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165,500 |
3901629-1
| 24,474,922 |
noncomm/PMC003xxxxxx/PMC3901629.xml
|
Wernicke-Korsakoff Syndrome in Primary Peritoneal Cancer
|
A 76-year-old woman with primary peritoneal cancer and multiple lymph node metastases received 6 cycles of paclitaxel and carboplatin. After the 6 cycles of chemotherapy, partial response was achieved. Six months after her last chemotherapy cycle, she was admitted to the hospital because of sustained nausea and general weakness, which she had experienced for several months. Chest and abdominal-pelvic computed tomography scans showed that peritoneal metastasis and lymph node metastasis had progressed. Her serum CA-125 level was elevated (1,655 U/ml). She received continuous parenteral nutrition because of intractable nausea. Four days after admission, she developed disorientation and dizziness, which were followed by ataxia and diplopia. A neurologic examination indicated that she had ophthalmoplegia. Her laboratory findings were as follows: white blood cell count 6.59 × 109/l, hemoglobin 12.0 g/dl, hematocrit 35.8%, blood platelet count 230 × 109/l, serum total protein 6.1 g/dl, albumin 3.3 g/dl, glucose 111 mg/dl, aspartate aminotransferase 21 IU, alanine aminotransferase 14 IU, blood urea nitrogen 9.0 mg/dl, creatinine 0.15 mg/dl, Na 139 mm, K 4.6 mm, Cl 107 mm, and Ca++ 0.98 mg/dl. There was no evidence of systemic infection or brain metastasis. Magnetic resonance imaging (MRI) of the brain showed hyperintensity in the mammillary body, medial aspects of both halves of the thalamus, cerebral aqueduct, tectal plate, and dorsal medulla on T2 fluid-attenuated inversion recovery (FLAIR) images (fig. ). The patient's serum thiamine level was 2.0 μg/dl (normal range 2.0–7.2 μg/dl). These findings were consistent with Wernicke encephalopathy. Thiamine (100 mg) was urgently administered intravenously, and ataxia and diplopia improved 2 days after thiamine injection. The other symptoms improved gradually. Fifteen days after the thiamine injection, she had recovered from her symptoms but displayed anterograde amnesia and disorientation with respect to time. A follow-up MRI scan of the brain showed improvement in the abnormal lesion (fig. ).
|
[[76.0, 'year']]
|
F
|
{'20434810': 1, '24963430': 2, '20622961': 1, '23413765': 1, '6127574': 1, '31386087': 1, '17434099': 1, '25931232': 1, '21537379': 1, '19018150': 1, '7309677': 1, '10858830': 1, '24474922': 2}
|
{'4054927-1': 1}
|
165,501 |
3901810-1
| 23,466,818 |
noncomm/PMC003xxxxxx/PMC3901810.xml
|
Remarkable tumor lysis in a hepatocellular carcinoma patient immediately following glypican-3-derived peptide vaccination
|
A 62-year-old male had a history of asymptomatic chronic hepatitis C. In September 2009, he was diagnosed with HCC. Laboratory data disclosed no abnormalities. Abdominal CT (CT) scans showed four lesions in the liver, and the patient was treated four times with hepatic artery chemoembolization. In December 2010, CT scans revealed a new lesion indicative of a tumor thrombus extending into the inferior vena cava. The patient was treated with sorafenib. However, the sorafenib treatment was discontinued in January 2011 due to progressive multiple intrahepatic tumors.\nAs no established therapeutic regimens exist for this condition, he was offered participation in a clinical trial of a GPC3 peptide vaccine for advanced HCC. HLA-typing revealed an HLA-A2 phenotype. The patient had a performance status of 0, and Child-Pugh class B disease. The patient did not have active HBV infection or rapidly progressive tumor thrombus before enrollment, met the eligibility criteria, and was enrolled after providing informed consent. Early-phase contrast-enhanced CT before treatment showed a maximum 68 × 51-mm tumor with multiple intrahepatic tumors and a 44 × 30-mm tumor invading the right atrium (). Pretreatment tumor markers were as follows: α fetoprotein (AFP), 852 ng/mL and des-gamma-carboxy prothrombin (DCP), 1346 mAU/mL. A liver biopsy was performed 1 week prior to GPC3 peptide vaccination according to the protocol. In April 2011, 3 mg of HLA-A2-restricted GPC3144-152 peptide (FVGEFFTDV) (American Peptide Co.) emulsified with incomplete Freund’s adjuvant (Montanide ISA-51VG; SEPPIC) was injected intradermally as the vaccine following Good Manufacturing Practice guidelines. The patient had a low-grade fever on day 6 following the first vaccination, and inflammatory and hepatic parameters were elevated on day 12 (). The abnormal laboratory findings improved later. Therefore, he received the second vaccination on day 26 after the first vaccination. On day 9 after the second vaccination, the patient was admitted to our hospital with a high fever and general fatigue. On admission, the patient’s C-reactive protein (CRP) level (10.76 mg/dL) and laboratory hepatic parameters were elevated. One day after hospitalization, aspartate aminotransferase and alanine aminotransferase and levels were elevated to 1,580 IU/L and 1,112 IU/L, respectively. The prothrombin time-international normalized ratio increased from 1.18 to 1.51. But the patient did not have ammonemia or asterixis. As seen by early-phase contrast-enhanced CT scan, most tumors in the liver were not contrast enhanced. Findings of the CT scan indicated tumor necrosis and regression. In contrast, the size of the tumor thrombus in the right atrium increased to a maximum of 83 × 50 mm (). Levels of the tumor markers AFP and DCP decreased temporarily to 634 ng/mL and 777 mAU/mL, respectively. He was infused with a liver-supporting agent (monoammonium glycyrrhizinate, glycine, and l-cysteine hydrochloride hydrate). The inflammatory and hepatic parameters improved 1 week after hospitalization (). We did not perform a liver biopsy when the hepatic parameters were elevated because they improved promptly. Nevertheless, his status worsened gradually. Protocol treatment was discontinued due to progressive disease and he died 30 days after the second vaccination. Based on the clinical course, we could not rule out the possibility that his condition had worsened as a result of the vaccine. Therefore, an autopsy was performed to determine the main cause of death and the elevated hepatic parameters, and to evaluate the anti-tumor effect of vaccination
|
[[62.0, 'year']]
|
M
|
{'28593566': 1, '12851874': 1, '16024626': 1, '20478057': 1, '23903757': 1, '32127929': 1, '19212669': 1, '16675576': 1, '28955856': 1, '24030702': 1, '25366870': 1, '30003192': 1, '15623647': 1, '29123959': 1, '31024850': 1, '24498550': 1, '21281401': 1, '23442593': 1, '25625609': 1, '32449239': 1, '12788060': 1, '27467945': 1, '17046096': 1, '26313767': 1, '26942076': 1, '23243625': 1, '27681717': 1, '20175033': 1, '16675560': 1, '22577059': 1, '19496787': 1, '31480259': 1, '31455319': 2, '19279469': 1, '15340416': 1, '14704832': 1, '29285841': 1, '23466818': 2}
|
{'6712705-1': 1}
|
165,502 |
3902161-1
| 24,474,992 |
noncomm/PMC003xxxxxx/PMC3902161.xml
|
Benefical Effects of Sigma-1 Agonist Fluvoxamine for Tardive Dyskinesia and Tardive Akathisia in Patients with Schizophrenia: Report of Three Cases
|
Ms B, a 43-year-old woman, had been diagnosed with schizophrenia for 22 years. She had been treated with conventional antipsychotics as haloperidol, zuclopenthixol, chlorpromazine for almost 12 years. For the last 10 years, she had been treated with various atypical antipsychotics such as olanzapine, aripiprazole, ziprasidone. She has be given quetiapine 800 mg/day and biperiden 4 mg/day for last two years. She had been also diagnosed as tardive dyskinesia for almost 10 years and her treatment was switched to atypical antipsychotics from typical antipsychotics for last 10 years. The results of brain magnetic resonance imaging (MRI), encephalography (EEG), blood chemistry, a complete blood count, and thyroid function tests were all normal. On psychiatric and physical examination, fatigue, difficulty concentrating and choreic movements on fingers of bilateral upper limbs were noted. Ms A was diagnosed with schizophrenia, residual type and medication induced movement disorder (tardive dyskinesia) according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Ms A scored 6 on the Abnormal Involuntary Movement Scale (AIMS). Fluvoxamine 100 mg/day was added to her treatment. At the fourth week, the dyskinesia had improved gradually based on scores of 2 on the AIMS.
|
[[43.0, 'year']]
|
F
|
{'23044468': 1, '20205742': 2, '20416096': 2, '8096816': 1, '20021354': 1, '10480663': 1, '26626327': 1, '22926615': 1, '10739324': 1, '18076369': 1, '21510237': 1, '9919323': 1, '15952902': 1, '21722302': 1, '21375464': 1, '17073684': 1, '11374328': 1, '2574607': 1, '8635179': 1, '17662961': 1, '31736582': 2, '7753075': 1, '16397584': 1, '30690950': 2, '23585991': 1, '34046607': 1, '1977872': 1, '23585988': 1, '8608783': 1, '15733622': 1, '24474992': 2}
|
{'3902161-2': 2, '3902161-3': 2, '6839319-1': 1, '6361034-1': 1, '2868038-1': 1, '2868038-2': 1, '2868038-3': 1, '2868038-4': 1, '2868038-5': 1, '2847563-1': 1, '2847563-2': 1}
|
165,503 |
3902161-2
| 24,474,992 |
noncomm/PMC003xxxxxx/PMC3902161.xml
|
Benefical Effects of Sigma-1 Agonist Fluvoxamine for Tardive Dyskinesia and Tardive Akathisia in Patients with Schizophrenia: Report of Three Cases
|
Mr M, a 41-year-old man, had been diagnosed with schizophrenia for 18 years. He had been treated with conventional antipsychotics as haloperidol, pimozide and zuclopenthixol for almost 13 years. For the last 5 years, he has been treated with olanzapine 20 mg/day and biperidene 4 mg/day. The results of MRI, EEG, blood chemistry, a complete blood count, and thyroid function tests were all normal. On psychiatric and physical examination, avolution, mood, anhedonia, insomnia, fatigue, difficulty concentrating and choreic movements on bilateral upper limbs were noted. The choreic movements has been existent for nearly seven years. Mr M was diagnosed with schizophrenia, residual type and medication induced movement disorder (tardive dyskinesia) according to the DSM-IV-TR. Ms A scored 11 on the AIMS. Fluvoxamine 100 mg/day was added to treatment. At the fourth week, the dyskinesia had improved gradually and observed to be improved in terms of tardive dyskinesia with on score of 3 on the AIMS.
|
[[41.0, 'year']]
|
M
|
{'23044468': 1, '20205742': 2, '20416096': 2, '8096816': 1, '20021354': 1, '10480663': 1, '26626327': 1, '22926615': 1, '10739324': 1, '18076369': 1, '21510237': 1, '9919323': 1, '15952902': 1, '21722302': 1, '21375464': 1, '17073684': 1, '11374328': 1, '2574607': 1, '8635179': 1, '17662961': 1, '31736582': 2, '7753075': 1, '16397584': 1, '30690950': 2, '23585991': 1, '34046607': 1, '1977872': 1, '23585988': 1, '8608783': 1, '15733622': 1, '24474992': 2}
|
{'3902161-1': 2, '3902161-3': 2, '6839319-1': 1, '6361034-1': 1, '2868038-1': 1, '2868038-2': 1, '2868038-3': 1, '2868038-4': 1, '2868038-5': 1, '2847563-1': 1, '2847563-2': 1}
|
165,504 |
3902161-3
| 24,474,992 |
noncomm/PMC003xxxxxx/PMC3902161.xml
|
Benefical Effects of Sigma-1 Agonist Fluvoxamine for Tardive Dyskinesia and Tardive Akathisia in Patients with Schizophrenia: Report of Three Cases
|
Ms M, a 36-year-old woman, had been diagnosed with schizophrenia for 6 years. She had been treated with quetiapine 600 mg/day for 5 years. For the last 1 year, she has been treated with olanzapine 20 mg/day. She began complaining of severe motor restlessness and an unbearable state of never being able to sit still for one month before her last visit for regular outpatient clinic control. The results of brain MRI, EEG, blood chemistry, a complete blood count, and thyroid function tests were all normal. On psychiatric and physical examination, anxiety, agitation and akathisia were noted. Ms M was diagnosed with schizophrenia, residual type; and medication induced movement disorder (tardive akathisia) according to the DSMIV-TR. On the Barnes Akathisia Rating Scale (BARS), global score was 5 (severe akathisia). Fluvoxamine 100 mg/day was added to her treatment. Three weeks after adding fluvoxamine 100 mg/day treatment, there was no reemergence of akathisia or other extrapyramidal side effects.
|
[[36.0, 'year']]
|
F
|
{'23044468': 1, '20205742': 2, '20416096': 2, '8096816': 1, '20021354': 1, '10480663': 1, '26626327': 1, '22926615': 1, '10739324': 1, '18076369': 1, '21510237': 1, '9919323': 1, '15952902': 1, '21722302': 1, '21375464': 1, '17073684': 1, '11374328': 1, '2574607': 1, '8635179': 1, '17662961': 1, '31736582': 2, '7753075': 1, '16397584': 1, '30690950': 2, '23585991': 1, '34046607': 1, '1977872': 1, '23585988': 1, '8608783': 1, '15733622': 1, '24474992': 2}
|
{'3902161-1': 2, '3902161-2': 2, '6839319-1': 1, '6361034-1': 1, '2868038-1': 1, '2868038-2': 1, '2868038-3': 1, '2868038-4': 1, '2868038-5': 1, '2847563-1': 1, '2847563-2': 1}
|
165,505 |
3902162-1
| 24,474,993 |
noncomm/PMC003xxxxxx/PMC3902162.xml
|
A 10-Week Memantine Treatment in Bipolar Depression: A Case Report. Focus on Depressive Symptomatology, Cognitive Parameters and Quality of Life
|
A 49-year-old male with the diagnosis of type I BD, treated psychiatrically for over 20 years, previously 5 times hospitalized, was admitted in a manic episode, when he tried to force the hospital door. During the first 2 weeks of olanzapine treatment the manic symptoms have been reduced. After the manic episode ended, some depressive symptoms emerged, quickly reaching a moderate severity. Continuing the therapy with lithium (1 g/day) and olanzapine (7.5 mg/day) for several weeks we have not noted any significant improvement. Treatment with mianserin, an alpha adrenergic antidepressant characterized by a low switch risk was started. After 6 weeks of mianserin (initially at 30 mg/day for 3 weeks, then raised to 60 mg/day) there was still no clinical improvement. After obtaining an informed consent, the patient started the intake of memantine with no other changes of the treatment. For the first week the daily memantine dose was 5 mg, every week it was increased by 5 mg to a maximum of 20 mg. Tolerance of the drug throughout its use was very good, the patient did not report any side effects whatsoever.\nThe patient had no other chronic illness than BD. Neurological assessments showed no abnormalities; the hematological, biochemical and hormonal (TSH) parameters were normal. In the CT scan no significant morphological changes were found.\nEvery week during the10 weeks of memantine treatment and also 6 weeks after its termination the patient was examined using the Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Hamilton Anxiety Scale (HAMA), Clinical Global Impression (CGI) and World Health Organization Quality of Life Scale (WHOQOL-BREF - short version, ). Before starting memantine (week 0-W0) and at the end of its use (W10) the patient also performed psychological examination panel ().\nAfter the memantine initiation we observed a consecutive improvement of depressive symptoms, which was noted early, what is congruent with the observations of Anand et al. We noted a significant improvement in mood, sleep parameters and appetite. After a quick improvement following first doses of memantine the level of anxiety remained on the same mild level. During the memantine period a brief mild depressive exacerbation was observed (ca. W5), which was conditioned by objective external circumstances, but with this exception the mood was quite stable and the patient gradually improved.\nIn depressive, hypomanic or manic but also euthymic bipolar patients the cognitive functioning is significantly worse than in normal population., Assessing the progress in the treatment we compared the performance results of such functions as attention [Wisconsin Card Sorting Test (WCST), d2 test], direct visual memory [Benton Visual Retention Test (BVRT) - method A, versions C and D], direct auditory memory (repeating digits directly) and operational memory (WCST, repeating digits backwards), visuo-spatial working memory [WCST, Trail Making Test (TMT) - Part B], psychomotor speed (TMT - Part A), language and communication functions of the right hemisphere [The Right Hemisphere Language Battery, polish version (RHLB-PL)], auditory verbal learning [Auditory-Visual Learning Test (AVLT) - with two alternative versions], verbal fluency (semantic: animals, fruits and phonemic: letters K and S) and executive functions [Ruff Figural Fluency Test (RFFT), TMT - Part B].\nCognitive functioning results before and after the treatment indicate a marked improvement in auditory verbal learning, accuracy of verbal material learning and reduction of susceptibility to distraction. The numerical parameters of concentration, perceptual speed and accuracy of work also improved.\nThe overall result of right hemisphere language functions and communication skills, direct auditory and operating memory and psychomotor speed remained on similar levels before and after the memantine treatment.\nThe results of direct visual memory tests are difficult to comment. The numerical parameters (the number of wrong and right answers) were slightly worse in the second assessment, however, despite the alternative version of the test, it cannot be regarded as equivalent in terms of psychometric properties. The WCST results were slightly worse on the second assessment.\nThe numerical parameters (both semantic and phonemic) of verbal fluency in both assessments were similar.\nIn the RFFT and TMT (Part B) tests, assessing - among others - executive functions, a qualitative improvement in the efficiency of planning (the use of a rotation strategy in RFFT) and also in the control of action (error-free switching of the TMT) was observed. This improvement may be partly explained by the learning effect.\nQuality of life was assessed using the popular WHOQOL-BREF (). Parallelly to the clinical improvement, we also noted better quality of life parameters in the items describing physical functioning - e.g., sleep, energy, treatment, pain (part 1) and environment - finances, health services, living place (part 4).\nDue to persistent mild depressive symptoms with a relatively excessive drive reduction, memantine and mianserin were stopped and venlafaxine was started (up to 75 mg per day). This resulted in a satisfactory drive improvement and remission of the depression without any manic symptoms for 3 weeks (weeks 11-15 in ).
|
[[49.0, 'year']]
|
M
|
{'15220008': 1, '19620854': 1, '17063225': 1, '22329473': 1, '25383489': 1, '18348597': 1, '22784018': 1, '14754775': 1, '9257940': 1, '33537916': 1, '18305307': 1, '21777188': 1, '19305787': 1, '18834506': 1, '22335130': 1, '19823634': 2, '34070216': 1, '21646824': 1, '14702270': 1, '10465680': 1, '20565444': 1, '21775832': 1, '18698875': 1, '29881276': 2, '21557878': 1, '12958742': 1, '17545748': 1, '25848287': 1, '16625590': 1, '27354963': 1, '22030128': 1, '20230766': 1, '24474993': 2}
|
{'5985765-1': 1, '2755164-1': 1}
|
165,506 |
3902163-1
| 24,474,994 |
noncomm/PMC003xxxxxx/PMC3902163.xml
|
A Case Report of Priapism Caused by Ziprasidon
|
A 43-year-old male patient was admitted to the emergency department of our hospital due to insomnia, irritability, aggression, self-talk, and complaints of non-compliance with his psychiatric medications over the previous two weeks. During his psychiatric examination, he did not make eye contact, was unwilling to communicate, and exhibited decreased self-care, poor speech content, dysphoric mood, and increased psychomotor activity. His thought content could not be assessed due to his irritability and dissimulative attitude. According to information received from his family and from clinical observations, he suffered persecution, reference, and grandeur delusions. Additionally, it was noted that there had been no use of psychostimulants other than irregular alcohol intake for five years, which had stopped two years previously, and he smoked a pack of cigarettes per day.\nThe patient had been followed up for nearly 20 years following a diagnosis of chronic schizophrenia, for which he had been hospitalized in a psychiatric institution 17 times. Examination of his past hospital files revealed that he had been prescribed various typical and atypical antipsychotics: haloperidol (20-30 mg/day), sulpiride (800 mg/day), pimozide (4 mg/day), clozapine (600 mg/day), risperidone (6 mg/day), olanzapine (20 mg/day), quetiapine (100-900 mg/day), chlorpromazine (200 mg/day), and amisulpride (800 mg/day). The patient did not describe any involuntary prolonged erections when questioned during his follow-ups or during his former psychiatric hospital admissions. He had been diagnosed with diabetes mellitus type 2 in 2006 and had been receiving antidiabetic treatment since that time.\nAfter his hospitalization, the patient continued to use metformin (2000 mg/day) in conjunction with ziprasidone (40 mg/day) and, as he had gastric ulcers, ranitidine (50 mg/day). The patient's total Positive and Negative Symptom Scale (PANSS) score was 131 (positive: 27; negative: 30; general psychopathology: 72). On the seventh day of treatment, a continuous painful penile erection was observed. The patient felt uncomfortable and stated that this condition had lasted for nearly 8 h and was not associated with sexual stimulation or desire. Following urologic consultation, no medical disorder or trauma that might have caused priapism was found in the patient's history, and laboratory values [complete blood count, biochemical parameters, activated partial thromboplastin time (aPTT), and International Normalized Ratio (INR)] were within the normal range. As it was thought that the antipsychotic medications might be the cause of the prolonged painful penile erection, ziprasidone treatment was discontinued but no emergency urological intervention was undertaken. The antipsychotic treatment regimen of the patient was reorganized and continued with amisulpride (800 mg/day) and quetiapine (600 mg/day). The priapism ameliorated without surgical intervention 8 h after discontinuation of ziprasidone and did not recur during the clinical monitoring of the patient.
|
[[43.0, 'year']]
|
M
|
{'10411963': 1, '10771452': 1, '15679220': 1, '21364331': 1, '12173794': 1, '17110819': 1, '20075651': 1, '12670127': 1, '18971111': 1, '15963007': 1, '16356688': 1, '12590634': 1, '19750074': 1, '17017839': 1, '16230163': 1, '16415722': 1, '18090503': 1, '34336343': 2, '26185449': 1, '21870309': 1, '24474994': 2}
|
{'8302361-1': 1}
|
165,507 |
3902537-1
| 24,501,445 |
noncomm/PMC003xxxxxx/PMC3902537.xml
|
An integrated approach in the treatment of varicose ulcer
|
A 61-year-old male patient presented to KLE Ayurveda Hospital, Belgaum, Karnataka, with the complaint of reddish ulcers above lateral malleolus of the right leg for 2 weeks, associated with pricking pain, burning sensation around the ulcers, edema, and blackish discoloration over the right lower limb. For the last 5 years, the patient had been suffering from varicose veins, and 2 years back, he developed varicose ulcer on the medial aspect of the ankle joint on the same leg and was treated with biomedicines successfully. Patient was addicted to Bīḍi (Indian cigarette filled with tobacco flake and wrapped in a Bauhinia racemosa leaf tied with a string at one end) smoking for 20 years, but had stopped it for the last 2 years. He was habituated to standing for long hours in his job, i.e. about 8 to 10, hours for the past 22 to 30 years. There was no history of any chronic illness such as diabetes mellitus and hypertension.\nOn examination, a reddish large ulcer and many small oval ulcers with sloping edges were found, along with mild serous discharge around lateral malleolus of the right leg. The large ulcer measured 3 cm in length, 2 cm in width, and 1.75 cm in depth, with three to four small ulcers without granulation tissue. The patient also had swelling and blackish discoloration around right ankle joint and feet, with grade III tenderness around an ulcer. Varicosity on calf region of the right lower limb tested positive for Trendelenburg test and negative for Moses’ sign, but pedal pulse was present which was suggestive of varicose ulcer features [].\nOn the basis of symptoms such as attivivṛttavraṇa (spreading nature), utsanna (elevated margin), raktavarṇa (reddish), srāva (secretion), dāha (burning sensation), and shopha (swelling) present in the patient, he was diagnosed as having duṣṭa vraṇa with vātapradhānatridoshajavraṇa. Informed consent was obtained from the patient for documentation and publication of his case history.\nThe following treatment schedule was executed:\nNimbāmr.tādi castor oil (processed castor oil with Azadirachta indica and Tinospora cordifolia) - 50 ml orally used for Nitya virecana with 50 ml Śuntṇ hīkashāyam for three continuous days Nitya virecana is the specific therapy in Ayurveda in which the medicine may be processed in oil or as decoction is administered orally for cleansing the bowel and liver system. This improves the Agni metabolism of the individual. This is the first and necessary step in any Basti therapy. Next therapy is the main line of treatment, i.e. Basti karma (specific scheduled course of medicine administered through rectal route).\nOn day 4 of management, Mañjiṣṭhādi Basti karma was started with Balaguḍūcyādi Anuvāsana Basti (60 ml) in kāla basti pattern. The schedule was planned in accordance with the chart given below.\nIn the preparation of enema decoction, the above order was followed for the mixing of medicine, and decoction enema was usually administered on empty stomach.\nIn N2 Basti, Go arkam (distilled cow's urine) is not added for the decoction and the Kaśāyam (decoction) preparation is changed to Kāyam (decoction) preparation is changed to Ks.īrapāka preparation.\nSpecific decoction processed in milk –Mañjiṣṭhā + Guḍūci + Yaṣṭhimadhu Kṣīrapāka (300 ml) used to prepare enema decoction.\nAB, Anuvāsana Basti (enema for oleation consists of only the medicine processed in oil or ghee).\nThe pain was measured on visual analogue scale (VAS), the edema was measured by figure-of-eight method of measuring ankle joint swelling,[] and the ulcerated wound was assessed by measurement and granulation tissue formation.\nNoticeable improvement in the symptoms was seen, it was upto 60% in Śotha (edematous swelling), Dāha (burning sensation) was reduced up to 40%, and Toda (pricking sensation) was reduced up to 30% after Nitya virecana. Moreover, Basti karma, Śotha (edematous swelling) was reduced to 95%, Dāha to 70%, and Toda (pricking sensation) was reduced to 80%. Healing of the ulcerous wound started with the proliferative stage by the 3rd day of the Basti course and the wound got healed up to 90% after the whole course of Basti karma with no adverse event during the entire course of treatment [].
|
[[61.0, 'year']]
|
M
|
{'11862173': 1, '18075885': 1, '24501445': 2}
|
{}
|
165,508 |
3902556-1
| 24,501,507 |
noncomm/PMC003xxxxxx/PMC3902556.xml
|
Minimal invasive endoscopic management of synchronous granular cell tumours in the colon and posterior mediastinum
|
A 3 × 2-cm posterior mediastinal mass was discovered in January 2011 on a computed tomography (CT) scan in a 52-year-old woman with a medical history of status-post right modified radical mastectomy in November 2007 for a T2N1M0, stage 2B invasive ductal carcinoma of the breast. She had no significant complaints. Due to the prior history of breast cancer, video-assisted thoracoscopic removal was planned and performed under general anaesthesia with double-lumen endotracheal tube. Inspection of the left hemithorax revealed a 2.5 cm mass in the left paravertebral area near the apex of the lung []. Excision was carried out using a combination of blunt and sharp dissection. Initial histopathological diagnosis yielded a spindle-cell neoplasm. After a 9 month of follow-up, screening colonoscopy revealed a submucosal mass measuring approximately 1 cm in diameter []. The patient was over 40-years old and had a history of breast cancer. Because of this, the colon was evaluated as a part of the screening program. The mass was excised en bloc by endoscopic mucosal resection (EMR) using a snare []. No other similar lesions were detected on her esophagogastroduodenoscopy.\nMacroscopic examination revealed submucosal lesion measuring 1.0 × 1.0 × 0.8 cm with a hard consistency. In cut sections, a solid lesion that was composed of yellowish and whitish portions was detected. H and E-stained sections of the lesion revealed a tumour, which was located in the submucosa and partly in the mucosa []. The tumour was characterized by solid masses of plump histiocyte-like cells. The tumour cells with abundant granular eosinophilic cytoplasm were containing acidophilic Periodic acid-Schiff (PAS)-positive diastase-resistant granules []. Immunohistochemical analysis revealed diffuse expression of S100 protein []. Desmin and cytokeratin stains remained negative.\nImmunohistochemical evaluation with a broader panel of antibodies of the mediastinal and colonic lesion were carried out again and revealed similar and immunohistological patterns, and the diagnosis was consistent with GCT.
|
[[52.0, 'year']]
|
F
|
{'26358060': 1, '26637199': 1, '9684595': 1, '8023268': 1, '19399282': 2, '19598311': 1, '17642225': 1, '24501507': 2}
|
{'2672140-1': 1}
|
165,509 |
3902557-1
| 24,501,508 |
noncomm/PMC003xxxxxx/PMC3902557.xml
|
Laparoscopic management of post-cholecystectomy sectoral artery pseudoaneurysm
|
A 29-year-old male underwent laparoscopic cholecystectomy. At operation, Callot's anatomy was normal. Gall bladder was mildly inflamed containing multiple stones. Cystic artery was small and divided with harmonic scalpel in coagulating mode after double sealing. Cystic duct clipped with locking clip and divided.\nAfter 2 weeks, the patient was readmitted to the hospital with complaints of fatigue. He appeared pale, afebrile, with pulse rate of 100 and blood pressure 110/60 and mild guarding over the right upper abdomen. Plain film of the abdomen showed no pathology. Blood investigation showed haemoglobin 8. 6 g/dl (pre operative was 15.6), bilirubin 2.7 mg/dl with indirect bilirubin 1.6, signifying haemolysis, and slight increase in liver enzymes (aspartate aminotransferase 138UI/L; alanine aminotransferase 106 UI/L). Abdominal ultrasound followed by computed tomographic (CT) angiography with vascular reconstruction revealed intraperitoneal blood, mainly in Gallbladder fossa, with active bleed (contrast blush) from right posterior sectoral artery pseudo aneurysm [].\nThe angiographic embolisation was discussed. As the bleeder originated from right hepatic artery very near the bifurcation of hepatic artery proper, there was a possibility that not only right hepatic artery, but hepatic artery proper also may need to be embolized to control the bleed risking massive liver necrosis. So, operative exploration was decided. After stabilisation, we proceeded with laparoscopy, keeping an open instrument trolley ready for laparotomy.\nAt laparoscopy, intra-abdominal blood clots were suctioned out and gall bladder fossa adhesions were dissected with suction tip. The pulsating pseudoaneurysm with clot was identified in the right hepatic artery/cystic artery area. While trying to dissect the right hepatic artery, the pseudoaneurysm started to bleed. Combination of pressure, suction, and temporary control with clips failed. While contemplating conversion, we put in an extra port and applied laparoscopic Pringle (vascular) clamp as that would have been the first step after conversion. The bleeding immediately reduced to a trickle. It was now possible to clearly identify the right hepatic artery and the sectoral artery stump and intracorporeally suture ligate the offending artery stump at the base taking some peri-arterial tissue to prevent slipping of the suture []. The controlled environment helped taking precise bites. As per CT, the bleeding point was away from right hepatic duct so risk of biliary injury was minimal. The patient made an uneventful recovery.
|
[[29.0, 'year']]
|
M
|
{'34558424': 1, '3470648': 1, '21170238': 2, '28690884': 1, '12019416': 1, '18333143': 1, '8418705': 1, '24501508': 2}
|
{'2997276-1': 1}
|
165,510 |
3902559-1
| 24,501,509 |
noncomm/PMC003xxxxxx/PMC3902559.xml
|
Mesh erosion after laparoscopic posterior rectopexy: A rare complication
|
A 40-year-old man presented with occasional bleeding per rectum since 10 months with low grade intermittent fever for 1 week. He had history of LPMR for complete rectal prolapse 2 years back, carried out elsewhere. His abdominal and per rectal examinations were unremarkable. Sigmoidoscopy revealed hyperemic mucosa with ulceration 15 cm from anal verge, with a part of the polypropylene mesh projecting into the rectum []. Computed tomography (CT) scan of abdomen showed asymmetric anterior wall thickening of rectosigmoid junction with fat stranding and minimal fluid collection. Review of his surgical notes revealed that a 15 cm × 10 cm polypropylene mesh was used for rectopexy. Since it was a large mesh fixed with multiple tacks and possible dense adhesions, transanal approach was not attempted. Under general anesthesia, in lithotomy position, diagnostic laparoscopy was done. There were multiple dense adhesions in the pelvis. After sharp adhesiolysis, folded, and densely adherent polypropylene mesh was identified. Appendix was inflamed with its tip densely adherent to the mesh []. Excision of the mesh with appendectomy was done. There was a small rectal perforation at the site of erosion, which was confirmed by air leak test. Tube drain was kept into pelvis and diverting ileostomy was performed. He had an uneventful recovery with the ileostomy functioning from 2nd day. Patient was discharged with the drain on the 4th day. The drain was removed after 2 weeks. Distal loopogram was carried out after 3 months, which showed no leak. Subsequently ileostomy closure was done.
|
[[40.0, 'year']]
|
M
|
{'25435827': 1, '31041515': 1, '26380050': 1, '12626911': 1, '19087777': 1, '27648031': 1, '8453130': 1, '28400698': 1, '24501500': 1, '19675793': 1, '24501509': 2}
|
{}
|
165,511 |
3902561-1
| 24,501,511 |
noncomm/PMC003xxxxxx/PMC3902561.xml
|
Laparoscopic extirpation of giant adrenal ganglioneuroma
|
A 33-year-old female presented to us with left flank pain and ultrasonography suggestive of left suprarenal mass. Present and past medical history was unremarkable. Computed tomography (CT) scan revealed a large left suprarenal mass which was well-marginated with homogenous low CT attenuation, non-enhancing, and free from surrounding structures []. Preoperative endocrine evaluation was normal. A diagnosis of non-functioning suprarenal tumor probably benign was presumed. Definitive extirpation was planned through laparoscopic approach.\nPatient was positioned in right lateral decubitus. Access was obtained through transperitoneal route. Four ports were utilized. A large suprarenal mass was identified encroaching medially beyond the medial border of aorta, superiorly abutting the diaphragm, laterally extending up to the parietal wall and displacing the kidney inferiorly []. Peritumoral plane was defined and dissection was carried out along this plane. Spleenopancreatic complex was released from lateral attachments and surface of tumor using harmonic scalpel through 5 mm lateral port. Dissection was continued with meticulous attention to hemostasis []. The adrenal vein was identified and control was achieved at the confluence with left renal vein. A plane of cleavage was defined between the aorta and the neoplasm and the attachments were freed along this plane. The lesion could be completely extirpated laparoscopically. Duration of surgery was 250 minutes. Estimated blood loss was 230 milliliters. Specimen was extracted through pfannenstiel incision. No significant intraoperative or postoperative happenings were recorded. Patient tolerated orals on first postoperative day. Drain was removed on the second day and the patient was sent home on the following day. On gross inspection, the specimen appeared bosselated with intact capsule measuring 17 × 11 × 7.5 cm []. Microscopic features were suggestive of GN, mature subtype of adrenal gland.
