patient_id
int64 0
167k
| patient_uid
stringlengths 8
10
| PMID
int64 1.34M
35M
| file_path
stringlengths 31
35
| title
stringlengths 7
377
| patient
stringlengths 55
95.4k
| age
stringlengths 14
33
| gender
stringclasses 2
values | relevant_articles
stringlengths 15
20.5k
| similar_patients
stringlengths 2
1.26k
|
|---|---|---|---|---|---|---|---|---|---|
163,400 |
3782589-1
| 24,082,781 |
noncomm/PMC003xxxxxx/PMC3782589.xml
|
Surgical Removal of Retained Subfoveal Perfluorocarbon Liquid through a Therapeutic Macular Hole with Intravitreal PFCL Injection and Gas Tamponade
|
A 67-year-old woman with loss of visual acuity in the left eye for 2 days was referred to our hospital. Best-corrected visual acuity (BCVA) in the left eye was hand motion. Fundus examination revealed a supero-temporal bullous macula-off retinal detachment with one peripheral retinal tear at the 3-o'clock direction. The patient underwent 23-gauge pars plana vitrectomy assisted by PFCL (perfluoro-n-octane; Alcon, Fort Worth, TX, USA) injection, laser treatment around the retinal tear and peripheral lattice degeneration, and PFCL-air exchange, followed by silicone oil injection. Two days later, subfoveal PFCL retention was noticed by funduscopy and optical coherence tomography (OCT) (). It is of note that the retina overlying the PFCL was extremely thin.
|
[[67.0, 'year']]
|
F
|
{'9524033': 1, '31502089': 1, '31044190': 2, '15076967': 1, '8486306': 1, '15289141': 1, '8619762': 1, '30249835': 1, '18195225': 1, '19029164': 1, '15492629': 1, '31660120': 2, '29118509': 2, '14707843': 1, '26469237': 1, '29270483': 1, '33116938': 2, '24082781': 2}
|
{'3782589-2': 2, '7548865-1': 1, '6446436-1': 1, '6815333-1': 1, '6815333-2': 1, '5657176-1': 1}
|
163,401 |
3782589-2
| 24,082,781 |
noncomm/PMC003xxxxxx/PMC3782589.xml
|
Surgical Removal of Retained Subfoveal Perfluorocarbon Liquid through a Therapeutic Macular Hole with Intravitreal PFCL Injection and Gas Tamponade
|
A 66-year-old woman with recurred rhegmatogenous retinal detachment of the right eye was referred to our hospital. The patient had a one-month history of scleral buckling, cataract operation, and pars plana vitrectomy with intravitreal gas injection in the right eye. Visual acuity of the right eye was limited to 20 / 200. A fundus examination revealed inferotemporal retinal detachment with multiple peripheral retinal tears at 10 o'clock complicated by proliferative vitreoretinopathy. She underwent two additional vitrectomies using PFCL, and reattachment of retina was achieved. Three months after the last surgery, however, a subfoveal PFCL bubble was found by funduscopy and OCT (), and visual acuity of the right eye was limited to 20 / 1,000.
|
[[66.0, 'year']]
|
F
|
{'9524033': 1, '31502089': 1, '31044190': 2, '15076967': 1, '8486306': 1, '15289141': 1, '8619762': 1, '30249835': 1, '18195225': 1, '19029164': 1, '15492629': 1, '31660120': 2, '29118509': 2, '14707843': 1, '26469237': 1, '29270483': 1, '33116938': 2, '24082781': 2}
|
{'3782589-1': 2, '7548865-1': 1, '6446436-1': 1, '6815333-1': 1, '6815333-2': 1, '5657176-1': 1}
|
163,402 |
3782679-1
| 24,073,322 |
noncomm/PMC003xxxxxx/PMC3782679.xml
|
Immunoglobulin G4-Related Disease Mimicking Unresectable Gallbladder Cancer
|
A 59-year-old man was referred to our emergency room with jaundice and right upper abdominal discomfort for 1 month. He complained of nausea, fatigue, loss of appetite, and yellowish discoloration of the skin. However, he did not complain of chilling sense and his body temperature was within normal limit.\nLaboratory data were as follows (values in parentheses indicate normal range): white blood cell count 7,780/mm3 (range, 4,000 to 10,000/mm3), hemoglobin 14.3 g/dL (range, 13 to 17 g/dL), hematocrit 40.1% (range, 39% to 52%), platelet count 233,000/mm3 (range, 130,000 to 400,000/mm3), asparatate aminotransferase 80 IU/L (range, 0 to 40 IU/L), alanine aminotransferase 138 IU/L (range, 0 to 40 IU/L), alkaline phosphatase 402 IU/L (range, 30 to 115 IU/L), total bilirubin 6.0 mg/dL (range, 0.2 to 1.2 mg/dL), direct bilirubin 5.0 mg/dL (range, 0 to 0.5 mg/dL), amylase 55 U/L (range, 30 to 100 U/L), lipase 60 U/L (range, 23 to 300 U/L), total protein 8.0 g/dL (range, 6 to 8 g/dL), albumin 4.3 g/dL (range, 3.3 to 5.2 g/dL), hepatitis B surface antigen negative, hepatitis B surface antibody negative, and urine bilirubin 3 positive (negative). The serum levels of carcinoembryonic antigen and α-fetoprotein were within normal limits; however, carbohydrate antigen 19-9 was 90 U/mL (range, 0 to 37 U/mL).\nAbdominal computed tomography (CT) revealed an infiltrative low density mass involving the neck portion of GB and adjacent hepatic parenchyma along with multiple radio-opaque gallstones in the fundus and neck portion (). However, there were not any abnormalities in pancreas and other organs on abdominal CT scan. As there was contiguous soft tissue infiltration involving the right and common hepatic artery, right and main portal vein, it was initially interpreted as unresectable GB cancer. The mass showed mild enhancement in the arterial phase and further delayed enhancement. In addition, there was diffuse symmetrical wall thickening of the extrahepatic bile duct and cystic duct. Magnetic resonance cholangiopancreatography (MRCP) revealed short segmental stricture at the proximal common hepatic duct with upstream bile duct dilatation (). Under the impression of GB cancer with direct hepatic invasion, ultrasonography-guided 18-gauge core needle biopsy was done at the hypoechoic lesion at S5 of the liver adjacent to the thickened wall of GB for pathologic confirmation. Histologic examination showed no malignant cells but only moderate periportal fibrosis with portal inflammation. In order to differentiate IgG4-related disease, we performed additional laboratory tests for autoimmune disorders as follows (values in parentheses indicate normal range): antinuclear antibody was negative: IgG 1,280 mg/dL (range, 700 to 1,700 mg/dL), IgA 381 mg/dL (range, 90 to 400 mg/dL), IgM 71.7 mg/dL (range, 45 to 230 mg/dL), IgG subtype IV 75 mg/dL (range, 6 to 121 mg/dL). Since the serum concentrations of autoimmune markers including the IgG4 were within normal range, the possibility of IgG4-RD was considered to be low. On our multidiscipline team conference this case was concluded as inoperable GB cancer. Therefore, biliary self expandable metal stent was inserted to treat the obstructive jaundice. After that, we took the biopsy once more in order to confirm the pathology. The microscopic examination of the second GB bed biopsy revealed diffuse lymphoplasmacytic infiltration and dense fibrosis (). Obliterative phlebitis and infiltration of some eosinophils were also found (). On immunohistochemical stain, the number of the IgG4+ plasma cells was counted up to 30/high power field (). Based on the characteristic findings of pathology, CT, and MRCP, the final diagnosis was IgG4-RD involving bile duct (SC), GB (cholecystitis), and hepatic parenchyma (inflammatory pseudotumor). And oral prednisolone therapy was started at a dose of 40 mg/day. After 4 weeks treatment it was tapered at 7 days interval with 5 mg dose. After total 11 weeks steroid treatment, it was stopped. And the symptoms had completely resolved without any complications. Abdominal dynamic CT after 4 weeks steroid treatment showed resolution of the hepatic mass lesion and decreased degree of GB wall thickening (). And the resolution state was maintained on follow-up abdominal CT after 11 months. The patient has been closely followed for 13 months in terms of recurrence and stent-related long-term complications, such as recurrent stone formation or stent obstruction due to epithelial hyperplasia.
|
[[59.0, 'year']]
|
M
|
{'26943444': 2, '22580936': 1, '19829899': 2, '32838747': 2, '18701557': 1, '12796582': 1, '22218969': 1, '22316447': 1, '18418862': 1, '14614606': 1, '27484098': 1, '18609677': 1, '15316319': 1, '34441293': 1, '18222442': 1, '30593191': 2, '21881964': 1, '25802499': 2, '17571078': 1, '21894477': 1, '24073322': 2}
|
{'4668245-1': 1, '4357679-1': 1, '2740269-1': 1, '7446048-1': 1, '6314772-1': 1}
|
163,403 |
3782680-1
| 24,073,323 |
noncomm/PMC003xxxxxx/PMC3782680.xml
|
Unusual Multiorgan Immunoglobulin G4 (IgG4) Inflammation: Autoimmune Pancreatitis, Mikulicz Syndrome, and IgG4 Mastitis
|
A 58-year-old woman was referred to our institution for nonspecific dyspepsia. She had been medically followed for several years for recurring mastitis of unclear etiology.\nMedical history was significant for thyroiditis diagnosed in 1976. For the last 3 years, she was followed by the Department of Ophthalmology, University Hospital Brno for histologically verified Mikulicz syndrome. Subsequently, salivary function was also tested, but only nonsignificant decrease in function was revealed.\nIn 2006, the patient noticed right-sided submandibular induration; extirpation was carried out for suspected malignancy which was ruled out by histological findings of a fibrotised salivary gland.\nIn 2009, she was examined by the oncology department for recurring mastitis; biopsy findings showed IgG4 infiltrates ( and ). A gastroenterology consult was then recommended for the patient's dyspepsia.\nBased on the patient's prior medical history, AIP was strongly suspected; therefore, serum immunoglobulin levels were tested. Total IgG was elevated (29.77 g/L; normal range, 7 to 16 g/L); IgG4 was more than 3-times the normal limit (920 mg/L; normal range, 8 to 140 mg/L) and rheumatoid factor and antipancreatic duct antibodies also tested positive. According to Japanese criteria, the findings indicated AIP with synchronous IgG4 mastitis and Mikulicz syndrome.\nAbdominal sonography and computed tomography revealed the typical picture of AIP-an enlarged sausage-like pancreas. The steroid treatment led to a normalization of sonographic finding ( and ).\nFurther endosonography confirmed a diffusely enlarged pancreas with rough, unclear outlines, and a small caliber duct.\nThe patient was treated with prednisone at an initial dose of 40 mg for 2 weeks. The dose was then tapered by 5 mg with a maintenance dose of 10 mg of prednisone prescribed for 3 months.\nThe patient has been followed for 1 year after completion of steroid treatment and she is symptoms free with normalized biochemical and sonographic findings. Additionally, the mastitis did not recur during the 12 months period.
|
[[58.0, 'year']]
|
F
|
{'17520222': 1, '27279578': 1, '17229877': 1, '14687846': 1, '32235676': 1, '14614606': 1, '28735232': 1, '18415756': 1, '19384187': 1, '17228127': 1, '16327291': 1, '17702660': 1, '18155707': 1, '16932997': 1, '16866659': 1, '13746542': 1, '18600383': 1, '19496802': 1, '30147902': 1, '19727085': 1, '19345283': 1, '17063091': 1, '2050373': 1, '15883477': 1, '19568232': 1, '17122509': 1, '18762470': 1, '16409315': 1, '7628283': 1, '19240063': 1, '24073323': 2}
|
{}
|
163,404 |
3783503-1
| 24,072,963 |
noncomm/PMC003xxxxxx/PMC3783503.xml
|
A case of orbital sebaceous gland carcinoma developing in an anophthalmic socket 65 years after enucleation
|
A 68-year-old woman presented in the Department of Ophthalmology of Tokyo University with swelling and non-bloody discharge in her right eyelid, which had developed over several months. The right eye had been enucleated at the age of three years old, due to congenital glaucoma. She did not undergo orbital implant surgery at that time. Apart from the enucleation, the patient had an unremarkable medical history, and no family history of malignancy. She had worn the original ocular prosthesis for more than 60 years without maintenance. Since one year before presentation, the patient noticed increasing difficulty in wearing the prosthesis.\nOn examination, a firm mass was palpable beneath the right upper and lower eyelids. Cilia were present in both upper and lower right eyelids. Gadolinium-enhanced magnetic resonance imaging revealed a contrast enhanced mass measuring 38 mm × 33 mm × 36 mm in the right orbit (). A clinical work-up for systemic disease, including complete blood cell count, chemistry panel, liver enzyme panel and imaging of the chest, was negative. There was no regional lymphadenopathy, and gallium scintigraphy revealed no systemic metastasis. A histopathologic examination of transcutaneous excisional biopsies of the mass revealed lobular aggregates of atypical basaloid cells, separated by fibrovascular stroma, and an inflammatory infiltration. The atypical cells had abundant clear multi-vacuolated cytoplasm, and oval nuclei with discernible nucleoli (). Tumor cells were immunoreactive for adipophilin and perilipin, which are useful markers for sebaceous gland carcinoma (). Esentreration of the right orbit was planned by performing multiple map biopsies, including the upper and lower eyelid skin, tarsus, orbicular muscle and skin, and deep tissues below the eyebrow. Within a month, the patient underwent orbital exenteration to excise the entire mass. The tumor had well defined margins and was enclosed by a capsule (). No spread to other sites were observed. Histopathologic examination of the excised tumor demonstrated a poorly differentiated sebaceous gland carcinoma with negative margins. The eye socket was reconstructed using a free rectus abdominal muscle flap and mucosal graft. The patient recovered well, and was able to wear a prosthesis after surgery. There was no evidence of recurrence of metastasis ten months after orbital exenteration.
|
[[68.0, 'year']]
|
F
|
{'12187415': 1, '18773280': 1, '5582833': 1, '11210789': 1, '18705767': 1, '7369322': 1, '14746603': 1, '15749305': 1, '18356712': 1, '22117887': 1, '20090491': 1, '9513243': 1, '16855506': 1, '24072963': 2}
|
{}
|
163,405 |
3783666-1
| 24,083,149 |
noncomm/PMC003xxxxxx/PMC3783666.xml
|
Non Peutz-Jegher syndrome associated malignant sex cord stromal tumor with annular tubules
|
A 32-year-old multiparous lady was admitted for abdominal pain. On pelvic examination, a mass separate from the uterus was felt in the fornices. Ultrasonography showed a well-defined, thickwalled, lobulated, cystic ovarian mass with irregular septae measuring 17 × 16 × 6 cm. As the findings were suggestive of malignant ovarian tumor, she underwent panhysterectomy. Uterus, cervix, and left adnexa were unremarkable. The right ovary was cystic and measured 21 × 18 × 5 cm with a smooth external surface. The cut surface was multiloculated, filled with hemorrhagical fluid with focal solid areas []. Microscopically, the cervix showed diffuse laminar endocervical hyperplasia. No adenoma malignum or mucinous metaplasia of endometrial or tubal epithelium was seen. Right ovary was replaced by a solid, cystic tumor composed of round to oval granulosa cells with vesicular nuclei and an occasional nuclear groove. Cytoplasm was moderate to scant and eosinophilic. Cells were arranged in sheets, nests, micro follicular, macro follicular, and insular pattern []. Simple and complex tubules encircling nodules of hyalinised PAS-positive basement membrane-like material were seen [Figures and ]. Nuclei showed antipodal arrangement with focal sertoliform pattern []. Luteinisation was evident in areas. The adjacent ovarian stroma showed invasion by the tumor and lymphatic emboli []. A diagnosis of malignant SCTAT was rendered after confirmation by immunohistochemistry (IHC) for inhibin and calretinin.
|
[[32.0, 'year']]
|
F
|
{'1732773': 1, '31966699': 1, '28101370': 2, '25886261': 1, '8428688': 1, '7104978': 1, '7522202': 1, '5429475': 1, '33715493': 1, '15863154': 1, '10786816': 1, '24083149': 2}
|
{'5242372-1': 1}
|
163,406 |
3783667-1
| 24,083,150 |
noncomm/PMC003xxxxxx/PMC3783667.xml
|
Giant chondroid syringoma with divergent differentiation: Cyto-histo-immuno correlation
|
A 50-year-old male presented with painless, progressively enlarging swelling over the lower back since 3 years. Examination revealed a firm non-tender swelling measuring 12 × 8 × 5 cm. Surface showed two nodules, largest measuring 6 × 5 × 4 cm and smallest 1.5 × 1 cm []. Aspiration yielded thick, mucoid, and gelatinous material.\nSmears showed cells arranged in loose cohesive clusters and in discretes, amidst which was chondromyxoid material []. Cells were round to oval, centrally located nuclei having fine chromatin with moderate to abundant cytoplasm, a few showed one to two prominent nucleoli [] consistent with chondroid syringoma.\nReceived a skin covered soft tissue mass which measured 14 × 9.5 × 4 cm. Skin measured 12.5 × 8.5 cm. External surface showed two nodules, largest measured 6 × 5 ×4 cm and smallest 1.5 × 1 cm. Cut surface revealed a lobulated mass showing grey white myxoid areas [].\nRevealed a well-demarcated neoplasm composed of round to oval cells arranged in sheets, tubuloalveolar, and branching cleft-like pattern. Tumor showed bands of eosinophilic material along with fibromyxoid stroma and chondroid areas. Areas showing lipomatous and clear cell changes [], cartilage [], osteoid bone formation [], and foci of calcification [] were also observed.\nThe tumor cells arranged in tubuloalveolar pattern showed expression of IHC markers. The inner layer of epithelial cells were positive for pancytokeratin (AE1 + AE2) [] and the outer layers expressed vimentin (V9) []. Mouse monoclonal antibodies manufactured by Biogenix were used for our study.
|
[[50.0, 'year']]
|
M
|
{'9504667': 1, '9138118': 1, '9822789': 1, '2556458': 1, '15335266': 1, '19693940': 1, '2456654': 1, '15739085': 1, '16638382': 1, '12930345': 1, '13907712': 1, '2848409': 1, '18301822': 1, '8187595': 1, '31118727': 2, '13905736': 1, '6096423': 1, '24083150': 2}
|
{'6497915-1': 1}
|
163,407 |
3783686-1
| 24,082,513 |
noncomm/PMC003xxxxxx/PMC3783686.xml
|
An Unusual Case of Refractory Metabolic Acidosis
|
A 25-year-old young male was brought to emergency department with history of headache, pain in abdomen, vomiting, difficulty in breathing, and multiple episodes of generalized tonic-clonic seizures, followed by loss of consciousness since last 10 h. There was no history of fever or head injury. He was chronic alcoholic and non-smoker. On examination, his general condition was low (E1M3 V1), he was tachypneic, his skin was cold and clammy, peripheral pulses were not palpable, and blood pressure was not recordable. Pupils were normal in size, not reacting to light and bilateral planter response was non-elicitable. Auscultation of chest revealed bilateral coarse crepitations. Rest of the examination was within normal limits. Arterial blood gas (ABG) analysis showed pH – 6.8, pCO2 – 23 mmHg, pO2 – 61 mmHg, plasma bicarbonate – 5 mmol/l, chloride – 96 mmol/l, serum lactate – 2.7 mmol/l, serum osmolality – 360 mmol/l, serum Na+ – 151meq/L, serum K+ – 4.6 meq/L and random blood sugar – 87 mg/dl. The patient was intubated and put on ventilatory support with 100% oxygen, intravenous fluids, dopamine, and noradrenaline infusion. Intravenous phenytoin loading was done for seizures.\nInvestigations revealed hemoglobin-12.9 gm%, total leukocyte count-14800/cumm, differential leukocyte count-P62 L38, platelet count-2.34 lacs/cumm, blood urea-86 mg/dL, and serum creatinine-2.6 mg/dL. Urine examination was normal. Liver function test showed SGOT-675IU/L, SGPT-437IU/L, and normal serum bilirubin. Calculated osmolality was 336 mmol/L suggestive of high anion gap metabolic acidosis with high osmolar gap. X-ray chest showed bilateral infiltrates in basal lung fields. Computed tomography (CT) of head showed necrosis in bilateral basal ganglia suggestive of alcoholic intoxication. In view of CT findings, history of alcohol intake was reviewed in detail. Patient attendees denied any usage of alcohol in last 10 days because of family restrictions that he was imposed. They also gave a history of consumption of some homeopathic preparation for the cough for last 5 days and he was taking it in excess to normal prescription. No other medicine was being given to the patient. Attendants were asked to bring the homeopathic medicine and it was Causticum Hah having 90% alcohol by vol/vol []. Patient had taken three bottles (1350 mL) of homeopathic medicine in last 5 days out of which about 450 mL (one bottle) was consumed in 2-3 h. The patient was managed on the lines of alcohol intoxication with dextrose containing fluids, intravenous thiamine, bicarbonate infusion, and intravenous broad spectrum antibiotics. Blood ethanol level of the patient was not done because this facility is currently not available in our institution and patient's attendant refused to get it done from outside laboratory due to financial constraints. The repeated ABG analysis showed persistent acidosis with low serum bicarbonate. There was no improvement in blood pressure and general condition of the patient. The patient died on 3rd day of the admission.
|
[[25.0, 'year']]
|
M
|
{'1469176': 1, '20175887': 1, '23029719': 1, '24082513': 2}
|
{}
|
163,408 |
3783687-1
| 24,082,514 |
noncomm/PMC003xxxxxx/PMC3783687.xml
|
A Rare Neurological Complication of Acute Organophosphorous Poisoning
|
A 30-year-old female patient ingested an unknown dose of Triazophos 40% (Hostathion) in a suicide attempt. As per the history revealed by her parents, she had consumed the above mentioned compound 8 h prior to hospitalization. At the time of admission to the ICU, the patient was drowsy with a Glasgow Coma Scale score of 10/15 and had bilateral pinpoint pupils reactive to light, blood pressure measured 140/70 mmHg. Her pseudocholinesterase level was 869 U/l (Normal: 4852-12000 U/l). depicts other laboratory parameters. She was treated with pralidoxime 24 g infusion over 48 h and atropine 120 mg infused over 4 days. Thereafter, the patient regained consciousness, but was immobile. On day 6, neurological examination revealed that the patient had coarse resting tremors with cog-wheel rigidity and signs of dyskinesia affecting both the upper and lower limbs, more predominant on the right side. Cerebral spinal fluid analysis following a lumbar puncture was normal. Magnetic resonance imaging (MRI) showed no focal abnormality in the brain parenchyma.\nThe patient's mobility did not improve despite complete recovery from respiratory and cardiovascular distress. It was noticed that even on the 10th day, she was unable to speak and turn around on the bed. In view of the above signs, a provisional diagnosis of OP-induced Parkinsonism was made. Treatment with tablet amantadine 100 mg/day thrice daily was started orally. After receiving therapy for a day, there was marked improvement in orientation, mobility, and speech. By the 4th day of amantadine treatment, cog-wheel rigidity, tremors, and bradykinesia improved. After 14 days of treatment with the same dose of amantidine, the patient recovered completely and the therapy was discontinued. She did not develop any adverse effects to amantidine. The patient was discharged on day 26 and subsequent follow-up revealed no signs of relapse.
|
[[30.0, 'year']]
|
F
|
{'21751614': 1, '11577800': 1, '26180430': 1, '15303389': 1, '21841947': 1, '10227636': 1, '10071118': 1, '16243228': 1, '25002781': 1, '7576821': 1, '21633583': 1, '11764185': 1, '24082514': 2}
|
{}
|
163,409 |
3783688-1
| 24,082,515 |
noncomm/PMC003xxxxxx/PMC3783688.xml
|
Intra-aural Route of Insecticide Poisoning
|
A 51-year-old housewife with no premorbid illness presented to the emergency department within 2 h of allegedly pouring monocrotophos (WHO Class Ib OP compound) into both her ears with the intention of deliberate self-harm after a family dispute. The daughter witnessed her pouring the OP compound into her ears as an impulsive act with no oral consumption. She had gastric cramps and loose stools with no other SLUDGE symptoms (SLUDGE–salivation, lacrimation, urination, defecation, gastric cramps and emesis). She also complained of burning sensation in both the ears. On examination she was drowsy, restless, and disoriented to time, place, and person. Her heart rate was 100/min, blood pressure was 100/70 mmHg, respiratory rate was 22/min, and pupil size was 2 mm bilaterally. She did not have neck muscle weakness or fasciculations. Examination of the ears did not reveal any sign of local inflammation, and bilateral tympanic membrane appeared intact. Rest of the systemic examination was unremarkable. Plasma butyrylcholinesterase level was 1141 U/L (reference range 3000-8000 U/L), thus confirming OP poisoning. Multiple aural irrigations with normal saline were performed to decrease further absorption of monocrotophos. Bolus doses of atropine were given to maintain the heart rate above 100/min. A low-dose atropine infusion was administered for 2 days and the patient was monitored in the ward for 5 days. She did not develop intermediate syndrome and was subsequently discharged after psychiatry counseling.
|
[[51.0, 'year']]
|
F
|
{'3350449': 1, '9192209': 1, '26250476': 1, '9204101': 1, '15020723': 1, '24082515': 2}
|
{}
|
163,410 |
3783707-1
| 24,082,448 |
noncomm/PMC003xxxxxx/PMC3783707.xml
|
Pyelo-hepatic abscess caused by renal calculi: A rare complication
|
A 25-year-old lady presented to the urological emergency with complaint of episodes of dull aching colicky pain in the right lumbar region for the past 1 year, which had increased in severity and become continuous for the past 2 weeks. Pain was associated with fever, chills, nausea, and anorexia. She also reported weakness and malaise, but did not give any history of urinary or bowel complaints. Physical examination revealed a pulse rate of 104/min, low blood pressure of 104/60 mm of Hg, respiratory rate of 22/min, and a temperature of 101°F. There was tenderness in the right hypochondrium and the right renal angle, but no visible fullness. Keeping a differential diagnosis of gall stone disease and pyonephrosis, an urgent ultrasound examination was done which showed grade III dilatation of the right kidney with internal echoes and multiple calculi, largest of size 18 mm, located in the pelvis. The liver showed a hypoechoic lesion of 10 × 10.2 cm in the right lobe. A breach in the renal capsule was demonstrated, communicating with the lesion in the liver. Laboratory investigations revealed marked leukocytosis, severe anemia (5.5 g/dl), mildly deranged renal function (blood urea 60 mg/dl, serum creatinine 1.6 mg/dl) and coagulopathy (International Normalised Ratio 1.63). Based on a working diagnosis of pyonephrosis with liver abscess with septicemia, the patient was resuscitated with fluids and given intravenous antibiotics and blood transfusion. Dehydration and coagulopathy were corrected and a contrast-enhanced computed tomography (CT) was obtained, revealing a hypodense peripherally enhancing lesion with air in the right lobe of the liver communicating with the upper calyx of the hydronephrotic right kidney with multiple calculi []. The function of the left kidney was normal as evident by normal contrast excretion. Right pleural effusion with consolidation of the right lower lobe of the lung was also seen. The patient's condition improved on antibiotics, and right DJ stenting was performed along with an ultrasound-guided drainage of 800 ml pus from the right lobe of the liver. Culture of both urine and pus grew Escherichia coli, sensitive to amikacin. She responded well to treatment and was discharged with a plan for right Percutaneous Nephrolithotomy after 6 weeks. On subsequent follow-up visits, ultrasonography showed minimal abscess in the liver.
|
[[25.0, 'year']]
|
F
|
{'9091559': 1, '29692514': 2, '7445311': 1, '18649927': 1, '3962022': 1, '21486444': 2, '1450841': 1, '6326541': 1, '1000895': 1, '8311522': 1, '24082448': 2}
|
{'3087700-1': 1, '5894293-1': 1}
|
163,411 |
3783708-1
| 24,082,449 |
noncomm/PMC003xxxxxx/PMC3783708.xml
|
Spontaneous closure of urethrovaginal fistula associated with pelvic fracture
|
A 45-year-old female sustained pelvic fracture with urethral injury due to a road traffic accident. Initial resuscitation, orthopedic management with internal fixation of the pubic bone, and suprapubic urinary diversion were done elsewhere. Suprapubic catheter was removed after 3 weeks. She was leaking urine from the vagina after the removal of the suprapubic catheter. She consulted us after 3 months of the initial injury with history of continuous leakage of the urine per vaginum. On pelvic examination, urine was seen emanating from the vagina and a scar was felt in the proximal vagina. Cystogram demonstrated the urethrovaginal fistula []. She was advised to get admitted for further management but she refused. She came after 15 days with acute urinary retention and cessation of the urinary leak per vaginum. Initial suprapubic urinary diversion was done followed by examination under anesthesia. Dense fibrosis with scarring was felt in the proximal vagina. On filling the bladder with methylene blue through the suprapubic catheter, no leak was demonstrable through the vagina. Retrograde urethrocystoscopy was not possible due to complete urethral obliteration. Antegrade cystoscopy revealed normal bladder wall along with complete obstruction and scarring at the level of bladder neck. A Mitrofanoff procedure was performed using the tapered ileal segment as intraoperatively, the appendix was found to be very short. She was discharged in satisfactory condition and is doing well till the last follow-up.
