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164,600 | 3853603-1 | 24,349,844 | noncomm/PMC003xxxxxx/PMC3853603.xml | Burn Injury Caused by Laptop Computers | A 24-year-old boy with reddish brown pigmented and painful dry skin, with no blisters, on his left leg was reported []. Burning caused by the laptop was observed. No other skin abnormalities were stated. No further laboratory tests or skin biopsy was not performed. No medical history until presentation of this condition was reported. The patient reported that he placed the portable computer in his lap while he was sitting cross-legged and playing computer games for 4 h. An interesting thing in this case is that the erythema was caused in just 4 h within 3 days. He recognized that the laptop got hot on the left side; however, regardless of that, he did not change its position. | [[24.0, 'year']] | M | {'11524043': 1, '18038695': 1, '7165330': 1, '12457838': 1, '22250245': 1, '22274001': 1, '15591087': 1, '33352652': 1, '9472438': 1, '1793491': 1, '20022704': 1, '20921068': 1, '24349844': 2} | {} |
164,601 | 3853604-1 | 24,349,845 | noncomm/PMC003xxxxxx/PMC3853604.xml | Cellular Schwannoma Arising from Sigmoid Mesocolon Presenting as Torsion | A 58-year-old female presented to emergency department with acute abdomen of 2 h onset. Clinically, the patient was afebrile and had tenderness in lower abdomen. Ultrasonography (USG) and emergency plain computer tomography (CT) scan was carried out. USG revealed a homogenous and hypoechoic solid lesion in pelvis without any evidence of lymphadenopathy. Plain CT displayed a large pelvic mass of approximate size of 17 cm × 15 cm × 12 cm extending to lower abdomen, with mass effect causing displacement of the bowel superiorly and toward right. Mass appeared relatively dense in plain CT. Right ovary could not be visualized and left ovary appeared bulky. There was moderate degree of ascites and minimal pleural effusion. Based on clinical symptoms and plain CT findings, a presumptive diagnosis of torsion of right ovarian neoplasm was made. Emergency laparotomy was carried out. During laparotomy, it was evident that the large mass was arising from sigmoid mesocolon and was twisted around its axis with marked congestion on its surface. Complete surgical excision was carried out. Histopathological examination of the specimen was carried out. Cut surface [] of the specimen revealed well encapsulated lesion containing multiple nodules of grey white solid areas and areas of congestion. Microscopic examination [] of multiple sections from grey white solid areas revealed fascicles, whorls and palisades (Antoni A areas) of spindle cells varying from wavy nerve bundles to plump elongated cells with moderate eosinophilic cytoplasm. Verocay bodies were absent and Antoni B areas were scanty. Dense hyalinization was evident in all the sections studied. Small to large caliber hyalinized congested blood vessels were seen. Immunostaining showed diffuse S-100 positivity [, inset] and no reactivity for CD117, CD34, SMA, CD31, HMB-45, and desmin. A diagnosis of cellular schwannoma with torsion was conferred. | [[58.0, 'year']] | F | {'17907300': 1, '21944791': 1, '19324168': 1, '12372915': 1, '12889049': 1, '24349845': 2} | {} |
164,602 | 3853606-1 | 24,349,847 | noncomm/PMC003xxxxxx/PMC3853606.xml | Periapical Infection Masquerading as a Nasal Pustule | A 28-year-old male presented at the Restorative dental clinic, University of Benin Teaching Hospital, Benin City, Nigeria with a discolored maxillary left central incisor (tooth #11) of 4 years duration [], patient could not remember what happened to the tooth, examination of the tooth revealed Ellis class I fracture on the mesial incisial edge of the tooth. However, there was no carious lesion on the tooth. Pulp sensibility test with electric pulp tester was not responsive, and periapical radiolucency was evident in the periapical radiograph. Root canal treatment was commenced on tooth #11 immediately, through an access cavity on the palatal surface of the tooth. The canal was irrigated with 0.9% saline and 2.5% sodium hypochlorite solution. Intracanal medicament (calcium hydroxide) was placed in the canal, and the access cavity was temporarily sealed with zinc oxide eugenol. Patient was given a 2 day appointment for determination of working length of the tooth since the working length was not determined during the initial visit because of time constrains and continuation of the root canal treatment. Patient showed up for his appointment, examination revealed that the tooth was asymptomatic, but there was a discharging sinus in the floor of the right nostril [].\nA further history revealed that the patient had been under the care of an Otorhinolargngologist for about 2 years for the treatment of the discharging sinus that he had been on several antibiotics, which he could not remember their names. The temporary seal and intracanal medicament were removed and the canal was checked using paper points, pus was revealed in the canal. Canal was the irrigated with 2.5% sodium hypochlorite and 0.9% saline alternatively. The working length was established at 29 mm using radiographic method [].\nBiomechanical preparation of the canal was done using the step back under copious irrigation. Non-setting calcium hydroxide dressing was placed in the canal as inter-appointment medicament and the patient was giving a 4 week appointment. Patient returned 4 weeks later symptom free and complete healing of the sinus in the floor of the right nostril. Canal was obturated with guttapercha using the cold lateral condensation technique []. Access was sealed with glass ionomer cement and the patient was given a 1 month review appointment. Review after 1 month showed that the patient was asymptomatic, and there was no sinus in the floor of the nose, Subsequent reviews at the 3 months and 6 months revealed no symptoms. | [[28.0, 'year']] | M | {'1524369': 1, '9477827': 1, '12469779': 1, '16977826': 1, '11199759': 1, '14676095': 1, '6853781': 1, '3950118': 1, '10377641': 1, '15220655': 1, '11290693': 1, '26649208': 2, '15759963': 1, '24349847': 2} | {'4662969-1': 1} |
164,603 | 3853607-1 | 24,349,848 | noncomm/PMC003xxxxxx/PMC3853607.xml | Typhoid Intestinal Perforation: 24 Perforations in One Patient | A 35-year-old male patient was admitted in surgery out-patient department with complains of fever for 2 weeks, abdominal pain and vomiting for 4 days, abdominal distension for 2 days, and constipation for 2 days. He did not receive any treatment during 2 weeks. There was no history of chronic abdominal pain or analgesic abuse, but patient was a smoker and alcoholic. There was no any history suggestive of previous typhoid infection. On physical examination, abdomen was tense, tender, and distended with absent bowel sound. Both guarding and rigidity were present all over the abdomen. On digital rectal examination, there was empty rectum. An upright abdominal radiograph showed free gas under both domes of diaphragm. Laboratory examinations gave the following results: Hematocrit 30%, white blood cell count 14500/cm3, platelets 268 000/cm3, sodium 138 mEq/L, potassium 3.2 mEq/L, blood urea 32 mg/dl, S. Creatinine 1.6 mg/dl, blood glucose 110 mg/dl, and total bilirubin of 2.5 mg/dl. Diagnostic test for hepatitis B, hepatitis C and HIV were negative. The patient was Widal positive (Titer of > 1:160). An abdominal ultrasound showed features consistent with intestinal perforation showing both free fluid and free air with fine floating echoes in peritoneal cavity. However, blood culture was negative for Salmonella typhi in the patient. No bile culture was performed pre-operatively. Hence, the diagnosis of acute peritonitis due to intestinal perforation was made pre-operatively.\nThe patient was resuscitated with intravenous fluid and commenced on antibiotics ceftriaxone and metronidazole pre-operatively. Nasogastric tube insertion for decompression and urethral catheterization was carried out for monitoring urine output. Exploratory laparotomy was performed through midline incision and fecal peritonitis with exudative flakes all over the intestine was found. Thorough peritoneal lavage was carried out with normal saline. There were 24 perforations (21 in terminal ileum and 3 in cecum) present in distal 35-40 cm of terminal ileum reaching up to ileocecal junction and the Cecum on anti-mesenteric border as shown in Figures and . Resection of the perforated intestinal segment with ileo-transverse anastomosis (side-to-side) with proximal loop ileostomy was performed. Abdominal tube drain Fr. 30 was put in pelvis after thorough peritoneal lavage using the normal saline and abdomen was closed in layers. Patient was kept on i.v. fluids and nil orally for 3 days. Broad spectrum antibiotic in the form of 3rd generation cephalosporin with metronidazole and fluoroquinolone were given for 7 days. Nasogastric tube and abdominal drain tube were removed on 3rd post -operative day (POD). Ileostomy started functioning on 4th POD. Patient was discharged on 7th POD with oral fluoroquinolone for 7 days. Histopathological examination revealed evidence of severe acute inflammation, with fibrinopurulent exudates extending along the serosal surface of intestine and acute and chronic inflammation was observed immediately adjacent to the site of perforation. Evidence of villous blunting and elongation of the crypts was observed, which suggests chronic mucosal injury. We were unable to isolate S. typhi from resected bowel specimen; however, stool culture was positive for S. typhi. We were unable to perform Polymerase chain reaction for isolation of S. typhi and other serotypes responsible for TIP due to scarcity of resources at our center. These findings are consistent with TIP. On the basis of these findings, the diagnosis of typhoid enteric perforation was confirmed. Patient came regularly for follow-up, gained weight, and managed ileostomy properly. We closed ileostomy after 12 weeks. | [[35.0, 'year']] | M | {'17629741': 1, '18408786': 1, '30836838': 1, '12839392': 1, '33999000': 1, '33755582': 2, '2031355': 1, '21546726': 1, '30346608': 1, '15792765': 1, '9803640': 1, '9193272': 1, '29312633': 1, '29430317': 2, '6498468': 1, '31666788': 1, '24349848': 2} | {'5753017-1': 1, '8103489-1': 1} |
164,604 | 3853609-1 | 24,349,850 | noncomm/PMC003xxxxxx/PMC3853609.xml | Xanthogranulomatous Endometritis: An Unusual Pathological Entity Mimicking Endometrial Carcinoma | Herein, we report a case of a 45-year-old multigravida who presented with the complaints of continuous bleeding per vaginum for last 3 months with irregular menstrual history for 1 year. Per vaginal examination showed bulky retroverted uterus with clear bilateral fornices and healthy cervix and vagina. Laboratory investigations showed leukocytosis and low hemoglobin (8.0 gm %). On ultrasonography, she had a bulky uterus with slight thickening of anterior wall. Endometrial thickness was 12 mm. With these findings, clinical diagnosis of endometrial hyperplasia/carcinoma was made. Subsequently, she underwent fractional curettage. Grossly, we received multiple soft tissue pieces together measuring 1.5 × 1.0 × 0.5 cm. Hematoxylin and Eosin (H and E) stained sections showed proliferative endometrial glands with loose and edematous stroma, along with numerous histiocytes having foamy cytoplasm, lymphocytes, plasma cells, and areas of hemorrhage [Figures -]. No evidence of malignancy was present. Serological marker for carcinoembryonic antigen was measured to exclude malignancy. Special stains for bacteria, acid-fast bacilli (AFB), and fungi were negative. With the above findings, histological diagnosis of XE was made. Patient is currently under regular follow-up. | [[45.0, 'year']] | F | {'30386451': 1, '16725016': 1, '33086455': 2, '17710239': 2, '3838238': 1, '2390008': 1, '27499597': 2, '34194800': 2, '24349850': 2} | {'1939916-1': 1, '7674763-1': 1, '7674763-2': 1, '8223691-1': 1, '4960947-1': 1} |
164,605 | 3853619-1 | 24,349,860 | noncomm/PMC003xxxxxx/PMC3853619.xml | An Extensive Denture-Induced Hyperplasia of Maxilla | A 51-year-old female patient visited the department of Oral Medicine and Radiology, Yenepoya Dental College, Mangalore with a complaint of pain while chewing since 1 year. She also gave a history of small soft tissue mass in relation to the upper arch which has developed to the present size over a 12-month period. The patient has been wearing upper removable complete denture for 6 years. Pain was moderate and intermittent. The patient used to wear the denture during night time also. Her denture had become loose over a period of time and teeth were attrited. Her medical and family history was noncontributory. She had no deleterious habit like tobacco chewing. Extra oral examination showed no abnormality. She was moderately built and nourished. Intraoral examination revealed multiple hyperplastic tissue folds in the right maxillary buccal vestibule extending from the right lateral incisor region to the third molar area with maxillary denture flange fitting in between the tissue folds []. There was an irregular ulcer measuring 2 × 1 cm in diameter on the surface of the lesion in relation to first molar covered with slough. The lesion was firm, nontender except in the area where ulcer was present. Palatal mucosa was normal and there was generalized recession of gingiva in the lower arch and bilaterally molars were missing. The denture hygiene was poor. On the basis of history and clinical examination a provisional diagnosis of denture-induced hyperplasia was made. The patient was instructed not to wear the denture. Hexigel ointment was prescribed to be applied on the ulcer. Oral prophylaxis was done in the lower arch. The patient was educated and motivated to maintain the oral hygiene. Seeing the extent of the lesion, a surgical resection was planned along the full length of the maxilla after reviewing the patient for any medical condition. The tissue was infiltrated with local anesthesia containing adrenaline 2% and posterior superior alveolar, infraorbital and greater palatine nerve blocks were given. Using a no. 15 surgical blade an outline for resection in a wedge shape was made along the length of the lesion. The resection was then carried out from the midline till the posterior tuberosity region. Hemostasis was achieved. The field was cleaned with betadine and saline solution. A primary closure was achieved using 3-0 vicryl suture material []. Postoperatively, antibiotics and analgesics were prescribed. The patient was instructed not to wear the denture and rinse the mouth with chlorhexidine mouthwash. The excised specimen [] was sent for histolopathological examination. It revealed hyperplastic epithelium in most of the areas, and the underlying connective tissue was fibrous, with moderate inflammatory infiltrate consisting of predominantly lymphocytes. The patient was recalled for follow-up after a week and the healing was satisfactory. The new denture was fabricated after 1 month []. The patient is on regular follow-up for 6 months and there was no recurrence of the lesion till date []. | [[51.0, 'year']] | F | {'20804684': 1, '14632931': 1, '16261799': 1, '34881043': 2, '19784472': 1, '17687178': 1, '28757870': 1, '24349860': 2} | {'8647225-1': 1} |
164,606 | 3853626-1 | 24,968,399 | noncomm/PMC003xxxxxx/PMC3853626.xml | Autoimmune pancreatitis mimicking pancreatic tumor | A 60-year-old male is presented with abdominal pain. On CT scan, a 70 × 66 × 48 mm' lesion was identified in the tail of the pancreas. Repeated aspiration demonstrated no malignancy, tumor markers were within the normal range. Control imaging studies showed enlargement of the mass, infiltrative growth, venous compression and appearance of a pathologic lymph node, suggesting a malignant process, therefore we decided surgical exploration (Fig. ). A solid, malignantly appearing lesion was identified in the body and tail of the pancreas, infiltrating the splenic hilum and transverse colon. A pylorus-preserving total pancreatectomy with splenectomy and extended right hemicolectomy was performed with an uneventful postoperative recovery (Fig. ).\nOn histological examination, both lesions contained elongated spindle cells, infiltration of plasma cells, lymphocytes, histiocytes and eosinophilic granulocytes. There was no evidence of malignancy. Large number of plasma cells were IgG positive, and 40% of the cells were IgG4 positive (Fig. ).\nLaboratory tests proved an elevated IgG4 level (2.4 g/l). | [[60.0, 'year']] | M | {'30687529': 2, '22416175': 1, '14579295': 1, '21947719': 1, '22316447': 1, '14687817': 1, '17026742': 1, '21997479': 1, '21412117': 1, '17555461': 1, '21452084': 1, '24968399': 2} | {'6320463-1': 1} |
164,607 | 3853662-1 | 24,347,975 | noncomm/PMC003xxxxxx/PMC3853662.xml | Safety and efficacy of generic drugs with respect to brand formulation | A 70-year-old woman presented with a history of recurrent urinary infections was admitted on July 10, 2012, to her general practitioner (GP) for the development of painful burning sensation when urinating. History revealed the presence of blood hypertension treated with calcium blockers (amlodipine, 10 mg/day) and a previous history of skin reaction after amoxicillin treatment. Clinical evaluation revealed discomfort in the lower abdomen and pain in the pelvic area. Laboratory findings of urinary samples documented the presence of leucocytes and blood, with an acid pH []. Moreover, urine had a strong smell and appeared cloudy.\nOn July 12, 2012, a diagnosis of acute cystitis was performed and a 7 days treatment with ciprofloxacin (Ciproxin, Bayer® 750 mg once daily) was prescribed; on 13 July microbiological evaluation of urine samples revealed the presence of Escherichia coli (2 × 105 colony forming units [CFU]/mL), with a good sensibility to both ciprofloxacin (Minimum inhibitory concentrations [MIC]: 4.9 mcg/mL; range: 0.06-8) and amoxycillin-clavulanate (3.96 mcg/mL; range: 1-16).\nDuring the follow-up performed on 20 July, the persistence of cystitis induced a new microbiological evaluation that revealed, 3 days later, an infection sustained from E. coli (5 × 105 CFU/mL) still ciprofloxacin-sensitive (MIC: 4.9 mcg/mL; range: 0.06-8).\nPharmacological evaluation revealed that the patient took the generic ciprofloxacin (Mylan Generics® 750 mg once daily) instead of the prescribed drug; therefore, the brand formulation of ciprofloxacin (Ciproxin, Bayer®; 750 mg once daily) was prescribed with an improvement of clinical symptoms and laboratory values [] and without the development of side-effects. | [[70.0, 'year']] | F | {'19354002': 1, '10822040': 1, '25709353': 2, '30864528': 1, '33679098': 1, '30886679': 1, '21976350': 1, '21098752': 1, '12419643': 1, '31474853': 1, '23756530': 1, '34877189': 1, '15772142': 1, '22466725': 1, '21953472': 1, '22836278': 1, '19534646': 1, '23737767': 1, '19902197': 1, '21637264': 1, '22480963': 1, '19776300': 1, '16871472': 1, '15194037': 1, '20528365': 1, '19430791': 1, '18303146': 1, '17535076': 1, '20329806': 1, '31011430': 1, '18292608': 1, '23826016': 1, '17301916': 1, '17523709': 1, '25210399': 1, '23143788': 1, '23084317': 1, '29024974': 1, '18843219': 1, '27536342': 1, '20347307': 1, '18852829': 1, '18460585': 1, '19442104': 1, '30362335': 1, '8459373': 1, '20855286': 1, '33947178': 1, '24347975': 2} | {'3853662-2': 2, '3853662-3': 2, '3853662-4': 2, '4319249-1': 1} |
164,608 | 3853662-2 | 24,347,975 | noncomm/PMC003xxxxxx/PMC3853662.xml | Safety and efficacy of generic drugs with respect to brand formulation | A 72-year-old woman has been brought to her GP's attention for the development of an acute bacterial bronchitis. History revealed the presence of blood hypertension in treatment with calcium blocker (amlodipine 10 mg daily) and a beta-blocker (atenolol 100 mg/day).\nOn examination, blood pressure was 120/85 mm Hg, body temperature was 38.6°C and no lymphadenomegaly/lymphadenopathy was observed. Cardiovascular and abdominal relieves were normal.\nClinical evaluation documented the presence of wheezing, coughing with green mucus and shortness of breath. Therefore, paracetamol (500 mg as need) and levofloxacin (Tavanic, sanofi-aventis® 500 mg tablet once daily for 10 days) were prescribed, but 4 days later the patient returned to the GP for the persistence of symptoms. A detailed pharmacological evaluation revealed that the patient was taking generic levofloxacin (Ranbaxy®, 500 mg once daily) instead of the branded ones because in agreement with Italian law, the pharmacist advised that a bioequivalent drug with a lower price was available.\nGeneric levofloxacin was changed to Tavanic® with a complete improvement of symptoms in 2 days and without the development of side-effects. | [[72.0, 'year']] | F | {'19354002': 1, '10822040': 1, '25709353': 2, '30864528': 1, '33679098': 1, '30886679': 1, '21976350': 1, '21098752': 1, '12419643': 1, '31474853': 1, '23756530': 1, '34877189': 1, '15772142': 1, '22466725': 1, '21953472': 1, '22836278': 1, '19534646': 1, '23737767': 1, '19902197': 1, '21637264': 1, '22480963': 1, '19776300': 1, '16871472': 1, '15194037': 1, '20528365': 1, '19430791': 1, '18303146': 1, '17535076': 1, '20329806': 1, '31011430': 1, '18292608': 1, '23826016': 1, '17301916': 1, '17523709': 1, '25210399': 1, '23143788': 1, '23084317': 1, '29024974': 1, '18843219': 1, '27536342': 1, '20347307': 1, '18852829': 1, '18460585': 1, '19442104': 1, '30362335': 1, '8459373': 1, '20855286': 1, '33947178': 1, '24347975': 2} | {'3853662-1': 2, '3853662-3': 2, '3853662-4': 2, '4319249-1': 1} |
164,609 | 3853662-3 | 24,347,975 | noncomm/PMC003xxxxxx/PMC3853662.xml | Safety and efficacy of generic drugs with respect to brand formulation | A 49-year-old woman, without a history of other systemic diseases presented to her GP's for a fever (38°C) that appeared 2 days before accompanied by coughing with mucus and shortness of breath. A diagnosis of acute bronchitis was postulated and a treatment with paracetamol (500 mg as need) and levofloxacin (Tavanic, sanofi-aventis® 500 mg tablet once daily for 10 days) was prescribed. Six days later, patient returned to the GP for the worsening of symptoms (fever 39.5°C and green mucus). History revealed the use of generic levofloxacin (Ranbaxy®, 500 mg once daily) instead of the branded ones; therefore, generic levofloxacin was changed to Tavanic® with a complete resolution of symptoms in 7 days. No side-effects appeared during drug treatment. | [[49.0, 'year']] | F | {'19354002': 1, '10822040': 1, '25709353': 2, '30864528': 1, '33679098': 1, '30886679': 1, '21976350': 1, '21098752': 1, '12419643': 1, '31474853': 1, '23756530': 1, '34877189': 1, '15772142': 1, '22466725': 1, '21953472': 1, '22836278': 1, '19534646': 1, '23737767': 1, '19902197': 1, '21637264': 1, '22480963': 1, '19776300': 1, '16871472': 1, '15194037': 1, '20528365': 1, '19430791': 1, '18303146': 1, '17535076': 1, '20329806': 1, '31011430': 1, '18292608': 1, '23826016': 1, '17301916': 1, '17523709': 1, '25210399': 1, '23143788': 1, '23084317': 1, '29024974': 1, '18843219': 1, '27536342': 1, '20347307': 1, '18852829': 1, '18460585': 1, '19442104': 1, '30362335': 1, '8459373': 1, '20855286': 1, '33947178': 1, '24347975': 2} | {'3853662-1': 2, '3853662-2': 2, '3853662-4': 2, '4319249-1': 1} |
164,610 | 3853662-4 | 24,347,975 | noncomm/PMC003xxxxxx/PMC3853662.xml | Safety and efficacy of generic drugs with respect to brand formulation | A 41-year-old man with 4 days of pain, tenderness, swelling and pressure around the eyes presented to his medical practitioner for clinical evaluation. Examination revealed the presence of fever (37.9°C), reduced sense of smell and taste and the patient lamented nasal obstruction with a yellow discharge from the nose.\nAcute sinusitis was diagnosed and due his allergy to betalactam drugs, a treatment with levofloxacin (Tavanic, Sanofi-aventis® 500 mg tablet once daily for 14 days) with beclomethasone (Bentelan, biofutura pharma S.p.A® 1 mg tablet every 8 h for 3 days) was prescribed and patient was asked to return after 3 days for clinical evaluation. During the follow-up, 3 days later, clinical evaluation revealed the persistence of symptoms with a worsening of the fever (38.5°C) and the patient referred that he was using a generic formulation of levofloxacin (Ranbaxy®, 500 mg once daily). The change from generic to brand formulation induced a complete resolution of symptoms in about 10 days. | [[41.0, 'year']] | M | {'19354002': 1, '10822040': 1, '25709353': 2, '30864528': 1, '33679098': 1, '30886679': 1, '21976350': 1, '21098752': 1, '12419643': 1, '31474853': 1, '23756530': 1, '34877189': 1, '15772142': 1, '22466725': 1, '21953472': 1, '22836278': 1, '19534646': 1, '23737767': 1, '19902197': 1, '21637264': 1, '22480963': 1, '19776300': 1, '16871472': 1, '15194037': 1, '20528365': 1, '19430791': 1, '18303146': 1, '17535076': 1, '20329806': 1, '31011430': 1, '18292608': 1, '23826016': 1, '17301916': 1, '17523709': 1, '25210399': 1, '23143788': 1, '23084317': 1, '29024974': 1, '18843219': 1, '27536342': 1, '20347307': 1, '18852829': 1, '18460585': 1, '19442104': 1, '30362335': 1, '8459373': 1, '20855286': 1, '33947178': 1, '24347975': 2} | {'3853662-1': 2, '3853662-2': 2, '3853662-3': 2, '4319249-1': 1} |
164,611 | 3853673-1 | 24,347,986 | noncomm/PMC003xxxxxx/PMC3853673.xml | Limitations and obstacles of the spontaneous adverse drugs reactions reporting: Two “challenging” case reports | A 58-year-old female was admitted to the emergency room for hematuria. A complete blood count was performed, which showed hemoglobin of 15.3 g/dl and a white blood cells count (WBCs) of 4700/mm3. Furthermore, hemogenic tests and urine test revealed a red blood cell carpet on urine sediment analysis. Afterwards, the patient was subjected to urological visit and ultrasonography of the urinary tract that did not evidence any current disease. The woman presented a history of gastric carcinoma with negative follow up, and was currently diagnosed with osteoporosis in advanced stage, with vertebral collapse, which was treated with risedronate 35 mg tablets (one tablet once a week). Two days before admission, the patient had undergone treatment with tizanidine (Navizan®-Athena Pharma Italia S.r.l.) 4 mg tablets (one tablet twice daily) for lower back pain. Her medical history did not reveal either recurrent cystitis or cystitis refractory to therapy or previous urinary tract infections such as to account for the current clinical presentation. There were also no predisposing conditions that could be responsible for the onset of this adverse event. Previous history of drug or alcohol abuse and allergies were not reported.\nSubsequently, tizanidine treatment was discontinued and the patient was treated with ciprofloxacin 500 mg twice a day, which resulted in improvement of the above mentioned renal adverse reaction and related symptoms. To assess the possible causal relationship between the drug and the observed adverse event (causality assessment) the Naranjo probability scale was used.\nThe value obtained by this algorithm was 4 indicative of a possible causal association between the suspected drug and the renal adverse reaction. | [[58.0, 'year']] | F | {'11854789': 1, '16305591': 1, '34257376': 1, '1478002': 1, '30740536': 1, '28979130': 1, '34886135': 1, '2874511': 1, '32954565': 1, '16119975': 1, '8727270': 1, '23055677': 1, '34021217': 1, '28533699': 1, '33574396': 1, '23353557': 1, '10783037': 1, '16946229': 1, '28856572': 1, '27837337': 1, '21733633': 1, '2882567': 1, '15284797': 1, '30233378': 1, '30341487': 1, '31742765': 1, '7970008': 1, '20927722': 1, '24347976': 1, '28848652': 1, '20852161': 1, '15462150': 1, '18167175': 1, '34386242': 1, '22706618': 1, '12696998': 1, '25969656': 1, '31649536': 1, '30858980': 1, '34528216': 1, '18199279': 1, '28770283': 1, '30356301': 1, '16689555': 1, '32296857': 1, '30274320': 1, '8735689': 1, '2566944': 1, '12046048': 1, '20927006': 1, '23505792': 1, '28652195': 1, '10491452': 1, '33937402': 1, '19929032': 1, '19671176': 1, '33186061': 1, '23395963': 1, '31799496': 1, '26251632': 2, '11072960': 1, '19874254': 1, '11198499': 1, '17178273': 1, '6507223': 1, '33141869': 1, '28166633': 1, '24347986': 2} | {'3853673-2': 2, '4524377-1': 1} |
164,612 | 3853673-2 | 24,347,986 | noncomm/PMC003xxxxxx/PMC3853673.xml | Limitations and obstacles of the spontaneous adverse drugs reactions reporting: Two “challenging” case reports | A 58-year-old female accessed hospital for acute respiratory failure secondary to asthma attack. Physical examination of the chest showed reduced breath sounds with scattered groans and wheezes, and SpO2 (arterial oxygen saturation measured by pulse oximetry) of 89%. The patient had a history of bronchial asthma treated with short-acting β2-agonist bronchodilators for about 10 years. Additionally, since 4 weeks he was taking bimatoprost 0.1 mg/ml, eye drops, solution (Lumigan®-Allergan Pharmaceuticals Ireland) for the treatment of open-angle glaucoma. The patient was treated with intravenous corticosteroid therapy, adrenaline by aerosol and oxygen.\nAfter hospital discharge, the patient reported what happened to her specialist ophthalmologist who diagnosed an asthmatiform crisis likely secondary to treatment with prostanoids and, therefore, decided to discontinue bimatoprost treatment. | [[58.0, 'year']] | F | {'11854789': 1, '16305591': 1, '34257376': 1, '1478002': 1, '30740536': 1, '28979130': 1, '34886135': 1, '2874511': 1, '32954565': 1, '16119975': 1, '8727270': 1, '23055677': 1, '34021217': 1, '28533699': 1, '33574396': 1, '23353557': 1, '10783037': 1, '16946229': 1, '28856572': 1, '27837337': 1, '21733633': 1, '2882567': 1, '15284797': 1, '30233378': 1, '30341487': 1, '31742765': 1, '7970008': 1, '20927722': 1, '24347976': 1, '28848652': 1, '20852161': 1, '15462150': 1, '18167175': 1, '34386242': 1, '22706618': 1, '12696998': 1, '25969656': 1, '31649536': 1, '30858980': 1, '34528216': 1, '18199279': 1, '28770283': 1, '30356301': 1, '16689555': 1, '32296857': 1, '30274320': 1, '8735689': 1, '2566944': 1, '12046048': 1, '20927006': 1, '23505792': 1, '28652195': 1, '10491452': 1, '33937402': 1, '19929032': 1, '19671176': 1, '33186061': 1, '23395963': 1, '31799496': 1, '26251632': 2, '11072960': 1, '19874254': 1, '11198499': 1, '17178273': 1, '6507223': 1, '33141869': 1, '28166633': 1, '24347986': 2} | {'3853673-1': 2, '4524377-1': 1} |
164,613 | 3853676-1 | 24,347,989 | noncomm/PMC003xxxxxx/PMC3853676.xml | Management of dermatologic toxicities associated with monoclonal antibody epidermal growth factor receptor inhibitors: A case review | A 75-year-old man was switched to a new line tumor therapy with panitumumab (Vectibix® - Amgen Europe B.V.) (6 mg/kg of bodyweight given once every 2 weeks) for the treatment of EGFR-expressing mCRC (stage IV) with KRAS wild-type, after failure of the following chemotherapy regimens: capecitabine/oxaliplatin, capecitabine/irinotecan, capecitabine/oxaliplatin/bevacizumab, capecitabine/bevacizumab.\nThe patient had no history of severe or life-threatening hypersensitivity to panitumumab and its excipients.\nOn the morning of October 30th, 2012, he was admitted to the oncology outpatient service to receive his first infusion of panitumumab (520 mg given once every 2 weeks). His skin was healthy and the drug was well-tolerated.\nSeveral hours after initial drug infusion, he developed a pruritic, erythematous eruption over anterior chest and face. Over the time, the skin reaction worsened; but the patient was not treated with any drug. Two weeks after starting panitumumab treatment and before the second infusion, the patient reported to his oncologist an intense, pruritic, skin eruption that was appeared on the face [], scalp, neck and upper chest. Therefore, he was referred to a dermatologist for an in-depth clinical evaluation. Physical examination revealed wide erythematous areas almost entirely covered by crusted papulopustular and pustular necrotic lesions.\nExcluding any drug-drug interactions (DDIs), a diagnosis of panitumumab-induced Grade 3B papulopustular skin rash, according to NCI-CTCAE v4.0, was made. Hence, the oncologist delayed the subsequent panitumumab dose until the severity of rash was reduced to at least Grade 2 and recommended a treatment with oral levofloxacin (500 mg once daily for 5 days), topical hydrocortisone 0.1% (cream: twice daily application for 5 days) and methylprednisolone 0.1% (cream: once daily application for 5 days).\nTwo weeks later, the severity of skin symptoms reduced to Grade 2B and clinical conditions of patient allowed the administration of a subsequent drug dose. However, the second panitumumab infusion was not performed because the patient refused it, fearing a second occurrence of dermatologic toxicities. Cutaneous side-effects had a complete resolution over the next several weeks. | [[75.0, 'year']] | M | {'21596817': 1, '14993230': 1, '22997576': 1, '18794062': 1, '31037378': 1, '20215799': 1, '12644979': 1, '20680104': 1, '16508634': 1, '20142600': 1, '17671985': 1, '31627177': 1, '19144681': 1, '22712013': 1, '22978333': 1, '23321777': 1, '15793550': 1, '17470858': 1, '18160805': 1, '23826016': 1, '27718067': 1, '20191181': 1, '19470276': 1, '21244375': 1, '20145956': 1, '33530427': 1, '22753904': 1, '25295247': 1, '17981431': 1, '21630130': 1, '23130185': 2, '20169314': 1, '20580896': 1, '18048820': 1, '24347989': 2} | {'3853676-2': 2, '3481419-1': 1} |
