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artery, posterior tibial artery, and peroneal artery did not contain much blood. Multiple branches of the small arteries could be seen in the calf and plaques were visible in these arteries. Gas density was high in the soft tissue of the right foot ().\nAfter admission, the patient was given symptomatic treatment including anti-inflammatory medication, detumescence, improvement of circulation and nutrients to the nerves, and anticoagulant medications. On April 3, 2018, under spinal anesthesia, right hallux amputation including necrotic tissue debridement and neurovascular tendon exploration was performed (). After surgery, the wound was treated with ozone therapy (). After the first

stage of hallux amputation and necrotic tissue debridement, ozone bagging therapy was applied. The wound was cleaned with saline before changing the dressing, and a disposable plastic

and space and was pleased to be evaluated. At that time, he was unable to move his right members and his speech was hypophonic, but no language defects in phonology, lexicon, or grammar were noted. The language and speech problems that had been observed two days prior to the assessment were no longer present. Also, he was oriented, alert, and collaborative, though not particularly troubled by the difficulties he was experiencing. presents a summary of the tests administered and the scores achieved.

“Normal” scores were considered those equal to or above the 16th percentile, percentiles 3–15 were regarded as “borderline,” and the 2nd percentile and below had been interpreted as “abnormal.”\nIt is evident that no language defects were observed,

window were enlarged and were resected out. Although the left lung had significant adhesions, the parietal pleura was free of tumor. The hilar vessels and the left main bronchus were divided separately using endostaplers, and the left lung was removed en bloc (). He was given postoperative intensive care, and his recovery was unremarkable. He was discharged on postoperative day 5 on pulmonary rehabilitation.\nHistology revealed a moderately differentiated keratinizing-type squamous cell carcinoma with a maximum diameter of 7.5 cm (T4) and visceral pleural invasion (PL1). Bronchial resection margin was free of tumor with a 10 mm clearance (pT4N0Mx). All 16 lymph nodes were free of tumor. There were no features to

cavitatory, and small due to the previous tuberculosis. An empyema with a large cavity around the lower lobe was noted. The pus culture was negative for TB. Several mediastinal lymph nodes on the aortopulmonary

intermittent high fevers; the decision was made to reevaluate for HLH. CT of abdomen and pelvis reported hepatosplenomegaly and reactive retroperitoneal and mesenteric lymphadenopathy. Clinical suspicion for lymphoma was low due to the rapid onset of symptoms, a positive Monospot test, and no other history of weight loss or night sweats. On hospital day seven, a CT chest for the evaluation of continued high-grade fevers showed prominent lower cervical, mediastinal,

hilar, and axillary lymph nodes. Multiple spiculated opacities were present throughout all lung lobes, which were interpreted to be a disseminated infectious process. Due to the high EBV load and ferritinemia, a decision was made to start ganciclovir. The liver enzymes and total bilirubin (TBili) levels continued to increase, and with our high suspicion for HLH, IL2-R levels were drawn

was admitted to the emergency department with sudden onset of right arm and leg weakness and slurred speech 50 min before presentation. His past medical history included a metallic aortic valve replacement 12 years ago, which was infected with MRSA and so this was replaced with tissue valve a month later. Other history included mild congestive heart failure (New York Heart Association class II) and a transient ischemic attack 2 years ago. Echocardiography (ECHO) 1 year prior to this admission had shown an ejection fraction of 41% but stable prosthetic valves. He was fit and independent in activities

of daily living. His medications on admission were frusemide, bisoprolol, amlodipine, losartan, spironolactone, and fluoxetine. He was no longer taking aspirin and dipyridamole at the time of admission.\nOn examination, he had a

was completely compressed. Despite the imaging findings, he did not show any cardiopulmonary symptoms or upper body edema. Initially, we intended to consult a pulmonologist for further examination before craniotomy; however, the removal of the tumor was prioritized because of progressive neurological symptoms.\nPeripheral 20-G and 22-G intravenous lines were secured at the right forearm and the right back of the hand. General anesthesia was induced with 100 mg of propofol plus 100

μg of fentanyl, and neuromuscular blockade was achieved with 50 mg of rocuronium. Manual ventilation with a mask was easily performed. Tracheal intubation with a 7.5 mm silicone reinforced tracheal tube was performed uneventfully. Before tube fixation, we confirmed that the distal tube end was positioned to avoid injury to the stenotic

having irregular menstrual cycles but was otherwise healthy presented with fever to the accident & emergency unit with severe generalized myalgia and arthralgia. Clinical assessment revealed a tachycardia with a pulse rate of 108 b.p.m and an initial blood pressure of 90/50 mmHg, indicating shock. Clinical picture favored dengue fever with the classic repertoire of symptoms. Since the patient had taken mefenamic acid, a non steroidal anti-inflammatory agent (NSAID) for myalgia for a few days, her complaint of fever for only one day at presentation suggested an erroneous timeline and a late presentation. Rest of the systemic examination was normal and clinically there was no

evidence of leakage of fluid in the chest and abdomen on presentation. She was started immediately on an intravenous infusion of 0.9% saline. Preliminary whole blood analysis demonstrated a low haematocrit of 32% with a reduced haemoglobin of 10.4 g/dL (11–17) and a platelet count of 173 × 10

in a comatose state with occasional left sided myoclonus and bilateral upper and lower extremity nonpitting edema. She was unresponsive to verbal or painful stimuli. The patient's TSH and free thyroxine (T4) levels as measured in the ICU initially trended down but began to rise again after two weeks ().\nThe diagnosis of myxedema coma was made based on the patient's clinical presentation and a score of 65 on the diagnostic scoring system published in 2014 by Popoveniuc et al. []. The typical characteristics of myxedema coma, including bradycardia, hypotension, and hypothermia, were absent in this case. However, a score of >60 using these criteria is reported to be diagnostic of myxedema coma with a sensitivity

To assess for adrenal gland functionality, ACTH and AM cortisol levels were measured. The patient's ACTH level was found to be 49.9 pg/mL and her AM cortisol level was noted at 27.1 mcg/dL, not suggestive of any adrenal gland dysfunction. The patient remained intubated in the ICU for two weeks

epithelial odontogenic tumour, keratocystic odontogenic tumour, ameloblastic fibroma, and ameloblastoma.\nExtraction of 37, 36, 35, and 34 was performed and a bioptic specimen of the lesion was obtained under local anaesthesia (2% lidocaine with 1 : 100,000 epinephrine). Histopathological evaluation showed a lesion composed of a fibroblastic/collagenous tissue with many strands or nests of odontogenic epithelial cells without cytological atypia. Focally prominent hyaline calcified foci, resembling osteoid and dentinoid material, were also present (). Such features favoured the diagnosis of a central odontogenic fibroma. After one month, the

The inferior margin of the lesion showed a proximity relation with mandibular canal and mental foramen.\nDifferential diagnosis included odontogenic myxoma, central giant cell granuloma, osseous dysplasia, desmoplastic fibroma, calcifying

revealed that the patient was HIV (positive).\nIntraoral clinical examination revealed a soft tissue growth on the right buccal mucosa, soft inconsistency. The lesion extended from the lower right canine to the lower right third molar and was accompanied by symptoms such as pain, bleeding, swelling

and paresthesia of the right side of the lower lip. The swelling was present intraorally for 6 months according to the history given by the patient. The swelling was flat in appearance with no ulceration present on it, mixed in color and the approximate size of the lesion at the time of biopsy was <5 mm.\nRadiographic examination was done including orthopantomogram (OPG) and computed tomography (CT) of the spine + brain + three-dimensional (3D) reconstruction. The OPG revealed

transplant and approved the living donor liver transplantation (LDLT). After completing the evaluation, LDLT was performed.\nHis father suffered from end-stage liver disease secondary to NASH cirrhosis, accompanied by type 2 diabetes mellitus. Evaluations revealed a Child-Pugh stage B, a model for end-stage liver disease (MELD) calculated score of 17 and a body weight at 100 kg.\nDuring the right lobe hepatectomy, only minimal adhesions were found. The liver appeared grossly normal with a sharp left lateral lobe. The left liver lobe was supplied by a branch of the left gastric artery and a smaller branch of the main hepatic artery. The donor common hepatic artery, after the bifurcation of the left

HA branch, was recovered with a segment of the gastroduodenal artery (Fig. ). We chose to perform a right lobe donation, the most commonly performed procedure in our center, since it provides a sufficient liver remnant volume. Additionally, in this particular case the left lobe had two small arteries in comparison with the right lobe

effort to return to running and continue his military career (). We suspected that a similar pathology of a persistent physis was present in the right proximal tibia and that this was contributing to his slow healing progression. Similar intraoperative pathology specimens were again obtained at the fracture site distal to the articular surface (), and these demonstrated fragments of purple to purple-gray staining matrix with chondroid metaplasia. This presence of cartilage distal to the articular surface was consistent with a persistent physis.\nAt four-and-a-half months from the index procedure (three months from the staged

expected for the stress fracture. It was easily debrided back to stable, healthy bone edges, and we were interested in analyzing its composition, so a biopsy was obtained and sent to the lab for analysis. Histology demonstrated nonossifying hyaline cartilage with admixed fibroconnective tissue consistent with a persistent physis ().\nAt the six-week follow-up visit after the procedure on his left knee, the patient was still having significant pain in his right lower extremity and, after extensive counseling, elected to undergo the same procedure on the contralateral limb in an

