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165,000 | 3876314-1 | 24,381,691 | noncomm/PMC003xxxxxx/PMC3876314.xml | A Painful, Blistering Rash | A 67-year-old man presented with painful oral and skin lesions developing over the last 2 months. The lesions initially formed in his mouth and lips, and slowly spread to his torso, groin, and extremities (). The lesions began as blisters that broke easily and were exquisitely painful to light touch. In the past few days, he also developed painful lesions on his eyes that were associated with redness and photophobia. The patient saw his primary care doctor at the onset of illness and failed to improve with courses of azithromycin, ciprofloxacin, and tetracycline. He was no longer able to tolerate anything by mouth because of pain and he had lost a significant amount of weight. His skin exam was notable for Nikolsky’s sign. | [[67.0, 'year']] | M | {'24381691': 2} | {} |
165,001 | 3876315-1 | 24,381,692 | noncomm/PMC003xxxxxx/PMC3876315.xml | Sedative Dosing of Propofol for Treatment of Migraine Headache in the Emergency Department: A Case Series | A 51-year-old male with past medical history of migraines, hypertension and depression presented with headache for the previous 24 hours. The pattern was typical of his migraine headaches. Initial vital signs were heart rate 97, blood pressure 135/93, respiratory rate 16 and pain scale of 9/10. His migraine had not responded to his home medications. Prior migraines requiring ED visits were treated with: prochlorperazine, diphenhydramine, acetaminophen, droperidol, ibuprofen, morphine, and normal saline. Physical exam was unremarkable for any focal neurologic findings other than photophobia.\nThe patient was consented for procedural sedation and treated with 1 mg/kg of propofol. Thirteen minutes after medication the patient was arousable. The patient was observed for an additional 1 hour and 9 minutes during which the headache decreased to 2/10 and then complete resolution with no further pharmacologic intervention. He was reassessed and discharged home with a total LOS of 2 hours. Discharge vital signs were heart rate 77, blood pressure 137/94, respiratory rate 16. | [[51.0, 'year']] | M | {'15099247': 1, '11900605': 1, '23187986': 1, '3259095': 1, '12482216': 1, '7943850': 1, '19923528': 1, '7856898': 1, '7870027': 1, '29610631': 1, '20397799': 1, '25704007': 1, '8528557': 1, '22587626': 1, '17264748': 1, '2985200': 1, '12010401': 1, '18809105': 1, '30868276': 1, '10759925': 1, '24381692': 2} | {'3876315-2': 2, '3876315-3': 2, '3876315-4': 2} |
165,002 | 3876315-2 | 24,381,692 | noncomm/PMC003xxxxxx/PMC3876315.xml | Sedative Dosing of Propofol for Treatment of Migraine Headache in the Emergency Department: A Case Series | A 51-year-old woman with past medical history of hypertension and migraines presented with 12 hours of 9/10 headache typical of her past migraines. Repeated doses of her home sumatriptan (100 mg) had failed. Initial vital signs were heart rate 60, blood pressure 193/105, respiratory rate 14. A full neurologic examination found no focal deficits. Initial treatment with compazine 10 mg intravenous (IV) and IV hydration with 1 L of normal saline was attempted with a pain score remaining 9/10. The patient was then consented and treated with 1 mg/kg propofol. A complete resolution of symptoms was achieved with a LOS of 2.75 hours. Discharge vital signs were heart rate 48, blood pressure 134/97, respiratory rate 18. | [[51.0, 'year']] | F | {'15099247': 1, '11900605': 1, '23187986': 1, '3259095': 1, '12482216': 1, '7943850': 1, '19923528': 1, '7856898': 1, '7870027': 1, '29610631': 1, '20397799': 1, '25704007': 1, '8528557': 1, '22587626': 1, '17264748': 1, '2985200': 1, '12010401': 1, '18809105': 1, '30868276': 1, '10759925': 1, '24381692': 2} | {'3876315-1': 2, '3876315-3': 2, '3876315-4': 2} |
165,003 | 3876315-3 | 24,381,692 | noncomm/PMC003xxxxxx/PMC3876315.xml | Sedative Dosing of Propofol for Treatment of Migraine Headache in the Emergency Department: A Case Series | A 62-year-old woman with a history of complex migraine presents with 5 days of 9/10 headache, with no relief from her home regimen of ibuprofen and rizatriptan. Past medical history was significant for irritable bowel syndrome, hepatitis C, and arthritis. She also complained of photophobia, left-sided facial paresthesias, and nausea, all of which were consistent with past migraine episodes. Initial vital signs were heart rate 73, blood pressure 151/84, and respiratory rate 18. Physical exam was remarkable only for decreased sensation on the left side of the face, in all 3 dermatomes. The patient was consented and treated with 1 mg/kg propofol. After five minutes she reported marked improvement with her pain score reduced to 3/10. On repeat evaluation she requested further treatment and was given intravenous compazine 10 mg IV, diphenhydramine 50 mg IV, and ketorolac 30 mg IV with 2 L intravenous saline. At discharge she reported full resolution of headache symptoms. Her total LOS was 4.8 hours. Discharge vital signs were heart rate 61, blood pressure 137/71, and respiratory rate 18. | [[62.0, 'year']] | F | {'15099247': 1, '11900605': 1, '23187986': 1, '3259095': 1, '12482216': 1, '7943850': 1, '19923528': 1, '7856898': 1, '7870027': 1, '29610631': 1, '20397799': 1, '25704007': 1, '8528557': 1, '22587626': 1, '17264748': 1, '2985200': 1, '12010401': 1, '18809105': 1, '30868276': 1, '10759925': 1, '24381692': 2} | {'3876315-1': 2, '3876315-2': 2, '3876315-4': 2} |
165,004 | 3876315-4 | 24,381,692 | noncomm/PMC003xxxxxx/PMC3876315.xml | Sedative Dosing of Propofol for Treatment of Migraine Headache in the Emergency Department: A Case Series | A 59 year old man with past medical history significant for migraines, insomnia, and hypothyroidism presented with four hours of 8/10 right-sided headache and photophobia. Symptoms were consistent with his typical migraine. Home treatment with naproxen and gabapentin had failed to improve his symptoms. Previous migraines requiring ED admission were treated with prochlorperazine 10 mg IV, diphenhydramine 50 mg IV, ketorolac 30 mg IV, morphine 6 mg IV, and promethazine 12.5 mg IV. Initial vital signs were heart rate 79, blood pressure 116/78, and respiratory rate 18. Neurologic examination revealed no focal deficits. The patient was then consented and treated with 1 mg/kg propofol. After 5 minutes the patient reported near complete resolution of symptoms with a pain score of 1/10. He was able to ambulate, tolerate oral intake, and was discharged shortly thereafter. His ED LOS was 2.8 hours. Discharge vital signs were heart rate 80, blood pressure 104/66, and respiratory rate 16. | [[59.0, 'year']] | M | {'15099247': 1, '11900605': 1, '23187986': 1, '3259095': 1, '12482216': 1, '7943850': 1, '19923528': 1, '7856898': 1, '7870027': 1, '29610631': 1, '20397799': 1, '25704007': 1, '8528557': 1, '22587626': 1, '17264748': 1, '2985200': 1, '12010401': 1, '18809105': 1, '30868276': 1, '10759925': 1, '24381692': 2} | {'3876315-1': 2, '3876315-2': 2, '3876315-3': 2} |
165,005 | 3876602-1 | 24,455,508 | noncomm/PMC003xxxxxx/PMC3876602.xml | Thyroid cancer in Gardner’s syndrome: Case report and review of literature | A 40-year-old gentleman with no previous medical or family history was referred to our hospital with a diagnosis of adenocarcinoma of the rectum. At our institute, a colonoscopic evaluation revealed multiple polyps scattered throughout the colon. He underwent panproctocolectomy with ileostomy. The histology showed tubulovillous and adenomatous polys in caecum, colon and rectum with a moderately differentiated adenocarcinoma of rectum. All lymph nodes were negative []. Fifteen months later, he had a swelling around the stoma site. CT scan showed a 9.5x5.6x7.5 cm peritoneal mass at the site of ileostomy with multiple smaller similar lesions throughout the abdomen. The tumor was excised (R1 resection) with reconstruction of the abdominal wall, histologically showing it to be a desmoid tumor The patient was given weekly systemic therapy with vinblastine, methotrexate and tamoxifen (methotrexate 30 mg/m2 weekly intravenously, vinblastine 6 mg/m2 weekly intravenously and tamoxifen 20 mg/m2 twice a day orally daily) for 6 cycles. Six months later (21 months following the diagnosis of colon carcinoma), CT scan showed a partial response of the desmoid tumors. A new thyroid nodule was detected at a screening ultrasound of the neck. FNAC confirmed the diagnosis to be papillary carcinoma of thyroid []. Total thyroidectomy was done which revealed a well-differentiated papillary carcinoma of the thyroid. The patient is currently on maintenance doses of thyroxine and is continued on tamoxifen. . Almost 3 years since the initial detection of Gardner’s syndrome, the patient continues to remain stable. | [[40.0, 'year']] | M | {'3060152': 1, '4720000': 1, '7304549': 1, '6872788': 1, '1847274': 1, '2852697': 1, '2551613': 1, '657934': 1, '6129922': 1, '32832171': 2, '3362267': 1, '6021668': 1, '18109906': 1, '5639668': 1, '7144838': 1, '5644968': 1, '2834476': 1, '8420756': 1, '8813970': 1, '19822006': 1, '2241052': 1, '3036290': 1, '499712': 1, '8498926': 1, '24455508': 2} | {'7426784-1': 1} |
165,006 | 3876616-1 | 24,455,521 | noncomm/PMC003xxxxxx/PMC3876616.xml | Emergency percutaneous tracheostomy in two cancer patients with difficult airway: An alternative to cricothyroidotomy? | A 48-year-old male, a known case of carcinoma buccal mucosa stage III and had already undergone commando procedure followed by chemotherapy and concurrent radiotherapy 3 months back, presented to triage with complaints of breathlessness, cough, difficulty in speaking of 1 day duration. On evaluation, there was an inspiratory stridor and labored respiration along with hypoxemia on room air (oxygen saturation (SpO2) 77% and PaO254 mm Hg). After an initial stabilization, he was immediately shifted to the hemato-oncology intensive care unit (ICU).\nHe was managed conservatively on the lines of laryngeal edema with adrenaline nebulization, steroids, antibiotics, and urgent surgical consultation. However, in next few minutes, patient’s condition worsened with increasing stridor, respiratory distress, and hypoxemia. He went into cardio-respiratory arrest, and resuscitation was started as per Advanced Cardiac Life Support (ACLS) protocol.\nThe call for definitive airway protection was taken as there was no improvement with the primary resuscitation. Orotracheal intubation was tried thrice by senior intensivist, however, it was unsuccessful. A rapid decision for PCT was taken by the critical care team along with on-call surgeon and was performed by Ciaglia technique using Blue Rhino PCT kit (Cook Critical Care Inc, Bloomington, IN) with size 7.0 tracheostomy tube. The time taken to secure an airway was less than 2 minutes, and position was confirmed with capnography. After tracheostomy, there was improvement in ventilation and SpO2. He was successfully resuscitated with the return of spontaneous circulation in approximately 11-12 minutes. Hypothermia protocol was initiated as per our hospital protocol.\nPatient showed gradual recovery, vasopressors and ventilatory support were subsequently tapered off, and the patient was transferred out, neurologically alert and oriented, with T-piece on day 5 [Figures and ]. | [[48.0, 'year']] | M | {'16978303': 1, '15035768': 1, '15200543': 1, '16369150': 1, '16325326': 1, '15028902': 1, '12717151': 1, '15933506': 1, '24455521': 2} | {'3876616-2': 2} |
165,007 | 3876616-2 | 24,455,521 | noncomm/PMC003xxxxxx/PMC3876616.xml | Emergency percutaneous tracheostomy in two cancer patients with difficult airway: An alternative to cricothyroidotomy? | A 62-year-old male who was a known case of carcinoma right bronchus stage IV with bone and brain metastasis was admitted with left-sided chest pain, progressively increasing breathlessness since 4 hours. On examination, he was drowsy, hypoxemic on room air (SpO2 88%, PaO2- 64 mm Hg on FiO2- 0.6), with decreased air entry and tympanic node on percussion on left side of the thorax. Chest X-ray revealed left-sided pneumothorax, and 28 Fr intercostal drain was immediately placed. There was transient improvement in SpO2 and respiratory acidosis. After 1 hour, he had generalized tonic clonic seizure, for which lorazepam was given, and he was started on bag and mask ventilation.\nThe decision to secure definitive airway was taken in view of an altered mental status with persistent respiratory failure. Orotracheal intubation was tried; however, it failed due to restricted mouth opening and restricted lower jaw movement, with Cormack and Lehane grade III on direct laryngoscopy. The decision for emergency PCT was then taken and performed by Ciaglia technique using Blue Rhino PCT kit with 7.5 tracheostomy tube. Procedure was completed in less than 3 minutes. The tube position was confirmed with capnography []. In spite of obtaining definitive airway and using all aggressive medical measures, patient failed to show any clinical improvement and died of refractory shock after 4 days of ICU stay. | [[62.0, 'year']] | M | {'16978303': 1, '15035768': 1, '15200543': 1, '16369150': 1, '16325326': 1, '15028902': 1, '12717151': 1, '15933506': 1, '24455521': 2} | {'3876616-1': 2} |
165,008 | 3876624-1 | 24,455,529 | noncomm/PMC003xxxxxx/PMC3876624.xml | Xanthogranulomatous pyelonephritis: Rare presentation of a rare disease | A 45-year-old female was referred to the radiology department for investigation of gradually progressive abdominal lump in right lumbar region which she first noticed about 6 months back. She had complains of right flank pain, fullness and pus in urine for the same duration, but intensity of pain has increased since last 15 days and had an episode of hematuria few days back. She also gave history of off and on fever, for which she took medications from local practitioners. However, she had no previous history of diabetes, hypertension, renal disease or urinary tract infection.\nOn local examination, temperature was slightly raised with an ill-defined firm to hard mass palpable in right lumbar region and was tender on palpation. Laboratory investigation showed leukocytosis with increase in neutrophil count. On admission, investigations done at our hospital showed raised blood serum creatinine (1.8 mg%) and urea (60 IU) level. However, blood sugar level was normal.\nAn X-ray kidney urinary bladder (KUB) showed a large soft tissue density mass in right lumbar region displacing bowel loops to the left side. Loss of right psoas shadow, blurring of pre-peritoneal fat planes and mild scoliosis of spine with concavity to right side was also noted []. CT abdomen was advised immediately which showed ill defined, poorly excreting right kidney with loss of corticomedullary differentiation. There was extensive heterogeneously enhancing collection with involvement of adjacent soft tissue in perinephric and pararenal space, pelvis and under surface of liver with involvement of ipsilateral psoas, quadratus lumborum and lateral abdominal wall muscles. No evidence of calculus was seen on CT. Inferior vena cava IVC was displaced anteriorly due to retroperitoneal lymphadenopathy; however, no evidence of extension of the lesion into IVC was seen []. A radiological diagnosis of Xanthogranulomatous pyelonephritis was suggested even in the presence of negative history of diabetes, prior episode of urinary infections, absence of calculus and presence of hematuria.\nDrainage of extrarenal abscess under coverage of piperacillin-tazobactum and metronidazole was performed and aspirate sent for cytology which showed lipid laden macrophages with few haemosiderin laden macrophages consistent with the diagnosis of Xanthogranulomatous type of Pyelonephritis []. This was followed by radical nephrectomy. The patient recovered well with uneventful post-operative period and patient was discharged on 7th post-operative day. The patient was last seen at 3 months follow up and has progressed well. | [[45.0, 'year']] | F | {'26171211': 1, '6609582': 1, '17098659': 1, '29264165': 1, '18203942': 1, '33245481': 1, '17054551': 1, '27257454': 1, '30983751': 1, '4686855': 1, '17662737': 1, '24455529': 2} | {} |
165,009 | 3876629-1 | 24,455,530 | noncomm/PMC003xxxxxx/PMC3876629.xml | Primary malignant melanoma of the vagina: A case report and review of literature | A 60 year old woman, P2 + 0, post-menopausal by 20 years, presented in gynecology department with the complaints of white discharge and recurrent small amount of bleeding per vagina for last 3 months. The patient was hypertensive, diabetic and had total abdominal hysterectomy with bilateral salpingo oophorectomy 20 years ago. Per speculum vaginal examination revealed, a brown colored, firm nodule of 1cm2 at lower 1/3rd postero lateral vaginal wall without any surrounding vaginal colour changes. Bilateral parametria were free and rectum was normal and there was no inguinal lymphadenopathy. Wide local excision biopsy (Free margin 1 cm) was done and sent for histopathological examinations. Unfortunately we lost follow up of the patient for next six weeks and she returned with histopatological report of lesion of malignant melanoma of vaginal mucosa. At this point, her vaginal examination revealed healing of the wound site with presence of indurations and diffuse black colour change of both lower 1/3rd of anterior and posterior vaginal wall []. MRI pelvis revealed a 3 × 1.9 × 1.6 cm mass in the posterolateral vagina with bilateral reactive lymph nodes in inguinal region.\nMetastatic work up was done. PET scan revealed an ill-defined soft tissue mass in mid vagina involving left lateral wall (1.5 × 1.2 cm) standard uptake value (SUV = 5.6) with perilesional fat plane preserved. Irregular linear uptake of 18 fluro deoxy glucose (FDG) (SUV 9.7) was found along left vaginal wall with no obvious CT scan lesion. Few subcentimeter lymph nodes (SUV 2.3) were also present in both inguinal and external iliac region.\nPatchy linear uptake (SUV 6.0) was found in right rectus abdominis muscle, with bilateral subcarinal lymph nodes (SUV 6.2) and another lesion was found in the infraumbilical region. However, definitive evidence of metastasis was not histopathologically confirmed by FNAC or excision biopsy.\nThe patient was treated with external beam radiotherapy (40 Gy in 10 fractions; 2 fractions per week) with palliative intent to the tumor bed, followed chemotherapy with six cycles of Temozolamide, 250 mg orally for 5 days, per cycle. The patient is alive after 1 year and under follow up []. | [[60.0, 'year']] | F | {'12094953': 1, '28064232': 1, '15063970': 1, '20147857': 1, '25973128': 1, '10071291': 1, '17608945': 2, '11321487': 1, '20527252': 1, '21099603': 1, '9698468': 1, '32642388': 1, '16398233': 1, '14699031': 1, '21872820': 1, '27570818': 1, '19242707': 1, '26336485': 1, '2755138': 1, '12409721': 1, '30065550': 1, '24455530': 2} | {'1934920-1': 1} |
165,010 | 3876636-1 | 24,455,526 | noncomm/PMC003xxxxxx/PMC3876636.xml | Squamous cell carcinoma lung: Presented with bilateral lower limb deep venous thrombosis with gangrene formation | A 41-year-old non diabetic non hypertensive non smoker woman was brought to our department with complain of dry cough, progressive shortness of breath for 2 weeks along with pain and swelling of both feet for 1 week. On examination there was bilateral pitting pedal oedema and raised body temperature of 101°F. Blackening of skin of all the toes on both feet with decreased local temperature and tenderness were revealed on local examination of feet. [] Multiple nodules over scalp were seen as incidental finding. For evaluation of respiratory symptoms, chest X-ray and CT scan thorax were done and revealed left sided massive pleural effusion with atelectasis of left lung.[] Pleural fluid study came as lymphocytic, exudative, ADA level 14 IU/ml with presence of malignant cell. Closed pleural biopsy and report suggested as metastatic squamous cell carcinoma. FNAC from scalp nodule was also positive for metastatic squamous cell carcinoma []. On fiber optic bronchoscopy, there was an infiltrating growth in left upper lobe bronchus and biopsy suggestive of squamous cell carcinoma []. USG doppler of venous system of both lower limbs revealed an organized thrombus in common iliac veins extending into superficial femoral vein with complete occlusion of venous system distal to it. Doppler angiography showed patency of bilateral arterial system like common iliac, internal iliac, external iliac, femoral, popliteal, anterior tibial, posterior tibial, and arteria dorsalis pedis and any arterial occlusion as a cause of gangrene had been ruled out. However, a coagulation profile did reveal the existence of hypercoagulable state with prothrombin time 14.4 s (control 12.5 s), partial thromboplastin time 43.5 s (control 32.2 s), International Normalized Ratio (INR) 1.16, D-dimer raised to 1030 μg/L and a fibrin degradation product 286 μg/ml (normal < 10 μg.ml). Serum for antinuclear antibody (ANA), Ig M and Ig G anticardiolipin antibodies, protein C and protein S was within normal limits. Patient was put on low molecular weight heparin (LMWH) enoxaparin sodium injection subcutaneously at a dose of 40 IU twice daily. After 5 days of treatment with LMWH, INR was repeated and found to be 2.5. Patient was shifted to oral warfarin 5 mg daily from LMWH after 7 days of treatment. She was diagnosed as a case of stage IV squamous cell carcinoma lung and treated with palliative chemotherapy regimen consisting of carboplatin and gemcitabine. After 1st cycle of chemotherapy patient was discharged in stable condition with oral warfarin at a dose of 5 mg daily and asked to check INR regularly. | [[41.0, 'year']] | F | {'21781268': 1, '19738121': 1, '1335159': 1, '11549773': 1, '9704665': 1, '12975470': 1, '15925818': 1, '8578472': 1, '9579631': 1, '10939433': 1, '7640230': 1, '12814981': 1, '17940477': 1, '19398575': 1, '10737280': 1, '12515735': 1, '24455526': 2} | {} |
165,011 | 3876644-1 | 24,455,551 | noncomm/PMC003xxxxxx/PMC3876644.xml | Osteosarcoma relapse as pleural metastasis | A 14-year-old male patient with osteosarcoma of tibia received preoperative chemotherapy with cisplatin and doxorubicin. He had undergone mid-thigh amputation in November 2007. Histopathological examination from the lesion at the upper end of tibia was suggestive of osteogenic sarcoma. The patient then received 6 cycles of cisplatin and doxorubicin until June 2008. A computed tomography (CT) thorax done at that time revealed no abnormality. The patient presented to us in April 2012 with cough and pleuritic chest pain for the last 7 days. Clinical examination findings were suggestive of left-sided massive pleural effusion. Hematological examination showed normocytic, normochromic anemia (Hb 9.5 g/dl) with normal erythrocyte sedimentation rate. Pleural fluid was lymphocytic, exudative in nature with adenosine deaminase level 13.3 (normal <30 U/L). Pleural fluid cytology for malignant cells was negative on three successive occasions. Contrast-enhanced CT thorax revealed a large, heterogeneous, calcified mass (+277 H.U) at left upper and middle lobe extending to the hilum, partially encasing the left main pulmonary artery along with left-sided massive pleural effusion resulting in complete collapse consolidation of the left lung []. CT-guided fine needle aspiration cytology from the lung mass was inconclusive. Flexible bronchoscopy done after pleural aspiration revealed no other abnormality. Thoracoscopy revealed a lung metastasis in right upper and middle lobe exposed on the surface of visceral pleura. A tumor about 2 cm in diameter was found on the surface of parietal pleura. Lung tumor was resected and biopsy of the pleural mass was carried out. Both the sections showed tumor composed of polygonal and spindle-shaped cells with hyperchromatic nuclei. The tumor cells showed nuclear pleomorphism. Tumor giant cells with large hyperchromatic nuclei were present. The tumor cells showed osteoid formation. Extensive areas of the tumor exhibited chondroid differentiation along with mitotic figures. The features were compatible with metastatic osteogenic sarcoma []. The patient was administered three more cycles of chemotherapy consisting of cisplatin and doxorubicin and did not develop any cumulative toxicity post-chemotherapy, in spite of the same chemotherapy regimen pre-relapse and post-relapse. | [[14.0, 'year']] | M | {'27058531': 1, '8649738': 1, '33834074': 1, '9418642': 1, '8622033': 1, '33796580': 1, '27455247': 1, '1514908': 1, '1058038': 1, '7989936': 1, '30386723': 1, '33111160': 1, '16702936': 1, '34386496': 1, '15659502': 1, '1423203': 1, '24455551': 2} | {} |
165,012 | 3876647-1 | 24,455,548 | noncomm/PMC003xxxxxx/PMC3876647.xml | Descending thoracic aorta dissection associated with esophageal carcinoma | A 45-year-old hypertensive male was admitted with complain of chest pain, dry cough along with dysphagia for 1 month. He was a diagnosed case of chronic obstructive pulmonary disease (COPD) on the basis of spirometry findings (postbronchodilator FEV1/FVC 65%, predicted FEV1 69% and absence of any significant postbronchodilator FEV1 reversibility) for past 3 years. On physical examination, patient had grade II clubbing with mediastinal percussion being dull and on chest auscultation bilateral vesicular breath sound with prolonged expiration and polyphonic rhonchi. Chest X-ray showed widening of mediastinum. Contrast-enhanced computed tomography (CT) scan of thorax showed presence of right upper paratracheal, right lower paratracheal, aortopulmonary, subcarinal lymphadenopathy. Lymph nodes were enlarged so massively so that it almost compressed surrounding structures. Esophagus was compressed and became almost like a slit-like opening with proximal dilatation as visible by water soluble contrast gastrograffin. On CT thorax there was an intra-esophageal growth projecting inside the lumen [].\nAnother striking feature was presence of a large dissecting aneurysm in descending thoracic aorta extending distally up to the origin of left renal artery. Both true and false lumen was clearly visible with a clot inside the false lumen. There was also presence of erosion of vertebral body due to pressure by dissecting aneurysm []. Fine needle aspiration cytology (FNAC) from vertebral erosion showed metastatic deposits in vertebra. Upper gastrointestinal endoscopy done for dysphagia showed an intra-esophageal fungating growth; from which biopsy was taken. Esophageal biopsy revealed squamous cell carcinoma of esophagus []. It was a rare case of squamous cell carcinoma of esophagus associated with dissecting aneurysm of aorta and vertebral metastasis visible on same CT scan thorax. Patient was managed conservatively for dissecting aortic aneurism with antihypertensive and statin. Patient was in advanced stage of cancer with metastasis to vertebra; hence, chemotherapy (5-fluorouracil and paclitaxel) and radiotherapy for dysphagia was given. | [[45.0, 'year']] | M | {'20194871': 1, '1849066': 1, '6702637': 1, '8010821': 1, '20233780': 1, '2773804': 1, '8350637': 1, '24455548': 2} | {} |
165,013 | 3876652-1 | 24,455,549 | noncomm/PMC003xxxxxx/PMC3876652.xml | Multiple trichoepitheliomas: A rare occurrence | A 52-year-old male reported with the chief complaint of multiple growths on the face for 25 years. On examination multiple dome shaped growths of varying sizes from 5 mm to 2 cm, soft to firm in consistency, non tender, non indurated were observed. In addition the patient had multiple brownish black pigmentations on the hands and back [Figure -]. No other contributory medical history was reported by the patient. The patient was moderately built and vital signs were within the clinically acceptable range. With the above features a clinical differential diagnosis of neurofibromatosis was considered. Two lesions, one from region lateral to the left ala of the nose and one lesion from above the right eyebrow, were excised. The gross specimen was 1.2 × 1 × 1 cm in size and brownish black in color []. Histopathological examination of the lesion revealed cystic areas that consist of central keratinaceous material surrounded by basophilic cells resembling basal cell carcinoma []. Tumor islands composed basaloid cells showing peripheral palisading arranged in solid islands, adenoid and lace-like pattern, surrounded by a moderately cellular stroma and condensation of mesenchymal cells around tumor islands in some areas [] Cystic areas contain keratin surrounded by basophilic cells and proliferations from the wall of the horn cyst [Figure and ]. Due to the varying histopathological features of the specimens obtained during the initial biopsy procedure, surgical excision of the lesions located on the right eyebrow and forehead region were carried out []. The gross specimens which measured approximately 1 × 1 × 0.5 cm contained cheesy material within [Figures and ]. Histopathological examination of the lesion on the eyebrow revealed solid areas resembling basal cell epithelioma with cribriform pattern [Figures and ] and central melanin pigmentation []. Whereas hisopathological examination of the lesion on the forehead revealed central keratin filled cystic areas, lined by stratified squamous epithelium with cells with eosinophilic cytoplasm and a vesicular nuclei, basal cells with hyperchromatic nuclei and a granular layer []. Cord-like proliferation of basaloid cells was seen in one area of the lining [Figures and ]. Based on the above histopathological findings a diagnosis of multiple trichoepithelioma was made.\nDifferential diagnosis considered in this case were TE, Trichofolliculoma and basal cell carcinoma (BCC). Trichofolliculoma represents aborted and disrupted attempt at follicle formation, which commonly affects adults and presents as a solitary lesion on the face. Usually a dome-shaped nodule showing a central pore with wool like tuft of immature, usually white hair is highly diagnostic. The present case presented multiple lesions and none showed the central pore with immature hair and hence the diagnosis of trichofolliculoma was ruled out.\nBCC may show similar features but the characteristic retraction artifact seen in BCC was absent and the presence of papillary–mesenchymal bodies, which is characteristic of TE was seen in the present case. | [[52.0, 'year']] | M | {'9793529': 1, '10815860': 1, '13963637': 1, '20499764': 1, '9270544': 1, '26622873': 1, '10725363': 1, '10228755': 1, '15289313': 1, '9557781': 1, '4308082': 1, '15086550': 1, '9256920': 1, '4711118': 1, '21238832': 1, '577252': 1, '24455549': 2} | {} |
165,014 | 3877440-1 | 24,404,545 | noncomm/PMC003xxxxxx/PMC3877440.xml | Hyponatremia Associated with Unilateral Hand Weakness and Numbness: A Case Report | A 62-year old previously healthy man, a machinist, presented with 3 months history of worsening right hand weakness and numbness with difficulty operating machinery at work. Patient also described numbness in his right axilla and right scapular region from last 1 year. The numbness progressed along the posterior aspect of his arm and forearm. It later involved the right hand with flexion deformity of the right hand and fingers. He reported anorexia, fatigability, unintentional weight loss of about 20 Ibs over 3 months and mild chronic cough with no history of fever, night sweats, hemoptysis or dyspnea. He denied neck pain, headaches, or dizziness. Patient also denied trauma to the neck or head. He had 40 pack-year smoking history but denied alcohol use. On examination, he had normal vital signs with no orthostatic changes and a BMI of 17. He appeared older than his stated age. He was conscious, cooperative, oriented to time, place and a person. He reported his mood as “desperate” because he had recently misplaced his glasses. His speech was slow, halting, and soft. His grip strength in right hand was 4/5 with atrophy of the interossei muscles and flexion deformity was noticed at the distal interphalengeal joints (DIP). Sensation to pinprick was reduced along the right C7, C8, and T1 dermatomes. Otherwise the reminder of physical examination was unremarkable. Laboratory investigation showed WBC of 13100cells/mm3 with monocyte of 20%. The biochemical profile showed serum sodium of 121 mmol/L (reference range 136-145 mmol/L), serum osmolality of 254 mOsmol/kg (reference range 270-300 mOsmol/kg), and urine osmolality of 451 mOmol/kg and urinary sodium concentration of 69 mmol/L. Potassium, urea, creatinine, corrected calcium, and liver function test were all within normal. The chest X-ray showed right apical pleural-based density suggestive of a soft tissue mass lesion []. CT scan chest was performed and showed large right apical mass suspicious for primary neoplasm (Pancoast tumor) with apparent chest wall invasion, mediastinal and right hilar adenopathy, and a separate left lung metastatic nodule [Figures and ]. MRI of the chest revealed large right apical superior sulcus pulmonary mass likely primary bronchogenic carcinoma with extensive local spread of disease was most prominent posteriorly involving and surrounding the proximal first and second ribs, spinous transverse processes, adjacent soft tissues and involving the right brachial plexus nerve roots exiting the upper thoracic spine [Figures and ]. CT guided core biopsy of the right apex mass was performed and histopathology showed a poorly differentiated non-small cell lung carcinoma (NSCLC), adenocarcinoma is favored [Figures and ]. Immunohistochemical staining showed cytokeratin 7 was positive, other staining such as the cytokeratin 20, TTF-1, and p63 markers were negative. Brain and abdomen computed tomography screening and bone scan showed no distant metastases could be demonstrated and tumor/node/metastasis staging (T3N2M1a) was stage IV.[] The biochemical profile was consistent with SIADH, a paraneoplastic syndrome secondary to NSCLC. Patient was treated with fluid restriction. On discharge, he was planned for out-patient palliative chemoradiation. After two courses of MIC chemotherapy (mitomycin, ifosfamide and cisplatin) three times weekly, his hyponatremia improved (sodium 131 mmol/L). Patient also reported partial improvement in his right hand weakness and had less fatigue. Patient refused further chemoradiation and opted for hospice based management. He later died few months later. | [[62.0, 'year']] | M | {'17507705': 1, '5688815': 1, '16272226': 1, '9536839': 1, '7629492': 1, '15366568': 1, '24404545': 2} | {} |