164,614 | 3853676-2 | 24,347,989 | noncomm/PMC003xxxxxx/PMC3853676.xml | Management of dermatologic toxicities associated with monoclonal antibody epidermal growth factor receptor inhibitors: A case review | A 74-year-old man was undergoing treatment with fluoropyrimidine and irinotecan-based chemotherapy regimen (continuous infusion every 14 days) and cetuximab (Erbitux® - Merck KGaA) (once a week) for EGFR-expressing rectal carcinoma with KRAS wild-type. The patient had no history of severe hypersensitivity reactions to anti-EGFR agent.\nOn the morning of October 29th, 2012, he was admitted to the oncology outpatient service to receive his first infusion of cetuximab (720 mg, 400 mg/m2 body surface area). Prior to infusion, the patient was administered with premedication drugs: ondansetron (8 mg intravenously) and atropine sulfate (0.25 mg subcutaneously). Four days after beginning the therapy, he developed a moderately intense erythema with papules on the face. After clinical evaluation, the skin reaction was not attributed to DDIs. A diagnosis of a cetuximab-related Grade 2B papulopustular skin rash (NCI-CTCAE v4.0) was made while a decision to continue initial treatment protocol, without dose modifications, was taken, according to manufacturer's guidelines for management of drug-related skin toxicities. The patient was advised both systemic and topical treatment: oral levofloxacin (500 mg once daily for 5 days); moisturizing, non-perfumed and soothing cream (twice daily application for 1 week); fusidic acid and betamethasone cream – 2% + 0.1% (twice daily application for 1 week). He was also advised to take sun-protective measures and avoid activities and products that were likely to dry skin, in order to reduce the risk of rash exacerbation.\nThese pre-emptive and treatment strategies improved skin symptoms and patient's compliance with therapy. | [[74.0, 'year']] | M | {'21596817': 1, '14993230': 1, '22997576': 1, '18794062': 1, '31037378': 1, '20215799': 1, '12644979': 1, '20680104': 1, '16508634': 1, '20142600': 1, '17671985': 1, '31627177': 1, '19144681': 1, '22712013': 1, '22978333': 1, '23321777': 1, '15793550': 1, '17470858': 1, '18160805': 1, '23826016': 1, '27718067': 1, '20191181': 1, '19470276': 1, '21244375': 1, '20145956': 1, '33530427': 1, '22753904': 1, '25295247': 1, '17981431': 1, '21630130': 1, '23130185': 2, '20169314': 1, '20580896': 1, '18048820': 1, '24347989': 2} | {'3853676-1': 2, '3481419-1': 1} |
164,615 | 3853678-1 | 24,347,991 | noncomm/PMC003xxxxxx/PMC3853678.xml | A possible case of natalizumab-dependent suicide attempt: A brief review about drugs and suicide | A 32-year-old woman was diagnosed with relapsing-remitting MS in 2001, displaying typical MS features on magnetic resonance imaging (MRI) and in the cerebrospinal fluid (presence of oligoclonal bands) according to McDonald's criteria. Initially, she was treated with subcutaneous high-dose interferon β-1a (44 mcg) thrice a week, for one year, and amitriptyline (25 mg/day), because she complained of migraine without aura and depression (Beck Depression Inventory score: 15). She was unable to tolerate the flu-like syndrome and she switched to glatiramer acetate for further three years. In October 2008, after discontinuation of glatiramer acetate due to adverse drug events (recurrent syncope), a significant progression in lesions was observed, on MRI investigation. In July 2010, the patient was admitted to our Clinical Neurology Department and she was commenced on natalizumab immunotherapy (300 mg every fourth week). At this point, she presented with an Extended Disability Status Scale Score estimated at 5 and a Beck Depression Inventory Score estimated at 4. We decided to continue the antidepressant therapy with amitriptyline (25 mg/every day) because she had benefit both in mood disturbance and migraine attacks (assessed on two attacks every month). After the twenty-fifth natalizumab infusion, she was brought into the Emergency Department, as she had collapsed next to an empty bottle of amitriptyline. She had a Glasgow coma scale score of 7 / 15, was tachycardic and twitchy. After a rapid sequence induction and intubation, she had benefit from gastric lavage. Unfortunately the toxicological assessment of dosage of drugs was not performed.\nShe was admitted to our Neurology Department and underwent a comprehensive clinical and laboratory investigation. In particular, the MRI examination did not show a progression of brain lesions, cerebrospinal fluid study was negative for JC virus, and anti-drug antibodies against natalizumab were not detected. A progressive multifocal leukoencephalopathy diagnosis was excluded and after psychiatric evaluation, a diagnosis was made of severe depressive disorder and psychosis. Indeed, as a precautionary measure natalizumab therapy was stopped, with improvement of psychosis after two weeks. On the basis of the Naranjo probability scale, we have documented a possible association between a suicidal attempt and natalizumab treatment, and we have reported this case as adverse drug reaction. Nevertheless, the exact contribution of amitriptyline and natalizumab to the genesis of suicidal attempts remains unclarified. We thought that natalizumab had induced suicidal ideation, because the depression disturbance was well-controlled by amitriptyline for several years and psychosis appeared after the introduction of natalizumab. However, it was not possible to exclude a synergic action of both drugs in the suicidal attempt. | [[32.0, 'year']] | F | {'15718539': 1, '15718538': 1, '22994856': 1, '30617497': 1, '9892952': 1, '21511689': 1, '19996040': 1, '19496806': 1, '9667561': 1, '23656853': 1, '21777829': 1, '12221156': 1, '22098148': 1, '20535512': 1, '1640228': 1, '23062672': 1, '24347991': 2} | {} |
164,616 | 3853771-1 | 24,968,395 | noncomm/PMC003xxxxxx/PMC3853771.xml | Ascaris lumbricoides: an unusual aetiology of gastric perforation | A 48-year-old male patient presented to the emergency room with severe upper abdominal pain along with vomiting for 2 days. There was no history of any drug intake, alcoholism or dyspepsia. He gave a history of occasional passage of round worms with stool. On examination, the patient was febrile with a pulse rate of 130/min and a blood pressure of 110/70 mm Hg. He was severely dehydrated with a low urine output. An abdominal examination revealed evidence of peritonitis. A straight X-ray abdomen showed free gas under both domes of diaphragm. His white blood cell count was 11000/µl, serum urea was 24.1 mmol/l, creatinine was 0.141 mmol/l, sodium was 120 mmol/l and potassium level was 3.1 mmol/l. After adequate resuscitation, an exploratory laparotomy was carried out. On opening the abdomen, air came out and around 1.2 l of bilious fluid was drained. A 1 cm × 1 cm perforation was found in the prepyloric region of stomach and two live Ascaris were seen protruding through the perforation (Figs and ). There was no scarring or induration around the perforation to suggest a long-standing peptic ulcer disease. A bundle of worms could be palpated within the small bowel. A biopsy from the margin of the perforation was taken. A rapid urease test of the biopsy specimen was negative. The perforation was repaired with Graham's omental patch after extracting the worm protruding through the perforation. Thorough peritoneal lavage was done and the abdomen was closed after placing a drain in the pelvis. The postoperative period was uneventful apart from wound infection which was treated conservatively. The patient was discharged on postoperative day 8 on anthelmentics. A histopathology report of the biopsy from the margin of perforation showed evidence of a focal acute inflammatory reaction. An upper GI endoscopy performed 1 month later did not show any evidence of peptic ulcer disease. These findings helped us in ruling out peptic ulcer disease as an aetiology for the prepyloric ulcer. | [[48.0, 'year']] | M | {'30310648': 2, '22198921': 1, '21499915': 1, '32467581': 1, '3304524': 1, '18358969': 1, '17356318': 1, '22567473': 1, '3236163': 1, '5936979': 1, '24968395': 2} | {'6172702-1': 1} |
164,617 | 3853783-1 | 24,349,670 | noncomm/PMC003xxxxxx/PMC3853783.xml | Peripheral Exudative Hemorrhagic Chorioretinopathy: A Variant of Polypoidal Choroidal Vasculopathy? | A 74-year-old Caucasian woman, with a history of a stable choroidal nevus in her right eye for 20 years, was referred to a retina specialist for evaluation of a newly detected focus of hemorrhage affecting the temporal peripheral fundus of the same eye inferior to the choroidal nevus. The hemorrhage persisted despite an intravitreal injection of bevacizumab and the patient was referred to us for further management. The patient had a history of diabetes mellitus, systemic hypertension and hypercholesterolemia.\nOn initial evaluation she had corrected visual acuity of 20/20 in both eyes and intraocular pressures were 20 and 18 mmHg in the right and left eyes, respectively. Anterior segment examination of both eyes showed mild nuclear sclerosis. Fundus of the left eye was unremarkable except for mild peripheral RPE atrophy and no evidence of AMD. On funduscopy of the right eye, a pigmented choroidal nevus measuring 6 by 4 millimeters in basal dimensions and with overlying drusen was noted at the equator along the 10 o’clock meridian. Inferior to the nevus and separate from it, two nearly confluent hemorrhagic pigment epithelial detachments (PED) were noticeable without any subretinal fluid or lipid exudation (A). There was no evidence of AMD.\nOptical coherence tomography (OCT) confirmed the presence of PED (B). Fluorescein angiography (FA) showed 2 focal areas of hyperfluorescence and leakage corresponding to the location of the PEDs (C). Due to the small size and peripheral location of the PEDs, observation was suggested.\nNine months later the hemorrhagic lesions were slightly larger with mild adjacent subretinal hemorrhage. ICGA revealed one large and several smaller polypoidal choroidal vessels corresponding to the location of the PEDs (D). After informing the patient of available treatment options, including continued observation, intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents, focal laser photocoagulation, or photodynamic therapy (PDT), one session of standard PDT with verteporfin was performed. Two months later, the sub-RPE and subretinal hemorrhage was stable in size but slightly darker in color (E). Repeat FA did not show any foci of leakage. On the next evaluation, three months later, the hemorrhagic lesion was larger in size but the patient continued to remain asymptomatic. Three weeks later, the patient experienced sudden onset of floaters and funduscopy showed a significant increase in the size of hemorrhagic PED (F), which measured 2.7 mm in thickness on B-scan ultrasonography. OCT revealed a large confluent PED with optically dense content (G). The patient received two monthly injections of intravitreal bevacizumab and on follow- up, three months later, the hemorrhagic PED was somewhat larger but the blood inside it had acquired a khaki color suggestive of old blood and lack of recent hemorrhage (H). Small foci of old subretinal hemorrhage were visible at the superior and nasal margins of the PED. | [[74.0, 'year']] | F | {'27312539': 1, '30464195': 1, '19750233': 1, '19800613': 1, '30766276': 1, '26148802': 1, '28058163': 1, '15134109': 1, '7257064': 1, '19157563': 1, '34481477': 1, '32549717': 1, '31511273': 1, '14711438': 1, '28112136': 1, '9514497': 1, '20577857': 1, '22310077': 1, '22836900': 1, '31238439': 1, '24349670': 2} | {} |
164,618 | 3853785-1 | 24,349,671 | noncomm/PMC003xxxxxx/PMC3853785.xml | Retinitis Pigmentosa Associated with Vasoproliferative Tumors and Coats-like Fundus | A 30-year-old female and a known case of RP was referred with complaints of recently decreased vision in her right eye. On examination, best corrected visual acuity (BCVA) was 20/200 and slit lamp examination was unremarkable except for trace cells in the anterior vitreous of both eyes. Fundus examination showed typical bilateral bone-spicule pigmentation and macular edema which was later confirmed by optical coherence tomography (OCT) (A). Two VPTs were present in the inferotemporal quadrant of the right eye measuring 8×6×5.5 mm and 4×3.5×2mm with extensive subretinal hard exudates. Fluorescein angiography (FA) showed some areas of capillary nonperfusion in the peripheral retina with telangiectatic and aneurysmal vascular changes around a leaking VPT lesion (). These changes resembled FA changes seen in eyes with Coats disease.\nLaser photocoagulation was applied on the VPT lesions in order to decrease their thickness and improve adjacent areas of nonperfusion. After 2 weeks, complementary cryotherapy of the VPTs was performed and the patient received an intravitreal injection of bevacizumab 2 weeks later. After 2 months, complete regression of the VPTs was noted together with persistent but stable subretinal exudates (D). The macular edema had resolved and visual acuity was improved to 20/60 at the last visit. There was no recurrence of the condition after 2 years of follow up. | [[30.0, 'year']] | F | {'11336930': 1, '32511120': 1, '17113430': 1, '2457260': 1, '32507488': 1, '7748132': 1, '19668510': 1, '20865031': 1, '5635337': 1, '1708517': 1, '28559726': 1, '19011602': 1, '24349671': 2} | {'3853785-2': 2} |
164,619 | 3853785-2 | 24,349,671 | noncomm/PMC003xxxxxx/PMC3853785.xml | Retinitis Pigmentosa Associated with Vasoproliferative Tumors and Coats-like Fundus | A 31-year-old female previously diagnosed with RP presented to our clinic complaining of decreased vision in her right eye over the past 4 days. BCVA was counting fingers at 1 meter in her right eye and counting fingers at 0.5 meter in the left one. Positive ocular findings included mild posterior subcapsular lens opacities, trace cells in the anterior chambers in both eyes, and trace blood and pigment in the anterior vitreous of the right eye. Fundus examination (A-C) revealed typical RP changes in both eyes, and macular distortion and wrinkling in the right eye. An inferotemporal exudative retinal detachment with a VPT lesion measuring 5×5×4 mm was present in the right eye and an inferotemporal VPT measuring 5×4×3mm with surrounding hard exudates was also present in the left eye. We performed FA, ultrasonography and OCT (C-G). FA revealed capillary nonperfusion with leaking aneurysmal and telangiectatic vessels not related to RP and the VPT.\nLaser photocoagulation was performed over the lesions and nonperfused areas in both eyes and after 2 weeks, cryotherapy was performed. A dense vitreous hemorrhage developed in the right eye over the following days which lasted for 3 months. As the condition was disabling, deep vitrectomy with membranectomy and ILM-peeling was performed. After 3 months, the patient showed improvement in retinal appearance (G-I). Lesion size and the associated exudates were notably decreased and vision was improved to 20/200 in the right eye but remained unchanged in the left one. There was no recurrence of the condition after 2 years of follow up. | [[31.0, 'year']] | F | {'11336930': 1, '32511120': 1, '17113430': 1, '2457260': 1, '32507488': 1, '7748132': 1, '19668510': 1, '20865031': 1, '5635337': 1, '1708517': 1, '28559726': 1, '19011602': 1, '24349671': 2} | {'3853785-1': 2} |
164,620 | 3853786-1 | 24,349,673 | noncomm/PMC003xxxxxx/PMC3853786.xml | A Case of Primary Congenital Glaucoma | An 11-year-old girl and a case of primary congenital glaucoma (PCG) with negative family history of glaucoma, was referred to our glaucoma service for uncontrolled intraocular pressure (IOP). Maximum tolerable medications and multiple glaucoma operations had failed to control her IOP.\nReview of the patient’s chart revealed an IOP of 30 mmHg and horizontal corneal diameter of 11.5 mm in both eyes when she had been 3 days old, at the time which she underwent superior and inferior trabeculotomy in both eyes at a single session. One year later, she had IOP of 30 mmHg in both eyes without optic nerve head cupping; however, corneal diameters had increased to 14 and 13.5 mm in the right and left eyes, respectively. The patient continuously received two topical glaucoma medications for 8 years thereafter with IOPs remaining around 28 mmHg. At 9 years of age, she underwent mitomycin C (MMC) augmented trabeculectomy in both eyes.\nUpon referral, the patient was on four topical agents including timolol, brimonidine, latanoprost and dorzolamide eye drops. Ten days after discontinuing all of these medications, IOP was increased from 35 to 56 mmHg and from 30 to 54 mmHg in the right and left eyes, respectively. summarizes the results of her most recent ocular examination. The optic nerve heads of both eyes are displayed in , and demonstrates the superior bulbar conjunctiva of both eyes.\nWhat are the important points about her corneal thickness (CCT) and IOP?\nWhat would your target IOP be for this patient?\nWhat is the preferred management for this patient? | [[11.0, 'year']] | F | {'15326129': 1, '646694': 1, '11133718': 1, '17410963': 1, '7073567': 1, '12567117': 1, '17102668': 1, '16527674': 1, '22623858': 1, '11912354': 1, '16308820': 1, '15505049': 1, '16602315': 1, '6849653': 1, '15118460': 1, '17106366': 1, '8488910': 1, '24349673': 2} | {} |
164,621 | 3853789-1 | 24,349,672 | noncomm/PMC003xxxxxx/PMC3853789.xml | Hypotropic Dissociated Vertical Deviation; a Case Report | A 25-year-old woman presented with esotropia of her left eye since the age of 3 to 4 months without any prior strabismus surgery or amblyopia therapy. She was apparently in good health.\nCyclorefraction was +3.74 -0.74 × 135° in her right eye, yielding BCVA of 20/25, and +3.5 -0.5 × 60° in the left eye with BCVA of 20/40. She had mild amblyopia and latent nystagmus in her left esotropic eye with appropriate corrective glasses. Worth-4-dot and Titmus tests revealed left eye suppression and no streopsis. There was bilateral lateral rectus and inferior oblique underaction (-1) together with bilateral superior oblique overaction (+2) with mild A-pattern. The function of other extraocular muscles was normal. While fixating with her right eye, prism alternate cover test revealed 40 and 45 prism diopters (PD) of esotropia in her left eye at far (6 m) and near (33 cm), respectively in addition to hypotropia of 3 PD accompanied by slow variable downward drift from 3 to 6 PD. While fixating with the left eye, there was no change in the position of the right eye. No extorsional movement was observed during downward drift which was not associated with manifest nystagmoid or rhythmic movements. Left eye hypotropia did not change with right or left gaze or head tilt. Slit lamp and fundus examination, and applanation tonometry were within normal limits in both eyes.\nShe underwent bimedial rectus muscle recession equal to 5.25 mm with 1/3 tendon width superior transposition to correct the esotropia and A-pattern simultaneously. Three months after surgery, while fixating with her right eye, mild esotropia and hypotropia of the left eye were occasionally observed (). When fusion was completely broken by the alternate cover test, 8 PD of esotropia and 3 PD of hypotropia with 3 to 4 PD of downward drift were measureable in her left eye (). We did not perform any additional procedure for correction of her hypotropic DVD since she seemed orthophoric most of the time and was satisfied with the result of the operation. | [[25.0, 'year']] | F | {'18775525': 1, '33303002': 2, '11304822': 1, '32586290': 2, '17070470': 1, '10849388': 1, '10496394': 1, '24349672': 2} | {'7731782-1': 1, '7318472-1': 1} |
164,622 | 3853796-1 | 24,319,345 | noncomm/PMC003xxxxxx/PMC3853796.xml | O-6-methylguanine-deoxyribonucleic acid methyltransferase methylation enhances response to temozolomide treatment in esophageal cancer | Herein we report a case of a 72-year-old man who had experienced 4-month history of dysphagia with solids and a subsequent 20 pound weight loss. An upper endoscopy revealed a partially obstructing mass located at 33 cm from the incisors, pathology characterized this tumor as moderately differentiated adenocarcinoma of the esophagus. A computed tomography (CT), endoscopic ultrasound and positron emission tomography (PET) were done as part of the staging work-up and the tumor was staged as T4N0M1. The PET scan revealed liver and adrenal metastasis []. The patient received a regimen comprised of epirubicin, cisplatin and 5-fluorouracil (ECF). Patient tolerated ECF therapy fairly well with resolution of his dysphagia; however, he developed lower extremity edema and distal neuropathy, both of which partially resolved once the chemotherapy course was completed. On restaging, he was noted to have a mixed response with progressive liver disease following 2 cycles of chemotherapy by CT and PET scan. He tested positive for MGMT methylation and received TMZ.\nThe study protocol was to evaluate TMZ, an agent commonly used with brain tumors and melanoma. This phase 2 study, IRB approved, targeted individuals with advanced aerodigestive tract cancers whose tumors display methylation of their MGMT promoters. TMZ was given at 225 mg by mouth daily for 7 days followed by 7 days off the therapy with each cycle lasting 28 days. Oncology clinic visits with laboratory testing occurred monthly and scans for staging purposes occurred every 8 weeks. The TMZ was to continue until disease progression occurred or the side-effects of the treatment became intolerable. | [[72.0, 'year']] | M | {'16161046': 1, '22042947': 1, '21684205': 1, '16477636': 1, '16682732': 1, '15870861': 1, '11070098': 1, '34638363': 1, '28052061': 1, '17114652': 1, '9850030': 1, '20351330': 1, '21296855': 1, '27556305': 1, '12744471': 1, '23100466': 1, '11309301': 1, '18952979': 1, '34503107': 1, '17211865': 1, '17021055': 1, '21509778': 1, '32759723': 1, '25015189': 1, '21472719': 1, '19027227': 1, '28225784': 1, '19549707': 1, '21135282': 1, '31109310': 1, '27110300': 1, '17329193': 1, '20728210': 1, '12131083': 1, '15758010': 1, '20631636': 1, '24319345': 2} | {} |
164,623 | 3853803-1 | 24,968,393 | noncomm/PMC003xxxxxx/PMC3853803.xml | A novel approach to management of a sacral defect in ileal pouch-sacral fistula | A 20-year-old man was admitted with pelvic and hip pain, anorexia and loss of weight. His past surgical history revealed a proctocolectomy with ileo-pouch anal anastomosis for familial adenomatous polyposis (FAP) carried out in another institution 3 years previously. This had been complicated by an anastomotic leak treated with a loop ileostomy that was taken down 6 months later. Subsequently, he developed a new pelvic collection and persistent pouch-presacral space fistula that was treated with a laparoscopic drainage and repeat loop ileostomy. A follow-up magnetic resonance imaging (MRI) showed improvement but persistence of pelvic phlegmon. Cultures of presacral fluid revealed a polymicrobial flora including Escherichia Coli, Enterococcus, Bacillus species and Eikenella Corrodens.\nAt the time of evaluation at our institution, he was afebrile and the laboratory tests, including inflammatory markers, were unremarkable. A computed tomography (CT) scan of the abdomen and pelvis showed a presacral fluid collection with a fistula between the pouch and the sacrum (Fig. ). An MRI of the pelvis was performed and this revealed signs of osteomyelitis involving the S2–S4 vertebrae (Fig. ). A laparotomy was performed and the ileal-anal pouch anastomosis was taken down, the sacrum was debrided leaving a large anterior bony defect. No omentum was available, so a 10 cm × 10 cm piece of Alloderm was used to cover the defect. The pouch fistula was excised and closed and the revised pouch re-anastomosed to the anus. The patient made an uneventful recovery and was discharged on the seventh postoperative day. Cultures from the sacral debrided tissue yielded Actinomyces spp. and a 12-week course of antibiotics (clindamycin) was commenced. | [[20.0, 'year']] | M | {'8402069': 1, '18998194': 1, '9014678': 1, '10499387': 1, '9077380': 1, '10101313': 1, '19247027': 1, '16741645': 1, '2171442': 1, '9788386': 1, '24968393': 2} | {} |
164,624 | 3853804-1 | 24,968,396 | noncomm/PMC003xxxxxx/PMC3853804.xml | Obstructive jaundice due to pancreatic pseudocyst in a pediatric patient | An 8-year-old boy presented to our hospital with jaundice and intermittent pain in the abdomen since last 1 year after a trivial blunt abdominal trauma sustained while at play. Jaundice was insidious and was gradually progressive and was associated with upper central abdominal pain which was intermittent. Pain was not radiating and of no specific character. There was no history of fever, bowel or urinary complaints. Past history was unremarkable. The patient was icteric and abdominal examination revealed a solitary mass in the upper mid-abdomen which was oval in shape and measuring 15 cm vertically and 10 cm horizontally. The upper margin was imperceptible from the inferior liver edge. It was not tender and not mobile. The liver edge was palpable 3 cm below the right costal margin. A clinical diagnosis of choledochal cyst was made and further investigated. Hemogram was within the normal limits. Liver function tests showed: total bilirubin was 2.8 mg/dl (direct 2.4 mg/dl), normal enzymes and raised alkaline phosphate (3881 U/l). Sonography was suggestive of choledochal cyst with hepatomegaly. Magnetic Resonance Cholangiopancreatography (MRCP) gave a picture of a type 1 choledochal cyst (Fig. a).\nThe patient was operated and the intra-operative findings (Fig. b) were of a large pseudocyst of pancreas arising predominantly from the head and body of the pancreas. The ‘C loop’ of the duodenum was splayed and stomach was pushed up anteriorly. Gall bladder and the portal anatomy were normal. The liver was enlarged and surface had fine nodules. There was no sign of active pancreatitis. An intra-operative cholecystogram was performed that showed unequivocal obstruction of the terminal common bile duct (CBD).\nA cysto-gastrostomy was performed along with a liver biopsy. Following decompression, the anatomy of structures around the ‘C Loop’ of duodenum normalized. A repeat cholecysto-cholangiogram could not be repeated due to technical reasons; hence, a tube cholecystostomy was performed to drain the obstructed biliary system and to have an access for postoperative cholecysto-cholangiogram. The post-operative course was uneventful. Bilirubin dropped to 1.9 mg/dl (direct 1.1 mg/dl). A repeat contrast study was arranged on the 10th post-operative day to demonstrate free passage of contrast across the biliary tree into the duodenum (Fig. a). Histopathology of the disk of tissue from the common wall between stomach and the pseudocyst showed features of pancreatic pseudocyst. The liver biopsy (Fig. b) showed features of chronic extra-hepatic biliary obstruction. After 3 months of follow-up, the patient is asymptomatic and is anicteric. Work up for etiology of pancreatic pseudocyst was done and no specific cause could be ascertained, hence attributed to trauma. However, an endoscopic retrograde cholangiopancreatography (ERCP) is also being planned to rule out pancreas divisum as a cause of pancreatitis. | [[8.0, 'year']] | M | {'6837858': 1, '1211986': 1, '13593993': 1, '10992816': 1, '9798883': 1, '14274862': 1, '725629': 1, '7406561': 1, '24968396': 2} | {} |
164,625 | 3853857-1 | 24,347,869 | noncomm/PMC003xxxxxx/PMC3853857.xml | Neonatal segmental enteritis due to cow's milk allergy | A 30-day-old boy baby was referred with abdominal distension, feculent vomiting and failure to thrive. He was born at term to a surrogate mother and weighed 3.2 kg at birth. He was started on cow's milk 6 h after birth and was discharged on the 3rd day. He was readmitted on the 7th day of life with clinical features suggestive of sepsis and probable necrotizing enterocolitis (NEC). He was managed conservatively and discharged 5 days later on infant formula and cow's milk. A few days later, he was brought back to the treating pediatrician with recurrent vomiting, abdominal distension and weight loss. Stool for reducing substances was negative. Malrotation of the gut was suspected and a barium meal was done and found to be normal. Barium enema was also normal. The C-reactive protein (CRP) was high and he was treated with intravenous antibiotics and other supportive measures. This was his third admission with clinical features of sepsis (raised CRP). Immunodeficiency was suspected and Immunoglobulin G (IgG), Immunoglobulin M (IgM) and Immunoglobulin A (IgA) were found to be normal. He was referred to our hospital to the pediatric surgery out-patient department on day 30 with gross abdominal distension and persistent vomiting. His admission weight was 2.8 kg and he was sick, wasted and dehydrated. A clinical diagnosis of HD with enterocolitis was made. He had features of acute abdomen with feculent vomiting and tenderness. X-ray of the abdomen showed dilated bowel loops. Ultrasound showed free fluid in the abdomen. Laparotomy was done. The jejunum showed features of segmental enteritis with turbid fluid and flakes in the peritoneum []. Colon was collapsed. Appendix was sent for frozen section biopsy to rule out total colonic aganglionosis. It was reported to be normal. Abdomen was closed after a wash. A diagnosis of segmental enteritis with peritonitis was made. The peritoneal fluid culture showed growth of Escherichia coli and Enterococcus faecalis and he was started on appropriate antibiotics. The general condition improved’, but the abdominal distension recurred when oral feeds were initiated. Parenteral nutrition was started. He was reviewed by the pediatric Gastroenterologist who suspected food allergy. A complete Immunoglobulin profile was done. IgG, IgM, and IgA were normal for age, but the IgE level was >315 IU/ml (N ≤ 1.5). CMPA was considered and the radioallergosorbent test (RAST) assay was done and was found to be strongly positive –6.82 (N ≤ 0.1).\nA diagnosis of segmental enteritis with peritonitis due to cow's milk allergy was made. Baby was started on a hypoallergenic formula. 48 h later, the abdominal distension started to resolve. He was on hypoallergenic infant formula and his discharge weight was 3.1 kg. His review weight at 7 months was 6.5 kg and the serum IgE had declined to normal levels. | [[30.0, 'day']] | M | {'22943656': 1, '21317467': 1, '19817954': 1, '2406081': 1, '16189674': 1, '20508631': 1, '22152876': 1, '34200020': 1, '3969294': 1, '24347869': 2} | {} |