(e.g. tracheostomy and respirator, anticoagulation therapy, etc.). After these treatments, he was in a stable condition, receiving hospital treatments for approximately 4 months. In order to receive comprehensive rehabilitation therapy, he entered our hospital approximately 5 months later after he showed the previously mentioned symptoms. When showing these symptoms 5 years ago, he was diagnosed with diabetes and high blood pressure and he was then administered drugs continuously. He had no particular family history of these diseases.\nAfter he was admitted into our hospital, he received a neurological examination. The test showed that he was in a conscious state. However,

he was diagnosed with infarctions of cerebella, pons, midbrain, corpus callsum, of the left occipital lobe and the right thalamus caused by bilateral vertebral and basilar artery occlusions. At ICU, he received acute phase treatments

knee two days ago. He accidentally hit his right knee to the wall two days back and sustained an abrasion to his knee. He started complaining of pain in his knee the next day and had to stop working. Pain got worse over night and he attended the emergency department the next day, from where he was referred to us with the suspicion of septic arthritis or cellulitis. He received intra-venous benzyl-penicillin and flucloxacillin in the emergency department.\nOn arrival, he was

afebrile and systemically stable but in considerable pain. Examination of the right knee revealed small superficial wound over patella, slight redness and increased temperature in surrounding area with grade I effusion in the joint. Movements of the joint was reduced and associated with severe pain. Neurological and vascular examination of the limb was satisfactory.\nThe initial blood investigation revealed white cell count (WCC) count

was referred from the orthopedics unit to the endocrinology unit, National Hospital of Sri Lanka, for further evaluation of recurrent femur fractures. She first experienced a right sided subtrochanteric fracture following a low trauma injury at the age of 20 years (), for which she underwent internal fixation. Thereafter, she experienced a left intertrochanteric femur fracture at the age of 22 years, 2 months prior to the current presentation.\nShe had an interesting past medical history. She was diagnosed to have a left side nephroblastoma at the age of 8 years, for which she underwent left side radical nephrectomy followed by chemotherapy. Thereafter, at the age of 14 years, she developed a

right sided facial swelling and was found to have a maxillary tumor which was described during the surgery as a well-circumscribed mass lesion in the left maxilla, eroding the anterior wall of maxilla and lateral nasal wall. She underwent partial maxillectomy for

of overlying subcutaneous tissue and skin. Enlarged right submandibular lymph node and a necrotic right deep cervical lymph node (level 2), 1.2 cm size were noted. Fat planes of mylohyoid muscles were lost. Bony structures of neck showed no abnormality. These findings suggested the possibility of inflammatory etiology-right submandibular sialadinitis []. Incisional biopsy from the swelling showed chronic inflammatory process with a few vague granulomas comprising epithelioid

cells, Langhan's giant cells, and lymphocytes. Special stains for acid fast bacillus (AFB) were negative. These features were suggestive of chronic granulomatous disease, most likely tuberculosis [ and ]. Serology for toxoplasmosis proved negative. Polymerase chain reaction (PCR) for mycobacterium tuberculosis was positive. Based on these findings, tuberculous sialadenitis was diagnosed and antitubercular treatment (ATT) was started, i.e., Isoniacid (INH) 300 mg, Rifampicin 450 mg, Pyrazinamide 1500 mg, and Ethambutol 800 mg for 2 months; INH 300 mg and Rifampicin 450 mg for

and 6.5 mm on the long side (the left side). Bony interference between the fragments and flaring of the proximal segment on the right side would be anticipated if a BSSRO was performed. Therefore, we planned to use UIVRO on the short side and SSRO on the contralateral side of the mandible.\nDuring the maxillary surgery, a Le Fort I osteotomy was performed to correct the

canting and yawing of the maxilla in a standard fashion based on the intermediate surgical wafer. In the mandible, conventional SSRO was begun on the long side of the mandible (the left side) and then IVRO was performed on the short side (the right side).\nOn the left side a SSRO was

the previous treatment regime. Upon referral, there was a suggestion for a trial of Electroconvulsive Therapy (ECT). Following admission, her mental status examination revealed severe depression with fleeting suicidal thoughts, delusion of a former male co-patient overpowering her brain with limited insight into her problem. She was initially given a diagnosis of Major depressive disorder with psychotic features.\nThis diagnosis was based on DSM IV criteria for major depressive disorder. All her blood work and MRI were normal in findings. By definition in terms of phenomenology, delusion is a belief, held with extraordinary conviction, unshakeable, with incomparable subjective certainty and

in contrast to person’s socio-cultural background. The patient in this case report stated that a person is overpowering her brain “sitting on my brain”, expressed firm belief of its reality and was unshakeable despite arguments presented against this belief. She was on Mirtazapine45 mg, Clonazepam 0.5 mg twice per day and Quetiapine800 mg per day without any beneficial effect before being

heparin was commenced to counter the hypercoagulability state known to be caused by intravenous immunoglobulins. His platelet count dropped down to 37×109 on postoperative day four. On day seven the platelet count improved to 190×109.\nRoutine postoperative ambulation was carried out. The patient was mobilised with the aid of crutches initially. He was discharged from the hospital on the eighth postoperative day after achieving independent walking with stair climbing and knee flexion of

80 degrees.\nThe patient was reviewed in the haematology clinic three days following discharge from the hospital. The platelet count measured then was 327×109. His platelet count trend is shown in . He was reviewed in the orthopaedic clinic after one week, three week and six weeks. The postoperative radiographs of his knee were satisfactory

past history included multiple episodes of deep vein thrombosis and pulmonary embolism. Coronary angiography demonstrated a single coronary artery arising from left coronary sinus (fig ) which divided into a normal sized left anterior descending artery (LAD) and a circumflex (Cx) artery. LAD had a 99% stenotic lesion beyond the first septal and was a good sized vessel going just beyond the left ventricular apex (Fig ). From its proximal segment, beyond the origin of first diagonal and prior to the origin of

first septal artery, arose 3 right ventricular branches, the largest of which crossed the right ventricular outflow tract (RVOT), 2 centimetres

nodes showed tumor infiltrations. Two weeks later a new hypodense lesion 2.2 cm in diameter was detected in the liver. A clinical check-up after 2 month demonstrated by thoracal and abdominal computertomography numerous suspicious mediastinal and paraaortal lymph nodes (Figure and ) and further suspect lesions in the liver. The patient confirmed that her mother died from renal cell carcinoma at the age of 47. Medical records of the mother were not available. No further cases of

RCC have been reported in the patient's family (Figure ).\nOn macroscopical examination cross sections of cervical lymph node demonstrated a grossly white, partly cystic, and necrotic mass.\nMicroscopical examination of the cervical lymph nodes revealed a tumor consisting of papillary formations

a TWINFIX Ti 2.8 mm Suture Anchor with one #2 ULTRABRAID Suture (Smith & Nephew Inc.). Antituberculosis chemotherapy started one day after the surgery, following a positive test of the fluid for acid-fast bacilli and a positive polymerase chain reaction for Mycobacterium tuberculosis. The patient received a total of 6 months of a rifampin-based regimen, which is recommended for musculoskeletal tuberculosis []. The patient initially received isoniazid 300 mg, rifampicin 600 mg, ethambutol 800 mg, and pyrazinamide 1500 mg daily for two months and then reduced to isoniazid and rifampicin for

the remaining four months. The elbow was immobilized in a posterior elbow slab with the forearm supinated for four weeks. Mycobacterium culture revealed Mycobacterium tuberculosis. Microscopic examination of the soft tissue revealed granulomatous inflammation with multinucleated Langhans giant cells and caseous necrosis.\nAt the 1-year follow-up, erythrocyte sedimentation rate was 10 mm/hr, and C-reactive protein was 2

and brain stem demonstrated normal appearance, and there was no evidence of mass lesion or midline shift. The MRI with and without contrast, performed 2 months later, revealed a tissue measuring 5 × 3 × 1 cm and weighing 12 g in the right orbital mass. The microscopic findings demonstrated a benign lesion composed of a mixture of angiomatous tissue and lobulated fatty tissue connected with skeletal muscle tissue,

which was suggestive of hemangioma. The brain computed tomography (CT) findings showed that there were no abnormalities in the brain structure. There was diffused skin and subcutaneous soft tissue edema in the cranial area, which was more pronounced in the radiation therapy site. The ultrasound

of fourteen distinct antimicrobial substances tested on the clinical MFC isolate. Susceptibility was interpreted using CLSI breakpoints (M24-A2 2011), if available. S = sensitive; R = resistant; I = intermediate.\nThe patient was transferred to the Infectious Diseases department for further diagnostics and treatment. Due to persistent back pain and mild paresthesia in the peripheral extremities, a whole spine MRI was performed, which showed no sign of disseminated infection. In addition, chest radiograph and abdominal ultrasound did not reveal any abnormal findings and the patient tested negative for Human Immunodeficiency Virus (HIV)-infection. Based on the American Thoracic Society / Infectious Diseases Society

