en_train.json

[
    {
        "text_id": "100247",
        "sentence_id": 1,
        "text": "A seventy two years old male presented to our clinic with swelling, pain, and limitation of movement at knee joint.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 2,
        "text": "The patient's history revealed swellings and pain at knee joint for nearly last 20 years.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 3,
        "text": "He was prescribed nonsteroidal anti-inflammatory drugs and rest.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 4,
        "text": "But pain didn't relieve and limitations in range of motion occurred at knee joint.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 5,
        "text": "Physical examination findings included a solid and semi-mobile mass at anterior knee region.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 6,
        "text": "Knee joint range of motion was 80 degrees flexion and 0 degrees extension.",
        "relations": [
            [
                "80 degrees",
                "range"
            ],
            [
                "80 degrees",
                "flexion"
            ],
            [
                "0 degrees",
                "range"
            ],
            [
                "0 degrees",
                "extension"
            ]
        ]
    },
    {
        "text_id": "100247",
        "sentence_id": 7,
        "text": "There wasn't any neurovascular pathology.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 8,
        "text": "Antero-posterior and lateral knee X-rays showed degenerative changes and a giant, irregular, calcific mass which started below patella and extended to suprapatellar area.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 9,
        "text": "Knee MRI revealed many loose bodies (consistent with synovial chondromatosis) isointense with fatty bone marrow at all sequences at the level of right knee joint.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 10,
        "text": "Scalloping was observed at tibial and femoral surfaces.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 11,
        "text": "Decision for a surgical intervention was made and after informing the patient, consent was taken.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 12,
        "text": "Under spinal anesthesia, a tourniquet was applied to right lower extremity.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 13,
        "text": "Right knee was entered with an anterior longitudinal incision.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 14,
        "text": "Cutaneous and subcutaneous tissues were passed.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 15,
        "text": "Quadriceps mechanism was opened with a medial parapatellar incision and patella was toppled to left side.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 16,
        "text": "Intraarticular mass was exposed.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 17,
        "text": "The mass was released from surrounding tissues by blunt excision and excised with enucleation.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 18,
        "text": "Then synovial tissue was excised with synoviectomy.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 19,
        "text": "Surgical area was irrigated using abundant isotonic solution.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 20,
        "text": "The excised mass was sent to pathology laboratory.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 21,
        "text": "Pathology evaluation showed that the mass was consistent with synovial chondromatosis.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 22,
        "text": "Active and passive exercises were started at an early period after surgery.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 23,
        "text": "Recurrence was not detected at his last control visit.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 24,
        "text": "Knee movements were at full range when compared with the other knee.",
        "relations": []
    },
    {
        "text_id": "100247",
        "sentence_id": 25,
        "text": "There was no pain or other complaints.",
        "relations": []
    },
    {
        "text_id": "100275",
        "sentence_id": 1,
        "text": "A 33-year-old woman came to Department of Fertility, Endocrinology and Reproduction at Saiful Anwar public Hospital and consulted that she has not menstruated since 5 years ago (28 years old).",
        "relations": []
    },
    {
        "text_id": "100275",
        "sentence_id": 2,
        "text": "Her initial menarche was at the age of 14 years and it is in accordance with the normal growth of a child at her age.",
        "relations": []
    },
    {
        "text_id": "100275",
        "sentence_id": 3,
        "text": "The patient had a regular menstrual period of 5-7 days, she replaced the pads for 2-3 times / day, and had no menstrual pain.",
        "relations": []
    },
    {
        "text_id": "100275",
        "sentence_id": 4,
        "text": "The patient has a history of injective contraceptive that was done every once a month in 2010, and after the injection, she menstruated for two months and then it stopped.",
        "relations": []
    },
    {
        "text_id": "100275",
        "sentence_id": 5,
        "text": "Based on clinical examination and a physical examination, the patient was diagnosed with secondary amenorrhea.",
        "relations": []
    },
    {
        "text_id": "100275",
        "sentence_id": 6,
        "text": "Investigations that were used are ultrasonography, thorax X-ray and CT Scan Head.",
        "relations": []
    },
    {
        "text_id": "100275",
        "sentence_id": 7,
        "text": "Ultrasonography and thorax X-Ray showed that patient is suspected to have right pleural effusion.",
        "relations": []
    },
    {
        "text_id": "100275",
        "sentence_id": 8,
        "text": "CT-Scan examination showed that bilateral ethmoidal sinusitis and pituitary gland was within normal limits.",
        "relations": []
    },
    {
        "text_id": "100275",
        "sentence_id": 9,
        "text": "The treatment plan in this patient is P test therapy with Prothyra 1x10 mg for 7 days, with control on 2 weeks after the use.",
        "relations": []
    },
    {
        "text_id": "100275",
        "sentence_id": 10,
        "text": "P test showed a negative result, because after 14 days of progesterone consumption the prothyra is not bleeding.",
        "relations": [
            [
                "a negative result",
                "test"
            ]
        ]
    },
    {
        "text_id": "100275",
        "sentence_id": 11,
        "text": "The treatment is followed by a E+P test (Estrogen+Progesterone) with Estrogen 1x0.625 mg for 21 days and an addition of Progesterone 1x10 mg on 12th -21st days, while the control was performed one week after the drug runs out.",
        "relations": []
    },
    {
        "text_id": "100275",
        "sentence_id": 12,
        "text": "Based on the E+P test, the obtained results were FSH: 8.71 MIU/mL, LH: 3.1 IU/L, Prolactin: 319.4 ng/mL.",
        "relations": [
            [
                "8.71 MIU/mL",
                "FSH"
            ],
            [
                "3.1 IU/L",
                "LH"
            ],
            [
                "319.4 ng/mL",
                "Prolactin"
            ]
        ]
    },
    {
        "text_id": "100275",
        "sentence_id": 13,
        "text": "The E+P test showed a negative result, so it was necessary to do hysteroscopy and curettage for the uterus evaluation.",
        "relations": [
            [
                "a negative result",
                "test"
            ]
        ]
    },
    {
        "text_id": "100275",
        "sentence_id": 14,
        "text": "Hysteroscopy results showed that there were grade 4 adhesions in the uterine cavum, with a pale colored connective tissue in the uterine cavum, which refers to the diagnosis of secondary amenorrhea suspect tuberculosis endometritis, while the result of tissue curettage was examined on the Anatomical Pathology department.",
        "relations": []
    },
    {
        "text_id": "100275",
        "sentence_id": 15,
        "text": "Results of anatomical pathology hysteroscopy showed endometrial tissue with stromal looks granulomas with lymphocytes, histiocytes, epithelioid and Langhans multinucleated giant cells and no malignancy was found in this preparation, which showed that patient's diagnosis is secondary amenorrhea suspected tuberculosis endometritis.",
        "relations": []
    },
    {
        "text_id": "100275",
        "sentence_id": 16,
        "text": "Based on the Anatomical Pathology hysteroscopy result, treatment was done by using anti-tuberculosis drug category I (FDC 1X3 tab) for 6 months.",
        "relations": []
    },
    {
        "text_id": "100275",
        "sentence_id": 17,
        "text": "Anatomical pathology result through macroscopic observation showed visible network of approximately 0.3 cm and 0.4 cm in diameter with a grayish-white color, while the microscopic observations showed fibromuscular tissue at high cylindrical epithelium with polyps shaped vacuolar, and inflammatory granulomatic and aplastic cells were not found.",
        "relations": [
            [
                "0.3 cm",
                "network"
            ],
            [
                "0.4 cm",
                "network"
            ]
        ]
    },
    {
        "text_id": "100340",
        "sentence_id": 1,
        "text": "Mrs B.S. 28 years old multiparous that we had received 02 hours after a vaginal delivery of a newborn alive weighing 2750 grams in a peripheral maternity 3 km away.",
        "relations": []
    },
    {
        "text_id": "100340",
        "sentence_id": 2,
        "text": "It was referred for postpartum hemorrhage.",
        "relations": []
    },
    {
        "text_id": "100340",
        "sentence_id": 3,
        "text": "His medical history was featureless.",
        "relations": []
    },
    {
        "text_id": "100340",
        "sentence_id": 4,
        "text": "On admission, she presented hypovolemic shock with blood pressure 76/44 mmHg, regular tachycardia at 136 beats per minute, polypnea to 39 cycles per minute.",
        "relations": [
            [
                "76/44 mmHg",
                "pressure"
            ],
            [
                "regular",
                "tachycardia"
            ],
            [
                "136 beats per minute",
                "tachycardia"
            ],
            [
                "39 cycles per minute",
                "polypnea"
            ]
        ]
    },
    {
        "text_id": "100340",
        "sentence_id": 5,
        "text": "The obstetrical examination objectified an involuted uterus, an absence of vaginal and perineal cervical lesions, a fluid and red blood originating of endouterine.",
