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sign (Additional file 5 (Short axial section of left ventricle shows right ventricle enlargement and ventricular septum deviation of left ventricle, showing “D” sign.)). Apical 4-chamber view showed that the right ventricular ratio increased and the contractile capacity decreased (Additional file 6 (4-chamber view of apical heart showed increased right ventricular ratio and decreased contractility.)). In consideration of fatal pulmonary

enlargement and ventricular septum deviation of left ventricle, showing “D” sign.)). Apical 4-chamber view showed that the right ventricular ratio increased and the contractile

deviation of left ventricle, showing “D” sign (Additional file 5 (Short axial section of left ventricle shows right ventricle enlargement and ventricular septum deviation of left ventricle, showing “D” sign.)). Apical 4-chamber view showed that the right ventricular ratio increased and the contractile capacity decreased (Additional file 6 (4-chamber view of apical heart showed increased right ventricular ratio and decreased contractility.)). In consideration of fatal pulmonary embolism, 1500,000 units of urokinase were immediately given trough intravenous drip. After 20 minutes, his autonomic heart rhythm was recovered, but continued to suffer from hypotension and coma, followed by multiple organ failure, and died 50 hours

endocrinologist’s opinion who advised for evaluation of a 24-hour urine metanephrine, normetanephrine, and vanillylmandelic acid levels which were raised beyond the normal range which was highly suggestive of pheochromocytoma (). Results of endocrinology and surgical oncology consultations were obtained for optimization of the treatment before surgery, and she was started on an alpha -blocker followed by a beta blocker for adrenal suppression. After two weeks of adrenal suppression with controlled hypertension and with the help of multidisciplinary team comprising of surgeons, anesthesiologist, and endocrinologist, she underwent an uncomplicated laparoscopic adrenalectomy ().

were raised beyond the normal range which was highly suggestive of pheochromocytoma (). Results of endocrinology and surgical oncology consultations were obtained for optimization of the treatment before surgery, and she was started on an alpha -blocker followed by a beta blocker for adrenal suppression. After two

of gestation with singleton pregnancy was referred to our institute with severe hypertension, headache, and dizziness for past two days. She was hospitalized and diagnosed with severe preeclampsia, with a blood pressure of 210/150 mmHg on admission. However, there was no history of blurring of vision, vomiting or epigastric pain. Her antenatal checkups were irregular though she took iron and calcium tablets in the last fourth month of gestation but had neither undergone screening for aneuploidy nor any anomaly. During her late second trimester she was started with oral labetolol 100 mg tablets twice daily after the

check valve.\nWe performed bursectomy and ATFL repair for this case. In the operating room, ankle arthrography was performed before the surgery. Contrast medium was injected into the right ankle joint and the joint was passively moved to spread the medium. The arthrogram showed contrast medium leaking from the anterior aspect of the joint into the tendon sheath of the EDL and the distal tibiofibular syndesmosis and from the posterior aspect of the joint into the tendon sheath of the flexor hallucis longus (FHL) and the tibialis posterior indicating ruptures

check valve.\nWe performed bursectomy and ATFL repair for this case. In the operating room, ankle arthrography was performed before the surgery. Contrast medium was injected into the right ankle joint and the joint was passively moved to spread the medium. The arthrogram showed contrast medium leaking from the anterior aspect of the joint into the tendon sheath of the EDL and the distal

a fluctuant mass 5 × 8 cm in size, over the anterolateral part of the right ankle (). There was no local heat or redness. A callus was formed just over the surface of the mass on the right foot and at the same position on the left foot. Tenderness was localized around the anterior talofibular ligament (ATFL), and instability and apprehension were evoked by the anterior drawer test. Clear yellowish fluid was aspirated from the mass

male was presented with his persistent back pain and daily pyrexia. He had suffered from chronic dyspnea on effort as a symptom of the chronic obstructive pulmonary disease and used home oxygen therapy of 2 l/min on occasional use. He had been followed up for non-small-cell lung cancer (NSCLC) of the left upper lobe (T2aN1M0), which was treated by the SBRT (50 Gy in four fractions) 4 years prior to the current visit. SBRT was effective enough to achieve complete response of the disease, and the patient had developed no evident recurrent disease so far. After the completion of SBRT, he occasionally complained about postprandial soreness in the upper chest for 4 years until the evaluation

used home oxygen therapy of 2 l/min on occasional use. He had been followed up for non-small-cell lung cancer (NSCLC) of the left upper lobe (T2aN1M0), which was treated by

He had suffered from chronic dyspnea on effort as a symptom of the chronic obstructive pulmonary disease and used home oxygen therapy of 2 l/min on occasional use. He had been followed up for non-small-cell lung cancer (NSCLC) of the left upper lobe (T2aN1M0), which was treated by the SBRT (50 Gy in four fractions) 4 years prior to the current visit. SBRT was effective enough to achieve complete response of the disease, and the patient had developed no evident recurrent disease so far. After the completion of SBRT, he occasionally complained about postprandial

Ltd., South Africa) which were subsequently inserted with excellent primary stability (Fig. ). The remaining maxillary teeth were then carefully extracted although it was not possible to preserve all the labial socket bone which was fused to several of the teeth. It was therefore decided to proceed with an alveoloplasty and insertion of two conventional zygomatic implants (Southern Implants Ltd., South Africa) on the right side which were inserted into the canine and second premolar sites with high primary stability (Fig. ). Standard implant bridge abutments (AMCZ

slightly oversized left fascio-cutaneous radial forearm flap which was carried out in parallel to the implant procedures. Following resection, the amount of bone remaining in the left zygoma was assessed and deemed satisfactory for the placement of two zygomatic oncology implants [] (Southern Implants

bridge was removed for repair. All implants were firmly integrated, the initial oral ulceration was now settling and the flap reconstruction was performing well with no evidence of breakdown or dehiscence (Fig. ). The bridge was repaired and re-fitted the same day, and arrangements were made for the construction of a new definitive acrylic bridge with a cobalt-chrome framework which was subsequently

maximal age-predicted heart rate with exercise. Exercise testing terminated due to fatigue with the patient reporting no chest pain during evaluation. No ischemic changes were noted on electrocardiogram during the study. Patient's chest X-ray was suggestive of possible RV on the left side of the chest with possible dextrocardia or ccTGA in the differential ().\nSubsequently, the patient underwent imaging evaluation with cardiac computed tomography (CT) for further evaluation of cardiac structure. CT angiography of the coronary arteries revealed normal origin and course of all coronary vessels with no evidence of coronary artery disease. CT evaluation of cardiac

no chest pain during evaluation. No ischemic changes were noted on electrocardiogram during the study. Patient's chest X-ray was suggestive of possible RV on the left side of the chest with possible dextrocardia or ccTGA in the differential ().\nSubsequently, the patient underwent imaging evaluation with cardiac computed tomography (CT) for further evaluation

military Medical Evaluation Board (MEB) was initiated due to the presence of moderate valvular disease and, as part of this process, cardiopulmonary exercise testing was scheduled despite recent history of gated exercise testing and no worsening of daily function per patient report. Cardiopulmonary exercise testing was carried out using cycle ramp protocol beginning at 0 Watts and incrementally increasing to workload of 157 Watts. The patient exercised for 7 minutes 10 seconds

was suspected to be colon cancer, and nodules in liver segments 2/3 (60 mm) and in segment 6 (57 mm) (Fig. a, b), which were suspected to be liver metastases. We retrospectively reevaluated the CT findings from a local hospital and detected liver nodules in segment 2/3 (35 mm) and segment 6 (26 mm), and the tumors had dramatically grown in size in only 2 months. [18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT showed colon cancer (maximum standardized uptake value (SUVmax) 14.4) and multiple liver metastases (S2/S3, unclear SUVmax; S6, SUVmax 11.3),

6 (26 mm), and the tumors had dramatically grown in size in only 2 months. [18F]-fluorodeoxyglucose (FDG) positron emission

a day starting after dinner on day 1 until after breakfast on day 15, followed by a 7-day break). After 10 courses, the patient presented with oxaliplatin-induced peripheral neuropathy [],

viable tissue for closure.\nPunch biopsies from the right lower extremity and left upper chest confirmed the diagnosis of Kaposi's sarcoma (). A multidisciplinary team initiated a conservative approach to

the medial aspect of his right calf (). Along with the lesions, the ipsilateral foot had severe edema and dry gangrene. Surgical debridement was considered but not initiated because of fear that it would lead to an above-the-knee amputation, given a lack of

were undertaken at 20 and 27 days after the initial dose of liposomal doxorubicin. For each round, one vial of medical maggots (Monarch Labs, Irvine, CA) was applied and removed after 48 hours by a wound nurse, according to the protocol provided by the manufacturer and Maggot Debridement

of the nodules showed numerous calcifications and localized amyloid deposition (). Immunohistochemical stains were performed and the neoplastic cells marked strongly for the neuroendocrine markers chromogranin A and synaptophysin (). Multiple immunostains for pancreatic peptides were performed. The neoplastic cells were positive for pancreatic polypeptide and negative for insulin, glucagon and somatostatin. Only a rare mitotic figure was identified but the Ki-67 mitotic index marker was calculated at 5% as measured by the Aperio image analysis system. The findings were

The neoplastic cells were positive for pancreatic polypeptide and negative for insulin,

perform a pylorus-preserving pancreaticoduodenectomy with total resection of the pancreas, splenectomy and cholecystectomy. Sectioning of the pancreas revealed numerous well-circumscribed, solid and tumoural masses ranging from minute up to the largest grossly identified lesion measuring 3.5 cm in diameter (). Many of the nodules were coalescing with only a scant amount of intervening normal pancreatic parenchyma present. The cut surfaces of the nodular masses were solid and showed a variegated pink to orange-red

presented with mastalgia and yellowish discharge from her right breast. She reported family history (maternal lineage) positive for cancer. Her mother was diagnosed with BC at 33 and died, and maternal grandmother at 65 years, also from BC. Uncle who had been a smoker died of lung cancer at the age of 70. She has no other live relatives and siblings and has one 3-year-old

son. Radiologic imaging found no suspicious lesions in the breast nor enlarged lymph nodes but showed solitary mediastinal mass which was surgically removed. Patohistological examination revealed fibrous tumor with increased mitotic activity, positive for CD34 and STAT6 by immunohistochemistry staining (Fig. ). Both tumors/breast cancer and solitary fibrous tumor have stained negative for p53 protein.\nNo further treatment was indicated and after 4 years of follow-up, a lesion in the upper left quadrant of the

dbSNP, COSMIC, gnomAD, and 1000 Genomes databases. The above methods confirmed a germline single nucleotide variant: (c.1101-1G>A) in TP53 gene. She was found to be heterozygous for single nucleotide variant (c.1101-1G>A) affecting the acceptor splice site at intron 10 in TP53 gene, consistent with LFS. This sequence is submitted to ClinVar database, accession number SCV001161439. There were no live siblings for additional germline testing and a 3-year-old son is not permitted for testing without father’s permission according to Croatian laws.\nIn order to gain additional insight into the genetic and molecular profile of the tumor, a

the system automatically generated a prosthesis using the contralateral tooth as a reference. From the analysis performed using the software, the occlusal contact of the intercuspal occlusion of the patient was concentrated in the middle third of the cervix, and it was therefore appropriate for composite resin restoration. An occlusal adjustment was made to eliminate anterior contact in the occlusion and to avoid contact with the prosthesis (Fig. ). We showed a picture of the result to the patient, and he was satisfied with it. The

of the patient was concentrated in the middle third of the cervix, and it was therefore appropriate for composite resin restoration. An occlusal adjustment was made to eliminate anterior contact in the occlusion and to avoid contact with the prosthesis

26 years old, sought care at the dental clinic with fractures of the left maxillary central incisor resulting from a sudden strike three months earlier. The patient had no clinical symptoms during this period (Fig. ). A clinical examination revealed that the left maxillary central incisor was fractured in the middle third of the crown and that this fracture involved the enamel and dentin with no pulp exposure and no signs or symptoms of a concussion or contusion. A routine cold vitality test of the tooth

is a 58-year old male who was being evaluated for inguinal hernia repair. His past medical history included CAD with prior stenting of the left circumflex artery, diabetes with a HbA1c of 5.7 and an 80-pack year smoking history. He reported a 37 kg unintentional weight loss over 6 months with postprandial abdominal pain and nausea. In addition, he had exertional angina relieved by rest and sublingual nitrates. He had an abdominal CT scan for evaluation of

with prior stenting of the left circumflex artery, diabetes with a HbA1c of 5.7 and an 80-pack year smoking history. He reported a

to achieve an activated clotting time (ACT) of greater than 450 seconds, and following aortic and right atrial cannulation, the patient was placed on cardiopulmonary bypass. Normothermic conditions were maintained. The mesenteric bypass was then performed from the supra-celiac aorta to the celiac artery and SMA with a bifurcated Vascutek® 12 mm × 6 mm Gelsoft™ graft (Terumo Cardiovascular Group, Ann Arbor, MI) in an end-to-end fashion (). After completion of the mesenteric bypass, the patient was cooled to 34°C, and coronary artery bypass grafting was performed with saphenous vein grafts to the first diagonal, first obtuse marginal, second

occlusion, as well as splinter hemorrhages of the fingernails (). The rest of the physical examination was inconspicuous and there were no signs of infection in the otherwise normal blood tests. The patient had no relevant personal medical history, nor family medical history. He had no history of drug or alcohol consumption. The patient’s written consent for use of his data and tissue for research purposes and the subsequent publication were obtained.\nUltrasound scan diagnosed an acute embolic closure of the

left popliteal artery and the patient underwent immediate embolectomy. Histological examination of the embolus showed thrombotic material without any sign of microorganisms. Further diagnostic workup during hospitalization displayed a visible vegetation with a cross diameter of 6 mm on

