Datasets:

hippocrates

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Multicare_common_train

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[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The patient was a twenty-one-year-old female primigravida with nine-month amenorrhea who was referred to the local hospital because of eclampsia. She had one episode of convulsion. When the patient came to the local hospital, she was brought with the baby's head outside the vagina and her shoulder stuck inside the vagina (shoulder dystocia). Episiotomy was given, and the baby was delivered. The placenta was delivered, and the uterus was well contracted. So she was referred to the urology center for further management. Examination \nGeneral condition was poor. Her vitals were: pulse 116/min and blood pressure 86/58 mmHg. Pallor was present. Episiotomy wound was visible. The urethra could not be delineated. On digital rectal examination, no evidence of rectal injury or blood on the gloved finger was found. Intraoperative findings \nThe bladder was open with around a 6cm to 8cm tear. Perioperative course\nThe duration of the surgery was 3:30 hours. The patient was kept on inotropic support and two packed cell volumes of blood were transfused. Postoperative course\nThe patient was vitally improved and inotropes were withheld on postoperative day (POD) 4. The abdominal drain was removed on POD 10.\nOUTPUT:" }, { "from": "agent", "value": "Vaginal Laceration, Urinary Bladder Injury, Pubic Diastasis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 40-year-old man who complained of 'fever, cough, and blood in sputum persisting for 3 days' was admitted to the Fifth People's Hospital of Shanghai, Fudan University, on 6 March 2013. He had a smoking history for 20 years (approximately 800 cigarettes/year) with an unremarkable medical history. On admission (6 March), physical examination showed a stable respiratory rate (20/min), normal blood pressure (130/80 mmHg), tachycardia (heart rate, 120 bpm), and fever (body temperature, 39 C). Moist rales were heard in the lower lobe of the left lung. Arterial blood gas analysis revealed hypoxaemia (arterial oxygen, 64 mmHg). Blood test showed normal white blood cell (WBC) count (4.99 x 109/L), while the percentage of neutrophils (78.4%) was higher than the normal range. Chest-CT showed multiple areas of segmental ground-glass opacity in the middle and lower lobe of the right lung with clear signs of air bronchogram; the left lung showed no pathological abnormality, and there were no signs of enlarged mediastinal lymph nodes (Fig. 1a). The patient was initially treated by moxifloxacin and oxygen treatment (nasal catheter oxygen inhalation with an oxygen flow rate of 4 L/min). On the day after admission (7 March), laboratory tests showed elevated enzyme levels: creatine kinase (CK), 984 U/L, creatine kinase isoenzymes (CK-MB), 20 U/L, lactate dehydrogenase (LDH), 498 U/L, alanine aminotransferase (ALT), 46 U/L, and aspartate aminotransferase (AST), 51 U/L. The patient's body temperature did not return to normal. We continued to obverse him while providing physical cooling. On day 2 after admission (8 March), the patient's clinical symptoms were not resolved, and his body temperature increased to 39.7 C. Hypoxaemia persisted after inhaling oxygen (arterial blood gas analysis: pH 7.5; arterial partial pressure of carbon dioxide, 30 mmHg; arterial partial pressure of oxygen, 64 mmHg) (Table 1). We replaced moxifloxacin with meropenem as antibacterial therapy.\nOUTPUT:" }, { "from": "agent", "value": "Avian Influenza A H7N9 viral infection" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: An 18-year-old male presented with a complaint of acute, right-sided, abdominal pain. He had a history of low-grade fever and vomiting. Physical examination did not reveal any significant abnormality except for diffuse abdominal tenderness. A complete blood count showed no abnormality; total leukocyte count and differential count was normal (eosinophils = 1%). US revealed dilated tubular cystic channels in the pelvis and complex, ill-defined cystic masses in the bilateral inguinal regions (Fig. 1). Mild enlargement of the liver and spleen was also noted. The patient was referred for a CT scan for further evaluation. CT of the abdomen revealed gross, diffuse, retroperitoneal edema with multiple small tubular hypodensities causing compression of the blood vessels and the bladder wall (Figs. 2A, B). In addition, multiple enlarged para-aortic and mesenteric lymph nodes were seen. We made a provisional diagnosis of thoracic duct obstruction with gross lymphedema and lymphangiectasia. US-guided diagnostic aspiration of fluid from the cystic lesions in the inguinal region was performed. During the workup, we obtained a history of mild scrotal swelling. High-resolution US of the scrotum revealed scrotal wall fluid with significantly mobile linear echogenic structures in it (filarial dance). US-guided aspiration of the scrotal wall fluid was also performed (Fig. 3). The study of fluid aspirated from the inguinal lesion and scrotal wall revealed motile larvae of Wucheria bancrofti, and this confirmed the diagnosis. The patient was given 100 mg of oral Hetrazan (Diethyl carbamazepine) three times a day. In addition, injectable analgesics, antibiotics, and steroids were prescribed. Antifilarial treatment was continued for three weeks, after which the patient showed good symptomatic response.\nOUTPUT:" }, { "from": "agent", "value": "Filariasis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 45-year-old male presented with left hip/groin pain, swelling, and a painful mass of the anterolateral left hip (i.e. tendency for the left hip to \"lock\")/thigh. On examination, prominence of the left TFL was noted along with weakness of left hip abduction and decreased sensation of the left leg/thigh. An MR arthrogram demonstrated a tear of the left anterosuperior acetabular labrum with an increased alpha angle supporting femoroacetabular impingement. Nine months later the patient underwent a left hip arthroscopy with labral repair/base fixation, femoroplasty, and capsular closure. Although the left hip/groin pain improved, he continued to complain of the painful hip mass and was referred to an orthopedic oncologist with the presumed diagnosis of a sarcoma. The pelvic MRI scans demonstrated asymmetry due to hypertrophy of the left TFL [Figure 1a and b]. There was no soft tissue fluid collection or mass. A substantially greater width of the TFL muscle was observed by high-resolution US on the left (33.4 mm) compared to the right (14.4 mm) side [Figure 2]. The needle EMG showed chronic denervation/reinnervation changes of the left TFL with large amplitude polyphasic units and complex repetitive discharges. Increased polyphasic units were also observed in the gluteus medius, vastus medialis, and tibialis anterior. The patient underwent an injection of 50 units of botulinum toxin (diluted to 5 units per 0.1 ml) under electromyographic guidance. He attained no improvement of his left leg spasms. Nevertheless, the patient will undergo an injection of 100 units of botulinum toxin within the next 3 months.\nOUTPUT:" }, { "from": "agent", "value": "Hypertrophy of the tensor fascia lata, Lumbar radiculopathy" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: In April 2013, a 79-year-old man was admitted to our general hospital for a 6-week history of progressive dysphagia to solids and liquids associated with weight loss of 3 kg. He denied any other symptoms. His past medical history included type II diabetes, hypertension, and COPD. He could walk and neurological examination showed no ocular symptoms or muscle weakness. There was a mild dehydration, but examination of the cardiovascular and abdominal systems was unremarkable. Investigations showed a mild increase of serum creatinine (1.3 mg/dL). Gastroscopy showed a mild hyperemic duodenitis: for this reason a therapy with Pantoprazole was started. During the stay in our ward he developed a progressive asthenia, leading to inability to walk and to lift the head to watch the examiner without using his hand. A blood sample was taken to test for acetylcholine-receptor antibodies. The same day, a total body CT scan with low-osmolality iodinate contrast agent (Iohexol, concentration 300 mgI/mL, volume 200 mL) was performed. Two hours later the patient developed an acute respiratory failure requiring orotracheal intubation and mechanical ventilation. In the Intensive Care Unit the weaning of mechanical ventilation was soon initiated and after two days the extubation was performed. After the extubation the patient showed complete dysphagia, dysarthria, hypophonia, and proximal muscle hyposthenia. While waiting for the serologic test, pyridostigmine was given: there was a marked improvement in the following 24 hours with a complete neurological recovery. Before the CT scan, the patient never experienced respiratory symptoms (dyspnea or orthopnea) and there were no signs of a reexacerbation of COPD (no productive cough; the chest examination was negative for rumors, the respiratory rate was always in the normal range, and the oxygen saturation ranged from 94 to 96 in RA). No new drug was added to the therapy with Pantoprazole (that had been administered daily for ten days before the acute respiratory event and it is still ongoing). Our diagnosis was a myasthenic crisis induced by the low-osmolality iodinate contrast agent.\nOUTPUT:" }, { "from": "agent", "value": "Myasthenia Gravis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 24-year-old man presented with multiple episodes of syncope. The left femoral vein was accessed with a 7-French triport sheath through which three quadripolar pacing electrode catheters were introduced in an attempt to reach the right atrium, right ventricular apex, and atrioventricular junction. However, access to the right ventricle was not possible. Iodinated contrast material was injected in order to obtain a venogram (Fig. 1). It was observed that the contrast material did not pass to the right atrium, which suggested an anomaly of the IVC. Magnetic resonance (MR) angiography of the thorax and abdomen was performed for further evaluation of congenital cardiac and vascular defects (Fig. 2). Venous return from the inferior body regions drained into the dilated azygos vein, while a segment connecting the IVC to the hepatic vein and right atrium was missing. No other cardiovascular abnormalities were found. 3). However, radiofrequency ablation was not successful. The patient was discharged home on metoprolol with no symptoms of palpitations. Aplasia of the IVC is a rare anomaly that is present in approximately 0.6% of the population. It usually presents through thrombosis of the lower extremities. We report a case of an adult patient with IVC interruption and azygos continuation, in whom any symptoms or signs of complications of this anomaly were absent. The anomaly initially prevented invasive electrophysiological evaluation from a femoral access.\nOUTPUT:" }, { "from": "agent", "value": "Aplasia of the Inferior Vena Cava, AV Block I, AV Block II" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Chest CT demonstrated significant RUL bullous disease. The patient underwent video-assisted thoracoscopic surgery, with resection of apical and posterior segments of the RUL. It was felt that the anterior segment was less diseased, and given the severity of baseline compromise and the need for tissue sparing, it was decided that the anterior segment was better not resected. A postoperative leak was present, and on postoperative day 5, IP was consulted; a completion lobectomy was not considered, again due to severity of underlying disease. Bronchoscopy with balloon occlusion was performed in the ICU. Sequential balloon occlusions from the proximal to the distal airways failed to impact the rate of air bubbling through the fluid chamber of the water seal chest drain. Whereas the BPF most likely emanated from the area of resection, the RUL, EBVs were empirically placed in two adjacent segments, the remaining anterior segment of the RUL and the superior segment of the right lower lobe (RLL), with a marked decrease in air leak. The next day, however, there was a marked increase in leak. Bronchoscopy with balloon occlusion was again performed, this time under general anesthesia in the OR. Only minimal reduction of the leak was seen, even with occlusion of the right main bronchus. The chest tube was clamped at its exit from the chest wall, with complete cessation of bubbles in the water chamber. This maneuver demonstrated that there was no defect in the chest tube apparatus external to the thorax. Given the lack of benefit from the previously placed EBVs, they were removed. A CT of the chest was ordered to look for an anatomic explanation for the EBV failure. This showed that the chest tube had migrated into an apical bleb present in the unresected anterior segment of the RUL. Based on these findings, the chest tube was clamped despite the air leak. The patient was subsequently discharged in stable condition.\nOUTPUT:" }, { "from": "agent", "value": "Bronchopleural fistula, Spontaneous pneumothorax, Pulmonary tuberculosis, Severe COPD" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The mother of Z.T. was 26 and the father was 28 years old. There was no consanguinity between them and they had no dysmorphic facial appearance or any systemic illnesses. The mother had not received regular medical follow- ups during her pregnancy. She had never used tobacco or alcohol. There was no history of drug use or exposure to X-ray after she became pregnant. She had no history of infection, abortus or stillbirth, either. Biochemical and microbiological examinations of Z.T. showed mild infection with a white blood cell count of 13500/mm3, C reactive protein level of 2 mg/dl and 64% neutrophil dominancy (63%) on the peripheral blood smear, iron deficiency anemia and hypocalcemia with a serum calcium level of 7.3 mg/dl. Her 25 OH-D level was low (10 ng/ml), parathyroid and thyroid hormone levels were normal (15.2 pg/ml and 2.1 IU/ml, respectively). After treatment with calcium and vitamin D, her serum calcium levels have sustained within normal ranges. Serologic test results for toxoplasma, rubella and cytomegalovirus (TORCH) were negative. Her cardiothoracic ratio increased and the cardiac apex was elevated on the chest X-ray. Abdominal ultrasonograms were normal except for a mild hepatomegaly. As there were two afebrile seizure attacks in her neonatal history, electroencephalography (EEG) was performed. EEG reports indicated that there were sharp wave activities on the frontocentral, centrooccipital and temporooccipital regions of the left serebral hemisphere in relation with the centrooccipital region of the right cerebral hemisphere. Ophthalmic and audiological examinations of Z.T. were unremarkable. Cranial and spinal magnetic resonance examinations (MRI) showed mild dilatation of the lateral ventricules and a lipoma on the philum terminale. The karyotype analysis of our case was reported as 46, XX. On her fluorescence in situ hybridization (FISH) analysis performed using DG (22q11) probe, deletion of band 11 on the long arm of chromosome 22 was detected.\nOUTPUT:" }, { "from": "agent", "value": "Fallot tetralogy, Velocardiofacial anomalies" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 46-year-old woman presented with a 3-month history of nonpruritic, nontender, hyperkeratotic papules and plaques that involved the upper and lower extremities. The patient was referred to the dermatology department from her oncologist to rule out disseminated zoster, as she had significant lymphopenia from long-term steroid use. On examination, discrete, erythematous, umbilicated papules and plaques with central, adherent, 1- to 2-cm hyperkeratotic cores were seen on the upper and lower extremities (Fig 1, A). Koebnerization was apparent on the forearms (Fig 1, B). Laboratory analysis found a normal creatinine level of 0.48 mg/dL, an elevated glucose level of 217 mg/dL, and a hemoglobin A1c of 11.5%. A punch biopsy of a lesion on the lower extremity was performed. Histologic analysis found a large epidermal ulcer with overlying prominent scale crust. Vertically oriented, brightly eosinophilic collagen fibers were seen in the dermis, epidermis, and scale crust (Fig 2), confirming the diagnosis of ARPC. Because of her concurrent cancer therapies, the patient declined any dermatologic intervention for her lesions. However, after 10 months of glycemic control and chemotherapy, her lesions were significantly improved, with resolution of the hyperkeratotic cores and residual postinflammatory hyperpigmented macules (Fig 3).\nOUTPUT:" }, { "from": "agent", "value": "Giant acquired reactive perforating collagenosis, Diabetes mellitus, Metastatic breast carcinoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: 'I cook ginger slices and brown sugar together whenever I experience the period pain. I have been using this method for quite a few years. I am sure it works very well.' (P9, Female, 48 years old)\nBoth Mellor and Tlou argued that the accessibility and affordability of alternative medicine, such as acupuncture, cupping and massage, are important reasons for patients' choices. We believe that the rural residents in Africa will benefit significantly from this kind of holistic approach in both treating and preventing diseases, especially at no or low extra cost. In a similar vein, Wassie et al. argued that the knowledge of TM can potentially assist in selecting plant materials and discovering their therapeutic effects. Wassie et al., in a study conducted in Ethiopia, further highlighted that 90.3% of the participants would like to acquire knowledge of herbal medicine. We believe that employing TCM theories to analyse African medicinal plants will broaden their actions and indications. After gaining basic knowledge of TCM, the rural residents in Africa will identify different functions of herbs to treat diseases or maintain health by themselves. With a deep understanding of the advantages of TCM, rural residents may be encouraged to accept multiple health behaviours, including diet changes, the use of herbal medicine, moxibustion, cupping and massage. According to the HBM, rural communities also like to enjoy good health. They are eager to try alternative medicine, even visiting herbalists. Self-efficacy, according to the HBM, which refers to the ability to conduct action, will also be encouraged. Furthermore, the number of qualified TCM service providers is essential for long-term implementation; as argued by Liu et al., most residents in rural areas prefer to have TCM treatment performed by qualified TCM practitioners.\nOUTPUT:" }, { "from": "agent", "value": "No specific diagnosis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: We describe a 23-year-old male patient who presented with right-sided painless neck swelling since one month. There was no history of trauma, fever, and systemic illness. The patient had no complains of weakness, dysphagia, and hoarseness of voice. On local examination, a single ovoid swelling was present in the right carotid triangle, anterior to the sternocleidomastoid, measuring 3 x 2 cms. Swelling did not move on deglutition or tongue protrusion. There was no loss of muscle power in all muscles, no signs of wasting, or neurological deficits. USG neck showed a hypoechoic lesion seen at bifurcation of the carotid artery. Moderate central and peripheral vascularity was seen within the lesion. Findings were suggestive of a carotid body tumor/nerve sheath tumor. CECT neck revealed a well-defined, well-encapsulated, peripherally enhancing soft tissue mass lesion of size 3.4 x 1.8 cm (Figure 6). The mass lesion was noted in the right carotid sheath between the right common carotid artery and internal jugular vein, posterolateral to the right lobe of thyroid. The lesion was seen below the carotid bifurcation. Features were suggestive of a vagal schwannoma. The tumor was approached by an anterior approach along the medial border of sternocleidomastoid. Platysma and fascia were dissected to reach the tumor. There was a medium-sized globular smooth mass, well-encapsulated seen engulfing the vagus nerve (Figures 7(a)-7(c)). Extracapsular tumor excision was done in toto by conventional technique. Vagus was severed in the process. Vagus was reanastomosed, using the sural nerve graft (Figure 7(d)). Postoperatively, the patient had mild dysphagia which resolved in two days. The patient reported a minimal change in voice. There were no signs of aspiration. Postoperative videolaryngoscopic assessment revealed right vocal cord palsy. The patient's voice improved with speech therapy.\nOUTPUT:" }, { "from": "agent", "value": "Head and Neck Schwannomas" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 76-year-old male was admitted to Department of Urology and Urological Oncology of Medical University of Lublin in September 2010. He presented to the Department of Urology two weeks earlier with gross hematuria and lower abdominal pain. He had a history of A tumor of the urinary bladder in August 2010, which was removed by transurethral electroresection. Microscopic examination diagnosed the tumor as moderately differentiated transitional cell carcinoma (no written data available). Cystoscopy done at the time of admission showed a diverticulum and a papillary tumor, both located within the posterior wall. The tumor was biopsied. CT scan was performed and did not show any other lesion within the patient's chest, abdomen, or pelvis. Blood and biochemical tests were unremarkable. As the patient did not agree for total cystectomy, we performed a partial resection of the bladder wall with removal of the tumor and diverticulum. The surgical specimen was fixed in 10% buffered formalin and sent to the Department of Clinical Pathomorphology for microscopic examination. Microscopy showed an ulcerated tumor composed of sheets and nests of mildly pleomorphic, small and mid-sized cells with scanty cytoplasm and dark hyperchromatic nuclei. Multifocal invasion of the bladder wall was observed with lymphovascular space involvement. Immunohistochemistry was performed and showed these neoplastic cells to be positive for cytokeratin, chromogranin, synaptophysin, and NSE and negative for vimentin. Scattered mitotic figures were observed and immunohistochemical staining for Ki 67, a marker of cell proliferation, was noticed to be positive in 33% of tumor cells. Microscopic appearance and immunoprofile were consistent with diagnosis of primary neuroendocrine SCC of the bladder. The patient was referred for further treatment in Department of Oncology. He did not agree to the suggested treatment in the form of adjuvant chemo- and radiotherapy. The cystoscopy carried out three months after surgery did not show any gross lesion within the bladder wall.