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A 25‐year‐old woman was referred to our department for having one spontaneous abortion and two voluntary terminations of pregnancy due to fetal hydrocephalus. Blood samples of this couple and tissue of the last hydrocephalic fetus were collected. The familial pedigree was consistent with X‐linked recessive inheritance (Figure 1). | 100 |
The third pregnancy was similar to the second one. The ultrasound scan evaluation at 25 + 4 gestation weeks revealed the bilateral ventriculomegaly with dilatation of the third ventricle and polyhydramnios. The magnetic resonance imaging (MRI) further proved the presence of callosal agenesis and lissencephaly (Figure 2). | 100 |
Graphic illustration of the hamstring tendons reconstruction of the sterno- and acromioclavicular joints using bony tunnels. Stabilization was reinforced with suture anchors placed at the base of the coracoid and on the antero-superior aspect of the first rib | 99.8 |
A. (High-power magnification; H&E) Severe arteriolar mucoid intimal thickening showing a considerable reduction of the arterial lumen with adjacent sclerotic changes (green arrow). Schistocytes and several fibrin thrombi can be appreciated within the lumen of small adjacent vessels (red arrow). B. (PAS stain; high- power magnification) Arteriolar thickening with adjacent tubular epithelium showing loss of brush border and tubular epithelial damage(black arrow). C. (Jones silver stain; high- power magnification) Arteriolar intimal damage (yellow arrow). | 99.6 |
He presented to his family doctor with a 3-month history of a progressively painful swollen right ankle. He was referred to an orthopedic specialist in a near-by provincial center where an MRI identified a suspected tumor in his distal tibia (see Figure 3). A biopsy confirmed the diagnosis to be a malignant fibrous histiocytoma type osteosarcoma. No systemic metastases were detected. | 100 |
We report the well-tolerated medical and surgical management of localized osteosarcoma in a patient with cystic fibrosis including the first reported identification and eradication of NTM during chemotherapy treatment. The observed positive pulmonary outcome following chemotherapy highlights several potential cellular mechanisms that deserve to be explored for possible therapeutic approaches for children with CF. | 99.9 |
Case 1. The patient 2.10 year old was referred for evaluation because of developmental delay and dysmorphic features. The karyotype of the patient was normal. Array-CGH analysis revealed a terminal deletion of the chromosome 8 (8p23.1p23.3) and a terminal duplication of the chromosome 10 (10q26.11q26.3). Unexpectedly additional FISH analysis showed an unbalanced translocation der(8)t(8;10)(p23.1;q26.11) in 77% and a normal karyotype in 23% of cells. | 100 |
The G banded karyotype was performed from 50 metaphases from peripheral lymphocytes. FISH examination of 250 nuclei was performed with centromeric probes (Cytocell) on three germ layers. Haplotyping of X chromosome was done by fragment analysis using ARGUS X-12QS kit and evaluated by ABI 3130 with software gene Mapper v 4.1. | 99.75 |
Constitutional trisomy 8 mosaicism could have remained undetected because of its wide phenotypic variability. This shows that array-CGH is more suitable for providing information on entire genomic dosage imbalances and should be considered before MLPA studies even if there is a sufficient clinical suspicion of a microdeletion/microduplication syndrome. | 99.3 |
The presence of a duplication and a deletion of non-subtelomeric regions in the same patient is a rare event. Duplication of 15q11.2 (OMIM # 608636) and deletion of 22q11.2 (OMIM #188400) each leads to a well-known syndrome but their presence in the same patient is very unusual. | 99.9 |
The phenotypic and genetic findings in our patient will be compared with those in previously reported females with MD to illustrate the variability and severity of the clinical manifestations in females with MD. Presumably the occurrence of X-linked recessive MD in the female might be explained by the skewed X inactivation forced by the selection against active derivative X chromosome. | 99.9 |
We report the peripheral blood karyotypes and clinical presentations of nine individuals with balanced translocations of sex chromosomes and autosomes seen over a 17-year period (2001 to 2018). At least 25 G-banded metaphases were analysed from each sample. | 99.9 |
Conclusions: Comparison of our patient’s phenotype with previously reported chromosome 14q interstitial deletion cases confirmed the presence of common clinical features and highlights the utility of array CGH as a diagnostic tool in clarifying the developmental delay etiology. | 99.9 |
The translocation t(12;21) is one of the most common rearrangements in pediatric acute B-cell lymphoblastic leukemias (B-ALL) and it is usually associated with a favorable prognosis with a cure rate of 90%. Herein we report a pediatric B-ALL case with t(12;21) within the context of a complex karyotype. | 99.94 |