(Medtronic Open Pivot™ AP 360®, 28 mm) was implanted. The histopathological analysis of the vegetation, also using PCR analysis, showed no identification of common or rare pathogens, or organisms. Light microscopy revealed a destructive, ulceropolyposis of the native valve combined with a florid inflammation composed predominantly of leucocytes and fibrin and again no signs of bacterial infection (). The patient

room where standard ASA monitors were applied and pre-oxygenation commenced. General anesthesia was induced with fentanyl, midazolam, lidocaine, propofol, and rocuronium. The patient was intubated with a left double lumen endotracheal tube (ETT) using a MAC 3 blade revealing a Cormack-Lehane grade I view. Careful attention with gentle manipulation was used during direct laryngoscopy and no telangiectasias were appreciated in the posterior oropharynx. The ETT was pretreated by soaking in warm sterile normal saline to allow pliability and lubricated to facilitate smooth

intubation and avoid airway trauma and rupture of any possible oropharyngeal telangiectasias. After successful intubation, correct positioning of the ETT was confirmed by bronchoscopy. After induction of general anesthesia, a cordis centeral venous catheter was inserted in the right internal jugular vein for central venous pressure monitoring and access for fluid and blood resuscitation if needed. A transesophageal echocardiogram (TEE) was performed ruling out an intracardiac thrombus or any

68. A chest x-ray reviled no cardiopulmonary pathology. There was a recent transthoracic echocardiogram completed revealing an ejection fraction of 59% with left ventricular hypertrophy and a mildly dilated left atrium. There were no signs of diastolic dysfunction, and the heart was otherwise structurally normal. Furthermore, there was also documented evidence of a negative lexiscan cardiolyte stress test preformed 3 months prior.\nThe patient was originally diagnosed with atrial fibrillation 8 years ago and had undergone successful

normal.\nOn presentation to our clinic, the patient was mildly cyanotic and reported dyspnoea on exertion. Interrogation of the device showed that the discharges were not caused by malignant ventricular arrhythmias but by episodes of AF with fast conduction entering the VF (ventricular fibrillation) treatment zone (). The device was programmed in DDD mode with two zones of therapy; VT at 176 b.p.m. and VF >207 b.p.m. The transthoracic bedside echocardiographic exam revealed two large aneurysms at the ostia of the coronary arteries. Both atria were markedly enlarged, and there were signs of mild pulmonary hypertension. The left atrium on

>207 b.p.m. The transthoracic bedside echocardiographic exam revealed two large aneurysms at the ostia of the coronary arteries. Both atria were

on transthoracic echocardiogram due to the acoustic shadow of the prosthetic aortic valve. We have no information regarding preoperative imaging and cannot speculate on the time of development of the aneurysms. Due to normal left ventricular function and CT angiography, we did not perform any other tests for myocardial ischaemia.\nA surgical approach was discussed with a surgeon as an option for both closure of the ASD and repair of the aneurysms but was declined by the patient due to the

posterior spinal fusion of cervical levels five through thoracic level two.\nThe patient was premedicated with 2 mg intravenous midazolam. All standard American Society of Anesthesiologists-required monitors were placed, and an infusion of dexmedetomidine was initiated at 1 mcg/kg for 10 minutes as a loading dose, per dexmedetomidine drug protocol. After 10 minutes, the infusion rate was decreased to 1 mcg/kg/hour. The dexmedetomidine infusion was then stopped after intubation, and general anesthesia was initiated with a propofol drip at 100 mcg/kg/minute, and a remifentanil drip was initiated at 0.3 mcg/kg/minute; both drips were continued throughout the procedure as a general anesthetic.

had no drug allergies.\nOn the day of surgery, the patient presented with a stabilizing halo fixation device in place and underwent an anterior cervical discectomy and fusion of cervical levels five through seven and a

mean arterial pressure steady at approximately 65 mmHg. Due to the patient’s unexplained polyuria, a polyuric workup was initiated including urine and serum electrolytes and osmolalities. The patient’s initial serum sodium was 136 mmol/L, which was measured four days prior to the surgery. During the procedure, his sodium increased to 148 mmol/L, and, one hour following surgery, his serum sodium was 149 mmol/L. The patient’s intraoperative serum osmolality was within normal limits (294 mOsm/kg). However, his urine osmolality was as low as 55 mOsm/kg, and upon subsequent lab analysis, it increased to 127 mOsm/kg. The patient was extubated following a return to supine position, and he was monitored in the postanesthesia care unit for neurologic

left eye and redness of eyes. She had oral aphtae and oral ulcers as well, that improved over time with treatment. She was treated earlier for right sided knee inflammation. She has been diagnosed with uveitis and for 5 years treated with on and off topical, peribulbar and systemic corticosteroids with periods of improvement and periods of worsening of symptoms. She developed cataract in both eyes and was planned for surgery two years ago, but

with uveitis and for 5 years treated with on and off topical, peribulbar and systemic corticosteroids with

EEG. Neurological examination was normal. She tested positive for HLA-B51. There was no family history of autoimmune diseases. Following treatment, initiated in the previous clinic, was continued: 0.1% dexamethasone eye drops (four times/day), tropicamide/phenylephrine eye drops (once/day), Methotrexat (MTX) 15 mg once a week followed by folic acid. The patient was diagnosed with the incomplete type of Behçet’s disease on the basis of the presence of a typical ocular symptoms and recurrent oral ulcers, retinal vasculitis recurred in both eyes in spite of treatment with

was transferred to our special care baby unit with spontaneous respiratory effort in facial oxygen. His white cell count and C-reactive protein level were within the normal range (6.3 and <5, respectively) while his blood cultures were negative at birth. The baby was treated with oral nystatin, intravenous benzyl penicillin and gentamicin. Isolation and barrier nursing was also advised.\nX-linked SCID (consistent with the mother's carrier type) was confirmed by genetics testing during the neonatal period. He received intravenous

therapy of 1 g immunoglobulin on Day 3 and was transferred to a specialist paediatric centre on Day 6. The baby underwent an unconditioned CD34-selected mismatched family donor bone marrow transplant (from

percentile). He required some initial resuscitation but was transferred to our special care baby unit with spontaneous respiratory effort in facial oxygen. His white cell count and C-reactive protein level were within the normal range (6.3 and <5, respectively) while his blood cultures were negative at birth. The baby was treated with oral nystatin, intravenous benzyl penicillin and gentamicin. Isolation and barrier nursing was also advised.\nX-linked SCID (consistent with the mother's carrier type) was confirmed by genetics testing during the neonatal period. He received intravenous therapy of 1 g immunoglobulin on Day 3 and was transferred to a specialist

due to a non-palpable breast lesion which was revealed via ultrasonic examination, with malignant ultrasonographical features. Her personal medical history and her psychosocial history were uneventful and Pap Smear tests were up to date and all negative. She was non-smoker and consumed alcohol only in social occasions. Her body mass index (BMI) was 30, 48 Kg/m []. Because of her mother’s breast cancer history (diagnosed with breast cancer at the age of 50, but never tested for BRCA), the patient was followed up via transvaginal ultrasonography and breast ultrasonic examination every six months since 2004.\nUpon arrival, physical examination of

her breasts did not reveal any palpable mass. Breast ultrasonography showed a hypoechoic lesion of 0,9 × 0,8 cm located in the lower inner quadrant, while breast magnetic resonance imaging confirmed the suspicious and possible

presented to our breast unit department due to a non-palpable breast lesion which was revealed via ultrasonic examination, with malignant ultrasonographical features. Her personal medical history and her psychosocial history were uneventful and Pap Smear tests were up to date and all negative. She was non-smoker and consumed alcohol only in social occasions. Her body mass index (BMI) was 30, 48 Kg/m []. Because of her mother’s breast cancer history (diagnosed with breast cancer at the age of 50, but never tested for BRCA), the patient was followed up via transvaginal ultrasonography and breast ultrasonic examination every six months since 2004.\nUpon

examination performed at the ENT department, and because the patient complained of severe breathing difficulties when lying flat in the supine position, he was instructed to maintain Semi-Fowler's position. For airway management, after discussion and consultation with the Departments of ENT and Anesthesiology, a decision was taken to secure the airway via intubation. The patient and his guardian were explained the tracheostomy procedure, possibility of an additional incision and drainage, and the patient care in the intensive care unit (ICU). After the obtaining the necessary consent, the patient was moved to the operation room (OR). During the pre-anesthetic evaluation in the OR,

patient was consulted for airway evaluation. Partial airway obstruction was observed on endoscopic airway

in the future, and the patient was transferred to the general ward for follow up observations for infection. The day after admission, the patient complained of mild swallowing and breathing difficulties, and his oxygen saturation level (SpO2) was 97%. Nasal cannular was used to administer 3 L/min of oxygen, and the process was monitored. However, the patient continued to experience breathing difficulties and the severity increased. After 2 hours, his vital signs were as follows: blood pressure of NIBP_SBP was 164 mmHg and NIBP_DBP 98

of his abdomen confirmed a similar-sized area of mild enhancement in the arterial phase, which was better visualized on subtraction sequence imaging. He had no evidence of metastasis. An octreotide scan was done but failed to show enhanced uptake in the area of the tail of the pancreas. He was subsequently referred to surgery and underwent successful laparoscopic distal pancreatectomy.\nSections of the resected tumor, which measured 1.2 cm in greatest dimension, showed a nested and trabecular proliferation of neoplastic cells separated by sclerotic stroma. Immunohistochemistry revealed that the neoplastic cells strongly expressed synaptophysin, chromogranin A, and insulin, confirming neuroendocrine differentiation and supporting

total calcium, albumin, and complete blood count. His hemoglobin A1c was 4.9%.\nAn initial computed tomographic (CT) scan of the abdomen reported no significant abdominal or pancreatic pathology. However, using a pancreatic enhancement protocol, we identified a 1.3 × 1.2-cm mass lesion in the tail of the pancreas (Fig. ). Magnetic resonance imaging (MRI)

neuroendocrine tumor (Fig. d). The tumor was completely excised, and neither lymphovascular invasion nor lymph node involvement was identified.\nSurgical resection resulted in normalization of the patient’s glycemic values, resolution of episodic neuroglycopenic symptoms, and, interestingly, significant improvement of lymphedema. He continued to do well 5 years later with

blood count, liver function tests and urinalysis were normal.\nNine months after cessation of medical treatment, ultrasonography showed a hetero-echo exophytic mass in the right kidney with a size of 58*42 mm. There were cortical cysts in the left kidney in the middle-lower region with the maximum diameter of 26 mm. The bladder wall was thickened. In CT scan

count, liver function tests and urinalysis were normal.\nNine months after cessation of medical treatment, ultrasonography showed a hetero-echo exophytic mass in the right kidney with a size of 58*42 mm. There were cortical cysts in the left kidney in the middle-lower region with the maximum diameter of 26 mm. The bladder wall was

were normal.\nNine months after cessation of medical treatment, ultrasonography showed a hetero-echo exophytic mass in the right kidney with a size of 58*42 mm. There were cortical cysts in the left kidney in the middle-lower region with the maximum diameter of 26 mm. The bladder wall was thickened. In CT scan a 60*44*42 mm cystic lesion without obvious internal septa and no enhancement was seen. Calcification in the cyst was observed. Follow-up sonography at the last visit 3 years after discontinuation of medications, demonstrated a 60*40*45 solid-appearance lesion without daughter cyst in mid portion of the right kidney (Fig. ). At

of left vocal cord palsy and a tracheal tumor that was revealed on computed tomography (CT). He had a previously resected left upper eyelid tumor that was diagnosed as schwannoma. However, he did not have other problems in his medical or family history. Laryngoscopy demonstrated a fixed left vocal cord. CT showed a tumor involving 3.5 cm of the left tracheal wall and protruding inside and outside the tracheal wall (Fig. ). Positron emission tomography (PET) presented a maximum standard uptake value of 3.09 on the tumor. There was no accumulation on other parts

of the body. Bronchoscopy verified a submucosal tumor affecting four tracheal cartilaginous rings (Fig. ). Endobronchial ultrasonographically guided transbronchial needle biopsy and aspiration did not detect malignant tissue and cells.\nAlthough a preoperative diagnosis could not be made, the tumor was suspected to be malignant. If the tumor were to become larger, tracheal resection for complete removal would become impossible due to associated risks. Therefore, we performed median sternotomy

rigid bronchoscopy had proven schwannoma before surgery, we might avoid trying the risky tracheal resection and observe the tumor unless tumor growing or tracheal stenosis occurred. However, at that time, it was not expected that the tumor was a benign tumor, such as schwannoma, and a repeat biopsy was not done. We therefore determined that we could make an accurate diagnosis and adequate treatment decision through surgery. After the intraoperative diagnosis, we determined to preserve the trachea and resect as much of the tumor as possible. Wright and coworkers argued that tracheal resection by

and the obturator and cannula were inserted sequentially. After inserting the cannula, PED and TA were initiated.\nDuring surgery, the scope was inserted into the posterior annulus where it revealed a migrated NP dyed blue (, left panel). After removing the displaced NP, the annular tear was clearly evident due to being filled with the blue NP. When the scope was moved to the site of the HIZ through the annular tear, a slightly red migrated NP was found (, right panel), suggesting inflammation and/or

was inserted into the posterior annulus where it revealed a migrated NP dyed blue (, left panel). After removing

the intradiscal injection. The patient then returned to baseball practice. During a practice session at spring camp, 2 weeks after the second injection, he again experienced mild discomfort in his back. The next day, he could not move because of severe pain, so he took analgesic medicine. However, as no pain relief was obtained for a week, he visited us again.\nshows the MRI findings just after the third episode of severe low back pain.

computed tomography (CT) Scan was advised. CT finding suggested a heterogeneously enhancing soft tissue thickening involving the left side of the face infiltrating temporal, infratemporal fossa and masticatory space []. There was subtle erosion of underlying bone and thickening with expansion (remodeling) at the lateral wall of orbit, zygomatic arch and anterior surface of maxilla of the left side. There was the widening of the inferior orbital fissure. The soft-tissue thickening seems to be infiltrating into the left buccal mucosa and

