Datasets:

hippocrates

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Multicare_common_train

like 0

[ { "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 50-year-old African-American postmenopausal woman presented to the hospital with a 1-h history of mild chest discomfort associated with nausea and diaphoresis. An electrocardiogram showed 2-mm inferoapical ST segment elevations (Fig. 1). The Emergency Medical Service was called and she received aspirin 325 mg. Upon presentation to our emergency department, she had improved symptoms. She was initially in mild distress and pale in appearance with a blood pressure of 179/103 mmHg and a respiratory rate of 12/min. Her medical history was notable only for depression. However, she had no prior history of hypertension or hyperlipidemia. The patient had recently stopped smoking, drank wine occasionally and denied any illicit drug use. She only took bupropion for depression and smoking cessation. Her first Troponin I was 0.073 ng/ml (normal range: 0.0-0.034 ng/ml). 2) without any atherosclerotic changes in the right or left coronary arteries. The patient remained hemodynamically stable without worsening of her symptoms, laboratory or electrocardiogram findings. The decision was made to manage conservatively with close monitoring. She was started on aspirin, unfractionated heparin, atorvastatin, metoprolol tartrate, lisinopril and intravenous nitroglycerin to help control her blood pressure. During the patient's 6-day hospitalization, she remained asymptomatic. Troponin I peaked at 7.6 ng/ml and rheumatologic work-up including anti-citrullinated protein antibodies, antinuclear antibody and anti-neutrophil cytoplasmic antibodies was negative. An electrocardiogram prior to discharge revealed persistent ST elevation in the previously involved leads (Fig. 3), whereas her echocardiogram showed akinesis in the apical region with an ejection fraction of 61%. On outpatient follow-up, the patient was clinically asymptomatic and no repeat angiography was done.\nOUTPUT:" }, { "from": "agent", "value": "Spontaneous coronary artery dissection" } ]

[ { "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 next morning starts similarly with an early morning social over coffee. Groups of six participants are assigned to separate classrooms where we are greeted by two faculty members. This is the unfolding case, and the faculty members are to serve as facilitators to guide us. We are presented with a case study on finding biomarkers for a new cancer drug that reads like a story. There is a protagonist, several supporting characters, a clear plot line, and it's actually quite engaging. The dilemma presented feels like a puzzle that I really want to solve. The facilitators sit silently at the table, while we begin our discussion. Within minutes our entire group is speaking over each other, and each of us is offering a different opinion; each of us insistent that ours is the best way forward. After several minutes of this cacophony, I ask the facilitators if we are on the right track. They smile and suggest we begin by ensuring that everyone in the group understands the terminology in the case, and precisely what the question or dilemma is. Assuming we all understand the topic seems to be our first mistake. Once we reviewed the case and all understood the tasks at hand, the facilitators suggest we spend a few minutes familiarizing ourselves with each other's professional expertise. Amongst the other participants, there is a basic scientist, an epidemiologist and someone who works in marketing for pharmaceutical companies. Like me, these three participants have never seen a patient professionally. The final two participants are physician researchers involved in clinical trials. Having a better handle on the various skills we had around the table, we begin to brainstorm the different angles of the problem. As a lab scientist, my thoughts immediately swing to the in vitro and in vivo experiments that must be done to better understand the biologic question. However, I soon realize that there is much more at stake and that the lab component is merely one tiny slice of a much larger pie. The case unfolds over three separate sessions. While I'm able to contribute to the conversation at the outset, I find myself reserved and quiet when the group begins to discuss issues around intellectual property, funding, clinical trials, patient involvement, companion diagnostics, ethics, and regulation. This case is much more complex than I had initially thought and I'm thankful we have so much diverse expertise sitting around the table.\nOUTPUT:" }, { "from": "agent", "value": "No diagnosis is mentioned in this 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: DC is a 53-year-old male with a 20-year history of obesity who weighed 404 lbs and had a BMI of 65 kg/m2 prior to surgery. His comorbid diseases included hypertension, congestive heart failure, Pickwickian syndrome, venous insufficiency, and asthma. Preoperatively, he underwent pulmonary function testing (which revealed chronic obstructive pulmonary disease), lower extremity duplex ultrasonography (negative), and a left heart catheterization (negative). After the initial laparoscopic port was placed, it was decided that completion of the laparoscopic procedure was not feasible due to the patient's body habitus, and his procedure was converted to an open Roux-en-Y gastric bypass, using a retrocolic approach and an EEA-21 stapled gastrojejunostomy. The operation was uncomplicated; a leak test with air was negative, and a gastrostomy was placed. He had an uneventful postoperative course and was discharged on the fourth postoperative day. He presented 18 days following surgery with collapse and shortness of breath. He was suspected of having a pulmonary embolus and was admitted to the intensive care unit. Because angiography was technically not feasible due to his weight and spiral computed tomography (CT) would pose a significant risk of nephrotoxicity given an elevated creatinine, the patient was given empiric thrombolytic therapy in addition to anticoagulation, fluid hydration, and inotropic support of his heart. Over the ensuing period, he developed abdominal distension with small bowel obstruction and a profoundly septic state. A small bowel resection was performed. The patient subsequently improved and was discharged 9 days later.\nOUTPUT:" }, { "from": "agent", "value": "Acute mesenteric venous thrombosis" } ]

[ { "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 70-year-old man presented with fatigue, dyspnoea, and weight loss since two weeks. There were no cough and haemoptysis. He was not using any medication and has never smoked. The medical history was significant for temporal giant cell arteritis (GCA) two years earlier, which remained in remission after nine months of corticosteroids. Eight years earlier, spirometry was normal. His family history was significant for chronic obstructive pulmonary disease (COPD) in his father, sister, and brother, while his brother and sister never smoked. Anti-MPO ANCA associated glomerulonephritis was diagnosed based on impaired renal function (eGFR CKD-EPI 14 mL/min/1.73 m2) with glomerular erythrocyturia, elevated inflammation parameters, and anti-MPO ANCA antibodies (15 U/L). The kidneys appeared normal on abdominal ultrasound, with an abdominal aorta of 2.6 cm. No kidney biopsy was performed. Cyclophosphamide 100 mg q.d. and prednisolone 60 mg q.d. were initiated. The symptoms remitted, the anti-MPO ANCA titre decreased to <1 IU/mL, and renal function improved to an eGFR of 40. The treatment was tapered and discontinued after one year. Eighteen months after the diagnosis, he presented with severe back pain of sudden onset since two days. Blood pressure was 170/82 mmHg, peripheral pulsations were normal, and no bruits were heard. Visceral perfusion and renal perfusion were adequate. The aorta was dilated up to 4.5 cm at the level of the diaphragm. The right subclavian, left coronary, bronchial, splenic, and celiac arteries were elongated and dilated. The CT scan showed signs of pulmonary emphysema. The anti-MPO ANCA titre remained negative. His renal function was stable and his urine analysis was normal.\nOUTPUT:" }, { "from": "agent", "value": "Alpha-1 Antitrypsin Deficiency, MPO-ANCA Associated Vasculitis, Aortic Dissection, Large vessel vasculitis" } ]

[ { "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 86-year-old man presented to our hospital for endoscopic biliary stone removal. The patient had a history of postoperative gastric cancer following distal gastrectomy and Billroth I reconstruction, as well as hypertension, and had been taking oral medications, such as nifedipine, amlodipine, and esomeprazole. Six days prior to the presentation, the patient underwent endoscopic papillary sphincterotomy at a different hospital. The patient was discharged with the advice of follow-up for biliary stone removal once the cholangitis subsided. The patient was admitted to our hospital for endoscopic biliary stone removal. Endoscopic retrograde cholangiopancreatography was performed the next day. Although the abdominal radiograph showed that the patient had a double-pigtail stent with a loop diameter of approximately 24 mm (Figure 1), the stent could not be visualized during endoscopic observation of the papilla, indicating that the stent had migrated into the bile duct where its looped end was likely caught within the papilla (Figure 1). Stent retrieval was attempted using various balloon and basket catheters; however, it proved challenging and was unsuccessful owing to the narrow papilla. Therefore, endoscopic papillary large balloon dilatation (EPLBD) was performed, wherein the papilla was dilated to a diameter of 12 mm (Figure 2). Grasping forceps were inserted into the bile duct, and the stent was successfully grasped and retrieved through the papilla (Figure 3). EPLBD improved the maneuverability of grasping forceps within the bile duct, ensuring a reliable grasp of the distal end of the stent, and eliminating resistance during extraction. Biliary calculi were also removed, and the treatment was completed without complications. The patient resumed eating the next day, intravenous fluids were stopped the same day, and the patient was discharged on a subsequent day.\nOUTPUT:" }, { "from": "agent", "value": "Cholangitis due to common bile duct stones" } ]

[ { "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 boy on CAPD with 4 exchanges per day (1000 mL/body surface area, 2 times 1.36% and 2 times 2.27% glucose solution) for 87 months was admitted to the hospital with severe bone pain and fatigue. Erythropoietin, iron, antihypertensive drugs, calcitriol, and calcium containing phosphate binder had been administrated but the patient was incompatible with his medication. He has been followed by another center for last 2 years unregularly. He was pale and growth retarded. Physical examination revealed tachycardia, tachypnea, hypertension, and edema. Laboratory findings were determined as follows: hemoglobin 5.4 g/dL, hematocrit 22%, serum urea 382 mg/dL, creatinine 9.8 mg/dL, albumin 3.1 g/dL, calcium 10.6 mg/dL, inorganic phosphorus 8.6 mg/dL, calcium-phosphorus product 91.1 mg2/dL2, iPTH 589 pg/mL (normal 9.5-75), and CRP 5.6 mg/dL (normal 0-0.8). Radiologic examination has been performed owing to severe pain on wrists and ankles. He was transferred to hemodialysis because of ultrafiltration failure. Medical treatment was rearranged according to his clinical and laboratory findings. Calcium containing phosphate binder was changed to calcium-free phosphate binders. His complains subsided and serum phosphorous level decreased gradually.\nOUTPUT:" }, { "from": "agent", "value": "Vascular calcification" } ]

[ { "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 is a 38-year-old male with a medical history of hydrocephalus, spastic quadriparesis and seizure onset at the hospital manifested as several minutes of whole-body stiffening and rhythmic shaking. This event occurred secondary to a seizure that hospitalized him in which he fell out of his wheelchair and was found by his father. He was found face down with associated tongue biting. Patient stated that he had a similar episode when he was 18 years old but never this severe. The only other variables between February and May were albumin that decreased from 4.2 to 3.7 g/dL and alkaline phosphatase that increased from 94 to 138 U/L. On the new medication regimen of lacosamide and gabapentin, the patient returned to baseline with no other major seizures one year later.\nOUTPUT:" }, { "from": "agent", "value": "Phenytoin Toxicity, Focal Epilepsy" } ]

[ { "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: On admittance to our hospital, the patient complained of progressive bone and muscular pain over the last 2 years, mainly located in the ribs, spine, hips, and shoulders which had led to a double symptomatic fracture of the wrist and femur. She had neither abdominal complaints nor diarrhea. On physical examination, she was pale. Her body mass index was 17,52. She had bad dentition, pronounced thoracic kyphosis (hyperbolic chest) with thoracic and lumbar percussion pain. Pelvis and shoulders also were painful on touching. There was muscle atrophy and symmetrical loss of proximal muscle strength. She had a painful limitation of the hips, left wrist and a genu varum (Figure 1). The dermatologic examination noted dermatitis herpetiformis at the arm (Figure 2). The relevant blood parameters were as follows: Calcemia: 92 mg/l (95-105); phosphatemia: 14 mg/l (25-45); low urine Calcium: 77,4 mg/24 h (100-300); alkaline phosphatase: 283 UI/l (35-117); low 25-hydroxy-vitamin D level <9 ng/ml (>30); PTH: 281,6 pg/ml (12-70) and iron deficiency anemia (hemoglobin: 10 g/dl, iron: 0.12 mg/l). Bone mineral density measurement showed extremely low absolute values and T-scores: 0.617 g/cm2 (T-score:-3,9) at the femoral neck, 0.882 g/cm2 (T-score:-4,8) at the lumbar spine and 0,22g/cm2 (T-score:-5,3) at the forearm. The patient responded well clinically and biologically to a gluten-free diet, iron and calcium-vitamin D supplementation.\nOUTPUT:" }, { "from": "agent", "value": "Celiac disease, Severe osteomalacia" } ]

[ { "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 reported that the eye had been wounded by a fountain pen. As this occurred during World War II, the eye was only treated with conservative methods for about 2 months. The patient reported that vision in the affected eye was as good as in the healthy eye prior to the injury. In the affected eye, the best-corrected visual acuity was counting fingers. The eyes did not squint. The slit lamp examination revealed a paracentral corneal scar, synechiae between the anterior capsule and iris, as well as leukocoria caused by an opaque capsular bag (Photos 1, 2). The patient underwent accessory investigations, i.e. ultrasonography (USG), ultrabiomicroscopy (UBM) and flash visual evoked potentials (FVEPs). The USG was normal, and the UBM showed an intact anterior and posterior capsule, with intact ligaments, peripheral remnants of the lens and posterior synechiae of the iris and capsule (Photos 3 A, B). The flash visual evoked responses (FVER), performed in accordance with International Society for Clinical Electrophysiology of Vision (ISCEV) standards, showed normal wave latencies in both eyes (Photo 4). The patient underwent anterior segment reconstruction with an intraocular lens placed in the sulcus. The synechiae were released and curvilinear continuous capsulorhexis was performed. After that, an anterior vitrectomy was performed and an intraocular lens (MA 60BM, Alcon) was placed in the sulcus (Photo 5). Moreover, her quality of life, which was independently assessed using the NEI VFQ-25 questionnaire, also showed a significant improvement.\nOUTPUT:" }, { "from": "agent", "value": "Penetrating trauma in right eye, Cataract in left eye" } ]

[ { "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, white Caucasian man was presented to our hospital emergency department with one-month history of jaundice, pruritus, acholic feces, dark urine, unintentional weight loss, and worsening pain in the lumbar region. On the date of admission the urine was light yellow and the patient reported that feces were of normal color and consistence. He denied alcohol or illegal drug use and had no travel history within the last 10 years. He reported jaundice and pruritus progressing for one month prior to admission. He denied having pain, nausea, vomiting, or elevated temperature during the whole month. Pain in the lumbar region was progressing during the last 2 years, due to PCa metastasis. Patient had metastatic PCa and underwent palliative hormonal therapy in ambulatory settings; he also had moderate aortic stenosis found by echocardiography and angina pectoris of class II according to the classification system by Canadian Cardiovascular Society. In year 2016, metastatic process involving the lumbar spinal and thoracic region was diagnosed using skeletal scintigraphy. Starting from year 2016 he received androgen deprivation therapy in outpatient settings and testosterone level was controlled in conjugation with PSA. Testosterone remained at castrate level. During physical examination, yellow skin, scratch marks on the back and thorax due to pruritus, and aortic murmur were revealed. Blood tests indicated that the patient had cholestasis, elevated alanine aminotransferase, elevated aspartate transaminase, elevated gamma-glutamyl transferase, and elevated bilirubin (Table 1). Infectious disease such as hepatitis C and hepatitis B was excluded using testing for antibodies. Autoimmune causes were also excluded; anti-mitochondrial antibody, anti-glycoprotein antibody-210, and anti-sp100 antibodies, IgA and IgM, were all negative. Alpha-fetoprotein was also negative. Alkaline phosphatase (ALP) was significantly elevated; thus isoenzyme of bone origin ALP2 was determined to differentiate the source of elevated ALP (Table 1). Ultrasound examination of abdomen was performed, with no evidence of extrahepatic bile duct dilatation or cirrhosis. Magnetic resonance cholangiopancreatography showed no cholestasis, but 1.5 cm diameter cyst was found in hepatic parenchyma. The patient received supportive and symptomatic therapy. Rapid deterioration of general health status occurred during hospitalization, with exitus letalis while in the hospital.\nOUTPUT:" }, { "from": "agent", "value": "Stauffer's Syndrome, Metastatic Prostate 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: For hemodynamic stabilization the patient was intubated and afterwards an upper endoscopy was performed. A small bleeding was clipped. Because of the discrepancy between the hemorrhagic shock and the small bleeding, a CT-Scan was immediately performed. During control angiography a persisting contrast filling of the aneurysm was seen, and therefore the aim was to place a second coil into the aneurysm. 1). An extraction of the coil was not possible and no other revascularization option was available. Therefore, the patient was transferred to our hospital for revascularization. The patient arrived intubated and was directly transferred to the operating room. As an alternative, the arterialization of the portal vein was considered. After preparation of a small arterial mesenteric branch, we performed a side-to-side running anastomosis between the artery and corresponding vein (Fig. 2A + B). The anastomosed branch of the vein was proximally ligated to avoid arterial backflow towards the small bowel. Postoperatively the patient was extubated on the first postoperative day (POD). Doppler ultrasound controls revealed elevated portal flows. Coagulation parameters normalized within 2 days postoperatively and the ALAT peaked on the POD 1 (400 U/l). The postoperative course was uneventful. Therefore, the patient was discharged on 30th POD. An Angio-CT Scan showed patent arterio-portal shunt (Fig. 3).\nOUTPUT:" }, { "from": "agent", "value": "Chronic pancreatitis, Stenosis of the pancreatic duct, Pancreatic fistula grade B, Acute upper gastrointestinal bleeding, Pseudoaneurysm of the ligated gastroduodenal artery, Complete occlusion of the hepatic artery, Severe delirium" } ]

[ { "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 55-year-old Hispanic female complained of pelvic pain, loss of appetite, weakness, and 40-pound weight loss in the last 5 months. She was also noted to have a small amount of bright blood per rectum. A computed tomography scan of the abdomen showed a 17 x 14 x 11 cm pelvic mass with cystic and solid components and internal septations, which appeared to encase the sigmoid colon (Figure 2(a)). A colonoscopy was performed to reveal a friable and hyperemic colonic mucosa at about 20 cm from the anus. No colonic mucosa was present (Figure 2(b)). The tumor markers were CA19.9: 50.1 U/mL and CEA: 3.7 ng/mL. The patient underwent a hysterectomy with bilateral salpingoophorectomy and rectosigmoid resection with end-to-end anastomosis. Gross examination of the specimen revealed a 16 cm multiloculated solid and cystic adnexal mass attached to a 12 cm segment of rectosigmoid colon. The heterogeneous cystic mass was filled with adipose tissue, hair, and sebaceous material. Upon opening, the segment of colon showed a large fistulous tract that measures 2 cm in diameter (Figure 2(c)). The patient was deemed to be stage IIIB and received six cycles of chemotherapy with cisplatin and taxol. She completed the chemotherapy and, after 8 months, there was no evidence of recurrence. After that, she was lost in follow-up.\nOUTPUT:" }, { "from": "agent", "value": "Malignant Transformation of Ovarian Mature Teratomas, Squamous 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 30-year-old male farmer presented with an eight-year history of a growing painless soft-tissue mass on the lateral aspect of his right ankle. The patient reported noticing lumps on his ankle after a tractor injury in an apple field. However, no treatment was provided. The patient was then referred to our institution for infectious disease consultation and possible surgical management due to increasing discomfort and work debilitation. He was initially placed on itraconazole. However, the mass continued to grow slowly, and surgery was deemed the best treatment option. MRI for pre-operative evaluation showed a 6-cm area composed of homogeneously enhancing round and serpiginous masses in the soft tissues inferior to the lateral malleolus, extending to the plantar subcutaneous tissues of the midfoot. The masses displayed low signal intensity on T1 and high signal intensity on T2 and STIR sequences, with some intervening and central foci of low T1-, T2-, and STIR-signal intensity (Figure 1, Figure 2, Figure 3, Figure 4). No tendinous or osseous involvement was present. There was no pathological evidence of a soft-tissue hemangioma. Postoperative course was uneventful, and the patient eventually was able to return to work. There has been no evidence of disease recurrence.\nOUTPUT:" }, { "from": "agent", "value": "Fungal mycetoma" } ]

