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165,600 | 3912667-1 | 24,550,612 | noncomm/PMC003xxxxxx/PMC3912667.xml | Transpleural central venous catheter discovered during thoracotomy | A 37-year-old male with cystic bronchiectasis in the left lower lobe was scheduled for left lower lobectomy. His preoperative checkup was unremarkable. Computerized tomography scan of the chest revealed cystic bronchiectasis in the left lower lobe with consolidation. Imaging cannot show “infection” and mild bronchiectasis in the right middle lobe. Following placement of routine monitors, thoracic epidural catheter was inserted in the T6-T7 interspace. Patient refused CVC insertion under local anesthesia. After induction of general anesthesia, the patient was intubated with right sided 41 FG double lumen tube. Left infraclavicular access for CVC was selected as the patient had to undergo left thoracotomy. Venipuncture was performed 1 cm lateral to the curvature of the middle third of the clavicle with the needle pointing horizontally directed at the sternal notch until free aspiration of blood was obtained. Positive pressure ventilation was withheld during the CVC insertion until free flow of blood was obtained. 16G catheter through needle CVC was introduced in the first attempt. The blood aspirated during the insertion was uninterrupted and no air or fluid was noticed. CVC was confirmed with easy aspiration of blood and appropriate waveform. The catheter was fixed at the mark of 12 cm from the tip of the catheter. Bedside chest xray to confirm CVC position was not immediately available and thus, the CVC was only used for monitoring the waveform. No fluids were infused through the CVC. During the surgical exploration, it was noticed that CVC was traversing the superior aspect of the pleural cavity []. Position of the CVC tip was reconfirmed and was found to be satisfactory as per the waveform and aspiration of blood.\nSuspecting the puncture site as a potential site for bleeding, it was decided to remove the catheter before thoracic cavity was closed. While it was being removed under vision, bleeding was noticed from both puncture sites at the pleural surface. Manual pressure was insufficient to stop the bleeding. Therefore, two sutures one at each puncture site were placed. Post-operative course was uneventful. | [[37.0, 'year']] | M | {'12719056': 1, '11495620': 1, '14709471': 1, '24550612': 2} | {} |
165,601 | 3912668-1 | 24,550,613 | noncomm/PMC003xxxxxx/PMC3912668.xml | Acute right heart syndrome: Rescue treatment with inhaled nitric oxide | A 39-year-old female, diagnosed case of chronic kidney disease on maintenance hemodialysis (HD) for the past 9 years with severe PAH secondary to chronic pulmonary thromboembolism (PTE) presented with the complaints of progressive breathlessness and abdominal distension for the past 1 week. Her history was suggestive of Grade III dyspnea with orthopnea. There was no history of fever or cough; blood pressure [BP] 92/46 mmHg, pulse rate [PR] 96/min, respiratory rate [RR] 36/min). Her recent records showed recurrent hypotension during her last few HD sessions.\nConsidering her non-tolerance to HD, it was planned to start her on peritoneal dialysis (PD). During the first cycle of PD, she developed severe hypotension and altered sensorium (after inflow phase). She was then shifted to intensive care unit (ICU) for further management.\nAt presentation to the ICU, she was drowsy, sluggishly responding to verbal commands. Her neck veins were distended. She had respiratory distress, with active accessory muscles of respiration. She had a loud P2, pan systolic murmur. Her abdomen was soft, mildly distended with evidence of free fluid and palpable liver (BP: 70/40 mmHg, PR: 102/min, RR: 30/min, SpO2: 99% on high flow O2 via non-rebreathing mask) Her labs were: Hemoglobin 12.3 g/dl, total leucocyte count 8600/μL, serum sodium 138 mEq/L, serum potassium 6 mEq/L, blood urea nitrogen 63 mg/dl, creatinine 6.0 mg/dl. Arterial blood gas (ABG) revealed hypoxia and hypercarbia with mixed acidosis (pH: 7.189, PaCO2: 60.3 mmHg, pO2: 52.7 mmHg, HCO3: 22.5 mmol/L, BE: 6.54 mmol/L, serum lactate 1.92 mmol/L). D-dimer and fibrin degradation product were high. An echocardiogram revealed markedly dilated right ventricle (RV)/right atrial/inferior vena cava (IVC); moderate tricuspid regurgitation (TR), severe pulmonary arterial hypertension (PAH) with (pulmonary artery systolic pressure [PASP] = 93 mmHg paradoxical septal motion; decreased right ventricular (RV) function and reduced left ventricular (LV) compliance. Work-up for sepsis and acute myocardial ischemia was carried out and was ruled out. Considering her critically ill state, she was not subjected to any radiological investigation to rule out acute pulmonary embolus.\nOn Day 1 of ICU admission, she was managed with high dose inotropes and vasopressors: Infusion nor-adrenaline (1 mcg/kg/min) and infusion dopamine (20 mcg/kg/min), empiric broad spectrum antibiotics, low molecular weight heparin and sustained low efficiency dialysis. By Day 2, her vasopressor requirement increased and infusion vasopressin (0.04 units/min) was added. In view of her poor sensorium, hemodynamic instability and acidosis she was electively intubated and ventilated. Her pre-intubation ABG was pH: 7.18, PaCO2: 60 mmHg, PO2: 66.6 mmHg, HCO3: 21.9 mmol/L, BE: 7.1 mmol/L while post-intubation ABG was pH: 7.29, PaCO2: 36.7 mmHg, PO2: 80.4 mmHg, HCO3: 17.3 mmol/L, BE: 8.3 mmol/L. On Day 3, echocardiography revealed findings similar to Day 1 echocardiography (PASP 95 mmHg). In view of her refractory pulmonary hypertension iNO was started (Day 3) through nitric oxide blender (NOxBOX, Ben font Scientific Ltd. Kent, England) at 5 ppm and then increased to 10 ppm. Her hemodynamic parameters showed a progressively improving trend after initiation of iNO. By 12 h (ICU Day 4) of iNO, vasopressors were tapered down. PD was restarted on Day 5 with cumulative negative balance of 2 L (approx). Blood gasses on Day 5 revealed pH: 7.45, PaCO2: 28.4 mmHg, PO2: 136.2 mmHg, HCO3: 20 mmol/L, BE: 5.3 mmol/L and lactates 1.61 mmol/L. Her follow-up echocardiography showed a significant reduction in PA pressures with PASP measuring 73 mmHg at 48 h and 63 mmHg at 72 h of iNO initiation []. Gradually, her vasopressor were weaned off completely and NO was withdrawn after 72 h (Day 6). She was extubated the next day and subsequently was maintained on non-invasive ventilation with inspiratory positive airway pressure of 12 mmHg, expiratory positive airway pressure of 4 mmHg. She was shifted out of ICU on Day 10. Throughout the ICU stay the methemoglobin levels were < 1%, as measured by the co-oximetry test. | [[39.0, 'year']] | F | {'26577797': 1, '19561888': 2, '33138181': 1, '1357245': 1, '2113542': 1, '7842196': 1, '20951319': 1, '19265089': 1, '11544423': 1, '17643631': 1, '9768716': 1, '12910335': 1, '24550613': 2} | {'2700444-1': 1, '2700444-2': 1, '2700444-3': 1} |
165,602 | 3912669-1 | 24,550,614 | noncomm/PMC003xxxxxx/PMC3912669.xml | Self-injection of intravenous carbolic acid and multiorgan failure | A 48-year-old male, pharmacist by occupation was found lying unconscious on the floor of his chemist shop with a 50 cc syringe partially filled with carbolic acid (household phenol) by his side. He was immediately rushed to the emergency department of our hospital. On inquiry, his wife said that he was staying aloof for past 1 week. He was otherwise healthy and was not on any regular medication. There was no history of smoking or alcohol intake.\nOn examination, he was irritable, but still following simple command like showing tongue when asked for. His extremities were cold. He was pale but not icteric. He had tachycardia (heart rate 116/min, regular) with blood pressure of 86/56 mmHg. He was tachypnic with a respiratory rate of 40/min. No abnormality was detected in respiratory system and abdominal examination. He was moving all four limbs spontaneously and there was no apparent cranial nerve deficit. His left forearm was swollen with evidence of thrombophlebitis extending up to the arm []. Random Blood Glucose was 95 mg/dl. Initial blood gas revealed hypoxia, lactic acidosis and respiratory alkalosis with a compensated pH (pH 7.35, PO2 75.9 mmHg, on 12 L O2 by mask, PCO2 33.1 mmHg, HCO3 17.8 mmol/L, lactate 5.2 mmol/L). Electrocardiogram was unremarkable except sinus tachycardia. Echocardiogram showed prominent Right Atrium with mild Tricuspid Regurgitation (estimated Pulminary Artery Systolic Pressure 37 mmHg); Inferior Vena Caval diameter of 12 mm with large respiratory variation; no wall motion abnormality and global ejection fraction EF 55%.\nAfter an initial fluid bolus of 1000 ml Normal Saline (NS) over half an hour and 500 ml × 2 of NS over next one and a half hour, he was continued on NS 100 ml/h with intermittent boluses of Furosemide. Oxygen supplementation with 40% Venturi Mask was started to maintain Oxygen saturation SpO2 above 92%. He was also given other supportive therapy in the form of intravenous Pantoprazole as stress ulcer prophylaxis and Ondansetron. After 2 h in the ICU, he had improvement in blood pressure, normalization of serum lactate level (2.3 mmol/L) and sensorium. He confessed to the self-injection of intravenous phenol. He also revealed that he tried to consume “All Out” liquid (Mosquito repellent containing 1.6% Pyrethrin) but immediately vomited out. At this time, he was oliguric and progressively more tachypneic with worsening oxygenation status. Chest X-ray showed bilateral patchy infiltrate []. Initial laboratory investigations revealed normal complete blood count; high blood urea nitrogen (21.1 mg/dl) and S Creatinine 2 mg/dl with normal electrolytes; deranged liver function test (S Bilirubin 3.02 mg/dl, direct Bilirubin 0.14 mg/dl, aspartate aminotransferase AST 211 U/L. alanine aminotransferase ALT 95 U/L, alkaline phosphate ALP 95 U/L. lactate dehydrogenase LDH 2574 U/L); normal serum Amylase; deranged coagulation parameters partial thromboplastin time 63.7 min, control 26 min and prothrombin time 27.8 min, control 12.4 min); high creatine phosphokinase (447 U/L). Urine analysis showed hemoglobinuria and proteinuria 3+. After an initial trial of noninvasive ventilation for half an hour, he was intubated and started on mechanical ventilation support with low tidal volume strategy.\nAfter 6 h, he was still oliguric with 45 ml of dark urine [] (Total intake 3500 ml). There was evidence of intravascular hemolysis with low serum Haptoglobin. His G-6PD level was normal. Abdominal ultrasonography examination was unremarkable. Hemodialysis was initiated in view of oliguria persistent metabolic acidosis and probable fluid overload. On day 2 he developed thrombocytopenia (platelet count 100,000/dl). In the subsequent days in the ICU his hypoxia improved but he continued to remain anuric. He was successfully weaned off the ventilator on day 4. On day 5 he was shifted to the ward on oxygen supplementation with 4 L O2 by nasal prong (maintaining SpO2 of 95%), still anuric on daily hemodialysis. On day 14, he was discharged from the hospital with normalization of all parameters except kidney function. He was advised 3 times a week maintenance hemodialysis, at discharge. His kidney function tests normalized over the subsequent 8 weeks of follow-up. | [[48.0, 'year']] | M | {'15725515': 1, '3926044': 1, '8492343': 1, '17852157': 1, '19881195': 2, '3324392': 1, '24550614': 2} | {'2772251-1': 1} |
165,603 | 3912670-1 | 24,550,615 | noncomm/PMC003xxxxxx/PMC3912670.xml | Hyperkalemia: A rare cause of acute flaccid quadriparesis | A 73-year-old diabetic, hypertensive and hypothyroid female presented with the complaints of rapidly progressive ascending paraparesis, progressing to AFQ in about 10 h. She woke up with bilateral lower limb weakness with gradual inability to move upper limbs and had developed difficulty in breathing by the time she presented to the hospital. She was on glimipride, metformin, thyroxine, atenolol, ramipril and spironolactone. There was no other significant history.\nOn admission, she was conscious and oriented. Her pulse rate, blood pressure, respiratory rate and temperature were 72/min, 124/60 mmHg, 20/min and 98°F, respectively. Her oxygen saturation was 93% on room air. Neurological evaluation revealed normal pupils, symmetrical normal bulk and hypotonia in all limbs. Upper limbs had proximal and distal power of 4/5. In lower limbs, proximal and distal power was 2/5 with no sensory deficit. Deep tendon reflexes were absent. Bilaterally the plantar reflexes were mute. There were no lateralizing signs and the cranial nerves were normal. Other systemic examination was unremarkable. A clinical diagnosis of acute inflammatory demyelinating polyneuropathy was made. Arterial blood gas mixed primary metabolic and the respiratory acidosis and initial serum potassium level was 9.1 mmol/L. Other laboratory tests were normal. Electrocardiograph [] showed tall T wave in anterior and lateral leads.\nRaised potassium levels raised the possibility of hyperkalemia induced AFQ. Urgent antihyperkalemic measures in the form of calcium gluconate, insulin dextrose solution, furosemide, beta-2 agonist nebulization and calcium polystyrene sulfonate (K-bind) with sorbitol, were instituted. Patient required non-invasive ventilation (NIV) support for type-2 respiratory failure. Hemodialysis was not required as she had a good urine output and serum potassium levels showed steady decline. Serial declining level of K+: 9.1, 8.6, 7.1, 6.1, 4.4 was accompanied by improving power and resulted in weaning of ventilatory support within 48 h.\nA nerve conduction velocity (NCV) study on day 1 was suggestive of demyelination. Subsequent NCV on day 4 was normal. She was shifted to the ward on day 4 by which time her biochemical parameters were normal. Electrocardiography on day 2 [] showed normal T wave in anterior and lateral leads. | [[73.0, 'year']] | F | {'16364505': 1, '91060': 1, '3998756': 1, '19304442': 1, '9489541': 1, '6709118': 1, '21150391': 1, '3495559': 1, '29371419': 1, '11161080': 1, '23349611': 2, '28567665': 1, '20716474': 1, '24550615': 2} | {'3548384-1': 1} |
165,604 | 3912686-1 | 24,551,017 | noncomm/PMC003xxxxxx/PMC3912686.xml | A rare case of alpha 1-antitrypsin deficiency associated with hypogammaglobulinemia and recurrent pulmonary thrombosis | A 89-year-old, non-smoking, Caucasian woman with past medical history of AATD, recurrent pneumonias, dementia, diabetes mellitus and hypertension presents with productive cough and exertional dyspnea. During the seventh decade of her life, she was diagnosed with bronchiectasis and showed persistent decline of her health. She incurred recurrent pneumonias due to pseudomonas, empyema thoracis and mycobacterial infections and further laboratory investigation revealed AAT serum level of 24 mg/ml (83-199 mg/dl) with ZZ phenotype.\nOn admission, physical exam revealed she was febrile and had bilateral crepitations at the lung bases. Laboratory diagnostics revealed white cell count of 13.6 × 109/l with a differential of 80% neutrophils, 11% bands, 5% lymphocytes, 2% monocytes and 2% eosinophils. Liver function test include alanine transaminase of 27 U/l, aspartate transaminase of 28 U/l, alkaline phosphatase of 130 U/l, total bilirubin of 0.1 mg/dl, albumin of 3.1 g/dl and total protein of 5.6 g/dl. A chest radiography showed bilateral infiltrates followed with a chest computed tomography which revealed bilateral lower lobe segmental pulmonary arterial filing defects consistent with pulmonary emboli and marked emphysema with lower lobe cystic bronchiectasis and nodular infiltrates []. The patient was initiated on heparin and warfarin anticoagulation therapy along with the intravenous antibiotics of vancomycin 1 g every 12 h and cefepime 1 g every 12 h. Sputum cultures grew pseudomonas but acid fast bacilli, viral, fungal and blood cultures remained negative. An echocardiogram did not show evidence of endocarditis. Subsequently, patient showed remarked clinical and physiological improvement and antibiotic vancomycin was discontinued. Pulmonary function tests demonstrated severe obstructive lung disease with forced expiratory volume in 1 second (FEV1) of 37%, FEV1/forced vital capacity of 61% and total lung capacity of 121%. Given the recurrent infections, immunoglobulin levels were checked and were suggestive of gamma immunoglobulin (IgG) of 514 mg/dl (normal 694-1618 mg/dl), immunoglobulin M of 30 mg/dl (normal 48-271 mg/dl) with normal immunoglobulin A of 270 mg/dl (normal 81-463 mg/dl). Antibody levels specific for capsular polysaccharides of Streptococcus pneumoniae and for tetanus toxoid were found low. She received monthly intravenous immunoglobulin infusions for immunoglobulin deficiency. Patient got discharged to home with oral anticoagulant warfarin and intravenous cefepime for completion of total 14 days. During follow-up of the patient, her episodes of recurrent infections decreased relatively, however she continued to have pulmonary emboli. Her coagulation profile revealed protein C of 29 μ/dl (normal 75-165 μ/dl), anti-thrombin III of 85 μ/dl (normal 85-130 μ/dl) with negative factor V mutation, lupus anticoagulant and cardiolipin antibody. | [[89.0, 'year']] | F | {'26005342': 2, '6193754': 1, '309692': 1, '7396316': 1, '27555756': 1, '32566054': 1, '24791168': 1, '6976255': 1, '18309698': 1, '6600917': 1, '34084683': 1, '1671123': 1, '22933512': 1, '19553648': 1, '24551017': 2} | {'4428364-1': 1} |
165,605 | 3912687-1 | 24,551,018 | noncomm/PMC003xxxxxx/PMC3912687.xml | Two cases of food-dependent exercise-induced anaphylaxis with different culprit foods | A 14-year-old Palestinian female middle school student seen initially in the allergy clinic on October 2009. She described frequent attacks of itchy hives, swelling of lips, and eyelids. They were followed by dyspnea, wheezing, and dizziness spills. She gave history of four attacks over the last year. In all the attacks, her symptoms appeared during physical exertion immediately following the ingestion of her dinner that usually contains wheat bread, cheese, and eggs. Surprisingly, she could tolerate these foods if it was not followed by exercise. Moreover, her symptoms never occurred if a meal did not precede performing the exercise activity. Her last attack was severe and occurred while jogging and running at the backyard immediately after having a slice of vegetarian pizza for which she attended the emergency room (ED). She gave history of not taking any medication specifically nonsteroidal anti-inflammatory drugs (NSAIDs) before having exercise. Also, the attacks were not related to her menstruation. Review of her past medical history and family history were noncontributory. In the ED, she was treated for anaphylaxis with intramuscular adrenalin and intravenous antihistamine, hydrocortisone, and fluids. And she was instructed to avoid eating cheese and eggs. In the allergy clinic, her physical examination was non remarkable and dermographism test was negative. Her baseline serum tryptase was normal. The serum tryptase was not checked in the ED during the attacks. The allergy skin prick testing for common foods showed a positive reaction to only wheat. A supervised graded oral challenge with wheat at rest was performed and was tolerated without any consequences. She was instructed to avoid any exercise for 4 h after ingestion of food, particularly the wheat. Over the last 2 years of regular follow-up, she described no single episode of anaphylaxis. | [[14.0, 'year']] | F | {'11490160': 1, '33150158': 1, '17495117': 1, '30214658': 1, '15836754': 1, '447945': 1, '20525119': 1, '33260469': 1, '27822074': 1, '28261038': 1, '10400849': 1, '22467837': 1, '20543674': 1, '17507204': 1, '11952547': 1, '11590393': 1, '18797181': 1, '24551018': 2} | {'3912687-2': 2} |
165,606 | 3912687-2 | 24,551,018 | noncomm/PMC003xxxxxx/PMC3912687.xml | Two cases of food-dependent exercise-induced anaphylaxis with different culprit foods | A 15-year-old Qatari male student was referred to the allergy clinic on January 2011 because of a suspected peanut allergy. He reported three episodes of anaphylaxis associated with the ingestion of peanut in the last 8 months. The first occurred while jogging 3 h, following eating a bar of peanut-containing chocolate. He developed flushing, large plaques of urticarial rash all over the body associated with periorbital facial swelling, shortness of breath, and wheezing. He was brought to the ED and treated for anaphylaxis attack. The second and the third episodes also occurred when he started running 2 h after having a piece of sweet that contains mixed nuts. He can tolerate eating nuts if no exercise is performed and he does not develop any symptoms if he exercises without eating nuts. Medical history is significant for childhood atopic dermatitis, bronchial asthma, and allergic rhinitis. He has strong family history of atopy. His father as well as three of his siblings has asthma and seasonal allergic rhinitis. Physical examination was unremarkable. Allergy skin prick testing for food showed positive reaction to peanut, almond, and hazelnut. A supervised graded oral challenges with peanut, almond, and hazelnut at rest were negative. He was advised to avoid any exercise for 4 h, following food ingestions particularly nuts. He has no attacks of anaphylaxis over the last 1 year of follow-up. | [[15.0, 'year']] | M | {'11490160': 1, '33150158': 1, '17495117': 1, '30214658': 1, '15836754': 1, '447945': 1, '20525119': 1, '33260469': 1, '27822074': 1, '28261038': 1, '10400849': 1, '22467837': 1, '20543674': 1, '17507204': 1, '11952547': 1, '11590393': 1, '18797181': 1, '24551018': 2} | {'3912687-1': 2} |
165,607 | 3912767-1 | 24,551,000 | noncomm/PMC003xxxxxx/PMC3912767.xml | Role of screening of whole spine with sagittal MRI with MR myelography in early detection and management of occult intrasacral meningocele | A thirty-year-old male presented with weakness in upper limbs, cervical pain, and mild fever. Whole-spine sagittal T2-weighted MRI showed mild spondylosis in the cervical region. However, an intrasacral cyst measuring approximately 3.8×3.7×1.8 cm was observed. On further detailed imaging, lumbarization of the S1 vertebra was seen with a low-lying conus medullaris terminating at L3-L4 level. In addition, a thickened fatty filum terminale was detected which was adherent to the intrasacral cyst at the S3-S4 level. The cyst had a small communication with the distal end of the thecal sac leading to a diagnosis of occult intrasacral meningocele [Figure –]. Laminectomy was done along with excision of the cyst and a part of thickened filum terminale. Histopathological examination showed the cyst wall to be formed by nonspecific fibrous tissue lining. The patient showed an uneventful postoperative course and good outcome with only mild pain during follow-up at one year. | [[30.0, 'year']] | M | {'28969239': 1, '5531903': 1, '7623956': 1, '2784267': 1, '11224896': 1, '18497497': 1, '29411052': 1, '18206241': 1, '2710309': 1, '9620003': 1, '9973911': 1, '16505968': 1, '3374775': 1, '3343608': 1, '24551000': 2} | {'3912767-2': 2} |
165,608 | 3912767-2 | 24,551,000 | noncomm/PMC003xxxxxx/PMC3912767.xml | Role of screening of whole spine with sagittal MRI with MR myelography in early detection and management of occult intrasacral meningocele | A twenty-year-old male presented with a history of weakness in the lower limbs and urinary incontinence. Sagittal T2-weighted MRI and MR myelography showed a large biloculated cystic lesion at S1-S5 level measuring approximately 10.1×4.5×2.5 cm. The upper locule of the lesion was partially communicating with the thecal sac. There was a thin septum between the upper and lower locules. The upper locule displayed CSF signal intensity on all sequences, whereas the lower locule appeared hyperintense on gradient diffusion imaging suggestive of a high protein content. Conus Medullaris terminated at the L3-L4 level with a slightly thickened fatty filum terminale. In addition, significant distension of urinary bladder with diverticulation of its wall was seen. This suggested the possibility of a neurogenic bladder [Figure –]. Excision of the cyst was performed along with the release of the filum terminale. During follow-up at around fourteen months, the patient had a fair outcome. Some degree of weakness persisted in the lower limbs, whereas urinary incontinence had improved significantly. The follow-up MR imaging showed a recurrent cyst in the sacrum measuring about 7.7×2.2×3.0 cm. However, the urinary bladder exhibited a reduction in the thickening of its wall. | [[20.0, 'year']] | M | {'28969239': 1, '5531903': 1, '7623956': 1, '2784267': 1, '11224896': 1, '18497497': 1, '29411052': 1, '18206241': 1, '2710309': 1, '9620003': 1, '9973911': 1, '16505968': 1, '3374775': 1, '3343608': 1, '24551000': 2} | {'3912767-1': 2} |
165,609 | 3912769-1 | 24,551,002 | noncomm/PMC003xxxxxx/PMC3912769.xml | Symptomatic Rathke's cleft cyst with a co-existing pituitary tumor; Brief review of the literature | A 39-year-old male presented to his primary care physician with a severe headache, fever and chills. The patient subsequently presented to the Emergency Department of an outside hospital due to worsening symptoms and the onset of substernal chest pain. His electrocardiogram was normal although the cardiac biomarkers were significantly elevated. In addition to working up the patient's cardiac compliant, computed tomography of the head was obtained due to the patient's persistent headache and the presence of horizontal nystagmus on exam. This scan revealed a large sellar mass. To further characterize this mass, a brain magnetic resonance imaging (MRI) was obtained. This revealed a 3.3 cm × 2.9 cm × 3.1 cm cystic mass in the sellar region []. He was then transferred to our institution for further management of his non-ST elevation myocardial infarction and sellar mass. Endocrine labs were obtained and were found to be significant for hypogonadotropichypogondism, with a total serum testosterone level of 23 ng/dL (normal range, 175-780 ng/dL), with all other pituitary labs within normal limits.\nThe patient subsequently underwent minimally invasive endoscopic transnasaltransphenoidal pituitary resection. Once the pituitary was exposed, an incision was made into the gland, releasing a large amount of fluid from the cyst. After removal of the lining of the cyst cavity, the wound was closed with a septal flap. The patient had an uneventful post-operative course and was discharged in a stable condition.\nHistological examination of the mass showed adenohypophyseal tissue with focal monomorphic proliferation consistent with an adenoma []. Also seen was cytokeratin-immunopositive cuboidal epithelium consistent with an RCC []. Immunohistochemical studies demonstrated tumor cells immunopositive for chromogranin, synaptophysin and human chorionic gonadotropin. However prolactin, adrenocorticotrophic hormone (ACTH) and growth hormone were seen to be negative. | [[39.0, 'year']] | M | {'18548895': 1, '17917812': 1, '25883817': 1, '1584358': 1, '626939': 1, '16095210': 1, '3670583': 1, '2919360': 1, '6483092': 1, '3320806': 1, '4058703': 1, '2918980': 1, '32033192': 1, '21934255': 1, '660898': 1, '12368625': 1, '15638297': 1, '32774326': 2, '12005257': 1, '7786427': 1, '19551516': 1, '9215319': 1, '5476241': 1, '19165221': 1, '17914599': 1, '30488233': 1, '8537515': 1, '21296991': 1, '31802354': 1, '11594426': 1, '7808605': 1, '14660734': 1, '9442498': 1, '26767975': 1, '3703147': 1, '16519575': 1, '1557952': 1, '20833337': 1, '14811058': 1, '15871552': 1, '972343': 1, '9861546': 1, '7505406': 1, '8189257': 1, '24551002': 2} | {'7388627-1': 1} |
165,610 | 3912770-1 | 24,551,003 | noncomm/PMC003xxxxxx/PMC3912770.xml | Neurenteric cyst at the craniovertebral junction: A report of two cases | A 7-year-old girl presented with complaints of gradually progressing neck pain of 7 months duration. The pain was localized in the neck and aggravated with neck movements. On examination, she had no focal neurological deficits and her laboratory investigations were normal. Magnetic resonance imaging (MRI) done revealed an intradural extramedullary lesion extending from C1 to C4 region, located ventrolateral to the upper cervical cord []. The patient underwent C1, C2 hemilaminectomy and subtotal excision of the lesion. Postoperatively, the patient had relief from neck pain. The histopathologic examination (HPE) was suggestive of NC.\nThe patient was advised regular follow-up. However, the patient had recurrence of symptoms 6 months post-surgery and a repeat MRI done showed recurrence of the lesion. The patient was re-operated. This time, a right far-lateral approach was taken to facilitate access to the cyst located ventral to the upper cervical nerves. The cyst was decompressed and the cyst wall was completely excised []. Postoperative period was uneventful. The HPE showed a cyst lined by columnar mucinous epithelium []. | [[7.0, 'year']] | F | {'18213442': 1, '16775266': 1, '2259418': 1, '10639817': 1, '22260959': 1, '10981766': 1, '9842427': 1, '21772801': 1, '26662045': 1, '8748762': 1, '16122218': 1, '12182790': 1, '11780908': 1, '25407831': 1, '9232102': 1, '24551003': 2} | {'3912770-2': 2} |
165,611 | 3912770-2 | 24,551,003 | noncomm/PMC003xxxxxx/PMC3912770.xml | Neurenteric cyst at the craniovertebral junction: A report of two cases | A 36-year-old lady presented with complaints of intermittent right-sided headache of 2 years duration with a 20-day history of diplopia, mild deviation of angle of the mouth to the left, and decreased hearing in the right ear. Neurological examination revealed right 6th, 7th, and 8th nerve paresis with cerebellar ataxia. Audiological investigation revealed a right sensorineural hearing loss. An MRI of the brain showed an extra-axial lesion in the right cerebellomedullary cistern, measuring 4 × 3 × 2.5 cm, extending from lower clivus up to the rim of foramen magnum []. The various possibilities considered were NC, epidermoid or dermoid cyst.\nThe patient was placed in the left lateral position, and a right far-lateral approach was taken. Intraoperatively, a thin-walled cyst was seen located ventral to the lower cranial nerves and extending from the 7th to the 8th complex up to the foramen magnum and extending into the jugular foramen. The cyst was decompressed by puncturing the cyst wall and aspirating its thick yellow contents. The cyst wall was gently separated and excised under Nerve Integrity Monitoring (NIM) []. The surgical cavity was irrigated with steroid impregnated saline. The postoperative period was uneventful.\nThe HPE was suggestive of NC with cyst wall lined with pseudostratified ciliated columnar epithelium []. | [[36.0, 'year']] | F | {'18213442': 1, '16775266': 1, '2259418': 1, '10639817': 1, '22260959': 1, '10981766': 1, '9842427': 1, '21772801': 1, '26662045': 1, '8748762': 1, '16122218': 1, '12182790': 1, '11780908': 1, '25407831': 1, '9232102': 1, '24551003': 2} | {'3912770-1': 2} |
165,612 | 3912771-1 | 24,551,004 | noncomm/PMC003xxxxxx/PMC3912771.xml | Giant orbital oncocytoma | A 19-year-old male from Papua New Guinea (PNG) presented with the long-standing complaint of left-sided proptosis which had slowly progressed over a period of 10 years. Visual acuity was preserved although lid retraction due to the degree of exophthalmos was causing exposure keratitis which could become sight-threatening. Computed tomography (CT) scan of the brain and orbits in PNG identified the cause to be a large soft tissue mass which was retro-ocular but entirely confined to the left orbit. The patient could not be treated in PNG and was subsequently referred to a tertiary hospital in Melbourne, Australia, for further assessment and specialist surgical treatment. On clinical examination, visual acuity was found to be 6/12 in the left eye and 6/5 in the right eye. Range of movement in the left eye was well preserved with very slight limitation of upward and downward gaze []. The cranial nerves were intact, Humphrey visual field testing revealed no deficit, and fundoscopy was unremarkable with normal appearances of the optic discs bilaterally.\nMagnetic resonance (MR) imaging of the brain and orbits demonstrated the lesion to be non-enhancing, multi-cystic, both intra- and extra-conal and infiltrating the left superior and inferior rectus muscles. The optic nerve was displaced by the mass but there was no radiological evidence of intracranial extension [Figures and ]. The most likely diagnosis based on the radiological findings was lymphangioma, oncocytoma was not considered. Surgical excision of the lesion was indicated to correct proptosis, reverse the corneal irritation, preserve vision and to obtain histology. Due to the retro-ocular location of the lesion, the planned approach was via a left fronto-orbitozygomatic craniotomy to maximize access and reduce the likelihood of injury to the globe and associated structures.\nIntraoperatively, the cystic mass was found to be diffusely infiltrating the superior and inferior recti, with no plane between tumour and normal tissue. Identification of the divisions of the oculomotor nerve and the abducens nerve was impossible due to the grossly distorted orbital anatomy and infiltrating tumour. The intraconal portion of the lesion was adherent to the optic nerve, displacing it laterally. The cystic elements containing a milky, turbid fluid were opened and the intraconaltumour was extensively debulked. A sub-total excision of the lesion was obtained.\nPost-operatively, there was initially significant periorbital swelling which improved rapidly. Formal ophthalmological review 11 days post-operatively revealed a dramatic improvement in the degree of exophthalmos although there was a complete ptosis possibly indicating deficit of the superior division of the oculomotor nerve, as well as a complete left lateral rectus palsy. Visual acuity remained unchanged.\nAt 1-month post-operatively, the previously noted ptosis and ophthalmoplegia remained unchanged with mild intortion of the eye in a resting state although acuity remained preserved. Delayed surgical correction of the ptosis and strabismus may be indicated in the future.\nHistological findings demonstrated fibrous connective tissue with multiple cystic spaces lined with a bi-layered cuboidal epithelium. Some fragments of normal lacrimal gland were also identified. The histological features were felt to be most consistent with a benign cystic oncocytoma, arising from the lacrimal gland []. | [[19.0, 'year']] | M | {'28943925': 1, '19843013': 1, '843279': 1, '21956543': 1, '24551004': 2} | {} |