164,626 | 3853858-1 | 24,347,870 | noncomm/PMC003xxxxxx/PMC3853858.xml | Single piece artificial urinary sphincter for secondary incontinence following successful repair of post traumatic urethral injury | A 14-year-old boy came to us with incontinence after post pelvic fracture-related urethral injury repair. He had suffered urethral injury in a road traffic accident 10-years-ago followed by staged urethral reconstruction. At the end of few months of urinary diversion, he had undergone urethral repair using abdominoperineal approach. Ten years following surgery, he was able to pass urine but he continued to dribble all the time. He had been on several modalities of medical management with no benefit. On examination, he had an abdominal and perineal scar of previous operation and deformed and scarred penile skin due to chronic use of condom catheter, leading to some tourniquet effect.\nThe renal function tests, urine routine, microscopy, and culture were normal. Ultrasound of the urinary tract revealed normal upper tracts and no post void residue. The post-operative micturating cystourethrogram (MCU) done 10 years after repair, revealed a normal capacity bladder. There was urinary leak at 200 ml, no vesicoureteric reflux, absence of urethral stricture, and no post void residual urine. Voiding cystometry showed that he had normal capacity stable bladder with leak at 200 ml and detrusor pressures in normal range []. On cystoscopy, the anastomotic site at posterior urethra at the junction of bulbar and prostatic urethra was identified and admitted 9F resectoscope with ease. The bladder mucosa was normal and the bladder neck was not closing adequately on withdrawal of the cystoscope into urethra.\nAfter detailed evaluation, he was put on conservative management for incontinence with a trial of anticholinergics, clean intermittent catheterization, pelvic floor exercises, and timed voiding for 6 weeks. The urinary leak persisted without any improvement. The child had suffered for 10 years and was constantly on diapers or using condom catheters with significant scarring of the penis and no relief with medical management.\nThe child was prepared for bulbar placement of the cuff by the perineal approach and placed in lithotomy position. A 12 F Foley catheter was placed. A midline perineal incision was made and bulbocavernosus muscle was dissected from the bulbar urethra by blunt dissection. Subdartos pouch was created through a separate inguinal incision for pump placement. The bulbar urethra was mobilized for cuff placement. We used the ZSI 375 (Zephyr surgical implants, Switzerland) artificial urinary sphincter []. The cuff was placed around the bulbar urethra with the urethral catheter in situ and secured with a nonabsorbable suture []. The urethral catheter was removed after filling the bladder and ZSI 375 was activated. The functioning of the sphincter device was checked and the position of the spring in the pump unit calibrated to the desired midline position. The pump was placed in subdartos pouch and fixed. The sphincter was deactivated and urethral catheter placed again.\nThe child was discharged the next day with the catheter in situ. Six weeks later, the catheter was removed and the device was activated. The father and the child were taught how to deflate the cuff. The child was observed for 24 hrs in the Hospital till he was comfortable in using the device. One year after surgery, the child now deflates the cuff on feeling the urge to micturate and passes urine in good stream, voids to completion with no incontinence. | [[14.0, 'year']] | M | {'12378452': 1, '2920260': 1, '4802066': 1, '17707005': 1, '17707006': 1, '2329618': 1, '24347870': 2} | {} |
164,627 | 3853859-1 | 24,347,871 | noncomm/PMC003xxxxxx/PMC3853859.xml | Malrotation with midgut volvulus associated with perforated ileal duplication | A 4-year-old male child was referred to us for complaint of pain in abdomen. On enquiry, there was intermittent history of bilious vomiting since infancy. There was no previous history as regard to abdominal distension. However, there was occasional history of abdominal pain, which was relieved by medication. On examination, his abdomen was distended, but it was non-tender. The weight of the patient was 9 kg. Thus he had failed to thrive. His ultrasound (USG) of abdomen suggested some fluid filled cystic spaces. A computerized tomography (CT) scan of abdomen was advised for confirmation of the diagnosis.\nOn next day, just after CT abdomen, the patient suddenly developed severe abdominal pain. X-ray abdomen showed pneumoperitoneum. Clinically the patient looked septic. His pulse rate was 130/min with a feeble pulse. An urgent laparotomy was planned. After initial stabilization, the patient was explored under general anesthesia. On exploration, we noticed malrotation of the gut, which was associated with two turns of midgut volvulus. The midgut did not have any evidence of ischemia or gangrene. It was complete malrotation having cecum in left hypochondrium and narrow mesentery. Ladd's bands were also present. The peritoneal cavity was grossly contaminated with fecal fluid. The perforation site was about one foot proximal to ileocecal region. The perforation was at the mesenteric side, and it was associated with a soft mesenteric mass communicating with the normal bowel. The mass was about 10 cm in length. The perforation was just at the junction of the mesenteric mass and the normal bowel [].\nAfter performing the Ladd's procedure, attention was placed towards the perforation. On attempting to resect the mesenteric mass, we noticed two lumens in the bowel distal to the perforation site and single lumen proximal to that [Figures and ]. The duplication appeared to be having all the layers of the bowel wall. When an attempt to ascertain the length of the duplication was made by inserting two Ryle's tube through the lumens, it was reaching up to ileocecal region. As the general condition of the patient was poor, complete resection of the bowel was not done, and a double barrel (triple barrel, to be more precise) was fashioned.\nIn the postoperative period, there was wound infection with superficial wound dehiscence. It was managed conservatively. The patient was discharged after 3 weeks with proper follow-up advise. During the follow-up, we had closed the ileostomy. As the duplication was reaching up to cecum, we had performed ileoascending anastomosis. The patient is fine. | [[4.0, 'year']] | M | {'18082686': 1, '15300555': 1, '10489177': 1, '27896171': 1, '26394623': 1, '17168282': 1, '8179838': 1, '20339180': 1, '27672583': 2, '8301501': 1, '24347871': 2} | {'5027064-1': 1} |
164,628 | 3853862-1 | 24,347,874 | noncomm/PMC003xxxxxx/PMC3853862.xml | Mediastinal hemangioma: Masquerading as pleural effusion | A 4-year-old male child presented to the out-patient department with the complaints of fever and cough of 3 months duration with respiratory distress of recent onset. Chest radiograph showed features of the right sided loculated pleural effusion []. Ultrasonography of the chest showed moderate pleural effusion with multiple thick irregular septa with low level internal echoes.\nOn needle thoracocentesis straw colored fluid was aspirated. Evaluation of pleural fluid revealed, cell count of 1,200/cu mm, proteins of 498 mg/dl and sugar of 59 mg/dl and no bacteria including acid fast bacillus was identified. Computed tomography (CT) of the chest revealed multiseptated lesion occupying lower 3/4th of the right hemithorax [].\nAn inter-costal drain (ICD) tube was placed in the right hemithorax as the child had respiratory distress. Post-procedure evaluation with chest radiograph and an ultrasonogram of thorax revealed a partially collapsed mediastinal mass lesion with residual cystic lesion, hence planned for surgical excision. Initially, video assisted thoracic surgery was attempted and converted to the right posterolateral thoracotomy through the 5th inter-costal space in view of poor visibility and obscure anatomy. The operative findings included, single well encapsulated cystic lesion with multiple loculations containing serosanguinous fluid. There were inflammatory adhesions to surrounding structures including lungs, parietal pleura and pericardium. The lesion was compressing middle and lower lobes with no invasion to surrounding structures. The cyst was excised in-to and subjected to histopathological examination. Post-operative recovery was uneventful. Post-operative chest radiograph showed well expanded lungs, ICD tube removed on the post-operative day 3 and the child was discharged on the next day.\nGross pathological examination of the tumor showed well encapsulated cystic lesion with multiple septations measuring 10 × 10 × 8 cm []. Microscopic examination revealed vascular spaces lined by flat endothelial cells; moderate intervening fibrocollagenous stroma along with few inflammatory cells []. These findings were diagnostic of capillary hemangioma. There was no evidence of cellular atypia or mitotic figures indicating that it was a completely benign lesion.\nPatient was followed-up in the out-patient department at 1 week, 1 month and 6 months and 1 year post-operatively and was doing well. The chest radiograph taken at 6 month follow-up visit was normal. | [[4.0, 'year']] | M | {'31944605': 2, '4352130': 1, '4479358': 1, '3105516': 1, '9609188': 1, '2198856': 1, '6420274': 1, '539616': 1, '8067508': 1, '10398787': 1, '7705821': 1, '3592837': 1, '29354184': 1, '7972751': 1, '2216593': 1, '24347874': 2} | {'7049481-1': 1} |
164,629 | 3853889-1 | 24,350,004 | noncomm/PMC003xxxxxx/PMC3853889.xml | Interesting and unusual clinical presentations in leprosy at a referral center | A 40-year-old female was referred with complaints of blisters on the right arm, forearm, and hand since two years. The patient had a history of tingling numbness in the right upper and lower extremity dating six years back. There was no history of hypopigmented patches or cutaneous lesions. There was no family history of leprosy or neuropathy. She was investigated with magnetic resonance imaging (MRI) of the spine and EMG/NCS three years before she was referred to our clinic. On examination, she was found to have a thickening of the right ulnar, median, and radial cutaneous nerves, and both posterior tibial nerves. Slit-skin smear was negative at multiple sites. Repeat EMG/NCS showed no sensory conduction in the right median, ulnar, radial, and both sural nerves, whereas amplitude and motor conduction velocity was reduced in the right median and both ulnar nerves. Laboratory investigations like hemogram, chest X-ray, urinalysis, liver function tests, renal function tests, and blood glucose levels were within normal limits. Finally, a biopsy of the left sural nerve was done which revealed three enlarged fascicles with a large number of infiltrating cells comprising lymphocytes, plasma cells, and macrophages in the endoneurium. Small clumps of acid-fast bacilli were seen in a good number of cells. A borderline lepromatous type of nerve lesion with evidence of type 1 reaction was diagnosed. | [[40.0, 'year']] | F | {'8684252': 1, '9178158': 1, '8727112': 1, '1022960': 1, '18085167': 1, '8835581': 1, '3373086': 1, '15273859': 1, '15081655': 1, '1640781': 1, '18808760': 1, '15485285': 1, '14513154': 1, '1890361': 1, '24350004': 2} | {'3853889-2': 2} |
164,630 | 3853889-2 | 24,350,004 | noncomm/PMC003xxxxxx/PMC3853889.xml | Interesting and unusual clinical presentations in leprosy at a referral center | A 38-year-old male, nondiabetic, was referred to our center for a slit-skin smear. The patient had a history of loss of sensation on the lateral aspect and heel of the left foot since three months. Past and family history was negative for neuropathy or leprosy. On examination, fine touch sensation was absent, whereas crude touch sensation was diminished in the left lower extremity. Left ulnar nerve, lateral peroneal, anterior tibial, and sural nerves were thickened. No hypopigmented patches were found. A diagnosis of leprosy was doubtful with such a short duration of complaints but EMG/NCS done before the patient was referred to us demonstrated left sural neuropathy. Therefore, a left sural nerve biopsy was done which showed granulomas comprising lymphocytes, macrophages, and epithelioid cells within and around fascicles. A borderline tuberculoid type of leprosy was diagnosed. | [[38.0, 'year']] | M | {'8684252': 1, '9178158': 1, '8727112': 1, '1022960': 1, '18085167': 1, '8835581': 1, '3373086': 1, '15273859': 1, '15081655': 1, '1640781': 1, '18808760': 1, '15485285': 1, '14513154': 1, '1890361': 1, '24350004': 2} | {'3853889-1': 2} |
164,631 | 3853893-1 | 24,350,008 | noncomm/PMC003xxxxxx/PMC3853893.xml | Two cases of giant pyogenic granuloma of scalp | A 28-year-old male presented with a dirty white colored fluffy swelling on the scalp of 10 days duration. Patient had a history of a scalp injury in a road traffic accident 17 days back, for which suturing was done at a private clinic. Patient did not clean the wound or wash scalp for the next 17 days. Sutures were not removed. He developed an asymptomatic swelling at the same site about 10 days after suturing which gradually grew in size. On cutaneous examination, a friable dirty cream white colored, soft, multi-lobular hemispherical swelling of 4 cm × 4 cm was seen on the left fronto parietal area of scalp []. On palpation, the swelling was non-tender and the base was adherent to the scalp, with bleeding from the base on manipulation. On firm pressure, the swelling was yielding and breaking like a empty gelatinous egg shell. Differential diagnosis considered were: Foreign body reaction to retained sutures, PG and mucormycosis, squamous cell carcinoma.\nPatient was negative for serologica l test for HIV and syphilis. Other routine investigations were with in normal limits. Scraping for fungal filaments and fungal culture were negative. Biopsy from the swelling revealed focally ulcerated epidermis with ulcerated area showing granulation tissue with proliferating fibroblasts and blood vessels []. Dense inflammation composed of lymphocytes, plasma cells, few PMN, and eosinophils. No evidence of granuloma or neoplasm was observed. Pathologist opined that it was a reactive pattern similar to PG with ulceration and exuberant granulation tissue amid dense acute-on-chronic inflammation.\nPatient was given systemic antibiotics, oral metronidazole, and topical betadine. The swelling regressed gradually in size over a period of 5 weeks, leaving behind an adherent crust. Sutures were removed by removing the crust only after swelling regressed completely. | [[28.0, 'year']] | M | {'18700251': 1, '17128822': 1, '14457324': 1, '28852300': 1, '27403353': 1, '7634842': 1, '16004024': 1, '18377654': 2, '15096149': 1, '19397571': 1, '10827405': 1, '9625645': 1, '30587632': 1, '24350008': 2} | {'2329656-1': 1} |
164,632 | 3853894-1 | 24,350,009 | noncomm/PMC003xxxxxx/PMC3853894.xml | Dystrophic epidermolysis bullosa associated with non-syndromic hypodontia | A12-year-old boy, a product of consanguineous marriage, was referred from the Department of Dermatology, Civil Hospital for favor of dental check-up. Patient was apparently alright at the time of birth. Patient developed vesicles and bullae 6 days after birth, over the face, scalp, trunk, and extremities, with loss of finger and toenails and inability to open the mouth wide. Oral hygiene was not practiced due to the formation of bullae following toothbrush trauma. The patient complained of toothache with food impaction in lower left posterior teeth region. History of pain, getting aggravated upon mastication and relieved upon medication was elicited from the patient. Pain was dull, intermittent, and non-radiating in nature. His diet was limited to soft or pureed foods. He had normal cognitive function and attended school. No allergies were reported.\nDermatological Examination revealed patchy alopecia over the scalp. Hyperkeratosis of palms and soles was seen. Sclerosis of fingers was present with fixed flexion deformity at distal interphalangeal joints and “claw-like” hands []. Fingernails are all intact except left thumbnail. Complete loss of toenails was seen []. Skin examination revealed generalized scarring with hypopigmented and hyperpigmented areas over the chest, back, and trunk. Nikolsky's sign was found to be positive in ankle region in the patient. Intraoral examination revealed healed lesions over the lower labial and lingual mucosa in canine-premolar region. White patch was seen over the right retromolar region [] with the overlying skin giving a collapsed/shrunken/shriveled appearance, suggestive of a freshly ruptured bulla. Oral hygiene was very poor and generalized gingival inflammation was seen []. He had a mixed dentition with severe occlusal carious lesions in first premolars and upper second molars. Both maxillary and mandibular lateral incisors and premolars were clinically missing. Detailed intraoral examination was not possible due to limited mouth opening caused by scarring of the lesions. | [[12.0, 'year']] | M | {'18280394': 1, '33202040': 1, '14628894': 1, '11903238': 1, '19250395': 1, '15157056': 1, '18573979': 1, '24350009': 2} | {} |
164,633 | 3853895-1 | 24,350,010 | noncomm/PMC003xxxxxx/PMC3853895.xml | Benign cephalic histiocytosis | A one and a half year old girl born of a non-consanguineous marriage presented with multiple asymptomatic raised lesions on both cheeks of 1 year duration. The lesions were slowly increasing in number.\nDermatological examination revealed multiple erythematous to hyperpigmented and skin colored papules limited to both cheeks []. General examination and systemic examination were within normal limits. Physical and mental development were adequate for her age.\nRoutine investigations including serum cholesterol and triglycerides were within normal limits.\nDifferential diagnosis considered were BCH, juvenile xanthogranuloma, and angiofibroma. Skin biopsy from one of the papules showed a normal epidermis and sheets of foamy macrophages, a few histiocytes, and occasional eosinophils in the dermis [Figure and ]. Immunohistochemistry of the biopsy specimen showed CD68 (macrophage marker) positivity and CD 1a (Langerhan's cell marker) negativity [Figures and ]. Correlating the clinical, histopathological, and immunohistochemistry findings, a final diagnosis of BCH was made. | [[1.5, 'year']] | F | {'8041659': 1, '10990580': 1, '22148022': 2, '3973127': 1, '12451377': 1, '3740882': 1, '24350010': 2} | {'3229948-1': 1} |
164,634 | 3853896-1 | 24,350,011 | noncomm/PMC003xxxxxx/PMC3853896.xml | A rare case of onychomycosis in all 10 fingers of an immunocompetent patient | A 42-year-old male vegetable vendor by occupation, presented to the Dermatology out-patient department of our hospital with brownish black discoloration and disfigurement of all the nails of 8 months duration. The patient first noticed it on the nail of the right index and middle finger which gradually spread to the other fingers and all the fingers of the left hand. On examination, all fingernails were brownish black in color with loss of texture and there were dystrophic changes as well as onycholysis in most of the fingers [].\nMultiple specimens of nail scrapings and clippings from different parts of the affected nails were collected from all fingers after cleaning the area with 70% alcohol. The samples were sent to the Microbiology department where direct examination by 40% Potassium hydroxide mount was done that showed branched septate hyphae. The clippings were cultured on two sets of Sabouraud's dextrose agar with and without antibiotics and cycloheximide which were incubated at room temperature and 37°C.\nAfter 3 days, growth was seen in all the tubes in the form of cottony white mycelium growth, which was soon covered with abundant black spores []. No bacterial growth was detected in the culture. Microscopic characterization of the fungal isolate was carried out by preparing a lactophenol cotton blue mount from the growth. They mostly consisted of erect conidiophores. The conidiophores terminated in a vesicle covered with phialides (biseriate). The secondary phialide bore chains of globose conidia were dark and covered the entire surface. The conidial head was large, black, and radiate. The fungal isolate was confirmed to be Aspergillus niger by these features. Repeat culture of the nail samples yielded the same organism.\nComplete blood count was normal except for a slight anemia with a hemoglobin of 11 g/dl. The fasting and postprandial blood sugar levels were normal; the tests for Human Immunodeficiency Virus(HIV) and Hepatitis B surface antigen (HBsAg) were negative. The patient gave no history of alcohol consumption, smoking, or any drug addiction. The patient was started on oral itraconazole 200 mg BD for 7 days for 2 consecutive months (oral Itraconazole pulse therapy). After 2 months, his nails did not show much improvement in the appearance, though the microscopy and culture of the nail scrapings were negative for fungal elements. So he was given pulse therapy of itraconazole for a further 2 months and was reassured that the nail color and texture will take some time to regain normalcy. | [[42.0, 'year']] | M | {'16040417': 1, '18445944': 1, '31502093': 1, '29147866': 1, '34071092': 1, '7496239': 1, '26693433': 1, '26474550': 1, '21220891': 1, '24350011': 2} | {} |
164,635 | 3853897-1 | 24,350,012 | noncomm/PMC003xxxxxx/PMC3853897.xml | Perplexing purpura in two females: Rare case of autoerythrocyte sensitization syndrome | A 19-year-old female presented with recurrent painful bruises over her extremities since 10 days, the first episode being at age of 16 years. Some episodes followed trivial trauma. She experienced a burning sensation at the injured site few minutes after trivial trauma, with subsequent redness and an appearance of painful bruise lasting for several days. She gave no history of bleeding tendencies or any underlying psychiatric illnesses. Cutaneous examination revealed residual ecchymotic irregular patches, 2 cm × 3 cm on the right arm and the legs, non-tender on palpation []. Rest of mucocutaneous, general and systemic examination was normal. Complete hemogram, platelet count, complete coagulation profile and antinuclear antibodies done to rule out other causes of purpuras were within normal limits. Radiological investigations were normal. Intradermal injection of 0.1 ml of autologous blood on flexure aspect of left forearm caused an immediate burning sensation at the injection site followed 2 h later by development of an oval, 2 cm, sharply defined erythematous macule []. Intradermal injection of 0.1 ml of saline used as a control on the same arm caused no reaction. Biopsy revealed presence of perivascular infiltrate of neutrophils extending up to the septae of the subcutaneous fat []. There was distinctive fibroinoid deposition around the blood vessels. In addition, there were dermal and subcutaneous hemorrhages. The clinico pathological correlation pointed to the diagnosis of autoerythrocyte sensitization syndrome. As psychiatric associations are frequent, a detailed psychiatric evaluation was done which revealed mixed anxiety depression disorder. Treatment was initiated with tab. Amytriptyline 10 mg and Lorazepam 0.25 mg ½ tab 3 times a day with no new lesions for a week but recurrence of lesions was noted probably secondary to trivial trauma thereafter. | [[19.0, 'year']] | F | {'14389381': 1, '917094': 1, '7897725': 1, '3615622': 1, '29204414': 1, '12442101': 1, '2486528': 1, '17050937': 1, '6662254': 1, '29644197': 2, '19192020': 1, '21716942': 1, '12911488': 1, '10966177': 1, '34194073': 1, '6211587': 1, '5131259': 1, '2345102': 1, '32038765': 1, '1713890': 1, '140323': 1, '24350012': 2} | {'3853897-2': 2, '5885616-1': 1, '5885616-2': 1, '5885616-3': 1, '5885616-4': 1, '5885616-5': 1} |
164,636 | 3853897-2 | 24,350,012 | noncomm/PMC003xxxxxx/PMC3853897.xml | Perplexing purpura in two females: Rare case of autoerythrocyte sensitization syndrome | A 30-year-old housewife presented with similar spontaneous bruising over upper extremities since 1½ months. There was no prior trauma, menstrual irregularities, or bleeding diathesis. Cutaneous examination revealed multiple ecchymotic patches over bilateral arms, non-tender on palpation []. Hemogram, coagulation profile and radiological studies revealed no abnormalities. The autologous whole blood intradermal injection showed a similar positive reaction as in case 1. Histopathology revealed non-specific changes of extravasation of erythrocytes in lower dermis and subcutis []. Her psychiatric evaluation revealed no abnormalities, however, in view of the diagnosis of AES she was started on tab citalopram 5 mg daily with no new lesions till date. | [[30.0, 'year']] | F | {'14389381': 1, '917094': 1, '7897725': 1, '3615622': 1, '29204414': 1, '12442101': 1, '2486528': 1, '17050937': 1, '6662254': 1, '29644197': 2, '19192020': 1, '21716942': 1, '12911488': 1, '10966177': 1, '34194073': 1, '6211587': 1, '5131259': 1, '2345102': 1, '32038765': 1, '1713890': 1, '140323': 1, '24350012': 2} | {'3853897-1': 2, '5885616-1': 1, '5885616-2': 1, '5885616-3': 1, '5885616-4': 1, '5885616-5': 1} |
164,637 | 3853898-1 | 24,350,013 | noncomm/PMC003xxxxxx/PMC3853898.xml | Familial myomatosis cutis et uteri, segmental type 2 | A 50-year-old female presented to us with history of developing multiple brown painful lesions which appeared initially over her left leg. They extended to appear insidiously over trunk, chest, and upper limbs about 25 years back which extended to appear insidiously despite excision of the left leg lesion. Pressure and exposure to cold aggravated the pain. She also underwent hysterectomy, owing to menorrhagia and multiple uterine fibromas, 25 years ago. Dermatological examination revealed multiple tender, hyperpigmented papulonodules over the left lower limb, trunk, right side of the chest, and bilateral upper limbs [Figures , and ,]. A clinical suspicion of leiomyomas was confirmed by histopathological findings of a circumscribed tumor in the dermis composed of bundles of smooth muscles cells arranged in an interlacing and whorled pattern, having abundant eosinophilic cytoplasm and elongated nuclei with blunt ends. Deep red color with Masson's Trichome confirmed smooth muscle fibers [Figure ,]. Mild lymphocytic infiltrate was present in the interstitial fibrous tissue. Gynecological consultation for her daughter's complaints of menorrhagia revealed uterine fibroids. A diagnosis of familial myomatosis cutis et uteri, segmental type 2 was made. She experienced pain relief with nifedipine and gabapentin. | [[50.0, 'year']] | F | {'16481725': 1, '11125318': 1, '12472537': 1, '11436362': 1, '22615521': 1, '24350013': 2} | {} |
164,638 | 3853899-1 | 24,350,014 | noncomm/PMC003xxxxxx/PMC3853899.xml | Bullous scabies in an adult: A case report with review of literature | A 26-year-old unmarried male presented with a four-day history of multiple blisters over both hands preceded by a two-week history of generalized pruritus. The patient was living alone. He also complained of itchy red raised lesions over the genitals. The itching was more during night. The patient denied any history of unprotected sexual exposure.\nExamination revealed multiple, erythematous excoriated papules on the wrist, trunk, lower limbs, and web spaces of fingers. Multiple erythematous papulonodular lesions were seen over the scrotum and penis. Multiple tense vesicles and bullae, 0.5-1.5 cm sized, containing clear fluid were also present on the dorsum of both hands and web spaces of fingers []. There were no mucosal lesions. Other cutaneous and systemic examination was unremarkable. A diagnosis of bullous scabies was considered.\nBiopsy and histopathology of one of the vesicles revealed epidermal spongiosis, multilocular intraepidermal blisters, subepidermal edema with dense lymphohistiocytic infiltrate, and a few eosinophils. The blister cavity also contained inflammatory cells with eosinophils being predominant. The presence of mites within the blister cavity was also noted []. Based on clinicopathological correlation, a diagnosis of bullous scabies was made.\nImmunofluroscence study could not be done due to economic constraints. The patient was treated with whole-body applications of 5% permethrin lotion and a single 12 mg dose of oral ivermectin along with oral antihistamines to control pruritus. New lesions stopped appearing and after one week, significant improvement was noted. Skin lesions cleared after one month. | [[26.0, 'year']] | M | {'27402514': 1, '34491217': 1, '8740286': 1, '16638387': 1, '12558642': 1, '25416848': 1, '16394369': 1, '48563': 1, '21291656': 1, '20642986': 1, '20109396': 1, '26092057': 2, '28883737': 2, '33768048': 1, '34504696': 1, '26622520': 1, '19090339': 1, '24350014': 2} | {'5574693-1': 1, '4475611-1': 1} |
164,639 | 3853900-1 | 24,350,015 | noncomm/PMC003xxxxxx/PMC3853900.xml | Lupus pernio without systemic involvement | A 50-year-old male presented with multiple asymptomatic erythematous skin lesions over the nose and both ears since 1 year. Patient had not taken any form of treatment for the same. The lesions were progressive and there were no aggravating or relieving factors. There was no history of fever, cough, nasal discharge, loss of sensation, or joint pains. Cutaneous examination revealed erythematous, firm plaques and nodules over tip, base and left ala of nose, right nasolabial fold, both pinna, and preauricular region [Figures –]. General examination and sensory examination were normal. There was no lymphadenopathy. Ophthalmic and systemic examinations were normal. Chest X-ray, routine hemogram, serum, and 24 h urinary calcium were normal. Erythrocyte sedimentation rate was 60 mm in the 1st h. Mantoux test was negative. Slit skin smears for acid fast bacilli and Leishmania donovani bodies were negative. Pulmonary function tests were normal. Angiotensin-converting enzyme levels were not done due to lack of resources. Skin biopsy revealed multiple, circumscribed, non-caseating tuberculoid granuloma with epithelioid cells and occasional giant cell [Figures and ]. Wade Fite and Periodic acid-Schiff (PAS) stain were negative. He was treated with betamethasone dipropionate 0.05% cream twice daily application. Within 6 months, skin lesions improved drastically. Patient is on follow-up for 6 years now and has not developed any new skin lesions or systemic involvement yet [Figures –]. | [[50.0, 'year']] | M | {'7212741': 1, '22121281': 2, '30555667': 2, '20948028': 1, '17041433': 1, '7132299': 1, '20877023': 1, '17314441': 1, '17656979': 1, '34725594': 2, '20049280': 1, '24350015': 2} | {'3221226-1': 1, '3221226-2': 1, '3221226-3': 1, '8553274-1': 1, '6250080-1': 1} |
164,640 | 3853902-1 | 24,350,017 | noncomm/PMC003xxxxxx/PMC3853902.xml | Inflammatory vitiligo versus hypopigmented mycosis fungoides in a 58-year-old Indian female | A 58-year-old Indian female presented to our office complaining of a 3-year history of white patches on her face, neck, trunk, and extremities. New lesions were continuing to develop, with the left anterior leg and right wrist being the most recently affected sites. Past medical history was significant only for osteoporosis and the patient denied taking any medications. She admitted to a trip to India several years prior but had no other recent travel. A review of systems was negative, with the patient denying pain, pruritus, dysesthesia, peripheral neuropathy, and alopecia of the scalp or eyebrows.\nOn physical examination, speckled, depigmented macules and patches on the eyelids, forehead, cheeks, neck, and hands were appreciated. In addition, hypopigmented patches with scaly, raised, erythematous borders were observed on the back, abdomen, legs, thighs, and buttocks [Figures –]. No hypoesthesia or dysesthesia of the patches was noted. There was no loss of hot or cold sensation within or surrounding the patches.\nAn in-office KOH was negative for fungal organisms. A punch biopsy was taken from the right lower back at the margin of a hypopigmented patch that was surrounded by erythema []. This revealed: “spongiosis, a superficial perivascular and interstitial scattering of lymphocytes in a papillary dermis of altered collagen, scattered single necrotic keratinocytes, multifocal vacuolar alteration of the junction, and mounds of parakeratosis” [Figures and ]. A second biopsy taken from the right medial buttock [] showed “superficial perivascular and sparse interstitial infiltrate of lymphocytes with a rare eosinophil, wiry bundles of collagen in the papillary dermis, mild spongiosis, lymphocytes sprinkled within the epidermis, and mounds of parakeratosis []. CD4 and CD8 stains demonstrated a helper: suppressor ratio of greater than 5:1 [Figure and ]. A CD7 stain demonstrated staining of approximately 30% of lymphocytes []. Further staining with Melan-A demonstrated a marked reduction of melanocytes but not complete absence []. Given the patient's previous report of travel to India, leprosy had been a consideration clinically but neither granulomas, foamy macrophages, nor perineural inflammation were identified histopathogically. A Fite-Faraco stain was also negative. With some worrisome features for mycosis fungoides, including wiry bundles of collagen, inflammatory infiltrate, and mild exocytosis, a polymerase chain reaction (PCR) assay for rearranged T-cell receptor gamma genes was obtained. This showed polyclonality, with the intensity of peak not consistent with that seen in clonal neoplasms.\nGiven the clinical findings of several classic appearing depigmented patches on the forehead, eyelids, and dorsal hands, the inflammatory nature of the lesions from which the biopsies were taken, the near-total loss of melanocytes evident with Melan-A staining, and PCR findings demonstrating a lack of monoclonality, the diagnosis of inflammatory vitiligo was favored. However, hypopigmented MF could not be definitively ruled out and the coexistence of two separate disease processes remained a possibility. Therefore, close follow-up of this patient remains important. | [[58.0, 'year']] | F | {'7751470': 1, '21393946': 1, '12948929': 1, '19120387': 1, '22240772': 1, '16436337': 1, '16923143': 1, '16309491': 1, '24350017': 2} | {} |