of America (ATS / IDSA) guideline and susceptibility testing results, antibiotic therapy was initiated with amikacin (initially 10–15 mg / kg of body weight once a day, intravenously, subsequently adjusted to serum level), levofloxacin (500 mg once a day, orally), and imipenem / cilastatin (0.5 g / 0.5 g twice

woman has presented with epigastric pain radiating to the back since 5 months before her admission. There was a history of diabetes mellitus, hypertension and hyperlipidemia and patient had no history of past surgery, pancreatitis or trauma which made the diagnosis of pseudo cysts less likely. The patient has not also reported any history of weight loss, nausea, vomiting, jaundice, or alcoholism. On physical examination, vital signs were normal without fever, chills or rigor, abdomen was soft without tenderness, or distension and extremities’ pulses were symmetric. Laboratory investigations have revealed a leukocytosis (white blood cell: 22600), mild anemia (Hb: 10.2 mg/dL), and raised blood sugar (blood sugar: 272 mg/dL). Abdominal ultrasound examination has illustrated

a heterogeneous mass with diameter of 59 × 76 between spleen and left kidney in LUQ. Abdomenopelvic computed tomography (CT) has shown a septated solid cystic 65 × 62 × 70 mass in the tail of pancreas, adjacent to left kidney. The mass has limited to lesser sac space and it has not invaded any contiguous organs, but it has displaced left kidney to downward. No calcification has revealed and the peri tumoral fat tissue has not

was made to proceed with delivery of the infant in order to commence chemotherapy for the patient. Betamethasone was given for fetal lung maturation. Blood and platelet transfusion to hematocrit of 31%

and platelet count of 100,000 was accomplished. Induction of labor with intracervical foley balloon and pitocin resulted in the delivery of a female infant with birth weight 2031 gms and Apgar scores 8 and 9 at 1 and 5 minutes, respectively. Histopathologic examination of the placenta showed slightly immature but otherwise normal 3rd trimester features without evidence

received 7 days vancomycin for treatment of Enterococcus faecium bacteremia. In addition, she developed bilateral trochanteric decubitus ulcers due to being bedridden for weeks. ESBL-producing Escherichia coli was isolated from those decubitus which were subsequently treated surgically and with 10 days ciprofloxacin. Finally, the

prolonged because of secondary complications including prolonged dysphagia subsequent to the retropharyngeal abscess and several hospital-acquired infections. Specifically, the patient required mechanical ventilation in the course of two hospital-acquired pneumonia episodes, the first episode empirically treated with 7 days ceftriaxone and erythromycin, the second with 7 days imipenem. Then, she

were taken which showed evidence of callus formation in the bone (). At this time, it was recommended that the patient begin gentle active range of motion exercises with extension and light flexion. He was also encouraged to become full weight-bearing with the brace until its removal two months postoperatively.\nFive months postoperatively, the patient reported no pain (0/10) and possessed 95% of his normal function at this time. On physical examination, he was nontender to palpation along the joint line. There was no laxity with varus or valgus stress. He demonstrated 5/5 quadriceps strength with no evidence of an extensor lag. He

had an active range of motion from 0 to 130 degrees of flexion, and there was no lag with straight leg raise. Repeat anterior-posterior and lateral X-rays demonstrated a well-reduced tibial tubercle fracture as well as well-positioned and nondisplaced hardware ().

radiographs taken at different angulations could not conform the exact pathway of the third root canal as it represents only a two-dimensional image.\nInformed consent was obtained from the patient for endodontic treatment of the involved teeth. The tooth was anesthetized using local anesthetic (2% Lignocaine with 1 : 100,000 epinephrine) solution by way of inferior nerve block of right side. Under rubber dam isolation, access cavity was prepared with round diamond burs in

The tooth was diagnosed with irreversible pulpitis based on clinical and radiographic findings and it was decided to undergo endodontic therapy for the lower right second premolar. IOPA revealed the presence of two root canals and a third root canal was suspected due to abnormal dimension in the middle third of the root. Additional IOPA

41-year-old male who presented to our outpatient department with minor symptoms, including dyspnea during heavy activities. The patient did not have a history of fever, weight loss, malaise, or carotid tenderness but had a 1-year-old history of dyspnea on exertion. The patient never had any previous indications of autoimmune diseases or infections. Approximately 17

years earlier, at the age of 24, the patient experienced a frequent loss of consciousness during exercise. He had no

we also used 200 mg of hydroxychloroquine daily simultaneously with a daily dose of 1.5 g of mycophenolic acid as a maintenance therapy.\nUnfortunately, though, 2 days after the initiation of therapy oxygen saturation levels suddenly dropped to 70% and the patient became dyspneic thus the patient was intubated. Unfortunately, the patient showed signs of hemoptysis which was suggestive of alveolar hemorrhage. She was intubated and 2 units of fresh frozen

pancytopenia. With all the aforementioned findings and signs, SLE became a confirmed diagnosis for the patient. Thus, intensive therapy with rituximab induction therapy along with 500 mg of prednisolone pulse therapy for 3 days was started,

of the right lobe of the liver (Fig. ), multiple wedge defects in both kidneys (Fig. ), and a partially occlusive thrombus within the common iliac and right external iliac arteries. An arteriogram subsequently confirmed bilateral iliac and superficial femoral artery thrombi. Assays for IgG and IgM anticardiolipin antibodies were negative (6.8 GPL and <4.0 MPL respectively), and rheumatoid factor was less than 20 IU/mL. HIV I and II, hepatitis B and C, and RPR, were all negative and her ferritin level was within normal limits. She underwent successful bilateral lower extremity thrombectomies. Her

renal function remained stable throughout her admission. She improved clinically on anticoagulation and heart failure therapy and repeat TTE 5 days after she presented showed no evidence of thrombi in either ventricle. Her lactic

a large mediastinal mass with bilateral hilar lymphadenopathy and partial collapse of the bilateral upper lobes (fig. ). Computed tomography of the thorax with contrast revealed a partially necrotic, lobulated mass measuring 17.6 × 9.5 cm in the anterior mediastinum with involvement of the thyroid gland and bilateral hila, encasing the superior vena cava. Numerous pulmonary nodules as well as mediastinal

and supraclavicular lymphadenopathy were noted. There was also moderate narrowing of the trachea at the level of the thoracic inlet. A focal lytic lesion in the right posterolateral 6th rib was concerning for metastatic disease. Staging scans obtained shortly thereafter ruled out metastatic disease in the brain and abdomen/pelvis. Thyroid function tests were within

the periphery of the solid masses showed a typical palisade arrangement []. These features led to the diagnosis of BCC of right lower lid.\nClinically, a rough estimate of tumor margins were made with the skin of the right lower eyelid on stretch using the following guides - transition in surface contour; altered vascularization (fewer capillaries and more telangectasia); altered skin color; tumor depth was judged

a periocular malignant mass. Histological examination of the tumor in the right eyelid revealed solid nests of darkly staining cells extending into the dermis. All the cells were similar to the basal cells (basaloid) of the epidermis and few nuclei showed abnormal mitotic figures, which took up an in-tensely dark blue stain with hematoxylin. The cells at

3.4 cm mass arising from the lower lateral alar cartilage () with no apparent invasion of the nasal septum or adjacent soft tissues. An incisional biopsy via the vestibular aspect revealed a well-defined avascular mass with a lobulated surface. The initial histopathological report was suggestive of benign enchondroma, however further review considered low-grade chondrosarcoma to be more likely. Imaging of the neck and chest showed no evidence of metastatic disease, but two small lung nodules were identified, with a subsequent diagnosis of primary adenocarcinoma of the lung.\nAfter discussion at the multidisciplinary head and neck meeting, the patient underwent primary

resection via an external rhinoplasty approach. The skin and soft tissue envelope (SSTE) was not adherent to the tumor, which was well-circumscribed and easily dissected from the surrounding soft tissue with no evidence of local invasion. Macroscopic resection of

determines her basal and bolus pump settings, carb ratio, sensitivity factor, and glucose targets. She checks her glucose readings 10–12 times a day during the first few weeks in order to fine-tune the pump settings and adjust to her new therapeutic management. In the months that follow, she finds that pump use is much more compatible with the hectic life of a college student. Her HbA1c drops to 6.9%. Thereafter, the patient continues to diligently check her blood glucoses 4–6 times a day and has only rare episodes of hypoglycemia. She is now contemplating obtaining a personal continuous glucose