|
[[45.0, 'year']]
|
F
|
{'11342950': 1, '10604377': 1, '23174242': 1, '31619862': 1, '1729508': 1, '17036168': 1, '24082449': 2}
|
{}
|
163,412 |
3783709-1
| 24,082,450 |
noncomm/PMC003xxxxxx/PMC3783709.xml
|
Pleomorphic undifferentiated sarcoma of urinary bladder with calcified pulmonary metastasis: A rare entity
|
A 29-year-old male presented with history of hematuria, dysuria, and bilateral flank pain of 2 months duration. He had undergone right ureteroscopy and double J stent (DJ stent) insertion for right ureteric calculus and bladder biopsy for bladder tumor 1 month earlier at another hospital (operative details not available). Bladder biopsy had revealed necrotic material. He had also undergone an open cysto-lithotomy 20 years earlier, i.e., at the age of nine years. He was of a low socio-economic status from a rural background, hailing from North Karnataka, where primary bladder calculus is still common. The patient did not give history of recurrent urolithiasis. So he was asymptomatic for the last 20 years.\nGeneral and systemic examinations were unremarkable. Per-rectal examination revealed a hard, nodular, bimanually palpable mass felt just above the prostate. Computerized tomography showed a heterogeneously enhancing mass with calcification, involving bladder base and lateral walls (70 mm × 52 mm) with bilateral hydro-ureteronephrosis (left < right) with right DJ stent in situ [] and with calcified pulmonary metastases [].\nCystoscopy revealed broad-based solid tumor, with necrotic material on the surface, occupying almost the whole of the urinary bladder except for the anterior wall and bladder dome. Both ureteric orifices were not seen. The lower end of the right DJ stent was almost completely engulfed by the tumor. The stent was seen just peeping out of the bladder mass on the right side and the right ureteric orifice could not be visualized inspite of the presence of the DJ stent. Transurethral resection of a part of the tumor was performed. The biopsy was reported as sarcomatoid variant of urothelial carcinoma with heterologous (osteosarcoma) differentiation []. Immunohistochemistry [] supports the diagnosis of undifferentiated pleomorphic sarcoma with osteoid formation.\nBone scan showed focal radio tracer concentration in the chest not conforming to any rib. Single-photon emission computed tomography showed uptake in lung parenchyma representing metastatic pulmonary lesions.\nThe patient was explained about the disease and the need for multimodality treatment. He refused any form of treatment and succumbed to his disease 3 months later.
|
[[29.0, 'year']]
|
M
|
{'21766082': 1, '21266796': 1, '20470701': 1, '33733296': 1, '10529668': 1, '7055656': 1, '22074680': 2, '24082450': 2}
|
{'3222691-1': 1}
|
163,413 |
3783711-1
| 24,082,452 |
noncomm/PMC003xxxxxx/PMC3783711.xml
|
Chylolymphatic cyst of the greater omentum presenting as abdominoscrotal swelling in a child
|
A 5-year-old male child presented with left scrotal swelling and abdominal distension. His mother had noted a painless left scrotal swelling since birth and it was gradually increasing in size. She also noticed increasing abdominal girth for approximately 2 years. There was no history of trauma. Growth and development were otherwise normal, as were his appetite and feeding habits. Bowel and micturition habits were also normal. The family history was unremarkable. The patient was not on any medication and had no known allergy. On examination, his abdomen was hugely distended. A soft, cystic lump was palpable involving left and central part of the abdomen. Shifting dullness was absent. The scrotum was hugely enlarged and right testis could be felt separately from the swelling but not the left testis. It was not possible to get above the swelling on the left side. The swelling was oblong in shape, cystic, irreducible, and nontranslucent. Cross fluctuation with abdominal lump was absent.\nRoutine blood tests were within normal limits. An ultrasound examination was performed, and it showed septated ascites and left hydrocele. Contrast Enhanched Computed Tomography showed huge septated cystic lesion [] filling whole of the left and central part of the abdominal cavity pushing away the bowel anteriorly and posteriorly. The scrotal and abdominal swellings communicated in the left inguinal region. Both the testes were visible in the scrotum. With these clinical and imaging findings, a provisional diagnosis of abdominoscrotal lymphatic cyst was made.\nThe patient underwent laparotomy through an oblique left lower abdominal incision. Initially, the retroperitoneal space was explored. As we could not see the swelling, the peritoneum was opened to find a huge, soft cystic lesion [] arising from the greater omentum was identified. The cyst was opened and drained thin hemorrhagic fluid. It was multilocular and the lower pole of the cyst was seen going inside the left internal inguinal ring. With slight traction, the part of the cystic swelling lying in the scrotum could be delivered. Approximately, 900 mL of fluid was drained. The cyst was excised completely along with adjacent omentum. The internal inguinal ring was closed with a purse string suture. A drain was placed in the peritoneal cavity and the abdomen was closed in layers. Postoperative period was uneventful. The abdominal drain was removed on the 2nd postoperative day and he was discharged on the 3rd postoperative day. Histopathological examination of the cyst demonstrated features of chylolymphatic cyst [].
|
[[5.0, 'year']]
|
M
|
{'27307861': 1, '11071410': 1, '15714155': 1, '9036901': 1, '19128491': 2, '21204665': 1, '11827194': 1, '11105431': 1, '6732494': 1, '8434287': 1, '24082452': 2}
|
{'2628642-1': 1}
|
163,414 |
3783712-1
| 24,082,453 |
noncomm/PMC003xxxxxx/PMC3783712.xml
|
A giant ureteric calculus
|
A 35-year-old lady presented with complaints of episodic pain in the right lumbar region for 1 year. Previously she was treated and the symptom subsided. On evaluation found to have large calculus in the right lower ureter causing severe proximal Hydroureteronephrosis and her physical examination was unremarkable. An X-ray of the kidney-ureter-bladder region showed a long slender calculus in the right lower ureter []. Her renal function was normal. Intravenous urography revealed good excretion of contrast from the left kidney, but no excretion was observed on the right side. Tc99 DTPA renal scan revealed right kidney has less function as compared to the left kidney.\nShe underwent laparoscopic right ureterolithotomy with removal of a giant ureteric calculus, 11 cm in longitudinal and 1.5 cm in transverse length []. The stone weighed 40 g. Post-operatively she recovered well and discharged and she remained well in follow-up.
|
[[35.0, 'year']]
|
F
|
{'33145021': 1, '15539842': 1, '30858733': 2, '10746407': 1, '1512840': 1, '12544292': 1, '24082453': 2}
|
{'6385762-1': 1}
|
163,415 |
3783716-1
| 24,082,927 |
noncomm/PMC003xxxxxx/PMC3783716.xml
|
Volume increase in craniopharyngiomas under growth hormone and/or sex hormones substitution: Role of tumors receptors or mere coincidence?
|
A young woman, aged 22, was referred to our department for a large craniopharyngioma. She was diagnosed at 12 years of age (in 2001), when she was noted to have severe short stature (−4 SD compared to children of the same age). At that time cerebral CT scan showed a totally calcified intra- and suprasellar mass measuring 45 × 17 × 15 mm suggesting a craniopharyngioma or a pituitary stone with thyreotroph,somatotroph and gonadotroph deficiencies. The vision was normal. As the pituitary lesion was totally calcified no intervention was performed. She was treated with Levothyroxine and had regular radiological monitoring by Magnetic Resonance Imaging (MRI). At 15 years old, as the tumor was stable, biosynthetic GH was prescribed. One year later GH was stopped because brain MRI revealed a solid, cystic and calcified tumor with discrete increase in its size. After stopping GH, the tumor remained stable, but pubertal development was lacking. At 17 years old, estrogens were introduced because of an important psychological impact of her hypogonadism. But, 4 months later, there was a rapid increase of the craniopharyngioma [] with intracranial hypertension that required a ventricular-peritoneal shunt.
|
[[22.0, 'year']]
|
F
|
{'21636786': 1, '21175094': 1, '11134091': 1, '19142625': 1, '10890179': 1, '22319039': 1, '20197669': 1, '22702213': 1, '15965669': 1, '20647974': 1, '7885545': 1, '15936368': 1, '26640612': 1, '22776798': 1, '20529601': 1, '9402587': 1, '15807869': 1, '22385801': 1, '16649976': 1, '24082927': 2}
|
{'3783716-2': 2}
|
163,416 |
3783716-2
| 24,082,927 |
noncomm/PMC003xxxxxx/PMC3783716.xml
|
Volume increase in craniopharyngiomas under growth hormone and/or sex hormones substitution: Role of tumors receptors or mere coincidence?
|
A young woman aged 21 was referred for complication of her craniopharyngioma, which was diagnosed at 11 years old when she consulted for severe short stature with excessive weight gain and headaches. An isolated growth hormone deficiency was diagnosed, and then she received hormone replacement without any radiological exploration!\nAfter 1 year the headaches worsened. The MRI revealed a pituitary lesion measuring 30 mm in height with solid, cystic, and calcified components pleading for a craniopharyngioma reaching the chiasmatic area. At the age of 12, the neurosurgery was done, and then a panhypopituitarism was diagnosed. She was treated with glucocorticoids and thyroid hormones. Then, she was lost in sight before radiological exploration.\nTwo years later, visual acuity decreased and the MRI revealed a 27 × 18 mm tumor (residual or recurrence?) with tri-ventricular hydrocephalus needing surgery.\nAt the age of 18, as her residual tumor seemed stable, she received estrogens for her hypogonadism. After 8 months, intracranial hypertension with impaired consciousness appeared, and then she was operated on for the third time [].
|
[[11.0, 'year']]
|
F
|
{'21636786': 1, '21175094': 1, '11134091': 1, '19142625': 1, '10890179': 1, '22319039': 1, '20197669': 1, '22702213': 1, '15965669': 1, '20647974': 1, '7885545': 1, '15936368': 1, '26640612': 1, '22776798': 1, '20529601': 1, '9402587': 1, '15807869': 1, '22385801': 1, '16649976': 1, '24082927': 2}
|
{'3783716-1': 2}
|
163,417 |
3783717-1
| 24,082,928 |
noncomm/PMC003xxxxxx/PMC3783717.xml
|
Atypical juvenile neuronal ceroid lipofuscinosis: A report of three cases
|
A 9-year-old Pakistani boy born to non-consanguineous parents with a normal perinatal period and early development and at 4 years, he began to show regression in motor and cognitive skills. He was unsteady and needed support, when walking at 6 and became wheelchair bound at 7 years. His speech was very slow and slurred but he had good hearing. He developed progressive visual loss and was unable to follow a bright red object at 7½ years. Interestingly, he hallucinated seeing spiders. He developed seizures, which were well controlled with valproate. Ophthalmological examination revealed dystrophic appearance of retina, attenuation of retinal vessels with a pale disc.\nSerial cranial magnetic resonance imaging (MRI) showed diffuse white matter hyperintensity in T2-weighted but not in FLAIR at 5½ years and subsequently, cerebral and cerebellar atrophy at 7½ years. Electroencephalogram (EEG) showed bilateral synchronous generalized epileptiform discharges. Electroretinogram (ERG) was absent and visual evoked potential (VEP) was normal. Palmitoyl protein thioesterase (PPT) and tripeptidyl peptidase I (TPP 1) enzyme activities were within normal range. Skin and muscle biopsy for inclusion bodies were negative and blood film showed no vacuolated lymphocytes. However, ultra structural examination of lymphocytes showed rare, membrane bound, condensed storage material with fingerprint profiles. CLN5 gene mutation was positive.\nAt last follow-up at 11 years, he was wheelchair bound but could walk with support, had severe visual impairment and slow and slurred speech. He was totally dependent for all his daily activities.
|
[[9.0, 'year']]
|
M
|
{'8837098': 1, '33377563': 1, '9492089': 1, '9535296': 1, '3146324': 1, '26141065': 2, '28468312': 1, '7020325': 1, '33792748': 1, '8216547': 1, '34331747': 1, '17679671': 1, '30919163': 1, '16759889': 1, '24082928': 2}
|
{'3783717-2': 2, '3783717-3': 2, '4491254-1': 1}
|
163,418 |
3783717-2
| 24,082,928 |
noncomm/PMC003xxxxxx/PMC3783717.xml
|
Atypical juvenile neuronal ceroid lipofuscinosis: A report of three cases
|
He was the 6-year-old brother of case 1 and his early developments were normal except for speech. He babbled at 5 months, copied noises at 8 months and only spoke with recognizable word at 2 year 7 months (his brother spoke at 18 months). He was more independent and active than his brother. He would play football (his eldest brother never ran or jumped) with other children and his expressive language had never been clear and had difficulty putting words together and had developed stammer. He was slow to learn and at 4 years, he began to have cognitive and motor regression.\nCranial MRI findings were very similar to that demonstrated on his brother's scan. At last follow-up (8 years), he had drooling saliva, he was wheel chair bound with deterioration in his speech, cognition, motor skills, and fully dependent for his needs. His visual acuity (VA) was 6/18 in each eye with normal fundi. He had developed seizures, which were controlled by valproate.
|
[[6.0, 'year']]
|
M
|
{'8837098': 1, '33377563': 1, '9492089': 1, '9535296': 1, '3146324': 1, '26141065': 2, '28468312': 1, '7020325': 1, '33792748': 1, '8216547': 1, '34331747': 1, '17679671': 1, '30919163': 1, '16759889': 1, '24082928': 2}
|
{'3783717-1': 2, '3783717-3': 2, '4491254-1': 1}
|
163,419 |
3783717-3
| 24,082,928 |
noncomm/PMC003xxxxxx/PMC3783717.xml
|
Atypical juvenile neuronal ceroid lipofuscinosis: A report of three cases
|
An 11-year-10-month-old Caucasian boy with normal perinatal and neurodevelopmental history was referred to us with 3-year history of progressive visual loss and visual hallucinations. His symptoms started with difficulty in reading, worsening handwriting, and flashes of lights in both eyes (BE). He gave us a description and consistently drew figures, which he appeared to be seeing in front of his eyes. The figures had a red border with circles and lines criss-crossing the circles.\nThe VA at first presentation was 6/60 in BE when he was 10 years. At last follow-up at 13, VA was 6/60 in right eye (RE) and 3/60 in left eye (LE). He was able to detect colours but could not read any letters. Visual field did not show specific defect. Optic disc and neurological examinations were unremarkable at last follow-up.\nVEP of BE were delayed while ERG was normal at 12 years. MRI and EEG were normal. Blood film showed no lymphocyte vacuolation. However, electron microscopy (EM) of buffy coat showed rare, membrane bound, electron dense, granular material associated with a lipid droplet in the cytoplasm of lymphocytes. PPT activity was low measuring 2.2 nmol/hr/mg protein and normal TPP-I. Molecular genetic analysis of exon 1-9 of CLN1 gene showed that he was heterozygote for p.Cys96Tyr and p.Arg151X mutations.\nA diagnosis of milder form of INCL (CLN1) was made. At his last neurology follow-up at 13 years, his vision remained poor. He had developed behavioral and cognitive problems. He had not developed seizures or motor difficulties.
|
[[10.0, 'month']]
|
M
|
{'8837098': 1, '33377563': 1, '9492089': 1, '9535296': 1, '3146324': 1, '26141065': 2, '28468312': 1, '7020325': 1, '33792748': 1, '8216547': 1, '34331747': 1, '17679671': 1, '30919163': 1, '16759889': 1, '24082928': 2}
|
{'3783717-1': 2, '3783717-2': 2, '4491254-1': 1}
|
163,420 |
3783718-1
| 24,082,929 |
noncomm/PMC003xxxxxx/PMC3783718.xml
|
Pediatric anti-N methyl D aspartate receptor encephalitis
|
A 13-years-old girl presented with recurrent episodes of new onset seizures. Semiology consisted of sudden onset of repetitive eye blinks with loss of contact with surroundings and facial twitching towards right side and dystonic posturing of upper limbs, lasting for one to two minutes, followed by post-ictal confusion. Some of the episodes were associated with secondary generalization. Child was born by normal full term vaginal delivery, and developmental milestones had been attained normally. There was no history of febrile seizures or any other CNS insult in past. Besides, no history of fever, abnormal behavior or altered sensorium was forthcoming. After the first seizure, levetiracetam 500 mg per day had been started by a pediatrician. However, seizures continued to recur at a frequency of almost an episode every other day, despite subsequent escalation of levetiracetam dose to 750 mg per day and the addition of second anti-epileptic, i.e. carbamazepine at the dose of 600 mg per day. About 10 days after the onset of seizures, parents noticed language abnormalities in the form of progressively decreasing word output. MRI Brain was unremarkable, except for a well-defined cystic extra-axial lesion along anteromedial aspect of left temporal lobe measuring 4.2 by 2.7 cm, with no contrast enhancement, suggestive of left temporal arachnoid cyst []. MRV of brain was normal. Interictal EEG done twice in 10 days revealed mild left temporal focal slowing and amplitude attenuation, possibly related to underlying arachnoid cyst. Neither awake nor sleep record revealed any abnormal epileptiform activity. Neurosurgical consultation was sought at this stage for further evaluation as to whether the arachnoid cyst could be epileptogenic and whether its surgical removal would be curative.\nExamination at this stage revealed a conscious patient with severe non-fluent aphasia with preserved comprehension. In view of short history, unrelenting seizures and rapidly progressive language deficits, possibilities of infectious (viral) encephalitis, immune encephalitis, and acquired epileptiform aphasic disorder (Landau Kleiffner Syndrome) were considered. Repeat MRI brain revealed interval development of few FLAIR hyperintensities in left temporal region []. CSF examination revealed mild lymphocytic pleocytosis (10 cells per high power field) with normal glucose and protein levels. CSF viral markers (for herpes simplex virus, Lyme, enterovirus, cytomegalovirus, and Epstein Barr virus), VDRL, gram stain, AFB stain, India ink, cryptococcal antigen and bacterial, mycobacterial, and fungal cultures were negative while immune markers i.e. anti-VGKC antibody, anti-NMDA antibody, and anti-GAD antibody were yet awaited. Levetiracetam was further hiked upto 1500 mg per day, carbamazepine was continued in the same dose, and empiric intravenous acyclovir 10 mg/kg body weight thrice a day were started. Over the next few days, the language deficits progressed further to global aphasia. Besides, patient developed orolingual dyskinesias as well as facial action myoclonus precipitated by attempted speech, smile or attempt to show her teeth. Moreover, relentless seizures continued to occur, despite further increase in anti-epileptics to 3000 mg levetiracetam, 1200 mg carbamazepine, and 20 mg clobazam per day. Twenty-four hour video EEG recording was done, which revealed 6 to 8 hertz background with intermittent left temporal slowing and frequent epileptiform activity arising from left mid-temporal leads with two instances of secondary generalization corresponding to clinical seizures, besides frequent facial jerks and oro-lingual movements with no EEG correlate. Sleep EEG did not show continuous slow waves and spikes. At this stage, despite the results of CSF immune markers not yet being available, it was thought prudent to treat the patient as immune encephalitis in view of the clinical evolution of the disease. Intravenous immunoglobulins were started in the dose of 0.4 g/kg/day for 5 days. A gratifying clinical response was achieved, with remission of the seizures within 3 days after starting IVIG. Language deficits too began to show gradual but definite improvement within the next few days. Meanwhile, two weeks after initiation of IVIG, anti-NMDA receptor antibody in CSF was reported positive, thus confirming it as a case of anti-NMDA receptor antibody-associated immune encephalitis. Pelvic ultrasonography and magnetic resonance imaging did not reveal any ovarian teratoma or any other neoplasm. Patient was discharged in a significantly improved state and currently remains on follow up with steadily resolving symptoms. The anti-epileptic drugs are being tapered, with no recurrence of seizures. Comprehension deficits of language have completely resolved while residual mild non-fluent aphasia is resolving. Likewise, extra pyramidal dyskinesias have fully resolved while facial myoclonus has become relatively very infrequent.
|
[[13.0, 'year']]
|
F
|
{'20016378': 1, '17262855': 1, '20739825': 1, '21045695': 1, '21163445': 1, '22109736': 1, '22028524': 1, '27606032': 1, '17898324': 1, '24082929': 2}
|
{}
|
163,421 |
3783719-1
| 24,082,930 |
noncomm/PMC003xxxxxx/PMC3783719.xml
|
Opercular syndrome: A case report and review
|
A 9-year-old male presented with unclear and slurred speech, drooling of saliva and inability to protrude tongue and difficulty swallowing since early childhood. He was born with emergency caesarean section (due to fetal distress) and birth weight was 2.5 kg. He developed seizures at 6 hours of life due to perinatal asphyxia, for which he was admitted in neonatal intensive care unit for a week. He had motor and cognitive delay with involvement of speech domain greater than social and motor domain. At the age of 6 years; he developed seizures which were brief, tonic-clonic, involving right side of body with loss of consciousness. Seizures were poorly controlled on multiple anti-epileptic drugs regimen consisting of sodium valproate, lamotrigine, and clobazam. He had no history of trauma, surgery. Family history was not significant.\nHe had dysarthria with nasal twang in voice, mouth half open and not able to close volitionally. He was unable to bring out the tongue beyond lower incisor. Hearing and understanding were normal. There was no tongue tie or any structural defect of tongue. Bilateral trigemino-facio-linguo-pharyngeal palsy was noticed on volitional control but automatic and emotional motor movements were well preserved. He was able to blink, close his eyes completely while sleeping, and move the jaw and facial muscles with spontaneous emotional responses like laughing or crying. There was no wasting or fasciculations of the tongue. There was hypertonia in all four limbs and deep tendon reflexes were exaggerated with normal jaw jerk along with extensor bilateral plantars. Electroencephalography (EEG) findings consisted of focal left fronto-temporal epileptiform discharges and magnetic resonance imaging (MRI) brain revealed bilateral fronto-temporal and parietal cortical and subcortical region encephalomalacia, with involvement of opercular region []. Induced sleep EEG did not reveal any continuous spike and wave discharges as seen in Continuous Spike and Wave discharges in Sleep (CSWS) or Landau-Kleffner syndrome (LKS).\nBased on above clinical findings, a diagnosis of acquired bilateral opercular syndrome due to perinatal asphyxia was considered.
|
[[9.0, 'year']]
|
M
|
{'10698330': 1, '8094839': 1, '27648177': 1, '34744670': 1, '31359986': 2, '34840879': 1, '11568407': 1, '17352959': 1, '24082930': 2}
|
{'6592203-1': 1}
|
163,422 |
3783720-1
| 24,082,931 |
noncomm/PMC003xxxxxx/PMC3783720.xml
|
Arteriovenous malformation associated with cyst in a child: Case report and review of literature
|
An 8-year-old boy presented with history of generalized tonic clonic seizures for the last 2 years. There was no history of sudden onset headache or neurological deficits, suggestive of bleed. On examination, there were no focal neurological deficits. An MRI was performed, which showed a nidus, seen as flow voids, in the medial parietal lobe on the right side with a large cystic area abutting it posteriorly. This was hyperintense on T2-weighted images and inverted completely on FLAIR images [Figure and ]. There was no evidence of hemorrhage on SWI (susceptibility-weighted images). A digital subtraction angiogram was subsequently performed, which showed the nidus was receiving arterial feeders from the pericallosal branches of the right anterior cerebral artery and draining into the superior sagittal sinus via cortical veins [Figure and ].\nVarious treatment options were discussed, and the patient was offered surgical excision of the AVM as the first choice. He underwent a parietal craniotomy and excision of the AVM. The AVM nidus and the draining vein was seen on the surface, and below that, there was a large cyst containing about 30 mL of clear fluid. The appearance of the fluid was like that of CSF. The AVM was completely excised, and the cyst was drained. Histological examination of the nidus showed abnormal arterial and venous channels, and the cyst wall had numerous thin-walled vascular channels containing hemosiderin in the fibrous tissue.\nA post-operative angiogram was done on post-operative day two, which showed complete excision of the nidus [Figure and ]. His post-operative stay in the hospital was uneventful, and was discharged on the third post-operative day. At 6-month follow-up, patient is neurologically normal, and is seizure-free on a single anti-epileptic drug.
|
[[8.0, 'year']]
|
M
|
{'30069104': 1, '8321405': 1, '17905064': 1, '3973731': 1, '2711901': 1, '25383642': 1, '7566381': 1, '24082931': 2}
|
{}
|
163,423 |
3783721-1
| 24,082,932 |
noncomm/PMC003xxxxxx/PMC3783721.xml
|
Primary occipital myxoma: A rare case report
|
A 12-year-old male had 2-month history of mild occipital headache which was unnoticed. Local hairdresser noticed a slight bulge in the occipital region while doing haircut. He reported this to the parents to seek medical advice. His MRI and CT brain showed evidence of a 5.3 × 4.6 × 4.9 cm expansile lytic sclerotic lesion arising from the right occipital bone showing prominent trabecular pattern. No significant soft tissue component or enhancement was seen. Anteriorly the lesion was causing significant indentation of the right cerebellar hemisphere. There was no edema but it was producing erosion of the right half of occipital bone extending up to C1 vertebra []. The diagnosis suggested was a malignant bone neoplasm (Ewing sarcoma) or intraosseus hemangioma. A craniotomy with near total excision of the mass was done leaving residual mass near the vertebral artery.\nMultiple small bony and soft tissue pieces with a slimy surface were submitted for histopathology. Sections after decalcification showed bone and tumor cells. Stellate cells with abundant myxoid matrix with few cells showing pleomorphic nuclei and few tumor giant cells were also seen. Histological diagnosis of fibromyxoid tumor [] was made and immunohistochemical markers were advised.\nOn immunohistochemistry the tumor cells expressed Vimentin []. They were immunonegative for SMA, Desmin, CD34, S-100, EMA, CK, CD31, and GFAP. The Mib-1 proliferation was <1%. Final diagnosis of myxoma with stromal atypia was made. 2D-echocardiography was done to search for primary but there was no mass lesion in the cardiac muscles. Postoperative radiotherapy for the residual lesion was started two weeks after wound healing and a total of 50.4 Gy in 28 fractions to tumor bed was given on linear accelerator. Mean dose to the brain stem was 1237 cGy. Post-radiotherapy CT Scan showed minimal edema and no residual disease [].
|
[[12.0, 'year']]
|
M
|
{'2215912': 1, '366086': 1, '15854102': 1, '17698701': 1, '3561744': 1, '18037039': 1, '17558455': 1, '10414581': 1, '24082932': 2}
|
{}
|
163,424 |
3783722-1
| 24,082,933 |
noncomm/PMC003xxxxxx/PMC3783722.xml
|
Ventriculo-peritoneal shunt: A rare cause of basal ganglia and thalamic abscess
|
An 18-month-old female child presented with fever, vomiting off and on for 2½ months and altered sensorium and seizure for 1 day at an outlying hospital.\nChild was operated at 25 days of life for cervical meningomyelocele and VP shunt was placed for hydrocephalus. Shunt revision was carried out at 1½ month of age for oozing from surgical site. At 6-month of age, VP shunt was seen protruding through anus, for which distal end of shunt was shortened surgically and shunt left in situ at the outlying hospital. No shunt revision was performed. Child remained well for next 1 year. At 18-month of age, child was referred to us with altered sensorium and Glasgow Coma Score of 8/15. Magnetic resonance imaging (MRI) revealed multiple abscesses in the left basal ganglia and one in thalamus which measured approximately 25 mm × 24 mm with midline shift of 11 mm [] and shunt was transversing through the trigone, quadrigeminal area into the thalamic area on the contra-lateral side. Investigation revealed high total leukocyte count (25700/mm3) with thrombocytosis (469 × 105), prothrombin time/international normalized ratio-20.1/1.99, Na+-123 mEq/L. Child was managed with mechanical ventilation, 3% saline, intravenous Meropenem (120 mg/kg/day q 8 h) and Vancomycin (60 mg/kg/day q 6 h) empirically. Hyponatremia was corrected gradually over next 48 h. VP shunt was removed and external ventricular drain (EVD) was placed in right ventricle for immediate decompression followed by stereotactic aspiration of abscess. Morganella morgagni, Klebsiella pneumonia, and Enterococcus faecalis were isolated from the pus and M. morgagni was isolated from blood. As per the sensitivity intravenous colistin (1.2 lakh IU/kg/day q 8 h) was added. EVD got dislocated and omaya reservoir was placed. Intravenous antibiotics were given for a total of 6 weeks and subsequently patient underwent VP shunt revision.
|
[[18.0, 'month']]
|
F
|
{'16230809': 1, '19701873': 1, '11453390': 1, '18581123': 1, '3808245': 1, '11825458': 1, '12845550': 1, '3329841': 1, '21320856': 1, '10555849': 1, '30101064': 1, '7505403': 1, '7942190': 1, '18663339': 1, '12134200': 1, '24082933': 2}
|
{}
|
163,425 |
3783723-1
| 24,082,934 |
noncomm/PMC003xxxxxx/PMC3783723.xml
|
Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes unveiled by valproate
|
A 12-year-old boy presented with headache, vomitings, and seizures of two weeks duration. The headaches were predominantly left-sided, severe, throbbing, associated with vomiting, lasting each time for 1-2 hours, and recurring 2-3 times in a day. There was no postural or diurnal variation of the headaches nor any associated fever, neck pain, visual symptoms, or focal neurological deficit. On second day of the onset of headache, he had three episodes of GTCS. He presented to us almost two weeks into the illness wherein the seizures did not recur, but the headache persisted. He was started on Sodium Valproate 400 mg/day, but within two days of starting treatment, he experienced worsening of headache, repeated bouts of vomiting, and recurrence of seizures. The child became very dull and lethargic. He also developed certain new symptoms in form of pain and weakness in lower limbs, with difficulty in getting up from squatting position, and requiring one person support for walking. There was no history of any difficulty in gripping or slippage of slippers, any weakness in upper limbs, sensory loss, limb incoordination, bladder bowel or cranial nerve involvement.\nHis general physical and systemic examination was unremarkable; in particular, there was no fever, jaundice, abdominal tenderness, or any organomegaly. The child was conscious, oriented to time, place and person but very lethargic and irritable. There were no signs of meningeal irritation. On motor system examination, muscle tone and nutrition was normal. There was tenderness over muscles of arms and thighs, and he did not allow formal testing of muscle power, though he was moving all limbs equally in bed. Deep tendon reflexes were normally elicitable, and planters were bilaterally flexors. Sensory examination was normal, and there were no cerebellar signs.\nHis routine investigations including hemogram, complete blood count, renal function tests, and serum electrolytes were normal. There was a worsening of liver functions as well as a rise in LDH and CPK levels after starting Valproate []. His serum lactate was 16.7 mg/dl (normal range 8-16 mg/dl). Viral markers including HIV, HBsAg, and anti-HCV all were all negative.\nHis X-ray chest, USG abdomen, 2D-Echo all were normal. MRI brain revealed an acute infarct in left occipito-temporal region and an old infarct in right occipito-temporal area [Figure -] with normal MR angiogram and MR venogram [Figure and ]. A possibility of valproate-induced myositis and hepatotoxicity were considered with probability of an underlying mitochondrial disorder, likely MELAS.\nValproate was stopped, and patient was loaded with intravenous Levetiracetam 1000 mg and continued on maintenance dose of 500 mg twice-daily. He started improving within 24 hours, became more active, pain and weakness in limbs decreased and abated completely over the next five days. There was no recurrence of seizures. The laboratory parameters also improved subsequently after stopping valproate [].\nMuscle biopsy from vastus lateralis revealed maintained fascicular architecture with minimal variation of fiber size. Intermyseal and perimyseal connective tissue was unremarkable. NADH and SDH stain revealed normal fiber typing and myofibrillar architecture. No ragged red fibers were identified on Gomori trichrome stain. After two weeks of hospital stay, he was discharged on Levetiracetam (500 mg twice-daily), CoQ10 (30 mg twice-daily), Levocarnitine 330 mg twice-daily), and cocktail of multivitamins (B complex including B1, B2, B12, folate, niacin, biotin, pyridoxine; vitamin A, vitamin C, along with iron, zinc, magnesium, chromium, selenium, L-methionine, L-arginine).