\nOUTPUT:" }, { "from": "agent", "value": "Small cell carcinoma of the urinary bladder" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: In this part of the experiment, the iMDA-BN's the ability of predicting disease-associated miRNAs was validated by case studies of three common human diseases, assuming that prior knowledge are only associations in HMDD v3.0. Specifically, the training set is made up of all the associations in the final descriptor. At the same time, we used the associations that did not appear in HMDD for the three diseases as a test set. After iMDA-BN gave prediction scores to the test set, the top 50 miRNAs with the highest score for each disease were validated in the dbDEMC database and the miR2Disease database. Its incidence increases rapidly with age, but its incidence decreases near the age of menopause.\nOUTPUT:" }, { "from": "agent", "value": "Breast Cancer, Colon Cancer, Lymphoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 25-year-old nulliparous patient was referred to colposcopy clinic for a high-grade squamous intraepithelial lesion detected on routine cervical screening cytology in April 2009. A previous Pap smear in June 2007 had shown a low-grade lesion. The patient was suffering from RRMS since age 21 and had been commenced on natalizumab 300 mg infusions every 4 weeks in June 2008. At colposcopy examination the patient was asymptomatic and had a cervical biopsy taken which confirmed cervical intraepithelial lesion grade 3. She was booked for a large loop excision of transformation zone (LLETZ) procedure. At her LLETZ 3 months later she had an extensive warty cervical lesion which was removed with several passes. A focus of perineural invasion but no definite lymphovascular space invasion was seen. The patient underwent a radical abdominal hysterectomy, bilateral pelvic lymphadenectomy and ovarian transposition. The final specimen did not show any residual CIN or carcinoma and the lymph nodes were negative. The final diagnosis was a FIGO stage 1B1 cervical SCC and no adjuvant therapy was given. At the time of cancer diagnosis, the patient had just completed the 12th Natalizumab infusion. The treatment was stopped and 6 months later changed to monthly methylprednisone. Her RRMS has been stable since. Follow up consisted of 3-monthly colposcopy examinations and vault cytology which were normal for 21 months. At the 2-year checkup, the patient was diagnosed with a vaginal vault lesion which on biopsy showed recurrent cervical SCC. CT, MRI and PET imaging revealed a 5 cm mass at the vault without distant metastatic spread. The recurrent disease was treated with radical chemo-radiotherapy consisting of external beam pelvic radiotherapy followed by pelvic boost and concurrent weekly Cisplatin chemotherapy. Treatment was completed in November 2011. The patient has been in full clinical remission since the chemoradiation but remains HPV positive for non-16/18 high risk subtypes in August 2018.\nOUTPUT:" }, { "from": "agent", "value": "Low-Grade Cervical Dysplasia, Invasive Squamous Cell Carcinoma, Relapsing Remitting Multiple Sclerosis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 73-year-old man presented to our facility with complaints of left upper quadrant pain and twenty-pound weight loss. A computed tomographic (CT) scan of the chest, abdomen, and pelvis revealed a huge upper quadrant complex mass (Figure 1A), whereas a biopsy of the mass revealed high-grade malignant neoplasm. He underwent radical nephrectomy, splenectomy, and resection of the diaphragm. On immunohistochemistry, the tumor stained positive for CK 7, PAX-8, and CD-10, whereas AE1/AE3 was focally positive (Figure 1B-E). Three months postnephrectomy, he complained of pleuritic chest pain. A CT scan of the chest revealed abnormal tissue in the inferior posterior left pleural space, and left-sided abdominal and peritoneal lymph nodes. Biopsy revealed sarcomatoid RCC. He received radiation therapy to that region and subsequent chemotherapy with sunitinib and gemcitabine. A repeat CT of the chest, abdomen, and pelvis 6 months after therapy initiation revealed no evidence of disease. Unfortunately, 9 months after chemotherapy initiation, the patient noted a tender subcutaneous nodule in the left chest wall. CT scan of the chest revealed a new irregular area of pleural soft tissue at the posterior medial aspect of the left lower lobe of the lung (Figure 1G). A positron emission tomography (PET) scan revealed multiple suspicious retrocrural and left aortic lymph nodes with intense 18F-fluorodeoxyglucose (FDG) avidity, in addition to several FDG-avid soft tissue lesions in the left chest and abdominal wall. He underwent radiation to the left abdominal wall and due to his high PD-1 and PD-L1 status he was prescribed pembrolizumab, which he received for only 3 months because of grade 4 immune-mediated pneumonitis. Repeat PET scans showed interval resolution of the previous lesions in the peritoneal and retroperitoneal cavities and the posterior left costophrenic angle, indicating a favorable response to therapy. Recent PET scans after more than 4 years of immunotherapy revealed no evidence of recurrent disease.\nOUTPUT:" }, { "from": "agent", "value": "Sarcomatoid Renal Cell Carcinoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 61-year-old right-handed male was referred to our department presenting shoulder pain for 12 months, without any known trigger event. The patient described a dull intermittent right shoulder pain, reporting acute exacerbations and tenderness. His complaints persisted despite medical treatment, including physiotherapy and long-standing medication with oral NSAIDs. During physical examination, there were no visible asymmetries between the shoulders and the patient exhibited no inflammatory signs. The neurologic and vascular examination of the right upper limb was normal. The shoulder range of motion and strength was preserved and painless. There were no evident or palpable masses, but the patient presented trigger-point tenderness at the posterolateral surface of the right shoulder. Plain radiographs were normal (Figure 1). Ultrasonography of the right shoulder denoted a hypoechoic nodular formation in the point of tenderness, measuring 13 mm (Figure 2). Magnetic Resonance Imaging (MRI) confirmed the presence of a well-limited oval-shaped mass located in the posterior fibers of the right deltoid muscle, measuring 25 x 10 x 6 mm, which was hypointense in T1 and hyperintense in T2-weighted images and exhibited strong enhancement with contrast (Figures 3). It was decided to perform an excisional biopsy of the lesion. Under general anesthesia, the patient was placed in 30 degrees left-lateral position and a 5 cm incision was made directly over the point of tenderness which had been priory marked. Surgical exploration identified a well-limited nodular lesion between the posterior fibers of the deltoid muscle, which was completely excised (Figures 4(a) and 4(b)). The patient was discharged in the next day after surgery and presented pain-free by the time of stitch removal. Gross examination of the specimen revealed a brownish nodular mass with 10 x 10 x 6 mm in size, while microscopic examination showed a well-limited lesion formed by ovoid epithelial cells without signs of atypia. No mitoses were observed. The lesion displayed a rich vascular network. Marginal excision was confirmed. Immunohistochemical staining was positive for expression of actin (alpha-SMA). The patient did not undergo any other treatment besides surgical excision of the lesion. After 4 years of follow-up, the patient is asymptomatic and showing no clinical or imagiological evidence of local or systemic recurrence.\nOUTPUT:" }, { "from": "agent", "value": "Glomus Tumor" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 20-year-old female was referred to our hospital with complaints of icterus and breathlessness. She had similar complaints one year back and was treated for jaundice by a local physician. Prior to her referral, she had been transfused three units of AB positive blood over one week. On general physical examination, there was marked pallor, icterus, tachycardia and tachypnea. She had mild hepatosplenomegaly. Hematological investigations revealed severe anemia (Hb - 2.7 gm/dl). There was mild leucocytosis and blood film showed autoagglutination with the presence of nucleated red cells (19/100 WBCs). Plasma and urine hemoglobin were raised. Liver function tests were deranged with indirect hyperbilirubinemia. Blood urea was also elevated (55 mg/dl). X-ray of the chest showed cardiomegaly. Patient had adequate urine output. The patient's sample was received in the blood bank for crossmatching. Cell and serum grouping showed a discrepancy with strong positive auto-control. Patient was typed as A Rh-positive with autoantibodies. Direct antiglobulin test with poly-specific Coomb's reagent (IgG + C3d) (Tulip diagnostics) was positive. Patient also had a positive antibody screen with all three reagent cells in the anti-human globulin test (Ortho cell panel, Ortho Diagnostics). Since the patient had life-threatening anemia with urgent requirement for transfusion, detailed phenotyping was not done and crossmatching was performed with several random A Rh-positive packed red cells but no compatible unit was detected. She received three 'least incompatible' A Rh-positive non-leuco reduced packed red cell units over three days as a life-saving measure after informed consent. No adverse events were reported during or after transfusion. Besides, she was also started on steroid therapy, antibiotics and diuretics. However, she developed sudden cardiorespiratory arrest on fifth day and could not be revived.\nOUTPUT:" }, { "from": "agent", "value": "Immune hemolytic anemia" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 75-year-old man, with a history of hepatitis B virus-related cirrhosis, underwent radical resection of right liver cancer 5 years ago. Half a year ago, he presented to our hospital with abdominal pain. He underwent comprehensive treatment, including radiofrequency ablation (RFA), radiotherapy and lenvatinib. Now, he came to our hospital for further surgery treatment. Follow-up laboratory examinations showed that the serum alpha-fetoprotein (AFP) level increased progressively to 71.5 ug/L (reference range: 0-3 ug/L). 18F-FDG PET/CT and 18F-FAPI PET/CT were performed to further evaluate the nature of the lesion (Figure 1). Astonishingly, 18F-FAPI PET/CT showed increased diffuse uptake of metastases in the hepatic capsule, which were negative in 18F-FDG PET/CT (Figure 1B). Furthermore, we accidentally observed wedge-shaped high 18F-FAPI uptake disorders around the tumor necrosis lesion after RFA in the right liver (Figure 1B, blue allow), consistent with the shape shown on MRI enhanced phase (Figure 2). Then, the patient was operated after exclusion of contraindications. RFA lesions with peripheral liver tissue were also resected, and histopathology confirmed complete necrosis of the tumor and surrounding benign hepatocyte degeneration and stromal fibrosis after RFA (Figure 3).\nOUTPUT:" }, { "from": "agent", "value": "Recurrent Hepatocellular Carcinoma, Right Peritoneal Metastasis, HCC Metastasis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: She was referred to our institution for surgical replacement of her aortic and mitral valves. Our IRB waived the requirement for patient consent for this report. Mean transmitral pressure gradient measured with continuous wave Doppler was 19 mmHg with a heart rate of 55 beats per minute. A midesophageal long-axis view with color flow Doppler demonstrated severe turbulence in the left ventricular outflow tract (LVOT) during diastole suggesting severe aortic regurgitation (Fig. 1; Video 2). A midesophageal aortic valve short-axis view (partially cut through the LVOT) suggested aortic regurgitation (Video 3). Significant shadowing from the mechanical mitral valve created difficulty in determining whether the jet resulted from aortic regurgitation or mitral inflow. Thus, other echocardiographic measures to differentiate the etiology of the diastolic LVOT turbulence were performed. A deep transgastric long-axis view which allowed imaging of the LVOT without shadowing from the prosthetic mitral valve, demonstrated absence of turbulence proximal to the aortic valve, suggesting that LVOT turbulence did not originate from the aortic valve. Furthermore, spectral Doppler demonstrated higher velocity flow, of less than 2.0 m/sec, after mitral valve opening rather than aortic valve closing, consistent with mitral inflow (Fig. 2). Additional echocardiographic evidence inconsistent with severe aortic regurgitation was documented, including aortic valve leaflets without significant abnormalities, a normal-appearing aortic root, and absence of flow reversal in the descending aorta. These findings suggested that diastolic LVOT turbulence was related to an eccentric mitral inflow jet, rather than aortic regurgitation. The patient underwent mitral valve replacement with a 27 mm St. Jude bi-leaflet mechanical mitral valve (St. Jude Medical, St. Paul, MN). TEE performed after separation from cardiopulmonary bypass demonstrated a well-seated mitral valve and a competent aortic valve.\nOUTPUT:" }, { "from": "agent", "value": "Severe mitral stenosis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: She complained of associated fever and chills for two days, sore throat, and copious white sputum. She denied shortness of breath, wheezing, and pleuritic chest pain. She also denied having hemoptysis. Patient denied having had any recent exposure to sick individuals. She is a 40-pack-year smoker, drinks alcohol socially, and admits drug use. Upon admission temperature was 98.1 F, blood pressure 112/61, heart rate 92 beats per minute, respiratory rate 18 breaths per minute, and saturation 99% in room air. Physical examination was significant for left lower lobe rhonchi without wheezing or rales. Laboratory studies were significant for elevated leukocyte count of 13.0 x 103/muL with a negative procalcitonin level. All other laboratory values were within normal limits. Urine drug screen was positive for opiates. Chest X-ray revealed left-sided infiltrative pattern (Figures 1(a) and 1(b)). Patient is subsequently scheduled for bronchoscopy. Prior to bronchoscopy, the patient disclosed additional information about her social history. She stated that 5 months prior to the admission, she was abusing cocaine and during an altercation with law enforcement she attempted to ingest a vial of cocaine. She denied having shortness of breath, wheezing, and fever. Patient was sent home with oral antibiotics along with her home medications.\nOUTPUT:" }, { "from": "agent", "value": "Chronic Cough, Pneumonia, Foreign Body" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 43-year-old man with a history of acid burn OS, cataract extraction with intraocular lens implantation and PK presented with a BCVA of hand motion at 2 feet and underwent KLAL. He was immediately started on prednisolone acetate drops QID, moxifloxacin drops QID, a tapering dose of oral prednisone, tacrolimus 3 mg PO BID, and MMF 1000 mg PO BID. He had a repeat PK 3 months after surgery and the prednisone and tacrolimus were tapered and eventually discontinued at 6 months and 1 year, respectively. His interim course was complicated by a persistent epithelial defect and ocular hypertension requiring a bandage contact lens and topical antihypertensive medication. Approximately 59 months after KLAL, while on topical prednisolone acetate QID, MMF 250 mg PO BID, and topical moxifloxacin QID, he presented with pain and photophobia. He was started on difluprednate 0.05% Q1H and MMF was up-titrated to 750 mg and eventually 1000 mg BID after 2 weeks.\nOUTPUT:" }, { "from": "agent", "value": "Acute graft rejection, Partial ocular surface failure, Acute PK rejection" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 52-year old woman presented to the Oral Oncology Clinic at MD Anderson Cancer Center with a chief complaint of numbness in her right lower lip and chin that had begun approximately 5 days previously. She had a painless swelling in her left maxilla that she attributed to trauma from eating. Intra-oral examination revealed a large mass of the left maxilla that involved both the premolars and the first molar extending buccally and palatally (Fig. 1). Although she denied any dentition-related symptoms, on examination teeth #12 and #13 (universal numbering system) had class II mobility. A panoramic radiograph showed an ill-defined radiolucency that extended superiorly towards the maxillary sinus involving the roots of teeth #12 and #13 (Fig. 2). A periapical radiograph showed the radiolucency to be ill defined. There appeared to be no lamina dura around the first premolar and the lamina dura around the second premolar appeared mottled (Fig. 3). An FNA of the maxillary lesion was performed and revealed plasma cell infiltration. Magnetic resonance imaging (MRI) was performed and demonstrated several maxillary lesions including a 1.4-cm lesion on the right anterior region, a 2-cm lesion within the right posterior maxilla, and a 3-cm lesion on the left; also several lesions were noted on the mandible that were not clinically visible (Figs. 4a, 4b). External-beam radiation therapy was prescribed with lateral appositional field coverage. No chemotherapy was prescribed at that time. At the patient's request, due to mucositis and dysphagia, radiation therapy was discontinued after 20-Gray (Gy) of radiation in 8 fractions using 6-MV photons; however, this limited therapy resulted in resolution of her neuropathy and maxillary swelling. An MRI scan was repeated after radiation therapy and revealed resolution of the lesion within the left maxillary alveolus with stability of the remaining lesions (Figs. 5a, 5b). The patient was subsequently lost to follow-up.\nOUTPUT:" }, { "from": "agent", "value": "Multiple Myeloma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A seventy-year-old woman was admitted to the orthopaedic outpatient department complaining of pain and swelling at the first ray of the right hand that had been occurring over the preceding two years. Furthermore, she described feeling weak when trying to catch or hold objects, including serious difficulties in carrying out basic daily activities. There was no previous history of trauma. The patient had worked as a hairdresser and was right-handed, with a personal history of hypertension under treatment. In addition, the pain worsened with compression on the axis of the first metacarpal together with a simultaneous circumduction movement (Crank test) and a rotational movement (Grind test). This abnormality did not decrease with passive abduction of the trapeziometacarpal joint. As for mobility, major limitation was observed in the opposition of the thumb. The patient displayed no signs of carpal tunnel syndrome or other entities such as trigger fingers or De Quervain's tenosynovitis. The mean value of the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH score) corresponded to severe difficulty in performing daily activities or severe symptomatology (66). The value of the visual analog scale was 8 out of 10. Radiographic assessment demonstrated a marked impingement of the trapeziometacarpal joint with a total loss of contour of the articular surfaces and the presence of subchondral cysts with a subluxation of the joint surface greater than a third. Osteophyte size was greater than 2 mm. As a result of the dysplastic morphology of the trapezium, conventional arthroplasty with trapeziometacarpal prosthesis was ruled out. Surgery for advanced rhizarthrosis was scheduled, and a percutaneous arthrodesis was performed as described below.\nOUTPUT:" }, { "from": "agent", "value": "Thumb Carpometacarpal Joint Arthritis, Rhizarthrosis Grade IV" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 65-year-old man, who was hospitalized in September 2015, complained bilateral hip joints pain for more than one year. Falling-down deteriorated the symptom of left side for one week. His right malleolus medial skin was abraded and gradually formed a painful ulcer three years ago. Then he sought medical care including adequate debridement and vacuum sealing drainage treatment for several times in other hospital, but the ulcer failed to heal. Tissue from ulcer edges were taken for histopathological examination (Fig. The ulcer was healed eventually after using prednisone acetate for two months (Fig. 2). Physical examination: the left lower limb external rotation of 45 , 2 cm shorter than the contralateral side, left leg rolling test (+), vertical percussion pain (+), bilateral hip Patrick sign (+). 3). After adequate preoperative evaluation and preparation, left total hip arthroplasty was carried out under the combined spinal-epidural anesthesia. During operation, the deep fascia and adipose tissues were observed edematous while muscular tissues were pinky which indicated poor blood supply intraoperatively. Bleeding volume of whole surgery was about 100 ml. Drainage tube was kept conventionally. Infection prevention, venous thrombosis prevention, analgesia and other conventional medical treatments were given according to standard clinical pathway in perioperative period of arthroplasty. In addition, 50 mg hydrocortisone was given intravenously 1 h preoperation, 1 h and 1st day postoperation respectively. Oral prednisone (5 mg, TID) were given from the 2nd day till the day when stitches were taken out. Drainage tube was removed 2nd day postoperation, then the patient began to walk with walking aid under medical supervision. Yellow exudate oozed out for a week postoperation and dressing was done once or twice a day according to exudation. Exudation decreased after 1 week, while stitches were taken out two weeks postoperation. Reexamination of X-ray showed left total hip arthroplasty prosthesis were in good position (Fig. 4). Following-up for 1 year, the patient recovered well without any complication of surgical site. The range of motion of left hip joint is 0 -130 , which meet the daily needs (Fig. 5).\nOUTPUT:" }, { "from": "agent", "value": "Femoral Neck Fracture, Pyoderma Gangrenosum" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 39-year-old man presented with 3-month history of cough and 1-month history of fever, diarrhea and shortness of breath. Neither social nor medical history was remarkable except past sexual intercourses with multiple male partners. On clinical examination, he had no rales and abnormal findings in the abdomen. Chest X-ray on admission showed bilateral reticulonodular shadows and a cavity on the right upper lobe (Fig. 1). Upper gastrointestinal endoscopy reveled diffusely scattered whitish-yellowish nodules measuring 5-10 mm in size in the duodenum (Fig. 2), and MAC was also cultured from the biopsy specimens. After 6-month of anti-mycobacterial therapy (isoniazid, rifampicin, ethambutol and clarithromycin), the symptoms had been resolved, and the improvement of the lung and duodenum lesions was noted. The risk of MAC bacteremia is approximately 60% within in 1 year for patients with MAC colonization in the gastrointestinal (GI) tract as compared with those without GI involvement. Because GI MAC infection may be the first presentation of AIDS associated opportunistic infection, it is essential to be alert for endoscopic findings, even in the era of effective ART.