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discharge from the MICU are displayed (Table ).\nThe patient remained on the ventilator through the tracheostomy at 100% FiO2 with a positive end expiratory pressure (PEEP) of 0 cmH2O. Due to the substantial pneumoperitoneum, there was concern for abdominal compartment syndrome. Bladder pressure was assessed which revealed a pressure of 11 mmHg (normal range: 0-15 mmHg). Repeat chest X-ray 12 hours later showed a slight improvement in subcutaneous emphysema as less free air was evident in the soft tissue. The patient had episode of fever and was treated with cefepime

showed large pneumoperitoneum with posterior displacement of the viscera, numerous gas densities in the mesenteric fat and retroperitoneum, extensive subcutaneous emphysema in the soft tissues extending to the level of the labia and anterior thighs bilaterally (Figures , ).\nFor further monitoring, the patient was transferred to the medical intensive care unit (MICU). Lab results at the time of admission and

incision in the midline of the dura and then continued with blunt dissection, opening the dura layer to caudal L2 and to cranial T10. Dura was then parted with stay thread until the vessel-rich tumor mass was exposed. The tumor mass was excised, and the surgical field was contaminated

by blood from hematomas from tumor vessels (). Bleeding was found to originate from the anterior part and posterior part of the cord, no bleeding source from the cerebrospinal fluid nor the subarachnoid space. The tumor mass was successfully evacuated with fragments of hematomas and necrotic tissues. The dura layer was then closed with a continuous suture. The tumor mass was fixed and transported for histopathology examination ().\nAt the time of discharge, the patient did not regain the function

of the gallbladder wall and a positive sonographic Murphy’s sign (Figure ). The common bile duct was prominent measuring seven millimeters in diameter. A follow-up magnetic resonance cholangiopancreatography did not reveal a common bile duct stone (Figure ). Initial laboratory investigations were unremarkable, except for a mildly elevated alanine aminotransferase level (Table ). Upon admission, he was initially started on intravenous antibiotics and underwent a laparoscopic cholecystectomy the next day. Post-procedure his pain improved and he

exam was unremarkable; however, his abdomen was tender to palpation in the right upper quadrant. Bowel sounds were normoactive and no guarding, rigidity, or organomegaly was elicited. No skin rashes were appreciated, and the neurological exam was within normal limits. An ultrasound of the abdomen this visit demonstrated multiple stones in the gallbladder with mild prominence

was admitted to the hospital as a case of unusual painless bleeding from the left side of the face (), left eye, and tear duct of two-week duration. The bleeding was described to be spontaneous, unpredictable, and intermittent, with no specific patterns, and it stopped spontaneously. There was no association with mood, activity, or sleep. The bleeding occurred mostly around the orbital regions, the tear ducts, and the face, with intact skin, and no blood or redness, or visual disturbance of the eyes, except

for mild perorbital tenderness. Several episodes of bleeding occurred prior to admission, and on admission two episodes occurred while the physician observed. Each episode

next year. Seventeen months after resection of the cerebellar metastasis, local recurrence was detected. The patient was treated with gamma knife SRS (peripheral dose 21 Gy). Six months later, a single new brain metastasis was found (8 mm large, left occipital lobe), which also was treated with SRS. Seven months after the second SRS procedure, a third one was added after diagnosis of two new infratentorial brain lesions (cerebellum and brain stem, respectively). Treatment planning

MRI also revealed a contrast-enhancing extramedullary mass at the level of the 5th cervical vertebra. Additional scans of the spine showed at least two more small metastases in the lower thoracic and upper lumbar region (Figure ). No cerebrospinal fluid (CSF) examination

referral to urology. His initial labs showed that he had developed acute kidney injury (AKI) with high blood urea nitrogen (24 mg/dL) and increasing creatinine (2.4 mg/dL). The AKI was due to the chronic intermittent urinary retention patient had been experiencing for at least the past 4 months. At the urology visit, the plan was made to relieve his obstructive uropathy with intermittent catheterization and to coordinate with his psychiatrist and Primary Care Physician (PCP) to manage his mental health medications.\nTwo days after, the urologist saw him, he presented with a febrile illness to the

few months. Renal labs and ultrasound of the kidneys and bladder were ordered immediately along with a

socially on the weekends. Her maternal grandmother died from brain cancer. There was no other family history of cancer. Genetic testing was not performed.\nWithin 1 month of starting radiation therapy, she presented with progressively worsening severe, sharp, constant pain of the right shoulder and chest associated with right arm numbness, cough productive of clear sputum, and dyspnoea on exertion. Pain was exacerbated by right arm movement. She denied any trauma, travel, or oedema of the arm.\nOn examination, she appeared frail with evidence of weight loss.

She had a heart rate of 86 b.p.m. and blood pressure of 121/74. On auscultation, coarse rales and rhonchi were present in the left lower lung field. Cardiac exam revealed a regular rhythm with no murmurs, gallops, or rubs. She had tender

The magnitude of the TENS was gradually increased to achieve the muscular twitching. It was further increased to achieve the mandibular jerk which was the clinical threshold value for the patient (5 mV) At this clinical threshold, the muscle

of the muscles was achieved, and the mandibular musculature was induced to guide the mandible in the physiologic position.\nTENS application was done with the help of the J5 myomonitor () Three electrodes were used to apply TENS - positive, negative, and ground electrode Positive and negative electrodes were pasted in the mandibular notch region in front of the ear, and ground electrode was pasted in the midline behind the neck

muscular arteries with fibrinoid necrosis with a polymorphonuclear infiltrate suggestive of a medium vessel vasculitis.\nWith the history of constitutional symptoms with severe myalgia, new onset hypertension, mononeuropathy together with angiographic changes, and medium vessel involvement in histology, we diagnosed PAN in our patient. After excluding viral causes such as hepatitis B, hepatitis C, and HIV, we had to start immediate immunosuppressive medication. Due to rapidly progressing limb-threatening disease, we started the patient

on steroid pulses and intravenous cyclophosphamide. Subsequently, due to the disabling ischaemic rest pain we referred the patient to vascular

year ago was treated in the local general hospital. Recently, she came to Department of Pediatric, School of Stomatology, the Fourth Military Medical University for treatment, with the chief complaint of recurrent swelling of the gum in the anterior teeth region and occlusal pain. Intraoral

clinical and X-ray examination showed that the neck of the crown oftooth 21 was broken at the 1/3 position, white filling was seen on the fracture surface, probing (–), knocking (+), and no obvious loosening of the tooth was found (). Periapical radiograph showed that the apical foramen with tooth 21 was open with periapical shadow and the pulp chamber was wide.\nAccording to the

(MELD) score of 35 at time of transplant. His donor was a 49-year-old man with no history of malignancy. Explant pathology revealed established cirrhosis with a 2.5 cm moderately differentiated HCC with evidence of microvascular invasion. After transplantation, he maintained stable liver function on an immunosuppressive regimen of tacrolimus and mycophenolate mofetil. He underwent two post-transplant liver biopsies, which revealed HCV recurrence: Grade 1, Stage 1 in 2008

and Grade 1, Stage 2 in 2010. His liver enzymes remained in the normal range at this time. He underwent HCC surveillance at 6 monthly intervals for the first 2 years after transplant and yearly thereafter

without detecting gastric retention and a urinary catheterization showed oliguria. A complete blood count showed moderate leukocytosis (13.67 WBC x103) and anemia (RBC 3.42 x106, Hb 10.4 g/dL, Ht 30.8%). An immediate abdominal sonography confirmed the clinical suspicion of spontaneous rupture of the spleen with massive hemoperitoneum (Figure\n). The patient immediately underwent an emergency laparotomy. Intraoperative findings have been massive hemoperitoneum (approximately 3 L of blood and coagula) due to a two-step rupture of the

of about 23 g.\nOn admission the patient was pale and suffering, and his vital parameters were as follows: oxygen saturation 100%; heart rate 90 bpm, temperature 36.5°C, blood pressure 90/45 mmHg. His medical history was otherwise negative, and no trauma or accident had been previously reported. An abdominal examination showed diffuse pain and peritoneal fluid was noticed at percussion; a nasogastric tube was placed

