Datasets:

hippocrates

/

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: Table 3 displays the baseline classification for the model with only the intercept with a predictive ability of 26%. However, when predictors are included in the model it is expected that the classification ability will improve. Table 4 displays the percentage of classification for the final model. From Tables 3 and 4, the classification percentage accuracy for the initial and final models is 26% and 76.1%, respectively. The sensitivity and specificity of the final model can be determined from the classification table (Table 4). Hence, the positive predictive value = 417/(417 + 374) = 52.72% and the negative predictive value = 1163/(122 + 1163) = 90.51%. A summary of various evaluation tests done on the model to ascertain its diagnostic capabilities is shown in Table 5. From Figure 2, platelet recorded the highest (0.772) area under the curve. Hb, Lymph, and age recorded ROC values of 0.650, 0.605, and 0.600, respectively. The model has a good predictive ability, since all the significant predictors had ROC values >0.5.\nOUTPUT:" }, { "from": "agent", "value": "Malaria" } ]

[ { "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 35-year-old, previously healthy woman, presented with severe headache and was transferred to the hospital. At presentation, the patient was drowsy, but did not show any focal neurological deficits. Her ocular position was neutral on both sides, and she presented with isochoric pupils. Ptosis was not found. Cranial computed tomography (CT) revealed a diffuse subarachnoid hemorrhage with a subtle ventriculomegaly. No abnormal findings were observed in the midbrain [Figure 1]. Three-dimensional CT angiography revealed a saccular aneurysm, 3 mm in diameter, at the branching site of the distal M1 segment of the left middle cerebral artery. The patient underwent open microsurgical clipping. During surgery, a ventricular catheter was placed in the left anterior horn, and the cerebrospinal fluid was intermittently drained to avoid excessive retraction to the left frontal lobe. After satisfactory clip application to the aneurysm neck, a commercially available silastic tube, 3.0 mm in an outer diameter, was placed in the basal cistern at the medial aspect of the clinoidal portion of the internal carotid artery and the anterior clinoid process [Figure 2]. Hematolytic agents such as papaverine or urokinase were not infused through the drain. Prompt CT revealed that the tip of the cisternal drain was displaced to the lateral aspect of the anterior clinoid process [Figure 3]. No other significant CT findings associated with the patient's symptoms were observed. The patient's mydriasis and sluggish light reaction recovered 7 days after surgery; however, photophobia in the left eye persisted for 6 months. In contrast, recovery from restriction of extraocular movements was necessitated 50 days after surgery [Figure 4].\nOUTPUT:" }, { "from": "agent", "value": "Oculomotor nerve palsy" } ]

[ { "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 51-year-old man had a history of recurrent allergic asthma. The patient was admitted for recurrent chest pain for 7 years, accompanied by chest pain-related syncope five times in 3 months. The chest pain was not related to effort but to asthma occurrence, aggravation, or sleep, and lasted for 5-30 min. Three months ago, he experienced chest pain again after getting a cold, and when it was severe, he lost consciousness for approximately 2 min. He previously underwent ECG and Holter ECG showing recurrent ST-segment elevation in leads II and III, as well as augmented vector foot and chest leads and intermittent cardioplegia for up to 9 s. On admission, ECG demonstrated ST-segment elevation and Q-wave myocardial infarction and grade III atrioventricular block (Supplementary Figure 2). Coronary angiography revealed severe local stenosis of the right coronary artery, which resolved after nitroglycerine injection (Supplementary Figure 3). Additionally, the left anterior descending artery and left circumflex artery narrowed down by approximately 20%, and the right coronary artery narrowed down by approximately 30% locally. Serum cardiac troponin was significantly elevated (3000.0 pg/mL, reference <34 pg/mL), and N-terminal pro-brain natriuretic peptide was mildly elevated (300 pg/mL). It was interesting that the blood test revealed elevated white blood cell and eosinophil levels of 15.1 x 109/L and 0.84 x 109/L while he was symptomatic. Plasma cytokine assays showed that concentrations of IL-8, TNF-alpha, and soluble suppression of tumorigenesis-2 (sST2) were significantly elevated (0.15 ng/mL, 0.03 ng/mL, and 80 ng/mL, respectively). 18F-FDG PET/CT revealed a diffuse FDG uptake increase in the coronary artery and the left ventricle (Supplementary Figure 4). Based on clinical symptoms and angiography and ECG results, the patient was diagnosed with VSA caused by the inflammatory response of the coronary artery. He subsequently underwent immunomodulatory treatments with intravenous injection of methylprednisolone (80 mg/day) and immunoglobulin (10 g/day), as well as oral sustained-release isosorbitol dinitrate and diltiazem (90 mg/day). After treatment for 1 week, he noted significant improvement in his symptoms, and IL-8, TNF-alpha, and sST2 levels returned to normal. During the 6-month follow-up period, there was no onset of chest pain. Patient 2:\nOUTPUT:" }, { "from": "agent", "value": "Variant Angina, Myocarditis" } ]

[ { "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 84-year-old Chinese woman, affected by diabetes type 2 from 32 years and positive for diabetes complications such as eye disease, nephropathy, neuropathy, and vascular disease, was evaluated for a routine control by her diabetologist. She was under insulin treatment and her blood sugar balance was acceptable. During the visit, the doctor noticed, probably due to the itchy skin, the presence of painful ulcerative lesions (the biggest one of 1 cm diameter) on the lowest part of the right leg (Figure 1), which the patient described as appeared for at least 3 weeks. The same day, the patient, after giving her informed consent about the treatment and also allowing the publication of the pictures, started the treatment on the lesions applying B-Cure Laser Pro (Erika Carmel, Haifa, Israel) on her own. This device (Figure 2) emits in the infrared spectrum (808 nm) with a green LED aiming beam indicating the irradiation area, which is an elliptic shape with the two axes measuring 45 and 10 mm for a total surface of 4.5 cm2. It was not necessary, for the patients, to wear protective glasses because the appliance used is classified as class I device by the American National Standard Institute. When applied in contact to the target tissue, outperformed plastic allows to maintain the beam at a distance of 10 mm. In this way, it is able to deliver to the tissues an output power of 250 mW (55.5 mW/cm2) emitted in micropulses with a frequency of 15 kHz, for an energy per minute of 14.4 Joules and a fluence per minute of 3.2 J/cm2. Treatment was daily performed for 2 sessions of 15 minutes (total fluence 48 J/cm2) by cutaneous application (Figure 3); after a week of treatment, the smallest ulcers (upper and right lower) dried and crusted (Figure 4) and the largest one (lower) had a significant improvement. Finally, all the ulcers got completed healed after 30 days of treatment (Figure 5).\nOUTPUT:" }, { "from": "agent", "value": "Diabetic Leg Ulcers" } ]

[ { "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-year-old male was referred for a 1-year history of lower limb paresthesia and weakness causing inability to walk and 10% weight loss. He also complained of a new violaceous patch on his right upper chest (Figure 2(a)). A 20 cm x 15 cm erythematous ill-defined violaceous patch was seen on the right upper chest accompanied by ipsilateral cervical lymphadenopathy. Dermoscopy was similar to the first case. Neurologic examinations confirmed muscle atrophy, weakness, and generalized hyporeflexia. Papilledema was found on ophthalmoscopy. Laboratory investigations showed erythrocytosis (19.2 g/dL), thrombocytosis (372 x 103 platelets/muL), elevated erythrocyte sedimentation rate (ESR) (20 mm/h), and thyroid-stimulating hormone (TSH) (8 uUI/mL). Skin biopsy of the violaceous patch was identical to the first case (benign vascular proliferation, HHV8-, CD34+) (Figure 2(b)). Treatment with cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone (CHOP) chemotherapy was initiated, followed by cyclophosphamide, dexamethasone, and thalidomide. Six months later, the patient recovered his original weight, the violaceous patch disappeared, and the upper and lower limb weakness improved. One year after treatment, the patient was able to walk again.\nOUTPUT:" }, { "from": "agent", "value": "Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal Gammopathy, and Skin changes syndrome, Castleman's disease, Mixed demyelinating polyneuropathy, Sternal plasmacytoma" } ]

[ { "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 woman presented to the gynecology clinic after a mass that had been present for two years had become increasingly uncomfortable. The patient reported itchiness and she also had concerns that the mass was increasing in size. She denied any purulent discharge or erythema around the area. The patient had no significant medical or family history. The patient presented to a family medicine clinic for evaluation of the mass. Due to its size, she was referred for evaluation by a gynecologist. On physical exam, a 2 x 3 cm rubbery, mobile, nontender mass was present on the external genitalia, 3 cm lateral to the clitoris and near the mons. The remainder of her genital exam was normal. Due to the size of the mass and discomfort the patient was experiencing, the patient underwent an uncomplicated excisional biopsy completed under spinal anesthesia. A 2 cm incision was made on the inferior portion of the mass and it was resected away from normal skin with Metzenbaum scissors. This was continued until the base was reached. The right labial 2.4 x 2.4 x 1.1 cm pink-tan nodule was removed in whole and sent to pathology in formalin. The specimen was sectioned serially to reveal pink-tan fibrous cut surfaces. At her follow up visit two weeks post-surgery, the patient reported no concerns. Her biopsy site was healing well with no signs of infection. No other imaging or diagnostic assessments were performed.\nOUTPUT:" }, { "from": "agent", "value": "Fibroadenoma" } ]

[ { "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 patient, 53-year-old male, visited the emergency room of our university hospital on July 22 1995 for sudden onset of drowsy mental status. On admission, the blood pressure was 140/90mmHg, the pulse rate was 72/min, body temperature was 36.8 C and respiration rate was 20/min. He had had no diabetes mellitus, no hypertension, no hemorrhagic diathesis in past histories. He had no history of acute trauma. In neurologic examinations, he had a deep drowsy mental status, disconnected orientation, sensory dysphasia but intact cranial nerve system, motor and sensory systems. Reflexes were normal. 1). Laboratory results as follows: CBC and ESR were normal. Bleeding time was normal (3 min). Both prothrombin time (PT 18.0 sec, INR 2.2, normal range < 1.14 INR) and activated partial thromboplastin time (APTT 49.0 sec, normal range < 35 sec), were markedly prolonged. Thrombin time was normal (5.4 sec; normal range 4+-2 sec). His parents had expired when he was young. He had five brothers and one sister. The were alive and had had no bleeding tendency. He had one son and three daughters. His son had had no bleeding tendency. He recovered with fresh frozen plasma and supportive care. 2). He completely recovered after three weeks from admission day and has been followed at the out-patient clinic.\nOUTPUT:" }, { "from": "agent", "value": "Coagulation Factor V Deficiency, Intracranial Hemorrhage" } ]

[ { "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 male was hospitalized with severe dyspnea and weight gain. Physical examination revealed orthopnea, bronchospasm, severe pitting edema up to his chest and generalized rhonchi. He had severe tachypnea with up to 40 breaths per minute. NT-proBNP was normal (20 pmol/L). Based on the acute clinical presentation, pulmonary congestion was suspected. The ECG showed no abnormalities. Chest X-ray was normal (i.e. no signs of pulmonary congestion), besides a slightly blurred left heart margin. Intravenous diuretics were started to reduce edema and beta-agonist inhalers were started to reduce bronchospasm. Within 48 hours, he had lost three kilograms and his respiration frequency had returned to normal (16 breaths per minute). Afterwards, cardiac ultrasound showed normal systolic left ventricular function and no signs of significant diastolic dysfunction. Right ventricular pressure was increased. Although computed tomography angiography (CTA) of the coronary arteries did not reveal any significant obstructions, the calcium score was 146 (> 90th percentile), which indicated the presence of coronary sclerosis. He was prescribed atorvastatine and reduced his cigarette use from 75 to 21 cigarettes per week. The patient used insulin, which he administered himself. It turned out that he injected himself with too much insulin, in order to induce hypoglycemia and receive extra food. To reduce pulmonary resistance and optimize cardiac function, continuous positive airway pressure (CPAP) was started.\nOUTPUT:" }, { "from": "agent", "value": "Prader-Willi syndrome, cardiovascular complications, morbid obesity, heavy smoking, hypertension, dyslipidemia, hypogonadism, frequent hypoglycemias, sleep apnea" } ]

[ { "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 69-year-old healthy female underwent a surveillance colonoscopy Figure 3. Her medical history was only significant for caesarean section, hysterectomy, oophorectomy, and irritable bowel syndrome. Her family history was significant for colorectal malignancy. She endorsed daily NSAID use in the form of ibuprofen and ASA for back pain. The patient had used Bi-Peglyte solution for bowel preparation. The patient was sedated before and during the procedure with a total of 3 mg of midazolam and 75 mcg of fentanyl. Carbon dioxide (CO2) was used to insufflate the colon. The colonoscope was advanced without difficulty to the cecum. Bowel preparation was good. Two flat polyps of 2 mm size were removed by cold snare polypectomy in the ascending colon. Two flat, larger polyps of 1 cm size were removed from the hepatic flexure and transverse colon using methylene blue and cold snare polypectomy. Moderate diverticulosis was noted in the sigmoid colon. Pathology demonstrated normal mucosa, one tubular adenoma, and two sessile serrated lesions without dysplasia. The patient developed abdominal pain and small volume rectal bleeding 6 days after the colonoscopy. There was no peritonitis. She underwent an urgent flexible sigmoidoscopy the next day. Starting at the distal sigmoid, a 9 cm, noncircumferential segment of erythema and friability consistent with ischemia was noted (Figure 4). There was no submucosal edema or ulceration. There was a small area of increased blood, although no active bleeding, onto which a single clip was placed. No biopsies were taken. A CT scan completed 7 days after the flexible sigmoidoscopy did not demonstrate any features consistent with ischemia. The patient did well clinically and did not require hospital admission.\nOUTPUT:" }, { "from": "agent", "value": "Ischemic Colitis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 45-year-old male presented with right knee pain that was gradual in onset and not associated with any previous trauma. He was evaluated by orthopedic surgery and found to have a large effusion of the right knee. The patient subsequently underwent an MRI of the involved extremity that showed a diffuse heterogeneous marrow signal in the visualized distal femoral diaphysis extending to the femoral condyles with associated periosteal inflammation. Also noted was a fairly large soft tissue mass extending along the lateral and posterior aspects of the distal femoral diametaphysis. There was heterogeneous enhancement of the marrow process and a soft tissue mass which raised concern for an underlying neoplasm. CT scan of the chest did not show evidence of lymphadenopathy but did reveal a large mass extending from the posterior mediastinum around the right paraspinal soft tissues. Bone scan showed intense abnormal activity in the right distal femur. Ki-67 expression was estimated to be between 80% and 90%. Cells partially expressed CD20 with loss of CD19. Immunohistochemical stains showed an expanded population of cells that were positive for CD45, CD20, PAX 5, CD10, and MUM1. He completed 6 cycles of chemotherapy with partial response. His treatment course was complicated by avascular necrosis of the right distal femur. Although there has been persistence of the right paraspinal mass, he has had no evidence of disease progression close to 2 years after completion of chemotherapy.\nOUTPUT:" }, { "from": "agent", "value": "Primary Bone Lymphoma, kappa-restricted large B-cell NHL, lambda-restricted B-cell NHL, unrestricted B-cell NHL" } ]

[ { "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 35-year-old woman who presented with a 5-day history of chest tightness and right leg pain was admitted to our emergency department on October 22, 2017. The patient had delivered (first pregnancy) 48 days prior and had an unremarkable medical history. Upon physical examination, dullness to percussion was noted over her right lower lung. Swelling, tenderness, and ecchymosis were present in the right medial thigh. The circumference of the right thigh was 53.5 cm, while that of the left thigh was 49 cm. Computed tomography angiography of the aorta showed a large amount of pleural effusion in the right thoracic cavity and partial right pulmonary collapse (see Fig. 1A). Under B-mode ultrasound guidance, thoracentesis was performed, and bloody pleural effusions were drained. Her white blood cell count was 17.9 (109/L), with 75.8% neutrophils; hemoglobin was 70 (g/L), and platelets were 238 (109/L). Prothrombin time (PT) was 15.20 s, and activated partial thromboplastin time (APTT) was 68.40 s. An APTT mixing study showed that her APTTs were 70.12 s, 30.45 s, and 60.40 s at 0, 1, and 2 h, respectively. Factor IX activity was 107.8 (%), factor XI activity was 66.9%, and factor VIII activity was 12.6%. The Bethesda assay showed a FVIII antibody titer of 7.4 Bethesda units (BUs). The diagnosis of AHA was confirmed. The regimen for this patient included aPCC (10 U/kg intravenously 3 times daily), hFVIII (20 IU/kg intravenously twice daily), prednisone (1 mg/kg orally once daily), and plasma (400 mL intravenously once daily). Two weeks later, the ecchymosis in her medial thigh improved, and PT and APTT were 17.70 s and 20.30 s, respectively. FVIII activity was 127.30%, and the FVIII antibody titer was 0 BU. After prednisone was tapered to 10 mg orally once daily, the patient was discharged. At the 2-month follow-up visit, her pulmonary computed tomography revealed that the pleural hemorrhage had subsided (see Fig. 1B). Prednisone was withdrawn at a rate of 20% every 2 weeks. The patient is now undergoing 6-month follow-up and has shown no recurrence.\nOUTPUT:" }, { "from": "agent", "value": "Acquired hemophilia A" } ]

[ { "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: Historically, he had developed acrodermatitis continua of Hallapeu-like skin lesions 7-8 months after taking treatment for a clinically suspected CAD despite having a normal electorcardiogram, echocardiography and treadmill test. Patient was taking diltiazem (75 mg/d), atenolol (50 mg/d), aspirin (75 mg/d) and atorvastatin (10 mg/d). He did not improve with topical emollients, tar and corticosteroid ointments and developed intolerable retching/vomiting after systemic methotrexate (15 mg/week). Although he continued with topical treatment, his skin lesions did not remit. However, his skin lesions disappeared completely within a month when he stopped all medications which were for CAD without his physician's advice. He did not develop any skin lesions after restarting diltiazem and atorvastatin on the insistence of his physician but these returned within a week after taking clopidogrel (75 mg/d) re-challenge (performed with his consent).\nOUTPUT:" }, { "from": "agent", "value": "Pustular Psoriasis" } ]

