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163,700 | 3800338-1 | 24,163,460 | noncomm/PMC003xxxxxx/PMC3800338.xml | Predicting intraoperative cardiovascular complication in patients with anterior mediastinal mass-role of central venous pressure monitoring | A 30-year-old male presented to the pre-anaesthetic clinic with history of dry cough for 9 months and recent onset of weight loss. There was no history of dyspnoea at any position. Dysphagia, muscular weakness, fatigue and drooping of eye lids were not elicited. On examination, he was conscious, comfortable without clinical evidence of either tracheal or SVC obstruction. The Pemberton's sign was negative. The chest X-ray showed mediastinal widening []. The CT scan [] revealed a large, 10.2 × 9.3 × 6.3 cm well-defined heterogeneous mixed density mass lesion lying over the brachiocephalic confluence, SVC, right atrium (RA) and right ventricular (RV) out flow tract without any pericardial or pleural effusion. The fat plane above pericardium was preserved and separate from the mass. The normal airway caliber was maintained. The CT guided biopsy was non informative with respect to the pathology of the lesion. Hence, this asymptomatic young, fit patient was posted for therapeutic excision of the anterior mediastinal mass with an uncertain chance of SVC and RV outflow obstruction during anaesthetic intervention.\nA sequential plan of thoracic epidural and inhalational induction was planned. An epidural catheter was inserted at T4-T5 interspace. Invasive monitoring which included left radial artery for systemic pressure monitoring, right internal jugular vein (IJV) for CVP and left femoral vein for inferior vena cava (IVC) access were established under local anaesthesia with titrated dose of intravenous midazolam and morphine. After recording the baseline parameters, segmental epidural anaesthesia (T1-T6) was established with incremental dose from 6-10 ml of 1% preservative free lignocaine. Increasing amount of Sevoflurane with gas oxygen mixture was used for induction of anaesthesia. During this period, the CVP progressively increased from 15 mmHg to 24 mmHg with stable systemic pressures, oxygen saturation and heart rate. The airway was secured with size 4 Proseal laryngeal mask airway (LMA) without any relaxant and the surgeon was requested to proceed with sternotomy and take control of the mass. But the CVP dropped and stabilized at around 20 mmHg following application of sternal retractor. Still, the systemic pressures were maintained around 100 mmHg systolic without vasopressors. The mass was predominantly a bag of necrotic material arising from thymus which was removed in toto with the accompanying pericardial and pleural window. The patient was breathing spontaneously throughout the procedure and as the pleural window was opened, we started assisted ventilation with the proseal LMA. With this, CVP stabilized at around 8 mmHg till the end of the procedure. The Proseal LMA was removed at end of the surgery and the patient was shifted to the postoperative ward with intercostal drain (ICD) in situ. The patient was asymptomatic and the ICD was removed after 2 days. The analgesia was maintained with epidural bupivacaine infusion. | [[30.0, 'year']] | M | {'8873546': 1, '2008955': 1, '15087617': 1, '16132894': 1, '17211158': 1, '3752559': 1, '21224977': 2, '7294388': 1, '8694382': 1, '24163460': 2} | {'3016580-1': 1} |
163,701 | 3800340-1 | 24,163,462 | noncomm/PMC003xxxxxx/PMC3800340.xml | Anaesthetic considerations in primary repair of tracheobronchial injury following blunt chest trauma in paediatric age group: Experience of two cases | A 14-year-old boy presented in the emergency department with a history of blunt injury to chest (run over by bullock cart) with respiratory insufficiency and episodes of vomiting with frank blood. On examination, child was irritable, tachypneic, with feeble peripheral pulses with features suggestive of left sided pneumothorax. An urgent bed side chest X-ray showed left pneumothorax []. After intercostal drain (ICD) insertion at 5th intercostal space his saturation improved to 95%. Continuous air leak was noticed through ICD tube and computerised tomography (CT) thorax revealed left main bronchus distal portion tear with severe collapse of the left lung (‘fallen lung sign’), left subclavian artery complete thrombosis with suspicious injury to left inferior pulmonary vein. Laboratory investigations revealed Bombay O blood group, haemoglobin = 9.3 g/dl, haematocrit = 25.6, other blood and urine investigations were normal. Though CT scan showed subclavian artery thrombosis, clinically there were no signs of ischaemia of limb and also radial and ulnar artery pulsations were felt moderately. Thus, patient was started on heparin 2500 IU empirically.\nAn immediate diagnostic bronchoscopy and posterolateral thoracotomy was planned. Written informed high-risk consent was taken. In the operating room, pre-operative vitals were heart rate = 112/min, blood pressure = 96/60 mmHg, SpO2= 95% with O2 support. After pre-oxygenation, patient was pre-medicated with intravenous glycopyrrolate 0.2 mg and fentanyl 40 μg. The patient's trachea was intubated with a 6-mm cuffed single lumen endotracheal tube (ETT) after induction with thiopental sodium and succinylcholine. Complete transection of the left main bronchus was confirmed with fibre optic bronchoscopy (FOB) and right endobronchial intubation and one lung ventilation (OLV) was achieved. Anaesthesia was maintained with isoflurane in 100% O2 and atracurium. Once bronchial transection repaired, ETT was pulled out of right bronchus and placed above the carina, both lungs ventilated saturation of 98-99% ensured. Post-repair, no air leak noticed with positive pressure ventilation and patient was extubated after confirming adequate respiratory efforts. Follow-up chest X-ray showed incomplete expansion of the left lung due to underlying contusion. ICD removed on 11th post-operative day. Child was discharged after 12 days. | [[14.0, 'year']] | M | {'10626870': 1, '8040179': 1, '12859314': 1, '27512169': 2, '22557830': 2, '22096291': 2, '24163462': 2} | {'3800340-2': 2, '3338236-1': 1, '3214563-1': 1, '4966357-1': 1} |
163,702 | 3800340-2 | 24,163,462 | noncomm/PMC003xxxxxx/PMC3800340.xml | Anaesthetic considerations in primary repair of tracheobronchial injury following blunt chest trauma in paediatric age group: Experience of two cases | A 5-year-old male child was admitted as an emergency following a blunt chest trauma. Early clinical examination showed signs of haemorrhagic shock with severe respiratory distress and right sided tension pneumothorax. A wide bore needle was inserted in 2nd intercostal space. Pneumothorax was confirmed by an urgent bed side chest X-ray. After inserting a chest drain and adequate fluid resuscitation, patient's vital parameters improved. Emergency CT scan showed massive pneumothorax with suspicion of right main bronchus injury. Patient's blood investigations were within the normal limits.\nAfter intravenous induction with ketamine 30 mg and succinylcholine 25 mg, patient's trachea was intubated with 5 mm uncuffed ETT. FOB revealed discontinuation of right main bronchus about 2 cm from its origin from carina. Left endobronchial intubation achieved with the help of FOB. After placing the child in left lateral position, a diagnostic thoracoscopy was done, which revealed no associated mediastinal injuries. Rest of the perioperative course was uneventful and was similar to the first case. | [[5.0, 'year']] | M | {'10626870': 1, '8040179': 1, '12859314': 1, '27512169': 2, '22557830': 2, '22096291': 2, '24163462': 2} | {'3800340-1': 2, '3338236-1': 1, '3214563-1': 1, '4966357-1': 1} |
163,703 | 3800341-1 | 24,163,463 | noncomm/PMC003xxxxxx/PMC3800341.xml | Leiomyoma of trachea: An anaesthetic challenge | A 23-year-old, 54 kg and 153 cm height girl presented for resection of a primary tracheal tumour. She reported a history of dry cough for 2 years with progressive dyspnoea, hoarseness of voice and wheezing for last 3 months. Patient had received treatment with bronchodilators and steroids and was being managed on the lines of bronchial asthma with no relief. Auscultation of chest revealed bilateral wheeze. Chest X-ray was normal, computerized tomography of chest and lower neck revealed a soft-tissue mass close to thoracic inlet, attached to left posterior wall in upper trachea causing luminal compromise. Positron emission tomography scan revealed 1.2 cm × 1.1 cm size soft-tissue mass at the level of C7 to D1 projecting into the tracheal lumen. On room air SpO2 was 95.3% while the arterial blood gas analysis showed PaO2 of 86 mmHg, PaCO2 40 mmHg, pH 7.42.\nPre-operative fiberoptic bronchoscopy was not done so as to avoid any airway irritation, which might have led to critical or complete airway obstruction.\nIn the operation theatre, patient was placed in supine position and standard monitoring including pulse oximetry, electrocardiography and non-invasive blood pressure was connected. An intravenous access was obtained followed by commencement of intravenous fluid. Injection fentanyl in slow incremental doses up to 100 μg and injection midazolam 1.5 mg intravenous bolus was given. This was followed by propofol infusion starting at 10 mg/kg/h until patient slept and gradually titrating it to 6 mg/kg/h followed by 1.5 mg/kg/h, at which level it was maintained throughout the procedure. After obtaining an adequate depth of anaesthesia an appropriate size nasopharyngeal airway was inserted, which was connected to anaesthesia circuit for delivery of air-oxygen mixture while maintaining spontaneous ventilation. Local anaesthetic spraying of airway with 4% lignocaine spray was done before insertion of rigid bronchoscope to prevent any stimulation of airway. This was followed by connection of anaesthesia circuit to the side arm of rigid bronchoscope and 2-4% sevoflurane with air O2 mixture was given to supplement intravenous propofol infusion for prevention of any stimulation of airway, which could precipitate complete obstruction.\nA tracheostomy tray was prepared and kept ready in the event of failure to control airway. Tumour tissue [] was extracted with rigid bronchoscopy forceps; bleeding was controlled by using adrenaline soaked gauze pieces and cautery. Seepage of blood and tissue distally into the trachea-bronchial tree was prevented by using judicious suctioning. A flexible bronchoscope was introduced through the barrel of rigid bronchoscope for further evaluation and suctioning.\nThe whole procedure was completed in 1 h during which time patient maintained oxygen saturation within normal range. Arterial blood gas analysis done during and completion of the procedure showed no retention of carbon dioxide. There were no episodes of desaturation, hypoxia or airway obstruction and patient was discharged home after 2 days. Histopathological evaluation of the excised tissue revealed it as tracheal leiomyoma. | [[23.0, 'year']] | F | {'26257423': 1, '18811890': 1, '12594151': 1, '21767960': 1, '16790673': 1, '22463875': 1, '17670386': 1, '19597402': 1, '12393369': 1, '21860199': 1, '22269742': 1, '28413295': 1, '24163463': 2} | {} |
163,704 | 3800369-1 | 24,163,563 | noncomm/PMC003xxxxxx/PMC3800369.xml | Appearance can be deceptive: Dentigerous cyst crossing the midline | An 80-year-old man, reported to the Department of Oral Medicine and Radiology with the chief complaint of pus discharge from the left lower front region of face since 2 years. Pus discharge was spontaneous, intermittent and started and stopped on its own. The pus discharge was not associated with any discomfort [].\nOn examination, extra-orally a fibrosed sinus opening was present on the left parasymphyseal region. The skin surrounding the sinus appeared normal in color with no secondary changes. On palpation, sinus opening was non-tender and fixed to the underlying bone with no frank discharge but a single, non-tender, movable left submandibular lymph node was palpable. Intra-orally generalized wasting disease of the teeth was present. Root stump in relation to 17, 21, 22, 27, 46 were present and 26, 34, 35, 43 were missing.\nIOPA in relation to 35, 36, 37 revealed radiolucency in the periapical region of 36 not contacting the teeth.\nMandibular cross-sectional occlusal radiograph showed diffuse radiolucency extending from 34 to 44 region, latero-medially and from periapex to lower border of mandible superior-inferiorly. The cortical plates are not expanded [].\nOPG showed a unilocular well-defined radiolucency extending lateromedially from the distal root of 36 to the mesial root of 47 and superior-inferiorly from the furcation area of the teeth to the lower border of the mandible. The periphery of the radiolucency is scalloped with sclerotic border. A well-defined radio-opacity is seen at the lower border of the mandible on the right side in the periapex of 44, which was identified as impacted canine (43) [].\nOn the basis of history, clinical and radiological examination, a provisional diagnosis of Odontogenic keratocyst was given.\nEnucleation of the cyst with chemical cauterization was done conserving the impacted canine to avoid fracture of lower border of the mandible. The teeth involved in the cystic lining were extracted. The surgery was done using local anesthesia and under antibiotic cover.\nThe cystic lining was sent for further histopathological examination. Histopathological examination revealed cystic epithelium comprising of 2-3 layers of non-keratinized stratified squamous epithelium. Fibrous connective tissue and slight inflammatory cell infiltrate was observed in connective tissue stroma. Hence, the diagnosis of Dentigerous cyst was confirmed [].\nHealing was uneventful and 1 week after the surgery, the surgical site showed good healing and the sutures were removed. The patient was recalled for follow-up every week and Iodoform dressing was given. The post-operative OPG taken after 2 weeks revealed healing by secondary intention []. Patient was lost to follow-up. | [[80.0, 'year']] | M | {'31944821': 1, '18301848': 1, '21985882': 1, '15901071': 1, '10489168': 1, '14179875': 1, '11817798': 1, '30678440': 1, '15858310': 1, '21699678': 2, '24163563': 2} | {'3138438-1': 1} |
163,705 | 3800370-1 | 24,163,564 | noncomm/PMC003xxxxxx/PMC3800370.xml | Distraction osteogenesis for management of obstructive sleep apnea secondary to TMJ ankylosis | A 12-years-old female patient who had been operated for left TMJ ankylosis six months back, reported with the primary complaint of unaesthetic small chin. On further evaluation, patient revealed excessive day time somnolence, obnoxious snoring, disturbed sleep, dullness throughout the day and inability to concentrate. On clinical examination patient had short-neck, small chin-throat angle, fullness of the cheek on the left-side, flatness of the cheek on the right side, chin deviated to left side, mouth opening of 35 mm and prominent antegonial notch on the left side []. Orthopentomogram revealed evidences of surgery in left TMJ region (arthroplasty). Lateral cephalogram showed a decreased pharyngeal space [].\nBased on history, clinical examination, lateral cephalogram, and polysomnography, a diagnosis of obstructive sleep apnea due to reduced upper airway space secondary to left TMJ ankylosis was made. The treatment plan selected was distraction osteogenesis to advance the mandible by 11 mm that would increase the upper airway space and at the same time correct the asymmetry. The procedure was performed under general anaesthesia. An intraoral distractor was fixed in the left angle region []. Following a latency period of 5 days, the distraction device was activated at the rate of 1 mm/day till the desired lengthe was achieved, that is 11 mm. After 2 months of consolidation period the distractor was removed under local anaesthesia. A thorough postoperative clinical and lateral cephalometric examination were done in addition to polysomnography. Lateral cephalogram showed an increase in the pharyngeal airway shadow []. The polysomnogram showed an improvement in the respiratory distress index of 5 (presurgery was 51) and a mean oxygen saturation of 98% (presurgery was 84%). Two years after the surgery, the patient had stable clinical results. The patient does not suffer from snoring, day time somnolence or fatigue. | [[12.0, 'year']] | F | {'18250212': 1, '9462762': 1, '12586531': 1, '12555933': 1, '10845284': 1, '18088635': 1, '11496167': 1, '20308752': 1, '14578784': 1, '16389337': 1, '24163564': 2} | {} |
163,706 | 3800372-1 | 24,163,566 | noncomm/PMC003xxxxxx/PMC3800372.xml | Small cell neuroendocrine carcinoma of the paranasal sinus | A 22-year-old female was referred to our center with a complaint of painless swelling on the left side of the face for 6 weeks duration. Extra-oral examination revealed the presence of an expansile swelling in the left maxillary region, extending into the peri-orbital region. There was stretching of the skin on the left face over the swelling. On intra-oral examination, a proliferative growth was noted in the left maxillary gingivo-buccal sulcus extending downwards till the level of the oral commissure [Figure and ]. Computerized tomography (CT) scan demonstrated a large destructive soft tissue lesion in the left maxillary sinus with extensions into the left nasal cavity, ethmoid and sphenoid sinus, left alveolus, and hard palate. Extensions were also noted into the infra temporal fossa, soft tissues of the cheek, masticator spaces, and the inferior orbital fissure [Figure and ]. An intra-oral biopsy of the lesion was done which on microscopy revealed a poorly differentiated neoplasm composed of monotonous sheets of small round blue cells with scanty cytoplasm and hyperchromatic nuclei, the cells were arranged in a rosettoid manner. The tumor cells were seen infiltrating the fibrocollagenous connective tissue with areas of necrosis; the mitotic activity was not clearly made out. Immunohistochemical profile showed tumor cell positivity for Epithelial Membrane Antigen (EMA), keratin, Neuron Specific Enolase (NSE), chromogranin, synaptophysin, and CD 57. The tumor cells were negative for vimentin, desmin, Leukocyte Common Antigen (LCA), CD 99, Human Melanoma Black (HMB 45), and Thyroid Transcription Factor-1 (TTF1). The tumor cells that showed strong nuclear positivity to Ki 67 was 50%. The final histopathology on immunohistochemistry correlation [Figures - and -] favored a diagnosis of SNEC. CT scan of the brain, thorax, and abdomen were normal. A bone marrow aspiration and biopsy did not show any atypical cells.\nA combination of concurrent chemotherapy and radiotherapy was planned. The patient received a total of 60 Grey of external beam radiotherapy along with four cycles of concurrent cisplatin and etoposide. There was a clinical complete response, a post-therapy CT scan (after 6 months) showed only residual thickening of the left maxillary antrum. The patient did not wish to undergo any further investigations/biopsy to confirm remission; she is being followed up with a combination of clinical examination and imaging and is presently symptom-free with no evidence of recurrence for close to 2 years now [Figures and ]. | [[22.0, 'year']] | F | {'24510632': 1, '25057271': 1, '15529129': 1, '12173330': 1, '32785868': 1, '14270662': 1, '22330330': 1, '7139532': 1, '33285758': 2, '9712424': 1, '11201814': 1, '6089995': 1, '9006501': 1, '24163566': 2} | {'7717802-1': 1} |
163,707 | 3800373-1 | 24,163,567 | noncomm/PMC003xxxxxx/PMC3800373.xml | Congenital cheek teratoma with temporo-mandibular joint ankylosis managed with ultra-thin silicone sheet interpositional arthroplasty | A 4-year-old girl presented with progressively decreasing mouth opening since birth and facial deformity. According to the parents, at birth there was a large soft-tissue mass involving the entire right cheek with restricted mouth opening, which was excised at 6 months of age when biopsy confirmed it to be a mature teratoma. Decrease in mouth opening continued even after surgery, with hypertrophy of the right infraorbital region.\nOn examination, a large cheek scar with loss of subcutaneous tissue severely restricted mouth opening (inter incisor distance < 3 mm) and maxillary hypertrophy in the infra orbital region were observed []. Oral hygiene was poor with absence of anterior teeth in both upper and lower jaw.\nComputed tomography face revealed loss of joint space, bony ankylosis between the coronoid process and zygomatic process of the maxilla with hypertrophy of infraorbital rim and the adjoining zygomatic arch [].\nChild underwent exploration of the facial skeleton using the previous preauricular scar. All soft-tissue adhesions between the cheek skin and the mandible were excised. Articular ankylosis had a fibrous component. Coronoidectomy was done to release the bony block between the infra orbital rim, zygomatic arch and the mandible with dramatic improvement in mouth opening []. After ensuring adequate mouth opening the hypertrophied malar prominence was shaved to ensure facial symmetry. As there was extensive scar tissue around the malar region most probably due to previous surgery, ultra-thin silicone sheet was used as an inter-positional material instead of standard temporalis muscle flap.\nAfter complete transaction of the ankylotic bone, the gap was kept bare enough so as to pass 0.2 mm ultra-thin silicon sheet of size 5 × 5 cm []. Medially, it was anchored with 3-0 nylon to medial pterygoid muscle and laterally to periosteum of zygomatic arch so as to fix the sheet securely and also to cover the two transacted bone ends completely.\nPost-operatively child was put on extensive physiotherapy using an acrylic dynamic jaw exerciser [ and ]. After 6 months of follow-up child has painless jaw movement with 2.5 cm inter incisor distance. Child is now planned for further refinement of facial contour. | [[4.0, 'year']] | F | {'2213309': 1, '22279275': 1, '16241183': 1, '20227851': 1, '10371317': 1, '14130698': 1, '17662465': 1, '15858305': 1, '15269046': 1, '24163567': 2} | {} |
163,708 | 3800381-1 | 24,163,549 | noncomm/PMC003xxxxxx/PMC3800381.xml | Buccinator-based myomucosal flaps in intraoral reconstruction: A review and new classification | The patient was a 12-year-old girl with benign pathologic lesion that involved soft palate. Posteriorly based buccinator myomucosal pedicle flap reconstructed the mucosal defect, immediately after resection [].\nThis flap relays on buccal artery (a branch of maxillary artery) for survival. Long buccal nerve accompanies this artery, therefore, it is neurovascular pedicle flap and sensory return is predictable. There was no need for pedicle base division. Donor site closed primarily. | [[12.0, 'year']] | F | {'20824643': 1, '17972306': 1, '25750841': 1, '21535983': 1, '22123550': 1, '2051046': 1, '6721043': 1, '1772861': 1, '17517161': 1, '27429953': 2, '10597674': 1, '3267502': 1, '18835756': 1, '7837922': 1, '20813563': 1, '22290874': 1, '2748738': 1, '21550782': 1, '22154378': 1, '7939364': 1, '2224360': 1, '19375032': 1, '10203218': 1, '1513887': 1, '18201631': 1, '25750845': 1, '2037694': 1, '19576805': 1, '2625012': 1, '26436060': 1, '34474545': 2, '26566439': 1, '19486743': 1, '14505627': 1, '28936552': 1, '15829876': 1, '16099439': 1, '18269024': 1, '15620623': 1, '21501773': 1, '12742209': 1, '18295354': 1, '20034822': 1, '21593669': 1, '24163549': 2} | {'3800381-2': 2, '3800381-3': 2, '3800381-4': 2, '3800381-5': 2, '3800381-6': 2, '3800381-7': 2, '3800381-8': 2, '4930847-1': 1, '4930847-2': 1, '8413924-1': 1} |
163,709 | 3800381-2 | 24,163,549 | noncomm/PMC003xxxxxx/PMC3800381.xml | Buccinator-based myomucosal flaps in intraoral reconstruction: A review and new classification | The patient was a 40-year-old man with melanoma of anterior maxilla. Under general anesthesia, wide surgical resection, and supraomohyoid neck dissection (SOHND) in the right side was done. Bilateral superiorly based buccinator myomucosal pedicle flap was used for reconstruction []. In this patient facial artery and vein were transected during right SOHND. The patient received postoperative radiotherapy. | [[40.0, 'year']] | M | {'20824643': 1, '17972306': 1, '25750841': 1, '21535983': 1, '22123550': 1, '2051046': 1, '6721043': 1, '1772861': 1, '17517161': 1, '27429953': 2, '10597674': 1, '3267502': 1, '18835756': 1, '7837922': 1, '20813563': 1, '22290874': 1, '2748738': 1, '21550782': 1, '22154378': 1, '7939364': 1, '2224360': 1, '19375032': 1, '10203218': 1, '1513887': 1, '18201631': 1, '25750845': 1, '2037694': 1, '19576805': 1, '2625012': 1, '26436060': 1, '34474545': 2, '26566439': 1, '19486743': 1, '14505627': 1, '28936552': 1, '15829876': 1, '16099439': 1, '18269024': 1, '15620623': 1, '21501773': 1, '12742209': 1, '18295354': 1, '20034822': 1, '21593669': 1, '24163549': 2} | {'3800381-1': 2, '3800381-3': 2, '3800381-4': 2, '3800381-5': 2, '3800381-6': 2, '3800381-7': 2, '3800381-8': 2, '4930847-1': 1, '4930847-2': 1, '8413924-1': 1} |
163,710 | 3800381-3 | 24,163,549 | noncomm/PMC003xxxxxx/PMC3800381.xml | Buccinator-based myomucosal flaps in intraoral reconstruction: A review and new classification | The patient was a 38-year-old male patient with large oronasal fistula from surgical resection and radiotherapy of nasal cavity angiofibroma, 10 years ago. Clinical picture was very similar to that of wide adult palatal cleft. Voice changes and difficulty in eating were the two main chief complaint of the patient. In delayed reconstruction 10 years after the first operation, the fistula closed with superiorly based buccinator island flap. Donor site was closed with inferiorly based masseter muscle flap effectively []. Buccal fat pad could not herniate in surgical field for donor site coverage, probably because of previous radiotherapy, thus masseter muscle flap became the choice. | [[38.0, 'year']] | M | {'20824643': 1, '17972306': 1, '25750841': 1, '21535983': 1, '22123550': 1, '2051046': 1, '6721043': 1, '1772861': 1, '17517161': 1, '27429953': 2, '10597674': 1, '3267502': 1, '18835756': 1, '7837922': 1, '20813563': 1, '22290874': 1, '2748738': 1, '21550782': 1, '22154378': 1, '7939364': 1, '2224360': 1, '19375032': 1, '10203218': 1, '1513887': 1, '18201631': 1, '25750845': 1, '2037694': 1, '19576805': 1, '2625012': 1, '26436060': 1, '34474545': 2, '26566439': 1, '19486743': 1, '14505627': 1, '28936552': 1, '15829876': 1, '16099439': 1, '18269024': 1, '15620623': 1, '21501773': 1, '12742209': 1, '18295354': 1, '20034822': 1, '21593669': 1, '24163549': 2} | {'3800381-1': 2, '3800381-2': 2, '3800381-4': 2, '3800381-5': 2, '3800381-6': 2, '3800381-7': 2, '3800381-8': 2, '4930847-1': 1, '4930847-2': 1, '8413924-1': 1} |
163,711 | 3800381-4 | 24,163,549 | noncomm/PMC003xxxxxx/PMC3800381.xml | Buccinator-based myomucosal flaps in intraoral reconstruction: A review and new classification | The patient was a 65-year-old edentulous male with mandibular ramus and angle ameloblastoma with perforation of soft tissue lingual to the ridge. Bony segmental resection with the removal of overlying involved mucosa was done. Intraoral incisions were used for tumor resection. Inferiorly based buccinator myomucosal pedicle flap was used for reconstruction. Donor site closed primarily. There was no need for pedicle division []. | [[65.0, 'year']] | M | {'20824643': 1, '17972306': 1, '25750841': 1, '21535983': 1, '22123550': 1, '2051046': 1, '6721043': 1, '1772861': 1, '17517161': 1, '27429953': 2, '10597674': 1, '3267502': 1, '18835756': 1, '7837922': 1, '20813563': 1, '22290874': 1, '2748738': 1, '21550782': 1, '22154378': 1, '7939364': 1, '2224360': 1, '19375032': 1, '10203218': 1, '1513887': 1, '18201631': 1, '25750845': 1, '2037694': 1, '19576805': 1, '2625012': 1, '26436060': 1, '34474545': 2, '26566439': 1, '19486743': 1, '14505627': 1, '28936552': 1, '15829876': 1, '16099439': 1, '18269024': 1, '15620623': 1, '21501773': 1, '12742209': 1, '18295354': 1, '20034822': 1, '21593669': 1, '24163549': 2} | {'3800381-1': 2, '3800381-2': 2, '3800381-3': 2, '3800381-5': 2, '3800381-6': 2, '3800381-7': 2, '3800381-8': 2, '4930847-1': 1, '4930847-2': 1, '8413924-1': 1} |
163,712 | 3800381-5 | 24,163,549 | noncomm/PMC003xxxxxx/PMC3800381.xml | Buccinator-based myomucosal flaps in intraoral reconstruction: A review and new classification | The patient was a 55-year-old female with squamous cell carcinoma of right lateral border of tongue (T3-N0-M0). Wide resection with safety margins was done. SOHND in the right side of the neck accompanied with preservation of facial vein and artery. The patient was dentate in posterior region, therefore inferiorly based buccinator myomucosal island flap was used for reconstruction []. The formed flap was turned around the inferior border of the mandible and brought to the lingual side to cover the raw surface of lateral tongue. Donor site managed with buccal fat pad mobilization that clinically epithelialized 3 weeks later. The patient received postoperative radiotherapy. | [[55.0, 'year']] | F | {'20824643': 1, '17972306': 1, '25750841': 1, '21535983': 1, '22123550': 1, '2051046': 1, '6721043': 1, '1772861': 1, '17517161': 1, '27429953': 2, '10597674': 1, '3267502': 1, '18835756': 1, '7837922': 1, '20813563': 1, '22290874': 1, '2748738': 1, '21550782': 1, '22154378': 1, '7939364': 1, '2224360': 1, '19375032': 1, '10203218': 1, '1513887': 1, '18201631': 1, '25750845': 1, '2037694': 1, '19576805': 1, '2625012': 1, '26436060': 1, '34474545': 2, '26566439': 1, '19486743': 1, '14505627': 1, '28936552': 1, '15829876': 1, '16099439': 1, '18269024': 1, '15620623': 1, '21501773': 1, '12742209': 1, '18295354': 1, '20034822': 1, '21593669': 1, '24163549': 2} | {'3800381-1': 2, '3800381-2': 2, '3800381-3': 2, '3800381-4': 2, '3800381-6': 2, '3800381-7': 2, '3800381-8': 2, '4930847-1': 1, '4930847-2': 1, '8413924-1': 1} |
163,713 | 3800381-6 | 24,163,549 | noncomm/PMC003xxxxxx/PMC3800381.xml | Buccinator-based myomucosal flaps in intraoral reconstruction: A review and new classification | The patient was a 22-year-old man with biopsy proven central giant cell granuloma of the mandible (CGCG) with bone perforation and soft tissue involvement. Defective mucosa after enucleation of the lesion made reconstructive procedures necessary. Random pattern buccinator myomucosal flap without including the axial artery in base covered the defect, therefore, soft tissue dehiscence and the problem of exposed bone cavity was prevented. Donor site closed primarily []. | [[22.0, 'year']] | M | {'20824643': 1, '17972306': 1, '25750841': 1, '21535983': 1, '22123550': 1, '2051046': 1, '6721043': 1, '1772861': 1, '17517161': 1, '27429953': 2, '10597674': 1, '3267502': 1, '18835756': 1, '7837922': 1, '20813563': 1, '22290874': 1, '2748738': 1, '21550782': 1, '22154378': 1, '7939364': 1, '2224360': 1, '19375032': 1, '10203218': 1, '1513887': 1, '18201631': 1, '25750845': 1, '2037694': 1, '19576805': 1, '2625012': 1, '26436060': 1, '34474545': 2, '26566439': 1, '19486743': 1, '14505627': 1, '28936552': 1, '15829876': 1, '16099439': 1, '18269024': 1, '15620623': 1, '21501773': 1, '12742209': 1, '18295354': 1, '20034822': 1, '21593669': 1, '24163549': 2} | {'3800381-1': 2, '3800381-2': 2, '3800381-3': 2, '3800381-4': 2, '3800381-5': 2, '3800381-7': 2, '3800381-8': 2, '4930847-1': 1, '4930847-2': 1, '8413924-1': 1} |
163,714 | 3800381-7 | 24,163,549 | noncomm/PMC003xxxxxx/PMC3800381.xml | Buccinator-based myomucosal flaps in intraoral reconstruction: A review and new classification | The patient was a 72-year-old man with lower lip squamous cell carcinoma (stage II). The lesion resected with safety margins, and denuded lip was reconstructed with anteriorly based buccinator myomucosal flap. The pedicle was 1 cm posterior to the oral commissural, and its width was 1.5 cm. The flap contained facial artery []. | [[72.0, 'year']] | M | {'20824643': 1, '17972306': 1, '25750841': 1, '21535983': 1, '22123550': 1, '2051046': 1, '6721043': 1, '1772861': 1, '17517161': 1, '27429953': 2, '10597674': 1, '3267502': 1, '18835756': 1, '7837922': 1, '20813563': 1, '22290874': 1, '2748738': 1, '21550782': 1, '22154378': 1, '7939364': 1, '2224360': 1, '19375032': 1, '10203218': 1, '1513887': 1, '18201631': 1, '25750845': 1, '2037694': 1, '19576805': 1, '2625012': 1, '26436060': 1, '34474545': 2, '26566439': 1, '19486743': 1, '14505627': 1, '28936552': 1, '15829876': 1, '16099439': 1, '18269024': 1, '15620623': 1, '21501773': 1, '12742209': 1, '18295354': 1, '20034822': 1, '21593669': 1, '24163549': 2} | {'3800381-1': 2, '3800381-2': 2, '3800381-3': 2, '3800381-4': 2, '3800381-5': 2, '3800381-6': 2, '3800381-8': 2, '4930847-1': 1, '4930847-2': 1, '8413924-1': 1} |
163,715 | 3800381-8 | 24,163,549 | noncomm/PMC003xxxxxx/PMC3800381.xml | Buccinator-based myomucosal flaps in intraoral reconstruction: A review and new classification | The patient was a 9-year-old boy with large peripheral giant cell granuloma in the mandibular alveolar ridge that extends from the right first permanent molar to the right canine area. After tumor removal, there was denuded area that was covered with posteriorly based buccinator island flap. Buccal fat pad covered the donor site []. | [[9.0, 'year']] | M | {'20824643': 1, '17972306': 1, '25750841': 1, '21535983': 1, '22123550': 1, '2051046': 1, '6721043': 1, '1772861': 1, '17517161': 1, '27429953': 2, '10597674': 1, '3267502': 1, '18835756': 1, '7837922': 1, '20813563': 1, '22290874': 1, '2748738': 1, '21550782': 1, '22154378': 1, '7939364': 1, '2224360': 1, '19375032': 1, '10203218': 1, '1513887': 1, '18201631': 1, '25750845': 1, '2037694': 1, '19576805': 1, '2625012': 1, '26436060': 1, '34474545': 2, '26566439': 1, '19486743': 1, '14505627': 1, '28936552': 1, '15829876': 1, '16099439': 1, '18269024': 1, '15620623': 1, '21501773': 1, '12742209': 1, '18295354': 1, '20034822': 1, '21593669': 1, '24163549': 2} | {'3800381-1': 2, '3800381-2': 2, '3800381-3': 2, '3800381-4': 2, '3800381-5': 2, '3800381-6': 2, '3800381-7': 2, '4930847-1': 1, '4930847-2': 1, '8413924-1': 1} |