|
[[33.0, 'year']]
|
F
|
{'12889507': 1, '14768652': 1, '28540670': 1, '33522915': 1, '17532597': 1, '30622759': 2, '18237516': 1, '27668117': 2, '26196309': 1, '19489680': 1, '24501511': 2}
|
{'5030439-1': 1, '6295176-1': 1}
|
165,512 |
3902562-1
| 24,501,512 |
noncomm/PMC003xxxxxx/PMC3902562.xml
|
Combined laparoscopic cholecystectomy with ileostomy reversal: A method of delayed definitive management of postoperative gallstone pancreatitis
|
A 31-year-old male with adenomatous polyposis coli gene mutation and familial adenomatous polyposis presented prophylactic surgical treatment. His preoperative endoscopic evaluation revealed no duodenal or ampullary pathology. He underwent an uncomplicated laparoscopic total proctocolectomy with ileal j-pouch anal anastomosis and diverting loop ileostomy. On postoperative day (POD) 8, he developed acute epigastric and right upper quadrant (RUQ) pain. His vital signs were normal and clinical exam was unrevealing. Laboratory studies revealed a white blood cell (WBC) count of 14,000, serum lipase and amylase of 1300, and normal bilirubin. Ultrasonography revealed gallbladder sludge. A diagnosis of GP was made. He was placed on bowel rest with IV hydration until pancreatitis improved clinically and biochemically. Cholecystectomy was deferred until planned ileostomy reversal. To decrease the risk of recurrent episodes of GP, endoscopic retrograde cholangiopancreatography with sphincterotomy (ERCP/S) was performed. He was discharged on POD 17. The patient then underwent ileostomy reversal and cholecystectomy as described below 6 weeks later.
|
[[31.0, 'year']]
|
M
|
{'19760330': 1, '8185397': 1, '12607047': 1, '28782748': 2, '11008727': 1, '20428915': 1, '15481317': 1, '15166953': 1, '24501512': 2}
|
{'3902562-2': 2, '6001291-1': 1, '6001291-2': 1}
|
165,513 |
3902562-2
| 24,501,512 |
noncomm/PMC003xxxxxx/PMC3902562.xml
|
Combined laparoscopic cholecystectomy with ileostomy reversal: A method of delayed definitive management of postoperative gallstone pancreatitis
|
A 44-year-old male with a history of sigmoid colectomy for endoscopically unresectable adenoma presented to us with rectal bleeding. Colonoscopy revealed recurrent sessile mass at the colorectal anastomosis. Biopsy revealed villous adenoma with high grade dysplasia. He underwent re-do low anterior resection with diverting loop ileostomy. He had an uneventful recovery and was discharged on POD 10. However, 4 days later he presented with epigastric and RUQ abdominal pain. The patient's clinical examination revealed mild epigastric tenderness. Laboratory studies revealed a WBC count of 13,000, lipase and amylase above 400, and normal bilirubin. Ultrasonography revealed gallstones (GS). GP was diagnosed and then managed non-operatively, similar to our first case. He refused ERCP/S. After discharging, the patient returned in 6 weeks for ileostomy reversal and cholecystectomy as described below.
|
[[44.0, 'year']]
|
M
|
{'19760330': 1, '8185397': 1, '12607047': 1, '28782748': 2, '11008727': 1, '20428915': 1, '15481317': 1, '15166953': 1, '24501512': 2}
|
{'3902562-1': 2, '6001291-1': 1, '6001291-2': 1}
|
165,514 |
3902574-1
| 24,501,491 |
noncomm/PMC003xxxxxx/PMC3902574.xml
|
Shock due to amlodipine overdose
|
A 28-years-old woman, with no significant past history, presented with giddiness, abdominal pain, vomiting, breathlessness, and reduced urine output 12 hours after consuming 50 tablets of amlodipine [of 5 mg strength]. She was rushed to a hospital near her home, found to have hypotension with hypoxemia; was intubated, given gastric lavage, inotropic support and 24 hours later, shifted to our hospital At presentation she was found to have blood pressure (BP): 60/40 mmHg, heart rate: 128/min, respiratory rate: 32/min with spO2 on room air: 85%, raised central venous pressure [22 cm of saline], anasarca and crepititions in both interscapular area. She was admitted to the intensive care unit (ICU). Investigations revealed: Total leukocyte count: 18500/uL; neutrophils: 86%, serum creatinine: 1.8 mg/dl (normal range: 0.6-1.3 mg/dl), blood urea nitrogen 42 mg/dl (normal range: 10-20 mg/dl), and features of type -1 respiratory failure (pO2-48 mmHg, pCO2-26 mmHg, pH - 7.52, HCO3-22 mmHg). Ionized serum calcium (4.8 mg/dl; normal range: 4.6-5.6 mg/dl, serum albumin (3.9 mg/dl; range 3.5-5.5 mg/dl), and serum amylase (32 IU/L; range 18-108 IU/L) level at presentation were normal. X-ray of chest revealed bilateral reticulonodular opacities, upper lobar zone venous prominence, bilateral pleural effusion, and no cardiomegaly []. Her electrocardiogram was normal. Echocardiography revealed normal-sized chambers, valves, right and left atrial pressures, and left ventricular ejection fraction. Cultures of blood, urine, and tracheal aspirate were sterile. Intravenous inotropes were continued (dopamine: 10-15 μg/kg/min; noradrenaline: 10-12 μg/kg/min), systolic BP increased to 90-110 mmHg when iv frusemide was added. Two boluses of calcium gluconate were given (10 ml of 10% solution) 15 minutes apart, thereafter, low-dose infusion (at the rate 1 mg/kg of calcium) was started; ionized serum calcium level was maintained between 4.8-5.3 mg/dl. Thoracentesis was performed, 300 ml of exudative effusion (total count: 2800/cmm, leukocytes: 2400/cmm; predominantly lymphocytes; lactate dehydrogenase – 698 U/L; protein – 3 g/dL) was drained from either side. She was ventilated initially invasively, later non-invasively; and empiric broad-spectrum antibiotics covering Gram-positive, Gram-negative organisms and Pseudomonas aeruginosa were started in view of prior hospitalization. Monitored parameters included clinical status, central venous pressure, urine output, fluid, and electrolytes including calcium levels and ECG every 4-6 hrs for first 48, thereafter every 12 hours. Her urine output improved after 24 hours. She was successfully weaned off ventilator after 48 hours; inotropes (noradrenaline after 18 hours, dopamine after 48 hours) and calcium infusion (after 48 hours) were gradually tapered off. She was shifted to a step-down ward from ICU after 72 hours and discharged after 5 days.
|
[[28.0, 'year']]
|
F
|
{'19742263': 2, '8167534': 1, '11386285': 1, '30595699': 2, '20643990': 1, '22013313': 2, '17622512': 1, '29123890': 2, '10465243': 1, '15898828': 1, '15656053': 1, '24501491': 2}
|
{'6286784-1': 1, '3190472-1': 1, '2738322-1': 1, '5674457-1': 1}
|
165,515 |
3902575-1
| 24,501,492 |
noncomm/PMC003xxxxxx/PMC3902575.xml
|
Acquired hemophilia complicated by cardiorenal syndrome type 3
|
A 65-year-old female with history of healed traumatic amputation of left 5th toe 2 months back, transferred to our hospital on mechanical ventilator and dopamine infusion with the complaints of hematuria for 1.5 months, subcutaneous hemorrhage for 15 days, oliguria for 3 days, and respiratory failure for 1 day. At presentation, she was alert, afebrile, and tachycardic, with high oxygen requirement. On examination, she was volume overloaded with multiple ecchymotic patches over limbs [], back, and buttocks.\nUltrasonography of abdomen showed hepatomegaly, right pleural effusion, bilateral hydronephrosis, and hydroureter with no calculus or focal mass lesion and normal blood flow bilaterally in the renal arteries and veins. ECG showed tall T-waves and arterial blood gas analysis (ABG) indicated metabolic acidosis with a base deficit of 6.8. Other investigations were hemoglobin 8.7 gm/dL, total leukocyte count 12,100/μL, platelet 297,000/μL, international normalized ratio 1.1, activated partial thromboplastin time (aPTT) 55.4 s (control 27 s), urea 117 mg/dL, creatinine 7.1 mg/dL, sodium 120 mEq/L, potassium 5.6 mEq/L. Chest radiograph showed bilateral pleural effusions with basal atelectasis []. Her liver function tests were normal. Echocardiography showed global hypokinesia with dilated cardiac chambers and left ventricular ejection fraction (LVEF) 25-30% []. Patient was immediately administered heparin-free hemodialysis with low sodium dialysate and a target ultrafiltrate of 3 L. Packed red blood cells (RBCs) and fresh frozen plasma were transfused during dialysis. All serological tests were normal.\nOver the next 3 days, her general condition improved with correction of dyselectrolytemia, discontinuation of vasopressors, and weaning from the ventilator; but she continued to have hematuria with a raised aPTT. Blood, urine, and tracheal secretions cultures were negative. Blood FVIII level was less than 1% and FVIII inhibitor was detected in serum Recombinant activated factor VII (rFVIIa) was given in a dose of 90 μg/kg as intravenous bolus and repeated after 4 h. Hematuria was relieved followed by normalization of creatinine. She was started on tablet metoprolol 25 mg/day and tablet prednisolone 50 mg/day. Patient was shifted out of ICU on 5th day of admission.\nDrug treatment for cardiac failure was optimized. Repeat echocardiography on the 10th day showed LVEF of approximately 35%. Dobutamine stress echocardiography was negative for reversible ischemia with significant improvement in LVEF. The patient was discharged on the 12th day of hospitalisation.
|
[[65.0, 'year']]
|
F
|
{'16138334': 1, '21626430': 1, '30127565': 1, '20037146': 1, '10923354': 1, '11187873': 1, '19336751': 1, '33829014': 1, '19040429': 1, '19826896': 1, '8828561': 1, '24501492': 2}
|
{}
|
165,516 |
3902576-1
| 24,501,493 |
noncomm/PMC003xxxxxx/PMC3902576.xml
|
Lemierre's syndrome presenting with septic shock
|
A 24-year-old young male weighing 80 Kg, with no co-morbidities presented with history of sore throat of 10 days duration, associated with difficulty in swallowing. 4 days before presenting to the hospital, he developed pain and swelling on the left side of the neck and had a 2 day history of severe throbbing headache with vomiting and restlessness. Examination of his oral cavity showed a bulge in the posterior pharyngeal wall, more towards left side and the uvula was deviated to the right. He was febrile, tachycardic, and had tender swelling on the left side of the neck involving the angle of mandible and upper third of the sternomastoid. Further systemic examination was unremarkable and his Hb 13.3 gm%, total count of 9800 cells/cumm, platelet count 282,210 cells/cumm, ESR 37 mm/h and was HIV negative. Magnetic resonance imaging of neck revealed a left parapharyngeal abscess and magnetic resonance (MR) venogram [] showed thrombosis of the left IJV and reduced flow or stasis in left transverse and sigmoid sinuses. Other investigations were unremarkable. A diagnosis of Lemierre's syndrome was made. The parapharyngeal abscess was drained under general anesthesia and was empirically started on imepenem awaiting culture reports of aspirated pus and devitalized tissue. Fondaparinux was started in view of thrombosis of left IJV.\nOn the 2nd post-operative day, patient had persistent hypotension with systolic pressures between 70 and 90 mmHg, not responding to repeated fluid boluses. The total count decreased to 3720 cell/cu mm, platelet count dropped to 35,000/cu mm, Activated partial thromboplastin time was prolonged (84 s), and serum procalcitonin 1.4 ng/mL. A diagnosis of septic shock was entertained and patient was shifted to intensive care unit. Imipenem was stopped and antibiotics vancomycin & clindamycin were started for Gram-positive coverage and metronidazole for anaerobic coverage as suggested by clinical microbiologist. Single donor platelet units were transfused for thrombocytopenia.\nCentral venous access was obtained via the right femoral vein. Neck veins and subclavian vein cannulation was not attempted in view of thrombosis of the left IJV. Fondaparinux was stopped in view of deranged coagulation and dropping platelet count. Inotrope in the form of noradrenaline infusion was started to maintain MAP > 65 mmHg.\nCultures of pus and devitalized tissue collected during surgery grew S. aureus sensitive to antibiotics vancomycin and clindamycin, which the patient was already receiving and blood culture was negative. No anaerobes were isolated in the specimens. Patient's condition remained stable for next 2 days after which he became progressively tachypneic and hypoxemic, with chest X-ray showing bilateral lower zone opacities. He required to be intubated and ventilated in view of persistent hypoxaemia. Over the next 3 days he made a gradual recovery. He was weaned off the inotrope and ventilator support. His platelet count improved to 379,000/cu mm, coagulation and chest X-ray normalized. After a further 3 days stay in intensive care unit, patient was discharged to ward. Throughout his stay in the hospital patient had a Glasgow coma scale 15/15 and demonstrated no neurological deficits. His further hospital course in the ward was uneventful and was discharged 3 weeks after his admission to the hospital. Oral linezolid was continued for 3wks in order to treat residual infective thrombus in the IJV.
|
[[24.0, 'year']]
|
M
|
{'19124638': 1, '24904685': 2, '25740463': 1, '15867055': 1, '15192164': 1, '22799122': 1, '33614331': 2, '9228388': 1, '10448489': 1, '27127661': 2, '24501493': 2}
|
{'4835622-1': 1, '4046005-1': 1, '7883589-1': 1}
|
165,517 |
3902577-1
| 24,501,494 |
noncomm/PMC003xxxxxx/PMC3902577.xml
|
Dramatic response to plasma exchange in systemic lupus erythematosus with acute complications: Report of two cases
|
A 28-year-old female presented with history of shortness of breath, cough with blood stained sputum and oliguria for 1 day. There was history of pedal edema, multiple joint pains associated with swelling for 10 days, with history of oral ulcers off and on and polymenorragia for 6-8 months. There was also history of untreated mild to moderate hypertension for 2 years. She was admitted inntensive care unit (ICU) for ventilator support. On examination, Jugular Venous Pressure (JVP) was raised with severe pallor and pedal edema. Auscultation of chest revealed fine crackles all over the chest. Abdominal examination showed hepatomegaly. X-ray and computed tomography (CT) scan of chest showed diffuse alveolar opacities in bilateral upper and middle lobes of lungs. Initial urea and creatinine values were 89 mg/dl and 2.2 mg/dl respectively. Serology revealed positive ANA and anti double strandard DNA antibodies. Patient was diagnosed as SLE with acute flare up in the form of diffuse alveolar hemorrhage and renal failure. Patient was intubated and put on a ventilator, started with pulse methylprednisolone therapy and injection cyclophosphamide. Three units of packed red cells were transfused for severe anemia (Hb-4.7 g/dl). As there was no improvement after 48 h, the treating physician planned plasma exchange for the patient. The patient was assessed for the procedure by transfusion medicine team and the patient was shifted to department of transfusion medicine on ventilatory support. One plasma volume of patient was exchanged with normal saline and 4% human serum albumin as replacement fluid. No procedural complications were observed and he was shifted back to ICU. After 24 h of the procedure, patient was successfully weaned off the ventilator and extubated with no fresh episodes of hemoptysis. However, urine output was still low with hematuria. A total of four plasma exchange cycles were done for the patient on alternate days and one plasma volume was exchanged each time. After the 2nd procedure, there was an improvement in urine output without any need for renal replacement therapy. After the 3rd procedure, urine output was normal without hematuria, with no fresh episodes of hemoptysis and a repeat X-ray showed clearing of hemorrhagic opacities from lungs. Patient was discharged after the 4th procedure, though azotemia persisted. Her total duration of hospital stay was 14 days with ICU stay of 10 days.
|
[[28.0, 'year']]
|
F
|
{'20568098': 1, '9193454': 1, '31360498': 2, '18583750': 1, '15168157': 1, '11035681': 1, '10155546': 1, '763252': 1, '26309442': 1, '154062': 1, '1569973': 1, '24501494': 2}
|
{'3902577-2': 2, '6637357-1': 1}
|
165,518 |
3902577-2
| 24,501,494 |
noncomm/PMC003xxxxxx/PMC3902577.xml
|
Dramatic response to plasma exchange in systemic lupus erythematosus with acute complications: Report of two cases
|
A 24-year-old male, a known case of SLE (for 13 years) with End Stage Renal Disease (class IV lupus nephritis) presented with shortness of breath, chest pain, and cough for 7 days. Patient had two episodes of diffuse alveolar hemorrhage in the past, managed with pulse steroids. The patient also had pulmonary tuberculosis and was on Anti-tubercular treatment for last 6 months. He was also Hepatitis B surface antigen (HBsAg) positive. He had received five pulses of cyclophosphamide prior to this admission. On examination, patient was tachypnoeic, endotracheal bleeding was present. There was right hypochondriac tenderness and hepatomegaly. He was admitted to ICU for ventilator support and was started on pulse methylprednisolone. Chest X-ray and CT scan showed bilateral middle and lower alveolar opacities. The possibility of acute exacerbation of SLE in the form of diffuse alveolar hemorrhage was considered. As there was no improvement on pulse steroids, plasma exchange was planned. Patient was assessed by transfusion medicine team and taken up for the plasma exchange on day 2 of ICU admission. Six cycles of plasma exchange were administered on alternate days by exchanging one plasma volume, using 4% human Serum Albumin as replacement fluid. After the 1st procedure there was clearing of the endotracheal tube bleeding and after the 2nd procedure patient could be successfully weaned off the ventilator and was shifted to the ward. Patient was on dialysis simultaneously and his renal function tests improved after the 6th procedure. His total duration of hospital stay was 17 days including 4 days in the ICU.
|
[[24.0, 'year']]
|
M
|
{'20568098': 1, '9193454': 1, '31360498': 2, '18583750': 1, '15168157': 1, '11035681': 1, '10155546': 1, '763252': 1, '26309442': 1, '154062': 1, '1569973': 1, '24501494': 2}
|
{'3902577-1': 2, '6637357-1': 1}
|
165,519 |
3902578-1
| 24,501,495 |
noncomm/PMC003xxxxxx/PMC3902578.xml
|
Refractory hyperkalemia related to heparin abuse
|
A 26-year-old male patient was admitted in the emergency department with the complaint of weakness of all four limbs since 1 day prior to admission, which was rapidly progressive. He was a pharmacist at a private nursing home addicted to multiple medicines including tramadol, diclofenac, pheniramine, and dexamethasone along with heparin to maintain the venous patency since several years. He was a known case of bronchial asthma and was on and off steroids for the past several years.\nOn admission, patient was conscious and oriented, hemodynamically stable with a heart rate of 112 beats/min, non-invasive blood pressure of 130/80 mmHg, respiratory rate of 24/min and a temperature of 99°F. There was no pallor. No signs of clubbing or lymphadenopathy were there. Oral thrush was present. Chest, cardiovascular system and per abdomen examination were grossly normal. On central nervous system examination, power was grade 3/5 in upper limbs and 1/5 in lower limbs. Generalized areflexia was present. Planters were bilateral flexors. Sensory examination was normal. Laboratory investigations are tabulated in . Arterial blood gas (ABG) at admission showed a normal pH (7.437) with hyperkalemia (K+ = 6.01). Although the first lab sample did not show hyperkalaemia, all repeat values did. Also the hyperkalemia was subsequently treated after 6 hours or so when repeat samples confirmed hyperkalemia. Patient was admitted to intensive care unit for monitoring and within an hour of admission, he got tachypnoeic with respiratory rate of 36-40/min and was put on non-invasive ventilation. Heart rate went up to 130 beats/min, regular but pulses got feeble. His blood pressure dropped down to 100/56 mmHg. At this time, invasive lines were put in, in the form of central venous cannulation and arterial line. Central venous pressure was 6 cm H2O and mean arterial pressure (MAP) was 55 mmHg. Patient was resuscitated with a fluid bolus of 1 litre normal saline. His blood pressure improved with MAP going up to 64 mmHg. He was further given 500 mL of normal saline in the subsequent hour and was started on normal saline 100 mL/h infusion. Subsequently, a MAP of >65 mmHg was targeted. Urine output was >0.5 mL/kg at all times. His chest X-ray showed a patch of consolidation on the right middle and lower zones. Echocardiography showed global hypokinesia with severe left ventricular dysfunction with ejection fraction of 30%. Repeat ABG after 6 h showed metabolic acidosis with lactic acidosis and hyperkalemia (pH = 7.257, pCO2 = 27.2, pO2 = 98.6, HCO3− = 13.8, Lactate = 7.1, K+ = 7.0). Lab values of S. K+ were 6.7 mEq/L and anti-hyperkalemia treatment was started in the form of calcium gluconate, dextrose-insulin, and salbutamol nebulization. With nephrologist's opinion, patient was urgently taken up for slow low-efficiency dialysis (SLED) of 8 h. Within 20 min of starting dialysis, patient had an episode of pulseless ventricular tachycardia. Patient was defibrillated and cardiopulmonary resuscitation (CPR) was done. Anti-hyperkalemia regimen was repeated. Urgent serum K+ levels done at the time of event were 9.1 mEq/L. After 40 min of CPR, patient was revived with normal sinus rhythm, was intubated and put on invasive ventilatory support. He was started on inotropes and vasopressors. Subsequent ABG done before the end of planned duration of SLED still showed persistent hyperkalemia (K+ = 7.1), with slight improvement in pH values. On discussion with the nephrologist, we planned to extend the ongoing SLED. After another 4 h of extended SLED, blood gas still showed raised potassium values (K+ = 7.2) with constant pH. For persistent hyperkalemia, SLED was further extended making a total duration of 20 h. Post dialysis, patient still had lab serum K+ level of 7.6 mEq/L. Next morning, patient developed blisters all over the body. He had coagulopathy and thrombocytopenia (PT/INR increased from 1.21 to 6.8 and platelets dropped down to 33,000 from 1.55 lacs/mm3), which was thought to be related to sepsis. On admission, patient was started empirically on ceftriaxone but in view of deteriorating clinical condition, he was shifted to meropenem, teicoplanin and ampicillin. It was an emperical selection of broad spectrum antibiotics keeping in mind MRSA and ampicillin for coverage for leptospira, with plans to de-escalate after obtaining culture reports. With deterioration in blood gas showing acidosis and again rise in potassium levels, patient was taken up for SLED again. He was dialyzed for more than 32 h, out of his 40 h hospital stay but his hyperkalemia remained refractory to antihyperkalemic agents and dialysis. Serial blood gases done showed that patient continued to have high anion gap acidosis and hyperkalemia at all times during his hospital stay []. This refractory hyperkalemia made us think over its cause. After ruling out all possible causes, it was considered to be related to heparin abuse. Following this, fludrocortisone in the dose of 100 μg/day was also added on morning of day 2. Correlating thrombocytopenia and coagulopathy also with heparin, activated clotting time was monitored and protamine sulphate was also given. On the 3rd day morning, patient had an episode of upper gastrointestinal bleed, following which he went into asystole. CPR was done according to protocol but patient could not be revived and was declared dead. Blood cultures obtained after 72 h showed methicilin-resistant staphylococci.
|
[[26.0, 'year']]
|
M
|
{'2350905': 1, '14082398': 1, '2663545': 1, '4004433': 1, '15414052': 1, '21181208': 1, '18672': 1, '3317900': 1, '17616536': 1, '25425851': 1, '18343525': 1, '2180218': 1, '25425852': 1, '10852087': 1, '21286456': 2, '7091949': 1, '11975115': 1, '24501495': 2}
|
{'3030052-1': 1}
|
165,520 |
3902579-1
| 24,501,496 |
noncomm/PMC003xxxxxx/PMC3902579.xml
|
Salmonella typhimurium meningitis in infancy
|
A 4-month-old female baby was brought to the pediatric emergency (ER) department of our hospital with complaints of fever and cold of two days duration, and upward deviation of eyes with tonic-clonic movements of the extremities since one hour. Past history revealed that she was born at term by normal vaginal delivery to a primigravid mother. Her birth weight was 3.25 kg and she cried immediately after delivery with no antenatal, intranatal and postnatal complications. She was immunized and had attained milestones as per the age. There was no history of diarrhea and rash. Initial examination at the emergency showed active convulsions, fever (39°C rectally), respiratory rate 46/min, heart rate 160 beats/min, blood pressure 100/60 mm Hg, capillary refill two seconds, weight 5.3 kg, bilateral symmetrical chest movements, no organomegaly with normal bowel sounds. Central nervous system examination revealed no focal deficits. Her anterior fontanelle was flat with increased tone and exaggerated reflexes. Ultrasound of the cranium was normal.\nThe child was immediately intubated for airway protection and shifted to the pediatric intensive care unit (PICU). Intravenous (IV) ceftriaxone and amikacin were initially started. Lumbar puncture (LP) was done which revealed a grossly turbid cerebrospinal fluid (CSF) with a total WBC count of 14,120/mm3, of which 87% were neutrophils. CSF protein was elevated to 564 mg/dl and sugar was 10 mg/dl. CSF gram stained showed gram-negative bacilli which on culture grew Salmonella sp. sensitive to ampicillin, chloramphenicol, cotrimoxazole, ciprofloxacin, ceftriaxone after 48 hours of incubation. This isolate was sent to National Institute of Cholera and Enteric Diseases, (Indian Council of Medical Research) Kolkata, which was identified as Salmonella typhimurium. In view of this unusual isolate, immunological deficiency was considered and was worked up accordingly. Her chest X-ray showed a normal thymic shadow. Her serum calcium and immunoglobulin levels were within normal limits.\nThe initial antibiotic therapy was later revised to ceftriaxone, chloramphenicol and ciprofloxacin based on CSF culture and sensitivity reports. She was also started on antiepileptic drugs in view of refractory seizures. Other laboratory investigations revealed hemoglobin 10.4 g/dl, total leucocyte count of 14,270/mm3 (neutrophils 75%, lymphocyte 22%) and platelet count of 1,09,000/mm3. Her coagulation parameters were within normal ranges. Stool and blood cultures were negative for Salmonella. By day nine, when the child showed signs of neurological improvement, antiepileptic drugs were tapered and the child was extubated and eventually shifted to the ward. The baby was continued on intravenous ciprofloxacin, ceftriaxone and chloramphenicol. Computed tomography (CT) scan of brain done on day 13, showed left middle cerebral artery territory (MCA) infarct. The child developed respiratory distress and developed new infiltrates on chest X-ray. On day 25, the child was shifted back to PICU in view of worsening respiratory distress, intubated and put on mechanical ventilator. A chest X-ray showed worsening with right lung haziness suggestive of consolidation of the entire right lung and left lobe opacity. Nosocomial pneumonia was suspected. Antibiotics were further revised to inj. meropenem, polymyxin and linezolid. The organism isolated from her endotracheal aspirate was Acinetobacter species which was managed with appropriate antibiotics. Despite all efforts her condition continued to deteriorate secondary to nosocomial pneumonia and she died on day 38 of admission
|
[[4.0, 'month']]
|
F
|
{'29238942': 1, '33281354': 1, '11770247': 1, '25889776': 2, '31125015': 2, '17582179': 1, '10452664': 1, '11062183': 1, '17158637': 1, '9735931': 1, '9397614': 1, '10457297': 1, '24501496': 2}
|
{'6776206-1': 1, '4350644-1': 1}
|
165,521 |
3902689-1
| 24,479,100 |
noncomm/PMC003xxxxxx/PMC3902689.xml
|
Seat Belt Sign and Its Significance
|
A 54-year-old gentleman presented with a history of road traffic accident while he was travelling in car got smashed into one pillar. All three fellow passengers were safe. He had history of transient loss of consciousness. There was no history of vomiting, ear, nasal bleed or convulsions. He was complaining of back pain radiating to left lower limb. There was chest pain. There was no pain abdomen. He was a known hypertensive on regular medication. Magnetic resonance imaging lumbosacral spine showed mild L4-5 prolapsed intervertebral disc (PIVD) with left nerve root compression. X-ray chest, abdomen and pelvis were normal. Computed tomography scan chest showed mild pleural effusion on the right side. Ultrasound abdomen was normal. Color Doppler for neck vessels was normal. Local examination revealed an oblique bruise in the neck and another bruise in the right flank (diagonally opposite to the neck bruise) suggestive of seat belt-related injury []. Patient was managed conservatively and did well.
|
[[54.0, 'year']]
|
M
|
{'3178000': 1, '26985421': 2, '32544828': 1, '1996397': 1, '13897066': 1, '9107338': 1, '4905861': 1, '19774955': 1, '5723861': 1, '12460976': 1, '19916127': 1, '22241693': 1, '34853758': 2, '11956373': 1, '16141013': 1, '9322665': 1, '15667824': 1, '12013287': 1, '19590352': 1, '9926756': 1, '13372023': 1, '24479100': 2}
|
{'4776614-1': 1, '8608678-1': 1}
|
165,522 |
3902690-1
| 24,479,101 |
noncomm/PMC003xxxxxx/PMC3902690.xml
|
Rhodococcus Equi: A Pathogen in Immunocompetent Patients
|
A 38-year-old female came with a complaint of lump in the upper quadrant of the right breast since 9 days following a trauma 15 days back due to a fall. There was no history of pain or fever. There was no history of nipple discharge, nipple retraction or ulceration of skin. On local examination a lump was found in the upper outer quadrant of the right breast which was nodular and erythematous. The lump was tender and there was local rise in temperature. It was firm to hard in consistency. Anterior axillary lymph nodes were palpable. The patient's vitals and systemic examination were normal. Investigations showed a total leucocyte count of 9,400 cells/cumm with neutrophils 84%, lymphocytes 13%, eosinophils 1% and monocytes 2%. Random blood sugar was 87 mg/dl. The patient was found to be HBsAg reactive and HIV nonreactive. Liver function tests were within normal limits. Ultrasonography of the right breast showed mixed echogenic collection in upper and outer quadrant indicating either infected hematoma or abscess. Incision and drainage were done under general anesthesia and the pus was sent for microbiological investigations. She was given intravenous amoxicillin-clavulanic acid 1.2 g 8-hourly for 6 days.\nGram staining of the sample revealed numerous pus cells and a moderate number of irregularly stained gram-positive bacilli which were acid fast by 1% H2SO4 Zeihl--Neelson staining [] Culture on blood agar showed growth of 1--2 mm sized orange pigmented, nonhemolytic colonies [] after 48 hours of incubation. MacConkey's agar did not show any growth. On Gram staining they were irregular Gram-positive bacilli with diphtheroid morphology. It was identified as Rhodococcus equi by conventional biochemical tests. It was sensitive to ampicillin, amoxicillin-clavulanic acid, cephalosporins, gentamicin, erythromycin, ciprofloxacin.\nPatient was discharged on the seventh day with advice of oral amoxicillin-clavulanate 625 mg three times a day for 10 days.
|
[[38.0, 'year']]
|
F
|
{'10472487': 1, '6067513': 1, '16424975': 1, '19946958': 1, '19332935': 1, '32467804': 2, '24479101': 2}
|
{'3902690-2': 2, '7249752-1': 1}
|
165,523 |
3902690-2
| 24,479,101 |
noncomm/PMC003xxxxxx/PMC3902690.xml
|
Rhodococcus Equi: A Pathogen in Immunocompetent Patients
|
A 78-year-old female came to surgical OPD with the complaint of pain abdomen and distension since 1 day and fever since 2 days. The patient was apparently normal when she developed pain in abdomen. It was insidious in onset, progressive in nature, throbbing type, with more on the right side, nonradiating, no aggravating or relieving factors were observed. Fever was high grade, insidious in onset, continuous with no variation. No history of vomiting or loose stools was found. She was nondiabetic, nonhypertensive. Her vitals and systemic examination were normal except per abdomen examination showed tender hepatomegaly. Laboratory investigations showed a total count of 18,599 cells/cumm with N 84%, L 13%, Platelet count was 390,000 cells/cumm. ESR was 45 mm at the end of the first hour. Serum total protein level was 5.7 g/dl, serum albumin 2.6 g/dl, serum globulin 3.1 g/dl, A/G ratio 0.8, serum AST 61.0 U/l, serum ALT 51.0 U/l, serum alkaline phosphatase 149.0 U/l. She was nonreactive for HIV and HBsAg.\nAspirate from liver abscess and Bactec blood culture were sent for microbiological investigations. Gram staining of pus showed numerous pus cells but no bacteria. Culture of the pus did not show any growth. The blood culture bottle flagged positive in 48 hours, Salmon-colored colonies grew which were gram positive bacilli and weakly acid-fast by 1% H2SO4. The colony was identified as Rhodococcus equi which was sensitive to ampicillin, amoxicillin-clavulanic acid, cephalosporins, gentamicin, erythromycin, ciprofloxacin. She was treated with ceftriaxone 1.5 g I.V BD for 14 days. She showed remarkable clinical improvement and discharged.
|
[[78.0, 'year']]
|
F
|
{'10472487': 1, '6067513': 1, '16424975': 1, '19946958': 1, '19332935': 1, '32467804': 2, '24479101': 2}
|
{'3902690-1': 2, '7249752-1': 1}
|
165,524 |
3902691-1
| 24,479,102 |
noncomm/PMC003xxxxxx/PMC3902691.xml
|
Pulmonary Tuberculosis Presenting Acutely as Paraplegia: An Unusual Presentation
|
A 19-year-old male patient presented with the complaint of acute onset paraplegia since 4 days. He reported to have slept normally at night and noticed that he could not move both his lower limbs when he woke-up the next morning. On examination, he was fully conscious, had a blood pressure of 128/80 mm of Hg, pulse rate of 78 beats/min, respiratory rate of 22/min and a temperature of 98.4°F. A neurological examination revealed flaccid areflexic paraplegia with sensory loss along with bowel and bladder involvement. On respiratory examination, there were occasional expiratory crepitations in the right infrascapular area. The cardiovascular and abdominal examinations were, however, normal. Patient had no history of cough with sputum, fever, night sweats, weight loss, trauma or vaccination in the recent past. A magnetic resonance imaging (MRI) spine was performed, which revealed a paravertebral abscess extending from T7 to L2 vertebra []. A computed tomography chest revealed bronchiectatic changes in the right lower lobe []. The sputum was positive for acid fast bacilli.