[ { "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 prior sleep study showed an elevated carbon dioxide level (45-50 mmHg) via transcutaneous carbon dioxide (TcCO2) monitoring with normal oxygen saturation. She also had ongoing feeding intolerance, poor weight gain, decreased energy, lethargy, and reduced self-ambulation. She presented with a significant decline in motor strength compared to the past year, which affected her mobility. Based on the results of this polysomnogram, the decision was made to initiate NIV, requiring the patient to go to SickKids for a mask fit. However, the FC was hesitant to participate in an in-person mask fitting due to the length of the commute to the hospital, her daughter's high anxiety issues, and fears regarding potential exposure to COVID-19. Therefore, a virtual mask fitting appointment was scheduled with the SickKids RT. The virtual visit was completed. Facial measurements for both nasal mask (nose height = 6.0 cm, nose width = 4.5 cm) and FFM (nose height = 9.0 cm, mouth width = 5.0 cm) were completed. The FC chose one large NM with a chin strap (she slept with her mouth open) and one medium FFM to try. During this virtual visit, mask fitting was completed in addition to extensive NIV education. The masks were then delivered from SickKids to the peripheral community hospital where she had an appointment 1 week later for NIV initiation and acclimation. The community RT reported that the FC preferred the FFM due to comfort and fit for her daughter and her daughter refused to wear the chinstrap. This virtual mask fitting session had several benefits. The SickKids RT, together with the community hospital RT, were able to expedite the mask fitting, allowing the patient to be initiated on NIV. The patient and FC reported satisfaction with the virtual visit and a reduction in stress and anxiety because they did not have to commute to multiple hospitals.\nOUTPUT:" }, { "from": "agent", "value": "Congenital Myopathy, Scoliosis, Obstructive Sleep Apnea, Central Sleep Apnea, Nocturnal Hypoventilation" } ]

[ { "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 out born baby boy was referred to our hospital with protruding abdominal mass with a lesion lateral to the umbilical cord. On admission, vital sign showed TPR of 35.7 C, 160/min, 39/min, BP 74/35 mmHg and body weight of 3212 gm. Physical examination showed good skin turgor and a mass with thin sac below the umbilical cord, measured 3.5*6 cm with visible intestine and a stoma like lesion with prolapsing mucosa and passage of meconium stool. Buttock area noted to have sacral dimpling. Cardiac, abdominal and spinal echography showed small interrupted interatrial septum at secundum portion with size of 0.2 cm with L to R shunt, mild peripheral pulmonary stenosis with pressure gradient of 8 mmHg, mild hepatomegaly, bilateral moderate hydronephrosis, and no spinal abnormal finding, respectively. Past medical history showed no history of amniocentesis, non-invasive prenatal test and with uneventful prenatal care. He was delivered by a 28 y.o., mother, G1P1, with gestational age 39 + 1 weeks. Birth Histroy did not showed sign of premature rupture of membrane nor delay of initial crying. The Apgar score at birth was 8, 9 at 1 and 5 mins. Operative surgery was done with operative finding of a protruding mass below the umbilical cord, covered with thin transparent sac, containing small bowel and ascitic fluid, with abdominal defect of about 3*4 cm. Fistulectomy, using wedge resection of the small bowel was done and the abdominal wall defect was primary close in two layers. Histopathologic examination of the lesion showed squamous epithelium-lining membranous sac continuous with intestinal mucosa. Postoperative chromosome study revealed 46XY with normal karyotype and feeding started on the 4th and was discharge on the 9th postoperative day.\nOUTPUT:" }, { "from": "agent", "value": "Vitelline fistula, Omphalocele" } ]

[ { "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: Further detailed information could enable us to clarify this presentation because of only limited investigation in affected cases. Image Caption and Description: \nImage caption: []\nImage description: []\nCase Report: \nThis boy was the first child of non-consanguineous Chinese parents and born at term with normal physical examination apart from mild hypotonia. During the first years of life, he presented with obviously delayed developmental milestones: he gained head control at 8 months, and walked alone without support at 3.5 years of age. Feeding difficulties were not reported but he had a chronic constipation. He had a history of febrile convulsions in infancy. His family history was unremarkable.\nOUTPUT:" }, { "from": "agent", "value": "Hemophagocytic Lymphohistiocytosis, Leukemia, CDK13-Related 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: The patient received posterior thoracic drainage with good clinical progress (Figures 1 and 2). Three months after his trauma, the patient begins to report purulent sputum, which was not present before, with unaccounted weight loss and without any fever or another respiratory signs. The clinical examination found a patient hemodynamically and respiratory stable, with pain on palpation in the posterior left hemithorax in relation to his rib fractures, while on the right side, no pain on palpation and no pleurocutaneous fistula. The patient underwent a chest CT scan which always objectified the calcified PE of the right side, with the appearance of an air-fluid level without flooding of the contrelateral lung (Figure 3). The bronchial fibroscopy showed purulent sputum from the lower lobe bronchus without visualization of a bronchopleural fistula. The surgical procedure was an open window thoracostomy (OWT) in the axillary region by resection of the middle arch (6-8 cm) of the fifth, sixth, and seventh rib (Figure 4). A bronchopleural fistula was found. This procedure is finished by suturing the cutaneous layers in the areas of pachypleuritis. The evolution is still now good and the patient does not present any purulent sputum. Three to six month after, we will perform a myoplasty with latissimus dorsi muscle, expecting that the OWT will be small in size and will be completely sterile.\nOUTPUT:" }, { "from": "agent", "value": "Chronic calcified pleural empyema, Closed chest trauma" } ]

[ { "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 presented with recurrent lower back pain (LBP) which worsened during the last 6 months. The pain increased with changing position and did not improve with walking. Alternating pain radiated to the gluteal region, thighs, and legs with pain in the left more than the right side (VAS for LBP 9/10, for lower limb pain 3/10). Examination showed only decreased sensations in the L5 dermatomal distribution. Instrumental fusion and decompression were initially planned, but both the patient and family declined surgical intervention. She was offered a palliative solution of a medial branch block which showed a good response (VAS for LBP decreased from 9 to 2). The patient was referred for physiotherapy, prescribed a lumbar belt and painkillers, and scheduled for radiofrequency on symptom recurrence. Isthmic spondylolysis and spine degeneration are the most common causes. Hence, surgery is reserved for patients with significant pain affecting daily life. Pain generation could arise from mechanical instability and/or nerve compression. Consequently, in the absence of central or lateral canal stenosis or significant symptoms, pain can be approached via minimal interventions, mainly medial and lateral branch blocks and radiofrequency. It should be noted that two diagnostic injections are needed to confirm the pain source. However, in the current case, the aim was palliative pain treatment and we considered a single injection enough.\nOUTPUT:" }, { "from": "agent", "value": "Degenerative Spondylolisthesis" } ]

[ { "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 54-year-old woman presented with complaints of transient right hand and arm numbness, along with facial twitching for 3 months. The patient had a 20-year history of epilepsy. Her neurological examinations were largely unremarkable. On MRI [Figure 1], abnormal signal intensity was noted on the left medial frontal region, predominantly hyperintense on T2/fluid-attenuated inversion recovery (FLAIR), and showed diffusion restriction on diffusion-weighted imaging sequence. Peripherally, the hemosiderin ring was appreciated on T2 sequences with signal dropout on susceptibility-weighted imaging. It showed patchy post-contrast enhancement on the contrast sequence. However, due to high signals on pre-contrast T1, it was difficult to comment on the extent of post-contrast enhancement. Surrounding edema and punctate foci of hyperintensities on the subcortical white matter with chronic ischemic changes were noted on T2/FLAIR sequences. Findings were therefore, suggestive of a cavernoma. Elective neuronavigation-guided craniotomy for maximus safe resection of the lesion was performed. Intraoperatively, it was noted to be an intra-axial soft to firm lesion with xanthrochromic discoloration throughout the lesion. Some abnormal vessels were difficult to coagulate; it was a clue that it could be a high-grade lesion rather than just a cavernoma. The histopathological examination revealed neoplastic glial cells with hyperchromatic nuclei, inconspicuous nucleoli, and a moderate amount of eosinophilic cytoplasm. Multiple gemistocytes and areas of palisading tumor necrosis alongside areas of mitoses were seen. However, no microvascular proliferation was appreciated.\nOUTPUT:" }, { "from": "agent", "value": "Glioblastoma, IDH-1 wild type" } ]

[ { "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: As SDOH are broad and complex in nature, one way to begin to design mHealth to align with SDOH is to focus on how the components of the patient work system can be expanded by examining one determinant and how patient work stemming from that determinant interacts with other components across a system. Transportation access is one SDOH that affects prenatal care utilization, access to postpartum care, and the management of underlying chronic conditions during and after a pregnancy. Structural discrimination embedded in the design of transportation systems has resulted in disproportionately low access to healthcare and public services in marginalized communities. Currently, there is a paucity of mHealth technologies that incorporate considerations for transportation access as it relates to maternal health. The technologies available have a narrow focus on accessing clinical services by supporting the delivery of monetary resources to pay for transportation and direct coordination of transportation. To expand on current technologies, Figure 1 presents a persona and scenarios grounded in qualitative interview data collected as part of a CBPR process focused on exploring transportation access to maternal health services through a patient work system lens. Scenarios are derived from the persona and are coupled with mHealth design recommendations to address the challenges posed in the scenarios. These recommendations serve as examples to illustrate how mHealth can be designed to align with SDOH and more research is needed to capture the breadth and depth of the lived experience of birthing persons with a diverse range of identities across a multitude of settings. It should be noted that these recommendations are not comprehensive and should be co-designed and co-developed with community members. This process could include approaches such as participatory design workshops. Methods such as affinity diagramming and dot voting can be used to thematically categorize and prioritize, respectively, design ideas. Moreover, additional determinants should be explored in-depth to create mHealth technologies that holistically attend to a wide range of SDOH.\nOUTPUT:" }, { "from": "agent", "value": "No specific diagnosis mentioned." } ]

[ { "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 man presented at our hospital with the complain of dyspnea. Chest radiography showed remarkable cardiomegaly (Fig. 1A). He did not have any past medical history, family history and any relevant genetic information. His smoking history was 2 packs per day for 30 years and his occupation was a truck driver. Computed tomography and magnetic resonance imaging revealed a giant anterior mediastinal tumor with fat component and there was a nodule with calcification partially (Fig. 1B, C and D). The tumor extended from the space of the mediastinum at the level of the cephalic vein to the diaphragm of bilateral thoracic cavity. Surgical resection was planned to relive the dyspnea. We chose clam shell approach at bilateral the fifth intercostal level to assure the safe operation field in the both the anterior mediastinum and the bilateral thoracic cavity. The first author who has been a surgeon for 10 years was the operator. The tumor adhered loosely to the chest wall, the cardiac sac and the diaphragm. The tumor could be mobilized with energy devices from the surrounded anatomical structures. Two thin veins flowing into the cephalic vein from the tumors were ligated. A complete en bloc resection of the tumor including an entire capsule was performed. The weight of the tumor was 3500 g (Fig. 2A). In the findings of hematoxylin and eosin stain, the size of adipocyte and lipoblast were different, and the nuclei of atypical stromal cell were misshapen (Fig. 2B). The nodule lesion was surrounded a scar-formed fibrosis and fell into necrosis in the center. Immune-histologic examination was negative for MDM2 and cyclin-dependent kinase 4. He could discharge on 10 days after surgery without dyspnea. Without adjuvant therapy, disease free survival for three years has passed in checking the recurrence by CT every 6 months.\nOUTPUT:" }, { "from": "agent", "value": "Liposarcoma, well-differentiated type" } ]

[ { "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 34-years-old Caucasian female presented with left upper arm weakness associated with paresthesia. The symptoms had started about 24 hours before, on waking. Physical examination revealed left hemiparesis, with diminished left upper (2/5) and lower (3/5) strength, and extensor plantar response on the left side. There were no cerebellar signs, and the cranial nerve examination was normal. The electrocardiogram showed normal sinus rhythm at 70 beats per minute, and blood pressure values were 160/90 mmHg. No other remarkable signs were present. Cranial multimodal computed tomography (CT) imaging was performed, showing no sign of cerebral hemorrhage and hypodensity on cortical and subcortical right frontoparietal regions, compatible with ischemic stroke. Thrombolysis was not performed because of the remote onset of the symptoms. Cranial Magnetic Resonance Imaging (MRI) showed an area of ischemia in the acute/subacute phase, without hemorrhagic infarction, with occlusion of the M2 segment of the middle cerebral artery. She was given a loading dose of acetylsalicylic acid and transferred to our division. Collecting a complete medical history, the patient revealed to be a habitual consumer of substances like heroine, methadone, cocaine, and alcohol; moreover, in the night before the episode, she had smoked crack cocaine. A toxicological screen resulted positive for cocaine and opioids. ECG and cardiac ultrasound were normal. Enoxaparin at the dosage of 100 U/kg twice/day was started, followed by warfarin therapy. Seriated CUs showed gradual dissolution of the thrombus (Figure 1). Her symptoms gradually improved during the next weeks, and she was discharged from the hospital in good general conditions. However, the patient continued drug abusing, and a new cerebral stroke occurred the year after.\nOUTPUT:" }, { "from": "agent", "value": "Carotid 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: Currently the patient presents malformations of the lower left limb (hip, knee and ankle), evident on the articular and periarticular level, where there are diffuse exostoses. This case discusses the main occupational concerns relating to the patient's workspace at a high floor level that could create critical issues in the event of an emergency exodus. Given the impossibility of placing the patient in heavy manual activities, employment is limited to office activities. Adjustments were carried out at the patient's workstation, and thus the patient has been recognized as fit to work. Increased frequency of breaks were prescribed in order to allow the physiological alternation of postures. This pathology is benign and localized. The abnormal growth process of the left leg began at the age of 18 months and led to the amputation of the distal phalanx of the second finger, which was repeated for recurrence at the age of 4 years. At 35 years the patient underwent subtotal amputation of the first finger and the removal of calcification of the back of the left foot. At the age of 40, he underwent surgical revision of the first finger and amputation of the distal third and fourth finger phalanges. Over the years, cerebriform connective tissue nevi (CCTNs) has developed on the left upper limb and has undergone surgical treatment of the suspected malignant nevi.\nOUTPUT:" }, { "from": "agent", "value": "Overgrowth 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 21-year-old woman had become aware of a mass on the palmar aspect of the distal phalanx of her left thumb 11 years earlier. The tumor had enlarged gradually over the years. Her medical history was unremarkable, with no traumatic injury of the left thumb. The tumor appeared to be sporadic, with no clinical findings indicative of neurofibromatosis. Despite occasional ulceration and fluid formation at its center, the patient was untroubled by the tumor and did not seek treatment before presenting to us with a large ulcerated lesion. Initial examination revealed a hard but elastic, immovable tumor of 30 x 25 mm on the palmar aspect of the distal phalanx of the left thumb, with an ulcer formed at the center (Fig. 1). Multidetector computed tomography (CT) of the tumor showed poor vascularization and no adhesion to the distal phalanx of thumb or articular cavity (Fig. 2). No pain, sensory disturbance, or motor dysfunction was noted. Total excision of the tumor was subsequently performed with digital nerve block under surgical microscope. Despite adhesion to the ulnar aspect of the distal digital nerve, the tumor was excised without injuring the nerve. Skin defect was reconstructed by grafting with artificial dermis. Histopathological findings revealed a fibrous capsule covering the tumor, directional growth of tightly organized spindle-shaped cells, and mixed Antoni A and B patterns; specifically, the Antoni A region was characterized by Verocay bodies appearing as palisading oval nuclei, and the Antoni B region showed loosely organized cells that lacked the characteristic organization pattern and thus had morphological features of tumor cells. 3, 4). The S-100 stain was positive. There was no evidence of infection, pain, complications such as ulcer formation, or recurrent tumor at 6 months postoperative, and the patient is scheduled to undergo reconstruction of the surgical site using a sensory flap.\nOUTPUT:" }, { "from": "agent", "value": "Ancient schwannoma" } ]

[ { "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 man presented with left-sided painless blurring of vision of one-week duration. His medical and ophthalmic history was unremarkable but he complained of moderate malaise and fatigue of recent onset. Best-corrected visual acuity was 20/50 OD and 20/150 OS. Mild nuclear cataract was noted bilaterally. A relative afferent pupillary defect was present in the left eye. Fundus examination revealed sectorial optic disc edema in the left eye, which corresponded to optic disc filling delay and late leakage on fluorescein angiography (Figure 1) as well as a related broad inferior-nasal arcuate scotoma. The erythrocyte sedimentation rate was 20 mm (1st hour) and C-reactive protein was within normal range. Blood pressure was 90/65 mmHg, pulse 105/min. A carotid Doppler study was normal. Further investigation in search of a thrombophilic tendency, including prothrombin time, partial thromboplastin time, protein C, free protein S, and antithrombin III yielded normal values. Polymerase chain reaction and hybridisation to allele-specific oligonucleotide probes (ViennaLab Labordiagnostika GmbH, Vienna, Austria) did not identify prothrombin, factor V or MTHFR thrombophilic mutations. Transfusions of packed red cells, initiated two weeks following the approximate date of initiation of symptoms, raised hemoglobin to 98 g/l, and were followed by biweekly transfusions and initiation of erythropoietin in order to maintain hemoglobin over 100 g/l. Within 10 days following admission, the visual acuity of the left eye had improved to 20/50 and remained stable for the rest of a six-month follow-up period, during which sectorial left optic disc pallor ensued.\nOUTPUT:" }, { "from": "agent", "value": "Nonarteritic anterior ischemic optic neuropathy, Chronic anemia, Myelodysplastic 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 37-year-old male presenting with 2 weeks of polyuria, polydipsia, and epigastric pain and vomiting was admitted in an intensive care unit for consciousness alteration. Taking his medical history by interrogating his parents did not reveal any alcohol abuse or a prior history of biliary colic. On admission, the initial assessment showed a Glasgow Coma Scale Score at 8/15, body temperature at 38.3 C, heart rate at 120 beats/min, blood pressure at 80/45 mmHg, respiratory rate at 30 breaths/min, and an oxygen saturation of 93% under room air. He needed intubation and mechanical ventilation. The laboratory tests showed serum glucose at 32 mmol/l, pH = 7.31, bicarbonate = 10.7 mmol/l, serum sodium = 132 mmol/l, serum potassium = 3.9 mmol/l, lipase = 511 U/l, cholesterol = 12.8 mmol/l, serum triglyceride = 75 mmol/l, WBC count = 3900/mm3, platelet count = 101000/mm3, and CRP at 496 mg/l. Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and bilirubin values were at the normal range. There was no evidence for gallstones. He was aggressively hydrated and received IV insulin. A repeat abdomen CT scan, performed 7 days later, showed a necrotic fluid collection which was infected. An endoscopic drainage was performed. The patient's neurological status deteriorated with no sign of waking up and multiple episodes of seizures. A brain CT scan was performed, showing cortical and subcortical hypodense lesion in the right frontal area. During his ICU stay, the patient developed septic shock with multiorgan failure. He died 45 days after ICU admission.\nOUTPUT:" }, { "from": "agent", "value": "Acute Pancreatitis, Diabetic Ketoacidosis, Major Hypertriglyceridemia" } ]