165,613 | 3912772-1 | 24,551,005 | noncomm/PMC003xxxxxx/PMC3912772.xml | Squash cytology of primary central nervous system lymphoma in an immunocompetent patient | This was a case report of a 38-year-old male patient who was admitted to neurosurgery with a history of headache and neck pain since 2 months. No history of antecedent head trauma, febrile illness, photophobia, seizures or previous diagnosis of any malignancy was present. He didn′t have lymphadenopathy or hepatosplenomegaly. Neurologic examination was not revelatory as no abnormality was found. His peripheral smear examination was normal. He was negative for human immunodeficiency virus (HIV).\nMRI of the brain revealed a well-defined lobulated focal mass measuring 4.5 cm × 3.6 cm × 3.5 cm with extensive adjacent white matter edema in right parieto-occipital lobe causing mass effect on right lateral and third ventricle and basal ganglia region with contralateral midline shift of 9 mm. On T1-weighted images mass was isointense to gray matter []. On T2-weighted and fluid-attenuated inversion recovery images, it appeared iso to mildly hyperintense []. There was mild restricted diffusion. The lesion showed intense homogeneous enhancement on post contrast study [Figure and ]. Small area of central necrosis was seen within the mass. MR spectroscopy revealed an elevated choline and lipid lactate. MRI findings were concluded as glioma.\nPatient underwent craniotomy for micro-neurosurgical complete resection by aspiration of the suspected glioma. Squash preparations were made from tissue received for frozen section and stained with hematoxylin and eosin. Monomorphic lymphoid tumor cells were seen without any fibrillary background []. The cells had large nuclei with prominent nucleoli and scant to moderate cytoplasm. Further, lymphoid cells having a blast like appearance with cytoplasmic vacuoles were recognized better on Leishman stain []. Tingible body macrophages and lymphoglandular bodies were seen. The frozen sections showed the tumor cells in sheets, but the cytologic details were not clear.\nWith intraoperative diagnosis of lymphoma infiltration on squash smears, on table bone marrow aspiration was done from the sternum to rule out hemopoietic malignancy in the marrow. The bone marrow smears showed normal marrow cells.\nA squash unstained smear was further studied with immunocytochemistry for CD45 (with a satisfactory positive control). The smears showed cytoplasmic CD45 positivity in intact tumor cells [].\nThe paraffin sections revealed the typical lymphoma cells displaying perivascular pattern and invading the brain [Figure and ]. The starry sky appearance was also seen []. The diagnosis of PCNSL was conferred. The immunohistochemical studies showed CD20 positivity [] in lymphoma cells while they were negative for CD3, CD10, Bcl2, Bcl6 [Figure –] and CD99. CD3 positive reactive T cells were seen amidst the lymphoma cells []. The negativity of lymphoma cells for CD10, Bcl2, Bcl6 and positivity to CD20 indicate the non-germinal center B-cell phenotype.\nThe final diagnosis of diffuse large B cell primary CNS lymphoma (DLBCL) was given. Post-operative contrast CT showed complete removal of the lesion and the patient received chemo and radiotherapy. MRI after 2½ years follow-up showed no evidence of recurrence. | [[38.0, 'year']] | M | {'16565780': 1, '15688978': 1, '17134117': 1, '19433528': 1, '18619384': 1, '15690139': 1, '10563426': 1, '9397461': 1, '17134115': 1, '21294090': 1, '24551005': 2} | {} |
165,614 | 3912773-1 | 24,551,006 | noncomm/PMC003xxxxxx/PMC3912773.xml | Schwannomatous components in a recurrent lipomyelocele: Report of a rare case | A 7-year-old male child presented with low back pain and difficulty in walking for last 6 months in 2003. The child had malaise, but without any neurologic deficits. Magnetic resonance imaging (MRI) revealed a lipomatous tumor at L4–L5 and L5–S1 intervertebral disc. The patient was operated under general anesthesia and the specimen was sent for histopathologic examination. Microscopic examination of the resected specimen confirmed a diagnosis of lipomyelocele.\nThe patient was followed up subsequently. At first, the patient was followed up at 3 months interval for 2 years and then at 6 months interval. During the follow-up period, in the year 2011, after 8 years of first operation, the patient again complained of low back pain and difficulty in walking. MRI examination revealed a lipomatous tumor at the previous location []. Mild bulge of L4–L5 and L5–L5–S1 intervertebral disc was seen causing slight pressure on thecal sac and existing perineural fat planes. Evidence of laminectomy was seen involving sacral segment as a sign of previous operation. The patient was operated again under general anesthesia and the resected specimen was sent for histopathologic examination. Microscopic examination revealed admixture of neural elements of spinal cord and fatty areas []. Focal area was showing features of schwannoma with hypocellular and hypercellular areas and Verocay bodies []. Thus, a histologic diagnosis of lipomyelocele with schwannomatous component was made.\nThe patient was on follow-up for 1 year. During this period, he was symptom free and no recurrence occurred. | [[7.0, 'year']] | M | {'20375914': 1, '15081131': 1, '18184836': 1, '19240973': 1, '26426667': 2, '21811702': 2, '10201700': 1, '15026728': 1, '19240974': 1, '24551006': 2} | {'3144596-1': 1, '3144596-2': 1, '3144596-3': 1, '4616857-1': 1} |
165,615 | 3912774-1 | 24,551,007 | noncomm/PMC003xxxxxx/PMC3912774.xml | Multiple intracranial abscesses: Heralding asymptomatic venosus ASD | A 13-year-old Saudi girl presented with 1 week history of headache, vomiting, and fever. She was treated by oral antibiotics with no relief. Two days prior to admission, she started talking incomprehensively, developed photophobia, and ataxia. Patient had chicken pox 4-weeks prior to admission that lasted 2 weeks. She also complained of chronic recurrent headache and fainting attacks with some abnormal movements, 4-5 times in the last 5 years. Each attack lasted a few minutes. She had exertional chest pain, dyspnoea, and palpitation on walking short distance. No treatment was sought for these conditions. There was no history of cyanotic or rheumatic heart disease or chronic infection. She had no exposure to chronic contagious diseases or animals.\nOn admission, HR was 105/min. Temperature and BP were normal and RR 32/min. No cyanosis, clubbing or lymphadenopathy. Paranasal sinuses were normal. No cardiac murmur. Other systemic examinations were normal. Neurologically, she was fully conscious and oriented with gross ataxia. Fundus showed early papilloedema. Muscle tone and power were normal in all the four limbs. There was no nystagmus or tremor. She could not walk without support.\nHematological tests revealed normal hemoglobin and polymorphonuclear pleocytosis with 80% neurtrophils. RBC count was normal. ESR was 62 mm 1st h and CRP 27 mg/L. Serum biochemistry showed raised GGT with reversed albumin globulin ratio. Blood culture was sterile. Tests for other infective and parasitic conditions were normal. Stool did not show any ova or cyst. PPD and HIV, both were negative. X-ray chest, ECG, and transthoracic echocardiogram (TTE) were normal. Transesophageal echocardiography (TEE) was refused by the patient. CT scan of the brain revealed almost 12 identical contrast enhancing ring lesions on both sides of the brain with uniform wall thickness and perilesional edema suggestive of multiple intracranial abscesses []. All the lesions were almost of same size indicating same age. Abdominal and pelvic ultrasounds were normal.\nShe was treated with Ceftriaxone, Vancomycin, Metronidazole, Mannitol, Dexamethasone, and Diphenyl hydantoin. She made significant improvement. Dexamethasone and Mannitol were withdrawn gradually once condition got stabilized. Two weeks after admission, the patient suddenly deteriorated, became bradycardic, lethargic, and had screaming attacks with labile mood and visual hallucinations. No cranial nerve or motor deficits were present. Mannitol and Dexamethasone were restarted. EEG showed abnormal slow waves with underlying multifocal epileptic discharges predominantly on right temporo-occipital region. Repeat CT scan of brain showed increase in the size of right thalamic lesion compressing the posterior III ventricle/aqueduct with obstructive triventricular dilatation and periventricular lucency. There were no changes in other lesions. She underwent stereotactic aspiration of the right thalamic lesion and 5 cc of brownish pus was aspirated. Gram stain showed gram positive cocci in chains. However, the culture was sterile. Repeatedly, blood cultures and TTE were normal. Empirically, Gentamycin was added to the treatment regimen and the patient gradually started improving. Repeat CT scan of brain showed gradual reduction in the size of abscesses. She was given IV antibiotics for 6 weeks and another 8 weeks of oral antibiotics.\nResolution of lesions was very gradual and total clearance of all the lesion took 30 months on MRI. Antiepileptic drugs were continued. Repeat TTE, 36 months later showed enlarged right heart chambers with a suggestion of venosus atrial septal defect (ASD) []. Pulmonary artery pressure (PAP) was 25-30 mmHg. TEE confirmed 1.8 cms sinus venosus ASD from the SVC side [] with anomalous drainage of right upper pulmonary vein. Right heart chambers were dilated. The shunt was left to right. She underwent correction of the defect and did well. | [[13.0, 'year']] | F | {'10878771': 1, '10461779': 1, '1990793': 1, '18596450': 1, '20663157': 1, '15875200': 1, '10916131': 1, '11025634': 1, '8244485': 1, '17312653': 1, '19810297': 1, '7708172': 1, '12795014': 1, '17600615': 1, '12068149': 1, '24551007': 2} | {} |
165,616 | 3912775-1 | 24,551,008 | noncomm/PMC003xxxxxx/PMC3912775.xml | A rare case of recurrent primary spinal echinococcosis | We report a 65 year old man who presented to us with complaints of low backache radiating to left hip for 3 years and urge incontinence for 20 days. Patient had underwent laminectomy with excision of hydatid cysts 13 years back []. Postoperatively patient had received albendazole therapy. On examination, all forms of sensations were decreased bilaterally and symmetrically in the saddle distribution. Motor deficit was not marked but ankle reflex was absent on both sides. Local examination revealed midline scar in lumbosacral region with prominent left paraspinal area. Total blood cell counts, erythrocyte sedimentation rate (ESR), complete biochemical serum, and urine parameters, coagulation tests, ultrasonography abdomen and chest radiograph were within normal ranges. ELISA for Echinococcus granulosus was positive. MRI revealed multiple loculated cystic swelling in left paraspinal area with extension into extradural space at S2 level causing thecal sac compression [Figures and ]. Patient was put on albendazole preoperatively and underwent re-exploration with excision of multiple hydatid cysts in lumbosacral spine [Figures and ]. Histopathological examinations confirmed hydatidosis. Postoperatively patient was put on combination therapy of albendazole and praziquantel. Patient recovered uneventfully with good bladder control and without new deficits. | [[65.0, 'year']] | M | {'7922837': 1, '7414479': 1, '7280247': 1, '26692911': 1, '34040806': 1, '9554015': 1, '11112873': 1, '16261123': 1, '9266261': 1, '17414991': 1, '21799621': 2, '9689631': 1, '10707401': 1, '17561751': 1, '12953951': 1, '17996916': 1, '1892028': 1, '24551008': 2} | {'3137835-1': 1} |
165,617 | 3912782-1 | 24,516,814 | noncomm/PMC003xxxxxx/PMC3912782.xml | Tibial bone fractures occurring after medioproximal tibial bone grafts for oral and maxillofacial reconstruction | Patient 1 was a 46-year-old, 68.2 kg male. He underwent right tibial graft surgery due to an oroantral fistula.() Fracture occurred when he jumped from a truck 20 days after surgery.() Noninvasive reduction and fixation were performed for 56 days (, ), and the fracture was completely healed after six months.() | [[46.0, 'year']] | M | {'12378490': 1, '5521530': 1, '12618977': 1, '12964798': 1, '3865491': 1, '12064877': 1, '15789317': 1, '9777498': 1, '29109841': 1, '28428919': 1, '1333008': 1, '15907349': 1, '33771180': 1, '8961013': 1, '11564109': 1, '22133867': 1, '1762010': 1, '10371319': 1, '12966306': 1, '17482845': 1, '20006156': 1, '24516814': 2} | {'3912782-2': 2, '3912782-3': 2, '3912782-4': 2} |
165,618 | 3912782-2 | 24,516,814 | noncomm/PMC003xxxxxx/PMC3912782.xml | Tibial bone fractures occurring after medioproximal tibial bone grafts for oral and maxillofacial reconstruction | Patient 2 was a 63-year-old, 56.6 kg female. She underwent right tibial graft surgery due to a mandibular radicular cyst. Fracture occurred when she jumped to exit a bus 12 days after surgery.() Noninvasive reduction and fixation were performed for 80 days (, ), and the fracture was completely healed after six months.() | [[63.0, 'year']] | F | {'12378490': 1, '5521530': 1, '12618977': 1, '12964798': 1, '3865491': 1, '12064877': 1, '15789317': 1, '9777498': 1, '29109841': 1, '28428919': 1, '1333008': 1, '15907349': 1, '33771180': 1, '8961013': 1, '11564109': 1, '22133867': 1, '1762010': 1, '10371319': 1, '12966306': 1, '17482845': 1, '20006156': 1, '24516814': 2} | {'3912782-1': 2, '3912782-3': 2, '3912782-4': 2} |
165,619 | 3912782-3 | 24,516,814 | noncomm/PMC003xxxxxx/PMC3912782.xml | Tibial bone fractures occurring after medioproximal tibial bone grafts for oral and maxillofacial reconstruction | Patient 3 was a 53-year-old, 55.6 kg male who underwent tibial graft surgery due to a maxillary dentigerous cyst.() Fracture occurred when he slipped and hit a stair edge 42 days after surgery.() Open reduction and fixation were performed at another hospital, and he fully recovered. | [[53.0, 'year']] | M | {'12378490': 1, '5521530': 1, '12618977': 1, '12964798': 1, '3865491': 1, '12064877': 1, '15789317': 1, '9777498': 1, '29109841': 1, '28428919': 1, '1333008': 1, '15907349': 1, '33771180': 1, '8961013': 1, '11564109': 1, '22133867': 1, '1762010': 1, '10371319': 1, '12966306': 1, '17482845': 1, '20006156': 1, '24516814': 2} | {'3912782-1': 2, '3912782-2': 2, '3912782-4': 2} |
165,620 | 3912782-4 | 24,516,814 | noncomm/PMC003xxxxxx/PMC3912782.xml | Tibial bone fractures occurring after medioproximal tibial bone grafts for oral and maxillofacial reconstruction | Patient 4 was a 35-year-old, 68.7 kg male who underwent right tibial graft surgery due to an odontogenic keratocyst of an anterior mandibular tooth and the premolar region. Fracture occurred when he bumped into a vending machine 18 days after surgery. Open reduction and fixation were performed at another hospital, and he fully recovered. X-ray images could not be obtained. | [[35.0, 'year']] | M | {'12378490': 1, '5521530': 1, '12618977': 1, '12964798': 1, '3865491': 1, '12064877': 1, '15789317': 1, '9777498': 1, '29109841': 1, '28428919': 1, '1333008': 1, '15907349': 1, '33771180': 1, '8961013': 1, '11564109': 1, '22133867': 1, '1762010': 1, '10371319': 1, '12966306': 1, '17482845': 1, '20006156': 1, '24516814': 2} | {'3912782-1': 2, '3912782-2': 2, '3912782-3': 2} |
165,621 | 3912785-1 | 24,516,821 | noncomm/PMC003xxxxxx/PMC3912785.xml | Alloplastic total temporomandibular joint replacement using stock prosthesis: a one-year follow-up report of two cases | A 50-year-old female patient who had no specific medical history visited the hospital with facial asymmetry (chin deviation to the right side), limitation of mouth opening, and jaw pain that had persisted for two years. The clinical examination showed limitation of mouth opening (approximately 20 mm) along with TMJ pain on the left side and deviation of chin top to the right side. The radiography and computed tomography showed signs of considerable osseous proliferation extended to the cranial base and multiple radiopaque lesions suspected as phlebolith.() The initial diagnosis was osteochondroma on the left condyle. She underwent condylectomy, and her chin top--which deviated to the right side--was also reduced to the midsagittal plane. Active physical therapy was conducted, and clinical favorable mouth opening (approximately 32 mm) was finally achieved in four months.() Two years after surgery, however, she complained of limitation of mouth opening and discomfort of mastication. The X-ray revealed trauma from occlusion (TFO) in the maxillary molar area on the ipsilateral side as well as progressive osteoarthritis on the previous resection area. Total TMJ replacement using stock prosthesis on the ipsilateral joint was finally planned.\nStock TMJ prosthesis consists of fossa and condylar components, each of which requiring preauricular and retromandibular approaches. After condylectomy was performed to secure spaces for prosthesis via the preauricular approach, retromandibular incision was conducted. Bone trimming of uneven surface on articular eminence was followed by the installation of fossa component, and subsequent positioning of the condylar component was accomplished. After the optimal occlusion of the patient was maintained, fixation of the mandibular component was done with titanium screw.() Since the TMJ replacement, the patient had not suffered from remarkable postoperative complications including ipsilateral facial nerve weakness, paresthesia, pain, and dysfunction. She began light mouth opening exercise two weeks after the surgery and subsequently performed active exercise. Finally, she was able to maintain approximately 30 mm mouth opening, favorable mastication capability, and alleviation of TMJ pain since two months postoperative.() | [[50.0, 'year']] | F | {'21332746': 1, '18022347': 1, '18088840': 1, '26568928': 1, '17656290': 1, '21376536': 1, '23769150': 1, '21889086': 1, '21044827': 1, '21878254': 1, '21123031': 1, '19464145': 1, '9638694': 1, '17517298': 1, '22771166': 1, '18657432': 1, '20594807': 1, '32612715': 1, '10632168': 1, '24516821': 2} | {'3912785-2': 2} |
165,622 | 3912785-2 | 24,516,821 | noncomm/PMC003xxxxxx/PMC3912785.xml | Alloplastic total temporomandibular joint replacement using stock prosthesis: a one-year follow-up report of two cases | A 21-year-old male patient--who had undergone closed reduction for the fracture of bilateral mandibular condyle caused by a traffic accident five years ago--visited the hospital with limitation of mouth opening and pain on the left TMJ. He also had no specific medical history and showed limitation of mouth opening (approximately 16 mm) accompanying TMJ pain and crepitus on the left side along with troubled lateral excursion. The computed tomography image revealed signs of fibrous ankylosis and heterotopic bone formation on the postero-lateral surface of the left condyle head and temporal bone.(, ) The plan of combined gap arthroplasty and total TMJ replacement was finally established.\nGap arthroplasty was performed, including condylectomy and excision of the 40×30×30 mm lesion of fibrous and bony ankylosis in the left TMJ.() After normal range of jaw movement (approximately 30 mm) was secured, retromandibular incision was done. Bone trimming of articular eminence was consequently conducted, followed by the installation of prosthetic components.() Postoperatively, the patient also began light mouth opening exercise followed by subsequent active exercise and achieved approximately 40 mm mouth opening in 2 months. He showed no loosening or missing of screws in the prosthetic component (, ) and substantial alleviation of pain on the ipsilateral joint and maintained up to 40 mm mouth opening.(, ) | [[21.0, 'year']] | M | {'21332746': 1, '18022347': 1, '18088840': 1, '26568928': 1, '17656290': 1, '21376536': 1, '23769150': 1, '21889086': 1, '21044827': 1, '21878254': 1, '21123031': 1, '19464145': 1, '9638694': 1, '17517298': 1, '22771166': 1, '18657432': 1, '20594807': 1, '32612715': 1, '10632168': 1, '24516821': 2} | {'3912785-1': 2} |
165,623 | 3912787-1 | 24,516,820 | noncomm/PMC003xxxxxx/PMC3912787.xml | Verruciform xanthoma of the palatal gingiva: a report of two cases | A 37-year-old man visited our hospital (Gangnam Severance Hospital in Seoul, Korea) because of a poorly healing wound on his palate. The patient accidentally discovered the wound one year prior to his first visit. Although the patient did not experience any pain, he described the lesion as being somewhat uncomfortable or sensitive when irritated by food or palpation. The patient was advised to undergo a biopsy even though the lesion did not seem to progress and change in size, shape, or position.\nThe patient did not report any significant past medical history, history of trauma, or exceptional medical or family history. He reported a 13-year smoking history but no other specific social habits. During the intraoral examination, a well-demarcated soft and pedunculated papule with a verruciform papillary surface was found on the left side of the hard palate. The lesion was approximately 1.5 cm in diameter, reddish in color, and clinically asymptomatic.() No other intraoral or skin lesions were identified. During the radiological examination, complete with periapical and panoramic radiographs, no specific findings were observed.() Considering the results of the clinical and radiographic examinations, we identified multiple provisional diagnoses of this lesion, including leukoplakia, papilloma, condyloma acuminatum, and malignancies such as squamous cell carcinoma or verrucous carcinoma. Given the lesion's size, history, well-demarcated margin, and the results of a neck node examination, however, the probability of malignancy was quite low. An excisional biopsy, rather than an incisional biopsy, was then planned and performed in order to resect the total lesion and obtain a definitive diagnosis. Histopathological examination revealed a papillary proliferation of the stratified squamous epithelial cell layer, which was covered with a hyperkeratotic layer of uniform thickness, about that of the stratum spinosum.() Distinctive foam cells, also referred to as xanthoma cells, as well as macrophages with vacuolated cytoplasm could be seen in the connective tissue layer when magnified under a high-resolution microscope.()\nAfter the lesion was totally resected, the surgical site underwent normal secondary healing processes. The patient had no complications, and there was no evidence of recurrent disease during the three-year follow-up period.() | [[37.0, 'year']] | M | {'12676251': 1, '8236821': 1, '28209012': 1, '26751781': 1, '19958440': 1, '5280461': 1, '2539022': 1, '28761282': 2, '29924759': 1, '21305367': 1, '17339158': 1, '1057149': 1, '17211369': 1, '28053911': 1, '3859615': 1, '19930992': 1, '16218939': 1, '24516820': 2} | {'3912787-2': 2, '5512415-1': 1} |
165,624 | 3912787-2 | 24,516,820 | noncomm/PMC003xxxxxx/PMC3912787.xml | Verruciform xanthoma of the palatal gingiva: a report of two cases | A 35-year-old man was referred to our clinic for evaluation of a lesion that developed on his hard palate. The patient became aware of the lesion one month prior to his first visit. During consultation, he complained that the lesion became sensitive when it came in contact with hot and salty foods, but he experienced no other specific symptoms. The patient had a history of an unknown sexually transmitted disease, which he contracted one year prior to his first visit and completely recovered from by the time of consultation. In addition, the patient had a 20-year history of heavy smoking. No other specific general diseases or exceptional medical history were noted. During the clinical examination, which was conducted during his first consultation, a soft sessile mass with a verrucous, papillary surface resembling a strawberry was found on the palatal gingiva of the left maxillary second premolar and first molar. The lesion was 2.5×1.0 cm in size, well demarcated, and pinkish in color. It was not painful when palpated. He also had a normal response in the percussion, mobility, and vitality tests of his teeth, however; the palatal aspect of his left maxillary first molar showed mild gingival recession. The radiological examination, including periapical and panoramic radiographs, did not yield specific results. Further, there was no enlargement or induration of his bilateral neck lymph nodes on palpation. Though we could not obtain more information about his medical history in regard to his sexually transmitted disease, we suspected a relationship. We diagnosed the lesion with differentials that included syphilis and malignancies such as squamous cell carcinoma or verrucous carcinoma. An incisional biopsy for a definitive diagnosis was performed one week after the initial examination. During histopathologic examination, histology slides obtained from the biopsy showed a papillary squamous epithelial cell layer covered with parakeratotic surface () and xanthoma cells in the subepithelial connective tissue layer (), distinctive features of VX. Conservative surgical resection was performed after the results of the biopsy were confirmed. Postoperative follow-up examination showed a well-healed surgical site, and the patient had no complaints.\nFour years after this resection, the patient returned to our clinic for the recurrent appearance of the lesion at the same site. The lesion appeared to have grown to a similar size, and its shape was also similar to the one resected previously. Further, the recurring mass affected the same part of the buccal gingiva around his left maxillary second premolar and first molar. Once a clinical diagnosis of a recurrent lesion of the pre-existing VX was made, a wide surgical resection, which included seemingly normal tissues surrounding the lesion, was performed. The results of the histopathologic examination of the recurrent lesion were the same as that of the initial lesion. The patient has been followed-up at regular intervals of fewer than six months for the past ten years, and there has been no evidence of VX recurrence. | [[35.0, 'year']] | M | {'12676251': 1, '8236821': 1, '28209012': 1, '26751781': 1, '19958440': 1, '5280461': 1, '2539022': 1, '28761282': 2, '29924759': 1, '21305367': 1, '17339158': 1, '1057149': 1, '17211369': 1, '28053911': 1, '3859615': 1, '19930992': 1, '16218939': 1, '24516820': 2} | {'3912787-1': 2, '5512415-1': 1} |
165,625 | 3912796-1 | 24,550,598 | noncomm/PMC003xxxxxx/PMC3912796.xml | Stevens-Johnson syndrome following use of metronidazole in a dental patient | A 50-year-old nonalcoholic male was diagnosed with erosive lichen planus and prescribed oral vitamins, topical triamcinolone, and oral metronidazole 400 mg twice daily. He took the first dose of metronidazole at 10.30 am and developed burning sensation and itching all over the body around 4 pm the same day. He took cetirizine tablet 5 mg orally on his own and the symptoms abated by evening. Then around 10 pm he took the second dose of metronidazole. After 2 h, he developed severe burning sensation and itching all over the body followed by dizziness, confusion, convulsions, and transient loss of consciousness for a period of 15-20 min. Around 2.30 am, he complained of shivering and palpitation and in the morning, he felt pain over the both feet during walking, redness over the face and neck, and itching and erosion over scrotal skin. He then consulted a general physician, who withdrew metronidazole and had referred him to a dermatologist. He visited the dermatologist the next day by which time he developed fever, ulcers around lips and oral mucosa, difficulty on swallowing and burning sensation during micturition. He had no history of neurological disease. His pulse, blood pressure and other systemic examinations were within normal limits; and he had hemorrhagic encrustation around the lips and oral mucous membrane [], erosion of scrotal skin, creamy urethral discharge, and big blisters over the both planter regions. His routine blood examination was normal except postprandial hyperglycemia (2 h postprandial blood plasma glucose level was 234 mg/dL) and urine examination showed plenty of pus cells, however culture was negative. He was diagnosed clinically and managed as a case of SJS with involvement of approximately 3% of total body surface area. He was treated with oral olopatadine 5 mg, methyl prednisolone 16 mg, famotidine 40 mg once a day, and erythromycin 500 mg thrice daily for 7 days. Methylprednisolone was tapered over the next 14 days. For hyperglycemia, patient had received glimeperide 1 mg orally once daily for 1 week which controlled the blood glucose levels and the patient remained euglycemic even after the drug was withdrawn. The patient recovered without any sequelae in 3 weeks. | [[50.0, 'year']] | M | {'32110375': 1, '25298597': 1, '17314152': 1, '29692452': 1, '16918620': 1, '29731949': 1, '25298596': 1, '32191702': 2, '34527487': 2, '31405062': 1, '8776350': 1, '33777846': 1, '7249508': 1, '1739287': 1, '24550598': 2} | {'7081979-1': 1, '7081979-2': 1, '8432438-1': 1} |
165,626 | 3912797-1 | 24,550,599 | noncomm/PMC003xxxxxx/PMC3912797.xml | Clopidogrel: A possible exacerbating factor for psoriasis | This 64-year-old human immunodeficiency virus-negative, non-smoker and non-alcoholic male patient presented with pustular psoriasis involving both palms and soles for the past >2years with waxing and waning clinical course. There was no personal or family history of psoriasis previously. Historically, he had developed acrodermatitis continua of Hallapeu-like skin lesions 7-8 months after taking treatment for a clinically suspected CAD despite having a normal electorcardiogram, echocardiography and treadmill test. Patient was taking diltiazem (75 mg/d), atenolol (50 mg/d), aspirin (75 mg/d) and atorvastatin (10 mg/d). Since both the drugs are known to precipitate/aggravate psoriasis atenolol and aspirin were stopped and clopidogrel 75 mg/d was prescribed by his physician. However, his skin lesions progressed relentlessly eventuating into palmoplantar psoriasis with pustulosis []. A skin biopsy from a pustular lesion showed hyperkeratosis, parakeratosis, acanthosis, papillomatosis and papillary neutrophilic collection suggestive of psoriasis having pustular differentiation []. He did not improve with topical emollients, tar and corticosteroid ointments and developed intolerable retching/vomiting after systemic methotrexate (15 mg/week). Although he continued with topical treatment, his skin lesions did not remit. However, his skin lesions disappeared completely within a month when he stopped all medications which were for CAD without his physician's advice. He did not develop any skin lesions after restarting diltiazem and atorvastatin on the insistence of his physician but these returned within a week after taking clopidogrel (75 mg/d) re-challenge (performed with his consent). Since then he has stopped all his drugs on his own and is free of psoriasis and has not developed any symptoms/signs of CAD. | [[64.0, 'year']] | M | {'15193841': 1, '9429837': 1, '12948927': 1, '16911296': 1, '11519503': 1, '20124268': 1, '12543298': 1, '24550599': 2} | {} |
165,627 | 3912798-1 | 24,550,600 | noncomm/PMC003xxxxxx/PMC3912798.xml | Necrotizing fasciitis secondary to bevacizumab treatment for metastatic rectal adenocarcinoma | A 49-year-old man was admitted to clinic with rectal bleeding. Low anterior resection with ileostomy was performed for rectal mass 5 cm from anus. According to the tumor, node, metastases classification, the pathological stage of the carcinoma was T3N1M0 (stage IIIA). The patient was treated with adjuvant 45 Gy chemoradiotherapy with 5-fluorouracil 225 mg/m2 daily and then fluorouracil-leucovorin-oxaliplatin (FOLFOX4) regimen. After two cycles of FOLFOX4 regimen, serum carcinoembryonic antigen levels had increased. In the radiologic evaluation with chest and abdominal computed tomography, new liver metastases in both lobes were detected. The hepatic metastases were unresectable, hence the patient shifted to regimen of 5-fluorouracil-leucovorin-irinotecan (FOLFIRI). After 12 courses of the FOLFIRI regimen every 2 weeks, the chemotherapy was stopped due to the stable liver metastases. Because of the new metastatic lesions in the liver and pelvic recurrence, bevacizumab added to FOLFIRI regimen. After 10 days of the third cycle of the FOLFIRI-bevacizumab regimen, the patient was admitted with fever, weakness, abdominal pain and erythema of the proximal side of right thigh. The laboratory evaluation revealed a white blood cell count of 22.000/μl (normal value 4,400-11,000/μl) with increased C-reactive protein to 160 mg/l (normal value: 0-10 mg/l). The magnetic resonance imaging (MRI) of the pelvis showed widespread significant air-fluid level abscess in the tissues of right gluteus maximus, gluteus minimus and vastus muscles. A clinical diagnosis of necrotizing fasciitis was made. Ultrasonography-guided drainage of the abscess was performed and 10F pigtail catheter was inserted to the abscess location. The microbiological culture of the material was revealed vancomycin-resistant enterococcus (VRE), Escherichia coli, and Bacteroides fragilis. The patient was treated with linezolid, imipenem, and metronidazole. Patient responded to treatment for initial few days, but on the 7th day of the antibiotic treatment, acute renal failure and septic shock was developed. The patient died due to the refractory septic shock. | [[49.0, 'year']] | M | {'15867200': 1, '24725844': 2, '15175435': 1, '11770800': 1, '1865403': 1, '20015718': 1, '21764243': 1, '19228540': 1, '17806049': 1, '32337042': 1, '31428562': 1, '16854763': 1, '18421710': 1, '24550600': 2} | {'3995739-1': 1} |