|
[[19.0, 'year']]
|
M
|
{'27587940': 1, '18321747': 1, '16542167': 1, '5805757': 1, '25883834': 2, '25161980': 1, '20595106': 1, '5805758': 1, '8110926': 1, '12577105': 1, '24479102': 2}
|
{'4392528-1': 1}
|
165,525 |
3902692-1
| 24,479,103 |
noncomm/PMC003xxxxxx/PMC3902692.xml
|
Hemichorea-Hemiballism in a Nonketotic Diabetic Patient
|
A 67-year-old male normotensive, nonsmoker, and diabetic patient presented with involuntary movements of left side of the body. He was known diabetic for 10 years and on good control with oral gliclazide preparation. Recently, he discontinued the medication for 5 days without any reason. His family members mentioned that the patient was reasonably well till the evening he presented. There was no history of fever or intake of any other drugs. Patient was oriented, conscious, and vital signs were normal. Patient was violently moving his left sided limbs []. Routine investigations were in normal limit except blood glucose was 35 mmol/l. There were no ketone bodies in urine. Computed tomography (CT) brain showed nonenhancing hyperdensities in the right sided basal ganglia region. Controlling of blood glucose reduced the intensity of movements. Oral tetrabenazine added prior to discharge from hospital. A follow-up visit after 4 weeks showed no residual movements.
|
[[67.0, 'year']]
|
M
|
{'11596778': 1, '11596662': 1, '8791916': 1, '8006661': 1, '19305947': 1, '20130292': 1, '16193255': 1, '22416165': 2, '7575804': 1, '11766783': 1, '24479103': 2}
|
{'3299165-1': 1}
|
165,526 |
3902693-1
| 24,479,104 |
noncomm/PMC003xxxxxx/PMC3902693.xml
|
Diabetic Neuropathy: Rare Presentation as a Painful Pseudoabdominal Mass
|
A 57-year-old male electronic engineer presented with severe burning dysesthesia and pain in D4-12 distribution on the right side of his chest and abdomen. He also experienced troublesome allodynia leading to decreased sleep, excessive day time sleepiness and fatigue. The symptoms according to him started 6 months prior to his present visit after he had a chest tube insertion for drainage of pleural effusion. On the basis of pleural fluid analysis he was subsequently diagnosed to have pulmonary tuberculosis and was started on antituberculous treatment.\nHe had elevated blood sugar at that time with fasting blood sugar (FBS) 246 mg/dl and postprandial blood sugar (PPBS) 360 mg/dl with glycated hemoglobin (HbA1c) 9.2%. He was first diagnosed to have diabetes 3 years ago and was on irregular treatment for the same. He was initiated on insulin therapy and discharged. A week later he noticed a right abdominal bulge especially after taking a heavy meal or while trying to get up from a lying posture. This was associated with a burning pain over the right lower chest and upper abdomen. The protrusion gradually increased in size.\nHe was extensively investigated for his “painful abdominal mass” including a gastrointestinal scopy and ultrasonography (USG) abdomen, however no abnormality could be detected. Meanwhile his blood sugar remained uncontrolled, he stopped insulin and changed to herbal medications. On initial evaluation at our hospital, his HbA1c was 8.9%. He was initially investigated by our gastroenterology department for his painful abdominal swelling. Since all results were within normal limits he was referred to neurology department for further evaluation. Meanwhile he also developed a right proximal lower limb weakness associated with wasting of thigh muscles leading to buckling at right knee joint. He had no relief of his painful abdominal sensory symptoms.\nOn examination there was a healed scar at the site of intercostal drain insertion in right fifth intercostal space on the anterior axillary line. All peripheral pulses were felt. Right thigh girth was 2 cm less compared to left side. He had weakness of hip adduction, knee extension, and hip extension all on the right side. The right abdominal muscles were weak with a protrusion of the abdomen mimicking a mass []. Abdominal reflexes were absent in all quadrants. Right knee jerk was absent and sensation to crude touch was diminished by 20% on the right side extending from D4 dermatome to right knee.\nOn investigations, he continued to have high blood sugars on admission. FBS 423 mg/dl and PPBS 384 mg/dl with HbA1c 8.9%. Cerebrospinal fluid (CSF) revealed normal sugar with protein 79 mg/dl and 2 cells/mm3, mononuclear. Magnetic resonance imaging (MRI) cervical, dorsal, and lumbosacral spine with contrast showed mild cervical canal stenosis at C3-C6. No evidence of spinal arachnoiditis. Nerve conduction velocity study (NCV); right femoral compound muscle action potential (CMAP) amplitudes were reduced and paraspinal electromyography studies (EMG) revealed denervation potential from thoracic and lumbar segments. Toxicological screening for herbal medication revealed no heavy metals. USG abdomen was normal.
|
[[57.0, 'year']]
|
M
|
{'8511133': 1, '554781': 1, '2729914': 1, '17549059': 1, '16461471': 1, '2812328': 1, '24479104': 2}
|
{}
|
165,527 |
3902810-1
| 24,475,360 |
noncomm/PMC003xxxxxx/PMC3902810.xml
|
First Case of Bartonella henselae Bacteremia in Korea
|
A 73-year-old woman was admitted to our hospital for evaluation of fever. The patient had diabetes mellitus that had been managed with oral hypoglycemic agents for 10 years. Six years previously, the patient underwent an orthopedic operation involving the insertion of internal fixation due to a right ankle fracture. She had no recent history of outdoor activities or contact with pet animals. Two weeks before admission, she developed fever without any localized symptoms. One week later, the patient visited the emergency room of our hospital for evaluation of fever. At that time, her body temperature was 39℃. To identify the cause of the fever, laboratory tests were conducted, which revealed the following: hemoglobin level, 12.9 g/dL; white blood cell (WBC) count, 5,120/mm3; platelet count, 164,000/mm3; aspartate aminotransferase level, 47 IU/L; alanine aminotransferase level, 56 IU/L; alkaline phosphatase level, 228 IU/L; C-reactive protein (CRP) level, 131.6 mg/L; and erythrocyte sedimentation rate, 22 mm/h. Blood culture grew coagulase-negative staphylococcus in 1 of the 2 sets, which was dismissed as a contaminant. An abdomino-pelvic computed tomography scan revealed neither splenomegaly nor lymphadenopathies. The patient refused to be admitted to hospital; therefore, oral amoxicillin-clavulanate was prescribed. The patient was scheduled to return to the outpatient department (OPD). The patient's condition did not improve while she was at home. Thus, the patient was admitted to our division on May 22, 2009.\nOn admission, she had a body temperature of 39.0℃, a pulse rate of 90/min, a respiration rate of 18/min, and blood pressure of 120/80 mmHg. Physical examination revealed no evidence of rash, eschar, or lymphadenopathy. Her WBC count had increased to 9,930/mm3, her platelet count to 189,000/mm3, and her CRP level to 179.2 mg/L. Other laboratory results, including repeated blood culture, revealed no significant changes. To determine the cause of the headache, cerebrospinal fluid was examined, which showed no abnormal findings. Gallium and positron emission tomography scans revealed no significant abnormalities. Transesophageal echocardiography revealed mild aortic regurgitation and no vegetation on the valve. Ceftriaxone was administered empirically for 5 days, followed by a combination of ceftriaxone and doxycycline for 6 days. Administration of these antibiotics resulted in minimal clinical improvement. Owing to her persistent fever, vancomycin and doxycycline were substituted on hospital day (HD) 16, and as a result, her fever decreased to 37.5℃ the next day. On HD 23, serologic test results for Q fever, which were analyzed at the Korea Centers for Disease Control and Prevention, were positive at titers of 1:64 for immunoglobulin (Ig) M and 1:1,024 for IgG in a blood specimen taken on HD 7. The treatment regimen was changed to a combination of doxycycline and hydroxychloroquine to target the possible chronic Q fever, and the fever reduced to below 37℃. The patient was discharged on HD 29, and followed up at the OPD on July 3, 2009. At this follow-up visit, antibody titers to Q fever were 1:32 and 1:2,048 for IgM and IgG, respectively.\nWe performed cell culture or shell vial culture assays routinely for all patients with FUO. EDTA-treated whole blood (0.3 mL) obtained at admission was inoculated onto a monolayer of ECV304 cells grown in a tissue culture flask (25 cm2). The inoculated blood was washed with phosphate buffered saline 24 h later, and the culture was maintained in M199 medium (Gibco BRL, Gaithersburg, MD, USA) supplemented with 10% heat-inactivated fetal bovine serum (Gibco BRL) in a humidified atmosphere containing 5% CO2 at 37℃. Media were changed every 3 to 4 days without subculture. Three months after inoculation, certain cytopathic effects were observed (). Nine days after subculture onto a blood agar plate, small transparent colonies were observed (). To identify the isolated bacterium, conventional PCR targeting the 16S-23S rRNA intergenic spacer (ITS) region of Bartonella species was performed, followed by sequencing, as described previously []. The pair of primers used for the amplification of the ITS gene were 16SF (5'-AGAGGCAGGCAACCACGGTA-3') and 23SI (5'-GCCAAGGCATCCACC-3'). The sequence alignment of the PCR product was 960 characters long (GenBank accession number: JQ638927.1). Pair-wise comparison using BLAST (National Institutes of Health, Bethesda, MD, USA) revealed that the isolate was most like B. henselae Houston-1 strain (maximum pairwise identity score: 98%).
|
[[73.0, 'year']]
|
F
|
{'1537892': 1, '8862597': 1, '16293997': 1, '29436346': 1, '15155180': 1, '19255530': 1, '11473990': 1, '9455513': 1, '32164559': 2, '18716449': 1, '17629679': 1, '29664377': 1, '19659429': 1, '15956379': 1, '23166430': 2, '21996096': 1, '34407077': 1, '24475360': 2}
|
{'3492683-1': 1, '7066777-1': 1}
|
165,528 |
3902811-1
| 24,475,359 |
noncomm/PMC003xxxxxx/PMC3902811.xml
|
A Case of Acute Pyogenic Sacroiliitis and Bacteremia Caused by Community-Acquired Methicillin-Resistant Staphylococcus aureus
|
A 57-year-old woman had severe right sacral-area pain and heating sensation that had begun 2 days before admission. She did not receive any medical treatment for her symptoms; she eventually visited the emergency room because of worsening of pain. The patient had no history of diabetes, hypertension, or pulmonary tuberculosis, but had received a hysterectomy 19 years ago as a treatment for uterine myoma. She had no history of hospital admission, surgery, hemodialysis, or medical prosthesis insertion in the last 10 years. The patient did not drink alcohol or smoke, had not been exposed to any trauma, and had not travelled to a foreign country in the previous 5 years. At the time of admission she was residing at home alone, was unemployed, and had not been in contact with any healthcare professionals or hospitalized patients in her recent past.\nHer vital signs were mostly normal: her blood pressure was 110/60 mmHg, her heart rate was 82 beats per minute, and her respiration rate was 20 breaths per minute. However, the patient was febrile (38.9℃). Physical examination revealed tenderness in the right sacral area and limitation in flexion of the right hip joint due to severe pain. Lung sounds were clear without any wheezing or crackles, and her heartbeat was regular without any murmur. Her abdomen was free of tenderness or rebound tenderness, and hepatosplenomegaly was not detected. Neurological examinations revealed normal lower extremity motor and sensory function. Peripheral blood examination showed a white blood cell (WBC) count of 13,000/mm3 (neutrophils 77.3%, lymphocytes 12.9%, monocytes 9.6%), a hemoglobin level of 12.7 g/dL, a platelet count of 196,000/mm3, an erythrocyte sedimentation rate of 53 mm/hr, and a C-reactive protein level of 18.05 mg/dL. Blood chemistry revealed a total protein level of 7.0 g/dL, an albumin level of 4.1 g/dL, a total bilirubin level of 3.2 mg/dL, an aspartate aminotransferase level of 30 IU/L, an alanine aminotransferase level of 25 IU/L, an alkaline phosphatase level of 125 IU/L, a blood urea nitrogen/creatine level of 11.4/0.4 mg/dL, a sodium/potassium level of 134/3.9 mEq/L, and a calcium/phosphorus level of 9.2/3.8 mg/dL. Urinalysis was normal. Chest and abdomen radiographs were normal, and echocardiography to rule out infective endocarditis was also normal. Hip magnetic resonance imaging (MRI) was performed, and revealed a 1.8 × 3.0 cm abscess anterior to the right sacroiliac joint, accompanied by infective arthritis with adjacent myositis ().\nPeripheral blood and urine cultures were performed before initiating antibiotic therapy under the suspicion of infective myositis and arthritis. Ceftriaxone (2 g every 24 h) was given intravenously. The abscess was surgically removed, and S. aureus was identified in blood and pus cultures 5 days after hospitalization. Vitek2 AST-P601 card (BioMérieux, France) analysis demonstrated susceptibility to ciprofloxacin, fusidic acid, gentamicin, habekacin, linezolid, mupirocin, nitrofurantoin, quinupristin/dalfopristin, rifampin, teicoplanin, telithromycin, tetracycline, tigecycline, TMP-SMX, and vancomycin (MIC 1 g/mL). It was also revealed that the pathogen was resistant to clindamycin, erythromycin, oxacillin, and penicillin. The D-test for inducible clindamycin resistance was positive.\nThe cultured strain was tested for the staphylococcal cassette chromosome mec (SCCmec) gene and the Panton-Valentine leukocidin (PVL) gene. Multilocus sequence typing (MLST) for SCCmec was carried out with multiplex-polymerase chain reaction methodology using a specific primer set, following the method of Oliveira et al. []. The results showed that the strain was SCCmec type IV-A. that was negative for PVL (). MLST analysis, according to the method of Enright et al., was conducted by sequencing analysis of 7 housekeeping genes (arcC, aroE, glpF, gmk, pta, tpi, and yqiL) []. The analysis revealed ST 72. The MLST database () revealed a sequence type of 1-4-1-8-4-4-3 (ST 72). On the sixth day of admission, the antibiotic regimen was changed to vancomycin (1 g every 12 h) plus rifampin (600 mg every 24 h). Rifampin was stopped after 20 days, and thereafter vancomycin was switched to teicoplanin (400 mg every 12 h due to the emergence of neutropenia after 25 days) and combined with intravenous levofloxacin (750 mg every 24 h). The latter antibiotic therapy was continued for an additional 10 days. The patient was discharged after her symptoms had subsided and her blood test results normalized. The patient was prescribed oral levofloxacin (750 mg every 24 h for 1 week) upon discharge. The patient did not show additional symptoms, and levofloxacin was continued for an additional 10 days on an outpatient basis. Treatment was stopped after a total of 8 weeks of antibiotic therapy, and no disease recurrence was reported after 1 year of follow-up.
|
[[57.0, 'year']]
|
F
|
{'2758766': 1, '17884831': 1, '10698988': 1, '2766603': 1, '20706753': 1, '9068926': 1, '21102219': 1, '1987181': 1, '26847855': 1, '14501940': 1, '23153120': 1, '17901064': 1, '12132845': 1, '30280145': 1, '12069968': 1, '32181037': 2, '21208910': 1, '15151590': 1, '16914702': 1, '7422427': 1, '24475359': 2}
|
{'7066396-1': 1}
|
165,529 |
3902819-1
| 24,475,358 |
noncomm/PMC003xxxxxx/PMC3902819.xml
|
Klebsiella Pneumoniae Associated Extreme Plasmacytosis
|
A 42-year-old man presented with high fever of 5 days' duration. He had been healthy without a noteworthy medical history and had not been in a tropical location in the recent past. On physical examination, he had an acute, ill appearance, a body temperature of 39.2℃, a pulse rate of 72 beats/minute, a blood pressure of 110/60 mm Hg, and no signs of tachypnea (22 respirations/minute). No remarkable erythroderma or lymphadenopathy was observed. There was no evidence of arthritis. No definite space-occupying lesion was noted on his neck, chest, abdomen, or pelvis by computed tomography (CT). A summary of his clinical course is illustrated in .\nLaboratory results on admission were as follows: hemoglobin level, 11.1 g/dL; white blood cell (WBC) count, 500/mm3; and platelet count, 6,000/mm3. Blood urea nitrogen (BUN; 20.1 mg/dL), creatinine (1.10 mg/dL), and calcium levels (8.4 mg/dL) were not increased. Although the alanine aminotransferase level (67 IU/L) was mildly elevated, the aspartate aminotransferase level (37 IU/L) was not. The C-reactive protein level was 44.4 mg/dL (reference range: 0.00-0.30 mg/dL). The serum immunoglobulin (Ig) and light chain measures were as follows: IgG, 22.88 g/L (reference range: 8.00-18.00 g/L); IgM, 1.08 g/L (0.038-2.460 g/L); IgA, 4.37 g/L (0.90-4.50 g/L); kappa light chain, 118.05 mg/L (3.30-19.40 mg/L); and lambda, 87.18 mg/L (5.71-26.30 mg/L). The rheumatoid factor was positive (18 IU/mL), but all the other autoimmune- related factors, including fluorescence anti-nuclear antibody, antineutrophil cytoplasmic antibody, and antibody panel for extractable nuclear antigen, were negative.\nOn chest radiography, pneumonic haziness was noted. This haziness worsened to definite pneumonic consolidation on the 4th hospital day (HD; ). Empirical intravenous antibiotic treatment with cefepime 2.0 g every 8 hours and ciprofloxacin 400 mg every 12 hours failed to improve his pneumonia or fever.\nOn the eighth HD, BM biopsy and aspiration showed 25% cellularity with marked plasmacytosis (80%), lymphoid cells (15%), and less than 5% of erythroid-myeloid-megakaryocytes. Immunohistochemical staining for kappa and lambda light chains on BM plasma cells demonstrated no light chain restriction (). The WBC count was 900/mm3, with 26% of plasma and plasmacytoid cells in peripheral blood. Cytogenetic analysis using the G-banding technique revealed a 46, XY karyotype without definite chromosomal aberration. Serum protein electrophoresis showed hypoalbuminemia and increased gamma-globulin with a polyclonal pattern. Serum protein immunoelectrophoresis and immunofixation electrophoresis showed no definite abnormal arc or band, respectively.\nK. pneumoniae was identified in both blood and sputum cultures on the eighth HD. Antibiotic susceptibility testing demonstrated resistance to ampicillin and piperacillin, while the pathogen was negative for extended-spectrum β-lactamase production. Tests for other infectious pathogens including human immunodeficiency virus, hepatitis A, hepatitis B, hepatitis C, Epstein-Barr virus, aspergillus, syphilis, legionella, pneumococcus, and mycobacterium were negative. There was no evidence of acid fast bacilli infection by direct smear, culture, or polymerase chain reaction. Considering his continuous febrile neutropenia and isolation of K. pneumonia from blood, the antibiotics were changed on the eighth HD to vancomycin 1.0 g intravenously every 12 hours plus levofloxacin 500 mg every 24 hours; his fever started to subside ().\nNo evidence of pneumonia was observed on the chest radiograph obtained on the 15th HD (). Follow-up blood cultures performed on the 15th and 20th HDs revealed no growth of bacteria ().\nBody temperature, however, elevated again to 39.5℃ on the 20th HD. CT evaluation showed multiple necrotizing consolidations on both lungs, suggesting invasive fungal infection (). A septated fungal organism was detected by CT-guided lung biopsy (). Antibiotics were changed to meropenem 1.0 g every 8 hours, amikacin 1.0 g every 24 hours, and amphotericin B deoxycholate 1.0 mg/kg every 24 hours; his clinical course improved except for intermittent low-grade fever.\nFollow-up BM biopsies and aspirations were performed on the 30th, 60th, and 90th HDs. These examinations revealed decreased cellularity (plasma cell proportion) of 10% (26%), 10% (11%), and < 10% (< 4%), respectively ().\nPlatelet concentrates and packed red blood cells were transfused, and granulocyte colony-stimulating factor (G-CSF) was administered several times starting from the second HD. However, severe pancytopenia, defined as < 200/mm3 of the absolute neutrophil count, did not improve. The patient underwent allogenic peripheral blood stem cell transplantation on the 98 HD. He died of pneumonia and intracranial hemorrhage 6 months after initial presentation.
|
[[42.0, 'year']]
|
M
|
{'11443640': 1, '10512180': 1, '22728555': 1, '23103724': 1, '12688365': 1, '1380772': 1, '17636450': 1, '12873179': 1, '19008591': 1, '17127739': 1, '3278799': 1, '3107339': 1, '15072706': 1, '11210903': 1, '16731597': 1, '24475358': 2}
|
{}
|
165,530 |
3902822-1
| 24,475,361 |
noncomm/PMC003xxxxxx/PMC3902822.xml
|
Secondary Syphilis with Nodular Vasculitis Mimicking Behçet's Disease
|
A 22-year-old man visited the Department of Rheumatology with several months history of recurrent oral ulcers, genital erosions () and crops of hyperpigmented tender nodules located on both shins (). The initial diagnosis was BD, which led to the initiation of steroid therapy. After 1 week, the nodular skin lesions on both shins had slightly improved, but the genital erosions and oral ulcers were aggravated and fever developed. To evaluate the patients for other diseases, the serum rapid plasma reagin (RPR) test was performed, and the result was positive. The patient had no history of medication before the appearance of the skin lesions. He did, however, have a history of heterosexual intercourse with multiple partners without the use of a condom. Laboratory profiling revealed a white blood cell count of 7,900/mm3, a hemoglobin level of 16.3 g/dL, a platelet level of 313,000/mm3, and a high sensitivity C-reactive protein level of 7.57 mg/dL. Hepatitis B, hepatitis C, and HIV serology were negative. The immunoglobulin (Ig) M-fluorescent treponemal antibody absorption test (FTA-ABS), the IgG-FTA-ABS, and the Treponema pallidum hemagglutination assay were all reactive. Spirochetes were also identified in a scrotal specimen using the Warthin-Starry stain (). The results of skin biopsies from his shins were concordant with nodular vasculitis (). After the diagnosis of secondary syphilis was made, intramuscular benzathine penicillin G was immediately initiated at a dosage of 2.4 MU once per week for 3 weeks. After the initiation of penicillin treatment, his signs and symptoms, including skin lesions, gradually improved. All lesions had resolved after 3 months. Non treponemal titer was also decreased from 2.6 RPR unit (R.U) to 1.5 R.U.
|
[[22.0, 'year']]
|
M
|
{'16638434': 1, '19127113': 1, '9261466': 1, '19786852': 1, '10448370': 1, '22970466': 1, '7790137': 1, '21622037': 1, '11326018': 1, '33235767': 1, '20666819': 1, '6121351': 1, '22335265': 1, '16954299': 1, '4348110': 1, '21390478': 1, '22645392': 1, '16325063': 1, '24475361': 2}
|
{}
|
165,531 |
3903804-1
| 24,478,904 |
noncomm/PMC003xxxxxx/PMC3903804.xml
|
Development of Complex Regional Pain Syndrome after a Snake Bite: A Case Report
|
A 44-year-old woman without any specific medical history presented to the emergency room of our hospital after a snake bite, (Agkistrodon ussuriensis, Chinese viper) near the right lateral malleolus, in a parking lot three months before being referred to the pain clinic. At that time, the patient complained of severe edema up to the right femoral region, acute pain, abdominal pain, muscle pain, double vision, dizziness, and nausea. Agkistrodon halys antivenin (6,000 IU) was intravenously injected, followed by the administration of antitetanus immunoglobulin, an antihistamine, a steroid, and antibiotics. At the time of the injury, the Visual Analogue Scale (VAS) pain intensity score was 100/100 (the patient felt as if her foot was exploding). The score gradually reduced up to 4 days after the injury as the swelling decreased.\nWhen the patient was referred to our pain clinic during the 3rd month after the injury (), she had static allodynia on the 2nd, 3rd, and 4th digits of the right foot along with repetitive pain that felt like needle stabs. The patient also exhibited hyperalgesia in the entire foot as well as constant tingling sensation the upper lateral malleolus. The pain worsened during walking; she experienced stiffness and edema with a VAS intensity of approximately 50/100 on the lateral sole and the top of the foot in addition to pain in the foot at the slightest exertion, such as walking up or down the stairs. The patient felt a sickly cold sensation in the heel that was alleviated by using a hot or cold pack. An electrophysiologic study performed at the end of 1st month after the injury indicated findings suggestive of damage to the right superficial peroneal nerve or around peripheral nerve; however, no abnormal features were observed in a 3-phase bone scan or on thermographic examination.\nOn the first day of the visit, an intravenous regional block was performed with 40 cc of 0.5% mepivacaine and 30 mg of ketorolac. In addition, 300 mg/day of gabapentin was administered in three divided dose. The constant tingling sensation and pain the upper lateral malleolus completely disappeared but she sporadically felt tingling pain near the bite area. The pain during walking decreased to a VAS intensity of 20/100, but the cold sensation in the heel persisted. On the 3rd day, when performing a secondary intravenous regional block with 40 cc 0.5% mepivacaine and 30 mg ketorolac, the patient developed urticaria in the entire calf with severe pain on the bite site and in the stiff and painful regions during walking. Therefore, dexamethasone 5 mg was injected through the same intravenous route as the mepivacaine injection. The severe pain diminished immediately after the injection.\nThe next day, the patient had minimal pain, when relaxed, and experienced pain with a VAS intensity of 15/100 on the lateral dorsal part of the foot while wearing shoes and walking. However, the sickly cold sensation was still present in the heel. On the 5th day, a lumbar sympathetic ganglion block was performed on the 2nd and 3rd vertebrae. The cold sensation in the heel reduced for 2-3 days after the block but returned at the same level as before; therefore, we decided to perform a sympathectomy using alcohol. The preoperative temperature of both heels was almost the same (left heel, 31.1℃; right heel, 31.0℃). 2 ml of contrast medium and 2 ml of 4% lidocaine were injected in the sympathetic ganglia at the L2 and L3 level. After a 10-min wait to confirm the absence of motor weakness and other abnormalities, 3 ml of 99% alcohol was injected on each side. The foot temperature at 15 min after the injection indicated a difference of 3.3℃ between the left (32.1℃) and right (35.4℃) side, and the patient felt a burning sensation on her foot.\nThe cold sensation in the heel completely disappeared 2 days after the sympathectomy. The following day, the patient was discharged with a VAS score of 10/100 and similar levels of pain while walking and relaxing. The dose of gabapentin was increased to 600 mg tid. The decrease in the pain was maintained during the 2-month follow-up period. A reduced dose of gabapentin (300 mg tid) was administered for the next 2 months. When the pain disappeared, administration of the drug (gabapentin 300 mg tid) as well as follow-up were discontinued.
|
[[44.0, 'year']]
|
F
|
{'15327810': 1, '15007401': 1, '30935096': 1, '12727271': 1, '16514322': 1, '21999367': 1, '19558072': 1, '21716610': 2, '8223936': 1, '20704671': 1, '15109522': 1, '20054678': 1, '34804529': 2, '26525636': 1, '12165312': 1, '1734775': 1, '19215592': 1, '33204179': 2, '32953303': 2, '20180838': 1, '17610454': 1, '24478904': 2}
|
{'3111559-1': 1, '7667582-1': 1, '8587178-1': 1, '7491678-1': 1}
|
165,532 |
3903805-1
| 24,478,905 |
noncomm/PMC003xxxxxx/PMC3903805.xml
|
Radiofrequency Thermal Ablation in Painful Myeloma of the Clavicle
|
The patient was a 57-year-old man with a history of coming into contact with chemical gases during the war of 1981. He was referred to the emergency room (ER) with an acute abdomen and hemorrhage about 6 years ago. At that time, the diagnosis was acute renal failure and myeloma. The patient's blood abnormality was treated very well in the hematology department and he went under dialysis. He did not come back to the hematology department for myeloma maintenance therapy until four months ago when he came to the ER with hoarseness, tenderness in a hind limb, bone pains, movement limitation in the forelimbs with severe pain (VAS 6) in the left clavicle. He underwent 10 sessions of clavicle radiotherapy before admission to the pain clinic. His clavicular pain did not respond to radiotherapy and opioids.\nIn the physical examination, the patient complained of generalized bone pain especially in left clavicle. There was a 5 × 7 cm mass in 1/3 of the internal part of the clavicle (). There was no redness or edema and the mass was fixed to the bone and in pain on palpation. It was a new localized, deep, uncomfortable pain in the left clavicle.\nBoth shoulders and arms were tender with movement limitation. Bilateral limited elbow extension and flexion deformity were seen. Hind limbs force was decreased (2 from 5). There was no sensory deficit. In the shoulder examination, there was no hypertrophy, heat, erythema and tenderness. Clavicle conventional radiofrequency was chosen as a treatment. The patient's blood test and coagulation test were normal (platelet counts = 7,400 per microliter). In the plain radiography other than widespread lytic myeloma lesions especially in the shoulders and arms, there was a big lesion in the left clavicle which was also detected in the chest X-ray and chest CT scan ().\nAfter IV sedation (midazolam 1 mg and fentanyl 50 mg), prep & drape were done in the supine position. The clavicular mass was antisepticised and the anesthetic was lidocaine 1%. Two radiofrequency needles (OWL, Diros Technology Inc., Ontario, Canada. sharp, 20 gauge, 100 mm, active tip 10 mm), 1.5 cm from each other were inserted into the mass. Under the guide of the fluoroscopy, the needles were inserted into the middle part of the mass and during the pass, the needles were aspirated for any possibility of blood. And then, after passing the bone and feeling a sense of pop in the non-ionic water, 3 ml of soluble contrast media (Iodixanol 320) were injected and its distribution was seen directly and the contours of mass were clear. The patient informed us of any shooting pain in the upper extremity during the procedure. After placing the pads on the patient's arm, the stylet was pulled out and the radiofrequency probe was inserted. Then, two times a radiofrequency current at 90℃ was applied for 60 seconds at the two points 1cm apart from each other. After that, 2 ml of 0.5% ropivacaine along with triamcinolone 40 mg were injected in each needle and then the needle and the probe were pulled out together (-). The procedure went very smoothly without any pain or need for more analgesic injection. In the recovery room, VAS dropped to zero and movement of the hands improved. He could move his shoulder and arms more comfortably. There was no hematoma or sensory and motor deficits or any kind of radiating pain in the extremity. The visual analogue pain score (VAS from 0 to 10) decreased from 8 to 0. In the next 3 months of follow-up, the patient was very satisfied with the procedure and there was no pain at the clavicular site and did not need any analgesic for it. The mass gradually became smaller. There were no complications. He did not suffer from any pain at the clavicular site until he died after 3 months.
|
[[57.0, 'year']]
|
M
|
{'23861996': 1, '18514456': 1, '12397128': 1, '9747834': 1, '14722039': 1, '18070690': 1, '9362430': 1, '21197288': 1, '15198130': 1, '20041484': 1, '11990856': 1, '10934280': 1, '18492671': 1, '19468917': 1, '18439817': 1, '16598666': 1, '11090390': 1, '24478905': 2}
|
{}
|
165,533 |
3903806-1
| 24,478,906 |
noncomm/PMC003xxxxxx/PMC3903806.xml
|
A Case of Neuromyelitis Optica Misdiagnosed as Cervicogenic Headache
|
A 33-year-old male patient came to the hospital complaining of headache that had been occurring for two weeks prior to his visit. One week before visiting the hospital, he received a cervical facet joint block and drug treatment in another hospital, but the pain continued so he visited the pain clinic at our hospital. In the first medical examination, the patient said that he did not have any unusual past history. The headache began at the left occipital region and then gradually spread to the posterior neck, where numbness and aching developed; there was no paresthesia. Additionally, during the same period, the patient had blurred vision as a symptom. The physical examination performed at the time of the hospital visit appeared to be normal.\nAt first, it was suspected to be a general cervicogenic headache, so a bilateral greater occipital nerve block was performed as a diagnostic block and his progress was monitored. Three days later in the clinic, the ache in the head area had slightly decreased, but the numbness had spread from the face to the posterior neck, both shoulders, and both arms. In addition, during the physical examination performed this time, the Lhermitte sign appeared to be positive. Hence, a more detailed past history was examined, and it was found that 15 years ago the patient's eyesight suddenly failed so he was diagnosed with optic neuritis, and during the same period, he also suffered from myelitis. Secondary headache due to central pain was suspected from the progress of the disease, past history, and physical examination, and thus C-spine MRI was performed. As a result, an extensive intramedullary high signal intensity was observed from the medulla oblongata to the C5 (). Visual acuity test, color vision test, visual field test, and fundus examination performed in ophthalmology to check for anomalies in the optic nerve all appeared to be normal, but in the subsequent goggle VEPS (visual evoked potentials), a bilateral ocular or prechiasmal lesion and suspicious bilateral upper brainstem lesion were observed. In addition, the oligoclonal band IgG appeared negative in the CSF analysis. There were no abnormalities in the brain MRI, and the NMO-Ab test was negative.\nBased on the past medical history and test results above, the patient was diagnosed with neuromyelitis optica, and steroid pulse therapy was performed for 5 days in which 1 g of solumedrol was given on each day. Subsequently, the neurological symptoms and MRI observations improved, so the drugs were changed to oral steroids and the patient was discharged ().
