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
|
|---|---|---|---|---|---|---|---|---|---|
163,600 | 3793528-1 | 24,130,392 | noncomm/PMC003xxxxxx/PMC3793528.xml | Heart failure induced by itraconazole | A 60-year-old female patient presented with the complaints of shortness of breath and swelling of the legs for 5 days. She was referred to cardiology clinic and was prescribed 2 × 200 mg/day of oral itraconazole; therapy was initiated 5 days ago by a dermatologist with the diagnosis of onychomycosis. On physical examination, blood pressure was: 130/80 mmHg, cardiac examination was normal, respiratory sounds decreased in basilar of both lungs. There was bilateral pretibial edema. Her electrocardiography and echocardiography were normal. Density in right lower zone and blunting of the right sinus in chest X-ray was observed. Patient was referred to pneumonology clinic. There was no infection or primary pulmonary disease. Patient had no cardiovascular disease or any other cardiac pathology before. The complaints appeared after initiation of itraconazole. According to Framingham study the patients had three minor criteria and major criteria as cause of complaints and findings that's why patients were accepted heart failure. As there was no other cause itraconazole[] was considered to be the culprit drug. Oral itraconazole was discontinued and patient was treated with 1 × 40 mg/day furosemide. Patient recovered within a week. Control echocardiography was normal. Exercise stress test was performed to eliminate coronary artery disease, which is a reason for heart failure and the test was normal. Thus, the patient's clinical signs and symptoms were thought to be due to itraconazole and not to any ischemic event with a probable causality relationship as analyzed by World Health Organization — Uppsala Monitoring Center Criteria. | [[60.0, 'year']] | F | {'11403818': 1, '1648887': 1, '23416206': 1, '29304209': 1, '32737869': 1, '33083707': 1, '32853199': 1, '8509564': 1, '2174854': 1, '8376698': 1, '24130392': 2} | {} |
163,601 | 3793529-1 | 24,130,393 | noncomm/PMC003xxxxxx/PMC3793529.xml | Anti B cell targeted therapy for autoimmune hemolytic anemia in an infant | A 4-month-old male infant, born to non-consanguineous parents, with uneventful perinatal history and thriving well on breast milk, presented with cough for 10 days and pallor for 2 days.\nInfant was pale with mild icterus, without any fever and any significant lymphadenopathy or organomegaly. Hemoglobin (Hb), reticulocyte counts were 3.2 g/dL and 6% respectively. Liver function test was normal, but with indirect hyperbilirubinemia (2.5 mg/dL out of 2.9 mg/dL of total bilirubin). Coagulation profile was normal. Direct Coomb's test (DCT) was strongly positive (4+). High performance liquid chromatography was normal with Hb F being elevated as per age. In urine microscopy, no fresh red blood cell (RBC) but hemolyzed RBCs were seen. There was no Rh or ABO incompatibility setting. Results for anti-nuclear antibodies (ANA) and for retrovirus were negative.\nHb level increased to 7.9 g% after packed RBC transfusion (15 mL/kg). However, his repeat Hb 24 h later dropped to 5.8 g% with agglutination in the smear and repeat DCT being again positive (4+). Immunoglobulin G (IgG) auto antibodies were high and diagnosis of AIHA further confirmed. He was started on IV Ig (2 g/kg/total) and on methylprednisolone (10 mg/kg/day). As Hb improved to 9 g% after 4 days, he was discharged with advice to continue oral prednisolone (2 mg/Kg). While tapering steroids, his Hb dropped to 6.7 g%, with repeat DCT being positive and with evidence of hemolysis in smear. A repeat course of IV Igs (1 g/kg) along with stepping up of prednisolone to 1 mg/kg/day was given as parents were not consenting for administration of rituximab. There was a transient improvement in Hb to 10 g%, which has dropped later to 7.8 g% on tapering steroids.\nHe was started on rituximab as response to steroids and IV Ig was ill sustained, after obtaining the parent's consent. Dose was calculated as per the body weight (by taking the standard recommendation of 375 mg/m2 once a week for 4 weeks) and 85 mg given once a week. Seven days after the 3rd dose, good hematological response (Hb > 10.5 g%, reticulocytes 3%) was observed. Though the patient was covered prophylactically by co-trimoxazole after 3rd dose of rituximab he developed severe pneumocystis carinii pneumonia (PCP). The PCP infection was thought to be secondary to immunosuppressive status because of on-going steroid treatment aggravated by rituximab.\nAfter rituximab treatment, steroids were tapered over a month and continued at a very low dose (0.2 mg kg/day initially and on alternate day later) for another 2 months as per the hematological picture. Currently, he is off steroids for 6 months from last rituximab dose and maintaining a Hb of 9-10 g%. The DCT is negative. | [[4.0, 'month']] | M | {'30225153': 2, '11705566': 1, '22565086': 1, '11548187': 1, '12531800': 1, '24130393': 2} | {'6129358-1': 1} |
163,602 | 3793530-1 | 24,130,394 | noncomm/PMC003xxxxxx/PMC3793530.xml | Hypersensitivity due to ceftriaxone mimicking measles in a child | A 7-year-old boy was brought with a history of fever of four days duration with cough and cold. The boy was earlier treated with an injection outside by a private practitioner. On examination, he was toxic with high fever of 102° F, congestion of eyes and throat with maculopapular rash over his face and neck []. He was tachypneic with bilateral crepitations and decreased breath sounds in the right infrascapular region. He was admitted and treated with injection ampicillin for the respiratory infection. On the next day, the rashes increased and appeared on the chest and upper extremities with increasing congestion of eyes. He was thought to have measles as he had contact with a person who had similar illness few weeks back near his home. He was treated with vitamin A, oxygen by face mask, nebulized salbutamol and intravenous fluids. Since fever spikes were persistent and TLC was elevated (21,000/cu.mm) with neutrophilia (90%), antibiotics were changed to injection ceftriaxone after test dose. After a period of two hours he was found to have increasing rashes with audible wheeze, loose stools and vomiting. By this time the rash was found throughout his body with clearing from face. Salbutamol nebulizations were increased in frequency and the child was monitored closely.\nOver the next eight hours child became better, was able to sit up comfortably with minimal distress and he was taking oral feeds. The rashes appeared less prominent. He received the second dose of injection ceftriaxone that afternoon and following that he felt dizzy, vomited and began to have distress. His rash once again increased and became prominent, this time, throughout the entire body involving the face with urticarial lesions in-addition to macula-papular lesions []. He appeared red and was warm with itching all over the body, especially around his ears. Drug allergy was suspected and was promptly treated with oxygen, parenteral pheniramine maleate, dexamethasone, and nebulization with salbutamol. Injection ceftriaxone was discontinued. Within half an hour, his breathing became normal and his rashes disappeared. This time the diagnosis was clear and the history was re-visited. On the fourth day of illness, the boy had received injection ceftriaxone by a local practitioner following which the rash had appeared. He had previously been treated with injection cefotaxime and ampicillin without having any reactions to them. There was history of wheezing without fever in the past and signs of allergic rhinitis and conjunctivitis which were of mild intermittent type. He had received one dose of measles vaccine at ten months of age. There was no family history of allergy. He was observed for further 24 hours during which he was totally asymptomatic and was discharged on oral azithromycin and prednisolone for 5 days. On follow-up a week later, the boy was totally well and asymptomatic. | [[7.0, 'year']] | M | {'18991698': 1, '22722755': 1, '15805383': 1, '12144556': 1, '31992389': 1, '18762521': 1, '24130394': 2} | {} |
163,603 | 3793531-1 | 24,130,395 | noncomm/PMC003xxxxxx/PMC3793531.xml | Ceftriaxone-induced hemolysis | A 60-years-old lady, with no past history of any drug allergies, presented with fever and productive cough of five days duration. Clinically, she had fever, tachycardia, tachypnea with crackles in the right mammary area. X-ray chest confirmed pneumonia in the right middle zone []. On admission, her investigation were as in []\nA diagnosis of community-acquired pneumonia was made, and patient was started on intravenous ceftriaxone one gram 12 hourly. Her hemoglobin dropped down to 7.5 g/dL within 24 hrs and further to 5.5 g/dL after 72 hrs, with peripheral blood smear showing marked polychromasia with three nucleated red cells per 100 white blood cells, schistocytes, a corrected reticulocyte count of 4.0% and LDH of 1221 units/L. Serum bilirubin rose to 2 mg/dl with indirect of 1.5 mg/dl. Direct Coombs test was positive. Urine for hemoglobin and hemosiderin was negative. A diagnosis of ceftriaxone-induced AIHA was made, and the drug was stopped immediately. Two units of packed red blood cells were transfused as she had symptomatic anemia, her hemoglobin increased to 8.6 g/dl and thereafter to 9.8 g/dl at discharge, after two weeks with no further deterioration. Bilirubin normalized on day six []. | [[60.0, 'year']] | F | {'4160334': 1, '34805481': 1, '28428532': 1, '1825363': 1, '11556301': 1, '20650555': 1, '21685026': 1, '32575628': 1, '16041663': 1, '24130395': 2} | {} |
163,604 | 3793532-1 | 24,130,396 | noncomm/PMC003xxxxxx/PMC3793532.xml | Fluvoxamine induced oculogyric dystonia and manic switch in a patient with obsessive compulsive disorder | A 21-year-old, Muslim male belonging to middle socio-economic status and educated up to intermediate degree had a family history of bipolar affective disorder in his paternal grandfather. He was well adjusted premorbidly and presented with 4 years of illness with no obvious precipitating factor, characterized by repeated, intrusive doubts about symmetry and repeatedly arranging household articles like clothes, shoes, furniture, books etc. He also had doubts on the linearity of the sentences he writes on pages and would write several times before he moved to the next page. He clearly was distressed with these symptoms and for the past 4 months was also complaining of predominant low mood, decreased interest in activities, ideas of decreased self-worth and pessimistic future. He was admitted as an inpatient with a diagnosis of OCD and comorbid moderated depressive episode according to ICD-10. His routine blood investigations including thyroid profile, computed tomography scan brain and electroencephalography were normal. He scored a total of 24 on Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and 15 on Hamilton Depression (HAM-D-17) Rating Scale. He was started on morning dose of fluvoxamine, with an initial dose of 50 mg to be hiked by 50 mg every 4th day. By the 2nd week, he started reporting of improvement especially in depressive symptoms (HAM-D-17 scores reduced to 10 whereas on Y-BOCS, he scored 22). On the 11th day of admission, he complained of oculogyric dystonia characterized by involuntary sustained upward gaze in both his eyes during morning hours. There were no signs and symptoms suggestive of pseudo-parkinsonism or any other movement disorders. He was administered injection promethazine 50 mg stat intramuscularly and the symptom subsided within an hour. Dose of fluvoxamine was decreased to 150 mg and further hiking was planned every 8th day. This symptom did not recur subsequently. By 25th day the fluvoxamine dose was increased to 250 mg and he showed significant improvement in both obsessive (Y-BOCS total score –14) and depressive symptoms (HAM-D-17 total score – 4). However, 2 days later, mental status examination revealed over familiar manner of relating, over productive speech, euphoric affect and inflated self-esteem. He scored 16 on Young Mania Rating Scale (YMRS). Fluvoxamine dose was reduced to 150 mg and 900 mg lithium was added, which was later increased to 1050 mg to obtain optimal serum level, i.e., 0.72 meq/L. He showed an improvement in manic symptoms within 10 days (YMRS total score –3) and maintained the improvement shown in obsessive symptoms.\nThere is a clear temporal relationship between the occurrence of dystonia and relatively faster titration in the dose of fluvoxamine to 200 mg. And reduction in the dose and subsequent slow titration was helpful. Also, temporal relationship between the occurrence of manic switch and dose of fluvoxamine was established. This particular class of drugs is known to cause the spectrum of side-effects as in our case. However, specific case of fluvoxamine causing oculogyric dystonia has not been reported in the literature. While considering the manic switch, a positive family history of bipolar illness in this case might have predisposed the patient to a manic switch; but neurobiological mechanisms of fluvoxamine might be sufficient to trigger a manic switch. The Naranjo adverse drug reaction probability score for oculogyric dystonia was –6 and for the induced manic switch was –5; both suggesting a “probable” association with administration of fluvoxamine. | [[21.0, 'year']] | M | {'22514151': 1, '20680187': 1, '16633151': 1, '20373470': 1, '16514246': 1, '12409687': 1, '8038948': 1, '21680025': 1, '24634707': 1, '24130396': 2} | {} |
163,605 | 3793557-1 | 24,124,302 | noncomm/PMC003xxxxxx/PMC3793557.xml | Protostylid: A case series | A 6-year-old South Indian girl came for routine dental checkup to the Department of Pediatric Dentistry. Family and medical histories were non-contributory. There was no reported history of orofacial trauma. Extra oral examination revealed no abnormalities. Upon intra oral examination, no soft-tissue abnormalities were observed except mild gingivitis. A bilateral protostylid was present on the buccal surface of the maxillary right and left first primary molars viewed in the frontal plane []. Protostylid, which is present on the left side, presents a free cusp apex that doesn’t reach the occlusal plane. Indeed, the protostylid is out of function since there is no occluding anatomical structure on the opposing mandibular arch. On buccal view, protostylid constitutes a conical shape, which was measuring about 3 mm cervico-occlusally and 3 mm mesio distally. Triangular prominence with its base below the gingival margin and its apex oriented occlusally. Protostylid on the maxillary right first primary molar was not prominent. | [[6.0, 'year']] | F | {'2620140': 1, '19179952': 1, '26376321': 1, '11123840': 1, '3468105': 1, '5273410': 1, '11407892': 1, '4459951': 1, '10704885': 1, '9392510': 1, '26312096': 1, '14620213': 1, '2131163': 1, '7848830': 1, '7626414': 1, '24124302': 2} | {'3793557-2': 2, '3793557-3': 2} |
163,606 | 3793557-2 | 24,124,302 | noncomm/PMC003xxxxxx/PMC3793557.xml | Protostylid: A case series | A 5-year-old girl and her 4-year-old brother came for routine dental checkup to the Department of Pediatric Dentistry. Family and medical histories were not relevant and it was her first dental visit. Intra oral examination revealed no soft tissue abnormalities and a protostylid was present on the maxillary first primary molars on right and left sides, but it was more prominent on the right side, it was conical in shape and was measuring about 4 mm cervico-occlusally and 3 mm mesio distally whereas on the left side, which was not prominent []. | [[5.0, 'year']] | F | {'2620140': 1, '19179952': 1, '26376321': 1, '11123840': 1, '3468105': 1, '5273410': 1, '11407892': 1, '4459951': 1, '10704885': 1, '9392510': 1, '26312096': 1, '14620213': 1, '2131163': 1, '7848830': 1, '7626414': 1, '24124302': 2} | {'3793557-1': 2, '3793557-3': 2} |
163,607 | 3793557-3 | 24,124,302 | noncomm/PMC003xxxxxx/PMC3793557.xml | Protostylid: A case series | A 13-year-old boy presented with proclination of anterior teeth, wants to take orthodontic treatment. No relevant medical and dental histories. Intra oral examination revealed angles class 2 molar relations and maxillary left second permanent molar (27) had a protostylid of conical in shape, which was measuring about 4.5 mm cervico-occlusally and 4 mm mesio distally [].\nFor all the four cases, preventive measures such as oral hygiene care, diet advice and topical fluoride gel were instituted and carious teeth were restored. | [[13.0, 'year']] | M | {'2620140': 1, '19179952': 1, '26376321': 1, '11123840': 1, '3468105': 1, '5273410': 1, '11407892': 1, '4459951': 1, '10704885': 1, '9392510': 1, '26312096': 1, '14620213': 1, '2131163': 1, '7848830': 1, '7626414': 1, '24124302': 2} | {'3793557-1': 2, '3793557-2': 2} |
163,608 | 3793559-1 | 24,124,304 | noncomm/PMC003xxxxxx/PMC3793559.xml | Cherubism: Report of a case | A 4-year-old boy presented with painless bilateral swelling of the mandible. When the boy was about 2 years old, the parents had noticed a change in facial symmetry of the face, which later on became more marked []. Intraorally the alveolar ridges were swollen at the angle region and were firm on palpation. Patient had moderate bilateral submandibular lymph node enlargement. Physical and mental development was normal. Patient's parents are healthy had no siblings and none of their relatives had facial deformities.\nRadiographically, the mandible showed a multilocular radiolucency with thin and expanded cortices, including the body and posterior rami bilaterally. The condyle and the condylar neck appeared normal. Maxilla was not involved. The second permanent molar bud was missing considering the age. Radiographically and clinically, symmetric involvement was evident []. CT scan revealed expansile remodeling with multiple osteolytic areas in the mandible []. Laboratory tests, which included serum calcium, phosphorous, alkaline phosphatase and parathyroid hormone were normal.\nBiopsy from the central area of both right and the left rami were taken. Histopathological examination showed fibrovascular collagenous connective tissue with dispersed giant cells []. Patient was recalled after 4 years and patient was asymptomatic; however, the facial asymmetry was evident []. Follow-up orthopantomogram also showed multilocular radiolucencies within the posterior body and rami of mandibular region bilaterally []. As the condition tends to resolve around 15 years of age, patient is kept under periodic follow-up. | [[4.0, 'year']] | M | {'15694152': 1, '17307601': 1, '13465106': 1, '10364528': 1, '10364527': 1, '24421967': 1, '17656300': 1, '26656340': 1, '11381256': 1, '11113824': 1, '16053841': 1, '16713807': 1, '17522488': 1, '28479714': 2, '24124304': 2} | {'5406808-1': 1} |
163,609 | 3793560-1 | 24,124,305 | noncomm/PMC003xxxxxx/PMC3793560.xml | Sturge-Weber syndrome with pyogenic granuloma | A 12-year-old girl reported to the department of Pedodontics RDC Loni with a complaint of swelling in the lower front gum region since 3 months. Clinically there was an isolated gingival swelling in the lower left anterior region between central and lateral incisors (31 and 32). The swelling was red and shiny in appearance measuring about 2 × 1 cm in size extending from mesial surface of central incisor to the mesial half of canine on the labial side and was extending on the lingual side of incisors measuring 0.8 × 0.5 cm in size. Both the swellings were connected at the interdental area of central and lateral incisors [Figures and ]. On palpation the swelling was a pedunculated mass, soft and easily movable from the base. On probing gently, the lesion showed considerable amount of bleeding. Extraorally the face was asymmetrical with slight enlargement on the right side of the face. Remarkably the enlarged right half of the face was bluish red in color. There was a prominent scar on the right side of the face in upper buccal region []. Parents revealed a history of surgery 7 years ago for a red swelling in the scarred area.\nIntraorally right half of the mouth was markedly red affecting labial and buccal mucosa, buccal vestibule, floor of mouth, tongue and palate while left side did not show any abnormalities. Intraoral periapical radiographs of the 31, 32, and 33 region and OPG were advised to rule out any bony involvement. The radiographs did not reveal any significant problems except presence of initial bone loss from the interdental area of 31 and 32.\nSince the lesion had a pedunculated base with little bony involvement excisional biopsy was carried out carefully followed by bony curettage. The entire procedure was performed under local anesthesia. Histopathological examination of the excised mass showed numerous endothelium lined spaces, abundant fibroblasts, collagen fibers, and polymorphonuclear leucocytes revealing features of pyogenic granuloma []. At the end of 1 month, the lesion had uneventful healing []. Six-month follow-up was quite satisfactory and there was no evidence of any recurrence. During surgery and curettage the amount of bleeding was controllable and no additional steps were required to stop the bleeding. This could have been due to the presence of granuloma on the left side which was not affected by the vascular lesion. | [[12.0, 'year']] | F | {'9632339': 1, '16172341': 1, '11559219': 1, '18408269': 1, '12241656': 1, '18974543': 1, '9863285': 1, '16078073': 1, '24124305': 2} | {} |
163,610 | 3793561-1 | 24,124,306 | noncomm/PMC003xxxxxx/PMC3793561.xml | Clinical spectrum of Silver - Russell syndrome | A 12-year-old female patient presented with global developmental delay and facial dysmorphism. Her chief complaint was irregularly arranged teeth. On examination, her height was 125 cm (<3rd %) and having the following features: Hypertelorism, triangular face, low set ears, scanty eyebrows, depressed nasal bridge, frontal bossing, poor vision of the right eye, crowding of upper and lower dental arches [Figures and ]. She was found to have an ear tag on the right ear and a pit on the left ear []. However, she did not have any hearing difficulties. She reported intolerance to heat and poor sweating ability. She had clinodactyly of the fingers and disproportionate toes []. She had trouble in running at school.\nHer facial features were leptoprosopic facial form having a facial index of 173.4 with the increase in lower facial third, convex profile, posterior divergence, hyperactive mentalis and shallow mentolabial sulcus. She had incompetent lips with interlabial gap of 10 mm. On intra oral examination, she had high arch palate and lower midline shifted to the left by 3 mm. The maxillary and mantibular dentition crowding was 8 mm and 4 mm respectively. She had Class I molar relationship on the right side and end - on the relationship on the left side. Canine relationship was Class II on both sides. She had an overjet of 3 mm and openbite of 6 mm. She was found to have crossbite in relation to the left posterior region. Cephalometric analysis indicated increased cranial base angle, decreased anterior and posterior cranial base length. Maxilla was retropositioned relative to cranium. Mandibular skeletal base was retrognathic to cranium. In short, she had Class II skeletal base, vertical growth pattern and deficient chin.\nThe father of this patient also had similar features []. The father was short. His ears were low set and had pits in both right and left ears. He also had hypertelorism, scanty eyebrows and hair on head absent, slanting eyes and poor sweating and heat intolerance. Mother and sibling of the patient were normal. Routine chromosome analysis of daughter and father indicated normal karyotypes.\nHematological investigations of the 12-year-old patient where carried out. Hematological values were within normal limits. Based on the history, clinical examination and investigation findings, a diagnosis of Silver - Russell syndrome was made. Differential diagnoses considered were Fetal Alcohol syndrome, Bloom syndrome and Robinow syndrome.\nPatient was advised regarding growth hormone therapy and orthodontic correction of malocclusion. The orthodontic treatment plan was to have a period of rapid maxillary expansion followed by fixed orthodontic therapy. The phase of rapid maxillary expansion is completed []. | [[12.0, 'year']] | F | {'13099907': 1, '19066168': 1, '13237189': 1, '13869653': 1, '27370225': 1, '15450': 1, '10544228': 1, '19364767': 1, '18992170': 2, '12437561': 1, '18329128': 1, '19700863': 1, '24124306': 2} | {'2585578-1': 1} |
163,611 | 3793562-1 | 24,124,307 | noncomm/PMC003xxxxxx/PMC3793562.xml | Bimaxillary unilateral gingival fibromatosis with localized aggressive periodontitis (eating the tooth at the same table) | A 15-year-old female patient accompanied by her uncle was referred to the Department of Periodontics, ACPM Dental Collage and Hospital, Dhule, (Maharashtra) for the complaint of progressively enlarging gums. According to her, gums started growing about 1 year back beginning in the upper left back tooth region and gradually progressively involved all the teeth on that side. Similar enlargement of gums was also noticed with the lower back tooth region of that side. As the patient had difficulty in chewing from that side she continued to chew from the opposite side. Over a period of time, as the enlargement took a massive form and caused difficulty in mastication and compromised her esthetics, the school authorities brought it to the notice of her parents and they approached for treatment for it.\nOn further communication, the patient's past medical history and dental history was non-significant and was reporting for the first time to dental hospital.\nExtraoral examination revealed a slight asymmetry of the face on the left side []. Intra-orally massive gingival enlargement was noted in the maxillary as well as mandibular gingiva, but only on the left side whereas the right side gingiva appeared normal. The gingival enlargement extended from distal aspect of maxillary left lateral incisor to second molar []. The mandibular gingiva enlargement extended from distal aspect of lower lateral incisor up to the second molar and almost encroached the occlusal surface leaving a small view of it. The degree of enlargement was categorized as grade 3 (Angelopoulos 1971) [].\nThe color of the gingiva appeared pink with consistency being firm and fibrous with no evidence of stippling on the affected side. Traces of plaque, food debris and calculus were noted on the affected side. Bleeding on probing was minimal/evident/present. Periodontal examination revealed deep periodontal pockets in relation to 25, 26, 27, 35, 36 and 37. Mobility of grade 3 degree was found with 26 and 27 and grade 1 degree mobility with 25 and 35. An orthopantomograph was advised to rule out bony changes. Along with this a complete blood examination along with hormonal analysis of estrogen and progesterone were advised.\nBlood examination reports revealed all parameters to be within the normal limits including hormones (estrogen and progesterone). Radiographic examination revealed severe angular bone loss localized around maxillary first and second molars and moderate bone loss around mandibular first and second molars, but of the left side only []. Based on onset of age, presence of minimal local factors, clinical, radiographic and non-significant medical history and a diagnosis of IGF with localized aggressive periodontitis was made.\nA biopsy was advised and sent for histopathological examination, which confirmed the features of fibrous gingival overgrowth. The section was stained with hematoxylin and eosin, which revealed thickened epithelium with elongated retepegs that penetrated deep into the connective tissue. Dense collagenous tissue bundles arranged in parallel were found scattered throughout the connective tissue. Few fibroblasts, inflammatory cells, blood capillaries were also found [].\nThe usual treatment for IGF consists of surgical excision of gingiva the treatment for aggressive periodontitis initially consists of Phase 1 therapy that comprises of scaling and root planing, advise on oral hygiene instructions, administration of antibiotics, drugs amoxicillin (500 mg) and metronidazole (400 mg) for 5 days, along with anti-inflammatory drugs (ibuprofen and paracetamol) and use of chlorhexidine mouthrinses The same was carried out for the patient. The patient was discharged with oral hygiene instructions and recalled after 4 weeks.\nAt the end of 4 weeks, internal bevel gingivectomy quadrant wise along with open flap debridement was carried out. This procedure eliminates the pocket reduces the bulk of tissue and makes plaque control much easier. External bevel gingivectomy remains the method of choice if no bony involvement exists. Maxillary first and second molars were extracted as their prognosis was hopeless. Interrupted sutures were placed and periodontal dressing given []. Healing after 2 weeks at suture removal was satisfactory. Patient was recalled again at the end of 3 months, during which time there were no signs of recurrence. The clinical picture of the jaws at the end of 3 months []. The patient was advised to get the missing teeth replaced. Follow-up at the end of 1 year showed no recurrence of gingival overgrowth []. | [[15.0, 'year']] | F | {'11203959': 1, '18689337': 1, '33188467': 1, '12423302': 1, '17189459': 1, '33642744': 2, '20461324': 1, '15187034': 1, '22852514': 1, '24124307': 2} | {'7904016-1': 1} |
163,612 | 3793563-1 | 24,124,308 | noncomm/PMC003xxxxxx/PMC3793563.xml | Management of impacted all canines with surgical exposure and alignment by orthodontic treatment | A 16-year-old girl reported to Department of Orthodontics, Dental faculty of C.S.M. Medical University, Lucknow, with the chief complaint of severe intermittent pain in upper and lower anterior teeth. Patient had past dental history of root canal therapy in the lower right lateral incisor and amalgam restorations and her medical history was not significant.\nOn clinical examination, extra orally patient shows incompetent lips with convex profile [Figures and ] Intraoral examination showed there was 100% overbite, 5 mm overjet and molars were in Class I relation [Figures ] The most noticeable feature was absence of both maxillary and mandibular canines [Figures ] In the maxillary arch, space was present between the lateral incisors and the first premolars, but in mandibular arch, there was some arch length discrepancy.\nEvaluation of panoramic radiograph, shows impacted maxillary and mandibular canines. Both maxillary canines were palatally impacted and mandibular canines were lingually impacted. All four canines were exerting pressure on the roots of lateral incisors. Lateral cephalometric evaluation shows the prognathic maxillae, high mandibular plane angle with protrusion of both upper and lower lips [ and , ].\nThe main treatment objectives for the patient were to relieve pain that was due to pressure of impacted canines on lateral incisors and to correct the patient's esthetics, overjet, overbite and correction of functional occlusion by bringing all the four permanent canines into alignment and occlusion.\nSurgical exposure of the impacted maxillary and mandibular canines followed by directional forces to bring them into occlusion was planned. Extraction of the maxillary, first premolars was planned for correction of the overjet, overbite and space management for the impacted maxillary canines. In the mandibular arch, extractions of the lateral incisors were planned due to arch length discrepancy and poor prognosis of mandibular left lateral incisors.\nInitial maxillary and mandibular arch alignment was performed and 0.019” × 0.025” stainless steel arch wires were inserted. A transpalatal arch in the maxillary arch and a lingual holding arch in mandible arch was placed to stabilize the molars. Thus adequate anchorage was planned before the canines’ exposure.\nExposure of the palatally impacted maxillary canines was performed by an open window procedure and lingual buttons bonded on the exposed crown surface.[] [] because the crowns of mandibular canines were in close proximity to the roots of the lateral incisors, both canines were exposed with closed flap technique and then lingual buttons were attached on the accessible surface of the teeth. The flap was replaced over the crown and the hook were exposed for force application.[] Only when we were assured of tooth eruption, the maxillary first premolars and mandibular lateral incisors were extracted. Glass ionomer cement bite block was placed on mandibular posterior teeth to prevent obstruction and facilitate movement of maxillary canines. Light orthodontic forces were applied from K-9 extrusion spring for the traction of the impacted canines into the extraction space[] [].\nSince light exposure of impacted canines without exposing cementoenamel junction results in better bone support latter as compared with heavy exposure with complete removal of follicular sac, bone was removed conservatively.\nTo activate the spring after it is engaged in the auxiliary tube of molar buccal tube the vertical arm is swung upward and ligated to the bonded attachment on the impacted canine. This provides a gentle extrusive force on the canine; the spring also has a buccal component of force due to the arcial pattern of activation and deactivation. The force needed to distalize the canine is achieved by cinching the spring back about 2 mm after it has been ligated to the canine. When the vertical arm of the K-9 spring is rolled upward and inward to be engaged to an impacted canine, the result is an intrusive force and a clockwise moment on the molar and premolars. A transpalatal arch and lingual holding arch control this reactive force and moment.\nSimultaneously an intrusion arch was ligated in both arches for the intrusion of maxillary and mandibular incisors. After completion of the traction, a series of stainless steel wires (0.016,” 0.017” × 0.025,” 0.019” × 0.05” and 0.021” × 0.025”) were ligated and final alignment and leveling accomplished. The case was completed within 2 years and 4 months and the final results are shown in post treatment photographs. | [[16.0, 'year']] | F | {'267436': 1, '11070629': 1, '15356485': 1, '1739070': 1, '11314175': 1, '11138652': 1, '24124308': 2} | {} |