[].\nUltrasonography revealed soft tissue thickening with respect to left temporal, infratemporal, orbital and buccal mucosa with vascularity seen on color Doppler with areas of subtle erosion of bone at places. Further for full bony extent contrast-enhanced

4.5 cm × 1.5 cm in size almost covering occlusal aspect of teeth, having pink in color and smooth surface with normal-appearing surrounding mucosa []. The growth was non-tender with mixed soft to firm consistency giving bag of worm feel. Similarly, two mucosal growth seen from left buccal mucosa, one 1cm posterior to left retrocommisure area and 2nd on anterosuperior aspect corresponding to 23 measuring 0.7 cm × 0.4 cm and 0.3 cm × 0.2 cm respectively. The left upper first molar (26) was missing.\nOn the basis of the above clinical findings differential diagnosis for pigmentation includes mongolion spot, melasma, blue nevus, drug-induced hyperpigmentation and for growth PNF, congenital melanocytic nevus (as hyperpigmentation and hypertrichosis common in both),

seconds. She appeared distressed when laying down reporting worsening pain; however, the abdomen was soft and non-tender to palpation. Systemic examination was otherwise unremarkable.\nUrine analysis showed no evidence of infection and blood tests revealed a C-reactive protein (CRP) of 23 mg/L and a normal full blood count with white cells of 13.4 × 109 cells/L. Liver function tests, urea and electrolytes, and venous blood gas were also normal.\nWith normal observations,

with a heart rate of 110 beats per minute, oxygen saturations of 99% on room air and respiratory rate of 22 breaths per minute. She was warm and well perfused with a central capillary refill time of <2

the patients’ pain was significantly reduced, pallor had resolved and her observations normalised. Abdominal examination at the time of surgical review was normal, but because of repeated presentations with abdominal pain and a rising CRP (93 mg/L) and white cell count (13.9 × 109 cells/L) the patient was admitted and a computed tomography (CT) scan of the abdomen and pelvis was arranged. Orthopedic review did not yield any acute orthopedic concerns regarding the scoliosis and they agreed with the plan for abdominal imaging. The CT scan failed to reveal an abdominal cause for her pain, but to our surprise showed an organizing right lower lobe pneumonia with a small

per minute, heart rate of 120 beats per minute, blood pressure of 110/60 mm Hg, and oxygen saturations of 75% on room air. The infant appeared acutely ill. He was diaphoretic. Physical exam revealed nasal flaring, with severe suprasternal, intercostal, and subcostal retractions. On

repeated pneumonic infections. There was no history of allergy, sleep apnea, and weight loss. No family history of asthma or atopy was present. Family history revealed that his sister was once diagnosed with right-sided heart by a clinician on routine examination. She had no history of repeated respiratory infections or repeated pneumonic infections. His parents were healthy and not related. His mother reported no problems during pregnancy.\nIn the emergency department (ED), the patient was reported to be in severe respiratory distress. Vital signs revealed temperature of 38°C, respiratory rate of 50 breaths

showed a normal liver and gall bladder on left side and a normal spleen on right side, suggestive of situs inversus. A CT of the paranasal sinuses revealed sinusitis. The examination showed opacified maxillary and ethmoidal sinus cavities (). A CT scan of the abdomen showed liver on the left and spleen on the right, suggestive of situs inversus (). Electrocardiogram showed signs of dextrocardia, inverted P waves in lead I, right axis deviation and QRS complexes get progressively smaller in leads V 1–V 6.

of the lung. When the shadow failed to change with time further investigations were ordered. This was when a tumour in the right atrium was discovered which was neither haemodynamically nor clinically relevant. Magnetic resonance imaging of the chest showed a spherical tumour (28 × 27 × 20 mm) attached to the wall of the right atrium. The T1 weighted image revealed homogenous signal intensity as well as a loss of signal due to fat tissue. The tumour didn't show any signs of contrast

medium uptake so that the diagnosis of a benign lipoma was made preoperatively. Transthoracic echocardiography excluded heart valve dysfunction and confirmed the presence of a mass in the right atrium.\nOn account

The atrium was then sutured. Afterwards, with the patient now being supported by partial cardiopulmonary bypass, the right lung was inspected. A hard resistance could be palpated in the right lower lobe. Considering the uncertainty of its nature and the use of extracorporeal circulation lobectomy was not performed. A biopsy was performed instead. The pleura was closed and the operation successfully completed.\nThe patient recovered well on the ward and was discharged 9 days after the operation with an appointment for a partial lobectomy at a different hospital. Macroscopical and histological examination of the cardiac tumour showed a tumour measuring

a length of 6 cm (Figure ). Imaging could not confirm if it was a recurrent mass, a surgical scar, or an incomplete excision. Due to a positive ER and PR, the decision of the tumor board was to initiate tamoxifen. One month later, the patient reported the feeling of a perineal mass, similar to the one felt prior to surgery. Another MRI was performed and showed a progression of the

pathological examination found a lesion with a proliferation of paucicellular spindle cells in a myxoid stroma and medium to thick-walled vessels of variable caliber. The stroma was without atypia. No mitoses or necrosis were identified. The histological aspect and immunohistochemical profile were consistent with the diagnosis of AA. The evaluation of the uterine specimen revealed two leiomyomas of 1.5 cm and 5.5 cm.\nThe patient’s evolution was satisfactory one month after the surgery with no symptoms suggesting a possible recurrence. An MRI performed four months after the procedure showed a right perirectal longitudinal tissular density with

Her past medical history was unremarkable. The patient reported a perineal mass in the standing position. Her only other symptom consisted of mild occasional dysuria. Rectal and vaginal examinations were normal.\nAn endovaginal ultrasound performed one year before the present events to assess a known voluminous fibroma made no mention of a pelvic mass. An ultrasound of the perineal soft tissues found a hypoechogenic and heterogeneous mass of 4 x 5 cm beneath the paramedian region of the buttock. Endoscopic ultrasound showed a pelvic heterogenous mass that did not seem to originate from the rectal

plugs extraction. The transfer was done using the Osteochondral Autograft Transfer System technique (OATS) (Arthrex, Naples, Florida). The donor plugs were transplanted by the anterolateral approach to the donor site, starting posteriorly toward the anterior area of the defect, while rotating the hip and ensuring orthogonal position

starting posteriorly toward the anterior area of the defect, while rotating the hip

femoral head impaction and acetabular teardrop fracture; no other associated traumatic injuries were detected. The patient had closed reduction performed under general anesthesia. An X-ray showed a good reduction with an important osteochondral impaction and a wide lateral femoroacetabular joint space. However, a CT scan,

had a computed tomography (CT) scan of the brain and an angiogram of the head and neck. These studies did not show any findings consistent with acute stroke, hemorrhage or arterial occlusion. Despite this, there was a concern for a right middle cerebral artery (MCA) stroke given the clinical presentation.\nThe patient was admitted to the neurological intensive care unit (NICU) and was not given intravenous thrombolytics for the suspected stroke as he had sustained moderate bleeding with the bronchoscopy. Later that night, the patient had generalized tonic-clonic seizures that were aborted with benzodiazepines and levetiracetam. The patient then underwent repeat CT and magnetic resonance imaging (MRI) scan

any findings consistent with acute stroke, hemorrhage or arterial occlusion. Despite this, there was a concern for a right middle cerebral artery (MCA) stroke given the clinical presentation.\nThe patient was admitted to the neurological intensive care unit (NICU) and was not given intravenous thrombolytics for the suspected stroke as he had sustained moderate bleeding with the bronchoscopy. Later that night, the patient had generalized tonic-clonic seizures that were aborted with

lesion in the bronchus intermedius that completely obstructed the RML and the RLL (Figure ). APC at 30 watts and gas flow at 0.8 liters/minute were applied to the tumor, followed by blunt dissection of devitalized tissues with cupped and rat tooth forceps. The blunt dissection resulted in moderate bleeding that was controlled with cauterization. The patient tolerated the four-hour procedure well and was then transferred to the recovery room.\nOn arrival at the recovery room, the patient was found to be drowsy

a normal platelet count. Both erythrocyte sedimentation rate (65 mm/1st h) and C-reactive protein (86 mg/dL) were elevated. Initial radiograph of left hip joint was normal, but subsequent x-ray which was taken 1 week later showed a narrow joint space and destruction of femoral head (Fig. ). Ultra sound scan of hip revealed small effusion with echogenic particles. MRI of hip was also suggestive of septic arthritis (Fig. ).\nAfter

h) and C-reactive protein (86 mg/dL) were elevated. Initial radiograph of left hip joint was normal, but subsequent x-ray which was taken 1 week later showed a narrow joint space and destruction of femoral head (Fig. ). Ultra sound scan of hip revealed small effusion with echogenic particles. MRI of hip was also suggestive

arthritis in susceptible patients. Since the blood cultures were repeatedly negative, we performed antibodies to B. pseudomallei, which came positive with a titre of 1/10240 by Indirect Haemagglutination Assay (IHA). The presumptive diagnosis of melioidosis was made based on clinical and microbiological grounds. Definitive treatment was started with intravenous imipenem 1000 mg 6 hourly and oral co-trimoxazole (1920 mg 12 hourly). The patient responded well to the above treatment with fever settling within 72 h of

appearance because of missing teeth and the lack of retention and stability with his previous RPD.\nThe patient's medical history revealed that he had radiation therapy on the right sight of mandibular buccal shelf region at the head and neck area. At the extraoral examination, a scar tissue at the right buccal shelf area was observed due to the surgical

appearance because of missing teeth and the lack of retention and stability with his previous RPD.\nThe patient's medical history

anamnesis was taken, the patient has reported that three maxillary teeth with severe mobility were extracted before application to the Department of Prosthetic Dentistry Clinic. The patient had no existing dentures for both jaws. He had difficulty in usage of his previous dentures due to lack of retention. Intraoral examination revealed that the patient had two maxillary central and lateral teeth with moderate mobility and five mandibular teeth, right lateral to left canine with no mobility []. Reduced vestibular sulcus depth and a fibrous scar tissue were examined at the right buccal region. Radiographic examination using the

hospital other than ours, complaining of icterus. She was diagnosed with advanced GBC. The surgeons there thought an operation was not indicated, and she was scheduled to be initiated on systemic chemotherapy. However, she presented to our hospital for a second opinion. Abdominal computed tomography demonstrated a large tumor in the neck and body of the gallbladder, with expansive growth and compression of the portal vein, common bile duct (CBD), liver bed and inferior vena cava. However, the tumor did not invade into these tissues (Figure A,B). The tumor extended to the bile duct, resulting in obstructive jaundice; therefore, the likely cause of tumor extension was tumor thrombus, cancer

second opinion. Abdominal computed tomography demonstrated a large tumor in the neck and body of the gallbladder, with expansive growth and compression of the portal vein, common bile duct (CBD), liver bed and inferior vena cava. However, the tumor did not invade into these tissues (Figure A,B). The tumor extended to the

the hepatic side, hepatic duct was resected to the most peripheral point where the hepatic ducts could be separated from the vasculature during the right hepatectomy. This is the limit of ductal resection [] to ensure negative margins (Figure B).\nThe macroscopic view of the cut specimen

irregular round and plate like lesion with raised borders at midesophagus (29-31 cm from dental arc, ). Furthermore another huge mass was seen beginning from the distal esophagus extending to cardia and fundus ( & ).\nThe main bulk of the tumor could be inspected in the retroversion maneuver in fundus. This mass was very fragile and bled either spontaneously and on touch. Separate biopsy samples were taken from both the above described lesions. Accordingly pathological evaluation was performed by two experienced pathologists. Sections from the esophageal lesion

was seen beginning from the distal esophagus extending to cardia and fundus ( & ).\nThe main bulk of the tumor could be inspected in the retroversion maneuver in fundus. This mass was very fragile and

columnar cells. The cells characterized by mildly hyperchromatic enlarged nuclei with eosinophilic cytoplasm. Taking the above histological findings into account, moderately differentiated squamous cell carcinoma and well differentiated adenocarcinoma were diagnosed ( & ).\nThoraco-abdominal computed tomography showed high density pulmonary nodules in right and left upper lobes along with a large mass with necrotic areas at medial wall of gastric fundus and cardia. Abnormal laboratory findings at the time of admission included iron deficiency anemia and an increased carcino-embryonic antigen (CEA) of 125 ng/ml.\nConsidering the lung metastasis

raised ICP, the headache was not attributed to asymmetric ventriculomegaly. She was asked to continue medications. She underwent MRI twice at the annual interval, with no change in her ventriculomegaly. The constructed interference in steady state three-dimensional sequence revealed a membrane blocking the foramen of Monro but no lesion []. Lumbar puncture was not done to find the etiology of the occlusion of foramen as the patient had unilateral ventriculomegaly, and it was

deemed as a contraindication. A final diagnosis of idiopathic occlusion of the left foramen of Monro was made. The proposed mechanism of headache was probably raised ICP due to obstruction

to monitor. The opening pressure was 22 mm Hg. The endoscope was inserted after ICP monitoring for 5 min. The fenestration of the septum pellucidum was performed at the level of avascular zone, between anterior and posterior septal veins. The fenestration was done with bipolar probe without coagulation. The stoma was dilated using a Fogarty balloon no. 3. At the end of the

mental status, as well as small acute stroke seen on MRI, patient underwent lumbar puncture on hospital day 1 to evaluate for signs of meningitis or systemic vasculitis. Her CSF studies were not consistent with those diagnoses, with 1–4 white blood cells per UL, 0–1 red blood cells per UL, glucose of 65 mg/dL (normal 40–70 mg/dL), protein of 46 mg/dL (normal 15–45 mg/dL) and gram stain and culture which was negative for growth. CSF was also negative for oligoclonal bands, herpes simplex virus, Ebstein-Barr virus, John Cunningham (JC) virus, cytomegalovirus, varicella zoster virus, and negative for growth of

day 1 to evaluate for signs of meningitis or systemic vasculitis. Her CSF studies were not consistent with those diagnoses, with 1–4 white blood cells per

presenting blood pressure was not available for review, her blood pressure was noted to be 158/99 mmHg immediately prior to her transfer.\nThe patient was admitted to the medical intensive care unit, and given persistent seizures, required intubation for airway protection. Physical exam was limited due to sedation. Brain MRI revealed multifocal white matter edema affecting the occipital and parietal lobes with patchy gadolinium enhancement, in a predominantly posterior distribution, but also with frontal lobe lesions with associated vasogenic edema and patchy enhancement (Figure ). A small, acute infarct in the left centrum semiovale on diffusion weighted imaging was also noted. She developed a fever early in this hospitalization and extensive

treated with low anterior resection and neoadjuvant chemotherapy, and pathology demonstrated a T3N1M0, moderately differentiated adenocarcinoma. He was referred to the hepatobiliary service for consultation. At presentation, he was asymptomatic. His past medical history was significant for hypertension. His only prior surgical procedure was low anterior resection for rectal cancer. On examination, he did not appear jaundiced; his abdominal examination was unremarkable and laboratory investigations were normal. His CT scan showed a single metastatic deposit in segment one of the liver. A positron emission tomography – computed tomography (PET/CT) scan was consistent