|
[[12.0, 'year']]
|
M
|
{'1422200': 1, '18705745': 1, '1549215': 1, '25777823': 1, '9243242': 1, '19722047': 1, '26823359': 1, '18392741': 1, '24700433': 1, '17226098': 1, '18626887': 1, '30214424': 2, '26356090': 1, '25565645': 1, '25149403': 1, '10959815': 1, '24082934': 2}
|
{'6125373-1': 1}
|
163,426 |
3783724-1
| 24,082,935 |
noncomm/PMC003xxxxxx/PMC3783724.xml
|
Phenotypic heterogeneity in skeletal muscle sodium channelopathies: A case report and literature review
|
A 14-year-old Asian boy presented to pediatric neurology with 4-year history of episodes of muscle stiffness and weakness in lower limbs, occurring following sitting (resting) for nearly 1 h after exercise. The muscle stiffness episode would improve following shaking of legs (“warm-up effect”). There was no history of difficulty in climbing stairs or running.\nHe was born at term vaginally to unrelated parents. There was no history of decreased fetal movements or polyhydramnios. He did not require active resuscitation at birth and weighed 3.4 kg. There was no history of feeding or breathing difficulties in the neonatal period, and his weaning period was uneventful. He had normal developmental milestones.\nFamily history was remarkable for his father having episodes of muscle stiffness; however, no specific diagnosis was assigned.\nPhysical examination did not reveal dysmorphism or neurocutaneous stigmata. His growth parameters were within normal limits. Gait was normal and Gower sign was negative. There was no evidence of calf muscle hypertrophy or limb weakness (proximal or distal). Tone, power, and deep tendon reflexes were normal in all the four limbs. Creatine kinase (CK) was elevated at 1024 IU/L (25-200). Electromyography (EMG) revealed myopathic changes []. There was evidence of muscle membrane irritability with myotonia, which was highly suggestive of a myotonic disorder. As a result, it was decided to arrange for short exercise testing as part of the myotonia protocol. At room temperature there was mild post-exercise potentiation for about half a minute, followed by recovery toward normal. Cold exposure produced reduction in muscle action potential amplitude to about 50% accompanied by severe clinical weakness. It also exposed a post-exercise drop in amplitude with slight recovery, and a subsequent progressive further decrease in the action potential with serial exercises [], which was consistent with features of paramyotonia congenita (PC) (Fournier pattern I). At this point the history and EMG suggested a myotonic disorder, and consequently the long exercise tests were not carried out. Molecular genetic testing was negative for myotonic dystrophy and MC (CLCN1). Further testing detected a heterozygous pathogenic mutation c. 2111C > T; p.Thr704Met in the coding regions (c. 2020-2376) and (c. 4571-4838) of sodium channel type IV α subunit (SCN4A).
|
[[14.0, 'year']]
|
M
|
{'16786525': 1, '1851726': 1, '20237798': 1, '11309455': 1, '15534250': 1, '19540760': 1, '19917643': 1, '15389891': 1, '24082935': 2}
|
{}
|
163,427 |
3783726-1
| 24,082,937 |
noncomm/PMC003xxxxxx/PMC3783726.xml
|
Relapsing Devic's disease in a child
|
A previously healthy 10-year-old girl was admitted to our department for sudden loss of vision in her left eye. The best corrected visual acuity (BCVA) was counting fingers in the left eye and 1.0 (Snellen Chart) in the right eye. Fundoscopy revealed left optic disk swelling. Brain magnetic resonance imaging (MRI) was normal. Two months later acute severe visual acuity loss occured in her right eye combined with quadriparesis. Ophthalmic examination revealed bilateral impaired pupil response. Her BCVA was counting fingers in both eyes. Biomicroscopic examination was normal. Fundus examination showed right optic disc swelling with left optic atrophy []. On fluorescein angiography that was performed at the onset of her right eye's symptoms, a leakage was seen at the late phase of her right eye []. On systemic examination, her blood pressure was 90/65 mmHg, pulse rate 85/min, and axillary body temperature 36.7°C. Neurological examination revealed weakness of both upper and lower limbs. A bilateral positive babinski sign was noted. Other cranial nerves and cognitive functions were normal. Laboratory work-up revealed normal hematocrit, white blood cell counts, platelets, and erythrocyte sedimentation rate. Analysis of cerebrospinal fluid (CSF) revealed a clear colour, protein 44 mg/dl, and sugar 79.4 mg/dl. Oligoclonal bands were positive. Visual evoked potential (VEP) study showed prolongation of P100 latency and amplitude loss in both eyes []. Electroretinogram was normal. MRI revealed abnormalities of spinal cord signal and longitudinal syringomyelia cavity from bulbus to thoracal 9 with hypointensity in T1-weighted images and hyperintensity in T2-weighted images along the spinal cord as a result of longitudinally extensive myelitis []. The cerebral region was normal at the onset [-upper images]. But 3 months later a demyelination plaque was seen in the left posterior frontal lobe [-lower images]. NMO-specific serum autoantibody against the water channel aquaporin-4 (Aqp4) was positive. Mitochondrial G3460A, G11778A, T14484C mutations were negative and proper distinction of NMO from Leber's hereditary optic neuropathy was done. A diagnosis of Devic's disease was made and the patient was treated initially with intravenous methyl prednisolone (650 mg/day for six days) followed by gradually tapered oral steroids. One month later 2 mg/kg/day azathioprine was added. Pulse methyl prednisolone therapy was repeated three times totally but clinical outcome was not favorable with significant bilateral optic atrophy [].
|
[[10.0, 'year']]
|
F
|
{'22487568': 1, '16687534': 1, '22859697': 1, '17706564': 1, '16717206': 1, '19415287': 1, '21300379': 1, '18325300': 1, '14760945': 1, '22084126': 1, '24082937': 2}
|
{}
|
163,428 |
3783727-1
| 24,082,938 |
noncomm/PMC003xxxxxx/PMC3783727.xml
|
Acute longitudinal myelitis as the first presentation in child with systemic lupus erythematosus
|
A 13-year-old Polish girl, previously fit and well, presented with history of pain in the left leg for 2 weeks progressing to bilateral weakness of legs and sensory loss. She was febrile for 2 days prior to admission. She had constipation and urinary retention. There was no history of trauma, recent vaccination, cough, skin rash, joints pain, oral ulcers, or any other clinical symptoms or signs suggestive of SLE.\nOn admission to hospital she was afebrile with normal vital observations and blood pressure. Examination of her cardiovascular and respiratory system was unremarkable. Abdominal examination revealed distended abdomen as a result of constipation and urinary retention. Neurological examination suggested normal cranial nerve examination with no bulbar palsy. The motor power in the lower limb at presentation was 3/5 MRC with areflexia. The motor power was 5/5 MRC in the upper limbs with brisk tendon reflexes. There was sensory loss from T4 below. In the next 24-48 h the motor weakness increased with complete weakness in the lower limbs and power deteriorating to 3/5 in the upper limbs. She was diagnosed with acute longitudinal myelitis and started on intravenous-pulsed methylprednisolone for 5 days followed by oral prednisolone in tapering doses.\nBlood results at presentation showed normal biochemistry but elevated CRP of 42 mg/L.(normal range 0-10 mg/L) The complete blood count was normal except for low lymphocytes of 0.77 × 109/L. MRI spine [] showed multi-focal multi-regional transverse myelitis involving spinal cord from C5 down to the conus. Extensive investigations were carried to identify the underlying cause. Cerebrospinal fluid (CSF) showed elevated white cell count (WCC) of 1570 × 106/L with predominant polymorphs and elevated protein of 0.78 g/L. All the cultures including blood, CSF, and urine were reported as no growth. The virology screen was negative including Lyme's serology. Anti nuclear antibodies (ANA) was positive with the titres being 1: 1600 and showing a speckled pattern. At this point pediatric rheumatology opinion was sought to rule out an auto-immune condition or a connective tissue disease leading to transverse myelitis. Rheumatology evaluation did not reveal any other signs suggestive of SLE or any other connective tissue disease. She did not satisfy the Americal College of Rheumatology (ACR) criteria for diagnosis of SLE.\nA further auto-antibody screen revealed significantly elevated double-stranded DNA antibody 355 iu/mL. Anti-Sm antibody, anti-U1 antibody, and anti-RNP70 antibody were positive. C3 and C4 were low. Immunoglobulin profile showed elevated IgG and IgM levels. Cardiolipin antibody and lupus anticoagulant were negative. Aquaporin IgG antibody was negative.\nThe lab markers were suggestive of SLE but with no convincing clinical features to correlate. She was transferred to local tertiary pediatric rheumatology unit. Based on the overall clinical picture and immunology markers, she was commenced on IV cyclophosphamide which was continued for seven cycles. She also underwent three cycles of plasmapheresis as treatment for SLE with ATM. After completion of IV cyclophosphamide cycles, she was commenced on azathioprine, oral prednisolone 10 mg once daily along with hydroxychloroquine. Initially, she needed subcutaneous enoxaparin therapy which was changed to Aspirin once she started mobilizing.\nShe had neuro rehabilitation in the form of intensive physiotherapy, support from the occupational therapy. She received botox injection in the lower limbs for her spasticity. Over the following few months she made significant recovery. Her repeat MRI of spine [] done 16 months later has shown complete resolution of the inflammatory changes. She was able to walk with the use of crutches to move around and uses wheel chair only for long distances. She self-catheterizes her bladder and has normal bowel movements with intermittent need for Movicol. She has normal motor power in the upper limbs and she has normal sensations both in upper and lower limbs. She has re-integrated back at her normal mainstream school. After 18 months of treatment with immunosuppressants and oral steroids, she has not developed any other clinical features of SLE.
|
[[13.0, 'year']]
|
F
|
{'14770030': 1, '18240179': 1, '12435571': 1, '10666167': 1, '10464567': 1, '19022478': 1, '14760797': 1, '3264603': 1, '7655499': 1, '24082938': 2}
|
{}
|
163,429 |
3783729-1
| 24,082,940 |
noncomm/PMC003xxxxxx/PMC3783729.xml
|
Spinal extradural inclusion dermoid cyst mimicking pseudomeningocele, appearing after 17 years of meningomyelocele repair
|
A 17-year-old boy who underwent lumbar meningomyelocele repair at the age of 2 months presented in the outpatient clinic with a progressive globular swelling in the lower half of the back and weakness of left foot for the past 6 months. No history of any alteration in the bladder and bowel habits. On examination a globular cystic mass of 8 cm × 8 cm size was noted at L3, L4 region sitting in the middle of previous MMC repair scar. It is poorly transilluminant and cough impulse was absent. Neurological examination was unremarkable except for weakness of the left foot dorsiflexors, having 4/5 power.\nMagnetic resonance imaging (MRI) LS spine showed a fluid filled globular swelling hypointense on T1 and iso to hyperintense on T2 extending from L3 to L5 [Figures and ]. Axial T2 images show a doubtful communication with the thecal sac at L4/5 level []. Urodynamic flow studies didn’t reveal any abnormality.\nA diagnosis of pseudomeningocele was made and excision of the sac with repair of the dural defect was planned. Intra operatively there was clear plane of cleavage present between the cyst and the skin and subcutaneous tissue. Small portion of the placode was seen pouting out of the thecal sac. The placode is adherent by thick connective tissue layer with the wall of the cyst []. There was no communication between the cyst and the thecal sac. The cyst was removed intact from the placode. Cyst opening revealed a mud colored highly viscous fluid []. Dura was opened and protruding portion of the placode was internalized. Patients’ neurological status remained the same as that of preoperative period at the time of discharge. At 1 year follow-up patient had complete improvement in the left foot weakness. Rest of the neurological examination was unremarkable.
|
[[17.0, 'year']]
|
M
|
{'5937643': 1, '12140301': 1, '10199258': 1, '3772475': 1, '2601815': 1, '14469387': 1, '24082940': 2}
|
{}
|
163,430 |
3783730-1
| 24,082,941 |
noncomm/PMC003xxxxxx/PMC3783730.xml
|
Pediatric sciatic neuropathy presenting as painful leg: A case report and review of literature
|
A 7-year-old girl with a background of early onset childhood asthma presented with an acute exacerbation of her asthma symptoms. Apart from regular low dose inhaled steroids, she was not on any other medications. Both her past medical and family histories are not significant.\nHer respiratory status gradually deteriorated despite being on intravenous salbutamol, aminophylline, and steroids. She needed intubation and mechanical ventilation for just over 24 hours after which she was successfully extubated and was recovering well.\nFive days later, she reported a burning pain sensation down the whole of the right leg with some sensory disturbance, which she mainly described as “numbness”. A week later, this was followed by weakness of that leg. There was no history of trauma preceding this. Upon clinical assessment, she was noted to have a foot drop with complete inability of ankle dorsiflexion and her right ankle jerk was completely absent.\nShe was only able to mobilize by hopping on her left leg. There was diffuse decreased sensation to pinprick and light touch but mainly from below the right knee to the toes. The rest of the clinical examination was normal.\nExtensive investigations showed a moderate eosinophilia at 1.35 × 109/L (normal range 0.05-1.0) with normal other blood counts and peripheral smear. Her eosinophilia gradually normalized in about 6 weeks. She had a normal full blood count checked prior to this admission. Concomitant with this, the IgE level was also raised at 391 KU/L (normal < 63). Her mycoplasma antibody (genetic prodrug activation therapy-GPAT) level was slightly elevated but this was thought to be of no clinical significance. The throat swab and the Anti-streptolysin O (ASO) titres did no show any evidence of a recent streptococcal infection. Moreover, polymerase chain reaction (PCR) testing for the common respiratory viruses was negative except for rhinovirus. Her auto-antibody screen including Anti-Nuclear Antibody-Hep 2, Centromere antibody, Monoclonal IgA, IgM, and IgG and subclasses, Rheumatoid factor antibody, were normal. Urine and stool culture were negative and the screening for parasites was negative in stool and blood.\nMRI demonstrated enlarged and high signal right sciatic nerve on T2-weighted images. This is seen as far down the nerve in the posterior mid thigh as imaged [Figures and ].\nNeurophysiology examination [] was limited as she was in extreme pain. The study showed features of right sciatic mononeuropathy probably axonal in nature. The peroneal part of the sciatic nerve was more involved. Electromyography could not be performed at the request of mother; therefore, exact site of pathology was difficult to localize.\nInitially, the patient did have daily exacerbations of severe neuropathic pain, which was quite disabling. The pain only responded partially to trials with multiple agents including gabapentin, opiates, and carbamazepine. Fortunately, the pain started to improve after a few weeks and this was also associated with marked improvement of her muscle power. She continued to make good progress and was able to independently mobilize within 5-6 months. A year later, the patient had made a complete motor recovery, although she is left with an area of abnormal sensation affecting the lateral border of her right leg and the dorsum of her foot.
|
[[7.0, 'year']]
|
F
|
{'33747694': 1, '2174666': 1, '7715627': 1, '2850315': 1, '3785282': 1, '1563451': 1, '1090795': 1, '8107705': 1, '18658074': 1, '1313550': 1, '1323757': 1, '11170938': 1, '15589447': 1, '2991872': 1, '21403109': 1, '34214785': 1, '10094252': 1, '24082941': 2}
|
{}
|
163,431 |
3783731-1
| 24,082,942 |
noncomm/PMC003xxxxxx/PMC3783731.xml
|
Extradural hematoma surgery in a child with Hutchinson–Gilford progeria syndrome: Perioperative concerns
|
A 7-year-old male child, known case of HGPS since 1 year of age, developed a right parietal extradural hematoma following a minor fall while playing. He presented with headache and nausea, was conscious but confused, and had no sensory-motor deficit. An emergency craniotomy and hematoma evacuation were planned. Pre-operative evaluation revealed a history of slow growth, progressively appearing features of ageing, normal intellectual development, and recurrent chest infections. The patient had typical manifestations of HGPS-like, a small thin built (height ~95 cm, weight ~11 kg), pinched nose with small nares, depressed nasal bridge, dry stretched-out skin, prominent veins, alopecia, sunken eyes without eyebrows and eyelashes, small pigeon-shaped chest, overall stiff joints, few missing teeth, a 2.5 cm inter-incisor gap, and normal mentation []. The presence of a disproportionately large head, mandibular hypoplasia, micrognathia, and class-3 Mallampati airway score was suggestive of a difficult airway in him. There was no evidence of cardiac, respiratory, or other systemic illness, and all relevant investigations including echocardiography were normal. Before the start of anesthesia, a well-equipped intubation cart and facilities for emergency tracheostomy were readied in anticipation of a difficult tracheal intubation; pediatric fibreoptic bronchoscope was not available to us. Direct laryngoscopy under deep inhalational anesthesia in the spontaneously breathing patient revealed a high, anterior larynx with non-visible glottic opening. After three attempts that utilized various intubation-facilitating maneuvres, it was possible to secure the airway with a small-sized (4.5 mm), uncuffed endotracheal tube with the help of an intubating stylet. The patient's remaining intra-operative course was uneventful; gentle patient positioning and handling during surgery and maintenance of hemodynamic stability were ensured. The child had an unremarkable post-operative period and subsequent hospital stay.
|
[[7.0, 'year']]
|
M
|
{'11359600': 1, '12541091': 1, '11696128': 1, '11305689': 1, '22701223': 1, '11485857': 1, '20150858': 1, '10722246': 1, '24082942': 2}
|
{}
|
163,432 |
3783732-1
| 24,082,943 |
noncomm/PMC003xxxxxx/PMC3783732.xml
|
Subcutaneous metastasis in medulloblastoma: A case report and review of literature
|
This 9-year-old boy presented with a history of gait ataxia for 1 month, and headache, vomiting and progressive drowsiness for 20 days. Computed tomography (CT) scan and magnetic resonance imaging (MRI) brain showed the presence of a midline posterior fossa mass with small punctate calcification and heterogeneous enhancement, causing obstructive hydrocephalus. Due to his poor sensorium, the child underwent an urgent right ventriculo-peritoneal shunt. Following this, he underwent midline suboccipital craniectomy, C1 posterior arch excision and gross total decompression of tumor. Post-operative imaging showed complete excision of the tumor. He was referred to an Oncology Center, where he was treated with cranio-spinal irradiation, along with chemotherapy. At 1 year follow-up, patient was doing well apart from mild gait ataxia, and a cranio-spinal MRI did not show any evidence of residual disease. However, CT scan done 27 months after surgery, showed a 5 mm × 15 mm enhancing lesion on left cerebellar hemisphere extending through left foramen of Luschka. Patient was advised excision of the tumor, followed by further adjuvant therapy, however he was lost to follow-up after that. After 4 years of primary surgery, patient presented with a swelling in right masseter region. He also had occasional vomiting and gait ataxia. MRI brain and spine showed a 3.6 cm × 2.7 cm irregular lobulated heterogeneous lesion involving left middle cerebellar peduncle and inferior vermis with diffuse pachymeningeal thickening and enhancement and diffuse spinal metastasis. In addition, there was a well-defined solid cystic lesion, heterointense, with areas of T2 shortening, enhancing brilliantly on contrast, in right masseter region. The lesion was located superficial to the mandible and was infiltrating the muscle and coming to the subcutaneous plane []. Imaging character of the lesion was same as that of cerebellar lesion. Chest X-ray, Ultrasound of the abdomen and bone scan was performed to rule out any other ENM, and were all negative. There were no other ENM. Fine needle aspiration cytology from the subcutaneous swelling showed numerous large basophilic cells with high nuclear cytoplasmic ratio, suggestive of medulloblastoma []. In view of disseminated metastasis, the child was given palliative and supportive care. He died 11 month after the diagnosis of ENM because of disseminated disease.
|
[[9.0, 'year']]
|
M
|
{'381159': 1, '13939379': 1, '7369716': 1, '4705167': 1, '20133080': 1, '24739212': 2, '2010766': 1, '24082943': 2}
|
{'4013534-1': 1}
|
163,433 |
3783800-1
| 24,082,752 |
noncomm/PMC003xxxxxx/PMC3783800.xml
|
Amelogenesis imperfecta: Four case reports
|
A 17-year-old male patient presented with a complaint of yellow discoloration of his teeth since 8 to 9 years. Patient was giving positive history of discolored anterior deciduous teeth; however, medical history and family history was unremarkable. Patient had permanent dentition with no missing teeth. All the anterior and posterior teeth were affected with brownish discoloration; while attrition present with posterior teeth. Height of the clinical crowns of upper and lower posterior teeth were reduced. In 11, 14, 21, 22, 24, 34, 42, pitting were present. Consistency of enamel was hard. Chipping of enamel was not present in any teeth []. Panoramic radiograph was taken which showed presence of a thin layer of enamel with radiodensity of enamel more than dentin []. On the basis of clinical and radiographic features, final diagnosis of hypoplastic AI was made.
|
[[17.0, 'year']]
|
M
|
{'8854424': 1, '21887005': 2, '21521920': 1, '17408482': 1, '11566262': 1, '22565521': 1, '24082752': 2}
|
{'3783800-2': 2, '3783800-3': 2, '3783800-4': 2, '3162864-1': 1}
|
163,434 |
3783800-2
| 24,082,752 |
noncomm/PMC003xxxxxx/PMC3783800.xml
|
Amelogenesis imperfecta: Four case reports
|
A 12-year-old male patient came with a complaint of yellow brown discoloration of his upper anterior teeth since 4-5 years. His parents were aware of discolored deciduous teeth. Family history was unremarkable. Patient had mixed dentition present with deciduous molar root pieces. On examination, brownish discoloration was present in 21, 11, 36, 46 and chalky white discoloration was present in relation with all other teeth. Incisal edges of 33, 34, 43, 44 were thin with dentin exposed. Enamel was softer in consistency with chipping of enamel on probing []. On the basis of clinical examination, provisional diagnosis of hypomaturation AI was made. Panoramic radiograph was advised which showed presence of a thin layer of enamel with radiodensity of enamel more than dentin and taurodontism of 16, 26 []. Final diagnosis of hypoplastic-hypomaturation-AI with taurodontism of 16, 26 was made.
|
[[12.0, 'year']]
|
M
|
{'8854424': 1, '21887005': 2, '21521920': 1, '17408482': 1, '11566262': 1, '22565521': 1, '24082752': 2}
|
{'3783800-1': 2, '3783800-3': 2, '3783800-4': 2, '3162864-1': 1}
|
163,435 |
3783800-3
| 24,082,752 |
noncomm/PMC003xxxxxx/PMC3783800.xml
|
Amelogenesis imperfecta: Four case reports
|
A 22-year-old female patient came with a complaint of yellow discoloration of teeth since 12-13 years. Patient was giving history of discolored anterior deciduous teeth. Medical history and family history was unremarkable. Patient had permanent dentition with no missing teeth. Upper and lower posterior teeth showed yellowish brown discoloration with attrition []. Consistency of enamel in affected teeth was hard and chipping of enamel not present in any teeth. On the basis of clinical examination, provisional diagnosis of hypoplastic AI was made and panoramic radiograph was advised which showed presence of a thin layer of enamel with radiodensity of enamel more than dentin []. Final diagnosis of hypoplastic AI was made.
|
[[22.0, 'year']]
|
F
|
{'8854424': 1, '21887005': 2, '21521920': 1, '17408482': 1, '11566262': 1, '22565521': 1, '24082752': 2}
|
{'3783800-1': 2, '3783800-2': 2, '3783800-4': 2, '3162864-1': 1}
|
163,436 |
3783800-4
| 24,082,752 |
noncomm/PMC003xxxxxx/PMC3783800.xml
|
Amelogenesis imperfecta: Four case reports
|
A 14-year-old male patient came with a complaint of yellow discoloration of teeth since 5-6 years. Past dental history was suggestive of discolored deciduous teeth. Medical history and family history was unremarkable. Anterior as well as posterior teeth of all segments showed brownish discoloration []. Height of the crowns of upper and lower posterior teeth were reduced. Consistency of enamel and dentin was hard. Chipping of enamel was not present in any tooth. On the basis of clinical features, provisional diagnosis of hypoplastic type of AI was made. Panoramic radiograph advised to confirm the diagnosis which showed presence of a thin layer of enamel with radiodensity of enamel more than dentin []. On the basis of clinical and radiographic features, final diagnosis of AI of hypomaturation type was made.
|
[[14.0, 'year']]
|
M
|
{'8854424': 1, '21887005': 2, '21521920': 1, '17408482': 1, '11566262': 1, '22565521': 1, '24082752': 2}
|
{'3783800-1': 2, '3783800-2': 2, '3783800-3': 2, '3162864-1': 1}
|
163,437 |
3783801-1
| 24,082,753 |
noncomm/PMC003xxxxxx/PMC3783801.xml
|
Osteochondroma of mandibular condyle: A clinic-radiographic correlation
|
A 45-year-old male patient reported to the department with complaint of painless hard slow growing swelling on the right TMJ area and asymmetrical face since two years. He noticed reduced mouth opening and deviation of the jaw while opening and closing the mouth []. There was no history of any trauma or ear infection. The medical history was non-contributory. The clinical examination revealed non-tender bony hard oval swelling on right TMJ measuring around 2 cm × 2 cm [], reduced TMJ movements, facial asymmetry with approximately 8 mm deviation of the midline to the right side, severe malocclusion, unilateral posterior cross bite on the right side, 7 mm negative horizontal overjet and 30 mm mouth opening. No pain but clicking sound was observed on TMJ movements.\nThe Panoramic radiograph [] and open and close right TMJ view [Figure , ] showed a well circumscribed oval-shaped mixed lesion having thin corticated rim. The lesion was attached to the neck of the right condyle. The coronal and axial computed tomograms showed a large hyperdense well defined cartilaginous/bone growth attached to the neck of the right condylar head. The lesion extended from the antero-medial surface of the condyle towards the glenoid fossa and sigmoid notch [Figures -]. The serological investigations were within normal limits.\nBased on history, clinical examination and radiographic findings, the diagnosis of osteochondroma of right TMJ was made with differential diagnosis of osteoma, benign osteoblastoma, chondroma, chondroblastoma. The patient due to phobia has refused surgical intervention and correction of malocclusion. Presently, he is under observation from last six months and no significant changes have been noted.
|
[[45.0, 'year']]
|
M
|
{'25924701': 1, '26125005': 2, '22124074': 1, '18351036': 1, '18661031': 1, '15141724': 1, '21203710': 1, '31110443': 2, '24082753': 2}
|
{'4483616-1': 1, '6503788-1': 1}
|
163,438 |
3783802-1
| 24,082,754 |
noncomm/PMC003xxxxxx/PMC3783802.xml
|
An innovative metal base denture design for a 55-year-old menopausal woman
|
A 55-year-old edentulous denture wearer female reported with the chief complaints of burning sensation in the oral cavity especially in anterior portion of mouth, frequent redness of mucosa, inability to sense temperature changes of food, and recurrent allergic and microbial infections with present acrylic dentures. Medical history revealed that the patient was undergoing treatment under a gynecologist for menopausal symptoms. Dental history revealed patient was edentulous since 2 years and had been experiencing above problems since 1 year.\nSo it was decided to fabricate a complete denture with a customized metal palate design that along with the ongoing treatment from gynecologist would relieve the patient from symptoms because contact sensitivity to denture base materials or to allergens and microbial antigens on the acrylic denture plate plays a greater role in burning sensation in edentulous persons.[]\nThe customized metal palate, apart from fulfilling the patient's needs, was designed in an innovative way with metal loops in specific directions and positions that would enhance interlocking with acrylic portion and also not to interfere with the teeth arrangement of artificial teeth.\nThe primary impression was made with irreversible hydrocolloid. Custom tray was fabricated and secondary impression was made with zinc oxide eugenol. The final cast derived from this impression was duplicated and refractory cast was formed. The refractory cast is used for the fabrication of the customized metal palate.\nA sheet of green spacer wax was adapted on the palatal portion of the cast covering the crest of the ridge and extending 2-3 mm beyond it. Loops of 2-3 mm length made of wax were attached to the peripheral border of the previously adapted palatal spacer wax. It was taken care that all these loops were 2-3 mm short of the sulcus as shown by straight arrow []. These loops would enhance the interlocking of acrylic. This was important because no loop should interfere with the acrylic border of the denture extending into the sulcus.\nTiny loops were placed slightly palatal to the crest as shown by the curved arrow []. The height of these loops was such that it would not interfere with the arrangement of artificial teeth but was sufficient enough for inflow of acrylic resin. A butt joint was created palatal to the crest at the junction of acrylic and metal that enhances the strength of the metal acrylic junction creates a smooth joining of acrylic with metal avoiding any step formation, thus making it comfortable for the patient.\nFor making the butt joint, a 2-mm cylindrical blue wax beading was adapted palatal to the crest of the ridge as shown by straight arrow []. A bard parker knife was run 45° to the border of the bead. Once the design of the palate in wax was done, wax sprues were attached and casting was done. The metal palate after finishing was placed now on the master cast [] and maxillary rim was made for jaw relations []. The jaw relations were recorded and teeth arrangement was done. After curing, the maxillary metal denture was finished and polished []. The patient's pre-treatment [] and post-treatment [] photographs showed marked improvement in esthetics. After 3-month follow-up, patient reported drastic improvement in symptoms previously mentioned.