\nOUTPUT:" }, { "from": "agent", "value": "Mycobacterium avium complex enteritis, HIV" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Our case is a 20-year-old male patient with C5-6-7 vertebrae fracture because of falling from height. Surgical operation has been applied to him; however, he did not benefit from the surgery. After the hospitalization of the patient, respiratory physiotherapy was utilized (respiratory exercises, postural drainage, etc.) regularly. This therapy has been applied for almost three months. In the third month of the follow-up, the patient remained stable for the duration of mechanical ventilation on CPAP mode, and we estimated that pulmonary rehabilitation with Threshold Inspiratory Muscle Trainer would be useful for pulmonary functions of him (Figure 1). However, we had a difficulty in operating the IMT device through the tracheostomy cannula. Upon this problem, we modified IMT device as seen in Figures 2 and 3. For three weeks, this modified device has been applied to the patient through 20-30 breaths per day (Figure 4). The relative pressure was 12 cm H2O (20% of MIP) in first week, 16 cm H2O (30% of MIP) in second week, and 20 cm H2O (50% of MIP) in third week. Sporadic IMT treatment has been applied, and, as a result, sufficient ventilation by mere room air has been achieved.\nOUTPUT:" }, { "from": "agent", "value": "Tetraplegia, Respiratuary failure, Diaphragmatic paralysis, Ventilator associated pneumonia" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: An Indian female, 56 year old, with Hodgkin's lymphoma in remission since 2001. Presenting at our thyroid clinic, she had noticed a left side neck swelling since one year and started feeling pressure symptoms since one month. Examination revealed a bilateral neck swelling that moved with swallowing. She had no history of irradiation therapy and no family history of thyroid cancer. Investigations showed normal TFTs. Follow up whole body fluorodeoxyglucose positron emission tomography integrated with computed tomography (FDG PET CT) showed no signs of lymphoma relapse or lymph node or distant organ metastasis, but showed incidental highly FDG positive bilateral thyroid nodules. US of the thyroid showed left thyroid nodule (4.5 cm) with a smaller nodule within it with heavy rim calcification and solid component with microcalcification at the bottom. US of the neck also showed 2 hypoechoic nodules in the right lobe, the largest was ill-defined with coarse calcification measuring (7 x 7 x 10 mm). No suspicious lymph nodes were seen. Ultrasound guided FNA showed atypical follicular lesion of undetermined significance (AUS). The patient underwent total thyroidectomy, and histopathology showed FTC, minimally invasive and multifocal classical variant PTC. The FTC in the left lobe was unifocal (4.5 x 3.5 x 2.5 cm), minimally invasive, < 0.1 mm from the posterior margin, no perineural invasion or angioinvasion, but present lymphatic invasion, and no extrathyroidal extension. Pathologic stage was pT3a pNx. The PTC was multifocal with nodular hyperplasia, present in both lobes (first focus in right lobe 1 x 0.8 x 0.7 cm, 0.1 mm from the anterior margin; second focus in right lobe 0.5 cm in maximum dimension; third focus in left lobe 0.6 cm in maximum dimension). No lymphatic, perineural or angioinvasion or extrathyroidal extension. Pathologic stage was mp T1a pNx. The patient was discussed in our thyroid MDT meeting and categorized as high risk stratification (ATA 2015) eligible for high dose radioactive iodine ablation. The patient travelled out of the country and was lost to follow up.\nOUTPUT:" }, { "from": "agent", "value": "Follicular Thyroid Carcinoma, Papillary Thyroid Carcinoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 2-month-old female Pug was presented with a history of the vestibular episodes especially during or after eating. The owners first noticed the episodes when the puppy started to eat dry food. General physical examination was unremarkable. Neurological examination showed very mild vestibular ataxia while the puppy was walking. After several seconds to a minute, the deficits mostly disappeared. Neuroanatomic localization was consistent with vestbulo-cerebellum. Differential diagnoses included congenital and degenerative causes, nevertheless, inflammatory and infectious conditions were considered as well. The complete blood count (IDEXX Lasercyte) and serum biochemistry results (IDEXX Catalyst, Clip 10) were normal for a puppy. Brain MRI was performed on the initial presentation day, and multiplanar T2W, T2W-FLAIR, T1W, and T1W post intravenous administration of a gadolinium based contrast agent (Omniscan, GE Healthcare AS, NO, 0.1 mmol/kg) images were acquired. The patient also had a midline fusion defect of the dorsal arch of C1, however, did not demonstrate any associated cervical instability. The cerebrospinal fluid (CSF) analysis [cisternal tap, TNCC and cytology (Statspin Cytofuge 12)] was within normal limits. Both infectious disease PCR assays (Ehrlichia canis, canine herpes virus, canine parvovirus, canine distemper virus, Neospora caninum, Toxoplasma gondii, and Anaplasma phagocytophilum) and tick encephalitis antibody testing from CSF were negative. The owners report a stable status after 4 months, and the puppy has learnt to compensate for the deficits. The episodes continue to occur; mostly after playing with sticks and toys and now are rarely noted during eating.\nOUTPUT:" }, { "from": "agent", "value": "Transient Postural Vestibulo-Cerebellar Syndrome, Cerebellar Hypoplasia" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 62-year-old woman was admitted to our hospital with the complaints of stomachache, distention, and constipation for the last 5 years. During physical examination her vital signs were normal, but a bulk at the abdominal midline and under the umbilicus was found and there was tenderness at the epigastrium of the abdomen. She had a medical history of myomectomy and a Pfannenstiel incision scar was observed. She had been operated on 20 years ago and there were no postoperative complications. As a comorbidity, she had hypertension. A well-circumscribed solid bulky lesion, 12x11.5x9 cm in size, was located via computed tomography (CT) scan at the abdominal midline, near the abdominal wall (Figure 1). Using contrast-unenhanced abdominal CT, a heterogeneous bulky lesion that consisted of hypodense cystic and hyperdense solid components was detected. After the introduction of the contrast agent, no significant contrast agent uptake by the bulk lesion was detected. It was suspected that the patient had a malign mesenchymal tumor. A heterogeneous non-specific solid bulky lesion with hypointense and hyperintense components, as well as cystic degenerative components at its center, was detected via magnetic resonance imaging (MRI) (Figure 2). After the introduction of contrast agent, some of the peripheral contrast uptake was seen in arterial-phase images. In the late-phase venous images, a bulky lesion was observed homogenously with enhancing contrast agent. Laparotomy was performed and there was a high level of intra-abdominal adhesion. Adhesions were separated via obtuse and sharp dissections. The bulk, which was approximately 10 cm in size, was located at the abdominal midline and was highly adhered to the segments of the small intestine (Figure 3). The bulk was resected with 40 cm of the small intestine (Figure 4) and sent to the Pathology Department for diagnosis (Figure 5). It was reported to be a textiloma at pathological examination.\nOUTPUT:" }, { "from": "agent", "value": "Gossypiboma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 61 year old male patient complaining of sudden onset chest pain of one hour was admitted to our emergency department. Primary percutaneous coronary intervention was performed and left anterior descending artery was stented with 3.0x 22mm sirolimus eluting stent. Prior to discharge transthoracic echocardiography showed hypokinesia in anterior wall with an ejection fraction of 40%. His ECG was sinus rhythm. The patient was discharged uneventfully with medical therapy including clopidogrel 75 mg, acetyl salicylic acid 300mg, metoprolol 50 mg, ramipril 5mg, sprinolactone 25mg and atorvastatin 80mg. He was admitted to our clinic 10 days due to discharge with dyspnea and palpitation. He had bibasilar crepitant ralles and tachycardia onphysical examination. ECG showed supraventricular tachycardia at a rate of 160 beats/min. Despite intravenous diuretics, amiodarone and oral beta blocker therapy, the patient condition deteriorated therefore electrical cardioversion was performed with biphasic shocks at 50 Jules, 75 Jules, 100 Jules and 150 Jules but sinus rhythm did not restore. As the normal sinus rhythm and hemodynamic could not be restored therefore electrophysiological study was performed to the patient. Diagnostic catheters were placed to coronary sinus and right ventricle. Long sheath was used for further stabilization of radiofrequency ablation catheter. Typical clockwise AFL line was revealed and cavo-tricuspid isthmus radiofrequency ablation was performed and sinus rhythm was successfully restored (Figs. 1 and 2). After successful RF ablation hemodynamic stability the patient was discharged uneventfully. Patient was found to be asymptomatic and at sinus rhythm during follow up visits of 1, 3, 6 months.\nOUTPUT:" }, { "from": "agent", "value": "Atrial flutter, Acute anterior myocardial infarction" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: At the age of 22, he was admitted to a psychiatric ward with a one-year history of persecutory delusional ideas, running commentary hallucinations, and behavioral changes with marked agitation. At the psychiatry ward, risperidone was tried for up to 8 mg/day, but clinical remission was not seen, so a switch to olanzapine was made. He was discharged with olanzapine 30 mg daily and flurazepam 30 mg but maintained hallucinations, abulia, hypersomnia and psychomotor retardation with significant compromise in functionality. He did not adhere to the proposed socio-occupational projects, preserving hallucinatory activity and negative symptoms. In ambulatory, a switch was made from olanzapine to clozapine, which was titrated up to 500 mg per day over a year. He maintained hallucinations in the form of derogatory comments, as well as negative symptoms (alogia, anhedonia, and asociality) and depressed mood. Concomitantly, he started amisulpride 50 mg/day. Due to lack of clinical improvement, clozapine continued to be titrated up to 800 mg/day, with blood counts showing no alterations, and amisulpride was discontinued. Clozapine dosing was requested, but the patient did not accept doing it. However, family members confirm therapeutic compliance, since they supervise the medication. Because he maintained hallucinatory activity and negative symptoms, with high impact on functionality, cariprazine 1.5 mg/day was added for 3 days and then increased up to 3 mg/day without adverse effects. After 30 days of cariprazine in combination with clozapine, we observed an improvement in his psychomotor drive and mood. After three months, he was more communicative and sociable (referring he had meeting friends from the past and joined them in recreational activities) and hallucinations were gone. His family members also noted a major improvement in the negative symptoms, and alertness. He was more helpful at chores in his house. After six months, the clinical improvement is still observed (subjectively and objectively) and the patient will start an occupation project in a rehabilitation structure.\nOUTPUT:" }, { "from": "agent", "value": "Schizophrenia" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A seven year old male patient was referred to the Pedodontic clinic for oral examination by the Paediatric Dermatologist. Parents reported that the child had been diagnosed with EB since birth when he developed a blister on the tongue during nursing. No significant family history or consanguinity was reported. The child's milestones were normal. Parents reported that due the blisters in the mouth they avoided brushing his teeth and had started brushing his teeth at six and half years of age. When presented to our department, the child had been brushing only in the morning with a soft brush and herbal toothpaste. Diet of the child was mainly vegetarian, non spicy and broken into smaller bite sizes for ease of eating. General clinical examination revealed a small and thinly built child with normal speech. Both hands had pseudosyndactyly, that is, mitten deformity of the hands and the finger nails were missing [Figure 1]. While the skin was dry and wrinkled on arms, neck, ear, the face had scabs and the scalp showed alopecia [Figure 2]. Microstomia was observed [Figure 3]. Buccal mucosa and palate appeared greyish white and ankyloglossia with erythematous patches was present [Figure 3]. Lingual sulcus was reduced in depth, while labial sulci and buccal vestibule were absent [Figure 4]. Both upper and lower labial frenum were absent. All deciduous teeth were present and all first permanent molars had erupted. The dentition was non-spaced with retroclined lower anteriors, and anterior deep bite. Dental caries was present in relation to 51, 52, 61 and 54. Skin biopsy was done and sent for histopathological and immunopathological examination. Histopathology confirmed the diagnosis of EB while immunopathology report confirmed the diagnosis of DEB stating that collagen band VII was absent at basement membrane zone (BMZ) ; and, laminin band V was present and keratin 14 showed a normal pattern. Barium meal radiograph revealed the presence of an esophageal stricture. During the first visit, oral prophylaxis was completed followed by fluoride varnish application. Parents were counselled on maintenance of the oral hygiene and avoiding cariogenic food. Carious teeth were restored in the subsequent visit. Patient was advised using a 0.05% sodium fluoride mouthwash and was placed on a recall every six months.\nOUTPUT:" }, { "from": "agent", "value": "Dystrophic epidermolysis bullosa" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: An 82-year-old man with a history of chronic diarrhoea was admitted with severe Gram-negative sepsis, mild jaundice (bilirubin 60 mumol/L), and coagulopathy (INR 1.9). The abscess was drained percutaneously and aspirates cultured Escherichia coli. Magnetic resonance cholangiopancreatography (MRCP) showed a common bile duct stone. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated an 8 mm common bile duct stone with preferential filling of contrast of the left intrahepatic ducts and aerobilia (prior to sphincterotomy) on the right (Figure 2). Initially, the collapsed gall bladder filled with contrast (Figure 3), but in later images contrast collected in another viscus, interpreted to be colon (Figure 4). A sphincterotomy was performed, the stone was removed with a balloon trawl, and a double pigtail stent was inserted. Following identification of the CCF, the patient underwent a colonoscopy. This showed bile staining of the transverse and ascending segments. At the hepatic flexure there was significant diverticulosis, but no fistulous opening was seen, and tumour was excluded. At surgery, the fistula was excisable and the opening to the colon was sealed with an omental plug. This, along with cholecystectomy, was performed as a one-stage procedure. Histology of the specimen confirmed the presence of an acutely inflamed fistula within the gall bladder with mucosal transition to large bowel mucosa. There was no dysplasia or malignancy detected. No gall bladder stones were found. The patient's recovery was complicated by a hospital acquired pneumonia from which he died 6 weeks later.\nOUTPUT:" }, { "from": "agent", "value": "Cholecystocolonic Fistulas, Liver Abscesses" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: An 83-year-old man, who had previously undergone partial gastrectomy with Billroth-I reconstruction due to gastric cancer, was admitted to our department, presenting with jaundice, fever, and nausea. Laboratory data showed an elevation of hepatobiliary enzyme and C-reactive protein. He was able to take only liquid food orally due to duodenal stenosis. It was necessary to perform biliary drainage first due to acute cholangitis. Endoscopic transpapillary biliary drainage was unsuccessful due to stenosis at the second portion of the duodenum and tumor invasion to the papilla of Vater. Using a convex linear array echoendoscope (GF-UCT240: Olympus Medical Systems, Co., Ltd., Tokyo, Japan), puncture of the extrahepatic bile duct via the duodenal bulb was performed with a 19G needle after obtaining the informed consent from the patient (Figure 1(a)). Following dilation of the puncture tract with a balloon catheter, 4 mm in diameter, a fully-covered metal stent (covered ZEOSTENT: Zeon Medical Inc., Tokyo, Japan), 6 cm in length and 1 cm in diameter, was placed across the puncture tract to bridge the duodenum and the bile duct (Figures 1(b) and 1(c)). After improvement of jaundice, using a duodenal scope (TJF 260V: Olympus Medical Systems), a duodenal metal stent (WallFlex duodenal stent: Microvasive, Boston Scientific Corp., Natick, MA), 6 cm in length and 22 mm in diameter, was placed across the stricture of the duodenum (Figure 2). No procedure-related complications occurred. He was able to take food orally and was discharged. Neither migration nor obstruction of the two stents was observed during the three months follow-up period.\nOUTPUT:" }, { "from": "agent", "value": "Pancreatic head cancer" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The rash affected the hands, feet, back, and chest. It developed into blisters that later ruptured. The rash was especially painful in the hands and feet. He also reported red eyes and difficulty eating for the past week. Vital signs upon presentation were as follows: temperature 36.4 C, pulse 83/min, respiratory rate 12/min, and blood pressure 121/60 mmHg. Physical examination of the patient revealed a severe rash covering less than thirty percent of the body, oral ulcers, and conjunctival redness (Figure 1). Laboratory data at the time of admission is notable for leukocytosis, electrolyte imbalances, and hepatic dysfunction (Table 1). The patient's current cancer treatment regimen included active hormonal therapy with leuprolide and active chemotherapy with docetaxel. He had received two cycles of docetaxel therapy (generic form: 75 mg/m2), with the last dose of docetaxel received two weeks prior to presentation. He was not on other medications at the time of admission. Treatment of the patient included intravenous fluid replacement, prednisone, piperacillin/tazobactam, ondansetron, and morphine. Wound and eye care were provided. Dermatology was consulted. Because our searches for an established association between SJS and docetaxel were in vain, we elected to obtain a punch biopsy of the lesions to establish pathological evidence of our diagnosis. The punch biopsies were obtained from the edges of lesions on the left forearm and left medial foot. Light microscopy of the hematoxylin and eosin-stained specimens were confirmatory for SJS (Figure 2). The patient clinically improved with supportive therapy and was discharged home. He was scheduled a follow-up with his oncologist to discuss other treatment options.\nOUTPUT:" }, { "from": "agent", "value": "Stevens-Johnson Syndrome, Metastatic Prostate Adenocarcinoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 44-year-old male with a history of hypertension, chronic kidney disease and reflux disease, presented with upper gastrointestinal bleeding and hemodynamic instability. A month prior to admission he underwent GDS and colonoscopy because of melena. No bleeding source was found, but GDS did reveal a submucosal mass in the lesser curvature of the stomach with central erosion suggestive for ectopic pancreas therefore no biopsies or endoscopic ultrasound (EUS) were performed. Figure 1 shows the submucosal mass in the lesser curvature of the stomach with central erosion (black arrow). At the time of admission the patient complained about melena and syncope. Physical examination revealed hypotension and tachycardia, but was otherwise unremarkable. Laboratory tests revealed low hemoglobin 5.1 mg/dL. Subsequent GDS revealed a submucosal protruding mass in the lesser curvature of the stomach with an eroded surface and bleeding stigmata, which is shown in Figure 2 (black arrow). This was treated with epinephrine injection and hemoclips. Computed tomography (CT) showed a mass in the stomach with a diameter of 3 x 7 cm without lymphadenopathy or signs of distant metastases. The patient was admitted to the ICU and continuous intravenous proton pump inhibitor was started. However, fluid resuscitation and blood transfusion remained necessary. Therefore, two days after admission, the patient underwent a partial gastrectomy. Figure 3 shows the wedge resection of the gastric mass with central hemorrhage (black arrow). The submucosal mass with central erosion seen with endoscopy and CT scan was characteristic for a GIST. Histopathologic examination confirmed the diagnosis, describing an epithelioid type GIST with focal necrosis and hemorrhage with clear resection margins. Immunohistochemical examination demonstrated partial positive CD117 and CD34. Figure 4 shows the brown coloration of the CD117 positive tumor cells. Twelve days after admission the patient was discharged. GDS, two months after partial gastrectomy, showed no signs of recurrent disease. Seven months later the patient remains recurrence free.\nOUTPUT:" }, { "from": "agent", "value": "Gastrointestinal Stromal Tumor (GIST)" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Mrs DM, a 75-year-old female patient, consulted her general practitioner because of malaise and dyspnea. She was known to have a history of myocardial infarction, hypertension and hypercholesterolemia. She had undergone a total left hip replacement. At that moment, she was on treatment with spironolactone, citalopram bromhydrate, dipyridamole, omeprazole, prazepam and fenofibrate. He decided to check D-dimer levels, which were found to be at 3.323 ng/ml (normal value <500 ng/ml). The patient was hospitalised 3 days later. On admission in the emergency ward, the patient complained of dyspnea, epigastric pain, nausea and vomiting. On physical examination she was found to have pain on palpation of the left side of the thorax. She had no temperature and her blood pressure was 110/80 mm Hg. A gastroscopy showed no abnormalities. D-dimer were checked again and now found to be at 4.274 ng/ml. Subsequently, an arterial bloodsample showed hypoxaemia (PO2=51 mm Hg) and hypocapnia (PCO2=25 mm Hg). The treatment started included administration of oxygen (from day 0 to day 7) and enoxaparin followed by acenocoumarol. The patient was admitted to the internal medicine ward. The rib cage X-ray suggested a fracture of the 10th rib. A pelvic ultrasound scan was done on the 9th day of hospitalisation, but was negative. Duplex ultrasound scan on the 10th day of the leg veins did not show any sign of deep venous thrombosis. The patient recovered well and was discharged on the 11th day. Acenocoumarol and the pre-hospitalisation treatment were continued at home.