Persius/hicric huggingface dataset:
Ortner's syndrome

# Overview
Ortner's syndrome is a rare cardiovocal syndrome and refers to recurrent laryngeal nerve palsy from cardiovascular disease .  It was first described by N. Ortner, an Austrian physician, in 1897.
The most common historical cause is a dilated left atrium due to mitral stenosis, but other causes, including pulmonary hypertension, thoracic aortic aneurysms and aberrant subclavian artery syndrome have been reported .
Dysphagia caused by a similar mechanism is referred to as dysphagia aortica, or, in the case of subclavian artery aberrancy, as dysphagia lusoria.
A second Ortner's syndrome, Ortner's syndrome II, refers to abdominal angina.
Otorrhea overview

# Overview
Ear discharge may be caused by an irritation or inflamed tissue within the mastoid, ear canal, or middle ear.

# Pathophysiology
When the middle ear becomes acutely infected by bacteria, pressure builds up behind the ear drum, usually but not always causing pain. In severe or untreated cases, the tympanic membrane may rupture, allowing the pus in the middle ear space to drain into the ear canal. If there is enough of it, this drainage may be obvious. Even though the rupture of the tympanic membrane suggests a traumatic process, it is almost always associated with the dramatic relief of pressure and pain.

# Natural History, Complications and Prognosis
Instead of the infection and eardrum perforation resolving, drainage from the middle ear can become a chronic condition. As long as there is active middle ear infection, the eardrum will not heal.

# Diagnosis

## CT
CT of temporal bones may be performed for cholesteatoma, mastoiditis, and CSF otorrhea.

# Treament

## Medical Therapy
Foreign bodies can be removed with alligator forceps under magnification. In a simple case of acute otitis media in an otherwise healthy person, the body's defenses are likely to resolve the infection and the ear drum nearly always heals. Antibiotic administration can prevent perforation of the eardrum and hasten recovery of the ear.
Proteus mirabilis
Proteus mirabilis is a Gram-negative, facultatively anaerobic bacterium. It shows swarming, motility, and urease activity. P. mirabilis causes 90% of all 'Proteus' infections. It belongs to the Tribe Proteae.

# Diagnosis
An alkaline urine sample is a possible sign of P. mirabilis.
P. mirabilis can be diagnosed in the lab due to characteristic swarming motility, and inability to metabolize lactose (on a MacConkey agar plate, for example.) Also P. mirabilis produces a very distinct odour.

# Disease
This rod shaped bacterium has the ability to produce high levels of urease. Urease hydrolyzes urea to ammonia, NH3+ and thus makes the urine more alkaline. If left untreated, the increased alkalinity can lead to the formation of crystals of struvite, calcium carbonate, and/or apatite. The bacteria can be found throughout the stones, and these bacteria lurking in the stones can reinitiate infection after antibiotic treatment. Once the stones develop, over time they may grow large enough to cause obstruction and renal failure.
Proteus can also cause wound infections, septicemia and pneumonias, mostly in hospitalized patients.

# Treatment
P. mirabilis is generally susceptible to most antibiotics apart from tetracycline, however 10%20% of P. mirabilis strains are also resistant to first generation cephalosporins and ampicillins.

## Antimicrobial regimen
- Proteus mirabilis Return to Top
- Proteus mirabilis
- Preferred regimen (1): Ampicillin 500 mg PO q6h or 2 g IV q6h
- Preferred regimen (2): Cefuroxime 250 mg PO bid or 750 mg IV q8h
- Preferred regimen (3): Ciprofloxacin 250-500 mg PO bid or 400 mg IV q12h
- Preferred regimen (4): Levofloxacin 500 mg PO OD or 500 mg IV q24h
- Note: Duration of treatment for uncomplicated UTI 3 days, pyelonephritis 7-14 days, complicated UTI 10-21 days and bacteremia is 7-14 days