[ { "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 was on steroids for the last 4 years and had a satisfactory response. He presented with breathlessness, with episodes of paroxysmal nocturnal dyspnoea of 1 week duration. There was no chest pain. The electrocardiogram showed typical ST elevation and pathological Q waves consistent with acute anteroseptal MI [Figure 1]. A two-D echocardiogram revealed dilated left atrium and left ventricle (LV). There was severe LV systolic dysfunction with hypokinesia of the left anterior descending (LAD) territory. Troponin-T test was positive. Creatinine kinase-MB was in the normal range. A computed tomography (CT) scan of the brain showed recent infarct in the left fronto-temporo-parietal lobe. Catheterization studies showed no evidence of any significant atherosclerotic coronary artery disease [Figure 2]. The carotid arteries on both the sides were normal. Other investigations were: lipid profile - total cholesterol, 195 mg/dl, low-density lipoprotein (LDL) cholesterol, 118 mg/dl, triglycerides (TG), 191 mg/dl, high-density lipoprotein (HDL) cholesterol, 38 mg/dl, very low density lipoprotein (VLDL) cholesterol, 38 mg/dl, significant proteinuria (albuminuria), serum hypoalbuminemia and thrombocytosis (platelet count, 9.3 lakhs/ml). The serum homocysteine, rheumatoid factor IgM, anti-nuclear antibody, anti-double-stranded DNA and anti-cardiolipin-IgM and IgG levels were in the normal range. His heart failure and hemiparesis improved over 1 week on conservative management with diuretics, antiplatelets (aspirin and clopidogrel), nitrates, statins and low-molecular weight heparin. He was discharged in a stable hemodynamic condition.\nOUTPUT:" }, { "from": "agent", "value": "Myocardial infarction, Nephrotic syndrome, Left ventricular failure, Right hemiplegia with aphasia" } ]

[ { "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 male presented to our Outpatient Department with chief complaints of pain and defective vision in the left eye after blunt trauma sustained due to a fall 3 days back. He was not a myope, and there was no history of prior ocular surgery or systemic condition predisposing to a weak sclera. His best-corrected visual acuity was 6/9 in the right eye and perception of light in the left eye. Intraocular pressure was 12 mmHg and 10 mmHg, respectively. On examination, his right eye was within normal limits except for nuclear sclerosis Grade 2. Left eye showed an inferior lid laceration that had been sutured elsewhere, with an intact orbital rim and infraorbital sensation. He had not undergone any other intervention during primary care. The anterior segment showed subconjunctival hemorrhage is not extending posteriorly, corneal edema, hyphema, and aphakia. Posterior segment examination revealed dense vitreous hemorrhage and no view of the retina. Lens echo was not seen in situ or in the vitreous cavity. 1]. After 360 conjunctival peritomy dislocated lens was removed from posterior subtenon's space with minimal manipulation [Fig. 2a and b] and sent for histopathology. A self - sealed scleral rupture [Fig. 2c] was identified in the superotemporal quadrant, just posterior to the spiral of Tillaux extending from 12 to 2 O'clock position. A 360 scleral buckle (#240 solid silicone band) was placed followed by standard 3 port parsplana vitrectomy. On the last follow-up, 4 months later, the retina was attached, but the best-corrected vision remained hand movements.\nOUTPUT:" }, { "from": "agent", "value": "Traumatic posterior phacocele, Retinal detachment" } ]

[ { "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 woman with diabetes mellitus has been referred to the transplant center at Abu Ali Sina hospital, the main center of liver transplantation in Iran, due to intermittent fever, weakness, and anorexia. She underwent liver transplant 10 months before her recent visit due to autoimmune hepatitis. All symptoms started 2 weeks before being referred to our hospital. The patient had no history of any respiratory symptoms include cough and dyspnea. There was no history of high blood pressure or coronary artery disease. She was taking medications including mycophenolate (720 mg per day), tacrolimus (2 mg per day), prednisolone (15 mg per day), folic acid (1 mg per day), and ursodeoxycholic acid (900 mg per day). The patient's vital signs were oral temperature, 37.9 C, heart rate of 105 beats per minute, respiration rate of 16 beats per minute, blood pressure of 110/70 mm Hg. On physical examination, the patient had jaundice, but lung and other organs were normal. Computed tomography (CT) scan of the chest was performed, in which multiple bilateral nodular infiltrates of varying sizes and a few patchy ground-glass opacity were observed (Figure 1). Table 1 shows the patient's laboratory results. After discussing the patient's condition in a multidisciplinary team, the patient was transferred to isolated room, mycophenolate was discontinued, and meropenem (1g IV q.8h), co-trimoxazole (400/80) one tablet twice daily, and hydroxychloroquine (HCQ) (400 mg/day) were started for 14 days. During the hospitalization period, the patient did not show any pulmonary symptoms.\nOUTPUT:" }, { "from": "agent", "value": "COVID-19, Common bile duct stricture" } ]

[ { "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 19-year-old female visited the Department of General Surgery due to a nodule in her lower left abdomen. During the first examination, a hard mass that exhibited poor mobility was detected in the lower left abdomen. Wide surgical resection was performed with a 3 cm superior margin. The inferior surgical margin was located at the pubic symphysis, and the resected area included the anterior and posterior rectus sheath, peritoneum, and the full thickness and width of the left rectus abdominis muscle. The peritoneum was closed primarily, and a muscle defect measuring 9 x 13 cm was repaired with an 11 x 15 cm pedicled anterolateral thigh flap, which included the vastus lateralis muscle (Figure 1). The descending branch of the deep femoral artery was dissected up to its origin, and the flap was harvested together with a motor nerve from the left thigh. The flap was tunneled under the rectus femoris muscle to medialize the neurovascular pedicle and then transferred to the abdominal wall defect (Figure 2). The vastus lateralis muscle was sutured to the remaining rectus abdominis muscle. The patient was able to walk 7 days after surgery and was discharged 2 weeks later. An MRI scan obtained at one postoperative month showed that the rectus abdominis muscle defect had been reconstructed with the vastus lateralis muscle flap, and no hernias had developed (Figure 3). When the patient flexed the hip joint and kept her abdominal muscles contracted, the transferred vastus lateralis muscle underwent voluntary contraction according to electromyography performed at 6 postoperative months (Figure 4).\nOUTPUT:" }, { "from": "agent", "value": "Desmoid 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 13-year-old girl presented to the Emergency Department with a 1-week history of coryzal symptoms and severe headaches. In the week leading up to her presentation the headache intensity had continued to increase up to the point where she could barely move. The patient had a past medical history of recurrent headaches and dizziness which first presented 5 months ago, however an MRI brain taken during this period showed no pathological changes and at the time she was discharged. She was admitted and started on intravenous antibiotics on admission: ceftriaxone, vancomycin, and metronidazole. The initial ophthalmology review indicated preserved optic function; however, this was associated with a significant soft tissue swelling along with reduced color vision. Both were seen in conjunction with diplopia and painful eye movements, which warranted close monitoring of her vision and further radiological investigation. Furthermore, a right frontal intracranial, extradural collection, with a depth of approximately 5 mm was noted. The results of a brain and sinus MRI in the subsequent week showed a reduced volume of the previously discovered anterior epidural collection. A neurosurgical review was advised, and this continued to be monitored with repeat imaging, seen below in Figure 2.\nOUTPUT:" }, { "from": "agent", "value": "Orbital Cellulitis, Progressive Calvarial Osteomyelitis" } ]

[ { "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 Hindu male, a postgraduate, working as a teacher, residing in a suburban area, with anankastic traits and nil contributory family history, presented two years back (January 2019) with complaints of repeated, irrational, intrusive (ego-dystonic) thoughts and doubts about contamination; persistent, repeated washing; and low mood since 37 years of age. The reason for consultation was an increase in symptoms and dysfunction. On mental status examination, the patient had an anxious affect, obsessive doubts, compulsive acts, and grade 4 insight. Physical examination was within normal limits. The Yale Brown Obsessive Compulsive Scale (YBOCS) score was 26. The patient was initiated on psychotherapy (12 sessions of exposure and response prevention) and pharmacotherapy (fluoxetine titrated to 80 mg). The patient reported improvement but could not follow up further due to the COVID-19 pandemic first wave crisis and defaulted treatment for a few months. The patient also complained of insidious onset of heaviness of head and limb paraesthesia. Subsequent limb stiffness and walking difficulty added to the distress. During this visit, he also reported difficulty in performing day-to-day activities such as buttoning and unbuttoning for a few days. On physical examination, the patient had increased tone in upper and lower limbs, with no other long tract signs. CT scan brain revealed calcification in bilateral basal ganglia (Figure 1). Routine blood investigations (complete blood count, sugar profile, liver function test, kidney function test) were within normal limits. Serum iPTH, calcium, magnesium, phosphorus, thyroid function, and alkaline phosphatase were within normal limits. On the Extrapyramidal Symptom Rating Scale, the questionnaire score was 5, examination of Parkinsonism and akathisia score was 6, and scores on clinical global impression of Parkinsonism and severity of akathisia were 3 each. Citing recent-onset extrapyramidal symptoms and signs and abnormal neuroimaging, cognitive screening was done. Mini Mental State Examination and Montreal Cognitive Assessment scores were 29 and 28. Fluoxetine was restarted, citing prior response. Baclofen (30 mg) was initiated as per liaison with the neurology team. Written informed consent has been obtained from the patient.\nOUTPUT:" }, { "from": "agent", "value": "OCD, Fahr'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: The virus was subtype B and fully antiretroviral susceptible (VL 260,000 copies/mL, log10 5.4, CD4 count 4 x 106/L, 2.5%). He was commenced on tenofovir, emtricitabine and efavirenz. He improved clinically, but the CD4 count plateaued at 11 x 106/L, 2.6%) and the VL only decreased to 88,000 copies/mL (log10 4.9) at 4 weeks and stalled at 56,000 copies/mL (log10 4.7) at 12 weeks. He reported no side-effects, no new sexual contacts and 100% adherence to HAART. He gave no travel history of note. Resistance testing revealed K65KR, M184V, K101E, Y181CY and G190CS. Comparison of the two sequences revealed only four out of 1007 sequences nucleotide changes between baseline and the second test, excluding residues exhibiting mixed bases, of which three resulted in amino acid changes within known resistance foci at RT residues 101, 184 and 190. The fourth was a synonymous nucleotide change. Based on the fact that the patient denied lack of exposure, reported good adherence and the commonly under drug pressure observed mutations, this lack of sufficient VL response was thought to be due to an unmasking of a primary minority species virus under drug pressure, rather than HIV superinfection. The patient's treatment was switched to zidovudine, lamivudine, raltegravir and boosted darunavir. Twenty-four weeks later he was feeling well and his VL was 41 copies/mL (log10 1.6) and his CD4 count 155 x 106/L, 17%.\nOUTPUT:" }, { "from": "agent", "value": "Transmitted drug-resistant HIV, Pneumocystis jiroveci 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: In this case report study, a 55-year-old Caucasian male was diagnosed with shortness of breath, fevers of unknown origin, total malaise and arthropathies on June 8, 2020. The patient experienced vomiting, diarrhea, and headaches, as well as loss of smell. Repetitive COVID-19 PCR nasal swabs came back negative, although antibody tests came back positive. With this, the patient was given a formal COVID-19 diagnosis and then spent 7 weeks hospitalized. During this time, the patient was moved into the ICU twice, both instances for a period of over a week. While the patient was never intubated, he was on BIPAP to address the shortness of breath. While hospitalized, the patient was treated with Zosym, Erythromycin, Remdesavir, IV steroids, and a 10-day course of oral Dexamethasone. At discharge, the patient was prescribed daily evening nebulizer treatments of 2.5mg Albuterol Sulfate every 6 hours or when needed. Two months after initial hospital admission, the patient was still experiencing symptoms:most prominently, sustained and prolonged shortness of breath. This resulted in severe fatigue that restricted the patient's ability to perform daily living activities. Prior to treatment initiation, the patient experienced extreme shortness of breath while going up stairs, however, was not able to go downstairs at all. This shortness of breath also resulted in the patient feeling extremely air hungry while eating or talking.\nOUTPUT:" }, { "from": "agent", "value": "COVID-19 long hauler, viral pneumonitis, acute respiratory distress, meningitis/encephalitis, hyperglycemia" } ]

[ { "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 68-year-old woman presented at our outpatient clinic complaining of left hemiparesis. She had a history of well-controlled hypertension and had a VP shunt placed 18 years ago for obstructive hydrocephalus due to midbrain cavernous malformation. CT images showed an enlargement of the right frontotemporal arachnoid cyst [Figure 2a], which we considered the cause of her left hemiparesis. A cysto-peritoneal shunt placement using a y-shaped connector was performed. Although there were no hemodynamic changes (her BP remained around 100/40 mmHg) or complications during the operation, the patient did not wake up after the anesthesia was completely terminated. Before the surgery, we had increased the valve pressure to 20 cmH2O because we were concerned about a rapid reduction in ICP; however, postoperative CT demonstrated remarkable shrinkage of the cyst with a small amount of bleeding [Figure 2b]. Following surgery, the patient experienced tonic-clonic seizures and developed status epilepticus on the following day. The emergency CT images showed low-density areas in the bilateral occipital lobes [Figure 2c], and MR imaging on the fourth day following surgery revealed diffuse hyper-intensity areas on FLAIR imaging in the temporal, parietal, and occipital lobes on both sides, and the right frontal lobe [Figure 2d]. Because we strongly suspected PRES, we initiated anticonvulsant therapy. Although the patient had been comatose and unresponsive for >10 days, she gradually started to respond 12 days after surgery and showed neurological improvement. MR images taken 27 days after surgery demonstrated an almost complete disappearance of edematous areas [Figure 2e]. The patient required rehabilitation for another few months, but recovered to a normal status in 6 months.\nOUTPUT:" }, { "from": "agent", "value": "Posterior reversible encephalopathy 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: Pretreatment PET-CT revealed an intensely FDG-avid GEJ mass extending to fundus with FDG-avid subcarinal and retroperitoneal lymph nodes. The patient underwent laparoscopic staging demonstrating large bulky tumor along lesser curvature extending to and encasing the left gastric artery with adenopathy. A PET/CT showed decreased FDG avidity in the GEJ mass [Figure 1a and b]. To maximize local control and swallowing function, he was treated with 5-fluorouracil and oxaliplatin with concurrent radiation to 37.5 Gy at 2.5 Gy per fraction. Following radiation, he resumed full dose FOLFOX and trastuzumab. A PET/CT scan was obtained 34 days after completion of radiation [Figure 1c and d]. There was 109 mm x 82 mm focal area of FDG uptake in the left lobe measuring SUV 12.1. Hepatic function was within normal limits, and he tolerated CRT with good clinical response. Due to concerning PET-CT findings, a magnetic resonance imaging (MRI) was performed which did not show any focal hepatic abnormalities.\nOUTPUT:" }, { "from": "agent", "value": "Stage IV, Her2-amplified metastatic gastroesophageal junction 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: Six days after cycle three of treatment, the patient was admitted to the hospital with lower abdominal pain, diarrhoea, and a pyrexia of unknown origin (PUO). Pericolonic inflammation of the hepatic flexure was detected on a CT scan of the abdomen. Extensive investigations including a full viral screen with polymerase chain reaction (PCR) for CMV showed a CMV viral load of 3,328,814 copies/ml (ref. <180 copies/ml) (Figure 1()), and treatment was commenced with ganciclovir 5 mg/kg for CMV colitis. After seven days, the medication was changed to cidofovir 5 mg/kg due to derangement of the liver function with a rise in ALT to 117 U/l (ref. 10-50 U/l), alkaline phosphatase 815 U/l (ref. 40-130 U/l), and gamma glutamyl transferase 1550 U/l (ref. 10-70 U/l). At this time, the CMV viral load had decreased to 812,307 copies/ml (Figure 1()). However, whilst on cidofovir, the CMV viral load increased to >1.6 million copies/ml, and weekly pulses of CMV immunoglobulin were added. This initially produced a response with a drop in the CMV viral load to 209,643 copies/ml followed by a rise to 920,330 copies/ml after a duration of twelve days. The treatment was changed to intravenous foscarnet given for two weeks, whereafter the patient was discharged on oral valganciclovir 450 mg twice daily (BD). At time of discharge, the CMV levels had dropped to 3405 copies/ml. Over the following six weeks, biweekly CMV levels as well as pre- and posttreatment valganciclovir levels to ensure therapeutic levels were performed. The dose of valganciclovir was increased to 900 mg BD upon which the CMV levels dropped to <180 copies/ml.\nOUTPUT:" }, { "from": "agent", "value": "Severe Cytomegalovirus Reactivation, Low-Grade Non-Hodgkin's 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: On examination, there was muscle spasm mainly in the upper trapezius with limitation to neck extension, lateral flexion, and rotation. She underwent a cervical X-ray and MRI which showed two moderate IVD protrusions at C4/5 and C5/6. The patient underwent percutaneous discectomy for both discs under local anesthesia and sedation. She began physiotherapy for strengthening deep muscles and relaxing extrinsic muscles and showed good improvement for 4 months. Discography is done as part of the percutaneous discectomy, and it requires the patient to be fully awake, which could be difficult to accomplish in cervical procedures. Consequently, discography is a confirmatory test in image-guided percutaneous procedures which form a bridge between conservative and classical surgical interventions.\nOUTPUT:" }, { "from": "agent", "value": "Degenerative Spine, Nociceptive Pain, Radicular Pain, Referred 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: She had been born at 40 weeks and 4 days after an uncomplicated pregnancy with a birth weight of 4010 grams to unrelated parents. In a previous examination, she was found to have bilateral renal duplication and bilateral ureteroceles corresponding to the upper moieties, with grade 5 vesicoureteric reflux in both lower moieties. The ureteroceles were managed with bilateral ureterocele incisions. A renal ultrasound found normally sized (6 cm long) kidneys with bilateral renal duplication, bilateral tortuous hydroureter, and thin renal cortex with increased cortical echogenicity and small cysts (Figure 2). Her serum creatinine peaked at 117 mumol/L after birth. The patient was not on any medication at the time of admission. Her weight dropped from 5180 grams at admission to 4890 grams one week later, a loss of 6%. On examination, she exhibited signs of dehydration with sunken fontanels and dry mucous membranes. She was afebrile. Blood work showed a calcium level of 4.98 mmol/L (reference interval (RI) 2.24-2.74 mmol/L), phosphate 0.83 mmol/L (RI 1.30 to 2.60 mmol/L), creatinine 63 mumol/L (RI < 53 umol/L), urea 13.7 mmol/L (RI < 7.0 mmol/L) and bicarbonate 15 mmol/L (RI 22-29 mmol/L). Her serum sodium was 134 mmol/L and her fractional sodium excretion was 20.06%, suggesting some sodium wasting, which is frequently seen in patients with renal dysplasia.\nOUTPUT:" }, { "from": "agent", "value": "PTHrP-related Hypercalcaemia, Congenital Anomalies of the Kidney and Urinary Tract (CAKUT), Stage 2 Chronic Kidney Disease (CKD)" } ]