165,015 | 3877441-1 | 24,404,546 | noncomm/PMC003xxxxxx/PMC3877441.xml | Posttraumatic Nonunion of the Clavicle in a 13-Year-Old Boy Causing an Arteriovenous Fistula | A 13-year-old boy was referred to clinic with a prominent dilatation on the right side of his neck that had been gradually enlarging since he sustained a displaced fracture of the middle third of his right clavicle 6 months previously. This was treated conservatively by the referring hospital []. The patient was uninhibited in daily activities, but complained of ongoing pain at the fracture site and was concerned about his cosmetic appearance. His past medical history consisted of a congenital atrial septal defect with partial anomalous pulmonary venous drainage, which was surgically corrected at the age of 18 months. On examination, there was a nonpulsatile dilation in the right anterior triangle of his neck overlying the clavicle which was tender on palpation. There was no other visible deformity and he had full range of motion of the ipsilateral shoulder.\nAn ultrasound and computed tomography (CT) scan were arranged, which revealed a hypertrophic angulated nonunion of the clavicle fracture. The surrounding callus formation was shown to be compressing the EJV, impeding its drainage, and causing the striking distension measuring 2 cm in diameter. The anatomy of the carotid and subclavian arteries appeared normal.\nFollowing multidisciplinary discussion, a decision was made to operatively reduce and fix the clavicle nonunion. Intraoperatively, gross callus formation was found at the fracture site. However, an arteriovenous fistula was also discovered in a vascular cavity in the callus between a branch of the subclavian artery and the EJV. The fistula was excised and adjacent veins ligated and closed by vascular surgeon before the clavicle fracture was reduced and fixed with a six-hole contoured plate without the use of bone graft.\nRadiographs taken 1 week postoperatively confirmed satisfactory position of the clavicle fixation. At 1-month follow-up, the EJV was less prominent and there was no residual pain around the shoulder. At 6-months follow-up, the patient was asymptomatic with full range of movement of the ipsilateral shoulder. Radiographs and CT scans showed union of the fracture site with good alignment of the clavicle []. A CT venogram revealed an enlarged right EJV with a stenosed lower end and tortuous collaterals to the right internal jugular vein and subclavian vein, but no residual arteriovenous fistula []. | [[13.0, 'year']] | M | {'1157382': 1, '12531380': 1, '12398126': 1, '19181992': 1, '19952962': 1, '6345551': 1, '9801786': 1, '20348286': 1, '29456747': 1, '18647403': 1, '24404546': 2} | {} |
165,016 | 3877442-1 | 24,404,547 | noncomm/PMC003xxxxxx/PMC3877442.xml | Gastrointestinal Kaposi's Sarcoma Presenting as Ileocolic Intussusception | A 42-year-old male presented with one week history of nausea, vomiting and peri-umbilical abdominal pain of few hours duration. He also had associated nonbloody diarrhea. He denies viral prodrome, sick contacts, recent travel, food poisoning, or any recent antibiotic use. Past medical history was significant for human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) with last CD4 count of 28 and viral load of 13,949. On physical examination, vital signs were within normal limits except blood pressure of 87/58 mmHg. Abdominal examination was significant for tenderness around peri-umbilical region and in right-lower quadrant without rebound tenderness. Bowel sounds were absent. Initial laboratory work was remarkable for hyponatremia (125 mmol/L) and hypokalemia (3.0 mmol/L). Computed tomography (CT) of abdomen with contrast showed long segment of small bowel that was seen projected into the lumen of a distended mobile cecum consistent with large ileo-colic intussusception []. It was also noted in several areas of nodular thickening in the gastric wall, small bowel, and ascending colon. Differential diagnosis at that time was tuberculosis, lymphoma, and KS. During the hospital course, patient was treated conservatively; he was kept nothing by mouth (NPO), was given intravenous fluids, and nasogastric suction was placed. Esophagogastroduodenoscopy (EGD) showed esophageal candidiasis and multiple raised erythematous lesions and masses distributed throughout the stomach with ulcerations. The lesions were nodular and polypoid and have a vascular appearance. No bleeding and no stigmata of recent bleeding were noted. The lesions ranged from less than 1 cm to approximately 4 cm in diameter []. Biopsies show KS [Figure and ] and tumor cells were positive for human herpes virus 8 (HHV-8). Patient's symptoms improved with conservative management and he was discharged on highly active antiretroviral therapy (HAART). Two weeks later, the patient was readmitted to our hospital with similar symptoms. Repeat CT-scan showed recurrent ileo-colic intussusception. Small-bowel series showed incomplete small bowel obstruction with spontaneous resolution of intussusception. Patient was discharged to continue HAART therapy and doxorubicin chemotherapy on weekly basis was added to his management. | [[42.0, 'year']] | M | {'15692796': 1, '31624759': 2, '12141706': 1, '4007399': 1, '1947766': 1, '18705759': 1, '10749966': 1, '15257549': 1, '34255129': 1, '15001993': 1, '24404547': 2} | {'6795727-1': 1} |
165,017 | 3877478-1 | 24,403,770 | noncomm/PMC003xxxxxx/PMC3877478.xml | Severe Onycholysis in a Card Illusionist with Alopecia Areata Universalis | We report the case of Mario, an eccentric 23-year-old man, a card illusionist who had alopecia areata (AA) universalis for the last 15 years. He had accepted his hair loss and was not seeking treatment for it. In January 2007, he consulted us because he developed severe abnormalities of all his fingernails.\nAt clinical examination, the fingernails were yellow – gray colored and showed severe onycholysis, involving the whole nail plate and nail bed hyperkeratosis []. The patient asked for treatment as the nail changes did not permit him to continue his work as card illusionist. He was treated with intramuscolar triamcinolone acetonide 0.5 mg/kg/month, for 3 months []. The nails improved rapidly with complete return to normality after 6 months. However, the 1-year follow-up revealed mild recurrence of nail symptoms. | [[23.0, 'year']] | M | {'28101018': 2, '8041648': 1, '18540984': 1, '28717940': 1, '4051533': 1, '1918465': 1, '24403770': 2} | {'5216217-1': 1} |
165,018 | 3877479-1 | 24,403,771 | noncomm/PMC003xxxxxx/PMC3877479.xml | Cylindroma of the Breast: A Rare Case Report | The present case report is about a 61-year-old woman who presented with freely mobile, firm, non-tender right breast mass of 2 cm diameter in upper inner quadrant since 4 years. There were no skin or nipple changes and no axillary lymphadenopathy. The patient had no significant family history or skin nodules. Mammography showed a well-circumscribed mass in the 1 o‘clock position of the right breast []. According to The Breast Imaging Reporting and Data System the score was 3 which mean that mammogram was probably normal, but a repeat was suggested. Ultrasonography showed well-defined heterogeneous mass noted in the right breast. Subsequently, fine-needle aspiration cytology was done using 22-G needle. Papanicolaou staining was done. Smears show numerous basaloid cells with scanty cytoplasm and round nuclei seen lying in jigsaw puzzle pattern []. Diagnosis of “probably benign” (C2) was made and biopsy was advised. The nodule was excised. Histological sections stained by hematoxylin and eosin revealed nests of basaloid cells arranged in a complex jigsaw puzzle like pattern. Many nests are surrounded by dense eosinophilic basement membrane material and thus confirmed the diagnosis of cylindroma []. The patient was followed for 12 months, which remained uneventful. | [[61.0, 'year']] | F | {'15899777': 1, '11914618': 1, '10792569': 1, '19725978': 2, '25951887': 1, '15252315': 1, '11395563': 1, '6331489': 1, '29651355': 2, '1655210': 1, '16484982': 1, '24403771': 2} | {'3224926-1': 1, '5831977-1': 1} |
165,019 | 3877480-1 | 24,403,772 | noncomm/PMC003xxxxxx/PMC3877480.xml | Familial Trichotillomania in Three Generations | A 13-year-old male presented with 1-year history of focal hair loss in the mid-frontal scalp. He was previously treated with local steroids for presumed alopecia areata, with no improvement. Examination revealed a patchy area of hair loss, with several short broken hairs of varying lengths []. On dermoscopy examination of the scalp, we found the typical features of TTM, including short hairs with trichoptilosis, broken hair (different lengths) and black dots []. Additionally, traumatic bleeding was evident. Histological examination showed trichomalacia with irregularly shaped hair follicles and melanin pigment casts [Figure and ]. Upon further questioning, the father admitted repeated pulling of his beard hairs since puberty, with mild-to-moderate severity of symptoms. The 60-year-old paternal grandfather also suffers from severe recurrent hair pulling of his beard since puberty, which sometimes precludes him from leaving home. | [[13.0, 'year']] | M | {'23372212': 1, '11779477': 1, '22437627': 1, '19199280': 1, '8698680': 1, '16224024': 1, '17003809': 1, '22942103': 1, '17713528': 1, '19926375': 1, '24403772': 2} | {} |
165,020 | 3877481-1 | 24,403,773 | noncomm/PMC003xxxxxx/PMC3877481.xml | Isolated Collagenoma on the Scalp: A Rare Presentation | The present case is about a 20-year-old male patient who presented with an asymptomatic swelling on the left fronto-parieto-occipital region of the scalp since last 10 years. The swelling was insidious in onset, started as single papular lesion in the parietal region and gradually progressed to reach the present size []. Contrast enhanced computed tomography scan of the head showed that the swelling was outside the skull bones, without any intracranial extension. Patient had gone to a plastic surgeon 5 years back and had undergone partial excision of the swelling. Excised tissue was subjected to histopathological examination at that time, but the report was not available with the patient. The swelling again increased in size and attained the present size. There was no history of trauma or any manual or other manipulation at the site prior to the development of the swelling. There was no history of spontaneous regression or reduction in size. There was no history of fainting and other localizing neurological sign. There was no feature suggestive of tuberous sclerosis such as adenoma sebeceum, seizures, ash leaf macules or confetti like macules. On physical examination, a well-defined circumscribed swelling measuring 14 cm × 11 cm, presented over scalp, involving left fronto-parieto-occipital region with some extension over right []. It was firm in consistency and non-compressible with a smooth surface. The skin and hairs overlying the swelling were normal except the brownish discoloration of the skin. Linear scar of size 13.5 cm × 0.5 cm of previous surgery was present over the swelling on the left side []. Systemic examination including skin, mucosa, nail and hair did not show any abnormality. A 4 mm incisional punch biopsy at the margin of swelling was sent for histopathological examination, which showed hyperplastic epidermis with thickened reticular dermis with dense collagen bundles that were arranged haphazardly in lower reticular dermis []. A single terminal follicle showed dense perifollicular fibroplasia with an increased number of fibrocytes. Special staining with Masson's trichrome stain showed green colored collagen bundles arranged haphazardly []. As patient had cosmetics concerns so he was referred to the plastic surgery for the complete excision of the lesion in steps. | [[20.0, 'year']] | M | {'7217375': 1, '15194953': 1, '28584376': 2, '16880583': 1, '29445568': 1, '24403773': 2} | {'5448268-1': 1} |
165,021 | 3877482-1 | 24,403,774 | noncomm/PMC003xxxxxx/PMC3877482.xml | Annular Alopecia Areata: Report of Two Cases | This was a case report of a 25-year-old male patient who presented with the chief complaints of asymptomatic loss of hair at multiple sites over the scalp for 2 month. Hair loss was annular in pattern as it was more obvious at the periphery compared with the center of the patch. There was no history of similar illness in family members and also no history of drug intake and trauma. On examination, there were multiple well-defined annular patches of non-scarring alopecia of size ranging from 2 cm × 3 cm to 4 cm × 4 cm present mainly at parietal and occipital region of scalp []. The area was smooth with no associated skin changes. Systemic examination was within the normal limits. Potassium hydroxide (KOH) examination of hair showed no fungal elements. Fungal culture with Sabouraud's media at 4 weeks revealed no growth. Histopathological examination from the hairless region in scalp showed a few vellus follicles in mid dermis with a sparse perifollicular lymphocytic infiltrate []. The dermis and subcutis also showed several follicular stellae representing former follicular papillae. The total number of follicles was substantially reduced with no terminal follicles. On the basis of clinical examination and histopathology, the diagnosis of annular AA was made. Patient was given intralesional injections of trimacinolone acetonide (5 mg/ml) every 4 weeks and showed remarkable improvement in the lesions after 3 months (3 intralesional injections) of follow-up []. | [[25.0, 'year']] | M | {'23180926': 2, '19881991': 1, '29440858': 2, '26452738': 1, '27127376': 2, '9810892': 1, '12833016': 1, '18032873': 1, '27688465': 2, '20055903': 1, '20523776': 1, '24403774': 2} | {'3877482-2': 2, '5029262-1': 1, '5803852-1': 1, '5803852-2': 1, '3500056-1': 1, '3500056-2': 1, '3500056-3': 1, '4830172-1': 1} |
165,022 | 3877482-2 | 24,403,774 | noncomm/PMC003xxxxxx/PMC3877482.xml | Annular Alopecia Areata: Report of Two Cases | A 27-year-old male patient presented with the chief complaints of asymptomatic loss of hair from the scalp for the past 3 months. The hair loss started as a small patch and gradually increased in size assuming an annular pattern. There was no history of similar illness in family, no history of drug intake and no history suggestive of systemic illness. On examination, a well-defined area of non-scarring alopecia in an annular pattern was present at the occipital region of the scalp []. KOH examination did not reveal any fungal hyphae. Histopathological examination of a tissue taken from the affected area confirmed the diagnosis of AA. The patient improved markedly in 5 months with the intralesional triamcolone acetonide injections (5 mg/ml) every 4 weeks. | [[27.0, 'year']] | M | {'23180926': 2, '19881991': 1, '29440858': 2, '26452738': 1, '27127376': 2, '9810892': 1, '12833016': 1, '18032873': 1, '27688465': 2, '20055903': 1, '20523776': 1, '24403774': 2} | {'3877482-1': 2, '5029262-1': 1, '5803852-1': 1, '5803852-2': 1, '3500056-1': 1, '3500056-2': 1, '3500056-3': 1, '4830172-1': 1} |
165,023 | 3877483-1 | 24,403,775 | noncomm/PMC003xxxxxx/PMC3877483.xml | A Case of Neurodermatitis Circumscipta of Scalp Presenting as Patchy Alopecia | The present case report is about a 60-year-old female patient who presented to dermatology out-patient department with itchy scalp lesion of 2 years duration. She also had complaints of localized loss of hair in that area. There was no history of any local applications. There was no history of any drug intake. On examination, there was a localized area of alopecia of 4 cm × 4 cm size with underlying skin showing marked thickening to form a boggy swelling [] on the right parietoccipital region. There were no other skin lesions or hair and nail changes. Systemic examination was within the normal limits. Provisional diagnosis of LSC of scalp and tinea capitis was made. Woods lamp examination was negative and potassium hydroxide mount did not reveal any fungal hyphae. Routine blood and urine investigations, blood sugar, liver, renal and thyroid functions were normal. On further interrogation patients bystanders gave a history that patient at times uses rock stones to rub scalp and may continue rubbing until it bleeds. Skin biopsy revealed hyper keratosis hypergranulosis acanthosis thickening of collagen in dermis suggesting LSC. Patient was given intralesional injection of triamcinolone acetonide 2.5 mg/ml weekly for 4 weeks along with doxepin hydrochloride 10 mg at night. Patient was referred to Psychiatry Department for counseling. There was marked reduction in itching in the 1st week and complete regrowth of hair at end of 4 weeks. Doxepin was stopped after 3 months [Figures and ]. Patient came for follow-up monthly thereafter for 6 months with no relapse []. | [[60.0, 'year']] | F | {'20864649': 1, '23533146': 1, '668973': 1, '21352317': 1, '19576479': 1, '29641708': 1, '31049348': 1, '20388609': 1, '21220876': 1, '25356369': 1, '31367603': 1, '20959279': 1, '15876603': 1, '33593424': 2, '16969446': 1, '11260190': 1, '32695702': 2, '24403775': 2} | {'7887785-1': 1, '7367573-1': 1, '7367573-2': 1} |
165,024 | 3877496-1 | 24,403,738 | noncomm/PMC003xxxxxx/PMC3877496.xml | Multi-organ Dysfunction Syndrome with Dual Organophosphate Pesticides Poisoning | A 27-year-old male was brought to the emergency department in an unconscious state. History from family members revealed that patient had ingested about 100 ml of preformed mixture (50:50) of dichlorvos and profenofos used as pesticide for agriculture purpose. He developed nausea, vomiting, abdominal cramps, difficulty in breathing and altered level of consciousness within 1 h of ingestion of poison. He had no significant past medical history or addiction. On arrival, approximately 6 h after ingestion, he was comatose with Glasgow coma scale of 3/15, pulse 94/min, respiratory rate 7/min, SpO2 85% on room air and systolic blood pressure 80 mm of Hg. His pupils were small in size with sluggish reaction to light and there were no focal neurological signs. There were coarse crepitations on chest auscultation. Examination of the abdomen and cardiovascular system was unremarkable. Clinical severity assessment showed severe poisoning: Acute physiology and chronic health evaluation (APACHE II) score 26, Glasgow coma scale of three and poison severity scale of three. He was immediately intubated, gastric lavage was performed and atropine, pralidoxime, bicarbonate infusion was started. Patient was shifted to intensive care unit on inotropic support. His initial investigations showed white blood cells 31400/mm3, hemoglobin 13.5 mg/dL, platelets 328000/mm3, random blood sugar 120 mg/dL, serum creatinine 1.73 mg/dL, serum lipase 425 U/L, serum glutamic-pyruvic transaminase (SGPT) 350 IU/L, serum glutamic oxaloacetic transaminase (SGOT) 310 IU/L, serum cholinesterase level 329/L and deranged coagulation profile (international normalized ratio 2.2 and activated partial thromboplastin time 97). Urine analysis revealed pH 5.5, specific gravity 1.030 and proteinuria. Arterial blood gas analysis on FiO2 28% was pH 7.03, PCO2 55 mm Hg, PO2 77 mm Hg and HCO3 of 7 mEq/L. Chest X-ray showed bilateral infiltrates. Other investigations, including creatinine phosphokinase, serum electrolytes were within normal limits. Electrocardiogram and computed tomography scan head were unremarkable. Hepatitis B surface antigen, hepatitis C virus and human immunodeficiency virus serology was negative.\nDuring 48 h after admission, his condition remained critical requiring inotropes, hemodialysis and ventilatory support. Arterial blood gas analysis showed persistent metabolic acidosis and hypoxia pH 7.14, PCO2 44, PO2 79, HCO3 13, PO2/FIO2 0.80. Creatinine phosphokinase increased to 10504 U/L. SGPT and SGOT peaked at 11320 IU/L and 15800 IU/L.\nDespite intensive resuscitation, the patient expired due to cardiac arrest 48 h after hospitalization. | [[27.0, 'year']] | M | {'16135310': 1, '11978898': 1, '16243090': 1, '14748407': 1, '14523881': 1, '12723899': 1, '14703547': 1, '18082777': 1, '19949736': 1, '19737786': 1, '26632728': 1, '24403738': 2} | {} |
165,025 | 3877498-1 | 24,403,954 | noncomm/PMC003xxxxxx/PMC3877498.xml | Optimal invasive key-hole neurosurgery with a miniaturized 3D chip on the tip: Microendoscopic device | A 44-year-old woman suffered 2 months from bitemporal hemianopsia and headaches. The MRI scan showed a big olfactory groove meningioma laying bifrontal as shown in Figure and . She had a right supraorbital craniotomy with 3D-ME visualization of the tumor [], and gross total removal [] was performed. Three months after surgery, her vision improves near to normal. Follow-up MRI scans showed no residual tumor as shown in Figure and . | [[44.0, 'year']] | F | {'10370716': 1, '10234974': 1, '9586924': 1, '25767569': 1, '9848846': 1, '23151873': 1, '9802871': 1, '19934971': 1, '19247901': 1, '31236288': 1, '9310976': 1, '23326013': 1, '18312893': 1, '19404107': 1, '21281081': 1, '20644436': 1, '29114270': 1, '22079141': 1, '15138845': 1, '22581663': 1, '33323565': 1, '9482171': 1, '24403954': 2} | {'3877498-2': 2, '3877498-3': 2} |
165,026 | 3877498-2 | 24,403,954 | noncomm/PMC003xxxxxx/PMC3877498.xml | Optimal invasive key-hole neurosurgery with a miniaturized 3D chip on the tip: Microendoscopic device | A 55-year-old woman had headache and speech impairment. The MRI scans showed left temporal epidermoid mass associated with a cystic lesion temporodorsal as shown in Figure and . She underwent a left pterional craniotomy and tumor visualization under 3D-ME-assisted technique []. Total removal under pure 3D-ME technique [] was performed. Intraoperative normal microscope was used only for control the tumor resection. The speech impairment improved immediately postoperative, and the follow-up MRI scans showed no residual mass [Figure and ]. | [[55.0, 'year']] | F | {'10370716': 1, '10234974': 1, '9586924': 1, '25767569': 1, '9848846': 1, '23151873': 1, '9802871': 1, '19934971': 1, '19247901': 1, '31236288': 1, '9310976': 1, '23326013': 1, '18312893': 1, '19404107': 1, '21281081': 1, '20644436': 1, '29114270': 1, '22079141': 1, '15138845': 1, '22581663': 1, '33323565': 1, '9482171': 1, '24403954': 2} | {'3877498-1': 2, '3877498-3': 2} |
165,027 | 3877498-3 | 24,403,954 | noncomm/PMC003xxxxxx/PMC3877498.xml | Optimal invasive key-hole neurosurgery with a miniaturized 3D chip on the tip: Microendoscopic device | A 65-year-old man with a 6-month history of left-sided weakness underwent an MRI scan. This showed left foramen magnum meningioma as shown in Figure -. He underwent a left far lateral craniotomy on the craniocervical junction with tumor 3D-ME visualization [], and gross total removal under pure 3D-ME-controlled technique [] was performed. Neither, microscope or normal 2D endoscope was used. Three months postoperative, the left-sided weakness improved and 6 months later, patient neurological deficit totally disappears. The follow-up MRI scans showed no residual or recurrent tumor as shown in Figure and . | [[65.0, 'year']] | M | {'10370716': 1, '10234974': 1, '9586924': 1, '25767569': 1, '9848846': 1, '23151873': 1, '9802871': 1, '19934971': 1, '19247901': 1, '31236288': 1, '9310976': 1, '23326013': 1, '18312893': 1, '19404107': 1, '21281081': 1, '20644436': 1, '29114270': 1, '22079141': 1, '15138845': 1, '22581663': 1, '33323565': 1, '9482171': 1, '24403954': 2} | {'3877498-1': 2, '3877498-2': 2} |
165,028 | 3877504-1 | 24,403,960 | noncomm/PMC003xxxxxx/PMC3877504.xml | Hemorrhagic colloid cyst: Case report and review of the literature | A 20-year-old lady presented with a 6 months history of progressive headache and memory disturbances. Few days prior to presentation, she had three episodes of generalized tonic clonic seizures. She also had gait disturbances and severe giddiness. Higher mental function examination revealed impaired recent memory. Fundoscopic examination showed bilateral papilloedema. Cranial nerve examination, motor and sensory examination was normal. Plantar reflexes were extensor on both sides and Romberg's sign was positive. Computed tomography (CT) scan of the brain showed isodense lesion located at foramen of Monro with hyperdense areas suggestive of hemorrhage with foraminal obstruction. The lesion was not enhancing on contrast []. Magnetic resonance imaging (MRI) brain revealed obstructive hydrocephalus due to a large lesion in the third ventricle which was homogenously hyperintense on T1-weighted images and homogenously hypointense on T2-weighted images [].\nRight lateral ventricle was entered via right frontoparietal craniotomy and an interhemispheric transcallosal approach. A grayish red, well-defined, soft to firm lesion was reached through the interforniceal approach. Needle aspiration was attempted but was unsuccessful. The surface of the cyst was vascular, so it was coagulated. The cyst wall was thickened and its separation from surrounding tissue was difficult. On opening the cyst, there was no colloid material, but a brownish yellow organized clot was found which was removed piecemeal. The clot was easily separated from the inner cyst wall. After almost complete evacuation of cyst content, the thick wall was held with biopsy forceps with one hand and with the other hand it was dissected from the surrounding parenchymal tissue. A complete excision of the cyst was ensured. Both internal cerebral veins were seen and found intact. Pathological examination confirmed hemorrhage within the colloid cyst. Microscopic examination also showed blood clots containing hemosiderin laden macrophages and many rhomboid cholesterol crystals and chronic inflammatory cells []. Post-operatively she had no seizures. Her memory function completely improved over a 3 week period. | [[20.0, 'year']] | F | {'28149106': 1, '16378869': 1, '7442988': 1, '3278501': 1, '7099406': 1, '3188671': 1, '8468606': 1, '9190693': 1, '14322940': 1, '1162586': 1, '341383': 1, '30351291': 2, '6263083': 1, '6621836': 1, '28236350': 1, '8686524': 1, '18486830': 1, '28210514': 2, '12066904': 1, '10470833': 1, '8988190': 1, '8988075': 1, '10470808': 1, '10404909': 1, '2716977': 1, '4528750': 1, '7361262': 1, '8027797': 1, '2045917': 1, '29114270': 1, '9297582': 1, '4773784': 1, '7771229': 1, '24403960': 2} | {'8015560-1': 1, '8015560-2': 1, '5292156-1': 1} |
165,029 | 3877505-1 | 24,403,961 | noncomm/PMC003xxxxxx/PMC3877505.xml | Grave's disease with transverse and sigmoid sinus thrombosis needing surgical intervention | A 42-year-old female, a diagnosed case of Graves disease, was on treatment for thyrotoxicosis. Her thyroid profile was as mentioned in . She was on Tab. Neomercazole 10 mg tds and Tab. Propranolol 10 mg tds. Serum Anti Microsomal Antibody (AMA) and Anti Nuclear Antibodies (ANA) levels were negative. Ultrasound (USG) thyroid showed increased size of both lobes of thyroid suggestive of goiter. Radio isotope thyroid uptake study showed a 33.6% thyroid uptake of 99mTcO4 (Normal 1-4%) suggestive of multinodular goiter with increased trapping function. Her thyroid hormone levels were controlled on anti thyroid medications.\nShe presented to us with headache, drowsiness, and decreased ability to move the left side of her body since three days. Computed Tomography (CT) of the brain showed a large right sided parietoccipital hypodense region with areas of hyperdensity suggestive of venous infarct with hemorrhagic transformation []. A right temporo-parietal craniotomy was performed. On opening the dura the brain was seen to be tense. A lax duroplasty was perfomed. Post-operatively, she was ventilated electively for 48 hours and then extubated. There were no added neurological deficits. She was given intravenous Mannitol 100 cc 8 hourly (for 3 days), Phenytoin Sodium 100 mg 8 hourly, along with other pre operative medicines. Three days (72 hours) after the surgery, she was started on injection Enoxaparin 0.6 mg subcutaneously 12 hourly for 6 days followed by Tab. Asprin 150 mg once a day for 6 months.\nPost operative CT scan performed after five days showed an organized infarct in the right parieto occipital region with no midline shift []. Magnetic Resonance Imaging (MRI) performed three weeks after the surgery showed well defined areas of altered signal intensity involving grey and white matter in right parieto occipital region with gyriform and adjacent dural enhancement []. Magnetic Resonance Venography (MRV) showed absent signals in right transverse and sigmoid sinus suggestive of thrombosis of these sinuses.\nShe gradually improved in her power in left sided limbs. At three months follow-up, the power in all four limbs was grade 5/5. Delayed (6 months post operative) MRV showed partial recanalization of the right transverse and sigmoid sinuses with evidence of collaterals []. These sinuses were opacified on post contrast images as well.\nHer thrombophilia profile which was sent on admission indicated low levels of Protein S and Antithrombin (AT) III. Other parameters were normal []. | [[42.0, 'year']] | F | {'16768094': 1, '3512953': 1, '28228636': 1, '12674153': 1, '11147882': 1, '12616091': 1, '20945813': 1, '17370653': 1, '19859836': 1, '10958314': 1, '3975957': 1, '655656': 1, '7886732': 1, '11108774': 1, '24403961': 2} | {} |
165,030 | 3877506-1 | 24,403,962 | noncomm/PMC003xxxxxx/PMC3877506.xml | Large primary intraorbital hydatid cyst in elderly | An 80-year-old female resident of Delhi was admitted to the hospital with 6 months history of proptosis of left eye and gradual diminution of vision in the same eye. The general physical examination showed no evidence of any neurocutaneous markers or swelling over the body. The neurological examination revealed proptosis of left eye with restricted movements in all directions. Visual acuity was only perception of light in left eye. There was no evidence of chemosis, redness in the eye. There was no bruit on auscultation.\nMagnetic resonance imaging (MRI) brain and orbit revealed a well-marginated cystic lesion in the left orbital apex. The lesion was located supero-laterally displacing optic nerve medially. The lesion was hypointense on T1 and hyperintense on T2 image without any septations or scolex []. Approximate dimension of the lesion was 3 cm × 3 cm × 2 cm. There was mild rim enhancement after contrast administration. Based on the MRI the differential diagnosis of hydatid cyst, neurocysticercosis, dermoid, lipodermoid, mucocele, encephalocele, inclusion cyst, teratoma, hematocele, schwannoma and paraganglioma were considered. The serological test for hydatid and neurocysticercosis were negative. Erythrocyte sedimentation rate was 10 mm at the end of 1st h, total leukocyte count-5600/cmm, differential leucocyte count: P-70%, L-20%, M-5%, E-5%. Computed tomography (CT) scan of the chest and abdomen were unremarkable.\nPatient underwent left lateral orbitotomy and gross total removal of cyst without rupture.\nOn macroscopic examination of the excised cyst wall a pearly white membranous tissue was appreciated, characteristic of hydatid cyst, measuring 3 cm × 3 cm and 0.2 cm thickness []. Histological examination of multiple longitudinal strips from the cyst wall revealed pale eosinophilic acellular laminated membranes lined by germinal epithelium, along with multiple scolices, confirming the diagnosis of ocular hydatid disease []. The scolices were seen to contain an array of refractile sickle-shaped hooklets.\nThe proptosis settled in the immediate post-operative period and there were some improvement in the eye movements. Patient had visual acuity of finger counting at 1 m at the time of discharge. | [[80.0, 'year']] | F | {'2398943': 1, '7955833': 1, '9085285': 1, '15489587': 1, '19897382': 1, '10707107': 1, '9163964': 1, '9645731': 1, '1768666': 1, '16200445': 1, '15912166': 1, '23120539': 1, '9276122': 1, '3068605': 1, '1993039': 1, '24403962': 2} | {} |
165,031 | 3877507-1 | 24,403,963 | noncomm/PMC003xxxxxx/PMC3877507.xml | Atlanto-axial dislocation associated with anomalous single vertebral artery and agenesis of unilateral internal carotid artery | We report a case of 34-year-old male who presented with history of progressively increasing difficulty in walking and progressively increasing spastic quadriparesis for 7 years. He had pain and paresthesia in his right upper limb for the past 2 years. On examination, the tone was increased in all four limbs with power 4+/5 and hand grips of 60%. Bilateral planters were extensor. Posterior columns were impaired bilaterally. He had a short neck with low hair line with restricted rotational neck movement. Computed tomography (CT) showed atlanto-axial dislocation (AAD) with atlanto-dental interval (ADI) of 8 mm in both flexion and extension with partially occipitalized atlas and basilar invagination (BI) with basal angle of approximately 148° and tip of odontoid crossing the Wackenheim clival canal line. Magnetic resonance imaging of the CVJ showed significant compression of the cord at the CVJ []. Transoral decompression and posterior fusion was planned in view of fixed AAD (in view of no change of ADI in flexion and extension) and BI. C1 anterior arch was drilled and tip of the dens was drilled and excised and dura was partially visualized but was not opened. So as to have an adequate decompression, bony drilling was further carried out laterally and downward. While drilling on the left side there was brisk bleeding which was controlled with muscle, glue, gelfoam and floseal. In view of suspected injury to the VA, posterior fusion was deferred and traction was continued. Intra-arterial digital subtraction angiography was planned for diagnosis of suspected VA injury and necessary therapeutic intervention. However, before shifting for digital subtraction angiography (DSA) there was rebleeding from oral wound to require re exploration and hemostasis. Patient was shifted to DSA room. DSA showed absent left ICA and the right VA. The left middle cerebral artery (MCA) was filling through the left VA and the left anterior cerebral artery (ACA) was filling from the right ICA. The left VA was taking an anomalous course with the V3 segment curving medially and reaching up to the midline just behind the odontoid process. The VA was injured in its extradural part as it was injured behind the odontoid (and there was no sub-arachnoid blood on CT). The site of injury was visualized and the stent was placed across the rent []. Next day the pack was removed and no bleeding was noticed. The sensorium of the patient did not improve. CT showed diffuse brain edema and anti-edema measures were initiated, but on the 5th post-operative day the patient expired. | [[34.0, 'year']] | M | {'8553261': 1, '7446236': 1, '29063266': 1, '2019822': 1, '19264491': 1, '20010391': 1, '15269464': 1, '16234673': 1, '28932744': 1, '19190881': 1, '24403963': 2} | {} |
165,032 | 3877508-1 | 24,403,964 | noncomm/PMC003xxxxxx/PMC3877508.xml | Unruptured anterior communicating artery aneurysms presenting with seizure: Report of three cases and review of literature | This 61-year-old male, with no history of any comorbid factors, presented with history of focal twitching over the left half of face for the last six months. He gave no history of aura, generalization or involvement of limbs. General, systemic, and neurological examination was unremarkable and scalp electroencephalogram (EEG) did not show any epileptiform discharges. Magnetic Resonance Imaging (MRI) of brain showed a well defined globular lesion in the suprasellar area, 13 × 12 × 11 mm in size, hypointense on T1, T2 with peripheral hyperintesity on T2 []. Computerized tomographic angiogram (CTA) head revealed a saccular aneurysm arising from the anterior communicating artery of size 15 × 12 mm, with neck of 5 mm. Digital substraction angiography (DSA) confirmed the presence of the saccular aneurysm measuring 10.8 × 6.8 mm directed antero-inferiorly with a neck of 5.2 mm []. Intraoperatively, the aneurysm was found to be large, thrombosed with a small flowing part. The aneurysm was surgically managed. The rim of cortex around the aneurysm appeared compressed but not gliotic, and hence was not removed. The patient is presently seizure free on 2 years follow-up on a single antiepileptic. | [[61.0, 'year']] | M | {'7188633': 1, '14741181': 1, '29717350': 1, '28904583': 2, '8113856': 1, '5552161': 1, '31092524': 1, '20495430': 1, '654968': 1, '5811716': 1, '3931272': 1, '16540332': 1, '3115711': 1, '14705724': 1, '27583172': 2, '8442705': 1, '10486297': 1, '3577859': 1, '24403964': 2} | {'3877508-2': 2, '3877508-3': 2, '4982348-1': 1, '5588650-1': 1} |