\nOUTPUT:" }, { "from": "agent", "value": "Pulmonary embolism" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 57-year-old Caucasian woman presented to our clinic with a palpable abdominal mass and symptoms of obstructive uropathy. Her past medical history included a total abdominal hysterectomy 15 years ago due to uterine fibromas and abnormal menstrual bleeding. Histopathology also reported a simple endometrial hyperplasia without atypia. Four years later she underwent another surgery due to an abdominal mass located in the pouch of Douglas that was strictly attached to the sigmoid colon. The mass was removed and a radical omentectomy and bilateral salpingo-oophorectomy was conducted. Histopathology report stated that the mass was a fibroma with no malignant characteristics. Physical examination during her last visit showed a large abdominal mass. CT scans revealed two more of reducable size, located at the parametria, that were adjacent to both ureters. The masses were surgically removed and small parts of both ureters had to be excised while ureteral catheters (pig-tails) were placed in order to resume the synechiae of the urinary tract. Macroscopic analysis showed a pelvic mass sized 13 x 13 x 7 cm and two smaller ones at the right and the left parametrium, sized 4 cm and 8 cm, respectively. 1).\nOUTPUT:" }, { "from": "agent", "value": "Perivascular Epithelioid Cell tumor" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Table 2 presents four case studies from SF and Sonoma country WIC sites. The length of the health coaching callbacks ranged from short follow-ups of 3 minutes to up to 45 minutes in some cases, with an average of 9 minutes per call. In Table 2, we describe synopses of coaching calls with relevant actionable items, such as follow-up topics, and community or clinic implications. These stories illustrate accounts of coaching to women who are representative of the enrolled participants in the STAR MAMA program. It is evident that the health coach serves as a connection between the woman postpartum and critical resources, including information, basic knowledge and tips about postpartum care, and links to their preferred primary care system. Moreover, the health coach is a key point of support not only for the health-IT call-based topics, but also for miscellaneous questions the new mother has doubts about. Figure 3 demonstrates how the HIT component integrates with health coaching and how the coaches use the participant-driven triggers to direct coaching calls and discuss specific and relevant topics during a session. These vignettes illustrate the depth and breadth of issues covered by health coaches during their interactions with participants.\nOUTPUT:" }, { "from": "agent", "value": "Diabetes Risk, Depression" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: His physical examination noted crackling sounds up to half the two lungs, the rest of the physical examination showed no specific abnormalities. Rest ECG recorded a sinus rhythm at 50, with negative T waves of epicardial ischaemia in the anterior leads (Figure 1). Ultrasensitive troponin was high at 5953ng/l (normal range = 2-34ng/l). Transthoracic echocardiography showed a normal sized left ventricle hypokinetic the anterolateral, anterior and anteroseptal walls. The Left ventricle ejection fraction was estimated at 43% by the Simpson Biplan method. There was no mitro-aortic valve or pericardial involvement. Right femoral coronary angiography was performed. Catheterization of the left network could not be achieved despite the use of several types of diagnostic catheters. An angioplasty (Figure 4) with placement of a 2.75x 18mm active stent was performed successfully (Figure 5). The patient did not benefit from intravascular ultrasonography (IVUS) or coronary scan for an accurate lesion assessment of this anomalous coronary connection as our center does not have these complementary examinations.\nOUTPUT:" }, { "from": "agent", "value": "Acute coronary syndrome with non ST segment elevation myocardial infarction, Anomalous connection of the left anterior descending artery" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 46-year-old man was transferred to our hospital due to an unexpandable lung after a closed thoracostomy for his spontaneous pneumothorax (Fig. 1A and B). It had occurred 4 days before the visit of the other hospital. He had a history of recurrent pneumonia. He had a gout without receiving corticosteroid therapy and was a 30 pack-year current smoker. His chest computed tomography (CT) scans showed a cavitary consolidation in the left upper lobe and micronodules in the right upper lobe (Fig. 1C). His left lung showed structural changes including emphysema and hypoplasia (Fig. 1C). 1D). We inserted an additional chest tube. We did acid fast bacilli stains (AFB), mycobacterial cultures, and M. tuberculosis PCR test in his sputa and pleural fluid. We also did a bronchoscopy test for further evaluation of TB due to negative results of AFB stain and Mycobacterium tuberculosis PCR test in his sputa and pleural fluid. His bronchoscopic specimens also showed negative results of AFB stain and M. tuberculosis PCR test. We removed his chest tubes after confirmation of fully expended his left lung on a chest radiography. He discharged from our hospital. One month after his discharge, he revisited to our emergency department due to dyspnea. We found out a recurrent pneumothorax in his left lung and inserted a chest tube. NTM was isolated from all mycobacterial cultures in his sputa, bronchoscopic specimen, and pleural fluid, and M. intracellulare was identified from all positive NTM cultures. His lung was expanded well after a closed thoracostomy and discharged after chest tube removal. We achieved a culture conversion after 4 months of treatment initiation. We stopped the intravenous amikacin after 6 months due to a development of hearing loss. We maintained the regimen for 16 months, and culture conversion maintained at the end of treatment. There was no recurrence at 6 months after treatment completion.\nOUTPUT:" }, { "from": "agent", "value": "Nontuberculous mycobacterial pulmonary disease, Unilateral pulmonary artery agenesis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The headache was worse in the morning and at the end of the day. There was neither seizure nor focal neurologic deficits. She did not report any vomiting or fever. There was no history of trauma, hypertension, liver disease, or alcohol consumption. Her combined antiretroviral treatment regimen consisted of zidovudine, lamivudine, and nevirapine and she was compliant to treatment. She consulted the HIV treatment center for the headache where she was treated empirically for cerebral toxoplasmosis with cotrimoxazole for six weeks without any improvement of the headaches. One week prior to admission, she presented with limping and weakness of the left side of the body. There were no seizures. Clinical examination revealed a fully conscious patient with a left proportional hemiparesis. There was no sensory deficit. There was no appreciable cerebral atrophy. The viral load was not determined. The hematoma was evacuated via a burr hole. The operation and recovery were uneventful. The patient did not receive any blood products perioperatively. The patient did not experience any bleeding problem during and after the surgery. The patient was discharged on day 7 after surgery.\nOUTPUT:" }, { "from": "agent", "value": "Chronic Subdural Hematoma, Thrombocytopenia, Human Immunodeficiency Virus Infection" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The metastatic workup included ultrasound of the liver. Repeat ultrasound did not reveal any changes from August 1998. Liver function tests were all within normal limits. The patient was scheduled for an elective laparoscopic cholecystectomy. The procedure commenced with a standard 4-port technique. A proximal clip was applied; a transverse partial cut was made distally, through which an intraoperative cholangiography was performed. No filling of the proximal biliary system could be demonstrated, and free flow in the duodenum was achieved. At this stage, the surgeon converted to open cholecystectomy. Careful dissection was carried on revealing a very short (2 mm) cystic duct connecting to what had previously been thought to be a cystic duct. A subtotal cholecystectomy was performed lateral to the confluence with the right hepatic duct. The clip was removed from the left hepatic duct, and a T-tube was placed via the previously made opening into the duct system. A T-tube intraoperative cholangiogram was performed (Figures 1 and 2) and documented the above-described anomaly. The postoperative course was smooth. A T-tube cholangiography was repeated on the 13th postoperative day and showed free flow into the duodenum. The tube was clamped on the 14th postoperative day and removed after 24 hours. The patient was seen in the outpatient clinic after 1 month. She was in good health, and her liver function tests were within normal limits.\nOUTPUT:" }, { "from": "agent", "value": "Breast carcinoma, Gallbladder stones, Bile duct anomaly" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Following coronary artery bypass grafting, a 73-year-old man presented with symptoms of palpitation, headache, sweating, and blurred vision. His initial systolic blood pressure was over 240 mmHg. The patient's medical history included type 2 diabetes, dyslipidemia, coronary heart disease, prostate cancer and long-standing hypertension that used to be well-controlled with 2 medications; Metoprolol 25 mg twice daily and Valsartan 80 mg daily. However, his hypertension had been harder to control for the past 2 years. His family history was unremarkable except for cases of sudden death for his maternal uncle and aunts. No familial syndromes were noted. Patient was worked up for severe postoperative hypertension with a computed tomography (CT) scan which revealed a small right adrenal mass measured at 31 mm (Figure 1). Biochemical testing included measurements of urinary fractionated metanephrines which revealed high normetanephrines with a value of 880 nmol/d (N < 240). However, metanephrines (148 nmol/d: N < 275), dopamine (936 nmol/d: N <2570), epinephrines (undetectable: N < 110), and norepinephrines (456 nmol/d: N < 440) were within the normal limits. Plasma free normetanephrines were 2.10 nmol/L (N <1.20) and free metanephrines 0.4 nmol/L (N < 0.48). The patient had normal calcitonin levels. A meta-iodobenzylguanidine (MIBG) scan showed intense and moderate uptake of a 2 x 2 x 3 cm mass of the right adrenal mass with no distant metastases. The patient underwent adrenalectomy and the diagnosis of PHEO was confirmed by histology post-operatively (Figure 2). PHEO of the Adrenal gland Scaled Score (PASS) was 4, and the ki67 proliferation index was less than one percent.\nOUTPUT:" }, { "from": "agent", "value": "Isolated Pheochromocytoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The patient is a 37-year-old woman with a positive genetic test for BRCA1 and a nodular neoformation in the superior-outer/superior-inner quadrant of the right breast (x-ray mammograph: R5, breast ultrasound U5, AGB B5) Figure 1. She underwent bilateral NASMs with a right sentinel lymph node biopsy on 20 June 2007. The sentinel lymph node biopsy was negative pT1c, psN0(i-). The biological characterization of the neoplasm was the following: ER neg-PGr neg-ki67 40%, c-erb-B2 neg, score 0. Immediately following the mastectomies, a bilateral 450 cc tissue expanders were positioned in a submuscular pocket Figure 2\nThe post-operative course was free of complication. In August 2007, the patient underwent prophylactic bilateral oophorectomies. On 28 January 2008, the patient underwent the second stage of the breast reconstruction. A partial bilateral capsulotomy was followed by a careful injection of cell-enhanced autologous fat into the subcutaneous areas. A total of 85 cc of cell-enhanced fat graft was injected on the left breast and 90 cc on the right. The tissue was obtained through a syringe-based liposuction of 355 cc of adipose tissue from abdomen and external thighs, which was performed at the beginning of the case. The tissue was then processed using an automated device (Celution 800/CRS-Cytori) to produce a cell-enhanced fat graft. The surgical procedure was completed with placement of 370-cc bilateral silicone gel implants Figure 3\nThe patient was discharged on post-operative day 1 and had no complications in the post-operative course. The aesthetic result was evaluated during a ten month follow-up after the second procedure. The patient evaluated the result as excellent, the surgeon as good. Graft retention in the mastectomy flap was evaluated with MRI and ultrasound at three months Figure 4. The oncological follow-up was negative at 17 months for local relapses and systemic metastasis.\nOUTPUT:" }, { "from": "agent", "value": "Infiltrating ductal carcinoma, Micro-fibroadenoma intracanalicolare" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Patient had been hospitalized each of the prior four months due to these symptoms of cyclic nausea, vomiting, and leukocytosis which occurred approximately monthly and were attributed to a stomach virus. Gross hematuria was not reported. There is no family history of urinary tract malignancy. Family history is notable for pancreatic cancer and ovarian cancer in non-first-degree relatives. Her prior surgical history includes teeth extractions and arm surgery. The patient does not smoke, but her father does smoke outside home. An ultrasound of the pelvis was obtained during a hospital admission which showed a 7 mm echogenic focus along the posterior wall of the bladder. Urogynecology then evaluated her as an outpatient. On presentation to urogynecology with her mother (primary caregiver), patient was noted to be physically well developed and well-nourished and in no acute distress in a wheelchair. She had abnormal facies and mentation. General physical and abdominal examinations were normal. Patient was unable to tolerate a full examination in the office; therefore, the decision was made to proceed with an examination under anesthesia and cystourethroscopy. Cystourethroscopy revealed an estimated 1.5 cm papillary cauliflower-like lesion on the right bladder sidewall lateral to the ureteral orifice. Immunohistochemical stains CK20 and P53 were negative. Patient was referred to urology for further evaluation and treatment. Urology performed a transurethral resection of the bladder tumor which was noted to be 1 cm on a narrow stalk. Complete resection of the bladder tumor was performed with mucosa around the stalk of the bladder tumor removed as well with no evidence of bladder perforation. Patient will continue to be followed by urology for surveillance cystoscopy under anesthesia every 3 months.\nOUTPUT:" }, { "from": "agent", "value": "Urothelial Carcinoma, Angelman Syndrome" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: An 85-year-old woman, known with hypertension and without any history of abdominal surgery, gallstones or allergies, was referred to the emergency department after having an episode of syncope associated with hematemesis and haematochezia. At admission, she showed signs of shock with diaphoresis, low blood pressure (57/42 mmHg), pulse rate 83 of beat/min and saturation of 100% under 2 L of oxygen. The medical history was limited due to acute confusion, but she reported epigastric pain for a week. She also mentioned a regular intake of NSAID for back pain. Physical examination revealed diffuse abdominal tenderness. Blood tests showed a metabolic acidosis (pH value of 7.27 and high lactate level of 5) and anaemia (haemoglobin of 77 g/l). After receiving 2 units of red blood cells, 1 litre of crystalloid solution and after initiation of amine support (Noradrenalin perfusion of 4.8 ml/h), her condition was stabilized, and a CT-scan of the abdomen was carried out. This revealed a CDF, inflammation of the first part of duodenum, signs of cholangitis and the presence of blood in the stomach (Figure 1). No gallstones were identified. A naso-gastric tube was placed, which removed 1.5 litre of blood from the stomach. During the endoscopy, the patient developed low blood pressure which was treated with the administration of 1 litre of crystalloid solution, 20 g of albumin, 2 units of red blood cells and 2 g of fibrinogen. The patient was then transferred to the intensive care unit, where she remained stable. Noradrenalin pump was gradually withdrawn, and no further transfusion was needed. A Helicobacter pylori antibody test was carried out, which came out positive. She was therefore put under a treatment of proton pump inhibitors, as well as a course of three antibiotics for 14 days (Bismuth salts, metronidazole, and tetracycline). The patient was discharged 9 days after admission. At one month follow up, the outcome was still uneventful, and the patient was doing well. Since then, she has remained asymptomatic. No further treatment, especially surgical, has been performed.\nOUTPUT:" }, { "from": "agent", "value": "Peptic ulcer disease, Choledocho-duodenal fistula, Gastro-intestinal bleeding" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 17-year-old Caucasian woman with no prior medical history presented with an extremely painful thyroid. She had noticed gradual enlargement of the thyroid gland since five years, but more rapid growth during the last six months, accompanied by pain on the right side. Moreover, she had difficulty swallowing because of pain, resulting in decreased food intake and 10 kg weight loss during the last six months. In addition, she complained of a coarse voice since several months. There was no fever. Analgetic therapy did not relieve the symptoms. On physical examination there were no signs of hypo- or hyperthyroid function. There was a WHO grade II goiter without palpable nodules which was extremely painful on examination. There were no enlarged lymph nodes in the neck, and there were no signs of respiratory distress. Laboratory tests showed biochemical euthyroidism: TSH level was 3.77 mU/L (normal value 0.4-4.4 mU/L), free thyroxine (T4) level was 13.4 pmol/L (normal value 10-24 pmol/L), and triiodothyronine (T3) level was 2.1 nmol/L (normal value 1.3-2.6 nmol/L). TPO antibody level was increased (459 ku/L). There was no increased leukocyte count (3,400/mm3) or increased erythrocyte sedimentation rate (5 mm/h). An I-123 scan showed a homogenously enlarged thyroid (slightly more increased on the right side) with a 24-hour uptake of 42%. The otolaryngologist excluded any pharyngeal or tracheal pathology. Esophagogastroscopy revealed no pathology explaining difficulty swallowing or weight loss. The patient was treated with nonsteroidal anti-inflammatory drugs and corticosteroids for several months without any improvement of symptoms. Finally, eight months following onset of pain, a total thyroidectomy was conducted. Immediately after surgery the pain had disappeared completely. Up to several years following surgery the patient was free of pain.\nOUTPUT:" }, { "from": "agent", "value": "Hashimoto's thyroiditis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: He had no history of myocardial infarction; ejection fraction (EF) was 55%. He was advised of urgent coronary artery bypass graft surgery (CABG). He was on aspirin, clopidogrel, statins, ACE I, and bisoprolol. His psychiatrist opined that the patient will not cooperate with major heart surgery and suggested a minimum of three sittings of ECT. His laboratory investigations were normal. The risk of severe heart failure, heart blocks, arrhythmias, and cardiac arrest was explained to relatives. On the day of the procedure, emergency medications, temporary pacemaker (TPM), and Intra-Aortic Balloon Pump (IABP) were kept ready. He was premedicated with oral Diazepam 10 mg one hour before the procedure His heart rate was 74/minute, NIBP 130/80 mmHg, and SPO2 was 100%. Two peripheral venous access were secured; and after preoxygenation, Glycopyrrolate 0.2 mg, Tramadol 50 mg, etomidate 0.2 mg/kg followed by suxamethonium bromide 40 mg were administered, and ECT shock was delivered by Thymatron TM System IV (Dantecmedical, UK); seizure activity induced which lasted for 45 seconds. Bradycardia (50 bpm), and hypertension (NIBP 170/100) occurred but settled within 2-3 minutes. He woke-up in 5 min, and was monitored for 45 minutes. He received three sittings of ECT with increasing energy percentages of 25, 30, and 40%. His symptoms improved and scheduled for CABG later.\nOUTPUT:" }, { "from": "agent", "value": "Left main and triple vessel Coronary Artery Disease (CAD), Depression, Anxiety disorder" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 65-year-old white male presented 10 days after the onset of a central scotoma in the left eye (LE). BCVA at presentation was 20/20 in the right eye (RE) and 20/32 in the LE. Fundus examination of the LE revealed an area of RPE atrophy in the inferonasal macula with foveal sparing (Fig. 1). FAF in the left eye revealed a trizonal pattern and a demarcating hyper-FAF line between the involved and uninvolved retina (Fig. 2); these findings were consistent with AZOOR. Ten days later, he returned complaining of distortion. Fundus examination revealed zonal lesion expansion, which was confirmed by FAF. The OCT revealed mild subretinal fluid (SRF) which explained his metamorphopsia. The patient returned a week later. At this time, visual acuity had reduced to 20/60, and two perilesional haemorrhages were observed along with a hypo-FAF zonal lesion expansion which included the fovea (Fig. 2). The OCT showed a significant increase of subretinal fluid. These findings were consistent with a type 2 (subretinal) CNV which was confirmed by fluorescein angiography. Consequently he received 3 monthly intravitreal bevacizumab injections. One month after the first injection, FAF revealed zonal progression (Fig. 2) and OCT revealed a worsening of SRF (Fig. 3). One month after the third injection, BCVA in the LE was 20/70 and the patient reported stabilization of his central scotoma. At month 5, BCVA was 20/60; OCT scan showed resolution of SRF, while FAF revealed minimal advancement of zonal lesion size. During follow-up the zonal lesions stabilized; the patient received 11 intravitreal bevacizumab injections on a treat and extend regimen for 4 years and maintained a BCVA of 20/60 in the LE.