She is motivated and desirous of initiating pump therapy. She undergoes pump training under the auspices of a professional team of experts, including the endocrinologist, trainer, and dietician. The physician

and a petroleum engineer. He was doing very well with no significant previous medical history of note. He had a history of contact with a COVID-19-positive campmate. There was no history of travel to tropical countries, no family history of heart block or sudden death, neither a previous history of jaundice nor a history of skin rashes. He sought medical advice four days before his referral to our

cardiac center because of headache and fever. He was admitted into the coronary care unit into a single negative pressure room and under strict droplet isolation precaution measures. Clinical evaluation revealed

tachypneic (room air –84%) with decreased air entry on the right side and with normal hemodynamics values. Cardiac auscultation revealed normal heart sounds and no cardiac murmur. A chest X-ray was done which showed a massive right-sided pleural effusion, and a right intercostal tube drainage was done at an outside hospital which drained 1 L of blood immediately and 1 L subsequently.\nThe patient was referred to our institute with the diagnosis of massive right hemothorax. An ultrasound of

the chest was done which showed gross right pleural effusion with collapse of underlying lung. A well-defined retrocrural collection of size 7 × 6 cm was noted. The liver was normal in echotexture. Emergency computed tomography angiography (CTA) was suggestive of massive right hemothorax, with an aortic rent at the T7 level communicating with the right pleura and multiple aortic rents at

medical history of hypertension and hyperlipidemia presented to the emergency department (ED) from a day care facility apartment where 2 people at the facility have tested positive for COVID-19 but she did not have any direct contact with these individuals. About 5 days before admission the patient developed a fever with a temperature of 102°F at home, and went to her primary medical doctor who sent her to the ED. In the ED she was found to have bilateral opacities on chest X-ray and had continued intermittent fevers with generalized weakness, cough, lethargy, and dyspnea and was sent

for testing for COVID-19 then transferred to our facility for further management. In our facility, her temperature was 101.7°F, blood pressure 148/76 mm Hg, heart rate of 99 beats per minute, respiratory rate of 18

After obtaining informed consent, the patient was operated under spinal anesthesia. Open reduction and internal fixation with proximal tibia locking compression plating with autologous bone grafting from the ipsilateral iliac crest (corticocancellous graft) along with lateral meniscectomy and arthrolysis of the knee joint was performed under spinal anesthesia, as shown in Figure . The post-operative period was uneventful.\nHospital course\nPost-operatively, the patient received intravenous amoxicillin-potassium clavulanate 1.2 g twice daily for seven days and amikacin sulfate 500 mg twice daily for five days followed by oral amoxicillin-potassium clavulanate 625 mg twice daily for seven days. Post-operative radiograph of the operated knee joint was taken on post-operative day 2, as shown in Figure . An above-knee slab

collateral ligament tear. In addition, the patient was counselled regarding expectations and outcomes.

site) followed by six 14 day cycles of IV paclitaxel chemotherapy (175 mg/m2/day). The patient demonstrated partial remission as the skeletal muscle metastasis reduced in size to 22 × 34 × 52 mm (including an area

of tumour necrosis) assessed by a repeat MRI scan in March 2018. However, the scan identified a new 53 × 40 × 18 mm subcutaneous UC metastasis

4 years of age, despite having communicative intent, language expression was quite restricted. He also had deficits in psychomotor and cognitive executive function that improved with time, especially regarding sensory integration, and he presented an attention deficit. At 5 years of age, an evaluation of language and cognitive development was performed using the Protocol of Observation Behavioral []. The examinations revealed the following: limited

oral language, with attempts to engage in dialogue; language disorder, especially in expressive language; deficit in motor skills and difficulties in the understanding and execution of tasks and games. With respect to activities of daily living,

was adapted and stitched together.\nThe patient showed no sign of infection, and the antibiotic treatment was adjusted to intravenous cefuroxime as monotherapy after consulting with the Department of Microbiology. The patient was discharged after 3 days with oral antibiotics, amoxicillin/clavulanic acid.\nSix months after the trauma, the patient had the last follow-up in the ophthalmology outpatient clinic. The visual acuity in the left eye had increased to 0.4, and there

of and manipulation in the sphenoid sinus, a 7-cm-long stick was extracted through the wound in the lower eyelid (Fig. ). Significant amounts of debris and splinters were removed through the nose. The skin laceration

to proceed with an induced abortion and opted to undergo a gravid myomectomy. She understood that elective surgery is typically postponed until the second trimester to minimize the fetal exposure to anesthesia and to reduce potential for fetal loss. Due to her tremendous discomfort, she decided to proceed with a first trimester myomectomy, accepting the risks of pregnancy loss, fetal injury and hysterectomy.\nA myomectomy was performed at 11 weeks gestation via a vertical skin incision. Upon entry into her pelvis, her uterus was found to be displaced into the left lower quadrant, and the

of outpatient medical management, she refused inpatient admission, indicating that she could not tolerate continued expectant management.\nOn presentation to our university hospital, magnetic resonance imaging was performed and showed compression of her colon, bladder and proximal urethra (Figure ). The large fibroid was noted to be posterior and the placenta, anterior. During options counseling at our institution, our patient decided that she was unable

too small to contain the intestinal organs. Consequently, the fascia was split proximally and distally of the hernia port; however, the abdominal wall could not be closed without the use of three pieces of nonabsorbable mesh each measuring 35 × 35 cm (Fig. ). The intra-abdominal organs were enclosed in the new cavity, and the skin was closed above the cavity.\nIn the following days, the patient gradually developed necrosis of the skin covering the mesh. The wound was revised and necrotized tissue excised leaving a 40 × 50 cm defect with the underlying mesh being intact. Thereafter, the patient was treated

performed via the vertical scar. Perioperatively, the abdominal wall defect measured 15 × 10 cm, and the ventricle, colon, and small intestine were encapsulated in a subcutaneous cavity. The lower 150 cm of the small intestine was cyanotic and torqued around the mesentery; detorquing resulted in revitalization. The intra-abdominal cavity was found shrunken and

Partial calcification of the pleura, pleural thickening, and pleural effusion were also found (). A yellowish substance was located in the lumen of the right upper lobe apical segmental bronchus at bronchoscopy and a pathologic examination of the substance was performed. The pathologist reported the substance to be pulmonary aspergillosis ().\nThe empyema was drained through a percutaneous catheter and air leakage was observed. Amphotericin B (AMB) was injected after the patient was diagnosed with pulmonary aspergillosis. After the administration of AMB, a fever that the patient had since the second day of admission subsided, the white blood cell count decreased from 12,900/mL to 7,900/mL, and C-reactive protein decreased from 22.9

field (). Tomography showed several cavitary lesions of different sizes, some of which had fluid collection, which suggested an infected cyst, an old tuberculosis scar, or active tuberculosis.

caused significant compression and 90% stenosis of the left coronary artery () (). Echocardiography showed moderate left ventricular dysfunction with an ejection fraction of 30%–35% and severe hypokinesis of the apex and apical part of the anterolateral wall of the left ventricle. At this point, we had to decide whether to perform a high-risk acute cardiac surgery (redo after the ventricular septal defect closure) at the risk of delaying the treatment of ongoing myocardial ischemia or perform a high-risk endovascular intervention. Finally, ad hoc percutaneous coronary intervention of the left coronary artery with stent implantation was performed ().\nAfter stabilization, CT

anterior ST-segment elevation myocardial infarction. Selective coronarography was performed, which showed pseudoaneurysm of the left aortic sinus

Maxillary lesions were also present, extending to the anterior margins of the maxilla, again with cortical erosion (Figures and ). The brain and pituitary gland were normal.\nWithin the pelvis, there was a well-circumscribed, periurethral mass within the left lobe of the prostate gland (3 × 4 × 4 cm) demonstrating slight T2 hyperintensity to muscle with irregular, linear central hypointense regions, and faint enhancement on the postcontrast T1 FS images. As well, a 2 cm mass at the superior/posterior aspect of the bladder on the right (Figures , , and

revealed loss of alveolar bone adjacent to the roots of the lower first molars bilaterally with erosion of the distal roots at these levels, in keeping with “floating teeth” ().\nAn MRI of the brain, face/palate, and pelvis was performed, which revealed multiple lesions within the mandible and maxilla. These lesions were slightly T2 hyperintense and T1 isointense to muscle with homogenous enhancement. There was involvement of the body of the mandible bilaterally, extending superficially and deeply to the mandibular margins with cortical erosion.

chest was notable for irregular pulmonary nodules. Repeat CT upon presentation showed progression to cavitary lesions, for which bronchoscopy was planned for investigation. At the time of presentation, medications included sildenafil 80 mg morning and night, and 60 mg afternoon; treprostinil 48 mcg via nebulizer every 4 h; and ambrisentan 10 mg daily. She required 3 L of oxygen at rest