# Characteristics
P. mirabilis can utilize urea and citrate. It can produce hydrogen sulfide gas, and forms clear films on growth media. It is motile, possessing peritrichous flagella, and is known for its swarming ability. It is commonly found in the intestinal tract of humans. P. mirabilis is not pathogenic in guinea pigs or chickens. It has the distinction of being the only pathogenic organism with a virulence factor named for late rock musician Frank Zappa.
Noteworthy is the ability of this species to inhibit growth of unrelated strains resulting in a macroscopically visible line of reduced bacterial growth where two swarming strains intersect. This line is named Dienes line after its discoverer Louis Dienes.
The micro-organism tests:
- Indole negative and Nitrogen Reductase positive (no gas bubble produced)
- Methyl Red positive and Vogues-Proskauer negative
- Catalase positive and Cytochrome Oxidase negative
- Phenylalanine Deaminase positive

# Gallery
- Proteus mirabilis bacteria grown on a xylose-lysine-deoxycholate (XLD) agar plate. From Public Health Image Library (PHIL).
Platelet factor 4
Platelet factor 4 (PF4) is a small cytokine belonging to the CXC chemokine family that is also known as chemokine (C-X-C motif) ligand 4 (CXCL4) . This chemokine is released from alpha-granules of activated platelets during platelet aggregation, and promotes blood coagulation by moderating the effects of heparin-like molecules. Due to these roles, it is predicted to play a role in wound repair and inflammation. It is usually found in a complex with proteoglycan.

# Genomics
The gene for human PF4 is located on human chromosome 4.

# Function
Platelet factor-4 is a 70-amino acid protein that is released from the alpha-granules of activated platelets and binds with high affinity to heparin. Its major physiologic role appears to be neutralization of heparin-like molecules on the endothelial surface of blood vessels, thereby inhibiting local antithrombin III activity and promoting coagulation. As a strong chemoattractant for neutrophils and fibroblasts, PF4 probably has a role in inflammation and wound repair.
PF4 is chemotactic for neutrophils, fibroblasts and monocytes, and interacts with a splice variant of the chemokine receptor CXCR3, known as CXCR3B.

# Clinical significance
The heparin:PF4 complex is the antigen in heparin-induced thrombocytopenia, an idiosyncratic autoimmune reaction to the administration of the anticoagulant heparin. PF4 autoantibodies have also been found in patients with thrombosis and features resembling HIT but no prior administration of heparin.
It is increased in patients with systemic sclerosis that also have interstitial lung disease.
The  human platelet factor 4 kills malaria parasites within erythrocytes by selectively lysing the parasite's digestive vacuole.
Palatal consonant
Palatal consonants are consonants articulated with the body of the tongue raised against the hard palate (the middle part of the roof of the mouth). Consonants with the tip of the tongue curled back against the palate are called retroflex.
The most common type of palatal consonant is the extremely common approximant Template:IPA, which ranks as overall, among the ten most common sounds in the world's languages. The nasal Template:IPA is also common, occurring in around 35 percent of the world's languages, in most of which its equivalent obstruent is not the plosive Template:IPA, but the affricate ]. Only a few languages in northern Eurasia, the Americas and central Africa contrast palatal plosives with postalveolar affricates - the only common ones being Hungarian, Czech, Slovak and Albanian.
Warning: the IPA symbols Template:IPA are commonly used, not for palatal stops, but for the palatalized velar stops Template:IPA, or the palatal affricates Template:IPA, or the alveolopalatal affricates Template:IPA, or even the postalveolar affricates Template:IPA. This is an old IPA tradition. True palatal stops are relatively uncommon, so it is a good idea to verify the pronunciation whenever you see Template:IPA in the transcription of a language.
Consonants with other primary articulations may be palatalised, that is, accompanied by the raising of the tongue surface towards the hard palate. For example, English Template:IPA (spelled sh) has such a palatal component, although its primary articulation involves the tip of the tongue and the upper gum (this type of articulation is called palatoalveolar). The palatal consonants identified by the International Phonetic Alphabet are:

# Notes
-  Ian Maddieson (with a chapter contributed by Sandra Ferrari Disner); Patterns of sounds; Cambridge University Press, 1984. ISBN 0-521-26536-3
Palladium hydride
Palladium hydride is metallic palladium that contains a substantial quantity of hydrogen within its crystal lattice. At room temperature and atmospheric pressure, palladium can absorb up to 900 times its own volume of hydrogen. This process is reversible. This property has been investigated because hydrogen storage is of such interest and a better understanding of what happens at the molecular level could give clues to designing improved metal hydrides. A palladium based store would be however prohibitively expensive due to the cost of the metal. Palladium electrodes have been used in some cold fusion experiments, under the hypothesis that the hydrogen could be "squeezed" between the palladium atoms to help them fuse at lower temperatures than would otherwise be required. No cold fusion experiments have achieved conclusive positive results, however, and the theoretical ability of palladium to accomplish this is in dispute.