T3N1M0, moderately differentiated adenocarcinoma. He was referred to the hepatobiliary service for consultation. At presentation, he was asymptomatic. His past medical history was significant for hypertension. His only prior surgical procedure was low anterior resection for rectal cancer. On examination, he did not appear jaundiced; his abdominal

regarding pre-surgery chemotherapy are made on a case-by-case basis. When the wait for surgery is likely to be beyond four weeks, usually patients will be offered chemotherapy. In this case, response to the various interventional radiology procedures was well beyond four weeks and for this reason chemotherapy was offered. A referral was made to medical oncologists for neoadjuvant chemotherapy and the patient received six cycles of FOLFOX. A

of right calf pain and swelling. She had no history of previous venous thromboembolic disease. The patient stated that the pain started after watching television for eight continuous hours. The following day, she noted persistent right calf pain. However, she was particularly engaged in national convention coverage and watched television continuously for approximately eight more hours. She recalls that she did not take any breaks from watching the convention; in fact she states she only moved from the chair once to go to the bathroom. After two days of mild

throbbing pain and swelling, she decided to have family members drive her to the ED.

an aspartate aminotransferase (AST) of 25 units/L, consistent with good control of her autoimmune hepatitis. Her international normalized ratio (INR) was 1.0. Ultrasound revealed occlusive thrombus to right popliteal and right posterior tibial vein (see ). A Computed Tomography Angiography (CTA) of the chest was positive for bilateral pulmonary emboli (see ): specifically right upper lobe, right middle lobe, and left lower lobe segmental thrombi. After two liters of

immediate suturing would result in an insufficient external nose width; therefore, we placed an incision at the ala of the nose and made every effort to maintain the shape of the ala. The final sutures were placed with trimming at some parts of the flaps for the achievement of a proper fit []. To prevent wound dehiscence, the vermilion on both sides was sutured to restrict opening. During the postoperative healing period, a nasoenteric feeding tube was used, and the patient did not

experience any other difficulties. Two weeks later, the upper and lower lips were separated under local anesthesia [Figure and ]. Despite the presence of a residual hematoma, the patient quickly recovered the ability for oral ingestion []. Because of extracapsular invasion in the lymph nodes, irradiation was performed to lower the risk of relapse. Once the patient could tolerate the intake of porridge, a total dose of 66 Gy was delivered to both sides of the neck and the primary tumor site.

sides of the neck.\nHistopathological examination of a biopsy specimen from the primary lesion revealed well-differentiated squamous cell carcinoma []. Moreover, 2-[fluorine-18] fluoro-2-deoxy-d-glucose (FDG) positron emission tomography/computed tomography showed increased FDG uptake by the primary lesion [Figure and ]. Several metastatic lymph nodes were also confirmed on both sides of the neck. A final diagnosis of squamous cell carcinoma (T2N2cM0) of the lower lip was made, and treatment was accordingly planned. First, excision surgery was performed. However, extracapsular invasion was a concern with lymph nodes showing

discomfort and palpitation was referred to our hospital. Examinations found no positive results except that Holter electrocardiography monitor revealed frequent ventricular premature contractions. He underwent the RFCA procedure since pharmacologic treatment did not show any significant improvement. After RFCA, the patient suddenly experienced dizzy, tight in the chest with cold sweat, bradycardia, and hypotension (89/50 mm Hg). Since chest X ray showed no sign of hydropericardium, vagal reflex was considered first. There was no improvement of blood pressure after rapid fluid infusion, and 2 mg atropine was administered intravenously. Fluoroscopy again showed increased heart shadow, and transthoracic echocardiography revealed hydropericardium. Protamine was administrated intravenously to neutralize heparin.

sweat, bradycardia, and hypotension (89/50 mm Hg). Since chest X ray showed no sign of hydropericardium, vagal reflex was considered first. There was no improvement of blood pressure after rapid fluid infusion, and 2 mg atropine was administered intravenously. Fluoroscopy again showed increased heart shadow, and transthoracic echocardiography

operating room for surgical exploration quickly due to active bleeding of the heart. Median sternotomy was performed. The pericardium cavity was filled with a large amount of blood and clot. After evacuating the pericardium cavity carefully, fresh blood was noted to be coming out of the left side of the heart, and the motion of the left ventricular free wall

serum and washes, the plates were treated with a goat–anti-human IgG antibody. After washing a horseradish peroxidase–conjugated donkey, anti-goat IgG is used for detection (Calbiochem; manufactured by Calbiochem, distributed by Merck, Darmstadt, Germany).\nBlood complement variables obtained 12 days after the delivery showed elevated levels of C3 and C4 and a slightly increased level of the soluble terminal complement complex (P-SC5b-9), as tested by standardized enzyme-linked immunosorbent assay. C3 protein appeared abundant in the patient’s plasma, but the molecular masses of the α and β chains did not differ from control samples in immunoblotting. No higher-molecular-weight C3-related bands were detected, indicating absence of covalent C3b complexes with

in-house enzyme-linked immunosorbent assay was used. Maxisorp plates (NUNC, Thermo Fisher Scientific, Vantaa, Finland) were coated o/n at 4 °C with human factor H (Complement Technology, Tyler, TX). After incubation with varying dilutions of patients

the patient was admitted because of headache, rising creatinine levels, and elevated blood pressure. Because of progressive uremia and imminent preeclampsia or HELLP syndrome, a cesarean section was performed the next day. At this point, partial HELLP syndrome according to the Tennessee classification system was evident. The evolution of various laboratory values is shown in .\nSoon after delivery TMA emerged. Clotting panel and differential diagnostic testing revealed no abnormalities. Renal biopsy

child born to nonconsanguineous parents presented with a history of large head and an abnormal compressible swelling on the right side of the scalp when she was 3 months old []. The swelling increased in size when the child cried. On examination, the child was found to have macrocephaly with delayed milestone in the form of neck holding at 1 year and standing with support at 22 months. On physical examination, there was a large compressible bluish scalp mass on the right parietal region with bony dents underneath. The mass was seen to increase in size on crying.

she was 3 months old []. The swelling increased in size when the child cried. On examination, the child was found to have macrocephaly with

midline masses of scalp-like dermoid, lipoma and encephalocele.[] Sometimes, it can mimic subepicranial varix where there is dilated venous sac on the scalp without communication with intracranial dural sinuses.[] Sinus pericranii may be associated with various other anomalies, like systemic angiomas and craniosynostosis.[] It can be diagnosed by clinical examination and radiological imaging. Usefulness of MR venography and computed tomography angiography has already been described to confidently diagnose sinus pericranii and exclude other mimicking causes of scalp swelling. However, conventional angiography may still be useful to rule out other vascular malformations like dural fistula and arteriovenous malformation. Demonstration of extracranial venous sac communicating with intracranial dural sinus via diploic or emissary veins is

tumor such as adenomatoid odontogenic tumor (AOT) were postulated.\nThe patient was conventionally managed by surgical debridement of the lesion followed by regenerative therapy. The involved tooth was nonvital, and endodontic therapy was carried out. The lesional tissue specimen was sent

for the histopathological examination.\nGross examination revealed multiple tissue fragments with the largest measuring 1.0 cm × 0.5 cm × 0.4 cm, being yellowish-white in color and soft in consistency []. Histopathologically, the sections exhibited stratified squamous surface epithelium at the one end of the section with the lesional tissue in

one of the very few cases where a histopathological picture of an odontogenic tumor simulated that of a salivary gland lesion. Thus, the sections were exposed to immunohistochemical analysis for CK 7, CK 19, CK 8/18, S100 and proliferation index markers ki-67 and p63. Low intensity staining with Ki 67 and p63 (only <30 cells per high-power field showing p63 positivity) along with the morphological features suggested benign nature of the lesion. Focal weak positivity with CK 19 and strong positivity

introducer was slowly withdrawn from the tunnel followed by the bar with the bar's convexity facing posteriorly until it emerges on the contralateral side. The bar was placed directly on the ribs in the submuscular position. Both the bar and the stabilizer were fixed together onto the underlying rib with multiple interrupted non-absorbable sutures. An excision of the

the ribs in the submuscular position. Both the bar and the stabilizer were fixed together onto the underlying rib with multiple interrupted

to the hospital, stating that a lifelong mass on the anterior chest wall had grown steadily to its present size. He also presented with an 8 years history of increasing depression of the anterior chest wall. Systematic questioning of the patient and his parents elicited no description of significant symptoms. However, the mass was increasingly prominent and the chest wall depression became progressively worse with age, causing the patient considerable emotional distress. Physical examination revealed a soft, fixed, painless mass originating from the anterior chest wall. The mass was associated with thinning of the skin,

of 1/5 and 2/5 in proximal and distal muscle groups of both upper extremities, respectively, with a strength of 2/5 in both lower extremities. Pinprick and temperature sensation were decreased at the approximate level of C2–C4 throughout the lateral torso and both upper extremities, while vibration and proprioception remained intact in all extremities. These findings reinforced the diagnosis of acute SCI. demonstrates the timeline of the events within 24 h after the procedure. A second brain MRIat this time showed evidence of T2/FLAIR hyperintense signal and increased diffusion restriction in the right cerebellar hemisphere at the site of Onyx embolization. As a result of the SCI, she developed hypercapnic respiratory failure requiring urgent endotracheal

new intermittent lower extremity weakness, but light touch sensation remained intact in all extremities. Clinical examination at this point was consistent with acute SCI. A second cervical MRI revealed more extensive abnormal signal centered at the C2 and C3 levels with associated cord expansion. Additionally, new signal abnormality had developed at the C5–C6 level, without associated cord expansion (). Her limb weakness continued to progress. On evaluation 1 day post-procedure, she had a strength

a four French angled vertebral catheter into the proximal cervical left vertebral artery (VA). As noted on the diagnostic angiogram, the left VA had a variant origin, arising directly from the aortic arch, and was chosen for access due to marked tortuosity at the origin of the right VA. Five micrograms of intra-arterial verapamil was administered to prevent vasospasm, and the five French guide sheath was advanced to the mid-cervical left VA, beyond the origin of the artery of cervical enlargement, which was

implied the presence of fetal urine outflow obstruction but not a decrease in urine production (Figures –, ). Sonographic assessment of fetal well-being, including Doppler velocimetry of the middle cerebral artery, umbilical cord artery, and ductus venous, and biophysical profiling, was normal. MRI was performed at 30 weeks of gestation to assess pulmonary development, which indicated possible pulmonary hypoplasia (). By 32 weeks of gestation, although the fetal bladder was filled, oligohydramnios persisted without any signs of premature rupture of the membranes, placental insufficiency, hydroureter, or hydronephrosis.

Taken together with the progression of bowel dilation which distended the fetal abdomen, fetal urethral stenosis or obstruction was expected to have triggered a misdirected urine flow from the bladder to the colon through the fistula. As deterioration of oligohydramnios and bowel dilation which lead to pulmonary hypoplasia by thoracic compression was progressive, expectant management was anticipated to worsen

intubation and high-frequency oscillatory ventilation accompanied with inhaled nitric oxide treatment due to severe respiratory failure with persistent pulmonary hypertension (). Regarding imperforate anus, cystostomy was performed on the first day, because a 3 Fr catheter did not pass through urethra into the fluid-filled bladder and abdominal ultrasonography showed a stone-like hyperechoic object in the urethra. On 36 days after birth, cystourethrography revealed high-type imperforate anus with patent rectourethral fistula, nonobstructive lower urinary tract, and urethral stenosis distal to the rectourethral fistula (). Postnatal MRI did not demonstrate any cerebral abnormalities including periventricular

born in Saudi Arabia, was presented to our department for elective laparoscopic cholecystectomy. He hailed from rural area with poor socioeconomic and sanitation status. He was suffering from gallbladder symptoms since past 9 years and was on oral hypoglycemic medication. He had been following the hospital for 3 months with recurrent attacks of biliary colic and multiple emergency department visits for pain control. All throughout this period, he kept afebrile.\nIn the clinic, he reported a history of repeated nausea and vomiting

of biliary colic and multiple emergency department visits for pain control. All throughout this period, he

The gallbladder was evacuated to make it easy to grasp. The impacted stone was thus extracted after draining the contents. By using this approach, cystic duct and artery were easily identified and ligated and finally the gallbladder was safely excised. All this procedure was accomplished laparoscopically.\nOn examining the gall bladder histopathology, marked

MTA (Angelus) as an apical plug. MTA was mixed according to the manufacturer's instructions. MTA was carried to the canal with an MTA MAP System (Dentsply Tulsa Dental Specialties) and compacted apically with a DX Condenser (Dentazon) and sterile paper points. The extent and thickness of the MTA

to the canal with an MTA MAP System (Dentsply Tulsa Dental Specialties) and compacted apically with a