|
[[55.0, 'year']]
|
F
|
{'10356550': 1, '467032': 1, '2304026': 1, '19056320': 1, '8582512': 1, '7629360': 1, '8149398': 1, '19652040': 1, '16958732': 1, '8040401': 1, '11811747': 1, '18313505': 1, '24082754': 2}
|
{}
|
163,439 |
3783804-1
| 24,082,756 |
noncomm/PMC003xxxxxx/PMC3783804.xml
|
Juvenile osteoporosis in a 5-year-old girl
|
A 5-year-old girl born of nonconsanguineous marriage presented with nonprogressive chest deformity since birth. A physician had done X-ray of spine that showed osteopenic bones with cod-fish appearance of spine and kyphosis without signs of rickets and had referred the patient to us. There were no fractures. Child had an elder sister of 6½ years of age who was normal. The patient had no other deformities and milestones were normal. She was on regular balanced diet. On examination, she had kyphosis and hunchback. Other systems were normal. Investigations showed serum calcium of 9.8 mg/dL, phosphorus of 4.8 mg/dL, and alkaline phosphatase of 1431 IU/L. Her serial calcium, phosphorus, and alkaline phosphatase are depicted in . Her urine calcium/creatinine was 0.46. Blood gas analysis showed no acidosis (pH 7.36, bicarbonate = 21.7) with ultrasound kidneys being normal and creatinine of 0.5 mg/dL. Bone mineral density (BMD) showed severe osteoporosis []. She was treated with oral calcium carbonate (50 mg/kg/day) and oral alendronate (0.5 mg/kg/day) for 9 months. Her 25 hydroxy Vitamin D levels at end of 6 months of therapy were 24 ng/mL (normal = 9-37.6 ng/mL) and serum parathyroid hormones were 27.9 pg/mL (normal = 12-95 pg/mL). Her deformity and BMD [] gradually improved and she had no adverse effects to alendronate.
|
[[5.0, 'year']]
|
F
|
{'10818429': 1, '12110417': 1, '15297692': 1, '917959': 1, '7430216': 1, '16355282': 1, '5049819': 1, '24082756': 2}
|
{}
|
163,440 |
3783806-1
| 24,082,758 |
noncomm/PMC003xxxxxx/PMC3783806.xml
|
Elbow dislocation with ipsilateral distal radius fracture
|
A 20-year-old male presented to our emergency department after falling from his bike and landing on his outstretched right hand. He complained of pain over right elbow joint and wrist joint. On physical examination, right elbow was grossly deformed and swelling was present over the wrist joint. Tenderness was present over both wrist and elbow joint. Range of motion of elbow and wrist joint were both painful and were not assessed. There was no distal neurovascular deficit. Plain radiographs showed posterior elbow dislocation and distal radius fracture with intraarticular extension [Figure and ]. Closed reduction of the dislocated elbow joint was immediately performed with elbow in extension under sedation. Distal radius fracture was then reduced with elbow in flexion. Because the patient did not want surgery for distal radius, it was decided to manage the fracture conservatively. An above-elbow cast was applied for 4 weeks, which was then converted to a below-elbow cast [Figure and ]. The cast was then removed after 2 more weeks. Active elbow and wrist movements were started after 6 weeks of trauma. At 6 months follow-up, patient has regained full flexion and extension of elbow and wrist joint and full pronation and supination of forearm. He has resumed his occupation as a laborer.
|
[[20.0, 'year']]
|
M
|
{'17304072': 1, '17968206': 1, '9563387': 1, '15087969': 1, '6029027': 1, '29732271': 2, '33546002': 2, '28003939': 2, '30769298': 1, '18029527': 1, '12774238': 1, '24082758': 2}
|
{'5933577-1': 1, '5158086-1': 1, '7837832-1': 1, '7837832-2': 1}
|
163,441 |
3783807-1
| 24,082,759 |
noncomm/PMC003xxxxxx/PMC3783807.xml
|
Uncoiling of reamer during intramedullary nailing for fracture shaft of femur
|
A 28-year-old male presented to the emergency department after a road traffic accident in which he was riding a motorcycle and was hit by a truck at a speed of approximately 60 kilometres per hour. He was brought with a grossly deformed right thigh and complained of pain in his right thigh and the inability to move it. An examination of his extremities revealed contusions over his right thigh without any evidence of penetrating injury. There was marked swelling and tenderness in the middle part of his right thigh associated with a closed injury. There was no distal neurovascular deficit. In view of the above clinical findings, a radiograph of his right thigh was suggested. The radiograph revealed unilateral displaced comminuted fracture of shaft femur []. Our patient was then given first aid in the form of Thomas splint and he was planned for reamed interlocking nailing.\nHe was taken to the operating room and was placed supine on a fracture table. After cleaning and draping in a standard fashion a greater trochanter entry point was made. To hasten the surgery the surgeon started with a reamer of 10 mm and whole canal was reamed over beaded guide wire. While removing the reamer from the canal, the reamer got stuck and it was neither going forward or backwards. An intraoperative image showed uncoiling of reamer. Further reaming in either clockwise or anticlockwise direction led to increased uncoiling of the reamer []. It was not possible to remove the assembly by pulling it out. A slotted hammer was positioned over the reamer against the drill attachments and the assembly was tapped out. Unfortunately, this led to the removal of the guide wire along the reamer []. A new guide wire was then again reinserted through the entry point into the canal and the procedure of interlocking nailing was completed successfully [Figures and ]. At six months’ follow-up the fracture had united and patient had resumed his occupation.
|
[[28.0, 'year']]
|
M
|
{'10630797': 1, '26137483': 1, '9057141': 1, '31749053': 1, '31061601': 1, '10799093': 1, '1748704': 1, '19411641': 1, '24082759': 2}
|
{}
|
163,442 |
3783808-1
| 24,082,760 |
noncomm/PMC003xxxxxx/PMC3783808.xml
|
Infiltrative odontogenic myxoma of the posterior maxilla: Report of a case
|
A 25-year-old female was referred to our service for the evaluation of a painless swelling on the right mid-facial region with rapid evolution since one month. Extra-oral examination revealed a diffuse swelling with respect to right mid-facial region that was firm and non tender on palpation causing significant facial asymmetry. Intra-oral examination revealed a firm, non tender swelling expanding the buccal cortex of right maxilla extending from the right first molar to third molar obliterating the buccal vestibule [Figure and ]. No palpable cervical lymphadenopathy was present.\nMaxillary occlusal view revealed radiolucent lesion with respect to right maxillary posterior region with interlaced bony trabeculae resulting in a multilocular spider web appearance; on basis of which a working diagnosis of odontogenic myxoma was made. Further to delineate the extent of the lesion, a computed tomography (CT) scan was carried out. CT scan (axial and coronal views) demonstrated a hypodense ill-defined expansile lesion of the right maxilla with expansion and thinning of the overlying buccal cortex and involvement of the right maxillary antrum. Destruction of the bony margins of medial and lateral walls of the right maxillary antrum, with extension into the nasal cavity resulting in the partial occlusion of the nasal passage was evident. CT scan also revealed destruction of the bony margin of posterior wall of the right maxillary antrum and lateral pterygoid plate. Right infra-orbital margin was seen pushed upwards with erosion of the medial wall of the orbit [Figure and ]. Irregular calcific strands were evident within the lesion [].\nSubsequently, an incisional biopsy was performed and the specimen was submitted for the histopathological examination. The specimen appeared macroscopically as soft gelatinous yellowish white mass with cut surface exhibiting characteristic slimy appearance. Light microscopic examination of the sections stained with H-E revealed spindle and stellate shaped fibroblastic cells set in a myxoid background with delicate haphazardly arranged collagen fibers interspersed with a variable number of tiny capillaries []. Few areas show isolated foci of residual bone []. Odontogenic islands, binucleated cells, cellular pleomorphism and mitotic figures were not appreciated. The histopathological features were consistent with the diagnosis of odontogenic myxoma. The tumor was surgically excised with partial enbloc resection of the maxilla. The postoperative course was uneventful. The patient has since been kept on regular follow-up, and treatment planning for dental rehabilitation is currently underway.
|
[[25.0, 'year']]
|
F
|
{'17996487': 1, '17507265': 1, '12663111': 1, '32509683': 2, '12076060': 1, '21266837': 1, '9482003': 1, '15145033': 1, '18245926': 1, '26155585': 1, '7999737': 1, '25684930': 2, '20251479': 1, '5249519': 1, '24082760': 2}
|
{'7266206-1': 1, '4319334-1': 1, '4319334-2': 1}
|
163,443 |
3783809-1
| 24,082,761 |
noncomm/PMC003xxxxxx/PMC3783809.xml
|
Schwannoma of floor of the mouth
|
A 28-year-old male patient presented with a complaint of enlarging swelling of 1 month duration in the right anterior floor of the mouth which was otherwise asymtomatic. On intra-oral examination, a 4 × 3 cm swelling in the right anterior floor of the mouth, with smooth surface, well-defined border, covered with normal appearing mucosa, was noted. On palpation, it was firm and tender. Computed tomography (CT) scans (axial view) showed a well-defined heterodense mass measuring 3.5 × 2.5 × 2.5 cm, with specks of calcification in the right sublingual region. There was a hypodense rim around the swelling causing smooth erosion of the adjacent mandible. No evidence of cortical irregularity or periosteal reaction was found. Furthermore, multiple enlarged, submental and bilateral submandibular lymph nodes were seen [].\nBased on the clinical findings, the CT scan features and anatomical location a provisional diagnosis of salivary gland tumor involving sublingual gland was given. The patient underwent surgical excision of the mass under general anesthesia; the post-surgical course was uneventful.\nMacroscopically, the resected mass was encapsulated, greyish-white in color, measuring 4 × 4 × 3 cm. It was oval, smooth and firm in consistency []. Microscopic examination revealed a well encapsulated tumor exhibiting areas of organized spindle-shaped cells in palisading arrangement around acellular, eosinophilic areas forming Verocay bodies giving Antoni type ‘A’ pattern. Other areas with Antoni type ‘B’ pattern exhibited less cellularity, less organized cells, which were plump, spindle-shaped and were generally seen adjacent to densely vascular areas []. Immunohistochemical investigation of the tumor cells showed diffuse, strongly positive staining for S-100 protein []. These findings were compatible with the diagnosis of Schwannoma.
|
[[28.0, 'year']]
|
M
|
{'11429745': 1, '13130451': 1, '1301493': 1, '24082761': 2}
|
{}
|
163,444 |
3783810-1
| 24,082,762 |
noncomm/PMC003xxxxxx/PMC3783810.xml
|
A rare case of Kikuchi-Fujimoto disease
|
A 29-year-old non-smoker, normotensive, non-diabetic, male patient presented with two painless, round swellings in right side of the neck for three months with low-grade fever. Initial sizes of the swellings were 2 × 3 cm, and 2 × 2 cm respectively, and their sizes were not increased. There were no respiratory symptoms. Other symptoms like night sweats, fatigue, skin rash, significant weight loss, and anorexia were absent. There was no past history or family history of tuberculosis or intake of antitubercular drugs. There was no history of similar swellings in recent or remote past. On general survey, his pulse rate was 96 beats/minute, respiratory rate 16 breaths/minute, axillary temperature was 99°F, and blood pressure was 110/70 mmHg. Examination of neck revealed two, non-tender, rounded swellings in posterior triangle of right side. Swellings were mobile, discrete, not fixed to underlying structures or overlying skin, and firm in consistency with lobulated surface. Sizes of the swellings were 2 × 3 cm, and 2 × 2 cm respectively, and margins were discrete, not palpable inferiorly. Transillumination test and fluctuation test were negative. There was no color change or discharging sinus on overlying skin. Examination of respiratory and other system revealed no abnormality.\nComplete hemogram and blood biochemistry were normal. Chest radiograph, posteroanterior view revealed no abnormality. Ultrasound of whole abdomen was normal. Anti HIV-1/2 antibodies were non-reactive. Mantoux test (5 TU) was negative (induration of 6 cm at 72 hours). The patient was advised tablet co-amoxiclav-625 mg three times daily for seven days. As there was no improvement, fine needle aspiration cytology of cervical lymph node was done, which revealed reactive lymphoid hyperplasia only, no granuloma or malignant cell was found. Finally, excision biopsy of the cervical lymph node was done to establish the diagnosis, and histopathological examination of biopsy specimen showed lymphoid follicles with germinal centers, paracortical coagulative necrosis containing karyorrhectic foci, suggestive of Kikuchi's disease. The necrotic focis are surrounded by reactive histiocytes, lymphocytes, and occasionally by plasma cells. Ziehl Neelsen stain revealed no acid fast bacilli []. Immunohistochemistry revealed predominance of CD8+ T lymphocytes and histiocytes in the karyorrhectic foci expressed positivity for CD 68 antigen. Serum anti-nuclear antibody and anti-dsDNA antibody was negative. So, our final diagnosis was Kikuchi's disease. As it is a self-limited disease entity, no active treatment was given further; the complete recovery was documented on follow up after one month.
|
[[29.0, 'year']]
|
M
|
{'7793478': 1, '25199195': 1, '3217625': 1, '7829938': 1, '16722618': 1, '15272543': 1, '15947977': 1, '21120436': 1, '15858692': 1, '8420463': 1, '19024143': 1, '24082762': 2}
|
{}
|
163,445 |
3783811-1
| 24,082,763 |
noncomm/PMC003xxxxxx/PMC3783811.xml
|
Adenolymphoma: A probing entity: Case report and review
|
A 65-year-old male patient visited the Department of Oral Medicine, with the chief complaint of swelling below the left ear lobe since six years. Swelling was insidious in onset and gradually increasing up to its present size. Medical and family history was non-contributory. Patient was a known smoker since the past 25 years and there was no history of alcohol consumption.\nOn examination, the lesion extended from the left ear lobule to the lower border of the ramus of the mandible superoinferiorly and also extended behind the left ear []. It was approximately 5 cm in greatest dimensions; smooth contoured, was firm in consistency and had well-defined borders. There were no surface markings and the temperature of the swelling was not elevated. It was midly tender on palpation.\nIntraoral examination revealed normal mucosa and orifices of the parotid gland. Stimulation of the parotid glands yielded normal salivary flow with normal consistency, quantity and color. Other intraoral findings were non-contributory. On aspiration, a clear fluid, light brown in color but viscous in consistency was obtained.\nBased on the history and clinical examination, a provisional diagnosis of Warthin's tumor was given. A differential diagnosis of pleomorphic adenoma, a low-grade parotid malignancy, lipoma and neurofibroma arising in the salivary gland were included. The investigatory workup included complete hemogram, extra-oral radiograph, ultrasonography, computed tomography and excisional biopsy of the lesion.\nRoutine hematological investigation values were found to be within normal limits. The orthopantomogram revealed no abnormalities. Ultrasonographic finding showed a well-defined hypoechoic mass in the lower pole of the left parotid gland. The mass measured about 4.34 × 2.49 × 3.39 cm []. The rest of the parotid gland parenchyma was normal and there was no evidence of ductal dilatation. Computed tomography examination revealed a rounded and well-defined cystic lesion involving the superficial lobe of the left parotid gland [].\nLater, excisional biopsy of the lesion was planned using partial parotidectomy as the technique of choice []. The tissue obtained was fixed in 10% of neutral buffered formalin, and processed routinely. The sections stained with Hematoxylin and Eosin revealed cystic spaces lined by a papillary epithelial proliferation which was bilayered. The cells of the epithelial lining appeared intensely eosinophilic. At the core of papillary projections a variable amount of lymphoid tissue with mature lymphocytes was observed [].\nThe patient did not present with any post-surgical complications. The patient is under regular follow-up to check recurrences, if any.
|
[[65.0, 'year']]
|
M
|
{'19433486': 1, '15861216': 1, '1571114': 1, '21808453': 1, '15576716': 1, '19680204': 1, '16761709': 1, '19434322': 1, '19753827': 1, '17548964': 1, '11890618': 1, '7467121': 1, '21710045': 1, '12811857': 1, '8678050': 1, '22203940': 1, '16504867': 1, '24082763': 2}
|
{}
|
163,446 |
3783813-1
| 24,082,765 |
noncomm/PMC003xxxxxx/PMC3783813.xml
|
Bilateral anterior shoulder dislocation
|
A 24-year-old man presented to accident and emergency department with complaints of acute shoulder pain involving both shoulders after trying to prevent a fall. He tried to prevent falling backward by extending both arms behind his back. He had no history of seizure, alcohol intake or previous shoulder dislocation. Both shoulders were abducted and externally rotated. Physical examination showed fullness over anterior aspect and bilateral squaring of his shoulders (epaulet sign). Both humeral heads were palpated in the anterior aspect of each joint and there was a global, painful restriction of range of motion in both shoulders, without any evidence of peripheral motor, sensory and vascular deficit.\nA clinical diagnosis of bilateral anterior shoulder dislocations with no neurovascular deficit was made. There was no evidence of any generalised ligamentous laxity. Radiographs confirmed bilateral anterior glenohumeral dislocation with greater tuberosity fracture on left side []. Both shoulders were reduced using Kocher's technique under sedation. Reduction of both shoulders was obtained which was confirmed radiologically [Figure and ]. Since the greater tuberosity fracture of left shoulder returned to its anatomical position after reduction, so it was decided to manage the fracture conservatively. Both arms continued to be neurvascularily intact and were armpouch in slings. Right shoulder was immobilized for one week and left shoulder for six weeks.\nThe patient received physical therapy as tolerated and no further episodes of instability ensued. At follow-up of two months the patient reported no pain and had returned to his normal activities of daily living with minimal discomfort. Both shoulders had near normal range of motion with pain only present at the extremes of motion. Both shoulders also had negative apprehension tests. Power was 5/5 in both shoulders. Radiographs showed an anatomical consolidation of greater tuberosity fracture of left shoulder joint. At the end of one year follow up, the fracture has united with no restriction of motion and the shoulders were defined as stable.
|
[[24.0, 'year']]
|
M
|
{'18587510': 1, '9562170': 1, '31198810': 2, '33363938': 2, '27005796': 1, '12051004': 1, '9475214': 1, '29242794': 2, '29552259': 1, '25685749': 2, '15674083': 1, '4005006': 1, '8592268': 1, '10422035': 1, '6708162': 1, '24082765': 2}
|
{'5727998-1': 1, '7752428-1': 1, '7752428-2': 1, '4310017-1': 1, '6555203-1': 1}
|
163,447 |
3783814-1
| 24,082,766 |
noncomm/PMC003xxxxxx/PMC3783814.xml
|
Ochronotic black meniscus during knee arthroscopy
|
A 30-year-old woman presented with complaints of pain in the left knee along with occasional episodes of locking for 1 year. Her physical examination revealed tenderness on the medial joint line and positive McMurray's test. Ordinary x-ray images of the knees were found to be normal. Magnetic resonance imaging (MRI) of the left knee revealed bucket handle tear of medial meniscus along with partial tear of anterior cruciate ligament. She was planned for arthroscopic partial meniscectomy in view of her complaints and MRI findings. During the arthroscopic examination of her left knee joint there was mild synovial hypertrophy and a bucket handle tear was found in the medial meniscus that appeared to be brownish black in color [Figures , ]. Anterior cruciate ligament was also found to be partially torn. Lateral meniscus and articular cartilage overlying medial femoral condyle also showed brownish black discoloration. Meniscectomy for bucket handle tear of medial meniscus was done and specimen was sent for histopathological examination.\nFurther investigations were planned for the diagnosis of ochronosis considering discoloration of the joint cartilage and menisci. The patient's freshly passed urine turned dark brown after addition of sodium hydroxide to the sample to facilitate oxidation. Ferric chloride test was also found to be positive. Histopathological examination of the excised tissue showed pigmentation and degenerative changes []. No pathological findings were detected with the detailed examination of the ear, sclera, skin, and cardiovascular system. Further treatment was done in the form of physiotherapy and by administering vitamin C and analgesics. After the medical and surgical treatment, the patient's complaints were alleviated and no complaints were registered, during the next follow-up.
|
[[30.0, 'year']]
|
F
|
{'11600986': 1, '7821069': 1, '14551566': 1, '5487565': 1, '33057760': 1, '15580350': 1, '9265798': 1, '1399524': 1, '19293619': 1, '17899002': 1, '24082766': 2}
|
{}
|
163,448 |
3784095-1
| 24,327,991 |
noncomm/PMC003xxxxxx/PMC3784095.xml
|
Multicystic benign mesothelioma of the pelvic peritoneum presenting as acute abdominal pain in a young woman
|
A 28-year-old woman, gravida 2, para 0, abortion 2, had been experiencing progressive lower abdominal pain for almost 7 months. The pain worsened a week prior to her admittance and remained constant. She denied fever or chills. Her appetite, bowel and urinary function were normal and she had no recent weight loss. She experienced regular menstrual cycles and a long-standing history of dysmenorrhea and dyspareunia. Past medical history was unremarkable and there was no history of previous abdominal surgery or gynecologic disorders. Family history was not notable.\nOn physical examination, the abdomen was mildly rigid and moderately distended. She had a tender mass behind the uterus but the cervix and genital tract appeared normal. Complete blood screening profile, urinalysis and serum CA-125 assay were within normal limits. Ultrasonography and computed tomography of the pelvis revealed a 10 × 7 cm multicystic mass with irregular borders occupying the rectouterine pouch ().\nWe decided to perform laparoscopic surgery. Laparoscopic trochars were placed below the umbilicus and lower abdomen (×3, 12 mm, 5 mm, 5 mm). During the laparoscopy, we observed multiple grapelike clusters of cysts within the rectouterine pouch. The cysts appeared to originate from the peritoneum of the rectouterine pouch and attached to the uterus and left adnexa. Additional small cysts were found on the greater omentum and serosal surface of the right fallopian tube. Careful exploration of the whole abdomen, including appendix, liver and diaphragm, revealed no other abnormalities. Intraoperative frozen section histology of the multiple grapelike clusters of cysts were suspicious for serous type benign cysts. A decision was made to excise all macroscopically visible cysts. Excision of multiple clusters of cysts in the rectouterine pouch via laparotomy, resection of the peritoneum of the rectouterine pouch, partial greater omentectomy and electro-fulguration (argon plasma coagulator) of small cysts on the serosal surface of the right fallopian tube was performed.\nGrossly, multiple cysts were present measuring up to 2 cm. Microscopically, the cysts were lined by flattened or cuboidal cells. The lining cells were reactive immunohistochemically for Pan-CK, calretinin, D2-40 and CK5/6 but negative for CD34 (). Histological examination of the excised specimens were consistent with a MBM of the pelvic peritoneum. The postoperative course was uneventful. The patient is well at 3-month follow-up with no clinical evidence of disease recurrence.
|
[[28.0, 'year']]
|
F
|
{'17007034': 1, '27899951': 2, '11920782': 1, '9698490': 1, '29372166': 1, '29850363': 2, '3708838': 1, '18476992': 1, '33391761': 1, '12733118': 1, '7121070': 1, '2299728': 1, '11884057': 1, '3174512': 1, '3421410': 1, '24327991': 2}
|
{'5102685-1': 1, '5914106-1': 1}
|
163,449 |
3784099-1
| 24,327,992 |
noncomm/PMC003xxxxxx/PMC3784099.xml
|
Temporary homonymous hemianopsia after epidural blood patch
|
A 33-year-old pregnant woman had been transferred to our outpatient clinic with the concern for preterm labor at 23 weeks gestation but was ultimately sent home. After a triplet pregnancy achieved through an in vitro fertilization embryo transfer in a private clinic, the patient underwent a McDonald operation at 16 weeks gestation due to the risk of preterm birth in multiple gestations. The patient then presented to the emergency department of our hospital at 30 weeks and 2 days gestation due to premature rupture of membranes. She was prepared for an urgent Caesarean section at 31 weeks and 3 days gestation due to sudden contractions. In a seated position, the patient underwent a midline approach to the L3-4 interspinous space using an 18 G Tuohy needle. Cerebrospinal fluid leaked while identifying the epidural space using the loss of resistance (LOR) technique with 2.5 mL of air. Dural puncture was suspected, and the needle was removed. As a result, the initially scheduled epidural anesthesia was changed to spinal anesthesia. Subsequently, we successfully initiated spinal anesthesia using a 26 G Quincke needle in the same location. The patient was move to a supine position after administering 10 mg of bupivacaine. The Caesarean section was initiated after confirmation of adequate anesthesia up to the fourth thoracic segment. All three babies and the placenta were delivered. All vital signs were stable before and after the anesthetic injection, and no abnormal findings were observed at the time of the procedure. The patient was advised postoperative bed rest and began early ambulation on the first postoperative day. Since the patient complained of mild tinnitus during ambulation without any other associated symptoms, closer follow-up was initiated.\nOn the second postoperative day, she complained of headache, nausea, and other symptoms, and she began complaining of a stiff neck and vomiting on the third postoperative day. These symptoms were alleviated in the supine position but recurred when the patient assumed standing or sitting positions. No other focal neurologic symptoms were identified at that time, and vital signs were stable. Despite conservative management including bed rest, the administration of fluid, analgesics and anti-nauseants, her symptoms persisted. The patient was sent to the Department of Neurology on the fourth postoperative day for suspected PDPH. She was encouraged to undergo epidural blood patch. We were initially planning to perform EBP after the confirmation of PDPH based on computed tomography (CT) scans; however, the scanning was delayed after the procedure due to limited availability. Subsequently, the patient was placed in the left lateral position, and the epidural space was identified using about 2.5 mL of air with the LOR technique at the L4-5 spinal level. No leakage of cerebrospinal fluid was detected at that time. Fifteen milliliters of the patient's own blood were injected using an aseptic technique. No specific physical findings were identified at the time of the procedure. The patient stayed on bed rest in the supine position and slept in the same posture. The CT scan taken immediately after the EBP procedure demonstrated pneumocephalus in the prepontine and premedullar cisterns (). After waking on the fifth postoperative day, the first postprocedure day following the EBP, she started to complain of an abrupt vision abnormality. Her vital signs were stable and no neurological symptoms were detected other than her visual disturbance, apart from her persistent mild headache. Visual field and fundal examinations were conducted in the Department of Ophthalmology. A right homonymous hemianopia was detected in the Humphrey visual field test (), but no abnormal findings were identified on fundal examination. Magnetic resonance imaging (MRI) was performed due to the clinical suspicion of homonymous hemianopsia, and demonstrated air bubble movement toward the left retrochiasmal visual pathways ().\nAfter pneumocephalus was identified as the cause of her visual disturbance and headache, we administered prophylactic antibiotics and highly concentrated oxygen. The patient was then placed on bed rest. Her symptoms of visual disturbance improved considerably over the course of the day, and a follow-up CT scan was performed. No further air density was observed. Although her mild headache remained, the visual disturbance completely disappeared by the end of the fifth postoperative day. The patient was discharged on the sixth postoperative day and was asymptomatic at her outpatient follow-up visit one week later.
|
[[33.0, 'year']]
|
F
|
{'17276839': 1, '16567710': 1, '10072010': 1, '12195619': 1, '4697213': 1, '7326919': 1, '12859316': 1, '7880516': 1, '24327992': 2}
|
{}
|
163,450 |
3784102-1
| 24,327,980 |
noncomm/PMC003xxxxxx/PMC3784102.xml
|
Intraoperative uterine artery embolization without fetal radiation exposure in patients with placenta previa totalis: Two case reports
|
A 40-year-old woman, gravida 0, was admitted to Seoul National University Bundang Hospital in August 2011 for elective Cesarean section and prophylactic intraoperative UAE at 36 weeks and 6 days gestational age. Two thirds of the placenta was located in the posterior wall of the uterus and the remaining placenta was located in the anterior lower segment of the uterus resulting in complete covering of the internal os of cervix. Under spinal anesthesia, a low transverse uterine incision was made and after gently penetrating part of the placenta directly behind the incision site, a live 2,815 g baby was delivered. The upper and lower cut edges and each lateral angle of the uterine incision were clamped using Allis forceps. The torn placental margin was also clamped using Allis forceps. An interventional radiologist, who had been already stood by, stepped into the operation field and then inserted an angiographic catheter into the right femoral artery and approached both uterine arteries using portable fluoroscopy. Insertion of the catheter took five minutes. During that time, the surgeon had observed the uterus carefully for detection of bleeding. Embolization was performed with gelfoam under fluoroscopic guidance for bilateral enlarged tortuous uterine arteries and it took 20 minutes (). After confirming via angiography that there was markedly decreased blood flow, the surgeon removed the placenta. However, bleeding from the implantation site was profuse even though both uterine arteries had been embolized. Bleeding was ultimately controlled by over-sewing the implantation site with 0-monofilament absorbable suture and the rest of the surgery was uneventful. Estimated blood loss for this surgery was 2,500 mL. The patient received five units of packed red blood cells and three units of fresh frozen plasma during the operation. The next day, the patient's hemoglobin was 10.1 g/dL and the sheaths were removed. Routine postoperative care was performed and the patient was discharged from the hospital four days after surgery with no complications.