Pakistan presented to our neurology emergency room with numbness in both lower limbs up to his umbilicus and difficulty in walking for the previous 15 days. He had fallen from a tree 2 months earlier and had no bleeding fraction and an unremarkable shoulder X-ray. He experienced mild pain in his right shoulder and neck after the trauma, which was relieved through medication, and was sent home.\nA physical examination displayed a good physique and a normal body mass index. There was no visible or palpable stepoff in the spine, and no tenderness was observed around the area of

fracture. A detailed neurological examination revealed that his upper limbs were normal, power was 5/5 according to the Medical Research

tear of her anterior cruciate ligament, terminal sulcus impaction injury, and a corner fracture of the posterior aspect of the lateral tibial plateau.\nThe patient subsequently underwent an ACL reconstruction utilizing bone-patellar tendon-bone autograft at an outside institution with an uneventful recovery. The initial postoperative radiographs from the outside institution were unremarkable ().\nApproximately 6 months after the ACL reconstruction surgery, the patient had reinjured her right knee from a slip and fall on the ice. Radiographs were obtained at this time (), with the

initial interpretation by an outside institution, read as being unremarkable. The patient's symptoms persisted; therefore, A MRI was obtained which demonstrated a new lesion in the anteromedial aspect of

negative for tooth 36. A panoramic radiograph showed a well-circumscribed radiolucent lesion located around the apex of the distal root of tooth 36 [] just above the mandibular canal. The lesion was approximately 10 mm in maximum diameter. After evaluating all the data, a root canal treatment of the left first molar was planned. At the same appointment, the root canal treatment was initiated on tooth 36. A rubber dam was applied and the access cavity was prepared. A hemorrhagic, purulent exudate was found from the distal canal of tooth 36. The working

length was estimated using an apex locator. The distal canal was instrumented with size 15–40 K-files and mesial canals with size 15–30 K-files using a step-back technique. During the instrumentation, the canal was irrigated copiously with 3% sodium hypochlorite solution using a 27-gauge endodontic needle after each instrument. Drainage was performed until the discharge through the canal ceased. The canals were dried with sterile paper points and then dressed with calcium hydroxide. A

the treatment subsequently.\nOn examination, her mental status was found to be normal and no psychiatric disorder was evident. She had history of frequent mood swings of mania and depression associated with episodic behavioral changes which was undoubtedly suggestive of bipolar affective disorder. Her general physical examination was unremarkable. All routine investigations were within normal limits. She was diagnosed as a case of bipolar affective disorder, currently in remission, with comorbid epilepsy. The patient was initiated on higher dose (800 mg) of sodium valproate which was further increased gradually to 1600 mg/day. At this stage, her seizure frequency was reduced to 1–2 convulsions/day on monthly intervals. A further increase in dose caused significant sedation and

seizure free period of 10–15 days. Her episodes of behavioral abnormalities had no correlation with onset of seizures. She reported insignificant improvement in her seizure disorder despite treatment. She accepted noncompliance to the regular treatment, thrice for 15–20 days duration each, during the last 2 years, and admitted that a further increase in seizure frequency during such breaks compelled her to resume

no definitive lesion in the right cervical LNs or distant metastasis.\nThe tumor in the right nasal cavity was biopsied using forceps, but the pathological examination resulted in necrotic tissue with suppurative granulation. It is unclear whether the biopsy revealed the presence of necrotic tissue or whether the biopsy procedure itself caused the necrotic tissue. An incisional biopsy of the left cervical

palate. Fluorodeoxyglucose-positron emission tomography (FDG-PET) showed high accumulation in the primary tumor, with a maximum standardized uptake value (SUVmax) of 9.63 (). The SUVmax of FDG-PET in the left medial and inferior cervical LNs was also high (6.90 and 4.62, respectively; ), although there was

patient with a prior history of a surgically treated Arnold Chiari type I malformation presented to the emergency department with right elbow pain and deformity after a fall. He had tripped while coming down the stairs and had landed on his right elbow in a flexed position. Prior to this injury, he had full range of flexion–extension and pronation–supination movements of his right elbow. There was no prior elbow injury.\nOn examination, he had normal vital signs. A right elbow joint effusion was present, and he was tender along the medial and lateral epicondyles of the right distal humerus. Pain was exacerbated on supination as well as on elbow flexion. The patient had intact neurovascular status distal to

the elbow. No wrist or shoulder joint tenderness was reported.\nInitial anteroposterior and lateral radiographs of

the diagnosis of PIL for 2 years was consulted to our department regarding the necessary surgical intervention for her anasarca-type edema, massive ascites, and refractory hypoalbuminemia. Her immune system was depressed, leading to frequent and severe infections. The diagnosis was made by the upper gastrointestinal system endoscopic examination that revealed duodenal lymphangiectasia []. She did not respond to dietary or medical (octreotide: 15–20 μg/kg, twice a day, subcutaneously) treatment. Partial intestinal resection had been performed twice before,

leading to transient decreases in symptom severity. Two months after the last partial intestinal resection, the patient was hospitalized due to edema and hypoalbuminemia at first only once a month, then twice a month, and finally weekly. In addition, her immune system was depressed due to protein loss, which was leading to frequent and

was admitted two more times, always in a floridly psychotic state with self-inflicted injuries and intoxicated with alcohol. Antipsychotic treatment comprised ziprasidone and quetiapine with no satisfactory effect. The patient was treated with ziprasidone only for a couple of weeks and in a low dose. Continuous was with quetiapine for almost two years in an initial dose of 500 mg and a maintenance dose of 100 mg daily, both without considerable effect. Dosage was reduced due to

months. The patient was diagnosed with paranoid schizophrenia according to the international classification of disease (ICD-10), which is commonly used in clinical routine as well as psychiatric research. During the following three months the patient

months without direct traumatic episodes. It had aggravated 3 months previously due to slipping in her bathroom. Motor weakness of her right thigh was apparent. The sensation of her lower extremities was normal. Her deep tendon reflexes seemed to be hypoactive, and there was no muscular atrophy.\nWe initially assumed that the weakness of her lower extremities was due

of right thigh pain and both lower extremity weakness. The patient had a limping gait due to the pain in her right thigh, which had persisted for 4

more aware of conversations around him, but was unable to hear or understand distinct words. He described visual distortions in the form of the environment and floor sinking away and the appearance of patterns moving on the carpet and chairs in the room. Additionally, he reported an “out-of-body” experience characterized by the feeling of being removed from his body, existing above it in space, and feeling that his surroundings were sinking away from him, which was also accompanied by

a feeling of paralysis. He reported having had a similar experience when administered ketamine before surgery for a broken leg. Four hours after drug administration, and after eating lunch, H.C.'s symptoms of nausea, faintness, dissociation, and auditory, visual, and perceptual alterations had almost completely subsided. Five hours after drug administration, he appeared

of the vessels led to difficult in reaching the exact site of the AVM, whilst the high flow from the arterial side continually forced the guide wires and catheters out of the transplant vein and back up into the common iliac vein as the inflated balloon at the origin of the artery failed to reduce the flow.\nTherefore, an additional 12F sheath and balloon (Medtronic ReliantM stent graft balloon catheter) were

inserted into the venous ipsilateral side, coming from an insertion site just above the initial puncture. This balloon allowed transient occlusion of the common iliac vein (Fig. ), to ensure the guide wire remained in the transplant vein and not forced back into the host common iliac vein by the arterial pressure coming through the AVM. Once the wire was secured in situ, an occlusion plug (10mmx7mm) (AMPLATZER ™ Vascular Plug II, Abbott) was advanced through a 6F sheath and deployed across the fistula (Fig. ). This led to good embolic occlusive result with subsequent angiography showing no flow across the previous fistula (Fig. – (a) pre occlusion plug and (b&c) post

artery while an ostial occlusion of the left renal artery was noted (Figures and ). Based on the emergent nature of patient's presentation we decided to proceed with percutaneous intervention (PCI) of the culprit lesion. The left renal artery was reengaged with a JR4 guide catheter and 5000 units of Heparin were administered. The lesion was probed with a Prowater wire whose passage proved difficult; therefore, a 1.25 mm support balloon was used to cross the

lesion. Intrarenal position was confirmed by advancing wire into upper and lower pole arteries. This was followed by sequential balloon dilatation with 1.5 mm, 2.5 mm, and 3.0 mm balloons. Intravascular ultrasound (IVUS) was used to assess the lumen of the renal artery. It was found to be a 5.0 mm vessel with severe

fracture involving the medial clavicle after falling off an all-terrain vehicle. He was initially seen in the emergency department, placed in a sling, and referred to the orthopedic service for definitive management. The patient is right-hand dominant and does not smoke. He has no prior history of injury to the right clavicle. At the time of his orthopedic consultation, his pain was described as moderate and sharp localized to the medial end of the right clavicle. The patient reported no numbness or tingling in his arm.\nPhysical examination revealed a healthy-appearing, pleasant male responding

appropriately and in no apparent distress. The pertinent findings on examination included no signs of cervical radiculopathy, no pain or winging of the scapula, intact skin, but significant tenting and swelling over the medial right clavicle, and obvious asymmetry of the right clavicle compared to the left clavicle consistent with a displaced fracture. The end of the