[ { "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 man referred from the Department of Internal Medicine regarding lesions in his oral cavity and complained of pain when swallowing. The intraoral examination found a painful single ulcer on the ventrolateral of the tongue, a white-yellowish base surrounded by a halo erythematous. We also found painless white corrugated, adherent plaques. It could not be scrapped (Figure 4B). Polymerase chain reaction (PCR) of CM to detect viral DNA was reactive and showed 7.11x102 copies/mL. Folic acid, clindamycin, co-trimoxazole, and fluconazole were prescribed by the internist, and ARV was given three weeks later. We gave diphenhydramine hydrochloride and gargling with 0.2% chlorhexidine gluconate.\nOUTPUT:" }, { "from": "agent", "value": "HIV stage IV with wasting syndrome, sol intracranial et causa toxoplasmosis cerebri, anemia et causa gastrointestinal bleeding, hyponatremia et causa Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH), malnutrition, CMV ulcers, oral hairy leukoplakia" } ]

[ { "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 58-year-old female with past medical history of hypertension, pica, cerebral palsy, seizure disorder, severe cognitive deficiency, and bowel resection for FB ingestion with colostomy presented to our institution after dark red stool was noted in her colostomy bag by nursing staff. The patient had a history of multiple FB ingestions requiring both endoscopic and surgical removal. On presentation her vital signs were normal and physical examination revealed a soft, nontender abdomen. Laboratory test results were significant for a hemoglobin 10.6 g/dL. Computed tomography (CT) scan of the abdomen showed metallic foci in the stomach, presumably ingested material. The patient underwent initial endoscopy which revealed a large (5 x 3 cm) FB of unclear material in the gastric body (Figure 1). Removal was attempted with a snare but was unsuccessful as the FB was too large to safely pass through the gastroesophageal junction (Figure 2). In addition, the use of cold and hot snare was ineffective in attempting to break the FB down into smaller pieces. The patient was transferred back to the medical floors with the intent on repeating the endoscopy with endoscopic scissors. Repeat endoscopy was then performed. An overtube was passed beyond the gastroesophageal junction and FB removal was again attempted with a snare. Retrieval was initially unsuccessful as the FB became lodged in the end of the overtube causing a fracture to the distal end of the overtube. The overtube was then removed and Ensizor Flexible Endoscopic Scissors (Apollo Endosurgery) were used to transect the FB into 2 pieces (Figure 3). The material ingested appeared to be a congealed and hardened plastic medical glove. The individual pieces were then successfully removed with a retrieval net and snare. The post-procedural course was uncomplicated and patient was discharged on post-procedure day 1.\nOUTPUT:" }, { "from": "agent", "value": "Foreign Body ingestion" } ]

[ { "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: Before DBS onset, by the end of the period that followed lead implantation, the patient's Y-BOCS score remained severely affected (Y-BOCS score of 22). Nonetheless, 3 months after the theoretical onset of DBS using the final set of fixed parameters reported earlier, the patient no longer complained of OCD symptoms, and his Y-BOCS fell to a score of 3. Clinically, he seemed soothed and did not feel the urge anymore for washing rituals, neither reported experiencing an insidious sense of contamination risk. The patient was euthymic; his personal interactive relationship skills had greatly improved; and he no longer consumed alcohol. Attesting such dramatic improvements, the patient even planned to resume his professional activity. Consequently, follow-up appointments were gradually spaced out, and 9 months post-lead implantation (hence after 6 months of DBS treatment), the patient was asymptomatic and stable, still with a low Y-BOCS score of 3. Nonetheless, at this time, during a routine check, the psychiatrist in charge of the study unexpectedly found out that the IPG was no longer operative because the battery had depleted completely long before. Unfortunately, we could not determine how long the battery might have been depleted by interrogating the IPG unit. The study blind was lifted, and investigators learned that the patient turned out to have been randomized to the VS/VC bilateral stimulation condition and treated with the last set of the earlier-reported parameters. In the absence of any specific complaint, and given the outstanding patient's recovery with consistent low Y-BOCS scores, in agreement with the patient, we decided not to replace the IPG. This decision was taken because it seemed unreasonable to operate the patient again considering: (1) the risk of infection or hemorrhage; (2) the risk of the anesthesia associated to the surgical procedure; (3) the risk of causing additional micro-lesions during implant removal; and (4) the risk of a recrudescence of OCD symptoms.\nOUTPUT:" }, { "from": "agent", "value": "Obsessive-Compulsive 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 64-year-old man presented with painless, sudden vision loss of 5-day duration in his left eye. On the examination, visual acuity in his left eye was hand motion while in the right eye it was at 16/20. The anterior segment examination was normal and intraocular pressures were 15 mmHg in both eyes. The pupils were equal, with a relative afferent pupillary defect in the left eye. Dilated fundus examination showed an area of interpapillomacular retinal ischemia with whitish edges and a cherryred spot in the macula in his left eye (Figure 1). The right eye was normal. Optical coherence tomography (OCT) (Heidelberg Engineering, Inc., Vista, CA, USA) imaging showed increased reflectivity of the inner retinal layers in the left eye. Central macular thickness was 650 uM (Figure 2). Fundus fluorescein angiography (FFA) revealed nonperfusion in the macular area with late staining of small veins and arterioles and leakage (Figures 3 and 4). He had left leg amputation caused by TAO twenty-five years ago. Also he had a history of smoking for forty-three years. Diagnostic workup including cardiovascular examination, electrocardiogram, echocardiogram, and Doppler evaluation of the neck vessels was within normal limits. Also hematological examination and other investigations related to CRAO were normal. On the basis of the diagnostic workup, laboratory evaluation, and patient history, occurrence of CRAO in the patient was considered due to TAO. Although limited benefit of hyperbaric oxygen therapy was considered, the patient was ordered hyperbaric oxygen therapy for 20 sessions. Following the treatment, his final visual acuity was 10/200 in the left eye and OCT imaging showed macular atrophy(Figure 5) at first month.\nOUTPUT:" }, { "from": "agent", "value": "Retinal Artery Occlusion, Buerger's Disease (Thromboangiitis Obliterans)" } ]

[ { "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: This 73-year-old man presented with right-sided tremor-dominant PD since 8 years. Initially he was treated with an anticholinergic and pramipexol, followed by levodopa after one year. At the time of presentation, he took levodopa/carbidopa 125 mg and pramipexol 0.6 mg tid, with an adequate treatment response. Neurological examination in the off-state revealed a classic right-dominant rest and jaw tremor, right dominant severe bradykinesia, moderate axial and limb rigidity, a typical hypokinetic gait and mild balance impairment during the pull test (off state UPDRS motor-score: 47, Hoehn & Yahr stage: 2.5). His clinical presentation was consistent with idiopathic, tremor-dominant and dopa-responsive PD. We performed the 'pointing test' as follows: we instructed the patient to grasp a pencil that was located about 70 centimeter away, with his left (i.e. least affected) hand, as fast as possible immediately following a verbal command. Whenever the patient made such an abrupt, brisk ballistic movement, the tremor of his right hand stopped for about 1 second. However, during trials that were performed with a non-ballistic movement (slower movement velocities and/or delayed movement initiation) of the left arm, the right-sided hand tremor was not interrupted (see online video supplement). This abnormal clinical pointing test was substantiated by accelerometry recording (Fig. 1A and B; sensors attached to the dorsum of the hands). This showed a consistent bilateral resting tremor with a frequency between 4.2 and 4.8 Hz (amplitude right >left). Following a rapid ballistic grasping movement of the left hand, a reproducible arrest of the right hand tremor was detected. It typically started around 0.2 seconds after movement onset and lasted for 0.8 to 1.6 seconds (Fig. 1A). A slower ballistic movement of the left arm did not produce this effect, with only an amplitude reduction but not tremor cessation (Fig. 1B).\nOUTPUT:" }, { "from": "agent", "value": "Parkinson'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: The girl was kept in an incubator. On examination, she was breathing spontaneously, was active and on oxygen supplements given at a rate of 2 l.m-1 via mask. Auscultation of the chest did not elicit any abnormality, but normal breathing sounds and no added sounds. Vital signs were as follows. Heart rate: 170 b.m-1; blood pressure: 85/40 mmHg; RR: 35 b.m-1. She was on oral feeding. Laboratory investigations showed the following results: urea 1.4 mmol/l; creatinine 19.0 mumol/l; K 5.5 meq/l; Na 141 meq/l; Hb 11 g/dl;0 platelets: 497x10.e9/l; coagulation profile: prothrombin time (PT): 12.4; activated partial thromboplastin time (APTT): 40.1. The pulmonologist who monitored the chest condition advised that the lung cysts were small in size. A pediatric surgical consultation for management of the lung cysts was obtained. It was suggested that there was no need for urgent surgery, but if pneumothorax develops during laser surgery then immediate intervention should take place. On 18 August 2007, anesthesia was given. Inhalational induction was done using sevoflurane. The anesthesiologist took long for induction before laryngoscopy and tried intubation but found that her condition was not fit for intubation as she was \"fighting.\" So, since she was on sevoflurane inhalation supplemental ketamine was given intravenously at a dose of 0.5 mg/kg. Atropine 0.1 mg was given as well and then recuronium 1 mg.kg-1 was injected, so laryngoscopy was done and trachea was intubated successfully. The respiration resumed as pressure support ventilation mood with the tube in place.\nOUTPUT:" }, { "from": "agent", "value": "Congenital cystic adenomatoid malformation of the lungs" } ]

[ { "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: Four family members (two children and their parents) continuously develop varicella after the grandmother's herpes zoster. The unvaccinated 16-month-old infant and his mother developed primary varicella with atypical clinical presentation; however, his 28-year-old father presented with a typical generalized vesicular rash. His vaccinated 4-year-old sister was clinically mild, which could be defined as a breakthrough varicella case. Image Caption and Description: \nImage caption: Rash in the girl (case 2, A) and the mother (case 3, B). Image description: One day after Case 1 admission (October 17), the boy's 29-year-old mother (Case 3) also developed a rare pruritic rash with vesicles on her trunk (Figure 3B) and a low-graded fever (37.6 C). Case Report: \nFive days before the boy's visit (October 11), his 4-year-old immunocompetent sister (the initial varicella patient, Case 2) had developed a low-graded fever and rare rash on her trunk (Figure 3A), and the lesions began crusted on October 14, without seeking any medical care. Her serum was taken at the boy's 7-day follow-up visit (October 26), and tested negative for anti-VZV IgM but positive for IgG (Table 1). The sister was confirmed that she had received one-dose varicella vaccination 3 years ago at her 14 months of age.\nOUTPUT:" }, { "from": "agent", "value": "Varicella-Zoster Virus" } ]

[ { "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 described in this report provided written consent prior to publication. He was seen at an ICU follow-up visit 2 months postdischarge. During the clinical meeting, the patient confided of a persistent memory that one of the team members was a witch, mixing potions to poison him. His wife provided a collateral history that, although the patient was normally mild, soft-spoken, and gentle, he was singularly curt and rude to this staff member without explanation. He also had memories of a \"German\" man in a white \"suit\" that when close to him in the ICU made him feel short of breath, and the patient described subsequent disorganized frightening/disquieting dreams of the same individual. The patient was able to provide specific and explicit descriptions that permitted both individuals to be identified. He also had persistent vivid memories of forcible confinement in a cave, where he could not escape, apart from a series of white doors, none of which seemed safe or from which he could exit. The patient was provided descriptions of the staff (one a nurse with longer grey hair, the other an RT known for always wearing a buttoned white lab coat) and descriptions of their roles with possible explanations for the \"memories\" (the nurse mixing/administering intravenous medications; the RT suctioning the patient with associated sense of dyspnea during periods of being disconnected from the ventilator) which provided some emotional relief to the patient. The memories of specific staff slowly faded, but the vivid disquieting dreams of confinement persisted for years.\nOUTPUT:" }, { "from": "agent", "value": "Community-acquired pneumonia, Severe hypoxic respiratory failure, Multiorgan dysfunction, Shock, Hepatic dysfunction, Delirium, Acute renal failure, Critical illness myopathy, Anxiety, Depression, Sleep disruption" } ]

[ { "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 9-year-old girl presented with asymptomatic swelling in her right upper chest that had lasted for four weeks. Physical examination revealed an elongated-shaped, nontender, fluctuating cutaneous lesion with reddish-brown discoloration measuring 1.8 x 0.8 cm [Figure 1a]. On digital palpation, a small hard nodule was felt in the lesion. Preoperative ultrasonography revealed a heterogeneous, hyperechoic mass surrounded by a low-echogenic area [Figure 1b]. An elliptical incision line that included two-thirds of the discoloured skin was made along the long axis. The lesion was carefully explored under local anaesthesia. As soon as the incision was made on the overlying skin, a slightly thick serous fluid gushed out from the lesion along with the release of a small solid tumour. The tumour had a pear-shaped, lobulated appearance (5 x 7 mm) with a variegated surface colour. Thick fibrous tissue forming a sac was cautiously removed from the surrounding tissue. The open wound was repaired primarily without leaving any dead space. The gross features of the lesion revealed a small solid tumour floating in an oval-shaped, serous-filled sac formed by thick fibrous tissue [Figure 2]. On histopathological examination, the specimens consisted of a solid tumour and dense fibrous connective tissue: the solid lesion revealed densely packed zones of eosinophilic masses containing shadow cells with peripheral basaloid cells and the extrusion of eosinophilic aggregations through the epithelial lining at the focal area of the periphery [Figure 3a]. Within the fibrous connective tissue, dense neutrophil infiltration with a few phagocytic macrophages was observed [Figure 3b].\nOUTPUT:" }, { "from": "agent", "value": "Pilomatricoma" } ]

[ { "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 female was evaluated for mild episodes of chronic pain in the right hypochondriac region which worsened for a few days. She also complained about constipation and mild dyspepsia. Medical history showed a scoliosis and exercise-induced asthma. Physical examination did not reveal any abnormalities. Routine laboratory tests were unremarkable. Subsequently, a contrast-enhanced computer tomographic scan and MRI were performed and showed a large multiloculated cyst (28 x 33 x 46 mm) with multiple thin septa in the head and neck of the pancreas (Figure 1). An endoscopic ultrasound (EUS) was performed and confirmed the presence of a large multiloculated cyst (5 x 5 cm) with clear borders, without nodules, calcifications, or perilesional lymphadenopathy. The remaining pancreatic parenchyma was normal. EUS-guided aspiration with a 22G needle demonstrated chylous liquid (Figure 2) but analyses showed low triglyceride (TG) levels (<10 mg/dl) (Table 1). Due to this discrepancy, a second EUS-FNA was performed three months later, again showing a milky fluid aspect. Cytological examination showed a hypocellular monster with only rare lymphocytes and neutrophils. There were no epithelial cells. There were no arguments for malignancy. A conservative policy was agreed on with a follow-up by MRI within 6 months.\nOUTPUT:" }, { "from": "agent", "value": "Cystic Lymphangioma" } ]

[ { "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 39-year-old female patient with uncorrected TOF and pulmonary atresia presenting to our emergency department with fever, elevated infection parameters, and hemorrhagic macular lesion on the middle finger of the right hand. Patient history revealed a Blalock-Taussig shunt performed for palliation in 1983 due to pulmonary atresia with subsequent spontaneous closure. Corrective surgery failed in 1998. Coronary angiography performed in 1997 was normal. On admission, a contrast-enhanced multidetector computed tomography (CT) of the chest and abdomen was performed to rule out focal thoracic or abdominal infection. The CT study demonstrated an absent pulmonary artery, a perimembranous ventricular septal defect (VSD) of 1.8 cm diameter, an atrial septal defect (ASD), and right ventricular hypertrophy (RVH). 1). The patient demonstrated multiple pulmonary and splenic emboli (Fig. 2). Echocardiography revealed an ostium secundum type ASD, a VSD, a moderately reduced left ventricular ejection fraction (45%), and two large vegetations on the tricuspid valve. Blood cultures were positive for staphylococcus aureus. Targeted antibiotic treatment was initiated immediately, and the patient was referred to the cardiac surgery department for tricusipid valve repair which was performed 2 days after admission. Due to a protracted clinical course and neurologic deterioration after surgery a cranial CT was performed. Several hypoattenuating cerebral and cerebellar lesions were predominantly localized in the right hemisphere consistent with thromboembolic events (Fig. 3). The further course of the patient was unfavorable, showing progressive cardiorespiratory insufficiency and increasing demand for vasoactive agents. Eighteen days after initial admission the patient passed away, due to cardiopulmonary failure.\nOUTPUT:" }, { "from": "agent", "value": "Uncorrected Tetralogy of Fallot, Pulmonary Atresia with Major Aortopulmonary Collateral Arteries, Septic 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 38-yr-old man was admitted to the emergency department with a history of pain and swelling of the right thigh of 3 days duration. On admission, his temperature was 39C, blood pressure 100/60 mmHg, and pulse rate 105/min. Laboratory studies showed a WBC count of 35,500/microL, CRP 30.0 mg/dL, and an ESR 120 mm/hr. A roentgenogram of the lower extremity demonstrated massive air shadow in the soft tissue (Fig. 1). Gas gangrene was suspected, accordingly, the patient was given a large dose of penicillin and an emergency operation was performed. No pus collection and no myonecrosis was found on operation, but a large amount of gas was drained and a pseudomembrane was found in the fascia of the thigh. Fasciotomy of the thigh and calf and a microbiologic examination were performed. The Gram-negative intestinal organism (Rahnella aquatilis) was obtained on culture. Three days after the operation, we detected the drainage of fecal materials from the inguinal area of the operation wound. 2). On biopsy, the lesion was confirmed to be a nonspecific ulceration. Accordingly, a low anterior resection of the fistular mass was performed (Fig. 3). Fecal materials were no longer drained, and the fasciotomy wound was covered with a split thickness skin graft. The patient was discharged three months after admission with a good general condition.\nOUTPUT:" }, { "from": "agent", "value": "Subcutaneous emphysema, Perforation of the rectum" } ]