        "relations": []
    },
    {
        "text_id": "100340",
        "sentence_id": 6,
        "text": "Furthermore, there was purpura.",
        "relations": []
    },
    {
        "text_id": "100340",
        "sentence_id": 7,
        "text": "We therefore concluded a significant postpartum hemorrhage complicated by coagulopathy.",
        "relations": []
    },
    {
        "text_id": "100340",
        "sentence_id": 8,
        "text": "Resuscitation measures were taken and an transfusion 1120 ml whole blood, red cell pellets 350 ml and 860 ml fresh frozen plasma have helped to management coagulopathy and anemia.",
        "relations": []
    },
    {
        "text_id": "100340",
        "sentence_id": 9,
        "text": "Blood count at admission highlighted severe thrombocytopenia 23 0000 platelets and hemoglobin levels of 3.9 g/dl.",
        "relations": [
            [
                "23 0000 platelets",
                "thrombocytopenia"
            ],
            [
                "3.9 g/dl",
                "levels"
            ]
        ]
    },
    {
        "text_id": "100340",
        "sentence_id": 10,
        "text": "The post natal care was also administered.",
        "relations": []
    },
    {
        "text_id": "100340",
        "sentence_id": 11,
        "text": "After seven days of hospitalization, she was going after an amendment to the clinical symptoms and normal laboratory tests.",
        "relations": []
    },
    {
        "text_id": "100340",
        "sentence_id": 12,
        "text": "Twenty five days later, she returned to obstetric emergencies for significant bleeding with severe anemia with hemoglobin 9 g/dL without signs of hypovolemic shock.",
        "relations": [
            [
                "9 g/dL",
                "hemoglobin"
            ]
        ]
    },
    {
        "text_id": "100340",
        "sentence_id": 13,
        "text": "The gynecological examination was normal.",
        "relations": [
            [
                "normal",
                "examination"
            ]
        ]
    },
    {
        "text_id": "100340",
        "sentence_id": 14,
        "text": "The balance sheet of the coagulation was normal including prothrombin to 92% and a normal activated partial thromboplastin time.",
        "relations": [
            [
                "normal",
                "sheet"
            ],
            [
                "92%",
                "prothrombin"
            ],
            [
                "normal",
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        ]
    },
    {
        "text_id": "100340",
        "sentence_id": 15,
        "text": "The treatments were based on oxytocin, tranexamic acid, etamsylate and strict regular monitoring.",
        "relations": []
    },
    {
        "text_id": "100340",
        "sentence_id": 16,
        "text": "Transvaginal ultrasound coupled Doppler was normal.",
        "relations": [
            [
                "normal",
                "Doppler"
            ]
        ]
    },
    {
        "text_id": "100340",
        "sentence_id": 17,
        "text": "In the absence of arterial embolization, she was going with ambulatory monitoring.",
        "relations": []
    },
    {
        "text_id": "100340",
        "sentence_id": 18,
        "text": "Two weeks later she presented again rebleeding requiring hospitalization resulting in a total hysterectomy after conditioning of the patient.",
        "relations": []
    },
    {
        "text_id": "100340",
        "sentence_id": 19,
        "text": "Histological examination of the surgical specimen objectified in the cervix and uterine body the presence of arterial vessels proliferation homes large and small caliber associated with tissue hemorrhage.",
        "relations": []
    },
    {
        "text_id": "100340",
        "sentence_id": 20,
        "text": "The postoperative course was simple.",
        "relations": []
    },
    {
        "text_id": "100315",
        "sentence_id": 1,
        "text": "A 3 years old boy without any particular diseases history, admitted to the emergency room for a bipolar trauma with a left hemicorporal point of impact following a domestic accident.",
        "relations": []
    },
    {
        "text_id": "100315",
        "sentence_id": 2,
        "text": "The delay to consult was 5 hours after the incident.",
        "relations": []
    },
    {
        "text_id": "100315",
        "sentence_id": 3,
        "text": "The clinical examination at admission had showed a deformed left superior member, painful on palpation with the presence of the humeral pulse and a right inferior member shortened and flexed, the thigh slightly in adduction, internal rotation with the member.",
        "relations": []
    },
    {
        "text_id": "100315",
        "sentence_id": 4,
        "text": "A radiological assessment was performed immediately; including a standard X-ray of the pelvis which showed a dislocated head of the right femur, completed secondarily by a CT Scan of the hip confirming the posterior type of the dislocation isolated from any fractures of the head of the femur.",
        "relations": []
    },
    {
        "text_id": "100315",
        "sentence_id": 5,
        "text": "The standard radiography of the left shoulder showed a Salter I epiphyseal separation of the humerus.",
        "relations": []
    },
    {
        "text_id": "100315",
        "sentence_id": 6,
        "text": "After one hour, we performed an orthopedic reduction of the dislocated hip monitored under scope, with placement of a pelvic splint for an analgesic aim to be kept during three weeks.",
        "relations": []
    },
    {
        "text_id": "100315",
        "sentence_id": 7,
        "text": "The radiological results were satisfactory with a restored bilateral symmetry of the articular anatomy.",
        "relations": []
    },
    {
        "text_id": "100315",
        "sentence_id": 8,
        "text": "The Salter I detachment of the humerus was orthopedically reduced then immobilized by a thoracoabdominal plaster be kept during a month.",
        "relations": []
    },
    {
        "text_id": "100315",
        "sentence_id": 9,
        "text": "The child has been discharged the next day.",
        "relations": []
    },
    {
        "text_id": "100315",
        "sentence_id": 10,
        "text": "Revised after a month, showed a stable left hip on the clinical examination.",
        "relations": []
    },
    {
        "text_id": "100315",
        "sentence_id": 11,
        "text": "In the decline of 2 years, we haven't noticed any recidivism and the functional results were good; On the radiography we do not have any signs of avascular necrosis no changes of the head of femur, of the acetabulum or the joint space.",
        "relations": []
    },
    {
        "text_id": "100372",
        "sentence_id": 1,
        "text": "We present here a case of Macrophage activation syndrome associated with Griscelli syndrome type 2 in a 3-years-old male born of consanguineous parentage.",
        "relations": []
    },
    {
        "text_id": "100372",
        "sentence_id": 2,
        "text": "His birth histories, his familie social history and developmental milestones were unremarkable.",
        "relations": []
    },
    {
        "text_id": "100372",
        "sentence_id": 3,
        "text": "He was born at full term with no antenatal or perinatal complications, He was on exclusively breast-fed, food diversification was started at 6 months old, his weight, length and psychomotor development were within the normal range, the child was described as a good eater, was on a normal diet and was thriving appropriately.",
        "relations": [
            [
                "within the normal range",
                "development"
            ],
            [
                "within the normal range",
                "length"
            ],
            [
                "within the normal range",
                "weight"
            ]
        ]
    },
    {
        "text_id": "100372",
        "sentence_id": 4,
        "text": "Furthermore the boy presented a progressive abdominal distension since birth, progressive pallor and recurrent episodes of fever since 1 year of age.",
        "relations": []
    },
    {
        "text_id": "100372",
        "sentence_id": 5,
        "text": "There was history of blood transfusions for last 2 months.",
        "relations": []
    },
    {
        "text_id": "100372",
        "sentence_id": 6,
        "text": "On the other side there was no history of jaundice, vomiting, urinary or bowel complaints, bleeding from any site or neurological complaints.",
        "relations": []
    },
    {
        "text_id": "100372",
        "sentence_id": 7,
        "text": "On admission, he was very pale with silvery gray scalp hair, white eyelashes, he was hypotonic, tachycardic, fever of 40°C, lymphoadenopathy and hepato-splenomegaly.",
        "relations": [
            [
                "40°C",
                "fever"
            ]
        ]
    },
    {
        "text_id": "100372",
        "sentence_id": 8,
        "text": "The blood count showed pancytopenia; 1980 white blood cells/µL (VN 4000-13 500/µL), neutrophils 820/µL, 910 cells/µL, hemoglobin (Hb) 6.3 g/dL (11.5-14 VN, 5 g/dL), platelets 44 000/µL (VN 150 000-400 000/µL), There were no giant cytoplasmic granules in leucocytes.",
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                "820/µL",
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                "910 cells/µL",
                "neutrophils"
            ],
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                "6.3 g/dL",
                "Hb"
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                "6.3 g/dL",
                "hemoglobin"
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            [
                "44 000/µL",
                "platelets"
            ]
        ]
    },
    {
        "text_id": "100372",
        "sentence_id": 9,
        "text": "The liver function tests were normal expect low albumin (2.1 mg/dL) and increased alkaline phosphatase (1196 mg/dL) with low fibrinogen (1.7g/l).",
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                "1.7g/l",
                "fibrinogen"
            ]
        ]
    },
    {
        "text_id": "100372",
        "sentence_id": 10,
        "text": "Serum triglycerides, ferrintin and lactic dehydrogenase were very high; respectively 4.75g/L; 2763µg/L and 597U/L. the C reactive protein (CRP) was elevated at 83mg/l.",
        "relations": [
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                "4.75g/L",
                "triglycerides"
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                "2763µg/L",
                "ferrintin"
            ],