We describe a series of 17 out of 370 AML patients who showed MLL gene rearrangements diagnosed at our Centre between November 2010 and February 2019. Interphase FISH analysis using Vysis breakapart probe for the MLL gene was positive for MLL gene rearrangement in all the 17 patients. Fourteen of the 17 patients had shown the rearrangement in G-banded karyotypes also. | 99.9 |
We present a prenatal case of a structural abnormal Y chromosome in which analyses by QF-PCR for the rapid screening for common aneuploidies and classical cytogenetics revealed apparently discordant results. The molecular assay was compatible with a Y chromosome disomy while the classical cytogenetics showed an apparently normal male karyotype. | 99.94 |
Family 1: A pathological CMA in a malformed fetus led to the finding of a reciprocal translocation t(5;12)(q35.1;p13.3) in the mother and also in the grandmother. A brother of this grandmother had documentation of a previous diagnosis of reciprocal translocation t(5;6)(q35.1;q27). The new studies performed in this side of the family showed the correct translocation detected in our lab t(5;12)(q35.1;p13.3) in the brother and his children. | 99.94 |
Complex chromosome rearrangements (CCR) account for a very small number of cases described in the literature. It is very rare that both homologues of the same chromosome pair are involved each in a different rearrangement. We report a case where a reconstructed derivative chromosome was observed in a fetus of a female carrier of two different translocations involving both chromosomes 4. | 99.9 |
The extended family study at the parents of the mother shows that her father is carrier of a 17q12 microduplication and her mother a 17q12 microdeletion. The haplotypes analysis in 17q12 confirm the transmission of theses 2 rearrangements to their daughter. | 99.94 |
This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine (equivalent to an institutional review board). This study was performed according to the approved guidelines and regulations. Written informed consent for study participation and publication of identifying information and images was obtained from each subject and child’s guardian prior to the study. A careful clinical record on the proband and his father was obtained by a medical geneticist and plastic surgeons. | 99.8 |
Tumor heterogeneity for MAPK activation may or may not associate with GNA11 mutational status. (A) Differential mutation status of a UM with high and no pERK1/2 immunostaining. Areas with strong staining showed no mutation while areas with no-staining showed heterozygous GNA11Q209L mutation. Yellow arrow highlights a blood vessel with strong pERK1/2 staining in a negative staining part of the tumor. Blue arrow highlights the location of the mutation. Only tumor regions with negative pERK1/2 staining showed the mutation. (B) Example of a tumor with prominent heterogeneity of pERK1/2 that was not associated with mutation status of GNA11. The red arrow shows tumor area with strong pERK1/2 staining. The blue arrow highlights the location of the mutation. Both the pERK1/2 positive and negative parts of the tumor showed the mutation. | 99.9 |
The variant c.793-1G > A identified in the proband tested has been previously reported in an individual affected with breast cancer and in individuals who underwent genetic tests for hereditary cancer risk . The variant database ClinVar contains entries for this variant (rs730881687) where it is listed as likely pathogenic and pathogenic (https://www.ncbi.nlm.nih.gov/clinvar/variation/182430/) without any available experimental evidence reported. Our clinical interpretation (pathogenic) for this variant along with the above experimental information has now been submitted to ClinVar (SUB5321389). | 99.75 |
One publication detailed four surgical site infections transmitted by a surgeon with nasopharyngeal carriage to four prostatic surgery patients . Pneumococcal infection occurred at skin and soft tissue near the surgical site of case-patients. Transmission was attributed to the surgeon persistently wearing a poorly fitting mask. | 99.94 |
Large vessels and tumour-suspicious regions were avoided. rCBV was calculated by dividing the tumour CBV by the CBV of the reference tissue. Figure 1 shows an example of ROI placement in the regions listed above.Fig. 1Examples of region of interest (ROI) placement in a patient with a glioblastoma multiforme in the temporal lobe in the right hemisphere. ROI placement in the contralateral hemisphere (left) in the eight regions: (A) Normal-appearing white matter (NAWM) by choice and grey matter (GM) by choice. (B) NAWM in a slice of tumour hotspot. (C) Putamen. (D) frontal and parietal NAWM. (E) Thalamus. (F) Centrum semiovale | 99.7 |
a A giant solid pseudopaillary tumor (16 cm) located in the pancreatic head and involving the superior mesenteric artery (SMA). b SMA reconstruction using an autologous great saphenous vein. c CT scan of a retroperitoneal ganglioneuroma involving the pancreatic head and SMA. d SMA reconstruction using a size-matched allogeneic frozen iliac artery graft | 99.9 |