163,716 | 3800389-1 | 24,163,556 | noncomm/PMC003xxxxxx/PMC3800389.xml | Natal and neonatal teeth among cleft lip and palate infants | A 4-week-old female infant presented with right sided complete cleft lip and palate with a pair of natal teeth in the lower central incisor region []. As per the history, the erupted teeth were present at birth. The teeth appeared dark brown in color, firm, and nonmobile. Gingival hyperplasia was seen around the tooth. Rest of the oral cavity was unremarkable. In addition, the infant had duplication of the 5th toe of both the feet []. The neonatal tooth was extracted at the time of cleft lip repair surgery. | [[4.0, 'week']] | F | {'21070704': 1, '10912720': 1, '6592231': 1, '9316308': 1, '27011740': 2, '32984097': 1, '16760742': 1, '8827385': 1, '15587092': 1, '1768361': 1, '22496123': 1, '21861247': 1, '21516279': 1, '22828761': 1, '8040698': 1, '11340731': 1, '10686863': 1, '15841901': 1, '21740173': 1, '10450638': 1, '3946356': 1, '15750423': 1, '15900817': 1, '8958351': 1, '20162872': 1, '9527312': 1, '15222788': 1, '22438645': 1, '24163556': 2} | {'3800389-2': 2, '3800389-3': 2, '4784154-1': 1, '4784154-2': 1} |
163,717 | 3800389-2 | 24,163,556 | noncomm/PMC003xxxxxx/PMC3800389.xml | Natal and neonatal teeth among cleft lip and palate infants | A 6-week-old male infant with left-sided complete cleft lip and palate presented with paired mandibular central incisor natal teeth []. The teeth erupted within 2 weeks after the birth. They were yellowish white, nonmobile, and directed obliquely toward the cleft alveolus on the left side. Gingival hyperplasia was present. Feeding difficulties pertaining to the cleft but not specific to the presence of teeth were recorded. The elder sibling who accompanied the infant had incomplete cleft lip [], but there was no history of similar natal teeth in him. There was no history of consanguineous marriage or cleft among parents. Extraction of the natal teeth along with curettage of the dental papilla was carried out during the cleft lip repair surgery. | [[6.0, 'week']] | M | {'21070704': 1, '10912720': 1, '6592231': 1, '9316308': 1, '27011740': 2, '32984097': 1, '16760742': 1, '8827385': 1, '15587092': 1, '1768361': 1, '22496123': 1, '21861247': 1, '21516279': 1, '22828761': 1, '8040698': 1, '11340731': 1, '10686863': 1, '15841901': 1, '21740173': 1, '10450638': 1, '3946356': 1, '15750423': 1, '15900817': 1, '8958351': 1, '20162872': 1, '9527312': 1, '15222788': 1, '22438645': 1, '24163556': 2} | {'3800389-1': 2, '3800389-3': 2, '4784154-1': 1, '4784154-2': 1} |
163,718 | 3800389-3 | 24,163,556 | noncomm/PMC003xxxxxx/PMC3800389.xml | Natal and neonatal teeth among cleft lip and palate infants | An 8-week-old male infant with left-sided cleft lip and alveolus presented to us on a following day of extraction of the mobile natal tooth by a local dentist. Baby was born at full term out of nonconsanguineous marriage and had no birth anomalies. Parents noticed eruption of tooth 4th day, following the birth and progressive increase in the size of the tooth. The tooth was present on the prominent point of the medial cleft alveolar segment and caused repeated trauma due to outward projection. The tooth further became excessively mobile, which was easily “pulled out” by a local dentist when consulted. The child was referred to us for the management of cleft lip. Examination revealed left-sided cleft lip and alveolus without any associated anomalies. The medial cleft alveolar segment was prominent and showed postextraction socket surrounded by gingival hyperplasia []. Extracted tooth was pale white showing soft tissue attachment mark differentiating crown without any root formation []. | [[8.0, 'week']] | M | {'21070704': 1, '10912720': 1, '6592231': 1, '9316308': 1, '27011740': 2, '32984097': 1, '16760742': 1, '8827385': 1, '15587092': 1, '1768361': 1, '22496123': 1, '21861247': 1, '21516279': 1, '22828761': 1, '8040698': 1, '11340731': 1, '10686863': 1, '15841901': 1, '21740173': 1, '10450638': 1, '3946356': 1, '15750423': 1, '15900817': 1, '8958351': 1, '20162872': 1, '9527312': 1, '15222788': 1, '22438645': 1, '24163556': 2} | {'3800389-1': 2, '3800389-2': 2, '4784154-1': 1, '4784154-2': 1} |
163,719 | 3800390-1 | 24,163,557 | noncomm/PMC003xxxxxx/PMC3800390.xml | A case of extensive left-sided facial atrophy of Romberg | A 50-year-old female presented with gradually progressive left-sided facial atrophy for the last 30 years. She also complained of intermittent left-sided headache for the last 8–9 years, which was throbbing, pulsatile with photophobia, phonophobia with history of visual auras. She had continuous tearing and redness of left eye since 3 years. There was no history of extraction of teeth, local trauma, seizures or lancinating pain suggestive of trigeminal neuralgia. The patient denied history of joint pains, rash, dyspnea, double vision and neurologic deficits in the extremities. Family history was non-contributory.\nOn examination, marked left-sided facial atrophy was present []. Oral cavity assessment disclosed left-sided tongue atrophy []. Ocular examination revealed enophthalmos and uveitis in left eye. The skin over left lower face had bluish hue. Rest of neurological examination was unremarkable. The investigations, including hematological parameters, blood sugar, serum creatinine, blood urea and liver function test revealed normal results. The C-reactive protein and erythrocyte sedimentation rate were not raised. The autoimmune markers, comprising antinuclear antibody, anti-double-stranded DNA antibody, anticardiolipin antibody and rheumatoid factor were non-reactive in sera. The viral studies for Epstein Barre virus, cytomegalovirus, dengue virus, herpes simplex virus and Japanese encephalitis virus showed negative results. Electroencephalography was reported to be normal. Magnetic resonance imaging of cranium did not demonstrate any abnormality []. Facial nerve stimulation at anterior ear on both sides revealed minor differences in latency and amplitudes []. Blink reflex on stimulation of supraorbital nerves showed insignificant differences of R2-R1, on left side 27.95 ms, while on right side 24.20 ms []. The clinical description and laboratory evaluation suggested the diagnosis of facial atrophy of Romberg and migraine with aura. The patient was prescribed propranolol 40 mg twice a day, flunarizine 10 mg/day as prophylactics for migraine along with abortive medications for control of acute headache. The patient was not willing for facial reconstructive surgery. On follow up after 6 months, her frequency of headache was significantly decreased. | [[50.0, 'year']] | F | {'18805077': 1, '20083791': 1, '12510729': 1, '18708310': 1, '19829858': 2, '26181554': 2, '19302950': 1, '9127045': 1, '17147965': 1, '26019431': 2, '19745718': 1, '14563334': 1, '29445726': 1, '24163557': 2} | {'2740286-1': 1, '4617071-1': 1, '4617071-2': 1, '4445209-1': 1} |
163,720 | 3800391-1 | 24,163,558 | noncomm/PMC003xxxxxx/PMC3800391.xml | Odontogenic myxoma | A 26-year-old female patient reported with the chief complaint of a painless gradually progressive swelling in the lower left side of face, which was initially noticed as a small swelling in the lower left vestibule and grew to the present size within a span of one and a half years. There was no history of trauma. Past medical and dental histories were non-contributory.\nExtra-oral examination revealed a diffuse, non-tender, bony hard swelling of the left body region of mandible, approx. 3-4 cm in size []. No local rise in temperature or change in color of the overlying skin was seen. No lymphadenopathy was observed.\nOn intra-oral examination, a single well-defined localized swelling at left buccal as well as lingual vestibular region, extending from 34 to 37 region, with displacement of 35, 36 and mobility of 34, 35, 36 and 37, was observed. There was no erythema, ulceration or pus discharge in the overlying mucosa [].\nRadiographically, the Orthopantomograph (OPG) showed a multilocular radiolucency, extending antero-posteriorly from the midline to left ramus region, and supero-inferiorly from the alveolar process to the lower border of the mandible. Poorly defined radiolucent lesion causing slight cortical expansion, with fine trabeculae, some intersecting at right angles, were evident. Displacement of 34, 35, 36, root resorption of 34, 35, 36, 37, 38 as well as scalloping between the roots of the involved teeth, was also apparent [].\nThe lesion was biopsied and submitted to the Department of Oral Pathology with the provisional diagnosis of ameloblastoma or odontogenic keratocyst (OKC).\nOn macroscopic examination, the biopsy specimen was in multiple pieces, 1–2 cm in size, whitish in color, transparent and slippery in nature and soft in consistency. On microscopic examination, H and E stained section revealed loosely arranged stellate-shaped cells with intermingled fibrillar processes in a homogenous mucoid ground substance with few collagen fibrils and capillaries [Figures and ]. Very few scattered odontogenic epithelial rests, areas of hemorrhage, and foci of bony trabeculae were visible. Odontogenic myxoma was the definitive diagnosis. | [[26.0, 'year']] | F | {'26682147': 1, '34457286': 2, '5610506': 1, '280645': 1, '16491154': 1, '22442596': 2, '4524831': 1, '6430823': 1, '8600281': 1, '1056455': 1, '17149953': 1, '5057105': 1, '13590722': 1, '5249519': 1, '268214': 1, '24163558': 2} | {'3304210-1': 1, '8380125-1': 1} |
163,721 | 3800392-1 | 24,163,559 | noncomm/PMC003xxxxxx/PMC3800392.xml | Median facial dysplasia: A rare craniofacial syndrome and the surgical management of associated cleft lip | A 9-month-old female baby presented with a false median cleft with hypotelorism, on further examination she had median cleft lip with rudimentary prolabium, poorly defined cupids bow, lack of upper labial frenum, flattened nose with widened nostrils and deficient collumella. The pre-maxilla seemed to be rudimentary in this patient, hence a lack of anterior alveolus was seen, but with no evidence of a cleft palate or alveolus. The dental occlusion of the patient could not be assessed as the teeth had not erupted.\nThe patients’ history revealed that she was a full-term normal delivery, with no known complications during pregnancy and no significant history of teratogenic exposure or familial history of cleft was present. The patient seemed to be of a normal intellect judging by the childs understanding and orientation of surroundings and had her normal milestones achieved with respect to the age. The diagnosis was made in the presence of the typical findings of deficient mid facial structures and absence of any clinically appreciable gross brain abnormalities.\nThe most important factor in reconstruction of the cleft lip in cases of MFD is the identification of the surgical reference points of chelioplasty [] which is a cumbersome process as the columella is deformed or poorly defined, hence the aid of adjacent midline structures such as the midpoint of nasal columella can be used as a guide to locate IS (Cupid bow summit point, Point 1), similarly the CPHR (Cleft Philtrum Horizontal Right, Point 2) is traced towards the non-cleft side, an equidistant point is marked as CPHL (Cleft Philtrum Horizontal Left, Point 3) on the cleft side based on the measurement between IS and CPHR. The CPHL’ (Point 3’) is marked based on the maximum thickness of the vermilion and verified by transferring the measurements of CHR (Cleft Horizontal Right point) -CPHR to CHL (Cleft Horizontal Left point) -CPHL’ []. The measurements of 5A and 5B are also noted for quantifying the shortening of the cleft side lip.\nThe incision using the reference points, C flap is developed till the midline of columella, and a back cut is given hence in that process developing a thick columella by dropping down a thick C flap, this provides the deformed or a poorly developed columella a structure. The reference points are further used as guide for dissection of the muscles and reorientation with its counterpart on the non-cleft side [Figure and ]. | [[9.0, 'month']] | F | {'278680': 1, '8480000': 1, '21458233': 1, '7073197': 1, '6828591': 1, '1448530': 1, '24163559': 2} | {} |
163,722 | 3800393-1 | 24,163,560 | noncomm/PMC003xxxxxx/PMC3800393.xml | Cleft palate lateral synechia syndrome | The case involved a male infant 1 day old at the time of presentation. He was the first child of healthy parents. The infant was delivered normally at full term with a low birth weight of 1,750 g. There were no particularly notable points in the family history, medical history, or reproductive history.\nOn examination, the patient had a restricted mouth opening resulting from congenital oral synechia due to membranous adhesion between the free margin of the cleft palate and the floor of the mouth, lateral to the tongue on the left side. The cleft was of secondary palate with intact premaxilla. There were no other abnormalities found in the patient. No obvious auricular or nasal deformities were appreciated. Digits and extremities appeared normal, as did genitalia. Examination of the heart revealed no abnormalities.\nThe congenital oral synechia appeared as a thin membrane with a broad attachment at the floor of the mouth measuring approximately 2 cm in anteroposterior width. At the palatal margin the attachment narrowed to about 0.5 cm []. The membranous adhesion was pale pink in color and appeared to be avascular.\nThe infant faced feeding problems due to the restricted mouth opening, and therefore an immediate surgical excision of the synechia was decided on. Feeding was done using an infant feeding tube till anesthetic clearance was obtained for the procedure. At 1 week after birth, the congenital synechia was excised under sedation uneventfully restoring adequate mouth opening and allowing normal feeding []. A surgical closure of the cleft palate is planned for a later date. | [[1.0, 'day']] | M | {'14604148': 1, '14891381': 1, '27274132': 2, '29594080': 2, '32174681': 1, '13476294': 1, '12041983': 1, '5052209': 1, '19368978': 1, '24163560': 2} | {'4878224-1': 1, '5866492-1': 1} |
163,723 | 3800394-1 | 24,163,561 | noncomm/PMC003xxxxxx/PMC3800394.xml | Non-syndromic odontogenic keratocysts: A rare case report | A 23-year-old male normally fit and well reported to the outpatient department of our hospital with a chief complaint of asymptomatic swelling and pus discharge from the left maxillary posterior region since 10 days.\nThere was no significant past medical history. A detailed examination of the maxillofacial region had no significant extra-oral findings. Intra-oral examination revealed a partially edentulous state; teeth 13, 14, 18, 27, 28, 37, and 47 were missing with slight expansion of the buccal cortical plate in the left maxillary posterior region. On exertion of pressure, a white creamy exudate expressed out of the area between 23 and 24, but there was no tenderness or bleeding on further palpation.\nA panoramic radiograph revealed multiple radiolucencies in all four quadrants []. Lesion in the left maxillary quadrant was associated with multiple impacted teeth and retained deciduous teeth. In the lower jaw, well-defined radiolucencies were associated with missing 37 and 47 which mimics dentigerous cysts. Diagnostic biopsy from the maxillary left quadrant was reported as OKC.\nThe patient's chest and skull radiographs were unremarkable. Dermatology consultation did not reveal any cutaneous abnormality. Hematological investigations were within normal limits. The patient was admitted to hospital, and enucleation of the cystic lesions was performed under general anesthesia and the surgical bed was treated with Carnoy's Solution. It was interesting to note that there were two separate entities in the right maxillary region with one of the lesion associated with the impacted canine and they were sent as two separate specimens. Four lesions (excluding the small lesion distal to tooth 36) were enucleated and sent for histopathological examination. The small cystic lesion distal to tooth 36 was kept under observation. The patient recovered uneventfully and was discharged the next day and is presently being kept under observation with regular follow ups at the interval of 3 months are being conducted.\nThe histopathologic report revealed that three out of four lesions were OKC and the other lesion which was associated with the impacted canine in the maxillary right quadrant was dentigerous cyst. Cystic lining of all three Keratocystic lesions was parakeratinized stratified squamous epithelium of uniform 6-8-cell thickness. The lining epithelium consisted of well-defined columnar basal cells in a palisade arrangement and with polarized nuclei. The height of the epithelial cells and the number of nuclei they contained were reduced. Satellite cysts and epithelial remnants were observed in the connective tissue capsule. | [[23.0, 'year']] | M | {'18088695': 1, '9470283': 1, '3131508': 1, '16978485': 1, '15901071': 1, '5286040': 1, '18088692': 1, '10332131': 1, '27448602': 1, '11429726': 1, '2408661': 1, '14044666': 1, '27011939': 2, '6958319': 1, '16454239': 1, '2482726': 1, '5270271': 1, '3290262': 1, '2668340': 1, '12686930': 1, '3127485': 1, '3293654': 1, '1370082': 1, '3480489': 1, '264648': 1, '24163561': 2} | {'4784071-1': 1} |
163,724 | 3800395-1 | 24,163,562 | noncomm/PMC003xxxxxx/PMC3800395.xml | Application of PRF in surgical management of periapical lesions | 24 year old male patient came to the Department of Conservative Dentistry and Endodontics Darshan dental college and hospital, Udaipur, Rajasthan, with the complaint of fractured tooth of upper front region of jaw since five year.\nOn investigation, periapical radiolucency involving 21, 22 was seen on IOPA and Color Doppler Echographic imaging revealed a granuloma of diameter 13 × 5 mm in size []. | [[24.0, 'year']] | M | {'31321573': 1, '31886202': 1, '9638695': 1, '12126382': 1, '30993143': 1, '2468466': 1, '16504861': 1, '16504850': 1, '27900247': 1, '12608674': 1, '12738942': 1, '30693233': 1, '25738094': 1, '19359860': 1, '24163562': 2} | {'3800395-2': 2, '3800395-3': 2} |
163,725 | 3800395-2 | 24,163,562 | noncomm/PMC003xxxxxx/PMC3800395.xml | Application of PRF in surgical management of periapical lesions | 32 year old male patient came to the Department of Conservative Dentistry and Endodontics with the complaint of draining sinus from upper front region of jaw. Patient had undergone Root canal treatment elsewhere two years ago in the same tooth.\nOn investigation, periapical radiolucency involving 12 was seen on IOPA and Color Doppler Echographic imaging showed granuloma of diameter 10 × 8 mm in size []. | [[32.0, 'year']] | M | {'31321573': 1, '31886202': 1, '9638695': 1, '12126382': 1, '30993143': 1, '2468466': 1, '16504861': 1, '16504850': 1, '27900247': 1, '12608674': 1, '12738942': 1, '30693233': 1, '25738094': 1, '19359860': 1, '24163562': 2} | {'3800395-1': 2, '3800395-3': 2} |
163,726 | 3800395-3 | 24,163,562 | noncomm/PMC003xxxxxx/PMC3800395.xml | Application of PRF in surgical management of periapical lesions | 35 year old male patient came, with a complaint of discoloured tooth of upper front region of jaw since 8 years. Patient had history of trauma 17 years ago.\nOn investigation, periapical radiolucency involving 21, 22 was seen on IOPA and Color Doppler Echographic imaging showing periapical cyst of diameter 17 × 15 mm in size []. | [[35.0, 'year']] | M | {'31321573': 1, '31886202': 1, '9638695': 1, '12126382': 1, '30993143': 1, '2468466': 1, '16504861': 1, '16504850': 1, '27900247': 1, '12608674': 1, '12738942': 1, '30693233': 1, '25738094': 1, '19359860': 1, '24163562': 2} | {'3800395-1': 2, '3800395-2': 2} |
163,727 | 3800415-1 | 24,174,732 | noncomm/PMC003xxxxxx/PMC3800415.xml | Massive pregnancy gingival enlargement: A rare case | A 23-year-old female patient reported to the Department of Periodontics, with a localized massive gingival overgrowth on the upper left front region In relation to 21, 22 and 23 with protruding lips [Figures –]. There was no history of drug intake and hereditary reasons. Patient was 8 months pregnant and revealed that her gums used to bleed on brushing since 3 months of pregnancy, but the enlargement came to the present size at this time, the patient reported that she felt difficulty in chewing, speech and closing of the lips, her esthetics was also compromised because of the enlargement. The gingival swelling was so massive that it was evident extraorally. On intraoral examination, the size of the lesion was about 3.5 cm × 2 cm in dimension and pedunculated. The tumor was bright red in color, soft that bled on slightest provocation. Subgingival calculus and plaque was present. Patient was unable to maintain oral hygiene in this area, because of gingival enlargement. Oral prophylaxis was performed after routine hematological investigation. Instructions regarding maintenance of oral hygiene were given and advised to return post-partum. She reported to the department 1 month after the delivery of the baby. The dimension of the tumor was same as before delivery. Minimum bone loss was observed on radiograph The gingival overgrowth was excised with the help of 15 no. b.p blade and electrocautery, the bleeding was controlled by the help of the ball tip of the electrocautery [Figures and ]. Periodontal dressing was Applied(coe-pack) in the involved region []. The excised lesion [] was sent for histopathological examination, which revealed epithelial proliferation and underlying capillary proliferation along with marked inflammatory cell infiltration seen []. The healing was uneventful and no relapse was seen on follow up []. | [[23.0, 'year']] | F | {'17209786': 1, '1923399': 1, '18112170': 1, '12972838': 1, '312316': 1, '5285837': 1, '15042797': 1, '4254244': 1, '17363331': 1, '12418714': 1, '6103927': 1, '24174732': 2} | {} |
163,728 | 3800416-1 | 24,174,733 | noncomm/PMC003xxxxxx/PMC3800416.xml | Peripheral ossifying fibroma | A 65-year-old man visited the Department of Periodontics, Hasanambha Dental College and Hospital with a history of a swelling that had gradually increased in size during previous 2 years. He had no history of previous swelling in the oral cavity. Past medical and family history was non-contributory.\nIntra oral examination revealed a solitary, pedunculated mass involving buccal interdental papilla and attached gingiva in relation to 26 and 27 []. Mass was pink in color with a smooth surface, measuring approximately 1.5 cm × 2 cm. No surface ulceration was noted. On palpation, it was non-tender and firm in consistency.\nIntra oral periapical radiograph showed no significant bony changes. Provisional diagnosis of POF was considered.\nThorough scaling and root planning was performed to eliminate the irritating factors and after a week, complete surgical excision of the lesion was performed under local anesthesia. To prevent recurrence, complete removal of the lesion and gingival curettage is ensured followed by oral hygiene maintenance instructions to the patient.\nMicroscopic examination showed fibro-cellular connective tissue interspersed with plump fibroblasts in between the collagen bundles, surfaced by parakeratinzed stratified squamous epithelium []. Stroma showed large trabeculae of lamellar bone [] and scattered basophilic, cementum like substances []. The histopathological features were diagnostic of peripheral ossifying fibroma.\nHealing was uneventful [] and patient is followed-up for 12 months without any recurrence. | [[65.0, 'year']] | M | {'21760674': 2, '26556782': 1, '23738938': 1, '21525678': 1, '30775321': 2, '21731281': 2, '21968923': 1, '18450191': 1, '7776054': 1, '25568770': 2, '33489156': 2, '24174733': 2} | {'4274488-1': 1, '7813068-1': 1, '6360821-1': 1, '3125660-1': 1, '3100863-1': 1} |
163,729 | 3800417-1 | 24,174,734 | noncomm/PMC003xxxxxx/PMC3800417.xml | A silent tumor of the gingiva: An unusual case report and surgical management with 1 year follow-up | A 25-year-old female patient was referred to the department of Periodontology with a gingival swelling in the upper right back region. The lesion was an incidental finding by her dentist at a routine dental check-up. A history suggested the swelling had been present for approximately 6 months. This swelling had not caused any pain and no other symptoms were reported by patient. The medical history was non-contributory and the patient did not smoke or drink alcohol.\nOn local examination, the lesion was smooth, firm with sessile base, non-ulcerated, painless, with normal color measuring 4 mm × 10 mm, extending from the mesial of maxillary right first premolar to the mesial of maxillary right first molar involving the marginal, papillary, and attached gingiva []. Intra oral periapical radiograph showed a mild crestal bone loss between 13 and 14 and between 14 and 15 [].\nBased on texture, differential diagnosis of granuloma or a possible fibroma was made. A punch biopsy of the lesion was conducted under local anesthesia and the specimen was submitted to routine histopathological analysis [Figures and ].\nHistopathologically, hematoloxylin, and eosin stained biopsy sections showed spindle-shaped cells, with fusiform or wavy comma-shaped nuclei distributed on a background of delicate connective tissue matrix [].\nHaving confirmed the occurrence of a neurofibrona, a complete exploration was made. There was no relevant family history and no evidence of NF, such as café-au-lait macules or freckling in the axillary and inguinal regions. No lisch nodules were detected during an ophthalmological study. The patient showed normal physical and mental development. With the above clinical and histological findings, the diagnosis of solitary neurofibroma of the gingiva was made and complete excision of the lesion was planned.\nUnder local anesthesia complete excision was achieved using no. 15 blade. The growth was carefully dissected and separated from the underlying tissues [Figures and ]. The excised specimen was almost 0.5 cm × 1 cm in size []. The bed of the lesion was examined for remnants, hemostasis was achieved and Coe pack was placed [Figures and ]. The post-operative period was uneventful. The patient was kept on a constant follow-up [] and after 12 months, there were no signs or symptoms derived from the lesion []. | [[25.0, 'year']] | F | {'10847541': 1, '12041525': 1, '15105854': 1, '24174734': 2} | {} |
163,730 | 3800418-1 | 24,174,735 | noncomm/PMC003xxxxxx/PMC3800418.xml | Pyogenic granuloma of the gingiva: A misnomer? – A case report and review of literature | A 22-year-old male reported to the Department of Periodontics, complaining of a swelling in the upper right jaw region, which caused discomfort while eating. The patient reported that he noticed the swelling 2 years ago, which was painless and gradually increased in size, during this period he had visited a medical doctor who had given him gum paint for application. He had stopped brushing the area due to bleeding from the area.\nOn extraoral examination, there was no visible swelling on the right side of the maxilla. Intraoral examination revealed a large sessile lobulated gingival overgrowth extending on buccal surfaces of 15, 16, 17 and 18. It was reddish pink in color with white patches and was approximately 21 mm × 44 mm in size. The surface was smooth no ulcerations were seen and it appeared ovoid in shape []. Buccally it extended beyond the occlusal plane of the teeth giving an appearance of missing teeth []. Oral hygiene was poor and the mouth showed large amounts of calculus. Teeth associated with it did not show any mobility. Radiographically, there were no visible abnormalities and the alveolar bone in the region of the growth appeared normal []. Routine hemogram was found to be normal. A provisional diagnosis of pyogenic granuloma was made. The differential diagnosis included peripheral ossifying fibroma, peripheral giant cell granuloma, hemangioma and fibroma.\nThe patient did not have any systemic problems and so the case was prepared for surgery on the basis of the clinical and radiographic evidence. Oral prophylaxis was completed and the lesion was excised under aseptic conditions. Excision of the lesion up to and including the mucoperiosteum was carried out under local anesthesia using a scalpel and blade, followed by curettage and through scaling of the involved teeth. Periodontal dressing was placed and the patient was recalled after 1 week for removal of the pack and checkup. The excised tissue [] was sent to the Department of Oral Pathology for histologic examination.\nHistopathological report revealed parakeratinized epithelium, stretched in some places and showed proliferation toward the base of the lesion. The underlying connective tissue stroma showed dilated and engorged blood vessels, extravasated red blood cells, angiogenesis, few inflammatory cells and bundles of collagen fibers []. The diagnosis pyogenic granuloma was histologically confirmed.\nThe patient was recalled every 3rd month for maintenance and to check for possible recurrence. This case was followed up for a period of 1 year and there has been no recurrence so far []. | [[22.0, 'year']] | M | {'1856307': 1, '5220911': 1, '2945586': 1, '25653822': 1, '12452987': 1, '16390473': 1, '28160580': 1, '1517491': 1, '27330700': 1, '25568770': 2, '30131631': 2, '11027379': 1, '15982213': 1, '10929871': 1, '11405040': 1, '30693455': 1, '9219124': 1, '7661279': 1, '27891481': 1, '9615106': 1, '20413199': 1, '7435775': 1, '12227329': 1, '1525078': 1, '32773973': 1, '5287019': 1, '10399647': 1, '33888950': 2, '10213': 1, '27382492': 1, '25699167': 1, '4396818': 1, '2654195': 1, '14871318': 1, '29456298': 1, '29769774': 2, '17220613': 1, '9617128': 1, '7364971': 1, '1923399': 1, '24859551': 1, '34408371': 1, '22434943': 1, '28757870': 1, '34629066': 2, '24174735': 2} | {'8041082-1': 1, '8504017-1': 1, '4274488-1': 1, '5939027-1': 1, '6077973-1': 1} |
163,731 | 3800420-1 | 24,174,737 | noncomm/PMC003xxxxxx/PMC3800420.xml | Gingival squamous cell carcinoma masquerading as an aphthous ulcer | A 38-year-old Indian woman reported to the Department of Periodontics, Government Dental College and Hospital, Hyderabad, India in July 2011 with a chief complaint of burning sensation and itching in relation to mandibular anterior lingual gingiva for past 1 month. Patient had provided informed consent to be profiled. Past dental history revealed that the patient had visited a couple of private general dental practitioners where the lesion was misdiagnosed as an aphthous ulcer and palliative care was provided for the same. As there was no improvement in her complaint, she decided to come to the dental school for an additional opinion. She was referred for diagnosis and treatment in post-graduate periodontics clinic. There was no contributing medical or family history except that the patient had undergone hysterectomy and appendectomy 10 years back. Patient was in good health and denied any deleterious habits like smoking, alcohol consumption or recreational drug use. No lymph nodes were palpable or tender in a head and neck examination.\nIntraoral examination revealed a clean mouth with good gingival health and minimal deposits with the full complement of teeth. Clinical examination of the lingual gingiva revealed a 1 cm × 1 cm ulcer extending mesiodistally from mid lingual surface of 41 to mesiolingual surface of 43 and corono-apically from the gingival margin to the floor of the mouth, not extending beyond the anterior part of lingual frenum. The surface of the lesion appeared to be ulcerated and pebbly with isolated areas of erythema and had well-defined borders that were found to be in level with the adjacent tissue. The ulcerated part of the lesion had rhomboid appearance. The surface of lesion toward the lingual frenum appeared to have a shaggy base covered with slough and there was no exudation []. Intraoral periapical X-ray showed bone loss extending up to the apical 3rd in relation to 41, 42 []. Since the clinical findings of the existing lesion didn’t correlate with any of the features of periodontal lesions and the fact that it has been present for the past 1 month was enough to suspect a malignant ulcer. At this stage, a provisional diagnosis of GSCC was made and after obtaining the patient's consent, an incisional biopsy was taken immediately. The specimen was then sent for histopathological examination.\nThe histological examination of the soft-tissue specimen revealed severe dysplastic changes of the epithelium. There were many sheets and clusters of cells, which were polygonal in shape and contained moderate to abundant pale acidophilic cytoplasm and sharp cellular margins. The nucleus was round to oval in shape and showed moderate pleomorphism, disorganization, coarse chromatin clumping and prominent nucleoli. Mitotic activity was high. There were patchy dense infiltrates of lymphocytes, plasma cells and neutrophils []. A clear and prominent feature was the presence of multiple, keratin pearls in connective tissue []. The above clinical and histological features are conclusive of invasive keratinizing GSCC.\nThe patient was immediately referred to a specialty hospital for cancer (Indo-American Cancer Institute, Hyderabad, India) where a computed tomography scan was taken to evaluate any alveolar bone invasion. Subsequently, the lesion was staged as T1N0M0. The involved teeth 41, 42 were extracted and the lesion was treated with radiation therapy alone (intensity modulated radiation therapy, 6600 U/33 fractions using ×6 photons). Six months follow-up revealed uneventful healing and no recurrence. | [[38.0, 'year']] | F | {'34194849': 2, '12004680': 1, '5890556': 1, '7552883': 1, '17258640': 1, '16253104': 1, '12618965': 1, '16805687': 1, '21365032': 1, '29183323': 2, '31949540': 1, '15646302': 1, '27781066': 1, '1062459': 1, '12699044': 1, '16332246': 1, '9738803': 1, '28932153': 2, '2400977': 1, '33879738': 1, '7811663': 1, '24421976': 1, '19272815': 1, '1422468': 1, '8959576': 1, '24174737': 2} | {'8214479-1': 1, '5594972-1': 1, '5706288-1': 1} |
