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intubated and ventilated. Pulse rate and blood pressure were 68 beats per minute and 130/80 mm Hg, respectively. There was no history of diabetes mellitus, hypertension, heart disease, stroke, or cancer. On neurological examination, she was semicomatose with flexion to painful stimulation. Both pupils appeared centrally fixed, dilated (6 mm), and nonreactive to direct or indirect light stimuli. Computed tomographic (CT) scanning demonstrated extensive subarachnoid hemorrhage spreading around the both Sylvian, basal, and interhemispheric cistern (). Emergency extraventricular drainage (EVD) was performed. Initial intracranial pressure (ICP) was 45 mm Hg, and subsequently, the pressure remained between 15 and 25 mm Hg after intermittent cerebrospinal fluid (CSF)

drainage. Seven hours after EVD, the right pupil became reactive to light, but left pupil was nonreactive

index (BMI) of 36.5 (obese Class II; according to WHO classification), came with complaint of pain in both knees (left >> right) with difficulty in walking for last 10 years with swelling on left leg for last 1 week. She had severe pain in the left knee which badly affected her activities of daily living. She was a known case of hypertension for last 8 years and hypothyroidism for last 20 years. She was recently diagnosed with diabetes mellitus. X-rays of the left knee

() showed advanced osteoarthritis, and she was advised for left TKA. On physical examination, the patient had swelling and mild tenderness over the left

of pain in his right ear since 2011. The patient was injured when a 400-kg metal device fell on his right leg during the course of his work (13th March). The patient was wearing security shoes and clothes at the time of the accident. He presented with a superficial abrasion (15 cm × 3 cm) on the front of the right lower leg, without heavy

bleeding, and swelling of the right ankle. X-rays and blood tests ruled out a fracture and organ failure (Fig. ). He was assessed by the attending surgeon at the University hospital in Linköping. Surgical

seen beneath the deep fascia and an attempt was made to remove all the visible cysts. The acetabular component was loose and it was easily removed. There was a complete loss of posterior column with discontinuity of ilium from pelvis. Curettage and excision of all the visible cysts was performed. A small

the hip (Figure ). She was given the option of having a hemi pelvic resection or an acetabular reconstruction leaving the hydatid cysts. She opted for the acetabular reconstruction option due to the potential functional loss associated with hemi pelvic resection. On 24/10/08 she underwent a customised Ice-cream cone hemi pelvic replacement [Stanmore Implants Worldwide]. During the operation, cysts were

man, with no history of hypertension, currently living in the US, first presented with a five-day history of persistent worsening headache and dizziness with intermittent nausea. He is a Type II diabetic with a significant medical history of a mechanical aortic valve replacement (St. Jude valve placed in Vietnam in 2008) requiring anticoagulation treatment with Coumadin. A routine workup included a non-contrast head CT that showed a 17 mm × 17 mm hypodense ovoid lesion in the cerebellar vermis with minimal effacement of the left wall of the fourth ventricle (A). Labs at presentation showed an International

normalized ratio (INR) of 5.66. Diagnostic Magentic Resonance Imaging (MRI) showed these to be hemorrhagic lesions favored to be multiple cavernous hemangiomas rather than metastatic or septic emboli. This conclusion was also supported by a

metal fragment was finally seen and removed with a small pituitary forceps (the so-called 'Black Pituitary Forceps'). After the removal of the metal fragment, C5-6 fusion was carried out with autologous iliac bone and an anterior cervical plate because the motion of the artificial disc was minimal when the remnant motion was carefully checked by distracting between the metal components in the C5-6 level, and the removed fragment seemed to attenuate the stability during cervical motion

expected to be in the close proximity. After deepening the dissection, a twinkling tip of the

a large tumor was found in the head of the pancreas and the descending duodenum (Fig. ). GDA was not involved. There were no obvious findings of peritoneal dissemination or liver metastasis, so we performed pancreaticoduodenectomy, with combined resection of the portal vein replaced by the right external iliac vein graft (Fig. ). The caudal limit of the tumor thrombus was just above the first branch of the SMV, and the SMV was cut at one orifice. The cranial side of the portal vein was cut in the hepatoduodenal ligament, and the splenic

vein was ligated. The portal vein was reconstructed by the interposition of the right external iliac vein graft. The portal vein flow was gradually interrupted by thrombosis formation so that collateral vessels developed. SMV flow was completely blocked, and

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

angiography was performed on the patient, and a partially thrombosed pseudoaneurysm of 28×24×27 mm in size compressing the left coronary artery was found. Ten days later, the patient developed a transient chest pain without a change in

absolutely necessary to define the six deformity parameters (Figure ). The web software gave us the calculated minimum correction time of 26 days for the left wrist and 28 for the right wrist, and the schedule the patient was expected to follow for struts adjustments every day. This calculation

was based on the six deformity measurements, the four settings of the reference ring, the initial six struts settings, the defined structures at risk, and the entered maximum safe distraction rate of 0.5 mm/d. The initiation of correction was started at the seventh postoperative day. The multiplanar deformity of the distal radius was corrected anatomically

J. F. is a sixty-seven-year-old, black female with a past history of Crohn's disease who presented with headache and visual field cut (NIHSS = 5). Her last colonoscopy revealed ulcerations in the transverse colon, descending colon, sigmoid and cecum. She also had a history of multiple ischemic strokes. She was outside of the 4.5-hour window for treatment with tPA when she arrived

to our emergency department. CT and MRI showed right PCA territory subacute ischemic infarct. Catheter angiogram was performed and found complete occlusion of the right PCA, but no evidence of vasculopathy or vasculitis. Transesophageal echocardiography revealed no embolic source. Hypercoagulation panel was

the liver accompanied by hilar lymphadenopathy. The patient was started on systemic therapy with etoposide and carboplatin in combination with somatostatin analogues with very good radiological effect. We use this regimen as a standard in patients with MINEN of gastrointestinal tract with dominant neuroendocrine component, even with no somatostatin receptors staining available. Now the patient is almost a year after being diagnosed with a tumor, after completion of 6 cycles of adjuvant chemotherapy (carboplatin + etoposide) in

after the discharge, the patient underwent a follow-up CT scan prior to the initiation of systemic therapy, which revealed a large recurrence of the disease at the resection surface of

40-year-old male patient presented to a hospital in December 2011 with a right-sided thyroid mass and hoarseness. An ultrasound scan (USS) and fine needle aspiration cytology was consistent with MTC. The blood laboratory analysis of the patient revealed high serum levels of calcitonin and CEA, 222 pg/mL and 18 ng/mL, respectively. In December 2011, the patient underwent a total thyroidectomy and bilateral neck lymphatic dissection with a good recovery. Histological analysis of this specimen revealed a 17 mm MTC. In total 49 lymph nodes were removed from the right central, paratracheal, right lateral neck, and

13 lymph nodes contained malignant deposits. These were positive for MTC (12 lymph nodes from the right and one lymph node from the left cervical). Tumor tissue

strength were his family, academic interests, especially in English, and his friends. He had an existential crisis and felt that his life was meaningless because he was no longer who he had once been, “I am alone in a world full of dying old men”. He felt it would be better for his misery to end than to keep existing with no meaning. He constantly asked his mother when would he die and would he end up like

is described as an individual’s search for meaning and purpose in life, the experience of the transcendent, and also one’s connectedness with others: his or herself, nature, and to the sacred realms, inside as well as outside of traditional religion []. In the patient’s case, his sources of

the antivirus, antibiotics, and other drugs which added up to a daily healthcare cost of over 10 K RMB only to merely maintain the basic life-support with hemoglobin in the 15–40 g/L range. The heart failure and kidney failures occurred during the conservative treatment which required symptomatic treatment and intensive care.\nAfter careful preparation, the patient's CD4 level rose to 272 cell/μL with the hemoglobin of 50.8 g/L and HIV-1 viral load dropped to below the detection level. On July 28, 2009, the joint relief operation was performed in patient's right hip under general anesthesia with intraoperative radial artery and central venous pressure monitoring (). 2000

u of factor VIII infusion was applied before the operation followed by 4000 u of VIII factor during the operation. The operating room implemented standard disinfection and isolation procedures to prevent occupational exposure of the healthcare professionals to the HIV during the surgery. After the skin incision was made on the patient's right thigh, the

surrounding the aneurysm (Figures -). He had never had any previous imaging of his abdomen for comparison. The patient was immediately transferred to vascular surgery at our center for assessment and definitive management.\nOn initial presentation to our facility, after the CT scan, the patient’s physical exam demonstrated a tender pulsatile abdominal mass. He was afebrile and vital signs were within normal limits. Peripheral pulses were within normal limits. There were no clinical manifestations of infective endocarditis. Laboratory investigations showed white blood cell count 10.3 x

and pantoprazole. All of his symptoms improved while on this regimen, but they relapsed thereafter.\nGiven his abdominal and back pain, a non-urgent computed tomography (CT) scan was performed three months after his symptoms developed, which demonstrated a large aneurysm in the infrarenal abdominal aorta measuring 8.2 x 5.8 x 8.5 cm, with retroperitoneal fat stranding