165,628 | 3913137-1 | 24,505,525 | noncomm/PMC003xxxxxx/PMC3913137.xml | Secondary Myelodysplastic Syndrome May Happen Same as Paraneoplastic Syndrome in a Period of Time and Prior to The Appearance of Malignancy: A case Study of 6 Patients | The first patients was a 27 year old female who has been referred because of Anemia and Leukopenia and during follow up due to Anemia continuity and refractory anemia, she underwent BMA and BMB and had MDS criteria ().\nBesides repeated blood injection along with supportive and therapeutic measures she had been followed up and during a 7 month period, she had a surgery because of Breast mass and she was diagnosed as breast cancer. Patient underwent chemotherapy and Anemia and Cytopenia has been completely resolved after the completion of treatment. | [[27.0, 'year']] | F | {'2672599': 1, '11846355': 1, '1503093': 1, '6931507': 1, '2003516': 1, '7986716': 1, '10688812': 1, '12393427': 1, '1379818': 1, '6952920': 1, '1736367': 1, '3460627': 1, '1736370': 1, '1419819': 1, '10828005': 1, '6340754': 1, '8547082': 1, '24505525': 2} | {'3913137-2': 2, '3913137-3': 2, '3913137-4': 2, '3913137-5': 2, '3913137-6': 2} |
165,629 | 3913137-2 | 24,505,525 | noncomm/PMC003xxxxxx/PMC3913137.xml | Secondary Myelodysplastic Syndrome May Happen Same as Paraneoplastic Syndrome in a Period of Time and Prior to The Appearance of Malignancy: A case Study of 6 Patients | The second patient was a 49 year old man who was referred to clinic because of Macrocytic Anemia and low Retic count and he underwent BMA and BMB because of Anemia continuity and has diagnosed as MDS in BMA (, ).\nDuring follow up period, patient required blood injection once each 15 days, so thalidomide was started for him. He had frequent infections because of leukopenia and had a history of hospitalization. During follow up period and after 1.5 months of thalidomide initiation and 9 months later, he was affected by colon cancer and had no problem in CBC diff. after treatment of colon cancer. | [[49.0, 'year']] | M | {'2672599': 1, '11846355': 1, '1503093': 1, '6931507': 1, '2003516': 1, '7986716': 1, '10688812': 1, '12393427': 1, '1379818': 1, '6952920': 1, '1736367': 1, '3460627': 1, '1736370': 1, '1419819': 1, '10828005': 1, '6340754': 1, '8547082': 1, '24505525': 2} | {'3913137-1': 2, '3913137-3': 2, '3913137-4': 2, '3913137-5': 2, '3913137-6': 2} |
165,630 | 3913137-3 | 24,505,525 | noncomm/PMC003xxxxxx/PMC3913137.xml | Secondary Myelodysplastic Syndrome May Happen Same as Paraneoplastic Syndrome in a Period of Time and Prior to The Appearance of Malignancy: A case Study of 6 Patients | The third patient was a 40 year old female due to refractory anemia and leucopenia. She underwent BMA and BMB and had MDS criteria including dyserithropoies and dysgranlopoiesis () who has been diagnosed by colon cancer during a12 months follow up period. | [[40.0, 'year']] | F | {'2672599': 1, '11846355': 1, '1503093': 1, '6931507': 1, '2003516': 1, '7986716': 1, '10688812': 1, '12393427': 1, '1379818': 1, '6952920': 1, '1736367': 1, '3460627': 1, '1736370': 1, '1419819': 1, '10828005': 1, '6340754': 1, '8547082': 1, '24505525': 2} | {'3913137-1': 2, '3913137-2': 2, '3913137-4': 2, '3913137-5': 2, '3913137-6': 2} |
165,631 | 3913137-4 | 24,505,525 | noncomm/PMC003xxxxxx/PMC3913137.xml | Secondary Myelodysplastic Syndrome May Happen Same as Paraneoplastic Syndrome in a Period of Time and Prior to The Appearance of Malignancy: A case Study of 6 Patients | The fourth patient was a 28 year old female who has been referred because of Macrocystic Anemia, thrombocytopenia and low Retic counts. During 6 months follow up interval, patient affected by neck mass and she was diagnosed as Hodgkin lymphoma. However she no need to blood transfusion but MDS criteria () disappeared after treatment of oncology disease. | [[28.0, 'year']] | F | {'2672599': 1, '11846355': 1, '1503093': 1, '6931507': 1, '2003516': 1, '7986716': 1, '10688812': 1, '12393427': 1, '1379818': 1, '6952920': 1, '1736367': 1, '3460627': 1, '1736370': 1, '1419819': 1, '10828005': 1, '6340754': 1, '8547082': 1, '24505525': 2} | {'3913137-1': 2, '3913137-2': 2, '3913137-3': 2, '3913137-5': 2, '3913137-6': 2} |
165,632 | 3913137-5 | 24,505,525 | noncomm/PMC003xxxxxx/PMC3913137.xml | Secondary Myelodysplastic Syndrome May Happen Same as Paraneoplastic Syndrome in a Period of Time and Prior to The Appearance of Malignancy: A case Study of 6 Patients | The fifth patient was a 39 year old female who was referred because of severe Anemia and Cytopenia and she was diagnosed as MDS in BMA (). During a 4 month follow up period, she had a mass in supraclavicular area and after neck mass resection; she was diagnosed as Hodgkin's lymphoma and patients required blood injection and antibiotics for infection treatment. After the treatment of fourth and fifth patients, blood disorders are totally resolved. In next BMA review, Myelofibrosis or RS (reed-sternberg cell) wasn't seen. | [[39.0, 'year']] | F | {'2672599': 1, '11846355': 1, '1503093': 1, '6931507': 1, '2003516': 1, '7986716': 1, '10688812': 1, '12393427': 1, '1379818': 1, '6952920': 1, '1736367': 1, '3460627': 1, '1736370': 1, '1419819': 1, '10828005': 1, '6340754': 1, '8547082': 1, '24505525': 2} | {'3913137-1': 2, '3913137-2': 2, '3913137-3': 2, '3913137-4': 2, '3913137-6': 2} |
165,633 | 3913137-6 | 24,505,525 | noncomm/PMC003xxxxxx/PMC3913137.xml | Secondary Myelodysplastic Syndrome May Happen Same as Paraneoplastic Syndrome in a Period of Time and Prior to The Appearance of Malignancy: A case Study of 6 Patients | The sixth patient was a 52 year old male who had referred to clinic because of pancytopenia including thrombocytopenia and anemia and leukopenia and demonstrated MDS criteria in BMA. For this patient initiated nutrition drug but no needed to transfusion.\nDuring a 20 month follow up period, no considerable progression in MDS observed and he underwent treatment because of gastric cancer and after the end of treatment, his blood disorders totally resolved. | [[52.0, 'year']] | M | {'2672599': 1, '11846355': 1, '1503093': 1, '6931507': 1, '2003516': 1, '7986716': 1, '10688812': 1, '12393427': 1, '1379818': 1, '6952920': 1, '1736367': 1, '3460627': 1, '1736370': 1, '1419819': 1, '10828005': 1, '6340754': 1, '8547082': 1, '24505525': 2} | {'3913137-1': 2, '3913137-2': 2, '3913137-3': 2, '3913137-4': 2, '3913137-5': 2} |
165,634 | 3913138-1 | 24,505,526 | noncomm/PMC003xxxxxx/PMC3913138.xml | Asymtomatic Essential Thrombocythemia in a Child: A Rare Case Report | We describe a 10 years old male with an incidental finding of an elevated platelet count. This patient had been admitted due to upper respiratory tract infection. His post medical history was unremarkable with a normal birth history and was taking no medications. Immunizations status was up to date. The platelet count at the time of referral was 950x109/L. The physical examination was normal with the exception of mild splenomegaly (just palpable splenomegaly). He had lower leg pain but deep vein thrombosis ruled out with color dupler ultrasonography. His parent platelet count was normal and there was no family history of thrombocytosis. His white blood cell count and differential count were unremarkable, and platelet size was not enlarged. Hb, ESR and C-reactive protein were all within normal ranges. Bone marrow examination was normocellular with relatively normal numbers and maturation of erythroid and myeloid lineages but show clusters of large megakaryocytes with increased hyperlobulated nuclei (). Myeloblasts are about 5% of all nucleated cells. Bone marrow biopsy show remarkable bony trabeculae and marrow spaces contain hematopoietic elements with predominance of large hyperlobulated megakaryocytes. Reticulin staining was negative for myelofibrosis. The overall histological features suggest chronic myeloproliferative disorder without myelofibrosis suggestive of ET. Cytogentic showed normal 46, XY karyotype. No bcr/abl chimaeric transcript was demonstrated by reverse transcription polymerase chain reaction. JAK2-V617F mutation was negative. Evaluation of the MPL W515L/K gene was negative in the patient. He received low dose aspirin (80mg/day). Her platelet count ranging from 303x109 to2131x109 /L. He was admitted to hospital because of anxiety and right lower leg pain. At this time his platelet count was 2131x109/L and we started hydroxyurea 1000mg and anagrelide 2mg for him. The mean platelet count was 1029x109/L. The platelet count has shown a trend of gradual fall over the past year and the latest platelet count was 580x109/L. He is asymptomatic now. | [[10.0, 'year']] | M | {'17455310': 1, '10606871': 1, '30679326': 1, '26495377': 2, '18723910': 1, '7700286': 1, '10651728': 1, '17171694': 1, '16849644': 1, '24505526': 2} | {'4614560-1': 1} |
165,635 | 3913141-1 | 24,505,527 | noncomm/PMC003xxxxxx/PMC3913141.xml | Primary Hyperaldostronisim as Initial Presentation of Adrenal Cortical Carcinoma with Liver Metastasis: A Case Report | A 22-year-old female patient with a 4-month history of weakness and tachycardia referred to Imam Reza hospital in Tabriz because of intensity of symptoms and loss of consciousness. The blood examination revealed decreased levels of potassium; 2.7 mEq/L and her blood pressure was 190/100 mmHg, she just received emergency agents as outpatient. After three months, symptoms flared up and the patient was admitted to the department of internal medicine. A detailed past medical history of the patient was taken; hypertension during last six months and preeclampsia in her prior pregnancy were detected. No family history of malignancies found. In her review of systems; weight loss (7kg during last four months), weakness, headache, tachycardia, nocturia, polyuria, polydipsia and frequency were found and there was no significant history of abdominal pain, vomiting, urinary incontinence or fever. Mucosal dehydration and positive trousseau test were points in general and physical examination. Before hospitalization she obtained atenolol 50mg/24h for hypertension. Liver and renal function tests, complete blood count and urine 24h analysis were within normal limits. Urine complete examination was negative for albumin and sugar, and in microscopic analysis; WBC: 15-16 and epithelial cell: 27-28 was reported, No crystals or casts were detected and urine culture was negative. Serum potassium was 2.9mEq/L and serum Ca ion was 0.87mmol/L. Arterial blood gas examination indicated metabolic alkalosis (PH = 7.54, PCO2 = 34.7, HCO3 = 29). ECG and chest x-ray were normal. Blood measurements of plasma aldostron and rennin after one hour upright standing posture in the morning were: aldostron = 350 units, rennin = 0.9 units. A captopril Suppression Test (CST) did not result in aldostron suppression. In order to confirm the first diagnosis, an abdominal spiral computed tomography was performed but there was no evidence of any lesions in liver, kidneys and adrenal glands. Despite the previous oral and later intravenous potassium supplementation of up to 40mEq/24h, potassium level was low and on the 10th day of hospitalization it was 3.2mEq/L. Calcium channel blockers, β-blockers and potassium sparing diuretics were added to the treatment and resulted in blood pressure decrease to 140/80mmHg on the last day of hospitalization. The patient was discharged from hospital but symptoms recurred after a week. In magnetic resonance imaging (MRI) of adrenal glands with IV contrast, a mass measuring 53×25×46 mm in size at the posterior aspect of inferior vena cava and medial side of liver just above right adrenal gland confirmed an adrenal gland tumor (). The patient underwent exploratory laparotomy with excision of right adrenal gland. The tumor had extended behind IVC, no invasion to adjacent organs or metastasis to lymph nodes was noted during the operation. Per-operative finding was a mass of about 6×5.5×1.5 cm.\nHistopathological examination revealed adrenal tissue with a cortical adenoma with areas of hemorrhage and necrosis, composed of cells with granular cytoplasm, mild and focal nuclear pleomorphism and occasional mitosis. After the surgical intervention, she was discharged uneventfully. Then she was followed-up irregularly due to pregnancy. Signs and symptoms have been revealed for six months, until the end of her first trimester (16th week), meanwhile she had flaring of hypertension and hypokalemia during anesthesia for McDonald's operation. Followed-up MRI showed no evidence of recurrent tumor at right side, even size or configuration of left side adrenal gland was normal. Her poor follow-up during pregnancy resulted in recurring hypertension and hypokalemia during cesarean section. On post operative control MRI of abdomen one year after right adrenalectomy, a round solid mass at the site of removed adrenal gland measuring 56×53 mm on diameter was seen. The mass involved the inferior aspect of the liver and probably superior anterior aspect of the right kidney. These findings indicated relapse of the removed adrenal tumor (). Liver needle biopsy was performed and proved liver tissue with relatively normal parenchymal cells and small focus of atypical cells. Primary surgery's slides reviewed; pathological examination revealed a cream-brown mass about 3.5×3 cm with hemorrhagic and necrotic areas. On microscopic assessment, neoplastic proliferation of adrenocortical cells in a diffuse pattern sometimes with severe pleomorphism, tumor cell necrosis with occasionally mitoses more than 5/50HPF was seen.\nTumoral cells also invaded the capsule, so according to Weiss criteria for malignancy, (Nine histological criteria of Adrenal Cortical Carcinoma: 1. Nuclear grade C Fuhrman III/I 2. Mitotic rate 5/50 hpf. 3. Abnormal mitosis 4. <25% clear cells 5. 1/3 diffuse architecture 6. Necrosis 7. Venous invasion 8. Sinusoidal invasion 9. Capsular invasion), this neoplasm had five of nine criteria which was compatible with adrenal cortical carcinoma ( and ).\nThe patient was discussed in tumor board and surgery planned for her followed by adjuvant treatment; surgery versus chemotherapy with mitotane. The Patient underwent surgery again with resection of right recurring adrenal tumor, liver right lobe segmental lobectomy, cholecystectomy and resection of retroperitoneal mass was done under general anesthesia. Histopathologic assessment of second surgical specimens showed segmental lobectomy of right hepatic lobe (14×12×12 cm) and retroperitoneal mass resection (5×5×4 cm) also showed the same microscopic features of primary adrenal cortical tumor composed of large eosinophilic cells with highly atypical nuclei arranged in peritheliomatous and diffuse pattern with extensive necrosis ( and ). | [[22.0, 'year']] | F | {'10622498': 1, '16551738': 1, '25765741': 1, '10732261': 1, '9893659': 1, '11260859': 1, '12478091': 1, '19574489': 1, '15913443': 1, '8242539': 1, '14514341': 1, '11572033': 1, '17966598': 1, '12614096': 1, '10679640': 1, '1455322': 1, '24505527': 2} | {} |
165,636 | 3913154-1 | 24,505,550 | noncomm/PMC003xxxxxx/PMC3913154.xml | A 34 Year Old Man with Purple Discoloration and Paresthesia | The patient is 34 y/o man presented with episodic painless purple discoloration and linear ungual hemorrhage of fingers and toes, associated with paresthesia since a month ago. He suffered from difficult walking due to progressive weakness in both lower limbs. He also experienced two episodes of amaurosis fugax in both eyes.\nHe reported occasionally fever without any special pattern. He also complained of 10-15 mins morning stiffness and 4 kg weight loss during previous month. He also experienced exertional dyspnea and dry cough since 2 weeks ago.\nHe had a few episodes of vertigo and because of the following symptoms he went to neurologist. Brain MRI which was done () and the patient was referred to rheumatologist for more evaluation.\nHe had history of left eye amblyopia since childhood, lumbar disc herniation 10 years ago and unilateral varicocele surgery last year. He took no medications and he did not smoke or use illicit drugs. He was married and worked as a salesman.\nOn examination, BP: 115/70, PR: 76/min, T: 37.2 oral, RR: 16/min. Subungual hemorrhage was seen in nearly all fingers plus a purple patch on the left sole. Muscle force, DTR and the remainder of examinations were normal. TTE was done before admission and was normal. A complete blood count and results of liver function tests were normal as were plasma levels of electrolytes, ESR and CRP. Serum Creatinin level was 1.6mg/dl and urine analysis revealed proteinuria and hematuria (). Under the clinical suspicion of systemic vasculitis, methylprednisolone and cyclophosphamide were administered and patient was scheduled for renal biopsy. Chest CT scan was done and right sided pleural effusion with multiple small nodules in right lung parenchyma was seen (). Pleural fluid analysis was exudative (), so imipenem and ciprofloxacin were started and because of the possibility of underlying malignancy, cytologic analysis of pleural fluid was requested.\nOn the fourth day of admission, he suddenly experiences a very severe right flank pain. U/A and CBC revealed hematuria and leukocytosis (WBC=17500) and abdominopelvic CT scan findings were infracted zones in both kidneys, suggestive for systemic vasculitis or embolic process ().\nTransthorasic echocardiography was repeated and this time a large size mass (12*5 mm) was seen on aortic valve that was suggestive for vegetation, so antibiotics were changed to cefazoline, ampicillin and gentamycin. During the next days Hemoglobin level dropped to 11.3gr/dl and due to thrombocytopenia and abnormal coagulation tests and fragmented RBCs in peripheral blood smear, subclinical DIC was suggested and FFP and packed cell were transfused and renal biopsy was canceled.\nTwo days later right hemi paresis was evolved and on examination right hemiparesia without any sphinctral dysfunction or sensory abnormality was detected. This time Brain MRI revealed evidence of one hyper signal lesion in left hemisphere of cerebellum ().\nTransesophageal echocardiography confirmed Aortic vegetation on RCC (7*5mm). On suspicion of underlying malignancy, whole body bone scan was done and findings were increased uptake in posterior ribs and spine, suggestive for metastasis. BMA and BMB were done and normal. Result of cytologic examination on pleural fluid revealed severe mesothelial hyperplasia with cytologic atypia and IHC report was suggestive for Adenocarcinoma with suspected origin of upper GI, pancreas or testis and lung and colon were low likely (negative for TTF 1 and positive for CK 7). At first, patient was candidate for VATS (video assisted thoracic surgery) but due to IHC report and patient unwillingness, VATS was canceled and searching for other sources of metastasis was started. During the admission, because of worsened dyspnea and orthopnea and exudative pleural fluid, chest tube was inserted.\nUpper GI endoscopy and biopsy revealed mild anthral gastritis. The results of serum tumor markers were BhCG <1 u/l (normal<10), AFP=3.5Iu/ml (normal=0-10), PSA=0.2ng/ml (normal=upto4), CA19-9=66.9u/ml (normal=0-36), CEA=5.8ng/ml (normal=non smoker < 3.4). Ultrasound of both testicles was normal and abdominopelvic CT was unremarkable for malignancy.\nFinally under the diagnosis of metastatis of unknown primary, chemotherapy regimen (Gemcitabin, oxaliplatin, paclitaxel) were administered. Patient had been feeling better after starting therapy and after a few sessions of physiotherapy, he was able to walk. Patient is now doing well and received two chemotherapy periods.\nMetastasis disease of unknown primary | [[34.0, 'year']] | M | {'9214418': 1, '661751': 1, '19823835': 1, '16859600': 1, '9217593': 1, '14760208': 1, '1259640': 1, '4000038': 1, '8339326': 1, '17881239': 1, '8129773': 1, '19932380': 1, '11916609': 1, '24505550': 2} | {} |
165,637 | 3913423-1 | 24,876,317 | noncomm/PMC003xxxxxx/PMC3913423.xml | Primary spindle cell sarcoma of the breast masquerading as necrotizing fasciitis | A 45-year-old healthy Caucasian female patient presented in the emergency department with sudden onset of left breast erythema. On examination, she had an oedematous, tender, erythematous left breast with areas of blistering, epidermolysis and necrosis. Observations demonstrated systemic inflammatory response syndrome with tachycardia, pyrexia and hypotension. Investigations demonstrated raised inflammatory markers, electrolyte abnormalities and severe anaemia. An ultrasound scan revealed the presence of gas and fluid-filled pockets.\nThe Laboratory Risk Indicator for Necrotising Fasciitis score can be utilized to risk stratify patients presenting with signs of cellulitis to determine the likelihood of necrotizing fasciitis. A score >6 of 13 indicates that necrotizing fasciitis should be seriously considered. In this case, a score of 8 was allocated for serum sodium of 126 mmol/l, haemoglobin of 6.6 g/dl and C-reactive protein of 306.7 mg/l. Her other biochemical markers were normal, including serum creatinine of 68 µmol/l, plasma glucose of 8.8 mmol/l and a leukocyte count of 11.5 × 109/l. A provisional diagnosis of necrotizing fasciitis was made, and the patient was referred to the breast surgeons. She was taken to the theatre immediately, where she underwent a mastectomy.\nThe histopathology demonstrated that the breast was partially replaced by a partly cystic and partly solid necrotic lesion. The cystic cavity contained blood clots. A microscopic examination showed an atypical undifferentiated spindle cell lesion with a fascicular architecture, pleomorphism and marked mitotic activity with areas of ulceration and necrosis (Figs and ). The initial set of immunostains performed showed that tumour cells were negative for cytokeratins (Fig. ), S100 and LCA. The tumour cells showed diffuse and strong vimentin positivity (Fig. ). Further immunocytochemical labelling showed weak expression of CD99, patchy strong expression of CD10 and patchy weak expression of smooth muscle actin. Cytokeratins (CAM 5.2) and EMA were expressed and there was no tumour-specific expression of CD34, desmin or myogenin. Fluorescent In-situ hybridization analysis failed to demonstrate evidence of a t(x:18) translocation using the LYS-SYT break apart probe. The diagnosis of a Grade 3 undifferentiated spindle cell sarcoma was made and although the tumour was reported to have a clear resection margin (5 mm) in most areas, the presence of necrosis and granulation tissue reaching the deep margin made the status of the margin uncertain.\nStaging computed tomography scan demonstrated left axillary lymphadenopathy and a small left-sided basal effusion. Following discussion of the case at the multidisciplinary meeting, radical completion mastectomy was recommended. In addition, she underwent adjuvant radiotherapy. Reconstruction was with a split thickness skin graft by the plastic surgery team prior to her radiotherapy treatment (Fig. ). | [[45.0, 'year']] | F | {'8293949': 1, '11955733': 1, '2386920': 1, '28974969': 2, '18514698': 1, '20824039': 1, '23062708': 1, '21398126': 1, '15981282': 1, '24876317': 2} | {'5604113-1': 1} |
165,638 | 3913425-1 | 24,876,319 | noncomm/PMC003xxxxxx/PMC3913425.xml | Laparoscopic reconstruction of the extrahepatic bile duct using a jejunal tube: an innovative, more physiological and anatomical technique for biliodigestive derivation | A 41-year-old man was referred to the University Hospital, Department of Digestive Surgery, Triangulo Mineiro Federal University, with jaundice, choluria and fecal hypocholia. The patient had undergone laparotomic cholecystectomy 2 days earlier. Upon physical examination, the patient was in good general health, pale (1+/4+), hydrated, jaundiced (1+/4+) and afebrile. The abdomen was slightly tender and bowel sounds were reduced. Abdominal ultrasonography performed on admission demonstrated dilatation of the intrahepatic bile ducts and only the proximal portion of the common hepatic duct was seen. The patient presented hyperbilirubinemia. Gamma-glutamyl transferase (γ-GT) was 235.4 U/L, alkaline phosphatase 187.6 U/L, aspartate aminotransferase (AST) 183.4 U/L and alanine aminotransferase (ALT) 485.7 U/L.\nThe patient was submitted to surgical intervention. Inspection showed a small fistula (probably the duct of Luschka []) in the gallbladder bed, the common hepatic duct was sectioned with loss of substance between segments, and the proximal and distal stumps were ligated with cotton suture. Next, catheterization of the fistula in the duct of the gallbladder bed was performed with a No. 4 Levine catheter. Cholangiography showed moderate dilatation of the intrahepatic bile duct and a sudden obstruction in the common hepatic duct 1 cm from the confluence of the hepatic ducts, corresponding to bile duct injury classified as Bismuth II (Fig. ).\nThe intervention chosen was reconstruction of the bile duct by interposition of a pedicled jejunal segment between the hepatic duct bifurcation and duodenum. A 5-cm segment was cut from the jejunal loop at a distance of 40 cm from Treitz angle (Fig. ) and divided into two segments of 2.5 cm, each containing their respective vascular pedicles (Fig. ).\nThe mesenteric and antimesenteric borders of the two segments were cut longitudinally (Fig. ), promoting jejunal detubularization and forming two separate pedicled rectangles (Fig. ). Side-to-side anastomosis proximal to the pedicle was performed with 3-0 continuous sutures of polyglactin 910 (Vicryl®) on a single plane.\nTransverse retubularization of the loop was performed with a No. 12 Levine catheter as a mold. A 21-cm tube was created using 3-0 continuous sutures of polyglactin 910 (Vicryl®) (Figs and ). The size of the tube was reduced to 15 cm by resection of the distal ends by ∼3 cm. A transmesocolic passage for the tube was created and an entero-enteral anastomosis was performed for reconstruction of jejunal transit.\nThe tube was formed and the common hepatic duct was anastomosed with interrupted 3-0 polypropylene (Prolene®) sutures. A longitudinal incision of ∼3 cm was made in the second portion of the duodenum, comprising the serous and muscle layers and preserving the mucosa.\nThe Levine catheter was maintained and exteriorized through the opening in the duodenum for subsequent radiological control and external biliary drainage into the duodenum.\nMagnetic resonance cholangiography performed 45 months after surgery showed a functioning tube (Fig. ). The patient continues to be anicteric and laboratory tests are normal. | [[41.0, 'year']] | M | {'15494281': 1, '11596899': 1, '16334939': 1, '10792064': 1, '11596904': 1, '12811663': 1, '17546287': 1, '9000197': 1, '8047944': 1, '14972237': 1, '24876319': 2} | {} |
165,639 | 3913426-1 | 24,876,321 | noncomm/PMC003xxxxxx/PMC3913426.xml | Synchronous asymptomatic colonic metastasis from primary esophageal squamous cell carcinoma | A 64-year-old male consulted one of our hospitals due to progressive dysphagia in August 2012. An endoscopic examination revealed middle thoracic ESCC (Fig. ). Computed tomography (CT) scans showed possible invasion of the aorta and multiple lymph node metastases (T4bN3M1 stage4) (Fig. ). The length of the tumor was ∼10 cm on CT scans. The patient received definitive chemoradiotherapy [two courses of cisplatin and 5-fluorouracil (FP) plus 50.4 Gy] followed by one course of FP chemotherapy, and incomplete response/stable disease was achieved. Although an endoscopic biopsy specimen was positive for cancer (Fig. ), post-treatment CT showed no invasion of the aorta. Fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) also suggested that the size of the tumor was diminished. The patient underwent colonoscopy to prepare for colonic interposition because the radiation field included the upper part of the stomach. Preoperative colonoscopy revealed a 1.0-cm submucosal tumor at the splenic flexure, and biopsy results indicated possible metastasis from primary ESCC (Fig. ). The submucosal lesion was positive for cytokeratin 5/6 (CK5/6), CK14 and p63, and negative for CK20 and Caudal type homeobox 2 (CDX2) (Fig. ). Colonic metastasis was not detected by FDG-PET before or after chemoradiotherapy. No other obvious hematogenic metastases were noted after chemoradiotherapy.\nThe patient underwent subtotal esophagectomy by right thoracotomy with thoraco-abdominal lymph node dissection and reconstruction with a gastric tube in January 2013. Local excision of the colonic submucosal tumor was also performed (Fig. ). A postoperative pathological diagnosis revealed that the colonic tumor metastasized from primary ESCC and remnant viable carcinoma cells were found in the primary site of the esophagus and lymph nodes (Fig. ). Even though the patient was discharged 18 days after surgery without any complications, he died on the 72nd postoperative day due to multiple bone metastases and pleural dissemination. | [[64.0, 'year']] | M | {'12416763': 1, '32309497': 1, '28203180': 2, '27173884': 2, '15549592': 1, '28428908': 2, '32309520': 1, '24876321': 2} | {'5260607-1': 1, '5000582-1': 1, '5395791-1': 1} |
165,640 | 3913427-1 | 24,876,322 | noncomm/PMC003xxxxxx/PMC3913427.xml | Confirmed testicular torsion in a 67 year old | A 67-year-old male presented to the emergency department with a 10-day history of left-sided testicular pain. Symptoms were of gradual onset, and were initially treated with antibiotics from his general practitioner. There was no history of trauma, injury, pyrexia or voiding symptoms. Urine dipstick test was negative.\nExamination revealed an acutely tender left groin and left testicle with a markedly enlarged, erythematous left hemi-scrotum. Antibiotics were changed to doxycycline from ciprofloxacin, and the patient was referred for an urgent ultrasound which was performed the following day. Full blood count revealed white cell count of 8.2×109/L with a C-reactive protein (CRP) of 48 mg/L. All other blood tests were normal.\nAn ultrasound scan revealed no vascularity within the left testicle. The patient was taken for scrotal exploration under general anaesthetic. This revealed a torted left testicle with no pus present. A left orchidectomy was performed along with right-sided testicular fixation. The patient had an uneventful post-operative course, and was discharged home the following day. | [[67.0, 'year']] | M | {'10843401': 1, '31709147': 1, '12107581': 1, '3292226': 1, '29738007': 1, '21518188': 1, '2188301': 1, '17848251': 1, '3599201': 1, '24876322': 2} | {} |
165,641 | 3913431-1 | 24,876,329 | noncomm/PMC003xxxxxx/PMC3913431.xml | Human papilloma virus-16 causing giant condyloma acuminata | A 28-year-old multiparous lady, married at the age of 18 years and having 2 living children presented to the Gynaecology outpatient department with a growth in the vulva. The lesions started 6 months earlier as pin-sized papules in her labia majora and fourchette, associated with itching. They gradually increased in size and eventually coalesced to form large tufts. There was no history of coital dysfunction or postcoital bleeding. She had no menstrual complaints, neither did it interfere with her bladder and bowel function.\nHer husband was examined and found to be free of any gross lesions. The lady denied any history of extra-marital sexual contact or assault.\nExamination of the lesion revealed a 12 × 5 cm warty growth, with a cauliflower-like surface, arising from right and left labia majora and minora. Similar lesions were also present on the clitoris with additional satellite lesions scattered around the perineum, perianal region and lower vagina. Upper vagina and cervix appeared normal (Fig. ).\nA Papanicolaou cervical smear was performed which revealed no abnormality. Her HIV, HBsAg and VDRL status were negative. Her haemoglobin was 10.9 g%. A biopsy, under local anaesthesia, was performed (to rule out verrucous carcinoma) which was reported as condyloma acuminata.\nThe lady underwent a simple vulvectomy under spinal anaesthesia. Labia majora and most of labia minora were excised sparing the clitoris. Lesions on the perianal areas were also excised. Smaller lesions were cauterized. Wound was closed with 2-0 vicryl. Post-operatively, ice dressing was applied to the wound (Fig. ).\nThe post-operative period was uneventful and sutures were removed on 10th postoperative day.\nThe histopathological examination of the specimen was reported as condyloma acuminata with no evidence of malignancy. A PCR of the specimen revealed the presence of HPV-type 16 PGMY CHUV assay was performed on the sample to rule out mixed infection and the presence of only HPV-16 was confirmed [].\nFollow-up after 1 year did not reveal any new lesions. | [[28.0, 'year']] | F | {'12807954': 1, '28160045': 1, '292429': 1, '15038869': 1, '22960830': 1, '15601491': 1, '11742180': 1, '20952254': 1, '18847553': 1, '21832011': 1, '31223511': 2, '17405118': 1, '24876329': 2} | {'6541941-1': 1, '6541941-2': 1} |