[ { "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 69-year-old male patient presented as an outpatient with increased creatinine levels (281 mumol/L) associated with proteinuria (2.5 g/24 h) and hematuria (110 g/L). His history was not unusual and he denied any abuse of alcohol, drugs, or over-the-counter stimulants. Review of his history was negative for any recent fever, rash, contact with sick persons, or acute illness involving the respiratory or gastrointestinal tract. The examination of ANCA and a chest radiograph were unusual. After starting treatment with cyclophosphamide pulse therapy, sequential therapy with low-dose prednisone (10 mg qid [every other day]), he underwent a 4-year follow-up. During this time, the level of serum creatinine was stable (Figure 1), and both proteinuria and hematuria improved (Figure 2). A chest CT scan was performed, which showed that the lung fibrosis remained unchanged (Figure 3). However, after the 4-year follow-up, the patient experienced a sudden and rapid deterioration in lung infiltration and exhibited pulmonary hemorrhage (PH) along with a progressively lower hemoglobin (Figure 3). Interestingly, there was not only no increase in creatinine levels (Figure 1), but also a negative conversion of p-ANCA. The galactomannan assay and Mycobacterium tuberculosis antigen-specific interferon (IFN)-gamma release assays (T-SPOT -TB test; Oxford Immunotec Ltd, Oxford, UK) were both negative. After immunosuppressive therapy (methylprednisolone and cyclophosphamide pulse therapy for 1 week), and empirical widened coverage of anti-infective therapy, progressive lung fibrosis occurred, the PH worsened, and he died from respiratory failure.\nOUTPUT:" }, { "from": "agent", "value": "ANCA-associated 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: A 73-year-old right-handed male with acute onset of right hemiparesis and aphasia was transferred to a primary hospital located 23 km from our institution. The NIHSS score at that time was 8. 1b). The patient received IV t-PA 135 min after onset, but significant improvement was not evident after 15 min from IV t-PA. The primary physician requested air transfer, and the patient arrived at our hospital 210 min after stroke onset. The patient got repeated CT, and it did not reveal any hemorrhage. The patient was moved to the angiography suite 260 min after onset. The patient could not keep rest, we induced general anesthesia with endotracheal intubation. Digital subtraction angiography (DSA) revealed persistent left ICA occlusion (Fig. 2a). Aspirin (200 mg) and clopidogrel (300 mg) were administered because atherothrombotic occlusion was suspected. A total of 5,000 IU heparin was intravenously administered, and initial carotid artery stenting proceeded under proximal balloon protection (Fig. 2b). Thereafter, the ICA was dilated (Fig. 2c), but the left MCA occlusion persisted (Fig. 2d). Recanalization was not achieved despite an IA infusion of urokinase (120,000 IU). The MCA was dilated with a balloon catheter (Fig. 2e), which resulted in complete recanalization (Fig. 2f). The NIHSS score at 24 hours after onset improved to 4. Assessment by MRI at 7 days after onset showed limited infarction in the frontal lobe (Fig. 3a) and MR angiography showed a patent left MCA (Fig. 3b). The patient remained free of neurologic deficits at 2 months after stroke onset.\nOUTPUT:" }, { "from": "agent", "value": "Infarction in the left middle cerebral artery territory, Left internal carotid artery occlusion" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 36-year-old Caucasean woman presented for a first pregnancy. She suffered from hypertrophy of the right leg 4 cm longer than left leg, atypically localized varices with an absent deep venous system at the right leg, and port-wine stains in multiple dermatomes on the right leg, abdomen, thorax, neck, face, and arms for which she had received cutaneous lasertherapy. There was no history of thrombosis. During pregnancy, no low-weight heparine nor low-dose acetylsalicylic acid was given. The patient did not demonstrate any change in her lower limbs during pregnancy. At 36 weeks, MRI of the lumbosacral spine proved to be impossible because the patient demonstrated severe claustrophobia. At 40 weeks, she went in spontaneous labour and a boy, weighing 3690 gram, Apgar 8 and 9 after 1 and 5 minutes was spontaneously born. Immediately after delivery, low-molecular-weight heparine was started (Fraxiparine 0.3 mL, Glaxo Smith Kline, Genval, Belgium). She left the hospital on the fourth postpartum day and continued the use of nadroparin. On the 13th day, she developed acute phlegmasia alba dolens with complete thrombosis of the superficial veins of the right leg. Treatment consisted of compressive stockings and intermittent pneumatic compression together with a therapeutic dose of low-molecular-weigh heparine (Fraxodine 0.8 mL, Glaxo Smith Kline, Genval, Belgium, nadroparine 15200IE anti Xa once daily subcutaneously). On the same day under local anesthesia, a trombectomy was performed through an inguinal incision to remove the largest trombi on the level of the lateral and anterior side of the right upper leg. In one week time, there was spectacular diminishment of the swelling of the right upper leg which went from 10 cm difference with the left upper leg to 2 cm in circumference. The low-molecular-weight heparin and elastic compressive stockings were continued for six weeks after the event.\nOUTPUT:" }, { "from": "agent", "value": "Klippel-Trenaunay 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: The Patient, a 60-years old Caucasian male found unconscious in a trailer park of gypsies, was carried to Emergency Department at night, intubated and haemodynamically stable. No other lesions were found. 2), without any evidence of thoracic wall wounds; there was no air outside the bowel (Fig. 3a) even if little air bubbles could be recognized near to the pubis (Fig. 3b). These findings were difficult to be interpreted, both by the radiologist, the surgeon and the anaesthesiologist, as patient's examination performed in the shock room after the CT scan confirmed the only presence of a single bullet-hole located at the back of the neck. As the Patient had no clinical and radiological signs of bowel perforation, it was decided for a \"wait-and-see\" attitude, scheduling a second CT scan for the following day. About 14 h later the second CT scan showed the presence of hematoma near the pubis, peritoneal air bubbles outside the bowel (Fig. 4a, b) and diffuse peritoneal free fluid (Fig. 5). The only possible explanation for the trajectory of the bullet was that it was shot through the anus; evidently, after the blow on the head, the patient had fallen face down and the assailant shot him throughout the anus. This interpretation was later confirmed by aggressor interrogation by the Police.\nOUTPUT:" }, { "from": "agent", "value": "Head gunshot wound, large subdural haematoma, retained bullet in the brain, retained projectile in the left lung, multiple perforations of small bowel, single perforation of the upper part of the rectum, double perforation of the stomach, small hole in the left diaphragm" } ]

[ { "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 underwent splenectomy 14 years before due to Hodgkin's lymphoma and had been immunized against Streptococcus pneumonae and Neisseria meningitidis. The following day, she was feeling worse and was evaluated at a medical center feeling worse and found to be hypotensive and tachycardic. Laboratory results (Table 1) showed thrombocytopenia, leukopenia, and increased serum levels of ALT, BUN, creatinine and procalcitonin. She was admitted to the ICU, remaining hemodynamically instable. Multiple confluent purpuric lesions were noticed to rapidly develop on her face and limbs. 24 h later she was transferred to a larger medical facility. Upon arrival, she was conscious but appeared severely ill and was tachycardic, hypotensive and tachypneic. Large generalized purpuric lesions were evident on her limbs, face and oropharynx, as well as acrocyanosis in both hands and feet with localized necrosis of finger tips (Fig. 6). The tip of the nose and surrounding skin were necrotic. Chest X-rays and an echocardiogram were normal. Empiric antimicrobial therapy was started with meropenem and vancomycin and she was given a pulse dose of methylprednisolone. Her condition continued to steadily deteriorate, requiring intubation and ventilator support. Rapidly expanding bullae developed on both upper and lower limbs (Fig. 7). Bilateral basal pulmonary infiltrates were seen on the chest X-ray and a repeat echocardiogram revealed global hypokinesia with a low ventricular ejection fraction. Nevertheless, after 72 h she began to improve gradually, and was discharged after 12 days. Serial blood cultures and bacterial antigen tests were negative. Conventional and real time PCR from serum samples were positive for CHIKV and negative for dengue virus. A dengue IgM serology was also negative. Other common and locally important viral and parasitic pathogens were also excluded by serology.\nOUTPUT:" }, { "from": "agent", "value": "Chikungunya fever" } ]

[ { "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: From the 10 patients, four (40%) were male and six (60%) were females. Mean age was 54,6 years old (43yo - 70yo). Mean lesion size was 4,1 cm; largest lesion was 14 cm. Three trocars were used to perform PR adrenalectomy: 12 mm balloon trocar (tip of the 12th rib), 5 mm (tip of the 11th rib) and 10 mm (midline between 12 mm trocar and spine). A 30 camera was used. A 5 mm laparoscopic LigaSure and a non-traumatic grasper were the only instruments used. Operative field was washed at the end with saline solution. No drainage. The fascial plane was closed with absorbable sutures, and skin was sutured with nylon. Nine (9) patients were submitted to complete PR adrenalectomy, and one patient was converted to laparotomy (10%) because of extensive fibrosis precluding access to retroperitoneal space, following a dorsal and lumbar trauma years before. Operation time for complete PR adrenalectomy was between 30 and 70 min, with a mean of 46,7 min. Blood loss was negligible in all patients submitted to complete PR approach (<20 ml). Post-operative in-hospital length of stay for complete PR technique was 1 to 4 days (mean of 2,2 days). There were no complications (0%), and no mortality (0%). Table 1. At three months of follow-up there were no complaints from any patient.\nOUTPUT:" }, { "from": "agent", "value": "Conn's syndrome, Pheochromocytoma, Cushing's syndrome, Non-functioning 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 22-year-old educated, unmarried female presented with the complaint of frequent spells of unresponsiveness for the last 4 years. Her spells were characterized by a variety of symptoms such as teeth clenching, up rolling of eyeballs, tightening of the limbs, and apparent unresponsiveness which would last for several hours. These spells were not preceded by premonitory symptoms such as dizziness, gastric irritation, and deja vu. There were no tongue bites, urinary or fecal incontinence, or fall injury related to these spells. The patient would gain consciousness immediately without any period of confusion. These spells would occur several times in a day but never while the patient was asleep. Her symptoms differed on different occasions. She was admitted as inpatient for detailed evaluation. There was no significant past or family history. Physical as well as radiological examinations were unremarkable. Serial mental state examination revealed only anxious affect. Psychological evaluation and intervention were initiated, but the patient did not show satisfactory cooperation in different settings. Anxiolytics and several classes of antidepressants and low-dose antipsychotics were prescribed for adequate duration, but to no avail. Her symptoms did not seem to respond to any intervention, which made both the attendant and the doctors clueless. To target her possible motor hyperresponsiveness, muscle relaxant eperisone was added presumptively. Eperisone was given orally in the dose of 50 mg twice a day and increased to 150 mg a day in divided doses. Her symptoms disappeared almost completely from the next day. This cannot be explained by any nonspecific \"halo effect\" of either the drug or the doctor as she was being treated with different drugs earlier too by the same team of doctors. On stopping eperisone, her symptoms recurred, and the symptoms improved on restarting the drug. She has been followed up for over a year now and no recurrence or change in symptoms has been observed.\nOUTPUT:" }, { "from": "agent", "value": "Dissociative convulsions" } ]

[ { "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: Pachalska et al. administered rTMS to a 26-year-old male who had previously (3-5 years) suffered a severe TBI which left him in a coma for 2 months. Twenty sessions of low-frequency (1 Hz) rTMS were administered over left frontal and temporal regions along with high-frequency (5 Hz) rTMS to right frontal and temporal regions. Although EEG spectra were no different post-rTMS, NO-GO ERP recordings showed improvement compared to pre-rTMS, though still much different from healthy controls. No seizure events or significant adverse side effects were reported. Recently, Koski et al. 15 patients with a score of 22 or greater on the PCS Scale received 20 daily sessions of rTMS (10 Hz at 110% resting MT; 20 5 s trains with 25 s ITI; 1000 pulses/session) over the left DLPFC. Two patients quit due to worsening symptoms and one for unrelated reasons. Of the 12 patients who completed treatment, 9 showed an improvement in symptoms (>5 point decrease on PCS scale) and 1 patient worsened. Patients also showed an overall decrease in ratings of headaches, as well as a (statistically uncorrected) decrease in symptoms of fatigue, trouble falling asleep, difficulty remembering, and numbness or tingling. No seizure events or serious side effects were reported. Nine out of twelve patients found 110% MT stimulation to be intolerable in the first session, but all patients tolerated this intensity by the sixth session following gradual intensity increases. fMRI scans demonstrated greater activations in DLPFC and greater deactivation of the rostral ACC during a working memory task following the last session compared to pre-treatment. Results of a 3-month follow-up with some patients indicate that maintenance treatments may be required to sustain the observed gains.\nOUTPUT:" }, { "from": "agent", "value": "Traumatic Brain Injury, Anosognosia, Executive Dysfunction, Behavioral Changes, Post-Concussion 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 58-year-old woman with a five-year history of a right-sided mass at the angle of the mandible sought evaluation after noting a recent increase in size with discoloration of the overlying skin. CT scan of the neck showed a mass measuring 3.2 x 2.9 cm involving the superficial lobe of the right parotid gland. Fine needle aspiration findings were consistent with a cystic lesion. On surgical evaluation, the tumor was found to be partially superficial and deep to the facial nerve branches. These were identified, dissected, and preserved while resecting the mass. Final pathology would confirm the frozen section diagnosis. The mass defect was reconstructed using a level I and II lymphofatty packet of tissue mobilized off the posterior aspect of the submandibular gland and SCM, advanced posteriorly and superiorly, and secured to the parotid fascia. Surgical technique for volume reconstruction was performed similarly for both cases (Figure 1). The lymphoadipose tissue of levels I and II within the neck was mobilized from the mandible, marginal mandibular nerve, sternocleidomastoid muscle, spinal accessory nerve, and the submandibular gland. Vascular supply to this tissue was preserved from the occipital and facial vessels. This fibrofatty tissue was then rotated into the parotid defect and secured in place to the parotid fascia. With satisfactory volume restoration, the wound was then closed in a layered fashion (Figure 2). In essence, the surgical steps of elevating and mobilizing the tissue flap are very similar to the initial steps of a neck dissection in level II. On three- and five-month postoperative follow-up, the patients were noted to have durable volume reconstruction with excellent contour of the parotid region (Figure 3).\nOUTPUT:" }, { "from": "agent", "value": "Papillary cystadenoma lymphomatosum 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 75-year-old patient was examined for hyperacusis in the left ear (LE) and sudden-onset intermittent pulsatile tinnitus. He also described rotatory vertigo triggered by loud noises. The physical examination, including otoscopy, was normal. cVEMPs showed a greater response on the LE, where the thresholds were at 80 dB nHL. The HRCT confirmed the presence of a left SSCD (Type I OCD; Figures 3B, C). Unfortunately, the hearing thresholds on the operated side increased to 80 dB nHL on all frequencies after the operation and did not improve. 10 months after surgery, after a period of improvement, the patient described a recurrence of rotatory vertigo and pulsatile tinnitus. Postoperative 3D magnetic resonance imaging (MRI) confirmed the expected absence of an endolymphatic signal, proving that the left SSC was rightly plugged (Figure 3D). When reviewing the postoperative HRCT control, two Type III OCDs could be observed: one involving the LSC and tympanic segment of the FN (LSC/FN) (Figures 3C, G), unknown in the literature at the time of the surgery, and a second dehiscence near the operated area probably due to the drilling during mastoidectomy (Figures 3D, F). The patient was lost to follow-up.\nOUTPUT:" }, { "from": "agent", "value": "Superior semicircular canal dehiscence, Bilateral sensorineural hearing loss, Left vestibular hypofunction" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 62-year-old female presented to the office complaining of bilateral groin pain that developed 8 months prior to presentation. The patient sought medical consultation at another facility and a radiographic evaluation was conducted revealing negative findings. Symptomatic treatment was prescribed with no improvement. Her past medical history included a homozygote pseudocholinesterase deficiency, a gastric banding 15 years ago, followed by an MGB-OAGB 5 years back. The patient discontinued her prescribed multivitamins 5 years ago. Her body mass index (BMI) at presentation was 25.43 kg/m2. The pain was described as being sharp, intermittent, and radiating to the anterior thigh with no accompanying paresthesia or muscle weakness. It increased in severity with time and activity, especially upon weight bearing and was rated 7/10 using the Visual Analog Scale (VAS). Physical examination revealed bilateral groin pain on ambulation and tenderness on palpation. Patient had a normal active and passive hip range of motion bilaterally with normal lower extremity neurovascular examination. A mild periosteal reaction was observed, mainly on the left side, with medial sclerosis surrounding the fracture line (Figure 1). Following clinical and radiological findings, a serum blood test was ordered to rule out bone metabolism abnormalities. Patient was noted to have a vitamin D level of 6 [30-60 ng/mL] and Parathyroid Hormone (PTH) of 395 [15-65 pg/mL]. Sedimentation rate, C-reactive protein, thyroid stimulating hormone (TSH), Calcium, and Phosphorus levels were within the normal range. A parathyroid scintigraphy ordered to rule out a parathyroid adenoma was negative. The patient was treated with bilateral prophylactic surgical fixation using short cephalomedullary nails. A full weight bearing postoperative protocol was implemented (Figure 3). Patient was followed-up at 3 weeks, 6 weeks, and 3 months with complete resolution of symptoms.\nOUTPUT:" }, { "from": "agent", "value": "Bilateral subtrochanteric insufficiency fracture, Secondary hyperparathyroidism caused by vitamin D deficiency" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: He presented a syncope and multiple episodes of ventricular tachycardia with a left-bundle branch block morphology and therefore was implanted with an internal cardiac defibrillator. By intracardiac ultrasound a focal aneurysm of the antero-septal wall of RVOT was identified, corresponding with that of contrast-enhanced computed tomography. Absence of trabeculations in the RVOT could be demonstrated at this level (Fig. 1). Catheter ablation of the right ventricular VT was performed with no-inducibility at the end of the procedure by programmed ventricular stimulation. There were no femoral or cardiac post-procedural complications. The ESC diagnosis of ARVD/C is based on morphological and functional changes of the right ventricle. In early stages patients are often asymptomatic but with a risk of death during effort which is still present. In late stages patients present symptomatic arrhythmias and structural changes of the right ventricle and RVOT are present. Structural changes include presence of aneurysm or motion abnormalities, and segmental or global dilation of the right ventricle. Transthoracic echocardiography is the first line imaging technique but it has a low ability to demonstrate localized RVOT aneurysm. The 'gold standard' in the diagnosis is selective right ventricular angiography, but tissue characterization is not possible with this technique. From a pathological point of view it is known that loss of trabeculations is a typical finding in patients with ARVD/C. Our report indicates that intracardiac ultrasound can demonstrate focal absence of trabeculations which adds additional value for ARVD/C diagnosis.\nOUTPUT:" }, { "from": "agent", "value": "Arrhythmogenic right ventricular cardiomyopathy/dysplasia, Focal aneurysm of the right ventricular outflow tract" } ]