Informed consent for the publication of this case report and use of the accompanying images was inferred for the patient as per the institution’s policy. All patients are informed that their images may be used for teaching purposes including publication in peer reviewed journals and are offered the option to opt out. | 99.44 |
Preoperative and postoperative slit-lamp photographs of iridodialysis patients who underwent double-armed polypropylene suture. a: preoperative appearance with iris dislocated between 4 to 9 o’clock. b: illustration of pupil restored to nearly round shape at 1 day after operation | 99.9 |
Interstitial lung disease was reported as a serious AE in a 2-year-old cblC-defective male patient treated with betaine anhydrous (2 g/day) who experienced respiratory distress related to pulmonary hypertension and interstitial lung disease leading to death. | 99.94 |
Two other deaths occurred during the registry. A 9-year-old CBS-deficient B6 non-responder male patient treated with 6 g/day of betaine anhydrous (initiated after the start of the event) experienced brain vein thrombosis which led to brain oedema and intracranial hypertension. The patient was diagnosed 2 days prior to the start of treatment and methionine levels were 433 μmol/L a day prior to death. A 15-month old MTHFR-deficient female patient treated with 3 g/day betaine anhydrous died of respiratory distress. These deaths were not considered as related to treatment. | 99.94 |
This article is a comparative study of two cases involving similar iatrogenic injuries that manifested after puncture for deep venous access and in which different diagnostic and treatment approaches were taken. The objective is to demonstrate how technological advances have influenced treatment of difficult-to-access cervicothoracic vascular traumas. A detailed review of the literature contributed to illustration of the evolution of this subject and supports our conclusions. | 99.9 |
It is often difficult to diagnose esophageal neurofibroma preoperatively. The preparation of ECMO could be considered in patients with severe airway obstruction for safe tracheal intubation. This is the first case of life-threatening giant esophageal neurofibroma with severe tracheal stenosis. | 99.9 |
MR and measurement of mean transmitral pressure gradients by TTE was performed intra-procedural and one day after MitraClip implantation. Intra-procedural and post-procedural TTE was performed by cardiologists specialized for non-invasive imaging according to current recommendations of the European Society of Cardiology . | 99.2 |
(a) Histological specimen showing the section of the distal sigmoid colon presumed to be malignant and the edges of the dental plate. Diverticular out-pouchings can also been seen in this specimen. (b) The recovered partial denture with a single tooth measuring 5 cm in longest length with sharp jagged edges that presumably contributed to its impaction. | 99.9 |
An example of treatment course at the Mainz center. a Initial finding involving wound necrosis following forefoot amputation in patient 5. b Intraoperative finding following debridement (wound area 29 cm2). c Interim result after 8 weeks of Omega3 wound matrix therapy. d Healed wound following a total treatment duration of 33 weeks (material used: 22 wound matrices à 3 × 7 cm) | 99.94 |
A surgical gesture consisting of a simple en bloc excision of the tumor without bone restauration has been proposed. Surgery took place under a brachial plexus block and was performed via a medial dorsal approach. A complete excision of the nidus was undertaken using an oscillating saw associated with the removal of the sclerotic bone inside the lesion with a curette. | 99.94 |
All patients were scheduled to undergo knee US examination and US-guided arthrocentesis on the same day. Two treated patients who had SF aspiration also underwent US-guided synovial biopsy from the supra-patellar pouch. This study was approved by the ethics committee of Keio University and written informed consent was obtained from all patients. | 99.75 |
Muscle CT at age 14 (Fig. 1b) showed at mid-thigh marked hypodensity of the sartorius bilaterally and of less extent of the upper part of the gracilis. MRI at age 35 (Fig. 1c) showed scattered abnormal high-intensity areas in the internal tongue muscle and in the posterior cervical muscles. | 99.94 |
Example of the course of electronic patient reported outcome measures in a 75-year-old patient who underwent definitive radiochemotherapy for locally advanced head and neck cancer. Day 45 constitutes the last assessment during therapy; d76 was approximately 3 weeks after the end of treatment. d: day; ADL: activities of daily life. | 99.94 |
Informed consent to allow publication of this case report and accompanying images was obtained from the patient who is described in this report in outpatient consultation room. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request. | 99.94 |
