bluuebunny/crossref_metadata_2025 huggingface dataset:
Advanced testicular cancer in a society of racial and socio-economic health disparity
Authors: Kaufman Michael
Published: June 2013

This is the case of an African-American man who presented with a 6 month history of impressive unilateral testicular swelling and abdominal pain. After a thorough workup he was found to have metastatic testicular seminoma causing multiple complex sequelae. This case highlights the essential diagnostic and therapeutic features of a common malignancy seen primarily in young men. His advanced disease presentation, complex management of multiple comorbidities combined with his African-American race and lower socio-economic status (SES) highlight an unusual paradigm shift in testicular cancer epidemiology from the more typical high SES Caucasian to the lower SES, less educated male patient. Beyond the unexpected clinical presentation, this case then presents multiple avenues of discussion regarding the unfortunate effects of racial disparities on disease presentation and progression that are plaguing our healthcare system today.
Tumefactive demyelination: an unusual cause of a spontaneously resolving homonymous hemianopia
Authors: Dwivedi R A , Dwivedi R E , Durnian J M , Young C A
Published: June 2013

A 21-year-old man presented to eye casualty complaining of altered vision associated with headache and vomiting upon waking. Clinical examination was unremarkable except for a right-sided homonymous hemianopia. The MRI scan of the brain revealed a space occupying lesion within the occipital lobe and MR spectroscopy highlighted this to be inflammatory in nature, most likely a tumefactive demyelinating lesion (TDL). Lumbar puncture displayed positive oligoclonal bands. The patient was managed conservatively and made a full recovery, with normal visual fields recorded after a 3 month follow-up. This is a case of a TDL manifesting itself as an unusual cause of homonymous hemianopia; misdiagnosis of TDL is common and potentially damaging to the patient.
Dentin dysplasia type I
Authors: Singh Aarti , Gupta Sangesh , Yuwanati Monal Bhaurao , Mhaske Shubhangi
Published: June 2013

Dentin dysplasia type I is a rare hereditary disturbance of dentin formation characterised clinically by nearly normal appearing crowns and hypermobility of teeth that affects one in every 100 000 individuals and manifests in both primary and permanent dentitions. Radiographic analysis shows obliteration of all pulp chambers, short, blunted, and malformed roots, and periapical radiolucencies of non-carious teeth. This paper presents three cases demonstrating classic features of type I dentin dysplasia.
Lead intoxication and knee osteoarthritis after a gunshot: long-term follow-up case report
Authors: Gameiro Vinicius Schott , Araújo Gabriel Costa Serrão de , Bruno Felipe Motta Moreira
Published: June 2013

This case is of a man who suffered gunshots and developed saturnism. Projectiles were removed from the abdomen, but one was left in the knee for 14 years. The patient presented with weight loss, headaches, loss of sight, tiredness, cramps, painful joints and trembling. We identified ataxic movements such as intense trembling of the limbs and anaemia. The abdominal pain caused eight internments in different hospitals, and the patient always received the diagnosis of intestinal subocclusion. We removed the bullet and did a wide synovectomy. The patient did not receive a clinical treatment with chelates. The symptoms of lead poisoning ceased, but he developed knee osteoarthritis, during the 7 years of follow-up.
Laparoscopically assisted repair of an acute traumatic diaphragmatic hernia
Authors: Safdar G , Slater R , Garner J P
Published: June 2013

A 60-year-old man with chronic obstructive pulmonary disease and a heavy smoker and drinker presented to the emergency department with left-sided thoracoabdominal pain after falling down the stairs. Initial clinical findings were left-sided chest tenderness with no clinical evidence of subcutaneous emphysema. Twenty-four hours later the patient's respiratory distress increased—repeat chest X-ray showed a left gastrothorax indicative of a ruptured left hemi diaphragm. Diagnostic laparoscopy in the supine position via an umbilical port confirmed the presence of the stomach, spleen and splenic flexure of the colon in the left chest. Laparoscopic reduction of the stomach and colon was performed, but a small upper midline incision was required to reduce the spleen without injury. The diaphragmatic tear was repaired by direct open suture. The patient required a brief period of postoperative ventilation via a tracheostomy. The patient remained well at a 3-month follow-up visit.
Lightning can strike twice: an unlucky patient of neurological interest
Authors: Gilbee Ebony S
Published: June 2013

Poliomyelitis, once a worldwide epidemic, is becoming increasingly rare owing to the introduction of the polio vaccine in the 1950s. It is estimated that the number of cases of polio has reduced by 99% since the Global Polio Eradication Initiative (GPEI) started in 1988. Amyotrophic lateral sclerosis (ALS) is another relatively uncommon condition which also affects anterior horn cells with debilitating neurological, and deadly, consequences. An unusual case of an aggressive form of ALS developing in a 72-year-old patient with paralytic poliomyelitis in childhood is presented. Her initial presentation was puzzling, and our approach to the diagnostic dilemma is discussed.
Acute phenytoin intoxication in a 4-year-old mimicking viral meningoencephalitis
Authors: Shukla Amlin , Sankar Jhuma , Verma Ankit , Dubey Nandkishore
Published: June 2013