163,613 | 3793564-1 | 24,124,309 | noncomm/PMC003xxxxxx/PMC3793564.xml | Oncologic profile of maxillary odontogenic myxoma: A rare case | A 34-year-old female patient approached the department for an opinion regarding a swelling in the left upper jaw. Past dental history revealed an episode of trauma 1 year back with a subsequent slow growing swelling in the posterior region of left maxilla\nWhen patient reported to the department, she had a bony hard non-tender diffuse swelling of approx. 2.5 cm × 2 cm on the left middle third of face obliterating the nasolabial fold. Intra-orally, the lesion obliterated the vestibule and extended from 23 to 26 regions. It was approx. 3 cm × 2 cm × 1 cm in dimension. Overlying mucosa showed no color change. The associated teeth showed grade 1 mobility. [].\nOrthopantamograph revealed a unilocular radiolucent lesion in 23 to 26 regions. Root resorption was observed []. None of the teeth were absent in maxillary jaw. Missing teeth were 37 and 46. Fine needle aspiration failed to show any cellular yield\nAn excisional biopsy harvested multiple small pieces of the lesional tissue. Gross specimen was yellowish white, glistening, gelatinous, lobulated mass [].\nHistopathological examination revealed typical features of myxoma, with loosely arranged stellate or spindle shaped cells within a myxoid matrix. At places, tumor showed collagen fiber bundles. Islands of odontogenic epithelium were seen. The findings were found consistent with OM [Figures and ].\nAlthough the incidences of recurrences are high, a 12 month asymptomatic follow-up has been recorded. [Figures and ] | [[34.0, 'year']] | F | {'22011900': 1, '18198753': 1, '7560205': 1, '20607463': 1, '19705152': 1, '34094841': 1, '22473349': 1, '16505272': 1, '21266837': 1, '17149953': 1, '18245926': 1, '22888844': 1, '18587209': 1, '24124309': 2} | {} |
163,614 | 3793565-1 | 24,124,310 | noncomm/PMC003xxxxxx/PMC3793565.xml | Lip reposition surgery: A new call in periodontics | A 35-year-old female patient reported to the outpatient department of Periodontics and Oral Implantology, Ahmedabad Dental College and Hospital with the chief complaint of excessive gingival display. The patient was apparently asymptomatic except the embarrassment of going in public due to gummy smile. On examination, she had an excessive gingival display of around 8-10 mm extending from maxillary right first molar (16) to maxillary left first molar (26). Furthermore, marginal gingival discrepancy was reported in relation to maxillary right central incisor (11) and maxillary left central incisor (21) along with short clinical crowns. The patient's medical history was non-contributory and there was no contraindication to surgical treatment.\nThe treatment suggested and performed were:\nSurgical crown lengthening[] in relation to maxillary right lateral incisor (12) to maxillary left lateral incisor (22) Surgical lip repositioning procedure for correction of a gummy smile.\nSurgical technique was performed after following complete aseptic precautions. Standard skin preparation was carried out by 10% povidone-iodine solution and temporary draping was done. Local infiltration was done using local anesthetic solution Lignox® (2% Lignocaine with 1:200,000 Adrenaline) in the vestibular mucosa and lip extending from right first molar to left first molar.\nThe surgical area was outlined using an indelible pencil. The procedure was initiated with a 15 no Bard-Parker blade by giving a partial-thickness incision following the mucogingival junction extending from right first premolar (14) to left first premolar (24). Followed by the first incision, another second horizontal incision parallel to first was made in the labial mucosa 10-12 mm apical to mucogingival junction. These two incisions were connected at each end by creating an elliptical pattern []. The partial-thickness flap was excised leaving the underlying connective tissue exposed to the oral cavity []. It is noteworthy that the amount of partial-thickness flap excised should be either double the amount of gingival display that needs to be reduced or a maximum of 10-12 mm tissue excision in order to prevent the involvement of labial minor salivary glands severing of which may lead to the formation of mucocele.\nComplete hemostasis should be attained by pressure pack. Henceforth, parallel incised margins were approximated with an interrupted stabilization suture using Vicryl® 5-0 at the midline to ensure proper alignment of the midline of the lip with that of the teeth []. Multiple interrupted sutures at a distance of 1 mm were taken on either side of the midline suture to approximate the flap margins.\nNon-steroidal anti-inflammatory drugs (Tablet Ibuprofen 400 mg 4 times a day for 3 days) along with oral antibiotics (Capsule Amoxicillin 500 mg 3 times a day for 7 days) were prescribed post-operatively. Patient was instructed to use ice packs immediate post-operatively for few hours with intermittent application on the upper lip and to minimize lip movement while smiling and talking. Patient was recalled for follow-up after a week.\nPost-operative symptoms included mild pain and swelling with feeling of tension on the upper lip while smiling. Sutures were removed after 2 weeks. The site healed uneventfully with scar formation at the suture line, which was concealed under the lip and was not apparent when the patient smiled.\nThis esthetic procedure is safe and has minimal side-effects. The patient was recalled after every 3 months for follow-up. The patient was highly pleased and satisfied with the esthetic outcome [Figures -]. | [[35.0, 'year']] | F | {'10825866': 1, '15022706': 1, '33632971': 1, '10654758': 1, '15739921': 1, '27041845': 2, '21731255': 2, '32001970': 2, '34660802': 1, '33708326': 1, '17073353': 1, '24124310': 2} | {'6967167-1': 1, '4795143-1': 1, '3118080-1': 1} |
163,615 | 3793566-1 | 24,124,311 | noncomm/PMC003xxxxxx/PMC3793566.xml | Osteosarcoma of mandible: Detailed radiographic assessment of a case | A 28-year-old male patient reported to Dental Department of a Private Hospital with the chief complaint of rapidly increasing swelling at left body of mandible []. Patient had visited an oral and maxillofacial clinic for tenderness at same site, and extraction of 38 was performed. After extraction, patient noticed fast progression of swelling with no relief in pain. Swelling was bony hard. Submandibular lymph nodes of involved side were palpable and non-tender. Intraoral examination revealed obliteration of buccal vestibule in relation to 35, 36 and 37. Intraoral radiograph, in early stage of disease, revealed widening of periodontal ligament (PdL) space in relation to 35, 36 and 37 without any evidence of odontogenic or periodontal disease.\nRadiographic imaging using CT, 3-D CT and CT angiography techniques were performed. CT scan revealed a large tumor mass originating from surface of outer cortex of body and angle of mandible []. Lesion extended from first molar to posterior border of ramus anterio-posteriorly. Tumor involved coronoid process above and extended 1.5 cm below lower border of mandible. Lower border of mandible was seen destroyed and replaced by connective tissue stroma of tumor. A mixed radiopaque and radiolucent mass with typical “sunburst” appearance at outer cortex with “codman's triangle” at the margins of tumor led to the diagnosis of OS []. 3D CT images revealed extensive spread of tumor mass. Tumor osteoid was seen forming a complex network radiating from body and angle of mandible and reaching coronoid notch []. Study of bone destruction pattern on CT scans revealed a predominant bone-destruction negative pattern. At most areas of tumor involvement the continuity of outer cortical plate is intact, with tumor osteoid radiating outwards. However, at lower border of mandible tumor mass is seen destroying entire thickness of bone and replacing with radioluscent soft-tissue mass. CT angiography was performed to assess the vascularity of tumor. The tumor was found to be extensively vascularized and the feeder vessel was identified to be external carotid artery []. Incisional biopsy showed osteoid areas lined by plump osteoblasts with hyperchromatic nuclei, mitotic figures, and sheets of cells showing nuclear and cellular pleomorphism, inflammatory cells, numerous blood vessels and hemorrhage []. Case was operated upon under general anesthesia, tumor mass resection with reconstruction using iliac crest was done []. Final diagnosis was consistent with that of representative specimen. | [[28.0, 'year']] | M | {'20452115': 1, '22055970': 1, '15742279': 1, '15897290': 1, '30693455': 1, '19212500': 1, '6573939': 1, '16446924': 1, '18230378': 1, '11312461': 1, '17467326': 1, '24496065': 1, '24124311': 2} | {} |
163,616 | 3793567-1 | 24,124,312 | noncomm/PMC003xxxxxx/PMC3793567.xml | Habitual biting of oral mucosa: A conservative treatment approach | An 8-year-old boy was referred to the Pediatric unit of the Oral Health Sciences Center by a private practitioner with chief complaint of “soft tissue growth” on right cheek mucosa, which did not heal with local application of ointment and was gradually increasing in size over a period of 4 months. An intraoral examination of the patient showed hypertrophic, soft, roughened, non-pedunculated growth of about 2 mm × 2 mm on right mucosa of cheek. The growth was opaque white, non tender, without any ulceration []. The patient gave the history of traumatic injury to cheek while eating after which the tissue started growing in size and had resulted in a habit of cheek biting. The growth was evident along the masticatory surfaces of the primary molars. The patient was aware of the habit of cheek biting during the day and occasionally during his sleep. No lymphadenopathy or other constitutional signs/symptoms were detected. As the history and clinical findings were suggestive of cheek biting, surgical excision of the soft tissue growth was done using cautery [], after which the patient presented with uneventful healing. The excised tissue was sent for histopathological examination which showed evidence of hypertrophic tissue. After 2 months, however, patient again reported with a growing tissue of almost similar dimensions as the previous one and present at the same site due to persistence of habit, as revealed by the parents []. Fabrication of mouth guard was planned to prevent any further trauma to cheek mucosa and to promote healing. Maxillary and mandibular impressions were made using irreversible hydrocolloid. Mouth guard was fabricated from soft polyvinyl sheet of thick resilient material (Bioplast® Scheu Dental GmbH Iserlohn Germany) of 2 mm thickness after occluding the dental casts and placing sheet in a vacuum formed pressure molding device (Biostar® Scheu Scheu Dental GmbH Iserlohn Germany) with a thermally controlled infrared heater []. The sheet extended laterally from first molar region on the left side to first molar region on right side []. The patient was directed to wear the appliance during daytime after school hours and at night during his sleep. Patient was reviewed every 2 months till 6 months and he presented with uneventful healing, with no recurrence. After 6 months, the appliance was discontinued. The patient was again recalled and reviewed 6 months after the discontinuation of appliance; the tissue remained healed with no sign of recurrence of any traumatic lesions on the cheek mucosa [Figure and ]. | [[8.0, 'year']] | M | {'15790365': 1, '9680913': 1, '9161197': 1, '11132513': 1, '27365937': 2, '31110609': 1, '6584829': 1, '16295227': 1, '1440138': 1, '6575340': 1, '30899464': 2, '9262803': 1, '17560136': 1, '1527736': 1, '12049080': 1, '9883322': 1, '33551622': 1, '24124312': 2} | {'3793567-2': 2, '6406147-1': 1, '4921885-1': 1} |
163,617 | 3793567-2 | 24,124,312 | noncomm/PMC003xxxxxx/PMC3793567.xml | Habitual biting of oral mucosa: A conservative treatment approach | A 7-year-old boy reported to the department with edematous growth on left side of lower lip. Growth occurred two months prior to presentation to dental clinic. Parents informed that the child had a previous episode of trauma to lower lip after which the growth appeared and started increasing in size over the period of time []. The child was seen biting his lower lip in the region of growth all the time while sitting in the dental chair and parents also confirmed regarding this habit of their child. It was planned to target the habit with habit breaking appliance instead of surgically treating the lesion. Soft polyvinyl sheet of 2 mm thickness (Bioplast® Scheu Dental GmbH Iserlohn Germany) was molded in vacuum formed pressure molding device on the maxillary arch cast (Biostar® Scheu Scheu Dental GmbH Iserlohn Germany). Patient was told to wear the appliance after school hours and even while sleeping []. After 2 weeks of continuous wearing of the appliance, patient presented with progressive regression of the lesion. He was instructed to continue to wear the appliance for 4 more weeks. After 4 weeks, the lesion had completely regressed so the appliance was discontinued and patient was kept under review []. | [[7.0, 'year']] | M | {'15790365': 1, '9680913': 1, '9161197': 1, '11132513': 1, '27365937': 2, '31110609': 1, '6584829': 1, '16295227': 1, '1440138': 1, '6575340': 1, '30899464': 2, '9262803': 1, '17560136': 1, '1527736': 1, '12049080': 1, '9883322': 1, '33551622': 1, '24124312': 2} | {'3793567-1': 2, '6406147-1': 1, '4921885-1': 1} |
163,618 | 3793568-1 | 24,124,313 | noncomm/PMC003xxxxxx/PMC3793568.xml | Surgical treatment of odontogenic myxoma and facial deformity in the same procedure | A 25-year-old female patient was referred to our department with a chronic headache. Patient's first diagnosis hypothesis was sinusitis and she had previously been referred to an otolaryngologist. Waters’ radiograph was performed, which demonstrated a limited radiopacity area into the right maxillary sinus. The patient's medical history was unremarkable. On physical examination, the patient was healthy, without swelling. The mucosa overlying the area of the lesion was the same color and texture as the surrounding mucosa. The sensory examination of the maxillary branch of the trigeminal nerve was normal bilaterally. Furthermore, she had aesthetic concerns about her high smile. Facial and cephalometrical examination revealed an excessively facial height and an excessive incisal and gingival display upon smiling. She was diagnosed with vertical maxillary excess and Class I malocclusion []. Initially, the patient was treated for third molar extraction 7 years ago; in this panoramic radiograph, was observed a discrete radiopacity area in the left maxillary sinus. It was probably an early stage of the lesion.\nA biopsy was taken with a Caldwell-Luc approach; histological result show abundant myxoid stroma with collagen fibrils presenting a diagnosis of OM.\nThe treatment planned was Le Fort I osteotomy with down-fracture to remove the tumor with segmental maxillectomy and 5 mm superior maxillary repositioning for better occlusion and facial esthetic.\nSurgery was performed under general anesthesia and nasal endotracheal intubation. Pre-orthognathic surgical models, radiographs, computed tomography face, photographs and biomodels were obtained before the surgery []. When the maxilla was down fractured, the tumor mass was visualized in the right maxillary sinus with four teeth involved in the lesion, which were removed. After the segmental maxillectomy, maxillary segment was stabilized with plate and screw in the anterior area on the right side and fixation on the anterior and posterior maxillary buttress on the left side. No intermaxillary fixation was used and it was not necessary turbinectomy.\nThe 3 years follow-up show satisfaction for the occlusal and esthetic result and the patient is disease-free []. A removable dental prosthesis without functional or aesthetic compromise is used []. | [[25.0, 'year']] | F | {'8899782': 1, '17507265': 1, '3522784': 1, '17463101': 1, '12796890': 1, '15145033': 1, '10188125': 1, '19027311': 1, '20251479': 1, '24124313': 2} | {} |
163,619 | 3793571-1 | 24,124,316 | noncomm/PMC003xxxxxx/PMC3793571.xml | Masson's hemangioma: A rare intraoral presentation | A 19-year-old female patient was referred to the Department of Oral and Maxillofacial Surgery by the Department of Oral Medicine for the diagnosis and management of a painless “swelling” in the left buccal mucosa. The intraoral swelling was noticed by the patient 1 year back. According to the patient, the swelling had recently enlarged interfering with her mastication. No changes of size or development of swelling during meal times were reported. The patient was in apparent good health and her medical history was non-contributory.\nClinical examination showed a 3 × 2 cm swelling in the left buccal mucosa, which was freely movable. Intra-orally, it was covered by a mucosa of normal texture and color. On digital palpation, the swelling was non-tender, non-fluctuant, and rubbery in consistency. The swelling had well-defined margins and was not fixed to the underlying as well as overlying structures. There was no sign of hypoesthesia or paresthesia of the area involved.\nA computerized tomography (CT) scan with enhancement was performed to confirm the existence of a well-demarcated mass lying anterior to the masseter muscle []. The lesion was solid, without any relation to the mandible. The remainder of the head and neck scan did not reveal any other pathology or lymph node enlargement. Although it was believed that magnetic resonance imaging could give more precise and accurate information for the diagnosis and management of the lesion, the patient refused any further imaging study.\nThe structures of oral cavity can be affected by numerous pathological conditions that could be developmental, inflammatory, or neoplastic in origin. Lesions in the oral cavity may be present for a longer period of time before the patient seeks any medical intervention, which is usually as a result of interference with swallowing or speech.\nBased on the clinical presentation of the swelling, it appeared that the mass originated from the underlying mesenchymal tissues as opposed to the overlying mucosa. Our differential diagnosis was broken down into the general categories of reactive lesions, benign neoplastic lesions, and infectious origin. Specifically, our differential diagnosis of this soft tissue mass of buccal mucosa included lesions of minor salivary gland origin (benign vs. malignant salivary gland tumor, mucocele), vascular origin (hemangioma), non-odontogenic soft-tissue infection, hematomas, an intramasseteric abscess, masseteric hypertrophy, benign neoplasms of smooth muscle origin (leiomyoma), and reactive and neoplastic neural lesions (traumatic neuroma, neurofibroma, neurilemoma).\nCystic lesions-like dermoid cysts were clearly excluded by the CT findings, because fluid in the cysts would not have demonstrated enhancement by the contrast material.\nNo history of trauma excluded the possibility of hematoma.\nTraumatic neuroma was also considered. However, traumatic neuromas typically occur in the mental foramen region, tongue, and lower lip. One-third to one-fourth of these lesions are painful and are usually associated with trauma. The patient had no history of trauma. Benign neural neoplasms such as neurofibroma and neurilemoma may present as smooth-surfaced nodules similar in color to the adjacent normal mucosa. Approximately 25-45% of schwannomas or neurilemomas occur in the head and neck region, with tongue and buccal mucosa representing the most frequent intraoral lesions. Therefore, benign neural tumor was considered in one of the differential diagnosis.\nSalivary gland tumors account for 1% of neoplastic lesions in the head and neck region.[]\nA salivary gland neoplasm could have been a possibility, because the lesion was in close proximity to both parotid gland and minor salivary glands of buccal mucosa. Although the parotid gland is by far the most common site for salivary gland neoplasms, accounting for 64-80% of all cases, CT scans of this patient failed to reveal any parotid gland enlargement. Approximately 11-15% of minor salivary gland tumors occur in buccal mucosa. These typically present as painless, slow-growing, firm, frequently mobile swellings.[] Taking into account the size of the lesion in the present case, the possibility that this could represent either a high-grade mucoepidermoid carcinoma or adenoid cystic carcinoma of minor salivary gland origin was considered.\nInfections and inflammatory lesions of perioral tissues may also present as a swelling in the buccal mucosa. Acute infections, such as Ludwig angina or cellulitis, which may derive from an odontogenic focus of infection, osteomyelitis, were not considered in the differential diagnosis because of the chronic nature of the condition.[] In addition, fever, malaise, and pain would normally accompany the clinical presentation of an acute infection, and tenderness to palpation and fixed or fluctuant overlying skin would be apparent in the clinical examination. In addition, an intramasseteric abscess was unlikely, because there was no redness of skin or oral mucosa over the mass and the patient had no associated symptoms of fever or pain.\nMasseteric hypertrophy is a benign condition characterized by an enlargement of the bilateral masseter muscle that appears as a homogenous enlargement on CT. In the present case, CT showed the lesion as a unilateral mass.\nMucoceles of the minor salivary glands are rarely >1.5 cm in diameter and are always superficial. Mucoceles found in deeper areas are usually larger. Mucoceles can cause a convex swelling, depending on the size and location, as well as difficulties in speaking or chewing.[] Mucoceles can appear at any site of the oral mucosa containing salivary glands. The two types of mucoceles are more commonly found at different sites. Extravasation mucoceles appear frequently on the lower lip, whereas retention mucoceles appear at any other location of the oral cavity. The lower lip is the most frequent site for a mucocele, as it is the most probable place for a trauma, especially at the premolar level. A study of 312 patients showed 230 lesions on the lower lip (73.7%), with the tongue as the second most common location (15.4%).[] These locations are followed by the buccal mucosa and palate and are rarely found in the retromolar region and posterior dorsal area of the tongue. Mucocele of buccal mucosa is a superficial lesion and, in the present case, the lump was deep in origin.\nHemangiomas frequently appear as reddish-blue lesions. Hemangiomas of the head and neck occur commonly in infancy and childhood, especially in girls. Hemangiomas in the masseter muscle are relatively rare, and approximately 90% of these lesions develop before the age of 30 years. However, this group of lesions was excluded from our differential diagnosis because the lesion did not blanch with pressure and needle aspiration was negative.\nLipomas are slow-growing, nearly always benign, adipose tumors that are most often found in the subcutaneous tissues.[] These tumors may also be found in deeper tissues such as the intermuscular septa, the abdominal organs, the oral cavity, the internal auditory canal, the cerebellopontine angle, and the thorax.[] Some lipomas are believed to have developed following blunt trauma. Lipomas usually present as non-painful, round, mobile masses, with a characteristic soft, doughy feel. The overlying skin appears normal. Lipomas can usually be correctly diagnosed by their clinical appearance alone. In the present case, the mass was mobile, non-tender, and rubbery in consistency, but non-slippery. Lipoma was also considered to be one of the differential diagnosis.\nNeedle aspiration yielded neither blood nor any other fluid. An incisional biopsy was performed under local anesthesia, during which, profuse bleeding was noted. The patient did not have a history of bleeding disorders and was not taking anticoagulant or other medication that could interfere with coagulation. Histopathological examination of the specimen revealed cystic spaces with papillary projections, fibrocollagenous tissue, and skeletal muscles, which was not conclusive of any typical pathology. An excisional biopsy was performed under local anesthesia. After clinical and radiological diagnosis, the patient was planned under conscious sedation. Intra-oral incision or parallel to occlusal plane was given. Submucosally lesion was identified and dissected bluntly from rest of the tissue, particularly in the region of masseter muscle. Whole of the lesion was removed and, after achieving hemostasis, the wound was closed primarily. The excised tissue was submitted for histopathological evaluation []. The lesion appeared macroscopically as an enucleated soft tissue lesion without evidence of bony involvement. Histopathological examination revealed increased vascularity. Endothelial cells arranged in multiple papillary-like projections within the major lumen. Dilated vascular space lined by plump endothelial cells with multiple anastomosing channels were seen. Papillary projections were proliferating into the lumen of the major vessel and surrounded by muscles of the vessel wall. No increased mitotic activity was evident [Figures and ]. Since there was no dysplasia in the endothelial lining, the possibility of angiosarcoma histologically was also ruled out. Attempt of thrombus formation was evident in the lumen of many vessels.\nImmunohistochemical staining was performed using an avidin-biotin method. Immunoreactivity for factor VIII was seen positive in the papillary structure of the cystic lining [].\nThe final diagnosis of Masson's hemangioma was made after extensively reviewing the slides and also after reviewing the archival literature. The patient was followed for several months and was found to be disease-free, without any evidence of local recurrence. | [[19.0, 'year']] | F | {'28761850': 1, '11115277': 1, '26225335': 2, '12820326': 1, '21173922': 1, '6666836': 1, '15865098': 1, '12363107': 1, '24891960': 2, '15026587': 1, '12618979': 1, '2701410': 1, '8442671': 1, '19172313': 1, '32274236': 2, '26855712': 1, '24124316': 2} | {'7136786-1': 1, '4033548-1': 1, '4513410-1': 1, '4513410-2': 1} |
163,620 | 3793572-1 | 24,124,317 | noncomm/PMC003xxxxxx/PMC3793572.xml | Telescopic overdenture: Perio-prostho concern for advanced periodontitis | A 65-year-old male reported to the Department of Prosthodontics, Subharti Dental Meerut, with a chief complaint of loose dentures and soreness of the mouth. Patient gave a medical history of diabetes mellitus since 15 years and hypertension since 23 years. He was currently on oral hypoglycemic and antihypertensive. He gave a dental history of wearing the same maxillary denture and mandibular RPD since 10 years, which gradually became loose. The patient also gave a history of undergoing periodontal surgeries around 8 months back.\nA preliminary examination revealed that the patient had missing 31, 32, 37, 41, 42, 47 and completely edentulous maxillary arch. There were grade II mobility with respect to 36 and 46. There was generalized grade I mobility of the remaining teeth. Also there was grade II furcation involvement of 36 and grade I furcation involvement of 46. A generalized pocket depth of 4-6 mm was noted. Oral hygiene was fair. Diagnostic impressions were made using irreversible hydrocolloid impression and an inter-occlusal bite registration was taken. The impressions were poured and the diagnostic models were mounted on a semi adjustable articulator. A diagnostic surveying of the models was done []. A complete radiographic survey was carried out to correlate with the clinical findings. The OPG revealed generalized horizontal bone loss up to the middle 1/3rd of the roots, and bone loss up to apical 1/3rd was seen in 36 and 46. Also, furcation involvement was seen in 36 and 46, thus indicating severe periodontitis. It was decided to extract both the mandibular molars due to advanced periodontitis followed by a thorough oral prophylaxis and a flap surgery in 35, 45 regions to decrease the pocket depth. The periodontal status was reviewed after 6 weeks. After ascertaining the decrease in tooth mobility and pocket depth, prosthetic rehabilitation was carried out. During the definitive intra-oral examination the potential abutments were evaluated clinically to determine their periodontal condition, pockets, mobility, caries, old restorations, vitality, abrasions, and supra-eruption [].\nThe diagnostic findings were as follows:\nA discrepancy in the occlusal plane was noted due to supra-eruption of 33, 45 The potential abutments had varying paths of insertion The mandibular teeth were lingually inclined The abutments had a large crown: Root ratio.\nIt was decided to prosthetically rehabilitate this patient with a telescopic denture for the mandibular arch and to use a complete denture for the maxillary arch. Intentional RCTs were performed on 33, 34, 35, 43, 44 and 45. Tooth preparation was done by preparing a chamfer finish line of 0.7 mm and axial wall heights of 4 mm in 33, 43, and 6 mm in 34, 35, 44, and 45 with a taper of approximately 8-10°. After the mouth preparation in the mandibular arch, gingival retraction was done and a final impression was made with addition silicone using the putty-wash technique. The first master model was prepared from the impression for fabrication of the primary copings. This was followed by making an interocclusal record using putty and a face bow transfer. In the laboratory, the wax patterns were prepared for the primary copings on 33, 34, 35, 43, 44, and 45. The patterns were milled to obtain a frictional surface for retention and then cast in to nickel chrome alloy (high chrome soft). Once the primary copings were evaluated for fit [], the copings were luted with temporary cement (zinc oxide eugenol) and an overimpression was made using the medium viscosity addition silicone impression material and the second master model was made []. This model would be used for fabrication of the cast partial superstructure. Bite registration was repeated and the models with the copings were mounted on a semi-adjustable articulator using the same face bow record. In the laboratory, the copings on the second master model were milled with a parallelometer to obtain a milled surface of minimum 4 mm for friction. The second master model together with the primary copings was duplicated and the refractory model was prepared. The cast partial framework was waxed up, which was then cast using a base metal alloy (cobalt-chrome) with the secondary coping overlay of the primary coping. After evaluating the fit of the framework in the mouth [], it was used as a carrier for cementing the primary copings in place. The primary copings were luted with glass ionomer luting cement (Type I; GC Fuji). A wax rim was prepared on the framework and acrylic teeth were set with the same shade as were veneered over the secondary coping. The maxillary complete denture was fabricated following normal single denture fabrication protocol. After verification of esthetics, function, and phonetics, the mandibular denture was processed []. The completed prostheses were evaluated for function, esthetics, and phonetics [].\nA telescopic overdenture was chosen for this patient because of its good retentive and stabilizing properties, rigid splinting action, and better distribution of stresses. Other treatment options included extraction of the remaining teeth, followed by a conventional complete denture. This was not selected because extraction would have decreased the available support and proprioception provided by the teeth and their periodontal ligaments. Implant supported prosthesis was not opted for as the patient was medically compromised and also because of the cost involved in the procedure. Clinical longevity of a telescopic overdenture is essentially influenced by the applied restorative concept of connecting the removable denture with the remaining teeth. With regard to the number, alignment, and periodontal status of the remaining teeth, the clinician needs to select the appropriate retainer for a long-term successful restoration. Telescopic or double crowns have proven to be an effective means of retaining overdenture. In this situation, a total of 6 abutments for telescopic copings were used to support the overdenture, thus creating a quadrilateral configuration. It has been reported that at least two abutment teeth should be splinted when attachment prostheses are used to make the stress patterns more favorable.[] The advantage of opting for this treatment plan was to distribute the load among the remaining periodontally weakened teeth, thus acting as a rigid splint. This option was thought to have a better prognosis for the remaining teeth as well as to have a more retentive prosthesis. The recommended alloys for fabrication of copings are the high noble (ADA Type IV). Ag-Au-Pd alloys have better precision and better retention, but are technique sensitive and costly. Base metal alloys (Cr-Co) can also be used because they have low thermal conductivity, thus the patient does not experience unpleasant thermal sensation caused by excessive tooth preparation. Moreover, they are easy to fabricate and more economical.[] The advantages and disadvantages of telescopic overdentures are summarized as follows:\nCreation of a common path of insertion Easy to perform routine oral hygiene Rigid splinting action Distribution of stresses to the abutment teeth Provision of suitable abutments for RPDs even when the remaining teeth are periodontally compromised Much easier insertion and removal for the patient Accommodates future changes in the treatment plan Psychologically well-tolerated by patients.\nIncreased cost Complex laboratory procedures Extensive tooth reduction required Increased number of dental appointments Difficulty in achieving esthetics Retention diminishes after repeated insertion/separation cycles Readjustment of retentive forces is difficult. | [[65.0, 'year']] | M | {'10347356': 1, '28533736': 1, '12631158': 1, '7012319': 1, '12752927': 1, '10023216': 1, '8094098': 1, '4897479': 1, '7007624': 1, '11484566': 1, '2657005': 1, '15025661': 1, '24124317': 2} | {} |
