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164,000 | 3817033-1 | 24,204,113 | noncomm/PMC003xxxxxx/PMC3817033.xml | Efficacy of reduced-fluence photodynamic therapy for serous retinal pigment epithelial detachment with choroidal hyperpermeability | The patient was a 38-year-old woman. She had been attending hospital for 15 months, with principal complaints of reduced visual acuity and distorted vision in the right eye. On initial examination, log of the minimum angle of resolution (log-MAR) best-corrected visual acuity (BCVA) of the right eye was 0.1. The images of FA, ICGA, and OCT are described in . No serous retinal detachment was evident on OCT images, which showed PED of half the disc diameter in the subfovea, including the fovea, and continuity of the inner and outer segments (IS/OS) line was unclear. FA showed hyperfluorescence in the early phase of contrast enhancement in the same location as the PED, and ICGA revealed hyperfluorescence in the mid-phase and late-phase of contrast enhancement in the same location as the PED, as well as hyperpermeability of the choroidal vessels in the surrounding area, resulting in a diagnosis of ISPED. In ICGA, no polypoidal lesion or branching vascular network, which is diagnostically seen in polypoidal choroidal vasculopathy, were observed. Because the PED had not improved, RFPDT (spot size: 5,400 μm) was performed 16 months after onset. The PED was seen to have completely disappeared 1 month after RFPDT. Continuity of the IS/OS line was restored on the OCT images, and logMAR BCVA improved to −0.1 with symptomatic improvement of the distorted vision. Visual acuity was maintained at 12 months posttreatment, with no recurrence of PED. No adverse events were seen in this case during follow-up after RFPDT. | [[38.0, 'year']] | F | {'12824827': 1, '646687': 1, '18046220': 1, '9279943': 1, '23456099': 1, '19896635': 1, '14660450': 1, '14707823': 1, '22840480': 1, '92197': 1, '26155086': 1, '30829024': 2, '24204113': 2} | {'3817033-2': 2, '6416479-1': 1, '6416479-2': 1} |
164,001 | 3817033-2 | 24,204,113 | noncomm/PMC003xxxxxx/PMC3817033.xml | Efficacy of reduced-fluence photodynamic therapy for serous retinal pigment epithelial detachment with choroidal hyperpermeability | The patient was a 42-year-old man. He had been attending hospital for 4 months, with the principal complaint of distorted vision in the right eye. On initial examination, logMAR BCVA of the right eye was −0.2. The images of FA, ICGA, and OCT were described in . No serous retinal detachment was evident on OCT images, which showed serous PED of one-fifth of the disc diameter at the subfovea, and continuity of the IS/OS line was unclear. FA showed hyperfluorescence in the same location as the PED, and ICGA revealed hyperfluorescence of the PED from the mid-phase to the late-phase and weak hyperfluorescence around the PED due to hyperpermeability of the choroidal vessels, resulting in a diagnosis of ISPED. Because the PED had not improved, RFPDT (spot size: 3,300 μm) was performed 6 months after onset. The PED was seen to have completely disappeared 1 month after RFPDT. Continuity of the IS/OS line was restored on OCT images, and logMAR BCVA was maintained, with symptomatic improvement of distorted vision. Visual acuity was maintained at 6 months posttreatment, with no recurrence of PED. No adverse events were seen in this case during follow-up after RFPDT. | [[42.0, 'year']] | M | {'12824827': 1, '646687': 1, '18046220': 1, '9279943': 1, '23456099': 1, '19896635': 1, '14660450': 1, '14707823': 1, '22840480': 1, '92197': 1, '26155086': 1, '30829024': 2, '24204113': 2} | {'3817033-1': 2, '6416479-1': 1, '6416479-2': 1} |
164,002 | 3817054-1 | 24,204,114 | noncomm/PMC003xxxxxx/PMC3817054.xml | Bilateral macular injury from a green laser pointer | A 13-year-old boy presented to our clinic complaining of decreased vision in both eyes 1 day after having intentionally gazed directly into the beam of a green laser pointing device (wavelength 532 nm), that had a maximum power rating of 5 mW (US Food and Drug Administration class 3A or IEC class 3R) stated on its labeling. He held the laser 5 cm away from his eyes for an estimated 30–60 seconds. Prior to this incident, the boy had reported no visual complaints. His last ocular examination had revealed visual acuity of 20/20 in both eyes.\nCurrent examination revealed best-corrected visual acuity of 20/50 in the right eye and 20/30 in the left eye. Anterior segments were normal in both eyes. Fundus examination showed bilateral, yellowish, oval-shaped, drusenoid-like lesions with attenuation of the foveal reflex ( and ).\nImaging studies were done on presentation to our practice 18 hours after exposure to the laser device. Optical coherence tomography (3D OCT; Topcon, Tokyo, Japan) of both eyes showed disruption of the outer retinal layer with nonspecific retinal thickening ( and ); red-free photographs demonstrated hypopigmented foveal dots bilaterally ( and ); fluorescein angiography showed early foveal hyperfluorescence in both eyes with late ill-defined leakage ( and ); and autofluorescence images showed heterogeneous hyperfluorescence in the macula of both eyes ( and ). Finally, a computerized 10–2 visual field threshold test (Humphrey Automated Perimeter; Humphrey Instruments, San Leandro, CA, USA), showed small pericentral scotomata in the right eye and a normal field in the left eye.\nThe patient was treated with an oral steroid (Prednisone; H.J. Harkins Company, Inc., Grover Beach, CA, USA) 1 mg/kg for 4 weeks then tapered over 2 months. At 3 months, visual acuity remained impaired but improved to 20/30 in the right eye and 20/25 in the left eye.\nAt 3 months, optical coherence tomography showed improvement of the retinal thickening in both eyes. The hyperreflective line representing the inner segment/outer segment junction was disrupted in the right eye and the left eye ( and ). The visual field improved and no scotoma was detected in the right eye. | [[13.0, 'year']] | M | {'15883281': 1, '22466425': 1, '26927809': 1, '28282068': 1, '26611842': 1, '22740016': 1, '32445700': 1, '9643781': 1, '30894692': 1, '28559725': 1, '30546136': 2, '34988368': 1, '11115266': 1, '22165950': 1, '9856195': 1, '25301883': 1, '20825327': 1, '21191730': 1, '10906379': 1, '20530564': 1, '26921203': 1, '9261305': 1, '29271340': 1, '24434663': 1, '24204114': 2} | {'6460723-1': 1, '6460723-2': 1, '6460723-3': 1, '6460723-4': 1} |
164,003 | 3817060-1 | 24,204,116 | noncomm/PMC003xxxxxx/PMC3817060.xml | Topical rebamipide improves lid wiper epitheliopathy | The patient was a 77-year-old female, diagnosed with dry eye at another clinic and treated with sodium hyaluronate ophthalmic solution and diquafosol sodium eye drops for several weeks. She has never worn contact lenses on a regular basis. Because of lack of improvement in her subjective symptoms, she visited Maebashi Red Cross Hospital. Her ocular symptoms were dryness and blurred vision in the right eye. Slit-lamp microscopy with fluorescein staining showed diffuse corneal erosion in the superior cornea and lid wiper staining with hyperemia of the palpebral conjunctiva in the right eye (, upper panels). With a diagnosis of LWE, rebamipide eye drops four times daily were prescribed and her other eye drops were discontinued. Fluorescein staining of the cornea and lid margin was remarkably improved (, lower panels) and subjective symptoms were reduced in 2 weeks from the start of rebamipide eye drops. Tear film break-up time (TBUT), Schirmer’s 1 test, and decimal visual acuity were examined before and 2 weeks after administration of rebamipide (). For TBUT, corneal staining with fluorescein solution was examined under standard illumination using a slit-lamp microscope with a cobalt blue filter. TBUT was measured three times using a stopwatch as the time from normal blinking to the first appearance of a dry spot in the tear film. Schirmer’s 1 test was performed to measure tear volume. | [[77.0, 'year']] | F | {'15106916': 1, '7924337': 1, '31426602': 1, '25574215': 2, '18295205': 1, '31259647': 1, '15257002': 1, '27257394': 2, '23635860': 1, '15665665': 1, '16876507': 1, '23009892': 1, '29123104': 1, '20168216': 1, '33513725': 1, '11346124': 1, '21052898': 1, '22969286': 1, '5121745': 1, '23676786': 1, '12394549': 1, '18832968': 1, '4092279': 1, '17216084': 1, '31192001': 1, '7896165': 1, '12824241': 1, '28587435': 1, '33477386': 1, '16783146': 1, '24940041': 1, '3480223': 1, '22406942': 1, '8387788': 1, '8103020': 1, '22914501': 1, '2736956': 1, '9753244': 1, '23836962': 1, '21413985': 1, '17898256': 1, '22335446': 1, '8393757': 1, '24204116': 2} | {'3817060-2': 2, '4872273-1': 1, '4280993-1': 1} |
164,004 | 3817060-2 | 24,204,116 | noncomm/PMC003xxxxxx/PMC3817060.xml | Topical rebamipide improves lid wiper epitheliopathy | The patient was a 71-year-old female on no medication during follow-up after cataract surgery 3 years earlier. She complained of foreign body sensation and blurred vision in the left eye and visited our hospital. Slit-lamp microscopy with fluorescein staining showed band-shaped corneal erosion in the central cornea and lid wiper staining with hyperemia of the palpebral conjunctiva in the right eye (, upper panels). We diagnosed this as LWE and administered rebamipide eye drops four times daily to her right eye. Fluorescein staining of the cornea and lid margin was remarkably improved (, lower panels) and subjective symptoms resolved in 3 weeks. TBUT, Schirmer’s 1 test, and decimal visual acuity were examined before and 3 weeks after administration of rebamipide in the same way as in case 1 (). | [[71.0, 'year']] | F | {'15106916': 1, '7924337': 1, '31426602': 1, '25574215': 2, '18295205': 1, '31259647': 1, '15257002': 1, '27257394': 2, '23635860': 1, '15665665': 1, '16876507': 1, '23009892': 1, '29123104': 1, '20168216': 1, '33513725': 1, '11346124': 1, '21052898': 1, '22969286': 1, '5121745': 1, '23676786': 1, '12394549': 1, '18832968': 1, '4092279': 1, '17216084': 1, '31192001': 1, '7896165': 1, '12824241': 1, '28587435': 1, '33477386': 1, '16783146': 1, '24940041': 1, '3480223': 1, '22406942': 1, '8387788': 1, '8103020': 1, '22914501': 1, '2736956': 1, '9753244': 1, '23836962': 1, '21413985': 1, '17898256': 1, '22335446': 1, '8393757': 1, '24204116': 2} | {'3817060-1': 2, '4872273-1': 1, '4280993-1': 1} |
164,005 | 3817061-1 | 24,204,117 | noncomm/PMC003xxxxxx/PMC3817061.xml | Intravitreal anti-VEGF injection for the treatment of progressive juxtapapillary retinal capillary hemangioma: a case report and mini review of the literature | A 44-year-old man, known to have VHL disease was referred to our ophthalmology clinic for routine fundus examination in 2008. The patient had chronic renal failure after he underwent bilateral partial nephrectomy for renal cell carcinoma, and he also had spinal cord hemangioma diagnosed by spinal magnetic resonance imaging. On examination, his best corrected VA was 20/20 both eyes. Intraocular pressure was 12 mmHg right eye and 13 mmHg left eye. Results of slit-lamp examination of both eyes and fundus examination of the right eye were normal. Fundoscopy of the left eye revealed an exophytic juxtapapillary capillary hemangioma along the nasal margin of the disc. No serous retinal detachment or exudates were observed in the macular or peripapillary area (). Fluorescein angiography of the left eye showed early and late hyperfluorescence of the lesion with no leakage (). A computerized Humphrey automated perimeter (Humphrey-Zeiss, San Leandro, CA, USA) (program 30-2) threshold test for visual field (VF) was normal in both eyes. No action was undertaken, and the patient was asked to return to the clinic yearly for follow-up.\nOn subsequent follow-up visits, we noticed a progressive increase in the size of the hemangioma, which in 2012 reached a diameter double that of the optic disc (). Also, some exudates and a minimal late leakage were observed in the peripapillary region on fluorescein angiography (). VA and VF remained unchanged. Due to the rapid increase in size of the JRCH, we decided to treat the patient with IVR. After detailed discussion with the patient, informed consent was received and IVR (0.5 mg ranibizumab; Lucentis, Genentech, Inc, San Francisco, CA, USA) was performed as an off-label treatment. Three weeks after a single injection of IVR, vascular channels within the hemangioma became less prominent. Six months after the single IVR, fundus examination showed a fibrotic, yellow-white appearance as a result of tumor scarring, and only few vascular channels could be seen within the hemangioma (). Fluorescein angiography revealed a decrease in the vessels within the hemangioma and a decrease in late leakage (). During all follow up visits, VA remained unchanged. After IVR, there was no further increase in hemangioma size, no significant systemic or ocular adverse events associated with IVR were noted, and no additional injections were needed. | [[44.0, 'year']] | M | {'9402176': 1, '30367611': 2, '11578646': 1, '16912012': 1, '25741522': 1, '31755476': 2, '31198883': 1, '20676670': 1, '17290195': 1, '17545966': 1, '34308441': 1, '33488018': 2, '24716060': 2, '34294146': 1, '12093647': 1, '19222401': 1, '12359597': 1, '17057815': 1, '32233147': 2, '17244223': 1, '31588386': 1, '19681788': 1, '11123261': 1, '20122739': 1, '12834696': 1, '24204117': 2} | {'7105784-1': 1, '7105784-2': 1, '7105784-3': 1, '7105784-4': 1, '7105784-5': 1, '6203990-1': 1, '6896561-1': 1, '7813133-1': 1, '3971562-1': 1} |
164,006 | 3817064-1 | 24,204,119 | noncomm/PMC003xxxxxx/PMC3817064.xml | Bilateral corneal ulceration in ocular graft-versus-host disease | A 53-year-old man presented complaining of dryness, redness, photophobia, and fluctuating visual acuity that began shortly after he underwent cataract surgery. The patient’s medical history was significant for ALL, necessitating allogeneic HSCT that resulted in ocular GVHD. At presentation, ocular examination revealed a 4.5 × 9.0 mm inferocentral area of stromal thinning in the patient’s left (first) eye. The affected eye was treated with lubricating eye drops, prophylactic antibiotics, corticosteroids, and a sutureless amniotic membrane. However, the corneal ulceration perforated, necessitating penetrating keratoplasty with temporal tarsorrhaphy. The patient returned 1 year later, reporting a decrease in visual acuity, ocular pain, and redness. Ocular examination revealed a 3.5 × 2.2 mm paracentral area of stromal thinning in the same (first) eye. The patient was treated with lubricating eye drops, prophylactic antibiotics, corticosteroids, and a therapeutic contact lens. The ulcer resolved over the next several weeks, leaving behind a small scar with thinning and neovascularization. The patient returned several weeks later, complaining of irritation and blurred vision. Ocular examination revealed a 2.2 mm2 area of stromal thinning in the right (second) eye. The patient was treated with lubricating eye drops, prophylactic antibiotics, corticosteroids, and a therapeutic contact lens. The corneal ulceration in the patient’s right (second) eye resolved. However, the patient returned with another corneal perforation in his left (first) eye located in an area of residual thinning. Corneal glue was placed, and a therapeutic penetrating keratoplasty was performed. At the patient’s last follow-up visit, his best corrected visual acuity (BCVA) was 20/30 in his right eye and 20/400 in his left eye. | [[53.0, 'year']] | M | {'16338616': 1, '34217703': 1, '7712745': 1, '16900025': 1, '22627859': 1, '21386923': 2, '25686388': 1, '21738349': 1, '20140022': 1, '23599118': 1, '33913829': 1, '28875340': 1, '16618614': 1, '22892710': 1, '16129099': 1, '16641398': 1, '19893038': 1, '7352872': 1, '16310475': 1, '22509110': 1, '17198025': 1, '10768324': 1, '1741146': 1, '22157574': 1, '17131029': 1, '22576252': 1, '14766066': 1, '32738300': 1, '11999366': 1, '11535499': 1, '17077659': 1, '34805617': 1, '15256996': 1, '26170614': 1, '16883364': 1, '25603230': 1, '17898256': 1, '20489577': 1, '19898506': 1, '19074071': 1, '16980935': 1, '24204119': 2} | {'3817064-2': 2, '3817064-3': 2, '3817064-4': 2, '3049733-1': 1, '3049733-2': 1, '3049733-3': 1, '3049733-4': 1} |
164,007 | 3817064-2 | 24,204,119 | noncomm/PMC003xxxxxx/PMC3817064.xml | Bilateral corneal ulceration in ocular graft-versus-host disease | A 28-year-old woman presented complaining of dryness, irritation, photophobia, and a “gush” of fluid from her right (first) eye that occurred 5 days before she presented to our clinic. The patient’s past medical history was significant for herpes simplex virus keratitis in her right eye, AML treated with allogeneic HSCT, and ocular GVHD. At presentation, ocular examination revealed an inferocentral corneal perforation plugged with iris tissue in the patient’s right (first) eye. Given that the anterior chamber was quiet, deep, and intact, surgery was deferred and aggressive broad-spectrum antimicrobial therapy with lubrication was initiated. The corneal perforation eventually healed, leaving behind a small scar with an adherent leukoma. The patient subsequently underwent cataract surgery in her left eye; the postoperative course was uneventful until 1 month after surgery, when she returned with pain, redness, and decreased vision. Ocular examination revealed a 2.0 × 1.2 mm inferocentral area of stromal thinning with underlying infiltrate and a <1.0 mm2 superocentral area of stromal thinning in the patient’s left (second) eye. The patient was treated with broad-spectrum antimicrobial therapy and aggressive lubrication, after which the ulcers healed with some residual thinning and scarring. At the patient’s last follow-up visit, her BCVA was 20/30 in her right eye and 20/30 in her left eye. | [[28.0, 'year']] | F | {'16338616': 1, '34217703': 1, '7712745': 1, '16900025': 1, '22627859': 1, '21386923': 2, '25686388': 1, '21738349': 1, '20140022': 1, '23599118': 1, '33913829': 1, '28875340': 1, '16618614': 1, '22892710': 1, '16129099': 1, '16641398': 1, '19893038': 1, '7352872': 1, '16310475': 1, '22509110': 1, '17198025': 1, '10768324': 1, '1741146': 1, '22157574': 1, '17131029': 1, '22576252': 1, '14766066': 1, '32738300': 1, '11999366': 1, '11535499': 1, '17077659': 1, '34805617': 1, '15256996': 1, '26170614': 1, '16883364': 1, '25603230': 1, '17898256': 1, '20489577': 1, '19898506': 1, '19074071': 1, '16980935': 1, '24204119': 2} | {'3817064-1': 2, '3817064-3': 2, '3817064-4': 2, '3049733-1': 1, '3049733-2': 1, '3049733-3': 1, '3049733-4': 1} |
164,008 | 3817064-3 | 24,204,119 | noncomm/PMC003xxxxxx/PMC3817064.xml | Bilateral corneal ulceration in ocular graft-versus-host disease | A 59-year-old woman presented complaining of dryness and irritation. The patient’s past medical history was significant for CML treated with allogeneic HSCT that resulted in ocular GVHD. Ocular examination revealed a 1.0 × 1.1 mm inferonasal epithelial defect with stromal thinning without any signs of infection in her right (first) eye. The patient was treated with lubricating eye drops, prophylactic antibiotics, corticosteroids, and a therapeutic contact lens. The corneal ulceration healed over the next several months, leaving behind minimal residual thinning. Shortly thereafter, the patient returned with a 1 mm2 area of stromal thinning in her left (second) eye. In addition to the standard therapy, she was prescribed topical anakinra (Kineret®; Swedish Orphan Biovitrum, Stockholm, Sweden), and her signs and symptoms resolved with minimal residual thinning. The patient’s BCVA was 20/30 in her right eye and 20/30 in her left eye at her last follow-up visit. | [[59.0, 'year']] | F | {'16338616': 1, '34217703': 1, '7712745': 1, '16900025': 1, '22627859': 1, '21386923': 2, '25686388': 1, '21738349': 1, '20140022': 1, '23599118': 1, '33913829': 1, '28875340': 1, '16618614': 1, '22892710': 1, '16129099': 1, '16641398': 1, '19893038': 1, '7352872': 1, '16310475': 1, '22509110': 1, '17198025': 1, '10768324': 1, '1741146': 1, '22157574': 1, '17131029': 1, '22576252': 1, '14766066': 1, '32738300': 1, '11999366': 1, '11535499': 1, '17077659': 1, '34805617': 1, '15256996': 1, '26170614': 1, '16883364': 1, '25603230': 1, '17898256': 1, '20489577': 1, '19898506': 1, '19074071': 1, '16980935': 1, '24204119': 2} | {'3817064-1': 2, '3817064-2': 2, '3817064-4': 2, '3049733-1': 1, '3049733-2': 1, '3049733-3': 1, '3049733-4': 1} |
164,009 | 3817064-4 | 24,204,119 | noncomm/PMC003xxxxxx/PMC3817064.xml | Bilateral corneal ulceration in ocular graft-versus-host disease | A 39-year-old man presented complaining of blurred vision and photophobia. The patient’s past medical history was significant for NHL treated with allogeneic HSCT that resulted in ocular GVHD, and an episode of stromal thinning. The patient presented complaining of blurred vision without any associated pain. Ocular examination revealed a 2 mm2 area of stromal thinning in the patient’s right (first) eye. Lubricating eye drops and cyclosporine (Restasis®; Allergan, Irvine, CA, USA) were increased, prophylactic antibiotics were initiated, and a therapeutic contact lens was placed. Shortly after this visit, the patient was admitted to Massachusetts General Hospital for systemic manifestations of chronic GVHD. At the time of admittance, the patient complained of severe pain, decreased visual acuity, and photophobia. Ocular examination revealed a 3.6 × 4.4 mm inferocentral area of stromal thinning in the patient’s right (first) eye. The corneal thinning continued to increase in the patient’s right (first) eye, and a central epithelial defect began to form in his left (second) eye. The epithelial defect in the left (second) eye rapidly progressed to stromal melting, necessitating treatment with a scleral lens. Following placement of the scleral lens, the patient reported increased comfort and his BCVA improved to 20/80 in his left eye; however, he died several days later from complications of systemic GVHD. | [[39.0, 'year']] | M | {'16338616': 1, '34217703': 1, '7712745': 1, '16900025': 1, '22627859': 1, '21386923': 2, '25686388': 1, '21738349': 1, '20140022': 1, '23599118': 1, '33913829': 1, '28875340': 1, '16618614': 1, '22892710': 1, '16129099': 1, '16641398': 1, '19893038': 1, '7352872': 1, '16310475': 1, '22509110': 1, '17198025': 1, '10768324': 1, '1741146': 1, '22157574': 1, '17131029': 1, '22576252': 1, '14766066': 1, '32738300': 1, '11999366': 1, '11535499': 1, '17077659': 1, '34805617': 1, '15256996': 1, '26170614': 1, '16883364': 1, '25603230': 1, '17898256': 1, '20489577': 1, '19898506': 1, '19074071': 1, '16980935': 1, '24204119': 2} | {'3817064-1': 2, '3817064-2': 2, '3817064-3': 2, '3049733-1': 1, '3049733-2': 1, '3049733-3': 1, '3049733-4': 1} |
164,010 | 3817136-1 | 24,204,118 | noncomm/PMC003xxxxxx/PMC3817136.xml | Orbital cellulitis following silicone-sponge scleral buckles | A 44-year-old schizophrenic, mentally retarded man presented with a few days of pain and proptosis of his previously operated eye. Seven months earlier, he had undergone vitrectomy and SB procedure for RRD. On presentation, the patient was afebrile with significant ocular movement restriction, with limited duction in all fields of gaze and conjunctival chemosis. Computed tomography (CT) revealed a possible eyelid abscess and an expanded SB. He was treated essentially with intravenous (IV) minocycline and tobramycin. After growth of S. aureus, treatment was changed to cloxacillin. The inflammation improved significantly. However, a significant conjunctival granuloma developed 14 months after initial surgery. He underwent buckle removal, conjunctival granuloma excision, vitrectomy, silicone injection, and cataract extraction. He was followed for 12 more months. | [[44.0, 'year']] | M | {'9747696': 1, '5492446': 1, '25230957': 1, '22516538': 1, '1866148': 1, '13898857': 1, '29780951': 1, '10037564': 1, '8351089': 1, '33574713': 1, '3684232': 1, '31920454': 1, '9627660': 1, '5562783': 1, '11097590': 1, '6838415': 1, '18210121': 1, '10546943': 1, '6395060': 1, '15590546': 1, '15655451': 1, '15488804': 1, '18241830': 1, '27413562': 2, '5847254': 1, '12928679': 1, '16829806': 1, '13747489': 1, '3629258': 1, '7340661': 1, '6837692': 1, '15209466': 1, '16829807': 1, '24204118': 2} | {'3817136-2': 2, '3817136-3': 2, '3817136-4': 2, '3817136-5': 2, '3817136-6': 2, '3817136-7': 2, '4927986-1': 1} |
164,011 | 3817136-2 | 24,204,118 | noncomm/PMC003xxxxxx/PMC3817136.xml | Orbital cellulitis following silicone-sponge scleral buckles | A 53-year-old woman with a history of normal-tension glaucoma and past laser trabeculoplasty treatment for both eyes presented with 7 days of pain, eyelid redness, significant chemosis, and proptosis of her eye, operated on for RRD 14 months earlier. Her visual acuity (VA) was 20/120. IV amoxicillin/clavulanic acid treatment was initiated, and buckle removal was undertaken. S. aureus was identified. During follow-up, she had cataract surgery and trabeculectomy. She was followed for the next 12 years; her last VA was 20/30. | [[53.0, 'year']] | F | {'9747696': 1, '5492446': 1, '25230957': 1, '22516538': 1, '1866148': 1, '13898857': 1, '29780951': 1, '10037564': 1, '8351089': 1, '33574713': 1, '3684232': 1, '31920454': 1, '9627660': 1, '5562783': 1, '11097590': 1, '6838415': 1, '18210121': 1, '10546943': 1, '6395060': 1, '15590546': 1, '15655451': 1, '15488804': 1, '18241830': 1, '27413562': 2, '5847254': 1, '12928679': 1, '16829806': 1, '13747489': 1, '3629258': 1, '7340661': 1, '6837692': 1, '15209466': 1, '16829807': 1, '24204118': 2} | {'3817136-1': 2, '3817136-3': 2, '3817136-4': 2, '3817136-5': 2, '3817136-6': 2, '3817136-7': 2, '4927986-1': 1} |
164,012 | 3817136-3 | 24,204,118 | noncomm/PMC003xxxxxx/PMC3817136.xml | Orbital cellulitis following silicone-sponge scleral buckles | A 74-year-old man presented with exposed SB implant, purulent discharge, painful eye, and VA of 20/240 10 months after RD surgery with SB and radial sponge repair. IV cloxacillin, cefazolin, and metronidazole were initiated, and an operation for the removal of the buckle was undertaken. S. aureus was identified. He was followed for the next 12 months, with normal findings; his last VA was 20/40. | [[74.0, 'year']] | M | {'9747696': 1, '5492446': 1, '25230957': 1, '22516538': 1, '1866148': 1, '13898857': 1, '29780951': 1, '10037564': 1, '8351089': 1, '33574713': 1, '3684232': 1, '31920454': 1, '9627660': 1, '5562783': 1, '11097590': 1, '6838415': 1, '18210121': 1, '10546943': 1, '6395060': 1, '15590546': 1, '15655451': 1, '15488804': 1, '18241830': 1, '27413562': 2, '5847254': 1, '12928679': 1, '16829806': 1, '13747489': 1, '3629258': 1, '7340661': 1, '6837692': 1, '15209466': 1, '16829807': 1, '24204118': 2} | {'3817136-1': 2, '3817136-2': 2, '3817136-4': 2, '3817136-5': 2, '3817136-6': 2, '3817136-7': 2, '4927986-1': 1} |
164,013 | 3817136-4 | 24,204,118 | noncomm/PMC003xxxxxx/PMC3817136.xml | Orbital cellulitis following silicone-sponge scleral buckles | A 79-year-old man presented with a few days of pain, eyelid redness, significant chemosis and restriction in globe movements, and proptosis of his eye operated on 6 years previously, with SB and radial sponge for RRD. On presentation, VA was 1/24, and CT revealed air around the buckle laterally with infection infiltration in the orbit. IV cefuroxime and metronidazole treatment was initiated, and an operation for the removal of the two implants was undertaken. S. aureus was identified, and the treatment was changed to cloxacillin according to the infection sensitivity. He was followed for the next 2.5 years and his last VA was 20/70. | [[79.0, 'year']] | M | {'9747696': 1, '5492446': 1, '25230957': 1, '22516538': 1, '1866148': 1, '13898857': 1, '29780951': 1, '10037564': 1, '8351089': 1, '33574713': 1, '3684232': 1, '31920454': 1, '9627660': 1, '5562783': 1, '11097590': 1, '6838415': 1, '18210121': 1, '10546943': 1, '6395060': 1, '15590546': 1, '15655451': 1, '15488804': 1, '18241830': 1, '27413562': 2, '5847254': 1, '12928679': 1, '16829806': 1, '13747489': 1, '3629258': 1, '7340661': 1, '6837692': 1, '15209466': 1, '16829807': 1, '24204118': 2} | {'3817136-1': 2, '3817136-2': 2, '3817136-3': 2, '3817136-5': 2, '3817136-6': 2, '3817136-7': 2, '4927986-1': 1} |
164,014 | 3817136-5 | 24,204,118 | noncomm/PMC003xxxxxx/PMC3817136.xml | Orbital cellulitis following silicone-sponge scleral buckles | A 75-year-old woman presented 3 days following a circular buckling for RRD with pain, eyelid redness, significant chemosis, proptosis, and VA of 20/240. Five years previously, she had had cataract surgery in her right eye. CT revealed orbital abscess (). The SB was removed and IV ciprofloxacin and cefazolin treatment was initiated. There was growth of P. aeruginosa, and IV ciprofloxacin was continued accordingly. She was followed for the next 12 months and her last VA was 20/30. | [[75.0, 'year']] | F | {'9747696': 1, '5492446': 1, '25230957': 1, '22516538': 1, '1866148': 1, '13898857': 1, '29780951': 1, '10037564': 1, '8351089': 1, '33574713': 1, '3684232': 1, '31920454': 1, '9627660': 1, '5562783': 1, '11097590': 1, '6838415': 1, '18210121': 1, '10546943': 1, '6395060': 1, '15590546': 1, '15655451': 1, '15488804': 1, '18241830': 1, '27413562': 2, '5847254': 1, '12928679': 1, '16829806': 1, '13747489': 1, '3629258': 1, '7340661': 1, '6837692': 1, '15209466': 1, '16829807': 1, '24204118': 2} | {'3817136-1': 2, '3817136-2': 2, '3817136-3': 2, '3817136-4': 2, '3817136-6': 2, '3817136-7': 2, '4927986-1': 1} |
164,015 | 3817136-6 | 24,204,118 | noncomm/PMC003xxxxxx/PMC3817136.xml | Orbital cellulitis following silicone-sponge scleral buckles | An 85-year-old woman presented with 6 hours of left-eye redness and pain. Twelve years earlier, she had had cataract surgery in her left eye. A few months later, she had RRD in her left eye, which was surgically repaired with SB and radial sponge. She presented with frozen globe, proptosis, ptosis, eyelid swelling, and +2 relative afferent pupillary defect in the left eye. CT revealed exophthalmos, dilatation of the superior ophthalmic vein, and retrobulbar and orbital fat infiltration, but no localized abscess (). She responded well to conservative treatment of IV amoxicillin/clavulanic acid and topical moxifloxacin eye drops. A significant clinical improvement was seen following this treatment. On discharge, her VA was 20/70. Ten months later, she presented with left painful eye and abduction limitation. There was a clinical picture of infected SB and she underwent SB removal. IV ciprofloxacin was initiated. There was a growth of Citrobacter koseri sensitive to the antibiotic. A significant clinical improvement was seen under this treatment. She was followed for the next 24 months, and her last VA was 20/40. | [[85.0, 'year']] | F | {'9747696': 1, '5492446': 1, '25230957': 1, '22516538': 1, '1866148': 1, '13898857': 1, '29780951': 1, '10037564': 1, '8351089': 1, '33574713': 1, '3684232': 1, '31920454': 1, '9627660': 1, '5562783': 1, '11097590': 1, '6838415': 1, '18210121': 1, '10546943': 1, '6395060': 1, '15590546': 1, '15655451': 1, '15488804': 1, '18241830': 1, '27413562': 2, '5847254': 1, '12928679': 1, '16829806': 1, '13747489': 1, '3629258': 1, '7340661': 1, '6837692': 1, '15209466': 1, '16829807': 1, '24204118': 2} | {'3817136-1': 2, '3817136-2': 2, '3817136-3': 2, '3817136-4': 2, '3817136-5': 2, '3817136-7': 2, '4927986-1': 1} |
164,016 | 3817136-7 | 24,204,118 | noncomm/PMC003xxxxxx/PMC3817136.xml | Orbital cellulitis following silicone-sponge scleral buckles | A 52-year-old woman presented with 4 days of right-eye pain with eyelid redness and swelling. Her VA was hand movements before eyes. An SB and radial sponge had been inserted for RRD 19 years previously. She refused to be admitted to the department, and oral amoxicillin/clavulanic acid with topical antibiotics and steroid was initiated. A few days later, there was exacerbation of the pain, limitation with globe elevation, and anterior-chamber reaction with cells +2. CT revealed infiltration around the SB (). IV amoxicillin/clavulanic acid was initiated, and the implant was removed. There was a growth of Sphingomonas paucimobilis sensitive to the entire antibiotics list. She was followed for the next 2.5 years, and her last VA was hand movements. | [[52.0, 'year']] | F | {'9747696': 1, '5492446': 1, '25230957': 1, '22516538': 1, '1866148': 1, '13898857': 1, '29780951': 1, '10037564': 1, '8351089': 1, '33574713': 1, '3684232': 1, '31920454': 1, '9627660': 1, '5562783': 1, '11097590': 1, '6838415': 1, '18210121': 1, '10546943': 1, '6395060': 1, '15590546': 1, '15655451': 1, '15488804': 1, '18241830': 1, '27413562': 2, '5847254': 1, '12928679': 1, '16829806': 1, '13747489': 1, '3629258': 1, '7340661': 1, '6837692': 1, '15209466': 1, '16829807': 1, '24204118': 2} | {'3817136-1': 2, '3817136-2': 2, '3817136-3': 2, '3817136-4': 2, '3817136-5': 2, '3817136-6': 2, '4927986-1': 1} |