# History
The absorption of hydrogen gas by palladium was first noted by T. Graham in 1866 and absorption of electrolytically produced hydrogen, where hydrogen was absorbed into a palladium cathode, was first documented in 1939. 

# Chemical structure and properties
The absorption of hydrogen produces two different phases, both of which contain palladium metal atoms in a face centred cubic (fcc) lattice, which is the same structure as pure palladium metal.  At low concentrations up to PdH0.02 the palladium lattice expands slightly, from 3.889 A to 3.895 A. Above this concentration the second phase appears with a lattice constant of 4.025A. Both phases coexist until a composition of PdH0.58 when the alpha phase disappears. Neutron diffraction studies have shown that hydrogen atoms randomly occupy the octahedral interstices in the metal lattice. (In a fcc lattice there is one octahedral hole per metal atom). The limit of absorption at normal pressures is PdH0.7, indicating that approximately 70% of the octahedral holes are occupied. The absorption of hydrogen is reversible, and hydrogen rapidly diffuses through the metal lattice.  Metallic conductivity reduces as hydrogen is absorbed, until at around PdH0.5 the solid becomes a semiconductor.

# Surface absorption process
The process of absorption  of hydrogen has been shown by scanning tunnelling microscopy to  require aggregates of at least three  vacancies on the  surface of the crystal to promote the dissociation of the hydrogen molecule. The reason for such a behaviour and the particular structure of trimers has been analyzed.

# Uses of palladium hydride
The absorption of hydrogen is reversible and is highly selective. Industrially a palladium based diffuser separator is used. Impure gas is passed through tubes of thin walled silver-palladium alloy. Hydrogen and deuterium readily diffuse through the alloy membrane. The gas that comes through is pure and ready for use. Palladium is alloyed with silver to improve its strength. To ensure that the formation of the beta phase is avoided, as the lattice expansion noted earlier would cause distortions and splitting of the membrane, the temperature is maintained above 300C.
Panaeolus bispora
Panaeolus bispora, also known as Copelandia bispora is a rare little brown mushroom that bruises blue and contains the hallucinogen psilocybin.
This mushroom is similar macroscopically to Panaeolus tropicalis, Panaeolus cambodginiensis and Panaeolus cyanescens, but can be differentiated by its two spored basidia.

# Description
This is a little brown mushroom that grows on dung and has black spores.  Can be found in Hawaii.
Pancreatic trauma
Contributors:  Cafer Zorkun M.D., PhD.

# Overview
- In the acute setting, pancreatic injuries may result in death due to associated vascular injuries.
- Delayed morbidity and mortality are usually caused by complications resulting from disruption of the pancreatic duct.
- Duct injury may lead to complications such as abscess, pancreatic pseudocyst, fistula, and pancreatitis.
- The pancreas is vulnerable to crushing injury in blunt trauma due to impact against the adjacent vertebral column.
- Two-thirds of pancreatic injuries occur in the pancreatic body, and the remainder occur equally in the head, neck, and tail.
- Isolated pancreatic injuries are rare, and associated injuries, especially to the liver, stomach, duodenum, and spleen, occur in over 90% of cases.
- In adults, over 75% of blunt injuries to the pancreas are due to motor vehicle collisions.
- In children, bicycle injuries are common, and child abuse may result in pancreatic injuries in infants.

# Diagnosis
- Pancreatic injuries may be difficult to diagnose clinically.

## Diagnostic Findings

### Computed Tomography
- Direct signs of pancreatic injury include pancreatic laceration, transection, and comminution. 
- Fluid collections, such as hematomas, pseudocysts, and abscesses, are often seen communicating with the pancreas at the site of fracture or transection.
- Focal enlargement of the pancreas and peripancreatic fluid are suggestive of pancreatic injury.
- Peripancreatic fat stranding, hemorrhage, and fluid between the splenic vein and pancreas are useful secondary signs.
Images courtesy of RadsWiki
- Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident
- Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident
- Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident
- Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident
- Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident
- Computed Tomography, Pancreatic laceration: A patient with pancreatic transection and pseudocyst formation from motor vehicle accident

# Treatment
Disruption of the pancreatic duct is treated surgically or by therapeutic endoscopy with stent placement, while injuries without duct involvement are usually treated nonsurgically.