\nOUTPUT:" }, { "from": "agent", "value": "Acute Zonal Occult Outer Retinopathy, Choroidal Neovascularization" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: nan\nOUTPUT:" }, { "from": "agent", "value": "Advanced Melanoma, Hepatitis C" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: E. J., a 36-year-old male, referred to Al-Zahra Hospital, which is a referral hospital in Isfahan, Iran, on May 31, 2017. He is married, has a bachelor's degree, and currently works as an employee at an office downtown Isfahan. However, he mentioned formerly working as a butcher and has had multiple direct contacts with the sheep and dogs when we seek his past history. Six months before referring to us, he had a small palpable sensation of a mass in the right arm for the first time. The mass was gradually growing. At the time of physical examination, as well as any other time in this whole 6-month duration of the disease, he never experienced any form of constitutional signs and symptoms (e.g. fever, shivering, musculoskeletal pain, diaphoresis, or weight loss) or any kind of rashes. Family history of such a condition was negative. Due to his former job and his exposure with the sheep from endemic areas in Isfahan, we clinically suspected an Echinococcus infection and obtained a chest X-ray, a lung multislice computed tomography scan, an intra-abdominal sonogram, complete blood count, and hemoglobin. All of the primary paraclinical results were normal. We thereafter obtained a magnetic resonance imaging (MRI) scan and a sonogram of the right arm. Figure 1 shows the patient's biceps brachii MRI documented by a camera. We referred the patient to the surgery department for biopsy taking and diagnosis confirmation.\nOUTPUT:" }, { "from": "agent", "value": "Hydatid Cyst" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Fighting a two front war was never a good idea. The government chose to build coalitions through careful compromises. The NPP with advice from the technical experts within the Ministry of Health did three things. (i) It offered Labour guarantees that government was only borrowing the money and that no part of the funds appropriate will be transferred or accounted against any worker's end of service benefit. (ii) All contributors to SSNIT and their dependants as well as all pensioners on SSNIT benefit will not have to pay premiums to be registered on the scheme. In effect, labour and for that matter the formal sector will have free health care in Ghana. (iii) Since formal sector labour has put up calculations on how much the 2.5% will be in terms of individual obligations, the informal sector will have to make up an equivalent in premiums. However, each informal sector contributor will have to carry one child so that all other dependants may benefit. Above 70 year olds were to be entirely exempted to be consistent with end of pension calculation for surviving pensioners which was pegged at 72 years. It was these negotiations that led to the setting of the premium at 7.2 Ghana cedis per annum or US$ 7.74. Once these compromises were negotiated, a coalition was built between government and labour that led labour to tone down and not engage with the VAT issues. It was possible that without this coalition building government could not have passed the bill. Here, labour as civil society, proved more powerful an ally to have than to compromise with opposition political parties in parliament. Technically, it should be admitted that a better engagement process should have been developed with the key stakeholders by the technical experts to ameliorate some of these issues coming up late in the process.\nOUTPUT:" }, { "from": "agent", "value": "No medical diagnosis is mentioned in the case report." } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: We report a case of a 48-year-old man referred for a reduced exercise tolerance for several months. He had no cardiovascular risk factors, except smoking, and a clinical history of an episode of amaurosis fugax 5 years before. Physical examination, blood pressure (BP), heart rate and electrocardiogram were normal. LV EF was normal, whereas LV end diastolic volume index (EDV/body surface area = 86 mL/m2), LV ESD (42 mm), and left atrium (LA) volume index (42 mL/m2) were increased. Global longitudinal strain (GLS) average was also in normal range (-22%) whereas global myocardial work index (GWI) and efficiency (GWE) were both reduced (1465 mmHg% and 72%, respectively). The reduction of the above-mentioned myocardial work (MW) components was particularly pronounced at the level of inferoseptal, inferior and posterior LV segments [Figure 1, Panel B]. Surgical mitral valvuloplasty with implantation of the Memo three-dimensional ReChord Ring was successfully performed without complications [Figure 1, Panel C]. At 6 months' follow-up, the patient was completely asymptomatic and no heart failure sign was detected on clinical examination. At TTE, MR resulted mild (1+/4+), LV EF was 50%, LV volumes and LA volume index were reduced but a residual paradoxical septal motion and right ventricular (RV) dysfunction (tricuspid annular plane systolic excursion = 14 mm and peak systolic velocity = 8 cm/s) were reported. GLS was also reduced (-13.4%) with a regional impairment involving especially septal basal segments, GWI (1318 mmHg%) was lower in comparison with presurgery values, despite its improvement in medium-basal inferoposterior LV segments, whereas GWE was significantly greater (90%) [Figure 1, Panel D].\nOUTPUT:" }, { "from": "agent", "value": "Barlow's disease" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 66-year-old female presented with a 1-month history of gradually worsening shortness of breath and productive cough. She was a non-smoker with history of gastroesophageal reflux disease, obstructive sleep apnoea, and transient ischemic attack. Her physical examination revealed inspiratory and expiratory wheeze. Chest X ray was normal. In view of persistent shortness of breath and normal radiograph, computed tomography pulmonary angiogram (CTPA) was done to rule out pulmonary embolism. CT scan showed an infiltrative mass measuring 3.0 x 2.5 x 2.5 cm in the right lateral wall of the lower trachea about 1 cm above the carina causing significant airway obstruction (Fig. 1a). The patient underwent rigid bronchoscopy with laser resection and tracheal stenting under general anaesthesia. After debulking, a 20 x 60 mm Ultraflex covered SEMS was placed in the trachea. Subsequent staging did not reveal extra- tracheal spread. She was offered tracheal resection and anastomosis. However she declined due to risks associated with the surgery. She also rejected concurrent chemo radiation, and opted only for radiotherapy, which was planned for 66 Gy in 33 fractions. One day prior to radiotherapy, she coughed out 2 small stent pieces mixed with sputum (Fig. 1b). Bronchoscopy showed breaks in the wires of the stent in the left lateral aspect at 3 places (Fig. 1c). The stent was otherwise well placed with good scaffolding effect on the trachea, maintaining tracheal patency. Decision was made to leave the stent in place in view of the maintained tracheal patency, risk of airway compromise from tumour if the stent was removed, and anticipated difficulties with stent removal due to granulation tissues at both the proximal and distal ends of the stent. She was given cough suppressant and radiotherapy was started. She had another episode of coughing out stent pieces 3 months after stent insertion. She was offered rigid bronchoscopy and removal of the stent but declined. Inspection flexible bronchoscopy showed good position of stent with stable areas of stent fracture. CT scan also revealed a patent tracheal stent with no focal soft tissue lesion seen within the trachea (Fig. 1d). She has remained well with the fractured stent in-situ for 1 year at the time of this writing.\nOUTPUT:" }, { "from": "agent", "value": "Adenoid cystic carcinoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 27-year-old female patient developed macrohematuria in January 2004. Imaging showed a large right renal mass without metastases. Maximum tumor diameter was 12 cm, with extensive necrosis, grade IV according to Fuhrman's nuclear grading system. A single hilar lymph node was found to be infiltrated, resulting in stage pT2 pN1 cM0. Neither the renal vein nor the adrenal gland was infiltrated. In August 2007, a routine follow-up ultrasound revealed multiple liver lesions. Fine needle aspiration confirmed the diagnosis of liver metastases of chromophobe RCC. A CT scan showed multiple bilateral pulmonary as well as diffuse liver metastases. Treatment with sunitinib 50 mg on a 4 weeks on/2 weeks off schedule was initiated, resulting in stable disease. However, the doses had to be reduced due to grade 3 palmar and plantar toxicity. At the end of March 2009, after 20 months of treatment, an MRI showed progressive liver disease as well as local recurrence and mesenteric lymph node metastases. Sorafenib was started as a second-line treatment. The initial dose of 800 mg daily had to be reduced to 600 mg due to a hematologic toxicity. No objective response was achieved, and the performance status decreased from 0 to 2, with a 7-kg weight loss. After 5 months of sorafenib therapy, an MRI revealed further progression at all sites (fig. 1; online suppl. video 1; see www.karger.com/doi/10.1159/000323804). At the end of August 2009, temsirolimus was started as a third-line treatment at a dose of 25 mg intravenously every week. In November 2009, disease stabilization was observed on CT. In February 2009, a further MRI showed a partial remission according to the RECIST criteria. Clinically, the patient had improved considerably (PS 0), and formerly elevated laboratory values normalized (LDH from 1,400 U/l, alkaline phosphatase from 142 U/l, gammaGT from 168 U/l). In July 2010, an impressive partial remission was documented by MRI (fig. 2; online suppl. video 2). Currently, the patient continues on weekly temsirolimus, is working full time, and is in excellent physical condition without experiencing any side effects.\nOUTPUT:" }, { "from": "agent", "value": "Chromophobe Renal Cell Cancer" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 33-year-old Caucasian gravid 1 para 0 was admitted at 40 weeks to the birthing unit in early labor. She had no significant medical history and (apart from pregnancy-induced hypertension) had an uneventful antenatal course. Twelve hours after onset of labor, she progressed to full dilation, with a vertex presentation, in the left-occiput-anterior position. Her second stage of labor was prolonged, and minimal progress was documented at two hours. It was at this point that the patient complained of central chest pain. On examination, swelling and crepitus was noted over the right side of her face and neck, extending over the anterior chest wall. Her chest was not hyper-resonant to percussion. Her voice was normal, and there was no tracheal deviation or stridor. Blood pressure, pulse rate, and oxygen saturations remained within normal limits. The patient continued to push with contractions, though progress remained minimal. An initial mobile chest x-ray (CXR) (Fig. Due to SPM, the patient subsequently underwent an urgent cesarean section under spinal anesthesia. There were no pulmonary lesions, bullae, or pneumothorax. There was no extravasation of oral contrast to demonstrate suggest esophageal perforation, and a gastro-graffin swallow performed day 1 after cesarean section confirmed that there was no esophageal breach. Laryngoscopy with a flexible bronchoscope did not reveal mucosal lacerations of the endolarynx. The patient was monitored closely after delivery. She was discharged on day 3 after cesarean section.\nOUTPUT:" }, { "from": "agent", "value": "Spontaneous pneumomediastinum, Severe subcutaneous emphysema" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 36-year-old patient was referred to our hospital one week after an emergency C-section in the 24th week of pregnancy because of binocular diplopia and blurred vision. The C-section was necessary due to the development of preeclampsia with HELPP syndrome. Both eyes had a BCVA of 20/25, no strabismus in primary position, normal motility and a normal slit lamp examination. Funduscopy of the right eye revealed a punctual retinal bleeding near the inferior branch of the retinal artery as well as a cotton wool spot near the superior branch of the retinal artery (Figure 2 A, B (Fig. 2)). In baseline OCT, SRF was detected (Figure 2 C, D (Fig. 2)). As the patient also complained of headache beginning two weeks before delivery, a magnetic resonance imaging (MRI) was effectuated immediately after the C-section. Symmetrical white matter abnormalities suggestive of edema can be seen in the computer tomography (CT) and MRI scans, mostly but not exclusively in the posterior parieto-occipital regions (Figure 2 E, F (Fig. 2)). PRES is a rare neurological disorder with still not completely explained pathophysiology. Like DIC, PRES it is not a disease in itself but an entity that can occur in different contexts such as renal diseases or (pre)eclampsia. PRES is mostly associated with hypertension and endothelial injury. Vasoconstriction resulting in vasogenic and cytotoxic edema is suspected of being responsible for the clinical symptoms as well as the radiological image. Differential diagnosis to explain the visual symptoms in this patient includes DIC, functional postpartal visual disturbance, pseudotumor cerebri, and bilateral retinal detachment due to severe preeclampsia. All these differential diagnoses could be excluded either by the funduscopic or radiological findings. In the follow-up OCT examination, the SRF was decreasing. In the follow-up MRI 3 months later, the parietal-temporal cerebral edema, correlating with PRES, was completely resolved. The treatment of PRES is symptomatic and focused on the underlying condition with an overall favorable prognosis. Clinical symptoms as well as imaging lesions are reversible in most patients. However, neurological sequelae including long-term epilepsy may persist in individual cases.\nOUTPUT:" }, { "from": "agent", "value": "Posterior reversible encephalopathy syndrome (PRES)" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 2-year-old boy was presented to a pediatric dermatology clinic with a chief complaint of non-itchy and painless tan-orange colored papules on the face, trunk, both upper arms and legs. These lesions first appeared when the patient was one-year-old. They initially started on the right cheek, and gradually spread to other areas of the face, the trunk, and the legs. There were no abnormalities at birth or a history of any previous trauma. The patient's familial and personal medical history were unremarkable. Dermatological examination revealed multiple lesions in the form of tan-orange papules and plaques on the face, ears (Figure 1A-C), trunk, both upper arms, and legs. Dermoscopy examination showed a brownish-yellow hue resembling \"setting-sun appearance\" (Figure 2A). The histopathological features of the lesions include infiltration of lymphocytes, foam cells, and histiocytes in the upper dermis. Additionally, histiocytes-forming Touton giant cells were also observed, supporting the diagnosis of JXG (Figure 2B). Furthermore, the immunohistochemistry analysis revealed that the cells were positive for CD68 and S100 (Langerhans cell and nerve cell), and negative for CD1a (Figure 2C). The patient's parents requested for the facial region to be prioritized due to its visibility, and they showed a preference towards non-invasive treatment. Therefore, topical rapamycin therapy (0.5 mg Certican everolimus compounded into 1% ointment) was initiated. It was applied twice daily to the right cheek, as per the family's preference, where the skin lesions first appeared. After 12 weeks of treatment, the lesions on the right cheek improved as it started to flatten and fade. The size of the largest lesion decreased from 25x10x3 mm to 10x8x1 mm. Encouraged by the results and lack of local side effects (such as irritation), the family opted to treat both of his cheeks. After 24 weeks of using topical rapamycin on both sides, most of the skin lesions on his face had flattened and faded (Figure 1D-F).\nOUTPUT:" }, { "from": "agent", "value": "Non-Langerhans Cell Histiocytosis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 27-year-old man without significant prior medical history was admitted in December 2014 for intense lumbar pains with right sciatalgia, lumbago and hypoesthesia. The spinal CT scan confirmed L5-S1 discarthrosis. He also presented a numb chin syndrome. At admission, his complete blood count showed: hemoglobin 107 g/L, platelet count 62 x 109/L, and white blood cell count 2.2 x 109/L with 6% of blast cells. 2). However, some areas showed intact cells with monoblast morphology, irregular nucleus, fine chromatin, nucleolus, and an intense basophilic cytoplasm. A diagnosis of AML of M5 subtype according to FAB classification was established. The cytogenetic analysis revealed a clonal aberration with 47, XX, +8[4]/46, XY[16], classified as intermediate-risk according to the ELN criteria. In molecular biology, there was no EVI1, WT1, FLT3-ITD, MLL nor CEBPA mutations or rearrangements, but oneNPM1 mutation. The patient received timed sequential induction chemotherapy with two sequences combining daunorubicin with cytarabine according to the ALFA-0702 protocol. Because of central nervous system involvement, treatment was completed by intrathecal chemotherapy administration. The patient received two further lines of treatment which did not allow any response. He finally died 10 months after the initial diagnosis.\nOUTPUT:" }, { "from": "agent", "value": "Bone Marrow Necrosis, Acute Leukemia" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Standard mutation extraction tools such as MutationMiner and tmVAR reviewed by Yepes et. al. are not effective in capturing most of the mutation evidences occurring in the eligibility criteria because these tools do not handle non-standard formats of structural variations for translocations (e.g. t(1;2)(p12;q13)), deletions (e.g. del (5q), -5q), or complex mutation mentions (e.g. Hence, we decided to design our own set of rules. We currently do not handle double negative (e.g. \"for patients whose AML does not have good risk cytogenetic features, i.e. t (8;21) and t(15;17) without c-kit mutations) or conditional negatives (e.g. No MLL rearrangements if 12 to 24 months old). We plan to make the NLP component more robust by including richer rules and capturing annotations for other features in the eligibility criteria, including trials for other cancer types. The advantage of ontology-based annotation management is that it not only helps structure the extracted information, but also facilitates data integration. Most of the existing annotations for eligibility criteria, generally stored in relational databases or as indices, are data silos that cannot be integrated easily. Our ontology can be easily integrated with LinkedCT and this combined dataset can serve as an enriched version for the later. Our RDF model can also be integrated with other biomedical datasets for capturing additional evidences for interactions between biomedical entities such as drugs, diseases and genetic-mutations. We can align our ontology with other mutation-specific ontologies (e.g. Sequence Ontology or OMM impact ontology). By converting the annotations to an instance of a domain ontology, an investigator can explore the annotation model using semantic queries in SPARQL or leverage other Semantic Web tools, such as reasoners that can check the consistency of the populated ontology. The mutation evidences captured by our system in the clinical trials may be disease-causing or disease-associated. Hence, the interactions between drugs and mutations that we extracted from the clinical trials may not specifically represent drug-target associations but rather reflect more loosely defined relationships between treatments and genetic-mutations. In the future, we plan to associate the disease-drug-mutation relationships extracted from clinical trials to relevant evidences found in sources like PubMed and PharmGKB in order to authenticate the extracted relationships.\nOUTPUT:" }, { "from": "agent", "value": "Leukemia" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Her white blood cell (WBC) count on the 3rd day was 2.2 x 103 with 65% neutrophils and platelet count of 117,000. Alanine transaminase (ALT) was 17.8 and aspartate transaminase (AST) was 55.2. By the 4th day, she became sleepy and lethargic and the level of consciousness gradually deteriorated. She was moved to high dependency care for further management. On neurological examination, she had increased tone in all four limbs with cogwheel rigidity. The lowest Glasgow coma scale documented was 10/15. Her vital parameters and serial packed cell volume readings remained stable without signs of fluid leakage. Lowest WBC count (1.9 x 103) was reported on day 5 of the illness and lowest platelet count was 50,000/mm3 on day 6. Liver enzymes deteriorated (ALT: 357, AST: 478) and serum albumin was 38 g/dL and INR was 1.17 on day 6. Tender liver was palpable 2 cm below the costal margin. Renal functions (sodium: 142 mEq/L, potassium: 4.2 mEq/L, blood urea: 7.6 mmol/L, and serum creatinine: 52 mumol/L) remained normal. Serum calcium remained between 2.08 and 2.69 mmol/L. Cerebrospinal fluid examination did not reveal any cells and had normal protein levels (42 mg/dL). Over the next 2 weeks following the acute illness, she showed complete recovery with no residual neurological disability.\nOUTPUT:" }, { "from": "agent", "value": "Dengue Fever, Thalamic and Basal Ganglia Involvement" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The genetic testing, performed by the Harvard-Partners Laboratory for Molecule Medicine (http://www.hpcgg.org/LMM/), involved sequencing the coding regions and splice sites of the genes encoding the sarcomeric proteins cardiac alpha-actin (ACTC), cardiac myosin-binding protein C (MYBPC3), cardiac beta-myosin heavy chain (MYH7), myosin regulatory light chain (MYL2), cardiac myosin essential light chain (MYL3), cardiac troponin I (TNNI3), cardiac troponin T2 (TNNT2), and tropomyosin 1 (TPM1). In addition, the genetic testing included sequencing the genes for alpha-galactosidase A (GLA), lysosomal associated membrane protein 2 (LAMP2), and AMP-activated protein kinase, gamma-2 subunit (PRKAG2), which are involved in storage diseases that can lead to cardiac hypertrophy. The sequencing effort revealed two variants in the MYH7 gene: the proband was doubly heterozygous for a R719Q variant (2156G>A in Exon19) as well as a T1513S variant (4537A>T in Exon 33). The R179Q variant alone was likely to be causative for HCM as it met the criteria for pathogenity based on segregation studies and frequency. However, the significance of the T1513S variant was unclear even though it was detected in one additional HCM patient tested by the reference lab (http://www.hpcgg.org/LMM/) and in one patient reported in the literature. In both of these prior cases, the T1513S variant was found in combination with the R719Q variant. Given the rare but recurrent presyncopal/syncopal complaints and significant family history of SCD, the proband received an internal cardiac defibrillator (ICD). The proband's 15-year-old sister was not found to have any genetic variants.