164,017 | 3818024-1 | 24,204,177 | noncomm/PMC003xxxxxx/PMC3818024.xml | Diagnosis of a T-lineage acute lymphoblastic leukemia through digitalized cell analysis of the pleural effusion | A 31-year-old man was admitted to the emergency room in August 2012 due to chest pain, dyspnea, cough, and fever. The patient did not have a medical history of night sweats, weight loss, or bleeding. The patient’s initial blood count was normal (white blood cell count: 8.55 × 109/L; red blood cell count: 4.71 × 1012/L; hemoglobin: 14.3 g/dL; and platelet count: 194 × 1 0 12/L). No lymph node enlargement was detectable upon physical examination. The electrocardiogram was normal; the echocardiogram showed pericardial effusion and a chest X-ray revealed bilateral pleural effusion (). Due to the fact that the patient’s general status was worsening, a thoracentesis was required. The fluid from the pleural effusion was sent to the laboratory for routine investigation.\nThe Sysmex XE-5000™ (Sysmex Corporation, Kobe, Japan) hematology analyzer, equipped with the body fluid module, was used as previously described to obtain the patient’s cell count, and to achieve white blood cell differentiation into mononuclear (MN) and polymorphonuclear cells; we obtained a cell count of 14,000 cells/μL (90% MN cells, and 10% polymorphonuclear cells). Cell cluster spreading from the MN area into the high-fluorescence area was observed (); this cell cluster had higher forward and side scatter than normal cells (), meaning that those cells were bigger and more complex. Cytospin preparation (CytoFuge2; IRIS International, Chatsworth, CA, USA) was performed with the pleural fluid using 250–300 μL of the cell suspension (20 cells/μL) to obtain a cell pellet of approximately 5,000 cells. The slides were air-dried and stained with the modified Wright-Giemsa method. Slides were analyzed using the CellaVision® DM96 (CellaVision AB, Lund, Sweden). Morphological examination () of the pleural fluid revealed a massive infiltration of immature cells, with large and clefted nuclei; the cytoplasm was basophilic without granules, and was scant in volume, large in size, presenting with fine chromatin and evident nucleoli. To clarify the nature of the immature cells observed in the pleural fluid, flow cytometry analysis was performed. A panel of antibodies including surface CD3 (CD3), cytoplasmic CD3 (CD3Cy), CD7, CD4, CD8, CD2, CD5, cytoplasmic TdT (TdTCy), CD45, and CD1a was used. The analysis was performed using a FACSCanto™ II flow cytometer (BD Biosciences, San Jose, CA, USA). Cytograms () showed that the cells (in red; P1) were CD45+/−, CD3−, CD7++, CD5+, CD2−, CD34+/−, CD1a−, CD3Cy+, TdTCy+, which were immature T-lineage cells. Therefore, a bone marrow aspirate was performed (), which showed an infiltration of lymphoblast cells. Flow cytometry analysis on peripheral blood and bone marrow () were also performed; according to the European Group for the Immunological Classification of Leukemia (EGIL) criteria, the malignancy was classified as Pro T-lineage acute lymphoblastic leukemia (T-ALL) (EGIL T1). Cytogenetic and fluorescence in situ hybridization analyses showed a normal karyotype.\nThe patient received induction therapy according to the Northern Italy Leukemia Group’s protocol. He achieved complete remission on November 2012. Two months later, he received cord blood allogeneic stem cell transplantation and died during aplasia due to septic shock. | [[31.0, 'year']] | M | {'20498027': 1, '14592643': 1, '20236183': 1, '24204177': 2} | {} |
164,018 | 3818626-1 | 24,250,705 | noncomm/PMC003xxxxxx/PMC3818626.xml | Laparoscopic phrenectomy for a diaphragmatic neurilemmoma | A 46-year-old man was referred to Sir Run Run Shaw Hospital (Hangzhou, China) in April 2009 with a perihepatic mass found during a medical checkup requiring further investigation. A plain chest X-ray revealed a local right diaphragmatic eventration []; abdominal ultrasonography demonstrated a 30 mm hypoechoic mass between the liver capsule and the diaphragm; a computed tomography [CT, Figure –] scan revealed a 30-32 mm tumor under the diaphragm; and enhanced magnetic resonance imaging [MRI, Figure and ] suggested a benign tumor, which was likely a diaphragmatic neurilemmoma at the same location. Simultaneously, a secondary diagnosis of asymptomatic cholecystolithiasis was confirmed. Given his absence of any discomfort and his inability to suspend his work, patient refused surgery and agreed to attend regular follow-up appointments instead.\nUnfortunately, his gallstones became symptomatic during the 16th month of follow-up with two attacks of cholecystalgia per month, although these attacks were relieved using antibiotics and antispasmodics while under the care of community hospitals. We encountered the patient again in November 2010, and he consented to a simultaneous laparoscopic cholecystectomy and diaphragmatic tumorectomy. At the time of his admission, all of the regular laboratory tests were normal, including carcinoembryonic antigen, α-fetoprotein, and neuron-specific enolase. The imaging findings were comparable to those 19 months earlier. In addition, the patient had a 4-year history of essential hypertension, which was satisfactorily controlled. Thus, he underwent laparoscopy under general anesthesia on November 9, 2010.\nPatient was placed in the prone position and four trocars were employed in accordance with our previous report:[] An umbilical trocar of 10 mm for the camera, a sub-xiphoid trocar of 12 mm as the main port, and two 5 mm trocars at the right midclavicular line for the assistant. A thorough exploration was undertaken, and a 3 cm mass underneath the right diaphragm was identified. At that time, an anti-Trendelenburg position was introduced, and the anesthesiologists turned down the tidal volume accordingly. While, the assistant fixed the diaphragm 2 cm away from the tumor, the surgeon performed a partial phrenectomy with our Laparoscopic Peng's Multifunctional Operative Dissector.[] Afterward, the diaphragm was continuously sutured with 2-0 Vicryl sutures [Ethicon Inc.; ]. The anesthesiologists were asked to manually expand the lungs using a breathing bag before the last suture was knotted in order to extrude the carbon dioxide from the thoracic cavity. Subsequently, the right subphrenic space was infused with water to perform an air test in the Trendelenburg position to identify any remaining diaphragmatic defects []; in addition, water was used to rule out an ongoing hemorrhage. Finally, a normal tidal volume and the anti-Trendelenburg position were resumed, and laparoscopic cholecystectomy was performed. The specimens were packed in a plastic bag and extracted via the 12 mm port []. A gross section of the mass revealed a multilobulated, yellowish, solid tumor with cystic parts [], and the intraoperative frozen section pathological diagnosis was a diaphragmatic neurilemmoma.\nThe entire skin-to-skin time was 65 min, and the artificial pneumothorax lasted 21 min. The intraoperative blood loss was less than 50 ml. No intraoperative blood transfusions or thoracic/abdominal drainage was needed. The intraoperative vital signs were stable, and no tension pneumothorax occurred. Post-operatively, the patient initiated oral intake and bedside activities 6 h later. No analgesics were used, and no complications occurred. He was discharged on the 3rd post-operative day, and the final pathology results confirmed the diagnosis of a diaphragmatic neurilemmoma by immunohistochemistry []. Patient has been observed for more than 2 years with no recurrence or symptoms. | [[46.0, 'year']] | M | {'21705782': 1, '20582518': 1, '19288159': 1, '2669637': 1, '18158051': 1, '20489098': 1, '19366544': 1, '33213428': 2, '13320560': 1, '22498413': 1, '20112635': 1, '15160759': 1, '9348627': 1, '13560782': 1, '18791670': 1, '18765062': 1, '8680550': 1, '18297354': 1, '3352275': 1, '29484235': 1, '10355655': 1, '5252744': 1, '24250705': 2} | {'7678197-1': 1} |
164,019 | 3818627-1 | 24,250,706 | noncomm/PMC003xxxxxx/PMC3818627.xml | Sprengel deformity and Klippel-Feil syndrome leading to cervical myelopathy presentation in old age | A 50-year-old woman admitted to the Alzahra Hospital, Isfahan, Iran. She presented with a 2 years history of neck pain and ataxia for 1 year. She hadn't urinary incontinence and she was referred to a neurosurgeon by a Neurologist because of her progressive gait ataxia.\nNeurological examination showed intact cranial nerves and no motor deficit, but we found impairment in pain sensory and light touch in both legs that was prominent on the right side of the body, hyperreflexia in the left knee, ankle jerk, and mild gait ataxia based on tandem and blind walking. Blood tests and urinalysis were normal. Physical examination revealed a short neck, a low occipital hairline and diminished cervical range of motion. The patient also had an elevated left scapula and a bony prominence extending from the shoulder to the neck. The range of motion of the neck and left shoulder was restricted. Anteroposterior and lateral radiographs revealed fused vertebral body of C5-C6 without spina bifida [Figures , and ].\nRadiographs in flexion and extension position demonstrated neither vertebral instability nor narrowing of the retrodental distance in ante- and retroflection. Plain thoracic and lumbar radiographs showed scoliosis with no other spinal anomalies. Subsequent Magnetic Resonance (MR) and computed tomography imaging with three dimensional reconstructions of the neck and shoulder revealed an atypical bone configuration of the left shoulder with elevation and dysplasia of the scapula and an aberrant bony structure extending from the superomedial border of the scapula to the C5 transverse process leading to constriction of the spinal canal [Figures –3]. These findings were interpreted as omovertebral bone with associated unilateral SD and KFS. Resection of the omovertebral bone and decompression of the spinal canal were indicated with respect to patient's clinical myelopathy.\nA curved incision was performed over the omovertebral bone from its cervical origin to its scapular termination. The intraspinal localized aberrant bony fragment, which we considered responsible for the neurological syndrome, was removed from the cleft in the posterior arch of C5, a laminectomy was performed at that level, and the omovertebral bone was partially resected.\nIn terms of gait ataxia the patient was neurologically unchanged, but she experienced a significant reduction in her neck pain, improved range motion of the neck, and the cosmetic result was good immediately after the operation. She recovered well from the procedure and was discharged from the hospital 3 days post-operatively. Follow-up radiographs demonstrated no further bony compression. There was no evidence of new instability resulting from the operative procedure occurred. | [[50.0, 'year']] | F | {'4436358': 1, '10693557': 1, '1739048': 1, '31772424': 1, '29492320': 2, '11877793': 1, '16035698': 1, '7593578': 1, '12188968': 1, '11985781': 1, '16849023': 1, '394335': 1, '17023841': 1, '15241163': 1, '20672958': 1, '6643564': 1, '1610048': 1, '24250706': 2} | {'5822809-1': 1} |
164,020 | 3818628-1 | 24,250,707 | noncomm/PMC003xxxxxx/PMC3818628.xml | Orbital solitary fibrous tumor: A rare clinicopathologic correlation and review of literature | A 31-year-old man presented at a tertiary care eye hospital in India with complaints of painless but slowly progressive protrusion of the right eyeball with fullness above the lids since the past 6 months. The best corrected visual acuity was 20/20, N6. Hertels at a base of 104 mm showed a proptosis of 4 mm. Ocular movements revealed restricted upgaze in the right eye. Palpation of the superior orbit revealed a well-defined mass that was non-tender, compressible and non-pulsatile in nature. Computed tomography CT scan showed a heterogenous but well defined mass in the right superior orbit with a moderate but progressively increasing contrast enhancement [Figure and ]. The globe, bony orbit and other orbital soft tissues were found to be within normal limits.\nA provisional diagnosis of a well-defined, moderate flow vascular lesion was made and a plan to surgically excise the lesion was made. A Benedict's incision was used to approach the superior orbit. The lesion was found to have a capsule around it but was not adherent to the surrounding orbital soft-tissues and thus a cryotherapy assisted complete excision was carried out without much difficulty. The post-operative period was uneventful. Hertel's exophthalmometry confirmed absence of a proptosis and the surgical wound healed well. Last examination was 1-year post-operatively without any evidence of recurrence and the patient is on a follow-up.\nGross examination showed a pinkish mass whose cut section was pinkish-grey with multiple areas of hemorrhage. Microscopic examination showed an encapsulated tumor with cellular and cystic areas. Spindle shaped tumor cells arranged in whorls with minimal atypia, moderate nuclear pleomorphism and inconspicuous nucleoli were noted []. The tumor showed vessels of varying caliber, dilated to compressed, lined by flattened endothelium []. However, stag horn channels and giant cells were not noted. Immunohistochemistry showed tumor cells showing a positive staining with CD99 [], strongly positive for CD34 and BCL-2 [] and background positivity for vimentin []. However, reticulin staining [] and smooth muscle actin (SMA) were negative []. The morphological and immunohistochemical features were consistent with a diagnosis of orbital SFT. | [[31.0, 'year']] | M | {'25761539': 1, '7705824': 1, '10574600': 1, '12867407': 1, '12136289': 1, '20871464': 1, '8796170': 1, '8116796': 1, '19707501': 1, '10026737': 1, '14499820': 1, '28054210': 1, '29682031': 1, '28050416': 1, '19085297': 1, '21056898': 1, '7522416': 1, '11642494': 1, '24250707': 2} | {} |
164,021 | 3818782-1 | 24,251,234 | noncomm/PMC003xxxxxx/PMC3818782.xml | Combination of inflammatory and amlodipine induced gingival overgrowth in a patient with cardiovascular disease | A 48-year-old Indian woman was referred to the department of periodontology, with the chief complaint of swollen gums. She felt discomfort with the disfigurement of gums which appeared un esthetic due to its more severity and there was bleeding and difficulty while chewing food.\nPast medical history revealed that she is under medication for hypertension with amlodipine (10 mg/day orally) for the last 2 years and 6 months. The amlodipine dose was increased to 50 mg/day orally and statins were prescribed due to the acute angina attack and hypercholesterolemia before 6 months of the dental visit.\nClinical examination was carried out by assessing the periodontal status by plaque index (PI), gingival index (GI), Russel's periodontal index. The patients oral hygiene status revealed the presence of more amount of plaque and some amount of calculus on both anterior and posterior surfaces of the teeth due to the presence of new niches for accumulation of plaque and microorganisms. There was generalized bleeding on probing and generalized probing depths ranging from 3 to 8 mm with greatest depths in relation to mandibular anteriors. Due to the outward enlargement of gingiva, there were no deep periodontal pockets.\nIntraorally, there was generalized GO on the labial and lingual/palatal surface of the maxillary and mandibular teeth, which was more pronounced in the labial surfaces than the lingual and palatal surfaces. The interdental papillae were enlarged, fibrous, and lobulated in appearance mainly around the mandibular and maxillary anterior teeth [].\nIn this case report, photographic analysis by Ellis and Seymour was used for assessing the gingival encroachment or overgrowth on adjacent surfaces for a gingival unit (0 = no encroachment of interdental papilla on tooth surface, 1 = mild encroachment producing a blunted papilla tip, 2 = moderate encroachment involving lateral spread of papilla across buccal tooth surface of less than one quarter tooth width, 3 = marked encroachment of papilla, more than One-fourth tooth width with loss of interdental papilla form).[] In this case report, score 3 severity of gingival enlargement was observed.\nGrade III mobility was observed in relation to mandibular anteriors. Generalized reddish color, purulent discharge in relation to mandibular anteriors and generalized bleeding on probing were observed due to the generalized inflammation of gingiva. Radiographic examination revealed generalized horizontal bone loss with more destruction of bone in relation to maxillary and mandibular anterior region [].\nBlood sample was taken at the patients first visit to the dental hospital. Serum total CHO, HDL, low density lipoprotein (LDL), and triglycerides (TG) were determined by autoanalyzer in the clinical laboratory.\nSeveral methods have been employed for the detection of putative periodontal pathogens in subgingival samples to identify the microbiologic profile of periodontitis. Here we had chosen a genetic microbiologic test to identify microbiologic profile in amlodipine induced gingival enlargement with CVD.\nA paper point made of cellulose is introduced into the deep periodontal pocket. After 10 s, the point is withdrawn and placed in a RNA stabilizer buffer and sent for hybridization []. The IAI Pado Test 4.5 (IAI ESCHENWEG 6. CH-4528 ZUCHWIL/SWITZERLAND) which is a genetic test used in this case study allowed for the identification and quantification of bacteria which have a preponderant pathogenic role in periodontitis.\nThe IAI Pado Test 4.5 is a biologic molecular test which allowed the identification and quantification. The specific periodontal pathogens like Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), and Treponema denticola (Td) were identified by this test.\nBiopsy was taken during the surgical phase and sent to the laboratory. It revealed mixture of dense and loose fibrous components with the chronic inflammatory cell infiltrate in the connective tissue and elongation of rete pegs in the epithelium. On the basis of patient's history, clinical features, laboratory investigations for lipid profile, microbiologic profile, and biopsy reports, a diagnosis of amlodipine induced GO in a patient with CVD was made. | [[48.0, 'year']] | F | {'18980513': 1, '31027273': 1, '8135450': 1, '11142671': 1, '1887359': 1, '10551182': 1, '10682092': 1, '19563277': 1, '29930781': 1, '16236046': 1, '10765878': 1, '3477631': 1, '9797793': 1, '1527689': 1, '7758039': 1, '6607894': 1, '9660335': 1, '20379416': 2, '10687229': 1, '26818898': 1, '11394395': 1, '10052772': 1, '29242684': 1, '12472834': 1, '8707974': 1, '24251234': 2} | {'2848789-1': 1} |
164,022 | 3818783-1 | 24,251,235 | noncomm/PMC003xxxxxx/PMC3818783.xml | Supratentorial neurenteric cyst mimicking hydatid cyst: A case report and literature review | A 67-year-old Mediterranean male who had episodes of seizures with altered consciousness. He was subsequently placed on keppra and became seizure-free. Magnetic resonance imaging (MRI) of the brain with and without gadolinium revealed a large well-defined left frontal cystic mass measuring 4.8 cm × 4.0 cm × 4.8 cm. The mass displays cerebrospinal fluid (CSF) intensity with low signal on T1-weighted and fluid-attenuated inversion recovery (FLAIR) images [] and high signal on T2-weighted (T2W) images []. The lesion contained sausage-shaped debris of high FLAIR signal in its dependent portion with an internal septation. On post contrast imaging, there is no discernible enhancement of the mass or any surrounding capsule. The diffusion tensor imaging (DTI) and diffusion weighted imaging exhibits presence of a high T2 signal wall surrounded by a low signal capsule. On the functional MRI, the left-sided primary motor cortex is seen along the posterior and lateral margin of the left frontal cyst []. The activated supplemental motor area is seen along the medial margin of the cyst. The DTI revealed that the white matter tracks of centrum semiovale are cleaved and displaced rather than infiltrated and destroyed []. The patient also underwent a computed tomography (CT) scan of the thorax and abdomen, as part of the patient's workup for suspected hydatid cyst disease, which revealed a mesenteric cystic lesion.\nBased on the pre-operative imaging findings, the patient was started on albendazole for treatment of the presumed hydatid cyst.\nLater, the patient underwent a stealth-guided left frontoparietal craniotomy for resection of cyst. The lesion was adherent to the cerebral pial surface and contained proteinaceous gelatinous yellowish discolored material. The lesion was irrigated several times with hypertonic saline to kill any hydatid ova. The patient's post-operative course was uncomplicated and albendazole was resumed. Histologically, the lesion showed a fibrous cyst wall lined by cuboidal to columnar, single to multilayered epithelium, which focally shows surface cilia and mucin production that is positive on alcian blue special histochemical stain. The cystic lining is immunoreactive for pan-cytokeratin and epithelial membrane antigen (EMA) and negative for glial fibrillary acidic protein (GFAP) and CK20 []. The histological features are consistent with an enterogenous/epithelial cyst. There is no evidence of hydatid cyst, scolex or other abnormal parasitic structure. Based on the final pathologic diagnosis, albendazole was discontinued. | [[67.0, 'year']] | M | {'9092858': 1, '22718406': 1, '18496166': 1, '19919821': 1, '21045510': 1, '12182790': 1, '34401938': 1, '18987836': 1, '16775266': 1, '20188565': 1, '17228229': 1, '8861319': 1, '15376491': 1, '31079180': 1, '21236685': 1, '22891004': 1, '3701354': 1, '1282539': 1, '16427417': 1, '9843277': 1, '16719408': 1, '20824292': 1, '33708675': 2, '19962230': 1, '18978968': 1, '9848864': 1, '10940427': 1, '9932896': 1, '15028155': 1, '21567287': 1, '15507425': 1, '10371636': 1, '16714456': 1, '24251235': 2} | {'7869303-1': 1} |
164,023 | 3818784-1 | 24,251,236 | noncomm/PMC003xxxxxx/PMC3818784.xml | Uterine leiomyoma with spontaneous intraleiomyoma hemorrhage, perforation, and hemoperitoneum in postmenopausal woman: Computed tomography diagnosis | A 55-year-old multiparous postmenopausal woman presented to our emergency department with acute sudden lower abdominal pain for 2 h associated with dizziness. She denied trauma or vaginal bleeding and has no other associated symptoms. Her last menstrual period was 1 year back. Her medical history is significant for uterine fibroids only. On general examination, she had mild pallor. Her vital signs were stable. Abdominal examination revealed distension of lower abdomen with diffuse tenderness and guarding. A firm tender mass was felt arising from the pelvis. Her lab results were within normal limits except hemoglobin level was 10.4 g/dL. CT scan of abdomen and pelvis with intravenous contrast was performed which revealed a large uterine mass arising from the fundus with heterogeneous appearance and active contrast extravasation inside it [Figures and ]. It also showed an evidence of perforation at the fundus and high density moderate-free fluid (hemoperitoneum) [Figures and ]. A repeated hemoglobin level after 2 h was 8.5 g/dL. Therefore, two packed red blood cells were given and the patient was taken emergently to operating room. Laparotomy was done and revealed enlarged uterus with fundal perforation and clot and tissue coming out from the perforation site as well as about 1 L of hemoperitoneum. A total hysterectomy with bilateral salpingo-oophorectomy was performed. The patient recovered after surgery with uneventful postoperative course and discharged home.\nGross pathological examination revealed enlarged uterus measured 15 × 14 × 9 cm. Bisected uterus showed solid mass measured 15 × 12 × 7 cm arising from the fundus with evidence of perforation. On microscopic examination, a cellular leiomyoma with evidence of hemorrhagic infarction is found. No malignant cells were identified. The uterine cervix, fallopian tubes, and ovaries were normal. | [[55.0, 'year']] | F | {'18926384': 1, '11704222': 1, '22696088': 1, '19881092': 1, '12110710': 1, '22765641': 1, '15385297': 1, '24251236': 2} | {} |
164,024 | 3819678-1 | 24,223,603 | noncomm/PMC003xxxxxx/PMC3819678.xml | Klebsiella pneumoniae liver abscess in an immunocompetent child | A 12-year-old boy was admitted to the Department of Pediatrics, Kangbuk Samsung Hospital, with a 4-day history of fever and headache. The day before admission, he vomited several times. On review of systems, the patient noted fatigue, headache, nausea, and vomiting, but denied any other symptoms, such as abdominal pain, diarrhea or visual change. He has been healthy without admission history or frequent infections. Family history was not remarkable. He did not have history of traveling, tick bites, or sick contacts during the last 6 months. His height was 158 cm (50th to 75th percentile) and weight was 45 kg (50th to 75th percentile). His initial vital signs included a temperature of 39℃, a heart rate of 126 beats/min, blood pressure of 118/74 mmHg, and respiratory rate of 20 breaths/min. He was alert. The scleras were not icteric and the neck was supple. The lungs were clear bilaterally, with no audible murmur on cardiac auscultation. The abdomen was soft and nontender, with no hepatosplenomegaly. The neurologic examination was unremarkable. The complete blood cell counts on the day of admission were hemoglobin (Hb), 12.0 g/dL; hematocrit (Hct), 35.1%; platelet, 179,000/mm3; and white blood cell (WBC), 15,400/mm3 (neutrophil, 85%; lymphocyte, 4%; monocyte, 11%). The blood chemistry showed glucose, 95 mg/dL (reference range, 60 to 100 mg/dL); aspartate aminotransferase (AST), 113 IU/L (reference range, 15 to 40 IU/L); alanine aminotransferase (ALT), 94 IU/L (reference range, 5 to 45 IU/L); lactate dehydrogenase, 605 IU/L (reference range, 120 to 330 IU/L); total bilirubin, 1.18 mg/dL (reference range, 0.2 to 1.3 mg/dL); total protein, 7.1 g/dL (reference range, 6.4 to 8.1 g/dL); albumin, 3.8 g/dL (reference range, 4.0 to 5.3 g/dL); alkaline phosphatase, 142 IU/L (reference range, 116 to 483 IU/L); γ-Glutamyl transpeptidase, 21 U/L (reference range, 25 to 24 U/L); and C-reactive protein (CRP), 22.05 mg/dL (reference range, <0.18 mg/dL). Coagulation panel demonstrated an international normalized ratio of 1.10 (reference rage, 0.89 to 1.10), prothrombin time of 12 seconds (reference range, 10 to 12 seconds), and activated partial thromboplastin time of 27 seconds (reference range, 26 to 37 seconds). The patient was negative for hepatitis B surface antigen and antibodies to hepatitis A and C virus. Abnormal findings were not observed in either the cerebrospinal fluid (CSF) study or the urinalysis test. Cultures of blood, urine and CSF were negative. The initial chest and abdomen X-ray had no remarkable findings.\nFive hours after the admission, he complained of right upper quadrant abdominal pain abruptly. Right upper quadrant tenderness was noted, but rebound tenderness was not. Due to abnormalities of liver function tests and abdominal pain, emerency abdominal computed tomography (CT) scan was ordered; it demonstrated 7.6 cm×9 cm×7 cm sized ill-defined multiply septated low density lesions in segments VII and VIII of the liver, consistent with hepatic abscess (). Hepatoduodenal ligament and lymph nodes were enlarged and these findings were regarded as reactive hyperplasia associated with the hepatic abscess. There were no remarkable findings in the gastrointestinal tract including appendix and other solid organ. Venous thrombosis was not seen in abdominal CT. The portal vein, hepatic vein and its branch were patent. The patient was treated empirically with parenteral antibiotics (metronidazole, 30 mg/kg/day; ceftriaxone, 100 mg/kg/day; amikacin, 22.5 mg/kg/day) and underwent ultrasound-guided percutaneous catheter drainage (PCD) of the liver abscess. Eight-French multiple-sidehole pigtail catheter were inserted into the abscess cavity and about 30 mL of thick dark-yellowish pus was drained. The procedure was performed under local anesthesia with the patient in supine position. Conscious sedation was not used. Drainage of the abscess yielded purulent material that grew K. pneumonia sensitive to all tested antibiotics, except for ampicillin and piperacillin. Amoeba antibody was negative. To evaluate the immune status of the patient, serum immunoglobulins (Ig), complements (C), and lymphocyte subsets were measured and the dihydrorhodamine (DHR) test was performed. Serum IgG (1,180 mg/dL), IgA (331.1 mg/dL), IgM (72.5 mg/dL), C3 (86.2 mg/dL), C4 (14.89 mg/dL), total complement activity (CH50 47.7 U/mL), and lymphocyte subsets, including CD3 positive T-cells (87%, 2,514/µL), CD4 positive T-cells (T4, 44%, 1,271/µL), CD8 positive T-cells (T8, 31%, 896/µL), T4/T8 ratio (1.42), CD19 positive B-cells (7%, 202/µL), and CD3 negative and CD16 and CD56 positive natural killer cells (6%, 173/µL), were all in the normal range for his age. No abnormal findings were observed in the DHR test.\nOn hospital day 11, the fever subsided. Also his headache, and right upper quadrant abdominal pain were improved. The laboratory findings were Hb, 11.8 g/dL; Hct, 34.8%; WBC, 10,600/mm3 (lymphocyte, 27%; neutrophil, 64%; monocyte, 7%; eosinophil, 2%); platelet, 495,000/mm3; CRP, 3.81 mg/dL; AST, 24 IU/L; and ALT, 8 IU/L. On hospital day 12, a follow-up abdominal CT scan revealed a slightly decreased, but residual hepatic abscess (5.9 cm×6.1 cm×5.5 cm) in the right lobe and bilateral pleural effusion with passive atelectasis. Pus (40 to 120 mL daily) was drained initially, but the rate of drainage gradually decreased to less than 10 mL per day over 3 weeks and drainage material became serous. On hospital day 20, a right upper quadrant ultrasound showed that the size of the liquefied abscess cavity had reduced to 3 cm. The percutaneous catheter was removed on hospital day 21 because the amount of drainage was scanty. The total amount of pus drained from abscess cavity was 370 mL for 20 days. On hospital day 25, subsequent ultrasound demonstrated a significant reduction in size of the abscess. Laboratory findings on hospital day 28 were improved as follows: WBC, 5,900/mm3 (neutrophil 48.9%); CRP, below 0.5 mg/dL; AST, 34 IU/L; and ALT, 10 IU/L. The patient was discharged on hospital day 29 and was switched to oral forms of treatment. The oral antibiotic, cefixime, was administered for 14 days. Two weeks after discharge, the third follow-up abdominal CT scan was performed in an outpatient setting: it revealed that the abscess of the right lobe was almost healed and the bilateral pleural effusions with passive atelectasis were disappeared (). The patient is now under follow-up care and has remained well over the last five months. | [[12.0, 'year']] | M | {'33724814': 1, '8237941': 1, '29618511': 1, '8606631': 1, '17335656': 1, '11799296': 1, '18993020': 1, '7915580': 1, '15667489': 1, '28402698': 1, '11519834': 1, '31161070': 2, '15551257': 1, '10987109': 1, '2686400': 1, '17175028': 1, '1979599': 1, '1750096': 1, '21326763': 1, '16456416': 1, '18971367': 1, '12373305': 1, '1872659': 1, '15578367': 1, '24223603': 2} | {'6487166-1': 1} |
164,025 | 3819683-1 | 24,223,604 | noncomm/PMC003xxxxxx/PMC3819683.xml | Mycoplasma pneumoniae associated stroke in a 3-year-old girl | A previously healthy 3-year-old girl with left-sided paresis was admitted to the Department of Pediatric Neurology in Korea University Ansan Hospital. Seven days before admission, she experienced an abrupt onset of high fever and cough. Three days prior to admission, fever subsided, but she was diagnosed with pneumonia at a local clinic. On the day of admission, left-sided hemiparesis and left facial palsy developed. She was transferred to our hospital with the presumed diagnosis of encephalitis from the local clinic. The patient's family history and past medical history were unremarkable.\nPhysical examination on admission revealed an alert, oriented girl. Her body temperature was 36.2℃, pulse rate 104/min, respiratory rate 22/min, and blood pressure 105/56 mmHg. Chest examination revealed crackles on the right lung. On neurological examinations, central type facial palsy was observed on the left side of face, and motor strength was decreased to grade III/VI in the left arm and leg.\nInitial laboratory studies showed a white blood cell (WBC) count of 15,110/mm3 with neutrophils of 60.9%, lymphocytes of 27.6%; hemoglobin, 13.0 g/dL; and platelets, 449,000/mm3. The erythrocyte sedimentation rate was 63 mm/hr and C-reactive protein, 0.5 mg/dL (reference range, <0.3 mg/dL). Biochemical investigations were normal. Lumbar puncture yielded clear cerebrospinal fluid (CSF) with an opening pressure of 170 mmH20. Cell counts showed WBC, 13/µL (10 lymphocytes); red blood cell, 20/µL; protein, 17 mg/dL; and glucose, 67 mg/dL, while the simultaneous blood glucose was 105 mg/dL. CSF was sterile on culture. Patchy infiltration of the right lung was recognized on the chest radiograph.\nInitially, intravenous vancomycin, cefotaxime and acyclovir were administered. Vancomycin and acyclovir were discontinued and oral azithromycin was added when immunoglobulin (Ig) M positivity was detected on the second day of admission. IgM antibody titer to M. pneumoniae determined by the enzyme-linked immunosorbent assay (ELISA) was increased to 9.7 RU/mL (reference range, 0.0 to 1.1 RU/mL), which was still positive (14.1 RU/mL) 13 days later. Prothrombin time and partial thromboplastin time, complement factors (C3, C4), protein C level and antithrombin III level were normal, but protein S level was decreased to 16% (reference range, 58.7% to 119.2%). Fibrinogen and fibrinogen degradation product (FDP) levels were 526 mg/dL (normal, 257 to 503 mg/dL) and 17.2 µg/mL (reference range, 0.1 to 3.6 µg/mL), respectively. Antinuclear antibodies (ANA) were weakly positive, and serum titer was 1:160 with a nonspecific whole cell staining pattern. Electrocardiography and echocardiography were normal. Magnetic resonance imaging (MRI) revealed an acute infarction in the territory of the right lenticulostriate artery (). However, magnetic resonance angiography showed no luminal narrowing or obstruction of regional vessels. Bacteriological cultures of blood and CSF were sterile.\nThree days after initiation of oral azithromycin treatment, respiratory symptoms began to improve. Intravenous cefotaxime was discontinued after confirming negative cultures in CSF and blood. Within five days, the left-sided hemiparesis and the left central facial palsy also started to resolve. After eight days of hospitalization, she could walk without dragging her leg, demonstrating minimal weakness, and she was subsequently discharged. Protein S level was increased to 37% two weeks after onset. One month after the beginning of her illness, this level normalized to 63%. Fibrinogen and FDP levels also normalized to 404 mg/dL and 2.3 µg/mL, respectively. ANA also became negative. Neurological symptoms totally resolved. | [[3.0, 'year']] | F | {'16148858': 1, '19617462': 1, '11595996': 1, '32791762': 2, '27938350': 2, '11913573': 1, '6643107': 1, '34335909': 1, '2887855': 1, '7243475': 1, '31723636': 2, '30186227': 1, '28643533': 1, '29326371': 2, '10373145': 1, '26629334': 1, '9600687': 1, '16848121': 1, '34434295': 2, '19208683': 1, '21280083': 1, '30622505': 1, '27335969': 2, '1622526': 1, '12064698': 1, '11677283': 1, '24223604': 2} | {'6786714-1': 1, '7387025-1': 1, '5148912-1': 1, '4784591-1': 1, '8383517-1': 1, '5778324-1': 1} |
