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disease. During her pregnancy, she presented with a recurrence of melanoma with metastases in the liver, bones, lungs, and brain. She died 3 months after delivery. The child was initially treated as an acute mastoiditis on the left side according to our clinic's protocol, and a double intravenous antibiotic scheme of cefotaxime + clindamycin and dexamethasone was administered. Subsequently, a myringotomy was performed on both sides under general anaesthesia, and ventilation tubes were placed. A purulent fluid was drained from the left side, which was sent for culture. The child showed an immediate improvement in her clinical picture, showing reduced otorrhoea on the left and reduced oedema in the left zygomatic and retroauricular region after the

months after delivery. The child was initially treated as an acute mastoiditis on the left side according to our clinic's protocol, and a double intravenous antibiotic scheme of cefotaxime + clindamycin and dexamethasone was administered. Subsequently, a myringotomy was performed

the area of the meninx-sigmoid corner. Furthermore, the wall of the sigmoid sinus was corroded. No thrombosis was observed of the sigmoid sinus. Neuromonitoring of the facial nerve was performed, and an urgent neurosurgical assessment was requested. Debridement and removal of the corroded bone fragments was performed.\nMultiple fragments of dark-coloured tissue were sent for an immediate histological examination. The history (individual and family),

CBS eye drops in April 2016, with the posology of 0.4 ml (8 drops) in RE, each day for a total of two months. In the GF dosages determined for the two CBS lots were administered during the first and second month.\nOn September 2016, the patient reported a significant relief from subjective symptoms of discomfort; in RE the OSDI was 28 out of 100, with VAS: 32 mm out of 100. Also in LE a reduction was observed, with OSDI score determined as

(8 drops) in RE, each day for a total of two months. In the GF dosages determined for the two CBS lots were administered during the first and second month.\nOn September 2016, the patient reported a significant relief from subjective symptoms of discomfort; in RE the OSDI was 28 out of 100, with

right eye or in the untreated left eye.\nIn the central 30-2 visual field tests before ((a): right eye RE; (b): left eye LE), at the end (c, d) and after four months (e, f) from the end of the CBS eye drop treatment were shown. An amelioration of the defect was observed in all the

abdominis myocutaneous (TRAM) flap were performed (). The right breast mass weighed 2,212 g at the time of excision.\nThe final pathology confirmed a malignant phyllodes tumor measuring 125 mm × 120 mm. The tumor showed brisk stromal overgrowth with lymph and vascular tumor emboli, and the mitotic count was 46 per 10 high power fields. All resection margins were negative and we obtained margins of more than 10 mm except for the deep resection margin which was less than 1 mm. Immunohistochemical staining for estrogen receptor (ER) and progesterone receptor (PR) were positive, but for human epidermal growth factor receptor 2 was

had suggested the possibility of a phyllodes tumor through review of the outside slides. The rebiopsy result was a diagnosis of phyllodes tumor, and a right modified radical mastectomy (MRM) and transverse rectus

with an inflammatory and ulcerative mass in her right breast that had been there since 2011. The mass had grown rapidly over the past 3 months and it was extremely painful with a huge ulcerative wound (). Breast ultrasonography and a core needle biopsy were performed initially in an outside breast clinic and the biopsy result was a diagnosis of invasive carcinoma of no specific type. She was referred to Korea University Medical Center, Ansan in January 2016, 2 weeks after being diagnosed.\nAdditional imaging workup was performed to check the primary breast mass and metastatic lesion, including a MRI of the breast; a CT scan of the chest and abdomen; a bone scan;

cystic lesion measuring 5.1 × 3.6 × 4.8 cm, with an echotexture consistent with that of an endometrioma, either within the cornua or in the fallopian tube; however, the exact location was difficult to identify using ultrasound.\nThe patient underwent diagnostic laparoscopy, which confirmed a bulge arising from the right uterine cornua and the presence of a cystic mass, indicative of a Müllerian anomaly. Appendectomy was concurrently performed because of a rigid and hyperemic appearance of the appendix, and minimal

endometriosis was fulgurated. She was referred to us for further care and worsening of the pelvic pain after she underwent the abovementioned laparoscopy. We performed laparoscopic excision of the uterine cyst following a procedure similar to that used for case 1. The intraoperative findings () were a 5-cm bulging mass arising from the right cornual region and unremarkable bilateral adnexae. The final pathology report confirmed JCA. The patient experienced proper recovery and pain relief immediately after the laparoscopic resection of the adenomyoma. During

lesion associated with acute worsening of chronic dysmenorrhea. She started menarche at the age of 14 years. Her periods were always regular at an interval of 28 days and associated with severe dysmenorrhea. She was prescribed oral contraceptive pills for dysmenorrhea, with partial relief. Before her referral to our clinic, she presented to the emergency room twice for worsening of pain in the lower quadrant. She underwent CT and ultrasound imaging, which revealed a cyst in the right lateral myometrium, consistent in its echotexture with that of an endometrioma. A CT of the abdomen and pelvis revealed a 4.7 ×

well.\nIn May 13, she came to our medical out-patient department (OPD) with a bottle of pink colored liquid claimed was vomitus. She was again evaluated on lines of Hematemesis. All her relevant Investigations that is hemogram, liver function test (LFT), renal function test (RFT), ultrasound (USG) Abdomen, Thyroid function test, USG thyroid, urine porphobilinogen, serum ceruloplasmin, stool for occult blood and ocular and dermatological examination were within normal limit. Individual continued to report to Medical OPD on a regular basis with persisting complaints. On 03 Jan 14 following a fresh complaint of pink colored vomitus; she was admitted and psychiatric consultation was sought.\nThere was no history of blood stained vomitus, malena, cramp abdomen, diarrhea, constipation, asthenia, pruritis, skin

Abdomen, Thyroid function test, USG thyroid, urine porphobilinogen, serum ceruloplasmin, stool for occult blood and ocular and dermatological examination were within normal limit. Individual continued to report to Medical OPD on a regular basis with persisting complaints. On 03 Jan 14 following a fresh complaint of pink colored vomitus; she was admitted and psychiatric consultation was sought.\nThere was no history of blood stained

tears were noted then on ophthalmological examination. After a period of 7–10 days she returned from the bathroom complaining of pink colored sweat staining her forearms and palms. Since the doctors were not able to “cure” her she was taken by her parents and in laws to multiple places of worship all over Maharashtra with the hope of a “cure”. Individual delivered a healthy male child in Dec 12. She continued to have the earlier complaints. Now whenever she had the episode she was given rest from childcare duty as the color

intrahepatic pressure of biliary tree which was increased because of stricture of the hepatico-jejunostomy site (). After PTBD, coughing and bilioptysis were markedly improved. Follow-up abdominal CT scans obtained four weeks after the catheter insertion showed a markedly reduced abscess cavity of the liver dome and improvement of the lung abscess in the right lower lobe. Thereafter, the amount of percutaneous drainage decreased gradually. When the amount of drainage reached less than 5 ml per day, the abscess cavity of the

liver dome and right-side lung did not show in the follow up CT scan (). After PCD catheter at the liver dome was removed, repeated

of 54.4 mg/dl (normal range: 8-20 mg/dl), serum creatinine of 3.74 mg/dl (normal range: 0.5-1.3 mg/dl), and C-reactive protein of 214 mg/L (normal range: 0-5

the patient reported some improvement of her symptoms. More specifically, she reported some transient improvement in her visual symptoms and there was also a decrease in the CSF opening pressure on a repeated lumbar puncture. In terms of other differentials, lymphoma was low on the probability as there was no history of weight loss, fever, or lymphadenopathy. Serum LDH was also within the normal range. Fundoscopy did not show any evidence of papilloedema. 2-3 weeks after being started on steroids, her vision continued to deteriorate. She

a repeated lumbar puncture. In terms of other differentials, lymphoma was low on the probability as there was no history of weight loss, fever, or lymphadenopathy. Serum LDH was also within the normal range. Fundoscopy did not show any evidence of papilloedema. 2-3 weeks after being

were then transferred to a tertiary centre (Walton Neurology Centre in Liverpool) for further review by a specialist neuroradiologist and expert opinion was sought from a neurologist. His opinion was that the top differential could be neurosarcoidosis and he recommended starting her on steroids and doing a lumbar puncture for CSF analysis. The lumbar puncture showed increased opening pressure of 41 cm of H2O. The CSF analysis revealed cellular deposit containing a mixed population of small lymphoid cells with no malignant cells. Also, on the CSF analysis, there was increased protein content of 12,90 g/L. A CSF culture was

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

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

with burns of I, II and small areas of III degree on ~75% TBSA. He had the following co-morbidities: a minor liver dysfunction, due to regular alcohol consumption; untreated hypertension; type II diabetes, under treatment with Metformin; a urethral stricture, which had been surgically treated. He was a very active man, due to his job – a firefighter-. The accident happened while he was preparing some kind of alcoholic beverage at home in a special boiler, so he was splashed by the hot boiling fluid, which resulted in the injuries, which

thereafter in lieu of alcohol he started consuming alprazolam (0.5 mg) tablets on and off to enjoy its pleasurable experience and subsequently developed dependence on these tablets. Since last 3 months he had been taking ten tablets of 0.5 mg alprazolam everyday along with frequent alcohol consumption (about once or twice weekly).\nDue to his increased substance use and inability to quit despite several attempts he was admitted in a private unauthorised de-addiction centre where he remained forcefully abstinent for about a week. There he developed fearfulness, suspiciousness with complaints of transient auditory hallucinations for which he was referred to

dependence on these tablets. Since last 3 months he had been taking ten tablets of 0.5 mg alprazolam everyday along with frequent alcohol consumption (about once or

been drinking regularly country made liquor daily with history of tolerance, withdrawal, having a strong desire for substance, negligence of alternative pleasures and use despite adequate knowledge about the harm related to substance use leading to a diagnosis of alcohol dependence as per International Classification of Diseases, 10th revision (ICD-10). Three years ago to control excessive alcohol use, his wife

normal sensory level was T4 (breast level). She had positive bilateral Babinski reflexes with loss of bowel and bladder continence. X-rays of the dorsal spine showed no hardware failure or any vertebral collapse at the proximal junctional area (). Reviewing the CT-myelogram confirmed the obstruction of dye flow at T4-5 level. She was taken immediately to the operating room where posterior spine decompression through laminectomies was done from T3 to T5 with extension of the instrumentation to T3 using transverse process hooks.\nOn the second day, the patient

She had positive bilateral Babinski reflexes with loss of bowel and bladder continence. X-rays of the dorsal spine showed no hardware failure or any vertebral collapse at the proximal junctional area (). Reviewing

initially for evaluation of severe mid-back pain and an inability to stand up straight. One year prior to her presentation, she had had an instrumented anterior and posterior spine fusion from T11 to S1 for a degenerative lumbar disc disease. Neurological examination showed intact motor power with normal sensation in both upper and lower extremities. A standing anteroposterior (AP) and lateral X-rays of the dorso-lumbar spine showed segmental pedicular screw instrumentation with interbody cages done at every level from T11 to S1 (). There was an apparent sagittal spine malalignment with a complete loss of lumbar lordosis and positive sagittal vertical axis. The uppermost pedicular screws at T11 level appeared to be backed

and culture. Increased polyclonal production of immunoglobulin light chains with normal free light chain ratio was present. Flow cytometry of whole blood revealed expansion of CD4+ lymphocytes with a normal CD4+/CD8+ ratio. Predominant left-sided, chronic sinus disease was detected on computed tomography (CT). His sputum culture produced moderate Pseudomonas growth. A chest X-ray in addition to chest, abdominal and pelvis CT were normal apart from a few prominent retroperitoneal lymph nodes of less than 8mm.\nOn presentation he was started on high dose methylprednisolone (500mg per day for 5 days), resulting in a marked improvement in functionality. His function continued to improve

blood ammonia level. Melioidosis, Rickettsia, human immunodeficiency virus, hepatitis B, hepatitis C, Brucella, Strongyloides, Venereal Disease Research Laboratory test (syphilis) serology were all negative, as was Mycobacteria microscopy

community he used intravenous amphetamine and occasionally intravenous heroin with shared needles for several years in addition to cannabis and infrequent ecstasy use. He has had a long history of alcohol abuse with periods of proactive abstinence.\nAn examination revealed right foot drop, bilateral leg weakness, some quadriceps wasting, bilateral hypertonicity of his lower limbs with sensory impairment reaching his upper thoracic region, and bilateral tingling and numbness in his upper limbs. Urinary incontinence was found to be due to neurogenic bladder dysfunction. Nerve conduction studies ruled out peripheral neuropathy and myopathy. His cranial nerve function was normal. His spinal cord magnetic resonance imaging (MRI) was normal, showing no

polymorphic VT after that.\nPatient was kept on dual antiplatelet therapy, statin and betablockers along with IV phenytoin which was stopped after 2 days. Seven days after the PCI, 24 hours Holter monitoring was done which showed normal sinus rhythm with infrequent VPCs and no evidence of NSVT or VT. Echocardiography before discharge showed

dual antiplatelet therapy, statin and betablockers along with IV phenytoin which was stopped after 2 days. Seven days

any ECG changes suggestive of coronary ischemia.\nDue to recurrent potentially fatal ventricular arrhythmia, urgent coronary angiography was done which showed 60% focal obstruction in proximal left anterior descending coronary artery (LAD) and diffuse obstruction extending from mid to distal right coronary artery (RCA), with maximal obstruction in mid RCA (85-90%) ().\nConsidering the critical obstruction of RCA responsible for polymorphic VT, emergency PCI of RCA was planned. After balloon dilatation of the obstruction, the RCA was stented with using a 2.75 x 32 mm Xtrm-Track CoCr Stent