|
[[40.0, 'year']]
|
F
|
{'10406301': 1, '18501901': 1, '20177297': 1, '21692756': 1, '19622981': 1, '18460450': 1, '18849689': 1, '22218410': 1, '16502171': 1, '11023169': 1, '20358016': 2, '24327980': 2}
|
{'3784102-2': 2, '2844598-1': 1}
|
163,451 |
3784102-2
| 24,327,980 |
noncomm/PMC003xxxxxx/PMC3784102.xml
|
Intraoperative uterine artery embolization without fetal radiation exposure in patients with placenta previa totalis: Two case reports
|
A 32-year-old woman, gravida 2, para 0, was admitted to Seoul National University Bundang Hospital at 35 weeks and 5 days gestational age with symptoms of vaginal bleeding in October 2011. Trans-vaginal ultrasonography revealed that the placenta completely covered the internal os. Approximately two thirds of the placenta was located in the posterior wall of the uterus and the remaining portion was located in the anterior lower segment of uterus. When the patient and her husband were counseled about the risk of hysterectomy, they strongly requested preservation of the uterus for future fertility. Therefore, a Cesarean section with prophylactic intraoperative UAE was planned. Under spinal anesthesia, a uterine incision was made transversely at the lower uterine segment. The surgeon could not avoid tearing the placenta before the female newborn weighing 2,465 g was delivered. The torn placental margins and the cut edges of the uterus were clamped by Allis forceps. During the interventional radiologist tried to insert an angiographic catheter into the right femoral artery for four minutes, the surgeon found a diffuse hemorrhage from the torn placental margin and cut edges of the uterus. At this point, the surgeon abandoned the plan of a prophylactic UAE. The surgeon removed the placenta manually and profuse hemorrhage from the placental bed sites developed. Although the implantation site was repeatedly over-sewn with 0-monofilament absorbable suture, bleeding was quite severe, thus a Cesarean hysterectomy was indicated. However, it was decided that intraoperative UAE would be attempted once more before the Cesarean hysterectomy since massive transfusion was successful. The interventional radiologist inserted an angiographic catheter into the right femoral artery and approached both uterine arteries. Embolization with gelfoam was performed under fluoroscopic guidance for bilateral enlarged tortuous uterine arteries (). Fortunately, blood flow decreased on angiography and bleeding through the vagina decreased. At this point it seemed possible to avoid a hysterectomy. The uterine wall was repaired after an additional intraoperative UAE. Estimated blood loss was 5,000 mL and massive transfusion (9 packs of RBC and 3 packs of FFP) was performed during the operation. Although bleeding decreased markedly after two attempts of intraoperative UAE, the patient was transferred to the angiography room for another attempt at UAE. Embolization of the uterine artery was performed with a coil in the angiography room () and then the patient was transferred to the intensive care unit (ICU) for close observation. While in the ICU, the patient received three more packs of RBC and six more packs of FFP as well as cryoprecipitate and platelet. The next day, her hemoglobin level was 10.2 g/dL and vital signs were stable. She was transferred to the general ward for further postoperative care. On the second day after surgery, the patient presented with a fever of 39.1℃ and after a full fever study, her antibiotic regimen was changed. The fever resolved on the fourth day and the patient was discharged from the hospital 10 days after surgery with no other complications.
|
[[32.0, 'year']]
|
F
|
{'10406301': 1, '18501901': 1, '20177297': 1, '21692756': 1, '19622981': 1, '18460450': 1, '18849689': 1, '22218410': 1, '16502171': 1, '11023169': 1, '20358016': 2, '24327980': 2}
|
{'3784102-1': 2, '2844598-1': 1}
|
163,452 |
3784107-1
| 24,327,979 |
noncomm/PMC003xxxxxx/PMC3784107.xml
|
Hepatoid carcinoma of the ovary without staining for alpha-fetoprotein
|
A 51-year-old woman presented to the department of internal medicine with left lower quadrant pain and hematochezia for a month. Colonoscopy revealed hyperemic mass with spontaneous bleeding at about 20 cm above the anal verge which almost obstructs the lumen. A computed tomography (CT) scan of the abdomen showed 12.5×7.8×11.2 cm sized large heterogeneous pelvic mass invading sigmoid colon and uterus (). There was peritoneal seeding and multiple metastatic lymphadenopathy along the bilateral iliac chain and retroperitoneal space up to level of left renal vein but the liver was normal in size and texture. Laboratory analysis revealed normal renal and liver function. The level of CA-125 was elevated to 37.5 U/mL but carcinoembryonic antigen (CEA) and CA-19-9 was normal. She was transferred to the department of Gynecology to rule out ovarian malignancy and positron emission tomography (PET) scan was done. PET scan showed large mass with heterogeneous FDG uptake in the pelvic cavity and multiple hypermetabolic seeding nodules, suggesting peritoneal seeding. The left supraclavicular lymphadenoapathy was seen and fine needle aspiration biopsy revealed metastatic carcinoma. She underwent an explorative laparotomy with total abdominal hysterectomy, bilateral salpingo-oophorectomy, appendectomy and tumorectomy including sigmoid colon with Hartmann's operation. The white-pink, granular appearance 9×8×6 cm sized cancerous mass with necrosis was found posterior to uterus which invades sigmoid colon. Frozen biopsy of the pelvic mass showed poorly differentiated carcinoma but the cell type was unknown because of severe inflammation. Bilateral pelvic lymph nodes were enlarged on palpation however, dissection was not performed. Histologically, the tumor was composed of solid sheets or aggregates of uniform cells with moderate or abundant eosinophilic cytoplasm, distinct cell borders, and centrally located nuclei with prominent nucleoli (). On immunohistochemical staining, p53, p16 was positive; hepatocyte paraffin-1, caudal type homeobox-2, Wilms Tumor-1, estrogen receptor and AFP was negative (). The tumor was relatively homongeneous, with no evidence of conventional germ cell tumor or ovarian surface epithelial tumor morphology. It was consistent with hepatoid carcinoma of the right ovary. After the surgery the CA-125 increased from 37.5 to 43.2 U/mL. But the level of serum AFP was 2.2 ng/mL (normal range, 0.0 to 10.0 ng/mL). Chemotherapy was started with an ovarian cancer regimen of paclitaxel 175 mg/m2 and carboplatin with an area under the curve of 5 every 3 weeks. Serum CA-125 returned to normal range after the first cycle of chemotherapy and remained within normal range (24 to 27 U/mL) during three cycles of chemotherapy. A CT scan after the three cycles of chemotherpy showed progression of disease with 4.3 cm recurrent peritoneal carcinomatosis in pelvic cavity and extensive metastatic lymphadenopathy with necrotic change in retroperitoneum, bilateral iliac chain and retrocrural area. Second line treatment with docetaxel was given three cycles but the disease progressed rapidly and ileus developed due to seeding mass in the abdominal cavity and pulmonary effusion newly developed. The patient expired 6 months after the initial diagnosis.
|
[[51.0, 'year']]
|
F
|
{'12819394': 1, '11578497': 1, '2445465': 1, '9611059': 1, '32384467': 2, '32322647': 1, '21422440': 1, '26937481': 1, '16884387': 1, '24327979': 2}
|
{'7220692-1': 1}
|
163,453 |
3784108-1
| 24,327,981 |
noncomm/PMC003xxxxxx/PMC3784108.xml
|
An asymptomatic ovarian steroid cell tumor with complete cystic morphology: A case report
|
A 52-year-old woman (2-0-1-2) was referred to the gynecology department of our hospital for a left adnexal mass incidentally found by liver computed tomography (CT). She was a hepatitis B carrier diagnosed with liver cirrhosis nine years previously, and the liver CT was part of her routine follow-up. Past surgeries included total abdominal hysterectomy for uterine myoma 14 years previously, and an exploratory laparotomy for abdominal adhesions and a peritoneal inclusion cyst 3 years ago. She had menarche at the age of 12 years, and her family history was unremarkable. She was taking hepatic protective medication.\nAbdominal examination revealed a fist sized palpable mass, without tenderness or rebound tenderness. On pelvic examination, the uterus was absent due to previous hysterectomy and the right adnexa was not palpable due to the central location of the left adnexal mass. No signs of virilization or hirsutism were observed. Laboratory analysis revealed normal values of blood count, hepatic-renal function, coagulation, and electrolytes. Tumor marker studies showed a slightly increased CA-19-9 of 40.62 U/mL (normal range, 0 to 37 U/mL), a normal carcinoembryonic antigen (CEA) of 3.69 ng/mL, and a normal CA-125 of 8.04 U/mL. Transvaginal ultrasound examination revealed no uterus and a large 10×8×7 cm3 sized well defined cystic mass located at the center of the pelvic cavity, with internal septation and no apparent solid portion (). The right adnexa was not clearly observed and no ascites within the pelvic cavity was found, suggesting a recurrent peritoneal inclusion cyst formed after the previous two surgeries.\nAn additional CT scan of the abdomen and pelvis showed a 10×8 cm sized round mass at the left adnexa, with internal septations and an enhancing solid portion, indicative of a borderline or malignant epithelial ovarian tumor. There was no lymph node enlargement or ascites, but the liver showed signs of cirrhosis ().\nThe patient underwent a laparoscopy under general anesthesia. The peritoneum and ileum displayed extensive adhesion from the umbilical trocar site to the previous laparotomy site, and although there was no ascites, the mass was not readily observed due to substantial adhesion. Adhesiolysis was performed on the adhesions to the surrounding peritoneum, small bowel, descending colon and sigmoid colon, revealing several septations of the mass and about 100 mL of dark brown serous fluid. As the adhesions were removed, no uterus was revealed, due to the previous hysterectomy, and adhesiolysis of the bladder revealed a 5×4 cm sized bluish left adnexal mass with a thin wall and serous contents. No abnormal signs were noted in the right adnexa, peritoneum, or omentum. After the left salpingo-oophorectomy, the ileum and sigmoid colon were injured from adhesiolysis by a tendency to tear easily, so laparotomy was performed with the general surgery department. The ileum had a 5 cm linear tear at 80 cm superior to the ileocecal valve and segmentectomy with anastomosis was performed. The sigmoid colon had a 3 cm linear tear, which was sutured. During surgery, gross examination and palpation of the internal abdominal organs yielded no notable abnormalities. The abdominal CT suggested a borderline or malignant epithelial ovarian tumor, but because of the patient's history of surgery 3 years before for abdominal adhesion and peritoneal inclusion cyst, and because extensive adhesion was noted during surgery, a recurrent peritoneal inclusion cyst was suspected and the surgery was concluded without any additional procedures.\nGross pathological findings showed a 6×6 cm sized mass, mostly cystic. The outer surface had heavy adhesions, and the mass was untidy internally, with a small inner solid portion, but no signs of hemorrhage or necrosis. Microscopic findings exhibited diffuse tumor cells with abundant eosinophilic granular cytoplasm and vacuolization, with no signs of nuclear atypicality and a mitotic count of 5 per 10 HPF (). Immunohistochemistry revealed a positive reaction to inhibin, calretinin, and vimentin, a moderately positive reaction to CD99, and a negative reaction to pan-CK, S-100, placenta-like alkaline phosphatase, and chromogranin (). The Ki-67 labeling index was low, under 5%. The histopathologic features supported a diagnosis of an ovarian steroid cell tumor, NOS.\nPostoperatively, the patient's testosterone level was normal, at 0.32 ng/mL (normal range, 0.14 to 0.76 ng/mL). No hormonal assays were done before surgery as there were no clinical manifestations of any hormone secretion. She is on regular follow-up at our outpatient clinic, with no evidence of recurrent disease for 21 months.
|
[[52.0, 'year']]
|
F
|
{'31827013': 1, '21355462': 1, '12192893': 1, '15258555': 1, '11733978': 1, '33435776': 2, '20035129': 1, '33663470': 2, '12649671': 1, '4294036': 1, '9587754': 1, '9496356': 1, '17326260': 2, '2823622': 1, '24327981': 2}
|
{'7934245-1': 1, '7809311-1': 1, '2628006-1': 1}
|
163,454 |
3784113-1
| 24,328,003 |
noncomm/PMC003xxxxxx/PMC3784113.xml
|
Primary malignant melanoma arising in a cystic teratoma
|
A 75-year-old postmenopausal woman was admitted with gall stones and was incidentally found to have a mass in her abdomen. She had no significant gynecologic history. Epigastric tenderness was noted during the general physical examination. The pelvic examination revealed a 20×10 cm, smooth, mobile, nontender cystic mass to the anterior aspect of the uterus. An ultrasound examination showed a pelvic mass measuring approximately 17×11 cm with mixed echogenicity and a thin septation, with no ascites. Computed tomography (CT-scan) revealed a multi-lobulated 19×15 cm cystic mass with calcification and fat, suggesting a teratoma. The mass was located centrally in the pelvis, appearing to originate from the right side of the uterus with no enlarged lymph nodes (). A 1-cm-sized gall stone was also seen. The tumor marker, CA-125, level was elevated at 56.60 IU/mL (range, 0 to 35 IU/mL), and levels of carcinoembryonic antigen and alpha feto-protein were normal. A frozen section of the ovarian tissue at the time of the laparoscopy suggested a malignant tumor of unknown type. As such, the patient underwent a laparoscopic total hysterectomy with bilateral salpingo-oophorectomy with partial omentectomy with cholectystectomy. The diagnosis of a malignant melanoma in an ovarian cystic teratoma was made by histologic examination. Grossly, the right ovary showed a 20×14 cm sized cyst and was solid in appearance, containing sebaceous material. Microscopically, an infiltrating area of atypical pleomorphic cells having macronucleoli and melanin pigments was found in the background of the mature cystic teratoma (). These pleomorphic cells were positive for melan A () and HMB 45 ().\nThe patient was re-evaluated, and the possibility of a melanoma at any other site, mainly skin, central nervous system, eye and gastrointestinal tract, was ruled out. Postoperatively, she received adjuvant immunotherapy with high-dose interferon (IFN)-α. Twelve months after the operation, a metastatic lesion of the liver was diagnosed. The patient underwent two cycles of Dacarbazine and two cycles of Cisplatin-Vinblastine-Dacarbazine chemotherapy. The patient died 17 months after the initial diagnosis.
|
[[75.0, 'year']]
|
F
|
{'937274': 1, '8525036': 1, '7308873': 1, '31775731': 2, '30630520': 2, '27331138': 1, '29564322': 2, '11531299': 1, '16343199': 1, '3546474': 1, '2323608': 1, '30412106': 1, '30693128': 2, '11788186': 1, '26023561': 1, '24328003': 2}
|
{'6882322-1': 1, '5854911-1': 1, '6332946-1': 1, '6327407-1': 1}
|
163,455 |
3784114-1
| 24,328,004 |
noncomm/PMC003xxxxxx/PMC3784114.xml
|
Retained placenta accreta after a first-trimester abortion manifesting as an uterine mass
|
A 41-year-old gravida 4 para 2 with a history of 1 Cesarean section and 3 dilatation and curettages presented with a complaint of vaginal bleeding. Her cycles were regular initially and became irregular 1 year ago. She was diagnosed with premature menopause at a private clinic and sought evaluation at our hospital. She had 1 full-term vaginal delivery 18 years ago and 1 Cesarean section due to a breech presentation 9 years ago. Several years ago before the Cesarean section, she underwent a dilatation and curettage. Three and six years after the uneventful Cesarean section, she underwent a dilatation and curettage at a local clinic for pregnancies estimated to be about 5 weeks gestation.\nPelvic examination revealed a slightly enlarged uterus. Vaginal ultrasonography revealed a 7.8 × 6.6 × 4.1 cm well-defined complex solid and cystic mass in the uterine wall and there was no vascular flow in the lesion (). All laboratory finding was not remarkable. Serum level of estradiol, prolactin, lutenizing hormone, and follicular stimulating hormone (FSH) were 25.42 pg/mL, 4.8 ng/mL, 32.54 mIU/mL, and 66.13 mIU/mL, respectively. Serum level of β-human chorionic gonadotrophin (β-hCG) was 0.27 mIU/mL. The endometrial line was not visualized. Based on the history and sonographic findings, the differential diagnosis included an endometrial cancer or a uterine myoma with degeneration.\nA diagnostic dilatation and curettage was performed. Friable tissue was recovered and frozen section revealed benign tissue. After evacuation, heavy uterine bleeding continued, and the blood pressure was 70/50 mm Hg, and the pulse rate was 130 beats per minute. An emergency hysterectomy was recommended with consent of the family. At the time of surgery, the uterine surface was shown to be smooth and there were no abnormal findings in the abdominal and pelvic cavity. Her vital signs recovered after transfusion of four units of packed red cells and two units of fresh frozen plasma. A total abdominal hysterectomy and incidental appendectomy were performed. The hysterectomy specimen showed a 9.0×6.0 cm red-brown mass adherent to the myometrium. The histopathlogic examination revealed a retained placenta accreta without atypical trophoblastic cells (). Her postoperative condition remained stable and she had a favorable progress. She was discharged 6 days later.
|
[[41.0, 'year']]
|
F
|
{'30510825': 1, '6966777': 1, '2126811': 1, '25538926': 2, '7665112': 1, '8638190': 1, '15339764': 1, '3435368': 1, '26495146': 2, '15512611': 1, '299782': 1, '17924226': 1, '24328004': 2}
|
{'4260288-1': 1, '4260288-2': 1, '4606209-1': 1}
|
163,456 |
3784115-1
| 24,328,000 |
noncomm/PMC003xxxxxx/PMC3784115.xml
|
A case report of prenatally diagnosed tetrasomy 18p
|
A 28-year-old primi gravid woman was referred to our fetal treatment center because of suspected fetal congenital heart disease at 32+4 weeks of gestation. The ultrasonography showed asymmetric intrauterine growth retardation (IUGR) with 5-week smaller abdominal circumference. The fetal echocardiography demonstrated dextrocardia with cardiomegaly (cardio-thoracic ratio, 0.64), mild pericardial effusion, and decreased left ventricular function (modified myocardial performance index, 0.68). There was no intracardiac abnormality. Doppler findings in the middle cerebral artery revealed increased peak systolic velocity (71 cm/sec, 1.3-1.5 MoM), which suggested fetal anemia. Imperforate anus was also suspected. The cordocentesis was performed at 33+2 weeks of gestation for identifying the karyotype, hemoglobin, and the presence of viral infection. The karyotyping confirmed tetrasomy 18p by G-banding and fluorescence in situ hybridization (). Fetal hemoglobin level was 9.7 g/dL and there was no evidence of viral infection such as toxoplasma, rubella, cytomegalovirus, and herpes simplex virus.\nThe male infant was delivered at 36+6 weeks of gestation; weighing 2,256 g, which was below 10 percentile. Apgar score was 6, 8 at 1, 5 minutes, respectively. Because of low oxygen saturation (76%), the baby was admitted to the neonatal intensive care unit. Initial hemoglobin level was 11.4 g/dL, and after transfusion of packed red blood cells, his oxygen saturation got over 97% without applying oxygen. Low-set ears with small auricles were shown () and muscle tone was increased. The postnatal echocardiography and cardiac computerized tomography revealed dextrocardia and mild cardiomegaly without pericardial effusion, and the cardiac function was within normal range. As prenatally suspected, the baby had a low type of imperforate anus, and underwent anoplasty. Swallowing difficulty was also found and after feeding rehabilitation therapy, the baby could be fed. There were no other abnormalities on further evaluations.\nAt the age of 3 months, the brainstem auditory evoked potentials and auditory brainstem response revealed right sensorineural hearing loss due to the peripheral conduction defect. The follow-up echocardiography still showed dextrocardia without cardiomegaly. The baby was scheduled for the developmental test.
|
[[28.0, 'year']]
|
F
|
{'30946338': 1, '20964117': 1, '20803640': 1, '11343341': 1, '9766419': 1, '22205896': 1, '16411237': 1, '8840117': 1, '20300761': 1, '20420032': 1, '6334486': 1, '16651677': 1, '33826125': 1, '28868271': 2, '17132906': 1, '24328000': 2}
|
{'5568194-1': 1}
|
163,457 |
3784121-1
| 24,328,002 |
noncomm/PMC003xxxxxx/PMC3784121.xml
|
A case of successful salvage chemotherapy of recurrent ovarian sertoli-leydig cell tumor
|
A 57-year-old multiparous woman presented with abdominal distension for one year. Her menopause was at 50 years of age. On physical examination, the abdomen was distended with a large pelvic mass. A computed tomography (CT) scan of the abdomen and pelvis revealed a 16.0×11.5 cm complex cystic and solid pelvis. Laboratory tests revealed an elevated serum CA-125 (113.5 U/mL). Other tumor markers including α-fetoprotein, lactate dehydrogenase, carcinoembryonic antigen and CA-19-9 were within the normal range.\nAn exploratory laparotomy was performed with findings of a mobile complex left ovarian mass, and no evidence of disease spread. Frozen biopsy revealed sex-cord stromal tumor. A total abdominal hysterectomy with bilateral salpingo-oophorectomy, peritoneal cytology, total omentectomy, incidental appendectomy, peritoneal biopsy, and pelvic and para-aortic lymph node dissection was performed. The permanent histopathologic exam confirmed a Sertoli-Leydig cell tumor of the left ovary, with intermediate differentiation and retiform elements (). The right salpinx was involved by the tumor cells and the peritoneal cytology was positive for tumor cells. Preoperative and postoperative hormone studies were within the normal range. The patient received three cycles of chemotherapy with bleomycin, VP16, and cisplatin. After eight months, a follow-up CT showed a newly developed irregularly-shaped mass around the hepatic flexure. The serum CA-125 level was 42.32 U/mL. She received twelve cycles of chemotherapy with paclitaxel and carboplatin. A CT scan after completion of the second-line chemotherapy showed complete remission of the recurrent lesion and the serum CA-125 level returned to the normal range. The patient was started on follow-up visits, and the patient was disease-free 51 months after completion of salvage treatment.
|
[[57.0, 'year']]
|
F
|
{'2685680': 1, '1275030': 1, '3911780': 1, '11205710': 1, '17617526': 1, '15337800': 1, '3000670': 1, '28501984': 1, '7237384': 1, '8602303': 1, '24328002': 2}
|
{}
|
163,458 |
3784122-1
| 24,328,001 |
noncomm/PMC003xxxxxx/PMC3784122.xml
|
Conservative multidisciplinary management of placenta percreta following in vitro fertilization
|
A 35-year-old nulliparous woman was referred at 24 weeks' gestation to our clinic with regular uterine contractions. She had a history of primary infertility due to bilateral occlusion of the fallopian tubes, and had undergone 10 cycles of IVF. She had no relevant family or medical history. Pelvic examination on admission revealed that the membranes were intact and that the uterine cervix was 90% effaced and 3 cm dilated. Vital signs were stable and microbiological examination revealed no abnormalities of the urine sample or vaginal swab.\nSonographic examination showed a vertex presentation, fetal biometry compatible with 24 weeks' gestation, an estimated fetal weight of 603 g, and location of the placenta in the right fundus with thinning of the myometrium. MRI of the pelvis was performed to confirm placental invasion. Axial and coronal T2-weighted MRI showed that placental tissue occupied the superolateral aspect of the fundus, and that the full thickness of both the myometrium and the uterine serosa was involved. There were no signs of placental invasion of adjacent organs ().\nOn admission, tocolytics were commenced to suppress the regular uterine contractions. Betamethasone was also administered to facilitate fetal pulmonary maturation. Despite these measures, the uterine contractions intensified and progressive changes in the uterine cervix were observed; thus, tocolytic therapy was discontinued 6 hours post-admission. The parents were fully informed of the potential complications associated with preterm birth and placenta percreta, and they decided that vaginal delivery should be attempted. Intrapartum fetal heart rate monitoring showed a reassuring pattern. A female newborn weighing 669 g was delivered 30 minutes after stopping tocolytics by spontaneous vaginal delivery, with Apgar scores of 2 and 4 at 1 and 5 minutes, respectively. The newborn was transferred immediately to the neonatal intensive care unit.\nSpontaneous delivery of placental tissue did not occur, and a decision was made to leave the placenta in situ. No significant hemorrhage occurred in the 1 hour period post-delivery. Pelvic arterial embolization was performed at the 1 hour post-delivery to prevent hemorrhage at the time of placental separation. Under fluoroscopic guidance, the bilateral uterine arteries were selectively catheterized and embolized with absorbable gelatin sponge pledgets.\nSix hours after delivery, maternal tachycardia and vaginal bleeding occurred, and placental detachment or uterine rupture was suspected. Therefore, a decision was made to remove the placenta in the operating room under general anesthesia. Most of the intrauterine placenta was removed vaginally using placental forceps under transabdominal sonography guidance. Emergency laparoscopy was performed, which revealed a ruptured placenta percreta with hemoperitoneum. Exploratory laparotomy was done immediately and primary resection of the remaining placental tissues and closure of the uterine wall was then performed (). The postoperative course was uneventful and the woman was discharged home 5 days postoperatively.
|
[[35.0, 'year']]
|
F
|
{'21638046': 1, '28950018': 1, '10847240': 1, '20604660': 1, '22109310': 1, '15695772': 1, '21585640': 1, '18720525': 1, '17634154': 1, '15298972': 1, '12053897': 1, '24328001': 2}
|
{}
|
163,459 |
3784123-1
| 24,328,028 |
noncomm/PMC003xxxxxx/PMC3784123.xml
|
Angiomyofibroblastoma of the vulva
|
A 40-year-old woman came to our outpatient clinic with a painless vulvar mass that started few months before, which had gradually grown. At first, she ignored the mass, because it did not have any symptoms, despite its enlargement. However, she decided that she had to go the hospital because the size of mass enlarged and she feel uncomfortable. She did not had any previous gynecological surgery and her laboratory data (complete blood cell count, creatinine, coagulation, selology) showed no significant abnormalities. Physical examination showed a hardened mass of about 2 cm in diameter of the right labia majora with tense elastic consistency. On pelvic examination, the uterus and bilateral ovary showed no abnormalities and pelvic lymph nodes were not swollen. First, the clinical impression of the mass was bartholin cyst or lipoma. Therefore, we decided that simple tumor excision was the proper treatment for the mass, and it was subsequently performed one month after as her second visit. On gross examination, the mass was well circumscribed and had a soft to firm legion with a size of about 2×2 cm; no more grown compare to one month ago as her first visit. The color of the mass cut surface was light gray to tan homogeneously. Surgical margins of the lesion were clear. Microscopically, the tumor demonstrated admixture of hypocelluar and hypercellular area in the background of edematous stroma. The abundant vessels of various wall thickness were distributed in the collagenous stroma. The stroma consisted of spindle and ovoid stromal cells with eosinophilic cytoplasm and no mitotic features or significant nuclear atypia (). The tumor also has estrogen and/or progesterone receptors and has immunoreactivity for vimentin ().\nCurrently, the patient was follow up was lost for about 7 years and we decided to follow up with her by a telephone call. She said she almost forgot about the mass removal event and there is no evidence of recurrence.
|
[[40.0, 'year']]
|
F
|
{'1314521': 1, '11428615': 1, '25648716': 2, '11293156': 1, '8980365': 1, '16943862': 1, '29854515': 2, '9298888': 1, '12819396': 1, '16681729': 1, '16001189': 1, '32477485': 2, '31391763': 2, '9023551': 1, '15278193': 1, '10672053': 1, '24328028': 2}
|
{'7246335-1': 1, '6643711-1': 1, '5949183-1': 1, '4314174-1': 1}
|
163,460 |
3784124-1
| 24,328,024 |
noncomm/PMC003xxxxxx/PMC3784124.xml
|
Failed transarterial embolization of subserosal uterine arteriovenous malformation
|
A 24-year-old woman, gravida 1 para 0, was referred to our hospital with vaginal bleeding for a week. She had a dilatation and curettage due to a missed abortion at a local hospital two months ago. After the procedure, she received an ultrasound, and heard that there were no specific findings in uterus. She had normal menstrual cycles, and no other medico-surgical history.\nOn admission, she had moderate vaginal bleeding. Transvaginal gray and color Doppler ultrasound examination demonstrated abnormal findings of increased high-velocity blood flows within the posterior myometrium (), and anechoic cystic lesion with high velocity vascular flow on the fundus of the uterus (). There was no communication between the subserosal AVM and endometrial cavity. An abdominal aortogram confirmed enlarged bilateral uterine arteries and subserosal AVM (). The AVM was additionally supplied by left ovarian artery (). Embolization of the bilateral uterine arteries and left ovarian artery was performed as treatment of choice to spare fertility. After embolization, there was no significant flow to the subserosal type AVM (). The patient tolerated the procedure well, and was discharged without problem.\nOne month later, the patient presented to the emergency room with severe abdominal pain and distension without vaginal bleeding. On admission, her blood pressure was 95/60 mm Hg, and pulse rate was 115 beat per minute. Hemoglobin was 9.5 g/dL. Abdominopelvic computed tomography scan demonstrated that the fundal AVM of uterus was ruptured, and there was a large amount of hemoperitoneum in the abdominopelvic cavity (). By emergency exploratory laparotomy, about 3×3 cm sized subserosal type AVM was noted on the fundus that had ruptured and was bleeding profusely (). The ruptured AVM was removed, and successfully repaired. The hematoma in the abdominopelvic cavity was removed. After surgery, the patient recovered well, and was discharged at hospital day 6 without complications. Five weeks later the external surface and internal area of the uterus appeared normal on ultrasonic examination.
|
[[24.0, 'year']]
|
F
|
{'2643064': 1, '18669767': 1, '21904854': 1, '22024270': 1, '17389192': 1, '12797189': 1, '10210350': 1, '10587177': 1, '25783637': 2, '12808674': 1, '9423660': 1, '16250925': 1, '23084688': 1, '17583252': 1, '24328024': 2}
|
{'4348402-1': 1}
|
163,461 |
3784128-1
| 24,328,027 |
noncomm/PMC003xxxxxx/PMC3784128.xml
|
Primary extraskeletal mesenchymal chondrosarcoma of the vulva
|
A 68-year-old woman was referred to our clinic with a diagnosis of a mass of the vulva. The patient had noticed a small but growing mass on her right vulva which had been palpated one month earlier. On physical examination, a globular, movable mass measuring about 4 cm in diameter was palpated in the right major labium. The mass was excised with a 2 cm resection margin. Frozen section biopsy of the resected specimen demonstrated a chondrosarcoma with a negative resection margin. The final pathological report confirmed a 6 × 2.8 × 2.3 cm sized EMC of the vulva revealing no microscopic lesions on the resection margins (). Tumor markers were within normal range (carcinoembryonic antigen [CEA], CA-19-9, CA-125, and alpha fetoprotein [AFP]). Immunohistochemistry was performed on the tumor to analyze the expression of vimentin, S-100 protein, desmin, and epithelial membrane antigen (EMA). The tumor was strongly positive for vimentin and S-100 protein but negative for the other markers. The patient recovered from surgery without any postoperative complications. Bone scans and chest radiographs for disease staging were negative. Thirty months following from the initial diagnosis, the patient revealed no evidence of recurrence as assessed by pelvic magnetic resonance imaging (MRI) and chest radiographs.