# Prognosis
- Although uncommon, early diagnosis is crucial, since delayed complications such as fistula, abscess, sepsis, and hemorrhage may lead to significant mortality, occurring in up to 20% of cases.
- Death due to delayed complications is usually due to sepsis and multiorgan failure.
- The main source of delayed morbidity and mortality from pancreatic trauma is disruption of the pancreatic duct. Injuries that spare the pancreatic duct rarely result in morbidity or death.
Parathyroidectomy
Parathyroidectomy is the surgical removal of one or more parathyroid glands. It is used in primary tumors or hyperplasia of the glands, especially when they produce excessive parathyroid hormone. As drugs such as Fosamax do not treat the underlying cause of parathyroid-related osteoporosis, surgery is the only cure.  Bone loss is reversible.
The location of the glands is generally behind the thyroid, but there is a lot of variation. Usually, the location of an enlarged gland has been confirmed via a sestamibi scan or on ultrasound.
During the operation, the patient is usually put under a general anesthetic (unconscious and pain free) or a local anesthetic (pain free). The surgeon makes an incision around an inch long under the Adam's apple.
The patient usually recovers very quickly after the operation.  The PTH level is back to normal within 10-15 minutes, and is confirmed by routine blood tests following the operation.
Paris quadrifolia
Paris quadrifolia (Herb Paris, True-lover's Knot) is a species of the genus Paris  in the family Melanthiaceae although authorities formerly regarded it as part of the Liliaceae family. It is related to Trillium with which it can be confused. Trillium however is generally 3-merous (3 leaves per whorl, 3 petals etc.) whereas Paris is 4-merous.
In the UK it has the familiar name of Herb Paris.
It has solitary flowers with 4 or more very narrow greenish filiform petals and green petaloid sepals. The flower is borne above a single whorl of four or more stem leaves. It prefers calcareous soils and lives in  damp and shady places especially old established woods and stream sides. It occurs locally in temperate and cool areas throughout Europe and Asia but is absent in the wild from the Americas, Africa and the southern hemisphere. In Britain it is more frequently found in the east of the country but it is uncommon throughout its range. Each plant only produces one, blueberry-like fruit, which is poisonous.
co:Paris quadrifolia
cs:Vrani oko ctyrliste
de:Einbeere
lt:Vilkauoge
nl:Eenbes
fi:Sudenmarja
sv:Ormbar
uk:
Patellar ligament

# Overview
The Patellar ligament (anterior ligament) is the central portion of the common tendon of the Quadriceps femoris, which is continued from the patella to the tuberosity of the tibia.
It is a strong, flat, ligamentous band, about 8 cm. in length, attached, above, to the apex and adjoining margins of the patella and the rough depression on its posterior surface; below, to the tuberosity of the tibia; its superficial fibers are continuous over the front of the patella with those of the tendon of the Quadriceps femoris.
The medial and lateral portions of the tendon of the Quadriceps pass down on either side of the patella, to be inserted into the upper extremity of the tibia on either side of the tuberosity; these portions merge into the capsule, as stated above, forming the medial and lateral patellar retinacula.
The posterior surface of the ligamentum patell is separated from the synovial membrane of the joint by a large infrapatellar pad of fat, and from the tibia by a bursa.
Pediatric urology
Steven C. Campbell, M.D., Ph.D.

# Overview
Pediatric urology is a surgical subspecialty of medicine dealing with the disorders of children's genitourinary systems. Pediatric urologists provide care for both boys and girls ranging from birth to early adult age. The most common problems are those involving disorders of urination and testes.
Some of the problems they deal with are:
- Bladder control problems such as enuresis and daytime urinary incontinence
- Undescended testes (cryptorchidism)
- Hypospadias
- Urolithiasis (bladder and kidney stones)
- Chordee and other minor malformations of the penis
- Phimosis
- Urinary obstruction and ureteral reflux
- Neurogenic bladder (e.g., associated with spina bifida)
- Tumors and cancers of the kidneys
- Repair of genitourinary trauma
- Genitourinary malformations and birth defects
Prune belly syndrome
Cloacal exstrophy, bladder exstrophy, and epispadias
Ambiguous genitalia and intersex conditions
- Prune belly syndrome
- Cloacal exstrophy, bladder exstrophy, and epispadias
- Ambiguous genitalia and intersex conditions
In North America, most pediatric urologists are associated with children's hospitals. Training for board certification in pediatric urology typically consists of a surgery internship as part of a urology residency followed by subspecialty training in pediatric urology at a major children's hospital.
Pediculus capitis