165,033 | 3877508-2 | 24,403,964 | noncomm/PMC003xxxxxx/PMC3877508.xml | Unruptured anterior communicating artery aneurysms presenting with seizure: Report of three cases and review of literature | This 57-year-old right handed gentleman, hypertensive since 5 years, presented with one episode of generalized tonic clonic seizure early in morning while getting up from bed. He had no significant past medical history including any history of seizures. General, systemic, and neurological examination was unremarkable, and scalp EEG did not show any epileptiform discharges. MRI and CT brain [] showed a well defined hyper dense lesion of size 20 × 16 mm in the suprasellar region. DSA revealed a partially thrombosed, lobulated aneurysm, the flowing part having a size 7.19 × 6.66 mm arising from the anterior communicating artery, directed inferiorly, with a neck of 3.2 mm. Patient underwent thrombectomy and surgical clipping of the aneurysm. The brain surrounding the aneurysm appeared gliotic and was partially removed. The patient has remained seizure free on one year follow-up on antiepileptic medication. | [[57.0, 'year']] | M | {'7188633': 1, '14741181': 1, '29717350': 1, '28904583': 2, '8113856': 1, '5552161': 1, '31092524': 1, '20495430': 1, '654968': 1, '5811716': 1, '3931272': 1, '16540332': 1, '3115711': 1, '14705724': 1, '27583172': 2, '8442705': 1, '10486297': 1, '3577859': 1, '24403964': 2} | {'3877508-1': 2, '3877508-3': 2, '4982348-1': 1, '5588650-1': 1} |
165,034 | 3877508-3 | 24,403,964 | noncomm/PMC003xxxxxx/PMC3877508.xml | Unruptured anterior communicating artery aneurysms presenting with seizure: Report of three cases and review of literature | This 35-year-old right handed gentleman, without any past history of medical illness, presented with history of two episodes of seizures in the last one year. His seizure semiology was suggestive of aura of epigastric pain followed by generalized tonic –clonic movement of all four limbs followed by loss of consciousness, without any post ictal confusion or focal neurological deficit. He gave no significant past history and his routine investigations results were also normal. Scalp EEG did not show any epileptiform discharges. CT brain plain showed a hyperdense lesion anterior to the sella on left side from the midline. MRI brain revealed a 24 × 18 mm saccular aneurysm arising from anterior communicating artery which was hypointense on T1-T2 with peripheral hypointensity on T2 and with evidence of thrombus. CT angiography confirmed the presence of a partially thrombosed, multilobulated, anterior communicating artery aneurysm in the left A1-A2 junction, and directed superolateraly with a size of 11 × 5 × 6 mm and neck of 4.5 mm []. He underwent left pterional craniotomy and clipping of aneurysm with removal of thrombus and excision of sac. The cortex surrounding the aneurysm did not look abnormal and was not removed. Presently, he is seizure free for the last 6-month on a single antiepileptic drug. | [[35.0, 'year']] | M | {'7188633': 1, '14741181': 1, '29717350': 1, '28904583': 2, '8113856': 1, '5552161': 1, '31092524': 1, '20495430': 1, '654968': 1, '5811716': 1, '3931272': 1, '16540332': 1, '3115711': 1, '14705724': 1, '27583172': 2, '8442705': 1, '10486297': 1, '3577859': 1, '24403964': 2} | {'3877508-1': 2, '3877508-2': 2, '4982348-1': 1, '5588650-1': 1} |
165,035 | 3877509-1 | 24,403,965 | noncomm/PMC003xxxxxx/PMC3877509.xml | Armoured brain of unknown etiology | A 15-year-old female child presented with history of one episode of generalized seizures followed by loss of consciousness for about 10-15 seconds 6 weeks ago. Since then, she was suffering with headache which was frontal, dull, and moderate without any nausea or vomiting. There was no history of trauma, fever, meningitis.\nShe was fully conscious, Glasgow Coma Score was 15/15 with no neurological deficit. There were no cerebellar, meningeal or frontal lobe signs. All routine hematological investigations and coagulation profile were normal.\nCT scan brain revealed bifrontal extraaxial hypodense collection with calcified inner layer of about 3-4 mm thickness over the brain causing mass effect [].\nShe was started on phenytoin sodium and subsequently underwent bifrontal craniotomy. There was about 50 ml of subdural collection which was clear serous, non foul smelling. Surface of the brain was covered with thick whitish egg shell like calcification which was carefully peeled off from the surface of brain []. After surgery patient's headache was relieved within 2-3 weeks with no seizure after surgery.\nFollow-up CT scan after one year showed complete expansion of brain with no mass effect []. | [[15.0, 'year']] | F | {'5295454': 1, '12118221': 1, '6856080': 1, '9298279': 1, '1580196': 1, '10708357': 1, '31435730': 1, '16716548': 1, '3400041': 1, '13681572': 1, '30459888': 2, '32688235': 1, '19107693': 1, '7692329': 1, '24403965': 2} | {'6208233-1': 1} |
165,036 | 3877536-1 | 24,404,557 | noncomm/PMC003xxxxxx/PMC3877536.xml | Primary Adrenal Lymphoma with Paraneoplastic Syndrome | This was a case report of 76-year-old male patient who was transferred to our facility with a 3 weeks history of headache, confusion, agitation, difficulty with speech, inappropriate body movements, anorexia and abdominal pain. On presentation, he had a temperature of 38.4°C, cognitive impairment and generalized weakness. His complete blood count, comprehensive metabolic panel, thyroid stimulating hormone, sedimentation rate, ammonia, vitamin B12 levels and anti-nuclear antibody test were negative. Patient was started on vancomycin and piperacillin/tazobactam for his fevers. Magnetic resonance imaging (MRI) of the brain showed tiny hyper-intensities in the right cerebellum on diffusion weighted sequence. Cerebrospinal fluid (CSF) analysis showed a normal cell count and glucose with elevated protein of 102 mg/dl (normal 15-45 mg/dl) and negative cultures. Electroencephalogram showed moderate to severe diffuse encephalopathic process in both hemispheres. His cultures remained negative. As no obvious source of his fever was found, a computed tomography (CT) of chest, abdomen and pelvis was done to rule out occult infection. CT of abdomen revealed 8.6 cm × 6.8 cm × 13 cm left adrenal mass displacing the left kidney laterally []. Adrenal hormone levels were normal and adrenal insufficiency was not demonstrated. Enzyme-linked immunosorbent assay immunoassay was positive for tau protein (1617 pg/ml) in CSF while the Creutzfeldt Jakob 14-3-3 test was ambiguous. Paraneoplastic antibody work-up showed N-type calcium channel antibody, though his CSF antineuronal nuclear antibodies, purkinje cell cytoplasmic antibodies, antiglial nuclear antibody and amphiphysin antibodies were negative.\nBiopsy of the adrenal gland revealed diffuse large B cell lymphoma positive for CD20 and Ki-67 stain showing a proliferative index >90%. Immunostains for cyclin D-1, CD10, S-100, chromogranin A, pankeratin and calretinin were negative []. Chemotherapy with cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab (CHOP-R) was administered followed by involved field radiation therapy. He had resolution of his neurological symptoms and repeat positron emission tomography (PET)-CT scan revealed a residual mass measuring 3.2 cm × 2 cm in the left suprarenal area without hypermetabolic activity []. | [[76.0, 'year']] | M | {'23304624': 2, '14730391': 1, '15160957': 1, '26252293': 2, '18490838': 1, '21374545': 1, '26419235': 2, '31192909': 1, '15764875': 1, '7739683': 1, '18559306': 1, '12089750': 1, '10553996': 1, '24404557': 2} | {'4588683-1': 1, '4616607-1': 1, '3529873-1': 1} |
165,037 | 3881208-1 | 24,400,215 | noncomm/PMC003xxxxxx/PMC3881208.xml | Parathyroid Cyst Presenting as Acute Pancreatitis: Report of a Case | A 67-year-old man was admitted to Chonnam National University Hospital with sudden onset of epigastric pain. The pain did not radiate along his back but was relieved to some extent by his leaning forward. He had a history of diabetes mellitus, essential hypertension, and an old cerebrovascular accident. He had no previous history of peptic ulcer diseases, cholecystitis with gallstones, any alcohol ingestion, or abdominal surgery. On admission, he was afebrile, his blood pressure and pulse were normal, and he appeared well-nourished. Scleral icterus was not present. His abdomen was mildly distended, with tenderness in the epigastrium. No abdominal masses were seen; the liver, gallbladder, and spleen were not palpable; and bowel sounds were slightly hyperactive. Laboratory indexes were as follows: white blood cell count, 9,000/mm3; hemoglobin, 15.7 g/dl; platelet count, 135,000/mm3; serum albumin, 4.4 g/dl; aspartate aminotransferase, 29 U/L; alanine aminotransferase, 29 U/L; alkaline phosphatase, 84 U/L; and γ-glutamyl transpeptidase, 148 U/L. Serum amylase and lipase were 293 U/L and 660 U/L, respectively. C-reactive protein was 2.6 mg/dl. The results of the renal function study were within normal limits. Serum triglyceride was 93 mg/dl and serum total calcium, ionized calcium, and inorganic phosphate were 10.3 mg/dl, 2.8 mEq/L, and 1.9 mg/dl, respectively. Abdominal computed tomography (CT) revealed mild swelling of the pancreatic head with peri-pancreatic fat infiltration () and fluid collection around the pancreatic tail (). The follow-up serum ionized calcium level was still elevated at 3.0 mEq/L. The serum level of parathyroid hormone (PTH) was 113 pg/ml. The results indicated hypercalcemia caused by hyperparathyroidism.\nUltrasonography and CT of the neck showed an approximately 5-cm cystic lesion at the inferior portion of the left thyroid gland, which suggested a parathyroid cyst (). The fine needle aspiration biopsy specimen suggested a cystic lesion. 99mTc sestamibi scintigraphy showed no evidence of parathyroid adenoma. The patient had prolonged hypercalcemia despite hydration and diuretics. He underwent surgical resection, and the histological examination with PTH stain was interpreted as a parathyroid cyst with focal parathyroid hyperplasia ().\nAt 3 weeks after the operation, his serum levels of PTH, total calcium, ionized calcium, inorganic phosphate, amylase, and lipase were normalized. Since the operation, he has had no recurrent episodes of acute pancreatitis. | [[67.0, 'year']] | M | {'10353566': 1, '22874807': 1, '34934453': 1, '22906890': 1, '19595349': 1, '2344146': 1, '7072912': 1, '19598003': 1, '27022378': 1, '22431942': 2, '30123260': 1, '19335036': 1, '16707751': 1, '24400215': 2} | {'3295540-1': 1} |
165,038 | 3881209-1 | 24,400,216 | noncomm/PMC003xxxxxx/PMC3881209.xml | Percutaneous Treatment of an Injured Coronary Stent Using the Looping Wire Technique | A 70-year-old man with unstable angina presented to our emergency room. He had a history of essential hypertension. Sixty-six months previously, he had been admitted owing to unstable angina pectoris and two coronary stents had been implanted at the first obtuse marginal (OM) branch (2.5×20 mm Taxus®, Boston Scientific, Natick, MA) and the proximal left anterior descending artery (LAD) (3.0×33 mm Cypher®, Cordis Corporation, Miami Lakes, FL), respectively.\nDiagnostic coronary angiography showed significant stenosis (90% diameter stenosis) at the proximal left circumflex (LCX) and moderate stenosis at the proximal LAD with distal left main involvement. We deployed two everolimus-eluting stents (EESs) at both the proximal LCX (3.5×23 mm Xience™ V stent, Abbott Vascular, Abbott Park, IL) and the distal left main/proximal LAD (4.0×28 mm Xience™ V stent) by use of the mini-crush technique under intravascular ultrasound (IVUS) guidance (iLab® Ultrasound Imaging System, Boston Scientific, Minneapolis, MN). We did final kissing balloon angioplasty and the IVUS showed good apposition and expansion of the two EESs. Coronary angiography showed good left coronary flow and no residual stenosis. However, after removal of the IVUS catheter, there was distal edge damage and shortening of the EES at the LCX (). Because of the patient's consent for the percutaneous treatment, we tried to cross the injured stent lumen with many kinds of wires, but this was ineffective. Therefore, we used a looping wire technique with a 0.014'' hi-torque Balance Middleweight (BMW) universal coronary guide wire (Abbott Vascular) to cross the injured stent and we successfully re-dilated the damaged portion of the stent by using multiple balloons [Ryujin® 1.25 mm (Terumo, Somerset, NJ), Voyager® 2.5 mm (Abbott Vascular), Voyager® 3.5 mm (Abbott Vascular) ()]. Finally, we deployed an additional EES (3.5×18 mm Xience™ V stent, Abbott Vascular) at the LCX over the injured stent. Coronary angiography showed good flow with dye staining at the LCX (). IVUS using the pull-back system from the distal coronary artery showed good expansion and the three EESs were well apposed, except for the partially crushed first-deployed EES of the proximal LCX (). There was no recurrence of chest pain and the patient was discharged from our hospital after intensive medication. The patient has been well during 3 years of clinical follow-up. | [[70.0, 'year']] | M | {'12357527': 1, '12668511': 1, '17195203': 1, '18971573': 1, '19246853': 1, '20967152': 2, '10842396': 1, '11113044': 1, '21779286': 2, '18296834': 1, '24400216': 2} | {'3132695-1': 1, '2957644-1': 1} |
165,039 | 3881210-1 | 24,400,217 | noncomm/PMC003xxxxxx/PMC3881210.xml | A Case of Gastric Cancer Manifesting as a Solitary Brain Metastasis in the Cerebellopontine Angle That Mimicked Acoustic Neuroma | A 57-year-old man visited our hospital in April 2012 with the complaints of left hearing loss and left facial paralysis of approximately 3 weeks' duration. He had no significant previous medical history and no complaints of gastrointestinal symptoms such as nausea, abdominal pain, melena, hematochezia, or weight loss. In the abdominal examination, neither a palpable mass nor hepatosplenomegaly was noted. A neurological examination showed the loss of left-side forehead creases, the patient's inability to close his left eye, left facial muscle weakness, a rightward deviation of the mouth angle upon smiling, and a loss of the left nasolabial fold. His sensory and motor functions in the upper and lower extremities were normal. Cytological examination of the cerebrospinal fluid revealed no evidence of malignancy. Magnetic resonance imaging (MRI) of the brain showed a 1×1.5 cm tumor in the cerebellopontine angle that extended to the inner auditory canal. The tumor was clinically diagnosed as an acoustic neuroma (). Owing to the diagnosis of a benign tumor such as acoustic neuroma, the patient underwent surgery via the translabyrinthine approach, and the tumor was completely removed. In contrast with our initial diagnosis, however, the pathological examination of the surgical specimen revealed cells from a poorly differentiated metastatic carcinoma. Immunohistochemical staining did not help to identify the primary site. A further investigation to identify the primary lesion was performed postoperatively. Blood chemistry analysis indicated a serum carcinoembryonic antigen level of 1.34 ng/ml (reference range, 0-5 ng/ml). Other tumor markers were within normal limits. Abdomen/pelvic and thoracic computed tomography (CT) scans revealed no evident masses or regional lymphadenopathy that would suggest malignancy, except for a hepatic cyst, renal cyst, and mild splenomegaly. A positron emission tomography (PET)-CT scan revealed an abnormal hypermetabolic lesion in the stomach antrum but no other metastatic lesions. An upper gastrointestinal endoscopy examination found active ulcerative lesions on the anterior wall of the gastric antrum that were compatible with Borrmann type II gastric cancer. The pathological examination of the gastric antrum revealed cells from a poorly differentiated carcinoma. A total gastrectomy was performed and a pathological analysis of the surgical specimen revealed a poorly cohesive carcinoma that was histopathologically identical to that of the resected brain tumor (). On the basis of the results of the pathological examination, the case was finally diagnosed as gastric cancer with a solitary brain metastasis and was graded according to the TNM staging system as pT2 (invasion of proper muscle), N3b (involvement of 21 of 43 lymph nodes), and M1 (brain metastasis). According to the final pathology report, lymphovascular and venous invasion of gastric cancer were observed in the surgical specimen. The patient received palliative combination chemotherapy with intravenous oxaliplatin 130 mg/m2 of body surface area (BSA) on day 1 and oral capecitabine 2,000 mg/m2 of BSA on days 1 to 14 every 3 weeks. After 3 cycles of the combination chemotherapy, follow-up abdomen/pelvic CT scan and brain MRI showed no evidence of recurrence. The patient continued to receive the palliative combination chemotherapy on an outpatient basis, with a disease-free survival duration of 45 weeks. | [[57.0, 'year']] | M | {'33605228': 1, '29181738': 1, '18309694': 1, '10622506': 1, '15209637': 1, '12378346': 1, '11593706': 1, '30805007': 2, '17963312': 1, '26893735': 1, '7516049': 1, '10883456': 1, '21319152': 1, '24400217': 2} | {'6360578-1': 1} |
165,040 | 3881407-1 | 24,404,399 | noncomm/PMC003xxxxxx/PMC3881407.xml | Autologous Immunoglobulin Therapy in Patients With Severe Recalcitrant Atopic Dermatitis: A Preliminary Report | A 21-year-old male patient with severe AD visited the emergency room of our university hospital with complaints of intractable pruritus and difficulty in sleep due to pruritus on August 30, 2010. The patient was diagnosed with AD at 5 months of age and reported a progressive worsening of his eczema over the past 5 years before the initial visit to our hospital. He had also allergic rhinitis; however, there was a no family history of allergic diseases. On physical examination, eczematous skin lesions on the whole body surface area were noted. The clinical severity score of AD in this patient (SCORAD value) at the initial visit was 81.5. Serum house dust mite-specific IgE assay (ImmunoCAP, Thermo Scientific Inc.) showed a strong positive result (). After admission, he was treated with a topical corticosteroid, systemic corticosteroid, and oral cyclosporine (200 mg/day). During the admission, he received subcutaneous allergen immunotherapy with house dust mite extract with ultra-rush schedule as previously reported. He was discharged from the hospital with clinical improvement. After discharge, he was treated with topical corticosteroid, topical calcineurin inhibitor, emollients, oral antihistamine, and oral cyclosporine (200 mg/day) as well as a monthly maintenance dose of subcutaneous allergen immunotherapy at the out-patient clinic of our university hospital. However, his clinical condition was not completely controlled even after treatment. At 11 months after the initial admission to our hospital, the patient was hospitalized again due to a severe acute exacerbation of AD with secondary bacterial skin infection. After admission, the acute flare-up was treated by a systemic corticosteroid with oral antibiotics. After discharge, he was again treated with oral cyclosporine (125 mg/day) and a monthly maintenance dose of subcutaneous allergen immunotherapy; however, these treatments did not effectively control AD symptoms and only the intermittent use of oral corticosteroids were effective for the control of acute exacerbations of AD.\nOn November 1, 2012 (at age 23), AIGT was started in this patient. The baseline SCORAD value of the patient measured at the day of initiation of AIGT was 88.0 (). The clinical severity of AD did not significantly improve in the patient during the first 4 weeks after the initiation of AIGT; however, the clinical condition started to improve 5 weeks after the initiation of AIGT. The SCORAD value was 55.0 at 8 weeks after the initiation of AIGT (37.5% decrease in the SCORAD value compared with the baseline value) (). Moreover, his AD symptoms progressively improved every 4 weeks during the follow-up for 24 weeks after the initiation of AIGT (). At 24 weeks after the initiation of AIGT, the SCORAD value was measured at 24.7 in the patient (a 71.9% decrease in SCORAD value compared with the baseline value). This clinical condition at 24 weeks after the initiation of AIGT was the best condition during the clinical observation of this patient during the follow-up over 3 years after the initial visit to our hospital. No side effects were observed during and after AIGT. | [[21.0, 'year']] | M | {'8435513': 1, '16892245': 1, '26847292': 1, '16484822': 1, '15330007': 1, '18385500': 1, '27593870': 1, '12588384': 1, '26273148': 1, '32935488': 1, '2318962': 1, '14657843': 1, '21935270': 1, '27126731': 1, '11336569': 1, '14702622': 1, '16282756': 1, '10352375': 1, '21632504': 1, '21151813': 1, '16815151': 1, '18388366': 1, '24404399': 2} | {'3881407-2': 2, '3881407-3': 2} |
165,041 | 3881407-2 | 24,404,399 | noncomm/PMC003xxxxxx/PMC3881407.xml | Autologous Immunoglobulin Therapy in Patients With Severe Recalcitrant Atopic Dermatitis: A Preliminary Report | A 33-year-old male patient with severe AD presented to the out-patient clinic of our university hospital with complaints of severe pruritus on July 20, 2010. The patient was diagnosed with AD shortly after birth. He also had asthma, allergic rhinitis, and allergic conjunctivitis. He had a family history of allergic rhinitis (elder brother). He was diagnosed with iatrogenic Cushing syndrome at age 11 on the basis of a moon face, obesity, and history of long-term oral corticosteroid treatment at the dermatology clinic of another university hospital. He was treated with a topical corticosteroid and oral antihistamine in the out-patient clinic of another university hospital for 22 years from the age of 11; however, the clinical condition of the patient was not effectively controlled by treatment. He had also received phototherapy (ultra-violet ray therapy) at the age of 22 for 31 months but discontinued due to concerns over the development of side effects from long-term phototherapy. He had received surgery for cataract and glaucoma. On physical examination, eczematous skin lesions on the whole body surface area were noted. The clinical severity score of AD in this patient (SCORAD value) at the initial visit was 60.4. Serum house dust mite-specific IgE assay (ImmunoCAP, Thermo Scientific Inc.) showed a strong positive result (). After the initial visit to our hospital, he was treated with oral cyclosporine (200 mg/day) for 1 year and then with a combination of oral cyclosporine (100 mg/day) and oral methotrexate (12.5 mg/week) for an additional 1 year in the out-patient clinic of our hospital. However, his clinical symptom of AD had not been effectively controlled.\nOn February 19, 2013 (at age 36), AIGT was started in this patient. The baseline SCORAD value of the patient measured at the day of initiation of AIGT was 60.7 (). The patient reported a subjective improvement in clinical symptoms of pruritus from 1 week after the initiation of AIGT and he reported a 100% improvement in the quality of sleep scores (scores from 10 to 0) at 3 weeks after the initiation of AIGT injection. The SCORAD value decreased to 43.1 at 4 weeks after the initiation of AIGT (29.0% decrease in SCORAD value compared with the baseline) and 28.2 at 8 weeks after the initiation of the AIGT (53.5% decrease in the SCORAD value compared with the baseline) in this patient (). The SCORAD value further decreased to 25.7 at 12 weeks after the initiation of AIGT (57.7% decrease in the SCORAD value compared with the baseline) in this patient. No side effects were observed during and after AIGT. | [[33.0, 'year']] | M | {'8435513': 1, '16892245': 1, '26847292': 1, '16484822': 1, '15330007': 1, '18385500': 1, '27593870': 1, '12588384': 1, '26273148': 1, '32935488': 1, '2318962': 1, '14657843': 1, '21935270': 1, '27126731': 1, '11336569': 1, '14702622': 1, '16282756': 1, '10352375': 1, '21632504': 1, '21151813': 1, '16815151': 1, '18388366': 1, '24404399': 2} | {'3881407-1': 2, '3881407-3': 2} |
165,042 | 3881407-3 | 24,404,399 | noncomm/PMC003xxxxxx/PMC3881407.xml | Autologous Immunoglobulin Therapy in Patients With Severe Recalcitrant Atopic Dermatitis: A Preliminary Report | A 27-year-old male patient with severe AD presented to the out-patient clinic of our university hospital with a complaint of pruritus on March 4, 2010. The patient was diagnosed with AD at the age of 14. He also had a past history of allergic rhinitis and asthma and a family history of atopic dermatitis (grandfather and aunt). On physical examination, severe eczematous skin lesions involving the face, neck, and anterior chest surface area were noted. He had been treated by a topical corticosteroid, oral antihistamine, and intermittent oral corticosteroid at the out-patient dermatology clinics of 2 different university hospitals for 12 years before the initial visit to our hospital. Additionally, he was also treated with oral cyclosporine (100 mg/day) for the last 6 months. However, his clinical condition was not effectively controlled. He had received surgery for cataracts of the right eye at the age 20. The clinical severity score of AD in this patient (SCORAD value) at the initial visit was 45.2. Serum house dust mite-specific IgE assay (ImmunoCAP, Thermo Scientific Inc.) showed a strong positive result (). He was treated with oral cyclosporine (100 mg/day), topical calcineurin inhibitor, and oral anatihistamine for 3 years at our clinic; however, his clinical condition of AD was not effectively controlled.\nOn January 13, 2013 (at age 30), AIGT was started in this patient. The baseline SCORAD value of the patient measured at the day of initiation of AIGT was 60.4 (). The patient reported a subjective improvement in the clinical symptoms of pruritus at 3 weeks after the initiation of AIGT. The SCORAD value decreased to 45.5 at 4 weeks after the initiation of AIGT (24.7% decrease in the SCORAD value compared with the baseline) and 39.3 at 8 weeks after the initiation of AIGT (34.9% decrease in the SCORAD value compared with the baseline) in this patient (). The SCORAD value increased to 59.2 at 12 weeks after the initiation of AIGT in this patient. No side effects were observed during and after AIGT. | [[27.0, 'year']] | M | {'8435513': 1, '16892245': 1, '26847292': 1, '16484822': 1, '15330007': 1, '18385500': 1, '27593870': 1, '12588384': 1, '26273148': 1, '32935488': 1, '2318962': 1, '14657843': 1, '21935270': 1, '27126731': 1, '11336569': 1, '14702622': 1, '16282756': 1, '10352375': 1, '21632504': 1, '21151813': 1, '16815151': 1, '18388366': 1, '24404399': 2} | {'3881407-1': 2, '3881407-2': 2} |
165,043 | 3881408-1 | 24,404,400 | noncomm/PMC003xxxxxx/PMC3881408.xml | A Case of Codeine Induced Anaphylaxis via Oral Route | A 30-year-old woman experienced dyspnea, urticaria, chest discomfort, and sweating within 10 minutes after taking codeine orally to treat a chronic cough. She had suffered from bronchial asthma since 2010, and her asthma was frequently exacerbated following multiple attacks of upper respiratory infection. Since her severe cough did not improve after the viral infection, codeine phosphate at a dose of 10 mg a day was prescribed to suppress her symptoms for 1 week. She did not experience any adverse drug reactions during the first week of codeine treatment; however, after 1 week, approximately 10 minutes after taking the codeine, she began to develop dyspnea, urticaria, sweating, and chest discomfort. In response to these symptoms, she stopped taking the medication. The patient had perennial rhinitis and a food allergy to shellfish, which presented as hives; however, she had no previous history of any drug allergies. She was referred to our clinic for the evaluation of her codeine allergy and the uncontrolled asthma. On the first visit, eosinophilia was not detected in peripheral blood, sputum, or nasal smears. Serum total and specific IgE levels to shrimp and crab were within the normal ranges. A skin prick test (SPT) to all of the common inhalant allergens (Bencard, Bradford, UK) showed negative responses. A forced expiratory volume at 1 second (FEV1), as measured by spirometry, was 62.5% predictive.\nAfter stabilizing her asthma, we planned to perform in vivo and in vitro tests to confirm whether her systemic reactions were caused by codeine and to evaluate the mechanism of the codeine-induced anaphylaxis. A SPT, a basophil histamine release test, and an open-label oral challenge test (OPT) were performed with codeine phosphate after obtaining informed consent. Furthermore, CYP2D6 genetic polymorphisms, which are often responsible for differences in responses to codeine between individuals, were evaluated. The SPT was performed with codeine (0.1-10 mg/mL) and morphine (0.1-10 mg/mL) extracts. Histamine and saline were tested as positive and negative controls, respectively. The SPT was positive to 1-10 mg/mL codeine with a mean wheal size of 3.5 mm, while negative results were obtained in 3 healthy adult controls. (No response to saline, 6×4 mm to histamine, 2×2 mm to morphine 0.1 mg/mL, 5×4 mm to morphine 1-10 mg/mL.) The OPT revealed a positive response. There was no response to initial intake of 5 mg codeine phosphate. When 10 mg codeine phosphate was administered after 2 hours, she immediately developed a systemic reaction, including dyspnea, wheeze, chest tightness, dizziness, and vomiting. Her blood pressure was 140/80 mmHg, pulse rate 95/minute, and body temperature was 36.8℃. The basophil histamine release test, which was performed according to previously described methods, showed a dose-dependent increase with serial additions of codeine phosphate, while minimal changes were noted in the 2 controls ().The CYP2D6 genotyping results revealed that the patient had the CYP2D6*1/*10 allele, which indicated that she was an intermediate metabolizer according to the expected enzyme activities reported on the CYP2D6 allele web site (). Based on these findings, the expert definition of her final diagnosis was codeine-induced anaphylaxis. We recommended her to avoid taking any codeine-based products. Her asthma and rhinitis were controlled using a medium dose of inhaled corticosteroids with a long-acting beta2-agonist inhaler, a leukotriene receptor antagonist, and an intranasal steroid. After 1 year, her FEV1% had improved to 87.3% predictive (2.23 L) compared to her initial FEV1 level (62.5% predictive, 1.58 L). | [[30.0, 'year']] | F | {'24951238': 1, '14597688': 1, '16191029': 1, '2478047': 1, '25749767': 1, '20560905': 1, '17441793': 1, '32625895': 1, '16778723': 1, '33401343': 1, '2403228': 1, '11467991': 1, '18484168': 1, '6327790': 1, '15010521': 1, '128641': 1, '34247332': 1, '12476405': 1, '22950030': 1, '14443378': 1, '2941218': 1, '21494059': 1, '24404400': 2} | {} |
165,044 | 3881409-1 | 24,404,401 | noncomm/PMC003xxxxxx/PMC3881409.xml | A Case of Idiopathic Hypereosinophilic Syndrome Presenting With Acute Respiratory Distress Syndrome | A 37-year-old male visited the emergency department at Samsung Medical Center, Seoul, Korea, presenting with a chief complaint of dyspnea. Initial symptoms had begun 1 week prior to his visit, characterized by fever and chills, followed by progressive respiratory difficulty. He appeared acutely ill. A crackling sound was heard upon chest examination. His heartbeat was regular without a murmur. A purplish discoloration of the right ankle was observed, but there were no local heat or tenderness. Initial blood pressure was 163/91 mmHg, pulse rate was 114 beats/min, respiratory rate was 24 breaths/min, and body temperature was 38℃. Oxygen saturation was initially detected as 87%, and increased to 95% upon oxygen supplement via nasal cannula at 5 L/min. Following oxygen supplementation, arterial blood gas analysis (ABGA) showed a pH of 7.39, partial pressure of carbon dioxide (PaCO2) of 40.9 mmHg, partial pressure of oxygen (PaO2) of 113.7 mmHg, and oxygen saturation of 98%.\nLaboratory tests revealed peripheral eosinophilia and thrombocytopenia with a white blood cell count of 22,580/µL (50% neutrophils, 31% eosinophils, 10% lymphocytes), Hb levels at 13.7 g/dL, and a platelet count of 26,000/µL. Prothrombin and activated partial thromboplastin times were 15 sec, and 35.4 sec respectively. Fibrinogen levels were within the normal range, but the concentration of D-dimer was markedly elevated at 26.69 µg/mL. Serum total IgE and ECP levels (939.4 IU/mL and 201.0 ng/mL, respectively) were both elevated, too. Tests for both anti-nuclear antibodies and anti-neutrophil cytoplasmic antibodies were negative. A test for parasites in the stool and serum were negative. Bone marrow biopsy showed normal cellularity with increased eosinophils. Fip1-like1 and platelet-derived growth factor receptor alpha (FIP1L1-PDGFRA) gene fusion was not detected. Patchy consolidation with ground-glass opacity in both lower lung zones was noticed in the initial chest radiography ().\nDuring the initial workup, the patient became progressively tachypneic with increased oxygen demand to 15 L/min via facial mask. The patient was transferred to the intensive care unit and oxygen supply was increased to 100% by high-flow nasal cannula. Despite supplementation, PaO2 levels remained low (49.9 mmHg) leading to a diagnosis of ARDS, and then the patient underwent intubation and mechanical ventilation.\nBronchoalveolar lavage (BAL) revealed marked eosinophilia (187/200 evaluated cells, 93.5% eosinophils). Skin biopsy of the right ankle showed diffuse eosinophilic perivascular infiltration of the dermis () and eosinophilic abscess of subcutaneous fat (). Duplex sonography revealed deep vein thrombosis in the left popliteal, soleal, and peroneal veins. Nerve conduction test and electromyography showed neuropathy in the right posterior tibial nerve.\nA diagnosis of IHES was reached based on the presence of peripheral and tissue eosinophilia, along with the exclusion of other causes of eosinophilia. High-dose corticosteroid (methylprednisone 1 mg/kg/day) therapy was initiated on the first day of admission. By day 3, eosinophil counts decreased to the normal range (). Extubation was performed on day 4 as a result of clinical and radiological improvements.\nA chest CT scan was obtained on day 9 to evaluate symptoms of mild dyspnea despite the dramatic improvement seen by simple radiography (). Pulmonary thromboembolism (PTE) was detected in the bilateral lobar and segmental branches of the pulmonary arteries (), and we started anticoagulant therapy. On day 23, the patient was discharged from the hospital with a gradual tapering of corticosteroids. | [[37.0, 'year']] | M | {'22548210': 2, '7842182': 1, '6846973': 1, '8520742': 1, '25830134': 2, '20639008': 1, '1090795': 1, '16612767': 1, '7046556': 1, '7091520': 1, '8131521': 1, '21036585': 1, '22797452': 1, '17868859': 1, '21997128': 1, '6878618': 1, '19910029': 1, '19630574': 1, '34935570': 1, '20358022': 1, '24404401': 2} | {'3328734-1': 1, '4377343-1': 1, '4377343-2': 1} |