We report here the case of a 4-year-old female preschooler who presented to the emergency department with generalised tonic-clonic convulsions and history of vomiting, irritability and dysarthria of short duration. On examination she was found to be responsive only to painful stimulus, had terminal neck stiffness and bilateral extensor plantars. In view of her clinical presentation, an initial diagnosis of viral meningoencephalitis was made in the emergency room and the child treated accordingly. On subsequent transfer to the intensive care unit (ICU), the parents revealed additional history of an elder sibling taking phenytoin for seizures. Therefore, a suspicion of acute phenytoin toxicity was made and phenytoin levels sent for confirmation. Her serum phenytoin level was 80 μgm/mL (normal: 10–20). The child was managed conservatively and discharged after 5 days of hospitalisation. We chose to report this case to highlight the unusual presentation of this rare intoxication.
Low-grade meningioma showing nearly equal density with spinal fluid on radiographic images
Authors: Tamura Ryota , Tomita Hideyuki , Shimizu Kazuhiko , Sugiyama Kazutoshi
Published: June 2013

A 61-year-old woman had an intracranial tumour that was located on the falx. Meningioma was suspected and the tumour rapidly grew over 1 year. It showed nearly equal density with spinal fluid showing almost no enhancement on radiographic images, like microcystic meningioma. Successful removal of the tumour was achieved. Histopathologically, the tumour was diagnosed as low-grade meningioma. The meningioma had variable sized microcysts and the appearance of solid area was meningothelial meningioma. This is a rare radiographic image for meningothelial meningioma.
Primary extraskeletal Ewing's sarcoma/primitive neuroectodermal tumour of breast
Authors: Ikhwan S M , Kenneth V K T , Seoparjoo A , Zin A A M
Published: June 2013

Primary primitive neuroectodermal tumour (PNET) and extraskeletal Ewing's sarcoma belongs to the Ewing's family of tumours. Primary tumours arising from breast are very rare. There are only a few case reports published on primary extraskeletal Ewing's sarcoma and PNET arising from breast. We present an extremely rare case of an inoperable primary Ewing's sarcoma arising from left breast with contralateral breast, lymphatic and lung metastasis.
A clinically hidden but severely destructive entity
Authors: Rastogi Khushboo , Verma Santosh Kumar , Bhushan Rajarshi
Published: June 2013

The diagnosis‘ Aggressive Periodontitis’ (AgP), defined by the International workshop for a classification of periodontal diseases and conditions in 1999, refers to the multifactorial, severe and rapidly progressive form of periodontitis, which primarily—but not exclusively—affects younger patients. Direct and indirect bacterial effects influencing the host immune response play a significant part in the aetiology of AgP comparable with chronic periodontitis. In addition to various virulence factors of specific periodontal pathogens, a genetic predisposition influences the outbreak and progression of the disease. This report describes the disciplinary treatment of AgP patient with progressing full-mouth bone resorption.
Haemophagocytic lymphohistiocytosis mimicking septic shock after the initiation of chemotherapy for squamous cell sarcinoma of the neck
Authors: Aryal Madan Raj , Badal Madan , Giri Smith , Aryal Shambhu
Published: June 2013

Haemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal disorder resulting from a highly stimulated immune response with uncontrolled accumulation of lymphocytes and macrophages in multiple organs. Both the inherited and acquired forms of this disease exist; the latter can sometimes occur secondary to different malignancies. In this report, we present a middle-aged Hispanic man who presented with features of septic shock during the course of chemotherapy for squamous cell carcinoma of the neck. Despite aggressive treatment for septic shock, he rapidly deteriorated and died after 30 h of admission. Autopsy findings confirmed a diagnosis of HLH. HLH should be recognised as a serious adverse event during chemotherapy for different malignancies including squamous cell carcinoma of the neck.
Chasing the ACE of hearts
Authors: D'Silva Andrew , Jassim Imad , Greenwood John , Grosser Konrad
Published: June 2013

A case study of a patient presenting with acute pulmonary oedema, dynamic ECG changes and a rise in cardiac biomarkers with no evidence of myocardial infarction. The clinical course followed a dynamic and inflammatory disease process with evidence of sarcoidosis on tissue histology. The patient had an excellent clinical response to corticosteroid therapy with minimal evidence of hyperenhancement (focal fibrosis) on cardiac MRI at 6 months. The case highlights the challenges in making a new diagnosis of sarcoidosis where involvement appears limited to the heart and lymphatic system.
Cervical nodular fasciitis in a 17-month-old child
Authors: Moura Antunes Sofia , Vieira Helena , Brito Anabela , Oliveira Maria Helena
Published: June 2013

Nodular fasciitis (NF) is an uncommon fibroblastic proliferation that usually arises in the extremities or trunk, less frequently in the head and neck region. It is frequently mistaken for a malignant tumour owing to its rapid growth, but it is ultimately a benign condition with spontaneous regression. We describe a case of a 17-month-old African girl with cervical NF in which spontaneous and complete regression of the lesion occurred following the diagnosis by fine needle aspiration cytology. We emphasise the importance of making an accurate and timely diagnosis, and the imperative role of fine needle aspiration cytology in this process, potentially avoiding further unnecessary surgical procedures.
Tubercular thyroid abscess
Authors: Kumar Awanish , Pahwa Harvinder Singh , Srivastava Rohit , Khan Khursheed Alam
Published: June 2013

We encountered a patient who presented with neck swelling, difficulty in swallowing, voice change along with systemic features such as evening rise of temperature, chronic cough and weight loss. Ultrasonography of the thyroid gland revealed two cystic swellings. An ultrasound guided fine needle aspiration cytology was suggestive of tubercular abscess. The patient responded well to antigravity aspiration of the swellings and antitubercular treatment.
Use of C2 spinous process screw for posterior cervical fixation as substitute for laminar screw in a patient with thin laminae
Authors: Nagata Kosei , Baba Satoshi , Chikuda Hirotaka , Takeshita Katsushi
Published: June 2013