27-mm ATS Open Pivot Bileaflet Heart Valve (ATS Medical Inc., Minneapolis, MN). At the time of mitral valve replacement, the fistulae were successfully ligated through not only left atrium but also the left circumflex coronaries’ side. Postoperatively, the patient made an uncomplicated recovery. At 3 months postoperatively, the transthoracic echocardiography was performed, which revealed pulmonary arterial pressure of 62 mmHg, and the closure of the fistulae was confirmed by 128-slice computed tomography ().\nCoronary artery fistula is a rare anomaly connecting coronary arteries to cardiac chambers or great

coronary artery fistulae drained into the left atrium with two terminal orifices ( and ). The fistulae were hemodynamically significant, and closure was indicated. In the operation, utilizing cardiopulmonary bypass, the mitral valve was replaced by a

to the cardiology clinic with a 20-year history of gradually increasing breathlessness on exertion and, in the previous 10 days, orthopnoea and paroxysmal nocturnal dyspnoea. Physical examination found irregular pulse with diastolic rumbling murmur. The electrocardiogram revealed atrial fibrillation with a ventricular rate of 120 beats/min and accompanying T wave abnormalities and minimal ST depression in inferior derivations. Chest radiograph revealed double shadow on the right cardiac silhouette and prominent pulmonary trunk with increased vascular markings. Transthoracic echocardiography revealed a mitral stenosis with a mitral area of 0.7 cm2, ejection fraction of 68%, and normal segmental wall motion, mild aortic

her viral load continued to decrease, with a level below 2 × 103 at 6 months of age, and was undetectable at 9 months of age. At 2.5 years of life CMV was not unexpectedly still detected in urine, but levels were too low for reliable mutation analysis. In spite of her marked developmental delay she

was undetectable at 9 months of age. At 2.5 years of life CMV was

daughter of a healthy, young couple. The pregnancy was followed up for microcephaly detected by prenatal ultrasound. The patient was born by caesarean section for pathological cardiotocography following premature rupture of membranes at 35 weeks; the birth weight was 2.06 kg (25th centile), and the head circumference was 30 cm (9th centile).\nAt birth, in addition to microcephaly, she was noted to have petechial rash, hepatosplenomegaly and respiratory distress requiring CPAP for the first 48 h of life. The platelet count was 44 × 103/μL and ALT was 6 IU/L. CMV was detected by PCR in blood and urine

and also received a simple blood transfusion. On hospital day (HD) 2, she was noted to have persistent fever and leukocytosis and so was started on intravenous Levofloxacin empirically. At that time, her left thigh pain appeared to be worsening, with a new area of swelling and warmth but no tenderness. X-rays of the left hip and left thigh were done, which showed heterogeneous appearance of the proximal left femoral shaft, which was thought to be likely secondary to sickle cell osteodystrophy, infarct, or infection.\nThe patient's blood cultures obtained on admission had shown no growth and her urine culture was negative. Her chest

swelling and warmth but no tenderness. X-rays of the left hip and left thigh were done, which showed heterogeneous appearance of the proximal left femoral shaft, which was thought to be likely secondary to sickle cell osteodystrophy, infarct, or infection.\nThe patient's blood cultures obtained on admission had shown no growth and her urine culture was

abscesses was undertaken: 3 right thigh abscesses were identified and approximately 4.5 mL of purulent fluid was drained; approximately 4.0 mL of fluid was aspirated from the left thigh fluid collection. Postprocedure CT scan showed minimal residual abscess fluid. Jackson Pratt drains were kept in situ and continued to drain moderate amounts of serosanguineous fluid.\nThree days after percutaneous drainage, the patient remained afebrile and her leukocyte count was consistently trending downwards. She had a repeat CT scan of the lower extremities, which showed decreased fluid collection and soft

both lung fields. A total body computed tomography scan (CT) without contrast confirmed the presence of lung metastases, bilateral hydronephrosis, and a mass in her right iliac fossa invading her ureter and her iliac artery.\nThere was also a mass in the right iliac mass but with a reduced size in the left iliac fossa invading her psoas muscle. The internal structure of the masses was homogeneous, apart from the centrally located amorphous high-attenuation areas. There was no fat inside the lesion.\nShe underwent hemodialysis and infusion therapy with rasburicase (Fasturtec

ultrasound (US) examination revealed her liver with gallbladder stones, a heterologous formation in her right iliac fossa with internal calcification, which compressed the iliac vessels, and a bilateral hydronephrosis more marked on the right than on the left.\nLaboratory tests revealed significant alterations (Table ). Her blood pressure was above 180 mmHg. A chest X-ray showed the presence of multiple metastases placed in

consistency, was whitish-gray in color, and there were large central calcified parts and areas of hemorrhagic-necrotic tissue. The mass was osteoblastic histological type, consisting of osteoblasts producing an osteoid material. The lesional cells showed great cytological atypia, high mitotic activity, and permeative growth pattern (Fig. ).\nThe tumor massively invaded our patient’s abdominal cavity and metastasized in both lung fields. According to these parameters, she was in a very poor prognostic subgroup, due to a very bulky and high growth rate tumor. This

because the Chamberlain and McGregor lines were normal. Cervical alignment was kyphotic with a C2-7 angle of -20.3°. An atlantooccipital dislocation was diagnosed because of the abnormal Powers ratio, but the BAI and BDI were normal. A 3-dimensional CT scan showed an anterior dislocation of the bilateral occipital condyles from the superior articular facets of C1. The clivo-axial angle was 160°. A lateral inclination of <20°

abnormal Powers ratio, but the BAI and BDI were normal. A 3-dimensional CT scan showed an anterior dislocation of the bilateral occipital condyles from the superior articular facets of C1. The

an anteflex position. A skin incision of about 7 cm was made, and the nuchal fascia was exposed on the right side. The right upper part of the C2 spinous process was cut, and the oblique capitis inferior muscle and the rectus capitis posterior major muscle were retracted laterally. The trapezius and rectus capitis posterior minor were partially dissected from the occipital bone. The C2 lamina, C1 posterior arch, and the occipital bone were exposed only on the

she was sent to ICU ward. Next morning, she was transferred to the ordinary ward. The upper abdominal pain gradually relieved. Five days after the laparoscopic exploration, another CT scan showed that the hematoma was largely resolved and we removed drain tube (Fig. d). She was discharged, 10 days after readmission.\nTotally, 13 papers, including 16 cases of ISH after LC were reported from 1994 to 2015 (Table

gradually relieved. Five days after the laparoscopic exploration, another CT scan

was a 32-year old woman with a one-year history episodes of cholecystitis treated conservatively. She did not have any other disease history. After an abdominal magnetic resonance imaging that confirmed multiple gallbladder stones (Fig. a), an elective LC was performed without intra-operative complications. The recovery was uneventful and the patient was discharged two days after operation. On the second day after discharge, the patient developed severe right upper abdominal pain and she was sent to our emergency department at 8:30 pm. At arrival, her heart rate was 110 bpm and

was removed and the caudal clamp was left in place. After the backflow was clear of thrombotic debris, the clamp on his caudal iliac vein was removed and the clamp at the cranial aspect left in place. The left leg was gently massaged from calf to thigh; as a result, some thrombi in

the caudal part of the vein were flushed out with the venous blood flow, and the sutures were

some signs of compartment syndrome with blisters in his calf, fasciotomy was not performed. He received systemic anticoagulation, initially with low-molecular-weight heparin, then with warfarin, titrating to an international normalized ratio (INR) between 2.0 and 2.5.Three days postoperatively, mechanical ventilation was discontinued and his signs and symptoms improved dramatically. Pulses in his left lower extremity became palpable on postoperative day 5, and the swelling and discoloration decreased. On postoperative day 30, he was taken off the OptEase® filter and the venogram showed a small amount of residual thrombus in his left external iliac vein (Figure \n). The inferior vena cava was patent, with no residual defects around the

of abnormal ileum. An approximately 12 centimeter long portion of ileum demonstrated concentric thickening. The radiologist offered a presumptive diagnosis of Crohn's.\nLaboratory evaluation demonstrated a normal complete blood count and normal iron studies. The patient underwent colonoscopy to further evaluate the ileal thickening. He tolerated colonoscopy prep without difficulty. Colonoscopy demonstrated left colon

undergone a colonoscopy in the past. The patient did not use aspirin or other non-steroidal anti-inflammatory medications on a regular basis.\nThe patient's physical exam was unremarkable. The patient was afebrile, vital signs were stable. The patient's abdomen was soft, non-tender and non-distended. There were no palpable masses in abdomen. There were no incisional scars on the abdomen.\nEvaluation included a CT scan of the abdomen and pelvis. The CT scan showed a benign appearing renal cyst and an area

inflammatory reaction similar to that seen in the initial biopsies. Granulomas were not identified (Figure ).\nThe patient has been symptom free for more than

seven days, for a presumptive diagnosis of diverticulitis. Since antibiotic did not seem to bring about a change in her clinical status, the patient decided to seek help at the ER. She was known to have diverticulosis, several past episodes of left sided diverticulitis, hypertension, hyperlipidemia, hypothyroidism, esophageal reflux, a hiatal hernia, and chronic obstructive pulmonary disease (COPD). Surgery for the recurrent diverticulitis was not done because of the old age of the patient who preferred to use antibiotics and

diverticulitis, hypertension, hyperlipidemia, hypothyroidism, esophageal reflux, a hiatal hernia, and chronic obstructive pulmonary disease (COPD). Surgery for the recurrent diverticulitis was not done because of the old

emergency room (ER) with a three-day history of right lower quadrant and periumbilical abdominal pain. Her primary care physician had prescribed oral levofloxacin 750 mg once daily for seven days, for a presumptive diagnosis of diverticulitis. Since antibiotic did not seem to bring about a change in her clinical status, the patient decided to seek

of left-sided chest pain, exacerbated by breathing, with no radiation to other sites, and associated with shortness of breath. The patient reported no recent trauma and his past medical history was unremarkable. On admission, his vital signs revealed temperature of 34.5°C, blood pressure of 80/40 mmHg, heart rate of 125 beats/min, and respiratory rate of 24 breaths/min with an oxygen saturation of 98% on room air. At physical examination, the patient was dyspneic and presented important painful distress. Cardiopulmonary examination was significant for muffled heart sounds on mitral focus and abolished breathing sounds in the

left hemithorax. Electrocardiography (ECG) showed normal sinus rhythm, and initial laboratory results were notable only

flowed out from the chest tube. One more unit of packed red blood cells was transfused and signs of hemodynamic instability did not reoccur during hospitalization. Owing to the persistent bleeding, the medical team chose to indicate video-assisted thoracic surgery (VATS) to accomplish definitive hemostasis of the bleeding source.\nOn the third hospitalization day, VATS was performed, after induction of general anesthesia, with camera inserted through the already

no history of jaundice, back pain or headache.\nOn examination, she was moderately built and nourished with weight of 83 kg, height of 161 cm and body mass index (BMI) of 32. She had a distended abdomen with a midline scar from a previous laparotomy. Firm non-tender mass felt all over abdomen with edema noted all over abdominal wall and bilateral lower limbs. Her bowel sounds were heard in the left upper quadrant of the abdomen. On digital rectal examination, a mass was felt anteriorly compressing the rectum. Her all lab parameters were within normal limits except for raised thyroid-stimulating hormone that was managed by increasing the dose of

thyroxin from 25mcg to 50mcg once daily. She was evaluated with a PET CT () which showed a mildly FDG avid, large heterogeneously enhancing lesion with a predominantly fat component

in breathing for 1 month. She had had a similar large lump in 2013 and 2017, and had twice undergone excision of the tumour elsewhere. Biopsy revealed a well differentiated liposarcoma. She received 6 cycles of chemotherapy after the second surgery and her last cycle was in March 2018. She had not had radiotherapy. She was well till November 2018 when she again noticed a lump in the lower abdomen which gradually increased in size occupying her entire abdomen. There were no symptoms suggestive of bowel or

along with partial closure of the skin defect. A small incision was made to perform a defunctioning sigmoid colostomy. No intra-abdominal bleeding was reported. The packs were removed two days later without any bleeding complications. A total of 22 units of blood were required during the first 48 hours of admission. Figures , show the site of injury before and after treatment, respectively.\nProgress\nContinuous follow-up examinations were done during the following months of the accident. Seven examinations under anesthesia were performed. The skin was not closed completely at the site of the procedure. Consequently, it was decided not to reallocate the anorectum to a further posterior direction and the wound was left

lateral extensions into both gluteal regions and the right thigh. In addition, a hand could be passed behind the rectum and into the sacral promontory.\nThe case was associated with extensive venous bleeding with the absence of major arterial tears. It was managed by the insertion of multiple packs

was a remaining 1 cm of normal perianal skin with no actual skin loss. Digital and proctoscopy examination showed an intact anorectum and its surrounding sphincters. Whereas exploring the wound revealed complete disruption of the posterior pelvic floor with lateral extensions into both gluteal regions and the right thigh. In addition, a hand could be passed behind the rectum and

and the eye was closed under saline. Similarly, RE underwent PPV ().\nIn this case, two solid IOFB were present which could not be removed from 23 G sclerotomy. One of the sclerotomies had to be enlarged for IOFB removal. On follow up grafts were clear and the retina was attached in BE, with no haze in

a PPV attempt was made to remove IOFB with intraocular forceps taking utter care of underlying retina. IOFB dispersed into a powdery form on the pressure by the intraocular forceps and was easily removed by passive suction by flute needle. Surgery was uneventful

extraction and posterior chamber intraocular lens (PCIOL) implantation in both eyes (BE) sequentially; one-week post presentation in the left eye (LE) and 2 months later in the right eye (RE). The patient improved remarkably in spite of an episode of acute graft rejection of the left eye which was treated by an intravenous bolus of methylprednisolone, 500 mg for 3 consecutive days, and intensive topical steroids.\nOn follow-up of four months

on the left side of her face and body but there was no obvious auditory, ophthalmic, dental, or internal organ trauma on clinical examination and no associated fractures on radiologic assessment. Her past medical history was unremarkable, with no regular medication or known drug allergies and she had normal developmental milestones. She was referred to a specialist center for a review of her cutaneous injuries, given oral morphine for her pain, and transferred across by ambulance.\nDetailed examination of her cutaneous injuries at