[ { "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 characteristics of the cases and the early outcomes are shown in Table 1. According to Sittitrai and Paydarfar, the early outcomes were evaluated based on these criteria:\n- The degree of blood circulation of the flap: Good: Bright pink flap; blood-receiving capillaries rapidly return immediately after decompression; The flap bloated because it receives adequate blood and a good pinprick test (bleeding, bright red blood). Average: The flap is pale, turning purple; slow return of blood-receiving capillaries (2 minutes); The flap was less edematous and the pinprick test showed little bleeding. Poor: The flap is purple; no blood receiving is observed; The flap was flaccid and non-edematous and there is no blood during the pinprick test. - State of flap: Good: No necrosis; no ulcers; The oral cavity has no odor. Average: The flap is partially necrotic (1/10 at the end of the flap); ulcers in 2-3 locations on the flap; The oral cavity does not have a rotten smell. Poor: Necrosis of the entire flap; ulcer - bacterial infection; The oral cavity has a rotten smell of necrotic tissue. - Surgical evaluation: Good: No further intervention. Average: Need to repair part of the flap. Poor: Have to make another flap. Postoperatively, no patient had partial necrosis of the flap or developed complications (infection, bleeding). The neck drainage was withdrawn after 24 hours and the time for nasogastric tube removal was 7 days (Figure 2). All patients spoke normally and could swallow. The submental flap gave good cosmetic results. There were no patients with drooping mouth after surgery. All three patients were discharged 10-12 days after surgery (Table 1).\nOUTPUT:" }, { "from": "agent", "value": "Tongue Cancer, Squamous 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 59-year-old female with advanced glaucoma underwent a bleb revision with bleb needling, mitomycin C, and subtenons triamcinolone for a failed trabeculectomy in the left eye. Three days after her bleb revision, she experienced floaters, pain, and acute loss of vision. She was started on oral prednisone and was referred for an evaluation 1 week later when her vision failed to improve. Visual acuities were 20/25 in the right eye and hand motions in the left eye. A relative afferent pupillary defect of the left eye was observed. Slit lamp exam demonstrated a triamcinolone depot in the inferior fornix (Fig. 1) and 2+ anterior chamber cell and vitreous cell in the left eye. Dilated examination of the left eye demonstrated 2+ vitreous haze and patchy retinal whitening temporally in association with sclerotic-appearing vessels within the inferotemporal quadrant. Examination of the right eye was unremarkable. Ceftazidime (2.25 mg/0.1 cc), vancomycin (1 mg/0.1 cc), and foscarnet (2.4 mg/0.1 cc) were injected intravitreally and the patient was started on trimethoprim/sulfamethoxazole (800 mg/160 mg). Five days later, a combined tractional and rhegmatogenous retinal detachment developed, prompting pars plana vitrectomy, endolaser, silicone oil instillation, injection of vancomycin, ceftazidime, voriconazole and foscarnet, and excision of subtenons triamcinolone acetonide. Vitreous specimens were obtained for bacterial and fungal cultures, PCR testing, and cytology. 1). Therapy with trimethoprim/sulfamethoxazole was continued.\nOUTPUT:" }, { "from": "agent", "value": "Toxoplasmosis chorioretinitis" } ]

[ { "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: Physical examination was consistent with a monoparesis of left upper extremity and left facial paralysis. No more sign occurred. Cerebral CT scan revealed embolic lesion in the right sylvian artery area. Medical history showed a high blood pressure and hypercholesterolemia. The patient had no prior history of arrhythmia. Electrocardiogram (EKG) and Holter EKG were in sinusal rhythm. Investigations in search of a potential cause of cerebral embolism included a Doppler ultrasound of the carotid arteries which was normal. The tumors were excised under normothermic cardiopulmonary bypass using ascending aorta and bicaval cannulation. Anterograde blood cardioplegia was used. The left atrial appendage was closed. Mitral leaflet and subvalvular apparatus were inspected and were free of tumors. Histological examination showed a papillary fibroelastoma including few fibroblasts, collagenous tissue, and elastic fibers surrounded by mucopolysaccharide acid. The patient had uncomplicated perioperative course and was discharged from hospital on postoperative day 8. At the 6-month followup, the patient was well. She has not experienced any neurological event. Transthoracic and transesophageal echocardiography did not find any recurrent tumour at 6-month followup.\nOUTPUT:" }, { "from": "agent", "value": "Left atrium papillary fibroelastomas, Ischemic cerebral stroke" } ]

[ { "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 eleven-year-old boy presented for cardiac consultation with a foreign body that he had coughed up a week earlier. He reported a sudden bout of cough that brought out this unusual material, which was blood-tinged but denied any history of significant hemoptysis, fever, or chest discomfort. There was no recurrence of symptoms and he did not seek any further medical attention locally. The foreign body was the entire prosthetic vascular graft [Figure 1] with sutures at either end and was easily identified as the graft of a Blalock-Taussig (BT) shunt. Subsequently, corrective surgery for TOF was done at the age of 2 years. The BT shunt was occluded by ligating in the middle, as is routinely done at the time of corrective surgery. The right ventricular systolic pressure fell to 60 mmHg (from 100 mmHg), and the relief was maintained at further evaluation 6 months later. The patient was lost to follow up thereafter, but was asymptomatic until the present episode. His present physical examination showed heart rate of 84 /min, blood pressure 100/70 mmHg, and a precordial ejection systolic murmur. There was no pneumomediastinum, any soft tissue shadow, or evidence of inflammation in the lungs. [Figure 2] A doubtful irregularity in the right upper bronchus was noted in light of his history, [Figure 3] but airways were generally unremarkable. No active intervention was done.\nOUTPUT:" }, { "from": "agent", "value": "Tetralogy of Fallot, Right pulmonary artery stenosis, Pulmonary regurgitation, Mild tricuspid regurgitation, Mild right ventricular dilatation and dysfunction" } ]

[ { "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: Long-term radioulnar joint congruency (11 years following injury) is not symmetric between the injured and non-injured wrist (Fig. 3B). Radio-scaphoid and radio-lunate joint congruency are also not symmetric in the amount (surface area) of the high contacting regions when comparing the injured and non-injured wrists although the location is similar. At baseline, this patient had average amounts of baseline pain and disability (PRWE: 88) but had a PRWE score which was 13 points higher than the cohort comparison. However, by 1 year, her pain and disability scores decreased and fell within the average range (PRWE: 15). Approxi-mately 11 years later, this patient's PRWE score was 12 having decreased 3 points from her 1 year score (Table 1). Overall at her long term follow-up visit, this patient was considered to have average amount of pain and disability. This patient's ROM at 1 year showed a deficit in radial and ulnar deviation however, these values were restored compared to the non-injured side approximately 11 years later (Fig. 2B). 3B). Her short-term follow-up radiographs indicate that she has healed in a slightly ulnar positive (+2.48mm) position (non-injured wrist: 0mm), but falls within the acceptable range for ulnar variance. Eleven years later, she remains in this slightly ulnar positive alignment. Her other radiographic characteristics are similar to her contralateral side (long term follow-up x-ray) and are also within the acceptable range. Based on x-ray, the Kellgren-Lawrence OA grade was 1 for the distal radioulnar joint grade 1 for the radio-carpal joint on the injured with no degenerative changes seen on the non-injured wrist (Table 2).\nOUTPUT:" }, { "from": "agent", "value": "Intra-articular distal radius fracture" } ]

[ { "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 29-year old white P1011 at 37 weeks of gestation who presented in early labor with fever, dry cough, headache, nausea, and vomiting. Her prenatal course was uneventful. She had a temperature of 102.3, a respiratory rate of 22, a heart rate of 105, and a pulse oxygen saturation of 100% in room air. She reported that her daughter had some respiratory symptoms and fever a few days earlier. Her lab results were unremarkable, with a white blood count of 4.9, with 8% lymphocytes. The patient was having irregular contractions, and her cervix was 1-2 cm open and 70% effaced. The fetal heart rate was 170 with moderate variability. Chorioamnionitis was suspected and she was admitted for labor augmentation. Because of the ongoing epidemic of H1N1 in the community, she was isolated with droplet precautions, placed in negative pressure room, and started on oseltamivir and ampicillin-clavulanic acid. The patient was augmented with oxytocin and had an uncomplicated vaginal delivery in 8 hours of a female infant weighing 3220 g, Apgar 9/9. She had an uneventful postpartum period and was discharged on postpartum day 2. The newborn tested negative for influenza A and B by real-time reverse transcription PCR. On her six-week postpartum visit she was asymptomatic, and the baby was doing well.\nOUTPUT:" }, { "from": "agent", "value": "Novel influenza H1N1" } ]

[ { "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 41 years old female, without any medical background, was referred for a core needle biopsy of a peri-areolar left breast mass. The lesion's diameter was 1,8cm and was categorized as BI-RADS IV from its radiological depiction. The woman's BMI was around 20. A general surgeon performed an ultrasound guided core needle biopsy by using a 14-gauge automated gun and needle and three samples of the lesion were obtained. The biopsy was completed uneventfully and the patient was discharged home after a 3-hour observation based on the protocol used in our institution. The next day she presented with chest pain and subsequently she passed out. 1). Patient's vital points were affected, (blood pressure 83/55 and heart beats reaching 120 per minute), hematocrit 24,2 and hemoglobin 7,2. A chest tube was urgently placed in the left hemithorax with air and bloody fluid drained while transfusion of red blood cells and fresh frozen plasma was granted. The total quantity of fluid drained by the chest tube was 1200 ml with bloody shade. The physicians of the regional hospital addressed to our department for further confrontation. The patient was transferred to our department after her vital points stabilized and the transportation was safe. The woman was stable when she arrived although the hemorrhage continued as pretty much 100-150ml of bloody liquid drained per hour. Furthermore the depiction in the X-ray suggested a persisted pneumothorax and gathering of coagulated blood. The confrontation included the transfusion of red blood cell and fresh frozen plasma, an immediate surgical intervention was decided as the woman's situation did not seem to improve. The patient was submitted to a video-assisted thoracic surgery in order to locate the site of the injury. Initially an encapsulated pleural effusion was drained, approximately 400ml, and a significant quantity of coagulated blood was found and removed (Fig. 1.). After this the visibility improved and the localization of the injury was possible. The hemorrhage was provoked by an injury of intercostal 4th intercostal artery after the temno biopsy (Fig. 1.). Fortunately the bleeding point was located and diathermy was used to clot the vessel. Moreover a small rupture of the lung parenchyma was restored. Following VATS the patient was hospitalized for one day at the intensive care unit and then she was moved to our department as her clinical condition and X-ray imaging improved (Fig. 1). Finally she was discharged in the 6th postoperative day in overall good condition.\nOUTPUT:" }, { "from": "agent", "value": "Hemopneumothorax" } ]

[ { "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 47-year-old man presented to his primary care physician with a 3-month history of intermittent epigastric abdominal pain, nausea, and vomiting. Routine laboratory analysis revealed normal liver function. The patient underwent an abdominal computed tomography (CT) scan, which revealed a 4.2 x 4.1 x 4 cm mass in the head and uncinate process of the pancreas. The scan also showed that the patient's entire colon was on the left side of the abdomen and the small bowel to the right (Fig. 2). Tumor marker analysis showed a normal CEA level and an elevated CA 19-9 level. At operative exploration, the fourth portion of the duodenum was in its normal position; however, the proximal jejunum immediately traveled to the patient's right side and most of the small bowel was to the right of the ascending colon and the cecum located in the pelvis. The SMA was rotated closer to the uncinate process and was encased by tumor making the lesion unresectable. A palliative antiperistaltic gastrojejunostomy and Roux-en-Y hepaticojejunostomy bypass were performed. The jejunal limb was not brought up in the usual retrocolic manner but in a right paracolic position due to the abnormal colonic location. Intraoperative biopsy of the palpable mass revealed a moderately differentiated PDA. The patient underwent gemcitabine-based chemotherapy and radiation postoperatively with successful downstaging of the tumor. He underwent operative re-exploration with successful resection of his tumor through a classic pancreaticoduodenectomy ~12 months after his initial exploration. The patient was discharged from the hospital on postoperative day 8.\nOUTPUT:" }, { "from": "agent", "value": "Hepatopancreatobiliary Tumors, Congenital Variants of Gastrointestinal Rotation, PDA with perineural tumor involvement, Metastatic 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 39-year-old woman was admitted to the hospital because of left groin pain. She had a past medical history of meningitis. Four years previously, she was found to have MCTD on the clinical diagnostic criteria of Sharp et al. At that time, she experienced arthritis, Raynaud's phenomenon, swollen hands and biopsy-proven myositis. Laboratory examinations revealed the following results: leukocyte count 3600/mm3, antinuclear antibody 1:640, speckled pattern, positive anti-nRNP & Ro antibody, LDH 208 U, CK 23 U. The patient was treated with hydroxychlorquine, prednisolone (10 to 20 mg/day, sometimes on 5 mg/day), piroxicam and angiotensin-converting enzyme inhibitor or calcium channel blocker. Thereafter, she was intermittently admitted to the hospital due to drug-induced hepatitis, severe dysplasia of the uterine cervix, fever with chills and painful lymphadenopathy. At the presentation, she visited the hospital due to back and left groin pain during walking down stairs about 15 days ago. She denied a significant trauma history. Pelvis X-ray previously checked was unremarkable except for an osteoporotic change (Figure 1A). Physical examination on admission showed positive a Patric test on the left hip joint. We suspected her to have the avascular necrosis of the left femoral head. However, MRI of the left femoral head did not confirm our suspicions but instead, revealed a synovitis with effusion. Simple pelvis radiograph was done. We recommended bed rest, tapering of prednisolone and management of steroid-induced osteoporosis. After 5 months, a follow-up pelvis X-ray revealed the healing of parasymphyseal fracture (Figure 1C).\nOUTPUT:" }, { "from": "agent", "value": "Parasymphyseal and associated insufficiency fractures of pubic rami, Mixed connective tissue 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: 1, Fig. 2), with classic flow compromise beginning at the terminus of bilateral internal carotid arteries. Over an 18 month period, serial MR perfusion studies utilizing Tmax (the time to maximum of the residue function) as a surrogate marker of cerebral hypoperfusion were obtained and showed increasing perfusion delays over the bilateral middle and anterior cerebral artery territories, concomitant with worsening seizure control (Fig. 2). Events could cluster and were exacerbated by presumptive orthostatic positional changes such as standing after prolonged sitting or toileting. On EEG a diffuse, poorly lateralized high voltage bifrontal pleomorphic delta was evident at baseline, though no falling events were captured on EEG. A multitude of anti-seizure medications were trialed and while they may have shown initial betterment of seizure controls, over the course of several years seizure control declined. Seizure types, medication burdens and time-based progression of findings, including seizure control are documented in the table. Because of increasing number of seizures and falls, and the known worsening in cerebral perfusion, she underwent a left indirect external carotid to internal carotid circulation bypass. Specifically the posterior auricular branch of the external carotid artery was sewn to the pial surface of the brain with dural eversion and temporal muscle placement on brain surface in an encephaloduromyosynangiosis (EDAMS) procedure. The more traditional donor of the superficial temporal artery was not utilized as it was already providing some collateral circulation to the brain. This was true of bilateral superficial temporal arteries. She recovered well and 3 months later returned for the same procedure on the right side. Intraoperatively the posterior auricular branch was found to be extremely small, even for an onlay graft in continuity; and so only dural inversions and temporal muscle onlay grafts were performed. Surgical outcomes post-operatively were excellent, At 15 months post-left bypass at one year post-right bypass there's been marked improvements while on triple drug anti-seizure medications (Table 1). She was more alert, showed a resolution of aphasia, used more spontaneous speech than she had in decades, no longer fell or slumped, and remained awake and alert during the day. Nine-month post-operative MRI scan shows marked improvements in bilateral CNS perfusion (Fig. 2).\nOUTPUT:" }, { "from": "agent", "value": "Down syndrome, Moyamoya disease, Drug resistant epilepsy" } ]

[ { "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, obese Somali gentleman was admitted with a history of acute onset of hallucinations and delirious behaviour. He was found by his relatives with suspected olanzapine overdose and had been on the floor for more than two days. He had a past history of depression and psychosis for which he was on this medication. The patient also had a longstanding history of \"Khat\" abuse (a flowering plant with amphetamine-like effects). On admission, he was noted to be disorientated and confused. He was afebrile, tachycardic and had a blood pressure of 110/70. His oxygen saturations were normal. Cardiovascular, respiratory, abdominal and neurological examinations were unremarkable. There were no signs of meningism. Blood tests revealed no significant abnormalities apart from elevated Creatine Kinase of 4,800 u/l, which was presumed to be due to rhabdomyolysis secondary to lying on the floor for a prolonged period. Arterial blood gases and chest X-RAY were normal, whilst his ECG showed sinus tachycardia. A CT scan of his brain did not reveal any abnormalities. Urine dipstick showed no evidence of a urinary tract infection. Serial ECGs showed the development of widespread flattened T waves and right axis deviation. He was subsequently reviewed by the psychiatrists and admitted to storing 90 olanzapine tablets and taking these with a clear suicidal intent following a severe depressive episode. He denied having taken any other medications and no other empty packaging was found, apart from that of his olanzapine tablets. He has since recovered completely.\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: 'I worked as a cleaner; my teacher found this job for me but told me later to stop because of my sickness, so I never worked after that.' These findings are consistent with the views documented in the literature (Gaunt & Lengnick-Hall; Gold et al.) Sources of income were considered important as these revealed the type of capital a person possessed. The participants disclosed that they occasionally received a stipend from the workshop in addition to disability allowances as a source of income. Participants reported that they were all recipients of a disability grant of R1600.00 per month from the government. For the purpose of this study, the government grant was regarded as an income. Seven participants also received a child support grant as an additional income. This finding suggests that these participants may escape poverty because of social grants. Studies in South Africa have found that social grants are beneficial in alleviating poverty (Gathiram; Loeb et al. ; Samson et al. ), and grants are effectively targeted and provide income to households (Samson et al.). All the participants reported that they received a monthly stipend ranging from R40.00 to R200.00 from income-generating activities based on their attendance and when their products were sold. It was indicated in the background information that the stipend was intended to be an interim payment given to participants to assist them in covering some of their basic costs while they were at the workshop rather than a fixed income to support family obligations.\nOUTPUT:" }, { "from": "agent", "value": "Disabilities" } ]

