functions were normal. A large mass was also noted in the mid-lower right part of the abdomen. Clinical diagnosis of the right breast mass and abdominal mass was ambiguous.\nUltrasound scan of the breast showed a hypoechoic area measuring approximately 28 cm in anteroposterior diameter in the upper half of right breast. Meanwhile, it was demonstrated that a relatively circumscribed complex echoic mass with posterior enhancement and uneven density and abundant vessels existed in this area. Calcifications were found focusing in the breast lesion, and several axillary lymph nodes were highly suspicious of metastasis. There were no other focal lesions noted on the scan. Mammography demonstrated an increased density with smooth contour corresponding to the palpable mass. The patient had also undergone an initial computed tomography scan, which revealed a spherical multicystic mass in the right abdomen that measured 259 mm in length, 170 mm in width, and 106 mm in height.\nFine-needle aspiration cytology and intraoperative frozen sections demonstrated and confirmed the malignancy of the mass in the right breast as infiltrating ductal carcinoma (IDC). Upon review of the biopsy specimen from the breast tissue at a multidisciplinary meeting, the diagnosis was reclassified as granulocytic sarcoma.\nThe patient underwent modified radical mastectomy of the right breast and laparoscopic excision of the abdominal mass in the lower right quadrant 15 days after gynecology consultation. The histology of both lesions was reviewed. No residual tumor was found in the surgical margin of the breast specimen. Having underwent 6 courses of chemotherapy, the patient is now under follow-up, and she has no relapsed disease.\nGross pathologic examination of the right breast specimen revealed a tumor that measured 4.5 cm in length, 3.0 cm in width, and 3.0 cm in height. A gray nodule was seen on gross section with punctiform necrosis. Microscopically, the right breast tumor exhibited a biphasic pattern consisting of epithelial and mesenchymal components of carcinosarcoma. The epithelial components were formed by poorly differentiated carcinoma that exhibited glandular tubiform and screen-form or nest-form patterns. The mesenchymal components contained connective tissue cells, spindle cells, osteoblastic cells, and bone matrix. Mesenchymal fibrous tissue was hyperplastic, and some mesenchymal cells had obvious heteromorphism. Cell nuclei were large and undergoing anachromasis. Mitotic activity within these cells was extremely high (). Bone matrix was present outside of these cells in some areas. No metastasis was found in 25 lymph nodes.\nGross pathologic examination of the mass from the lower right quadrant of the abdomen showed a tumor measuring 14.0 cm in length, 12.0 cm in width, and 7.0 cm in height with gray capsule wall. The thickness of the capsule wall was 0.2–0.5 cm. Fatty tissues and hairs were prevalent in the tumor. Microscopically, the capsule wall contained squamous epithelium. Skin appendages such as sweat and sebaceous glands were found under the epithelium. There were also some ovarian tissues. Keratinized tissues, which were stained in red, were apparent in the capsular space ().\nImmunohistochemical studies of the breast tumor showed that the epithelial components were positive for c-erbB2 but negative for estrogen receptor (ER), progesterone receptor (PR), vimentin, and cytokeratin 5/6 (CK5/6). In contrast, the mesenchymal components were positive for vimentin and negative for ER, PR, and c-erbB2. In addition, epithelial membrane antigen (EMA), smooth muscle antigen (SMA), S-100 protein, and P63 were not expressed in either the epithelial or mesenchymal component of the breast tumor ().