She was in pain but was hemodynamically stable and had a patent airway. She was noted to have cutaneous injuries with associated swelling

out-patient clinic review, the burns sites appeared to be healing with no evidence of infection. The non-adherent dressings applied to the sites on her left upper limb were replaced and the parents were advised to continue applying Vaseline to the face. The child had had some

sizes. There was no axillary lymphadenopathy. This clinical picture is typical of a breast fibroadenoma. However, with her underlying history of a mediastinal NET, the diagnosis of breast metastases was kept in mind. Sonographic assessment of the breast was done to further characterize the lesions and showed multiple oval-shaped hypoechoic lesions with irregular margins and posterior acoustic enhancement (B). These suspicious features may represent primary breast malignancy or breast metastases.\nWith the possible diagnosis of breast

Upon reviewing the CT scan with the patient in the clinic, she complained of enlarging bilateral painless breast lumps over the past 3 months which was not previously present. She denied family history of breast and ovarian malignancies. Clinical examination revealed multiple mobile breast lumps with a firm consistency over bilateral breast of varying

a district hospital with an increasing anterior neck swelling over a period of 6 months with symptoms of superior vena cava syndrome. She was previously well with no known medical, surgical or genetic problem. On physical examination, the patient had a congested facial appearance, with a large hard fixed anterior neck mass. She was ambulating well with neither features of respiratory compromise nor signs and symptoms of carcinoid syndrome. Initial differentials include a large multinodular goiter or thyroid malignancy. Chest radiography showed a widened mediastinum. In view of the large nature of the mass, we opted for a computed tomography (CT) of the neck and

synechia of the iris was obviously beneath the lesion of the cornea, while the other internal structures of the right eye were not clearly visualized. The cornea of the left eye (diameter, 11.0 mm) was clear and no abnormality was found. Color Doppler ultrasonography was performed for the right eye under sedation, which revealed that the eyeball was intact, while a crumby lesion that linked the cornea and the iris was observed in front of the crystalline lens; however, the vitreous cavity was clear and no abnormality was found in the posterior segment (Fig. ).\nThe infant was the second child delivered normally by the mother at full term. General physical examination of the infant

revealed no other noticeable abnormality. However, the mother had a history of repeated upper respiratory tract infection

the wound with a boundary that clearly differentiated it from the surrounding corneal tissues. The residual mass had a spiral-shaped presentation, while no distinct pigment tissue was found (Fig. ). Anterior chamber paracentesis was performed at 11 o'clock position of the limbus, and only a little aqueous fluid flowed out. Considering the possibility of pupillary block caused by anterior synechia, peripheral iridotomy was also performed. TobraDex eye ointment was applied to the eye, followed by eye patching. The mass

on hospital admission day #10. By the time surgery evaluated the patient, she had four bowel movements, one of which was loose in nature, and she stated her abdominal pain was much improved. Physical exam did reveal abdominal pain with light or deep palpation in the right lower quadrant, directly over McBurney's point. An abdominal X-ray was obtained which was unremarkable and

new labs were sent at this time. The complete blood count (CBC) did show an acute elevation of the WBC to 16.4 K/μL. Because of this acute elevation in WBC and concern for appendicitis on physical exam, we ordered a

a very distended, necrotic gallbladder that was torted a full 360° in the counterclockwise direction (). Luckily the gallbladder had not perforated at this time. Because it was acute gallbladder disease without gross contamination of the abdominal cavity, we were able to perform the cholecystectomy in the traditionally described laparoscopic approach. The volvulus was reduced and the gallbladder was removed through identification of the critical view and ligating the cystic duct and artery.\nPostoperatively the patient did very well. She was started on a diet shortly after her surgery and her pain remained well controlled. The pathology report revealed acute gangrenous cholecystitis. The patient was discharged to a rehab center on

II metabolism) between morphine and hydromorphone, the patient's opioids were rotated from oral morphine to parenteral hydromorphone as the clinical picture continued to unfold. Further workup revealed an unremarkable head CT and EEG. Clinical evaluations and laboratory assessments suggested that, in the setting of her declining physical and renal function (creatinine 1.0 mg/dL with prior baseline 0.6 mg/dL and estimated glomerular filtration rate (eGFR) 55 ml/min/BSA with prior baseline >60 ml/min/BSA), the delirium could be the result of an accumulation of active neurotoxic morphine metabolites (morphine-3-glucuronide). In addition, she was dehydrated, constipated, and had not slept in several days. Unfortunately, her delirium persisted despite correction of metabolic derangements, hydration, and an aggressive bowel regimen.\nUrology was consulted,

physical and renal function (creatinine 1.0 mg/dL with prior baseline 0.6 mg/dL and estimated glomerular filtration rate (eGFR) 55 ml/min/BSA with prior baseline >60 ml/min/BSA), the delirium could be the result of an accumulation of active neurotoxic morphine metabolites (morphine-3-glucuronide). In addition, she was dehydrated, constipated, and had not slept in several days. Unfortunately, her delirium persisted despite correction of metabolic derangements, hydration, and an aggressive

and was eventually transitioned to parenteral fentanyl, given that fentanyl is a unique medication that is largely hepatically metabolized into inactive metabolites. Despite common lore that fentanyl and methadone are agents that do no produce active metabolites and therefore do not elicit OIN, case reports of synthetic opioids eliciting OIN do exist in the literature [, ]. Unfortunately, despite aggressive supportive measures and conversion of parenteral hydromorphone to parenteral fentanyl without reduction for cross-tolerance, she continued to have persistent pain with minimal resolution of her systemic neurotoxicity.\nGiven the concern for poorly controlled cancer-associated pain, the palliative care and pain medicine teams collaborated from the initial visit with concerning symptoms of OIN. At

Taylor ring external fixator[ at every follow-up visit. But the patient was satisfied with the outcomes of previous operations and refused our advice.\nThe data about surgical result and the follow-up outcome are as follow. The patient underwent 5 operations in the whole treatment time of 3 years and 2 months. The bone healing time of fibular osteotomy was 8 months. The lengthening procedure of femur had continued for 102 days, and the external fixator was applied for 663 days. The total lengthening of femur achieved during the reconstruction

in the whole treatment time of 3 years and 2 months. The bone healing time of fibular osteotomy was 8 months.

every step. She was very eager to walk upright by her own leg rather than amputating.\nDuring the physical examination, upper limbs and spine were unaffected, as well as the right lower extremity. The left side of hip was stable and normal in terms of range of motion. The knee was rigid and the range of movement was extension 0° and flexion 30°. There was a bowing with convexity laterally and the lower leg was externally rotated relative to the femoral condyle. Leg length discrepancy (LLD) was 22 cm, which was mostly from the left lower leg. The left foot was in a 45° equinovarus deformity but the foot shape was normal. The movement

revealed innumerable uniform polyps most heavily concentrated in the cecum. Biopsy revealed mantle cell lymphoma. A 78-year-old woman with history of hypertension and hyperlipidemia presents to the surgical clinic for colonoscopy. Upon review of systems, patient reports dysphagia. Her physical examination was remarkable for a soft nontender anterior cervical lymphadenopathy, and a left supraclavicular lymph node enlargement (Virchow's node; Troisier's sign). Upper endoscopy and colonoscopy were scheduled within the next week. Upper endoscopy revealed a partially occluding oropharyngeal submucosal lesion. There were no signs of ulceration or any mucosal involvement. Some polyps were observed

within the esophagus, but the stomach and duodenum were unremarkable. Colonoscopy revealed numerous polyps were increasing in quantity from the transverse colon to the cecum. On colonoscopic inspection,

to the hospital without prior colorectal cancer screening. Physical examination was significant for Virchow's node (Troisier's sign). Colonoscopy revealed innumerable uniform polyps most heavily concentrated in the cecum. Biopsy revealed mantle cell lymphoma. A 78-year-old woman with history of hypertension and hyperlipidemia presents to the surgical clinic for colonoscopy. Upon review of systems, patient reports dysphagia. Her physical examination was remarkable for a soft nontender anterior cervical lymphadenopathy, and a left supraclavicular lymph node enlargement (Virchow's node; Troisier's sign). Upper endoscopy and colonoscopy were scheduled within the next week. Upper endoscopy revealed a partially occluding oropharyngeal submucosal lesion. There were no signs

of the neck and both the anterior and posterior aspect of the chest extending up to the 4th intercostal space (Figure \n). The hemangioma had small areas which were ulcerated and inflamed as well as healed scars. A soft bruit was appreciated on auscultation over the hemangioma. She had no petichiae or ecchymoses and her conjunctivae were pink. No lymphadenopathy was detected.\nCardiovascular examination was remarkable only for a pulse rate of 104/min. The blood pressure was 100/60 mm Hg. Abdominal examination revealed mild right loin tenderness without any organomegaly. Clinical pelvic examination

aspect of the chest extending up to the 4th intercostal space (Figure \n). The hemangioma had small areas which were ulcerated and inflamed as well as healed scars. A soft bruit was appreciated on auscultation over the hemangioma. She had no petichiae or ecchymoses and her conjunctivae were pink. No lymphadenopathy was detected.\nCardiovascular examination was remarkable only for a pulse rate of 104/min. The blood pressure was 100/60 mm Hg. Abdominal examination revealed mild right

areas of the hemangioma became positive for Staphylococcus aureus sensitive to both penicillin and cloxacillin. Dengue NS1 antigen was negative. Ultrasonic examination of the abdomen excluded splenomegaly, features of portal hypertension and chronic liver disease. HIV, ANA, antiphospholipid antibodies, antiplatelet antibodies and Coombs test were all negative.\nBackground consumptive coagulopathy was excluded with normal baseline INR, APTT, D-dimers by modified ELISA and fibrinogen levels. There was also no laboratory evidence of acute derangement of the coagulation profile in relation to the

to presentation when he injured the same wrist while fixing a used tire. He abraded his wrist against the dirty tire and 2 weeks thereafter his wrist started to progressively swell. A week prior to presentation yellowish pus started emanating from the wrist wound. He tried soaking his wrist in warm water and applied topical antibiotic cream without relief. He had a long-standing history of chronic right wrist pain following a closed fracture of his right wrist from a motor vehicle accident sustained 9 years prior to presentation, with preexisting radiographic

evidence of wrist joint erosion with cystic changes in the distal radius, ulna, and carpal bones together with joint space narrowing suggesting secondary posttraumatic osteoarthritis. The patient also had a history of polysubstance abuse which included intravenous (IV) heroin use and alcohol abuse. This may have rendered him

time of presentation. Blood cultures were sent prior to the administration of antibiotics. CT guided aspiration was performed thereafter and the aspirate was sent for microbiologic analysis. The patient also underwent an open arthrotomy with incision and drainage of frank pus from the right wrist after his wrist swelling persisted status after CT guided aspiration. The patient was on empiric antibiotic therapy prior to collecting intraoperative microbiological samples for analysis. Anaerobic blood agar plates (AnBAP) Becton Dickinson, Kanamycin-vancomycin laked blood agar (KV-BAP) Becton Dickinson, Colistin-nalidixic acid blood agar (CNA-BAP) Becton Dickinson, and prereduced chopped meat broth (CMG) Becton Dickinson showed growth of bacterial colonies. F.

28, where steroids were continued. On November 3, an infectious disease physician was consulted at hospital D who noted that the patient’s symptom of spasms when swallowing suggested a possible diagnosis of rabies. When specifically questioned about the patient’s exposure to wild animals, family members reported extensive contact with bats that had occupied the patient’s home in the weeks before illness onset. The physician notified UDOH, which recommended collecting clinical specimens, including skin, saliva, cerebral spinal fluid (CSF), and serum. Rabies PEP was not indicated

treatment was initiated for presumed autoimmune encephalitis. Because of refractory seizures beginning on October 26, he was transferred to hospital D on October

years who lived in Utah sought chiropractic treatment in Idaho for neck and arm pain thought to be caused by a recent work-related injury. On October 19, he was evaluated in the emergency department of hospital A for continued neck pain, nuchal muscle spasms, burning sensation in his right arm, and numbness in the palm of his right hand. He had no fever, chills, or other symptoms of infection. Dehydration was a concern because the patient reported he was unable to drink liquids because of severe pain and muscle spasms. The patient received a prescription for a steroid for muscle spasms

in March 2015 with chest pain. Family history was negative for diabetes. A chest X-ray revealed a left lung mass confirmed on subsequent chest CT to be a left upper lobe mass measuring 5.2 × 3.7 × 3.8 cm with left hilar and AP window lymphadenopathy. A bone scan on 3/19/15 was negative for osseous metastases. She underwent bronchoscopy with sampling of the level 4 L, 7 and 11 L lymph node stations. Samples from stations 7 and 4 L were negative for malignancy, but the 11 L station contained tumor cells consistent with high grade

scan on 3/19/15 was negative for osseous metastases. She underwent bronchoscopy with sampling of the level 4 L, 7 and 11 L lymph

monitoring. A hemoglobin A1c level on 1/12/16 was 7.1% (normal range 4.6–6.1%). C-peptide levels on 1/16/16 (while BG 377 mg/dL) and 1/18/16 (while BG 423 mg/dL), were < 0.1 ng/mL (normal range 0.8–3.85). Further evaluation to establish the diagnosis of autoimmune diabetes (Type 1), provided the following results: glutamic acid decarboxylase 65 (GAD-65) antibody > 30 U/ml (normal < 1.0); tyrosine phosphatase islet 2 antibody (IA-2) 6.1 U/ml (normal < 0.8); insulin autoantibody (IAA) 0.4 U/ml (normal < 0.4). HLA genotyping was homozygous

its division into the superficial and deep rami (Figures and ).\nThe normal course of the ulnar nerve in the forearm is between the flexor carpi ulnaris and the flexor digitorum profundus. The dorsal branch, which is responsible for the sensory innervation of the medial half of the hand and half of the digits, arises approximately 5 cm proximally to the wrist. In

and the flexor digitorum profundus. The dorsal branch, which is responsible for the sensory innervation of the medial half of the hand and half of the digits, arises approximately 5 cm proximally to

reported a rare finding of the dorsal branch of the ulnar nerve which began in the upper quarter of the forearm and divided into medial and lateral branches. The medial branch merged from the hypothenar region with the deep branch from the ulnar nerve and the lateral branch became cutaneous. The communication branches between the ulnar and the median nerve are well recognized and the majority of cases are directed from the ulnar to the median nerve [,]. However, in most cases, these communication branches affect the sensory innervation of the

ready to wear a partial denture in case of future loss of tooth. Implant was not considered due to financial constraint of the patient. As the conventional intraoral radiographs do not indicate the true size and spread of the lesion, the patient was sent for CBCT to evaluate the true size and nature of the lesion. Informed consent was obtained from the patient and a CBCT imaging of the

of future loss of tooth. Implant was not considered due to financial constraint of the patient. As the conventional intraoral radiographs do not indicate the true size and spread of the lesion, the patient was sent for CBCT to evaluate the true size and nature of the