164,026 | 3819691-1 | 24,224,150 | noncomm/PMC003xxxxxx/PMC3819691.xml | Adverse Events Associated with Azathioprine Treatment in Korean Pediatric Inflammatory Bowel Disease Patients | A 9-year-old girl was hospitalized with fever, and numerous erythematous, pustular lesions with tenderness on her face and both arms. Due to her prednisolone-dependent ulcerative colitis, AZA treatment with a dose of 1 mg/kg/day had been initiated 10 days before admission. Laboratory tests showed leukocytosis and markedly raised erythrocyte sedimentation rate and C-reactive protein level on admission. Despite antibiotic treatment after admission, fever continued and skin lesions worsened. Skin biopsy was performed, and pathologic examination revealed massive neutrophilic infiltrates in the entire dermis. Tissue culture results were negative for bacterial and fungal infection. Considering the clinical course, laboratory findings, and histopathologic examinations, Sweet syndrome was suspected. Two days after discontinuing treatment with AZA, the fever subsided and skin lesions showed improvement. | [[9.0, 'year']] | F | {'16918876': 1, '18557712': 1, '23633304': 1, '2758725': 1, '19252404': 1, '32438538': 2, '9246020': 1, '17439508': 1, '19142964': 1, '10833476': 1, '25641386': 1, '18516013': 1, '17026564': 1, '10208641': 1, '9753482': 1, '18577852': 1, '34027115': 1, '22050052': 1, '10875470': 1, '15317038': 1, '18616518': 1, '18593894': 1, '33532972': 1, '29298460': 1, '24224150': 2} | {'3819691-2': 2, '7606952-1': 1} |
164,027 | 3819691-2 | 24,224,150 | noncomm/PMC003xxxxxx/PMC3819691.xml | Adverse Events Associated with Azathioprine Treatment in Korean Pediatric Inflammatory Bowel Disease Patients | A 15-year-old boy who had been diagnosed with CD was admitted with complaints of high fever and oral lesions for 2 days. Treatment with AZA had been initiated 1 month before with a dose of 2.5 mg/kg/day, which had been prescribed at an other hospital. Neutropenia occurred 7 days after treatment with AZA and drug doses were reduced to 1 mg/kg/day. The initial laboratory test at admission showed pancytopenia, with a white blood cell count of 1,700/mm3, an absolute neutrophil count of 70/mm3, hemoglobin of 11.7 g/dL, and a platelet count of 45,000/mm3. Despite discontinuation of treatment with AZA, pancytopenia worsened and high fever continued. Blood culture results were negative for bacteral and fungal infection. After 10 days of treatment with antibiotics, G-CSF and blood transfusion, his pancytopenia showed improvement and the fever subsided. Not until 5 months after discontinuation of AZA did his pancytopenia fully recover. | [[15.0, 'year']] | M | {'16918876': 1, '18557712': 1, '23633304': 1, '2758725': 1, '19252404': 1, '32438538': 2, '9246020': 1, '17439508': 1, '19142964': 1, '10833476': 1, '25641386': 1, '18516013': 1, '17026564': 1, '10208641': 1, '9753482': 1, '18577852': 1, '34027115': 1, '22050052': 1, '10875470': 1, '15317038': 1, '18616518': 1, '18593894': 1, '33532972': 1, '29298460': 1, '24224150': 2} | {'3819691-1': 2, '7606952-1': 1} |
164,028 | 3819693-1 | 24,224,153 | noncomm/PMC003xxxxxx/PMC3819693.xml | Congenital Internal Hernia Presented with Life Threatening Extensive Small Bowel Strangulation | A 6-year-old boy visited pediatric emergency department due to sudden onset abdominal pain which developed 1 hour ago. He had complained diffuse abdominal pain and vomited clear fluid twice in the hospital. Vital sign was stable and the physical examination revealed dehydrated tongue and diffuse abdominal tenderness. Laboratory test showed unremarkable except elevated white blood cell count of 24,310/mm3 with normal differentiation. Plain abdominal radiograph showed nonspecific small bowel gas which suggested mild ileus () and abdominal ultrasound revealed diffuse small bowel wall thickening with ascites (). A contrast-enhanced abdominal computed tomography (CT) was recommended, but his father refused to undergo the further evaluation and discharged against our medical advice.\nFifteen hours later, he was rushed by ambulance to the pediatric emergency department again with altered mentality. He did not respond to the painful stimuli, his both pupils were dilated to 5mm and showed severe abdominal distension. His blood pressure was uncheckable with weakly palpable femoral pulse, percutaneous oxygen saturation was 77% and blood sugar level was 22 mg/dL. Pretibial intraosseous cannulation was performed urgently due to failure of the intravenous catheterization and fluid and medications were infused through the intraosseous cannulation. He was in shock state and arterial blood gas analysis showed pH of 7.15 and bicarbonate of 7.7 mM. Hemoglobin and hematocrit levels were 10.1 g/dL and 27.7%, but rapidly decreased to 4.7 g/dL and 13% respectively, just one hour later. Also he was in disseminated intravascular coagulopaty state with antithrombin III of 38.9%, D-dimer of 9.18 mg/L, prothrombin time of 1.61 international normalized ratio, activated partial thromboplastin time of 43.9 seconds and lactic acid of 10.9 mmol/L. After the initial hydration, central venous catheter could be placed via the left subclavian vein and massive fluid, transfusions, and inotropics could be delivered. The contrast-enhanced abdominal CT scan performed immediately after maintaining systolic blood pressure of 90 mmHg. CT scan showed large amount of ascites, bowel wall thickening with poor or absent enhancement of the strangulated bowel segment. The serrated beak sign and whirl sign of the obstructive bowel loop were identified at the transition zone which might indicate closed loop obstruction (). Surgical exploration was performed immediately. On the operation field, three quarters of the small bowel was herniated through the two fingerbreadth defect of mesentery located on near the ileocecal valve (). All herniated small bowel showed diffusely hemorrhagic, edematous and inflammatory change. Under the diagnosis of congenital IH with strangulated small bowel, resection of more than 2 meters of gangrenous small bowel was followed by the anastomosis of proximal jejunum and terminal ileum.\nAfter four-day treatment at pediatric intensive care unit, he was improved enough to move to general ward and started soft diet on the 5th day after operation. He did not fully recover yet due to hypertension after renal ischemic injury and short bowel syndrome, fortunately, his cognitive function is normal and he is gradually improving conditions. | [[6.0, 'year']] | M | {'21608444': 1, '11353110': 1, '26064813': 1, '23731500': 1, '16110100': 1, '23685474': 1, '34094757': 2, '21856100': 1, '21735180': 1, '9408486': 1, '34307581': 2, '24224153': 2} | {'8283599-1': 1, '8171990-1': 1} |
164,029 | 3819694-1 | 24,224,154 | noncomm/PMC003xxxxxx/PMC3819694.xml | Congenital Chloride Diarrhea in Dizygotic Twins | A 6-month-old male presented to our outpatient clinic with poor feeding and irritability. He was the second of non-identical twins, born by cesarean section at 32 and 2/7 weeks gestational age due to preterm labor and transverse lie of one fetus. Since their mother had polyhydramnios and both showed small bowel dilatation on prenatal ultrasound (), both newborns were suspected to have congenital intestinal obstruction and their mother was transferred to this hospital before delivery. Amnioreduction has been conducted twice at previous hospital but there were no data for diagnosis such as amniotic fluid analysis. The birth weight of the male twin was 2,130 g and that of the female was 1,720 g. They were treated in the neonatal intensive care unit (NICU) for prematurity and low birth weight. During that time, they showed recurrent abdominal distension and ileus, but there was no evidence of bowel obstruction on either abdominal sonography or small bowel series (). They were discharged at 42 day of age.\nOne month later, the male was admitted for poor weight gain. Sucking was insufficient and he was irritable. He had hyponatremia and metabolic alkalosis. Blood gas analysis showed a pH of 7.645 and a base excess of +16.0 mmol/L. Other laboratory findings were serum sodium 115 mEq/L, serum potassium 2.6 mEq/L, serum chloride 57 mEq/L. urine sodium 8 mEq/L, urine potassium 3.2 mEq/L, urine chloride 9 mEq/L, urine osmolality 61 mOsm/kg H2O, and serum osmolality 235 mOsm/kg H2O. Renin activity (116.89 ng/mL/h; normal range, 2.0-35.0 ng/mL/h) and aldosterone level (>1,393 pg/mL; normal range, 65-860 pg/mL) were elevated. He had watery diarrhea, but stool culture and stool occult blood examinations were negative. Electrolytes were corrected and symptoms improved. He was discharged but the cause of hyponatremia and metabolic alkalosis was not clear.\nThe infant was admitted at 6 months of age because of diminishing body weight and developmental delay. He was only able to consume milk and could not eat solid food. He was unable to lift his head or roll over, did not grasp anything and rarely laughed or babbled. His body weight was 3.6 kg (corrected age, 4 months; below the 3rd percentile) and his height was 60 cm (corrected age, 4 months; 5th to 10th percentile). He again had hyponatremia and metabolic alkalosis. Urine osmolality was elevated and urine sodium was low: urine sodium <10 mEq/L, urine potassium 8.9 mEq/L, urine chloride 8 mEq/L, urine osmolality 390 mOsm/kg H2O and serum osmolality 215 mOsm/kg H2O. Hypotonic hyponatremia with urine osmolality >100 mOsm/kg, decreased extracellular fluid volume, and urine sodium <10 mEq/L suggest presence of extrarenal solute loss. Metabolic alkalosis with low urine chloride (<10 mEq/L) suggest vomiting, gastric drainage, diuretic use, or chloride-losing diarrhea, and other common misdiagnosis such as Bartter's syndrome could be excluded. This results prompted evaluation of fecal electrolytes. He had been experiencing numerous daily episodes of watery stool. Stool Cl- and pH was 124 mEq/L and 6.18, respectively. He was diagnosed as CLD ().\nThe patient had been born to non-consanguineous parents. His twin sister was doing well after discharge from NICU but she also had frequent diarrhea and growth retardation (corrected age, 4 months; body weight 5.1 kg, below the 3 percentile) and her twin brother was diagnosed with CLD. She was also underwent some blood tests with exams on stool electrolyte, confirming her with CLD as well. She showed relatively minor abnormality in electrolyte level of serum and stool than her twin brother ().\nAt the present time, 13 months after diagnosis, both twins are orally receiving NaCl and KCl. The dose of NaCl and KCl dosage were adjusted with constant monitoring of the patients' electrolyte level. In the last outpatient clinic, the dosage was NaCl 4.2 mEq/kg/day, KCl 0.8 mEq/kg/day for the male, and NaCl 3.2 mEq/kg/day, KCl 1.2 mEq/kg/day for the female patient. The male's body weight is 10.5 kg (corrected age, 17 mo; 25th to 50th percentile), serum sodium is 141 mEq/L, serum potassium is 4.3 mEq/L and serum chloride is 105 mEq/L. The female's body weight is 10.2 kg (corrected age, 17 months; 25th to 50th percentile), serum sodium is 141 mEq/L, serum potassium is 3.7 mEq/L and serum chloride is 103 mEq/L. Their serum electrolytes are being maintained within normal range and their body weights and developments are gradually improving (). Gene study was recommended, but parental consent was not given. | [[6.0, 'month']] | M | {'21150650': 1, '11587020': 1, '33173177': 1, '9886994': 1, '17531020': 1, '10881594': 1, '3267361': 1, '19912155': 1, '11302976': 1, '21127979': 1, '22362191': 1, '12442266': 1, '5111762': 1, '15300594': 1, '32231454': 2, '2492559': 1, '22779076': 1, '23274434': 1, '16641574': 1, '24224154': 2} | {'7096564-1': 1} |
164,030 | 3819695-1 | 24,224,155 | noncomm/PMC003xxxxxx/PMC3819695.xml | Acute Urinary Retention in a 47-month-old Girl Caused by the Giant Fecaloma | A 47-month-old female\nVoiding difficulty and urinary incontinence\nThe patient was born fullterm with a birth weight of 2.4 kg. At the age of 2 weeks, she was diagnosed with Hirschsprung disease and underwent the Duhamel operation. At that time, a ganglion cell was noted at the proximal sigmoid. After the operation, she was able to evacuate the bowels well until 6 months of age and she stopped visiting the outpatient clinic. She has a history of constipation of over 1 year. Constipation had been managed with oral lactulose and enema using glycerin at a nearby hospital over 1 year when she complained abdominal pain, agitation and holding her stools with 3- or 4-day interval. After enema, sausage-shaped stools were frequently observed. Her mother could not remember the exact characters of stool. There was no abnormal and unusual feeding history or urinary pattern before admission.\nThe patient was transferred to our hospital due to acute urinary obstruction. One week ago, diffuse lower abdominal pain developed which was managed at a local clinic with medicine for constipation. However, abdominal pain persisted. One day before admission, abdominal distension and voiding difficulty developed.\nOn initial evaluation the patient had a blood pressure of 110/70 mmHg, a pulse rate of 96 beats/min, a respiratory rate of 24 breaths/min, a body temperature of 36.5℃ with a body weight of 14.5 kg (the 50-75 percentile) and a height 99.9 cm (>the 97 percentile). She was irritable because she could not pass urine despite the feeling of micturition. Her abdomen was distended, and focal tenderness was present at the lower quadrant. Auscultation revealed lower than normal bowel sounds. The location of the anal orifice on the perineal area and anal tone were both physiologic. No abnormal dimple or skin lesion on her sacral area was observed and her neurologic examination was physiologic and normal. Fecal materials were palpable on digital rectal examination.\nAbundant fecal materials were observed on abdominal X-ray (), and ultrasonography (USG) of the abdomen revealed a distended bladder with a thin bladder wall and both hydronephrosis of grade III (). Hematological examinations and blood chemistries were as follows: a hemoglobin level of 13.0 g/dL, a total white cell count of 5.9×109/L, a platelet count of 357×109/L and granulocyte and lymphocyte levels of 41.5% and 46.1%, respectively; A serum calcium level of 9.7 mg/dL (8.6-10.2), a magnesium level of 1.2 mg/dL (1.5-2.3), a sodium level of 144.1 mmol/L (135-145), a potassium level of 3.6 mmol/L (3.3-5.1) and a chloride level of 104.6 mmol/L (98-110). Her blood urea nitrogen, creatinine, hepatic transaminase and C-reactive protein levels were normal. Urinalysis collected via a catheter was normal. Thyroid function test was not checked. Sigmoidoscopy could not be performed to her because of a large amount of feces in her distal colon despite repeated glycerin enema and digital evacuation.\nAfter urinary catheterization, 720 mL of urine was drained and abdominal pain and distension was improved. However, urinary obstruction persisted and urinary catheterization was kept continuously. On day 3 after admission, voiding difficulty persisted despite loose stool passage after repeated glycerine enema. For ruled out the abdominal mass, whole-abdominal computed tomography (CT) was performed and showed a large fecaloma in the sigmoid colon and a displaced bladder (). The coronal image of the CT showed that the distal part of the colon was markedly dilated and contained heterogeneous materials consisting of impacted feces. The markedly dilated distal colon was suspected as Duhamel pouch. The bladder neck was displaced into the upper abdomen because of the large fecaloma-filled pouch. After repeated glycerin enemas and digital evacuations, spontaneous urination was noted on day 5. USG revealed a normal sized bladder and improved both hydronephrosis. However, she could not evacuate bowels sufficiently by herself. We could palpate a membranous tissue in her rectum at the time of digital evacuation. On day 7, a colon study revealed a giant Duhamel pouch filled with fecal materials without a definitive the membranous tissue in her rectum (). We decided to perform an operation because she had a giant Duhamel pouch, an unidentified membranous tissue and to perform a full-thickness rectal biopsy. Two weeks later, operation was done after sufficient evacuation of the feces in her rectum. A septum was noted in Duhamel pouch, which ran transverse direction in her rectum on the operative findings. Post-Duhamel septum revision was performed. Histopathologic findings of the full-thickness rectal biopsies showed a ganglion cell in the rectum. Since the operation, she has been visiting our outpatient clinic regularly. She has been free of defecation and urination difficulties without the need for medicine. | [[47.0, 'month']] | F | {'11226994': 1, '23462384': 1, '8244110': 1, '16493541': 1, '33623720': 2, '10022162': 1, '34659668': 1, '23336648': 1, '33828868': 1, '6624617': 1, '2765819': 1, '9454315': 1, '2637625': 1, '10442609': 1, '21749849': 1, '10777196': 1, '32933229': 2, '10777195': 1, '26473140': 2, '19196473': 2, '27162906': 1, '11763494': 1, '21976230': 1, '11176514': 1, '34343797': 1, '27336021': 2, '17565653': 1, '24224155': 2} | {'2642792-1': 1, '7875629-1': 1, '4905124-1': 1, '4600704-1': 1, '7533188-1': 1} |
164,031 | 3819696-1 | 24,224,152 | noncomm/PMC003xxxxxx/PMC3819696.xml | A Case of Esophageal Candidiasis in an Adolescent Who Had Frequently Received Budesonide Nebulizing Therapy | A 13-year-old female adolescent visited our pediatric clinic presenting with nausea, dysphagia and abdominal pain. Her abdominal pain was localized to the epigastric area. The symptoms started 1 month ago, and became aggravated 2 weeks ago. The pain occurred intermittently, and became severe during the post-prandial period and at midnight, and was aggravated by a heavy meal. Her appetite was also decreased, but the body weight had not decreased. Her height was 152.3 cm (20th percentile), body weight was 41.6 kg (15th percentile), and body mass index was 17.9 (30th percentile). She had a history of frequent nebulizer therapy with budesonide for severe coughing at a private pediatric clinic although she had not been diagnosed with asthma or chronic bronchial disease. Every time she visited the pediatric clinic for the cough, she was prescribed nebulizer therapy with budesonide once a day for 2 or 3 consecutive days. This had occurred 3 times during the previous winter season. The dose of budesonide could not be confirmed. Her last budesonide nebulizer therapy was 2 months before she visited our clinic. Her history of use of antibiotics was unclear. The physical examination was nonspecific, except for mild epigastric tenderness. Blood studies were done, and they showed WBC 4,600/mm3 (polymorphonuclear neutrophils 54%, lymphocyte 36%, monocyte 7%), hemoglobin 12.9 g/dL, platelet 245,000/mm3, and C-reactive protein was negative. Electrolytes, total protein, albumin, calcium, phosphorus, cholesterol, liver enzymes, renal profiles, total bilirubin, direct bilirubin, CD3 and CD4 were within the normal range. In addition, serum Helicobacter pylori IgM and Ig G, and hepatitis B virus serologic tests were also negative, and human immunodeficiency virus was negative. Chest x-ray film showed no abnormality. Peptic ulcer disease was suspected clinically, so we planned an upper gastrointestinal endoscopic examination. On her first endoscopic examination, we found normal oral, gastric, and duodenal mucosa, but there were creamy white pseudo-membranes and multiple erosions on the whole of the esophageal mucosa (). Pathologic studies were performed on the esophageal biopsies of the lesion. KOH staining showed hyphae that suggested a fungal infection. Hematoxylin and eosin staining of the biopsy showed numerous hyphae and yeasts on the surface of the epithelia in the hyperkeratotic squamous epithelium of the esophagus (). Pathologically the lesion was consistent with candidal infection. So we were able to confirm candidiasis of esophagus. We thought that our patient was not in an immunocompromised state because she had no history of admission or operation, and was on no special medications except for budesonide. The patient's growth percentile was normal, and there was no immune-comprised clinical feature. So, we planned a wait-and-see approach without any antifungal treatment because the lesion could possibly heal naturally in an immunocompetent healthy host.\nAfter 1 month, a follow-up esophagoscopic examination was performed. The previous whitish creamy pseudo-membranes and erosions were still noted on the whole esophagus (). We decided to prescribe an antifungal agent, oral fluconazole, that is usually well tolerated and effective for esophageal candidiasis, in the dose of 6 mg/kg per day for 2 weeks. As she took the medicine, her dysphagia, nausea, and abdominal pain improved gradually.\nA follow-up esophagoscopic examination was performed 2 weeks after the cessation of the anti-fungal therapy. The whitish creamy pseudo-membranes and multiple erosions were no longer seen in the esophagus (). The esophageal mucosa was normal. Her symptoms also improved completely. She is now in excellent condition. | [[13.0, 'year']] | F | {'18034973': 1, '19484677': 1, '22096388': 1, '12512183': 1, '19718541': 1, '14572559': 1, '6339183': 1, '14685037': 1, '18949340': 1, '24224152': 2} | {} |
164,032 | 3819851-1 | 24,249,994 | noncomm/PMC003xxxxxx/PMC3819851.xml | Bilateral transversus abdominis plane block as a sole anesthetic technique in emergency surgery for perforative peritonitis in a high risk patient | A 67-year-old woman, 55 kg was admitted to hospital with a 3-day history of abdominal pain, nausea and vomiting. She was diagnosed to have chronic obstructive pulmonary disease (COPD) 5 years ago and had four episodes of prior hospitalization secondary to acute exacerbation. She often required nebulisers and had an exercise tolerance of approximately 100 yards. In the week prior to admission she had received oral antibiotics and steroids for an infective exacerbation of COPD. On admission to the hospital she had signs of peritonitis and her abdomen was noted to be markedly distended. Ultrasonographic scan revealed a possible bowel (duodenal) perforation. She was tachypneic (RR 28/min) with evidence of accessory muscle use. Examination revealed reduced bi-basal air entry with crepitations all over the chest and chest X-ray showed consolidation of the right middle and lower lobe. Her arterial blood gas revealed type I respiratory failure (FiO2 0.60, pH 7.37, pO258 mmHg, pCO245 mmHg). Her heart rate was 112/min, and BP 90/60 mmHg. She was anemic with hemoglobin of 6 g%. S. urea - 102 and S. creatinine-2 g%. Intravenous acetaminophen was administered for pain relief, but despite this she could not cough or take deep inspiration due to ongoing pain. She was categorized as American society of anesthesiologists (ASA) physical status grade IV/E and was planned for emergency laparotomy. We planned to avoid general, epidural or spinal anesthesia, so we opted for TAP block under ultrasound guidance as a sole anesthetic technique. After proper explanation to the patient about the technique of TAP block, she was taken to operation theatre table and monitors attached. Pulse oximetry showed oxygen saturation of 88% on room air. Hence oxygen supplementation was carried out with venturi mask with oxygen flow at 6 L/min. Saturation improved to 92%. After securing an IV access with 18G (Gauge) needle on the right dorsum of the hand, she was sedated with intravenous dexmedetomidine infusion at 4 mcg/kg/min to make her comfortable, cooperative, and pain free for performing the block. Then she was laid supine with the anterolateral abdominal wall exposed bilaterally from the iliac crest to the sub-costal margins and scrubbed aseptically. The block was performed using an aseptic ultrasound guided in-plane technique (s-nerve sonosite, HFL38 (Company brand name of the 6.0 to 13.0 MHz linear probe) probe, 100 mm sonoplex needle). When the needle tip position is within the TAP neuro-fascial plane a mixture of 20 ml of 0.25% bupivacaine, 20 ml of 1% Lidocaine and 0.2 mg adrenaline was injected slowly through the needle. The same steps were repeated on the contra-lateral side. A remarkably good clinical effect was achieved within 30 min with almost complete resolution of pain. After 30 min, the abdominal incision was carried out without pain. All the vital signs remained normal intraoperatively. Effective coughing and deep breathing became possible and her tachypnea gradually resolved. Laparotomy revealed an ileal perforation, which was sealed with omentum. She made a slow post-operative recovery to be discharged from hospital 14 days after admission. | [[67.0, 'year']] | F | {'26034327': 1, '19020158': 1, '19059922': 1, '24249979': 1, '25328723': 2, '8517522': 1, '8871461': 1, '16418039': 1, '17717264': 1, '17717265': 1, '19934395': 1, '33329834': 1, '19059927': 1, '10493273': 1, '26755845': 1, '11576144': 1, '6419632': 1, '31572995': 1, '434530': 1, '18165577': 1, '31572089': 1, '6650905': 1, '2340250': 1, '6873640': 1, '1206186': 1, '24249994': 2} | {'4190973-1': 1, '4190973-2': 1} |
164,033 | 3819852-1 | 24,249,995 | noncomm/PMC003xxxxxx/PMC3819852.xml | Case series: Dexmedetomidine and ketamine for anesthesia in patients with uncorrected congenital cyanotic heart disease presenting for non-cardiac surgery | Case 4 was a 20-year-old female patient, a diagnosed case of TOF who presented with a frontal lobe abscess with a 12 mm midline shift and features of septic shock. She was posted for emergency craniotomy and drainage of the abscess. There was a history of occasional episodes of cyanotic spells since the last 1 year. However, she had not undergone any corrective or palliative surgery and was not on any medication. Preoperative evaluation revealed SpO286% on room air, arterial blood gas (ABG) analysis showed PaO247.8 mmHg, pH 7.465, PaCO250.3 mmHg, and HCO330 mmol/l. She was being managed with vasopressors (noradrenaline: 0.05-0.07 g/kg/min) to maintain the mean arterial pressure (MAP) above 65 mmHg. After preoxygenation, the patient was induced with dexmedetomidine 1 g/kg and ketamine 2 mg/kg over 10 min. Anesthesia was maintained on controlled ventilation with vecuronium and an infusion of dexmedetomidine (0.7-1.0 g/kg/h) and ketamine (2 mg/kg/h). Paracetamol 1 g IV was added for analgesia though no inhalational anesthetic was used for maintenance. Cardiac output and systemic vascular resistance (SVR) were monitored by FlotracTM. SVR was maintained <1,200 dyne.s/cm5 by an infusion of noradrenaline (0.05-0.1 g/kg/min). There was a large parietal abscess and about 100 ml of pus was drained. In view of the raised intracranial pressure (ICP) and septic shock, she was electively ventilated in the ICU. | [[20.0, 'year']] | F | {'33487841': 2, '9935034': 1, '15192002': 1, '27275039': 1, '26330739': 1, '33995542': 1, '24623919': 1, '22067985': 1, '18223350': 1, '17312201': 1, '29109649': 1, '21123635': 1, '25886322': 1, '19263361': 1, '32509610': 1, '32005295': 1, '21821507': 1, '25937652': 2, '25886232': 1, '9886728': 1, '23223916': 1, '12116797': 1, '7741286': 1, '34703060': 1, '10195519': 1, '24249995': 2} | {'3819852-2': 2, '7819399-1': 1, '4408654-1': 1} |
164,034 | 3819852-2 | 24,249,995 | noncomm/PMC003xxxxxx/PMC3819852.xml | Case series: Dexmedetomidine and ketamine for anesthesia in patients with uncorrected congenital cyanotic heart disease presenting for non-cardiac surgery | Case 5 was a 2-year-old boy who was diagnosed as TOF with a large subaortic VSD, bidirectional shunt, severe pulmonic stenosis, and overriding of aorta with a small sized pulmonary artery on echocardiography.[] The child had developed right hemiparesis at 1 year of age and his heart disease was detected during the work up. He recovered well over the next few months, but could not undergo any palliative surgery for TOF. He developed a malignant right parietal lobe infarct with features of raised ICP at 2 years of age. A decompressive right hemicraniectomy was done under general anesthesia. The child developed cerebrospinal fluid (CSF) leak from the surgical site and an external lumbar drain was placed 3 days later for controlled CSF drainage. During both the above procedures, dexmedetomidine (1 g/kg and 1-1.5 g/kg/h) and ketamine (2 mg/kg and 2-2.5 mg/kg/h), respectively were used for induction and maintenance of anesthesia. The former surgery was done with controlled ventilation using muscle relaxation and the latter procedure was carried out with the two drugs along with oxygen via face mask with spontaneous respiration. The child maintained hemodynamic stability perioperatively and recovered uneventfully. | [[2.0, 'year']] | M | {'33487841': 2, '9935034': 1, '15192002': 1, '27275039': 1, '26330739': 1, '33995542': 1, '24623919': 1, '22067985': 1, '18223350': 1, '17312201': 1, '29109649': 1, '21123635': 1, '25886322': 1, '19263361': 1, '32509610': 1, '32005295': 1, '21821507': 1, '25937652': 2, '25886232': 1, '9886728': 1, '23223916': 1, '12116797': 1, '7741286': 1, '34703060': 1, '10195519': 1, '24249995': 2} | {'3819852-1': 2, '7819399-1': 1, '4408654-1': 1} |
164,035 | 3819853-1 | 24,249,996 | noncomm/PMC003xxxxxx/PMC3819853.xml | Spontaneous central vein thrombosis in a patient with activated protein C resistance and dengue infection: An association or causation? | A 21-year-old non-obese female patient with no co-morbid illness was referred to our intensive care unit (ICU) from a private hospital with history of high grade fever with chills 8 days back with respiratory distress for 6 days and altered sensorium for 2 days. She was apparently healthy, unmarried, and had no history of hormone intake. She was intubated for altered sensorium and had already received mechanical ventilation for 48 hours. She was referred to us in a state of shock with vasopressors infusions on flow (dopamine through peripheral line). Additionally, she had edematous peripheries (right upper limb swelling was more as compared to the left). She had leukocytopenia (2,400/cmm), thrombocytopenia (20,000/cmm), and normal prothrombin time, activated partial thromboplastin, and thrombin times and fibrinogen levels. Neck ultrasonography (USG) prior to an attempt of right IJV cannulation revealed a non-compressible right IJV along with absence of venous flow in color Doppler strongly suggestive of right IJV thrombus. Her left IJV and SCV were compressible (checked by using linear ultrasound probe supraclavicularly) and patent, hence we inserted the central line in the left SCV for hemodynamic monitoring, fluid resuscitation and vasopressor use. Radiologists evaluated and confirmed right IJV thrombus with extension towards right SCV. Her lower limb Doppler study was, however, within normal limits. Echocardiography showed mild tricuspid regurgitation with ejection fraction <55% with mild dilatation of main pulmonary arteries. Urgent thoracic computed tomography (CT) angiography revealed left distal pulmonary artery thrombosis []. We immediately started unfractionated heparin (loading dose: 80 U/kg followed by continuous infusion @ 20 U/kg/hr.) to achieve a target activated partial thromboplastin time (APTT) of 2-2.5 times the normal. Further investigations demonstrated APC-R using the test kit STA -staclot APC-R (Diagnostica Stago, Asnieres, France) and genetic markers for thrombosis using polymerase chain reaction showed homozygous to Factor V Leiden mutation. After achieving the target APTT, oral vitamin K anticoagulants (OVKA) in the form of warfarin 5 mg was started along with the heparin to aim international normalized ratio (INR) of 2-2.5. We achieved target INR within next 5 days. Then, heparin was stopped and warfarin was continued. Her other supportive management included fluids, sedation, vasopressors, broad spectrum antibiotics, enteral nutrition, and mechanical ventilation. In the meantime, Dengue IgM Enzyme-linked immunosorbent assay (ELISA) (Dengue IgM capture ELISA, PanBio, Australia) was also found to be positive. Within the next week her hemodynamic status improved and she could be weaned off from the ventilator. After the shock recovered, we did thrombophilia testing of this patient []. Her swelling of the right upper limb was regressed gradually. But, her right IJV and SCV thrombus persisted with partial recanalization in follow up USG []. She was discharged on oral warfarin treatment. She is now under our follow-up. Importantly, her father, mother, and younger sister underwent factor 5 Leiden mutation test which was tested negative. | [[21.0, 'year']] | F | {'21511556': 1, '18522648': 1, '20128794': 1, '25821628': 2, '22461473': 1, '33407545': 2, '17855836': 1, '8164741': 1, '12387654': 1, '12569754': 1, '21340752': 1, '24249996': 2} | {'4364112-1': 1, '7789584-1': 1} |