Both nonsurgical and surgical endodontic treatment options were presented and discussed with the patient. The absence of adequate root canal filling led to the decision to perform nonsurgical root canal retreatment on tooth #34, and the patient agreed to participate and signed the consent form. The patient was scheduled for two treatment visits.\nIn the first visit, tooth #34 was isolated by a #9 rubber dam clamp and

complaint of abdominal fullness and weight loss of 10kg during the last year. A huge abdominal mass was palpated, and she was referred to the gynecology department to search for a tumor of uterine origin. She was premenopausal and had no significant past medical history. Physical findings revealed

was palpated, and she was referred to the gynecology department to search for a tumor of uterine origin. She was premenopausal and had no significant past medical

examination of the endometrium was unsuccessful due to a deviated uterine cervix. At this point, preoperatively, we suspected the tumor was a leiomyosarcoma or leiomyoma with degeneration.\nThe patient underwent laparotomy, where we identified a huge tumor occupying a space from the pelvis to the diaphragm. The tumor surface was smooth and hard with many dilated veins (). A massive tumor with a diameter of 30 cm was observed arising from the posterior uterine wall with a smooth contour and invaded the retroperitoneal cavity under the mesentery. The tumor was firmly adhered to both the mesentery and right ovary. There were no findings of extra-uterine dissemination. The intraoperative frozen section report for

admission to the ICU, her consciousness was maintained in an alert state, the paralysis in the right limbs and aphasia resolved completely, and the EEG showed normal results. Transthoracic echocardiography performed on the day after admission showed that the left ventricle ejection fraction (LVEF) was reduced to 44%, and left ventricle global hypokinesia and moderate systolic dysfunction were observed. After that, consecutively performed coronary angiography (CAG), spasm provocation test, cardiac MRI, and 24-hr

an alert state, the paralysis in the right limbs and aphasia resolved completely, and the EEG showed normal results. Transthoracic echocardiography performed on the day after admission showed that

for a condition where her arms were raised and her limbs were stretched continually for approximately 1 min while sleeping after an episode of alcohol intake. She did not undergo any particular tests and neither was she administered any drugs, under the assumption that these symptoms were temporary and had been caused by alcohol intake. Three years prior, a similar episode occurred during sleep, for which some medical tests were conducted such as electrocardiogram (ECG), brain MRI, and electroencephalogram

gastric type and Peterson’s defect was not closed. The above described bowel trifurcation had sunken postero- inferior to the spleen and had herniated through a potential space underneath the spleen and torsed around the splenic vessels and hilum. This picture was consistent with perisplenic small bowel volvulus. As noted earlier there was a massively dilated proximal small bowel segment above the spleen, displacing it caudally. Careful adhesiolysis was performed inferior to the spleen to release the segment of the trifurcation. The bowel segments once reduced were assessed and appeared

The dilated bowel complex was decompressed using needle aspiration to help reduction of the bowel loops. The ileo cecal junction was then identified and traced back to the perisplenic hilar region. The trifurcation of three bowel loops (Roux limb, biliopancreatic limb and common limb) were identified with identification of ligament of Treitz. The prior gastric bypass was of ante colic- ante

42-year-old Hispanic female presented to the emergency room with a one-day history of epigastric abdominal pain, nausea and vomiting. The pain was mostly in left upper quadrant of abdomen, sharp, intermittent, without any alleviating or aggravating factors. It was associated with multiple episodes of nausea and bilious vomiting. Patient denied any fevers, chills, diarrhea, constipation and prior similar episodes. Her relevant past surgical history included Laparoscopic Roux-en-Y gastric bypass (LGBP) 13 years ago and recent robotic assisted Total abdominal hysterectomy with

amputation on the left leg. During this admission, the patient experienced squeezing precordial pain and intermittent abdominal pain.\nOn Aug. 30, 1982, factor VIII concentration was 200% and factor V 100% of the normal control. The euglobulin lysis time was 3 hours. FDP was less than 10 μg/dl. The fibrinogen was 407 mg/dl. The serum antithrombin III level was within normal range. The platelet aggregation test revealed increased aggregability with ADP (patient, 91.3%; control, 77.5%), epinephrine (patient, 82.5%; control, 72.5%), and collagen (patient, 81.3%; control, 70.0%).\nThe two-dimensional echocardiography repeated

factor V 100% of the normal control. The euglobulin lysis time was 3 hours. FDP was less than 10 μg/dl. The fibrinogen was 407

He was discharged on Aug. 16, 1976.\nBetween Aug., 1976 and Feb., 1982, the patient had to be amitted to the hospital three times. The first time was for the sudden development of dizziness, the second time for abdominal pain due to ileus, and the third time because of chest tightness and abdominal pain.\nHe had had an appendectomy at the age of 13 and had contracted typhoid fever at 14. According to his history his father and younger brother had hypertension. He smoked about two packs of cigarettes per day and consumed a little alcohol.\nThe chest X-ray revealed mild cardiomegaly with a prominent left ventricle. Occasional premature ventricular contractions were

a 34-years-old pregnant woman with a single gestation. An omphalocele enclosing mixed intestinal and hepatic content was diagnosed at 12th week (). Nuchal translucency (NT) was normal, and no other associated malformations were observed. Parents were counseled regarding ultrasound findings. A genetic study was performed including karyotype, 60K Array-CGH, and methylation-sensitive multiplex ligation probe analysis to analyze the presence of epigenetic and genetic changes related to BeckwithWiedemann Syndrome (BWS), all of them being negative. Parents were informed of the results, as well as the impossibility of ruling out BWS completely despite the negativity of the genetic study, since this disorder is caused by epigenetic defects and there

are up to 20% of cases whose diagnosis is clinical and therefore postnatal. After counseling, the patient decided to continue with gestation. The 20th week anomaly scan showed no associated malformations, except a slight upward and

age, two inguinal hernias were diagnosed and repaired surgically (). During the exploration of the left herniated sac, the ileocecal junction and the appendix

The first at the age of 1½ years was perceived by the parents as not significant, whereas the second at the age of 2½ years was severe. The boy had fallen off his bicycle against a fence outside the family's house. Trauma was recorded in PDHS with the diagnoses of avulsed teeth #51 and 61 and uncomplicated crown fracture tooth #52. Three weeks after trauma,

The first at the age of 1½ years was perceived by the parents as not significant, whereas the second at the age of 2½ years was severe. The boy had fallen off his bicycle against a fence outside the family's house. Trauma was recorded in PDHS with

and alveolar fracture at the area was suspected. At the age of 7, teeth #11 and 21 had not erupted. One year later, it was noted that the erupted tooth #11 had atypical crown shape and enamel hypoplasia whereas tooth #21 had not erupted yet. Periapical radiograph showed that tooth #21 had aberrant crown anatomy similar to the erupted tooth #11 (). At the age of 9, the boy was referred to a private orthodontist due to delayed eruption of tooth #21 (). The orthodontist perceived the delayed eruption as a result of a supernumerary tooth and referred the patient to an oral surgeon at the

flow from the left upper extremity into the SVC excluding the left chest wall VM from causing any further PE. In order to maintain long-term patency of these stent-grafts, a small arterio-venous fistula was

into the SVC excluding the left chest wall VM from causing any further PE. In

21-year-old woman with a massive mediastinal–left chest wall VM, atresia of the left subclavian vein, and CTEPH was referred for evaluation primarily for PTE and secondarily for heart–lung transplantation. The patient was born with a compressible mass extending from the left neck, left chest, and left axillary areas. Six months prior to referral, she was diagnosed with an acute PE and treated with warfarin. She had not had an acute venous thromboembolic event prior to this and therefore was not previously on anticoagulation. She then reported progressive exercise intolerance progressing to severe dyspnea on exertion, ultimately becoming wheelchair-bound. Her pulmonary artery pressure was elevated and oral tadalafil

cm intraluminal polypoid mass (A). Histology revealed a poorly differentiated diffuse adenocarcinoma involving the whole wall, associated with extensive fibrosis and surface erosion. Mononuclear inflammatory cell infiltration was present. No lymph nodes or resection margins were involved. A final diagnosis of EBVaGC stage IIA was made. Immunohistochemistry characterized tumour cells as CAM 5.2 positive, CK7 and CK20

diffuse adenocarcinoma involving the whole wall, associated with extensive fibrosis and surface erosion. Mononuclear inflammatory cell infiltration was present. No lymph nodes or resection margins were involved. A final diagnosis of EBVaGC stage IIA was made. Immunohistochemistry characterized

CD3 + T lymphocytes, CD20 + B lymphocytes, CD68 + monocytes and CD79a + plasma cells. In situ hybridization (ISH) for Epstein–Barr early RNA EBER (Epstein–Barr encoded RNAs) showed that EBV genomes were present within the nuclei of almost all neoplastic epithelial cells but not in the inflammatory mononuclear cells (B,C). EBV presence was confirmed by polymerase chain reaction (PCR) using specific primers for EBNA1 (Epstein–Barr nuclear antigen 1)

her primary care provider in January 2012 with some hematochezia and diarrhea accompanied by lower abdominal pain. After a change in diet failed to resolve her symptoms, she subsequently underwent a computed tomography (CT) scan, which showed severe proctocolitis. The patient was administered steroids in addition to metronidazole, but her symptoms did not resolve. She underwent a colonoscopy in June 2012, which showed the presence of a

mass nearly obstructing the rectum.\nOn June 21, 2012, she underwent a low anterior resection of a stage IV rectosigmoid adenocarcinoma (approximately 5 × 4 × 1.5 cm). The tumor was moderately differentiated. A wedge resection of a left hepatic lobe was performed at the same time

At about that time (September 2012), the patient was started on XELOX chemotherapy (oxaliplatin 100 mg/m2 over two hours, Day 1, every three weeks; capecitabine 850 mg/m2 orally twice daily, Days 1 to 14, every three weeks) and received approximately three cycles. Although the patient tolerated the first cycle well, the day after chemotherapy she had one isolated episode of complete blindness in her right eye, which lasted 15 seconds. A similar but shorter episode lasting between eight and 10 seconds occurred during the second cycle of XELOX. The last (third) cycle was not

obturator was tried in patient's mouth for retention and comfort. Then the cast partial denture framework with the prosthetic teeth was tried in the patient's mouth and evaluated for extension, retention, stability, occlusion, and phonetics (). Cobalt samarium magnets of 4 mm dimension were placed over the tissue side of cast

for retention and comfort. Then the cast partial denture framework with the prosthetic teeth was tried in the patient's mouth and evaluated for extension, retention, stability, occlusion, and phonetics ().

type IV stone (ultra rock) and a secondary cast was obtained. The lateral undercuts in the defective area were blocked out and a hollow bulb obturator was processed using a lost salt technique. The hollow bulb obturator was tried in patient's mouth for retention and comfort. Then the cast partial denture framework with the prosthetic teeth was tried in the patient's mouth and evaluated for extension, retention, stability, occlusion, and phonetics (). Cobalt samarium magnets of 4 mm dimension were placed over the tissue side of cast partial denture framework

apparent diversion of some collateral flow to the pregnant uterus. Urine drug screen was positive for cocaine. Due to worsening symptoms likely secondary to increased vascular demand of the gravid uterus and

to worsening symptoms likely secondary to increased vascular demand of the

was no need for acute surgical intervention as the patient had preserved motor function and her pain was adequately controlled. She was discharged home on enoxaparin 100 mg BID and aspirin 81 g daily. Despite anticoagulation, she was readmitted 11 weeks after delivery with flank pain and found to have a left renal artery infarct and extension of

portion lying intracranially, and only the distal end was visible just below the angle of the mandible. Unsure about the further step, a literature search was done, and it was found that there were only a few cases reports regarding such tumors with at least two reports suggesting radiosurgery as an alternative to surgical management ().\nHence, with no possibility of tumor resection without sacrificing the hypoglossal nerve, the procedure was abandoned, and the patient was planned for cyberknife therapy. No immediate post-operative complications were noted,

regarding such tumors with at least two reports suggesting radiosurgery as an alternative to surgical management ().\nHence, with no possibility of tumor resection without sacrificing the hypoglossal nerve, the procedure was abandoned, and the patient was planned for cyberknife therapy. No immediate post-operative complications were

evaluation with an ECG and cardiac echo was performed to rule out the cause of an infarct. ECG and cardiac echo were found to be normal. Computed tomography angiogram of the neck was done (), which showed a highly vascular mass, 2.8 x 3.4 x 6.0 cm in size, arising above the carotid bifurcation with its feeding vessel arising from the right external carotid artery. It was splaying the right internal carotid artery anteriorly and medially

as routine follow-up. His initial symptoms had completely resolved and a repeat chest radiograph on that day showed clear lungs with no evidence of metastatic deposits (figure ). Although no histological confirmation of the metastatic nature of the lung lesions was obtained, it is highly likely that his pulmonary metastases had regressed spontaneously as the patient had not received any immunotherapy in the meantime. The patient remains well five months after the operation.\nRenal cell cancer accounts for 2% of all

on that day showed clear lungs with no evidence of metastatic deposits (figure ). Although no histological confirmation of the metastatic nature of the

patients with advanced renal cell carcinoma compared to a variety of other options with less toxicity [].\nThere have been case reports in the literature that describe spontaneous regression of metastatic renal cancer [,-].\nBumpus described the first reported case of spontaneous regression of metastatic renal cell carcinoma in 1928 []. Metastatic sites include brain, bone, hilar adenopathy and most commonly pulmonary metastases. The clinical pattern of the improvement is not uncommonly the complete disappearance of disease, and often the regression is long-lasting. Many of these cases are associated with surgical removal of the primary tumor, but regression can also occur in association