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

spherical clusters resembling “mirror balls” []. These findings suggested a malignant tumor of the urinary system and favored adenocarcinoma.\nThe biopsy and TUR samples showed that the tumor comprised papillo-tubular lesions []. The epithelial cells covering the tumor were cuboidal and single layered, and some of these cells showed a “hobnail pattern.” Most of the cells had eosinophilic cytoplasm, except for a few that had clear cytoplasm. The cells with a clear cytoplasm were positive for periodic acid-Schiff reaction. The epithelial cells showed relatively mild cytological atypia and did not invade the stroma. Mitotic figures were

except for a few that had clear cytoplasm. The cells with a clear cytoplasm were positive for periodic acid-Schiff reaction. The epithelial cells showed relatively mild cytological atypia and

A 42-year-old woman presented with a 3-month history of bloody discharge from the urethra and lower back pain. Physical examination performed showed no remarkable changes on admission. She did not show urinary dysfunction. Laboratory data of the blood were within normal limits. Serum levels of tumor markers were not evaluated. Cytological examination of the urine sediment was highly suggestive of adenocarcinoma. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a tumor (diameter, 47 mm), which involved the urethra entirely []. There were no remarkable changes in the gynecological system and no swelling was observed in the intra-abdominal and intrapelvic lymph nodes. Cystourethroscopy showed two diverticula fenestrated in the

recent escalation in the doses and addition of other antidepressants (SSRI) and benzodiazepines with concomitant intake of drugs like metoprolol, pantoprazole and some herbal medications associated with typical features, presumptive diagnosis of SS was made as per Hunters criteria. All antidepressants were stopped. Sedation using titrated doses of propofol (10 mg/hr) to maintain Ramsay

presenting complaints as described above.\nIn the ICU, patient was hemodynamically stable but severely agitated and restless and not responding to commands. Laboratory parameters measured included Hb 12.8 g%, TLC 10800/mm3, platelet count 2.7 lakh/mm3, INR 1.0, Na+ 117meq/L, K+ 4.5meq/L, serum creatinine 0.9 mg/dL and ABG pH 7.424/PaO2 109/PaCO2 28.9/HCO3 18.6/BD −4.3/SpO2 99%/lactate 0.7/Na+ 117/K+ 3.9/iCa+2 3.55/glucose 90 mg/dL/Cl− 83 mEq/L. In view of the

working diagnosis of gastroenteritis induced hyponatremia with sepsis was made. The patient received infusion of 3% NaCl, antibiotics and oxygen supplementation @ 6 L/min through venturi mask. In view of aggression and altered sensorium, CT brain was done, which was normal. An assessment by neurologist was done, who advised for MRI Brain for further evaluation. Patient was kept nil per oral in view of possibility of further deterioration and need for mechanical

downward by the tumor, and the compression worsened when his left arm was dropped as shown in the angiography. Because of this, we ensured that the arm remained abducted, and the subclavian vessels and brachial plexus were released easily because these structures were separated by the thin membrane enveloping the tumor when the tumor was resected

worsened when his left arm was dropped as shown in the angiography. Because of this, we ensured that the arm remained abducted, and the subclavian vessels and brachial plexus were released easily because these structures were separated by the thin

Slight weakness of the extensor digitorum communis and extensor carpi radialis brevis muscles was detected. Adson's test for TOS was positive with loss of radial pulse and numbness in the left arm and hand, and Wright's hyperabduction test was negative. Plain radiographs of the left shoulder showed that the bony mass adjacent to the clavicle had markedly increased compared with 8 years previously (Figures and ). Computed tomography of the left shoulder showed a bony lesion involving the left clavicle protruding in the posteroinferior direction, adhering to the coracoid process of the scapula; the subclavian artery was located under the

the chief complaint of a right-sided swelling in the mandible. This swelling has caused slight asymmetry of the face since 6 months, which gradually enlarged up to the present size ().\nThe patient gave a history of generalized weakness, lethargy, and weight loss noticed

the mandible. This swelling has caused slight asymmetry of the face since 6 months, which gradually enlarged up to

lesion was identified as a brown tumor of hyperparathyroidism, and the patient was referred to the endocrinology department.\nKidney function blood tests were done. Serum creatinine and blood urea nitrogen were normal. Chronic renal failure could not be considered the cause of hyperparathyroidism. However, we noted severe vitamin D deficiency (). The initial impression was of secondary hyperparathyroidism due to this vitamin D deficiency.\nIt was decided that vitamin D supplementation was the best therapeutic option. The patient was started on vitamin D 100,000 IU per fortnight for 6 weeks which is the equivalent of half an ampoule of 200,000 IU/1 ml. Thereafter, the patient was kept on 200,000 IU

practitioner (GP) to the Gastroenterology outpatient department as an urgent case. The patient had a past medical history of diabetes mellitus type 2, chronic kidney disease (CKD), and hypertension, which were all well-controlled with medical therapy. He did not have any family history of gastrointestinal or any other malignancies. An ultrasound of the abdomen organized by his GP had suggested multiple liver metastases. He underwent a gastroscopy and CT scan to confirm the findings seen on the ultrasound. His CT scan confirmed multiple liver metastases (Figures , ).\nThe gastroscopy showed large

malignant-looking ulceration at the lesser curvature of the stomach (Figures , ), which on biopsy was reported as poorly differentiated adenocarcinoma. His case was discussed in the multidisciplinary meeting (MDM) and a diagnosis of gastric adenocarcinoma (histopathology) with widespread metastasis (radiological) to the liver was made, and an oncology review was recommended. Following the oncology review, the patient was started on palliative chemotherapy with epirubicin, oxaliplatin, and capecitabine.

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

score for the following four days was 3.5, no pain relief was required. Later on the patient did not notice any tenderness or discomfort within the postsurgical area. The maximal edema rated as 5 by the Numeric Rating Scale was observed on the third postoperative day. Then edema gradually decreased; its score was 3 by the end of the first week and remained at the same level for up to 14 days.\nBased on the panoramic radiograph data () the autograft

software Planmeca Romexis Viewer (Planmeca Oy, Finland).\nNeither adverse events nor serious adverse events were observed. The postoperative pain score did not exceed 6 within the first three days after surgery; it was controlled with pain-relievers; an average

mastication due to partial mandibular edentulism on the right side.\nIn 2011, in a clinic at place of the patient's residence, she was diagnosed to have fibrous dysplasia of the mandible on the right side, for which the patient underwent the resection of the lower jaw from the frontal region to the right ramus with external approach. Later on she had two surgeries of microsurgical mandibular reconstruction with the

an implant-fixed prosthesis; however, at that time, the patient elected not to proceed with this option because of the additional economic burden. Eventually, however, the patient opted for rehabilitation with a fixed implant-supported prosthesis. The patient was not willing to undergo extensive surgical intervention, including preprosthetic surgery and placement of additional implants. Therefore, we elected to replace the implant-supported overdenture with an implant-fixed prosthesis in May 2010.\nAfter the impressions were taken, the implant-fixed prosthesis was fabricated with a cantilever design comprising two dental units. The mandibular prosthesis was then inserted in February 2011, and the final occlusion was verified and adjusted (Figs. , ). The prosthesis was

attached to the implants using prosthetic screws. The screw holes were filled with a dental temporary material overlaid with light-curable composite resin. The patient was highly satisfied with the improvement in oral rehabilitation as a result of the new prosthesis. She was instructed on brushing techniques and reviewed every

cells. Few duct-like structures were observed, but microcysts were occasionally noted (Fig. ). The specimen histologically resembled a mucoepidermoid carcinoma [], but presented as a rare gingival carcinoma of the mandible. Treatment in May 1992 involved resection of the alveolar ridge between the right and left second molar regions, preserving the right inferior alveolar nerve, followed by bilateral upper neck dissection and transplantation of a lateral tongue flap to cover the alveolar ridge defect (Fig. ). Histopathological examination

intravenously administered steroids preoperatively.\nThe following radiographic evaluation revealed patella alta, which was in agreement with the complete patellar tendon rupture on the left knee, but not on the right side, in which partial quadriceps tendon rupture was suspected. A magnetic resonance imaging (MRI) was performed and confirmed the initial speculations (). The report excluded any other injury, as meniscus and cruciate ligaments were found intact.\nAfter admission and having signed an informed consent form, the patient underwent reconstruction of

revealed patella alta, which was in agreement with the complete patellar tendon rupture on the left knee, but not on the right side, in which partial quadriceps tendon rupture was suspected. A magnetic resonance imaging (MRI) was performed and confirmed the initial speculations (). The report excluded any other injury, as meniscus and cruciate ligaments were found intact.\nAfter admission and having signed an informed consent form, the patient underwent reconstruction

ruptured tendon were identified; thus, complete rupture of the patellar tendon was confirmed and was reconstructed with the use of non absorbable sutures (Ethibond no. 2) (). A 4.5 mm screw was inserted in the tibial tuberosity, and the sutures were reinforced by a metallic wire tension band (). The tourniquet was deflated, and meticulous heamostasis was applied. Interrupted sutures were used, and a drain was applied.\nThe tourniquet was then inflated above the right knee at 250 mm Hg for 30 min. Using a similar approach centered to the suprapatellar area, a partial quadriceps tendon tear was identified involving almost 75% of the tendon. The rupture was similarly

surgical intervention.\nA thoracic level four to six laminectomy was planned with the excision of an intradural arachnoid cyst with dural repair. In addition, a separate incision was made for a lumbar level one to three laminectomy, with the excision of an intradural arachnoid cyst with complex dural repair at lumbar level three, the site where the patient had a prior dural defect and was found to be leaking cerebrospinal fluid (CSF). Surprisingly, at surgery, the cysts at thoracic level four to six and lumbar level one

to three were noted to be extradural in nature. In both areas, we were able to work around the curved edges of the superior mass and detect the area connecting to the midline of the dura where a small area of communication within the dura was visualized. At both the thoracic level four to six and lumbar level one to three, the caterpillar-like cysts were excised epidurally and

obtained (Figures -) and revealed caterpillar-like pan-neuraxis arachnoid cysts that initially appeared to be intradurally distributed throughout her spinal canal.\nTwo were visualized in the thoracic region, one extending from thoracic (T) level one to four and the other extending from thoracic level four to six. Two were localized to the lumbar region, one extending from lumbar level one to three, and the other extending from lumbar level four to five. Upon completion of a thorough neurological exam, our patient had full strength in both her upper and lower extremities without any pronator drift; a sensory exam indicated an intact system. However, on more special testing,

performed. A part of the right seminal vesicle was ligated and cut because of injury and bleeding. The surgery time was over 10 hours. Total blood loss during the surgery was 7,205 ml, and blood transfusion of 6,820 ml was necessary in total.\nThe black arrows in the figures indicate injury tracks confirmed by operative findings (). Therefore, we were able to diagnose intraperitoneal bladder rupture and bowel injury secondary to rectal impalement.\nThe patient's postoperative recovery was good. Thirteen days after

the operation, retrograde cystography revealed no extravasation from the bladder. The patient was decatheterized and left our hospital 34 days after the operation. Two months later, intravenous pyelography

bowel injury. Then, extended surgery was performed to repair the bowel injury that was recognized during laparotomy and to repair the bladder and rectal ruptures and to divert feces. The extended open surgery revealed a through-and-through bladder perforation: a 3-cm diameter intraperitoneal bladder rupture near the dome and bladder rupture with right ureter injury at the posterior wall. Also revealed were 3 distinct ileal injuries and rectal anterior trauma with communication to the bladder, anal injury, and a right seminal vesicle injury. The bladder injuries were repaired and a right ureterocystoneostomy was performed. To facilitate urine drainage from the

interrupted sutures to cover the peritoneum sac.\nA transobturator light weight polypropylene mesh (Surgimesh®, Aspide Medical Laboratoire, La Talaudière, France) was placed, fixed to the iliopubic rami with the 2/0 polypropylene sutures and with one arm placed through the transobturator foramen on each side (C and D). Finally, the mesh was attached to the anterior vaginal wall with polypropylene 2/0 interrupted sutures. This type of mesh and fixation was chosen since the vaginal vault was not accessible through this surgical approach. The mesh was