[]. The organism was susceptible to all antibiotics tested with minimum inhibitory concentrations (MICs) of trimethoprim/sulfamethoxazole ≤ 0.25/4.75 µg/mL, ciprofloxacin ≤ 0.12 µg/mL, moxifloxacin ≤ 0.25 µg/mL, amikacin ≤ 2 µg/mL, doxycycline ≤ 0.5 µg/mL, clarithromycin ≤ 2 µg/mL, linezolid ≤ 1 µg/mL, imipenem ≤ 2 µg/mL, cefepime ≤ 1 µg/mL, amoxicillin/clavulanate ≤ 2/1 µg/mL, ceftriaxone ≤ 4 µg/mL, minocycline ≤ 1 µg/mL, cefoxitin ≤ 8 µg/mL, tigecycline ≤ 0.5 µg/mL, and tobramycin ≤ 1 µg/mL.\nFor a few days before and then after undergoing CABG,

the patient stayed in her daughter's house, where a dog was kept as a pet. We cultured specimens from the dog to

hospital, the patient presented at the emergency ward. Respiration and circulation were normal and the patient was afebrile. A computed tomography (CT) scan of the brain was performed as well as an analysis of the cerebrospinal fluid, with both indicating no pathological signs. A neurological consult ordered an electroencephalogram (EEG) and a magnetic resonance imaging (MRI) of the brain to be performed as soon as possible at a secondary hospital to which the patient was referred. At arrival to the secondary hospital on the second postoperative day, the patient

from where the patient went home after 3 h accompanied by her next of kin. During the first postoperative evening and night, the patient’s next of kin observed that the patient had problems with articulating words followed by increasing anxiety and confusion. At the next morning, the patient only spoke unrecognizable words, and by the afternoon, she could not walk. Approximately 24 h after leaving the

duration. There were no complaints of fever or weight loss or symptoms suggestive of compression of adjacent structures. The patient was afebrile and had a cystic, non-tender, non-translucent and smooth swelling occupying the whole of the neck anteriorly, extending from the hyoid bone to the suprasternal notch. The lower limit of the swelling could not be reached. There were no neck nodes or dilated tortuous neck or chest wall veins.\nChest X-ray revealed widening of the mediastinum and a soft tissue neck swelling, continuous with the mediastinal shadow (Fig ). On neck ultrasonography, a predominantly cystic, multiseptate mass lying superficial to the

thyroid lobes was evident. Fine needle aspirate cytology from the swelling showed largely necrotic material with few macrophages and mixed inflammatory cells on a background of proteinacious material, suggesting a diagnosis of a dermoid cyst. There were no acid-fast bacilli, bacterial and fungal elements on microscopy

normochromic anemia, serum bilirubin-1.2mg/dl, aspartate aminotransferase 18 U/L, alanine aminotransferase 16 U/L, serum alkaline phosphatase 76 U/L, serum protein- 5.1 g/dl with albumin- 2.3 g/dl, serum creatinine- 1.7 mg/dl, blood urea- 130 mg/dl. Urine examination showed 4+ protein, 50–60 red cells per high power field (HPF), 40–50 white cells/HPF, erythrocyte sedimentation rate 123 mm/hr, serum C-reactive protein 1.90mg/dl. Antinuclear antibody (ANA) by immunofluorescence was 4+ homogenous (1:80 dilution), anti-double stranded deoxyribonucleic acid (dsDNA) antibodies

normal.\nInvestigations revealed anemia (hemoglobin 5.9g/dl), total leucocyte count 8000/mm3, differential leucocyte count – neutrophils 81%, lymphocytes 12% (absolute lymphocyte count-960/mm3), platelets- 209,000/mm3, reticulocyte count- 3%, peripheral blood smear showed normocytic

of the intestine was checked by laparoscopy immediately; the color of the terminal ileum was slightly dark, but the serosal surface and peristalsis looked good, so it was observed. On the next day, contrast-enhanced CT revealed improvement of blood flow of the SMA () and enhancement of the intestinal tract (). It was confirmed that the color of the terminal ileum became better by laparoscopy. Furthermore, this CT revealed the aortic dissection changed to a type A dissection, and total aortic arch replacement was performed immediately after the laparoscopy. Heparin (15000 units per day)

A metallic stent (E-Luminexx Vascular Stent, Bard Peripheral Vascular, Inc., Tempe, AZ, USA) with a diameter of 6 mm and a length of 6 cm was then placed into the SMA. We decided to use this self-expandable stent because the abdomen is at a risk of strong compression by trauma. We considered that a self-expandable stent was better than a balloon-expandable stent because of its greater radial strength []. Thereafter, the peripheral blood flow of the SMA was improved (). The condition

well separated which indicated some flow problem at the aqueduct level.\nOn the fourth day, the patient was taken for another trial of coiling but that also was difficult; there was also an occlusion of the left carotid system by a thrombus. CT of the brain showed deterioration when compared to the previous examination; the ischemic areas were better demarcated corresponding to the left MCA and part from the left anterior cerebral artery with perforating branches to the basal ganglia. The midline shift had increased and there was an increase in the effacement of gyri and sulci.\nCerebral angiography revealed a

thrombosis in the left internal cerebral artery (ICA) and MCA. Of note, there was no carotid artery aneurysm. Partial mechanical thrombectomy for MCA/ICA system was done.\nAfter the last attempt of failed coiling, the pupils became fixed and dilated at

was performed at this point and confirmed minimal change disease. Following the renal biopsy she was commenced on cyclosporine (5 mg/kg/day) therapy and alternate day steroid therapy at 40 mg/m2 and went on to achieve remission in one week.

steroid sensitive NS. Unfortunately, five months after her steroid treatment was weaned she developed a clinical relapse of her nephrotic syndrome. She recommenced treatment with high dose steroid therapy. Again she responded within one week of commencing steroid treatment. However, when the steroid-weaning regimen was started, she suffered further proteinurea. Despite the return to high dose steroids she failed to achieve remission after 4 weeks of daily oral steroid treatment at 60 mg/m2, and 3 day of IV methylprednisolone at 600 mg/m2. A percutaneous renal biopsy

observed posterior synechia of the iris and massive vascular tissue integration within the lens (Fig. ). During surgery, after detaching the posterior synechia of the iris, we noticed deficiencies in the anterior capsule of the lens. The lens appeared wrinkled and had a diameter of approximately 3 mm (Fig. ). Substantial integration of vascular tissue was observed in the posterior capsule of the cataractous lens. Following posterior capsulotomy, the red light reflex disappeared. We then performed anterior vitrectomy.\nPathological examination revealed that the right lens and capsule contained little connective tissue. We also observed fibrous

tissue hyperplasia, hyaline degeneration, calcification, and follicular cystic changes, in addition to active proliferation of fibrocytes (Fig. ).\nBCVA remained unchanged in either eye following surgery. Postoperative examination further revealed a transparent right cornea. The right anterior chamber was

abdomen with guarding and reduced bowel sounds. He also reported worsening epigastric pain that was not responding to analgesia with vomiting. Repeat blood works showed he had an elevated white cell count of 21.3 × 109/l and normal serum amylase and lipase. In addition to the treatment he was getting he was

also started on antibiotics and antipyretics. The patient was prepped for an emergency laparotomy and consent obtained for the same as he now had peritonitis.\nAt laparotomy, a perforation of D4 on the anterior wall was found involving less than 50% of the circumference with minimal

was transected between the common carotid trunk and the left subclavian artery, and a 29 mm stented graft (Frozenix, Lifeline, Tokyo, Japan) was inserted. Its stump was anastomosed to a 26 mm four-branched graft (J graft, Lifeline, Tokyo, Japan). The systemic circulation was resumed with a 9 mm side branch of the four-branched graft, and the common carotid trunk was anastomosed to the first 11 mm side branch. After the grafts connected to the axillary arteries were passed into the mediastinal space, bilateral axillary arteries were reconstructed via the extraanatomical bypass using second and third 9 mm side branches of the arch graft. The cardiopulmonary

bypass was terminated after sufficient rewarming.\nThe mechanical ventilator support was 16 h, and thereafter, the patient experienced an uneventful postoperative course. Postoperative computed tomographic findings

a primary complaint of gait disturbance. The patient had a history of hypertension and cerebral infarction, and she had been taking oral antihypertensive and antiplatelet agents. The patient had no sequelae of cerebral infarction, after which she had a good course taking oral antihypertensive and antiplatelet agents. Diabetes mellitus is a common cause of Charcot arthropathy, but the patient did not have diabetes mellitus. The patient also had no family history of a cause of Charcot arthropathy or a neurological disease. She had a history of the present deformities

of the left knee joint and ankle from around 65 years of age, but the patient left them untreated because she did not have severe pain. From around 69 years of age, varus deformity of the left ankle progressed. The patient developed difficulty walking and, therefore, visited our department for consultation. Physical examination showed that the left leg was shorter by 20 mm, with a functional leg length discrepancy.