All operated mice (lesion and sham) were placed under a heating lamp (temperature controlled at 30 °C ± 2 °C) for recovery. Postoperatively all mice were single housed and regularly screened for seizures and later for locomotor deficits. Conscience was regained after three to four hours post-op. During four days following the surgery all mice had the possibility to drink water with an addition of 10% glucose to sustain recovery. | 99.7 |
A mesenteric lymph node demonstrated atrophied cortical follicles and medullary cords (Figure 4a). Scattered to coalescing lymphocytes within the cortex and medullary cords were revealed by IHC to be CD3+ T cells (Figure 4b) and CD20+ cells. An in-situ hybridization assay indicated that scattered and aggregating lymphocytes within the mesenteric lymph node contained small amounts of intracellular viral nucleic acid (Figure 4c). A sample of bone marrow was considered by IHC to be histologically normal (Figure 4d) and diffusely CD3 negative (Figure 4e). An in-situ hybridization assay demonstrated moderate numbers of hematopoietic cells containing viral nucleic acid (Figure 4f). | 99.94 |
The patient was discussed in a multidisciplinary oncology meeting and the decision was made to proceed with surgical extirpation of the right kidney and the paraaortic mass. We performed an open right radical nephrectomy with right retroperitoneal lymph node dissection and excision of left paraaortic mass. | 99.94 |
Her altered mental status was initially interpreted in context of a Systemic Inflammatory Response Syndrome (SIRS) due to a suppurative otitis media and she was hospitalized to comply intravenous antibiotics and fluids (due to prostration she was unable to perform oral antibiotic treatment or hydration). | 99.94 |
Cardiovascular MR. (a) Transaxial steady-state free precession cine of the ascending aorta shows the intraluminal mobile mass. (b) Axial slice of axial spin echo (half-Fourier acquisition single-shot turbo spin-echo) sequence at the same position as the CT image in Figure 3. The irregularly thickened anterior wall of the aortic graft with intraluminal components is noteworthy. (c) Axial slice of gradient echo (true fast imaging with steady-state free precession) sequence at the same position as the previous image confirms the irregularly thickened anterior wall of the aortic graft with vegetation extending into the lumen. | 99.9 |
An urgent surgery of the ascending aorta was performed and the imaging findings were confirmed. The perigraft tissue was abnormal with adhesions and suppurated fibrin layers; there was an intraluminal vegetation attached to the anterior wall. The aortic valve appeared unaffected. The graft was then replaced. The patient made a full recovery after post-operative antibiotic therapy. | 100 |
An example of an ultrasound measurement. a Initial position. A1: distance between the dorsal surfaces of the ulnar and the radius at the initial position. b Final position after compression. A2: distance between the dorsal surfaces of the ulnar and the radius at the final position after the compression. Arrow shows pressure to the ulna. A1–A2 were defined as the changes of radioulnar distance | 99.25 |
Patient operated in an interdisciplinary approach for synovial sarcoma of the lower extremity. (A) Pre-OP MRI of the lower extremity with visible mass in the left lower leg. (B) Excised tumor tissue with resected fibula segment. (C) Tumor bed with prophylactic plate osteosynthesis on tibia. (D) Clinical presentation in the 6 months follow-up. | 99.94 |
Patient presenting with a tibia-infiltrating leiomyosarcoma. Resulting primary bone defect was bridged by fibula-pro-tibia operation in an interdisciplinary approach. Pre-OP clinical (A) and MRI (B) presentation of the tumor. (C) Excised tumor tissue with affected tibia segment and lower leg during the resection. (D) Beginning tibialization of the fibula graft in the 8 months follow-up x-ray. | 100 |
Fifteen-year old male patient presenting with osteosarcoma in the distal femur. Femoral reconstruction was performed with a free fibula graft combined in an allograft as described by Capanna. Pre-OP MRI presentation of the sacroma mass in the distal femur (A). Intraoperative images of the resected tumor (13 cm length) (B) and the resulting femoral defect (C). X-ray of the result in the 2 month follow-up (D). (E) and (F) demonstrate the intraoperative preparation of the microvascular free fibular autograft supported by a peripheral massive allograft shell. | 100 |
Knee reconstruction with tumor prosthesis and microsurgical soft tissue coverage in a patient presenting with femur-infiltrating leiomyosarcoma. (A) Pre-OP MRI of the left knee (B) Resected distal femur with tumor free margins (C) Intraoperative situation with implanted modular tumor prosthesis after tumor resection. (D) Post-operative esthetic outcome in the 6 months follow-up. | 99.94 |
(A) The basal functional imaging by FDG-PET before starting imatinib revealed a pathological FDG up-take corresponding with several abdominal lesions. (B) Functional imaging by FDG-PET after one month of treatment revealing a complete metabolic response of all lesions. | 99.94 |