163,621 | 3793573-1 | 24,124,318 | noncomm/PMC003xxxxxx/PMC3793573.xml | A rare presentation of hybrid odontogenic tumor involving calcifying cystic odontogenic tumor and plexiform ameloblastoma | A 17-year-old male patient reported with a presenting complaint of swelling in the lower part of face on the side since 1 month. The swelling was initially small in size and gradually kept increasing. The increase in the size of swelling was associated with tooth mobility in the mandibular right quadrant. The swelling was not associated with any episode of pain or paresthesia and could not be linked to any history of previous trauma or dental infection. Patient visited a private practitioner to seek treatment, but instead was referred to out-patient department.\nOn extraoral examination, a diffuse swelling was evident in the chin region on the right side extending to the mandibular body to some extent []. The swelling was painless and soft to firm on palpation. Lymph node examination revealed palpable single right submandibular lymph node which was firm and non-tender.\nIntraoral examination [] revealed diffuse swelling with 41, 42, 43 region involving both labial and lingual aspect of size around 1.5 cm × 1 cm each, which was soft to firm and non-tender on palpation. Radiographic diagnosis [Figures and ] revealed a large ill-defined, non-corticated interradicular radiolucent lesion with 43 and 42 region causing pathologic drifting and external root resorption of 42, 41, 31. An important finding was evidence of a small focus of calcification near the periapical region of 41.\nUnder the clinic-radiographic diagnosis of calcifying epithelial odontogenic cyst, patient was advised for aspirational biopsy, which yielded clear fluid. The lesion was enucleated along with the involved teeth, viz. 43, 42, 41, 31. The histopathological examination of the specimen showed a cystic cavity lined with tall, columnar odontogenic cells along with the presence of ghost cell keratinization and basophilic material with cystic cavity lined by tall columnar odontogenic cells, which is suggestive of CCOT associated with plexiform ameloblastoma []. The patient has been followed-up for 6th month until date and shows no signs of recurrence. | [[17.0, 'year']] | M | {'17942348': 1, '13949298': 1, '15243475': 1, '15472661': 1, '10432200': 1, '8138974': 1, '16504870': 1, '9526728': 1, '22669147': 1, '25013415': 1, '31565444': 2, '24124318': 2} | {'6745101-1': 1} |
163,622 | 3793574-1 | 24,124,319 | noncomm/PMC003xxxxxx/PMC3793574.xml | Pachyonychia congenita tarda: A rare case report | A 45-year-old male patient was referred from Department of Dermatology, Government District Hospital for examination of whitish lesions in the mouth. History of present illness revealed that oral lesions along with thickening of nails and callosities on palms and soles were present since 10 years of age. These changes were spontaneous in origin and gradually increasing in severity. Soles were severely affected causing discomfort and pain on walking. Associated excessive sweating of soles and palms present. Whitish plaques in the mouth were asymptomatic. The patient was born of non-consanguineous parents.\nPatient's dental and medical histories were non-contributory. His family history revealed that his father, brother and son have a similar condition, but declined clinical examination. No tissue abusing or parafunctional habits reported. General examination revealed that patient was moderately built and nourished for his age. Patient had an altered gait. Nails were extremely hard, thickened, opaque brown, lusterless and free edges were raised by a thick horny masses of subungual keratosis. Palmoplantar keratosis was more marked on pressure areas and elbows []. All vital signs were within normal limits.\nExtraoral examination revealed no abnormalities. Solitary right and left submandibular lymph nodes were palpable, 1 cm × 1 cm, mobile and firm. On intraoral examination, full complement of teeth was present. Labial mucosa, ventral surface of tongue, floor of the mouth, vestibular mucosa and oropharynx revealed no abnormalities.\nLeukokeratosis characterized by diffuse whitish, non-tender and non-scrapable plaque such as lesions of the both right and left buccal mucosae [], left retromolar region [], dorsal aspect of the tongue [], hard and soft palate and gingivae [] were present. Angular cheilosis was present bilaterally [].\nAll routine investigations such as complete hemogram, urine analysis and fasting blood sugar were within the normal limits. Potassium hydroxide examination of nail clippings and fungal culture of the nails were negative. Biopsy from palmar lesion was suggestive of palmoplantar keratoderma. Incisional biopsy was carried out on the left buccal mucosa and histopathological features were suggestive of oral leukokeratosis [].\nBased on the characteristic clinical presentation and history, a diagnosis of PCT was made. There is currently no specific treatment for PC. Available treatments generally are directed at specific manifestations of the syndrome. Oral lesions do not require treatment. For symptomatic treatment of extraoral lesions the patient was referred to the Department of Dermatology, Government District Hospital where he was put on oral vitamin A, keratolytic agents and emollients. | [[45.0, 'year']] | M | {'27559502': 2, '17767101': 1, '16700840': 1, '17429440': 1, '16250205': 1, '27057022': 2, '16250204': 1, '7671418': 1, '16250210': 1, '24124319': 2} | {'4976406-1': 1, '4817447-1': 1} |
163,623 | 3793575-1 | 24,124,320 | noncomm/PMC003xxxxxx/PMC3793575.xml | Platelet-rich fibrin-mediated revitalization of immature necrotic tooth | An 11-year-old boy was referred to the department of conservative dentistry and endodontics for evaluation and treatment of left maxillary central incisor. The patient gave the history of bicycle fall 2 years ago. The medical history was non-contributory. The extraoral examination showed no significant changes. The intra-oral examination showed absence of any soft tissue abnormalities. Clinical examination of teeth revealed slight discoloration in tooth #21. It was sensitive to percussion and palpation tests. It did not respond to 1, 1, 1, 2-tetrafluoroethane (Endo-Ice; Hygenic Corp., Akron, OH, USA) and electric pulp test (Analytic Technology, Redmond, WA, USA). The adjacent teeth were caries free, asymptomatic, and tested positively. The periodontal examination of all teeth showed probing depths within normal limits. An intraoral radiograph was taken with paralleling technique using XCP positioner (extension cone paralleling technique) (Dentsply) showed an immature root with periapical pathology and open apex in tooth #21 and an associated immature supernumerary tooth []. On the basis of clinical and radiographic findings, the pulpal diagnosis of necrotic pulp with symptomatic apical periodontitis was made for tooth #21. Various treatment options were explained and the parents gave the consent for regenerative endodontic procedures with the aid of PRF.\nLocal anesthesia was obtained by using 2% lignocaine with 1:200000 epinephrine. Access preparation was done in tooth #21 under rubber dam isolation. Minimal instrumentation was done and the canal was irrigated with 10 mL of 2.5% NaOCl. It was dried with paper points. Equal proportions of ciprofloxacin (Bayer, Leverkusen, Germany), metronidazole (Shionogi and Co, Ltd, Osaka, Japan), and minocycline (Aurobindo, Andhra Pradesh, India) were ground and mixed with distilled water to a thick paste consistency. This antibiotic mixture was placed in the canal using an amalgam carrier and packed with large endodontic pluggers. The access cavity was sealed with Cavit (ESPE, Chergy Pontoise, France). After 4 weeks, tooth #21 was asymptomatic and showed no sensitivity to percussion and palpation. A 5 ml of whole blood was collected from the median cubital vein of the patient for the preparation of PRF clot []. Under rubber dam isolation, temporary restoration was removed. The triple antibiotic mixture was washed out with saline. After drying the canal with paper points, the fibrin membrane was pushed [] with Buchanan Hand Plugger Size #2 (Sybron Endo, Orange, CA) 1 mm beyond the confines of working length and coronally to the level of cementoenamel junction. Three millimetres of MTA was placed directly over the PRF clot and tooth was temporarily restored. After 72 hours, permanent restoration was done with composite (Esthet.X HD, Dentsply, UK). The patient was kept on follow-up at 6 and 12 months [] for re-evaluation. Tooth #21was asymptomatic and was not sensitive to percussion or palpation tests. Sensitivity tests with cold and Electric Pulp Tester elicited a positive response. Radiographic examination showed resolution of the periapical lesion, further root development and continued apical closure in tooth #21 and associated supernumerary tooth. | [[11.0, 'year']] | M | {'11404920': 1, '18615993': 1, '20597062': 1, '34211068': 1, '15085519': 1, '283177': 1, '15789325': 1, '18634921': 1, '1723382': 1, '8493529': 1, '10356470': 1, '15491506': 1, '12147742': 1, '16646642': 1, '30103724': 1, '18565373': 1, '14651290': 1, '12847449': 1, '14482575': 1, '17183711': 1, '5215726': 1, '16504849': 1, '4864882': 1, '21238815': 1, '32581489': 2, '33420674': 1, '275441': 1, '20825593': 1, '9167629': 1, '26697145': 1, '8467233': 1, '12110105': 1, '15085044': 1, '16409322': 1, '12013255': 1, '16504850': 1, '16504851': 1, '30820079': 1, '11585146': 1, '30546220': 2, '34646323': 1, '16643291': 1, '9638695': 1, '9206436': 1, '18041512': 1, '4204733': 1, '1521505': 1, '16948608': 1, '11544818': 1, '31096718': 1, '15946271': 1, '5221182': 1, '26097752': 2, '17227377': 1, '3460802': 1, '3891978': 1, '19187989': 1, '24124320': 2} | {'7299885-1': 1, '4449924-1': 1, '6249949-1': 1} |
163,624 | 3794448-1 | 24,147,210 | noncomm/PMC003xxxxxx/PMC3794448.xml | Delayed Post-Hypoxic Leukoencephalopathy: Case Report with a Review of Disease Pathophysiology | A 43 year old female with chronic back pain developed depression and attempted suicide with an overdose of diazepam and methadone after an argument with her husband in the evening. She intentionally consumed approximately 40 to 50 tablets of diazepam at 5 mg strength as well as an unknown quantity of methadone tablets was found the following day in an unresponsive state with a respiratory state of only 4 breaths per minute but was revived at a local hospital with the use of naloxone. Although she could awaken and answer questions appropriately, this was only transient and required a naloxone drip infusion over 24 hours; no flumazenil had been used. Her potassium was also elevated initially at 7.6 that later normalized and had a leukocytosis secondary to mild aspiration pneumonia that was successfully treated with antibiotics. She was discharged within one week in a much improved state to a psychiatric facility. After two days as in-patient for psychiatric care, she was discharged to home in a markedly improved state with a mental status that was back to her baseline and fully able to be self-sufficient without any cognitive deficits. Interview with family and friends confirmed that she was cognitively normal and fine up until 3 weeks after the event when she abruptly changed midday and seemed confused and forgetful with a rapid worsening the following day. She was first noted not be able to play cards with her family, had developed social withdrawal with a lack of personal hygiene, and became incontinent as well. She appeared very lethargic and not very interactive. After this continued for approximately 5 days without any improvement, she was evaluated at the Emergency Dept. and admitted after a CT head exam disclosed marked and diffuse hypointensity throughout the subcortical white matter (). This was later evaluated by MRI as being a confluent change throughout the entire white matter, and appeared diffusely hyperintense on both FLAIR and T2 weighted sequences (), with hyper-intensity also noted on diffusion weighted imaging. The unusual feature though was that the cerebellar white mater had been spared, and that the change was a strictly supratentorial effect () without altering signal intensity for the white matter tracts in the internal capsule and brain stem area. Using large voxels placed over the semi-centrum ovale, MR spectroscopic analysis at 1.5 Tesla showed elevated abnormal elevations in the choline and creatinine peaks with a small peak seen for lactic acid as well (). Neurological exam revealed a blunted flat affect with abnormally slow gait and left side neglect, with disorientation and very poor short term recall. As the patient had a detectable benzodiazepine level at approximately 83 ng/mL, 1.0 mg flumazenil was given in 0.2 mg increments every 30 seconds during EEG monitoring. Although background slowing improved slightly, there was a clear and definite transient neurological improvement. Serum benzodiazepine levels continued to decline from 67.9 to 32.8 ng/mL over 4 days, with modest clinical improvement in her mental status also observed. Follow-up evaluation revealed substantial improvement both clinically and radiographically, with a normal mental status and normal MR imaging of the brain within one year of the event, with normal metabolism of both the gray and white matter of the brain, as assessed by 18F-FDG PET imaging (). | [[43.0, 'year']] | F | {'29881586': 2, '12587659': 1, '1008849': 1, '16091540': 1, '11815692': 1, '33100569': 1, '9371929': 1, '4142927': 1, '28947587': 1, '30250433': 1, '34408806': 2, '31750035': 1, '13679276': 1, '1247396': 1, '20166270': 1, '42427': 1, '26357591': 1, '32993556': 2, '33377670': 1, '8183444': 1, '11459905': 1, '28936091': 2, '29922522': 2, '33629035': 2, '1609067': 1, '826924': 1, '7872887': 1, '14487254': 1, '31952488': 1, '28724360': 2, '8440282': 1, '6860181': 1, '24147210': 2} | {'5602241-1': 1, '7523250-1': 1, '5986050-1': 1, '7881437-1': 1, '8361286-1': 1, '5517815-1': 1, '6003800-1': 1, '6003800-2': 1} |
163,625 | 3794845-1 | 24,124,381 | noncomm/PMC003xxxxxx/PMC3794845.xml | Rapid tumor necrosis and massive hemorrhage induced by bevacizumab and paclitaxel combination therapy in a case of advanced breast cancer | A 27-year-old premenopausal woman with no family history of breast cancer noticed a 1-cm lump in her left breast in January 2010. Thereafter, she became pregnant, and the lump gradually increased in size to occupy her entire left breast by July. She first visited a breast clinic that referred her to the Shinshu University Hospital with suspected breast cancer. Physical examination at her initial visit revealed a hard, swollen, and erythematous left breast, with many palpable and enlarged lymph nodes in the bilateral axillae and left supraclavicular to lateral cervical region. Histopathological examination of a core needle biopsy specimen revealed invasive ductal carcinoma (scirrhous carcinoma) that was histological grade 3, estrogen receptor-negative, progesterone receptor-negative, and human epidermal growth factor receptor type 2 (HER2)-positive. A relatively high Ki-67 index (30%–40%) was also observed. Computed tomography revealed multiple metastases to the liver, mediastinal lymph nodes, and supine and pelvic bones. A final diagnosis of stage IV breast cancer was made when she had entered gestational week 24.\nThe patient was treated with three triweekly cycles of cyclophosphamide (500 mg/m2), Adriamycin® (Kyowa Hakko Kirin Co., Ltd., Tokyo, Japan) (60 mg/m2), and fluorouracil (500 mg/m2) therapy (). A slight decrease in size of the primary tumor in the left breast was induced by this therapy; however, the multiple liver metastases enlarged. Therefore, induced delivery was planned to enable the administration of trastuzumab-based therapy. A healthy fetus was delivered through the vagina without blood transfusion at gestational week 35 in February 2011, and weekly paclitaxel (80 mg/m2) with trastuzumab (2 mg/kg) treatment was initiated thereafter. A partial response was observed for the liver metastases; however, the primary lesion gradually increased in size and the inflammation became exacerbated despite the new treatment. In July 2011, her treatment was changed to lapatinib and capecitabine as a third-line therapy. The size of the primary tumor decreased slightly and its progression was temporarily inhibited. Although the multiple liver metastases were successfully controlled by these therapies, the primary tumor began to enlarge again in December 2011. Thereafter, treatment was changed to weekly trastuzumab (2 mg/kg on days 1, 8, and 15) and vinorelbine (25 mg/m2 on days 1 and 8) as a fourth-line therapy; however, almost no clinical response was observed. Therefore, in January 2012, a fifth-line combination therapy was initiated with docetaxel (75 mg/m2 on day 1) and carboplatin (6 area under the curve [AUC] on day 1) plus trastuzumab (2 mg/kg on days 1, 8, and 15). This treatment also had to be discontinued after one cycle because of marked anorexia. In the meantime, the primary tumor grew rapidly and extended beyond the skin in April 2012. To inhibit this growth, eribulin (1.4 mg/m2) was initiated as a sixth-line therapy; however, she was readmitted with dyspnea due to massive left pleural effusion after one cycle. By that time, the size of the primary tumor had increased to 15 × 12 × 9 cm, and its surface had become nodular and partially erosive.\nAs it was considered that the primary tumor became resistant to anti-HER2-based therapy, combination therapy with paclitaxel (90 mg/m2 on days 1, 8, and 15) and bevacizumab (10 mg/m2 on days 1 and 15) was initiated as a seventh-line therapy after removal of the pleural effusion by thoracocentesis (). Three days after the first infusion of paclitaxel and bevacizumab, the volume of the primary tumor occupying her entire left breast began to decrease and its color turned to dusky red, followed by spread of skin erosion. The entire mass flattened drastically because of rapid tumor necrosis. Next, the erosion developed deep ulceration and necrosis, with loss of all skin layers over an extensive area. This led to exposure of the underlying pectoralis major muscles by the end of the first cycle of treatment. Gradually, most of the tumor became necrotic and a large area of the pectoralis major muscle was exposed, with the remaining tumor at the rim of the ulcerated lesion 4 weeks after bevacizumab initiation.\nSix days after initiation of the second treatment cycle, she was readmitted to our hospital because of massive hemorrhage from the surface of the necrotic residual tumor in her left breast. Hemostasis was achieved by applying pressure with gauze and oxidized cellulose. To prevent further hemorrhage, the surface of the residual tumor was covered and compressed firmly with thick gauze; however, massive hemorrhage occurred again on the following day, necessitating several hours of manual compression. The total blood loss during these 2 days was approximately 1,800 mL; therefore, she required 560 mL of leukocyte-reduced red cell concentrate transfusion on the first day and an additional 280 mL on the following day. The bleeding from the ulcerated tumor finally ceased. The combination therapy of paclitaxel and bevacizumab was discontinued and local treatment of the ulcerated lesion was continued. Because the ulcerated lesion caused severe pain, both opioid and nonopioid analgesics were administered. The patient desired to be with her family; therefore, she was discharged after 2 weeks of hospitalization. Thereafter, she visited our hospital daily for local treatment. Because of the lack of healing in the large ulcerated lesion as well as the patient’s request for temporary cessation of anticancer therapy, only local treatment was administered. Twelve days after discharge, however, her respiratory status suddenly deteriorated and she experienced cardiopulmonary arrest in the ambulance en route to the hospital. Cardiopulmonary resuscitation was unsuccessful and the patient eventually succumbed. Although an autopsy was not performed, we considered that she died from respiratory failure caused by carcinomatous lymphangitis as determined by a chest X-ray. | [[27.0, 'year']] | F | {'22377126': 1, '15175435': 1, '21569417': 1, '23569311': 1, '33859885': 1, '17404076': 1, '20736943': 1, '17634832': 1, '18801882': 1, '15169807': 1, '16849749': 1, '17686822': 1, '20567970': 1, '12506171': 1, '17110625': 1, '22068139': 1, '12890841': 1, '24124381': 2} | {} |
163,626 | 3794967-1 | 24,124,390 | noncomm/PMC003xxxxxx/PMC3794967.xml | Fever of unknown origin successfully treated by oren-gedoku-to (huanglian-jie-du-tang) | A 33-year-old woman was admitted to our general medicine department with FUO which had persisted for longer than 2 months and was resistant to treatment with nonsteroidal anti-inflammatory drugs and prednisolone 20 mg/day. Her fever was remittent, and body temperature ranged from 37.5°C to 38.5°C. She reported sweating and headache, but did not complain of body weight change, pain, nausea, abnormal vaginal bleeding, or diarrhea.\nTo treat dysmenorrhea and premenstrual syndrome, she had been prescribed oral contraceptives (levonorgestrel, ethinylestradiol) for 7 years, and the dose had remained unchanged during that period. She had no history of pregnancy, and a gynecologic examination revealed no infectious or malignant findings.\nShe had been receiving regular follow-up care for mild depression for 3 years at our department of psychiatry and had been prescribed the antidepressants, aripiprazole and duloxetine hydrochloride, until 2 months before admission. Her depressive symptoms were stable upon presentation to our department. She had asthma, which was well controlled with the inhaled steroid budesonide (200 μg, once daily).\nShe was a housewife and only had sexual contact with her husband who had no sexually transmitted diseases. She had no pets and no animal or insect bites. She had not traveled for one year and had no history of drug abuse. A family history revealed no hereditary cause of fever.\nHer height was 152 cm and body weight was 56 kg. Her mental status was alert, and blood pressure was 92/60 mmHg in a sitting position. Although the rise in body temperature was accompanied by an increase in pulse rate, her pulse was normal, ranging from 58 to 82 beats per minute. Her pulse rate was regular in rhythm, and its size, and tension were within the normal ranges. Her body temperature was 38.5°C and her respiratory rate was 15 per minute. Physical examination revealed no abnormalities, such as focal inflammation, lymph node swelling, skin rash, or abnormal heart sounds.\nLaboratory analysis showed no biological inflammation C-reactive protein 0.0 mg/L, and interleukin-6 (2.1 pg/mL, normal range <4.0 pg/mL) and tumor necrosis factor-α (0.6 pg/mL, normal range 0.6–2.8 pg/mL) were normal. A chest X-ray showed no abnormal findings, and sputum culture for acid-fast bacteria was negative. In addition, an interferon-γ release assay (QFT-2G, Oxford Immunotec Co, Ltd Oxford UK) was not positive (0.30 IU/L, normal range <0.80 IU/L). The results for the remaining biological tests were all in the normal ranges, as shown in . Contrast thoracic and abdominal computed tomography, brain magnetic resonance imaging, and gallium scintigraphy excluded infection, including tuberculosis, and rheumatic/inflammatory, neoplastic, or other focal abnormalities.\nFever decreased 2 days after adding Yokukan-san to 7.5 g of powdered OGT, which is the standard dose for adults (). OGT was then prescribed for an additional 10 days, and fever has not relapsed after a follow-up period of 2 months. | [[33.0, 'year']] | F | {'23378767': 1, '1651090': 1, '22729955': 1, '11331078': 1, '17511878': 1, '12622601': 1, '10893436': 1, '27548137': 1, '31867052': 1, '12603493': 1, '13734791': 1, '9284789': 1, '21296144': 1, '12601677': 1, '34938107': 1, '25610485': 1, '24124390': 2} | {} |
163,627 | 3794984-1 | 24,124,396 | noncomm/PMC003xxxxxx/PMC3794984.xml | Wegener’s granulomatosis mimicking inflammatory bowel disease and presenting with chronic enteritis | A 57-year-old Ukranian male with a 45-year history of smoking but no other medical history presented in August 2008 complaining of months of intermittent abdominal pain, diarrhea, and a 40 lb weight loss. His symptoms presented over the course of 1 year. His diarrhea was initially evaluated and attributed to gastroenteritis. Routine studies were sent, including a stool culture. S. arizonae (subtype III), which is associated with osteomyelitis and gastroenteritis in reptile handlers, was isolated and the patient reported contact with a pet iguana. Computed tomography of the abdomen and pelvis was ordered and revealed a 1.5 × 1.7 cm speculated pulmonary nodule in the right upper lobe and thickening of the duodenal, jejunal, and colonic wall with scattered surrounding lymphadenopathy.\nThe patient was placed on antibiotics and continued to suffer from continued diarrhea and weight loss, so inflammatory bowel disease was suspected. In September 2008 he underwent endoscopic studies which revealed a hiatal hernia, old blood in the stomach, mucosal swelling near the gastric antrum, and three areas of circumferential ulceration and inflammation with mucosal pigmentation/erythema (see ). The areas were biopsied, and the biopsy showed reported duodenitis and jejunitis with acute on chronic inflammation. There were no signs of architectural distortion or cryptitis/crypt abscesses, Helicobacter pylori stains were negative, and no bacteria were apparent on biopsy. Given that the biopsies did not show any findings consistent with the suspected diagnosis of inflammatory bowel disease, his symptoms were attributed to S. arizonae gastroenteritis.\nFine needle aspiration of his pulmonary nodule was nondiagnostic, showing only clustered atypical epithelial cells. A positron emission tomography scan was obtained and showed a focus of hypermetabolic activity in the right upper lobe which was read as probable granulomatous disease.\nHe continued to have recurrent episodes of abdominal pain and vomiting in November 2008, and treatment of the presumptive S. arizonae gastritis/enteritis with trimethoprim-sulfamethoxazole and ciprofloxacin failed to improve his symptoms. S. arizonae was not grown from stool samples that were resent.\nOne month later, the patient presented with back pain and decreased urine output. Acute kidney injury was noted, with a serum creatinine of 4.37 mg/dL, while urine studies revealed severe proteinuria and hematuria. Initially the acute kidney injury was thought to be secondary to prerenal azotemia from dehydration or acute interstitial nephritis secondary to treatment with ciprofloxacin and trimethoprim-sulfamethoxazole. A c-ANCA level was drawn for workup of his renal failure and came back at >100 U/L. He then underwent repeat endoscopy which showed normal gastric mucosa, but granular and unusually pigmented duodenal mucosa (). Biopsies of multiple sites were obtained, which later came back positive only in the ascending colon, which showed a tubular adenoma. Slides from a macroscopic jejunal ulcer seen on endoscopy () showed inflammation but no features typical of inflammatory bowel disease. Given the unexplained nature of his systemic symptoms, acute kidney injury, and the positive c-ANCA, a kidney biopsy was performed and showed rapidly progressive glomerulonephritis due to pauci-immune crescentic glomerulonephritis with 25% crescents ().\nThis renal biopsy result was clearly consistent with an ANCA-associated lesion, and the patient received three doses of cyclophosphamide between February and April 2009. Given the finding of a pulmonary nodule, video-assisted thoracoscopic surgery was performed in June 2009. The pathology results later came back positive for adenocarcinoma with clear margins. The lesion was surgically excised and a subsequent positron emission tomography scan was found to be negative for metastasis. He resumed cyclophosphamide therapy in December of 2009 and has had significant improvement of his gastrointestinal symptoms, renal impairment, and systemic symptoms on steroid and immunosuppressive therapy. | [[57.0, 'year']] | M | {'2071011': 1, '12753164': 1, '10851287': 1, '19395336': 1, '3997764': 1, '18038922': 1, '16341975': 1, '2362612': 1, '14662995': 1, '17925931': 1, '27698975': 2, '16188871': 1, '11754304': 1, '8229147': 1, '16266240': 1, '1556431': 1, '2002115': 1, '15540571': 1, '16351033': 1, '2746597': 1, '2664643': 1, '30538527': 1, '15789904': 1, '2202308': 1, '3957113': 1, '19891303': 1, '19953044': 1, '33832425': 2, '16500793': 1, '19631101': 1, '15758841': 1, '9198504': 1, '17353860': 1, '8546743': 1, '10738434': 1, '17419446': 1, '9619888': 1, '8297703': 1, '24124396': 2} | {'8028736-1': 1, '5045678-1': 1} |
163,628 | 3795405-1 | 24,133,552 | noncomm/PMC003xxxxxx/PMC3795405.xml | Joint Pain Undergoes a Transition in Accordance with Signal Changes of Bones Detected by MRI in Hip Osteoarthritis | A 67-year-old woman, 153 cm tall, and weighing 54 kg visited our hospital. She had fallen and experienced bone fractures in her wrist before she visited our hospital. At her first visit, she complained of right hip joint pain (P4). Plain radiographs showed OA at KL grading III (Fig. ). Since then, joint pain has shown repeated remission and deterioration. However, her pain has recently much decreased (P0). Recent plain radiographs also showed OA at KL grading III. Recent hip MRI showed no signal changes in right hip joints (Fig. , ). | [[67.0, 'year']] | F | {'19410032': 1, '25250098': 2, '25317214': 2, '22868925': 1, '23321609': 1, '3780104': 1, '6478691': 1, '23179574': 1, '23412214': 1, '16075165': 1, '3488657': 1, '25436838': 1, '19631073': 1, '26776564': 2, '24358070': 2, '25568659': 1, '16190135': 1, '22859924': 1, '31136802': 1, '17161286': 1, '3363134': 1, '18499718': 1, '24133552': 2} | {'3795405-2': 2, '3795405-3': 2, '4192849-1': 1, '4192849-2': 1, '4192849-3': 1, '4726085-1': 1, '4726085-2': 1, '4726085-3': 1, '4726085-4': 1, '3866704-1': 1, '3866704-2': 1, '4166791-1': 1} |
163,629 | 3795405-2 | 24,133,552 | noncomm/PMC003xxxxxx/PMC3795405.xml | Joint Pain Undergoes a Transition in Accordance with Signal Changes of Bones Detected by MRI in Hip Osteoarthritis | A 74-year-old woman, 152.0 cm tall and weighing 57.5 kg with no history of OA visited our hospital. At her first visit, she complained of right hip joint pain (P4). Plain radiographs showed OA at KL grading IV (Fig. ). Since then, joint pain has shown repeated remission and deterioration. Recent plain radiographs also showed OA at KL grading IV. MRI was performed at the time of right hip joint pain (P4). MRI showed high signal change in the entire femoral head and acetabulum in T2-STIR (Fig. ). | [[74.0, 'year']] | F | {'19410032': 1, '25250098': 2, '25317214': 2, '22868925': 1, '23321609': 1, '3780104': 1, '6478691': 1, '23179574': 1, '23412214': 1, '16075165': 1, '3488657': 1, '25436838': 1, '19631073': 1, '26776564': 2, '24358070': 2, '25568659': 1, '16190135': 1, '22859924': 1, '31136802': 1, '17161286': 1, '3363134': 1, '18499718': 1, '24133552': 2} | {'3795405-1': 2, '3795405-3': 2, '4192849-1': 1, '4192849-2': 1, '4192849-3': 1, '4726085-1': 1, '4726085-2': 1, '4726085-3': 1, '4726085-4': 1, '3866704-1': 1, '3866704-2': 1, '4166791-1': 1} |