165,642 | 3913432-1 | 24,876,330 | noncomm/PMC003xxxxxx/PMC3913432.xml | Breast filariasis | A 50-year-old lady hailing from Bihar (India) presented to surgical outpatient department with the history of intermittent fever with chills for 6 months and gradually increasing right breast lump for 1 month. There was no history of nipple discharge. General physical examination was unremarkable. Breast examination revealed a large 8 × 8 cm breast lump involving all quadrants with well-defined margins, firm in consistency, bosselated surface, mobile (no fixity to pectoral muscle), the overlying skin was indurated, hyperpigmented with few dilated veins. Nipple was retracted on ipsilateral side and peau de orange was absent (Fig. ). In the right axilla few pectoral group of lymph nodes was enlarged (2 × 3 cm). Rest of the systemic examination was normal. A provisional clinical diagnosis of inflammatory breast carcinoma was made.\nFine needle aspiration cytology (FNAC) of the breast lump and the axillary lymph node was reported as a hemorrhagic aspirate showing many eosinophils, neutrophils and histiocytes along with microfilaria of W. bancrofti (Fig. ), no malignant cells were seen and an impression of filarial mastitis was made. Differential leucocyte count was P69 L19 M04 E08 and the absolute eosinophil count was 1200 cells/mm3 (0–450 cells/mm3) corroborating with the cytology report.\nMidnight peripheral blood smear showed—normocytic normochromic red blood cells, no microfilaria were seen. Ultrasound of the breast showed multiple cystic lesions in 3, 7 and 11 o'clock positions. There was no evidence of adult filarial worms. A final diagnosis of breast filariasis was made and the patient was started on diethyl carbamazine 6 mg/kg/day for 21 days. Following which the patient showed dramatic response with the resolution of the overlying pigmentation and a gradual decrease in lump size. | [[50.0, 'year']] | F | {'5443068': 1, '31579198': 2, '8629415': 1, '18417874': 1, '8453019': 1, '6349200': 1, '24876330': 2} | {'6767959-1': 1} |
165,643 | 3913433-1 | 24,876,331 | noncomm/PMC003xxxxxx/PMC3913433.xml | Metastatic breast cancer in the mandibular condyle mimicking temporomandibular joint (TMJ) disease | A 48-year-old woman was referred to our clinic for clarification of a preauricular swelling, headache and pain of the right TMJ.\nShe had a 12-year history of metastatic adenocarcinoma of the left breast. Mastectomy, axillar lymphadenectomy and primary chemotherapy of the left breast had been performed. Due to distant metastases right adnexectomy and radiotherapy of the left iliac bone were done.\nBecause of multiple bone metastases the patient had also received hormone and bisphosphonate therapy.\nSeveral months before referral the patient complained about symptoms in the right TMJ region and was then sent to an otorhinolaryngologist, who suspected a parotitis. The investigation with ultrasound showed a healthy parotid gland and an enlarged articular capsule. Aspiration cytology from the preauricular swelling was then performed. No malignant tumour cells were detected. After the aspiration she felt better and the swelling disappeared. The symptoms were interpreted as a degenerative arthritis.\nApproximately 4 months later symptoms returned. A computed tomography (CT) scan of the head was ordered by the oncologist. An osteolytic lesion and partial sclerosis of the right condylar head and neck were found, as well as effusion in the right TMJ (Fig. ). The signs were interpreted as arthritis of the TMJ.\nBecause of persistence of the swelling, massive preauricular and temporal pain and a slight impairment of mouth opening the patient was referred to us.\nClinically, a preauricular swelling on the right side which caused asymmetry was visible. The overlying skin was normal. Palpation was painful and consistence was fluctuant. No deviation was found at mouth opening. Mouth opening was 43 mm, but subjectively reduced. Occlusion was, despite the preauricular swelling, correct.\nAfter clinical examination an magnetic resonance imaging (MRI) scan was done. A large joint effusion in the right TMJ was found and interpreted as an arthritis (Fig. ).\nBecause of the history of breast cancer and the persistent pain and swelling, an arthrocentesis, lavage and application of 20 mg Kenacort into the right TMJ was performed. The histology showed synovial cells, hystiocytes, erythrocytes, but no malignant cells.\nOne week later there was no swelling visible and the patient was painless.\nA full-body skeletal scintigraphy was done, which did not show an obvious pathology in the right TMJ (Fig. ). Due to this, a SPECT/CT was performed for clarification. High uptake of nuclides was seen around the osteolysis of the right condyle (Fig. ). Sclerotic changes without increased uptake were noted in the left condyle (Fig. ).\nThe sclerosis of the left TMJ was suspected to be a non-active metastasis.\nIn summary, from the radiological findings bilateral TMJ metastases were diagnosed, which were, however, not confirmed histologically.\nBecause of persisting symptoms in the right TMJ, a palliative radiotherapy was done to the right condyle with a total dose of 40 Gy (16 fractions). After that the patient was free of pain.\nAt the last clinical follow-up (November 2013) the patient was free of complaints and no swelling was detectable. | [[48.0, 'year']] | F | {'3858999': 1, '8746264': 1, '15965773': 1, '20381938': 1, '9653498': 1, '18533016': 2, '21789963': 1, '16546656': 1, '14342927': 1, '17138711': 1, '24876331': 2} | {'2427012-1': 1} |
165,644 | 3913434-1 | 24,876,332 | noncomm/PMC003xxxxxx/PMC3913434.xml | Major complications following total en bloc spondylectomy for giant-cell tumor | We present the case of a 32-year-old female, referred because of pain localized in the mid-dorsal region, with onset several months earlier and progressive worsening. The pain aggravated with local palpation and trunk movement. Lately, she also manifested weakness in the lower limbs.\nThe radiographic study identified an expansive lesion in the eighth thoracic vertebra (T8), with local kyphosis and imminent instability. She performed a computed tomography (CT) scan and magnetic resonance imaging (MRI), which better defined the bone involvement and already revealed invasion of the medullary canal (Fig. ). A percutaneous CT-guided core-needle biopsy was then undertaken, and the histologic report confirmed the diagnosis of giant-cell tumor.\nDue to the advanced stage of the lesion, with associated instability that could result in major neurologic deficits in a short time period, a total en bloc spondylectomy of T8 by a posterior-only approach was performed (Fig. ). The operation followed the technique proposed by Tomita et al. and was complemented with anterior-column reconstruction with a titanium mesh filled with structural allograft, as well as pedicle screw instrumentation, from T6 to T10 (Fig. ). During the procedure, the eighth dorsal nerve routes were sacrificed.\nThe surgery went uneventful, taking 5 h to complete. The immediate postoperative period was favorable, without reported neurologic deficits (besides the ones attributed to T8 nerve root ligation).\nThe patient started the pulmonary rehabilitation protocol by the second postoperative day, showing encouraging progression. However, by the third day, she initiated complaints of progressive dyspnea with associated impaired gas exchange. A CT scan confirmed bilateral hemothorax requiring bilateral thoracentesis (Fig. ), after which she immediately recovered from the previous symptoms.\nIt was only by the 19th postoperative day, which the patient showed worsening of her general status with fever, dyspnea, decreased gas exchange and an increase in inflammatory markers. A new CT scan was performed, revealing a moderate fluid collection in both lungs, compatible with empyema (Fig. ). The patient evolved to a septic state, which required her to be transferred to the intensive care unit.\nDue to the ongoing postoperative infection, a new operation was undertaken with surgical debridement of the infected tissues, allograft and titanium mesh extraction, which were replaced by iliac crest tricortical autograft for anterior support (Fig. ). The posterior pedicle instrumentation was kept, after copious irrigation of the surgical wound. Drains were placed in the thoracic cavity and paravertebral spaces.\nBlood cultures, as well as those from pus samples collected intraoperatively and from the explanted mesh and allograft identified Enterobacter aerogenes as the pathogenic agent. The same bacterium was isolated in a sample of allograft sent for cultures on the day of the index operation. A pathogen-directed course of i.v. antibiotic therapy was initiated.\nTen days after the revision operation, the patient was diagnosed with a lower respiratory tract infection, with Acinetobacter baumannii being identified in sputum samples.\nConcurrently, a newly resurged septated empyema had developed in the paravertebral space, which demanded for a combined anterior and posterior approach, for complete drainage (Fig. ). Twelve days later, an additional posterior open drainage was necessary to address a subcutaneous abscess. Samples collected intraoperatively from this last operation isolated methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa as pathogens.\nThe several complications sustained, as well as the prolonged hospitalization, took a significant toll on the patient, leading to considerable physical and psychological burden.\nIn response to the therapeutic measures adopted, there was a progressive improvement in clinical and analytic parameters, which allowed the discharge from the hospital, 79 days after initial admission. A custom-molded thoracolumbar brace was prescribed, as well as maintenance of physical therapy to regain muscle strength.\nCurrently, after 9 months from the initial surgery, the patient remains stable and asymptomatic with no evidence of infection or tumor relapse (Fig. ). The follow-up imaging studies show encouraging evolution without bone graft resorption or failure of the instrumentation (Fig. ). | [[32.0, 'year']] | F | {'22179322': 1, '18156047': 1, '28639571': 1, '22448122': 1, '16437342': 1, '21045974': 1, '18214553': 1, '9051895': 1, '8015835': 1, '23096699': 1, '11276839': 1, '24876332': 2} | {} |
165,645 | 3913435-1 | 24,876,333 | noncomm/PMC003xxxxxx/PMC3913435.xml | Intrathoracic migration of a Kirschner wire | A 49-year-old woman admitted to our hospital complaining of breathing-dependent chest pain and dyspnea with progressive onset lasting for 2 h. The pain was acute at onset, sharp in nature, worse on deep inspiration, did not radiate and was not reproducible with palpation. A day before presenting to us, she was admitted to another emergency unit with an acute pain in the right abdomen. Her symptoms had been interpreted as dyspepsia and she was discharged from the hospital with simple treatment.\nThe most remarkable of her past medical history was that she had been undergone total hip replacement 8 years ago at another institution. Previous pelvic radiograms of that period were not available.\nOn presentation, the patient was in mild respiratory distress with a respiratory rate of 30 breaths per min, heart rate of 90 bpm and oxygen saturation measured via pulse oximetry of 93% on room air. A respiratory examination revealed that right-sided findings of reduced chest expansion, diminished breath sounds and dullness in the lower right chest were found.\nLaboratory investigations were within normal limits. The ECG was unremarkable. Chest X-ray showed the presence of a metallic image ∼5–6 cm long, located in the right hemithorax. There was a large hemothorax but no pneumothorax (Fig. ). The investigation was complemented by a chest computed tomography (CT) that confirmed the presence of a metallic wire in the right pleural space.\nTaking into account the hemodynamic state of the patient, her physical examination, the laboratory results and the CT-scan findings, we decided to perform an urgent surgical removal of the K wire under general anesthesia.\nShe was placed in a left lateral decubitus position and a posterolateral thoracotomy in the fifth right intercostal space was used. The wire was removed without complications. Surprisingly, no injury was noted to any intervening abdominal structure intra-operatively. As a precaution, a 28-F chest tube was placed. There was no air leak or bleeding postoperatively and the tube was removed on the second postoperative day. The postoperative outcome was favorable and the patient was discharged on postoperative Day 4 with a normal chest radiogram (Fig. ). | [[49.0, 'year']] | F | {'19773179': 1, '16299458': 1, '2681607': 1, '18658165': 1, '17670030': 1, '16631702': 1, '20361375': 1, '19632433': 1, '22101576': 1, '15759823': 1, '24876333': 2} | {} |
165,646 | 3913436-1 | 24,876,334 | noncomm/PMC003xxxxxx/PMC3913436.xml | Component separation in abdominal trauma | A 51-year-old male received a penetrating stab wound to the abdomen and underwent an immediate emergency laparotomy. Findings at laparotomy were splenic hilar injury, a through-and-through enterotomy of the stomach and transection of the left renal vein. The stomach was repaired, a splenectomy was performed and ligation of the left renal vein was undertaken with temporary clamping of the aorta. The abdomen was packed, and a temporary topical negative pressure closure of the abdomen was undertaken. The patient required 24 units of packed red cells, 20 units of fresh frozen plasma and 4 units of platelets to achieve resuscitation. Twenty-four hours later, the patient was returned to the operating room for a relook laparotomy. The transverse colon had patchy ischaemia, so a damage control resection of the colon was undertaken. Minor bleeding points on the abdominal wall were controlled. The topical negative pressure closure was reapplied. On the fourth postoperative day, a second relook laparotomy was undertaken. The colon was anastomosed. The abdomen was unable to be closed, and the topical negative pressure dressing was reapplied. On the ninth postoperative day, a further attempt was made to close the abdomen but this was not successful. The topical negative pressure closure was reapplied.\nOn the 11th postoperative day, a component separation was performed. The topical negative pressure dressing was removed leaving the defect shown with the anterior sheath retracted away from the midline (see Fig. . The overlying skin was released bilaterally from the abdominal wall, and the anterior rectus sheath was released. To achieve this, the external oblique was incised at Point A, and the incision taken high to the costal margin and as low as possible to allow maximal release. The internal oblique is then exposed (Point B), and the released edge is visible at Point C (see Fig. ).\nA posterior sheath release was then performed to provide medial movement of the sheath, so that it could be closed in the midline (see Fig. . A 25 × 25-cm biologic mesh (Strattice™ Reconstructive Tissue Matrix,–LifeCell Corp.) was rotated to a diamond shape and secured in the pre-peritoneal space, to the lateral fascia (see Fig. . The rectus muscle was closed, and the component separation allowed for the anterior sheath to be closed in the midline (see Fig. . Primary skin closure was undertaken, and the patient returned to the ward.\nOn the 16th postoperative day, he suffered a witnessed ventricular fibrillation cardiac arrest. He was resuscitated and subsequently anticoagulated. The following day a computed tomography scan revealed a large abdominal wall haematoma anterior to the rectus sheath. He returned to theatre on the 17th postoperative day. The fascia was found to be intact, and the haematoma evacuated. Topical negative pressure was reapplied. On the 21st postoperative day, the skin was reclosed. He returned to the ward and was discharged on the 49th postoperative day, following implant of a cardiac defibrillator, with an intact wound (see Fig. ). | [[51.0, 'year']] | M | {'2143588': 1, '23351508': 1, '16490553': 1, '12517546': 1, '22169002': 1, '22421484': 1, '20009699': 1, '15619476': 1, '20637331': 1, '22763262': 1, '24876334': 2} | {} |
165,647 | 3913437-1 | 24,876,335 | noncomm/PMC003xxxxxx/PMC3913437.xml | The Trotter procedure: a forgotten approach? | A 42-year-old male with Gorlin syndrome was referred by his General Practitioner to the Ear, Nose and Throat department with progressive dysphagia and voice change. Examination including fibre-optic nasendoscopy was normal, whilst magnetic resonance imaging (MRI) of the tongue base revealed no pathology. Following a period of observation, his symptoms progressed and a repeat MRI showed a discrete mass in the tongue base (Fig. ). A panendoscopy was performed and biopsies demonstrated a myolipoma.\nAs the diagnosis was benign, the head and neck multidisciplinary team recommended laser de-bulking, and this was subsequently carried out on two separate occasions. The patient's dysphagia, however, became progressively worse, and it was therefore decided to resect the tumour via a median labiomandibular glossotomy (Trotter procedure) for access.\nFollowing a prophylactic tracheostomy, access to the tongue base lesion was achieved by successive midline divisions of the lip, mandible, floor of mouth and tongue (Fig. ). The tongue was divided avascularly along its midline raphe.\nThe tumour was successfully removed and the tongue and floor of mouth closed in layers. The mandible was reduced and fixed using pre-bent 2.0 miniplates and screws, before placement of a suction drain and closure of the lip.\nThe patient underwent an uneventful recovery. The tracheostomy was removed on the third post-operative day and a soft diet was re-established by the fifth day. The patient was discharged 7 days after the procedure. At 3-month follow-up, he reported no functional impairment and the surgical site had healed well (Fig. ). Too date, 3 years post-operatively, he remains asymptomatic with no evidence of tumour recurrence. | [[42.0, 'year']] | M | {'1703396': 1, '17908355': 1, '15908068': 1, '24876335': 2} | {} |
165,648 | 3913544-1 | 24,511,223 | noncomm/PMC003xxxxxx/PMC3913544.xml | Periocular necrotizing fasciitis following retrobulbar injection | A 33-year-old female patient presented to the eye clinic at Jimma University Hospital with bilateral painless progressive loss of vision, and on examination was found to have bilateral presenile cataract, so was admitted to the eye ward to have left eye cataract extraction. On the following day, she underwent standard preoperative preparation of the left eye and was taken to the operating theater. The left eyelid and periorbital area were cleaned with 70% alcohol. During retrobulbar injection of 4 mL of lidocaine hydrochloride 2% and epinephrine 1:100,000, she developed moderate retrobulbar hemorrhage which warranted cancellation of the planned cataract surgery. Tubicort® (Tubilux Pharma S.p.A, Rome, Italy) (hydrocortisone 0.5% + oxytetracycline 0.9%) eye suspension was instilled and the eye was patched. She was given a 500 mg oral loading dose of acetazolamide and a maintenance dose of 250 mg qid, and sent to the eye ward for bed rest and follow-up.\nOn the next day, she had diffuse, warm, tense, and tender reddish blistering eye lid swelling associated with headache and periorbital pain, but her body temperature was normal. With the impression of severe retrobulbar hemorrhage, lateral canthotomy and cantholysis were done to relieve the pressure, and she was given paracetamol 1 g tablets as required and continued acetazolamide. However, the globe was still tense. Hence, surgical evacuation of orbital hematoma through anterior orbitotomy was attempted but no significant hematoma was found. Post-orbitotomy, intravenous cloxacillin 500 mg qid and ceftriaxone 1 g twice daily was started. Chloramphenicol eye ointment was applied twice daily. Vital signs were stable (pulse rate 90 per minute, respiratory rate 16 per minute, temperature 36.5°C, blood pressure 90/70 mmHg).\nOn subsequent days (3 and 4), the upper and lower eyelids of the left eye and the surrounding face became blue-gray and necrotic, with loss of touch and pain sensation over the swelling and around it (). The patient was unable to open the lid, so visual acuity was not measured. At this stage, necrotizing fasciitis was considered and intravenous metronidazole was added.\nOn day 5, surgical debridement was done and necrotic foul-smelling tissues over the upper lid, lower lid, and deep orbital tissue under the lateral canthus were removed (). A specimen was sent for culture which grew S. aureus. Other hematological and serological tests (for fasting blood sugar, white blood cell count with differential, erythrocyte sedimentation rate, and venereal disease research laboratory and human immunodeficiency virus) were unrevealing.\nIntravenous cloxacillin, ceftriaxone, and metronidazole, as well as daily wound care and dressing with Furacin® (Universal Twin Labs, Mumbai, India) ointment was continued but there was no improvement. On day 13, redebridement was done; at this time, the bulbar conjunctiva, sclera, and orbital tissue were necrotic and vision was no light perception. The clinical decision for orbital exenteration was taken and discussed with the patient and her family, but she declined and self-discharged against medical advice and repeated counseling, and did not return for further follow-up.\nThe patient had no previous or current nasal discharge, history of trauma, previous facial/nasal/ocular wound, known drug allergy, history of drug usage, or personal or family history of known systemic diseases (diabetes mellitus, hypertension, or cardiac, renal, or liver disease). | [[33.0, 'year']] | F | {'12925624': 1, '16231249': 1, '15735411': 1, '23924443': 2, '17593324': 1, '10621873': 1, '9373117': 1, '15814880': 1, '12414425': 1, '16294199': 1, '19897473': 1, '3734465': 1, '24511223': 2} | {'3750427-1': 1, '3750427-2': 1, '3750427-3': 1} |
165,649 | 3913545-1 | 24,511,225 | noncomm/PMC003xxxxxx/PMC3913545.xml | Periorbital muscle atrophy associated with topical bimatoprost therapy | A 58-year-old Chinese female was referred to the oculoplastics services of National University Hospital, Singapore, for right upper eyelid ptosis of 1.5 years’ duration and difficulty in closing her right eye. She had a history of bilateral primary angle closure diagnosed in 2003, for which bilateral laser peripheral iridotomies were performed. She was started on topical latanoprost 0.005% once every night to the right eye, as intraocular pressure (IOP) was suboptimal. Subsequently, she underwent an uneventful right cataract extraction with intraocular lens implantation that same year. As IOP remained optimal postoperatively, she was taken off topical latanoprost. Her condition remained stable until 2008 when there were progressive defects in her right visual field with increased IOP. Thus, she was started on topical bimatoprost 0.03% (Lumigan, Allergan, Inc) once every night to her right eye.\nOn review after 3 months, IOP was found to have been controlled adequately. However, she reported an onset of right upper eyelid drooping 2 months after starting treatment. There was no history of trauma or eyelid surgery. The ptosis did not show any diurnal variability or fatigability, and there was no diplopia. A detailed evaluation by the neuro-ophthalmology team revealed no underlying neurological cause. Four months after starting treatment, the treated eye was found to have long eyelashes and ocular pigmentation. Subsequently, the patient reported worsening of her right ptosis after 12 months on treatment and was keen for referral to the oculoplastics team.\nBy the time the patient was reviewed by the oculoplastics team in 2010, her right upper eyelid ptosis had persisted for 1.5 years. Measurements of the palpebral aperture (PA) of her right and left eye were 6 mm and 8 mm, respectively. Measurements of marginal reflex distance 1 (MRD1) for her right and left eyes were 0.5 mm and 2 mm, respectively. Levator palpebrae function was 8 mm for the right eye and 14 mm for the left eye. Lid creases measured 7 mm and 5 mm for the right and left eye, respectively.\nEventually, the patient underwent a surgical correction of her ptosis with levator muscle advancement in August 2011. Surgery was uncomplicated and postoperative recovery was uneventful. Seven months after the operation, her PA measured 9 mm and 8 mm while MRD1 measured 4 mm and 3 mm for the right and left eye, respectively.\nThe pre- and postoperative clinical photos of her eyelids are shown in and , respectively. Preoperatively, she had clinically significant right ptosis obscuring her visual axis, and right lagophthalmos with orbicularis oculi muscle weakness. | [[58.0, 'year']] | F | {'7628355': 1, '18645437': 1, '21953485': 1, '21562439': 1, '12488264': 1, '21691584': 1, '22942109': 1, '9442016': 1, '9279651': 1, '15300114': 1, '16935336': 1, '22936280': 1, '8940395': 1, '29632789': 1, '22107041': 1, '20689791': 1, '21158579': 1, '20618554': 1, '29854658': 1, '24511225': 2} | {} |
165,650 | 3913549-1 | 24,511,239 | noncomm/PMC003xxxxxx/PMC3913549.xml | Effective use of everolimus as salvage chemotherapy for ovarian clear cell carcinoma: a case report | The patient was a 53-year-old woman, gravida 3, para 2. She had first menstruated at age 14 years and reached menopause at age 49 years. Her family history and medical history were unremarkable. Due to the diagnosis of ovarian cancer in 2010, she underwent total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and pelvic and para-aortic lymph node dissection. Adenocarcinoma was diagnosed based on examination of cells from ascitic fluid. The pathological diagnosis of the extracted organ was CCC. Clinically, the ovarian cancer was stage IC. Postoperatively, the patient received six cycles of paclitaxel/carboplatin therapy (paclitaxel 175mg/m2 on day 1, carboplatin area under the curve 6 mg/ml per min on day 1, every 21 days) and achieved remission. Within 6 months after the final administration of this chemotherapy, however, the CA125 level increased and ascites developed, while computed tomography (CT) showed dissemination throughout the abdominal cavity. Accordingly, the diagnosis was platinum-resistant recurrent ovarian cancer. Six cycles of CPT-11/pegylated liposomal doxorubicin therapy (CPT-11 80 mg/m2 on days 1 and 15, and pegylated liposomal doxorubicin 30 mg/m2 on day 3, every 28 days) were started in April 2011. Although the antitumor efficacy after three cycles was sufficient to achieve stable disease (SD), progressive disease was apparent at the completion of six cycles. Therefore, the treatment was switched to gemcitabine/docetaxel therapy (gemcitabine 800 mg/m2 on days 1 and 8, docetaxel 60 mg/m2 on day 8, every 21 days) starting in November 2011. The patient completed five cycles but did not respond to this therapy, showing progressive disease. After a full explanation to the patient and her husband that there would be no next chemotherapy according to the guidelines for recurrent ovarian cancer and that CCC is always chemotherapy resistant, the patient elected to receive oral administration of everolimus. Oral everolimus administration (everolimus 10 mg/day on days 1–28, a 28-day period comprised one cycle) was started in March 2012 as medical care without health insurance coverage. presents CT images before treatment, after three cycles, and after six cycles. shows the changes in CA125 levels. The tumor reduction rate was 11.4%, according to measurements based on CT images. The antitumor response according to Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 was SD. Additionally, the Eastern Cooperative Oncology Group (ECOG) Performance Status was 1 throughout this therapy. During the sixth cycle, however, the patient discontinued treatment for financial reasons. Treatment was thus suspended upon completion of the sixth cycle. With regard to adverse events, the patient developed grade 3 anemia and grade 1 hypercholesterolemia as hematotoxicities in the fifth and third cycle, respectively. As for non-hematotoxicities, she had grade 1 fatigue, grade 1 malaise, and grade 1 stomatitis. The adverse events in each cycle are shown in . These adverse events necessitated neither postponement of the start of the next cycle nor suspension of administration. Starting in October 2012, the treatment was again switched to gemcitabine/docetaxel therapy (gemcitabine 800 mg/m2 on days 1 and 8, docetaxel 60 mg/m2 on day 8, every 21 days). In the middle of the second cycle, a rapid increase in ascitic fluid and CA125 elevation were observed. Thereafter, the patient received best supportive care and died in December 2012. | [[53.0, 'year']] | F | {'19690197': 1, '32958005': 1, '31075885': 1, '20826764': 1, '19097774': 1, '22204724': 1, '15520168': 1, '16166416': 1, '21243393': 1, '16290000': 1, '29212287': 2, '22529265': 1, '15208673': 1, '18653228': 1, '19349352': 1, '20194812': 1, '23899586': 1, '7165009': 1, '19007975': 1, '22204725': 1, '34885229': 1, '21614172': 1, '21752435': 1, '24511239': 2} | {'5706933-1': 1, '5706933-2': 1} |
165,651 | 3913897-1 | 24,505,564 | noncomm/PMC003xxxxxx/PMC3913897.xml | A case of the rare variant of Klinefelter syndrome 47,XY,i(X)(q10) | The 33-year-old patient, who had been born to a 25-year-old woman and her 30-year-old husband, was referred to a male infertility clinic due to azoospermia. The patient generally looked healthy with a normal male appearance. His height was 160 cm, body weight 53 kg, and body mass index 20.7 kg/m2. There was a normal male pattern of body hair, and he had no gynecomastia. No mental retardation was observed. Examination of the external genitalia revealed both small testes to be normally positioned, but on palpation they had a soft consistency and a volume of 5 mL each. There were no abnormalities of the epididymis or the vas deferens and no signs of varicocele.\nThe family history of infertility was negative, and the fertility tests for his younger brother were normal. From two semen analyses by centrifugation, he was diagnosed with complete azoospermia. Endocrinologic investigation revealed elevated FSH and LH levels with FSH 69.04 mIU/mL (normal range, 1.27-19.26 mIU/mL), LH 22.17 mIU/mL (normal range, 1.24-8.62 mIU/mL), prolactin 26.48 mIU/mL (normal range, 2.64-13.13 mIU/mL), and testosterone 2.31 mIU/mL (normal range, 2.80-8.00 mIU/mL).\nMetaphase spreads from the lymphocytes were prepared and trypsin-Giemsa banded according to standard techniques. His karyotype revealed 47,X,i(Xq),Y on 50 metaphase chromosomes with no mosaicism, and all of the isochromosomes were apparently monocentric (). The microdissection for testicular sperm extraction was negative, and the histology of a testes biopsy revealed severe tubular atrophy showing only a few atrophic seminiferous tubules showing Sertoli cells only with Leydig cell hyperplasia (). Genetic counseling about the disease was performed, and the possible usage of donor sperm was discussed for the fertility problem. Androgen replacement therapy was also recommended to avoid symptoms and sequelae of androgen deficiency. | [[33.0, 'year']] | M | {'17632769': 1, '32071206': 1, '4430497': 1, '19247915': 1, '8870925': 1, '19852429': 1, '15262106': 1, '18687426': 1, '6540997': 1, '24505564': 2} | {} |