164,036 | 3819854-1 | 24,249,997 | noncomm/PMC003xxxxxx/PMC3819854.xml | Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy | 66-year-old gentleman, ASA 3 was scheduled for laparotomy for duodenal tumour excision. His other medical conditions were type 2 diabetes mellitus, cardiomyopathy, chronic smoker, and obstructive sleep apnoea on Continuous Positive Airway Pressure (CPAP) machine. Postoperative analgesia options were discussed with the patient. He was not keen on epidural, but happy to consider other options. He was offered patient controlled analgesia (PCA) fentanyl, QL block, and multimodal analgesia. We had explained the QL block as a novel technique. He preferred to undergo the block while sleeping. After taking informed consent, anesthesia was induced with propofol (Fresofol® fresenius, Sydney, New South Wales, Australia), fentanyl (fentanyl citrate DBL Hospira, Melbourne, Australia), and rocuronium (Esmeron, MSD, Sydney, New South Wales, Australia) for Neuro muscular (NM) paralysis. Maintenance of anesthesia was with 50:50 O2 and air with sevoflurane. The abdomen was opened via right-side large subcostal incision. The procedure lasted 2.5 h and was uneventful. At the end of the procedure, he was positioned in left lateral to obtain appropriate view of QL and TAP extensions of lateral abdominal muscles. Aseptic precautions were taken by wearing sterile gown and sterile drapes. Ultrasound Macro Maxx™ (SonositeInc, Bothell, Washington, USA) was used with linear probe (HFL38_10-5 MHz) covered with sterile plastic sheath SiteRite (Bard Access Systems Inc., Salt lake city, Utah, USA) placed in the anterior axillary line to visualize the typical triple abdominal layers. Then, the probe was placed in the midaxillary line and at this juncture the layers of abdominal layers started to taper. When the probe was placed in the posterior axillary line as per the posterior approach, sonoanatomy showed first the transversus abdominis disappearing then the internal oblique and external oblique forming aponeurosis and appearance of QL noticed []. shows typical muscles layers and the fascia. At the junction of the tapered ends of abdominal muscles and QL, a 21 g 100 mm SonoPlexStimu cannula needle (Pajunk Medizintechnologie Geisingen, Germany0) was inserted in plane [] and confirmed its position by injecting saline. Under ultrasound (US) guidance, saline separating the fascia similar to what is seen in the TAP plane was observed. Then in that space 25 mL of 0.5% ropivacaine (Naropin-AstraZeneca, Sydney, North South Wales, Australia) was injected []. Pain scores using the numerator rating scale (NRS) from 0 to 10 were recorded hourly in recovery room and then in the high dependency ward and fentanyl use was monitored for 24 h. He received a fentanyl PCA with bolus dose of 20 mcg with lock out interval of 5 min and multimodal analgesia comprising paracetamol1g every 6 h and parecoxib (Dynastat, Pfizer Pty Ltd, North South Wales Australia) 40 mg daily.\nPostoperatively in recovery, he did not require any further analgesia. Pain scores were 0/10 and the ipsilateral sensory block was T8-L1. The first analgesic request was about 3 h postoperative. After 15 h, he started experiencing pain requiring more fentanyl PCA amounting to 720 mcg for the remaining day. The average pain scores on day one were 4/10 at rest and 6/10 on coughing and comfortable. The 2nd day, the pain scores were 7/10 and 9/10 requiring 1000 mcg of fentanyl. | [[66.0, 'year']] | M | {'31649394': 1, '29988696': 1, '34512025': 1, '30140533': 1, '34682755': 1, '17179269': 1, '25788791': 1, '28154824': 1, '34679966': 1, '21897502': 1, '33542562': 1, '34739706': 1, '31623572': 1, '30283187': 1, '29033750': 1, '31508661': 1, '31741568': 1, '32923287': 2, '30386022': 1, '31341831': 1, '30863471': 1, '30291414': 1, '34243719': 1, '33162602': 1, '34938113': 1, '32256907': 1, '19624629': 1, '30662131': 1, '30050698': 1, '33938653': 1, '28512101': 1, '32867683': 1, '21851346': 1, '32008278': 1, '27761032': 1, '29536008': 1, '34184312': 1, '30852882': 1, '27583851': 1, '20830871': 1, '33437078': 1, '24249997': 2} | {'7486087-1': 1, '7486087-2': 1} |
164,037 | 3819855-1 | 24,249,998 | noncomm/PMC003xxxxxx/PMC3819855.xml | Pseudothrombocytopenia in perioperative patient: A significant laboratory artifact | A 37-year-old euglycemic and normotensive male was found to have thrombocytopenia on his routine perioperative check-up before elective implant removal surgery. The orthopedic surgeon had cancelled his surgery and he was referred to Emergency Department for further work up. There was no history of fever, rash or bleeding tendency. He was not on any concurrent medications or herbal agents. His family history was non-significant. Physical examination was unremarkable. A complete blood count with standard EDTA, which revealed white blood cell count of 6.0 × 103/mm3, hemoglobin of 14 g/dL and platelets of 4.0 × 103/mm3 by automated counter. A peripheral blood smear prepared from the same blood showed clumping of platelets. The coagulation profile, electrolyte levels, liver, renal and thyroid function tests, autoimmune screens, C-reactive protein and tumor markers were within normal range. Human immunodeficiency virus and hepatitis serology were negative. Chest radiography and abdominal ultrasonography did not reveal any abnormality. A repeat analysis of blood anticoagulated with citrate revealed a platelet count of 2.5 × 103/mm3 with normal distribution in the peripheral smear. The patient was diagnosed as pseudothrombocytopenia due to EDTA induced platelet aggregation (EIPA) and hence, further treatment or blood work was not initiated. The patient's surgery was rescheduled and performed without any complication. The surgical site showed no abnormal bleeding and his subsequent platelet counts during his post-operative period drawn in EDTA tubes constantly reported as thrombocytopenia. | [[37.0, 'year']] | M | {'21661128': 1, '27142615': 1, '17224004': 1, '2505643': 1, '23181217': 1, '20530050': 1, '20961195': 1, '24249998': 2} | {} |
164,038 | 3819856-1 | 24,249,999 | noncomm/PMC003xxxxxx/PMC3819856.xml | Anesthesia for a patient of acromesomelic dysplasia with associated hydrocephalus, Arnold Chiari malformation and syringomyelia | A 10-year-old male patient (30 kg, 122 cm) presented with short stature and a stooping posture due to pronounced kyphoscoliosis [] along with back pain for the past three years. History of snoring, breath holding, cyanosis, paradoxical chest movement, restless sleep, daytime somnolence and family history of dwarfism were absent. He was cooperative, had normal mental function and intellectual development without any neurological deficit. Airway examination revealed adequate mouth opening, Mallampati class-II and unrestricted neck extension.\nPulmonary functional tests and laboratory values were within regular limits. Chest and cervical region X-ray appeared normal, without subluxation on flexion and extension. Thoracic kyphosis was present with a Cobb's angle of 35° []. Magnetic resonance imaging of brain revealed hydrocephalus, ventriculomegaly, a short posterior fossa, tonsillar herniation and a 3-mm syrinx. Posterior fossa decompression by C1, C2 laminectomy with removal of a foramen magnum rim was planned.\nOn the night before surgery the patient was instructed to follow standard ASA fasting guidelines. Anticipating difficult venous cannulation due to the coarse and loose skin [], the AV300 Vein Viewing System was used to identify a vein in the dorsum of the left hand, which was marked.\nOn the day of surgery, the patient was brought to the operation theatre in a calm state and 5-lead ECG, non-invasive blood pressure and pulse oximetry were connected. A 20-G intravenous cannula was inserted into the previously marked site after application of EMLA cream.\nThe severe kyphoscoliosis and gibbus deformity prevented the patient from assuming a supine position for intubation []. We modified the position by placing a thick pillow that supported the occiput and compensated the gibbus deformity []. Keeping the difficult airway cart ready the child was sedated with intravenous midazolam (1 mg), fentanyl (60 g) and a bolus dose of propofol (60 mg). After confirming the ability to mask ventilate and glottic visualisation following a gentle check laryngoscopy, vecuronium (3 mg) was administered to facilitate intubation. Endotracheal tube size prediction in such patients is difficult.[] Age formula predicted an endotracheal tube size of 6.5 mm, but we could intubate the patient with a 5.5-mm cuffed, flexomettalic endotracheal tube. The operative site being near the brainstem, the left radial artery was cannulated for invasive blood pressure monitoring and an oesophageal temperature probe was inserted. Anesthesia was maintained with an air-oxygen mixture (1:1) and isoflurane, and intermittent boluses of vecuronium and fentanyl as needed.\nAfter preloading with 200 ml of normal saline, the patient was positioned prone on pillows keeping the abdomen free for excursions and the pressure points were padded. Surgery was completed in about 2 h. Postoperatively the patient was turned supine and placed on a thick pillow in a position similar to intubation. The neuromuscular block was antagonised and the trachea was extubated after complete awakening. The patient was shifted to the ICU for monitoring. Injection of paracetamol (500 mg intravenously six-hourly) provided postoperative pain relief. After an uneventful postoperative period, the patient was discharged after 3 days with advice for spinal extension brace, physiotherapy and follow-up. | [[10.0, 'year']] | M | {'9634515': 1, '8423184': 1, '7433666': 1, '22526432': 1, '10633136': 1, '2221443': 1, '33854687': 1, '24249999': 2} | {} |
164,039 | 3821095-1 | 24,222,807 | noncomm/PMC003xxxxxx/PMC3821095.xml | Fulminant Hepatitis Due to Father-to-Newborn Transmission of Herpes Simplex Virus type 1 | A 8-day old male newborn was admitted to the emergency ward for abdominal pain with 39°C fever. Escherichia coli pyelonephritis was laboratory-documented on the urine sample. At this time, except for an elevated inflammatory marker (CRP = 15 mg / l), liver function tests, blood cell count and hemostasis markers were normal. He was transferred to pediatric unit to receive intravenous antibiotics. Eleven days later, his condition suddenly deteriorated with jaundice, abdominal collateral circulation, hepatosplenomegaly, and diarrhea in a febrile context(39.5°C) suggesting splenic hypertension; he was transferred to the neonatal intensive care unit. Biologic analyses showed a severe hepatic failure (prothrombin ratio at 25%, fibrinogen at 0.19g/L) with severe cytolytic hepatitis (AST = 2,720 IU/L, ALT = 1,353 IU/L, normal range = 6-40 IU/L), moderate cholestasis (total bilirubin at 119 µmol/L), severe thrombocytopenia (13g/L) and disseminated intravascular coagulation (fibrin monomer at 50 µg/mL, activated coagulation time at 58 sec). He was transfused with platelet, plasma and fibrinogen units. An empirical treatment by aciclovir was started. Bacterial sepsis was ruled out since blood and CSF cultures were negative. Other conditions such as metabolic disease, macrophage activation syndrome and hemochromatosis were negative (myelogram, iron status). Hepatotropic viruses (hepatitis A-E viruses, Cytomegalovirus, Herpes simplex virus (HSV), varicella-zoster virus, and Epstein-Barr virus) were tested via serology and PCR or RT-PCR-based genome amplification, but were negative except for HSV for which acute serum contained IgM, and HSV PCR was positive in whole blood and in the liver biopsy []. HSV type 1 (HSV-1) infection was confirmed using PCR based typing []. Histologic analysis of the liver biopsy showed a severe disseminated cytolysis. Thorough clinical examination of the patient did not find either mucocutaneous vesicles or encephalitis signs. Before this episode and apart from the pyelonephritis, the first 3 weeks of life were associated with normal weight gain. The treatment by intravenously acyclovir was prolonged during 21 days. The clinical and biological examinations progressively improved and the newborn was discharged after one month. | [[8.0, 'day']] | M | {'17142491': 1, '12517231': 1, '16210107': 1, '6315906': 1, '14726453': 1, '10878056': 1, '4018103': 1, '15236921': 1, '440848': 1, '11483781': 1, '12682146': 1, '24222807': 2} | {} |
164,040 | 3821194-1 | 24,250,149 | noncomm/PMC003xxxxxx/PMC3821194.xml | Carmakila: An effective management by kshara karma | We describe the case of a 22-year-old woman with a 5-year history of verrucous plaque on the posterior area of the right ear pinna extending into the scalp. Lesions were well-circumscribed, 3 cm × 12 cm, oval, characterized by flat, slightly elevated black-colored papules, and were smooth, slightly hyperkeratotic ranging from few to hundreds in number [].\nIn Ayurveda, we do get references relating to warts as charmakila.[] Author sushruta recommends chedana (excision), agnikarma (cauterization), kshara karma (applying caustic alkali) in the management of charmakila.[] Further, there is direct indication of pratisaraneeya (to be applied) kshara for charmakila.[]\nThere are number of drugs mentioned to be used in the kshara preparation in Ayurveda. Five kilogram of dried apamarga (Achyranthes aspera) plant was burnt down to ash. 500 g ash of apamarga panchanga was added with 6 times its quantity of water, kept overnight, and filtered for 21 times. Filtrate solution was boiled till 2/3rd part evaporated. To the remaining solution, red-hot lime stone, Shankha and Shukti were added in the quantity of 1/10th of apamarga solution. Further, the mixture was heated on a mild fire till it attained a paste-like form. Finally, 5 g of paste of citraka (Plumbago zelanica) was added and allowed to cool. The final product was stored in glass container and used as teekshna pratisaraneeya kshara.\nWhile the lesion was larger in size, it was decided that the teekshna pratisaraneeya kshara would be applied in two settings at two different sites on same lesion with a gap of 3 days. The kshara is allowed to stay at site for 15 min or till the patient develops a slight burning sensation []. Subsequently kshara was washed with lemon juice.[] With the application of kshara, the hyper-keratinized tissue was corroded out, which can be best understood by the pain expressed by the patient. Finally, the lesion was washed with normal saline.\nOn the subsequent day, it was observed that the lesion where teekshna pratisaraneeya kshara was applied was raised with slight collection appearing like wet scab []. The scab was removed to see a red-colored wound at the base. Further, the wound was managed on the principles of shuddha vrana (healing ulcer) with jatyadi taila for daily dressing. The same procedure was followed for remaining lesion.\nContemplating the vata kapha prakriti of the patient, tablet gandhaka rasāyaṇa 500 mg one tablet twice a day and triphalā guggulu 500 mg one tablet thrice a day, were orally administered for 10 days to hasten the healing and the course was uneventfull. Within 15 days, the wound was completely healed with minimum scar tissue []. | [[22.0, 'year']] | F | {'24250149': 2} | {} |
164,041 | 3821211-1 | 24,249,936 | noncomm/PMC003xxxxxx/PMC3821211.xml | Therapist Concerns and Process Issues in Grappling with Functional Autobiographical Amnesia | Ms. A, 20-year-old unmarried undergraduate student hailing from an urban middle socio-economic status background was brought by the parents with the complaints of sudden loss of personal memory from the previous 2 weeks. A detail evaluation revealed the following features of this case.\nThe onset was acute; the parents reported that memory loss was noticed immediately after Ms. A woke up from sleep one morning. The parents did not report any major event in the preceding 1 month period. Following further inquiry, it was reported that a relatively minor event (an argument with a sibling) had happened on the previous evening. During this argument, the sibling had reportedly commented that the mother's health was being affected due to Ms. A's behavior (talking with friends for a long time over the phone, after coming home from college).\nMs. A was able to recognize her immediate family members which included three younger siblings but was unable to recognize her relatives, friends, and school name, class in which she was studying, her study materials and personal belongings. Ms. A reported no memory of events prior to 2 weeks in her life and this included her inability to recollect her early school days. There was some patchy and vague recollection of the past experiences; however, this was for less than a handful of facts. The parents also reported that she was not being able to remember how to do tasks that she had learnt earlier such as painting, doing arithmetic sums etc. On the whole, there was a loss of autobiographical (episodic) memory for the past several years, as well as some loss of semantic, and procedural memory. However, Ms. A did not exhibit significant anterograde amnesia.\nIn addition, Ms. A was observed (and also reported) to be behaving in a childlike fashion in terms of her manner of talking and her demanding behaviors as well as her interests and play behaviors. Although Ms. A repeatedly reported inability to execute tasks or recollect events in her life, she did not express high distress about this. She reported that she was being informed about past events as well as other facts of her life by others. However, she could not remember them herself or experience these as her own memories.\nThe family members were extremely distressed as they felt that Ms. A was suffering from a major neurological problem from which she might never recover. They were coping with the situation by treating Ms. A with a lot of overt attention and affection, prompting/helping in carrying out chores, narrating various life events and experiences and showing photographs etc., to help her regain lost memories.\nAfter a thorough evaluation and ruling out history suggestive of organic causes, a diagnosis of dissociative amnesia was made and the case was taken up for psychological management.\nThe initial phase in therapy revolved around sessions with the family members. These were aimed at exploring potential sources of stress in the client as well as in the family as such. The sessions were also aimed at conveying the nature of the diagnosis, providing emotional support and hope building in addition to helping them to change their behaviors, which seemed to be reinforcing the maintenance of Ms. A's regressive behaviors. These sessions resulted in additional information about Ms. A's temperament and personal history. She was described to be a sensitive child. The parents also reported history of her having gone away from home and staying in a women's hostel for a period of about 20 days (6 months ago). The matter was discussed amongst the family members and Ms. A at that point reported that she had gone away as she was upset with the parents for “not loving her” or “understanding her.” Her parents assured her of their care and concern and persuaded her to come back home. This entire episode was considered by the parents as a past event that did not have any apparent connection to the sudden onset of amnesia that occurred a few months later. The parents were explained about the possible psychogenic nature of the amnesia.\nThe therapist, while validating their distress and empathizing with them about their sense of social embarrassment about the past episode, discussed alternate ways in which they could respond to the current problem. They were advised to try minimizing excessive emotional expression about the amnesia in the client's presence and attempt normalizing of family routines and their own behaviors to the extent possible. They were also advised to use minimal verbal prompts to guide her actions and encourage her to engage in small tasks appropriate for her age as well as reinforce her for doing so (e.g. treating the younger siblings as younger rather than of the same age, helping in house hold chores etc.). The family members had completely shut off Ms. A's interactions with distant relatives, friends and acquaintances and avoided taking her out for any function or social occasion. This was due to the fear of embarrassment about her inability to remember significant others or behave in age appropriate fashion. The parents were advised to try prompting Ms. A in advance in a non-obtrusive manner and take her to social gatherings/for general outings etc., while making such outings contingent on her age appropriate behavior. Supportive work with parents and coaching them in the use of a behavioral approach significantly helped in normalization of interactions and activities as well as a reduction in regressive behaviors. Over time, there was a decrease in the prompts required to complete day-to-day tasks too.\nThe initial sessions with the client were aimed at building a therapeutic alliance. However, this was one of the major challenges as it paradoxically required the therapist to intermittently connect to Ms. A by (initially) behaving with her “as though” she was a child and not a young adult. This stance was a temporary one within sessions, during which the therapist, at appropriate junctures attempted to convey to the client the context of their interaction, the distress of the family members, and that the therapist would attempt to help her regain her lost memories. It was also conveyed that her problems were understood as possibly resulting from difficult/painful experiences in life. On the whole, the therapist attempted to connect to the “child-self” while gradually introducing content that aimed at drawing out the “adult-self” of the client in conversation. Here, the term child-self and adult self are referred to denote the states during which the client behaved in a regressive fashion and those brief periods during which her behavior was more age appropriate respectively. During both the states, the client reported the same problems with her memory. Whenever, she was suggested to make efforts to recall something from the past, Ms. A. reported experiencing headache while making an effort to do so.\nDuring this phase, Ms. A was reinforced by the therapist (as well as the parents) for gradually reducing engagement in regressive/child-like behaviors.\nThe therapist repeatedly conveyed to Ms. A that slowly there would be a recovery of her memory and also that he would support the process of dealing with the difficulties that may be experienced as a consequence of recollecting any painful events/issues in her life. As the client reported a lot of strain and headache while trying to remember past events, it was planned to use abdominal breathing technique to induce a relaxed state followed by a guided imagery procedure for facilitating recovery of memories. A script was prepared that included a few factual details of Ms. A's life in a chronological sequence from early school years onwards (e.g. name of the primary school, outing with the family etc.). Only a few general factual details were included and mention of any difficult/stressful past events was avoided. The guided imagery procedure was conducted in a story like narrative format that encouraged the client to imagine undertaking a journey and (re-) discovering some experiences of her life. It also incorporated suggestions that Ms. A would be able to recollect many more events and experiences in her life outside the sessions, beyond what was being narrated. The entire process was aimed at helping Ms. A to maintain a relaxed state while exposing herself gradually to some of the factual details of her past. This allowed the availability of clues for further recovery of memories while providing a safe therapeutic setting to re-own the memories being narrated. This procedure continued for three sessions. The client was co-operative for the same. Though, she did not report a dramatic recovery of her memories, over time her complaints about not being able to remember decreased, and she was able to recollect several personal facts across sessions.\nHer behaviors became more and more age appropriate during the sessions. She also became more amenable to discuss some of the difficult incidents in her life when prompted by the therapist about the same. She mentioned a few other experiences in bits and pieces that she did not feel ready to discuss with the parents at that point of time. These involved her fears about her future. The prospect of disclosing her fears with the parents was discussed in the session, in order to mobilize their support for her. However, Ms. A was reluctant to discuss the specific matters and hence her concerns were discussed with her parents in general terms without divulging very specific details and they were guided regarding ways of providing her the support she would require. Ms. A repeatedly indicated that she had started understanding how to handle the issues related to her difficult experiences and beyond a point she expressed unwillingness to talk about these in sessions. The client was assured about the availability of a safe setting to disclose and discuss painful material when she chose to do so and at the pace at which she wanted to do so. The focus then shifted to discussion regarding resuming studies, and regaining a sense of confidence by being meaningfully engaged. The client re started going to college, and also joined a few short-term courses. The quality of relationship with the parents improved significantly, who were able to manage their anxieties and reinforce the gains made over time in terms of symptom reduction as well as functional recovery. The client occasionally complained of headache, which she attributed to thinking about the stressful experiences in the past and its possible repercussions on the future. However, she was able to deal with the same through engaging in therapy sessions (on once a month basis), as well as dialog with the parents. The follow-up/booster sessions were gradually spaced out to once in 3-4 months. | [[20.0, 'year']] | F | {'11551273': 1, '19762410': 1, '21206585': 1, '12244076': 1, '24249936': 2} | {} |
164,042 | 3821212-1 | 24,249,937 | noncomm/PMC003xxxxxx/PMC3821212.xml | A Classical Case of Bulimia Nervosa from India | A 22-year-old, unmarried female medical undergraduate, belonging to an urban Hindu extended nuclear family of the upper socio-economic status from a metropolitan city, with predominantly narcissistic and a histrionic traits and family history of recurrent depressive disorder in paternal grandmother, presented with the poor eating habits of insidious onset for 9 years. During her 8th class, she developed liking for a boy in her class who rejected her calling fat. Though, she managed to move on; however, developed dissatisfaction for her body image, and would consider herself fat on the mirror and started looking for means to reduce weight. With gradually increasing concern over growing fat, she started skipping two meals and would take only one meal and salads in class 10th. Over next 6-7 month period, she lost up to 12 kg and looked thin, although she would consider it inadequate and would find herself flabby, in front of the mirror, although at other times, she could appreciate that her clothes had become loose. However, she never had symptoms of micronutrient deficiency or menstrual irregularity. At the same time, she also developed intense liking for the high calorie foods. She would binge on them 5-6 times a month and would regret afterwards. She tried to induce vomiting also once or twice. She started exercising for 1-1½ h in order to compensate weight gain out of binging. This pattern continued for next 1-1 when she gave up working out unwillingly, to focus more on studies, and she gained about 4-5 kg. She would be distressed with it. She passed class 12th with expected marks and qualified for MBBS course. She restarted dieting; however, within few months she again started having increased craving for the high calorie foods and binging, which would be more when she would deny food in parties. Though she knew that her Body Mass Index (BMI) was well within normal range, she started taking one tablet of Orlistat daily secretly along with skipping meals and rejoining gymnasium in order to reduce her weight to below 50 kg, which was below normal for her height. She would often consume isaphgul husk for purging after binging. She sold her gold necklace without informing the family members to undergo liposuction. She could undergo a single session after which it came to the knowledge of a family member, who refrained her. During last 5 year, she would compare herself with every female she met or read about in novels, would feel better on seeing obese females, and feel let down if they were slim. She could not spend an hour without fear of becoming obese. In recent times, she would avoid parties, going out with friends, standing for photos, and would spend hours in the gymnasium.\nAt the time of consultation in the Psychiatry out-patient department, her BMI was 23, which is within normal range. Her laboratory investigations including, complete hemogram, liver, and renal function tests, serum electrolytes, plasma blood glucose levels were normal. She was put on Fluoxetine 40 mg, and Cognitive Behavior Therapy was started. She is under regular OPD follow-up with sustained improvement since last 18 weeks. | [[22.0, 'year']] | F | {'11740169': 1, '21743711': 1, '21206888': 1, '31391662': 1, '2047498': 1, '16721169': 1, '15448397': 1, '14566926': 1, '16815322': 1, '34268054': 2, '12956542': 1, '24249937': 2} | {'8266603-1': 1} |
164,043 | 3821213-1 | 24,249,938 | noncomm/PMC003xxxxxx/PMC3821213.xml | Bupropion-Warfarin Combination: A Serious Complication | A 55-year-old male was on treatment for dysthymic disorder (DSM IV TR) since 12 years. He was a heavy smoker. The treatment was mainly with psychotherapy, with periods of antidepressants off and on. He was mostly on bupropion, in doses ranging from 150 mg/ day to 300 mg/day. He responded well to treatment, had few depressive symptoms intermittently, and his smoking had decreased to about 6-8 cigarettes a day. A year back, he developed DVT, at which time, the dose of bupropion was 300 mg/day. He was put on warfarin and the desired level of INR, that is, 2-3, was achieved. At this time, the surgeon did not know that the patient was taking bupropion 300 mg/day. After a couple of weeks, when the patient informed him of this, bupropion was abruptly stopped. The subsequent blood test showed an alarming INR level of 8.0. The patient was under observation, and the surgeon put him back on bupropion, 300 mg/day. The INR returned to the desired level, with no complication. The warfarin was stopped after DVT resolved. The patient remained free of depression and so, bupropion was gradually tapered off. | [[55.0, 'year']] | M | {'10560276': 1, '15876900': 1, '10073515': 1, '7944078': 1, '3977518': 1, '7433768': 1, '8369688': 1, '8792056': 1, '12452751': 1, '18691982': 1, '9822060': 1, '9669190': 1, '1928485': 1, '11532381': 1, '50160': 1, '8037888': 1, '19724766': 1, '26985117': 1, '9017779': 1, '9278211': 1, '11089724': 1, '23045839': 1, '18406992': 1, '24817486': 1, '24249938': 2} | {} |
164,044 | 3821214-1 | 24,249,939 | noncomm/PMC003xxxxxx/PMC3821214.xml | Cotard Syndrome with Catatonia: Unique Combination | A 45-year-old married female belonging to low socio-economic condition of rural background with a family history of psychosis in younger brother is the patient. Twenty years back she had a history of severe depressive episode without psychotic features with post-partum onset. It remitted completely after 6 months and thereafter, she had optimum functioning with no psychiatric symptoms. The current episode had onset about 2 years back precipitated by significant family conflict regarding the daughter's marriage. She gradually developed persistent and pervasive sadness, severe anhedonia, crying spells, worthlessness, hopelessness, and suicidal ideation. After 3-4 months of the onset of illness, for treatment she was taken to a nearby city (Jaipur). There they could not afford the treatment due to financial losses. Thereafter, family members noted that her speech output decreased further and she would only speak in a very soft and monotonous voice that her dead-body is in Jaipur. When others would confront her she would be insistent and even request them to get her buried. She would also deny food and water and would say that there is nothing inside her abdomen and body. She would have severe psychomotor retardation, would change her posture very infrequently and often stare at a particular direction for several minutes without blinking.\nWhen she presented to us about 2 years after the onset of illness she was stuporous. There was no history suggestive of any organic illness. On admission, though, she was severely malnourished (weight 28 kg, body mass index - 11.7), her vitals were stable, and systemic examination were within normal limits. There was a score of 11 (mutism - 3, posturing - 2, immobility - 1, staring - 2, withdrawal - 3) on Bush Francis Catatonia rating scale (BFCRS). A lorazepam challenge test carried out with 2 mg of intravenous lorazepam showed dramatic improvement and BCFRS score decreased to 2.\nThereafter, she was started on lorazepam upto 8 mg parenterally in divided doses and her nutrition and hydration were maintained. Her routine investigations like hemogram, blood biochemistry including liver, kidney function tests, and electrolytes were within normal limits. Further investigations such as Electroencephalogram (EEG), magnetic resonance image of brain, HIV status, VDRL, thyroid level were done. Serum folate and vitamin B12 was advised, but could not be carried out because of lack of resources. Lack of memory deficits and a normal higher cognitive function ruled out dementia. She was diagnosed as a case of recurrent depressive disorder with currently severe depressive episode with the psychotic features as per International Classification of Diseases-10 (ICD-10). She was started on tablet sertraline up to 200 mg and olanzapine up to 10 mg and lorazepam was tapered gradually. There were no catatonic symptoms from 2nd week. Hamilton Rating Scale for Depression (HAM-D) decreased to 22 on the 2nd week and 16 after 4 weeks. There was also significant an improvement in her body weight (up to 40 kg) and overall functioning. | [[45.0, 'year']] | F | {'19470281': 1, '20562636': 1, '12011289': 1, '21037126': 1, '28053798': 2, '10954402': 1, '22677219': 1, '10678525': 1, '7625193': 1, '9065683': 1, '25540544': 2, '10883714': 1, '24249939': 2} | {'4271387-1': 1, '4271387-2': 1, '5178336-1': 1} |