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                "597U/L",
                "dehydrogenase"
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            [
                "83mg/l",
                "CRP"
            ],
            [
                "83mg/l",
                "protein"
            ]
        ]
    },
    {
        "text_id": "100372",
        "sentence_id": 11,
        "text": "A chest X-ray was normal while the abdominal ultrasound showed a hepatomegaly and a splenomegaly, free biliary ducts without ascites.",
        "relations": [
            [
                "normal",
                "X-ray"
            ]
        ]
    },
    {
        "text_id": "100372",
        "sentence_id": 12,
        "text": "Because of hepato-splenomegaly, pancytopenia, hyperferritinemia and hypofibrinogenemia the diagnosis of Macrophage activation syndrome was evoked indicating a bone marrow aspiration that showed numerous morphologically benign macrophages with haemophagocytic activity that comforting the diagnosis of a SAM according to Ravelli and HLH-2004 criteria.",
        "relations": []
    },
    {
        "text_id": "100372",
        "sentence_id": 13,
        "text": "Blood culture, urine examination, malarial serology, Kala Azar serology, viral serologies such as EBV, hepatitis A, B, C and human immunodeficiency virus HIV, serologies of rickettsia, syphilis and toxoplasmosa were negatives.",
        "relations": [
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                "negatives",
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                "negatives",
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            [
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        ]
    },
    {
        "text_id": "100372",
        "sentence_id": 14,
        "text": "Serologies of CMV and rubella showed an old immunization.",
        "relations": []
    },
    {
        "text_id": "100372",
        "sentence_id": 15,
        "text": "The immunological tests such as antinuclear antibodies (ANA), anti-LKM1, anti-mitochondria and anti-smooth muscle antibodies were negatives.",
        "relations": [
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                "negatives",
                "antibodies"
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                "ANA"
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            [
                "negatives",
                "antibodies"
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    },
    {
        "text_id": "100372",
        "sentence_id": 16,
        "text": "Because of the consanguineous family, notion of recurrent infection and the presence of silvery-gray color of the hair and eyebrows, diagnosis of Griscelli Syndrome was evoked directing a light microscopy examination of the hair that showed a large, irregular clumps of pigments characteristic of Griscelli Syndrome.",
        "relations": []
    },
    {
        "text_id": "100372",
        "sentence_id": 17,
        "text": "The molecular biology showed mutation in RAB27A gene confirming the diagnosis of a Griscelli syndrome type 2.",
        "relations": []
    },
    {
        "text_id": "100372",
        "sentence_id": 18,
        "text": "The first-line therapy in management of Macrophage activation syndrome complicating Griscelli syndrome type 2 was based on the parenteral administration of high doses of corticosteroids (methylprednisolone pulses 1g/0.73m 2 /day for 3 days then 60mg/m 2) with poor response; persisting with involvement of the 3 cell lines in the blood count, elevated ferritin and triglycerides.",
        "relations": []
    },
    {
        "text_id": "100372",
        "sentence_id": 19,
        "text": "Given the lack of response to steroids, Etoposide was started for 3 days associated with cyclophosphamide, the evolution was good with improvement of count blood cells, ferritin was lessening while the bone marrow showed decreased numerous of macrophages with low haemophagocytic activity.",
        "relations": []
    },
    {
        "text_id": "100372",
        "sentence_id": 20,
        "text": "On the other side the infectious process was good managed by perfusion of Antibiotics such as Ceftazidim in combination with aminoside.",
        "relations": []
    },
    {
        "text_id": "100372",
        "sentence_id": 21,
        "text": "The patient was sent home with prednisone and cyclosporine, He was placed on the list of bone marrow transplantation (BMT).",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 1,
        "text": "Mr F.B a 70-year-old male patient presented in our institution because of the occurrence of a right epistaxis.",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 2,
        "text": "First of all, the patient is not smoking and reported an aneurysm of the abdominal aorta surgically treated by prosthesis under plavix.",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 3,
        "text": "The beginning of the symptomatology goes back to 2 months before with right nasal obstruction of progressive onset, associated with right epistaxis and bloody rhinorrhea with right chronic eye watering.",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 4,
        "text": "Nasal Endoscopy examination revealed a pinnkish burgeoning mass bleeding on contact and filling the right nostril vestibule.",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 5,
        "text": "The patient didn't presents neurological signs nor cervical lymph nods.",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 6,
        "text": "Otherwise, ophthalmologic examination found normal visual acuity and ocular mobility on both sides.",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 7,
        "text": "Sinonasal computed tomography (CT) found a right nasal process enhanced after injection of contrast product with relatively little washing at the late time.",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 8,
        "text": "Otherwise, there is no extension involvement at the level of the cavum and the pterygo palate fossa.",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 9,
        "text": "This finding found also a crenate appearance of the posterior nasal mucosa especially of the middle turbinates and contralateral inferior turbinate with a left deviation of the nasal septum with nasal spur.",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 10,
        "text": "Nasosinusal MRI shows a progressive increase in size of the tissue mass compared to the previously CT occupying the right nasal fossa on almost all of its height, measuring 4 × 2.8 × 3.5cm without extension within the cavum with probable invasion of the lower part of the nasolacrimal duct and mass effect on both the sinusonasal bone septum and the intersinusonasal septum.",
        "relations": [
            [
                "4 × 2.8 × 3.5cm",
                "measuring"
            ]
        ]
    },
    {
        "text_id": "100383",
        "sentence_id": 11,
        "text": "This finding shows ethmoidal sinus fluid retention.",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 12,
        "text": "The appearance, even if it remains unspecific, is compatible with inverted papilloma.",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 13,
        "text": "The patient underwent complete endoscopic removal of the tumor with ethmoidectomy and right maxillary antrostomy.",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 14,
        "text": "The extemporaneous examination is in favor of a malignant tumor lesion.",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 15,
        "text": "Histopathologic analysis shows a tumor proliferation made of polymorphic cells with major anisocytosis, most often located in lobules.",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 16,
        "text": "There is sometimes a somewhat palisadic seat on the periphery of the tumor mass.",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 17,
        "text": "The mitotic index is 10 mitoses per 10 high power fields.",
        "relations": [
            [
                "10 mitoses per 10 high power fields",
                "index"
            ]
        ]
    },
    {
        "text_id": "100383",
        "sentence_id": 18,
        "text": "The immunohistochemical study of the tumor found that the cytokeratin KL1 and CK7 and the neuroendocrine marker Chromogranin A, synaptophysin and CD56 are positive.",
        "relations": [
            [
                "positive",
                "cytokeratin"
            ],
            [
                "positive",
                "CD56"
            ],
            [
                "positive",
                "synaptophysin"
            ],
            [
                "positive",
                "marker"
            ]
        ]
    },
    {
        "text_id": "100383",
        "sentence_id": 19,
        "text": "Proliferation index Ki67 is of the order of 80%.",
        "relations": [
            [
                "the order of 80%",
                "index"
            ]
        ]
    },
    {
        "text_id": "100383",
        "sentence_id": 20,
        "text": "Otherwise there is an absence of expression of PS100, MelanA, HMB45, desmin, p40, CD45 and EBV.",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 21,
        "text": "The clear positivity of cytokeratins formally excludes the diagnosis of olfactory neuroblastoma and leads to neuroendocrine carcinoma.",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 22,
        "text": "Given the atypia, the mitotic index, and the Ki67 proliferation index, it is a high-grade large-cell neuroendocrine carcinoma.",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 23,
        "text": "Extension assessment, comprising a PET SCAN, was negative.",
        "relations": [
            [
                "negative",
                "SCAN"
            ],
            [
                "negative",
                "assessment"
            ]
        ]
    },
    {
        "text_id": "100383",
        "sentence_id": 24,
        "text": "Postoperative treatment consisted in adjuvant polychemotherapy, with six cycles (cisplatin and etoposide), Followed by loco regional external radiotherapy.",
        "relations": []
    },
    {
        "text_id": "100383",
        "sentence_id": 25,
        "text": "After 6 month follow-up, the patient was in complete clinical and radiological remission.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 1,
        "text": "A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain.",
        "relations": [
            [
                "40°C",
                "fever"
            ]
        ]
    },
    {
        "text_id": "100399",
        "sentence_id": 2,
        "text": "The patient's past medical history was non-significant.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 3,