|
[[33.0, 'year']]
|
M
|
{'22810075': 1, '16717206': 1, '22284054': 1, '12629245': 1, '22487568': 1, '12390636': 1, '28281110': 1, '30891640': 1, '23320783': 1, '33473247': 1, '20880299': 1, '21300379': 1, '26017519': 1, '21286867': 1, '23060108': 1, '21067820': 1, '19032123': 1, '26615899': 1, '24948869': 1, '18439216': 1, '22087205': 1, '17215722': 1, '24478906': 2}
|
{}
|
165,534 |
3903807-1
| 24,478,907 |
noncomm/PMC003xxxxxx/PMC3903807.xml
|
Ultrasound-Assisted Mental Nerve Block and Pulsed Radiofrequency Treatment for Intractable Postherpetic Neuralgia: Three Case Studies
|
A 45-year-old man visited our pain clinic with the chief complaint of right mandibular area pain. The patient had been diagnosed with facial herpes zoster in the right V3 area 9 months previously. The right facial pain had continued for 9 months despite medical treatment. During this period, 300 mg pregabalin, 10 mg amitriptyline, and three 37.5 mg tramadol/375 mg acetaminophen combination tablets were administrated per os daily but had little effect. He had paroxysmal, sharp, and shooting pain in the right mandibular area. The pain was aggravated by touching the right mandibular area, and palpation over the right mental foramen reproduced the pain. Pain severity was 10/10 on a VAS.\nHence, we started pain intervention for PHN in the left V3 area. We initially blocked the right mental nerve under US with a 10-12 MHz linear transducer using a mixture of 2 ml 2% mepivacaine and 20 mg triamcinolone. This procedure decreased the pain immediately, and pain severity was 0-1/10 on a VAS. One month after this intervention, his pain relief was >90%. Because relief was maintained continuously throughout the 2, 4, 6, and 12 months follow-ups after US-assisted mental nerve block, no additional treatment including medication was provided.
|
[[45.0, 'year']]
|
M
|
{'16336478': 1, '18806537': 1, '28357404': 1, '19504162': 1, '23342215': 2, '14622704': 1, '20048652': 1, '20227832': 1, '18666055': 1, '19252116': 1, '25999760': 2, '18460194': 1, '21168309': 1, '19404120': 1, '18477070': 1, '22351099': 1, '19491172': 1, '13587390': 1, '7869414': 1, '34596124': 2, '25419389': 1, '23342210': 2, '24478907': 2}
|
{'4437613-1': 1, '4437613-2': 1, '3546218-1': 1, '8483850-1': 1, '3546213-1': 1}
|
165,535 |
3904114-1
| 24,516,767 |
noncomm/PMC003xxxxxx/PMC3904114.xml
|
Visualization of a Small Ventricular Septal Defect at First-pass Contrast-enhanced Cardiac Magnetic Resonance Imaging
|
Here we present a case of a 12-year-old male (height 144 cm, weight 32 kg), born at term by spontaneous delivery, who had been previously diagnosed with a muscular VSD and an atrial septal defect (ASD). The ASD was closed by surgical intervention. In 2006, non-compaction of left ventricle (LV) posterior wall was suspected at echocardiography. In 2010, an echocardiographic examination was performed at our institution. The report was as follows: Situs solitus, normal atrio-ventricular and ventricular-arterial connections, no ASDs; small muscular apical VSD of 3 mm in diameter [] and patchy appearance of the posterior wall of the LV. The patient was recommended a cardiac MRI exam.\nCardiac MR was performed using a 1.5-T scanner (Sonata, Siemens, Erlangen, Germany), with a 4-element phased-array cardiac coil. Cine steady-state free precession (SSFP) sequences were acquired on long-axis two-chamber, four-chamber, and short-axis views to cover the whole LV. A retrospective electrocardiogram-gating was used. A turbo-gradient-echo first-pass perfusion with echoplanar readouts sequence was acquired for three long-axis four-chamber slices. Contrast material (0.1 mmol/kg of gadoterate meglumine for a total of 7 ml), followed by 20 ml of saline solution were intravenously injected, through a 22 G plastic needle in an antecubital vein of the left arm, at a rate 2 ml/min. Cine true-fast imaging with steady-state precession images were segmented semiautomatically (Syngo-Argus, version VE32B, Siemens Medical Solutions, Erlangen, Germany) to obtain ejection fraction (EF), end-diastolic volume (EDV), normalized to body surface area (EDV index [EDVI]), and end-systolic volume index (ESVI) of the LV and right ventricle (RV).\nThe cine SSFP sequences showed a hypertrabeculation of the mid-lateral and inferior wall and of the apical septum with a ratio between normal and hypertrabeculated myocardium of about two[] [ and ]. No septal defect was initially detected on cine evaluation. During the first-pass perfusion, a jet of highly concentrated contrast material was clearly visible from the apical VSD throughout the RV [ and ]. We calculated following LV and RV volumes and EF: EDVI 91 ml/m2 and ESVI 29 ml/m2 and EF 68% for LV, EDVI 49 ml/m2, ESVI 24 ml/m2 and EF 52% for RV. The following diagnosis was reported: Apical VSD and hypertrabeculation of the mid-lateral and inferior wall and of the apical septum.
|
[[12.0, 'year']]
|
M
|
{'16567565': 1, '7594083': 1, '24516767': 2}
|
{}
|
165,536 |
3904807-1
| 24,489,478 |
noncomm/PMC003xxxxxx/PMC3904807.xml
|
Chemotherapy-induced enterocutaneous fistula after perineal hernia repair using a biological mesh: a case report
|
A 70-year-old man with a T3V1N0M0 rectal tumor underwent laparoscopic APR followed by adjuvant chemotherapy with oxaliplatin, fluorouracil, and calcium folinate. At 1 year control, radiological work-up and colonoscopy showed no signs of recurrence or distant metastases. Thirteen months after the APR, the patient developed a perineal hernia and had a reconstruction of the pelvic floor with a biological mesh (Permacol™) via a transperineal approach. The postoperative course was uneventful, and the initial follow-up with a pelvic–abdominal computed tomography (CT) scan 4 months after the surgery showed no signs of locoregional recurrence or reherniation. Nine months after the perineal hernia operation, the patient experienced weight loss. A thoracic–abdominal CT scan was performed and showed multiple metastases to the liver and lungs. The patient was treated with chemotherapy: bevacizumab, irinotecan, calcium folinate, and fluorouracil. Twelve months after the perineal hernia operation, but only 6 weeks into chemotherapy, the patient developed signs of sepsis with a high temperature, tachycardia, and hypotension and complained of pain in the right buttock. Physical examination showed signs of infection at the area. Possible differential diagnoses could have been local recurrence of the rectal cancer, intraabdominal abscess, or pelvis sepsis. We could have chosen to examine the patient with a positron emission tomography scan or, for example, an ultrasound (US)-guided biopsy, but we chose an acute US examination. This revealed an abscess, and drainage was established by a US-guided procedure. The patient was moved to an intensive unit and started treatment with intravenous fluids and broad-spectrum antibiotics. The following CT scan with contrast given through the drain showed a subcutaneous abscess cavity located in the perineum, with communication to the small bowel (). The patient underwent a laparotomy, and operative findings confirmed a perineal fistula from the distal ileum (). A resection of the small bowel with primary anastomosis was performed. The postoperative course was complicated by severe fluid and electrolyte disturbances. The patient was in the intensive care unit for a total of 16 days before treatment with pressors, intravenous fluids, and parenteral nutrition stabilized the patient. The perineal wound was treated with vacuum-assisted closure for a total of 20 days. There were no complications in the closure treatment. According to the patient’s request, he was discharged to hospice for terminal care after 28 days of hospital stay.
|
[[70.0, 'year']]
|
M
|
{'28508281': 1, '23136823': 1, '22321523': 1, '19482548': 1, '29744089': 1, '22156873': 1, '31024927': 1, '27240846': 1, '20958912': 1, '23136820': 1, '24489478': 2}
|
{}
|
165,537 |
3905093-1
| 24,492,439 |
noncomm/PMC003xxxxxx/PMC3905093.xml
|
Clinical experiences in fungal keratitis caused by Acremonium
|
A 64-year old woman injured her left eye with vegetable matter. On examination, biomicroscopy revealed a peripheral corneal epithelial defect, which was surrounded by ring-shaped stromal infiltration with a feathery border (). Corneal scraping showed hyphae. The patient was started on an hourly instillation of topical 0.5% moxifloxacin (Vigamox; Alcon Laboratories, Inc., Fort Worth, TX, USA), 0.15% amphotericin B (Ambisome, Yuhan Corporation, Seoul, Korea), 0.2% fluconazole (Diflucan, Ilyang Pharmaceutical, Seoul, Korea), and oral fluconazole (Oneflu, Joongwea Shinyak, Seoul, Korea), 100 mg twice daily. After 1 week, there was no reduction in the size of the corneal infiltrate (). Corneal cultures were subsequently positive for Acremonium ( and ). The patient was lost to follow-up, but returned 2 weeks later with worsening of the infiltrate and a large epithelial defect (). The cornea was re-scraped to improve the penetration of the topical treatment. Despite hourly treatment with topical eye drops, the patient’s corneal condition failed to improve. We added topical 5% natamycin (Natacyn; Alcon) to the regime. After 2 days, we observed a marked reduction in the size of the infiltrate. Topical amphotericin B and natamycin were gradually tapered over the next 5 weeks. At the final visit, her best-corrected visual acuity (BCVA) was 0.5, and there was no recurrence over the following 6 months ().
|
[[64.0, 'year']]
|
F
|
{'20577905': 1, '11679001': 1, '34811468': 1, '1956281': 1, '32855878': 1, '17667272': 1, '8599069': 1, '20625061': 1, '14708962': 1, '14967302': 1, '21068274': 1, '14748802': 1, '4227164': 1, '24492439': 2}
|
{'3905093-2': 2, '3905093-3': 2, '3905093-4': 2, '3905093-5': 2}
|
165,538 |
3905093-2
| 24,492,439 |
noncomm/PMC003xxxxxx/PMC3905093.xml
|
Clinical experiences in fungal keratitis caused by Acremonium
|
A 76-year old man complaining of severe ocular pain in his left eye was referred to our hospital. He had a history of trauma by plant material. Slit-lamp biomicroscopy showed a central corneal infiltrate that was associated with a large epithelial defect and hypopyon (). The patient was started on an hourly instillation of topical 0.5% moxifloxacin, and intravenous ciprofloxacin, twice daily. After 5 days on this therapy, the condition of the left eye worsened with the appearance of an endothelial plaque. Repeated corneal smears showed septate fungal hyphae. The patient was administered with hourly doses of 0.15% amphotericin B and 0.2% fluconazole, with oral fluconazole. Over the next 7 days, corneal cultures were positive for Acremonium. Topical 5% natamycin and 1% voriconazole (Vfend; Pfizer Pharmaceuticals Korea, Seoul, Korea) with oral fluconazole were prescribed immediately. The final VA was 0.5, and there was no recurrence in the following 6 months ().
|
[[76.0, 'year']]
|
M
|
{'20577905': 1, '11679001': 1, '34811468': 1, '1956281': 1, '32855878': 1, '17667272': 1, '8599069': 1, '20625061': 1, '14708962': 1, '14967302': 1, '21068274': 1, '14748802': 1, '4227164': 1, '24492439': 2}
|
{'3905093-1': 2, '3905093-3': 2, '3905093-4': 2, '3905093-5': 2}
|
165,539 |
3905093-3
| 24,492,439 |
noncomm/PMC003xxxxxx/PMC3905093.xml
|
Clinical experiences in fungal keratitis caused by Acremonium
|
A 75-year old male patient was injured in his left eye with vegetable matter. On slit-lamp examination of the left eye, there was a central white stromal infiltrate with corresponding epithelial defect and endothelial plaque (). Corneal smears showed hyphae. The patient was started on an hourly instillation of topical 0.5% moxifloxacin, 0.15% amphotericin B, 0.2% fluconazole, and oral fluconazole. After 7 days on this therapy, the size of the infiltrate was markedly reduced, and the hypopyon had disappeared. Corneal cultures were subsequently positive for Acremonium. The final BCVA was 0.5, and there was no recurrence in the following 4 months ().
|
[[75.0, 'year']]
|
M
|
{'20577905': 1, '11679001': 1, '34811468': 1, '1956281': 1, '32855878': 1, '17667272': 1, '8599069': 1, '20625061': 1, '14708962': 1, '14967302': 1, '21068274': 1, '14748802': 1, '4227164': 1, '24492439': 2}
|
{'3905093-1': 2, '3905093-2': 2, '3905093-4': 2, '3905093-5': 2}
|
165,540 |
3905093-4
| 24,492,439 |
noncomm/PMC003xxxxxx/PMC3905093.xml
|
Clinical experiences in fungal keratitis caused by Acremonium
|
A 78-year old man complaining of decreased vision in his left eye was referred to our clinic. He had been injured in this eye with vegetable matter. Slit-lamp biomicroscopy showed mild conjunctival injection and a peripheral corneal infiltrate was associated with an epithelial defect in the left eye (). Corneal smears showed hyphae. He was started on an hourly instillation of topical 0.5% moxifloxacin, 0.15% amphotericin B, 0.2% fluconazole, and oral fluconazole. After 2 days of therapy, the clinical feature of the left eye had worsened, with the appearance of new stromal infiltrates. Topical application of 5% natamycin was included in his treatment regime. Seven days later, Acremonium was isolated from corneal culture. Despite this treatment, the patient’s condition failed to improve and the cornea was melting around the limbus. The treatment was changed to topical 5% natamycin and 1% voriconazole, and oral voriconazole, 200 mg twice a day. After 13 days of therapy, the patient underwent conjunctival flap surgery due to a progressive thinning of the cornea. After surgery, the corneal lesion was improved and topical natamycin and voriconazole were gradually tapered. The final BCVA was 0.15, and there was no recurrence in the following 2 months ().
|
[[78.0, 'year']]
|
M
|
{'20577905': 1, '11679001': 1, '34811468': 1, '1956281': 1, '32855878': 1, '17667272': 1, '8599069': 1, '20625061': 1, '14708962': 1, '14967302': 1, '21068274': 1, '14748802': 1, '4227164': 1, '24492439': 2}
|
{'3905093-1': 2, '3905093-2': 2, '3905093-3': 2, '3905093-5': 2}
|
165,541 |
3905093-5
| 24,492,439 |
noncomm/PMC003xxxxxx/PMC3905093.xml
|
Clinical experiences in fungal keratitis caused by Acremonium
|
A 74-year old woman was injured in her right eye with grass. On slit-lamp examination of the right eye, there was a paracentral whitish stromal infiltrate with an overlying epithelial defect and an endothelial plaque (). Corneal smears showed hyphae. She was started on an hourly regimen of topical 0.5% moxifloxacin, 0.15% amphotericin B, 0.2% fluconazole, 5% natamycin and oral fluconazole. Seven days after corneal culture, the organism was identified as Acremonium. The patient’s final VA was 1.0, and there was no recurrence in the following 2 months ().
|
[[74.0, 'year']]
|
F
|
{'20577905': 1, '11679001': 1, '34811468': 1, '1956281': 1, '32855878': 1, '17667272': 1, '8599069': 1, '20625061': 1, '14708962': 1, '14967302': 1, '21068274': 1, '14748802': 1, '4227164': 1, '24492439': 2}
|
{'3905093-1': 2, '3905093-2': 2, '3905093-3': 2, '3905093-4': 2}
|
165,542 |
3905115-1
| 24,497,889 |
noncomm/PMC003xxxxxx/PMC3905115.xml
|
Myocardial Infarction Type 4b in Human Immunodeficiency Virus-Infected Patient
|
A 52-year-old male with HIV infection, asthma and varicose veins presented to the hospital with first-ever chest pain. The patient had no history of diabetes mellitus, kidney disease or smoking. Initial 12-lead electrocardiography (ECG) revealed ST-segment elevation in V 2-5 leads, and ST-segment depression in II, III and aVF. The patient was immediately transferred to a catheterization laboratory, where coronary angiography was performed, which showed a dominant right coronary artery with no significant stenosis, acute occlusion of the left anterior descending artery and chronic occlusion of the intermediate branch. Primary percutaneous coronary intervention (PCI) with implantation of an Integrity bare metallic stent (Medtronic Cardiovascular, Santa Rosa, CA, USA) 3.0×1.2 mm into the left anterior descending artery was performed, resulting in complete reperfusion {Thrombolysis in Myocardial Infarction (TIMI) 3 flow}. Intravascular ultrasound was not performed during the procedure. Initial echocardiography revealed a 1.65×1.55 cm blood clot, fixed in an area near the apical part of the left ventricle (LV). His total cholesterol was 4.29 mmol/L, low density lipoproteincholesterol (LDL-C) 2.7 mmol/L and triglycerides 1.37 mmol/L and estimated glomerular filtration rate was >60 mL/min/1.73. The patient was prescribed aspirin 75 mg, clopidogrel 75 mg, enoxaparin 60 mg, ramipril 2.5 mg, nebivolol 2.5 mg and atorvastatin 40 mg. Because of the retroviral infection, he had been receiving combined antiretroviral therapy (cART) for 6 years. The cART regiment consistied of 2 nucleoside reverse transcriptase inhibitors (emtricitabine and tenofovir), and protease inhibitor lopinavir boosted with ritonavir (lopinavir/r). His plasma HIV ribonucleic acid (RNA) levels, measured by real-time polymerase chain reaction were undetectable. The counts of T lymphocytes CD4 and CD8 were 625 cells/µL (norm, 410-1590 cells/µL) and 818 cells/µL (norm, 190-1140 cells/µL), respectively. The CD4/CD8 ratio was 0.76. After 5 days of hospitalization, he was discharged and instructed to continue the prescribed medications.\nTwo weeks after discharge, the patient was readmitted to the hospital because of general fatigue and malaise. Full examination did not reveal any abnormalities other than the previously described blood clot in LV. The patient was discharged and referred for ambulatory surveillance by a cardiologist when his coagulation parameters including the activated partial thromboplastin time (aPTT) were in the normal range. After 10 days (37 days from the first hospitalization), the patient again presented to the hospital with acute chest pain. His troponin I level was 4.74 ng/mL, and in the ECG, a QS complex was seen in leads V 1-3, with new ST-segment elevation. With an initial diagnosis of type 4b myocardial infarction (MI) (), the patient again underwent coronary angiography, which showed acute occlusion of the left anterior descending artery because of in-stent thrombosis. After a bolus of eptifibatide, the thrombus was aspirated with good hemodynamic results (TIMI 3 flow). Follow up echocardiography showed a change in the diameter of the clot in the LV (from 1.65×1.55 cm to 2.2×1.2 cm), and akinesis of the apex, a part of the intraventricular septum, and the anterior wall, with an ejection fraction of 33%. Due to the thrombosis, platelet function tests were performed. The aspirin reaction unit was 394, and the P2Y12 reaction unit was 155. At this time, his total cholesterol was 2.8 mmol/L, LDL-C 1.4 mmol/L and triglycerides 1.7 mmol/L. The patient was prescribed aspirin 75 mg, prasugrel 10 mg, carvedilol 25 mg, torasemide 5 mg, ramipril 2.5 mg, spironolactone 12.5 mg, atorvastatin 40 mg and warfarin (to keep the INR at 2.5). A modification of the cART regimen was introduced. The patient still received the combination of emtricitabine and tenofovir, but the protease inhibitor was changed from lopinavir/r to darunavir/r. After 6 months of follow-up, the patient is in good general condition, with undetectable HIV RNA levels and no drop of T helper lymphocytes CD4.
|
[[52.0, 'year']]
|
M
|
{'19249633': 1, '20660842': 1, '23369416': 1, '22922414': 1, '21228007': 1, '20496114': 1, '23013077': 1, '22413967': 1, '18614861': 1, '17460226': 1, '24497889': 2}
|
{}
|
165,543 |
3905116-1
| 24,497,890 |
noncomm/PMC003xxxxxx/PMC3905116.xml
|
Percutaneous Closure of an Iatrogenic Ventricular Septal Defect Following Concomitant Septal Myectomy at the Time of Aortic Valve Replacement
|
A 77-year-old female was diagnosed with severe AS and ABSH. On echocardiography, the patient showed a restriction of aortic cusp movement, raised trans-aortic peak instantaneous velocity of Vmax (5.93 m/s), mean pressure gradient of 80.49 mm Hg, peak pressure gradient of 140.56 mm Hg and a narrowed effective orifice area of 0.64 cm2. She also manifested moderate tricuspid regurgitation (TR) with a dilated tricuspid annulus and an elevated right ventricular systolic pressure (RVSP) of 56 mm Hg. Based on indications for surgery in AS, she underwent AVR using a 19-mm Carpentier-Edward valve (CE valve, Edwards Lifesciences LLC, Irvine, CA, USA) with concomitant septal myectomy and tricuspid annuloplasty (TAP), using a 28-mm Edwards MC3 (Edwards Lifesciences LLC, Irvine, CA, USA).\nAfter a successful operation, the patient complained of worsening dyspnea. On physical examination, a new continuous pansystolic murmur was noted. Echocardiogram demonstrated an abnormal high-velocity jet between the LVOT and right ventricle (RV) with a raised velocity of 4.78 m/s and peak pressure gradient of 91.33 mm Hg, suggesting the presence of a possible iatrogenic VSD (). The VSD was muscular in location, suggesting of complication by myectomy, not AVR in which it is usually present with membraneous type of VSD. The diameter of the VSD was about 12 mm, and the distance from the tissue aortic valve was about 1.5-2 cm. There was also an RV volume overload with moderate TR and an elevated RVSP of 61 mm Hg, despite the TAP. Medical treatments to maintain an optimal volume status was not effective, and the overall medical condition was poor. Therefore, a closure of the iatrogenic VSD with percutaneous intervention was decided, as it was felt to be hemodynamically significant.\nAt the right heart catheterization with the blood oximetry series to assess the degree of intra-ventricular shunting, there were remarkably elevated RV and pulmonary artery (PA) filling pressures, with an unidirectional left to right shunt of 2 : 1 (Qp/Qs=2).\nOn the 5th postoperative day, percutaneous closure of the VSD was attempted. It was decided that an attempt would be made to cross the VSD first from the RV (trans-septal technique). Left femoral artery and right femoral vein were punctured with 7 Fr sheaths. An LV angiogram showed a significant flow into RV cavity. Crossing of the VSD was made from the right side, using a 0.035-inch hydrophilic guidewire (angled straight tip, Terumo Medical, Tokyo, Japan) supported by a 5 Fr multipurpose catheter (Infiniti; Cordis, Miami, FL, USA), which was advanced into the LV apex. Then, the guidewire was replaced by a 0.035-inch extra-stiff guide wire (260-cm length, Amplatz Extra-Stiff, Cook, Bloomington, IN, USA). Then, a 14-mm Amplazter VSD occluder (AGA Medical Corporation, Golden Valley, MN, USA) attached to a delivery cable was advanced through the defect. The LV disc of the Amplazter VSD occluder was deployed first in the LV, and released the RV disc of the device in the RV by rotating the delivery cable in a counterclockwise direction (). An LV angiogram was performed confirming a minimal residual VSD flow, and intraoperative transesophageal echocardiogram demonstrated an excellent positioning of the device without shunting or any interference with aortic valve functions. At postprocedural catheterization, the PA pressure and saturation were decreased dramatically, from 50/15 mm Hg (mean 26 mm Hg), 91%, to 31/17 mm Hg (mean 23 mm Hg), 75%. Postprocedural echocardiogram showed a minimal shunt between the LVOT and RV without LVOT obstruction ().
|
[[77.0, 'year']]
|
F
|
{'17239717': 1, '20103321': 1, '16181882': 1, '22547641': 1, '6681825': 1, '17684082': 1, '18577883': 1, '16969878': 1, '3042405': 1, '24497890': 2}
|
{}
|
165,544 |
3905117-1
| 24,497,891 |
noncomm/PMC003xxxxxx/PMC3905117.xml
|
Transcatheter Closures for Fistula Tract and Paravalvular Leak after Mitral Valve Replacement and Tricuspid Annuloplasty
|
A 71 year-old man was admitted due to exertional dyspnea (New York Heart Association functional class III). He had a past medical history of pericardiectomy due to effusive-constrictive pericarditis 29 years ago and mitral valve replacement with tricuspid annuloplasty due to severe mitral and tricuspid regurgitation 11 years ago. His electrocardiogram showed atrial fibrillation with controlled ventricular rhythm. Transthoracic echocardiography showed abnormal shunt flow from the aorta to the right atrium, a tissue defect in the mitral annulus with moderate PVL (distal jet area of 7 cm2), mild tricuspid regurgitation with mild resting pulmonary hypertension (maximal velocity of tricuspid regurgitation jet=3.2 m/s), and an enlarged left ventricle with near normal systolic function (end-diastolic dimension of the left ventricle=67 mm, ejection fraction=51%). Transesophageal echocardiography (TEE) also revealed continuous abnormal shunt flow through a fistula tract from the aorta (noncoronary cusp) to the right atrium (), and about a 4-5 mm sized tissue defect in the mitral annulus with moderate PVL (). On computed tomography, about a 3 mm PVL was observed at the lateral aspect of the mitral annulus (). His calculated logistic EuroSCORE and STS risk score were 16.7% and 7.0%, respectively. After discussion with both the surgical and interventional teams, we decided to perform staged transcatheter closures for both the fistula tract and mitral PVL.\nThe first procedure was conducted under general anesthesia with fluoroscopic and TEE guidance. A 7 French (Fr) sheath was inserted through the right femoral vein and 6 Fr sheaths were placed in both femoral arteries. A 6 Fr pigtail catheter was inserted through the right femoral artery. After a peripheral angiogram with a pigtail catheter, we confirmed the existence of a fistula tract between the aorta and right atrium. The fistula tract could be crossed with a 260 cm long 0.032 inch Terumo wire, and it was confirmed by TEE. A 6 Fr Cournand catheter was advanced into and passed through the defect. Another 6 Fr Cournand catheter was introduced into the right atrium (). Using a Curry intravascular retriever, the guidewire was captured and withdrawn through the right femoral sheath. The guidewire was exchanged for a 0.035 inch stiff wire using a 6 Fr Cournand catheter. The 6 Fr Cournand catheter was replaced with an 8 Fr delivery sheath that was advanced into the ascending aorta. Because the sizes of the tissue defect on TEE were 9 mm in length and 4 mm in width, we selected an 8/6 mm sized Amplatzer duct occluder. After proper device positioning, which was confirmed using fluoroscopy and TEE, the device was deployed ( and ). Immediate TEE showed a well-positioned device, and disappearance of the abnormal shunt flow between the aorta and right atrium ().\nAfter the first procedure, his symptoms improved slightly and a follow-up echocardiography two months after the first procedure showed slightly decreased left ventricular diastolic dimension with reduced ejection fraction (from 51% to 46%) and persistent resting pulmonary hypertension. Percutaneous closure of the PVL was attempted to decrease left ventricular volume overloading. Under general anesthesia, a 7 Fr sheath was inserted through the right femoral vein and a 6 Fr sheath was inserted through the right femoral artery. A TEE was also used for guidance. A pigtail catheter was placed into the posterior cusp of the aortic valve through the right femoral artery. The sheath in the right femoral vein was exchanged for a Mullin sheath and dilator, which was advanced over a 0.032-inch guidewire into the superior vena cava. Thereafter, the guidewire was removed and a Brockenbrough needle was gently advanced to within a few millimeters of the tip of the dilator, and the needle was flushed and connected to a manifold for continuous pressure monitoring. With fluoroscopic guidance (RAO 45 degrees), the interatrial septum was punctured at the site of the fossa ovalis. The Mullin sheath was advanced into the left atrium. The stainless steel wire was crossed over the tissue defect in the mitral annulus. Using a 6 Fr multipurpose catheter, the stainless steel wire was exchanged for a 0.035 inch stiff wire (). After several dilatations with a septal dilator, the 8 Fr delivery sheath was placed in the left ventricle. Because the defect size on the TEE was about 4-5 mm, we also chose an 8/6 mm sized Amplatzer duct occluder. After proper device positioning was confirmed on the TEE, the device was deployed (). The TEE that was performed immediately afterwards showed a well-positioned device and a trivial PVL (). At 24 hours post-procedure, transthoracic echocardiography also showed well-positioned devices and no remnant shunt flow or PVL. Echocardiography immediately after the procedure showed persistent left ventricular dysfunction (ejection fraction=47%) but disappearance of resting pulmonary hypertension.
|
[[71.0, 'year']]
|
M
|
{'18237605': 1, '1385506': 1, '16969856': 1, '19301353': 1, '16355372': 1, '17578053': 1, '11590691': 1, '23338724': 1, '15065155': 1, '20650438': 1, '15800890': 1, '20844623': 1, '24497891': 2}
|
{}
|
165,545 |
3905118-1
| 24,497,892 |
noncomm/PMC003xxxxxx/PMC3905118.xml
|
Two Cases of Super-Giant Coronary Aneurysms after Kawasaki Disease
|
A 31-month-old girl presenting with a fever was admitted to a nearby hospital. She showed bilateral conjunctival injection, swelling of the hands and feet, enlargement of the cervical lymph nodes, and a polymorphous rash. Because she was considered to have KD, IVIG (2 g/kg) and high-dose aspirin were given to her on the 5th day of illness. Because the fever persisted, she received additional IVIG (2 g/kg) on the 7th day. Intravenous methylprednisolone was infused on the 9th day because of persistent fever. Echocardiography showed a mildly enlarged coronary artery. The fever dropped on the 16th day, and she was discharged with oral methylprednisolone (2 mg/kg∙day) and low-dose aspirin (5 mg/kg∙day).\nAt the outpatient department on the 25th day of illness, her echocardiography revealed that the right coronary artery (RCA) was severely dilated up to 16 mm in diameter. She was transferred to our hospital. On admission, her vital signs were as follows: blood pressure, 120/60 mm Hg; pulse rate, 140 beats/min; respiratory rate, 24 breaths/min; temperature, 37.6℃. Her great toe tip and sole were desquamated. Her platelet count was 648000/uL; erythrocyte sedimentation rate, 72 mm/h; and serum C-reactive protein, 0.42 mg/dL. Her serum creatine kinase-MB was normal. However, her serum troponin I level was higher than normal at 0.58 ng/mL. The echocardiography showed giant CAA and thrombus formation in the left anterior descending artery (LAD), RCA, and left circumflex artery (LCX). The maximal diameter of the RCA, LAD, and LCX was 16 mm, 9.9 mm, and 7.5 mm, respectively. The flow through coronary artery was intact ().\nShe was transferred to the intensive care unit because she was at a high risk of aneurysmal rupture or myocardial infarction. She was intubated and deeply sedated with midazolam, ketamine, and vecuronium, and was also given continuous intravenous esmolol and nicardipine. For preventing further thrombus formation, intravenous heparin was infused continually, and oral methylprednisolone was tapered off on schedule. After stabilization of her heart rate and blood pressure, we added oral atenolol (2 mg/kg∙day) and amlodipine (0.1 mg/kg∙day) to stop the intravenous esmolol and nicardipine and replaced the intravenous heparin with warfarin. On the 46th day of illness, she returned to the general ward. Despite the adequate dose of aspirin and warfarin, echocardiography on the 57th day showed that the thrombi had reappeared in the RCA. Therefore, we added clopidogrel (0.75 mg/day) to her medication.\nShe underwent cardiac computed tomography (CT), which revealed aneurysmal dilatation of coronary arteries. The maximal diameter of the proximal LAD, LCX, and RCA was 10.8 mm, 7.4 mm, and 18 mm, respectively. She was discharged with oral aspirin, warfarin, clopidogrel, atenolol, and amlodipine on the 68th day. On the 9th month of illness, she underwent cardiac CT and echocardiography. The size of the CAAs had not increased, while the thrombus in the RCA had disappeared (). At the last follow-up visit, which was 10 months after the onset of KD, the patient was doing well without any symptoms.
|
[[31.0, 'month']]
|
F
|
{'30709892': 1, '29143203': 1, '24633902': 1, '30468032': 1, '19436123': 1, '11059533': 1, '28765744': 1, '440805': 1, '22405251': 1, '18535756': 1, '8822996': 1, '10920183': 1, '22869678': 1, '22307434': 1, '34387979': 2, '17250496': 1, '22706758': 1, '10365587': 1, '18234143': 1, '16215725': 1, '15302199': 1, '11380911': 1, '1853711': 1, '24497892': 2}
|
{'3905118-2': 2, '8357373-1': 1}
|
165,546 |
3905118-2
| 24,497,892 |
noncomm/PMC003xxxxxx/PMC3905118.xml
|
Two Cases of Super-Giant Coronary Aneurysms after Kawasaki Disease
|
A 4-year-old boy was admitted to a nearby hospital because of fever. He showed conjunctival injection, enlargement of cervical lymph nodes, and edema and erythema of the hands and feet. Under the diagnosis of KD, he was given 2 g/kg of IVIG and high-dose aspirin. Because his fever did not subside, additional IVIG (2 g/kg) was given on the 6th day. On the 8th day, 1 mg/kg∙day of oral prednisolone was started; the fever subsided 2 days later. He was discharged with oral prednisolone (0.5 mg/kg∙day) on the 11th day, and prednisolone was discontinued on the 29th day.\nOn the 32nd day of illness, echocardiography at the outpatient department showed multiple giant CAAs. Cardiac CT also revealed a giant, bead-shaped, fusiform aneurysm in multiple coronary arteries; the diameter of the RCA, left main coronary artery (LMCA), and LAD was 22.3 mm, 7.9 mm, and 16.8 mm, respectively. CT scan revealed multiple thrombi in the LCX, RCA, and LAD, as well as multifocal stenosis in the LCX. Oral warfarin, aspirin, and amlodipine were started, and the patient was transferred to our hospital on the 41st day of illness. On admission, he denied any symptoms. His vital signs were as follows: blood pressure, 99/70 mm Hg; pulse rate, 109 beats/min; respiratory rate, 24 breaths/min; temperature, 36.7℃. His fingertips were desquamated.\nWe added oral carvedilol (0.28 mg/kg∙day) to decrease his blood pressure and heart rate. On the 44th day, repeated cardiac CT was performed to determine whether an emergency operation was necessary; the largest diameter of the proximal RCA, LMCA, and LAD was 23 mm, 7 mm, and 14 mm, respectively. Multiple thrombi were observed in the LAD and RCA, while the thrombus in the proximal LAD lesion had decreased (). Because no significant change had occurred since the previous cardiac CT, we continued the medical treatment. The thrombus in the RCA had nearly disappeared on the 53rd day. On the 67th day of illness, the thrombus in the LAD looked organized, and the diameter of the coronary arteries did not change on follow-up echocardiography. He was discharged with warfarin, aspirin, amlodipine, and carvedilol (1.3 mg/kg∙day).\nOn the 109th day of illness, a large thrombus on the RCA had developed, and cardiac enzyme was elevated at a routine check-up visit after a dental procedure. Before the dental procedure, warfarin was replaced by subcutaneous enoxaparine. He underwent emergent coronary angiography and intracoronary urokinase (4000 IU/kg) infusion (), but there was little effect. We added clopidogrel (1.1 mg/kg∙day) and maintained intravenous heparin for 8 days. He was subsequently discharged without any symptoms and further complications. At the last follow-up visit (9 months after the onset of KD), the patient was doing well without any symptoms.