one-year history of asthma presented to the emergency room with non-specific symptoms including fatigue, dyspnea, numbness in the right leg, nausea, vomiting, and dizziness. Two months prior to presentation, he had a sinus surgery and within few days after this surgery, he developed cough and dyspnea, so he was admitted to outside hospital for possible pneumonia. He was treated with cefuroxime, Tamiflu, and oral prednisone. He improved momentarily with steroids. Two weeks later, he returned to the outside hospital complaining of right foot plantar numbness and dyspnea, he was discharged home on Levaquin as they thought he may have some residual sinus disease left. One week later he was seen by a pulmonologist at

outside hospital and they noticed that one of the cultures grew staph, hence started on Bactrim. He took Bactrim for three days and his mother noticed that he developed some mental status changes, hence Bactrim was stopped. After this, no more symptom of mental status change was noticed. Over the next few weeks, the patient noticed tachypalpitations, continued to have fatigue, shortness of

nephrolithiasis, and childhood polio with consequent bilateral lower extremity atrophy, presented to the emergency department with epigastric pain associated with persistent, non-bilious vomiting. Patient mentioned a history of a pancreatic cyst, which he had been told was harmless. A CT scan from 5 years prior to his presentation demonstrated a 10 × 8 cm septated cystic lesion in the head of the pancreas (Fig. a). In the intervening 5 years, no additional diagnostic work-up or surveillance had been performed.\nUpon

arrival at the emergency department, the patient was tachypneic, but his blood pressure and heart rate were normal. His abdomen was soft, mildly distended, with generalized abdominal tenderness worse in the upper quadrants bilaterally. Laboratory results were significant for a leukocytosis of 17,000/μL, and a

uneventful medical history. There was a large (approximately 9 mm in diameter; large arrow Figure ) common wart on the middle knuckle of the right hand as well as 23 smaller warts (1 mm to 4 mm) at the base of and behind the knuckle of the index finger (small arrows, Figure ). The large wart was first noticed 9 years earlier. Within 1-2 years it had reached its maximum size as well as spread to multiple surrounding sites. Because of her occupation as a piano teacher, the subject reported experiencing considerable psychological distress over the visibility of the warts and the need

to frequently use her hands in front of others. Over the course of the previous 2 years, several treatments for common warts on the right hand were unsuccessful despite perfect compliance. The treatments attempted included two courses of essential oil blends which were

settings on highly-frequent and tightly-paired words repeatedly to obtain a comprehensive KeyGraph in discussion with physicians and a nurse, since the definition of high frequency and co-occurrence can influence keyword clustering []. This human-computer interaction is an important step in Scenario Map Analysis allowing creative ideas in investigators. In this study, highly-frequent words were defined as words that appeared more than 6 times in the

interview. The KeyGraph can visualize relationship among main structure as cluster consisted of highly-frequent and co-occurrent words (block nodes and solid lines in

position, head neutral at the midline. After the lateral masses of C1 and C2 are exposed, first C2 entry point is determined and transarticular screw is placed as in the routine procedure. Generally, 45 ± 3 × 4 mm screw is suitable. In our opinion, this technique may provide better outcome in anteriorly displaced oblique fractures. If the fracture is displaced, it must be reduced with an manuel reduction manevuer of intraoperative manipulation. Then, contralateral entry point is drilled at a point 2-mm lateral and 1-mm inferior compared with the first one []. This

extension graphs were normally at this period. The follow-up time is 26th month.\nDetailed 3D anatomical evaluation of the VA and the transverse foramina is necessary to determine VA and bony anatomy. The patient is placed in prone

confirmed the pleocytosis with cell count of 54/µL (lymphocytes 81%). There was also increased level of protein with 5.04 g/L, but normal glucose level. Serological tests were positive for lgG coxsackie virus and lgG varicella-zoster, and CSF tests of IgM/G virus were negative. Mycobacterium tuberculosis and parasites were not detected in CSF, and oligoclonal bands were not detected as well. Electroencephalogram of asymptomatic period showed no abnormality.\nInitial treatment with non-steroidal anti-inflammatory drugs, ganciclovir, mannitol and anti-epileptic medications at an external hospital did not halt the recurrence of the symptoms. During admission at our hospital, she was given

conducted in our hospital revealed slightly increased CSF opening pressure of 30cmH2O, and

after infusion therapy (cephalosporins) at the local clinic. The patient had frequent vomiting and poor appetite. She went to the gastroenterology department for treatment, but her symptoms still aggravated after symptomatic treatment. In the past 3 days, she had blurred vision and progressive vision loss, accompanied by unconsciousness, so she was transferred to our hospital for emergency treatment. She had always been in good health, no history of hepatitis or tuberculosis, no history

of trauma surgery, no history of food or drug allergy, no history of exposure to toxic substances, full-term delivery, and no family history.\nHer vitals on admission were: temperature 36.8 °C, pulse 72 beats/min, respiratory rate 19/min, blood pressure 106/71 mm Hg. She was wheeled into the ward, physical examination cooperation. There was no yellow staining or bleeding spots on the skin mucosa, no swelling of superficial lymph nodes, and no positive signs

care facilities, for the seizures. Parents introduced traditional herbal oral medication at 2 years when seizures remained intractable, and which he continued till presentation at the CAMH unit. Speech has remained audible but incomprehensible since the 6th month of life till

date and has not received any specific therapy for this. Though described as socially interactive with people he was observed to be hyperactive and aggressive in the past 5 years. These features, in addition to the recurrent seizures even in school had resulted in poor academic performance. Persistent complaints and rejection by schools culminated in complete withdrawal from school. Pregnancy and

Bard, Inc.). Postangioplasty venography each time demonstrated no significant improvement in stenosis. The stenosis was then angioplastied with an 18 mm × 40 mm XXL balloon (XXL angioplasty balloon: Boston Scientific Corporation). Postangioplasty venography demonstrated moderate improvement in the stenosis ().\nThe pressure gradient remained 11 mm Hg. At this point, the etiology of the stenosis was

dilated with a 12 mm × 40 mm Conquest balloon (Conquest angioplasty balloon: C. R. Bard, Inc.) and a 16 mm × 40 mm Atlas balloon (Atlas angioplasty balloon: C. R.

unstable maternal hemodynamic status is among the criteria for surgery. Other criteria for surgery include fetal congenital malformations, fetal viability, gestational age at presentation and availability of facilities for neonatal care. If the fetus is alive, surgery may be performed regardless of gestational age or fetal status due to difficulties in predicting placental separation leading to massive hemorrhage. If the fetus is dead, surgery is necessary due to the risk of disseminated intravascular coagulopathy (DIC) or sepsis, although a period of 4–8 weeks may be allowed for observation to allow atrophy of placental vessels [,].\nIn our patient, the placenta was easily removed by performing wedge resection at the

patient required emergency laparotomy due to the suspicion of hemoperitoneum, as

was then injected using an 18-gauge angiographic needle with a snap-on wing (Cordis, Johnson & Johnson Company, N.V., Roden, Netherlands) in the scar area. The lysis of scar tissue was obtained by moving the needle in an anterograde direction and leveraging the strength of exiting fat to overcome the fibrous tissue resistance and a retrograde technique that is performed entering the needle for its entire length at the dermal-epidermal junction and then, while extracting the needle, releasing fat. In both ways, we obtained a subcision of the scar to release

entrapped nerves. A total of about 7 cc of adipose tissue was injected.\nFollowing surgery pressure dressing was applied over donor site for 5 days and antibiotic therapy was recommended for 5 days.\nClinical assessment was subsequently performed after surgical procedure at 5 and 14 days and 1, 3, and 6 months. During all clinical follow-ups, we observed a progressive release of scar retraction together with an important improvement of pain symptoms.

deteriorated and she was intubated for airway protection on hospital day 18. She had escalating episodes of autonomic instability, manifested by episodes ranging from narrow complex tachycardia with heart rates in the 140–160 bpm to severe bradycardia induced by vasovagal maneuvers such as coughing, suctioning of the endotracheal tube, and defecation. These episodes were initially self-limited but over subsequent days necessitated active pharmacologic intervention including combination of multiple rounds of glycopyrrolate and/or atropine and low doses of epinephrine during the episodes.\nThe initial treatment of the bradycardic episodes was targeted

at reduction of vagal stimuli and triggers for bradycardia. This included suppression of coughing episodes with intravenous fentanyl and premedication with inhaled lidocaine before endotracheal suctioning. Intermittent propofol and ketamine sedation were also attempted to decrease vasovagal triggers but no clinical efficacy was appreciated. An early tracheostomy (ICU day 5) was done to help alleviate the airway irritation, decrease IV sedation, and facilitate mobilization.\nThe patient continued to have two further episodes of severe bradycardia that progressed to cardiac asystole necessitating cardiopulmonary resuscitation. The period of asystole was recognized

(), and a revision surgery was subsequently performed. The entry point for the revised intramedullary hole was created to prevent varus position, and good anatomical reduction was achieved (). The lag screw was successfully inserted into the center of the femoral head. Additionally, the cancellous bone isolated from the right ilium was autogenously implanted into the fracture site. One day after the revision surgery, one-third partial weight-bearing was advised. Low-intensity pulse ultrasonography was also performed to

promote fracture healing. Because the patient had breast cancer, she was not prescribed teriparatide, a parathyroid hormone (PTH) agent. At 12 weeks after the revision surgery, full weight-bearing was advised because callus formation was detected on follow-up radiographs (). Finally, the fracture healed by 13 months after the revision surgery (), and the patient could walk without support and independently perform activities of daily life.\nThe laboratory findings after the primary surgery are shown in

unfortunately due to health insurance coverage problems he had to stop etanercept and consequently his skin conditioned dramatically deteriorated and resembled his baseline condition when he first reported to our clinic. Therefore cyclosporine (Neoral) 200 mg twice daily was introduced for approximately 2 months till he received his insurance approval for adalimumab (Humira) and again his skin and arthritis gradually improved. His platelets count rose while being off etanercept and even when

he was treated with cyclosporine and his skin condition started to improve his platelets counts remained

biopsies showed no evidence of atrophy or malignancy.\nDuring the patient's admission, the neurology team was consulted, and they initially advised to stop all medication. They also requested brain computed tomography (CT) and whole spine MRI. Later, when the diagnosis of vitamin B12 deficiency was established, the neurology team advised that there is no need for further neurological investigations. An abdomen and pelvis CT with contrast was performed for further evaluation of the focal hepatic lesion and showed multiple focal hepatic cystic lesions with normal liver enzymes. The patient is being followed up by the gastroenterology team.\nThe patient was started

of the patient. Tests for human immunodeficiency virus and syphilis and drug screening tests were negative. Magnetic resonance imaging (MRI) of the whole spine was performed and showed osteophytic lesions at the C3-C4, C5-C6, and C6-C7 levels. The spine MRI was normal otherwise. Brain MRI with contrast showed diffuse involutional brain changes and chronic white matter ischemia. An upper endoscopy was performed and was normal. In addition,

confirmed the diagnosis of GIST and an unchanged mutation status. Sorafenib was increased to 400 mg orally once daily. Three months after dose escalation, image evaluation showed a 15% reduction in tumour size (shown in Fig. ). Since the patient was in performance status 0, resection of the tumour of 2.7 cm was performed in February 2018. Resection was complete with free margins.\nAfter tumour resection, sorafenib 400 mg orally once daily was reintroduced, and the patient is still in treatment with the same dose of sorafenib in March 2021. The patient