trauma, the patient underwent a thorough examination (). Compared to the uninjured right wrist, the range of motion (ROM) of the left wrist was significantly restricted. Active closing of the fist was not possible especially due to incomplete reduction of swelling of the dorsum of the hand. No pain was observed over the trapezoid. In further clinical examinations after 14 weeks and five months (), the pain over snuffbox and wrist abated completely. Follow-up examinations 12 and 16 months after initial trauma (, and

patient complained swelling over the lateral epicondyle of the humerus, pain and loss of strength when extending fingers and wrist.\nFollow-up x-rays did not show any further changes and K-wires wires were removed after six weeks (). The patient attended physiotherapy one week after the removal of the K-wires. Eight weeks after the initial

detected.\nAt laparotomy (L) orchidectomy with removal of tumor, (R) orchidectomy, omentectomy and appendisectomy was performed [Figures –]. Histopathological examination of the excised specimens: Left testis: embryonal cell carcinoma, Right testis– normal, omentum – metastatic deposit, appendix- chronic appendicitis. Her postoperative recovery was uneventful. She was discharged on 18– December 2007 and advised to attend the Gynecology OPD after three weeks at which her S

hepatic secondary or significant lymphadenopathy was noted. Serum AFP came down to 3.4 IU/ml and S. B. hCG: 3.24 mIU/ml. After proper counseling and written and informed consent, laparotomy was done on 10 December 2007 under general anesthesia. The findings were: left testis was enlarged, 15×10 cm, right testis was of normal size, no uterus/ovaries

a hemostatic matrix (FloSeal). Wound closure was performed in layers in the usual manner.\nThe patient reported waking up from the anesthetic with symptoms of left arm nerve pain. Further assessment revealed reduced sensation in the left hand, predominantly the index finger, paresthesia over the lateral aspect of the left forearm, as well as spontaneous twitching of the biceps muscle. Clinical examination showed a positive Tinel’s sign over the ICD generator, weakness of the biceps muscle, reduced sensation over the lateral forearm and within the median nerve distribution. Ulnar and radial nerve function were found to be intact.\nSubsequent nerve conduction studies performed within weeks of the ICD placement

DR pulse generator). This procedure was performed in a different hospital. During the second procedure the initial subpectoral pocket was found to have been placed rather superior and lateral, requiring the formation of an entirely new pocket. The new pocket was lined with an absorbable antibacterial envelope (TYRX). Significant bleeding following removal was controlled using

review of included report bibliographies, with two publications unable to be included as the full article could not be viewed. All case reports were of metastatic lung cancer causing appendicitis.\nOf the 12 cases included, the mean age was 63.7 years with 11 of 12 cases being male. In only three cases did the patients present with an appendicitis which subsequently led to the diagnosis of metastatic lung cancer. Of the eight patients with a pre-existing diagnosis of metastatic lung cancer, the mean time from diagnosis was just less than eight

months, with six of these receiving chemotherapy at the time of presentation. Out of 12 cases, 10 presented with a perforated appendix.\nOf these 12 cases, half were small cell and half were non-small cell carcinomas [, , , , , , , , , , , ].

relation to mandibular incisors of one month duration. Clinically, only four mandibular anterior teeth were present which includes left incisors, right central incisor, and canine. Rest of the teeth were extracted due to chronic generalized periodontitis. Clinical examination revealed the lesion to be soft to firm in consistency with no bleeding on probing. Grade 3 mobility of anterior teeth was found except for the left lateral incisor which was grade I mobile. The overlying mucosa appeared

blanched and no evidence of ulceration was noticed. Oral hygiene was poor.\nRadiographic examination showed extensive bone resorption in relation to the mandibular anterior (left lateral incisor to right lateral incisor) region with a floating tooth appearance []. A tentative diagnosis of pyogenic granuloma was suggested by the oral surgeons as there were no other

his desire to maintain his natural tooth structure, he and his guardians chose fractured fragment reattachment. As there was minute pulp exposure following trauma, Simple reattachment procedure using dual cure composites would not have offered predictable success. Hence, instead of a simple reattachment, vital pulp therapy using MTA, followed by fractured fragment reattachment, functionally strengthened by fiber reinforced composites was planned.\nThe fractured fragment was cleaned, verified for its fit on

extraction as the last resort.\nAll the viable treatment alternatives were explained in depth to the patient and his legal guardians. Considering the young age of the patient and

limbs.\nOn examination in the neurosurgical clinic, the patient had hyperaesthesia from the neck down, most prominent in the hands and groins. The patient had reduced grip strength of 3/5, finger extension and abduction of 3/5, wrist flexion and extension of 3/5, elbow flexion of 4+/5, elbow extension of 4/5 and shoulder abduction of 4+/5 on the Medical Research Council power scale. Hip flexion was 3/5, with all other muscle groups in the lower limb at 4+/5. The patient had very brisk reflexes with pathological spreading in the upper and lower limbs. There

urine, reduced manual dexterity and neck pain. A neurology assessment was finally sought and an MRI for suspected myelopathy was organised.\nOn presentation to our neurosurgical clinic, the patient’s complaint remained sensory dysaesthesia from her neck down, particularly affecting her hands and groins. She complained of her body feeling like a ‘wet gel-like substance’. In addition to the above symptoms, the patient also complained of a 3-year medical history of numbness and tingling in her upper

to the trough value of the blood concentration, and her ptosis improved. The value of anti-acetylcholine receptor (AChR) antibody gradually decreased (71 to 10 nmol/L). Following 6 month observation, erythema on the extremities and body trunk suddenly appeared (Fig. ), which was diagnosed as drug eruption. The drugs for MG were thus reduced or interrupted. The patient developed progressive muscle weakness and fatigue and was admitted to the hospital.\nThe post-administration course and blood examination values are shown in Fig. . Aspartate aminotransferase (AST) and alanine

3 mg/day, prednisolone 5 mg/day, and pyridostigmine 180 mg/day.\nWhen she underwent an operation for colon cancer, chest computed tomography as a preoperative examination revealed local recurrence of a nodule 1 cm in diameter on the innominate vein and a small nodule in the anterior mediastinum (Fig. ). We recommended radiotherapy for the recurrent lesions, but she wished to undergo observation for a while. She hoped to receive treatment for the exacerbation of ptosis.\nThe dose of tacrolimus was increased according

the childbirth delivery forced her to the childbirth delivery room early. As she had undergone a vaginal delivery 3 years ago, vaginal delivery was induced but failed. Therefore, a decision was made to do a Cesarean section.\nAfter entering the operating room, the surgeons made the parturient woman take the lithotomy position to try a vaginal delivery again, but it was unsuccessful. Spinal anesthesia was administered to the patient since she had spent only 5 hours fasting. The surgeons put the patient in the

right lateral decubitus position and disinfected the puncture part between the L3-L4 spinous processes with betadine solution. Then, the surgeons inserted 26 G Quinke, a

sounds, such as the sound of her alarm clock.\nThe patient had a history of misophonia (; )—a disorder characterised by strong negative emotions in response to particular sounds. The patient's misophonia began during her childhood (age 12) and was mainly triggered by the sounds of her father eating and sniffing. In adulthood, she described similar misophonic reactions to sounds made by her husband, such as ‘clicking’ sounds when he spoke. After her stroke, she perceived more ‘clicking’ sounds in speech. Breathing noises—which had not bothered her previously—also triggered misophonic reactions. In general, she

found that a wider variety of sounds triggered misophonic reactions (for example, the distorted sound of the running tap), and she experienced misophonic reactions more intensely. Other triggers included the sound of music from headphones worn by others and the sounds made by people typing at work. She had numerous misophonic episodes,

function tests (pH: 7.30, K: 6 mEq/L, and creatinine: 4 mg/dL). After the patient was unresponsive to verbal commands and developed confusion and disorientation, he was transitioned to hemodialysis immediately about after 24 h from the first seizure for rapid removal of contrast agent and improve the metabolic acidosis and hyperkalemia. Non-contrast head CT scanning performed 48 h after the onset of symptoms showed sulcal effacement in the right cerebral hemisphere due to cerebral swelling (). The neurological symptoms fully resolved after performing hemodialysis a second time and conservative treatment. During the observation period after the first hemodialysis, the patient remained seizure-free. A magnetic resonance imaging (MRI) and MR angiography at 90 ho from patient’s symptoms showed

no sign of bleeding no edema and no swelling or cortical enhancement on the T1-weighted images (T1WIs) or on the fluid-attenuated inversion recovery (FLAIR) images ( to ). Subarachnoid hemorrhage was also ruled out by the absence of any hyperdensity in the sulci on the MRI and the control CT. Actually, CIE was diagnosed based on the patient’s