Rigid screw fixation of C2 including transarticular screw and pedicle screw contain the risk of vertebral artery (VA) injury. On the other hand, translaminar screws are considered to be safer for patients with anomalous VA. But C2 translaminar screw placement was limited in patients who have thin laminas and there is marked variation in C2 laminar thickness. Appropriate C2 fixation method for a patient who has thin laminas and high-riding VA together was controversial. Here, we present a case of an elderly Asian woman who had thin laminas and high-riding VA together with progressive myelopathy to report a first case of C2 spinous process screw insertion. Although the stability and safety of C2 spinous process screw was reported in cadaver series, there was no clinical report to our knowledge. Spinous process screw can be an option of C2 fixation for patients with high-riding VA and severe degenerated cervical spines including thin C2 laminas.
Brugada syndrome with elevated cardiac biomarkers
Authors: AlKendi Fatima , Jamil Mujgan , Qureshi Anwer , Jamil Gohar
Published: June 2013

A 45-year-old man presented to our hospital with a history of palpitations, presyncope and chest pain. Vital signs and physical examination were unremarkable. Initial ECG  revealed sinus rhythm with non-specific ST changes. Subsequent ECGs showed rsr′ in V1 and saddle-back pattern of ST elevation in lead V2, indicative of type 2 Brugada ECG pattern. Telemetry monitoring revealed multiple runs of asymptomatic non-sustained polymorphic ventricular tachycardia. Ajmaline challenge test confirmed the diagnosis of Brugada syndrome. The subsequent rise and fall of cardiac biomarkers was suggestive of acute myocardial infarction which was refuted by having normal coronaries by cardiac catheterisation. Echocardiogram showed normal cardiac structures and function without any evidence of myopericarditis. Automated intracardiac defibrillator was recommended which the patient declined.
Ring chromosome with deletion 7q in acute myeloid leukaemia
Authors: Mohamed Muhajir , Dun Karen , Sharma Sharad , Khalafallah Alhossain
Published: June 2013

Cytogenetic abnormalities can be detected in approximately 50–60% of newly diagnosed adult patients with acute myeloid leukaemia (AML). Monosomy of the chromosome 7 (−7) and deletion of the long arm of the chromosome 7 (7q–) are considered as high cytogenetic-risk AML with a poor prognosis. These abnormalities can occur, as a single chromosomal aberration, in approximately 8% of newly diagnosed AML. We report an elderly patient with AML who had deletion 7q (7q–) along with ring chromosome, which was demonstrated in conventional cytogenetics and fluoresecent in-situ hybridisation techniques.
Severe parainfluenza pneumonia in a case of transient hypogammalobulinemia of infancy
Authors: Cotugno Nicola , Manno Emma Concetta , Stoppa Francesca , Sinibaldi Serena , Saffirio Claudia , D'Argenio Parizia , Marano Marco , Nardo Matteo Di , Palma Paolo
Published: June 2013

Human parainfluenza viruses (HPIVs) infection, largely known to cause self-limiting bronchiolitis and pneumonia in immune competent patients, can lead to severe to fatal pulmonary disease in immune disorders, such as primary or acquired-immune deficiencies. We report the case of a 1-year-old child who developed an acute respiratory distress syndrome. Because of a progressive respiratory failure unresponsive to conventional treatment extracorporeal membrane oxygenation (ECMO) was rapidly started. HPIV-3 infection was diagnosed on the rhinopharyngeal fluid and immunological examinations revealed a hypogammaglobulinemia. A combination therapy with ribavirin, intravenous immunoglobulin (IVIG) and steroid under ECMO support was started with considerable improvement. Subsequent analysis and more specific immunological assessment resulted normal confirming the diagnosis of transient hypogammaglobulinemia of infancy (THI). This case highlights the importance of prompt therapy with early ECMO support in combination with ribavirin, IVIG and steroids in patients affected by severe HPIV-3 pneumonia and THI.
Concomitant acromioclavicular and miliary tuberculosis
Authors: Agathangelidis Filon , Boutsiadis Achilleas , Fouka Evangelia , Karataglis Dimitrios
Published: June 2013

A 48-year-old man was being treated unsuccessfully for miliary tuberculosis for 5 months until he presented with acromioclavicular joint swelling. Imaging of the shoulder revealed destruction of the acromioclavicular joint and the patient was brought to the operating theatre and underwent the excision of the distal end of the clavicle, synovectomy and drainage of the abscess. Surgery was followed by prompt clinical, functional and radiological improvement. Histopathology confirmed the diagnosis of acromioclavicular tuberculosis. Resistance to appropriate antituberculous treatment in patients with miliary tuberculosis can sometimes be a result of undiagnosed extrapulmonary site of infection.
Antiglycine receptor antibody and encephalomyelitis with rigidity and myoclonus (PERM) related to small cell lung cancer
Authors: Kyskan Robert , Chapman Kristine , Mattman André , Sin Don
Published: June 2013