The peritoneum was closed with a purse-string polydioxanone 1 suture, and reinforcement of 2/0 poliglecaprone interrupted sutures. The urogenital diaphragm and bulbo-spongiosus muscles were then sutured in the midline using 2/0 poliglecaprone

tumor involved the left lateral wall and the bladder neck. A positron emission tomography showed enlarged iliac lymph nodes and a neoadjuvant chemotherapy based on platinum (M-VAC: methotrexate, vinblastine, doxorubicin and cisplatin) was prescribed. No pelvic irradiation was necessary.\nA robotic radical cystectomy, hysterectomy with bilateral adnexectomy, extended pelvic lymphadenectomy and urethrectomy with heterotopic Bricker urinary diversion was performed. Due to the locally advanced disease prior to chemotherapy a broad resection was performed including a complete urethrectomy.\nThe postoperative recovery was marked by a delayed vestibule healing and an inguinal hematoma

mm) of the defect, the treatment decided on was root coverage using an epithelial embossed graft technique. The treatment plan was explained to the patient, and a duly signed written consent was obtained. Oral prophylaxis was done 2 weeks before surgery.\nUnder local anesthesia, a

measured at the center of an imaginary line from mucogingival junction (MGJ) to marginal gingiva, using an endodontic file with stopper after anesthetizing the region. Intraoral radiograph in relation to the tooth concerned showed no bone loss.\nConsidering the height (3 mm) and width (5

technique using 4–0 silk suture was used to secure the tissues, with the papilla and graft being picked up together on each side, without tension for uninterrupted healing []. Similarly, the palatal area at the donor site was sutured with 4–0 silk continuous sling sutures. A periodontal dressing was kept in place for 1 week. Analgesics (paracetamol 500 mg twice daily for 3 days) were prescribed, and the patient was instructed to rinse with 1:1diluted 0.2% chlorhexidine mouth rinse for 1 min twice daily for 10 days. The periodontal dressing (Coepack®) and sutures were removed

at 35 weeks with complaints of intermittent pain in the lower abdomen that was radiating to her back for the last 5 hours. There was no associated complaint of leaking or bleeding per vaginum. Her antenatal period was uneventful. However, she was diagnosed as having a fibroid on the left side of the uterus but reported no complications that could be attributed to it. Her general and systemic examination was unremarkable. All the antenatal investigations were normal. Her recent ultrasound (USG) report suggested a single live intrauterine pregnancy with an intramural fibroid measuring 8.6

uterus but reported no complications that could be attributed to it. Her general and systemic examination was unremarkable. All the antenatal investigations were normal. Her recent ultrasound (USG) report suggested a single live intrauterine

previous lower segment caesarean section (LSCS) presented to our outpatient department (OPD) at 35 weeks with complaints of intermittent pain in the lower abdomen that was radiating to her back for the last 5 hours. There was no associated complaint of leaking or bleeding per vaginum. Her antenatal period was uneventful. However, she was diagnosed as having a fibroid on the left side of the uterus but reported no complications that could be attributed to it. Her general and systemic examination was unremarkable. All the

removed 25 days after the operation. Repeat CTA confirmed successful tamponade of the fistula 40 days after the operation (). Antibiotic treatment was administered during hospitalization. Laboratory findings showed that the patient's WBC count was 23.0×109/mL with 79.1% neutrophils (NEs) on the second day after the

operation. The WBC count and NE returned to normal after 14 consecutive days of administration of the antibiotic meropenem based on cultures of the mediastinal exudates, which were positive for Pseudomonas aeruginosa seven days after the operation. The patient was switched to oral antibiotics and discharged on May 18, 2011. He was re-admitted to remove the esophageal stent 80 days after the operation. Esophageal endoscopy

single episode of vomiting of approximately 50 mL of fresh red blood. The patient had swallowed a chicken bone prior to the onset of the discomfort. His vital signs were stable during physical examination, and there was no fever on arrival at the hospital. Laboratory findings revealed a white blood cell (WBC) count of 19.9×109/L and hemoglobin (Hb) levels of 84 g/L. He vomited approximately 300 ml of bright red blood and produced a large amount of tarry stool on March 29, 2011. His Hb

hospital with shortness of breath two days ago, associated with a progressively worsening tongue and neck swelling that developed for five days. She was referred to the emergency room from her Primary Care Physician (PCP) office for high clinical suspicion of angioedema. Earlier that day the patient had presented to her PCP office with a progressively worsening, asymmetric (right greater than left) tongue swelling for five days. The tongue swelling had disrupted the patient's sleep and made it difficult

room from her Primary Care Physician (PCP) office for high clinical suspicion of angioedema. Earlier that day the patient had presented to her PCP office with a progressively worsening, asymmetric (right greater than left) tongue swelling for five days. The

rate and rhythm. Lung examination was notable for decreased air entry bilaterally without any added sounds. Skin exam was without evidence of any erythema, swelling, or rash. The remainder of the examination was unremarkable. Her initial lab work including a comprehensive metabolic panel and complete blood count were within normal limits. Her erythrocyte sedimentation rate was elevated at 59 mm/hr. An initial chest x-ray and x-ray of the soft tissues of the neck were unremarkable. A clinical diagnosis of angioedema related to either ACE inhibitor use or other etiology was made. The patient immediately received steroids,

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

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

doses. His prolactin levels were still high at the time of his discharge from the hospital. Urology was consulted in the hospital, and an aggressive bladder program was initiated with close follow-up planned with his primary care, urologist, and psychiatrist.\nThe differential diagnoses of hyperprolactinemia clinically depend on the level of prolactin.\nLow levels of hyperprolactinemia have found to be due to medications, hypothyroidism, and kidney problems. Clinical judgment, when encountered with higher levels of hyperprolactinemia (>200 ng/mL), calls for ruling out pituitary adenoma. Our patient had many medications that could potentially interact with each

was decided to proceed with the removal of the stents after a course of antibiotic. We decided to remove the stents in one sitting, thereby mitigating the possibility of a forgotten stent again.\nAfter obtaining informed consent, the patient underwent cystoscopy that showed heavy encrustation with stones of size 3 cm around the vesical ends of the stents (Figure ). Hence, using a stone punch, the encrustations were removed leaving the stents intact. The vesical end of one stent was uncurled and pulled out of the urethral meatus and held under traction by an assistant while

a semirigid ureteroscope was inserted into the corresponding ureter (Figure ). Ureteroscopy revealed complete encrustation of the ureteric part which was fragmented using pneumatic lithotripter working up all the way to the pelviureteric junction (Figure ). A dilated ureter aided in passing the semirigid ureteroscope up into the renal pelvis. The renal

was performed. As she was asymptomatic, the patient never made it to remove the stents. Noncontrast computed tomography was done, which revealed bilateral gross hydroureteronephrosis with thinning of cortex in both the kidneys (Figure ). There were bilateral ureteric double J stents with heavy encrustation in both the renal and vesical ends (Figure ). Contrast-enhanced computed tomography was avoided on account of the persistently high renal parameters.

until Day 3 and three embryos until Day 5. Embryos were vitrified by Cryotop method using Kitazato vitrification media and the Cryotop device. Both Day 3 and Day 5 embryos were thawed in the same day using Kitazato thawing media following standard protocol. After thawing embryos were cultured individually in 20 μL droplets of Global Total medium under mineral oil at 37°C in 5% CO2 in air until embryo transfer.\nThe patient underwent a frozen mixed double embryo transfer (MDET) with two high grade quality embryos in a natural cycle. A natural cycle

oocytes were retrieved and seven of them were metaphase II. ICSI was performed and six two-pronuclear embryos were achieved. Three embryos were cultivated in a single one-step medium in Embryoscope

attempts and a 5-year history of primary infertility. In each IVF procedure a different number of good quality embryos were transferred and failed to implant. The infertility assessment screening showed normal condition and the case was described as idiopathic.\nShe had regular menstrual cycles and normal serum hormone concentrations. Her partner had normal sized testes and his semen analysis revealed normozoospermia (concentration: 110 × 106; total motility: 65% and

external carotid artery to secure its patency and, from there, stent-supported coiling was performed to occlude the proximal segment (). Secure proximal placement of the coils was not possible in a single-catheter technique owing to the high flow turbulence within the aneurysm sac. By using a double-catheter method, two coils could be placed simultaneously directly outside the stent wall facing the proximal segment of

there, stent-supported coiling was performed to occlude the proximal segment (). Secure proximal placement of the coils was not possible in a single-catheter technique owing to the high flow turbulence within the aneurysm sac. By using a double-catheter method, two

was admitted to our department with a rapidly progressive cervical pulsatile and painful swelling on the right side (). Apart from the swelling, a neurological examination also showed right-sided palsy of the hypoglossal nerve. The patient's history indicated that, in 1999, direct revascularization using a vessel graft to treat an extracranial giant aneurysm of the left ICA had failed due to technical problems in performing an adequate anastomosis causing left hemispheric ischemia. Neurological impairment such as right-sided hemiparesis or aphasia was not seen at the current presentation.\nCerebral digital subtraction angiography (DSA) showed

normal valves. Duplex vascular ultrasound revealed total total occlusion of the right subclavian artery with poststenotic flow pattern while the left subclavian artery was significantly narrowed.\nAn aortogram revealed normal aortic arch with total occlusion of the right subclavian

count. The serological study for ANA, cANCA and pANCA were all negative, her liver function test, renal function test, thyroid function test and urine analysis were all within normal limits. The Mantoux test for TB was performed and it was strongly positive (25 mm).\nECG showed sinus tachycardia with left axis deviation and signs of left ventricle enlargement.\nThe chest x-ray and abdominal ultrasound were normal. Echocardiography showed left ventricular hypertrophy with normal other internal dimensions and

right hand affection more than the left. Two years before presentation, she used to have fever in the evening and, gradually, she developed a persistent fever in the last 6 weeks without cough or weight loss.\nShe gave a past history of hypertension, which had been diagnosed when she was eight years old. She was regular antihypertensive medication (amlodepine and aldomet). The dosage of her medications had been decreased gradually by her physician over the last few months and were finally stopped completely based on a belief that her hypertension was spontaneously cured! She also gave

of consciousness followed by repeated generalized seizures. During ambulance transport, she was drowsy but able to protect her airway. On admission to the National Brain Aneurysm Center, she suffered another seizure. An intravenous anticonvulsant load was administered, and she was emergently intubated. Admission CT-scan revealed a hyperdense 2 × 3 cm2 lesion involving the temporoparietal junction with an associated 7 mm high attenuation nidus at its anterior margin. This lesion was surrounded by vasogenic edema []. MRA demonstrated the presence of a 2

her airway. On admission to the National Brain Aneurysm Center, she suffered another seizure. An intravenous anticonvulsant load was administered, and she was emergently intubated. Admission CT-scan revealed a hyperdense 2 × 3 cm2 lesion involving the temporoparietal junction with an associated 7 mm high attenuation nidus

segment seemed ill-advised. In addition, it was unclear how straightforward it would be to locate the aneurysm within the sylvian fissure or whether the involved segment could be primarily repaired once identified. Due to the poor caliber of the posterior division STA, a traditional extracranial-intracranial (EC–IC) bypass was not feasible. Therefore, we decided to perform an IC–IC short jump graft bypass in preparation for endovascular sacrifice of the parent vessel related to the aneurysmal segment.\nAt surgery, the anterior division of the STA was exposed and dissected over an

did not identify any abnormalities. The height of this patient was 150 cm and the weight was 51 kg, and the BMI was 22.67 kg m−2. She had no developmental problems, no history of alcohol consumption, smoking, or illegal substance use. No family history of psychiatric illnesses was reported. Laboratory examinations such as routine blood tests, biochemical indexes, infectious markers, and thyroid hormones were all in the normal references. Electroencephalogram and cranial magnetic resonance imaging were also normal. She

occurred about three or four times each week, and had last for 3 months. She had suicidal thoughts and attempts prior to hospitalization.\nOn admission, physical and neurologic examinations

the patient appeared to be excited, talkative, active, and energetic. These symptoms persisted for four days and she scored 30 out of 44 points on the Young Manic Rating Scale. A mania episode was considered and topiramate was thought to be the culprit. Therefore, the dose of topiramate was decreased to 25 mg per day promptly, and the patient gradually became calm in the next 2 days. However, the BED symptoms recurred and the dose of topiramate was again increased to 50 mg per day. Meanwhile, the dosage of quetiapine was escalated up to 500 mg per night to stabilize her mood. Finally, with a combination of quetiapine (500 mg

L3-5 spinous processes. While straight leg raising test was negative, femoral stretch test was positive at both sides. Neurological examinations revealed decreased muscle power for the right quadriceps femoris and left tibialis anterior (Manual Muscle Test grade IV). His knee and ankle reflexes at the right leg disappeared, and sensation at the medial side of his left calf

diminished. Pathological reflexes were negative at both legs. Lumbar spine MR imaging revealed an intradural lesion (14 × 8 mm2)

functions were normal since he was sick.\nOn physical examination, there was mild tenderness on L3-5 spinous processes. While straight leg raising test was negative, femoral stretch test was positive at both sides. Neurological examinations revealed decreased muscle power for the right quadriceps femoris and left tibialis anterior (Manual Muscle Test grade IV). His knee and ankle reflexes at the right leg disappeared, and sensation at the medial side of his left calf diminished. Pathological reflexes were negative at both legs. Lumbar spine MR imaging revealed an intradural lesion (14 × 8 mm2) at the left side of the dural sac and a herniated disc of moderate size at the right lateral recess of the L3/4 spinal canal (Figs. and

was again initiated. However, eight months after the diagnosis of prostate cancer, left hip arthroplasty was required due to a large area of bone destruction in the femur (). Antiresorptive therapy was continued for the next 9 months until the Metabolic Bone Diseases Outpatient Clinic, where the patient was attending, closed. The patient did not report to any other clinic for the next eight months.\nAfter this time the patient was admitted to our department, with strong pain in the left hip. Alkaline phosphatase and acute phase reactants were normal. Bone scintigraphy and CT scan of the left hip revealed findings which might be consistent with loosening of

prostate cancer antigen (PSA) was revealed in a routine blood test (the patient was having the PSA level checked once a year). Per rectal biopsy indicated prostate adenocarcinoma. Treatment with bisphosphonates was periodically stopped. No metastases were found and the patient underwent radical surgical resection of the prostate gland. Pamidronic acid at 90 mg every 3 months