|
[[4.0, 'year']]
|
M
|
{'30709892': 1, '29143203': 1, '24633902': 1, '30468032': 1, '19436123': 1, '11059533': 1, '28765744': 1, '440805': 1, '22405251': 1, '18535756': 1, '8822996': 1, '10920183': 1, '22869678': 1, '22307434': 1, '34387979': 2, '17250496': 1, '22706758': 1, '10365587': 1, '18234143': 1, '16215725': 1, '15302199': 1, '11380911': 1, '1853711': 1, '24497892': 2}
|
{'3905118-1': 2, '8357373-1': 1}
|
165,547 |
3905332-1
| 24,516,849 |
noncomm/PMC003xxxxxx/PMC3905332.xml
|
Epidermoid cyst of spleen mimicking splenic lymphangioma
|
A 14-year-old boy was admitted with complaint of progressively enlarging mass and pain in left hypochondrium since last few months. There was no history of abdominal trauma and no symptoms like vomiting and constipation pertaining to gastrointestinal tract. History was negative for infection by malaria or any hematological disorder. Physical examination showed good general condition. In the area of left hypochondrium, a smooth firm, non-tender mass was palpable. The liver was not enlarged. The laboratory investigations were within normal limits. On USG, a well-defined intrasplenic hypoechoic lesion was seen measuring 8 cm × 6 cm with internal septations; CT scan also revealed similar findings. Keeping in view the above findings, a clinical diagnosis of lymphangioma was made. Therapeutic procedure in the form of splenectomy was performed due to the large size of the tumor and tissue was sent for histopathologic examination.\nWe received a specimen of spleen measuring 15 cm × 10 cm × 7 cm. On serial sectioning, a large cyst of size 8 cm × 8 cm was identified at one end []. Wall of the cyst showed trabeculations and the cyst contained an opaque dark-colored fluid. Rest of spleen showed congestion. Microsections examined revealed a cyst wall lined by pseudo-stratified epithelium. Focally, the lining epithelium was flattened, and the cyst wall was composed of fibrocollagenous tissue and congested blood vessels. Rest of the splenic tissue showed congestion []. Immunohistochemical panel for epithelial and vascular markers were performed. The lining cells were positive for pancytokeratin and were negative for CD-34 [Figures and ]. The cyst was diagnosed as epithelial cyst rather than lymphangioma.
|
[[14.0, 'year']]
|
M
|
{'16425403': 1, '6027763': 1, '33859922': 2, '11893134': 1, '34158804': 2, '11782581': 1, '10101570': 1, '29656712': 2, '21195332': 1, '13559574': 1, '25320525': 1, '7338833': 1, '24516849': 2}
|
{'8182210-1': 1, '8040935-1': 1, '5901864-1': 1}
|
165,548 |
3905334-1
| 24,516,839 |
noncomm/PMC003xxxxxx/PMC3905334.xml
|
Port site and peritoneal metastases after laparoscopic cholecystectomy for incidentally found gallbladder carcinoma
|
A 59-year-old female patient presented with recurrent billiary colic and nausea. Her past medical history was not significant. Her physical examination was unremarkable. Ultrasonography of abdomen revealed choleliathiasis with no indication of tumor and normal common bile duct. Her liver function tests and other biochemical investigations were normal. Laparoscopic cholecystectomy was carried out with standard four trocar technique (two 10 mm and two 5 mm). Operative findings were edematous thick-walled gallbladder with severe inflammation in Calot's triangle. There was no evident spillage of bile inside peritoneum. There was no macroscopic evidence of tumor in the excised gallbladder mucosa. However, histological examination revealed well-differentiated adenocarcinoma confined to lamina propria, diagnosed having T1 gallbladder cancer with negative margins including cystic duct stump and no areas of deeper invasion. Considering her stage of gallbladder cancer, simple cholecystectomy was sufficient. The patient presented to us after 3 months with painful swelling at umbilicus and jaundice. Her abdominal ultrasonography revealed mass lesion 9 × 10 cm in the gallbladder fossa with two subcutaneous nodules, one at the umbilical port and the other at the midclavicular port. Her CT scan examination revealed similar findings with other peritoneal nodules. Patient refused further investigation and treatment.
|
[[59.0, 'year']]
|
F
|
{'9845574': 1, '8044537': 1, '11373097': 1, '11201004': 1, '29582801': 1, '24516839': 2}
|
{}
|
165,549 |
3905342-1
| 24,516,838 |
noncomm/PMC003xxxxxx/PMC3905342.xml
|
Multiple sclerosis or neurological manifestations of Celiac disease
|
Our patient is a 37-years-old woman with a history of chronic abdominal pain since 2004. Anti-endomysial antibody (Ab) of isotype IgA (16 u/mL), and anti-gliadin antibody of isotype IgA (67 u/ml), and IgA tissue transglutaminase antibody (186 u/mL) was present in the serum. Gastric and duodenal biopsy documented chronic gastritis associated with Heliobacter pylori and chronic duodenitis, but not celiac disease-related pathological findings. Gluten-free diet (GFD) was started and her GI symptoms subsided, so diagnosis of celiac disease was made.\nIn her past history, about 18 years ago, her left-eye became ophthalmoplegic and without a definite diagnosis, after corticosteroid therapy, it was recovered completely within 1 month. Five years ago, she suffered from diplopia that was binocular and continued until now. Few months before, she became ataxic. She thought that it has been related to diet. Although, it evolved and established completely within a few days, so she met a neurologist and her brain MRI showed demyelinating plaques compatible with multiple sclerosis [], without any structural abnormality in cerebellum []. Her visual evoked potentials (VEP) were abnormal too (delayed responses with normal wave configuration). Oligoclonal band was seen in CSF examination. Therefore, the clinical diagnosis of MS was made and Avonex (Beta interferon 1-a, IM, weekly) was introduced to her. Till now, she has not had any relapse, and her neurological disability (EDSS) is fixed.\nNow, she has episodic ataxia and slurred speech especially whenever she is tired. On neurological examination, she has binocular diplopia and fine horizontal nystagmus when she looks to the left side. Her plantar reflexes are upward.\nAbdominal reflexes are not detectable and her deep tendon reflexes are symmetric and exaggerated (3+). Her gait is ataxic and she falls when turns rapidly. Other neurological examinations are not remarkable.
|
[[37.0, 'year']]
|
F
|
{'11171906': 1, '86833': 1, '448378': 1, '8038550': 1, '15247173': 1, '9521289': 1, '16214317': 1, '18566033': 1, '11788557': 1, '9843103': 1, '12171942': 1, '16968605': 1, '24516838': 2}
|
{}
|
165,550 |
3905351-1
| 24,478,812 |
noncomm/PMC003xxxxxx/PMC3905351.xml
|
Bilateral Temporal Bone Langerhans Cell Histiocytosis: Radiologic Pearls
|
A previously healthy 2-year-old girl presented with a ten day history of progressive left-sided postauricular erythema and swelling. She was noted to have clinical worsening while being treated with antibiotics, and was referred to our hospital for further evaluation for acute mastoiditis.\nOn examination, the patient's left ear was protuberant anteriorly from swelling posteriorly. There was overlying erythema and swelling in the postauricular area. This area was very soft, and a bony edge was palpated surrounding the soft area. It was not warm or tender. External auditory canal examination showed the posterior canal wall to be pushed forward, impacting the anterior canal wall. The posterior canal wall had a pink, irregular surface consistent with granulation-like changes. The right ear exam was normal. No skin lesions or ear drainage were noted. Neurologic exam was normal. The remainder of the exam was unremarkable.\nLaboratory studies revealed a mild normocytic anemia (9.8 g/dL; reference range 11.0 to 14.0 g/dL), a mild leukocytosis (11.2 x10(9)/L; reference range 6.0 to 11.0 x10(9)/L), an elevated C-reactive protein (58 mg/L; reference range < 8 mg/L) and erythrocyte sedimentation rate (64 mm/hour; reference range <22 mm/hour).\nThe skull radiograph demonstrated lytic lesions of the bilateral temporal bones (Fig. ). Imaging with computed tomography (CT) revealed bilateral bony erosion of the temporal bone in the petromastoid region, left greater than right, with left-sided extension into the soft tissue (Fig. ). Differential diagnosis based on imaging included unusual otomastoiditis, Langerhans cell histiocytosis, rhabdomyosarcoma, lymphoma, metastasis such as neuroblastoma, or unusual Wegener’s granulomatosis. For further characterization of these lesions and to evaluate for the presence of intracranial extension, magnetic resonance imaging (MRI) was conducted (Fig. ). Again, bilateral temporal bone changes and left sided soft tissue prominence were noted. This extended superiorly, along the tegmen tympani where there was minimal adjacent dural thickening and enhancement without brain parenchymal involvement (Fig. ). These lesions enhanced with gadolinium. Given the sparing of the labyrinth (Fig. and ), the bilaterality, and the overall appearance, the findings were most consistent with LCH.\nDefinitive diagnosis was confirmed with biopsy. Pathology revealed positive immunohistochemical staining for CD1a, which is pathognomonic for LCH. Skeletal survey, CT of the chest, abdomen, and pelvis, and bone marrow biopsy were all negative for signs of further involvement. Audiometry demonstrated left-sided conductive hearing loss.\nUpon diagnosis, the patient proceeded with standard induction therapy including vinblastine and prednisone for six weeks followed by repeat imaging. She had an incomplete response, and thus received a second induction. She then went on to receive continuation therapy with vinblastine and prednisone. Interim imaging with CT (Fig. ) and MRI (Fig. ) has suggested a positive response to therapy with no progression of disease. Additionally, her hearing improved on subsequent audiometry.
|
[[2.0, 'year']]
|
F
|
{'22495611': 1, '11668004': 1, '15289942': 1, '12105792': 1, '18355926': 1, '33071667': 2, '33614334': 2, '32185056': 2, '31080537': 1, '29587787': 1, '29657688': 1, '10628482': 1, '20363036': 1, '23109216': 1, '24478812': 2}
|
{'7069888-1': 1, '7883190-1': 1, '7529136-1': 1}
|
165,551 |
3905355-1
| 24,478,810 |
noncomm/PMC003xxxxxx/PMC3905355.xml
|
Benign Notochordal Cell Tumor of the Sacrum with Atypical Imaging\nFeatures: The Value of CT Guided Biopsy for Diagnosis
|
A 74-year-old man with a long-standing history of hip and back pain presented for evaluation of progressively worsening symptoms. Nonsteroidal anti-inflammatory drugs, narcotics, and physical therapy resulted in pain reduction from a debilitating 9/10 to a manageable 6/10 on a visual analogue pain scale. However, the patient experienced difficulty going up stairs, gait imbalance, progressive weakness, and bowel and bladder incontinence, prompting him to pursue further medical intervention.\nUnenhanced magnetic resonance imaging (MRI) of the lumbar spine with dedicated images of the sacrum (Fig. ) showed a lesion in the S3 segment that extended to the superior aspect of S4. The lesion had a lobulated morphology and demonstrated intermediate signal on T1-weighted and heterogeneous signal on T2-weighted images, with areas of intermediate and high signal. In addition, the lesion contained tiny round foci of increased T1 signal that suppressed on T2-weighted images with fat suppression, indicative of a small component of intralesional fat. Although the lesion was predominantly intraosseous, there was focal permeation through the posterior cortex with a tiny nodular soft tissue mass in the adjacent spinal canal. Intravenous gadolinium was not administered due to patient claustrophobia, which precluded additional image acquisitions. At this time, the differential diagnosis included BNCT, chordoma, hemangioma, metastatic carcinoma, chondrosarcoma, myeloma, or lymphoma.\nUnenhanced CT of the sacrum demonstrated diffuse subtle sclerosis in the lesion without evidence of a destructive osteolytic component (Fig. ). This finding along with the foci of intralesional fat noted on MRI strongly favored a diagnosis of BNCT. However, given the focal permeation of tumor through the dorsal cortex forming a tiny nodular extraosseous soft tissue mass, the lesion was considered atypical for BNCT, and a biopsy was recommended for definitive histologic diagnosis.\nFollowing interdisciplinary discussion, a decision was made to perform a minimally invasive percutaneous CT-guided biopsy rather than pursue a metastatic work-up.\nCT-guided biopsy (Fig. ) was performed with the patient in an oblique prone position on the CT table with the spine and pelvis positioned 15 degrees to the right to align the left S4 pedicle with the gantry. This position facilitated an uneventful biopsy of the intraosseous tumor component at S3 via a left S4 transpedicular approach using coaxial technique with 3 cores obtained using a trephinated 14 gauge needle and one final core obtained with an 11-gauge needle. Although lesions in which chordoma is the leading differential diagnosis are traditionally approached with a (near) midline biopsy tract, this tract was deliberately selected to allow best sampling of a tumor in which the role of the biopsy was to confirm the imaging impression of BNCT. Additionally, in the unlikely event that a chordoma was diagnosed, definitive treatment in this 74 year old gentleman would be proton beam therapy in which the biopsy tract could be sterilized.\nThe submitted needle biopsies showed (Fig. ) typical morphological features of BNCT, with a hypocellular proliferation of bland, eosinophilic, epithelioid cells, often showing striking cytoplasmic vacuolization, and mimicking adipose tissue. Morphological features of chordoma, such as myxoid matrix, cords and chains of epithelioid cells, physaliphorous cells, mitotic activity and necrosis, were absent. By immunohistochemistry the neoplastic cells were strongly positive for cytokeratins using the OSCAR monoclonal antibody and for the notochord-specific transcription factor brachyury.\nAt initial clinical follow-up, the BNCT was thought to be incidental to the pain syndrome. The patient will be followed with periodic MRI of the sacrum to ensure stability of the lesion.
|
[[74.0, 'year']]
|
M
|
{'23609202': 1, '15480648': 1, '15633956': 1, '12107574': 1, '21343509': 1, '18188556': 1, '15803192': 1, '22300861': 1, '20197427': 1, '10450882': 1, '28776089': 1, '11810168': 1, '20121620': 1, '15186275': 1, '21847746': 1, '20855213': 1, '16203885': 1, '24478810': 2}
|
{}
|
165,552 |
3905487-1
| 24,494,093 |
noncomm/PMC003xxxxxx/PMC3905487.xml
|
Reporting a Case of Injecting Methylphenidate (Ritalin) Tablets, Intensified Symptoms of Schizoph-renia or Induce Separate Mental Disorder?
|
The patient was a 38-year-old single man from Kerman city who was admitted in Shahid Beheshti Hospital of Kerman four years ago because of aggression and behavioral change for the first time. According to the patient, he has been using oral Ritalin for the past 6 months and in the recent months, he has diluted tablets in water and injected intravenously and after injection, the shape and meaning of objects have changed for him. He had sometimes injected even up to 4 Ritalin tablets. According to the patient, he feels that he has parasitic infection and he sees cockroaches with blue color crewel on his body and because of that he has burned different parts of his body by cigarettes to destroy them. Also, he sees these bugs on the floor and around objects and because of that he fired house items many times and even fired his bed, TV and personal computer (PC). Even once, his entire house was burned in fire. Sometimes he washed objects with water to destroy bugs. He would stand under the shower for hours to send away these bugs. People around him have always seen him playing with water or fire. Along with these symptoms, he was suspicious to others and believed that they have prepared amulet for him and followed him sometimes. He complained of sleeplessness and restlessness. In physical examination, multiple skin abscesses and acute cellulitis caused by injections were visible on different areas of his body and there was bilateral pitting edema on his legs. He had also tachycardia and there was no problem in the brain CT scan and heart echocardiography.\nIn psychological condition examination, he was restless and to some extent irritable. He also had flight of ideas and noted vision and touch fantasies as well as delirium of harm and damage and being under control. Attention was reduced but immediate, near and far memories were natural. Also, knowledge of time, place and person was normal. Impairment in judgment and vision was evident. The patient was hospitalized for the diagnosis of psychotic disorder due to Ritalin injection and after preventing Ritalin consumption and recovery from infection symptoms, fornication signs were resolved. In later interviews with the patient, schizophrenic symptoms such as deliriums of pessimism and being under control were detected and the patient was treated for schizophrenia diagnosis. After discharge, in spite of regular medication, he was hospitalized for two times and both times it was after Ritalin tablet injections and he was discharged after disease symptoms were controlled and there was no obstacle for medication. By preventing Ritalin consumption after discharge, he has not experienced psychotic symptoms yet and his background disease is under control with anti-psychotic drugs.
|
[[38.0, 'year']]
|
M
|
{'25984277': 1, '9862747': 1, '7219483': 1, '15339823': 1, '19502578': 1, '19171629': 1, '7399505': 1, '8109495': 1, '769722': 1, '1849397': 1, '24494093': 2}
|
{}
|
165,553 |
3905496-1
| 24,494,084 |
noncomm/PMC003xxxxxx/PMC3905496.xml
|
Psychosis following Tramadol Withdrawal
|
Patient was an unemployed 30-year-old single male with high school diploma from Kerman and was admitted in Beheshti Hospital for the first time. The reason for his referral was severe agitation and anxiety in past week following sudden tramadol cessation. He said that the cause of his agitation and anxiety was fear of the security police force that had been following and threatening him and wanted to kidnap him. He also believed that some black points were formed in his memory and he could see god in television and could see some tiny creatures around him. He also had some severe withdrawal symptoms as rhinorrhea, epiphora, nausea, diarrhea, musculoskeletal pains, tremors, tic in his shoulders and head, agitation, headache, and sleeplessness.\nHe had a history of heroin and opiate addiction for several years and during cessation started using tramadol. After complete heroin and opiate cessation about 2 years ago, he was taking 300mg of tramadol per day until a week ago when he suddenly stopped taking tramadol and was referred to this center with the above mentioned symptoms. In his history there was no evidence of opioid abuse in past 2 years. He had no family history of any specific mental or physical illness.\nIn psychological examination, he was well alert and had time, place and person orientation. His concentration and attention was reduced. He was anxious and had normal affection. Restlessness was revealed in his psychomotor examination.\nHe had persecutory delusion, delusional mood, and first stage of trema, and had Lilliputian hallucinations.\nNeurological examination was normal and EEG, brain CT scan, and MRI showed no organic abnormalities. Based on DSM-IV, tramadol withdrawal syndrome was considered at the admission and psychosis following drug cessation was the differential diagnosis. The patient was treated with analgesic, sedative, and hypnotic drugs but antipsychotic was not prescribed. After 3 days all physical and mental symptoms including hallucinations and delusions completely subsided. Therefore tramadol cessation diagnosis was confirmed and psychosis following drug withdrawal syndrome was ruled out.
|
[[30.0, 'year']]
|
M
|
{'31920635': 1, '10985875': 1, '10617309': 1, '31896879': 2, '32378056': 1, '11124199': 1, '11384913': 1, '12633909': 1, '12167549': 1, '11565620': 1, '8862961': 1, '1309873': 1, '1519677': 1, '24494084': 2}
|
{'6862981-1': 1}
|
165,554 |
3905497-1
| 24,494,083 |
noncomm/PMC003xxxxxx/PMC3905497.xml
|
Rare Variant of Lycanthropy and Ecstasy
|
Patient was a 28-year-old, unemployed, married male living in Kerman province, Iran. His education level was 5th grade and was brought to Beheshti Psychiatry Hospital in Kerman for his aggressiveness and restlessness. The patient complained of people who were observing him with an intention to harm.\nThe patient believed that his father had changed to a boar and frequently attacked him, his brother had changed to a horse and sometimes kicked him, and his mother changed to a donkey and continuously brayed. He said that his soul sometimes left his body and went to various places with these animals and found what others do in their houses. He also stated that there was an angel protecting him and he could hear some people talking to him about his daily activities. He believed that there was a chicken in his head capturing his body and pushing his brain with thoughts that were not his. He believed that his wife was wearing a ring and by moving it puts more stress on his brain and more unpleasant feeling and for this reason had asked his wife to move out.\nIt was found in his history that following taking many ecstasy pills for opium cessation in an unofficial opium cessation center, he developed some delusional symptoms. He had been under physician's observation for several months and after relative recovery, he stopped his medications and the symptoms aggravated again. There was no history of mental problems before taking ecstasy. He had persecutory delusions, depersonalization, passivity, loss of ego boundary, out of body experience, synesthesia, lycanthropy, thought insertion delusions and auditory and visual hallucinations. His time, place and person orientation and memory were intact. His neurological exam showed no important point. He had normal brain CT scan and MRI. Based on his history and diagnostic criteria of DSM-IV-TR (1), the patient was admitted with schizophrenia diagnosis and received 15 mg olanzapine daily. His lycanthropic symptoms stopped after two weeks of treatment and other symptoms improved gradually after second month of admission.
|
[[28.0, 'year']]
|
M
|
{'9807860': 1, '12119307': 1, '2405100': 1, '16681172': 1, '14674954': 1, '11417261': 1, '15667438': 1, '10364725': 1, '15701110': 1, '14513928': 1, '17244180': 1, '24494083': 2}
|
{}
|
165,555 |
3905562-1
| 24,494,161 |
noncomm/PMC003xxxxxx/PMC3905562.xml
|
Fetishism Due to Methamphetamine (Glass) Abuse: A Case Report
|
The patient was a 41 year-old, unemployed, divorced male, with high school diploma, residing in Kerman (one of the central Iranian cities). According to his biography concerning sexual background, he experienced his first ejaculation in 14 years old by masturbation and frequently masturbated through the age of 22 years. He married in 22 and experienced frequent intercourses with his wife from which he gained pleasure and it was his preferable method. He commenced drug abuse from the age of 20 years and was involved in different types of substances. Her wife left ten years ago. The patient has started crystal (glass) administration through insufflations since seven months ago and has been taking crystal only since. Simultaneous with crystal abuse, wearing women’s underwear has been the only medium through which the patient reached sexual orgasm. The desire rose with increasing crystal administration. He has masturbated since, wearing women’s underwear, as a preferable method of sexual arousal. Subsequent to crystal (glass) dependency, he has had no desire to have intercourse with women. No instances of paraphilia were seen in his previous records, he is not suffering from any specific psychiatric disease nor is he taking specific medications.
|
[[41.0, 'year']]
|
M
|
{'20619627': 1, '20004662': 1, '22332856': 1, '8871382': 1, '16005288': 1, '8789509': 1, '17563217': 1, '19589643': 1, '32410695': 1, '20622144': 1, '18430520': 1, '16255475': 1, '12971179': 1, '21728034': 1, '24494161': 2}
|
{}
|
165,556 |
3905631-1
| 24,516,840 |
noncomm/PMC003xxxxxx/PMC3905631.xml
|
Clear cell hidradenoma
|
A 31-year-old man presented with a solitary, asymptomatic 2 × 2.5 cm nodule on the occiput region of the scalp. About 2 years ago, the patient noticed a papule in this area, but due to being small and without symptoms, no action for diagnosis and treatment was taken. About 4 months ago, the lesion has started to grow quickly and gradually had become a 2 × 2.5 cm nodule [].\nThe lesion was cone shaped with a small ulcer and little discharge in the apex. Lesion was asymptomatic but because of recent rapid growth and location of the tumor that touch pillow during sleep, has found a little pain and burning. The lesion was sampled, and after confirmation of diagnosis complete elliptical excision was performed and resent to pathology [Figures and ].\nMacroscopic examination specimen consisted of skin-covered mass measuring 2.5 × 2 × 1.5 cm3. It was firm in consistency. The cut surface was grayish white and homogenous.\nMicroscopic examination the histopathological examination of the specimen showed similar morphology. The dermis showed tumor lobules composed of cellular masses separated by eosinophilic, homogenous material [].\nIn solid portions of the tumor, two types of cells could be recognized. One cell type is polyhedral with a rounded nucleus and slightly basophilic cytoplasm. Another cell type was usually round and contains very clear cytoplasm, the cell nucleus appears small and dark [].\nNo atypical mitotic figures were noticed. The diagnosis of clear cell hidradenoma or nodular hidradenoma was made.
|
[[31.0, 'year']]
|
M
|
{'6292273': 1, '4297448': 1, '2984259': 1, '10917110': 1, '9261469': 1, '34667702': 1, '10886280': 1, '4291187': 1, '18106970': 1, '13199772': 1, '10727324': 1, '24516840': 2}
|
{}
|
165,557 |
3905827-1
| 24,478,611 |
noncomm/PMC003xxxxxx/PMC3905827.xml
|
Late cytomegalovirus infection after hematopoietic stem cell\ntransplantation: case reports
|
A 34 year-old male patient underwent related allogeneic HSCT eight months after the\ndiagnosis of B-cell acute lymphoblastic leukemia (ALL). The pre-transplant serostatus\nfor CMV indicated D+R+. Fludarabine, Ara-C, etoposide and\nmelphalan were used in the conditioning regimen. Prophylaxis for graft-versus-host\ndisease (GVHD) was carried out using cyclosporine and methotrexate initiated at D+4. The\npatient had some fever peaks on D+6 (38.5C), D+7 (38.4 and 38.7C) and D+12 (38.1C),\nhowever none were related to CMV. On D+21 the patient had no complaints and on D+24 he\nwas discharged. The patient received acyclovir (200 mg/day) as post-transplant\nprophylaxis for 47 days (D+28 to D+75). On D+56 he showed the first signs of chronic\nGVHD with elevated liver enzymes, labial mucosa with areas of hyperpigmentation and\nwhitish inner mouth mucosa, palmar and plantar hyperemia, nausea, itching of the back\nand oropharynx sensitivity. On D+63 the patient presented abdominal pain. Due to signs\nof skin, gastrointestinal (GIT), mouth, and liver GVHD, the cyclosporin was changed to\nalternating 100 mg and 200 mg doses and prednisone (60 mg/day) was associated. On D+94,\nthe patient reported asthenia, mild fever, epigastric pain, pain in the mouth and a sore\nthroat, all related to GVHD. A smear and CMV antigenemia during this period were both\nnegative. On D+101, the patient still had epigastric pain and pain in the oral cavity\nattributed to GVHD however the CMV antigenemia revealed 30 positive cells/200,000\nleukocytes (). Immediately, even with\nsubclinical infection, treatment was initiated with intravenous ganciclovir (5\nmg/kg/dose b.i.d) for ten days, continuing with ambulatory ganciclovir for 15 days. The\ntotal leukocyte counts at D+100 and D+101 were 2.73 x 109/L and 3.0 x 109/L,\nrespectively. The antigenemia became negative by D+118 and at D+148 remained negative.\nOn D+248, the patient still showed signs of liver, ocular, oral mucosa and skin GVHD.
|
[[34.0, 'year']]
|
M
|
{'14647838': 1, '15931364': 1, '22062802': 1, '22922523': 1, '19136435': 1, '19966850': 1, '17625763': 1, '24478611': 2}
|
{'3905827-2': 2}
|
165,558 |
3905827-2
| 24,478,611 |
noncomm/PMC003xxxxxx/PMC3905827.xml
|
Late cytomegalovirus infection after hematopoietic stem cell\ntransplantation: case reports
|
A 50-year-old female patient underwent unrelated allogeneic HSCT after diagnosis of\nmyelodysplastic syndrome (refractory anemia with excess blasts II). The pre-transplant\nserostatus for CMV indicated D+R+. Fludarabine, busulfan and\nanti-thymocyte globulin (ATGAM) were used in the conditioning regimen. On D+79,\ncutaneous and gastrointestinal tract GVHD was diagnosed and confirmed by duodenal\nbiopsy. At this time, tacrolimus and methylprednisolone were introduced. The patient had\nfever and CMV antigenemia as shown by 29 positive cells/200,000 leukocytes only on D+180\n(). Therapy with intravenous\nganciclovir (5 mg/kg/dose) for 14 days was introduced immediately and ambulatory\ntreatment continued for seven days with ganciclovir (200 mg/day). The antigenemia became\nnegative on D+201. At D+229, the patient developed mild fever and the CMV antigenemia\nwas two positive cells/200,000 leukocytes (). Due to the low value of antigenemia and spontaneous resolution of the\nfever, antiviral therapy was not initiated. On D+236, the CMV antigenemia was negative\nand remained so until D+257. On D+995, the patient had liver, gastrointestinal and\nocular GVHD.
|
[[50.0, 'year']]
|
F
|
{'14647838': 1, '15931364': 1, '22062802': 1, '22922523': 1, '19136435': 1, '19966850': 1, '17625763': 1, '24478611': 2}
|
{'3905827-1': 2}
|
165,559 |
3906655-1
| 24,516,768 |
noncomm/PMC003xxxxxx/PMC3906655.xml
|
Hemimandibular Hypertrophy - Hybrid Variants: Report of Two Cases
|
A 34-year-old male patient reported to the out-patient department with a complaint of asymmetric appearance of his face. He had been involved in a road accident 15 years ago that had caused severe trauma to his chin. There were no other contributory findings in his dental, medical, and family history. On clinical examination, marked facial asymmetry was observed in the lower region of the face with deviation of the chin to the left. The mandibular body and ramus appeared longer and wider on the right side as compared to the left side []. Intra-oral examination revealed transverse canting of occlusal plane on the right side. Posterio-anterior view of the skull demonstrated elongation of the condyle on the right side. Height of the ramus and body of the mandible were also larger along with transverse canting of the occlusal plane on the right side []. Three-dimensional computed tomography (CT) image showed elongation and enlargement of condyle, ramus, and body of the mandible on the right side []. Scintigram demonstrated hot spots indicative of increased uptake of radioisotope in the condylar region on the right side []. Thus on the basis of clinical and radiographic features, diagnosis of hemimandibular hypertrophy-elongation hybrid variant of the right side was confirmed. Patient was referred to the oral and maxillofacial surgery department, where orthognathic surgery was done and both function and esthetics of the patient's facial structure were restored [].
|
[[34.0, 'year']]
|
M
|
{'12387615': 1, '9971928': 1, '16191911': 1, '10790442': 1, '3461097': 1, '29782597': 1, '19164410': 1, '8711329': 1, '24516768': 2}
|
{'3906655-2': 2}
|
165,560 |
3906655-2
| 24,516,768 |
noncomm/PMC003xxxxxx/PMC3906655.xml
|
Hemimandibular Hypertrophy - Hybrid Variants: Report of Two Cases
|
An 18-year-old female patient reported to the out-patient department with a complaint of gradually developing asymmetry of her face. She first noticed asymmetry of her face after a trauma she suffered about 5 years earlier. Since then the condition had gradually deteriorated and attained the present status. No information relevant to the condition was elicited from past dental, medical, and family history. On extra-oral examination, marked facial asymmetry was observed in the lower face region with deviation of chin toward the left side. Enlargement of the right side of mandible was clearly seen []. On intra-oral examination, mandibular central incisor midline was found not to coincide with facial midline. Open bite was present on the right posterior tooth region []. Panoramic radiograph revealed elongation of condyle, condylar neck, ramus and body of mandible on the right side. Horizontal dimension of the mandibular body was also larger as compared to that on the left side. The distance between the mandibular roots and the inferior alveolar nerve on the right side was more than that on the left side []. Further, CT demonstrated elongation and medial rotation of right lower border of the mandible [Figure and ]. On the basis of all these findings, diagnosis of hemimandibular hypertrophy-elongation hybrid type was confirmed.
|
[[18.0, 'year']]
|
F
|
{'12387615': 1, '9971928': 1, '16191911': 1, '10790442': 1, '3461097': 1, '29782597': 1, '19164410': 1, '8711329': 1, '24516768': 2}
|
{'3906655-1': 2}
|
165,561 |
3906659-1
| 24,516,774 |
noncomm/PMC003xxxxxx/PMC3906659.xml
|
Giant Pindborg Tumor (Calcifying Epithelial Odontogenic Tumor): An Unusual Case Report with Radiologic-Pathologic Correlation
|
A 38-year-old female patient reported to the dental hospital with an 8-year history of swelling on the right side of the face. The patient had initially noticed a small swelling on the right side of the face which progressively grew to attain its present size, due to which mastication and speech were compromised.\nOn clinical examination, a huge, well-circumscribed swelling was seen on the right side of the face, ovoid in shape, extending from the right ramus crossing the midline up to the left parasymphysis region of the mandible, measuring 12 × 10 cm in greatest diameter, bony hard in consistency, and nontender on palpation [Figures , ]. Mouth opening was restricted; the interincisal distance being 20 mm. Intraorally, a large swelling was seen extending from tooth 33 up to the right retromolar region with bicortical expansion, obliterating the right buccal sulcus, with lobulations present on the lingual aspect []. Both the maxillary and mandibular teeth were displaced and were mobile on the affected side.\nOwing to the slow-growing nature, well-circumscribed appearance, bony hard consistency and its presence in the tooth bearing region, a provisional clinical diagnosis of benign bony odontogenic neoplasm, was made. Ameloblastoma, CEOT, and ossifying fibroma were considered in clinical differential diagnosis.
|
[[38.0, 'year']]
|
F
|
{'22623944': 2, '22190756': 1, '11175269': 1, '30981981': 1, '21327587': 1, '34337187': 1, '26604515': 2, '27266209': 1, '23248488': 2, '22190811': 1, '24516774': 2}
|
{'4611947-1': 1, '3519231-1': 1, '3353704-1': 1}
|
165,562 |
3906661-1
| 24,516,771 |
noncomm/PMC003xxxxxx/PMC3906661.xml
|
A Rare Presentation of Bilateral Maxillary Dens Invaginatus Diagnosed Using Cone Beam Computed Tomography
|
A 22-year-old male patient presented with a complaint of occasional pain and tenderness in the right maxillary lateral incisor. Patient had an unremarkable medical history and reported no history of dental trauma.\nPatient was under treatment planning stage of orthodontic therapy for Angle's Class I malocclusion. The bilateral dens invaginatus was identified on a dental panoramic tomography taken for orthodontic diagnostic purposes.\nClinical examination revealed maxillary right lateral incisor (tooth 12) positioned out of the arch and caries on the palatal aspect of the maxillary left lateral incisor (tooth 22). Morphologic alteration was observed in both teeth. Crown portion of tooth 12 was wider both mesiodistally and buccolingually with prominent cingulum and a palatal groove []. A palatal groove was observed in tooth 22 with no significant alteration in the dimensions of the crown []. On pulp sensitivity testing using cold test, tooth 12 did not respond, while tooth 22 responded normally. On radiographic examination, two enamel-lined invaginations were observed for tooth 12, but the extent of invaginations was unclear []. A single pear shaped enamel-lined invagination extending on to the root surface was observed for tooth 22 [].\nBecause of the invagination, the morphology of the pulp canal space and the relationship between the two were not entirely clear from the conventional diagnostic radiographs. It was decided that a limited-volume CBCT scan of the maxilla may be helpful in understanding the internal anatomy of the tooth and determining the most appropriate treatment protocol.\nPatient was informed of the intended benefits and potential risks of the CBCT scan. After obtaining written informed consent, a CBCT (CS 3D Imaging Software) of the maxilla was performed with the following exposure parameters: 70 kV, 10 mA and 10.8 s [].\nCareful examination of cross-sectional images of tooth 22 revealed invagination extending apically beyond the cemento-enamel junction and ending as a blind sac without communicating with the dental pulp, confirming it as Oehlers Type 2 variant []. Cross-sectional images of tooth 12 revealed large Type 2 invagination as it was extending toward the root and communicating with the pulp and the second invagination was Type 1 with no communication with the pulp [Figure and ].\nBased on the confirmative findings of CBCT, conservative nonsurgical endodontic treatment was planned for tooth 12 with the double dens and simple restorative procedure for Type 2 dens invaginatus in tooth 22.