a severe decrease in joint ROM (flexion, 100°; extension, 0°; abduction, 30° internal rotation, −5°, external rotation, 20°). Spine and sacroiliac joints did not show any significant findings upon physical examination. A simple radiograph showed no remarkable findings thus an magnetic resonance imaging (MRI) was conducted. Exudation in the right hip joint was increased, and his acetabular articular cartilage and acetabular labrum were almost completely obscured (; ). His C-reactive protein and erythrocyte sedimentation rate were in the normal range. Serum markers for rheumatoid

arthritis, including the rheumatoid factor, were also normal. The patient did not have a family history of rheumatoid arthritis. The patient was initially diagnosed with transient synovitis of the hip and arthrocentesis was administered after hospitalization. The findings of the hip joint fluid were all normal. After hospitalization, he was enrolled in a conservative treatment, including traction and physical therapy, yet he did not noticeably improve. Accordingly, a total hip replacement arthroplasty

he was suffered of feeding disorders). On the family’s screen questionnaire, his mother reported using her mobile phone herself for more than 3 hours a day while his father reported essentially watching the TV.\nSubsequently, his parents were asked to completely stop any and all screen and media exposure for all the family (the sister is 6 months old). Written pieces of advices were provided to the father by the pediatrician to increase outdoors

the TV News with his father after work) since his first 6 months and that he was habitually watching YouTube Kid alone on the parents’ smartphone for 3 hours a day, especially during mealtime (as

gait, and bilateral jerky type multidirectional nystagmus, but his mental status was alert and he did not show sensory changes in his extremities. On the evaluation of dizziness, neurological evaluation and consultation to Otolaryngology Department was done. His dizziness was not associated with spinning sensation, and it was nontrue vertigo type. He had no ear fullness or tinnitus, and his ear drums and hearing function were all intact. On neurological examination, his cranial nerve

function test or deep tendon reflex test showed no remarkable findings, and rapid alternating test and finger-to-nose test also showed normal findings. On standing, he was slightly swaying

mg and hydrocortisone-50 mg) intravenously. Her trachea was intubated with a tracheal tube (4 mm ID) to provide chest physiotherapy and endotracheal suction was done to remove secretions. Lignocaine 1% 1 mL was instilled intratracheal through endotracheal tube to reduce the irritation of the tracheobronchial tree and hence, to control cough reflex. The trachea was extubated when the child was awake. During postoperative care, she was given humidified oxygen by

was retrieved safely but with great difficulty. It was a plastic piece in tortoise shape with multiple sharp pointed projections measuring 5 mm × 9 mm []. During the procedure, the child was ventilated gently through bronchoscope with oxygen, nitrous oxide (1:1) and halothane 1-2%. Besides the initial dose, only two intermittent doses of succinylcholine (5 mg IV each) were required. She maintained her all vitals and oxygenation throughout the procedure.\nShe was given steroids (dexamethasone-2

line in (A)) and 11.5 mm on the left side (blue line in (A)).\nTwo years before the clinical onset of CMA, the patient underwent follow-up MR imaging. As shown by , retrieval and retrospective examination of these images indicated that the anatomical deformity in the right maxillary sinus had not progressed (the red and blue lines in (B) indicated distances from the center line of 19 and 11 mm, resp.).\nIn the 2 years after the second MRI, the patient started complaining of repeated sinus-related symptoms such as cheek pain or pressure on both sides and anterior purulent nasal discharge once every 1 or 2 months ().

of the midbrain to the nose tip) to the most deviated medial wall of the maxillary sinus was 19 mm on the right side (red

initiated 17.5 months postmastectomy. The patient tolerated chemotherapy well without significant side effects. Interval imaging after 2.5 months of treatment demonstrated a decrease in the size of the four lesions to 1.3 × 1.0 × 1.5 (from 2.8 × 2.0 × 2.6 cm) at the 9:00 position, 1.6 × 0.9 × 1.3 (from 3.0 × 1.7 × 2.8 cm) at the 9-10:00 position, 1.5 × 1.5 × 1.9 (from 1.7 × 1.4 × 2 cm) at the 10:00 position, and 1.5 × 1.6 × 2.1 (from 3.4 × 2.8

clinical stage IIIC disease (T4a, pN3b, M0).\nThe patient was referred to medical oncology, and given the extent of disease; it was felt that pre-operative chemotherapy would assist the surgeon in obtaining margins when the area of recurrence was resected. The patient's systemic chemotherapy regimen consisted of six cycles of adriamycin/cyclophosphamide and three cycles of dose-dense paclitaxel. This treatment was

the location, and also substantiated by a precise neurological objective examination, we deduced a very high pre-test possibility of neuralgia associated with the ninth cranial (glossopharyngeal) nerve in. The diagnostic procedure was performed by MRI of the cranial base with fine cuts at the cerebral trunk level. This allowed for the determination of a compression by a vascular structure derived from the right vertebral artery named PICA (posterior inferior cerebellar artery) (Fig. , , ).\nThe initial treatment according to specialist consultation was

of the pharyngeal reflex without distal neurological deficits. Vital signs were normal, he was normotensive, had a regular heart rhythm and normal ambient oxygen saturation. Laboratory findings were normal.\nFrom a diagnostic point of view, considering the characteristics of the pain, its quality, the temporal characteristics and

partial colectomy of transverse colon (20 cm). Postoperative histopathologic study revealed a 7∗6∗5 cm mass in transverse colon. The tumor was sharp, extended up to the serosa (T3), without vascular, perineuronal, and lymphoma invasion. None of the 6 removed lymph nodes were involved. Both proximal and distal margins were free of tumors. The tumor should be at least at stage IIa of the Duck class (T3, N0, Mx).\nPostoperative reevaluation of the patient defined that the patient had similar transient abdominal pain since the start of her last

and this hypothesis was not acceptable by surgeons. Therefore, patient underwent colonoscopy which showed a mass in a spleen curvature of colon. Patient transferred to the oncology ward and underwent

at his left foot without any ulcer or bleb, moist skin, or pitting edema, and the left dorsalis pedis and posterior tibial pulse could be palpated (1+) but were diminished (). The motor functions remained intact. Doppler ultrasonography was performed and revealed an uncompressible vein along the midsuperior femoral vein to the popliteal vein. His laboratory investigation showed that the leukocytosis and creatinine level rose from 1.04 mg% to 1.62 mg% and creatinine phosphokinase (CPK) was 322 U/L. He

for surgical pulmonary embolectomy.\nOn the next day at the surgical intensive care unit (ICU), he developed progressive left leg edema with cyanosis. He had no fever and he could still move his leg, but his pain could not be evaluated since he was delirious. On examination, his left lower limb exhibited discoloration

suggestive of inflammatory and sensitized conditions. Physical treatments including assisted active and passive range of motion (ROM) exercise and ice-massage, hot packs, and gradual weight bearing were started to obtain graded desensitization. These physical treatments lasting 20 minutes in each session were conducted once a day and were continued until the final visit. The physician and physical therapists instructed the patient and his mother in CRPS I and the validity of the treatments at every

visit. On the 11th day, VAS score for pain during motion was reduced to 53 mm and the patient was able to move his ankle and touch the sole of his foot on the floor. On the 22nd day, VAS was remarkably reduced to 2 mm and allodynia and edema were completely gone. The administration of celecoxib and pregabalin was terminated. On the 35th day, he reported no pain. He could

observed, along with mild aortic valve insufficiency. The ascending aorta was dilated (approximately 5 cm). There were no respiratory symptoms, and spirometry did not show significant abnormality.\nThe patient underwent TKR. On the first day after the operation, she developed dense right arm weakness and left homonymous hemianopia. There were no other obvious focal neurological deficits. CT and brain MRI showed innumerable T2 FLAIR hyperintensities, demonstrating high diffusion-weighted imaging signals that were consistent with

multifocal acute infarcts. These were predominantly cortically/subcortically distributed in both the right and left cerebral hemispheres within the frontal, parietal and occipital regions; additionally, there was a small focus within the left cerebellar hemisphere, favouring a central embolic cause. The patient was managed according to

cancers as well as no other important former medical visits were reported. Pleural aspiration was performed resulting in 200 ml serous-hemorrhagic fluid. Cytology analysis of pleural fluid revealed ductal cell carcinoma. Fine-needle aspiration of the lump near the ulceration in the right breast also showed ductal cell carcinoma. Ultrasonography of the

lymph nodes. More detail history taking revealed that the patient recognized a lump around 2 cm in diameter since a year before admission. The lump grew slowly, and skin ulceration appeared since the past month. No previous history of gynecological cancers as well as benign tumor in the breast including fibrocystic, ductal papiloma and atypical ductal hyperplasia. Her personal history included G3P3, menarche at 14 years, breast feeding for 18–24 months of each child, and using of hormonal contraception for 4 years. No family history of breast and gynecological