165,045 | 3881776-1 | 22,858,709 | noncomm/PMC003xxxxxx/PMC3881776.xml | Newly forming bone graft: a novel surgical approach to the treatment of\ndenuded roots | Patient #1 was a 44-year-old systemically healthy never-smoker female who presented\nfor treatment at the Clinics of the Discipline of Periodontics at Bauru School of\nDentistry, University of São Paulo, Brazil. Patient reported no use of antibiotics or\nother medicines in the previous 6-month period. Treatment plan involved extraction of\nthe mandibular left central incisor and root coverage of the mandibular right second\npremolar, which showed a 5 mm-deep and 4 mm-wide recession at baseline examination.\nNo tooth mobility was present. Clinical and radiographic examination suggested a\nslight loss of soft and hard tissues at distal sites compatible with a Miller class\nIII recession defect, since the mandibular right second premolar was adjacent to an\nedentulous ridge. | [[44.0, 'year']] | F | {'19335074': 1, '14653400': 1, '11022773': 1, '9287070': 1, '17199533': 1, '2636222': 1, '11699470': 1, '9526912': 1, '29177556': 1, '3858267': 1, '9706863': 1, '20367089': 1, '11829391': 1, '15068108': 1, '7751120': 1, '16398692': 1, '11063399': 1, '7891244': 1, '32839885': 1, '8515369': 1, '6950085': 1, '9051969': 1, '10505811': 1, '295291': 1, '17076780': 1, '1453307': 1, '11203580': 1, '20450359': 1, '1625156': 1, '11422587': 1, '3866056': 1, '22858709': 2} | {'3881776-2': 2, '3881776-3': 2} |
165,046 | 3881776-2 | 22,858,709 | noncomm/PMC003xxxxxx/PMC3881776.xml | Newly forming bone graft: a novel surgical approach to the treatment of\ndenuded roots | Patient #3, a 35 year-old female, presented a deep recession defect (5 mm) at the\nmandibular right second premolar. Patient was systemically healthy, never smoker, and\nreported no use of any medication or periodontal treatment in the 6-month period\nprevious to baseline examination. There was no clinical sign of trauma from occlusion\nor tooth mobility. Clinical and radiographic examination suggested a Miller's class\nIII recession defect. | [[35.0, 'year']] | F | {'19335074': 1, '14653400': 1, '11022773': 1, '9287070': 1, '17199533': 1, '2636222': 1, '11699470': 1, '9526912': 1, '29177556': 1, '3858267': 1, '9706863': 1, '20367089': 1, '11829391': 1, '15068108': 1, '7751120': 1, '16398692': 1, '11063399': 1, '7891244': 1, '32839885': 1, '8515369': 1, '6950085': 1, '9051969': 1, '10505811': 1, '295291': 1, '17076780': 1, '1453307': 1, '11203580': 1, '20450359': 1, '1625156': 1, '11422587': 1, '3866056': 1, '22858709': 2} | {'3881776-1': 2, '3881776-3': 2} |
165,047 | 3881776-3 | 22,858,709 | noncomm/PMC003xxxxxx/PMC3881776.xml | Newly forming bone graft: a novel surgical approach to the treatment of\ndenuded roots | Patient #4 was a 32-year-old female with a 4-mm-deep recession defect at the\nmandibular right second premolar. No tooth mobility was present, and there was no\nclinical sign of trauma from occlusion. Patient reported to be systemically healthy\nand never smoker. Additionally, patient reported no regular use of medications or\nperiodontal treatment during the past 6 months. Clinical and radiographic examination\nsuggested a Miller's class III recession defect. | [[32.0, 'year']] | F | {'19335074': 1, '14653400': 1, '11022773': 1, '9287070': 1, '17199533': 1, '2636222': 1, '11699470': 1, '9526912': 1, '29177556': 1, '3858267': 1, '9706863': 1, '20367089': 1, '11829391': 1, '15068108': 1, '7751120': 1, '16398692': 1, '11063399': 1, '7891244': 1, '32839885': 1, '8515369': 1, '6950085': 1, '9051969': 1, '10505811': 1, '295291': 1, '17076780': 1, '1453307': 1, '11203580': 1, '20450359': 1, '1625156': 1, '11422587': 1, '3866056': 1, '22858709': 2} | {'3881776-1': 2, '3881776-2': 2} |
165,048 | 3881831-1 | 23,032,213 | noncomm/PMC003xxxxxx/PMC3881831.xml | Serial extraction: 20 years of follow-up | An eight-year-and-two-month-old Caucasian female patient had a chief complaint of an\nupper inter-incisor diastema. In the facial analysis, the patient showed a harmonious\nface and a normal labial posture. In the intraoral clinical examination, the presence of\na large diastema was observed, together with several early extractions of primary teeth,\nwith great space loss, and, consequently, a reduction of upper and lower arch length\n().\nIn the panoramic radiograph, presence of multiple extractions of primary teeth was\nverified, with consequent lack of space due to retroclination of the permanent teeth,\nas was the presence of all permanent teeth, which had either erupted or were at\nseveral developmental stages, except for the third molars ().\nThe treatment protocol was composed of two stages: one interceptive and one\ncomprehensive. In the interceptive phase, a serial extraction program was performed,\nwhich aimed especially at correcting the discrepancies of the dental arch, fostering\nfavorable conditions for a normal development of the occlusion. Due to the great lack\nof space, initial planning comprised anchorage preparation: a) an extraoral appliance\nin the upper arch (cervical headgear) to obtain upper molar distalization; b) an\nactive lip bumper, on the lower arch; c) bracket installation on the upper incisors\nto close the diastema, and to provide space for lateral incisor eruption. Still in\nthis stage, primary first molar extractions were indicated to accelerate eruption of\nfirst premolars, which were to be extracted sequentially to create space for the\npermanent canine teeth ().\nAfter the eruption of all permanent teeth, at the end of interceptive phase, new\nradiographs were obtained to plan the comprehensive phase (). In this phase, a fixed appliance was installed aiming\nto align, level, and correct the axial inclinations, and small diastemas (). shows the treatment finalization, when the patient was oriented regarding\nthe use of retainers: an upper Hawley appliance, and a lower 3x3 retainer.\nTwenty years after the end of the interceptive treatment, a new follow-up appointment\nwas scheduled. It could be noted that the facial proportion balance was preserved,\nwith only a small relapse at the upper arch, and lower anterior crowding (). | [[8.0, 'year'], [2.0, 'month']] | F | {'13741513': 1, '9674686': 1, '12080304': 1, '2333853': 1, '10587605': 1, '4943019': 1, '5253953': 1, '2064071': 1, '277071': 1, '16644417': 1, '9503136': 1, '2256562': 1, '4525065': 1, '10799116': 1, '12080305': 1, '1074878': 1, '23032213': 2} | {} |
165,049 | 3881846-1 | 24,212,997 | noncomm/PMC003xxxxxx/PMC3881846.xml | Mandibular metastasis of adenocarcinoma from prostate cancer: case report\naccording to epidemiology and current therapeutical trends of the advanced prostate\ncancer | Male patient, white, 54 years old, was admitted in the Oral and Maxillofacial Trauma and\nSurgery Team at Hospital de Base de Bauru (Bauru Base Hospital), in March 2009. The\npatient's main complaint was pain in the left mandibular region above the median line\nand paresthesia of the anatomical areas sensitized by the Left Alveolar Inferior Nerve,\nbranch of the Mandibular Nerve and Trigeminal Nerve. The first signal related by the\npatient was a pathology originated from a root treatment about one year before, which\ndeveloped a mandibular abscess clinically treated. Once healed from this abscess,\nchronic pain persisted in half mandible associated with localized paresthesia. Because\nof the posterior absence of dental symptoms even as mandibular pain and face\nparesthesia, the clinical dentist referred the patient to the one who suggested the\ndiagnosis of Trigeminal Neuralgia, establishing treatment with Carbamazepin 200 mg and\nGabapentin 300 mg, both once a day, that lasted about 1 year or more.\nThe patient's medical history revealed pharmacologically controlled diabetes and\nprostate acinar adenocarcinoma Gleason score 7 (3+4), with initial PSA score on 4.78.\nThis latter treated in 2005 by means of radical prostatectomy performed in January 2006\n(pT3N0M0), having follow-up procedures with urology, but in a random and intermittent\nmanner, a history not explored or valued by neurology.\nPhysical examination revealed left mandibular bulging in the buccolingual aspect and\ntooth mobility involving bulging region extending to the opposite canine tooth\nassociated with a slight gums erythema, but without symptoms compatible with periodontal\ndisease. In addition, we observed the absence of pathognomonic signs and symptoms of\nclassic Trigeminal Neuralgia, showing no intermittent pain, neither specific localized\npain spots (trigger-points). Based on this clinical symptomatology, we established a\nhypothesis of diagnosis as osteomyelitis and/or cancer, not yet discarding the\npossibility of Atypical Neuralgia of the Trigeminal Nerve ().\nThrough a radiography exam, it was possible to define a mild, diffuse radiolucency in\nthe left mandibular body. The Computed Tomography Scan showed an anatomical structure\nalteration with osteolysis areas in the premolars, molars and in the left region of the\nchin ( and ).\nBecause of that, we carried out an incisional biopsy and culture/antibiogram of\nsensitivity of the affected area. The results showed adenocarcinoma (clear cell type)\nwith necrosis areas and infiltrating bone and soft tissue. The isolated microorganism\nwas Staphylococcus aureus. These findings suggest a metastatic tumor\ninfected by via hematogenous route. The tumor had no communication between the internal\nand external environment, without skin or mucosa fistula, confirmed by whole-body bone\nscintigraphy with special interest in the mandibular region, where increased uptake of\nthe radiocontrast agent was observed, as well as in many areas, such as the right\nclavicle and scapula, humerus, ribs, spine, sternum, hip bone and femur (right/left)\n().\nAfter confirming a definitive diagnosis, the patient was taken to the Oncology Clinic,\nwhere in May 2009 was admitted to the Clinical Oncology Department with a metastatic\nbone disease diagnosis (prostate acinar adenocarcinoma) confirmed by three different\nmethods: bone scintigraphy, incisional biopsy and immunohistochemical analysis of\nmandibular lesions. The treatment consisted of the use of goserelin acetate (3.6\nmg/month) and bisphosphonate (clodronate, 4 ampoules/month). The patient was evaluated\nas having good disease control and good tolerance to treatment for some months, when\ndisseminated neoplasm and pulmonary involvement led to a lethal outcome, with the\npatient's death in less than a year. | [[54.0, 'year']] | M | {'11056492': 1, '10328657': 1, '9145716': 1, '28462174': 1, '17992450': 1, '18061527': 1, '21542742': 1, '27847740': 1, '9653498': 1, '9800563': 1, '29682391': 2, '11814064': 1, '25760260': 1, '18852982': 1, '15470213': 1, '33955707': 1, '24212982': 1, '12576032': 1, '34229504': 1, '33088553': 2, '12394689': 1, '17644123': 1, '17138711': 1, '17321866': 1, '34349444': 2, '34026480': 1, '16449183': 1, '1555836': 1, '7542823': 1, '32322507': 1, '27992832': 1, '24212997': 2} | {'5846346-1': 1, '7562882-1': 1, '8272517-1': 1} |
165,050 | 3881860-1 | 23,329,250 | noncomm/PMC003xxxxxx/PMC3881860.xml | Partial maxillary osteotomy following an unsuccessful forced eruption of\nan impacted maxillary canine - 10 year follow-up. Review and case\nreport | A 17 year old female patient was referred in 2001, after 31 months of orthodontic\ntreatment. On 12/29/1998, during this previous treatment time she underwent surgery,\nwhen a device was placed for orthodontic traction of the maxillary right canine,\nresulting in an unfavorable outcome. No notable particularities could be found, both\nupon current anamneses and a physical exam. In the course of the intra-oral exam, an\northodontic device could be seen with an open coil spring between teeth 12 and 14 for\nspace maintenance (). Tooth 13, with\ntransalveolar inclination, presented clinical exposure of its crown on the palate, with\nits vestibular face mesially rotated and three orthodontic buttons still present for\nelastic traction ().\nPeriapical and panoramic radiographic exams, dating from January 14, 2001, reveal\ntooth's 13 apex constrained within the ennis inverted Y. Significant bone loss could\nalso be seen distal to 12 and mesial to 14 (, ).\nPrevious history substantially reduced expectations for success in future attempts of\nsurgical orthodontic traction. Although the patient was well within a favorable age\n(13-19 years), proper orthodontic\ntreatment was conducted with space opening and well directed inter-arch elastic force\nfor much beyond the necessary time, without distinguishing signs of tooth movement.\nAfter the patient and her parents were advised about the possible prosthetic\nrehabilitation alternatives, they were favorable to the indication of partial maxillary\nosteotomy.\nThe appliance selection must conform to the orthodontist prescription. In addition, it\nis recommended that the brackets, with hooks or kobayashi on the posterior teeth, be\nproperly bonded and accessed for resistance. A rigid passive rectangular wire is\nnecessary, preferably .019"x.025". The arch-wire should be continuous in the mandibular\narch and segmented in the maxillary arch, separating the mesial and distal segments. The\nwire ends must be properly bent to protect the surgeon. A .025 mm steel ligature wire\nmay be used as a tie-together to stabilize the mesial and distal segments as rigid\nunits, not allowing individual tooth movements. Anterior hooks or kobayashi should be\nplaced in the upper and lower arches. Lastly, orthodontic buttons should be bonded on\nthe palatal side of the bicuspids on the distal segment, to allow for cross-bite\nelastics.\nThe surgery took place on March 02, 2001, under general anesthesia. The procedure was\ncomprised of the maxillary right canine removal and a partial maxillary osteotomy, with\nmobilization of the alveolar distal segment containing teeth 14 to 17. After the\northodontic wire was sectioned, bicortical osteotomies, vestibular and palatal, were\nperformed, on both the horizontal and vertical aspects. Fractures were performed with\nstraight and curved chisels, allowing for the liberation of the distal dento-alveolar\nsegment. Vertical osteotomies enabled the establishment of a breach in the alveolar\nprocess where the liberated segment was moved into, in a mesial direction, nearly\nclosing the gap. Aiming to preserve any residual viable periodontium, attention was\ngiven to maintain an approximate 1.5 mm margin of bone distal to 12 and mesial to 14.\nPost-surgically, by means of elastic traction, the approximation of the distal segment\nwas concluded. A single straight spaced 1.5 mm titanium miniplate with 4 holes, fixed\nwith 4 titanium miniscrews 4 mm long, was used for the osteosynthesis. Areas of ischemic\nformation of the gingiva could be observed during the suture, which were eliminated by\nresizing the traction elastics, thus reinforcing the significance of proper orthodontic\nanchorage.\nIntermaxillary immobilization was sustained for 21 days and during weekly postoperatory\ncontrols. When the elastics were removed and exchanged for new ones, mandibular movement\nwas encouraged. After three weeks, the segmented orthodontic arch-wire was substituted\nfor a continuous arch, maintaining stability of the segment and sustaining the formation\nof a callus.\nThe patient was cleared for orthodontic movements in April 24, 2001. Full treatment was\nconcluded on October 23, 2001, 7 months and 21 days later, with braces removal and\ninstallation of removable retainers. After 9.7 years, on October 29, 2010, due to\npatient request, the internal rigid fixation was removed. On the clinical and\nradiographic control of January 10 and 17, 2012 (, , , ), both stability and pulpar\nvitality could be confirmed after 10 years and 10 months of follow-up with excellent\nperiodontal conditions. | [[17.0, 'year']] | F | {'296087': 1, '13883048': 1, '17822544': 1, '1062935': 1, '20685529': 1, '21889061': 1, '1545064': 1, '18088712': 1, '21724096': 1, '20924537': 1, '11757008': 1, '8291494': 1, '21625740': 1, '9680907': 1, '22748996': 1, '1739070': 1, '5235604': 1, '23329250': 2} | {} |
165,051 | 3882904-1 | 24,403,980 | noncomm/PMC003xxxxxx/PMC3882904.xml | Cat-Scratch Disease In Adult Hospitalized For Prolonged-Fever Associated With Multiple Lymphadenopathies and Weight Loss | Mr. A, born on December 7, 1993 (19 years old) was hospitalized from 10-12-2012 to 17-12-2012 in the Service of Medicine B-Hepato-Gastro-Enterology of Tulle Hospital Center, for adenopathy of internal-underside of left elbow with prolonged-fever. The medical antecedent revealed a complete vaccination, obesity and smoking. In the history of the disease, we noted a deterioration of general condition involving asthenia, anorexia and weight loss with a loss of 15 kgs weight during the last three months (previous weight 105 kg). The general condition deterioration syndrome worsened with the appearance of a significant swelling inside the left arm associated with alternating fever-apyrexia and night sweats. There was no antecedent of travel in the tropics, insect sting or bite. The patient was a butcher living with a kitten and was regularly scratched by it. He had no urinary or pulmonary functional signs.\nAt the day of hospitalization the physical examination confimed the deterioration of general condition (asthenia, anorexia, weight loss), the temperature was 38.5°C, weight 88 kgs, height 182 cm, blood pressure 120/70 mmHg, there was no neurological, pulmonary or cardiovascular signs. The abdomen was soft, compressible, painless and had no hepatosplenomegaly. Clinical examination funded a left submaxillary and axillary infra centimeter adenopathies. The clinical examination which was otherwise unremarkable, revealed also an adenopathy with 5 to 6 centimeters of diameter at the internal face of the left elbow. This adenitis was firm, painful, moving and warm.\nThe laboratory tests performed on the day of admission (Day-0: D-0) highlighted: leukocytosis with neutrophil polynuclear predominance [White Blood Cells (WBC): 19.9 Giga/L, neutrophils Polunuclear: 14.5 Giga/L, C-reactive protein (CrP): 18 mg/L] (Table ). The remaining biological assessment, chest and left elbow radiographs were unremarkable, while the left elbow echography showed altered inflammatory of internal elbow soft tissue, consisting of a fluid collection, surrounded by a subcutaneous infil-tration and lymph node swelling underlying. To complete medical and biological exploration, a thoracic-abdominal scanner highlighted several axillary, supraclavicular, mediastinal, hilar, iliac and inguinal centimeter lymph nodes.\nIn summary, this observation showed an impaired general condition syndrome in prolonged fever context with suppurative adenitis, weight loss and multiple lymphadeno-pathy in a young adult patient. The diagnostic hypotheses were rejected by the respective laboratory tests: toxoplas-mosis, infectious monocucléose, HIV-1, HIV-2, Bartonel-losis and Brucellosis serology were found to be negative. The intradermal reaction (IDR) to tuberculin and quantiferon assay was negative. The Cytomegalo virus (CMV) and Ebstein Barr virus (EBV) serologies were in favor of a pre-vious infection. As the Bartonellosis serology was negative, the diagnosis of Cat-scratch disease was based on the patho-logical analysis of the biopsy specimen of the lymph node excisional which showed necrotizing granulomatous inflam-mation with central necrosis surrounded by epithelioid cells and Langhans’ giant cells, strongly suggesting Bartonella henselae infection. The Ziehl coloration and cultures in search of Acido-Alcohol-Resistant Bacillus (AARB) were negative.\nTaking into consideration the bacteriological results, a bi-empiric antibiotic therapy covering pyogenic and atypic germs was initiated (Amoxicillin-Clavulanic Acid: 1g x 3 daily associated with Doxycycline: 2 x 100 mg daily). Due to intolerance (nausea and vomiting) the Doxycicline was replaced by azithromycin (250 mg daily). The clinical and biological outcomes were favorable although adenitis with 2 centimeters persisted for forty five days (D-45) after azithromycin treatment initialization (Table ), thus justifying the continuation of this antibiotic treatment during eight weeks. The patient was also reviewed in consultation at day-75 (D-75) after the beginning of treatment. Clinical examination showed an overall decrease of the node diameter, absence of superficial lymph nodes, night sweats and asthenia, recovery of appetizing and stable weight of 86 Kg. | [[19.0, 'year']] | M | {'12906736': 1, '21243990': 1, '10447753': 1, '11868771': 1, '20625509': 1, '4061408': 1, '27161111': 1, '12203159': 1, '16081914': 1, '8537257': 1, '17073081': 1, '11787880': 1, '22785507': 1, '18842353': 1, '17319959': 2, '16935770': 1, '15621836': 1, '1608685': 1, '15755513': 1, '16189275': 1, '9655532': 1, '26062543': 1, '21470466': 1, '21702667': 1, '19256242': 1, '24403980': 2} | {'1810538-1': 1} |
165,052 | 3882928-1 | 24,416,490 | noncomm/PMC003xxxxxx/PMC3882928.xml | An Insidious Cardiac Sarcoma Presenting with Progressive Neurologic Dysfunction | A 45 year-old Caucasian woman, with no significant past medical history, developed newonset headaches. She was initially treated conservatively with rest and analgesics over the course of several months. However, her symptoms gradually worsened and began to include nonspecific mental status changes such as forgetfulness, daytime somnolence and postural imbalance. She eventually sought care at a local emergency department where her review of symptoms at the time was negative for any cardiac or respiratory involvement. Physical examination revealed no abnormal findings in the chest on auscultation. During the course of her evaluation a magnetic resonance imaging scan revealed two brain lesions, one in the right frontal lobe measuring 2×1.7 cm with extensive edema and another in the left parietal lobe measuring 0.8×0.6 cm on the axial T1-weighted images (, yellow and red arrow, respectively). She underwent a stereotactic biopsy of the right frontal lobe lesion that revealed a spindle cell sarcoma with highgrade features of necrosis, increased mitoses, and nuclear pleomorphism.\nSubsequent staging computed tomography scans of the chest, abdomen and pelvis were not able to identify a primary tumor site. However, a PET scan revealed a FDG-avid in the left atrium. Further evaluation with a transesophageal echocardiogram showed a 2.5×1.8 cm left atrial mass at the base of the posterior mitral valve leaflet with mobile fronds (, yellow circle). An MRI of the chest further demonstrated that this mass was irregular and extended into the appendage and down the anterolateral mitral annulus without interfering with mitral valve function. Shortly thereafter, she underwent stereotactic radiosurgery for the two cerebral metastases present that was later followed by an excision of the left atrial mass with a pericardial patch reconstruction of the atrium and pulmonary veins. Intraoperatively, the tumor was found to obliterate the left atrial appendage and extended into the mitral valve annulus (, yellow arrow). Unfortunately, the mass proved to be larger than radiographic imaging had predicted making the goal of achieving clear margins unattainable, as a small rim of residual tumor was left behind in the atrioventricular groove. The final pathology confirmed a 5.5×5.1×2.1 cm high grade undifferentiated cardiac sarcoma.\nDuring the subsequent month as she was recovering from her surgery, she began to have severe headaches again and an MRI of the brain revealed several new lesions. Moreover, a repeat CT of the chest also showed interval growth of the mass within the left atrium as compared to post-surgical CT studies. She underwent palliative whole brain radiation therapy but continued to experience headaches, visual disturbances, and numbness in the upper extremities. She eventually transitioned to palliative care in view of the rapid progression of disease in the brain. | [[45.0, 'year']] | F | {'19464464': 1, '8873720': 1, '10928510': 1, '11156679': 1, '18428209': 1, '16675225': 1, '10458824': 1, '2783798': 1, '18602663': 1, '3510706': 1, '2158636': 1, '2237900': 1, '8448740': 1, '20609770': 1, '24416490': 2} | {} |
165,053 | 3882929-1 | 24,416,491 | noncomm/PMC003xxxxxx/PMC3882929.xml | Bilateral Tubulocystic Renal Cell Carcinomas in Diabetic End-Stage Renal Disease: First Case Report with Cytogenetic and Ultrastructural Studies | A 62 year-old man with end stage renal disease on hemodialysis due to type II diabetes and hypertension presented with neck and chest pain. A computed tomography (CT) scan to exclude aortic dissection incidentally revealed bilateral complex renal masses less than 3.0 cm in greatest dimension. The patient reported two to three weeks of painless gross hematuria, but denied fever, flank pain, and lower urinary symptoms. Given the patient’s comorbidities and the small size of the lesions, the patient was reluctant to undergo the recommended surgical intervention. Repeat CT scan of the abdomen 5 months later showed relative stability of the lesions with one cyst having grown from 1.1 to 1.3 cm. There was also a small nodular enhancing component considered suggestive of renal cell carcinoma. After an additional 6 months, a complete abdominal CT showed no growth of the cysts but heterogeneous attenuation suggested nodularity or thick septations consistent with malignancy.\nAfter an additional 7 months (18 months after presentation), a repeat CT showed bilateral and multiple enhancing lesions: a 2.6×2.3 cm lesion and a 1.3×1.6 cm lesion in the left mid-kidney, a 1.8×1.7 lesion in the right upper pole, and a 1.5×1.6 cm lesion in the right midkidney (, ). Additional bilateral enhancing lesions did not show interval growth. Cystoscopy and urine cytology at that time were negative for malignancy. A CT urogram showed no excretion of contrast, limiting evaluation of the upper urinary tracts. At that time, with recurrent hematuria, and told of progression of the lesions, the patient elected to undergo bilateral laparoscopic radical nephrectomy.\nThe left kidney and perinephric fat measured 10.5×7.5×4.5 cm and weighed 125.5 grams. The right kidney and perinephric fat measured 11×8×4.5 cm and weighed 190 grams. On cut section, there were multifocal unencapsulated sharply demarcated gray spongy cystic lesions ranging from 0.3 to 2.5 cm in diameter in renal cortex and renal medulla (, ). The cystic lesions contained clear serous fluid. The renal capsules and perinephric fat were grossly uninvolved. Simple cortical cysts were also seen separately. Numerous black multifaceted calculi ranging from 0.1 to 0.2 cm in greatest dimension were present within both renal pelvises (, ). On microscopic examination, the cystic lesions were composed of tightly packed tubules and cysts separated by bland fibrous stroma (). The cysts were lined by a single layer of cuboidal to columnar cells, often with a hobnail appearance. The cells had large round to oval nuclei (Fuhrman grade 2 to 3), prominent nucleoli, and abundant eosinophilic cytoplasm (, ). No desmoplastic reaction or cellular ovarian-type stroma was present. No areas of solid or papillary growth was seen in either kidney. Papillary renal cell carcinoma was not present. Pathologic stage was pT1 for both kidneys.\nImmunostains for vimentin, PAX-2, AE1/AE3, p63, p504S(AMACAR), 34 beta E12, cytokeratin 8/18, EMA, cytokeratin 7, cytokeratin 20, and CD10 were performed using a Dako Autostainer with prior heat induced epitope retrieval in a water bath with buffered Citrate (pH 6.0) and EDTA (pH 8.0) (). The tubulocystic carcinoma cells showed diffuse strong immunoreactivity () for AMACR, AE1/AE3, CK8/18, CD10 and PAX2, and focally strong immunoreactivity for CK7 (), EMA, Vimentin and 34BE12. No immunoreactivity was seen for P63 and CK20. The tubule-containing and cystic areas of the tumor demonstrated equal immunoreactivity for pan-cytokeratin, CK8/18 and AMACR. Immunoreactivity for 34BE12, CK7, CD10 and EMA was greater in the tubule-containing areas, relative to the cystic areas.\nThe uninvolved renal parenchyma bilaterally showed extensive global glomerular sclerosis, interstitial fibrosis, tubular atrophy with thickening of tubular basement membrane, and focal interstitial chronic inflammation. The non-sclerotic glomeruli showed diffuse nodular mesangial expansion, with numerous Kimmelstiel-Wilson lesions highlighted by Periodic Acid Schiff (PAS) stain. Onion-skin thickening of the arterioles was noted. Both kidneys showed multiple simple cysts. Theses changes are consistent with the patient’s clinical history of end-stage renal disease in the setting of hypertension and diabetes.\nFluorescence in situ hybridization (FISH) was performed on a representative section from the left kidney tubulocystic carcinoma using methods described earlier. Briefly, 4.0 micrometer sections from a representative, formalin-fixed, paraffin-embedded block were cut and utilized for FISH studies. To confirm the cytogenetic abnormalities reported previously in a case of TC-RCC, a UroVysion bladder cancer kit containing probes for chromosome 7 (CEP7, spectrum green), and chromosome 17 (CEP17, spectrum aqua) (Abbott Molecular/Vysis Cat. no.36-161070) was used.\nThe FISH data were analyzed using methods described before. The corresponding hematoxylin and eosin slides were reviewed before the FISH study and areas of tumor and normal renal tubules were marked. One hundred nuclei from normal and tumor areas were examined for signals from probes under the fluorescence microscope with 1000 magnification. Normal renal tubules were used as a control. Definitions of chromosomal gain and loss of chromosomes 7, 17 were based on the Gaussian model and related to the non-neoplastic controls. Any tumor with a signal score beyond the cut-off value was considered to have a gain or loss of the specific chromosome. The cut-off values for each probe were set at mean +3 SD of the control values. Gains of chromosomes 7 and 17 were present in 11% and 35% of the tubulocystic RCC cells. Adjacent normal renal tubule cells showed gains of chromosomes 7 and 17 in 1% and 0% of cells, respectively.\nA formalin-fixed sample of the specimen was used for the EM study. The specimen was transferred from neutral buffered formalin to 3% Sorenson’s phosphate buffered glutaraldehyde and washed in 0.1M Sorenson’s phosphate buffer (pH 7.3). The tissue was then post-fixed in 2% osmium tetroxide, dehydrated in a graded series of ethanol. Samples were then transferred to propylene oxide, incubated in mixtures of propylene oxide and eponate 812 (Electron Microscopy Sciences), and embedded in eponate 812 at 60 degrees centigrade. 1.0 micron-thick sections were cut for orientation and 70 nm sections were made for ultrastructural examination. These sections were placed on copper grids and stained with uranyl acetate and lead citrate and examined in a JEM 1010 electron microscope.\nUltrastructural examination revealed the presence of two types of cells. The type I cells () were composed of cuboidal cells bound on their luminal surfaces by tight junctions. The nuclear contour of these cells ranges from irregular () to oval (). Nucleoli were prominent (). There were well-formed brush borders with long microvilli with prominent rootlets (). The cytoplasm of these cells had numerous mitochondria, many of which contained dense plaques (). Lipid material and membrane bound granules were also present. These cells were bound by basement membrane material. Interstitial material consists of fibroblasts, collagen, and blood vessels. These ultrastructural features are characteristic of proximal convoluted tubules. Type I cells were seen in the tubular component of the TCRCC. The type II cells () were present in a single layer, with desmosomal junctions and luminal surfaces bound by tight junctions. The cytoplasm of these cells contained rough endoplasmic reticulum, mitochondria, and lipid droplets. The surfaces of these type II cells were devoid of microvilli (). The base of the glands was bound by basement membrane material. These ultrastructural features are characteristic of distal nephrons. Type II cells were seen in the cystic component of the TC-RCC. No cells had ultrastructural characteristics of both type I and type II cells.\nThe patient died of non-tumor related causes 16 months post-bilateral nephrectomy. No tumor recurrence or metastasis was noted by the time of his death. | [[62.0, 'year']] | M | {'19011562': 1, '19494850': 1, '9372874': 1, '18594469': 1, '20332483': 1, '15897741': 1, '19898225': 1, '18223319': 1, '17786473': 1, '24416491': 2} | {} |
165,054 | 3882930-1 | 24,416,492 | noncomm/PMC003xxxxxx/PMC3882930.xml | A Case of Small Cell Carcinoma of the Vagina | The patient was an 81-year-old woman with 6 pregnancies, 1 childbirth, and menopause at the age of 56. Past medical history: at the age of 75, she developed hypertension and atrial fibrillation that were treated by a local physician with some medications. At the age of 79, the patient underwent cataract surgery. The patient repeatedly recognized menstruationlike genital hemorrhage 1 year before visiting a hospital. Speculum examination performed by the previous gynecologist detected a hemorrhagic tumor-like mass on the vaginal wall. Small cell carcinoma was diagnosed on histopathological examination, and the patient was referred to our department. Physical findings included a height of 150 cm and body weight of 53 kg. The blood pressure was 147/102 mmHg. Colposcopy detected a fragile, hemorrhagic tumor-like mass mainly on the posterior vaginal wall (). The mass did not have continuity with the uterine cervix. Transvaginal ultrasound suggested atrophy in the uterus, and there were no abnormal findings. A unilocular left ovarian cyst with the longest diameter of 40 mm was recognized. Cytodiagnosis of the vaginal tumor suggested relatively small atypical cells in conglomeration with a high N/C ratio or with bare nuclei that were densely stained with nuclear chromatin. Biopsy tissue diagnosis of the vaginal tumor indicated alveolar solid growth of nuclear chromatin-rich atypical cells with a high N/C ratio and a partially recognized rosette-like structure on the background of the necrotic tissue, suggesting a differentiated neuroendocrine system (). Immunostaining was positive for chromogranin A and synaptophysin (, ). According to the above, primary small cell carcinoma of the vagina was diagnosed.\nMRI findings detected irregularity in the posterior vaginal wall (). PET-CT detected positive accumulation in the lesion in the superior vagina, which had been indicated by MRI (). No abnormal accumulation was recognized in any other organ including the lung fields (). Tumor markers were SCC 1.7 ng/mL, CA 19-9 3.5 U/mL, CA 125 5.6 U/mL, and NSE 13.4 ng/mL (normal value: 12.0 ng/mL or less).\nStage I vaginal small cell carcinoma was diagnosed. Considering the age and complication, radiotherapy was selected. Radiotherapy included whole pelvis irradiation with 45 Gy/25 fractions by Linac and high-dose-rate brachytherapy with 18 Gy/3 fractions. An adverse event due to radiotherapy was Grade 1 skin disorder alone. Colposcopy after radiotherapy detected only a trace-like elevation on the vaginal wall (). Cytological diagnosis of the same site was negative. On CT performed for evaluation after treatment, the lesion on the vaginal wall became ambiguous and no lymph node metastasis or metastasis in distant organs was recognized. The patient remains alive without any disease 1 year and 8 months after the treatment. | [[81.0, 'year']] | F | {'12648603': 1, '15197564': 1, '18369310': 1, '16538063': 1, '9190988': 1, '7705280': 1, '10838495': 1, '24416492': 2} | {} |