Crohn's disease. She was started on prednisolone 40 mg daily, omeprazole 20 mg daily, mesalazine 1 gram tds, and calcium and vitamin D supplements.\nInitially, she responded well to the treatment and prednisolone was tailed down and stopped. She maintained an ESR of 26 and a CRP of <6 and remained asymptomatic for five months. However, in January 2014, she developed abdominal pain, nausea, bloating, and anorexia and a CT enterogram was

she responded well to the treatment and prednisolone was tailed down and stopped. She maintained an ESR of 26 and a CRP of <6 and remained asymptomatic for five months. However, in January 2014, she developed abdominal pain, nausea, bloating, and anorexia and a

no blood pressure could be recorded on the left side. Lower limb pulses were equal bilaterally. Blood investigations were normal except for mild anaemia (Hb 10.7) and an ESR of 29. ANA, ENA, and ANCA tests were negative. A PET/CT scan confirmed the circumferential mural thickening (5 mm) starting at the origin of the left subclavian artery extending distally for approximately 3.5 cm with significant stenosis. Similar circumferential mural thickening was also present in the lower segment of thoracic aorta and in the left axillary artery and proximal part of the brachial arteries (). The aortic arch

undergoing a surgery to remove an enlarging bone tumor in the left temporal region 2 years ago. She later got pregnant and delivered her child but never got back for a checkup until she was admitted to our hospital with a severe and unresponsive to medication headache that progressed over the course of 6 months and blurred vision that progressed to complete left-sided vision loss. Physical examination revealed a tough and mobile yet fixed at the base 7-cm mass towards the left of

the frontal bone. Many more masses were revealed in the left side of the skull including the anterior cranial fossa, orbit, base of the skull and the left part of the occipital region where the previous procedure was performed (). These masses had been increasing in size probably under the influence of pregnancy hormones causing pain that radiated along the orbital and maxillary branches of the left trigeminal nerve. Physical examination and

rims are unsymmetrical and pointy, and it bulges into the left orbit outside the muscles causing exophthalmos with a semi-complete proptosis of the eyeball out of the orbit ( and ). This lesion applies pressure to the left frontal and temporal lobes causing mild edema in both these lobes without invading the brain tissue. This edema in turn applies pressure to the left lateral ventricles (minor shift of the elements of the midline to the right side can be seen on CT) (). Due to the tumor’s wide spread, the surgical procedure was

tumor cells with abundant, eosinophilic, and clear cytoplasm. Numerous mitoses were also detected. The tumor cells exhibited solid or thick-trabecular patterns with scanty stroma containing blood vessels that resembled HCC and expansive invasion into the gastric wall (Fig. ). Features of enteroblastic differentiation and Schiller-Duval bodies were absent.\nImmunohistochemical staining was performed to characterize the tumor cells (Table ). The tumor cells stained

positive for AFP and Sal-like protein 4 (SALL4), but were negative for carcinoembryonic antigen, synaptophysin, chromogranin A, and neural cell adhesion molecule (Fig. –). According to these findings, the patient was diagnosed with GHAC. No tumor cells were observed during the cytological examination of ascites. LN metastases were detected in 6 LNs (20%) and a solitary metastasis

upper abdominal and lower left back pain 1 month and 1 week prior to examination, respectively. He was referred to our hospital after the pain had worsened. The patient experienced spontaneous lumbar and epigastric pain with muscular defense of the epigastrium and accompanying tenderness. Blood test results indicated a white blood cell count of 12,430 /μL, a C-reactive protein level of 0.6 mg/dL, and mild but increasing inflammation. No abnormal findings were reported from the other blood counts, biochemical examinations, and coagulation tests.\nAbdominal contrast-enhanced

systemic complications.\nTwenty-four hours after the second intravascular embolization, the patient was transferred to the operating room for surgical resection (). By positioning her prone on the operating table we were able to manipulate the lesion satisfactorily. An incision was made along the right posterior medial limb from the upper portion of the buttock to the thigh. Dissection through the superficial tissues necessitated some dissection through tumor tissue, which was highly vascular with large friable vessels. To reduce intraoperative bleeding, we decided to use the system Stapling Endo (Endo GIA) (). Once deep to the lesion, it was possible to encompass it

transferred to the operating room for surgical resection (). By positioning her prone on the operating table we were able to manipulate the lesion satisfactorily. An incision was made along the right posterior medial limb from the upper portion of the buttock to the thigh. Dissection through the superficial

Cultures grew Escherichia coli and the patient was started on IV cefepime, vancomycin, and gentamicin. Vacuum-assisted wound closure (VAC; Kinetic Concepts Inc., San Antonio, TX, USA) was placed with 150 mmHg continuous suction and the patient responded well. The surgical wound healed and the patient was discharged after a total of 5 weeks and was followedup in clinic with physical examination and serial local MRI every 3 months ().\nTwo years postoperatively,

emergency department with right wrist pain and decreased range of motion of the forearm following a friendly grappling match. On history, he was mildly intoxicated by alcohol at the time of the injury. His friend had performed an arm-bar holding the patient's right arm between his legs while pulling on the forearm with his hands. The patient tried to escape the maneuver by forcefully pulling and pronating his forearm. He immediately felt pain in his right forearm and was unable to use it afterwards. His past medical history was significant for alcohol, tobacco, and cocaine use. He was not known to be suffering any

intoxicated by alcohol at the time of the injury. His friend had performed an arm-bar holding the patient's right arm between his legs while pulling on

department with right wrist pain and decreased range of motion of the forearm following a friendly grappling match. On history, he was mildly intoxicated by alcohol at the time of the injury. His friend had performed an arm-bar holding the patient's right arm between his legs while pulling on the forearm with his hands. The patient tried to escape the maneuver by forcefully pulling and pronating his forearm. He immediately felt pain in his right forearm and was unable to use it afterwards. His past medical history was significant for alcohol, tobacco, and cocaine use. He was not known to

be as follows: the left common carotid artery, right common carotid artery, right subclavian artery, and ALSA originating from the KD (). Moreover, a right common iliac artery aneurysm with a maximal diameter of 48 mm could be recognized.\nOn the day before the scheduled surgery for iliac aneurysm, the subject complained of sudden back pain and numbness of the left arm. CT analysis revealed a retrograde type A aortic dissection and occlusion of ALSA. The false lumen had thrombosed, and an intimal tear was found in the KD (). The ascending aorta was 39 mm in

a maximal diameter of 48 mm could be recognized.\nOn the day before the scheduled surgery for iliac aneurysm, the subject complained of sudden back pain and numbness of

devices, angiography showed successful exclusion of the KD and a small type 2 endoleak. Finally, a blood pressure gradient of 13 mmHg was observed between the arms.\nThe patient’s post-procedure course was uneventful. Neither left arm claudication nor subclavian steal syndrome occurred. Although CT scanning revealed a small endoleak, the stent graft was correctly positioned, and the KD had been successfully excluded (). The patient was successfully discharged from the hospital on the seventh day after the treatment. Three months later, endovascular repair of the right common

of these were used for cosmetic reasons with the rest being for patients who were getting breast reconstruction after mastectomy. It is unlikely that the mechanism of development of ALCL is related to the chemotherapy. Both saline-filled and silicone breast implants have been implicated in the pathogenesis of ALCL of the breast. Although silicone prostheses were thought to be biologically inert, there are case reports with localized and distant granulomatous inflammation in the breast and reactive lymphadenopathy. Animal studies have shown that silicone may be immunogenic. Silicone gels contain potentially

these were used for cosmetic reasons with the rest being for patients who were getting breast reconstruction after mastectomy. It is unlikely that the mechanism of development of ALCL is related to the chemotherapy. Both saline-filled and silicone breast implants have been implicated in the pathogenesis of ALCL of the

been used very much.\nCHARACTERISTICS OF ANAPLASTIC LARGE CELL LYMPHOMA\nHistopathologically ALCL is characterized by large pleomorphic cells with a horse shoe nucleus. The morphology of cells in ALCL of the breast is the same in patients with or without breast implants. These cells have a high mitotic index. About 60 to 85% of these ALCL tumors stain for surface marker CD30 (Ki-1). They are positive for EMA (epithelial membrane antigen) and for other T cell markers such as CD3, CD4, CD5, CD7 or CD43. It is interesting that most systemic ALCL are ALK positive; however,

after intravenous dextrose administration. He had experienced this type of episode twice before he visited our hospital but did not have any problems during the previous few days. He had no family history of any endocrine metabolic diseases, and physical examinations showed no special findings. The patient was admitted on the basis of hypoglycemia for 2 weeks. Except for the

but did not have any problems during the previous few days. He had no family history of any endocrine metabolic diseases, and

and metanephrines. For the tumor located in the retroperitoneum, a tumorectomy was performed. In the course of this operation, there was no evidence of a tumor in the kidney or adrenal gland, but tumor turned out to be in the splenic parenchyma as found by intraoperative ultrasonography. As a result, a total splenectomy was performed.\nHypoglycemia-related symptoms disappeared after surgical resection was performed. The patient is still alive and well without evidence of local tumor recurrence 15 years after the operation.\nGrossly, the resected spleen (130 g: 10 × 6.5 × 4 cm) was received.

1.5T magnetic resonance scanner (Magnetom VISION, Siemens, Erlangen, Germany). For functional imaging, echo-planar imaging (EPI) was used (matrix = 64×64). Five rest conditions were alternated with five activation conditions, and each period consisted of 120 images at 22-second intervals (repetition time). These 1,200 images were collected and analyzed according to the time. During the activation period, the stimuli consisted of card pictures showing a full house, four-of-a-kind,

losses by gambling. He presently maintained his job and social relationships stably after treatment.\nfMRI was performed on a

second fMRI scan was also obtained on the seventh day after medication ().\nThree weeks after discharge (six weeks after beginning of the fluvoxamine prescription), BDI, STAI, and GSAS were again administered, and the same assessments were also carried out at six and nine months after beginning of the medication (). Additionally, fMRI scans took place at six weeks and six months after medication ( and ).\nThe patient did not undergo individual or group cognitive behavioral therapy, nor did he participate in

pain in the external auditory canal rather than in the areas near the auricles. Accordingly, beside to Bell's palsy, we considered an atypical type of Ramsay-Hunt syndrome that doesn't show dermatological lesions, as our possible differential diagnosis. We started with high doses of steroid (prednisolone, 60 mg/day) and antiviral drug (Acylovir 1800 mg/day) after the patient was hospitalized. Even though it's rare to present severe otalgia from primary or metastatic tumors of the skull base, we performed a CT scan of the temporal bone to rule out these

this patient was of great severity compared to that generally shown in Bell's palsy, and he complained of a stronger, deep

order to confirm the presence of other metastasis to other organs and the existence of an originating region of the metastatic tumor. The PET-CT scan show-ed a high fluorodeoxyglucose uptake in the left middle cranial fossa, both ribs, left scapula and the left adrenal gland. We also observed a lesion of 3 cm in the upper lobe of the right lung () and tried to perform a biopsy on the upper lobe of right lung in suspicion of lung cancer with multiple areas of metastasis. However, it was not allowed as the

37th week of her second pregnancy with a relatively sudden hearing loss and tinnitus in the left ear. Initially, the symptoms were fluctuating. She suffered from attacks of vertigo and slight difficulty in finding words. Approximately 2.5 months after having given birth, she developed painless visual acuity impairment and noticed a dark shadow in the inferior visual field of the right eye.

fluctuating. She suffered from attacks of vertigo and slight difficulty in finding words. Approximately 2.5 months after having given birth, she developed painless visual acuity impairment and

with a relatively sudden hearing loss and tinnitus in the left ear. Initially, the symptoms were fluctuating. She suffered from attacks of vertigo and slight difficulty in finding words. Approximately 2.5 months after having given birth, she developed painless visual acuity impairment and noticed a dark shadow in the inferior visual field of the right eye. Clinical fundoscopy examination revealed an occlusion of the superior retinal arteries and a pale ischemic edema of the retina in the upper quadrants (fig. ). In the left eye, a pale optic nervehead, thin arterial white ‘ghost vessels’ and an atrophic retina were

large diameter myelinated fibers with no evidence of inflammation or fibrosis []. The patient was managed symptomatically. By the seventh day of his admission, his downbeat nystagmus had resolved completely and by the 10th day, both the 6th and 7th nerve

evidence of inflammation or fibrosis []. The patient was managed symptomatically. By the seventh day of his admission, his downbeat nystagmus had resolved completely

tibial nerves. Temporal dispersion was not encountered in any of the studied nerves. Sensory nerve conduction studies revealed decreased Sensory nerve action potential (SNAP) amplitudes in both median and ulnar nerves while sural and superficial peroneal SNAPs, on both sides, were not recordable. However, dorsal ulnar cutaneous SNAPs were normally recorded. Needle Electromyography (EMG) revealed changes of chronic denervation in extensor digitorum brevis, and first dorsal interosseous, bilaterally. Grade one fibrillations were recorded from right Tibialis anterior and left Flexor digitorum sublimus. EMG of quadriceps, medial gastrocnemius, brachioradialis, pronator teres, biceps, deltoid, on both sides, was normal. The pattern evoked VEP revealed prolonged P100 latency (left: 137 ms; right: 144 ms.; normal, ≤104.5 ms) [Figure and

camera and endowrist instruments were introduced through the trocars. Monopolar scissors on the right side and bipolar forceps on the left side with either a fenestrated grasper or a Maryland dissector for retraction were used. After the setup, the first author continued the surgery at the console. During the inspection, there was no presence of disease within the abdominal cavity. For the pelvic lymphadenectomy, the paravesical and pararectal regions were identified. After the dissection of the internal and external iliac artery bifurcation, the ureter was retracted medially. There was a bulky lymph node that was 3 × 3 cm in size between the external iliac vein and

instruments were introduced through the trocars. Monopolar scissors on the right side and bipolar forceps on the left side with either a fenestrated grasper or a Maryland dissector for retraction were used. After the setup, the first author continued the surgery at the console. During the inspection, there was no presence

is, fastening of the patient side cart to the trocars, the camera and endowrist instruments were introduced through the trocars. Monopolar scissors on the right side and bipolar forceps on the left side with either a fenestrated grasper or a Maryland dissector for retraction were used. After the setup, the first author continued the surgery at the console. During the inspection, there was no presence of disease within the abdominal cavity. For the pelvic lymphadenectomy, the paravesical and pararectal regions were identified. After the dissection of the internal and external iliac artery bifurcation, the ureter was retracted medially. There was

the lower sternal hardware, sternal debridement, bilateral pectoralis advancement flaps, and skin closure. Cultures taken during this final operation eventually grew Mycobacterium abscessus. After extensive multidisciplinary discussions, further chest wall resection was felt to be high-risk. A referral was placed to a center with expertise and he was discharged on oral azithromycin, intravenous amikacin, and intravenous imipenem.\nDuring the ensuing months, he was monitored closely as an outpatient. Drainage from the inferior wound recurred four months following discharge, prompting referral to our institution. Imaging revealed a substernal fluid collection with a draining sinus tract,

be high-risk. A referral was placed to a center with expertise and he was discharged on oral azithromycin, intravenous amikacin, and intravenous imipenem.\nDuring the ensuing months, he was