163,732 | 3800421-1 | 24,174,738 | noncomm/PMC003xxxxxx/PMC3800421.xml | An unusual clinical presentation of plasma cell gingivitis related to “Acacia” containing herbal toothpaste | A 17-year-old girl was referred to the Department of Periodontics with the chief complaint of gingival overgrowth and mobility in her teeth for the last 2 years. She reported that the problem has begun in lower anterior and progressed involving both the arches. Patient appeared fit and indicated no current or previous systemic disease during her medical history interview.\nIntraorally, severe diffuse gingival enlargement of both the arcades (more pronounced on the right side) was observed covering almost all the surfaces of teeth and projecting into the vestibule [Figure –]. Gingiva was bright red, friable, fibrous as well as edematous in consistency. The erythema was disproportionate to the amount of plaque and calculus remaining on the dentition panoramic radiograph demonstrated generalized alveolar bone loss []. Probing depth ranged from 10 mm to 12 mm with an attachment loss of 7-9 mm and was more in the right molar region. Grade 2 mobility was present around the mandibular and maxillary first and second molars and grade 1 around the mandibular right premolars.\nLaboratory tests revealed no evidence of any systemic disease such as leukemia, scurvy and hormonal disorders.\nInternal bevel gingivectomy was performed in the maxillary arch and left mandibular region[]. Adjunctive amoxicillin (500 mg, 3 × 1) plus metronidazole (400 mg, 3 × 1) for 7 days was prescribed to treat AgP. Patient could not continue her treatment for personal reasons and when she reported after 1 year, the recurrence of gingival enlargement was noticed [Figure –]. Periodic panoramic radiographic examination revealed progressive alveolar bone loss, which was more pronounced on the right lower molars []. Biopsy showed hyperplastic stratified squamous epithelium along with ulceration of epithelium at places. Sub-epithelial tissue revealed a large number of normal plasma cells, few eosinophils and inflammatory granulation tissue [Figure and ]. A diagnosis consistent with PCG was made. To clarify whether this enlargement was due to a hypersensitivity reaction, the screening for the various antigenic substances was done. The patient was questioned about the habitual use of chewing gum, mouthwash and toothpaste. The only relevant history given by the patient was the use of herbal toothpaste (Babool, Dabur Oral Care Products, India) for the last 3-4 years. The patient was advised to discontinue the use of herbal toothpaste, which dramatically reduced the severity of enlargement within 2 weeks [Figure –]. Moreover, the patient herself switched on to other herbal toothpaste (Meswak, Dabur Oral Care Products, India) after discontinuing Babool toothpaste. Thus, it was highly probable that babul extract from the Babul tree “Acacia Arabia” was responsible for the gingival enlargement in the present case as all other constituents of both the herbal toothpastes are similar.\nBlood test (enzyme-linked immunosorbent assay) for allergy of toothpaste components disclosed very high level of allergen specific antibody and symptoms relation for Acacia (105 kUA/L; normal value < 0.35 kUA/L), which confirmed “Acacia” as causative allergen.\nRight mandibular second molar with hopeless prognosis was extracted. Although pocket depth reduced significantly from 10-14 mm to 6-8 mm, but clinical attachment level was not reduced significantly. Surgical procedures were carried out on right molar region to treat AgP and residual enlargement. Patient was advised to continue with regular toothpaste.\nPatient was recalled at 1, 3, 6 months and after that she was recalled at 6 months interval. No recurrence of gingival enlargement was noticed in both arches and probing depth ranged from 3 mm to 5 mm []. Panoramic radiograph showed no further progression of bone loss []. | [[17.0, 'year']] | F | {'26922434': 1, '2306395': 1, '33670562': 1, '17486188': 1, '31934461': 2, '15552069': 1, '7825113': 1, '8473532': 1, '8277398': 1, '1870070': 1, '15236497': 1, '2736170': 1, '20461324': 1, '24174738': 2} | {'6942776-1': 1} |
163,733 | 3800422-1 | 24,174,739 | noncomm/PMC003xxxxxx/PMC3800422.xml | Spontaneous correction of pathologically migrated teeth with periodontal therapy alone | A 27-year-old female patient reported with the chief complaint of increasing spacing between her upper front teeth since the last nine months. There was no history of previous dental treatment. Her family and medical history were noncontributory. The patient provided a history that there was no spacing between the maxillary central incisors two years back. A gradual increase in spacing was noticed between the maxillary central incisors over the last nine months. On intraoral examination, other than a poor oral hygiene status, a 9 mm deep periodontal pocket was noticed between the maxillary central incisors. Both the teeth were showing Miller's Grade I mobility. There was high labial frenum attachment and a 2 mm diastema was present between the two central incisors []. Functional occlusal evaluation was done, which revealed an increased overbite that could be traumatic to the opposing maxillary teeth. An intraoral periapical radiograph revealed horizontal bone loss in between #11 and #21 [].\nAfter the completion of Phase-1 therapy, the patient was re-evaluated, during which the pocket depth was reduced to 7 mm. There was no gingival recession around the involved teeth. Occlusal equilibration was done to relieve the occlusal interference in the maxillary and mandibular anterior teeth. Periodontal flap surgery, along with excision of the high frenum attachment was planned, explained to the patient, and informed consent was obtained from the patient. Under local anesthesia, frenectomy was performed and a full-thickness mucoperiosteal (papilla preservation) flap was reflected []. Thorough degranulation was followed by root planing and saline irrigation. Black silk was used for suturing and simple interrupted sutures were placed []. Periodontal dressing was also done. The patient was discharged after giving postoperative instructions and prescribing antibiotics and analgesics/anti-inflammatory drugs. After one week, the periodontal dressing and sutures were removed and the area was thoroughly irrigated with saline. Three months postoperatively, there was complete closure of the diastema [] and both the teeth showed no signs of clinical mobility. Intraoral periapical radiographs showed bone gain between the two maxillary central incisors []. At three months, the periodontal probing depth was 3 mm and a gingival recession of 2 mm was noticed around both the maxillary central incisors. The patient was explained the importance of maintenance therapy and also the chances of a relapse of pathological migration in case of recurrence of periodontal disease. The patient was provided the option of a retainer to maintain the tooth in position, which the patient declined. The patient is being followed with no signs of recurrence of pathological migration. | [[27.0, 'year']] | F | {'22248948': 1, '15948679': 1, '21206927': 1, '19582238': 1, '22292151': 1, '21889001': 1, '20614039': 1, '21394296': 2, '34393408': 2, '18277692': 1, '24174739': 2} | {'8336778-1': 1, '3051056-1': 1, '3051056-2': 1, '3051056-3': 1} |
163,734 | 3800423-1 | 24,174,740 | noncomm/PMC003xxxxxx/PMC3800423.xml | The perio-esthetic-restorative approach for anterior rehabilitation | A 28-year-old female patient who was referred from Department of Conservative Dentistry and Endodontics to Department of Periodontics, Subharti Dental College, Meerut to increase the length of the clinical crown in relation to maxillary right central incisor, maxillary right lateral incisor, maxillary left central incisor, maxillary left lateral incisor and maxillary left canine for placement of fixed prosthesis. A detailed medical and dental history was obtained from the patient. A thorough clinical examination was performed. It revealed severe loss of the tooth structure due to caries []. The teeth were endodontically restored. Radiographic examination showed Gutta Percha point in the apical one-third for the placement of post and core []. On probing, a generalized depth of 2 mm was observed [] with 3-4 mm of attached gingiva. The teeth were not mobile. Maxillary and mandibular impressions were taken and diagnostic casts were obtained along with pre-operative intraoral photographs.\nAn average of 2 mm of the clinical crown and 2 mm of biologic width was required to place the subgingival margins of the crown for which surgical crown lengthening was planned. According to classification by Lee[] the present case falls under Type III category. A signed consent form was obtained from the patient.\nBefore planning for the surgery, complete plaque and calculus removal was done. After giving anesthesia, bone sounding was carried out to determine the amount of osseous reduction to be done. Undisplaced flap surgery with osseous recontouring was performed to increase the clinical crown length and to maintain the biologic width [].\nMaximum preservation of keratinized gingiva was performed. Ostectomy followed by osteoplasty was performed to obtain at least 4 mm of healthy tooth structure above the alveolar crest. The scalloping of the flap was performed anticipating the final underlying osseous contour. Flaps were sutured back. Routine post-operative instructions were given. The medications prescribed were, amoxicillin 500 mg tid for 5 days and paracetamol tid for 3 days.\nPatient was recalled after 1 week for suture removal and after 1 month for re-evaluation []. 3 months post-surgery, the patient was referred to the Department of Conservative Dentistry and Endodontics for the fabrication of the crowns []. | [[28.0, 'year']] | F | {'9656930': 1, '15615335': 1, '276259': 1, '8477863': 1, '3482204': 1, '15739921': 1, '4500509': 1, '10093519': 1, '6988243': 1, '2033546': 1, '26609452': 2, '24174740': 2} | {'4644817-1': 1} |
163,735 | 3800712-1 | 24,156,006 | noncomm/PMC003xxxxxx/PMC3800712.xml | Diagnosis of Iliotibial Band Friction Syndrome and Ultrasound Guided Steroid Injection | A 64-year-old woman came to our pain clinic with the symptom of right lateral side thigh pain which occurred from one year ago. Her pain started from knee lateral side and the pain was radiated to buttock area. When she started to walk, the pain was triggered and whenever symptoms aggravated, she could feel the tingling sensation through a whole leg which made her limping. She described her pain as pin pricking or stabbing with her pain severitiy 7-8/10 on the visual analogue scale (VAS).\nBefore she felt the lateral leg pain, she had the lipoma removing surgery around the lower knee. However, we did not think it is the main problem causing the symptom.\nAlthough her pain always started from knee lateral side, ultimately she could feel severe pain coming from entire thigh. Therefore, we performed straight leg raising and Patrick test to rule out any spine and pelvic problem. She was negative to all these tests and did not show any local tenderness around back or buttock. However, we could check significant local tenderness on right lateral side of knee. Also we performed knee instability test on both side which showed no abnormality. She showed local tightness around the lateral side of thigh compared to nonpainful side.\nAs the pain always started from the knee and aggravated by walking, we suspected some pathologic changes from inside the knee like meniscus or cruciate ligament. We decided to evaluate knee magnetic resonance imaging (MRI) study and simple X-ray. Her MRI study showed slight degenerative change on meniscus which seemed to be unrelated to the current pain. However, we could identify high signal intensity appearing at ITB through coronal and axial image (). We assessed that ITB syndrome is causing the pain.\nTo alleviate her symptom, we prescribed 37.5 mg tramadol/375 mg acetaminophen combination tablet (Paramacet tab: Donga, Seoul, Korea), 5 mg amitriptyline per os twice daily but had little effect. We educated her about the ITB specific stretching exercise which was known to improve the symptom by lengthening of the ITB. She continued to perform this stretching exercise for a month but the pain relief was not satisfactory.\nTo improve her symptom, we planned local corticosteroid injection by ultrasound guidance. We explained about the procedure, efficacy, and possible side effects of local corticosteroid injection. The skin was aseptically draped with betadine and the ultrasound transducer was covered with a sterile transparent sheath and aseptic gel. We used a 10-12 MHz linear transducer (IU 22, Philips, Netherlands). First, we marked the maximal tenderness area and the transducer was applied longitudinally to the lateral side of the knee. We could easily identify the ITB, femoral lateral condyle, tibia, and recess. Also we could find the local fluid collection under the ITB () which should not appear normally. Before injection, we checked whether the transducer was covering the maximal tenderness area. We targeted the needle tip beneath the iliotibial band and confirmed its location by injecting small amount of saline (). We payed close attention not to inject the medication into ITB itself. Following negative aspiration, 1% lidocaine 1ml and triamcinolone 20 mg was injected.\nAfter one week, the patient was followed up and she was fully recovered from previous pain. She told us that she never felt any kind of pain after injection. One month later, she was followed up again and she could not feel any pain around knee and thigh. | [[64.0, 'year']] | F | {'22994651': 1, '32514741': 1, '26682669': 1, '23396761': 1, '17208506': 1, '21702969': 1, '8734891': 1, '33785675': 1, '21063495': 1, '34523008': 1, '19484234': 1, '29236137': 1, '22134205': 1, '10405728': 1, '16533314': 1, '15155424': 1, '17349469': 1, '28238018': 1, '23259236': 1, '20890700': 1, '24156006': 2} | {} |
163,736 | 3800713-1 | 24,156,007 | noncomm/PMC003xxxxxx/PMC3800713.xml | Approach for Epiduroscopic Laser Neural Decompression in Case of the Sacral Canal Stenosis | A 32-year old male patient visited our institution with the chief complaint of pain in the right hip and the lower back which started after he had experienced a minor traffic accident ten months prior to his visit. The pain became severe when he bent his waist, and an paresthesia was found with a numbness going to the tip of the right middle toe. The physical examination showed a positive finding in the straight leg raising test (20 degree/60 degree). The lumbosacral plain film showed that the disc space between L4 and L5 was narrow. The patient had no particular history. The patient's pain was not relieved but continued even after a caudal epidural steroid injection as well as after interlaminar epidural steroid injections given at one week intervals. Because the magnetic resonance imaging (MRI) showed a central herniated lumbar disc between L4 and L5 and compression of the right L5 nerve root, we decided to perform ELND.\nThe patient was hospitalized one day before the operation, and provided written informed consent. He started fasting eight hours before the operation and showed nothing unusual in the preoperative blood test. On the day of the operation, cefazolin 1 g was intravenously injected one hour before the beginning of the operation for the purpose of preventing an operation related infection. The patient was put into the prone position on the surgical table after arriving at the operating room. The position was adjusted with a Wilson frame and a pillow at the abdomen so that lumbar flexion could be unfolded and the upper body could be a little bit higher than the lower body. Afterwards, a wide area around the sacral hiatus was disinfected with aseptic technique. Local anesthesia was performed in the region to be operated on with 1% mepivacaine. Under direct fluoroscopy guidance, an 18 G Tuohy epidural needle was inserted into the sacral hiatus through the epidural space, and a 0.8 mm guide wire was inserted through the Tuohy needle. Keeping the guide wire in position, the Tuohy needle was carefully removed. In the process of making a small incision on the skin with a No. 11 blade and inserting a dilator through the guide wire, an unexpected resistance was found with the access. Despite repeated attempts carried out several times, the insertion to the sacral canal failed. We stopped the operation temporarily and reviewed the lumbosacral MRI sagittal plane image. It was found in the image that the conjugate diameter of the top 1/3 of the S4 spinal canal was 3.40 mm, which was smaller than the 3.96 mm outer diameter of the dilator for the epiduroscopy introducer set used in the operation (4007 Epiduroscopy introducer set, Myelotec, USA), and smaller than the 3.89 mm outer diameter of the introducer sheath (). Therefore, we decided to perform a S4 laminotomy at the entrance of the narrowed sacral canal with a hiatus rasp () designed to widen the canal opening. After making an incision of about 2 cm on the skin and on the sacrococcygeal ligament, the rasp was inserted into the narrowed region expanding the narrow sacral canal space by applying repeated rotational force (). Then, the dilator was normally inserted, and the channel and the space leading to the epidural space were widened, and the procedure could be stably completed. The patient's symptoms improved, and he was discharged two days after the operation. | [[32.0, 'year']] | M | {'27631213': 1, '21107931': 1, '23342204': 1, '16155035': 1, '14668657': 1, '29204309': 1, '33371065': 1, '34218614': 1, '16858469': 1, '33461536': 1, '19637298': 1, '9135359': 1, '24478903': 1, '32566059': 1, '24156007': 2} | {} |
163,737 | 3800714-1 | 24,156,008 | noncomm/PMC003xxxxxx/PMC3800714.xml | Computed Tomography (CT) Simulated Fluoroscopy-Guided Transdiscal Approach in Transcrural Celiac Plexus Block | A 54-year-old male patient was diagnosed with pancreatic cancer and suffered from intractable, severe epigastric pain with a score of 5 to 8 out of 10 on the Numeric Rating Scale (NRS). Furthermore, the abdominal pain was not responsive to opioids and other medications.\nTherefore, we planned to perform celiac plexus neurolysis and reviewed the patient's anatomy on the abdominal CT image with contrast to determine the target point, ideal depth, and insertion angle through CT simulation. The celiac trunk was located at the T12 vertebral body level. At this level, the classic conventional transcrural approach via "walking off" the vertebral body was simulated, but the needle pathway was impeded by the kidney on the right side and by the aorta on the left side (). Then, we simulated the transdiscal pathway through the T11-12 intervertebral disc. The pathway was drawn from the target point to the lateral side of the right superior articular process of the T12 vertebra and extended to the skin.\nThe point at which the pathway crossed the posterior skin surface was designated as the needle insertion point (I). The distance from the midline spinous process of the T12 (S) to the needle insertion point was measured against the scale printed on the axial CT image (IS: 3.6 cm). The angle between the proposed needle pathway and the midline was designated as the needle insertion angle (*) (). The distance between the target point and the anterior margin of the vertebral body was measured, and the anteroposterior (AP) diameter of the vertebral body was also measured. The proportion of these two values was used to estimate the proper depth of the needle in the fluoroscopic image.\nIn the operating room, the patient was placed in a prone position, and we identified the T11-12 intervertebral disc space. In this case, the predetermined insertion angle was 18 degrees on the right side. Therefore, we rotated the fluoroscopy tube 18 degrees to the right side. The insertion point was the lateral margin of the superior articular process of the T12, and it was marked 3.6 cm to the right of the midline. After anesthetic infiltration was deepened in a fan fashion, the skin was punctured with a 16 g needle, and a 20 g Chiba needle was introduced through the 16 g needle. After contacting the disc, the fluoroscope was rotated to the lateral position. We inserted the needle through the disc while checking the tip position with the AP and lateral fluoroscopic images. After penetrating the disc, the 20 g Chiba needle was advanced up to the predetermined depth, which was 2/3 of the AP diameter of the vertebral body from the anterior margin of the vertebral body. Frequent fluoroscopic images for both the AP and lateral views were used to guide the needle when advancing it in the correct plane. While advancing the needle, we checked the loss of resistance using saline to penetrate the crura of the diaphragm. Contrast was injected to confirm the proper spread; the contrast flow showed a smooth curvilinear contour corresponding to the anterolateralaortic space, and it silhouetted the runoff of the celiac artery. On the AP view, the contrast spread across the midline. On the lateral view, the needle penetrated the disc, and its tip was located at 2/3 of the AP diameter anterior to the vertebral body. Then, 15 ml of 2% lidocaine followed by 15 ml of 99% ethyl alcohol was injected for neurolysis ().\nThere were no adverse events during the procedure. The patient tolerated the entire procedure well and did not complain of pain related to the procedure. The next day, during follow-up, the patient reported an abdominal pain score of 2 to 3 out of 10 on the NRS. After 1 week, the patient expressed great satisfaction with the results and was discharged. | [[54.0, 'year']] | M | {'7947429': 1, '3750081': 1, '1550278': 1, '15898036': 1, '23299904': 1, '20235178': 1, '6194498': 1, '16533471': 1, '11379673': 1, '21455084': 1, '34593666': 1, '17710015': 1, '22117980': 1, '7195158': 1, '32492883': 1, '24156008': 2} | {} |
163,738 | 3800733-1 | 24,155,766 | noncomm/PMC003xxxxxx/PMC3800733.xml | Breast Metastasis from Rhabdomyosarcoma of the Anus in an Adolescent Female | An 18-year-old female patient was referred to our department for evaluation of a lump in the left breast noticed 1 week earlier. The patient had a past medical history of acute lymphoblastic leukemia (ALL) and anal RMS. Eleven years earlier, at age seven, she was referred to our hospital because of fever and both knee pain. On femur and leg simple X-ray, there was irregular marginated osteolytic lesion with cortical destruction in distal femur and proximal tibia. The complete blood count was as follow: hemoglobin 12 g/dL, white blood cell count 5,000/µL with 37% of blast cell and platelet count 106,000/µL. We performed bone marrow biopsy and aspiration on iliac crest and the bone marrow specimen was packed with leukemic blasts (more than 95%). The immunohistochemical stain revealed the blast cells were positive for myeloid lineage (CD33 and CD13) and B-cell lineage (CD79a, CD20, and CD19). Finally, she had been diagnosed as biphenotype ALL and treated with the Children's Cancer Group (CCG)-106B protocol and prophylactic 18 Gy cranial irradiation []. During follow-up, she had remained in complete remission state. One year earlier, she visited our hospital due to an anal mass and accompanying pain. Pelvic computed tomography (CT) scan revealed an 8.5 cm sized heterogenous enhancing mass around the anus. Multiple enlarged lymph nodes were found on both inguinal area and bilateral iliac chain (). There was no evidence of distant metastasis on fluorodeoxyglucose-positron emission tomography and computed tomography (FDG-PET/CT). For the tissue confirmation, we performed needle biopsy on the anal mass. The cells were small and round shaped on hematoxylin and eosin (H&E) stain and the mass was negative for CD3, CD20, CD79a and ETS-1, and positive for CD56, CD99 and desmin based on immunohistochemical stain. The mass was subsequently diagnosed as RMS. The patient underwent vincristine, adriamycin, and cyclophosphamide based chemotherapy. And a total of 4,500 cGy in 25 fractions of radiotherapy dose was given to the pelvis. Following treatment, FDG-PET/CT showed no uptake at the primary tumor site with complete remission state.\nUpon clinical examination, a firm, round and nontender mass was found in her left breast, measuring 3×3 cm. There was no palpable mass in the contralateral breast and both axillary areas. Breast ultrasonography showed a 2.3 cm sized circumscribed oval hyperechoic mass with central hypoechoic portion (). Core needle biopsy was consistent with RMS. Chest, abdominal, and pelvic CT scans and FDG-PET/CT were evaluated for metastatic disease. Intense FDG uptake was present in the left breast and retrocrural space at the level of L1 verterbra (). For the decreasing tumor burden, mass excision was performed. The mass was well-circumscribed and, on section, shows a pale-tan solid fleshy cut surface with focal hemorrhage. No necrosis was identified in the specimen (). The mass was composed predominantly of primitive small round blue cells which were surrounded by collagenous fibrous septa. Some cells with rhabdoid feature were also seen (H&E stain) (). Immunohistochemical stain demonstrated strong positivity for CD56, CD59 and desmin as identical to anal mass (). The breast mass was finally diagnosed as metastatic alveolar RMS based on H&E and immunohistochemical stain. The pediatric oncologist started topotecan and cyclophosphamide chemotherapy and radiation therapy. | [[18.0, 'year']] | F | {'7438025': 1, '20194946': 1, '27046981': 2, '20730885': 1, '2386920': 1, '9212842': 1, '22882949': 1, '23690411': 1, '8229139': 1, '15871711': 1, '14652147': 1, '24155766': 2} | {'4790135-1': 1, '4790135-2': 1} |
163,739 | 3800734-1 | 24,155,767 | noncomm/PMC003xxxxxx/PMC3800734.xml | Breast Carcinoma with Choriocarcinomatous Features: A Case Report | A 56-year-old woman presented with a palpable mass in the upper outer quadrant of the right breast. She had no previous history of hydatidiform moles or choriocarcinoma. Following the first radiological studies that included mammography and ultrasonography (), she was referred for staging using F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). This scan showed a soft tissue mass with low accumulation of FDG with a maximum standardized uptake value (maxSUV) of 1.98 in the right breast (). No other hypermetabolic lesion was detected in the body. Clinically, the F-18 FDG PET/CT scan revealed malignancy in the right breast. The patient underwent a right mastectomy and a biopsy of sentinel nodes. The resected tumor was 2.4 cm in diameter with relatively well-defined irregular margins (). The cut surface was partially hemorrhagic and mostly gray to whitish-in color. Microscopically, the tumor was a typical high-grade invasive ductal carcinoma with multiple foci of choriocarcinomatous features without any other metaplastic squamous or spindle cell components (). The choriocarcinomatous lesion contained highly pleomorphic tumor cells with an increased nucleus-cytoplasmic ratio, prominent nucleoli, and syncytiotrophoblast-like multinucleated giant cells. The area of choriocarcinomatous differentiation comprised approximaterly 25% of the entire invasive carcinoma. Immunohistochemically, only the choriocarcinoma-resembling tumor cells were reactive for the hCG antibody (), but negative for HER2/neu, estrogen receptor (ER), and progesterone receptor (PR). Fifty percent of the tumor cells were reactive for the Ki-67 antibody. A diagnosis of BCCF was confirmed based on IHC and histological phenotype results. The postoperative serum β-hCG level (3.18 mIU/mL) was not increased significantly, while the 4 sentinel nodes showed no metastatic deposits. | [[56.0, 'year']] | F | {'12100118': 1, '22091297': 2, '2163358': 1, '29681814': 2, '2449877': 1, '4374964': 1, '21877993': 1, '19622963': 1, '10504554': 1, '20465601': 1, '987011': 1, '15044750': 1, '21825864': 1, '18323284': 1, '6278975': 1, '15060884': 1, '24155767': 2} | {'3214386-1': 1, '5903105-1': 1} |
163,740 | 3804584-1 | 24,204,150 | noncomm/PMC003xxxxxx/PMC3804584.xml | Selegiline remarkably improved stage 5 treatment-resistant major depressive disorder: a case report | A 51-year-old man had been diagnosed with major depression 6 years prior to beginning selegiline treatment. During that time, he was treated with imipramine, a tricyclic antidepressant (TCA) (150 mg/day), and his symptoms remitted. However, although he continued medication for 4 years, his depression relapsed. Imipramine was thus replaced with milnacipran, a serotonin and noradrenalin reuptake inhibitor (150 mg/day) and then paroxetine, a selective serotonin reuptake inhibitor (40 mg/day), but those were ineffective, and he was later admitted to our hospital. Concurrent administration of amoxapine, a tetracyclic antidepressant (TeCA) (150 mg/day), lithium carbonate (800 mg/day), and cabergoline (1 mg/kg) improved his symptoms, and he was discharged. His plasma lithium concentration was 0.61 mEq/L. However, he again relapsed into depression 8 months later, despite receiving treatment. His major symptoms included fatigue, loss of motivation, and decline in work efficacy. Subsequently, he was readmitted to our hospital.\nDuring this second hospitalization, amoxapine (200 mg/day), amitriptyline, a TCA (200 mg/day), imip-ramine (250 mg/day), and clomipramine, a TCA (150 mg/ day) were consecutively used for at least 4 weeks, but none were effective. Additional lithium augmentation had no effect, and the addition of olanzapine (5 mg/day) was ineffective. Likewise, pramipexole (2.625 mg/day) induced the side effects of oral dyskinesia and auditory hyperesthesia, while the addition of triiodothyronine was stopped because of palpitations. ECT was administered ten times, and depressive symptoms disappeared transiently. However, the patient’s depression relapsed again 1.5 months later, despite the continuation of clomipramine after ECT. Selegiline (2.5 mg/day) treatment was started after he signed the informed consent form. The daily dose of selegiline was increased by 2.5 mg every week up to a maximum of 10 mg/day. Mianserin, a TeCA, (60 mg/day), and valproate (600 mg/day) were also concurrently used, but the dosages of those drugs remained constant during selegiline treatment. Before initiating selegiline treatment, the patient received a score of 19 on the 17-item Hamilton Depression Rating Scale (HDRS). During selegiline treatment, his score on the HDRS decreased to 9 points at week 8 and 4 points at week 20. He returned to work after 49 weeks of selegiline treatment. No side effects from selegiline treatment were either observed or reported. We followed up with the patient approximately 2 years and 5 months after the trial with selegiline. During this period, no relapse occurred.\nFDG-PET scans were measured twice, before selegi-line treatment and after 20 weeks of selegiline treatment. Two experienced nuclear medicine physicians visually interpreted the images. Twenty weeks after selegiline treatment, selegiline-induced enhancement of glucose metabolism was observed in the bilateral basal ganglia by FDG-PET, while decreases were shown in those in the occipital lobe (). The methods used to conduct and analyze the PET scan were as follows: a 10-minute regional static scan was performed with a Siemens ECAT HR+ scanner using the three-dimensional (3D) mode, and the image was reconstructed in the brain mode, using Siemens’ ecat software, version 7.2.2 (Siemens AG, Munich, Germany). The images were acquired via 3 minutes of transmission scanning and 10 minutes of emission scanning. The energy window was 350−650 keV. In the brain mode, the acquired 3D sonograms were converted into two-dimensional (2D) sonograms, using Fourier rebinning. The images were reconstructed using the direct inversion Fourier transformation method. We used a Hanning reconstruction filter with a 4 mm full width at half-maximum (FWHM). The reconstruction matrix was 256 × 256, and the field of view was 33 cm in diameter. The FWHM was 6.4 mm after reconstruction.\nMoreover, the patient’s plasma dopamine levels (<5 to 9 pg/mL) and urine PEA levels (<0.5 to 179.4 ng/mg CRE [creatinine]) were greater after 12 weeks of selegiline treatment compared with baseline, although the plasma HVA and noradrenalin levels were not changed. The MAO-B activity of blood platelets was nearly completely inhibited by administering selegiline 10 mg/day. | [[51.0, 'year']] | M | {'16402116': 1, '32175515': 1, '21319866': 1, '15279565': 1, '20598753': 1, '31442412': 1, '16062100': 1, '17502787': 1, '19890238': 1, '19931627': 1, '17088868': 1, '33614888': 1, '12411221': 1, '22348642': 1, '7519005': 1, '20708060': 1, '17475737': 1, '19913058': 1, '24204150': 2} | {} |
163,741 | 3804591-1 | 24,204,159 | noncomm/PMC003xxxxxx/PMC3804591.xml | VEGF is a target molecule for peritoneal metastasis and malignant ascites in gastric cancer: prognostic significance of VEGF in ascites and efficacy of anti-VEGF monoclonal antibody | Our patient was a 62-year-old female diagnosed with type 4 gastric cancer, whose clinical course has been partially reported previously by our colleague. Exploratory laparoscopy revealed severe peritoneal metastasis with malignant ascites. The patient received two cycles of S-1 plus intraperitoneal docetaxel; disappearance of her peritoneal metastasis was confirmed by second-look laparoscopy. Subsequently, the patient underwent total gastrectomy with D2 lymph node dissection which completed an R0 resection. Eighteen months after surgery, the patient’s cancer recurred and was treated with four cycles of weekly paclitaxel, while the patient suffered from symptomatic ascites requiring frequent paracenteses. Because of lack of response, the patient was administered bevacizumab monotherapy (5 mg/kg) intravenously. Despite only one administration, the patient noted an improvement in abdominal distention and required no paracenteses. After bevacizumab therapy, the patient received eight cycles of weekly paclitaxel. She died of aspiration pneumonia due to ileus (). | [[62.0, 'year']] | F | {'16015045': 1, '11579392': 1, '18282805': 1, '17121902': 1, '18561992': 1, '15250229': 1, '26597177': 1, '15274387': 1, '8608475': 1, '8119973': 1, '9777956': 1, '19502868': 1, '34298750': 1, '17114652': 1, '16797681': 1, '19329124': 1, '10026754': 1, '18036640': 1, '33616416': 1, '21544429': 1, '29863151': 1, '22202382': 1, '10779624': 1, '16515588': 1, '34198773': 1, '33793095': 1, '20740349': 1, '31667175': 1, '11749847': 1, '21844504': 1, '31498567': 1, '20033809': 1, '9565747': 1, '16767357': 1, '2479986': 1, '26621525': 1, '32724431': 1, '20041328': 1, '2478587': 1, '9607631': 1, '2910444': 1, '10640968': 1, '19918848': 1, '11857038': 1, '30210225': 1, '26855589': 1, '26087333': 1, '11093042': 1, '29385993': 1, '16086118': 1, '12131083': 1, '2758258': 1, '14572781': 1, '27597973': 1, '17075117': 1, '14654557': 1, '24204159': 2} | {} |