[ { "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 June 2016, a 76-year-old male with a past medical history significant for nephrolithiasis and diverticulitis, presented to the authors' institution with extensive hyperpigmentation involving both lower extremities. The patient had an extensive orthopedic and orthopedic infectious disease history. He underwent a left total knee arthroplasty in 1988 at an outside institution and underwent revision surgery in 1992. In 2001, he underwent a second revision for fractured patella that was complicated by an infection with a coagulase-negative Staphylococcus. He received six weeks of treatment with parenteral vancomycin followed by oral trimethoprim-sulfamethoxazole. Because of increasing knee pain, in March 2005, the prosthesis was explanted. Operative cultures from the knee grew Enterococcus sp., Prevotella sp, viridans group Streptococcus, as well as Candida parapsilosis. After completing antimicrobial treatment with vancomycin, ertapenem and fluconazole, he underwent reimplantation using a rotating hinged knee arthroplasty in September 2005 (Fig. 1). Unfortunately, operative cultures were positive for coagulase-negative Staphylococcus. In 2010, he sustained a periprosthetic fractures that required open reduction and internal fixation. His left knee has been clinically quiescent and stable for a number of years. He uses a brace as well as a cane to ambulate. At a follow-up in February 2012, it was noted that he had slight discoloration in the lower extremities. When he was seen again in June 2016, there was extensive blue-gray pigmentation in both cheeks and in the lower extremities (Fig. 2), as well as sub-ungual blue-gray pigmentation in both hands (Fig. 3).\nOUTPUT:" }, { "from": "agent", "value": "Diffuse skin hyperpigmentation, Chronic minocycline use, Prosthetic joint 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: A 70-year-old female patient with multiple cancers history was admitted with a burn index of 32.5 because of a house fire. Continuous hemodiafiltration (CHDF) was initiated. Her skin showed pink coloration and reddish-purple effluent fluid was observed from the beginning to the discontinuation of CHDF (Fig. 1A). Renal function and urine output gradually recovered, and similar pigmentation of urine to effluent fluid was observed (Fig. 1B). Hydroxocobalamin contains cobalt, which is red and characteristics water-soluble, so the urine turned reddish as if blood in the urine. Some dialysis machines reportedly misrecognized blood leak because of dialysate discoloration by hydroxocobalamin. A membrane of AN69-ST (Baxter Limited., Tokyo, Japan), which can only partially remove myoglobin and free hemoglobin by filtration, and two dialysis machines of ACH-Sigma (Asahi Kasei Medical Co., Ltd., Tokyo, Japan) and TR-2020 (Toray Medical, Co., Ltd., Tokyo, Japan) were used and no false alarm of blood leak occurred. Of note, high myoglobin level in blood and effluent might influence the color of effluent fluid.\nOUTPUT:" }, { "from": "agent", "value": "Cyanide poisoning, Acute kidney injury, Rhabdomyolysis" } ]

[ { "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 53-year-old Caucasian woman presented with a 40-year history of severe plaque psoriasis. The patient had recalcitrant psoriasis that was unresponsive to multiple conventional therapies such as methotrexate and acitretin. The patient also had a 20-year history (>800 treatments) of psoralen plus ultraviolet A (PUVA) therapy. Her past medical history was notable for a benign compound nevus on the left anterior thigh, which was completely excised in January 2011. In January 2012, the patient was screened (including physical examination, baseline laboratory studies, and screening for latent tuberculosis and chronic viral infections) and began etanercept therapy (50 mg subcutaneously twice weekly). After 3 months, the patient was responding insufficiently to etanercept and was switched to infliximab (5 mg/kg at weeks 0, 2 and 6, and then every 8 weeks thereafter). This treatment resulted in the complete disappearance of her psoriasis. Twelve months after beginning the infliximab treatment, the patient developed palpable lymphadenopathy in the left inguinal region. Given the suspect nature of the palpable mass, the patient underwent an inguinal lymph node biopsy. Positron emission and computed tomography scans were negative for distant metastatic disease. Infliximab was discontinued and a complete inguinal lymph node dissection was performed, which revealed no additional nodal involvement. A full skin evaluation did not reveal any suspicious lesions, but 4 cm below the metastatic lymph node, the scar from the previously removed nevus could be seen (fig. 1). 2). A BRAF V600E mutation was detected and the patient was enrolled in a clinical trial of combined adjuvant therapy with dabrafenib and trametinib.\nOUTPUT:" }, { "from": "agent", "value": "Nodal Melanoma Metastasis, Nevoid 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: Computer tomography (CT) and magnetic resonance imaging (Figs 1 and 2) revealed a resectable tumor of the head of the pancreas, a duplicated IVC and a PV trifurcation. The two common iliac veins did not join together at lumbar 4 (L4) vertebra level but ascended separately along the celiac aorta, representing right and left IVC. Specifically, the right external and internal iliac veins joined, forming the right common iliac vein that ran along the abdominal aorta, representing the right IVC. The left IVC formed exactly like the right one while draining to the left renal vein (Fig. 1). This variation can be characterised as 'type 2a' in accordance with the classification shown in Fig. 3 (type 2a). Moreover, in our patient, a Whipple procedure was performed without post-operative complications. Duplication of the IVC is a rare anatomical entity that did not affect the surgical treatment in our case per se. Another interesting aspect refers to the right IVC invasion in case of PDAC and double IVC; in this case, the duplication may help the hepatobiliary surgeon sacrifice the main vessels due to multiple retroperitoneal collaterals. Thus, this hypothesis needs to be proven anatomically. Another important aspect in locally advanced PDAC is the portal-mesenteric complex replacement, followed by the performed splenorenal shunt. Anatomy knowledge is of great importance in such circumstances, as it may affect the technique of reconstruction.\nOUTPUT:" }, { "from": "agent", "value": "Pancreatic duct adenocarcinoma, Duplicated inferior vena cava, Trifurcated portal vein" } ]

[ { "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 woman visited the Department of Obstetrics and Gynecology in our hospital because of a complaint of sudden dyspnea on effort. She was previously diagnosed with endometriosis and prescribed a combination oral contraceptive pill (drospirenone/ethinylestradiol betadex, trade name; Yaz , Bayer, Leverkusen, Germany). Following the Kumamoto Earthquakes and subsequent aftershocks in April 2016, she spent 7 nights in a vehicle. She noticed sudden dyspnea on effort when she walked outside the car on the 8th morning after the first earthquake. Although she walked around for personal reasons during the daytime, she spent nights in her small car with her legs in a hanging position. She noticed swelling and pain in her left lower extremity, and her serum D-dimer levels were 13.2 mug/mL. 2A) and in the left lower extremity (posterior tibial, soleus and gastrocnemius vein) (Fig. 2B). Her plasma brain natriuretic peptide and high-sense troponin T concentration levels were 97.2 pg/mL and 0.0061 ng/mL, respectively. She was diagnosed with PTE and admitted to our department. On admission, her blood pressure was 129/80 mmHg and her heart rate was 72 beats per minute. Her degree of oxygen saturation (SaO2) in arterial blood gas was 97.7%. Her body mass index was 24.4 kg/m2. Electrocardiography and cardiac ultrasound did not indicate heart failure. An investigation of most factors related to thrombus formation (including protein C, protein S, antithrombin, and antiphospholipid antibodies) revealed that all such factors were normal. The discontinuation of the oral contraceptive and the administration of rivaroxaban (30 mg, daily), a direct oral anticoagulant (trade name: Xarelto , Bayer) was initiated according to the results of the EINSTEIN-PE trial. After 7 days, a follow-up contrast-enhanced CT scan revealed a reduction in the thrombosis (Fig. 3). The patient was followed up with rivaroxaban. The patient gave her consent for the publication of this study.\nOUTPUT:" }, { "from": "agent", "value": "Venous Thromboembolism, Deep vein thrombosis, Pulmonary Thromboembolism" } ]

[ { "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: Five agar plugs from a 5-day-old F. solani culture on Czapek Dox agar medium was added to 70 mL CMC medium [15 g/L carboxymethyl-cellulose sodium salt (C4888; Sigma-Aldrich) 1 g/L NH4NO3, 1 g/L KH2PO4, 0.5 g/L MgSO4 7H2O, 1 g/L Bacto yeast extract (Becton, Dickinson and Company, Sparks, MD, USA] in a 250 mL baffled flask. The culture was incubated in the dark for 5 days at 20 C with 100 rpm. The medium was filtered through a sterilized syringe lightly packed with glass wool before the flow through was centrifuged at 5000 g for 40 min at 5 C. The supernatant was carefully discarded and the pellet resuspended in 10 mL cold sterile H2O. This step was repeated twice with centrifugation for 20 min, before the macroconidia were ready for transformation. The F. solani macroconidia were transformed with pSHUT4-eYFP using A. tumefaciens AGL1 as previously described. The transformation mixture containing A. tumefaciens and F. solani was spread onto induction medium plates containing a black filter paper (Frisenette, Denmark, 140.090). Positive controls included plates with and without filters plated with either plasmid carrying A. tumefaciens or macroconidia. After incubation at 22 C for 3 days, the filters were moved to V8 agar plates containing 150 microg/mL G418 (Gibco) and 300 microg/mL cefoxitin sodium (Sigma-Aldrich). After 7 days, the filters were moved to new V8 agar plates containing 150 microg/mL G418 where colonies started to emerge after 1-5 days. Single colonies were transferred to potato dextrose agar (PDA) plates containing 200 microg/mL G418. All incubation steps were carried out in darkness.\nOUTPUT:" }, { "from": "agent", "value": "The case report does not provide information about a diagnosis as it is a scientific experiment report, not a medical 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: Patient information: a 9-year-old Moroccan male, the second of 3 children with 2nd degree of consanguineous parents, came in a standard medical screening in a primary school. He was presented with 3 years past medical history of bilateral ptosis and lipothymic discomfort. Clinical findings: general examination found short stature with a BMI within normal limits (17kg/m2). On the first examination, the visual acuity was 20/100 in the right eye and 20/80 in the left eye. The inspection found bilateral ptosis (Figure 1). Ocular motility examination revealed partial external ophthalmoplegia with mild limitations in gaze in all directions. The pupillary light reflex was present. Intraocular pressure was good in both eyes. Slit-lamp biomicroscopic examination found a calm anterior segment. After dilatation, funduscopy of both eyes showed bilateral atypical pigmentary retinopathy with macular dystrophy (Figure 2). The diagnosis of KSS was suspected. The patient was referred to the cardiology and neuropediatric department. Examination found normal cardiac auscultation and normal neurological assessment. Diagnostic assessment: fluorescein angiography found areas of hyper- and hypofluorescence called \"aspect of salt and pepper\" (Figure 3). The electrocardiogram revealed a 3rd degree atrioventricular block with an average ventricular rate at 37 b/min (Figure 4). The biological assessment including thyroid testing, hepatic balance, glycemia, lactic acid, renal function, blood cell, and urine analysis was normal, except for creatine phosphokinases (347 UI/L), and lactates (241 mg/L). A biopsy of the deltoid muscle found ragged red fibers with Gomori Trichome. Diagnosis: the KSS diagnosis was retained following clinical triad: bilateral ptosis, pigmentary retinopathy, and an alteration of cardiac conduction, and then confirmed by muscular biopsy. Therapeutic interventions: it was decided to realize the implantation of a double chamber pacemaker (Figure 5). Follow-up and outcome of interventions: follow-up after one week was uneventful. Patient perspective: the young boy was very satisfied during his hospitalization and after the treatment. The patient was delighted with the care he received and was optimistic about the outcome of his condition. Informed consent: children under the age of 18 are not allowed to give consent. Informed consent was obtained from his parents for us to publish the case report and use the pictures.\nOUTPUT:" }, { "from": "agent", "value": "Kearns-Sayre 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 39-year-old man with unremarkable medical and ophthalmological history presented to the ophthalmology emergency room, complaining of metamorphopsia and vision loss on his left eye, after receiving a facial laser hair removal session the week before. The laser used was a 1064 nm Nd:YAG laser. Three days before he was diagnosed with keratoconjuctivitis sicca and treated with ocular lubricants. On that occasion, his visual acuity was 20/20 in his right eye and 20/32 in his left eye. No pathological findings on anterior pole slit lamp examination were observed. Intraocular pressure measured by Goldman applanation tonometry was normal (17/18 mmHg). Retinography of his left eye revealed perifoveal hyperpigmentation (Fig. 1) compared to the right eye, which had a preserved foveal glow. Fluorescein angiography showed an early hyperfluorescent spot in the foveal area, with increased leakage during the late phases (Fig. 2). On autofluorescence, a hypoautofluorescent halo was observed surrounding a hypoautofluorescent foveal spot (Fig. 3). 4a). Given our patient's mild visual acuity loss and absence of choroidal neovascularization, we opted for close follow-ups every 4 weeks, when we measured visual acuity and performed OCT. Visual acuity slowly improved to 20/20 over the first 4 months. The PED did not display any change at four months. At 12 months, vision remained 20/20 but the patient still complained of a small scotoma and metamorphopsia, mainly in his near vision. On OCT B scan, the PED had experienced a decrease in its size (Fig. 4b).\nOUTPUT:" }, { "from": "agent", "value": "Retinal toxicity" } ]

[ { "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: Electroencephalograms always showed diffuse slow activity. Brain computerized tomography and magnetic resonance imaging (MRI) (Figures 1-3) scan controls did not reveal any increase in the volume of lesion. Approximately 2 years ago, the patient began to present psychiatric symptoms as apathy, indifference, loss of initiative, mood changes, reduction of sexuality, all evoking a state of depression. The following psychological tests were administered: Perception of Housing Quality Scale, Mini Mental State Evaluation, Activities of Daily Living, Patient Health Questionnaire, and Geriatric Depression Scale. All tests showed abnormal scores expressing a depression of moderate to severe type. Paroxetine, an antidepressant of the selective serotonin reuptake inhibitor class, was administered at 20 mg oral daily dose. The improvement of the signs of depression was gradual and in fact the patient is continuing therapy successfully with a maintenance dose of 10 mg oral daily as confirmed by psychological test control results. No adverse effects related to antidepressant were reported. The patient always refused any surgical option.\nOUTPUT:" }, { "from": "agent", "value": "Headache, Epilepsy, Late-onset Kleist's pseudodepression syndrome, Frontal lobe cavernoma of the cerebral left hemisphere" } ]

[ { "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 referred to a trauma hospital and the surgery was scheduled for the following day. Soft tissues were classified as Tscherne I, and no distal neurovascular compromise was observed. A kidney transplant had been performed 10 years prior due to polycystickidney disease. However, the patient omitted this information despite questioning by the medical team about priorsurgical procedures. (Fig. 1 and 2) depict pre-operative images. After general anesthesia, the patient was placed in supine oblique position on a radiolucent table with a contralateral subgluteus bump. Prophylactic antibiotic was administered. Although the use of tourniquet should facilitate fracture reduction and fixation, we have not used it in this case to prevent ischemic complications related to the patient age and comorbidities. Fracture reduction was achieved with a ball-spike pusher and K-wires provided provisional fixation. During the most distal plate hole drilling, we observed a high volume of silicone drainage. After extensive debridement, we completed the posteromedial fixation and removed the bump to achieve supine position and permit anterolateral fixation. An anterolateral approach was performed, and an L-shaped locked plate fixed the anterolateral fragment. (Fig. (Fig. 4) shows fracture reduction and fixation with plate and screws. Knee Society Score function after 9 months was 80 points (Fig. 5).\nOUTPUT:" }, { "from": "agent", "value": "Tibial Plateau Fracture, Calf Augmentation Implant Disruption" } ]

[ { "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: Emergency endoscopy was performed directly using a large channel (6 mm diameter) endoscope. After 1 h of endoscopy, mechanical ventilation became impossible due to an abdominal compartment syndrome. Immediate laparotomy was performed and the stomach had to be evacuated from air and coagula manually with a simultaneously positioned 52-F tube. To stop the ongoing bleeding after coagula evacuation, a Sengstaken-Blakemore balloon was placed. During the first 24 h the patient received 16 erythrocyte concentrates, 2 platelet concentrates, 1,200 ml fresh frozen plasma, 10 g fibrinogen and coagulation factors (2,000 IU Beriplex , see table 1, plus 1,250 IU coagulation factor XIII). Due to repetitive declines in hemoglobin and the endoscopic proof of bleeding from the esophagus, the patient got a transjugular intrahepatic portosystemic shunt (TIPSS) inadequately lowering the directly measured portal pressure from 46 to 35 mm Hg 2 days later. The patient's hepatic function, however, remained impaired, the reason why the patient was listed for transplantation on hospital day 5 (MELD score at that time was 29) and transplanted on hospital day 12. Today, 2.5 years later, the patient is in good health.\nOUTPUT:" }, { "from": "agent", "value": "Esophageal variceal bleeding, Liver cirrhosis" } ]

[ { "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: On presentation, the patient was in shock (blood pressure 95/60 mmHg), with a distended abdomen and haemoglobin of 7.2 g/L, despite having received three units of packed red blood cells (pRBC). Intravenous (IV) fluid resuscitation with prophylactic antibiotics was administered. Triphasic computed tomography angiogram (CTA; Fig. 1) identified locules of gas within the retroperitoneal para-aortic soft tissue, in keeping with a fistulous communication with the duodenum; CTA did not identify active bleeding. The patient was transferred to the interventional endovascular suite for emergency EVAR. Bilateral percutaneous femoral access was obtained. Angiography identified aortic narrowing with thrombus at the level of the duodenal stent without pseudoaneurysm. An occlusion balloon was placed within the thoracic aorta for 10 minutes to reduce hypotension. A 23 x 12 x 12 GORE bifurcate stent graft (WL Gore, Flagstaff, AZ, USA) with an iliac artery limb extension (16 x 12 x 10) on the left was implanted (Fig. 2). Day 1 post-operatively the right iliac limb occluded resulting in acute limb ischaemia, probably due to limb compression within a narrow aorta. Graft thrombectomy, four compartment fasciotomy, and bilateral balloon expandable stents were placed in the contralateral gate and right iliac limb. Post-operative issues included pain, physical deconditioning, and concerns of stent graft infection due to ongoing elevated inflammatory markers, treated empirically with piperacillin-tazobactam. The patient was discharged after five weeks to rehabilitation with lifelong oral moxifloxacin and died at an external facility. His cause of death is not known to the authors; his overall survival was two years.\nOUTPUT:" }, { "from": "agent", "value": "Aortoduodenal Fistula, Malignant Gastric Obstruction, Metastatic Colorectal 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: On April 9, 2022, the patient was hospitalized again due to increased pain and numbness in extremities. After this admission, a detailed physical examination indicated palpable neck lymph nodes, symmetrical tetraparesis, reduction in reflexes, and hyperalgesia. Further fine-needle aspiration of the nodes for cytological examination suggested the presence of metastatic tumor cells, although their origin cannot be unequivocally stated. In addition, FDG-PET/CT showed focal hypermetabolism of a soft-tissue mass in the nasal cavity, suggesting a malignant tumor lesion (Figures 1C, D). Surprisingly, the results showed that the patient's serum anti-Hu antibody was positive. Eventually, a definitive diagnosis of PPN was made. The patient was subsequently transferred to the department of otolaryngology for resection and biopsy of the nasal mass. Unexpectedly, the pathological results of this neoplasm shown high-grade round cell malignant tumor, which was consistent with ONB. According to the pathological grading standard of Hyams, ONB could be divided into four grades (Table 1). HE staining of this patient presented obvious mitotic figures, significant nuclear pleomorphism, and lack of typical lobular structure, meeting the diagnostic criteria of Hyams grade IV (Figures 2A, B). CD99, P63, FLI1, LCA, HMB45, Desmin and vimentin were negative, supporting the diagnosis of ONB. Proliferation marker studies using Ki-67 revealed a high proliferative index of 40%. After tumor resection and neck lymph nodes dissection, the patient recovered well with nasal ventilation improved. Although the symptoms of numbness and pain in the extremities were still present, they were significantly relieved. The patient is currently undergoing chemotherapy in the Oncology department and will be followed up continuously.\nOUTPUT:" }, { "from": "agent", "value": "Paraneoplastic Peripheral Neuropathy, Olfactory Neuroblastoma" } ]