164,641 | 3853903-1 | 24,350,018 | noncomm/PMC003xxxxxx/PMC3853903.xml | Dermatomyositis associated with malignancy: A report of 3 cases | A 36-year-old male presented with complaints of itchy red lesions over the periorbital area, forehead and malar area associated with photosensitivity since 3 months, painless swelling around both eyes since 1 month and pain over the shoulder and hip region, nasal twang of voice and difficulty in deglutition since 2 days. Cutaneous examination of the patient revealed periorbital erythema, edema and hyperpigmentation [Heliotrope rash, Figure and ]. Similar erythema and hyperpigmentation were also present on the neck, chest, shoulders and back [Shawl sign, [Figure and ]. Erythematous hyperpigmented papules were present on the knuckles and both elbows [Gottron's papules, Figure and ]. Musculoskeletal examination revealed proximal muscle weakness of shoulder and hip girdles. Skin biopsy from the erythematous lesion on the forehead revealed atrophic epidermis, focal basal cell vacuolar degeneration, dermal edema, mild perivascular lymphocytic infiltrate and abundant mucin in the dermis [Figure and ]. Blood investigations of the patient revealed raised erythrocyte sedimentation rate (ESR), elevated titers of muscle enzymes (LDH and CPK-MM) and electromyography (EMG) showing first-degree muscle disease, confirming the diagnosis of dermatomyositis. Rhinolaryngoscopy of the patient revealed articular defects of vocal cords due to bulbar muscle palsy [detailed investigations are mentioned in Tables and ]. The patient was simultaneously investigated for underlying malignancy. Barium swallow of the patient showed esophageal motility disorder, computed tomography (CT) scan of the abdomen revealed thickening in the pyloric region, causing mild luminal compromise, esophago-gastro-duodenoscopy (OGDscopy) showed presence of gastric ulcer at the pyloric antrum and biopsy from the gastric ulcer confirmed the diagnosis of poorly differentiated adenocarcinoma of the stomach [Figure and ]. The patient was diagnosed as DMS associated with poorly differentiated gastric adenocarcinoma. The patient received oral prednisolone 1.5 mg/kg/day with low potent topical corticosteroids and sunscreen. The patient's skin lesions and muscle symptoms showed excellent response [Figure –] to the treatment with reduction in the titers of muscle enzymes []. After clinical improvement, prednisolone was tapered gradually and the patient was referred to an oncologist for management of gastric adenocarcinoma. Unfortunately, the patient was lost to follow-up. | [[36.0, 'year']] | M | {'12046828': 1, '12452993': 1, '9636749': 1, '11300169': 1, '10692055': 1, '9466195': 1, '18203322': 1, '11298544': 1, '19499841': 1, '11872415': 1, '7562762': 1, '10895343': 1, '5794943': 1, '12071815': 1, '9208890': 1, '20592760': 2, '18306999': 1, '24350018': 2} | {'3853903-2': 2, '3853903-3': 2, '2879548-1': 1, '2879548-2': 1} |
164,642 | 3853903-2 | 24,350,018 | noncomm/PMC003xxxxxx/PMC3853903.xml | Dermatomyositis associated with malignancy: A report of 3 cases | A 65-year-old married female, operated case of carcinoma of the right breast (in situ ductal carcinoma), presented with complaints of sudden appearance of swelling and redness over the right breast since 2 weeks. The swelling was associated with appearance of red-colored minimally itchy lesions on the forehead, cheeks, nape of neck retroauricular area and pinna since 6 days. The patient also developed generalized swelling all over the body since 2 days with difficulty in raising her arms above the head and getting up from the squatting position. Cutaneous examination of the patient revealed violaceous erythema over the periorbital area, forehead, malar area, chin ([], pre- and postauricular area [Figure and ] and both the breasts [Figure and ]. Systemic examination of the patient revealed generalized edema and musculoskeletal system examination revealed proximal muscle weakness affecting the limb girdles. Laboratory investigations of the patient revealed raised ESR and markedly elevated muscle enzymes (LDH, CPK-MM) [Tables and ]. Electromyography showed presence of myopathic denervation consistent with polymyositis, while a muscle biopsy from the quadriceps muscles revealed inflammatory myositis. Skin biopsy from the erythematous lesion revealed atrophic epidermis, focal basal cell vacuolar degeneration and dermal edema [], suggesting the diagnosis of dermatomyositis. The patient was simultaneously investigated for the recurrence of operated ductal carcinoma of the breast and metastasis. Ultrasonography of the right breast showed edema of the skin and subcutaneous tissue with fluid collection in the subcutaneous tissue without evidence of any mass. Positron emission tomography (PET) scan of the whole body did not reveal recurrence of previous malignancy or metastasis. The patient was diagnosed as dermatomyositis associated with treated ductal carcinoma of the breast and was initially started on oral prednisolone 1.5 mg/kg/day. But, in the absence of satisfactory improvement, subcutaneous injection methotrexate 15 mg/week was added. The patient showed excellent improvement in skin lesions and muscle function within 2 weeks [Figure –] with reduction in titers of muscle enzymes []. The dose of oral steroids and methotrexate was tapered slowly without recurrence of the disease, leading to complete discontinuation of the treatment at the end of 4 months. | [[65.0, 'year']] | F | {'12046828': 1, '12452993': 1, '9636749': 1, '11300169': 1, '10692055': 1, '9466195': 1, '18203322': 1, '11298544': 1, '19499841': 1, '11872415': 1, '7562762': 1, '10895343': 1, '5794943': 1, '12071815': 1, '9208890': 1, '20592760': 2, '18306999': 1, '24350018': 2} | {'3853903-1': 2, '3853903-3': 2, '2879548-1': 1, '2879548-2': 1} |
164,643 | 3853903-3 | 24,350,018 | noncomm/PMC003xxxxxx/PMC3853903.xml | Dermatomyositis associated with malignancy: A report of 3 cases | A 58-year-old married male presented with complaints of swelling and redness of the periorbital area, face, trunk and upper extremities since 2 months, difficulty in raising limbs and getting up from squatting position since 15 days and nasal twang of voice and nasal regurgitation of the food since 1 day. The patient was apparently alright 3 months ago, when he developed increased frequency of micturition, urgency and reddish discoloration of urine lasting for 3-4 days. The patient was investigated and diagnosed to have high-grade transitional cell carcinoma of the urinary bladder with extension to prostate on biopsy of the prostate. Cutaneous examination of the patient revealed confluent macular violaceous erythema and edema of the periorbital area, forehead and malar area [] with erythematous rash on the neck, chest [] and back. Systemic examination of the patient revealed generalized edema and musculoskeletal system examination revealed weakness of the muscles of limb girdles.\nLaboratory investigations of the patient revealed raised ESR, positive antinuclear antibody test (ANA 4+) and markedly elevated muscle enzymes (LDH, CPK-MM). Electromyography showed presence of myopathic denervation consistent with polymyositis, while a muscle biopsy from the quadriceps muscles revealed inflammatory myositis. Urine examination of the patient showed 30-40 RBCs/hpf, 8 to 15 transitional epithelial cells and 3-5 pus cells/hpf [Tables and ]. Skin biopsy from the violaceous erythematous lesion reveled atrophic epidermis, basal cell vacuolar degeneration, dermal edema and perivascular inflammatory infiltrate with abundant mucin in the dermis [Figure and ]. Ultrasonography of the abdomen and pelvis revealed 1 cm × 3.2 cm-sized mass at the bladder base, involving the prostate and suspected to be transitional cell carcinoma of the bladder. CT scan of the abdomen reveled ill-defined, mildly enhancing lesion at the bladder base extending into the prostate which on biopsy and immunohistochemistry confirmed the diagnosis of high grade transitional cell carcinoma. Rhinolaryngoscopy of the patient showed bulbar palsy. The patient was diagnosed as DMS associated with transitional cell carcinoma of the bladder and received oral prednisolone 1.5 mg/kg/day and subcutaneous injection methotrexate 15 mg/week in view of severity of skin and muscle involvement. Skin lesions of the patient showed complete resolution after 2 weeks of the treatment [Figure –], but muscle function recovery was monitored by fall in titers of muscle enzymes []. Unfortunately, the patient died of sudden cardiac arrest while awaiting the surgery. | [[58.0, 'year']] | M | {'12046828': 1, '12452993': 1, '9636749': 1, '11300169': 1, '10692055': 1, '9466195': 1, '18203322': 1, '11298544': 1, '19499841': 1, '11872415': 1, '7562762': 1, '10895343': 1, '5794943': 1, '12071815': 1, '9208890': 1, '20592760': 2, '18306999': 1, '24350018': 2} | {'3853903-1': 2, '3853903-2': 2, '2879548-1': 1, '2879548-2': 1} |
164,644 | 3853904-1 | 24,350,019 | noncomm/PMC003xxxxxx/PMC3853904.xml | Follicular mucinosis | A 5-year-old girl child presented with a two-year history of a non-pruritic, occasionally scaly spots initially present on the back, which spread to involve the trunk. The child was otherwise healthy with a past medical history of atopic dermatitis and no previous surgeries. Her medications included: multi-vitamin, fish oil, and vitamin D.\nIn her family history, her mother had seasonal allergies and father had hypertension and basal cell carcinoma.\nUpon examination, there were orange-tan, patches with follicular papules involving the trunk [Figures and ]. At that time, no laboratory tests were ordered. Previous biopsies completed in 2010 and early 2012 showed “Conspicuous patchy infiltrates of lymphocytes associated with hair follicles at the level of the infundibulum and isthmus, associated with mild focal follicular spongiosis and vacuolar alteration of the interface between the outer root sheath and the dermis. Additional findings include lymphocytes that are sparse superficial perivascular and intraepidermal, a rare necrotic keratinocyte, and focal smudging of the dermoepidermal junction.” Another biopsy of the upper and lower back was performed on 02/16/2012 and showed the following: “The findings in these two specimens are identical to those in the previous biopsies, with lymphocytic infiltrates that surround, and involve, follicular infundibular and isthmic epithelium [Figures –]. Associated follicular epithelial spongiosis is, for the most part, mild, though there is focal spongiosis that may be graded as moderate. Colloidal iron stains at multiple levels from both specimens demonstrate mucin, both within the infundibular epithelium and the perifollicular sheath. Immunohistochemical stains performed on Specimen “2” (Upper back) reveal a mild loss of CD7 positivity (approximately 40% of cells staining overall), when compared with CD3, CD2, and CD5, CD4 and CD8 stains reveal an overall helper: Suppressor ratio of approximately 5:1, while CD45RO and CD45RB appear to stain cells in both compartments in a roughly equal fashion.” Upper back: “molecular gene rearrangements negative.” The diagnosis: Follicular mucinosis. | [[5.0, 'year']] | F | {'19632741': 1, '15569029': 1, '12451369': 1, '32171541': 1, '19615011': 1, '24350019': 2} | {} |
164,645 | 3853905-1 | 24,350,020 | noncomm/PMC003xxxxxx/PMC3853905.xml | Disseminated Mycobacterium chelonae infection: Complicating a case of hidradenitis suppurativa | A 28-year-old, married, male presented with complains of pain, discomfort and purulent discharge from both axilla and inguinal regions since 4 years duration with intermittent partial regression and relapse. He had been treated by general practitioners for all these years with systemic and local antibiotics without much relief. He also complained of low-grade intermittent fever, weight loss and weakness since 6 months.\nOn examination, suppurative nodules, plaques, and discharging sinuses were seen over both the axilla and inguinal region with involvement of the scrotum [Figures –]. The discharge consisted of cream colored pus without granules or any specific odour. In some areas there were healed lesions with scarring and fibrosis. Axillary and inguinal group of lymph nodes were palpable and non-tender. He had normal pulse rate, blood pressure, chest was clear and no organomegaly was seen. Laboratory investigations revealed hemoglobin 11.6 g%, TLC 9,000/mm3, Differential count showed N 64%; L 32%; E 3%; M 1%; ESR 60 mm in 1st hour and fasting blood sugar 230 mg/dl. Mantoux test was negative. Serum for VDRL and HIV tests was non-reactive. Chest X-ray was normal. Gram staining of the purulent discharge from the axilla and inguinal region showed the presence of Gram positive cocci in clusters []. Zeihl Neelsen (ZN) staining revealed the presence of acid fast bacilli []. The pus sample from all the four sites were inoculated separately in blood agar, MacConkey agar, Lowenstein-Jensen (LJ) media in duplicate, one covered with black paper to rule out scotochromogens and in SDA slants. After 48 h of incubation two types of colonies were seen on MacConkey agar media, which was found to be Gram positive cocci in clusters and acid fast bacilli. On the 6th day non-pigmented colonies were seen in LJ media which were found to be acid fast [] No growth was seen in SDA slants after 4 weeks of incubation. Both the organisms were identified as S. aurues and M. chleonae based on preliminary staining, growth characteristics and biochemical findings. M. chelonae and S. aureus were isolated from all the four sites from where samples were collected. Biopsy of the lesion showed foreign body type granulomas around the hair follicle with inflammatory cell infiltrate, fibrosis and destruction of appendageal structures suggestive of HS. Differential diagnosis of furnculosis, scrofuloderma, actinomycosis, lymphogranuloma venereum and granuloma inguinale were ruled based on microscopic findings of the pus, absence of genital ulcer as well as history of contact, no spread from bone or lymph node, or on any bony prominence, chronicity and bilateral nature of the lesions.\nThe lesions were drained after excision to provide local relief to the patient. The infection was treated with clarithromycin (500 mg) twice daily for 12 weeks, injection tobramycin (16 mg) twice daily for 2 weeks along with local application of mupirocin. The discharge was sterile on culture after 2 weeks of treatment. Isotretinoin (40 mg daily in two divided doses), dapsone (100 mg daily) and zinc gluconate (200 mg daily) were given for 6 months. He was also given insulin as his fasting blood sugar was high. The lesions showed signs of regression with disappearance of the distressing symptoms like tenderness, swelling and discharge. | [[28.0, 'year']] | M | {'11757889': 1, '19293006': 1, '16273821': 1, '28442828': 1, '10783823': 1, '24350020': 2} | {} |
164,646 | 3853906-1 | 24,350,021 | noncomm/PMC003xxxxxx/PMC3853906.xml | Erythrokeratodermia variabilis: Two case reports | A 10-year-old boy came to our clinic for brownish and red spots that had started 5 years ago and had appeared from time to time. The red spots initially spread centrifugally and disappeared without any mark, however, the brownish lesions on the anterior part of trunk and arms did not disappear. He was seen by different physicians and was treated with various fungal treatments that were not beneficial. No similar lesions were detected in other family members. No systemic disease was detected.\nThe dermatological examination showed erythematous, annular plaques located on the anterior part of chest, arms, and neck; and brownish hyperkeratotic plaques on the left shoulder and axillary region [Figure and ]. No lesions were detected on the palm, sole, nail, hair, teeth, or mucosa. The histopathological examination of the hyperkeratotic plaque showed hyperkeratosis with moderate papillomatosis and acanthosis []. | [[10.0, 'year']] | M | {'11122035': 1, '2420287': 1, '16008642': 1, '12833406': 1, '9784050': 1, '20199434': 1, '16918639': 1, '21352304': 1, '16297190': 1, '12220269': 1, '17573869': 1, '30859115': 1, '19171995': 1, '24350021': 2} | {'3853906-2': 2} |
164,647 | 3853906-2 | 24,350,021 | noncomm/PMC003xxxxxx/PMC3853906.xml | Erythrokeratodermia variabilis: Two case reports | A 15-year-old boy was admitted to our clinic for transient redness and brownish-crusty lesions. He had these lesions since age 2. He was seen by several physicians and he was treated with different treatments including salicylic acid, and corticosteroids that were ineffective. Erythematous lesions appeared from time to time that worsened with physical activities and heat, and disappeared spontaneously. However, the brownish crusty lesions did not recover. His parent was a second-degree relative. His sister had similar symptoms, but did not come to the clinic for an examination. The dermatological examination showed well-marginated, brownish hyperkeratotic lesions symmetrically distributed on the axillary regions, antecubital fossa, inguinal region, and lower extremities [Figure and ].\nNo fungal elements were detected in potassium hydroxide preparations in both patients. The laboratory tests including complete blood count, liver function tests, lipid profile, glucose, creatinine, serum urea nitrogen, calcium, phosphate, and urinalysis were within normal limits.\nThe histopathological assessments of hyperkeratotic lesion showed basket-like hyperkeratosis, papillomatosis, acanthosis, and perivascular lymphocytic infiltration of the dermiş []. The clinical and histopathological findings were consistent with EKV. Systemic therapy in case one was refused by the parents; so topical corticosteroid treatment was initiated. The second patient was treated with acitretin po (25 mg/d). The lesions were regressed with mild hyperkeratosis at the end of 4 months treatment. Then the patient discontinued the treatment. During the 1 year follow-up period, he occasionally had episodes of erythema and mild degree of hyperkeratosis. | [[15.0, 'year']] | M | {'11122035': 1, '2420287': 1, '16008642': 1, '12833406': 1, '9784050': 1, '20199434': 1, '16918639': 1, '21352304': 1, '16297190': 1, '12220269': 1, '17573869': 1, '30859115': 1, '19171995': 1, '24350021': 2} | {'3853906-1': 2} |
164,648 | 3853907-1 | 24,350,022 | noncomm/PMC003xxxxxx/PMC3853907.xml | Amyloidosis cutis dyschromica | A 26-year-old female presented with hyperpigmentation of skin since birth and progressively developed, hypo- and de-pigmented spotty macules over the extremities and trunk during childhood. She was born to parents of second-degree consanguineous marriage, with history of similar skin lesions in maternal uncle. Patient did not give any history of photosensitivity, blistering, itching or developmental delay.\nGeneral physical examination was normal. Cutaneous examination revealed diffuse hyperpigmentation with mottled spotty, well-defined, de-pigmented and hypopigmented macules ranging from pinpoint to 2 × 2 cm in size. Some of the de-pigmented macules were atrophic []. Her face and abdomen was relatively spared with involvement of the extremities. Hair, teeth, nails and oral mucosa were normal. Ophthalmology and ENT assessments were normal. Systemic examination was unremarkable.\nHistopathology of hypopigmented lesion showed atrophic epidermis with loss of rete ridges. The upper dermis revealed eosinophilic extracellular nodular deposits and mild perivascular aggregates of chronic inflammatory cells, of which lymphocytes predominate []. These eosinophilic deposits stained brick red with Congo Red stain [].\nHistopathology of the hyperpigmented lesion also showed eosinophilic deposits that stained brick red with Congo Red.\nAll other routine investigations were within normal limits.\nWith these findings, a diagnosis of ACD was made. | [[26.0, 'year']] | F | {'16043923': 1, '7527208': 1, '12184644': 1, '11355326': 1, '9888342': 1, '9863286': 1, '34286474': 1, '21320354': 2, '19538186': 1, '10733268': 1, '26288409': 2, '33959537': 1, '1626966': 1, '2224732': 1, '11722454': 1, '902842': 1, '24350022': 2} | {'4533539-1': 1, '3048549-1': 1} |
164,649 | 3853908-1 | 24,350,023 | noncomm/PMC003xxxxxx/PMC3853908.xml | Progressive symmetric erythrokeratoderma with nephrotic syndrome: Coincidence or new association? | A15-year-old boy born of second-degree consanguineous marriage presented with asymptomatic scaly skin lesions on the extremities since 5 years. Lesions initially started on dorsum of feet, and gradually progressed to involve knees and hands. These lesions were persistent and nonmigratory. There was no history of similar skin eruptions in the family or siblings. He had steroid-dependent nephrotic syndrome from infancy.\nCutaneous examination showed well-demarcated, hyperpigmented, hyperkeratotic scaly plaques distributed symmetrically on the dorsum of hands and feet, elbows, knees, and tendoachillies [Figures –]. Palms and soles were normal. There was no abnormality of hair, nails, or mucous membrane. There was no musculoskeletal or ocular abnormality. He had puffiness of face with cushingoid features and pedal edema. Skin biopsy revealed hyperkeratosis, focal parakeratoses, acanthosis, normal granular layer, and a moderate mononuclear infiltration in upper dermis []. Based on clinical and histopathological findings, diagnosis of PSEK was made. He was treated with emollients, topical steroids, and keratolytics with marked improvement. | [[15.0, 'year']] | M | {'17664748': 1, '18799882': 1, '30984600': 1, '27051833': 1, '20921653': 1, '1828175': 1, '6210589': 1, '27512197': 1, '23130266': 2, '11918723': 1, '2150049': 1, '21860161': 1, '24350023': 2} | {'3481936-1': 1} |
164,650 | 3853909-1 | 24,350,024 | noncomm/PMC003xxxxxx/PMC3853909.xml | Unilateral acrosyringeal lichen planus of palm | A 30-year-old male presented with multiple, discrete asymptomatic punctate keratoses and pits over left palm since one month. These lesions were gradual in onset and progressive in nature. There was no history of vesiculation or oozing or of similar lesions elsewhere on the body. Examination revealed multiple tiny pits some containing keratotic plugs []. Mild scaling was seen at the edges and some of the plugs also showed collarette scaling. No other skin lesions were seen on the body. Nails and oral mucosa were normal. There was no history of any other systemic or skin disease. There was no history of any drug intake prior to lesions.\nA diagnosis of palmar lichen nitidus, LP and pompholyx was thought and a skin biopsy was obtained from a representative lesion.\nHistopathological examination revealed compact orthokeratosis, focal parakeratosis, hypergranulosis, irregular slightly saw-tooth acanthosis with focal vacuolar alteration of basal layer with degeneration of basement membrane and few necrotic keratinocytes. In papillary dermis, band-like dense lymphocytic infiltrate mainly in juxtaposition to the acrosyringium with sparing of surrounding epidermis was seen. Liquefaction degeneration of the acrosyringeal basal cell layer with a dilated acrosyingium having a parakeratotic plugs were seen as prominent finding [Figures and ]. A dilated acrosyringium with parakeratotic plug on histology, explained punctate keratoses seen clinically. However, even on multiple step sections, epidermal perforation could not be found. Thus probably spontaneous shedding of parakeratotic plugs was speculated as a cause of pits seen clinically. On clinicopathological correlation, a diagnosis of acrosyringeal LP of palm was made. Patient is advised to apply topical clobetasol and 3% salicylic acid cream twice daily along with moisturizers and is under follow-up. | [[30.0, 'year']] | M | {'2445156': 1, '21727704': 1, '28035216': 1, '34063840': 1, '27990397': 1, '12707472': 1, '27730052': 1, '10730766': 1, '22772646': 1, '20061732': 1, '24350024': 2} | {} |
164,651 | 3853915-1 | 24,350,030 | noncomm/PMC003xxxxxx/PMC3853915.xml | A cases series of Piezogenic pedal papules | A 19-year-old female admitted for numerous soft and round lesions on the heels that became prominent with standing. The lesions initially appeared on the lateral and posterior parts of both feet, and their size and number continued to increase over time. Standing and walking resulted in a continuous pain in the heels that gradually intensified. The pain subsided with the cessation of standing and walking, and also by applying pressure in areas of the feet other than the heels. The patient had no previous history of feet injuries and of excessive or continuous pressure exerted on the feet (due to factors such as excessive weight, jumping, etc.).\nWhen no pressure was applied to the lesions, they presented as soft, round, skin-colored and about 0.1-0.4 cm diameter papules on the outer edges of the heels. Under pressure, the lesions became harder, tense and painful []. One papular lesion was completely excised from the lateral of the patient's left foot. A histopathological evaluation revealed hyperkeratosis, irregular acanthosis, thickening of the dermis and small fat cell populations in the dermis (H-E staining, ×5) []. As the patient had complaints of pain and did not wish to undergo surgery, intralesional corticosteroid injection was performed twice. No improvement or recovery was detected on follow-up visits. The patient is currently under follow-up. | [[19.0, 'year']] | F | {'3624559': 1, '15186050': 1, '15649213': 1, '5694945': 1, '28217479': 1, '34222585': 1, '16377984': 1, '27057035': 1, '17656899': 1, '9146543': 1, '3596887': 1, '24350030': 2} | {'3853915-2': 2} |
164,652 | 3853915-2 | 24,350,030 | noncomm/PMC003xxxxxx/PMC3853915.xml | A cases series of Piezogenic pedal papules | A 33-year-old male, amateur marathon runner, presented with similar papules for over a year that gradually increased in number over the past 3 months. Clinically, the number of lesions was less compared to the other cases. He did not accept to have a biopsy, so histopathological analysis was not able to be performed. Intralesional steroid injection was not helpful.\nPiezogenic papules are constituted of herniations of fat tissue into weight-carrying connective tissue of the heels.[] They occur as a result of continuous pressure on the heels, as a result of factors such as excessive weight, jumping, running, or carrying heavy loads. The pain appears to be caused from the continuous contact between the papules and footwear, although some have proposed that neurovascular anoxia in the lesions may also contribute to the pain.[]\nPiezogenic papules are generally observed in healthy individuals, sportsmen and especially among marathon runners.[] It is for this reason it is considered as among the frictional and mechanical dermatoses related to sports and observed among athletes. Of our cases, the third was a marathon runner. Patients with Ehler–Danlos syndrome, Prader Willi syndrome, rheumatic heart disease and rheumatoid arthritis have been reported in the literature.[] There are few cases with heart valve disease concomitant to pedal papules that were identified in the literature. Only two cases related with rheumatic valve disease has currently been reported.[]\nIn the histopathologic findings of piezogenic pedal papules, dermal fibrosis and the herniation of subcutaneous fat tissue from the papillary dermis are observed.[]\nTreatment outcomes are not always satisfactory. Patients successfully treated with compression treatment, intralesional steroid and anesthetic injection[] have been reported in literature. Changes in footwear and orthopedic support are also known to alleviate the pain and symptoms associated with the papules. Surgery options including the excision of the papules as well as a sealing of the existing hernia can also be performed in patients received unsuccessful conservative treatments. The surgery option is more effective than the conservative methods.[] Since our cases did not want to have surgery, a combination of triamcinolone and lidocaine was injected intralesionally into the larger lesions. However, this treatment was not successful in all of the cases.\nIn conclusion, piezogenic pedal papule is a benign pathology that has been identified in the past four decades. It is presumed to be observed more frequently than it has been reported. As observed in our four cases, different associations can be observed in its etiology. It is overlooked by certain physicians, while other physicians that are unfamiliar with the pathology may not be able to diagnose it. There are no accompanying systemic diseases in most cases. It is important to relieve the patients’ concern regarding its process, and to attempt various treatment options in symptomatic individuals. | [[33.0, 'year']] | M | {'3624559': 1, '15186050': 1, '15649213': 1, '5694945': 1, '28217479': 1, '34222585': 1, '16377984': 1, '27057035': 1, '17656899': 1, '9146543': 1, '3596887': 1, '24350030': 2} | {'3853915-1': 2} |
164,653 | 3853974-1 | 24,964,328 | noncomm/PMC003xxxxxx/PMC3853974.xml | Pleomorphic adenoma of lacrimal gland | A 62-year-old male patient referred to our clinic due to painless exophthalmia of his right eye for the last 2 years. On neurological examination of the patient, there was no abnormality except for the up-gaze restriction and severe exophthalmia. Computerized tomography revealed an intraorbital mass in the right eye. A well-defined 2.5-cm isodense mass was located on the right lacrimal gland. The mass was contrasted homogenously (Fig. a and b). Cranial magnetic resonance imaging (MRI) revealed an isointense mass on the superolateral part of right orbita in the coronal intersections and it was contrasted homogenously (Fig. a and b). The existing score of our patient according to Rose and Wright was +8 points. Combined orbitofrontal craniotomy was performed through a transcranial approach. The well-defined, soft, white, 2.5-cm mass was removed completely. Exophthalmoses disappeared after the surgery (Fig. a and b). Histological examination of the surgical specimen covered the epithelial and stromal components that formed the glandular structures. Keratinized plugs were seen in some glandular lumens. Cartilaginous differentiation of stroma was found (Fig. a–d). Based on these findings, the tumor was diagnosed as pleomorphic adenoma. There was no recurrence after 8-year clinical follow-up. | [[62.0, 'year']] | M | {'19096692': 1, '29755265': 1, '1237083': 1, '16127259': 1, '32089922': 2, '1320924': 1, '14579116': 1, '34926199': 1, '1320923': 1, '9596497': 1, '7378993': 1, '24964328': 2} | {'7021468-1': 1} |
164,654 | 3854271-1 | 22,570,089 | noncomm/PMC003xxxxxx/PMC3854271.xml | Interleukin-10-dependent down-regulation of interferon-gamma response to Leishmania by Mycobacterium leprae antigens during the clinical course of a coinfection | A 46-year-old male patient presented with a clinically active mucosal leishmaniasis and lepromatous leprosy coinfection, the clinical picture of which has been previously described in detail (). The diagnosis of polar lepromatous leprosy was based on positive results from smears of skin samples from the earlobes, elbows, and knees, with an average bacterial index of 4+ with Ziehl-Nielsen staining. Mucosal leishmaniasis was diagnosed by isolation of Leishmania from the nasal mucosal lesion. The isolated parasites were characterized as Leishmania braziliensis by isoenzyme analysis (). The patient was treated for leishmaniasis with meglumine antimoniate for 30 days with a low-dose schedule of 5 mg/kg per day of pentavalent antimony and for leprosy with a multidrug therapy regimen () with 24 monthly supervised doses. Leprosy treatment was started 10 months before the beginning of leishmaniasis therapy and ended 13 months after its completion. Nine months after diagnosis, the leishmaniasis lesion was considered to be healed, leaving partial mutilation of the nose. Relapse was noticed 13 months after cure of the mucosal lesion, with erosion of the nose and large edema and infiltration of the nose and lips extending to the malar region. On that occasion, Leishmania parasites were again isolated from a biopsy specimen from the nasal lesion, but the patient had no clinical sign of leprosy and skin smears obtained bilaterally from earlobes, elbows, and knees showed a bacterial index of 0 (zero). | [[46.0, 'year']] | M | {'15853916': 1, '27629065': 1, '17152018': 1, '15655736': 1, '28127365': 1, '29031287': 1, '8006444': 1, '12942392': 1, '17544832': 1, '29494584': 1, '16412059': 1, '15081655': 1, '8147488': 1, '11791986': 1, '9041358': 1, '16299275': 1, '32051036': 1, '8515073': 1, '10736116': 1, '11685267': 1, '18585959': 1, '12438348': 1, '19270278': 1, '8102388': 1, '21592112': 1, '2535060': 1, '22570089': 2} | {} |