A 64-year-old man, with no relevant past diseases, complained of left hip pain and numbness of the left lower extremity. He had experienced these symptoms for the last several years, but their intensity was low. The patient was taking paracetamol and over-the-counter nonsteroidal anti-inflammatory drugs periodically, and all this time he did not report to the doctor. The pain had been getting worse for about one month, so finally the patient reported to the doctor. There was no history of trauma reported. Anteroposterior hip radiograph was performed, which revealed bone destruction in the greater trochanter area, and decreased bone density in the head and neck of the femur. Besides a slightly elevated level of alkaline phosphatase (1.5 ×

streptococci, Viridans streptococci, and Candida albicans were isolated in one of the buttocks specimens. Acinetobacter baumannii grew in one set of blood cultures. Urine and stool cultures were not collected as patient never manifested gastrointestinal or urinary symptoms. The histopathologic evaluation showed a benign breast tissue with abscess formation and necrosis. Acid-fast bacilli, Gomori methenamine silver, and pancytokeratin immunohistochemical stains were negative for pathogens and atypical epithelial cell population, respectively.\nEach surgical specimen underwent routine bacterial workup. For aerobes, Sheep Blood, Chocolate, and MacConkey agars were used and, for anaerobes, Anaerobic Sheep

Gomori methenamine silver, and pancytokeratin immunohistochemical stains were negative for pathogens and atypical epithelial cell population, respectively.\nEach surgical specimen underwent routine bacterial workup. For aerobes, Sheep Blood, Chocolate, and MacConkey

were not collected as patient never manifested gastrointestinal or urinary symptoms. The histopathologic evaluation showed a benign breast tissue with abscess formation and necrosis. Acid-fast bacilli, Gomori methenamine silver, and pancytokeratin immunohistochemical stains were negative for pathogens and atypical epithelial cell population, respectively.\nEach surgical specimen underwent routine bacterial workup. For aerobes, Sheep Blood, Chocolate, and MacConkey agars were used and,

had undergone endoscopic submucosal dissection for conventional gastric adenocarcinoma 13 years earlier. During follow-up evaluation, two different masses were identified in the stomach. Endoscopic examination revealed that the mass in the lower body was a huge ulceroinfiltrative lesion with a dirty base, and the mass in the upper body was a 2.4-cm-sized submucosal lesion with surface erosion (fig. ). In the space between the two lesions, no abnormalities were recognized. These observations indicated that the mass in the lower body was a typical advanced gastric tumor, derived from epithelial cells, and the mass in the upper body appeared

to be a submucosal tumor of nonepithelial cell origin, such as a gastrointestinal stromal tumor or leiomyoma. The huge mass in the lower body was biopsied and histologically demonstrated to be a poorly differentiated adenocarcinoma with lymphoepithelioma-like features.\nThe patient underwent a total gastrectomy. The

was a 69-year-old man who had undergone endoscopic submucosal dissection for conventional gastric adenocarcinoma 13 years earlier. During follow-up evaluation, two different masses were identified in the stomach. Endoscopic examination revealed that the mass in the lower body was a huge ulceroinfiltrative lesion with a dirty base, and the mass in the upper body was a 2.4-cm-sized submucosal lesion with surface erosion (fig. ). In

looked at the room once with a smile, touched all the dolls and came out. The child was asked about her experiences in the play. She reported that she really enjoyed it and wanted her mother and grandfather to get the dolls to play with her. She was appreciated for her cooperation. She was encouraged to speak about

looked at the room once with a smile, touched all the dolls and came out. The child was asked about her experiences in the play. She reported that she really enjoyed it and wanted her mother and grandfather

to school. This probably led to anxiety and fear of abandonment from the mother. When she was not able to read and write, like other children, pressure was evident from the teachers who used to punish her sometime. There was some evidence for feelings of anxiety as well as anger toward parents, which was suppressed, and this resulted in withdrawn behavior and academic difficulties.\nThe child was seen at Child and Adolescent Mental Health Unit (CAMHU), NIMHANS. Client-centered play therapy was planned, and the session was carried out in CAMHU playroom under the supervision of the second author. The child was seen in a playroom consisting of various toys. The session was carried out everyday on

canine and lateral incisor is higher than the others, there is a probability that the segment not only placed 3 mm below its ideal position but also placed a few degrees deviation off the vertical axis (). The misplacement of the segment is explained to the patient and segmental osteotomy is suggested. The patient rejected the suggestion indicating that she is tired of serial surgical operations, thus the malpractice played

a negative effect on her psychology as well.\nA conservative treatment was taken into consideration. The indication was porcelain laminate veneers for the maxillary incisors and right canine, all ceramic crown for maxillary right first premolar because of excessive hard tissue loss and a

prepared teeth and light-polymerized for 40 s (Elipar Free Light, 3M ESPE) from palatal, buccal and incisal sides.\nExcess luting cement was removed and the marginal area was finished and polished with abrasive discs. The metal-ceramic fixed partial denture on the anterior mandibula and the full coverage all ceramic crown for maxillary right first premolar are constructed with conventional procedures and cemented (,). Restorations were checked to avoid any occlusal interference.\nThe patient was satisfied with her new smile line and excellent view of the anterior teeth (,). She

oppressed the posterior wall of the stomach. These image findings indicated AVM, and it was considered that the pancreatitis was caused by AVM. We considered that total pancreatectomy (TP) could not be prevented because there were findings associated with AVM in the pancreatic head and tail. To prevent brittle pancreatic diabetes caused by total islet loss, islet autotransplantation (IAT) was planned at the same time. We already had approval of the Ethics Committee of Tohoku University School of Medicine for the clinical project of TP with

2.0 cm-sized) in pancreatic head and the portal vein was enhanced at an early stage. It also showed a 2.5 cm cystic lesion in the pancreatic tail, which was suspected to be a pancreatic pseudocyst. The pseudocyst

packed in one bag containing 200 mL of heparinized (containing 1,500 units of heparin) transplantation solution. We connected the bag to one side of the portal vein catheter and dripped the islets into the portal vein. The other side of the catheter was connected to a pressure monitor and the portal vein pressure was measured during the whole procedure of transplantation. The portal vein pressure during transplantation was 8–9 mmHg and no elevation was detected. The IAT

revealed a preserved normal architecture. The majority of the portal tracts were slightly expanded and contained mild inflammatory cell infiltrate composed of lymphocytes and plasma cells, extending focally into the liver parenchyma (Fig. ). Lobular activity was mild and was composed mainly of lymphocytes at the sites of hepatocyte drop-out (Fig. ). An increased number of apoptotic hepatocytes were also noted. The histological features were consistent with mild autoimmune hepatitis.\nBased on the clinical signs and laboratory results our patient fulfilled the Kasukawa diagnostic criteria for MCTD including Raynaud’s syndrome, polyarthritis, reduced DLCO, elevated serum levels of muscle enzymes and positive anti-U1 RNP antibodies. Elevated liver enzymes, positive ANA, high titers of serum immunoglobulin G and

parenchyma (Fig. ). Lobular activity was mild and was composed mainly of lymphocytes at the sites of hepatocyte drop-out (Fig. ). An increased number of apoptotic hepatocytes were also noted. The histological features were consistent with mild autoimmune hepatitis.\nBased on the clinical signs and laboratory results our patient fulfilled the

syndrome. The symptoms first appeared one year before admission when parents noted white fingers on both hands. In September 2011, eight months after the first symptom, the main complaint was fatigue and loss of appetite. He was not gaining weight. No significant fevers above 38 °C were noted, but he was occasionally having mild temperature from 37–38 °C. Gradually his fingers became blue when he was in a cold environment. The change of color became fixed in time and other manifestations

time for the procedures was prolonged to 4 h and 25 min probably because of poor brain relaxation. Fluid balance including crystalloids and colloids infusion (5600 ml), blood products transfusion (560 ml), urine output (2650 ml), and blood loss (625 ml) was 2885 ml.\nAfter the surgery, the patient was turned to the supine position. Massive facial edema was apparent, and the bilateral upper extremities were significantly swollen. Immediately, a bronchoscopic examination was performed to evaluate the patency of the trachea, which revealed a worsened

for the procedures was prolonged to 4 h and 25 min probably because of poor brain relaxation. Fluid balance including crystalloids and colloids infusion (5600 ml), blood products transfusion

a suspected metastatic brain tumor. He had suffered from gait disturbance and visual field defects for 3 months. He has recently developed left hemiplegia due to multiple brain lesions. He had no specific past history aside from being a heavy smoker. The main brain tumor was located in the right occipital lobe, and the imaging study suggested that it was a metastatic tumor from lung cancer. A subsequent chest CT revealed a large solid tumor (maximum diameter, 72.25 mm) in the mediastinum (Fig. ). As for the main bronchus, the

regression and recurrent head drops for the past 1 month. She had language predominant global delay with a current developmental age of 15–18 months. Her perinatal period was uneventful. There was no past history of exanthematous illness. The child had repetitive myoclonic jerks every 9 s. Neurological examination revealed a normal fundus with central hypotonia and bipyramidal signs. The EEG and MRI were suggestive of SSPE which was confirmed by elevated anti-measles antibody titers in CSF. At 4-week follow-up, the child was in vegetative state.\nSSPE is frequently misdiagnosed or not suspected because of the variable

presentation. Given the heterogeneous expression, accurate initial diagnosis of SSPE was made in only 21% cases presenting to a tertiary care center in South India.[] The first child in our report is exceptional for the early onset of SSPE and also for the short latent period of 14 months. The two cases highlight the fulminant nature of such

ascertained. Genetically determined immune dysfunction in the first 2 years of life preventing a successful cell-mediated immune clearance of measles virus has been implicated in the susceptibility to SSPE.[] Genetic polymorphisms of programmed cell death-1, Toll-like receptor 3, MxA, interleukin-4, and interferon-1 genes have also been hypothesized but not proven. Besides, the role of phylogenetic spectrum of the wild-type measles virus in the etiopathogenesis has to be considered.[] The wild-type measles D3 and D6 are the most prevalent genotypes identified in SSPE on nucleotide sequence analysis. However, D7 genotype with hypermutation in the M gene has been isolated in an adult with fulminant SSPE from autopsy in South India and its association is still speculative.\nThe

distal branch of the right internal iliac artery. Since the stability of the pelvic retroperitoneal hematoma was confirmed with repeat imaging, surgical evacuation of the hematoma was not pursued. On HD37, she developed hematuria, for which cystography was performed that showed bladder rupture due to mass effect from the pelvic hematoma (Fig. ). This was managed conservatively by urology. After a 10-week hospitalization, she was discharged with significant improvement in cardiac function.\nThe lack of improvement in lower extremity

internal iliac artery. Since the stability of the pelvic retroperitoneal hematoma was confirmed with repeat imaging, surgical evacuation of the

On HD11, she first noticed bilateral foot drop and numbness, which were attributed to critical illness. Arm and proximal leg strength were normal. A follow-up CT chest/abdomen/pelvis performed several days later showed stability of the retrouterine hemorrhagic fluid collection. On HD20, worsening hypotension prompted a repeat CT that showed interval development of a large right-sided pelvic retroperitoneal hematoma associated with contrast extravasation and mass effect on the bladder (Fig. ) and small bowel wall thickening concerning for ischemic bowel. An exploratory laparotomy was performed during which small bowel resection and hemoperitoneum evacuation were performed. Interventional radiology addressed the intercurrent

scores were 8, 6, and 9 at 1, 5 and 10 min respectively. The baby was immediately taken to neonatology for thorough screening by the paediatrics team and was found to be healthy with no congenital abnormalities. Careful exploration of the abdomen revealed a placenta implanted on the greater omentum and on the small bowel mesentery [Fig. ]. There was no plane of cleavage and any manoeuver to remove the placenta was susceptible

min respectively. The baby was immediately taken to neonatology for thorough screening by the paediatrics team and was found to be healthy with no congenital abnormalities. Careful exploration of the abdomen revealed a placenta implanted on the greater omentum and on the small