|
[[55.0, 'year']]
|
F
|
{'20713713': 1, '12189386': 1, '16538049': 1, '20847886': 1, '17603561': 1, '7850054': 1, '19126225': 2, '21347193': 1, '16546865': 1, '10370783': 1, '21070449': 1, '17009109': 1, '33942253': 1, '17066230': 1, '20879052': 1, '21811528': 2, '24625319': 2, '34540509': 2, '22854062': 2}
|
{'8440239-1': 1, '3140887-1': 1, '3976087-1': 1, '2627815-1': 1, '2627815-2': 1}
|
163,292 |
3777464-1
| 22,176,774 |
noncomm/PMC003xxxxxx/PMC3777464.xml
|
Recurrent isochromosome 21 and multiple abnormalities in a patient suspected of having acute myeloid leukemia with eosinophilic differentiation—a rare case from South India
|
A 76-year-old man of Indian origin, with history of ischemic heart disease, was presented to the Outpatient Clinic of Medical Oncology, Regional Cancer Centre due to marked variation in blood count, in addition to anemia, thrombocytopenia, mild splenomegaly, and leukocytosis. Initial complete blood count displayed 4.8 g/dL of hemoglobin, leukocyte count of 50 500 cells/mm3 undiluted blood, and thrombocyte count of 65 000 cells/mm3 undiluted blood. Blood picture showed predominant neutrophils, marked shift to the left with atypical monocytes, 12% blasts, and 6% basophils. Initial bone marrow study revealed hypercellular marrow with 35% blasts and mild eosinophilia. Blasts were peroxidase-positive. The hematological and clinical parameters were consistent with AML-M4 [E0] that resembles blast crisis of chronic myeloid leukemia (CML). Using conventional cytogenetics and fluorescence in situ hybridization (FISH), the case was confirmed not to be CML blast crisis. Using standard protocols, unstimulated bone marrow culture and chromosome analysis were performed on G-banded metaphases using Cytovision software. The karyotypes were prepared according to the International System for Human Cytogenetic Nomenclature (2005). FISH was performed using BCR/ABL Dual Color, Dual Fusion Translocation Probe (Vysis). All studies were carried out after obtaining written informed consent from the patient and approval from the Institutional Review Board of the Regional Cancer Centre. Cytogenetic analysis using G-banding revealed the karyotypes in 50 intact metaphases, and the results are summarized in . In addition, rare phenomena including tetraploid endoreduplication and ring chromosomes were noted.
|
[[76.0, 'year']]
|
M
|
{'7485166': 1, '8098967': 1, '19188705': 1, '17161791': 1, '23100969': 1, '1912553': 1, '17236200': 1, '8943844': 1, '14014312': 1, '10369161': 1, '7522535': 1, '15996491': 1, '16219152': 1, '14767474': 1, '2400804': 1, '20064153': 1, '15070659': 1, '15120908': 1, '21685371': 1, '9218106': 1, '21216845': 1, '12759627': 1, '10029816': 1, '26306071': 1, '16631607': 1, '22176774': 2}
|
{}
|
163,293 |
3777496-1
| 22,516,480 |
noncomm/PMC003xxxxxx/PMC3777496.xml
|
A case report of primary small cell carcinoma of the breast and review of the literature
|
In October 2011, a 39-year-old woman presented a painless mass in her left breast for 3 months. There were no accompanying symptoms such as nipple retraction, dimpling, or palpable axillary lymph nodes. Physical examination revealed a 2 cm × 2 cm, elastic, firm, ill-defined suspicious mass in the upper outer quadrant of her left breast. On the mammography, the mass appeared round with indistinct margins with lots of punctates and scattered calcifications along the duct ().\nAdditionally, an ultrasound scan revealed two solid and low heterogeneous echoes in the left breast: one was in the 3 o'clock position, 35 mm away from the nipple (); the other was also in the 3 o'clock position, 65 mm away from the nipple (). Both were poorly defined with irregular borders. However, the levels of serum tumor markers, including carcino-embryonic antigen (CEA), carbohydrate antigen 125 (CA125), CA15-3, and CA19-9 were all within normal limits.\nThe patient did not undergo a fine needle biopsy. An intraoperative biopsy confirmed the pathologic diagnosis of SCC with the component of ductal carcinoma in situ (DCIS). As a result, she underwent modified radical mastectomy with axillary lymph node dissection. Microscopically, the mass (in the 3 o'clock position, 35 mm away from the nipple) was about 0.8 cm × 0.5 cm × 0.5 cm, which was diagnosed histologically as an intermediate grade DCIS, whereas the second mass (in the 3 o'clock position, 65 mm away from the nipple) was about 1.4 cm × 1.2 cm × 0.6 cm and was comprised of intermediate grade DCIS (30%) and SCC (70%). Histological examination showed that the tumor was composed of small round or oval cells with a high nucleocytoplasmic ratio, small hyperchromatic nuclei, inconspicuous nucleoli, and scant cytoplasm, which were arranged diffusely and patchily. Widespread necrosis was present (). Immunohistochemically, tumor cells of the DCIS component were positive for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). However, the tumor cells of the SCC component were negative for these markers, whereas the Ki67 proliferation index (percentage of Ki67-positive cancer nuclei) was 70%. Furthermore, the SCC tumor cells were highly positive for neuroendocrine differentiation markers including synaptophysin (), neuron specific enolase (NSE) (), thyroid transcription factor-1 (TTF1) (), and CD56 (), but they were negative for chromogranin A (CgA) (). Histological examination also demonstrated 1 positive lymph node out of 13 level I axillary lymph nodes.\nTherefore, a search for a non-mammary primary site was carried out, especially focusing on pathologic changes in the lungs. The result of computed tomography (CT) scans of the neck, chest, and upper abdomen were all within normal limits, and bone scintigraphy was negative for metastatic disease. As a result, we concluded that the breast was the primary site, and primary SCC of the breast was diagnosed.\nThe patient was treated with six cycles of docetaxel (75 mg/m2) and carboplatin (350 mg/m2) in combination once every three weeks. After the initial treatment, the patient was clinically monitored for disease relapse and metastasis.