A 39-year-old man (a lifetime non-smoker) presented with a locked left jaw and leg myoclonus. Clinical and electromyographic findings were in keeping with progressive encephalomyelitis with rigidity and myoclonus (PERM) syndrome. A thoracic CT scan demonstrated a 19 mm right hilar nodule, which was proven to be small cell lung cancer on bronchoscopic biopsy. Serological evaluation of the patient's plasma revealed antibodies against glycine receptors (serology negative for anti-GAD, anti-Yo, anti-Hu, anti-Ri, antiamphiphysin, anti-Ma2/Ta, anti-CRMP5 and anti-NMDA receptor). After his cancer was treated with chemotherapy and intravenous immunoglobulins (IVIg), neurological symptoms resolved but returned several months later without any evidence of cancer recurrence. Symptoms were refractory to corticosteroids and IVIg therapy. Rituximab was then initiated, which led to a dramatic and sustained resolution of symptoms. To our knowledge, this is the first case of PERM related to antiglycine receptor antibodies from paraneoplastic syndrome, which resolved with rituximab.
Beware of gossypibomas
Authors: Karasaki Takahiro , Nomura Yukihiro , Nakagawa Tassei , Tanaka Nobutaka
Published: June 2013

Gossypiboma, a retained surgical sponge, is a rare complication that can occur after any type of surgery. Despite the precautions, the retention of foreign bodies still occurs. We describe a case of a 33-year-old woman with epigastric pain. She was initially diagnosed with acute cholangitis with choledocholithiasis. Although common bile duct stone was successfully removed endoscopically, her epigastric pain did not completely subside. She had undergone an emergency caesarean section at a suburban maternity hospital 6 weeks prior to the referral. A contrast-enhanced CT revealed an encapsulated mass showing a spongiform pattern with fluids and gas bubbles inside, and gossypiboma was suspected. A retained surgical sponge without radiopaque markers was removed surgically. Except for a wound infection, the postoperative course was uneventful. Gossypiboma should always be considered in the differential diagnosis of indeterminate abdominal pain, infection or a mass in patients with a prior surgical history.
Femoral arteriovenous fistula associated with calf pain 2 months after removal of a haemodialysis catheter
Authors: Chiba Kyoji , Hara Miho , Takeshita Yasuyo , Machii Masato
Published: June 2013

Double-lumen catheters are widely used to achieve temporary access to circulation in patients requiring acute haemodialysis (HD); however, several complications are associated with the insertion of these catheters. Arteriovenous fistula (AVF), a rare but significant complication of catheter insertion, has been reported in several cases. In this report, we describe a case of a right femoral AVF that caused calf pain 2 months after HD catheter removal. The right ankle-brachial index was 0.46, and the diagnosis of AVF was confirmed using colour Doppler ultrasound and three-dimensional CT. The fistula was managed by surgical vascular repair. The right ABI improved to 1.06, and the absence of fistula was confirmed using three-dimensional CT. Therefore, physicians and nursing staff should be aware of the potential of this complication and should perform clinical and medical examinations at the insertion and removal of temporary HD catheters.
Idiopathic intracranial hypertension and transverse sinus stenoses
Authors: Skyrman Simon , Fytagoridis Anders , Andresen Morten , Bartek Jiri
Published: June 2013

An 18-year-old woman was diagnosed with idiopathic intracranial hypertension (IIH) and bilateral transverse sinus stenoses (TSS), after presenting with papilledema and decreased visual acuity. Lumbar puncture revealed an opening pressure of >60 cm H2O. MRI showed bilateral TSS believed to be associated with the IIH. Initial treatment consisted of symptom relief by a temporary lumbar drain for cerebrospinal fluid (CSF) diversion, while the pros and cons of a more permanent solution by insertion of a ventriculoperitoneal shunt (VPS) or bilateral transverse sinus stent was discussed. A VPS was inserted since the patient had improved with CSF diversion. MRI verified reopening of the venous sinuses after shunt placement, and the patient remains asymptomatic with no signs of relapse after 3 years of follow-up.
Hypoglycaemia begets hypoglycaemia
Authors: Arora Alok
Published: June 2013

Drug-induced (insulin/insulin secretagogue) hypoglycaemia is the most common cause of hypoglycaemia particularly in the elderly. It is estimated that hypoglycaemia of any severity occurs annually in 5–20% of patients taking antihyperglycaemic agents. Although these hypoglycaemic episodes are rarely fatal, they can be associated with serious clinical sequelae. The half-life for most sulfonylurea medications is 14–16 h; they can cause severe, prolonged hypoglycaemia. It is important to recognise, prevent and treat hypoglycaemic episodes secondary to the use of antihyperglycaemic agents. Patient education has become focused on minimising hyperglycaemia but emphasis must be placed on minimising even minor subclinical hypoglycaemia because it will contribute to a vicious cycle of hypoglycaemia begetting hypoglycaemia. Ten per cent dextrose is recommended for the reversal of all hypoglycaemic episodes rather than the conventional 50% dextrose. Octreotide can be an option for recurrent and relapsing hypoglycaemia in an acute setting.
Catatonia and parkinsonism as a sequelae of typhoid fever: a rare experience
Authors: Talukdar Payel , Dutta Arghya , Rana Sukriti , Talukdar Arunansu
Published: June 2013

Although neurological manifestations of typhoid fever was thought to be obsolete from modern world, emergence of multidrug resistant typhoid bacilli and reporting of outbreak of typhoid fever with a range of early neuropsychiatric manifestations from various parts of world has led clinicians and investigators to re-evaluate the clinical spectrum of this endemic sinister disease. An 18-year-old male student was admitted in psychiatry ward with mutism, staring look, posturing and rigidity. There was history of typhoid fever 1 week before for which he was prescribed cefuroxime. Although investigations fail to provide any clue, his catatonic symptoms disappeared 2 weeks later giving way to resting tremor, bradykinesia, cog-wheel rigidity but without gait abnormality. He was successfully treated with lorazepam, amantidine, olanzapine and pramiprexole. The patient was asymptomatic within a month. He had no recurrence of symptoms till last follow-up, 6 months from the illness.
Von Meyenburg complexes mimicking metastatic disease at laparotomy for focal nodular hyperplasia
Authors: Bieze Matthanja , Verheij Joanne , Phoa Saffire S , van Gulik Thomas M
Published: June 2013