[ { "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 on a 20- year-old healthy male, who presented at the surgical emergency department complaining about pain at the left forearm and wrist ensuing a fall from his motorcycle without third party interference. The patient reported of an initial driving speed of 10-20 mph. Helmet and protective clothing was worn. Due to the anamnestic information and clinical examination an x-ray of the left hand and forearm was performed. It showed no pathologic results (Fig. 1). With respect to the clinical suspicion of an osseous injury to the left wrist, positive fovea ulnaris sign and Triangular Fibro- Cartilage Complex (TFCC) load test, an additional computed-tomography was initiated. 2, Fig. 3). The patient got an outpatient treatment immobilized by an intrinsic plus forearm cast and an appointment for a clinical 1- week follow-up was scheduled. By this point, local examination showed a moderate swelling of the wrist. He described slight pain of the ulnar wrist and forearm. Due to this, the pronation and ulnar deviation was compromised. The patient was treated with a closed forearm brace for another 4 weeks under avoidance of supination and pronation. He was seen again 5 weeks after trauma denying any pain. Neither swelling, nor instability of the DRUJ was eminent. Painless range of motion with solely terminal limitations (pro-/ supination 85/0/85 , dorsal extension/ palmar flexion 35/0/50 , radial abduction/ ulnar abduction 25/0/30 ). A performed x-ray of the left wrist showed no secondary dislocation. The patient was discharged with the proviso of full weight bearing and free range of motion. Following a planned outpatient MRI of the wrist a 10- week follow- up of the patient showed no significant changes of the results. The MRI revealed the integrity of the TFCC and an osseous consolidation of the fracture with a persistent bone marrow edema (Fig. 4). No further follow-up has been scheduled.\nOUTPUT:" }, { "from": "agent", "value": "Isolated distal, non-displaced, intraarticular ulna 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: In our case PTC was metachronous and not therapy related. This is verified by the fact that the patient did not receive etoposide or high doses of methotrexate, or local radiotherapy. The radiation exposure was minimal; only two X-rays were performed at diagnosis, while imaging of the head was performed with MRI and no CT-scans. Therefore, a causative relationship is highly unlikely. More specifically, a 9-year-old boy, with low risk [RO-]LCH, V600E BRAF mutation positive, received vinblastine/prednisolone according to the LCH III protocol, and achieved remission. Four years following diagnosis of LCH, in the routine follow-up, an 8 mm lesion was revealed in the thyroid gland by ultrasound. No information exists on the V600E BRAF mutation status from the LCH cases co-existing with PTC. In our case, the LCH sample was positive for the V600EBRAF mutation, while the PTC was negative for the mutation. It is possible that LCH and PTC share a common determinant, despite the different BRAF mutation status, as approximately half of the reported cases of LCH are negative for the mutation and only around half of the reported PTCs are positive for the mutation . The role of the V600E BRAF mutation is currently unknown. One could speculate that, since the LCH has been shown to increase the expression of T-helper type 2 cytokines, the presence of the V600E BRAF mutation could exacerbate this defect in LCH cytokine regulation. Thus, the particular oncogene might be eliciting an inflammatory pro-tumorigenic microenvironment, possibly linking the LCH-induced deregulated immunologic cascade to neoplastic transformation. It would be of great interest to have more information on the BRAF mutation status from cases of LCH co-existing with PTC, as it would help to elucidate the role of V600E BRAF mutation in PTC development. Thus, routine evaluation of the thyroid gland at diagnosis and during follow-up should be considered. Further research is needed to understand the association of LCH with PTC, as well as the molecular and immunological basis for this tropism to the thyroid gland.\nOUTPUT:" }, { "from": "agent", "value": "Langerhans cell histiocytosis, 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: The first case was a 64-year-old female admitted with an initial symptom of dyspnea (body Mass Index (BMI) = 33 kg/m2). The vital signs upon admission were as follows: Blood pressure (BP) = 125/75 mmHg, O2 saturation (O2Sat) = 82% (in room air), respiratory rate (RR) =24/minute and heart rate (HR) = 125/minute. The patient's disease history included diabetes and her drug history comprised of Lithium, olanzapine and sodium valproate. On day 4 of admission, the patient experienced a sudden drop in BP, with the systolic BP reaching 55 mmHg, and O2 Saturation reducing to 70-75%, she also had severe dyspnea. At this time the creatinine level of the patient was 1.8mg/dL. The CT angiography revealed severe right ventricular (RV) dilation and massive PTE (Figure 1). Meanwhile, echocardiography showed severe RV dilation, pulmonary artery systolic pressure (PASP) of about 65mmHg and McConnell's sign. Heparin and Alteplase treatment were immediately started for the patient with a dose of 100mg in two hours. After two hours, the BP was measured, which had reached 110/75 mmHg. The echocardiography performed after the treatment revealed resolution of McConnell's sign and severe RV dilation, and showed a PASP of about 40mmHg. During the following four days, patient's overall status improved and her O2Sat reached normal levels. The patient was discharged seven days after the anticoagulant treatment, with further oral prescriptions. Case 2\nOUTPUT:" }, { "from": "agent", "value": "Massive Pulmonary Thromboembolism, 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: A 63-year-old male presented with diplopia, dizziness and headache. He was undergoing hemodialysis due to end-stage renal disease caused by hypertension and had undergone about 40 months of maintenance hemodialysis via an AVG in his left forearm. The ophthalmological examination revealed severe left conjunctival congestion. His history and physical examination as well as routine laboratory test values were unremarkable except for renal dysfunction. Angiography showed severe segmental stenosis of the anastomotic site between the graft and left internal jugular vein. Also there was a backward blood flow from the left internal jugular vein and the flow drained into the right internal jugular vein through the right dural venous sinuses (Fig. 1A). Brain MRI and MR angiography (MRA) showed a time-of-flight (TOF) signal in the intracranial sinuses including the left sigmoid sinus and left cavernous sinus and also the left superior ophthalmic vein (Fig. 1B) without cavernous sinus bulging. A dilated left superior ophthalmic vein was also seen with flow void on T2-weighted imaging (Fig. 1B). No other remarkable findings that could cause the neurological symptoms were seen in the other images. Percutaneous transluminal angioplasty (PTA) with balloon dilatation and stent placement was performed for stenosis of the graft-left internal jugular vein anastomotic site. The post-stent digital subtraction angiography showed no residual stenosis with mild residual retrograde blood flow along the left internal jugular vein (Fig. 1C). Two weeks after the procedure, the patient's symptoms including diplopia, dizziness, and headache were improved. A follow-up brain MRI was performed three months after the procedure. The TOF signal in the intracranial sinuses and left superior ophthalmic vein had disappeared (Fig. 1D). The patient has been undergoing regular follow-ups at an outpatient clinic without neurologic symptoms. This study received an ethical review exemption from the Institutional Review Board of author's institution and the requirement for informed consent was waived (IRB No. SCHUH 2021-02-015).\nOUTPUT:" }, { "from": "agent", "value": "Cerebral Venous 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: A 25-year-old female with pain and swelling of the right ankle and no history of trauma reported to our outpatient clinic. Past medical history was unremarkable. Eight years ago, she noticed a painless posteromedial ankle swelling. Four years ago, she noticed occasional pain and increased swelling of the ankle during and after running, which resolved with rest. Over time, the pain started occurring while walking and occasionally during the night, which would wake her up from sleep. The American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score was 48, while visual analogue scale (VAS) for pain was 3 while resting and 8 in movement. Physical examination revealed painful posteromedial ankle swelling (Figure 1). Standing up on toes provoked pain in the right ankle. There were no noticeable skin changes. The normal range of motion in the ankle was observed, with no signs of ankle instability or impingement. There were no signs of neurovascular impairment, with negative Tinel's sign. On plain lateral radiographs, the obliteration of the Kager's fat pad was observed, with no bony deformities or malalignment. On MRI, the presence of ASM was revealed, which had a muscular insertion on the medial side of the calcaneus. As the symptoms progressed, surgery was scheduled. The procedure was performed under spinal anesthesia in a supine position with the use of a tourniquet. The incision was made just medial to the Achilles tendon proximally and extended down to the proximal border of the tarsal tunnel (Figure 2). ASM was identified, bluntly dissected, and completely resected. Histopathologic analysis confirmed that the resected specimen was a skeletal muscle. Non-weight-bearing walk with two crutches was recommended for the first two weeks. After that, weight-bearing, as tolerated, was allowed in conjunction with recommended range-of-motion exercise of the ankle. Gradual return to daily activities was permitted ten weeks after the surgery. At the final follow-up six months after the surgery, the patient showed significant improvement with no complications or recurrence of symptoms and has returned to her previous level of activity. The AOFAS Ankle-Hindfoot score was 90, while VAS for pain was 0 while resting and 2 in movement.\nOUTPUT:" }, { "from": "agent", "value": "Accessory Soleus Muscle" } ]

[ { "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 contrast-enhanced CT scan (CECT) of the chest done elsewhere revealed an aberrant right subclavian artery [Figure 1]. A 256 slice CECT scan was ordered in our hospital for the exact anatomical characterization of the aberrant vessel. The scan showed an aberrant origin of the right subclavian artery from the medial wall of the descending thoracic aorta, just distal to the origin of the left subclavian artery [Figures 2 and 3]. The artery crossed to the right side at the level of the fourth thoracic vertebra, causing posterior compression of the esophagus. An additional finding that was noted was the common origin of the right and left common carotid arteries. The arch was left-sided, with a left descending thoracic aorta. Under general anesthesia a median sternotomy was performed. The arch was followed down from the top and the aberrant right subclavian artery was identified just distal to the origin of the left subclavian artery on the medial wall of the descending thoracic aorta. Loss of the right radial artery trace on clamping the aberrant vessel confirmed that the vessel was indeed the right subclavian artery. The artery was carefully divided at its site of origin and the aortic end oversewn with two layers of continuous polypropylene sutures. The artery was next brought to the right side from behind the esophagus and the anastomosed end side to the right common carotid artery, after confirming that there was no torsion of the mobilized vessel [Figure 4]. Pericardial patch closure of the ostium secundum ASD was performed in a routine manner, under cardiopulmonary bypass, under mild hypothermia using the standard cannulation techniques. The patient had an uneventful postoperative course and was discharged on day six from the hospital.\nOUTPUT:" }, { "from": "agent", "value": "Dysphagia Lusoria, Atrial Septal Defect" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 52-year-old woman with a not better-specified history of thoracic great vessel malformation presented to the emergency department upon indication of her primary care physician. She referred to experiencing pain in the chest and right upper limb since the last 10 months, more intense in the last days. Because of her history and the intensification of symptoms, she underwent an ECG-synchronized computed tomography angiogram (CTA) of the heart and thoracic aorta and a subsequent, not ECG-synchronized scan extended from brain to pelvis to exclude other vessels malformations. Arterial duct appeared fibrotic and partially calcified [Figure 1 and 2A]. The thoracic descending aorta was bilaterally refilled, distally to interruption, by collaterals of subclavian arteries arisen after vertebral arteries origin [Figure 2B]. Both collateral arteries presented proximal voluminous aneurysms, the biggest on the right side with endoluminal dissection flap [Figures 2B and 3A] and at least three on the left side [Figure 2A]. Collateral circulation was evident from the internal mammary artery, in particular, the left one [Figure 2A and B]. Aortic root showed a bicuspid aortic valve morphology [Figure 3C] with thick and calcified valvular flaps and an enlargement of the tubular segment of the ascending thoracic aorta [Figure 3B] was reported. No other aneurysm was detected in the rest of the body.\nOUTPUT:" }, { "from": "agent", "value": "Interrupted aortic arch" } ]

[ { "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 treated with neoadjuvant chemotherapy and radiation therapy that lasted three months following which she underwent low anterior resection with ileostomy that was followed by adjuvant chemotherapy. Following the completion of her chemotherapy she underwent secondary anastomosis (ileoanal Hartmann's pouch anastomosis). She had a double J catheter placed, and additional chemotherapy was started, with no success, however, in controlling her disease. Given the poor response to many lines of chemotherapy and the poor outcome associated with her disease, she was transferred to palliative care for best supportive care. The patient's overall prognosis was discussed with her in details, and she elected to have a \"do not resuscitate\" (DNR) status. A few weeks later, she was admitted in order to control her increasing pain with intravenous narcotic infusion. During her hospital stay and while on LMWH, she developed hematuria; urine analysis showed numerous red blood cells and 20 white blood cells, and the urine culture was positive for Escherichia coli for which she was treated with antibiotics. Microscopic hematuria continued, and the primary team planned insertion of an inferior vena cava (IVC) filter.\nOUTPUT:" }, { "from": "agent", "value": "Rectal cancer, Disease recurrence in retroperitoneal lymph nodes, Sacral mass, Iliofemoral deep vein thrombosis (DVT), Disease progression in para-aortic lymph nodes, Right hydronephrosis, Adrenal metastasis, Large destructive mass lesion involving the S1-S2 segment" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 22-year-old healthy male came to Haruka Community Pharmacy. Although he was not in a diseased state, he was found to have a moderately high BP during a medical examination at his university. He was not a shift worker, and had normal sleeping patterns. The community pharmacist recommended that he check his HBPM regularly, and hence, he began HBPM. The home BP telemonitoring system involved the use of Medical LINK (Omron Healthcare Co., Ltd., Muko, Kyoto, Japan). This system wirelessly transmits BP data to a central web server via a mobile network. The community pharmacist can examine the patient's BP data at any time via the Internet. The pharmacist advised the patient to measure his BP twice per day (when he wakes up and before he goes to bed), and gave him a printed handout outlining the importance of lifestyle modification before starting BP monitoring. A pharmacist intervention was conducted every two weeks during the monitoring period. Briefly, the pharmacist collected information regarding his lifestyle from an interview, and advised him about lifestyle modification. Home BP telemonitoring was continued for a period of 28 days. The average values of the patient's systolic and diastolic BPs are shown in Figure 1. Although the frequency of measuring his BP at home was 85.7% before the monitoring period (data not shown), it was increased to 96.4% afterward (Figure 1). The mean values for daytime and nighttime systolic blood pressures were 131 mmHg and 137 mmHg, respectively, and diastolic blood pressure was 78 mmHg. The average nighttime systolic BP was higher than that of the daytime BP (Figure 2). The pharmacist consulted a physician based on the results of BP telemonitoring, and ABPM was conducted. BP was measured for a 24-hour period using an FB-270 device (Fukuda Denshi Co., Ltd., Tokyo, Japan). The BP values during ABPM are shown in Figure 3. \"Nighttime\" was defined as the patient's actual sleeping time, based on his diary. The mean daytime and nighttime BP were 135/80 mmHg and 120/73 mmHg, respectively.\nOUTPUT:" }, { "from": "agent", "value": "Nocturnal 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: CT of the head and neck showed no intracranial haemorrhage or mass lesions. Fluid-attenuated inversion recovery (FLAIR) images from brain MRI revealed extensive confluent pontine and middle cerebellar peduncle oedema with effacement of the fourth ventricle. Extensive but less confluent vasogenic oedema was seen in the supratentorial brain, predominantly frontally (figure 1). Susceptibility weighted imaging (SWI) demonstrated numerous thalamic, callosal and subcortical white matter micro-haemorrhages (figure 2). Magnetic resonance angiography confirmed the absence of vasoconstriction and occlusion, and the results of thoraco-abdominal CT, abdominal MRI and renal vascular ultrasound sonography were unremarkable. Anaemia was recognised as a secondary haemolytic phenomenon. The RBC and platelet depletion, elevated LDH and total indirect bilirubin levels, decreased haptoglobin levels and the presence of schistocytes in a smear of peripheral blood prompted suspicion of TMA. MH was identified as the likely direct cause of TMA. Hyperaldosteronism was considered since the patient was hypokalaemic at admission. However, plasma renin activity, serum aldosterone, morning cortisol, serum metanephrine and serum normetanephrine levels were within the normal ranges, and analysis of 24-hour urine samples also revealed normal levels of catecholamine and its metabolites. As a result, endocrine disorders were considered unlikely.\nOUTPUT:" }, { "from": "agent", "value": "Posterior reversible encephalopathy syndrome, Thrombotic microangiopathy, Malignant 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: A 52-year-old male presented complaining of dysphagia in both solid food and liquids for the last fifteen days. Tumor markers were CEA 55 mlU/mL and Ca 19-9 854 IU/mL. The patient was fit for major surgery, and palliative operative approach was decided due to possible disseminated disease. The presence of a pheochromocytoma was excluded measuring urine vinyl-mandelic acid (VMA) levels, which were normal. The patient was discharged on the 16th postoperative day, because of postoperative pneumonia, which was treated with intravenous antibiotics. In his follow-up visits, the patient remains disease-free eighteen months later.\nOUTPUT:" }, { "from": "agent", "value": "Esophageal adenocarcinoma, Adrenal metastasis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 21-year-old male who is an avid sportsman presented to the emergency department with a 3-day history of pain and swelling of the right upper limb. He had joined a gym club three months prior where he partakes in weightlifting. His only past medical history was COVID-19 12 months prior. He had no family history of thromboembolic disease. His examination revealed a swollen and erythematous right upper limb. His peripheral pulses were palpable and comparable to the opposite side. His range of movements were intact. The left upper limb and both lower limbs were normal. He had no symptoms of pulmonary embolism. Right upper limb POCUS was concerning for subclavian vein thrombus with a distended right subclavian vein. The findings are demonstrated in Figures 1-3 and corresponding Videos S1-S3. Blood work up revealed a non-negative D-dimer at 0.93 mg/l (reference range <0.50mg/l). His chest x-ray showed no obvious abnormalities, and no evidence of an accessory rib. Once the diagnosis of subclavian vein thrombosis was made, low-molecular-weight heparin was initiated, and he was admitted under General Medicine. An urgent formal ultrasound confirmed an acute 6 cm thrombus within the right subclavian vein . Furthermore, it showed normal compressibility and colour flow within the right basilic vein, brachial vein, cephalic vein and axillary vein without any evidence of thrombosis. The patient underwent thrombectomy and venoplasty by Interventional Radiology the next day due to severity of symptoms, followed with anticoagulation. These are demonstrated in Figures 4-6. Video S4 shows the initial digital subtraction venogram from the right arm which demonstrates thrombotic occlusion of the right subclavian vein with collateralization. He was initially treated with Low Molecular Weight Heparin (LMWH), then switched to Apixaban. The IR venogram showed an acute thrombotic occlusion of the right subclavian vein with a high-grade stenosis at the junction of the first rib and clavicle. He was discharged on anticoagulation and is being followed up for consideration of a first rib resection. The importance of POCUS in this case is demonstrated through the 1-day turnaround between diagnosis and interventional treatment.\nOUTPUT:" }, { "from": "agent", "value": "Paget-Schroetter 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 27-year-old multiparous patient presented to labor and delivery at 38 weeks of gestation for evaluation of sudden onset, left upper quadrant pain that radiated to the midline. The patient also reported regular, painful contractions. She had a past medical history significant for nephrolithiasis during her previous pregnancy, bipolar disease, and migraines. Prior surgeries included a diagnostic laparoscopy for chronic pelvic pain, Loop Electrosurgical Excision Procedure, and 2 elective terminations of pregnancy. The patient was a 5-6-cigarette/day smoker. On admission vital signs were within normal limits. Physical examination revealed her abdomen to be soft and minimally tender to palpation. A complete blood count was within normal limits with a hemoglobin of 12.4 g/dL. A urine drug screen was negative and a urinalysis revealed no blood or evidence of infection. Fetal status was reassuring and an obstetric ultrasound revealed no apparent pathology. The patient's pain improved with intravenous narcotics, antacids, and a muscle relaxer and was attributed to a likely musculoskeletal etiology. However, the patient was found to be in spontaneous labor and progressed to deliver a male infant without complication. Intrapartum pain relief was provided via epidural. On the first postpartum day the patient again complained of left sided flank and upper abdominal pain and was presumptively treated for nephrolithiasis, given the clinical presentation and history, with intravenous narcotics and hydration. Despite treatment, the pain worsened and was associated with nausea and two episodes of emesis. An MRI performed at the request of the attending physician confirmed these findings as seen in Figure 2. She denied any trauma or use of anticoagulants. Total cortisol level was normal at 14.7 ug/dL with a low ACTH of 5.0 pg/mL. The patient was monitored with serial assessments of hemoglobin and remained clinically and hemodynamically stable. Her pain was controlled with intravenous narcotics. She was discharged on postpartum day 4 with a plan for short interval follow-up.\nOUTPUT:" }, { "from": "agent", "value": "Spontaneous Adrenal Hemorrhage" } ]