2.80 L/min, pulmonary vascular resistance of 16 Woods units, and transpulmonary gradient of 74 mmHg. It was decided she should pursue lung transplantation; however, during workup she developed a persistent dry cough. Computed tomography (CT)

restrictions made this process of engagement more challenging.\nThe police decided against placing the patient under Section 136 as he was not deemed to a be an acute threat to himself or others. Two days

later, he presented to another ophthalmic institution with further bleeding but again absconded prior to intervention. On the third day following his initial presentation, the hostel staff raised concerns that the injury may have

knee and mild low back pain. Her pain score was 8/10 in the numeric rating scale (NRS). Prior to visiting our clinic, she had been diagnosed with multilevel lower lumbar degenerative changes, including a bulging disc and central canal stenosis at L3-4 and L4-5 on lumbar MRI. She received fluoroscopic-guided transforaminal epidural blocks repeatedly at the local spine center. However, the spinal blocks were not effective for her anterior thigh pain, and so lumbar spine surgery was planned. However, she refused to have lumbar surgery and visited our pain clinic. In her

history, she was an officer and worked seated for long periods. She usually crossed her legs while sitting until the pain got worse. Although the patient could not remember the duration of the disease, she said that there was intermittent pain for about 25 years since childbirth and the pain had gradually exacerbated recently. There was no remarkable medical history or antecedent trauma. The patient continued to

(above the dentate line), and indigo carmine poured into the rectum was discharged from the perineal opening (). Vaginoscopy did not reveal a fistula tract in the vagina. Finally, a rectoperineal fistula was diagnosed. No evidence of Crohn's disease was observed. Anatomical schema demonstrating the position of fistula tract was

pain, followed by an uncontrollable passage of gas or feces at the perineum. A small pinhole with a discharge was noted at the left perineum, at the 5-O'clock direction of the vagina, and 5 mm from the vaginal orifice. Magnetic resonance imaging revealed a small fistula tract from the lower rectum, but an external opening or perianal abscess was not revealed (). Colonoscopy also showed a small orifice at the anterior wall of the lower rectum

apart from a small nodular area at the lesser curvature of the stomach. Biopsies from this area were reported as showing chronic inflammation only. Since he presented with Iron deficiency anaemia with low haemoglobin levels, he further underwent colonoscopy, which was inconclusive. Repeat OGD and biopsies that were taken four

was negative. His creatinine was slightly elevated at 130 mcmol/L (59-104), consistent with CKD. His liver function tests were completely normal. Given his background of metastatic gastric carcinoma, he agreed to be investigated again with a gastroscopy and CT scan of the chest, abdomen, and pelvis. The gastroscopy showed no signs of malignancy

portions of the calvarium that were encountered were resected if tumor involvement was appreciated. Given the aggressive nature of the neoplasm, no attempt was made to reconstruct the bony defect at the time of initial surgery []. Elective cranioplasty was scheduled for after completion of the adjuvant treatment. Postoperatively, the patient had an uncomplicated hospital course and was discharged 6 days later. The patient has undergone a course of radiotherapy. On his latest follow-up, 8 months postsurgery, the patient has stable chronic paresis (3/5) in the right lower extremity (from the intratumoral hemorrhage), but no new deficits. He is able to

ambulate without assistance and his scalp has healed well in spite of adjuvant radiotherapy. Postoperatively, MRI scans have not shown any recurrence thus far.\nMicroscopic sections of the tumor demonstrated variable cellularity and growth pattern []. There were high-grade, neoplastic spindle cells with mitosis and rudimentary small vessel differentiation. The congested dilated vessels were lined by neoplastic endothelium with intraluminal budding. Immunohistochemically, the endothelial cells were positive for CD34, CD31, factor

diameter of 15 mm and 39 mm were discovered in the upper and lower poles of the right kidney, respectively (). Their mean CT attenuation value was 39 HU. No renal vein or IVC tumor

(average 1 bottle of beer per day).\nWork-up: An abdominal and pelvic non-contrast CT revealed a 36 × 31-mm, ellipsoid, and hypodense mass in the external branch of the right adrenal region (). It was well-demarcated with a CT value of about 27 Hounsfield units (HU). Hypodense lesions with a

the urologist. The final diagnosis was pancreatic hydatid cyst.\nThe patient had another episode of acute edematous pancreatitis after a month of surgery, and the amylase level was over 1000 U/L. The development of local retroperitoneal abscess required puncture and drainage by CT; the patient also developed a deep venous thrombosis and

the endocyst membrane was removed (). A Foley catheter was placed in the residual cavity. The simple renal cyst needs no intervention according to

an outpatient in 2012 with a two-week history of pain in the right leg and hyposensibility of the right calf. For further investigation, an MRI of the lumbar spine was performed showing a right-sided cystic tumor of the pelvis instead of a suspected disc herniation. In the following, an abdominal CT scan was performed revealing an osteolytic involvement of the right ileum, os sacrum, and the right-sided neuroforamina s1–s4 ().\nOn physical examination, the patient showed a moderate swelling of the right gluteal region with a slight reduction in range of motion

of the right hip due to severe pain during leg movements. Otherwise the exam was unremarkable with normal blood circulation in both legs and intact sensitivity except for the

dysfunction, a second operation was not performed. Chest CT on the 1 April 2016 showed that the two masses were significantly enlarged and locally fused. The boundary between the masses, the left atrial appendage, and the right atrium wall was unclear. Multiple new masses of different sizes were apparent in the right lower hilum and both sides of the heart. Part of the mass was seen to be protruding into the lungs. Fusiform soft tissue was seen in the left side interlobar fissure pleura (Fig ), and recurrence

in the mediastinal pleura was confirmed.\nOn chest CT on 22 July 2015, two soft tissue density masses were seen in front of the mediastinal thymus and left pulmonary artery area. Because of significant cardiac

day culture, and blood biochemical tests showed a total protein of 43.4 g/L, albumin 26.2 g/L, globulin 17.2 g/L, triglyceride 0.64 mmol/L, white blood cells 3.3×109 /L and a C-reactive protein of 2.52 mg/L. Echocardiography revealed a pericardial effusion (Fig. A) and a normal mechanical valve at the mitral position with no obvious perivalvular leakage. On day 31, a CT scan showed a massive pericardial

effusion, right sided pleural diffusion and partial pulmonary atelectasis (Fig. B).\nThe chyle analysis test was repeated on day 41, after the patient had been given food with a high fat content, and found to be positive. In the intervening period

Pathology Association.\nWe performed a systematic review of the literature that focused on different treatment strategies and prognosis. We found 28 cases of PRMSu described in the English language literature between 1982 and 2020. Recorded variables, including age, size of the uterus, vaginal bleeding, extrauterine spread, treatment methods, and follow-up are shown in . The Kaplan–Meier method was used to analyze and compare the overall mean survival rate and different mean survival rates under different treatment strategies. IBM SPSS statistical software version 19.0 (IBM SPSS, Armonk, NY, USA).\nThis systematic review of the literature

approximately 20% (). The final diagnosis was PRMSu with metastasis to the great omentum. The pathological results were confirmed by Zhejiang Province

picking when he applied topical over the counter antibiotic and antiseptic creams. However, he could not resist picking the scars over these wounds and the wounds would never heal. Over time, he reported that “he gave up” on his skin picking behavior as he noticed that the left leg wound was gradually getting worse. Due to the worsening pain and foul-smelling discharge from the wound, he decided to come to the emergency room (ER).\nWhen he presented to the ER, he was found to have an extensive wound on distal left foot with exposure of the underlying muscle tissue, oozing of blood and surrounding

basis, sometimes that episode could last for minutes. This compulsive behavior started off with picking the skin around his nail beds and slowly got worse. He reported few occasions of having painful sores and wounds due to the skin

of the ascending aorta () and the distal anastomosis with a 26-mm J-graft (Japan Lifeline, Tokyo, Japan) was performed excluding the intimal tear. Then, we removed the femoral arterial cannulation and resumed antegrade reperfusion through an epiaortic branch of the graft followed by ascending aorta replacement. After extubation on postoperative day (POD) 4, no neurological deficiencies were noted, but she developed respiratory dysfunction accompanied by a severe strider, which demanded transit support of non-invasive positive pressure ventilation (NPPV) for 5 days. She was discharged on POD 60. A new communicating dissection from the RAA to the descending aorta was shown on postoperative CT

cerebral perfusion. Systemic cooling was also discontinued. During the resection of the ascending aorta without opening both aortic arches, systemic perfusion was not interrupted. We found an intimal tear in the distal end

week of daily psychological therapy sessions with the psychologist in our unit, he started walking by himself: it was a miracle for us to see him like that. He was discharged completely healed, with still evolving scars that did not show any sign of turning pathological. The small eschars on his heels were slowly healing, too. He was recommended to use scar gel (with onion extract and another one that was silicone based) ().\nAfter 3 months from the discharge, the patient’s scars

showed signs of turning hypertrophic/ keloid in some regions: the right scapular area, the right flank, some dot-like areas on the back and on the anterior thorax, also on the right arm ().\nHe started wearing special

plans to follow up in the urology clinic in 2 weeks (see Figures and ).\nShe maintained her follow-up appointment and reported that she was doing well overall. She could not feel the hematoma like she could before, her pain was improving, and she denied any gross hematuria. She reported some drainage from around the catheter as well as some bladder spasms along with some mild fatigue. The physical exam confirmed significant improvement of her urethral and anterior vaginal wall hematoma. A repeat cystoscopy was scheduled for 2 weeks.\nNo other acute events occurred

before the 2-week follow-up. On repeat cystoscopic examination, her urethra was found to have healed well (see ), and there was no residual hematoma appreciated on cystoscopy or on physical exam; the bladder was unremarkable. The Foley catheter was removed, and

type 2 diabetes mellitus) presented with plantar perforating disease on his right, which was not treated by a specialist. With the decompensation of the diabetes, the wound worsened with hyperemia in the instep, discharge of purulent secretion from the side of the foot close to the orifice, fever, chills, and pain in the lower limb. Without satisfactory wound response after 7 days of initial debridement, fever persisted, along with an increased area of necrosis toward the leg, a foul odor, pain, edema, and discharge of purulent secretion. Due to the worsening of the wound, the patient was referred to our hospital. After admission, empirical antibiotic

therapy was started with 4.5 mg tazocin administered intravenously 6/6 hours, 500 mg daptomycin administered once a day and glycemic control. Vascular surgery was performed to assess the wound and vascularization of the right lower limb. Due to the extent of the lesion and edema