164,655 | 3854482-1 | 24,968,419 | noncomm/PMC003xxxxxx/PMC3854482.xml | An unusual presentation of a solid pseudopapillary pancreatic tumor | An otherwise healthy 14-year-old girl was referred to the Department of surgery Uppsala University Hospital from another hospital where she underwent a trauma-CT after receiving an elbow to the abdomen during a basketball game. The CT displayed no signs of traumatic injury, but revealed a 6.5 × 4.5 × 5.0 cm large tumor in the pancreatic head (Figs and ) which displaced the portal vein, vena cava and hepatic artery. Further investigation revealed that the patient had felt tired and had lost some weight during the past 6 months. Contrast-enhanced ultrasound with Doppler indicated a tumor with both solid and cystic structures, but no signs of vascular encapsulation. The investigation was complemented with positron emission tomography, hormone screening and an ultrasound of the heart. On the contrast-enhanced ultrasound the tumor appeared resectable; therefore no endoscopic ultrasound or biopsies were taken.\nThe patient underwent surgery, pylorus-preserving pancreaticoduodenectomy, and recovered well post-operatively and was discharged after 9 days. In the post-operative check-up 4 weeks after discharge, the patient was still doing well and histopathologic examination revealed an R0-resected solid pseudopapillary pancreatic tumor (SPPT).\nThe follow-ups were conducted at the referring hospital and MRI of the pancreas has been performed twice: 4 years after the operation, there were no signs of recurrence. | [[14.0, 'year']] | F | {'2207560': 1, '19845185': 1, '19818965': 1, '7482268': 1, '8893639': 1, '15922212': 1, '18154930': 1, '20106656': 1, '24968419': 2} | {} |
164,656 | 3854545-1 | 24,968,415 | noncomm/PMC003xxxxxx/PMC3854545.xml | A rare cause of faecal peritonitis: jejunal perforation in a patient undergoing treatment for pulmonary tuberculosis | A 26-year-old Indian man presented with generalized abdominal pain, vomiting and absolute constipation. Symptoms had developed over several months, with night sweats, weight loss, malaise and reduced appetite, shortly after returning from a trip to India.\nHe had been started on triple therapy for presumed pulmonary TB, based on a suspicious chest radiograph 6 months prior, showing bilateral ill-defined shadowing in the upper-lung zones with signs of paratracheal lymph node enlargement.\nOn assessment he was found to be septic with tachycardia, hypotension and peritonitis on examination. He underwent an emergency laparotomy, revealing two tight jejunal strictures, one of which had perforated. Two small bowel resections of lengths 7 and 10 cm were performed, with primary anastomosis.\nOne week post-operatively, he developed pyrexia and right iliac fossa pain. An abdominal ultrasound scan revealed a 1 × 6 × 8 cm collection in the right iliac fossa. Although not amenable to drainage, a diagnostic aspiration was performed and the specimen returned negative for acid-fast bacilli. A repeat scan 10 days later after antibiotics detected a tiny volume of free fluid, with no identifiable collection.\nHistology revealed fibrinous exudates over the serosal surface of both resected jejunal specimens, with lymphoid aggregates and occasional granulomas. This, in context with the presentation, was in keeping with abdominal TB.\nFollowing recovery, he was discharged and completed the remaining duration of anti-tuberculous therapy. He made satisfactory progress on follow-up and required long-term supplements for Vitamin D deficiency following extensive jejunal resection. | [[26.0, 'year']] | M | {'7807661': 1, '33628536': 2, '31065355': 1, '16197489': 1, '5673108': 1, '16673312': 1, '22299550': 1, '22546662': 1, '21899455': 1, '32674552': 2, '6054587': 1, '24968415': 2} | {'7889363-1': 1, '8359699-1': 1} |
164,657 | 3854653-1 | 24,968,433 | noncomm/PMC003xxxxxx/PMC3854653.xml | Choice of imaging modality in the diagnosis of sciatic hernia | An 80-year-old lady was referred to the on-call surgical team by her GP with a 3-week history of a right-sided swelling of the buttock. Although associated with a mild discomfort, there were no urinary or bowel symptoms. Her GP had prescribed a trial of clarithromycin to no effect. She had a past medical history of hypertension, osteoarthritis and pemphigus vulgaris and a past surgical history of a perianal abscess requiring incision and drainage. She was allergic to penicillin and took regular oral betamethasone, xylometazoline nasal spray and topical aqueous cream. She did not consume alcohol, was a non-smoker and lived in warden-controlled accommodation. On examination, her cardiac, respiratory and abdominal examinations were normal. Digital rectal examination revealed a non-tender stool-filled rectum with no palpable masses. On standing, a swelling on the medial aspect of the right buttock became apparent which was easily reducible, had audible bowel sounds and a positive cough impulse. Admission bloods were unremarkable. She was reviewed by the on-call consultant who discharged her with a working diagnosis of possible obturator hernia, with a plan for an outpatient CT of her pelvis and follow-up in clinic.\nCT scan of the pelvis did not identify a cause for the swelling (Fig. ). Due to the positional nature of the swelling, a gluteal ultrasound was organized, which revealed a large colonic sciatic hernia (Fig. ). As the patient had minimal symptoms and was not keen for surgical intervention, a plan for conservative management was agreed and the patient was discharged from clinic. | [[80.0, 'year']] | F | {'21121389': 1, '19418010': 1, '31278606': 2, '19927522': 1, '20197431': 1, '21935810': 1, '20103066': 1, '30959363': 1, '32006905': 2, '24968433': 2} | {'6611857-1': 1, '6611857-2': 1, '6611857-3': 1, '6611857-4': 1, '6611857-5': 1, '6611857-6': 1, '6611857-7': 1, '6611857-8': 1, '6611857-9': 1, '6611857-10': 1, '6611857-11': 1, '7000447-1': 1} |
164,658 | 3854914-1 | 24,968,398 | noncomm/PMC003xxxxxx/PMC3854914.xml | Multiple simultaneous small bowel intussusceptions in an adult | A 41-year-old female presented with 3 weeks of intermittent crampy epigastric abdominal pain, nausea and diarrhea. She was able to tolerate a liquid diet but not solids. She had one episode of vomiting and lost 6 lbs over the course of 3 weeks. Her vital signs, physical examination and laboratory studies were unremarkable. She did not have a history of prior abdominal surgery or malignancy. A CT scan demonstrated two areas of small bowel intussusception (Fig. A and B), without evidence of bowel obstruction or mass. The patient underwent exploratory laparoscopy using a 5 mm 30° camera and two 5 mm working ports. Six separate regions of intussusception within the small bowel were discovered between 55 and 130 cm from the ligament of Treitz. All areas of intussusception were short and witnessed to undergo spontaneously reduction (Fig. A and B), except for one (Fig. ), which was resected through a mini-laparotomy. There was no obvious evidence of masses, adhesions or serosal abnormalities along the small bowel. There were prominent lymph nodes noted in the small bowel mesentery (Fig. ). The postoperative course was uneventful and she was discharged 4 days after her operation. She had resolution of symptoms and had no recurrence after 3 years of follow-up. Pathologic examination of the small bowel demonstrated no evidence of malignancy, lead point, pathologic changes or sprue. Likewise, there was no evidence of acid-fast organisms, fungal or helminth parts identified. The enlarged mesenteric lymph nodes demonstrated reactive follicular hyperplasia and multifocal non-necrotizing lipogranulomas. | [[41.0, 'year']] | F | {'3484870': 1, '937658': 1, '21830152': 1, '18092641': 1, '7469558': 1, '32139983': 1, '24968398': 2} | {} |
164,659 | 3854980-1 | 24,968,420 | noncomm/PMC003xxxxxx/PMC3854980.xml | Massive traumatic abdominal hernia repair with biologic mesh | A 27-year-old male with no past medical history was the driver and sole occupant of a car which crashed through a fence at 80 kph and hit a lamp post. He was wearing a seatbelt, the airbags did not deploy and despite the significant intrusion into the passenger space, he extricated himself unaided. He was resuscitated according to Advanced Trauma Life Support® principles. The primary survey identified decreased air entry at the base of the right lung and right-sided abdominal and lower chest tenderness. Abrasions were evident over the anterolateral abdominal wall and a large, right-sided abdominal swelling was noted.\nTrauma series computed tomography (CT) scans demonstrated a flail segment between the sixth and eight ribs with disruption of the intercostal muscles and a small right haemothorax (Fig. a). In the abdomen, there was hepatic contusion with an intrinsic liver injury (Fig. b). Blood was noted around the liver with minor active haemorrhage. The right abdominal wall was ruptured—the right rectus abdominis muscle had been torn from its costal attachments to the midpoint. The hepatic flexure of the colon had herniated through the intercostal muscles of the eighth and ninth ribs and was lying adjacent to the fractured ribs (Fig. c). Both small and large bowel had herniated through the abdominal wall lateral to rectus abdominis, but remained covered by external oblique (Fig. d). Herniation of small and large bowel immediately adjacent to the fractured ribs raised the suspicion of occult bowel injury not detected on CT.\nThe operative management was undertaken by both thoracic and abdominal surgeons. The ribs were re-opposed with absorbable polyglycolic acid sutures and a chest drain inserted. At laparotomy, it was noted that the hernia sac contained omentum, the bowel having reduced spontaneously under general anaesthesia. A small rent in the mesentery of the proximal small bowel was noted. The abdominal defect was repaired with a 20 × 30 cm sheet of cross-linked acellular porcine dermal collagen (Permacol™, Covidien, Gosport, Hants, UK) which was sutured to the margins of the fascial defect with interrupted nylon sutures, using a ‘bridge’ technique, with a 5-cm underlay on the left.\nPost-operatively, the patient was managed in the intensive care unit for 24 h. A seroma that developed at the hernia site after 1 week was treated conservatively. Impaired abdominal wall function, particularly reduced mobility, was noted post-operatively. Sitting up from lying down position and hip flexion caused difficulty, but improved with intensive physiotherapy. He was discharged home 9 days after admission.\nSix weeks after discharge, he was well with good mobility. He had a persistent seroma at the hernia site. A repeat CT of the thorax and abdomen at 10 weeks demonstrated no residual defect in the anterior abdominal wall and resolution of the seroma (Fig. ). | [[27.0, 'year']] | M | {'17551808': 1, '32802663': 1, '12575786': 1, '8114153': 1, '20919672': 1, '22143748': 1, '18405697': 1, '26957824': 2, '21843736': 1, '22436406': 1, '24968420': 2} | {'4766762-1': 1, '4766762-2': 1, '4766762-3': 1, '4766762-4': 1, '4766762-5': 1} |
164,660 | 3854998-1 | 24,968,397 | noncomm/PMC003xxxxxx/PMC3854998.xml | Ileal diverticulitis: an uncommon diagnosis for right lower quadrant pain | A 75-year-old obese African-American woman presented to the emergency department with progressively worsening, severe and constant aching right lower quadrant pain for 3 days. She described the pain as starting in the epigastrium and moving to the right lower quadrant after 1 day. She vomited once 2 days ago, but denied current nausea, vomiting or diarrhea. Her last bowel movement was 1 day prior to admission. She denied fever, chills and urinary symptoms. Her past medical history included hypertension, diabetes mellitus and hypercholesterolemia. On examination, she was afebrile with stable vital signs. Palpation of the right lower quadrant elicited rebound tenderness and guarding. Bowel sounds were normoactive. Laboratory investigations were essentially within the normal range. Abdominal computed tomographic scan with oral and intravenous contrast media showed an inflammatory mass in the right lower quadrant and a small amount of free fluid on the right side of the pelvis and in the cul-de-sac (Fig. a and b). The appendix was not specifically identified. The patient was given a dose of Cefotetan and taken to the operating room for an open appendectomy. A transverse incision was made at McBurney's point and the appendix was visualized. It was noted that the appendix was extremely inflamed and thickened with mesentery down to the cecal base. Further exploration showed a large mass at the ileocecal junction involving the appendix (Fig. ). The appendix also had a necrotic base. In addition, multiple nodular masses were observed in the ileum and cecum. Because a carcinoma could not be excluded, the decision was made to perform a right hemicolectomy with primary anastomosis. Pathology revealed Ileal diverticulitis. | [[75.0, 'year']] | F | {'27815648': 1, '2114067': 1, '33887852': 2, '30755807': 2, '19999912': 1, '18092289': 1, '20306919': 1, '24968397': 2} | {'8050703-1': 1, '6348891-1': 1} |
164,661 | 3855010-1 | 24,968,422 | noncomm/PMC003xxxxxx/PMC3855010.xml | Ectopic gynaecomastia on the inner aspect of the thigh in an otherwise healthy man | A 28-year-old man attended the general surgical outpatient clinic with a mass in the upper medial aspect of his left thigh. This had been thought to be a lipoma by his General Practitioner and was referred for consideration of its removal. The patient was otherwise healthy and denied any pain, infection or discharge from the lesion over the preceding years. The lump was present since puberty and was slowly enlarging in size to the extent that it had started interfering with his gait on walking or running and it was these symptoms that led him to present for medical attention.\nOn examination, a 10 × 5 cm lesion was identified in the medial aspect of his left upper thigh. This was discrete from genitalia and was associated with a nipple areolar complex (Fig. and ). A smooth, well-defined edge to the mass was noted. There were no firm masses within the lesion and no nipple discharge could be elicited. Abdominal, testicular and neurological examination showed no abnormal findings. On assessment of his biochemical endocrinology profile, all parameters were within normal ranges. An ultrasound examination of the left thigh was consistent with mixed density breast tissue but no evidence of malignancy.\nA mastectomy of this lesion was duly undertaken under general anaesthesia. This was undertaken using simple diathermy. The incision included the nipple areolar complexes and the skin flaps were raised in a manner similar to a standard mastectomy. Complete excision was confirmed by dissection to muscular fascia. Primary closure of the tissues was possible without tension on the superficial tissues.\nHisto-pathological analysis of this lesion confirmed the mass to be an ectopic breast mass with no underlying malignancy. This patient had a complete and uneventful recovery. On subsequent review, this gentleman remains well. | [[28.0, 'year']] | M | {'18998203': 1, '8585676': 1, '19408804': 1, '22536461': 1, '24968422': 2} | {} |
164,662 | 3855058-1 | 24,968,423 | noncomm/PMC003xxxxxx/PMC3855058.xml | Congenital cholesteatoma presenting with Luc's abscess | A 5-year-old boy presented with progressive left supra-auricular swelling for 2 weeks associated with left ear pain and low-grade fever. There were no complaints of ear discharge or hearing impairment by the child or parents. There was no recurrent ear pain before. Further history revealed no recent upper respiratory tract infection or trauma. Clinical examination showed a fluctuant mass measured 2 × 3 cm at the left supra-auricular region that was consistent with abscess. Otoscopic examination demonstrated mild edematous external auditory canal with intact tympanic membrane. There was a whitish mass seen medial to the tympanic membrane.\nTympanogram showed type B with failed auditory brainstem response on the affected side and normal hearing on the right side. High-resolution computerized tomography (HRCT) of temporal bone revealed soft tissue mass in middle ear cleft and ossicular destruction suggestive of cholesteatoma and Luc's abscess formation at left temporal bone (Fig. ). Under general anaesthesia, surgical exploration through post-auricular incision confirmed lucs abscess. Further exploration of middle ear and mastoid cavity revealed cholesteatoma eroding all ossicles and involving mastoid bone. Modified radical mastoidectomy was done (Fig. ). Postoperatively, patient recovered well without any complications. | [[5.0, 'year']] | M | {'19814752': 1, '17931451': 1, '12117340': 1, '19459075': 1, '20502372': 1, '31955213': 1, '22224310': 1, '19745736': 1, '9205610': 1, '30325335': 1, '24968423': 2} | {} |
164,663 | 3855067-1 | 24,968,394 | noncomm/PMC003xxxxxx/PMC3855067.xml | Ossicular malposition in Larsen syndrome: a case report | A 7-year-old female presented with a longstanding history of bilateral hearing loss, more noticeable on the right side. She had a recent diagnosis of Larsen syndrome, and was homozygous for the CHST3 gene, for which the inheritance is autosomal recessive. She did not have a filamin B mutation.\nThere was no evidence of facial dysmorphia, although she had skeletal dysplasia and congenital right-sided hip and knee dislocations. Furthermore, she had previous left hip and knee subluxations, and hallux valgus. Prior echocardiography had revealed thickened aortic valve cusps.\nOn examination, she was noted to have narrow ear canals, with grade 1 microtia. She had bilateral middle ear effusions in keeping with glue ear. After a period of active surveillance, her glue ear resolved, but she continued to have a hearing deficit, with a right-sided mild conductive hearing loss with thresholds of ∼40 dB.\nAt this stage, a computed tomography (CT) scan of the temporal bone was undertaken. The stapes was maloriented on the oval window; however, the other ossicles appeared normal (see Figs and ). There was no middle ear effusion at the time of the CT scan.\nAfter discussions regarding the options for management, she was managed conservatively. She did not require hearing aids. | [[7.0, 'year']] | F | {'10580256': 1, '18279569': 1, '2382789': 1, '2343906': 1, '14779259': 1, '30916490': 2, '3378369': 1, '7193744': 1, '10471860': 1, '20830804': 1, '24968394': 2} | {'6503063-1': 1} |
164,664 | 3855073-1 | 24,964,326 | noncomm/PMC003xxxxxx/PMC3855073.xml | Acute appendicitis as a rare complication of gastric band | A 29-year-old female patient was admitted into the surgical department of Nicosia General Hospital because of a lower abdominal intermittent and cramping pain for the last 24 h. On physical examination, the patient had sensitivity during palpation at the lower abdomen, more predominant at the right iliac fossa. Rebound tenderness was absent during the first examination, as well as the rest of the signs of acute appendicitis. The patient had the following laboratory blood test results: WBC 9.25 × 109/l, neutrophils 69.3%, lymphocytes 20.0%, Mon 9.3%, HGB 9.7 g/dl, HcT 31.3%, MCV 69.4 fl, MCH 21.5 pg, MCHb 31.0 g/dl, PLT 220 × 109/l, glucose 116 mg/dl, urea 18 mg/dl, creatinine 0.8 g/l, Na 139 mmol/l, K 3.9 mmol/l, Tbil 0.81 mg/dl, ALP 61 U/l, γ-GT 8 U/l, AST 10 U/l, ALT 14 U/l, LDH 325 U/l and amylase 103 U/l. Urine test showed no urinary infection and pregnancy test was also negative. Plain chest and abdominal X-rays showed no pathology. Because of her persistent pain and the unclear symptoms that prevented a final diagnosis to be made, she had an ultrasound of the abdomen. The ultrasound revealed a small amount of fluid at the right iliac fossa, and revealed no other pathology of the appendix or any other internal organ. From her past medical history, a laparoscopic procedure for gastric band implantation due to obesity was recorded five years ago. The gastric band worked perfectly well and she lost about 30 kg. She did not complain for any abdominal pain that could be connected to the gastric band, and she did not have any symptoms from erosion or migration of the band. A small flip-over of the port of the gastric band was reported by the patient and it was noted on clinical examination.\nAfter 2 days of hospitalization, observations and clinical examination, she developed acute peritonitis, so she was taken to the operating theatre. A sub-umbilical midline incision was executed to have a good access to the abdomen.\nThe peritoneal cavity was entered and the lower abdomen was thoroughly explored. Signs of infection were noted in the right iliac fossa. The appendix was attached to the ovary and pus was around them. During careful dissection, a strangulation of appendix's lumen from the tube of the gastric band was noted (Figs and ). The tube encircled the appendix and caused the intraluminal disruption that initiated the process of infection. We released the adhesions between the appendix and the tube and proceed to appendectomy. We then narrowed the length of the tube to prevent any future complications, e.g. intestinal obstruction, and thoroughly washed out the peritoneal cavity. | [[29.0, 'year']] | F | {'22236382': 2, '23446665': 1, '15549627': 1, '19640797': 1, '18751761': 1, '18000969': 1, '19005195': 1, '23329713': 1, '16198769': 1, '24964326': 2} | {'3269383-1': 1} |
164,665 | 3855092-1 | 24,968,424 | noncomm/PMC003xxxxxx/PMC3855092.xml | Transection of left common pulmonary vein during left upper lobectomy: how should it be reconstructed? | A 62-year-old man complained of cough and bloody sputum and consulted our hospital. Chest computed tomography (CT) showed a nodule with a diameter of 15 mm in the left upper lobe. Pathologic study of a specimen obtained by transbronchial biopsy showed small cell lung cancer. Positron emission tomography and brain magnetic resonance imaging revealed a clinical stage of T1N0M0 as categorized by the 7th edition of the union for international cancer control (UICC) classification.\nThoracoscopic left upper lobectomy was performed. The common trunk of the left pulmonary vein was misidentified as a superior pulmonary vein until incidental transection with an endostapler during port access surgery. The caliber change between the common trunk and the inferior pulmonary vein was marked. Thoracoscopic surgery was converted to open thoracotomy. The left upper bronchus and pulmonary arteries to the left upper lobe were transected with endostaplers, and the common trunk of the pulmonary vein was left intact. The left main pulmonary artery was then clamped under intravenous heparin injection to achieve an activated coagulation time of 200 s. Annuloplasty of the inferior pulmonary vein was completed during intermittent declamping of the left pulmonary artery. The orifice of the inferior pulmonary vein was augmented by a cuff technique using an orifice of the superior pulmonary vein, as shown in Fig. . The staples on the stump of the left common pulmonary vein on the atrial side were removed to adjust the augmented orifice of the left inferior pulmonary vein under partial clamping of the left atrium following pericardiectomy. End-to-end anastomosis was completed using running sutures with a 4-0 polypropylene thread. The anticoagulant therapy was continued until 2 months after surgery. The postoperative course was uneventful, and the patient was discharged on postoperative day 14. A pathologic study showed stage T1N2M0 small-cell carcinoma as categorized by the 7th edition of the UICC classification. Postoperative enhanced CT demonstrated successful reconstruction of the left common trunk (Fig. ). | [[62.0, 'year']] | M | {'32944319': 1, '29078649': 1, '19231436': 1, '15919274': 1, '25922744': 1, '14739316': 1, '24968424': 2} | {} |
164,666 | 3855167-1 | 24,964,318 | noncomm/PMC003xxxxxx/PMC3855167.xml | Pseudoaneurysm of the internal iliac artery resulting in massive per-rectal bleeding | An 83-year-old male presented to the emergency department with a history of passing a cupful of bright red blood with his morning bowel motion. His past medical history was significant for diverticular disease, which had resulted in a perforated sigmoid colon 23 years before, requiring Hartmann's procedure which was subsequently reversed.\nHe arrived with a blood pressure of 130/75 mmHg and a tachycardia of 104 beats per minute. The haemoglobin level was 13.7 g/l on arrival. Rigid sigmoidoscopy in the emergency department revealed an empty rectum with copious amounts of stool and blood up to 10 cm. The patient was presumptively diagnosed with a diverticular bleed and admitted to the general surgical unit for observation. The following day a further significant per-rectal bleed occurred on the ward, associated with chest pain and ECG changes. Blood tests revealed a haemoglobin drop to 11.3 g/l and an elevated serum troponin level of 0.19 μg/l. Myocardial infarction was diagnosed and he was placed on telemetry in a cardiac monitoring unit. A further massive per-rectal bleed was reported on the ward that evening, with a subsequent drop in haemoglobin to 7.7 g/l. Resuscitation was commenced with three units of packed red blood cells and a mesenteric CT angiogram arranged.\nAn arterial phase CT abdomen with IV contrast was performed. This revealed a contrast blush within the descending colon closely associated with an aneurysm of the internal iliac artery. The possibility of an arterial fistula to the colon was raised, and a vascular surgery consult was sought. Angiography confirmed a false aneurysm arising from the proximal aspect of the left internal iliac artery along its medial and inferior wall. Endovascular coil embolization was performed with occlusion of the vessel at the level of the aneurysm.\nNo further episodes of per-rectal bleeding have been reported in 3 months following embolization. Follow-up colonoscopy revealed multiple diverticulae in the descending colon, but the site of the previous bleed was not evident. | [[83.0, 'year']] | M | {'16120928': 1, '15939637': 1, '11806552': 1, '4838394': 1, '18503897': 1, '24654250': 1, '12546595': 1, '17859134': 1, '20706068': 1, '8005125': 1, '24964318': 2} | {} |
164,667 | 3855171-1 | 24,968,432 | noncomm/PMC003xxxxxx/PMC3855171.xml | Adenocarcinoma in long-segment Barrett's esophagus 44 years after total gastrectomy | In October 2011, a 74-year-old male was admitted to our hospital due to ulceration of the upper to middle thoracic esophagus. The patient had undergone total gastrectomy because of ulcerative stricture of the esophagogastric junction at the age of 30. Following this surgery, he had recurrent bile acid reflux for >40 years which had increased in frequency from 10 years ago. When the patient was 62 years old, an endoscopic examination revealed long-segment Barrett's esophagus, and he subsequently underwent yearly check-up and endoscopic examinations. Irregular mucosa was found 27 cm from the incisors, and the oral margin of Barrett's esophagus was 17 cm from the incisors (Fig. ). Frequent bile regurgitation was found during an endoscopic examination. Pathological examination of biopsied specimens from the irregular mucosa revealed adenocarcinoma.\nAlthough adenocarcinoma was thought to be limited to the mucosal layer, the patient requested resection for adenocarcinoma as well as Barrett's esophagus due to intractable bile reflux. We performed subtotal esophagectomy with lymph node dissection in the prone position and reconstructed the esophagus with ileocolic interposition. During laparotomy, we confirmed that jejunojejunostomy was located 10 cm from esophagojejunostomy. Postoperative pathological diagnosis from a Barrett's epithelial section was well-differentiated adenocarcinoma (T1a 2.0 × 3.0 cm) (Figs. and ). There was no lymph node metastasis (N0).\nAlthough free jejunal graft was needed due to anastomotic leakage at the site of esophagoileostomy, he was discharged 110 days after the first surgery. Final resection of the remaining Barrett's epithelium was performed concurrently with free jejunal graft. He is now well and without any evidence of recurrence. | [[74.0, 'year']] | M | {'3183331': 1, '8792716': 1, '15102519': 1, '15555010': 1, '12831243': 1, '8760598': 1, '20485611': 1, '32990834': 2, '1331573': 1, '6415597': 1, '2239878': 1, '24968432': 2} | {'7524988-1': 1, '7524988-2': 1, '7524988-3': 1} |
164,668 | 3855188-1 | 24,968,416 | noncomm/PMC003xxxxxx/PMC3855188.xml | Caecum herniation through the Foramen of Winslow | A 41-year-old woman presented with a 2-day history of severe, central, cramping abdominal pain of gradual onset, which progressively radiated to the right side of her abdomen. It was relieved by lying on her right side, assuming the foetal position or by bending forwards on the floor. Conversely straightening or stretching her abdomen exacerbated the pain. The patient had not opened her bowels (although she was still passing small amounts of flatus) in 3 days and had been vomiting for 48 h.\nHer laboratory results showed leukocytosis of 14.4 × 109, her other results were unremarkable.\nPlain abdominal radiography (Fig. ) displayed a dilated viscus in the left upper quadrant with absence of colonic shadow on the right side of the abdomen. Initially this was reported as a large distended stomach, but in retrospect was thought to be the caecum.\nAn ultrasound scan of her gall bladder was performed to rule out the possibility of acute cholecystitis; this showed a small amount of free fluid and a known ovarian dermoid cyst.\nComputed tomography was used for diagnosis. Although initially reported as caecal volvulus, in hindsight there were features indicative of the herniation. (Figs and ).\nOn the basis of the computed tomography findings, the patient was taken to theatre for her presumed caecal volvulus. At laparotomy however, the caecum was noted to be herniating through the foramen of Winslow causing closed loop obstruction. It could not be reduced by gentle traction, so the lesser sac was opened up and the caecum decompressed with a small enterotomy and suction to allow reduction. A right hemicolectomy with stapled side-to-side anastomosis was then performed to remove the compromised bowel and the foramen was left open. The patient had an uneventful postoperative recovery and was discharged 4 days later (Figs and ). | [[41.0, 'year']] | F | {'3439931': 1, '28203560': 2, '18436183': 1, '16498098': 1, '27176504': 1, '1991616': 1, '24968416': 2} | {'5309177-1': 1} |
164,669 | 3855215-1 | 24,968,418 | noncomm/PMC003xxxxxx/PMC3855215.xml | An unusual case of bilateral verrucous carcinoma of the foot (epithelioma cuniculatum) | A 44-year-old male with a diagnosis of intellectual disability presents with a many year history of enlarging cauliflower-like tumours of both feet (Fig. ).\nEight years prior to presentation, he had similar warty lesions resected from between the clefts of three toes on the left, with an amputation of one toe on the right. The histopathological report showed warty Bowen's disease with well-differentiated SCC.\nThe growths involved the interdigital folds of the toes of both feet. A CT scan showed tumour bony cortical disruption of the left second toe, with features suspicious for bone marrow invasion. The patient was further investigated with MRI, which showed tumour appearing to be closely related to bone and interphalangeal joints.\nThe extent of the lesions and possibility of bony involvement resulted in the decision to perform bilateral forefoot amputations.\nThe patient was followed up for 1 year and no further recurrences or metastasis were detected. He was able to ambulate with the assistance of orthotics.\nHistologically, the specimen displayed both endophytic and exophytic morphology, comprising of warty papillomatous projections lined by variably atypical stratified squamous epithelium and overlying hyperkeratosis and parakeratin. The endophytic component showed deep acanthotic growths with a periphery of mitotically active basaloid cells and variable atypical squamous cells with frequent atypical mitoses. The endophytic downgrowths of tumour formed burrows filled with keratinous material, in keeping with verrucous carcinoma. No lymphovascular or perineural invasion was identified. Immunohistochemical staining for p16 showed strong nuclear and cytoplasmic reactivity, suggesting an human papillomavirus (HPV) related tumour. | [[44.0, 'year']] | M | {'7442260': 1, '30568820': 1, '28702408': 1, '6168555': 1, '421497': 1, '17550457': 1, '29796321': 2, '7042070': 1, '3511327': 1, '26676984': 2, '3771900': 1, '991089': 1, '11924683': 1, '13219306': 1, '24968418': 2} | {'4799040-1': 1, '5896404-1': 1} |