2005, mutation analysis was not part of daily practice.\nIn September 2017, a recurrence of GIST in relation to the ileum was discovered on CT imaging which retrospectively could be detected already in August 2016, and biopsy was carried out (shown in Fig. ). The disease had then been stable, without recurrence, in 95 months during adjuvant treatment with sorafenib after resection of recurrence. Histopathology

investigation found no consanguineous marriage.\nOn admission, his heart rate was 60 rpm (pacemaker rhythm), and blood pressure was 119/75 mmHg while on antihypertensive drugs. Whereas transthoracic echocardiography showed diffuse cardiac hypofunction with ejection fraction 42%, no ventricular and atrial dilatations were observed. According to his medical record, his ejection fraction was 62% in his 50’s and had deteriorated gradually.\nA neurological examination revealed significant muscle weakness in lower limbs with pes cavus. The extent of muscle weakness was the same in the proximal and distal parts of lower limbs (Table ). Muscle weakness in

and rejected to get a genetic analysis. His mother and sister had hypertension and ischemic stroke. His children were in their 30’s and remained healthy with no gait disturbance and cardiac disease. Our

vomiting, diarrhea, 30 pound weight loss over 2–3 months, generalized body aches most pronounced in the lower back for 5 days, and a positive pregnancy test. Past medical history was significant for hypertension, dysphagia, 4 caesarean sections and bilateral tubal ligation. Family history was noncontributory. She denied tobacco, alcohol, or intravenous drug abuse. Physical exam revealed reproducible pain upon palpation of the spine. The bimanual exam was negative for discharge, cervical motion tenderness, or pelvic tenderness. A routine urine pregnancy test was positive and

subsequent serum testing demonstrated a β-hCG level of 154 mIU/ml. The patient denied sexual intercourse in over 2 years and confirmed having a normal menstrual period less than 2

an average built boy dressed casually. During the initial interview, he attempted to run off and was restrained physically by his father. He was angry and screamed using obscene words. He was admitted to the in-patient unit. Sertraline was

and stubborn, his school teachers claimed he was a well-behaved child who could concentrate and completed the tasks he was given. There was evidence of inconsistent parenting styles with his father being authoritarian and mother being very permissive.\nOn mental state examination, he was

5 mg had been initiated to obtain a target INR between 2.5 and 3.5. Our patient also had hypothyroidism, which was being treated with thyroxine replacement therapy. On arrival to the hospital, her full blood count was found to be within the normal range, however her INR was recorded as 5.5. A clinical examination revealed a large, soft, dark red swelling involving the anterior region of the floor of her mouth, indicative of sublingual hematoma. The Wharton's duct of the submandibular gland was distinctly visible on opening (Figure ). As a result

follow-up. Her medical history was significant for rheumatic fever as a child, resulting in valvular heart disease for which our patient had mitral and aortic mechanical valve replacements in 1991 and 2002, respectively. Warfarin

the wall of the atrium and invaded the adjacent pericardial fat. The tumor cells had round to oval nuclei with finely stippled chromatin, often with a prominent nucleolus, and had small amounts of poorly defined cytoplasm. These findings were consistent with hemangiosarcoma. Anisokaryosis was moderate. Mitotic figures were 1–2 per high power field. Neoplastic infiltrates extended to all tissue margins. Sections of the pericardial masses also consisted of large areas of hemorrhage, occasionally interspersed with variably sized infiltrates

of the tumor cells seen in the right auricular mass ().\nFifteen days postoperatively, intravenous injectable chemotherapy was initiated with doxorubicin 30 mg/m2. This protocol was repeated every 3 weeks

in the morning.\nAnamnesis revealed bilateral conjunctivitis, which occurred about a month ago and completely resolved within a week after treatment with topical tobramycin. Furthermore, the patient has been wearing corrective contact lenses (−3, 0 Dsph. both eyes) for about five years. Single use and daily wear soft contact lenses containing 31% nelfilcon A and 69% water were used by the patient. At admission, BCVA was RE 0, 6 and LE 0, 4. Intraocular pressure was RE

No pain or photophobia was reported by the patient. Blurred and hazed vision was discovered by the patient after waking up

linguistic difficulties and problems with reading, writing, spelling and calculation. A detailed neuropsychological assessment identified primary problems with executive functioning, though his memory was relatively good and there were no notable problems with visuospatial functioning. He had six children, four of whom have ID (Fig. ). His second child (Family 1, Patient II:2 in Fig. ), was born at 38 weeks gestation with a birth weight of 3.03 kg. There were no neonatal concerns. She was reported to have speech delay

and mild motor delay. She sat by 7 months and walked by two and a half years. She was diagnosed with moderate to severe learning difficulties and attended a special educational needs school.

of 10 on the Numeric Rating Scale (NRS). Furthermore, the abdominal pain was not responsive to opioids and other medications.\nTherefore, we planned to perform celiac plexus neurolysis and reviewed the patient's anatomy on the abdominal CT image with contrast to determine the target point, ideal depth, and insertion angle through CT simulation. The celiac trunk was located at the T12 vertebral body level. At this level, the classic conventional transcrural approach via "walking off" the vertebral body was simulated, but the needle pathway

was diagnosed with pancreatic cancer and suffered from intractable, severe epigastric pain with a score of 5 to 8 out

at a lower dose of 100 mg twice daily. A physical examination revealed that the patient did not experience any worsening of any skin lesions, lymphoedema, and no palpable lymphadenopathy in the left axillar region after 1 month from re-initiating treatment. However, the patient then experienced a second recurrence of the psoriasis-like rash, which led to a second interruption of treatment for 5 weeks. These symptoms were well managed

with T-cell infiltration based on skin histopathology (Fig. ). In line with suggested guidance, idelalisib dosing was interrupted for 4 weeks [], and the patient was treated with topical steroids. She experienced improvement to grade 1 but without complete resolution (Fig. ). Idelalisib was reinitiated

weakness with paresthesia, which was attributed to an injury sustained while playing football. He was prescribed analgesics and advised by an orthopedic surgeon to take bed rest for his lower limb ailment. His lower-back radiograph was normal. On examination at the ES, he had tachypnea and tachycardia with elevated jugular venous pressure and was normotensive with no pallor or pedal edema. His cardiovascular system examination revealed a loud second heart sound and a right

ventricular third heart sound. His respiratory system examination was normal. The examination of his nervous system was suggestive of a right lower lumbosacral (L3-S1) radiculopathy. A moderate, tender hepatomegaly was detected in abdominal palpation. His oxygen saturation in the ES was 92 percent at room air temperature.\nInitial blood investigations revealed leukocytosis with neutrophilia and normal liver and renal

and she was afebrile. There were no masses or tenderness upon abdominal palpation. Initial labs were within normal limits, and screening tests were negative for pregnancy and sexually transmitted infections.\nA computed tomography of the abdomen and pelvis without contrast was notable for a 4.7 cm mass involving the wall of the terminal ileum, with speckled calcifications, adjacent lymphadenopathy, and a small amount of dense fluid in the pelvis (). No hepatic abnormalities were visualized. Colonoscopy demonstrated a 4-5 cm friable

for the past few years.\nThe patient also reported a 2-year history of vasovagal syncope, with an increase in presyncopal episodes during the 2-week course of her abdominal pain. These episodes were sometimes associated with heart palpitations, shortness of breath, and chest pain, which had previously been diagnosed as anxiety and gastroesophageal reflux disease. The history was otherwise noncontributory.\nThe patient's vital signs were unremarkable

denied opting for it.\nIntervention\nElectrical Stimulation\nInterrupted galvanic current used to target intrinsic muscles of the hand and foot muscle with 90-90-90 set of contortions given. Along with the facilitation techniques were used to enhance the outcome of muscle contraction, which is achieved through electrical stimulation. This was continued for three weeks.\nStrengthening Exercises\nFor lower limb and pelvis muscles was done as it was grade 3 in the initial. With the help of De Lorme’s; progressive resistance exercise (PRE) program based on 10 repetitions maximum (10RM) where the patient begins sets of training by performing

made based on EMG+NCV study reports and familial predisposition. Also on examination, diabetes was ruled out to rule out for diabetic neuropathy. The patient was suggested to undergo nerve biopsy, but because of financial constraints patient

by congestive heart failure exacerbation which was ultimately managed with diuretics. The remainder of the postoperative course was uneventful, and the patient was ultimately discharged on postoperative day 5. At four months post-op, the patient is doing well with a creatinine of 1.62. Follow-up imaging has been delayed due to the COVID-19 pandemic.\nThe pathologic analysis of the spleen found no diagnostic abnormalities,

due to the proximity of the spleen and the mass being significantly involved with the renal hilum. To aid in access to the mass, a splenectomy had to be performed. The adrenal mass was densely adherent to the renal hilum, specifically the renal vein. After unsuccessful attempts to safely release the renal hilum, the decision was made to perform a nephrectomy, with the adrenalectomy and mass excision. The postoperative course was complicated

medullary thyroid carcinoma. Neck lymph node dissection was additionally performed due to the results of the frozen biopsy. And the patient has been warned that if the results of permanent biopsy was confirmed to medullary thyroid carcinoma as of the frozen biopsy, total thyroidectomy is necessary.\nSubsequently, a permanent section

obtained from the patient was evaluated. The tumor showed well margination with thin fibrous capsule (Fig. a and b). The basic growth pattern and morphology of the tumor