        "text": "He was a student and had not received any medication.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 4,
        "text": "He had a pet dog and reported no recent travel.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 5,
        "text": "During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C.",
        "relations": [
            [
                "normal",
                "signs"
            ],
            [
                "38°C",
                "temperature"
            ]
        ]
    },
    {
        "text_id": "100399",
        "sentence_id": 6,
        "text": "Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 7,
        "text": "The remainder of physical examination was unremarkable.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 8,
        "text": "Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L).",
        "relations": [
            [
                "20.830",
                "count"
            ],
            [
                "20.830",
                "WBC"
            ],
            [
                "28mg/dl",
                "level"
            ],
            [
                "56 IU/L",
                "aminotransferase"
            ],
            [
                "56 IU/L",
                "ALT"
            ],
            [
                "255 IU/L",
                "dehydrogenase"
            ],
            [
                "255 IU/L",
                "LDH"
            ]
        ]
    },
    {
        "text_id": "100399",
        "sentence_id": 9,
        "text": "Alkaline phosphatase (ALP) was normal.",
        "relations": [
            [
                "normal",
                "ALP"
            ],
            [
                "normal",
                "phosphatase"
            ]
        ]
    },
    {
        "text_id": "100399",
        "sentence_id": 10,
        "text": "Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 11,
        "text": "Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe.",
        "relations": [
            [
                "5.6cm",
                "diameter"
            ],
            [
                "5.2cm",
                "diameter"
            ]
        ]
    },
    {
        "text_id": "100399",
        "sentence_id": 12,
        "text": "The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 13,
        "text": "The patient was admitted for further evaluation and treatment.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 14,
        "text": "Culture guided antimicrobials and appropriate drainage was our first option.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 15,
        "text": "Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 16,
        "text": "All cultures resulted negative.",
        "relations": [
            [
                "negative",
                "cultures"
            ]
        ]
    },
    {
        "text_id": "100399",
        "sentence_id": 17,
        "text": "Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 18,
        "text": "A thick, purulent material of 40cc was drained and sent for culture.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 19,
        "text": "Microbiology revealed a Gram-negative bacterium that presented slow growth.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 20,
        "text": "On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 21,
        "text": "Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 22,
        "text": "Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 23,
        "text": "Thorough screening for other possible sources of infection, resulted negative.",
        "relations": [
            [
                "negative",
                "screening"
            ]
        ]
    },
    {
        "text_id": "100399",
        "sentence_id": 24,
        "text": "Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation.",
        "relations": [
            [
                "negative",
                "vegetations"
            ],
            [
                "negative",
                "echocardiography"
            ]
        ]
    },
    {
        "text_id": "100399",
        "sentence_id": 25,
        "text": "Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative.",
        "relations": [
            [
                "negative",
                "leismania"
            ],
            [
                "negative",
                "brucella"
            ],
            [
                "negative",
                "echinococcus"
            ],
            [
                "negative",
                "Entamoeba"
            ]
        ]
    },
    {
        "text_id": "100399",
        "sentence_id": 26,
        "text": "Gastrointestinal endoscopic evaluation was unrevealing.",
        "relations": [
            [
                "unrevealing",
                "evaluation"
            ]
        ]
    },
    {
        "text_id": "100399",
        "sentence_id": 27,
        "text": "The patient was also HIV negative and no other immunodeficiency conditions were identified.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 28,
        "text": "Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 29,
        "text": "To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS).",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 30,
        "text": "The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S).",
        "relations": [
            [
                "≤0.125",
                "ceftriaxone"
            ],
            [
                "≤0.5",
                "cefepime"
            ],
            [
                "≤0.125",
                "ciprofloxacin"
            ],
            [
                "≤0.5",
                "gentamycin"
            ],
            [
                "≤0.125",
                "amikacin"
            ],
            [
                "≤0.032",
                "meropenem"
            ]
        ]
    },
    {
        "text_id": "100399",
        "sentence_id": 31,
        "text": "Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 32,
        "text": "Thankfully, no surgical procedure was required.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 33,
        "text": "The drains were removed immediately the fluid from the abscess cavities became clear.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 34,
        "text": "Meropenem was administered for a total of 2 weeks.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 35,
        "text": "Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery.",
        "relations": []
    },
    {
        "text_id": "100399",
        "sentence_id": 36,
        "text": "Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 1,
        "text": "A 61-year-old woman, gravida 3 para 3, presented with an increased size of ovarian cyst.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 2,
        "text": "Her history revealed a diagnosis of left ovarian cyst 3cm in diameter 3 years previously.",
        "relations": [
            [
                "3cm",
                "cyst"
            ]
        ]
    },
    {
        "text_id": "100427",
        "sentence_id": 3,
        "text": "Her serum cancer antigen (CA) 125 and CA 19-9 levels were within the normal ranges, and she was followed up at 6-month intervals at a private hospital.",
        "relations": [
            [
                "within the normal ranges",
                "levels"
            ]
        ]
    },
    {
        "text_id": "100427",
        "sentence_id": 4,
        "text": "The ovarian cyst size had not changed in size and structure on biannual transvaginal ultrasound (TVS).",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 5,
        "text": "However, she was referred to our institution in July 2016 with progression of ovarian cyst to 6cm on a pelvic ultrasonogram 2 weeks ago.",
        "relations": [
            [
                "6cm",
                "progression"
            ]
        ]
    },
    {
        "text_id": "100427",
        "sentence_id": 6,
        "text": "The patient underwent menopause at age 48 years, with an uneventful past menstrual cycle.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 7,
        "text": "She had no medical history except the benign thyroid nodule, no relevant surgical history and had not received hormonal therapy.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 8,
        "text": "Routine blood chemistry and serum tumor marker analysis showed that the levels of carcinoembryonic antigen, CA 19-9, CA 125, and human epididymis protein 4 were all within the normal ranges.",
        "relations": [
            [
                "within the normal ranges",
                "protein"
            ],
            [
                "within the normal ranges",
                "CA"
            ],
            [
                "within the normal ranges",
                "CA"
            ],
            [
                "within the normal ranges",
                "antigen"
            ]
        ]
    },
    {
        "text_id": "100427",
        "sentence_id": 9,
        "text": "Uterine cervical cytology at the time of admission was normal.",
        "relations": [
            [
                "normal",
                "cytology"
            ]
        ]
    },
    {
        "text_id": "100427",
        "sentence_id": 10,
        "text": "TVS showed a left ovarian unilocular cyst, size 6cm × 5cm × 4cm, with diffuse low-level internal echoes, thin walled, smooth margined, no septa and no papillary projections.",
        "relations": [
            [
                "6cm × 5cm × 4cm",
                "size"
            ]
        ]
    },
    {
        "text_id": "100427",
        "sentence_id": 11,
        "text": "The uterus size was 6cm × 4cm × 3cm, and a 1cm uterine myoma was found in the fundus.",
        "relations": [
            [
                "6cm × 4cm × 3cm",
                "size"
            ],
            [
                "1cm",
                "myoma"
            ]
        ]
    },
    {
        "text_id": "100427",
        "sentence_id": 12,
        "text": "Pelvic contrast-enhanced computed tomography (ECT) images revealed a unilocular cystic lesion measuring 6 cm at its widest dimension, without enhancing solid intramural nodules and no evidence of lymphadenopathy or ascites.",
        "relations": [
            [
                "6 cm",
                "measuring"
            ]
        ]
    },
    {
        "text_id": "100427",
        "sentence_id": 13,
        "text": "CT scan indicated benign ovarian cystic tumors.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 14,
        "text": "The patient underwent laparoendoscopic single-site (LESS) surgery.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 15,
        "text": "On laparoscopic inspection, the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 16,
        "text": "The left fallopian tube was grossly unremarkable and the left ovary was atrophied.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 17,