A mutation consisting of a deletion of 10 bp and the insertion of a cytosine (c.2534_2543delinsC) affecting exon 18 of PDGFRA (involving residues from 845 to 848: p.His845_Asn848delinsPro) was detected (NM_006206 - GenBank) (Fig. 4). KIT resulted as a wild-type for the hotspot exons examined.Figure 4(A) Chromatogram showing a deletion of 10 bp and the insertion of a cytosine (c.2534_2543delinsC) affecting exon 18 of PDGFRA (involving residues from 845 to 848: p.His845_Asn848delinsPro); (B) chromatogram showing the counterpart wild-type exon 18 of PDGFRA. | 99.5 |
(A) Chromatogram showing a deletion of 10 bp and the insertion of a cytosine (c.2534_2543delinsC) affecting exon 18 of PDGFRA (involving residues from 845 to 848: p.His845_Asn848delinsPro); (B) chromatogram showing the counterpart wild-type exon 18 of PDGFRA. | 99.7 |
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Case 3. \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$1/2 \leq s< r <1$\end{document}1/2≤s<r<1. | 99.94 |
The Ethics Committee of the Isfahan University of Medical Sciences approved this project. All family members signed informed written consent prior to recruitment. They met the following criteria: 1) confirmation of HL by Pure tone audiometry (PTA) from 250–8000 Hz 2) the autosomal recessive inheritance deduced through pedigree analysis 3) existence of three or more affected members within the pedigree. A complete clinical investigation was performed to exclude environmental exposures and to determine the presence of syndromic findings in each family. | 99.7 |
Meningitis was clinically suspected in the presence of previously described signs . Sepsis was clinically suspected in the presence of a compatible clinical syndrome and abnormal chemical test results . A case was considered confirmed in the presence of positive culture or molecular tests . | 99.9 |
Six days after admission the patient had a generalised tonic-clonic seizure. Progressive petechial haemorrhage was visible on repeat CT corresponding to the area of parenchymal abnormality. Progressive neurological symptoms were documented with new mild right-sided neglect and 4/5 right upper limb weakness. The patient was prescribed a loading dose of phenytoin and commenced on levetiracetam with good effect. | 100 |
Long-term outpatient clinical follow-up is ongoing. Headache symptoms have entirely resolved and right upper limb weakness remains mild (1/5) with minimal ipsilateral pronator drift. Moderate expressive and receptive dysphasia persist but have improved since readmission. The patient uses a computer to aid with communication. Seizures are well controlled on levetiracetam. | 99.94 |
Axial T2 (left) and axial T1 weighted post-contrast sequences (right) performed 18 months after initial presentation identified progressive insula and temporal lobe encephalomalacia and volume loss with persistence of enhancing left insular granulomas which remain stable in size and morphology. | 100 |
Herpes simplex encephalitis may rarely induce a chronic granulomatous reaction with headache and intractable seizures the most common presenting clinical features. Enhancing “mass-like” granulomatous nodules are rarely identified on MR brain imaging. CSF PCR is frequently negative for the detection of viral DNA in this context. Chronic granulomatous encephalitis is almost exclusively reported in children. We report a very rare case of suspected adult chronic nodular granulomatous encephalitis. | 99.94 |
A 15.25 year old boy was referred to the pediatric endocrinology clinic for evaluation of short stature. His height was 149.9 cm (-3.04 SDS) and his weight 52.3 kg (-2.3 SDS) with a HC 53.8 cm (-2.0 SDS) at presentation. He was 2.05 SD shorter than his TH. Clinical and laboratory characteristics of the patient at presentation and during follow-up are given in Table 1. | 100 |
His parents were unrelated but originated from the same village. Table 2 shows clinical and laboratory characteristics of the patient and his mother and sister. Mother’s height was 155.6 cm (-1.28 SDS). She reported achieving menarche at 13 years. Father passed away due to chronic renal failure. His reported height was approximately 170 cm (-0.9 SDS). There was no information on the father’s pubertal history. TH of the patient was 169.3 cm (-0.99 SDS). His elder sister’s birth weight was 3000 g at 40 weeks of gestation (-0.9 SDS) and height was 157.1 cm (-1.02 SDS) at 21 years of age. Her age at menarche was 12 years. | 99.94 |
Puberty of the patient started at 15.9 years. Testes volumes were 6 mL/6 mL (Tanner stage G2). His height was -3.0 SDS at onset of puberty. His bone age was retarded by approximately two years when compared to his chronological age. His peak height velocity was 7 cm/year during progression of puberty (Tanner stage G3; Figure 1) and total height gain during puberty was 19.6 cm. | 99.94 |