165,652 | 3913974-1 | 24,505,207 | noncomm/PMC003xxxxxx/PMC3913974.xml | Retinal Damage in Chloroquine Maculopathy, Revealed by High Resolution Imaging: A Case Report Utilizing Adaptive Optics Scanning Laser Ophthalmoscopy | A 53-year-old Asian woman with a history of lupus erythematosus was initially treated with hydroxychloroquine (Plaquenil, unknown dose) for 5 years. Approximately 3 years ago, the patient's medication was changed to chloroquine (400 mg daily). Within a few years of taking chloroquine, she noticed a circular shadow in her central vision, which she described as an arch surrounding her central vision. At first, she only noticed a superiorly oriented half-moon shadow that lasted for a few seconds during reading. The shadow was seen while both eyes were open and disappeared after a few seconds. Because of these symptoms and the presence of bull's eye maculopathy on fundus examination, chloroquine was discontinued and the patient's medication was changed to dapsone (unknown dose).\nThe best-corrected visual acuity (corrected with current spectacles) of the highly myopic patient during her most recent examination was 20 / 25 in both eyes, with no evidence of an afferent pupillary defect. Slit-lamp examination indicated that the anterior segment was unremarkable and Goldmann applanation intraocular pressure was normal (16 mmHg) in both eyes. However, a significant central defect was noted on Humphrey visual field (HVF) examination (Humphrey Visual Field Analyzer 10-2; Humphrey Instruments, San Leandro, CA, USA) in both eyes. Dilated fundoscopy revealed tilting of the optic nerves in both eyes, consistent with myopia, and a ring-shaped area of RPE depigmentation in the parafoveal area of the left eye (). Fundus autofluorescence (FAF) imaging revealed a hypofluorescent lesion in the foveal and perifoveal areas correspond with the bull's eye retinopathy. In the left eye, a prominent hypofluorescent lesion was also noticed on FAF imaging, reflecting marked atrophy of the RPE layer ().\nCross-sectional retinal scans, obtained with SD-OCT (Spectralis HRA+OCT; Heidelberg Engineering, Heidelberg, Germany) showed obvious thinning of the macula and disruptions in the outer retina. More specifically, loss of the photoreceptor inner/outer segment (IS/OS) junction corresponded to the location of the maculopathy as identified on fundus photography, FAF, and HVF 10-2. The outer retinal layer had a moth-eaten appearance at the IS/OS junction, but the thickness and appearance of the inner retina were within normal limits. Additionally, a downward displacement of the overlying retina was seen in perifoveal areas and corresponded to the hypofluorescent lesion in FAF images. Unlike the anatomically disrupted areas, which corresponded to the bull's eye lesion, the central fovea had normal thickness and structure on SD-OCT in both eyes ().\nInstead of using a deformable mirror to correct for wavefront aberrations, the AO system used in the current study utilized a dual liquid crystal on silicon spatial light modulators (LCOS-SLMs; X10468-02, Hamamatsu Photonics, Morimoto, Japan) first introduced by Hirose et al. []. Although deformable mirrors have been widely used, their performance is limited with respect to compensating large amounts of aberration of human eyes. Meanwhile, although LCOS-SLM is able to compensate large amounts of aberration by the phase wrapping method utilizing a continuity of the wavefront of a laser beam, it is only capable of compensating a particular polarization component. Most AO systems simultaneously process the measurement/compensation of aberration and SLO imaging. This system is very efficient at following changes in aberration of a subject according to change in imaging location, but is not suitable for obtaining high contrast images because the power of the lights used for simultaneous imaging and measurement/compensation of time is limited for safety. In this study, we overcame these problems by adopting dual LCOS-SLM to compensate the two orthogonal polarization components and sequential processing of SLO imaging and measurement/compensation of aberrations [].\nAO-SLO images were obtained and cone density was measured 0.5, 1.0, and 1.5 mm from the center of the fovea in each of the 4 major directions (superior, inferior, nasal, and temporal). A montage was then created and verified by checking the correspondence between the AO-SLO and wide-field images. Cone density was calculated using photoreceptor analysis software (Canon, Tokyo, Japan). To obtain an accurate cone density, the axial length, anterior chamber depth, and keratometry values were all considered when counting cone cells, which were represented in images as bright spots 2 to 5 µm in size. We manually selected areas of interest, and excluded retinal vessels and artifacts that obscured the underlying cone mosaic. AO-SLO images showed patch cone mosaic lesions, indicating abnormal regions of missing or lost cones. In addition, the observed cones were asymmetrical in shape and size and varied in brightness ().\nCone densities in the right eye were 14,927, 10,377, and 11,853 cones/mm2 at 0.5, 1.0, and 1.5 mm from the center of the fovea, respectively. The corresponding cone densities in the left eye were 16,692, 12,564, and 13,100 cones/mm2, respectively. The cone density at 1.5 mm from the center of the fovea was closer to normal than the other distances; however, the photoreceptors located 1.5 mm from the foveal center exhibited asymmetrical shapes and sizes, and varied in brightness in AO-SLO images. Additionally, SD-OCT images showed an abnormal IS/OS cytoarchitecture 1.5 mm from the foveal center. When we matched the disrupted areas on the AO-SLO images with the visual field test, the areas with abnormal cone mosaic patterns and low cone density corresponded with the location of visual field defects on HVF (). | [[53.0, 'year']] | F | {'26237736': 1, '29876348': 1, '25796216': 1, '14089382': 1, '23276813': 1, '14066046': 1, '20126479': 1, '19436374': 1, '9255117': 1, '12093666': 1, '2324310': 1, '28515477': 1, '29993035': 1, '12972762': 1, '23443027': 1, '27349992': 1, '8712882': 1, '23604511': 1, '102610': 1, '14498679': 1, '28282061': 1, '31701183': 1, '1393809': 1, '24505207': 2} | {} |
165,653 | 3913975-1 | 24,505,208 | noncomm/PMC003xxxxxx/PMC3913975.xml | Anaplastic Large Cell Lymphoma Involving Anterior Segment of the Eye | This case report followed the tenets of the Declaration of Helsinki and was approved by the institutional review board of Dongguk University, Ilsan Hospital.\nA 36-year-old woman presented with multiple facial masses in the left submandibular and forehead area (). Incisional biopsy of the forehead lesion revealed ALCL with positivity for CD30, CD3, and ALK (). No evidence of other body part involvement was found on magnetic resonance imaging (MRI), positron emission tomography (PET), or cerebrospinal fluid analysis. With a diagnosis of ALCL involving skin only, the patient received 1 cycle of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy. On day 5 after chemotherapy, the patient complained of conjunctival injection, ocular pain, and blurred vision in the right eye. Ophthalmic examination detected a mild inflammatory reaction in the anterior chamber with normal visual acuity, intraocular pressure (11 mmHg), and fundus findings in the right eye. Topical fluorometholone (0.1%) was prescribed to control inflammation. However, the symptoms rapidly aggravated. On the second visit after 2 days, the patient's right eye demonstrated severe inflammatory reaction with dense fibrin clots around the pupillary margin in the anterior chamber with significant corneal edema (). No fundus details were observed and ocular ultrasonography revealed a relatively clear posterior segment (). Because the complete blood count showed reduced white blood cell count of 1.61 × 103/µL (normal range, 4.0 to 10 × 103/µL) with an absolute neutrophil count of 580 (normal range, 1,500 to 7,700), the presumed diagnosis was endogenous endophthalmitis or neoplastic masquerade syndrome. Cytologic examination and aqueous humor culture were simultaneously conducted with vancomycin (1 mg/0.1 mL), ceftazidime (2 mg/0.1 mL), and dexamethasone (250 µg/0.1 mL) intravitreal injections. A 0.5% moxifloxacin ophthalmic solution was applied every two hours. Vancomycin was administered in travenously. A cytospin smear of aqueous humor aspiration revealed atypical lymphocytes (). On the next day of aqueous humor culture, acute angle closure developed (intraocular pressure rose to 40 mmHg) due to pupillary block by dense fibrin (). Tissue plasminogen activator (25 µg/0.05 mL) was injected into the anterior chamber to reduce fibrin and open the aqueous passage, but this therapy failed. The increased intraocular pressure (IOP) (over 40 mmHg) was uncontrollable despite maximum tolerated drug therapy including intravenous mannitol, anti-glaucoma ophthalmic solutions, and oral acetazolamide. Blood and aqueous humor cultures showed no bacterial growth. Laser iridotomy was attempted to relieve the pupillary block, but fibrin materials closed the opening within one day. Surgical removal of dense fibrotic membrane was attempted but failed due to recurrent bleeding and fibrotic membranes. MRI showed focal enhancement of the iris, ciliary body, and anterior chamber without posterior segment involvement (). A PET scan revealed increased fluorodeoxyglucose (FDG) metabolism in the right eye, right thyroid, and uterine wall (). Oncologists recommended localized radiation therapy to the right orbit. After 2 consecutive radiation therapy sessions with 3 Gy each, intraocular pressure normalized to 19 mmHg, the anterior chamber deepened, and fibrin material gradually disappeared. After 30 Gy of radiation therapy in total, the patient's best-corrected visual acuity was restored to 20 / 25 with an IOP of 11 mmHg without glaucoma medication (). No evidence of tumor recurrence was detected at 18 months after radiation therapy. | [[36.0, 'year']] | F | {'16488933': 1, '6766795': 1, '8259276': 1, '19358142': 1, '21184080': 1, '18954321': 1, '9174543': 1, '19585354': 1, '31635036': 1, '22594613': 1, '21850985': 1, '10434868': 1, '15042403': 1, '18501272': 1, '20852443': 1, '16050462': 1, '21455243': 1, '12576439': 1, '19907112': 1, '25971162': 1, '19099202': 1, '14678933': 1, '17511113': 1, '15565454': 1, '3658352': 1, '8604740': 1, '8129012': 1, '30930667': 1, '15806372': 1, '20212217': 1, '24505208': 2} | {} |
165,654 | 3913985-1 | 24,505,203 | noncomm/PMC003xxxxxx/PMC3913985.xml | A Korean Patient with Lattice Corneal Dystrophy Type IV with Leu527Arg Mutation in the TGFBI Gene | An 87-year-old woman visited our clinic for a scheduled cataract surgery. At the time of preoperative evaluation, mild localized semitransparent opacity was noted in both corneas. The opacity showed lattice-shaped, granular deposits with asymmetrical patterns in the stroma (). The right eye was more severely affected, showing nodulolinear amyloid deposits located mainly in the anterior stroma; the left eye showed less linear and macular opacity. The patient demonstrated a good visual outcome after the surgery, with a best-corrected visual acuity of 0.8 in both eyes.\nGenomic DNA samples from the patient were extracted from peripheral leukocytes using the Easy-DNA Kit (Invitrogen, Carlsbad, CA, USA). Polymerase chain reaction was performed on this genomic DNA with specific primers for the TGFBI gene (); the results showed a Leu527Arg mutation in the TGFBI gene (). In addition to the Leu527Arg mutation, two more single-nucleotide polymorphisms (SNPs) were also identified: a T>C variation at cDNA position 1620 resulting in Phe540Phe and a G>A variation at cDNA position 1678+23 ().\nThe patient's only family members, her son and granddaughter, did not show any corneal stromal manifestations. They also did not have any known mutations in the TGFBI gene specific for LCD type IV, though both showed the T>C variation at cDNA position 1620 and the G>A variation at cDNA position 1678+23, just as in the present case. | [[87.0, 'year']] | F | {'9054935': 1, '9799082': 1, '20357204': 1, '15623763': 1, '28393022': 1, '11923233': 1, '24505203': 2} | {} |
165,655 | 3913986-1 | 24,505,204 | noncomm/PMC003xxxxxx/PMC3913986.xml | Treatment of an 8-mm Myxoma Using Acellular Corneal Tissue | A 32-year-old male patient was examined for vision loss and the presence of a mass in the left eye in December 2010. He had been examined at other hospitals for chronic open-angle glaucoma of the left eye that had persisted since 2006. Small blisters of the cornea began to appear in October 2007; these blisters progressed gradually and eventually invaded the entire cornea. Before the appearance of the lesion, no other treatments, such as laser therapy or phototherapy had been applied, with the exception of eye drops (Alphagan-P; Allergan, Irvine, CA, USA). When the patient first visited our clinic, the visual acuity of his left eye was light perception, and the intraocular pressure (IOP) measured by a Tono-Pen (Tono-Pen AVIVA, Reichert, NY, USA) was 43 mmHg. Upon, slit-lamp examination, a 8.7 × 7-mm gelatinous mass and blisters covering the entire cornea with new vessels at the 6 o'clock position were observed. The entire corneal thickness was 1.39 mm, the depth of the degenerated lesion was 0.89 mm, and the residual corneal tissue was 0.50 mm, as measured by anterior optical tomography (Visante optical coherence tomography; Carl Zeiss Meditec, Dublin, CA, USA) ().\nThe host cornea was trephinated to a level of 70% to 80% of its thickness using the 8.0-mm Hessburg-Barron disposable vacuum trephine (Katena Instruments, Denville, NJ, USA). A blunt spatula was used to separate the overlying corneal tissue along the plane of dissection. The anterior lamellar stroma (about 80% in thickness) was removed using Vannas scissors. The residual stroma was removed layer-by-layer with repeated dissections until Descemet's membrane was exposed. The acellular corneal tissue, with a diameter of 8.5 mm, was sutured in place using 32 interrupted stitches of 10-0 nylon. We performed permanent amniotic membrane grafting with a temporary amniotic membrane patch to minimize epithelization delay. The temporary amniotic membrane and stitches were removed one week after the surgery, and the corneal epithelial defects remained one month after surgery. However, these defects had healed by three months after surgery. IOP remained within the normal range, and visual acuity increased to 20 / 200. One year after treatment, no recurrence was observed ().\nThe size of the lesion was 8.7 × 7 mm, and it consisted of gelatinous white tissue with an irregular surface. Under the corneal epithelium, myxoid tissue was observed, with a severely vacuolar degenerated stroma beneath the myxoid tissue. The myxoid tissue was positive on Alcian blue staining (pH 2.5), and a few scattered fibroblasts were observed on hematoxylin and eosin (H&E) staining (, , and ). The lesion appeared to be a loose, hypocellular, minimal collagen-depositional, glycosaminoglycan-rich myxoid mass in the subepithelial anterior stroma. Moreover, the central site of the lesion exhibited vacuolar change beneath the myxoid tissue (). The spindle cells were negative for amyloid (Congo red) and the vacuoles were negative for chondrocytes (Toluidine blue). | [[32.0, 'year']] | M | {'17133067': 1, '3863808': 1, '21993467': 1, '433739': 1, '14253111': 1, '9220253': 1, '19034139': 1, '18917127': 1, '9071537': 1, '9400767': 1, '7643488': 1, '12062226': 1, '21803324': 1, '9683143': 1, '2759356': 1, '12542732': 1, '15043547': 1, '18329930': 1, '3580351': 1, '2123735': 1, '11588424': 1, '21673302': 1, '31511491': 1, '24505204': 2} | {} |
165,656 | 3913987-1 | 24,505,205 | noncomm/PMC003xxxxxx/PMC3913987.xml | Macular Hole Formation after Pars Plana Vitrectomy for the Treatment of Valsalva Retinopathy: A Case Report | A 20-year-old female patient was referred to our hospital due to a sudden decrease in visual acuity in the left eye after heavy alcohol consumption. She denied any history of trauma or sexual contact. Her medical and ocular histories were unremarkable. Previous medical records reported that the patient had a history of severe vomiting following heavy drinking. In the left eye, the best-corrected visual acuity (BCVA) was hand motion. The anterior segment was unremarkable in both eyes. Fundus examination was normal in the right eye but revealed a well-circumscribed premacular hemorrhage about 4 DDs in size beneath a transparent membrane with glistening reflexes extending over the macula in the left eye. No posterior vitreous detachment (PVD) was evident. Time-domain OCT (TD-OCT) revealed an intact foveal contour and two membranes of differing optical reflectivity, identified as the internal limiting membrane (ILM) and the posterior hyaloid, respectively, with blood beneath the hyperreflective membrane ().\nDuring a nine-week follow-up period, the premacular hemorrhage resolved spontaneously, and the BCVA in the left eye returned to 20 / 100. Yellowish residual sub-ILM deposits, however, were present, and a thick preretinal membrane was visible over the fovea ().\nThe patient requested aggressive treatment. After full explanation of the expected effects and possible complications of vitrectomy, the patient provided informed consent. A 23-gauge pars plana vitrectomy was performed using a minimal core vitrectomy technique. PVD was created using triamcinolone acetonide and a vitreous cutter only around the posterior pole. The ILM was peeled off using 23-gauge microforceps after staining the ILM with indocyanine green (Diagnogreen; Daiichi Pharmaceutical, Tokyo, Japan). The ILM was removed from a 2- to 3-DD area centered on the fovea. The thick preretinal membrane and the ILM were removed, but the residual foveal deposits could not be extracted because they had adhered to the fovea. The surgeon expected the deposits to absorb spontaneously, so fluid-air exchange was not performed. Two weeks after the first vitrectomy, the foveal deposits had resolved, but a full thickness MH was observed. Postoperative SD-OCT, which was used to analyze the cross-sectional image almost every day (), did not reveal an MH during the first seven days. A second vitrectomy was performed using standard techniques to create a total PVD and to remove the remnant peripheral vitreous with fluid-air exchange through an extrusion cannula. The eye was flushed with a 15% perfluoropropane gas-air mixture to ensure complete exchange. After the second surgery, the patient was instructed to maintain a strict face-down position for three days in the hospital until MH closure was confirmed.\nSix months after the second surgery to close the MH, the BCVA in the left eye had improved to 20 / 25. SD-OCT showed that the MH had closed with only slight scarring of the photoreceptor inner segment/outer segment junction (). | [[20.0, 'year']] | F | {'29563705': 2, '16946748': 1, '3584811': 1, '4696667': 1, '29854517': 2, '25117955': 2, '29181326': 1, '31198885': 1, '30210884': 2, '31374025': 1, '11203179': 1, '16883367': 1, '7786214': 1, '10636437': 1, '17229799': 1, '14516831': 1, '24505205': 2} | {'5964536-1': 1, '6126077-1': 1, '4136644-1': 1, '5848358-1': 1, '5848358-2': 1, '5848358-3': 1, '5848358-4': 1, '5848358-5': 1, '5848358-6': 1} |
165,657 | 3913988-1 | 24,505,206 | noncomm/PMC003xxxxxx/PMC3913988.xml | Use of Optical Coherence Tomography to Evaluate Visual Acuity and Visual Field Changes in Dengue Fever | A 40-year-old woman presented with a 1-year history of afterimages in both eyes after having Dengue fever. Her best-corrected visual acuity (BCVA) was 20 / 20 in both eyes, and her intraocular pressure was normal. Slit examination revealed no abnormal findings. Retina examination revealed hemorrhaging in the retina inner layer and RPE atrophy in both eyes. Fluorescein angiography demonstrated fluorescence blockage by retinal hemorrhage. ICG showed late hypofluorescence due to choroidal filling disorder, and infrared (IR) imagery showed hypofluorescence that included both foveae. OCT imagery revealed disruption of the inner segment/outer segment junction (IS/OS) junction and outer retina thinning at the hypofluorescence site of the IR imagery ( and ). | [[40.0, 'year']] | F | {'15522372': 1, '11755858': 1, '12972783': 1, '25120345': 1, '12234522': 1, '17030709': 1, '11549879': 1, '12436482': 1, '7811870': 1, '30315262': 1, '28980843': 1, '17561258': 1, '8032282': 1, '2733064': 1, '16692987': 1, '24505206': 2} | {'3913988-2': 2, '3913988-3': 2} |
165,658 | 3913988-2 | 24,505,206 | noncomm/PMC003xxxxxx/PMC3913988.xml | Use of Optical Coherence Tomography to Evaluate Visual Acuity and Visual Field Changes in Dengue Fever | A 40-year-old woman presented with an upper visual field defect in the left eye after contracting dengue fever 1 month prior. The right eye was normal. BCVA was 20 / 30 in the left eye, and no other abnormal findings were found in the anterior segment. Retina examination revealed RPE atrophy in the left eye. Fluorescein angiography (FA) of the left eye showed a patch choroidal perfusion delay and a window defect due to RPE atrophy. IR imagery demonstrated hypofluorescence in the superior nasal area including the fovea. OCT imagery revealed disruption of the IS/OS junction and outer retina thinning at the hypofluorescence site of the IR imagery. | [[40.0, 'year']] | F | {'15522372': 1, '11755858': 1, '12972783': 1, '25120345': 1, '12234522': 1, '17030709': 1, '11549879': 1, '12436482': 1, '7811870': 1, '30315262': 1, '28980843': 1, '17561258': 1, '8032282': 1, '2733064': 1, '16692987': 1, '24505206': 2} | {'3913988-1': 2, '3913988-3': 2} |
165,659 | 3913988-3 | 24,505,206 | noncomm/PMC003xxxxxx/PMC3913988.xml | Use of Optical Coherence Tomography to Evaluate Visual Acuity and Visual Field Changes in Dengue Fever | A 29-year-old woman treated for dengue fever 1 year prior presented with a visual field defect in the left eye. All symptoms and test were normal in the right eye. The anterior segment was normal. Retina examination showed RPE mottling in the left eye. FA revealed a faint window defect in the left eye, and IR imagery revealed hypofluorescence in the fovea area. OCT imagery revealed disruption of the IS/OS junction and outer retina thinning at the hypofluorescence site of the IR imagery. | [[29.0, 'year']] | F | {'15522372': 1, '11755858': 1, '12972783': 1, '25120345': 1, '12234522': 1, '17030709': 1, '11549879': 1, '12436482': 1, '7811870': 1, '30315262': 1, '28980843': 1, '17561258': 1, '8032282': 1, '2733064': 1, '16692987': 1, '24505206': 2} | {'3913988-1': 2, '3913988-2': 2} |
165,660 | 3915150-1 | 24,511,489 | noncomm/PMC003xxxxxx/PMC3915150.xml | Correction of Short Nose Deformity Using a Septal Extension Graft Combined with a Derotation Graft | A 62-year-old woman presented with a severely contracted nose and columellar retraction. Previously, the patient had a silicone implant, which was removed at an outside clinic after chronic infection. A two-layer dissection, above and beneath the scar tissue, was performed for skin and alar cartilage elongation. A septal extension graft using septal cartilage was performed, along with a columellar strut, derotation graft, tip onlay, and shield graft harvested from the ear. A dermofat graft was used for dorsal augmentation between the skin and the scar tissue (). | [[62.0, 'year']] | F | {'17658425': 1, '33503738': 1, '33758974': 1, '9290671': 1, '33714247': 1, '14663242': 1, '28507846': 1, '24511489': 2} | {} |
165,661 | 3915153-1 | 24,511,488 | noncomm/PMC003xxxxxx/PMC3915153.xml | Effective Septal Extension Graft for Asian Rhinoplasty | A 28-year-old woman with two prior operations presented with an upturned nose caused by contracture from a prior operation. She underwent the removal of the implant with the capsule and the scar, and a type I septal extension graft was applied to lengthen the nasal tip. After 6 months, the postoperative tip angle had decreased to 98 degrees from a preoperative tip angle of 132 degrees, and the postoperative tip was mobile and natural (). | [[28.0, 'year']] | F | {'17223514': 1, '10937908': 1, '22538276': 1, '9290671': 1, '18176231': 1, '25129372': 1, '17088182': 1, '23395883': 1, '13520023': 1, '8016254': 1, '8084629': 1, '17659419': 1, '16547635': 1, '24511488': 2} | {'3915153-2': 2, '3915153-3': 2} |
165,662 | 3915153-2 | 24,511,488 | noncomm/PMC003xxxxxx/PMC3915153.xml | Effective Septal Extension Graft for Asian Rhinoplasty | A 26-year-old woman with two prior operations visited the clinic out of dissatisfaction with the results of prior operations. A type II septal extension graft and tip graft were applied to remove the implant with the capsule and the scar tissue and at the same time conduct an upturned tip correction and projection. A silicone implant was used for dorsal augmentation. The preoperative tip angle was 128 degrees and the nasal height was 27 mm. After 24 months, the postoperative tip angle had decreased to 107 degrees and the nasal height had become 28 mm. In accordance with the patient's preferences, the nasal tip height was not modified (). | [[26.0, 'year']] | F | {'17223514': 1, '10937908': 1, '22538276': 1, '9290671': 1, '18176231': 1, '25129372': 1, '17088182': 1, '23395883': 1, '13520023': 1, '8016254': 1, '8084629': 1, '17659419': 1, '16547635': 1, '24511488': 2} | {'3915153-1': 2, '3915153-3': 2} |
165,663 | 3915153-3 | 24,511,488 | noncomm/PMC003xxxxxx/PMC3915153.xml | Effective Septal Extension Graft for Asian Rhinoplasty | A 19-year-old woman with no prior operations presented excessive nostril show from the frontal view and a retracted columella. A type III septal extension graft was applied for the correction of the nasal tip and columellar retraction at the same time. The postoperative columella-labial angle after 6 months had increased to 93 degrees from a preoperative columella-labial angle of 79 degrees (). | [[19.0, 'year']] | F | {'17223514': 1, '10937908': 1, '22538276': 1, '9290671': 1, '18176231': 1, '25129372': 1, '17088182': 1, '23395883': 1, '13520023': 1, '8016254': 1, '8084629': 1, '17659419': 1, '16547635': 1, '24511488': 2} | {'3915153-1': 2, '3915153-2': 2} |
165,664 | 3915160-1 | 24,511,498 | noncomm/PMC003xxxxxx/PMC3915160.xml | Mild Ptosis Correction with the Stitch Method During Incisional Double Fold Formation | A 19-year-old female presented with 2 mm MRD1 on both eyes, which appeared to be worse due to hooding of excess skin causing effacement of the lid margin. Excess skin and muscle were excised through the incisional method, which also resulted in adhesion-like septated tissue around the septum being freed up. The MRD1 measurements at 3 months postoperatively were 5 mm on both eyes (). | [[19.0, 'year']] | F | {'18216695': 1, '20181539': 1, '26306083': 1, '17060734': 1, '27029811': 1, '21478063': 1, '24511498': 2} | {'3915160-2': 2, '3915160-3': 2, '3915160-4': 2} |
165,665 | 3915160-2 | 24,511,498 | noncomm/PMC003xxxxxx/PMC3915160.xml | Mild Ptosis Correction with the Stitch Method During Incisional Double Fold Formation | A 28-year-old female presented complaining of sunken eyes and discomfort when opening her eyes. The skin and muscle excision was kept at a minimum and the 2-loop technique as described above was used for ptosis correction. MRD1 was increased from 3.5 mm preoperatively to 5.5 mm at 8 months postoperatively. Resolution of discomfort with eye opening and the correction of sunken eyes was maintained at 8 months postoperatively (). | [[28.0, 'year']] | F | {'18216695': 1, '20181539': 1, '26306083': 1, '17060734': 1, '27029811': 1, '21478063': 1, '24511498': 2} | {'3915160-1': 2, '3915160-3': 2, '3915160-4': 2} |
165,666 | 3915160-3 | 24,511,498 | noncomm/PMC003xxxxxx/PMC3915160.xml | Mild Ptosis Correction with the Stitch Method During Incisional Double Fold Formation | A 31-year-old female, with a history of double eyelid surgery 4 years earlier through a partial incision technique, presented complaining that her eyes still appeared small and tired. The double eyelid was revised and ptosis was corrected with our technique as described above. The MRD1 was increased from 2.5 mm preoperatively to 5 mm at 3 months postoperatively (). | [[31.0, 'year']] | F | {'18216695': 1, '20181539': 1, '26306083': 1, '17060734': 1, '27029811': 1, '21478063': 1, '24511498': 2} | {'3915160-1': 2, '3915160-2': 2, '3915160-4': 2} |
165,667 | 3915160-4 | 24,511,498 | noncomm/PMC003xxxxxx/PMC3915160.xml | Mild Ptosis Correction with the Stitch Method During Incisional Double Fold Formation | A 46-year-old female, with a history of bilateral upper and lower blepharoplasty 10 years earlier, presented for revision. The MRD1 on the right was 2 mm and on the left was 1.5 mm. The asymmetry became more pronounced when the frontalis muscle action was blocked, with an MRD1 of 2 mm on the right and 1 mm on the left. Incisional double eyelid surgery was performed on both eyes, with 1-loop on the right and 2-loops on the left for ptosis correction. At 3 months postoperatively, an MRD1 of 3 mm was maintained bilaterally with improvements in the lower scleral show phenomenon (). | [[46.0, 'year']] | F | {'18216695': 1, '20181539': 1, '26306083': 1, '17060734': 1, '27029811': 1, '21478063': 1, '24511498': 2} | {'3915160-1': 2, '3915160-2': 2, '3915160-3': 2} |
165,668 | 3915161-1 | 24,511,499 | noncomm/PMC003xxxxxx/PMC3915161.xml | Repair of Inferior Sternal Cleft Using Bilateral Sternal Bar Turnover Flaps in a Patient with Pentalogy of Cantrell | Our patient is a 4-year-old Indonesian Chinese boy, diagnosed with pentalogy of Cantrell. At 10 months of age, he required early corrective cardiac surgery due to deteriorating cardiopulmonary function, and the repair of sternal, diaphragmatic, and abdominal wall defects was planned at the same time. He had partial herniation of the heart through a lower sternal defect (ectopia cordis), which was only covered by thin skin, allowing the cardiac pulse to be seen (). Although autologous tissue was preferred over alloplastic material, the patient's native tissue was not adequate for a reliable reconstruction at that time. A staged procedure was planned, and a resorbable PLLA-PGA plate was implanted as a temporary shield over his heart in the first stage []. This provided a stable soft tissue cover over his heart for 3 years. We carried out the second stage of rigid sternal reconstruction at 4 years of age, when the patient's thoracic skeleton had grown.\nOur technique for reconstruction of the inferior sternal defect is as follows: the patient is placed in a supine position. A sagittal incision is made over the previous midline scar. Skin and pectoralis major muscle flaps are raised using fine needle diathermy, exposing the sternal bar and proximal costal cartilages (). The superior rectus attachments are dissected from the lower border of the sternal bar and ribs. Further, the cartilaginous sternal bars are bisected using a scalpel, along their length, from lateral to medial, leaving the medial perichondrium intact (). This allows the anterior half of the bisected sternal bars to be turned over medially to cover the inferior sternal defect. The cartilaginous flaps are sutured together in the midline using polypropylene sutures, constituting a complete thoracic skeletal ring (). After suture apposition of the divaricated superior rectus muscles with polyglactin sutures, the rectus muscles are re-attached to the reconstructed lower sternum using polypropylene sutures. For sustained postoperative pain control, 0.025% bupivacaine is administered using elastomeric infusors via two epidural catheters. These are placed under the sternal bars, one on each side. The bupivacaine will infuse at 2 mL/hr over the next 48 hours. We place the drainage catheter over the sternal bars to avoid draining the infused bupivacaine solution. Further, bilateral pectoralis major flaps are advanced and sutured in the midline to cover the reconstructed sternum before skin closure.\nThe patient was admitted to a high dependency ward for 24 hours. The epidural infusion catheters were removed after 48 hours and the drainage catheter after 3 days. The patient remained relatively pain-free during the hospitalization and was discharged on postoperative day 5. The 10-month follow-up revealed that he was well and the reconstruction had remained rigid (). No complications were noted. | [[4.0, 'year']] | M | {'25926914': 1, '31590448': 2, '20948422': 1, '9800797': 1, '29379702': 1, '25473208': 1, '20006040': 1, '22703818': 1, '13592660': 1, '24511499': 2} | {'6826365-1': 1} |
165,669 | 3915162-1 | 24,511,500 | noncomm/PMC003xxxxxx/PMC3915162.xml | Pseudoaneurysm Leading to Necrotizing Fasciitis at the Femoral Arterial Puncture Site | A 78-year-old man with ischemic heart disease underwent cardiac catheterization and percutaneous transluminal coronary angioplasty via the femoral artery. His premorbid condition included old age, liver cirrhosis, renal cell carcinoma, diabetes mellitus, and significant ischemic cardiomyopathy. Six days following discharge from the hospital, the patient experienced severe sharp pain in the right groin with no skin discoloration of the right lower extremity. On physical examination, a pulsatile mass was noted in the right groin. Lower-extremity angiography revealed a PA of the superficial femoral artery (). Hematoma removal and bleeder ligation were performed by a vascular surgeon. The affected part of the superficial femoral artery was freed, the aneurysm was opened along its length, and the thrombus was evacuated. A heparin infusion was begun postoperatively.\nFive days later, the patient developed progressive abdominal pain, fever, vomiting, skin discoloration, and wound induration (). A laboratory study revealed that the white blood cell count was 2000/µL, erythrocyte sedimentation rate (ESR) level was 11 mm/hr, and reactive protein-C (CRP-C) level was 17.91 mg/dL; all these were mildly elevated values. Further, the creatine kinase-MB (CK-MB) level was in the normal range, but the myoglobin level was elevated to 174 ng/mL (normal range, 22-75 ng/mL). The sodium level was found to be 132 mmol/L (normal range, 135-153 mmol/L), a slightly lowered level, and blood urea nitrogen (BUN) was 25.6 mg/dL (normal range, 8-20 mg/dL). Computed tomographic scans of the abdomen and perineal region revealed fluid accumulations involving multiple subcutaneous spaces and the peritoneum. The patient also had ileus of multiple bowel loops (). At that time, he was diagnosed with necrotizing fasciitis of the upper thigh, abdomen, and perineum. The necrotic wound was serially excised, and treatment was performed with the VAC device. VAC therapy was conducted for a period of 12 days (). The patient had an uneventful recovery with a normal range of laboratory results and finally underwent wound closure (). | [[78.0, 'year']] | M | {'17163887': 1, '10615187': 1, '22355518': 1, '3282407': 1, '19811550': 1, '17629176': 1, '22694053': 1, '24511500': 2} | {'3915162-2': 2} |