|
[[68.0, 'year']]
|
F
|
{'21651669': 1, '18038872': 1, '30967942': 1, '21816677': 1, '8430193': 1, '12965134': 1, '18723991': 1, '22208489': 1, '7883427': 1, '25849226': 1, '12599237': 1, '21393900': 1, '15992919': 1, '9781944': 1, '12911733': 1, '24328027': 2}
|
{'3784128-2': 2, '3784128-3': 2}
|
163,462 |
3784128-2
| 24,328,027 |
noncomm/PMC003xxxxxx/PMC3784128.xml
|
Primary extraskeletal mesenchymal chondrosarcoma of the vulva
|
A 52-year-old, postmenopausal woman visited our clinic with a complaint of a mass of the vulva. She had noticed a small but growing mass on her left vulva which had been palpated 2 months earlier. On physical examination, a globular, movable mass measuring about 2 cm in diameter was palpated in the left major labium. The mass was excised with a 2 cm resection margin. The pathological report confirmed a 4×3.8×2 cm sized EMC of the vulva revealing no microscopic lesions on the resection margins. Immunohistochemistry was performed on the tumor to analyze the expression of vimentin, S-100 protein, desmin, Pan-CK, smooth muscle actin, and EMA. She recovered from surgery without any complications. Bone scans and chest radiographs for disease staging were negative. After twenty four-month of following the initial diagnosis, the patient remains without evidence of any recurrent disease as assessed by pelvic MRI and chest radiographs.
|
[[52.0, 'year']]
|
F
|
{'21651669': 1, '18038872': 1, '30967942': 1, '21816677': 1, '8430193': 1, '12965134': 1, '18723991': 1, '22208489': 1, '7883427': 1, '25849226': 1, '12599237': 1, '21393900': 1, '15992919': 1, '9781944': 1, '12911733': 1, '24328027': 2}
|
{'3784128-1': 2, '3784128-3': 2}
|
163,463 |
3784128-3
| 24,328,027 |
noncomm/PMC003xxxxxx/PMC3784128.xml
|
Primary extraskeletal mesenchymal chondrosarcoma of the vulva
|
A 59-year-old woman was referred to gynecologic clinic with a diagnosis of the lipoma of the left vulva. She identified a small but growing mass before one month. A globular, movable mass measuring about 3 cm in diameter was palpated in the left major labium. The mass was excised with a 2 cm resection margin. Frozen section biopsy of the resected specimen demonstrated a chondrosarcoma with a negative resection margin. The final pathological report confirmed a 4×4×3 cm sized EMC of the vulva revealing no microscopic lesions on the resection margins. Tumor markers were within normal range (CEA, CA-19-9, CA-125, and AFP). Immunohistochemistry was performed on the tumor to analyze the expression of vimentin, S-100 protein, desmin, and EMA. The tumor was strongly positive for vimentin, but negative for the other markers. The patient recovered from surgery without any postoperative complications. Bone scans and chest radiographs for disease staging were negative. After twenty four-month of following-up, she did not present any recurrence as assessed by pelvic MRI and chest radiographs.
|
[[59.0, 'year']]
|
F
|
{'21651669': 1, '18038872': 1, '30967942': 1, '21816677': 1, '8430193': 1, '12965134': 1, '18723991': 1, '22208489': 1, '7883427': 1, '25849226': 1, '12599237': 1, '21393900': 1, '15992919': 1, '9781944': 1, '12911733': 1, '24328027': 2}
|
{'3784128-1': 2, '3784128-2': 2}
|
163,464 |
3784133-1
| 24,328,025 |
noncomm/PMC003xxxxxx/PMC3784133.xml
|
Liver recurrence in early endometrial cancer with focal myometrial invasion
|
In May 2007, a 69-year-old Korean woman presented at our emergency room with a chief complaint of vaginal bleeding, which had started a few days earlier. She was healthy at birth and had no history of underlying disease or a clotting abnormality. In addition, there was no history of oral medication, pregnancy, or any other gynecological/surgical problem. Transvaginal ultrasound revealed hematometra and necrotic materials in the uterine cavity. Abdomino-pelvic computed tomography (CT) revealed hematometra occupying the whole distended uterine cavity and ascites (). An endometrial biopsy obtained via dilation and curettage showed endometrioid adenocarcinoma of the uterus, grade 2 (). Her serum CA-125 level was 514.0 U/mL (normal range, <35.0 U/mL). The patient subsequently underwent surgical staging, including total abdominal hysterectomy, bilateral salpingooophorectomy, and pelvic and para-aortic lymphadenectomy. Final pathological findings revealed 2009 International Federation of Obstetrics and Gynecology stage IA endometrioid adenocarcinoma, grade 2, with focal myometrial invasion. Peritoneal washings were negative for malignant cells. The patient was then treated with adjuvant brachytherapy to a total dose of 3,000 cGy in 6 fractions of 500 cGy each. After treatment, serum CA-125 had returned to the normal range.\nThe patient remained under close follow-up every three month (CA-125 and pelvic exam) and was without any evidence of recurrent disease until November 2008. At that time, her serum CA-125 level was found to have increased to 93.03 U/mL, and a subsequent F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) scan revealed recurrent mass with abnormal FDG uptake in the liver. A liver biopsy revealed recurrent adenocarcinoma. The patient then underwent six cycles of a 3 weekly paclitaxel and carboplatin chemotherapy regimen. However, 8 months after completing chemotherapy, serum CA-125 was elevated and abdomino-pelvic CT revealed multiple recurrences. Second-line chemotherapy with 5-FU and cisplatin was attempted, but her response was poor, and her general condition became aggravated. The patient is currently under hospice care, and is being treated as a terminal cancer patient.
|
[[69.0, 'year']]
|
F
|
{'11812074': 1, '16882052': 1, '16217955': 1, '22237781': 1, '22513918': 1, '10791524': 1, '20078668': 1, '17145260': 1, '24328025': 2}
|
{}
|
163,465 |
3784134-1
| 24,328,026 |
noncomm/PMC003xxxxxx/PMC3784134.xml
|
Ovarian metastasis from pulmonary adenocarcinoma
|
A 44-year-old non-smoking Korean woman visited the local clinic with chest and back pain. A pulmonary nodule was seen on chest computed tomography (CT), and the patient was diagnosed with an unresectable pulmonary adenocarcinoma after performing bronchoscopy washing and right supraclavicular lymph node biopsy. After being diagnosed, she was transferred to Samsung Medical Center (SMC). At that time, brain, bone and pleural metastases were seen, therefore, the patient was treated with pemetrexed-cisplatin-based chemotherapy. After the forth cycle, the chest CT showed that the nodule had slightly decreased in size. At that point, the patient was planned to undergo the remaining chemotherapy cycles.\nThree weeks later, she felt abrupt low abdominal pain. She then visited the hospital and underwent CT and laboratory testing. The CT revealed no specific findings except for a myoma-like mass in the pelvis. She was then transferred back to SMC. On physical examination, a fetal head size mass was detected in the lower abdomen, and the patient felt mild abdominal pain and tenderness. Tarchycardia and a mild fever were also noted.\nUltrasound revealed, a 12.55 × 8.29 cm diffuse hypoechoic cystic mass with papillary projection in the pelvic cavity. Magnetic resonance imaging (MRI) and CT imaging revealed a 12 × 9.3 cm cystic and solid mass arising from the right adnexa as well as a torsion knob and hemorrhage, suggesting torsion of a cyst on the right ovary (). CA-125 and CA-19-9 values were within the normal ranges.\nThe patient subsequently underwent an exploratory laparotomy, during which a 10 cm right ovarian cyst with significant torsion of >720 degrees. Frozen section of the right ovarian specimen demonstrated malignancy. Bilateral salpingo-oophectomy, total abdominal hysterectomy and partial omentectomy was performed. Gross pathological examination showed 12 ×10 cm of right ovarian tumor and cystic space showing a black hemorrhage and solid portion. Microscopic pathology revealed metastatic adenocarcinoma on the right ovary, no evidence of malignancy was seen in the left ovary, uterus, or omentum ().\nAfter the surgery, a chest CT showed no interval change of the lung, pleura, lymph node size, while brain MRI showed slightly increased multiple brain metastatic lesions. Her lung cancer was followed by an oncologist who changed chemotherapy regimen to crizotinib, the target therapy. With regular follow-up imaging, she has remained on crizotinib until now (27 months), and underwent gamma knife surgery twice as well as 2 cycles of radiotherapy (brain, spine). With crizotinib, her condition and cancer mass are stable, therefore, the oncologist is continuing the target therapy.
|
[[44.0, 'year']]
|
F
|
{'16006793': 1, '3692671': 1, '20676319': 1, '16278010': 1, '17617518': 1, '9059352': 1, '34925576': 1, '25580142': 2, '20189289': 1, '6692304': 1, '20018420': 1, '17184826': 1, '27999779': 1, '7557597': 1, '34055350': 1, '24328026': 2}
|
{'4286783-1': 1}
|
163,466 |
3784135-1
| 24,328,015 |
noncomm/PMC003xxxxxx/PMC3784135.xml
|
Pulmonary embolism and deep vein thrombosis related to oral contraceptive use
|
A 24-year-old woman (gravida 0) visited our clinic due to left inguinal pain on every step and edema of left leg four months after taking Yasmin (Bayer HealthCare, New York, NY, USA). This pain and edema were started a week ago and aggravated three days ago. Her weight was 69 kg, and height 170 cm. She was a non-smoker. Her job was a company worker. The patient and family members had not suffered prior VTE. She received pelviscopic ovarian cystectomy of 5 cm sized left ovarian endometrioma at another clinic a year ago. Two weeks after operation, she was injected gonadotropin releasing hormone (GnRH) per four weeks for six months continuously. A month after sixth GnRH injection, she had started taking Yasmin 21-tablet continuously without seven-day discontinuation period for four months to prevent recurrence of endometriosis. During taking the fifth pack of Yasmin, she felt left inguinal pain on ambulation, and edema of left leg. So, she admitted our clinic. Her vital signs were as stable. Body temperature 120/80 mm Hg, pulse rate 72/min, respiratory rate 20/min, body temperature 36.5℃. She had no chest discomfort, breathing difficulties and skin color change of left leg. The circumference of her left thigh was proximal 64 cm, distal 48 cm, and right proximal 57 cm, distal 43 cm, respectively. Her left radial artery and dorsalis pedis artery were palpable well. Laboratory findings were below. Complete blood count, chemistry profile, and urine analysis were all normal range. Prothrombin time 11.6 sec (normal, 9.8 to 12.4 sec), partial thromboplastin time 96.6% (normal, 80% to 135%). Anti-cardiolipin antibody IgG/IgM, Lupus anticoagulant, Factor V Leiden (FV, Q506) were all negative. Protein C activity was 109% (normal, 70% to 130%), and protein S activity 99% (normal, 65% to 140%). D-dimer was elevated to 2.68 µg/mL (normal, 0 to 0.5 µg/mL). Chest posterial-anterial and electrocardiogram were normal findings. Chest pulmonary angiography computed tomography (CT) (contrast enhanced) showed pulmonary thromboembolism in BLLs' basal pulmonary arteries and 32-mm sized consolidation in right lower lobe posterior segment as considering pulmonary infarction (). Lower extremity venogram CT (contrast enhanced) showed thrombosis in inferior vena cava (IVC) and diffuse DVT below the level of left external iliac vein (). We injected low molecular weight heparin (LMWH) 60 mg per 12 hours subcutaneously for seven days and overlapped heparin with 4 mg warfarin five days. After five days of combined therapy, we changed to 4 mg warfarin per oral. We determined the proper dose of warfarin by a blood test reported as the international normalized ratio. She discharged with warfarin. She had taken warfarin for six months thereafter. She had normal menstrual cycles and no recurrence of PE and DVT during 12-month follow-up.
|
[[24.0, 'year']]
|
F
|
{'21511805': 1, '11463678': 1, '33794564': 1, '22219145': 1, '15963100': 1, '9263726': 1, '8644593': 1, '22065352': 1, '23090561': 1, '29904039': 1, '19679613': 1, '12234943': 1, '11357157': 1, '21511804': 1, '24328015': 2}
|
{}
|
163,467 |
3784138-1
| 24,328,014 |
noncomm/PMC003xxxxxx/PMC3784138.xml
|
Synchronous occurrence of primary malignant mixed müllerian tumor in ovary and uterus
|
A 57-year-old woman was admitted on January 2011 because of irregular vaginal bleeding for the last 10 months and recently aggravating in amount. She experienced the menopause on her age of 50. She had visited other clinic on June 2010 and was advised to follow up for the uterine tumor. Her family history was not contributory. Vital signs were within normal range and consciousness was clear. On physical examination, no abdominal tenderness or rebound tenderness was identified. Necrotic tissue covered with blood clot was noticed on cervix observed through vaginal speculum. The results of complete blood count, urinalysis, serologic tests, electrocardiogram, and chest X-ray were within normal range. Serum CA-125 and CA-19-9 levels were 12 U/mL and 2 U/mL, respectively. On abdominopelvic computed tomography (CT) examination, a mass of 8 cm in diameter arising from uterine corpus and 5.5 cm sized cystic and solid mass on right ovary were identified ().\nExplo-laparotomy was performed on February 2011 under the impression of endometrial cancer with ovarian metastasis. Low midline incision was placed under general anesthesia. Right ovarian mass was fixed on the posterior aspect of uterus and rectal wall by dense adhesive band and surrounded by necrotic tissue debris and blood clot. Extrafascial hysterectomy and bilateral adnexectomy was performed. Right ovarian mass was ruptured during the manipulation. Poorly differentiated sarcoma was suspected from frozen biopsy of both uterus and right ovary. Left adnexa was grossly free of tumor. However, multiple metastases of diameter 0.5 to 2 cm were identified on greater omentum. Partial omentectomy and appendectomy was performed. Small metastatic nodules were identified and all removed from right pelvic wall and mesentery of small intestine. No gross residual tumor was left.\nOn gross examination, huge polypoid mass of 8×4 cm was identified in uterine cavity and two myomatous nodule in myometrium. Cervix and both fallopian tubes were free of tumor (). On microscopic examination, endometrial tumor was composed of mostly invasive cells with large and polymorphic nucleus with pale and distinct plasmid. Sarcomatous component was overwhelming and included small area of adenomatous component which was attributed as adenosarcoma of MMMT (). Immunohistochemical staining with CD10 of both ovary and uterus was positive. The tumor arising from ovary was mostly composed of sarcoma while the individual cells looked different from those of uterine tumor and did not include adenomatous component (). The metastatic nodules showed the histologic feature that are similar to that of the ovarian tumor suggesting the metastases originated from the ovary. This case was diagnosed as primary MMMT arising from uterus and from ovary as well.\nOral intake was initiated on postoperative day 3 and no significant complication was noticed. She was discharged on day 9 and three cycles of chemotherapy with paclitaxel 175 mg/m2 plus carboplatin with area under the curve (AUC) 5. The follow-up was lost because she refused further treatment.
|
[[57.0, 'year']]
|
F
|
{'19772676': 1, '19133051': 1, '6263458': 1, '15099942': 1, '8175017': 1, '2156771': 1, '4371193': 1, '15139057': 1, '9576296': 1, '28546804': 1, '2982713': 1, '27718181': 1, '20688363': 1, '3457508': 1, '12051874': 1, '11606097': 1, '17451459': 1, '30150919': 2, '24328014': 2}
|
{'6107091-1': 1}
|
163,468 |
3784139-1
| 24,328,012 |
noncomm/PMC003xxxxxx/PMC3784139.xml
|
Development of Purtscher-like retinopathy after pre-eclampsia combined with acute pancreatitis
|
A 33-year-old primigravida was transferred to the Kyung Hee University Medical Center for preterm labor and pre-eclampsia at 36+4 weeks gestation. She had a twin pregnancy after in vitro fertilization-embryo transfer. Her blood pressure measured 140/100 mm Hg. Her urine protein was 4+ and 24-hour urinary protein excretion was 2,333 mg/day. She did not have headache, visual disturbances, or pitting edema. She had regular uterine contractions and a cervix dilated about 2 cm. An emergency cesarean section was performed uneventfully, and healthy twin babies were born.\nOn the second postoperative day, the patient had abdominal distension, steady epigastric and whole abdominal pain. An abdominal X-ray examination showed paralytic ileus. Laboratory examination showed white blood cell (WBC) count of 11,890, low Ca+ of 6.4 mg/dL, elevated blood urea nitrogen (BUN) of 64 mg/dL, serum creatinine of 1.5 mg/dL, aspartate transaminase (AST) of 52 IU/L, alanine aminotransferase (ALT) of 21 IU/L, elevated C-reactive protein (CRP) of 20.74 mg/dL, triglyceride 1,080 mg/dL and otherwise non-specific. At that time, she started complaining of blurry vision. Because pre-eclampsia-related visual disturbances are common, we did not perform a formal ophthalmic examination. We decided on conservative management including nasogastric drainage, parenteral nutrition, non per os, pain control, and avoidance of toxic renal medications.\nOn the fifth postoperative day, the patient had flank pain, diarrhea, tachycardia (pulse 112 per minutes) and fever (38℃). Laboratory examination showed WBC count of 14,900, low Ca+ of 5.6 mg/dL, AST of 61 IU/L, ALT of 33 IU/L, elevated CRP of 8.56 mg/dL, and normalized BUN and serum creatinine. Bacterial cultures were taken from blood and urine, and antibiotics were started. Her visual loss was equivocal.\nThe patient still had epigastric pain, a fever (38.3℃) and visual loss in both eyes until eight days after operation. At this point, we therefore decided to do an abdominal computed tomography (CT) scan and an ophthalmology consultation. The abdominal CT scan showed enlargement of pancreas with fat infiltration, fluid collection in the pancreatic area and no other abnormal findings. Serum amylase and lipase levels were elevated at 149 U/L (normal range, 25 to 125 U/L), and 128 U/L (normal range, 5.5 to 58 U/L) respectively, on the day of CT scan. The patient was diagnosed as having acute pancreatitis based on her steady epigastric pain and abdominal CT scan. She recovered fully upon resolution of pancreatic necrosis with conservative management and drainage of the underlying fluid collection.\nOn the same day, the patient underwent an ophthalmologic examination, and her visual acuity test was 0.02 (right) and finger count 30 cm (left). There were multiple discrete retinal changes, and macular yellow patches, known as Purtscher flecken, in both eyes. A retinal splinter hemorrhage was seen in the right eye upon retinal photography (). A fluorescein angiogram showed arteriolar occlusion, and retinal ischemia, typical signs of Purtscher-like retinopathy. She was diagnosed with Purtscher-like retinopathy based on her symptoms and the results of the ophthalmologic examinations. Because there are no definite guidelines for the treatment of this condition, her visual acuity was closely monitored with conservative management. We also performed a brain magnetic resonance imaging (MRI) to rule out cortical blindness. The brain MRI showed unremarkable findings (). Two months after onset of visual loss, her visual acuity test was 0.08 (right) and 0.01 (left) and the multiple yellowish patches had decreased in both eyes on retinal photographs. At a recent follow-up (two years after the onset of her visual symptoms), her corrected visual acuity was 0.2 (right) and 0.1 (left). There was gradual improvement in the visual functions of both eyes, but she still had visual impairment.
|
[[33.0, 'year']]
|
F
|
{'28275964': 2, '16500213': 1, '22852104': 2, '17452181': 1, '12365700': 1, '22495060': 1, '12555046': 1, '27846860': 2, '18716785': 1, '32709768': 1, '17556428': 1, '16147620': 1, '15007192': 1, '24328012': 2}
|
{'5111279-1': 1, '5876418-1': 1, '3407612-1': 1}
|
163,469 |
3784143-1
| 24,328,016 |
noncomm/PMC003xxxxxx/PMC3784143.xml
|
Gynecologic complication of chronic graft-versus-host disease: Vaginal obstruction
|
A 43-year-old, gravida 4, para 2 woman came to the gynecology clinic for counseling about premature menopause. She had been diagnosed with acute myeloid leukemia 2 years earlier and treated with induction and consolidation chemotherapy using idarubicin and cytosine arabinoside. After developing complete remission, physician recommended patient to have gynecological examination. At the gynecology clinic office, gynecologist conducted pelvic examination with Papanicolaou (Pap) test. The uterine cervix revealed cooper intrauterine device (IUD) tail string which got stuck into exocervix, but otherwise non-specific finding (). Of course the IUD was immediately removed. The result of Pap test was reactive cellular changes. Eleven days after gynecologic consultation, patient underwent Allo-PBSCT and the donor was her younger brother. There was no evidence of residual disease on a bone marrow biopsy performed 10 months after transplantation.\nTwenty-six months after Allo-PBSCT, she revisited our gynecology clinic and it was found that her follicle-stimulating hormone level was greater than 100 IU/mL and estradiol was 4.14 pg/mL. By reviewing the patient medical record and taking a medical history, it was found that when she started chemotherapy, her menstrual cycle completely disappeared. About one year after chemotherapy, the patient tried coitus with husband, but vaginal dryness and dyspareunia were very severe, so could not have sexual intercourse. However, patient had no other menopausal symptoms like hot flush, sleep disturbance, mood swing and so on. To introduce sequential hormone replacement therapy (HRT), we performed clinical examination. The clinical examination revealed extensive vulvar atrophy with flattening but otherwise non-specific appearance including uterine cervix. After that, the patient started sequential HRT.\nFourteen months after initiation of HRT, it was discovered that her upper vaginal canal was completely obstructed (). The lower vagina had a normal appearance. The human papillomavirus (HPV) deoxyribonucleic acid (DNA) chip test and Pap test were conducted in vagina not in uterine cervix because of obstruction of upper vaginal canal. The HPV DNA chip test was positive for HPV (other type) in the vagina. The Pap test was negative. Trans-rectal ultrasonographic findings were hematocolpos and atrophic uterus (). We explained the results to the patient and provided reassurance. The patient is currently being treated with tibolone and we recommended non-hormonal moisturizing vaginal gel and vaginal dryness and dyspareunia were much improved.\nHere, we present the case of a woman who after Allo-PBSCT, showed obstruction of the upper vagina as a chronic complication of GvHD.
|
[[43.0, 'year']]
|
F
|
{'12091329': 1, '12069746': 1, '7004534': 1, '27095951': 1, '12123398': 1, '7231460': 1, '27802832': 1, '11843399': 1, '16545722': 1, '12414005': 1, '10100570': 1, '6750475': 1, '30793107': 1, '28503642': 2, '19282026': 1, '10517692': 1, '9827972': 1, '12114271': 1, '7033104': 1, '24328016': 2}
|
{'5412147-1': 1}
|
163,470 |
3784146-1
| 24,328,013 |
noncomm/PMC003xxxxxx/PMC3784146.xml
|
Prune-belly syndrome detected by ultrasound in the first trimester and the usefulness of vesicocentesis as a modality of treatment
|
A 36-year-old woman (gravida 1, para 0) at gestational age of 11+6 weeks was transferred to our hospital for further evaluation of the suspected fetal abdominal cyst. She had been diagnosed with diabetes mellitus 2 years before and had regular insulin injections. Otherwise, she had neither familial nor past medical history. Ultrasonography at our hospital confirmed enlarged fetal bladder with the size of 2.7×2.5 cm () but the classic 'key hole sign' was absent. Other fetal biometric values were appropriate for the gestational age; crown rump length (CRL) 45 mm, neural tube (NT) 0.7 mm.\nChorionic villus sampling resulted in 46, XY karyotype. Based upon informed consent, vesicocentesis with 22-gauge spinal needle was performed under ultrasonographic guidance (Voluson E8, GE Medical Systems Kretztechnik GmbH & Co. OHG, Zipf, Austria). The aspirated fetal urine was analyzed. As fetal bladder was not enlarged again until 1 week after vesicocentesis, the procedure seemed to be effective. However, the pregnancy was interrupted because the patient and her husband changed their mind and strongly requested termination of pregnancy. Postmortem gross examination confirmed prenatal ultrasooographic diagnosis. Besides, undiagnosed anomalies were identified; bilateral cleft lip, cleft palate, bilateral club feet, and polydactyly ().
|
[[36.0, 'year']]
|
F
|
{'28573127': 1, '19112462': 1, '9819877': 1, '25505': 1, '11778997': 1, '10830822': 1, '18053783': 1, '18631918': 1, '20504067': 1, '28580040': 1, '2187354': 1, '11330729': 1, '16135579': 1, '11056030': 1, '3062156': 1, '22198807': 1, '24328013': 2}
|
{}
|
163,471 |
3784680-1
| 24,083,214 |
noncomm/PMC003xxxxxx/PMC3784680.xml
|
Florid osseous dysplasia in a middle-aged Turkish woman: A case report
|
A 42-year-old female patient was admitted to the Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University with a complaint of bleeding on the gums. The patient's medical history included having undergone treatment for pernicious anemia and a gastric ulcer two years earlier. On intraoral examination, the patient was asymptomatic except for a few restored and missing teeth.\nA lesion was found incidentally on routine periapical radiographs taken for the restored teeth and edentulous areas (). Radiopaque masses were coincidentally observed in the periapical radiographs but the exact boundaries of the masses could not be seen. For further and more detailed examination, cone-beam computed tomography (CBCT) and a panoramic radiograph were taken. The panoramic radiograph and CBCT revealed maxillary bilateral and symmetrical, well-defined, round, radiopaque masses in contact with the root of the maxillary right second molar and left first molar teeth. Lobular, irregularly shaped radiopacities with clear radiolucent demarcation were also present in the right edentulous mandibular molar area ( and ). The bucco-lingual aspects of the lesions were best visualized on the axial CBCT image (). CBCT added valuable radiographic information regarding the relationships of the lesions with significant anatomical structures, cortical plates, and tooth roots. After ethyl chloride application, the teeth were found to be vital. The overlying mucosa and gingiva had no signs of inflammation. A diagnostic biopsy was taken from the right mandibular molar area under local anesthesia. The obtained specimen was sent for a histopathological examination. Dirty yellow, bone-hard tissues of 1 cm×1 cm×0.6 cm dimensions were analyzed in this examination. On the basis of the histopathologic findings, the tumor was diagnosed as FOD (). Because of the asymptomatic nature of the tumor, no further treatment was proposed. The patient was advised to have routine follow-up examinations at six-month intervals. The patient has been encouraged to maintain an effective oral hygiene program. The case has been followed up over the last 14 months and has remained asymptomatic.
|
[[42.0, 'year']]
|
F
|
{'16060474': 1, '16429193': 1, '17767096': 1, '12942053': 1, '20819127': 1, '27601835': 2, '18525072': 1, '20069261': 1, '29721232': 1, '12917278': 1, '9638705': 1, '29963485': 2, '15849576': 1, '9470284': 1, '24083214': 2}
|
{'4989573-1': 1, '6015922-1': 1}
|
163,472 |
3784681-1
| 24,083,215 |
noncomm/PMC003xxxxxx/PMC3784681.xml
|
A repeatedly recurrent desmoplastic ameloblastoma after removal and allobone graft: Radiographic features compared with histological changes
|
A 40-year-old man visited the Chosun University Dental Hospital with a tender swelling on his anterior palatal area. The overlying mucosa appeared normal and all the teeth in the affected area were caries free and reacted positively to both thermal and electrical stimuli. His medical history was non-contributory.\nA panoramic radiograph revealed a multilocular and mixed radiolucent/radiopaque expansile lesion extending from the right second premolar to the left canine of the maxilla, presenting a soap bubble appearance in the middle third of the lesion, and ill-defined radiopacity in the left third of the lesion (). The lesion showed an often curved and scalloped border extending to the middle portion of the roots of the upper anterior teeth. The lesion was diagnosed provisionally and radiographically as ameloblastoma with histological evidence of a developmental cyst showing a cystic structure lined by epithelium with incisional biopsy (). After endodontic treatment of multiple upper anterior teeth, he underwent enucleation of the lesion and an allobone graft by an oral surgeon. Histopathologically, the enucleated mass showed unicystic ameloblastoma with peripheral palisading of hyperchromatic epithelium and loose fibrous stroma (). The fistula formation process near the bone graft area was persistent. After being treated repeatedly with antibiotics and dressing for about 5 months, he finally underwent removal of the allobone.\nFour years after the first surgery, a recurrent tumor was found in the same area. A panoramic radiograph showed a unilocular cystic radiolucency in the area corresponding to the right part of the primary lesion (), and re-enucleation of only the cystic lesion and Tutoplast grafting were performed. Histopathologically, the enucleated mass had changed from a developmental cyst to the desmoplastic type of ameloblastoma that contained small islands and thin cords of ameloblastic epithelium within a dense fibrous connective tissue stroma ().\nThe patient returned with the symptom of mild pain at the site of the operation 5 years after the second surgery. A panoramic radiograph revealed a soap bubble appearance in the periapical area of the right first and second molars (). On the axial cone-beam computed tomographic (CBCT) images, multiple small cyst-like structures were found adjacent to the maxillary sinus and in the anterior area, which were separated by normal bone. The lesion at the molar area was well demarcated from the maxillary antrum (). Sagittal CBCT images showed small loculations in the molar and anterior area, respectively, and they were separated by normal bone (). The tumor showed a relatively defined border, and it was adjacent to the maxillary sinus ().\nFinally, the tumor histology became a follicular pattern next to the desmoplastic type that contained small cystic tumor islands and thin cords of ameloblastic epithelium within connective tissue stroma ().