[ { "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 underwent oral antibiotic therapy with metronidazole for 7 days postoperatively. In October 2019, a diagnostic hysteroscopy was conducted and revealed a posterior uterine myoma and no intrauterine adhesions. Subsequently, the patient complained of abdominal pain, which led to multiple gynecological consultations. In December 2019, she underwent oral antibiotic therapy with metronidazole and co-amoxicillin for 7 days for suspicion of endometritis. The patient felt no clinical improvement and consulted twice again for abdominal pain and metrorrhagia. In early February 2020, after 4 months of persistent abdominal pain, she presented in our institution because a carbuncle in her right iliac fossa had appeared (Figure 1). She also reported an increased abdominal pain, metrorrhagia, and purulent vaginal discharge. She complained of inappetence and an involuntary 8 kg weight loss during the last 2 months. She was hemodynamically stable and had no fever. Laboratory findings showed leukocytosis (13.7 G/L), elevated c-reactive protein (244 mg/L), and anemia (hemoglobin 87 g/L). The patient received IV antibiotic therapy. As she was in favor of a radical treatment, a total hysterectomy with bilateral salpingectomy by midline laparotomy was performed. The bacteriological analyses identified an Enterococcus faecalis strain that was sensitive to co-amoxicillin. The antibiotic therapy was pursued for a total of 14 days with a favorable clinical evolution. The patient was discharged 9 days after surgery. Two months after, she was treated conservatively for bartholinitis. In May 2020, she was evaluated by our general surgeon for a possible right abdominal wall reinforcement. The results of a CT scan showed no need of further surgery.\nOUTPUT:" }, { "from": "agent", "value": "Uterocutaneous Fistula, Second Trimester Fetal Demise, Chorioamnionitis" } ]

[ { "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 man in his early 60s with a history of hypertension, according to him for \"years,\" presented with mild chest discomfort since eight months, which he attributed to his intense weightlifting regimen. He had mild retrosternal pain (4/10) radiating to both arms, which was aggravated by physical activity and relieved with rest. The patient was not taking the prescribed blood pressure medication, as he was noncompliant. Upon physical examination, his right arm blood pressure was 152/68 mm Hg, and his left arm pressure was 167/62 mm Hg, with a heart rate of 55/minute. Further examination detected a grade III/VI systolic and IV/VI diastolic murmur. Radial pulses were stronger on the left than on the right, while pedal pulses were equally bilateral. An electrocardiogram (ECG) revealed sinus bradycardia with nonspecific T-wave abnormality; a chest X-ray noted a widened mediastinum. The patient was treated with labetalol, and surgical consultation was obtained. During surgery, an 8-cm wide section of the aorta with an intimal tear and atheroma was noted. Postsurgical TTE revealed a normal ejection fraction, as well as resolution of the AR. The patient was discharged in stable condition after four days of hospitalization.\nOUTPUT:" }, { "from": "agent", "value": "Thoracic Aortic 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: A six-year-old boy presented with symptoms that included shock-like jerky movements of the limbs, inability to hold his neck, functional urinary incontinence, and dependence on the mother for most daily activities. There was no visual deficit, with normal ophthalmoscopic examination. A physical examination revealed hypertonicity and hyperreflexes in both upper and lower limbs with a positive Babinski sign. He was unable to speak but otherwise appeared to have normal intellectual ability. The other child of the same parent was observed to be normal. Initially, the patient's mother found a defective suckling of milk at birth, which was compensated by bottle feed and weaning. The milestones were normal until the age of two when the patient developed fever associated with seizures. This episode of seizure was misdiagnosed as a common febrile seizure. After this episode there was progressive spastic tetraparesis that made him unable to walk, talk, and caused difficulty in swallowing. The patient was reported to suffer from approximately twenty episodes of seizures a day. He had great difficulty in swallowing and had to be fed only a semi-solid and liquid diet. A brain magnetic resonance imaging (MRI) showed demyelination in the brain stem and cerebellum. A brain magnetic resonance (MR) spectroscopy revealed elevated myo-inositol and choline-containing compounds with decreased N-aspartyl aspartate in the affected white matter area, and the grey matter showed neuronal degeneration. The patient was advised to undergo physiotherapy to help maintain muscle tone and circulation. Cerebrospinal fluid evaluation, electroencephalography (EEG), and electromyography (EMG) tests could not be performed due to patient's concerns. The patient was prescibed anticonvulsant drugs to minimize the seizure episodes and drugs to ease muscle spasticity.\nOUTPUT:" }, { "from": "agent", "value": "Krabbe 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 patient was a full-term baby boy born via normal spontaneous vaginal delivery. His birth weight was 2.718 kg, and the Apgar score was 9 and 10 at 1 min and 5 min, respectively. He was born to consanguineous parents and did not have a family history of hematological disease or similar conditions. At 2 h after delivery, he developed tachypnea, bradycardia, and oxygen desaturation, and he was shifted to the neonatal intensive care unit. The neonate had oliguria in the first 24 h of life, and he also had one episode of epistaxis. Blood-stained urine was observed in the urine catheter, and a coffee-ground-colored fluid was drained from the orogastric tube. Complete blood count performed at the age of 2 h revealed a platelet count of <8.5 (according to both automated and manual examination), a white blood cell count of 36.40 x 109/L, a hemoglobin level of 21.7 g/dl, and a hematocrit value of 63.9%. Based on a consultation with a hematologist, TTP was suspected due to unexplained thrombocytopenia. A full septic workup was carried out, and based on the findings, he was intravenously administered antibiotics. The patient's lactic acid level was 3.2 mmol/L, and his bone profile was normal. Furthermore, the total bilirubin level was 348.4 micromol/L, and renal function profile showed that his urea level was 8.2 mmol/L (which is higher than normal for his age) and creatinine level was 178 micromol/L (which is also much higher than normal for his age). Two days later, abdominal distention was noticed. Abdominal radiography showed the presence of a large pneumoperitoneum along with spontaneous gastric perforation. An urgent pediatric surgery consultation was requested, and total gastrectomy and feeding jejunostomy were performed. Histopathological analysis revealed gastric perforation with features of ischemic insult.\nOUTPUT:" }, { "from": "agent", "value": "Congenital Thrombotic Thrombocytopenic Purpura, Mesenteric Ischemia" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: An 18-year-old female was diagnosed with HCM at the age of nine. She presented with recurrent syncope. At that time, her 12-lead electrocardiogram (ECG) showed sinus rhythm, Q-waves and negative T-waves in leads V5 and V6 with a QRS duration < 120 ms. [Figure 1, left panel]. Her first degree relatives were screened with ECG and echocardiogram, however, no phenotypic HCM was found. The patient remained asymptomatic under treatment with atenolol 50 mg/day for 7 years, when she suffered a cardiac arrest following an episode of emotional stress. Resuscitation was initiated by her mother, and continued by paramedics. [Figure 1, right panel] A dual chamber ICD (Maximo DR 7278, Medtronic, Inc, MN, USA) was implanted. The patient was discharged and treated with atenolol 50 mg twice a day. Atenolol dose was increased and the patient has remained asymptomatic since the last six months.\nOUTPUT:" }, { "from": "agent", "value": "Hypertrophic Cardiomyopathy, Malignant Arrhythmias, Ventricular Fibrillation, Ventricular Tachycardia" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: At the gestational age of 32 5/7 weeks, she presented with sudden onset of hypertonic uterus, abdominal discomfort, hypotension, and shortness of breath (oxygen saturation 90%). An emergency cesarean was performed. The laboratory test results showed hemoglobin electrophoresis of S 51%, C 47.5%, and F 1.5%, hemoglobin 8.4 g/dL, white blood cell count (WBCC) 34.3x109/L, platelet count 142,000/mm3, alanine aminotransferase (ALT) 35 U/L, aspartate aminotransferase (AST) 54 U/L, total bilirubin 1.5 mg/dL, and lactate dehydrogenase (LDH) 791 U/L. The patient was transferred to the ICU immediately post-cesarean, where examination revealed that the uterus was contracted and without abnormal bleeding. At the fifth hour post-partum, she presented with bradycardia and hypotension. An intravenous infusion of vasoactive drugs and broad-spectrum antibiotics were administered. A red blood cell transfusion was performed. At the tenth hour post-cesarean, she presented with cardiovascular shock, bradycardia, hypotension, and cardiac arrest.\nOUTPUT:" }, { "from": "agent", "value": "Acute chest syndrome, Hemoglobin SC disease, Preeclampsia, Fetal growth restriction, Placental abruption, Diffuse hypokinesis of the right ventricle with dilatation of the right chambers, Bone marrow pulmonary emboli" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 46-year-old man, who was earlier in sinus rhythm, presented with anginal type of chest pain of three hours duration. The electrocardiogram recorded in emergency room (ER) is shown in Figure 1. The varying atrioventricular block results in long-short cycle sequences that are followed by QRS complexes with increased width (130 msec) (indicated by * in Figure 1).. The long-short cycle sequence predisposes to both aberrant conduction as well as VPB. The absence of longer returning cycle following the wide QRS beats points to probable diagnosis of aberrancy. But, the relatively fixed coupling interval of 640 - 680 msec, reversal of the \"rabbit ears\" in the wide QRS beats in V1 (RSr' instead of rSR') and the R/S ratio of < 1 in V6 argue against the diagnosis of Ashman's phenomenon. As the fast, irregular ventricular response aggravates myocardial ischemia, reverting to sinus rhythm is mandatory. The patient also requires reperfusion of the infarct related coronary artery at the earliest. He underwent successful fibrinolysis and electrical cardioversion to sinus rhythm. Post cardioversion he was started on oral beta-blocker therapy. The further in hospital course was uneventful and he continued to be in sinus rhythm at 4 months of follow-up.\nOUTPUT:" }, { "from": "agent", "value": "Inferior wall myocardial infarction, Atrial fibrillation, Ventricular premature beats" } ]

[ { "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 female patient was admitted to the Chair and Department of Oral Surgery in the Medical University of Lublin, complaining about a painless swelling on the hard palate. History revealed that the swelling was detected 20 years ago. The tumor was growing slowly. Intraoral examination revealed an oval-shaped, circumscribed lesion, adherent to the underlying structures, covered with slightly erythematous palatal mucosa (Fig. 1). The size of this lesion was about 2 cm in diameter. The submandibular lymph nodes on the left side were enlarged, painful and movable. The swelling extended from the mid-palatal area to the left alveolar ridge. The overlying mucosa was smooth and intact, but was stretched and thus shiny in comparison with the healthy area on the opposite site of the palate. The checkup orthopantomogram (Fig. 2) did not reveal pathological changes in the bone structures and then due to the clinical examination, outlook and the history of the disease the decision concerning surgical excision of the lesion was made. Excision of the mass was done under anesthesia (Fig. 3). The whole tumor mass was separated out with careful dissection. Mucosa around the lesion was marked and incised using the surgical blade. Then the wide dissection was performed and the whole encapsulated tumor mass was excised (Fig. 4) along with the mucoperiosteum and the eroded bone of the palate with the boundary line localized in the surrounding healthy tissue (Fig. 5). Hemostasis was achieved by use of electrosurgery. The oro-antral communication that came into existence after the dissection of the tumor was supplied with plastic surgery by the Wassmund-Borusiewicz method. The wound was sutured and the mass sent for histopathological examination. The patient's postoperative course was uneventful. No recurrence was observed after a follow-up of 1.5 years.\nOUTPUT:" }, { "from": "agent", "value": "Pleomorphic 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 30-year-old woman was admitted at emergency department for a pathologic fracture of the left femur bone, after a mild trauma. The patient's medical history, as well as her family history were unremarkable. The physical examination showed a painful and swollen left hip with inability to move the lower limb because of the pain. Apart from these trauma-related signs, there were no fever, skin lesions, lymphadenopathy or other organomegaly. An X-ray radiograph has been performed and revealed at the traumatic site, a relatively well-limited trochanteric osteolityc lesions at the fracture's site (Fig. 1). No other lesions have been discovered. The biological check-up was within normal limits. Biopsies have been performed for histopathological evaluation. After treatment with 10% nitric acid (decalcification), the histological examination of the submitted bone biopsies showed a dense inflammatory infiltrate destroying the bone tissue (Fig. 2a). It consisted of admixed numerous plasma cells, lymphocytes, neutrophils, eosinophils and histiocytes. Prominent emperipolesis figures are seen with large histiocytes that engulf inflammatory cells such as plasma cells, neutrophils and macrophages (Fig. 2b). Beside these emperipolesis figures, there are some large histiocytes with oval nuclei and granular chromatine and inconspicuous nucleoli. Also, in some areas, scattered cells with \"bean-shaped\" and grooved nuclei are visible. At imunohistochemistry, many mononucleated cells show intense membraneous expression of CD1a, whereas giant multinucleated cells with emperipolesis stain negative (Fig. 3a). Also, some CD1a positive cells are round-shaped with oval nuclei, and a large cytoplasm, morphologically reminiscent of RDD cells (Fig. 3b). These cells have overlapping features between RDD and LCH cells, they have been called \"transitional cells\". However, both cell types express CD68 and S-100 protein (Fig. 4). Finally, the diagnosis of combined RDD and LCH has been made.\nOUTPUT:" }, { "from": "agent", "value": "Langerhans cell histiocytosis, Rosai-Dorfman 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: Her past medical history and family history were unremarkable. She had not taken any medications during her pregnancy. 1A). Fetal echocardiography showed a mesocardia, a rotation of the fetal heart with the apex of the heart located in the mid-thorax with a structurally normal heart, and no signs of cardiac compression (Fig. 1B). Left lung area to head circumference ratio was 2.54. There were no other abnormalities observed. A female infant was delivered vaginally at 39.0 weeks of gestation with a birth weight of 3,230 g and Apgar scores at 1 and 5 minutes of 6 and 9, respectively. 2). At 7 days after birth, repair of the CDH was performed. At the 15 month follow-up, the infant was doing well.\nOUTPUT:" }, { "from": "agent", "value": "Intrathoracic kidney, Right congenital diaphragmatic hernia" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 5-year-old boy, born out of non-consanguineous marriage, presented with high-grade fever and right-sided upper abdominal pain. He was admitted and received intravenous antibiotics for 14 days in a peripheral center. Now at 5 years of age, he had hepatomegaly and palmoplantar keratoderma. There was no dental abnormality. Laboratory investigations showed anemia, neutrophilic leucocytosis, high erythrocyte sedimentation rate (ESR), elevated C- reactive protein (CRP), and high serum immunoglobulins (Table 1). He was initiated on cloxacillin and vancomycin. However, he continued to have fever even after 14 days of antibiotics. Acute phase reactants were also elevated. However, the intraoperative findings revealed no drainable collection, and only organized calcified pus was noticed. The pus culture was sterile, and the biopsy revealed a fibrocollagenous tissue. In view of the persistent fever, he was initiated on oral prednisolone (1 mg/kg/day). There was prompt defervescence and normalization of acute phase reactants. Prednisolone was continued for 4 weeks and tapered off over the next 2 weeks. The targeted next-generation sequencing (invitae primary immunodeficiency gene panel) showed a novel pathogenic homozygous complex rearrangement in the CTSC gene (resulting in the deletion of exon 1, which includes the initiator codon, and exon 3). He is on follow-up for 18 months, is taking cotrimoxazole prophylaxis, and is doing well.\nOUTPUT:" }, { "from": "agent", "value": "Papillon-Lefèvre syndrome, Liver abscess" } ]