). A whitish shiny mass filled the lumens without any attachment to the surrounding intima, except that the tumor was attached to the intima of the left interlobar PA. The tumor was completely removed from the vessel lumen (Fig. ). Next, the longitudinal incision of the right PA behind the aorta and the superior vena cava was extended to the right interlobar PA. The neoplasm had no attachment to the intima in this

Due to critical symptomatic obliteration of the pulmonary circulation, an emergency surgery was performed on the second day of hospitalization. Preoperative FDP D-dimer was 1.9 μg/mL, slightly higher than the normal limit (within 1 μg/mL).\nFollowing a median sternotomy and institution of cardiopulmonary bypass, deep hypothermic circulatory arrest was induced for the removal of the tumor. The longitudinal incision was made on the main PA extending into the left PA (Fig.

The graft was irradiated with 10MV photons at a total dose of 50 Gy. The curetted defect in the iliopubic ramus was then filled with antibiotic-loaded cement. We added 2 g of vancomycin and 1.2 g of tobramycin per 40 ml to the 0.55 g of gentamycin-loaded cement. Finally, the irradiated bone was reimplanted in its anatomical position and fixed with plates and screws (). Minimal gaping at the osteotomy site due to the sawblade is inevitable and was treated by compression within the fixation plates in order to maximize the probabilities of direct bone healing. No gaps were visible in the end of the procedure.

Histopathological analysis confirmed a low-grade chondrosarcoma.\nPostoperative evolution was uneventful, and the patient was discharged home after ten days on partial weight bearing for 3 months. At 4-year follow-up, she presented full recovery of her left hip, was pain free in her daily-life activities, and had regained amateur sport activity such as skiing and jogging. Plain films revealed healed osteotomy

and crackles persisted above both lung fields, the drainage had features of air leakage, and the patient did not tolerate lying down. As there was no clinical improvement, and the patient's severe condition persisted, heart failure was suspected, and echocardiography was performed. Due to the patient's status, the examination was conducted in a sitting position; it revealed the “presence of a meager amount of fluid with gas bubbles in the pericardium, without signs of impaired myocardial contractility”. Physical examination revealed no signs of cardiac tamponade. Due to the lack

right lung, numerous atelectatic foci in the right lung field, and fluid levels corresponding to confined air bubbles with fluid (). Despite the improved X-ray image, no improvement was observed in the patient's general condition. The rales

to our department for sustainable foamy urine for more than one year. He also complained of intermittent hair loss and recurrence of oral ulcers.\nApproximately one year prior, the patient was hospitalized at a local hospital for the same reason, and routine urine tests indicated microscopic hematuria and proteinuria. He did not pay much attention, and there was no further diagnosis or treatment because of a lack of conscious symptoms. One month prior, his blood pressure rose to 145/91 mmHg for unknown reasons; microscopic hematuria and heavy proteinuria were again detected.\nThe patient had no comorbidities.\nThe patient's father had asymptomatic microscopic hematuria and proteinuria, as detected in a

routine physical examination approximately 2 years prior. The patient had a daughter and a son; the daughter (7 years old) had asymptomatic microscopic hematuria, and the son had microscopic hematuria and proteinuria. His son had ever been diagnosed with chronic nephritis at a local hospital.\nThe patient's appearance was normal, without edema. His systolic and diastolic blood pressures were 141 mmHg and 90 mmHg, respectively; his pulse rate

lesion of the left breast at the 4 o’clock position. There was an eschar formation with macerated tissue underneath. No crepitus, erythema, or other surrounding skin changes were appreciated. Incidentally, there were 3 enlarged right posterior cervical lymph nodes found. The rest of the physical examination was unremarkable. Laboratory studies were as

shown in and .\nAfter review of her disease course, bilateral involvement, negative biopsies and cultures, and lack of improvement with empiric antibiotics, she was diagnosed with presumed idiopathic granulomatous mastitis. She was started on a prolonged course of prednisone 20 mg daily in addition to wound care with zinc oxide bandages daily. Pantoprazole 40 mg daily was added for gastrointestinal protection. She was later prescribed a 10-day course of doxycycline due to worsening green-yellow

early complications were seen. At 3-month follow up, he had regained the full range of rotation movement on his right forearm. However, 4 years postoperatively, the patient returned to the authors’ clinic for a reappeared deformity on his right forearm. A subsequent radiograph was taken and demonstrated a long, expansile lytic lesion in the middle and proximal ulna surrounded by an irregular thin bone shell, indicating recurrence of the tumor (Figure B). The lesion was enlarged and extended proximally to the coronal process level. The bowing deformity in the ulna, as well as in the radius was more severe than the initial presentations. On being informed

of the natural history of fibrous dysplasia, the parents refused further treatment and determined to observe. At the last follow-up, 8 years postoperatively, the lesion and the deformity in the ulna had been further progressive,

remodeling procedure was done using a dacron straight graft of 24 mm. The technique of the remodeling procedure followed the recommendations of the Homburg group []. The post procedure intraoperative echocardiogram showed a residual mild regurgitation of the valve, which was considered acceptable. The jet was central, in its origin and direction, and the effective height of the repaired cusps was 8 mm.\nThe fetal status was assessed before surgery and after the completion of the procedure by transabdominal

echography, showing an alive fetus.\nThe postoperative course of the patient was uneventful. She was discharged

suggestive of seizures) led to hypothesize a cardiac cause, and the patient was sent for cardiology consultation to be evaluated for loop recorder implantation (ILR).\nThe baseline 12-lead electrocardiogram (ECG) confirmed sinus rhythm 65 bpm with stable LBBB (Figure A). The patient did not complain angina or palpitations. The transthoracic echocardiogram revealed a globally hypokinetic left ventricle with reduced left ventricular

Levetiracetam, with no effect. Lamotrigine and Clobazam were added but were ineffective. The persistence and increased frequency of the episodes despite a poly-antiepileptic therapy and their unusual clinical presentation (ie, the correlation with the patient's position and the co-occurrence of hypotonic falls with rapid recovery, which are not

the hospital with complaints of dysphagia for solid foods for more than one year which had progressively increased in severity. At presentation, she had also developed difficulty in swallowing liquids and had a history of regurgitation of food after meals. There was no history of cough or difficulty in breathing during meals, thus ruling out the possibility of a tracheoesophageal fistula.\nA thorough physical examination revealed a lump in the left breast of approximately 3 × 3 cm in size. The lump was hard in consistency with

irregular margins, and it was not fixed to the skin or to underlying structures. Two firm, mobile ipsilateral axillary lymph nodes with mild tenderness could be palpated. Our patient did not have any family history of breast or ovarian carcinoma. She had breastfed all three of her children and had been postmenopausal for eight years. There was also no history of oral contraceptive pills or hormone replacement therapy.\nUpper gastrointestinal endoscopy revealed

for gradually progressing right lower abdominal pain. His past history included prostate carcinoma with bone metastasis at 60 years of age, and type 2 diabetes mellitus diagnosed at 62 years of age with poor control of the hemoglobin A1c (HbA1c) level measuring 8.0%. Family history revealed that his siblings had type 2 diabetes mellitus and his uncle had gastric cancer. He had a personal history of social alcohol drinking

of less than 60 g per day, and smoking of 25 cigarettes per day for 25 years but had quit for over 20 years. Current medications included bicalutamide for prostate carcinoma, metformin, glimepiride and sitagliptin for type 2 diabetes mellitus, and ramelteon, suvorexant, and zolpidem for insomnia.\nThe vital signs of the patient were

mild internal tetraventricular hydrocephalus, periventricular white matter macrostructure alteration, a complete configuration of the circle of Wills without any cerebral arteriovenous malformation, a selar and orbital region with normal MRI signal; hypoplasia of the right transverse sinus.\nThe patient was put on a low-calorie diet. Mannitol 150 mg/ ml for 10 days was initiated, associated with Dexamethasone 8 mg/ 2 ml injection for 10 days, the latter being subsequently switched to Methylprednisolone 16 mg for 4 days.\nThe neurologist performed a lumbar puncture that showed an elevated opening pressure of 25 mmHg (34 cm H2O)