120/69, respiratory rate was 22 breaths per minute, oxygen saturation of 98% on room air and temperature of 36.90 C.\nThe patient’s pulse was regular and of normal volume. Apex beat was noted in the 5th intercostal space with normal S1 and S2 on auscultation. Chest expansion was symmetrical and breath sounds were normal with bilateral good air entry.\nThe abdomen was symmetrical but tense without surgical scars. Striae gravidarum and a linea nigra were visible. There was marked tenderness on abdominal palpation, particularly in the peri-umbilical area and associated with each fetal movement. Palpation of the

the FB. This attempt also failed because the distal end of the FB was impacted in the bronchus and, therefore, did not allow the dormia basket to open alongside. Taking into account the failure of the various instruments to extract the FB it was decided to attempt extraction with the rigid bronchoscope. The patient and the family were informed and counseled about the failure of the procedure so far, the need for rigid bronchoscopy under general anesthesia, and the possibility of needing surgery in case the rigid bronchoscopy also failed.\nThe next day the procedure was undertaken in the operation theater under general anesthesia. Initially, a 7.5 mm outer diameter, 43 cm

further down in the bronchial tree in a fourth order basal subsegment []. A thin dormia basket was inserted through the working channel of this bronchoscope to snare

man presented to us with complaints of a recurring cough and occasional blood-streaked sputum. The problem started after a dental procedure during which he had a choking episode and aspirated a dental drill, which was being used for a root canal treatment. He denied any fever, chest pain, or shortness of breath. He had no other medical problems of note beside the above. Clinical examination was essentially normal. The patient had brought with him an X-ray of the chest, which was normal, and CECT of the thorax with reconstructions in which the slender metallic FB was seen lodged in one of the basal sub-segments of the left lower lobe [Figures –]. A decision

twins were also joined at the upper abdomen from the sternum to umbilicus. Above and below the area of fusion, they showed two normal upper and lower limbs. The twins were placed under nursing care and followed up at the provincial hospital for 1.5 months. The twins were then referred to our hospital for continued follow-up examinations and a planned intervention. The twins were healthy and well-nourished. A multidisciplinary team that was formed in preparation for the intervention determined that separation should be delayed until the twins gained adequate weight with independent

provincial hospital for 1.5 months. The twins were then referred to our hospital for continued follow-up examinations and a planned intervention. The twins were healthy and well-nourished. A multidisciplinary team that was formed in preparation for the intervention determined that

during expansion. The injection port was then placed on baby B’s chest, and the expander was filled with a baseline of 70 mL sterile saline (0.9% NaCl) to stop blood from entering the dissection cavity. The expander was well-tolerated by the twins with no signs of local or systemic reactions. The first injection into the expander began on the 6th day of tissue expander insertion, before removing the sutures. We performed further injections into the expander every 2

past medical history of two recent motor vehicle accidents presented to the emergency department with complaints of recurrent episodes of dizziness, lightheadedness, confusion.\nHis first motor vehicle accident occurred while driving a truck to work. The patient was unsure if he lost consciousness at that time and felt confused after the accident. He subsequently went to the emergency department to seek further medical attention. Diagnostic studies were negative. Head computed tomography (CT) showed no acute intracranial abnormality and

electrocardiogram (ECG) showed normal sinus rhythm. He was diagnosed with a concussion. There was a concern for syncope at which he underwent Holter monitoring with negative results.\nThe second event occurred one

the same area as noted on the head CT (Figure ). It was thought the area of encephalomalacia was inciting seizure activity. He was started on carbamazepine 200 mg twice a day for seizure prophylaxis.\nUpon follow up with neurology and cardiology, the initial concussion during the first motor vehicle accident irritated a small focus of encephalomalacia in the left temporal lobe that was not spotted on initial head CT inciting simple and partial complex seizures. It was thought at the time that the episode of asystole was from sinus node

less invasive approaches for extended surgery, such as LSP, are employed.\nCases for which LSP is indicated are generally locally advanced malignant tumors that often involve surrounding organs, and proper assessment is critical. If tumor invasion to the surrounding organs is suspected and preservation of the left lung cannot be expected upon initial diagnosis, this minimally invasive combined thoracoscopic approach has several advantages. With initial left-sided VATS, resectability can be evaluated in advance and in a less invasive manner than with thoracotomy. Confirmation of no invasion to the surrounding tissue makes

invasive approaches for extended surgery, such as LSP, are employed.\nCases for which LSP is indicated are generally locally advanced malignant tumors that often involve surrounding organs, and proper assessment is critical. If tumor invasion to

in advance and in a less invasive manner than with thoracotomy. Confirmation of no invasion to the surrounding tissue makes left pneumonectomy beneficial. Right thoracotomy provides safety and precise anastomosis at the time of carinal reconstruction.\nAn initial right thoracotomy could be considered, but it is difficult to

isolated by centrifugation at 3000 × g at 4°C for 10 minutes within one hour of collection. The plasma was then transferred to screw-cap polypropylene tubes and frozen at −80°C until further analysis. The gefitinib concentration in the plasma samples was determined using validated high-performance liquid chromatography coupled with tandem mass spectrometry in the Clinical Pharmacology Research Center Laboratory of Peking Union Medical College Hospital (PUMCH), as previously reported.\nAs shown in Figure , the peak plasma concentration of gefitinib occurred

on the days in which the patient did not receive HD. Additional blood samples were drawn at 25 and 29 hours (the times before and after HD the next day). Plasma was

lobectomy (pT1N0M0, stage IA) 18 years prior to our report complained of an intermittent mild fever and cough for two months and was admitted to our hospital. She was affected by CRF as a result of hypertension and had undergone HD three times a week and hemofiltration twice a month for the past nine years. A computed

She had a medical history of hypertension and atrial fibrillation. Eight years before, when she was 82, an advanced atrioventricular block was diagnosed after a syncopal episode and she received a permanent dual chamber pacemaker implantation. She underwent coronary computed tomography (CT) and radioisotope examination at this time, but there was no evidence of cardiomyopathy or of ischemic heart disease. The tip of the pacemaker lead was observed to pass through a PFO at the left ventricular apex; she received a follow-up examination because of no serious adverse event. She had no history of lung disease or tobacco smoking. She had no subjective symptoms associated with cardiovascular

and radioisotope examination at this time, but there was no evidence of cardiomyopathy or of ischemic heart disease.

time, which were measured by pulse oximetry.\nHer physical examination findings on admission were as follows: clear level of consciousness and severe hypoxia and cyanosis observed only in the right lateral decubitus position. These symptoms were immediately improved in the left lateral decubitus, the supine, and the upright position. Arterial blood gas values were consistent with her symptoms. Partial arterial oxygen pressure (PaO2) and arterial oxygen saturation (SaO2) decreased only in the right lateral decubitus position (Table ). These observations were reproducible. There was no evidence of lung rales or cardiac murmur.\nLaboratory

presented with generalised abdominal pain and nausea. His haemoglobin on admission to the peripheral hospital was found to be 7.5 g/dL. His background was significant for chronic pancreatitis and subsequent type 2 diabetes mellitus. Furthermore, three years ago he developed a biliary stricture after laparoscopic cholecystectomy that required multiple biliary stents and ultimately a hepaticojejunostomy.\nPhysical examination was unremarkable except for mild pallor, palmar erythema, and moderate ascites. Routine blood

tests on transfer to our unit are shown in .\nHe received multiple blood transfusions throughout his admission (eight in the peripheral hospital, requiring a further twenty-six units in our unit). He was also treated with octreotide and terlipressin due to a high suspicion of portal hypertension induced gastrointestinal haemorrhage.\nAn oesophagogastroduodenoscopy (OGD) was performed on admission to the peripheral

varices and portal hypertensive gastropathy, with no source of bleeding identified. A CT four-phase liver examination was performed and showed a nodular liver and occlusion of the main portal vein with cavernous transformation ().\nDuring this

This showed a long, hypodense region in the right nasopharynx suspect for a hematoma as well as an aneurysmatic dilatation of the origin of the right internal maxillary artery (). The subsequently performed conventional angiography confirmed the presence of an internal maxillary artery pseudoaneurysm, approximately 2 cm after the bifurcation of the arteria carotis communis which was successfully coiled (). Two days later the Bellocq tampon was removed without problems, and a week after the initial fall, the patient could

the Bellocq tampon was to be removed 48 hours later. That night however, during routine endotracheal suctioning, the patient started to cough inducing pulsatile oral blood loss suspect for an arterial vascular injury. The bleeding was successfully controlled, and subsequently a CT angiography (CTA) of the head and neck was performed.

were given. Crash reintubation followed, and during a second reinspection of the oro- and nasopharynx the bleeding again had stopped spontaneously. The site of the previous blood loss could not be identified. A Bellocq tampon was left in place and given the hemodynamic instability, and the still unknown origin of the massive bleeding the patient

left eye. She had used OK lenses for vision correction for 1 year. She often touched the lenses directly with her wet hands after washing her hands with tap water. She had received an antiviral treatment for 3 days at the previous clinic, but the symptoms worsened before referral to our cornea clinic. Upon presentation, her visual acuity was counting fingers at 15 cm. Slit-lamp examination revealed stromal edema () and a corneal ulcer measuring 2 × 2 mm with fluorescent staining (). Confocal laser microscopy revealed structures highly resembling amoebic

antiviral treatment for 3 days at the previous clinic, but the symptoms worsened before referral to our cornea clinic. Upon presentation, her visual acuity was counting fingers at 15 cm. Slit-lamp examination revealed

eye. She had used OK lenses for vision correction for 1 year. She often touched the lenses directly with her wet hands after washing her hands with tap water. She had received an antiviral treatment for 3 days at the previous clinic, but the symptoms worsened before referral to our cornea clinic. Upon presentation, her visual acuity was counting fingers at 15 cm. Slit-lamp examination revealed stromal edema () and a corneal ulcer measuring 2 × 2

metastasis. Due to positive surgical margins, radiotherapy was considered. However, to avoid the morbidity associated with irradiation, a decision was made to administer adjuvant chemotherapy (temozolomide) for 3 months.\nOne year later, in 2014, a biopsy of a new pigmented lesion on the anterior hard palate extending both to the right and left of midline revealed melanoma in situ. The patient underwent another surgical resection of the hard palate. Histology revealed melanoma in situ, again with positive anterior margins. A second resection was

radiotherapy was considered. However, to avoid the morbidity associated with irradiation, a decision was made to administer adjuvant chemotherapy (temozolomide) for 3 months.\nOne year

The patient subsequently was started on pembrolizumab 2 mg/kg every 3 weeks. She tolerated both imiquimod and pembrolizumab well, experiencing only constipation, fatigue, and arthralgias.\nAfter 2 months of imiquimod therapy, the patient reported irritation and bleeding of the hard palate. Treatment was reduced to once every 3 days. After 6 months of imiquimod and pembrolizumab therapy, repeat biopsy of the left hard palate/gingiva showed no melanoma (). Given the complete histologic response, topical imiquimod

167 mg/dL, LDL cholesterol 151 mg/dL, and HDL cholesterol 43 mg/dL. Patient was on diet modification for hyperlipidemia and refused any medications for that. An obstructive series ruled out intestinal obstruction. CRP was not measured as the CT scan results were satisfactory to the managing team. A computed tomographic (CT) scan () of the abdomen with contrast showed diverticulosis coli without surrounding inflammation. Wedge-shaped hypodense lesions were incidentally identified

on the upper and mid poles of the right kidney as well as the upper pole of the left kidney. This necessitated a renal protocol CT scan () with and without intravenous contrast, only to confirm multiple infarcts in the right kidney with small ischemic foci in the left kidney. An admission electrocardiogram (EKG) accidentally revealed new onset atrial fibrillation with controlled ventricular response.\nHeart

emergency room (ER) with a three-day history of right lower quadrant and periumbilical abdominal pain. Her primary care physician had prescribed oral levofloxacin 750 mg once daily for seven days, for a presumptive diagnosis of diverticulitis. Since antibiotic did not seem to bring about a change in her clinical status, the patient decided to seek

excluded; and (3) prediction of a deleterious functional effect by bioinformatics programs (e.g., MutationTaster; Polyphen2; Combined Annotation Dependent Depletion, CADD; and SIFT), loss of function, and deleterious mutations were considered.\nSanger sequencing was performed to verify the identified variant. The primers were designed by Primer Quest Tool (F:5′-GCTGGTTGGTTTGATGTCTTAG, R:5′-GGAACTTGA CTTGCAGGAAAC). The PCR conditions were set as follows: 95°C for 30 s, 56°C for 30 s, and 72°C for 1 min, for a total of 35 cycles using T3 Super PCR Mix (TSINGKE, Beijing, China). The PCR products were electrophoresed on

(e.g., MutationTaster; Polyphen2; Combined Annotation Dependent Depletion, CADD; and SIFT), loss of function, and deleterious mutations were considered.\nSanger sequencing was performed to verify the identified variant. The primers

regions) and synonymous mutations were excluded; (2) high allele frequencies relative to population databases (>0.01%) (e.g., 1,000 Genomes Project, ESP, and gnomAD) were excluded; and (3) prediction of a deleterious functional effect by bioinformatics programs (e.g., MutationTaster; Polyphen2; Combined Annotation Dependent Depletion, CADD; and SIFT), loss of function, and deleterious mutations were considered.\nSanger sequencing was performed to verify the identified variant. The primers were designed by Primer Quest Tool (F:5′-GCTGGTTGGTTTGATGTCTTAG, R:5′-GGAACTTGA CTTGCAGGAAAC). The PCR conditions were set as follows: 95°C for 30 s, 56°C for 30 s, and 72°C for 1 min, for a total of

suspected based on the clinical presentation as well as subtle features appreciable on the radiographs as discussed with our radiologists. Manual reduction was attempted but was unsuccessful. In spite of advice for surgical reduction, patient was not keen initially as the prescribed analgesics were efficacious in treating the pain and patient was still able to walk and jog without severe symptoms. However, the patient returned 1 week later (4 weeks from initial injury), this time keen for surgical intervention due to persistent swelling and stiffness.\nThe risks and benefits of surgical

intervention were discussed with the patient and informed consent was taken. The patient underwent open exploration, resection of interposed sesamoid, and

of another institution where he was given symptomatic treatment and had dorsoposterior (DP) and oblique radiographs of the left great toe performed (). He was told that the radiographs did not reveal any acute fracture and was advised to rest and to attend at the Orthopaedic Surgery Specialist Outpatient Clinic 2 weeks

tumor in the left main bronchus without invasion to surrounding organs (), and the patient underwent rigid endoscopic bronchial tumor resection 7 days after the cesarean section () []. The histological type could not be identified at this point, and left lung atelectasis developed due to postoperative inflammatory changes. CT examination 4 weeks after the endoscopic resection confirmed relapse of bronchial tumor. Owing to obstruction by the recurrent bronchial tumor and to rule out the possibility of malignancy, left main lung bronchial resection and bronchoplasty were performed 6 weeks

delivery of the baby. A cesarean section was performed at 34 weeks of gestation due to previous cesarean delivery. She delivered a female infant weighing 1322 g, with Apgar score of 8 and 9 points at 1 minute and 9 points at 5 minutes, respectively. The pH of umbilical artery blood gas was 7.321. A chest CT taken after delivery revealed a bronchial

was necessary. Additionally, her blood pressure was elevated at 32 weeks of gestation and fetal growth was restricted at -2.0 SD of normal fetal growth, so that she was diagnosed with preeclampsia (PE-EO). Following counseling with the patient, her family, and respiratory medicine doctors, a bronchoscopic tumor resection was planned following the delivery of the baby. A cesarean section was performed at 34 weeks of gestation due to previous cesarean delivery. She delivered a female infant weighing 1322 g, with Apgar score of 8

of uveitis treated in other clinics before. Child reported first symptoms 5 years ago, which consisted of blurry vision in right eye first then 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 parents refused surgical intervention. Two years prior to referral to

our clinic she had laser fotocoagulation in both eyes due to retinal vasculitis and was started on Methotrexat 15 mg weekly. Despite the administration of local and systemic corticosteroids and MTX, inflammation persisted; therefore, the patient was referred to our clinic for second opinion.\nThe best corrected visual acuity (BCVA)