initially presented to her primary care physician two weeks prior to presenting to our orthopaedic clinic with limping and intermittent refusal to bear weight through the left leg. The mother of the patient denied any previous trauma or constitutional symptoms but did endorse foreign travel; they were living in Japan at the time of presentation to our department. The patient was current on all vaccinations.\nThe initial orthopaedic evaluation revealed a well-appearing, healthy child in no acute distress. The gait exam revealed that she refused to weight bear on the left lower extremity. The patient had very mild generalized tenderness in the left midfoot region; otherwise, no other area of tenderness

was appreciated upon further examination of the lower extremities. She had full, painless range of motion of her hip, knee, and ankle joints. There was no erythema or swelling of the left foot; however, there was a mild effusion of the ankle. She was neurovascularly intact with normal reflexes.\nShe was afebrile, and vital signs were within normal parameters. Radiographs of the left lower extremity revealed no osseous abnormality (). Laboratory findings

infiltrates. We had performed a subtotal gastrectomy on her for this reason 2 months prior to her current presentation. Treatment with oral capecitabine (1500mg twice daily) was initiated 48 hours before she was admitted to our hospital. The echocardiogram taken in the emergency room was within the normal limits, including a sinus heart rate of about 62 beats per minute (bpm) and physiological hemodynamic parameters and negative biochemical markers for myocardial necrosis (including cardiac troponin I (CTnI), creatine phosphokinase, creatine kinase isoenzyme MB, lactate dehydrogenase, and serum glutamic oxaloacetic transaminase). She was transferred to the coronary intensive care unit (ICU)

for further observation. The echocardiogram, which was performed when the patient was pain-free, revealed normal ventricular volume, no segmentary wall hypokinesia with a left ventricular ejection fraction of 72%, normal diastolic heart function, normal valve flow and absence of pericardial effusion (Figure ). Taking

ambulate as tolerated after surgery.\nThree patients were included in this case series: a recalcitrant nonunion of the distal humerus, nonunion of a wrist fusion secondary to a distal radius giant cell tumor en bloc excision and a thumb distal phalanx reconstruction due to complete distal phalanx loss. Average age was 49 years old (31–59), one female, two males, one right upper limb and two left upper limbs, one right knee donor site and two left knee donor sites (see ). None were smokers,

DASH score was 12.5 ().\nPostoperative treatment included 81 mg of aspirin daily for 30 days. The flap was assessed using Doppler 2 weeks after surgery, and the donor site was examined as well. All patients were allowed to bear weight and

presented to her primary care physician for a growing mass on the left side of her neck. CT imaging of the neck was obtained, which depicted multiple mass lesions in the left neck, with the largest measuring 6 cm x 8 cm x 6 cm and characterized as a mixed cystic and solid mass displacing the trachea and other related structures rightwards. A core biopsy of the mass was then obtained. Epithelial cells were diffusely positive for HBME and vimentin, variable for CK903, and weakly for CD57 with a low Ki67 proliferation rate. These makers were suggestive of

thyroid cancer and subsequent staging revealed metastatic papillary thyroid cancer (Stage III, PT4a/PN1b). She underwent a total thyroidectomy with left neck dissection. She was noted to have esophageal serosal, perineural, and angioinvasion involvement of the tumor per

of rectal misoprostol, the uterine arteries were blocked and the B-Lynch suture was done. No blood transfusion was required for the mother and her hemoglobin (Hb) level 6 hours after the operation was 9 g/dl; her pre-operational Hb level was 10g/dl. The mother was discharged 3 days after delivery with no complications.\nFor close follow up, the mother and her newborns were visited two weeks after delivery; they were all healthy and had no problem. The infants were visited once again 6 months later revealing normal physical and mental development in all four. shows the babies at 6 months of age.\nThis project has been approved by Ethical Committee and Vice Chancellor for Research of Mashhad University of Medical

D weighed 2100 and 1980 gram with an Apgar score of 7-8 and 9-10, respectively. Among the 4 neonates, only quadruplet B was transferred to the NICU; she was discharged after 2 days in good health. and show the quadruplets after birth.\nBecause of atonic uterus during the cesarean section, after the administration of the appropriate dosage of oxytocin and methylergonovine and 800µgr

at which point she presented to hospital. She had been suffering from a background of nasal congestive symptoms and intermittent headaches for the previous ten days.\nOn admission, her visual acuity was 6/4 in her right eye and limited to perception of light in her left eye in all quadrants. In her left eye, there was a relative afferent pupillary defect and red desaturation. Eye movements were normal. Fundoscopy of her left eye revealed optic disc swelling but nothing else; the macula was normal, there was no vascular sheathing

three day history of gradual loss of sight occurring from the superior to the inferior aspect of her vision - 'like a shadow' falling over her left eye where she was able to see 'grey only' in the upper half of her left visual field with the lower half appearing 'blurry'. In addition, she had been concurrently experiencing dull pain around her left eye and on eye movements, especially left eye adduction.\nOver the next 24 hours her vision further deteriorated. She was now able to see 'grey only' in the whole left visual field

the next 3 years. They were all similar, some associated with lateral tongue laceration suffered during the event. He was seizure-free for 6 months and then began to have spells at least monthly. He denied an aura or premonition preceding his seizures. His wife reported at night that he would “cry” at the onset and then appears to have clonic jerking bilaterally and symmetrically, up to 3 minutes in duration. He was reported to be distressed for a few minutes after the episodes. Brain MRI was reportedly normal

or urinary incontinence, but he was disoriented afterward for much of that day. He had another episode within the same month while he was performing physical training exercises, whereby he collapsed and remained confused for hours, but no report of witnessed convulsions. An evaluation at that time was unrevealing. He had 12 episodes in

was that the roots of the right first unerupted molar were developed in comparison with the opposite side and had unusual radiolucency with them.\nOn the basis of the clinical and radiographic features, the differential diagnosis of this lesion included odontoma, cementoblastoma, and osteoblastoma. Considering the radiographic features based on the attachment to the tooth root, we ruled out osteoblastoma. However, microscopic examination was necessary to differentiate between odontoma and cementoblastoma. Surgical enucleation of the lesion, including the removal of the involved teeth,

was planned and executed under general anesthesia.\nThe tumor mass was embedded in the root of the deciduous mandibular second molar tooth and had an irregular surface with a maximum dimension of 1.6 cm.\nHistopathologic examination revealed sheets of a cementum-like material entrapped within the vascular connective tissue stroma ().\nThe intervening connective tissue stroma was loose and vascular. Prominent reversal lines were seen

was sent back to the operating room for reexcision lumpectomy to ensure full 1 cm margins around the malignant tumor. A lateral intercostal artery perforator flap was performed for appropriate wound coverage.\nThe patient has been doing well since the time of surgery with no current signs of metastasis or local recurrence. Chemotherapy was not currently indicated, and although radiation therapy was recommended, the patient

necrosis (–). The tumor was within 0.5 mm of the closest resection margin. Therefore, per the 2019 National Comprehensive Cancer Network guidelines, the patient

to represent a neoplastic or inflammatory process. In addition, a plain abdominal radiograph was done, showing dilated small bowel loops, suggestive of small bowel obstruction (Figure ). The CT scan images showed high-grade small bowel obstruction and transition zone with ileal wall thickening, fat stranding, and prominent lymph nodes (Figures , ).\nThe patient underwent laparoscopic exploration, which revealed two mid ileal masses. The proximal part related to the masses was dilated,

where the distal part was collapsed. The mid ileal masses were attached to the small bowel mesentery, and hence the procedure was converted to the midline laparotomy. The affected bowel was found

the emergency room (ER) following severe bilateral injuries to his eyes as an attempt to self-enucleate. The patient called his son to his bedroom after attempting to manually pull his eyes out with his fingers because he was instructed to do so by God and felt the need to cleanse myself from sin. The patient was transferred to the ER by ambulance and appeared calm. The son reports that the patient had been acting strange and displayed decreased appetite and increased wakefulness. He was noted to draw complex numerical pyramid schematics

in a notebook, and endorsed that God was speaking to him more over the past week. He was diagnosed with bipolar disorder 18 years ago with most recent manic episode occurring 16 years ago, resulting in a failed suicide attempt by hanging and subsequent hospitalization. Since then, the patient followed up with an outpatient psychiatrist on Risperdal 1 mg every night (QHS) and lithium 900 mg QHS and was otherwise noted to be highly functional and performed well at a high functioning professional. The patient had no other history of self-harming behavior.\nOn mental status exam he appeared well groomed with good hygiene

pressure of 39.9 mmHg, an O2 pressure of 131 mmHg, and a bicarbonate concentration of 20.8 mmol/L.\nLaboratory workup included a complete blood count, and measurement of serum electrolytes, lactate, cardiac and liver enzyme levels. The results were the following: white blood cell count 9.8 × 109/L with 41% polymorphonuclear cells; a hemoglobin level 10.4 g/dL; platelet count 336 × 106/L; troponin 0.003 ng/mL; sodium concentration 144 mmol/L; potassium 3.5 mmol/L; chloride 99 mmol/L; bicarbonate 16 mmol/L; glucose 346 mg/dL; blood urea nitrogen

bilaterally and reactive to light, preserved corneal and oculocephalic reflexes, and a downward Babinski reflex bilaterally.\nArterial blood gas analysis on mechanical ventilation on 100% fraction of inspired oxygen (FiO2) showed a pH of 7.34, a CO2