Caucasian woman presented at our institution with immobilizing back pain, known for 4 years but exacerbating for 3 months. The past history included smoking (about 15 pack-years), appendectomy and tonsillectomy as a child, and extensive endometriosis which required surgical excision of sigmoid colon and hysterectomy sixteen years earlier. Conventional X-rays of the thoracic and lumbar spine revealed degenerative alterations only. However, magnetic resonance imaging (MRI) demonstrated multiple lesions in all vertebral bodies with a pathologic fracture in the 8th thoracic vertebral body. Blood count was completely normal. Suspecting bone metastases of a yet unknown primary tumour, a thoracoabdominal CT scan was performed, revealing disseminated small nodules in both lungs (max. 1.0

× 0.5 cm in diameter) and small polypoid intraluminal lesions in the gall bladder

a range of 0–30 degrees with a plan to gradually increase the range of movement of the knee. He was also referred to physiotherapy.\nAt the fifth week review he had no tenderness over his patella and the effusion had resolved. He was able to flex his knee comfortably to 30 degrees in his brace. The degree of flexion in the brace was sequentially increased to 60 degrees, then 90 degrees and the patient was reviewed two weeks later (seven weeks after injury) at which point he could flex to 100 degrees without any discomfort. Radiographs taken

his crutches. On examination, only a small residual effusion was noted and radiographs revealed though no further displacement, and the fracture line was still visible. He was able raise his leg straight but flexion was limited to 15 degrees. The patient was put in a knee brace at this visit, fixed to

x 7 cm without apparent extension into the pelvis. The differential diagnosis was unchanged, so the patient underwent CT-guided biopsy. He then underwent MRI using a 3T Skyra MRI (Siemens AG, München, Germany) for further evaluation. He underwent open subtotal debulking of his disease because his disease was felt to be too bulky and not amenable to arthroscopy. Both the percutaneous biopsy and final histologic diagnosis from the resected specimens were thought to be most consistent with synovial osteochondromatosis, with no evidence of atypia or cellularity.\nApproximately one year later, his residual disease progressed and resulted in limiting his range of motion. He underwent a

mild left hip degenerative changes. The radiographic differential diagnoses included synovial chondromatosis and synovial chondrosarcoma.\nHe subsequently underwent a CT scan, which demonstrated extensive calcifications adjacent to the left hip with asymmetric soft tissue enlargement and mild degenerative changes of the hip joint (Figure ). The masses were mostly anterior and medial, and the conglomerate measurement was approximately 13

paw sign was observed due to dilation of the renal calyces on CT of the abdomen (). Complex cystic renal mass or renal malignancy and cystic degeneration were mentioned as a probable diagnosis.\nIn addition, chest X-ray revealed mild pleural effusion and a soft tissue density pleural based lesion in right hemithorax. A thoracic CT scan with and without contrast medium injection was advised to investigate the latter findings further ().\nThoracic CT revealed bilateral smaller than 2 cm irregular bordered nodules

in both lung fields. Also, a 3.5 cm × 2.5 cm cavitating lesion in the right upper lobe, a wedge-shaped consolidation in the right lower lobe, right pleural effusion, and right hilar adenopathy were seen in thoracic CT scan. Thoracic metastasis was suggested.\nOn laboratory investigations before treatment, other than elevated ESR (99 in 1 hour),

to intermittent rectal tube decompression for management of megacolon. The patient himself was unable to self-insert a rectal tube, but up until this point, the patient's wife had been administering twice daily microlax enemas. As such, we broached the idea with the patient and his wife whether she would be willing to learn rectal tube insertion for decompression. Having been in hospital for more than 5 months at this point, they were willing to consider any

options that may give them an opportunity for discharge into the community with some degree of symptom control and they readily agreed.\nOver the next 3 days, we did daily rectal tube education with the patient and his wife with good decompression of both gas and faeces. A decision was made to use a

dressing. Some superficial telangiectasia were also noted on the anterior aspect of the ankle joint which were not present elsewhere on her limbs. There was no change in skin pigmentation. The leg circumferences were reduced by 5.5 cm at the calf and 1.5 cm at the ankle when compared to the normal leg. Passive dorsiflexion was symmetrically zero degrees. Passive plantar flexion was 30° in the cast leg and 40° in the normal leg. Her passive knee movements were normal. Doppler ultrasound showed good flow at the dorsalis pedis and

of the skin surface revealed small pitted ulcers 1-2 mm in diameter replacing the normal skin pores. Healthy pink granulation tissue was seen at the base of these ulcers which appeared clean and were not infected (Figure ). They did not bleed on palpation and required no

was performed with 25 times of radiotherapy and two courses of capecitabine and oxaliplatin (XELOX) regimen. A review of rectal cavity ultrasound showed that the original lesion size was 2.42 cm × 0.68 cm, suggesting UT3N1. Therefore, laparoscopic radical resection of rectal cancer and transverse colostomy was performed between the navel and xiphoid. Post-operative pathology showed slightly poorly differentiated residual adenocarcinoma in the intestines, which invaded into the deep muscular layer. In the intestinal wall, a large number of foam cells with calcification were

cm from the anus, with a size of 4.22 cm × 0.50 cm. The adenocarcinoma was relatively even in internal echo and had a relatively smooth surface, suggesting UT3N1. Neoadjuvant therapy

transfusion was not needed. Frozen intraoperative pathology was reported as metastatic carcinoma. As the amount of bone and tumor removed was likely destabilizing and the bone quality found to be poor at these levels, a posterolateral pedicle screw fusion was performed from T12 through L4 [].\nFinal histopathologic analyses revealed abundant tissue necrosis with an estimated live tumor cell presence of only 5-10% []. Immunohistological analysis indicated a final diagnosis of metastatic choriocarcinoma.\nPostoperative metastatic disease burden workup revealed that

stabilize the spine, as well as obtain tissue diagnosis before the full metastatic workup had been completed. Bilateral laminectomies were performed from L1 through L3. Soft tumor mass was removed extradurally from within the canal, resulting in thorough decompression of the conus and cauda equina. Surprisingly, blood loss was not particularly bad and

In our case, extensive sternum involvement of GSS-induced sternum instability and the possibility of pathologic fracture could cause respiratory failure and incidental injury of the heart or lungs. Although the patient’s pain was not severe, aggressive treatments such as radiotherapy and immunotherapy were planned to suppress disease activity and decrease the extent of the osteolytic lesion. Consequently, radiotherapy (40 Gy) was delivered to the anterior chest wall including the sternum for 1 month. After radiotherapy, immunotherapy with interferon alpha (INF-α)

and pathological findings suggested a monocentric osteolytic bone disease such as Gorham-Stout syndrome (GSS).\nAs there is no approved treatment for GSS, various treatment methods have been utilized on a case-by-case basis without proven principles. If the lesion is localized, then surgery is the principal treatment modality. However, surgery is not usually possible because of inadequate bone for fixation and extensive osteolysis [].

for the same. The child was a bit timid and apprehensive probably because of the psychological effects of surgery and anopthalmosis at the tender age. The steps involved in the fabrication were demonstrated to the child, so as to win his confidence and cooperation during the procedure.\nTo begin with, the anopthalmic socket of the right eye was cleaned of debris and secretions. An impression of the socket was made

underlying implant, and the case was deemed fit for the fabrication of a custom ocular prosthesis. The treatment plan was explained to the patient's guardian, and written consent was obtained

11, 2013. He followed up at the hospital before surgery, 1 month, 3 months, and 6 months after the obesity surgery. He underwent examinations for anthropometry, body component, blood test, and dietary survey on each visit. Abdominal computed tomography (CT) was performed 6 months before and after the surgery. Dietary counseling included nutritional assessment, changes in eating behavior, nutrient considerations, weight-loss strategies, motivation, telephone consultation, and nutrition diagnosis. All physicians and a professional nutritionist provided patient education on every visit along with the feedback the test results.\nChanges in the patient's anthropometry, body fat, and

blood test measurements during the 6 months following the surgery are shown in . The patient's weight decreased by approximately 20 kg from 93 kg to 73.3 kg, close to his target weight of 70 kg. His body fat decreased from 32.4 kg to 22.2 kg, and body fat percentage decreased from 35.5% to 33.0%. His waist circumference decreased by approximately 20 cm from 114 cm to 93.4 cm. His liver function test decreased to normal levels, which was