164,670 | 3855217-1 | 24,968,425 | noncomm/PMC003xxxxxx/PMC3855217.xml | A rare cause of bowel obstruction in pregnancy | A 30-year-old primigravid Caucasian female presented at 38 weeks and 3 days gestation with 24-h of abdominal pain, nausea and vomiting. She continued to pass flatus and had opened her bowels the day before. Past medical history included polycystic ovarian syndrome and right donor hepatectomy 6 years prior in a living-related liver transplant. She took no regular medications, had no allergies and did not smoke or drink alcohol.\nOn assessment, she appeared to be uncomfortable and had a tympanitic abdomen, which was generally tender but soft to palpation with scant bowel sounds. Vital signs were normal and fundal height was appropriate for gestational age. A ‘Mercedes-Benz’ scar was seen (a Chevron incision extended up to the xiphoid), consistent with previous liver surgery. Urinalysis was negative for infection, pelvic examination was unremarkable and cardiotocography showed a reassuring foetal trace. Rectal examination showed an empty vault with no masses and was negative for occult blood.\nLaboratory investigations revealed a high normal white cell count (16 × 109/l, reference range for pregnancy 5.9–16.9) with mild neutrophilia (14.4 × 109/l, normal 3.9–13.1). Haemoglobin, electrolytes, renal and liver function tests and lactate were normal.\nProvisional diagnosis of adhesive partial small bowel obstruction was made. A nasogastric tube was inserted, affording marginal symptomatic relief. Rectal enema was unsuccessful. Plain radiography showed colonic faecal loading with superolateral displacement of bowel loops by the gravid uterus, without evidence of obstruction or free sub-diaphragmatic air. Ultrasound showed a viable foetus with no specific intra-abdominal pathology.\nIncreasing analgesic and antiemetic requirements prompted induction of labour at 38 weeks and 4 days gestation, with vaginal delivery of a baby boy. Despite clinical improvement initially, symptoms worsened again 24 h postpartum. She was no longer passing flatus and there were no audible bowel sounds. Repeat abdominal radiograph showed a large bowel obstruction with caecal dilatation up to 13 cm (Figures and ). The small bowel was also dilated, up to 5 cm.\nThe patient was brought to the operating theatre for midline laparotomy. Large volume ascites was encountered and several small bowel adhesions divided. A transition point was identified in the right upper quadrant, with incarceration of omentum and colon through a 2 cm defect in the posterolateral right hemidiaphragm, producing a Richter's hernia. The defect was extended to facilitate reduction of the hernial contents. The herniated omentum was necrotic, but the large bowel appeared viable. The defect was closed with interrupted figure-of-eight 0-Ethibond sutures (Johnson and Johnson). A 14-French Foley catheter was placed into the pleural space through the diaphragmatic defect and slowly withdrawn on suction as the diaphragmatic sutures were tightened to prevent pneumothorax.\nThe patient's symptoms resolved postoperatively and mother and baby discharged home on the seventh postoperative day. Retrospective review of the preoperative erect chest X-ray showed a knuckle of herniated colon was in fact visible above the diaphragm (Figure ). | [[30.0, 'year']] | F | {'9297523': 1, '18751950': 1, '3285266': 1, '17663385': 1, '16911950': 1, '17921006': 1, '21314565': 1, '16813617': 1, '11423274': 1, '14607054': 1, '24968425': 2} | {} |
164,671 | 3855220-1 | 24,968,400 | noncomm/PMC003xxxxxx/PMC3855220.xml | Haemosuccus pancreaticus due to aberrant vessels from the coeliac trunk: a rare cause of Gastrointestinal (GI) bleeding with diagnostic and therapeutic challenges | A 63-year-old male who had been investigated for iron deficiency anaemia of 1 year duration presented with repeated bouts of melaena. He was a hypertensive for which he was on regular antihypertensive treatment. He did not give a past history suggestive of peptic ulcer disease, chronic pancreatitis, alcohol consumption or chronic liver disease. He was not on medications such as non-steroidal anti-inflammatory drugs or anti-coagulants. On examination, he was pale but there were no stigmata of chronic liver disease. His abdominal examination was normal except the digital examination of rectum revealing melaena stools. His haematological investigations including iron studies were suggestive of iron deficiency anaemia. The upper GI endoscopic examination showed mild antral gastritis. Colonoscopy was normal. Superior mesenteric artery angiogram showed abnormal serpiginous vessels in relation to the right colic artery. He was further investigated with capsule enteroscopy and contrast CT abdomen, but showed normal findings. Subsequently, he underwent extended right hemi-colectomy (Fig. ). The histology of the specimen showed abnormal vessels in the serosa and subserosa of the right colon.\nTwo weeks later he presented again with an episode of haematemesis and haematochezia. His full blood count showed a haemoglobin of 5.5 g/dl with microcytic hypochromic anaemia. Following resuscitation and stabilization, he underwent urgent upper GI endoscopy which revealed fresh bleeding from the ampulla of Vater.\nAn emergency laparotomy was done to control the bleeding. A duodenotomy was done and pulsatile bleeding from the ampulla of Vater was seen (Fig. ). On exploration, there was an abnormal tortuous vessel on the pancreatic head (Fig. ), which was originating from the coeliac trunk entering the head of the pancreas with several branches. Abnormal vessels were ligated and haemostasis was achieved (Fig. ). Post-operatively he also underwent angio-embolization of abnormal vessels originating from the coeliac trunk (Fig. ) and was discharged on post-operative day 14, but subsequently presented with an episode of massive upper GI and lower GI bleeding. Repeat angio-embolization failed due to difficulties in selective embolization of aberrant vessels in the pancreatic head region. Patient did not consent for a pancreatectomy and subsequently passed away due to massive GI bleeding. | [[63.0, 'year']] | M | {'7572914': 1, '1478171': 1, '10453154': 1, '11820656': 1, '3305128': 1, '10817187': 1, '33210190': 2, '1634182': 1, '14714167': 1, '19718363': 1, '24968400': 2} | {'7674537-1': 1} |
164,672 | 3855244-1 | 24,964,325 | noncomm/PMC003xxxxxx/PMC3855244.xml | A double aortic arch presenting in the 7th decade of life | A 64-year-old woman presented to the Vascular Outpatient department concerned about a 12-month history of an increasingly prominent, pulsatile swelling on the right side of her neck. She was otherwise asymptomatic, with no history of pain, breathing difficulties, swallowing difficulties, cerebral ischaemic events or symptoms of underlying thyroid disease. On examination, she had a 2-cm pulsatile and non-tender swelling in her right supra-clavicular fossa. Her past medical history included type II diabetes mellitus and hypercholesterolaemia. She was normotensive and had no history of cardiovascular disease. Her regular medication was metformin and simvastatin.\nShe had previously presented in 2002 with a 3 × 4 cm pulsatile mass on the left side of her neck, which was asymptomatic. A duplex scan at the time reported a tortuous aorta with no evidence of an aneurysm. She was subsequently discharged without follow-up.\nFigures and are photographs taken of our patient at follow-up.\nA duplex scan performed on this presentation demonstrated a high, prominent and ectatic aortic arch visible above the sternum, with a diameter of 2.0 cm. The innominate artery appeared ectatic, tortuous with localized wall thickening and had a reported diameter of 1.8 cm. An outpatient computed tomography (CT) angiogram was arranged to help delineate the underlying anatomy. Figure shows a coronal section of this CT angiogram. Figures and show the anterior and posterior views of the 3D reconstruction, respectively.\nFigures – demonstrate a DAA with the right carotid and right subclavian arteries arising from the right-sided arch and left carotid and left subclavian arteries from the left-sided arch. There is also a minor narrowing of the right-sided arch at a kink between the right carotid and subclavian origins. Figure demonstrates both arches rising up into the neck explaining the clinical presentation.\nDAA is rare accounting for ∼1% of all congenital cardiac abnormalities, but it is the most prevalent developmental abnormality of the embryological pharyngeal arches [, ]. In normal embryological development, the right fourth pharyngeal arch regresses at 36–38 days gestation whilst the left, fourth pharyngeal arch persists eventually becoming the aortic arch. In cases of DAA, the right fourth pharyngeal arch persists forming a right aortic arch []. This is in continuity with the left aortic arch dorsally forming a complete vascular ring, which encircles and frequently compresses the trachea and oesophagus.\nDAA is commonly associated with other cyanotic congential cardiac abnormalities including Tetrology of Fallot and Transposition of the Great Arteries [, ]. McElhinney et al., looking at the frequency of chromosome 22q11 deletions in patients with isolated anomalies of the aortic arch, found chromosome 22q11 deletions in 14% (3 out 22) of patients with a DAA, leading the authors to propose that this genetic abnormality is an important aetiological factor in DAA [].\nClassically, DAA is divided into three main subtypes depending on the dominance and partial atresia of the relative arches. Seventy-five percent of patients with DAA have a right dominant arch, 20% have a left dominant arch with the remaining 5% have a so-called balanced type [], as was the case with our patient.\nPatients with DAA typically present with symptoms resulting from compression of the trachea and oesophagus. Over 90% of patients present with respiratory symptoms, including stridor, dyspnoea, cough and recurrent respiratory infections [, ]. Less commonly, patients present with gastrointestinal symptoms such as vomiting and poor oral intake. It is rare for the clinical presentation to manifest outside of infancy. Three separate studies found mean age at presentation to be 1.4 years, 6 and 7 months [, , ]. There are only a handful (<15) of reported cases of patients presenting in adulthood. These patients have been found to have DAA incidentally during imaging for separate pathology or have had long-standing intractable respiratory/gastrointestinal complaints. As far as we are aware, this is the first reported case of a patient presenting with a pulsatile but otherwise asymptomatic neck lump.\nThe imaging modality used for identification and delineation of underlying anatomy in DAA varies between studies and reports. Chest X-ray may demonstrate deviation or compression of the trachea, or a right aortic arch contour, however, these findings are frequently absent or may be easily missed. Prior to the advent of CT and magnetic resonance (MR) angiography; barium swallow, echocardiography and duplex imaging were the most commonly used modalities for DAA detection. These modalities, however, are limited by operator/reporter dependency. For an anatomical variant as rare as DAA, many cases may potentially be missed or misinterpreted as in our case. Echocardiography has the advantage of being able to identify intra-cardiac abnormality. Currently, the most robust imaging modalities are CT/MR angiography. Exact anatomy using three-dimensional reconstruction can aid easy interpretation and surgical approach.\nThe only accepted management for symptomatic DAA is surgical with most centres opting for a left thoracotomy and division of the minor arch. The mean mortality in three separate studies using a left thoracotomy was 1.7% (4/234) [, , ]. Post-operative complications included bleeding, residual respiratory obstruction, vocal cord paralysis, pneumothorax, pneumonia, chylothorax and feeding difficulties. Prolonged post-operative respiratory complaints have been reported to be as high as 54% []. Unfortunately, due to a paucity of evidence, there is no consensus on how to manage asymptomatic patients particularly those that present in adulthood. Subsequently, most reports have advocated a conservative approach [, , ]. | [[64.0, 'year']] | F | {'5659407': 1, '30163531': 1, '31500640': 1, '15793042': 1, '15942575': 1, '22602836': 1, '1554267': 1, '17000782': 1, '11419896': 1, '22073330': 2, '24964325': 2} | {'3209599-1': 1} |
164,673 | 3855273-1 | 24,968,391 | noncomm/PMC003xxxxxx/PMC3855273.xml | Accessory spleen in pancreatic tail | A 76-year-old male presented to his general practitioner with nausea, weight loss and change in bowel habit. A recent colonoscopy was unremarkable, a computed tomography (CT) abdomen and pelvis showed a homogenously enhancing 13-mm lesion in the tail of the pancreas, with the reported differentials including neuroendocrine tumour or a pancreatic adenocarcinoma. A subsequent magnetic resonance imaging (MRI) illustrated the lesion enhancing homogenously in the portal venous post-contrast phase suggesting a solid neoplastic lesion, likely to be primary (Fig. ). He went on to have a distal pancreatectomy and splenectomy with an uneventful recovery. Pathology revealed a splenunculus with no evidence of malignancy (Fig. ). | [[76.0, 'year']] | M | {'6610329': 1, '2119113': 1, '20518423': 1, '29404984': 1, '19016272': 1, '30115724': 1, '30898942': 1, '13670140': 1, '33377995': 1, '11012435': 1, '28567109': 1, '18385564': 1, '24968391': 2} | {} |
164,674 | 3855276-1 | 24,968,430 | noncomm/PMC003xxxxxx/PMC3855276.xml | Large gallstone impaction at a Meckel's diverticulum causing perforation and localized peritonitis: report of a case | An 82-year-old man was admitted to the hospital with a 12-h history of right iliac fossa pain. He woke up with the pain, which gradually progressed throughout the course of the day. He felt feverish with anorexia and nausea; there were no other bowel symptoms. On admission, physical examination revealed a soft abdomen with maximal tenderness over Mcburney's point, localized percussion tenderness and Rovsing's test was positive.\nHe had low-grade pyrexia and his inflammatory markers were raised with a white cell count of 15.2 × 109/l and a C-reactive protein of 62. Plain chest and abdominal radiographs were unremarkable. Past medical history included gastroplasty and multiple dilatations for a benign oesophageal stricture, he was otherwise well.\nA computed tomography (CT) scan was performed in light of the patient's age (Fig. ), which reported ‘a dilated fluid filled appendix, containing an appendicolith.’ Laparoscopic appendicectomy was therefore planned (Fig. ).\nDuring laparoscopy, there was evidence of localized peritonitis, and an inflamed MD was found containing a large gallstone that had eroded through the wall. The appendix appeared to be normal (Fig. ).\nThe operation remained laparoscopic and the MD was resected using an Endo GIA™ 45 stapler, allowing continuity of the small bowel. The specimen and gallstone were extracted through the superior umbilical port site in an endobag.\nThe specimen was extracted and confirmed a 3×2.5 cm gallstone based on its yellow-green colour and laminated crystalline appearance [] (Fig. ).\nOur patient recovered well postoperatively and was discharged 2 days later. At a 3-week outpatient follow-up, the patient was back to his usual diet and feeling well. The histology report confirmed that the specimen was an MD with gangrenous inflammation, focal perforation and no evidence of malignancy. | [[82.0, 'year']] | M | {'10706156': 1, '14997931': 1, '27933137': 2, '10319010': 1, '3824672': 1, '17021300': 1, '24968430': 2} | {'5124704-1': 1} |
164,675 | 3855280-1 | 24,968,401 | noncomm/PMC003xxxxxx/PMC3855280.xml | A tale of Wünderlich syndrome | A 63-year-old Caucasian female with no known history of trauma, anticoagulation or bleeding diathesis was presented to the emergency department with sudden-onset, sharp abdominal and right flank pain. The associated symptoms included near-syncope, diaphoresis, nausea and vomiting. Her personal history included renal calculus, hypertension and diabetes mellitus. Previous surgical history included back surgery for hemagioblastoma removal years ago, but she denied history of percutaneous nephrolithotomy. She claimed no known drug allergies and no recent changes in home medications.\nAlthough persistently hypotensive at her initial presentation, she later developed hemodynamic instability systolic blood pressure of 82 mmHg. She was stabilized with crystalloid fluid resuscitation without additional needs for blood products. A physical examination revealed a mildly obese, afebrile female with severe right upper quadrant, epigastric and costovertebral angle tenderness.\nThe patient's hemoglobin was 10.5 g/dl, creatinine 1.39 mg/dl, estimated glomerular filtration rate 38 ml/min/1.73 m2 and international normalized ratio of 1.1.\nA pre- and post-contrast CT scan of the abdomen and pelvis revealed a large right perinephric hematoma within the anterior aspect of the retroperitoneum (Fig. ). This hematoma distended the renal fascia, crossed the midline and displaced other peritoneal and retroperitoneal structures. Free fluid and a hyperdense focus of vascular contrast were present adjacent to the hematoma. The estimated size of the hematoma was 13 cm in the cephalocaudad, 12 cm in the transverse and 8.5 cm in the anteroposterior dimension. The vena cava, renal artery and renal vein were narrowed likely due to vasospasm, but the aorta was otherwise unremarkable.\nAn emergent renal angiogram revealed two right renal arteries with active contrast extravasation from the subsegmental branch of the superior right renal artery (Fig. A). This was successfully embolized (Fig. B). This case was clinically diagnosed as a spontaneous retroperitoneal hemorrhage with subcapsular hematoma, otherwise known as WS.\nA follow-up abdomen/pelvis CT/CTA demonstrated complete resolution of active extravasation and no pseudoaneurysm formation. The patient remained hemodynamically stable and was discharged home uneventfully. Her 3-month follow-up magnetic resonance imaging (MRI) did not reveal any remarkable findings. | [[63.0, 'year']] | F | {'33062596': 1, '33776340': 2, '22022645': 1, '28642963': 1, '9560512': 1, '16985559': 1, '19589577': 1, '2300864': 1, '28764242': 1, '33889338': 2, '9471886': 1, '20646742': 1, '12835370': 1, '30214791': 2, '21765296': 1, '12384111': 1, '24968401': 2} | {'7992525-1': 1, '6132092-1': 1, '8043530-1': 1} |
164,676 | 3856266-1 | 24,340,258 | noncomm/PMC003xxxxxx/PMC3856266.xml | Intralesional Steroid Injection to Prevent Stricture after Near-Circumferential Endosopic Submucosal Dissection for Superficial Esophageal Cancer | A 72-year-old man visited our hospital for the treatment of esophageal cancer. He had undergone a low anterior resection for colorectal cancer 1 year previously. Oral capecitabine was administered after surgery as an adjuvant treatment. There were no significant abnormal findings in the physical examination. All the laboratory findings were within normal limits. Computed tomography and positron emission tomography revealed no distant metastasis. An initial upper endoscopy showed a lugol-voiding lesion involving more than three-quarters of the circumference of the lower esophagus, extending 39 to 43 cm from the incisors (). Endoscopic ultrasound revealed no evidence of submucosal invasion or regional lymph node metastasis. Histopathological findings from another hospital revealed high-grade squamous cell dysplasia, but squamous cell carcinoma could not be excluded. We decided to perform ESD. Because the lesion was near circumferential, a high probability of post-ESD stricture was expected. In this case, we needed to obtain clearer views and to control the scope in detail throughout the procedure; therefore, this patient underwent ESD with tracheal intubation and general anesthesia in an operating room.\nThe ESD procedure was performed using a single-channel upper endoscope (GIF-H260Z; Olympus, Tokyo, Japan) with a transparent cap. Circumferential markings were made using a hook knife (KD-620LR; Olympus) just outside the lesion, on soft coagulation mode of a high-frequency generator for electrosurgery with an automatically controlled system for cutting and coagulation (ERBE, Tübingen, Germany). A total amount of 80 mL normal saline solution mixed with epinephrine was injected into the submucosal layer to lift the mucosa including the tumor. After the lesion was lifted, mucosal incision and dissection was made with a hook knife and an IT knife (KD-611L; Olympus) (). The en bloc resection was completed without complications (). Bleeding in the post-ESD ulcer was coagulated with hemostatic forceps. The total procedure time was approximately 55 minutes. Just after dissection and hemostasis, a single-session endoscopic triamcinolone injection was administered (). Triamcinolone acetonide (Triam, 40 mg/mL; Shinpoong Co., Seoul, Korea) was diluted with saline to make a 20 mg/mL solution. A total of 80 mg (4 mL) triamcinolone was injected into the deep submucosa and the superficial proper muscle layer of the ulcer base at eight sites, with a 0.5 mL dose at each site. The depth of needling was as shallow as producing a small amount of spillage into the esophageal lumen side during injection to avoid possible abscess formation. The resected area was 54×27 mm in size. Three neoplastic lesions (38×17, 11×7, and 7×3 mm) were found in the specimen (). The histopathologic diagnosis was well-differentiated intramucosal invasive carcinoma confined to the lamina propria without lymphovascular invasion.\nSerial esophagography was performed 2 and 4 weeks later to assess the post-ESD stricture. Mild irregular segmental narrowing was seen in the lower esophagus, but no definite passage disturbance was observed (). Follow-up upper endoscopy was performed after 4 months, which revealed only a post-ESD scar (). The scope was passed without resistance. The patient did not complain of dysphagia and showed a good outcome for 6 months after ESD. Moreover, no single session of EBD has been needed. | [[72.0, 'year']] | M | {'2004679': 1, '21492854': 1, '22930171': 1, '20861798': 1, '16281141': 1, '31355238': 1, '12556777': 1, '16013002': 1, '19565442': 1, '26949124': 1, '27618866': 1, '33426235': 1, '22136782': 1, '30835010': 1, '26983549': 1, '9337171': 1, '31058109': 1, '16921303': 1, '19577748': 1, '18611924': 1, '21234854': 1, '21542926': 1, '24340258': 2} | {} |
164,677 | 3856267-1 | 24,340,259 | noncomm/PMC003xxxxxx/PMC3856267.xml | A Polypoid Mucosa-Associated Lymphoid Tissue Lymphoma of the Stomach Treated with Endoscopic Polypectomy | A 34-year-old woman visited our hospital for the management of a gastric polyp detected by an upper gastrointestinal endoscopy recently performed at a private clinic during a routine medical examination. She had no record of medical illness other than a history of uterine myomectomy at our hospital. She was asymptomatic, and her physical examination did not reveal any abnormality. She underwent upper gastrointestinal endoscopy, and a 2.5-cm polypoid lesion was found on the great curvature side of the upper body of the stomach (). Biopsy was performed. The pathologic review was suggestive of early-stage marginal zone B-cell lymphoma of MALT type. The tissue was also positive for H. pylori on Giemsa staining. Her laboratory data were as follows: white blood cells, 7,710/mm3 (neutrophil 58.7%, lymphocyte 32.6%, monocyte 5.5%); hemoglobin, 14.1 g/dL; platelets, 176,000/mm3; total protein, 6.1 g/dL; albumin, 3.7 g/dL; total bilirubin, 0.7 mg/dL; aspartate aminotransferase, 20 IU/L; alanine aminotransferase, 21 IU/L; alkaline phosphatase, 41 IU/L; blood urea nitrogen, 11.4 mg/dL; creatinine, 0.83 mg/dL; sodium, 143 mEq/L; potassium, 4.0 mEq/L; chloride, 107 mEq/L; and lactate dehydrogenase, 304 IU/L. An abdominal computed tomography (CT) showed a 1.8-cm polypoid lesion with minimal stalk in the high body of the stomach. No other abnormal findings, including lymph node enlargement, were noted (). Bone marrow examination revealed no abnormal finding.\nAs the initial treatment, H. pylori eradication was performed with a 2-week course of amoxicillin (2×1,000 mg daily), clarithromycin (2×500 mg daily), and rabeprazole (10 mg daily). The eradication was successful, as confirmed by Giemsa staining in the follow-up endoscopy. However, on endoscopy 6 months later, there was no change in the size and morphology of the polypoid MALT lymphoma lesion. Multiple specimens were obtained, and the pathologic evaluation showed the same result of marginal zone B-cell lymphoma of MALT type. We also performed abdominal CT and positron emission tomography but found no systemic lymphoma involvement.\nTo confirm the diagnosis of low-grade lymphoma and exclude the possibility of high-grade lymphoma, we decided to perform polypectomy, which allows collection of enough tissue specimens including the submucosal layer. The lymphoma was removed en bloc, endoscopically with a snare (), after submucosal injection of hypertonic saline. No complication occurred. The final pathologic diagnosis was marginal zone B-cell lymphoma of MALT type, polypoid (). The lymphoma was 1.8×1.3 cm in size and confined to the submucosal layer. The lateral and basal resection margin was clear. At follow-up endoscopy 6 months after polypectomy, a linear whitish scar was observed without evidence of recurrence (). She has been followed up for 3 years without recurrence. | [[34.0, 'year']] | F | {'22741120': 1, '7783535': 1, '11171816': 1, '11559725': 1, '9322502': 1, '6193858': 1, '8435794': 1, '16923505': 1, '11559724': 1, '8944565': 1, '9389360': 1, '9586910': 1, '11754390': 1, '8287808': 1, '21890816': 1, '16524666': 1, '17071488': 1, '14615444': 1, '9308704': 1, '24340259': 2} | {} |
164,678 | 3856268-1 | 24,340,260 | noncomm/PMC003xxxxxx/PMC3856268.xml | Gastric Outlet Obstruction Due to Gastric Amyloidosis Mimicking Malignancy in a Patient with Ankylosing Spondylitis | A 65-year-old woman was referred to us because of abdominal distention, nausea, and vomiting that had been occurring for a month. Her medical history includes a diagnosis of ankylosing spondylitis 1 year ago, and she had been taking celecoxib daily. Physical examination revealed decreased bowel sounds and direct tenderness in the lower abdomen. Complete blood cell count showed a leukocyte number of 7,470/µL, hemoglobin of 8.8 g/dL, and platelet count of 301,000/mm3. Her blood chemistry values were as follows: total protein, 6.1 g/dL; albumin, 3.1 g/dL; total bilirubin, 0.4 mg/dL; aspartate aminotransferase, 26 U/L; alanine aminotransferase, 16 U/L; alkaline phosphatase, 368 U/L; blood urea nitrogen, 16.6 mg/dL; creatinine, 1.4 mg/dL; erythrocyte sedimentation rate, 79 mm/hr; and C-reactive protein, 2.8 mg/dL. Blood coagulation test revealed a prothrombin time/activated partial thromboplastin time of 11.8/29.5 seconds. Abdominal radiography showed a huge gastric shadow with a large amount of food materials in the gastric lumen. Abdominal computed tomography showed a large amount of retained food materials in the stomach and diffuse wall thickening of the gastric antrum (). Endoscopy revealed marked edema of the mucosa, multiple ulcerations, and luminal narrowing and limited distensibility of the gastric antrum (). Endoscopy also showed pyloric stenosis with ulceration (), but endoscopic mucosal change was not observed in the duodenum (). We performed endoscopic biopsies of the gastric antrum and the duodenum, which revealed the deposition of eosinophilic amorphous materials in the lamina propria and the submucosa in the stomach but not in the duodenum on hematoxylin and eosin staining (), and the accumulation of apple-green materials in the lamina propria and the submucosa in the stomach on Congo red staining (). Electron microscopy showed amyloid fibrils in the subepithelial layers (). The histological findings were compatible with amyloidosis, and the amyloid was identified as the AA type on immunohistochemical testing with monoclonal antibodies specific to serum amyloid A protein. Colonoscopy with random biopsies showed no colonic involvement by the amyloidosis. Bence-Jones proteins were present in urine, but an M-peak was not found in serum. Moreover, there were no abnormalities on bone marrow biopsy. Her final diagnosis was amyloidosis secondary to ankylosing spondylitis presenting with gastric outlet obstruction. Subtotal gastrectomy was recommended because of the worsening obstruction symptoms; however, she refused surgery and wanted to be transferred to another hospital. Three months later, she died of aspiration pneumonia during medical treatment. | [[65.0, 'year']] | F | {'17554124': 1, '1439845': 1, '7863383': 1, '17611708': 1, '8484668': 1, '6307041': 1, '16510115': 1, '13583346': 1, '20051751': 1, '8115892': 1, '11260801': 1, '17554117': 1, '33740238': 1, '9302305': 1, '12471730': 1, '15866260': 1, '18076735': 1, '8163134': 1, '4036936': 1, '8331978': 1, '19929583': 1, '24340260': 2} | {} |
164,679 | 3856270-1 | 24,340,262 | noncomm/PMC003xxxxxx/PMC3856270.xml | Gastrostomy in a Patient with Situs Inversus Totalis | A 65-year-old woman was transferred to our department for PEG insertion during nasogastric tube feeding because of dysphagia caused by ICH. She was taking medication for hypertension and osteoporosis for the last 7 years. She was diagnosed with SIT during a colonoscopy performed 2 years prior; she has no family history of this condition. At the time of transfer, she was maintaining a blood pressure of 130/80 mm Hg, heart rate of 65 to 80 beats per minute, body temperature of 36.5℃, and respiratory rate of 18 breaths per minute with alert consciousness. Her heart rate was normal without heart murmur. No difference was found from the previous examination of the chest, and no abnormal findings were detected in the abdomen, limbs, and skin. Analysis of peripheral blood showed a white blood cell count, platelet count, and hemoglobin of 5,170/mm3, 9.7 g/dL, and 290,000/mm3, respectively.\nThe liver function test results were as follows: aspartate aminotransferase/alanine aminotransferase, 13/9 IU/L; prothrombin time-international normalized ratio, 1.08; and partial thromboplastin time, 32.4 seconds (reference range, 20 to 38). The renal function tests were within the reference ranges. Dextrocardia was observed on a chest radiograph (), and complete right to left reversal of internal organs was detected on abdominal computed tomography (CT) scan, indicating a finding of SIT (). No abnormal findings were found on the CT scans of the spleen and major blood vessels. Upper gastrointestinal endoscopy was conducted identical to a general endoscopic procedure, with the patient in a left lateral decubitus position. Along with preoperative monitoring of pulse rate and oxygen saturation, midazolam (3 mg) and propofol (50 mg) were administered via intravenous injection as a pretreatment. The endoscope was turned counterclockwise when it was passed from the bulb to the descending part of the duodenum. The gastric angle, when observed with a J shaped retroflection at the antrum, was mirrored from its normal position. No specific findings were detected during the endoscopy except for a mild chronic superficial gastritis. A puncture site was chosen with the help of an endoscopic light after manually pressing the stomach wall to find the thinnest site. Subsequently, a gastrostomy feeding tube (PEG-24-Pull; Wilson-Cook Medical GI Endoscopy, Winston-Salem, NC, USA) was inserted into the anterior wall of the lower gastric body, which looks like the posterior wall of the lower gastric body in a normal person (). The nutrition was delivered directly into the stomach the next morning after PEG insertion, and no specific complications were observed. | [[65.0, 'year']] | F | {'12712813': 1, '7698596': 1, '34597972': 1, '16818055': 1, '1528471': 1, '8096573': 1, '1021593': 1, '31893103': 1, '11236325': 1, '9357192': 1, '32231508': 2, '15069640': 1, '17854150': 1, '24340262': 2} | {'7098364-1': 1} |