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

position.\nThe following day, inferior vena cavagram was performed demonstrating high grade intrahepatic IVC stenosis with extensive collateral flow through the azygous system and thoracolumbar venous plexus ().\nThe pressure gradient across the stenosis measured 11 mm Hg. The stenosis was sequentially 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.

crazy pavement pattern [ and ]. As there was no radiological evidence of infection and fluid overload, a diagnosis of interstitial pneumonitis was considered. A drug-induced etiology of the lung pathology was considered secondary to mycophenolate sodium (idiosyncratic reaction as there was no skin rash, arthralgia, or blood eosinophilia) and the drug was withdrawn. Over the next 4 days, he showed progressive improvement. His oxygen requirement came down dramatically, and he was discharged on day 14 in stable clinical condition without any oxygen requirement. A repeat

CT scan of the chest after 4 weeks showed considerable improvement in the pulmonary infiltrates. [ and ] The patient is doing well after 6 months posttransplantation.

a 43-year-old woman who presented with a large pelvic mass and was admitted to Shandong Cancer Hospital and Institute in June 2006. Her only complaint was lower abdominal pain. Pertinent past medical and surgical history include: benign hypertension for 2 years, prior cesarean delivery, prior hysterectomy, and inferior vena cava filter placement approximately three years prior for history of venous thrombus.\nThe patient reported undergoing a total hysterectomy and bilateral ovarian cystectomies for uterine fibroids 3 years prior to this presentation at a local hospital. Pathologic review

of this specimen shows uterine IVL based on the Immunohistochemical staining profile and <5 mitotic figures per 10 high-power fields. Additionally, in April 2006, three months prior to her current presentation, the patient was

to which he consented.\nSurgery was conducted using a lateral approach. Once the incision was made, bloody, dark, dirty-colored thick material continuously drained out (Figures , ). As a result, metallosis was suspected, and the collected material was sent for histopathology and detailed report (D/R).\nThe fracture was identified, the broken plate was removed, and thorough wound debridement was completed. The fracture was then reduced and fixed using a distal femur locking plate and a bone graft. The wound was closed in layers, and the stitches were removed after two weeks. Gradual knee movements were allowed as tolerated. Follow-ups were conducted every two

was non-tender, fluctuant, and measured 10 × 15 cm in size.\nThe patient’s blood workup came back normal. Radiographs were done, which showed a failed plate (distal femur condylar plate) and breakage of the implant (Figure ). A diagnosis was made of implant failure with non-union secondary to a distal femoral fracture of the right side. The patient was then told about his condition and was thoroughly counseled regarding the need for surgical exploration,

set ears, hypertelorism, broad and small nose, webbing of the neck was present, the left shoulder was higher set than the right shoulder, low set and widely spaced nipples, and dark patches were present on the forearm. Testes were not palpable [Figures and ]. Systemic examination revealed murmur on cardiovascular examination. Mental Status Examination showed that patient was well kempt and co-operative, with nonspontaneous speech and decreased content of speech with euthymic affect. He was worried about his health and performance in school. There were no obsessions, delusions or hallucinations. Memory, orientation, insight and judgment were intact.\nUltrasonogram of

the abdomen revealed a left ectopic kidney, right undescended testis, and absent seminal vesicles.\nTwo-dimensional echocardiogram showed branch pulmonary artery stenosis.\nKaryotyping showed 46 XY.\nEEG and CT scan head were normal.\nOn Seguin form board test, IQ was 90 (lower range of normal).\nOn Wisconsin card sorting test, he successfully completed only two categories and made 65 correct responses including 63 errors. He failed to maintain set once, which occurred on the mid-trial of

a more precise location and definition of the pathological features of the resorption sites. CBCT was performed in all three dimensions - axial, sagittal, and cross-sectional - with a slice thickness of 1 mm by using a Promax CBCT scanner (Planmeca, Helsinki, Finland) together with 3D rendered images. The axial () and panoramic reconstructed images () of the left maxillary first molar clearly showed multiple resorptive areas. The cross-sectional images showed internal resorption of the teeth, including the right maxillary central incisor, first and second premolars, left central and lateral incisors, canine, and right mandibular second premolar (). Further, external resorption was found

was detected.\nInitially, a panoramic radiograph was taken. The radiograph showed evidence of resorption in several teeth, including the right maxillary central incisor, first and second premolars, left maxillary central and lateral incisors, second premolar, and first molar, and the unerupted left maxillary canine (). A decision was made to perform CBCT with 3D reconstruction to obtain

mL of 0.5% doxorubicin into the 2 sites (Fig. ).\nOn the first day after the operation, the patient reported significant relief from the right lower back pain and approximately 50% pain relief in the lower abdomen and groin. In addition, he could now sleep on his right side, and turning over was not aggravating the pain. One month later, the pain was relieved completely, and we detected hypoesthesia at the T11 and T12 dermatomes (DN4, 2

points). The pregabalin was reduced to 150 mg/day, and the use of oxycodone was stopped. In the second month after the operation, the patient received a course of chemotherapy for the cervical lymph node metastasis. The patient felt pain again (VAS, 3 points; DN4, 4 points) in the right lateral position at the 4th month,

with mineral trioxide aggregate (white ProRoot MTA, Dentsply Tulsa dental, Tulsa, OK, USA). While an endodontist worked with the extracted #37, an oral surgeon removed the tooth fragment from the extraction socket of #37 (). After placing the tooth back into the socket, there was no mobility, and no additional splinting was needed thereafter. Total tooth fragment removal was confirmed with periapical radiographs (). One week after surgery, the tooth was slightly mobile and sensitive to percussion. The patient was instructed to have a temporary resin crown for protection. However, when the patient visited our clinic for a 3-month follow up, the tooth remained asymptomatic, and the periapical radiolucency had decreased. The results of a

from the extraction socket.\nOne week before surgery, an orthodontic elastic separating ring was inserted into the interdental space between #36 and #37 to increase the mobility of #37. The surgical procedure was performed as planned without any complications. The extracted #37 was retro-prepped and retro-filled

on the culture examination of the specimen harvested during surgery. A hard brace was applied for 3 months after surgery. Laboratory findings at 3 months after surgery showed no evidence of inflammatory signs; white blood cell count was 5000/μL, C-reactive protein level was 0.1 mg/dL, and erythrocyte sedimentation rate was 4 mm/h. Two years after surgery, the infected anterior site had healed, and bony fusion was successfully achieved (). The patient is now completely asymptomatic without a brace and has not had a recurrence of infection.

3 months at the same dose of the preoperative period was continued after surgery, as these antibiotics have been proven to be effective against Mycobacterium abscessus, which was identified

of dysphagia and regurgitation. upper gastrointestinal (UGI) endoscopy was done which showed large wide mouthed diverticulum in lower oesophagus around 36 cm from the incisors. The mucosa within the lumen of diverticulum was normal and there was no other lesion in oesophagus, stomach or duodenum. Subsequently, barium swallow and Contrast Enhanced Computerised Tomography chest and abdomen were done which confirmed the diagnosis of epiphrenic diverticulum measuring 5 cm in maximum diameter arising from posterolateral wall of oesophagus around 4 cm above the Gastro Esophageal junction. Oesophageal manometry showed diffuse increase in pressure tracings with hypertensive Lower Esophageal Sphincter but normal peristalsis and LES relaxation

with swallow. Twenty-four hour pH study did not reveal presence of preoperative reflux. The patient was taken up for surgery based on the severity of symptoms and objective