[ { "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 68-year-old female patient with a history of BD, maintained under lithium carbonate for 24 years, presented to the emergency room with brutal onset of subconfusion, insomnia, and visual hallucinations. According to her relatives, the patient was diagnosed with BD after a manic episode for which she was admitted in a psychiatric unit when she was in her late twenties. Afterward, she presented mainly manic and hypomanic episodes. Five years earlier, the patient's referring psychiatrist put the patient under 500 mg lithium carbonate monotherapy, and she had been stable all this period. At admission, the patient neuropsychiatric evaluation found vivid visual hallucinations with onirism and confusion. Electrocardiogram and brain MRI were normal. Calcitonin, thyroid stimulating hormone (TSH), ionogram, azotaemia, and creatinine were normal. The patient's total serum calcium level after correction was high (127 mg/l [normal: 88-105]) and the serum parathormone level (PTH) was five times normal values (380 pg/ml [normal: 8.7-79.6]). Urine methoxylated derivatives were negative, which eliminated pheochromocytoma. The patient received furosemide (120 mg per 24 hours), zoledronic acid (4 mg in a single dose), and parenteral rehydration. Lithium therapy was discontinued. Five days after her admission, and even if the serum calcium level decreased to 93 mg/l, psychiatric symptoms got worse: the patient showed anxiety, subagitation, visual hallucinations, and incoherent speech. PTH levels were monitored on days 2, 5, 7, and 15 and then a month later.\nOUTPUT:" }, { "from": "agent", "value": "Lithium-Associated Hypercalcemia, Bipolar Disorder, Parathyroid Adenoma" } ]

[ { "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 woman presents with nausea and vomiting accompanied by systemic features of infection. She reports a recent episode of cellulitis of the right index finger due to injury by a thorn. She was treated with cephalexin and clindamycin for 10 days, followed by Bactrim and clindamycin as prescribed by her primary care physician. She reports beginning the Bactrim one week prior to admission. She also reports the occasional use of naproxen, unrelated to her recent cellulitis. On presentation, her blood pressure was 174/103, heart rate was 96, and temperature was 37.4 C. A mild, linear papular rash was noted across the midline of the abdomen (Figure 1). The papules were approximately 2-3 mm in size and were non-pruritic and non-blanchable. Lab results included an elevated troponin (2.380), aspartate aminotransferase (176), and alanine transaminase (132). WBC was 12.2 with neutrophils (88.8) and eosinophils (0.5%) (Table 1, 2). EKG showed no ischemic changes (Figure 2). Cardiology was consulted due to the elevated troponins (Table 3). Echocardiography demonstrated diffuse hypokinesis and an ejection fraction of 55% (Video 1). Cardiac catheterization revealed normal coronary arteries. At this time, the cause of her symptoms was suspected to be systemic infection due to the progression of her cellulitis as she met systemic inflammatory response syndrome (SIRS) criteria, had a suspected source of infection, and signs of organ dysfunction. She was started on broad-spectrum antibiotics as well as intravenous fluids. On day four, the eosinophil count increased to 11.2%. This was accompanied by the evolution of the papular rash, becoming confluent and morbilliform over her abdomen and back (Figures 3, 4). Management included discontinuation of all culprit drugs and symptomatic management with intravenous fluids and supplemental oxygen as needed. Laboratory values and vital signs were continuously monitored. Her symptoms and rash improved, and the patient was discharged on day seven (Figure 5). The patient agreed to follow up with her primary care physician within three to six days.\nOUTPUT:" }, { "from": "agent", "value": "Drug Reaction With Eosinophilia and Systemic Symptoms" } ]

[ { "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 patient was a 4-day-old girl born after a normal pregnancy and spontaneous vaginal delivery. Myoclonic seizures were observed in the baby right after the delivery. She had generalized hypotonia. Routine laboratory blood and urine tests were unremarkable. Seizures were controlled by phenobarbital. Computed tomography (CT) and MRI examinations were performed on the fourth day of life. A CT scan was unremarkable. T1- and T2-weighted sequences of the MRI examination were also normal [Figure 1a]. A diffusion MRI sequence was added to the imaging protocol. A maximum gradient strength of 30 mT/m was administered. The diffusion MRI sequence used was the so-called trace sequence, a single-shot, spin-echo, echo-planar imaging sequence, which averages the data from the three (x, y, and z) gradients, and provides automatically generated ADC (apparent diffusion coefficient) maps. The acquisition time was 22 sec with TR = 3900 msec, and TE = 116 msec; the slice thickness was 5 mm. The diffusion-weighted images, obtained with a b value of 1000 sec/mm2, revealed apparent high-signal changes in the splenium of the corpus callosum, and occipital lobes [Figure 1b]. The ADC maps (which are free from T2 shine-through effects) revealed that the ADC values of the involved regions (0.69 x 10-3 mm2/sec) were low, compared to other parenchyma regions with value of 1.24 x 10-3 mm2/sec [Figure 1c]. A radiological diagnosis of NALD was suggested to the clinicians. The diagnosis was confirmed by the demonstration of abnormaly high levels of saturated, very long chain of fatty acids (VLCFA) (C24/C22, C26/C22, and pipecolic acid) in a plasma assay.\nOUTPUT:" }, { "from": "agent", "value": "Neonatal Adrenoleukodystrophy" } ]

[ { "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 an automatic implantable cardioverter-defibrillator (AICD) implant, and he has been on amiodarone for almost 12 months to control his A fib. He denied any symptoms of hyperthyroidism. He was following with his cardiologist, and laboratory tests showed suppressed TSH <0.01 mU/l with high normal free T4 1.7 ng/dl, 6 months after starting the amiodarone. There was no documented baseline TSH prior to the amiodarone use. Repeat laboratory workup showed normal free T4 1.3 ng/dl and normal free T3 3.1 pg/ml with TSH <0.01 mU/l. Antibodies testing showed TSI <89%, TRAb 7%, and TPO antibody 31 IU/mL. A 24-hour urine iodine was ordered and came back elevated >1000 mcg/L, so 99m-STS was ordered instead of RAIU to assess for AIT. The 99m-STS showed intense initial intense uptake of the tracer activity within the thyroid parenchyma followed by a near complete washout in the 3-hour delayed images suggestive of AIT-1 (Figure 1). Thyroid ultrasound (US) showed diffusely enlarged (left more than right) thyroid gland with relatively isoechoic, predominantly solid nodules replacing the entire gland. Right lobe has dominant midupper pole nodule 3.7 x 1.9 x 2.2 cm. Two lower pole nodules measure 2.6 x 1.2 x 1.3 cm and 1.9 x 1.3 x 1.9 cm. Left lobe contains a dominant nodule measuring 7.1 x 5.1 x 5.7 cm. There was mild diffuse internal blood flow on CFDS. Afterward, thyroid function tests normalized. Amiodarone was continued to control his A fib.\nOUTPUT:" }, { "from": "agent", "value": "Amiodarone-Induced Thyrotoxicosis, Multinodular Goiter" } ]

[ { "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: Despite the existence of best practice guidelines for the diagnosis of DMD, implementation of these recommendations in different parts of the world is challenging. Here, we present 4 unique case studies which illustrate the different diagnostic pathways of patients with DMD in Middle Eastern countries and highlight region-specific challenges to achieving timely and accurate genetic diagnosis of DMD. A lack of disease awareness and consequential failure to recognize the signs and symptoms of DMD significantly contributed to the delayed diagnoses of these patients. Additional challenges included limited available funding for genetic testing and a lack of local specialist and genetic testing centers, causing patients and their families to travel vast distances for appointments in some countries. Earlier and more accurate genetic diagnosis of DMD in this region would allow patients to benefit from effective disease management, leading to improvements in health-related quality of life. Image Caption and Description: \nImage caption: []\nImage description: []\nCase Report: \nA second muscle biopsy was performed when the patient was almost 10 years old. Multiplex immunoblot analysis unequivocally showed the absence of dystrophin protein. A karyotype analysis then showed the presence of a de novo X-chromosome translocation near the site of the DMD gene (t[X;1][p21.3;p22.2]), confirming a DMD diagnosis in the female patient. Owing to the complexity of the genetic test results, further discussions between the clinical geneticist and the family were required to explain the results and the final diagnosis.\nOUTPUT:" }, { "from": "agent", "value": "Duchenne Muscular Dystrophy" } ]

[ { "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: This infant was born to Asian parents. The baby's mother was a 34-year-old woman, and her father was a 32-year-old man. The mother was gravida 2 and para 1 (G2P1) with good prenatal care. There was no family history of congenital abnormalities on either side of the family, and the parents were not consanguineous. The mother also had no history of tobacco, alcohol, or substance abuse. The mother's antenatal examination was uneventful except for gestational diabetes. During pregnancy, the mother's blood glucose was maintained between 6.1 mmol/l and 8.1 mmol/l without any drug treatment. The infant's gestational age was 37 weeks and 3 days. Owing to dyspnea 2 h after the birth, the neonate also received further examination in the NICU. On examination, a perineal defect was noted. The groove extended vertically downward from the base of the vaginal fourchette to the anterior rim of the anus at the 12 o'clock position. There were no signs of malformation, bleeding, fistula, secretions, or infection noted in the genital area (Figure 2). During admission, the infant had normal excretory functions. Her vital signs were as follows: temperature of 36.5 C; heart rate of 110 beats/min; respiratory rate of 65 breaths/min; and blood pressure of 75/39 mmHg. The neonate was discharged home with her parents at 9 days of life when all her conditions improved. Both patients in case one and case two were advised to undergo follow-up examinations.\nOUTPUT:" }, { "from": "agent", "value": "Asphyxia neonatorum, neonatal wet lung disease, fetal macrosomia, cephalohematoma of newborn, PDA, myocardial injury, congenital perineal groove, neonate of a diabetic mother" } ]

[ { "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 four-month-old male patient, with non-bloody diarrhea for 20 days, was brought to our hospital due to a two-day history of high fever. The patient was unconsicious, his general condition was poor and he could pull his hand only with painful stimuli. Laboratory tests revealed: hemolytic anemia (haemoglobin 7 g/dL), presence of schistocytes in the peripheral smear, thrombocytopenia (platelet 39000/muL) and renal failure findings (serum creatinine 1.3 mg/dL, urea 47 mg/dL). Other laboratory tests revealed increased ALT (2399 IU/L), AST (1338 IU/L), and INR (14) levels, compatible with liver damage. Polymerase chain reaction (PCR) test was performed with stool culture for Shiga toxin detection; the test result was negative. CT images of that unconscious patient revealed diffuse white matter hypodensity compatible with cerebral oedema, lateral ventricle compression, sulcal effacement and dense cerebellum (Figure 1). Cranial MRI showed normal basal ganglia, thalamus and cerebellum, whereas mild hyperintensity of the cerebral cortex and white matter was revealed on T2/FLAIR sequences (Figure 2). The diffusion weighted imaging revealed restricted diffusion in the cerebral cortex and white matter with corresponding low signal intensity on the apparent diffusion coefficient maps (Figure 3A, 3B). Intracranial carotid arteries and their branches appeared signal void on T2-weighted images. No sign of hemorrhage was present on CT, T1 or SWI images. MRI images of the next month showed development of bilateral subdural effusion (Figure 4B).\nOUTPUT:" }, { "from": "agent", "value": "Hemolytic Uremic Syndrome, Multicystic Leukoencephalomalacia" } ]

[ { "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 72-year-old man with a prior history of hypertension presented to our hospital in April 2013 owing to the acute onset of chest pain at rest, which radiated to his jaw and left arm and was associated with profuse sweating. He denied any history of chest trauma, syphilis, pericarditis, or previous myocardial infarction. On examination, he had a pulse of 92/minute, blood pressure of 170/90 mmHg, respiratory rate of 20/minute, and temperature of 37.1 C. Palpation of the peripheral pulses and of the precordium, inspection of the jugular veins, and auscultation of the lungs disclosed normal findings. There were no peripheral arterial bruits. Cardiac examination revealed normal first and second heart sounds. There was an atrial gallop sound and a grade 2/6 systolic ejection murmur along the left sternal border. All the data of blood chemistry were normal. Electrocardiography showed ST-segment depression of 2 mm and T-wave inversion in the precordial leads. Chest radiography was normal. Transthoracic echocardiography showed akinetic anterior wall, septum, and apex, mild mitral regurgitation, and ejection fraction of 45%. The patient improved with bed rest, aspirin, clopidogrel, statin, beta-blocker, intravenous nitroglycerin, and anticoagulation. The patient had an uneventful hospitalization and was discharged on aspirin and warfarin therapy. At 6 months' follow-up, he remained asymptomatic.\nOUTPUT:" }, { "from": "agent", "value": "Left Main Coronary Artery Aneurysm" } ]

[ { "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 right-handed woman presented with left-hand tremor started eight years before. The uptake on cardiac MIBG scintigraphy was reduced. However, off-periods were prolonged, so she was transferred to our hospital for LCIG treatment. During that time, she was given levodopa (700 mg/day, seven times), COMT inhibitors (600 mg/day, six times), rasagiline (1 mg), istradefylline (40 mg), and rotigotine (18 mg/day). During her on-periods, the UPDRS-III score was 34, and MMSE and FAB scores were 27/30 and 16/18, respectively. Also, she could not open her eyelids spontaneously, and her eyes were closed throughout all consultations. This persisted for at least one year, and her condition impaired her daily activity. Due to the prominent alternating phenomenon of on-state and off-related disability, she was administered intrajejunal LCIG infusion four years later. The UPDRS-III score decreased to 17, and this on-state persisted after LCIG treatment (carbidopa-levodopa, 68/15.7 mg/h) in addition to rotigotine (18 mg/day) due to morning and night akinesia. Her eyelids elevated spontaneously, and after leaving the hospital, she could already open her eyes on every visit to our hospital, although she sometimes complained of difficulty. AEO did not show visible contraction of orbicularis oculi muscle or facial muscles. Before opting for LCIG treatment on the two patients, each outpatient doctor informed the patients and their families about the LCIG treatment. Moreover, the patients agreed to receive this treatment. MMSE and FAB testing were performed to determine whether LCIG pump and gastrostomy tube management were possible. Written informed consent was obtained from these patients for the publication of this case report.\nOUTPUT:" }, { "from": "agent", "value": "Parkinson's Disease, Apraxia of Eyelid Opening, Rapid Eye Movement Sleep Behavioral Disorder, Restless Leg 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 59-year-old female with a past medical history of tobacco abuse, hypertension, and coronary artery disease and prior percutaneous coronary intervention presented with complaints of angina and subsequently underwent coronary angiography. The procedure was performed via the right radial artery approach. A 5 French Jacky catheter was used to engage the left coronary artery system, and a 6 French Judkins Right 4 catheter was used to engage the right coronary artery system. The procedure was completed without difficulty from the operator, and the patient was transferred to the postoperative holding area in stable condition. However, immediately after the procedure, the patient began to experience chest pain and odynophagia. Stat electrocardiogram and bedside echocardiogram were unremarkable, and a CT scan demonstrated an ill-defined fluid collection present in the superior mediastinum (Figure 1). Consequently, the patient was admitted to the cardiac care unit but continued to complain of midsternal chest pain and odynophagia. The patient remained hemodynamically stable and without any airway compromise. The patient was managed expectantly with analgesia. A repeat CT scan a day later again demonstrated the ill-defined collection which had now extended into the inferior right paravertebral aspect near the gastroesophageal junction. The patient was monitored closely and improved clinically over the course of four days and was subsequently discharged home in good condition. On outpatient follow-up, the patient reported her symptoms had completely resolved.\nOUTPUT:" }, { "from": "agent", "value": "Mediastinal Hematoma" } ]

[ { "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 present a case of a 24-year-old Hispanic male diagnosed at age 13 with idiopathic PAH. At age 21, he had worsening shortness of breath and poor exercise capacity. Echocardiogram followed by a right heart catheterization (RHC) showed poor hemodynamics (Table 1) and he was started on selexipag 200 mcg that up titrated to 1600 mcg twice daily. He was able to perform all activities of daily living with no limitation and claimed to exercise regularly. At the age of 24, three years after initiation of selexipag, he developed worsening shortness of breath with chest pressure on exertion. He complained of diarrhea, nausea, headache, facial flushing, and jaw pain that he attributed to taking selexipag. He underwent an echocardiogram followed by RHC on selexipag (1600 mcg twice daily), ambrisentan (10 mg daily), and tadalafil (40 mg daily). Due to poor tolerance of selexipag, worsening hemodynamics, elevated brain natriuretic peptide levels of 388 pg/dl, and presence of pericardial effusion on echocardiogram, he was offered parenteral prostacyclin therapy. However, patient declined, thus decision was made to transition to oral treprostinil from selexipag. In February 2018, he was admitted for this transition. He was afebrile, heart rate of 85 per minute, respiratory rate of 16 per minute, blood pressure of 135/70 mmHg, oxygen saturation was 95% on room air, and euvolemic on physical exam. Selexipag was slowly tapered, while oral treprostinil was increased to a final dose of 7.5 mg three times daily without any significant side effects except for slight headaches. He noticed improvement in nausea, headache, diarrhea, facial flushing, and jaw pain. The total duration of the transition was 10 days as outlined in Table 1. During the hospital course, echocardiogram and RHC were performed before and after completing this transition with improvement in hemodynamics (Table 1). He was completely off selexipag and taking oral treprostinil 7.5 mg three times daily at the time of discharge (11th day).\nOUTPUT:" }, { "from": "agent", "value": "Pulmonary arterial hypertension" } ]