164,045 | 3821215-1 | 24,249,940 | noncomm/PMC003xxxxxx/PMC3821215.xml | Meige's Syndrome: Rare Neurological Disorder Presenting as Conversion Disorder | A 35-year-old female presented to the Department of Psychiatry with complaints of sideways deviation of the jaw since one and half year. At the beginning, the deviation was 4-6 times a day and was not causing much difficulty for the patient. Gradually frequency increased and she developed chin thrusting movement. She also developed increased rate of blinking and these movements were very embarrassing to her. With a progressive course the severity of symptoms increased causing difficulty in sleep and problem in daily routine activities. She could voluntarily inhibit the symptoms to some extent.\nThe symptoms were precipitated with the emotional stressors, suggesting some secondary gain. No relevant past or family history of any medical or psychiatric illness was found. She was educated up to class fourth. Premorbid personality was well adjusted. Mental status examination shows she had anxious mood. There was no formal thought and perceptual disorder. She was well oriented, alert, had normal fluency, repetition and naming. Her attention, calculation and abstraction were absolutely normal. General physical exam was unremarkable. Neurological exam showed intact cranial nerve, coordination, motor and sensory fun normal. Ophthalmological exam showed no visual defect, absence of Kayser Fleischler ring. Hematological examination–Haemoglobin, Differential Count, Total Leukocyte Count etc., were normal. Blood sugar, Liver Function Test, Thyroid function test, Computed Tomography Scan and Magnetic Resonance Imaging was within normal limit. Psychological assessment that is chemical and verbal abreaction could not reveal anything. The patient was sent to the neurologist for opinion and diagnosed as a case of Meige's syndrome. She was prescribed Trihexyphenidyl and Clonazepam. There was a little improvement on next follow-up. | [[35.0, 'year']] | F | {'10560894': 1, '9078810': 1, '10588425': 1, '10618045': 1, '24249940': 2} | {} |
164,046 | 3821231-1 | 24,249,956 | noncomm/PMC003xxxxxx/PMC3821231.xml | Familial dysbetalipoproteinaemia presenting with cauliflower xanthoma | A 43-year-old man was presented to outpatient endocrine clinic of Tabriz University of Medical Sciences, Tabriz, Iran, by his sister for evaluation of skin lesions. He had multiple lesions on shoulders and back, lateral and medial part of dorsal surface of the foot, medial and lateral malleus of both feet, and dorsal and palmar surface of both hands. Siblings of the patient have been followed up in that clinic for clinically diagnosed type-III dysbetalipoproteinaemia. This diagnosis was based on characteristic palmar, eruptive, tuberous and trauma site xanthomas with typical high levels of both total cholesterol and triglycerides in the plasma. Both parents had normal serum lipid levels. History of coronary artery or other atherosclerotic disorders were negative in index case and siblings. There were not any other complaint, and as a greengrocer, he had an active lifestyle. He had a pathology report of skin lesion biopsy that was performed by a dermatologist few months ago, with presence of lipid laden macrophages consistent with diagnosis of xanthoma. Fasting serum lipid levels reported as: Total cholesterol = 507 mg/dl, Triglycerides = 470 mg/dl and High Density Lipoprotein (HDL) cholesterol = 41 mg/dl. He had normal fasting blood sugar, and normal thyroid, renal and liver function tests. Complete blood counts and urine analysis was also normal. Physical examinations revealed numerous xanthomas resembling cauliflower on both knees [], unusual eruptive, tuberous xanthomas same as previous lesions, on the lateral malleus of both feet [].\nThere were lots of smaller xanthomas on the right shoulder [], and cauliflower like xanthomas on the extensor side of the left upper extremity, especially on the elbow []. Based on available information, the patient diagnosed as familial dysbetalipoproteinaemia (FDL) and the unique lesions on the lower limb called “Cauliflower xanthoma”. Although siblings of this case had the same disorder, they didn’t develop such lesions.\nBy searching in the medical data bases, we cannot find a previous such a lesion. Therefore, we decided to present this case without revealing patient's name, after taking his consent.\nConsidering the fact that the treatment with high dose Statin was effective in correction of lipid abnormality and regression of skin lesions in his three siblings, we wanted to try the treatment procedure in this patient but he refused any intervention. | [[43.0, 'year']] | M | {'12518040': 1, '16638433': 1, '10640929': 1, '12506591': 1, '12889666': 1, '19921193': 1, '21757618': 1, '10552997': 1, '18798589': 1, '7772082': 1, '24249956': 2} | {} |
164,047 | 3821232-1 | 24,249,957 | noncomm/PMC003xxxxxx/PMC3821232.xml | Cervical intramural pregnancy: Report of a rare case | A 22-year-old lady, P1+1, presented at the emergency room, with bleeding P/V. She gave history of having amenorrhea for 12 weeks. A positive pregnancy test report was with her, carried out 1 month back. Routine blood test showed a Hb% of 9 gm%. Ultrasonography (USG) showed [] moderately bulky uterus (98 mm × 76 mm × 65 mm), with empty endometrial canal. Midline endometrial echo was not shifted. Endometrial thickness was normal 7 mm. Internal os was closed. A heterogeneous space occupying lesion (SOL) was found (61 mm × 60 mm) in the cervical region. Sonographic impression was that of a cervical ectopic pregnancy. No adnexal mass was detected and the ovaries were normal. No fluid was present in pouch of Douglas (POD). No pleural fluid/ascites was present. Beta human chorionic gonadotrophin (hCG) level was 28700 mIU/ml at this point of time. Bleeding per vaginal (P/V) was continuous and heavy. General condition of the patient started deteriorating. Our patient presented with active heavy bleeding and from the beginning, owing to the deteriorating condition of the patient termination of the pregnancy was strongly favoured by both physicians and the patient. Emergency laparotomy was carried out and hysterectomy was performed after obtaining the consent.\nThe specimen composed of the uterus with cervix [Figures and ]. No adnexa were present. The uterus measured 9 cm and cervix measured 11.5 cm. Endometrial cavity was empty. Internal os was not open. Cervix showed the presence of adherent haemorrhagic mass, infiltrating into the wall, situated below the anterior peritoneal reflection. On histological examination, no product of conception was seen in sections from the body of the uterus and endometrium showed features of secretory phase. Sections from the haemorrhagic mass in cervical wall showed chorionic villi amidst a lot of haemorrhage [Figures and ], establishing the diagnosis of cervical pregnancy. | [[22.0, 'year']] | F | {'28955106': 1, '19231293': 1, '8994238': 1, '19838985': 1, '8134052': 1, '25810679': 2, '3314739': 1, '8855677': 1, '662235': 1, '24249957': 2} | {'4367055-1': 1, '4367055-2': 1} |
164,048 | 3821233-1 | 24,249,958 | noncomm/PMC003xxxxxx/PMC3821233.xml | An interdisciplinary approach to treat crown-root-fractured tooth | A 26-year-old healthy female had traumatic fractured of left maxillary central incisor for 1 day. Clinical examination showed a cervical fracture with pulp exposure. For the tooth fracture, only the labial part was 1 mm above the gingival margin; all the other parts, including mesial, distal and lingual parts, were 3-5 mm subgingival. Patient presented class I occlusion relations and good oral hygiene []. Gingiva was slightly swollen and no gingival laceration was present. Further periapical radiography showed that the root canal was vacant, the fracture line was oblique, the periodontal membrane was normal and the remaining root length was about 14 mm, with no additional root fracture image on the remaining part of the root []. After full discussion with the patient about the advantages and disadvantages of the alternative treatment approaches, including immediate implant and tooth-extraction followed by fixed or removable partial denture replacement, the patient chose to preserve the remaining root and perform a multidisciplinary treatment. Then the treatment plan was divided into four phases as follow:\nRoot canal therapy was performed for left maxillary central incisor and the periapical radiography after RCT was satisfied [].\nFull mouth periodontal prophylaxis cleaning and initial periodontal therapy were done before orthodontic extrusion.\nA 0.8 mm Stainless Steel (SS) wire was cemented into the root canal space for the retention of orthodontic arch wire. The standard edge wise brackets were bonded on maxillary teeth and 0.018 × 0.025 inch Nickel-Titanium (NiTi) full arch wire (TP Orthodontics. Inc.) was engaged into maxillary brackets. A 0.2-0.3 N levelling and alignment extrusion force was applied, readjusted every 2 weeks. After 9 weeks engagement, 2 mm tooth structure was occlusally elevated with the simultaneous elevation of the surrounding periodontal bone tissue [].\nAfter 4-month retention to prevent relapse, the crown lengthening surgery including gingival flap operation, alveoloplasty and gingivoplasty were performed to create an optimal relation between the gingival and margin of restoration. During the operation, the necessary clinical crown and suitable gingiva anatomy were reserved [Figures and ].\nTwo month after the periodontal crown lengthening surgery for the proper wound healing process, prosthodontic restoration was performed. After fibre post and resin core (Tenax Fiber White, Coltene Whaledent Inc.) had been built up [], an accurately fitting provisional crown was fabricated and cemented. Tooth preparation and silicon rubber impression were made, and all-ceramic crown was fabricated by LAVA (3M ESPE).\nColour-selection was performed using a new Crystaleye Spectrophotometer (Olympus, Japan). After transferring the colour-selection picture to computer, dentist discussed the shape and shade of final restoration with the patient and finally decided to reproduce the colour by simulating the right maxillary central incisor.\nFinal restoration was cemented with RelyX Unicem resin cement (3M ESPE). Patient was satisfied with the result of prosthodontic restoration []. One year follow-up evaluation indicated the restoration and gingival profile were healthy and stable without relapse. | [[26.0, 'year']] | F | {'6935587': 1, '9564429': 1, '17663354': 1, '4516470': 1, '3867652': 1, '27515522': 1, '15588553': 1, '6381360': 1, '6936521': 1, '10946334': 1, '3514725': 1, '24249958': 2} | {} |
164,049 | 3821234-1 | 24,249,959 | noncomm/PMC003xxxxxx/PMC3821234.xml | Intraoral malignant melanoma | A 52-year-old female reported to the Out Patient Department, Drs. Sudha and Nageswarao Siddhartha Institute of Dental Sciences, Gannavaram, India, with a complaint of black discolouration in the upper gums in relation to the front teeth since 6 months. The patient gave a history of extraction of lower posterior teeth 5 yrs previously and past medical history was non-contributory.\nOn intraoral examination, a diffuse, sessile and asymptomatic swelling, with a smooth surface and of black colour was observed on the maxillary gingiva of anterior teeth involving both the labial as well as palatal side. On the right side of the maxilla the lesion was elevated and a well-defined blackish-brown colour discolouration present on right buccal and lingual mucosa [Figures and ].\nOn palpation the left submandibular lymph node was palpable and approximately 2 × 2 cm, non-tender, firm, which was fixed to the underlying tissues. Based on clinical appearance pigmented lesions like melanoacanthoma, nevus and melanoma were considered under differential diagnosis made. Blood investigations and radiographic features did not reveal any significant findings. Incisional biopsy of the lesion was performed and sent for histopathological examination.\nHaematoxylin and eosin-stained sections showed invasion of the connective tissue stroma by sheets and islands of pleomorphic epithelioid, spindle cell atypical melanocytes containing brownish to black pigment in the cytoplasm. The lesion was diagnosed as melanoma [Figures and ]. Further this was confirmed immunohistochemically by using HMB-45, which showed strong positivity of the tumour cells []. | [[52.0, 'year']] | F | {'26664783': 2, '8680974': 1, '14586846': 1, '24643680': 1, '32189911': 2, '16569245': 2, '18284541': 1, '15732878': 1, '27504432': 1, '2290643': 1, '20657106': 1, '18538076': 1, '22367683': 1, '10745167': 1, '18047516': 1, '33207424': 1, '21712630': 1, '19159022': 1, '8064463': 1, '22265336': 1, '4853771': 1, '24249959': 2} | {'1475844-1': 1, '7069155-1': 1, '4664796-1': 1} |
164,050 | 3821249-1 | 24,250,129 | noncomm/PMC003xxxxxx/PMC3821249.xml | Ayurvedic management of adverse drug reactions with Shvitrahara Varti | A 58-year-old, male patient visited the out-patient department (OPD) of Rasa Shastra and Bhaishajya Kalpana during the month of November, 2012 presenting with symptoms of non-segmental vitiligo spreading over elbow and knee joint. History revealed that patient is non-hypertensive, non-diabetic and did not have any symptoms of endocrinal or immunological disorders. He worked in brass industry for the last 5 years and retired recently. On analysis, his Prakriti is found to have Pitta dominance. The lesions were non-itchy without any discharge.\nPatient was prescribed Shvitrahara Varti [] as a local applicant along with internal drugs []. It is advised to convert Varti into a paste by levigating in the presence of Gomutra and apply as a thin layer over the affected area (elbow and knee) followed by exposure to sun rays in the morning.\nAfter three consecutive topical applications, patient started feeling a burning sensation over the parts affected. Burning sensation became intense followed by pain, blister formation and mild inflammation. He stopped application of Shvitrahara Varti from day 3. On consecutive days, the blisters became extensive, dark red in color with purple margins and the blisters bursted of their own with watery discharge. Patient attended the OPD for treatment on 7th day []. | [[58.0, 'year']] | M | {'33299922': 1, '12707482': 1, '21956273': 1, '7977362': 1, '24250129': 2} | {} |
164,051 | 3821284-1 | 24,250,738 | noncomm/PMC003xxxxxx/PMC3821284.xml | Unusual case of a vanishing bronchus of the left allograft in a lung transplant recipient | A 17-year-old female lung transplant recipient for cystic fibrosis underwent bronchoscopy to assess response to both intravenous (IV) pulse methylprednisolone for acute A2B0 allograft rejection diagnosed 2 weeks earlier and ongoing IV ganciclovir and foscarnet for cytomegalovirus (CMV) infection. Upon inspection of the left main bronchus, there were substantial changes as compared to the bronchoscopy 2 weeks before, showing narrowing of the airway lumen and mucosal edema with friability to the point of not being able to advance the bronchoscope into either the left upper or lower lobe segments. Subsequently, the right allograft was evaluated with bronchoalveolar lavage and transbronchial biopsies of both right middle and lower lobes being performed without difficulty. The patient tolerated the procedure well including biopsies until 5 min after withdrawing the bronchoscope when she dropped her oxyhemoglobin saturation (SaO2) to 86% despite mechanical ventilation. Chest radiograph revealed left lung collapse [], so the bronchoscope was immediately re-inserted with the discovery of complete occlusion or vanishing of the left main bronchus []. The bronchoscope was not able to be advanced through this tissue occluding the airway, so alligator forceps were used to try to perforate it. After numerous attempts, eventually a small opening [] was obtained. However, her respiratory status declined due to severe hypoxic respiratory failure with no improvement with inhaled nitric oxide and trial of high-frequency oscillatory ventilation. She was therefore placed on VV ECMO with immediate normalization of SaO2. While on VV ECMO, balloon dilatation of the left main bronchus was successfully performed through the small opening attained earlier. A CRE™ balloon was used to dilate the area from 4 mm initially to 6 mm, and then to 8 mm diameter. The balloon was passed through a 6.4 mm dia Olympus bronchoscope. She was removed from ECMO the following day and extubated 3 days later. The remaining part of her hospital course was unremarkable with her being discharged 2 weeks later. | [[17.0, 'year']] | F | {'28331451': 1, '16774820': 1, '10800787': 1, '17692669': 1, '16399312': 1, '24250738': 2} | {} |
164,052 | 3821285-1 | 24,250,739 | noncomm/PMC003xxxxxx/PMC3821285.xml | Bronchial atresia in a neonate with congenital cytomegalovirus infection | A 9-day-old boy presented with a history of increased work of breathing and cyanosis. He was born at 40 weeks gestation via vacuum extraction for fetal distress. His birth weight was 3.0 kg with normal Apgars and did not require any resuscitation. Meconium-stained liquor was noted at delivery. He was discharged home at 48 h of age. Antenatal ultrasound at 22 weeks of gestation demonstrated hyper-echoic changes in the thorax and abdomen which did not progress throughout pregnancy. At presentation to the hospital, he was in moderate respiratory distress and was commenced initially on continuous positive airway pressure, but he required mechanical ventilation for respiratory deterioration in the 2nd week of life. He had a normal white cell count and C-reactive protein. Blood cultures were negative. CMV was detected by polymerase chain reaction (PCR) in urine and blood, and in endotracheal aspirate samples. In addition, stored blood samples (from newborn screen) taken on day 2 of life were also positive for CMV by PCR. CMV immunoglobulin M antibody was also positive. A head ultrasound demonstrated diffuse peri-ventricular calcification. A chest computed tomography (CT) scan was performed [Figure –]. Flexible bronchoscopy and echocardiography were normal.\nDue to an ongoing requirement for mechanical ventilation associated with left mediastinal shift and lung compression from an overinflated right middle lobe (RML), the child had a RML lobectomy [].\nPathology revealed a bronchocele with an 11-mm mucus plug [] in a sub-segmental bronchus of the RML. Although bronchi were seen to arise from the cyst and communicate with the distal lung causing marked over-inflation, no direct continuity was identified between the bronchocele and proximal bronchi. Cytomegalovirus inclusions with minimal surrounding inflammation were noted on microscopy of the peripheral lung.\nAfter excision of the RML, the patient was extubated and gradually weaned off oxygen. However, following anesthesia for a central line placement at 1 month of age for a 6-week course of ganciclovir for cCMV infection, he developed further respiratory distress. A repeat CT scan demonstrated persistent hyperinflation of the residual right lung, especially the right lower lobe. Instead of further lobectomy with permanent loss of lung mass, right lung volume reduction surgery was performed. There was subsequent marked clinical improvement and he was discharged home aged 3½ months and continues to thrive with no respiratory distress. | [[9.0, 'day']] | M | {'12567392': 1, '13060202': 1, '1491929': 1, '15608465': 1, '18542942': 1, '3807776': 1, '5925105': 1, '3541551': 1, '8929306': 1, '33407289': 2, '14043682': 1, '16566056': 1, '24250739': 2} | {'7788814-1': 1} |
164,053 | 3821418-1 | 24,250,165 | noncomm/PMC003xxxxxx/PMC3821418.xml | Anterior communicating artery aneurysm presenting with vision loss | A 65 years old, gentleman presented with headache of 3 months duration, and loss of vision in right eye of 15 days duration. He was suffering from non specific headache for which he did not seek medical attention. About 15 days back his vision decreased in right eye, which progressed to complete blindness within a week. He never had sudden onset of headache with vision loss. At admission he was conscious and alert. His best corrected visual acuity was no perception of light in right eye and 6/6 in left eye. He had relative afferent pupillary defect in right eye, and brisk pupillary reaction to light in left eye. The fundoscopy revealed pale disc in right eye and normal disc in left eye. The visual fields assessment was done with computerized static visual field analysis using zeiss humphrey. The SITA FAST test was performed using goldmann parameters. Right eye could not be assessed because of poor vision. The left eye showed temporal hemianopsia. He did not have any other neurological deficits. The blood investigations revealed normal hematological and biochemical profile. The visual evoked potential revealed absence of all waves in right eye, and increased latency (N75-77.1 ms, P100-113.1 ms, and n145-157.8 ms) in left eye. Unenhanced CT scan of head showed a hyperdense suprasellar lesion. The MRI of brain showed a well defined rounded suprasellar lesion measuring 26 × 25 × 23 mm, which was composed of concentric rings of differing intensities, suggestive of partially thrombosed giant aneurysm. Post contrast MRI showed an aneurysm arising from anterior communicating artery (AComA), which was directed posteriorly []. Digital subtraction angiography (DSA) confirmed the findings on MRI []. The patient was offered surgery for securing aneurysm. As there was uncertainty about visual recovery he did not opt for any treatment and was discharged against medical advice. | [[65.0, 'year']] | M | {'19409004': 1, '31583174': 2, '10659014': 1, '9065547': 1, '24250166': 1, '21344962': 1, '9336493': 1, '21682570': 1, '27583172': 2, '26809261': 1, '29988914': 1, '24250165': 2} | {'6763677-1': 1, '4982348-1': 1} |
164,054 | 3821420-1 | 24,250,167 | noncomm/PMC003xxxxxx/PMC3821420.xml | Thoracic extraosseous, epidural, cavernous hemangioma: Case report and review of literature | A 40-year-old male presented with a band-like feeling of constriction at the nipple level for eight months, followed by numbness to all modalities of sensation below this level. During the last month, progressive ascending spastic paraparesis had rendered him wheelchair-bound. There was no history of trauma, fever, deformity, tenderness over the spine, weight loss, or bowel or bladder dysfunction. He had no neurocutaneous markers. He had grade 3/5 medical Research Council (MRC) spastic paraparesis, exaggerated bilateral knee and ankle reflexes, and sustained ankle clonus on the left side. There was a graded sensory impairment to all modalities below the fourth thoracic dermatome. His hematological and biochemical investigations were within normal limits. The chest skiagram was normal.\nMagnetic resonance imaging (MRI) of the thoracic spine revealed an extradural lesion, opposite the T2-T4 vertebral bodies, which was homogenously isointense on T1- and hyperintense on T2-weighted images. The lesion was located dorsally and had compressed the thoracic cords ventrally. The axial sections revealed that the mass was located eccentrically; more on the patient's left side, with a small projection into the intervertebral foramen. The spinal cord at that level could be seen displaced ventrally and to the right. A central hyperintensity on T2-weighted imaging, within the cord substance, was also observed. Of note was the presence of a remote intraosseous T8 vertebral hemangioma. The lesion enhanced avidly and homogenously with contrast []. Computerized tomography (CT) of the upper dorsal spine did not reveal any bony destruction or widening of the intervertebral foramen. A radiological differential of an extradural schwannoma or meningioma was considered.\nThe patient underwent a T2-T4 laminectomy. Intraoperatively, the mass was encountered within the epidural fat and immediately beneath the laminae. It was reddish in color, firm, friable, and highly vascular. It was located epidurally, mostly dorsal to the thecal sac, but also extended laterally to the left, along the left T2 nerve root sheath. Its blood supply was derived from the intervertebral foramina on both sides. Initially, the tumor's dorsal surface was devascularized, with bipolar cautery, under the operating microscope. Its arterial feeders were then sequentially cauterized and interrupted, just medial to the intervertebral foramina, taking care not to injure the dorsal nerve roots. The lesion was then peeled off the surface of the dura and the adjacent nerve sheaths. The lesion was excised en bloc. The underlying dura was then opened, taking care to preserve the arachnoid, to ensure total microsurgical excision.\nThe patient was discharged 48 hours after surgery. His postoperative course was significant for a subjective improvement in spasticity and numbness. The histopathological examination indicated a CH []. On the last follow-up, 12 months after surgery, a check craniospinal MRI confirmed complete excision, with no recurrence at the operative site and no other new lesions. His power and sensations were nearly normal and he had returned to work. | [[40.0, 'year']] | M | {'14620197': 1, '18348033': 1, '14689287': 1, '19588130': 1, '34621572': 2, '20213297': 1, '19305089': 1, '21572634': 2, '2053068': 1, '11242225': 1, '16859248': 1, '690691': 1, '15926084': 1, '26409007': 1, '16998281': 1, '11810396': 1, '17698523': 1, '25960818': 1, '26279817': 2, '33816222': 1, '25674348': 2, '14520522': 1, '7838334': 1, '19487867': 1, '21877050': 1, '3764652': 1, '20887151': 1, '29552231': 1, '9028843': 1, '7163968': 1, '15543055': 1, '24250167': 2} | {'3075829-1': 1, '8492414-1': 1, '4323510-1': 1, '4534743-1': 1} |
164,055 | 3821421-1 | 24,250,168 | noncomm/PMC003xxxxxx/PMC3821421.xml | Uncontrolled seizures resulting from cerebral venous sinus thrombosis complicating neurobrucellosis | The case was a 33-year-old woman who was referred to the Neurology Clinic of Vali-e-Asr Hospital, Arak, Iran, with headache, asthenia, decreased appetite, fever, sweating, and increased number of seizures up to 3-4 times a day. Night sweats and fever; suspicious myalgia description, and residence in rural area and being in contact with farm animals; counseling for infectious diseases; and medical assessments for brucellosis and hepatitis C and B were in the patient's history. The patient's history indicated that she was diagnosed with a complex partial seizure persisting for 10 years. A month before referral to the hospital, her seizure had gone out of control and, despite the patient's frequent visits and increased drug dose, the treatment had not been successful. Prior to admission, the patient was prescribed 50 mg lamotrigine and 400 mg carbamazepine three times a day and 1 mg folic acid once a day.\nThe patient's body temperature was 37.8 °C, which did not pose any significant problems. A nervous system examination also indicated that the patient was in a complete state of awareness and did not demonstrate neck stiffness.\nRoutine lab tests reported increased liver enzymes and normal CBC. The results of Wright's agglutination test (1/640), Coombs-Wright test (1/640), and 2ME (1/320) were positive and confirmed brucellosis, while hepatitis C and B were not verified. Concurrently, an evaluation was carried out to discover the cause of abrupt increase in the frequency of seizures in spite of treatment with antiepileptic drugs. A brain CT scan revealed hyper-dense areas in the left posterior parietal and temporal lobe together with peripheral hypo-density, hemorrhagic focus, and edema around it []. An MRI indicated a suspicious lesion similar to those in hemorrhagic infarction or hematoma in the left temporal lobe and an abnormal signal in the left transverse sinus []. Hence, on suspicion of venous sinus thrombosis, an MRV was prescribed for the patient [].\nWith the verification of brucellosis, treatment was performed by administration of Rifampin (600 mg/d), Doxycycline (100 mg two times a day), and Streptomycin 1 g/day. Streptomycin was stopped after 10 days while Rifampin and Doxycycline continued for eight weeks. In addition, Warfarin and Heparin were administered, eventually leading to the control of seizures. Three days after admission and the initiation of treating brucellosis and CVST, seizure was finally under control and the fever and other symptoms disappeared. Therefore, the patient was discharged with anti-brucellosis drugs Carbamazepine 200 mg three times per day, and Warfarin, in good general health conditions without fever and signs of infection.\nIn the third month after treatment, Wright's agglutination and 2ME tests showed 1/40 and 1/20 respectively. These values of Wright's agglutination and 2ME tests are negative in Iran based on guidelines for tuberculosis control program. The prescribed Warfarin continued for one year and during the first year an MRI and MRV showed a decline in venous sinus thrombosis symptoms and brain bleeding. | [[33.0, 'year']] | F | {'29670827': 2, '11118257': 1, '21983375': 1, '20973948': 2, '2269999': 1, '11496852': 1, '10622773': 1, '15858188': 1, '11096759': 1, '16796579': 1, '10064259': 1, '33743640': 2, '24778791': 2, '24250169': 1, '16283479': 1, '24250168': 2} | {'3992242-1': 1, '7980546-1': 1, '5893346-1': 1, '5893346-2': 1, '5893346-3': 1, '5893346-4': 1, '5893346-5': 1, '5893346-6': 1, '5893346-7': 1, '5893346-8': 1, '5893346-9': 1, '2984467-1': 1} |
164,056 | 3821423-1 | 24,250,170 | noncomm/PMC003xxxxxx/PMC3821423.xml | Was it a case of acute disseminated encephalomyelitis? A rare association following dengue fever | A 32-year-old female from rural background presented in medical outpatient department with complaints of high grade fever with chills, myalgias and arthralgia along with abdominal pain and occasional vomiting for 5-6 days. She was febrile and had tachycardia. Rest of the examination was normal. Her investigations showed thrombocytopenia (platelet count 60,000/cmm) and positive serology for acute dengue infection. The serum IgM antibody to dengue virus was positive. The serum IgM antibody were analyzed by ELISA method using IgM ELISA Kit by Panbio Invernis Medical Innovations, Australia. We could not assess type of dengue infection due to technical constraints. She was treated conservatively and shown improvement. About two weeks later she returned in emergency ward in state of altered consciousness with history of two episodes of generalized tonic clonic convulsions. She had normal vitals and general examination except mild pallor. Neurological examination revealed that she was drowsy but arousable and disoriented. There was no apparent cranial nerve palsy, motor deficit or signs of meningeal irritation. Ophthalmological evaluation did not show any abnormality. Her hematological and biochemical parameters were also within normal limits.\nCerebrospinal fluid examination (CSF) revealed total leukocyte count 320/cmm with 85% lymphocytosis, CSF proteins 200 mg/dl. CSF glucose, chloride and adenosine deaminase were within normal limits. Gram stain and microscopy for Mycobacterium tuberculosis was negative. Magnetic resonance imaging (MRI) brain revealed patchy areas of hyper intense signals on FlAIR (fluid attenuated inversion recovery sequence) images [Figure –]. ELISA for HIV was negative. Serology for viral hepatic markers, Japanese encephalitis, Epstein Barre virus and HSV-1 was also negative. She was treated with intravenous methyl prednisolone 1 gm once daily for five days then oral prednisolone 40 mg/day tapered over 3-4 weeks. Rapid clinical improvement was noticed. The repeat MRI after two weeks also showed almost complete resolution of patchy demyelinating lesions []. | [[32.0, 'year']] | F | {'32983732': 2, '1509881': 1, '20739796': 1, '10555827': 1, '11791985': 1, '20393243': 1, '16217059': 1, '30507366': 1, '28665957': 2, '32669894': 1, '20739802': 1, '24250171': 1, '11376180': 1, '32656109': 1, '20739799': 1, '6150430': 1, '12111572': 1, '24250170': 2} | {'5509372-1': 1, '7515800-1': 1} |
164,057 | 3821425-1 | 24,250,172 | noncomm/PMC003xxxxxx/PMC3821425.xml | Hypothalamic glioma masquerading as craniopharyngioma | A 25-year-old female patient presented with a history of headache, vomiting, and blurring of vision of 2-month duration. On examination the patient was conscious and cooperative. Visual acuity was 6/18 bilaterally. Fundus was normal. Reduction of the left temporal visual field was seen. Pupils were bilaterally symmetrical and reactive to light. CT and contrast-enhanced MRI of the brain [Figures –] was performed which revealed a solid cystic mass lesion involving the hypothalamus and the thalamus displacing and compressing the third ventricle. Inferiorly the lesion was extending into the interpeduncular cistern. The pituitary stalk and optic chiasm were not visualized separately from the lesion. The pituitary gland was normal in location and signal intensity. The solid component of the lesion showed enhancement on contrast administration. A provisional diagnosis of a suprasellar craniopharyngioma was given. The patient was subsequently operated upon and a right frontoparietal craniotomy with subtotal excision was performed. On histopathology the lesion was diagnosed as a hypothalamic glioma []. Post-surgery the patient developed central diabetes insipidus and is currently E4V4M4 status with left hemiplegia. | [[25.0, 'year']] | F | {'9761047': 1, '17620469': 1, '21150045': 1, '9010523': 1, '10867564': 1, '7841074': 1, '1668642': 1, '11733333': 1, '12876396': 1, '24250174': 1, '1727168': 1, '30097693': 1, '24250173': 1, '24250172': 2} | {} |