163,742 | 3804612-1 | 24,204,108 | noncomm/PMC003xxxxxx/PMC3804612.xml | Sensory exotropia due to keratoconus and review of the literature | We present the case of a 17-year-old boy with bilateral keratoconus, exotropia, and a nodular lesion of the bulbar conjunctiva in the left eye. A prism cover test revealed a 45 prism D exodeviation (). The aligned eye was the right eye and the keratoconus in this eye was of late onset. Vision in the left eye was poor and the keratoconus was advanced in this eye. The patient has a corrected visual acuity of 6/9 in his better and aligned eye and an acuity of 1/60 in the affected eye. Keratometric measures were 42.75 D at an axis of 28° and 49.0 D at an axis of 118° in the right eye, and 52.0 D at an axis of 154° and 58.75 D at an axis of 64° in the left eye. SimK1 was 45.24 D at an axis of 113° and Sim K2 was 42.75 D at an axis of 25° in the right eye. Sim K of the left eye could not be obtained because of a high steep keratometry value. Refraction in the right eye was +1.5, −7.5 × 25° and refraction in the left eye could not be obtained (). | [[17.0, 'year']] | M | {'20693553': 1, '18306118': 1, '298827': 1, '22040642': 1, '9493273': 1, '3920945': 1, '22406940': 1, '3934105': 1, '8224286': 1, '32982479': 2, '6811951': 1, '16491238': 1, '11520756': 1, '24204108': 2} | {'7498931-1': 1} |
163,743 | 3804653-1 | 24,167,795 | noncomm/PMC003xxxxxx/PMC3804653.xml | Two Indices Affecting the Directions of the Sylvian Fissure Dissection in Middle Cerebral Artery Bifurcation Aneurysms | A 48-year-old woman presented with drowsy mentality due to a ruptured left MCA bifurcation aneurysm. It was difficult to expose the M1 vessel for proximal control through distal to proximal sylvian fissure dissection, so she is assigned to group I. The M1 slope gap was 1.31 mm and the M1 angles was 10.2° (). We confirmed this in the intraoperative surgical view (). | [[48.0, 'year']] | F | {'12696776': 1, '17882747': 1, '7701417': 1, '8622152': 1, '22028759': 1, '8146736': 1, '17445599': 1, '30955058': 1, '9384389': 1, '33776597': 1, '24167795': 2} | {'3804653-2': 2} |
163,744 | 3804653-2 | 24,167,795 | noncomm/PMC003xxxxxx/PMC3804653.xml | Two Indices Affecting the Directions of the Sylvian Fissure Dissection in Middle Cerebral Artery Bifurcation Aneurysms | A 65-year-old woman presented with severe headache due to a ruptured right MCA bifurcation aneurysm. It was easy to expose the M1 vessel for proximal control through distal to proximal sylvian fissure dissection so she is assigned to group II. The M1 slope gap was 6.53 mm and the M1 angles was 51.7° (). We confirmed this in the intraoperative surgical view (). | [[65.0, 'year']] | F | {'12696776': 1, '17882747': 1, '7701417': 1, '8622152': 1, '22028759': 1, '8146736': 1, '17445599': 1, '30955058': 1, '9384389': 1, '33776597': 1, '24167795': 2} | {'3804653-1': 2} |
163,745 | 3804656-1 | 24,167,798 | noncomm/PMC003xxxxxx/PMC3804656.xml | Single-session Coil Embolization of Multiple Intracranial Aneurysms | A 47-year-old woman presented with a severe headache of sudden onset with a stuporous mentality (HHG III). The initial CT scan revealed diffuse SAH (Fisher grade III) in the basal cistern and dense focal intracranial hemorrhage (ICH) in the interhemispheric fissure with intraventricular hemorrhage (IVH) (). The left internal carotid angiogram demonstrated a 4.5-mm pericallosal (A2) aneurysm with a relatively wide neck and a 6-mm sized middle cerebral artery bifurcation aneurysm with a wide neck (). The right internal carotid angiogram showed a 4.5-mm sized MCA bifurcation aneurysm with a wide neck (). We decided that the left pericallosal artery aneurysm was the cause of bleeding because of its proximity to the ICH. All 3 of these aneurysms were embolized in a single procedure. Under general anesthesia, a 6F guiding catheter was placed at the left ICA. The ruptured pericallosal aneurysm was selected with a microcatheter, and 4 detachable coils were delivered into the aneurysm lumen (). After confirming complete obliteration of the pericallosal aneurysm, the left MCA bifurcation aneurysm was selected with the same microcatheter. Although the aneurysm was wide-necked, the initial coil deployed provided a stable frame for 5 additional detachable coils into the aneurysm sac. Repeated angiogram showed a nearly complete embolization of the MCA bifurcation aneurysm and good patency of the MCA (). Finally, we repositioned the same guiding catheter to the right ICA. Five detachable coils were enough for near-complete obliteration (). The course of procedure and subsequent recovery was uneventful. The patient did not experience post-procedural contrast-induced complications. A follow-up magnetic resonance angiography confirmed continued occlusion of aneurysms and wide patency of the parent arteries (). | [[47.0, 'year']] | F | {'7354892': 1, '9179887': 1, '10764255': 1, '22120339': 1, '21709595': 1, '7708165': 1, '7838326': 1, '5635959': 1, '11546888': 1, '27668108': 2, '31579341': 1, '22921040': 1, '25207907': 1, '10657411': 1, '32215085': 1, '19096540': 1, '19669689': 1, '675488': 1, '15987583': 1, '4009274': 1, '34588719': 1, '12511744': 1, '11354403': 1, '25516149': 1, '31362238': 1, '24167798': 2} | {'5030425-1': 1} |
163,746 | 3804661-1 | 24,167,803 | noncomm/PMC003xxxxxx/PMC3804661.xml | Distal Subclavian Artery Occlusion Causing Multiple Cerebral Infarcts Consequence of Retrograde Flow of a Thrombus? | A 47-year old female presented in our emergency room with a confused mentality, left side weakness, and left forearm pain. She had no relevant medical history; however, upon questioning, she revealed that she had been prescribed medication at another orthopedic clinic for left shoulder pain 2 weeks previously. Swelling and tenderness of the left forearm was noted, and blood pressure was not measurable, and no pulse was detected in the left upper limb. On the right side, blood pressure was 130/80 mmHg with a regular radial pulse of 80 beats per minute. Disorientation with respect to time and place, a slightly lethargic mental status, and left side hemiparesis with hyperreflexia and Babinski's sign were observed during neurologic examination. The routine battery of blood tests, which included electrolyte analysis, complete blood count, thyroid function test, coagulation factors, and erythrocyte sedimentation rate, did not indicate any abnormalities, except a decrease in protein S activity (48%) and an elevated erythrocyte sedimentation rate (51 cm/hr). Brain magnetic resonance imaging (MRI) with angiography showed acute infarctions in the left posterior cerebral artery (PCA) territory, right thalamus, right medial temporal lobe, and right superior cerebellar artery territory of the cerebellum with mild stenosis of the right PCA and the carotid portion of the right internal carotid artery, suggestive of an embolic source proximal to the origins of common carotid and vertebral arteries bilaterally. Normal transesophageal echocardiography and 24-hour holter monitoring were performed in order to exclude possible explanations for cerebral thromboembolism from the heart. Brachial computed tomography (CT) angiography showed occlusion of the left axillary and brachial arteries. Based on suspicion of a cerebral thromboembolism originating from the occluded subclavian artery, intravenous infusion of non-fractionated heparin was administered daily at 1000 units/h with careful monitoring of activated partial thromboplastin.\nOn day 3, the patient complained of aggravated left arm pain; her left hand was found to be cold to the touch and pale in appearance. Emergent thrombectomy was performed, resulting in rapid subsidence of the left arm pain and recovery of the left radial pulse. Pathologic examination of the thrombus revealed that it contained fibrin, blood clots, and arterial tissue, suggesting organizing thrombi. Anti-coagulant therapy with warfarin was continued postoperatively. The patient was discharged with mild left arm weakness and a left side tingling sensation. Repeat testing for protein S activity after 3 months showed a 2-fold decrease in protein S activity (20%), which was also compatible with protein S type I deficiency. | [[47.0, 'year']] | F | {'11098322': 1, '22741548': 2, '16311157': 1, '20945813': 1, '1386500': 1, '24167803': 2} | {'3475120-1': 1} |
163,747 | 3804663-1 | 24,167,805 | noncomm/PMC003xxxxxx/PMC3804663.xml | The Difference of Each Angiographic Finding After Multiple Stent According to Stent Type in Bilateral Vertebral Artery Dissection | A 55-year-old female with stupor was admitted to our hospital. A computed tomography (CT) scan with CT angiography revealed thick SAH with associated hydrocephalus and fusiform dilation of bilateral V4 VAs (). The patient underwent cerebral angiography, which revealed the presence of a bilateral V4 segment dissecting aneurysm, and a double origin posterior inferior cerebellar artery (PICA) was observed on the left side (). Each vertebral artery was similar in size. Because the hematoma showed even distribution on CT, the ruptured side could not be specified. We planned on simultaneous treatment of the bilateral lesions using the overlapping stent-alone technique.\nThe procedure was performed under local anesthesia using standard neuro-endovascular techniques. Due to the risk of rebleeding, intravenous injection of heparin was not administered at the beginning of the procedure. In order to facilitate simultaneous treatment, we opted for a transfemoral approach. On the left-sided lesion, an SES was applied because the BMS could not be advanced into the left VA due to vascular tortuosity. Two SESs (Neuroform3 stent, Boston Scientific, Voisins-le-Bretonneux, France; 4.5×20 mm) were deployed across the dissecting lesion. The guiding catheter was then repositioned at the origin of the right VA. The first BMS (Driver RX, Medtronic, Minneapolis, MN, USA; 3.5×18 mm) was deployed at the proximal end of the dissection. A second BMS (Driver RX, Medtronic, Minneapolis, MN, USA; 3.5 × 15 mm) was placed distally within the previously placed stent with a telescoping overlap of approximately 10 mm. In this fashion, the dissecting segment was covered by the 2 stents. We did not perform stent-assisted coiling because an additional coiling procedure might have risked re-rupture of the dissecting aneurysm and led to a life-threatening situation. Final images confirmed the placement of the stents across the entire length of the aneurysms (). The patient received 100 mg of oral acetyl salicylic acid daily after the initial treatment. A follow-up right VA angiography 2 months after the initial treatment showed minimal contrast filling into the pseudo lumen through the stent and showed near-complete healing of the lesion (). In contrast, a left VA angiogram showed an increase in size of the dissecting aneurysm (). The angiographic result led us to believe that the lesion on the left side was ruptured and that the SESs used on this lesion were not sufficient to induce pseudo-luminal thrombosis.\nRetreatment was performed via a transbrachial approach in order to overcome VA tortuosity. The transradial or transbrachial approach, which is the preferred approach, offers a more direct route to the ipsilateral vertebral artery in cases where the vertebral artery has a more acute angle or tortuosity.\nTherefore, based on navigation of the stent into the lesion, the transbrachial method is considered superior to the transfemoral approach because the guiding catheter can be advanced distally without increasing the risk of flow arrest. Three BMSs (FlexMaster F1 stent, Abbott, Abbott Park, IL, USA) with commercially available lengths of 19 mm, 16 mm, and 12 mm and diameters of 3.5 mm were deployed using an overlapping technique (). Evaluation of CT angiography with maximum intensity projection on the first day after retreatment showed a marked reduction in the size of the pseudolumen. A follow-up left VA angiogram 5 months after retreatment showed complete healing of the aneurysm without in-stent stenosis (). The patient recovered without any neurological deficits. | [[55.0, 'year']] | F | {'15711986': 1, '15703929': 1, '19855144': 1, '7791980': 1, '21778439': 1, '18518712': 1, '25393341': 1, '15730593': 1, '16670864': 1, '15255247': 1, '28355880': 1, '22639713': 2, '21796008': 1, '19342544': 1, '20851626': 1, '12943592': 1, '20508955': 1, '32792460': 1, '16266047': 1, '21302192': 1, '18207505': 1, '18162911': 1, '2404089': 1, '17032857': 1, '18264766': 1, '11259724': 1, '16253701': 1, '24167805': 2} | {'3358603-1': 1} |
163,748 | 3804664-1 | 24,167,806 | noncomm/PMC003xxxxxx/PMC3804664.xml | Ruptured Mycotic Aneurysm of the Distal Middle Cerebral Artery Manifesting as Subacute Subdural Hematoma | A 72-year-old male patient visited our hospital for headache and drowsiness. He slipped and suffered from blunt traumas to his head 10 days before his visit to the hospital. He showed right hemiparesis with a motor power of grade IV/V in the right upper and lower limbs. The initial Glasgow coma scale score was 12 (Eye response - 3, Verbal response - 4, Motor response - 5). He had no extracranial wounds and the vital signs were stable, but his body temperature was mildly elevated. The patient had a history of type 2 diabetes mellitus and hypertension, and he was a heavy alcoholic.\nEnhanced computer tomography (CT) of the brain showed subacute subdural hematomas on both fronto-parietal areas and an enhancing nodule in the left parietal area (). No signs of scalp contusion and skull fracture were found. CT angiography revealed that the enhancing nodule was a saccular aneurysm located at the M4 segment of the left middle cerebral artery (MCA). Cerebral angiogram showed 2 aneurysms; one located at the distal left MCA and the other at the bifurcation of the left MCA ().\nLaboratory studies revealed an elevated erythrocyte sedimentation rate (ESR, 49 mm/hr), white blood cell count (WBC, 12,990/µL) and C-reactive protein (CRP, 9.28 mg/L), but other hematological and biochemical parameters were within normal range. Blood cultures were negative and there was no evidence of infective endocarditis in the echocardiography.\nIntravenous ceftriaxone 1 g every 12 hours was started. His symptoms improved gradually over the next few days. The enhanced CT 10 days after admission revealed disappearance of the aneurysm located at the M4 segment and partial resolution of SDH (). Additional angiography was performed 20 days after antibiotic therapy. It revealed complete resolution of the aneurysm at the left distal MCA (). Antibiotics were continuously given for 4 weeks with moderate improvement of his symptoms and the patient was discharged. Because the aneurysm located at the bifurcation of the left MCA was small and had no interval change, we decided to observe it in our outpatient department. | [[72.0, 'year']] | M | {'20751186': 1, '14409147': 1, '11857942': 1, '31497128': 2, '11449712': 1, '14972429': 1, '12383359': 1, '18820172': 1, '15227610': 1, '15494903': 1, '2441289': 1, '21358398': 1, '19838745': 1, '580794': 1, '14705320': 1, '7477721': 1, '9592817': 1, '3754002': 1, '12450304': 1, '8165497': 1, '11806111': 1, '33767899': 2, '19322683': 1, '12428355': 1, '16462464': 1, '3841193': 1, '16504845': 1, '28680736': 2, '6893602': 1, '580294': 1, '16631720': 1, '28149112': 1, '18303107': 1, '6548001': 1, '10804057': 1, '28149111': 1, '17067923': 1, '17360002': 1, '24167806': 2} | {'7982092-1': 1, '6703069-1': 1, '5482160-1': 1} |
163,749 | 3804665-1 | 24,167,807 | noncomm/PMC003xxxxxx/PMC3804665.xml | Microsurgical Extraction of a Malfunctioned Pipeline Embolization Device Following Complete Deployment | A 59 year-old female presented with seizures. Computed tomography angiography (CTA) head demonstrated a giant right middle cerebral artery (MCA) aneurysm with mass effect on the adjacent frontal and temporal lobes (). The decision was made to treat the aneurysm with a flow-diverting stent. The patient underwent digital subtraction angiography (DSA), revealing a partially thrombosed, giant right MCA bifurcation aneurysm with a recanalized portion measuring 11.1×7×7 mm. A ReFlex 058 catheter (Reverse Medical, Irvine, CA, USA) was advanced through a 6 French shuttle sheath placed in the right common carotid artery (CCA) into the distal right internal carotid artery (ICA). Under continuous roadmap guidance, a Marksman microcatheter (ev3, Irvine, CA, USA) was advanced over a Transcend microguidewire (Boston Scientific, Fremont, CA, USA) through the ReFlex catheter into an M3 MCA branch distal to the aneurysm. A 3.25 × 25 mm PED was deployed through the Marksman catheter across the neck of the aneurysm.\nHowever, during deployment of the PED, its proximal edge became pinched (). After removal of the ReFlex catheter, attempts to dilate the proximal portion of the stent with a balloon were unsuccessful. After control angiograms through the guide catheter in the CCA demonstrated sluggish flow through the distal right MCA branches, the decision was made to remove the PED. However, since the deployment wire had been removed from the stent, it was no longer possible to retract the proximally pinched stent. The Marksman catheter was removed and a final control angiogram showed less delay in distal MCA flow, no thrombus formation on the stent, and no evidence of distal emboli. The patient was taken to the intensive care unit on therapeutic anticoagulation with a heparin infusion in addition to standard dual antiplatelet therapy (aspirin 325 mg and clopidogrel 75 mg daily). She awoke with a left pronator drift but was otherwise neurologically intact. However, post-procedural CT perfusion continued to show delayed flow through the right MCA.\nTherefore the patient was taken back to the neurointerventional suite the next day. Repeat DSA found thrombus formation along the proximal PED with sluggish filling of the distal MCA. An attempted thrombolysis was performed with an infusion of 10 mg of abciximab but was unsuccessful. Next, multiple attempts were made to retrieve the PED utilizing a variety of devices including Goose Neck snares (Microvena, White Bear Lake, MN, USA), an Alligator retrieval device (Chestnut Medical Technologies, Menlo Park, CA, USA), and a Merci Retriever (Concentric Medical, Mountain View, CA, USA) but they all failed. Ultimately the procedure was aborted. The final control angiogram at this point demonstrated a large, flow-limiting thrombus in the M1 trunk and very sluggish flow distally. The patient began to develop a dense left-sided hemiparesis after the failed retrieval attempt and post-procedure magnetic resonance imaging (MRI) demonstrated multiple acute right MCA distribution thromboembolic infarcts ().\nDue to the patient's deteriorating neurological exam and the inability to retrieve the partially thrombosed PED by endovascular approaches, neurosurgery was consulted and we emergently decided to take the patient for microsurgical extraction of the PED to restore flow to the MCA. Upon performing a wide right-sided craniotomy, the giant, partially thrombosed MCA aneurysm was immediately evident upon dural opening. The calcified dome was opened and intra-aneurysmal thrombus was debulked. Upon removal of the thrombus, the lumen of the MCA was exposed and the PED was easily removed (). The proximal MCA M1 segment was identified just distal to the ICA bifurcation and proximal vascular control was achieved with a temporary clip. The M2 branches were seen incorporated within the aneurysm neck. The excess aneurysm dome was resected but due to the anatomy of the neck, the opened aneurysm dome could not be reapproximated with a clip. Therefore the remainder of the aneurysm was resected, resulting in detachment of the posterior MCA M2 division from M1 trunk. The senior author (KCL) attempted to reanastamose the posterior M2 division to the M1 but due to the friable nature of the vessel walls, the 8-0 nylon suture would not hold. Given the length of time that the vessel had been occluded and the likelihood that the infarct had completed, the decision was made to abort the surgery at this time to prevent hyperperfusion injury. The clips were left in place and the bone flap was left off to allow for infarct-related edema. As expected, the patient awoke from surgery with a dense left-sided hemiplegia. The patient underwent percutaneous gastrostomy and was discharged to a rehab facility 1 week post-operatively. The patient subsequently underwent cranioplasty 2 months later with an unchanged neurological exam. | [[59.0, 'year']] | F | {'27009193': 1, '21979492': 1, '31903371': 2, '9867550': 1, '17053593': 1, '21148256': 1, '27066443': 1, '27651873': 2, '22454786': 2, '22360865': 1, '22362818': 1, '12867109': 1, '34442437': 1, '21994109': 1, '28163518': 2, '23418004': 1, '11904050': 1, '25045653': 2, '22996749': 1, '21990782': 1, '18981833': 1, '24765610': 2, '24167807': 2} | {'4102752-1': 1, '5244076-1': 1, '3997924-1': 1, '6896616-1': 1, '6896616-2': 1, '3299951-1': 1, '5028615-1': 1} |
163,750 | 3804666-1 | 24,167,808 | noncomm/PMC003xxxxxx/PMC3804666.xml | Idiopathic Lenticulostriate Artery Pseudoaneurysm Protruding into the Lateral Ventricle: A Case Report | A 28-year-old man presented with sudden onset of severe headache without any definite history of trauma. He was previously diagnosed with bipolar disorder and had been taking lithium for 3 years. Computed tomography (CT) scans revealed isolated IVH in the right lateral ventricle. An enhanced small round lesion (4.5 mm in diameter) was found on the medial surface of the right caudate nucleus by contrast CT (). The patient underwent external ventricular drainage (EVD) for the IVH. The following day, digital subtraction angiography (DSA) was performed and revealed an aneurysm arising from the distal part of the medial LSA (). Using 3-dimensional reconstruction images, the aneurysm was measured to be 7.5×4.5 mm. There was no evidence of MMD or AVM. The patient recovered without any newly developed neurological deficits and a follow-up CT scan showed complete resolution of the IVH.\nFollowing removal of the EVD catheter, the size of the aneurysm slightly decreased (4.0×2.3 mm). A short-term follow-up of the aneurysm was recommended, to which the patient agreed. However, DSA performed a month later revealed a slightly enlarged aneurysm (4.2×3.2 mm). Moreover, the shape of aneurysm was changed. Considering the risk of rebleeding, we recommended surgical treatment. Endovascular obliteration of the aneurysm was deemed impossible due to the small caliber of the LSA. Instead, the aneurysm was clipped via the interhemispheric transcallosal approach with assistance of a neuro-navigation system. The aneurysm was found in the right lateral ventricle, attached to the caudate nucleus (). To prevent injury to the caudate nucleus, we decided to clip the neck of the aneurysmal sac rather than undertake a complete resection. This was particularly important since the patient did not present any neurological deficits prior to surgery. A protruding pulsating sac partially enveloped by a hematoma was observed, and 2 aneurysm clips were successfully applied to the most proximal part of the sac (). The patient recovered well.\nDSA performed 4 days later revealed a considerable residual aneurysm sac beside the clips (). Given the risk of rebleeding, a second operation was planned for complete resection of the aneurysm. After revised craniotomy and careful dissection of the caudate nucleus, the aneurysm sac and clips were completely removed (). DSA after revised craniotomy showed no evidence of aneurysm (). Short- and long-term memory tests were performed, and memory impairment was not observed. Fortunately, the patient recovered without any neurological sequelae.\nHistopathological examination was conducted on the resected aneurysm. Hematoxylin-eosin staining revealed partially organized thrombi surrounded by a collagen wall. Examination of the vascular wall structure by elastin staining failed to show an elastin layer around the hematoma. The aneurysm was subsequently diagnosed as a pseudoaneurysm (). Since there was no evidence or history of recent head trauma, this case was regarded as idiopathic LSA pseudoaneurysm causing IVH. | [[28.0, 'year']] | M | {'17210297': 1, '7666957': 1, '18812959': 1, '3751701': 1, '22336670': 1, '22633465': 1, '28480112': 2, '30294496': 2, '11818604': 1, '10721256': 1, '11844276': 1, '31218656': 1, '23406825': 1, '19877777': 1, '20635851': 1, '3990927': 1, '24167808': 2} | {'6169348-1': 1, '5402333-1': 1} |
163,751 | 3804667-1 | 24,167,809 | noncomm/PMC003xxxxxx/PMC3804667.xml | Intraosseous Arteriovenous Malformation of the Sphenoid Bone Presenting with Orbital Symptoms Mimicking Cavernous Sinus Dural Arteriovenous Fistula: A Case Report | A 43-year-old female was referred to our hospital under the impression of a left CSDAVF. On presentation, she revealed left chemosis and proptosis that had developed ten days previously following several weeks of ipsilateral retroorbital pain and headache. She also had diplopia mainly due to ipsilateral abducens palsy. Brain magnetic resonance imaging (MRI) from the referring hospital showed a dark-signaled void lesion at the left paracavernous region and mild dilatation of the ipsilateral cavernous sinus and superior ophthalmic vein.\nOn physical examination, her right lower leg was hypertrophied with a geographic pattern of bluish cutaneous stains (). No vascular bruit was audible in the limb and she had no complaints about her leg. There was no family history of note, including no history of vascular malformations. We diagnosed our patient as KTS basis on her features.\nAngiography showed a triangular-shaped vascular chamber fed by multiple feeders of the left external carotid artery (ECA) especially from the terminal branches of the left internal maxillary artery and accessory meningeal artery (). The vascular chamber drained via the ipsilateral cavernous sinus with significant reflux into the ipsilateral superior and inferior ophthalmic veins while the inferior petrosal sinus was patent (). No additional feeder was noted on internal carotid injections and right external carotid angiography. A subsequent right femoral arteriogram showed no vascular abnormalities in her hypertrophied lower leg.\nA retrospective review of her brain MRI showed that the vascular mass corresponded with the dark-signaled mass in the left side of the sphenoid body and the medial aspect of the greater wing (). Subsequent contrast-enhanced computed tomography (CT) revealed an osteolytic space of densely enhancing vascular chamber surrounded by a sclerotic bony margin, consistent with imaging findings of an intraosseous AVM ().\nWe performed endovascular treatment with Onyx (EV3, Irvine, CA, USA) embolization to relieve her orbital symptoms. The patient was placed under general anesthesia and was heparinized. Vascular access was obtained with a 5F guiding catheter (Envoy, Cordis, Miami Lakes, FL, USA). On the super-selective angiograms of the major feeders, we found that the feeders near the vascular chamber consisted of numerous fine arteries rather than sizeable fistulas. The left accessory meningeal artery was catheterized with a dimethysulfoxide (DMSO)-compatible microcatheter (Rebar 14, EV3, Irvine, CA, USA), which was advanced to be sited in the prenidal position and successfully wedged. Following successful solidification of the reflux, the liquid embolic material (Onyx 18, EV3, Irvine, CA, USA) was injected slowly until it started to fill the draining vein. Three bottles of Oynx were injected. The post-embolization angiogram showed prominent reductions in vascularity and degree of AV shunting. The patient awakened from general anesthesia without any neurologic deficits. She was maintained on low-molecular-weight heparin during the postprocedural period. Her eye symptoms gradually resolved over 3 days and she was discharged without any complications. A 3-month follow-up angiogram demonstrated complete obliteration of the AVM (). | [[43.0, 'year']] | F | {'9443675': 1, '15905966': 1, '18216519': 1, '28210402': 1, '21663404': 1, '12374928': 1, '33767889': 1, '34408896': 2, '20651014': 1, '7931600': 1, '1537171': 1, '20404675': 1, '19246532': 1, '31811518': 1, '24167809': 2} | {'8366072-1': 1} |
163,752 | 3804668-1 | 24,167,810 | noncomm/PMC003xxxxxx/PMC3804668.xml | Giant Cystic Cerebral Cavernous Malformation with Multiple Calcification - Case Report | A right-handed, 19-year-old male was referred to the division of neurosurgery due to right sided motor weakness (grade II/II) that persisted for 3 months. Since the age of 5, the patient had been clinically diagnosed with 1st grade mental retardation and epilepsy with daily prescription medication as follows: levetiracetam 500 mg 1T twice a day (bid), valproate 600 mg 1T bid, topiramate 100 mg 1T bid, clonazepam 0.5 mg 1T per day. Also, the patient had familial history of an 18-year-old sister with an astrocytoma on her left pons, diagnosed when she was 10 years old. After a surgical resection, she fully recovered. No other family members had significant clinical history.\nThe patient's computed tomography (CT) scan revealed a well-defined cystic mass with a size of 7.2×4.6×6 cm filled with 2 cm intra-cystic nodule on left fronto-parietal lobe. There were also multiple parenchymal calcifications in both parietal lobes (). The mass was lobulated, ovoid, and bulging, and had surrounding edema with mass effect. The patient's magnetic resonance imaging (MRI) showed the mass as low signal intensity (SI) in T1-weighted images (WI), but high SI in T2WI (). The 2 cm intra-cystic nodule was heterogeneous high SI in T1WI, low SI in T2WI and slightly enhanced, heterogeneous high SI in T1-weighted contrast-enhanced coronal image (). Based on the CT and MRI findings, the lesion was diagnosed as a low-grade glioma or congenital infection such toxoplasmosis or cytomegalovirus, or even a neurocysticercosis. Surgical resection was decided upon as the course of treatment. A left frontal craniotomy was performed, followed by a transcortical approach to remove the mass. From the MRI, the T1 low SI, T2 high SI lesion in the surgical field was identified as a cyst with yellow fluid, and was removed with aspiration. The intra-cystic nodule, which was 2×2 cm in size, freely movable, relatively hard, with a yellow surface, and low vascularity, was resected en bloc. There were no significant complications or bleeding. After the operation, the patient made a rapid recovery. Motor weakness was improved to grade III/III. However, the histological exams of the mass revealed it to be a CM (). The follow-up CT scan showed no residual lesion (). | [[19.0, 'year']] | M | {'16988810': 1, '33307903': 2, '12782930': 1, '18066488': 1, '8113854': 1, '17579921': 1, '20174956': 1, '3960293': 1, '17918674': 1, '19111256': 1, '9562593': 1, '3655889': 1, '2505513': 1, '1919691': 1, '11333376': 1, '14752192': 1, '14572971': 1, '7351568': 1, '12925254': 1, '15934180': 1, '34247276': 1, '6726375': 1, '20096038': 1, '26523262': 2, '7753307': 1, '9199678': 1, '24167810': 2} | {'4626352-1': 1, '7739106-1': 1, '7739106-2': 1} |
163,753 | 3804669-1 | 24,167,811 | noncomm/PMC003xxxxxx/PMC3804669.xml | The Pterional Approach and Extradural Anterior Clinoidectomy to Clip Paraclinoid Aneurysms | A 46-year-old female presented with an incidental right paraclinoid aneurysm. The 8.66×4.81-mm aneurysm was located at the ophthalmic segment of the ICA, anteriorly and superiorly directed. The preoperative axial T2 MRI scans showed a signal void lesion near the right optic nerve. The images obtained from the digital subtraction angiography of the right carotid artery showed that the saccular aneurysm was directed medial-superiorly and compressed the right optic nerve superolateraly (). The patient experienced dizziness and diplopia. Her visual-field examination showed right inferior quadrantanopia. A decision was thus made to clip the aneurysm through decompression of the optic nerve instead of coil embolization. The 2-dimensional (2D) CT angiography showed that the ACP was an obstacle to clipping the aneurysm (). The aneurysm clipping was finished without complications. The postoperative 2D CT angiography scan shows that the entire ACP was removed, and the aneurysm was clipped with 2 15-mm straight clips (). Her visual field was much improved at an 8 months postoperative exam.\nA 42-year-old female presented with sudden-onset severe headache. The CT scan showed right-frontal-base hemorrhage. The 2D angiography showed that the aneurysm was situated in the site of the hemorrhage. The ACP was an obstacle to clipping the aneurysm (). The 3D CT angiography showed the paraclinoid internal carotid artery aneurysm directed to superolateral side (). A decision was made to clip the aneurysm through hematoma evacuation. The postoperative CT scan showed that the entire ACP was removed, and the aneurysm was clipped with 2 15-mm curved clips (). | [[46.0, 'year']] | F | {'897986': 1, '3989589': 1, '22120307': 1, '19834393': 1, '10764284': 1, '27510391': 1, '2362670': 1, '9322855': 1, '22120327': 1, '21082045': 1, '23133730': 1, '16888539': 1, '12234451': 1, '24167811': 2} | {} |