[ { "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: Upon arrival at the NICU, arterial blood gas analysis was normalized and routine investigations showed no signs of infection. Urea, creatinine and electrolytes were normal; liver transaminases were equally normal, as were alkaline phosphatase, bilirubin and albumin. The coagulation was severely disrupted with a prolonged prothrombin time and an international normalised ratio of 2.64. This was corrected by administration of fresh frozen plasma and an additional parenteral administration of Vitamin K. The patient received packed red cells to correct anaemia. Chest X-ray revealed bilateral patchy pulmonary infiltrates (Figure 1). In the following hours, the patients' respiratory state deteriorated. We observed a severe and progressive respiratory acidosis (pH 7.11, pO2 74.9 mmHg, pCO2 72.7 mmHg, bicarbonate 17.6 mmol/l, base excess -8.6 mmol/l, lactate 1.5 mmol/l). Chest X-ray revealed progression of the pulmonary infiltrates. Mechanical ventilation became increasingly difficult with a need for higher positive end-expiratory pressures (PEEP) and peak-inspiratory pressures during synchronized intermittent mandatory ventilation (SIMV). High frequency oscillation ventilation was tried, but SIMV with high PEEP (up to 10 cm H20) proved most successful. Meanwhile, repetitive endotracheal suctioning continued to clear bloody secretions from the airways. Echocardiography showed a normal size and shape of the heart as well as a normal cardiac function. Cranial ultrasound was normal. After stabilization, computed tomography of the chest was performed in order to identify any underlying intrathoracic lesion or vascular anomaly. Apart from massive pulmonary infiltrates, no structural lesions were found. Bronchoscopy could not identify obvious upper airway injuries.\nOUTPUT:" }, { "from": "agent", "value": "Medium-chain Acyl-CoA dehydrogenase deficiency, Neonatal pulmonary haemorrhage" } ]

[ { "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: Example 2: A 21-year-old female patient presented with \"irregular erythema on the left side of the face\" on April 18th, 2022. The erythema has been present since birth and has gradually increased in size and darkened in color as she grew older, spreading around the left orbit to the middle of the same side of the face. The patient underwent treatment with radioactive isotopes (Sr90) for the erythema when she was between 1 and 5 years old and reported partial improvement, but no significant changes in color or size of the erythema have occurred in the past 10 years. The patient denied any similar family history and her parents were not closely related. There was no significant history of infection or trauma during the mother's pregnancy, and the patient was delivered at full term without complications. Physical examination showed a large irregular erythema located on the left side of the face and around the left orbit, which did not cross the midline, was not raised above the skin surface, did not pulsate, faded slightly under pressure, and had normal skin temperature. Dermoscopy revealed a brown reticular pigmentation, reticular and branched vessels, and white structureless areas in some regions. Superficial tissue ultrasound showed a slight increase in skin thickness (up to 1.9 mm) at the erythema site on the left side of the face, compared to 1.6 mm on the opposite side, with no significant blood flow signals or definite masses in the skin or subcutaneous layers. Patients are satisfied with the current evaluation of the current treatment effect, and considering the cost of treatment and the necessity of treatment, we are not planning a fourth PDT (See Figure 2).\nOUTPUT:" }, { "from": "agent", "value": "Port-Wine Birthmark, Fresh Hemangioma, Scarring" } ]

[ { "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 was found to be hypotensive (69/49 mm Hg), tachycardic (112 bpm) and had a leukocyte count of 15,300/mul without bandemia. A chest X-ray showed moderate bilateral effusions. The patient underwent thoracentesis, and was started on empiric cefepime, vancomycin and metronidazole for a possible health-care associated pneumonia. Following this, he underwent a minimally invasive trans-thoracic approach for T8 corpectomy, T7-9 interbody cage placement and fusion with plating without complication, and was eventually discharged home. Several days after the most recent presentation to the other hospital, the patient was transferred to our institution for radiation therapy and the initial antibiotic regimen that had been started was continued. In the following days, a blood culture drawn on admission had growth in the anaerobic bottle of one out of the two obtained sets and revealed gram-positive rods on gram stain. A sputum culture grew Candida albicans, pleural fluid cultures were negative and a chest X-ray did not show infiltrates or consolidation. Three days after the hospital transfer, the blood cultures were growing Clostridium species. At that time, the leukocytosis had resolved and the patient continued to be hemodynamically stable with improved abdominal pain, however he developed intermittent nausea and vomiting attributed to ongoing radiation therapy. Vancomycin and cefepime were discontinued, and the patient was continued on metronidazole alone. On day 18 of his hospitalization, the Clostridium spp. was identified as C. subterminale. During his third week of hospitalization at our institution, the patient died secondary to complications related to his malignancy.\nOUTPUT:" }, { "from": "agent", "value": "Clostridium subterminale septicemia, Esophageal 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 specialist endocrinologist established the indication for surgical treatment and the present euthyroid status of the patient. No notable co-morbidities were present. The operating team consisted of one consultant with special interest in endocrine surgery and medium - high volume of thyroid and parathyroid cases (50 - 60 operations per year) and 2 registrars. Although the left lobe was significantly bigger (Fig. On the right,we first mobilized the lobe anteriorly and medially by severing the middle thyroid vein and the vessels of the upper pole. We identified the inferior thyroid artery and its branches and, as we usually do, we commenced the search of the ILN, first cranially and then caudally, being unable to find any nervous structure resembling ILN in the tracheo-esophageal groove. In this way, we encountered a transverse structure emerging from the vagus, approximately at the level of the cricothyroid junction and entering the larynx at the lower margin of the cricothyroid muscle. We carefully dissected its entire length and preserved this structure (Fig. 2) that proved to be a non-recurrent ILN. The postoperative course was uneventful, without any sign of hypocalcaemia, without dysphonia and the repeat indirect laryngoscopic exam was normal.\nOUTPUT:" }, { "from": "agent", "value": "Multinodular goiter, Non-recurrent inferior laryngeal nerve" } ]

[ { "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 most recent DEXA scan showed low BMD with a T-score of -2.3 for the lumbar spine and a T-score of -3.5 for the left hip. Because of the relatively young age of the patient and absence of extracranial metastases, the multidisciplinary tumor board decided to treat the brain metastases with stereotactic radiotherapy for a long-lasting effect, but with a palliative intent. Depending on the volume of the metastases, a stereotactic dose of 1 x 18 Gy, 1 x 21 Gy or 1 x 24 Gy was prescribed for five metastases using Volumetric Modulated Arc Therapy (VMAT) with three 6 MeV photon Flattening Filter Free (FFF) beams. In this example, the adjacent skull received a mean dose of 7 Gy without special dose planning restrictions on the skull (Fig. 1). Because of the high complications risk, due to chest deformities that may cause respiratory problems, cervical fragility that may lead to difficulties during intubation and due to possible hyperthermia caused by anesthesia, surgery for the lung tumor was not recommended. The patient was therefore referred for sequential radiotherapy. A dose of 25 x 2.6 Gy was prescribed to the lung tumor and the hilar and mediastinal lymph nodes, using one 10 MeV photon VMAT arc. No extra radiotherapy dose planning constraints for the bone of the chest or other tissue types were prescribed. During and after brain irradiation and lung radiotherapy, the patient did not experience any extra acute side effects or difficulties regarding OI.\nOUTPUT:" }, { "from": "agent", "value": "Stage IV non-small cell lung cancer with cerebral metastases, Osteogenesis Imperfecta type 1" } ]

[ { "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 protocol was approved by the institutional review board and informed consent obtained for the patients. Pressure-volume loops were obtained through direct measurement using microconductance catheters (CD Leycom, Zoetermeer, The Netherlands) in two patients presenting for catheterisation before stage 2 palliation. Patient information and haemodynamic data of each patient are summarised in Table 1. Pressure-volume loop analysis was performed off-line using specialised software (ConductNT version 3.18; CD Leycom). Conductance volumes were calibrated using end-systolic and end-diastolic volumes obtained from magnetic resonance imaging performed on the same day. Patients were transported directly from the catheterisation laboratory to the magnetic resonance suite and were cared for by the same anaesthesia team. The anaesthestic regimen was not standardised for each patient. In each patient, a 4-Fr microconductance catheter was placed in the systemic ventricle using an antegrade approach through the atrioventricular valve. A 5-Fr transseptal sheath was used to aid in stable positioning of the catheter. Pressure-volume loops were obtained under general anaesthesia during expiratory hold for 10 s. Careful attention was given to place the catheter in centre of the ventricle and eliminate volume segments outside of the ventricle. Pressure-volume loop indices were calculated using averaged single-beat methods to avoid the risks involved with load alteration. Averaged pressure-volume loops for the two patients are displayed in Figure 1 with the calculated indices displayed in Table 2. Most noticeably, the patient with right ventricle-to-pulmonary artery shunt had an absence of isovolumic contraction, whereas the patient with the modified Blalock-Taussig shunt displayed preservation of the isovolumic contraction phase. This difference is most apparent in indices related to pressure-volume loop area such as ventricular stroke work and pressure-volume area, both of which were lower in the patient with a right ventricle-to-pulmonary artery shunt.\nOUTPUT:" }, { "from": "agent", "value": "Shunted single ventricles" } ]

[ { "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: There were no loss of consciousness and no history suggestive of cranial nerve, sensory, or autonomic involvement. The child had four previous relapses in the past 1 year since onset and was off steroids for 2 months before onset of current illness. Urine output was adequate and there was no history of reddish urine. On examination, she was conscious, well alert with evidence of facial puffiness, pedal edema, and abdominal distention. Vitals were stable and blood pressure at the time of admission was 130/94 mmHg (>95th centile for age and height). She was conscious, well alert with marked reduction in speech output although comprehension was well preserved. She had flaccid hemiparesis with brisk deep tendon reflexes and bilateral extensor plantar response. Sensory system was tested normal. There were no cerebellar or meningeal signs. Her coagulation profile including prothrombin time and international normalized ratio was within normal range. Her serum creatinine was 0.8 mg/dl. Her urine examination revealed albumin of 3+ with no microscopic pus cells or red blood cells. Cholesterol levels were 340 mg/dl and serum albumin was 2.1 g/dl. Her antinuclear antibody and antiphospholipid antibody levels were normal. Carotid Doppler study was normal.\nOUTPUT:" }, { "from": "agent", "value": "Unilateral Transient Watershed Cerebral Infarct, Frequently Relapsing Nephrotic 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 70-year-old male presented to our otolaryngology outpatient clinic with the chief complaint of a progressively grown skin lesion on the scalp. The lesion first appeared one year ago. His medical history included hypertension, hypothyroidism, and coronary disease. A thorough physical examination revealed a well-defined, crusted lesion on the scalp of approximately 3.8 cm x 3 cm. Surgical excision was performed under general anesthesia. The lesion was removed with macroscopically negative surgical margins of 1 cm (Figure 1 A). The depth of the excision was up to the periosteum of the skull (Figure 1 B). Once the lesion was removed, the surgical specimen was used to measure the size of the required free skin graft (Figure 1 C and D). The loose skin from the right supraclavicular area was recruited to cover the skin defect in the scalp (Figure 1 E). Thus, a full-thickness graft was created for scalp reconstruction. The donor site was primarily closed with simple interrupted sutures. The graft was incorporated with continuous interlocking absorbable sutures (Figure 1 F). At the surface of the graft, numerous buttonholes were created to prevent the formation of a postoperative hematoma. A tight dressing with bolster dressing was recruited to apply adequate pressure on the skin graft. The timeline of the postoperative course and the healing process is demonstrated in Figure 2. A month after the reconstruction, we performed debridement of the crusts (in places where the graft was not integrated properly) at the posterior part of the graft to promote healing by secondary intention.\nOUTPUT:" }, { "from": "agent", "value": "Squamous cell carcinoma (SCC) of the skin" } ]

[ { "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: Case 2 was a 12-year-old female with history of B-cell ALL s/p unrelated donor bone marrow transplant (BMT) in 2015, GVHD, s/p renal transplant in 2021, drug reaction with eosinophilia and systemic symptoms (DRESS), multiple antibiotic allergies, hypogammaglobulinemia requiring monthly IVIG, and chronic lung disease of unclear etiology with left-sided diaphragmatic paresis requiring nocturnal BiPAP at night. In December 2021, she was diagnosed with COVID-19 in the setting of fever without hypoxemia, received monoclonal antibodies in the ER given her high risk for hospitalization with immunosuppression, and was discharged home. Her fever subsided, but she continued to have a persistent dry cough. Two weeks after initial presentation, she became hypoxemic and required supplemental oxygen. Three days later, she was admitted for worsening hypoxemia and fevers. CXR on admission showed worsening left lower lobe opacities. Linezolid was started for presumed bacterial superinfection without any significant improvement, and she was eventually transferred to the ICU for worsening fever and hypoxemia. In the ICU, she was intubated, and broad antimicrobial coverage was started with IV vancomycin, cefepime, and amphotericin. All other viral PCR panels, bacterial, fungal, and AFB cultures were negative. She also received IV methylprednisolone, 1 dose of anakinra, and 1 dose of tocilizumab for COVID-19-related TMA/DAH. The patient gradually improved, and repeat tracheal aspirates showed decreasing subsequent viral loads. She was extubated 1 week later, weaned to room air after 10 days, and then discharged home.\nOUTPUT:" }, { "from": "agent", "value": "Persistent SARS-CoV-2 Infection, Thrombotic Microangiopathy, Diffuse Alveolar Hemorrhage, 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: 1A). Preoperative digital subtraction angiography (DSA) showed that there was cross-flow from the contralateral side through the anterior communicating artery filling the middle cerebral artery (MCA) territory. The balloon occlusion test (BOT) showed that she could tolerate a 30-minute occlusion (Fig. 1B). However, the stump pressure of the external carotid artery (ECA) sustained low value of 45 mmHg as a stump pressure at 110 mmHg of systolic pressure during the BOT. 1C). 2A-I). Postoperative three dimensional-computed tomography angiography (3D-CTA) showed that the reconstructive ECA-CCA bypass has occluded. Postoperative DSA showed that the left STA was filling in a retrograde fashion from the right STA over the midline of the head (Fig. 1D, E). A reversed single STA-MCA bypass was performed using a naturally formed \"bonnet\" STA (Fig. 1F). 1G). Postoperative 3D-CTA showed that the anastomosed bonnet STA perfused the MCA territory (Fig. 1H). The postoperative course was uneventful. 2J-R). As of 6 months after surgery, the patient has been doing well.\nOUTPUT:" }, { "from": "agent", "value": "Symptomatic common carotid artery occlusion, Malignant thyroid tumor, Transient ischemic attacks, Cerebral infarction at the frontal lobe" } ]

[ { "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 healthy, non-smoking, male was referred to the plastic surgery department due to a growing mass on the scalp. The patient had first noticed the mass about 9 months earlier. He did not have any physical discomfort related to it but became worried because of the increasingly rapid growth. The patient did not report any symptoms of weight loss, fatigue or loss of appetite and had no history of previous malignancies. Clinical examination revealed a 4 x 5 cm, erythematous tumor in the right occipital region (Fig. 1). On palpation the tumor appeared pulsating, soft and non-adherent to the underlying bone. There were no palpable lymph nodes regionally. Differential diagnoses considered were other vascular tumors such as pyogenic granuloma, Kaposi sarcoma and angiosarcoma. CT-angiography showed a richly vascularized, extracranial tumor with multiple large veins. The tumor was surgically excised under local anesthesia with a 5 mm margin and the defect reconstructed with a split skin graft. Histopathological examination revealed a well-defined mass in the deep dermis and subcutis, partly enclosed in a fibrous pseudocapsule. The process was formed by alveolar, tubular and tubulocystic formations of cells with clear cytoplasm and central, round nuclei (Figs. 2 and 3). Immunohistochemistry showed the lesion was positive for broad-spectrum cytokeratin, Vimentin and PAX8, and negative for S-100 and Leucocyte Common Antigen. The patient was referred to the department of urology where a CT-scan and a PET-CT were obtained and revealed a 13 cm tumor in the left kidney, small lung metastases bilaterally and multiple suspicious mediastinal lymph nodes. 4), pT3a. No systemic treatment was initiated. Follow-up CT-scan three months postoperatively showed that one of the lung metastases had grown 3 mm, but otherwise no progression in the disease.\nOUTPUT:" }, { "from": "agent", "value": "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: Her history is also significant for recurrent UTIs during her childhood and progressive difficulty with voiding. At the age of 11, the patient started dialysis and began performing clean intermittent catheterization (CIC) four times daily with spontaneous intermittent incontinence. At the time of initial evaluation, she was on oxybutynin 15mg XL daily and had not seen a urologist for over two years. Her pre-transplant urologic evaluation included voiding cystourethrogram (VCUG), cystoscopy, urodynamics (UDS) and MRI of the lumbar and sacral spine. The VCUG revealed no vesicoureteral reflux. 1). The patient was unable to void during the study despite receiving permission. MRI of the lumbar and sacral spine did not reveal canal or foraminal stenosis. The patient reported improvement in urgency between catheterizations after her first intravesical botulinum toxin injection. 2). The decision was made to continue the scheduled injections instead of pursuing a more aggressive option to manage her elevated storage pressures. She went on to receive a renal transplant after her 6th intravesical botulinum toxin injection and continues to have optimal graft function with scheduled injections every six months and CIC.\nOUTPUT:" }, { "from": "agent", "value": "Neurogenic bladder, End-stage renal disease (ESRD), Recurrent urinary tract infections (UTIs)" } ]

[ { "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-month-old male infant was admitted at the emergency department with pain and swelling in dorsoulnar aspect of the right hand started few hours before. Physical examination revealed a tender swelling over the forth metacarpal, with limited movement of both carpometacarpal and the metacarpophalangeal joints; any sign of injury, trauma, or wound was appreciated. Temperature was normal in the first examination, but at three hours after admission fever >38 C appeared. Laboratory studies showed elevation of leukocyte count (17.0 x 109/L) and C-reactive protein (56.3 mg/L). Plain radiographs showed hyperdensity of the forth metacarpal (Figure 1). A radionuclide 99mTc bone scan showed increased uptake in the forth metacarpal (Figure 2), whereas magnetic resonance images (M.R.I.) showed cortical destruction, diaphyseal and physeal involvement, and adjacent soft tissue oedema (Figure 3), all this consistent with osteomyelitis. Intravenous (iv.) empirical antibiotic therapy was started with cloxacillin and gentamicin, but clinical evolution was unfair with persistent fever. Due to it, surgery was planned. Debridement and curettage were performed. Cultures were positive for Serratia marcescens, and antibiotic therapy with iv. cefotaxime was established. Marked clinical improvement was noted in the first week, the reason by which he returned to home with oral treatment with cefuroxime and Trimethoprim-Sulfametoxazole. The pain and swelling of the hand resolved completely 1 month after surgical debridement. In review at three years later, radiological examination showed a discrete shortening of forth metacarpal, probably caused by the physeal spread of infection, but with complete function of the hand (Figure 4). The patient needed two further hospital admissions due to systemic infections (one for an endocarditic infection).\nOUTPUT:" }, { "from": "agent", "value": "Acute haematogenous metacarpal osteomyelitis, Chronic granulomatous 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 70-year-old woman was referred to the emergency department by her general practitioner with a year long history of increasing dyspnoea. She stated her dyspnoea had gradually worsened over 1 year. On admission she was dyspnoeic on minimal exertion. She was on no regular medications. She was a non-drinker and a non-smoker. Her oxygen saturations were 92% on room air. Her abdomen was distended with a fluid thrill and she had pitting oedema up to her mid shin. 1) and Pemberton's sign was negative. She had mildly deranged liver function tests with aspartate aminotransferase of 57 and gamma-glutamyl transpeptidase of 52. She was mildly hypoalbuminaemic with an albumin of 31 g/l. Her thyroid function tests were normal. Viral hepatitis screen was negative. The patient was admitted with presumed decompensated heart failure and treated with diuretics. Echocardiography showed normal heart function and liver ultrasound revealed liver cirrhosis causing her abdominal ascites and lower limb oedema. The right effusion appeared moderate and complex, with no loculations. A chest drain was inserted and 1.2 litres of fluid was drained (Fig. 2). Analysis of the fluid revealed a pH of 7.53, triglycerides 19.3 g/dl and predominantly lymphocytic fluid. Bronchoscopy showed circumferential 5 cm tracheal narrowing distal to the cords with no invasion. 3 and 4).\nOUTPUT:" }, { "from": "agent", "value": "Bilateral Chylothorax, Retrosternal Goitre" } ]