164,058 | 3821428-1 | 24,250,175 | noncomm/PMC003xxxxxx/PMC3821428.xml | Uncommon dyselectrolytemia complicating Guillain–Barré syndrome | A 41-year-old male presented with rapidly progressive symmetrical predominantly proximal quadriparesis of 4 days duration with tingling paresthesiae in limbs for 2 days. Productive cough for 2 days without fever occurred 1 week earlier. There was no history of alcohol consumption or exposure to drugs, bites, stings, and inoculations. He had no past history of similar symptoms, muscle aches, or thyroid dysfunction. There was no family history of neuromuscular diseases.\nHeart rate was 88 beats/minute and blood pressure was 130/80 mmHg without respiratory insufficiency. He was awake, alert with symmetrical proximal muscle weakness (shoulders 2/5, elbow and lower limbs 4/5, wrist and fingers 5/5 by Medical Research Council [MRC] grading). There was mild weakness in the intrinsic hand muscles. Sensations, cranial and neck muscles were normal; muscle stretch reflexes sluggish and plantars flexor.\nThe serum potassium was 2.6 mEq/L, magnesium 1.7 mg/dL with mild metabolic alkalosis. Serum creatinine kinase (CK) was normal. Quadriparesis remained unchanged despite correction of hypokalemia to 4.0 mEq/L over 12 hours at which time nerve conduction studies (NCS) revealed increased distal motor latencies, partial conduction block along with nonlength-dependent reduction of amplitudes []. Lumbar cerebrospinal fluid (CSF) revealed albuminocytological dissociation with 250 mg/dl protein and 20 cells/mm3 (lymphocytes 75%, polymorphs 25%).\nQuadriparesis progressed with appearance of asymmetric lower motor neuron facial weakness and on fourth hospital day he required mechanical ventilation. Plasmapheresis was initiated on the third hospital day with 10 L removed over the next 9 days. Serum potassium and magnesium levels declined despite oral and parenteral supplements. Although patient could be weaned from ventilator after 12 days with moderate improvement of quadriparesis, he continued to have persistent hypotension and bradycardia requiring vasopressor support. The serum cortisol, thyroid hormones, CK-MB, echocardiography, and abdominopelvic imaging by ultrasound and contrast enhanced computerized tomography were normal.\nRepeat nerve conductions before discharge revealed persistence of the abnormalities with increase in the latencies along with persistent dyselectrolytemia []. At discharge 42 days after admission, the muscle power was 4/5 and he walked with minimal assistance. He was discharged on potassium supplements, spiranolactone, and dietary modification for hypomagnesemia. During follow-up the weakness completely recovered by 4 months. At the last follow-up 30 months after discharge, patient has persistent hypomagnesemia (1.5 mg/dl) with hypocalciuria (90 mg/day; normal 100-300 mg/day). Nerve conductions revealed significant improvement of distal latencies, amplitudes, and conduction velocities at 18 months []. Serum magnesium and potassium levels in his siblings were normal. | [[41.0, 'year']] | M | {'24250177': 1, '19377223': 1, '12473141': 1, '18250508': 1, '29026553': 2, '18667063': 1, '16271648': 1, '9734597': 1, '10399749': 1, '19237821': 1, '11168953': 1, '24250176': 1, '24250175': 2} | {'5628240-1': 1} |
164,059 | 3821431-1 | 24,250,178 | noncomm/PMC003xxxxxx/PMC3821431.xml | A diagnostic and therapeutic challenge involving a case of dysphagia in association with cervical osteophytosis and a dental pain | A 42-year-old female patient was referred to the dental department complaining of difficulty in swallowing. She reported pain with every swallow (odynophagia), causing constant discomfort, but no other obvious symptoms or systemic problems. She had been a practicing dentist for the last 12 years, and reported mild pain on swallowing which had worsened within 2-3 days of onset. She was prescribed medication (azithromycin 500, cephalexin 500, and ibuprofen) for throat infection without any relief. Subsequently, she developed intermittent but acute throbbing pain and tenderness in her maxillary molars on the right side, and was referred to the dental department.\nOn examination, pain on percussion was evident with regard to teeth #16 and #17. Intraoral radiography showed proximal caries in tooth #17, while tooth #16 had evidently been satisfactorily root canal treated. As the pain was not relieved by medication (cephalexin 500 and serratiopeptidase-diclofenac potassium), endodontic treatment was administered to tooth #17. Four days after the treatment, the patient resumed with persistent dysphagia, without tooth pain. On examination, previously root canal treated tooth #16 was tender, and was therefore considered for re-endodontic treatment. A complaint of severe piercing pain on instrumentation to the mesio-buccal canal of tooth #16 perplexed endodontists, ultimately they decided to go for mesial root resection expecting that it would resolve the problem, but the dysphagia persisted [].\nA fortnight later the patient returned with worsened dysphagia without dental pain. At the eye/ear-nose-throat (ENT) department, the otorhinolaryngologist diagnosed the case as tonsillitis, and a week later, as sinusitis. The treatment plan was changed with each different diagnosis, without any relief. The patient was then advised to undergo endoscopy, which ultimately proved to be normal. Ultrasonography (USG) of the neck and thyroid function tests also turned normal.\nThe patient was referred to the orthopedic department where they revealed a “stiff neck,” which proved to be the main cause of dysphagia. On palpation and pressure at C3 and C4 levels, the patient experienced pain with restricted spinal movements. Cervical radiographs revealed osteophytic projections impinging upon the posterior pharyngeal wall at the levels of C3, C4, and C5, and cervical hypolordosis []. The osteophyte at the pharyngo-esophageal junction was positioned in such a way that it interfered with the swallowing movement. The patient was ultimately diagnosed with osteophytosis involving C3, C4, and C5.\nThe initial treatment planned was nonsurgical. The patient was referred to the chiropractor/physiotherapist for management of stiff neck. In conjunction with nonsteroidal anti-inflammatory drugs, the nutritional supplements were prescribed for a month.\nThe treatment also included muscle relaxant massages, spinal adjustment with neck exercise, and traction sessions. | [[42.0, 'year']] | F | {'21484285': 1, '7420148': 1, '4437247': 1, '24250179': 1, '2980259': 1, '5218028': 1, '22679683': 1, '22824718': 1, '18574355': 1, '24250178': 2} | {} |
164,060 | 3821433-1 | 24,250,180 | noncomm/PMC003xxxxxx/PMC3821433.xml | Twelfth cranial nerve involvement in Guillian Barre syndrome | A thirteen year old boy presented with acute progressive areflexic flaccid quadriparesis associated with motor cranial nerve involvement with bilateral facial and bulbar weakness. He had an upper respiratory infection one week preceding the motor weakness which started from the lower limbs. On day seven after the onset of motor weakness of limbs, the child developed significant bulbar weakness, difficulty in talking and could not move the tongue. He was totally anarthric. On day nine, he had significant respiratory muscle weakness requiring mechanical ventilatory support. On day fourteen, bilateral tongue atrophy without fasciculations was noticed []. The nerve conduction studies (NCS) were suggestive of severe demyelinating motor sensory polyradiculoneuropathy. The facial nerve conductions revealed facial neuropathy. His anti-ganglioside antibody panel in the blood showed positive IgM GM2, GT1b, IgG GM1,2,3 and GT1b antibodies. His CSF showed albuminocytological dissociation and his Antinuclear antibody was negative. His magnetic resonance image (MRI) brain was normal. He was treated with intravenous immunoglobulin at a daily dose of 0.4 g/kg for five days. The child required prolonged ventilatory care for 22 days. He showed gradual improvement and started swallowing after eight weeks of the onset of illness. The wasting of the tongue also improved gradually at 3 months after the onset of illness []. At 6 months follow up, he was walking with support with residual bilateral foot drop. Repeat NCS was suggestive of motor sensory demyelinating radiculoneuropathy with improvement in conduction velocities and compound muscle action potential amplitudes compared to baseline study.\nTwelfth nerve involvement, either isolated or as a part of multiple cranial nerve involvement is quite uncommon and only two cases has been reported till date as a part of multiple motor cranial nerve involvement in a case of GBS. Tan et al., reported a case of fulminant GBS with quadriplegia and total paresis of motor cranial nerves and Polo et al., reported a case of atypical GBS with multiple cranial neuropathies including XIIth cranial nerve involvement. | [[13.0, 'year']] | M | {'8747867': 1, '21214559': 1, '28223738': 2, '24250181': 1, '34017665': 2, '9543317': 1, '33093137': 1, '12134346': 1, '24250180': 2} | {'5296210-1': 1, '8130644-1': 1} |
164,061 | 3821435-1 | 24,250,182 | noncomm/PMC003xxxxxx/PMC3821435.xml | Absence status seen in an adult patient | A 43-year-old woman was referred to our clinic by the psychiatrist for indifference to her surroundings and failure to answer the questions posed to her for the last two days. She was reported mild impairment of consciousness manifests as slow reaction, behavior, and mental functioning. These impairment of consciousness periods occur about 10 times an hour, each lasting for 10-20 seconds. A detailed examination of the patient's history showed that her complaints started when she was 10 years old and occurred 2-3 times a week for 10 seconds each. During these periods of absentmindedness, the patient stared at a certain point, did not answer any questions, and after a period of 10-15 seconds, she resumed whatever she was doing before the seizure. Her coordination was impaired and she was uncooperative. The patient was admitted to hospital.\nHematological estimations and serum biochemical analyses were normal. Cranial MRI was evaluated as normal. Her EEG revealed 3-Hz diffuse spike-and-slow wave activity []. The patient was evaluated as absence status epilepticus and administered valproic acid (20 mg/kg/IV loading followed by 2 mg/kg/IV infusion for 24 hours on end). Her seizures stopped after 8 hours. The EEG taken 1 day later was evaluated as normal []. The EEG taken 1 day later was evaluated as normal []. It was found out that the patient did not suffer from any GTC or myoclonic seizures in her history and did not receive any medical treatment. She was diagnosed juvenile absence epilepsy and put on 1000 mg/day oral valproic acid treatment. The patient was found seizure-free in the clinical follow-up. Follow-up EEGs were also evaluated as normal. | [[43.0, 'year']] | F | {'18093147': 1, '18783966': 1, '14593634': 1, '1734289': 1, '11393330': 1, '24250182': 2} | {} |
164,062 | 3821436-1 | 24,250,183 | noncomm/PMC003xxxxxx/PMC3821436.xml | Suprasellar dermoid cyst associated with colloid cyst of the third ventricle: Disordered embryogenesis or a mere coincidence? | A 22-year-old male patient presented with on and off frontal headaches and occasional blurring of vision for 1 year. Patient was operated initially for suprasellar dermoid cyst 5 years back. Bifrontal craniotomy and partial excision of dermoid cyst was performed during previous surgery. Patient was asymptomatic 4 years after first surgery. Clinical examination was normal with visual acuity of 6/6 in both eyes without evidence of any field defects on perimetry. Routine hematological and biochemical investigations were normal. Hormone status of the patient was normal. Magnetic resonance imaging (MRI) revealed mainly cystic lesion in the suprasellar region with small solid component anteriorly which was hyperintense on T1-weighted sequences without any contrast enhancement. Cyst wall did not show any enhancement on contrast. Simultaneously a colloid cyst of 1.2 × 1.5 cm was seen at the foramen of Monro, mainly occupying third ventricle with evidence of mild hydrocephalus []. An old bifrontal craniotomy was re-explored and complete excision of suprasellar dermoid cyst was achieved through bilateral subfrontal approach along with transcortical transventricular excision of colloid cyst in the same setting. Intraoperatively, suprasellar cyst was containing a whitish fluid with fat globules with small solid vascularized fatty nodule. Post-operative scans showed complete excision of both the lesions []. Histopathological findings confirmed the diagnosis []. | [[22.0, 'year']] | M | {'11490192': 1, '10705930': 1, '14322940': 1, '1895117': 1, '1636378': 1, '29557987': 1, '10807239': 1, '8869070': 1, '24250184': 1, '2472473': 1, '20423684': 1, '15287458': 1, '32656143': 2, '8416224': 1, '24250183': 2} | {'7335152-1': 1} |
164,063 | 3821438-1 | 24,250,185 | noncomm/PMC003xxxxxx/PMC3821438.xml | Nosocomial Escherichia coli meningitis in adults: Report of four cases and literature review | A 44-year-old Pakistani male patient, admitted to the trauma intensive care unit after having a sustained severe head injury and forearm fracture caused by a car accident. He had immediate loss of consciousness and cranial computed tomography (CT) showed multiple skull fractures involving left frontal bone extending downward to involve the roof of orbit bone, base of the skull and anterior cranial fossa. On the following days the patient improved, he became semiconscious, but cerebrospinal fluid (CSF) leak was noted. On the fifteenth day of admission, patient developed fever with deterioration in his consciousness level. Neurological examination revealed unconscious patient, however, examination for meningeal signs was not possible due to patient's condition. CSF examination showed 6675 leucocytes/μl with 80% neutrophils, a protein level of 230 mg/dl and a glucose level of 34.2 mg/dl. Direct examination of CSF showed Gram-negative rods, and cultures yielded extended spectrum beta lactamase (ESBL) Escherichia coli, sensitive to meropenem, gentamycin and piperacillin-tazobactam. Production of ESBL was determined by disk testing in our clinical microbiology laboratory according to the Clinical and Laboratory Standards Institute performance standards M100-S20. MICs of third generation cephalosporins and of amoxicillin–clavulanate were used as confirmatory criteria of ESBL production detected by the BD Phoenix system. Isolates recorded as possible ESBL producers by the BD Phoenix system were prospectively tested for ESBL production by using combined discs method (BD Sensi-Disc) using ceftazidime (30 μg), cefotaxime (30 μg) with and without clavulanic acid (10 μg). An increase in the inhibition zone diameter ≥5 mm in the presence of clavulanic acid was considered confirmation of ESBL production. Blood cultures were negative. Cranial CT showed parenchymal changes consistent with cerebritis. The patient was treated initially with ceftriaxone (4 g/day), which was shifted to meropenem upon receipt of culture results. The treatment continued for 3 weeks after which the patient improved and discharged from the intensive care unit without any sequela other than his primary illness. | [[44.0, 'year']] | M | {'32128063': 2, '26654107': 2, '22321435': 1, '15989143': 1, '7979482': 1, '11200386': 1, '17293507': 1, '33490961': 1, '15973009': 1, '29318066': 2, '24250185': 2} | {'3821438-2': 2, '3821438-3': 2, '3821438-4': 2, '4676899-1': 1, '5727644-1': 1, '7034454-1': 1} |
164,064 | 3821438-2 | 24,250,185 | noncomm/PMC003xxxxxx/PMC3821438.xml | Nosocomial Escherichia coli meningitis in adults: Report of four cases and literature review | A 29-year-old previously healthy Nepalese man, with no history of arterial hypertension, was admitted to our hospital complaining of headache, vomiting and left sided weakness. On examination his blood pressure was high, 220/140 mmHg. Neurological examination showed conscious, oriented patient with left sided weakness. Cranial CT showed right sided intraventricular hematoma with significant mass affect (shift of midline structure to the left). Magnetic resonance imaging (MRI) was performed and there were no vascular malformations or aneurysms. On the 7th day of admission, the intraventricular hematoma was evacuated and a right external ventricular drain (EVD) was inserted. The patient was kept in the surgical intensive unit. Two days later, the patient developed fever, headache and vomiting. Meningeal signs were absent and CSF examination revealed 190,000 leucocytes/μl predominantly neutrophils with protein of 399 mg/dl and glucose of 3.6 mg/dl. Gram stain examination of CSF showed Gram-negative rods, and cultures yielded E. coli sensitive to ceftazidime, ceftriaxone, cefepime, meropenem, piperacillin-tazobactam, ciprofloxacin and amoxi-clavulinate and resistance to ampicillin. Blood cultures were negative. Cranial CT showed parenchymal changes consistent with cerebritis. The patient was treated with meropenem, vancomycin and supportive treatment, but he died on the 14th day after admission most probably due to multiple unrelated complications. | [[29.0, 'year']] | M | {'32128063': 2, '26654107': 2, '22321435': 1, '15989143': 1, '7979482': 1, '11200386': 1, '17293507': 1, '33490961': 1, '15973009': 1, '29318066': 2, '24250185': 2} | {'3821438-1': 2, '3821438-3': 2, '3821438-4': 2, '4676899-1': 1, '5727644-1': 1, '7034454-1': 1} |
164,065 | 3821438-3 | 24,250,185 | noncomm/PMC003xxxxxx/PMC3821438.xml | Nosocomial Escherichia coli meningitis in adults: Report of four cases and literature review | A 52-year-old Sudanese man brought to the emergency department because of loss of consciousness. His medical history was remarkable for hypertension and diabetes mellitus. Cranial CT showed large cerebellar hematoma with dilatation of supratentorial ventricular system associated with impending conization. An urgent craniotomy and hematoma evacuation was carried out and EVD was performed. Patient remained unconscious but with stable vitals. Four days later, the patient developed fever. CSF examination revealed the following values; leucocytes 6083/μl with 97% neutrophils, glucose 32.4 mg/dl and protein 250 mg/dl. CSF and blood cultures yielded E. coli resistant to ampicillin, ceftazidime, ceftriaxone, cefepime, piperacillin-tazobactam, ciprofloxacin and amoxi-clavulinate and sensitive to meropenem. Despite antibiotic treatment with meropenem and supportive therapy, the patient deteriorated and died 4 weeks after admission probably due to overwhelming sepsis in addition to his primary illness. | [[52.0, 'year']] | M | {'32128063': 2, '26654107': 2, '22321435': 1, '15989143': 1, '7979482': 1, '11200386': 1, '17293507': 1, '33490961': 1, '15973009': 1, '29318066': 2, '24250185': 2} | {'3821438-1': 2, '3821438-2': 2, '3821438-4': 2, '4676899-1': 1, '5727644-1': 1, '7034454-1': 1} |
164,066 | 3821438-4 | 24,250,185 | noncomm/PMC003xxxxxx/PMC3821438.xml | Nosocomial Escherichia coli meningitis in adults: Report of four cases and literature review | A 40-year-old Egyptian man was admitted to the neurosurgery service at Hamad general hospital. He had lower back pain of sudden onset and the straight-leg-raising test on 30 ° was positive. A central disc herniation was documented at L4-L5 by MRI of the lumber spine. Lumbar discectomy was performed with drain insertion. Four days later, the patients developed severe headache, vomiting and fever and there was obvious neck stiffness. Examination of CSF showed a leucocyte count of 56250/μl with 87% neutrophils, protein level of 298 mg/dl, and glucose level of <1.8 mg/dl. Gram staining of CSF demonstrated the presence of Gram-negative bacilli. CSF yielded ESBL E. coli sensitive to meropenem, piperacillin-tazobactam and gentamycin, but blood culture was negative. The patient was treated with meropenem and supportive treatment. After 15 days of treatment the patient's condition improved, allowing his discharge without any sequela other than his primary illness. | [[40.0, 'year']] | M | {'32128063': 2, '26654107': 2, '22321435': 1, '15989143': 1, '7979482': 1, '11200386': 1, '17293507': 1, '33490961': 1, '15973009': 1, '29318066': 2, '24250185': 2} | {'3821438-1': 2, '3821438-2': 2, '3821438-3': 2, '4676899-1': 1, '5727644-1': 1, '7034454-1': 1} |
164,067 | 3821439-1 | 24,250,186 | noncomm/PMC003xxxxxx/PMC3821439.xml | The enigma of transient splenial hyperintensity: In cryptococcal meningitis | A 16-year-old Hindu girl was admitted to the hospital with chief complaints of fever for 20 days, ataxia and diplopia for 3 days. The fever was low grade, intermittent, and with evening rise of temperature and was associated with headache which was holocranial, bursting, and non-throbbing. She developed acute onset ataxia over 1-2 days and diplopia associated with vomiting. She is immunocompromised (HIV positive) since birth, her parents were seropositive (both died 8-10 years ago due to AIDS-related complications). Antiretroviral therapy was started 2 months prior to admission because CD4 count was 92 cells/mm3 at that time, although she was asymptomatic then.\nOn physical examination, she was conscious, oriented, and afebrile, body mass index (BMI) was 20. Her pulse rate was 86 per minute, blood pressure was 110/70 mmHg and there was no superficial lymphadenopathy. Cranial nerve examination revealed bilateral papilloedema and bilateral lateral rectus palsy. Motor system exam revealed 4-/5 power in right proximal lower limb. Finger-nose test, heel-shin test were abnormal on both sides, and deep tendon reflexes were diminished on the right lower limb. However, sensory system examination and control of bowel/bladder were normal. Examination of respiratory, cardiovascular, and abdomen were within normal limits.\nAfter 3 days of admission she developed right-sided lower motor neuron (LMN) type of facial nerve palsy [], she also developed herpes labialis nearly the same time. Initially, she was put on mannitol and oral acyclovir to control herpes labialis.\nSubsequent investigations showed Hb 9.9 gm%, TLC 7500/mm3 (Neutrophlis 76%, Eosinophils 2%, Basophils 0%, Lymphocytes 20%, Monocytes 2%), platelet count 2,80,000 per mm3, fasting plasma glucose 90 mg/dl, blood urea 20 mg/dl, serum creatinine 1.0 mg/dl, serum billirubin 0.6 mg/dl, total protein 8.0 g/dl (albumin 4.0 g/dl), AST 33U/L, and ALT 35 U/L.\nMRI of brain revealed hyperintensity of Splenium of Corpus Callosum in FLAIR (“Boomerang sign”) [], although T2 and T1 with contrast did not show any such abnormality. On doing lumbar puncture, cerebrospinal fluid (CSF) pressure was very high (10-12 drops/sec). CSF examination showed 55 cells/mm3 (Neutrophils 4%, Lymphocytes 96%), glucose 6.0 mg/dl, protein 123 mg/dl, chloride 128 mmol/L, and adenosine deaminase 1.60 U/L (normal <5 U/L). Antitubercular drugs (ATD) were started empirically but her condition continued to deteriorate with increasing headache and sequential development of lower motor neuron (LMN) type of facial palsy on the left side [] with partial improvement of the facial palsy of the right side. CSF polymerase chain reaction (PCR) for Epstein barr virus was negative but Cryptococcus antigen became positive by enzyme immunoassay. Amphotericin B was added to the regime. Her CD4 count at this time was 246 cells/mm3. She started improving gradually, her facial palsy and sixth nerve palsy resolved. She was discharged from the hospital after 2 weeks with an advice to continue fluconazole and cotrimoxazole.\nShe came for regular follow-ups, was doing well. A repeat MRI of brain was done after 2 months, it showed complete resolution of the splenial hyperintensity in FLAIR []. | [[16.0, 'year']] | F | {'16983624': 1, '15767508': 1, '1486477': 1, '26713030': 1, '12879315': 1, '24250187': 1, '15557501': 1, '12790901': 1, '9974067': 1, '10331103': 1, '17032879': 1, '11254767': 1, '9757323': 1, '17885738': 1, '12296661': 1, '16984867': 1, '24250186': 2} | {} |
164,068 | 3821441-1 | 24,250,188 | noncomm/PMC003xxxxxx/PMC3821441.xml | Removal of cervical spinal tumor with large inferio-lateral extension through anterolateral (interscalene and transforaminal) approach | A thirty years old male presented with neck pain and left sided brachialgia. His neck movements were restricted and painful (mild to moderate pain). There was an ill-defined fixed mildly tender mass in left lower posterior triangle of neck. Hoffman's sign was bilaterally positive. But motor, sensory and autonomic functions including reflexes were normal in all limbs. Other general and systemic examination revealed no abnormality. MRI of cervical spine showed a 4 × 6 × 4 cm intradural extramedullary tumor with paraspinal extension through left C6 and 7 intervertebral foramen [Figure –]. Plain X-ray cervical spine showed large intervertebral foramen between C6 and 7 on left side [Figure and ].\nAnterolateral (interscalene) approach was used to remove the tumor completely.\nSupine position; with 20 ° elevation of head and neck. Head was turned to right side. Left shoulder was slightly elevated and kept on slight traction toward the leg.\nUnder the operating microscope, a 4 cm transverse incision was made 4 cm above the middle third of left clavicle that extended over the posterior part of sternocleidomastoid muscle and anterior part of trapezius [].\nAfter cutting of subcutaneous tissue and platysma in the same line of skin incision investing layer of deep cervical fascia was cut along the posterior border of sternocleidomastoid 3 cm up and down to the skin incision line. Tumor was found after deep fascial incision. Sternocleidomastoid muscle was retracted anteriorly to exposure anterior scalenus muscle. On the anterior surface of anterior scalenus muscle phrenic nerve was identified and safeguarded by medial mobilization. Anterior scalenus muscle was cut above its insertion to scalenus tubercle of first rib after taking care not to injure subclavian vessels. Sternocleidomastoid muscle was retracted anteriorly and trapezius muscle was retracted posteriorly and the tumor was dealt. Fascia over the tumor capsule was dissected and tumor debulking was started but it was very hard and minimally vascular. Tumor was debulked by cutting with micro-scissor and sharp BP blade (No. 11). After removal of lateral part of tumor upper and middle trunk of brachial plexus came in view that were safeguarded. Medial part of the tumor was relatively soft and suck able, so removed by suctioning. Intraspinal intradural part was dealt through the C6 and 7 intervertebral foramen which was already capacious. The tumor easily came out through the dural opening along with arachnoid which was peeled off and tumor removed completely [Figure –]. Any bony work for foraminal enlargement was not needed and spinal stability seemed to be intact. Vertebral artery did not come in view. A portion of arachnoid remained outside the spinal canal through the dural opening with leaking of CSF. The redundant arachnoid was put inside the dura but closure of dural opening was not possible. For prevention of CSF leak, pseudo-meningocele or arachnoid herniation two pieces of thigh fat was put in the dead space. Wound was closed in layers without drain.\nPost operatively patient recovered uneventfully. Histopathological examination of operative specimen reported schwannoma Antoni A. His neurology after operation was intact. Postoperative MRI at the end of 4 months after operation showed no residual tumor but there was a pseudo-meningocele with grafted fat at the operated site [Figure –]. | [[30.0, 'year']] | M | {'3084994': 1, '9316042': 1, '7760192': 1, '19934978': 1, '8869056': 1, '24250189': 1, '19455006': 1, '7412981': 1, '496615': 1, '3950739': 1, '9482178': 1, '1846409': 1, '18261768': 1, '14699292': 1, '12925264': 1, '18248284': 1, '24250188': 2} | {} |
164,069 | 3821543-1 | 24,235,850 | noncomm/PMC003xxxxxx/PMC3821543.xml | High-dose, short-interval daptomycin regimen was safe and well tolerated in three patients with chronic renal failure | An 80-year-old woman who was diagnosed with infectious endocarditis due to methicillin-resistant Staphylococcus epidermis (MRSE) was administered daptomycin 5.9 mg/kg every other day, which is the regimen recommended in Japan (). Three days later, daptomycin was changed to linezolid because inflammation markers had not improved; however, on day 7, nausea developed, suggesting an adverse effect of linezolid, so teicoplanin was started. Four days later, improvement in inflammation markers, such as numbers of white blood cells and C-reactive protein level, was less than expected, and nausea continued.\nTherefore, we were consulted as infectious disease physicians; we suggested reinstituting daptomycin, but on a daily basis under careful observation, given that the every other day regimen had been ineffective on the first 3 days. Additional anti-MRSA drugs, such as rifampicin, were also considered, but the patient had a history of allergy to rifampicin. Unfortunately, mild interstitial pneumonia was subsequently seen on chest X-ray; however, the more expected adverse effects, such as elevation of CPK and creatinine, did not occur during the course of daptomycin treatment. The pneumonia improved with corticosteroid therapy soon after daptomycin administration was discontinued. | [[80.0, 'year']] | F | {'18206530': 1, '14740787': 1, '17240105': 1, '17005801': 1, '21549573': 1, '16426793': 1, '34337679': 1, '19500039': 1, '20846832': 1, '12654665': 1, '27488025': 1, '17620372': 1, '19584384': 1, '11353628': 1, '21393205': 1, '17682996': 1, '21208910': 1, '19896341': 1, '23254428': 1, '24235850': 2} | {'3821543-2': 2, '3821543-3': 2} |
164,070 | 3821543-2 | 24,235,850 | noncomm/PMC003xxxxxx/PMC3821543.xml | High-dose, short-interval daptomycin regimen was safe and well tolerated in three patients with chronic renal failure | A 75-year-old woman admitted to stabilize chronic heart failure was found to have MRSA bacteremia. Teicoplanin was started, but she complained of lumbago, and osteomyelitis was also found on magnetic resonance imaging. Therefore, treatment was changed to linezolid because better tissue penetration was expected (). However, platelets decreased to less than 1 × 105 cells/μL (4.3 × 104) as an adverse effect of linezolid, and so we were consulted on day 28. Because of the results from the patient described in case 1, who did not show an increase of CPK and creatinine, we suggested a change to daptomycin 6.2 mg/kg daily under close observation, in spite of her renal function (creatinine clearance 19.1 mL per minute). One month later, no adverse effects, including no elevation of CPK and creatinine, had occurred, and daptomycin therapy was clinically eifficacious. | [[75.0, 'year']] | F | {'18206530': 1, '14740787': 1, '17240105': 1, '17005801': 1, '21549573': 1, '16426793': 1, '34337679': 1, '19500039': 1, '20846832': 1, '12654665': 1, '27488025': 1, '17620372': 1, '19584384': 1, '11353628': 1, '21393205': 1, '17682996': 1, '21208910': 1, '19896341': 1, '23254428': 1, '24235850': 2} | {'3821543-1': 2, '3821543-3': 2} |
164,071 | 3821543-3 | 24,235,850 | noncomm/PMC003xxxxxx/PMC3821543.xml | High-dose, short-interval daptomycin regimen was safe and well tolerated in three patients with chronic renal failure | An 85-year-old man who had undergone surgery for urinary bladder tumors was admitted because urinary infection was suspected. There were no findings indicating pyelonephritis by ultrasound examination, but meropenem 0.5 g twice daily was begun empirically by the primary physicians because of their suspicion of severe sepsis due to Gram-negative rods, including extended-spectrum beta-lactamase-producing strains of Escherichia coli and Klebsiella species, which are seen (about >20%) in urology patients in Japan (). However, 2 days later, MRSA, with a minimum inhibitory concentration for vancomycin of 1 μg/mL (susceptible), was isolated from the blood culture, and vancomycin was started at a dose determined by the renal function (creatinine clearance 16.3 mL per minute). The dosage of meropenem and vancomycin determined by the primary physicians was quite low at first (half of the usual) because of concern for possible deterioration of renal function. In fact, vancomycin was ineffective and the trough level was quite low (7.8 μg/mL). Further, MRSA was again isolated from the day 3 blood culture, and inflammation indicators, such as white blood cells and C-reactive protein level, had not improved. Indicators of the physical condition of the patient, such as blood pressure and respiratory status, had also worsened; therefore, we were consulted and, because of our experiences with cases 1 and 2, we again suggested that vancomycin should be changed to daptomycin 8 mg/kg daily under careful observation. After administration of daptomycin, blood cultures became negative for MRSA, and inflammation markers also improved. No adverse effects were noted, including no decreased creatinine clearance. | [[85.0, 'year']] | M | {'18206530': 1, '14740787': 1, '17240105': 1, '17005801': 1, '21549573': 1, '16426793': 1, '34337679': 1, '19500039': 1, '20846832': 1, '12654665': 1, '27488025': 1, '17620372': 1, '19584384': 1, '11353628': 1, '21393205': 1, '17682996': 1, '21208910': 1, '19896341': 1, '23254428': 1, '24235850': 2} | {'3821543-1': 2, '3821543-2': 2} |