163,754 | 3804678-1 | 24,156,039 | noncomm/PMC003xxxxxx/PMC3804678.xml | Early Gastric Cancer with Neurofibroma Mimicking a Metastatic Node: A Case Report | A 72-year-old woman, with no history of neurofibromatosis or other systemic disease, was referred to Chosun University Hospital (Gwangju, Korea) for EGC. She had undergone laparoscopic cholecystectomy several years previously.\nAbdominal computed tomography did not show the gastric tumor lesion but revealed a well-defined, 1.6 cm sized ovoid retroperitoneal mass located posterior to the duodenum (). Before her operation, she was diagnosed as EGC with distant nodal metastasis posterior to the duodenum.\nThe patient was placed in the supine position under general anesthesia. An operator and scopist stood to the right side of the patient, and an assistant surgeon stood to the left of the patient. A total of 5 trocars (two 12-mm trocars and three 5-mm trocars) were used. The first dissection began with the mobilization of the duodenum from hepatoduodenal ligament and right gastrocolic ligament. An assistant retracted the duodenum left laterally, and an operator dissected between the pancreaticoduodenal unit and inferior vena cava (IVC) and right renal vein. The mass was easily exposed by a sharp dissection and removed (). Several vessels from the mass to the IVC were ligated by the LigaSure™ vessel sealing system (Valleylab, Boulder, CO, USA).\nFrozen biopsy reported that there was no adenocarcinoma component. After this report, laparoscopic distal gastrectomy with gastrojejunstomy was performed. Operative time was 3 hours and 40 minutes.\nThe final pathological diagnosis was a gastric adenocarcinoma that invaded a mucosa (T1a) without nodal metastasis (0/20, N0) and neurofibroma with immunohistochemical stains positive for S-100 protein (). | [[72.0, 'year']] | F | {'18581590': 1, '11957040': 1, '19390927': 1, '12533638': 1, '17917741': 1, '18535773': 1, '17613201': 1, '15665570': 1, '16538053': 1, '21768233': 1, '16917863': 1, '18669424': 1, '29426349': 2, '14714257': 1, '11504376': 1, '24156039': 2} | {'5807732-1': 1} |
163,755 | 3804679-1 | 24,156,040 | noncomm/PMC003xxxxxx/PMC3804679.xml | Laparoscopic Total Gastrectomy in a Gastric Cancer Patient with Intestinal Malrotation | A 44-year-old male was diagnosed with early gastric cancer on a routine health evaluation. Physical examination was unremarkable, and laboratory findings showed no abnormalities. He had no abdominal pain, nausea, or vomiting. He did not receive any previous abdominal surgery. Esophagogastroduodenoscopy revealed gastric cancer at the upper body of the stomach (). Contrast-enhanced computed tomography showed no demonstrable mass in the stomach. Additionally, incidental intestinal malrotation was revealed (). He was scheduled for laparoscopic surgery after obtaining informed consent for the procedure.\nAfter general endotracheal anesthesia was induced, an infraumbilical incision was made, and a 10-mm trocar was introduced into the peritoneal cavity using an open technique. Pneumoperitoneum was established, and other trocars were inserted under direct vision in the superior parts of the left upper quadrant (left upper port, 5 mm), right upper quadrant (right upper port, 5 mm), left flank (left lower port, 12 mm), and right flank (right lower port, 12 mm) of the abdomen. The locations of the trocars were the same as in other total gastrectomies performed at our institution. The operation was performed as previously described, with slight modification., The greater omentum was divided and dissected toward the lower pole of the spleen. The left gastroepiploic vessels and short gastric arteries were isolated and ligated. After dissection of the head of the pancreas, the right gastroepiploic vessels were ligated and divided. After ligation of right gastric artery, the duodenum was transected with a linear stapler. The left gastric vessels were exposed and divided for adequate lymph node dissection. Lymph nodes along the splenic vessels were cleared. After two laparoscopic bulldog clamps were applied on the distal esophagus, the esophagus was transected with an energy device. We used nonabsorbable 2-0 thickness monofilament with grasper and needle driver for purse string suture. After the purse-string suture at the esophagus was completed, the jejunum was identified under direct vision for the esophagojejunostomy. The small bowel was located on the right side of the abdomen, and the ligament of Treitz was absent (). The appendix and colon were found on the left side of the patient (). There were no Ladd's band and no vascular anomaly while preparing jejunal limb. Due to the altered small bowel configuration, we modified the minilaparotomy site. We extended the right lower port site up to 3.5 cm rather than in the usual left lower port site to account for the intestinal malrotation. The previously identified jejunum was brought out and transected with a linear stapler. A jejunojejunostomy was made 50 cm distal to the tentative esophagojejunostomy site. A circular stapler was inserted into the transected jejunum. After extracorporeal installation of anvil to the circular stapler, the prepared jejunum with circular stapler were introduced into the peritoneal cavity (). When the anvil was inserted in the esophagus appropriately, a previously made pursestring suture was tied, and a circular stapler was fired. The jejunal stump was closed with a linear stapler. The jejunojejunostomy remained in the right upper quadrant. The Roux limb was brought up in a 'reverse C fashion' due to the abnormal anatomy (). We did not perform appendectomy. The patient recovered without any complications. He was discharged on postoperative day 5. At the six-month outpatient follow-up, he was recovering well and tolerating a regular diet (). | [[44.0, 'year']] | M | {'17674943': 1, '16151680': 1, '18656040': 1, '19715803': 1, '21003936': 1, '2382946': 1, '15454150': 1, '23539255': 1, '28315152': 1, '30911866': 2, '2273427': 1, '22170319': 1, '31157800': 1, '1273757': 1, '23200796': 1, '804277': 1, '24156040': 2} | {'6433996-1': 1} |
163,756 | 3804680-1 | 24,156,041 | noncomm/PMC003xxxxxx/PMC3804680.xml | Gastrointestinal Stromal Tumor with Extensive Lymphatic Metastasis: A Case Report | A 53-year-old male cadaver was donated to our laboratory. He was 175 cm tall and weighed 80 kg. The cause of death was acute myocardial infarction. There was no evidence of trauma or surgery. During an autopsy, the authors observed morphological features and distribution of the tumors and took photographs. The histological samples were obtained and analysed by hematoxylin-eosin stain and immunohistochemistry and then consulted with pathologist on the microscopic findings of the tumors.\nAfter the opening of the anterior abdominal wall and peritoneum, a large number of round and various-sized tumors (0.5~2.4 cm in diameter) were exposed on the greater omentum (). The superior part of the greater omentum was stuck in the right iliac fossa and adhered to adjacent peritoneal surfaces. The authors examined the intestinal loop following the removal of the greater omentum, and then the first primary mass was detected on the ileum at 90 cm proximal to the ileocecal junction. The mass was 6.1×3.4×4.0 cm sized. It was firm and adhered to adjacent parietal peritoneum and the greater omentum. A cutting plane of the mass was bright brown coloured and the cavity of the central necrosis was open to the lumen of the intestine (). The second primary mass was detected at the middle of the small intestinal loop and 3.7×4.2×3.2 cm sized (). It was adhered to adjacent small bowel and its cutting plane was bright brown coloured. The small foci of the central necrosis and a pattern of swirl were also observed on cutting planes. Moreover, a lot of mesenteric and iliac lymph nodes were enlarged.\nThe tumor mass lied within the tunica muscularis of the intestinal wall and there was no evidence of mucosal invasion. The tumor cells were spindle-shaped and densely packed in swirling pattern. The cytoplasm of the cells were eosinophilic and the nucleus did not show distinct mitotic figure. Lymphatic spread was confirmed by identification of the subcapsular lymphatic sinus within the pathologic samples obtained from the greater omentum, mesentery, and posterior abdominal wall (). The CD117 antigen was negative and the CD34 was partially positive in immunohistochemical assay (). The desmin and the S-100 protein were not detected. Consequently, the authors diagnosed this tumor as the GIST with lymph node metastasis on the basis of the diagnostic guide of Hirota and Isozaki. | [[53.0, 'year']] | M | {'11719439': 1, '11243536': 1, '12094370': 1, '10448591': 1, '10534170': 1, '16398673': 1, '15599299': 1, '15123459': 1, '10199467': 1, '11034250': 1, '11456049': 1, '24156041': 2} | {} |
163,757 | 3804736-1 | 24,155,683 | noncomm/PMC003xxxxxx/PMC3804736.xml | A Rare Presentation of Follicular Lymphoma: Cerebellar Involvement, Successfully Treated with a Combination of Radiotherapy and Chemotherapy | A 57-year-old male patient was referred to the Department of Internal Medicine with complaints of dizziness, dyspnea and respiratory distress when conducting daytime activities. The patient also had unexplained fever over 38℃, sweating and loss of several kilograms in 5-months, which are B symptoms of lymphomas. A plain chest radiography revealed massive bilateral pleural effusion and the thoracentesis fluid represented chylothorax. Computed tomography of the thorax, abdomen and pelvic areas showed bilaterally enlarged multiple conglomerated lymph nodes in the anterior and posterior cervical, supraclavicular, mediastinal, axillary, paraaortic, and inguinal regions. A biopsy of the supraclavicular lymph node revealed grade 2 follicular lymphoma (). The tumor cells stained positive for CD20, CD10, bcl-2, and bcl-6, which is concordant with the B-germinal center cell phenotype. A bone marrow biopsy showed paratrabecular lymphoid infiltration of the B-cell phenotype, which is also consistent with follicular lymphoma infiltration. Based on these findings, the case was classified as stage IV-B disease according to the American Joint Committee on Cancer (AJCC) staging []. Therefore, according to our institutional chemotherapy regimen for B-cell lymphomas including follicular lymphoma, we administered six courses of rituximab-based cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) chemotherapy. The patient achieved complete response according to the Response Evaluation Criteria in Solid Tumors (RECIST) criteria [] and was followed up regularly every three months for one year, until he applied again with complaints of painless left cervical swelling, dizziness and disequilibrium progressing over a six-week period. He did not experience any contributing symptoms such as vomiting, headache or fever. His physical examination, including neurological and ear systems and vital signs, were inconclusive. Plasma levels of the metabolic parameters including fasting glucose, serum electrolytes and liver and renal function tests were within normal ranges. F-18 fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography revealed a right cerebellar diffuse intensity and left supraclavicular lymph nodes with high maximum standardized uptake value (SUV max) uptake levels of 11.3 and 12.3, respectively (). Moreover, lesser degrees of FDG uptake were detected in inferior cervical lymph nodes, the right mastoid antrum and left supraspinatus muscle regions. Excisional biopsy of one of the left cervical lymph nodes showed grade 2 follicular lymphoma as previously described. These clinical and pathological findings were consistent with relapse of the primary disease. Brain magnetic resonance imaging showed a homogeneously-contrasted lesion, with a maximum diameter of 1.5 cm and isointense appearence of gray matter, involving the dural surface completely on posterior, inferior, and lateral regions of the right cerebellum. Internal contours of the lesion were rough and extended into the cerebellar sulcus. There were also milimetric nonspecific gliotic focuses on both areas of frontoparietal subcortical white matter on the magnetic resonance image (). Taken together, these findings led to a diagnosis of concurrent dural and lepto-meningeal involvement. Therefore, a second-line chemotherapy regimen consisting of 350 mg/m2 rituximab on day 1, 20 mg/m2 fludarabine on days 1 to 3 and 240 mg/m2 cyclophosphamide on days 1 to 3 was started. Whole brain radiotherapy was sequentially administered at a dose of 300 cGy and was scheduled for 10×300 cGy. During the first-year follow-up period, the patient's symptoms and complaints were completely resolved and this case was assessed as a complete response according to the RECIST criteria []. | [[57.0, 'year']] | M | {'3574856': 1, '15642707': 1, '10830740': 1, '16720183': 1, '7059915': 1, '8990144': 1, '11556690': 1, '17203594': 1, '17645243': 1, '19097774': 1, '10974623': 1, '16955025': 1, '12587792': 1, '29108238': 1, '826017': 1, '30046502': 2, '25544910': 2, '24155683': 2} | {'6038588-1': 1, '4269308-1': 1} |
163,758 | 3804737-1 | 24,155,684 | noncomm/PMC003xxxxxx/PMC3804737.xml | Angiomatoid Fibrous Histiocytoma as a Second Tumor in a Young Adult with Testicular Cancer | A 27-year-old man was admitted with a palpable abdominal mass in May 2009. Chest and abdominopelvic computed tomography (CT) scan showed enlarged para-aortic lymph nodes measuring 9 cm in size, including supraclavicular, mediastinal, and abdominal lymph nodes. Multiple liver and lung metastases were also observed. Levels of serum beta-human chorionic gonadotrophin (beta-hCG), alpha-fetoprotein (AFP), and serum lactate dehydrogenase (LDH) were elevated (beta-hCG, 175,910 mIU/mL; AFP, 109.5 ng/mL; LDH, 475 IU/L). A positron emission tomography (PET)-CT scan showed multiple areas of strong fluorodeoxyglucose (FDG) uptake in the aforementioned lesions. Percutaneous lung biopsy for metastasis confirmed the histological diagnosis of seminoma. Ultrasonography of the testis showed a diffuse infiltrative lesion of the right testis. The patient underwent right orchiectomy. Pathologic examination also revealed a seminoma. Although the diagnosis of seminoma was confirmed in lung and orchiectomy specimens, because of the elevated level of AFP, it was considered to be mixed germ cell tumor (GCT) with seminoma. Based on chest CT, abdominopelvic CT, PET scan, and tumor markers, the patient's state corresponded to stage IIIC and the high risk group according to the American Joint Committee of Cancer (AJCC) staging system and International Germ Cell Cancer Collaborative Group (IGCCCG) classification. After undergoing right orchiectomy, he received primary chemotherapy with bleomycin, etoposide, and cisplatin (BEP). After four cycles of BEP (July 2009), on the subsequent chest and abdominopelvic CT scan, metastatic nodules in the lung and liver had almost disappeared. However, the mediastinal and para-aortic lymph nodes, which had obviously decreased in size, were still evident. The largest residual mass was a para-aortic lymph node, which was seen as a thin-walled, cystic mass, measuring 3.2 cm×2.3 cm. A follow-up PET-CT scan showed no FDG uptake in the residual masses. Levels of beta-hCG, AFP, and LDH were normalized. According to the guidelines, surgical resection should be performed at all sites of residual mass. However, due to the presence of multiple lesions, which were scattered throughout the thorax and abdomen, removal of all residual masses was impossible. Therefore, the patient received two additional cycles of etoposide and cisplatin (EP) and the treatment was completed. Chest CT, abdomen CT, and PET-CT showed no significant change in the residual masses and no newly developed lesions were observed during the following year. At 16 months after chemotherapy (December 2010), a mass in the left supraclavicular area was observed on follow-up neck CT. The mass was a well-defined enhancing lesion with an internal necrotic or cystic component measuring 3×2.2×2 cm in size (). This lesion did not show FDG uptake on PET-CT (). The other residual masses had decreased in size. The levels of all tumor markers were consistently within normal limits (beta-hCG, <0.1 mIU/mL; AFP, 3.3 ng/mL; LDH, 171 IU/L). The supraclavicular mass, which had been growing for the last three months, was suspected of being metastatic and was surgically resected. Histological examination revealed a subcutaneous, fibrohistiocytic proliferation with cystic spaces and a pseudocapsule, surrounded by lymphoid tissue (). At high power, the tumor cells were spindle or epithelioid in shape, and were arranged in a nodular pattern (). In immunohistochemical staining, the tumor cells were positive for CD68 () and desmin (focal) (), and negative for epithelial membrane antigen, S-100, CD34, and human melanoma black 45. Based on the morphology and results of immunohistochemical staining, a diagnosis of AFH was made. He did not receive subsequent chemotherapy or radiation therapy. Relapse of the tumor did not occur within 12 months. | [[27.0, 'year']] | M | {'18094413': 1, '19018083': 1, '16174857': 1, '228836': 1, '26162466': 1, '10571514': 1, '2174650': 1, '15837411': 1, '18376290': 1, '14684503': 1, '11063792': 1, '9121405': 1, '2170972': 1, '10735967': 1, '15884099': 1, '8792977': 1, '24155684': 2} | {} |
163,759 | 3804738-1 | 24,155,685 | noncomm/PMC003xxxxxx/PMC3804738.xml | Successful Treatment by Chemotherapy of Pineal Parenchymal Tumor with Intermediate Differentiation: A Case Report | A 37-year-old male visited a clinic due to a headache and dizziness in December 2010. There was no distinguishable observation in his past history, physical examination, and laboratory tests. In addition, the head-up-tilt-table test and video eyeball exam showed no obvious abnormalities. Computed tomography (CT) of his brain was performed and a mass measuring 2.5 cm in size was observed in the midbrain and obstructive hydrocephalus. The tumor showed intermediate enhancement in T1-weighted magnetic resonance (MR) imaging and a high intensity of enhancement in T2-weighted MR (). Differential diagnosis based on MR imaging included germinoma, PPT, and glial tumor. Neurosurgeons performed an immediate occipital craniotomy and partial removal of the tumor in 2010. Histological diagnosis concluded that the mass was a PPT with intermediate differentiation. The majority of the tumor tissue consisted of small hyperchromatic cells with moderately increased cellularity and a high nuclear to cytoplasmic ratio. The tumor cells showed some atypical mitosis but rarely exhibited mitotic activity. A clear Homer Wright rosette, many of which have been termed "pineocytomatous resettes" was not found (). Diffuse staining for neuron specific enolase and focal staining for synaptophysin were observed, while the immunohistochemistry analysis showed very little glial fibrillary acidic protein (GFAP) staining. Such a focal staining pattern of synaptophysin staining in the pineal region neoplasm, coupled with the lack of GFAP staining was most consistent with a PPT ().\nHe underwent irradiation with 54 Gy of radiation on 27 fractions for removal of the remaining tumor for approximately one month after surgery. However, a remnant mass in the superoposterior aspect of the midbrain had extended to the hypothalamus and the third ventricle approximately five months after the operation. MR imaging showed leptomeningeal enhancement in the infratentorial fossa, indicating tumor cell seeding. (). He was referred to the department of medical oncology for palliative chemotherapy and was treated with a procarbazine, lomustine, vincristine (PCV) regimen one month later. The size of the remaining tumor in the midbrain and the leptomeningeal enhancement was reduced in the follow-up brain MR imaging. Two months later, after the sixth cycle of PCV chemotherapy, no evidence of the tumor was observed in the brain MR imaging (). No additional signs of a tumor were observed in the latest follow-up imaging, which was performed approximately 20 months after the initial diagnosis. The patient was free of any signs of recurrence without any neurological deficits six months after the end of treatment. | [[37.0, 'year']] | M | {'25963154': 1, '22362162': 1, '8334641': 1, '16708548': 1, '8348511': 1, '7688912': 1, '7751882': 1, '10705018': 1, '25977909': 2, '16904896': 1, '10732440': 1, '7753001': 1, '19170892': 1, '9840380': 1, '12775745': 1, '10668895': 1, '27226060': 1, '24155685': 2} | {'4426279-1': 1} |
163,760 | 3804803-1 | 24,179,640 | noncomm/PMC003xxxxxx/PMC3804803.xml | Radiotherapy for Metastatic Fibrolamellar Hepatocellular Carcinoma | A 28-year-old Caucasian female presented to her local urgent care center with flu-like symptoms and fatigue. On physical exam, an abdominal mass was palpated, prompting a computed tomography (CT) scan of her abdomen. A large, heterogenous enhancing mass with central low attenuation change was discovered in the left liver lobe. She later indicated that she had felt abdominal fullness and pain in the left upper quadrant, but denied constitutional symptoms, jaundice, or pruritis. The patient had a significant family history for ovarian, lung, prostate, and breast cancer. She had a 10 year history of smoking one pack per week. Testing for Hepatitis B and C were both negative. The patient’s presenting lab values included AFP 7.8 ng/mL, alkaline phosphatase 115, AST 72, ALT 124, total/direct bilirubin 0.9/0.2, Na 139, K 4.2, Platelets 400, and INR 1.0. Biopsy of the mass confirmed a grade 1-2 FLHCC and chest imaging did not reveal any metastases.\nThe patient underwent a left lateral liver resection to remove the 11.7×9.8×6.1 cm FLHCC mass. The surgical margins were negative with no evidence of vascular invasion; however, three out of six hepatic artery and periportal lymph nodes were positive for FLHCC. Following resection, the patient did not receive chemotherapy. Three months after the operation, her AFP levels had declined to <0.8 ng/mL and imaging was negative for metastatic disease. During the seventeen months following the liver resection, the patient had two separate surgical interventions to remove growing abdominal and thoracic lymph nodes and masses. At twenty-two months following the liver resection, the patient noted a cough and was found to have a new, large (2.6×2.3 cm), right hilar lymph node as well as old and new pulmonary nodules. At this time, radiation oncology was consulted to treat the right hilar lymph node. She was not deemed a suitable candidate for definitive radiation treatment at that time, due to the numerous enlarging areas of metastatic disease and the lack of symptoms from the hilar metastasis. After three months of watching, the right hilar node decreased in size, but multiple subpleural and subcarinal nodules arose, and a perigastric lymph node continued to grow slightly. The patient decided to not pursue treatment at that time and decided to watch and wait. Three months later CT imaging showed significant growth of the sub-pleural nodules and right hilar nodules with maintenance of the subcarinal lymph nodes. The patient continued to decline standard treatments.\nFour months later, the pulmonary nodules had grown significantly large (one measured 6×10 cm) as well as a lymph node on the gastrohepatic ligament (). The patient began to have symptoms of a dry cough and shortness of breath due to mass effect and invasion of the chest wall. At this time, we began palliative radiation treatment of the pulmonary metastasis with 40 Gy in ten fractions over a thirteen day time period (). The patient tolerated the radiation therapy well and began capecitabine and interferon alfa-2b therapy eight days after the radiation treatment. She developed symptoms consistent with radiation pneumonitis approximately 85 days after treatment, which resolved with prednisone.\nThe FLHCC pulmonary metastases showed a remarkable response to the radiation treatment. We utilized Eclipse software to contour and record dimensions and volumes for the treated metastatic tumor. According to the RECIST criteria, the patient was classified as a partial response. Measurements of the treated metastatic right lung mass pre-treatment resulted in a maximal left-right (LR) diameter of 9.1 cm, a maximal anterior-posterior (AP) diameter of 10.6 cm, a maximal superior-inferior (SI) diameter of 14.0 cm, and a volume of 538 cm3 (). At four months post-treatment, the mass measured LR diameter 7.6 cm, AP diameter 5.6 cm, SI diameter 9.1 cm, and volume 100 cm3 (), and at six months post-treatment, the mass measured LR diameter 7.6 cm, AP diameter 5.8 cm, SI diameter 8.5 cm, and volume 75.8 cm3 (). These changes constitute a 81.4% and 85.9% decrease in tumor volume and a 35.0% and 39.3% decrease in the longest diameter (SI diameter) at four and six months respectively. The effect was exclusive to the treated pulmonary metastases treated with radiation. Other known metastatic lesions progressed during the chemotherapy suggesting the response was due primarily to the radiotherapy. Unfortunately the patient continued to develop pulmonary metastases ( and ). Due to the prior pneumonitis, radiotherapy had been held and chemotherapy was used to treat the progressive disease. The response in the treated metastases had been durable during the 6 months of follow-up ( and ). | [[28.0, 'year']] | F | {'29468286': 2, '27508204': 1, '8147605': 1, '13282629': 1, '21344351': 1, '19638962': 1, '20224721': 1, '33088374': 1, '19097774': 1, '19144491': 1, '26990031': 1, '8553667': 1, '10025374': 1, '24179640': 2} | {'5876273-1': 1} |
163,761 | 3804804-1 | 24,179,641 | noncomm/PMC003xxxxxx/PMC3804804.xml | Cardiac Metastasis in Renal Cell Carcinoma without Vena Cava or Atrial Involvement: an Unusual Presentation of Metastatic Disease | A 70 year old gentleman underwent left-sided nephrectomy for limited-stage clear cell renal cell carcinoma (ccRCC). More than 20 years later, a chest computed tomography (CT) scan incidentally revealed the presence of a large solid mass in the left ventricle. The patient exhibited no specific signs or symptoms of cardiac involvement and had an excellent performance status. Echocardiogram demonstrated a mass in close proximity to the mitral annulus, with preserved mitral valve function and left ventricular ejection fraction. Cardiac magnetic resonance imaging (MRI) confirmed the finding of a posterior mass measuring 5.5×3.9×34.8 cm in the left ventricle which involved the full thickness of the myocardium from the endocardial surface to the pericardium, causing moderate dyskinesia of the left ventricular wall. Subsequent staging studies confirmed isolated cardiac involvement, with no evidence of metastatic disease elsewhere, and surgical resection of the mass via median sternotomy and institution of cardiopulmonary bypass was planned. However, intraoperatively, the mass was found to be highly vascular and interdigitated with normal myocardium, and was deemed unresectable. An open biopsy was performed, and pathological evaluation was consistent with metastatic clear cell renal cell carcinoma. Given the location of the mass and its involvement of the full thickness of the left ventricle, the potential unforeseen risks of ventricular wall necrosis with either external beam or stereotactic body radiation therapy (SBRT), as well as systemic targeted therapy were discussed with the patient, who elected watchful waiting.\nFive months later, he was found to have significant enlargement of the ventricular mass based on repeat imaging studies (7.1×4.4×4.3 cm), though he continued to remain asymptomatic. Treatment with weekly temsirolimus was subsequently initiated and was well tolerated. However, approximately five months later, the patient developed metastatic bone disease and underwent palliative radiation therapy for a symptomatic lytic lesion of the proximal right humerus. Therefore, although the cardiac mass had remained stable on targeted therapy with temsirolimus, it was felt that a change in systemic therapy was warranted given the rapid progression of bony metastatic disease. The patient was subsequently initiated on treatment with pazopanib at 800 mg daily, which was poorly tolerated with persistent transaminitis despite a decrease in dose to 200 mg daily, so the drug was eventually discontinued 3 months later. Subsequently, therapy was changed to sunitinib which has been well tolerated with evidence of stable disease for the last 7 months. Since initiation of systemic therapy, serial MRIs have shown remarkable stability in the size of the ventricular mass, with gradual development of central necrosis (). | [[70.0, 'year']] | M | {'17590846': 1, '3553111': 1, '20100962': 1, '21789121': 1, '16330672': 1, '17538086': 1, '25193011': 2, '7598599': 1, '18279399': 1, '12934772': 1, '9972905': 1, '31440470': 2, '31363405': 2, '26893801': 1, '22056247': 1, '18156031': 1, '21810682': 1, '20028918': 1, '19144884': 1, '21514065': 1, '8215825': 1, '17151773': 1, '25232327': 1, '19487381': 1, '15044878': 1, '19436786': 1, '16684070': 1, '8540447': 1, '33794918': 2, '30687063': 1, '33903838': 2, '8254792': 1, '17215530': 1, '24179641': 2} | {'4158341-1': 1, '8063158-1': 1, '6619468-1': 1, '8015162-1': 1, '8015162-2': 1, '8015162-3': 1, '8015162-4': 1, '8015162-5': 1, '8015162-6': 1, '8015162-7': 1, '6694747-1': 1} |
163,762 | 3804805-1 | 24,179,642 | noncomm/PMC003xxxxxx/PMC3804805.xml | An Oncocytic Variant of Intraductal Papillary Neoplasm of the Bile Duct that Formed a Giant Hepatic Cyst | The patient, a 59-year old man, was admitted with a complaint of abdominal fullness and early satiety and a 30x25 cm cystic mass in the right hepatic lobe, demonstrated on computed tomography (CT) (). The cyst was simple and without malignant features such as septations or wall thickening. On magnetic resonance imaging (MRI), the signal pattern of the cystic contents had low signal intensity on T1-weighted images () and high intensity on T2-weighted images (). No septations or wall thickening was evident on MRI. Abdominal angiography demonstrated no vascularization in the cyst wall. The tumor markers CA19-9, CA125, AFP and PIVKA-II were all normal. An 18F-fluorodeoxyglucose positron emission tomography scan (FDG-PET) demonstrated an FDG avid area in the cyst wall (). Collectively, these findings were consistent with a low risk of malignancy, as the mass was suspected to be a hepatic cyst. As the patient was highly symptomatic, the decision was made to proceed with fenestration. Laparotomy exposed the cyst which was covering the epigastrium (). The cyst was opened and a small excrescence was present in the area corresponding to the hypermetabolic area on FDG-PET (). This tissue was removed and evaluated by frozen section. Cellular atypia was present; however, no malignancy was identified. The remainder of the cyst wall appeared unremarkable. The patient had an uncomplicated course and was discharged home on Day 15 post surgery. Pathological examination showed most of the cyst wall was composed of a fibrotic tissue (). However, in the permanent sections using frozen tissue for intraoperative diagnosis, papillary proliferation of atypical cells with enlarged nuclei was observed (). The rate of proliferation (MIB-1 index) of these atypical cells was 47%, which suggested that the cystic lesion was possibly malignant. On histology, a biliary cystadenocarcinoma of the oncocytic type or an intraductal papillary neoplasm of the bile duct was suspected. FDG avidity was not detected in the residual cyst following the surgery. Therefore, the patient remained under observation.\nEight months post surgery, FDG uptake was again noted in the residual cyst. A partial hepatectomy encompassing the cyst and hepatic right middle lobe was performed (). The patient had an uncomplicated post-operative course and was discharged home on Day 15 post surgery. Pathological examination demonstrated papillary atypical epithelium lining portions of the cyst wall () which was contiguous with the normal bile duct epithelium (), indicating that the cyst originated in the biliary tree. The tumor cells again displayed oxyphilic granular cytoplasm. As there was no evidence of invasion, the diagnosis was an oncocytic variant of high-grade dysplasia from an IPNB. The patient had no evidence of recurrence on either CT or FDG-PET for 40 months. | [[59.0, 'year']] | M | {'11711897': 1, '1369804': 1, '18636656': 1, '19944406': 1, '11343227': 1, '15972051': 1, '19540556': 1, '16360234': 1, '33317146': 1, '19589423': 1, '15849506': 1, '11584359': 1, '21191517': 1, '26604656': 1, '14720143': 1, '12412172': 1, '20035356': 1, '18626437': 1, '32011460': 2, '8239774': 1, '30049183': 1, '21160963': 1, '22504729': 1, '19322511': 1, '29951366': 1, '24179642': 2} | {'7220086-1': 1} |