\nOUTPUT:" }, { "from": "agent", "value": "Hypertrophic Cardiomyopathy" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The 16-month-old patient is the first child of healthy, non-consanguineous parents. He has a normal male karyotype and no family history of developmental or neuropsychiatric disorders, except for schizophrenia in his maternal grandmother. This child was born at term by caesarean section with hypoxia, and his Apgar scores were 6 and 9 at 1 and 5 min, respectively. At birth, his weight was 3450 g (50-80th percentile), and his length and head circumference were not reported. He has suffered from a feeding disorder from birth and still continues to exhibit eating refusal and vomiting problems. He had general DD and started walking at 15 months of age. His speech was delayed, with first babbling at approximately 8 months old, and he still cannot consciously generate words. He appeared to exhibit gaze avoidance and did not respond when his name was called. He preferred to look at traffic lights and exit signs. He continuously knocked the desk in the examination room with his hands or other objects. At 16 months of age, physical examination revealed the following findings: a weight of 9.95 kg (10-20th percentile), a height of 80.1 cm (20-50th percentile), and minor dysmorphic facial features, including mild hypertelorism, a short mandible and a protuberant forehead (Fig. 1). MRI scanning of his brain was unremarkable, and the EEG and fragile X screening results were also normal. Cognitive/developmental evaluation using the Bayley Scales of Infant Development-2 showed that his cognitive and language skills, as well as his motor skills, were well behind for his age (MDI < 50; and PDI = 66). The Autism Diagnostic Observation Schedule (ADOS)-Toddler Module was used for autism screening. The results of this test revealed that the patient had a social affect score of 20, a restricted and repetitive behavior score of 5 and an overall total score of 25, indicating a likely diagnosis of moderate-to-severe ASD. His was finally diagnosed with ASD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria.\nOUTPUT:" }, { "from": "agent", "value": "Autism Spectrum Disorder" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 78-year-old male was admitted with acute dyspnea and dysphagia for 3 days, and a 3-month history of increasing circumference of the neck. Two months prior to admission, ultrasound and computed tomography (CT) scan of the neck demonstrated two masses, of 6.8 cm and 5 cm each in largest diameter. The patient's past medical history included chronic atrial fibrillation, congestive heart failure, and chronic obstructive pulmonary disease (COPD). On presentation at admission, the patient's vital signs were stable, with bilateral large and firm masses at cervical palpation, irregular heart rate, and bilaterally equal breath sounds. Given his symptoms, the patient was started on intravenous methylprednisolone. Cardiac workup and transthoracic echocardiogram showed a left ventricular ejection fraction of 65%. Flexible laryngoscopy evaluation revealed no upper airway distortion. The neck masses began to rapidly decrease in size, with concomitant symptomatic improvement with steroid administration. Flow cytometry revealed lymphoid B-cells positive for CD19, CD20, Kappa+/CD19+, and Lambda+/CD19+, and negative for CD10. The polymerase chain reaction (PCR) study of immunoglobulin heavy chain gene rearrangement showed clonal B-cells with polyclonal background. To fully characterize the tumor, the patient then underwent open biopsy with pyramidal lobe and isthmus excision.\nOUTPUT:" }, { "from": "agent", "value": "Thyroid Lymphoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 6-year-old boy was diagnosed with the left lower lobe pneumonia and pleural effusion and was put on parenteral cefotaxime and clindamycin treatment. He then improved clinically and was discharged 7 days later with oral amoxicillin clavulanate treatment. After four days, however, he was readmitted to the hospital with fever and cough. A chest X-ray revealed left lower lobe pneumonia and pleural effusion. As a case of complicated pneumonia was considered, we started parenteral cefotaxime and clindamycin treatment, 10 days after which his clinical and radiological findings were improved. At the 12th of day of hospitalization, however, he developed at 39 C, which we considered as a side effect of antibiotics. Therefore, antibiotic treatment was stopped. At the same day, he also developed a generalized maculopapular erythematous rash, which was considered an allergic reaction secondary to antibiotics (Figure 1). Despite the administration of antihistaminic drugs, his clinical status quickly deteriorated with generalized edema, lymphadenopathies and hepatosplenomegaly. Laboratory tests showed a white blood cell count of 4,300/mm3, a lymphocyte count of 1,300/mul, a hemoglobin level of 11.2 gr/dl, a platelet count of 120,000/mul, an eosinophil ratio of 10% on peripheral blood smear, a C-reactive protein level of 20 mg/dl, a procalcitonin level of 23.94 ng/ml and an erythrocyte sedimentation rate of 48 mm/h. Anti-nuclear antibody, anti-double strain DNA, the serologic tests for Epstein Bar virus, herpes simplex virus, parvovirus, mycoplasma, toxoplasmosis, rubella, cytomegalovirus were all found negative. Bone marrow aspiration was consistent with an autoimmune reaction. An echocardiographic examination was found normal. A Thoracic computerized tomography revealed multiple enlarged axillary, supraclavicular and anterior mediastinal lymph nodes. As the patient met 8 out of 9 RegiSCAR criteria for the diagnosis of DRESS, pulse methyl prednisolone (30 mg/kg/day) was administered for three days followed by 2mg/kg/day. On the 2nd day fever resolved and cutaneous rash and edema improved. He was discharged ten days after the appearance of eruptions. The patient's father gave consent for publication of his son's pictures.\nOUTPUT:" }, { "from": "agent", "value": "Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 22-year-old female, farmer by occupation, presented with complaints of chest pain and progressive weakness of left lower limb that had persisted for 3 months. There was no history of fever, weight loss, or trauma. The general physical examination was unremarkable. Respiratory system examination revealed dullness on percussion and tenderness in left infraclavicular, suprascapular, and interscapular regions. The routine laboratory investigations were normal. Radiographs of chest, performed in posterior-anterior (PA) and lateral projections, demonstrated well-defined homogenous soft tissue opacity in the posterior mediastinum. There was erosion of the 4th rib posteriorly, scalloping of superior margin of 5th rib, and widened fourth intercostal space [Figure 1a and b]. There was erosion of the overlying 4th rib with scalloping of the 5th rib and widened intervening intercostal space [Figures 2 and 3]. Based on the imaging findings, the possible differential diagnosis included neurogenic tumors, aggressive malignant masses like round cell tumors (Ewing's sarcoma, primitive neuroectodermal tumors, and others), lymphoma, or metastasis. The diagnosis was confirmed macroscopically preoperatively and by histopathological studies postoperatively. Postoperative recovery was uneventful and the patient was discharged and put on adjuvant chemotherapy with mebendazole for 2 years. The patient was monitored with routine follow-ups for 5 years with no evidence of recurrence.\nOUTPUT:" }, { "from": "agent", "value": "Hydatid cyst" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 30-year-old married woman, a homemaker, educated up to class XII, with upper socio economic background, was brought with complaints of forgetfulness, anger outbursts, irritability, stiffness and loss of sensation in left hand since 3 years. Onset was abrupt, and it was continuous in course. The precipitating factor was cardiac and respiratory arrest during the delivery of the third child. The patient was functioning normally till the delivery of the third child. Cardiac and respiratory arrest occurred during labor; she was on ventilators for 24 hours, was unconscious for 5 days and hospitalized for 15 days. After discharge from the hospital, she was able to recognize friends and relatives; however, she did not remember the reason for hospitalization. She had stiffness and partial loss of sensation in the left hand. She would forget day-to-day events, phone numbers, etc. This caused distress to family members. Biological functions were normal. Sexual functioning was devoid : it was a conscious decision made by the husband fearing that the patient might become pregnant. Her husband wanted to remarry due to her above-mentioned condition. She was brought to NIMHANS in February 2004. She was referred from adult psychiatry unit to family psychiatry Unit and Neuropsychology Unit for family therapy and neuropsychological assessment and rehabilitation. After obtaining written informed consent from the patient, neuropsychological assessment and retraining were carried out. Neuropsychological assessment showed deficits in attention, fluency, working memory, planning, verbal and visual learning and memory. The neuropsychological profile was indicative of dorso-lateral pre-frontal cortex and bilateral temporal lobe involvement. Cognitive retraining was carried out for a period of 7 months over 138 sessions : everyday for 1 hour. Principles of saturation cueing were followed. The tasks were given in an order of increasing difficulty. The tasks were designed in such a way that the design had provisions for scoring error and time [Table 1].\nOUTPUT:" }, { "from": "agent", "value": "Hypoxic Encephalopathy" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 20-year-old woman presented for a routine eye examination. Her best-corrected visual acuity was 20/20 in the right eye and 20/25 in the left eye. Fundus examination revealed in both eyes the presence of multiple egg-shaped hyperpigmented retinal lesions (at least 4), sur-rounded by a depigmented halo (Figure 1, black arrows). The patient's medical history and general examination were unremarkable but her family history was pertinent for familial adenomatous polyposis (FAP) in a sister and colon cancer in her mother. She then was scheduled for bi-yearly screening colonoscopy. They can occur as solitary or multiple, they may be found in the normal population and are usually observed during routine ophthalmos copy. Multiple or bilateral CHRPE mayoccur in Familial Adenomatous Polyposis (FAP), an autosomal dominant diseasecaused by mutations in the adenomatous polyposis coli (APC) gene. Colorectal examination is crucial for early intervention and treatment, as the colon polyps progress to malignancy in nearly 100% of cases. Multiple and bilateral CHRPE in FAP isconsidered a clinical disease marker. However, the absence of CHRPE has no predictive value for absence of GS or FAP.\nOUTPUT:" }, { "from": "agent", "value": "Congenital hypertrophy of the retinal pigment epithelium, Gardner's syndrome" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Patient information: this was a 33-year-old G2P1 woman who presented to our emergency unit at 15 weeks of gestation for symptoms of weakness, amnesia, confusion and paresthesia. She had no prior medical or surgical history, and the first pregnancy was uneventful. Moreover, our patient had no history of alcohol consumption. Clinical findings: upon examination, the patient was conscious, disoriented and confused with Glasgow coma score of 13/15. The neurological examination revealed loss of equilibrium with incoordination of gait and ataxia. Blood pressure was 90/60 mmhg, pulse rate was 100/min and the patient was afebrile. There was no restriction of ocular movements, but vertical nystagmus was found. Visual acuity was preserved. Timeline of current episode: the patient reported that 25 days before this visit, she had presented excessive nausea and vomiting that were managed by a general practitioner. In spite of receiving antiemetics, her vomiting became intolerable which led to confusion and weakness. Diagnostic assessment: ophthalmoscopy revealed bilateral disc swelling and superficial retinal hemorrhage. Laboratory tests showed the following anomalies: low hemoglobin and potassium levels (9.9 g/dl and 2.4mmol/l respectively) and elevated liver enzymes ASAT=102 ALAT=109. Ultrasound showed a single live intrauterine fetus. Brain MRI showed a diffuse T2/FLAIR hyperintensity in the thalamus (posteromedial zone, bilateral and symmetric) (Figure 1), the periaqueductal gray (Figure 2) and the mammillary bodies (Figure 3). Therapeutic interventions: thiamine intravenous administration was initiated with a dose of 200mg/8 hours for 5 days, and then maintained with a dose of 100mg/12 hours. The patient also received intravenous glucose, saline solution with added potassium and antiemetic therapy. Follow-up and outcome of interventions: the patient s clinical condition began to improve and she no longer had any major deficits in memory or gait. On discharge, the patient was able to walk with assistance. Patient perspective: our patient and her family were satisfied with our management and therapeutic protocol especially that the patient s evolution was spectacular after thiamine administration. Informed consent: the patient was informed of the specifics of her condition, of the reasons that made her case special and of the authors' interest in publishing it. She has given her informed consent to allow the authors to use her case for this case report.\nOUTPUT:" }, { "from": "agent", "value": "Wernicke encephalopathy" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: An 80-year-old male complained of progressively decreasing memory over the previous 2 years. Word finding was particularly difficult. Orientation in time and place was reduced, and he developed difficulties in finding the treatment rooms during hospitalization. Additionally, vision began to be disturbed. He scarcely read anymore due to the effort required. Financial affairs were managed together with his wife. Neurological examination was completely normal, and, in particular, there were no signs of rigidity, hypokinesia or tremor. The UPDRS-III motor score was 0. Clinical chemistry did not reveal any significant abnormality apart from slightly elevated homocysteine (16.1 mumol/l). Mini Mental State Examination (MMSE) was within normal limits (28 of 30 points), but extensive neuropsychological testing revealed significant abnormalities regarding attention, visuospatial capabilities, short-term and working verbal memory, verbal episodic memory and naming. Orientation and executive functions were preserved (table 3). Moreover, during the session massive fluctuations were present. Cerebrospinal fluid (CSF) was normal with respect to basic parameters, but phosphorylated tau at threonine 231 was elevated and beta-amyloid (Abeta1-42) was decreased. Cerebral magnetic resonance imaging (MRI) revealed no significant vascular lesions, but frontotemporal atrophy was noted, with relative preservation of hippocampal formation (fig. 1). The findings were supported by typical CSF data. Although only one core feature (fluctuation) was present, FP-CIT-SPECT was performed and revealed a diminished dopamine transporter uptake in the basal ganglia (fig. 2a).\nOUTPUT:" }, { "from": "agent", "value": "Dementia, Probable dementia of the Alzheimer type, Probable DLB" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: She initially underwent wide local excision followed by a sentinel lymph node biopsy and left inguinal lymph node dissection. She then received immunotherapy with dendritic cells and IL-2 as part of a phase II clinical trial. She then had 4 cycles of biochemotherapy: IL-2, interferon, cisplatin, vinblastine, and temozolomide. Unfortunately, she had posterior reversible encephalopathy syndrome complicated by seizures and discontinued treatment. In 2008, the patient had another recurrence on the right posterior thigh, which was resected followed by adjuvant radiation therapy to the posterolateral thigh. In April 2016, the patient had erythema and subcutaneous nodules of the right anterior thigh at the vaccine sites from 2007. The patient also had mild postsurgical and radiation changes in the right posterolateral thigh, not overlapping with the nodules. An ultrasound scan performed in March 2017 found architectural distortion of the subcutaneous soft tissue along her right lateral thigh scar as well as superficial subcutaneous foci of posterior acoustic shadowing in the right midanterior thigh, most likely representing foci of fat necrosis. These subcutaneous nodules haven't been biopsied per patient's request.\nOUTPUT:" }, { "from": "agent", "value": "Metastatic melanoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: 104 patients were included in the final analysis. Median length of stay was 4 days. There were no mortalities. She underwent washout, multiple debridements and end colostomy ultimately surviving to placement in rehab and eventual complete restoration of bowel continuity. Neither of these patients had prior pelvic irradiation. In the IcGA group, 4 patients underwent an intraoperative change in management based on the subjective assessment of the IcGA fluorescence. This change in management involved selecting a better fluorescing distal segment of bowel to use as part of the anastomosis. The number of IcGA needed to change management was 18. The postoperative course was uneventful for 84% of patients; 16% had one or more postoperative complications (Table 4). Two of these complications, occurring in a single patient, were Clavien-Dindo Classification grade 4, mandating a single return to the operating room. Otherwise all other complications were Clavien-Dindo Classification grade 1 or 2. Overall mortality was 0%.\nOUTPUT:" }, { "from": "agent", "value": "Diverticulitis, Crohn's colitis, Anastomotic dehiscence, Necrotizing soft tissue infection" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The physical examination revealed no abnormal findings. Laboratory results were all within normal limits. Informed consent was obtained prior to the operation and laparoscopic cholecystectomy with NIRFC was performed\nIn the operating room, a single dose of ICG (0.05 mg/kg) was injected IV one hour prior to making a surgical incision. We used a specially designed laparoscopic system for fluorescence imaging (KARL STORZ Near Infrared System, Tuttlingen, Germany). Under general anesthesia, a 10-mm trocar was inserted through the umbilicus. The patient was positioned to reverse Trendelenburg with left tilting. Establishment of pneumoperitoneum was executed and intraabdominal pressure was applied and maintained at 12 mmHg during the operation. Two other trocars were introduced under direct visualization at the right flank and epigastric areas. Before dissection of the Calot triangle, the display mode was altered to the fluorescent imaging. 1). Dissection progressed carefully after the display mode was changed to conventional imaging (Fig. 2A). Then another tubular structure was fluorescent imaged. Partial dissection of Calot triangle was performed carefully. 2B and C). The operation time was 15 minutes. The patient was able to eat a soft diet on postoperative day 1. Postoperative laboratory tests were all within the normal limits and the patient was discharged on postoperative day 2. After a week the patient showed a tolerable status without any complications.\nOUTPUT:" }, { "from": "agent", "value": "Gallbladder polyp, Cystic duct variation" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The child was delivered at 36 weeks because of fetal distress occurring as a result of a lack of amniotic fluid. The parents' marriage was nonconsanguineous. The child was hospitalized for 36 days in the neonatal intensive care unit. General examination of the head and the face reveled the following signs: abnormalities of the skull with hypoplastic mandible, micrognathia, frontal bossing; a beak-shaped nose; abnormalities of the eye, with microblepharon, flat orbits, and enophthalmos; atrophy of the skin over the nose and the eyelids associated with hypotrichosis of the scalp; and dental anomalies including malocclusion, caries, and malformed teeth. The cycloplegic refractive error was +1.50 in both eyes. A diagnosis of HSS was made on the basis of the criteria reported by Francois. Ocular adnexal examination revealed a microblepharon with bilateral upper eyelid retraction, entropion, and bridging of the tarsal plates off the ocular surface. Preoperatively, the distance between the upper lid and the apex of the corneal limbus was 6 mm. There was also marked orbital fat atrophy with relative enophthalmos. The upper fornix was unusually deep (Figure 1A) with copious accumulation of thick mucopurulent discharge (Figure 1B). Corneal involvement produced pain, burning, foreign body sensation, tearing, blurred vision, and severe photophobia. Visual acuity was 20/100 and 20/200 in the right and left eye, respectively. Ocular motility was within normal limits. Mental development was reported to be normal. Genetic analysis, and an orbital and cerebral computed tomography (CT) scan were performed before surgery. Transnasal fiberscope examination of the upper airway was performed before surgery in order to investigate the upper airway anatomy. General anesthesia and intubation were uneventful. A recession and extirpation of the levator aponeurosis and Muller muscle were performed through an anterior lid crease approach.\nOUTPUT:" }, { "from": "agent", "value": "Hallermann-Streiff syndrome, Severe bilateral enophthalmos, Silent brain syndrome, Congenital nasolacrimal duct atresia, Traumatic keratopathy, Nasal cavity restriction, Macroglossia, Epiglottic hypoplasia" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 44-year-old female underwent routine laparoscopic RNYGB with an initial BMI of 41 and associated comorbidities of diabetes mellitus, diabetic gastroparesis, and gastroesophageal reflux disease. She initially had greater than usual and prolonged postoperative nausea that did eventually resolve with the use of Doxepin. Her weight loss was much greater than average, at 6 months postop her BMI was 26, and she complained of constipation and some abdominal pain. After 11 months, her BMI was 22, with an excess body weight loss of 100%. At this time, the patient developed persistent and refractory symptoms of postprandial nausea and emesis. These symptoms led to an extensive workup including a CT scan of the abdomen, ultrasound, and hepatobiliary scan, which were all unremarkable. A diagnostic laparoscopy with enterolysis and laparoscopic cholecystectomy was performed. At that time, a fluid-filled distal stomach remnant was identified indicating possible partial duodenal obstruction. A gastrostomy tube was placed at this operation. Upon retrospective review of the CT scan, a narrowing of the SMA/aorta angle was noted (Figure 2). SMA syndrome could not be confirmed by placing contrast through her gastrostomy tube to evaluate the distal stomach and the duodenum, because the contrast went freely through the third and fourth portions of the duodenum. The patient continued to have symptoms, so we proceeded to perform a laparoscopic gastroduodenojejunostomy, again through the pylorus, using the common channel of the jejunum. Postoperatively, all of her symptoms of nausea and emesis completely resolved. At the time of surgery, her BMI had reached a low of 21. At 2 years of follow-up, her BMI was stable at 23.