164,072 | 3822027-1 | 24,228,148 | noncomm/PMC003xxxxxx/PMC3822027.xml | Unidirectional valve malfunction by the breakage or malposition of disc - two cases report - | A 46-year-old-female was scheduled for laparoscopic subtotal hysterectomy due to uterine myoma in our hospital. The preoperative laboratory findings were all within the normal ranges except for low hemoglobin of 9.0 g/dl. The patient was premedicated with intramuscular injection of glycopyrrolate 0.2 mg and midazolam 2 mg 30 minutes before induction of anesthesia. When the patient arrived at the operating room, blood pressure was 140/80 mmHg, heart rate 90 beats/min, respiratory rate 18 times/min, and SpO2 98%. After a normal test of preanesthetic leak test by closing the pop-off valve, occluding the Y-piece, and pressurizing the circuit to 30 cmH2O with the oxygen flush valve and flow test by using the ventilator and a breathing bag attached to the "Y"-piece as described in the 1993 FDA Anesthesia Apparatus Checkout Recommendations [] on the breathing circuit, propofol 120 mg and rocuronium 30 mg were given intravenously, followed by uneventful endotracheal intubation. After intubation, SpO2 was 99% and end-tidal CO2 (ETCO2) measured through a previously calibrated side stream capnometer (S/5™ Anesthesia Monitor, GE Healthcare, Finland) was 34 mmHg. The anesthesia was maintained with O2 1.5 L/min, air 2.5 L/min, sevoflurane 2-3 vol%, and remifentanil 0.2-0.5 µg/kg/min. The anesthesia ventilator (Narcomed 2B, Dräger, Germany) was set at volume control mode (tidal volume 500 ml, respiratory rate 10 times/min, I/E ratio 1 : 2). Systolic blood pressure was maintained at 100-150 mmHg, diastolic pressure at 60-90 mmHg, heart rate at 50-90 beats/min. About 10 minutes after the anesthesia began, ETCO2 suddenly increased to 52 mmHg and PICO2 30 mmHg was noted (). It was the second general anesthesia of the day in this operating room. In addition, during the first 10 minutes, the capnography wave form was normal. Therefore, we initially suspected an erroneous capnometry reading and recalibrated. Breath sounds were clear and bilaterally equal. Since the core temperature measured using a Thermoscan® (infrared tympanic thermometer IRT4020, Braun, Germany) was normal range (36.4℃), malignant hyperthermia was ruled out. Carbon dioxide absorbent had not changed color. This implied the possibility of rebreathing. Blood pressure was 115/62 mmHg and heart rate was 85 beats/min. When the breathing system was rechecked, breakage of the expiratory unidirectional valve through transparent dome, which is divided into three pieces, was discovered (). After replacement of the broken disc by a new one, the capnogram waveform returned to normal. The surgery was completed smoothly and the patient had an uneventful recovery. | [[46.0, 'year']] | F | {'11004059': 1, '5279730': 1, '8863110': 1, '6424510': 1, '7065389': 1, '9370843': 1, '14601200': 1, '4014737': 1, '14768521': 1, '15920203': 1, '24228148': 2} | {'3822027-2': 2} |
164,073 | 3822027-2 | 24,228,148 | noncomm/PMC003xxxxxx/PMC3822027.xml | Unidirectional valve malfunction by the breakage or malposition of disc - two cases report - | A 23-year old man was admitted for tonsillectomy to our hospital. The preoperative laboratory findings were all within normal limits. The patient was premedicated with intramuscular injection of glycopyrrolate 0.2 mg and midazolam 2 mg 30 minutes before induction of anesthesia. When the patient arrived at the operating room, blood pressure was 110/70 mmHg, heart rate 61 beats/min, respiratory rate 14 times/min, and SpO2 98%. After a normal preanesthetic leak test by closing the pop-off valve, occluding the Y-piece, and pressurizing the circuit to 30 cmH2O with the oxygen flush valve and flow test by using the ventilator and a breathing bag attached to the "Y"-piece as described in the 1993 FDA Anesthesia Apparatus Checkout Recommendations [] on the breathing circuit, propofol 140 mg and rocuronium 30 mg were given intravenously, followed by an uneventful endotracheal intubation. The SpO2 was 100% and ETCO2 measured through a sidestream capnometer (S/5™ Compact Anesthesia Monitor, Datax-Ohmeda, Finland) was 38 mmHg after intubation. Following confirmation that there were no problems with ventilation in both lungs, a tube was fixed in the area that was 23 cm away from the incisor. The anesthesia ventilator (Aestiva/5, Datex-Ohmeda, Madison, USA) was set at volume control mode (tidal volume 600 ml, respiratory rate 12 times/min, I/E ratio 1 : 2). At that time, ETCO2 increased to 46 mmHg, PICO2 of 4 mmHg, and a gradually sloping descending limb of inspiratory phase were noted, which implied inspiratory valve malfunction (). Blood pressure was 156/87 mmHg and heart rate was 75 beats/min. When we inspected the inspiratory valve through the transparent dome, the disc was not located in the center, horizontally. We disassembled the unidirectional valve component right away, which revealed an improper orientation of disc and disc locking apparatus (). After correction, the capnogram waveform returned to normal. The surgery was completed smoothly and the patient had an uneventful recovery. | [[23.0, 'year']] | M | {'11004059': 1, '5279730': 1, '8863110': 1, '6424510': 1, '7065389': 1, '9370843': 1, '14601200': 1, '4014737': 1, '14768521': 1, '15920203': 1, '24228148': 2} | {'3822027-1': 2} |
164,074 | 3822028-1 | 24,228,149 | noncomm/PMC003xxxxxx/PMC3822028.xml | Acute onset Lance-Adams syndrome following brief exposure to severe hypoxia without cardiac arrest -a case report- | A 48-year-old man underwent right partial glossectomy with neck dissection for tongue cancer under general anesthesia. Past medical history showed that he had been diagnosed with diabetes mellitus (DM) for five years and that he is a 30 pack-year smoker. During the five hours of operation, his vital signs were kept stable and blood sugar levels were well controlled between 82-84 mg/dl. Pulse oxygen saturation (SpO2), pulse rate, and non-invasive blood pressure (NIBP) were stable during immediate postoperative period in the recovery room.\nHe began complaining of troubled breathing and showed agitation 30 minutes after arrival in the recovery room. We informed his otolaryngologist of the situation and relieved the dressing bandage around his neck. As his oxygen saturation gradually decreased to 0%, we started bag-mask ventilation. NIBP was checked, 149/92 mmHg. SpO2 was immediately recovered to 96%. Although severe hypoxemia occurred, it did not lead to cardiac arrest, which was known from palpable pulse of radial artery throughout the course. His heart rate remained above 40 beats/min. At the same time, his otolaryngologist arrived and immediately opened the incision site for decompression. At once, he was able to breathe and his saturation was maintained 100%.\nHe was transported to the operating room to remove the hematoma of his neck. Intubation was performed without difficulty and mechanical ventilation was applied with FiO2 50%. All vital signs were unremarkable (SpO2 98-99%, heart rate 80-120 beats/min, and temperature 36.0-36.2℃), except blood pressure. It was checked below 90/60 mmHg twice during the 2 hours of operation, and ephedrine 10 mg was injected. On average, the mean arterial pressure was kept between 60-80 mmHg. At the end of the operation, his condition was stable and appropriate for extubation. Bispectral index (BIS) was increased to 90 and his eyes were opened spontaneously; he was extubated. However, soon after extubation, he showed generalized tonic-clonic seizure and it was only discontinued by inhalation of sevoflurane and administration of thiopental. He was reintubated and phenytoin, lorazepam, and midazolam were administered to control the seizures. He was admitted to the intensive care unit (ICU) in a sedated state. Light reflexes were normal. Blood glucose level was 200 mg/dl.\nSix hours later, when a tactile stimulus was applied, he developed widespread myoclonic seizures on all four limbs, even under infusion of large dose of anticonvulsants. Two days later, he was still deeply sedated to control myoclonic seizures, but the frequency and duration of seizures were only mildly reduced. His brain computed tomogram (CT) showed no remarkable evidence of hypoxic brain damage and his electroencephalogram (EEG) study showed normal findings. On day 10 of hospitalization, his sedatives were completely withdrawn and he became alert with a frowned face and myoclonus affecting both knees and ankles. The treatment with sodium valproate and levetiracetam were continued for recovery. Three weeks later, magnetic resonance (MR) brain imaging did not show any abnormalities (). Two months after surgery, he showed ataxic movement and gait disturbance. His myoclonic action has been well controlled by medications. He has been on intensive rehab for his recovery. | [[48.0, 'year']] | M | {'9062938': 1, '15919781': 1, '30739241': 1, '16864809': 1, '20130351': 1, '5704831': 1, '25929661': 1, '21926285': 1, '21317997': 1, '27708982': 1, '8246014': 1, '30713935': 1, '17910113': 1, '12067014': 1, '7709394': 1, '19604197': 1, '18514823': 1, '13928398': 1, '24228149': 2} | {} |
164,075 | 3822029-1 | 24,228,150 | noncomm/PMC003xxxxxx/PMC3822029.xml | Coexistence of expanding abdominal aortic aneurysm and aggravated intervertebral disc extrusion -a case report- | A 73-year-old male, height 172 cm and weight 75 kg, was referred to our institution after having been seen 3 months previously due to worsening lower back pain which radiated to the left buttock and thigh as well as claudication that had lasted three months. His lower back pain had been treated with caudal blocks for the last 3 years. A lumbar spine radiograph revealed degenerative scoliosis and narrowing of multiple intervertebral disc spaces. A magnetic resonance imaging (MRI) scan demonstrated marked lumbar 3-4 (L3-4) intervertebral disc extrusion, lumbar spinal stenosis, and an L3 compression fracture. He was treated with one L3-4 epidural block, medial branch blocks, and received nonsteroidal anti-inflammatory drugs. His radicular pain and claudication improved, but he complained of low back pain consistently. Therefore, a transforaminal epidural block and percutaneous epidural neuroplasty were performed. After the treatments, all symptoms improved, and only mild lower back pain which increased with walking remained. However, 2 weeks later, he was hospitalized for left leg paralysis and excruciating lower back pain that did not diminish when laying down. MRI was repeated, which identified aggravated L3-4 disc extrusion and a dilatated abdominal aortic aneurysm of nearly 6.0 cm (). Careful review of the previous MR images identified a curvilinear atherosclerotic (calcified) lateral wall of an abdominal aortic aneurysm and fusiform aneurysmal dilation of the abdominal aorta anterior to the vertebral body (). The patient was referred to the neurosurgery department of our hospital for further examination and treatment for the disc extrusion and abdominal aortic aneurysm.\nHe presented to our hospital with intractable lower back pain and pitting edema of both lower extremities. His blood pressure was 110-130/79-90 mmHg and his pulse rate was 70-80 min. Abdominal contrast enhanced computed tomography (CT) confirmed a focal lower abdominal aortic aneurysm with crescent-form mural thrombus formation, without evidence of rupture (). A sensory conduction study and motor conduction study revealed left lumbar radiculopathy mainly of the L4, L5 nerve roots, as well as hypoesthesia on the right L4 to L5 dermatomes. Muscle strength was fair plus in left L5 innervations on manual muscle testing. The range of motion and reflexes were normal. In all extremities, the arteries were readily palpable and no pulsating mass was detected on abdominal palpation. There were no other abnormal findings on the physical examination. Bloodwork showed total cholesterol 191 mg/dl, triglycerides 137 mg/dl, LDL cholesterol 137 mg/dl, HDL cholesterol 30 mg/Dl and HDL ratio 6.3. The surgeons elected to perform decompressive hemi-laminectomy and microdiscectomy on L3-L4 and transforaminal lumbar interbody fusion on L3-L4. After neurosurgery, the patient's neurologic symptoms improved except for the lower back pain. He was transferred to the thoracic surgery department and underwent endovascular aneurysm repair and aortic stent graft interposition. After surgery, his lower back pain diminished. He underwent physiotherapy for 1 month and was then discharged. | [[73.0, 'year']] | M | {'16876618': 1, '17541001': 1, '12756363': 1, '16762671': 1, '1933203': 1, '11479188': 1, '15471668': 1, '29143100': 1, '20060675': 1, '21629398': 1, '16549646': 1, '20881774': 1, '9718003': 1, '884822': 1, '19364978': 1, '24228150': 2} | {} |
164,076 | 3822030-1 | 24,228,151 | noncomm/PMC003xxxxxx/PMC3822030.xml | Coagulopathy following venous air embolism: a disastrous consequence -a case report- | An 18 year-old female patient was scheduled for a craniotomy and excision of a mid-brain ependymoma in a seated position. Her clinical, biochemical and coagulation parameters were normal. In the operating theatre, standard monitors (electrocardiograph [ECG], non invasive blood pressure, pulse oximeter) were attached. General anesthesia was induced with fentanyl and thiopentone and intubation was facilitated with vecuronium. Anesthesia was maintained with oxygen, air, isoflurane, fentanyl and atracurium with controlled ventilation using a tidal volume of 500 ml and respiratory rate (RR) of 12 breaths/min to achieve normocarbia. Intra-operative monitoring (using a Datex Ohmeda S5) included heart rate, ECG, oxygen saturation by pulse oximetry, RR, end-tidal carbon dioxide (EtCO2), central venous pressure (CVP) (via the basilic vein), invasive blood pressure, airway pressure, volume of intravenous fluids infused, urine output, nasopharyngeal temperature, arterial blood gas (ABG), blood glucose and blood loss. Transesophageal echocardiography was not monitored as this was not available in our institute. There were no hemodynamic changes during moving the patient to a seated position. Baseline ABG analysis and CVP were normal.\nAt the time of opening of the dura, there was a sudden decrease in EtCO2 from 36 to 20 mmHg and then, further, to 15 mmHg. Concurrently there was a small tear in the occipital sinus. A VAE was therefore suspected. The EtCO2 changes observed during the VAE, with corresponding arterial blood gas analyses, are depicted in . There were no associated changes in hemodynamics or oxygenation. The EtCO2 returned to normal within a few minutes, following measures such as administration of 100% oxygen and prevention of further air entrainment through packing of the surgical site with saline-soaked gauze. The tear in the occipital sinus was identified and clipped.\nExcision of the tumor was uneventful, and intra-operative blood loss during the excision was around 500 ml. CVP was maintained at around 11-14 cmH2O. The patient remained hemodynamically stable. During the final stages of dura closure, application of the Valsalva maneuver was requested by the surgeon to check for cerebrospinal fluid leaks and assess the adequacy of hemostasis. Immediately after releasing the sustained positive pressure during the Valsalva maneuver, the EtCO2 again suddenly decreased from 30 to 9 mmHg, followed by a reduction in blood pressure to 62/30 mmHg and ST-T depression by 1 mmHg. Precordial auscultation at the apex of the heart revealed a mill-wheel murmur. The PaCO2 to EtCO2 gradient was 39 mmHg (). A massive VAE was contemplated and the surgeon was cautioned.\nImmediately, 100% oxygen was administered and the incision site was packed with saline-soaked gauze pieces. The patient was then repositioned in a left lateral recumbent position. About 50-60 ml of air was aspirated from the central venous catheter. She was resuscitated with 1 L of intravenous voluven® (6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride injection) and an injection of 6 mg mephenteramine. Blood pressure and EtCO2 returned to normal. The mill-wheel murmur disappeared. Soon afterwards, the rest of the surgical procedure was continued in the lateral position.\nAt the time of wound closure, bleeding was noted from the suture line and the wound was therefore reopened to check for the source of the bleeding. The bleeding from the wound was diffuse, with no identifiable bleeding site. An abnormality in coagulation was suspected. Since blood loss was high and hemostasis could not be obtained surgically, two units of packed red blood cells (PRBCs), four units of fresh frozen plasma (FFPs) and four units of platelet-rich plasma (PRPs) were administered without waiting for the coagulation profile report. Initially, the blood began to clot and the bleeding stopped. The patient was shifted to the neurosurgical intensive care unit for post-operative ventilation and observation. Later, there was continued oozing from the operative site and from the external ventricular drain (EVD). A post-operative computerized tomography scan of the brain showed a hematoma at the operative site, which was evacuated on the first post-operative (PO) day. Surgical findings showed further oozing from the operative site and surrounding cerebellar surfaces. These were corrected with blood and blood products. The patient's blood parameters and coagulation profile, with interventions made in the following PO days are shown in . There was continued oozing at the operative site and also from other intravenous and arterial cannulation sites. She deteriorated neurologically, showing clinical features of raised intracranial pressure and an EVD persistently draining blood. On the fourth PO day, inotropic support was initiated, as the patient developed persistent hypotension along with a decreasing Glasgow Coma Scale value and absent pupillary reaction. Finally, on the fifth PO day, she passed away despite resuscitative measures. | [[18.0, 'year']] | F | {'14633569': 1, '29241232': 1, '5088480': 1, '1957857': 1, '15973914': 1, '15170398': 1, '21198503': 1, '34717530': 2, '20009308': 1, '9172037': 1, '17197859': 1, '16556106': 1, '7879778': 1, '32566316': 2, '24228151': 2} | {'7294353-1': 1, '8557023-1': 1} |
164,077 | 3822031-1 | 24,228,152 | noncomm/PMC003xxxxxx/PMC3822031.xml | Anesthetic management of a patient with Lennox-Gastaut syndrome with intractable epilepsy -a case report- | The patient was a 34-month-old girl with a height of 90 cm and weight of 12.5 kg who was diagnosed with Lennox-Gastaut syndrome who was scheduled for surgical treatment of a lower lid epiblepharon. She was born by normal spontaneous vaginal delivery with a weight 3.52 kg at 38 weeks 6 days and there were no specific abnormalities in the antenatal exam. At the age of 40 days, she began to show signs of generalized tonic-clonic seizures. At that time, there were no abnormalities in her EEG and magnetic resonance imaging (MRI), but video-electroencephalographic monitoring showed lateralized to midline central, regionalized to central. Repeated EEG and MRI were normal and an epilepsy monitoring unit showed hypermotor seizures in the left frontotemporal and central regions.\nShe displayed developmental delay when compared to toddlers in the same age group. Because of the ataxia and muscle atrophy, she had been bedridden. Although she took antiepileptic drugs (AEDs), the tonic seizures persisted. As an additional treatment, she had given a ketogenic diet for 2 months. However, it also had no effect and was stopped. The frequency of the seizure was about three to ten times per day. Her preoperative vital signs, chest X-ray and laboratory data were normal ().\nThe patient took phenobarbital (30 mg), vigabatrin (300 mg), carbamazepine (250-200-100 mg), levetiracetam (250 mg), leucovorin (5 mg), pyridoxine (12.5 mg), lamotrigine (chewable, 12.5 mg) until the morning of the day of operation. Midazolam (1.2 mg, 0.1 mg /kg) was administered intravenously for sedation upon entering the operating room. Before anesthesia, the blood pressure was 94/60 mmHg, heart rate was 89 beats/min and oxygen saturation was 100%. Anesthesia was induced with thiopental sodium (50 mg, 5 mg/kg) intravenously and mask ventilation was started with 5 vol% isoflurane and 100% oxygen. After checking that the mask ventilation was operating properly, rocuronium bromide (10 mg, 1 mg/kg) was administered. After a minute, proper muscle relaxation was verified and the glottis was exposed using a Machintosh laryngoscope number 2. The trachea was intubated with an endobronchial tube with a 4.5 mm envelope. Mechanical ventilation was started with pressurecontrolled ventilation at a pressure 14 cmH2O (a tidal volume 90-100 ml) and a respiratory rate of 18-20 beats/min. Anesthesia was maintained with isoflurane (1.0-1.2 vol %) in oxygen (40%). Monitors included electrocardiography, pulse oxymetry and capnography, and inspired and the end-tidal concentrations of isoflurane were measured. During the operation, the blood pressure was 85-100/40-50 mmHg, heart rate was 85-110 beats/min, oxygen saturation was 100% and body temperature was 36.1-36.7℃. The blood sugar level was 149 mg/dl during the middle of the operation. The operation lasted a total of about 2 hours and 150 ml Ringer's lactate solution was supplied. At the end of surgery, anesthetics were discontinued. She recovered spontaneous respiration and glycopyrrolate (0.1 mg, 0.01 mg/kg) and pyridostigmine (2.5 mg, 0.2 mg /kg) were intravenously injected. After extubation was performed, her respiratory and circulatory conditions were stable and she was transferred to the postanesthetic care unit (PACU). Forty minutes later, during her stay with her mother in the PACU, she had a tonic seizure attack with mild eyeball deviation. The duration of the seizure was thirty seconds and there was no saturation change during the convulsion. According to her mother, the seizure was similar to her usual symptoms. She was discharged from the hospital the following day without complications. | [[34.0, 'month']] | F | {'21351810': 1, '12027914': 1, '21790560': 1, '19211283': 1, '19590288': 1, '20841413': 1, '18931234': 1, '15230698': 1, '20421790': 1, '17578972': 1, '16633775': 1, '2108815': 1, '11074184': 1, '18173905': 1, '24228152': 2} | {} |
164,078 | 3822065-1 | 24,228,240 | noncomm/PMC003xxxxxx/PMC3822065.xml | Orthodontic and surgical management of cleidocranial dysplasia | A 12-year-old Asian boy diagnosed with CCD presented with his father, who had the same condition. The patient's chief complaint was described by his father as "anting normal eruption of his permanent teeth and better alignment of his upper and lower arches." His medical and surgical histories included recurrent otitis media with tubes placed in the tympanic membranes and bilateral femoral osteotomies to correct coxa vara. The boy showed the classical craniofacial features of CCD: broad forehead, hypertelorism, and short upper third of the face (). The initial extraoral examination revealed a retrognathic and vertically deficient maxilla (), resulting in a concave facial profile.\nThe initial intraoral examination revealed a skeletal class III pattern with 9-mm anterior crossbite and 3-mm open bite, moderate-to-severe maxillary crowding, and mild mandibular crowding (). The panoramic radiograph showed nine retained primary teeth, seven supernumerary teeth, four impacted permanent teeth, and no congenitally missing permanent teeth (). The initial lateral cephalogram confirmed the skeletal class III relationship due to maxillary underdevelopment ().\nThe treatment involved five steps and was expected to continue until skeletal maturity, when the underdeveloped maxilla was to be surgically corrected. The first step was to treat multiple primary and newly erupted permanent teeth for caries due to poor oral hygiene.\nAt age 14, nine retained primary teeth (i.e., 53, 62, 63, 74, 73, 72, 82, 83, and 84) were extracted and seven supernumerary teeth were surgically removed under general anesthesia (). All the permanent canines were also removed, because they were determined to be nonretrievable due to severe impaction. The permanent teeth were observed for possible spontaneous eruption over 9 months.\nThe mandibular lateral incisors and maxillary right lateral incisor failed to erupt spontaneously. These teeth were surgically exposed and bonded with brackets and gold chains tied to maxillary and mandibular lingual arches for guided eruption (). Simultaneously, a mesiodens and the maxillary right primary second molar were extracted. Shortly thereafter, full maxillary and mandibular fixed orthodontic appliances were placed for alignment and coordination of the dental arches (). The maxillary right lateral incisor was repositioned in the canine space ().\nTo correct the transverse maxillary discrepancy, a transpalatal arch was used. At skeletal maturity (age 19), the maxilla was advanced and downfractured to correct 6 mm of the sagittal maxillary discrepancy and vertical deficiency (). The postsurgical healing was good with excellent patient compliance and the orthodontic treatment was completed ().\nThe final step was implant placement and prosthodontic rehabilitation. Implants were placed for the maxillary right lateral incisor and left canine and mandibular canines (). The mandibular right canine-premolar space required two separate implants. Because the second molars were the last teeth to develop and the patient had been in treatment for a long time, these teeth were not retrieved. Treatment was completed with the delivery of the final crowns for the implants at age 24.\nThe final extraoral and intraoral photographs are shown in . Fifty-three hard-tissue and soft-tissue landmarks were digitized by an orthodontist using Dolphin software (version 11.5; Dolphin Imaging and Management Solutions, Chatsworth, CA, USA). The pretreatment and posttreatment lateral cephalograms were superimposed to illustrate treatment-induced changes (). Comparison of the ANB, overbite, and overjet values between these time points () showed a dramatic improvement in the sagittal jaw relationship after the maxillary advancement surgery and orthodontic treatment. | [[12.0, 'year']] | M | {'18797104': 1, '9182765': 1, '26389062': 1, '14516670': 1, '19028669': 1, '21040462': 1, '17321454': 1, '26339428': 1, '9182762': 1, '29498969': 1, '30514338': 1, '30123273': 2, '11510638': 1, '29520374': 1, '17023750': 1, '29664332': 1, '9527313': 1, '16222673': 1, '26301237': 1, '9009920': 1, '19280233': 1, '23102800': 1, '25243150': 1, '24228240': 2} | {'3822065-2': 2, '6079435-1': 1} |
164,079 | 3822065-2 | 24,228,240 | noncomm/PMC003xxxxxx/PMC3822065.xml | Orthodontic and surgical management of cleidocranial dysplasia | A 14-year-old Caucasian girl diagnosed with CCD presented for orthodontic treatment with a desire to have greater number of teeth to be visible. Her mother and younger sister also had CCD. Her medical and surgical histories revealed mitral valve prolapse, tethered spinal cord, arthritis, Crohn's disease, thyroid reduction surgery, tonsillectomy, and Z-plasty of the lingual frenulum. The initial evaluation revealed jaw pain, bilateral temporomandibular joint clicking, and facial muscle pain. Mouth breathing, tongue thrusting, and clenching habits were also noted.\nThe patient had a concave facial profile and decreased facial height due to maxillary underdevelopment. Her lips were retrusive, resulting in an edentulous appearance (). The intraoral examination showed that she had five retained primary teeth (i.e., 55, 63, 75, 74, and 73) and 15 fully erupted permanent teeth (). She had a negative sagittal jaw relationship with class III malocclusion due to the hypoplastic maxilla (). On the panoramic radiograph, 14 impacted permanent teeth were identified and the left mandibular second molar was determined to be congenitally missing (). The lateral cephalogram confirmed maxillary hypoplasia (). Multiple impacted supernumerary teeth had been extracted 2 years earlier along with the mandibular right first molar, due to extensive caries.\nOrthodontic treatment was initiated with the following objectives: maxillary expansion, removal of the retained primary and supernumerary teeth, guided eruption or extrusion of the impacted permanent teeth, and correction of the class III jaw relationship by maxillary advancement surgery.\nA hyrax expander was placed for 2 months, which achieved 11 mm of expansion (). Heavy upper and lower wires were placed; the retained primary teeth were removed; and impacted permanent teeth 11, 15, 21, 22, 23, 35, and 47 were surgically exposed and bonded with gold chains placed close to the cusp tips for guided eruption (). All the bonded teeth except 21 erupted after approximately 11 months. The maxillary left central incisor was extracted because of exposure of the root, which was very short.\nOrthodontic alignment and coordination of the dental arches were complete in 14 months (). Le Fort I osteotomy was performed at age 18 (). With the removal of the remaining orthodontic appliances and placement of an implant and a fixed prosthesis for the maxillary left central incisor, the treatment was completed (). However, the patient's poor oral hygiene during the retention stage led to complete loss of the maxillary dentition.\nAlthough no post treatment extraoral and intraoral photographs were obtainable, because of the loss of the maxillary teeth, the Dolphin software was used to digitize and superimpose the pretreatment and postsurgical lateral cephalograms (). Comparison of the ANB and overjet values between these time points indicated improvement in the sagittal jaw relationship after the maxillary advancement surgery and orthodontic treatment (). The overbite also improved significantly, from -6.7 mm to 0.1 mm\nWe reviewed our database (FileMaker Pro 10.0 V3; FileMaker Inc., Santa Clara, CA, USA) of all the individuals with CCD who had been diagnosed at the UCSF. summarizes their clinical features.\nSeventeen (nine female and eight male) affected individuals were identified. Four of 15 individuals (the height of two individuals was not recorded) had short stature. Further, 57% had a family history of CCD, with one-to-three generations of CCD passed down in the family. Eight of the 17 individuals had vertebral changes such as scoliosis. The characteristic features of this condition, such as missing or hypoplastic clavicles, persistent metopic sutures, frontal bossing, and hypertelorism, were observed in 93%, 94%, 88%, and 69% of these subjects, respectively. A high incidence of otitis media that required surgery to place pressure-equalization tubes was noted. Seven patients had speech problems and received speech therapy ().\nRegarding the dental features, congenital hypodontia was observed in 12% of this population. The number of retained primary teeth ranged from 0 to 20, with the mandibular canine being the most frequently retained primary tooth (). On average, the mandibular primary teeth were slightly more likely to be retained than the maxillary ones. The number of impacted permanent teeth ranged from 3 to 27, with the incisors and canines being the most frequently impacted in the maxillary and mandibular arches, respectively (). Zero to 18 supernumerary teeth were observed.\nNoteworthily, 14 of the 17 subjects had maxillary hypoplasia, 88% had class III malocclusion due to the hypoplastic maxilla, and 10 patients required Le Fort I maxillary advancement surgery. | [[14.0, 'year']] | F | {'18797104': 1, '9182765': 1, '26389062': 1, '14516670': 1, '19028669': 1, '21040462': 1, '17321454': 1, '26339428': 1, '9182762': 1, '29498969': 1, '30514338': 1, '30123273': 2, '11510638': 1, '29520374': 1, '17023750': 1, '29664332': 1, '9527313': 1, '16222673': 1, '26301237': 1, '9009920': 1, '19280233': 1, '23102800': 1, '25243150': 1, '24228240': 2} | {'3822065-1': 2, '6079435-1': 1} |
164,080 | 3822304-1 | 24,189,079 | noncomm/PMC003xxxxxx/PMC3822304.xml | Radiologically isolated syndrome: an uncommon finding at a university clinic in a high-prevalence region for multiple sclerosis | The patient with RIS was a 43-year-old woman without any neurological symptoms or any history of neurological disorders except for migraine since more than 10 years. A neurological examination did not reveal any pathological findings. She had good effect of triptanes. Owing to her long history of migraine and still frequent attacks she was referred for MRI of the brain in February 2001. The scan showed 15 supratentorial T2 lesions, of which 12 were periventricular and 2 were juxtacortical. Gadolinium-enhanced sequences showed enhancement in one of the lesions. Thus three of the four of the Barkhof criteria were fulfilled. Images obtained from this patient can be seen in . Owing to the MRI findings, she was referred to a neurologist in March where a second neurological examination was normal. Cerebrospinal fluid analysis revealed oligoclonal bands and an elevated IgG index. In May she returned to the neurological clinic due to a sudden onset of intermittent bilateral symptoms in arms and hands. A new neurological examination revealed bilateral tremor and dysmetria. A new MRI in June showed three new non-enhancing supratentorial lesions. She was diagnosed with MS and at a follow-up in September the symptoms in the upper extremities had worsened. She received prednisolone treatment and was started on interferon β therapy. In November she had Lhermitte's sign and MRI showed a cervical spine lesion. Except for one occurrence of lower extremity symptoms in 2005, she has remained relapse free as of the latest neurological follow-up in March 2013. | [[43.0, 'year']] | F | {'9397021': 1, '8669231': 1, '29082298': 1, '19597085': 1, '12708816': 1, '13704472': 1, '34093421': 1, '19667020': 1, '16696904': 1, '22218466': 1, '22300971': 1, '23886745': 1, '21559385': 1, '6615282': 1, '16256141': 1, '19687093': 1, '20610492': 1, '21748263': 1, '2741673': 1, '22760099': 1, '21270417': 1, '22262744': 1, '20657230': 1, '21459810': 1, '26000228': 1, '17978290': 1, '8845702': 1, '20645263': 1, '10404909': 1, '20971756': 1, '18507677': 1, '26846927': 1, '19073949': 1, '23635962': 1, '18202208': 1, '32009206': 1, '23380650': 1, '24189079': 2} | {} |