U/3 L 0.9% normal saline). Absorbable synthetic calcium sulfate beads (Stimulan, Biocomposites, UK) infused with amikacin (5 g in 50 cc of beads) were placed in the wound bed (Figure ). A temporary wound vac was placed, and the patient was admitted to the cardiac surgery ward.\nTissue staining revealed granulomas with acid-fast bacilli in the connective tissue surrounding the lower sternum, but no active infection of the bone (Figure ). Weekly operative debridements were performed while obtaining new cultures and replacing the amikacin beads. At five weeks following initial sternectomy, cultures showed no growth. Wound closure required an omental flap to fill the spatial

the tumor, and the tumor had a relatively clear boundary with the surrounding tissues. The arch of the azygos vein was hard in nature, wherein the embolus could be palpated (Fig. a, b and c). The operative process included entering the posterior-lateral 5th intercostal space of the right chest to expose the esophageal bed and open the mediastinal pleura; the superior vena cava at the arch of the azygos vein was first dissociated, and sidewall forceps were used to clip the converging point of the superior vena cava and azygos vein. This, in turn, prevented tumor thrombus detachment, and

tumor had a relatively clear boundary with the surrounding tissues. The arch of the azygos vein was hard in nature, wherein the embolus could be palpated (Fig. a, b and c). The operative process included entering the posterior-lateral 5th intercostal space of the right chest to expose

the upper abdomen was performed to make a gastric tube, and esophagogastric anastomosis was completed through a right neck incision.\nPostoperatively, enteral combined with intravenous nutritional therapy was given. The patient received a clear and liquid diet on day 8 after surgery and was discharged without any severe complications. Postoperative pathology revealed the proliferation of fibrous tissue at the submucosal and muscular layers of the esophageal tumor bed, and a multinucleated

for 3 min and then Amacrylate tissue adhesive was used instead of sutures for holding the donor tissue at its placed position.\nPeriodontal dressing Coe Pak (De Trey/Denstply, Konstanz, Germany) was applied over the operated area covering the exposed bone. The patient was prescribed with antibiotic therapy, that is, amoxicillin 500 mg, thrice a day and analgesic, that is, ibuprofen 400 mg twice a day for 5 days.\nTooth-brushing was discontinued for the first 2 weeks at the surgical site and 0.2% chlorhexidine mouth rinse was instructed until 4 weeks after surgery. Coepak was removed 10 days

after the surgical procedure and the patient was asked to maintain meticulous oral hygiene. Healing had proceeded uneventfully.\nIn 3 weeks, healing was nearly complete, with minimal postoperative discomfort to the patient. At 6 months postoperative,

recalled after 1 week for the surgery.\nAfter assuring surgical asepsis, a preprocedural rinse with 0.2% chlorhexidine gluconate was accomplished. Local anesthesia was first administered bilaterally by using a mental nerve block. Later, a horizontal incision was made using a no. 15 surgical blade at the mucogingival junction retaining all of the attached gingiva []. A split-thickness flap was reflected sharply, dissecting muscle fibers and tissue from the periosteum.\nThe recipient site preparation included two incisions. First, intracrevicular incision and a

eight months of pain in the posterior region of the left shoulder, with no history of acute trauma. The patient stated that the pain began after starting a job where he carried sandbags of approximately 25 kg on the affected shoulder. The pain began after two months on the new job and progressively worsened with time. The pain was worse with exertion. The

shoulder. The pain began after two months on the new job and progressively worsened with time. The pain

work, and physical therapy (analgesia, stretching, and strengthening) was used for four months, with no clinical improvement. New imaging exams (radiography, computed tomography (CT), and magnetic resonance imaging (MRI)) revealed the absence of consolidation (Figures and ). Thus, after 4 months of conservative treatment and 1 year after the onset of symptoms, surgical treatment was recommended.\nThe patient was placed in the prone position, and a 10 cm incision was made along the scapular spine towards the lateral edge of the acromion. The

within it, measuring 19 mm × 8 mm (Fig. ), with a strong acoustic shadow but no twinkling artifact. Due to the unclear ultrasound picture, an abdominal computed tomography (CT) was perform and showed an oval structure (22 mm × 7 mm × 13 mm) with a density similar to body fat in the slightly dilated right renal pelvis. A smaller structure (< 10 mm) with similar density was located within the urinary bladder. A definitive diagnosis could not be established and the suggested differential diagnosis included, apart from atypical nephrolithiasis, a foreign body and lipoma. A first uroscopic attempt to identify the nature

mm × 8 mm (Fig. ), with a strong acoustic shadow but no twinkling artifact. Due to the unclear ultrasound picture, an

and chronic kidney disease presented with a mass in the renal pelvis in ultrasound during routine check-up. The urinary tract anomaly was first revealed in the 26th week of pregnancy with bilateral hydronephrosis and possible posterior urethral valve in prenatal ultrasound. The delivery was uncomplicated with a birth weight of 3860 g and an Apgar score of 10. During the neonatal period, a voiding cystourethrography was performed and ruled out a posterior urethral valve as well as vesicoureteral reflux. Dynamic renal scintigraphy showed significant loss of the left kidney function and impaired

pain management and addiction medicine practice. She was known to the attending physician for decades. The patient had long-term chronic complex pain (migraines, fibromyalgia, etc) and had a bipolar 2 diagnosis. Her bipolar condition was diagnosed when the patient was in her early 50s. The patient had never reported or remembered having had suicidal ideations.\nPatient had bariatric surgery approximately 5 years beforehand. Complications from the bariatric surgery included adhesions, ongoing abdominal pain, nausea, anorexia, hypoproteinaemia, progressive weight loss and overall failure to thrive. Despite the best of conservative nutritional support, the patient’s failure to thrive warranted

consideration of parenteral nutrition.\nThese medical concerns were in addition to family stressors and other situational stressors. Patient also continued to have pain scores of about 5 out of 10. Patient struggled with moderate recurrent depression over

and low dose oral ketamine. She took a variety of supplements and was getting extensive behavioural support. Of note, the patient’s medical regimen had been relatively stable for a month or more prior to the onset of suicidal ideations. Patient never had any adherence issues related to her medical regimen. Her husband was willing and able to help oversee and dispense medications as indicated.\nThe patient’s dose of opioids was reduced several months previously because of symptoms associated with feeling ‘loopy’ and poor memory. Because there was no clear aetiology for these symptoms, it was hypothesised absorption and assimilation concerns were contributing to the changes in

in place with k-wires (). Fixation was achieved with three absorbable Biotrak Helical Nails© (Acumed, LLC, Hillsboro, Oregon, USA) in a triangular fashion to the underlying subchondral bone (). The piece was then probed and found to be stable. Temporary fixation pins were removed, and the knee was ranged through a full arc of motion.

to the underlying subchondral bone (). The piece was then probed and found to be stable. Temporary fixation pins were removed, and the knee was ranged through a

of maintaining a non-weight bearing status to his right lower extremity in the interim to minimize risk of further damage to this loose cartilage fragment.\nThe patient was taken to surgery. An exam under anesthesia was then conducted. He was stable to varus and valgus stress and could achieve full extension. Flexion was not tested to protect his loose fragment within the knee. A diagnostic arthroscopy then took place. He was found to have no cartilage damage to the undersurface of the patella. No loose bodies

visual loss. The temporal field of vision in his left eye was impaired due to an injury he sustained in a football game 25 years earlier, however he noted progressive visual loss bilaterally over the last several years. Examination of his visual acuity

visual loss. The temporal field of vision in his left eye was impaired due to an injury he sustained in a football

eye was impaired due to an injury he sustained in a football game 25 years earlier, however he noted progressive visual loss bilaterally over the last several years. Examination of his visual acuity with a Snellen chart at the time revealed 20/30 acuity in the right eye and 20/70 acuity in the left eye. Four years earlier, he had 20/30 acuity on the right and 20/50 on the left. Ophthalmological evaluation revealed normal corneas,

primary osseous and chondroid malignant tumors (e.g. chondrosarcoma). After reviewing the management options, the patient elected to proceed with left frontal tumor resection, as it was likely responsible for her worsening symptoms. Informed patient consent was obtained for her treatment.\nThe lesion was approached and resected through a left frontal craniotomy. The arachnoid was noticeably thickened over the mass. The lesion was extremely firm and near entirely calcified with an irregular, tanned/pink appearance as well as minimal internal vascularity. The lesion was dissected from the surrounding brain tissue and “en bloc” resection was achieved with no complications.

from the surrounding brain tissue and “en bloc” resection was achieved with no complications.

A 67-year-old woman presented with a six-year history of recurrent focal seizures with impaired consciousness suggesting a left hemispheric origin. The patient had a recent increase in the frequency of seizures with poor response to medical treatment. Magnetic resonance imaging (MRI) at the onset of seizures revealed multiple heterogeneous intracranial lesions located in the ventral midbrain and in the left frontal white matter. The MRI features of the lesions were fairly similar, demonstrating hypointensity on T1- and T2-weighted images. The lesion in the left frontal lobe showed moderate contrast enhancement as well as a mild adjacent hyperintense signal on T2-weighted images. Minimal to no contrast enhancement was observed around the lesion in

five-week duration and continuous leakage of urine five days prior to presentation. Patient was involved in a pedestrian motorcycle accident in which she was hit by a power bike on a trunk C road. There was immediate loss of consciousness lasting about thirty minutes but no craniofacial bleed, vomiting, or seizures. There was bleeding from associated perineal laceration on the right side of the

involved in a pedestrian motorcycle accident in which she was hit by a power bike on a

it and right anterolateral vaginal wall (). Upward pressure on this mass reveals the bladder neck and ureteric orifices. Urethra was located in bridge of tissue but deviated laterally to the left. There was a palpable wide pubic diastasis. Posterior vaginal wall was intact and cervix was situated in normal position. Digital rectal examination was essentially normal with no communication between the rectum and posterior vaginal wall. Straight leg raising test was zero degree on the right and 30° on the left. Pelvic X-ray

clothes, would be forced to take bath or get nails/hair trimmed, and efforts to these were often met with aggression from the patient. Eventually, he stopped going to school and his family sought faith healing. Within the next 5–6 months, his illness worsened. Fixed gaze, reduced eye blinking, smiling out of context, diminished speech, and refusal to eat food were the reasons for which he was brought to us. His physical examination was unremarkable and his mental state examination using the Kirby's

method showed an untidy and ill-kempt child, with infrequent spontaneous acts, and occasional resentment for examination. He had an expressionless face, with occasional smiling to self, negativism, and mutism. No rigidity in any of the limb was

another, continuously for up to 1–2 h, with intermittent stops and often insisted his mother to follow the suit, stand nearby him, or else he would clang on her. He prohibited other family members except his mother near him and would accept his meals only from her. He repeatedly sought assurance of his mother if he had spoken everything right. He also washed his hands repeatedly, up to 10–20 times at one time, and was unable to elaborate reason for the same. His mood during that period was largely irritable with no sadness or fearfulness. He

metastasized to the left femur (Figure and ); therefore, 300 mg/day of tegafur-uracil (UFT) in combination with radiotherapy, consisting of bilateral irradiation of 45 Gy in 15 fractions, was applied to the metastasis. At the beginning of November 2009, the patient underwent systemic chemotherapy with 135 mg nedaplatin (CDGP) and 90 mg docetaxel (DTX), followed by 300 mg/day UFT at the end of the same month. At the beginning of December 2009, the patient underwent segmental resection of the lower left jaw, left supraomohyoid neck dissection, and lower jaw reconstruction using titanium plates. At the end of December in the same year, the femoral tumor

chemotherapy with 135 mg nedaplatin (CDGP) and 90 mg docetaxel (DTX), followed by 300 mg/day UFT at the end of the same month. At the beginning of December 2009, the patient underwent segmental resection of the lower left jaw, left supraomohyoid neck dissection, and lower jaw reconstruction using titanium plates. At

radiotherapy, consisting of bilateral irradiation of 45 Gy in 15 fractions, was applied to the metastasis. At the beginning of November 2009, the patient underwent systemic chemotherapy with 135 mg nedaplatin (CDGP) and 90 mg docetaxel (DTX), followed by 300 mg/day UFT at the end of the same month. At the beginning of December 2009, the

left ventricular ejection fraction (LVEF) of 59% and a mild regurgitation in mitral valve, which meant the patient's cardiac condition was well. (Fig. ). The patient was told to rest adequately, avoid strenuous exercise and follow-up every six months. Digital Radiography (DR) revealed mild cardiac enlargement (Fig. ).\nOn postoperative day 8, the patient 's incision healed well and there was no abnormality on physical examination. The patient was discharged on postoperative day 8, and no medication was required post-discharge. A one-year follow-up

and a mild regurgitation in mitral valve, which meant the patient's cardiac condition was well. (Fig. ). The patient was told to rest

the left atrium. The mass was attached by a pedicle to the atrial septum and protruded into the left ventricle through the mitral orifice in diastole and returned to the atrium in systole, leading to obstruction of the mitral orifice during diastole. The cardiac atrium was enlarged, and the left ventricular ejection fraction (LVEF) was 65%. (Fig. ). A medium echoic mass measuring 14 mm × 14 mm attached to the LV papillary muscle was also demonstrated by TTE. The mass moved back and forth in the left ventricle. (Fig. ). This was suggestive of LV myxoma with LA myxoma. Additionally, severe