His sister’s IGF-1 concentration was low but his mother’s was normal. Although their IGFBP-3 concentrations were decreased they were higher than that of the patient. His sister and mother had normal fasting insulin and glucose levels. Their L1-L4 BMDs were also normal (Table 2). | 99.94 |
Pedigree and verification of the de novo variation in SAMD 9 in the family. a The proband has a heterozygote variant but the parents not. b Pedigree of the patient is shown with SAMD9 / SLC19A2 genotype information. Black square indicates the patient affected by MIRAGE syndrome caused by a de novo variant in SAMD9. Rhombus indicate stillbirth. NA denotes genotype not available. Square filled with dots indicates the proband suffered from TRAM syndrome. The compound heterozygote found in the patient was carried by father and mother respectively | 99.94 |
We present a case report where the combination of laparoscopy and TURP was complicated by erosion of the mesh into viscera which was presented as an inguinal abscess. This case is reported by an operator with experience as a digestive surgeon. This research work has been reported in line with the SCARE checklist . | 99.94 |
These five cases included death from 1) a bowel perforation following a mechanically induced abortion; 2) a central venous line sepsis in a woman in the ICU with bleeding from coagulation disorders following fetal death syndrome; 3) a craniotomy wound infection in a hypertensive woman with intracranial bleeding and eclampsia; 4) severe sepsis following multi-organ failure after iatrogenic hypotension due to overdose of antihypertensive medication in severe pre-eclampsia and 5) endocarditis in a woman with aortic valve prosthesis. | 99.9 |
The internal anal sphincter was sutured end-to-end with interrupted polydioxanone (PDS) 3-0 sutures. The external anal sphincter was sutured with overlapping interrupted PDS 3-0 sutures. The skin was closed with a T-suture using Monosyn 3-0. A small part of the skin was left open for drainage. A Foley catheter was used until the 1st postoperative day. Perioperative prophylactic antibiotics with methronidazol 1 g and doxycycline 400 mg intravenously were administered. | 99.9 |
Findings of the reconstruction operation. a Reconstruction via an anterior thoracic route with free jejunum interposition and gastric tube. b Vascular anastomosis of the feeding artery and drainage vein of free jejunum. End-to-end anastomosis of the jejunal artery and left superior thyroid artery. End-to-side anastomosis of the jejunal vein and left internal jugular vein | 99.9 |
Six other patients with severe acute rejection 1.5–8 years post transplantation received 3 × 1 g methylprednisolone alone without antibody therapy./ Responders to anti-CD4 therapy were characterized by creatinine levels below 50% of maximum increase 4 weeks after rejection treatment. | 99.56 |
The third case described in this paper had complete epidemiologic and molecular evidence that acquisition was from the use of tap water with the nebulizer. Molecular typing of the isolates (patient 3 clinical and environmental isolates from Hospital B and the nebulizer; patient 2 clinical and Hospital A environmental isolate) were the same sequence type suggesting use of tap water in the nebulizers as the possible source of infection. | 99.9 |
a Chest computed tomography showing multicystic changes in the lower lobe of the right lung. b Enhanced computed tomography showing the right aberrant artery arising from the descending aorta (arrow). c Three-dimensional computed tomography showing the right aberrant artery arising from the descending aorta (arrow) | 99.94 |
Surgical planning of the Z-plasty along the post-burn scar contracture. The marking of the incision runs along the shortened flexion fold. The post-burn scar contracture was released after performance of the Z-plasty. The full thickness skin graft was inserted into the incision defect after stretching the small toe in full extension. | 99.9 |
Postoperative course was uneventful for both recipient and donor. The donor stayed at the intensive care unit for one day and the recipient was discharged from the intensive care unit after two days. The total length of hospital stay for both recipient and donor was six days. | 99.94 |
The patient is positioned supine on a radiolucent operating table with the knee flexed at 30 degrees. Tourniquet use depends on the surgeon and may be used in very distal fractures. The use of a lateral femoral distractor with pins placed in the femoral diaphysis and proximal tibia metaphysis facilitates fracture alignment and disimpacts intra-articular fragments. Intra-operative use of C-arm is necessary for proper plate placement and fracture reduction and alignment . | 99.9 |
A rare but known complication of IED is inflammatory joint arthropathy that potentially leads to permanent erosive joint changes. This leads to a spectrum of focal joint changes causing gait disorders requiring surgical interventions to complete loss of mobility needing joint arthroplasty as a last resort. | 99.9 |