165,055 | 3882931-1 | 24,416,493 | noncomm/PMC003xxxxxx/PMC3882931.xml | Metastatic Meningioma Presenting as Cancer of Unknown Primary | A 72-year-old Caucasian male patient was admitted to our hospital for excision of the metastatic adenocarcinoma of the skull vertex. It was diagnosed at an outside facility as carcinoma of unknown primary. He was initially diagnosed four years ago, when he presented to his primary care physician for worsening left hip pain, which was accompanied by mild muscular atrophy. A computerized tomographic (CT) scan demonstrated mixed sclerotic and lytic lesions in the left iliac wing. A bone scan demonstrated increased activity in the left sacroiliac joint. Magnetic resonance imaging (MRI) of lumbar spine showed abnormal signal in the left sacrum and ilium, consistent with metastatic disease. This area was biopsied and showed a metastatic poorly differentiated carcinoma, diffusely positive for widespectrum cytokeratin and negative for TTF1. Restaging studies did not demonstrate any other lesions. He was subsequently evaluated by radiation oncology and underwent radiation therapy to the left hip. The patient did well over the next 18 months, when he returned with an enlarged skull mass and received site directed radiation therapy. No biopsy of the skull mass was performed at this visit. He presented again in 6 months with a left tibial lesion for which he was treated with palliative radiation. A biopsy performed at this presentation did not demonstrate any neoplasm. Six-months later, he presented with increasing size of the skull mass and was initiated on chemotherapy with a regimen consisting of carboplatin and etoposide. He did have a moderate response to treatment. However, on follow-up, he was noted to have CT evidence of invasive and enlarging osseous metastasis measuring six centimeters (cm) involving the right frontal bone along with mild localized mass effect on the right frontal lobe. Consequently, he underwent another series of treatment with radiation therapy to the skull mass with a total dose of 35 grays (Gy). Despite an initial response to therapy, he subsequently had further progression of the calvarial mass including cutaneous breakdown, and presented to our institution for care.\nA nuclear medicine PET/CT of trunk showed an intensely FDG avid mass in the posterior left pelvis involving soft tissue and left iliac bone. Additionally, he underwent a subtotal resection of the skull mass, demonstrating anaplastic meningioma (). A CT guided biopsy of left iliac mass also revealed metastatic anaplastic meningioma. An octreotide scan () was performed revealing significant uptake in the left hip and right distal femur for which palliative radiation therapy was recommended, which was administered locally. However, he presented to a local ER soon after completion of radiation therapy with worsening left-sided weakness with CT evidence of cerebral edema. MRI revealed enhancing mass at the site of prior partial resection consistent with progressive disease (). He was no longer a candidate for surgery. Salvage radiation was attempted, but the patient continually to decline, and was ultimately enrolled in hospice for end of life care. | [[72.0, 'year']] | M | {'23082735': 1, '23476859': 2, '21529167': 1, '23031373': 1, '16628476': 1, '15987576': 1, '22133182': 1, '1696924': 1, '25838054': 1, '22647829': 1, '23797223': 1, '15079029': 1, '17618441': 1, '23463172': 1, '9199633': 1, '24416493': 2} | {'3586463-1': 1} |
165,056 | 3882932-1 | 24,416,494 | noncomm/PMC003xxxxxx/PMC3882932.xml | Scrotal Skin Metastasis from Rectum Adenocarcinoma | A 65-year-old man reported in March 2010 with rectal bleeding and tenesmus. Colonoscopy demonstrated an exophytic and ulcerated lesion at the lower rectal region (the tumor was 3 cm superior of the anal verge obstructing 1/3 of intraluminal pathway). Incisional biopsies confirmed the presence of adenocarcinoma of the rectum. Computed tomography (CT) of abdomen and pelvis demonstrated a locally invasive distal rectal neoplasm, without evidence of distant metastases. Magnetic resonance imaging (MRI) of a pelvic region confirmed a locally advanced neoplasm. Therefore the tumor was a radiologically T3 N0 M0 low rectal cancer.\nIn April 2010, preoperative chemoradiotherapy with a total dose of 5040 cGy, given in 28 fractions, five days per week was applied. As a concomitant chemotherapy he received 5-Fluorouracil given in five days bolus injection (400 mg/m2) plus folinic acid (30 mg/m2) per day during the first and fifth weeks of radiotherapy. Then, he was scheduled for low anterior resection six weeks following the completion of chemoradiotherapy. Pathological stage was T4 N0 M0. After the surgery, he received a boost dose of radiotherapy (10 Gy in 5 fractions) due to positive radial margins. He was subsequently treated with 2 cycles 5FU-FA chemotherapy.\nIn June 2011, one year after surgery, PET/CT (18-Fluorodeoxyglucose positron emission tomography based computerised tomography) demonstrated a recurrence in the lower part of the rectum (Suv max: 10.76). At that time there was no pathologic evidence of recurrence, so the patient only followed up.\nIn January 2012, subsequent PET/CT showed a progression of the rectal recurrences, including the spermatic cord with increased FDG uptake (Suv max: 22.15). Ultrasonography demonstrated a slightly thickening of the skin of the left scrotum. The patient had the painless, hazelnut-sized slightly reddish nodules affecting the skin of the left scrotum (). The nodular lesions were up to 14 mm in diameter. The patient then underwent an excisional biopsy from the left scrotal nodules. Macroscopic examination revealed four noduler formations; the bigger one being 3.5 cm. In microscopic assessment; the tumors were under the squamous epithelium and to form atipic glandular formation (). This gland formations consist of cells with scanty cytoplasm, hyperchromatic nuclei and atypic epithelial feature (). Biopsy of the skin compared with the original rectal cancer material, both tumor have same histopathology (). Resection margin was also involved with the tumoral tissue.\nAt this stage, the patient was given orally twice a day, Xeloda (Capecitabine) treatment (1250 mg/m2, in total; 2500 mg/m2). He also received palliative radiotherapy to the left scrotal region with electron beams. Radiotherapy was applied with 6 MeV energy, 300 cGy daily fractions, a total dose of 4500 cGy. During treatment and in the early period, we saw only grade 2 skin side effects according to RTOG acute toxicity criteria. Then, as a late side effect we observed grade 2 skin toxicity (patichy atrophy and hair loss) and grade 3 subcutaneous toxicity (severe induration and contracture). The patient is still alive without any distant metastasis after the therapy which was initiated 12 months ago. | [[65.0, 'year']] | M | {'12653722': 1, '19183499': 2, '8335743': 1, '32446230': 2, '30693133': 1, '26824966': 1, '11295934': 1, '34745779': 2, '16688461': 1, '29643717': 2, '12653719': 1, '12867694': 1, '20012668': 1, '11016477': 1, '2298962': 1, '24416494': 2} | {'2647915-1': 1, '8563144-1': 1, '7243000-1': 1, '5883837-1': 1} |
165,057 | 3882933-1 | 24,416,495 | noncomm/PMC003xxxxxx/PMC3882933.xml | A Presacral Solitary Fibrous Tumor with Extramedullary Hematopoiesis: Radiologic and Pathologic Findings | An asymptomatic 40-year-old woman was referred to our Hospital to investigate a pelvic mass detected by a gynecological ultrasonography in a private diagnostic center. She suffered from epilepsy well controlled with carbamazepine. Routine blood chemistry revealed a sideropenic anemia (RBC 3.60×1012/L; Hb 9.7µg/dL; MCV 73.9 fL; HCT 26.6%; MCH 26.9 pg; MCHC 35.1 g/dL; plasma-iron concentration 40 µg/dL; plasma-transferrin concentration 179 mg/dL), decrease of blood levels of sodium (129 mmol/L) and chlorine (90 mmol/L). Urinalysis was normal. Serum level of CA 15-3 was slightly elevated (43 U/mL; upper normal limit 32 U/mL); serum CA 125, CEA, Alpha-FP and CA 19-9 were within normal limits.\nComputed tomography (CT) detected a presacral well demarcated lobulated mass, measuring 12.5×9×10 cm; the lesion was homogenously hypoattenuating relative to muscles on non-contrast enhanced scans and inhomogeneously hyperattenuating on contrastenhanced scans; neither intratumoral fat nor calcium deposits were evident (). The mass displaced the rectum on the right side, the vagina and the uterus anteriorly, without evidence of local spread or erosion of the sacrum and the coccyx ().\nThe patient was then investigated with a 3T magnetic resonance imaging (MRI). The mass was homogenously isointense to the muscles on T1-weighted MRI (). On T2-weighted MRI the mass was well demarcated by a hypointense capsule and heterogeneous but hyperintense on T2-wheighted fat saturation images (); diffusion weighted images demonstrated a water diffusion restriction (). The mass strongly enhanced after intravenous gadolinium contrast medium administration; small non-enhanced foci and hypertrophic vessels were also appreciable ().\nNo nuclear medicine investigation was performed.\nThe patient was then operated on and rapidly recovered after surgery. She was free from local recurrence and metastases on the basis of a MRI and an whole body CT one year after the operation.\nGrossly the tumor was well circumscribed, firm, homogeneous and brownish in color, measuring 10 cm in diameter on cut surface.\nMicroscopically it was a mesenchymal neoplasm characterized by ovoid or spindle cells with focal nuclear pleomorphism and by a prominent branching, hemangiopericytomalike vascular pattern (). There was no evidence of necrosis and the mitotic activity was low (1 mitosis/10 HPF).\nThe immunohistochemical examination showed staining for CD34, bcl2 and vimentin, and negativity for desmin, smooth muscle actins, various cytokeratins, S100 protein, Synaptophysin and Chromogranins.\nIn addition the presence of sparse multinucleated cells prompted the search for extramedullary hematopoiesis, which was confirmed by specific immunostainings for megakaryocytes (CD61), precursors of granulocytes (myeloperoxydase) and of red blood cells (CD71) (). | [[40.0, 'year']] | F | {'20852090': 1, '22726986': 1, '22101909': 1, '19006781': 1, '21343490': 1, '11920476': 1, '21415186': 1, '20566782': 1, '10782156': 1, '16359538': 1, '17175794': 1, '20011312': 1, '10612786': 1, '21155003': 1, '9849394': 1, '29805622': 1, '22532921': 1, '17933000': 1, '16359532': 1, '22582360': 1, '24416495': 2} | {} |
165,058 | 3883063-1 | 24,416,501 | noncomm/PMC003xxxxxx/PMC3883063.xml | Biphenotypic Acute Leukemia with t(15;17) Lacking Promyelocytic-retinoid Acid Receptor α Rearrangement | A 55-year old Japanese woman was referred to our hospital with elevated white blood cell (WBC) counts with blasts. Her laboratory data on admission showed rising WBC counts (13.4×109/L; 76% blasts, 1% band, 6% segmented, 16% lymphocytes, 1% monocytes) with anemia and thrombocytopenia (hemoglobin 9.3 g/dL and platelets 110×109/L). Coagulation studies were normal. Lactate dehydrogenase was slightly raised to 367 IU/L (normal range 120-245). Bone marrow aspiration revealed replacement of normal marrow by blasts (94%). We detected differences in the size of the blasts, corresponding to an abnormal lymphocyte-like cell population with a high nuclear/cytoplasmic (N/C) ratio, but without granules in the cytoplasm (). These blasts were negative for myeloperoxidase (MPO) and esterase. Morphological findings were compatible with acute lymphoblastic leukemia (ALL-L2, FAB classification).\nImmunophenotype with double-color flow cytometry showed positivity (>30%) for CD19 (90.8%), CD22 (45.4%), CD79a (92.4%), CD13 (40.9%), CD33 (94.6%), CD34 (95.8%) and HLA-DR (93.8%). MPO was negative (2.0%). Double staining for CD19xCD33 was strongly positive (96.6%). The use of the EGIL scoring system revealed 5 points for B-lymphoid lineage and 2 points for myeloid lineage. The immunophenotype analysis was conclusive for a diagnosis of BAL.\nChromosomal analysis with G-banded karyotype of the bone marrow cells showed 46, XX, t(4;12)(q21;p11), t(15;17)(q22;q12) in all 24 metaphase spreads (). Fluorescence in situ hybridization (FISH) performed on interphase nuclei using an LSI PML/RARα dual color, dual fusion translocation probe (Vysis, USA) showed two separate PML and RARα signals () in 1000 interphase nuclei and all metaphases analyzed. No PML/RARα fusion signal was identified.\nThe patient was initially treated with the Japan Adult Leukemia Study Group (JALSG)-ALL202 chemotherapy protocol () and induction for ALL treatment was completed. The bone marrow aspirate at the end of the induction phase revealed hematologic complete remission (CR). After the consolidation phase I (with a high dose of cytarabine), the patient experienced the complication of septic shock with acute phlegmonous gastritis. Thereafter, we administered a single dose (9 mg/m2) of gemtuzumab ozogamicin (GO), an anti-CD33 antibody conjugate, independent of the JALSG protocol, and subsequently, completed the course until consolidation phase V. Furthermore, we continued maintenance phase therapy using the JALSG protocol until two years after the onset of disease, during which time we administered GO (6 mg/m2) twice. At present, 1.7 years after the end of chemotherapy, the patient has remained in hematologic first CR during the over 3.7 years follow up. | [[55.0, 'year']] | F | {'10459339': 1, '9450804': 1, '17593028': 1, '19477514': 1, '16019491': 1, '31371984': 2, '10233384': 1, '10897134': 1, '21228332': 1, '7564526': 1, '30310796': 1, '29550836': 1, '65649': 1, '10457405': 1, '11552979': 1, '9321529': 1, '8982049': 1, '24416501': 2} | {'6633400-1': 1} |
165,059 | 3883066-1 | 24,416,485 | noncomm/PMC003xxxxxx/PMC3883066.xml | Rapidly Worsening Bulbar Symptoms in a Patient with Spinobulbar Muscular Atrophy | A 45 y/o man with a history of asthma and migraines presented to the neurology clinic in 2000 complaining of a 10-year history of progressive muscle cramps that initially affected his jaws and forearms but subsequently involved his neck and all of four limbs. He also reported a 10-year history of tremors in his upper extremities that also worsened in severity over time. Family history was positive for tremors in his maternal aunt and 2 of his 3 brothers, and cramps in his third brother. Examination at the time of presentation was remarkable for obvious gynecomastia, mild periorbital facial weakness, possible wasting of the sternocleidomastoid muscles, fasciculations in multiple muscles of the face and arms, and a 10 Hz postural tremor in the arms. Of note, mental status, reflexes, strength, sensation and gait were all normal. Curiously, electrodiagnostic testing showed evidence of a generalized sensory neuropathy with absent left sural, median, ulnar and dorsal ulnar cutaneous nerve sensory responses and a slightly reduced superficial radial nerve sensory amplitude and conduction velocity. Electromyo graphy showed evidence of acute denervation in the left lateral gastrocnemius and extensor digitorum brevis and evidence of chronic denervation in multiple muscles of the left upper and lower extremities. DNA testing for Kennedy’s disease confirmed the diagnosis revealing an expansion of 47 CAG repeats (normal being <33). The patient declined treatment for his tremor.\nThe patient continued to be seen in clinic on an annual basis, with slowly progressive disease with increasing difficulty climbing stairs and squatting. He was still able to continue working full time, however. At age 54 the patient reported new hoarseness and mild dysphagia which slowly worsened over the next year. He denied any heartburn or regurgitation. Videofluoroscopic evaluation of his swallowing revealed mild oropharyngeal dysphagia as well as evidence of esophageal reflux, but no laryngeal penetration or frank tracheal aspiration. Follow up swallowing evaluations were recommended every 3 to 6 months. The patient was subsequently seen at age 55 for an annual follow up visit, reporting increased difficulty climbing ladders and stairs. He additionally reported hoarseness after speaking for 5-10 minutes, persistent dysphagia and diffuse cramps.\nPast medical history included mild intermittent asthma; hay fever with rhinitis and conjunctivitis during the summer; tonsillectomy; and migraines. No history of smoking. Medications were sumatriptan and acetaminophen/hydrocodone as needed and fluticasone nasal spray as needed during allergy season.\nOn physical exam he had fasciculations in the hand and tongue and with exertion in the face and platysmus muscles. There was temporal wasting and moderate gynecomastia noted. Voice was coarse, slightly nasal and weak, with moderate bilateral facial weakness present and cranial nerves otherwise intact. Reflexes were absent in the biceps, rest were 2+. Strength was 4/5 in the tongue and hip flexors; 4±/5 in the deltoids, biceps, triceps; rest 5/5, and gait was relatively normal. Body mass index was 24.5 kg/m.\nThe patient returned for an urgent visit, 3 months later, during allergy season. He reported a recent URTI with development of nasal congestion, rhinorrhea, severe post nasal drip, frequent throat clearing, globus pharyngeus, cough, dyspnea and wheezing. He had also experienced several episodes of sudden severe difficulty breathing, with throat tightness and audible stridor, which were very frightening and prompted two visits to the emergency department, where he was sent home after some improvement with prednisone and bronchodilators.\nThe patient was seen 2 weeks later at pulmonary clinic. He was feeling better, dyspnea and wheezing had resolved, but still reported mild residual nasal congestion, globus and frequent throat clearing. He was given a prescription for daily nasal fluticasone spray and cetirizine, with albuterol inhaler as needed. Pulmonary function tests (PFT) were ordered.\nPFT values were within normal limits: forced expiratory volume in 1 second (FEV) 3.66 L (81%), forced vital capacity (FVC) 2.92 L (89%), FEV/FVC ratio 80. Flow volume loop was abnormal, consistent with fixed airway obstruction (). The patient developed laryngospasm with loud stridor and dyspnea during maximal expiratory pressure maneuvers. He was referred to Ears, Nose and Throat Clinic for airway inspection. Flexible fiberoptic nasolaryngoscopy showed no airway lesions or masses. Moderate erythema throughout the glottis and supraglottic larynx was noted, along with diminished abduction of the vocal cords. He was suspected of having laryngopharyngeal reflux and treated with esomeprazole, 40 mg daily, along with behavior modification. He was seen 10 weeks later. Globus pharyngeus and throat clearing were almost gone, and the prior baseline chronic dysphagia had resolved and hoarseness had improved. He was eating more with increased appetite and was very satisfied with the response to therapy. | [[45.0, 'year']] | M | {'4233749': 1, '18625138': 1, '28392964': 1, '21216197': 1, '19405197': 1, '15728312': 1, '32695362': 1, '30787905': 1, '19846582': 1, '10498060': 1, '24416485': 2} | {} |
165,060 | 3883189-1 | 24,403,762 | noncomm/PMC003xxxxxx/PMC3883189.xml | Management of failed metal-backed glenoid component in patients with bilateral total shoulder arthroplasty | An 80-year-old male presented with a history of bilateral glenohumeral arthritis status post-bilateral total shoulder replacements (left shoulder in 1996 and right shoulder in 1997). Both shoulders were replaced with the Kirschner modular II-C components (Kirschner Medical Corp., Fair Lawn, New Jersey), which is comprised of a modular humeral head/proximal porous coated stem and a metal-backed pressed fitted glenoid component with proximal and distal interlocking fixation screws. Patient experienced a routine intraoperative and post-operative course after both shoulder replacements without any complications.\nIn terms of the left shoulder, patient reported a few years of good pain relief and functional improvements after the shoulder replacement. However, he started to have intermittent left shoulder pain about 3 years after surgery that progressed to constant pain and significant limitation in terms of his range of motion and also functional activities. On physical examination, his forward flexion (FF) was 0-60, external rotation (ER) of 0-15 and internal rotation to his back pocket only. He also had significant pain with any range of motion on examination. Strength testing demonstrated 4/5 in supraspinatus and 4/5 in ER. Anteroposterior radiograph of the left shoulder showed significant loosening of the metal-backed glenoid component and cavitary bone loss with failure of fixation of both screws []. Computed tomography scan confirms the massive bone loss in the glenoid with associated rotator cuff tear. Due to the significant glenoid bone loss, patient underwent a resection arthroplasty in 2010 (14 years from the original procedure). At the most recent follow-up (2012), patient had no pain on the left shoulder. His range of motion measurements were: FF[] = 0-90, abduction = 0-50, ER = 0-45 []. Radiographs revealed of the resection arthroplasty revealed a small amount of heterotopic bone formation around the humeral shaft []. His simple shoulder test (SST) score was 16 and American Shoulder and Elbow Surgeons (ASES) score was 23.\nOn the right shoulder, patient also reported progressive intermittent pain that started about 4-5 years after the initial procedure. This also progressed to constant pain and significant limitations of his activities of daily living. On physical examination, patient range of motion was FF = 0-90 passive and 0-30 active, ER = 0-20 and internal rotation (IR) to the back pocket only. Patient also demonstrated significant weakness with supraspinatus and ER strength testing. Radiographs revealed failure of the metal-backed glenoid with obvious radiolucency indicating lysis around the glenoid component []. Patient underwent a revision arthroplasty to a large head hemiarthroplasty (2012) with removal of both failed metal-backed glenoid and the loose humeral stem. At the time of surgery, it was noted that the PE was worn with resulting metal on metal articulation and metallosis of the soft-tissue around the failed glenoid component. At the most recent follow-up (7 months post-op), range of motion was: FF = 0-70, abduction = 0-50 and ER = 0-65 []. He reports minimal pain on the right; however, he does have limitations of his daily activities due to his decreased range of motion. Radiographs demonstrate superior migration of the hemiarthroplasty without evidence of loosening []. His outcome scores included a SST score of 16 and an ASES score of 25. | [[80.0, 'year']] | M | {'22036536': 1, '15107698': 1, '17606786': 1, '3833948': 1, '15726075': 1, '22048095': 1, '21705237': 1, '22361717': 1, '21330156': 1, '21328021': 1, '20554454': 1, '23116927': 1, '20190310': 1, '23238604': 1, '31211193': 1, '22058304': 1, '10226968': 1, '12851570': 1, '12195253': 1, '25672497': 1, '22588413': 1, '22047787': 1, '15570228': 1, '22361714': 1, '16979048': 1, '19297199': 1, '21419661': 1, '7466956': 1, '12378161': 1, '17931898': 1, '18829916': 1, '22959525': 1, '24403762': 2} | {'3883189-2': 2} |
165,061 | 3883189-2 | 24,403,762 | noncomm/PMC003xxxxxx/PMC3883189.xml | Management of failed metal-backed glenoid component in patients with bilateral total shoulder arthroplasty | A 75-year-old male presented to the clinic with a history hemochromatosis and bilateral glenohumeral arthritis status post-bilateral total shoulder replacements (left shoulder in 1999 and right shoulder in 2002). Both shoulders were also replaced with the Kirschner modular II-C components (Kirschner Medical Corp., Fair Lawn, New Jersey, USA).\nIn terms of the left shoulder, patient reported several years of good pain relief and functional improvements after the shoulder replacement. However, he started to have intermittent left shoulder pain about 8 years after surgery that progressed to constant pain and significant limitation in terms of his range of motion and also functional activities. On physical examination, his FF was 0-80, ER of 0-45 and internal rotation to L3. He also had significant pain with any range of motion on examination and strength testing demonstrated 4+/5 in supraspinatus and 4–/5 in ER. Anteroposterior radiograph of the left shoulder showed catastrophic failure of the metal-backed glenoid component with breakage of both screws []. Given the pain and functional impairment, the patient underwent revision arthroplasty with removal of the metal-backed glenoid and humeral components. Intraoperatively, significant metallosis was encountered. In addition, there was a concern for infection. Intraoperative frozen section indicated acute inflammatory reaction with a high WBC seen on the high-powered field. Based on the high probability of a coexistent infection, a decision was made to place prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) antibiotic humeral component and bone graft the glenoid cavitary defect with iliac crest autograft bone graft. Subsequently, intraoperative cultures grew both Methicillin-resistant Staphylococcus aureus (MRSA) and Propionibacterium acnes. Patient was treated with 8 weeks of intravenous antibiotics and Peripherally Inserted Central Catheter (PICC) line. Arthroscopic biopsy was then performed and demonstrated no evidence of persistent infection. Patient underwent revision arthroplasty to a custom reverse prosthesis component (Biomet comprehensive custom reverse prosthesis, Warsaw, IN) in 2008. Patient tolerated the procedure well with no intraoperative or post-operative complications. On the most recent follow-up (2012), patient had no pain on the left shoulder. His range of motion measurements were: FF = 0-170, abduction = 0-95, ER = 0-30 []. Radiographs revealed the custom reverse prosthesis was stable without evidence of loosening or failure []. His SST and ASES measured 83 and 78 respectively.\nOn the right shoulder, patient also reported progressive intermittent pain that started about 6 years after the initial procedure. This progressed to constant pain and significant limitations on the overall range of motion. On physical exam, patient's range of motion was: FF = 0-60 passive, ER = 0-20 and IR to the side only. He also had significant weakness with supraspinatus and ER testing. Radiographs revealed lucency behind the metal-backed glenoid without failure of the two screws as well as marked decrease in the space between the humeral head and metal-backed glenoid indicating wear []. Patient underwent revision arthroplasty with removal of the glenoid component and humeral modular head. An intraoperative biopsy was also obtained, which was positive for P. Acnes and subsequent placement of a PROSTALAC spacer was performed. Furthermore, he had a prolonged course of IV penicillin via PICC line. In 2010, patient underwent a revision arthroplasty with reverse shoulder prosthesis (Tornier Aequalis Reverse system. Bloomington, MN) and iliac crest bone graft of the glenoid. Harvesting of the iliac crest was performed with an oscillating saw and a 3 cm × 3 cm tri-cortical crest was obtained. The iliac crest was shaped to fit the glenoid defect and the metaglene was fixed onto the crest and native glenoid with a central plug and two compression screws. Patient tolerated the procedure well with no intraoperative or post-operative complications. On the most recent follow-up (2 years post-op), range of motion: FF = 0-120, abduction = 0-80, ER 0-75 and IR to back pocket []. He reports minimal pain on the right and no limitations to his activities of daily living. Radiographs demonstrate the reverse prosthesis in a good position without evidence of loosening or failure []. His SST and ASES scores measured 100 and 88 points respectively. | [[75.0, 'year']] | M | {'22036536': 1, '15107698': 1, '17606786': 1, '3833948': 1, '15726075': 1, '22048095': 1, '21705237': 1, '22361717': 1, '21330156': 1, '21328021': 1, '20554454': 1, '23116927': 1, '20190310': 1, '23238604': 1, '31211193': 1, '22058304': 1, '10226968': 1, '12851570': 1, '12195253': 1, '25672497': 1, '22588413': 1, '22047787': 1, '15570228': 1, '22361714': 1, '16979048': 1, '19297199': 1, '21419661': 1, '7466956': 1, '12378161': 1, '17931898': 1, '18829916': 1, '22959525': 1, '24403762': 2} | {'3883189-1': 2} |
165,062 | 3883190-1 | 24,403,763 | noncomm/PMC003xxxxxx/PMC3883190.xml | Successful treatment of fractures of the base of the acromion after reverse shoulder arthroplasty: Case report and review of the literature | A 71-year-old right-handed woman presented with a 2-year history of right shoulder pain and dysfunction, which began abruptly when lifting a heavy load. At the initial evaluation, her range of motion was limited, particularly in active abduction as she achieved only 45 degrees in this plane. A cuff arthropathy (Hamada grade 3) was diagnosed and the decision was taken to proceed with reverse shoulder arthroplasty. To complete the pre-operative assessment, a CT scan was performed which confirmed there was no acromial pathology involved.\nA reverse shoulder prosthesis and a biceps tenodesis was carried out (Delta Xtend™, Depuy, Warsaw, IN, USA) through a deltopecoral approach []. The patient's right arm was immobilized in a sling and the range of motion exercises were started 6 weeks after arthroplasty []. Five months after surgery, she sustained a blow to the right shoulder but sought medical attention 1 month later, at her scheduled follow-up visit. Radiographs showed a displaced fracture at the base of the acromion []. A CT scan was performed to better characterize the fracture. This showed that both the humeral and glenoid components were well fixed and the only pathology was the fracture.\nShe was taken to the operating room and her previous incision was extended into a “sabre” incision to better expose the acromion. Two small fragment (3.5 mm) locking plates (Synthes, West Chester, PA, USA) were used in a 90/90 configuration; one was a fragment specific clavicular plate and the other a reconstruction plate. The fragment specific clavicular plate was applied on the superior edge of the scapular spine in a compression mode. Distally, 2.7 mm locking screws were used. A second reconsrtuction plate was applied from the posterior acromion to the posterior cortex of the scapular spine, in the infraspinatus fossa. Long screws were placed from the posterior to the anterior acromion. Fixation was solid, but in order to protect the construct, the patient was placed in an abduction brace for 6 weeks.\nEighteen months after fracture fixation, the patient was satisfied with the clinical result []. She was capable of 125 degrees of abduction, 160 degrees of forward flexion, 85 degrees of external rotation in adduction, and 60 degrees of internal rotation. Her QuickDASH score was 29.5 (compared to 82.5 pre-op) and Constant score was 69 on the affected side compared to 85 on the left side, for a “good” functional outcome. | [[71.0, 'year']] | F | {'22583895': 1, '11182731': 1, '20506958': 1, '31757937': 1, '22013577': 1, '29222664': 1, '21493106': 1, '19250846': 1, '27583005': 1, '29968503': 1, '21448773': 1, '15726075': 1, '33330203': 1, '33681847': 1, '32913063': 2, '31956943': 1, '16085607': 1, '22192769': 1, '28898793': 1, '24403763': 2} | {'7484859-1': 1} |
165,063 | 3883201-1 | 24,404,460 | noncomm/PMC003xxxxxx/PMC3883201.xml | Masochistic habits in a child patient: A case report and its management | A 6-year-old female patient with the chief complaint of pain along with burning sensation in relation to the gums between her upper-left back teeth for the past 10 days. At the time of the clinical examination, the patient had a healthy appearance and seemed relaxed and communicative, average in her studies at second standard with normal IQ level. Socio-economic status revealed that parents were from middle class socio-economic background leading a happy contented life.\nDuring the intraoral examination a bite-wing radiograph was taken to rule out for any foreign body impaction or proximal caries. There was evidence of gingival stripping on the buccal surface extending 4 mm apical to the cement–enamel junction and a narrow zone of attached gingival margin measuring approximately 1 mm []. There was also loss of papilla height on the distal aspect of the first deciduous molar tooth. The gingiva in this region was edematous, reddish, and had an ulcerated appearance (“the ulcer looked raw”); plaque deposits were minimal.\nThe parents were interviewed regarding any unusual practices or habits involving the child's mouth. Mother indicated that the child pricked at the area with her fingernails and also child patient had a habit of left forearm sucking, since birth for the past 6 years. A Hyperpigmented area of 12 × 7 mm was visible in the left forearm region [].\nA detailed family history was taken to rule out untoward family background. All were negative and not supportive for the cause. It was concluded that severe gingival stripping and hyper-pigmentation on the forearm observed in this case was primarily the result of self-injury. It was recommended that a full arm sleeve covering the arm and fingers during sleeping and play hours can be used for habit breaking []. Selective grinding of cusps was done on the lower-left first and second primary molars. Topical anesthetic gel was prescribed.\nAfter 1-month follow-up, the gingiva in relation to the upper-left deciduous molars healed []. After 1-year follow-up, the parents reported that the child discontinued the habit of NB and also the forearm sucking frequency was reduced. Dermatological management for hyper-pigmentation on the left forearm scar was done. | [[6.0, 'year']] | F | {'10420242': 1, '6575172': 1, '6592553': 1, '23358880': 1, '4507270': 1, '8897536': 1, '8530335': 1, '8002775': 1, '9262803': 1, '28274078': 1, '9122322': 1, '24404460': 2} | {} |
165,064 | 3883202-1 | 24,404,461 | noncomm/PMC003xxxxxx/PMC3883202.xml | Repeated snake bite for recreation: Mechanisms and implications | A 25-year-old software engineer came to emergency department (ED), with a request to get himself tested for HIV infection, even though he did not have any previous episodes of unprotected sexual intercourse or any illicit drug use. However, he said that he has subjected himself willfully to repeated snake bite over a period of 6 months with an interval of 30-45 days between each exposure. Patient was questioned on the awareness of toxic effects of snake venom and he had optimal knowledge. Incidentally, he said that he was stressed very much and had insomnia, due to immense work pressure. As some of his colleagues exposed to snake bite willfully felt relieved of his stress and experienced euphoria, patient accepted for willful snake bite and felt relaxed and had good sleep also. With patient's consent, he was investigated for HIV and his serology was negative. After this episode another friend of primary case, who is also a software engineer of 23 years old, came to ED with same request, as he has subjected himself to willful snake bite. He experienced sound sleep for 20-24 h and had relaxed mind after snake bite without any hang over/head ache, tremor, and sense of crawling. He also felt that his sexual desire has increased. Both of them did not experience any withdrawal symptoms. General and systemic examination including psychological assessment did not reveal any abnormalities in both. Their basic hematological and biochemical profile were within acceptable levels.\nInterestingly, these two cases informed that there are different dens in different cities wherein people who want to have snake bite are allowed to sit in chairs. The person in charge of snakes holds the snake near the head end of snake just distal to lip margin. Initially, he makes the snake to inject minimal bite in little toe or index finger for minimal envenomation, and then, he makes the snake to bite in lip or tongue of individuals according to their wish. The most commonly used snakes were krait, cobra, and green snake. Persons who were bitten, showed jerky movement and left the room within few minutes. From the reports provided orally, six persons lost their life due to such procedure. Many people who use such dens were from high socioeconomic status and well educated. Some of them were youth and college students. | [[25.0, 'year']] | M | {'19128201': 1, '13844637': 1, '29875536': 2, '7638877': 1, '21302184': 1, '13626968': 1, '13268822': 1, '16588047': 1, '19922674': 1, '16539838': 1, '1136977': 1, '2132253': 1, '34984148': 2, '24404461': 2} | {'8715837-1': 1, '5968650-1': 1} |