        "text": "The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components, but solid components were not seen inside.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 18,
        "text": "Clinical diagnosis was suggestive of left paratubal cyst.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 19,
        "text": "The patient underwent hysterectomy and BSO.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 20,
        "text": "Although tumor markers were normal and there was no presence of papillary projections, the progression in size in the postmenopausal woman indicated a possible malignancy.",
        "relations": [
            [
                "normal",
                "markers"
            ]
        ]
    },
    {
        "text_id": "100427",
        "sentence_id": 21,
        "text": "Frozen sections were prepared from surgery specimens and confirmed a benign cyst.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 22,
        "text": "After surgery, the pelvic cavity was explored and no specific findings were found in the abdominal cavity.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 23,
        "text": "Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 24,
        "text": "The tumor cells showed nuclear atypism and stratification, which are histological characteristics of borderline tumor.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 25,
        "text": "A final diagnosis of paratubal borderline serous tumor was confirmed.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 26,
        "text": "The patient was discharged from the hospital on postoperative day 3.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 27,
        "text": "CT images were retrospectively evaluated, focusing on the left ovary, fallopian tube, and paratubal cyst after surgery.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 28,
        "text": "Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst, indicating that the left ovary, fallopian tube and paratubal cyst were separate structures, similar to those seen during surgery.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 29,
        "text": "The tumor was not completely staged, and a comprehensive surgical staging operation was recommended; however, the patient refused adjuvant surgical treatment and opted for close follow-up.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 30,
        "text": "Pelvic ECT, TVS and tumor markers were checked every three months.",
        "relations": []
    },
    {
        "text_id": "100427",
        "sentence_id": 31,
        "text": "The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis.",
        "relations": []
    },
    {
        "text_id": "100437",
        "sentence_id": 1,
        "text": "A 28-year-old female patient presented to outpatient dental clinics for full mouth rehabilitation.",
        "relations": []
    },
    {
        "text_id": "100437",
        "sentence_id": 2,
        "text": "On physical examination, the patient was awake, alert, oriented, and her blood pressure, temperature and heart rate were within normal limits.",
        "relations": [
            [
                "normal limits",
                "temperature"
            ],
            [
                "normal limits",
                "pressure"
            ],
            [
                "normal limits",
                "rate"
            ]
        ]
    },
    {
        "text_id": "100437",
        "sentence_id": 3,
        "text": "Upon taking medical history the patient revealed that was diagnosed with thymoma MG and on medication including pyridostigmine bromide 60 mg, azathioprine 50 mg and prednisone 20 mg.",
        "relations": []
    },
    {
        "text_id": "100437",
        "sentence_id": 4,
        "text": "Intraoral examination showed fair oral hygiene multiple fixed prosthodontic restorations and multiple carious teeth, multiple remaining roots and lipomatous tongue atrophy.",
        "relations": []
    },
    {
        "text_id": "100437",
        "sentence_id": 5,
        "text": "The patient was referred to her neurologist to provide a detailed history about her medical condition and to coordinate with him regarding the steroid dose take to avoid any complication during patient management.",
        "relations": []
    },
    {
        "text_id": "100437",
        "sentence_id": 6,
        "text": "A consultation letter had been received from her neurologist explaining the patient medical condition which starts with difficulty in breathing, chewing and swallowing, there was no external ocular weakness, motor weakness, sphincter dysfunction, sensory deficits, muscle wasting and no signs of diplopia, dizziness, double vision, ptosis or any difficulty in maintaining balance.",
        "relations": []
    },
    {
        "text_id": "100437",
        "sentence_id": 7,
        "text": "Patient underwent chest CT scan with contrast which show evidence of thymoma benign tumor of the thymus that has been the possible causes of MG.",
        "relations": []
    },
    {
        "text_id": "100437",
        "sentence_id": 8,
        "text": "Diagnosis was confirmed with measuring serum level of acetylcholine receptor antibodies, later treatment plan had been formulated including drugs to control the condition and then thymectomy to avoid sever complication to the patient.",
        "relations": []
    },
    {
        "text_id": "100437",
        "sentence_id": 9,
        "text": "Before proceeding to the dental management of the case; CBC and blood chemistry had been requested form the patient.",
        "relations": []
    },
    {
        "text_id": "100437",
        "sentence_id": 10,
        "text": "Creatinine level was below normal (42.23 umol/l), with normal levels of albumin, urea, uric acid, AST, ALT, cholesterol, triglycerides and bilirubin.",
        "relations": [
            [
                "below normal",
                "level"
            ],
            [
                "42.23 umol/l",
                "level"
            ],
            [
                "normal",
                "AST"
            ],
            [
                "normal",
                "albumin"
            ],
            [
                "normal",
                "ALT"
            ],
            [
                "normal",
                "cholesterol"
            ],
            [
                "normal",
                "triglycerides"
            ],
            [
                "normal",
                "bilirubin"
            ],
            [
                "normal",
                "urea"
            ],
            [
                "normal",
                "acid"
            ]
        ]
    },
    {
        "text_id": "100437",
        "sentence_id": 11,
        "text": "Patient had elevated WBC “12.52 x 10 9 /L” and Platelet “453 x 10 9 /L” with reduction in RBC “4.4 x 10 9 /L” and Eosinophil count “0.07”.",
        "relations": [
            [
                "elevated",
                "WBC"
            ],
            [
                "12.52 x 10 9 /L",
                "WBC"
            ],
            [
                "453 x 10 9 /L",
                "Platelet"
            ],
            [
                "4.4 x 10 9 /L",
                "RBC"
            ],
            [
                "0.07",
                "count"
            ]
        ]
    },
    {
        "text_id": "100437",
        "sentence_id": 12,
        "text": "Consultation with patient neurologist regarding the steroid dose to reduce the susceptibility of developing adrenal crisis.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 1,
        "text": "A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 2,
        "text": "She also had pain on defecation, night sweats and fever.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 3,
        "text": "On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min.",
        "relations": [
            [
                "28 breaths per min",
                "rate"
            ]
        ]
    },
    {
        "text_id": "100466",
        "sentence_id": 4,
        "text": "She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling.",
        "relations": [
            [
                "38.2 0 C",
                "temperature"
            ]
        ]
    },
    {
        "text_id": "100466",
        "sentence_id": 5,
        "text": "The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size.",
        "relations": [
            [
                "about 30 weeks",
                "size"
            ]
        ]
    },
    {
        "text_id": "100466",
        "sentence_id": 6,
        "text": "The mass was firm, immobile with an irregular surface not attached to overlying skin.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 7,
        "text": "There was no ascites and no hepatosplenomegaly.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 8,
        "text": "The cervix looked grossly normal but was displaced anteriorly.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 9,
        "text": "Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 10,
        "text": "Examination of the other systems was normal.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 11,
        "text": "Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10).",
        "relations": [
            [
                "6.5g/dl",
                "haemoglobin"
            ],
            [
                "slightly elevated",
                "antigen"
            ],
            [
                "44U/ml",
                "antigen"
            ],
            [
                "0.258mIU/ml",
                "gonadotropin"
            ],
            [
                "7 ng/ml",
                "fetoprotein"
            ]
        ]
    },
    {
        "text_id": "100466",
        "sentence_id": 12,
        "text": "Her CD4 count was 63cells/mm 3.",
        "relations": [
            [
                "63cells/mm 3",
                "count"
            ]
        ]
    },
    {
        "text_id": "100466",
        "sentence_id": 13,
        "text": "Her renal and hepatic function tests were normal.",
        "relations": [
            [
                "normal",
                "tests"
            ]
        ]
    },
    {
        "text_id": "100466",
        "sentence_id": 14,
        "text": "An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa.",
        "relations": [
            [
                "19.6cm x 12.5cm",
                "measuring"
            ]
        ]
    },
    {
        "text_id": "100466",
        "sentence_id": 15,
        "text": "The uterus and its endometrium were normal.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 16,
        "text": "Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 17,
        "text": "The patient was taken for surgical exploration and staging for ovarian malignancy.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 18,