163,763 | 3804807-1 | 24,179,644 | noncomm/PMC003xxxxxx/PMC3804807.xml | Combined Modalities Treatment of Pulmonary Metastasis from an Urachal Adenocarcinoma | A 37-year old man, non-smoker, underwent a partial cystectomy with resection of urachus and umbilicus in 2002 for a mucinous urachal adenocarcinoma. Thoracic and abdominal computed tomography (CT) scan showed no abnormalities. Four years later, he was referred for multiple lung nodules (in the middle lobe, the right upper lobe, and left lower lobe) without any other visceral lesion (). There was no deterioration in performance status, and no symptom. Bronchoscopy showed no anomaly and no histological diagnosis was obtained. There was no evidence of infectious disease. A surgical removal of the right upper lobe nodule was performed by axillary thoracotomy. Pathological findings confirmed metastasis of the urachal adenocarcinoma. The patient was treated with chemotherapy consisting of three courses on Day 1 and Day 14 of 5-fluorouracil 400 mg/m2 as intravenous (i.v.) bolus followed by 2400 mg as i.v. continuous injection over 46 h and irinotecan 90 mg/m2. Tolerance was acceptable, despite a grade 2 neutropenia. CT scan showed lung nodules had almost disappeared. Four months later, the disease progressed with increasing size of the previously described lung nodules. Three cycles of chemotherapy with the same drugs were administered, with an acceptable clinical tolerance; due to a persistant neutropenia, chemotherapy was administered on Day 1 and Day 21 instead of Day 1 and Day 14 and the patient had to receive granulocyte colony-stimulating factor (G-CSF). There was then a small regression of the nodules, with persistent activity on PET scan on the right lower lobe nodule. A surgical approach was decided, and a metastasectomy (in the right upper and lower lobes) was performed. Two months later, a CT scan showed two new nodules, one on the left upper lobe and one on the left lower lobe () with a high metabolic activity on PET scan. The same chemotherapy was administered to the patient. After four cycles, the disease was stable, with decreased activity on PET scan. A surgical removal of the metastases was performed, with a wedge resection of the anterior part of the left basal pyramid and metastasectomy in the anterior part of the left upper lobe. During follow up, six months later, another PET scan showed a new nodule in the right lower lobe and a new mass on the right upper lobe, with parietal involvement (); a CT-guided transparietal biopsy of this mass confirmed the recurrence of the urachal carcinoma. Chemotherapy was administered, consisting of three courses on Day 1 and Day 14 of 5-fluorouracil 400 mg/m2 as i.v. bolus followed by 1200 mg as i.v. continuous injection over 46 h, irinotecan 90 mg/m2 and bevacizumab 5 mg/kg. Tolerance was fair with mild vomiting and no changes in hematologic parameters. The disease was stable. Three courses of chemotherapy with an association of capecitabine 2000 mg/m2/day from Day 1 to Day 14 and oxaliplatin 130 mg/m2 on Day 1and Day 21, with grade 3 nausea and vomiting, were administrated. There was a slight decrease in the metabolism intensity of the metastases on PET scan. Surgery (right pneumonectomy with rib resection) was proposed to the patient. The patient died during surgery because of hemorrhagic shock due to a pulmonary artery wound, in June 2009, seven years after the diagnosis of urachal carcinoma, and three years after appearance of metastases. | [[37.0, 'year']] | M | {'25337842': 1, '17499279': 1, '22271499': 1, '16697798': 1, '17181485': 1, '22532915': 1, '11549502': 1, '18786207': 1, '12629346': 1, '21381016': 1, '16826585': 1, '22396380': 1, '19252435': 1, '17932892': 1, '22901574': 1, '17115389': 1, '8256396': 1, '24179644': 2} | {} |
163,764 | 3804808-1 | 24,179,645 | noncomm/PMC003xxxxxx/PMC3804808.xml | A Rare Location for a Common Bone Tumor, Meta-Diaphyseal Giant Cell Tumor of Bone in an Adult Patient | A 46 years old otherwise healthy female patient was referred to our clinic because of a bone lesion in her left femur. She noticed deep aching pain in her left thigh two months earlier. She denied any history of trauma or any febrile episode during that period. The patient was seen by different physicians and finally an orthopedic surgeon did order a plain X-ray that showed a destructive bone lesion in her left distal femur with a permeative pattern (). Computed tomography (CT) scanning () and magnetic resonance imaging (MRI) () showed that the lesion was located in meta-diaphysial area and it had eroded the anterior bone cortex of left femur, but there was no soft tissue extension by the lesion.\nAll laboratory data including CBC, blood calcium, Phosphorus and Alkaline-Phosphatse level was within normal limits. Serum parathyroid assay reported to be within normal range. All other staging studies including chest and abdomen CT scan and whole body bone scanning was negative for any other abnormal lesion. Because of her age and the pattern of the lesion, she underwent an open incisional bone biopsy. The result was compatible with primary giant cell tumor of bone ().\nSubsequently she underwent curettage and internal fixation with a side plate augmented with bone cement. She did recover uneventfully and so far with a follow-up of 24 months she is doing good and there is no local recurrence for the lesion detected. | [[46.0, 'year']] | F | {'8421014': 1, '7380862': 1, '3514036': 1, '1608863': 1, '3805057': 1, '4910256': 1, '7449206': 1, '3511063': 1, '6833323': 1, '24179645': 2} | {} |
163,765 | 3804809-1 | 24,179,646 | noncomm/PMC003xxxxxx/PMC3804809.xml | Testicular Fibroma of Gonadal Stromal Origin with Minor Sex Cord Elements, Presenting with Hydrocele | A 40-year old male presented with painless scrotal swelling that had gradually increased in size for two years. He had no hormonal symptoms. On examination, enlarged firm left testis and hydrocele with positive translucency test was detected. The ultrasonogram () showed grossly enlarged left testis measuring 7.6×4.5 cm with diffusely heterogeneous echo-texture. There were multiple well-defined nodular and heterogeneously echoic lesions found within the left scrotum adherent to the wall. A large amount of free fluid was seen in the left scrotal sac. The right testis and epididymis were unremarkable. The patient had undergone testicular FNAC one year before and mesenchymal tumor had been diagnosed. A review of slides revealed cellular smear with 3-dimensional clusters and groups composed of bland looking spindle cells ().\nThe patient underwent left high inguinal orchidectomy and the specimen was sent for histopathological examination. The testis was firm, measuring 7.5×7×6.5 cm, and had a partially attached tunical sac which contained multiple well-defined nodules on its inner surface. The cut surface of the testis was gray-white, mostly solid, with few cystic areas (). A thin rim of normal appearing testicular tissue was present (). Microscopically, sections from the testis and the tunical sac nodules showed nests of spindle cells arranged in bundles separated by variable amounts of collagen (). The nuclei were fairly uniform with evenly dispersed chromatin and mitotic figures of up to 2 MF/10 high power fields were present. Occasional foci showed tubules which were lined by cuboidal cells and contained central hyaline materials (). On immunohistochemical examination, the tumor cells showed strong immunoreactivity for vimentin () and were immunonegative for calretinin, WT-1, inhibin, pancytokeratin, cytokeratin 5/6, smooth muscle actin, CD 34 and S 100 protein. The ki 67 proliferative index was 2% (). Lining cells of the tubule were immunoreactive for inhibin (). The post-operative period was uneventful and there was no evidence of disease after a follow-up period of six months. | [[40.0, 'year']] | M | {'8236607': 1, '8884355': 1, '2435040': 1, '2091005': 1, '9237180': 1, '1661453': 1, '10971698': 1, '10235496': 1, '9060599': 1, '1593701': 1, '14184710': 1, '24179646': 2} | {} |
163,766 | 3804811-1 | 24,179,648 | noncomm/PMC003xxxxxx/PMC3804811.xml | Cutaneous Malignant Rhabdoid Tumor in the Palm of an Adult | A 27-year-old male consulted our Medical Center complaining of a right palm neoplasm that had been present for 6 months. On examination, a 4.0×4.5 cm, hard, round, protuberant tumor was found on the ulnar side of the right palm (). Magnetic resonance imaging (MRI) showed that the mass adhered to the 5th metacarpal bone and invaded the hypothenar muscle and flexor tendons, but no mass in the head and abdomen. Histological analysis of a biopsy specimen suggested epithelioid sarcoma. Computed tomography revealed right axillary lymph node metastasis.\nSurgery consisted of radical excision of the palm tumor along with axillary lymph node resection. En bloc resection of the tumor with a skin margin of 2 cm, including the 5th metacarpal bone, 4th intrinsic muscles, 5th flexor tendons, and neuro-vascular bundle, was performed. The 4th metacarpal bone-exposing wound was covered with artificial dermis.\nAfter verification that the surgical margins were free from tumor invasion by histological analysis, secondary reconstruction with the nerve graft and free skin graft was performed 2 weeks later. The patient received 4 chemotherapies with doxorubicin (30 mg) and ifosfamide (5 g), and radiotherapies with a total dose of 60 Gy to the palm and axilla.\nAfter 12 months, the patient showed no tumor relapse, and regained pinch and grip function and showed resolved sensory disturbance of the ring finger.\nMacroscopically, the tumor was located in the subcutis, measuring approximately 4.0×4.5 cm in size. It was grossly recognized by its white-yellow color with poor delimitation between the tumor and surrounding soft tissue. Microscopically, the sections showed the proliferation of round or oval tumor cells with vesicular rounded nuclei, prominent nucleoli, and eosinophilic cytoplasm in a sheet, accompanied by a focal myxoid matrix. Abundant rhabdoid cells with cytoplasmic inclusion bodies were observed (). Mitotic figures were occasionally noted. Immunohistochemically, the tumor cells were positive for S-100 protein, GFAP, beta-catenin, and EMA (), but negative for cytokeratins (CAM5.2, AE1/AE3, CK 14), alpha-SMA, desmin, HHF35, p63, HMB45, Melan A, MiTF, CD34, HLIB45, glypican 3, and myogenin. The loss of SMARCB1 (SWItch/Sucrose NonFermentable-related, matrix-associated, actin-dependent regulator of chromatin, subfamily b, number 1)/INI1 immunoreactivity was also recognized. The feature was that of an SMARCB1/INI1-deficient tumor, highly suggestive of an extrarenal malignant rhabdoid tumor. | [[27.0, 'year']] | M | {'11469343': 1, '17377740': 1, '21666498': 1, '8987055': 1, '17692365': 1, '11972104': 1, '8453588': 1, '18607629': 1, '1712749': 1, '1323543': 1, '21796761': 1, '11100813': 1, '20479553': 1, '11378339': 1, '12911733': 1, '24179648': 2} | {} |
163,767 | 3804813-1 | 24,179,650 | noncomm/PMC003xxxxxx/PMC3804813.xml | A Rare Case of Langerhans Cell Histiocytosis of the Skull in an Adult: a Systematic Review | A 41-year old male who presented to the Emergency Department after falling while water-skiing at 40-50 km/hr. He landed face first onto the water but did not lose consciousness and remembered that he was in trouble.\nThe patient recalls his face feeling puffy for 10-15 min but then settled and both his eyes were bleeding for approximately 30 min. He complained of neck and right shoulder pain and a frontal headache. His previous medical history included surgery for lumbar disc prolapse and chronic headaches, which had persisted for the last 2-3 months prior to presentation. Medications included Dothiepin (TCA) and Salazopyrin (Sulfasalazine). On assessment, the patient was conscious (GCS 15), had a BP of 123/92, pulse of 72, and an oxygen saturation of 95%. There was periorbital bruising and swelling with a laceration of the right inner aspect of the upper eye-lid which was bleeding and blood was present in both eyes. A full opthalmology assessment found no abnormalities. Radiological assessment included X-rays of the head (), pelvis, C-spine, right shoulder, lumber spine, and a CT of the head. The radiographs showed no evidence of acute fractures/dislocations. The head CT showed a small hypersensitivity with a small extra axial collection with a maximum thickness of 1mm. Differential diagnoses included an arachnoid cyst, haemangioma, meningioma or a secondary lesion. Due to the possibility of a malignant lesion a bone scan was also undertaken and subsequently showed an active lesion. The patient was admitted and had a craniotomy to excise the skull tumor. The excised lesion consisted on bone with soft tissue (30×20×7 mm). Histopathological examination of the specimen, which included immunoperoxidase studies revealed a rounded defect of the bone which consisted of a proliferation of fibrous stroma within which can be seen inflammatory foci ().\nImmunoperoxidase studies were positive for S100 and CD68 and negative for HMB45 and Cam 5.2. The patient is currently well. | [[41.0, 'year']] | M | {'10326709': 1, '3197424': 1, '10770168': 1, '17415918': 1, '26722570': 1, '12105792': 1, '28694627': 1, '8888814': 1, '12146808': 1, '8950330': 1, '14556926': 1, '20805658': 1, '29527366': 2, '16982579': 1, '31641396': 1, '15928676': 1, '18259837': 1, '24179650': 2} | {'5733184-1': 1} |
163,768 | 3804815-1 | 24,179,652 | noncomm/PMC003xxxxxx/PMC3804815.xml | Apocrine Adenocarcinoma of the Vulva | A 67 year old female presented with an enlarging left vulvar lesion thought to be cystic clinically. Her past medical history was remarkable for a remote history of treated lymphoma, the details of which were not available. There was no history of apocrine or adenexal tumor elsewhere in the body. Clinically there was no regional lymph node enlargement.\nExcisional biopsy of the tumor showed a pink, tan hair bearing fragment of skin measuring 2.7×2.0×1.8 cm. The resection margin was inked. Serial sectioning of the specimen revealed a nodular dermal tumour with focal areas of cystic degeneration filled with a tan coloured paste like material.\nMicroscopic examination revealed fairly well circumscribed but unencapsulated dermal nodule composed of solid sheets and trabeculae of cells with features of adenocarcinoma (). The cells were large, polygonal with well-defined cell membrane and abundant granular eosinophilic cytoplasm. The nuclei showed moderate pleomorphism with vesicular chromatin and prominent central nucleoli. Abundant mitotic activity and focal necrosis were evident (). Focal involvement of the deep inked resection margin was identified. The overlying epidermis was unremarkable (). Normal mammary-like glands were not identified in the surrounding tissue. There was no lymphovascular invasion.\nThe carcinoma cells expressed carcinoembryonic antigen (CEA), Cytokeratin (CK) 7, epithelial membrane antigen (EMA) and Gross cystic disease fluid protein (GCDFP)-15, confirming the apocrine nature of the tumor (). The cells were negative for estrogen/progesterone (ER/PR), CK20, leukocyte common antigen (LCA), CK5/6, wilms tumor (WT)-1 and hepatocyte paraffin (HepPar)-1. | [[67.0, 'year']] | F | {'13199769': 1, '18369309': 1, '1666822': 1, '25930015': 1, '8465990': 1, '27053571': 1, '6269104': 1, '27668109': 2, '18347508': 1, '28826403': 2, '19251959': 1, '8005737': 1, '6198933': 1, '12581149': 1, '27073659': 1, '8040464': 1, '4327053': 1, '24179652': 2} | {'5567554-1': 1, '5030426-1': 1} |
163,769 | 3804816-1 | 24,179,653 | noncomm/PMC003xxxxxx/PMC3804816.xml | Unusual Region for Pericardial Malignant Mesothelioma: Cutaneous Manifestation in a Turkish Woman | A 37-year-old female patient was admitted with a 10-day history of shortness of breath, palpitation and inability to sleep on her back. The plain chest X-rays showed extensive pericardial effusion. She was a lifelong nonsmoker, and there were no risk factors in her medical history. After the diagnosis was confirmed with echocardiography, the patient was operated under general anesthesia. Pericardiocentesis was performed with midline incision below the sternum. Approximally 500 mL of hemorrhagic pericardial fluid was aspirated. She had significant symptomatic relief after drainage. The mediastinal region was decreased in the follow-up chest radiograph, and echocardiography revealed minimal pericardial effusion. A cytological evaluation of the pericardial fluid was negative for malignant cell or infection. She was discharged with medical treatment follow-up. Approximately 7 months later, she was readmitted to the clinic with complaint of a mass at the incision site (). Ultrasonography revealed a multi-loculated collection (abscess) at the incision site. The patient underwent surgery under local anesthesia, and the mass was removed in its entirety and sent for pathological examination. Histologically, the tumor was composed of neoplastic epithelial cells arranged in irregular tubular and papillary structures that had extensively invaded the muscular and lipomatous tissue. Focal areas were also seen in which atypical cells were arranged in storiform or patternless pattern separated by dense collagenized tissue. Microscopic examination revealed malignant mesothelioma of epithelioid and desmoplastic type. The neoplastic cells were cuboidal and had distinct cell borders, a low-to-moderate nuclear-to-cytoplasmic ratio, pale-to-clear cytoplasm, and pleomorphic round-to-oval nuclei. The neoplastic cells were strongly positive for calretinin and focally positive for Ber-Ep4 and MOC-31. Thyroid transcription factor (TTF)-1 and thyroglobulin immunostaining, which was performed to differentiate from thyroid papillary carcinoma because of papillary proliferation of epithelioid cells, was negative (). On the basis of these findings, the morphological diagnosis was malignant mesothelioma. Positron-emission tomography-computerized tomography (PET-CT) showed increased 18F-fluorodeoxyglucose (FDG) uptake (SUV max: 17.80) in a 53×53×76 mm lobulated mass extending to the paracardiac area of skin beneath the sternum with pericardial thickening (). Lymphadenopathy was found with increased FDG uptake posterior to the body of the pancreas. | [[37.0, 'year']] | F | {'10877273': 1, '14769729': 1, '17269529': 1, '3376853': 1, '7850826': 1, '18580495': 1, '16206657': 1, '15182263': 1, '24179653': 2} | {} |
163,770 | 3804817-1 | 24,179,654 | noncomm/PMC003xxxxxx/PMC3804817.xml | Renal Leiomyosarcoma | We present the case of 69-year-old woman who was found to have a large left abdominal mass in evaluation for diffuse abdominal pain accompanied by asthenia and nauseas. Non abnormalities were observed in routine laboratory examination, except a ferriprive anemia: hemoglobin 10.8 mg/dL (12-14 mg/dL). A computed tomographic scan imaging demonstrated an 18 cm lesion from the left kidney; no thrombus in renal vein or cava and neither regional lymph nodes or adrenal gland involved were informed (). Open right radical nephrectomy by lumbotomy without lymph adenectomy (intraoperatively no grossly visible lymph nodes were identified) was performed. The surgical specimen revealed a solid multinodular mass measuring 18×15 cm () which probably originates in the renal capsule (). The histopathogical examination demonstrated a renal high-grade leiomyosarcoma, which renal capsule infiltration but without extend over there (), and did not extend to pelvis, renal vein or adrenal gland. All excised hilar fat lymph nodes were free of disease. The immunohistochemical profile with smooth muscle actine was difusely positive (). Focal immunostaining were found for desmin, vimentin and CD117 (KIT). No immunostaining were observed for melan A, HMB-45 and S-100 protein. Adjuvant chemo therapy was not performed based upon not data in survival benefit. Five years after the operation, she was in good health with no sign of recurrence or metastases. | [[69.0, 'year']] | F | {'18521899': 1, '12439573': 1, '8381704': 1, '18378136': 1, '21154746': 1, '34746221': 1, '32747914': 2, '1998475': 1, '26005972': 1, '4819688': 1, '19820372': 1, '23159583': 1, '16359541': 1, '16788949': 1, '1942380': 1, '24179654': 2} | {'7728114-1': 1} |
163,771 | 3804818-1 | 24,179,655 | noncomm/PMC003xxxxxx/PMC3804818.xml | Secondary Aneurysmal Bone Cyst Following Chondroblastoma of the Patella | A 25 year-old male was referred to our hospital complaining of left knee pain. He had the symptom for 2 years without a prior history of trauma. The pain deteriorated after participating in a Judo competition. He visited a nearby hospital and a radiolucent area of the patella was pointed out on the plain radiograph of a knee. He was suspected of a bone tumor and referred to our hospital. He did not have any relevant family history of tumor or medical history. Physical examination showed a slight atrophy of the left thigh (42 cm compared to his right, which was 45 cm), but did not show tenderness or restriction in range of motion. The overlying skin was smooth without any hotness or redness. Plain radiograph showed a soap bubble-like radiolucent area in the medial patella measuring 1.7×2.4 cm. Periosteal reaction was absent ().\nOn the MRI, the lesion was depicted as low intensity on T1WI and high on T2WI, which was diffusely enhanced after gadolinium-contrast administration. The tumor was composed of multiple cavities, and fluid level was observed in each compartments. There was no obvious invasion to the adjacent muscle or joint ().\nThe tumor was composed mostly from blood filled cavities and intraoperative histological finding revealed a lesion with fibrotic changes and proliferation of histiocyte-like cells and fibroblasts, accompanied by multinucleated giant cells, hemosiderin deposits and bony fragments. No evidence of malignancy was present. Intralesional curettage was performed with the addition of heat ablation and was later filled with artificial bone graft.\nOn histopathology, the tumor was a giant cell lesion with fragmented bones with fibrosis, hemosiderin deposits and mild infiltration of chronic inflammatory cells compatible with ABC. In limited areas, there were monocytes that were short spindle-shaped and slightly positive with S-100 staining, which was consistent with chondroblastoma (,).\nPostoperative period was uneventful. During his 9 months follow-up, no recurrence or arthritic change of the knee has developed (). | [[25.0, 'year']] | M | {'11060436': 1, '7773657': 1, '11486695': 1, '4585180': 1, '3966195': 1, '21088467': 1, '16203891': 1, '3588400': 1, '3276387': 1, '21701004': 1, '7146925': 1, '32280609': 1, '15509679': 1, '9683708': 1, '19055920': 1, '5458269': 1, '22951298': 1, '15972914': 1, '18815789': 1, '22202063': 1, '13106840': 1, '24179655': 2} | {} |
163,772 | 3804819-1 | 24,179,656 | noncomm/PMC003xxxxxx/PMC3804819.xml | Renal Medullary Carcinoma Response to Chemotherapy: a Referral Center Experience in Brazil | A 23 year-old black man with sickle cell trait had a six-month history of right back pain associated with dyspnea and weight loss. An ultrasound revealed a six centimeters renal mass. One month later, he was referred to our service for investigation. Computed tomography (CT) scan showed a renal mass measuring eleven centimeters (cm) associated with pleural effusion and signs of lymphangitic carcinomatosis. He was empirically treated with sunitinib 50 mg per day for one week, until the result of the biopsy. The renal mass biopsy revealed renal medullary carcinoma. Owing to the worsening of the dyspnea and the biopsy results, sunitinib was discontinued and chemotherapy with cisplatin 35 mg per square meter plus gemcitabine 1000 mg per square meter both administered on D1 and D8 on a 21 day cycle was introduced. The patient died just one day after the beginning of the chemotherapy and two weeks after renal biopsy (a brief summary of patients epidemiological characteristics, therapies, response and survival rates are presented in Supplementary Table 1). | [[23.0, 'year']] | M | {'20002663': 1, '28326262': 1, '32259323': 1, '27605964': 1, '12475675': 1, '16895289': 1, '26870200': 1, '25692619': 2, '25754217': 1, '32410064': 1, '16549825': 1, '20979179': 1, '15602719': 1, '28913767': 1, '30656488': 1, '28360450': 1, '7528470': 1, '18068443': 1, '24179656': 2} | {'4622500-1': 1} |
163,773 | 3804820-1 | 24,179,657 | noncomm/PMC003xxxxxx/PMC3804820.xml | Pulmonary Atypical Carcinoid Tumor in a 15-Year-Old Girl: a Case Report and Review of the Literature | A 15-year-old healthy girl presented with cough and dyspnea for 3 days duration. Her past medical history showed reactive airway and asthma since last year. Physical examination showed blood pressure: 125/85; pulse rate:\n124/min; respiratory rate: 20/min; and temperature: 36.7°C. Heart examination was normal. There were decreased breathing sounds over the left lung. There was no wheezing or rales. Abdominal examination was normal with no organo megaly. Extremities were normal with no clubbing, edema or cyanosis.\nLaboratory examination showed leuckocytosis (WBC=16.4×103/mL), hemoglobin was normal (Hb=12 gr/L) and erythrocyte sedimentation rate was 14.\nWith the clinical impression of pneumonia, a chest X-ray was performed; it showed lung infiltration and consolidation (). Spiral computed tomography scan of the chest showed a small hypodensity in left main bronchus (). According to this finding and the patient’s vague history of foreign body ingestion, rigid bronchoscopy was performed which showed a small polyp like mucosal projection in left main bronchus, measuring 1×0.5 cm. The mass was excised by bronchoscopy. The patient had an uneventful postoperative course. The specimen in the pathology department received as a small nodule of about 1 cm with grey color and soft consistency. Microscopic findings showed bland looking epithelial to spindle shaped cells with mild atypia and nesting pattern separated by delicate fibrovascular stroma (,). The cells were rich in mitosis, i.e. there was 4 mitosis/0 HPF. The cells were strongly positive with Synaptophysin. According to the WHO criteria (2004) the tumor was diagnosed as AC. The patient was scheduled for bronchial sleeve operation, but unfortunately she didn’t accept to perform any additional procedure, but now after about 6 months, she is doing well and symptom free. | [[15.0, 'year']] | F | {'17140801': 1, '12629632': 1, '1337202': 1, '21290133': 1, '15714450': 1, '17196822': 1, '8128051': 1, '29432305': 1, '17185889': 1, '21043816': 1, '19513967': 1, '16938641': 1, '21587121': 1, '24179657': 2} | {} |
163,774 | 3804822-1 | 24,179,659 | noncomm/PMC003xxxxxx/PMC3804822.xml | Lymphoepithelioma-Like Carcinoma of the Skin: Case Report and Approach to Surgical Pathology Sign Out | A 87-year old male presented to his family physician with a two week history of a skin lesion on his right anterior chest. On physical exam, particular emphasis was on head and neck assessment. On inspection of the head and neck there were no gross abnormalities including asymmetry, swelling, discoloration and or trauma. Major lymph nodes were identified symmetrically on both sides of the neck. All cranial nerves were tested to be within normal limits of functioning. The oropharynx was visualized to be without obvious lesions or deformity. On examination of the chest, a solitary 2.5 cm light brown ulcerated polyploid growth was seen. The surrounding epidermis was without erythema or hemorrhage. No telangiectatic vessels were seen grossly.\nDuring the course of getting worked up for possible metastatic disease, a head/neck CT was performed. The results of this scan were essentially normal anatomy without any obvious lesion present (including nasopharynx). The lesion was removed with the clinical diagnosis of an epidermal carcinoma. Since the excision the patient was been in good medical health with no recurrent tumor or distant metastatic spread.\nHistopathology on low power showed an unremarkable epidermal surface, with no ulceration or dysplastic changes (). The architecture of the lesion was that of scattered nests of tumor cells with diffuse lymphocytic infiltrate between epithelial nests. On higher power examination (), the biphasic nature of the lesion became more apparent. The tumor cells were mainly polygonal in shape with an eosinophilic cytoplasm, containing vesicular nuclei, prominent atypia, numerous mitosis, diffuse lymphoplasmacytic infiltrate surrounding the epithelial nests and an infiltrating tumor margin. Histological features that may suggest a more aggressive form of LELCS such as involved surgical margins, lymphvascular and or perineural invasion were all negative on examination.\nImmunohistochemical (IHC) studies showed that the tumor cells were diffusely positively for epithelial differentiation (AE1/AE3 and EMA) and more specifically squamous cell involvement with CK5/6 (). Lymphoid cell markers (LCA, CD3 & CD20) were also helpful in identifying reactive nature of the surrounding lymphoid cells, while remaining negative for the epithelial tumor nests. Melanoma markers (S-100 & HMB45) and neuroendocrine markers (Chromogranin, Synaptophysin & CD56) were also negative for tumor cell involvement. The tumor cells also reacted negativity with Epstein-Barr virus (EBV) (). The full immunohistochemistry panel is summarized in .\nThe clinical history of unremarkable head and neck examination with supporting radiology correlate the theory that this lesion was a different entity from the nasopharyngeal counterpart. Therefore hematoxylin and eosin (H&E), immunohistochemistry (IHC) and clinical history were all consistent with the diagnosis of lymphoepithelioma – like carcinoma of the skin (LELCS). | [[87.0, 'year']] | M | {'1369803': 1, '25506535': 1, '7611549': 1, '29723365': 1, '7699121': 1, '8973744': 1, '23133769': 2, '22346102': 2, '7872253': 1, '10782160': 1, '20227583': 1, '31501980': 2, '18179760': 1, '26420974': 1, '8902094': 1, '1384378': 1, '7590694': 1, '24179659': 2} | {'3485757-1': 1, '3271451-1': 1, '6811378-1': 1} |
163,775 | 3804823-1 | 24,179,660 | noncomm/PMC003xxxxxx/PMC3804823.xml | Angiofibrolipoma of the Calf | A 9-year-old boy presented with a history of right calf swelling noticed since birth which was slowly increasing in size. The swelling became painful about a year prior to presentation. He had no preceding history of trauma or fall. There was history of weight loss that was first noticed at the age of 7 years though weight loss was not marked. There was no pain from other parts of the body. There was no history of bone pain, jaundice, abdominal pain, chest pain or cough to suggest a metastatic lesion. There was no history of similar swelling in the siblings or parents. At presentation, essential findings were those of a young boy that was not pale, anicteric, with no significant lymph node enlargement. Musculoskeletal examination showed a 18×32 cm firm mass involving the upper 2/3 of the right leg posteriorly extending from the popliteal fossa down to the gastrosoleus junction with a punched out scar at the site of the previous incisional biopsy; which had been done prior to been planned for definitive management. The edges were poorly defined and tender on deep palpation. There was no clinical vascular deficit. Mid calf circumference on the right limb was 44 cm and 24 cm on the left. The mass was fixed to the underlying structure. The child maintained the ankle in an attitude of plantar-flexion. Attempt at standing plantigrade or placing the foot plantigrade resulted in pain, he therefore walked on his toes. Plain radiograph revealed a soft tissue mass at the posterior aspect of the right leg with no bone involvement ().\nHematological parameters were within normal limits. Incisional, with later excisional biopsy were done. The excision was a marginal excision. Intra-operative findings were: i) a mass approximately 15×9×4 cm arising from the two heads of the gastronemius muscle at its origin in the popliteal fossa; ii) a yellowish-pink mass closely related to the posterior tibial artery at its origin in the fossa, the mass had to be dissected and removed piecemeal around the neurovascular bundle to prevent injury; iii) the soleus muscle had to be stripped off the gastronemius and the latter was detached at the gastrosoleus junction; iv) the cut surface of the mass was solid and yellowish with numerous ecchymotic patches ().\nHistology showed fibrocollagenous tissue composed of adipose tissue and numerous thinwalled and congested vascular vessels. Also seen were chronic inflammatory cells, mainly lymphocytes and plasma cells. No evidence of malignancy seen in all the sections examined. Findings were consistent with angiofibrolipoma (). | [[9.0, 'year']] | M | {'3941380': 1, '17555654': 1, '12009070': 1, '20339251': 1, '17011434': 1, '16094125': 1, '19784004': 1, '27252949': 2, '28435645': 2, '18602235': 1, '9403060': 1, '24179660': 2} | {'4627109-1': 1, '5379235-1': 1} |
163,776 | 3804824-1 | 24,179,661 | noncomm/PMC003xxxxxx/PMC3804824.xml | Peristomal Pagetoid Spread of Urothelial Carcinoma of the Ureter | The patient was a 69-year-old female who developed macroscopic hematuria 7 years ago. Under clinical diagnosis of bladder carcinoma, she underwent transurethral resection, with a resultant pathological diagnosis of urothelial carcinoma in situ (CIS). Two years later, she developed recurrence of stage Tis UC in the most distal part of the left ureter and underwent left nephroureterectomy. One year later, she had intravesical recurrence of UC as stage Tis disease with resistance to BCG therapy and underwent radical cystectomy and reconstruction with ureterocutaneostomy. Two years ago, peristomal inflammation developed and persisted despite regular medication for dermatitis.\nTwo dermatologists (S.I. and M.T.) suspected squamous cell carcinoma or metastatic skin carcinoma by inspection and performed peristomal skin biopsy. Under a diagnosis of a peristomal Paget phenomenon of UC, we performed en-bloc resection of the remaining ureter and peristomal skin with a sufficient normal margin () and percutaneous nephrostomy, followed by reconstruction of the abdominal wall to wrap the exposed fascia with surrounding excess skin.\nPagetoid cells and conventional CIS cells were observed by light microscopy in the distal two-thirds of the right ureter. The pagetoid cells formed a cluster and had spread to basal layers of transitional epithelium with partial squamous metaplasia. These cells were characterized by abundant clear cytoplasm with occasional vacuoles, enlarged hyperchromatic nuclei and overt nucleoli. Pagetoid cells had also spread into the peristomal epidermis directly from the ureteral mucosa () and were present among p63-positive cells (i.e. epidermal basal cells), which showed that pagetoid cells had spread to the basal layer of the epidermis. However, the basal membrane between the epidermis and dermis was intact and the tumor cells had not invaded the dermis. The intraepidermal pagetoid cells had abundant mitoses and formed a papillary or pseudoalveolar architecture. The surrounding stroma showed prominent congestion and infiltration of lymphocytes and histiocytes, but neither via-vessel extension nor direct invasion of neoplastic cells (). In immunohistochemistry, the cells in the epidermis and ureteral mucosa were positive for CK7 and CK20 () and pagetoid cells were positive for HER2 (). In contrast to the distal region, the proximal surgical end of the ureter was free of cancerous cells. | [[69.0, 'year']] | F | {'12991388': 1, '8105314': 1, '10730755': 1, '25950342': 1, '10772679': 1, '31981047': 1, '8244321': 1, '11224606': 1, '22547349': 1, '19018200': 1, '15005693': 1, '9331290': 1, '24179661': 2} | {} |