|
[[40.0, 'year']]
|
M
|
{'18091060': 1, '26557637': 1, '1484205': 1, '10594850': 1, '25298945': 2, '8233435': 1, '17234534': 1, '33037797': 1, '23633444': 1, '6587306': 1, '15498648': 1, '12464906': 1, '3143780': 1, '3472145': 1, '21723654': 1, '16429706': 1, '26261564': 1, '11402276': 1, '8464613': 1, '12040207': 1, '9081764': 1, '26984790': 2, '10052385': 1, '7633291': 1, '20971659': 1, '1941336': 1, '19631576': 1, '3886859': 1, '8890057': 1, '9766545': 1, '11377234': 1, '21159544': 1, '21459020': 1, '9861335': 1, '8218083': 1, '24083215': 2}
|
{'4181134-1': 1, '4793556-1': 1}
|
163,473 |
3784682-1
| 24,083,216 |
noncomm/PMC003xxxxxx/PMC3784682.xml
|
A rare case of dilated invaginated odontome with talon cusp in a permanent maxillary central incisor diagnosed by cone beam computed tomography
|
A healthy 24-year-old male patient visited the Department of Conservative Dentistry and Endodontics with complaints of mild pain and swelling in relation to a maxillary left central incisor that had lasted for a week. Extraoral examination revealed no abnormality. On intraoral examination, the right mandibular first molar, which had been extracted a few months earlier due to caries, was missing. There were metallic restorations in some posterior teeth. The left maxillary central incisor had a diffuse concavity in the mid labial surface, and the tooth was labially placed in relation to the other maxillary incisors (). On the palatal aspect, a pronounced cingulum, or talon cusp (Type I), was observed (). The tip of the talon cusp had a deep pit formation. The tooth did not respond to an electric pulp test. The tooth was tender on percussion.\nConsidering the unusual anatomy observed clinically, it was decided to perform CBCT imaging (Kodak 9500 Cone Beam 3D system, Carestream Health Inc., Rochester, NY, USA) in order to evaluate the anatomy radiographically and reach a treatment plan. The exposure parameters of CBCT were 90 kVp tube voltage, 10 mA tube current, and the images were obtained with a voxel size of 0.20mm×0.20 mm×0.20 mm. The exposure time was 10.8 seconds. The images were examined with Carestream 3D Imaging software (Atlanta, GA, USA). The CBCT panoramic image of the affected tooth () showed an image resembling a wide immature root apex. Based on the image and clinical symptoms, a treatment of apexification with mineral trioxide aggregate (ProRoot MTA, Dentsply, Tulsa Dental Specialties, Tulsa, OK, USA) would usually have been considered. However, as the pulp space in the crown portion was not clearly visible on the panoramic radiograph, CBCT reconstructed 3D images were examined in order to further evaluate the anatomy of the tooth prior to attempting endodontic treatment. The images focusing on the maxillary left central incisor were also obtained in sagittal, coronal, and axial planes of 200-µm slice thickness.\nThe reconstructed 3D CBCT images of the involved tooth revealed a complex structure comprising a ring-like formation of the root, and the labial view showed the root surface to be much broader than the contralateral incisor (). The parasagittal sections of the CBCT clearly showed the invagination between the crown proper and talon cusp and extending beyond the crown root junction, at which point the invagination dilated to form a huge ring-like structure in the root. The talon cusp also showed the presence of traces of pulpal tissue within (). The CBCT axial images revealed the pulp space to be compressed and discontinuous within the ring ().\nBased on the clinical and radiographic findings, the diagnosis of dens invaginatus of the most severe variant, termed dilated invaginated odontome, was made in the maxillary left central incisor with talon cusp associated with periapical pathology. As the CBCT revealed a very complex root canal anatomy not amenable to successful cleaning and shaping, the choice of surgical or non-surgical endodontics was ruled out. This was explained to the patient, consent obtained, and the tooth was extracted under local anesthesia. Histological examination was performed for the soft tissue within the ring-like structure. After extirpation of the soft tissue, a distinct invagination pit formation was seen at the beginning of the dilation of the root (). The histological examination of the contents of the invagination revealed that it was not pulp tissue but comprised of a vascular fibrous connective tissue exhibiting a mixed inflammatory cell infiltrate comprising polymorphs, lymphocytes, plasma cells, and focal aggregates of Russell bodies. Basophilic material suggestive of microorganisms was also present ().
|
[[24.0, 'year']]
|
M
|
{'10332241': 1, '26989523': 2, '11310143': 1, '20123392': 1, '21966333': 2, '22814684': 1, '5262843': 1, '34943493': 2, '30175195': 1, '13477660': 1, '19298576': 1, '10530205': 1, '19133103': 1, '10442951': 1, '21424052': 1, '26858491': 1, '7568721': 1, '24083216': 2}
|
{'8700689-1': 1, '3178899-1': 1, '4771879-1': 1}
|
163,474 |
3784683-1
| 24,083,217 |
noncomm/PMC003xxxxxx/PMC3784683.xml
|
CBCT findings of periapical cemento-osseous dysplasia: A case report
|
A 45-year-old Iranian woman was referred to the private clinic in the city of Hamadan for implant consultation. Her past medical history was not notable, and there was no evidence of systemic disease. She had no history of trauma to the mandible. In the extra-oral examination, no abnormal symptoms were observed. Intra-oral examination revealed normal oral mucosa, the absence of soft tissue expansion, and teeth of a normal color. Periodontal tissues were normal. All of the teeth were asymptomatic, with no pain or tenderness on percussion or palpation. The involved teeth were vital in an electric stimulation test.\nFor assessment before implant insertion, CBCT had been ordered. During evaluation of the implant insertion areas on Promax3D CBCT (Planmeca OY, Helsinki, Finland), a radiolucent-radiopaque mixed lesion located on the apices of the lower incisors was observed. On the axial, sagittal, and coronal CBCT images, the extension of the lesion was observed from the mesial side of the right mandibular lateral incisor to the distal side of the left mandibular lateral incisor. It was a multifocal lesion in which solitary lesions were reached together and made a larger lesion. The total dimension of the lesion was about 16.6 mm in the mesiodistal direction and 6.9 mm in the longest superior-inferior direction. On the panoramic reconstructed CBCT image, the lesion associated with the left mandibular lateral incisor was radiolucent, whereas the lesion on the apex of the left central incisor was mixed radiolucent-radiopaque and the lesion associated with the right central incisor was radiopaque with a radiolucent rim around the lesion of this tooth ().\nBy using the CBCT, the state of the lesion relative to the buccal and lingual cortical plates could be assessed, which might not be possible on the conventional radiographs. On the axial image, two expansion and thinning areas of the buccal cortex were revealed. One of them was located at the mesial side of the right canine and the other between the left central and lateral incisors (). On the axial and cross-sectional images, the discontinuity of the lingual cortex was found at the area between the two central incisors on several consecutive sectional images (). This cortical discontinuity was more obvious on the three-dimensional (3D) CBCT images (). However, it should be considered that the cortical bone could be seen to have destruction on 3D images, even though it would have been thin without discontinuity on the cross-sectional images.\nOn the digital periapical radiograph that was taken for further follow-up, a typical feature of PCOD was observed (). There was no root resorption or tooth displacement. The lamina dura surrounding the apical areas of the involved teeth was lost. Periodontal ligament space widening was found, especially around the root of the left lateral incisor.\nBased on the patient clinical and radiographic findings, a diagnosis of multifocal periapical cemento-osseous dysplasia was made. No treatment was considered. The only recommendation was periodic radiographic follow-up.
|
[[45.0, 'year']]
|
F
|
{'20614314': 1, '21755799': 1, '29284472': 1, '26730374': 1, '33678062': 1, '6593423': 1, '7970604': 1, '21346079': 1, '8957829': 1, '14117363': 1, '25576510': 1, '14569813': 1, '21683027': 1, '29721232': 1, '21467823': 1, '29963485': 2, '8236819': 1, '31640721': 1, '34300216': 1, '10489168': 1, '12917278': 1, '18757721': 1, '9927089': 1, '24083217': 2}
|
{'6015922-1': 1}
|
163,475 |
3784880-1
| 24,083,178 |
noncomm/PMC003xxxxxx/PMC3784880.xml
|
Pancreatic paraganglioma: An extremely rare entity and crucial role of immunohistochemistry for diagnosis
|
A 55-year-old lady presented to our hospital with a complaint of epigastric discomfort and swelling in left side of the abdomen for preceding 3 months along with slight dragging sensation. Her family history and past history was unremarkable. The physical examination of abdomen revealed a palpable, non-tender lump over left hypochondrium extending up to midline and mild tenderness in epigastrium. No palpable lymphadenopathy of supraclavicular, cervical, and inguinal region were detected. She was normotensive. Her total blood count was within normal limit, except low hemoglobin level. Biochemical investigations for urea, creatinine, and RBS showed normal physiological values. Urine examination for vanil mandelic acid (VMA) was within normal limits. Liver function tests and Chest X-ray were normal. The Ultrasonography revealed a lesion in the tail of pancreas with differential diagnosis of pancreatic malignancy and metastatic tumor. Further imaging by CECT revealed the lesion as multicystic, size of 17 cm × 19 cm [] with an impression of a malignant pancreatic tumor. In color Doppler study, the tumor appeared to be highly vascular. The patient underwent exploratory laparotomy. On gross examination, the tumor was well-circumscribed, round, like a football with glistening surface reddish-brown in color and measured 17 cm × 19 cm. On cut section, the tumor revealed a thickened capsule of size 1.2 cm. The entire tumor mass underneath the capsule showed extensive necrosis, cystic, and hemorrhagic areas []. Microscopically, the tumor composed of oval to round cells arranged in an organoid and trabecular pattern, separated by a delicate vascular network, giving an appearance of classic Zellballen pattern []. The tumor cells have abundant acidophilic cytoplasm containing granules with moderate variation in size and shape and insignificant mitosis. Areas of variable necrosis and hemorrhage were noted []. Immunohistochemistry for chromogranin A showed characteristic punctate pattern of staining by cytoplasmic granules of tumor cells [] and S-100 nuclear immunoreactivity shown by thin lining of sustentacular cells encircling the nests. The cytokeratin was non-reactive and Ki67 labeling was <2%. Therefore, morphology, immunohistochemical features were consistent with extra adrenal paraganglioma. The patient's post-operative course was unremarkable. There was no evidence of disease recurrence at 10 months of follow up with ultrasonography post-operatively.
|
[[55.0, 'year']]
|
F
|
{'18607119': 2, '26801079': 2, '21623107': 1, '23256053': 1, '25624744': 1, '34621864': 2, '26945413': 1, '26309372': 1, '21811702': 2, '33968704': 1, '2912871': 1, '21546704': 1, '34712035': 2, '24083178': 2}
|
{'3144596-1': 1, '3144596-2': 1, '3144596-3': 1, '4722732-1': 1, '8515802-1': 1, '8462202-1': 1, '2627194-1': 1}
|
163,476 |
3784882-1
| 24,083,180 |
noncomm/PMC003xxxxxx/PMC3784882.xml
|
Acute mania after thyroxin supplementation in hypothyroid state
|
A right-handed 27-year-old unmarried Indian male nondiabetic, normotensive, vegetarian was diagnosed with hyperthyroidism 7 months earlier [antithyroid peroxidase antibody: 16.1 (reference range: 0–65) IU/mL, T3: 5.59 (reference range: 0.92–2.33) nmol/L, T4: 207.30 (reference range: 60–120) nmol/L, thyroid stimulating hormone (TSH): 0.05 (reference range: 0.35–5.5) IU/ mL, 99mTc-pertechnetate thyroid scan suggestive of thyroiditis] and started on medications (neomercozole 30 mg/day) by an endocrinologist. Three months later he started complaining of weakness and lethargy and upon investigating his TSH levels were raised significantly [TSH: 32.7 IU/mL, T4: 8.6 (reference range: 12–22) pm/L, ultrasonography thyroid—both lobes mildly hyperechoic and heterogenous in pattern with no definite nodule or calcification seen] and he was shifted to thyroxine 25 μg per day in view of hypothyroidism. Subsequently, after about a week of treatment, he developed manic symptoms (euphoria, increased talkativeness, over familiarity, over religiosity, increased energy levels, reduced need for sleep, abusive and violent behavior with socio-occupational dysfunction). He presented to psychiatry department with 2 months history of such symptoms and was admitted. Upon investigating, TSH levels were found to be within normal limits with increased T3 [T3: 5.48 (reference range: 2–4) pg/dL, T4: 1.30 (reference range: 0.6–2) ng/dL, TSH: 3.74 IU/ mL]. His manic symptoms remitted within 5 days of stopping thyroxine and initiating valproate 800 mg/ day and olanzapine 20 mg/day. His Young Mania Rating Scale[] scores (to assess improvement in mood symptoms) reduced from 28 to 11 in 5 days and thyroid hormone levels normalized within 20 days.\nPatient was euthymic with normal thyroid hormone levels after 2 months of followup wherein his medications were tapered off and did not show mood symptoms when seen 2 months later.
|
[[27.0, 'year']]
|
M
|
{'16187922': 1, '26525086': 1, '21553358': 1, '3759918': 1, '7437657': 1, '6257196': 1, '2891683': 1, '728692': 1, '21808723': 1, '28100579': 1, '7249508': 1, '24083180': 2}
|
{}
|
163,477 |
3784883-1
| 24,083,181 |
noncomm/PMC003xxxxxx/PMC3784883.xml
|
Short fourth and fifth metacarpals in a case of idiopathic primary hypoparathyroidism
|
A 22-year old woman was referred to endocrine clinic because of three episodes of generalized tonic-clonic seizure from one month ago. She was the product of consanguineous marriage. She was newly married and had no children. As far as she knew, family history was negative for similar disorder or other endocrine problems. She had normal regular menses. She was an oriented female with normal face appearance and short body stature (her height was 153 cm; her weight and BMI were 60 kg and 25.6 kg/ m2 respectively).\nShe had normal vital signs:\nBP: 100/70 mm Hg, Temperature: 37°C, Pulse rate: 80/ min and regular, Respiratory rate: 16/min.\nPhysical exam revealed shortening of fourth and fifth metacarpal in both hands with greater degree of fourth metacarpal involvement in right hand. The knuckles of her ring and little fingers looked depressed during clinching fist position [Figures and ]. Hands movements and function were normal. Radiograph study of hands showed short fourth and fifth metacarpal in both hands []. Deep tendon reflexes were normal and plantar reflexes were flexor. Chvostek's and Trousseau's signs were negative at the time of admission to endocrine ward.\nLaboratory results showing the following results: WBC: 7700/μl, hemoglobin (Hb):11.7g/dl, mean cell volume (MCV): 84 (fl), platelet (Plt):255,000/μl), blood urea: 19mg/dl, Cr: 0.8 mg/dl, blood sugar: 73 mg/dl, Potassium: 3.6 mEq/L, Sodium: 141 mEq/L, calcium:5.3-7.1 mg/ dl (8.5-10.4), Ionized calcium: 3.88 mg/dl (4.6-5.3), serum phosphorus:6.4-7.3 mg/dl (2.8-4.5), serum Mg (magnesium): 2.20 mg/dl (1.8-2.6), serum ALP (serum Alkaline phosphatase):162 IU/L (64-306), Intact PTH: 17.91pg/ml (15-65), serum Albumin: 4.2 gr/dl (3.5-5.2). Liver function, urine analysis and thyroid function tests were all normal. Erythrocyte sedimentation rate (ESR) was 17 mm/hour and RF (Rheumatoid factor) was negative.\nThere were transient sharp epileptiform discharges in both frontocentral regions predominantly in right side in Electroencephalography (EEG) study.\nCXR and ECG results were normal.\nBrain magnetic resonance imaging (MRI) revealed multiple abnormal signal foci at subcortical white matter and there was no space occupying lesion.\nThere were nonspecific nonenhancing T2 and FLAIR high signal foci at left forceps major area in brain magnetic resonance imaging (MRI) with and without contrast.\nWe made the diagnosis of IPH and she was initiated on intravenous calcium infusion along with oral calcium tablets, calcitriol and also sodium valproate and after controlling of her hypocalcemia she was discharged to home and she was advised to return to the clinic for periodic monitoring with serum calcium and phosphorous levels and 24 hours urinary calcium collection.
|
[[22.0, 'year']]
|
F
|
{'4171956': 1, '16514227': 1, '10675953': 1, '6094168': 1, '27478774': 1, '19841552': 1, '24083181': 2}
|
{}
|
163,478 |
3784885-1
| 24,083,183 |
noncomm/PMC003xxxxxx/PMC3784885.xml
|
Local recurrence as a first sign of parathyroid malignancy! Need to redefine the criteria for diagnosis of parathyroid carcinoma
|
A 40-year-old lady presented 3 years back with recurrent fractures. There was history of pancreatitis and renal stones in the past. She was bed-ridden due to the fractures, muscle weakness, and severe fatigue. Biochemical evaluation revealed serum calcium 13.3 mg% (Range 8.4-10.5 mg%), serum phosphorus 1.8 mg% (2.5-4.2 mg%), S iPTH 1891 pg/ml (20-60 pg/ml), S alkaline phosphatase 4320 IU/L. USG neck revealed 2.38 × 1.6 5 × 1.58 cm well-defined hypoechoeic lesion in the region of the left inferior parathyroid gland, which was also clinically palpable. At surgery, grayish-white, firm, left inferior parathyroid tumor was identified. The gross intra-operative features led to a suspicion of parathyroid carcinoma, even though there was no local invasion or regional lymphadenopathy. Hence, left hemi thyroidectomy was also performed along with the tumor excision. Other 3 parathyroids were inspected and found to be normal in size, shape, and position. Intra-operative PTH demonstrated >80% drop in the iPTH after excision. The histopathology report was adenoma [Figure and ]. Immunohistochemistry for malignancy (Rb protein) was not performed. She was under follow-up every 6 months. Patient was having normal serum calcium and iPTH for 3 years after surgery; however, she later developed hypercalcemia. At the second admission, her serum calcium was 15.8 mg%, S iPTH 822 pg/ml. Ultrasound neck and MIBI scans revealed the local recurrence [Figure and ]. No distant uptake of MIBI was noticed, ruling out a distant metastasis. X-ray of the chest and USG abdomen also did not reveal any distant metastasis. Re-exploration revealed recurrence at the previous surgery site and hence, a wide local excision with the adjoining strap muscles was performed. The histopathology confirmed parathyroid carcinoma []. At a follow-up of 3 months, patient has normal calcium and iPTH levels.
|
[[40.0, 'year']]
|
F
|
{'16123819': 1, '1518393': 1, '21747854': 1, '1767540': 1, '8338192': 1, '14635072': 1, '4693587': 1, '9088069': 1, '11157996': 1, '3589961': 1, '2666678': 1, '16680588': 1, '24083183': 2}
|
{}
|
163,479 |
3784886-1
| 24,083,184 |
noncomm/PMC003xxxxxx/PMC3784886.xml
|
Lithium-induced parathyroid dysfunction: A new case
|
A 28-year-old lady reported to the endocrinology department for evaluation of hypercalcemia detected at a local hospital. She was receiving 600 mg of lithium carbonate for bipolar mood disorder for last 2 years. She had a history of weight gain, polyarthralgia, and generalized weakness since 6 months. Clinical examination revealed an obese [body mass index (BMI) 36.30Kg], depressed lady with proximal girdle muscle weakness and generalized bone tenderness. Investigations revealed altered thyroid function: FT4 0.77 ng/dl (0.94-1.71 ng/dl) and thyroid stimulating hormone (TSH) 1.45 μIU/ml (0.45-4.5 μIU/ml). Serum corrected calcium levels were 11 mg/dl (8.5-10.2 mg/dl) on repeated assessment and serum phosphate was 2.4 mg/dl (2.7-4.5 mg/dl). Serum intact parathyroid hormone (PTH) was 489.6 pg/ml (16-62 pg/ml). Serum alkaline phosphatase was 1073 IU/l (39-117 IU/l) and Bone Mineral Density (BMD) studies showed Z scores of −2.5 and −2.9 on hip bones and lumbar spines, respectively. Serum albumin and creatinine remained in the normal ranges (4.1 g/dl and 0.8 mg/dl, respectively). 24-h urinary calcium was reduced to 75 mg (normal 100-300 mg), phosphorus was reduced to 288 mg (400-1300 mg), and creatinine was 408 mg (urine volume 1750 ml). The calcium creatinine clearance ratio was 0.013. Serum magnesium was 2.4 ng/dl (1.7-2.55 ng/dl). Serum 25-OH vitamin D estimation showed a normal level of 69 nmol/l (25-125 nmol/l). The serum prolactin (pooled and diluted) was 14.90 ng/ml (1.67-16.11 ng/ml), and serum insulin (total) was 5.80 μIU/ml (4-30 μIU/ml).\nSince the clinical and biochemical features were suggestive of lithium-induced hyperparathyroidism, lithium was discontinued. The clinical features and biochemical parameters did not normalize after 3 months of cessation of lithium treatment (serum calcium was 11.4 mg/dl and PTH 882.5 pg/ml). So, the patient was prepared for surgical treatment after localization studies. 99 mTc-sestamibi dual phase scintigraphy showed significant tracer retention in delayed images, suggestive of hyperfunctioning left inferior parathyroid gland. The patient was subjected to routine total neck exploration since lithium-induced parathyroid hyperplasia was still a possibility. The left inferior parathyroid gland was enlarged and hard in consistency. This was removed en bloc with neighboring soft tissue since parathyroid carcinoma was suspected. The other parathyroid glands appeared normal Rapid intraoperative PTH assay showed a fall from 1063 to 89.84 pg/ml after 10 min of the excision, ensuring completeness of resection.\nThe excised tissue showed a well-encapsulated tumor measuring 2 cm in size and weighing 3.9 g. Microscopy revealed diffuse sheets of cells separated by thin fibrovascular septa. Cells were round or oval with eosinophilic cytoplasm and focal areas of necrosis. Capsular infiltration and vascular invasion were seen. Immunostaining for Ki 67 showed less than 3% positive staining and so was diagnosed as atypical adenoma.\nThe patient received oral calcium supplementation for 12 months since the BMD studies showed osteopenia 6 months after the operation. The patient has been reviewed periodically for the last 31 months and the serum corrected calcium level remains within normal ranges. She is on thyroxine supplementation even though lithium was discontinued.
|
[[28.0, 'year']]
|
F
|
{'31559266': 2, '12658498': 1, '19923405': 1, '15827049': 1, '690088': 1, '8255296': 1, '10354657': 1, '4252812': 1, '17559137': 1, '32317977': 1, '9284708': 1, '31309015': 2, '15792560': 1, '4124825': 1, '24083184': 2}
|
{'6609280-1': 1, '6751439-1': 1, '6751439-2': 1, '6751439-3': 1}
|
163,480 |
3784888-1
| 24,083,186 |
noncomm/PMC003xxxxxx/PMC3784888.xml
|
Bilateral adrenal infarction in Crohn's disease
|
A 25-year-old female patient presented with gradual onset right shoulder pain for 1 week, which was constant and achy in nature and radiated to the left shoulder, down to her back and bilateral flanks. The pain was worse on the right side. She also complained of weakness, decreased oral intake and nausea but did not have any fever, vomiting or diarrhea. She was diagnosed with Crohn's disease since the year 1995 with extensive perianal disease complicated by abscess formation and rectovaginal fistula. She had also been put on filgrastim, a granulocyte colony-stimulating factor (G-CSF) analog for chronic leucopenia secondary to azathioprine treatment for Crohn's disease. Physical examination at the time of current admission revealed pallor, mild tachycardia with a heart rate of 115/minute and blood pressure of 96/56 mm Hg. There was epigastric and costovertebral tenderness with mild voluntary guarding. There was no rebound tenderness and her bowel sounds were faint. WBC count was 4.5 × 109/L. Although the patient did not have significant electrolyte abnormalities (sodium: 137 mEq/L, potassium: 4.6 mEq/L), there was postural tachycardia and hypotension.\nMRI of the spine and sacroiliac joints did not reveal any evidence of infection/inflammation/disc disease that could be attributed as a cause of the pain. CT scan of abdomen and pelvis with contrast showed some edema in the rectum in keeping with her Crohn's disease as well as some mild terminal ileitis. There was also increased thickening and hypodensities in both the adrenals []. Further evaluation with MRI [Figure -] revealed that the adrenals were bulky bilaterally. They showed hypointense signal on T1WI and hyperintense signal intensity on T2WI without any demonstrable hemorrhage. Following administration of gadolinium-based contrast, there was no enhancement of the parenchyma signifying a lack of viable parenchyma, based on which a diagnosis of adrenal infarction without hemorrhage was made.\nBiochemical confirmation of adrenal insufficiency was made by low plasma cortisol (21 nmol/l) and ACTH stimulation test that failed to raise the plasma cortisol levels to more than 25 nmol/l. She did not have any altered skin pigmentation or any history of hypotensive episodes in the past making the possibility of a long standing primary adrenal insufficiency unlikely. The PTT and INR were normal. Anticardiolipin antibodies and Lupus-like anticoagulant were negative. She was put on replacement steroids for which she showed a good response. Her appetite improved and she was discharged with complete resolution of pain.
|
[[25.0, 'year']]
|
F
|
{'12483364': 1, '9370885': 1, '15797086': 1, '15208142': 1, '32451675': 1, '14561675': 1, '11502319': 1, '12950241': 1, '32922854': 1, '24083186': 2}
|
{}
|
163,481 |
3784889-1
| 24,083,187 |
noncomm/PMC003xxxxxx/PMC3784889.xml
|
Malignant thyroglossal duct cyst with synchronous occult thyroid gland papillary carcinoma
|
A 52-year-old male presented to our department with a painless swelling in front of neck progressing slowly over the past 6 years. He complained of a rapid increase in size over the past 6 months. No history of irradiation. Clinical examination and CT evaluation suggested the presence of an irregularly-shaped complex TGDC measuring 6 × 5 cm with solid and cystic components. There was also evidence of fine calcification within the solid areas []. There was also a mildly enhancing nodule found in right lobe and isthmus of thyroid with fine calcification within the nodules. There was no cervical lymphadenopathy. Ultrasound-guided FNAC from the solid area of the TGDC suggested papillary carcinoma. Sistrunk operation for thyroglossal cyst done using a single transverse neck incision, and per-operative thyroid exploration revealed a hard nodule in the right lobe of thyroid with few enlarged paratracheal nodes. Since there was a strong suspicion of malignant thyroid nodule as well, total thyroidectomy and central compartment dissection was completed in the same sitting. Gross examination revealed TGDC, which was multiloculated and had solid and cystic areas (about 2 cm) []. There was a 0.5 cm nodule in the isthmus and a 1 cm nodule in the right lobe of thyroid gland. Microscopic diagnosis [Figures -] was multifocal papillary carcinoma of thyroid and thyroglossal cyst with no metastasis in level VI nodes. Post op I131 scan showed 0.3% uptake in the thyroid bed and no evidence of functioning distant metastasis. Patient is on suppressive thyroxin therapy.
|
[[52.0, 'year']]
|
M
|
{'15186613': 1, '31966901': 1, '15068626': 1, '10629147': 1, '11510730': 1, '19346653': 1, '20499433': 2, '32731174': 1, '1998873': 1, '21042530': 2, '24083187': 2}
|
{'2964854-1': 1, '2880280-1': 1}
|
163,482 |
3784890-1
| 24,083,188 |
noncomm/PMC003xxxxxx/PMC3784890.xml
|
Concurrent parathyroid carcinoma and adenoma: A rare presentation of a rarer disease entity
|
A 45-year-old male patient presented to the Medicine out patients’ department with history of gradually progressive generalized body pain, with severe pain in multiple joints of the body for past four months. He was advised to get investigated and given symptomatic treatment. The patient lost to follow up. He was brought to the emergency of the hospital a month later, with history of inability to move both lower limbs and the right upper limb for last five days.\nThe patient was admitted, and diagnosed to have bilateral femoral shaft fractures and left fracture shaft humerus. Radiological skeletal survey revealed gross osteoporosis, bilateral shaft femur fractures, fracture of the left humerus, multiple rib fractures on right side, tufting of the phalanges of the metacarpals of both hands and mottling of the skull bones [].\nHematological examinations were within normal limits, except a hemoglobin level of 8.5 g/dl. Serum urea, creatinine, sodium and potassium were within normal limits. But serum calcium was elevated to a level of 14.9 mg/dl, while serum phosphate was 2.4 mg/dl. His 24 hours urinary calcium was 1176 (Normal – 100-300). Bone marrow biopsy was also within normal limits. Serum parathyroid hormone was 1842 pg/ml (Normal – 15-65 pg/ml). Primary hyperparathyroidism was suspected and an ultrasonography of the neck done. Though clinically the neck was normal, ultrasonography of the neck [] revealed a pair of hypoechoic well defined SOLs abutting both lobes of thyroid from the posterior aspect. The one on the right side was 3.6 × 2.6 cm, and the one on the left was 1.5 × 1.2 cm in size. Both lobes of thyroid were normal and there was no evidence of lymphadenopathy. Technetium Tc99 m sestamibi scan revealed increased uptake consistent with the parathyroid gland only on the right side.\nBilateral neck exploration was planned. During exploration, a hard greyish mass of around 4 × 2 cm was seen in the area of the right inferior parathyroid gland, densely adherent to the right lobe of thyroid. Tissue from the mass was sent for frozen section and reported to be parathyroid adenoma. But in view of clinical suspicion, intraoperative findings and hard grating sensation on cutting through the mass, an en block resection of the right thyroid lobe with the parathyroid mass and adjacent soft tissues was done. On the left side the left lower parathyroid gland was seen to be enlarged to 1 × 2 cm approximately. It was firm and could be easily dissected free from the left lobe of thyroid. This gland was also excised. No lymphadenopathy was seen in the region. The upper two glands were identified and found to be normal. Intraoperative PTH assessment was not done as all four glands were identified. Post-operatively, the serum PTH came down to 16.2 pg/ml.\nThe post-operative period was uneventful and the serum calcium levels returned to normal levels within fourdays. The final histopathology revealed carcinoma of the right sided gland with capsular and vascular invasion. There was invasion into the adjacent thyroid lobe. The left lobe was reported to be a parathyroid adenoma [].\nAnemia improved and was 10 g/dl a week after surgery. The fractures were treated conservatively initially in view of the gross osteoporosis. The patient was started on bisphosphonates. Definitive fixation of the fractures was done a month later, after the bone density improved.