        "text": "At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 19,
        "text": "The right ovary was enlarged to about 10cm diameter.",
        "relations": [
            [
                "about 10cm",
                "diameter"
            ]
        ]
    },
    {
        "text_id": "100466",
        "sentence_id": 20,
        "text": "The left fallopian tube and ovary could not be distinguished and separated from the tumour.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 21,
        "text": "The rest of the abdominal organs and omentum looked grossly normal.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 22,
        "text": "There was no ascites.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 23,
        "text": "Tumour was friable and was removed by blunt and sharp dissection.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 24,
        "text": "Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 25,
        "text": "The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 26,
        "text": "She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 27,
        "text": "We had encountered significant bleeding from the friable tumor.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 28,
        "text": "Patient was sent to the high dependency unit where she recovered postoperatively.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 29,
        "text": "Histology of the specimens showed a large B cell lymphoma.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 30,
        "text": "A haematologist consulted and peripheral blood film and bone marrow aspirate were done.",
        "relations": [
            [
                "normal",
                "results"
            ]
        ]
    },
    {
        "text_id": "100466",
        "sentence_id": 31,
        "text": "Both results were normal, ruling out abnormal cells in both samples.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 32,
        "text": "She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine.",
        "relations": []
    },
    {
        "text_id": "100466",
        "sentence_id": 33,
        "text": "She has also been initiated on highly active antiretroviral therapy.",
        "relations": []
    },
    {
        "text_id": "100497",
        "sentence_id": 1,
        "text": "A 26 years old nulliparous woman presented to our observation for severe right-sided epistaxis, non self-limiting.",
        "relations": []
    },
    {
        "text_id": "100497",
        "sentence_id": 2,
        "text": "She had few episodes in the previous two weeks of epistaxis, even 3-4 per day, usually stopping spontaneously.",
        "relations": []
    },
    {
        "text_id": "100497",
        "sentence_id": 3,
        "text": "She reported a negative ENT consultation except for mild hyperemia of nasal mucosa.",
        "relations": []
    },
    {
        "text_id": "100497",
        "sentence_id": 4,
        "text": "The pregnancy was unremarkable, considered at low risk, at 39.6 weeks of gestation.",
        "relations": []
    },
    {
        "text_id": "100497",
        "sentence_id": 5,
        "text": "Her familiar and personal history was negative for blood coagulopathies and hypertension.",
        "relations": []
    },
    {
        "text_id": "100497",
        "sentence_id": 6,
        "text": "We tried to stop severe epistaxis with nasal packing and intravenous tranexamic acid.",
        "relations": []
    },
    {
        "text_id": "100497",
        "sentence_id": 7,
        "text": "On the basis of the failure of our procedures an otolaryngologist performed an endoscopy identifying bleeding enlarged vessels.",
        "relations": []
    },
    {
        "text_id": "100497",
        "sentence_id": 8,
        "text": "Nasal packing with hemostatic sponge was successful, the pregnant woman was admitted to ob&gyn department.",
        "relations": []
    },
    {
        "text_id": "100497",
        "sentence_id": 9,
        "text": "Her hemoglobin levels dropped down to 6 mg/dl and she needed 4 red cell packs.",
        "relations": [
            [
                "6 mg/dl",
                "levels"
            ]
        ]
    },
    {
        "text_id": "100497",
        "sentence_id": 10,
        "text": "The day after her right nostril despite the tampons started bleeding again.",
        "relations": []
    },
    {
        "text_id": "100497",
        "sentence_id": 11,
        "text": "She was referred to otolaryngologist who packed again the nose, bilaterally and used hemostatic glue.",
        "relations": []
    },
    {
        "text_id": "100497",
        "sentence_id": 12,
        "text": "After 2 more days she started bleeding again, her nose was again packed with glue and tampons and further 2 red cell packs were given.",
        "relations": []
    },
    {
        "text_id": "100497",
        "sentence_id": 13,
        "text": "The obstetric scan revealed biometry at 40 th centile, the Bishop score was 5, so we decided to induce labour after obtaining her informed written consent.",
        "relations": [
            [
                "40 th centile",
                "biometry"
            ],
            [
                "5",
                "score"
            ]
        ]
    },
    {
        "text_id": "100497",
        "sentence_id": 14,
        "text": "The labour induction was performed with intravaginal prostaglandins (10 mg dinoprostone).",
        "relations": []
    },
    {
        "text_id": "100497",
        "sentence_id": 15,
        "text": "After 18 hours the labour seemed to proceed well with cervical dilatation of 6 cm, level of head 0, but the cardiotocography (CTG) trace revealed anomalies that after 1 hour induced the shift versus cesarean section.",
        "relations": [
            [
                "0",
                "level"
            ]
        ]
    },
    {
        "text_id": "100497",
        "sentence_id": 16,
        "text": "No epistaxis happened during labour nor during cesarean section.",
        "relations": []
    },
    {
        "text_id": "100497",
        "sentence_id": 17,
        "text": "Two days after nasal tampons were removed, the patient was discharged the day after.",
        "relations": []
    },
    {
        "text_id": "100497",
        "sentence_id": 18,
        "text": "One month later the woman reported general good health and no epistaxis episodes, nor mild nor massive.",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 1,
        "text": "Male infant 9.5 month old was examined in the emergency department of our hospital because of an empty scrotum and the ipsilateral testis lying in a high iliac crest position.",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 2,
        "text": "With the increase in intrabdominal pressure [crying etc.] there was an ever-increasing swelling with spiral course from the groin to ipsilateral iliac crest.",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 3,
        "text": "On clinical examination, a reducible mass was present in the right ileac crest.",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 4,
        "text": "The swelling looked like a spigelian hernia [4].",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 5,
        "text": "However no abdominal wall defect could be palpated at that area.",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 6,
        "text": "Moreover the ipsilateral scrotum was empty and the testis could be palpated with difficulty lying in a high inguinal position.",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 7,
        "text": "Ultrasonography showed a loop of herniated small bowel and an undescended testis on the right.",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 8,
        "text": "At operation, under general anesthesia, an extended transverse inguinal incision was made.",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 9,
        "text": "Upon entering the inguinal canal a large hernia sac was identified.",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 10,
        "text": "This followed a course through the superficial inguinal ring, extended upwards to the anterior abdomninal wall below the subcutaneous plane and was fixed in the area of the right iliac crest.",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 11,
        "text": "We noticed that the hernia orifice was in a higher than normal position 5 cm from the pubic bone.",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 12,
        "text": "This bulk was easily reduced back to the abdomen along with an ipsilateral mobile intravaginal testis.",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 13,
        "text": "After careful isolation of the sac at a length of 3 cm the ipsilateral testis was isolated.",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 14,
        "text": "The vas and the vessels were intravaginal, the gubernaculum was fixed in an ectopic position and the dorsal inguinal wall was lax.",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 15,
        "text": "We removed the large sac after separating the vas and vessels and the testis.",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 16,
        "text": "Moreover we strengthened the dorsal inguinal wall, fixated the testis in a subdartos pouch and closed the wound.",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 17,
        "text": "Patient stayed for a day in the hospital.",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 18,
        "text": "No postoperative complications happened.",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 19,
        "text": "Three years later the boy was operated for left hydrocele.",
        "relations": []
    },
    {
        "text_id": "100508",
        "sentence_id": 20,
        "text": "The boy remains in perfect health now five years after the initial operation.",
        "relations": []
    },
    {
        "text_id": "100593",
        "sentence_id": 1,
        "text": "A 27-year-old pregnant woman presented to our facility at 35 weeks' gestation with a 3-months history of right upper abdominal pain associated with generalized itch, tea colored urine, mastic -colored stool, and significant weight loss.",
        "relations": []
    },
    {
        "text_id": "100593",
        "sentence_id": 2,
        "text": "No headache, blurred vision or spontaneous bleeding were mentioned.",
        "relations": []
    },
    {
        "text_id": "100593",
        "sentence_id": 3,
        "text": "She was not a known diabetic or hypertensive and has no history of blood transfusion.",
        "relations": []
    },
    {
        "text_id": "100593",
        "sentence_id": 4,
        "text": "Clinical signs on examination included mild pallor and cholestatic jaundice.",
        "relations": []
    },
    {
        "text_id": "100593",