163,630 | 3795405-3 | 24,133,552 | noncomm/PMC003xxxxxx/PMC3795405.xml | Joint Pain Undergoes a Transition in Accordance with Signal Changes of Bones Detected by MRI in Hip Osteoarthritis | A 72-year-old woman, 155.0 cm tall and weighing 57.0 kg with no history of OA visited our hospital. Bilateral hip joint pain started about 5 years ago; since then, bilateral joint pain has improved and worsened repeatedly. She first visited our hospital about 6 months ago and complained of continuous right hip joint pain (P4). Her left hip joint pain has improved (P1). Plain radiographs showed bilateral hip OA of KL grading III (Fig. ). MRI analysis showed no signal changes in the left hip joint, and bone cysts and local signal changes in her right femoral head (Fig. , ). | [[72.0, 'year']] | F | {'19410032': 1, '25250098': 2, '25317214': 2, '22868925': 1, '23321609': 1, '3780104': 1, '6478691': 1, '23179574': 1, '23412214': 1, '16075165': 1, '3488657': 1, '25436838': 1, '19631073': 1, '26776564': 2, '24358070': 2, '25568659': 1, '16190135': 1, '22859924': 1, '31136802': 1, '17161286': 1, '3363134': 1, '18499718': 1, '24133552': 2} | {'3795405-1': 2, '3795405-2': 2, '4192849-1': 1, '4192849-2': 1, '4192849-3': 1, '4726085-1': 1, '4726085-2': 1, '4726085-3': 1, '4726085-4': 1, '3866704-1': 1, '3866704-2': 1, '4166791-1': 1} |
163,631 | 3796681-1 | 24,133,669 | noncomm/PMC003xxxxxx/PMC3796681.xml | Co-development of autoimmune hepatitis and Sjögren's syndrome triggered by the administration of herbal medicines | The patient was a 53-year-old woman who presented to our hospital with a 10-day history of yellowish skin coloration. She took herbal medicines of unknown origin as health supplements for 4 weeks until 4 weeks before the development of jaundice. She was healthy, and her medical history was unremarkable. She was not prescribed of any medications and rarely consumed alcohol.\nHer vital signs were unremarkable she denied travel history and past illness. Family history (including autoimmune disease) was not specific.\nLaboratory tests revealed the following results: aspartate aminotransferase (AST) level, 1,136 U/L (normal range, 5-34 U/L); alanine aminotransferase (ALT) level, 1,415 U/L (normal range, 0-55 U/L); alkaline phosphatase (ALP) level, 203 U/L (normal range, 40-150 U/L); and total bilirubin, 8.5 mg/dL (normal range, 0.2-1.4 mg/dL). The findings of serologic tests for hepatitis A, B, and C viruses and tests for detecting other viruses, including Epstein-Barr virus, cytomegalovirus, and herpes simplex virus, were negative. The titer of antinuclear antibody was 1:320, with the antigen-antibody reaction showing a speckled pattern. The results of studies for autoimmune markers, including anti-smooth muscle, antimitochondrial, liver-kidney microsomal, anti-ds DNA, anticentromere, and anti-Scl-70 antibodies, were negative. The levels of anti-Ro and anti-La antibodies were 258 and 429 U/mL (normal range, <150 U/mL), respectively, and immunoglobulin G (Ig G) level was 2,347 mg/dL (normal range, 700-1,400 mg/dL).\nAbdominal ultrasonography revealed slightly coarse echotexture of the liver parenchyma, indicating diffuse parenchymal disease. After admission, the patient complained of dryness in her mouth and foreign body sensation in her eye, which she had not experienced previously. Therefore, we performed a salivary gland scan and Schirmer's test. The salivary gland scan showed hot uptakes in both the salivary glands at 10 and 40 min and markedly diminished excretory function of both salivary glands. The Schirmer's test showed wetting of the paper by 2 mm in 5 min. We suspected primary Sjögren's syndrome (pSS) and administered conservative treatment. The results of liver function tests (LFTs) performed 21 days after admission revealed the following improved values: AST/ALT levels, 207/61 U/L; and total bilirubin level, 3.72 mg/dL. We first diagnosed the condition as drug-induced liver injury and performed follow-up evaluations in the outpatient department. The serum bilirubin and IgG levels obtained 10 days after this diagnosis repeatedly increased to 6.2 mg/dL and 3,039 mg/dL, respectively. We performed the liver biopsy for abnormal LFTs of unknown origin and biopsy findings showed interface hepatitis with moderate porto-periportal lymphoplasmacytic infiltration, periportal fibrosis, hepatic rosette formation and piecemeal necrosis (). There was no evidence of centrilobular zone 3 necrosis, suggestive of toxic hepatitis.\nOn the basis of the scoring system proposed by the International Autoimmune Hepatitis Group and the Simplified Criteria for the Diagnosis of AIH, the scores for our patient's condition were 16 and 8, respectively, and she was diagnosed with AIH. Initially, she was administered 30 mg prednisolone and 50 mg azathioprine. Prednisolone dosage was tapered down to 10 mg for 2 weeks. Thereafter, her condition improved, and within 3 months after the treatment, the results of the LFTs were within the normal range. She has been receiving maintenance therapy with 10 mg prednisolone and 50 mg azathioprine for 1 year, and no complications have been observed during this period (). | [[53.0, 'year']] | F | {'20512992': 1, '17004542': 1, '25749982': 1, '7683617': 1, '22234756': 1, '15356412': 1, '9328334': 1, '12362579': 1, '9128330': 1, '18793567': 1, '14722198': 1, '20087196': 1, '14690138': 1, '29922671': 1, '15693852': 1, '24133669': 2} | {} |
163,632 | 3796682-1 | 24,133,670 | noncomm/PMC003xxxxxx/PMC3796682.xml | Genotype-4 hepatitis E in a human after ingesting roe deer meat in South Korea | A 43-year-old male presented with abdominal discomfort for 3 weeks and jaundice lasting 1 week. He had a past history of diabetes mellitus, which had been diagnosed 3 years prior to admission to our hospital. However, he arbitrarily stopped taking hypoglycemic agents. The patient was a heavy alcohol drinker, with the consumption of 2 to 3 bottles of Soju, distilled liquor, 4 to 5 times a week. He denied any travel outside South Korea in the preceding years. About 6-8 weeks before hospitalization, he ingested raw meat (about 300 g) of a captured wild roe deer inhabiting in Gyeongnam province with his friends, who enjoyed hunting on a regular basis.\nPhysical examination on admission was generally normal, except for jaundice. Mild tenderness was only noted in the epigastric area. Initial laboratory data showed white blood cell count of 4.88×103/mm3 (polymorphonuclear neutrophils, 57.2%; lymphocytes, 36.4%; and eosinophils, 1.5%), elevated serum total bilirubin level of 12.3 mg/dL, serum aspartate aminotransferase (AST) level of 1,637 IU/L, serum alanine aminotransferase (ALT) level of 1,949 IU/L, random glucose level of 220 mg/dL and HbA1c level of 10.8%. Hepatitis B surface (HBs) antigen, immunoglobulin M (IgM) anti-hepatitis B core antigen, anti-hepatitis C virus (HCV), HCV RNA (RT PCR) were all negative with positive anti-HBs. As a result of IgM anti-hepatitis A virus (HAV) was negative with positive immunoglobulin G (IgG) anti-HAV, acute hepatitis A could be excluded. Abdominal computed tomography showed findings compatible with secondary changes in acute hepatitis, and fatty infiltration with splenomegaly, which implied concurrent alcoholic liver disease. Seven days after admission, results of IgM anti-HEV and IgG anti-HEV were both positive, the optical density value of IgM anti-HEV of 3.656 (cut-off value: 0.276) and IgG anti-HEV of 3.384 (cut-off value: 0.375), which confirmed the diagnosis of acute viral hepatitis E. IgM anti-HEV and IgG anti-HEV were measured by a commercial immunoassay (HEV IgM and HEV IgG ELISA, Genelabs Diagnostic Pte. Ltd, Singapore). The serum total bilirubin peaked at 24.3 mg/dL and rapidly decreased. The levels of AST and ALT were highest at the time of admission and then showed a rapid decrease. Twenty-three days after admission, the patient was discharged with a total bilirubin of 8.06 mg/dL, AST of 130 IU/L and ALT of 133 IU/L (). Two months after discharge, IgM anti-HEV and IgG anti-HEV were both still positive with the optical density value of IgM anti-HEV of 3.315 (cut-off value: 0.282) and IgG anti-HEV of 2.753 (cut-off value: 0.375). Diagnosis of hepatitis E was confirmed by the detection of both IgM and IgG anti-HEV in serial samples and by the detection of serum HEV RNA.\nViral RNA was extracted from 140 µL of anti-HEV IgM-positive serum in phosphate-buffered saline using a QIAamp viral RNA mini-kit (Qiagen, Hilden, Germany) according to the manufacturer's instructions. Purified RNA was used to generate the ORF2 of HEV using One-Step RT-PCR with a PLATINUM Taq Kit (Takara, Shiga, Japan). Briefly, RT-PCR was performed on 5 µL of purified RNA from serum in 50 µL of 2× reaction mix with 0.2 µM each primer (forward: 5' aggttggcgctctgtcgaga-3'; reverse: 5'-acagtcggctcgccattggc-3'). Reverse transcription was performed for 30 min at 50℃ and for 2 min at 94℃ followed by 40 cycles of 94℃ for 30s, 55℃ for 30s and 72℃ for 2 min, and a final extension step of 10 min at 72℃. The second round of PCR was performed under the same conditions as the first-round PCR with 0.2 µM each of the same primers.\nThe relationship between the sequences is shown in the dendrogram. The length of each pair of branches represents the distance between the sequences. Phylogenetic trees were constructed by the neighbor-joining method based on the ORF2 sequence. All strains were separated into four groups according to their genotypes. Sequence analysis was conducted using the software VectorNTI and MEGA 4.1 beta. Bootstrap values are indicated for the major nodes as a percentage of the data obtained from 1000 resamplings.\nWe identified genotype 4 human HEV from the 43-year-old Korean male patient with acute hepatitis, who had never been abroad. He was negative for serum markers of hepatitis A, B and C viruses and positive for anti-hepatitis E virus as IgM class leading to the diagnosis of hepatitis E, whose ORF2 nucleotide sequence from the patient was isolated. The identified Korean HEV strain named 2010-JKSH-CKK (HM769726) belonged to genotype 4, based on comparison with previously reported HEV strains (, ). When comparing the ORF2 region, HM769726 was closely related to the two strains EU849134 and FJ763142 with a nucleotide similarity of 97 and 98%, respectively (). The two human strains by HEV genome from Korean patients, who had never been aboard, were isolated in Gyeonggi-do, Korea. Among swine HEV isolates, HM769726 was closely related to EU332143-45 from Heilongjiang, China (). | [[43.0, 'year']] | M | {'19910247': 1, '27572076': 2, '30784199': 1, '11413380': 1, '16804348': 1, '29284214': 1, '22195239': 1, '21130029': 1, '21914057': 1, '9413292': 1, '12907011': 1, '19122408': 1, '15094239': 1, '9275216': 1, '11867187': 1, '25906163': 1, '29442296': 1, '17439520': 1, '27657108': 1, '17928756': 1, '18330507': 1, '32894411': 1, '33317114': 1, '22405947': 1, '21084220': 1, '12917455': 1, '24934984': 1, '30497051': 1, '29623595': 1, '12964128': 1, '32625551': 1, '20390311': 1, '31333309': 1, '31625032': 1, '16632918': 1, '33058031': 1, '9407381': 1, '33535675': 1, '24133670': 2} | {'5066380-1': 1} |
163,633 | 3796684-1 | 24,133,672 | noncomm/PMC003xxxxxx/PMC3796684.xml | Primary hepatic lymphoma mimicking acute hepatitis | A 57-year-old woman visited the emergency department at our hospital with generalized edema which developed a month previously. Her clinical history did not include any specific disease, and her family history was unremarkable. On physical examination, there was no abnormal finding except splenomegaly. The initial results of laboratory investigations were as follows: serum total bilirubin level of 3.0 mg/dL (normal range: 0.2-1.2 mg/dL), direct bilirubin level of 1.5 mg/dL (normal range: 0-0.4 mg/dL), aspartate aminotransferase (AST) of 54 U/L (normal range: 0-37 U/L), alanine aminotransferase (ALT) of 10 U/L (normal range: 0-40 U/L), gamma-glutamyl transpeptidase (γGT) of 177 U/L (normal range: 11-43 U/L), alkaline phosphatase (ALP) of 240 U/L (normal range: 42-98 U/L), and lactate dehydrogenase (LDH) by 842 U/L (normal range: 211-423 U/L). Prothrombin time (PT) and activated partial thrombin time (aPTT) were initially within normal range. On peripheral blood cell count, all of the blood cell counts declined: red blood cell count of 3.12×106/mL (normal range: 4.2-6.3×106/mL), white blood cell count of 1.5×103/mL (normal range: 4-10×103/mL), and platelet count of 80×103/mL (normal range: 130-400×103/mL). The test for peripheral blood cell morphology also showed normocytic, normochromic anemia, leukopenia and thrombocytopenia. Serological tests for hepatitis A, B and C viruses, Ebstein-Barr virus and cytomegalovirus were all negative.\nInitial abdominal CT demonstrated hepatosplenomegaly, edematous wall thickening of the gallbladder, and effusion in the pleural and pericardial spaces. The initial diagnosis was acute hepatopathy with unknown cause. There was no evidence of lymphadenopathy in the abdomen (). On the abdominal ultrasonography (US) performed 3 days after the CT study, the echogenicity of the liver parenchyma was mildly coarse, supporting the CT diagnosis of parenchymal disease ().\nOn the 10th hospitalized day, the laboratory evaluation showed deteriorating hepatic function: the international normalized ratio (INR) of PT was elongated to 1.81. The levels of total and direct bilirubin were also elevated to 27 and 16 mg/dL, respectively. As the next step, US-guided liver biopsy was performed using an automatic biopsy gun (Tru-cut, TSK laboratory, Japan). Two pieces of specimen were obtained, and histopathology showed numerous lymphocytes infiltrating into the periportal space and hepatic sinusoid. On high-power field of microscopy, variably sized, hyperchromic nuclei with mitotic activity in the lymphocytes were seen. The results of immunochemical profiles of this specimen revealed B cell lineage. The final pathologic diagnosis was diffuse large B-cell type of non-Hodgkin's lymphoma.\nThe patient refused to receive any treatment for the lymphoma and expired 27 days after initially being hospitalized due to hepatic failure. | [[57.0, 'year']] | F | {'14687834': 1, '10430328': 1, '16177555': 1, '32246350': 1, '8453587': 1, '20008237': 1, '26443451': 1, '12216750': 1, '28596829': 2, '27234986': 1, '19035335': 1, '24133672': 2} | {'3796684-2': 2, '5448865-1': 1} |
163,634 | 3796684-2 | 24,133,672 | noncomm/PMC003xxxxxx/PMC3796684.xml | Primary hepatic lymphoma mimicking acute hepatitis | A 59-year-old man visited the gastroenterology department at our hospital with abdominal bloating. His clinical history did not reveal any specific disease, and his family history was also unremarkable. On physical examination, no abnormality was found, and the results of laboratory investigations were also normal. Initial abdominal US demonstrated mild coarseness of the liver without any focal lesion ().\nFive days after the initial abdominal US, he revisited the emergency department with newly developed symptoms including high fever over 39.5℃, general weakness, cough and sputum. On physical examination performed on his second visit, mild hepatomegaly and tenderness on the right upper quadrant were identified. There were no palpable lymph nodes. The laboratory evaluation showed deteriorated hepatic function: AST of 200 U/L, ALT of 20 U/L, γGT of 223 U/L, ALP of 477 U/L, LDH of 1,060 U/L. The levels of total and direct bilirubin were highly elevated to 27 and 16 mg/dL, respectively. On peripheral blood cell count, all of the blood cell counts declined: red blood cell count of 3.31×106/mL, white blood cell count of 5.5×103/mL, and platelet count of 110×103/mL. Serological tests for hepatitis A, B and C viruses, Ebstein-Barr virus and cytomegalovirus were all negative. Abdominopelvic CT scans taken at the emergency department showed hepatosplenomegaly with collapsed gallbladder, suggestive of acute hepatitis.\nFollow-up abdominal US performed 9 days after the initial study revealed a further decrease in the background echogenicity of the hepatic parenchyma as well as hepatomegaly. The gallbladder was collapsed and accompanied by diffuse wall thickening (). Eight days later, the hepatic echogenicity had become coarser and hepatosplenomegaly was markedly aggravated. Moreover, the gallbladder wall was more thickened and the amount of ascites was increased (). The changes observed on serial US and CT imaging resembled those observed in progressively worsening acute hepatitis, leading to the diagnosis of idiopathic fulminant hepatopathy.\nAs the next step, US-guided liver biopsy was performed using an automatic biopsy gun. Two pieces of specimen were obtained, and the histopathology demonstated numerous lymphocytes mainly infiltrating into the periportal space. On the high-power filed of microscopy, lymphocytes with nuclei of variable size and mitotic activity were seen. The result of immunohistochemical profiles of this specimen revealed peripheral T-cell lymphoma. However, the special stain for γδ T-cell receptor was negative, and the final pathologic diagnosis of peripheral T-cell lymphoma, was reached.\nThe disease was not responsive to chemotherapy using cyclophosphamide hydroxydoxorubicin, vincristine and prednisolone (CHOP), and rapidly progressed to multiple organ failure with severe sepsis and pancytopenia. The patient eventually expired three weeks after admission. | [[59.0, 'year']] | M | {'14687834': 1, '10430328': 1, '16177555': 1, '32246350': 1, '8453587': 1, '20008237': 1, '26443451': 1, '12216750': 1, '28596829': 2, '27234986': 1, '19035335': 1, '24133672': 2} | {'3796684-1': 2, '5448865-1': 1} |
163,635 | 3796694-1 | 24,133,508 | noncomm/PMC003xxxxxx/PMC3796694.xml | IVUS-guided rotational atherectomy for unexpandable paclitaxel-eluting stent: A case report and review of literature | A 76-year-old, non-diabetic and non-hypertensive female was referred to our emergency department with a diagnosis of acute coronary syndrome. Three months earlier, she underwent percutaneous coronary intervention (PCI) with a Taxus Liberte 2.75 × 24 mm stent (Boston Scientific Co. Natick, MA) implanted in the left anterior descending (LAD) artery for refractory angina, and had been on aspirin 100 mg and clopidogrel 75 mg a day. Upon arrival, her vital signs were stable, and there were no signs of heart failure.\nThe electrocardiographic findings and elevation of troponin-I (6.8 ng/dL) were consistent with non-ST elevation myocardial infarction. Transthoracic echocardiographic findings, including left ventricular function, were normal. Intravenous infusion of un-fractional heparin was initiated. Urgent coronary angiography revealed a well localized, hazy filling defect in the stented segment in mid-LAD (). Under the impression of late stent thrombosis, PCI with a non-compliant 3.25 × 12 mm balloon (Quantum balloon, Boston Scientific Co. Natick, MA) was performed. However, the balloon could not be fully expanded even with inflation pressure up to 28 atm. (). Intravascular ultrasound (IVUS) (Atalantis 2.9 Fr; Boston Scientific Co., MA) interrogation of the stented segment revealed an underexpanded stent (, ). The narrowest part of the ring was 1.47 mm × 1.49 mm in diameter. Under intravenous tirofiban infusion, rota-ablation was performed for 11 runs, five with a 1.5 mm burr and six with 1.75 mm burr. In each run, the rotation speed was 150,000 r/min and the burr was advanced very slowly for < 20 s to prevent speed deceleration < 3,000 r/min, and maintain adequate coronary flow with good myocardial Blush noted. After rota-ablation, IVUS images confirmed adequate ablation of the pre-existing stent and calcified layers (). Post-dilation with a non-compliant 3.25 × 12 mm balloon (Quantum balloon, Boston Scientific Co., Natick, MA) at 8 atm achieved full expansion of balloon (). Thus, a Taxus Liberte 3.5 × 32 mm stent was deployed at 14 atm, and a satisfactory result was documented by angiogram and IVUS imaging, respectively (, ). The patient's PCI course was uneventful and discharge followed a few days later on aspirin and clopidogrel. Follow-up angiography nine months later revealed < 30% instent restenosis (). | [[76.0, 'year']] | F | {'28115812': 1, '11170330': 1, '24133505': 1, '15808753': 1, '19805850': 1, '29443790': 2, '17697816': 1, '15687540': 1, '14624430': 1, '24133508': 2} | {'5839823-1': 1} |
163,636 | 3796695-1 | 24,133,509 | noncomm/PMC003xxxxxx/PMC3796695.xml | Mechanism and management of burr entrapment: A nightmare of interventional cardiologists | Case 1 was a 60-year-old lady with lupus nephritis complicated with end stage renal disease under regular hemodialysis for decades. Rotablation for the heavily calcified left anterior decending artery (LAD) () was performed by 1.5 mm rotablator burr initially and followed by another 1.75 mm one. During the pecking motion of the 1.75 mm burr at 160,000 r/min, it was suddenly stuck at the distal LAD and could not be activated even after intracoronary nitroglycerin injection (). A hydrophilic Fielder FC wire (Asahi Intech, Japan) and a stiff Conquest wire (Asahi Intech, Japan) were tried to pass the entrapped burr for dilation of the segment that entrapped it, but both failed. The burr was re-activated after increased the speed up to 180,000 r/min and could be advanced distally followed by successful retrieval. | [[60.0, 'year']] | F | {'15808753': 1, '10953109': 1, '10627374': 1, '15558759': 1, '9637449': 1, '10624071': 1, '22579342': 1, '31200774': 1, '15172398': 1, '21547995': 1, '24133505': 1, '30510810': 2, '12203923': 1, '9236427': 1, '21793173': 1, '21780279': 1, '12891607': 1, '34316929': 1, '11387607': 1, '22334323': 1, '17391217': 1, '32577280': 2, '24133509': 2} | {'3796695-2': 2, '3796695-3': 2, '3796695-4': 2, '3796695-5': 2, '6232790-1': 1, '7290249-1': 1} |
163,637 | 3796695-2 | 24,133,509 | noncomm/PMC003xxxxxx/PMC3796695.xml | Mechanism and management of burr entrapment: A nightmare of interventional cardiologists | Case 2 was a 65-year-old gentleman with type 2 diabetes and dyslipidemia, who was admitted for PCI because of unstable angina. Heavily calcified from proximal to distal LAD was revealed by both angiography and intravascular ultrasound. Rotablation using a 1.5 mm burr was performed at a speed of 180,000 r/min. The burr was entrapped at the distal LAD during a long run of more than 10 s (). The stuck burr was retrieved by pulling vigorously on the guiding catheter (GC), GW and rotablator burr simultaneously. However, it resulted in a spiral dissection and acute closure at the distal LAD, which was successfully rescued by re-wiring and stenting. | [[65.0, 'year']] | M | {'15808753': 1, '10953109': 1, '10627374': 1, '15558759': 1, '9637449': 1, '10624071': 1, '22579342': 1, '31200774': 1, '15172398': 1, '21547995': 1, '24133505': 1, '30510810': 2, '12203923': 1, '9236427': 1, '21793173': 1, '21780279': 1, '12891607': 1, '34316929': 1, '11387607': 1, '22334323': 1, '17391217': 1, '32577280': 2, '24133509': 2} | {'3796695-1': 2, '3796695-3': 2, '3796695-4': 2, '3796695-5': 2, '6232790-1': 1, '7290249-1': 1} |
163,638 | 3796695-3 | 24,133,509 | noncomm/PMC003xxxxxx/PMC3796695.xml | Mechanism and management of burr entrapment: A nightmare of interventional cardiologists | Case 3 was a 69-year-old woman who was admitted due to stable angina. Long calcified LAD with acute angulation at its middle part was observed during PCI. RA was performed using a 1.5 mm burr, which was entrapped after passing the angulated segment during the first run (). Despite all efforts, the burr could not be retrieved successfully and the patient was sent for emergent surgery to retrieve the burr. | [[69.0, 'year']] | F | {'15808753': 1, '10953109': 1, '10627374': 1, '15558759': 1, '9637449': 1, '10624071': 1, '22579342': 1, '31200774': 1, '15172398': 1, '21547995': 1, '24133505': 1, '30510810': 2, '12203923': 1, '9236427': 1, '21793173': 1, '21780279': 1, '12891607': 1, '34316929': 1, '11387607': 1, '22334323': 1, '17391217': 1, '32577280': 2, '24133509': 2} | {'3796695-1': 2, '3796695-2': 2, '3796695-4': 2, '3796695-5': 2, '6232790-1': 1, '7290249-1': 1} |
163,639 | 3796695-4 | 24,133,509 | noncomm/PMC003xxxxxx/PMC3796695.xml | Mechanism and management of burr entrapment: A nightmare of interventional cardiologists | Case 4 was a 74-year-old male with left main (LM) bifurcation disease and received bypass surgery years ago. PCI for the LM bifurcation and calcified LAD lesions was performed because all the bypass grafts were occluded. RA for the heavily calcified LAD was attempted using a 1.5 mm burr. However, it was stuck beyond a stenotic calcified lesion. A Conquest wire was passed distally followed by 2.5 mm balloon inflation at the stenotic lesion to retrieve the entrapped burr successfully (). After stenting for the LAD, the LM bifurcation was successfully treated by simultaneous kissing stenting. | [[74.0, 'year']] | M | {'15808753': 1, '10953109': 1, '10627374': 1, '15558759': 1, '9637449': 1, '10624071': 1, '22579342': 1, '31200774': 1, '15172398': 1, '21547995': 1, '24133505': 1, '30510810': 2, '12203923': 1, '9236427': 1, '21793173': 1, '21780279': 1, '12891607': 1, '34316929': 1, '11387607': 1, '22334323': 1, '17391217': 1, '32577280': 2, '24133509': 2} | {'3796695-1': 2, '3796695-2': 2, '3796695-3': 2, '3796695-5': 2, '6232790-1': 1, '7290249-1': 1} |
163,640 | 3796695-5 | 24,133,509 | noncomm/PMC003xxxxxx/PMC3796695.xml | Mechanism and management of burr entrapment: A nightmare of interventional cardiologists | Case 5 was a 72-year-old woman who was admitted for stable angina. Heavily calcified LAD and left circumflex artery (LCX) were found and a 1.25 mm burr was employed first for the LCX lesion. During the pecking motion of rotablation, the burr was suddenly trapped at middle LCX and could not be retrieved (). The entrapped burr was removed by manual traction of the burr and guide wire, which resulted in injury and acute closure at the ostium of LCX. Intra-aortic balloon pump was inserted for hemodynamic support and antegrade flow of LCX was restored by successful re-wiring and stenting. | [[72.0, 'year']] | F | {'15808753': 1, '10953109': 1, '10627374': 1, '15558759': 1, '9637449': 1, '10624071': 1, '22579342': 1, '31200774': 1, '15172398': 1, '21547995': 1, '24133505': 1, '30510810': 2, '12203923': 1, '9236427': 1, '21793173': 1, '21780279': 1, '12891607': 1, '34316929': 1, '11387607': 1, '22334323': 1, '17391217': 1, '32577280': 2, '24133509': 2} | {'3796695-1': 2, '3796695-2': 2, '3796695-3': 2, '3796695-4': 2, '6232790-1': 1, '7290249-1': 1} |
163,641 | 3796706-1 | 24,133,520 | noncomm/PMC003xxxxxx/PMC3796706.xml | A successful team treatment for left main shock syndrome | A 59 year-old male was admitted to our hospital experiencing recurrent chest pain for 6 years and severe pain for 10 h. He had been smoking for seven years and had prior 5 years history of hypertension (160/90 mmHg). On physical examination, the patient was clammy and normal blood pressure (115/60 mmHg), with normal heart sounds and bilateral pulmonary rales on the lower zone of lungs. His electrocardiogram demonstrated ST segment elevation in leads I, aVL, aVR, V1 through V4, ST segment depression in lead II, III and aVF (). Chest X ray indicated a minor increase in pulmonary markings. Acute anterioseptal and lateral myocardial infarction (Killip Class II) and hypertension were diagnosed and the patient was immediately transferred to the catheterization laboratory from the emergency unit. 300 mg aspirin, 600 mg loading dose of clopidogrel and 5000 U of intravenous heparin were administered.\nAs soon as the coronary angiography was performed, the blood pressure of the patient had dropped to 80/50 mmHg with dyspnea. Coronary angiography disclosed a left main occlusion in the middle portion of its body and a severe stenosis at the proximal posterior descending artery of right coronary artery ().\nWe decided to perform PCI on LMCA. At first, intra-aortic balloon pump (IABP) was inserted and the blood pressure was increased to 95/50 mmHg, except for severe hypoxemia. So an extracorporeal membrane oxygenation machine (ECMO) was inserted via left femoral venoarterial access. The blood pressure was increased to 105/50 mmHg after a while. After one coronary soft guide wire (0.014 inch run through; teromo, Japan) had been passed into the left anterior descending (LAD) coronary arteries, the distal left main portion and LAD was predilatated with 1.5 × 15 mm balloon inflated at 16 atm. Subsequently, LAD was dilatated with SPRINTER 2.0 × 12 mm balloon inflated at 14 atm and a FIRE STAR 2.5 × 15 mm balloon inflated at 14 atm. Distally to this lesion with Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow, both LAD and diagonal branch presented a significant diffuse lesion while circumflex (CX) ostia presenting with coronary aneurysm (). Therefore, we ended the procedure.\nThe patient was then monitored in Coronary heart disease Care Unit (CCU) with 3.4 L/min of Extracorporeal Membrane Oxygenation (ECMO) and 1: 1 counterpulsation of IABP supporting on the first day after PCI. The total 24 h urine volume increased from 1050 mL of the second day to 3170 mL of the third day after PCI. So the IABP was withdrawn and ECMO volume was turned down to 2.4 L/min.\nHowever, the number of platelets in the whole blood of the patient dropped from 140 G/L on the first day to 76 G/L on the fifth day with normal liver, kidney and blood clot function, a successively CABG (AO-SVG-LAD and AO- SVG-D1-PDA) was then performed. On the second day after CABG, ECOM was withdrawn successfully. The patient is now on his three month uneventful follow-up. | [[59.0, 'year']] | M | {'26006141': 2, '18651437': 1, '19168529': 1, '19720640': 1, '22322287': 1, '22922416': 1, '22611136': 1, '8222198': 1, '24133520': 2} | {'5779146-1': 1, '5779146-2': 1} |
163,642 | 3796902-1 | 24,133,331 | noncomm/PMC003xxxxxx/PMC3796902.xml | Osmotic demyelination syndrome following slow correction of hyponatremia: Possible role of hypokalemia | A 47-year-old non-alcoholic male presented to the ER with altered sensorium. One week earlier, he had been started on ofloxacin for a lower urinary infection, following which he developed oliguria and swelling of whole body. On examination, he had pedal edema, facial puffiness, and mild hypertension (146/92 mmHg). Urine examination revealed a protein 100 mg/dl, 18-20 WBC, and 2-4 RBC per HPF. Serum creatinine was 1.8 mg/dl, and a diagnosis of drug-induced interstitial nephritis was made. Furosemide (60 mg daily) was prescribed. A history of jaundice, diabetes, uremia, or trauma was denied.\nOn examination, the patient was an average-built man in grade 2-3 encephalopathy without any localizing neurological deficits. Rest of the general physical and systemic examination was normal. CBC was normal. Serum urea was 48 mg/dl (normal 10-38) and the creatinine 1.6 mg/dl (normal 0.6-1.2). Serum sodium was 94 mmol/l (normal 135-145), serum potassium 2.5 mmol/l (normal 3.5-5.3), and the chloride 105 mmol/l (normal 98-110). The serum osmolality was 238 mOsm/kg (normal 285-295) with a urine osmolality 292 mOsm/kg. Spot urinary sodium was <10 mmol/l (normal >20). ABG analysis and rest of serum biochemistry was normal. The patient was started on 3% NaCl till the sodium level reached 120, when 3% saline was replaced with 0.9 N saline. Correction was given at a rate not exceeding 8 mmol/l day, and serum sodium of 135 was achieved over a period of 8 days. Simultaneously, serum potassium levels were corrected with intravenous potassium chloride []. The patient's consciousness improved dramatically but only to deteriorate again after a period of 72 hours with steady deterioration over 24 hours till his speech became incomprehensible and he developed quadriparesis. Neurological examination revealed generalized spastic quadriparesis, mutism and inability to swallow, characteristic of a pseudobulbar state with spontaneous eye opening consistent with the diagnosis of locked-in-syndrome. MRI of the brain revealed symmetrical areas of altered signal intensity in the pons and basal ganglia, being hypointense on T1-weighted imaging [] and hyperintense on T2-weighted imaging [Figures and ]. The involved areas were also hyperintense on a fluid inversion recovery (FLAIR) images [], suggesting a diagnosis of pontine and extrapontine myelinolysis. The patient received supportive treatment for about a month when he succumbed to intercurrent sepsis. | [[47.0, 'year']] | M | {'30931308': 1, '8192171': 1, '29340311': 1, '31516629': 1, '25099180': 1, '29540223': 2, '30843157': 2, '15316041': 1, '17880558': 1, '31691515': 1, '18044169': 1, '15742105': 1, '11148672': 1, '30357070': 1, '17598369': 1, '34136577': 1, '32172192': 1, '18358621': 1, '3713747': 1, '24133331': 2} | {'5853098-1': 1, '6437239-1': 1} |