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[[22.0, 'year']]
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M
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{'10332241': 1, '23029634': 2, '19262734': 1, '20500234': 1, '17036586': 1, '19133103': 1, '19298577': 1, '23137215': 1, '13477660': 1, '24516771': 2}
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{'3440932-1': 1}
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165,563 |
3906774-1
| 24,520,234 |
noncomm/PMC003xxxxxx/PMC3906774.xml
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Harlequin ichthyosis: Case report
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A 31-year-old pregnant woman was admitted to the Zabol Amir-Al-Momenin hospital for her third pregnancy due to preterm, premature rupture of membrane and obstetric pain. Gestational age was approximately 30 weeks and 1 day based on both the first day of the last menstrual period and ultrasound. No remarkable complication was noted in the last ultrasound examination at 28 weeks of pregnancy. A female baby with HI was born via normal spontaneous vaginal delivery. Her birth weight, length, and head circumference was 2.1 kg, 44 cm, and 29 cm, respectively []. Parents had a distant relation and had two other normal healthy children. Thick skin with deep fissures, general hyperkeratinization, cyanosis, flat fontanels, ectropion, immature eyes and auricles, eclabium, bradycardia, bradypnea, and moaning were noted in the physical examination. Antibiotic therapy and conservative treatments were started after admission to the neonatal intensive care unit. However, the parents self-discharged their newborn daughter at the same day after birth.
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[[31.0, 'year']]
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F
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{'16181466': 1, '21475604': 1, '16007249': 1, '15756637': 1, '19434086': 1, '16682764': 1, '17385787': 1, '21339420': 1, '33235748': 2, '16847209': 1, '24520234': 2}
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{'7669385-1': 1}
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165,564 |
3906775-1
| 24,520,235 |
noncomm/PMC003xxxxxx/PMC3906775.xml
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Zolpidem dependence, abuse and withdrawal: A case report
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The patient was 32-year-old jeweler man who had diploma degree was referred to psychiatric clinic because of restlessness, irritability, myalgia, muscle cramps, sweating, palpitation, insomnia, muscle tic, and jump due to withdrawal of daily use of 400 mg zolpidem. He started to use heroin recreationally since 1997 and after 1 year had used it daily in snuff route for 3 years. Then, he was introduced to Narcotics Anonymous (NA) and was abstinent for 6 years. Two years ago, he used Orap (pimozide) and Xanax (alprazolam) to treat tic and simultaneous anxiety, but he discontinued Xanax because of failure to reduce anxiety and insomnia and his physician prescribed 10 mg tablet of zolpidem instead of Xanax. After use of first dose of zolpidem, he experienced euphoric mood of his heroin addiction and reminded heroin use. The next day, to avoid experience of heroin dependency and its induced euphoria, he used 40 tablets of diphenoxylate with zolpidem, but gradually increased dose of zolpidem and diphenoxylate simultaneously so that he used 100 tablets of zolpidem and 120 tablets of diphenoxylate within 6 months. Then, 6 months later, he discontinued diphenoxylate and used 110-140 10 mg tablets of zolpidem (1,100-1,400 mg) until he experienced convulsion with use of 200 10 mg tablets of zolpidem and hospitalized, and after discharge zolpidem was discontinued completely for 1 month but prescribed zolpidem 10 mg/day again after 1 month. Tics were treated completely with zolpidem use but its dosage increased to 1,000 mg/day again and within 6 months decreased to 400 mg/day and discontinued completely a few days before attending psychiatric clinic and he had classic symptoms and signs of opioid withdrawal (runny nose, diarrhea, myalgia, irritability, insomnia, and …). He had no history of physical problems and known diseases and only had a history of tic in past psychiatric history. Two of his cousins were opioid dependent in family history.
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[[32.0, 'year']]
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M
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{'9399127': 1, '12680751': 1, '16128733': 1, '21143957': 2, '28989915': 1, '11154097': 1, '17362446': 1, '30359892': 1, '33888666': 2, '10517569': 1, '29991431': 1, '17324242': 1, '19807814': 1, '33827492': 2, '1403792': 1, '14519173': 1, '33241538': 1, '17875189': 1, '24520235': 2}
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{'8025526-1': 1, '8077048-1': 1, '8077048-2': 1, '8077048-3': 1, '8077048-4': 1, '8077048-5': 1, '8077048-6': 1, '8077048-7': 1, '8077048-8': 1, '3014964-1': 1}
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165,565 |
3906776-1
| 24,523,789 |
noncomm/PMC003xxxxxx/PMC3906776.xml
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Thyrotropinoma and multinodular goiter: A diagnostic challenge for hyperthyroidism
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A 63-year-old female patient was admitted to our university hospital with knee pain. The pain was present for more than ten years, but recently became intense and resistant to analgesics. She had mild hypertension, which was under control. She had exopthalmus and multiple bilateral thyroid nodules on physical examination. There was no family history of thyroid disease.\nThyroid function tests revealed high freeT3 (FT3) and freeT4 (FT4) levels with high TSH, on two consecutive tests. All other laboratory tests including thyroid auto-antibodies were normal except high follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels, indicative of menopause []. The GH and age- and sex-matched IGF-1 levels were normal. The alpha subunit level was within normal range. GH suppression was obtained with the oral glucose tolerance test.\nOn ultrasonography, the right thyroid lobe measured 26 × 28 × 56 mm and the left thyroid lobe measured 29 × 30 × 61 mm. The isthmus was 15 mm and there were multiple nodules with the greatest having a diameter of 28 × 14 × 24 mm, on the right lobe. Thyroid scintigraphy revealed a minimally hyperplastic gland with hypoactive nodularity. Thyroid fine needle aspiration biopsy was consistent with benign cytology.\nThe thyrotropin-releasing hormone (TRH) test before and after the T3 suppression test was applied []. There was no response to the TRH and the results did not change after suppression with T3 preparation. An adenoma on the left side, with a 9 × 11 mm diameter, was present on pituitary magnetic resonance imaging (MRI). The tumor was hypointense in T1W Gd (+) and hyperintense in the T2W sequences. The sella basement had widened and the infundibulum was deviated to the right [ (A&B)].\nEndoscopic endonasal transsphenoidal surgery was performed and the adenoma was removed totally [ (C&D)]. Immunohistochemical examination of the tumor showed that it was a plurimorphous plurihormonal adenoma co-secreting TSH and GH [ (A&B&C&D)]. The postoperative anterior pituitary hormone levels were within normal reference range, including the thyroid hormones (TSH: 2.41 mIU/mL, FT3: 4.7 pmol/L, FT4 18.2 pmol/L).\nTwo months after pituitary surgery, the patient developed overt thyrotoxicosis with suppressed TSH levels (TSH was 0.009 uIU/mL). Thyroid scintigraphy revealed a hyperactive nodule. Radioactive iodine treatment was given. The patient was rendered euthyroid, and she is being followed without any recurrence of pituitary tumor or thyrotoxicosis.
|
[[63.0, 'year']]
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F
|
{'18940949': 1, '19051037': 1, '19945025': 1, '9534036': 1, '21845579': 1, '18923369': 1, '16967720': 1, '17347873': 1, '19098060': 1, '15929672': 1, '19534624': 1, '15966514': 1, '17848845': 1, '18226733': 1, '18590428': 1, '11761429': 1, '33929339': 1, '27095865': 2, '19636221': 1, '1306520': 1, '21803715': 1, '24523789': 2}
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{'4815389-1': 1}
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165,566 |
3907196-1
| 24,394,852 |
noncomm/PMC003xxxxxx/PMC3907196.xml
|
A rare cause of upper gastrointestinal haemorrhage: Ruptured cystic artery pseudoaneurysm with concurrent cholecystojejunal fistula
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An 86-year-old male presented to the Emergency Department with a two-day history of colicky right upper quadrant (RUQ) pain associated with bilious vomiting. Relevant background included hypertension, diabetes mellitus and hypercholesterolaemia. On examination, the patient was icteric with an associated pyrexia of 38 °C, hypotension and tachycardia. Abdominal examination revealed mild tenderness in the RUQ.\nLaboratory investigation revealed raised inflammatory markers with a white blood cell count of 24.0 × 109 L−1 and C-reactive protein of 95 mg/L (Normal range: <7.5 mg/L). Liver function tests (LFTs) were also deranged with an alkaline phosphatase of 450 μ/L (46–111 μ/L), Alanine Transaminase of 142 μ/L (<45 μ/L) and Bilirubin of 60 μmol/L (<20 μmol/L). An ultrasound examination revealed a 5.7 cm calculus within the gallbladder surrounded by heterogeneous material; a diagnosis of cholangitis was made. The patient received fluid resuscitation with intravenous crystalloid and was commenced on broad-spectrum antibiotics.\nSubsequently, the patient passed a significant volume of malaena and fresh blood per rectum (PR), associated with cardiovascular instability. Emergency oesophagogastroduodenoscopy (OGD) revealed fresh blood in the second part of the duodenum and a tubular clot adherent to the medial wall (). This was assumed to be originating from a duodenal ulcer and apparent haemostasis was achieved with injection of 15 ml of 1:10,000 adrenaline. However, the patient continued to pass malaena and PR blood following the procedure. As such, a contrast-enhanced computed tomography (CT) scan was performed, demonstrating: (1) small bowel obstruction secondary to a gallstone impacted in the distal ileum (a) (2) a thick-walled and inflamed gallbladder with evidence of recent intra-cholecystic bleeding (b), and (3) a 12 mm pseudoaneurysm emanating from the cystic artery (c and d). In retrospect, the blood clot seen at OGD was likely to be haemobilia originating from the ampulla of Vater.\nThe patient underwent emergency laparoscopy and the gallbladder was found to be necrotic and surrounded with dense adhesions. Division of these exposed a cholecysto-jejunal fistula containing clotted blood that was extending into the gallbladder. Evacuation of this clot revealed a 1 cm × 2 cm pseudoaneurysm originating from the cystic artery, which began to bleed during dissection and the procedure was subsequently converted to an open laparotomy via a Kocher incision. A subtotal cholecystectomy was performed with oversewing of Hartmanns pouch and the aneurysm was successfully resected from the gallbladder fossa. The diseased jejunal loop was mobilised and the defect from the fistula was oversewn. Despite detailed examination of the small bowel, the gallstone located on CT could not be identified within the terminal ileum. The laparotomy wound was therefore closed under the assumption that the stone had passed spontaneously. The patient was discharged following a fifteen-day inpatient stay and remained well at six-week outpatient follow-up.
|
[[86.0, 'year']]
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M
|
{'10392949': 1, '34811584': 1, '27281100': 1, '17004870': 1, '19717255': 1, '21326564': 1, '17468824': 1, '16521193': 1, '18333143': 1, '17386110': 2, '22520246': 1, '29459583': 1, '16784952': 1, '34869829': 2, '20354255': 1, '11443421': 1, '22880508': 1, '31182944': 2, '26021378': 1, '24394852': 2}
|
{'6547271-1': 1, '8635945-1': 1, '1851966-1': 1}
|
165,567 |
3907205-1
| 24,394,859 |
noncomm/PMC003xxxxxx/PMC3907205.xml
|
Right hepatectomy for combined primary neuroendocrine and hepatocellular carcinoma. A case report
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A 51-year-old man presented to our outpatient clinic with a 9-month history of dull aching abdominal pain and a medical history of hepatitis C. Periodic hepatic ultrasound follow-up showed a mass in the right hemiliver. A CT scan of the abdomen revealed a 20 cm × 15 cm mass occupying most of the hemiliver with cystic degeneration and calcification and multiple dilated collaterals related to the mass (). The mass was compressing the right portal vein, yet no invasion detected (). CT volumetry estimated the residual left hemiliver volume including the middle hepatic vein to be 1300 cc. Serum level of alpha-fetoprotein (AFP) was slightly elevated (2.3 ng/ml). The patient had normal liver enzymes, total serum bilirubin of 1.2 mg/dl, serum albumin of 3.3 mg/dl and INR of 1.1. CA19-9 and CA125 were normal. CT of chest and extrahepatic abdomen showed no other lesions.\nThe patient underwent laparotomy through a J shaped incision (). On exploration the mass was found to be capsulated, 20 cm × 15 cm occupying most of the right hemiliver with multiple dilated collaterals extending from the mass to the diaphragm and the hepatic flexure of the colon. No ascites was found. No peritoneal nodules or significant lymph nodes. Right hepatectomy was done. Blood loss was 2500 cc and the patient received 4 units of blood intraoperatively due to presence of collaterals and large size of the mass making mobilization and resection of the right lobe technically challenging. The patient had an eventless post-operative course and was discharged on the 6th post-operative day.\nThe resected specimen measured 20 cm × 15 cm and weighed 4500 g. Cut section revealed a well-defined heterogeneous gray-white to brown friable mass 7.5 cm in diameter (). The surrounding liver was non-cirrhotic.\nMicroscopically, the tumor consisted predominantly of monotonous small- to medium-sized neoplastic cells arranged in trabeculea separated by sinusoidal spaces. Tumor cells had round to oval punctuate nuclei within conspicuous nucleoli and scanty cytoplasm (A). The tumor was accompanied by wide areas of geographic necrosis with high mitotic rate that ranged between 2 and 20/10 HPF. The whole morphological picture was reminiscent of high grade NEC. The surrounding liver tissue revealed chronic hepatitis without cirrhotic changes.\nImmunohistochemically, the tumor cells were strongly positive for synaptophysin (D) and focally positive for chromogranin-A. Interestingly, the tumor cells showed patchy positive coarse granular staining for HerPar-1 in less than 1% of tumor cells (B and C) while Glypican-3staining was negative. The immunohistochemical findings supported the diagnosis of combined high grade NEC and HCC. Follow up period was short but no recurrence detected up to 6 months after surgery.
|
[[51.0, 'year']]
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M
|
{'33726764': 2, '32590784': 2, '34336917': 2, '19686999': 1, '29147223': 2, '6147306': 1, '8561091': 1, '29794961': 2, '15533230': 1, '7539881': 1, '30271748': 2, '28834900': 2, '12658390': 1, '23094854': 1, '34727269': 2, '27384317': 1, '27895410': 2, '28895097': 2, '12940779': 1, '11685737': 1, '24394859': 2}
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{'6056365-1': 1, '8316597-1': 1, '6160311-1': 1, '5649886-1': 1, '7968236-1': 1, '5107604-1': 1, '7328923-1': 1, '8563892-1': 1, '5593802-1': 1, '5572022-1': 1}
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165,568 |
3907695-1
| 23,780,404 |
noncomm/PMC003xxxxxx/PMC3907695.xml
|
Fetus in fetu: a medical curiosity—considerations based upon an intracranially located case
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A male newborn (a son of a 19-year old primiparous healthy mother—delivery was by cesarean section in the 33rd week of gestation, family history of multiple births was not remarkable) was admitted to the Intensive Care Department of the University Children’s Hospital in Kraków in the first day of life due to a large intracranial tumor. The tumor was diagnosed in the 31st week of gestation during routine ultrasound examination and confirmed by MRI (Fig. ). The pregnancy was terminated in the 33rd week of gestation with prior induction of lung maturation by dexamethasone administered to mother.\nThe newborn was presented in a grave state with symptoms of respiratory failure. A large partially intracranial tumor with a diameter of 9 cm was found. The tumor distorted child’s head and was covered by grayish blue skin. The eyeball was dislocated with exophthalmos.\nLow levels of serum proteins, hypoglycemia, dyselectrolytemia, and metabolic acidosis were found in laboratory tests. The level of AFP was 183,173.6 ng/ml. There was no cardiac defect or other abnormalities in the abdomen. CT confirmed that the tumor is expanding within the structures of the craniofacial region of his head (Fig. ).\nIt has been decided to remove the tumor surgically immediately, to give the child the chance of survival (Fig. ). However, just at the moment of introduction to anesthesia, the child abruptly deteriorated and the operation has not been started. Eventually, the child died the next day.\nThe general autopsy showed that the male newborn has a weight of 3,100 g, with features of fetal respiratory distress syndrome (Fig. ). Apart from the head which measures 44 cm in diameter, no other abnormalities in the child’s body were found.\nThe large tumor of 9 cm in diameter occupied the right anterior, medial, and pterygopalatinal cranial fossae, partially displacing the child’s brain to the left. The tumor was entirely encapsulated and connected to the rest of the body by a distinct vascular stalk (Fig. ). It caused a significant destruction and an enormous defect of the cranial vault measuring 8 × 7.5 cm and 5.5 cm deep.\nAfter the incision of the capsule, four relatively well-developed limbs (with fingers) appeared, protruding from the rest of the rather featureless tumor mass (Fig. ). Microscopically, apart from the relatively well-formed musculoskeletal structures of limbs (Fig. ) that were covered with skin (Fig. ), there were haphazardly distributed different tissues or fragments of organs like intestine (Fig. ), glands, muscles, and fat tissue. However, different neuroectodermal derivatives, like structures resembling primitive neural tubes, ganglions, neuroglial, and ependymal structures, were dominant (Fig. ).\nThere was no complete genetic profile obtained from histological materials, just individual genetic features in some STR structures. Examination of amelogenin gene in three specimens revealed chromosome X and Y characteristic for male sex.
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[[19.0, 'year']]
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M
|
{'17228158': 1, '8942525': 1, '18352794': 1, '18447681': 1, '28217238': 1, '10369997': 1, '16938354': 1, '19184054': 1, '17556829': 1, '34911473': 2, '32968878': 1, '24693883': 2, '26266375': 1, '7077386': 1, '18493782': 1, '18186928': 2, '33628563': 2, '34467432': 1, '10235344': 1, '22208315': 1, '9021587': 1, '23780404': 2}
|
{'7895588-1': 1, '2253549-1': 1, '8672559-1': 1, '3996905-1': 1}
|
165,569 |
3908273-1
| 24,693,176 |
noncomm/PMC003xxxxxx/PMC3908273.xml
|
Stem cell therapy for congestive heart failure
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A 58-year-old male with relapsed HL was referred to our bone marrow transplantation unit in October 2009. He was given 8 courses of combination chemotherapy with doxorubicin, bleomycin, vincristine, and dacarbazine (ABVD) between June 2008 and February 2009 and achieved complete remission. However, his disease relapsed 3 months after completing the last cycle of ABVD and he was decided to be treated with DHAP (cisplatin, cytarabine, dexamethasone) followed autologous stem cell transplantation (SCT). After the completion of first course of DHAP regimen, he developed acute myocardial infarction (AMI) and coronary artery bypass grafting (CABG) was performed. After his cardiac function stabilized, 3 additional courses of DHAP were given and he was referred to our centre for consideration of autologous SCT. Computed tomography scans obtained after chemotherapy confirmed complete remission. Stem cells were collected from peripheral blood after mobilization with 10 µg/kg/day granulocyte colony-stimulating factor (G-CSF) subcutaneously. Collection was started on the fifth day of G-CSF and performed for 3 consecutive days. Flow cytometric analysis of CD 34 was used to identify hematopoietic stem cells. During the last evaluation before stem cell transplantation, conventional echocardiogram (ECHO) revealed left ventricular systolic dysfunction with an ejection fraction of ALEF: 44%, MODEF: 45%, MUGA scan showed a decreased left ventricular ejection fraction (LVEF: 43%) ().\nIn view of these findings, the patient was found ineligible for SCT and he was offered to give his peripheral blood stem cells for the treatment of heart failure. After receiving the patient’s signed informed consent form, a total number of 3.49x106/kg CD 34+ cells were infused via antecubital vein. Echocardiographic studies performed 2 months after stem cell therapy revealed a similar ejection fraction rate while a significant improvement in left ventricular ejection fraction (ALEF: 55%, MODEF: 57%) was noticed in ECHO performed 7 months after stem cell therapy ().\nEF values at various time periods are shown on . Myocardial perfusion scintigraphy was also performed and showed infarction containing viable tissue in inferior wall (). Myocardial positron emission tomography revealed that glucose metabolism was conserved in inferior wall.\nHL was in complete remission in the 2 months follow up after SCT but SCT for HL was not contemplated because renal failure due to chemotherapy developed later.
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[[58.0, 'year']]
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M
|
{'11348593': 1, '18843721': 1, '15019658': 1, '21362705': 1, '17533201': 1, '17675261': 1, '12439633': 1, '11548889': 1, '20576835': 1, '16627051': 1, '24693176': 2}
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{}
|
165,570 |
3908485-1
| 24,520,551 |
noncomm/PMC003xxxxxx/PMC3908485.xml
|
Stroke in a patient with pulmonary arteriovenous fistula: A case report study
|
A 40-year-old male was presented to neurology department (Alzahra Hospital, Isfahan, Iran) with chief complaint of sudden diplopia and dysarthria accompanied by facial palsy. The symptoms had started 48 h earlier and recovered within hours after admission; however, patient's diplopia and facial paresis continued. During his childhood he was treated with Phenobarbital after he was diagnosed with seizures because of recurrent cyanotic attacks and syncope. He had a therapeutic open-thorax surgery after a PAVF was found in an exploratory angiography 13 years ago. Although, the PAVF was closed in the surgery, he has been experiencing episodes of fatigue and shortness of breath during the last 13 years. He had no history of smoking or thrombotic vascular diseases. In physical exam the patient had normal vital signs. He had left-side facial palsy and hemi paresis. He was dysarthric and complained of diplopia when looking to the right side. His electrocardiogram was normal with no arrhythmias. In chest X-ray, there were no signs of cardiomegaly, structural abnormalities, increased pulmonary vascular markings or mass-related findings. Arterial blood gas test indicated normal levels of arterial Oxygen. Both laboratory tests for hypercoagulable states and vasculitis panel were negative. In computed tomography (CT-scan) no lesions were found however, in the T2-magnetic resonance imaging (MRI) images, a hyper-signal lesion in the right thalamic region of his brain was seen []. Based on the history, we tested the patient for vascular anomalies. A trans-cranial Doppler [] with positive bubble test discovered an open arteriovenous shunt, which was confirmed with a trans-esophageal echocardiogram. The patient had an open PAVF. We put the patient on proper anti-coagulants to prevent further damages. Angiographic images were used to determine the site of fistula. The fistula was closed through surgery and further examinations showed proper blood circulation in higher areas of his lungs, which previously had been bypassed by the AVF. He was put on anticoagulant for 6 months. In 1-month follow-up, he had no complaints of fatigue or shortness of breath, and neurological symptoms were minimized.
|
[[40.0, 'year']]
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M
|
{'10501873': 1, '34478123': 2, '6219255': 1, '15736259': 1, '2408201': 1, '21305489': 1, '16614045': 1, '14742615': 1, '24520551': 2}
|
{'8571431-1': 1}
|
165,571 |
3908535-1
| 24,523,805 |
noncomm/PMC003xxxxxx/PMC3908535.xml
|
Flecainide associated torsade de pointes: A potential case of reverse use dependence
|
A 69-year-old woman with a past medical history of hypertension and symptomatic paroxysmal atrial fibrillation presented to the emergency department with altered mental status that occurred on past two nights. She described awakening during the night after wetting her bed and feeling paralyzed. Her husband noticed her “thrashing around the bed with garbled speech” and activated emergency medical service.\nHer home medications had been lisinopril 2.5 mg twice a day, flecainide 150 mg twice a day, dabigatran 150 mg twice a day, digoxin 0.125 mg daily and diltiazem CD 120 mg daily. Her digoxin and diltiazem were discontinued recently due to symptomatic sinus bradycardia. Transthoracic echocardiogram showed a structurally normal heart and a recent nuclear stress test was negative for perfusion defect.\nAt the time of admission the physical exam was significant for bradycardia at a rate of 50 beats/min with otherwise normal vital signs. She had no focal neurological deficits and her cardiac exam was normal. Laboratory evaluation exhibited normal basic metabolic panel, thyroid function tests, blood counts, urine and serum drug screen. Electro cardiogram (ECG) demonstrated sinus bradycardia at a rate of 49 beats/min, first degree AV block (PR interval 272 ms), and QT prolongation (QTc 506 ms). QRS duration was 100 ms.\nShortly after admission she had a cardiac arrest. She was successfully resuscitated after 2 rounds of external defibrillation. A telemetry rhythm strip at the time of the event showed non-sustained ventricular tachycardia (VT) with “R on T” phenomenon leading to polymorphic VT in a TdP pattern followed by ventricular fibrillation []. ECG after her resuscitation demonstrated sinus bradycardia, QT prolongation (QTc 546 ms) and QRS widening (160 ms). The patient underwent coronary angiography, which showed normal epicardial arteries.\nFlecainide was discontinued and intravenous lidocaine was started. She underwent placement of a dual-chamber intracardiac defibrillator and her atrial pacing rate was set to 80 beats/min. Due to previous side effects, the patient was unable to tolerate amiodarone or sotalol. As the patient was very symptomatic during atrial fibrillation, a rhythm control strategy with flecainide and diltiazem was utilized. Prior to discharge, she was monitored in the hospital for 3 additional days after restarting flecainide and there was no recurrence of her arrhythmia. At a 6-week ICD interrogation appointment, she was in stable condition and had no arrhythmia.
|
[[69.0, 'year']]
|
F
|
{'8762029': 1, '1279606': 1, '1900101': 1, '21317626': 1, '11852963': 1, '4956181': 1, '8246130': 1, '26159617': 1, '2114236': 1, '7889236': 1, '20185054': 1, '24523805': 2}
|
{}
|
165,572 |
3908537-1
| 24,523,807 |
noncomm/PMC003xxxxxx/PMC3908537.xml
|
Large retroperitoneal paraganglioma concurrent with periampullary adenocarcinoma
|
An 81-year-old woman with fit physiologic condition, was admitted to our institution in Isfahan, Iran, in 2012, because she experienced progressive abdominal fullness and dull epigastric pain for a few months. Her past medical history was unremarkable. Her blood pressure and heart rate were within normal limits and liver enzymes including serum glutamic oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), alkaline phosphatase and gamma glutamyl transferase showed increased values. Bilirubin level, Carcinoembryonic antigen and cancer antigen 19-9 levels were within normal limits.\nIn the abdominal examination a large mass on upper paramedian, left side was touched. A computed tomography (CT) scan of the abdomen demonstrated a large retroperitoneal solid-cystic mass and significant dilation of gallbladder, intra and extra hepatic and pancreatic ducts [].\nMagnetic resonance cholangiopancreatography of the patient showed large solid-cystic tumor anterior to left psoas muscle and left kidney, inferior to pancreatic tail. It showed either, complete obstruction of main distal pancreatic duct and distal Common Bile Duct (CBD) [].\nThe patient underwent endoscopic retrograde cholangiopancreatography (ERCP), which revealed a tumoral papilla (2 cm × 2 cm × 1 cm) and biopsy was taken. Microscopic examination of papi biopsy showed adenocarcinoma.\nShe was planned for surgery with frozen section examination of abdominal mass. At the time of surgery, an encapsulated, hypervascular mass (approximately 13 cm × 10 cm × 4 cm) was observed in her retroperitoneal area with the central degeneration and hemorrhage and was subsequently excised [].\nPathological analysis of the mass on frozen section showed a cellular lesion with probability of malignancy, without any sign of metastatic carcinoma.\nPancreaticoduodenectomy was considered for management of her periampullary mass. In permanent histologic sections, the abdominal mass revealed an encapsulated tumor; the tumor cells were arranged in sheets, large nests and organoid patterns, and contained mild pleomorphic nuclei with low mitotic activity []. The neoplasm was histologically benign, with no evidence of invasion, compatible with a paragangliom. The histologic evaluation of peiampullary tumor revealed an adenocarcinoma in stage IIB. After three months from patient's surgery, her treatment has been completed and patient seems to be healthy.
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[[81.0, 'year']]
|
F
|
{'15719371': 1, '11459270': 1, '18547417': 1, '9637545': 1, '1987845': 1, '22716303': 2, '17264467': 1, '20108122': 1, '21188160': 2, '15180952': 1, '20100402': 1, '24523807': 2}
|
{'3004405-1': 1, '3441355-1': 1}
|
165,573 |
3908696-1
| 24,523,999 |
noncomm/PMC003xxxxxx/PMC3908696.xml
|
Hepatic cerebrospinal fluid pseudocyst: A rare complication of ventriculoperitoneal shunt
|
A 40-year-old male patient presented to the hospital with a 7-day fever, abdominal distention, and pain. His medical and surgical history includes VP shunt placement following a head injury from a motor vehicle crash one year earlier. The patient had no history of malignancy and pancreatic or liver disease. An initial physical examination revealed low-grade fever with mild right-upper-quadrant discomfort and a slightly distended abdomen. Bowel sounds were normal, and there were no peritoneal signs. A central nervous system (CNS) examination was within normal limits. Blood test on admission showed mild leukocytosis (WBC, 13,200/mm3), anemia (hemoglobin, 9.0 g/dL; hematocrit, 26.9%), elevation of C-reactive protein levels (15.70 mg/dl) and erythrocyte sedimentation rate (110 mm/h), as well as glutamic oxaloacetic transaminase levels (255 U/L), glutamic pyruvic transaminase levels, (186 U/L) gamma-glutamyl transferase levels (275 U/L), and alkaline phosphatase levels (162 U/L). Bilirubin was normal. Examination of the CSF indicates VP shunt infection, and a microbiological analysis showed Staphylococcus epidermidis. The ultrasonographical and abdominal computed tomography (CT) evaluation of the abdomen showed a cystic lesion in the hepatic segment V measuring 81 × 74 × 62 mm, with the shunt catheter placed inside [Figures and ]. The cystic mass did not show contrast enhancement. After this, we took out the proximal and distal VP shunt catheter from the previous cranial and abdominal incision (right lower abdominal quadrant), and an adequate antibiotic treatment was administrated for 14 days. A follow-up brain CT scan revealed no enlargement of the ventricular size, and a CT of the abdomen showed a regression of the cystic form [] with a marked decrease in abdominal symptoms within 3 days and normalization of the abdominal condition within 10 days after the removal of the VP shunt.\nTwo weeks after the surgical procedure, a subsequent cranial CT scan showed bilateral ventricular dilatation, and after three consecutive negative CSF cultures, we performed a shunt reinsertion on the opposite side of the peritoneum. On his 20th day in the hospital, the patient was discharged with complete resolution of previous symptoms. Liver enzymes returned to normal levels, and no clinical recurrence of the hepatic CSF pseudocyst was evident during the 9-month follow-up period.
|
[[40.0, 'year']]
|
M
|
{'3568524': 1, '3009014': 1, '17992040': 1, '9917545': 1, '18373825': 1, '5349089': 1, '14972271': 1, '30937097': 2, '17566200': 1, '33530051': 1, '1502630': 1, '28584681': 2, '16679653': 1, '15472455': 1, '7942187': 1, '20096426': 1, '34469214': 1, '6375883': 1, '20963636': 1, '15942277': 1, '447048': 1, '14999512': 1, '21943017': 2, '22226632': 1, '23183082': 1, '7242901': 1, '9118143': 1, '10681683': 1, '15550231': 1, '3950166': 1, '2755746': 1, '13163727': 1, '2699757': 1, '31818327': 2, '26266167': 1, '3242798': 1, '24523999': 2}
|
{'6413594-1': 1, '6413594-2': 1, '6902322-1': 1, '5445654-1': 1, '5445654-2': 1, '5445654-3': 1, '5445654-4': 1, '3189151-1': 1}
|
165,574 |
3908887-1
| 24,493,921 |
noncomm/PMC003xxxxxx/PMC3908887.xml
|
Listeria monocytogenes endophthalmitis following keratoconjunctivitis
|
A 27-year-old healthy white male presented with history of mucopurulent conjunctivitis that was treated with topical tobramycin eye drops for 5 days prior to presentation. After 21 days, he complained of redness and photophobia in the right eye followed by decrease in vision in the same eye. The patient reported a history of photorefractive keratectomy in both eyes 6 months prior to presentation. There was no history of trauma or contact lens wear.\nOn eye examination, the best corrected visual acuity in the right eye was hand motion, and in the left eye was 20/20. Intraocular pressure was 18 mmHg in the right eye and 13 mmHg in the left eye. Slit-lamp biomicroscopy of the right eye revealed keratitis with severe corneal edema. The anterior chamber was deep and showed brown pigmented hypopyon. The left eye was normal. Diagnostic B-scan ultrasonography of the right eye was performed and showed exudates and opacification of the vitreous. After 2 days, a vitreous biopsy was done and intravitreal injection of vancomycin 1 mg/0.1 mL and ceftazidime 2.25 mg/0.1 mL were given. Gram stain showed multiple Gram-positive bacilli. The culture revealed growth that was labeled as contamination.\nThe patient was kept on topical tobramycin and systemic amoxicillin and clavulanate antibiotics, but there was no improvement. The clinical picture of endophthalmitis started to be established with profound loss of vision, hypopyon, and massive vitritis. Four days following the initial tap, the patient was taken to the operating room again and an anterior chamber paracentesis was done and aqueous specimens obtained. Anterior chamber washout and vitreous biopsy were performed. The patient received intracameral antibiotics comprising vancomycin 1 mg/0.1 mL, ceftazidime 2.25 mg/0.1 mL, and cefuroxime 1 mg/0.1 mL at that time. Vitreous tap was taken and intravitreal antibiotics comprising vancomycin 1 mg/0.1 mL and ceftazidime 2.25 mg/0.1 mL were given again. The samples were sent for microbiology and polymerase chain reaction. The result from the aqueous tap was positive for L. monocytogenes that was resistant to most drugs except for penicillin and aminoglycosides. The polymerase chain reaction for aqueous and vitreous tap was negative. A diagnosis of L. monocytogenes-induced endophthalmitis was made. The patient was hospitalized and received intravenous penicillin 0.5 million units every 6 hours, and fortified gentamicin drops were applied hourly to the right eye for 7 days. The ocular inflammations subsided. However, eye examinations revealed that the shallow anterior chamber progressively became flat; the cornea remained edematous; the pupil showed 360° posterior synechiae; the lens was cataractous; and the posterior pole was obscured over the course of 2 weeks. A diagnostic B-scan was performed and showed diffuse thickening of the retinochoroidal layer, but no choroidal detachment (). Ultrasound biomicroscopy revealed a thick cornea; lens displacement anteriorly, almost touching the cornea; and a 360° shallow ciliary body detachment. The condition progressed and the eye developed phthisis bulbi 4 months after onset.