        "sentence_id": 5,
        "text": "Her blood pressure was 100/70 mmHg with a pulse rate of 98 beats/min, respiratory rate about 16/min and oral temperature of 37°C.",
        "relations": [
            [
                "100/70 mmHg",
                "pressure"
            ],
            [
                "98 beats/min",
                "rate"
            ],
            [
                "16/min",
                "rate"
            ],
            [
                "37°C",
                "temperature"
            ]
        ]
    },
    {
        "text_id": "100593",
        "sentence_id": 6,
        "text": "Respiratory, cardiovascular and neurological examinations were unremarkable.",
        "relations": []
    },
    {
        "text_id": "100593",
        "sentence_id": 7,
        "text": "The abdomen was grossly distended with visible collateral veins.",
        "relations": []
    },
    {
        "text_id": "100593",
        "sentence_id": 8,
        "text": "Liver was enlarged, hard, nodular with a painful irregular edge.",
        "relations": []
    },
    {
        "text_id": "100593",
        "sentence_id": 9,
        "text": "The spleen was not palpable.",
        "relations": []
    },
    {
        "text_id": "100593",
        "sentence_id": 10,
        "text": "There was bipedal edema up to the mid shin.",
        "relations": []
    },
    {
        "text_id": "100593",
        "sentence_id": 11,
        "text": "Fetal heart rate was 140 bpm and regular.",
        "relations": [
            [
                "140 bpm and regular",
                "rate"
            ]
        ]
    },
    {
        "text_id": "100593",
        "sentence_id": 12,
        "text": "Laboratory examination showed leukocytosis, anemia and normal platelet counts.",
        "relations": [
            [
                "normal",
                "counts"
            ]
        ]
    },
    {
        "text_id": "100593",
        "sentence_id": 13,
        "text": "Aspartate aminotransferase (AST) were raised (4times upper limit), total protein and albumin were low, 43g/L and 25g/L respectively, INR 1.20 and glycaemia 0.70g/L.",
        "relations": [
            [
                "4times upper limit",
                "AST"
            ],
            [
                "4times upper limit",
                "aminotransferase"
            ],
            [
                "low",
                "protein"
            ],
            [
                "low",
                "albumin"
            ],
            [
                "43g/L",
                "protein"
            ],
            [
                "25g/L",
                "albumin"
            ],
            [
                "1.20",
                "INR"
            ],
            [
                "0.70g/L",
                "glycaemia"
            ]
        ]
    },
    {
        "text_id": "100593",
        "sentence_id": 14,
        "text": "Her alphafeto-protein (AFP) was higher (2232 ng/mL).",
        "relations": [
            [
                "higher",
                "alphafeto-protein"
            ],
            [
                "higher",
                "AFP"
            ],
            [
                "2232 ng/mL",
                "alphafeto-protein"
            ],
            [
                "2232 ng/mL",
                "AFP"
            ],
            [
                "positive",
                "HBsAg"
            ]
        ]
    },
    {
        "text_id": "100593",
        "sentence_id": 15,
        "text": "HBsAg was positive.",
        "relations": [
            [
                "negative",
                "HCV"
            ],
            [
                "negative",
                "HIV"
            ],
            [
                "negative",
                "viruses"
            ]
        ]
    },
    {
        "text_id": "100593",
        "sentence_id": 16,
        "text": "She tested negative to human immunodeficiency viruses (HIV) and HCV.",
        "relations": []
    },
    {
        "text_id": "100593",
        "sentence_id": 17,
        "text": "Abdominal ultrasound showed a heterogeneous coarse liver with multiple hypoechoic lesions.",
        "relations": []
    },
    {
        "text_id": "100593",
        "sentence_id": 18,
        "text": "Pelvic scan revealed a normal fetus with a gestational age of about 35 weeks.",
        "relations": []
    },
    {
        "text_id": "100593",
        "sentence_id": 19,
        "text": "The diagnosis of hepatocellular carcinoma on a decompensated cirrhosis was made.",
        "relations": []
    },
    {
        "text_id": "100593",
        "sentence_id": 20,
        "text": "She was managed with analgesia, spironolactone and tenofovir added for prevention of mother-to-child transmission of the hepatitis B infection.",
        "relations": []
    },
    {
        "text_id": "100593",
        "sentence_id": 21,
        "text": "The plan was to have the mother's health improved to securely induce the labour.",
        "relations": []
    },
    {
        "text_id": "100593",
        "sentence_id": 22,
        "text": "Unfortunately, at day two of hospitalization, the patient experienced progressive loss of conscious along with epistaxis and multi-organ failure.",
        "relations": []
    },
    {
        "text_id": "100593",
        "sentence_id": 23,
        "text": "Laboratory assessment revealed HB-8.4g/dL, WBC 37500 cells/dL, Platelets 436000/ul, INR-2.57 and recurrent hypoglycemia.",
        "relations": [
            [
                "8.4g/dL",
                "HB"
            ],
            [
                "37500 cells/dL",
                "WBC"
            ],
            [
                "436000/ul",
                "Platelets"
            ],
            [
                "2.57",
                "INR"
            ]
        ]
    },
    {
        "text_id": "100593",
        "sentence_id": 24,
        "text": "Cesarean section was urgently performed and the outcome was a healthy newborn weighted 2.9kg but the mother died soon after.",
        "relations": [
            [
                "2.9kg",
                "weighted"
            ]
        ]
    },
    {
        "text_id": "100605",
        "sentence_id": 1,
        "text": "A 22-year-old woman, without any formerly diagnosed diseases, presented to the emergency department with a 3 day history of dyspnea, fatigue and central chest pain.",
        "relations": []
    },
    {
        "text_id": "100605",
        "sentence_id": 2,
        "text": "She reported increasing dyspnea that developed in the previous month.",
        "relations": []
    },
    {
        "text_id": "100605",
        "sentence_id": 3,
        "text": "She also had intermittent pain in the small joints for several months.",
        "relations": []
    },
    {
        "text_id": "100605",
        "sentence_id": 4,
        "text": "There was no family history of SLE.",
        "relations": []
    },
    {
        "text_id": "100605",
        "sentence_id": 5,
        "text": "On examination, she had a temperature of 38.2°C, a heart rate of 115 beats/minute, blood pressure of 90/60mmHg, respiratory rate of 25 breaths/minute, muffled heart sounds and jugular distention.",
        "relations": [
            [
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                "25 breaths/minute",
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        ]
    },
    {
        "text_id": "100605",
        "sentence_id": 6,
        "text": "The electrocardiogram showed sinus tachycardia and low voltage.",
        "relations": []
    },
    {
        "text_id": "100605",
        "sentence_id": 7,
        "text": "The chest radiograph showed an enlargement of the cardiac silhouette with a right-sided pulmonary effusion.",
        "relations": []
    },
    {
        "text_id": "100605",
        "sentence_id": 8,
        "text": "The echocardiography revealed a large circumferential pericardial effusion, with diastolic collapse of the right atrium, dilated inferior vena cava and 30% respiratory variation of the Doppler mitral valve, confirming the diagnosis of cardiac tamponade.",
        "relations": []
    },
    {
        "text_id": "100605",
        "sentence_id": 9,
        "text": "Initial workup showed normochromic normocytic anemia with hemoglobin at 8.5g/dl, CRP: 75mg/L, renal and liver function tests were normal.",
        "relations": [
            [
                "8.5g/dl",
                "hemoglobin"
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            [
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        ]
    },
    {
        "text_id": "100605",
        "sentence_id": 10,
        "text": "Emergency pericardiocentesis was indicated but could not be performed because of the incapability to place the guidewire into the pericardial cavity.",
        "relations": []
    },
    {
        "text_id": "100605",
        "sentence_id": 11,
        "text": "So, urgent surgical pericardiectomy with window procedure was realized, 1200 of clear fluid was evacuated.",
        "relations": []
    },
    {
        "text_id": "100605",
        "sentence_id": 12,
        "text": "The pericardial fluid contained 2900 white blood cells/mm³, 100 red blood cells/mm³, bacteriological culture and cytologic examinations yielded negative results.",
        "relations": [
            [
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    {
        "text_id": "100605",
        "sentence_id": 13,
        "text": "The pericardial biopsy showed features of nonspecific inflammation, malignancy and tuberculosis were ruled out.",
        "relations": []
    },
    {
        "text_id": "100605",
        "sentence_id": 14,
        "text": "Further investigations were accomplished to determine the etiology.",
        "relations": []
    },
    {
        "text_id": "100605",
        "sentence_id": 15,
        "text": "Immunological workup revealed antinuclear antibodies titer of 1:1280, positive anti-SSA and anti-SM antibodies and hypocomplementemia.",
        "relations": [
            [
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    {
        "text_id": "100605",
        "sentence_id": 16,
        "text": "The coombs test was positive.",
        "relations": [
            [
                "positive",
                "test"
            ]
        ]
    },
    {
        "text_id": "100605",
        "sentence_id": 17,
        "text": "The diagnosis of systemic lupus erythematosus was established based on hemolytic anemia, serositis, arthralgia, positive anti nuclear and anti SM antibodies and low complement.",
        "relations": []
    },
    {
        "text_id": "100605",
        "sentence_id": 18,
        "text": "The patient was started on intravenous therapy with methylprednisolone followed by prednisone 60mg by mouth daily with hydroxychloroquine.",
        "relations": []
    },
    {
        "text_id": "100605",
        "sentence_id": 19,