|
[[39.0, 'year']]
|
F
|
{'15901010': 1, '18668318': 1, '15262362': 1, '16325513': 1, '18504641': 1, '14750249': 1, '29047418': 2, '6089995': 1, '19578049': 1, '16166438': 1, '19828414': 1, '16998932': 1, '6091325': 1, '20591162': 2, '11260311': 1, '19860307': 1, '15743041': 1, '10976697': 1, '15385324': 1, '32391224': 2, '15019697': 1, '24179664': 2, '12902441': 1, '11486176': 1, '10656743': 1, '9778114': 1, '20661411': 1, '15010880': 1, '16873572': 1, '9990271': 1, '20668605': 2, '25853028': 1, '11762336': 1, '11249037': 1, '11107070': 1, '6303551': 1, '1311484': 1, '21989436': 1, '11041059': 1, '32411090': 2, '9755683': 1, '7534975': 1, '6302908': 1, '19294494': 1, '18357385': 1, '15976350': 1, '17986808': 1, '22516480': 2}
|
{'2902213-1': 1, '5648460-1': 1, '7201766-1': 1, '7205366-1': 1, '3804827-1': 1, '2913980-1': 1}
|
163,294 |
3777520-1
| 22,464,651 |
noncomm/PMC003xxxxxx/PMC3777520.xml
|
Chondroblastoma in the long bone diaphysis: a report of two cases with literature review
|
A 15-year-old boy was admitted to hospital because of persistent pain in the left leg for 2 weeks. Physical examination revealed a tender swelling and pressing pain in the media region of the left leg. There was no evidence of soft tissue mass or concurrent illness. The patient had no history of trauma or irradiation in this region. A plain radiograph showed a well-defined lytic defect, measuring 5-6 cm in diameter in the diaphysis of the left tibia (). CT scans demonstrated an area of extensive lytic bony destruction with little discernible residual cortex and no significant periosteal reaction. The margins were well delineated, and there was no matrix formation within the lesion (). T1-weighted MRI showed an irregular, slightly low signal intensity mass with central nodularity (), which exhibited heterogeneity and slightly high signal intensity on T2-weighted images (). The bone emission computed tomography (ECT) showed clearly defined radiopharmaceutical uptake in the media part of the left leg (). A benign osseous lesion, such as non-ossifying fibroma, fibrous dysplasia, and eosinophilic granuloma, was suspected because of the less aggressive radiological features. Examination of frozen sections was performed during the operation and the pathologic diagnosis was chondroblastoma. Curettage and bone grafting were performed with subsequent cessation of pain. The final pathologic diagnosis was consistent with the frozen section diagnosis (). Postoperatively, the function of the leg was excellent and no recurrence was found at the 60-month follow-up.