|
[[27.0, 'year']]
|
M
|
{'102203': 1, '32397694': 1, '22972049': 1, '17068464': 1, '27424034': 2, '26437938': 2, '15013893': 1, '1455294': 1, '29086326': 1, '17332901': 1, '1906370': 1, '3141669': 1, '21103198': 1, '18724160': 1, '33103228': 1, '4964814': 1, '27602088': 1, '22638923': 1, '11738433': 1, '15480698': 1, '11427612': 1, '21475652': 2, '15460335': 1, '24493921': 2}
|
{'4947317-1': 1, '3062758-1': 1, '4593987-1': 1}
|
165,575 |
3908908-1
| 24,493,935 |
noncomm/PMC003xxxxxx/PMC3908908.xml
|
Spontaneous bilateral peripapillary, subhyaloid and vitreous hemorrhage with only minor platelet deficit in idiopathic thrombocytopenic purpura
|
A 45-year-old female with underlying ITP and diabetes mellitus presented to the Department of Ophthalmology, Hospital Raja Perempuan Zainab II, complaining of a sudden onset of reduced vision in both eyes, of about 3 weeks in duration. This was associated with floaters in both eyes. There was no history of trauma, intense aerobic exercise, heavy lifting, straining on the toilet, vomiting, coughing, or vigorous sexual activity. She had been diagnosed with ITP several years before, with initial presentation of menorrhagia. Examination revealed visual acuity of 6/36 and 6/60 in the right and left eyes, respectively. Anterior segment findings were unremarkable. Fundus examination showed bilateral peripapillary, subhyaloid and vitreous hemorrhage, which was more pronounced in the left eye (). There were no diabetic retinopathy changes noted. Systemic examination did not reveal any petechiae, bruises, or mucosal bleeding.\nHematological evaluation was carried out. The patient’s platelet count was 120×109/L (normal: 150−450×109/L); her hemoglobin count was 93 g/L (normal: 120–160 g/L). Coagulation profile (prothrombin time and partial thromboplastin time) was normal.\nAfter consultation by a hematologist, she was treated with oral prednisolone, starting dose of 50 mg daily (1 mg/kg/day) for 1 week. Oral prednisolone treatment was then slowly tapered down over the next month. Review at 6 weeks showed spontaneous partial resolving of hemorrhages (), and slight improvement of vision (to 6/24 – both eyes). It was recommended to the patient that she undergo left eye vitrectomy (in view of the fact the subhyaloid hemorrhage was just adjacent to the macula), but the patient has not yet consented to the operation.
|
[[45.0, 'year']]
|
F
|
{'25390700': 1, '15906065': 1, '5640547': 1, '11860445': 1, '567032': 1, '27800200': 2, '31049321': 1, '16286631': 1, '5252200': 1, '12782172': 1, '21836362': 1, '25694840': 2, '20413929': 2, '24493935': 2}
|
{'2886257-1': 1, '5075305-1': 1, '4324978-1': 1}
|
165,576 |
3909841-1
| 24,497,799 |
noncomm/PMC003xxxxxx/PMC3909841.xml
|
Balloon Occlusion Retrograde Transvenous Obliteration of Gastric Varices in Two Non-Cirrhotic Patients with Portal Vein Thrombosis
|
The patient was a 35-year-old woman with history of Crohn's disease and a history of portal vein thrombosis and splenic infarction 5 years ago. She underwent a total abdominal colectomy and was admitted for persistent left upper quadrant pain 10 days after surgery. An abdominal-pelvis computed tomography (CT) scan 10 days after surgery showed interval development of main portal vein thrombosis with extension into both the right and left portal veins () and small isolated varices in the gastric fundus (). She was discharged with Coumadin and Lovenox after control of pain. She was readmitted 2 weeks later for increasing left upper quadrant pain. The 2 week follow-up abdominal-pelvis CT scan showed an interval decrease in the size of the portal vein thrombosis but a new inferior mesenteric vein thrombosis () and an interval increase in the size of the gastric varices (). The patient did not have any symptoms of upper gastrointestinal (GI) bleeding at admission.\nDue to the portal and inferior mesenteric vein thrombosis, she was planned to continue on anticoagulation with Coumadin therapy. However, due to the presence of gastric varices, a significant risk of variceal bleeding existed with anticoagulation medication. Additionally, an interval increase in the size of the gastric varices was observed on the CT scan compared with previous scans. The primary care team wanted to treat these gastric varices with a minimally invasive procedure such as BRTO, although the size of the gastric varices was relatively small. Therefore, she was referred for the BRTO procedure for prophylactic embolization of the gastric varices considering the presence of a gastrorenal shunt. Laboratory data before the BRTO procedure was creatinine, 0.65 mg/dL; bilirubin, 0.1 mg/dL; aspartate transaminase (AST), 10 units/L; alanine transaminase (ALT), 7 units/L; albumin, 2.7 g/dL; and PT/INR, 18.5 sec/1.51.\nThe procedure was performed under moderate sedation with intravenous midazolam hydrochloride and fentanyl citrate. We initially accessed the right internal jugular vein and placed a 9 Fr sheath. An 8 Fr renal double curve guiding catheter (Vista Britetip IG; Cordis, Miami, FL, USA) was placed in the left renal vein. Then, a 6 Fr balloon wedge pressure catheter (Teleflex Medical, Arrow International Inc., Reading, PA, USA) was placed in the gastrorenal shunt, and balloon occluded retrograde venography was performed. A venogram showed filling of the small gastric varices (). The sclerosant was administered with the occlusion balloon inflated, and the varices were filled under fluoroscopic guidance over 30 minutes. We used 4 mL of 3% sodium tetradecol sulfate as the sclerosant (Sotradecol; AngioDynamics, Queensbury, NY, USA) mixed with 2 mL lipiodol (Ethiodol; Savage Laboratories, Melville, NY, USA) and 6 mL of air. The spot image after embolization showed shrunken gastric varices with lipiodol uptake (). The balloon occlusion catheter was left in place for 30 minutes. Then, no residual gastric varix was observed after some reflux of sclerosant agent into the coronary vein, and no retrograde flow into the renal vein was observed after deflating the occlusion balloon. Thus, we decided to remove the occlusion catheter and sheath.\nThe patient was started on anticoagulation treatment and was discharged home on Coumadin. The post-procedural course was uneventful with no evidence of upper GI bleeding. A follow-up upper endoscopy at 105 days post procedure showed complete resolution of the gastric varices. Follow up CT scans at 3 and 5 months post BRTO procedure showed complete resolution of the portal vein thrombosis and complete obliteration of the gastric varices ().
|
[[35.0, 'year']]
|
F
|
{'15872320': 1, '20684965': 1, '31040991': 1, '12407350': 1, '22942552': 1, '28246514': 1, '23322829': 1, '15383850': 1, '25808874': 1, '9707073': 1, '22081920': 1, '7575812': 1, '21106386': 1, '20932597': 1, '12845306': 1, '20308910': 1, '16964806': 1, '24497799': 2}
|
{'3909841-2': 2}
|
165,577 |
3909841-2
| 24,497,799 |
noncomm/PMC003xxxxxx/PMC3909841.xml
|
Balloon Occlusion Retrograde Transvenous Obliteration of Gastric Varices in Two Non-Cirrhotic Patients with Portal Vein Thrombosis
|
The patient was a 51-year-old woman with necrotizing pancreatitis and extensive enterocutaneous fistulas also complicated by portal vein thrombosis with cavernous transformation and splenic vein thrombosis (). She also had multiple episodes of upper GI bleeding for which she had undergone an upper GI endoscopy and ligation of the varices. She underwent splenic artery and gastroduodenal artery embolization due to recurrence of the upper GI bleeding. She was referred for a BRTO procedure due to continual upper GI bleeding even after multiple variceal ligations, splenic and gastroduodenal artery embolization, and persistence of multiple gastric varices on both upper GI endoscopy and CT imaging (). Laboratory data before the BRTO procedure was creatinine, 0.6 mg/dL; bilirubin, 4.4 mg/dL; AST, 92 units/L; ALT, 59 units/L; albumin, 2.2 g/dL; and PT/INR, 19.1 sec/1.58.\nThe same BRTO technique that was described for the first case was used. A balloon occluded retrograde venogram showed filling of the gastric varices and multiple collateral veins including the inferior phrenic vein (). Two collateral veins including the inferior phrenic vein were catheterized with a 2.7 Fr microcatheter (Progreat; Terumo Medical, Elkton, MD, USA) and embolized with multiple 6 mm and 4 mm microcoils (Nester coil; Cook Inc., Bloomington, IN, USA). A Gelfoam slurry was used to embolize multiple small collateral veins before administering the sclerosant. The sclerosant was administered with the occlusion balloon inflated, and the varices were filled under fluoroscopic guidance over 40 minutes. Six mL of 3% sodium tetradecol sulfate was used as the sclerosant (Sotradecol; AngioDynamics) mixed with 3 mL lipiodol (Ethiodol; Savage Laboratories) and 9 mL of air. A spot image after embolization showed shrunken gastric varices with lipiodol uptake (). The balloon occlusion catheter was left in place overnight through the guiding catheter. The patient was monitored in the intensive care unit to assess the therapeutic response as well as delayed complications. A complete blood count and hepatic function panel were obtained to assess the therapeutic response the following morning. The sheath and catheters were removed the following morning after checking lipiodol uptake on plain abdominal radiography.\nThe patient's upper GI bleeding cleared within a few days after the procedure, and she was discharged. Follow-up upper endoscopy 65 days post procedure showed normal gastric mucosa. Additionally, follow-up CT scans at 6 months post BRTO procedure showed complete obliteration of gastric varices (). However due to underlying necrotizing pancreatitis with multiple enterocutaneous fistulas and abdominal wounds, she expired 8 months post procedure due to complicated sepsis.
|
[[51.0, 'year']]
|
F
|
{'15872320': 1, '20684965': 1, '31040991': 1, '12407350': 1, '22942552': 1, '28246514': 1, '23322829': 1, '15383850': 1, '25808874': 1, '9707073': 1, '22081920': 1, '7575812': 1, '21106386': 1, '20932597': 1, '12845306': 1, '20308910': 1, '16964806': 1, '24497799': 2}
|
{'3909841-1': 2}
|
165,578 |
3909845-1
| 24,497,802 |
noncomm/PMC003xxxxxx/PMC3909845.xml
|
Imaging Findings Of Desmoplastic Fibroma Rarely Involving The Clavicle: Case Report
|
A 28-year-old man, with a history of sudden right shoulder pain during forceful flexion of his upper arm visited our hospital complaining of tenderness, resting pain, and limitation of range of motion due to pain. Initial work-up with plain radiograph demonstrated an oval shaped osteolytic lesion on the medial one-third of the right clavicle with pathologic fracture (). Further evaluation with MRI was done after 10 days (). The lesion showed hypointense to isointense signal compared to its adjacent muscle on T1-weighted images, and hypointense to isointense signal on T2-weighted images. After intravenous gadolinium contrast administration, the lesion presented heterogeneous enhancement. The mass showed a expansile bulging contour with endosteal erosion and periosteal reaction with enhancement. The aggressiveness of the tumor could not be evaluated easily due to the combined fracture. Our initial impression was benign primary bone tumor with low aggressiveness rather than malignant tumor. However, the patient was lost to follow up. Two years later, he came back to our hospital due to pain. Excisional biopsy was done. Histologically, the tumor was generally hypocellular to moderately cellular and composed of bland fibroblasts in a background of numerous thick and wavy collagen fibers. Thin spicules of residual trabecular bone with reactive changes were presented within the tumor. Multiple sections of the tumor presented no evidence of cellular pleomorphism, changes in the nuclear cytoplasmic ratio, nuclear hyperchromasia, or mitotic activity. Despite its bland appearance, the tumor showed multifocal soft tissue extension (). These findings resembled those of soft tissue desmoids. Thus, the tumor was diagnosed as a desmoplastic fibroma of bone, which is considered as an intraosseous counterpart of soft tissue desmoids. Finally, a wide resection including the lesion and adjacent tissues was done with an allogenous fibular bone graft and an autogenous corticocancellous iliac bone graft.
|
[[28.0, 'year']]
|
M
|
{'3997926': 1, '10794556': 1, '25113037': 1, '13556467': 1, '2772196': 1, '34077396': 2, '1913545': 1, '8059254': 1, '26379329': 1, '3062792': 1, '15908527': 1, '8780539': 1, '24497802': 2}
|
{'8174550-1': 1}
|
165,579 |
3909846-1
| 24,497,803 |
noncomm/PMC003xxxxxx/PMC3909846.xml
|
Calcifying Aponeurotic Fibroma: Case Report with Radiographic and MR Features
|
A 67-year-old healthy man presented with a 20-year history of a painless, slow growing mass in the dorsum of his right wrist. Physical examinations showed a firm, non-tender, palpable mass, measuring 1.5-cm, and overlying the carpal bones in the dorsum of his wrist. Radiographs demonstrated a relatively ill-defined soft tissue mass with speckled calcifications on the dorsal ulnar aspect of the wrist. Cortical scalloping of the underlying carpal bones was demonstrated (). MRI showed an ill-defined rounded subcutaneous soft tissue mass partially encasing the tendons of the extensor carpi ulnaris (ECU) and the extensor digiti minimi (EDM) on the dorsum of the wrist. MRI revealed low to intermediate signal intensity on the T1-weighted image (T1WI) and heterogeneous mixtures of low and high signal intensity on the T2-weighted image (T2WI). The mass showed heterogeneous intense contrast enhancement after intravenous gadolinium administration. The lesion had a poorly demarcated margin and was associated with edema like signal changes in the adjacent soft tissues on MR images (). In view of the radiographic and MR findings, the preoperative differential diagnosis included soft tissue chondroma, bizarre paraosteal osteochondromatous proliferation (BPOP), giant cell tumor (GCT) of the tendon sheath, fibroma of the tendon sheath, nodular fasciitis and a small sized synovial sarcoma. The mass was excised and was revealed to be an off-white colored, firm lesion. The mass adhered to and involved the tendon sheaths of ECU and EDM, the adjacent extensor retinaculum, and the wrist joint capsule with the intracapsular extension. The triquetral and hamate cortical bone erosions were seen. However, the mass could be excised without any resection of the bones or tendons. Microscopically, an ill-defined tumor mass showed multifocal calcifications surrounded by dense fibrous stroma. The fibrous stroma revealed mixed cellular areas near the calcification and lesser cellular fibromatosis-like areas in the background. Multilayers of fibroblasts with small round nuclei, histiocytes and multinucleated giant cells in the cellular areas were adjacent to the calcification. Lesser cellular and densely collagenous areas showed early chondoid metaplasia-like cellular changes such as small round nuclei and perinucler clear spaces in the hyalinized stroma. There were neither cellular atypism nor mitosis in the fibroblasts (). A pathologic diagnosis of calcifying aponeurotic fibroma was made.
|
[[67.0, 'year']]
|
M
|
{'5483662': 1, '19266204': 1, '34260526': 2, '27236326': 1, '20680624': 1, '28828138': 1, '3760506': 1, '31297550': 1, '29243144': 1, '9865839': 1, '30728691': 1, '14689252': 1, '19926768': 1, '25901261': 2, '13032926': 1, '24497803': 2}
|
{'8284703-1': 1, '8284703-2': 1, '8284703-3': 1, '4393499-1': 1}
|
165,580 |
3909847-1
| 24,497,804 |
noncomm/PMC003xxxxxx/PMC3909847.xml
|
Growing Heterotopic Calcification in the Prevertebral Space of a Cervical Spine as a Late Complication of Irradiation: Case Report
|
A 74-year-old female with rheumatoid arthritis was admitted to the department of orthopedic surgery with pyogenic arthritis in her right elbow. She had a history of chemotherapy and radiotherapy due to tonsil cancer 21 years ago. She was referred for an otolaryngologic consultation due to chronic neck pain and swallowing difficulty on hospital day 7. The patient's complete blood cell count showed leukocytosis of 14.4 × 103/mm3 (normal range, 4.0-10.0 × 103/mm3) on admission, which decreased gradually and normalized at the time of the otolaryngologic consultation. Her C-reactive protein level was 16.9 mg/dL (normal range, 0-0.3 mg/dL) on initial examination and had fallen to 5.0 and 2.0 mg/dL on a follow up study performed on hospital days 5 and 8, respectively. No clinical or laboratory evidence of chronic renal failure or hypercalcemia was detected. She had no history of cervical spine trauma or infection. No cervical motion limitation was observed on a physical examination. Pharyngo-laryngoscopic findings were also unremarkable.\nA neck computed tomography (CT) scan revealed symmetric fatty atrophy of both the parotid and submandibular glands that seemed to be associated with the previous radiation therapy. Soft tissue swelling in the pharyngeal mucosal space, the retropharyngeal space, and the prevertebral space was observed with obliteration of the parapharyngeal space and fat planes around the carotid sheath. These findings suggested chronic radiation changes with fibrosis. The radiation changes were most prominent at the C2 and C3 levels, so these areas were thought to be included in the radiation field. The chronic neck pain and swallowing difficulty seemed to be due to radiation-induced changes in the pharyngeal mucosa and radiation-induced sialoadenitis. No evidence of tonsil cancer recurrence was detected.\nHowever, prevertebral soft tissue calcification was observed with a curvilinear configuration at the level of C2 and C3 (). The calcification was about 1.4 × 0.6 × 2.1 cm in size. It was irregularly shaped and partly fragmented. Prevertebral soft tissue thickening was noted at the C2 and C3 level (at C2: 9.1 mm; at C3: 8.2 mm). Additional prevertebral calcification was found at the C3-4 and C6-7 intervertebral disc levels, and they were thought to be associated with degenerative changes in the intervertebral discs (). The C2 and C3 bodies and posterior elements showed osteopenia and coarsening of trabeculae. suggesting radiation osteitis or osteoradionecrosis. Mild degenerative changes were observed in the lower cervical spine. No significant findings suggesting atlantoaxial involvement of rheumatoid arthritis were found.\nA neck CT scan obtained 7 years ago demonstrated calcification at the same site (). The calcification was about 0.9 × 0.5 × 1.5 cm in size and was ovoid-shaped and smooth-margined. The retropharyngeal and prevertebral soft tissue swelling was slightly more prominent compared with that of the later study. Findings of C2 and C3 osteoradionecrosis were not significant 7 years ago.\nFollow-up C-spine lateral radiography after 1 year showed no change in size or configuration of the calcification (). Although not histopathologically confirmed, the lesions were thought to be benign because they grew slowly and remained unchanged for at least 1 year. Based on the clinical course and association with previous radiation therapy, the diagnosis was heterotopic calcification in the prevertebral space as a late complication of radiation therapy.
|
[[74.0, 'year']]
|
F
|
{'16189311': 1, '32117050': 2, '8888390': 1, '11932224': 1, '22011827': 1, '12036841': 1, '5350664': 1, '21410128': 1, '22974213': 1, '21852912': 2, '3792067': 1, '18752059': 1, '24497804': 2}
|
{'3150679-1': 1, '7028822-1': 1}
|
165,581 |
3909849-1
| 24,497,806 |
noncomm/PMC003xxxxxx/PMC3909849.xml
|
Infratentorial and Intraparenchymal Subependymoma in the Cerebellum: Case Report
|
A 28-year-old man was referred to our institution for a brain tumor that was detected on brain computed tomography (CT) performed at an outside hospital for intermittent headache. He had other non-neurologic symptoms, other than intermittent headache, for the past 1 year. The patient was previously healthy with unremarkable past medical history. A neurological examination revealed no abnormal features, and initial lab findings were normal. Pre-contrast CT revealed a well-defined cystic and solid intraaxial mass with internal calcifications in the cerebellum, which measured 4.3 × 3.5 cm (). Magnetic resonance image (MRI) revealed a mural nodule within the cystic mass. The mural nodule showed iso-to-hypointensity (relative to normal white matter) with multiple nodular high-signal intensities, suggesting calcifications on the T1-weighted image and hyper intensity on the T2-weighted image (). There was no evidence of peritumoral edema around the mass and no enhancement of the mural nodule or cyst wall on the gadolinium-enhanced T1-weighted image. Diffusion-weighted image showed iso- or low-signal intensity without diffusion restriction while the same lesion was increased ADC relative to brain parenchyma (). The mass was located near and displaced the fourth ventricle; however, it did not communicate with the ventricle, and normal parenchyma was clearly identified between the mass and the fourth ventricle on the thin-section three-dimensional T1-weighted images (). Cerebral angiograms demonstrated a rather hypovascular mass; neither feeding vessels nor tumor staining was visualized (). The patient underwent suboccipital craniotomy. The cerebellum showed mild bulging, and a yellowish-colored mass was identified via a supracerebellar approach. During the dissection of the mass from the cerebellum, fluid gushed out from patchy gray mass, which was composed of a gelatinous material. Within the surgical field, there was a sharp demarcation between the mass and the surrounding normal tissue, and there was no evidence that the mass was connected with the fourth ventricle.\nHistopathological analysis revealed a clustered cellular neoplastic proliferation with islands of high nuclear density and dense and abundant fibrillary matrices. The tumor cell nuclei were round and isomorphic, but active mitosis was not observed (). Occasional vascular pseudorosettes and calcifications were also seen. There was no evidence of atypia, vascular endothelial proliferation or necrosis. Immunohistochemical analyses were positive for glial fibrillary acidic protein and epithelial membrane antigen and negative for Ki-67, which supported the diagnosis of subependymoma.\nThe postoperative follow-up MRI revealed a total removal of the tumor resection; the normal cerebellar tissue remained well between the fourth ventricle and the postoperative parenchymal defect. This observation supports our hypothesis that the tumor did not contact the fourth ventricle. The patient was discharged without neurologic sequelae 10 days after surgery.
|
[[28.0, 'year']]
|
M
|
{'33948324': 2, '16639322': 1, '32803310': 1, '15861411': 1, '2746271': 1, '22891004': 1, '7572512': 1, '7622676': 1, '34725697': 1, '17569000': 1, '32047339': 1, '2929389': 1, '712391': 1, '2107685': 1, '10926103': 1, '24497806': 2}
|
{'8088500-1': 1}
|
165,582 |
3909850-1
| 24,497,807 |
noncomm/PMC003xxxxxx/PMC3909850.xml
|
Hyperostotic Esthesioneuroblastoma: Rare Variant and Fibrous Dysplasia Mimicker
|
A 65-year-old male initially presented at another institution with mild visual disturbances, loss of taste, and proptosis. CT imaging was suggestive of fibrous dysplasia. No treatment was administered at that time. Serial imaging performed over three years showed slow progression of the lesion? with no significant clinical deterioration. The patient was subsequently referred to our institution. CT, MRI and FDG-PET imaging were performed. CT () showed expansile, diffuse hyperostosis of the ethmoid bones, nasal septum, superomedial orbital walls and anterior frontal skull base. There was an extensive intracranial and extracranial enhancing soft tissue thickening along the hyperostotic bones. MRI () showed hypointense T1 and T2 signals of the bone marrow that corresponded to the hyperostotic bones on CT, with moderate diffuse enhancement. The rind of soft tissue mass along the hyperostotic bones showed hypointense to isointense T1 and T2 signals and diffuse enhancement. Intracranial rim enhancing small cysts were observed at the tumor-brain interface. Multi-focal extracranial mucoceles were also identified. FDG-PET () showed a corresponding diffuse hypermetabolic uptake in the soft tissues and bones. Endoscopic biopsies of the mass and bone confirmed the diagnosis of ONB with osseous tumor infiltration (). The patient opted for non-surgical treatment and expired in about 2 years.
|
[[65.0, 'year']]
|
M
|
{'16468421': 1, '11904342': 1, '9252701': 1, '9921927': 1, '2779776': 1, '18359353': 1, '9569435': 1, '7976934': 1, '22571851': 1, '19568473': 2, '8073990': 1, '16615428': 1, '3335673': 1, '2810830': 1, '10542931': 1, '17977259': 1, '8377924': 1, '19517391': 1, '24497807': 2}
|
{'2702054-1': 1}
|
165,583 |
3909852-1
| 24,497,809 |
noncomm/PMC003xxxxxx/PMC3909852.xml
|
Von Hippel-Lindau Syndrome: Demonstration of Entire Disease Spectrum with 68Ga-DOTANOC PET-CT
|
A 52-year-old lady remove was presented with an abdominal lump of 6-month in duration. She gave history of left eye surgery five years back, following an episode of sudden onset loss of vision. Since then, she had loss of vision in the left eye. There were no other CNS symptoms. She also gave history of similar eye surgery in her younger son (age-28 years), following a similar episode of unilateral loss of vision. On examination, she was not hypertensive. She had no perception of light in the left eye, while the right eye visual acuity was normal. Because of the presence of secondary cataract in the left eye, her posterior chamber could not be evaluated. There were no cerebellar signs. Abdominal examination revealed a large lump in the right upper and lower quadrant. Complete hemogram, renal function tests and liver function tests were normal.\nContrast enhanced CT of the abdomen revealed a hypervascular mass (7.8 × 5.8 × 5.1 cm), arising from the interpolar region of the left kidney with multiple feeding vessels arising from the left renal artery and supplying the mass (). The findings were suspicious for RCC. Multiple cortical cysts were also seen in both kidneys. Another large (9.6 × 7.4 × 5.4 cm) hypervascular mass lesion was seen in the body and tail of the pancreas, which was suspicious for metastasis from RCC (). Bilateral adrenals were normal. Because of the hypervascular nature of pancreatic mass biopsy was not attempted.\nSubsequently, SSTR PET-CT was done with 68Ga-DOTANOC to characterize the pancreatic mass. PET-CT revealed intense 68Ga-DOTANOC uptake (maximum standardised uptake value [SUVmax] = 18.6) in the pancreatic mass, characterizing it as a NET (). It also demonstrated a solitary liver metastasis (segment III) with intense 68Ga-DOTANOC uptake (SUVmax = 13.2), confirming it to arising from pancreatic NET (). The left renal mass showed only a mild 68Ga-DOTANOC uptake (SUVmax = 3.1) (). Interestingly, a hypodense lesion was seen in the left cerebellum, showing increased 68Ga-DOTANOC uptake (SUVmax = 9.9) (). Another focus of 68Ga-DOTANOC uptake was seen in a lateral part of the left globe (SUVmax = 8.3) corresponding to a heterogeneous lesion seen on CT ().\nGadolinium enhanced magnetic resonance imaging (MRI) of the brain was done to characterise the CNS lesions seen on 68Ga-DOTANOC PET-CT. It showed a nodular lesion (2 × 2 cm) in the lateral half of the left cerebellar hemisphere with intense post contrast enhancement (). An eccentric nodule was also noted in the lateral part of the left globe with intense post contrast enhancement (). MRI findings were consistent with hemangioblastoma of the left retina and cerebellum. Imaging findings confirmed the diagnosis of VHL syndrome. Therefore, serum and urinary catecholamines levels were done for screening of pheochromocytoma and paraganglioma, and were found to be normal. Fine needle aspiration cytology from the liver lesion confirmed the diagnosis of metastatic NET. The patient is now being worked up for palliative radionuclide therapy with 177Lu-DOTATATE.
|
[[52.0, 'year']]
|
F
|
{'27130508': 1, '1895313': 1, '1394233': 1, '12814730': 1, '15081659': 1, '21971823': 1, '8620515': 1, '28094316': 1, '21386872': 1, '28291009': 2, '18358680': 1, '26268347': 2, '21157217': 1, '21750886': 1, '24497809': 2}
|
{'5350504-1': 1, '5350504-2': 1, '5350504-3': 1, '4535675-1': 1}
|
165,584 |
3909853-1
| 24,497,810 |
noncomm/PMC003xxxxxx/PMC3909853.xml
|
Spontaneous Intramural Full-Length Dissection of Esophagus Treated with Surgical Intervention: Multidetector CT Diagnosis with Multiplanar Reformations and Virtual Endoscopic Display
|
A 54-year-old man was admitted to our hospital with a several-day history of chest pain and swallowing difficulty. The chest pain had commenced after he drank alcohol. Endoscopy performed at another hospital just prior to admission revealed a laceration in the thoracic esophageal mucosa (). The patient had been diagnosed with diabetes mellitus 10 years previously.\nUpon admission, chest CT was performed under the impression of esophageal perforation to assess the underlying esophageal causes and mediastinal complications. Axial, coronal, and sagittal images revealed the esophageal double lumen and the absence of free air in the mediastinum (). Curved multiplanar reconstruction images showed the full extent of false lumen with two tears on mucosal flap at cervical and mid-thoracic esophagus in a single image plane (). 3D volume rendering images demonstrated tears on the mucosal flap between the distended false and collapsed true lumen (). Virtual CT endoscopic () views from the same CT dataset also depicted an elliptically shaped laceration on the dissection flap and an air-distended false lumen extending from the cervical to the distal esophagus, comparable to what was seen on the fiberoptic endoscopic view.\nEven though he experienced dysphagia and chest pain, the patient had not ceased to eat and drink prior to admission, and consequently developed signs of infection (high fever and an elevated blood white blood cell count) that were apparent on admission. Since the clinical and imaging findings supported a diagnosis of a complicated IED with infection, dissected segment was surgically excised () and an esophagogastric anastomosis was constructed. Abundant pus and food material were found in the distal blind end of the false lumen of the surgical specimen. The presence of cervical and mid-thoracic mucosal tears was also confirmed upon specimen examination.
|
[[54.0, 'year']]
|
M
|
{'26493809': 1, '11315903': 1, '18641013': 1, '16775691': 1, '21904510': 1, '18936020': 1, '16322952': 1, '15100114': 1, '30363664': 1, '5676956': 1, '24497810': 2}
|
{}
|
165,585 |
3909862-1
| 24,497,792 |
noncomm/PMC003xxxxxx/PMC3909862.xml
|
Monosegmental Hepatobiliary Fibropolycystic Disease Mimicking a Mass: Report of Three Cases
|
A 44-year-old woman presented with mild upper abdominal pain and a lobulated mass in the left lobe of the liver. This patient had undergone abdominal computed tomography (CT) scan for similar pain at a local hospital 4 years previously, and a hepatic mass had been detected. The laboratory tests showed no abnormal findings and physical examination was normal. The evidence of polycystic kidney or liver disease was absent. There was no family history of polycystic kidney or liver disease. On the present admission, ultrasound showed an ill-defined, isoechoic mass, with internal cystic components in the lateral segment of the liver (). A three-phase abdominal CT scan showed an irregularly-marginated multicystic mass with tubular components, and with no contrast enhancement (). The remaining liver was normal. This mass did not show a change in the size or contour as compared with that observed 4 years previously. Laparoscopic left lateral segmentectomy was performed. The cut surface of the hepatic left lobe showed aggregates of numerous small and large biliary cysts (). Microscopically, the left hepatic mass showed numerous dilated intrahepatic bile ducts with irregular contours, infoldings, and protrusions, surrounded by thick fibrous tissue, which are known features of ductal plate malformation. There were ductal plate malformations of numerous dilated biliary cysts (). Immunohistochemical stains for CD10 (), CK7 (), and MUC1 () showed positive reactions in the lining (epithelial cells) of dilated cysts, as well as proliferative bile ductules.
|
[[44.0, 'year']]
|
F
|
{'19083218': 1, '12239064': 1, '1398487': 1, '15888616': 1, '3958471': 1, '25053917': 1, '20518892': 1, '21840516': 1, '2294544': 1, '20512666': 1, '19182506': 1, '33995794': 2, '24497792': 2}
|
{'3909862-2': 2, '3909862-3': 2, '8106784-1': 1, '8106784-2': 1}
|
165,586 |
3909862-2
| 24,497,792 |
noncomm/PMC003xxxxxx/PMC3909862.xml
|
Monosegmental Hepatobiliary Fibropolycystic Disease Mimicking a Mass: Report of Three Cases
|
A 46-year-old man presented with incidentally discovered hepatic mass in the right lobe of the liver. The laboratory tests showed no abnormal findings, and physical examination was normal. The evidence of polycystic kidney or liver disease was absent. No family history of polycystic kidney or liver disease was recognized. A three-phase abdominal CT scan showed an ill-defined mass composed of numerous cysts and tubular lesions in segment VI of the liver (). Magnetic resonance (MR) images showed a cystic mass with very high T2 and low T1 signal intensities (). Post-contrast MR images showed no contrast enhancement of this mass (). The remaining liver was normal. Percutaneous biopsy was performed. Microscopic findings of the needle biopsy specimen showed several, irregular-shaped, dilated intrahepatic bile ducts, lined by the cuboidal biliary epithelial cells (). There were also ductal plate malformation and numerous inflammatory cells in a background of fibrous tissue. Immunohistochemical stains for CD10 (), CK7 (), and MUC1 () showed positive reactions in the lining (epithelial cells) of dilated cysts, as well as proliferative bile ductules. Follow-up imaging 18 months later showed no interval change of this cystic mass.