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

male with history of bicuspid aortic valve presented to the emergency department (ED) the day after his senior prom with the chief complaint of right foot pain that had been gradually worsening over the prior three days. He had awoken at 4:30 am that morning and found that he could no longer bear weight on the right foot due to the intensity of the pain and had been using an old set of crutches to ambulate around his home. The patient indicated that the pain was primarily over the dorsal aspect of the foot, radiated up the back of the calf and was worse with bearing weight and

pain that had been gradually worsening over the prior three days. He had awoken at 4:30 am that morning

only for an unexplained anemia with a hemoglobin of 8.9 g/dL. The patient was given a 1 L bolus of normal saline, but remained tachycardic on re-examination with a heart rate as high as 134 bpm. His electrocardiogram was otherwise normal. The decision was made to draw a D-dimer, which came back elevated at 721 μg/L. After a discussion with the patient and his

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

the right femur and the right tibia, and the epiphyseal lesions of the distal femur and the proximal

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

changes of the mass in the left uterine cornu—the mass was compressed and its size did not differ significantly.\nAt the 41st week of gestation, the patient was admitted to the Obstetrics department due to the spontaneous rupture of membranes—transparent amniotic fluid was observed. A healthy female neonate (weight 2850 g, height 50 cm) with Apgar scores of 9 at 1 min and 10

the Obstetrics department due to the spontaneous rupture of membranes—transparent amniotic fluid was observed. A healthy female neonate (weight 2850 g, height 50 cm) with Apgar scores of 9

have been related to the uterus. .\nAn urgent Magnetic Resonance Imaging (MRI) was performed. A 36 × 20 × 36 mm size cystic mass with T2-hyperintense wall in the left cornual region was observed. An MRI scan also showed one more fetus inside the uterine cavity with placenta located on the left lateral wall. The diagnosis of a heterotopic angular pregnancy in the left cornu of the uterus was established. The patient was hospitalized for further observation.\nDuring hospitalization, blood and urine tests’ results were within the normal range. A multidisciplinary team (MDT) decided to keep

virus antibody, Cryptococcus antigen, and Toxoplasma antibody, were negative (Full laboratory testing in CSF is shown in ). In addition, the results of echocardiography, vascular ultrasound, and MRI of the head were all unremarkable (). However, within 24 h, mNGS detected 22 reads (A total of 19,870,653 sequence reads) corresponding to Brucella genus in CSF, but nothing was tested in peripheral blood. Subsequently, the identification of Brucella was confirmed by the SAT kit (Sinoreca, Beijing) in CSF and peripheral blood, antibody titers against Brucella in CSF and peripheral blood were 1:80 and 1:160, respectively. Therefore, the treatment was adjusted to doxycycline (0.1 g q8h), rifampin (0.45 g qd), and cefatriaxone (2.0 g ivgtt bid).

After 20 consecutive days of the new treatment, his headache and blurred vision diminished, with body temperature returning to normal. The patient was discharged from the hospital with cefatriaxone (2.0 g ivgtt bid), doxycycline (0.1 g tid), and rifampicin (0.15 g tid) (The timeline of this case can

to the local hospital in September 2020 after having paralysis of both the lower limbs and blurred vision for 30 days. He was administered medicine for invigorating blood circulation and eliminating stasis, glucocorticoid, and nutrition treatment for 10 days. On October 10, 2020, he was discharged from the hospital after his headache and the symptom of the paralysis of lower limbs diminished. However, he continued to have the symptom of blurred vision and was treated with 40 mg prednisone every day.\nThree days later, the patient's headache was aggravated, and he suddenly developed symptoms such as obnubilation, tic of limbs, foaming at the mouth, and

atrophic tubules, interstitial fibrosis, and chronic inflammation. The remaining glomeruli showed no increase in the mesangial matrix or mesangial cellularity. The glomerular capillaries were patent without endocapillary hypercellularity. The glomerular capillary walls were normal on periodic acid-Schiff and silver stains. There was only mild interstitial fibrosis and tubular atrophy involving <25% of the cortical area outside the areas of the scar by the Masson trichrome stain. Arterioles showed mural thickening and small foci of hyalinosis. At least 7

biopsy was performed on the 9th hospital day. The specimen contained up to 40 glomeruli, of which 14 were sclerosed. The sclerotic glomeruli were clustered in a region of scar with surrounding

aminotransferase 12 U/L (11–39 U/L), alanine aminotransferase 19 U/L (12–78 U/L), alkaline phosphatase 86 U/L (45–117 U/L), albumin 2.4 g/dL (3.2–4.5 g/dL), total bilirubin 1.6 mg/dL (0–1.0 mg/dL), lactate dehydrogenase 570 U/L (84–246 U/L), and haptoglobin 160 mg/dL (30–200 mg/dL). Arterial blood gas showed pH 7.45, PaO2 58 mmHg, PaCO2 32 mmHg, HCO3 21.4 mmol/L, and SaO2 88.5% on 50% FiO2. Anti-nuclear antibody (ANA) indirect immunofluorescence assay was negative. ANCA was positive at 1 : 1280 dilution and exhibited cytoplasmic staining pattern. MPO-ANCA was strongly positive at 114 AU/ml (0–19

this point, the patient was lost for further follow-up at our institution due to combination of patient's status of serving in the military and living out of state. Approximately 1 year and 7 months after the ACL reconstruction, the patient was referred back to our tertiary referral center for further assessment and treatment of the medial tibial bone lesion. Radiographs and MRI from the

tenderness over the anteromedial aspect of the patient's knee in the area of tibial tunnel. Review of outside films by a musculoskeletal radiologist and an orthopedic surgeon in our center included a differential diagnosis of infection, benign fibrous lesion such as fibrous dysplasia, and nonossifying fibroma. At

films by a musculoskeletal radiologist and an orthopedic surgeon in our center included a differential diagnosis of infection, benign fibrous lesion such as fibrous dysplasia, and nonossifying fibroma. At this point, the patient was lost for further follow-up at our institution due to combination of patient's status of serving in the military and living out of state. Approximately 1 year and 7 months after the ACL reconstruction, the patient was referred back to our tertiary referral center for further assessment and treatment of the medial tibial bone lesion. Radiographs and MRI from the outside institution (Figures and ) showed significant progression of the lesion.

“if I try to hold them, it becomes painful.” In addition to the pain and discomfort in the neck and head area, the patient was bothered by the fact that the movements were noticeable by other people. In the beginning, his movements were less frequent and less intense, but they gradually got worse in terms of frequency, amplitude and the initiation sites got

the movements were noticeable by other people. In the beginning, his movements were less frequent and less intense, but they gradually got worse in terms of frequency, amplitude and the

lumbar paraspinals, triceps and biceps. The movement started with right pectoralis contraction with almost simultaneous contraction of left pectoralis (there was some variability, with some movements having up to 15 ms of delay). Between 20 and 30 ms later there was a contraction of the supraspinalis, triceps and the biceps. The muscles of the back had some more variability, but it was important to note that in all the trials, there was initially a contraction of the lumbar paraspinals (in some cases at the same time as the right pectoralis, in other cases up to 30 ms later), followed by thoracic paraspinals going against a rostro-caudal propagation ().\nIn regard to the Bereitschaftspotential, we observed

the original suspicion of breast cancer; however, this parameter was later examined and found to be 882 mg/dL (reference range 4.5–117 mg/dL), which met the blood criterion. Furthermore, the analytical findings of the mammary gland tissue and lymph node met the pathological criteria. Accordingly, the present case was finally and definitively diagnosed with IgG4-RM.\nAs noted, breast cancer was initially suspected, and IgG4-RM was diagnosed only after a needle biopsy. The diagnosis may have been reached sooner if an IgG4 analysis had been performed. However, this is not a realistic assumption. Still, in such cases, misdiagnosis can complicate treatment. Currently, surgery is the

if all three, clinical and pathological, or clinical and blood criteria are met, respectively.\nIn the present case, the mammary gland and axillary lymph node findings met the clinical criteria. The IgG4 level was not initially investigated because of

Clinical findings include diffuse or localized enlargement, mass, nodular, and/or hypertrophic lesions in single or multiple organs. Blood findings include high IgG4emia, defined as a level of ≥ 135 mg/dL. Pathological findings include prominent lymphocytes, plasma cell infiltration, and fibrosis, with an IgG4-positive/IgG-positive cell ratio > 40% and ≥ 10 IgG4-positive plasma cells per high-powered microscopic field. Cases are defined as definite, probable, or possible if all three, clinical and pathological, or clinical and blood criteria are met, respectively.\nIn the present case,

hypoattenuation in the right frontoparietal lobe with a loss of gray-white matter differentiation concerning for an infarction in the right MCA territory without evidence of hemorrhagic conversion (Figure ).\nThe MRI brain scan showed acute to sub-acute cortical infarcts that involved the right frontal lobe in the right MCA territory without mass effect or evidence of hemorrhagic conversion (Figure .) Also, a transthoracic echocardiogram was done that showed no intracardiac shunt or thrombus.\nThe patient was placed on

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 of the brain with and without contrast. The CT scan showed an area of

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

stored in histidine-tryptophane-ketoglutarate solution at +4°C for 10 days. Anastomosis of the bile duct was performed by duct-to-duct anastomosis to the donor right hepatic duct remnant.\nAt the time of transplantation the

+4°C for 10 days. Anastomosis of the bile duct was performed by duct-to-duct anastomosis to the donor right hepatic

of the donor hepatic artery a direct anastomosis to the recipient supraceliac aorta was not feasible so an allogenic iliac artery conduit was required. The interposition graft was obtained from a heart-beating donor of a previous OLT and stored in histidine-tryptophane-ketoglutarate solution at +4°C for 10 days. Anastomosis of the bile duct was performed by duct-to-duct anastomosis to the donor right hepatic duct remnant.\nAt the time of transplantation the patient received induction immunosuppression consisting of 500 mg methylprednisolone and 20 mg basiliximab, the

of the right tonsillar region. The complaints had started one year before with a right sided feeling of pressure in the oral cavity and the neck. In 1966, 38 years before the patient presented to our department, he had been treated for a squamous cell carcinoma of the left tonsil in the territory of the former Soviet Union. At that time, the then 13-year-old boy underwent radical surgery followed by adjuvant radiotherapy with a cumulative radiation dose of 101 Gray. Although the patient was only 13 years old

treated for a squamous cell carcinoma of the left tonsil in the territory of the former Soviet Union. At that time, the then 13-year-old boy underwent radical surgery followed by adjuvant radiotherapy with a

marginal tumor-extension in the region of the left-sided soft palate. Re-operation was carried out by laser-surgery of the left-sided soft palate and histological examination revealed no tumor-remnants to be left in situ. The course of disease and treatment was then supervised by clinical and radiological follow-up control-investigations at regular 3 months intervals. Unfortunately, a biopsy taken from the middle of the soft palate in June 2005 again revealed microscopic signs of tumor-relapse. At that time the patient was free of symptoms and did not show a clinical correlate of tumor-recurrence. Surgical resection of these findings had to be performed

significant personal distress and social dysfunction, but, between episodes, a full recovery with normal functioning had always been achieved.\nIn terms of drug treatments, during the first two episodes, she was given haloperidol and benzodiazepines, and on discharge after the second admission, drug treatment was withdrawn as a result of a shared decision-making process (). After a third manic relapse with hospital admission, lithium was added to haloperidol and benzodiazepines. This combination treatment was effective only in the short term, as in 2001 a new manic episode occurred during treatment (as documented by lithium blood concentration of 0.8 mEq/litre). Haloperidol

was stopped and olanzapine started as an add-on treatment. In 2003, the patient abruptly stopped all drug treatments and subsequently suffered from a new episode with hospital admission. The same drug treatment was restored, and after recovery the patient agreed to see the treating

with the treating psychiatrist about the possibility of actively seeking a pregnancy, during 2012, the patient had consultations with the treating gynaecologist and family doctor, who gave advice on pros and cons of stopping versus continuing drug treatment. Subsequent discussions involved the patient's partner, who had never seen the patient during a manic phase and was in favour of stopping

was referred to our department for further investigation. On physical examination, the palmar aspect of the left hand and the area of the previous incision were tender to palpation and swollen while a slight atrophy of the thenar muscles was apparent. There was a sensory loss in the area innervated from the median nerve as compared with the controlateral hand and Tinel's sign was evoked over the median nerve at the

thenar muscles was apparent. There was a sensory loss in the

extension of fingers were painful. As a result, additional investigation was deemed necessary and magnetic resonance imaging (MRI) was selected for delineating any potential pathology in the carpal tunnel or the surrounding tissues. MRI showed a misdiagnosed, volarly placed soft tissue mass with well-defined margins and an ovoid shape which was in direct contact with the flexor tendons (Figure ).\nBecause of the persistent symptoms and the radiographic abnormalities, surgical exploration and tumor resection were scheduled. Under axillary block a well-circumscribed, encapsulated mass in the deep palmar tissues was identified causing significant compression of the median nerve. The tumor was