presented to our clinic, the patient had already undergone an MRI that showed mild ventriculomegaly with no apparent obstacle in the drainage of CSF.\nWe suspected the diagnoses of idiopathic intracranial hypertension and referred the patient to a pediatric neurologist for further workup and management.\nIn the first day of hospitalization in the pediatric neurology department, the patient developed diplopia due to abducens nerve palsy.\nCerebral angio MRI showed:

adenocarcinoma (RCC) a few years ago status post partial nephrectomy and was in remission, presented to the emergency room (ER) with a 10-day history of severe right lower extremity (LE) pain, redness, and swelling. No history of recent travel, trauma, immobilization, or surgery. No history of DVT in the past. He was not compliant with his medications that included Lisinopril and atorvastatin. His physical examination showed swelling of the right LE with erythema, edema, tenderness, and positive Homans’ sign. Dorsalis pedis and posterior tibial arteries pulses were +3 bilaterally. No cyanosis or blanching of the lower extremities. The rest of the physical examination was

unremarkable. His basic laboratory workup including complete blood count, prothrombin time, partial thromboplastin time (PTT), international normalized ratio (INR), and the comprehensive metabolic panel was normal (). His LE venous Doppler showed acute DVT from the proximal right superficial femoral vein through the popliteal vein and involving the calf veins. The patient was given analgesics orally, but his pain did not subside so he was

a palpable mass in the left frontal bone as well as headaches and seizures since the age of 8 years. She was born after a normal labor. Nine years later, when she attended the clinic, a physical exam was undertaken that revealed a firm and rounded palpable mass at the left frontal bone ().\nOn neurological exam, the patient had no focal signs. She had normal mental status and vital signs. She was conscious, and her pupillary reflex to light was normal, as were the muscular force, the deep tendon reflexes, and her sensibility. The computed tomography (CT) scan of her head showed a left

frontal bone a protrusion ().\nThe CT scan also showed an underlying hypoattenuating, supratentorial lesion in the left frontal lobe and interhemispheric space, which was oval in shape with regular and well-defined borders, suggesting an arachnoid cyst that did not cause a shift in the midline structures when the left frontal lobe was compressed

differential cells and hyaluronic acid level could not be measured at our hospital. The pleural fluid was considered exudative based on Light's criteria.\nAfter admission, the patient showed no findings suggestive of an infection. However, because opportunistic infections could not be ruled out, the previously prescribed oral prednisolone 5 mg per day was discontinued. Although prednisolone discontinuation could cause adrenal insufficiency, the benefits of discontinuation were considered to be superior.

a positive result on the Rivalta reaction. The specific gravity of the fluid was 1.037, lactate dehydrogenase level was 483 IU/L, protein level was 5.4 g/dL, adenosine deaminase (ADA) level was 37 IU/L, and glucose level was 89 mg/dL. Bacterial and mycobacterial cultures yielded negative results, and no malignant cells were observed. Many lymphocytes, some histiocytes, and a few mesothelial cells were also observed. The percentage of

was procured by laparoscopic right donor transperitoneal nephrectomy with utilization of linear stapler Endo-GIA as previously described []. The warm ischemic time was 3 minutes measured from the first clip applied to the renal artery until the kidney was perfused with preservation solution. The graft was cold flushed with HTK solution and preserved on ice during the left nephrectomy of the recipient. The total duration of the donor nephrectomy was 95 minutes and total blood loss due to the procedure was 25 mL. The donor was discharged at day 4 after the nephrectomy.\nThe recipient

was placed in a modified lateral decubitus position and flexed for hyperextension of the left flank. Pneumoperitoneum was established via a Veress needle placed

patient in the right lateral recumbent position allows manipulation of the left internal jugular venous catheter. In addition, it is possible to quickly recognize any mechanical damage to the operation site when inserting the CVC.\nTo insert the CVC, the patient's head was lowered 5° and the neck was rotated approximately 15° to the right. The internal jugular vein was punctured with an 18-gauge needle with ultrasound guidance. After vein puncture, a J-tip guide wire was inserted and the needle was removed, the insertion site for the catheter was dilated with a venodilator, and a 7 Fr. central vein catheter (Two-lumen Central Venous Catheterization Set with Vantex®, Edward Lifescience Co., USA) was

inserted. Subsequently, the aspiration of blood by the two lumens of the catheter was observed, and the catheter was secured at a depth of 18 cm below the skin after checking the CVP waves.\nThe patient was placed in the right lateral recumbent position for surgery. Surgery was performed after performing one lung ventilation. The concentration of sevoflurane and the dose of the remifentanil

18-year old Yemeni mother whose husband is her first cousin. The patient's initial genetic evaluation was at 6 months of age; chromosome analysis revealed 46, XX normal complement and SNP arrays revealed multiple regions of homozygosity consistent with parental consanguinity. Severe hypertrichosis and a low anterior hairline that merged

with the eyebrows were observed, and excessive body hair was present on the patient's back and extremities, as well as on the upper lip, genitalia, and axillary regions. Hair overgrowth progressed on her face trunk, eyebrows and

expert management. We followed up the patient's progress and learned that her CT scan did not show any metastatic lesion in the body and also her nuclear bone scan showed an increased isotope uptake at the lesional site. The patient was planned for a radical hemi-mandibulectomy, but before the scheduled date she died. Death was due to massive uncontrolled local disease. It had been a

serum alkaline phosphatase level was within normal limits. The patient was referred to the Regional Cancer Center for

examination 10 months later, having managed to afford CT spine. The two-centimetre midline nodule had subsided; only a two-millimetre papule with a small central invagination remained in its place. Over two years, the child's legs had become spastic, left more than right, and she developed persistent urinary and faecal incontinence. She maintained a sense of bladder fullness which facilitated bladder catheterisation. Progressive scoliosis with marked lumbar lordosis was noted (see ).\nThe CT scan demonstrated multilevel spinal dysraphism and deformity above and below the level of the now-resolved swelling. Axial CT sections revealed a dorsal dermal sinus at the level of T12 connecting

anaerobic causes of bacterial meningitis and abscess. Unfortunately, blood cultures had not been done prior to starting empirical antibiotic therapy. Five weeks after admission, the child and her mother absconded from the hospital due to inability to afford the cost of care. The family was also unable to afford a spinal CT scan (75 American Dollars) during admission.\nThe child and her mother returned to the paediatric neurology clinic for a follow-up

gradually worsening generalized abdominal pain for 24 hours. Other symptoms were anorexia, nausea, and vomiting. He had no remarkable past medical, familial, and habitual history. He did not take any medication previously. He was a student in the fourth grade of middle school.\nOn examination he had tachycardia (pulse rate of 115 beats per minute) but all other vital sign parameters were normal. An abdominal examination revealed severe generalized abdominal tenderness with rebound

tenderness and abdominal wall guarding. These findings proved acute abdominal syndrome which necessitated emergent laparotomy.\nUltrasonography reported a hypoechoic region adjacent to his gall bladder extending down to the lower pole of his right kidney suggesting fluid collection. Intra-abdominal fluid and a few lymph nodes in the right lower quadrant with the greatest dimension of 12 mm were also detected.\nLaboratory

referred by a general dentist, being asymptomatic, with caries located in the buccocervical region of the crown, which had reached the pulp chamber. The general dentist performed an initial cleaning of the caries two weeks prior, but given its depth and extent, the patient was referred for a specialized assessment. She had no history of systemic or allergy problems. In the clinical examination, a dental giroversion, with a maladjusted temporary restoration surrounded by recurrent cavities, was observed. Under magnification, it was confirmed that the caries was in clear communication

with the pulp chamber. Response to the sensitivity test was intense and transitory. Radiographic examination revealed a sudden loss in the continuity of the canal () and the presence of a groove in the outer part of the root,

episodes of mild bleeding which prevented the patient from her normal life. Current physical examination found a murmur on auscultation over the mass and Doppler ultrasonography showed a fast and high-flow lesion which speculated to be AVM. Magnetic resonance imaging (MRI) showed non-capsulated superficial soft tissue mass in the sacro-gluteal region. The mass was large and measured approximately (12*10*4) cm. It consisted primarily within the skin and subcutaneous fat in the retro sacro-gluteal region

birth but it was asymptomatic and diagnosed as a naevus. However, at the age of eight years, the lesion aggressively progressed and became painful and haemorrhagic. No family history was significant. The patient went to a dermatologist who prescribed local steroids without any benefits. The lesion continued to become larger and more painful. No signs of puberty were present at time of presentation and no trauma other than sitting for long periods during school was reported.\nCurrently, the lesion became around 12 cm at the longer diameter and 10 at the shorter one with irregular

was 3100 g, the Apgar scores were 10 in 1 and 5 minutes. Time of CIA balloon occlusion was 15 minutes. The hemorrhage volume intraoperation was 1000 mL, and the patient was transfused with 2 units of red blood cells.\nAt