|
[[46.0, 'year']]
|
M
|
{'19083218': 1, '12239064': 1, '1398487': 1, '15888616': 1, '3958471': 1, '25053917': 1, '20518892': 1, '21840516': 1, '2294544': 1, '20512666': 1, '19182506': 1, '33995794': 2, '24497792': 2}
|
{'3909862-1': 2, '3909862-3': 2, '8106784-1': 1, '8106784-2': 1}
|
165,587 |
3909862-3
| 24,497,792 |
noncomm/PMC003xxxxxx/PMC3909862.xml
|
Monosegmental Hepatobiliary Fibropolycystic Disease Mimicking a Mass: Report of Three Cases
|
A 50-year-old man presented with incidentally discovered hepatic mass in the right lobe of the liver, during evaluation of sigmoid colon cancer. The laboratory tests showed no abnormal findings, and physical examination was normal. The evidence of polycystic kidney or liver disease was absent. No family history of polycystic kidney or liver disease was recognized. Ultrasound showed an ill-defined echogenic mass with multiple varying-sized cystic components in the right lobe of the liver (). A three-phase abdominal CT scan showed an irregularly-marginated mass with tubular components but with no contrast enhancement (). MR imaging showed a cystic mass with very high T2 signal intensities (). Post-contrast MR image showed a cystic mass with no contrast enhancement (). 3 dimensional magnetic resonance cholangiopancreatography (MRCP) showed a cystic mass with tubular and cystic components (). The remaining liver was normal. Anterior resection of sigmoid colon cancer was performed, and TNM staging according to the American Joint Committee on Cancer was a stage II lesion (T2N0M0). A follow-up imaging study 18 months later showed no interval change of this cystic mass.
|
[[50.0, 'year']]
|
M
|
{'19083218': 1, '12239064': 1, '1398487': 1, '15888616': 1, '3958471': 1, '25053917': 1, '20518892': 1, '21840516': 1, '2294544': 1, '20512666': 1, '19182506': 1, '33995794': 2, '24497792': 2}
|
{'3909862-1': 2, '3909862-2': 2, '8106784-1': 1, '8106784-2': 1}
|
165,588 |
3909863-1
| 24,497,793 |
noncomm/PMC003xxxxxx/PMC3909863.xml
|
Malignant Glomus Tumor of the Peritoneum: Case Report
|
A screening gynecological exam was performed in a 47-year-old woman. The bimanual pelvic exam revealed the presence of bilateral parauterine masses. These masses were partially mobile and poorly demarcated. Transvaginal ultrasound showed a right parauterine mass of 11.9 × 4.7 cm and a left one of 13.2 × 7.9 cm. The masses were heterogeneous with irregular margins and were barely vascularized, which encompassed the left ovary and fallopian tubes. No free liquid was observed. A double phase contrast-enhanced multidetector computed tomography (CT) scan was performed with the intravenous injection of 120 mL non-ionic contrast medium at flow rate of 4 mL/sec. The CT exam, which included a late arterial phase of the thorax and abdomen followed by a portal phase of the abdomen and pelvis, revealed a poorly defined mass occupying the inframesocolic peritoneal space and both paracolic gutters. This mass showed extensive low-density areas (with CT density values around 25 Hounsfield units [HU]) with interspersed foci of higher attenuation (approximately 50 HU) and some small calcifications (). The CT examination did not reveal any significant changes in tumor density between both phases of the acquisition. Laboratory tests evidenced high levels of CA125 antigen. An exploratory laparotomy was performed. Intraoperative findings demonstrated a poor-defined abdominopelvic soft tissue mass with extensive areas of necrosis attached to the parietal peritoneum, the visceral peritoneum of the uterine fundus, terminal ileum loops and umbilicus. The remainder of the abdominal cavity including the gastrointestinal tract and ovaries was normal. Macroscopically, the resected specimen was a large peritoneal tumor measuring 45 × 30 cm in diameter, with a smooth surface, shiny, very congestive and hemorrhagic. After cutting, heterogeneous brittle and frayed hemorrhagic areas were identified without a definite pattern. Microscopically, the mass had abundant capillary-sized vessels, which had small round to dilated endothelium-line lumina surrounded by uniform sheet-like epitheloid tumor cells. Immunohistochemically, vimentin, (alpha)-smooth muscle actin, HHF-35 actin and collagen IV were stained intensely (). Tumor cells were negative for desmin, CD31, CD34, cytokeratin AE1/AE3, melan-A and HMB 45. Finally, the pathologic diagnosis was peritoneal GMS. One year later, the patient remains asymptomatic without radiologic evidence of tumoral recurrence.
|
[[47.0, 'year']]
|
F
|
{'10935651': 1, '10193335': 1, '11441554': 1, '17883128': 1, '9298887': 1, '18349460': 1, '1661115': 1, '17633048': 1, '11553174': 1, '11355180': 1, '12096860': 1, '18492684': 1, '21071379': 1, '19325052': 1, '7503361': 1, '16226974': 1, '11145243': 1, '18590843': 1, '18716115': 1, '18521375': 1, '18376775': 1, '24497793': 2}
|
{}
|
165,589 |
3909864-1
| 24,497,794 |
noncomm/PMC003xxxxxx/PMC3909864.xml
|
Small Bowel Obstruction Caused by Peritoneal Immunoglobulin G4-Related Disease Mimicking Carcinomatosis: Case Report
|
A 57-year-old female presented with a several-year history of unexplained dyspeptic symptoms. Numerous vague causes were suggested including oesophagitis due to a small hiatal hernia and treated with lansoprazole and dysfunction of the sphincter of Oddi on the basis of a hepato-biliary scintigraphy (data not shown).\nDuring the past year, the patient had experienced three acute episodes characterized by hypogastric colic pain followed colickly pain followed by alimentary-but occasionaly fecaloid-vomiting. These episodes lasted for about 24 to 48 hours and ended by diarrheal debacle. During the last episode, the patient was admitted to the emergency room after the ending diarrheal debacle. Laboratory tests and abdominal plain film were normal at this time. A new episode of abdominal pain compelled the patient to get readmitted to the emergency room. The pain was increasing for a period of 24 hours. The patient remained apyretic. On physical examination, the abdomen was distended. On palpation, there was diffuse tenderness especially in the right iliac fossa. Auscultation revealed a metallic sound. Laboratory test results indicated a mild inflammation with a CRP level of 5.84 mg/L (normal value: < 5 mg/L) and a white blood cell count of 16200 units.\nContrast-enhanced abdominal multidetector-row computed tomography () revealed a subocclusive intestinal syndrome. The middle and distal small bowel loops were distended along with the presence of hydroaeric levels. The transitional level was found within the pelvic area, and the origin seemed to be related to diffuse peritoneal carcinomatosis including pelvic masses and nodules diffusely covering and encasing the gynecological structures, the terminal ileum and the pelvic folds. A small amount of ascites was present. Numerous smaller nodules were scattered in the hypogastrium and in both iliac fossae. Some nodules were partially calcified and moderately enhanced on delayed contrast-enhanced CT scan. A possible ovarian origin was considered. The option of an emergency surgery was chosen to treat the subocclusive intestinal syndrome. An extensive surgical procedure was performed at one time including total radical hysterectomy, debulking, omentectomy, and resection of the ileo-cecal junction with resection of more than 30 centimeters of the terminal ileum.\nGross anatomy () showed numerous whitish nodules which extensively covered and invaded the gynecologic structures, the wall of the ileum and the mesenteric fat tissue. The pattern of invasion was that of diffuse carcinomatosis. On sections, some of these nodules were found to deeply penetrate the entire bowel wall from the serosa to the mucosa ().\nMicroscopically (), these nodules showed areas of dense storiform fibrosis separated by areas of dense lymphoplasmacytic inflammatory infiltrate containing numerous normal plasma cells. Typical mild to moderate eosinophilia, germinal center formation and obliterative phlebitis were also detected. IgG4 immunostaining showed numerous IgG4-positive plasma cells.\nThe final diagnosis was IgG4-RD with a predominant but a very unusual peritoneal involvement. The serum IgG4 level was not assessed in the preoperative period, but it was found to be normal in the postoperative and follow-up periods.\nThe patient was treated by methylprednisolone with an initial dose of 32 mg per day. This dose was reduced in a stepwise manner to 12 mg per day. Due to persistent small peritoneal nodules in the right iliac fossa and in the pouch of Douglas after six months (data not shown), azathioprine at a dose of 100 mg daily was added. Concomitantly, the dose of methylprednisolone was gradually lowered to 2 mg per day. At one year of evolution, the remaining small nodules were stable (data not shown).
|
[[57.0, 'year']]
|
F
|
{'18682417': 1, '29222587': 1, '22693517': 1, '14614606': 1, '11236777': 1, '33088547': 1, '29417330': 1, '32552502': 1, '34544364': 2, '22504255': 1, '21918050': 1, '26798227': 2, '23118580': 2, '22736240': 1, '22187229': 1, '26798216': 2, '23089913': 1, '22449233': 1, '21881964': 1, '23255748': 1, '21803920': 1, '24497794': 2}
|
{'4720812-1': 1, '4720802-1': 1, '3484302-1': 1, '8454001-1': 1}
|
165,590 |
3910308-1
| 24,524,069 |
noncomm/PMC003xxxxxx/PMC3910308.xml
|
Medial Malleolar Insufficiency Fracture of the Ankle in an Elderly Patient with Osteoporosis
|
A 65-year-old female patient presented with left ankle pain of 2 months' duration. There was no history of trauma or bisphosphonate use for osteoporosis and the pain was activity-related and relieved partially by rest or elevation. In the past medical history, no special diseases such as diabetes, hypertension, and cerebrovascular diseases were present and she was a non-smoker and a non-drinker. The physical examination showed mild localized tenderness in the medial aspect of the ankle and no swelling. The range of motion of the ankle was full, and stability was intact. She was 157 cm in height, had a body weight of 58 kg, and her body mass index was 23.5 kg/m2. The bone mineral density (BMD) was measured utilizing peripheral quantitative computed tomography (P-QCT; Somatom sensation 16, Simens, Erlangen, Germany). On assessment of the results, severe osteoporosis was considered because the BMD and T-score of the lumbar vertebrae (L1-4) were 40.4 mg/cm3 and -4.31 (). At the time of visiting, a plain radiograph of the left ankle showed a fracture that was not clearly depicted but showed as a faint vertical sclerotic line in the medial malleolus of the ankle joint (). She was treated with restriction of activity and non steroidal anti-inflammatory drugs (NSAIDs). After 3 weeks of treatment, she still had pain in the left ankle. Magnetic resonance imaging (MRI) was performed. The MRI of the left ankle revealed an irregular vertical low signal line with surrounding marrow edema at the junction of the medial malleolus and the tibial plafond which did not extend to the medial malleolar cortex of the tibia (). We diagnosed a medial malleolar insufficiency fracture of the ankle.\nAn operation was performed because of progressive pain and difficulty of ambulation during the follow-up, leading to early recovery and normal activities. The patient was placed in the supine position under spinal anesthesia. The fracture was internally fixated with a percutaneous cannulated screw under c-arm guidance () and at the same time an arthroscopic procedure was performed. The arthroscopic examination revealed no displacement of the medial fracture line within the joint but synovitis was observed. Arthroscopic debridement was performed. After surgery, she was kept in a non-weight bearing cast for 5 weeks. At the fifth week, she was allowed to perform ankle range of motion exercises and partial weight-bearing walking. As of the 4-month follow-up, there was bony union and she had recovered to full activity with the treatment including osteoporosis medications (). The patient was informed of this report.
|
[[65.0, 'year']]
|
F
|
{'15187856': 1, '31293713': 1, '23238501': 1, '23138969': 1, '1632335': 1, '9578100': 1, '19340388': 1, '20953931': 1, '18334027': 2, '18806133': 1, '14102934': 1, '21644194': 1, '23333055': 1, '24524069': 2}
|
{'2276224-1': 1}
|
165,591 |
3910313-1
| 24,524,067 |
noncomm/PMC003xxxxxx/PMC3910313.xml
|
A Case of Teriparatide on Pregnancy-Induced Osteoporosis
|
Patient: A 39-year-old woman\nChief complaint: Low back pain\nCurrent medical history: A woman began to have low back pain at 2 months after vaginal birth. She had no significant past medical history. Her low back pain exacerbated at 3 months after delivery. Magnetic resonance imaging (MRI), provided by the previous hospital, revealed multiple compression fractures (L1-L5) on her lumbar vertebrae. On admission, the patient was breastfeeding after her first birth.\nFamily history: Her father had lung cancer.\nPast history: The patient had sympathectomy due to hyperhidrosis. However, she had no history of other drug.\nPhysical findings: On physical examination, her blood pressure was 110/70 mmHg and her pulse was 72/minute. Height was 156 cm, weight was 50 kg, and body mass index was 20.5 kg/m2. No lump felt in thyroid gland. Neither abdominal tenderness nor hepatosplenomegaly was detected. Tenderness was present on lower back.\nLaboratory findings: Peripheral blood examination revealed white blood cells 7,660/µL, hemoglobin 13.4 g/dL, platelet 218,000/µL, aspartate aminotransferase (AST)/alanine aminotransferase (ALT) 19/24 IU/L, blood urea nitrogen (BUN) 18.0 mg/dL, creatinine 0.76 mg/dL, calcium 9.7 mg/dL (8.2-10.4) , and phosphorus 4.2 mg/dL (1.9-4.4). Thyroid stimulating hormone (TSH) was 1.73 µIU/mL (0.35-5.58) and free thyroxine was 1.49 ng/dL (0.89-1.76). Luteinizing hormone was 0.8 mIU/mL (0.1-6.0), estrogen was 51.23 pg/mL (150-350), estradiol was 34.85 pg/mL (22-250), 24-hour urine cortisol was 26.51 µg/day (10-121), and urinary calcium was 259 mg/day (100-300). Parathyroid hormone (PTH) was 10.6 pg/mL (14-72), serum 25-hydroxy-vitamin D was 28.80 ng/mL (30-100), serum alkaline phosphatase was 332 IU/L (104-280), osteocalcin was 30.46 ng/mL (11-30), and cross-linked C-terminal telopeptide of type I collagen (CTX) was 1.15 ng/mL (0.01-0.60).\nRadiologic examination: Lateral view of lumbar vertebrae detected a loss of vertebral height in L1-L5 (). MRI exhibited multiple compression fractures in the same lumbar region (). Bone scan revealed increased uptake in left 6-8th ribs and L1-L5 (). On dual energy X-ray absorptiometry (DXA), L1-L4 Z-score was -2.2, and BMD value was 0.855 g/cm2. However, it was difficult to assess the condition correctly due to compression fractures. Femur neck Z-score was -1.4 on both sides, and BMD value was 0.754 g/cm2 ().\nTreatment and outcome: After the diagnosis of pregnancy-associated multiple compression fractures, the patient was given oral bromocriptine 2.5 mg once daily for a week to stop breast feeding. Once breastfeeding stopped, the patient was given oral administration of calcium 3,000 mg and vitamin D (cholecalciferol 800 IU) and daily subcutaneous injection of 20 µg of teriparatide. In 4-month follow-up, serum calcium was 9.4 mg/dL, phosphorus was 3.5 mg/dL and, PTH was 19.1 pg/mL, showing normal ranges. Serum osteocalcin increased to 62.24 ng/mL, compared with the baseline value, whereas alkaline phosphatase decreased to 239 IU/L, CTX 0.608 ng/mL. The Z-score and mean BMD values improved to -0.7 and 1.040 g/cm2, respectively. Low back pain gone and teriparatide has been prescribed for 10 months at outpatient clinic during follow-up examination.
|
[[39.0, 'year']]
|
F
|
{'18633621': 1, '16758139': 1, '20307690': 1, '10750571': 1, '20230328': 1, '33620518': 1, '19533208': 1, '10912848': 1, '10369729': 1, '22105654': 1, '34732196': 1, '25939309': 1, '29145296': 1, '11118824': 1, '25525595': 2, '13234409': 1, '8709404': 1, '8287577': 1, '15355570': 1, '24524067': 2}
|
{'4265516-1': 1}
|
165,592 |
3910316-1
| 24,524,068 |
noncomm/PMC003xxxxxx/PMC3910316.xml
|
Compression Fracture in Postpartum Osteoporosis
|
A 42-year-old multiparous woman arrived at the emergency room with back pain. One month earlier, she had a tertiary cesarean section and a left ovarian cystectomy. During the cesarean section, there were no other complications. She had breast-fed her baby after delivery. Her height was 159 cm and her weight was 56 kg. She had no other bone anomaly. She did not exercise on a regular basis. She had no past surgical or family histories, nor had trauma. On physical examination, she had diffuse back pain. The pain was so severe that she had difficulty in getting up for 7 days. The lumbar spine anteroposterior (AP) and lateral revealed recent compression fractures of T12, L1, and L3. A bone scan also revealed increased bone uptake, perfusion, and multiple recent compression fractures of T12-S1 (). Bone marrow density determined using dual energy X-ray absorptiometry (DXA) revealed that the T-scores for the lumbar vertebrae L1-L4, femoral neck, and femoral total were significantly low in the patient (). She was given calcium 500 mg daily and a chest brace for non-weight bearing.
|
[[42.0, 'year']]
|
F
|
{'16758139': 1, '17852140': 1, '14714147': 1, '25025003': 1, '27891031': 1, '10501778': 1, '10369729': 1, '22507833': 1, '18633621': 1, '28217686': 2, '24524068': 2}
|
{'5313358-1': 1, '5313358-2': 1, '5313358-3': 1, '5313358-4': 1, '5313358-5': 1, '5313358-6': 1}
|
165,593 |
3912242-1
| 24,501,716 |
noncomm/PMC003xxxxxx/PMC3912242.xml
|
Stereotactic body radiotherapy for solitary spine metastasis
|
A 54-year-old man was diagnosed with renal cell carcinoma for which he underwent a nephrectomy in 2006, confirmed as pT3N0M0, stage III, without adjuvant therapy. Two years later a bone metastasis was detected in the T8 spine (), and the patient complained of severe back pain. His verbal/visual analogue scale (VAS) score was 8, and his Eastern Cooperative Oncology Group (ECOG) performance status was 1. We recommended vertebroplasty before radiosurgery because of a pathologic compression fracture in T8 spine, but the patient refused this. Radiosurgery was administered instantly, with a total dose of 24 Gy in 3 fractions, after which, the patient's pain improved with a VAS score of 3 and he required less than half the maximum dose of analgesics. Treatment with the oral chemotherapeutic agent, sunitinib has been continued. He was followed for 36 months until July 2011 without any evidence of recurrence or metastasis on positron emission tomographic-computed tomographic (PET-CT) and MRI scans. He was confirmed to be alive until November 2013, but we had no current information about him from the past 2 years because he subsequently transferred to a hospital near his home.
|
[[54.0, 'year']]
|
M
|
{'12573746': 1, '31878807': 1, '17252218': 1, '20039084': 1, '19540375': 1, '18215498': 1, '16564447': 1, '12195075': 1, '1702559': 1, '19718252': 2, '26639199': 1, '28265240': 1, '18234445': 1, '17224814': 1, '11224867': 1, '17416863': 1, '17688054': 1, '21277118': 1, '27781486': 1, '18514775': 1, '15280758': 1, '24501716': 2}
|
{'3912242-2': 2, '3912242-3': 2, '3912242-4': 2, '2729313-1': 1}
|
165,594 |
3912242-2
| 24,501,716 |
noncomm/PMC003xxxxxx/PMC3912242.xml
|
Stereotactic body radiotherapy for solitary spine metastasis
|
In 2006, a 58-year-old man was diagnosed with hepatocellular carcinoma, cT1N0M0, stage I in segment 8 and was treated with transcatheter arterial chemoembolization and radiofrequency ablation, which controlled the liver lesion. Two years later, he visited hospital because of upper back and right shoulder pain. This was investigated by performing PET-CT and CT, which revealed a T3 spinal metastasis (). The patient was referred to our hospital for radiosurgery. At admission, he complained of sensory changes in both legs and in the lower abdominal area, and weakness in both lower extremities with fourth/fifth muscle strength. His VAS score for pain was 7, even with opioid analgesics. At that time, his ECOG performance status was 2, and the level of serum α-fetoprotein was elevated at 702 ng/mm3.\nA spine MRI before radiosurgery revealed a marrow infiltrative lesion at the pedicle, articular processes, laminas, and spinous process of T3, findings compatible with bone metastasis. Seven days after radiosurgery, the patient reported that his pain had started to improve. Subsequently, he reported that he was free of pain and no longer needed analgesics. Two weeks after radiosurgery, his neurologic symptoms resolved and his serum α-fetoprotein level dropped to 36.31 ng/mm3, and after 4 months, this level normalized at 2.99 ng/mm3. Since the radiosurgery was performed on the T3 spine, no further treatment was given until April 2012. At 52 months after radiosurgery, two liver lesions (8 and 12 mm) were found on segments 3 and 6, respectively, and treated with radiofrequency ablation. These two lesions were verified as controlled on follow-up liver CT and PET-CT and evidenced by a serum α-fetoprotein level of 2.4 ng/mm3. The metastatic T3 lesion had been radiologically controlled for 71 months after radiosurgery without relapse, pain, or neurological symptoms; in fact, there had been no evidence of disease.
|
[[58.0, 'year']]
|
M
|
{'12573746': 1, '31878807': 1, '17252218': 1, '20039084': 1, '19540375': 1, '18215498': 1, '16564447': 1, '12195075': 1, '1702559': 1, '19718252': 2, '26639199': 1, '28265240': 1, '18234445': 1, '17224814': 1, '11224867': 1, '17416863': 1, '17688054': 1, '21277118': 1, '27781486': 1, '18514775': 1, '15280758': 1, '24501716': 2}
|
{'3912242-1': 2, '3912242-3': 2, '3912242-4': 2, '2729313-1': 1}
|
165,595 |
3912242-3
| 24,501,716 |
noncomm/PMC003xxxxxx/PMC3912242.xml
|
Stereotactic body radiotherapy for solitary spine metastasis
|
A 56-year-old woman patient was treated with modified radical mastectomy followed by chemoradiation therapy for breast cancer, pT2N2M0, stage IIIA in 1996. Nine years after primary treatment, a bone metastasis was detected in the T9 and T10 spine. Palliative radiotherapy was administered with a total dose of 30 Gy over 12 fractions to the T8-T11 spine, and palliative chemotherapy was continued.\nThe patient returned to hospital in 2007 because of back pain. At presentation, she complained of pain with VAS score of 5, without neurologic symptoms and an ECOG performance status of 1. MRI revealed bone metastasis on the left side of the vertebral body, pedicle, lamina, both articular processes of T10 spine, and left articular process of T9 spine (). Radiosurgery was administered to the metastatic spine lesions at 6 Gy/fraction to a total dose of 24 Gy. The patient reported being in less pain within 7 days of radiosurgery and was subsequently pain-free and continued to be so until the last follow-up. She did not receive further chemotherapy or hormonal therapy until 74 months after the radiosurgery. In May 2013, a new lung metastasis was noted in the right upper lobe and treated with wedge resection. The histological findings were compatible with lung metastasis and the pathological report confirmed that the 3 × 2.2-cm tumor, visceral pleural invasion, and hormonal receptors were again negative. On follow-up PET-CT and chest CT at 80 months after the radiosurgery (6 months after the wedge resection), no fluorodeoxyglucose uptake was seen in the T9 and T10 spine and there were no abnormal lesions suggestive of recurrence or metastasis.
|
[[56.0, 'year']]
|
F
|
{'12573746': 1, '31878807': 1, '17252218': 1, '20039084': 1, '19540375': 1, '18215498': 1, '16564447': 1, '12195075': 1, '1702559': 1, '19718252': 2, '26639199': 1, '28265240': 1, '18234445': 1, '17224814': 1, '11224867': 1, '17416863': 1, '17688054': 1, '21277118': 1, '27781486': 1, '18514775': 1, '15280758': 1, '24501716': 2}
|
{'3912242-1': 2, '3912242-2': 2, '3912242-4': 2, '2729313-1': 1}
|
165,596 |
3912242-4
| 24,501,716 |
noncomm/PMC003xxxxxx/PMC3912242.xml
|
Stereotactic body radiotherapy for solitary spine metastasis
|
A 52-year-old man was diagnosed with rectal cancer, stage III (pT3N1M0) in 1999 and was treated with low anterior resection followed by chemoradiation therapy and then an oral chemotherapeutic agent. After 6 years, lung metastasis had developed in the left lower lobe and was treated with wedge resection followed by chemotherapy. After a further 2 years, a follow-up PET-CT showed a focal hypermetabolic lesion in the C3 vertebral body (), a finding compatible with metastasis, although this was asymptomatic. He was referred to our hospital for radiosurgery to the C3 spine as primary treatment.\nAfter radiosurgery of 24 Gy over 3 fractions, no further chemotherapy was given, and no further tumor recurrence has been noted for 66 months.
|
[[52.0, 'year']]
|
M
|
{'12573746': 1, '31878807': 1, '17252218': 1, '20039084': 1, '19540375': 1, '18215498': 1, '16564447': 1, '12195075': 1, '1702559': 1, '19718252': 2, '26639199': 1, '28265240': 1, '18234445': 1, '17224814': 1, '11224867': 1, '17416863': 1, '17688054': 1, '21277118': 1, '27781486': 1, '18514775': 1, '15280758': 1, '24501716': 2}
|
{'3912242-1': 2, '3912242-2': 2, '3912242-3': 2, '2729313-1': 1}
|
165,597 |
3912243-1
| 24,501,717 |
noncomm/PMC003xxxxxx/PMC3912243.xml
|
A patient who has survived for a long period with repeated radiotherapies for multifocal extrahepatic metastases from hepatocellular carcinoma
|
A 55-year-old man with hepatitis B and C was diagnosed with HCC in September 2006, and subsequently underwent a right lobectomy of the liver and cholecystectomy. HCC was multiple and the largest lesion was 7 cm. HCC was Edmondson-Steiner grade 3/3 and complicated by cirrhosis. There wasn't vascular invasion and resection margin was clear. During follow-up, lung metastasis was found and wedge resection was undergone twice (right lower lobe, July 2009; left lower lobe, January 2011). In March 2011, he felt pain on a palpable mass of his left shoulder. He visited local clinic and a biopsy of the mass revealed metastatic HCC. He was referred to our hospital in March 2011 for further evaluation and treatment. His Eastern Cooperative Oncology Group performance status was 1. Soft tissue metastases in the left shoulder area and abdominal wall were showed on computed tomography and positron emission tomography/computed tomography (PET/CT). There was no intrahepatic lesion and α-fetoprotein (AFP) was normal. And Child-Pugh score was 5 (Class A).\nHuge hard fixed masses were detected on his left pectoralis major, deltoid, and left teres minor muscles in which metastatic HCC was confirmed (). Radiotherapy was delivered 35 Gy in 14 fractions for each lesion. After radiotherapy, back mass was softened and its size decreased. The masses of pectoralis major and deltoid muscle were also decreased (). The brain metastasis was detected during the radiotherapy. He underwent Gamma Knife (Elekta AB, Stockholm, Sweden) stereotactic radiosurgery and started to take sorafenib (200 mg/day) in other hospital.\nDue to about 6-cm sized painful abdominal mass, he underwent radiotherapy in another hospital. Radiotherapy was delivered 40 Gy in 16 fractions.\nThough left pectoralis major and deltoid lesions nearly disappeared and pain was improved after radiotherapy, pain of left teres minor muscles area was aggravated and hard fixed mass was palpable again. A total dose of 30 Gy in 12 fractions for the left teres minor muscle area was delivered over a 3-week period.\nTwo painful recurred hard fixed masses were detected on abdominal wall. A total dose of 30 Gy in 15 fractions () and 27 Gy in 9 fractions were delivered for each lesion. The masses showed decreased metabolism grossly on outside PET/CT in December 2012. In January 2013 he received excision of the abdominal wall mass due to aggravated pain. In February 2013, a recurred abdominal mass was detected again and another excision was undergone because of previous radiotherapy history.\nHe felt pain on his left shoulder, new metastatic lesion in acromial angle was detected. He received radiotherapy of 20 Gy in 5 fractions. Pain was improved after radiotherapy.\nA small scalp mass was detected, and excisional biopsy was performed on October 2012. The pathology of the lesion was metastatic HCC. He also felt a newly growing mass in his right arm. Radiotherapy was undergone for the tumor bed of his scalp and the right deltoid muscle area. A total dose of 35 Gy in 14 fractions was delivered for each lesion, and the pain was relieved.\nA 5-cm sized rapid-growing hard fixed mass was detected with pain on his left anterior chest wall again. Radiotherapy of 35 Gy in 14 fractions was delivered, and pain was improved.\nThe patient underwent 7 courses of radiotherapy and took sorafenib orally (at starting dosage of 200 mg/day and a maintaining dosage of 600 mg/day) from April 2011 to July 2013. His hepatic function has been well preserved and the level of AFP has been normal. The brain metastasis had been also stable. Lung metastasis was suspicious on chest CT but that had not been progressed though intramuscular lesions were progressed after radiotherapy. He is still alive and is possible to carry on ordinary activities.
|
[[55.0, 'year']]
|
M
|
{'28839518': 2, '10966697': 1, '25694768': 1, '30834339': 1, '17230611': 1, '21517968': 1, '20047860': 1, '32776310': 1, '16246200': 1, '21460607': 1, '15780048': 1, '18238922': 1, '21437884': 1, '23613665': 1, '19192651': 1, '17126206': 1, '17554121': 1, '21916984': 1, '19224838': 1, '16901768': 1, '22647077': 1, '24501717': 2}
|
{'5550763-1': 1}
|
165,598 |
3912649-1
| 24,550,628 |
noncomm/PMC003xxxxxx/PMC3912649.xml
|
Coronary sinus and atrioventricular groove avulsion after motor vehicle crash
|
A 17-year-old male presented to our hospital after a high-speed motor vehicle crash that required prolonged extrication followed by rapid-sequence intubation. He required one unit of packed red blood cells for hypotension. On arrival to the trauma bay, he was normotensive with a heart rate of 70 beats/min. A 36-French chest tube was placed for left hemothorax. Initially, a sample of 1500 ml of blood was evacuated before output ceased. Patient remained hemodynamically stable. A focused abdominal sonogram for trauma (FAST) was negative for fluid in the abdominal and cardiac windows.\nFull-body computed tomography (CT) scan revealed a retained left hemothorax and subtle irregularity of the proximal descending aorta concerning for aortic disruption []. Following imaging, the chest tube resumed high output requiring further resuscitation and emergent exploration. Cardiothoracic surgery was called to the operating room due to concern for aortic disruption. Upon exploring the left chest through a thoracotomy, there was no active hemorrhage in the left pleural space. The aorta was uninjured. The pericardium was traumatically ruptured, but the avulsed and skeletonized left phrenic nerve was intact [].\nControl of bleeding was attempted by placing a large sheet of surgifoam along the atrioventricular groove at the base of the heart. Shortly thereafter, the heart distended and the patient arrested requiring emergent cardiopulmonary bypass achieved by cannulating the left apex and right atrium. Further, inspection revealed avulsion tears of the coronary sinus extending to the inferior vena cava. There was a separate avulsion of the right atrial appendage near the right coronary artery. Avulsion tears were repaired using pledgeted polypropylene sutures carefully avoiding adjacent coronary arteries. Excellent hemostasis was achieved and cardiopulmonary bypass was weaned. Post-operatively the patient recovered without further cardiac events and has been discharged from rehabilitation.
|
[[17.0, 'year']]
|
M
|
{'6708151': 1, '25409742': 2, '8015020': 1, '2669640': 1, '20009675': 1, '2256761': 1, '15345976': 1, '1994075': 1, '10366211': 1, '24550628': 2}
|
{'4246540-1': 1}
|
165,599 |
3912650-1
| 24,550,629 |
noncomm/PMC003xxxxxx/PMC3912650.xml
|
Migrating bullet: A case of a bullet embolism to the pulmonary artery with secondary pulmonary infarction after gunshot wound to the left globe
|
A 25-year-old male was brought to the emergency department after being found at the side of the road. At presentation, the patient was unconscious. His vital signs were: blood pressure of 145 mmHg systolic over 122 mmHg diastolic, heart rate of 130 beats/min, respiratory rate of 24, and peripheral oxygen saturation of 91% on room air. Physical exam was notable for facial lacerations and a ruptured left globe related to a gunshot entrance wound. No exit wound was identified. A head computed tomography (CT) demonstrated the trajectory of the bullet, which had ruptured his left globe, travelled along the skull base fracturing his carotid canals bilaterally, and was located in the right transverse sinus []. The bullet was round and measured approximately 5 mm in diameter, the characteristic size and shape of a BB gun bullet.\nDue to extensive intracranial haemorrhage, the patient was taken to the operating room for placement of an external ventriculostomy shunt catheter. Post-operatively, contrast enhanced computed tomography angiography of the head was performed, which demonstrated occlusion of the left internal carotid artery []. However, it was also noted that the previously identified bullet was no longer located in the right transverse sinus. At admission, a portable chest radiograph had been unremarkable []. Approximately 2.5 h later, a repeat post-operative chest radiograph showed a new round foreign body resembling a BB that projected over the left hilum with interval development of a wedge shaped pulmonary opacity silhouetting the left hemidiaphragm []. It was suspected that the BB had embolized through the right jugular vein to the patient's heart and to a peripheral branch of a left lower lobe pulmonary artery. Chest CT confirmed that the bullet was now located in a left lower lobe with an associated pulmonary infarct, a small left-sided pneumothorax, and extensive pneumomediastinum [Figure and ]. The patient was admitted to the intensive care unit and evaluated by cardiothoracic surgery. No intervention to remove the bullet was performed as the patient was critically ill from a neurological perspective.
|
[[25.0, 'year']]
|
M
|
{'20828693': 1, '6368853': 1, '16970239': 1, '1788847': 1, '31543646': 2, '4406880': 1, '26770857': 2, '30392466': 2, '320947': 1, '6988604': 1, '34754541': 1, '773320': 1, '32550058': 2, '1474637': 1, '24550629': 2}
|
{'6735202-1': 1, '6217764-1': 1, '7294874-1': 1, '4685071-1': 1}
|
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