|
[[45.0, 'year']]
|
M
|
{'11391371': 1, '19740619': 1, '15952075': 1, '20640422': 1, '18727711': 1, '21454227': 1, '30264018': 1, '18830623': 1, '15318009': 1, '17559137': 1, '17041203': 1, '24083188': 2}
|
{}
|
163,483 |
3784952-1
| 24,083,055 |
noncomm/PMC003xxxxxx/PMC3784952.xml
|
Neuronavigation-guided endoscopic and hodotopic approach to an arachnoid cyst
|
A 68-year-old elderly female who has been suffering from mild left hemiparesis for the past 4 years presented to our hospital with history of sudden onset of left sided tonic-clonic seizures that became generalized. She was intubated because of airway compromise. Physical examination prior to intubation disclosed that the patient had left hemiplegia and hyperreflexia on the left limbs with extensor plantar reflex. The cranial nerves and systemic examination were normal. The computed tomography (CT) scan of the brain showed a large right fronto-parieto-temporal cystic lesion measuring 7 × 5 × 5 cm with a midline shift of 1 cm, suggestive of an arachnoid cyst [Figure -]. A neuronavigation-guided endoscopic fenestration of the cyst was done to communicate the arachnoid cyst with the ipsilateral sylvian cistern [Figure -]. Fenestration of the cyst to directly communicate with the ipsilateral lateral ventricle was thought as an inappropriate choice because of the close proximity of the cyst wall with important ipsilateral white matter projection pathways and inferior occipito-frontal fasciculus or inferior longitudinal white matter tracts revealed by the 3 Tesla MR system with DTI and MR tractography (Gyroscan Intera, Philips Medical System, Eindhoven, Netherlands) [Figure and ]. By using an endoscope mounted navigational system (Medtronic StealthStation TREON™ cranial software; Medtronic Inc., Minneapolis, USA), an appropriate burr hole with intended trajectory to the ipsilateral sylvian cistern was made guiding the neurosurgeon safely while inside the cystic cavity to the area of interest. Subsequently, fenestration was performed with the aid of a biopsy and bipolar forceps. The surgery was uneventful and lasted approximately an hour.\nPostoperatively, a repeated CT scan of the brain revealed a smaller arachnoid cyst with correction of the midline shift [Figure -]. The patient was weaned off from the ventilator and her hemiplegia improved gradually.
|
[[68.0, 'year']]
|
F
|
{'8019776': 1, '16753625': 1, '17698540': 1, '20386138': 1, '7838397': 1, '9917544': 1, '16320191': 1, '17409790': 1, '8781589': 1, '17295043': 1, '27195030': 1, '20121445': 1, '17891343': 1, '21346655': 1, '17764831': 1, '16607477': 1, '19247900': 1, '22089324': 1, '14734867': 1, '15906202': 1, '18813171': 1, '24083055': 2}
|
{}
|
163,484 |
3784953-1
| 24,083,054 |
noncomm/PMC003xxxxxx/PMC3784953.xml
|
Ossification of the ligamentum flavum as cause of thoracic cord compression: Case report of a Latin American man and review of the literature
|
A 38-year-old male patient with a normal medical history, presented with a 6 month progressive gait disturbance and urinary incontinence. There was no history of previous trauma. Physical examination showed spastic paraparesis (grade 3/5), bilateral positive Babinski sign, with increased deep tendon reflexes. Sensory level at T9 was ascertained. Rectal sphincter was preserved.\nDorsal spine magnetic resonance imaging (MRI) was obtained, which showed hypertrophy and ossification of the posterior ligamentous complex from T3 to T10 and underlying myelopathy. No discal pathology was reported. Computed tomography (CT) demonstrated bone density all long the posterior segment of the dorsal spinal canal and a 50% reduction of anteroposterior diameter [Figures and ]. Imaging of the cervical and lumbar spine showed no abnormalities.\nSerum calcium, phosphorous, uric acid, and glucose levels were normal. A discrete elevation of alkaline phosphatase level was observed (485 mIU/ml, normal range up to 306 mIU/ml).\nPatient underwent a dorsal approach under general anesthesia in a prone position. A midline incision was made and the T3 to T9 lamina were removed. Extensive drilling of the ossification was performed. Thinned laminas were attached to the spinous process of the superior and inferior vertebrae.\nPatient underwent an intensive care unit stay, complicated with paralytic ileus and respiratory tract infection. At hospital discharge, patient remained paraparetic with a 3/5 muscular strength, mild hypoesthesia in both lower limbs, and bladder incontinence. Rectal sphincter was continent. At 6 months, he was able to walk with a cane, with no sphincter or sensory alterations.
|
[[38.0, 'year']]
|
M
|
{'16572617': 1, '16925079': 1, '22883949': 1, '21361753': 1, '12450281': 1, '16010269': 1, '12391454': 1, '21600492': 1, '19910768': 1, '10078125': 1, '33321989': 1, '1641735': 1, '21777514': 1, '26223744': 1, '17702747': 1, '18050374': 1, '26033987': 1, '15175776': 1, '21914169': 1, '19844616': 1, '24083054': 2}
|
{}
|
163,485 |
3785391-1
| 24,082,793 |
noncomm/PMC003xxxxxx/PMC3785391.xml
|
Use of recombinant human antithrombin concentrate in pregnancy
|
Patient 1 is a 31-year-old female with a history of unprovoked pulmonary embolism at age 20. Thrombophilia testing was completed due to her young age and a family history of pulmonary embolism in her brother. The patient was found to be AT deficient with an AT activity of 37%. She was maintained on long term anticoagulation with warfarin. Her other past medical history was significant for supraventricular tachycardia, rheumatoid arthritis, endometriosis, pyelonephritis, Crohn’s disease, and gastroesophageal reflux disease. The patient became pregnant in 2010 and was switched to enoxaparin at 4 weeks gestation. Her pregnancy was complicated by gestational diabetes, which was controlled by diet and exercise. Additionally, she had one admission due to supraventricular tachycardia and was found to have irregular uterine contractions. Due to the AT deficiency, anticoagulation was monitored using anti-Xa levels with goal peak level >0.6 IU/mL. At the highest dose, she required enoxaparin 120 units (~1.4 units/kg) subcutaneously every 8 hours ().\nPatient 1 was admitted at 35 weeks and 4 days due to concerns for preterm labor. She was continued on enoxaparin until the evening of hospital day (HD) 2. She started rhAT on HD3 with a loading dose of 48.5 IU/kg (calculated from [100-baseline activity]/1.3) and maintenance dose of 11 IU/kg/hour (calculated from [100-baseline activity]/5.4). She underwent induction of labor via cervical ripening catheter and oxytocin when the AT level was in the normal range. Amniotomy was performed on HD5, and the patient vaginally delivered a healthy infant weighing 2,268 grams on HD6. Apgar scores were 7 and 9 at 1 and 5 minutes, respectively. The estimated blood loss was 250 mL. The rhAT infusion did not require dose modifications and the patient’s AT levels remained between 90%–108% (). Intravenous unfractionated heparin was started immediately postpartum and was adjusted by anti-Xa levels. Additionally, the patient was started on warfarin on the evening of delivery. Admission hemoglobin of the patient was 14.4 g/dL and postpartum hemoglobin was 11.5 g/dL. She was continued on an unfractionated heparin and AT3 infusion until the international normalized ratio (INR) was greater than 2.0 and she was subsequently discharged.
|
[[31.0, 'year']]
|
F
|
{'18226138': 1, '11721729': 1, '23662090': 1, '22380425': 1, '7117919': 1, '27207982': 1, '18327412': 1, '24082793': 2}
|
{'3785391-2': 2, '3785391-3': 2}
|
163,486 |
3785391-2
| 24,082,793 |
noncomm/PMC003xxxxxx/PMC3785391.xml
|
Use of recombinant human antithrombin concentrate in pregnancy
|
Patient 2 is a 40-year-old female with a past medical history significant for viral encephalitis and a left leg superficial thrombosis at age 32 while taking oral contraceptive pills. Her oral contraceptive pills were discontinued and she was treated with anti-inflammatory medication. At age 40, patient 2 was 8 weeks pregnant with her third child and sought evaluation for right calf and popliteal pain. She was diagnosed with a non-occlusive deep vein thrombosis of the distal femoral, popliteal, and posterior tibial vein. A hypercoagulable evaluation showed an antithrombin activity of 38%–41%. Her sister, father, and daughter were subsequently diagnosed with antithrombin deficiency but have not experienced thrombosis. Patient 2 was initially treated with enoxaparin at 1.5 mg/kg daily, and was switched to twice daily dosing after the antithrombin deficiency was diagnosed (). At the highest dosage, she required enoxaparin at 1.8 mg/kg twice daily to maintain therapeutic anti-Xa levels. Her pregnancy was otherwise uncomplicated and she was admitted at 37 weeks 4 days gestation for induction of labor. She received a bolus of 41.4 IU/kg and maintenance infusion of 10 IU/kg (calculated as above). Labor induction began once antithrombin levels had normalized. The patient vaginally delivered a healthy male with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. Estimated blood loss was 300 mL. Her antithrombin levels remained between 96%–127% without adjustment of her infusion (). An unfractionated heparin infusion was started 4 hours after delivery. She was discharged on HD9 on warfarin and twice daily enoxaparin until her INR was >2.0 two days later. She has been maintained on therapeutic anticoagulation due to her history of thrombosis in the setting of antithrombin deficiency.
|
[[40.0, 'year']]
|
F
|
{'18226138': 1, '11721729': 1, '23662090': 1, '22380425': 1, '7117919': 1, '27207982': 1, '18327412': 1, '24082793': 2}
|
{'3785391-1': 2, '3785391-3': 2}
|
163,487 |
3785391-3
| 24,082,793 |
noncomm/PMC003xxxxxx/PMC3785391.xml
|
Use of recombinant human antithrombin concentrate in pregnancy
|
Patient 3 is a 27-year-old female with a history of pulmonary embolism 4 days after cesarean delivery of her first child. She was treated with weight-based enoxaparin without monitoring of anti-Xa levels. The patient sought hematology evaluation when she was 8 weeks pregnant with her second child. A hypercoagulable work-up was notable for an antithrombin level of 63%. Repeat testing showed antithrombin activity levels of 64%–73% with normal antigen levels. The patient had no family history of thrombosis. Due to the discrepancy between the amount of clinical heparin resistance and her antithrombin activity, sequencing of the SERPINC1 gene was completed. She was found to have a heterozygous mutation in the heparin binding site (c.218C > T, p.Pro73Leu) which is associated with type II antithrombin deficiency. To achieve therapeutic anticoagulation, the patient was treated with 1.8 mg/kg of enoxaparin. She did not require further increase in her enoxaparin dose after therapeutic levels were obtained (). She underwent elective induction at 37 weeks 3 days after rhAT infusion was initiated. Her last dose of enoxaparin was 24 hours prior to induction. Patient 3 required a cesarean delivery on HD2 due to intrapartum spontaneous conversion to breech presentation. A healthy male infant was delivered with an estimated blood loss of 1,200 mL due to uterine atony. Eight hours postpartum the patient was started on heparin infusion and warfarin. She achieved therapeutic anticoagulation within 4 hours. Her AT activity remained in the normal range without adjustments of her rhAT infusion (). On HD3, the patient developed right arm pain and was noted to have an occlusive superficial thrombus of the right basilic vein and a nonocclusive deep thrombosis of the distal right axillary vein associated with the peripherally inserted central catheter (PICC). The PICC was removed as it was considered the etiology of the thrombosis, and the patient continued the rhAT via a peripheral intravenous infusion. The patient’s right arm pain resolved and she was discharged on HD8 after therapeutic anticoagulation with warfarin was achieved.
|
[[27.0, 'year']]
|
F
|
{'18226138': 1, '11721729': 1, '23662090': 1, '22380425': 1, '7117919': 1, '27207982': 1, '18327412': 1, '24082793': 2}
|
{'3785391-1': 2, '3785391-2': 2}
|
163,488 |
3785582-1
| 24,086,802 |
noncomm/PMC003xxxxxx/PMC3785582.xml
|
Proposed Treatment Protocol for Frostbite: A Retrospective Analysis of 17 Cases Based on a 3-Year Single-Institution Experience
|
A 57-year-old man sustained second-degree frostbite to both feet while walking outdoors barefoot. The patient presented with erythema and vesicle formation at the time of the onset of injury. In addition, the patient achieved re-epithelialization by day 9. The patient was completely cured without any sequelae. Furthermore, the patient presented no gait disturbance or sensory impairment ().
|
[[57.0, 'year']]
|
M
|
{'11769921': 1, '21097571': 1, '30359097': 1, '33569011': 1, '21465915': 1, '26575137': 1, '2243830': 1, '8356126': 1, '8203772': 1, '27494386': 1, '21392800': 1, '27843971': 1, '7772322': 1, '19734516': 1, '11040315': 1, '2003255': 1, '9088467': 1, '10647591': 1, '24086802': 2}
|
{'3785582-2': 2, '3785582-3': 2, '3785582-4': 2}
|
163,489 |
3785582-2
| 24,086,802 |
noncomm/PMC003xxxxxx/PMC3785582.xml
|
Proposed Treatment Protocol for Frostbite: A Retrospective Analysis of 17 Cases Based on a 3-Year Single-Institution Experience
|
A 43-year-old woman sustained third-degree frostbite to both hands while climbing a mountain. The patient presented with a blue-gray discoloration seen at the time of the onset of injury. In addition, the patient exhibited full-thickness skin necrosis on day 23. Therefore, the patient underwent debridement and a split-thickness skin graft on day 24. The patient achieved a complete cure on postoperative week 5. In this patient, however, the treatment period was relatively longer; the patient received the treatment until up to postoperative week 3 (at day 56 following the onset of injury). However, the patient complained of limited joint mobility due to swelling of the hand and joint stiffness. These symptoms were improved through continuous finger movement and rehabilitation therapy. However, the patient had persistent sensory impairment ().
|
[[43.0, 'year']]
|
F
|
{'11769921': 1, '21097571': 1, '30359097': 1, '33569011': 1, '21465915': 1, '26575137': 1, '2243830': 1, '8356126': 1, '8203772': 1, '27494386': 1, '21392800': 1, '27843971': 1, '7772322': 1, '19734516': 1, '11040315': 1, '2003255': 1, '9088467': 1, '10647591': 1, '24086802': 2}
|
{'3785582-1': 2, '3785582-3': 2, '3785582-4': 2}
|
163,490 |
3785582-3
| 24,086,802 |
noncomm/PMC003xxxxxx/PMC3785582.xml
|
Proposed Treatment Protocol for Frostbite: A Retrospective Analysis of 17 Cases Based on a 3-Year Single-Institution Experience
|
A 67-year-old man sustained third- and fourth-degree frostbite to both hands while climbing a mountain. The patient presented with a blue-gray discoloration seen at the time of the onset of injury. Dry, black mummification had appeared by day 18. The patient underwent amputation and reconstruction with a groin flap and local flap on day 21. The patient underwent flap detachment 16 days after the first operation. As seen in patient 12, despite a longer treatment period, the patient also achieved a complete cure but complained of symptoms such as limited joint mobility and sensory impairment. The limited joint mobility was greatly improved by exercise. However, the sensory impairment persisted ().
|
[[67.0, 'year']]
|
M
|
{'11769921': 1, '21097571': 1, '30359097': 1, '33569011': 1, '21465915': 1, '26575137': 1, '2243830': 1, '8356126': 1, '8203772': 1, '27494386': 1, '21392800': 1, '27843971': 1, '7772322': 1, '19734516': 1, '11040315': 1, '2003255': 1, '9088467': 1, '10647591': 1, '24086802': 2}
|
{'3785582-1': 2, '3785582-2': 2, '3785582-4': 2}
|
163,491 |
3785582-4
| 24,086,802 |
noncomm/PMC003xxxxxx/PMC3785582.xml
|
Proposed Treatment Protocol for Frostbite: A Retrospective Analysis of 17 Cases Based on a 3-Year Single-Institution Experience
|
A 40-year-old man was referred to us after undergoing early escharectomy at seven days after the onset of injury in another clinical department. Due to the progression of necrosis in both feet over time, the patient underwent below-knee amputation at 34 days following the onset of injury. The patient was currently using a prosthetic foot ().
|
[[40.0, 'year']]
|
M
|
{'11769921': 1, '21097571': 1, '30359097': 1, '33569011': 1, '21465915': 1, '26575137': 1, '2243830': 1, '8356126': 1, '8203772': 1, '27494386': 1, '21392800': 1, '27843971': 1, '7772322': 1, '19734516': 1, '11040315': 1, '2003255': 1, '9088467': 1, '10647591': 1, '24086802': 2}
|
{'3785582-1': 2, '3785582-2': 2, '3785582-3': 2}
|
163,492 |
3785589-1
| 24,086,809 |
noncomm/PMC003xxxxxx/PMC3785589.xml
|
One-Stage Nipple and Breast Reconstruction Following Areola-Sparing Mastectomy
|
A 29-year-old female visited with invasive lobular carcinoma measuring 3.9 cm×3.6 cm in size in the upper outer quadrant of the right breast without nipple involvement. The tumor mass was 2.8 cm from the edge of the areola. The patient underwent ASM of the right breast and axillary lymph node dissection by a breast surgeon. The breast was immediately reconstructed with a TRAM flap, and the nipple was simultaneously reconstructed with a modified C-V flap. At 18 months postoperatively, the patient was satisfied with the outcome and had no recurrence, but a gutter-like depression around the reconstructed nipple occurred. The authors think this was probably due to excessive scarring around the nipple ().
|
[[29.0, 'year']]
|
F
|
{'12875600': 1, '14646645': 1, '7530272': 1, '30466233': 1, '11520082': 1, '31964120': 2, '21713165': 1, '33633985': 1, '9655408': 1, '19407611': 1, '8654609': 1, '22903381': 1, '9193184': 1, '18495564': 1, '15336725': 1, '17051099': 1, '10597677': 1, '21136577': 1, '13947579': 1, '26430632': 1, '11888874': 1, '15474435': 1, '21042102': 1, '3828737': 1, '19644246': 1, '24086809': 2}
|
{'3785589-2': 2, '6976742-1': 1, '6976742-2': 1}
|
163,493 |
3785589-2
| 24,086,809 |
noncomm/PMC003xxxxxx/PMC3785589.xml
|
One-Stage Nipple and Breast Reconstruction Following Areola-Sparing Mastectomy
|
A 33-year-old female presented with invasive lobular carcinoma measuring 1.8 cm×1.5 cm in size in the right breast without nipple involvement. The tumor mass was 4.3 cm from the edge of the areola. She had already undergone conventional mastectomy of the left breast with immediate TRAM flap breast reconstruction 1 year earlier. The patient underwent ASM of the right breast and axillary lymph node dissection by a breast surgeon. The breast was immediately reconstructed with an LD flap and the nipple was simultaneously reconstructed with a modified C-V flap. At 6 months postoperatively, the patient was satisfied with the outcome and had no recurrence ().
|
[[33.0, 'year']]
|
F
|
{'12875600': 1, '14646645': 1, '7530272': 1, '30466233': 1, '11520082': 1, '31964120': 2, '21713165': 1, '33633985': 1, '9655408': 1, '19407611': 1, '8654609': 1, '22903381': 1, '9193184': 1, '18495564': 1, '15336725': 1, '17051099': 1, '10597677': 1, '21136577': 1, '13947579': 1, '26430632': 1, '11888874': 1, '15474435': 1, '21042102': 1, '3828737': 1, '19644246': 1, '24086809': 2}
|
{'3785589-1': 2, '6976742-1': 1, '6976742-2': 1}
|
163,494 |
3785593-1
| 24,086,813 |
noncomm/PMC003xxxxxx/PMC3785593.xml
|
Reconstruction of the Lower Extremity Using Free Flaps
|
A 28-year-old man had a 10 cm × 15 cm soft tissue defect on the dorsum of the left foot caused by an electrical burn, and concurrently had bone exposure in the first and second toes. Following debridement, we performed arthrodesis of the first toe using a K-wire to prepare the recipient sites. The left scapular fascial free flap was elevated and then inset to the recipient sites. In this patient, an end-to-end anastomosis was performed between the circumflex scapular artery and the dorsalis pedis artery. In addition, two venae comitantes were anastomosed end-to-end to the great saphenous vein and the vena comitante of the dorsalis pedis artery. A split-thickness skin graft was performed over the flap. In the left scapular region, which served as the donor site, primary closure was performed ().
|
[[28.0, 'year']]
|
M
|
{'1852822': 1, '32268659': 1, '26618139': 1, '27730016': 1, '2668546': 1, '27161144': 2, '31879482': 1, '30656130': 1, '8479318': 1, '32547980': 2, '1493528': 1, '7661898': 1, '11130641': 1, '9091910': 1, '25510761': 1, '7089097': 1, '27930679': 1, '25408784': 1, '7934806': 1, '17524975': 1, '8618220': 1, '34142464': 1, '25931780': 1, '388482': 1, '30374640': 1, '31964123': 1, '33936914': 1, '33446776': 1, '2765737': 1, '34352955': 1, '22588794': 1, '3704001': 1, '7071227': 1, '30649621': 1, '3773691': 1, '24086813': 2}
|
{'3785593-2': 2, '3785593-3': 2, '3785593-4': 2, '7276582-1': 1, '4881932-1': 1}
|
163,495 |
3785593-2
| 24,086,813 |
noncomm/PMC003xxxxxx/PMC3785593.xml
|
Reconstruction of the Lower Extremity Using Free Flaps
|
A 17-year-old man presented necrosis of the right first and second toes after sustaining a crushing injury in a traffic accident. In addition, the patient also had a 7 cm × 11.5 cm soft tissue defect on the plantar forefoot. The necrotized first and second toes were amputated from the metatarsophalangeal joint. The recipient sites were prepared by debridement. The plantar forefoot comes into contact with the floor during walking. We therefore elevated the medial plantar sensory free flap on the contralateral side of the plantar region for the reconstruction procedure. The medial plantar artery distributed in the flap was anastomosed to the dorsal pedis artery of the recipient site. In addition, two venae comitantes were anastomosed end-to-end to the great saphenous vein and the vena comitante of the dorsalis pedis artery. The medial plantar nerve innervating the flap was anastomosed to the deep peroneal nerve of the recipient site. A fullthickness skin graft was performed at the donor sites ().
|
[[17.0, 'year']]
|
M
|
{'1852822': 1, '32268659': 1, '26618139': 1, '27730016': 1, '2668546': 1, '27161144': 2, '31879482': 1, '30656130': 1, '8479318': 1, '32547980': 2, '1493528': 1, '7661898': 1, '11130641': 1, '9091910': 1, '25510761': 1, '7089097': 1, '27930679': 1, '25408784': 1, '7934806': 1, '17524975': 1, '8618220': 1, '34142464': 1, '25931780': 1, '388482': 1, '30374640': 1, '31964123': 1, '33936914': 1, '33446776': 1, '2765737': 1, '34352955': 1, '22588794': 1, '3704001': 1, '7071227': 1, '30649621': 1, '3773691': 1, '24086813': 2}
|
{'3785593-1': 2, '3785593-3': 2, '3785593-4': 2, '7276582-1': 1, '4881932-1': 1}
|
163,496 |
3785593-3
| 24,086,813 |
noncomm/PMC003xxxxxx/PMC3785593.xml
|
Reconstruction of the Lower Extremity Using Free Flaps
|
A 39-year-old man had undergone external fixation at another hospital for the management of an open comminuted fracture of the right tibia received in a traffic accident. Then, in the department of orthopedic surgery at our medical institution, the patient also underwent iliac bone grafting at the site of a bone defect caused by the comminuted fracture. However, he bone graft necrotized and progressed to osteomyelitis. Therefore, the patient was referred to us for reconstruction. At the time of referral, the patient had a 8 cm × 12 cm soft tissue defect, accompanied by a bone defect approximately 8 cm in size. We performed debridement, including the dead bone tissue with osteomyelitis to prepare the recipient sites. We elevated an osteocutaneous free flap from the left side, involving 12 cm of fibula, and then inset it to the recipient site. Following the fixation of the proximal and distal part of the tibia using a screw, we performed external fixation. The artery was anastomosed end-to-side to the anterior tibial artery. In addition, 2 venae comitantes were anastomosed end-to-end to the lesser saphenous vein and the vena comitante of the anterior tibial artery. A split-thickness skin graft was performed at the donor sites ().
|
[[39.0, 'year']]
|
M
|
{'1852822': 1, '32268659': 1, '26618139': 1, '27730016': 1, '2668546': 1, '27161144': 2, '31879482': 1, '30656130': 1, '8479318': 1, '32547980': 2, '1493528': 1, '7661898': 1, '11130641': 1, '9091910': 1, '25510761': 1, '7089097': 1, '27930679': 1, '25408784': 1, '7934806': 1, '17524975': 1, '8618220': 1, '34142464': 1, '25931780': 1, '388482': 1, '30374640': 1, '31964123': 1, '33936914': 1, '33446776': 1, '2765737': 1, '34352955': 1, '22588794': 1, '3704001': 1, '7071227': 1, '30649621': 1, '3773691': 1, '24086813': 2}
|
{'3785593-1': 2, '3785593-2': 2, '3785593-4': 2, '7276582-1': 1, '4881932-1': 1}
|
163,497 |
3785593-4
| 24,086,813 |
noncomm/PMC003xxxxxx/PMC3785593.xml
|
Reconstruction of the Lower Extremity Using Free Flaps
|
A 41-year-old man underwent open reduction and internal fixation at the department of orthopedic surgery at our medical institution to treat an open fracture of the left tibia received in a traffic accident. Afterwards, however, the patient presented with necrosis of the soft tissue over the pretibial area, accompanied by the presence of a 35 cm × 17 cm soft tissue defect. The patient was therefore referred to us for further evaluation and treatment. We performed debridement in the operation room and prepared the recipient sites. Then, we elevated the left latissimus dorsi muscle free flap and inset it to the recipient site. The artery was anastomosed end-to-end to the anterior tibial artery. In addition, 2 venae comitantes were anastomosed end-to-end, one each to the great saphenous vein and the vena comitante of the anterior tibial artery. A split-thickness skin graft was performed over the flap. Primary closure was performed in the donor site ().
|
[[41.0, 'year']]
|
M
|
{'1852822': 1, '32268659': 1, '26618139': 1, '27730016': 1, '2668546': 1, '27161144': 2, '31879482': 1, '30656130': 1, '8479318': 1, '32547980': 2, '1493528': 1, '7661898': 1, '11130641': 1, '9091910': 1, '25510761': 1, '7089097': 1, '27930679': 1, '25408784': 1, '7934806': 1, '17524975': 1, '8618220': 1, '34142464': 1, '25931780': 1, '388482': 1, '30374640': 1, '31964123': 1, '33936914': 1, '33446776': 1, '2765737': 1, '34352955': 1, '22588794': 1, '3704001': 1, '7071227': 1, '30649621': 1, '3773691': 1, '24086813': 2}
|
{'3785593-1': 2, '3785593-2': 2, '3785593-3': 2, '7276582-1': 1, '4881932-1': 1}
|
163,498 |
3785594-1
| 24,086,814 |
noncomm/PMC003xxxxxx/PMC3785594.xml
|
Vascularisation of Urethral Repairs with the Gracilis Muscle Flap
|
A 28-year-old man presented with a recurrent right mixed germ cell testicular tumour that had extended across the midline and through the tunica albuginea, ulcerating through the left scrotal skin (). The tumour involved the corpus spongiosum and was deeply adherent to the urethra. Oncologic resection resulted in a 1-cm defect over the ventral wall of the bulbar urethra. The defect was repaired over a Foley catheter with a single layer of Polydioxanone 5/0 (PDS). The urethral anastomotic site was exposed with minimal surrounding local tissue for a layered perineal closure. A pedicled gracilis muscle flap was used as an onlay to vascularise the repair site. The remnant scrotal skin was mobilised, and the skin defect could be closed primarily (). An MCU performed 3 months postoperatively showed smooth passage of urine and absence of stricture or leak (). He recovered well and was able to micturate with a good stream ().
|
[[28.0, 'year']]
|
M
|
{'15536673': 1, '8469106': 1, '25510761': 1, '30560057': 1, '8792985': 1, '12796652': 1, '12771742': 1, '2231971': 1, '34036143': 2, '3273078': 1, '28210852': 1, '21233704': 1, '1896539': 1, '2073348': 1, '16752191': 1, '2219977': 1, '32565658': 2, '5813551': 1, '24086814': 2}
|
{'3785594-2': 2, '3785594-3': 2, '3785594-4': 2, '7292441-1': 1, '8138672-1': 1, '8138672-2': 1}
|
163,499 |
3785594-2
| 24,086,814 |
noncomm/PMC003xxxxxx/PMC3785594.xml
|
Vascularisation of Urethral Repairs with the Gracilis Muscle Flap
|
A 64-year-old man presented with a stage IIc rectal carcinoma. He underwent an abdominoperineal resection which included part of the posterior wall of the prostatic urethra as the tumour was adherent to it. The defect was repaired and despite suprapubic urinary diversion, a urethrocutaneous fistula developed 1 month later. Repeat surgery showed a small prostate remnant with a 3 cm prostatic urethral defect. The prostate remnant with its urethral segment were resected to the bladder neck (). The bulbar urethra was then mobilised and anastomosed directly to the bladder neck. There was an absence of soft tissue posterior to the anastomosis due to the previous abdominoperineal resection. A gracilis muscle was wrapped around the anastomosis to buttress and support it (). In addition, a gluteus maximus muscle flap was transposed into the pelvic cavity to obliterate the dead space. He had an uncomplicated recovery and the MCU showed smooth passage of urine with no stricture or leak after 3 months (). However, he was incontinent and had to wear diapers.
|
[[64.0, 'year']]
|
M
|
{'15536673': 1, '8469106': 1, '25510761': 1, '30560057': 1, '8792985': 1, '12796652': 1, '12771742': 1, '2231971': 1, '34036143': 2, '3273078': 1, '28210852': 1, '21233704': 1, '1896539': 1, '2073348': 1, '16752191': 1, '2219977': 1, '32565658': 2, '5813551': 1, '24086814': 2}
|
{'3785594-1': 2, '3785594-3': 2, '3785594-4': 2, '7292441-1': 1, '8138672-1': 1, '8138672-2': 1}
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.