and treatment. Combined positron emission tomography-computed tomography (PET-CT) test showed multiple pulmonary nodules with the largest diameters up to 5 mm in the right upper lobe and right lower lobe as well as “ground glass” shading at the top of the lung. The findings were not felt to represent malignant disease and no other abnormalities were found. The patient was diagnosed and staged as malignant nodular-type ulcerated melanoma

area of the surgical scar of the previous biopsy.\nIn December 2015, she was referred to the Oncology Department for evaluation

gadolinium enhancement (Fig. ) ratio was >4 with late gadolinium enhancement (Fig. ), in a pattern compatible with myocarditis (Fig. ).\nCorticosteroid therapy was initiated with prednisone 2 mg per kilogram body weight for 1 week, and because of the suspicion that the myocarditis was caused by pembrolizumab, prednisone was continued for 2 weeks at a dose of 1 mg/kg.\nTroponin level decreased from 1,103 ng/L to 300 ng/L. Virology testing was performed (hepatitis serology, Q-FEVER phases). DNA PCR for EBV and CMV was

inferior-most branches of the facial nerve were sacrificed because of adherence to tumor. Pathology of the surgical specimen showed an intermediate grade mucoepidermoid carcinoma, 1.8 cm in greatest dimension, with peripheral cystic changes (). The tumor was confined within the parotid gland and margins were negative, although the closest margin was <1 mm from tumor. Pathology did not reveal lymphovascular or perineural invasion, and zero of 31 lymph nodes were positive for tumor. The patient was staged as pT1, pN0, M0.\nPost-operative radiotherapy was recommended due to intraoperative findings of suspicious tumor tracking along the facial nerve, close margins, intermediate grade, and invasion into the deep parotid lobe. A dose of 60 Gy was prescribed to

were sacrificed because of adherence to tumor. Pathology of the surgical specimen showed an intermediate grade mucoepidermoid carcinoma, 1.8 cm in greatest dimension, with peripheral cystic changes (). The tumor was confined within the parotid gland and margins were negative, although the closest margin was <1 mm from tumor. Pathology did not reveal lymphovascular or perineural invasion, and zero of 31 lymph nodes were

revealed a hypoechoic, partially solid, partially cystic nodule in the superficial portion of the left parotid gland. Fine needle aspiration was performed and was non-conclusive, although suspicious for low-grade mucoepidermoid or ACC. Chest X-ray was normal.\nThe patient underwent a superficial left parotidectomy: the mass was 1.3 cm, superficial, well-encapsulated, and not adherent to the facial nerve. It was completely resected with negative margins (1 mm), and found to be well-differentiated mammary analogue secretory carcinoma. Zero of two lymph nodes were involved by tumor, and no lymphovascular invasion or perineural invasion was identified. The pathology department compared the new slides with the tumor from seven years prior, and found

based on the sensitivity results. Computed tomography scan of the abdomen, as part of workup for septic shock, showed dilated common bile duct. Right upper quadrant ultrasound showed cholecystitis with clinical suspicion of acute cholangitis. He did have right upper quadrant pain, fever, and elevated alkaline

suffered septic shock with a fever of 39°C and hypotension. Blood, urine, and respiratory cultures were obtained, and broad-spectrum antibiotics (vancomycin and zosyn) were started empirically. Two blood cultures were positive for Klebsiella oxytoca, which was sensitive to ceftriaxone, levofloxacin, and gentamycin and resistant to ampicillin and cefazolin. Urine and respiratory cultures did not grow any bacteria. Antibiotics were tailored to ceftriaxone

On hospital day 12, he developed a new-onset intermittent complete heart block with significant pauses (), requiring temporary transvenous pacing. Transthoracic echocardiography (TTE) detected severe aortic incompetence, with a large aortic vegetation measuring 1.7 × 0.6 cm (). This was a new finding compared to a TTE done on the second day of admission. He did not have any chest pain, shortness of breath, cough, or palpitations. No signs of IE such as petechiae, splinter

and grade I tooth mobility over the upper and lower anterior teeth and lower right second molar []. In addition, the diastema between the upper incisors closed “spontaneously” after treatment.\nPocket elimination periodontal surgery was initially planned to treat the upper right and lower right second molars; however, nonsurgical treatment was eventually selected as the final treatment plan after the patient rejected surgery and the residual periodontal pocket depth were mostly less than 6 mm with horizontal bone loss pattern (Fig. ) []. After 3 months of follow-up, the patient

was referred to our prosthodontic department for oral rehabilitation with removable partial dentures. The dentures were designed with palatal strap, lingual bar, and wrought-wire clasps (Fig. ). The periodontal supportive treatment recall interval was monthly in the first year and every 3 months subsequently []. A clinical examination

hard and soft palates, floor of the mouth and tongue. An intraoral examination revealed highly inflamed periodontal tissue with heavy plaque and calculus deposition. Fibrotic changes over interdental papillae, facial and also lingual gingivae were noted, especially in the anterior segment (Fig. ). The patient’s upper left and lower left molars were missing. Her anterior teeth were flaring and highly mobile with a diastema of approximately 2.5 mm between the maxillary central incisors. Upon examination, we noted full mouth

however, no improvement in ventilation and peak pressures was noted. Six minutes after the elevation in peak pressures, the 7.0 mm nasal RAE tube was removed, and bag-mask ventilation was initiated. Peak pressures elevation and ongoing difficulty with ventilation continued. The patient's oxygen saturation declined from 98% to 54%, and her heart rate decreased from 104 to 64 bpm, but no significant decline in blood pressure was noted. The patient was reintubated using a McGrath video laryngoscope and a 7.0 mm oral endotracheal tube, and ventilation was initiated via Ambu bag and supplemental oxygen. The patient's oxygen saturation increased to 96% and her heart rate

to 92 bpm.\nShe began to develop significant left-sided facial and bilateral neck and chest edema with crepitus, indicating subcutaneous air. Decreased right breath sounds were noted with auscultation. Intraoperative chest x-ray revealed significant bilateral subcutaneous air, pneumomediastinum, and a large right-sided tension pneumothorax (). An attempt at needle decompression failed because of large chest wall thickness. General surgery emergently placed a 32-French chest tube on the right side without complication, resulting in an almost immediate improvement in ventilation and tidal volumes and resolution of the tension pneumothorax. The

left mandibular angle through an intraoral approach without complications. The patient developed an infection at the site of the hardware and nonunion of the fracture site as a result of noncompliance—lack of smoking cessation and poor oral hygiene—with postoperative instructions. For treatment of the nonunion and infection, the patient returned to the operating room (OR) approximately 1 month after the initial surgery for debridement and removal and replacement of the hardware. Two months from the time

been taking warfarin for paroxysmal AF. He had a smoking history of 1.5 packs per day for 32 years and cholecystectomy 2 years ago, but he had no specific medical history or history of peripheral vascular disease, being bed-ridden for a long period, or glucocorticoid usage. The patient had normal femoral, popliteal, and ankle pulses bilaterally on palpation. The ankle brachial index (ABI; right, 1.06; left, 1.04) and echocardiography showed no specific clinical manifestation. After 3 days of warfarin hold for perioperative bridging anticoagulation therapy,

popliteal, and ankle pulses bilaterally on palpation. The ankle brachial index (ABI; right, 1.06; left, 1.04) and echocardiography showed no specific clinical manifestation. After 3 days of warfarin hold for perioperative bridging anticoagulation therapy,

specific medical history or history of peripheral vascular disease, being bed-ridden for a long period, or glucocorticoid usage. The patient had normal femoral, popliteal, and ankle pulses bilaterally on palpation. The ankle brachial index (ABI; right, 1.06; left, 1.04) and echocardiography showed no specific clinical manifestation. After 3 days of warfarin hold for perioperative bridging anticoagulation therapy, the patient’s international normalized ratio (INR) was 1.72.

size of the lump at the lateral aspect of the thigh decreased with treatment, the lump and pain over the area persisted even after he was discharged from the local hospital. Further, he experienced on-and-off fever again, though he was afebrile upon discharge from the local hospital. With time, he experienced difficulty in walking with increasing severity of pain in the lateral aspect of the right upper thigh, for which he sought medical advice. On admission to our hospital, he had high-grade fever, and he denied any respiratory or urinary symptoms. His bowel motions were normal with normal color and contour. He was a farmer and had a history of exposure to surface water. He was a

in the lateral aspect of the right upper thigh, for which he sought medical advice. On admission to our hospital, he had high-grade fever, and he denied any respiratory or urinary symptoms. His bowel motions were normal with

infective myositis but without abscess formation. The findings of contrast-enhanced computed tomography of the chest and abdomen were normal. The patient underwent ultrasound-guided muscle biopsy, which showed coagulative necrosis in the muscle/subcutaneous tissue; infiltration with neutrophils, lymphocytes, and plasma cells in the adjacent tissue; focal suppuration; granulomata with Langhans-type giant cells; and focal fibrosis in the muscle (Fig. ). The histopathological features were suggestive of melioidosis. A muscle biopsy specimen was sent for bacterial culture and antibiotic sensitivity testing as well as culture for tuberculosis and melioidosis, and all results were negative.

presented to the clinic with generalized abdominal pain for 4 months that was constant and dull. Patient had a history of intermittent GI bleeding for about 6 years with no known source of bleeding despite having a workup at different hospitals. Past history includes hypertension, benign prostatic hyperplasia, gastritis, and anemia. Patient had undergone colonoscopy and esophagogastroduodenoscopy about four months ago that showed no abnormalities. He subsequently underwent a computed tomography scan of abdomen that showed a lobulated mass like structure originating from a bowel anastomosis. However, the patient

with no known source of bleeding despite having a workup at different hospitals. Past history includes hypertension, benign prostatic hyperplasia, gastritis, and anemia. Patient had undergone

stromal tumor measuring 9.5 × 9 × 8 cm . Mitoses were 10 per 50 high power fields. There was no lymphovascular infiltration or metastasis noted. Immunohistochemically, the tumor cells were positive for Ckit (CD117) Dog1, Vimentin and negative for CD34, Desmin, Chromogranin, and S100. According to TMN staging, the pathological stage of the excised tumor is PT3 Nx Mn/a, stage IIIB. These findings indicate a high risk of recurrence at

Asian girl presented to the emergency department of Cumilla Medical College and Hospital, Bangladesh, with increasing pain in the right lower abdomen of 3 months’ duration. She experienced severe, colicky pain in the right lower abdomen with the onset of menstruation. Her pain did not radiate and was not associated with fever, vomiting, or urinary complaints. She denied any

past medical or surgical history. She had had menarche 3 months earlier and had a regular menstrual cycle with dysmenorrhea and cyclical abdominal pain. For the latter problem, she was prescribed analgesics from a local pharmacy, which resulted in transient improvement of the symptoms. She

the emergency department of Cumilla Medical College and Hospital, Bangladesh, with increasing pain in the right lower abdomen of 3 months’ duration. She experienced severe, colicky pain in the right lower abdomen with the onset of menstruation. Her pain did not radiate and was not associated with fever,

have any pain, fever or weight loss. She had a history of snake bite by a Malayan pit viper to her left leg when she was 14 years old. Her leg became markedly swollen and she could not walk for 2 months. She was treated by a traditional healer. Finally, she could walk again but her ankle and toes could not perform

active dorsiflexion. At the first visit, a physical examination showed a 20×10cm mass in her left leg. The mass was not tender or inflamed. Sensation was decreased over the dorsum of her left foot.A plain X-ray showed a large soft tissue mass at the anterior compartment of

weight loss. She had a history of snake bite by a Malayan pit viper to her left leg when she was 14 years old. Her leg became markedly swollen and she could not walk for 2 months. She was treated by a traditional healer. Finally, she could walk again but her ankle and toes could not perform active dorsiflexion. At the first visit, a physical examination showed a 20×10cm mass in her left leg.

and stridor; repeat chest imaging revealed stable tumor size without new extension. Repeat bronchoscopy then showed worsening tracheal stenosis of mixed subtype (intrinsic and extrinsic) with tumor regression back to the carina only. Mucus plugs were removed from both lungs and then a Bonastent was placed, 16x60 mm, over the stenotic area. The patient was treated with systemic steroids and discharged home. Outpatient follow-up PET/CT showed a mild increase in the size of the tracheal disease now with cervical, supraclavicular, and mediastinal lymph nodes involvement. The patient was continued on chemotherapy and follow-up bronchoscopy to re-evaluate the stent location, and tracheal stenosis showed the

patient was treated with systemic steroids and discharged home. Outpatient follow-up PET/CT showed a mild increase in the size of the tracheal disease now with cervical,

flat. On exam, she had a faint stridor and was slightly tachypneic with a respiratory rate of 22 breaths per minute. CT of the neck was performed, revealing soft tissue prominence within her cervical trachea.\nThoracic surgery explored the neck due to the presence of stridor but that did not reveal any extratracheal abnormal tissue and no apparent lymph nodes

both the femora and the tibia had not been closed. The lesions in the diaphyses of the right femur and the right tibia were distended causing the surrounding cortex to thin (). Technetium bone scintigram showed increased uptake in the diaphyses of the right femur and the right tibia and the right pelvis and around the bilateral knees and ankles (). On magnetic resonance imaging (MRI), the epiphyseal lesions of the distal femur and the proximal tibia showed a low

the surrounding cortex to thin (). Technetium bone scintigram showed increased uptake in the diaphyses of the right femur and the right tibia and the right pelvis and around the bilateral knees and ankles (). On magnetic resonance imaging (MRI), the epiphyseal lesions of

cells. The trabeculae consisted of immature woven bone, the form of which resembled “alphabet soup.” There was lack of osteoblast rimming surrounding the trabeculae (). A histological diagnosis of FD was made. Three months after the second surgery, the patient fell and sustained a fracture in the proximal diaphysis of the right femur and underwent osteosynthesis using an intramedullary nail. There was no recurrence in the lesions in the diaphyses of