A 44-year-old woman presented with symptoms of fatigue and increasing abdominal discomfort. MRI with the hepatobiliary contrast Gd-EOB-DTPA (Primovist) was performed showing a 6 cm lesion in segment 2/3 of the liver typical for focal nodular hyperplasia (FNH). Because of severe complaints attributed to the lesion, the patient was scheduled for resection. At laparotomy multiple small white lesions were found throughout the liver with enlarged locoregional lymph nodes. Macroscopically, the findings could be consistent with widespread metastases and the surgeon felt compelled to determine the nature of these lesions before continuing resection. Final diagnosis revealed multiple bile duct hamartomas and an FNH lesion as was expected.
A lumpy appendix
Authors: Dholakia Shamik , Hashimi Yasmin , Agarwal Atul , Toe Kyi
Published: June 2013

A De Garengeot hernia is a rare and interesting presentation of a groin lump, with the diagnosis usually only being identified during surgery. It still presents clinicians with diagnostic and therapeutic challenges, owing to the lack of signs associated with sepsis and so an important case to highlight. We present a case report of a 90-year-old woman who developed a De Garengeot hernia as part of her presentation of bowel obstruction illustrating the importance of careful examination and to ensure prompt diagnosis and initiation of appropriate multidisciplinary management.
Surgical intervention for adnexal masses during pregnancy
Authors: Telli E , Yalcin O T , Ozalp S S , Hassa H
Published: June 2013

We aimed to evaluate the influence of surgical intervention on gestational and neonatal outcomes in women who underwent elective surgery in the second trimester of gestation because of an adnexal mass. We retrospectively reviewed the hospital records of women who underwent elective surgery for adnexal masses in the second trimester of gestation between 2006 and 2012. The ages of the women ranged between 17 and 33 years. Eight women underwent a laparotomy, and one woman, who aborted on the day of the operation, underwent a laparoscopy. Dermoid cysts, cystadenoma and borderline ovarian tumours were present in four, two and two of the women, respectively. Eight women had no complications after surgery and delivered healthy newborns at term. We concluded that elective surgery on an adnexal mass in the second trimester of gestation is safe for both the mother and the fetus.
Bilateral knee extensor disruption in severe crouch gait
Authors: Elhassan Yahya , Kiernan Damien , Lynch Tim , Brien Tim O
Published: June 2013

Crouch gait is one of the most troublesome abnormal gait patterns in ambulant patients with spastic diplegic cerebral palsy (CP). Although CP is a non-progressive condition, crouch gait can result in knee extensor disruption (KED) causing deterioration or cessation of ambulation. Diagnosis of KED in crouch gait is often overlooked. We report a seminal case of a 28-year-old active woman with diplegic CP with severe crouch gait who was referred for gait analysis due to subjective decreased walking speed and endurance. Gait analysis showed kinematic features typical of KED and radiology confirmed the diagnosis.
Massive pulmonary embolus and a precariously positioned thrombus: teetering on a knife edge!
Authors: Garala Kanai , Chelliah Rajesh , Hudson Ian
Published: June 2013

Pulmonary embolism (PE) is a common condition seen regularly by emergency physicians. The authors describe a patient who presented with shortness of breath and syncope. He also experienced drowsy, clammy and sweaty episodes. He was tachycardic, tachypnoeic and saturating at 92% on air. A chest X-ray was normal but an ECG showed S1Q3T3. A CT pulmonary angiography performed showed bilateral pulmonary emboli with a large inferior vena cava (IVC) thrombus. Echocardiography revealed severely dilated right ventricle and atrium, severe right ventricular impairment, pulmonary hypertension, large mobile friable clots seen extending into the tricuspid valve. A multidisciplinary team decided the safest management approach was intravenous heparin. The patient recovered and repeat echocardiography 5 days later showed significantly smaller clots. The extension of an IVC thrombus into the heart and prolapsing into the tricuspid valve is an extremely rare presentation. Furthermore this case demonstrates the importance of echocardiography when diagnosing and generating bespoke management plans for PE.
Lungs on fire
Authors: Batra Sandeep , Vaid A K , Bhargava Rahul , Gupta Sachin
Published: June 2013

A 50-year-old man was diagnosed as classical Hodgkin's lymphoma stage III B. He had been a reformed smoker and has had a coronary artery disease as his comorbidity. He was started on adriamycin, bleomycin, vinblastine, dacarbazine (ABVD)-based chemotherapy. An interim disease evaluation was suggestive of metabolic complete response after four cycles of ABVD. After completion of his sixth cycle, he presented with low-grade fever, dry cough, generalised malaise and increasing dyspnoea on exertion. FDG (18 fluoro-deoxyglucose) positron emission tomography (PET)-CT revealed intensely FDG avid diffuse activity in mid and lower zone both lung fields. He was started on intravenous steroids along with broad spectrum antibiotic and antifungal cover. Clinical, radiological and laboratory assays did not reveal any infective pathology. He was diagnosed as bleomycin-induced pulmonary toxicity (BIP). Despite best supportive care, his pulmonary functions deteriorated and he developed cardiac arrhythmias. He finally succumbed to the irreversible chemotherapy toxicity of a curable malignancy.
Metal impaction: an unusual cause of dysphagia
Authors: Anwuzia-Iwegbu C , Quereshi Y , Walker R , Patel B
Published: June 2013