165,065 | 3883203-1 | 24,404,462 | noncomm/PMC003xxxxxx/PMC3883203.xml | Candidiasis: An unusual cause of persistent high-grade fever in mid-pregnancy | A 29-year-old female in 27th week of her gestation presented to obstetrical emergency ward with chief complaints of high-grade fever for the last 8 days. Initially, she was treated as an outpatient at the community hospital by a primary physician for fever and mild cough. She was prescribed tablet Amoxicillin 500 mg four times daily for 5 days on suspicion of upper respiratory tract infection on an empirical basis. In addition, her routine investigations done at a community hospital revealed a hemoglobin value of 10.8 g%, a random blood sugar value of 132 mg%, a blood count value of 10,600/cumm. No abnormality was detected in the routine urine examination. On the basis of investigation reports, she was discharged home on the same day by the primary care physician after the routine examination. In spite of taking the prescribed medication, no clinical improvement occurred and fever could be controlled only intermittently by administration of antipyretics. However, after completion of the prescribed duration of antibiotic therapy, fever remained persistently high in the range of 100–102 °F. The pregnant state, persistent fever refractory to treatment, discomfort, and resulting anxiety were the main decisive factors, which forced the primary physician to refer the patient to a higher center instead of going for the battery of tests for PUO during the follow-up visit. The entire treatment was carried out at home, and she was never admitted at the community hospital.\nOn admission at our tertiary care center, besides fever, she did not give any history of bowel symptoms but dysuria was one of the presenting features. After a thorough initial clinical evaluation, all the requisite investigations for possible causes of pyrexia were sent for. Her general physical examination revealed numerous maculopapular lesions over the upper abdomen including the inframammary region. [] On local examination of genitalia, a purulent and foul smelling discharge was present at the vagina along with extensive vulval ulceration as well as the presence of papular lesions on the perineum, groin, and inguinal region. The most striking feature during her physical examination were the presence of rashes which the patient did not convey to the primary care physician as these were thought to be of little significance and unrelated to pregnancy by the parturient. Moreover, in an Indian set-up, female pregnant patients are reluctant to allow for complete examination by the attending primary physician. Ultrasonography (USG) examination of the abdomen was not informative of any significant pathology and a live foetus of approximately 27 weeks gestation was confirmed by USG report. Awaiting the laboratory investigations, an urgent physician and dermatologist consultation was sought. She was provisionally diagnosed to be a case of PUO with possibility of systemic bacterial infection and local fungal infection (intertrigo). On the basis of provisional diagnosis, she was prescribed tablet cefoperazone in an empirical manner and local application of clotrimazole powder. The laboratory profile turned out to be absolutely normal including blood count, urine complete and culture sensitivity examination, blood culture and sensitivity, erythrocyte sedimentation rate, malaria parasite film, renal function panel, liver function tests, sputum culture and sensitivity, viral markers for HIV and hepatitis, VDRL, and other pathologies. Other routine investigations such as blood sugar were absolutely normal, but peripheral blood film revealed the presence of normochromic normocytic anemia. In spite of administration of antibiotic therapy, she had persistent fever in the range of 101–102°F with occasional remissions of few hours after administration of antipyretics.\nThe clinical scenario of refractory fever and the laboratory findings enforced us to review our diagnosis. After thorough discussion among the physician, dermatologist and the obstetrician, a possible diagnosis of intertrigo with severe invasive and systemic candidiasis infection was thought of. The clinical scenario was thought of as a flare-up of opportunistic fungal infection in the context of systemic administration of antibiotics. However, the contradictory fact to this clinical scenario was the presence of these rashes for the last one month. The diagnosis was further confirmed by the presence of candida growth on KOH preparation and she was treated with fluconazole tablet 150 mg once a week, washing with KMnO4 and local application of clotrimazole powder besides the administration of ongoing antibiotic regimen. She responded to this therapeutic regimen and fever subsided gradually over a period of 2 days. The entire later course of gestation was uneventful, and the patient delivered a normal healthy baby at term pregnancy. | [[29.0, 'year']] | F | {'23919197': 1, '15703536': 1, '9839360': 1, '10619727': 1, '9407158': 1, '15166070': 1, '18514828': 1, '4014176': 1, '25422561': 1, '15373964': 1, '14756894': 1, '24404462': 2} | {} |
165,066 | 3883204-1 | 24,404,463 | noncomm/PMC003xxxxxx/PMC3883204.xml | A brain-dead pregnant woman with prolonged somatic support and successful neonatal outcome: A grand rounds case with a detailed review of literature and ethical considerations | Our patient was a 35-year-old woman, gravida 2 para 2, with no previous history of chronic medical illnesses except for gestational diabetes. She presented at 16 weeks of gestation to the emergency department with an acute-onset excruciating headache after waking up in the morning. The patient had tonic-clonic convulsions at home as witnessed by her husband. In the emergency department, the patient had low Glasgow Coma Scores (GCS) that required intubation. At the emergency department, a computed tomography (CT) scan revealed a left frontal hematoma measuring 5 × 2.6 × 3.5 cm with mild edema and mass effect causing a midline shift of 4 mm to the right. There was also bleeding that spread to the left lateral ventricle via the third ventricle into the fourth ventricle. Additionally, there was a left subdural hematoma that measured 4 mm in diameter. The basal cisterns were still open.\nCT angiography (CTA) of the brain done on the same day revealed frontal lobe bleeding, carotid bifurcation aneurysm, and a small subarachnoidal bleeding. Especially relevant was the intraventricular bleeding that could lead to a later hydrocephalus. The patient was then sent to the operating room (OR) on the same day where a trial of coiling of the aneurysm failed. The patient was then admitted to the intensive care unit (ICU) for monitoring and supportive measures. She remained sedated on mechanical ventilation (MV). She was noted to have 2 mm size midposition pupils with sluggish reaction to light bilaterally. On the second day, a second trial of endovascular coiling failed.\nOn the third day in the ICU and upon physical examination, the patient had a sudden dilatation of the left pupil to 3 mm with a sluggish reaction to light, and the right pupil remained 1 to 2 mm in size. Additionally, her heart rate dropped to 55–59 beats/minute with a blood pressure of 110/60 mmHg that was managed with crystalloid and colloid therapy plus low doses of norepinephrine. Urgent CT of the brain was then performed and revealed modest subarachnoidal rebleeding with a spastic reaction of the vessels with extended ischemia in the middle cerebral artery (MCA). Moreover, there were signs of mesotemporal herniation on the left side. The third ventricle was well separated which indicated some flow problem at the aqueduct level.\nOn the fourth day, the patient was taken for another trial of coiling but that also was difficult; there was also an occlusion of the left carotid system by a thrombus. CT of the brain showed deterioration when compared to the previous examination; the ischemic areas were better demarcated corresponding to the left MCA and part from the left anterior cerebral artery with perforating branches to the basal ganglia. The midline shift had increased and there was an increase in the effacement of gyri and sulci.\nCerebral angiography revealed a thrombosis in the left internal cerebral artery (ICA) and MCA. Of note, there was no carotid artery aneurysm. Partial mechanical thrombectomy for MCA/ICA system was done.\nAfter the last attempt of failed coiling, the pupils became fixed and dilated at 7 mm bilaterally. Therefore, the patient was shifted to the OR on the same day for decompressive craniotomy and placement of external ventricular drains (EVD) for monitoring intracranial pressure (ICP). The patient then came from OR ventilated and sedated with fixed dilated pupils (right pupil 4 mm in size, and left was 7 mm in size) with no cough or gag reflexes and an ICP monitor reading of less than 10 mmHg. On the fifth day, the ICP started rising and reached up to 50 mmHg. Medical management for high ICP was started and included muscle relaxants, mannitol, hypertonic saline infusions, and thiopental coma without success. As such, ICP remained elevated until removal of the monitor on the eighth day of admission.\nUpon physical examination, the patients had a GCS of 3 with no gag or cough reflexes, while the pupils were 5 mm dilated in size and fixed. Consequently, sedation was stopped on the ninth day. Apnea test was not done due to a viable fetus and the use of vasopressors, whereas EEG was not done because of the local scalp and skull conditions as the brain tissue was visible.\nUpon confirmation of this diagnosis, our patient received full ventilatory and nutritional support, vasoactive drugs, maintenance of normothermia, and other supportive measures required to prolong gestation and improve the survival prognosis of her fetus. The 110-day hospital course of the patient was complicated by medical problems that included severe hypotension managed with vasopressors, and hypertension treated with antihypertensives. Intranasal 1-deamino-8-d-arginine vasopressin (DDAVP, Rhone-Poulenc Rore Pharmaceutical Inc., Collegeville, PA) and water flushes through the nasogastric tube (NG) were initiated for the treatment of diabetes insipidus and hypernatremia. Additionally, the patient developed several episodes of sepsis due to pneumonia, urinary tract infection, and line infection that were treated successfully with antibiotics. Moreover, the patient developed meningitis that was treated with meropenem 2000 mg intravenously three times daily and vancomycin 1000 mg twice daily with a target trough level of 15 to 20 mg/L. Panhypopituitarism was also treated with thyroid hormone replacement and steroids. Hypothermia was managed with passive rewarming and blankets. A tracheostomy was performed on the 18th hospital day. Early in the hospital course, feeding was initiated through an NG tube. All decisions regarding the treatment of the patient were taken with the consensus of her family. The current status of the patient was discussed with a multidisciplinary approach and involved the adult and infant ethics committees. The decision was to continue somatic support until the patient was 32 weeks gestation and a cesarean section (CS) could be done. An ultrasound scan after admission revealed intrauterine growth retardation (IUGR) with biometry corresponding to 25 weeks gestation, an estimated fetal weight of 650 gm, and oligohydramnios with no other fetal anomalies. Subsequently, intrauterine monitoring of the fetus was performed using serial ultrasounds, heart rate monitoring, and amniocentesis. Betamethasone therapy was also administered for fetal lung maturity and prophylaxis of fetal respiratory distress syndrome.\nLower segment CS was performed. A preterm male in breech presentation was delivered with an Apgar score of 6/7/9 at 1, 5, and 10 min, respectively, and an average weight of 750 gm. The baby was immediately transferred to the neonatal intensive care unit (NICU). Application of nasal continuous positive airway pressure (CPAP) was necessary owing to a mild respiratory distress syndrome.\nApnea test was done twice on the mother with positive results on both occasions. On the basis of the clinical examinations and these confirmatory technical tests, death was pronounced. | [[35.0, 'year']] | F | {'29643882': 1, '3191063': 1, '34625089': 1, '7109206': 1, '10454672': 1, '12682499': 1, '19930309': 1, '680611': 1, '11051621': 1, '12433531': 1, '15618920': 1, '10933736': 1, '9726218': 1, '19460668': 1, '31431925': 1, '11651609': 1, '34001845': 1, '3688063': 1, '2761925': 1, '16215355': 1, '31485106': 1, '10394539': 1, '32431420': 1, '3392814': 1, '7109202': 1, '11075735': 1, '21087498': 1, '26830897': 1, '12781540': 1, '24404463': 2} | {} |
165,067 | 3883215-1 | 24,404,532 | noncomm/PMC003xxxxxx/PMC3883215.xml | Symptomatic Infantile Hepatic Hemangioendothelioma Successfully Treated with Steroid | One day old male infant, after an uncomplicated pregnancy and delivery, was referred from the periphery with a presenting feature of poor feeding and respiratory distress. There was no antenatal ultrasonography report available. Examination revealed an irritable child, weighing 2.7 kg, in respiratory distress with relative ratio about 120/min, hazard ratio 180/min, and a high-volume pulse. There was cardiomegaly, a grade 3/6 ejection systolic murmur in the tricuspid area and a left ventricular S3. There were fine crackles over both lungs at the basal region. Liver was soft, 4 cm below the costal margin at the right mid clavicular line. A large firm mass, with irregular surface was palpable over left hypochondrium, epigastric and left lumbar region measuring about 8 × 5 cm, not bimanually palpable.\nThe complete hemogram were normal. There was evidence of prerenal azotemia (blood urea 47 mg/dL and creatinine 0.94 mg/dL). Serum bilirubin, liver enzymes, and serum alpha fetoprotein (AFP) (1.5 mcg/mL) were essentially normal.\nThe chest X-ray showed cardiomegaly and pulmonary venous congestion. The electrocardiography was normal except sinus tachycardia. Echocardiography showed left and right ventricular dilatation, with normal valves and intact septae. There was no patent ductus arteriosus or coarctation. Ejection fraction (EF) was 58% along with mild tricuspid regurgitation and trivial mitral regurgitation.\nUltrasonography of the abdomen showed a well-defined lump measuring 8.5 × 5.2 cm, having marked internal vascularity in the upper abdomen, separated from spleen and kidney. Liver was enlarged with hugely dilated left hepatic vein (LHV). Intrahepatic biliary radicals and common bile duct were also dilated [].\nThen computed tomography (CT) scan of the abdomen showed features suggestive of hemangioendothelioma of liver arising from the left lobe exophytically. Focal calcifications were present; LHV was dilated and there was narrowing of aorta below the level of the celiac artery [].\nCardiac failure was managed with fluid restriction, oxygen, diuretics, and inotropic support for 2 days. But there was no clinical improvement noted. Then after studying different literature, oral prednisolone was started in a dose of 4 mg/kg/day in two divided doses. There was a dramatic improvement in general physical condition of the child. Prednisolone was tapered to 4 mg/kg/day on alternate days after 2 weeks, 2 mg/kg on alternate days by 6 weeks and 1 mg/kg on alternate days at 3 months. At 3 months follow-up, the child was gaining weight steadily, size of the mass had decreased considerably, and echocardiography showed normal EF (65%). Follow-up USG showed a decrease in vascularity and size of the hemangioendothelioma (3.2 × 2.1), but LHV was still dilated. | [[1.0, 'day']] | M | {'32923186': 2, '32662716': 2, '8669536': 1, '11880743': 1, '11100498': 1, '11960239': 1, '33532427': 2, '31601179': 2, '32139986': 1, '8955471': 1, '32541524': 2, '24404532': 2} | {'6788120-1': 1, '7842472-1': 1, '7478462-1': 1, '7302649-1': 1, '7361506-1': 1} |
165,068 | 3883217-1 | 24,404,534 | noncomm/PMC003xxxxxx/PMC3883217.xml | Congenital Longitudinal Radial Deficiency in Infants: Spectrum of Isolated Cases to VACTERL Syndrome | This was a case report of a 1-month-old-female infant was referred from evaluation of the congenital deformity of left upper limb. The baby was born to a 22-year-old primipara mother at term and her perinatal history was unremarkable. She was born at term by normal vaginal delivery following an uneventful pregnancy. She was the second child of non-consanguineous parents and there was no family history of any congenital anomaly. Physical examination of the baby was revealed deformity of the left forearm with radial deviation at the wrist and absent thumb [Figure and ]. There was no anal opening at birth and an emergency colostomy was already performed. Barium study performed later confirmed rectovaginal fistula []. Echocardiography showed situs solitus with dextroposition. X-ray chest also revealed D11 hemivertebrae []. Ultrasonography (USG) abdomen was normal. Based on these, she was diagnosed as VACTERL syndrome. Due to associated anomalies, passive physiotherapy had been advised to the parents in consultation with physiotherapists. The baby later developed an infection in the right lung and was treated accordingly. She has been planned for staged repair of rectovaginal fistula followed by re-anastomosis. | [[1.0, 'month']] | F | {'3559066': 1, '10816398': 1, '1264431': 1, '22742195': 2, '16401942': 1, '21483577': 1, '21301772': 1, '22300427': 1, '17213381': 1, '23129952': 1, '34210017': 1, '24404534': 2} | {'3883217-2': 2, '3883217-3': 2, '3883217-4': 2, '3404954-1': 1} |
165,069 | 3883217-2 | 24,404,534 | noncomm/PMC003xxxxxx/PMC3883217.xml | Congenital Longitudinal Radial Deficiency in Infants: Spectrum of Isolated Cases to VACTERL Syndrome | Here we report a case of a 7-month-old-female child was brought by her parents with deformity of the left forearm and absent thumb, which was present since birth []. The baby was the third child in the family and there was no family history of any consanguinity or similar deformity. Her intrauterine history was unremarkable. Physical examination revealed mild deformity of the left forearm, which appeared shorter than contralateral side with radial deviation at the wrist and absent thumb. Routine blood investigations were normal. The radiographs of the forearm with hands revealed type II CLRD [Figure and ]. The ulna on the affected side was shorter than contralateral side. USG abdomen and echocardiography were normal. Patient was taken up for corrective surgery in the form of centralization []. She is on regular follow-up and progressing well and had been planned for thumb reconstruction surgery at 18 months of age. | [[7.0, 'month']] | F | {'3559066': 1, '10816398': 1, '1264431': 1, '22742195': 2, '16401942': 1, '21483577': 1, '21301772': 1, '22300427': 1, '17213381': 1, '23129952': 1, '34210017': 1, '24404534': 2} | {'3883217-1': 2, '3883217-3': 2, '3883217-4': 2, '3404954-1': 1} |
165,070 | 3883217-3 | 24,404,534 | noncomm/PMC003xxxxxx/PMC3883217.xml | Congenital Longitudinal Radial Deficiency in Infants: Spectrum of Isolated Cases to VACTERL Syndrome | A 6-month-old-male child was brought by his parents with deformity of the left forearm. He was born at term by normal vaginal delivery following an uneventful pregnancy. He was the second child of non-consanguineous parents and there was no family history of any congenital anomaly. X-ray forearm with hand was advised, which revealed type IV CLRD []. X-ray chest revealed vertebral segmentation anomaly in the form of hemivertebrae and rib anomalies []. USG abdomen and echocardiographic evaluation were normal. Magnetic resonance imaging spine was advised, which did not reveal any abnormality in the cord. Parents did not gave consent for operative procedure. The mother had been taught passive stretch exercises in consultation with physiotherapists and had been advised regular follow-up. | [[6.0, 'month']] | M | {'3559066': 1, '10816398': 1, '1264431': 1, '22742195': 2, '16401942': 1, '21483577': 1, '21301772': 1, '22300427': 1, '17213381': 1, '23129952': 1, '34210017': 1, '24404534': 2} | {'3883217-1': 2, '3883217-2': 2, '3883217-4': 2, '3404954-1': 1} |
165,071 | 3883217-4 | 24,404,534 | noncomm/PMC003xxxxxx/PMC3883217.xml | Congenital Longitudinal Radial Deficiency in Infants: Spectrum of Isolated Cases to VACTERL Syndrome | A 1-month-old-male infant was referred from a peripheral health center for evaluation of the congenital deformity of right upper limb. The baby was born to a 25-year-old primipara mother at term and his perinatal history was unremarkable. Physical examination of the baby revealed deformity of right forearm with radial deviation at the wrist and complete absent thumb. Routine blood investigations were within normal limits. Plain radiographs of the forearm with hands showed complete absence of radius and thumb on right side []. USG abdomen and echocardiography of the neonate did not reveal any significant finding. The parents were advised consultation with the physiotherapist and regular follow-up. He is planned for centralization at around 6-9 months of age. | [[1.0, 'month']] | M | {'3559066': 1, '10816398': 1, '1264431': 1, '22742195': 2, '16401942': 1, '21483577': 1, '21301772': 1, '22300427': 1, '17213381': 1, '23129952': 1, '34210017': 1, '24404534': 2} | {'3883217-1': 2, '3883217-2': 2, '3883217-3': 2, '3404954-1': 1} |
165,072 | 3883218-1 | 24,404,535 | noncomm/PMC003xxxxxx/PMC3883218.xml | Congenital Bilateral Perislyvian Syndrome: Case Report and Review of Literature | This was a case report of a 7-year-old male child, with a history of generalized tonic-clonic seizures since 2 years, born of vagina delivery with breech presentation. The child had delayed milestones, poor phonation with drooling of saliva and mental retardation and had feeding and swallowing difficulties with protrusion and movement of the tongue moderately impaired. On examination, there was atrophy of the muscles below knee with exaggerated plantar extensor reflexes on both sides. Reflexes were brisk on both sides. And also had bisyllabal speech (normally seen in 12-month-old infants). Magnetic resonance imaging (MRI) of the brain was performed, which showed the multiple small gyri in bilateral parieto-occipital cortices []. There was thickening of the grey matter around the sylvian fissure bilaterally with irregular cortex and widening the fissures [Figures and ]. Bilateral sylvain fissures were hypoplastic and extended dorsally up to the perirolandic region. The body of lateral ventricles shows inverted appearances, typical for this condition. | [[7.0, 'year']] | M | {'12174967': 1, '8145902': 1, '8094839': 1, '15626542': 1, '15168097': 1, '14970044': 1, '9530947': 1, '11508551': 1, '24404535': 2} | {} |
165,073 | 3883238-1 | 24,403,716 | noncomm/PMC003xxxxxx/PMC3883238.xml | Demodex spp. Infestation in a breast-cancer patient: A case report | A 45 year-old female has been admitted to oncology clinic for a medical treatment of breast cancer. Utilizing the National Comprehensive Cancer Network guidelines (NCCN), patient's stage was T2N1MO and we have decided to apply adjuvant chemotherapy of Adriamycin, cyclophosphamide and 5-fluorouracil. Her systemic physical examination was normal except redness on her cheeks and forehead. The patient skin type was oily and her face-washing habit was use of hand soap twice a day. There was no abnormality in biochemical and haematological laboratory values. Due to the itchy redness on her cheeks and forehead, we had performed an examination for demodex before chemotherapy; and we have identified 20 mites/cm2 on her right and left cheeks, and 15 mites/cm2 on her forehead. D. folliculorum was sought in the lesion sites using the non-invasive method, known as standardised skin surface biopsy (SSSB). When our patient came to our clinic with increasing complaint of itchy rash after the first course of chemotherapy, we have reexamined demodex. The result of microscopic examination revealed large amount of demodex of 50 mites/cm2 on her right and left cheeks and 30 mites/cm2 on her forehead, which were significantly higher than the first detection results [Figures and ]. This increase probably was associated with immune suppression caused by chemotherapy. | [[45.0, 'year']] | F | {'18173609': 1, '22135150': 1, '16892604': 1, '15196158': 1, '22135149': 1, '24403716': 2} | {} |
165,074 | 3883239-1 | 24,403,717 | noncomm/PMC003xxxxxx/PMC3883239.xml | A case of concurrent several forms of thyroid cancer | A 40-year-old man presented to medical clinic with right neck mass appeared 2-3 months before. He had not any significant findings in his past medical history except functional colitis. He had not history of smoking, drinking, or drug abusing. He neither had exposure to radiation. He had been working in a shoes workshop without any known risk factors for thyroid cancer. Family history revealed the presence of brain tumor in his cousin. Physical examination showed the absence of lymphadenopathy, organomegaly, or skin changes. The only finding was a round firm painless mass with 2.5-cm diameter at posterior triangle in right side of the neck.\nBlood tests showed normal CBC (with differentiation), FBS, renal, hepatic and thyroid functional tests, U/A, coagulation tests, and CEA, with minimally increased alpha-feto-protein. Thyroid ultrasonography with superficial 7.5-MHz probe was normal. Spiral CT-scan of lungs, abdomen, and pelvis was normal without metastatic lesion. Spiral CT-scan of neck showed a 42 × 37 × 31 mm solid tumor with peripheral calcification in right side posterior triangle behind the SCM muscle, with anteromedial replacement of carotid artery. FNA of the mass revealed PTC.\nRight thyroid lobectomy was performed with right neck lymphadenectomy from level II-V. Early pathologic survey showed normal tissue with mild chronic inflammation for thyroid right lobe, and follicular variant of papillary carcinoma with diffuse areas for resected mass at posterior triangle in right side of the neck [Figures and ].\nConsultation to another expert pathologist revealed the presence of an occult focal area of papillary carcinoma in right thyroid lobe with metastasis to right posterior cervical lymph node, in which papillary and follicular variant transformed to anaplastic cancer [Figures and ].\nThe patient underwent adjuvant radiotherapy with Cobalt 60 THR machine. This therapy continued for five sessions in every week at level I-V and right supraclavicular and infraclavicular region with the dosage of 4500 CG in combination with 30-mg adriamycine. Then, by exclusion of spinal cord, the radiotherapy as boost dosage of 2600 CG was continued at level III-V and right supraclavicular and infraclavicular region without chemotherapy. He is alive and healthy after 4 years. His left thyroid lobe is intact and is being followed-up regularly. Until now, no recurrence is detected. | [[40.0, 'year']] | M | {'15863962': 1, '18838882': 1, '11035572': 1, '7977430': 1, '3334817': 1, '15739211': 1, '16627915': 1, '11833496': 1, '9028369': 1, '2578727': 1, '32377487': 2, '27169108': 1, '32645594': 2, '3623435': 1, '28032497': 1, '33292836': 2, '20551551': 1, '22425061': 1, '10714625': 1, '24403717': 2} | {'7198103-1': 1, '7640618-1': 1, '7341056-1': 1, '7341056-2': 1, '7341056-3': 1, '7341056-4': 1, '7341056-5': 1, '7341056-6': 1} |
165,075 | 3883240-1 | 24,403,718 | noncomm/PMC003xxxxxx/PMC3883240.xml | Bilateral impacted femoral neck fracture in a renal disease patient | A 47-year-old female was referred to the Orthopaedic Surgery and Trauma department because of pain in both groin and hip region while going for regular hemodialysis for her renal problem. She has been diagnosed as having diabetes mellitus (DM), hypertension (HTN) 10 years previously and was diagnosed as having chronic renal failure (CRF) 8 years back and has been receiving hemodialysis three times a week for the past 5 years. Consent from the relevant authority and from the patient was obtained to publish the case.\nThere was no history of injury, trauma, fall, seizure, steroid medication, fluoride treatment, smoking and alcohol abuse. On physical examination there was no active bilateral motion of the hips and very painful on passive movement. Pelvic radiograph examination did not clearly show fractures but the shortened neck of femur was seen and suggesting femoral neck fracture. The routine blood examination showed that she had moderate anaemia and serum urea was 17.6 mmol/L (normal value: 2.5-14.5), creatinine was 401.02 umol/L (normal value: 50.4-98.1), calcium total was 2.39 mmol/L (normal value: 2.10-2.55), phosphate inorganic was 1.07 mmol/L (normal value: 0.74-1.52), vitamin D was 53.48 pmol/L (normal value: 60-108) and para-thyroid hormone level was 105.37 ng/L (normal value:10-65).\nComputed tomography (CT) of pelvic [] was performed and showed the impacted bilateral fractures of neck of femurs with minimal right varus angulation. Multiple vertebral bodies’ collapses are also present with severe and diffuse reduction in mineralization. Gibbous deformity present due to the fractures of vertebral bodies of (thoracic spine) T6, T7, T8, T10 and (lumbar spine) L1. Bilateral hydro-nephrosis and thickening of the bladder wall were found on abdominal ultrasonography.\nThe patient and relatives were educated on the possible complications of the treatment of bilateral femoral neck fracture and they decided not to go for any surgical intervention. She was not able to walk and mobilised on wheel chairs only. After one year of bilateral femoral neck fracture, she is still alive and on regular dialysis with wheel chair mobilisation. | [[47.0, 'year']] | F | {'4040914': 1, '12666297': 1, '9602817': 1, '9602784': 1, '8039943': 1, '2225628': 1, '34775322': 1, '6370824': 1, '32293406': 2, '7593062': 1, '6408099': 1, '26811714': 1, '10990395': 1, '4924794': 1, '4830515': 1, '30167423': 2, '24403718': 2} | {'6114199-1': 1, '6114199-2': 1, '7158116-1': 1} |
165,076 | 3883259-1 | 24,404,369 | noncomm/PMC003xxxxxx/PMC3883259.xml | Primary Perianal Tuberculosis in a Diabetic Patient | A 52-year-old man presented with acute perianal abscess with ulcerated and indurated edges. The lesion developed as an insidious onset of 1 month duration. The patient is a known case of diabetes for last 5 years and he is on anti-diabetic treatment. There was no past history or family history suggestive of tuberculosis. Local examination of anus showed a 2 cm × 1 cm swelling with posterior ulceration and irregular margin. Per rectal examination and colonoscopy revealed no abnormality. Laboratory findings including, routine hematological parameters, biochemical parameters (renal function test and liver function test), and urine biochemical findings were normal. Erythrocyte sedimentation rate (ESR) was mildly raised to 25 mm/h. Radiological tests like chest X-ray, abdominal contrast computed tomography were normal. Sputum smear examination on three consecutive days was negative for acid fast bacilli. Histopathological examination of biopsy from the edge of lesion revealed organizing inflammatory granulation tissue, areas of caseating necrosis and scattered epithelioid histiocytes. EZN staining was positive for acid fast bacilli []. Polymerase chain reaction (PCR) of biopsy material was positive for mycobacterium tuberculosis. The patient was put on anti-tubercular treatment for 6 months and the lesion healed completely without any recurrence in 1 year of follow-up. | [[52.0, 'year']] | M | {'19555537': 1, '9195814': 1, '7630074': 1, '16615850': 1, '8672766': 1, '7837722': 1, '9364811': 1, '1558924': 1, '24404369': 2} | {} |
165,077 | 3883268-1 | 24,404,410 | noncomm/PMC003xxxxxx/PMC3883268.xml | Vena Caval Anomalies | A 44-year-old fit and active female was referred by her general practitioner with palpitations, mostly occurring at rest. Electrocardiography performed in the community demonstrated sudden onset of an atrial tachycardia of 115 beats per min. When assessed in hospital, she was asymptomatic with a blood pressure of 110/62 and a regular pulse rate of 50 beats per min. Resting electrocardiography revealed sinus rhythm with poor R wave progression with no evidence of left ventricular hypertrophy or ischemia. A 24-h electrocardiography demonstrated four beats of atrial tachycardia.\nA transthoracic echocardiogram demonstrated a prominent coronary sinus, moderate mitral regurgitation, and a bicuspid aortic valve []. Transesophageal echocardiography showed normal biventricular systolic function, left atrial dilatation, mild to moderate mitral regurgitation, and tricuspid regurgitation. The aortic valve was bicuspid with trivial aortic regurgitation but no significant stenosis. The ascending aorta was dilated for her age and body surface area, with a maximum diameter of 4.0 cm. There was no evidence of aortic coarctation or dissection.\nSaline contrast echocardiography was performed via the left and right arms [], [], [] and []. This confirmed PLSVC with no obvious shunt. Cardiac magnetic resonance imaging (MRI) demonstrated bicuspid aortic valve with dilated aortic root. A PLSVC was seen draining into the coronary sinus and then the right atrium. A separate right-sided non-hypoplastic superior vena cava also emptied into the right atrium. It was noted that a left-sided IVC drained into the coronary sinus and right atrium. Three hepatic veins were seen emptying into a short right-sided IVC, again draining into the right atrium. | [[44.0, 'year']] | F | {'18400641': 1, '1797901': 1, '26955497': 2, '11451829': 1, '2194663': 1, '7788639': 1, '24404410': 2} | {'4756163-1': 1} |