|
[[15.0, 'year']]
|
M
|
{'9584382': 1, '5060653': 1, '17443729': 1, '16010594': 1, '33897850': 1, '7399520': 1, '17306329': 1, '3610613': 1, '18290384': 1, '29268433': 1, '14717211': 1, '32405481': 2, '4023729': 1, '9686022': 1, '7610417': 1, '8402563': 1, '16295494': 1, '16484006': 1, '10591928': 1, '11342780': 1, '9683708': 1, '26530393': 1, '3978565': 1, '15138578': 1, '8951497': 1, '3997927': 1, '3988915': 1, '17657552': 1, '17304775': 1, '15734522': 1, '15972914': 1, '17727486': 1, '10629544': 1, '3604981': 1, '9477099': 1, '8253461': 1, '10954104': 1, '3588400': 1, '9001683': 1, '12913842': 1, '22464651': 2}
|
{'3777520-2': 2, '7210901-1': 1}
|
163,295 |
3777520-2
| 22,464,651 |
noncomm/PMC003xxxxxx/PMC3777520.xml
|
Chondroblastoma in the long bone diaphysis: a report of two cases with literature review
|
A 21-year-old woman was admitted because of a fixed palpable mass in the right humerus over 1 month. On physical examination, an approximately 2 cm, firm, fixed mass was noted in the media of the brachium. The overlying skin was normal and there was no sensory or motor deficit. There was no evidence of soft tissue mass or concurrent illness. A plain radiograph showed an osseous protuberance in the diaphysis of the right humerus (). CT scans demonstrated an ossifying bony protuberance arising from the cortex. There was no evidence of extension to the adjacent soft tissue (). A benign lesion was suspected. En bloc resection from the bottom of the protuberance, including some normal cortex, was performed. The final pathologic diagnosis was chondroblastoma, with tumor cells positive for S-100 (). After the operation, the function of the arm was excellent, and there was no recurrence at the 48-month follow-up.\nThese two atypical cases indicate that, except for the distinctive site of long bone diaphysis, which made diagnosis difficult, the patients' ages, symptoms, X-ray and CT images, treatments, and prognosis were in accordance with typical lesions in the epiphysis and metaphysis.
|
[[21.0, 'year']]
|
F
|
{'9584382': 1, '5060653': 1, '17443729': 1, '16010594': 1, '33897850': 1, '7399520': 1, '17306329': 1, '3610613': 1, '18290384': 1, '29268433': 1, '14717211': 1, '32405481': 2, '4023729': 1, '9686022': 1, '7610417': 1, '8402563': 1, '16295494': 1, '16484006': 1, '10591928': 1, '11342780': 1, '9683708': 1, '26530393': 1, '3978565': 1, '15138578': 1, '8951497': 1, '3997927': 1, '3988915': 1, '17657552': 1, '17304775': 1, '15734522': 1, '15972914': 1, '17727486': 1, '10629544': 1, '3604981': 1, '9477099': 1, '8253461': 1, '10954104': 1, '3588400': 1, '9001683': 1, '12913842': 1, '22464651': 2}
|
{'3777520-1': 2, '7210901-1': 1}
|
163,296 |
3778233-1
| 23,645,094 |
noncomm/PMC003xxxxxx/PMC3778233.xml
|
Leprosy in a rheumatology setting: a challenging mimic to expose
|
A 33-year-old nonsmoker male, a known case of Hansen’s disease (skin biopsy-proven borderline lepromatous) on supervised long-term treatment (prednisolone and clofazimine) since 4 years was referred to the rheumatology clinic with an acute onset of feeling cold in the index, middle, and ring finger of the left hand; since 1 month, he recalled episodic severe pain and burning sensation in the fingers. The patient did not have diabetes or any other relevant disease. Ten days later, he developed painful gangrene of the digital pulps of the index, middle, and ring finger of the left hand (Fig. ).\nOn examination, he also had atrophied, nodular, and healed ulcerative scars over the face, neck, and extremities with few scattered diffuse hypopigmented hypoesthetic lesions; ulnar and peroneal nerves were thickened. New skin lesions or any other systemic abnormality was absent. Detailed laboratory investigations showed normal erythrocyte sedimentation rate (ESR) with mild normocytic normochromic anemia, marginally raised C-reactive protein; seronegativity for RF, ANA, anti-CCP, and anticardiolipin antibodies; and seropositivity for isolated anti-ds DNA (ELISA) in low titer. Routine cardiac evaluation (including Doppler/echo) was normal, and peripheral blood flow Doppler studies suggested reduced distal arterial blood flow in the right arm. A right subclavian artery angiography was consistent with focal distal arteritis lesions. Other causes like cervical rib and proximal subclavian/arterial compressive lesions were excluded. A diagnosis of vasculitis was made and considered to be a likely complication of leprosy. A short course of tapering high dose of orally administered prednisolone (begun at 30 mg daily and 6 weeks later on 5 mg daily), orally administered hydroxychloroquine, and antiplatelet agents was added to ongoing anti-leprosy drugs. The patient showed steady recovery, and the affected digital pulps healed with scars and some loss of pulp substance.