A 41-year-old unemployed construction worker with a background of insulin-dependent diabetes mellitus, hypertension, chronic kidney disease stage 3, previous incisor tooth abscess aged 9, for which he was fitted with metal dentures, underwent a right below knee amputation. Postoperative day 8 he experienced episodes of dysphagia and vomiting postparandial. CT thorax revealed a foreign body in the midline region of the mediastinum. After two failed attempts at endoscopic extraction of the metal denture, the patient underwent surgical extraction of his metal denture.
Lymphangioma: surrounding the ovarian vein and ovary
Authors: Gonen Korcan Aysun , Abali Remzi , Oznur Meltem , Erdogan Cuneyt
Published: June 2013

Lymphangiomas are usually benign lesions seen in the head and neck region in children. Intra-abdominal localisation is rare and the majority of these cases are in early childhood. Retroperitoneal lymphangiomas constitute approximately 1% of all lymphangiomas. They are generally diagnosed incidentally, may be asymptomatic or may present with a palpable abdominal mass. A limited number of cases of ovarian lymphangiomas have been reported in women, whereas there are no reported cases of paraovarian localisation. We present a rare case of lymphangioma located in bilateral paraovarian region and along the left ovarian vein with radiological findings.
Successful management of native-valveBrucellaendocarditis with medical therapy alone
Authors: Shetty Ranjan K , Madken Mohit , Naha Kushal , Vivek G
Published: June 2013

A 71-year-old Asian-Indian male agriculturist presented with fever since 3 months. Clinical examination revealed hepatosplenomegaly and an early diastolic murmur in the aortic area. Echocardiography confirmed aortic regurgitation with large vegetations on the aortic valve leaflets, and also showed mild left ventricular dilatation with systolic dysfunction. Although blood cultures were persistently sterile, serology forBrucellawas strongly positive. On retrospective questioning, the patient confirmed frequent occupational exposure to cattle. Surgical intervention was offered, but refused by the patient on financial grounds. Medical therapy for brucellosis with rifampicin, doxycycline and streptomycin resulted in complete and durable recovery.
Acrodermatitis enteropathica-like skin lesions in a neonate
Authors: Arora Kamal , Das Rashmi Ranjan , Panda Shasanka Shekhar , Kabra Madhulika
Published: June 2013

A male neonate was born to a sixth-gravida mother with a history of four early-neonatal deaths. On day 21 of life, the patient was admitted for poor feeding, vomiting and encephalopathy. Final diagnosis of propionic acidaemica (propionylcarnitine, 17.67 μmol/L) was made. He was managed by peritoneal dialysis followed by protein-free and special lipid diet, sodium benzoate and multivitamins. On day 28 of life, he developed acrodermatitis enteropathica-like skin lesions on perioral and diaper area that did not respond to oral zinc or antimicrobials. A possibility of acrodermatitis acidaemica was kept and supplementation with essential amino acids started, following which the skin lesions regressed.
Jejuno-jejunal intussusception: an unusual complication of feeding jejunostomy
Authors: Krishna Sunil , Prabhu Raghunath , Thangavelu Siddharth , Shenoy Rajgopal
Published: June 2013

The jejuno-jejunal intussusception is a rare complication of jejunostomy tube placement. We are reporting a case of 33-year-old man who was suffering from absolute dysphagia due to carcinoma of cricopharynx with advanced metastatic disease, who underwent Stamms feeding jejunostomy as a part of palliative care. After 1 month he presented with colicky type of pain in the abdomen and vomiting. Sonogram of abdomen revealed a target sign and a feeding tube in a dilated jejunum. Abdominal CT proved the sonographic impression of jejuno-jejunal intussusception. He, therefore, underwent exploratory laparotomy and resection and anastomosis of the intussuscepted bowel. New feeding jejunostomy (FJ) was done distally from the anastomotic site. As per the literature this complication has been reported in Witzels jejunostomy. In our case the patient had undergone Stamms jejunostomy with placement of a Ryle's tube. Intussusception should be considered if a patient comes with abdominal pain and vomiting following FJ.
Portal pyaemia secondary to open haemorrhoidectomy: need for prophylactic broad spectrum antibiotics
Authors: Prabhu Raghunath , Natarajan Arjun , Krishna Sunil , Thangavelu Siddharth
Published: June 2013

A 70-year-old man presenting with long standing grade 3 Haemorrhoids, underwent open haemorrhoidectomy under spinal anaesthesia. The patient passed stools on subsequent day and there was no bleeding per rectum. On day 5, he complained of dull aching upper abdominal pain. On physical examination, the abdomen was soft and there was mild tenderness in the epigastric region. Subsequently, he developed high temperature with chills and rigors. His condition failed to improve and the abdominal pain increased in severity. There was no pain in the perianal region and per rectum examination was normal. Leucocyte count rose to 12×109/L and there were toxic changes on peripheral smear. Blood culture grewStaphylococcus aureus. Liver enzymes were mildly elevated. Coagulation profile was deranged. Fibrin degradation products were positive. D-dimer was high. CT revealed acute thrombosis of left portal vein and microabscesses suggestive of portal pyaemia.
Empirical equation for evaluating the dispersivity of cohesive soil
Authors: Fan Henghui , Kong Lingwei
Published: June 2013