163,643 | 3796903-1 | 24,133,332 | noncomm/PMC003xxxxxx/PMC3796903.xml | Thrombotic thrombocytopenic purpura secondary to ABO group incompatible blood transfusion in a patient after cardiac surgery | A 64-year-old male patient developed nausea, vomiting and chills during red blood cell (RBC) suspension transfusion on the second day of coronary by-pass surgery. Transfusion was stopped immediately. Caring physicians recognized an error in labeling of the RBC suspension. With a preliminary diagnosis of ABO incompatible transfusion reaction, aggressive hydration was instituted. In the follow-up, hemoglobin values dropped and lactate dehydrogenase (LDH) and serum creatinine levels started to increase proportionally. Urine color was darkened with a gradual development of oligo-anuria and acute kidney injury (AKI). On the 7th day of transfusion, platelet count decreased and LDH level increased significantly. In peripheral blood smear, polychromasia and abundant schistocytes were seen. TTP was diagnosed according to following criteria: Thrombocytopenia, microangiopathic anemia, increase in LDH level, and development of AKI. We started hemodialysis and plasmapheresis on the 8th day because of TTP and AKI. After 11 and 15 sessions of hemodialysis and plasmapheresis, respectively, platelet, LDH, urea, creatinine levels and urine output improved. Steroid therapy (1 mg/kg/day) was given simultaneously. The patient showed a dramatic improvement, and plasmapheresis and hemodialysis were stopped subsequently. On the 41th day of admission he had bloody diarrhea and C. Difficile toxin A was found to be positive in feces and vancomycin was administered for pseudo-membranous enterocolitis. On the 50th day, multiple infarctions were seen on cranial CT that was performed for the evaluation of confusion. Blood urea, creatinine and LDH levels increased, hemoglobin and platelet levels decreased again. In addition schistocytes were seen in blood smear. Plasmapheresis was performed because of recurrent thrombotic microangiopathy and hemodialysis was also started again. Thrombocytopenia persisted until the patient died eventually due to cardiac arrest. The pertinent laboratory data and major interventions are chronologically illustrated in []. | [[64.0, 'year']] | M | {'16173957': 1, '19180138': 1, '21470236': 1, '20701734': 1, '16672704': 1, '18712712': 1, '15922897': 1, '651382': 1, '19591220': 1, '28912376': 1, '16760911': 1, '32607340': 2, '24987245': 1, '17124092': 1, '15055865': 1, '17258124': 1, '15978100': 1, '24133332': 2} | {'7322435-1': 1} |
163,644 | 3796904-1 | 24,133,333 | noncomm/PMC003xxxxxx/PMC3796904.xml | Acute arterial thrombosis associated with inadvertent high dose of tranexamic acid | A 27-year-old male with no known co-morbidity sustained penetrating injuries to the perineum, rectum, bladder neck, and bowel following a fall on a sharp object. After initial resuscitation, he underwent surgical repair of his injury with ileostomy and primary repair of bladder neck injury. The perineum was contaminated with rectal content. After debridement and hemostasia, a delayed closure was planned. Patient had a stormy course in the intensive care unit (ICU), with the delayed abdominal closure being followed by wound dehiscence, ventilator-associated pneumonia and adult respiratory distress syndrome (ARDS). He was managed with ventilator support, antibiotics, parenteral nutritional, and thromboprophylasix with low molecular weight heparin (LMWH). Despite his stormy course, he was recovering from ARDS and healing perineal wound; In the 3rd week of his ICU admission, he had sudden bleeding from the bladder neck manifesting as hematuria through Foleys catheter and pericatheter bleeding from the urethra. The bleeding was managed with surgical exploration of perineal wound and direct compression. He was transfused with two unit of packed red blood cell (PRBC), and 1 gm of TA was ordered. But, by mistake, the patient received 10 gm of TA as bolus, followed by 1 gm infusion for 8 hrs. Patient was stabilized and was doing well on a ventilator until the attending nursing staff noticed pallor and coldness of the right lower limb after 6-8 hours of TA administration. Suspecting acute arterial occlusion, an urgent contrast angiography was done, which revealed arterial thrombosis involving right common iliac artery extending from the bifurcation of aorta up to the proximal femoral artery [].\nConsultation of a vascular surgeon was sought; the patient was systemically heparinized as per the hospital protocol to keep activated partial throboplastin time (aPTT) 2-2.5 times the control value. A few hours later, there was increasing pallor of the limb with loss of arterial pulsations in the entire lower limb with associated swelling. Immediate decompressive fasciotomy was done to prevent further ischemic injury. In view of worsening ischemic changes, the patient was planned for aorto-femoral bypass grafting. But, before he was prepared for the operating room, there was return of blood flow, skin color and arterial pulsations to the lower limb. Surgical intervention was postpone. Eventually, the patient recovered well from the arterial thrombosis and also from ARDS and was discharged from the ICU after about 10 days from the arterial thrombosis on LMWH prophylaxis. | [[27.0, 'year']] | M | {'31492172': 1, '20554319': 1, '2611113': 1, '33575543': 2, '33191708': 1, '2533604': 1, '19016686': 1, '29521284': 1, '22188866': 1, '59118': 1, '12144537': 1, '28507566': 1, '9485231': 1, '3373703': 1, '24133333': 2} | {'7866715-1': 1} |
163,645 | 3796926-1 | 24,133,313 | noncomm/PMC003xxxxxx/PMC3796926.xml | Modified valgus osteotomy of the femoral neck for late presenting femoral neck stress fractures in military recruits | A 26-year-old military man presented to us with a complaint of pain in the right hip and a limp for a duration of eight weeks. There was no history of trauma. He consulted a local clinic after one month of his field training when he had vague pain in the right hip. A radiograph was prescribed, which showed no abnormality. He was advised anti-inflammatory drugs. Despite relief in symptoms for a short period, with mechanical activity his pain and limp aggravated.\nClinical examination revealed tenderness in the right Scarpa's triangle, hip flexion of 110°, abduction of 30°, adduction of 10° and external rotation of 15° and no internal rotation. There was a shortening of 1.5 cm. Plain radiographs of the pelvis with both hips showed a partially displaced femoral neck fracture with a varus deformity []. The fracture surfaces were smooth. Magnetic resonance imaging confirmed the viability of the femoral head []. He was offered surgical treatment and he underwent realignment osteotomy at the basicervical area. After reduction fixation was done with three partially threaded cancellous screws. Active and passive physiotherapy was started as tolerated by the patient in the immediate postoperative period. Crutch walking with non-weight bearing on the affected limb was instructed for a period of six weeks. Subsequently gradual weight bearing was allowed, with full weight bearing achieved after two months. At the end of the four-year followup, there was no evidence of avascular necrosis of the head of the femur [] and the Harris hip score was 92, indicating excellent functionality []. | [[26.0, 'year']] | M | {'21818050': 1, '3189661': 1, '3797351': 1, '16951116': 1, '24932049': 1, '7447671': 1, '19946774': 1, '21881882': 1, '2252096': 1, '3812860': 1, '24932048': 1, '1777782': 1, '17337724': 1, '6415522': 1, '19142687': 1, '9553536': 1, '6217486': 1, '2266444': 1, '24133313': 2} | {} |
163,646 | 3796927-1 | 24,133,314 | noncomm/PMC003xxxxxx/PMC3796927.xml | Percutaneous osteoplasty in treatment of bone lymphangiomatosis | We present a case of a 34 year old woman who was diagnosed as bone lymphangiomatosis in the femur and tibia. The patient had undergone surgery for the lower limb discrepancy. Epiphysiodesis distal of the right femur was done at the age of 12 years and left femoral lengthening at the age of 14 years. Since, the age of 21 years the patient has had symptoms of lymphangitis, with an acute inflammatory process in the left thigh and leg as well as signs and symptoms of phlogosis, pain, edema, functional impairment and a fever of 39.5°C. Laboratory tests showed leukocytosis with left shift. Throughout the years, she suffered an additional thirteen episodes of lymphangitis, which was bacterial in some cases.\nAt the age of 29, the patient underwent curettage and filling of the femoral and tibial cavities with freeze-dried bone and autogenous cancellous bone from the iliac crest. As a result of these procedures, it was observed that this was a particular case of dysplasia as there was an accumulation of lymph in the interior of the cavity as well, which suggested lymphatic dysplasia or bone lymphangiomatosis. Reabsorption of the bone grafts was later observed, which coincided with two additional episodes of lymphangitis.\nThe differential diagnosis included neoplastic and proliferative bone marrow disorders, especially histiocytosis; as well as benign lesions such as solitary bone cysts, fibrous dysplasia, fibrous bone defects, cystic fibrous osteitis resulting from hyperparathyroidism and congenital generalized fibromatosis. She was diagnosed by histopathological study and she was treated by percutaneous osteoplasty and was followed for 2 years and 10 months in the femur and 2 years and 3 months in tibia.\nThe radiographic imaging preosteoplasty showed large areas of medullary resorption and cortical thinning of distal femoral and proximal tibial epiphysio metaphysial region [], CT scans revealed decreased trabeculation and endosteal scalloping with cortical thinning []. Magnetic resonance imaging (MRI) scans revealed diffuse lymphangiomatosis of bones and soft-tissues [].\nHistological sections stained with H and E, which revealed dense fibro-connective tissue with an abundance of large-caliber vascular channels []. Said channels were lined by flat monostratified epithelium, which tested positive for D2-40 (antibody that specifically stains lymphatic endothelial cells) through a specific immunohistochemical technique []. The postoperative images show cavities filled with acrylic cement in tibia (December 2010) [] and femur (May 2010) []. After over 2 years of followup (2 years and 10 months in the femur and 2 years and 3 months in tibia) there are no signs of disease progression at this level in the radiographic images []. | [[34.0, 'year']] | F | {'5489694': 1, '18521484': 1, '31377837': 1, '7768662': 1, '15810951': 1, '21044823': 1, '15634828': 1, '5350678': 1, '15959357': 1, '20074817': 1, '24133314': 2} | {} |
163,647 | 3796928-1 | 24,133,315 | noncomm/PMC003xxxxxx/PMC3796928.xml | Bioball universal modular neck adapter as a salvage for failed revision total hip arthroplasty | A 70 year old female was operated for left femoral neck fracture with THA using metal on metal prosthesis (ASR). 1 year later she developed aseptic loosening and a peri-prosthetic fracture of the femur, which was revised with fully coated stem (Solution System, Depuy International Ltd., UK) and cerclage wires []. Ten weeks after the surgery, on weight bearing, the stem subsided and the hip dislocated []. Because maximum size of the femoral neck was already used in the first surgery, the acetabular liner was changed to a constrained liner. But, after 1 month of the surgery, the neck got dislodged from the stem []. Version was found changed intraoperatively. This difficult hip with recurrent dislocation was salvaged using the bioball neck adapter and the version was restored. At 2 years followup, the fracture has united and the patient is pain free and mobile, with no further episode of dislocation []. There was no thigh or trochanteric pain till the last followup. | [[70.0, 'year']] | F | {'19662975': 1, '8776055': 1, '22784893': 1, '16124960': 1, '19885062': 1, '12068424': 1, '21462150': 1, '14646718': 1, '19219434': 1, '32001976': 1, '32440498': 1, '12478503': 1, '15577491': 1, '24133315': 2} | {'3796928-2': 2, '3796928-3': 2} |
163,648 | 3796928-2 | 24,133,315 | noncomm/PMC003xxxxxx/PMC3796928.xml | Bioball universal modular neck adapter as a salvage for failed revision total hip arthroplasty | A 62 year old male had cemented THA for idiopathic avascular necrosis, but started to have progressively increasing pain and limping 3 months after the surgery. The X-rays confirmed early and severe osteolysis. This hip was revised by using a fully coated stem []. The stem showed subsidence in 4 months time [], despite keeping the patient nonweight bearing for 2 months on crutches. It was managed successfully using the bioball adapter [], with no incidence of re-dislocation at 1.5 years followup. There was no trochanteric pain or thigh pain. | [[62.0, 'year']] | M | {'19662975': 1, '8776055': 1, '22784893': 1, '16124960': 1, '19885062': 1, '12068424': 1, '21462150': 1, '14646718': 1, '19219434': 1, '32001976': 1, '32440498': 1, '12478503': 1, '15577491': 1, '24133315': 2} | {'3796928-1': 2, '3796928-3': 2} |
163,649 | 3796928-3 | 24,133,315 | noncomm/PMC003xxxxxx/PMC3796928.xml | Bioball universal modular neck adapter as a salvage for failed revision total hip arthroplasty | A 35 year old male (ankylosing spondylitis) with bilateral hip involvement was operated elsewhere and had bilateral total hip replacement, but both the hips got infected. The infected implants were removed and the patient was left with a bilateral excision arthroplasty (Girdlestone's procedure). After a period of 1 year, after the infection had subsided, he was operated for left hybrid THA. While waiting for the right revision hip arthroplasty, he fractured his right femur after a trivial fall. He was operated on the right side and a revision total hip replacement was performed using the fully porous coated stem (Solution Depuy). After 3 months, when the patient was made to bear weight, the stem subsided and the patient developed a painful right hip. The pain was due to subsidence and instability as the patient could not bear weight on the affected side. The version was found to be changed intraoperatively. We managed to restore the hip biomechanics and restore the version using the bioball neck adapter. The patient has been under followup for 3 years now without any further incidence of instability. | [[35.0, 'year']] | M | {'19662975': 1, '8776055': 1, '22784893': 1, '16124960': 1, '19885062': 1, '12068424': 1, '21462150': 1, '14646718': 1, '19219434': 1, '32001976': 1, '32440498': 1, '12478503': 1, '15577491': 1, '24133315': 2} | {'3796928-1': 2, '3796928-2': 2} |
163,650 | 3796930-1 | 24,133,317 | noncomm/PMC003xxxxxx/PMC3796930.xml | Fungal prosthetic joint infection after total knee arthroplasty | A 62 year old hypertensive non diabetic female presented with pain, swelling in the left knee and difficulty in walking in the left knee for the last 6 weeks. A TKA of the left knee was done 2 years ago. She had an uneventful period after the TKA.\nOn examination, a 15 cm vertical midline surgical scar healed by primary intention of the initial TKA was present on anterior aspect of knee. The local temperature was raised. The range of motion was terminally restricted in flexion and was associated with pain. No deformity was noted, however, mediolatera instability was present. Patient was neurologically intact and distal pulsations were well felt.\nRadiologically, there was osteolysis over the anterior femoral cortex, posterior femoral condyles and under the tibial base plate []. Complete hematological study and urine microscopy revealed no significant abnormality besides elevated erythrocyte sedimentation rate (ESR) (75 mm at 1 hour) and C-reactive protein (CRP) (84 mg/l).\nKnee joint aspiration was carried out under sterile conditions. The fluid obtained was sent for analysis. Characteristics of the aspirate were 5 ml fluid, cloudy with low viscosity, white blood cell count was 15,000/cubic mm, with 68% polymorphonuclear leucocytes. Gram staining was negative, but 10% KOH mount, done to rule out fungal infection as a standard hospital protocol, was positive suggesting a fungal infection.\nA decision to perform 1st stage of revision TKA was taken after consultation with the patient and her family. In consultation with infectious disease specialist, it was decided to culture and identify the organism on intraoperative samples. The previous vertical incision was used to approach the joint. Per-operatively there was turbid synovial fluid, granulation tissue, implant loosening and adherent cement Synovial fluid and tissue was sent for culture and sensitivity studies.\nImplant removal, debridement and antibiotic (vancomycin) plus antifungal (amphotericin B) impregnated cement spacer insertion was done []. Post-operative period was uneventful []. Medical therapy included intravenous fluconazole 400 mg OD for 6 weeks followed by oral fluconazole 400 mg BD for 12 weeks. Bacterial culture was negative. Fungal culture was positive for Candida tropicalis. Sabouraud dextrose agar and the rapid API 20 microtube system were used for identification of species. Antifungal sensitivity was performed on the isolate.\nPatient was followed up at weekly intervals and after 20 weeks, the ESR (23 mm at 1 hour) and CRP (6.3 mg/l) were within normal limits. Repeat aspiration was sterile. During the 2nd stage of revision, TKA quadriceps snip technique was used. Spacer was removed; the defect was non contained involving cortical and metaphyseal bone. TC3 Depuy system and fluted stems were implanted (Depuy, India). Posterior femoral augmentation and reconstruction with allograft was done. Femoral head allograft was used as bone graft to fill up the defect. There was no maltracking of patella []. Tissue was sent for microbial analysis, which turned negative. Postoperative period was uneventful and patient was discharged on oral fluconazole 400 mg BD for 10 weeks.\nThe surgical wound healed adequately and after physiotherapy, a painless range of motion of 10-90° with a stable knee was obtained. We did not use any scoring system pre or postoperatively. Patient maintained status quo until last followup 24 months after 2nd stage of revision surgery []. | [[62.0, 'year']] | F | {'22529086': 1, '19884422': 1, '11796623': 1, '11402423': 1, '9645532': 1, '32793759': 1, '24744131': 1, '8836355': 1, '32282732': 1, '31363471': 1, '11880958': 1, '9741450': 1, '34141680': 2, '28540147': 2, '31286031': 1, '9247001': 1, '9355014': 1, '33269276': 2, '20652534': 1, '24133317': 2} | {'5441142-1': 1, '8180338-1': 1, '7674749-1': 1} |
163,651 | 3797277-1 | 24,137,563 | noncomm/PMC003xxxxxx/PMC3797277.xml | Sorafenib-triggered radiation recall dermatitis with a disseminated exanthematous reaction | 50-year-old man with chronic hepatitis B presented with an incidental computed tomography (CT) finding of a liver mass. He had been treated with lamivudine for chronic hepatitis B for five years. Dynamic liver magnetic resonance imaging showed an approximately 3.8-cm-sized single nodular mass with arterial enhancement and washout on segment 5. His serum alpha-fetoprotein level was 3.1 ng/mL. Liver biopsy revealed HCC with a background of chronic active hepatitis. A chest CT showed a dense, mass-like consolidation in right upper lobe. Bronchoscopic biopsy demonstrated extranodal marginal zone B-cell lymphoma of bronchus-associated lymphoid tissue. He was treated with hepatic bisegmentectomy (segments 5.6) for HCC.\nAt the one-year follow-up after surgery, multiple intrahepatic recurrent masses, peritoneal seeding masses, and a right chest wall mass were detected by dynamic liver MRI. Trans-catheter arterial chemoembolization was performed for the multiple intrahepatic metastases. For the chest wall mass, palliative radiotherapy (RT) was delivered with a total dose of 39 Gy in 13 fractions. Parallel opposing fields with wedge filters were used (). Sorafenib at 400 mg twice daily was begun on the day following completion of RT.\nAt a follow-up visit on the 14th day post-RT, the patient complained of mild pruritus of the right chest wall, and an erythematous patch with dry desquamation was observed on right chest wall which matched area previously irradiated and was consistent with RRD (). Because the pruritus was tolerable, sorafenib was continued at 400 mg twice daily. He visited the hospital again 10 days later presenting with a disseminated exanthematous rash and severe pruritus (). Sorafenib was stopped and an oral antihistamine was prescribed to relieve symptoms. At the 1-week follow-up after the cessation of sorafenib, the pruritus and skin rash were resolved (). Sorafenib was started again concurrently with an oral antihistamine drug and the skin rash did not recur. | [[50.0, 'year']] | M | {'18070211': 1, '19746202': 1, '18650514': 1, '26884901': 1, '16384753': 1, '19056253': 1, '24971021': 2, '26907093': 1, '28825507': 2, '10606426': 1, '19095497': 1, '11369064': 1, '29037022': 2, '13813586': 1, '29670787': 2, '19028406': 1, '16168567': 1, '19372036': 1, '19952730': 1, '18317586': 1, '24137563': 2} | {'5833239-1': 1, '5815258-1': 1, '4069149-1': 1, '5647756-1': 1} |
163,652 | 3797651-1 | 24,143,066 | noncomm/PMC003xxxxxx/PMC3797651.xml | A case of presumed choroidal metastasis from carcinoid tumor treated by photodynamic therapy with verteporfin | A 75-year-old woman who noticed floaters in her left eye for 2 weeks was referred to Tokyo Medical University Hospital in September 2010. She had a history of abdominal surgery for colon cancer (well-differentiated adenocarcinoma) in 2007. At presentation, her best-corrected decimal visual acuity was 0.6 oculus dexter (OD) and 0.9 oculus sinister (OS). Fundus examination revealed an orange-yellow mass that was 8 disc diameter (DD) in size with no measurable height at the inferotemporal side of the fundus OD, and a yellow-white mass 12 DD in size and 4.8 mm in height at the superior side of the fundus OS ( and ). Fluorescein angiography of the left eye showed hyperfluorescence inside the mass from early to late phase ( and ). Serum levels of carcinoembryonic antigen, cancer antigen 19-9, and cancer antigen 125 were within normal limits. A gallium-67 citrate scintigraphy scan showed no obvious abnormal uptake in the whole body including the eyes. Single-photon emission computed tomography with N-isopropyl-p-[123I] iodoamphetamine, which is known to be useful for the diagnosis of uveal melanoma, demonstrated no abnormal uptake in the eyes.\nIn September 2011, the masses at the inferotemporal side OD and at the superior and inferior sides OS had enlarged, but visual acuity was preserved in both eyes. On both T1 and T2-weighted magnetic resonance images of the left orbit, iso-dense regions relative to the cerebral white matter were found consistent with the masses. A systemic workup to search for extraocular primary lesions revealed multiple nodules in the subcutaneous tissues of bilateral breasts on ultrasonography and neoplastic lesions in the right bronchial tubes on chest computed tomography. Histopathology of the tumor from a breast biopsy revealed foci of oval and spindle-shaped cells in alveolar and palisading arrangement (), and that from a lung biopsy showed oval hypertrophic nuclei and proliferation of atypical epithelial cells in rosette-like arrangement. Immunohistochemical staining was positive for CD56, chromogranin A, and synaptophysin. These imaging and histological findings were consistent with breast and lung carcinoid tumors.\nFrom the clinical findings, general systemic workup, and clinical course, this case was presumptively diagnosed as choroidal metastasis from breast or lung carcinoid tumor. Fifteen months after the initial examination, the masses in both eyes expanded further. The mass at the inferotemporal side of the right eye was 20 DD in size and 3.5 mm in height. The mass at the superior side of left eye was 28 DD in size and 14.9 mm in height, and the mass at the inferior side was 7 DD in size and 5.5 mm in height. The left optic disc was invisible because of the enlarged mass, and best-corrected visual acuity was reduced to hand motion ( and ). An indocyanine green angiogram of the right eye showed choroidal vessel staining inside the mass from the early phase, and a mixture of hyper- and hypofluorescence in the late phase ( and ).\nExternal-beam radiotherapy of 40 Gy was used to treat the tumor in the left eye. Although the tumor in the right eye showed a tendency toward rapid expansion and required aggressive treatment to preserve vision, the tumor was still small and we had reservations about using external-beam radiotherapy due to the risk of adverse effects such as radiation retinopathy. Consequently, PDT was performed on her right eye after obtaining informed consent.\nStandard PDT was conducted with intravenous infusion of verteporfin at a dose of 6 mg/m2 body surface area over 10 minutes. Treatment parameters were 689 nm at 50 J (600 mW)/cm2 for an exposure time of 83 seconds. The diameter of each spot was 6,500 μm, and three spots with overlapping margin were administered. The tumor at the inferotemporal side was reduced to 7 DD and no measurable height after treatment. Later, a new mass 4 DD in size appeared at the inferonasal side and remained unchanged. The tumor at the superior side of the left eye was reduced after radiotherapy and the optic disc became visible ( and ). Best-corrected decimal visual acuity was 0.8 OD and 50 cm hand movement OS at 14 months after PDT (30 months after the initial visit) and the patient’s general condition was stable. | [[75.0, 'year']] | F | {'16879581': 1, '6101129': 1, '10532441': 1, '20709311': 1, '8008351': 1, '30524492': 1, '25827542': 1, '1157019': 1, '12839856': 1, '6176523': 1, '27843513': 1, '12466172': 1, '9261313': 1, '17056382': 1, '7997334': 1, '22386261': 1, '15183811': 1, '33553848': 1, '17187011': 1, '15108037': 1, '219697': 1, '31341995': 1, '5458261': 1, '16720153': 1, '18973950': 1, '21109962': 1, '24143066': 2} | {} |
163,653 | 3797944-1 | 24,143,321 | noncomm/PMC003xxxxxx/PMC3797944.xml | Duodenal Mucosa-Associated Lymphoid Tissue Lymphomas: Two Cases and the Evaluation of Endoscopic Ultrasonography | A 52-year-old man visited with right upper quadrant pain. His physical examination, routine hematology, and biochemistry tests were normal. Endoscopy showed a depressed lesion with fold clubbing and granular base on the duodenal bulb (). EUS showed superficially spreading type hypoechoic lesion showing wall thickening of the second layer and partial indentation of the third layer of the duodenum (). Histological examination of the stomach was positive for H. pylori. Histology of the duodenal infiltration was compatible with MALT lymphoma: presence of lymphoepithelial lesions with a monoclonal population and positivity for CD20 and bcl-2 and negativity for CD3 and cyclin D1 (). An abdominal computed tomography (CT) scan demonstrated no lymph node enlargement. The patient was diagnosed as having stage IE1 MALT lymphoma according to the Ann Arbor classification modified by Musshoff. We decided to eradicate H. pylori with amoxicillin (1,000 mg twice daily), pantoprazol (40 mg twice daily), and clarithromycin (500 mg twice daily) for 2 weeks. At 2 months after the completion of the antibiotic treatment, right upper quadrant pain was subsided and there was no evidence of H. pylori in the gastric mucosa, but endoscopy disclosed no sign of regression of the duodenal lesion. Repeated endoscopy showed regression of the depressed lesion with granular base after 4 months (). EUS also demonstrated remission of wall thickening 7 months later (). Histological evaluation noted no lymphoepithelial lesion and immunoglobulin heavy chain rearrangement, but aggregates of lymphoid cells were persistent. Follow-up abdominal CT scans showed no evidence of lymph node enlargement. The patient was amenable to frequent endoscopies, so we decided to monitor the patient with short-term follow-up endoscopies and biopsies. The most recent endoscopy, 10 months after H. pylori eradication, showed grossly normal mucosa in the duodenal bulb. | [[52.0, 'year']] | M | {'11247887': 1, '8942749': 1, '8495833': 1, '12297744': 1, '11171816': 1, '17185085': 1, '27482191': 2, '6193858': 1, '22229204': 1, '9228971': 1, '18309692': 1, '8684218': 1, '10192204': 1, '15143903': 1, '19122505': 1, '21623135': 1, '24143321': 2} | {'3797944-2': 2, '4945810-1': 1} |
163,654 | 3797944-2 | 24,143,321 | noncomm/PMC003xxxxxx/PMC3797944.xml | Duodenal Mucosa-Associated Lymphoid Tissue Lymphomas: Two Cases and the Evaluation of Endoscopic Ultrasonography | A previously healthy 51-year-old man visited our hospital for a routine check-up. Physical examination and routine hematological and other laboratory studies were normal. Endoscopy showed a whitish granular lesion on duodenum third portion (). EUS showed superficially spreading and hypoechoic lesion that was similar to the first case (). Histological examination of the stomach was positive for H. pylori. Histology of the duodenal infiltration was compatible with MALT lymphoma: presence of lymphoepithelial lesions and diffuse infiltration of small lymphoid cells with the monoclonality of immunoglobulin heavy chain and positivity for CD20 (). Chest CT scan showed approximately 0.6-cm sized left supraclavicular lymph node enlargement. Abdominal CT disclosed multiple lymphadenopathy approximately 1 cm in diameter at aortocaval and mesenteric lymph nodes. The patient was classified as having stage IIIE MALT lymphoma, so we administered systemic cyclophosphamide, vincristine, prednisone, and rituximab every 3 weeks. The patient achieved complete remission after six courses of chemotherapy. A follow-up endoscopy after the chemotherapy showed complete regression of the duodenal MALT lymphoma and the enlarged lymph node disappeared on CT scan. The patient was followed up without recurrence for about 6 months. | [[51.0, 'year']] | M | {'11247887': 1, '8942749': 1, '8495833': 1, '12297744': 1, '11171816': 1, '17185085': 1, '27482191': 2, '6193858': 1, '22229204': 1, '9228971': 1, '18309692': 1, '8684218': 1, '10192204': 1, '15143903': 1, '19122505': 1, '21623135': 1, '24143321': 2} | {'3797944-1': 2, '4945810-1': 1} |
163,655 | 3797945-1 | 24,143,322 | noncomm/PMC003xxxxxx/PMC3797945.xml | A Case of Gastric Inverted Hyperplastic Polyp Found with Gastritis Cystica Profunda and Early Gastric Cancer | A 77-year-old male was admitted to undergo gastric endoscopic submucosal dissection. He had been diagnosed with a metachronous early gastric cancer on the posterior wall of the mid body 2 weeks before the admission. In the past history, he had undergone endoscopic submucosal dissection due to early gastric cancer on the anterior wall of the antrum of the stomach and gastric polypectomy due to multiple hyperplastic polyps in the stomach 1 year and 8 months before the admission. On admission, the physical examination was unremarkable. Complete blood count results showed white blood cell of 5,800/mm3, hemoglobin of 13.1 g/dL, and platelet of 214,000/mm3. The blood chemistry was analyzed as total protein of 7.6 g/dL, albumin of 4.1 g/dL, total bilirubin of 0.6 mg/dL, aspartate aminotransferase of 33 IU/L, alanine aminotransferase of 23 IU/L, alkaline phosphatase of 51 IU/L, serum creatinine of 1.4 mg/dL, total cholesterol of 176 mg/dL, and fasting blood glucose of 97 mg/dL. Endoscopic examination demonstrated superficial depressed lesion with spontaneous bleeding on the posterior wall of the mid body (). He underwent endoscopic submucosal dissection successfully.\nThe resected specimen was 4.5×3×0.5 cm and had 1.5×0.5-cm superficial depressed lesion in the center (). Microscopically, 1.5×0.5-cm-sized, well-differentiated tubular adenocarcinoma was noted. It was confined to the mucosa and did not have involvement of lateral and deep margins, lymphatic invasion, vascular invasion, and perineural invasion. In addition, gastritis cystica profunda was also noted in the submucosa. Especially, nodular inverted proliferation of the normal appearing gastric epithelium and glands in the submucosa was noted in the center of the resected specimen. It measured 5 mm and showed mild glandular atypia. It was diagnosed to be a gastric IHP (). He was discharged without special complications after the endoscopic submucosal dissection. | [[77.0, 'year']] | M | {'27099452': 1, '17097828': 1, '25834348': 1, '12583438': 1, '7286916': 1, '31027092': 2, '33169712': 1, '4014540': 1, '20697192': 1, '29851789': 1, '8493869': 1, '24143322': 2} | {'6831260-1': 1} |
163,656 | 3797946-1 | 24,143,323 | noncomm/PMC003xxxxxx/PMC3797946.xml | Gastrointestinal Cancers in a Peutz-Jeghers Syndrome Family: A Case Report | A 17-year-old male patient was diagnosed as PJS because of dark pigmented macules on the lips and multiple hamartomatous polyps in the stomach, duodenum, and colon. He had anemia and underwent polypectomy in the duodenum and colon. His maternal grandfather, mother, two uncles and two cousins were patients with PJS (). One uncle had died of lung cancer at the age of 32. His mother used to be screened with endoscopy to remove large polyps.\nOne and half years later, he underwent jejunal segmental resection due to intussusceptions. Thereafter, he underwent gastroduodenoscopy and colonoscopy every 2 to 3 years.\nWhen he was 23 years old, colonoscopic polypectomy was done and high-grade dysplasia was found in colonic polyp. Simultaneously, his mother presented abdominal discomfort at the age of 51. Computed tomography (CT) scan showed a 3-cm sized multiseptated cystic lesion with enhanced nodular portion in the pancreas (). To make sure ductal communications of the lesion and to reveal the drainage of mucin, endoscopic retrograde cholangiopancreatography (ERCP) was done. ERCP showed a focal filling defect and extraductal collection of dye at the pancreatic body. Ultrasound-guided biopsy revealed intraductal papillary mucinous adenoma with low grade dysplasia and CA 19-9 in the aspirated fluid from the pancreas was elevated to 379.58 U/mL. Partial pancreatectomy was performed and intraductal papillary mucinous carcinoma in situ was confirmed ().\nWhen he was 27 years old, he suffered from abdominal discomfort and dizziness. His conjunctiva was pale and hemoglobin was 7.3 g/dL but other biochemical studies were normal. Gastroduodenoscopy revealed multiple papillary polyps diffusely covering the greater curvature of the corpus (). Wide endoscopic polypectomy was performed under general anesthesia. Histological examination revealed hamartomatous polyps with low-grade dysplasia and focal intramucosal carcinoma (). CT scan showed remnant massive polyps in the stomach. The patient was referred to surgical department for operation but subtotal gastrectomy was performed in another hospital following the opinions of his family. | [[17.0, 'year']] | M | {'19916169': 1, '30740205': 2, '27081323': 1, '16707622': 1, '20051941': 1, '22067184': 1, '15398245': 1, '26600934': 1, '20581245': 1, '27444139': 1, '11113065': 1, '9428765': 1, '25505712': 1, '24143323': 2} | {'6354681-1': 1} |