163,777 | 3804825-1 | 24,179,662 | noncomm/PMC003xxxxxx/PMC3804825.xml | A Very Unusual Thyroid Tumor: a Nodule with Mature Fat Papillary Hyperplasia and Focal Atypia | A 51-years old man presented with a clinical diagnosis of multinodular goiter. The patient did not show evidence of autoimmune disorders or thyroiditis and the thyroid function was normal. He was referred to surgery and complete thyroidectomy with intraoperative histological examination was performed. The thyroid was enlarged with a weight of 55 g, measuring 5×4.5×4.5 cm in the right lobe and 5×3×3 cm in the left lobe. Macroscopically, the right lobe harboured a cystic-colloid hemorrhagic nodule 2.5 cm diameter while two colloid nodules of 2 cm and 3 cm respectively, were found in the left lobe. All of the aforementioned nodular lesions were examined intraoperatively. The cystic nodule in the right lobe showed a diffuse papillary architecture with slight overlapping and enlarged nuclei; as a consequence an intraoperative histological diagnosis of suspicious papillary thyroid carcinoma/papillary hyperplasia with atypia, was posed. The two nodules in the left lobe were considered benign, although one of them also showed cystic aspects with papillary architecture. The lesions were finally sampled, formalin fixed and paraffin embedded for the final histological evaluation. Microscopically two colloid-cystic nodules showed papillary structures with a delicate stroma and prominent intralesional mature fat (). Furthermore, the nodule in the right thyroid lobe showed cytological features suspicious for PTC. The nuclei in fact were sometimes enlarged, with scattered grooves, overlapping and clearing, but no nuclear pseudoinclusion or psammomabodies were found (). The lesion did not show a complete capsule and merged with the surrounding thyroid tissue. Neither mitotic figures nor necrosis were found. In the left nodule the nuclei were basally located with dark chromatin without atypical features. To exclude the diagnosis of a PTC and to better categorize these lesions, the expression of two well known thyroid cancer associated antigens namely Galectin-3 (Gal-3) and HBME-1 was evaluated by using immunohistochemical procedures. A biotin-free immunoperoxidase detection system was applied, and foamy macrophages were considered as internal positive control for Gal-3 immunostaining. The left nodule showed a faint and focal cytoplasmic immunoreactivity for Gal-3 (data not shown), while the suspicious lesion in the right thyroid lobe showed a variable immunoreactivity for Gal-3 with nuclear and cytoplasmatic pattern of staining. Interestingly galectin-3 expression was restricted to those cells showing atypical cytological features whereas HBME-1 immunostaining further highlighted the plasma membrane aspect of these atypical cells ( and ) However the larger part of the papillary lesion was unreactive with both Galectin-3 and HBME-1. On the basis of the morphological and immunophenotypical analysis we classified the lesion as an adenomatous nodule with fat-rich stroma and papillary atypical hyperplasia, with focal expression of Galectin-3 and HBME-1 reflecting an incipient transformation in PTC. To exclude the presence of a PTC, we carefully examined the rest of the thyroid for a total of 28 slides. | [[51.0, 'year']] | M | {'2682616': 1, '11425367': 1, '17587245': 1, '6433552': 1, '19917474': 1, '21691201': 1, '13077091': 1, '19332917': 1, '10965826': 1, '2660611': 1, '19168408': 1, '24179662': 2} | {} |
163,778 | 3804826-1 | 24,179,663 | noncomm/PMC003xxxxxx/PMC3804826.xml | Multiple Liver Abscess Formation and Primary Gastrointestinal Stromal Tumor | A 31-year old Caucasian man with a history of iron deficiency anemia and intermittent gastrointestinal bleeding over the course of 4 years, presented with cyclic fever, a mild cough, loss of appetite, and occasional diarrhea. The patient had no causes of immunosuppression such as HIV and he was on no medication. Previously, four esophagogastroduodenoscopies, a capsule study and colonoscopy (performed at another institution) found no source for blood loss. It was noted that his hematocrit had fallen from 43 to 33. He was admitted to hospital and commenced on empiric antibiotic therapy with azithromycin.\nA CT scan of the thorax, abdomen and pelvis showed a 3×3.5 cm mass in the small bowel and numerous hypodense lesions throughout the liver, measuring up to 2 cm. A PET/CT demonstrated mild FDG uptake in the small bowel mass and intense uptake in the liver lesions (). To differentiate liver infection versus malignancy, a CT-guided liver biopsy was performed. It showed necrotic cells, a few polymorphonuclear leukocytes, and purulence, but there were no malignant cells (). The gram stain showed no organisms, and the culture was negative. Aspiration of one of the liver lesions showed many cells, but no polymorphonuclear leukocytes and no organisms. The culture from the aspirate was negative for bacteria, fungi, and acid fast bacillus.\nThe patient continued experiencing febrile episodes on azithromycin, and consequently antibiotic coverage was broadened to metronidazole and ceftriaxone. Due to persistent febrile episodes, his antibiotic treatment was revised to ertapenem, and subsequently to a combination of metronidazole, daptomycin, imipenem and micafungin on the 6th and 8th day post admission, respectively. The patient was transferred to the University of Washington Medical Center and the antibiotic schedule changed to metronidazole, daptomycin, meropenem and caspofungin, as per institutional guidelines. Repeat chest X-ray and blood cultures remained clear during this time. With this therapy, the patient’s clinical condition dramatically improved and the febrile episodes completely ceased, indicating the liver lesions were most likely infectious abscess. Blood cultures remained negative and further investigations revealed no cause for the temperature spikes. His ESR was 98 and CRP 265. CEA was undetectable at less than 0.7. With the cyclic fever resolved, the patient was discharged and the treatment was modified to intravenous daptomycin and meropenem.\nTwo weeks following discharge from hospital, with no further febrile episodes, the patient underwent laparoscopic small bowel resection and core needle biopsy of one of the liver lesions. The small bowel mass was 3 cm in size and located in the distal jejunum. On pathology the small bowel mass had a spindle cell morphology and on immunohistochemistry the tumor cells showed expression of CD117, confirming the diagnosis of a gastrointestinal stromal tumor (). The mitotic activity was 0-1 mitosis/10 HPF, no necrosis was seen, and all margins were clear. A follow up FDG-PET/CT a month post surgery showed a near complete resolution of the innumerable hypermetabolic foci scattered throughout both lobes of the liver (). Only a single punctate focus of FDG accumulation was identified within the liver with a maximum SUV value of 4.6 which was a substantial decrease in size and maximum SUV in comparison to the previous examination. CT with intravenous contrast showed significantly smaller hypodense lesions scattered throughout the liver. After about 6 weeks of treatment with daptomycin and meropenem, his antibiotic schedule was changed to oral moxifloxacin and augmentin, which were eventually stopped. He was on antibiotic therapy for a total of 12 weeks. The patient has recovered fully and is feeling well 17 months following the laparoscopic small bowel resection. Surveillance scans have shown no evidence of local recurrence or metastatic disease. | [[31.0, 'year']] | M | {'21960905': 1, '21960904': 1, '26680222': 1, '9438854': 1, '15882238': 1, '8983609': 1, '20054325': 1, '12181401': 1, '1526231': 1, '22202387': 1, '18159178': 1, '19404209': 1, '24179663': 2} | {} |
163,779 | 3804827-1 | 24,179,664 | noncomm/PMC003xxxxxx/PMC3804827.xml | A Case of Small Cell Cancer of the Breast in a Male with Synchronous Stage IV Non-Small Cell Lung Carcinoma | A 61 year old Caucasian male was transferred from an outside facility for respiratory failure and acute renal failure. On arrival, the patient had been intubated at the outside facility so he was moved to the intensive care unit. Two days after admission, hemoptysis was noted from the patient’s endotracheal (ET) tube. A computed tomography (CT) scan of the chest was performed and demonstrated a left upper lobe bronchial obstruction with associated atelectasis, bilateral pleural effusions and mediastinal lymphadenopathy (LAD). The obstruction at the time was assumed to be related to an endobronchial malignancy due to fullness of the hilum per radiology. A bronchoscopy was performed the next day. This documented an endobronchial mass in the posterior segment of the right upper lobe, a mass obliterating the entire orifice of the posterior left upper lobe with active bleeding. Biopsies were obtained from the lung masses as well as bronchial washings from both lungs. Pathology revealed a non-small cell lung carcinoma (NSCLC) with squamous cell type from the right upper lobe biopsy and atypical squamous metaplastic mucosa with fibrin material from the left upper lobe biopsy.\nOne week later, the patient underwent a video-assisted thoracoscopic surgery (VATS) procedure with pleural stripping and drainage of the right sided effusion to check for a source of malignancy. Cytology of the effusion was negative for any malignant cells. Pleural biopsy demonstrated fibrinopurulent exudate, marked inflammation, necrosis and hemorrhage without any evidence of malignancy.\nCT scans of the abdomen, pelvis and head were performed for staging of disease. A chronic, left atrophic kidney was found but otherwise scans were negative for malignancy. A bone scan was also performed and was negative for metastatic lesions.\nHe was extubated successfully and continued on hemodialysis for his renal failure thought to be related to hypotension and one working kidney. At discharge, he was transferred to a rehabilitation facility with an appointment for a local oncologist near his home to begin treatment.\nApproximately one month after discharge, he returned to our hospital for hemoptysis. A repeat CT scan of the chest was done and showed no change in the size of the mass documented in the left upper lobe but did show improvement in the consolidation and atelectasis documented two months prior. It also revealed gynecomastia of the right breast without obvious masses. The patient had a biopsy by interventional radiology (IR) of the lingula. Pathology showed a non-small cell lung cancer of squamous cell type. After almost complete resolution of the patient’s hemoptysis, a bronchoscopy was repeated due to a positive biopsy of the right upper lobe on previous admission but no mass documented on CT scan of the chest. Repeat bronchoscopy demonstrated sharp carina, irregularity of the anterior segment of the right upper lobe, and abnormal mucosa of the left main bronchus towards the lingula. Biopsies were taken of the abnormal mucosa of the left upper lobe and bronchoalveolar lavage (BAL) was taken of the right upper lobe. An endoscopic bronchial ultrasound (EBUS) was performed as well and a biopsy was taken of an L4 lymph node that was enlarged on visualization. Pathology demonstrated non-small cell carcinoma squamous cell type of the biopsies of the left upper lobe irregularity and a negative cytology of the BAL from the right lung.\nThe patient was discharged home and had decided to continue further follow up with our office for treatment. Given the delay in treatment, a PET scan was ordered prior to beginning treatment. PET showed a left pulmonary hilar lesion with an SUV of 18.8 (), a right precarinal lymph node with calcification and SUV of 4, right breast retroareolar uptake with an SUV of 2.8 () and an atrophic left kidney. On questioning, the patient had complaints of a right breast mass for approximately one week. On examination, a mass could be felt in the right breast in the retroareolar region and was approximately 3 cm in size. Before treatment could begin for his lung cancer, a biopsy of this mass was obtained in IR. Pathology from this biopsy demonstrated a neuroendocrine carcinoma with a Nottingham score of 8 (glands = 3, nuclei = 2, mitoses = 3), grade III. The tumor consisted of sheets of crowded cells with hyperchromatic, pleomorphic nuclei with high nuclear cytoplasmic ratio (NC ratio), scant cytoplasm, easily seen mitoses (). Immunohistochemical staining results showed: CD56 - strong positive, synaptophysin - strong positive, p63 - moderately positive, nuclear, diffuse, CK5/6 - negative and TTF-1 - negative. These results were most consistent with a high grade small cell carcinoma of the breast. This biopsy was compared to the patient’s previous biopsies and there was no resemblance noted in any of the samples. No in-situ component was identified in the biopsy specimen. In light of the PET scan being negative for any other metastatic sites of disease, this was labeled as a primary small cell carcinoma of the right breast with a simultaneous diagnosis of Stage IV NSCLC of the lung.\nThe patient received radiation therapy (RT) to the right breast concurrently with chemotherapy using carboplatin and etoposide. He completed RT to the right breast in one month with a total dose of 5000 cGy and a tumor boost to the right breast of 1000 cGy in 5 days. Due to hemoptysis at presentation and recurrence at a future date, it was decided to give RT to the left upper lobe of the lung to prevent further and possible fatal hemoptysis. He completed this radiation in 56 days with a total dose of 6660 cGy. As of now, the patient has completed 5 cycles of carboplatin/etoposide and is doing well. CT scan of the chest has shown resolution of the breast mass and volume loss of the left upper lobe without malignancy or new disease. The breast mass has resolved on examination. | [[61.0, 'year']] | M | {'20052730': 1, '21657157': 1, '16998932': 1, '6091325': 1, '22968627': 1, '22520734': 1, '17614337': 1, '19563623': 1, '23213972': 1, '22516480': 2, '17653910': 1, '21070442': 1, '21989436': 1, '19661365': 1, '851951': 1, '24179664': 2} | {'3777496-1': 1} |
163,780 | 3804828-1 | 24,179,665 | noncomm/PMC003xxxxxx/PMC3804828.xml | Primary Multicentric Angiosarcoma of Bone: True Entity or Metastases from an Unknown Primary? Value of Comparative Genomic Hybridization on Paraffin Embedded Tissues | A 69-year-old man with previous myeloid splenomegaly presented secondary acute myeloid leukemia (AML)(CD33+, 47XY, +9 and 49XY, +8, 10) in 2008. He underwent induction chemotherapy (aracytin/idarubicin), consolidation following remission, and allograft without total body irradiation. He underwent cyclosporin and steroid therapy for cutaneous graft versus host disease for six months. In April 2009, the patient, on remission from his AML, presented with painful swelling of the inferior extremity of his ulna. X-rays showed a destructive lytic mass with irregular borders and cortical erosion, complicated with spontaneous fracture. He underwent surgical biopsy, gross resection (curettage) and cementoplasty. Whole-body diagnostic work-up included X-rays of painful areas, blood tests, chest-abdomino-pelvic CT and bone scan. He had two other soap-bubble lytic lesions of his wrists () on X-rays, inT1-weighted hyposignal on MRI (, right insert). Pathological specimen showed a high-grade tumor. On microscopy, round epithelioïd tumor cells were separated by collagenous tissue, forming dense vascular channels and solid nests without necrosis (). Cells harbored enlarged nuclei of irregular shape and size with numerous mitoses and scant basophilic cytoplasm. Immunohistochemistry showed strong diffuse anti-CD31 (), CD34, FLI1 expression in tumor cells with Ki67 60%. Tumor cells were negative for anti-pancytokeratin antibodies AE1, AE3, EMA, desmin, protein S100, CD20, CD3, HHV8, LMP and D2.40. Centrally-reviewed diagnosis, within the French Sarcoma Group (FSG), was epithelioïd high-grade angiosarcoma of bone. The patient, WHO performance status 1, underwent hypofractionated radiation therapy with concomitant low-dose weekly paclitaxel (25 mg/m2) on bone tumors. The patient experienced symptomatic relief and grade 2 radiodermatitis. One month later, the patient had a round centimetric lymphadenopathy in the submandibular area, metastatic on biopsy from his angiosarcoma. The patient had worsening limited mouth opening. CT and MRI revealed unresectable contrast-enhanced masses of the right parapharyngeal space. Histology showed poorly-differentiated angiosarcoma () phenotypically comparable with his bone angiosarcoma (). Comparative Genomic Hybridization (CGH) performed on paraffin-embedded tissues, as previously described, upon patient consent and FSG approval, revealed gain of chromosomes 8 and 9, consistent with angiosarcoma. Genomic profiles were similar in bone and head and neck soft-tissue lesions (, ) suggesting tumor clonality. The bone fragment however presented additional 12p and 18p losses (, arrow) (). There was neither cMyc (8q24) amplification nor additional genomic instability. Profiles showed full chromosomes or chromosome arm alterations, rather indicated mitotic segregation instability.\nThe patient underwent conformal irradiation on gross head and neck disease with a complete response. He subsequently underwent 12 courses of radiation therapy on long bones, always with durable pain relief and consolidative effect. He had monthly zoledronate therapy for eight months. He then developed multifocal destructive lesions of the extremities and skin nodules in October 2011. He underwent 3 cycles of doxorubicin with progressive disease. AML relapsed in June 2012. He died of AML in July 2012, 36 months after the diagnosis of angiosarcoma, which was progressive at last follow-up. | [[69.0, 'year']] | M | {'18521223': 1, '26550053': 1, '9630175': 1, '15462503': 1, '12766574': 1, '14663364': 1, '23466575': 1, '20008140': 1, '19737647': 1, '8635113': 1, '7198934': 1, '31919587': 1, '21323951': 1, '15692948': 1, '11958899': 1, '23319690': 1, '2942182': 1, '24179665': 2} | {} |
163,781 | 3804829-1 | 24,179,666 | noncomm/PMC003xxxxxx/PMC3804829.xml | A Case of Myxoid Adrenocortical Neoplasm: Computed Tomography and Magnetic Resonance Imaging Characteristics | A 70-year-old man was found to have an adrenal mass on non-enhanced computed tomography (CT) scanning, performed as part of a detailed examination for liver dysfunction by the attending physician. He was referred to our hospital for further examination and treatment. Examination on admission revealed that the patient was moderately overweight (weight, 71.5 kg; height, 167.8 cm; BMI, 25.6) and hypertensive (133/75 mmHg); hypertension was treated with nifedipine. Laboratory findings were within normal ranges except for γ-guanosine triphosphate, which was 51 IU/L (normal range 10-47 IU/L). He also underwent endocrine evaluation, which showed no functional abnormalities. CT scanning demonstrated a solid, homogeneous mass (24×38×34 mm) with well-defined edges in the left adrenal gland. Attenuation measurements were 22 Hounsfield units (HU) on the precontrast image, 111 HU on the arterial phase image, and 29 HU on the delayed phase image (). Magnetic resonance imaging (MRI) showed no loss of signal intensity in T1-weighted out-of-phase images but high signal intensity on T2-weighted and diffusionweighted images (DWI) (). A temporal enhancement effect was seen on dynamic MRI. Left open adrenalectomy was performed.\nThe mass was macroscopically visualized as a well-circumscribed, golden yellow tumor (), histologically characterized by an incomplete capsule and focally infiltrative margin. The tumor cells were arranged in glandlike structures and the background of the tumor was myxoid. In some areas, a trabecular pattern was also recognized. Tumor cells contained scant cytoplasm, although clear cells with relatively abundant cytoplasm were focally observed (, ). Hematoxylin and Eosin staining revealed that tumor cells were present outside the capsule and had infiltrated the fatty tissue without disruption of the reticulin network (, ). Mitotic figures were rare (<1/20 under high-power field). Tumor cells immunohistochemically stained positive for melan-A, α-inhibin, synaptophysin, and vimentin, and negative for p53; the MIB-1 index was 2%. The tumor fulfilled 2 of the Weiss criteria (paucity of clear cells, high nuclear grade only focally) (). Hough score and van Slooten index were 1.21 (diffuse growth pattern, pleomorphism) and 7.4 (regressive changes, structural changes, nucleoli), respectively. Mitotane was not used as an adjuvant therapy. Neither recurrence nor metastasis was detected during the 10 months of follow-up. Long-term follow-up with imaging and adrenocortical hormonal measurement was implemented because two cases of recurrence have previously been reported. | [[70.0, 'year']] | M | {'9648789': 1, '21997290': 1, '474519': 1, '11044054': 1, '583122': 1, '6703192': 1, '22800844': 1, '19912359': 1, '20534995': 1, '22086150': 1, '22031318': 1, '3967172': 1, '24179666': 2} | {} |
163,782 | 3805163-1 | 24,179,667 | noncomm/PMC003xxxxxx/PMC3805163.xml | Ventricular Fibrillation after Bortezomib Therapy in a Patient with Systemic Amyloidosis | A 64-year-old female suffering from general fatigue, appetite loss, and weight loss was referred to our institute for the investigation of M-protein and hypercalcemia. Upon hospital admission, her Eastern Cooperative Oncology Group performance status was 2 and her Karnofsky performance status (KPS) was approximately 50%. She was also found to suffer from class II heart failure according to the functional classification system of New York Heart Association (NYHA). Physical examination revealed a palpable liver edge 15 cm below the costal margin and bilateral pretibial pitting edema.\nResults of her blood test revealed the following: aspartate aminotransferase, 81 (normal, 13-33) U/L; alkaline phosphatase, 534 (115-359) U/L; γ-glutamyl transpeptidase, 311 (10-47) U/L; lactate dehydrogenase, 343 (119-229) U/L; calcium, 11.7 (8.7-10.3) mg/dL; creatinine, 1.18 (0.4-0.7) mg/dL; brain natriuretic peptide (BNP), 1630.5 (0-8.4) pg/mL; N-terminal prohormone of BNP (NT-proBNP), 8290 (0-125) pg/mL; and troponin T, 0.242 (0-0.014) ng/mL. Her serum beta-2 microglobulin level was 5.5 (0-2.5) mg/L and free light chain difference (FLC-diff) was 33.46 mg/dL.\nImmunoelectrophoresis demonstrated a monoclonal immunoglobulin light-chain with λ isotype in the urine. A bone marrow aspirate revealed 10% plasma cells with CD38+, CD138+, and cytoplasmic λ+ phenotypes. An iliac biopsy confirmed the infiltration of plasma cells. Diffuse osteoporosis was revealed by radiography, and magnetic resonance imaging showed the absence of focal lesions. Histopathological examination revealed amyloid infiltration in biopsy samples of the gastric mucosa.\nMarked cardiomegaly was noted on chest radiography. Electrocardiography (ECG) revealed left-axis deviation, low-voltage QRS complexes, and first degree atrioventricular block (). A 24-h Holter ECG demonstrated 129 beats of ventricular premature contractions (VPCs) and 1268 beats of atrial premature contractions (APCs), including 5 VPC short runs (maximum, 5 runs) and APC short runs (maximum, 8 runs; ). Transthoracic echocardiography revealed a left ventricular ejection fraction of 64%, diffuse thickening of the left and right ventricular walls with granular sparkling, and pericardial effusion.\nShe was diagnosed with systemic AL amyloidosis associated with Bence Jones protein type multiple myeloma (MM). After written informed consent was obtained from the patient, administration of dexamethasone and bortezomib (oral dexamethasone, 20 mg/day, days 1-4; bortezomib, 1.3 mg/m2/day, subcutaneous injection on day 4) was initiated under 24-h ECG monitoring (). The incidence of tachycardia was decreased through dexamethasone treatment. Serum calcium levels were corrected by intravenous infusions of normal (0.9%) saline with elcatonin, leading to increased body weight. After adjustment of infusions and diuretic treatment, her body weight returned to that at baseline. The day before the onset of VF, her serum mineral levels were within normal limits as follows: calcium, 9.2 mg/dL; magnesium, 1.8 (1.8-2.7) mg/dL; and potassium, 3.9 (3.6-4.9) mmol/L. The patient no longer complained of insomnia, constipation, or the stress of hospital admission. However, approximately 84 h after bortezomib administration, in the middle of the night, the patient conversed with nursing staff and walked to the rest room for urination. A few minutes later, her cardiac monitor alarm sounded and showed VF pattern. She was found lying down at her bedside. Cardiopulmonary resuscitation (CPR) using direct current shocks with epinephrine and amiodarone was initiated. Her serum mineral levels were as follows: sodium, 138.1 (138-146) mmol/L; potassium, 3.56 mmol/L; ionized calcium, 1.11 (1.1-1.4) mmol/L; and bicarbonate, 29.9 (22-30) mmol/L. Continuous CPR for approximately 30 min failed to recover the cardiac features required to sustain the general circulation, but just after the injection of vasopressin, her arterial pulsations recovered. However, she died of heart failure 8 h after the onset of VF.\nAutopsy revealed congested, hemorrhagic lungs and right and left ventricular hypertrophy (heart weight, ≥400 g). Gross examination revealed round-to-web-like yellow waxy deposits in the myocardium. Histopathological examination revealed cardiac amyloid deposition, even in the atrioventricular node, and no ischemic lesion was complicated (). The amyloidosis had also spread to the tongue, lung, liver, colon, kidney, bone marrow, adrenal gland, thyroid gland, and ovaries. | [[64.0, 'year']] | F | {'21562045': 1, '18633693': 1, '22331187': 1, '31559459': 1, '20519734': 1, '21952908': 1, '23294331': 1, '22964848': 1, '22425731': 1, '12904524': 1, '27499835': 2, '11795886': 1, '16689991': 2, '23479568': 1, '26284951': 1, '20458563': 1, '16116334': 1, '22331953': 1, '18242546': 1, '17561972': 1, '12601813': 1, '29696194': 1, '15958804': 1, '16198646': 1, '24179667': 2} | {'1475607-1': 1, '4961869-1': 1} |
163,783 | 3805164-1 | 24,179,668 | noncomm/PMC003xxxxxx/PMC3805164.xml | Pericardial Tamponade: a Rare Complication of Sternal Bone Marrow Biopsy | An 80-year-old man was brought to the regional hospital because of unclear abdominal pain, diarrhea and concomitant dehydration. He was admitted with diagnosis of pancreatic irritation and acute enteritis. Later, on the basis of laboratory examination of anemia (Ery 3.77×1012L, Hb 112 g/L, Hct 0.35) and thrombocytopenia (72×109L), sternal bone marrow aspiration biopsy was performed. Approximately 45 minutes after the procedure the patient was complaining about general weakness and backache. Echocardiography examination showed pericardial effusion. Later, computer tomography scan excluded suspected ascending aortic dissection. Because of slowly ongoing hemodynamic stability deterioration, the patient was transported to cardiac surgical facility. Transoesophageal echocardiography confirmed pericardial tamponade with right atrium and ventricle compression and dyskinesis (Figure 1A). Immediate surgery was indicated.\nBefore surgical field draping off, puncture site on sternum was clearly visible (Figure 1B). After midline sternotomy, blood effusion in upper mediastinal tissue was found. When pericardial sac was opened, approximately 300 mL of blood were evacuated and hemodynamic stability was immediately achieved. Stab injury was found on the ascending aorta (Figure 1C). This location was sutured with pericardial pledgets. During postoperative course rehydration and short-time full parenteral nutrition was necessary. Overall state of health gradually improved and the patient was transferred back to regional hospital on 7th post-operative day for further rehabilitation. | [[80.0, 'year']] | M | {'22986229': 1, '34442518': 1, '23352376': 1, '7407523': 1, '2919469': 1, '15026717': 1, '33014251': 1, '4042891': 1, '3578205': 1, '28698857': 1, '12786808': 1, '31465426': 1, '24179668': 2} | {} |
163,784 | 3805168-1 | 24,179,638 | noncomm/PMC003xxxxxx/PMC3805168.xml | Conservative Management of Chronic Aortic Dissection with Underlying Aortic Aneurysm | A 68-year old female presented to the emergency department complaining of nausea and vomiting which were getting progressively worse over the morning of her admission. She also complained of a central epigastric pain, which she described as sharp, non-stabbing and non-radiating. The pain was rated as 9 out of 10 on the intensity scale and she recalled the pain started shortly after the episodes of vomiting. Episodes of headache, dizziness, lightheadedness and slight blurring of vision were also reported but she denied any syncope, fever or chills. In terms of past medical history, she suffered from hypertension, hyperlipidemia, an abdominal aortic aneurysm and chronic renal insufficiency status post pyleography.\nOn examination on admission to the emergency department, the patient was found to be in hypertensive crisis with the highest blood pressure reaching 206/102 on her left arm and 243/129 on her right arm. On general observation, she was found to be appropriately orientated but in moderate distress with diaphoresis. Clinical observations recorded included a heart rate of 74 beats/min, respiratory rate of 32/min, while pulse oximetry was 97%. Abdominal examination revealed a soft, non-tender, non distended abdomen with normal bowel sounds. No carotid bruits were heard on auscultation and no palpable or pulsating mass was found. The epigastric area was tender but there was no guarding or rebound tenderness. Her cardiovascular examination revealed mild tachycardia, normal heart sounds, no murmurs and no gallop. Her respiratory examination was unremarkable apart from the presence of rales in the lungs. No abnormalities were detected in the peripheral pulses. As a first-line investigation, an echocardiogram was ordered which showed a normal sinus rhythm and non-specific ST-T wave changes. Cardiac enzymes, amylase, lipase and troponins were also ordered and were all within normal limits. Her chest X-ray was also normal showing a normally proportioned heart and no abnormality in the thoracic aorta. There was no pulmonary congestion, infiltrates or pleural effusions. Other baseline investigations included a complete blood count, liver function tests, and urea, electrolytes and creatinine levels.\nBased on the location, nature of the pain and the clinical observations of the patient, a provisional diagnosis of acute aortic aneurysm was made. The first-line management was to control her excessively high blood pressure so as to reduce the risk of any possible complications. She was, therefore, started on an i.v. nitroglycerin drip in the emergency department and later switched to a nicardipine i.v. drip as there was only an initial response to the nitroglycerin. With her pain adequately managed, she was admitted to the cardiac care unit to ensure strict blood pressure control which was appropriately kept under 110/70. Computed tomography (CT) of the chest, abdomen and pelvis was performed and an aortic aneurysm was found at the base of the diaphragm. This was consistent with her history of an aneurysm that in 2006 measured 4.4 cm. Further investigation with an MRI confirmed the presence of an aneurysm still spanning 4.4 cm, but in addition, a chronic aortic dissection in the descending thoracic aorta was also seen. The dissection was located at the level of the celiac artery and measured 5.0 cm. The presence of thrombi and calcifications within the lumen created by the aortic dissection makes the dissection consistent with a chronic presentation versus an acute episode.\nOnce stabilized, the patient was reassessed and it was concluded that her epigastric pain was most likely due to hypertensive emergency with an underlying aortic aneurysm and chronic aortic dissection. Based on the location of the dissection, it was classified as Stanford B, and given the aneurysm was less that 5.5 cm, it was decided that it would be best managed conservatively with strict blood pressure control. The patient was, therefore, started on labetolol. Strict control of the patient’s blood pressure and hyperlipidemia was also the conservative choice in treatment of the coexisting aneurysm. The patient has now been monitored for the last two years. | [[68.0, 'year']] | F | {'10096974': 1, '16442379': 1, '2312107': 1, '7841651': 1, '3309654': 1, '20308170': 1, '10685714': 1, '19573744': 1, '5458238': 1, '16675250': 1, '17696630': 1, '29666091': 1, '10077517': 1, '1202971': 1, '20058512': 1, '1636606': 1, '10567316': 1, '13577293': 1, '7810492': 1, '12147183': 1, '17101856': 1, '13259422': 1, '11511117': 1, '1423985': 1, '20826293': 1, '7828300': 1, '10391340': 1, '9694450': 1, '2232021': 1, '24179638': 2} | {} |