As indicated by the theory of a clay–water–electrolyte system, the dispersive mechanism of cohesive soil involves three aspects: low clay content, high sodium ion percentage, and strongly alkaline pH. Accordingly, an empirical equation was established with an associated procedure and criteria proposed for evaluating the dispersivity of cohesive soil. The equation consists of four soil physical and chemical indicators: liquid limit (WL), clay content (PC), sodium percentage in the pore water (PS), and pH. The equation is F = 4 − 0.01(2WL + PC − PS) + 0.1 pH, where F is the soil dispersivity value. Compared with the evaluation based on laboratory tests, the empirical equation had higher accuracy for the evaluation of the dispersivity of cohesive soil, and was thus conducive to greater engineering safety. This indicates that the proposed empirical equation is applicable for evaluating the dispersivity of cohesive soil in general engineering.
ASSESSING THE PERFORMANCE OF ENERGY-AWARE MAPPINGS
Authors: BENOIT ANNE , MELHEM RAMI , RENAUD-GOUD PAUL , ROBERT YVES
Published: June 2013

We aim at mapping streaming applications that can be modeled by a series-parallel graph onto a 2-dimensional tiled chip multiprocessor (CMP) architecture. The objective of the mapping is to minimize the energy consumption, using dynamic voltage and frequency scaling (DVFS) techniques, while maintaining a given level of performance, reflected by the rate of processing the data streams. This mapping problem turns out to be NP-hard, and several heuristics are proposed. We assess their performance through comprehensive simulations using the StreamIt workflow suite and randomly generated series-parallel graphs, and various CMP grid sizes.
RECENT RESULTS FROM ATLAS AND CMS ON HIGGS, SUPERSYMMETRY AND PHYSICS BEYOND THE STANDARD MODEL SEARCHES
Authors: NAHN STEVE , TSYBYCHEV DMITRI
Published: June 2013

The large hadron collider (LHC) physics program is finally on the way to help uncover the mechanism responsible for electroweak symmetry breaking, with each of experiments collecting up to 5 fb-1 of data at center-of-mass energy of 7 TeV. In this review, we summarize searches for physics beyond the Standard Model at ATLAS and CMS experiments at LHC.
MATHEMATICAL ANALYSIS OF PARALLEL CONVECTIVE EXCHANGERS WITH GENERAL LATERAL BOUNDARY CONDITIONS USING GENERALIZED GRAETZ MODES
Authors: BOUYSSIER JULIEN , PIERRE CHARLES , PLOURABOUE FRANCK
Published: July 2013

We propose a mathematical analysis of parallel convective exchangers for any general but longitudinally invariant domains. We analyze general Dirichlet or Neumann prescribed boundary conditions at the outer solid domain. Our study provides general mathematical expressions for the solution of convection/diffusion problems. Explicit form of generalized solutions along longitudinal coordinate are found from convoluting elementary base Graetz mode with the applied sources at the boundary. In the case of adiabatic zero flux counter-current configuration, we recover the longitudinally linearly varying solution associated with the zeroth eigenmode which can be considered as the fully developed behavior for heat-exchangers. We also provide general expression for the infinite asymptotic behavior of the solutions which depends on simple parameters such as total convective flux, outer domain perimeter and the applied boundary conditions. Practical considerations associated with the numerical precision of truncated mode decomposition is also analyzed in various configurations for illustrating the versatility of the formalism. Numerical quantities of interest are investigated, such as fluid/solid internal and external fluxes.
CosMIn: THE SOLUTION TO THE COSMOLOGICAL CONSTANT PROBLEM
Authors: PADMANABHAN HAMSA , PADMANABHAN T.
Published: July 2013

The current acceleration of the universe can be modeled in terms of a cosmological constant Λ. We show that the extremely small value of [Formula: see text], the holy grail of theoretical physics, can be understood in terms of a new, dimensionless, conserved number Cosmic Mode Index (CosMIn), which counts the number of modes crossing the Hubble radius during the three phases of evolution of the universe. Theoretical considerations suggest that N ≈ 4π. This single postulate leads us to the correct, observed numerical value of the cosmological constant! This approach also provides a unified picture of cosmic evolution relating the early inflationary phase to the late accelerating phase.
A survey of intelligent assistants for data analysis
Authors: Serban Floarea , Vanschoren Joaquin , Kietz Jörg-Uwe , Bernstein Abraham
Published: July 2013

Research and industry increasingly make use of large amounts of data to guide decision-making. To do this, however, data needs to be analyzed in typically nontrivial refinement processes, which require technical expertise about methods and algorithms, experience with how a precise analysis should proceed, and knowledge about an exploding number of analytic approaches. To alleviate these problems, a plethora of different systems have been proposed that “intelligently” help users to analyze their data.

This article provides a first survey to almost 30 years of research on intelligent discovery assistants (IDAs). It explicates the types of help IDAs can provide to users and the kinds of (background) knowledge they leverage to provide this help. Furthermore, it provides an overview of the systems developed over the past years, identifies their most important features, and sketches an ideal future IDA as well as the challenges on the road ahead.
On the practicality of cryptographic defences against pollution attacks in wireless network coding
Authors: Newell Andrew , Dong Jing , Nita-Rotaru Cristina
Published: July 2013

Numerous practical systems based on network coding have been proposed in recent years demonstrating the wide range of benefits of network coding, such as increased throughput, reliability, and energy efficiency. However, network coding systems are inherently vulnerable to a severe attack, known as
packet pollution
, which presents a key obstacle to the deployment of such systems. Several cryptographic schemes have been proposed to defend against pollution attacks.