164,081 | 3822352-1 | 24,235,798 | noncomm/PMC003xxxxxx/PMC3822352.xml | Infected inguinal hernia mesh presenting as pseudotumor of the bladder | A 53-year-old male presented to the surgical department with lower abdominal pain. An ultrasound revealed a well-defined 5.6 × 4.6 cm isoechoic lesion superior to the urinary bladder and connecting with the umbilicus via a duct, suggesting an urachal remnant lesion or an infected urachal cyst. Subsequently, he was referred to our urology department for further management.\nHe was diabetic and had undergone a laparoscopic inguinal hernia mesh repair 2 years previously. Physical examination revealed some abdominal tenderness. Urine sediment and culture showed no abnormalities, laboratory findings were normal and abdominal computed tomography (CT) scan confirmed a urachal cyst []. Preoperative cystoscopy showed normal bladder mucosa. The patient deferred intervention for 9 months for personal reasons. On laparotomy, a 10-12 cm fibrous nodular mass was seen arising from the dome of the urinary bladder, fixed to the right posterior surface of the rectus muscles. Because the procedure was performed late at night, no pathologist was available so frozen section could not be done. Because of its malignant appearance, we considered the risk of invasion and metastasis very likely, what resulted in discontinuation of the procedure. Incisional biopsy was taken and procedure was deferred until histopathological examination was done. Because the preoperative CT scan had become dated, we repeated an abdominal CT scan postoperative, which showed a lesion with heterogeneous solid components and thickening of anterior bladder wall []. Histopathological examination revealed fibroinflammatory tissue.\nRuled out malignant disease, 6 days after the initial procedure relaparotomy with frozen section was planned. During dissection, the tumor was identified infiltrating the posterior wall of the right rectus sheath. Frozen section was done to exclude a sampling error and to rule out an inadequate first sample. Further dissection revealed presence of the previously placed inguinal mesh []. Excision of ventral part of the bladder wall, total fibrous tissue, and mesh was performed and frozen section was suggestive of inflammatory pseudotumor. Histopathological examination confirmed the frozen section, without any signs of malignancy []. The postoperative period was uncomplicated and patient was discharged asymptomatically after 3 days. | [[53.0, 'year']] | M | {'15649297': 1, '7611533': 1, '21858435': 1, '9338743': 1, '10215837': 1, '24744531': 1, '24235798': 2} | {} |
164,082 | 3822353-1 | 24,235,799 | noncomm/PMC003xxxxxx/PMC3822353.xml | Emphysematous pyelonephritis with IVC thrombus in new onset diabetes mellitus | A 48-year-old, premenopausal lady was admitted with constant and dull aching right sided flank pain of a week's duration. She had a fever for three days and three episodes of gross painless hematuria without clots. She had decreased urine output for 5 days, but no lower urinary tract symptoms. She was recently diagnosed to have diabetes mellitus but was not on any anti-diabetic measures.\nOn examination, she was febrile, with pulse rate of 90/min and blood pressure of 120/80 mmHg. She was not anemic or icteric and was fairly well hydrated. Abdomen was soft with no distension but tenderness was present in the right renal angle without any mass. External genital examination and per vaginal examination were normal.\nHer laboratory results were notable for a raised total leukocyte count with increased polymorphs and the platelet count was 180,000cells/cu.mm. Urine examination revealed deposits showing plenty of WBC and 20-25 RBCs/hpf. Urine culture and sensitivity showed E. coli 103/hpf, sensitive to amikacin, piperacillin-tazobactum, and cefoperazone sulbactum. Blood culture was sterile. Renal functions showed blood urea of 120 mg/dl, serum creatinine of 5.4 mg/dl, serum sodium of 130mEq/dl, serum potassium of 4.2mEq/dl. Serum prothrombin time, activated Partial Thromboplastin Time (APTT), assay of antithrombin III, proteinC, proteinS, and anti-phospholipid antibodies were normal.\nX-ray KUB showed colonic shadows displaced downwards and the right renal area was occupied by gas shadows. Right kidney measured 14 cm × 4.4 cm and hyperechogenic gas shadows were observed on the ultrasonogram (USG). Left kidney measured 10.2 cm × 3.8 cm. Coticomedullary differentiation and pelvicalyceal system were normal [].\nContrast enhanced computed tomographic scan of (CECT) revealed right kidney enlargement with perinephric stranding, air pockets in the pelvicalyceal system, parenchyma, and deep to the Gerota's fascia. A thrombus was seen in the right renal vein, extending into the IVC. Color Doppler confirmed the findings [-]. Diethylene triamine pentaacetic acid (DTPA) isotope study was deferred due to raised renal parameters. The patient was started on injection Piperacillin with tazobactum, 4.5 g IV twice daily for 7 days. Metronidazole 500 mg IV thrice daily was also started empirically to cover anerobic infections. She was also anticoagulated with Heparin 5,000 units IV four times a day. She was hemo-dialysed 4 times and her urine output improved to 1.5-2L/day. Her serum creatinine decreased to 2 mg/dl and blood urea of 62 mg/dl in a week's time.\nThe patient improved symptomatically and repeat USG color Doppler showed complete recanalization of the IVC thrombus and partial recanalization of the right renal vein thrombus. As she was considered high risk for any other surgical procedure, cystoscopy and right sided double J stenting was performed under local anesthesia and her urine output improved to 3L/day. A DTPA scan showed right differential function of 33% and total glomerular filtration rate (GFR) was 59 ml/min [].\nThe patient became symptom free and was discharged. She is on regular follow up now and a repeat CECT and magnetic resonance imaging (MRI) showed the right kidney with improved function even after 3 months [ and ]. | [[48.0, 'year']] | F | {'31519724': 1, '10737279': 1, '31983919': 2, '17631348': 1, '11251339': 1, '24235799': 2} | {'6968883-1': 1} |
164,083 | 3822354-1 | 24,235,800 | noncomm/PMC003xxxxxx/PMC3822354.xml | Fetus in bladder | A 29-year-old female, with 2 living children, underwent medical termination of pregnancy at 17th week of gestation in her native village. The patient did not have any medical records and did not know the method of termination adopted by the village doctor. She presented to our hospital the next day with complaints of gross hematuria and pain abdomen. On examination, her abdomen was soft and non-tender. Previous lower-segment Cesarean section (LSCS) scar was noted. Ultrasonogram abdomen showed a dead fetus of approximately 17 weeks in the bladder []. All other routine investigations were within normal limits. Cystoscopy showed dead fetus in the urinary bladder with a wide vesicouterine fistula 2 cm proximal to trigone in the posterior wall of bladder [].\nThe abdomen was opened by a Pfannensteil incision. Cystotomy was performed and the dead fetus was removed. Both the anterior wall of the uterus and the posterior wall of the bladder were closed with absorbable sutures with omental interposition. Ligation of bilateral fallopian tubes was performed. The post-operative period was uneventful and there was no urinary incontinence after catheter removal. | [[29.0, 'year']] | F | {'10361852': 1, '28105051': 2, '31269093': 1, '4027516': 1, '15491573': 1, '13411039': 1, '3540759': 1, '24235800': 2} | {'5220462-1': 1} |
164,084 | 3822356-1 | 24,235,802 | noncomm/PMC003xxxxxx/PMC3822356.xml | Obstructive uropathy due to uretero-inguinal hernia: An uncommon occurrence | A 67-year-old obese man was referred for further investigation following an episode of sudden - onset left-sided loin pain that had lasted for 6 h and then resolved spontaneously. He had type 2 diabetes mellitus, but no other relevant past medical history. Physical examination revealed a large left - sided irreducible, non-tender inguino-scrotal hernia, and laboratory investigation, including serum creatinine was within normal limits. An ultrasound scan of his renal tract revealed left-sided hydronephrosis, and a subsequent computed tomography scan showed left-sided hydronephrosis with a dilated ureter that was seen to enter the large inguino-scrotal hernia [Figures and ]. It then took a path back out of the hernia where it became non-dilated and inserted into the bladder in its usual position.\nA subsequent dimercaptosuccinic acid (DMSA) scan confirmed reduced function of the affected kidney, contributing 35% to overall renal function and hence he underwent a mesh repair of this hernia with careful dissection of the ureter from the hernial sac and his post-operative recovery was uneventful. | [[67.0, 'year']] | M | {'32611416': 2, '15972443': 1, '12213362': 1, '26180656': 2, '12612799': 1, '22498400': 1, '8632585': 1, '34489391': 1, '24235802': 2} | {'7329524-1': 1, '4490576-1': 1} |
164,085 | 3822357-1 | 24,235,803 | noncomm/PMC003xxxxxx/PMC3822357.xml | Peripheral primitive neuroectodermal tumor of the adrenal gland: A rare entity | A 37-year-old female presented with an episode of dull aching pain in the left loin. There was no history of hematuria, calculuria, lower urinary tract symptoms (LUTS), headache, palpitation, excessive sweating, weight loss, jaundice, or fever with chills. Her pulse rate was 70/min and blood pressure was 110/70 mm Hg. There was no palpable mass. Her serum cortisol (8 a.m., 4 p.m., and midnight), dehydroepiandrosterone (DHEAS), testosterone, electrolytes, urinary metanephrines, and normetanephrines were normal. Her 24 h urine cortisol was raised and low-dose dexamethasone test was positive. She was diagnosed to have Cushing's syndrome. Ultrasonography revealed an 8 × 7 cm large heterogenous left adrenal mass with internal echogenic components. Contrast-enhanced computed tomography (CECT) abdomen and pelvis also showed an 8 × 7 cm left adrenal mass with no fat density []. Left open radical nephrectomy, adrenalectomy, and spleenoraphy was done as the tumor seemed to infiltrate the kidney and was densely adhered to the spleen and the diaphragm. She had an uneventful postoperative recovery. She was given hydrocortisone during the operation which was gradually tapered in the postoperative period. Following excision of the mass, the 24 h urine cortisol level returned to normal.\nGross specimen showed a 12 × 10 × 8 cm left adrenal mass, infiltrating the left kidney. Cut section showed hemorrhagic and necrosed adrenal mass adherent to the kidney []. Microscopy showed a predominantly necrotic and hemorrhagic tumor with few viable areas composed of diffuse sheets of small to medium sized round cells with round to oval vesicular nuclei exhibiting mitoses up to 10-15/50 hpf and containing scant to moderate cytoplasm. The tumor cell nests infiltrated the thick fibrous capsule and extended into the pericapsular adipose tissue. There were foci of vascular invasion []. Immunohistological staining using CD 99 showed strong positivity []. There was weak positivity with FLI 1, in at least 50% of cells []. | [[37.0, 'year']] | F | {'29544549': 1, '7513503': 1, '10652933': 1, '28376845': 2, '3334970': 1, '27790563': 1, '20430773': 1, '15001993': 1, '19349548': 1, '24235803': 2} | {'5379633-1': 1} |
164,086 | 3822414-1 | 24,250,023 | noncomm/PMC003xxxxxx/PMC3822414.xml | Tc-99m macro aggregated albumin scintigraphy – indications other than pulmonary embolism: A pictorial essay | A 49-year-old male patient who is a known case of cryptogenic cirrhosis suspected to have HPS was referred for MAA scan []. | [[49.0, 'year']] | M | {'937842': 1, '3665319': 1, '18495027': 1, '9453490': 1, '17125634': 1, '34006236': 2, '19816701': 1, '12796194': 1, '4635418': 1, '7557096': 1, '4846113': 1, '27168866': 2, '20636308': 1, '1732368': 1, '33841523': 1, '930949': 1, '16398982': 1, '2403962': 1, '7421288': 1, '3616987': 1, '20113679': 1, '24250023': 2} | {'3822414-2': 2, '3822414-3': 2, '3822414-4': 2, '3822414-5': 2, '3822414-6': 2, '8130273-1': 1, '4854064-1': 1} |
164,087 | 3822414-2 | 24,250,023 | noncomm/PMC003xxxxxx/PMC3822414.xml | Tc-99m macro aggregated albumin scintigraphy – indications other than pulmonary embolism: A pictorial essay | A 35-year-old female who is a known case of multidrug resistant tuberculosis presented with orthopnea, left sided chest pain and productive cough. Her chest X-ray was suggestive of pyopneumothorax. Intercostal drain insertion and pleural fluid aspiration was done. As patient's condition was not improving by medical management, surgical management was contemplated. She underwent pulmonary function test, which showed adequate FEV1 value. In view of extensive involvement of the left lung parenchyma, cardiothoracic surgeon wanted to predict the post-operative FEV1 by virtue of a lung perfusion scintigraphy. The calculated differential MAA distribution in the left lung was 9% and hence, we predicted a 9% loss of the estimated FEV1 post-pneumonectomy. Patient was thus cleared for surgery [Figures and ]. | [[35.0, 'year']] | F | {'937842': 1, '3665319': 1, '18495027': 1, '9453490': 1, '17125634': 1, '34006236': 2, '19816701': 1, '12796194': 1, '4635418': 1, '7557096': 1, '4846113': 1, '27168866': 2, '20636308': 1, '1732368': 1, '33841523': 1, '930949': 1, '16398982': 1, '2403962': 1, '7421288': 1, '3616987': 1, '20113679': 1, '24250023': 2} | {'3822414-1': 2, '3822414-3': 2, '3822414-4': 2, '3822414-5': 2, '3822414-6': 2, '8130273-1': 1, '4854064-1': 1} |
164,088 | 3822414-3 | 24,250,023 | noncomm/PMC003xxxxxx/PMC3822414.xml | Tc-99m macro aggregated albumin scintigraphy – indications other than pulmonary embolism: A pictorial essay | A 58-year-old male patient was admitted with breathlessness, associated dry cough and fever. He was diagnosed to have bilateral bullous disease of lungs. Bilateral bullectomy was planned. Hence, patient was referred for lung perfusion scan to predict post-operative FEV1 and to look for segmental differential perfusion. However, surgery was later deferred due to associated severe cardiac comorbidities [Figures and ]. | [[58.0, 'year']] | M | {'937842': 1, '3665319': 1, '18495027': 1, '9453490': 1, '17125634': 1, '34006236': 2, '19816701': 1, '12796194': 1, '4635418': 1, '7557096': 1, '4846113': 1, '27168866': 2, '20636308': 1, '1732368': 1, '33841523': 1, '930949': 1, '16398982': 1, '2403962': 1, '7421288': 1, '3616987': 1, '20113679': 1, '24250023': 2} | {'3822414-1': 2, '3822414-2': 2, '3822414-4': 2, '3822414-5': 2, '3822414-6': 2, '8130273-1': 1, '4854064-1': 1} |
164,089 | 3822414-4 | 24,250,023 | noncomm/PMC003xxxxxx/PMC3822414.xml | Tc-99m macro aggregated albumin scintigraphy – indications other than pulmonary embolism: A pictorial essay | A 69-year-old male patient, who is a known case of right hepatocellular Ca with right portal vein thrombosis, was referred for Tc-99m MAA scintigraphy for planning liver radionuclide microspheres therapy. Tc-99m MAA scintigraphy showed significant MAA uptake corresponding to the site of CT detected liver tumor. There was minimal MAA shunting in bilateral lungs. No other extra hepatic sites of abnormal MAA uptake were seen. Patient was thus considered for liver radionuclide microsphere therapy with reduction in administered activity [Figures and ]. | [[69.0, 'year']] | M | {'937842': 1, '3665319': 1, '18495027': 1, '9453490': 1, '17125634': 1, '34006236': 2, '19816701': 1, '12796194': 1, '4635418': 1, '7557096': 1, '4846113': 1, '27168866': 2, '20636308': 1, '1732368': 1, '33841523': 1, '930949': 1, '16398982': 1, '2403962': 1, '7421288': 1, '3616987': 1, '20113679': 1, '24250023': 2} | {'3822414-1': 2, '3822414-2': 2, '3822414-3': 2, '3822414-5': 2, '3822414-6': 2, '8130273-1': 1, '4854064-1': 1} |
164,090 | 3822414-5 | 24,250,023 | noncomm/PMC003xxxxxx/PMC3822414.xml | Tc-99m macro aggregated albumin scintigraphy – indications other than pulmonary embolism: A pictorial essay | A 21-year-old male patient with sudden onset dyspnea was referred for ventilation perfusion scan to look for pulmonary embolism. In view of the acute presentation and no risk factors, a simultaneous venography study using Tc MAA was scheduled. Tc-99m MAA was injected simultaneously through bilateral pedal veins as part of pulmonary perfusion scan to look for deep vein thrombosis. Whole body images showed significant collateral vessels with associated anteromedial basal segmental lung perfusion defect in the left lung [Figures and ]. Later doppler study of bilateral lower limbs confirmed subacute thrombus involving left iliac and left common femoral veins. | [[21.0, 'year']] | M | {'937842': 1, '3665319': 1, '18495027': 1, '9453490': 1, '17125634': 1, '34006236': 2, '19816701': 1, '12796194': 1, '4635418': 1, '7557096': 1, '4846113': 1, '27168866': 2, '20636308': 1, '1732368': 1, '33841523': 1, '930949': 1, '16398982': 1, '2403962': 1, '7421288': 1, '3616987': 1, '20113679': 1, '24250023': 2} | {'3822414-1': 2, '3822414-2': 2, '3822414-3': 2, '3822414-4': 2, '3822414-6': 2, '8130273-1': 1, '4854064-1': 1} |
164,091 | 3822414-6 | 24,250,023 | noncomm/PMC003xxxxxx/PMC3822414.xml | Tc-99m macro aggregated albumin scintigraphy – indications other than pulmonary embolism: A pictorial essay | A 27-years-old known cirrhotic female patient, who underwent peritoneal venous shunt (PVS) 6 months ago, was referred for the evaluation of shunt patency. There was no history of malena or hemetemesis. On examination, her abdomen was very tense and mildly tender with positive fluid thrill. Dilated cutaneous veins (caput medusae) were visible around the umbilicus. From this clinical presentation, it was evident that her PVS was not functioning properly. It was confirmed by Tc-99m MAA shunt scintigraphy and site of shunt obstruction was localized by a simple and non-invasive nuclear medicine protocol [Figures and ]. | [[27.0, 'year']] | F | {'937842': 1, '3665319': 1, '18495027': 1, '9453490': 1, '17125634': 1, '34006236': 2, '19816701': 1, '12796194': 1, '4635418': 1, '7557096': 1, '4846113': 1, '27168866': 2, '20636308': 1, '1732368': 1, '33841523': 1, '930949': 1, '16398982': 1, '2403962': 1, '7421288': 1, '3616987': 1, '20113679': 1, '24250023': 2} | {'3822414-1': 2, '3822414-2': 2, '3822414-3': 2, '3822414-4': 2, '3822414-5': 2, '8130273-1': 1, '4854064-1': 1} |
164,092 | 3822415-1 | 24,250,024 | noncomm/PMC003xxxxxx/PMC3822415.xml | Diffuse nesidioblastosis diagnosed on a Ga-68 DOTATATE positron emission tomography/computerized tomography | A 50-day-old pre-term female infant presented with persistent hyperinsulinemic hypoglycemia. The child was born at 35 weeks of gestation, with breathing difficulty since birth. She developed cyanosis on day 2 of life with seizures thereafter. On investigation the child was found to be hypoglycemia (blood glucose level = 16.8 mg/dl) and hyperinsulinemia with serum insulin levels of 149.70 IU/ml (n = 2.0 IU/ml). Screening for sepsis was negative. The child required intravenous glucose infusion up to 10 mg/kg/min and oral feeds fortified with glucose to maintain euglycemic state. Ga-68 DOTATATE positron emission tomography/computerized tomography (PET/CT) scan showed diffusely increased tracer uptake in the entire pancreas with no abnormal tracer uptake anywhere else in the body, suggestive of a diffuse variant of nesidioblastosis []. The child is currently on injection octreotide but not fit for definitive surgical management (near total pancreatectomy). | [[50.0, 'day']] | F | {'31237140': 1, '19970380': 1, '9625298': 1, '17236890': 1, '9589638': 1, '15809476': 1, '10202168': 1, '10685982': 1, '20020586': 1, '9522211': 1, '17382266': 1, '24250024': 2} | {} |
164,093 | 3822417-1 | 24,250,026 | noncomm/PMC003xxxxxx/PMC3822417.xml | 18F-fluorodeoxyglucose positron emission tomography/computed tomography in a case of malignant peripheral nerve sheath tumor: An unusual presentation | A 64-year-old male, working as a gardener, presented with multiple rapidly progressive asymptomatic skin colored raised lesions 2-4 cm in diameter, over the medial border of the right foot and lower part of the right leg since 1 month. The lesion was subjected to punch biopsy, with clinical differential diagnosis of sporotrichosis, actinomycetoma, linear cutaneous leishmaniasis and atypical mycobacterial infection. Histopathology revealed a malignant mesenchymal tumor, which was confirmed to be a MPNST on immunohistochemistry. Soon thereafter, the lesions rapidly increased in size and number and began to ulcerate and become painful []. Magnetic resonance imaging (MRI) of the right lower limb revealed multiple enhancing nodular lesions seen involving the skin and subcutaneous tissue. Subsequently, a whole body 18F-FDG PET/contrast-enhanced computed tomography (CECT) scan was performed on a whole body full ring PET/CT camera (Discovery STE 16, GE). 370 MBq of 18F-FDG was administered intravenously subsequent to a 6 h fast. Whole body CECT scan was performed after intravenous instillation of non-ionic contrast medium. After the CT scan, an emission scan was performed from head to thigh for 2 min per frame. Images were reconstructed by 3D VUE algorithm (GE) and viewed on a Xeleris workstation (GE) using the volumetric protocol. The study revealed multiple FDG avid nodular lesions (maximum standardized uptake value 18.6) in the right lower limb [], which were many more in number compared with those picked up on cutaneous examination.\nMPNSTs arise from a peripheral nerve or its branches or from the nerve sheath.[] Although they may arise spontaneously, up to 50% arise in patients of neurofibromatosis 1 (NF1).[] Histopathological and immunohistochemical studies play an important role in the diagnosis of these tumors. MRI is the imaging modality of choice because it can reveal the nerve of origin and its relationship to adjacent structures.[] Although it is well-known that these tumors can extend for considerable distances along nerves, it may not always be possible to delineate the origin from the nerve. A recent study by Bilgic et al. Has shown that the nerve origin could be identified only in 45-56% cases.[] There have been recent reports of FDG PET/CT in MPNST, most of which have been performed in patients with NF1. It has been documented as a useful tool in monitoring clinically stable NF1 patients with plexiform neurofibromas as it could predict which were more likely to subsequently grow rapidly.[] It has also been found that in patients with NF1 harboring MPNSTs; higher FDG uptake is associated with poorer survival rates.[] It has proved efficacious in distinguishing benign from malignant nerve sheath tumors. In addition, it can assist in guiding targeted needle core biopsies and may provide critical information in tumors that are not amenable to biopsy.[] It thus plays an important role in the staging, restaging and post-therapy follow-up of MPNST in NF1.[] A high FDG uptake has been documented in sporadic MPNSTs also, as is well seen in the coronal maximum intensity projection image [] in the present case.\nMPNSTs usually present as discrete masses, which may be multifocal, especially in cases of NF1. The present case was unusual in its presentation, owing to the linear arrangement of multiple nodules over the lower extremity in a gardener, raising the possibility of infectious dermatoses. These multiple hypermetabolic mildly enhancing nodular lesions were restricted to the skin and subcutaneous tissue with no extension into the underlying muscles []. The additional lesions detected on PET/CT were also proven to be MPNST based on histopathology with immunocytochemistry []. Radical surgical resection is the treatment of choice in MPNST.[] They are generally considered chemotherapy and radiotherapy resistant tumors. Though multimodality therapy, including surgical resection and adjuvant radiotherapy, is available, the prognosis remains dismal. | [[64.0, 'year']] | M | {'16881077': 1, '2119249': 1, '18071635': 1, '25177396': 1, '1561333': 1, '15192465': 1, '10218464': 1, '31612779': 1, '19924789': 1, '9808129': 1, '16404595': 1, '14530818': 1, '24250026': 2} | {} |
164,094 | 3822418-1 | 24,250,027 | noncomm/PMC003xxxxxx/PMC3822418.xml | Evaluation of bone metastasis as the first presentation of hepatocellular carcinoma using 18-fluorodeoxyglucose positron emission tomography-computed tomography | A 75-year-old man presented with left thoracolumbar pain that he had for 3 weeks to internal medicine out-patient department in Ataturk University School of Medicine, Erzurum at Turkey. He had no history of previous injury. The patient did not have clinical symptoms of systemic diseases, such as malaise, weight loss or fever. Physical examination revealed local tenderness over the left iliac crest. Abdominal, respiratory, cardiovascular and neurological examinations were normal. An abdominal ultrasound showed that the liver was enlarged and that there were multiple echogenic lesions in the right lobe of the liver with varying diameters between 1 and 4 cm. The images suggested malignant lesions, either metastasis or HCC. Blood tests showed a high α-fetoprotein (AFP) level (50,000 IU/ml; normal range, <5.8 IU/ml). The PET/CT images showed focally increased 18F-FDG uptake in liver segments V and VII. In addition, multiple foci of increased 18F-FDG uptake in lytic bone lesions involving the vertebrae, ribs, pelvic bones and left femur with associated soft-tissue components were seen []. A pathological examination of biopsy material taken from the left eighth rib confirmed metastatic HCC []. | [[75.0, 'year']] | M | {'18688127': 1, '18483745': 1, '17462181': 1, '11564960': 1, '24250027': 2} | {} |
164,095 | 3822419-1 | 24,250,028 | noncomm/PMC003xxxxxx/PMC3822419.xml | Bone scintigraphic patterns in patients of tumor induced osteomalacia | A 32-year-old female patient presented to our hospital with a history of progressive, generalized weakness and bony pain of 1½ year duration, after having unsuccessful treatment at different hospitals. Her biochemical report revealed low serum phosphate level with elevated fibroblast growth factor 23 (FGF23) (452.6 RU/ml) and alkaline phosphatase level while other investigations were within the normal limits. She was subjected to bone scan to rule out metabolic bone disorders and assess the secondary bony changes. Bone scan was performed after 4 h of intravenous injection of 20 mCi of technetium 99m methylene diphosphonate. The bone scan demonstrated increased radiotracer uptake over the mandible, ribs, vertebrae and sternum suggestive of metabolic bone disease. There were features of prominent costochondral beadings and increased tracer uptake over multiple growth plates []. The TIO has been established on subsequent imaging followed by excision of tumor that came out to ameloblastic fibroma. | [[32.0, 'year']] | F | {'7830124': 1, '2594039': 1, '18369618': 1, '14158235': 1, '28326350': 1, '13155814': 1, '1985332': 1, '32455150': 1, '7451793': 1, '21490240': 1, '10495143': 1, '11705323': 1, '31293296': 1, '15777669': 1, '19138617': 1, '632900': 1, '8177270': 1, '14730508': 1, '26907825': 1, '6548080': 1, '18936605': 1, '16239206': 1, '11136887': 1, '33469091': 1, '26917888': 1, '24250028': 2} | {'3822419-2': 2, '3822419-3': 2} |
164,096 | 3822419-2 | 24,250,028 | noncomm/PMC003xxxxxx/PMC3822419.xml | Bone scintigraphic patterns in patients of tumor induced osteomalacia | A 26-year-old female patient presented with a history of proximal muscle weakness, low backache and pain both lower limbs of 1 year duration, more so for last 3 months. The provisional diagnosis of hypophosphatemic rickets secondary to TIO was made on the basis of biochemical and imaging findings. The FGF23 (918.2 RU/ml) and alkaline phosphatase were markedly elevated and low phosphorus level. The bone scan revealed bilateral multiple ribs, bilateral shoulders, acetabulum and femoral heads and mild increased focal uptake in right mid foot focally. In addition, the delayed bone scan revealed increased focal uptake in left proximal fibula (also noticed on flow and pool phases) however that was not related to metabolic pattern []. Finally, patient turned out to be a case of TIO. The tumor was excised and histopathology revealed it to be suspicious of mesenchymal tumor. | [[26.0, 'year']] | F | {'7830124': 1, '2594039': 1, '18369618': 1, '14158235': 1, '28326350': 1, '13155814': 1, '1985332': 1, '32455150': 1, '7451793': 1, '21490240': 1, '10495143': 1, '11705323': 1, '31293296': 1, '15777669': 1, '19138617': 1, '632900': 1, '8177270': 1, '14730508': 1, '26907825': 1, '6548080': 1, '18936605': 1, '16239206': 1, '11136887': 1, '33469091': 1, '26917888': 1, '24250028': 2} | {'3822419-1': 2, '3822419-3': 2} |
164,097 | 3822419-3 | 24,250,028 | noncomm/PMC003xxxxxx/PMC3822419.xml | Bone scintigraphic patterns in patients of tumor induced osteomalacia | A 34-year-old female presented with progressive weakness in proximal muscles. Her biochemical profile revealed low phosphorus, elevated FGF23 level (147.9 RU/ml) and the rest were within the normal limits. She was diagnosed to be suffering with severe hypophosphatemic osteomalacia. Whole body bone scan showed increased tracer uptake in bilateral maxillary bone, bilateral shoulder, wrist, sternoclavicular, knee and ankle joints, multiple ribs and mid shaft of bilateral femora []. The tumor was localized on functional imaging. It was resected out with histopathology report consistent of mesenchymal tumor and resulting in significant relief of symptoms post-operatively. | [[34.0, 'year']] | F | {'7830124': 1, '2594039': 1, '18369618': 1, '14158235': 1, '28326350': 1, '13155814': 1, '1985332': 1, '32455150': 1, '7451793': 1, '21490240': 1, '10495143': 1, '11705323': 1, '31293296': 1, '15777669': 1, '19138617': 1, '632900': 1, '8177270': 1, '14730508': 1, '26907825': 1, '6548080': 1, '18936605': 1, '16239206': 1, '11136887': 1, '33469091': 1, '26917888': 1, '24250028': 2} | {'3822419-1': 2, '3822419-2': 2} |
164,098 | 3822420-1 | 24,250,029 | noncomm/PMC003xxxxxx/PMC3822420.xml | Broncho-esophageal fistula leading to lung abscess: A life-threatening emergency detected on FDG PET/CT in a case of carcinoma of middle third esophagus | A 37-year-old male presented with grade III dysphagia. He also had recent onset high grade fever with chills. Nasogastric tube (NGT) was placed. Upper gastro-intestinal endoscopy (UGIE) showed friable mass in the middle third of esophagus, biopsy from which showed adenocarcinoma cells. Staging FDG PET/CT study was done. Maximum intensity projection image showed an hypermetabolic area in mid-thorax [-thick arrow] with diffuse low grade uptake around it [-thin arrow]. Axial fused PET/CT image [Figure and - arrow] showed a large intensely FDG avid soft-tissue mass in the middle third of esophagus, closely abutting the right main and segmental bronchi, measuring 32 mm × 32 mm, with maximum standardized uptake value of 27.2. Abutting this mass, a centrally necrotic ill-defined mass, with air pockets within and peripheral low intensity FDG uptake in the thick walls; was seen in the right lung parenchyma, in the lower lobe [Figure and -arrow heads]. Minimum intensity projection (minIP) reformatted sagittal [] and axial CT [] images showed a definite communication (arrow-head) between the mass (thick arrow) and the right lower lobar bronchus (thin arrow). Patient, when again asked for any complaints, said to have coughing immediately after swallowing. On collating history and imaging findings and also considering the fact that the patient underwent interventions like NGT placement and UGIE, a diagnosis of lung abscess secondary to BE fistula was made. Patient was started immediately on antibiotics and underwent esophageal stenting. Radiotherapy, though indicated, was ruled out due to presence of BE fistula. | [[37.0, 'year']] | M | {'11243981': 1, '20165591': 1, '34040307': 1, '9925392': 1, '6635173': 1, '17058646': 1, '22582047': 1, '23207263': 1, '24250029': 2} | {} |
164,099 | 3822421-1 | 24,250,030 | noncomm/PMC003xxxxxx/PMC3822421.xml | Prostate cancer with lytic bone metastases: 18F-fluorodeoxyglucose positron emission tomography-computed tomography for diagnosis and monitoring response to medical castration therapy | A 67-year-old male patient presented with low grade fever of 3 months duration. During routine work-up, multiple lytic lesions were demonstrated on the radiograph of pelvis, suspicious for metastases. The patient underwent 18F-FDG PET-CT for localization of the primary malignancy. 18F-FDG PET-CT images revealed multiple lytic lesions involving almost entire skeleton, showing increased 18F-FDG uptake (highest maximum standardized uptake value-6.9 [SUVmax]) [Figure and ]. The prostate gland was enlarged and showed increased 18F-FDG uptake along the periphery (SUVmax-5.5) []. Also noted were enlarged 18F-FDG avid pelvic (SUVmax-10.6) [] and retroperitoneal (SUVmax-6.4) [] lymph nodes. Based on the 18F-FDG PET-CT findings a diagnosis of carcinoma prostate with nodal and lytic skeletal metastases was made. The diagnosis was confirmed with transrectal ultrasound guided biopsy from prostate, which revealed prostatic adenocarcinoma with perineural invasion (Gleason score-9/10). The serum prostate specific antigen (PSA) was elevated (370 ng/ml; normal: 0-4 ng/ml).\nAs lytic metastases are uncommon in prostate cancer, the patient underwent bone marrow biopsy to rule out any other malignant pathology. Bone marrow biopsy revealed metastatic carcinoma, positive for cytokeratin and PSA but negative for thyroid transcription factor-1, confirming the diagnosis. The patient was advised orchiectomy, which he refused. The patient was then put on medical castration therapy with combined androgen blockade. He was given luteinizing hormone releasing hormone agonist goserelin (10.8 mg subcutaneous injection every 3 months) along with non-steroidal anti-androgen bicalutamide (50 mg once daily orally).\nSix months later the patient was referred for response assessment 18F-FDG PET-CT. 18F-FDG PET-CT revealed that most of the lytic lesions were replaced with sclerotic lesions with no significant 18F-FDG uptake [Figure and ], except for lytic lesions in eighth dorsal vertebra, which showed mild 18F-FDG uptake (SUVmax-3.2). Also noted was a reduction in size of the prostate gland and disappearance of peripheral 18F-FDG uptake (SUVmax-1.1) []. The pelvic and retroperitoneal lymph nodes also have disappeared [Figure and ]. Thus, a diagnosis of minimal residual disease was made on 18F-FDG PET-CT. This correlated with serum PSA levels, which showed drastic reduction (0.14 ng/ml; normal: 0-4 ng/ml). | [[67.0, 'year']] | M | {'21342722': 1, '26870210': 1, '34385796': 1, '33720051': 1, '8638000': 1, '11505204': 1, '21285676': 1, '27567615': 1, '16105512': 1, '21149473': 1, '29445457': 2, '12031380': 1, '9935208': 1, '3621814': 1, '24250030': 2} | {'5799632-1': 1} |
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