(A) 18FDG-PET scan showing three hypermetabolic nodular lung lesions localized at the medial (1) (SUV max 3.1) and lateral (2) (SUV max 2.7) segment of the right medium lobe and at the apical segment (3) of the left inferior (SUV max 3.9) lobe of the lungs. (B) pWBS showing 131-I uptake corresponding to the hypermetabolic lung lesions localized at the medial segment of the right lobe and at the left inferior lobe. | 99.25 |
The patient remained hypotensive and hypoxemic despite aggressive supportive management. The patient went into cardiac arrest 11 hours after ED presentation with asystole and could not be resuscitated with prolonged advanced cardiac life support (ACLS) protocol measures. | 99.94 |
The patient’s travel companion remained well during and after the trip. None of the other tourists on the tour developed symptoms during the trip. No information regarding their health status after the trip was available. No contacts of the patient had any symptoms of influenza after her return from her travel. | 99.9 |
The last presented cases all had as a main issue the informed consent. Surely informed consent is invariably necessary for every medical procedure. It is mandatory for the patient to be informed of any treatment or medical treatment and obtaining informed consent at the time of admission to any hospital unit does not imply acceptance of any further investigations or treatments . | 99.9 |
An 85-year-old with RP was referred to our center in April 2016 for decrease in visual acuity and metamorphopsia in the left eye (LE) for a few weeks. The patient had the clinical diagnosis of retinitis pigmentosa from the age of 15 years old and for this reason did not do military service. He reported a history of night blindness and narrowing of the subjective visual field in both eyes with a recent visual impairment in the LE. Best corrected visual acuity was 0.1 LogMAR (80 LN) in the right eye (RE) and 0.7 LogMAR (50 LN) in the LE. The visual field test was not reliable due to the poor collaboration of the patient. | 100 |
In conclusion this case highlights the importance of history taking and clinical evaluation of psychotic patients for causes other than primary psychiatric illness and the need for video EEG monitoring in the psychiatric department. It also highlights the importance of consideration of diagnosis of CPS even when the EEG is normal based on clinical suspicion and improvement with antiepileptic medication. | 99.94 |
Planning includes the process where these volumes are delineated. This is illustrated with the example (see Figure 3) of a large right cheek that has failed surgery. This lesion is mapped with RCM by the dermatologist. The patient was consented and a planning appointment was made. At planning the radiation oncologist reproduced the RCM area on the patient's face. A template was made of that area. A mask was made for the patient; the template was used to put the area defined by the template on to the mask; the lines on the mask were then marked out with wire so that during the planning scan the marks could be captured by the scanning. | 99.94 |
There are very few cases that cannot be treated with radiotherapy. One case is radiotherapy to lentigo maligna of the conjunctivae on the globe. This could be treated with brachytherapy. There could also be an unsealed source solution to this. Both would be considered experimental. | 99.56 |
It is known that the occurrence of hard exudates (HE) is one of the main threats to vision loss especially when they occur near or on fovea . Figure 1 shows an example of color retinal fundus image with HE. HE appears at late background and NPDR stages on the surface of retina as bright yellowish or white at different locations and with variable shapes and sizes ranging from a few pixels to thousands of pixels in the retinal images. It is well accepted that the detection of HE in color retinal images plays a vital role in DR diagnosis and monitoring the progress of treatment. HE detection is therefore the main emphasis of this study. | 99.75 |
a Fluoroscopic image showing focal ‘wasting’ of the pre-dilatation angioplasty balloon (arrow) through the stent wall. b Post Supera stent deployment showing satisfactory stent opening through the cephalic arch stent graft. c Antegrade venogram showing good flow through the Supera stent into the subclavian vein with no residual stenosis. d Retrograde venogram performed 6 months after stent deployment showing a widely patent Supera stent and axillary vein | 99.94 |
Plain film of the pelvis demonstrated the avulsion of the anterior segment of the left iliac crest apophysis (Figure 1). Complementary CT with 3D reconstructions (Figure 2) was preferred to ultrasound because of the very strong habitus of the patient. Avulsion of the iliac crest apophysis with respect of the anterior superior iliac spine apophysis was confirmed. Signs of preexisting chronic mechanical bone stress of the parent bone were also found on plain films (Figure 1) but also on axial CT views (Figure 2c). Finally 3D CT views clearly illustrated the axis of the avulsion producing outwardly and downwardly emphasizing the action of the tensor fascia lata (Figures 2 & 3). The patient was successfully treated conservatively. | 99.94 |