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[[33.0, 'year']]
|
M
|
{'26233690': 1, '19208598': 1, '30022301': 1, '27186586': 1, '29141716': 1, '33767935': 2, '3909408': 1, '31117984': 2, '20496570': 1, '20374320': 1, '33849463': 1, '4078361': 1, '20842467': 1, '25580317': 2, '6416726': 1, '25412733': 1, '17434910': 1, '30024562': 2, '25431725': 2, '17077158': 1, '9458213': 1, '20724432': 1, '23645094': 2}
|
{'3778233-2': 2, '3778233-3': 2, '4280809-1': 1, '7983738-1': 1, '6086502-1': 1, '6530132-1': 1, '4238274-1': 1, '4238274-2': 1}
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163,297 |
3778233-2
| 23,645,094 |
noncomm/PMC003xxxxxx/PMC3778233.xml
|
Leprosy in a rheumatology setting: a challenging mimic to expose
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A 55-year-old male patient with chronic RA of 9 years in duration was well controlled (near remission) with long-term supervised administration of leflunomide and methotrexate. The patient developed acute urticaria-like rash on the neck, and upon consultation with the dermatologist, oral hydroxychloroquine and a short course of oral prednisolone were added. After a modest response, the patient developed erythematous papulonodular nontender itchy lesions (Fig. ) all over the body, but maximally over the lower trunk and abdomen along with polyarthralgias and severe painful right ankle swelling and a limping gait. The patient was afebrile and did not have any other systemic abnormality. Leflunomide was suspected to have caused the skin lesions and was stopped. Serum uric acid level was significantly elevated and allopurinol, prescribed. Orally given diclofenac was added for the symptomatic relief of arthritis but was discontinued (? hypersensitivity) because the skin lesions worsened (relapse of generalized urticaria lesions). The skin lesions were opined to be a drug-induced leucocytoclastic reaction/vasculitis; allopurinol was also stopped. A moderately high dose of orally given methyl prednisolone with a slow taper (over weeks) was started. A concurrent work-up was negative for ANA and other collagen vascular diseases. A week later, the patient had made little recovery, and a skin biopsy was carried out which demonstrated AFB and a histopathological picture consistent with a lepromatous reaction.\nThe patient was started on multidrug treatment (dapsone, rifampicin, clofazimine), and the patient responded clinically (bearable pain and mild limping) over 12 weeks or so. Oral weekly administration of 15 mg methotrexate, along with daily administration of 400 mg hydroxychloroquine and low-dose steroids (7.5–10 mg prednisolone), was continued. Moderate to severe polyarthritis continued, with elevated ESR, and hence, 2 g sulfasalazine and 100 mg minocycline were added. Few days later, the patient developed severe oral aphthous ulcers, requiring stoppage of methotrexate. The arthritis and skin lesions settled over almost 15 months of intense follow up. After a period of waxing and waning, the skin lesions of Hansen’s disease also subsided with diffusely scattered reddish brown macules.
|
[[55.0, 'year']]
|
M
|
{'26233690': 1, '19208598': 1, '30022301': 1, '27186586': 1, '29141716': 1, '33767935': 2, '3909408': 1, '31117984': 2, '20496570': 1, '20374320': 1, '33849463': 1, '4078361': 1, '20842467': 1, '25580317': 2, '6416726': 1, '25412733': 1, '17434910': 1, '30024562': 2, '25431725': 2, '17077158': 1, '9458213': 1, '20724432': 1, '23645094': 2}
|
{'3778233-1': 2, '3778233-3': 2, '4280809-1': 1, '7983738-1': 1, '6086502-1': 1, '6530132-1': 1, '4238274-1': 1, '4238274-2': 1}
|
163,298 |
3778233-3
| 23,645,094 |
noncomm/PMC003xxxxxx/PMC3778233.xml
|
Leprosy in a rheumatology setting: a challenging mimic to expose
|
A 52-year-old woman presented with painful rapidly progressive symmetrical polyarthritis of about 4 months in duration, without any extra-articular features, and was diagnosed with clinical RA. She was grossly limited in her daily activities and complained of prolonged morning stiffness. Other than symptomatic treatment, she also begun on oral daily administration of 10 mg leflunomide and 5 mg prednisolone. She was also on regular supervised medication for diabetes, hypertension, and epilepsy. On questioning, she recalled a history suggestive of suffering from leprosy (?polyneuritic) along with pulmonary tuberculosis several years ago and receiving prolonged therapy for about 18 months.\nTwo months later, she developed erythematous scaly macular rash on the back and lower limbs along with small ulcers on both soles. The arthritis was almost settled, and minimal tenderness elicited in the wrists and small joints of the hands. Her ankles and feet looked somewhat puffy. She complained of numbness and abnormal feeling in the feet and lower part of the legs. Neurological examination showed wasting of thigh muscles and hyperesthesia in the upper and lower limbs. She did not have any other systemic abnormality. Laboratory investigations showed a near normal hemogram with elevated CRP and seronegative for RF, ANA, and anti-CCP. Metabolic and hepatic parameters were normal, but renal functions were mildly deranged with elevated serum creatinine. Her serum uric acid was grossly elevated at 12.0 mg/dl (lab normal <7 mg/dl). X-ray of the hands showed juxta-articular osteoporosis and erosions typical of RA. Ultrasonography of the abdomen and pelvis showed mild hepatomegaly only. She was further investigated by a dermatologist who opined that the current complication was an activation of old leprosy in the form of probable lepra reaction, but a close differential of an adverse event due to leflunomide was also considered; skin clip was negative for AFB. The antiarthritis medication was changed to only symptomatic drugs, and anti-leprosy drugs were added and continued with low-dose orally given prednisolone. Six months later, she improved considerably with healed skin lesion, minimal numbness in the extremities, and absence of arthritis.