163,657 | 3797947-1 | 24,143,324 | noncomm/PMC003xxxxxx/PMC3797947.xml | Successful Endoscopic Mucosal Resection of a Low Esophageal Carcinoid Tumor | A 49-year-old woman underwent upper endoscopy due to intermittent epigastric soreness and heartburn. A 0.8×0.5-cm, ovoid, elevated, submucosal esophageal lesion was detected 35 cm from the incisors (). The overlying mucosa was intact but showed slightly erythematous central change and had a soft consistency. The surface of the tumor was stained with iodine. Endoscopic ultrasonography (EUS; 20 MHz, miniprobe) demonstrated a 4.4×3.3-mm, well demarcated, homogenous, hypoechoic, round mass lesion within the mucosal layer, and the submucosal layer beneath the lesion was observed to be intact ().\nA biopsy was performed and the mass was diagnosed as a carcinoid tumor. We informed the patient of the characteristics of carcinoid tumor. The patient chose to undergo endoscopic resection. EMR was performed by snaring the lesion following a submucosal saline injection (). There were no immediate complications. Histologic examination of the resected specimen revealed that the tumor was located in the mucosal layer (between the mucosa and muscularis mucosa) as indicated by EUS. The tumor consisted of round cells arranged in sheets without mitoses, and the resection margin was free (). Immunohistochemical studies demonstrated positivity for neuron-specific enolase, synaptophysin and chromogranin as supporting evidence of an esophageal carcinoid tumor (). A second endoscopy performed 2 months after the first demonstrated a linear whitish scar, with no residual lesion. Computed tomography imaging of the thorax was unremarkable.\nIn the present patient, there were no such clinical manifestations.\nLindberg et al. reported that esophageal carcinoid tumors exhibit marked male predominance, with a male to female ratio of 6:1. Age at diagnosis is widely variable, ranging from 45 to 82 years. Symptoms presented in their study were dysphagia (64%), weight loss (43%), pain (14%), reflux esophagitis (14%), fatigue (7%), and melanotic stools (7%). Only one patient had previously reported symptoms consistent with carcinoid syndrome.\nKlöppel et al. reported that most esophageal carcinoid tumors histopathologically are poorly differentiated neuroendocrine carcinomas and mixed endocrine-exocrine carcinomas, usually ranging from 4 to 10 cm in diameter. They present as fungating or ulcerated masses deeply infiltrating into the esophageal wall and are associated with early spread to the regional lymph nodes or infiltration of adjacent organs. In contrast, most well-differentiated neuroendocrine tumor/neuroendocrine carcinomas are less than 4 cm in diameter, present as polypoid lesions and are rarely associated with lymph node metastases and thus have an excellent prognosis.\nThe management of locoregional carcinoid tumors depends on tumor site and primary site as well as the general condition of the patient. Resection is the primary treatment approach for most localized carcinoid tumor. Most early reports recommend that esophageal carcinoid tumors be treated surgically by esophagogastrectomy or subtotal esophagectomy with gastroesophageal anastomosis.,, Currently, however, EMR of selected carcinoid tumors is accepted as a safe and effective alternative. The use of a ligation band at the lesion base may increase the ease and safety of EMR, and therefore ligation bands have been utilized for the treatment of other esophageal pathologies (i.e., Barrett's dysplasia) and for rectal carcinoid resection.\nEUS allows accurate description of the depth of tumor invasion into the esophageal wall, as well as the identification of internal features of the tumor. In our patient, the location of the tumor was clearly demonstrated by EUS and was consistent with pathological findings. EUS appears to be an excellent method to detect the depth of tumor invasion in the esophageal wall and has proven utility in staging and interventional planning (endoscopic or surgical) for gastrointestinal carcinoid tumors.\nEsophageal carcinoid tumors is a very rare disease. However, with increasing rates of screening upper endoscopy and recent technical improvement in endoscopy and radiology, detection of small esophageal carcinoid tumors may be increasing, adding to our findings. Due to improvements in EUS imaging techniques and EMR techniques, endoscopic treatment can successfully achieve complete resection of selected esophageal carcinoid tumors with few complications. We report a case of successful EMR of a low esophageal carcinoid tumor. | [[49.0, 'year']] | F | {'17198475': 1, '227580': 1, '4418379': 1, '4134908': 1, '15599742': 1, '9024720': 1, '5431572': 1, '11868015': 1, '8609694': 1, '22679117': 1, '18289355': 1, '30302162': 1, '17684761': 1, '5255420': 1, '9118026': 1, '25780296': 1, '24143324': 2} | {} |
163,658 | 3797948-1 | 24,143,325 | noncomm/PMC003xxxxxx/PMC3797948.xml | Systemic Amyloidosis Manifested by Gastric Outlet Obstruction | An 80-year-old female presented to Division of Gastroenterology, Department of Internal Medicine, Chung-Ang Medical Center with a complaint of a 2-week history of vomiting. She was a nonsmoker, did not consume alcohol and had no previously diagnosed disease. The patient complained of epigastric pain and had mild epigastric tenderness. She was admitted to the hospital for evaluation and treatment. Laboratory data revealed anemia (9.5 g/dL), but she had a white blood cell and a platelet count within normal ranges. Serum chemistry indicated a hypoproteinemia and hypoalbuminemia (total protein, 5 g/dL; albumin, 1.7 g/dL), but without abnormal liver or renal function. An esophagogastroduodenoscopy showed erythematous and edematous mucosa on the antrum with pyloric stenosis (). A computed tomography scan with contrast revealed diffuse wall thickening in the antrum of the stomach with partial gastric outlet obstruction, and without either perigastric fat infiltration or regional lymphadenopathy (). Histopathologic examination showed the deposition of amorphous, homogeneous, and acidophilic material in the gastric mucosal. The amyloidal protein was proven by a positive Congo red stain result (). Immunohistochemistry performed on biopsy results was C-kit (-), SMA (-), CD34 (-), S-100 (-), and Ki-67 (<1%).\nThe existence of a gastric amyloid tumor suggested systemic amyloidosis. Therefore, we did blood examinations, rapid plama reagin, rheumatoid factor, urinalysis, chest-abdominal simple X-ray examinations, skull and pelvic series, rectal biopsy with sigmoidoscopy, electrocardiography, and cardiac ultrasonography. A serum and urine immunfixation electrophoresis showed abnormal band of restriction in lambda light chain, suggesting monoclonal component. The cardiac ultrasonography had shown a small amount of pericardial effusion and diastolic dysfunction grade I. Small amounts of both pleural effusion and ascites were noted on the computed tomography scan. Other examinations revealed no specific finding. She was diagnosed with AL type systemic amyloidosis that presented as gastric outlet obstruction.\nDuring her admission, she developed symptoms, repeated bile color vomiting, malabsorption, systemic edema, dyspnea, and melena. On hospital day 14, a follow-up esophagogastroduodenoscopy showed progressed infiltration type gastric outlet obstruction and a single hole was noted on the antrum of nasogastric tube insertions site (). During the esophagogastroduodenoscopy, the scope did not pass through the pylorus. She refused further evaluation and treatment such as chemotherapy or surgery. Instead, she was managed conservatively with total parenteral nutrition therapy and intravenous proton pump inhibitor. She died of disease progression after 34 hospital days. | [[80.0, 'year']] | F | {'12145619': 1, '33968346': 2, '8244111': 1, '16507582': 1, '16830294': 1, '19288419': 1, '17912358': 1, '5087334': 1, '15561687': 1, '17465486': 1, '24143325': 2} | {'8101516-1': 1} |
163,659 | 3797949-1 | 24,143,326 | noncomm/PMC003xxxxxx/PMC3797949.xml | Gastric Somatostatinoma: An Extremely Rare Cause of Upper Gastrointestinal Bleeding | A 49-year-old woman with a history of type 2 diabetes mellitus for a few years presented with chronic abdominal discomfort and nausea for 1 year. She was treated for peptic ulcer disease but did not get better. Three months earlier, she complained of severe abdominal pain, significant weight loss, and chronic intermittent watery diarrhea. Abdominal sonography showed a large epigastric mass, 10×16 cm in size, with multiple hyperechoic nodules at both lobes of the liver and peripancreatic lymphadenopathy, suspected to be metastatic spread to the lymph nodes. Blood test results were within normal limits, and only hyperglycemia was noted. Blood tests for measuring hormone levels were not available in our institute. The patient was scheduled for a computed tomography (CT) scan of the upper abdomen. While she was waiting at the radiology unit, she developed hematemesis and was referred to the internal medicine department for further treatment. She was admitted, and the gastric lavage showed the presence of blood. Her hemoglobin level was 10 mg/dL. Endoscopy showed a large mass, approximately 15 cm in diameter, in the upper gastric body. The mass extended down to the antrum and duodenal bulb with blood oozing (). Next, endoscopic ultrasonography was performed, and a large well-defined isoechoic gastric subepithelial mass more than 13×8 cm in diameter was detected (). The mass arose from the third and fourth layers of the gastric wall. Multiple intra-abdominal and peripancreatic lymphadenopathy were detected, and the lesions varied in size from 8 to 25 mm. Fine needle aspiration was performed on the mass, and the cytology results led to a suspicion of malignancy. The CT scan showed a large soft tissue mass, with multiple liver metastases and intra-abdominal lymphadenopathy (). Finally, the patient underwent surgery. Gross pathology showed tumor involvement of the posterior wall of the stomach, with the tumor forming a large intramural multinodular mass (). Multiple well-circumscribed masses were detected at the pancreatic head and body and at the first part of the duodenum. Multiple liver nodules were also noted. Histopathology showed that the tumor was arranged in solid nests or in an acinar pattern infiltrating from muscularis propria of the stomach through the mucosa and extending to the duodenum. The tumor cells were cuboidal in shape with ample granular eosinophilic cytoplasm. Their nuclei were monotonous and bland, with salt and pepper nuclear chromatin, a typical characteristic of neuroendocrine tumors including positivity for typical characteristic of psammoma bodies (). Immunohistochemical staining for synaptophysin showed diffuse positivity in the cytoplasm (). Only a few tumor cells showed scattered positivity for somatostatin on immunohistochemistry (). A definitive diagnosis of somatostatinoma was made. The patient underwent distal gastrectomy with Billroth I anastomosis and cholecystectomy. However, she developed acute jejunal obstruction 2 weeks later due to intussusception from the jejunal leiomyoma and underwent gastrojejunostomy. She refused any further adjuvant chemotherapy or hormone therapy and received only palliative treatment. She passed away 8 months later because of massive liver metastasis. | [[49.0, 'year']] | F | {'19998510': 1, '32905002': 1, '19719976': 1, '20043348': 1, '21940726': 1, '20496141': 1, '9691916': 1, '21943457': 1, '21437171': 1, '20084576': 1, '22574531': 1, '11680591': 1, '20526564': 1, '10235228': 1, '19080351': 1, '66472': 1, '24143326': 2} | {} |
163,660 | 3797950-1 | 24,143,327 | noncomm/PMC003xxxxxx/PMC3797950.xml | Endoscopic Resection of Giant Colonic Lipoma: Case Series with Partial Resection | A 65-year-old female was referred to our center due to a giant colon lipoma detected on a colonoscopy. The patient had intermittent abdominal discomfort in the right lower quadrant. A wide-based 3×3-cm size yellowish protruding mass without mucosal change was detected at the ileocecal valve during colonoscopy (). We planned to perform an unroofing technique with a snare catheter (ASM-1-S; Wilson-Cook Medical Inc., Winston-Salem, NC, USA) at the center of the lesion so that the remaining lipoma could flow out of the exposed surface. It was deemed as appropriate to remove the roof of the center because the wide base of the lipoma could impede the conduction of electric current. ERBE ICC 200 (Elektromedizin, Tubingen, Germany) was used as the electrosurgical unit; at the Endo-cut mode (120 W, effect 3), partial resection was performed twice, each time lasting for less than 5 seconds, to resect about half of the mass (). Typical yellow tissue indicating lipoma could be seen on the exposed surface (). The patient was relieved of the abdominal discomfort afterwards. At 3-year follow-up colonoscopy, a surgical scar was observed but not any remaining lipoma (). | [[65.0, 'year']] | F | {'24869989': 1, '11419863': 1, '16937511': 1, '10744833': 1, '34733082': 1, '15918213': 1, '22275025': 1, '26790957': 2, '4026070': 1, '16281142': 1, '32746773': 1, '19418405': 1, '27843431': 2, '9378215': 1, '2227312': 1, '21857468': 1, '10950091': 1, '31334429': 1, '33953464': 1, '12842756': 1, '9494006': 1, '29905219': 1, '16482419': 1, '24143327': 2} | {'3797950-2': 2, '3797950-3': 2, '4721020-1': 1, '5091224-1': 1, '5091224-2': 1} |
163,661 | 3797950-2 | 24,143,327 | noncomm/PMC003xxxxxx/PMC3797950.xml | Endoscopic Resection of Giant Colonic Lipoma: Case Series with Partial Resection | A 46-year-old female was referred to the center with a colonoscopic finding of 3×3 cm giant lipoma at the sigmoid colon during a health examination performed 3 years ago. Being asymptomatic, the patient had been followed on an outpatient basis but was referred to our center due to continued abdominal discomfort in the left lower quadrant. A wide-based 3×3-cm yellowish globular mass without mucosal change was detected 30 cm above the anal verge during colonoscopy (). Partial resection technique was performed with a snare catheter at the center of the lesion so that the remaining lipoma could flow out of the exposed surface (). Since the mass was attached in a globular form, snare catheter was placed slightly apart from the base for optimal constriction. At the Endo-cut mode (120 W, effect 3), partial resection was performed for less than 10 seconds to resect most of the mass. Typical yellow tissue indicating lipoma could be observed on the exposed surface (). The colonoscopic finding at the next day confirmed flowing out of the remaining lipoma tissue at the exposed lesion (). The patient was relieved of the abdominal discomfort afterwards. At 1-year follow-up colonoscopy, a surgical scar was observed but not any remaining lipoma (). | [[46.0, 'year']] | F | {'24869989': 1, '11419863': 1, '16937511': 1, '10744833': 1, '34733082': 1, '15918213': 1, '22275025': 1, '26790957': 2, '4026070': 1, '16281142': 1, '32746773': 1, '19418405': 1, '27843431': 2, '9378215': 1, '2227312': 1, '21857468': 1, '10950091': 1, '31334429': 1, '33953464': 1, '12842756': 1, '9494006': 1, '29905219': 1, '16482419': 1, '24143327': 2} | {'3797950-1': 2, '3797950-3': 2, '4721020-1': 1, '5091224-1': 1, '5091224-2': 1} |
163,662 | 3797950-3 | 24,143,327 | noncomm/PMC003xxxxxx/PMC3797950.xml | Endoscopic Resection of Giant Colonic Lipoma: Case Series with Partial Resection | A 48-year-old male was referred to the center with diagnosis of a benign lesion in the ascending colon detected by abdominal-pelvic computed tomography and abdominal discomfort in the right lower quadrant. At colonoscopy, a 4×7-cm cylindrical protruding mass without mucosal change was detected originating from the proximal ascending colon (). As the size of the mass was much bigger than the other cases, we first tried partial resection with a snare catheter at the apical end of the mass unlike the other cases. At the Endo-cut mode (120 W, effect 3), partial resection was performed for 20 seconds unsuccessfully due to the impeded conduction of the electric current by the submucosal lipoma tissue (). It was found that the diameter of the mass became decreased toward the base of the cylindrical mass, which was why we retried partial resection slightly apart from the origin. Simulations were performed several times near the base of the mass, before performing the resection, in order to find the proper placement of the snare catheter with optimal constriction while avoiding possible thermal injury (). Partial resection was performed for less than 5 seconds to reset most of the mass. Typical yellow tissue indicating lipoma could be observed on the exposed surface (). As observed from the resected specimen of the mass, the apical end of the mass was too thick to apply electric current without inflicting severe thermal injury on the adjacent tissues, while the actual resected part was relatively thinner and the electric current was well-applied with rare thermal injury on the adjacent tissues (). The patient was relieved of the abdominal discomfort afterwards. At 1-year follow-up colonoscopy, a surgical scar was observed but not any remaining lipoma. | [[48.0, 'year']] | M | {'24869989': 1, '11419863': 1, '16937511': 1, '10744833': 1, '34733082': 1, '15918213': 1, '22275025': 1, '26790957': 2, '4026070': 1, '16281142': 1, '32746773': 1, '19418405': 1, '27843431': 2, '9378215': 1, '2227312': 1, '21857468': 1, '10950091': 1, '31334429': 1, '33953464': 1, '12842756': 1, '9494006': 1, '29905219': 1, '16482419': 1, '24143327': 2} | {'3797950-1': 2, '3797950-2': 2, '4721020-1': 1, '5091224-1': 1, '5091224-2': 1} |
163,663 | 3797951-1 | 24,143,328 | noncomm/PMC003xxxxxx/PMC3797951.xml | Repetitive Colonoscopic Decompression as a Bridge Therapy before Surgery in a Pregnant Patient with Chronic Intestinal Pseudo-Obstruction | A 31-year-old woman presented with abdominal pain, distension, and constipation at a fetal gestational age of 17 weeks. The patient's symptoms aggravated at fetal gestational age of 10 weeks and her last pregnancy was aborted 2 years earlier at another hospital due to severe intestinal obstruction. She had suffered from unexplainable obstructive symptoms 5 years earlier and was diagnosed with CIP because of repetitive obstructive symptoms without any visible obstructive lesion observed on abdominopelvic computed tomography (CT), barium enema, or colonoscopy (). Anorectal manometry was performed at another hospital and the results were normal. She was most recently admitted to our hospital 5 months ago because of recurrent obstructive symptoms. Because the intravenous administration of neostigmine was not effective, colonoscopic decompression was performed at that time. The patient was discharged after her condition improved.\nAt the time of admission, physical examination revealed the presence of abdominal distension and diffuse tenderness. Laboratory examination revealed a white blood cell count of 8,120/mm3, a hemoglobin level of 9.9 g/dL, a platelet count of 281,000/mm3, a blood sugar level of 99 mg/dL, a blood urea nitrogen level of 12.2 mg/dL, a creatinine level of 1.1 mg/dL, a sodium level of 139 mEq/L, a potassium level of 3.8 mEq/L, a chloride level of 104 mEq/L, a calcium level of 8.7 mg/dL, a phosphorous level of 3.6 mg/dL, and a magnesium level of 1.8 mg/dL. Neither radiologic study nor neostigmine administration could be performed because of the risk to the fetus. Colonoscopy was performed to provide decompression because the patient's pain and distension worsened after 5 days of conservative care. The colonoscope was passed just beyond the splenic flexure, at which point the lumen was found to be obstructed by a large fecal bezoar (). Attempts to break the fecal bezoar with an endoscopic snare (Olympus Disposable Electrosurgical Snare SD-210U-10; Olympus Medical Systems Corp., Tokyo, Japan) met with limited success. After suctioning the retained gas and contents of the proximal colon, a drainage catheter (ENBD-7-LIGUORY, 7 Fr, 250 cm; Cook Medical Inc., Winston-Salem, NC, USA) was placed through the working channel of the endoscope. The catheter was irrigated periodically with normal saline to prevent obstruction and ensure that the intestinal contents and gas were drained effectively. The patient's symptoms improved for a few days after decompression but recurred soon thereafter. Additional two attempts at endoscopic decompression were made and a new drainage catheter was inserted in each of the attempts until surgery could be performed.\nSubtotal colectomy with endileostomy was performed electively at a fetal gestational age of 21 weeks. Ileorectal anastomosis could not be performed due to the enlarged uterus and was postponed until after delivery. The excised colon measured 100 cm in length. The proximal portion from the cecum to the descending colon was dilated up to 16 cm in diameter and a focally narrowed transitional zone was observed around the sigmoid colon (). Full colonic sections were obtained for histopathological analysis, which revealed no apparent histopathological alteration in the muscularis propria or neural plexuses (). However, immunohistochemistry for C-KIT (CD 117) revealed fewer interstitial cells of Cajal (ICCs) in dilated portions of the colon compared to the undilated part (). Stool passage was normalized after surgery and pregnancy was maintained and resulted in a full-term delivery. | [[31.0, 'year']] | F | {'15339791': 1, '15238207': 1, '8858319': 1, '10403850': 1, '21970872': 1, '346432': 1, '9274662': 1, '15479666': 1, '21679643': 1, '33344584': 1, '21222160': 1, '24143328': 2} | {} |
163,664 | 3797952-1 | 24,143,329 | noncomm/PMC003xxxxxx/PMC3797952.xml | Retroperitoneal Cystic Lymphangioma Diagnosed by Endoscopic Ultrasound-Guided Fine Needle Aspiration | A 66-year-old female presented to her primary care physician for evaluation of 3 months of abdominal pain. Her pain was associated with heartburn, bloating, and indigestion and had been unresponsive to acid suppressing therapy. She denied any nausea or vomiting but did note occasional diarrhea. Further evaluation was performed with an abdominal ultrasound which revealed a 5 cm hypoechoic mass in the region of the tail of the pancreas. She underwent a magnetic resonance imaging (MRI) which confirmed the mass and noted it to be cystic in nature with multiple thin septations (). The patient was referred to gastroenterology and underwent EUS with FNA of the cystic lesion. EUS identified a 4.7×3.3 cm cystic lesion with internal septations adjacent to the tail of the pancreas, but not within the pancreas itself (). White colored fluid was aspirated using a 19 gauge Cook Echotip FNA needle and initial fluid analysis was notable for lymphocytes. A fluid triglyceride level was noted to be elevated at 8,243 mg/dL. The patient was referred to surgery and underwent laparoscopic removal of the cystic lesion. Post resection, surgical pathology specimens were consistent with a cystic lymphangioma (, ). At her 1 month postoperative visit, the patient noted significant improvement in her abdominal pain. | [[66.0, 'year']] | F | {'11419147': 1, '30505770': 1, '21607159': 1, '28123564': 1, '22606623': 2, '8738615': 1, '26200558': 2, '21135518': 1, '26064332': 1, '8637214': 1, '5913566': 1, '26651336': 2, '27386481': 1, '15812422': 1, '22572132': 1, '15933705': 1, '34926026': 2, '9529502': 1, '31564993': 2, '24143329': 2} | {'4752158-1': 1, '6731960-1': 1, '4675055-1': 1, '3350296-1': 1, '8654082-1': 1} |
163,665 | 3798226-1 | 24,143,070 | noncomm/PMC003xxxxxx/PMC3798226.xml | Scattered depressions with temporal preponderance in visual field test coexisting with optic disc temporal atrophy in cerebral arteriovenous malformation | A 22-year-old man suffering from visual disturbance, starting 5-years ago and gradually decreasing over time, presented to our ophthalmology department. Although his previous ophthalmic examination data were not available, he had no family history of any systemic or ophthalmologic disorders. At presentation, his best corrected visual acuity (BCVA) was 20/50 in the right and 20/100 in the left eye. Dilated fundoscopic examination revealed bilateral optic disc temporal pallor (). Visual evoked potentials (VEP) revealed delayed P100 latencies particularly observed in the smaller patterns in both eyes (). Pupillary light reflex was normal in both eyes. Automated visual field testing (Humphrey Instruments Inc., San Leandro, CA, USA) demonstrated scattered depressions with temporal preponderance resembling incomplete bitemporal hemianopsia (). Retinal nerve fiber layer (RNFL) map analyzed with spectral domain optical coherence tomography (SD-OCT) confirmed the presence of optic disc temporal atrophy (). Brain magnetic resonance imaging (MRI) and cerebral computed tomography angiography (CTA) revealed AVM, which was located adjacent to inferomedial portion of the posterior limb of the right internal capsule at the level of lateral ventricle ( and ). Chiasmal compression or atrophy was not observed. AVM was draining into the choroidal veins at the level of the posterior horn of right lateral ventricle. | [[22.0, 'year']] | M | {'15221308': 1, '19979442': 1, '18436809': 1, '26682178': 1, '23607064': 1, '9733296': 1, '12963606': 1, '2333918': 1, '11150281': 1, '10080216': 1, '2058499': 1, '24143070': 2} | {} |
163,666 | 3798357-1 | 24,173,186 | noncomm/PMC003xxxxxx/PMC3798357.xml | Atrophic dermatofibroma | Female, 57 years-old, had brown spots located on her left flank. Clinically\nwell-defined, of firm consistency, atrophic surface measuring 3x2 cm, initially noticed\nabout 10 years ago (). She complained of\nmild itching in the area. She denied previous trauma or injection. On examination, a\ncentral depression was shown after compression of both sides of the lesion.\nAfter excision of the lesion, the histopathological examination with hematoxylin and\neosin revealed epidermal hyperplasia and, in the center of the lesion, a slight\nepidermal atrophy. In the dermis, there was a proliferation of spindle cells in\nstoriform arrangement with central retraction of the dermis (). Orceine staining revealed the absence of elastic fibers\nin the middle of the proliferation (). The\nimmunohistochemical evaluating was positive for XIIIa factor and negative for CD34,\nconfirming the diagnosis of dermatofibroma in its atrophic variety ( and ). | [[57.0, 'year']] | F | {'15250897': 1, '16503899': 1, '31049230': 2, '15324399': 1, '14512938': 1, '27790113': 2, '10885409': 1, '12956693': 1, '31338755': 1, '7545142': 1, '20520936': 1, '3429722': 1, '24173186': 2} | {'6458953-1': 1, '5073680-1': 1} |
163,667 | 3798359-1 | 24,173,188 | noncomm/PMC003xxxxxx/PMC3798359.xml | Chronic graft-versus-host disease: clinical presentation of multiple\nlesions of lichenoid and atrophic pattern | A 52-year-old male patient presented with a history of an allogeneic bone-marrow\ntransplant (matched sibling donor) performed in a reference Hospital, due to acute\nmyeloid leukemia one year before. A conditioning regimen had been followed with oral\nbusulfan and fludarabine phosphate and he was immunosuppressed from day 2 pre-transplant\nwith cyclosporine, initial dose of 3mg/kg and 7mg/kg after the 21th day\npost-transplant, sustained for 241 days plus tacrolimus and mycophenolate mofetil for\nseven and 45 days respectively. The patient denied acute GVHD and his clinical follow-up\nwas unremarkable until six months post-transplant, when oral and skin lesions of chronic\nGVHD appeared. Since then the patient has been treated with prednisone up to 1mg/kg/day\nwith partial remission of the clinical picture. The initial skin lesions were described\nas erythematous and pruriginous papules, starting on the trunk with progressive\nspreading and oral lesions similar to lichen planus, with ulcers on the lower lip\ncausing restriction to mouth opening.\nExamination showed diffuse spotted hyper and hypopigmented skin, multiple lichenoid and\natrophic lesions plus almost complete scarring alopecia, acral edema and erythema plus\nonychodistrophia of the 20 nails (-). Buccal examination showed shallow ulcers on the\nbuccal mucosa and tongue, periodontal disease, salivary gland hypofunction, depapillated\ntongue and decreased taste. No pulmonary, gastrointestinal or renal involvement was\ndetected. Histology of skin lesions showed discrete hyperkeratotic and atrophic\nepidermis with vacuolar interface dermatitis and scattered apoptosis of keratinocytes\nplus superficial sclerosis, vascular proliferation and mild lymphocytic infiltrate,\nsuggestive of late evolution of lichenoid lesions ( and ). | [[52.0, 'year']] | M | {'17085303': 1, '22421124': 1, '12490799': 1, '16461782': 1, '16338616': 1, '21263156': 1, '19282026': 1, '15665847': 1, '22421123': 1, '24173188': 2} | {} |
163,668 | 3798360-1 | 24,173,189 | noncomm/PMC003xxxxxx/PMC3798360.xml | Pigmented eccrine poroma: report of an atypical case with the use of\ndermoscopy | A female, 36-year-old patient, of mixed race, homemaker, with history of asymptomatic\nlesion in the palm of her right hand for 3 years. During the examination a dark papule,\nof firm, marked consistency, well-defined contour and anfractuous surface, measuring\naround 0.5 cm diameter was observed in the right palmar region ( and ).\nDermoscopy revealed a white-gray area; black dots; polymorphic vascular structures and\nbluish-red gaps ( and ). There were no pseudopods, webs or pigmental\nstriae.\nHistopathology revealed proliferation of uniform cuboid cells with light-colored\ncytoplasm and evident intercellular bridges (). There was also hyperkeratosis, melanin pigments and abundantly\nvascularized stroma, aspects that are compatible with pigmented eccrine poroma (PEP).\nThere were no alterations suggestive of malignancy (). After diagnostic confirmation, the lesion was surgically\nremoved. | [[36.0, 'year']] | F | {'17684381': 1, '26312678': 2, '29194789': 1, '19445878': 1, '26896294': 1, '12974711': 1, '18269598': 1, '20098856': 1, '11168759': 1, '20516657': 1, '31723462': 1, '13361538': 1, '24173189': 2} | {'4540512-1': 1, '4540512-2': 1} |
163,669 | 3798361-1 | 24,173,190 | noncomm/PMC003xxxxxx/PMC3798361.xml | Case report of cutaneous histiocytic sarcoma: diagnostic and therapeutic\ndilemmas | An 82-year-old female patient presented since 15 days prior to consultations two\nasymptomatic nodular and crateriform lesions, about 1.0 cm wide, covered with central\nkeratosis and crust and erythematous-violaceous infiltrated edges in the right arm and\nbreast ( and ). An excisional biopsy of the lesions was made. The histological\ndiagnosis was of indeterminate malignant neoplasm with deep margins involved and the\nimmunohistochemical examination was positive for CD68, CD4, CD11c, fascin , CD45, CD163\nand lysozyme, factor XIIIa was inconclusive and markers of melanin, B and T cells and\ncytokeratin were negative (, and ). The\nultrasonography of soft tissues, breast and axillary lymph nodes and brain and abdomen\nCT scans showed no signs of neoplastic disease. Tomography of the chest revealed\nmultiple bilateral pulmonary nodules, which were stable in sequential scans and\ntherefore were not biopsied. Other hematological tumors having been excluded, a\ndiagnosis of primary cutaneous histiocytic sarcoma was made. The management included\nobservation of excision sites without expanding margins and periodic oncological and\ndermatological follow-up. No sign of recurrence was evidenced in the twelve-month\nfollow-up period. | [[82.0, 'year']] | F | {'15696128': 1, '29850341': 2, '31598348': 2, '19623422': 1, '11435656': 1, '24173190': 2} | {'5941799-1': 1, '6769387-1': 1} |
163,670 | 3798362-1 | 24,173,191 | noncomm/PMC003xxxxxx/PMC3798362.xml | Non-cultured melanocyte/keratinocyte transplantation for the treatment of\nstable vitiligo on the face: report of two cases | A male patient, 41 years old, driver. Previously submitted to surgical reconstruction\nand insertion of a prosthesis to replace the eye lost in an automobile accident.\nAfter the surgery, he noticed the onset of a depigmented macule in the periorbital\nregion, which was diagnosed as localized segmental vitiligo. Topical treatment was\nstarted with corticosteroids, viticromin and excimer laser (17 sessions), with\ndiscreet improvement (5%). He was referred for melanocyte transplantation, which was\nperformed on the lesion in the left periorbital region (). Two months after the transplant a 60% improvement in\nrepigmentation was observed during patient assessment and photographic evidence\n(). Four months later there was an\nincrease in repigmentation (75%) of the treated area, resulting in an excellent\ndegree of patient satisfaction (). | [[41.0, 'year']] | M | {'9640371': 1, '21603806': 1, '16389417': 1, '21864935': 1, '22421646': 1, '26457199': 1, '21572677': 1, '16650168': 1, '28852293': 1, '20676476': 1, '16207186': 1, '29186240': 1, '22329760': 1, '24173191': 2} | {'3798362-2': 2} |