[ { "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 female patient was the second child of non-consanguineous parents of mixed European ancestry. She was born at term via vaginal delivery following an uncomplicated pregnancy. Following delivery, she did well and was discharged from the hospital without incident. Throughout the first year of life, her development was apparently normal and she achieved all developmental milestones on time. At about 1 year of age, she began experiencing episodes of recurrent emesis and encephalopathy with laboratory evaluations showing lactic acidosis and hypoglycemia (as low as 9 mg/dL). The episodes typically lasted between 2 and 10 days with return to baseline following each episode. She was admitted to a community hospital for these episodes and supported with intravenous (IV) dextrose. Laboratory evaluations performed during these episodes showed lactic acidosis and hypoglycemia and at age 5 also included transaminase elevations (of unknown degree). At school, she exhibited evidence of some learning disability requiring special education in all grades. At 12 years of age, she was functioning at a 1st- to 2nd-grade level. She had experienced 1 seizure that occurred at less than 5 years of age and was associated with an episode of hypoglycemia, which required a rapid infusion of dextrose-containing parenteral fluids. Over time, she developed an avoidance of high protein and high fat foods, maintaining a diet primarily composed of carbohydrates. A biochemical workup was initiated at 12 years of age. Her plasma amino acids demonstrated small amounts of alloisoleucine (~8 muM) on two occasions, with normal or low concentrations of branched chain amino acids. Urinary organic acid never displayed ketoacids. A fibroblast culture was assayed at Emory University, GA for BCKDH activity showing 24.3% of normal leucine decarboxylation.\nOUTPUT:" }, { "from": "agent", "value": "Leigh 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: She was born at term by cesarean section (pelvic presentation) following an uneventful pregnancy, with an Apgar score of 8 and 9 at 1 and 5 minutes, respectively. Her birth weight was 4,030 g (87th percentile), length 53 cm (87th percentile), and head circumference 36 cm (83rd percentile). Her neonatal period was unremarkable, as was her early psychomotor development. She had a history of primary nocturnal enuresis and vesical instability, treated with desmopressin and oxybutynin hydrochloride since the age of six. She presented learning difficulties when she attended elementary school (2nd grade), and was included in a special education program at the age of ten. At the time of diagnosis, her initial tyrosine level was 1,769 micromol/L. On the first nutritional status evaluation, her daily natural protein intake was 1.4 g/kg. This value dropped to 1.08 g/kg, and she started taking supplementation with 0.7 g of amino acids/kg from phenylalanine- and tyrosine-free amino acid mixtures, enabling a consistent decrease of tyrosine levels below 300 micromol/L. Her physical examination and growth were normal (weight and height at the 50-85th percentile), with an unremarkable neurological examination. The genetic study revealed the same mutation as her brother in homozygosity. After initiating a low-protein diet, her behavior and school performance did not improve. The minimum level of daily natural protein intake reached was 0.65 g/kg at 14 years of age. She is currently in 7th grade, still in the special education program, and under treatment with methylphenidate. Her latest formal developmental assessment (Wechsler Intelligence Scale for Children , third edition, Portuguese version) revealed a global IQ score of 68, with a verbal IQ of 68 and a performance IQ of 77 (Figure 2).\nOUTPUT:" }, { "from": "agent", "value": "Tyrosinemia type III, ADHD" } ]

[ { "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 multiple prior hospitalizations and was undergoing evaluation for liver transplant. His MELD score was 19 on admission. This occurred despite optimal use of diuresis, noninvasive ventilation and paracenteses. He was intubated on hospital day five. On the day of intubation, his total bilirubin was 2.1, serum creatinine 1.65, international normalized ratio (INR) 2.4 and serum sodium of 142 (MELD of 16). Mechanical ventilation was with assist control with tidal volumes of 350 mL, rate of 32, PEEP of 16 on 90% FiO2. Arterial blood gas showed a pH of 7.25, CO2 of 55, and O2 of 116. After intubation, he had progressive and refractory hypoxemia requiring increasing PEEP with high FiO2 to maintain oxygenation. Therefore, he was given 2.9 million units of 4-factor prothrombin complex concentrate (4F-PCC) (based on weight) and within 1 h following administration his INR was measured at 1.5. There was an immediate improvement of oxygenation, and there were no bleeding complications.\nOUTPUT:" }, { "from": "agent", "value": "Nonalcoholic steatohepatitis-induced cirrhosis, Portal hypertension, Esophageal varices, Pneumonia, Hypoxic respiratory failure, Bilateral pneumothoraces, Coagulopathy, Hepatic decompensation" } ]

[ { "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 preliminary analysis for the collected data demonstrates that 21.4% of the study population's age is under 20 years old while the remaining 83.6% is above 20 years old (33.7% of them are between 30-40 years old while 25.5% are between age 20-30 years old). Although this indicates that the incidents rate in adults is higher, the obesity factor possibly increases the incidents in younger populations. Figure 1 shows the age distribution in our study population. Among our data in the dataset, gender is studied. It is found that 64.1% of the total subjects are male (84 subjects) while 37.4% are female (49 subjects). This association is reported in China back in February 2020. Figure 2 shows the gender domination in the study population. In the IP dataset, 43% (56 subjects) have O+ blood group while 24% (32 subjects) have A+. However, this finding contradicts a similar study in Germany that excludes such a link. Figure 3 shows the blood group in the study population. As it is illustrated in our study, 23% of 131 subjects are smokers whereas is the remaining 77% are non-smokers. Figure 4 shows the percentage of smoker and non-smoker subjects in the study population. Moreover, most subjects develop symptoms like cough, fever, diarrhea, headache, fatigue, loss of taste and smell while few of them don't develop any symptoms as shown in Fig. 5. We notice that subjects' history with chronic diseases is not related to the infection pattern nor administration of multivitamins as supported in. Figures 6 and 7 show the distribution of chronic disease and multivitamins administration in the study population respectively. A soft copy is sent to the subjects as a link. The actual subjects' size is 330 subjects. However, due to difficulties in obtaining their consent and conducting the survey, it has led to limiting the subjects' size to 131. These factors include but are limited to; wrong/unresponsive contacts' number, refusal to participate, subjects' unfamiliarity with their blood groups, medications, height, and weight. This prevents us from reaching a higher targeted sample size.\nOUTPUT:" }, { "from": "agent", "value": "COVID-19" } ]

[ { "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 has had a myomectomy in another health centre 6 months ago. On the 29th postoperative day, she experienced disorders with severe colicky abdominal pain and intermittent fever. The abdominal ultrasound was inconclusive and conservative management provided partial improvement. One week before her admission, the transit disorder got worsened with subocclusion. Initial tests revealed the following vital parameters: blood pressure 90/70 mmHg, pulse 110/min, respiratory rate 25/min, and temperature 39.1 C. Examination revealed a firm, mobile, and painful swelling in the epigastric area. There was tenderness in the right iliac fossa and enteric contents through a dehiscence of the laparotomy wound. Computed Tomography (CT) scan revealed low density, heterogeneous spongiform mass obstructing the colonic lumen (Figure 2). Emergent laparotomy showed multiple abscesses, and a tumor of the transverse colon. While performing colectomy we found a large abdominal swab (30/30 cm) that had migrated to the colon lumen (Figure 3). The operation ended by colostomy and ileostomy. When reviewing the previous operation report, we found out that there had been a textile count procedure.\nOUTPUT:" }, { "from": "agent", "value": "Colic Migration of a Forgotten Abdominal Swab, Subocclusive Syndrome, Enterocutaneous Fistula, Anemia, Septic Shock" } ]

[ { "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 age 59 years, he presented with complaints of decreased vision and myodesopsia in both eyes. Prior to this surgery, anti-retroviral therapy was initiated with a cART regimen of raltegravir (RAL) plus TDF/FTC according to the national protocol. Thereafter, he experienced asymptomatic orthostatic hypotension, slowed movement, progressive gait instability, and severe constipation. All these symptoms and signs persisted without cognitive changes, and co-treatment with levodopa/carbidopa and a dopamine agonist was started. At a medical evaluation at age 65 years in our hospital, brain magnetic resonance imaging (MRI) showed the \"hot cross bun\" sign in the pons, as well as cerebellar and brainstem atrophy. Finally, MSA was diagnosed and taltirelin hydrate was added to his treatment. However, symptom progression continued, and additional progressive symptoms of dysphagia became apparent; therefore, oral tablets of levodopa/carbidopa, a dopamine agonist, and taltirelin hydrate had to be provided after crushing.\nOUTPUT:" }, { "from": "agent", "value": "HIV-1 infection, multiple system atrophy (MSA), syphilis, left pulmonary adenocarcinoma of pathological stage pT3N0M0, pStage IIB, reduced renal function" } ]

[ { "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 43-year-old woman with no particular pathological history. She presented with progressive dyspnea which has evolved towards an inspiratory bradypnea that worsened until she ultimately required an emergency tracheotomy. Laryngoscopic examination showed an obstructive mass in the right infraglottic area. A punch biopsy of larynx tumor and excision of left cervical adenopathy were performed. The patient reported general signs such as weight loss and nocturnal sweats in the last six months. The ECOG (Eastern Cooperative Oncology Group) performance status was 2, and the clinical examination revealed a tumoral syndrome made of bilateral cervical lymphadenopathy. Blood test showed leukocytosis at 11300/mm3 with hyperlymphocytosis at 6200/mm3 predominantly of small mature lymphocytes and a high LDH level at 779 U/l (the upper normal level limit of the laboratory is 245U/l). The rest of the biological assessment was normal. The 18-FDG positron emission tomography (PET) scan showed an over and under diaphragmatic lymph node involvement and bilateral pathological pulmonary nodules (Figure 1(a)). A pathological laryngeal hypermetabolism with cricoid cartilage involvement (SUVmax = 15) was noticed (Figure 2), and bone marrow biopsy was negative. She was treated by immunochemotherapy with 4 cycles of R-DHAOx (rituximab, high-dose aracytine, oxaliplatin, and dexamethasone), followed by autologous hematopoietic stem cell transplantation (ASCT). The therapeutic evaluation by PET scan shows a complete remission (Figure 1(b)), and it was decided to continue with maintenance therapy with rituximab every 2 months, but it was refused by the patient. At the last visit, 18 months of ASCT, the patient was always disease free.\nOUTPUT:" }, { "from": "agent", "value": "Mantle Cell 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 previously healthy 20-year-old female presented to the clinic with a 2-month history of an enlarging submental neck mass. She originally noticed the mass while pregnant. Four weeks after giving birth, however, the area became increasingly more painful and firm to palpation. She began to have pain with swallowing. Physical examination revealed submental and floor of mouth fullness that was exquisitely tender to palpation, limiting the ability to examine her. A neck ultrasound and computed tomography (CT) scan were obtained and showed a multiloculated cystic lesion with calcifications and a central solid component present in the submental space extending down towards the hyoid (Figure 1). There was no radiologic or clinical evidence of thyroid gland disease or neck lymphadenopathy. A clinical fine-needle aspiration (FNA) was performed to further evaluate the mass and showed mixed inflammatory cells with histiocytes in a background of proteinaceous fluid, consistent with a cyst. Thyroglobulin was significantly elevated within the cystic contents, raising suspicion for malignancy. The patient underwent a Sistrunk procedure along with total thyroidectomy. There was no radiographic evidence of lymphadenopathy, and therefore, no neck dissection was planned; however, given the size and location of the mass, contents of level IA and the superior part of level VI were taken with the specimen. A formal level VI neck dissection was not performed due to the negative preoperative imaging. Intraoperative findings included a large cystic mass consistent with a TGDC and a small palpable nodule within the thyroid gland (Figure 2). Her postoperative course was uneventful. She is currently being considered for postoperative radioactive iodine ablation.\nOUTPUT:" }, { "from": "agent", "value": "Thyroglossal Duct Cyst 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: Sixty-three-year-old female patient is followed with diagnosis of idiopathic PD since 6 years in our clinic. The patient has undergone STN DBS due to painful dystonia and drug resistant tremor. The patient's clinical motor symptoms were assessed by UPDRS III in both off and on medication states. Thus, levodopa response (LR) rate of the patient was determined. During the operation, the STN regions with the highest amplitude via electrophysiological recordings from the right and left STN were determined. Then, to determine the permanent contacts on each electrode, each target was tested in terms of the best motor benefits clinically and minimal side effects. The patient was examined by a movement disorders specialist neurologist (DA) during these tests which are made in increments of 1 mAmp voltage. After all, the right electrode was placed within center of the STN and the left electrode was placed within the anterior part of the STN. During the operation, when the anterior part (target -1) of the left STN was stimulated at higher voltages (5 mAmp), the patient developed presyncopal symptoms. However, when the stimulation was stopped symptoms improved. The stimulation was immediately stopped and the patient improved. The latest, the right electrode, which is at ventral of the STN, has been stimulated as monopolar by 2,1 mV, and the left electrode has been stimulated as bipolar by 3 mV. Preoperative clinical and demographic characteristics of the patient are shown in Table 1.\nOUTPUT:" }, { "from": "agent", "value": "Parkinson's disease, Syncope" } ]

[ { "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 had no complaints prior to this episode. His chronic conditions were managed by hydrocortisone, aspirin, lisinopril, hydrochlorothiazide, warfarin, allopurinol, and ezetimibe. His past surgical history was positive for coronary artery bypass surgery and aortic valve replacement at the age of 36 years. On neurological examination, the patient was disorientated but obeyed commands and opened his eyes spontaneously. No cranial nerve deficit was detected except for hearing loss in the right ear. Pure tone audiometry performed after resolution of the acute condition showed normal ranges in both ears. However, the patient's laboratory results included a fasting plasma cholesterol level of 18.40 mmol/L and a low-density lipoprotein cholesterol level of 15.4 mmol/L. An urgent CT scan of the head performed in the emergency room showed an aggressive hypodense posterior fossa that was soft tissue mass destroying the right temporal bone and the adjacent occipital bone. The mass measured 45 mm x 65 mm, extended upwards to the posterior temporal bone, and was causing compression and deviation of the fourth ventricle and brain stem with obstructive hydrocephalus. A similarly obstructive lesion involving the mastoid portion of the petrous bone with a small tissue component was seen in the posterior fossa on the left side (Fig. 7). MRI showed bilateral heterogenous enhancement of extra-axial posterior fossa lesions originating from the mastoid cavity and petrous bones. The lesion on the right measured 53 mm x 77 mm x 75 mm and the lesion on the left measured 41 mm x 34 mm x 31 mm (Fig. 8). The patient was taken immediately to the operating room for decompression craniotomy to stabilize his condition. A right retrosegmoid craniotomy was performed intraoperatively. The bone was found to be very thin, and a greasy-looking yellow lesion was found extramurally that was removed easily by suctioning and curettage. The patient's postoperative course was uneventful, and his preoperative complaints improved. The patient was discharged home with a good neurological status. The mass on the left side is being followed up in the otolaryngology and neurosurgery departments and seems to be stable in size.\nOUTPUT:" }, { "from": "agent", "value": "Familial hypercholesterolemia, Bilateral cholesterol granuloma" } ]

[ { "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 Chinese woman, gravida 2, para 1, BMI 20.70 kg/m2, noticed a protrusion in size of 2 x 1 cm from her vagina at 13th week of gestation in 2015. The protrusion was not sensible while resting but rather palpable after moving. Pelvic examination revealed stage 3 POP, with point C as the leading edge using the POPQ examination (Aa+3, Ap+3, Ba+6, Bp+6, C+6, D+1, gh 5, pb 1, tvl 10 ). A no. 5 ring pessary in size of 7x7 cm (see Figure 1) was applied to keep the uterus inside the pelvic cavity after manual reposition. The gravid uterus persisted in the abdominal cavity after removing at the 30th week of gestation because it became larger. An alive healthy baby boy of 2680 g was delivered after four-hour labor at 39+3 week's gestation on the 5th of October 2015. 3 ring pessary in size of 5x5 cm has been applied to keep the uterus inside the pelvic cavity after manual reposition until now. At the time of reporting, pelvic examination of this woman revealed stage 3 POP, with point C as the leading edge using the POPQ examination (Aa-2, Ap-2, Ba-1, Bp-1, C+2, D-3, gh 5, pb 1, tvl 10). Follow-up is on-going.\nOUTPUT:" }, { "from": "agent", "value": "Uterine Prolapse" } ]

[ { "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 scheduled to undergo an elective tricuspid valve replacement and closure of an incidentally discovered patent foramen ovale. The device was kept in its programmed VVIR mode, and the rate was increased from 60 to 80 beats per minute in anticipation of the upcoming surgery. The patient underwent a right-sided thoracotomy with tricuspid valve replacement using a bioprosthetic valve. The surgeon used monopolar electrocautery for the duration of the cardiac surgery. No EMI leading to oversensing nor rate modulation was detected during intraoperative electrocardiography and interarterial invasive monitoring despite the operative proximity to the Micra VR and use of monopolar electrocautery. The operation was uneventful, and the patient was transported to the intensive care unit intubated, on epinephrine, norepinephrine, and milrinone postoperatively. Later that day, she was noted to not be moving her left side; emergent head computed tomography (CT) was significant for right-sided edema. Repeated head CT after continued weakness showed severe diffuse edema. Given these findings, the family decided to proceed with comfort care measures; she died on postoperative day eleven.\nOUTPUT:" }, { "from": "agent", "value": "Severe tricuspid regurgitation, Tachycardia-bradycardia syndrome with intermittent complete heart block, Pacemaker dependence" } ]