165,670 | 3915162-2 | 24,511,500 | noncomm/PMC003xxxxxx/PMC3915162.xml | Pseudoaneurysm Leading to Necrotizing Fasciitis at the Femoral Arterial Puncture Site | A 46-year-old woman with symptoms of hemoptysis underwent bronchial angiography via the femoral artery. The patient's premorbid conditions were liver cirrhosis, chronic renal failure, diabetes mellitus, and obesity. However, upon the patient's return to the emergency room, she had a huge hematoma at the femoral arterial puncture site. Color-flow Doppler ultrasonography revealed a giant hematoma and hemorrhagic liquid at various concentrations in the upper third of the right thigh (). Angiography revealed a PA of the superficial femoral artery. Thrombolysis and bleeder ligation with Gelfoam were performed twice by an interventional radiologist. However, on the fourth postoperative day, the patient developed intense thigh swelling accompanied by bleeding from the surgical wound, induration, and marked tenderness. Seven days later, she was diagnosed with necrotizing fasciitis of the upper thigh, abdomen, and perineum (). A laboratory study revealed that the white blood cell count was 12,870/µL, ESR level was 29 mm/hr, and CRP level was 28.48 mg/dL (normal range, 0-0.5 mg/dL); all these values were mildly elevated. Further, the CK-MB level was elevated to 10.7 ng/mL (normal range, 0.1-5.8 ng/mL) and the myoglobin level was elevated to 565 ng/mL (normal range, 22-75 ng/mL). The sodium level was found to be 142, which was a slightly lowered level, and BUN was 27.3 mg/dL (normal range, 8-20 mg/dL). The necrotic wound was serially excised, and treatment was performed with the VAC device. The VAC therapy was conducted for a period of 21 days. However, the patient died of multiorgan failure and aspiration pneumonia. | [[46.0, 'year']] | F | {'17163887': 1, '10615187': 1, '22355518': 1, '3282407': 1, '19811550': 1, '17629176': 1, '22694053': 1, '24511500': 2} | {'3915162-1': 2} |
165,671 | 3915189-1 | 24,511,423 | noncomm/PMC003xxxxxx/PMC3915189.xml | Early Postoperative Retrograde Jejunojejunal Intussusception after Total Gastrectomy with Roux-en-Y Esophagojejunostomy: A Case Report | A 77-year-old woman visited Chonbuk National University Hospital because of gastric adenocarcinoma detected at a periodic examination. She had no history of abdominal surgery. Radical total gastrectomy with Roux-en-Y esophagojejunostomy was performed. After radical total gastrectomy, the jejunum was resected 20 cm below from the Treitz ligament. Distal part of resected jejunum was pulled up through the transverse mesocolon, and esophagojejunostomy was constructed in end-to-side anastomosis by using an EEA stapler (25 mm; Covidien, Mansfield, MA, USA). Fifty centimeters below the esophagojejunostomy site, a jejunojejunostomy was constructed by performing end-to-side hand-sewn anastomosis. A nasojejunal feeding tube (NJFT) was inserted into the distal part of the efferent loop of the jejunostomy for early postoperative enteral nutrition. A closed drain tube was placed at the esophagojejunostomy through the abdominal wall.\nOn the fifth postoperative day, the patient complained of abdominal pain, and bile-colored fluid was seen in the closed drain tube. A water-soluble contrast swallowing imaging study indicated leakage at the esophagojejunostomy site and dilatation of the Roux limb and the afferent loop of the jejunojejunostomy, which indicated intestinal obstruction (). Emergency surgery was performed.\nDuring surgery, retrograde jejunojejunal intussusception accompanied with NJFT was found at the efferent loop of the jejunojejunostomy. The intussusception was approximately 7 cm in length from the NJFT tip portion to the jejunojejunostomy and showed mild edematous changes without necrosis (). Manual reduction without bowel resection and primary repair of esophagojejunostomy was performed, and the NJFT was removed. Feeding Jejunostomy for enteral nutrition was constructed at the distal part of the efferent loop of the jejunojejunostomy. On the ninth repostoperativeday, a follow-up soluble contrast swallowing imaging study showed no leakage. She was discharged without complications on the 23rd re-postoperativeday. | [[77.0, 'year']] | F | {'33269270': 2, '21490899': 1, '11321349': 1, '26425267': 1, '34876149': 1, '16618618': 1, '7138069': 1, '15759123': 1, '27813022': 2, '31620523': 1, '26943396': 2, '11680941': 1, '20011406': 1, '13190201': 1, '24511423': 2} | {'7674735-1': 1, '7674735-2': 1, '5095090-1': 1, '4747958-1': 1} |
165,672 | 3915190-1 | 24,511,424 | noncomm/PMC003xxxxxx/PMC3915190.xml | Laparoscopic Distal Gastrectomy in a Patient with Situs Inversus Totalis: A Case Report | In February 2012, a 52-year-old male was diagnosed with early gastric cancer through a screening esophagogastroduodenoscopy (EGD). The patient visited our hospital for further evaluation and surgical treatment, if needed. He had been diagnosed with SIT about 30 years previously, but he had not developed any specific disease until this point. His body mass index (BMI) was 22.8 kg/m2, and he had no other underlying disease and no family history of SIT or stomach cancer. The patient had no history of surgery, except for a right inguinal hernia repair in 2007. Initial vital signs were stable, and a systemic review and physical examination revealed nothing of note. Laboratory examination, including tumor markers, likewise showed no abnormal findings. The chest x-ray film suggested dextrocardia, and an EGD image of the patient indicated an opposite orientation of the pylorus and the stomach (). The lesion was 2 cm proximal to the pylorus. Preoperative clipping was performed 1 cm proximal (angle, superjacent, low body anterior wall) and 1 cm distal (prepyloric antrum) to the ill-defined early gastric cancer lesion on the mid-antrum lesser curvature. Poorly differentiated adenocarcinoma was found on biopsy. Endoscopic-ultrasonography (EUS) showed submucosal invasion but no definite perigastric lymphadenopathy. Computed tomography (CT) showed transposition of the organs (). There was also focal wall thickening and enhancement in the lesser curvature of the prepyloric antrum with multiple, tiny lymph nodes in the perilesional and perigastric space.\nAs there were no distant metastases or visible invasion into adjacent organs, the clinical stage was cT2N0M0, and we decided to perform LADG with D1+ lymph node dissection. Prior to surgery, abdominal angiographic CT with three-dimensional (3D) reconstruction was performed to uncover any variations and to verify the exact structures and locations of the vessels. There were two major artery variations: a replacing common hepatic artery from the superior mesentery artery, and 2 branches from the left gastric artery ().\nLaparoscopic surgery was performed. We decided to use the same placement of ports as we do for normal patients (). However, we used a 12 mm trocar instead of a 5 mm trocar for the 1st assistant, in case the position of the operator changed. Intraoperatively, there was an obvious transposition of the abdominal organs (). Partial omentectomy was done followed by ligation of the left gastroepiploic vessels. While dissecting the area around the right gastroepiploic vessels and the suprapancreatic portion, the surgeon tried to move to the opposite side, but found that it was easier to perform this dissection on the usual side. The epigastric incision was primarily used as a port for liver retraction before extracorporeal anastomosis. With the liver retracted by the 1st assistant, the lesser omentum was opened. This patient had a common hepatic artery originating from the superior mesenteric artery, so the right gastric artery came from the celiac trunk. Due to its small size, careful dissection and ligation were performed (). Lymph node dissection was performed around the celiac axis and along the lesser curvature. The two branches of the left gastric artery were identified and were found to match the preoperative 3D reconstruction image. The radiologist confirmed the anatomic variation in the surgical field and both branches were safely ligated at the root (). After the D1+ lymph node dissection, an extension of the epigastric port site was made for extracorporeal anastomosis. The now freely movable stomach was brought up to the incision. A modified extracorporeal, double-stapling, end-to-end Billroth I anastomosis procedure was performed (). The operation time was 220 minutes and there were no intraoperative events, with an estimated blood loss of 100 ml. There were no immediate postoperative complications, and the patient was discharged eight days after the operation without any complications.\nThe final pathology showed a 3.3×2.2×0.3 cm sized, poorly differentiated Borrmann type 3 lesion with invasion limited to the muscularis propria. There was no metastasis in any of the 29 retrieved lymph nodes. The final stage was pT2N0, Stage 1B according to the American Joint Committee on Cancer 7th edition. | [[52.0, 'year']] | M | {'1295099': 1, '20037843': 1, '26087838': 2, '29012980': 1, '17708549': 1, '22563541': 2, '29657611': 2, '21573921': 1, '20526627': 1, '29695579': 1, '28953685': 1, '33887833': 1, '25202406': 2, '21573920': 1, '29499701': 2, '33622883': 1, '12404047': 1, '26401091': 1, '11468444': 1, '27703309': 1, '26366368': 2, '24511424': 2} | {'3915190-2': 2, '4156176-1': 1, '4472267-1': 1, '5894452-1': 1, '5834864-1': 1, '4560153-1': 1, '3341483-1': 1} |
165,673 | 3915190-2 | 24,511,424 | noncomm/PMC003xxxxxx/PMC3915190.xml | Laparoscopic Distal Gastrectomy in a Patient with Situs Inversus Totalis: A Case Report | A 68-year-old male underwent a screening EGD in September of 2012. There were no remarkable findings in the routine laboratory examination including tumor markers, except for an elevated creatinine level (1.95 mg/dl). This was due to the chronic kidney disease and hypothyroidism for which he was being treated. Despite these conditions, preoperative risk assessment indicated tolerability of a laparoscopic operation. The patient had no history of abdominal surgery. His preoperative BMI was 23.55 kg/m2, and a chest x-ray film revealed dextrocardia. EGD showed a hyperemic nodular lesion on the mid antrum anterior wall. Biopsy confirmed well-differentiated adenocarcinoma (). EUS showed definite involvement of the submucosa, but proper muscle layer invasion was suspected. CT showed SIT with no other remarkable findings (). There were no vascular anomalies, and no metastasis or invasion into adjacent structures, so the clinical stage was cT2N0M0. TLDG with delta anastomosis and D1+ lymph node dissection was scheduled. The operator stood on the same side as if there was no SIT throughout the operation. A flexible scope was used through the 12 mm trocar made on the umbilicus. Two 12 mm trocars and two 5 mm trocars were used, making a V shape (). Exposure of the hepatoduodenal ligament and the lesser omentum was achieved with the retraction of the falciform and the left lobe of the liver using a single suture technique.\nPartial omentectomy was performed about 4 cm from the gastroepiploic arcade. The left gastroepiploic vessels were ligated near the fundus and omentectomy was performed along the greater curvature. The right gastroepiploic vessels were then ligated, and the right gastric artery was ligated onto the root from the common hepatic artery. A linear stapler was inserted through the 12 mm trocar on the right side of the patient, and the duodenum was divided just distal from the pylorus. The left gastric artery and the coronary vein were ligated during lymph node dissection along the superior border of the pancreas. After completing lymph node dissection along the lesser curvature, D1+ lymph node dissection was completed. The stomach was divided at the angle portion by a linear stapler and delta-shaped anastomosis was performed (). The resected specimen was delivered through the umbilicus, with extension of the incision. The operation time was 117 minutes and the estimated blood loss was 50 ml, without any intraoperative complications. There were no postoperative complications and the patient was discharged 5 days after the operation.\nThe final pathology reported a 3.2×1.2×0.1 cm sized, well-differentiated adenocarcinoma, localized within the lamina propria. Fifty-nine lymph nodes were retrieved, none of which contained a metastasis. The final pathology was pT1aN0, stage IA. | [[68.0, 'year']] | M | {'1295099': 1, '20037843': 1, '26087838': 2, '29012980': 1, '17708549': 1, '22563541': 2, '29657611': 2, '21573921': 1, '20526627': 1, '29695579': 1, '28953685': 1, '33887833': 1, '25202406': 2, '21573920': 1, '29499701': 2, '33622883': 1, '12404047': 1, '26401091': 1, '11468444': 1, '27703309': 1, '26366368': 2, '24511424': 2} | {'3915190-1': 2, '4156176-1': 1, '4472267-1': 1, '5894452-1': 1, '5834864-1': 1, '4560153-1': 1, '3341483-1': 1} |
165,674 | 3915392-1 | 24,554,867 | noncomm/PMC003xxxxxx/PMC3915392.xml | An innovative approach in the management of palatogingival groove using Biodentine™ and platelet-rich fibrin membrane | A 24-year-old male patient who had a complaint of dull and intermittent pain at the palatal side of the left maxillary lateral incisor came to Department of Endodontics. During the clinical examination, the left maxillary lateral incisor (#10) had an intact crown without caries or fracture, with negative vitality testing and a positive response to percussion []. The tooth was grade 2 mobile. Periodontal probing disclosed a periodontal pocket (9 mm) at the mesiopalatal line angle of the tooth and concomitantly, a PGG which extended into the gingival sulcus []. Facially the gingival sulcus had 8 mm probing depth. Oral hygiene was satisfactory. An occlusal radiograph revealed a large periapical lesion with a bony defect extending beyond the apical third of the root []. Gutta-percha tracing into the sinus tract and periodontal pocket revealed a communication with the periapical area. Based on the tests and the radiographic findings, the diagnosis was necrotic pulp, suppurative periradicular periodontitis and localized periodontitis secondary to the palatal groove on tooth #10.\nIn phase one therapy, oral prophylaxis was performed. Stabilization of the tooth was done with stainless steel wire and composite resin. Endodontic access was performed after placing a rubber dam and disinfecting the area with 2% chlorhexidine digluconate (Calypso, Septodont, India). Working length was determined by using electronic apex locator Root ZX (J. Morita Mfg. Corporation, Kyoto, Japan) and file in-radiograph with 15 no. K-files. The root canal was cleaned and shaped by rotary Ni-Ti ProTaper System along with Glyde (Dentsply Maillefer Company, USA) using crown down technique. The root canal was copiously irrigated with 2.5% sodium hypochlorite (Novo Dental Product, India). Access cavity was temporized with calcium hydroxide and TERM. Patient was recalled after 1 week; the tooth was asymptomatic. Root canal was irrigated again with normal saline and dried using paper points. Before obturation, master points were seated to test their suitability to canal and radiograph was taken. The canal was obturated with selected master gutta-percha cone (variable taper]) and AH-Plus sealer (Dentsply Maillefer Company, USA). The coronal gutta-percha cones were sheared off using heated instrument, and vertical compaction was done using the heated pluggers at the canal orifices. During the periodontal phase of the therapy, complete extraoral and intraoral mouth disinfection was done with betadine and local anesthesia was administered (xylocaine 2% with epinephrine 1:80,000). A surgical flap was raised from the palatal aspect and labial aspect, and the PGG was isolated to its most apical extent []. Thorough scaling and root planning was performed over the groove to remove the bacteria that might have colonized there. The diseased granulation tissue was curetted out with Gracey curette number 1/2 and 5/6; (Hu-Friedy Manufacturing Co, Chicago, IL) to leave the soft tissue more conducive to regeneration. A chemical conditioning of the groove was performed and Biodentine™ (Septodont, St. Maur-des-Fossés, France) was applied into the defect []. With the help of an air-driven surgical handpiece (Impact Air, Palisade Dental), the apical root end was resected and sealed with Biodentine™ (Septodont, St. Maur-des-Fossés, France) []. The area was kept isolated of blood and tissue fluids during the setting of the cement by using local hemostatic gelatin sponge (Pfizer Inc, New York, NY).\nA 12 ml sample of whole blood was drawn intravenously from the patient's right antecubital vein and centrifuged (REMI Model R-8c with 12 × 15 ml swing out head) under 3,000 rpm for 10 min to obtain the PRF which was jelly-like in consistency. PRF clot started to release its serum (PRF-clot exudates) and was ready for compression into the membrane. The bony defect was filled with freeze-dried bone allograft (LifeNet, Virginia Beach, VA) []. Without delay autologous PRF membrane was placed [] and the flaps were secured with 4-0 polyglactin 910 sutures (Vicryl, Ethicon, Inc., Piscataway, NJ).\nFollowing surgery, the patient was placed on doxycycline 100 mg, with instructions to take two capsules immediately, then one capsule every day for 14 days. In addition, a 0.12% chlorhexidine gluconate rinse was prescribed and ibuprofen was given for discomfort. The patient was asymptomatic postoperatively and sutures were removed after 7 days. The patient was recalled for 6 months for a period of 2 years. There was both a clinical and radiographic improvement. Clinically, there was a reduction in the pocket depth of 5 mm in 6 months and patient is asymptomatic with a 3 mm non-bleeding sulcus at the end of 24 months. There was a significant reduction in radiolucency radiographically []. | [[24.0, 'year']] | M | {'8227457': 1, '29372451': 1, '3867723': 1, '26124612': 2, '27656596': 1, '20850685': 1, '28503472': 1, '25984480': 2, '19905939': 1, '5235230': 1, '15533215': 1, '27965900': 2, '27141225': 2, '1940748': 1, '19089687': 1, '22025843': 2, '20799908': 1, '26180420': 1, '22394277': 1, '19450911': 1, '25506153': 2, '24554867': 2} | {'3198569-1': 1, '4841352-1': 1, '5124660-1': 1, '4479763-1': 1, '4252939-1': 1, '4432261-1': 1} |
165,675 | 3915394-1 | 24,554,868 | noncomm/PMC003xxxxxx/PMC3915394.xml | A simplified technique of orthograde MTA obturation on the elected canals of posterior teeth: Two case reports | A 31-year-old male patient visited my office for a persistent symptom associated with tooth no. 2. The medical history was noncontributory but he had a present history of unsatisfied endodontic treatment from his previous dentist with respect to this tooth. No written or radiographic records were available with him. His mouth opening was less than normal. On exploration, the mesiobuccal (MB) and distobuccal (DB) canals were found to be filled and were satisfactory. The unfilled palatal (PC) was well enlarged and prepared, but its apical constriction was grossly violated to such an extent that a 55 no. H file went through it easily []. Apart from apical transportation and zipping, apical vertical root fracture (VRF) was also suspected. Therefore, of the many treatment options proposed, orthograde MTA obturation of the entire PC was elected and informed consent was granted.\nThe working length was determined electronically (Raypex 5, VDW GmbH, Munchen) and the canal was circumferentially filed upward using the H file no. 20 through 40. Further shaping was avoided as it was already shaped. Copious irrigation with 1.5% NaOCL and 15% EDTA was performed using a side-vented 27-gauge irrigation syringe. Then, white ProRoot MTA (Dentsply, Tulsa Dental Specialties, Tulsa, TN, USA) was packed in the PC [] as per the general technique described below []. The postoperative period was uneventful and tenderness to percussion resolved in 2 weeks’ time. | [[31.0, 'year']] | M | {'20859484': 2, '7673836': 1, '26180414': 1, '29177813': 1, '8908918': 1, '7995237': 1, '27553664': 1, '33598244': 2, '11716086': 1, '20351970': 1, '22144801': 1, '8151240': 1, '7499980': 1, '18215687': 1, '14606796': 1, '8151252': 1, '19482173': 1, '18811594': 1, '21228953': 1, '22368340': 2, '10726528': 1, '33923426': 1, '10321187': 1, '24554868': 2} | {'3915394-2': 2, '3284019-1': 1, '3284019-2': 1, '3284019-3': 1, '7869352-1': 1, '2936099-1': 1, '2936099-2': 1} |
165,676 | 3915394-2 | 24,554,868 | noncomm/PMC003xxxxxx/PMC3915394.xml | A simplified technique of orthograde MTA obturation on the elected canals of posterior teeth: Two case reports | A 40-year-old asthmatic and phobic male was referred from a local clinic to manage the incomplete fracture of tooth no. 19 that runs from the mesiolingual canal (MLC) to the distal canal (DC) in the furcal region []. There was persistent dull pain on biting that reportedly developed after the shaping session and after all the presenting symptoms of acute apical abscess were controlled. As per the previous records, the mesial and distal canals were prepared by protaper files (Dentsply Maillefer) up to F3 and F5, respectively. There was periapical radiolucency in the mesial root and minimally in the furcal region too.\nWith due informed consent, Interlig fiber (Angelus, Brazil) was bonded across the fracture and the rest of the core was built using a para core after blocking all three canal orifices with GP stumps []. This partial core served as an intracoronal splint and bypassed the need of extracoronal splinting during treatment. It also helped in sealing the fracture in its earliest stage, restricting further ingress of microbes. After verifying the WL electronically, the canals were irrigated copiously with 1.5% NaOCL, 15% EDTA and 2% chlorhexidine solution, respectively. Then, each canal was unitarily obturated with pro root MTA as described in the technique above [].\nThe recall visit at 1 year revealed radiographic evidence of osseous healing in relation to the mesial root apex, and there was no evidence of further furcal breakdown []. | [[40.0, 'year']] | M | {'20859484': 2, '7673836': 1, '26180414': 1, '29177813': 1, '8908918': 1, '7995237': 1, '27553664': 1, '33598244': 2, '11716086': 1, '20351970': 1, '22144801': 1, '8151240': 1, '7499980': 1, '18215687': 1, '14606796': 1, '8151252': 1, '19482173': 1, '18811594': 1, '21228953': 1, '22368340': 2, '10726528': 1, '33923426': 1, '10321187': 1, '24554868': 2} | {'3915394-1': 2, '3284019-1': 1, '3284019-2': 1, '3284019-3': 1, '7869352-1': 1, '2936099-1': 1, '2936099-2': 1} |
165,677 | 3915395-1 | 24,554,869 | noncomm/PMC003xxxxxx/PMC3915395.xml | Restoration of incisal half with edge-up technique using ceramic partial crown in turner's hypoplasia: A case report | An 18-year-old female patient reported to conservative dentistry clinic with a chief complaint of mutilated front teeth compromising esthetics []. After taking an elaborate history which revealed that the patient had a trauma to the deciduous teeth when she was 1-year-old. Gingiva was inflamed and patient had edge to edge bite. On clinical intraoral examination, patient's oral hygiene was moderate with generalized gingival inflammation and partially mutilated and discolored upper central incisors. Vitality tests of all the teeth showed positive response for thermal and electric pulp testing indicating the vital status of the pulp. The radiographic examination showed no abnormality of the hard tissue at the periapical area. Diagnosis was made as Turner's hypoplasia of upper two central incisors with proximal caries. Treatment planning was done after considering many factors such as conservation of tooth structure, esthetics, occlusion, and economy.\nDuring the initial appointment, thorough oral prophylaxis was done. Impressions were made with alginate impression material (Zelgan Plus, Dentsply India Pvt. Ltd, India). Study models were prepared. Proximal caries were removed and composite resin build up with Filtek™ Z250 (3M ESPE, Dental Products, St. Paul. U.S.A) was done to restore the hypoplastic defects and the carious defects. Tooth preparation was done to receive edge-up, all ceramic partial crowns for both the upper central incisors.[] Deep chamfer finish lines were given using SC850-018, supercoarse, round end taper diamond point (IQ Dental Supply Inc.). Finish lines were kept at the junction of middle third and cervical third of the crown to include all the enamel defects and to also conserve the remaining healthy tooth structure to remain untouched. Tooth reduction was done for about 1 mm all around to accommodate ceramic material. Bite was corrected by occlusal contouring of the lower teeth. Secondary impressions were made using vinyl polysiloxane impression material (Dentsply Caulk, USA) and custom made acrylic temporary crowns were cemented with a zinc oxide eugenol (Dental Products of India, Mumbai, India) temporary luting cement material. Ceramic edge-up partial crowns were prepared using pressable all ceramic material (Cergo Kiss, Dentsply, India). Teeth were polished with pumice and cleaned thoroughly to remove eugenol, if any. Crowns were checked for occlusion and cemented with resin cement Rely X™ Veneer cement (3M ESPE, Puerto Reco). Crown margins were polished with ceramic polishing kit (Shofu, Inc., Japan) []. Six months follow-up showed the crown margins are in satisfactory condition []. | [[18.0, 'year']] | F | {'22114432': 2, '9452691': 1, '1343012': 1, '14765635': 1, '26180414': 1, '1860127': 1, '15295316': 1, '7600246': 1, '23019507': 1, '24554869': 2} | {'3220148-1': 1, '3220148-2': 1, '3220148-3': 1, '3220148-4': 1} |
165,678 | 3915396-1 | 24,554,870 | noncomm/PMC003xxxxxx/PMC3915396.xml | Endodontic management of a maxillary first and second premolar with three canals | This was a case report of a of 45-year-old female patient with non-contributory medical history reported to the dental office complaining of intermittent pain in the maxillary left quadrant since 1 week. Clinical examination revealed a large amalgam restoration with secondary caries on both first and second maxillary left premolars []. The teeth were sensitive to percussion. Vitality test on both the premolars elicited no response to both cold and Electric Pulp Tester (EPT). Radiographs showed loss of lamina dura and peri apical widening in both the teeth (24 and 25).\nA diagnosis of Irreversible pulpitis with Apical Periodontitis was made and non-surgical endodontic treatment was planned for both tooth 24 and 25 followed by fixed partial denture prosthesis. Local anesthetic was administered with buccal infiltration of 1.8 ml of 2% Lignocaine with 1:200,000 epinephrine. The teeth were isolated with a rubber dam and coronal access prepared. On careful examination of the pulp chamber floor of both 24 and 25 three separate root canal orifices were identified (mesiolingual, mesiobuccal and distal). The root canals were negotiated with DG 16 explorer (Hu Freidy, USA) and ISO Size 10 files. The working length was registered with Root ZX Mini apex locater (J. Morita, Japan) which was confirmed later with radiographs [] The cleaning and shaping was done with crown down technique with Protaper Rotary instruments (Dentsply Maillefer) as per the manufacturer's instructions using 17% of ethylenediaminetetraacetic acid (Glyde, Dentsply) as lubricant and 5.2% of sodium hypochlorite as irrigant. Considering the time taken to complete the therapy, the teeth were completed in two visits. After the biomechanical preparation of both the premolars, the root canals were dried with paper points and a paste of calcium hydroxide (Ultracal, Ultradent USA) was used as intracanal medication. A provisional restoration of Cavit (3M ESPE) was placed between visits. At the second appointment, the patient was completely asymptomatic. The root canals of both the teeth were once again flushed with 5.2% sodium hypochlorite and the canals were dried. The master cone radiograph was taken [] and the root canals were then obturated using F2 Protaper Gutta-percha (Dentsply Maillefer) using AH plus resin sealer (Dentsply, Detrey) and post obturation radiograph was taken [].\nThe orifice was then sealed with Flowable composite (Ivoclar Vivadent) and the access cavity was then restored using SureFil composite resin (Dentsply).\nThe 1 year follow-up radiographs with two angulations was taken to clearly identify the canals [Figure and ]. | [[45.0, 'year']] | F | {'31198390': 1, '2607264': 1, '4524384': 1, '21116391': 1, '9693586': 1, '11236917': 1, '1779219': 1, '1290917': 1, '25214724': 1, '24944457': 2, '29386789': 2, '8241762': 1, '16982267': 1, '6595621': 1, '19410077': 1, '3855959': 1, '23029633': 2, '4524838': 1, '6574207': 1, '24554870': 2} | {'3440931-1': 1, '3440931-2': 1, '4056405-1': 1, '5767836-1': 1} |
165,679 | 3915397-1 | 24,554,871 | noncomm/PMC003xxxxxx/PMC3915397.xml | Successful removal of a 16 mm long pulp stone using ultrasonic tips from maxillary left first molar and its endodontic management | A 40-year-old female reported to the department of conservative dentistry, with a chief complaint of food impaction and pain in the left upper molar region. The pain started a month ago and was dull, gnawing in nature with moderate intensity. She reported to the clinic only when the pain became severe. On clinical examination, it was observed that the maxillary left first molar had a deep occlusal caries with an exposed pulp. The tooth was severely tender on percussion and had moderate pain on palpation. Pulp testing with electric pulp tester (Parkell Inc. Edgewood, NY, USA) and thermal test using hot gutta percha elicited non-responsiveness from the suspect tooth, intraoral periapical (IOPA) radiograph revealed diffused radio-opacities throughout the pulp chamber and in the palatal root canal. The canal outlines for the mesiobuccal and distobuccal roots were quite clear and traceable till the apex [].\nBy evaluating the tooth clinically and radiographically, a diagnosis of pulpal necrosis with acute apical periodontitis was made and an endodontic approach was planned for this tooth.\nAccess was gained to the pulp chamber after administration of local anesthesia (2% lignocaine with 1:100,000 epinephrine) under rubber dam isolation. No drop was felt in the pulp chamber since it was completely obliterated. The calcified mass was clinically visible as an irregular translucent mass attached to the walls and the floor of the pulp chamber. After careful extensions of the access cavity, an ultrasonic nonactive tip with active lateral part Start-X™ #1 (Dentsply Maillefer) was introduced with a Piezo ultrasonic generator (EMS MINIPIEZON) for further refinement of access cavity walls and displacement of the calcified mass. An ultrasonic tapered and active tip Start-X™ #3 (Dentsply Maillefer) [] was introduced to remove the calcific obstruction. The entire mass could be dislodged from the walls of the pulp chamber and its underlying attachment. The calcified mass thus removed, had its extension into the palatal root canal that traversed along its entire length []. The length of calcified tissue was measured to be 16 mm long []. The shape of the calcified mass confirmed to the shape of pulp chamber and palatal root canal.\nAfter locating the root canal orifices, the patency of all the three root canals was checked with #10 K file (Kerr USA). The working length was determined by Root ZX II (J. Morita, Kyoto, Japan) apex locator for all the three root canals and confirmed by a radiograph []. The root canals were cleaned and shaped by rotary nickel-titanium ProTaper instruments (Dentsply Maillefer) using Glyde (Dentsply Maillefer) as a lubricant. The canals were sequentially irrigated using 5.2% sodium hypochlorite and 17% ethylenediaminetetraacetic acid (EDTA) during the cleaning and shaping procedure. The canals were thoroughly dried and all the root canals were coated with AH-plus resin based sealer (Dentsply Maillefer). Obturation was carried out using the ProTaper gutta percha point. The access cavity was restored with posterior composite resin (ClearfilmajestyTposterior, Kuraray America, Inc. NY, USA). Post-obturation radiograph was taken which showed well-obturated root canals []. The patient was asymptomatic during follow-up after 6 months [] and was advised to get this tooth crowned.\nThe calcified mass thus removed was preserved in 10% neutral buffered formalin and was embedded in paraffin wax for the histopathological evaluation []. The histopathological result revealed multiple calcified masses lying free within the pulp tissue. These calcified masses varied in their size and were scattered throughout the substance of pulp, they resembled dystrophic calcification []. | [[40.0, 'year']] | F | {'26266224': 1, '6579031': 1, '6928291': 1, '27403069': 1, '15667634': 1, '9823142': 1, '12035956': 1, '3077408': 1, '3858411': 1, '5262479': 1, '1061788': 1, '24554871': 2} | {} |
165,680 | 3915425-1 | 24,505,543 | noncomm/PMC003xxxxxx/PMC3915425.xml | Bilateral Wilms' Tumor Metastasis to Right Spermatic Cord | The patient is a 33-month-old male whom his mother had discovered right flank mass at the time of dressing one week before admission. Abdominal examination revealed right and left flank mass and mild distention. His physical examination was otherwise unremarkable except blood pressure 130/90 mmHg. The patient was one of two identical twins. He had not congenital anomalies and the other twin was normal. Two months earlier, he had undergone herniorrhaphy for right inguinal hernia. Ultrasound of the abdomen revealed a 73×79 mm and 75×78mm heterogeneous mass without calcification in the right and left kidney, respectively and lymph node in Para-aortic area with 25mm in diameter. Contrast-enhanced computed tomography (CT) scan of the abdomen findings were similar to that of ultrasound without evidence for inferior vena cava and renal vein involvement. Chest CT scan did not show evidence of metastases. Then open biopsies from both kidneys were performed. The histopathology showed infiltration of both kidneys with blastemal cell predominant component, vascular invasion in the tumoral tissue and favorable histology without anaplasia ().\nPara-aortic lymph node biopsy was positive for tumoral involvement. Complete blood count with differential, liver and renal function tests were all within normal range. Erythrocyte sedimentation rate was 89mm/hr. Diagnosis was consistent with stage V favorable-histology Wilms' tumor and treatment was initiated with chemotherapeutic agents including vincristine, actinomycin D, and doxorubicin. Eight weeks following treatment the tumor size of both sides decreased more than 50% and ultrasound demonstrated a 28×40mm and 34×36mm tumor mass in the right and left kidney, respectively. Blood pressure returned to normal range. He underwent right radical nephrectomy and immediately received abdominal irradiation (1080 cGy in 10 fraction dose). Chemotherapy continued with previous drugs. Two months later, ultrasonography revealed a mass measuring 69×69mm in right renal fossa, but tumor size in the left side was without any significant change. Subsequently, the chemotherapy regimen changed to ifosfamide, crboplatin and etoposide (ICE). Following the fourth cycle of ICE, at routine physical examination a right scorotal mass on spermatic cord was noted. Ultrasound revealed a spermatic cord mass measuring 1×1.5×2cm without testicular involvement. The patient then underwent exicisional biopsy and histologic examination suggested WT metastases to spermatic cord (). Two weeks later, lungs CT scan showed multiple nodules and on the ultrasound examination, liver metastases and widely disseminated tumor spread in abdomen were identified. Chemotherapy with ICE regimen continued but unfortunately, he died 2 months later owing to progressive disease and distant metastases. | [[33.0, 'month']] | M | {'1326580': 1, '5343486': 1, '201330': 1, '28975113': 1, '6255123': 1, '12415406': 1, '16049972': 1, '2163592': 1, '22009010': 1, '2849034': 1, '24505543': 2} | {} |