# Overview
The head louse (Pediculus humanus capitis) is an obligate, ectoparasitic, wingless insect spending its entire life on human scalp and feeding exclusively on human blood. Humans are the only known host of this parasite. Humans can also be infested with the pubic or crab louse (Pthirus pubis) and/or with the  body louse (Pediculus humanus humanus).Head lice infect hair on the head. Tiny eggs on the hair look like flakes of dandruff. However, instead of flaking off the scalp, they stay put. Head lice can live up to 30 days on a human. Their eggs can live for more than 2 weeks. Head lice spread easily, particularly among school children. Head lice are more common in close, overcrowded living conditions.
Pediculus humanus capitis is most commonly found on the scalp, behind the ears and near the neckline at the back of the neck. Head lice hold on to hair with hook-like claws found at the end of each of their six legs. Head lice are rarely found on the body, eyelashes, or eyebrows.

# Morphology
The dorso-ventrally flattened body of the louse is divided into head, thorax and abdomen. On the head, one pair of eyes and one pair of antennae are clearly visible. The mouthparts are adapted to piercing the skin and sucking blood.  The legs, with their terminal claws, are adapted to holding the hair-shaft. They cannot jump from head to head and being wingless insects they also cannot fly.  In males (Fig.1), the first pair of legs are slightly larger and also used for holding the female during copulation. Males are slightly smaller than females and are characterized by the pointed end of the abdomen and the well-developed genital apparatus visible inside the abdomen. Females are characterized by two gonopods in the shape of a W at the end of their abdomen (see figure above). The eggs (Fig.3) are oval-shaped and ca. 0.8 mm in length. Immediately after oviposition they are shiny, round, and transparent. Head lice are 1-3 mm in size, varying according to their stage of development. They are usually grayish in color but depending on the time since their previous blood-meal they can be also reddish-brown.
- Fig. 1. Male of head louse
Fig. 1. Male of head louse
- Fig.3.Louse egg
Fig.3.Louse egg

# Biology
During its lifespan of 4 weeks a female louse lays 50-150 eggs (nits). The egg hatches to the first nymphal stage, which after three moltings develop to nymph 2, nymph 3 and eventually to either a male or female louse. Adult lice copulate frequently and the females lay an average of 3-4 eggs daily. A generation lasts for about 1 month. All stages are blood-feeders and they bite the skin 4-5 times daily to feed. During oviposition the female excretes a glue-like substance from a gland located at the posterior end of the body and attaches the eggs on the hair of the host. Although any part of the scalp may be colonized, lice favor the nape of the neck and the area behind the ears, where the eggs are usually laid.
Pel-Ebstein fever

# Overview
Pel-Ebstein fever is a rarely seen condition noted in patients with Hodgkin's lymphoma in which the patient experiences fevers which cyclicly increase then decrease over an average period of 1 or two weeks.  The same type of cyclic fever is also associated with other conditions such tuberculosis, but it is not called "Pel-Ebstein fever" unless the fever is associated with Hodgkin's.

# Causes
The cause is currently unknown although speculation centers on host immune response, lymph node necrosis, and damaged stomal cells. 

# Treatment
Treatment with nonsteroidal antiinflamitory agents or treatment of the underlying Hodgkin's (usually with chemotherapy) will help the symptoms. 

# Eponym
The condition is named after Wilhelm Ebstein and PK Pel who both published papers in 1887 noting the phenomenon.   

# Controversy
Researchers have speculated whether this condition truly exists.  In an article in the New England Journal of Medicine, Richard Asher refers to Pel-Ebstein fever as an example of a condition that exists only because it has a name.  "Every student and every doctor knows that cases of Hodgkin's disease may show a fever that is high for one week and low for the next week and so on. Does this phenomenon really exist at all?..."