164,680 | 3856271-1 | 24,340,263 | noncomm/PMC003xxxxxx/PMC3856271.xml | A Case of Early Gastric Cancer with Solitary Metastasis to the Pleura | A 76-year-old woman with a 1-month history of epigastric discomfort was referred to the Department of Gastroenterology. She was being treated as an inpatient in the department of neurology after a diagnosis of Parkinson disease. Twenty days previously, she was found to have a gastric ulcer after having undergone upper gastrointestinal endoscopy in a local clinic. She continued to complain of abdominal discomfort, although she had been taking ulcer medications. On admission, her physical examination findings and laboratory data were unremarkable. A small amount of left pleural effusion was noted on a chest radiograph, and an abdominal radiograph showed no abnormality. Because she had upper respiratory symptoms, including cough, on admission, she had received antibiotics for suspected pneumonia. During her hospital course, a few days after starting the antibiotics, she showed improvement in respiratory symptoms. Symptoms associated with Parkinson disease and other upper respiratory symptoms had been well controlled with an oral antiparkinson drug and oral cough syrups followed by 3-day intravenous antibiotics. She did not report any upper respiratory symptoms, so the pleural effusion was expected to disappear soon.\nUpper gastrointestinal endoscopy was performed to evaluate her symptoms. Endoscopic examination demonstrated a slightly elevated lesion (4 cm) with multiple shallow erosions, absence of a definite ulcer scar, and bridging or converging folds over the anterior wall of the antrum (type IIa) (). The endoscopic ultrasonographic (EUS) image revealed that the diffuse thickened hypoechoic lesion was limited to the mucosal layer, with no irregular narrowing or budding sign (). Histopathological examination of gastric biopsies showed a moderately well-differentiated adenocarcinoma. Abdominal computed tomography (CT) revealed no evidence of gastric wall thickening, enlargement of abdominal lymph nodes, or distant metastasis. The lesion was diagnosed as mucosal gastric cancer. She was transferred to our department for ESD, which was performed according to the expanded ESD criteria.\nOn the day after ESD, the patient reported fever and frequent cough. A follow-up chest radiograph showed an increased amount of left pleural effusion (). Aspiration pneumonia was suspected, and a diagnostic thoracostomy was performed along with initiation of intravenous antibiotic therapy.\nThe ESD specimen revealed a round, brownish, elevated lesion measuring 6×4×0.4 cm, with no surface change. Microscopic examination showed that the tumor was limited to the submucosal layer, with no involvement of the deep resection margin. The tumor showed clusters, or nests, of moderately well-differentiated adenocarcinoma, mostly confined to the large, dilated lymphatic channels with adjacent foci of stromal invasion (). The mucosal layer also showed multifocal lymphatic tumor emboli without stromal invasion.\nAnalysis of the left pleural fluid revealed the following findings: red blood cells, 32,000/mm3; white blood cells, 1,120/mm3; neutrophils, 4%; lymphocytes, 38%; adenosine deaminase activity, 15.4; and pH, 7.36. The ratio of pleural fluid protein to serum protein was 0.98. The ratio of pleural fluid lactate dehydrogenase (LDH) to serum LDH was 0.66. Metastatic adenocarcinoma cells were unexpectedly detected by cytological examination of the pleural effusion ().\nTo determine the primary site of metastatic adenocarcinoma, immunohistochemical (IHC) staining tests and positron emission tomography (PET)-CT were performed. EGC metastasis to the pleural space is rarely observed, but the ESD specimen from this patient showed this unusual histopathological feature.\nThe results of IHC staining tests were as follows: D2-40, positive; cytokeratin 7 (CK7), positive; CK20, negative; CD56, negative; synaptophysin, negative; human epidermal growth factor receptor-2, negative; and thyroid transcription factor-1, negative. The test results were negative for mucin (MUC) 1 and MUC2, and positive for MUC5A and MUC6.\nPET-CT showed a focal abnormal hypermetabolic lesion in the aortopulmonary window, most likely representing malignant uptake; the standard uptake value (SUV) was 8.76. The SUV was elevated in the left lower lobe of the lung, with pleural effusion; the SUV of 4.43 indicated probable benign uptake.\nAfter all analyses, instead of gastric metastasis, we concluded that the proper diagnosis was primary EGC metastasis to the pleura, with accompanying unusual histological findings. We planned to start chemotherapy, but she refused further treatment and wanted to undergo conservative management. She died 1 year after the diagnosis. | [[76.0, 'year']] | F | {'16440415': 1, '9272937': 1, '7300058': 1, '17334711': 1, '19890694': 1, '2226095': 1, '12748245': 1, '10777153': 1, '10832666': 1, '31191753': 1, '11959875': 1, '3301516': 1, '3620874': 1, '3607727': 1, '12435900': 1, '19475584': 1, '11504376': 1, '24340263': 2} | {} |
164,681 | 3856272-1 | 24,340,264 | noncomm/PMC003xxxxxx/PMC3856272.xml | A Case of Parasite Invasion of the Intestinal Tract: A Missed Diagnosis in Irritable Bowel Syndrome | A 24-year-old man was referred to our gastroenterology department for the specialized management of persistent symptoms such as intermittent epigastric and lower abdominal pain that had begun approximately 7 months earlier. The pain had developed gradually and tended to aggravate after meals.\nOne month prior to his referral to our department, the patient had visited a primary outpatient clinic several times and was administered medication to control symptoms, but his symptoms did not improve. The patient was later admitted to a primary hospital for 1 week, where gastroduodenoscopy, colonoscopy, abdominal sonography, and laboratory testing was performed to identify the cause of the symptoms. On the basis of these examinations, he was diagnosed with IBS and administered medication. However, because of poor symptom control, the patient was referred to our hospital for specialized management of IBS. The patient had no medical history, including drug history, and had lost approximately 5 kg over the previous 7 months. The patient had a history of 5 pack-years of smoking and social alcohol consumption. The patient's father was diagnosed with pulmonary tuberculosis 1 month earlier and was receiving medication. The patient was employed as a cell phone salesman, but helped with work on his father's farm every weekend. His associated symptoms were frequent nausea with vomiting and diarrhea-like loose stools.\nPhysical examination findings were nonspecific and he showed chronic rather than acute illness. He had no tenderness or rebound tenderness on his abdomen. Laboratory test results of peripheral blood, blood biochemistry, and serum electrolytes were all within the normal ranges. Urine analysis and stool occult blood test showed no abnormal findings. Because of his weight loss, we tested his glucose and thyroid-associated hormone levels. His fasting blood glucose level was 87 mg/dL and the results of the thyroid function test were normal. We reviewed the imaging studies performed at the primary hospital. Gastroduodenoscopy showed chronic atrophic gastritis with erosion, and colonoscopy showed nonspecific terminal ileitis. Abdominal ultrasonography findings were nonspecific. After referral to our hospital, we changed his drugs to control symptoms. As intermittent lower abdominal pain persisted, we considered additional examinations such as small intestine endoscopy or capsule endoscopy to evaluate the small intestine. Considering the patient's compliance and the possibility of observation of the terminal ileum, we chose capsule endoscopy. On capsule endoscopy, the terminal ileum was normal, but a whitish tubular organism suspicious of a parasite with nearby multiple erosive lesions was observed at the proximal jejunum (, Supplementary Video 1 [available online at ]). Although we had considered the diagnosis to be IBS until that point, we changed the diagnosis to parasitic intestinal infection on the basis of the capsule endoscopic images. Additional examinations for parasitic infections, including blood testing and stool examination, were performed. His eosinophil count was 120/mm3 (reference range, 50 to 500); the results of the enzyme-linked immunosorbent assay were negative for cysticercosis, Sparganum, Paragonimus, and Clonorchis sinensis; and the result of a stool parasite test was also negative. Although the additional tests did not give additional information, based on symptoms, the results of examinations, and factors such as location (proximal jejunum), morphology (whitish small tubular shape), size (<2 cm), and erosive mucosal lesions around the organism, we diagnosed the patient with parasitic infection, and more precisely hook worm (Ancylostoma duodenale) infection at the proximal jejunum. We therefore empirically prescribed albendazole (400 mg/day) for 3 days. Ten days after administration of the drugs, the patient's symptoms slowly abated, and the patient recovered with no specific symptoms. | [[24.0, 'year']] | M | {'22837873': 1, '14642761': 1, '15335409': 1, '3949235': 1, '16678561': 1, '15861265': 1, '22474433': 1, '15191504': 1, '20942938': 1, '16678553': 1, '15614587': 1, '10520844': 1, '19575763': 1, '17661757': 1, '6106097': 1, '30408947': 1, '3983524': 1, '23106005': 1, '15317893': 1, '22004256': 1, '24340264': 2} | {} |
164,682 | 3856273-1 | 24,340,265 | noncomm/PMC003xxxxxx/PMC3856273.xml | Intestinal Capillariasis Diagnosed by Endoscopic Biopsy | In June 2004, a 42-year-old male patient was admitted to our hospital with a nearly 2-year history of intractable diarrhea. He had been residing in the Philippines for 9 years before his visit. He was a fisherman, and he enjoyed eating raw fish. He experienced watery diarrhea several times daily during the last 2 years, with no significant impact on his daily life. However, the diarrhea unexpectedly worsened approximately 2 months before presentation, resulting in a weight loss of 10 kg. He was thus admitted to a hospital in the Philippines, but no improvement was observed. He subsequently returned to Korea for evaluation and treatment several days before admission to our hospital.\nOn presentation, he complained of symptoms including severe diarrhea, weight loss, and abdominal pain. Physical examination revealed stable vital signs with normal blood pressure and heart rate. Routine laboratory tests revealed leukocytosis with a white blood cell count of 16,550/mm3 but without eosinophilia, hyponatremia (sodium level, 128.5 mmol/L), hypokalemia (potassium level, 3.11 mmol/L), and hypoalbuminemia (albumin level, 1.2 g/dL). Further laboratory studies and colonoscopy were performed to rule out any medical conditions leading to chronic diarrhea. Results of the stool examination for parasites, acquired immune deficiency syndrome test, and antineutrophil cytoplasmic antibody test were negative. Thyroid function test showed a free thyroxine level of 1.27 ng/dL, a triiodothyronine level of 80.01 ng/dL, and a thyroid-stimulating hormone level of 3.94 µIU/mL, all within the reference range. Colonoscopy revealed no significant abnormal findings. Abdominopelvic computed tomography (AP CT) showed diffuse wall thickening of the small bowel with mesenteric lymph node enlargement. This was followed by a small bowel series to verify the presence of the lesion found in AP CT. A plain radiograph of the small bowel revealed straightening of the lumen, known as a ribbon-like appearance in the ileum, without abnormal disturbance of passage (). Although the folds of the jejunum were relatively spared, those and the villi of the ileum were obliterated, along with the luminal straightening. A second colonoscopy session was planned for the purpose of biopsy to detect mucosal lesions in the ileum that may be indicative of the cause of the diarrhea (). Although the second colonoscopy also failed to identify any striking anomaly in the mucosae of the terminal ileum and colon, endoscopic biopsy at the distal ileum was performed because of the suspicion of several diseases limited to the small intestine; this revealed chronic inflammation with mucosal atrophy, eosinophilic infiltration, and the presence of parasitic worms in the mucosa, consistent with intestinal capillariasis (). The diagnosis of intestinal capillariasis was confirmed, and the patient received 400 mg of albendazole daily for the next 4 weeks. At the end of 4 weeks, all of his symptoms abated, and he showed an increase in body weight from 48 to 58 kg. While stool examination, probably the simplest method of evaluating parasitic infestation, was performed as part of the initial examination, neither the larvae nor the ova of the parasite were observed. Thus, after the confirmation of C. philippinensis infection through a pathologic study, stool examination was repeated once before albendazole treatment and three times after medication to further validate the finding. Nevertheless, the result of stool examination was negative in all five occasions. | [[42.0, 'year']] | M | {'10605499': 1, '8480863': 1, '6008334': 1, '5647122': 1, '23035938': 2, '1576584': 1, '15285025': 1, '23230331': 1, '6035887': 1, '9599894': 1, '8286640': 1, '2491692': 1, '18203280': 1, '29996625': 1, '16687685': 1, '8167107': 1, '24340265': 2} | {'3531305-1': 1} |
164,683 | 3856274-1 | 24,340,266 | noncomm/PMC003xxxxxx/PMC3856274.xml | Percutaneous Cholangioscopic Lithotripsy for Afferent Loop Syndrome Caused by Enterolith Development after Roux-en-Y Hepaticojejunostomy: A Case Report | A 74-year-old woman was admitted with a 2-day history of fever and acute abdominal pain. The patient had undergone choledochal cyst excision, left hepatectomy, and RYHJ for IHD stones and a choledochal cyst 12 years previously. On admission, blood pressure was 90/57 mm Hg, pulse rate was 116 beats per minute, temperature was 38.5℃, and tenderness in the right upper quadrant of the abdomen was detected. Laboratory findings were as follows: white blood cell count, 14,900/mm3 (normal range, 4,000 to 10,800); platelet cell count, 81,000/mm3 (normal range, 150,000 to 400,000); C-reactive protein, 11 mg/dL (normal range, 0 to 0.3); aspartate aminotransferase, 129 IU/L (normal range, 7 to 38); alanine aminotransferase, 187 IU/L (normal range, 4 to 43); total bilirubin, 6.2 mg/dL (normal range, 0.1 to 1.3); and alkaline phosphatase, 432 IU/L (normal range, 103 to 335). An abdominal computed tomography (CT) scan showed a single stone in the sixth branch of the right IHD and a stone measuring 3 cm in the afferent loop with diffuse dilatation of the upstream small bowel loop and IHD (). Afferent loop syndrome caused by an enterolith was diagnosed on the basis of the clinical features and imaging studies.\nBecause the patient was septic and her condition was unstable, we performed urgent percutaneous transhepatic biliary drainage (PTBD). A 10 Fr pigtail catheter for PTBD was passed over the guide wire and placed in the jejunal limb through B6 after B6 of the IHD was punctured using a 21-gauge hollow needle under ultrasound guidance, and a guide wire was inserted through the needle into the bile duct. After PTBD, the patient showed a gradual improvement of her general condition. Because the enterolith was located in the jejunal limb near the hepaticojejunostomy site on abdominal CT and cholangioenterogram, peroral endoscopic access to the enterolith was difficult, and surgical treatment was refused by the patient, we decided to perform percutaneous transhepatic cholangioscopy (PTCS) for removal of the IHD stone and the enterolith. First, the PTBD tract was dilated to 18 Fr using a dilator to allow insertion of a standard choledochoscope (CHFP20Q; Olympus Co., Tokyo, Japan) into the bile duct 7 days after PTBD. One week later, PTCS was performed for stone removal. Cholangioscopic examination showed an IHD stone and a large enterolith. The IHD stone was a black-pigmented stone and the jejunal loop stone was grayish and hard (). Because the hepaticojejunostomy site was not stenotic and an enterolith was located in the jejunal limb near the hepaticojejunostomy site, the cholangioscope could access the enterolith. Electrohydraulic lithotripsy (EHL) was performed to fragment the enterolith. An electrohydraulic shock wave generator (Lithotron EL 25; Walz-electronic Inc., Rohrdorf, Germany) set at an output of 2,000 V was used for the generation of shock waves of increasing frequency (intensity of 500 mJ), which were applied with a continuous sequence of discharge. After stone fragmentation, the enterolith was pushed out through the jejunojejunal anastomosis to the efferent loop using the cholangioscope and a saline flush (). The cholangiogram showed that the IHD and the afferent loop were clear, without any remnant stone. The PTBD catheter was removed, and the patient began oral intake 1 day after the procedure. The patient made a full recovery without any complications, and was discharged 2 days after the procedure. | [[74.0, 'year']] | F | {'25058778': 2, '10664345': 1, '10235224': 1, '19365684': 1, '17909975': 1, '10675451': 1, '17109128': 1, '20642613': 1, '24340266': 2} | {'4114374-1': 1} |
164,684 | 3856285-1 | 24,340,165 | noncomm/PMC003xxxxxx/PMC3856285.xml | A Case of Acute Aortic Dissection Presenting with Chest Pain Relieved by Sublingual Nitroglycerin | A 77-year-old Korean woman came to the outpatient clinic of the department of family medicine, Seoul National University, Seoul, Korea, presenting with chest pain that started the day before. She had a medical history of hypertension and had been on medication (losartan and aspirin) for 5 years. The day before, at about 7 PM she suddenly felt a strong chest pain of numerical rating scale (NRS) 8-10 in the substernal area. She described the character of the pain as oppressive without radiating pain. This excruciating pain lasted for about 10 minutes combined with a doomed feeling, diaphoresis, and difficulty in taking deep breaths. She also felt slight faintness with urinary incontinence. She visited a local clinic the next morning and chest pain was relieved to NRS 3-4 after 3 tablets of sublingual nitroglycerin. When she came to our outpatient clinic, she presented with moderate chest pain of 3/4 on the NRS. She looked acutely ill, and nothing specific was detected in her heart and lung sounds. Under assessment of ACS she was immediately referred to the emergency department. Initial vital signs at the emergency room were stable: blood pressure 108/75 mm Hg, pulse rate 82/min, respiration rate 20/min, body temperature 36.6℃, saturation 99%. Electrocardiogram (EKG) was immediately taken which showed normal sinus rhythm with nonspecific ST deviation. Laboratory findings were as follows: creatine kinase (CK) 129 IU/L, CK-myocardial band 3.0 IU/L, troponin I 0.03 ng/mL, C-reactive protein 0.59 mg/dL, white blood cell 8,900/µL, hemoglobin 11.4 g/dL, D-dimer assay 13.60 ug/mL. Cardiac enzyme levels were all within normal limits and nothing specific was found on the laboratory tests except an increase in D-dimer. The chest radiograph showed mild mediastinal widening with no active lung lesions (). From the data above, it was less likely that the cause of chest pain was from ACS. Therefore, an additional imaging study was performed: computed tomography (CT) angiography + 3-dimensional aorta (contrast) (). Surprisingly, the CT results showed aortic dissection type A starting from the distal ascending aorta with its distal extent just proximal to the right main renal artery (). The diameter of the ascending aorta was 50 mm and there was no evidence of coronary artery os involvement. The thoracic surgery department was immediately contacted and the patient had an emergency operation: replacement of ascending aorta, proximal arch, and innominate artery with Hemashield graft and open heart valvuloplasty of the aortic valve due to mild aortic regurgitation. The patient showed postoperative atrial fibrillation, which was managed by continuous infusion of amiodarone. Otherwise, she recovered well from the surgery and was discharged 18 days after the operation, with short-term follow-up at the outpatient clinic of thoracic surgery. | [[77.0, 'year']] | F | {'18503227': 1, '33791417': 2, '17350381': 1, '20124134': 1, '7985606': 1, '21555704': 1, '21969019': 1, '17145990': 1, '14707946': 1, '11980527': 1, '21968475': 1, '10685714': 1, '10807810': 1, '2256762': 1, '14959911': 1, '26550312': 1, '11511117': 1, '21099124': 1, '15473405': 1, '8350637': 1, '24340165': 2} | {'8009502-1': 1} |
164,685 | 3857263-1 | 24,348,016 | noncomm/PMC003xxxxxx/PMC3857263.xml | Ocular cysticercosis in a 32-year-old man in Abuja: ultrasonic features as an aid in diagnosis | A 32-year-old man from Enugu, South Eastern Nigeria, presented to the Rachel Eye Center in Abuja, Federal Capital Territory of Nigeria, with loss of vision affecting the right eye for a period of 2 months. This was described as a “shadow” in that eye, and was associated with a right-sided headache. He had been to a number of eye care facilities where he had been put on prednisolone tablets and cefuroxime capsules with no change in his status. It later transpired that he had once worked on a pig farm soon after his National Youth Service Corps service about 3 years previously.\nOn examination, his visual acuity was 6/4 and 6/6 R/L, N6 in the right eye and N5 in the left eye. The anterior segment was unremarkable in both eyes. Vitreous reaction in the right eye was 2+ cells. Fundus examination of the right eye revealed a solid-looking elevation of the retina of 3–4 disc diameters in the inferior temporal quadrant of the retina about 1.5 disc diameters high. There was an associated retinal detachment in the lower half of the retina in the form of “undulating water marks”.\nThe B-scan probe was moved from one side of the closed upper eyelid to the other, and some images were acquired by placing the probe on the lower lid as well. B-scan ultrasound in the right eye showed dome-shaped, echogenic, well defined thick membranous structures extending into the vitreous space from the posterior and temporal aspects of the right eye. The membranes were attached in their peripheries to their origins, with their convex sides projecting towards the center of the eye. These membranes were not mobile during the examination. In addition, multiple, small, round echogenic bodies of varying sizes were seen in the submembranous spaces, (later found to be bladder forms of recognizable organisms with suckers). These bodies were also nonmobile.\nThe overall appearance suggested choroidal detachment with submembranous bodies, later discovered to be from ocular cysticercosis. In addition, some slices (, , and ) showed areas of a rather shallow slightly mobile membranous structure extending into the vitreous space, suggestive of a shallow retinal detachment and consistent with the clinical findings on binocular indirect ophthalmoscopy. shows the main features of ocular cysticercosis.\nBecause the main cyst appeared to be a choroidal rather than a retinal detachment, we made the decision to drain the fluid and send it for histopathologic analysis through a radial trans-scleral suprachoroidal incision. Some amber-colored semiviscous liquid was seen. In addition, some cheesy material was also noticed to prolapse from the surgical wound, with subsequent collapse of the choroidal detachment. This was carried out 2 days after presentation. Later on, histologic sections showed a cystic lesion lined by the tegument of an organism. Within the lesions were bladder forms of recognizable organisms with suckers. There was a prominent investing tegument and smooth muscle fibers. The suggested histologic diagnosis was that of ocular cysticercosis.\nThe patient was subsequently started on albendazole and observed. Over the next few weeks, some retinal hemorrhage was noticed over the surgical site, extending to involve the inferior temporal quarter of the fundus. This was later noticed to resorb slowly, leaving some apparently necrotic areas on the retina inferiorly. At this stage, the patient was lost to follow-up. | [[32.0, 'year']] | M | {'7487226': 1, '22146156': 1, '26862090': 1, '7918290': 1, '30230445': 1, '28539760': 1, '20930852': 1, '6607676': 1, '12932389': 1, '16327117': 1, '26377900': 1, '12270733': 1, '6932237': 1, '12750103': 1, '24348016': 2} | {} |
164,686 | 3857264-1 | 24,400,247 | noncomm/PMC003xxxxxx/PMC3857264.xml | Sensorimotor polyneuropathy and foot-drop as result of a prostate cancer paraneoplastic syndrome | An 80-year-old male with a history of gastroesophageal reflux disease, benign prostatic hyperplasia, and diabetes presented with 2 days of gross hematuria, worsening hesitancy, and difficulty urinating. Prior to this, the patient had had a 6-month history of lower urinary tract symptoms for which his primary medical doctor had prescribed an α1 receptor antagonist at a dose of 0.4 mg orally once daily. This initially brought about brief mild improvement in the patient’s symptoms, but ultimately there was an increase in lower urinary tract symptoms. The patient denied renal colic, flank pain, or any constitutional symptoms. He had not suffered any recurrent urinary tract infections in the past and denied taking any anticoagulants other than two aspirin occasionally for headache.\nOn presentation to the urology clinic, the patient was found to have severe obstructive urinary symptoms. Rectal examination revealed a grossly abnormal prostate gland with nodularity throughout the entire palpable surface. Laboratory information showed a prostate serum antigen of 20.2 ng/mL. His most recently documented prostate serum antigen was 8.5 ng/mL, which was from one year previously. Baseline blood urea nitrogen/creatinine was 32/0.87. Because the patient had obstructive symptoms and a post void residual of 319 mL, a Foley catheter was placed and he was scheduled for a cystoscopy (as part of the hematuria workup)/voiding trial. He was also put on silodosin 8 mg per day orally and ciprofloxacin 500 mg orally twice daily for 7 days. Upon the patient’s return to the office, his Foley catheter was draining adequately. Post void residual was 600 mL. Cystoscopy showed a large amount of clot in the base of the bladder, which was irrigated to clear, and no active bleeding was noted. Significant distortion and posterior impingement of the trigone was noted, left hemitrigone being greater than the right. No diverticulum or stones were noted. Prostatic urethra showed a near visually obstructing prostate but no intraluminal filling defects of the bladder. A computed tomography (CT) urogram showed left hydronephrosis down to the trigone and some mild nonspecific adenopathy. Urine culture and sensitivity was positive for a Proteus urinary tract infection. The patient was already on ciprofloxacin (which was shown to be sensitive) and responding to treatment. Bicalutamide 50 mg orally once daily and finasteride 5 mg orally once daily were prescribed.\nThe patient underwent transrectal ultrasound and sampling of the prostate gland. It was noted that the patient’s prostatic volume was 14.6 cc. Due to the patient’s age, gross hematuria, and comorbid conditions, a limited six-core prostate biopsy was performed. Biopsy showed six of six cores positive for an adenocarcinoma Gleason grade 9 (5+4) prostate cancer (see ). CT scan and bone scan did not show any evidence of metastatic spread. The patient was diagnosed with clinical stage T2cN0M0 prostate cancer. The patient completed and passed a voiding trial. Bicalutamide, silodosin, and finasteride were continued. A depot suspension of leuprolide acetate (30 mg intramuscularly every four months) was started. Calcium and vitamin D were added for additional support (entirely prophylactic, given that the patient had no vitamin deficits prior to starting leuprolide). At this stage in the patient’s clinical course, his urinalysis was normal and his post void residual was down to 67 mL. The patient was counseled on the management options and chose intensity modulated radiation therapy (IMRT) as treatment for his prostate cancer.\nFiduciary gold seed markers were placed. The patient underwent a planning CT scan which was fused with a magnetic resonance imaging (MRI) scan. The prostate and seminal vesicles were contoured with a planning CT scan, expanded into planning target volumes, and a radiation plan was developed. The patient received 46 treatments over 64 days for a total dose of 8,280 cGy. Phase 1 (planning target volume 1) consisted of the prostate, seminal vesicles, and regional lymph nodes receiving 4,500 cGy in 180 cGy daily fractions. Phase 2 (planning target volume 2) consisted of the prostate alone receiving 3,780 cGy in 180 cGy daily doses. Intensity-modulated radiation therapy using an image-guided linear accelerator (Varian Instruments Inc, Palo Alto, CA, USA) was utilized to minimize both acute side effects and long-term sequelae. The patient tolerated his treatments well. Mild urinary symptoms were experienced, but his urination had been improving and his international prostate symptom score was <15 (9). Therefore, the patient did not require any additional medications and we felt that any surgical intervention (such as transurethral resection of the prostate) for symptomatic relief was not warranted at this time. The patient did develop some bowel symptoms that required a change in diet.\nThe patient was examined by his urologist post radiation therapy and was clinically doing well. He had a post void residual of 104 mL and a significantly reduced prostate serum antigen of 0.4 ng/mL. Repeat renal and bladder ultrasound showed resolution of his previously noted left hydronephrosis. However, just after intensity-modulated radiation therapy ended, the patient began to experience right lower extremity weakness and intermittent numbness from the mid calf distally. The patient had not experienced any falls or trauma. His serum glucose was under control throughout his entire evaluation (prior to treatment it was noted to be 122 mg/dL and then post treatment measured 88 mg/dL). This progressed to require an evaluation by a neurologist. Physical examination showed a mild wide-based stance with decreased stride length and a tendency to circumduct the right lower extremity, with mild to moderate right foot-drop. Initial evaluation included a lumbar puncture, comprehensive metabolic panel, complete blood count, urinalysis, positron emission tomography scan, renal ultrasound, and CT scans of the head and spine. All initial studies were negative. Further evaluation included an electromyogram, as well as an MRI scan of the brain/cervical and thoracic spines. MRI of the brain specifically showed only mild diffuse cortical atrophy. The cervical and thoracic spine MRI scans showed a T2 hyperintensity spanning the lateral cortical spinal tracts of the entire cervical and thoracic cords.\nBlood work was collected locally, sent to the Mayo Clinic, and profiled in their paraneoplastic autoantibody evaluation. The profile was consistent with organ-specific neurologic autoimmunity, which suggested an association with multifocal neurologic mainfestations. Specifically, the blood work revealed a positive neuronal voltage-gated potassium channel antibody. These findings combined with MRI of the spine led the neurologist to diagnose the patient with a paraneoplastic syndrome. Magnetic resonance neurography was not done. The patient’s nerve pain was based solely on his personal perspective. The patient was given an ankle-foot orthosis and a cane for ambulation, was started on intravenous immunoglobulin therapy, and referred for home-based physical therapy. At this time, the patient felt that both his strength and ambulation had improved, and his physical therapist agreed. The patient has not experienced any new complaints. | [[80.0, 'year']] | M | {'22220977': 1, '19608787': 1, '23407760': 1, '21139643': 1, '19641351': 1, '20652272': 1, '24400247': 2} | {} |