The patient had no memory of discomfort after consumption of fruits or juices during childhood but reported an increasing occurrence of the reported postprandial symptoms starting in adolescence that eventually became very uncomfortable and led her to consult. The patient’s parents were not consanguineous, and she did not display hepatomegaly or altered linear growth.\nIn April 2013, during a routine laboratory work-up that included a pre- and post-meal plasma glucose measurement, the patient experienced an event of asymptomatic hypoglycemia (glycemia 2 h post-meal: 29 mg/dL). She consulted our department

with these results. Past medical history included an episode of pulmonary thromboembolism and upper limb deep venous thrombosis in 2011 secondary to protein C deficiency. She received subcutaneous enoxaparin 40 mg a day since 2011 until July of 2015, when she was started on daily oral aspirin 100 mg. Surgical history included appendectomy and herniorrhaphy (×2). She reported a family history of deep venous thrombosis, throat cancer and diabetes mellitus.\nWe performed an ambulatory 72-h continuous glucose monitoring (CGM) and a biochemical work-up that ruled

wound surfaces were tread with vacuum therapy. Six days after amputation, the patient got a split-thickness skin graft on the remaining wound surfaces on the stump ( and ). Internal fixation with an endomedullary nail was performed simultaneously in the left tibial fracture.\nFive weeks after admission, a free gracilis muscle flap was used to reconstruct the defect on the left lower leg. The flap was raised with a 9-cm pedicle and connected end to side to the anterior tibial artery 5 cm from

of foot flap reconstruction for length preservation was performed three weeks after trauma. The flap was based on the anterior tibial neurovascular bundle and dorsalis pedis skin. All bone was dissected from the flap, the sole and remaining gastrocnemius and soleus muscle where excised because of inadequate circulation. The dorsal site of the foot was used as a cover over the proximal tibia stump. Remaining

specialities, Ballaigues, Swizterland) accompanied by copious irrigation with 2.5% sodium hypochlorite (Dentpro, Chandigarh, India). A calcium hydroxide paste dressing (Metapex; Meta Biomed Ltd, Choenju city, Chungbuk, Korea) was placed to alkalinize the environment and control bleeding at the perforation. The calcium hydroxide dressing was changed twice every 15 days. Master cone radiograph was taken [] and the canal below the resorptive defect was obturated with gutta percha (Dentsply, Maillefer) and AH Plus sealer (Dentsply, Maillefer, Konstanz, Germany) using a combination of cold lateral condensation and vertical

of a small communication between the resorptive defect and the lateral periodontium. Working length determination was established using apex locator (Root ZX II; Morita, Tokyo, Japan) and radiography []. The canal was prepared using crown down technique with ProTaper files (Dentsply, Tulsa dental

was classified as Gross Motor Function Classification System (GMFCS) level V. The fundus was normal. Extraocular movements were full, pupils were equally reactive, and no facial asymmetry was noted. Basic blood tests including complete blood count, liver function test, renal function test, thyroid profile, calcium, plasma ammonia, and lactate were normal. Tests for inborn errors of metabolism in the form of blood tandem mass spectrometry (TMS) and urine gas chromatography-mass spectrometry (GCMS) were normal. MRI done at nine months of age showed hypomyelination of deep and subcortical white matter, including U fibers appearing hyperintense in

with partial head lag, appendicular hypertonia, and spasticity of limbs. Deep tendon reflexes were brisk, the plantars were bilateral extensor, and the range of motion of the hips and knees was limited. The child’s functional status

level of 99.96 mmol/L (280 mg/dL), creatinine level of 671.8 µmol/L (7.59 mg/dL), and an estimated glomerular filtration rate of 7.6 mL/min/1.73 m2 (New Schwartz).\n24-h urine collection revealed a uric acid level of 1.1 mmol/24 h (186 mg/24 h) (with a total urine volume of 430 mL) and random urine uric acid to creatinine (UA/C) ratio of 2.7 (mg/mg). Electrolyte analysis indicated metabolic acidosis (bicarbonate level of 14.1 mmol/L), hyponatremia (sodium level of 129 mmol/L), hyperkalemia (potassium level of 7.14 mmol/L), and hyperphosphatemia (2.77 mmol/L). Other electrolytes were within normal limits.\nChest radiography showed thoracic scoliosis

of the hip, knee, and shoulder. He weighed 22 kg and was 140 cm tall (less than the third percentile of the Centers for Disease Control and Prevention, National Center for Health Statistics 2000 growth chart). The diuresis rate was 0.9 mL/kg/h. The laboratory workup results showed a hemoglobin level of 60 g/L (6.0 g/dL), serum uric acid level of 1608 µmol/L (27 mg/dL), urea

after the surgery in the colorectal surgery clinic.\nThe duration of surgery was 124 minutes for patient 1 and 142 minutes for patient 2. After the surgery, colostomy functioned properly in both patients. The length of hospital stay for patient 1 was 5 days and for patient 2 was 4 days. Both patients started walking and taking liquid food 1 day and 2 days after the surgery, respectively.\nThe patients

twice a day subcutaneously.\nThis procedure was done on a human in this study for the first time, and an attending colorectal surgeon with more than 6 years of experience performed the procedure.\nThe follow-up visits were scheduled for 1 week, 1 month, 3 months, 6 months, and 12 months

or aneurysm or dissection. There was no evidence of organ or bowel infarction. Subsequent Digital subtraction angiogram performed with therapeutic intent confirmed the CT findings []. Also, superior mesenteric artery injection showed retrograde filling of the hepatic and splenic arteries via the anterior,

posterior pancreaticoduodenal arcades and the gastroduodenal artery [].\nSevere abdominal pain present in spite of good collateral flow indicates dissection to be the cause of pain, rather than intestinal ischemia. Also, in view of peri-celiac fat infiltration on CT and the complicating

important, once inside the joint, to just use careful blunt dissection in order to avoid damage to the cartilage.\nIn order to avoid damage to the cartilage it is important to carefully insert the handle into the joint by gliding through the femoropatellar groove () until it reaches the tibia. A solid connection between the handle and the tibia has to be confirmed through the image intensifier (lateral view).\nOnce placing the guide wire it is important to know that the centering sleeve has a concentrical and excentrical

a flexion of approximately 10-15° in order to get a perfect exposure of the suprapatellar entry. From there on no further movement of the lower leg during nailing is necessary.\nDuring the incision it is important to split the quadriceps tendon in midsubstance. Afterwards use your finger to carefully feel for the retropatellar nook in order to be sure to be inside the femoropatellar joint.\nIt is

returned to the senior author, weighing 45 Kg. The patient underwent total parenteral nutrition for 5 months, and returned to his normal weight of 60 Kg.\nOn July 1st 2001, the patient underwent a third operation, this time performed by the senior author, with another ear, nose, and throat surgeon to tackle any intra-operative oesophageal injury. During the operation, no signs of oesophageal perforation became evident. At surgery, much fibrosis was found. To reach the vertebral plane, MESNA (sodium 2-mercaptoethanesulfonate) (Uromitexan, Bristol) was intra-operatively applied

on the fibrous tissue to ease tissue dissection. A modified dissector was used to release the drug locally []. Duration of local application was about 20–30 s; repeated applications were performed during surgery. Average volume of agent used was about 10cm3.\nRemoval of the plate

the brachial plexus and completed the ultrasound guided stellate ganglion block, without any further complications. A repeat test dose was administered and visualized real time under ultrasonography. Following the test dose, 10ml of a mixture of 1% Lidocaine and 0.25% Bupivacaine with 40mg of Depomedrol was injected, in small increments. Vital signs remained stable. There was an approximately 20C increase in temperature compared to the right hand. His pain in the wrist also decreased dramatically. At the conclusion of the procedure, patient was noted to have features of Horner’s syndrome including a left sided ptosis, without hoarseness of voice or swallowing difficulty. He was then discharged home after monitoring

for 30 minutes post procedure. Two days post procedure, patient reported a mild discomfort in his throat and chest. He declined our recommendation to go to the Emergency room for evaluation. During his follow up visit in two months, he reported occasional feelings of fullness in his ears and tinnitus which also resolved over

affected by the resection, so that joint instability and early secondary osteoarthritis were expected in case of resection alone without reconstruction. Still, the most important two-thirds of the joint cartilage were spared, so that primary total hip arthroplasty could be avoided. For these reasons, a hip-preserving approach using custom-made osteotomy guides and ECI followed by reimplantation of the irradiated segment as massive osseocartilaginous structural graft was chosen. The surgical team planned the resection margins and the cutting guides based on MRI- and CT-based reconstructions of the patients' hemipelvis were fabricated by a company specialized in