[ { "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 21-year-old gentleman was referred to us with the history of intermittent left flank pain of 2 weeks duration. He had no previous history of biliary lithiasis, alcohol consumption or abdominal surgeries. Computed tomography (CT) Kidneys, Ureter, Bladder showed a left renal pelvic calculus of 10 mm x 8 mm without any hydronephrosis [Figure 1]. No other abnormality was detected on the CT scan. His blood chemistry and urine analysis were normal. SWL (Dornier Compact Delta, Germany) was performed at 15 kv with 60 shocks per minute for a total of 2700 shock waves, using fluoroscopic guidance. Approximately 24 h after SWL, he developed severe pain in the epigastrium and peri-umbilical regions with persistent vomiting. On physical examination, he had tachycardia and was tachypnoeic. Blood pressure was 130/80 mmHg. His abdomen was distended and mild guarding in the epigastrium and periumbilical region was present. On biochemical evaluation, he had an increase in white blood cells count (17 x 103 mu/L), renal and liver function tests were within normal limits. X-ray abdomen and X-ray chest were normal. Ultrasound showed minimal peri-pancreatic fluid collection. Rest of the abdomen was normal. Serum amylase was 1165 mu/L (normal range: 30-110 mu/L) and serum lipase was 8625 mu/L (normal range 15-322). There was no evidence of pancreatic necrosis in the contrast enhanced CT scan. Blood and urine culture reports revealed no growth. He was treated conservatively with nasogastric tube insertion, bowel rest, parenteral nutrition, intravenous antibiotics and intravenous somatostatin. No residual fragment of renal calculus was found in the follow up CT scan.\nOUTPUT:" }, { "from": "agent", "value": "Acute pancreatitis, Pancreatic pseudo cyst" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The patient underwent gamma-knife treatment twice and neurosurgical resection twice within the last 2 years. The patient also received third neurosurgical resection and implantation of an Ommaya device. As shown in Figure 1a, immunohistochemistry (IHC) indicated high and homogeneous B7-H3 expression in tumor samples, with a histochemistry score of 180. Consistent with the IHC result, immunofluorescence imaging of tumor-isolated primary cells also confirmed the overexpression of B7-H3 (Figure 1b). During CAR-T-cell manufacturing and quality control testing, the tumor recurred in the neurosurgical resection cavity and left parietal-occipital lobe, as detected by magnetic resonance imaging (MRI) scanning. Forty days after the third neurosurgical treatment, the patient received the first cycle of CAR-T-cell therapy. The patient received first-round treatment following a dose-escalating principle, including three doses (cycle 1: 2 x 106 cells, cycle 2: 6 x 106 cells, and cycle 3: 1.5 x 107) of CAR-T cells through the Ommaya device. Because of the rapid invasion of the tumor in the left parietal and occipital lobes, the patient asked for a fourth neurosurgical treatment, and the surgery was performed 6 days after the third cycle CAR-T-cell treatment. After CAR-T-cell therapy, the tumor specimens were subjected to evaluation with IHC. Unfortunately, the patient exhibited expiratory dyspnoea and died of pulmonary embolism the next day after neurosurgical treatment.\nOUTPUT:" }, { "from": "agent", "value": "Anaplastic meningioma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The patient is a 71-year-old woman with a past medical history of hypertension, hyperlipidemia, type 2 diabetes mellitus, and severe aortic stenosis who underwent SAVR in August 2015. SAVR was successfully performed using a 23 mm diameter Magna bioprosthetic valve. During the surgery, antegrade cardioplegia was first administered to achieve electromechanical arrest. From this point, a dose of cold blood retrograde cardioplegia was administered to the coronary sinus every 15 minutes. The patient had an uncomplicated postoperative course and had returned to her usual lifestyle. A postoperative echocardiogram demonstrated a normal ejection fraction and a normally functioning bioprosthetic aortic valve with a mean gradient of 8-10 mmHg across the valve. The patient had been compliant with medications, including aspirin, statin, and beta-blocker. In June 2017, the patient presented with pressure-like exertional chest pain. An electrocardiogram demonstrated 1 mm ST segment depression in leads I, aVL, V2, and V3 (Figure 1). Laboratory investigations revealed elevation of the serum troponin I level to 2.3 ng/ml (normal value: less than 0.032 ng/ml). Guideline-directed medical therapy for non-ST elevation myocardial infarction (NSTEMI) was begun, and the patient was assigned to an invasive strategy. The lesion was less likely a catheter-induced spasm because (1) there was no direct catheter engagement or deep intubation of the vessel and (2) it persisted despite bolus administration of intracoronary nitroglycerin as well as continuous intravenous infusion of nitroglycerin prior to and during the procedure. Intravascular ultrasound (IVUS) could not be considered due to severity of the stenosis. The lesion was successfully treated using balloon dilations and a single 4.5 mm x 13 mm bare-metal stent (BMS) with excellent angiographic result (Figure 3). The patient was discharged from the hospital the next day without acute complications and was asymptomatic at 4 months of follow-up after the percutaneous coronary intervention (PCI).\nOUTPUT:" }, { "from": "agent", "value": "Coronary Ostial Stenosis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: He was reluctant to attend his treating psychiatrist for follow-up as he thought he was well controlled with regard to his illness. Upon difficulties procuring lorazepam over the counter, he stopped taking the drug 7 days back. He initially complained of having rebound insomnia and a few anxiety symptoms. After 7 days, there was a slowness of movement, less speaking, keeping food in the mouth for a long time before swallowing. This prompted the family members to take him to the psychiatry OPD. On examination, he was found to have rigidity, mutism, negativism, mundane posturing, and staring. BFCRS scale was applied and the score was 21. After admission, serum tests for creatine phosphokinase (CPK), electrolytes, metabolic, and biochemistry profile, and imaging of the brain with electroencephalogram (EEG) were advised. He was administered injectable lorazepam and Ryle's tube feeding. A neurological consultation referral was done and that revealed no central nervous system (CNS) abnormality. The dose of lorazepam was supervised to be under the sedative threshold. He started responding in the evening after intake of 8 mg lorazepam. It was continued and by the third day, the BFCRS score came down to 10 and he started to move, sit on the edge of the bed, and take food orally. Meanwhile, the serum and imaging reports were collected and found to be unremarkable except the serum sodium level was 130 mmol/L for which appropriate addition of salt was recommended. On the sixth day, the BFCRS score came down to zero and the serum sodium level was 139. A detailed history was taken that revealed two manic episodes without psychotic symptoms over the last two-and-a-half years with no history of substance use. His mental status examination found worriedness and inability to concentrate for a long time. Sodium valproate was re-instituted at a dose of 750 mg/day. Lorazepam was gradually tapered down to 2 mg/day over the next 4 days and he was discharged with sodium valproate 1.5 g/day and lorazepam 2 mg/day with suggestions of regular follow-up and sleep hygiene maintenance.\nOUTPUT:" }, { "from": "agent", "value": "Benzodiazepine withdrawal catatonia, Bipolar affective 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: 1A).\nOUTPUT:" }, { "from": "agent", "value": "T1DM, severe retinopathy with blindness, end-stage renal disease (ESRD) caused by diabetic nephropathy, severe hypoglycemic episodes, extensive lipoatrophy and lipohypertrophy at the insulin injection sites, hepatitis C" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 16-year-old high school student from north Tamil Nadu presented to the neurology outpatient department in April 2017 with a history of high-grade intermittent fever and holocranial headache, which was followed a day later by asymmetrical weakness in all four limbs including the bulbar muscles. Clinical examination showed exaggerated deep tendon reflexes including the jaw jerk with bilateral extensor plantar reflexes. He had an upper motor neuron type of facial involvement on his right side and expressive aphasia. His symptoms progressed and in another 3 days, he became bed bound, unable to swallow or verbalize, but was able to communicate with his parents only through eye movements and sounds. Subsequently, his sensorium worsened and he had to be intubated and mechanically ventilated. CSF showed normal counts and sugars with elevated protein. MRI showed symmetric swelling of the thalamus, hypothalamus, brainstem, and cerebellar hemispheres with areas of patchy central diffusion restriction. Also, there was diffuse spinal cord involvement showing long segment cord swelling in the cervical cord as well as in the lower thoracic cord along with conus. The electromyography showed features of motor axonopathy involving all limbs and paraspinal muscles, suggesting significant lower motor neuron involvement. Clinical diagnosis was acute necrotising encephalomyelitis with peripheral nervous system involvement. The patient was started on IV acyclovir, which was later changed to oseltamivir when he was found to be influenza H1N1-positive. He was also administered a course of IVIg (IV immunoglobulin). The patient gradually improved and was weaned off the ventilator. He underwent a rehabilitation programme and was discharged after 40 days. At the time of discharge, he was walking with one-person support and was only minimally dependent for his activities of daily living. He was followed up in our outpatient clinic. He continued to improve and had achieved a modified Rankin Score of 1 after 3 months of discharge. The first three cases were from Vellore district. They presented on 11 September 2015 (Case 1), 8 August 2015 (Case 2), and 22 September 2015 (Case 3) as shown in Figure 1 for geographical location of cases.\nOUTPUT:" }, { "from": "agent", "value": "West Nile 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: A 75-year-old patient with an active 50 pack year smoking history and COPD was initially referred for evaluation of an incidentally identified 2.3 cm left lower lobe lung nodule without mediastinal or hilar adenopathy (Fig. 1A). She underwent ENB utilizing the SPiN Thoracic Navigation System (Veran Medical Technologies, St. Louis, Missouri) with biopsies performed under fluoroscopic guidance. Surveillance imaging approximately 12 months later revealed interval development of a 7 mm right lower lobe nodule. Given the small size, this nodule was followed with serial CT imaging. Interval growth was noted and given increasing concern for malignancy, a biopsy was attempted (Fig. 1B). She underwent repeat bronchoscopy and biopsy 19.6 months after the initial procedure utilizing ENB with the super Dimension Navigation System (Medtronic, Minneapolis, Minnesota) with r-EBUS combined with fluoroscopy. 1C). Unfortunately, months later she experienced a large cerebrovascular accident and was transitioned to palliative care.\nOUTPUT:" }, { "from": "agent", "value": "Small cell carcinoma, Squamous cell carcinoma, Stage IV 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: Echocardiography demonstrated a dysynchronous and dilated left ventricle with an estimated ejection fraction of 20%. His past medical history included dialysis-dependant renal failure and chronic lymphocytic leukaemia. Repeated cannulation of his central venous system had resulted in complete occlusion of the superior vena cava (SVC) and both subclavian veins (Figure 1). A functioning right internal jugular (IJ) tunnelled dialysis line was in-situ. On the basis of comorbidities, he was deemed unsuitable for an epicardial left ventricular lead so he came forward for attempted transvenous approach. The IJ dialysis line was wired and the length of the track was sequentially dilated with 7mm and 9mm angioplasty balloons. The right subclavian vein was punctured under ultrasound guidance, wired with difficulty and eventually dilated up to 7mm (Figure 2). Recanalization of the SVC and right subclavian was achieved (Figure 3). An active fixation 6French bipolar pacing lead was sited in the right ventricular (RV) apex. A larger french defibrillation lead (for CRT-D) could not be accommodated. The coronary sinus was cannulated with a multipurpose shaped guiding catheter and a Medtronic Attain Ability LV lead advanced to the terminal portion of a lateral vein. A 5Fr passive fixation pacing lead was advanced to the right atrium. A paediatric dialysis catheter was re-sited in the right IJ vein. The final lead positions were satisfactory (Figure 4). The procedure was completed without complication. At 4 months, the patient's functional class was NYHA 2 with significant improvements in LV ejection fraction, mitral regurgitation and end diastolic dimensions (Table 1) demonstrated on echocardiography.\nOUTPUT:" }, { "from": "agent", "value": "NYHA class 3 heart failure, left bundle branch block, first degree AV node block" } ]

[ { "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 mass was hard and fixed and extended from the glans proximally up the shaft. He also had bilateral palpable inguinal lymphadenopathy. There were no associated constitutional symptoms. Given there was a high suspicion for malignancy, the patient underwent partial penectomy within a month of presentation. Following the procedure, the patient had PET-CT for staging, and imaging revealed enlarged hypermetabolic bilateral axillary lymph nodes concerning for metastatic disease. In addition, there was a large centrally necrotic lymph node conglomerate in his left groin that had increased FDG avidity. The left inguinal mass was also found to be metastatic well-differentiated SCC. His diagnosis was staged at T2N3M0. After his surgical procedures, patient was started on adjuvant chemotherapy. He began first line chemotherapy with paclitaxel, ifosfamide, and cisplatin (TIP). He underwent 4 cycles of TIP but eventually developed disease progression on repeat imaging. At this point, the patient was started on cetuximab given EGFR amplification on tumor analysis with the FoundationOne testing platform. However, the patient had an allergic reaction to cetuximab, so his treatment was changed to panitumumab. The patient had stable disease and a progression-free survival of 6 months with anti-EGFR treatment, which is clinically significant given that this treatment was given in the second-line setting for an aggressive tumor type that other than chemotherapy there is no other approved drug to date. The patient was ultimately started on the PD-1 inhibitor nivolumab. He had initial response to immunotherapy followed by stable disease, so he had a disease control rate of an additional 6 months with this investigational agent at that time. Ultimately, he was placed on hospice and passed away two years from the the time of diagnosis.\nOUTPUT:" }, { "from": "agent", "value": "Penile Cancer, Invasive Keratinizing Squamous Cell Carcinoma, Metastatic 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: ILS, a 44-year-old female homemaker complained of sudden fullness in the left ear a year before, followed by daily serosanguineous to purulent otorrhea, with progressive hearing loss and tinnitus. She denied prior otorrhea, vertigo, or contact with tuberculosis. She had received prior treatment with amoxicillin/clavulanate, ciprofloxacin, and topical gentamicin/betamethasone. The patient had SLE, controlled with prednisone 10 mg/day. She had no cervical lymphadenopathy and the oral cavity, pharynx, and rhinoscopy were normal, with normal VII function bilaterally. The right otoscopy was normal; the left otoscopy disclosed whitish mucous secretion at the bottom of the ear canal. Laboratory tests were normal. Computed tomography (CT) showed pneumatized mastoids, with the left appearing opaque without erosions. Audiometry showed ipsilateral moderate mixed hearing loss. Chronic suppurative otitis media (CSOM) was suspected. A tympanomastoidectomy was performed, which disclosed friable whitish tissue in the mastoid and middle ear without cholesteatoma, anvil erosion, or misidentified stirrup. A mastoid debridement was performed, followed by specimen collection and fascia graft. Ossiculoplasty was left for a subsequent procedure. The patient evdeveloped tinnitus, progressive wound dehiscence, otorrhea, and afacial paresis that recovered in three weeks. She was started on azathioprine and prednisone 40 mg. Two months later, the mastoid was fully exposed (Fig. 1), and tuberculosis was suspected. The material collected during surgery was insufficient to establish the diagnosis. She had a non-reactive PPD and normal chest X-ray. A biopsy performed through the dehiscent incision showed extensive granulomatous reaction with, giant multinucleated epithelioid cells with focal necrotic areas. Fungus and AFB culture results were negative. Considering these data, the physicians decided to establish an early antituberculosis regimen: rifampicin, isoniazid, pyrazinamide, and ethambutol for two months, followed by isoniazid and rifampicin for seven months. Improvement in healing was observed after 30 days (Fig. 1). After three months, the incision was closed. One year later, she remained with tinnitus, discrete otorrhea, and tympanic perforation. Audiometry showed no responses at 6 and 8 kHz, with preservation of thresholds at the other frequencies.\nOUTPUT:" }, { "from": "agent", "value": "Tuberculous otomastoiditis, Lupus" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 65-year-old man with an extensive smoking history, very severe chronic obstructive lung disease complicated by chronic hypoxemic respiratory failure requiring continuous supplemental oxygen support developed new onset non-pleuritic chest pain. A chest x-ray and computed tomography (CT) revealed a cavitated left upper lobe lung (LUL) mass measuring 3.7 x 2.6 cm without pathologic enlarged mediastinal lymphadenopathy (Fig. 1). A position emission tomography-computed tomography (PET-CT) revealed hypermetabolic activity in Ref. LUL mass (SUVmax 17.4); pleural-based focus, medial aspect of the posterior left lower hemithorax (SUVmax 3.3); and pleural-based focus, more lateral aspect of the posterior left lower hemithorax (SUVmax 5.7) (Fig. 2). The patient underwent an US-guided thoracentesis, with cytology that resulted negative for malignancy. Three weeks later, the Pulmonary Service was consulted for consideration of performing a diagnostic bronchoscopy. We performed a pleural ultrasound using a generic, portable ultrasound equipped with a phase array 5-1Mhz probe, with the patient seated in an upright position. A pleural-based nodule and a small anechoic pleural effusion were identified. Color Doppler revealed no evidence of a pleural-based arteriovenous malformation. Using a \"free-hand\" technique, a BioPince needle (18Gx10 cm; Argon Medical Devices, Inc, USA) was passed four times at the same angle of the US probe (Fig. 3). A thoracentesis was subsequently performed, with a total of 20mL pleural fluid drained. Pleural fluid analysis was consistent with a lymphocyte-predominant exudate, negative for malignancy.\nOUTPUT:" }, { "from": "agent", "value": "Non-small cell lung carcinoma, Stage IV 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 92-year-old woman was referred to the emergent department because of abdominal pain, vomitus, and abdominal distention that had started 3 days ago. The quality of abdominal pain was crampy in the periumbilical area and not radiated to any anatomic region. The last defecation and gas passing was 3 days ago. She had no fever. Her past medical and surgical history was clear. General appearance showed a very old woman and very slim body (weight: 38 kg), with a dry mucosal surface. Vital signs were normal. Other physical examination was norma,l and the abdomen had no tenderness, mass, and hernias on palpation. Also, the rectal exam was empty. Laboratory tests including complete blood count, creatinine, amylase, lipase, electrolytes, and cardiac enzymes were in normal limits. Upright and supine abdominal X-ray showed small bowel with air-fluid levels and dilated bowel loops (Figures 1 and 2). Intravenous fluids were started, nasogastric tube was fixed, and about 600 cc of fecaloid discharge was removed. Because of complete obstruction with fecaloid discharge from nasogastric tube, she was a candidate for laparotomy. The surgery was performed by general anesthesia and a midline incision. Laparotomy revealed dilation of many of intestinal loops and a small internal hernia. Other segments of small bowel were normal. Segmental small bowel resection including the diverticulum was performed with a primary end to end anastomosis.\nOUTPUT:" }, { "from": "agent", "value": "Intestinal Obstruction by Meckel's Diverticulum" } ]

[ { "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: Treatment solutions for mild TBI typically concentrate on complete rest, while non-traditional therapeutic options remain largely ineffective. The patient received a formulated dosage of hydrogen every 2 hours, with the first intervention given immediately after an initial examination (~ 15 min after the injury). The overall score for Sport Concussion Assessment Tool 2 (SCAT2), a standardized method of evaluating injured athletes for concussion, increased from 68 points (severe disruption) at baseline to 84 points (mild disruption) at 24-h follow-up. The patient reported no side effects of hydrogen intervention. Conclusions: This case has demonstrated that intensive consecutive therapy with oral transmucosal hydrogen formulation is a beneficial strategy with regard to the reduction of presence and severity of symptoms of sport-related mild TBI. Image Caption and Description: \nImage caption: []\nImage description: []\nCase Report: \nAt the initial examination, the patient was profiled using Sport Concussion Assessment Tool 2 (SCAT2), a standardized method of evaluating injured athletes for concussion . The total number of concussion symptoms was 18 (out of maximal 22), with a symptom severity score of 53 (out of 132). Total SCAT2 score was 68 out of 100 points, approximately 25.3% below normative values (91.08) . In addition, the patient has shown a diminished ability to keep balance during a single-leg stance test (SLST) for non-dominant foot (total number of errors 5 out of 10).\nOUTPUT:" }, { "from": "agent", "value": "Mild Traumatic Brain Injury" } ]