163,671 | 3798362-2 | 24,173,191 | noncomm/PMC003xxxxxx/PMC3798362.xml | Non-cultured melanocyte/keratinocyte transplantation for the treatment of\nstable vitiligo on the face: report of two cases | A male patient, 35 years old, presented generalized acrofacial vitiligo, with several\nlesions on the hands, feet and frontal region. A previous treatment with psoralene\nand sun exposure did not improve lesions significantly. He was submitted to\nmelanocyte suspension transplantation for treatment of frontal region lesions (). Three months later a 90% improvement\nin repigmentation was observed, measured by photographic assessment, with excellent\nuniformity of color (). The patient\ndemonstrated a high degree of satisfaction and desire to have further transplant\nsessions to treat other affected areas. | [[35.0, 'year']] | M | {'9640371': 1, '21603806': 1, '16389417': 1, '21864935': 1, '22421646': 1, '26457199': 1, '21572677': 1, '16650168': 1, '28852293': 1, '20676476': 1, '16207186': 1, '29186240': 1, '22329760': 1, '24173191': 2} | {'3798362-1': 2} |
163,672 | 3798364-1 | 24,173,193 | noncomm/PMC003xxxxxx/PMC3798364.xml | Dermoscopy examination of petechial lesions in a patient with Dermatitis\nHerpetiformis | We report a clinical case where purpuric lesions on the hands of a patient with DH were\nexamined under dermoscopy.\nA 22 year-old Caucasian man with one and a half year history of generalized excoriated\ncutaneous lesions was admitted with intense pruritus. Numerous excoriated papules and\ncrusts were distributed on the scalp, neck, dorsum, extensor surface of the limbs, in\naddition to the lumbar and intergluteal areas. Petechial lesions on the volar aspect of\nthe digits of the hands and feet were visible (). Dermoscopy examination (DermLite Photo; 3Gen) of the volar surface of the\nfingers revealed erythematous and violaceous dots (new petechial lesions) and\nerythematous and brown dots (old petechial lesions) (). The patient's medical history included hypothyroidism. He\npresented no gastrointestinal symptoms. He was right-handed.\nThe vicinity of a purpuric lesion on the second finger of his right hand was biopsied.\nHematoxilineosin stain revealed a subepidermal vesicle with neutrophils infiltrate in\nthe dermal papillae (). Direct\nimmunofluorescence exam of the apparently normal perilesional skin revealed granular IgA\ndeposits on the upper dermis (). The\nserum level of anti-transglutaminase IgA antibodies was 18U/ml (ELISA, normal range:\nunder 10U/ml) and G6PD was normal. Dapsone 100mg per os was initiated. After 3 days,\nthere was no pruritus, and a glutenfree diet was accepted. On the 20th day of treatment,\nwe saw only residual hyperpigmentated lesions. | [[22.0, 'year']] | M | {'20713845': 1, '19503978': 1, '3956260': 1, '6345814': 1, '7899181': 1, '21571167': 1, '24173193': 2} | {} |
163,673 | 3798365-1 | 24,173,194 | noncomm/PMC003xxxxxx/PMC3798365.xml | Ectopic cutaneous Schistosomiasis | This was a thirty-five year-old, white, female patient born in Paraíba and resident in\nJacarepaguá/RJ for the last 34 years. She presented with a cluster of reddish-coppery\nasymptomatic macules and papules on the left buttock, arising 30 days after a waterfall\nbathing at the countryside of the state (\nand ). The diagnostic hypotheses were larva\nmigrans, residual herpes simplex and sarcoidosis. Histopathological examination showed\nepithelioid granulomas surrounding eggs with an insinuation of a lateral spine,\ncontaining miracidia ( and ). Complete examination of gastrointestinal system\nand parasitological stool analysis did not show any alterations. | [[35.0, 'year']] | F | {'22124551': 1, '27447892': 1, '9876440': 1, '31507346': 1, '26178192': 1, '24173194': 2} | {} |
163,674 | 3798366-1 | 24,173,195 | noncomm/PMC003xxxxxx/PMC3798366.xml | Case for diagnosis | A 53-year-old Caucasian male was referred to our Department due to an asymptomatic\nerythematous plaque on the left buttock evolving for 5 months and with progressive\nincrease. On physical examination, an erythematous-brownish plaque was observed with a\nraised erythematous-red border and areas of erosion (). There were no other signs or symptoms. A biopsy showed\nhyperkeratosis, acanthosis and spongiosis, as well as epidermotropism of isolated and\ngrouped large-sized atypical lymphocytes with pale halos, also present in the upper\ndermis. Immunohistochemistry revealed positive staining of these cells for CD3 and CD8\n() without staining for CD4, CD30 and\nCD56, consistent with the diagnosis of pagetoid reticulosis (PR) - Woringer-Kolopp\ndisease (WKD). The microbiological examinations of the skin were negative. Three weeks\nlater the patient developed several nummular erythematous lesions with a scaling border\nscattered on the legs (). We repeated the\nbiopsy, which revealed identical findings plus positive staining for CD45 and a\nproliferative index of 90% (Ki67). Subsequently, these lesions increased in size,\nassuming the shape of the original plaque and a diagnosis of Ketron-Goodman disease\n(KGD) was established. The patient started treatment once daily with betamethasone\ndipropionate ointment and, simultaneously, was referred to the haematological outpatient\ndepartment to exclude systemic involvement. All tests were normal, including the\nperipheral blood immunophenotyping, the bone marrow biopsy and the\nthoracoabdomino-pelvic computed tomography scans. After 4 months of therapy with topical\nbetamethasone dipropionate, all the lesions cleared, with the exception of a single\nlesion on the left foot, which was submitted to radiotherapy and resolved in 4 months.\nIn a follow-up over 2 years the patient has remained free of signs and symptoms. | [[53.0, 'year']] | M | {'20652112': 1, '15692063': 1, '21738977': 1, '12140457': 1, '1832931': 1, '27195265': 1, '15677982': 1, '24173195': 2} | {} |
163,675 | 3798367-1 | 24,173,196 | noncomm/PMC003xxxxxx/PMC3798367.xml | Case for diagnosis | A 70-year-old male patient with a prior history of diabetes and hypertension presented\nwith hyperkeratotic, erosive nodules scattered over the trunk and limbs, scratching\nlesions and marked scaling, with two months of evolution. The palms, bilaterally,\npresented honey-colored crusting and burrows (). He complained of pruritus, mainly at night, but there was no\nepidemiological context of infestation. He was hospitalized to treat a cellulitis in the\nright leg. On dermoscopy (Dermalite Pro II) we observed burrows in the palm of the hand,\nwith identification of a mite in its extremity (). Light microscopy of skin scrapings (after 10% potassium hydroxide) of one\nof the burrow allowed a better view of the agent (). | [[70.0, 'year']] | M | {'2112989': 1, '16573253': 1, '7838209': 1, '16166133': 1, '20520938': 1, '17190621': 1, '24173196': 2} | {} |
163,676 | 3798368-1 | 24,173,197 | noncomm/PMC003xxxxxx/PMC3798368.xml | Case for diagnosis | An 83 year-old man with a history of total bilateral amaurosis, of unknown cause, and\nwith no other relevant known diseases, was observed for an 8 yearlong pruritic\npolycyclic erythematous plaque of the left axilla (). He had been continuously medicated with topical antifungals and steroids,\nwith disease progression. No lymphadenopathies were found. Histology of skin biopsy\nrevealed an intraepidermal proliferation of large cells with clear cytoplasm and\npleomorphic nuclei, either loosely scattered or in small nests (). Immunohistochemistry was CK7 positive and negative for\nCK20 and Melan A (). After diagnosis of\nExtramammary Paget's Disease, total excision with 2cm margins was performed, with a\nposterior brachial cutaneo-fascial flap and a graft from the right thigh. Mammography,\nbreast ultrasound and thoraco-abdomino-pelvic computerized tomography detected no\nchanges. 24 months after surgery the patient remains without evidence of local or\nunderlying internal malignancy. | [[83.0, 'year']] | M | {'20676471': 1, '23127181': 1, '20883922': 1, '19578667': 1, '21244378': 1, '19018812': 1, '21676258': 1, '20975878': 1, '20951507': 1, '24173197': 2} | {} |
163,677 | 3798369-1 | 24,173,198 | noncomm/PMC003xxxxxx/PMC3798369.xml | Do you know this syndrome? | Thirty-four year old white female patient, presented with facial lesions for the past 14\nyears. At the exam 2-3 mm normochromic papules were distributed mainly around the eyes,\nnostrils and mouth and temporal areas. Also, clustered normochromic papules with a plain\nand smooth surface were present in the dorsal area of the tongue and gingival areas.\nOther visible lesions were: palmoplantar keratosis, with central depression and\nextension to the wrists; one papular, non-pedunculated smooth-surfaced lesion on the\nshoulder and flat wart-like lesions on the dorsal region of hands and lateral parts of\nthe feet ( to ). This patient also had macrocephaly, ogival palate, adenoid\nfacies and palpable thyroid nodules. The largest nodule was biopsied and cytological\nexam showed only hyperplasic cells without evidence of malignancy.\nAnatomopathological exam of a facial papule showed unspecific alterations and the\nshoulder lesion analysis resulted in sclerotic fibroma. We did not observe koilocytosis\non the flat wart-like lesions. Electrocoagulation sessions on the facial papules\nprovided esthetic improvement of the lesions. | [[34.0, 'year']] | F | {'22503188': 1, '27471403': 1, '16388286': 1, '18757421': 1, '28847996': 1, '19177005': 1, '18972196': 1, '24173198': 2} | {} |
163,678 | 3798370-1 | 24,173,199 | noncomm/PMC003xxxxxx/PMC3798370.xml | Do you know this syndrome? | Fourteen-year-old male patient, born and resident in São João dos Patos (Maranhão\nState), was seen at the HRAN/SES/DF Dermatology Service, with a history of keratotic\npapulonodular-verrucous lesions on the torso, and both upper and lower limbs. He also\npresented with areas of alopecia and an extremely pruriginous retroauricular\nlichenification ( and ).\nThe patient had a prominent forehead and a broad nose (). He had antecedents of: pneumonia, otitis and recurrent diarrhea\nsince four months of age. His brother died of pneumonia at four months of age; and there\nwas no history of familial consanguinity. Laboratory work-up showed: leukocytosis\n(60.900/mm3) with eosinophilia (90%), IgE levels of 11.600 mg/dL; negative\nanti-HIV 1 and 2 tests and negative anti-Toxocara and anti-Aspergillus. Besides the\natopic eczema, we diagnosed multiple vulgar warts and molluscum contagiosum. | [[14.0, 'year']] | M | {'18398125': 1, '21603822': 1, '16940164': 1, '19700878': 2, '27222657': 1, '17881745': 1, '16651279': 1, '16585322': 1, '24173199': 2} | {'2804128-1': 1} |
163,679 | 3799273-1 | 24,163,800 | noncomm/PMC003xxxxxx/PMC3799273.xml | Successful Prognosis of Brain Abscess during Pregnancy | A 24-year-old woman who lived in Saitama, Japan had three pregnancies, two childbirths, body mass index (BMI) of 22.3, and unremarkable past medical and family histories. Furthermore, her pre pregnancy weight was 55 kg and her height 163 cm.\nShe also had an uneventful first trimester, but developed a fever of >39°C at 22nd week, 1st day of pregnancy. Because of prolonged headache and nausea, she was referred to our hospital in Saitama for complete physical examination on October 2008. On admission, she had blood pressure of 103/51 mmHg, heart rate of 100 beats per min (bpm), body temperature of 39.0°C, mild stiffness in the neck, and cold extremities. No neurological abnormalities, such as consciousness disturbance or paralysis, were observed. However, brain computed tomography (CT) for the prolonged headache revealed a 1.5 cm mass in the right frontal lobe, while hematological analysis showed an elevated white blood cell count of 12,400 cells/µl (neutrophils, 87.7%). Cerebrospinal fluid findings were positive for gram-positive bacteria, an increased cell count (especially for neutrophils) of 2,332 cells/µl, and a low glucose concentration of 30 mg/dl. Brain MRI revealed a 1.5 cm mass with a high intensity signal inside and a low intensity T2 signal on the margin in the deep white matter of the right frontal lobe. Based on the above findings and a high intensity zone surrounding the mass on diffusion-weighted images, she was immediately placed on intensive therapy with concurrent administration of antibiotics cefotaxime (2 g/day) and meropenem (3 g/day), as well as glycerin 20 g/day to reduce intracranial pressure. shows a list of examinations performed in search of causal factors, while the results show the isolation of methicillin-sensitive Staphylococcus aureus (MSSA) from the throat. On the other hand, she had no dental problems. Because of unremarkable upper gastrointestinal endoscopy findings and a negative fecal occult blood test result, the possibility of brain metastasis of a malignant tumor was ruled out. After six weeks of intensive therapy with concurrent administration of two antibiotics and glycerin, the headache and nausea disappeared along with a reduction in the number of white blood cells. Subsequent brain MRI at 28th week, 4th day of pregnancy showed no enlargement of the abscess and disappearance of the surrounding edema, with no indication of puncture drainage. At this point, she was switched to oral administration of amoxicillin 750 mg/day for four weeks and was discharged at 29th week, 3rd day of pregnancy. shows the post admission course.\nShe vaginally delivered a 2,890 g girl baby at 38th week, 5th day of pregnancy, with no abnormalities. No neurological abnormalities were evident during a five-year follow-up observation conducted over the phone.\nMRI findings at the 22nd and 28th week of pregnancy are shown in . | [[24.0, 'year']] | F | {'11441689': 1, '15105710': 1, '7310502': 1, '9567940': 1, '15547546': 1, '8777495': 1, '21768856': 1, '10449268': 1, '11130469': 1, '19574942': 1, '17056261': 1, '17420130': 1, '1925282': 1, '24163800': 2} | {} |
163,680 | 3800291-1 | 24,163,533 | noncomm/PMC003xxxxxx/PMC3800291.xml | Aggressive Curettage-Cryosurgery for Human Papillomavirus-16 Associated Subungual Squamous Cell Carcinoma In Situ | The first patient was a 58-year-old female with a subungual BD on a finger. She had previously been described as having a patient-specific HPV-16 strain in archival sample from intraepithelial neoplasia grade II on the portio of the uterine cervix in 1970 and subsequently in a subungual BD of the left ringfinger.[]\nIn 1995 an incomplete surgical excision of the subungual tumour was performed and therefore the surgeon suggested extirpation of the terminal phalanx. However, the patient, as being a pianist, wanted to try another form of treatment. In 1996 CC was carried out. After avulsion of the nail the tumour was found to cover most of the nail-bed. The patient had slight pain during the first few days after treatment but no analgesics were needed. Healing by secondary intention was without any complications. The final result was good with a well-functioning finger and with no recurrence after more than 5 years [Figures –]. | [[58.0, 'year']] | F | {'11277891': 1, '9205498': 1, '12637918': 1, '17263801': 1, '16227107': 1, '758529': 1, '21288282': 1, '8881791': 1, '9068728': 1, '20626443': 1, '20033323': 1, '458019': 1, '8304759': 1, '12487665': 1, '14871224': 1, '24163533': 2} | {} |
163,681 | 3800292-1 | 24,163,534 | noncomm/PMC003xxxxxx/PMC3800292.xml | Dermafrac™: An Innovative New Treatment for Periorbital Melanosis in a Dark-Skinned Male Patient | A 48-year-old Indian male (skin type V) presented with complaints of dark circles under his eyes for past 2 years. It had started with light brown pigmentation under his eyes that gradually worsened to brownish black, velvety looking skin at the time of presentation. He was also bothered with the dryness, uneven texture and fine lines on the skin of his face. His past medical history was significant for hypothyroidism (currently euthyroid on oral levothyroxine 100 μg daily) and hyperlipidemia well controlled on rosuvastatin. There was no history of anaemia, diabetes, hypertension or any other significant medical or surgical illness. There was no personal or family history of atopy. He was not on any topical eye medications. His occupation involved working on the computer for 6-8 h a day.\nGeneral physical examination was normal. In the infraorbital area, there was dark brown-black pigmentation extending along the tear trough onto the lower eyelid with thickened skin with a subtle velvety texture []. On stretching the skin, there were no congested vessels visible and there was no obvious scleral pigmentation. There was some hyperpigmentation of the upper eyelid also, which was more prominent laterally than medially. He did not have any significant pigmentation of the skin on his forehead, neck or cheeks, and there was no evidence of acanthosis nigricans elsewhere and no pigmentary demarcation lines on his perioral area or limbs. His haemoglobin was 14.2 and peripheral smear was normocytic normochromic.\nWe decided to treat him using the new DermaFrac™ treatment that combines microchanneling using precisely calibrated needle penetration with simultaneous vacuum-assisted serum infusion. He underwent 12 DermaFrac™ treatments (at 2 weekly intervals) for his entire face and forehead using the hand-piece with a 0.25-mm tip-cap at a pressure of 10 mmHg. After disinfection of the skin, two passes were given at each sitting. Anti-aging serum (containing meristoyl pentapeptide 17 sympeptide, acetyl octapeptide-3 SNAP 8, palmitoyl pentapeptide-4 matrixyl, acetyl hexapeptide-8 argirilene and tripeptide syn-ake) was infused for 10 sessions and the lightening serum (containing kojic acid) for 2 sessions. He was also advised to apply a tinted SPF 40 sunscreen in the morning all over his face. At each visit, the patient was asked to score the improvement on a visual analogue scale from 0 to 10, with 0 as no improvement and 10 as total clearance (Patient's Global Assessment, PGA).\nThe patient noticed gradually progressive improvement in his skin texture as well as marked improvement in his under eye dark circles [Figures and ]. According to physician global assessment, there was 50–75% improvement in periorbital melanosis after 4 sittings and 75–90% improvement after 12 sittings, as assessed by 2 independent physicians. The patient reported improvement on a scale of 0 to 10, with 0 as no improvement and 10 as total clearance, with ‘5’ after four sittings and ‘7’ after twelve sittings. No side effects were observed, and the patient reported that he was comfortable and relaxed during the treatment sessions. | [[48.0, 'year']] | M | {'17147559': 1, '20300368': 1, '27559496': 1, '18088764': 1, '22621220': 1, '23112513': 1, '19434788': 1, '33104926': 1, '28848356': 1, '18349665': 1, '20808602': 1, '7773602': 1, '10937120': 1, '9204168': 1, '24163534': 2} | {} |
163,682 | 3800293-1 | 24,163,535 | noncomm/PMC003xxxxxx/PMC3800293.xml | Treatment of Facial Lesions of Multicentric Reticulohistiocytosis by Carbon Dioxide Laser | A 40-year-old female patient, diagnosed with MRH (biopsy proven) 2 years ago, presented at our outpatient department with asymptomatic, nonprogressive, multiple fleshy papules, and nodules over the face [], scalp, retroauricular region [], and nail folds of the finger nails [“coral bead” appearance-]. Xanthelasma palpebrum were visible over both the upper eyelids []. Erythematous nodules were present over both elbows []. She had developed deforming polyarthiritis and shortening of fingers over both hands since 4 years []. Currently, she complained of severe neck pain for which she was to be investigated.\nShe had been on treatment with injectable methotrexate 15 mg once a week since the last 1 year which she discontinued 3 months ago as she was symptomatically better. Currently, she was receiving calcium supplements, folic acid, and pain killers orally. While the joint pain improved, her skin lesions persisted in spite of treatment. The facial lesions were disfiguring causing her psychological distress.\nThe patient was under the combined care of the departments of medicine, orthopedics, and dermatology. She underwent all relevant investigations such as complete blood count (raised Erythrocyte sedimentation rate), liver function tests, renal function tests, antinuclear antibody profile, radiological investigations, including X-ray of affected parts [], Ultra sonography abdomen and computed tomography of the brain; the reports of which were not suggestive of internal malignancy. Skin biopsy [ and ] from a nodule over elbow revealed large mononucleated and multinucleated giant cells with ground glass cytoplasm with a background of fibrosis with scant inflammatory infiltrate in the dermis, thereby reaffirming the diagnosis of MRH.\nWe used CO2 laser to ablate the lesions over the face and retroauricular regions. In the first sitting, the nasolabial lesions were targeted. Topical anesthesia (combination cream of tetracaine and lidocaine) was applied an hour prior to procedure. CO2 laser at 7.0 W with a 100 mm hand piece (1.0 mm spot size) in superpulse mode was used to ablate the lesions. There was no significant bleeding during or postprocedure. Topical antibiotic cream (fusidic acid 1%) was applied after the procedure. A follow-up after 3 weeks revealed that the skin had healed with no significant hyperpigmentation or scarring [].\nThe other involved sites were treated similarly and follow-up was done after another 3 weeks []. The results were excellent both subjectively and objectively. Currently, the patient has been on steady follow-up for 8 months with no recurrence of lesions over the ablated sites. | [[40.0, 'year']] | F | {'20808594': 1, '19886958': 1, '10594575': 1, '25900189': 1, '8546728': 1, '11859589': 1, '33235866': 1, '12582374': 1, '20657124': 1, '24163535': 2} | {} |
163,683 | 3800302-1 | 24,163,516 | noncomm/PMC003xxxxxx/PMC3800302.xml | Brain hypoperfusion on Tc-99m-ethylene dicysteine diethyl ester single-photon emission computed tomography in Hashimoto's encephalopathy | We present a 17-year-old female who had an acute episode of left-sided weakness and hypoesthesia and dysphasia for around 15 min. It was associated with progressive right frontal headache and vomiting. As past medical history, she had recently been diagnosed of autoimmune hyperthyroidism, but she had undergone no treatment. Laboratory evaluation showed high free T4 (FT4) (26 pg/ml, normal 8-18) and remarkably elevated serum levels of antithyroperoxidase (3,228 Ul/ml, normal < 60) and antithyroglobuline antibodies (>22,200 UI/ml, normal < 280). Since clinical features were unspecific, it was necessary to exclude causes of encephalopathy (infectious, metabolic, toxic, vascular, neoplastic, paraneoplastic, etc.). Both brain computed tomography (CT) scan and magnetic resonance imaging (MRI) showed normal findings. Patient was noted to have elevated cerebral spinal fluid (CSF) protein as well as diffuse slowing on electroencephalogram (EEG). A brain SPECT 45 min after injection of 68.8 MBq (18.6 mCi) of Tc-99m ECD was performed. Projection data were obtained on a gamma camera millennium VG (GE, Medical Systems, USA) in a 128 × 128 matrix using zoom of 1.5, 64 views, 20 s/view. SPECT images showed diffuse and patchy defects of the cortical uptake [].\nWith all these findings, HE was diagnosed and steroid therapy was initiated. Clinical symptoms disappeared and there was a decrease in antithyroid antibody levels. Treatment for hyperthyroidism was started with antithyroid drug and titers of FT4 normalized. A repeat brain SPECT was performed 3 months later with the injection of 66.6 MBq (18.0 mCi) of Tc-99m ECD using a dual-head gamma camera (Elscint Helix, GE Medical Systems, USA). The data acquisition parameters were 64 × 64 matrix using ×2 zoom, 64 views, 20 s/view. SPECT images showed small uptake defects, but demonstrating significant improvement of perfusion respect from the previous study [].\nAfter 3 years of follow-up, patient remains free from relapse or recurrence of the neurological symptoms. | [[17.0, 'year']] | F | {'12949305': 1, '9270613': 1, '15290119': 1, '10641616': 1, '16941808': 1, '12580699': 1, '18096026': 2, '17850170': 1, '16786216': 1, '12788967': 1, '24163516': 2} | {'2235848-1': 1} |
163,684 | 3800303-1 | 24,163,517 | noncomm/PMC003xxxxxx/PMC3800303.xml | Utility of bone scintigraphy in diagnosis of post- traumatic osteitis pubis | A 58-year-old, post-menopausal, nulliparous woman, presented with severe pain in anterior lower part of abdomen and left hip region, since 2 months, pain was insidious in onset and started, soon after a minor stretch injury to pelvis while getting down from a bus. There was no history of acute or chronic illness, fever, abdominal surgery, endoscopic procedure, or arthritic disease. Clinical examination revealed localized pain in inguinal, suprapubic and left hip region, aggravating with walking. Her insidious onset of pain at these sites raised high suspicion of soft tissue, ligament or avulsion injury in pelvis. She was evaluated with routine hematological investigations and X-ray pelvis, they were normal and ruled out bone fracture or a lesion in symphysis pubis causing pain. To evaluate further, she was referred for technetium-99m methylene diphosphonate bone scintigraphy. Her bone scintigraphy, anterior and posterior planar image of pelvis revealed intense radiotracer uptake in symphysis pubis region. In addition to this, area of mild diffuse increase tracer uptake with focal intense lesion was localized in lower part of left sacroiliac (SI) joint []. She was also evaluated with bone single photon emission computerized tomography (SPECT) of pelvis. SPECT, reconstructed transverse and coronal images showed intense uptake in symphysis pubis, mild diffuse increased tracer uptake with focal intense lesion in left SI joint, lower part []. Both planar and SPECT findings were correlated with the site of trauma and suggestive of reactive and reparative changes in symphysis pubis and left SI joint. We also correlated these findings with CT scan using software based fusion of SPECT and CT images which showed no structural abnormality in symphysis pubis and documented early sclerotic changes in lower part of left SI joint, suggestive of post-trauma, arthritic changes []. Patient was reassured and managed conservatively with bed rest and non-steroidal anti-inflammatory drugs, which relieved her symptoms. | [[58.0, 'year']] | F | {'20799960': 2, '11681783': 1, '9719351': 1, '7468902': 1, '21966337': 1, '16950146': 1, '13881848': 1, '7783998': 1, '4422968': 1, '27833318': 2, '17088684': 1, '12640151': 1, '7674865': 1, '3975721': 1, '539844': 1, '24163517': 2} | {'5041421-1': 1, '2939629-1': 1} |
163,685 | 3800304-1 | 24,163,518 | noncomm/PMC003xxxxxx/PMC3800304.xml | Somatostatin receptor positron emission tomography/computed tomography (PET/CT) in the evaluation of opsoclonus-myoclonus ataxia syndrome | A two year old male child presented with acute onset of ataxia. His parents reported involuntary eye movements in child of two weeks duration. There was no history of fever and other systemic complaints. On clinical examination, he was found to have OMA syndrome. His previous investigation included chest X-ray, urinary vanillylmandelic acid (VMA) measurement, brain MRI and CSF examination, which did not reveal any abnormality. With suspicion of underlying neuroblastoma, SSR PET/CT with 68Gallium DOTATATE was performed. 1.5 mCi of 68Gallium-DOTATATE was injected intravenously to the patient. After 1 hr of injection, patient was scanned on dedicated 16 slice PET /CT. Whole body diagnostic CT scan was obtained as part of PET/ CT protocol on Multislice CT with 3.5 mm slice thickness.\nThe scan demonstrated increased tracer uptake in left paravertebral region at the level of T3-T5 vertebrae [Arrow in ]. Maximum standardized uptake value SUVmax of the lesion was 10.1. On CT and fused PET/CT images the uptake localized to a soft tissue density lesion with specks of calcification within [Figure and , arrows]. Physiological tracer distribution was noted in the spleen, kidneys and urinary bladder. The paravertebral lesion was suggestive of NB. Surgical resection of lesion confirmed diagnosis of NB. Post surgery and short course of steroids, OMA resolved. At present, one year after the initial presentation; this child has no evidence of disease. | [[2.0, 'year']] | M | {'12601702': 1, '2723981': 1, '21680680': 1, '22526961': 1, '11598603': 1, '9815638': 1, '17992098': 1, '15574722': 1, '8229235': 1, '18383518': 1, '17089089': 1, '21279352': 1, '21610907': 1, '1394242': 1, '20484441': 1, '24163518': 2} | {'3800304-2': 2} |
163,686 | 3800304-2 | 24,163,518 | noncomm/PMC003xxxxxx/PMC3800304.xml | Somatostatin receptor positron emission tomography/computed tomography (PET/CT) in the evaluation of opsoclonus-myoclonus ataxia syndrome | A two and half year old male child presented with acute onset of myoclonus, occasional opsoclonus and ataxia. Previous evaluation included a lumbar puncture and brain MRI, both failing to show an abnormality. Suspicion of paravertebral mass was raised in a recent chest X-ray. Considering the possibility of the mass being neuroblastoma, the patient was referred to the nuclear medicine department for further evaluation. We evaluated the child with SSR PET/CT using 68Gallium DOTATATE. 1.5 mCi of 68Gallium-DOTATATE was injected intravenously to the patient. After 1 hr of injection, patient was scanned on dedicated 16 slice PET /CT (GE – STE 16). Whole body diagnostic CT scan was obtained as part of PET/CT protocol on Multislice CT with 3.5 mm slice thickness.\nThe SSR PET/CT revealed intense tracer uptake in chest which localized to a soft tissue density mass in the paravertebral region (T1-T4 levels) with SUVmax of 21.0 [, long arrow]. On CT the lesion showed evidence of calcification in it [, arrow]. Considering patient's symptoms, these CT findings along with positivity for somatostatin receptor expression on PET, suggested diagnosis of NB. Additionally multiple areas of increased tracer uptake were noted in the bone marrow of long bones and almost entire axial skeleton with no obvious CT demonstrable abnormality [Figure and ]. These features were indicative of widespread marrow metastases. Biopsy of the paravertebral mass confirmed the diagnosis of NB. Considering the extensive disease, the child is receiving chemotherapy for last four months. There is mild clinical improvement in the OMA. | [[2.5, 'year']] | M | {'12601702': 1, '2723981': 1, '21680680': 1, '22526961': 1, '11598603': 1, '9815638': 1, '17992098': 1, '15574722': 1, '8229235': 1, '18383518': 1, '17089089': 1, '21279352': 1, '21610907': 1, '1394242': 1, '20484441': 1, '24163518': 2} | {'3800304-1': 2} |
163,687 | 3800305-1 | 24,163,519 | noncomm/PMC003xxxxxx/PMC3800305.xml | Metastatic squamous cell carcinoma thyroid from functionally cured cancer cervix | A 68-year-old female patient presented with swelling in the left side of the neck of 6 weeks duration progressively increasing in size and not associated with any pain, difficulty in swallowing or alteration of speech. The swelling was located in the lateral aspect of neck, lobulated and appeared lymph nodal in origin. There was also an associated nodular swelling of the left lobe thyroid. Ultrasonography of neck revealed multiple necrotic cervical lymph nodes on the left side and multiple hypo echoic nodules in the left lobe associated with thyroid enlargement. Positron emission tomography/computed tomography (PET/CT) revealed hyper metabolic multiple level left cervical lymph nodes with necrosis and hypermetabolic large hypo dense nodule with specks of calcification in the left lobe thyroid, few small hypo dense nodules were also seen in the right lobe as well []. Fine needle aspiration cytology from the cervical node and thyroid revealed keratinizing squamous cell carcinoma. Detailed clinical history of the patient revealed previous histopathological evidence of squamous cell carcinoma cervix that had occurred 12 years ago and treated with hysterectomy followed by post-operative radiation to pelvis. Patient underwent total thyroidectomy and radical neck dissection on the left side of the neck. Histopathology revealed thyroid follicles with adjacent tumor tissue composed of polygonal cells with vesicular pleomorphic nuclei, prominent nucleoli and a moderate amount of eosinophilic cytoplasm arranged in sheets with focal keratin pearl formation suggestive of squamous carcinma amidst thyroid follicles []. The thyroid specimen was subjected to real time polymerase chain reaction study for any presence of high risk human papilloma virus signature, which is not detectable patient was given post-operative radiotherapy to neck along with concurrent chemotherapy with weekly cisplatin. Interim PET/CT after 6 weeks surprisingly revealed extensive disease with the multiple metabolically active lung, liver and bone metastasis []. Patient was restaged with progression of disease and management changed from curative to palliative intent. | [[68.0, 'year']] | F | {'19969962': 1, '16243176': 1, '878020': 1, '12049568': 1, '11712793': 1, '15405683': 1, '12821362': 1, '841351': 1, '14734665': 1, '12620999': 1, '24163519': 2} | {} |