( and ). There was adequate retrograde filling of the LCX as far as the LAD and LCX bifurcation. No LMCA was evident. The LAD was antegradely filled from the LCX and retrogradely by a large collateral artery from an RCA ventricular branch that extended to the cardiac apex. The middle third of the LAD was diffusely hypoplastic.\nA dobutamine stress echocardiogram (DSE) was immediately performed to determine the potential need for surgical coronary artery intervention. DSE analysis confirmed good left ventricular function with no evidence of regional wall motion abnormalities.\nThe transcatheter secASD closure was deferred pending

cardio-surgical evaluation of the coronary artery findings. The overall appearance was judged to be a congenital coronary artery anomaly, but the diffusely hypoplastic LAD raised the question of an inflammatory, and thus acquired aetiology.\nIt was decided that the risks of surgical coronary artery intervention to bypass graft or re-anastomose the left

the usual way. Postoperative period was uneventful and patient was discharged on 5th postoperative day. The biopsy of the appendix was reported as chronic appendicitis. After 15 days, he developed pain in the umbilicus with no fever, vomiting, or pus discharge. Ultrasonogram abdomen showed no abnormality. Patient was treated with oral antibiotics and analgesics for 15 days. There was no response, and after 1 month umbilical exploration

was planned assuming stitch abscess as the cause of pain. Exploration was done by a vertical incision around the umbilicus and no abscess was found, and the wound was closed with 1/0 Ethilon. After exploration, there was increase in the severity of umbilical pain and it was aggravated by touch. The pain was severe enough that

poured with dental stone. A lingual arch incorporated with two molar tubes (on the edentulous side) was fabricated using 0.9 mm wire on the lower cast (). Wax up was done on the edentulous span containing artificial molar teeth (to replace 84 and 85), such that the molar tubes were incorporated into the wax up in order to later serve as hinges for the dentulous component. On the

buccal side of the dentulous component, another molar tube was placed, such

apex via the 5F sheath to protect the patient from bradyarrhythmia.[] Mean pulmonary artery pressure was measured at 35 mmHg.\nThrombectomy was performed using a 6F AngioJet Xpeedior catheter directed to both main pulmonary arteries via a 9F MP-1 catheter in the right ventricle (Fig. ). This was undertaken through the 10F sheath in the right femoral vein. The AngioJet system was used for a total of 2 minutes and 10 seconds and selective pulmonary angiograms revealed significant reduction in thrombus burden from both left and right pulmonary arteries with significant restoration of blood flow (Fig. , Additional file ). A quantitative measure of perfusion improvement was not assessed due to

our relative inexperience with this procedure. Clinically, however, as perfusion returned to each main vessel the patient suffered what appeared to be a pre-syncopal episode on both occasions although all observations including heart rate, blood pressure and oxygen saturations remained within the normal range. Why this occurred remains unclear. The entire process took a total of 1 hour and 35 minutes and required 90 ml of contrast.

ventilatory weaning was performed 4 days later with a second acute respiratory distress and a new endotracheal intubation. On the sixth postoperative day, the patient presented a productive cough, a temperature of 38.2°C, and a suspicion of wound infection of the operative site and developed rapidly an increasing emphysema of the neck and the upper torso. Computerized tomodensitometric cervical and thoracic examination showed a pneumomediastinum and a leak from the anterior part of the trachea secondary

a postoperative ENT check. The patient was admitted into intensive care unit, and a systemic corticotherapy (1 mg/kg/day) was introduced. A new attempt of

were indicative of L-NOP. Hence, we started with 5% lidocaine medicated plaster treatment (12 hours a day).\nThe patient was informed that at the time of treatment, no specific indications had been published for 5% lidocaine medicated plaster for L-NOP. For this reason, written informed consent was obtained from the patient both for the treatment, and separately for the publication of this case report and any accompanying images.\nFor practical reasons, we first decided to apply the plaster to the area(s) of maximal pain during the day. After 14 days of treatment, spontaneous pain intensity was

measured as a score of 6.7 on the VAS, accompanied by a marked reduction in the painful area (). Upon neurological evaluation with a Von Frey hair (4.56 g corresponding to a target

was 0.94 mg/dL (NR: <1 mg/dL). HIV 1&2 antigen and antibody test were negative. Magnetic resonance imaging (MRI) of face showed preseptal soft tissue thickening consistent with cellulitis. Ocular globe, postseptal space, ocular lenses, extraocular muscles, optic nerve sheath, lacrimal glands, and retro-bulbar fat appeared normal with no involvement from infection (Figure ).\nBlood cultures returned negative after 5 days of incubation. Serum sample was sent for microbial cell-free DNA test also known as meta-genomic testing. It showed 459 DNA molecules per microliter (MPM) of human adenovirus D in the serum sample with normal range of

creatinine, and liver function tests were all within normal limits except for an elevated blood sugar of 268 mg/dL (normal range [NR]: 70-110 mg/dL). Procalcitonin was normal at 0.04 ng/mL (NR: <.1 ng/mL), erythrocyte sedimentation rate was elevated at 54 mm/hour (NR: 1-13 mm/hour), and C-reactive protein

arm. Physical therapy was continued for 3 months following surgery, after which the patient stopped attending the sessions. She consulted specialists at several different institutions and all advised conservative therapy. Conservative therapy continued unsuccessfully until the patient was referred to the senior author's institution for further evaluation.\nAt the time of presentation to the senior author's institution, 1 year after the index operation, the patient complained of excessive pain that awakened her from her sleep and severely limited her daily activities. On physical examination of the right shoulder, an unconventional matured incision scar was

visible []. Her right acromion was readily palpable and the bulk of the deltoid muscle could be easily palpated over the superior portion of the arm with attempts at shoulder abduction. The active range of motion (ROM) of the right shoulder was severely limited: active scapular abduction was 50° and both active external and internal rotations were limited to

screaming sometimes without apparent reason. He did not respond to instructions and appeared distant when attempts were made to interact with him. He however often responded to the word 'take', especially if the individual interacting with him was holding a biscuit or any other snacks, which he usually snatched away forcefully and ate voraciously. Associated behavioral problems included destructive tendencies, screaming without apparent reason and running around the destitute home in a circle, which gave him delight as he almost always resisted any attempt to stop him and often required forceful intervention

his fingers. He often snatched away other children's meal and snacks after finishing his own. Presently at the age of 13 years the patient could not utter a word, only shouting and

visible beyond the incisal margin after fixing ().\nA small recess was prepared in the pulp chamber of fractured segment of 11 and 21 and was tried against the remaining crown portion with the post for approximation. The opposite surface of the fractured crown was then etched with 37% phosphoric acid and the fragment was luted in the correct position using dual cure resin (ParaCore-Coltene Whaledent) with slight pressure. Excess of

the material was removed using a sharp instrument from the edges and was light cured for 20 seconds for faster polymerization. A bevel was prepared on the margins of the approximating surfaces of 11 and 21 on the labial side and the margins were sealed with nanocomposite (Brilliant NG-Coltene Whaledent). Polishing of the surface was done with polishing disks which ensured an aesthetic blending of the margins ().\nPatient was recalled after six months and one year. On examination, 11 and 21 were found

made up of cortical and cancellous bone and placed to one side (Fig. a–c). An epidural catheter was placed inside the soft tissue of the graft site and left overnight. It had a continuous fusion of a local anaesthetic to improve post-operative pain and encourage early mobilization.\nPreviously, using CT scans, a titanium construct was made to guide the outline of

of her operation. The Osmed pellets were removed from the subperiosteum (Fig. a and b) and the iliac bone graft was taken,

of the posterior vaginal mucosal defect, and the subcutaneous fat tissue on the distal area of the flap was removed to thin the flap, while confirming bleeding from the flap margin (Fig. c). The flap was sutured to the surrounding vaginal wall with absorbable interrupted horizontal mattress sutures (Fig. d). Before donor site skin closure, a small suction drain was placed in the gracilis muscle harvested space. We show the illustrations of the operative procedure in Fig. . The patient had

open drainage for subcutaneous abscess and was discharged on the 21st postoperative day. Seven months after the radical operation, we confirmed the fistula repair by pelvic examination of the vaginal wall and colonoscopic exam of the anorectal wall (Fig. ). Sigmoid-colostomy reversal was performed. The patient has experienced no RVF and complete anal function without soiling and has not been trying to do sexual intercourse in

increased to 50 mg. About 25 days later, the patient again developed depressive symptoms in the form of mild fatigue and some decrease in self-confidence, which lasted for 3-5 days. She now scored only 7 on Hamilton depression rating scale during the episode. There were no ideas of hopelessness, helplessness, worthlessness, or suicidal ideation. However, the lack of confidence still prevented her from carrying out her duties in those 3-5 days, although otherwise she was symptomatically much better.

However, with one session of supportive counseling, she managed to get back to work as well. In the subsequent month, although she complained of mild fatigue, there were no other symptoms and

disappeared. His intraocular pressure was still over 30 mmHg and a repeat trabeculectomy with mitomycin C was planned. In the first month after the herpetic keratouveitis attack, trabeculectomy with mitomycin C was performed about halfway through an eight-week interval between two doses of infliximab. Neither ocular inflammatory attacks nor infectious complications were observed in the operated eye

healed, patchy iris atrophies were detected and the anterior chamber reaction was under 1+ (), so the topical acyclovir therapy was discontinued. Topical prednisolone acetate was gradually tapered as the anterior chamber inflammation

the patient unexpectedly died. The emergency CT scans (shown in Fig. ) showed a brain abscess in the left hemisphere, confirmed later by the pathology report. Officially, the adverse event was not related to the irradiation, as it has never been associated with post-RT brain toxicity in the literature. Nevertheless, we can assume that this situation is an indirect treatment side effect. The patient had persistent chronic sinusitis, and the skull base bones exceeded their dose tolerance, which could potentially be open gates to the brain infection.\nThe patient worked as a nurse until her death and