[ { "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 8 year old boy presented with a swelling on the left side of the face (A). On inquiry, he revealed that it had been rapidly growing since he first noticed 15 days earlier, and was associated with sharp pain at night. He had constitutional symptoms such as weight loss and fatigue, but no history of fever. On examination, the swelling had a shiny appearance, with no changes in skin color and the mouth opening was partly restricted. There was no local rise of temperature. The left submandibular lymphnodes were palpable, non-tender and fixed. Intraorally, there was a large nodule (B) measuring 5x3 cms, in the lower left buccal sulcus. The nodule was red in color, covered by necrotic slough, and showed areas of bleeding. It was tender, indurated and fixed to the underlying structures. The differential diagnosis included Burkitt's lymphoma, rhabdomyosarcoma, Ewing's sarcoma. On radiographic examination, there were no cystic areas, and bony erosions with respect to the mandible. The patient was treated with chemotherapy (vincristine, actinomycin-D, cyclophosphamide) plus radiotherapy (5200cGy for 8weeks). No recurrence has occurred during a six month follow up period, and he is still under long term review. Rhabdomyosarcoma is a rapidly growing, childhood malignancy of striated muscle, that exhibits some male predilection. Rhabdomyosarcoma of the oral cavity accounts for 10-15% of all the head and neck cases; the most common sites are tongue, palate and buccal mucosa.\nOUTPUT:" }, { "from": "agent", "value": "Rhabdomyosarcoma-Embryonic type" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: An 18-year-old male was admitted to the ICU with fractures of the 2nd and 3rd cervical vertebrae and concomitant acute respiratory failure type I. Staphylococcus aureus and COS Acinetobacter baumannii were repeatedly isolated from bronchial secretions during the second and the third week of his hospitalization, respectively. The antibiotics were vancomycin, broad-spectrum cephalosporins, clindamycin, piperacillin/tazobactam, aminoglycosides, quinolones, meropenem and colistin (given for a total of 21, 15, 9, 7, 25, 7, 6 and 11 days respectively, up to the 34th day of ICU stay). On the 34th day of ICU stay PDR Pseudomonas aeruginosa grew from his bronchial secretions. At that time, he was receiving colistin, meropenem, ofloxacin and gentamicin. He continued to receive the same antimicrobial combination. PDR Pseudomonas aeruginosa was not isolated again from subsequent cultures of bronchial secretions. Instead, Acinetobacter baumannii grew again from bronchial secretions on the 35th day of hospitalization and in subsequent cultures by the 45th day of ICU stay. Meanwhile a gradual improvement of the infection was noted.\nOUTPUT:" }, { "from": "agent", "value": "Pneumonia, Infections due to pandrug-resistant (PDR) Gram-negative bacteria" } ]

[ { "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 admission the patient was sleepy with the the glascow coma scale at 13, eye examination revealed pupils to be equal and reactive to light bilaterally, blood pressure was 150/100 mmHg with 4+proteinuria without signs of trauma, no concept of convulsions, or tongue biting, the patient denied any headache, visual disturbances or epigastric pain. The cardiopulmonary examination was unremarkable. The obstetric examination note long neck and posterior closed and intact membrane. Obstetric ultrasound reveale an estimated fetal age of 27 weeks' with adequate fluid volume. Laboratory studies included a hemoglobin of 13,6g/l, platelet count 178000/mm3, serum glutamic oxaloacetic transaminanse (SGOT): 11 IU/L, glutamic puryvate transaminase (SGPT): 15IU/L, urea: 0, 4 g/l, creatinine: 6.6mg/dl, total bilirubin: 8mg/dl. A first dose of betamethasone was administrated to enhance fetal lung maturity. The patient was admitted on the same day in the operating room and the hematoma was evacuated. The evolution was marked by neurological improvement without any motor or sensory deficit; she was well oriented and responsive to questions and commands. At the fifth day the parturient has delivered naturelly a 32 weeks' newborn who died in the ICU because of respiratory distress and prematurity.\nOUTPUT:" }, { "from": "agent", "value": "Spontaneous subdural hematoma, Preeclampsia" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: An 82-year-old woman presented with subacute onset of swelling of the left leg. Her vital signs and physical examination results were unremarkable except for extensive edema of the left leg. She had no medical history of cardiovascular or pulmonary disease, malignant tumor, trauma, or surgery. Ultrasound of the lower extremities revealed DVT of the left superficial femoral vein to the popliteal veins. She was given a direct oral anticoagulant (rivaroxaban, 15 mg bid) and compression stockings for one month. Three months later, although DVT had completely disappeared, swelling of the leg remained. Ultrasound showed no DVT, but the arterial flow pattern indicated venous blood flowing back into the toe (Figure 1(a)) and diffuse iliac AVFs (Figure 1(b)). Enhanced computed tomography scans showed left external iliac vein dilation, some iliac AVFs, and occlusion of the common iliac vein. Lower left extremity angiography showed the presence of multiple AVFs in the common and internal iliac arteries (Figure 2(a) and (b)) and the occluded common iliac vein (Figure 2(c)). Embolization for AVFs seemed to be difficult to perform because of the possibility of development of collateral circulation and a large number of AVFs. Endovascular therapy was performed on the occlusion site. After the passage of a 0.014-inch guidewire, intravascular ultrasound revealed no DVT, with the left common iliac vein compressed by the iliac artery and sacrum, suggesting MTS. Balloon angioplasty was performed, and anterograde blood flow and sufficient acute gain were obtained (Figure 2(d)). The pressure of the external iliac vein was reduced from 42/38 mm Hg to 12/10 mm Hg. After the procedure, echocardiograms showed no pulmonary hypertension. One year follow-up echocardiograms showed mild restenosis of the common iliac vein, but she had no symptoms (Figures 1(c) and (d)).\nOUTPUT:" }, { "from": "agent", "value": "Iliac May-Thurner syndrome, Arteriovenous fistula" } ]

[ { "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 32-year-old male patient with a past medical history of newly diagnosed diabetes mellitus, recently diagnosed hyperlipidemia, hypertension, mood disorders, and methamphetamine use in remission presented to the ED with palpitations and constant right-sided chest wall pain for two days. He denied any abdominal pain and his physical exam showed no abdominal tenderness, distension, guarding, or rigidity. The patient did not appear to have any triggering medications that could have precipitated the event. Initial cardiac workup showed an electrocardiogram with normal sinus rhythm, troponin < 0.01 ng/ml, and an unremarkable chest x-ray. The patient was tachycardic and tachypneic with a white blood cell count of 16.4 x 103/uL and normal lactic acid. Additional labs obtained in the ED showed blood glucose 356 mg/dl, anion gap 24 mEq/L, bicarbonate 7 mEq/L, pH 7.17, 2+ ketones on urinalysis, and hemoglobin A1c greater than 17.6%. His calculated body mass index was 23.5 kg/m2. A lipid panel was obtained due to a history of hyperlipidemia and showed triglycerides 2172 mg/dL, cholesterol 351 mg/dL, and HDL 14 mg/dL. Subsequently, a lipase test was found to be elevated at 472 U/L. On nil-per-os status and an insulin drip, triglycerides decreased to < 500 mg/dL over the course of two days at which point the insulin was discontinued. The patient was started on fenofibrate and a statin prior to discharge.\nOUTPUT:" }, { "from": "agent", "value": "Acute Pancreatitis Secondary to Hypertriglyceridemia, Diabetic Ketoacidosis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 62-year-old woman with a history of mild seasonal asthma and gastroesophageal reflux presented with an eight-month history of cough. Initially it was \"... very much like an asthma cough. Very little phlegm and just aggravating.\" Eventually it became intractable occurring \"any time during the day or night, except when I was sleeping.\" The cough was worse with exertion, cold air, and talking. It caused posttussive vomiting. \"I would be wracked with uncontrolled coughing that would leave me hot, weak, sweating, exhausted and usually having vomited.\" In the few months prior to presentation she had also experienced profound fatigue, drenching night sweats, and a 25-30-pound weight loss but no documented fever (quotation marks indicate the patient's words). Physical examination was normal with no pulmonary wheezes or crackles, no abdominal masses, and no lymphadenopathy. Inhaled corticosteroids, bronchodilators, oral prednisone, montelukast, and esomeprazole did not help. Oral hydrocodone gave temporary relief. Fortuitously a high resolution CT scan of the chest included her upper abdomen and revealed a 6.5 cm heterogeneous lesion in the upper pole of the right kidney with local lymphadenopathy but no involvement of the diaphragm. There were a lytic lesion in the body of L4 and three small pulmonary nodules, the largest being 1.7 cm. Also fortuitously the patient's presentation to our emergency room coincided with the publication the same week of a very similar case in the Canadian Medical Association Journal. A laparoscopic right radical nephrectomy and lymph node dissection were performed. The diaphragm was not involved. The renal vein and one of seven nodes were involved. Postoperatively the patient stated, \"My cough seemed to disappear with my kidney. I was glad to wish both a farewell.\" Her L4 lesion was irradiated and she was treated with sunitinib. Unfortunately she developed widespread bony metastases and died 14 months after the start of her cough. During the metastatic course of her illness the cough did not return but she was on large doses of narcotics for bony pain.\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: A 44-year-old man with a five-year history of hypertension and gout was admitted to our hospital 1 day after his fourth cupping procedure. He was hit on the head by a heavy object a month previously. Ten days after the accident, he developed a mild headache and neck muscle spasms. He underwent traditional medical treatment, including cupping and acupuncture, once a week. One of the cups was positioned on the ONJ. The patient's neck discomfort was successfully alleviated after the treatment. However, after the third round of cupping therapy, his headache worsened, although it could be relieved by lying down. Furthermore, he clearly remembered an aggravating and constant headache with dizziness and vomiting after the cup on his ONJ was removed during the 4th cupping procedure. An MRI of the head was conducted and showed bilateral SDH (Figure 2H), with slight delirium, but without other marked neurological impairment. The patient had not received coagulation-related medications prior to the onset of the headache. His PT, bleeding time and clotting time were within normal ranges. As mentioned previously, he rejected surgical therapy and was treated with the ATO. Seventeen days later, his headache had exacerbated. Head MRI revealed a slight expansion of the bilateral frontotemporal paroccipital chronic SDH (Figure 2J). A new round of combination therapy was restarted at the same dose with intensive monitoring of the patient's vital signs. Two months later, the patient recovered well without any neurological sequelae (Figure 2K).\nOUTPUT:" }, { "from": "agent", "value": "Subdural 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: Bulls-eye displayed the perfusion abnormalities and assessed the affected myocardium. In the upper bulls-eye images (Fig. 1) a normal MPI SPECT is depicted in another individual for comparison, and in the lower images, the MPI SPECT of the present case demonstrated perfusion defects. Coronary angiogram in 2017 showed no hemodynamically significant coronary abnormalities (Fig. Due to a very small probability of significant epicardial stenosis no intravascular ultrasound or optical coherence tomography were performed. Similar results were obtained by echocardiography which demonstrated a left ventricle with marginal systolic function, concentric hypertrophy and progressive hypokinesia of the mid-inferior septal and mid-inferior lateral regions and akinesia of basal inferior segments (Suppl. Video S1, 2012, 2016, 2017). Moreover, as part of the initial exam in 2013, a dipyridamole stress echocardiogram was performed in order to assess coronary flow reserve, which was relatively small in this patient (2.4). The etiology of the discordant results in the present patient between MPI SPECT and angiography may be due to an irregular vasoconstrictor/ vasodilatory coronary capability.\nOUTPUT:" }, { "from": "agent", "value": "Myocardial ischemia, Chronic kidney 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 56-year-old man presented with visual disturbances, discomfort, and poor cosmetics in his left eye. Before visiting our hospital, he had undergone trabeculectomy for the first time when he was 45 years old and underwent second surgery of trabeculectomy at age 46 in his left eye using a fornix-based conjunctival flap with MMC. A slit-lamp examination of the left eye revealed a large OHB; the anterior chamber has a normal depth and the lens status was IOL (intraocular lens) (Figure 2(a)). Fundus examination revealed the cup disc ratio of 1.0 in the left eye. The best-corrected visual acuity (BCVA) was 20/125 in the right eye and 20/60 in the left eye. IOP was 11 mmHg in the right eye and 9 mmHg in the left eye without the use of antiglaucoma drugs. We resected the OHB in his left eye. There was a slight leakage around the fornix margin of the excision, but it stopped naturally on postoperative day 5 (Figure 2(c)). The corneal total HOAs improved from 0.50 mum to 0.38 mum. Simulated retinal images of Landolt C based on corneal wavefront data had improved clearly with reduced total corneal HOAs. The symptom of constant foreign body sensation was also reduced, and improvement of poor cosmetic was also seen (Figures 2(b) and 2(c)).\nOUTPUT:" }, { "from": "agent", "value": "Overhanging Bleb, Primary Open-Angle Glaucoma" } ]

[ { "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 was admitted to our department with chest pain that had lasted one hour and dyspnea following emotional distress. On examination, blood pressure was 125/80 mmHg, pulse rate was 88/min and regular, and a systolic murmur 2/6 Levine was audible. The echocardiogram (ECG) showed sinus rhythm and prominent ST elevation in lead V2. During the echocardiogram, akinesia of medium septum, septal apex (Wall Motion Score Index: 1.36) and mild mitral regurgitation were detected. Chest pain, ECG and echocardiogram changes subsided spontaneously 30 min after admission. After a common main stem (CMS), the artery divided into a dominant RCA, and into a left main stem (LMS) that finally bifurcated into the left anterior descending (LAD) and left circumflex artery (LCX). The coronary arteries were normal without any significant stenosis and without any extrinsic compression. Contrast enhanced CT confirmed the diagnosis (Figure 1B). The large RCA (5mm) and LAD showed no signs of stenosis, coursing behind the aortic bulb and towards the interventricular sulcus (Figure 2). Dipyridamole-echo stress test at maximal heart rate was negative for inducing ischemia. The patient was discharged with the following medications: simvastatin, ramipril, diltiazem and clopidogrel. At follow up at 36-months the patient was in good health without any recurrence of acute coronary syndrome.\nOUTPUT:" }, { "from": "agent", "value": "Single coronary artery from the right sinus of Valsalva, Non-ST segment myocardial infarction" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 30-year-old Caucasian woman presented to the emergency department with self-limited severe chest heaviness, which started at rest and lasted for three hours. She had associated dyspnea on exertion and diaphoresis. Her past medical history was significant for panic disorder and postpartum depression. Medication usage included an oral contraceptive (OCP), alprazolam, citalopram, and lansoprazole. Vital signs demonstrated blood pressure 157/105 mmHg and heart rate 79 beats/min. Physical exam was remarkable for obesity, otherwise normal. Laboratory data were significant for a white blood cell count of 11.10 th/mm3, serum potassium of 3.4 mmol/L, aspartate transaminase of 70 U/L, and human chorionic gonadotropin was negative. Cardiac enzymes were significant for elevated troponin I 27.64 ng/ml (normal value [NV]: 0-0.78), creatine kinase (CK) of 484 U/L (NV: 10-150 U/L), and CK-MB of 56 ng/mL (NV: 0-5 ng/mL). Initial electrocardiogram (EKG) was unremarkable. Computed tomography angiogram showed no evidence of acute pulmonary embolism. Patient was admitted and started on intravenous heparin infusion. The following day the patient underwent transthoracic echocardiogram, which demonstrated mild hypokinesis of the inferior and septal walls with a normal ejection fraction. Patient was transferred to the catheterization lab and a coronary angiogram was performed. There was a 70% stenosis in the proximal RCA and diffuse luminal irregularities of the vessel (Fig. 1). No significant lesions were seen in the left coronary system. Percutaneous coronary angioplasty was performed. A 3.0 x 38 mm drug eluting stent and 4.0 x 38 mm bare metal stent were inserted in the RCA. Patient was started on aspirin, prasugrel, metoprolol, lisinopril, and atorvastatin. She was advised to stop the OCP.\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: Patient information: a 61-year-old patient with no significant past history underwent L4-L5 laminectomy indicated for lumbar canal stenosis. Following the intervention, he requested to be discharged and continue wound dressing on out-patient basis. Three weeks later, he developed a constant low-grade fever, associated with left flank pain, hip pain and back pain. Clinical finding: on physical examination, the patient looked cachectic with a tender distended abdomen and bi-pedal edema. The lung examination was normal. The wound dressing on his back was soiled and oozed a purulent discharge. Full blood count showed hyperleukocytosis at 31,900 /mm3. The hemoglobin was 8.2g/dl. It showed the presence of an oscillating mass on the anterior leaflet of the tricuspid measuring 13mm x 7mm, compatible with a vegetation (Figure 3). The empiric antibiotherapy was to target staphylococcus and streptococcus. Due to limitations in the setting, blood cultures were not performed. Ethics approval and consent to participate: written informed consent was obtained from the patient for publication of this case report and any accompanying images.\nOUTPUT:" }, { "from": "agent", "value": "Tricuspid valve infective endocarditis, Psoas abscess, Septic pulmonary emboli, Severe tricuspid regurgitation" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 57-year-old married woman, Gravida 9, Para 8, consulted with the gynecologic ward by gasteroentrology consultant and then admitted complaining abdominal pain and distension since last two months (Figure 3). She lost 10 kg during these 2 months which is highly suggestive of a serious problem. Her past medical and gynecologic history was unremarkable. Family history was negative. In physical examination she was pale. Abdomen was distended with tenderness in the palpation of the periumbilical and hypogastric areas. Hemoglobin was 9.4 mg/dL. Serum tumor markers were normal except CA-125 >1000 u/mL. Chest X-ray was normal. Ultrasonography showed normal liver, spleen, kidneys, and uterus, but showed cystic masses in both adnexa with septation in favour of malignancy. Computerized tomography showed ascites. No sign of metastasis. So laparatomy with midline incision was done with impression of ovarian malignancy. About one liter ascites aspirated and omental cake with miliary seeding, which were seen all over the peritoneum and pelvic organs and over the liver and spleen, has been biopsied. Ovarian masses were removed and sent for frozen sections along with the other biopsied specimens with the result of granulomatosis. Because of necrotic and hemorrhagic appearance of uterus and ovaries as well as the patient's age and condition total abdominal hysterectomy and bilateral salpingooophorectomy were done to prevent postoperation complications. Result of permanent pathology was fibrotic right oviduct with granulomatous inflammation. Right ovary with granulomatous inflammation in favour of TB ascitic fluid cytology showed inflammatory cells. All three cases were in very good status in 6 months followup with normal pelvic exam, normal pelvic ultrasonography and CA125 measurement.\nOUTPUT:" }, { "from": "agent", "value": "Familial tuberculosis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: On November 2011, following the confirmation of disease progression for 4 years, the BRAF V600E mutation was detected and the treatment with vemurafenib was initiated at a dosage of 1,440 mg/day. The patient referred no remarkable adverse events due to drug dosing, excepted of accentuated photosensitivity, resulting in overall improvement of the disease and stabilization of clinical status. In agreement with the initiation of the treatment with vemurafenib, preventive cryopreservation of spermatozoa was performed. Semen parameters at both the time of cryopreservation and at follow-up in 2015, after 4 years of treatment with vemurafenib, are reported in Table 1. The patient showed semen parameters, such as sperm count, sperm motility, and cell viability, above the reference values for normal fertility at both basal and follow-up. In order to address any possible influence of BRAFi on sperm DNA status, the evaluation of sperm aneuploidies and fragmentation of sperm DNA were also assessed, finding no additional impairment of these specific parameters. The hormonal pattern of testis function, such as serum total testosterone and luteinizing hormone levels, were within the normal-ranges. On the base of the observed normal semen parameters at follow-up, no contraindications were given on regard to seek for natural fertility on November 2015. Since then, after about 1 month of attempts, the partner (38 years old) reported spontaneous pregnancy with a regular course and normal amniocentesis for male fetal karyotype. The pregnancy ended with preterm cesarean section at the gestational age of 8 months for membrane rupture. At birth, the baby weighed 2,100 g showed absence of major abnormalities.\nOUTPUT:" }, { "from": "agent", "value": "Metastatic Melanoma, Vitamin D insufficiency, Subclinical hypothyroidism" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: His ability to understand speech understanding gradually deteriorated. At the following visit during the summer of 2013, the microotoscopic examination indicated a normal eardrum on both sides. The Carhart notch was present on both sides (2 kHz). The stapedial reflex was absent bilaterally, while the multiple-frequency tympanogram revealed a resonance frequency of 1250 Hz on the left and of 1750 Hz on the right side. In September 2013, the patient underwent an uneventful KTP laser stapedotomy on the right side, while the ossicular chain was reconstructed with a self-crimping heat memory NiTiBOND piston. On postoperative day 13, he suffered House-Brackmann grade III facial palsy on the right side while shaving (Figure 3). The symptom was accompanied by a slight pain in the right ear. No signs of either acute external otitis or acute otitis media were detected, and the blood tests showed normal parameters. By postoperative day 42, the patient had recovered completely (Figure 4) following Medrol and Acyclovir therapy administered in the same manner as described in case 1, and the audiometric evaluation revealed a mean of 5 dB ABG on 0.5-1-2-3 kHz, while the mean bone conduction threshold had improved by 5 dB.\nOUTPUT:" }, { "from": "agent", "value": "Delayed Facial Paralysis, Progressive Bilateral Hearing Loss, Stapes Fixation" } ]