\nOUTPUT:" }, { "from": "agent", "value": "Superior mesenteric artery syndrome" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 62-year-old male with no reported past medical history presented with worsening left foot swelling after cutting his toenail. Abnormal vital signs included a blood pressure of 166/99 mmHg, heart rate of 121 beats per minute, and a fingerstick blood glucose of 500 mg/dL. On physical examination, his left foot was swollen, warm, erythematous, and tender to palpation. There was a poorly healing wound on the plantar surface of his left foot. Of note, crepitus was not felt. A point-of-care ultrasound (POCUS) of the left foot was performed which showed extensive cobblestoning without a discrete fluid collection, and deeper \"dirty\" shadowing suggestive of subcutaneous air (Figure 1). When gentle pressure was applied with the transducer, the subcutaneous air mobilized, confirming our suspicion that the \"dirty\" shadowing visualized was indeed subcutaneous air (Video S1). We call this novel sonographic finding \"sonographic crepitus.\" In the emergency department, an X-ray of the patient's foot was performed revealing diffuse soft tissue gas (Figure 2). From the emergency department, he was taken to the operating room for a transmetatarsal amputation. A surgical wound culture grew multiple organisms including Enterococcus faecalis, Bacteroides fragilis, Streptococcus mitis, Streptococcus oralis, and Streptococcus constellatus. Four days later, he was discharged to an acute rehabilitation facility with a wound vacuum. One month after the initial presentation to the emergency department, he was discharged to home care. He was recently discharged from home care services and currently follows with general surgery and wound care specialists as an outpatient, with improvement in his wound healing. The ability to properly operate POCUS and identify these findings requires additional training that may not be ubiquitous.\nOUTPUT:" }, { "from": "agent", "value": "Necrotizing fasciitis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The following case illustrates the performance of one-piece titanium implants for complete functional and esthetic rehabilitation in the esthetic zone. A 49-year-old male patient suffering from glaucoma and hypertension was seeking help at the dental practice with complaints in the upper jaw. The tooth had a hopeless prognosis but the surrounding bone was assessed to be appropriate for implantation (Figure 6(d)). Subsequent to minimal invasive extraction, socket preservation with soft-tissue augmentation by means of a free gingival graft was conducted (Figure 6(a)). Healing occurred uneventful, and soft-tissue dimensions could be preserved (Figure 6(b)). The implantation was performed three months after extraction. To support the alveolar ridge during implantation, a connective tissue pedicle using the roll technique was performed. The connective tissue was prepared from the palatinal area and rotated to the buccal site of the implantation site (Figure 6(c)). After implantation of the one-piece implant (FairOne ; diameter: 5.0 mm and length: 10 mm) (Figure 6(e)), the flap was repositioned and tension-free suturing was secured (Figure 6(f)). A temporary provisional composite crown for esthetic demands was delivered directly after implantation (Figure 6(g)). After implantation, postsurgical radiographs were taken with a proper parallel technique to monitor the bone crest and correct positioning of the implants (Figure 6(h)). One week after uneventful healing, sutures could be removed with interdental papilla remained well preserved (Figure 6(i)). The patient reported only slight pain directly postoperative. The composite crown was replaced with a metal-supported ceramic crown, and after four months of healing, stable soft-tissue conditions without recession formation could be documented (Figure 6(j)). The clinical and radiological situation remained stable even 10 years after intervention with a good prognosis (Figures 6(k) and 6(l)).\nOUTPUT:" }, { "from": "agent", "value": "Chronic apical periodontitis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Neurological morbidity includes hydrocephalus, spinal cord compression, and cognitive decline. While many neurological symptoms have been described, stroke is not a widely-recognized manifestation of MPS I. Accordingly, patients with MPS I are not routinely evaluated for stroke, and there are no guidelines for managing stroke in patients with this disease. We report the case of a child diagnosed with MPS I who presented with overt stroke and repeated neurological symptoms with imaging findings for severe ventriculomegaly, infarction, and bilateral terminal carotid artery stenosis. Direct intracranial pressure evaluation proved negative for hydrocephalus. The patient was subsequently treated with cerebral revascularization and at a 3-year follow-up, the patient reported no further neurological events or new ischemia on cerebral imaging. Cerebral arteriopathy in patients with MPS I may be associated with GAG accumulation within the cerebrovascular system and may predispose patients to recurrent strokes. However, further studies are required to elucidate the etiology of cerebrovascular arteriopathy in the setting of MPS I. Although the natural history of steno-occlusive arteriopathy in patients with MPS I remains unclear, our findings suggest that cerebral revascularization is a safe treatment option that may mitigate the risk of future strokes and should be strongly considered within the overall management guidelines for patients with MPS I. Image Caption and Description: \nImage caption: (Upper) Initial MRI of left MCA overt stroke identified on T2, diffusion, and MRA. (Lower) Two years after right cerebral revascularization demonstrating no new ischemic or infarcted territories and increased right cerebral cortical vascularity. Image description: A 2-year postoperative MRI demonstrated increased cortical vascularity without progressive ischemic changes (Figure 3, Lower panel). Case Report: \nThe patient underwent right-sided indirect revascularization with pial synangiosis and dural inversion, which was well-tolerated without post-operative complication. A 2-year postoperative MRI demonstrated increased cortical vascularity without progressive ischemic changes (Figure 3, Lower panel). At a 3-year follow-up, the patient was clinically well with resolution of paresis and without recurrent symptoms.\nOUTPUT:" }, { "from": "agent", "value": "Mucopolysaccharidosis Type I" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Wound cultures gave negative results upon initial debridement. The initial management consisted of intravenous antibiotics and debridement. The plastic surgery service was consulted on day 12. Negative pressure wound therapy was started immediately following the debridement on day 12. Nanocrystalline silver mesh (Acticoat; Smith & Nephew, St. Petersburg, FL) without the absorbent layer was used as a contact layer (Figs 2c and 2d), and polyurethane foam was used as the wound filler. Because of the difficulty in maintaining a vacuum seal, the NPWT dressing was placed over the entire ear auricle. The external auditory canal was dressed with Xeroform gauze (Fig 3a), and the auricle was incorporated into the dressing (Fig 3c). The dressing was irrigated with sterile water daily through an irrigation tube both to promote exudate clearance and to activate the silver in the dressing. The polyurethane foam was placed directly adjacent to the canal beneath the overlying occlusive dressing (Fig 3c). The wound interface pressure was set to -80 mm Hg, and the dressing was changed and the wound debrided at 3- to 5-day intervals in the operating room. The wound bed was fully granulated after 20 days from the initial debridement and required a total of 7 days of NPWT. It was closed with a meshed, split-thickness skin graft (Figs 4a-4b), and the patient had an uneventful recovery. The patient had a first-stage reconstruction of the ear lobule at 14 months after the injury (Fig 4c) and will undergo 1 more procedure to complete the sulcus restoration and removal of more of the split-thickness graft.\nOUTPUT:" }, { "from": "agent", "value": "Periauricular and Auricular Necrotizing Wound From Brown Recluse Spider Bite, soft-tissue cellulitis, necrosis of the skin of the lateral neck and lower auricular cartilage, methicillin-resistant Staphylococcus aureus infection" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The patient was medicated with antidepressants and anxiolytics without benefit. Her medical history included diabetes mellitus, hypertension, hyperlipidemia, thyroid goiter, and cervical disc hernia. There was no relevant family history or drug abuse. Routine EEG, cerebral CT, and analysis (including thyroid function) were normal. At the psychiatric evaluation, the patient was conscious, oriented, and cooperative. She was anxious, with an apprehensive facial expression. The speech was coherent and focused on her health problems and on her difficulty of having a good night sleep. When asked to detail her complaints, it emerged that patient's symptoms had started at the age of 35 years. Her husband mentioned that every night, during the sleep, the patient suddenly became agitated. He described screaming, fear, bizarre movements of feet and legs, more rarely, movements of upper extremities and, very rarely, complex motor behavior as getting out of bed with posterior falling down (no generalized seizures observed), and perplexity if awakened. These episodes were stereotypic and lasted about 5-10 minutes. No aggressive behavior was observed. No eventual trigger factors were identified. The patient also mentioned that in daytime she felt anxious due to the fear of falling asleep and repeating the same symptoms; that is why she complained of her \"fear to be alone.\" An anticonvulsant treatment with oxcarbazepine was started. Within one week, symptoms remitted completely, allowing her to a good night sleep, which the patient considered an unequivocal improvement. She still mentioned anxiety and fear of being alone; for that, an antidepressant (escitalopram in low dose) was added. One month later, no night episodes occurred; anxiety symptoms also remitted. The patient was referred to neurologist for further observation, exams, and etiological clarification.\nOUTPUT:" }, { "from": "agent", "value": "Epilepsy, Ekbom Syndrome, Mood Instability, Nocturnal Visual Hallucinations" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 6-month-old male patient presented with a fever and cough lasting 1 day. Favipiravir (200 mg/tab) was prescribed as first-line therapy at a dose of 82 mg/kg/day on Day 1 and favipiravir syrup (CRA Favi-Kids; 800 mg/60 ml) at a dose of 29 mg/kg/day on Days 2-5. The bright blue color of the cornea was observed under sunlight (Figure 1). Symptoms improved after 3 days of favipiravir therapy. The cornea returned to normal color on Day 5 after stopping the medicine. An eye examination was performed by an ophthalmologist using a handheld slit lamp 2 weeks after SARS-CoV-2 infection. The patient was able to fix and follow the light in all directions. No blue pigment deposit was observed on the surface of the iris or the anterior lens capsule. The anterior chamber was deep and clear and lacked content. No evidence of fluorescence was observed when a cobalt blue filter was applied.\nOUTPUT:" }, { "from": "agent", "value": "COVID-19, Favipiravir-induced bluish corneal discoloration" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 74-year-old man presented with symptoms of vomiting and abdominal pain for 10 h. His body temperature was 38.1 C; blood pressure, 144/91 mmHg; radial pulse rate, 118 beats/minute. Abdominal examination revealed tenderness and muscular defense in the epigastric fossa. Blood tests showed a white blood cell count of 7470/mm3, and a C-reactive protein concentration of 6.39 mg/dL. Computed tomography (CT) scan revealed a solid mass measuring approximately 14 cm x 7 cm within the pelvis, and free air around the gastric cardia and perihepatic fluid (Fig. 1a-c). These findings suggested peritonitis induced by organ rupture. Emergency laparotomy revealed an approximately 14-cm solid tumor in the jejunum, located 100 cm from Treitz's ligament (Fig. 2). The tumor was perforated, with a hole measuring approximately 5 mm. Segmental resection of the jejunum with the tumor showed that the resected mass was a well-circumscribed tumor, measuring 14 cm x 7 cm and penetrating the jejunum. The solid parenchyma contained an area central necrosis with a fistula to the lumen of the jejunum. (Fig. 3) Hematoxylin and eosin staining showed proliferation of spindle-shaped cells, and immunohistochemical staining showed that the tumor was positive for c-kit and CD34, with approximately 10% of the tumor cells positive for nuclear expression of the proliferation-associated antigen Ki-67. (Fig. Chemotherapy was initiated with a lower dose of imatinib mesylate, but the treatment was discontinued 3 months later due to cough and general malaise. The patient died 22 months after surgery.\nOUTPUT:" }, { "from": "agent", "value": "Acute diffuse peritonitis, Primary gastrointestinal stromal tumor of the jejunum, High-risk GIST of the jejunum, Cardiac insufficiency, Pneumonia, Liver metastases" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The patient's mother was 21 years old with one older son. She tested positive to GBS during the first pregnancy, but tested negative during this one. According to guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynecologists, she did not meet the criteria to receive antibiotic prophylaxis against GBS for this delivery. Her older child had no significant medical issues during his infancy. The patient was transferred to a tertiary referral center for cardiac evaluation and antibiotic treatment. A repeat echocardiogram confirmed the mobile 2.7 mm vegetation from the anterior mitral leaflet, along with mild mitral regurgitation. The decision was made to treat with IV antibiotics and observe progress. On the 7th day of IV antibiotics, the mitral valve vegetation was noted to be smaller, now measuring 1.9 mm. The patient remained asymptomatic at this stage. On the tenth day of IV antibiotics, he had fluctuating conscious levels with focal seizure activity lasting 20-30 s at a time. His fontanelle was noted to be bulging. He had a code called and was transferred and stabilized in the intensive care unit. The next morning in the intensive care he became unstable with bradycardia and hypertension with a systolic pressure of 90 and low diastolic pressure of 25. Over the following 2 months, he underwent repeat neurosurgical procedures and had a flap of skull removed to allow decompression of the brain. He completed a 6-week course of IV Benzyl-penicillin with complete resolution of the vegetative lesion and only mild mitral regurgitation.\nOUTPUT:" }, { "from": "agent", "value": "Infective Endocarditis, Late Neonatal Group B Strep Sepsis, Intracranial Hemorrhage, Mycotic Aneurysm, Right Hemiplegia" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Here, we reported ICC in a 59-year-old Japanese woman with back pain, who had been referred to our hospital by her family physician. There were no special notes in her past medical, drug, and family history, or in her relevant physical examination and other significant clinical findings including no alcoholic habits. At admission, the CEA and CA19-9 levels were 910.5 ng/mL and 1965.3 U/mL, respectively. There were no evidences of hepatitis infection. (Table 1). Computed tomography (CT) findings revealed the presence of two low-density masses 68 mm in diameter in hepatic segments 2 and 3 and 72 mm in diameter in segment 8, with early enhancement of the peripheral area as the main loci. 1, Fig. 2). After hepatic arterial chemoembolization therapy with drug-eluting beads (DEB-TACE), angiographic-subsegmentectomy (AS) and systemic chemotherapy with Gemcitabine and S1 were performed, tumor shrinkage was confirmed, and the tumor markers decreased to just above the normal range (Fig. 3). Thus, the patient was referred to our hospital for surgery. 4). After the simulation of hepatic resection, left lateral segmentectomy and 8th subsegmentectomy were performed (Fig. 5). Blood loss was 600 mL, and the operative time was 470 min. Pathological examination after R0 resection revealed that no viable neoplastic cells remained in the specimen (Fig. 6). The patient was discharged on day 29 after surgery without complications, and no chemotherapy was administered. Two years and 10 months after the surgery, the patient is alive without relapse (Fig. 7).\nOUTPUT:" }, { "from": "agent", "value": "Intrahepatic cholangiocarcinoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: He presented with bilateral class I molar relation with permanent dentition. In phase I, maxillary expansion was planned to provide room for labial tipping of 11, 12 with removable appliance (Fig. 7). Postinsertion instructions were given and patient was advised soft diet. Seven days after wearing of appliance, the jack screw was activated. The activation method was demonstrated and instructed to the patient. Patient was reviewed every fortnight. Two months later enough room was achieved for 11, 12. In phase II and fixed segmental orthodontic therapy with Begg's brackets for labial tipping of 11, 12, was planned. Begg's brackets were bonded from 14 to 24. NiTi wire of 0.014 inch with ovoid arch form was engaged (Fig. 8). Additional space was gained through mesial stripping of 13 followed with fluoride varnish application. The jack screw was sealed with self-cure and was used as a retainer appliance and in order to obtain the occlusal clearance. At each fortnight, the patient was reviewed and checked for the correction and oral hygiene status. Rapid correction of the incisor relationship occurred. Debonding was done three weeks later, when the anterior-posterior arch relationship with respect to 11and 12 were corrected (Figs 9 and 10). Hawleys appliance was delivered for retention.\nOUTPUT:" }, { "from": "agent", "value": "Cross bite" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 48-year-old woman (weight 90.5kg, BMI 34.25 kg/m2) with past medical history of well controlled hypertension and hypothyroidism underwent abdominoplasty with repair of rectus diastasis and bilateral breast implantation in October 2021. The procedure was uneventful, and patient was discharged home. Patient reported that she had felt short of breath since her surgery, and her symptoms had become progressively intolerable. She also complained of poorly controlled pain from her surgical wounds. Arterial blood gas showed acute hypercapnia with pH 7.25 and PaCO2 56. Computed Tomography (CT) angiography was performed and was negative for pulmonary embolism. Lung windows were significant for bilateral lower lobe lung atelectasis with prominent reduction of lung volumes (Fig. 1). Chest x-ray also demonstrated a significant reduction in lung volumes when compared to pre-operative films (Fig. 2a and b). Patient was managed with non-invasive positive pressure support and admitted to the Medical Intensive Care Unit. Due to persistent respiratory acidosis and breathing fatigue, patient was eventually intubated and supported on volume-cycled ventilation. Initial ventilator settings were tidal volume (TV) 380 ml, respiratory rate (RR) 20 and positive end expiratory pressure (PEEP) of 5 cm H2O. Arterial blood confirmed correction of acute hypercapnia. Peak inspiratory pressure (PIP) was 40 cm H2O, and plateau pressure (Pplat) was 32 cm H2O. Static compliance was calculated to be 13 ml/cm H2O. Bladder pressure measurements were performed which showed borderline to grade 1 intraabdominal hypertension (11-14 mm Hg). Over the next 48 hours, the patient was unable to tolerate pressure support breathing consistent with ongoing ventilatory failure and repeat chest x-rays showed persistently low lung volumes. On day 4 of her ICU stay, patient was taken to the operating room for reversal of abdominoplasty. The midline muscle repair was released and removed with an expansion and loosening of the fascia, with an almost immediate discernible improvement in inspiratory pressures. By the following day, static compliance had improved to 24 ml/cm H2O and gradually improved to the mid-30s by the time she was successfully extubated. Postoperative chest x-ray (Fig. 2c) showed restoration of lung volumes.\nOUTPUT:" }, { "from": "agent", "value": "Severe acute respiratory failure" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The extent of phenotypic manifestations also depends on cell mosaicism, the proportion of 46,X,dic(X;Y)/45,X cells, and their tissue distributions. The significant clinical impact of the 45,X cell line on the development of different organs has been reported. For example, Kaprova-Pleskacova et al. reported 46,X,psu dic(Y) in a girl with another cell line 45,X and Portnoi et al. described a patient with the mosaic karyotype 45,X/46,X,der(X)t(X;Y)(p11.4;p11.2). In our patient, the SRY gene was only present in the dic(X;Y) cells, which constituted 65 % of the cells in the peripheral blood. We infer that SRY-positive cells were predominant in the gonadal tissue. The 45,X cell line was not identified by FISH in the bone-marrow cells of our patient. We assume it had a later postzygotic origin in the peripheral blood cells, and did not influence the development of the gonads or other organs. The malformation of the right external ear after a scissors-inflicted injury during a haircut is very uncommon. However, ear deformities or hearing failure have been reported as the consequences of SHOX deletions in women with Turner's syndrome, although rarely in cohorts of LWD patients. However, to our knowledge, cell dysplasia induced by the healing process of a cut wound has not been reported. The influence of SHOX expression on cell proliferation and viability was demonstrated by Marchini et al.. Generally, wild-type SHOX induces cell-cycle arrest and apoptosis by altering the expression of other cell-cycle-regulating proteins in humans (RUNX2, SOX2). In the growth plate, hypertrophic chondrocytes express SHOX, which exerts a potent antiproliferative effect. A study of in vitro-cultured human auricular chondrocytes confirmed the overexpression of the RUNX2 gene, which implies hypertrophy. SHOX-mediated cell-cycle arrest is altered when SHOX expression is reduced, and we hypothesize that the hyperplasia of the auricular cartilage could have been caused in vivo by abnormal levels of cell growth inhibitors, mediated by SHOX haploinsufficiency.