Pelvic plain film (a) and focused view (b) of the left iliac crest illustrate avulsion of the anterior part of the left iliac crest apophysis. Diastasis between the parent bone and the apophysis is clearly visible. The apophysis is displaced outwardly and downwardly (white arrow). Transverse fracture of the iliac crest apophysis itself is associated (black arrow). Preexisting bony sclerosis of the parent iliac bone due to chronic overuse is visible (white stars). | 99.9 |
Typical posture of a right-handed soccer during fast kicking (a) volume rendering CT view of the muscles inserting on the iliac crest of our patient (b). Kicking is initiated by rotating the pelvis far to the left (curved black arrow on a) around the supporting left leg and by bringing forwards the thigh of the right kicking leg while maintaining the upper trunk to the right (curved white arrow on a). The sudden traction and contraction of the left external oblique (white arrow) probably pulls the apophysis off the left iliac crest. The action of the external oblique muscle is abruptly thwarted (red flash) by the antagonist traction of the gluteus medius (grey arrow) but merely of the tensor fascia lata (black arrow) that displaces the avulsed apophysis outwardly and downwardly. Black star = Sartorius. | 99.9 |
The status of posteromedial support. a A distinct absence of posteromedial support with no contact between the proximal and distal fragments (black arrow). b An avulsion fracture of the lesser trochanter with contact between the proximal and distal fragments (white arrow). c An impacted fracture of the proximal and distal fragments (white dotted arrow) | 99.2 |
Treatment of a bilateral rostral lower lip avulsion in a cat. (A) Prior to debridement of oral tissues. (B) After debridement of oral tissues a tacking suture was placed to reduce dead space by anchoring the connective tissue of the lower lip to symphyseal connective tissue. (C) Final closure was accomplished using simple interrupted sutures placed interproximally. | 99.94 |
Treatment of a bilateral rostral and caudal lower lip avulsion in a dog. (A) Prior to debridement of oral tissues. (B) Following debridement of oral tissues and extraction of remaining mandibular incisor teeth. (C) Placement of an intraosseous guide hole. (D) Reduction of dead space by anchoring the connective tissue of the lower lip to the mandibular symphyseal connective tissue. (E) Final closure with simple interrupted sutures. (F) Penrose drain placed. | 99.94 |
OCT images illustrating retinal changes over time (day 1 to day 7) postoperatively. The three flat reflective bands on the OCT images correspond to the three chips on the neurostimulating array shown in the SLO fundus image. The chips blocked the tissue underneath from being seen on OCT. Retina on the chips in OCT demonstrates thinning from postoperative days 1 to 7. | 99.9 |
a H&E staining of the primary urothelial tumor (40X magnification). b Immunohistochemistry (IHC) reveals strong staining of AFP in the primary resection specimen (40X magnification). c Staining for PD-L1 shows very strong expression in more than 50% of cancer cells (40X magnification) | 99.1 |
Representative coronal reconstruction from CT scans obtained throughout the clinical course. (*) indicate retroperitoneal lymphadenopathy and white arrows indicate peritoneal metastases. a CT scan from initial staging (prior to neo-adjuvant chemotherapy). b Progressive disease while on pemetrexed. c Further progression on paclitaxel. d Significant reduction in tumor burden following third dose of pembrolizumab | 99.75 |
We retrospectively evaluated our experience with overlap anastomosis with autonomic nerve-preserved mesojejunum for the lifted jejunal limb in laparoscopic distal gastrectomy with intentional regional lymph node dissection. We also discuss the surgical techniques and technical pitfalls of this approach. | 99.9 |
Catheters were inserted by an experienced interventional radiologist in the Interventional Unit via percutaneous access. The procedure was performed under sterile theatre conditions with ultrasound guided venous access. All TDCs inserted in our centre are cuffed. The catheter is tunnelled subcutaneously for approximately 9 cm – 10 cm from the venous access site. The catheter is then placed under fluoroscopic control with tip positioning in the right atrium. Cutaneous fixation is created with sutures until cuff adhesion – approximately 8–12 weeks. Initial patency and positioning are confirmed during the procedure. The catheter is then locked with heparin (1000 μ/mL) | 99.94 |
Extremely elevated BLLs (BLLs ≥70 μg/dL) now occur rarely in children . We report three cases of severe childhood lead poisoning from folk medications specifically prescribed for treating rhinitis. These cases were complicated by concurrent abnormal liver function which can affect lead poisoning treatment. | 99.94 |
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