165,681 | 3915464-1 | 24,555,001 | noncomm/PMC003xxxxxx/PMC3915464.xml | Juvenile Ischemic Stroke Secondary to Cardiogenic Embolism: A Rare Case Report | Our patient was a 24-year-old male presented to the emergency department with the chief complaint of right-sided weakness without any loss of consciousness. He reported sudden onset of weakness within the previous 24 h having occurred after exercise and followed by difficulty in speech. No further specific symptoms including nausea, vomiting, vertigo, chest pain, or headache were noted prior to the emergence of sudden weakness except for a complaint of recent dyspnea on exertion (DOE). In his medical history, we detected a period of posttraumatic seizure that had been controlled with carbamazepine; he had stopped the course of medication 3 months ago. Also, a suspicious history of rheumatic fever in childhood without any documented therapy or diagnosis was present.\nIn physical examination, he was alert and oriented with obvious aphasia as he was able to obey the commands yet unable to speak. His vital signs were as follows: BP = 110/70 mm Hg, PR = 70/min, RR = 16/min, BT = 37°C. In his respiratory and cardiovascular examination, there was no specific abnormal finding. His peripheral pulses were symmetric and normal. In central nervous system examination, he had a right-sided hemiplegia with muscle force of 2/5 in upper and lower extremities; right plantar reflex was extensor, while the left plantar reflex was flexor and his deep tendon reflexes were increased up to 3+. Due to his lateralized signs, the spiral brain computed tomography (CT) scan was recommended and routine lab tests were checked simultaneously. In spiral brain CT, a hypodense lesion could be observed in the left middle cerebral artery (MCA) [].\nThe lab tests results were as follows:\nErythrocyte sedimentation rate (ESR) = 47 mm/h, PT = 14.4 s, International normalized ratio (INR) = 1.33, PTT = 30.9 s, K = 4.5 mmol/L, Na = 141 mmol/L, Blood sugar (BS) = 94mg/dL, Blood urea nitrogen (BUN) = 13 mEq/dL, Cr = 1.06mg/dL, Creatine phosphokinase (CPK) = 116 U/L, Creatine phosphokinase-MB (CPKMB) = 27U/L, lactate dehydrogenase (LDH) = 358 U/L, White blood cells (WBC) = 6700/mm3 (Neut = 57%, Lymph = 40%, Mono = 3%, Eos = 0%, BASO = 0%, BAND = 0%.), Red blood cells (RBC) = 4.32 million/mm3, hemoglobin (Hb) = 11.5g/dL, Hematocrit (Hct) = 35.5 g%, Platelet (PLT) = 221000/ mm3.\nThe NIHSS of the patient was 14; however, no intravenous thrombolysis therapy was considered due to the delayed referral to our center (more than 3-4.5 h).\nDue to his history of DOE and occurrence of his signs and symptoms exactly following exercise, echocardiography was suggested. Interestingly, echocardiography revealed multiple masses in all cardiac chambers [left atrium (LA) and Left ventricular (LV) (two separated), right ventricle (RV) and right atrium (RA) in order of largest to smallest, respectively] []. Findings were in favor of a multiple myxoma. On the basis of cardiology consultations, association of a multiple cardiac myxoma and probable cerebral emboli originating from it forced anticoagulant therapy because of high risk of hemorrhagia of lesion did not start. He was admitted at cardiac surgery intensive care unit and scheduled to undergo cardiac myxoma resection 2 days after his emergency department admission. The day following cardiac surgery, his hemiplegia resolved and he was ambulated at the time of discharge. Furthermore, muscle forces of the upper and lower limbs improved from 2/5 and 2/5 to 3/5 and 4/5 before and after operation, respectively. Postoperation imaging of the patient including brain CT scans and magnetic resonance imagings are presented in Figures -. The follow-up CT scan revealed evidences of remained ischemic injury in the left MCA 2 months after operation []. | [[24.0, 'year']] | M | {'3188128': 1, '16324591': 1, '25237582': 1, '11388092': 1, '23761612': 1, '30607344': 1, '10447567': 1, '23692492': 1, '18706121': 2, '1984900': 1, '24482970': 1, '14609975': 1, '23037608': 1, '7486462': 1, '11306860': 1, '26107455': 1, '33100092': 1, '23390780': 1, '24555001': 2} | {'2531170-1': 1} |
165,682 | 3915726-1 | 24,511,525 | noncomm/PMC003xxxxxx/PMC3915726.xml | Urosodeoxycholic Acid Therapy in a Child with Trimethoprim-Sulfamethoxazole-induced Vanishing Bile Duct Syndrome | A previously healthy 7-year-old boy was hospitalized with jaundice. Two weeks before admission, he had developed mucous diarrhea and mild fever. At that time, he was treated with oral TMP-SMX (trimethoprim 80 mg and sulfamethoxazole 400 mg [Septrin; Samil Pharmaceutical Co., Seoul, Korea], 0.83 tablet twice a day, trimethoprim 8 mg/kg) for 4 days under a presumptive diagnosis of infectious colitis at a private clinic. One day later, he showed icteric sclera, followed by progression of jaundice. After 8 days of the onset of icteric sclera, he was referred to our hospital because jaundice and pruritus became aggravated.\nHe had no previous history of hepatitis, hepatobiliary diseases, or chronic illness. Family history was nonspecific. Three months before the appearance of jaundice, he received amoxicillin-clavulanic acid for 5 days because of acute tonsillitis at a private clinic.\nAt admission, he had jaundice and complained of mild epigastric pain and pruritus. On physical examination, his body temperature was 37℃, heart rate 95 beat/min, respiratory rate 22/min, and blood pressure 100/60 mmHg. His growth and development were normal. Although his whole body was icteric, he was not so ill-looking. There was no pharyngotonsillar inflammation and cervical lymph enlargement. Heart and lung sounds on auscultation were normal. The abdomen was soft and flat without tenderness. The liver was palpable 3 finger breath below the right subcostal margin. There was no splenomegaly.\nThe initial hematologic study showed hemoglobin 11.0 g/dL, white blood cell 4,450/mL (eosinophil 4.3%), platelet 412,000/µL, reticulocyte 1.47%, prothrombin time 10.8 seconds, and partial prothrombin time 27.8 seconds. Liver function tests were as follows: aspartate transaminase (AST)/alanine transaminase (ALT) 231/220 IU/L, total bilirubin (TB)/direct bilirubin (DB) 8.4/7.5 mg/dL, alkaline phosphatase (ALP) 1,028 IU/L, gamma-glutamyl-transpeptidase (GGT) 708 IU/L, and albumin 3.8 g/dL. The total cholesterol level was 490 mg/dL. The Coomb test for direct and indirect was negative. Other serologic tests showed ceruloplasmin 45 mg/dL, immunoglobulin G 851 mg/dL, complement 3/4 each 165/37 mg/dL, antinuclear antibody (-), and antineutrophil cytoplasmic antibody (-). Viral markers for A, B, C, Epstein Barr virus, cytomegalovirus, herpes simplex virus, mycoplasma, and parvovirus were all negative.\nLiver ultrasonography and abdominal computed tomography showed normal enhancement patterns of hepatomegaly with no visualization of the common biliary duct and gallbladder. Hepatobiliary scan demonstrated normal liver uptake, but no visualization of the gallbladder and duodenum on 150-minute delayed images ().\nTreatment with UDCA (20 mg/kg/day [Ursa; Daewoong Pharmaceutical Co., Seoul, Korea]) was started on hospital day 2. On hospital day 12, liver function test results were similar to those of the admission day showing AST/ALT 103/100 IU/L and TB/DB 8.8/8.0 mg/dL. After discharge from the hospital, he was maintained on UDCA.\nLiver biopsy was performed 36 days after the onset of jaundice due to no improvement of cholestasis: TB/DB 8.7/8.6 mg/dL, ALP 709 IU/L, and GGT 548 IU/L. Histologic examination revealed bile plugs and biliary stasis around the central vein with the disappearance of the interlobular bile ducts. Cytokeratins (CKs) 7 and CK 19 were negative by immunohistochemistry. These findings were consistent with those of VBDS ().\nAfter confirmation of VBDS, UDCA was increased to 30 mg/kg/day. Afterwards, there was improvement in cholestasis. Nine weeks after the onset of jaundice, liver tests at the outpatient clinic showed AST/ALT 77/64 IU/L, TB/DB 1.29/0.66 mg/dL, ALP 815 IU/L, GGT 529 IU/L, and total cholesterol 385 mg/dL. Two weeks later, AST/ALT and total cholesterol normalized. Seven weeks later, ALP and GGT were within the normal range. Clinical progression and treatment course are shown in . Three months after recovery of VBDS, he received amoxicillin-clavulanic acid for 7 days due to acute rhinosinusitis. After that, there was no clinical and laboratory abnormalities associated with VBDS for 1 year. The patient has been followed regularly at the outpatient clinic. | [[7.0, 'year']] | M | {'15289784': 1, '11837721': 1, '9721172': 1, '8995964': 1, '31317370': 1, '16773706': 1, '2254635': 1, '34399711': 2, '30268094': 2, '18637204': 2, '25668620': 1, '2791808': 1, '20388938': 1, '10636987': 1, '11129214': 1, '11521175': 1, '9138126': 1, '16205517': 1, '33615212': 1, '18242505': 1, '19142556': 1, '22008955': 1, '24511525': 2} | {'8365906-1': 1, '2490670-1': 1, '6162916-1': 1} |
165,683 | 3915732-1 | 24,511,524 | noncomm/PMC003xxxxxx/PMC3915732.xml | Association between Celiac Disease and Intussusceptions in Children: Two Case Reports and Literature Review | A 7-year-old boy was admitted due to vomiting, diarrhea, and severe abdominal pain since three days ago. His vital signs were stable. In physical examination, he was ill, pale with normal heart and lung. His weight and height were 17 kg (<5% weight percentile for age for boys) and 116 cm (10% height percentile for age). Abdominal examination showed distention, bowel sounds were hyperactive and palpation was painful and tender diffusely without palpable mass. Abdominal ultrasonography was done due to sustained abdominal pain and revealed an intussuscepted bowel segment with pseudo-kidney appearance without obstruction (). His intussusception was reducted neither over the time nor by barium enema, so underwent surgical reduction. Intussusception was ileoileal type, with multiple enlarged lymph nodes. In investigation for concomitant failure to thrive, he was anemic (hemoglobin, 10.4 g/dL) and tissue transglutaminase levels (tTG IgA, IgG) were 268 U/mL (normal range, 0-12), and 3.6 U/mL (normal range, 0-1), respectively. Duodenal biopsies were taken and histopathology revealed marsh III celiac disease (). After 6 months gluten free diet (GFD) his weight raised 3 kg and tTg IgA reached to 28 U/mL and tTG IgG to 1 U/mL. | [[7.0, 'year']] | M | {'22965520': 1, '20033844': 1, '23679928': 1, '32476759': 1, '5687900': 1, '10626866': 1, '22832512': 1, '15974238': 1, '27551336': 1, '11915497': 1, '9327372': 1, '21592630': 1, '11294274': 1, '20081545': 1, '33488134': 1, '18057156': 1, '16888777': 1, '24511524': 2} | {'3915732-2': 2} |
165,684 | 3915732-2 | 24,511,524 | noncomm/PMC003xxxxxx/PMC3915732.xml | Association between Celiac Disease and Intussusceptions in Children: Two Case Reports and Literature Review | A 5-year-old girl was hospitalized because of abdominal distention and severe bilious vomiting. Her defecation was not changed but was loose. She had history of anorexia, poor weight gain and abdominal distention since infancy but had not have visited previously. She was toxic, febrile and cachectic with weight of 12 kg (<3% weight percentile for age for girls) and height of 96 cm (<5% height percentile for age for girls). Her lung was normal but heart was tachycardic. Abdomen was distended with hyperactive bowel sound, and diffuse tenderness was noted on palpation. Her abdominal X-ray revealed air-fluid levels, indicative of bowel obstruction. Abdominal ultrasonography revealed gas distention of bowel loops and reductable transient intussusceptions with donuts appearance on the right side of the abdomen (). Nasogastric tube was inserted. After three days of serum therapy and administration of antibiotics, vomiting had stopped and abdominal distention decreased gradually. Laboratory tests revealed leukocytosis (18,400/mm3) with polyneucleosis (11,800/mm3), anemia (hemoglobin, 8.4 g/dL), normal serum electrolytes, tTG IgA >800 U/mL, and tTG IgG >200 U/mL. Diagnosis of celiac disease was confirmed with endoscopic duodenal biopsies, showing histopathology of marsh III (). After six months GFD, she had got good appetite and gained 6 kg of weight and her distention was resolved near completely. | [[5.0, 'year']] | F | {'22965520': 1, '20033844': 1, '23679928': 1, '32476759': 1, '5687900': 1, '10626866': 1, '22832512': 1, '15974238': 1, '27551336': 1, '11915497': 1, '9327372': 1, '21592630': 1, '11294274': 1, '20081545': 1, '33488134': 1, '18057156': 1, '16888777': 1, '24511524': 2} | {'3915732-1': 2} |
165,685 | 3916142-1 | 25,002,996 | noncomm/PMC003xxxxxx/PMC3916142.xml | Xeroderma Pigmentosum-Trichothiodystrophy overlap patient with novel XPD/ERCC2 mutation | A 25-y old male () was referred with dry skin, lentigines, cutaneous warts and dysmorphic features. He was conceived by healthy, non-consanguineous Caucasian parents and born after an uneventful pregnancy. At the age of three, he was diagnosed with strabismus and hypermetropia and since 12 y of age he used hearing aids because of sensorineural hearing loss. Since early childhood the patient suffered from very dry skin and became easily sunburned despite preventive measures although he never developed blisters. From early puberty he gradually developed many freckles, sparse, thin hair, photophobia and growth retardation ().\nHe had an older brother who died at age 26 due to ruptured appendicitis and salmonella sepsis. The deceased brother had a similar phenotype with short stature, ichthyosis, hypogonadism, epilepsy, mild mental retardation and diabetes mellitus. A second brother and a sister displayed none of these traits and were considered healthy. The patient’s height was 165 cm (healthy siblings had a height between 180 and 200 cm). Medical history, clinical examination and laboratory and imaging test revealed diseases in many organs.\nHe had dry, parchment-like skin with ichthyosiform scaling mainly on the back and scattered, but pronounced, lentiginous pigmentation (). Viral warts were seen on his hands, knees and feet. He had sparse, brittle and unruly hair and koilonychia with distal nail splitting (). Hair microscopy showed some variation in the calibre of the hair shafts with few trichorrhexis nodosa-like defects. Some hairs had focal ribboning/undulation and irregular contours. No “tiger-tail pattern” was observed using polarizing light microscopy. Cystine content in hair was only slightly decreased to 8.2 mol% (normal values 10.0−10.5 mol%, analysis performed by Dr Josef Föhles, Aachen, who provided reference values). At the age of 28, basal cell carcinoma was diagnosed on his shoulder.\nEye examination revealed photophobia and severely decreased visual acuity (1/60 on the right eye and 12/60 on the left eye) (). He had esotropia but no nystagmus. He had bilateral microphthalmos with an axial length of 18.39 mm on the right eye and 18.53 mm on the left eye, but normal corneal size (12 mm on both eyes). He had hypopigmentation of the iris with transillumination. Corneas were normal with the exception of limbal vascularization. Before cataract surgery he had an excessive hyperopia +13 D on both eyes. He had bilateral cataract with punctate lens opacities. Ophthalmoscopy revealed hypopigmentation of the retina, tortuosity of the vessels and macular lesions with pigment epithelial derangement and atrophy, retinal fibrosis and macular folds on both eyes. Earlier performed visual evoked potential (VEP) was normal and electroretinography did not show any signs of tapetoretinal degeneration.\nHe had a high-pitched voice, micropenis (2 cm) and cryptorchidism with high levels of plasma luteinizing- and follicle stimulating hormones and very low plasma testosterone. Pubic and axillary hairs were absent. Type 2 diabetes was diagnosed at the age of 26 and required insulin treatment. The pituitary-adrenal axis and thyroid function were normal.\nNeurologic examination showed progressive ataxia and a broad-gauged gait. Varying imaging studies showed thickened theca cranii and a dysmorphic sella turcica as the only clear-cut abnormal findings and EEG was normal. Multiple CT scans as well as an MRI of the cerebrum were normal at around age 27.\nBetween ages 25 to 31, he developed progressive renal disease with an increase in P-creatinine from 114 to 252 µmol/l, persistent albuminuria around 1.0 g/l and intermittent hematuria. Renal biopsy revealed partial atrophy and sclerosis with scattered hyaline tubular casts but immunoflourescent evaluations were all negative. Electron microscopy showed expanded mesangium and unevenly thickened glomerular basement membranes with varying density but without deposits. The renal disease was complicated by nephrogenic anemia, renal osteodystrophy and arterial hypertension. MCV was low, but within normal range and HBa2 was not tested. Due to hypercholesterolemia treatment with Simvastatin was initiated but had to be discontinued due to acute renal failure caused by rhabdomyolysis. Kidney function was restored after three weeks on dialysis.\nMitochondrial function was normal when respiratory enzymes were measured in a liver biopsy. Plasma concentrations of amino acids were normal except for a slight elevation of P-cysteine. A biopsy from striated muscles did not reveal any primary muscular disorder.\nDue to recalcitrant viral warts and frequent pneumonias, a lymphocyte-subpopulation evaluation was conducted showing normal fractions and concentrations of T-, B- and NK-cells. CD4+ count was slightly below normal levels and CD4+/CD8+ levels inversed T- and B- memory cell levels were unexpected high, mimicking levels of a much older person. It was concluded that the patient was slightly immunodeficient. | [[25.0, 'year']] | M | {'33315086': 1, '21959366': 1, '9195225': 1, '3365865': 1, '26184184': 1, '12393803': 1, '19934020': 1, '11369901': 1, '17273966': 1, '12975162': 1, '30860024': 1, '17276014': 1, '11709541': 1, '33007515': 1, '20171149': 1, '12531012': 1, '9651581': 1, '15692466': 1, '19179371': 1, '18603627': 1, '18470933': 1, '21480477': 1, '11242112': 1, '25002996': 2} | {} |
165,686 | 3916159-1 | 24,554,809 | noncomm/PMC003xxxxxx/PMC3916159.xml | Atrioventricular Septal Defect with Common Atrioventricular Junction Guarded by a Common Valve Consisting of Left Atrioventricular Trifoliate Valve | A 32-year-old man presented to our clinic with the following history. His family history was negative for congenital heart defects and the patient had no siblings. Immediately after birth the cardiac status with a systolic murmur along left sternal border leading to a pediatric center where is diagnosed. The growth and mental development were normal, but marked cyanosis, weakness, clubbing, and intolerance of physical activity was present. At the age of nine the patient was referred to a cardio-pediatric center abroad where was diagnosed as complete atrioventricular canal defect, pulmonary atresia, and persistent ductus arteriosus. The patient condition was improved significantly and remained stable for the next eight year. At 17 years of age he was hospitalized again at the same center because of cyanosis, palpitations, and weakness with intolerance to physical activity. The patient had several documented episodes of atrial fibrillation.\nAt the age of 32, the patient presented to our clinic with severe cyanosis, he complained of shortness of breath with minimal exertion, and chest pain. The physical examination was remarkable for a 4/6 systolic murmur heard at the left sternal border, and cardiac frequency 130 beats per minute. The patient was noted to experience severe shortness of breath with even minimal exertion and was deeply cyanotic.\nThe electrocardiogram demonstrated atrial fibrillation, with ventricular frequency 100/min, and bifascicular block. Chest radiograph indicated a small pleural effusion on the right and bilateral hilopulmonary stasis. The heart was moderately enlarged with prominence of the aorta. An echocardiogram was performed (Figure , ).\nPatient was diagnosed in his early childhood with a congenital anomaly. In the very early echocardiography findings the presence of rudimentary inter ventricular and inter atrial septum leading to a common atrioventricular canal with one atrioventricular valve was described. This is also in the context of the malformations occurring during the intrauterine development of the embryo. From a perspective of adult congenital heart disease, the enlargement and the slight modifications of the heart cavities through the age, leaded to echocardiography view of hardly seen the rudimentary part of the interventricular septum, creating a perception of a single ventricular and a single atrium heart. An atrioventricular septal defect with common atrioventricular junction guarded by a common valve was seen. Both atriums were dilated, while pulmonary atresia and patent ductus arteriosus were also diagnosed in the early childhood. The main diagnoses were: atrioventricular septal defect with common atrioventricular junction guarded by a common valve, pulmonary atresia, persistent ductus arteriosus, and congestive heart failure. | [[32.0, 'year']] | M | {'21256509': 1, '19135190': 1, '16580940': 1, '17105897': 1, '23804724': 1, '10775990': 1, '23182167': 1, '12631536': 1, '21357347': 1, '5932615': 1, '24554809': 2} | {} |
165,687 | 3916505-1 | 24,516,829 | noncomm/PMC003xxxxxx/PMC3916505.xml | Asymmetry in mesial root number and morphology in mandibular second molars: a case report | A 16-year old male patient presented to the Department of Conservative Dentistry and Endodontics with a chief complaint of pain in his lower right posterior region of mouth for one week. The patient revealed a history of mild intermittent pain for the past 2 months, which had increased in intensity since one week ago. The patient reported subjective symptoms of prolonged sensitivity to hot and cold food and drinks. The pain was spontaneous and aggravated particularly at night and required analgesic to get relief from pain. The medical history contained no abnormal data. Clinical examination revealed a deep carious lesion on the proximal surface of right mandibular second molar (tooth #47). Palpation and percussion test of the involved tooth did not reveal any tenderness. The tooth was not mobile and periodontal probing around the tooth was within physiological limits. Thermal testing of the involved tooth with heated gutta-percha (Dentsply Maillefer, Ballaigues, Switzerland) and cold spray (Roeko Endo-Frost, Coltène-Whaledent, Langenau, Germany) caused an intense lingering pain, whereas electronic pulp stimulation (Parkell Electronics Division, Farmingdale, NY, USA) caused an early response. The preoperative diagnostic radiograph showed carious lesion closely approximating the pulp with no signs of periapical changes (). From the clinical tests and radiographic findings, a diagnosis of symptomatic irreversible pulpitis was made and endodontic treatment was initiated.\nRadiographic evaluation of the involved tooth revealed an unusual anatomical configuration suggesting the possibility of the presence of two mesial roots (). The mesial surface of the tooth was restored with composite resin (P60, 3M ESPE, St. Paul, MN, USA) after caries excavation to enable optimal isolation. The tooth was anesthetized using 1.8 mL 2% lidocaine with 1 : 200,000 epinephrine (Xylocaine, AstraZeneca Pharma India Ltd., Bangalore, India). Following rubber dam isolation, an endodontic access cavity was established. On inspection with a DG-16 endodontic explorer (Hu-Friedy, Chicago, IL, USA) under an operating microscope (Roslane Meditech, Haryana, India), the pulp chamber floor revealed three canal openings corresponding to the two mesial and one distal roots (). The mesiobuccal, mesiolingual, and distal canal orifices were located in their regular locations at the angles in the floor-wall junction. Further inspection of the pulpal floor was done for search of other orifices that were absent. Coronal enlargement was done with a nickel-titanium (NiTi) ProTaper SX rotary file (Dentsply Maillefer) to improve the straight-line access. The pulp tissue was extirpated using barbed broaches (Dentsply Tulsa, Tulsa, OK, USA). The working length was initially determined with the help of an apex locator (Raypex5, VDW, Munich, Germany) and confirmed using radiographs taken at different horizontal angulations. The working length radiographs showed three independent root canals in three separated roots (). Cleaning and shaping was done using ProTaper NiTi rotary instruments (Dentsply Maillefer) along with ethylenediaminetetraacetic acid (Glyde File Prep, Dentsply Tulsa) using a crown-down technique. Irrigation was performed using 3% sodium hypochlorite solution (Cmident, Cmident, New Delhi, India). Afterwards, a closed dressing was given with a sterilized cotton pellet in the pulp chamber with access cavity restored with Cavit G (3M ESPE).\nTo confirm this rare and unusual morphology, dental imaging of the tooth with the help of CBCT (Carestream CS 9300, Carestream Dental LLC, Atlanta, GA, USA) was planned. An informed consent was obtained from the patient, and a multi-slice scans of the mandible was performed with a tube voltage of 90 kV and a tube current of 15 mA. All measures were taken to protect the patient from radiation. The involved tooth was focused, and the cross-sectional images were obtained in transverse, axial, and sagittal planes (). All images were analyzed with the help of CS 3D Imaging software (Carestream Dental LLC). Horizontal slices of the molar were obtained at 0.5-mm thickness, and were studied at different levels (coronal, middle, and apical third of the roots) to determine the level of root bifurcation and degree of root separation (). The images confirmed that the right mandibular second molar had 2 mesial roots and 1 distal root with independent canal in each. The mesial roots were well separated and were bifurcated at the level of coronal one third. In contrast, the contralateral mandibular second molar was asymmetrical. It had 2 roots, 1 mesial, and 1 distal with 2 canals in the mesial root and 1 canal in the distal root ().\nAt the second appointment, the patient was asymptomatic. Temporary restoration was removed and irrigation was done with copious amounts of 3% sodium hypochlorite and 17% ethylenediaminetetraacetic acid (EDTA, Prevest Denpro Ltd., Jammu, India). The canals were finally flushed with sterile saline. Master cones were selected by placing cones corresponding to the size of the last finishing file used to the working length and was confirmed radiographically (). The canals were dried with absorbent points (ProTaper, Dentsply Maillefer) and obturation was carried out with ProTaper gutta-percha cones (Dentsply Maillefer) using AH Plus resin sealer (Dentsply Detrey GmbH, Konstanz, Germany). The tooth was then restored with a posterior composite resin core (P60, 3M ESPE). Final radiograph was taken to establish the quality of the obturation (). The patient remained asymptomatic during 1 year follow-up period. | [[16.0, 'year']] | M | {'17668967': 1, '19184298': 1, '11307455': 1, '5277376': 1, '2640921': 1, '15273645': 1, '17185133': 1, '3251990': 1, '24082907': 2, '12420579': 1, '17993215': 1, '8241760': 1, '294389': 1, '7825400': 1, '24516829': 2} | {'3782248-1': 1} |
165,688 | 3916506-1 | 24,516,830 | noncomm/PMC003xxxxxx/PMC3916506.xml | Clinical effectiveness of combining platelet rich fibrin with alloplastic bone substitute for the management of combined endodontic periodontal lesion | A 35 year old male patient reported to the Department of Periodontics with a complaint of pain in the upper left front tooth region associated with pus discharge for 2 months (). He also gave history of trauma around 7 years back and noticed discoloration of tooth with time but he took no treatment as the tooth was asymptomatic. On intraoral examination there were no carious teeth. Intraoral periapical X-ray (IOPA) was taken which revealed radiolucency along the distal side of the entire root surface to the apex (). Electric pulp testing was done to check the vitality of the tooth which confirmed that the tooth was non vital and the tooth was tender on percussion. Vertical probing depth was measured which was found to be 8 mm on distal side. Endodontic treatment was taken up first and then periodontal regenerative surgery was planned for treatment of defect.\nOn the day of surgery, PRF was prepared. Exactly 10 mL of whole blood was drawn by venipuncture of the antecubital vein and collected in two 5 mL sterile glass tubes coated with an anticoagulant, acid-citrate-dextrose. Whole blood was initially centrifuged (3,000 rpm for 10 minutes, ).The plasma was then aspirated with a micropipette and subjected to a second centrifugation at 2,000 rpm for 10 minutes, which allowed the precipitation of the platelets (0.8 to 1.2 mL) to fall onto the bottom. Coagulated preparation of 0.3 mL of PRF was obtained by its combination with 0.1 g of calcium chloride (). Then graft material was mixed with the coagulated platelet rich plasma (PRP) preparation.\nThe area selected for surgery was anesthetized using xylocaine with adrenaline 1 : 200,000. A full thickness flap was raised at the labial aspect using intracrevicular incision (). Thorough curettage of the defect area was done and a combination of PRF and bioactive glass was placed in the defect ( and ). Closure of soft tissue flap was done with non resorbable black silk (3-0) suture using interrupted suturing technique. The sutures were removed 10 days after surgery. The patient was scheduled for regular recall intervals at 3, 6, 9 and 12 months. PRF and bone graft resulted in substantial amount of bone fill (), and probing depth was reduced to 2 mm. | [[35.0, 'year']] | M | {'17257158': 1, '34513650': 1, '9700451': 1, '19228091': 1, '17539709': 1, '31886202': 1, '32189849': 2, '12886996': 1, '18454658': 1, '26295020': 1, '19249588': 1, '15948682': 1, '30519588': 1, '118123': 1, '29692843': 1, '18245923': 1, '29662262': 1, '25738094': 1, '22676983': 1, '33149696': 2, '24516830': 2} | {'7604462-1': 1, '7069109-1': 1, '7069109-2': 1, '7069109-3': 1} |
165,689 | 3916507-1 | 24,516,831 | noncomm/PMC003xxxxxx/PMC3916507.xml | Diagnosis and treatment of teeth with primary endodontic lesions mimicking periodontal disease: three cases with long-term follow ups | A 67-year-old male patient visited our clinic for evaluation and further treatment of the left mandibular first molar (#36). His chief complaint was "my lower gum has been swollen." The patient's medical history was unremarkable. The patient had received a class II gold inlay restoration on that tooth several years ago. For the past month, he had felt a slight discomfort while chewing. A clinical examination revealed slight sensitivity to percussion and bite, 2 degrees of mobility, no response to cold, and a positive response to the electric pulp test. Gingival swelling, which was confined to the distal aspect of #36, was observed, and periodontal probing was within normal limits, except for the buccal and distal surfaces of the distal root. A periapical radiograph showed apical radiolucencies on both roots, and there was no alveolar bony support around the distal root (). The initial diagnosis of the tooth was partial or total necrosis of the pulp with an acute apical abscess. The possibility of root fracture was considered because of vertical bone loss, the large metallic restoration, and prior bite discomfort history. Endodontic treatment was considered as the first choice.\nAfter an inferior alveolar nerve block, anesthesia was achieved using 2% lidocaine containing 1 : 100,000 epinephrine, and the gold inlay was removed. The tooth was isolated with a rubber dam, 4 orifices were located, and the working lengths were determined with an electronic apex locator (RootZX, Morita, Tokyo, Japan). Upon access opening, two mesial canals were vital, however, two distal canals were necrotic. No crack lines were detected in the access cavity. The canals were instrumented using Gates Glidden Drills, stainless steel hand K-files, ProTaper, and ProFile rotary files (Dentsply Maillefer, Ballaigues, Switzerland). All canals were enlarged to the size of a #35 file and continuously irrigated using 2.5% sodium hypochlorite (NaOCl). The canals were dried, and calcium hydroxide was applied as a medicament. No antibiotics were prescribed as the swelling was localized and there were no signs of fever. A week later, at the second visit, the patient was asymptomatic, and the gingival swelling had subsided. The canals were irrigated using 2.5% NaOCl. At the third visit, 2 weeks after the procedure, the patient was asymptomatic. Master gutta percha cones were placed, and periapical radiographs were taken to confirm the working lengths. The canals were obturated with the continuous wave technique using System B and Obtura II (). The patient was sent to a prosthodontist for further tooth restoration. During an 8-year follow up, the patient remained asymptomatic, and the periapical radiolucency disappeared (). | [[67.0, 'year']] | M | {'12474007': 1, '3858235': 1, '12236902': 1, '28318161': 1, '25984480': 2, '9926769': 1, '23611400': 1, '294394': 1, '6579193': 1, '29707028': 2, '9226384': 1, '24516831': 2} | {'3916507-2': 2, '3916507-3': 2, '5911307-1': 1, '4432261-1': 1} |