We conduct a detailed analysis and an experimental evaluation in a realistic wireless network coding setting of a set of representative cryptographic defenses against pollution attacks. Our analysis identifies severe limitations of asymmetric-based schemes, which impose high communication overhead by placing constraints on the basic network coding parameters and high computation overhead by relying on numerous operations over large fields. Our analysis also shows that symmetric cryptographic schemes, while having better performance than asymmetric cryptographic-based schemes, impose prohibitive overhead in the presence of multiple byzantine adversaries. We further evaluate these schemes by using a set of typical network coding system parameters on a realistic topology. Our experimental evaluation shows that all the schemes we compare induce a throughput degradation that negates the performance benefits of network coding in the presence of multiple colluding adversaries.
Using likely invariants for automated software fault localization
Authors: Sahoo Swarup Kumar , Criswell John , Geigle Chase , Adve Vikram
Published: July 2013

We propose an automatic diagnosis technique for isolating the root cause(s) of software failures. We use likely program invariants, automatically generated using correct inputs that are close to the fault-triggering input, to select a set of candidate program locations which are possible root causes. We then trim the set of candidate root causes using software-implemented dynamic backwards slicing, plus two new filtering heuristics: dependence filtering, and filtering via multiple failing inputs that are also close to the failing input. Experimental results on reported software bugs of three large open-source servers show that we are able to narrow down the number of candidate bug locations to between 5 and 17 program expressions, even in programs that are hundreds of thousands of lines long.
OWL
Authors: Jog Adwait , Kayiran Onur , Chidambaram Nachiappan Nachiappan , Mishra Asit K. , Kandemir Mahmut T. , Mutlu Onur , Iyer Ravishankar , Das Chita R.
Published: July 2013

Emerging GPGPU architectures, along with programming models like CUDA and OpenCL, offer a cost-effective platform for many applications by providing high thread level parallelism at lower energy budgets. Unfortunately, for many general-purpose applications, available hardware resources of a GPGPU are not efficiently utilized, leading to lost opportunity in improving performance. A major cause of this is the inefficiency of current warp scheduling policies in tolerating long memory latencies.

In this paper, we identify that the scheduling decisions made by such policies are agnostic to thread-block, or cooperative thread array (CTA), behavior, and as a result inefficient. We present a coordinated CTA-aware scheduling policy that utilizes four schemes to minimize the impact of long memory latencies. The first two schemes, CTA-aware two-level warp scheduling and locality aware warp scheduling, enhance per-core performance by effectively reducing cache contention and improving latency hiding capability. The third scheme, bank-level parallelism aware warp scheduling, improves overall GPGPU performance by enhancing DRAM bank-level parallelism. The fourth scheme employs opportunistic memory-side prefetching to further enhance performance by taking advantage of open DRAM rows. Evaluations on a 28-core GPGPU platform with highly memory-intensive applications indicate that our proposed mechanism can provide 33% average performance improvement compared to the commonly-employed round-robin warp scheduling policy.
Research directions for 21st century computer systems
Authors: Hill Mark D.
Published: July 2013

Four recent efforts call out architectural challenges and opportunities up and down the software/hardware stack. This panel will discuss,
"What should the community do to facilitate, transcend, or refute these partially overlapping visions?"
The panel is chaired by Mark D. Hill with other panel members not finalized for the ASPLOS'13 proceedings.
GPUfs
Authors: Silberstein Mark , Ford Bryan , Keidar Idit , Witchel Emmett
Published: July 2013

PU hardware is becoming increasingly general purpose, quickly outgrowing the traditional but constrained GPU-as-coprocessor programming model. To make GPUs easier to program and easier to integrate with existing systems, we propose making the host's file system directly accessible from GPU code. GPUfs provides a POSIX-like API for GPU programs, exploits GPU parallelism for efficiency, and optimizes GPU file access by extending the buffer cache into GPU memory. Our experiments, based on a set of real benchmarks adopted to use our file system, demonstrate the feasibility and benefits of our approach. For example, we demonstrate a simple self-contained GPU program which searches for a set of strings in the entire tree of Linux kernel source files over seven times faster than an eight-core CPU run.
Buffer minimization in earliest-deadline first scheduling of dataflow graphs
Authors: Bouakaz Adnan , Talpin Jean-Pierre
Published: July 2013

Symbolic schedulability analysis of dataflow graphs is the process of synthesizing the timing parameters (i.e. periods, phases, and deadlines) of actors so that the task system is schedulable and achieves a high throughput when using a specific scheduling policy. Furthermore, the resulted schedule must ensure that communication buffers are underflow- and overflow-free. This paper describes a (partitioned) earliest-deadline first symbolic schedulability analysis of dataflow graphs that minimizes the buffering requirements.

Our scheduling analysis consists of three major steps. (1) The construction of an abstract affine schedule of the graph that excludes overflow and underflow exceptions and minimizes the buffering requirements assuming some precedences between jobs. (2) Symbolic deadlines adjustment that guarantees precedences without the need for lock-based synchronizations. (3) The concretization of the affine schedule using a symbolic, fast-converging, processor-demand analysis for both uniprocessor and multiprocessor systems. Experimental results show that our technique improves the buffering requirements in many cases.