MRI (June 2020) showed promising results with tumor shrinkage to 0.4 cm3, without evidence of radionecrosis or any other adverse effects (shown in Fig. ).\nIn August 2020, 1 year after the last treatment,

planning. Physical examination by the urologist revealed a 5 cm × 6 cm firm, nodular, mobile mass attached to the posterior lip of the urethra (). Further examination of the urethra did not reveal any additional masses or extensions. No preoperative imaging was performed.\nThe patient was scheduled for an examination under anesthesia, cystoscopy, and planned vaginal excision of the mass from the posterior urethral edge. Further imaging with ultrasound, CT scan, or MRI was deferred pending final pathologic findings.\nAt the time of a

examination by the colorectal surgeon it was determined that this lesion was not arising from the perianal region but was in fact of periurethral or anterior vaginal wall origin (). The patient was referred to urology for further evaluation and discussion of surgical

was mild and a small amount of dentoalveolar expansion was not necessary to achieve an adequate transversal interarch relationship.\nComprehensive orthodontic treatment was conducted using preadjusted brackets. Dentoalveolar expansion was performed with expanded maxillary archwires supported on the second molars, which in turn would be anchored by a welded transpalatal bar fabricated with 1.2 mm round wire.\nAfter alignment and leveling and 30 days after placement of 0.019′′ × 0.025′′ archwires, the patient underwent a second CBCT scan in the same machine to evaluate the biological effects of orthodontic decompensation (). The same exam was used for planning the orthognathic surgery. At this stage, the facial profile and occlusal relationships were worse than in

mandibular arch.\nThe initial dental cast manipulation showed that the posterior crossbite was mainly a consequence of a Class III anteroposterior interarch relationship. Occluding the dental casts in Class I showed that maxillary constriction

pressure gradient/drop across it. The annuloplasty ring was well seated. The TOE transducer was removed in the operating theatre and inspected for blood or signs of bleeding, neither of which was observed.\nAfter the patient woke up in ICU a few hours post surgery, and his airway was extubated, a careful history and communication showed no evidence of injury to the patient’s neo-oesophagus/upper gastrointestinal system. The patient started to take small sips of clear fluids a few hours post surgery and soon after that soft food, without any

complications. The patient was discharged from hospital after 5 days and intermittently followed up over the next month, with no indication of any further cardiac, thoracic or upper gastrointestinal complications.\nThis case highlights the

maintain adequate hemodynamics in spite of administering massive transfusion protocol and continuous epinephrine infusion, we introduced arterio-venous extracorporeal membrane oxygenation (ECMO). Under ECMO support, an emergency operation was performed with a two-pronged approach with a laparotomy and thoracotomy. Exploring the thoracic and abdominal cavities, we detected only the diaphragm rupture

than pelvic fracture, so we decided to explore the abdominal and thoracic cavities because of the presence of the diaphragmatic injury. As we were unable to

February 2015 for bleeding gingival enlargement evolving for 12 months. She complained of esthetics, discomfort, and difficulties of plaque control. According to medical history, the patient had received a kidney transplantation 2 years earlier (2013). She has been administrating a daily immune suppressor treatment based on cyclosporin A 125 mg, prednisolone 5 mg, and mycophenolate mofetil 500 mg per day as a prophylaxis against organ transplant rejection.\nThe patient had a very poor oral plaque control; the plaque index PI [] and gingival index

GI scores [] were high which were, respectively, 2 and 2.75.\nThe clinical examination revealed an erythematous, edematous gingival overgrowth localized at the buccal and lingual side of the anterior teeth. The gingival overgrowth appeared as localized nodular enlargement of

interventions.\nDuring her hospitalization, the patient informed us that she believed she was 27 years old. She informed us that she was currently living in Aomori Prefecture and working as a receptionist, which accurately reflected events she experienced at age 27. She could recall memories of her marriage at age 25, but not her daughter, whom she gave birth to at 27. On a separate occasion, the patient adopted a birthing posture, as if she was re-experiencing the delivery that she had gone through when she was 27. However after informing her of her true age (55 years old), she recognized this fact, and her memory

showed signs of instability in cognition and attention to her surroundings. Although she retained verbal ability, she was disoriented with respect to time and place. Retrograde and anterograde amnesia were also present; she could not recall the work she was engaged in or when and how she was admitted to our hospital. Spontaneous tonic spasms appeared in her limbs bilaterally. A standard bedside neurological examination revealed otherwise normal findings for her cranial nerves, motor and sensory functions, and coordination. She had no special medical and family history or relevant past

youngest one. They had no physical and/or mental abnormalities. Their parents were consanguineous and they had no abnormalities either. The patient’s uncle was diagnosed with BD several years ago. The socio economic level of the family was low. The patient didn't have any past psychiatric or medical problems. Her symptoms started about 6 months ago by some rapid cycles of mood swings and she showed marked mood liability, distractibility and rages and

explosive temper tantrums (lasting up to several hours). At each episode she was starting to laugh most of the time even whole night for about two weeks. She didn't show talkativeness and impairment in perception or thought. After passing this phase, she was crying with the same pattern for another two weeks. Her

patient was easily intubated in the first attempt. The correct placement of the endotracheal tube was confirmed by chest auscultation. The entire process took thirty seconds. The tube was fixed securely with the help of a bandage. The anaesthesia was maintained with 40:60 O2: N2O, inj. Vecuronium bromide and halothane. The surgeons proceeded with the tracheostomy. Despite meticulous dissection, they had difficulty in locating the trachea. The light wand was introduced into the endotracheal tube and the transillumination directed the surgeons towards the exact location.[] As the surgeon was about to incise the trachea, the endotracheal tube cuff was deflated and the light wand was removed. When the trachea was adequately incised, the orally placed

endotracheal tube was slowly pulled out and a 7.5 mm ID cuffed tracheostomy tube was inserted. The breathing circuit was connected to the tracheotomy tube. Facial laceration was debrided and closed. The entire surgical procedure took 1.5 hours. Giving reversal reversed the residual effect of neuromuscular blockade. After ensuring an adequate tidal volume and when the patient was following commands patient was shifted in the postoperative room. Oxygen inhalation was continued

In the alveolar bone was observed resorption areas with apposition areas characterized by reversion and/or incremental lines. No signs of malignancy were detected. The patient was informed about the diagnosis, and a minimally invasive surgery to KCOT removal was proposed and accepted

by the patient. Written informed consent was obtained prior to initial treatment.\nThe treatment of the KCOT started with the marsupialization of the lesion by excision of the overlying mucosa and opening of the window of 1.5 cm size into the cystic cavity and suturing the cyst lining to the oral mucosa. The cavities in the anterior part of the mandible were kept open using a syringe by the patient and suturing in

right). Accordingly, she underwent emergency surgery on the day of admission. After a left frontotemporal craniotomy, the Sylvian fissure was opened, exposing the superior and inferior trunk (M2) of the middle cerebral artery. We found small intracranial aneurysm (< 2 mm) in the bifurcation of the left middle cerebral artery. During surgery, only one small aneurysm was clipped (Fig. A, and B) because it was difficult to identify another one, which was in the most peripheral part of the left middle cerebral artery. Three days later, the peripheral aneurysm, which was difficult to be identified in the initial

surgery, was clipped and wrapped using the Navigation System (Stealth Station S7 Surgical Navigation System, Medtronic Inc., Minneapolis, Minnesota, USA) (Fig. C, and D). The small distal intracranial aneurysm, which was clipped during the second surgery, was

lobectomy with intact surgical stump. The remainder of the visible tracheobronchial tree on the right side was normal and fully patent. Examination of the left tracheobronchial tree, findings consistent with a left mainstem bronchial injury beginning approximately 0.5 cm below the main carina and along its medial wall and continuing down to approximately 1 cm above the intermediate carina separating the take-offs to the left upper and lower lobes. The injury

the anesthesiologist removed the double lumen endotracheal tube under direct vision with a video laryngoscope and placed a single lumen endotracheal tube (Figures and ). At this time, a bronchoscopist conducted a thorough examination of the airway, revealing findings consistent with a right upper

of adhered loop. (Figure ).\nUnder microscope, spindle-shaped or epithelioid cells were arranged as a plate and the rudimentary vessel lumen were detected occasionally (Figure ). Separated from these two lesions, several small angiosarcomas containing foreign body granulomas were found in the subserosal layer of the intestine. Also, the nodules of liver and mesentery were diagnosed as metastatic angiosarcomas.\nImmunohistochemical staining was performed and tumor cells were positive for CD31, CD34, and vimentin (Figure ), whereas negative for factor antigen, CD117, and S-100. The tumor

cells were also negative for cytokeratin (AE1/3) and EMA. The foreign body granulomas were surrounded by CD31 positive cells, partially or entirely.\nThe previously resected mass, which was diagnosed as abscess, was reviewed. In a low magnification field, abscess in

acuity was 0.6 in the right eye and 0.12 in the left eye. There was a relative afferent pupillary defect in the right eye. On fundoscopy, bilateral optic disc oedema with haemorrhages at the disc margin was seen (Figure 1 ). Treatment with cyclosporine A was interrupted and the dose of prednisolone was increased to 24 mg in combination with mycoplenolatic mofetil. One month later his vision was at 0.4 in the right eye and 0.25 in the left eye. The papillary oedema gradually subsided and the