|
[[52.0, 'year']]
|
F
|
{'26233690': 1, '19208598': 1, '30022301': 1, '27186586': 1, '29141716': 1, '33767935': 2, '3909408': 1, '31117984': 2, '20496570': 1, '20374320': 1, '33849463': 1, '4078361': 1, '20842467': 1, '25580317': 2, '6416726': 1, '25412733': 1, '17434910': 1, '30024562': 2, '25431725': 2, '17077158': 1, '9458213': 1, '20724432': 1, '23645094': 2}
|
{'3778233-1': 2, '3778233-2': 2, '4280809-1': 1, '7983738-1': 1, '6086502-1': 1, '6530132-1': 1, '4238274-1': 1, '4238274-2': 1}
|
163,299 |
3778262-1
| 24,179,780 |
noncomm/PMC003xxxxxx/PMC3778262.xml
|
DTI detects water diffusion abnormalities in the thalamus that correlate with an extremity pain episode in a patient with multiple sclerosis
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In context of a pilot examination for a clinical trial study a 38-year-old female patient with early MS, diagnosed according to revised McDonald criteria (), was admitted for MRI at 10 different time points (average inter-scan interval = 25.6 days +/− 13.1 days SD, total interval = 230 days), after obtaining written informed consent. The background of the pilot study was to examine the reproducibility of DTI parameters on MS patients. The patient presented with a first relapse of sensory symptoms of the left body side in 2011 and was diagnosed with relapsing remitting multiple sclerosis (RRMS) in 2012 according to McDonald criteria. At that time she showed dissemination in space () and time in addition to oligoclonal bands, 6 lymphocytes/μl and intrathecal IgG production. This first relapse was contralateral (left) to the episode of central pain and sensory symptoms of the relapse described in the following. She was treated with immunomodulation (interferon ß 1a, once weekly i.m.) after the first relapse, and when she entered the series of DTI scans her expanded disability status scale (EDSS) was 2.0. Within the series of imaging scans she developed an episode of central pain and abnormal somatosensory and thermal sensations on the right hand side of her body. These symptoms occurred and disappeared simultaneously. Since this combination of symptoms developed over 2 days and remained for > 24 h we considered this episode as a relapse according to the international accepted definition of MS relapses. In addition, sensory symptoms and central pain very well responded to steroid therapy.
|
[[38.0, 'year']]
|
F
|
{'18155611': 1, '20947397': 1, '30118142': 1, '25610761': 1, '27864731': 1, '12507704': 1, '29984171': 1, '20660417': 1, '17475808': 1, '21423758': 1, '21393412': 1, '19359204': 1, '22441196': 1, '20145026': 1, '20685979': 1, '22548835': 1, '19525897': 1, '21820063': 1, '19394969': 1, '16139182': 1, '17875909': 1, '21720932': 1, '21387374': 1, '21613600': 1, '26030676': 1, '24776739': 1, '16365731': 1, '19192042': 1, '29038922': 1, '22872165': 1, '17507803': 1, '19064879': 1, '10925179': 1, '26920497': 1, '20724544': 1, '19369608': 1, '16043456': 1, '18329297': 1, '22679481': 1, '32532336': 1, '17566765': 1, '20574966': 1, '25161898': 1, '24179780': 2}
|
{}
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