The tumor infiltrated the anterior portion of the acetabulum, in a non-weight-bearing area, and no joint effusion or radiological signs of osteoarthritis were present. Approximately one third of the joint surface was

burning pain and numbness in the dorsal part of the proximal interphalangeal joint of the middle finger. No fractures were seen on radiographs; therefore, analgesic treatment was provided. After 4 months, pain remained constant and worsened with direct pressure of the proximal interphalangeal joint. She denied having fever or weight loss.\nPhysical examination revealed a diffuse mass (approximately 1 × 1 cm) on the ulnar and dorsal side of the proximal phalanx of the middle finger of

She had forced traction of the middle finger of the left hand from the reins of the horse.\nThe patient presented with insidious

to 21 × 7 mm (). Postgadolinium images did not show any evidence of uptake and there was no involvement of the subendocardium or the valves. It also showed a moderate mitral regurgitation with posteriorly directed jet along with LVOT turbulence.\nThe patient was referred for surgical evaluation and he underwent a surgical resection of the mass via transaortic approach. Intraoperatively the mass was identified as a fibrofatty tissue, which was resected without any complications. His postoperative course was uneventful. His symptoms significantly improved after the surgery permitted him to resume work.\nHistopathological examination of the excised specimen showed benign hypertrophic myocardial muscle cells

systolic pressure was >350 mmHg. There must have been a component of contamination by the mitral regurgitation, but irrespective of that he undoubtedly had a significantly high pressure gradient across the LVOT. For better tissue characterization, a CMR was repeated which demonstrated an interval increase in the size of mass

compared with 4.3 mg/dl, preoperatively. The patient was easily arousable and followed commands appropriately. However, approximately 4 hrs later, the patient complained of headache and right eye pain. Her headache was treated with analgesics, however 3 hours later, she was found to be tachypenic, bradycardic, and hypotensive, and was unresponsive with fixed, dilated pupils. She was emergently intubated and resuscitated. After approximately 15 minutes, she regained consciousness, and responded appropriately to commands. Her pupils returned to 3 mm and because reactive. Neurology was consulted and she was loaded with Dilantin due to her history of seizure disorder. An urgent CT scan was ordered. On route to the CT scanner, she

of 45 mg was delivered in this patient. During the operation, the patient had no significant electrolyte abnormalities aside from the expected glucose elevation seen during the perfusion period. The maximum serum glucose was 355 mg/dL and the lowest serum sodium was 135. The operation was generally uneventful; no blood transfusions were required and the patient was transferred to the ICU in stable condition. Postoperatively, all serum electrolytes were normal and albumin was 3.4 mg/dl

pressure. The dizziness was described as either a spinning sensation or a sense of disequilibrium. She was prescribed diazepam 1 mg by mouth daily for symptomatic relief, but it was not effective. She was also given a course of dexamethasone 2 mg by mouth daily, but that also did not alleviate symptoms. She continued to experience dizziness, vertigo, nausea, intermittent headaches with sensitivity to light and sound, and occasional sharp right ear pain. She reported that these symptoms were affecting her mood as well.\nShe was then referred to neurotology for evaluation. Examination of her head and neck did not show any masses. Otomicroscopy was normal. Examination of cranial nerves, including extra-ocular movements, facial movement and

sensation, tongue and palate movement, and shoulder shrug, was normal. A 512-Hertz tuning fork was used for the Weber test, which was midline (normal), and the Rinne test,

there was no deficit in any limb and his tendon reflexes were normal. He had no other systemic illness.\nLaboratory investigations showed little abnormality other than an increased erythrocyte sedimentation rate (54 mm in the first hour).\nA lateral view of plain radiographs showed a fracture of the body of his second cervical (C2) vertebra with mild displacement of the fractured anterior body fragment. The odontoid process appeared to be in normal alignment with his C1 vertebra. There was also a significantly increased prevertebral soft tissue shadow anterior to the

deglutition. On examination, he had tenderness over the spinous processes of the upper half of his cervical spine along with spasm of his neck muscles. There was no deformity or gibbus. Our patient had gross restriction of motion of his cervical spine in all directions. He had no palpable lymph nodes in his neck. On neurological examination,

subjective tinnitus distress became “not so annoying,” and the “echoing tinnitus” that was the cause of the patient’s discomfort at the time of the initial visit disappeared. Only the pulsatile tinnitus, which seemed to be related to palpitations, remained.\nOne year and seven months after the initial visit, palpitations and pulsatile tinnitus, as well as anxiety and

patient with psychotherapy once a month, which continued until the 7th therapy session was completed. At the end of psychotherapy, our test results showed THI at 60, SDS 45, STAIs 32, and STAIt 43, showing a further improvement trend. The THI score was still high at 60, but the

low back pain that worsened in June and July. She was not taking any medications and had no history of conditions such as autoimmune diseases, diabetes, pulmonary disease, tumors, trauma, or acupuncture. Initially, her low back pain occurred after carrying heavy objects and was paroxysmal. At that time, a local doctor performed lumbar computed tomography (CT). The results were normal and the patient was diagnosed with lumbar muscle strain and treated with analgesics. Her pain persisted. When her low back pain worsened with no improvement in a supine position, magnetic resonance imaging was performed and showed multiple nodular abnormal signals in the thoracolumbar

spine and accessories, lumbar 3-sacral 1 disc degeneration, and swelling (). Positron emission CT revealed bone lesions with increased fluorodeoxyglucose (FDG) uptake in the sternum, left clavicle, multiple ribs, and multiple vertebral bodies of the spine and

of alexia. She described how whilst driving she realised that although she could read the figures on car registration plates, she had lost the ability to understand words and sentences seen on window stickers or roadside advertisements. Other than this deficit, she had not noticed any alteration in her vision.\nHer medical history revealed that the patient had suffered an ischaemic stroke 15 months previously, causing temporary weakness in the right hand. Subsequently, she was discovered to have erythrocytosis, with a haemoglobin level of 181 g/l. Imaging of her abdomen revealed a mass within the right kidney for which she underwent right total nephrectomy.

The diagnosis of renal cell carcinoma was confirmed on histology, and there was no evidence of tumour spread beyond the kidney. During the postoperative

the chest demonstrated multiple pulmonary nodules, including a 2.5 cm right middle lobe nodule and a 1.2 cm left lower lobe nodule along with bilateral hilar adenopathy. A staging fluorodeoxyglucose positron emission tomography (FDG PET) scan noted abnormal uptake within several right hilar lymph nodes and diffuse osseous FDG uptake within the sternum, thoracic, lumbar, and pelvic bones. The pulmonary nodules identified on CT imaging were also found to be FDG-avid, right middle lobe (SUV 11.5), two left upper lobe nodules (SUV 6.4 and 5.1), and right upper lobe (SUV 5.0) (). Flexible bronchoscopy with biopsy was performed and demonstrated malignant spindle cell tumors with geographic necrosis consistent with metastatic GBM. The tumor

cells were positive for GFAP, weakly positive for S100, and negative for synaptophysin, EMA, HHV-8, HMB-45, desmin, CD34, keratin, chromogranin, and CD117. MIB-1 proliferative index was approximately 40%. AFB and GMS stains were negative.\nOne month later, he resumed

started on oral rosuvastatin 10 mg daily for dyslipidemia at the discretion of the primary care physician. She denied alcohol abuse or a family history of gastrointestinal disease. Upon presentation to the emergency room, vital signs were stable and physical examination was remarkable for epigastric tenderness without guarding or rigidity and normal bowel sounds. The rectal examination was unremarkable, and the stool occult blood was negative.\nThe laboratory data

nausea, vomiting, and epigastric pain for 7 days. She admitted to a history of multiple drug intolerances. A few days prior to the presentation, the patient was

of heart failure.\nAn electrocardiogram (ECG) showed sinus rhythm with ventricular repolarization abnormalities in the inferior lateral wall (). Moreover, the echocardiographic study demonstrated global left ventricular (LV) hypokinesia and dilatation with preserved right ventricular function (). Laboratory work-up documented an increase of creatine kinase-myocardial band (CK-MB) and troponin. Furthermore, N-terminal-prohormone B-type natriuretic peptide (NT-proBNP) was increased as well, consistent with LV dysfunction. Further blood investigations did not show any inflammatory markers increase, eosinophilia, electrolytic imbalance, and liver, or kidney dysfunction ().\nThe patient was hemodynamically stable, but

phase, the physical examination revealed a mild apical systolic murmur (2/6 on the Levine grading scale), without any other clinical manifestations

of neoadjuvant chemotherapy, a mastectomy, adjuvant radiotherapy, and adjuvant hormonal therapy. At the time of referral she still received hormonal therapy. At baseline (T0), before intake and start of treatment, patient A had a score of 47 on the subscale fatigue severity of the Checklist Individual Strength (CIS), indicating presence of severe fatigue (see ).\nAfter the intake, Patient A completed the first EMA. She completed 69 of the total of 70 assessments. In the fatigue scores of patient A during the first EMA is plotted

(E0, blue line). In the scores on the maintaining factors of patient A at E0 are shown. One variable had a mean successive difference (MSSD) of less than 50. Based on the analyses, four factors Granger caused fatigue. These four factors were associated with two optional treatment modules. The factor that predicted fatigue in the most valid VAR models was avoidance