165,690 | 3916507-2 | 24,516,831 | noncomm/PMC003xxxxxx/PMC3916507.xml | Diagnosis and treatment of teeth with primary endodontic lesions mimicking periodontal disease: three cases with long-term follow ups | A 43-year-old female patient visited our clinic because of intermittent discomfort of her right mandibular teeth. She had visited 2 other dental clinics, and both dentists recommended extraction of her right mandibular first molar because they believed the mesial root might be vertically fractured. Based on her prior dental history, #46 was pulpotomized several years ago and had maintained asymptomatic until 2 months ago. The tooth was sensitive to percussion and bite. There was no mobility, and periodontal probing was within normal limits. Large periapical lesions in both roots and a J-shaped alveolar bone defect in the mesial root were observed in the periapical radiographs (). A cone-beam computed tomography (CBCT, Pax-Zenith3D, Vatech, Yongin, Korea, 104 kVp, 5.5 mA) was also performed to rule out a vertical root fracture (). The tooth was diagnosed as a previously initiated tooth with chronic apical periodontitis. The possibility of vertical root fracture was explained to the patient, but we believed a primary endodontic lesion without any fractures was possible, so nonsurgical endodontic therapy was suggested as the first option.\nThe gold crown and amalgam core were removed. There was no visible crack or fracture line found on the outer and inner access cavity walls. Conventional root canal treatment was performed using a protocol similar to that described in case 1. Three canals were found and enlarged to a 0.04 taper of the #35 Profile (). At the second visit, the patient was asymptomatic, and the canals were clean. The canals were obturated, and a composite resin core was built (). At a 3-month follow up (), the patient was asymptomatic and sent to the department of prosthodontics for a crown restoration. The tooth underwent routine check-ups and was asymptomatic through a 2-year follow up (). | [[43.0, 'year']] | F | {'12474007': 1, '3858235': 1, '12236902': 1, '28318161': 1, '25984480': 2, '9926769': 1, '23611400': 1, '294394': 1, '6579193': 1, '29707028': 2, '9226384': 1, '24516831': 2} | {'3916507-1': 2, '3916507-3': 2, '5911307-1': 1, '4432261-1': 1} |
165,691 | 3916507-3 | 24,516,831 | noncomm/PMC003xxxxxx/PMC3916507.xml | Diagnosis and treatment of teeth with primary endodontic lesions mimicking periodontal disease: three cases with long-term follow ups | A 50-year-old female patient was referred from a private dental clinic to our hospital for a proper diagnosis and treatment of the left mandibular second molar. Her chief complaint was gingival swelling around the tooth. A sinus tract was traced to the distal aspect of the distal root (). In the periapical radiographs, a toothlike fragment was observed where the sinus tract was traced. She had a surgical extraction of #38 6 months ago, and a class II gold restoration on #37 thereafter. Her prior dentist suspected a distal root fracture of #37. There was no response to cold or electric pulp test on #37. The tooth was not sensitive to percussion or bite tests. There was no abnormal mobility, and a periodontal probing test appeared normal except for apical full-depth probing on the distal root. The initial diagnosis of #37 was pulp necrosis with chronic apical abscess, and the existence of tooth remnants of #38 was also considered as a contributing factor. We decided on a nonsurgical endodontic treatment for the necrotized second molar. The patient was informed that the lesion would not respond to root canal therapy, so a surgical approach should be considered to remove the tooth fragment.\nAfter removal of the gold onlay on #37, root canal treatment was initiated according to the above-mentioned protocol. Even after 3 canal preparations were completed up to #35 and copious 2.5% NaOCl irrigation was performed, the sinus tract on the distal side remained (). Surgical removal of the #38 fragment was decided. Computed tomography (CT, Somtom Sensation 64, Siemens, Erlangen, Germany, 120 kVp, 90 mA) was performed to evaluate the location of the fragments, which were observed on the distal proximity of #37 (). An oral surgeon expected that removal of tooth remnants might be difficult without excising a large amount of cortical bone. Therefore, an intentional replantation of #37 was planned, while the tooth fragments of #38 were retrieved from the extraction socket.\nOne week before surgery, an orthodontic elastic separating ring was inserted into the interdental space between #36 and #37 to increase the mobility of #37. The surgical procedure was performed as planned without any complications. The extracted #37 was retro-prepped and retro-filled with mineral trioxide aggregate (white ProRoot MTA, Dentsply Tulsa dental, Tulsa, OK, USA). While an endodontist worked with the extracted #37, an oral surgeon removed the tooth fragment from the extraction socket of #37 (). After placing the tooth back into the socket, there was no mobility, and no additional splinting was needed thereafter. Total tooth fragment removal was confirmed with periapical radiographs (). One week after surgery, the tooth was slightly mobile and sensitive to percussion. The patient was instructed to have a temporary resin crown for protection. However, when the patient visited our clinic for a 3-month follow up, the tooth remained asymptomatic, and the periapical radiolucency had decreased. The results of a periodontal pocket probing were within normal limits. The 1- and 2-year follow-up radiographs revealed a gradual decrease in radiolucency (). | [[50.0, 'year']] | F | {'12474007': 1, '3858235': 1, '12236902': 1, '28318161': 1, '25984480': 2, '9926769': 1, '23611400': 1, '294394': 1, '6579193': 1, '29707028': 2, '9226384': 1, '24516831': 2} | {'3916507-1': 2, '3916507-2': 2, '5911307-1': 1, '4432261-1': 1} |
165,692 | 3916508-1 | 24,516,832 | noncomm/PMC003xxxxxx/PMC3916508.xml | Chronic maxillary sinusitis caused by root canal overfilling of Calcipex II | A 60 year-old man complained of the continuous dull pain on the upper right second premolar and first molar area, where had received endodontic treatment in a private dental clinic about two years ago, and was referred to the Department of Conservative Dentistry in Gangneung-Wonju National University Dental Hospital (GWNUDH). His systemic medical history was not relevant to the present lesion.\nIn panoramic view and standard radiogram there found that the root canal fillings were incomplete, and small amount of root canal materials was spilled into the periapical area. During the retreatment it was found that both teeth were filled with temporary canal filling materials rather than the gutta-percha cone. The temporary root canal materials were confirmed Calcipex II materials through the document information from the private dental clinic. Both teeth were carefully irrigated with 1% NaOCl solution to remove the remaining Calcipex II paste, but accidentally some amount of Calcipex II paste were spilled again into periapical area (). The teeth were refilled with gutta-percha cone. The periapical radiopaque image of Calcipex II almost disappeared after two months, and the teeth became asymptomatic. However, in one and a half year after the canal filling treatment he felt mild pain in the right maxillary molar area, and was diagnosed maxillary sinusitis caused by periapical granuloma through the clinical and radiological observation ().\nThe periapical lesions including the sinus mucosa were surgically removed via the enucleation of lesion through intra-oral approach. The removed specimen was fixed in 10% neutral formalin, embedded in paraffin, and sectioned in 4 µm thickness. The usage of biopsy specimens filed in the Department of Oral Pathology, Gangneung-Wonju National University Dental Hospital was approved by our institutional review board (IRB2013-2). In the microscopic observation, the removed periapical lesion and sinus mucosa showed lumps of Calcipex II granules which were gradually scattered into the surrounding tissues (). In high magnification the Calcipex II granules were about 1 - 2 µm in diameter, and slightly dark and translucent in the center of grayish black granules (). Most of the Calcipex II materials were engulfed by infiltrated macrophages, and they were dispersed into the periapical area without the additional recruitment of polymorphonuclear leukocytes (PMNs) and lymphocytes (). Some macrophages were filled with the Calcipex II granules in their cytoplasms, and gradually undergone to cellular apotosis instead of the degradation of Calcipex II granules and multinucleated giant cell formaton (). However, it was conspicuous that the Calcipex II engulfment by macrophages was processed without chemotatic inflammatory reaction of PMNs and lymphocytes, consequently resulting in the chronic foreign body granulomatous inflammation in the periapical region and antral sinus mucosa.\nThe Calcipex II granules scattered diffusely into the connective tissue were gradually accumulated in the secretory epithelial cells of antral mucosa (). A lot of Calcipex II granules were found in the distal cytoplasms of the ciliated columnar epithelial cells (), particularly, some Calcipex II granules were secreted into sinus lumen via the exocytosis of the columnar mucous epithelial cells (). However, the maxillary sinusitis generally showed granulomatous rather than the ordinary suppurative inflammation, and healed uneventfully after the removal of granulomatous lesion containing Calcipex II granules. On the other hand, several foci of dystrophic calcification appeared in the periapical granuloma tissue (). The dystrophic calcified bodies were small and irregular in shape (), usually aggregated with one another, and admixed with the fine granules of Calcipex II in their periphery (). | [[60.0, 'year']] | M | {'15349968': 1, '2531288': 1, '2594328': 1, '589983': 1, '16101873': 1, '30609762': 1, '12453025': 1, '12059933': 1, '11523595': 1, '9587299': 1, '2094762': 1, '15009407': 1, '18554187': 1, '18270846': 1, '2392667': 1, '10551129': 1, '3859448': 1, '30941289': 1, '19168376': 1, '24010088': 1, '29142877': 1, '24516832': 2} | {} |
165,693 | 3916509-1 | 24,516,833 | noncomm/PMC003xxxxxx/PMC3916509.xml | Use of ultrasound Doppler to determine tooth vitality in a discolored tooth after traumatic injury: its prospects and limitations | A 47-year-old female patient visited our department due to traumatic injury to her upper right lateral incisor (tooth #12). She sustained the injury 3 days before she visited our clinic by a fist blow injury to her face. Tooth #12 was subluxated, and showed a positive response to a percussion test. It did not show any response to a cold test or EPT. The tooth was diagnosed with subluxation, and we decided to wait and observe its course. There was no discomfort during the 2 weeks after the injury, but there was no response to the thermal test or EPT, and a reddish discoloration was observed ().\nAt 6 weeks after the injury, the patient did not show any discomfort, but the discoloration lasted, and the tooth did not respond to cold or EPT. We decided to use the ultrasound Doppler unit to evaluate the vitality of the pulp, and the result was shown in . Tooth #12 produced a typical pulsated image, which represents normal vital pulp (). We explained the results and implications of the test to the patient. We decided to continue to wait and observe the tooth because the patient had no discomfort, did not mind the discoloration at that time, and was willing to wait to determine whether the tooth could recover to normal without any treatment. At 10 weeks after the injury, the tooth had returned to a normal shade and regained its normal responses to the cold test and EPT (). | [[47.0, 'year']] | F | {'14708655': 1, '29959598': 1, '29583037': 1, '11199733': 1, '14600700': 1, '22066894': 1, '15660755': 1, '17368329': 1, '20171355': 1, '2699588': 1, '19267966': 1, '9795741': 1, '277144': 1, '19249589': 1, '8272505': 1, '17437866': 1, '17258641': 1, '277443': 1, '3457703': 1, '22034968': 1, '3074062': 1, '12887385': 1, '24516833': 2} | {'3916509-2': 2, '3916509-3': 2} |
165,694 | 3916509-2 | 24,516,833 | noncomm/PMC003xxxxxx/PMC3916509.xml | Use of ultrasound Doppler to determine tooth vitality in a discolored tooth after traumatic injury: its prospects and limitations | A 30-year-old female patient visited our clinic for further treatment of traumatized anterior teeth. She had sustained an injury from a fall 2 weeks ago, and had visited a local clinic immediately after the trauma. The subluxated tooth #21 was splinted with composite resin and wire from tooth #13 to tooth #23, and then the local dentist referred her to our clinic. In the periapical radiographic view, the root and periapical area were normal (). Tooth #21 showed negative responses to the thermal test and EPT, a positive response to the percussion test, and pinkish discoloration (). The other teeth showed normal responses to all of the tests. In the ultrasound Doppler test, tooth #21 produced a normal pulsated response like those of the other teeth, and we were also able to hear the beat of the pulsation from the speaker (). At 4 weeks after the injury, tooth #21 showed normal response to percussion, again. In the other tests, the results were also the same as in the previous visit. At 6 weeks after the injury, tooth #21 still showed pinkish discoloration and negative responses to the thermal test and EPT. At 10 weeks after the injury, the shade of tooth #21 returned to normal (). At 12, 16, 20, and 24 weeks after the injury, the patient did not feel any discomfort at all. In the ultrasound Doppler test, tooth #21 showed a vital response, but it did not respond to the cold test or EPT. In the periapical view, the root and periapical area were within the normal range. The negative response continued throughout the follow-up period for 9 months. At that time, she was pregnant and wanted to delay her next visit until after her delivery. | [[30.0, 'year']] | F | {'14708655': 1, '29959598': 1, '29583037': 1, '11199733': 1, '14600700': 1, '22066894': 1, '15660755': 1, '17368329': 1, '20171355': 1, '2699588': 1, '19267966': 1, '9795741': 1, '277144': 1, '19249589': 1, '8272505': 1, '17437866': 1, '17258641': 1, '277443': 1, '3457703': 1, '22034968': 1, '3074062': 1, '12887385': 1, '24516833': 2} | {'3916509-1': 2, '3916509-3': 2} |
165,695 | 3916509-3 | 24,516,833 | noncomm/PMC003xxxxxx/PMC3916509.xml | Use of ultrasound Doppler to determine tooth vitality in a discolored tooth after traumatic injury: its prospects and limitations | A 22-year-old female patient visited our department to have her teeth bleached. She thought her teeth were generally yellowish, and she was especially unsatisfied with the shade of tooth #11, which showed yellowish brown discoloration (). She reported experiencing trauma to her anterior teeth when she was in primary school, and she had finished orthodontic treatment approximately 7 years before presentation. However, she did not know exactly when tooth #11 started to become discolored. In the radiograph, the coronal pulp space was obliterated, whereas the pulp space was present in the root area. There was no radiolucency in the periapical region, but the root apex was slightly shortened (). In the cold test, tooth #11 did not show any response, although she occasionally displayed a delayed response. The tooth did not respond to the EPT. In the ultrasound Doppler test, tooth #11 showed an image and sound typical of a vital tooth (). We decided to perform vital tooth bleaching first and then re-evaluate the color to decide whether restorative treatment was needed. Home bleaching was started using 15% carbamide peroxide gel (Opalescence, Ultradent, South Jordan, UT, USA). Additional home bleaching was continued only for tooth #11 after she was satisfied with the shade of her other teeth. After approximately 2 months of bleaching, she was satisfied with the shade of tooth #11 and did not want any further treatment (). | [[22.0, 'year']] | F | {'14708655': 1, '29959598': 1, '29583037': 1, '11199733': 1, '14600700': 1, '22066894': 1, '15660755': 1, '17368329': 1, '20171355': 1, '2699588': 1, '19267966': 1, '9795741': 1, '277144': 1, '19249589': 1, '8272505': 1, '17437866': 1, '17258641': 1, '277443': 1, '3457703': 1, '22034968': 1, '3074062': 1, '12887385': 1, '24516833': 2} | {'3916509-1': 2, '3916509-2': 2} |
165,696 | 3916680-1 | 24,516,709 | noncomm/PMC003xxxxxx/PMC3916680.xml | Gemcitabine-Induced Hemolytic Uremic Syndrome in Pancreatic Cancer: A Case Report and Review of the Literature | In June 2011, a 56-year-old male visited a local hospital complaining of dyspepsia and back pain. Contrast-enhanced computed tomography (CT) revealed a 4.4 cm mass at the head of his pancreas (). He was referred to our hospital, where we found the mass had invaded the main portal vein, common hepatic artery, and stomach. An endoscopic biopsy revealed moderately differentiated adenocarcinoma. The patient was diagnosed with locally advanced, unresectable pancreatic cancer (cT4N1M0). Laboratory tests showed serum hemoglobin level of 14.9 g/dL, platelet count of 166,000/µL, blood urea nitrogen of 21.3 mg/dL, and serum creatinine level of 1.28 mg/dL. The carcinoembryonic antigen level was 2.34 ng/mL (normal range, 0 to 5 ng/mL) and carbohydrate antigen 19-9 was 798 U/mL (normal range, 0 to 37 U/mL).\nConcurrent chemoradiotherapy (CCRT) with original gemcitabine weekly (1,000 mg/m2 per week, day 1, 8, 15, 22, and 29) and 25 radiation therapy (total radiation dose, 4,500 cGy) was performed from June 30 to August 3, 2011. One month after CCRT, a repeat abdominal CT showed that the pancreatic mass had decreased from 4.4 to 3.0 cm but remained unresectable. The tumor response was considered a partial response to treatment. On October 21, 2011, gemcitabine therapy was administered weekly (1,000 mg/m2 per week, day 1, 8, and 15) for 3 out of 4 weeks. A cumulative dose of gemcitabine from June 30, 2011 was 26,250 mg.\nIn February 2012 during week 2 of cycle 5, the patient was admitted for generalized edema and general weakness. He developed acute renal failure and had an elevated serum creatinine level of 2.08 mg/dL (normal range, 0.5 to 1.40 mg/dL). On physical examination, the patient had dyspnea on exertion, lower extremity pitting edema, and a blood pressure of 200/140 mm Hg. The patient's hemoglobin level had decreased to 7.7 g/dL (normal range, 13.0 to 17.0 g/dL) and a platelet count of 87,000/µL (normal range, 150,000 to 400,000/µL). The reticulocyte count was 11.69% (normal range, 0.5% to 2.31%), with a corrected reticulocyte count of 6.6% and an elevated lactate dehydrogenase (LDH) level of 459 IU/L (normal range, 110 to 247 IU/L). A peripheral blood smear showed macrocytic hypochromic anemia with mild anisopoikilocytosis composed of schistocytes and acanthocytes (). There was no evidence of proteinuria or hematuria, but the patient was positive for urine hemoglobin. The patient's total bilirubin, obtained from an indirect Coombs test, was normal and the patient's haptoglobin level was <10 mg/dL.\nThe laboratory tests confirmed MAHA, thrombocytopenia, and acute renal failure-leading to a diagnosis of gemcitabine-induced HUS. The patient started plasmapheresis due to oliguria and bilateral pleural effusion. After 19 plasmapheresis treatments, the patient's creatinine level decreased to 2.02 mg/dL and he was able to maintain self-urine output. The patient declined further chemotherapy due to his poor general condition after HUS treatment. He was transferred to a nursing home for hospice care and has continued with outpatient palliative therapy. | [[56.0, 'year']] | M | {'19203505': 1, '27602753': 1, '29766468': 1, '10885900': 1, '26157323': 1, '18344882': 1, '30394581': 1, '30962211': 1, '10188900': 1, '18097666': 1, '21278560': 1, '15197810': 1, '12324937': 1, '10070921': 1, '10575189': 1, '31935318': 1, '13274004': 1, '20938119': 1, '16006690': 1, '30662800': 1, '15790464': 1, '19116715': 1, '34104442': 2, '28747219': 2, '23569497': 1, '7960602': 1, '19816959': 1, '10223245': 1, '24516709': 2} | {'8155781-1': 1, '5530476-1': 1} |
165,697 | 3916717-1 | 24,195,576 | noncomm/PMC003xxxxxx/PMC3916717.xml | Recurrent pulmonary aspergillosis and mycobacterial infection in an unsplenectomized patient with type 1 Gaucher disease | A 65-year-old man, originating from northern Greece but living in Sweden for over 30 years, had been referred to the Hematology Center Karolinska for a consultation concerning suspected Gaucher disease. His past medical history was significant for several co-morbidities (). Because of splenomegaly (18 cm) and mild thrombocytopenia, a bone marrow (BM) examination was performed at the age of 51, disclosing the presence of foamy macrophages classified as Gaucher cells (GCs). However, further investigations aimed at the confirmation of GD diagnosis were not performed at that time.\nAt the age of 54 years, he developed malaise and a chronic cough. He was a smoker for 25 years but quit at the age of 50. Radiological examination disclosed mild pulmonary fibrosis and aspergillosis in the right lung. The microbiological examination of secretions from a bronchoalveolar lavage (BAL) showed growth of Aspergillus fumigatus and mycobacteria other than tuberculosis (MOTT). Antifungal therapy with itraconazole (100 mg 2 × 2 p.o.) was administered for 6 weeks, but the MOTT infection was not treated. Of note, several weeks after therapy onset, the patient's clinical course was complicated by pulmonary bleeding (the coagulation work-up was normal apart from moderate thrombocytopenia). The fungal infection did not fully respond to therapy, and 2 years after diagnosis the patient underwent a partial resection of the right lung due to an aspergilloma (). After surgery, his general status improved rapidly.\nAt age of 59, the patient developed shortness of breath and cough. Echocardiography showed septal left ventricular hypertrophy, normal systolic function of the left ventricle (EF of 50%–60%), signs of diastolic dysfunction, mild insufficiency of both aortic and pulmonary valves, and a slightly elevated pressure in the pulmonary artery (PA) of 42 mmHg. Repeated microbiological examination of the BAL secretions revealed a growth of Aspergillus fumigatus and Aspergillus nidulans, but was negative for MOTT. HIV serology was negative, excluding acquired immunodeficiency syndrome (AIDS). Voriconazole was administered for aspergillosis periodically for 2 years (at the age 61–62 years). Afterwards, the patient's symptoms regressed, and control spirometry showed only moderately decreased results (VC 3.72 L, 82%; FEV1 3.04 L, 84%; FEV1/SVC 82%; FVC 3.72 L, 82%). Chest X-ray did not show any active pathological lesions. However, computed tomography imaging (CT) revealed pronounced fibrosis of lung parenchyma.\nAt the time of hematologic consultation (at the age of 65), thrombocytopenia and hyperferritinemia were noted. The final diagnosis of GD1 was confirmed by the absence of glucocerebrosidase activity in peripheral blood leukocytes and an increased activity of plasma chitotriosidase. Further direct DNA sequencing of the GBA1 gene revealed heterozygous mutations in the GBA1 gene ().\nThe patient's status consisting of splenomegaly, thrombocytopenia, and an increased susceptibility to pulmonary infections, which was probably due to lung involvement in the course of GD, was assessed as an indication for commencing treatment of GD. The patient was started on miglustat, which was considered the first line of GD1 treatment at that time due to the worldwide supply shortage of Cerezyme® during 2009–2010 (). He received the commercially available miglustat capsules at a dose of 100 mg three times a day orally.\nInterestingly, the patient experienced an unusually rapid improvement of the whole blood platelet count (PLT), which normalized already after 2 months of miglustat therapy. Unfortunately, the patient developed malaise, diarrhea, poor appetite, weight loss (10 kg, 16% of his baseline body weight), and mild tremor for which miglustat was deemed accountable. During this time, the patient also developed cough, and a microbiological examination of the BAL secretions revealed growth of Aspergillus fumigatus (sensitive to voriconazole) and Mycobacterium avium. Inflammatory activation was observed at that time as presented in .\nThe patient discontinued miglustat after 4 months of treatment due to the adverse events and the above-mentioned pulmonary infections. Voriconazole was administered, and after 10 days his cough decreased but, after some days, returned, alongside malaise and night sweats. CT of the chest disclosed a new infiltrate in the lower lobe of the right lung, despite antifungal therapy (). Treatment with rifampicin, ethambutol, and clarithromycin for Mycobacterium avium was initiated. After 4 months of therapy, the patient was stronger, his cough and night sweats were clearly reduced, and he had regained 10 kg of body weight.\nAfter the Cerezyme® supply shortage had ceased, the patient was offered to start ERT. Unfortunately, he strongly refused administration of ERT despite our recommendations. Now, almost 2.5 years after the initiation of the triple therapy, and with intermittent periods of negativity, the patient is recurrently positive for Mycobacterium avium in his sputum, despite 8 months of triple therapy administered during the preceding year. During the periods of deterioration in his general condition, he was also positive for Aspergillus fumigatus in sputum. | [[65.0, 'year']] | M | {'21670466': 1, '16189163': 1, '20780767': 1, '11312209': 1, '8167344': 1, '8317468': 1, '7363908': 1, '18338393': 1, '8777974': 1, '19743447': 1, '8541556': 1, '10801168': 1, '900150': 1, '22247978': 1, '25619630': 1, '22515974': 1, '27064303': 2, '2959782': 1, '27015311': 1, '19804996': 1, '8457465': 1, '11493717': 1, '30342532': 2, '1445974': 1, '24195576': 2} | {'6196019-1': 1, '4967266-1': 1} |
165,698 | 3916718-1 | 24,079,344 | noncomm/PMC003xxxxxx/PMC3916718.xml | An uncommon cause of acutely altered mental status in a renal transplant recipient | We report a case of a 57-year-old female with sudden onset of altered mental status (time and person perception) following an episode of seizures, without any kind of hallucinations, and accompanied by headache. She was a kidney transplant recipient, and the above episode occurred on the thirtieth postoperative day after transplantation. She had been diagnosed with end-stage renal disease (ESRD) and had been on hemodialysis for 5 years before she received a graft from a deceased donor in our center. She was also hypertensive and treated with beta-blockers, namely bisoprolol.\nPhysical examination revealed no focal neurological signs such as paralysis, cortical blindness, or Babinski's sign. After the described episode, the patient was generally stuporous with rare incidence of hyperactivity. Her body temperature was normal, blood pressure reached 203/147 mmHg, and the heart rate was 123 bpm. Her Hct at admission was 31.4%, C-reactive protein 1 mg/dL, Hb 9.3 g/dL, and WBC 4794 leukocytes/mm3. TSH, T4, T3, FT3, and FT4 were within normal ranges, and C-reactive protein at episode was 7 mg/dL.\nHer blood pressure was controlled by intravenous esmolol infusion, with no improvement of the clinical status. Her immunosuppression regimen included tacrolimus, corticosteroids, and mycophenolate mofetil, according to our immunosuppression protocol. Serum tacrolimus concentrations were measured continuously and were between 6.5 and 7.5 ng/dL. Although these tacrolimus concentrations are generally considered satisfactory and not capable of triggering a tacrolimus-related encephalopathy, the dose of the drug was further tapered after the episode just to keep serum creatinine within preferred ranges (1.3 mg/dL; eGFR >60 mL/min/1.73 m2).\nAt the same time, a set of examinations was applied, due to the wide spectrum of differential diagnoses mentioned above. Fundoscopic examination and cerebrospinal fluid analysis including cultures and PCR analysis for HSV 1 and 2 showed no abnormalities. Brain computerized tomography (CT) scans showed no hemorrhagic or ischemic lesions. Electroencephalography analysis was not suggestive of epilepsy. MRI of the central nervous system showed signal abnormalities in the pons and the parietal and occipital lobes. More specifically, fluid-attenuated inversion recovery (FLAIR) MRI () revealed high-signal areas in the occipital and parietal lobes (mainly cortical area and subcortical white matter of the right occipital lobe). Furthermore, T2-weighted (T2W) MRI () showed hyperintense signal involving the cortical and subcortical areas of the occipital lobes and the pons. These signal abnormalities were characteristic of vasogenic edema in the above-mentioned brain areas. These lesions were considered as indicative of PRES.\nPsychiatric evaluation, on the other hand, excluded delirium. Antidepressive therapy was administered due to previous history of depression. She was treated intravenously, and 2 days after the initiation of therapy her condition improved significantly. However, her discharge was delayed as the clinical picture was also complicated by an episode of bacteremia, due to multidrug-resistant Pseudomonas aeruginosa, sensitive only to colistin. She was treated with this medication, given in a dose of 9 × 106 IU daily, intravenously for 25 days.\nAt a 6-month follow-up, the patient is in good shape, without presenting similar episodes of altered mental status. | [[57.0, 'year']] | F | {'23175479': 1, '17110690': 1, '19715942': 1, '15037879': 1, '17462379': 1, '22886172': 1, '20699617': 1, '19076332': 1, '3047546': 1, '8559202': 1, '17928960': 1, '23354301': 1, '15705136': 1, '7979215': 1, '20435835': 1, '26666662': 1, '24079344': 2} | {} |
165,699 | 3917170-1 | 24,554,914 | noncomm/PMC003xxxxxx/PMC3917170.xml | Anticonvulsant hypersensitivity syndrome associated with carbamazepine administration: Case series | A 30-year-old male patient was suffering from herpes labialis, for which he consulted local physician and was prescribed tablet carbamazepine 200 mg two times a day, tablet acyclovir dispersible 200 mg five times a day, tablet pregabaline 75 mg twice a day and tablet methylcobalamine 500 μg thrice a day. He improved initially from herpes labialis lesions but after 10 days, developed lesions in oral mucosa which spread to the face, upper extremities, trunk and ultimately all over the body for which he consulted the same doctor. He was treated with steroids, cetirizine, and erythromycin and the initial treatment was continued as such. He was suspected to be having reactivation of the herpes virus or drug reaction. But the severity of the lesion was pointing more toward drug allergic reaction. Moreover he was continuing the tablet acyclovir in routine prescribed doses, so possibility of virus reactivation was very minimal. The condition of the patient worsened after 5 days and was referred to dermatology department of Dhiraj Hospital, a tertiary care teaching rural hospital. On cutaneous examination, multiple hyper-pigmented lesions and some target lesions were present all over the body, creamy-curdy lesions over the tongue, oral mucosa, and palate []. On ophthalmic examination, multiple scaly lesions in lids, gross lid swelling, purulent discharge, congested conjunctiva, ulceration in conjunctiva, and lower fornix. The patient was suspected of having AHS due to drug allergic reaction. Blood investigations revealed WBC count 6800/mm3, neutrophils 78%, lymphocytes 15%, urine albumin 4+ and SGPT 66 IU/l, suggestive of liver and kidney involvement.\nCarbamazepine was stopped and the patient was treated with injection dexamethasone 8 mg and injection pheniramine maleate 4 mg intramuscularly once a day for 3 days, tablet azithromycin 500 mg once a day for 6 days, injection ranitidine i.v. two times a day. He improved after 5 days of treatment and his SGPT levels returned to normal. | [[30.0, 'year']] | M | {'16641839': 1, '10612272': 1, '34067134': 1, '34959331': 1, '27730770': 1, '32455203': 1, '27999472': 2, '28127149': 1, '28638280': 2, '31085955': 1, '29564734': 1, '11072960': 1, '21986395': 1, '34621604': 2, '31982029': 2, '21428769': 1, '24554914': 2} | {'3917170-2': 2, '3917170-3': 2, '5472963-1': 1, '5153889-1': 1, '6983282-1': 1, '8463002-1': 1} |
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