[ { "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: There was another case of a 47 years old man who smokes. He was attending clinic and was constantly counseled on the need to stop smoking and the resources available to him to help him stop. He was working on what the best strategy to use to quit smoking until he met one mobile doctor who just came into town. Just because the mobile \"doctor\" was a total stranger in the town who did not know that the man smokes, the man believed all that he told him and bought the drugs at an expensive price and dropped the idea of quitting smoking. Case 3: Another man gave an account of his family 's encounter with a mobile \"doctor\" who came to their house to test and diagnose them. He said that being a bit literate; he was not interested in the diagnosis but that the wife opted to have the mobile \"doctor\" examine her. The \"doctor\" said that the hot feeling in her abdomen is because there are some fluids in her abdomen and that her fallopian tubes are blocked. He said that she should bring 8,000 naira ($50) so that he could give her drugs to flush open the fallopian tubes so that the fluid in the abdomen will go and that the hot feeling in the abdomen will stop. The man said that what got him surprised and confused was that the wife was a known hypertensive. Then when he asked the wife if she has a feeling of abdominal hotness, the wife answered in the affirmative. So he was wondering how someone could make such accurate diagnosis with just a digital thermometer. Although, they did not buy the drugs, it made him to believe that perhaps the mobile \"doctors\" could be right after all.\nOUTPUT:" }, { "from": "agent", "value": "Lung Cancer, 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: A 31-year-old gravida 2, para 1 woman presented to the emergency department with sudden onset suprapubic and pelvic pain. The patient was a gestational carrier and she had undergone day 5 fresh blastocyst transfer after IVF during a spontaneous cycle. She was otherwise healthy and her only medication at the time of presentation was micronized 17B- estradiol (ESTRACE) 2mg orally TID. At the time of her presentation she was posttransfer day 25, correlating with an estimated gestational age of 6+2wks. Upon clinical assessment in the emergency department the patient reported intermittent suprapubic and pelvic pain beginning the previous day. She denied any syncopal episodes, bowel or bladder symptoms, or vaginal bleeding. Investigations revealed a beta-hCG of 1038IU/L, Rh negative status with no antibodies, and hemoglobin of 140 g/L. Ultrasound reported a retroverted uterus with no evidence of an intrauterine pregnancy or endometrial thickening. The right ovary appeared normal; however there was a complex mass surrounding the left adnexa measuring 7.5x3.5x3.5cm. There was no distinct gestational sac seen and a moderate amount of echogenic free fluid in the pelvis. The patient was brought to the OR for emergent laparoscopy under general anesthetic. Intraoperatively a moderate amount of hemorrhagic material was found in the cul-de-sac. There was active bleeding from the left ovary, which involved at least a third of the ovarian cortex, as well as the fimbria of the left fallopian tube. It was our intention to preserve the patient adnexa, and we started the surgery as a partial oophorectomy. Unfortunately the bleeding encountered was difficult to control. Given the extent of hemorrhage, a left salpingooophorectomy was performed without complications. Hemostasis was achieved and the patient was transferred to recovery in stable condition. The patient had an uneventful postoperative recovery and was given Rh immunoglobulin prior to discharge.\nOUTPUT:" }, { "from": "agent", "value": "Ovarian Ectopic Pregnancy" } ]

[ { "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: Angioplasty was first attempted on the right limb which was the most symptomatic. The right common femoral artery was punctured and a 6F sheath inserted. The SFA and popliteal artery were stented with excellent angiographic results. Angiogram demonstrated that the right SFA was totally occluded by the footplate that had got caught in the SFA origin presumably onto plaque (Image 1). The occlusion was crossed with a 0.018-in guidewire, the catheter advanced, and angiographically confirmed to be within the luminal mid-common femoral artery (CFA). A 6 mm x 40 mm (EverFlex; ev3) and 5 mm x 15 mm (Express Vascular SD; Boston Scientific) balloon-mounted bare metal nitinol stents were deployed flush to the SFA origin with excellent angiographic result, maintained haemostasis, and no residual stenosis (Image 2). Haemostasis on the left was achieved with manual compression.\nOUTPUT:" }, { "from": "agent", "value": "Failed Angio-Seal Footplate Deployment, Heavily calcified and stenosed right popliteal artery, Stenoses of the superficial femoral artery and popliteal artery on the left, Non-healing ulceration of both lower limbs, Diabetes" } ]

[ { "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 admission the patient had palpable thyroid nodules. The patient had nor hoarseness neither discernible cervical lymph nodes. Blood tests including TSH, T3 and T4 were in the normal spectrum. An ultrasound scan detected tumescent masses on the surface of both thyroid lobes. Following these, total thyroidectomy was finally scheduled. A standard thyroid collar incision of ~6 cm was made, 1-2 cm above the sternal notch and was extended over the sternocleidomastoid muscles. At first, the middle thyroid vein was ligated and the superior poles were mobilized. Both the carotid artery and the jugular vein were gently retracted. Surgeons performed gradual dissection along with the tracheoesophageal groove until the RLN's entry in the larynx and unexpectedly identified that the extralaryngeal bifurcation point (ELBP) of the left RLN was located at a mean distance of 7 cm from the left CTJ (Fig. 1). Such an anatomic variation may augment the probability of the RLN injury or of its branches. Subsequently, identification of the RLN at a single point is not suffice for safe thyroidectomy. Then, surgeons exposed the right RLN which was detected as in common, in the right tracheoesophageal groove, medially to the common carotid artery, branching within the proximal 1-2 cm of the CTJ. Thyroidectomy continued in usual fashion and was uneventful. The patient was discharged the second postoperative day, when the drainage placed was removed. At the follow-up, the 10th postoperative day, the patient had none complication.\nOUTPUT:" }, { "from": "agent", "value": "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: A 75-year-old woman was referred to our hospital in June 2010 after the detection of anemia and renal dysfunction. Her serum IgA level was 2,845 mg/mL. She initially refused BD therapy, as she was concerned about potential side effects such as interstitial pneumonia. She had agreed to use weekly BD therapy (1.7 mg of bortezomib and 20 mg intravenous dexamethasone) when her IgA was elevated after several conventional therapies, including MP and dexamethasone monotherapy (serum level of IgA was up to 946 mg/mL in April 2011 from the normal range). Pancytopenia was observed after weekly bortezomib and dexamethasone injection with a marked decrease in the IgA levels (down to 73 mg/mL after one month), suggesting a very good partial response. Bortezomib therapy was changed to weekly, then monthly, and the patient was free of granulocytopenia and did not require transfusions. After continuing BD therapy for approximately one year, IgA and beta2 microglobulin again became elevated. Biweekly injection of bortezomib became ineffective by early 2012. The patient's serum IgA level was 1,515 mg/mL in March 2012. She agreed to add thalidomide, 50 mg daily, to BD, according to our previous treatment experience (as in case 1). After VTD 50 was initiated, a rapid decrease in the IgA and beta2 microglobulin levels was observed and the patient again attained a partial response (IgA level was reduced to 290 mg/mL in October 2012). These effects continued for eleven months without any sensory disturbance. After repeated deterioration of the laboratory data despite VTD 50 therapy, a rapid progressive disease status was observed, and other drugs such as lenalidomide had a minimal effect.\nOUTPUT:" }, { "from": "agent", "value": "Refractory Multiple Myeloma, IgA lambda myeloma, ISS stage III, Plasma cell leukemia" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The female partner was 32 years old with no prior conceptions or attempts. Subsequent office hysteroscopy confirmed a normal uterine cavity. Her testing and evaluation were otherwise unremarkable. On exam his testes were symmetric and 32 cc's in volume, and there were no clinical varicoceles. His endocrine workup revealed an FSH of 4.9 mIU/mL and a morning serum testosterone of 437 ng/dL. Semen analyses, as expected, demonstrated a complete absence of motility. Over the course of his evaluation, six semen analyses were performed. Concentrations ranged from 8 to 19 million/cc (total count 16 to 38 million) with 0 to 2 % normal forms by strict criteria. Following the female partner's myomectomy and post-operative recovery, the couple had undergone three IVF-ICSI attempts using fresh ejaculated sperm. Each cycle resulted in the retrieval of 4 to 12 mature oocytes, with resulting fertilization rates of 0 to 42 %. A single blastocyst was transferred during the first cycle without success. The second and third cycles utilized sperm selected based upon the hypo-osmotic swelling assessment in an effort to optimize outcomes. Viability testing was also judged with the mechanical touch technique, which uses a combination of morphology and tail flexibility for assessment. Two day three embryos were transferred with the third cycle resulting in a biochemical pregnancy that did not progress. Following the three failed cycles, the couple elected for another attempt using fresh testicular sperm. This cycle resulted in the retrieval of 13 mature oocytes, nine of which fertilized. Two high quality embryos (10-cell, 8-cell) were transferred on day three. The couple successfully delivered a singleton pregnancy at term. A single resulting blastocyst was also frozen. The couple desired further family building and pursued transfer of their remaining frozen blastocyst. Unfortunately no pregnancy resulted, and the couple proceeded to another IVF-ICSI attempt using freshly procured testicular sperm. With this cycle, seven of 16 mature oocytes fertilized normally and two day three embryos were transferred (8-cell, 10-cell). A resulting twin pregnancy was successfully delivered.\nOUTPUT:" }, { "from": "agent", "value": "Kartagener's Syndrome, Symptomatic mural fibroids" } ]

[ { "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: Past medical history was significant for diabetes mellitus type 2 managed by oral hypoglycemic agents. She had no previous surgeries. There was no history of hemolytic disease. On examination, vital signs and abdominal examination were unremarkable. Investigations showed that white blood cells count and liver function tests were all within normal limits. Ultrasound of the abdomen showed normal gallbladder with no features of calculus cholecystitis, but with a single large gallstone (approximately 6 cm). She was placed in the supine position, and a trans-umbilical camera port was inserted in addition to another 3 working ports. Intra operatively, there was some adhesions between the gallbladder and duodenum which were released by endoscopic scissors. The gallbladder wall was thick and the gallstone occupied almost all of Hartmann's pouch which rendered grasping the gallbladder difficult. After identifying Calot's triangle and clipping the cystic artery and duct, the gallbladder was dissected from the liver bed, put in an endobag and removed out after extension of the trans umbilical incision. The procedure was undertaken by an experienced laparoscopic general surgeon. The gallstone measured 6 x 4 x 3.3 cm. Post-operative course was uneventful and the patient was discharged home after 1 day. The patient was followed up after two weeks, where she had no active complaints.\nOUTPUT:" }, { "from": "agent", "value": "Biliary colic, Chronic cholecystitis with intestinal metaplasia and cholesterolosis" } ]

[ { "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: GPA was first diagnosed in a 20-year-old donor. Due to extended lung bleeding, the donor required extracorporeal membrane oxygenation (ECMO) support. Under ECMO support, a fatal subarachnoid bleeding occurred. After 5 days, the ECMO was successfully weaned. Echocardiography and coronary angiography revealed a good inconspicuous heart function under very low inotropic support. The patient was accepted as an organ donor according to the German Organ Transplantation Foundation and valid Eurotransplant guidelines. After the organ was accepted, orthotopic heart transplantation was performed. The cold ischemic time was 193 minutes. An immediate stable sinus rhythm was achieved. The intraoperative transesophageal echocardiography showed an excellent biventricular function. The patient was transferred under low inotropic support and nitric oxygen (NO) insufflation toward our intensive care unit. The NO could be weaned within the first 5 hours; the catecholamine therapy could be substantially reduced, keeping epinephrine on a low-dose basis for 3 days. With sufficient pulmonary function, the patient was extubated 6 hours after the operation. No relevant rhythm disturbances occurred. Mobilization started immediately after removing the pulmonary catheter. The immunosuppressive regimen in our institute is based on a triple-drug regimen including corticosteroids, mycophenolate mofetil, and calcineurin inhibitor (ciclosporin). An induction therapy with antithymocyte globulin was applied to the patient. Based on a cytomegalic virus status mismatch, an immune globulin therapy was conducted. Repeated echocardiography revealed normal left ventricular function and good right ventricular function without relevant valve insufficiency. The direct postoperative course was uneventful and free from major complications. With stable levels of immunosuppression therapy, stable cardiopulmonary function, and no of signs of infection, the patient was discharged to a rehabilitation clinic. Endomyocardial biopsy was performed 25 days after the transplantation, with histopathological inconspicuous findings with no indication of rejection (International Society of Heart and Lung Transplantation, revised Allograft Rejection System, Grade 0, ISHLTOR).\nOUTPUT:" }, { "from": "agent", "value": "Granulomatosis with Polyangiitis" } ]

[ { "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 a history of repeated episodes of gross hematuria, weight loss, and reduced appetite. On evaluation, he was found to be cachexic, with pallor and icterus. He was anemic, with raised bilirubin and mildly altered liver enzymes. The contrast-enhanced CT scan showed a lobulated enhancing bladder mass with a paravesical extension (Figure 3), abdominal lymphadenopathy and multiple liver metastases\n. The initial biopsy was reported elsewhere as poorly differentiated carcinoma. IHC was not performed on the initial biopsy. The slides were reviewed. Sections from the lesion showed a proliferation of tumor cells arranged in sheets and nests, with moderately pleomorphic small cells, with scant cytoplasm, hyperchromatic round to overlapping oval nuclei, and inconspicuous nucleoli (Figure 4A). Brisk mitoses (>50 mitotic figures/10HPF) and a few karyorrhectic debris were noted. Hemorrhage and necrosis were also seen. On IHC, the tumor cells were positive for neuroendocrine markers, chromogranin (Figure 4B), and synaptophysin. The tumor cells also expressed positivity for EMA and p63. The tumor cells were negative for LCA, ruling out the differential diagnosis of lymphoma (Figure 4C). Based on these findings, a final diagnosis of SmCC was given. Ki-67 labeling index was 99% (Figure 4D). The patient was advised on the prognosis and started on palliative care. He is currently on follow-up (seven months to date).\nOUTPUT:" }, { "from": "agent", "value": "Neuroendocrine tumors of the urinary bladder, Small cell carcinoma of the urinary bladder" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Our patient was a 55-year-old man with a past history of hypertension and spine surgery. He went to our Emergency Department with a two months history of colicky abdominal pain, more intense at the right inferior abdominal quadrant. He had also unintentional weight loss of 8 kg in the previous four months. Physical examination revealed tenderness in the right inferior abdominal quadrant. Laboratory tests were normal. 1). 2). 3). 4). Postoperatively, the patient did well, without complication. He was discharged home uneventful at the 7th postoperative day (Table 1). On pathological examination, gross inspection of the specimen revealed a solid, well-defined mass, measuring 5 x 5 x 4.5 cm, near the base of the appendix with exophytic growth into intestinal lumen. It obstructed the appendix, causing a mucocele. There was no nuclear atypia or mitotic activity. Immunohistochemically, it was positive for smooth muscle actin and negative for desmin, CD34, S100, CD31, AE1AE3 and CD117. It also stained negative for ALK. The tumor was removed completely. He did well in the last 7 months.\nOUTPUT:" }, { "from": "agent", "value": "Inflammatory myofibroblastic tumor, Ileocecal intussusception" } ]

[ { "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 male (height 5'11\", weight 217 lbs [98.6 kg], and body mass index [BMI] 29.48 kg/m2) presented with a 1-year history of progressive bilateral low back pain, numbness, and weakness accompanied by 2 months of bowel incontinence and urinary retention. On examination, he exhibited mild bilateral lower extremity weakness (e.g., hip adduction [4/5 bilaterally], quadriceps [4/5 bilaterally], and dorsiflexion [4/5 left]). The lumbar magnetic resonance imaging (MRI) with and without gadolinium demonstrated L3-S1 severe spondylosis/ stenosis, for which he underwent a L3-5 decompressive laminectomy [Figure 1a-d]. Two weeks postoperatively, he continued to experience numbness and weakness of both lower extremities and continued sphincter incontinence. The postoperative lumbar MRI with and without gadolinium showed typical postsurgical changes from L3-S1. Five months later, he still had a residual motor deficit (4/5), diffuse bilateral hyperreflexia/bilateral Babinski responses, decreased pinprick/light touch in both lower extremities (no specific level), and decreased vibratory sensation over the ankles and knees bilaterally. The clinical picture was that of an upper motor neuron disorder. Within 1 month of surgery, the patient's symptoms had improved.\nOUTPUT:" }, { "from": "agent", "value": "Thoracic myelopathy" } ]