And 1-0 absorbable suture cerclage was placed in the lower uterine segment via the posterior fornix. After observation of no active bleeding, the occlusion balloons were released and the uterine and abdominal incisions were closed layer by layer. The weight of the infant

a 10 × 10 × 5 cm3 inflammatory colonic mass (Fig. C). The wall of the colon had necrotic patches (Fig. A). The jejunum wall had an inflammatory reaction that narrowed its lumen, nevertheless, no necrosis was found (Fig. B). The 3 × 3 × 2 cm3 cavity in the colonic mass contained purulent material and two adult Ascaris lumbricoides of 15 and 7 cm (Fig. C), one of which had multiple eggs in its uterine tubule (Fig. A). Beside this cavity, a 1 × 2 cm2 perforation was discovered. Bowel perforation due to roundworms, with colonic wall necrosis, was the final diagnosis.\nThe postoperative period was

uneventful, the patient was discharged after a 14-day antibiotic an anthelmintic treatment, and once full diet resumed. Nevertheless, 1 month later, she returned to the emergency with fever and abdominal pain. On clinical examination, abdominal tenderness and fecaloid fluid drained from

respectively. A PET-CT revealed hypermetabolic activity with soft tissue stranding in the subcutaneous region of the anterior pelvis, bilateral pelvic and inguinal hypermetabolic lymph nodes, and a four-millimeter left apical lung nodule (, ). These findings were concerning for a metabolically active neoplasm.\nThe patient subsequently completed two cycles of chemotherapy with cyclophosphamide, doxorubicin and vincristine alternating with ifosfamide and etoposide. By this time, the confirmatory genetic studies returned negative, thus questioning the original diagnosis. The case was then referred to another expert pathologist at Brigham and Women’s hospital

in Boston who suggested MPNST. The patient underwent localized radiotherapy with follow up MRI showing minimal soft tissue stranding, resolving postsurgical change, and no definite residual or recurrent tumor. Previously identified inguinal and

compared with that obtained immediately after surgery, but the subsidence had not progressed when assessed 6 months after surgery (). The patient demonstrated 30° hyperextension of the MP joint of the thumb, which was slightly better than that before surgery. The palmar and horizontal

abduction were both 65°, and she could adduct the thumb to touch the palmar and radial side of the palm. Her grip strength improved from 12 kg preoperatively to 25 kg postoperatively. The tip and side pinch strengths had recovered from 1.2 kg and 2.8

level of bladder neck and eliminated perineal urethrostomy as an option.\nThe surgery was performed as a combined procedure by both urology and plastic surgery team under general anesthesia. The growth was excised with a macroscopic margin of 1 cm from skin down to the rectus sheath and cuff of the bladder with the cystostomy tract also removed en bloc (). Intraoperatively, we found that the tumor did not invade into the bladder.\nFull-thickness reconstruction was done with inferior epigastric artery based vertical rectus abdominis myocutaneous pedicled

flap from the left side. As shown in , skin incision was made vertically and the width of the skin paddle was decided by the defect in the excision site in a way to close the defect. The myocutaneous flap was harvested while preserving the posterior rectus sheath and the flap was delivered through the subcutaneous tunnel into the defect site without compromising the vasculature.\nA silicon catheter was passed through the center of the flap while taking care not to damage the vascular supply to the flap (). The catheter tip was placed

muscle groups involved. When he was asked to stop the movements, he was able to partially control the movements, but he reported that, “if I try to hold them, it becomes painful.” In addition to the pain and discomfort in the neck and head area, the patient was bothered by the fact that the movements were noticeable by other people. In the beginning, his movements were less frequent and less intense, but they gradually got worse in terms of frequency, amplitude and the initiation sites got more diverse and numerous.\nDuring the evaluation at our clinic, the frequency of his jerky movements differed

unsupported triggered a more severe set of jerks characterized by flexion of the upper trunk and neck and exhaling and grunting repeatedly. The movements were variable in terms of frequency, intensity and the

2018 with pigmented lesions of the maxillary gum that expanded up to the hard palate. He reported that a small pigmented macule had appeared on the maxillary gum, near the right central incisor, five years before. At that time, his dentist performed a biopsy that reported a benign melanotic macula. In April 2018, a new ulcerated pigmented lesion appeared on the central part of the hard

palate, and upon examination in the Oral Pathology Unit, the maxillary gum macula was enlarged, involving the mucosa of both sides of the upper gum and hard palate. In particular, the anterior labial gum pigmentation extended interdentally and became continuous with a large black pigmented lesion

polyneuropathy. Investigations for metabolic, infectious, and immune-mediated neuropathies and movement disorders were unremarkable with bland cerebrospinal fluid and no abnormalities on MRI brain and whole spine. Muscle biopsy and assessment for mitochondrial depletion or multiple deletions were not performed.\nA trial of low-dose levodopa/benserazide uptitrated to 300 mg of daily levodopa was performed with a significant improvement in tremor and dystonia ( in the online-only Data Supplement) without significant side effects, and the patient was able to continue full-time work. However, in the

last four years, he developed incipient progressive external ophthalmoplegia; a resting tremor in the right upper limb; occasional myoclonic jerks in the shoulder, arm, forearm

penile metastasis may be asymptomatic without any clinical sign of the lesion at the time of staging. Indeed, abdomino-pelvic MRI and/or CT scan do not systematically include the penis in routine clinical practice. In this context, diagnosis may be more tricky and challenging. FDG/PET-CT analysis may represent a valuable non-invasive technique which correctly identifies such lesions providing an extensive staging in a single session. Although 18F-FDG/PET-CT has been shown to improve baseline staging in the nodal staging of bladder cancer [], controversy stills exists in relation to the widespread use of PET/CT in clinical practice []. One of the main reasons is its additional cost for a test with low sensitivity [].\nDefinitely,

reported, penile metastases from urothelial carcinoma of the bladder may be detected by either pelvic CT scan or MRI [–]. Classically, the corpus cavernosum is the site of involvement of metastatic penile carcinoma whereas the glans penis and corpus spongiosum are rarely involved []. Even though MRI may able to distinguish metastatic lesion from primary tumor of the penis, the presence of penile lesion must be pathologically confirmed. Percutaneous biopsies are also possible using penile block as anesthesia []. However, as presented in our case report,

obtain access through conventional access sites. Furthermore, there was a severe stenosis of the left internal carotid artery, and a mild stenosis of the left common carotid artery. However, arterial access could be obtained proximally at the left carotid artery. The CCTA showed extensive coronary calcifications, with a severe stenosis in the LAD, a moderate stenosis in the right coronary artery (RCA) and a moderate stenosis in the left circumflex artery (LCx), and

artery disease, with a total occlusion of the infrarenal aorta and both common iliac arteries (Leriche Syndrome), a total occlusion of both subclavian arteries, and a critical stenosis of the brachiocephalic artery (Figure ), explaining the inability to

Otherwise, her echocardiogram at that time revealed a structurally normal heart, and her electrocardiogram (ECG) was normal except a shortened PR interval (106ms) without any evidence of preexcitation syndrome.\nAt the age of 18 years, she presented to the emergency department due to acute-onset speech difficulty and headache while she was driving her car. In the emergency department, she was given a presumptive diagnosis of complicated migraine and received clonidine, lorazepam,

sports physical examination, she was noted to have a grade I/VI systolic murmur. Ultimately, she was diagnosed with a patent foramen ovale by a bubble study.

coronary artery bypass grafting with course complicated by sustained ventricular tachycardia leading to CIED placement (dual-chamber implantable cardioverter-defibrillator with pacemaker function) presented to the hospital with complaints of redness at the site of his insertion pocket one month after implantation. There was also some purulent drainage from the insertion site few days prior to presentation. He did not have any fevers or chills. Upon presentation to the emergency department, the vital signs revealed a heart rate of 79 beats per minute,

respiratory rate of 20 per minute, blood pressure of 125/79 mmHg, oxygen saturation of 97% on room air, and temperature of 97.5°F. Physical examination was significant for erythema at the CIED insertion site with tenderness to palpation and expression of purulent fluid. Cultures were sent from the emergency department. Laboratory data showed normal white cell count of 5100 per microliter and mild thrombocytopenia with

mass to involve the superior mesenteric, splenic and portal veins (Figures , ).\nShe underwent a CT-guided biopsy of this mass which showed high-grade diffuse large B-cell lymphoma (DLBCL) NHL with a Ki-67 of 80%. Morphologically, no granulomas or Reed-Sternberg cells were seen and further immunostaining performed showed positivity for LCA, CD20, PAX-5 (weak and focal), CD10 (diffuse), BCL-2 (diffuse) and BCL-6 (about 30%), while being negative for CD3, CD5, CD20, CD23, cyclin D1, MUM1, c-MYC, AE1/AE3, CAM 5.2, CK7 and CK20, suggesting NHL DLBCL (Figure ).\nA positron emission tomography (PET)-CT was

heterogeneously enhancing soft tissue mesenteric mass with necrosis surrounding the celiac trunk and the superior mesenteric artery. It also revealed an additional extensive tumor thrombus extending from the mesenteric