\nOUTPUT:" }, { "from": "agent", "value": "Primary Myelofibrosis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 60-year-old man presented to the emergency room for a second time within one week for a 2-week history of intense lower quadrant abdominal pain. The patient was not febrile and had no leukocytosis. A CT study showed an enlarged distal appendix with a 1.8 x 3.8 cm fluid-like or cystic lesion with mild mural thickening (Figure 1A, Figure 1B). There was also mild wall thickening of the more proximal appendix. There were no enlarged periappendiceal lymph nodes. The patient had a normal appendix on a CT exam obtained approximately one and a half year before (Fig. 2). The patient had a history of previous small bowel resection and exploratory laprotomy 9 and 22 years ago, respectively. The reason for these surgeries was small bowel obstruction, otherwise unknown. Due to prior surgeries and adhesions on laproscopy, open appendectomy was performed. The distal appendix was found to be dilated with tan-pink and markedly eroded mucosa with a wall thickness of 0.3 cm. The remainder of the resected appendix had tan mucosa and wall thickness of 0.7 cm.\nOUTPUT:" }, { "from": "agent", "value": "Goblet Cell Carcinoid, Acute Appendicitis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A1 and A2) with Pseudomonas aeruginosa and Aspergillus fumigatus colonization, as well as multiple hospitalizations for respiratory infections. At the time of admission, she weighed 52 kg was 165 cm tall and had Forced Expiratory Volume in 1 second (FEV1) of 720 cc (21%) and Total Lung Capacity (TLC) of 3650 cc (79%). She was also hypoxemic, requiring oxygen support therapy. The patient entered the list for lung transplantation in February 2017, with low priority, due to her clinical and functional stability. For better understanding, we perform a timeline (Table 1). In October 2018, the patient was admitted to the Intensive Care Unit (ICU) for dehydration secondary to diarrhea, with subsequent acute renal failure and oligoanuria requiring continuous venovenous hemodiafiltration (CVVHDF). At the ICU, she developed a respiratory infection (Fig. B1 and B2) and septic shock requiring invasive mechanical ventilation. Antibiotic therapy was started with ceftolozane/tazobactam and ciprofloxacin considering an antibiotic sensitivity test (AST) positive for Pseudomonas aeruginosa infection. Due to worsening respiratory failure, it was necessary to start venovenous extracorporeal membrane oxygenation (VV-ECMO). After failure of weaning from mechanical ventilation, the patient underwent tracheostomy, maintaining invasive mechanical ventilation, awake-ECMO and CVVHDF. The absence of improvement in renal function granted formal indication for combined lung-kidney transplantation (CLKT). During the 32 days of ICU stay, 27 of them under \"awake-ECMO,\" the patient suffered hemothorax and hemopericardium secondary to anticoagulation, which evolved to cardiac arrest that was successfully reversed. Physical rehabilitation was limited at this point, and only in-bed mobilization exercises were feasible.\nOUTPUT:" }, { "from": "agent", "value": "Cystic fibrosis, AA amyloidosis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 59-year-old male presented with severe constipation, bloody stool and a loss of 10% of his body weight over 3 months. The patient's medical history included diabetes mellitus and angina pectoris. His abdomen was soft and exhibited no tenderness on examination. Laboratory findings revealed a hemoglobin concentration of 14.7 g/dL. Serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels were 130.7 ng/mL and 67.3 U/mL, respectively. Colonoscopy revealed a tumor with ulceration in the rectum (15 cm above the anal verge). Abdominal computed tomography revealed that the wall thickness of the rectum showed extensive invasion of the bladder wall and enlarged regional lymph nodes (Fig. 1). Distant organ metastasis, including liver metastasis and peritoneal dissemination, was not observed on the preoperative radiological findings. Thus, the lesion was assigned a preoperative classification of T4bN2bM0 stage IIIC according to the 8th Union for International Cancer Control (UICC) guidelines. Therefore, the patient initially underwent external loop colostomy of the transverse colon. Next, the patient received chemotherapy including FOLFOX plus bevacizumab. After 12 cycles of chemotherapy, the tumor size was markedly decreased, and all lymph node metastases had disappeared. Furthermore, extensive invasion between the rectal tumor and bladder wall was not observed (Fig. 2). Subsequently, the patient underwent conventional resection of the rectum with D3 lymph node dissection and closure of the colostomy. 3, Fig. 4a, b). Thus, the lesion was assigned a final classification of ypT0N0M0 stage 0. The patient's postoperative recovery was uneventful, and he was discharged from the hospital after 11 days. The patient did not exhibit recurrence during the 36-month follow-up period. The ethics committee of the Tsukuba Medical Center Hospital approved this study (#2019-010). Informed consent was obtained for the publication of this case from the patient concerned.\nOUTPUT:" }, { "from": "agent", "value": "Locally advanced rectal cancer" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 52-year-old woman of Cuban origin was referred to our clinic for skin hardening for over 15 years. Her past medical history was pertinent for mild asthma and severe glaucoma. On skin examination, there were three ill-defined indurated, depressed plaques measuring 10 cm x 15 cm on the left mid-back, 7 cm x 7 cm on the left posterior shoulder, and 15 cm x 3 cm linear induration extending to the left forearm (Figure 1(a) and (b)). Examination of the oral mucosa and genitalia was unremarkable. Workup, including complete blood count, chemistry, renal and liver function tests, borrelia serology, antinuclear, and systemic sclerosis specific antibodies, was normal, except for mild eosinophilia. A punch biopsy of the left upper back lesion demonstrated a normal epidermis and superficial dermis. There was non-inflammatory extensive sclerosis in the deep dermis, subcutaneous tissue, and fascia. Pre-treatment screening for hepatitis B, hepatitis C, human immunodeficiency virus, QuantiFERON-TB Gold, and strongyloides serology were performed and subsequently revealed the presence of strongyloides antibodies, which were confirmed by fecal culture. The patient was treated with oral ivermectin resulting in a resolution of her respiratory symptoms and normalization of the eosinophil counts. When the patient returned to our clinic, a new linear depressed plaque on the mid-forehead was noted (Figure 1(c)). She also complained of worsened vision in the right eye and new-onset migraine-type headache. She was referred to her treating ophthalmologist, and a magnetic resonance imaging (MRI) of the brain was ordered. The MRI showed no skeletal or parenchymal abnormalities. Ocular examination revealed stable glaucoma. Oral prednisone 1 mg/kg/day (tapered over 3 months) and methotrexate 20 mg/week with folic acid and vitamin D supplementation were prescribed with regular follow-up. After 3 months of therapy, the size and induration of the truncal plaques had improved (Figure 2(a) and (b)). The linear groove over her forehead remained stable (Figure 2(c)). No new episodes of migraine headaches have occurred.\nOUTPUT:" }, { "from": "agent", "value": "Adult-onset en coup de sabre scleroderma, Linear localized scleroderma profunda, Eosinophilic fasciitis, Strongyloidiasis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: His history included dyslipidemia, type 2 diabetes mellitus, and coronary artery disease that had been treated with right coronary artery stenting 10 years ago. On arrival, he had a blood pressure of 132/58 mm Hg, heart rate of 50 bpm, and oxygen saturation of 98% on room air. A 12-lead ECG obtained on admission (Figure 1) shows bradycardia with a slow ventricular rate of 50 beats/min. The QRS duration is 90 ms, and the QT and QTc intervals are 402 and 391 ms, respectively. Serial highly sensitive cardiac troponin I levels were less than 16 ng/L (reference range 0-45 ng/L). All the laboratory data including the inflammatory markers and electrolytes were within normal limits. A repeat ECG (Figure 2) obtained 10 minutes after his initial presentation showed resumption of sinus rhythm and complete resolution of ST segment elevation in the inferior leads. The transthoracic echocardiogram showed normal biventricular function without any regional wall motion abnormalities. A regadenoson myocardial perfusion imaging study was negative for any reversible ischemia.\nOUTPUT:" }, { "from": "agent", "value": "Atrial Repolarization Waves Mimicking Inferior Wall ST Segment Elevation Myocardial Infarction, Ectopic Atrial Rhythm, Musculoskeletal chest wall pain" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 57-year-old male presented with abdominal pain, fatigue, high fever, and weight loss of 6 kg for two months. His previous medical history was unremarkable. Physical examination revealed pain on the left side of the abdomen and hepatosplenomegaly. Laboratory findings were as follows: erythrocyte sedimentation rate 86 mm/h, leukocyte 12600/microl, neutrophile 7200/microl, thrombocyte 510000/microl, monocyte 2100/microL, hemoglobin 10.2 g/dl, hematocrit 30%, MCV 74.6 fl, and lymphocyte 2200/microl. Computed tomography (CT) of the chest showed multiple mediastinal lymphadenopathies (maximum size 15 mm) and bilateral apical fibrotic bands. A uniform-density mass lesion of 70 mm that filled retrovesical and left pelvic area was detected in abdominal CT. The lesion surrounded superior part of sigmoid colon and there were multiple lymph nodes in the retro-vesical, celiac, para-aortic and para-iliac areas (Figure 1). Histological examination of samples that were obtained during diagnostic laparotomy showed epithelioid granulomas, Langhans? type multinucleated giant cells, and caseous necrosis (Figure 2). Lowenstein-Jensen culture of samples confirmed the presence of TB. Antituberculous therapy comprising rifampicin, isoniazid, ethambutol and pyrazinamide was initiated and continued for two months, and the patient was maintained on rifampicin and isoniazid for 6 months. In the sixth month follow-up of patient, cerebrovascular hemorrhage developed. The patient died due to this.\nOUTPUT:" }, { "from": "agent", "value": "Tuberculosis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 44-year-old male with a history of high blood pressure was admitted with the clinical symptoms of progressive dysphagia and hoarseness in the course of 2 days. Computed tomography scan showed a circumferential middle-third esophageal growth, which was ~5 cm long, with significant regional lymphadenopathy but without extraesophageal spread. There were enlarged mediastinum and paracardiac lymph nodes in the computed tomography image, suggesting positivity for malignancy as well (Figure 3). Unfortunately, the patient lost the opportunity to perform esophagectomy. Taking into account the poor prognostic factors such as transmural extension and lymph node positivity, the patient was given two cycles of Doxorubicin plus cisplatin. During the second course of chemotherapy, he discovered that his right ring finger had a protrusion for the first time, which was soft, cystic and 2.0x1.8 cm in size (Figure 4). Initially, the patient thought that this protrusion was caused by swelling which occurred 1 day prior. Radiologic studies revealed no bony metastasis (Figure 7). A subsequent metastatic work-up did not reveal any other site of metastases. Then, the patient underwent phalangectomy of his right ring finger. He was planned to undergo palliative chemotherapy and radiotherapy to the metastatic sites, but unfortunately his condition started deteriorating and he succumbed to the disease within 2 months of diagnosis of metastasis.\nOUTPUT:" }, { "from": "agent", "value": "Squamous cell carcinoma of the esophagus, Metastatic squamous cell carcinoma in the right ring finger" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 60-year-old man was referred to our department of endocrinology for the evaluation of a neck mass. His past medical history included ischemic cardiomyopathy, hypertension, and hyperlipidaemia, and he underwent right nephrectomy 23 years earlier for RCC classified as stage 1 (T1b). He smoked 20 cigarettes/day, and his treatment included statin, salicylic acid, angiotensin-converting enzyme inhibitor, and diltiazem. In July 2019, he complained of a right cervical mass. Ultrasound (Figure 1) revealed a large hypoechoic polylobular nodule in the right lobe with a dense central vascularisation, classified as EU-TIRADS 5. FNA cytology was performed and showed normal cells and was classified as Bethesda 2. The patient was lost to follow-up and came back in July 2020 with the same symptoms. There was no hoarseness. On clinical examination, the thyroid was enlarged and a hard nodule was palpable in the right lobe, without cervical adenopathy. Ultrasound found the same nodule measuring 42 x 22 x 28 mm. There were no microcalcifications. Biologically, the thyrotropin level was at 0.42 mU/L, the free T4 level was normal, and there were no thyroperoxidase antibodies. The thyroglobulin level was normal at 27 pg/L. He underwent total thyroidectomy. The histopathological examination showed large clear cells positive for CD10, vimentin, CK19, and PAX 8 with lymphatic and venous metastasis (Figure 2). Thyroid Transcription Factor 1 (TTF1) was completely negative, ruling out a primary tumour of the thyroid. The postoperative course was uneventful, and bone scintigraphy and computed tomography also revealed the absence of any other metastases. External radiation completed the treatment. Radiation was delivered to a total dose of 50 Gy in 25 fractions at 2 Gy per day 5 days per week. Six months later, the patient remained free of recurrence.\nOUTPUT:" }, { "from": "agent", "value": "Solitary Intrathyroid Metastasis, Renal Cell Carcinoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Hence, 24 months after surgery, the child was referred to the osteopath, who examined the functional status of the musculoskeletal apparatus and the pelvic region. The main somatic dysfunctions were in the pelvic floor, which presented with an unbalanced tissue texture between the two sides, as well as in the sacroiliac region, linked with an asymmetric passive movement capacity of the sacrococcygeal region. The child received 4 OMTs that were scheduled once a month, each with a duration of 45 min. Indirect manual techniques were used for management of the somatic dysfunctions. These types of technique are characterized by passive movement of the dysfunctional region in a position of less tissue tension. Along with the pharmacological regimen, the child mainly received balanced ligamentous tension treatment of the sacroiliac joint, balance and hold treatment of the sacrococcygeal ligaments and counter-strain treatment of the pelvic floor (Fig. 1). At the end of each OMT session, a balance treatment between the subdiaphragmatic region and the pelvic floor was administered together with craniosacral therapy. During the entire duration of the OMT, laxative therapy was continuously monitored by the paediatrician and adjusted according to response. After the first OMT, an intermittent slight increase in the child's defaecation frequency was reported by the parents, who managed the incomplete evacuations with enemas and senna. Moreover, after the third OMT, an increase in defaecation frequency was observed (from 2 to 3), associated with a reduction of the intense colic abdominal pain, which led to interruption of the laxative regimen according to the indication of the paediatrician. Enemas were administered by the parents when needed, decreasing to 2 applications per week. In addition, after the third and fourth OMTs, the discharge frequency improved, together with an increase in frequency from 3 to 4 evacuations per week, respectively, leading to completely autonomous defaecation at the end of the treatment period. The pseudoincontinence stopped 3 months after the OMTs began, observing a modification on the Bristol Stool Chart from type 6 to type 3. Enema kept being used only sporadically with a time period of 2-3 months between each application (Fig. 2).\nOUTPUT:" }, { "from": "agent", "value": "Severe Postoperative Chronic Constipation, Anorectal Malformation" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 29-year-old woman had a history of repeated cough, expectoration, wheezing, and dyspnoea for 2 years. Her peripheral blood tests at this visit revealed an increased peripheral eosinophil count (18.7%, 1.86 x 109/L). Her routine blood tests during vaginal delivery 6 months ago showed no abnormally elevated eosinophil count or ratio. Her blood gas analysis (unoxygenated) results were pH 7.45, PCO2 34 mmHg, PO2 63 mmHg, and HCO3:23.6 mmol/L. Physical examination revealed rough wheezing over both sides of the lung field. Bronchoalveolar lavage (BAL) showed 16% eosinophils. Chest CT images revealed multiple ground-glass opacities in the regions of both lung fields (Fig. 2a-c). BAL showed 17% eosinophils (260 x 105 mL) (Fig. 2d). After receiving an intravenous drip of 40 mg of methylprednisolone for 5 days, the patient's symptoms improved significantly, and the treatment was followed with inhalation of 160 microg of budesonide and formoterol fumarate powder twice daily. The patient's chest CT images were reviewed after 1 month (Fig. 2e-h). The changes in lung function are shown in Table 1. The patient had a history of allergic reactions to \"penicillin\" and \"levofloxacin\".\nOUTPUT:" }, { "from": "agent", "value": "Severe, eosinophilic asthma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 5-month-old baby was admitted to the hospital with a 2-day history of a high fever, influenza-like symptoms, and a dry cough but no gastrointestinal or neurological symptoms. The vital signs were: temperature 39.1 C, respiratory rate 40 per minute, blood pressure 80/50, and oxygen saturation 98%. The fever did not resolve, while respiratory specimens and stool did not grow any significant isolate on the corresponding bacteriological media. The patient was previously noted as a case of \"undiagnosed failure to thrive\" and scheduled for cardiology assessment since the family history suggested the possibility of a congenital heart disease. The microbiology laboratory noted a positive blood culture bottle, which initially did not yield an organism in gram staining. There was also no growth found on the routine subculture media in the first day. However, after 48 hours, scanty growth was detected, which was oxidase negative and had a microscopic appearance of gram-negative coccobacilli. Routine processing could not identify the organism. Then, further clinical data obtained from the attending physician suggested a possible chronic morbidity that could predispose the patient to an opportunistic pathogen; the colonies were subcultured on multiple laboratory media, including Skirrow's media, which were incubated microaerophilically at 25 C, 27 C, and 42 C for 48 hours. Heavy growth was detected on Skirrow's media at both 25 C and 37 C but not at 42 C, with the typical colonial morphology of Campylobacter (Figure 1). Further testing showed strong oxidase-positive and typical reactions for C. fetus. The VITEK 2 system (bioMerieux Inc., Craponne, France) gave 99% identification accuracy of the colonies obtained from the Skirrow's media but failed to identify the organism grown on routine blood culture plates. Sensitivity testing was done using the VITEK 2, which showed susceptibility to ampicillin, cefuroxime, chloramphenicol, gentamicin, and imipenem. Imipenem was recommended, and the patient remained afebrile from the second day of imipenem treatment, then was discharged in asymptomatic condition 18 days post-identification of the organism, after completion of 22 days of antimicrobial therapy.\nOUTPUT:" }, { "from": "agent", "value": "Bacteremia caused by Campylobacter fetus, Bronchopneumonia, Ventricular septal defect" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 76-year-old Caucasian man was referred to our institution for evaluation of a large open scalp wound, secondary to excision and prior radiation of squamous cell carcinoma (SCC) of the left temporal scalp (Figure 1). Prior to this he had history of multiple skin lesions including actinic keratosis and basal cell carcinoma located on the chest, back, head, and upper extremities. There was no previous history of melanoma. He was diagnosed with SCC approximately 10 years prior to evaluation by our team. Treatment with Mohs micrographic surgery and a course of radiation therapy were administered at that time. He then developed a local recurrence and a metastasis to the parotid gland approximately 5 years later. This was treated by parotidectomy with facial nerve dissection, excision of the temporoparietal lesion, and radiation therapy. His current wound failed to heal since that time. The defect in the temporoparietal region was full-thickness, with exposed calvarium, without the presence of periosteum. He underwent surgical excision of the defect, including craniectomy, due to apparent involvement of the dura (Figure 2). A left latissimus dorsi myocutaneous flap was harvested for coverage of the defect (Figure 3). Due to flap inset considerations the skin island was removed from the latissimus muscle and was de-fatted. The muscle flap was inset and the full-thickness skin graft, taken from the original donor site, was chosen to cover the free flap (Figure 4). He followed up in our clinic 1 week after discharge, and again at 3 weeks, through which time he remained on IV antibiotics. There were no complications and he recovered well. Approximately six months later, he underwent cranioplasty for reconstruction of his calvarial defect. The patient recovered well, and had no initial complications. At this time he was scheduled for full skin cheques every 3 months at the dermatology clinic due to his other dermatologic issues related to actinic keratosis, basal cell carcinoma, and surveillance for recurrence of SCC. Approximately 19 months following his free flap reconstruction, a pigmented lesion located centrally within the skin graft overlying the flap was discovered (Figure 5). A biopsy was taken which showed atypical melanocytic proliferation and the lesion was excised with wide margins. The defect was closed primarily without any complications. As this was in the centre of the flap and skin graft, it necessarily arose in the transferred tissue.\nOUTPUT:" }, { "from": "agent", "value": "Primary melanoma in situ" } ]