165,078 | 3883269-1 | 24,404,404 | noncomm/PMC003xxxxxx/PMC3883269.xml | Long segment spinal epidural extramedullary hematopoiesis | A 25-year-old male with known thalassemia intermedia, who had never previously required a blood transfusion, presented with a 1-month history of stiffness and weakness in both lower extremities without accompanying sphincteric dysfunction. The general physical examination revealed palpable splenomegaly, while the neurological assessment demonstrated localized tenderness over the D5 level, with attendant 4/5 weakness in both lower extremities, hyperactive bilateral Patellar and Achilles reflexes with bilateral Babinski responses, and a graded sensory loss to pin appreciation below D5.\nThe magnetic resonance imaging (MRI) of the thoracic spine revealed a posterior, isointense soft tissue epidural mass extending from D2 to D12 on both pulse sequences (T1, T2), suggestive of “red marrow” [Figures and ]. The cord appeared compressed anteriorly, thinned, and atrophic. The vertebral bodies displayed isointense to hypointense signals on both T1WI and T2WI images along with coarsening of the trabecular pattern; these findings suggested a hypercellular bone marrow consistent with EMH. Of interest, the cervical spine MR was normal.\nThe patient was given multiple blood transfusions and it was decided to repeat a MRI after a period of 8 weeks and further treatment plan will be decided based on the MRI findings. | [[25.0, 'year']] | M | {'10870303': 1, '17405752': 1, '23330877': 1, '18552471': 1, '21111477': 1, '21912883': 1, '9806521': 1, '9883960': 1, '7846603': 1, '7897533': 1, '27857455': 1, '12838112': 1, '7304292': 1, '7387474': 1, '22470615': 1, '13151530': 1, '34084519': 2, '8266922': 1, '8718506': 1, '14765145': 1, '6944618': 1, '8965112': 1, '20204423': 1, '8306365': 1, '28133558': 2, '1583517': 1, '29899793': 1, '12604297': 1, '3720753': 1, '7247589': 1, '7143072': 1, '16462720': 1, '1113158': 1, '24404404': 2} | {'8142798-1': 1, '5241451-1': 1} |
165,079 | 3883271-1 | 24,404,413 | noncomm/PMC003xxxxxx/PMC3883271.xml | Radiological Imaging Findings of a Case with Vertebral Osteoid Osteoma Leading to Brachial Neuralgia | An 18-year-old male patient presented with a 6-month history of pain in the neck, shoulder, and left arm. The pain had increased over 6 months and become more evident during the night. He had no infection or history of trauma. He had been treated with salicylates and other painkillers that reduced his complaints. On physical examination, hypoesthesia was found on his C7-T1 dermatomas and no pathological finding was evident in the laboratory evaluation.\nOn anteroposterior cervical X-ray of the patient, a well-contoured radiolucent nodular lesion, 1.5 cm in diameter, which had a thin highly sclerotic rim around was evident on T1 vertebra left lamina-transverse process junction. In addition, minimal scoliosis whose opening was toward left was noticed on cervical vertebral axis []. Upon finding the brachial neuralgia and nodular lithic lesion on the bone, contrast-enhanced MRI examination was performed to determine the possible association of lesion with brachial plexus elements and neighboring tissues as well as to rule out other causes of brachial neuralgia such as disc lesions. On MRI of the patient, about 1.5 cm diameter bone lesion of slightly expansile nature located on T1 vertebra left transverse process-lamina junction was observed. There was a rim around the lesion, which was well-contoured and had focus areas void of signal on all MRI series, suggesting millimetric calcification and hypointense sclerosis. There were hypointense signals on T1-weighted series and slightly hypointense signals on T2-weighted series, concordant with intense edema in the paravertebral soft tissues and in the bone marrow of vertebra where the lesion was located and in adjacent vertebrae [Figures and ]. After the application of paramagnetic contrast agent, a heterogeneous mild enhancement was noticed on the lesion and intense medullary bone marrow enhancements were seen on adjacent bone structure. Intense enhancement was observed on the left apical pleural surface and soft tissues around the truncus, on left C7-T2 nerve roots, and paravertebral soft tissues adjacent to the lesion [Figures and ]. Although MRI findings of the lesion showing extensive edema in surrounding tissues suggested osteoid osteoma, CT examination was performed to make a more detailed evaluation of vertebral bone structures and to confirm the diagnosis. A well-contoured hypodense lesion showing typical osteoid osteoma features having heterogeneous hyperdense calcified bone matrix in T1 vertebra left lamina-transverse process junction was observed on cervicothoracic vertebra CT. Density increase concordant with intense sclerosis was noticed on adjacent bone structures []. After the operation, pathologic diagnosis confirmed the radiologic diagnosis of osteoid osteoma. | [[18.0, 'year']] | M | {'18034242': 1, '15973540': 1, '1887121': 1, '11981626': 1, '18515029': 1, '22340346': 1, '33900941': 1, '27795776': 1, '12944597': 1, '26139654': 1, '26266175': 1, '10700833': 1, '17030549': 1, '24404413': 2} | {} |
165,080 | 3883272-1 | 24,404,414 | noncomm/PMC003xxxxxx/PMC3883272.xml | Computed Tomography Findings of an Unusual Maxillary Sinus Mass: Brown Tumor Due to Tertiary Hyperparathyroidism | A 59-year-old man presented with a 10-month history of progressively increasing swelling in the left maxillary sinus and associated pain. He also had signs and symptoms of chronic renal failure developing following long-standing pyelonephritis with urolithiasis. He was maintained on hemodialysis 4 h, three times per week. Physical examination revealed a large mass located in the left maxillary sinus. The mucosa-covered lesion was discernible at the left maxillary vestibule. Routine laboratory exams revealed the following: Blood urea nitrogen 33 mg/dL, serum creatinine 7.8 mg/dL, serum calcium 11.7 mg/dL (normal range: 8.6-10.2 mg/dL), alkaline phosphatase 304 IU/L (normal range: 40-150 IU/L), and parathormone 1942 pg/mL (normal range: 12-65 pg/mL). Due to the high serum calcium level, the patient was diagnosed with tertiary HPT associated with long-standing chronic renal failure. Maxillofacial computed tomography (CT) scan revealed a 38 × 46 × 68 mm, well-defined, lobular, expansile radiolucent mass in the left maxillary sinus extending through the left nasal cavity, floor of the orbit, left infratemporal fossa, and premaxillary soft tissue. The anterior, medial, and posterior walls of the maxillary sinus were eroded. The mass was slightly hyperdense with adjacent soft tissue on contrast-enhanced maxillofacial CT scan []. The differantial diagnosis of the lesion included benign and malignant tumors of jaw, odontogenic tumors, infectious diseases, metastasis, simple bone cyst, and Brown tumor.\nThe incisional biopsy followed by histopathologic investigation of the excised mass revealed a lesion with regions of discrete bone resorption with osteoclast activity, fibroblasts with areas of hemorrahage, and multinucleated giant cells []. Finally, together with the medical history, imaging and pathological findings, and laboratory results, our case was diagnosed as tertiary HPT with Brown tumor of maxillary sinus. Ultrasound examination of the neck showed enlargement of all four parathyroid glands. A subtotal parathroidectomy was performed. Postoperatively, there was distinct improvement as shown in the blood profile with serum phosphate, calcium, and parathormone levels dropping to 5.2 mg/dL, 9.8 mg/dL, and 3 pg/mL, respectively. There have been no signs of enlargement or destruction of adjacent bone tissue during the 27-month follow-up period. CT scan (in January, 2013) 27-months post-treatment showed thickened cortical bone of the tumor walls, decreased tumor size, and increased density of the lesion matrix []. | [[59.0, 'year']] | M | {'16798410': 1, '21462819': 1, '28616750': 1, '26413096': 2, '19830212': 2, '10450884': 1, '6828717': 1, '14505628': 1, '12796885': 1, '20549204': 1, '19114425': 1, '24404414': 2} | {'2737776-1': 1, '4556817-1': 1} |
165,081 | 3883274-1 | 24,404,402 | noncomm/PMC003xxxxxx/PMC3883274.xml | Microsurgical anatomy of the transsylvian translimen insula approach to the mediobasal temporal lobe: Technical considerations and case illustration | A 19-year-old female presented with new onset of grand mal seizures. Cerebral angiogram [] and magnetic resonance imaging (MRI) of the brain [] demonstrated a Spetzler–Martin grade 4 arteriovenous malformation (AVM) situated in her dominant left mediobasal temporal lobe. The AVM extended from the uncus, involved the parahippocampal gyrus and extended posteriorly to the level of the ambient cistern. The AVM had feeding vessels off the AChA, the posterior communicating artery (Pcomm) and the MCA. Venous drainage of the AVM was through the basal vein of Rosenthal. The options of stereotactic radiosurgery and microsurgical resection were discussed with the patient. It was thought that embolization of the AVM would not be safe due to feeders from AChA and Pcomm perforators. The patient and her family chose to proceed with microsurgical resection.\nThe patient was placed in Mayfield headholder and head was turned to the right with the head slightly extended with the malar eminence the highest point. A left frontotemporal craniotomy along with a two piece orbitozygomatic approach was performed. The sylvian fissure was split widely under the microscope. The M1, ICA, Pcomm, and AChA were identified. Next the limen insula was identified as the area adjacent to the bifurcation of the MCA on the temporal side. Next, the temporal horn of the lateral ventricle was entered at a 45° angle. The AVM was identified in the ventricle. Next, the uncus was resected through the limen insula. Then, using the ventricle as a landmark, through the limen insula corridor the lateral margin of the AVM was dissected. Since the major blood supply of the AVM was supplied by the anterior choroidal at the choroidal point, these feeders were disconnected. Subsequently, the perforators from the posterior cerebral artery and Pcomm were disconnected. We sequentially circumferentially dissected the AVM using a combination of corridor through the limen insula and the ICA oculomotor triangle. Access to the lateral and posterior margins of the AVM was achieved through the translimen insula approach, as described earlier, and these margins were disconnected from their vascular pedicles. At the end there were several draining veins that merged into the basal vein of Rosenthal. These draining veins were eliminated at the very end. An immediate postoperative cerebral angiogram and MRI confirmed complete resection of the AVM [Figure and ] and patency of the AChA, the Pcomm, and PCA.\nPostoperatively the patient was kept intubated and completely sedated with systolic blood pressure range of 90-110 mmHg for 24 hours. Patient's postoperative examination after extubation showed that she was neurologically normal with the exception of a profound left frontalis palsy most likely from extended retraction on the nerve during surgery. At her 6 month follow-up the patient's frontalis nerve palsy is improving. She has had one seizure since surgery and thus still taking her antiepileptic. After the postoperative seizure, a second agent was added and the patient has been seizure free. | [[19.0, 'year']] | F | {'11134379': 1, '30069085': 1, '10584849': 1, '21767263': 1, '1605083': 1, '21841521': 1, '15137609': 1, '14633296': 1, '19612976': 1, '11841723': 1, '21937930': 1, '8492868': 1, '9576254': 1, '17041498': 1, '6689724': 1, '15028139': 1, '20539796': 1, '21613468': 1, '4084377': 1, '10193618': 1, '15540910': 1, '15794836': 1, '15157288': 1, '10549950': 1, '20173571': 1, '10761659': 1, '18408087': 1, '10493377': 1, '7472442': 1, '20489509': 1, '20679924': 1, '19035702': 1, '17041492': 1, '21099562': 1, '27659830': 1, '7054420': 1, '8861693': 1, '15912253': 1, '7842614': 1, '24404402': 2} | {} |
165,082 | 3883331-1 | 24,403,796 | noncomm/PMC003xxxxxx/PMC3883331.xml | Spindle cell carcinoma of the gingiva: A rare occurrence | A 46-year-old male patient reported to the Department of Periodontology, Faculty of Dental Sciences, Sri Ramachandra University, Chennai, India with an intraoral swelling in relation to the lower left first and second premolars for the past 8 months associated with a dull pain. The swelling was initially small and gradually increased in size. He was a known asthmatic, but not under any systemic medication. He gave a history of smoking cigarettes (2 packets/day) for the past 30 years and keeping the tobacco quid on the left side of the vestibular area, but had stopped the habit because of burning sensation. On clinical examination, a single sessile erythematous swelling with a fungating whitish mass in the center was seen []. On palpation, it was firm in consistency measuring about 1.5 cm (apicocoronally) and 2.0 cm (mesiodistally) extending from the mesial aspect of tooth 34 to the mesial aspect of tooth 36. Both the premolars exhibited grade 1 mobility with tenderness on vertical percussion and no attachment loss. A single submandibular lymph node was palpable on the left side.\nPatient was counseled regarding the cessation of the smoking habit. Scaling was performed on the first visit and selective grinding of the opposing cusp in occlusion was carried out. At the recall visit, the surface necrosis had disappeared (which could have probably been due to withdrawal of tobacco quid usage).\nComplete hemogram, intraoral periapical radiograph and orthopantomograph were taken. Except for an increase in the eosinophil count, all the other blood parameters were within normal range. No significant alterations were evident in the radiographs []. Based on the clinical findings, a provisional diagnosis of SCC was given.\nAn incisional biopsy of the growth was performed under local anesthesia. The tissue specimen was immediately transferred into 10% buffered formalin solution, sent for routine histopathological examination and were further subjected to immunohistochemical (IHC) analysis.\nHistologically, the tumor showed an ulcerated parakeratotic stratified squamous epithelium [] with a focus of epithelial pearl formation []. The underlying connective tissue stroma revealed richly cellular pleomorphic spindle cells arranged in fascicles resembling a herring bone pattern characteristic of a fibrosarcoma []. The sections were further subjected to IHC for cytokeratin, vimentin and CD34 expression. IHC analysis revealed spindle shaped cells that showed positive reactions for cytokeratin [] and vimentin [] but negative for CD34 []. Antibody to podoplanin, a molecule expressed in lymphatic endothelial cells was used. Positive membrane immunoreactivity was observed in the basal cell layer and connective tissue stroma with a relatively increased lymphatic network complexity as compared with the tumor free zone [].\nA whole body plain and contrast computed tomography (CT) view was performed. CT view of mandible with contrast revealed a 17.8 mm × 4.7 mm sized soft-tissue density lesion in the buccal aspect of the body of the mandible on the left side with no evidence of bony erosion []. Few sub centimeter sized lymph nodes were present in the left submandibular [] and bilateral deep cervical (level II) regions [].\nPatient was referred to an oncologist. Following chemotherapy, the patient was subjected to surgical management that involved a segmental resection of the mandible with supraomohyoid neck dissection followed by radiation therapy. | [[46.0, 'year']] | M | {'14570033': 1, '7272943': 1, '11904340': 1, '27630965': 1, '17098672': 1, '28781811': 1, '5424530': 1, '28479698': 2, '19040765': 2, '9563574': 1, '27042594': 1, '13413797': 1, '6935609': 1, '31110445': 2, '24403796': 2} | {'2627831-1': 1, '6503799-1': 1, '6503799-2': 1, '5406791-1': 1} |
165,083 | 3883332-1 | 24,403,797 | noncomm/PMC003xxxxxx/PMC3883332.xml | Importance of ultrasonography and magnetic resonance imaging in diagnosis of cysticercosis of temporalis muscle mimicking temporal space infection | A 35-year-old male patient reported to the Department of Oral Medicine and Radiology with the chief complaint of restricted mouth opening and heaviness on the right side of face since 1 month []. On examination, patient was moderately built and nourished and his vital signs were within the normal limit. He took a vegetarian diet and had no deleterious habits. Extraoral examination revealed a diffuse swelling present in the right infratemporal region measuring approximately 2 cm × 2 cm in size near the outer canthus of the eye []. Swelling was firm, compressible and non-tender on palpation. Overlying skin of the swelling was normal. On intraoral examination, there was grossily decayed mandibular right third molar with deep dental caries in it. It was tender, on probing percussion and palpation. Interincisal; opening was 30 mm. Based on history and clinical examination, a provisional diagnosis of masticator and predominantly temporal space infection secondary to carious mandibular right third molar was given. Radiographic examination revealed an ill-defined radiolucency in apical one-third of mandibular right third molar []. Antibiotic therapy was started, though patient responded to treatment there was a slight improvement in mouth opening, but the temporal swelling still persisted. We planned for high resolution USG on Toshiba Aplio XG USG unit (Japan) with 7.5 MHz linear array transducer probe, it revealed oval 5 mm sized cystic areas with eccentric echogenic nidus with in the right temporalis muscle []. There was mild adjacent edema, but no evidence of collection noted. Surprisingly no sign of infection in the form of cellulitis or edema were seen.\nThe right masseter muscle was normal since, ultrasound helps in detection of superficial fascial space infections. Magnetic resonance imaging (MRI), which is the gold standard for fascial space infections was done by HDe Signa 1.5-T unit with a dedicated coil and revealed 12 mm × 7 mm × 8 mm cystic lesion with hypointense nidus noted with in the belly of the right temporalis muscle with hyperintensity of muscle until mandibular insertion site on image suggestive of intramuscular parasitic cyst []. Furthermore, inflammatory changes were seen in the right masticator space prestyloid parapharyngeal space pterygomandibular fissure and right malar region subcutaneous fat suggestive of space infection []. With the help of USG and MRI, we came to final diagnosis of cysticercosis of the right temporalis muscle, which was an incidental finding. MRI also helped in diagnosing fascial space infection involving masticator, parapharyngeal and pterygomandibular spaces. Empirical antibiotic therapy was given and subsequently incision and drainage was done in masticator space region, 48 was extracted. Cysticercosis was managed conservatively. Patient was given albendazole 15 mg/kg body weight/day for 14 days. A repeat MRI was performed after 3 months, which showed no abnormality in the right temporal region []. | [[35.0, 'year']] | M | {'11833875': 1, '12932389': 1, '25348741': 1, '27508147': 1, '17955174': 1, '21529806': 1, '17223588': 1, '17395067': 1, '22124076': 1, '9766536': 1, '30449967': 2, '30344386': 1, '11152193': 1, '34104406': 2, '25734242': 1, '21378424': 1, '23059599': 1, '18239039': 1, '29383316': 2, '17706437': 1, '26500910': 1, '15316549': 1, '19464659': 1, '16388881': 1, '21209548': 1, '24403797': 2} | {'8177903-1': 1, '6180738-1': 1, '5775515-1': 1, '5775515-2': 1, '5775515-3': 1, '5775515-4': 1} |
165,084 | 3883333-1 | 24,403,798 | noncomm/PMC003xxxxxx/PMC3883333.xml | Overdenture locator attachments for atrophic mandible | A 68-year-old female patient reported with major complaint of loose lower complete denture prosthesis. The patient had been wearing a denture for the past 15 years and had a complaint of loose mandibular dentures for the last 5 years. On intraoral examination, the mandibular ridge was found to be severely resorbed. A thorough medical and dental history of the patient was recorded. As per procedure, physician's consent was taken besides doing routine blood investigation and tests.\nMaxillary and mandibular study models were made. Orthopantomograph [] and Dentascan was undertaken to assess the bone for selection of implants. Since the old denture of the patient was not appropriate for implant supported prosthesis, a new prosthesis was fabricated for the patient in accordance with the physiologic and functional aspects. Dentascan and lower denture were used to fabricate surgical stent. The Noble Active narrow platform implants; size 3.5 mm × 10 mm and 3.5 mm × 13 mm [] were placed by surgically raising flap in canine to canine region. The knife edge ridge in the anterior region was flattened and basal bone improved. Standard post-operative surgical protocol was maintained and patient was asked not to use lower denture for 3 weeks. After 3 weeks, lower denture was locally relined with soft liner Mollosil Detax Germany.\nAfter 6 months of the integration period, a definitive prosthodontic therapy was started by exposing the cover screws of implants. 5 mm flared Noble active healing abutments were placed to establish per mucosal seal. After 2 weeks, healing abutments were removed and depth measurements from the implant platforms to the most coronal aspect of the surrounding gingival levels were taken with the help of World Health Organization periodontal probe. Locator Implant Abutment height was computed by measuring the total soft-tissue depth and subtracting 0.5 mm for the platform shifting area of noble active implant.\nIn the above case, on one side 3 mm and other side 4 mm (Zest Anchors) locator abutment was placed [] with the help of a special gold plated Abutment Driver. The abutments were tightened to 25-30 N with a torque wrench. The plastic resilient male caps with the metal housing can be processed into the denture by indirect laboratory technique or can be directly picked chair side. This allows denture to be snapped into the locator abutments. The chairside pick-up procedure is same as ball attachments. White blockout spacer or rings [] and black processing male are provided by the manufacturer for ease in procedure. In the above procedure, chair side pick-up procedure with auto polymerizing resin was performed and blue male inserts were given to patient for initial few months [].\nThe retention can be increased gradually by changing to higher retentive caps, according to individual patient's usage and needs. These plastic resilient caps can be easily changed chairside during a recall appointment with Locator core tool. The angulation between implants can be measured with angle measurement guide which helps in the selection of specific male resilient cap. | [[68.0, 'year']] | F | {'21743398': 1, '22720291': 1, '19417876': 1, '21911034': 1, '33223695': 1, '9922733': 1, '22754570': 1, '22413394': 1, '22299092': 1, '30745754': 1, '15346755': 1, '22320359': 1, '24403798': 2} | {} |
165,085 | 3883334-1 | 24,403,799 | noncomm/PMC003xxxxxx/PMC3883334.xml | Unusual solitary neurofibroma on the lower lip of a child | A 12-year-old Brazilian male reported to the Department of Pediatric Dentistry, School of Dentistry, University of Cuiabα, Cuiabα, Brazil. The child presented with bothered by a swelling on the lower of his lip. The nodule measured 0.6 × 0.3 cm and was reported to have appeared 2 years ago. On clinical examination, the asymptomatic lesion was identified at the middle border of his lower lip, presenting sessile soft tissue growth and smooth surface with a color similar to normal mucosa [].\nThere was neither any history of injury to the lower lip nor any source of stimulus that could be related to the lesion. Medical and familial history did not contribute to the diagnosis. Based on the clinical appearance of the lesion, differential diagnosis was either traumatic fibroma or mucocele. An excisional biopsy was planned to establish a definitive diagnosis.\nThe surgical procedure was performed with under local anesthesia and the lesion was completely removed by a no. 15 Bard-Parker blade. Three interrupted silk 4.0 sutures were placed to achieve hemostasis. The excised tissue was sent for histopathological investigation. On the postoperative visit after 2 weeks, sutures were removed and healing was satisfactory. After 3 weeks, the lower lip was completely healed.\nHistopathological investigation revealed that the tumor was composed of interlacing bundles of elongated cells with wavy nuclei and small nerve fibers. These cells are bland and disorderly with intracellular collagen strands [Figures and ]. Immunohistopathologic assessment showed cells positive for S-100 [Figures and ]. Pathological diagnosis was a NF with no signs of malignancy. There were no signs of recurrence at the 1-year follow-up visit []. | [[12.0, 'year']] | M | {'286274': 1, '26770842': 2, '23102003': 1, '6247681': 1, '16460259': 1, '21644043': 1, '3031179': 1, '11438454': 1, '20389070': 1, '27840843': 2, '21301902': 1, '8411029': 1, '20217161': 1, '22937377': 2, '22928136': 2, '21959460': 1, '19912641': 2, '24403799': 2} | {'3420410-1': 1, '3423774-1': 1, '5103477-1': 1, '2783016-1': 1, '4684847-1': 1} |
165,086 | 3883335-1 | 24,403,800 | noncomm/PMC003xxxxxx/PMC3883335.xml | A new modified tandem appliance for management of developing Class III malocclusion | This was a case report of an 8-year-old young boy who had a complaint of reverse relation of the front teeth. On extraoral examination, he has mild concave facial profile with midface deficiency, competent lips and no temporomandibular joint disorder or facial asymmetry []. Intra oral examination revealed anterior cross bite and tendency toward Class III malocclusion (as multiple anterior teeth were in cross bite), with a 2 mm reverse overjet and 40% overbite []. No forward functional shift of mandible was noted on closing movement of mandible. Patient was unable to achieve the edge to edge contact on the incisors. The family history was contributory as patient's father has similar malocclusion.\nOn analysis of lateral head cephalogram patient had Class III maxillomandibular relation (ANB = −2°, Wits appraisal = −2 mm). There was horizontal growth tendency with FMA 18°, SM-MP 4°, and Jarabak ratio was 69.5%. Maxilla was deficient and retrognathic with normal mandible. Upper and lower incisors were normally placed in there basal bone [Figures and , ].\nFor early management of the case we planned to use of new modified tandem appliance with keeping objectives in our mind to relieve anterior cross bite as early as possible to provide harmonious jaw growth. Bite registration was done after fabrication of the band on upper and lower second deciduous molars. The upper and lower models were mounted on the articulator with wax bite and then appliance was fabricated in laboratory. After fabrication of appliance; it was properly finished, polished and bands were cemented by glass ionomer luting cement []. Modified face bow was adjusted so that the junction of outer and inner bow should fall at the commissure of lips for easy elastic traction application. An 8 oz, elastic was used for 4 weeks, followed by a 14 oz. Initially, patient was instructed to wear the appliance minimum of 10-12 h/day, including while sleeping. The wear time was gradually increased up to 14-16 h/day. Patient was advised to visit after 1 week to monitor the compliance and check the proper adjustment of appliance and then scheduled to recall at every 4 weeks to monitor the progress. | [[8.0, 'year']] | M | {'13353914': 1, '3461703': 1, '7503035': 1, '3075214': 1, '9573887': 1, '21778583': 1, '12747076': 1, '3328750': 1, '10629513': 1, '17143347': 1, '9622758': 1, '19075381': 1, '14530417': 1, '8338074': 1, '9484212': 1, '10205955': 1, '5273734': 1, '9517727': 1, '11314139': 1, '3485393': 1, '27144056': 1, '9699402': 1, '24403800': 2} | {} |
165,087 | 3883336-1 | 24,403,801 | noncomm/PMC003xxxxxx/PMC3883336.xml | Rootless teeth: Dentin dysplasia type I | A 14-year-old girl reported with a complaint of mobile and irregularly placed teeth.\nGeneral examination showed convex profile, competent lips, normally developed maxilla but slightly sagitally underdeveloped mandible []. Intraoral examination showed normal appearance of crowns and gingiva with no signs of gingivitis or periodontitis []. Clinical examination showed grade II mobility with maxillary and mandibular incisors and molars and had missing maxillary and mandibular right laterals. She presented with crowding in maxillary and mandibular anterior region [Figures and ].\nPanoramic radiograph showed normal appearance of crown, rudimentary root formation with all teeth except maxillary right canine and mandibular right first premolar. Obliterated pulp chambers were found with most of the teeth [].\nPatient's medical history revealed no disturbance in general health. Clinical and radiograph examination of the patient's parents and siblings revealed no such disorder or any previous familial history of such condition, so she is considered as first generation sufferer of DD.\nHistory, clinical and radiographic findings revealed this case as ‘DD type I’.\nConsidering the age of the patient, treatment was aimed in maintaining the health of existing teeth. Conservative treatment was advised with maintaining excellent oral hygiene and dietary measures with fluoride supplements. A multidisciplinary approach with extraction of the teeth with poor prognosis i.e.; maxillary and mandibular anteriors and replacement with implant supported prosthesis was advised once her growth is complete. To receive implants, bilateral indirect sinus lifting, onlay bone grafting with autogenous grafts in maxillary and mandibular anterior region was advised, if required. | [[14.0, 'year']] | F | {'16603045': 1, '17452557': 1, '14466295': 1, '6935585': 1, '162890': 1, '7970601': 1, '26693824': 1, '1063351': 1, '16966898': 1, '24403801': 2} | {} |
165,088 | 3883337-1 | 24,403,802 | noncomm/PMC003xxxxxx/PMC3883337.xml | Modified quad helix appliance for thumb sucking and cross bite correction | A 9-year-old boy accompanied by his parents reported to the Department of Pediatric Dentistry with the chief complaint of forwardly placed upper front teeth. Parents reported history of active thumb sucking by the child since childhood, sucking his left thumb during sleep only. Child's mother revealed that he was unable to refrain from the habit even after repeated motivation from them. Clinical examination revealed the following features: Early mixed dentition stage, narrow and V shaped maxilla, proclined maxillary central incisors, mesio labial rotation of 11, 21. Median diastema of about 2 mm was also present [Figure and ]. Patient exhibited an overjet of 9 mm, a negative open bite of 0.5 mm and bilateral posterior crossbite extending up to primary canines.\nCephalometric evaluation revealed a skeletal Class II tendency with normodivergent facial pattern [Figure and ]. The anterior dentition presented with mild dentoalveolar proclination []. Analysis of the cast revealed adequate arch length in both maxilla and mandible with arch dimensions depicted in . Based on the investigations, the case was diagnosed as skeletal Class II (border line) and dental Class I with bilateral posterior crossbite and anterior open bite.\nThe child was counseled in the same visit regarding the deleterious effect of digit-sucking habit on dental occlusion, facial esthetics and he was self-motivated to stop the habit by himself. However, he expressed inability to refrain from the habit. Then, we planned intercepting the habit with a modified design of quad helix appliance.\nMolar separation was achieved using orthodontic separators. After banding the maxillary molar, an alginate impression was made with the bands in position and the cast was prepared. A modified quad helix crib appliance was fabricated with 0.036 inch stainless steel wire. Anterior component of the quad helix was modified to form 3 cribs, which are continuous with the anterior helices and the posterior component retained the conventional design. The expansion arms extended up to the primary canine region. The wire component was soldered to the molar bands in situ [].\nThe appliance was tried intra orally before cementation to ensure optimal fit and extension of the crib. It was cemented in the passive form and was not activated until 2 weeks, which allowed the child to acclimatize. The presence of crib in the appliance made it extremely difficult for the child to place the thumb in the mouth. Thus it acted as a deterrent to eliminate the habit. After 2 weeks, the appliance was activated for transverse expansion of maxillary arch using 3-prong plier at the inner leg []. The activation expanded the appliance close to 2 mm generating 100-150 g force. The correction of posterior crossbite was monitored every 3 weeks and the appliance was activated until overcorrection was achieved. Crossbite correction was achieved in 6 months along with successful interception of habit [Figure and ]. The magnitude of expansion achieved in inter-canine and inter-molar width is demonstrated. Post-treatment cephalometric evaluation revealed marked improvement in the upper incisor inclination, interincisal angle, palatal plane and increased vertical dimension. No change was noted in the sagittal relation of the jaws [ and ]. A simple Hawley's retainer was prescribed as retention appliance. | [[9.0, 'year']] | M | {'16769491': 1, '19336627': 1, '12572258': 1, '32110471': 1, '10925776': 1, '17605486': 1, '15185810': 1, '11314397': 1, '10474101': 1, '4564170': 1, '11997758': 1, '20298655': 1, '10790440': 1, '24403802': 2} | {} |
165,089 | 3883338-1 | 24,403,803 | noncomm/PMC003xxxxxx/PMC3883338.xml | Juvenile pleomorphic adenoma of masticator space: The first case report | A 16-year-old female patient reported to our department with the complaint of swelling in the left cheek region since 6 months. The swelling was nonpainful and was not associated with any toothache or discharge or any secondary changes []. Intraoral examination revealed a small swelling causing left buccal vestibular obliteration, extending from distal side of second premolar to maxillary tuberosity []. Computed tomography (CT) showed a hyperdense soft-tissue mass in the left masseteric space without involvement of any hard tissue. Magnetic resonance imaging (MRI) revealed a well-defined smooth capsular outlined left masticator space lesion []. The lesion was located lateral to left pterygomaxillary fissure and abutting lateral margin of alveolar arch of maxilla. Posterior margin was close to condylar process of mandible. No bony remodeling or erosion was seen. Medially lesion was displacing and compressing masseter. It has also resulted in mild anterior bowing of maxillary antral floor. Patient was sent to oral surgery department for incisional biopsy. Histopathology of incisional biopsy specimen revealed epithelial component consists of epithelial and myoepithelial cells with divergent growth patterns, including trabecular, tubular, solid, cystic and papillary architecture in a connective tissue background of myxoid in nature. A diagnosis of PA was given and excision of the whole mass was planned out. The case was taken under pre-anesthetic check-up. General anesthesia was given with nasotracheal tube using halothane and propofol. The incision was placed intraorally in the left vestibular region and was extended posteromedially using sharp and blunt dissection. The complete tumor was visualized and the surface of the tumor was firm in consistency. The complete tumor along with capsule was excised [Figures and ] and surgical site was irrigated with 10% betadiene mixed with normal saline in 1:1 ratio. Closure was done in layers keeping in mind the opening of stenson's duct. The excised tumor mass was sent for histopathological evaluation. On gross examination, the tumor mass measured 38 × 32 × 36 mm3 in size, with a whitish, faintly lobulated and focally glistening cut surface. The histopathological findings of the excised specimen were consistent with the incisional biopsy report [Figures –], confirming the diagnosis of PA. Post-operative healing was uneventful with maintenance of normal vestibular depth []. | [[16.0, 'year']] | F | {'12904903': 1, '9890456': 1, '3744850': 1, '18835644': 1, '4048449': 1, '18587216': 1, '32994879': 2, '19772659': 2, '1649424': 1, '14656569': 1, '11754224': 1, '20614271': 1, '12190133': 1, '17889377': 1, '24403803': 2} | {'2759908-1': 1, '7511052-1': 1} |