163,785 | 3805180-1 | 24,159,261 | noncomm/PMC003xxxxxx/PMC3805180.xml | Dubowitz syndrome: common findings and peculiar urine odor | A 5-year-old girl was presented to our institution because of failure to thrive. She was the fifth child of unrelated parents originating from the same village in the south of Lebanon. She was born vaginally at term to a 33-year-old mother; her birth weight was 2,200 grams. The course of pregnancy was normal and the mother denied any medication use, smoking, or alcohol intake. The girl’s perinatal history was significant for neonatal jaundice requiring phototherapy. The family history was unremarkable except for mental retardation in a maternal uncle and a congenital heart defect in an older brother.\nIn early infancy, the girl had feeding difficulties and failed to thrive. She also had a history of recurrent respiratory infections and eczematous skin changes. In addition, since birth she had had a musty urine odor that had never been reported in her family. Urine analyses were repeatedly normal.\nAt consultation, developmental evaluation revealed a hyperactive child with significant speech delay. Her vocabulary consisted of 10–15 words. She used few two-word sentences. Otherwise, the gross and fine motor abilities were adequate for her age. She made good eye contact and could understand and carry out simple verbal instructions, but she had a short attention span and impulsive behavior.\nUpon examination, her height was reported at 84 cm, her weight was 10 kg, and her head circumference was 44 cm, all below the third percentile according to US Centers for Disease Control growth charts.\nShe had fair, dry skin and sparse, fine blond hair. Her face was elongated with a high sloping forehead. She had sparse lateral eyebrows, long eyelashes, wide-set eyes (telecanthus) with hypertelorism, low-set ears, a broad nasal bridge with a prominent tip, micrognathia, a thin upper lip, a high-arched palate, dental caries, a sacral dimple, and eczematous skin changes on the extremities, mainly on the flexural areas ( and ).\nWhen she smiled, her facial skin wrinkled and she looked like a prematurely aged girl (). The remainder of the physical examination was normal.\nLaboratory workup yielded normal results for the following tests: complete blood count, serum blood urea nitrogen, creatinine, sodium, potassium, chloride, total serum protein, liver function, lipid profile, thyroid hormone, urine organic acids, plasma acylcarnitine profile and free carnitine level, plasma amino acids, serum lactate and pyruvate levels, plasma zinc, plasma immunoglobulins including normal immunoglobulin E levels, urinalysis, urine cultures, stool studies, insulin-like growth factor 1, antiendomyseal antibodies, sweat chloride, and 46, XX karyotype.\nOther tests included MRI examination of the brain, X-rays of the spine, a voiding cystourethrogram, and an upper gastrointestinal series; all were normal. An echocardiography revealed a trace mitral regurgitation. Bone age was 2-years delayed compared with the chronological age. | [[5.0, 'year']] | F | {'22577224': 1, '10797433': 1, '12598394': 1, '8723121': 1, '18990984': 1, '22121397': 1, '14296916': 1, '23074674': 2, '2358105': 1, '16191007': 1, '23372718': 1, '10508998': 1, '24159261': 2} | {'3447229-1': 1} |
163,786 | 3805425-1 | 24,198,959 | noncomm/PMC003xxxxxx/PMC3805425.xml | Mazabraud's syndrome: case report and literature review | A 54-year-old woman was referred to our clinic with a complaint of pain in her right gluteal region with radiation to her foot that had been present for 2 months. The pain was most pronounced during sitting and jogging, and a physiotherapist detected a mass in the proximal right semitendinosus muscle. She had no history of trauma and was otherwise healthy. However, she had a previous history of breast fibroadenomatosis, carcinoma in situ of the uterine cervix, and uterine fibroma.\nConventional X-rays of the right femur demonstrated a 9.5 × 3.3 cm intra-osseous cystic lesion with sclerotic margins at the right femoral neck in the subtrochanteric and metaphyseal region (Fig. a). A similar lesion was observed within the right ileum above the acetabulum (Fig. b). The lesions were interpreted as being consistent with fibrous dysplasia. Ultrasonography of the right gluteal region revealed a 3 × 4.2 × 4.5 cm hypoechoic soft tissue mass located in the musculature below the ischial tuberosity (not shown). There was no involvement of the adjacent bone. Moreover, the patient underwent magnetic resonance imaging (MRI) of her pelvis and right thigh with and without intravenous administration of a gadolinium-containing contrast agent. The examination showed multiple cystic and solid tumor-like lesions within the bones and muscles. The largest of the soft tissue masses was located in the proximal right adductor magnus muscle and measured 5.5 × 4.4 × 2.9 cm. Two similar lesions were observed in the proximal right adductor brevis muscle with diameters of 1.4 and 1 cm, respectively, and a lesion extending 1.3 cm was located in the rectus femoris muscle. The muscle masses showed low signal intensity on T1-weighted images and high signal intensity on T2-weighted images and short T1 inversion recovery (STIR) images. The signal intensity increased after contrast injection. Skeletal changes related to fibrous dysplasia were evident within the right ilium and in the proximal diaphysis of the right femur measuring 7 and 8 cm, respectively. The bone lesions demonstrated a slight thinning of the cortical bone but no real destruction. The bony lesions were typical of fibrous dysplasia, but the diagnosis of the soft tissue lesions was uncertain, including differentials such as soft tissue sarcoma, lymphoma, and neurofibroma (Fig. ).\nUltimately, the patient underwent an 18F-FDG PET/CT of the neck, chest, abdomen, and thighs at our clinic. The patient received an intravenous injection of 370 MBq of 18F-FDG at rest in dimmed ambient light with minimal background noise. The patient was asked to fast for 6 h before the bolus injection of FDG (water only). One hour after the injection, the PET/CT scan was performed under standard resting condition using a 64-channel PET/CT scanner (Discovery VCT, GE Healthcare, Milwaukee, WI, USA). Images were acquired for 2.5 min in three-dimensional (3D) mode and were filtered and reconstructed using standard techniques. The examination demonstrated a slightly increased FDG uptake (standardized uptake value [SUV] max 2.1) within the solid-appearing regions of the intramuscular lesions in the right hip and thigh and the findings were interpreted as intramuscular myxomas. Moreover, we observed moderately to highly increased tracer uptake (SUVmax 7.0) within the right ilium and the proximal diaphysis of the right femur that was consistent with fibrous dysplasia. The accompanying CT findings were concordant, demonstrating multiloculated and expansive intramedullary lesions with areas of both thickening and thinning of the cortical bone but without cortical destruction. The areas with FDG-uptake on the PET/CT also showed contrast enhancement on the MRI with intravenous gadolinium (Figs. and ). The scan showed no signs of malignancy; thus, enlarged lymph nodes or FDG uptake in lymph nodes was not observed in the neck, chest, and abdomen. The spleen was of normal volume, homogeneous and without focal changes or uptake of FDG. The bone marrow had no signs of lymphomatous infiltration. Overall, the PET/CT findings were interpreted as consistent with Mazabraud's syndrome.\nAfter the scans, the intramuscular mass located in the proximal right adductor magnus muscle was excised. It had well-defined borders and measured 6 × 5 × 3 cm. Histological examination of the lesion supported the radiological diagnosis of myxoma (Fig. ). | [[54.0, 'year']] | F | {'7932967': 1, '2735277': 1, '10525796': 1, '26722294': 1, '5581510': 1, '26288523': 2, '26245479': 2, '15188030': 1, '31275685': 2, '17589842': 1, '19339582': 1, '34854944': 1, '4967408': 1, '9191425': 1, '11241472': 1, '28258512': 1, '22609175': 1, '30484079': 1, '26530393': 1, '8956590': 1, '29863575': 1, '10993273': 1, '11828328': 1, '6054147': 1, '9719504': 1, '3456858': 1, '26568824': 1, '28224215': 1, '29926115': 1, '11154006': 1, '21707965': 2, '31559221': 2, '16319649': 1, '14691924': 1, '24198959': 2} | {'4527122-1': 1, '6558611-1': 1, '3141698-1': 1, '6742871-1': 1, '4531453-1': 1} |
163,787 | 3805426-1 | 24,198,960 | noncomm/PMC003xxxxxx/PMC3805426.xml | Focal portal vein stenosis in an adolescent potentially related to complicated umbilical catheter insertion in the neonatal period | A 14-year-old girl presented with a gradual onset of fatigue and apathy. Laboratory analysis revealed a pancytopenia as summarized in Table . Liver function tests were within normal limits. Her medical history was non-specific except for a preterm birth at 7 months and observation at the neonatal intensive care. At that time a venous umbilical catheter was placed for intravenous fluid administration. However, catheter position was not documented by abdominal plain film. There was no history of hepatitis or other diseases in this otherwise healthy girl. Screening abdominal ultrasound was within normal limits, except for a splenomegaly with a maximal splenic diameter of 17 cm. In order to exclude portal venous and hepatic parenchymal disorders a magnetic resonance angiography (MRA) as well as a transjugular liver biopsy and pressure measurements were performed. MRA revealed a discrete, focal irregularity of the extrahepatic portal vein main branch. The liver biopsy was within normal limits without signs of fibrosis or cirrhosis. Pressure measurements showed a wedged hepatic venous pressure of 11 mmHg and inferior vena cava pressure of 9 mmHg. Further, a gastroscopy was performed, revealing major varices in the lower esophagus and signs of hypertensive gastropathy. The varices were endoscopically ligated, as it was suggested that the anemia could be associated with occult or intermittent bleeding from these varices. Finally, additional laboratory analysis could not identify any thrombophilic parameter disorder. Based on these findings, it was decided to perform direct transhepatic portography and percutaneous treatment.\nUnder general anesthesia, access to the right portal vein was made using ultrasound guidance. Venography clearly revealed a moderate focal stenosis of the main portal vein, potentially associated with a focal intimal dissection. Additionally very large gastric and esophageal variceal collaterals were also clearly visible (Fig. a). Pressure measurements over the stenosis were: 16 mmHg proximal and 6 mmHg distal to the stenosis resulting in a pressure gradient of 10 mmHg. Balloon angioplasty with a 10-mm diameter balloon did not result in sufficient re-expansion of the stenosed segment. It was decided to insert a self-expanding nitinol stent with a length of 4 cm and a nominal diameter of 12 mm (Zilverstent, Cook Medical, Bloomington, IN, USA) which was postdilated up to 10 mm diameter. Pressure measurements after stenting were: 12 mmHg proximal and 10 mmHg distal to the stented segment resulting in a residual pressure gradient of 2 mmHg. Completion venography confirmed the correct appositioning and expansion of the stent and absence of any collateral flow (Fig. b). Patient recovered well after the procedure and could leave the hospital 2 days later. Follow-up was performed by clinical, ultrasound, and laboratory evaluation at regular intervals: every 3 months in the first year and yearly thereafter. Clinically, all signs of chronic anemia disappeared and gastroscopy was normal without visible esophageal varices or hypertensive gastropathy. Ultrasound evaluation could demonstrate a normal volume of the spleen with maximal diameters after 1, 2, 3, 4, and 5 years of 13.2 cm, 13.2 cm, 13.6 cm, 13.8 cm, and 14 cm, respectively, which is at the upper limit of normal values (12–14 cm). Duplex-ultrasound flow measurements were on all evaluations between 40 and 60 cm/s over a 5-year follow-up period. Finally, values of red blood cell, white blood cell, and platelet count normalized during follow-up (Table). | [[14.0, 'year']] | F | {'19339200': 1, '14667123': 1, '18956224': 1, '17911510': 1, '12646473': 1, '19854066': 1, '24198960': 2} | {} |
163,788 | 3805462-1 | 24,198,961 | noncomm/PMC003xxxxxx/PMC3805462.xml | Eagle's syndrome | A 30-year-old woman presented with a 4-month history of right submandibular pain and swelling, as well as sore throat prominent on the right side of the pharynx, and difficulty in swallowing solid foods. On clinical examination she had referred pain on bilateral palpation of the oropharynx. Cervical ultrasonographic evaluation was unremarkable. Eagle's syndrome was suspected. A cervical lateral radiograph showed an elongated styloid process (Fig. ). Computed tomography (CT) with axial (Fig. ), coronal (Fig. ), and three-dimensional (3D) volume-rendering CT images (Fig. ) showed complete ossification of the stylohyoid ligaments with pseudoarticulations. A lateral neck radiograph showed calcifications from the base of the skull to the hyoid bone. An external approach for the removal of the styloid processes was planned and resulted in complete relief of the patient's symptoms. | [[30.0, 'year']] | F | {'22664285': 1, '15041871': 1, '19240828': 1, '26015690': 1, '20558961': 1, '14564284': 1, '10214896': 1, '17997158': 1, '11562889': 1, '16320226': 1, '21213007': 2, '22244077': 1, '18771827': 1, '23031688': 2, '11815916': 1, '18083436': 1, '10958426': 1, '18790603': 1, '20339566': 1, '19621249': 1, '24198961': 2} | {'3095808-1': 1, '3492092-1': 1} |
163,789 | 3805463-1 | 24,198,962 | noncomm/PMC003xxxxxx/PMC3805463.xml | Acute endovascular repair of iatrogenic right internal carotid arterial laceration | A previously healthy 58-year-old man was admitted to an ear, nose, and throat (ENT) specialist due to a right-side serous otitis media and hearing loss. Initially he was treated medically but with no significant improvement of his condition. He was referred for a magnetic resonance imaging (MRI) examination, which showed a right-side contrast-enhancing meningeal skull base expansion with tumor growth into the prepontine cistern, sphenoidal sinus, and along the right ICA (Fig. ).\nA transsphenoidal biopsy from the tumor concluded with a meningo-epithelial meningioma (WHO grade I), and he was scheduled for two-step surgery, starting with the tumor component medial of the ICA. He was admitted to the neurosurgery department in good physical condition, and with a normal neurological and hormonal status. Surgery was performed through a transnasal transsphenoidal approach from the right side. The tumor was fibrotic and during resection a profuse arterial hemorrhage occurred. Hemostasis was achieved temporarily by surgical packing and the patient was admitted to angiography.\nThrough a right-side femoral access, a 6 French (F) sheath (Boston Scientific, Sunnyvale, CA, USA) was placed and a 5 F right coronary catheter (Boston Scientific, Sunnyvale, CA, USA) was used for selective angiography. The angiogram showed some extravasation of the contrast medium, shaped as a small irregular pseudoaneurysm at the distal part of the C3 segment of the right ICA (Fig. ). The extravasation was limited due to the temporary hemostasis. The angiogram also revealed a small proximal segment of the anterior cerebral artery (A1) and a large posterior communicating artery (PCOM) on the right side. Due to tortuous anatomy, a 0.014-inch floppy guidewire was replaced by a 0.0035-inch hydrophilic wire (Boston Scientific, Sunnyvale, CA, USA). With some manipulation a stentgraft (4.5/16 mm Jostent Graftmaster; Abbott Laboratories, Abbott Park, IL, USA) was placed and deployed with balloon dilatation, and the bleeding was immediately occluded (Fig. ). There were no thromboembolic complications and the puncture site was closed successfully. Because of the perioperative bleeding, administration of intra-arterial Heparin (5000 IE) was delayed until the stentgraft was in place. The patient recovered uneventfully and a computed tomography (CT) scan the following day showed an open stentgraft and no bleeding was seen (Fig. a). The CT also confirmed the small A1 (Fig. b) and the large PCOM on the right side, as well as a hypoplastic proximal segment of the right posterior cerebral artery (P1). He continued on Plavix 75 mg daily for a period of 6 months; during this period no events related to the covered stent occurred. | [[58.0, 'year']] | M | {'23096412': 1, '29650785': 1, '9127026': 1, '23312351': 1, '3883217': 1, '21990462': 1, '9007854': 1, '1562408': 1, '22406926': 1, '22953119': 2, '16766960': 1, '24198962': 2} | {'3420369-1': 1, '3420369-2': 1} |
163,790 | 3806121-1 | 24,159,263 | noncomm/PMC003xxxxxx/PMC3806121.xml | Unusual case of contralateral Horner’s syndrome following stellate-ganglion block: a case report and review of the literature | A 47-year-old female presented to our institution with right-hand pain secondary to Raynaud’s phenomenon. Her pain persisted despite medical management. Physical examination revealed cold skin, hyperalgesia, allodynia, pink-to-purple discoloration of her right hand, and symmetric pupillary size. She was scheduled for a right-side SGB. The patient was placed in the supine position with her neck hyperextended and her jaw slightly opened. Monitored anesthesia care and intravenous sedation was initiated. The skin and subcutaneous tissue in the right paratracheal area was anesthetized using 3 mL lidocaine 1% at the level just above the C6 transverse process (Chassaignac’s tubercle). The right carotid artery was retracted laterally using the index and middle finger from the nondominant hand, and was then advanced posteriorly squeezing the subcutaneous tissues towards the C6 transverse process. With the dominant hand, a syringe with a 22-gauge short-bevel needle was advanced perpendicularly down until Chassaignac’s tubercle was felt at a depth of about 2 cm. The needle was then withdrawn 1–2 mm. After confirming a negative aspiration, a total of 10 mL local anesthetic (lidocaine 1.5% and bupivacaine 0.5% at 1:1 ratio) was injected with intermittent aspiration. After the procedure, the patient experienced significant pain relief and subjective warmth in her right upper extremity, as well as ptosis, miosis, and conjunctival injection (Horner’s syndrome) on the left, contralateral side. Right-extremity temperature was measured using surface-temperature monitoring, and showed an increase from 32.4°C to 34.7°C. Right pupillary size was noted to be unchanged from baseline examination, and no facial flushing was noted. At the patient’s 2-week follow up visit, she had continued pain relief and did not require additional pain medications. | [[47.0, 'year']] | F | {'21198471': 1, '5810130': 1, '20882175': 2, '3948040': 1, '1581263': 1, '29416250': 1, '8095400': 1, '8075467': 1, '33145140': 2, '30713916': 1, '10925936': 1, '8351337': 1, '24159263': 2} | {'2943702-1': 1, '7599049-1': 1} |
163,791 | 3806560-1 | 23,867,717 | noncomm/PMC003xxxxxx/PMC3806560.xml | Clinical and morphological evaluation of gold micro shunt after unsuccessful surgical treatment of patients with primary open-angle glaucoma | A 90-year-old man with GMS removed from the right eye 29 months after implantation. IOP was 25.0 mm Hg (Ganfort), and progression in the visual field was observed (MD=−17.91). The central corneal thickness (CCT) increased from 480 to 568 μm and the corneal decompensation was detected despite the lack of GMS contact with the endothelium (OCT Visante). In the middle portion of GMS the presence of collagen-rich connective capsule-like reaction about 100-μm thick was found (). The presence of cell-rich collagen-poor connective tissue was also found between the plates. There were also observed chronic inflammatory infiltration cells, polynuclear giant cells, and small blood vessels (). | [[90.0, 'year']] | M | {'31413822': 1, '31568666': 1, '20805134': 1, '21873316': 1, '25624673': 1, '26175960': 1, '22249233': 1, '27253968': 1, '2914753': 1, '21861086': 1, '19273788': 1, '28900712': 1, '28600745': 1, '25246758': 1, '34127842': 1, '27051320': 2, '23867717': 2} | {'3806560-2': 2, '3806560-3': 2, '3806560-4': 2, '4807951-1': 1} |
163,792 | 3806560-2 | 23,867,717 | noncomm/PMC003xxxxxx/PMC3806560.xml | Clinical and morphological evaluation of gold micro shunt after unsuccessful surgical treatment of patients with primary open-angle glaucoma | In the case of a 69-year-old woman GMS+ was removed from the left eye 21 months after surgery. Before removal, IOP was 24.0 mm Hg (Xalacom). Progression in the visual field (MD=−8.55) and corneal decompensation were observed. CCT increased from 534 to 676 μm despite the lack of GMS contact with the endothelium. In the middle portion of GMS the presence of collagen-rich connective capsule-like reaction was detected, but the capsule was thin (about 50 μm). In case no. 2 the presence of cell-rich collagen-poor connective tissue was found between the plates. | [[69.0, 'year']] | F | {'31413822': 1, '31568666': 1, '20805134': 1, '21873316': 1, '25624673': 1, '26175960': 1, '22249233': 1, '27253968': 1, '2914753': 1, '21861086': 1, '19273788': 1, '28900712': 1, '28600745': 1, '25246758': 1, '34127842': 1, '27051320': 2, '23867717': 2} | {'3806560-1': 2, '3806560-3': 2, '3806560-4': 2, '4807951-1': 1} |
163,793 | 3806560-3 | 23,867,717 | noncomm/PMC003xxxxxx/PMC3806560.xml | Clinical and morphological evaluation of gold micro shunt after unsuccessful surgical treatment of patients with primary open-angle glaucoma | The cause of GMS removal from a right eye of a 70-year-old man was the decrease of endothelium from 2579 to 1685 cells mm−2 despite the lack of contact with GMS, and progression in the visual field was observed (MD=−3.49). IOP was 22.0 mm Hg (Ganfort) 28 months after the surgery. In the middle and distal part the GMS was surrounded by collagen-rich connective tissue capsule. The proximal, middle and distal portion channels were partially filled with dense amorphous protein masses (). | [[70.0, 'year']] | M | {'31413822': 1, '31568666': 1, '20805134': 1, '21873316': 1, '25624673': 1, '26175960': 1, '22249233': 1, '27253968': 1, '2914753': 1, '21861086': 1, '19273788': 1, '28900712': 1, '28600745': 1, '25246758': 1, '34127842': 1, '27051320': 2, '23867717': 2} | {'3806560-1': 2, '3806560-2': 2, '3806560-4': 2, '4807951-1': 1} |
163,794 | 3806560-4 | 23,867,717 | noncomm/PMC003xxxxxx/PMC3806560.xml | Clinical and morphological evaluation of gold micro shunt after unsuccessful surgical treatment of patients with primary open-angle glaucoma | In a 52-year-old man, 41 months after primary surgery, GMS+ was removed from the right eye because of the lack of IOP control despite of the maximal antiglaucoma therapy (Duotrav, Azopt). There were observed an increase of IOP to 41.0 mm Hg and progression in the visual field (MD=−4.23). No contact of the implant with the endothelium was observed. Collagen-rich connective tissue in the implant channels and dispersed chronic inflammatory infiltrations both around and inside the implant were detected. Lymphocytic infiltration (LCA+) was accompanied with clusters of numerous polynuclear giant cells (). | [[52.0, 'year']] | M | {'31413822': 1, '31568666': 1, '20805134': 1, '21873316': 1, '25624673': 1, '26175960': 1, '22249233': 1, '27253968': 1, '2914753': 1, '21861086': 1, '19273788': 1, '28900712': 1, '28600745': 1, '25246758': 1, '34127842': 1, '27051320': 2, '23867717': 2} | {'3806560-1': 2, '3806560-2': 2, '3806560-3': 2, '4807951-1': 1} |
163,795 | 3806668-1 | 24,163,681 | noncomm/PMC003xxxxxx/PMC3806668.xml | Cataract Surgery for Tilted Lens in Peters’ Anomaly Type 2 | A 16-year-old female, born with corneal opacity in both eyes, developed cataracts and was diagnosed with Peters’ anomaly type 2. This patient did not exhibit any of the systemic abnormalities commonly associated with Peters’ anomaly. Corneal opacity and conjunctival epithelial flaps had been observed in the left eye since childhood due to the high-grade dysgenesis of the anterior segment, and light perception was absent in the left eye. In the right eye, the corneal opacity had spread from the center of the cornea to the inferotemporal side (fig. ), and a synechia was detected between the corneal epithelium and the iris from the inferonasal to the inferotemporal side. Additionally, preoperative changes were detected in the circle form of the inferotemporal pupillary margin, due to the synechia (fig. ). Severe opacity was also observed in the cornea overlying the inferotemporal synechia between the corneal endothelium and the iris. Fortunately, the lens was still visible, because the central cornea had only mild opacification. A cataract was present in the lens, with severe opacity at the anterior pole. Ultrasound biomicroscopy (UBM) of the anterior segment revealed synechia between the anterior iris and the lens; an anterior deviation and tilting of the lens were also observed (fig. ). The right eye had an axial length of 27.39 mm, with a preoperative visual acuity of 20/250 and a preoperative refractive error of −13.00 – 5.00 × 120. The tilted lens resulted in severe astigmatism and was a cause of the diminished visual function. Severe opacity of the lens was observed at the site of the inferotemporal synechia; therefore, cataract surgery was necessary to remove the lens opacity and improve the astigmatism.\nThe progressive decline in visual acuity caused by the cataract resulted in cataract surgery on the right eye. In order to make synechiolysis from the opposite side, a 2.8-mm clear corneal incision was made on the superonasal side, and viscoelastic materials (Viscoat 0.5, Alcon, Tokyo, Japan) were used to protect the corneal epithelium and maintain the intracameral space. The inferonasal synechia was severed between the cornea and the iris using intraocular scissors. The synechia between the anterior iris and the lens capsule was also severed with intraocular scissors. Phacoemulsification was performed and an intraocular lens (16.5 diopter, KS-Xs, spherical lens, STAAR, Chiba, Japan) was inserted into the capsular bag.\nNeither hemorrhage nor increased intraocular pressure were observed postoperatively. Six months postoperatively, there had not been any positional deviation of the intraocular lens, nor increase in corneal opacity (fig. ); UBM did not reveal any positional deviation of the intraocular lens (fig. ). At this time, the patient's visual acuity had improved to 20/100, with a postoperative refractive error of +0.50 –[N1] 2.00 × 60. The large improvement in astigmatism was due to the absence of any intraocular lens positional deviations. | [[16.0, 'year']] | F | {'8446330': 1, '18650657': 1, '21448066': 1, '11705147': 1, '10361984': 1, '17601429': 1, '3355418': 1, '10201611': 1, '22157569': 1, '24163681': 2} | {} |
163,796 | 3806669-1 | 24,163,687 | noncomm/PMC003xxxxxx/PMC3806669.xml | Generalized Subcutaneous Emphysema Caused by Injection of Air into the Penis for Autoerotic Purposes | A 31-year-old man came to our emergency room seeking medical attention for severe neck pain. He informed us that 2 days before, after excessive consumption of alcohol, he had made an incision into the skin of his penis below the frenulum by means of a needle in order to insufflate air into the opening with a standard ball pump (fig. ) for autoerotic purposes. He had been suffering from severe pain in the neck area since the morning.\nBelow the frenulum, a reddened incision of approximately 5 mm in diameter could be seen which extended into the hypodermis. Apart from that, the penis was without pathological symptoms such as swelling, hyperthermia or redness. Also, the penis was not rigid and there were no crepitations. In the neck area and on the remaining trunk, crepitations could be felt. This was where the patient's pain was located, radiating dorsolaterally from the cervical area into the trapezius muscle.\nThe psychological exploration of the patient's sexuality clarified that he had distinctive sadomasochistic masturbation fantasies. The patient had not pursued these sadomasochistic thoughts so far because he had not been aware of them.\nThe laboratory results were unremarkable. Because the patient was capable of spontaneous and pain-free micturition and the external examination showed no anomalies, a cystoscopic examination of the urethra was not carried out. A CT examination of the abdomen revealed generalized subcutaneous emphysema extending from the scrotum to the abdomen and the cervix (fig. ).\nThe patient was admitted for observation. He received antibiotic treatment with a gyrase inhibitor in order to avoid an infection of the area around the frenulum. The medical focus was on the neck pain caused by the air gradually travelling through the hypodermis from the genital area to the cranial area. The pain was stabilized without difficulty by means of metamizole. After 2 days, it was no longer possible to detect any crepitations in the neck area. | [[31.0, 'year']] | M | {'7989685': 1, '30171153': 1, '20685595': 1, '20347122': 1, '14414787': 1, '27390577': 1, '28149749': 1, '14951888': 1, '20970792': 1, '17205371': 1, '24163687': 2} | {} |
163,797 | 3806670-1 | 24,163,679 | noncomm/PMC003xxxxxx/PMC3806670.xml | Intravitreal Dexamethasone Implant (Ozurdex) in Coats’ Disease | A 12-year-old boy who had stage 3a Coats’ disease and a history of a severe visual decline in OD was referred to us for treatment. On examination, visual acuity was counting fingers at 2 m in OD and 10/10 in OS. The anterior segment was unremarkable, with normal intraocular pressure in both eyes. While the left fundus was normal, there was considerable exudation involving the posterior pole, almost forming a macular plug and a slight epiretinal membrane in OD (fig. ). Extensive peripheral retinal vascular telangiectasia was also evident. Fluorescein angiography demonstrated wide areas of peripheral nonperfusion and dilated vessels of the lightbulb hyperfluorescence type (fig. ). In addition to two sessions of indirect laser photocoagulation 3 months apart, five consecutive monthly 0.05-mg ranibizumab injections were given under general anesthesia at each occasion. As the visual prognosis seemed poor due to submacular exudate plaque, we decided to inject an Ozurdex implant and discussed this option with the family. Upon acceptance of the patient's family, an intravitreal Ozurdex injection was carried out under general anesthesia without any complication (fig. ). A temporary rise in intraocular pressure reaching a level of 32 mm Hg was noted 5 weeks after the injection, which was successfully managed with an antiglaucomatous medication. One year after the Ozurdex injection, visual acuity was counting fingers at 2 m due to fibrotic macular scarring, and intraocular pressure was normal (fig. ). | [[12.0, 'year']] | M | {'22938515': 1, '22440929': 1, '28860707': 1, '33062317': 1, '28974211': 1, '34054468': 2, '18317342': 1, '22548046': 1, '20417567': 1, '11336931': 1, '23269680': 1, '21139479': 1, '30895419': 1, '30186147': 2, '31024824': 1, '11336930': 1, '32443362': 2, '19955197': 1, '29380183': 1, '34901745': 1, '17342503': 1, '20379736': 1, '23221067': 1, '24163679': 2} | {'3806670-2': 2, '6120373-1': 1, '7254772-1': 1, '8138144-1': 1} |
163,798 | 3806670-2 | 24,163,679 | noncomm/PMC003xxxxxx/PMC3806670.xml | Intravitreal Dexamethasone Implant (Ozurdex) in Coats’ Disease | A 7-year-old boy was sent to our clinic because of left exotropia and decreased visual acuity in OS. On examination, visual acuity was 10/10 in OD and 2/10 in OS. Slit-lamp examination and intraocular pressure were normal in both eyes. While the right fundus was normal, there was a hard exudate plaque at the left macula associated with extensive peripheral retinal telangiectasia (fig. ). Fluorescein angiography showed wide areas of peripheral retinal nonperfusion and classic lightbulb type hyperfluorescent vascular dilatations (fig. ). Optical coherence tomography (OCT) exhibited serous macular detachment (fig. ). Our diagnosis was stage 3a Coats’ disease. Therapeutic options and visual prognosis were discussed with the family, and we decided to proceed with indirect laser photocoagulation and a simultaneous intravitreal 0.7-mg dexamethasone implant injection. Under general anesthesia, indirect laser photocoagulation was performed in nonperfused areas and capillary dilations, and an intravitreal Ozurdex injection was given (fig. ). At week 6 after injection, the intraocular pressure was 28 mm Hg and timolol maleate and brinzolamide combination was prescribed twice a day. At 3 months after injection, the intraocular pressure was 15 mm Hg and antiglaucomatous medication was stopped. At 6 months after injection, visual acuity was 3/10 in OS and macular exudates were gradually resolving with no serous macular detachment (fig. ). | [[7.0, 'year']] | M | {'22938515': 1, '22440929': 1, '28860707': 1, '33062317': 1, '28974211': 1, '34054468': 2, '18317342': 1, '22548046': 1, '20417567': 1, '11336931': 1, '23269680': 1, '21139479': 1, '30895419': 1, '30186147': 2, '31024824': 1, '11336930': 1, '32443362': 2, '19955197': 1, '29380183': 1, '34901745': 1, '17342503': 1, '20379736': 1, '23221067': 1, '24163679': 2} | {'3806670-1': 2, '6120373-1': 1, '7254772-1': 1, '8138144-1': 1} |
163,799 | 3806671-1 | 24,163,651 | noncomm/PMC003xxxxxx/PMC3806671.xml | Pyloric Gland Adenoma: A Case Report | A 60-year-old male patient presented to the gastroenterology clinic due to epigastric pain, heartburn and distension. His anamnesis revealed that these complaints had been present for about a year and that he was on medication due to them. In his medical history, he had only hypertension. His physical examination and laboratory test results were normal. Abdominal ultrasonography was normal as well. Based on these findings, upper gastrointestinal system endoscopy was planned. During endoscopic examination, an approximately 2 cm polyp with a lobulated surface was detected in the proximal gastric corpus and polypectomy was performed. Microscopic examination revealed a polyp consisted of glands, some of which presented cystic dilatation, and arranged back-to-back under gastric foveolar epithelium that covered the surface. On immunohistochemical examination, while MUC 5AC was positive in the gastric foveolar epithelium that covered the surface of the polyp and was negative in glandular structures, MUC 6 was found to be positive in the glands and negative on the surface of the polyp (fig. , fig. ). Since the morphological appearance of the glands and the immunohistochemical MUC 6 positivity were consistent with pyloric glands, the lesion was reported as ‘pyloric gland adenoma’. A gland that was covered with cells having hyperchromatic nuclei and presented pseudostratification in a focal area inside the polyp attracted attention. This area was considered as high-degree dysplasia since hyperchromatic nuclei had reached up to cell surface (fig. ). | [[60.0, 'year']] | M | {'8970203': 1, '34160413': 2, '16952035': 1, '15838649': 1, '18830123': 1, '12360042': 1, '11964052': 1, '12715167': 1, '24163651': 2} | {'8238336-1': 1} |
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