initiated. Tacrolimus was replaced by cyclosporine because of confusion. Three months later, the liver function had normalized with therapeutic blood levels of cyclosporine around 75 µg/l, the viral load at that moment was 130,499 IU/ml. Four months after the liver transplantation, the patient developed an acute visual loss in both eyes. Best-corrected visual

care plan which required more than one surgery. Based upon prior behavior, the care team judged the patient would be unable to maintain or adjust a multiplanar corrective frame, nor return for periodic office visits and radiographs. As such, a single-stage procedure was planned.\nThe patient was brought to the operating theater with general anesthesia, pharmacologic paralysis, and supine positioning. Two approaches were used. The

degrees of motion through his tibiotalar joint. Due to the deformity, the patient stated that his lower extremity was not functional for simple activities of daily living, such as prolonged standing or walking any distance less than a block. Although he would comply with postoperative nonweight-bearing restrictions, the patient stated he would not participate in any

implant, and the cytology aspirate of the peritoneal fluid showed pools of acellular mucoid material. On hospital day 7, the patient’s leukocytosis rose to 23 K, and repeat imaging demonstrated a more organized collection with intraperitoneal air in addition to multiple thick, wall-enhancing, complex cystic multiseptated lesions. Given these findings on imaging as well as her clinical presentation, the patient was taken to the operating room (OR) jointly with surgical oncology and gynecology oncology for a peritoneal

with intermittent fevers. Her abdominal exam also remained unchanged, with persistent pain that was under control with pain medication. It was unclear if the abdominal wall mass was neoplastic, and given our initial nonoperative approach, a biopsy was performed for tissue diagnosis to properly guide further treatment. A core needle biopsy of the abdominal wall mass demonstrated a uterine leiomyoma

extremely friable, and based on the size of the lesion as well as its position in the duodenum, combined with the patient's bleeding disorder, it was felt that it would be safer to remove the polyp via surgery with partial bowel resection rather than endoscopic polypectomy. The lesion was biopsied once with cold forceps and was then tattooed and the patient was given several doses of factor VII for hemostasis. The next day, surgery was consulted, and the child was taken back to the operating room for robotic resection. A small 2- to 3-cm section of jejunum

to the procedure with pediatric hematology consulted for administration of NovoSeven RT to help with bleeding control due to his factor VII deficiency. During the upper endoscopy, a large polypoid lesion was noted near the ligament of Treitz that had a notable clot from a prior bleed but no other abnormal surrounding mucosa (Fig. ). The tissue was

A 28-year-old woman, para 1-0-0-1, was diagnosed with invasive squamous cell carcinoma of the cervix at 12 weeks of gestation and she was referred to the University of the Ryukyus Hospital. Specular examination showed a sessile tumor measuring approximately 2 cm in diameter on the anterior lip of the cervix. At 15 weeks of gestation, magnetic resonance imaging showed a lesion consistent with cervical carcinoma FIGO stage IB1. Both the patient and her husband were informed about the treatment options

and the possible consequences of such treatments on the pregnancy. The couple was also informed about the option to perform radical abdominal trachelectomy (RAT) as a

the tip in the right axillary artery. A 70 mm long/12 mm diameter Wallgraft endoprosthesis (Boston Scientific, Natick, MA, USA) was successfully implanted in the right subclavian artery while the 8.5 F sheath in the subclavian artery was simultaneously extracted.\nImmediate post-implantation angiography demonstrated a patent stent-graft and acute occlusion of the right internal mammary artery and the right vertebral artery. There was no evidence of contrast extravasation and no clinical evidence of subclavian artery bleeding. (figure ) The patient remained hemodynamically stable. The right groin sheath was extracted

and groin hemostasis was achieved. The patient was transferred to the Intensive Care Unit (ICU) for further care. Right arm and right leg pulses were all palpable and there was no clinical evidence of hemorrhage.\nThe patient spent 3 days in the ICU and was then discharged to the ward. She recovered with no evidence of peripheral vascular or neurologic sequelae. She was discharged from hospital

of Tbilisi State Medical University (# 44/3 04.06.2014). On further evaluation, a diagnosis of colonic cancer (sigmoid) was established, and in 2013, he underwent sigmoid bowel resection. The histopathological analysis of the specimen showed a moderately differentiated adenocarcinoma and confirmed tumour-free resection margins. He did not receive any adjuvant treatment. He remained asymptomatic until May 2014, when he developed features of pain in his right hypochondrium and fatigue. Computed tomography (CT) revealed a 10.7 cm lesion in segment 4 and two smaller lesions in segment 6 with imaging

characteristic of CLM (see , a,b), and a diagnosis of TXNXM1, stage IV was made. A biopsy was performed in December 2014, which revealed moderately differentiated adenocarcinoma in the liver, and a diagnosis of liver cancer secondary to CLM

much busier than she had been when she was simply an employee. Within a year, her attentional difficulties and memory issues gradually progressed, and at approximately 57 years of age, she became so inattentive and forgetful that it interfered with her work and family life at home. For example, she forgot meetings with important clients, transferred money to the wrong bank account, and these failures resulted in poor management of her company.

At home, she experienced increasing difficulties with remembering prior commitments with her family and misplacing items, which her family members noticed. With the encouragement of her family and employees,

suggestive of obstructive jaundice (Bilirubin 113, ALP 136). CT of his abdomen and pelvis showed a common bile duct stone with upstream dilatation and a pancreatic neck suggestive of acute necrotising pancreatitis. There were no collections at this point. He underwent endoscopic retrograde cholangiopancreatography, sphincterotomy and stone retrieval successfully with no residual stones.\nHe subsequently developed recurrent bouts of pancreatitis, where

interval CT showed development of a pseudocyst of up to 11 cm in maximal diameter. After discussion with the patient, plans were made to proceed with laparoscopic cystgastrostomy. However, on the day before his operation, he developed acute

toe extension or flexion (0/5 MRC). She had persistent global sensory loss in the calf and foot.\nAfter fasciotomy, a Doppler ultrasound demonstrated an occlusive DVT in her right femoral vein at the level of the venous repair. She was started on heparin until an IVC filter was inserted. At 72 hours after fasciotomy, she had conversion of the temporary medial femoral plate to a locked intramedullary nail (), as well as repeat irrigation and debridement of her traumatic wound, and split-thickness skin grafts (STSG) for the traumatic wound and fasciotomy incisions.

The lower leg fasciotomy sites were clean and the muscles were viable. She subsequently underwent definitive fixation of her left iliac wing fracture and left humerus fracture two weeks after her admission. She was restarted on heparin and the IVC filter was removed. She

was identified and safely separated from the hernial sac including the diverticulum. The plane was followed into the scrotum where the entire diverticulum was removed from the hemiscrotum. There were no adhesions within the scrotum of the diverticulum to surrounding layers, which made a secondary scrotal incision unnecessary. Haemostasis was ensured in these areas and the bladder was closed with two layers of continuous vicryl.\nTwo weeks following the procedure he underwent a trial of voiding, which he passed successfully. He was discharged home and returned 6 months later with for a follow-up ultrasound of his

outer surface of the bladder and the diverticulum. However, it was not possible to identify the spermatic cord at this stage; therefore, the neck of the diverticulum was transected in order that a point of traction was created.\nThis facilitated dissection with a combination of blunt and sharp technique. The spermatic cord

). The bone marrow blood was transferred into another 20-cc syringe filled with Affinos® granules to impregnate them ( ). Next, a guidewire was inserted through the guide needle sheath and placed in a vertebral body. Then, the guide needle was removed, and hollow cannulated pedicle screws (Solera®, Medtronic Sofamor Danek, MN, USA) were inserted along the guidewire with conventional technique. In this manner, a total of 12 mL of fresh bone marrow blood werecollected from normal vertebral bodies between the

levels T10 and L3. Subsequently, a 5-mm inserter for vertebroplasty (Kuraray Co., Ltd., Tokyo, Japan) was transpedicularly attached to the T12 vertebral body under fluoroscopic guidance, and Affinos® granules impregnated with bone marrow blood were injected under C-arm fluoroscopic guidance until the bone defect was completely filled. Finally, short pedicle screws were

systemic examination was normal. Cardiovascular system examination revealed audible first and second heart sounds and no murmurs. Respiratory system examination showed a respiratory rate of 21 breaths/minute, normal chest contour, trachea centrally located, normal chest expansion, and normal breath sound on auscultation. Per abdominal examination, abdomen was flat, moving normally with respiration, and there were no visible superficial veins. The abdomen was soft and nontender. The liver, spleen, and kidneys were not palpable. No shifting dullness and bowel sounds were normal on auscultation.\nThe patient was counselled for emergency marsupialization, and informed consent was obtained. Preoperative antibiotics

were given: ciprofloxacin 500 mg orally 12 hourly for 5 days, metronidazole 400 mg orally 8 hourly for 7 days, and doxycycilline 100 mg orally bid for 7 days.