165,090 | 3883339-1 | 24,403,804 | noncomm/PMC003xxxxxx/PMC3883339.xml | Full mouth rehabilitation of a patient with reduced vertical dimension using multiple metal ce ramic restorations | A 45-year-old man reported for the treatment of his severely worn dentition and his chief complaint was that he could not eat anything because his teeth were worn too much, were hypersensitive and had an unesthetic appearance. Patient had no relevant medical history. Intraoral examination revealed a generalized loss of tooth structure that was greater in the maxillary anteriors and mandibular posteriors. Mandibular canines, left lateral incisor and first premolars were severely worn [Figure –]. Maxillary left first molar was grossly decayed. The anterior teeth had sharp enamel edges, dentinal craters and attritional wear due to the loss of posterior support. 26, 47, 42, 41 and 31 were missing []. The facial type of patient was square and his lip was hypertonic. Patient did not have temporomandibular disorders, but a discrepancy between centric occlusion (CO) and maximum intercuspal position was found when she was guided to centric relation (CR) with bimanual technique.\nTo determine whether VDO had been altered, the following aspects were investigated.[]\nHistory of wear: Physiologic wear can be compensated by tooth eruption in general, but accelerated wear may exceed the rate of eruption. The patient liked vegetables and acidic fruits and her favourite food was tough and fibrous Phonetic evaluation: If the distance between the incisal edge of the mandibular incisors and lingual surface of the maxillary incisors is about 1 mm, the patient is able to pronounce “s” normally. The patient's increased space altered the “s” sound to “sh” Interocclusal rest space: The patient's interocclusal rest space that was measured to be 5-6 mm. This was greater than the normal value of 2-4 mm Facial appearance: Wrinkles and drooping commissures around the mouth were observed The possible causes of patient's worn dentition might include posterior interferences, parafunction, eating habit and dental ignorance.\nThe options presented to the patient were removable partial dentures and full mouth rehabilitation with metal ceramic restoration with or without crown lengthening procedure and implant retained replacement of missing teeth. The patient was anxious about implant surgery, so this option was excluded. As there was clinical evidence of reduced VDO, full mouth rehabilitation with increasing VDO was planned.\nPatient's casts were mounted on a semi-adjustable articulator (Hanau™ Modular Articulator; Whip Mix Corp., Louisville, USA) using a face-bow record and an interocclusal record was made with the aid of a lucia jig and polyvinylsiloxane occlusal registration material (Exabite II; GC Corp., Tokyo, Japan).\nVertical dimension at rest was found to be 68 mm by using facial measurements after swallowing and relaxing and was verified using phonetics. VDO was found to be 61 mm using Niswonger's and Thomson's technique. Freeway space was 7 mm.\nThe existing VDO was increased by 4 mm using the incisal guidance pin of the articulator to a new VDO of 65 mm. The splint was designed to offer bilateral contacts of all posterior teeth in CR and guide the anterior teeth in excursive movements. The anterior guidance disoccluded the posterior teeth in all jaw positions except CR.\nThe adaptation of the patient to the increased VDO was evaluated during a 1 month period using the orthodontic appliance. No muscle tenderness or temporomandibular discomfort was found. Increasing the VDO was mandatory to allow the condyles to assume their most SAM position in intimate contact with the thinnest part of biconcavity of disc. It permitted the entire temporomandibular joint (TMJ) complex to attain an improved functional health and allowed the posterior avoidance patterns of occlusion to wane and a new vertical dimension to be established.\nAfter recording the CR using lucia jig and wax-rim, diagnostic wax-up was performed. | [[45.0, 'year']] | M | {'6389829': 1, '17532914': 1, '26929544': 2, '11807475': 1, '15060487': 1, '20516094': 1, '6957602': 1, '6997465': 1, '22557909': 2, '22114392': 2, '18992566': 1, '10756287': 1, '24403804': 2} | {'3341744-1': 1, '4762360-1': 1, '3220095-1': 1} |
165,091 | 3883340-1 | 24,403,805 | noncomm/PMC003xxxxxx/PMC3883340.xml | Invasive cervical root resorption: Engineering the lost tissue by regeneration | A 35-year-old non-smoking male patient presented for consultation at the Endodontic Department with a chief complaint of swelling and pus discharge in the upper left canine [Figures and ]. Patient's medical history was non-contributory. Patient reported trauma to his upper teeth when he was about 20 years old. After performing sensitivity tests, tooth #11 was diagnosed as having pulpal necrosis. Clinical examination revealed localized gingival recession and gingival enlargement in relation to tooth #11. Probing pocket depth on the mesial surface of the tooth #11 was 10 mm with a high bleeding score. Radiographic examination showed two bowl shaped radiolucency at mesial aspect of the root. Based on the clinical and radiological finding, we came to the diagnosis of localized chronic periodontitis and pulpal necrosis with external inflammatory root resorption. The treatment plan was informed to the patient, which included patient motivation, oral hygiene reinforcement, scaling and root planning, endodontic procedure and lastly surgical intervention. Patient and his parents were informed of possible discomforts and potential risks concerning the planned treatment procedure and prognosis.\nIn phase one therapy oral prophylaxis was performed. Endodontic access cavity was prepared after placing a rubber dam and disinfecting the area with 2% of chlorhexidine digluconate (Calypso, Septodont, India). Working length was determined by using the electronic apex locator Root ZX (J. Morita MFG. Corporation, Kyoto, Japan) and file in-radiograph with 15 number K-files. The root canal was cleaned and shaped by Rotary Ni-Ti Protaper System along with GLYDE (Dentsply Maillefer Company, USA) using the crown down technique. The root canal was copiously irrigated with 2.5% sodium hypochlorite (Novo Dental Product, India). Access cavity was temporized with calcium hydroxide and temporary endodontic restorative material (TERM). Patient was recalled after 1 week; the tooth was asymptomatic. Root canal was irrigated again with normal saline and dried using paper points. Before obturation, master points were seated to test their suitability to canals and radiograph was taken. The canals were obturated with selected master gutta-percha cone (variable taper) and AH-Plus sealer (Dentsply Maillefer Company, USA). The coronal gutta-percha cones were sheared off using heated instrument and vertical compaction was done using the heated pluggers at the canal orifices. The access cavity was restored with a composite (Clearfil Majesty; Kuraray, Osaka, Japan).\nThe surgical procedure was performed under local infiltration anesthesia (2% of lidocaine with 1:100,000 adrenaline) on vestibular mucosa. An intrasulcular incision was made from the distal surface of the maxillary left central incisor to the distal surface of the maxillary left canine and full-thickness mucoperiosteal flap was elevated. Surgical exploration revealed that two lesions were present on the mesial surface of upper left canine and there was no palatal intercommunication []. Granulomatous tissue within the defect area was removed and 90% of trichloroacetic acid was applied to the resorptive defect for coagulation necrosis. The resorptive defects were restored with microfilled composite (Durafill VS; Heraeus Kulzer GmbH, Dormagen, Germany) to a thickness of about 1 mm and light cured for 20 s. The rest of the defects were restored with Resin modified glass ionomer cement (RMGIC) (Fuji II LC; GC Corporation, Tokyo, Japan) to a smooth finish with a cervical matrix and light cured for 20 s [].\nA test dose of 12 ml sample of whole blood was drawn intravenously from the patient's right antecubital vein and centrifuged (REMI Model R-8c with 12 ml × 15 ml swing out head) under 3000 rpm for 10 min to obtain the PRF, which was jelly like in consistency. PRF clot started to release its serum (PRF-clot exudates) and was ready for compression into the membrane. The bony defect was filled with freeze-dried bone allograft (LifeNet, Virginia Beach, VA) and PRF []. Without delay autologous PRF membrane was placed [] and the flaps were secured with 4-0 polyglactin 910 sutures (Vicryl, Ethicon, Inc., Piscataway, NJ). After the surgery, the patient was prescribed amoxicillin 1 g twice a day for 1 week and 0.2% of chlorhexidine mouthwash 15 ml twice a day for 2 weeks. The desired gingival contour was achieved; the patient was asymptomatic 1 week after the surgery and the sutures were removed. Patient was followed-up for 6 months, [] 1 year [] and 2 year. At 2-year follow-up period, periodontal status of related tooth demonstrated mild mobility with normal probing depth, no gingival recession and no loss of clinical attachment [Figures and ]. | [[35.0, 'year']] | M | {'16939018': 1, '20623670': 1, '3078294': 1, '10323156': 1, '12637896': 1, '23112492': 2, '19410071': 1, '19836723': 1, '28808471': 2, '21496676': 1, '23833463': 2, '24403805': 2} | {'3482758-1': 1, '3698593-1': 1, '5527220-1': 1} |
165,092 | 3883341-1 | 24,403,806 | noncomm/PMC003xxxxxx/PMC3883341.xml | Orthodontic management of non-syndromic multiple supernumerary teeth | This paper reports a case of a 23-year-old man who reported with a chief complaint of spacing in the anterior maxillary region []. An intraoral examination showed two supernumerary teeth on the palatal aspect of the maxillary premolar region bilaterally and one supernumerary tooth on the buccal aspect of the right maxillary molar region, thus constituting three fully erupted supernumerary teeth in the maxillary arch [] and a supernumerary tooth at the lingual aspect of premolars in the mandibular arch on the right side []. There was no relevant medical history and the patient was otherwise healthy. Physical and extra-oral examinations revealed no additional abnormalities wherefore, conditions such as cleidocranial dysostosis, Gardner's syndrome, ectodermal dysplasia and Apert's syndrome were excluded. There was no familial history of supernumeraries elicited by the patient. A panoramic radiograph revealed three impacted supernumerary teeth in the mandibular posterior region, of which one was on the right side and two on the left side of the mandible []. The maxilla showed one impacted supernumerary tooth in the right premolar region and one on the left side between lateral incisor and canine, thus making five impacted supernumeraries in the oral cavity. This resulted in a dental formula of 40 teeth (32 normal, 8 supernumeraries [5 impacted and 3 erupted]). The treatment of the patient began with the extraction of erupted maxillary and mandibular supernumeraries followed by fixed appliance therapy. Straight wire appliance (0.022 Roth prescription) was used. The impacted supernumeraries were left in situ as they were not asymptomatic. Space closure was performed using class III elastics and echains []. A permanent lingual retainer was placed after debonding [Figures and ]. He was advised on the need for periodic recall and observation for any cystic changes with the impacted supernumeraries. | [[23.0, 'year']] | M | {'9241925': 1, '29731581': 2, '19476099': 1, '2407326': 1, '19300360': 1, '33817726': 1, '3478360': 1, '12121534': 1, '14625596': 1, '24403806': 2} | {'5917532-1': 1} |
165,093 | 3883342-1 | 24,403,807 | noncomm/PMC003xxxxxx/PMC3883342.xml | Retrieval of a metallic obstruction from the root canal of a premolar using Masserann technique | A 55-year-old male patient, who reported for endodontic retreatment, required the management of a metallic obstruction found in the root canal of tooth 34 (left mandibular first premolar) to facilitate retreatment in the same tooth. Periapical radiographic examination of tooth 34 showed the metallic obstruction, which was suspected to be separated instrument, in the middle-third of the root canal with a poor Gutta-percha obturation extending only up to the obstruction. Furthermore, the root outline of tooth 34 revealed the possibility of an anatomical variation in the form of an additional root or a canal []. In the treatment plan, a decision was taken to negotiate the obstruction and explore the possibility of an additional canal in tooth 34. The gutta-percha obturation was removed using Xylene (Merck specialties, Mumbai, India) and H-files (Dentsply Maillefer, Ballaigues, Switzerland). Bypassing of the obstruction was attempted using size 08 and size 10 K-files (Dentsply Maillefer). However, bypassing failed as the obstruction was found tightly wedged into the root canal dentin and it was decided to retrieve the metallic obstruction by using a Masserann Kit (Micro Mega, Besancon, France).\nThe coronal access in tooth 34 was refined using diamond points (Shofu Preparation Kit, Japan). Radicular access to the obstruction was straightened by the sequential use of gates-glidden drills (Mani Inc., Japan). Since the size of the obstruction was not known, end cutting trephan having an appropriate diameter was selected by superimposing it over the obstruction on the radiograph. The trephan was run at slow speed in anticlockwise direction to cut the radicular dentin around the obstruction. The apical advancement of the trephan was radiographically monitored []. When coronal portion of the obstruction was freed from the dentin, extractor tube of 1.2 mm diameter was guided into the canal to encircle and grip the obstruction. The encirclement of the obstruction by the extractor tube was radiographically confirmed [] and the plunger rod of the tube was rotated in a clockwise direction to snugly grip the obstruction against the wall of the extractor tube. Following the confirmation of gripping the obstruction using tactile sense, the extractor tube was gently turned in back and forth motions to loosen and retrieve the obstruction from the canal. Retrieval of the obstruction from the canal of tooth 34 was radiographically confirmed []. Closer observation of the obstruction revealed that it was the fragment of a separated H-file [].\nA ledge was detected apical to the site of obstruction in tooth 34 following the retrieval of the obstruction. The ledge was negotiated using size 10 K-file. Further exploration of the pulp space revealed the presence of an additional canal. Following canal negotiation, working length was determined using the apex locator (Propex, Dentsply Maillefer) and radiographs []. Canals were shaped and cleaned in a crown down manner using NiTi files (ProTaper, Dentsply Maillefer). Irrigation was carried out using 2.5% sodium hypochlorite and 2% of chlorohexidine. Calcium hydroxide (Calcicur, VOCO, Germany) was used as an intracanal medicament.\nIn the subsequent visit, canals of tooth 34 were obturated using Gutta-percha points (ProTaper, Dentsply Maillefer), sealer (AH-plus, Dentsply Maillefer) and lateral compaction method. The access opening was restored with silver amalgam [] and the patient was suggested to undergo post endodontic treatment. | [[55.0, 'year']] | M | {'20456518': 1, '12877265': 1, '19421387': 1, '2084213': 1, '17055902': 1, '15088037': 1, '26877743': 1, '20416418': 1, '19345805': 1, '10825835': 1, '12772969': 1, '27134994': 1, '16861084': 1, '8143573': 1, '11199757': 1, '24403807': 2} | {} |
165,094 | 3883343-1 | 24,403,808 | noncomm/PMC003xxxxxx/PMC3883343.xml | Gorlin-Goltz syndrome: A rare case report | A 13-year-old boy visited our hospital with a chief complaint of swelling on lower anterior region of the jaw since 10 days. Swelling was approximately 2 cm × 1 cm in size, soft to firm in consistency and tender on palpation. Intraoral examination revealed his deciduous teeth were still present and few permanent teeth were missing [].\nThe orthopantomogram was advised, which revealed three cystic lesions in the mandible and two involving the maxillary sinus on either side with the displaced permanent teeth []. Owing to the presence of multiple cysts like lesions in the jaw, GGS was suspected and further investigations were carried out.\nThe radiograph of the skull showed bilamellar calcification of the falx cerebri []. Physical examination revealed macrocephaly with a head circumference of 92 cm (normal for a 13-year-old boy is 54-57 cm), frontal bossing, depressed nasal bridge, hypertelorism and mandibular prognathism []. Palmar pits were brown coloured and measuring 1-3 mm in diameter []. No other anomalies of the skeletal, cardiovascular, or central nervous system were present. On the basis of clinical findings, diagnosis of GGS was made. Prior to the surgical procedure, an arch bar was placed on the lower jaw to prevent fracture of the mandible as well as to splint the unsupported permanent teeth. The cyst enucleation was done under general anesthesia via intraoral approach. After the cystic lesions enucleated, large areas of bone loss were seen and the displaced permanent teeth were visible on the floor of the cystic cavity []. The enucleated cystic lining was sent for histopathological examination.\nCarnoy's solution was then applied using cotton rolls for a period of 5 min. The excess solution was then irrigated using saline and the cavity was packed with bismuth iodine paraffin paste. The pack was removed after 7 days and regular irrigation of the cavity was done.\nThe histopathological examination of the enucleated tissue showed parakeratinized uniform squamous epithelial lining, five to eight cells thick with fairly flat base. The epithelium demonstrated a well-developed basal layer of palisaded columnar cells with polarized hyperchromatic nuclei. Multiple satellite and daughter cysts were seen in the connective tissue wall []. The histopathological examination confirmed the diagnosis of OKC.\nThe parents of the patient were examined and underwent radiological evaluation; neither of them had any features of the GGS. | [[13.0, 'year']] | M | {'26604574': 1, '16327143': 1, '10066029': 1, '30736811': 2, '13851319': 1, '3480489': 1, '3131508': 1, '11250631': 1, '19032739': 1, '21887009': 2, '19234436': 1, '27448602': 1, '9096761': 1, '1750770': 1, '7984134': 1, '24403808': 2} | {'3162868-1': 1, '6367745-1': 1} |
165,095 | 3883344-1 | 24,403,809 | noncomm/PMC003xxxxxx/PMC3883344.xml | Gingival enlargement unveiling sarcoidosis: Report of a rare case | A 36-year-old female patient reported to the Department of Periodontics, in our institute, with the chief complaint of generalized overgrowth of gums. Patient had noticed it from the past 10 years, which has gradually increased to the present state. Medical history was not significant. Patient was asked about endocrine abnormality (to rule out pregnancy gingivitis), intake of drugs like nifedipine, cyclosporine and phenytoin (to rule out drug induced gingival enlargement) and history of any allergy. All of which were negative. To rule out hereditary gingival fibromatosis, she was asked about family history, with particular importance to family dental history, which was negative. Her socioeconomic condition was poor and she was uneducated, belonged to a village. She gave a significant dental history of similar gingival overgrowth 12 years back which was treated by a local dental surgeon, then. Patient could not recollect the details regarding treatment given to her at that time. Two years after the treatment, patient noticed a recurrence of gingival enlargement and has been gradually increasing to the present state, much severe than previous one. Patient had difficulty in eating and pain in gums while brushing teeth, with occasional bleeding. Clinically she had severe generalized gingival enlargement, soft and spongy, reddish pink which bled on touching, particularly in lower anterior region where the enlargement almost covered the clinical crowns []. Her oral hygiene status was fair (Greene and Vermillion Index).[] She had missing teeth – 18, 35, 45, 48 (FDI Federation Dentaire Internationale System). She did not give any history about extraction of these teeth.\nAn orthopantomograph was taken which showed mild alveolar bone loss in upper and lower anterior teeth and missing (congenitally) 18, 35, 45, 48 [].\nTreatment consisted of oral prophylaxis (scaling and polishing procedures) and oral hygiene instructions. She was advised to rinse twice daily with 0.2% chlorhexidine mouthwash, 10 ml, 1:1 dilution for 15 days. After 1 month, on reevaluation, it was observed that the enlargement had not reduced in severity, size, clinical appearance and consistency and was same as 1 month back. Hence, the inflammatory cause of gingival enlargement was also ruled out and she was posted for surgical excision.\nInformed consent was taken prior to the surgical procedure. Lower anterior region was chosen for first surgical session as the enlargement was severest in this region. Surgical excision was performed under local anesthesia using the external bevel gingivectomy technique []. The excised tissue was submitted for histopathological examination which demonstrated non-caseating epithelioid cell granulomas, typical of granulomatous conditions, using hematoxylin and eosin staining []. Multinucleated giant cells were evident throughout the granuloma. Based on the histological findings, a number of special investigations were undertaken, to rule out various granulomatous diseases. Mantoux test and Sputum test was negative for tuberculosis. Complete blood count reports showed eosinophil count -24% (normal range 0-4%). Serum angiotensin converting enzyme (sACE) levels were - 1038.5 nkat/L (normal range lesser than 670 nkat/L). Chest X-ray showed hilar lymphadenopathy. Based on the histopathological examination, elevated sACE levels, increased eosinophil count and chest X-ray findings, diagnosis of sarcoidosis was made. The patient was referred to the physician for further investigations and treatment. Since she did not have symptomatic pulmonary involvement she was not given any medications for sarcoidosis and was kept under regular follow-up by the physician for 5 months. She did not show any symptoms of the disease and was referred back for treatment of gingival enlargement.\nOther areas of gingival enlargement were treated by external bevel gingivectomy. Patient was followed-up by us for 1 month after completion of full mouth gingivectomy and showed good healing with no signs of recurrence of gingival enlargement [] after which the patient went back to her village and has not reported again for follow-up. | [[36.0, 'year']] | F | {'18547685': 1, '6595009': 1, '6247943': 1, '19561785': 1, '10560120': 1, '22422021': 1, '15888103': 1, '11312418': 1, '6573187': 1, '8893388': 1, '26380825': 1, '9110911': 1, '5246816': 1, '12172448': 1, '9413651': 1, '17703966': 1, '29456308': 2, '7618312': 1, '12588537': 1, '24403809': 2} | {'5813348-1': 1} |
165,096 | 3883345-1 | 24,403,810 | noncomm/PMC003xxxxxx/PMC3883345.xml | Combined soft and hard tissue augmentation for a localized alveolar ridge defect | This was a case report of a 30-year-old male patient who was referred to the Department of Periodontology, Kanti Devi Dental College and Hospital, Mathura, India for correction of ridge defects in the lower anterior region. Patient gave a history of extraction of the mandibular right canine due to periodontal reasons around 6 months back. On intra-oral examination, loss of ridge height and loss of facio-lingual width was noticed. Hence, a diagnosis of Seibert's Class III alveolar ridge defect was made []. Grade I recession was noticed on the mandibular right lateral incisor and canine. A treatment plan involving augmentation of the alveolar ridge defect with bone grafts and soft-tissue grafts was formulated, informed to the patient and consent was obtained.\nAfter achieving adequate local anesthesia, vertical releasing incisions were placed on the distal line angle of lateral incisor and mesial line angle of first premolar. A full thickness flap was elevated until the muco-gingival junction and partial thickness flap was reflected beyond the muco-gingival junction []. Granulation tissue/connective tissue present at the base of the defect was removed. A template was used to determine the size of the soft-tissue graft needed to augment the defect. MucoMatrixX, an animal derived, collagen based soft-tissue graft was sutured to the labial flap []. Bone graft was placed into the defect. Labial flap was coronally advanced and interrupted sutures were placed to unite the labial and lingual flaps. Periodontal pack was placed and patient was recalled after 10 days for suture removal. Post-operative instructions were given and analgesics were prescribed for pain control. After 10 days, sutures were removed and remarkable improvement in ridge thickness and height was noticed. One month later, after evaluation of the ridge contour and dimensions, patient was referred to Department of Prosthodontics for placement of the prosthesis. All possible prosthetic options were discussed with the patient. Due to financial constraints, patient could not afford for implant supported prosthesis, instead patient choose for a fixed prosthesis. A porcelain fused to metal crown with mandibular left lateral incisor and mandibular left first premolar as abutment was delivered to the patient []. Patient is being followed without any major complaints. | [[30.0, 'year']] | M | {'6578906': 1, '34447156': 1, '32580409': 1, '12119811': 1, '26486125': 1, '18473033': 1, '23266776': 1, '21772724': 2, '20427923': 1, '22092478': 1, '24403810': 2} | {'3134050-1': 1} |
165,097 | 3883348-1 | 24,403,813 | noncomm/PMC003xxxxxx/PMC3883348.xml | Juvenile psammomatoid ossifying fibroma: An unusual case report | A 14-year-old female patient reported with the chief complaint of large painless swelling on the right lower jaw region since 1 year. The swelling had rapidly grown since 5 months to attain its present size. There was no history of trauma, pain, any discharge and extraction of any teeth. The right side submandibular lymph node was palpable, single in number, about 1 cm in size, mobile, soft in consistency and non-tender on palpation.\nExtraorally a diffuse swelling was present on the right lower side of face, approximately 10 cm × 6 cm in size, extending anteroposteriorly 2 cm away from the midline on left side until right angle of mandible and superoinferiorly from a line connecting angle of mouth to angle of mandible until 2.5 cm below the lower border of mandible. Color and temperature of overlying skin was normal. It was non-tender and hard in consistency.\nIntraorally lower labial and buccal cortical expansion was present extending from midline until 48 region and minimal lingual cortical expansion was present []. Hard-tissue examination revealed 41 was rotated, 43 was labially erupted and deciduous canine and molars were retained. 44 and 45 were clinically missing. Provisional diagnosis of Dentigerous cyst with 15 was made. Differential diagnosis given was unicystic ameloblastoma, ameloblastic fibroma, calcifying epithelial odontogenic tumor, ossifying fibroma and odontogenic myxoma.\nOn fine needle aspiration cytology no fluid was aspirated. Orthopantomograph (OPG) revealed mixed radiolucent radiopaque lesion extending from 34 until distal aspect of 47 regions with a radiopaque dense mass near the apical aspect of 84 and 85. Borders were well-defined and thinning of lower border of mandible was present. Root resorption of 85, 86 and 46 was present. Inferior alveolar canal was displaced to lower border of mandible [].\nAxial, coronal and sagittal sections of computed tomography scan showed multilocular lesion with multiple internal septa []. It revealed intact lower border of mandible and the lesion crossing the midline. 3D reconstruction showed formation of internal septa and areas of homogenous calcification [].\nHistopathological examination showed small spherical hematoxyphillic ossicles i.e., psammoma such as bodies, cellular connective tissue stroma and bony trabeculae []. The final diagnosis was JPOF. The patient was referred to Oral surgery department for surgical removal of the tumor. 6 months post-operative OPG of patient [] and intraoral [] examination showed no recurrence. | [[14.0, 'year']] | F | {'15580124': 1, '24421970': 1, '22654369': 1, '11925539': 1, '19070769': 1, '26681872': 2, '10895636': 1, '20587961': 1, '24403813': 2} | {'4678565-1': 1} |
165,098 | 3883349-1 | 24,403,814 | noncomm/PMC003xxxxxx/PMC3883349.xml | Recurrent unicystic mural type ameloblastoma in a 9-year-old boy, 8 years follow-up | A 9-year-old boy presented with large, well-defined unicystic radiolucency with unerupted second premolar permanent tooth in left mandible base []. On intraoral examination, there were no sign of lesion such as bone expansion or ulceration. After the radiologic and intraoral examination, FNA procedure was performed by a dental surgeon with initial diagnosis of dentigerous cyst.\nThe slides were wet fixed and stained with hematoxylin and eosin. Cytological evaluation of FNA demonstrated individual cell with eosinophilic cytoplasm and cantered nucleolus, on the other hand tightly packed groups of oval and elongated epithelial cells of basaloid appearance with thin chromatin pattern without any cellular atypia or pleomorphism \n. The cytological findings were diagnostic for “odontogenic epithelial lesion without atypia.” The therapeutic approach to the lesion was excision with the extraction of molar primary tooth and the first and second permanent premolar teeth. Histopathological examination of excisional material was performed by Oral Pathology Department of Gazi University Dental Faculty. Macroscopically, the specimen was brownish cystic lesion measuring 3.5 cm × 2.5 cm × 2.0 cm. Cyst has multiple, small intraluminal cystic spaces. Multiple sections of the tumor were prepared routinely and stained with hematoxylin and eosin. Histologically, the lesion was nearly completely cystic, lined by ameloblastomatous epithelium with additional intraluminal extensions. Cyst epithelium was composed of peripherally palisaded basaloid cells and stellate reticulum cells, which exhibits follicular pattern. There were also tumor islands on the cyst wall []. According to these histopathological findings case was diagnosed as “unicystic ameloblastoma, mural type.” Dental surgeons approved no further treatment because of the continuing bone development of patient.\nThe 8 years post-operative follow-up revealed a recurrence at the same location []. The only clinical symptom was a slight bone expansion, which patient did not aware of. Radiographically the lesion was well-defined and FNA could not be performed due to firm and solid texture of the lesion. After the intraoperative “conventional ameloblastoma, follicular type” diagnosis from frozen sections, further bone resection was applied with safety margins. The diagnosis was approved by paraffin block sections of the lesion [Figures and ]. shows recovering bone defect after 8 months of surgery, free of tumor. | [[9.0, 'year']] | M | {'12089689': 1, '18585610': 1, '15717753': 1, '23175880': 1, '19674470': 1, '22143740': 1, '21883485': 1, '12419147': 1, '7633291': 1, '28717292': 1, '11023100': 1, '24403814': 2} | {} |
165,099 | 3883381-1 | 24,427,505 | noncomm/PMC003xxxxxx/PMC3883381.xml | Alexander Disease: Report of Two Unrelated Infantile Form Cases, Identified by GFAP Mutation Analysis and Review of Literature; The First Report from Iran | A 15 month-old boy was referred to our hospital for evaluation of seizure disorder and developmental regression. He was the second child of non-consanguineous parents, born at term by elective cesarean section after an uneventful pregnancy. His birth weight and head circumference (HC) were 3.1Kg and 34cm, respectively. Family history was unremarkable. He attained head holding at 7 months of age. Visual fixation and following were not good. First episode of seizure occurred with fever at the age of 5 months. The second episode of seizure occurred without fever at the age of 7 months, and then developmental regression started. Macrocephaly (HC 51 cm), generalized spasticity and searching nystagmus were the main neurological findings. Metabolic tests including High performance liquid chromatography (HPLC) of serum aminoacids, urine organic acid profile, serum ammonia and lactate level and thyroid function tests were within normal limit. Brain MRI showed four of the five diagnostic criteria of Alexander disease described by van der Knapp et al in 2001[, ] ().\nThe diagnosis of AD was confirmed by genetic analysis, which revealed a heterozygous mutation of p.Arg239His in the exon 4 of GFAP gene.\nA 5.5 year-old boy was referred to our hospital for evaluation of developmental regression and seizures. He was the third child of healthy and consanguineous parents, born at term by elective cesarean section after an uneventful pregnancy. His birth weight was 3 Kg, HC at birth was not determined. Family history was unremarkable. At the age of 6 months he had developmental delay and was not able to partial weight bearing. Following the DPT vaccination seizures started and thereafter developmental regression occurred. Significant findings in physical examination were macrocephly (HC 51cm) and spasticity. Laboratory tests similar to the first patient, were all within normal limit. As in case 1, brain MRI showed four of the five diagnostic criteria of AD described by van der Knapp et al in year 2001 (). Genetic study revealed a heterozygous mutation of p.Arg79His in the exon 1 of GFAP gene.\nAccording to the age of onset our two cases were the infantile type. MRI findings were compatible with four of the five criteria of van der Knapp et al (2001)[, ] for the diagnosis of AD. Based on following criteria, AD diagnosis in our patients was wstablished.Periventricular rim (high signal on T1 and low signal on T2-weighted images. Extensive white matter abnormalities predominantly of frontal lobe and cystic degeneration of anterior deep periventricular white matter ( and ). Abnormalities of the basal ganglia and thalami. Brain stem abnormalities especially involving the mid brain area. | [[15.0, 'month']] | M | {'18054694': 1, '20721574': 1, '12754360': 1, '14623218': 1, '28764307': 1, '25584279': 1, '11567214': 1, '18410858': 1, '31942421': 1, '19128991': 1, '19386454': 1, '11138011': 1, '24427505': 2} | {} |
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