164,687 | 3857382-1 | 24,339,716 | noncomm/PMC003xxxxxx/PMC3857382.xml | Hemolytic Anemia Case Caused by an Inverted Inner Felt after Bentall Operation | A 26-yr-old male patient presented to our emergency room with acute chest pain on April 8, 2010. He was diagnosed with type A aortic dissection and underwent an emergency Bentall operation. We reinforced the proximal and the distal anastomoses using inner and outer felt strips. Computed tomography taken two days after the operation to evaluate postoperative mediastinal widening showed no anastomosis site stenosis (). The patient's postoperative course was uneventful.\nThree months after the operation, he developed mild dyspnea on exertion and carotid bruit was audible. An echocardiogram showed normal mechanical aortic valve function. One year after the operation, the patient reported dyspnea and dizziness with exertion and the carotid bruit worsened. There was evidence of hemolytic anemia (hemoglobin 7.8 g/dL, total bilirubin 1.8 mg/dL, direct bilirubin 0.6 mg/dL, lactate dehydrogenase 897 IU/L, schistocytes in peripheral blood). A treadmill test was positive at stage II. Echocardiogram again showed normal mechanical aortic valve function. Coronary angiogram was performed to rule out coronary button anastomosis site stenosis. There was no coronary stenosis however, there was significant stenosis between the graft and the aorta anastomosis and the diameter of stenotic site was about 13 mm ().\nDuring the reoperation, we found the inner felt at the distal anastomosis was stiff and inverted from the 6- to 12-hr direction. The most significant inversion was about 100 degrees (). The inversion was the cause of the stenosis. The luminal diameter of the anastomosis site was 13 mm which was same as measured with the aortogram. The anastomosis site was excised at a 1-cm width including the inner and outer felts used for reinforcement. Reanastomosis between the aorta and the graft was completed without felt reinforcement. Dyspnea, carotid bruit and hemolysis disappeared (Hb 14.2 g/dL) after the reoperation. The patient is still doing well and continuing with regular follow up. | [[26.0, 'year']] | M | {'11431957': 1, '30610362': 1, '16844927': 1, '11144767': 1, '16401994': 1, '18442587': 1, '14529167': 1, '717243': 1, '21766281': 1, '27858229': 1, '24339716': 2} | {} |
164,688 | 3857383-1 | 24,339,717 | noncomm/PMC003xxxxxx/PMC3857383.xml | Immunoglobulin G4 Non-Related Sclerosing Disease with Intracardiac Mass Mimicking Mitral Stenosis: Case Report | A 70-yr-old woman came to an emergency department with aggravation of dyspnea of three months duration at 7th July in 2012. Her vital signs were stable, and physical examination did not reveal any significant findings. Initially, electrocardiogram showed the ordinary finding as normal sinus rhythm and left ventricular hypertrophy. The transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) showed a left atrial (LA) mass-like lesion attached to the anterior leaflet of the mitral valve (MV), which could be suggestive of thrombus, tumor, or severe mitral stenosis (MS) (). This mass-like lesion occurred functional MS that the mean pressure gradient (mean PG) of MV was measured as 15.2 mmHg. In addition, the patient had moderate pulmonary hypertension with a measured right ventricular systolic pressure (RVSP) of 69 mmHg. The patient's past medical history was significant, with an operation for an intradural extramedullary spinal cord tumor at thoracic vertebrae 3-5 in 2007.\nLaboratory tests showed elevated erythrocyte sedimentation rate (ESR, 120 mm/hr) and C-reactive protein (CRP, 7.42 mg/dL). Abdominal computed tomography (CT) demonstrated localized aortitis involving the proximal abdominal aorta with a periaortic cuff of soft tissue and mild calcifications (). Abdominal CT was performed to identify and decide an available biopsy site around the periaortic area.\nWe also conducted other image modalities. It was the reason that we wanted to obtain more evidences, because we could not confirm the definite diagnosis or characterization about this mass inside the heart by echocardiography. Coronary CT angiography showed diffuse soft-tissue infiltration (). Cardiac magnetic resonance imaging (MRI) findings, which were discerning for thrombus and tumor, were indicative of a mass diffusely involving the LA wall, MV, interatrial septum (IAS), and aortomitral continuity, resulting in severe MS that was likely a mass such as lymphoma rather than a thrombus and wall thickening involving the LA with extension to the MV leaflet ().\nAdditionally, it was necessary to be excluded that this mass might have the potency of malignancy and the lesion of other metastatic site. Positron emission tomography (PET) is the ideal imaging modality recognizing the inflammatory or malignancy lesion as the degree of standardized uptake value (SUV) and detecting the metastatic lesion. In this patient, the result of PET indicated highly active metabolic inflammation in the ascending aorta, abdominal aorta and right proximal common iliac artery. The increased fludeoxyglucose (FDG) uptake in the LA and septum of the heart suggested that an active inflammatory lesion was more likely ().\nExcisional biopsy of the aorta wall mass revealed lymphoplasmacytic infiltration and fibrosis (). The infiltrate was granulomatous with central microabscess. The abundant plasma cells stained for CD38 and IgG (). Additionally, Masson's trichrome stain showed adventitial fibrosis (). However, only 5% of the plasma cells stained for IgG4 (), which was suggestive of IgG4 non-related sclerosing periaortitis.\nThe finding of IgG4-positive plasma cells within the aortic wall led us to perform additional serologic investigations. Serum IgG levels were found to be substantially increased (1969 mg/dL). Serum IgG4 level was normal at 53 mg/dL. Serum and urine protein electrophoresis demonstrated normal patterns aside from a peak in the gamma region.\nThe patient was prescribed prednisolone (1 mg/kg/day for 4 weeks). She continued taking 60 mg/day of prednisolone for four weeks, after which the dosage was tapered. By the time she completed 12 weeks of treatment, her ESR level had dramatically decreased to 6 mm/hr and CRP had decreased to 0.1 mg/dL. Dyspnea was completely relieved by steroid administration. TTE showed that the size of the LA mass had decreased (). In hemodynamic parameters, mean PG was improved as 4.42 mmHg and RVSP as 45 mmHg was also better than previous results. Coronary CT angiography, cardiac MRI demonstrated the decreased extent of soft tissue lesion arounding the LA and MV after steroid treatment (). We could not find the inflammatory mass-like lesion of periabdominal aortic area in PET (). | [[70.0, 'year']] | F | {'21037477': 1, '18701557': 1, '22504232': 1, '22690221': 1, '22316447': 1, '22218969': 1, '14614606': 1, '22137380': 1, '18609677': 1, '19217746': 1, '24562718': 1, '21628856': 1, '21881964': 1, '22736240': 1, '21107087': 1, '24339717': 2} | {} |
164,689 | 3857384-1 | 24,339,718 | noncomm/PMC003xxxxxx/PMC3857384.xml | A Case of Liver Fibrosis with Splenomegaly after Oxaliplatin-Based Adjuvant Chemotherapy for Colon Cancer | A 45-yr-old Korean man presented with lower abdominal pain in June, 2011. Workup revealed obstructing descending colon mass with pericolic infiltration. He had no significant past medical history. The patient also denied any previous use of alcohol and was not taking any prescription medication or herb. Result of his initial laboratory physical examination was unremarkable, and all initial laboratory values were within normal limits. Evaluation for evidence of viral infection with either hepatitis B or C was negative. The patient underwent left hemicolectomy of the primary T4N2M0 (Stage III) tumor. Surgical pathology revealed moderately differentiated adenocarcinoma of colon. He was then treated with 12 cycle of FOLFOX4 (5-flurouracil [Day 1, 2: 400 mg/m2 + 600 mg/m2]+ oxapliplatin [Day 1: 85 mg/m2] over a 6-month period. The latter part of this treatment was complicated by persistent thrombocytopenia (lowest platelet count of 52,700/µL during chemotherapy). Restaging CT scans demonstrated a good response to treatment. But 4 month after treatment, splenomegaly was noted radiographically (). Gastro-esophageal varix was not observed in endoscopy, but we postulated portal hypertension from splenomegaly with enlarged splenic artery and portal vein. Five month after chemotherapy, he underwent right hepatectomy due to isolated metastatic lesion in S6 and S8 lobe. Platelet count ranged 100,000/µL when hepatectomy was peformed. The liver parenchyma showed diffuse sinusoidal dilatation and centrilobular vein fibrosis with liver cell necrosis without steatosis. To investigate the pathogenesis of liver fibrosis, immunohistochemical stains such as CD31 and α-SMA were conducted with control group which was obtained from grossly normal autopsy liver. The immunohistochemical stains for CD31 and α-SMA were positive along the sinusoidal spaces in the patient, while negative in the control group (). After operation, the patient is currently being treated with systemic chemotherapy. | [[45.0, 'year']] | M | {'22387320': 1, '19093069': 1, '18156931': 1, '16648507': 1, '14675713': 1, '18449915': 1, '8818692': 1, '18272318': 1, '16377516': 1, '18160247': 1, '19822514': 1, '28061766': 1, '14998849': 1, '20645011': 1, '24339718': 2} | {} |
164,690 | 3857385-1 | 24,339,719 | noncomm/PMC003xxxxxx/PMC3857385.xml | A Case of Acute Motor and Sensory Axonal Neuropathy Following Hepatitis A Infection | A 21-yr-old male was transferred to our hospital due to respiration difficulties and progressive weakness at 16th July 2010 from a local hospital where the patient had been admitted after a 7-day history of symptoms of acute viral hepatitis. In addition, the patient did not have a past history of respiratory or gastrointestinal infection within 1 month before onset of progressive weakness. Physical examination upon referral to our hospital showed the patient presented with anorexia, jaundice, and elevated transaminase levels (serum glutamic oxaloacetic transaminase, 385 IU/L; serum glutamic pyruvic transaminase, 376 IU/L). Immunoglobulin M (IgM) antibodies against HA were detected in blood and cerebrospinal fluid (CSF). Based on impaired liver function tests, clinical features, and the presence of anti-HA IgM antibody; the absence of markers for hepatitis B, C, D, E, diagnosis of acute HA was established. CSF analysis showed protein, 156 mg/dL; glucose, 61 mg/dL, with no pleocytosis. Results of serological and CSF tests for C. jejuni, cytomegalovirus (CMV), Epstein-Barr virus (EBV) and Haemophilus influenzae (H. influenzae) infection were negative. Anti-GQ1b and GM1 antibodies were not found in serum. An abdominal ultrasound showed altered echotexture of liver parenchyma. On neurological examination, the mental status of the patient was alert. By the Medical Research Council (MRC) grading, the patient had weakness with areflexia in both proximal upper limbs (MRC grading 4), both distal upper limbs (MRC grading 2), both proximal lower limbs (MRC grading 4), and both distal lower limbs (MRC grading 2). Pin-prick, vibratory, and joint position senses were reduced in glove and stocking distribution. Nerve conduction studies (NCSs) were performed at 2 weeks after the onset of weakness. The findings of motor NCSs showed markedly reduced amplitudes of CMAPs whereas distal latencies and motor conduction velocities were normal in bilateral peroneal, and posterior tibial nerves, without evidence of demyelination. The findings of sensory NCSs revealed decreased amplitudes of SNAPs and normal conduction velocities in bilateral median, ulnar, and sural nerves (). F-wave response was absent in the right median and both peroneal nerves. The needle electromyography examination demonstrated markedly abnormal reduction in recruitment, with positive sharp waves in the bilateral tibialis anterior and peroneus longus muscles. Based on clinical features with motor and sensory involvement, laboratory findings and electrophysiologic investigation, this patient was diagnosed the AMSAN subtype of GBS following acute HA viral infection according to proposed diagnostic criteria of GBS (). The patient was treated with 0.4 mg/kg/day of intravenous immunoglobulin for 5 days and recovered slowly. Four months later, the patient continued to exhibit marked wasting and weakness of the distal upper and lower limb muscles. | [[21.0, 'year']] | M | {'2881973': 1, '10526194': 1, '16708185': 1, '8572662': 1, '20920814': 1, '30899482': 2, '31380008': 2, '9170022': 1, '19356935': 1, '11306855': 1, '14767096': 1, '7718965': 1, '11871407': 1, '19295182': 1, '15676111': 1, '24339719': 2} | {'6663291-1': 1, '6406140-1': 1} |
164,691 | 3857502-1 | 24,327,780 | noncomm/PMC003xxxxxx/PMC3857502.xml | An Autochthonous Case of Canine Visceral Leishmaniasis in Korea | A 12-year-old neutered female mixed-bred dog weighing 5.9 kg presented to the Veterinary Medical Teaching Hospital, College of Veterinary Medicine, Seoul National University on July 24, 2006 after an episode of epistaxis and decreased appetite of 2 days' duration. The dog was born and raised in a residential area at Daeband-dong, Dongjak-gu, Seoul near where was Yongma Mountain and was living with its littermate and dam, none of which had been taken to a CanL endemic country. Physical examinations revealed pale mucous membranes (gingival and buccal) and a single diffuse firm round dermal nodule, 10×10 cm in diameter, extending from the lateral flank to the lateral abdomen. The skin nodule persisted for a year, and was tentatively diagnosed as panniculitis based on biopsy and histological examinations. Coagulation profiles and blood pressure were all within reference limits. The nodule was aspirated using a 23G needle and smears were cytologically stained. Numerous intracellular and extracellular organisms with basophilic nuclei and bar-shaped kinetoplasts were observed (), consistent with characteristic features of Leishmania sp.\nBased on cytological findings, tissue aspirates from the nodule were submitted for in vitro culture. Samples were first incubated in Dulbecco's Modified Eagle's Medium (DMEM) (Invitrogen, Carlsbad, California, USA) supplemented with 20% (v/v) heat-inactivated fetal calf serum (FCS) in an atmosphere of 5% CO2 and 95% air at 37℃ for 1 week, after which the medium was replaced with Schneider's Drosophila medium (GIBCO™ Schneider's Drosophila Medium 1X, liquid) (Invitrogen) with 20% heat-inactivated FCS, and incubated at 24℃ []. However, the culture was uninformative.\nFor PCR, DNA was extracted from the specimen using a commercial DNA Extraction Kit (AccuPrep® DNA Extraction Kit, Bioneer, Daejeon, Korea) with minor modifications [,]. In order to diagnose and obtain genomic data, PCR assays were performed with following primer pairs [,]; R174 (5'-GGTTCCTTTCCTGATTTACG-3') and R798 (5'-GGCCGGTAAAGGCCGAATAG-3') which were specific to the partial small subunit ribosomal RNA (SSU rRNA) gene (600 bp) of Leishmania, and N13A (5'-AACTTTTCTGGTCCTCCGGG-3') and N13B (5'-CCCCCAGTTTCCCGCCC-3') which were specific to a 120 bp fragment of the L. infantum kinetoplast DNA minicircle. The PCR products from each gene fragment were purified using a commercial gel extraction kit (QIAEX II Gel Extraction Kit, QIAGEN Inc., Valencia, California, USA). DNA sequencing was carried out using an automated DNA sequencer (ABI system 3700, Applied Biosystems, Inc., Foster City, California, USA). Using the DNA Basic module (DNAsis MAX, MiraiBio, Alameda, California, USA), gene sequences of the Korean canine Leishmania sp. (Leishmania infantum isolated from a dog in this study) were compared with those of the other known Leishmania species. The nucleotide sequences of the 600 bp fragment of the SSU rRNA gene and 120 bp fragment of the kinetoplast DNA minicircle gene from the Leishmania-infected dog described in this study were deposited in GenBank under accession numbers EU825208 and EU825207, respectively.\nPCR analysis of the aspirated samples showed both the 600 bp band specific for Leishmania and 120 bp L. infantum-specific kinetoplast DNA minicircle () [-]. Nucleotide sequence comparisons of the SSU rRNA gene of the organism with that of other parasites available in GenBank revealed that the organism shared greater than 99% identity with 10 of 13 strains of Leishmania spp. and above 98% identity with the other 3 Leishmania spp. (). The sequence comparison of the kinetoplast minicircle DNA of the organism with that of other parasites available in GenBank revealed that the organism shared 96.5-98.3 nucleotide identities with LLM-719, LEM-2298, and IPT1 strains of L. infantum. The organism also showed relatively high nucleotide identities of the kinetoplast minicircle DNA with Leishmania chagasi and Leishmania donovani, sharing 95.6-96.5% similarity (). However, the organism revealed to have very low nucleotide (69.7%) identities with Leishmania amazonensis (). Based on these data, the Korean Leishmania species from the dog described in this study was confirmed to be L. infantum and the dog was therefore diagnosed with CanL. Following the diagnosis, the dog was euthanized upon its owner's request. | [[12.0, 'year']] | F | {'7573707': 1, '26617444': 1, '16473467': 1, '17089780': 1, '9988320': 1, '10209819': 1, '15649998': 1, '16414196': 1, '30915375': 1, '22607079': 1, '16838205': 1, '7615719': 1, '28095666': 1, '23467266': 2, '1565128': 1, '9095161': 1, '24327780': 2} | {'3582933-1': 1} |
164,692 | 3858090-1 | 24,340,155 | noncomm/PMC003xxxxxx/PMC3858090.xml | Glomus Tumor of Hoffa's Fat Pad and Its Management by Arthroscopic Excision | A 42-year-old woman presented to us with a history of pain in her right knee for the past one year. The trigger spot for the pain was located just medial to the ligamentum patellae at the level of the joint line. The pain was sharp and shooting in nature and was precipitated by pressure over the trigger spot. The patient was very apprehensive and would not allow repeated examination due to the fear of precipitating the severe pain. The patient was also unable to squat or sit cross legged since deep knee bending would also precipitate the pain. There was no history of aggravation of pain with change in the temperature. She had visited numerous local physicians for the past one year, but despite the dramatic presentation, no diagnosis had been made in the patient till then. Her inflammatory parameters (cell counts, 7,800; erythrocyte sedimentation rate [ESR], 10 mm 1st hour) were normal. A radiograph of the knee was normal. Magnetic resonance imaging (MRI) of the knee revealed a 1 × 1 cm nodule at the inferior aspect of the patella in Hoffa's fat pad. This nodule was hyperintense on T2-weighted images and hypointense on T1-weighted images (). A characteristic clinical picture along with supportive MRI findings led us to suspect glomus tumor as a possible diagnosis. An ischemia test was done at this stage and was found to be positive, and it substantiated our diagnosis. Due to the intraarticular nature of the nodule, no attempt was made to infiltrate it with local anaesthetic.\nThe patient was taken up for arthroscopy of the right knee under a tourniquet. Standard anterolateral and anteromedial portals were used. Intraoperatively, a pedunculated 0.8 × 0.5 cm reddish brown nodule arising from Hoffa's fat pad was seen. A 70° scope was also used to inspect the fat pad. The reddish brown color of the nodule made it easy to differentiate from the surrounding yellow fat pad (). The fat around the pedunculated nodule was carefully shaved to reveal the base. The nodule was excised from the base and the tissue sent for histopathological examination. No separate incision or portal was required to remove the nodule. The fat pad was inspected again and parts of the surrounding synovium were removed to ensure complete removal and decrease the chances of recurrence.\nThe histological evaluation confirmed the diagnosis of glomus tumor. H&E staining () revealed a well-circumscribed, encapsulated lesion composed of hyalinized variably sized blood vessels lined by flattened endothelium with the perivascular region showing a solid proliferation of monomorphic round to oval cells with fine chromatin, inconspicuous nucleoli and moderate cytoplasm. A further confirmation was made using immunohistochemisty for smooth muscle actin which showed diffuse cytoplasmic positivity ().\nPostoperatively the patient had dramatic total relief from pain and she remains asymptomatic at the last follow-up after 15 months. | [[42.0, 'year']] | F | {'19136262': 1, '4286269': 1, '26130071': 1, '9020456': 1, '26254119': 1, '17240152': 1, '32166215': 2, '4315716': 1, '9586981': 1, '7822348': 1, '13757611': 1, '24340155': 2} | {'7059490-1': 1} |
164,693 | 3858131-1 | 24,471,040 | noncomm/PMC003xxxxxx/PMC3858131.xml | Expansile keratocystic odontogenic tumor in the maxilla: immunohistochemical studies and review of literature | A 57-year-old man was referred to the clinic for the evaluation of facial swelling and asymmetry. The panoramic view showed a large cystic lesion from the anterior maxilla to the entire left side of the maxilla and maxillary sinus. The teeth involved showed no deviation, but slightly resorbed roots were detected. In the computed tomography (CT) views, the cystic tumor was expanded to the buccal and palatal bony wall with partial disruption of cortical bone.() The lesion was tentatively diagnosed as KCOT because of its aggressive expansion with homogenous fluid-filled lumen. The patient underwent endodontic treatment for all teeth involved, and the expansile maxillary tumor was radically excised with Weber-Ferguson incision, showing no recurrent sign for more than 5 years' follow-up period.()\nIn the histopathological features of H&E-stained slides, thin lining of stratified squamous epithelium and thin parakeratotic surface on the lumen side of the cyst were observed, indicating KCOT. To characterize this tumor, specimens were immunostained with BCL2, BAX, Ki-67, and p53 and p63 antibodies. For the immunohistochemical analysis, tumor specimens were embedded in paraffin blocks, and then cut into 4-µm sections and mounted on silane-coated glass slides. Sections were maintained at room temperature for 12 hours, and then deparaffinized; after hydration they were immunostained using an automated immunostainer (BenchMark XT; Roche Korea, Seoul, Korea). The primary antibodies used and immunohistochemical staining results are summarized in . Positive immunostaining intensities were graded as +++, ++, +, and - for strong, moderate, weak, and negative staining, respectively.\nIn the immunostained slides, p53 and p63 proteins were strongly expressed in the lining epithelium of the tumor, BCL2 and Ki-67 were moderately expressed in the epithelium and stromal tissues of tumor, and BAX was almost negatively detected.(, ) | [[57.0, 'year']] | M | {'17928730': 1, '25566331': 1, '19158536': 1, '23207846': 1, '18088685': 1, '27818958': 2, '16053892': 1, '18449109': 1, '22207432': 1, '24783143': 1, '22684875': 1, '18256893': 1, '5286148': 1, '21780975': 1, '11117688': 1, '21215666': 1, '9282204': 1, '22072419': 1, '12076694': 1, '24471040': 2} | {'3858131-2': 2, '5087983-1': 1} |
164,694 | 3858131-2 | 24,471,040 | noncomm/PMC003xxxxxx/PMC3858131.xml | Expansile keratocystic odontogenic tumor in the maxilla: immunohistochemical studies and review of literature | A 54-year-old man visited for evaluation after sustaining unilateral facial swelling. Following the radiological examination, large expanded intrabony cystic lesion was found in the left maxilla and maxillary sinus. The lesion occupied the entire unilateral maxilla and maxillary sinus with the expansion and erosion of cortical bone. Tooth displacement was not detected, but some root resorption was observed in the teeth involved.() Benign cystic lesion much like KCOT was diagnosed due to its radiological and clinical features and was completely excised with Weber-Ferguson incision. The patient had been followed up for 2 years without any evidence of recurrence.()\nThe histopathological feature of H&E-stained slide was similar to that of case 1, with thin-lining epithelium and parakeratinized luminal surface as demonstrating features of KCOT. Immunohistochemical analysis of the tumor specimen was performed as described previously with case 1. Strong expression of p53 and p63, positive but weak detections of BCL2 and Ki-67, and negative detection of BAX were observed, and these expression patterns were similar to those of case 1.(, ) | [[54.0, 'year']] | M | {'17928730': 1, '25566331': 1, '19158536': 1, '23207846': 1, '18088685': 1, '27818958': 2, '16053892': 1, '18449109': 1, '22207432': 1, '24783143': 1, '22684875': 1, '18256893': 1, '5286148': 1, '21780975': 1, '11117688': 1, '21215666': 1, '9282204': 1, '22072419': 1, '12076694': 1, '24471040': 2} | {'3858131-1': 2, '5087983-1': 1} |
164,695 | 3858146-1 | 24,471,025 | noncomm/PMC003xxxxxx/PMC3858146.xml | Displacement of dental implants into the focal osteoporotic bone marrow defect: a report of three cases | A 51-year-old woman with no medical history was referred by a private dental clinic for the management of displacement of implant fixture in the right mandible posterior area on November 7, 2011. Two days earlier, an implant accidentally fell into the mandible body of the #46 area during implant surgery. She complained of hypoesthesia on the right lower lip and chin area. Cone-beam computed tomography (CBCT) imaging of the jaws showed 2.0×0.7 cm radiolucency with quite ill-defined and irregular borders located from the premolar area to the right midbody of the #46, #47 edentulous regions and indicated the implant location to be near the mandibular inferior border area.() Block anesthesia of the right mandibular nerve was administered together with infiltration anesthesia of the surrounding tissues. A mucoperiosteal flap was raised, and a periosteal elevator was placed under the periosteum. Bone osteotomy (1.0×0.5 cm) was performed at the lateral corpus of the mandible with fissure bur and osteotomes. A rectangular cortical bone window was removed. The implant (4.0 mm wide, 8.0 mm long) was exposed and carefully removed without any damage to the mandibular neurovascular bundle. The inner side of the corpus was empty, without any cancellous bone. The osteotomy window was put back to its original position without fixation. The mucoperiosteal flap was replaced and sutured. Postoperatively, a 5-day course of amoxicillin and chlorhexidine rinse was prescribed. The sutures were removed 7 days postoperatively. She complained of hypoesthesia of the right lower lip and chin area during the 9 months' follow-up.() | [[51.0, 'year']] | F | {'21238846': 1, '6819349': 1, '22873712': 2, '14651274': 1, '18201600': 1, '32801922': 1, '2196504': 1, '17923346': 1, '27747641': 2, '18379448': 1, '15532316': 1, '21365033': 1, '17096860': 1, '3277106': 1, '3457122': 1, '24471025': 2} | {'3858146-2': 2, '3858146-3': 2, '5005556-1': 1, '3489784-1': 1} |
164,696 | 3858146-2 | 24,471,025 | noncomm/PMC003xxxxxx/PMC3858146.xml | Displacement of dental implants into the focal osteoporotic bone marrow defect: a report of three cases | A 60-year-old woman with medical history of hypertension was referred by another department of our dental center for the management of displacement of implant fixture in the left mandible posterior area on July 16, 2012. Thirty minutes earlier, one implant accidentally fell into the mandible body of the #36 area during implant surgery.() Note, however, that the #37 implant (4.5 mm wide, 8.0 mm long) placed simultaneously with #36 had good initial stability. CBCT imaging of the jaws showed radiolucency with quite ill-defined and irregular borders located from the premolar area to the left midbody of the #36, #37 edentulous regions and indicated the implant location to be near the mandibular canal.() The removal of implant fixture followed the same procedure as that of case 1. The implant was 4.5 mm wide and 10.0 mm long.() Three months later, replacement of the #36 implant (4.0 mm wide, 10 mm long) was performed with autogenic and xenogenic bone graft.() Bone grafts were made on the upper third portion of the implant. It had three-walled defects, but primary stability was sufficient. Six months after the #37 implant placement and three months after the #36 implant replacement, secondary surgery was performed, followed by the delivery of prosthetics; healing proceeded uneventfully without any postoperative complication. | [[60.0, 'year']] | F | {'21238846': 1, '6819349': 1, '22873712': 2, '14651274': 1, '18201600': 1, '32801922': 1, '2196504': 1, '17923346': 1, '27747641': 2, '18379448': 1, '15532316': 1, '21365033': 1, '17096860': 1, '3277106': 1, '3457122': 1, '24471025': 2} | {'3858146-1': 2, '3858146-3': 2, '5005556-1': 1, '3489784-1': 1} |
164,697 | 3858146-3 | 24,471,025 | noncomm/PMC003xxxxxx/PMC3858146.xml | Displacement of dental implants into the focal osteoporotic bone marrow defect: a report of three cases | A 51-year-old woman with medical history of myoma uteri was referred by a private dental clinic for the management of displacement of implant fixture in the left mandible posterior area on November 28, 2012. Three hours earlier, one implant accidentally fell into the mandible body of the #36 area during implant surgery.() The CBCT image of the jaws showed radiolucency with quite ill-defined and irregular borders located from the premolar area to the left midbody of the #36, #37 edentulous regions and indicated the implant location to be near the mandibular inferior border. The removal of implant fixture followed the same procedure as that of case 1. The implant was 4.0 mm wide and 10.0 mm long. Healing proceeded uneventfully during the 3 months' follow-up. | [[51.0, 'year']] | F | {'21238846': 1, '6819349': 1, '22873712': 2, '14651274': 1, '18201600': 1, '32801922': 1, '2196504': 1, '17923346': 1, '27747641': 2, '18379448': 1, '15532316': 1, '21365033': 1, '17096860': 1, '3277106': 1, '3457122': 1, '24471025': 2} | {'3858146-1': 2, '3858146-2': 2, '5005556-1': 1, '3489784-1': 1} |
164,698 | 3858160-1 | 24,471,015 | noncomm/PMC003xxxxxx/PMC3858160.xml | Self-inflating oral tissue expander for ridge augmentation in the severely atrophic mandible | A 48-year-old female patient was diagnosed with severe bone resorption after peri-implantitis and removal of her previous 3 implants for tooth loss due to periodontitis. Three new implants were planned for rehabilitation. First, she needed vertical bone augmentation and soft-tissue expansion due to severely resorbed ridge.()\nOsmed tissue expander (cylinder type, 0.15 mL) was inserted subperiosteally in the region of the lower right posterior area and fixed with 1 micro screw (Jeil self-tapping mini screw, 1.4×3 mm, Jeil Medical Corp., Seoul, Korea) under local anesthesia with lidocaine (2% Lidocaine HCL, Epinephrine Inj., Yuhan Corp., Seoul, Korea) and midazolam (Midazolam 5 mg/5 mL, Bukwang Pharmaceutical Co., Seoul, Korea) intravenous sedation.()\nThe tissue expander was left in place for 6 weeks and expanded from 0.15 mL to 0.7 mL. After bony augmentation with composite bone graft (autogenous bone [harvested from right ramal area]+xenograft [Bio-Oss; Geistlich, Wolhusen, Switzerland]), tension-free coverage of the augmented bone was achieved using the soft tissue that had been created. The tissue expander was used because of the firmness of soft tissue. Six months later, the grafted bone was very hard and intact. When implant surgery was done, insertion torque was 25 Ncm; currently, the operation site is healing following prosthetic treatment.() | [[48.0, 'year']] | F | {'27995490': 1, '20637032': 1, '12005140': 1, '25848145': 1, '32316310': 1, '20678133': 1, '19959265': 1, '11093177': 1, '21044131': 1, '7054790': 1, '24471015': 2} | {'3858160-2': 2} |
164,699 | 3858160-2 | 24,471,015 | noncomm/PMC003xxxxxx/PMC3858160.xml | Self-inflating oral tissue expander for ridge augmentation in the severely atrophic mandible | A 54-year-old female patient was diagnosed with severe bone resorption on the right mandibular posterior area. The patient wanted to have 3 more implants for right-side molar rehabilitations. Bone graft and new implants were planned, but the vertical height of the remaining alveolar bone was low and close to the inferior alveolar nerve canal, posing a limitation in implant surgery.(, )\nFirst, the insertion of tissue expander was performed for soft tissue augmentation. Buccolingual incision to secure a pouch was done, and Osmed tissue expander (cylinder type, 0.045 mL) was inserted and fixed using screw fixation.()\nThe expander was left in place for 3 weeks and expanded from 0.045 mL to 0.24 mL.()\nNerve repositioning surgery for inferior alveolar nerve repositioning was done during implant surgery. Simultaneous implant surgery was done after autogenous and xenogenic bone graft and tension-free soft tissue coverage using self-inflating tissue expander.\nOne and a half years after the operation, the inserted dental implant and expanded soft tissue healed well. In the neurologic examination, the sensory of the lower right lip was improved, and periodic follow-up was done with no complaints from the patient.() | [[54.0, 'year']] | F | {'27995490': 1, '20637032': 1, '12005140': 1, '25848145': 1, '32316310': 1, '20678133': 1, '19959265': 1, '11093177': 1, '21044131': 1, '7054790': 1, '24471015': 2} | {'3858160-1': 2} |
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