163,688 | 3800306-1 | 24,163,520 | noncomm/PMC003xxxxxx/PMC3800306.xml | Myocardial bridge: The cause of angina in a young man | A 32-year-old non-smoker, hypertensive male presented with angina on efforts of 2 months duration. A clinical examination was unremarkable. Electrocardiogram showed left ventricular hypertrophy without any ST and T changes. 2-D echocardiography showed no regional wall abnormality, left ventricular ejection fraction 0.60, and a concentric left ventricular hypertrophy. Exercise treadmill test with Bruce protocol showed a significant down-sloping ST depression in leads III, aVF, and V4-V6, at 10 Metabolic Equivalent of Task (METS) of exercise. An exercise stress thallium-201 single photon emission computed tomography (SPECT) showed reversible perfusion defect in septum of left ventricle []. His routine blood biochemistry was normal. Fasting lipid levels were-total cholesterol 145 mg%, low-density lipoprotein 89mg%, high-density lipoprotein 37 mg%, and triglycerides 95 mg%. A coronary angiography revealed myocardial bridging of mid part of LAD [Figures and ]. Left circumflex and right coronary arteries were normal. He was put on atenolol 50 mg/day and had a favorable clinical outcome and continues to be followed. | [[32.0, 'year']] | M | {'8636548': 1, '30279761': 1, '12918640': 1, '12411842': 1, '7662465': 1, '2019202': 1, '12575960': 1, '11772888': 1, '1439639': 1, '24163520': 2} | {} |
163,689 | 3800307-1 | 24,163,521 | noncomm/PMC003xxxxxx/PMC3800307.xml | Incidental detection of superior sternal cleft on Technetium-99m methylene diphosphonate bone scan | A 45-years old male patient, who was a recently diagnosed case of moderately differentiated adenocarcinoma of prostate with Gleason's score of 3 + 4 = 7, was referred for Tc-99m MDP bone scan to rule out skeletal metastases. He complained of upper backache for 2 months and had a history of trauma to the left lower leg 1 week prior to performing the bone scan. The serum prostate specific antigen level was >100ng/ml. On clinical examination, there was a midline bony defect in the region of the manubrium sterni with no apparent bulge or paradoxical respiratory movements.\nA whole body planar Tc-99m MDP bone scan and single-photon emission computed tomography-computed tomography (SPECT-CT) of the thoracic region was performed 3 h after intravenous injection of 20 mCi of Tc-99m MDP on a dual head gamma camera (Infinia: single slice SPECT-CT; GE, USA). The study was performed with a urinary catheter in situ.\nThe planar images of the bone scan revealed focal MDP uptake in the D4 vertebra [ (red arrow)], focal uptake in the mid shaft of the left tibia [ (blue arrow)] and a U-shaped photopenia in the region of the sternum [ (black arrow)]. Corresponding SPECT-CT images of the thorax revealed localization of the focal tracer uptake in the sclerotic metastasis in the body of the D4 vertebra [ (red arrows)]. The U-shaped photopenia in the sternum corresponded to a bony cleft involving the manubrium and upper half of the sternum [ (blue arrow)].\nThe Tc-99m MDP bone scan thus helped in diagnosing a congenital superior sternal cleft, metastasis in the body of the D4 vertebra and post-traumatic changes in the mid shaft of the left tibia. | [[45.0, 'year']] | M | {'10803333': 1, '8607636': 1, '12596098': 1, '22228364': 1, '11445804': 1, '20859036': 1, '7434274': 1, '21737294': 1, '1924580': 1, '24163521': 2} | {} |
163,690 | 3800308-1 | 24,163,522 | noncomm/PMC003xxxxxx/PMC3800308.xml | Rare case of isolated splenic metastases from gastric cancer detected with fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography | A 55-year-old male patient diagnosed as gastric cancer involving fundus and gastroesophageal junction underwent distal esophagogastrectomy a year before. He presented with the left side abdominal pain and was referred for the whole body PET/CT to differentiate it as benign or malignant and to rule out any other sites of metastasis. PET/CT revealed intense uptake in the hypodense lesion in the spleen and no other sites of metastasis []. Splenectomy was performed, which confirmed metastasis from gastric cancer. | [[55.0, 'year']] | M | {'15632034': 1, '17550328': 1, '19487993': 1, '11404506': 1, '32950063': 2, '28637437': 2, '26852359': 1, '17048456': 1, '18705414': 1, '12541027': 1, '10747308': 1, '24163522': 2} | {'5480154-1': 1, '7502201-1': 1} |
163,691 | 3800309-1 | 24,163,523 | noncomm/PMC003xxxxxx/PMC3800309.xml | Paget's disease diagnosed on bone scintigraphy: Case report and literature review | A 46-year-old man, driver by occupation, presented with a history of sudden onset pain abdomen, which was colicky in nature and localized to the right lumbar region. There was no history of dysurea, hematuria, fever, loose stools, or vomiting. He also had a history of multiple joint pains for the last 4 months, aggravated for the past 1 week. He also complained of excessive worries, tension, and having sleep disturbance. There was no history of fever, weight loss, skin rash, loss of appetite, or backache. There was no past history of diabetes, hypertension, tuberculosis, polyarthritis, or any other significant illness. His family history was not contributory. Investigations revealed normal hemogram and urine examination. His blood urea, creatinine, LFT, electrolytes, and sugar levels were normal. Abdominal ultrasound revealed bilateral renal calculi with gross pelvicalyceal dilatation of right kidney and right hydroureter. Renal pyelogram showed non-functioning right kidney with multiple left-sided renal calculi. Tc99m diethylene triamine pentaacetic acid (DTPA) renogram revealed normal functioning and draining left kidney with a GFR of 55 ml/min and poorly functioning right kidney with a GFR of 10 ml/min. The patient underwent ureteroscopy with intra-corporeal lithotripsy of right kidney and bilateral DJ stenting. In addition, he underwent multiple sittings of extracorporeal shock wave lithotripsy. He had normal ESR, negative CRP, negative rheumatoid factor, serum ionised calcium 4.4 mg/dL, and serum alkaline phosphatase 86 IU/ml. Whole-body bone scan done revealed extremely hot focus involving the right humerus (head and proximal shaft) and left hemipelvis-features, suggestive of Paget's disease []. X-rays of right humerus and pelvis did not reveal any abnormality []. Magnetic resonance imaging (MRI) showed thickened cortex with altered signal intensity involving the right humerus head and proximal shaft and left iliac bone, commensurate with the bone scan findings [Figures and ]. A bone biopsy from left iliac crest was done, which showed irregular bony trabeculae lined by plump osteoblasts, with multinucleate osteoclasts and increase in cement lines []. Serum calcium was 9 mg/dL and PTH level was 12 pg/ml, both normal. Hence, a diagnosis of Paget's disease was made and the patient was started on biphosphonate therapy. He is under follow-up and has shown marked improvement in symptoms. | [[46.0, 'year']] | M | {'9224668': 1, '6494476': 1, '32939203': 2, '2805532': 1, '16135834': 1, '7215363': 1, '675119': 1, '10568141': 1, '33088752': 1, '9916784': 1, '6448603': 1, '12235348': 1, '10321928': 1, '16899779': 1, '16151674': 1, '24163523': 2} | {'7478306-1': 1} |
163,692 | 3800318-1 | 24,163,513 | noncomm/PMC003xxxxxx/PMC3800318.xml | Hemimegalencephaly: A rare cause of hemihypoperfusion on 99m technetium-ethyl cysteinate dimer brain perfusion single-photon emission computed tomography | An 11-year-old male child was referred to a tertiary care hospital with history of gradually increasing seizures frequency since infancy. The child had delayed milestones and right hemiparesis. Seizures were mainly right sided, complex partial in nature and refractory to medical treatment over the past decade. The child was born out of non-consanguineous marriage, at term with a normal vaginal delivery. There was no family history of neurologic diseases. Non-contrast computed tomography (CT) of head showed diffuse enlargement of left cerebral hemisphere with midline shift towards right while the right cerebral hemisphere was normal []. T2W magnetic resonance imaging (MRI) images showed diffuse gyral thickening involving the left cerebral cortex causing midline shift and scalloping of inner table of left calvarium []. White matter in both cerebral hemispheres show normal myelination. Linear hyperintensities involving the subcortical U fibers of left fronto-parietal region were seen on the fluid attenuation inversion recovery image [].\nPost-gadolinium T1W image in axial plane showed no abnormal enhancement []. Tc-99m ECD brain perfusion SPECT revealed diffusely decreased tracer uptake in the left cerebral hemisphere, with normal uptake in the right hemisphere suggestive of left cerebral hemihypoperfusion [-]. | [[11.0, 'year']] | M | {'9152535': 1, '7694999': 1, '10921489': 1, '20965696': 1, '21740749': 1, '14971616': 1, '7803084': 1, '9099483': 1, '2073303': 1, '19021826': 1, '10454232': 1, '3499489': 1, '17565595': 1, '24163513': 2} | {} |
163,693 | 3800319-1 | 24,163,514 | noncomm/PMC003xxxxxx/PMC3800319.xml | Long segment jejuno-ileal duplication cyst with ectopic gastric mucosa detected on 99mTc-pertechnetate scintigraphy | A 6-year-old male child operated for exstrophy of the urinary bladder 4 years back presented with a 10 days history of fever, vomiting, abdominal pain and hematochezia. At presentation, hemoglobin was 10 g/100 ml and total leucocyte count 10,200/mm3 with normal coagulation parameters. Suspecting a Meckel's diverticulum, dynamic abdominal scintigraphy was performed under a gamma camera for 20 min after intravenous injection of 37 MBq (1 mCi) of 99mTcO4 (pertechnetate). Tracer uptake was seen in the central abdomen, corresponding to the shape of the small intestinal loops. The intensity was seen to increase simultaneously with that of the stomach, indicative of extensive ectopic functioning gastric mucosa []. USG showed a large well defined bean-shaped cystic lesion in the left lumbar region with a positive gut signature and internal debris and echoes, suggestive of an infected EDC. Exploratory laparotomy was performed and a 150 cm long tubular jejuno-ileal duplication cyst communicating with the ileal lumen was excised [Figures and ]. Presence of EGM in the cyst was confirmed on histopathology, which showed hyperplastic gastric lining epithelium, with viliform transformation at places [] and marked edema and vascular congestion in the submucosa. However, the patient's condition deteriorated post-operatively, and the child died of septicemia 9 days after surgery. | [[6.0, 'year']] | M | {'643355': 1, '16046423': 1, '2190153': 1, '19225931': 1, '12235349': 1, '25589809': 2, '11353301': 1, '718292': 1, '27818823': 2, '2916861': 1, '8617148': 1, '31215413': 2, '27652171': 2, '9170453': 1, '24163514': 2} | {'6582472-1': 1, '5081433-1': 1, '5028348-1': 1, '4290069-1': 1} |
163,694 | 3800320-1 | 24,163,515 | noncomm/PMC003xxxxxx/PMC3800320.xml | Hepatic metastasis disguised as fat spared area in the background of fatty liver: Detection on FDG PET/CT | A 65-year-old gentleman was diagnosed with carcinoma of sigmoid colon 2 years back, for which he underwent sigmoid colectomy. Histopathological analysis revealed moderately differentiated adenocarcinoma. Patient then received adjuvant chemotherapy. Serial carcino-embryogenic antigen (CEA) levels and follow-up imaging were normal until 1 year, when metastatic lesion was seen in segment VII of liver. Patient underwent transarterial chemo-embolization (TACE) and radiofrequency ablation (RFA), which led to complete regression of liver lesion. Follow-up was uneventful for 6 months, after which a rising trend was seen in CEA levels. Whole body 18 F — FDG PET/CT study was done. Maximum intensity projection (MIP) image showed diffuse tracer uptake in left side of liver [] – arrow] and a focus of abdominal uptake [– arrowhead] in midline. Axial venous phase CT images showed fatty infiltration in entire right lobe of liver [ — thick arrow], with associated post-treatment changes at the site of treated liver lesion. Left branch of portal vein was patent, with no evidence of tumor infiltration. Axial fused PET/CT image showed no tracer uptake in the right lobe. Diffuse pattern of intense tracer uptake was seen in a wedge shaped area in the left lobe of the liver [ — arrow] which, however, showed normal enhancement on CT images [ — arrow]. Maximum standardized uptake value (SUVmax in g/ml) was 17.3. No focal hypodense lesion was seen. Midline abdominal uptake corresponded to the abdominal wall metastatic nodule [Figure and — arrow]. Though FDG uptake pattern in liver favored metastasis in the background of rising CEA, the anatomical picture was not supportive. Hence, CT guided biopsy was performed, which was confirmatory for metastases from adenocarcinoma. Patient was started on alternative chemotherapy regimen, and follow-up PET/CT was done in 3 months. MIP images showed persistent hypermetabolism in the left lobe metastases [ — arrow], with mild reduction seen in metabolic activity of abdominal wall deposit [ — arrowhead]. Axial CT and fused PET/CT images showed no change in metabolic activity and extent of metastatic site in the left lobe of liver, max SUV being 16.7 [Figure , - arrows]. There was a mild reduction in metabolic activity of abdominal wall nodule, with size remaining unchanged, as seen on the axial CT [ — arrow] and fused PET/CT [ — arrow] images. In view of stable disease, with no new metastatic site, patient is being planned for left hepatectomy and abdominal nodule excision [Event chronology - ]. | [[65.0, 'year']] | M | {'1523289': 1, '18936622': 1, '8079006': 1, '15972430': 1, '3512002': 1, '9605913': 1, '2755781': 1, '20173137': 1, '24163515': 2} | {} |
163,695 | 3800333-1 | 24,163,455 | noncomm/PMC003xxxxxx/PMC3800333.xml | Tricuspid valve endocarditis following central venous cannulation: The increasing problem of catheter related infection | A 45-year-old female with accidental flame burns of the chest and upper limbs (approximately 30%) was referred from another hospital with high fever and breathlessness requiring Ventilatory support. She was primarily treated there for superficial burns, during which time a right internal jugular vein catheter was inserted in the intensive care unit (ICU) for administration of drugs and volume. Five days after insertion of the CVC, the patient developed high fever and, over the next 7 days, breathing difficulty, this was interpreted as sepsis and supported by laboratory investigation and growth of methicillin-resistant Staphylococcus aureus (MRSA) in the blood sample. Appropriate antibiotics were administered and the patient showed no clinical improvement despite 3 weeks of antibiotic treatment. She persistently recorded high temperatures and was breathless even at rest. She was referred in this status to our hospital and was put on respirator for poor blood gas values. Further evaluation of sepsis with transthoracic echocardiogram showed large vegetation, measuring approximately 3 cm, on the anterior tricuspid leaflet (ATL) with no tricuspid regurgitation. Other cardiac valves were normal. Trans-oesophageal echocardiogram confirmed the findings []. The patient had to be ventilated for respiratory decompensation secondary to showering of the pulmonary circuit by tiny vegetations on the ATL and was taken for surgery immediately. Through a standard median sternotomy, the heart was placed on cardiopulmonary bypass and the tricuspid valve was approached through the right atrium after cardioplegic arrest. Large vegetation was seen occupying almost half of the anterior tricuspid leaflet [], and the vegetation seemed to travel down the chordal apparatus as well. Other leaflets of the tricuspid valve and the pulmonary valve were normal. Total vegetectomy was performed with curettage of the anterior tricuspid leaflet and the remaining defect in the ATL [] was repaired with a piece of native pericardium. Because the patient was culture positive for MRSA, a prosthetic ring was not placed and the patient weaned off cardiopulmonary bypass with minimal support. She was afebrile the next day of surgery and remained so till her discharge from the hospital. The vegetation grew MRSA. | [[45.0, 'year']] | F | {'10992821': 1, '11794152': 1, '20014189': 1, '17414086': 1, '11573684': 1, '984931': 1, '10667513': 1, '9210532': 1, '9298048': 1, '28348945': 2, '30170639': 1, '731756': 1, '2653011': 1, '33623565': 1, '18029099': 1, '19347002': 1, '9853151': 1, '24163455': 2} | {'5348219-1': 1} |
163,696 | 3800334-1 | 24,163,456 | noncomm/PMC003xxxxxx/PMC3800334.xml | Perioperative management of an elderly patient of hypertrophic obstructive cardiomyopathy for knee arthroplasty and the role of peripheral nerve blocks | A 69-year-old female weighing 78 kg, a medically managed (atenolol 25 mg and amlodipine 10 mg once daily) case of HOCM was scheduled for bilateral knee arthroplasty. She had intermittent episodes of dyspnoea and fatigue. There was no history of angina, syncopal attacks, or any sudden death in her family. Systemic examination revealed a regular pulse rate of 68 beats/min , and a grade 3/6 crescendo-decrescendo systolic murmur was heard between the left sternal border and apical area, not radiating to the carotids. Electrocardiography (ECG) showed normal sinus rhythm with nonspecific T wave changes in leads II, III, and aVF with left ventricular hypertrophy and left axis deviation. Chest X-ray showed cardiomegaly with clear lung fields. Echocardiography showed asymmetrical septal hypertrophy, left ventricular outflow tract obstruction (LVOT) with peak systolic gradient (PSG) of 56 mmHg, moderate mitral regurgitation and moderate diastolic dysfunction with ejection fraction of 56%. Computerised tomographic (CT) angiogram showed normal coronaries.\nBoth cardiac drugs were continued till the morning of surgery along with a premedication of oral ranitidine 150 mg and alprazolam 0.25 mg. In the operating room, baseline blood pressure (BP), heart rate (HR) and respiratory rate (RR) were 160/90 mmHg, 68/minute and 14/minute, respectively. The patient was given injection metoprolol 2 mg, 80 mcg fentanyl and midazolam 2 mg intravenously, before establishing invasive monitoring (left radial blood pressure and right jugular venous pressure), opening central venous pressure (CVP) was 8 mmHg. Bilateral perineural femoral nerve catheters were placed with the help of a nerve stimulator. A bolus of 8 mL of 2% lignocaine with 8 mL of 0.2% ropivacaine was injected in each femoral catheter before the incision of each side, followed by a continuous infusion of ropivacaine 0.2% 8 mL/hour intra and postoperatively. Half an hour later, induction and intubation were accomplished using propofol 100 mg, morphine 8 mg, midazolam 1 mg and vecuronium 8 mg. Mild hypotension occurred with BP falling to 100/50 mmHg, which was managed with a bolus of 200 mL crystalloid and injection phenylephrine 50 μg. To prevent intubation stress, esmolol 30 mg was given intravenously 90 seconds before intubation. Anaesthesia was maintained with 66% nitrous oxide in oxygen and isoflurane 0.2-0.4% (because of its myocardial depressive properties, halothane is an ideal agent in such patients but due to its nonavailability in our institute, isoflurane was used without any adverse haemodynamic changes); the average duration of both tourniquets was 35 to 40 minutes. At the time of both tourniquet deflations, systolic pressures dropped by more than 20% each time which responded to a judicious administration of crystalloid and phenylephrine 100 mcg. CVP remained between 8 and 10 mmHg and urine output was 500 mL with an input of 2.5 L of crystalloids. The surgery lasted for four hours; neuromuscular blockade reversed with neostigmine 3.5 mg and glycopyrrolate 0.6 mg and esmolol 30 mg was given again to prevent exaggerated haemodynamic response at extubation. Post extubation, the patient was haemodynamically stable (BP: 124/62 mmHg, HR: 74/minute) with saturation of 100% on oxygen of 2 L/minute. Postoperatively, the patient was transferred to a special intensive care unit (ICU) for further management.\nTwo hours postoperatively, the surgical drains were opened. Four hours later, we noted increase in heart rate upto 94-96 beats/ min; BP was 110/75 mmHg, CVP and RR were10 mmHg and 33/ min respectively and desaturation up to 90% on room air, with bilateral drain loss of about 100 mL each. Her pain assessment on a verbal analogue score was 6 (on a scale of 0-10). Immediately, the oxygen was increased from 2 to 5 L/minute. For pain and tachycardia, a bolus of ropivacaine 0.2%, 8 mL was given through each femoral catheter along with metoprolol 2 mg intravenously, and liberal fluids continued. Also, other parenteral analgesics like diclofenac, paracetamol and tramadol were started on a regular basis, as per our ICU protocol. Six hours postoperatively, dyspnoea persisted with the occurrence of bilateral fine crepts in chest now and CVP increased to 12 mmHg with heart rate and BP being 88-90 beats/min and 108/70 mmHg, respectively. Echocardiography showed a decreased PSG of 45 mmHg. So, furosemide 20 mg and another dose of metoprolol 2 mg were given intravenously. The patient passed about 1200 mL urine over the next three hours; her tachycardia and tachypnoea both settled with an HR of 78/minute and RR of 20/minute and blood pressure increased to 136/67 mmHg. Her daily dose of atenolol was increased from 25 mg once a day to 50 mg orally twice a day. Forty-eight hours later, the patient was shifted from the ICU after removing femoral catheters. The rest of the hospital stay was uneventful. | [[69.0, 'year']] | F | {'4046165': 1, '12957437': 1, '11402405': 1, '16171671': 1, '8712439': 1, '16394705': 1, '16301267': 1, '12417536': 1, '24163456': 2} | {} |
163,697 | 3800335-1 | 24,163,457 | noncomm/PMC003xxxxxx/PMC3800335.xml | Electrical storm: Role of stellate ganglion blockade and anesthetic implications of left cardiac sympathetic denervation | A 52-year-old male, weighing 55 kg, received stents in left anterior descending artery (LAD) and first diagonal artery and a permanent pacemaker (VDD) following anteroseptal myocardial infarction (MI) with complete heart block 2 years ago. Postoperative course was complicated with recurrent ventricular tachycardia (VT) and syncopal attacks requiring hospitalization and DC cardioversion on four occasions. The pacemaker was found to be properly functioning during this period. He was readmitted 5 days ago for electrophysiological studies and radiofrequency ablation for VT. Cardiology evaluation revealed pulse rate of 70/min and systemic blood pressure (BP) of 100/70 mmHg. Findings on transthoracic echocardiography were a dilated left ventricle with a very low ejection fraction (20%), akinesia of LAD territory and grade-1 mitral regurgitation. Preoperative medication consisted of oral amiodarone 300 mg and sustained release metoprolol 50 mg once and twice a day respectively. During electrophysiological studies, VT could be easily induced, and the VT circuits were mapped and ablated at the anterobasal left ventricle. After an arrhythmia-free interval of 24 hours, he started having repeat episodes of monomorphic VT, degenerating into polymorphic VT and VF, requiring frequent cardioversions [].\nHypokalemia, hypomagnesemia and hypothyroidism were excluded as triggering factors for arrhythmias on laboratory investigations. Severe hypotension and episodes of transient loss of consciousness warranted ventilatory therapy and inotropic support with epinephrine 0.1 mcg/kg/min. The trachea was intubated after administration of 200 mcg of fentanyl, 3 mg midazolam, 30 mg propofol and muscle relaxation with vecuronium 10 mg. Sedation was maintained using infusions of midazolam 1 mg/hour and fentanyl 60 mcg/hour. As the VT was resistant to treatment with magnesium, amiodarone and lidocaine LSGB was performed under ultrasound guidance using a 7.5 MHz probe (Site-Rite ultrasound system, Bard Access, Inc., USA). A 23-G 4-cm long needle was advanced through the prevertebral fascia till its tip was placed in the longus colli muscle. Injection of 6-ml 0.25% Bupivacaine solution resulted in bulging of the longus colli compartment and caudad and cephalad spread, which was verified on ultrasound. Warming of left upper limb and left Horner's syndrome confirmed the success of LSGB. Patient remaining arrhythmia-free for 2 hours immediately after the blockade and incidents of VT were dramatically reduced subsequently for 12 hours.\nConsidering the benefits of LSGB toward pacifying the ES, we decided to perform LCSD under general anaesthesia via supraclavicular surgical approach. Placing high thoracic epidural catheter and video-assisted thoracoscopy (VAT)-guided ablation of left upper thoracic sympathetic ganglia were other options, which, however, were considered inappropriate given the unstable hemodynamic condition of patient and deranged left ventricular function. Upon arrival in the operation suite, his heart rate and systemic blood pressure were 78 bpm and 90/68 mmHg, respectively. External defibrillator paddles were placed around chest. Monitoring essentially consisted of electrocardiogram (leads II and V5) and invasive arterial blood pressure. Since the endotracheal tube was in situ, anaesthesia was deepened with bolus administration of fentanyl 200 mcg, midazolam 2 mg, propofol 25 mg and vecuronium 6 mg and maintained with sevoflurane adjusting concentration to maintain BIS between 50 and 60. Cervicothoracic sympathectomy was performed through neck excising left stellate ganglion and second thoracic ganglion with sympathetic chain. No further deterioration occurred in the intraoperative period and the patient was transferred back to the ICU for elective ventilation. The VT load significantly abated in the immediate postoperative period. Trachea was extubated 8 hours after surgery and inotropic support was tapered off over next 24 hours. He was discharged in a hemodynamically stable condition and remained symptom-free without any incident of VT for past 8 months. | [[52.0, 'year']] | M | {'29270467': 1, '31938783': 2, '34269285': 2, '30405288': 2, '27479203': 1, '21692973': 1, '20541038': 1, '2205413': 1, '7102501': 1, '17987096': 1, '27330206': 2, '2006745': 1, '12419728': 1, '31689853': 2, '10942741': 1, '18463378': 1, '28757855': 1, '15051644': 1, '34008041': 1, '7577781': 1, '2919100': 1, '10073835': 1, '32670729': 2, '21494516': 1, '21468247': 1, '20337957': 1, '20219758': 1, '25566341': 1, '21841870': 1, '20479150': 1, '21478052': 1, '27318998': 1, '16360091': 1, '24163457': 2} | {'7357303-1': 1, '4910484-1': 1, '6201651-1': 1, '6946516-1': 1, '6955023-1': 1, '8404609-1': 1, '8404609-2': 1, '8404609-3': 1} |
163,698 | 3800336-1 | 24,163,458 | noncomm/PMC003xxxxxx/PMC3800336.xml | Anaesthetic management of a case of idiopathic intracranial hypertension | A 45-year-old female, weighing 70 kg presented with complaints of headache, menorrhagia and pain in the abdomen was admitted to our hospital. She was posted for transcervical resection of the endometrium and patient had a past history of headache and blurring of vision 2 years ago and was diagnosed to have IIH and was on tablet acetazolamide 250 mg every 6 h. She had a history of lumbar CSF drainage twice. Patient had a history of hypertension and was on tablet atenolol once daily. On pre-operative examination, pulse was 70/min and blood pressure was under control. Other general and systemic examination was normal. All other investigations were within normal limits. Computer tomography brain was normal and magnetic resonance imaging revealed partially empty sella and no pituitary mass lesion, cerebral hemisphere and ventricles were normal. Fundus examination revealed chronic papilledema, optic nerve pallor and perimetry showed increased size of blind spot. Neurologist advised preoperative CSF pressure measurement and drainage if pressure is high. CSF manometry was performed in the lateral decubitus position and CSF pressure was more than 250 mm H2O with normal cytological and biochemical profile. 20 mL of CSF was drained with a 22 gauge Quincke's needle. After drainage the CSF pressure was 150 mm H2O. Patient was posted for surgery after 2 days.\nOn the day of surgery, injection glycopyrrolate (0.2 mg), injection midazolam (2 mg) and injection fentanyl (200 μg) were given intravenously as pre-medication. Anaesthesia was induced with propofol 175 mg and tracheal intubation was facilitated with vecuronium 5 mg injection plain lignocaine 2% 5 ml was given to attenuate pressor response. Anaesthesia was maintained with oxygen, nitrous oxide, propofol infusion, and vecuronium. Intra-operatively injection mannitol 1 g/kg was given. Monitoring included pulse oximetry, electrocardiogram (ECG), noninvasive blood pressure noninvasive blood pressure (NIBP), ETCO2, urine out-put and temperature. At the end of surgery neuro-muscular block was reversed with injection neostigmine 3.5 mg and glycopyrrolate 0.4 mg. She was shifted to post-operative recovery room and monitored for 48 h with pulse oximetry, ECG, NIBP, urine out-put, and temperature. She was completely asymptomatic at discharge. | [[45.0, 'year']] | F | {'17223812': 1, '9534686': 1, '4061929': 1, '21519980': 1, '18090572': 1, '10825324': 1, '33447195': 2, '16614664': 1, '24163458': 2} | {'7796751-1': 1} |
163,699 | 3800337-1 | 24,163,459 | noncomm/PMC003xxxxxx/PMC3800337.xml | Cerebral salt wasting syndrome in craniopharyngioma | A 45-year-old, 60 kg, male complaining of moderate degree headache for 15 days attended our out-patient department. Magnetic resonance imaging of brain revealed that he had sellar-suprasellar space occupying lesion (24 mm × 20 mm × 26 mm), predominantly solid in nature, without hydrocephalus, suggesting craniopharyngioma []. While waiting for elective surgical removal of that lesion, he became drowsy and admitted in our hospital. He was a patient of known hypothyroidism and was on oral thyroxin (0.1 mg daily). There was no history of convulsion or localising neurological deficit and patient was non-diabetic and non-hypertensive. Following admission, patient was found dehydrated (decreased in skin turgor), his pulse rate was 94/min; blood pressure was 96/60 mm Hg and Glasgow coma scale was 13/15. On investigation, haemoglobin was 10.8 g% and among other findings, total leucocyte count was 6600/cumm, blood glucose was 109 mg/dl, blood urea and serum creatinine were 58 mg/dl and 1.5 mg/dl respectively. Serum electrolyte studies revealed sodium 117 mmol/L and potassium 4 mmol/L. Chest X-ray and electrocardiogram detected no abnormality. Thyroid hormones and serum cortisol were within the normal limit. A central venous line through subclavian route was done and central venous pressure (CVP) was noted 3-4 mm of Hg. As patient was hyponatremic and dehydrated, we started normal saline (NS) infusion at the rate of 150 ml/h (change in serum Na+ equals to the replacement fluid Na+- serum Na+ divided by total body water + 1 and we wanted to correct serum by 0.5 mmol/L with a total increase of serum Na+ 8 mmol/L/24 h)[] to make the patient euvolemic. His urine output in 24 h was also recorded and found to be 3.5 L. At the same time, urine and blood samples were sent for further studies to detect the cause of hyponatremia. Investigations showed serum osmolality 264 mOsm/kg H2O, urinary osmolality 430 mOsm/kg H2O and urinary spot sodium 132 mmol/L and a diagnosis of CSWS was made. Infusion of NS was continued along with every 2 h monitoring of serum sodium. Even after 24 h of NS infusion, as serum Na+ level got slightly increased to 119 mmol/L, we preferred to infuse hypertonic saline (3% sodium chloride) at a rate of 45 ml/h. Patient gradually became conscious and oriented as serum sodium level increased to 130 mmol/L over next 48 h. Following improvement, patient was put up for definitive surgery. During the surgery, conventional neuroanaesthetic technique was used and the patient was reversed well. Intraoperative and immediate post-operative period remained uneventful. On the 4th post-operative day, patient again became drowsy. Although post-operative computed tomography scan revealed nothing abnormal, serum sodium was found to be 122 mmol/L and urine spot sodium 92 mmol/L. Sodium replacements was started immediately with NS infusion. Waxing and waning of the state of hyponatremia persisted for next 27 days and managed accordingly with sodium replacement through nasogastric tube, NS and occasional 3% saline infusion. However, with this treatment his high urinary sodium gradually became normal and serum sodium gradually reached normal level and patient became clinically stable. Patient was discharged, after 2 weeks of observation as he had been maintaining normal serum sodium level throughout that period. | [[45.0, 'year']] | M | {'8747964': 1, '2672426': 1, '10824078': 1, '28160775': 2, '15949241': 1, '14855556': 1, '12531971': 1, '290232': 1, '11836078': 1, '8810741': 1, '24163459': 2} | {'5292142-1': 1} |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.