        "text": "She had a good clinical response and control echocardiography showed complete resolution of the pericardial effusion without recurrence.",
        "relations": []
    },
    {
        "text_id": "100645",
        "sentence_id": 1,
        "text": "A 53-year-old woman presented with a posterior left retroauricular mass, that was discovered 10 months ago and resected respectively at a local hospital.",
        "relations": []
    },
    {
        "text_id": "100645",
        "sentence_id": 2,
        "text": "Ten days after this operation, a pruritic, painless lesion of a size 2 cm x 2 cm was observed at the incision area.",
        "relations": [
            [
                "2 cm x 2 cm",
                "size"
            ]
        ]
    },
    {
        "text_id": "100645",
        "sentence_id": 3,
        "text": "The patient had no history of migraine, loss of hearing, drug allergy, or trauma.",
        "relations": []
    },
    {
        "text_id": "100645",
        "sentence_id": 4,
        "text": "Otoscope examination revealed an external auditory meatus protrusion, with a normal tympanic membrane.",
        "relations": []
    },
    {
        "text_id": "100645",
        "sentence_id": 5,
        "text": "Magnetic resonance imaging (MRI) revealed a heterogeneous lesion.",
        "relations": []
    },
    {
        "text_id": "100645",
        "sentence_id": 6,
        "text": "The patient underwent extended left parotidectomy.",
        "relations": []
    },
    {
        "text_id": "100645",
        "sentence_id": 7,
        "text": "An s-incision of 10 cm long was made extending from the earlobe towards the mandibular angle.",
        "relations": []
    },
    {
        "text_id": "100645",
        "sentence_id": 8,
        "text": "With palpation, the tumour was located in the parotid gland.",
        "relations": []
    },
    {
        "text_id": "100645",
        "sentence_id": 9,
        "text": "The superficial lobe of the parotid gland was gradually removed with caution to the facial nerve trunk.",
        "relations": []
    },
    {
        "text_id": "100645",
        "sentence_id": 10,
        "text": "The tumour had invaded the deep lobe of the parotid gland and the posterior wall of the external auditory canal.",
        "relations": []
    },
    {
        "text_id": "100645",
        "sentence_id": 11,
        "text": "The deep lobe of the parotid gland was removed simultaneously, and the left cervical lymph node dissection was performed in levels II-IV, with its adipose connective tissue.",
        "relations": []
    },
    {
        "text_id": "100645",
        "sentence_id": 12,
        "text": "The diameter of the larger lymph node being 2 cm.",
        "relations": [
            [
                "2 cm",
                "diameter"
            ]
        ]
    },
    {
        "text_id": "100645",
        "sentence_id": 13,
        "text": "A method of sleeve resection was used to remove the protruding posterior wall of the external auditory canal.",
        "relations": []
    },
    {
        "text_id": "100645",
        "sentence_id": 14,
        "text": "A drainage tube was inserted.",
        "relations": []
    },
    {
        "text_id": "100645",
        "sentence_id": 15,
        "text": "There was no complication, the operation was completed and the patient recovered well.",
        "relations": []
    },
    {
        "text_id": "100645",
        "sentence_id": 16,
        "text": "The pathological results showed that the tumour of about 2 cm x 2 cm x 1.4 cm, involved the epidermis, vessels, and nerves.",
        "relations": []
    },
    {
        "text_id": "100645",
        "sentence_id": 17,
        "text": "There was a distribution of the lymph node with metastasis and distribution of the external auditory canal with mucoepidermoid carcinoma.",
        "relations": []
    },
    {
        "text_id": "100645",
        "sentence_id": 18,
        "text": "Immunohistochemistry results showed CK7 (+), calponin (-), CK5/6 (+), P63 (+), S-100 (-), Dog-1 (+), CD117 (-), Ki-67 (+5%), P53 (-), and EMA (+).",
        "relations": [
            [
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    },
    {
        "text_id": "100645",
        "sentence_id": 19,
        "text": "Hematoxylin and eosin (H&E) staining indicated a D-PAS positive.",
        "relations": [
            [
                "positive",
                "D-PAS"
            ]
        ]
    },
    {
        "text_id": "100645",
        "sentence_id": 20,
        "text": "The clinical diagnosis was pleomorphic adenoma.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 1,
        "text": "Patient information: a 9-month-old boy presented to the emergency room with a 3-day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38.5°C for 24 hours.",
        "relations": [
            [
                "38.5°C",
                "peaks"
            ]
        ]
    },
    {
        "text_id": "100655",
        "sentence_id": 2,
        "text": "His parents had noted an ankle trauma in the previous week.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 3,
        "text": "The primary care physician had initially suspected a talus fracture.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 4,
        "text": "His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 5,
        "text": "However, the child continued to experience ankle pain and fever.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 6,
        "text": "He was returned to the emergency room after two days.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 7,
        "text": "His symptoms were aggravated.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 8,
        "text": "The ankle was noted to be slightly edematous, but warm to the touch, and diffusely tender to palpation.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 9,
        "text": "His temperature was 39°C.",
        "relations": [
            [
                "39°C",
                "temperature"
            ]
        ]
    },
    {
        "text_id": "100655",
        "sentence_id": 10,
        "text": "Diagnostic assessment: the hemoglobin was 9.5 g/dl, the white blood cell count was 18800/mm 3, and the C-reactive protein (CRP) was 75 mm/h.",
        "relations": [
            [
                "9.5 g/dl",
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            [
                "75 mm/h",
                "CRP"
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        ]
    },
    {
        "text_id": "100655",
        "sentence_id": 11,
        "text": "Serum laboratory studies, including CBC count and inflammatory markers, were all elevated.",
        "relations": [
            [
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            [
                "elevated",
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            [
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        ]
    },
    {
        "text_id": "100655",
        "sentence_id": 12,
        "text": "An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 13,
        "text": "However, the computed tomography (CT) scan findings revealed a talus fracture.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 14,
        "text": "A magnetic resonance imaging (MRI) was not done as it was not available.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 15,
        "text": "Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 16,
        "text": "The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 17,
        "text": "Therapeutic intervention: the patient was urgently taken to the operating room.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 18,
        "text": "During the operation, the ankle joint was explored through an anterior approach.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 19,
        "text": "There were some false membranes, a thin turbid fluid and a pertuit at the junction bone cartilage of the talus.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 20,
        "text": "The talar cartilage was regular and normal-looking.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 21,
        "text": "The pertuit, allowing access to a cavity, was cleaned and the yellow organized fibrinous pus was drained.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 22,
        "text": "The biopsy specimens for the histopathological examination and culture were taken at that site.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 23,
        "text": "Curettage and irrigation were performed, and the joint was closed over suction drains.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 24,
        "text": "An empirical antibiotic treatment IV (cephalosporin + gentamycine) was initiated.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 25,
        "text": "Follow-up and outcomes: febrile peaks persisted during the first three days.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 26,
        "text": "The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 27,
        "text": "The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 28,
        "text": "So, the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 29,
        "text": "Drainage was maintained for twelve days (until normalization of CRP) and intravenous antibiotics for 3 weeks.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 30,
        "text": "In the third week, the peripheral leukocytes count was 8600/mL, and the CRP decreased to 2.43mg.",
        "relations": [
            [
                "8600/mL",
                "count"
            ],
            [
                "2.43mg",
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        ]
    },
    {
        "text_id": "100655",
        "sentence_id": 31,
        "text": "The patient's antibiotic was then substituted by oral pristinamycin for three weeks.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 32,
        "text": "In the fourth week, the ESR and CRP were 7 mm/hr and 3 mg/L, respectively.",
        "relations": [
            [
                "7 mm/hr",
                "ESR"
            ],
            [
                "3 mg/L",
                "CRP"
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        ]
    },
    {
        "text_id": "100655",
        "sentence_id": 33,
        "text": "At that time, the patient did not complain of any pain or limitation of the range of motion of the ankle.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 34,
        "text": "The cast was removed six weeks after surgery.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 35,
        "text": "At six months, radiographies showed that the lesion healed completely.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 36,
        "text": "The parents were very satisfied.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 37,
        "text": "Their child acquired walking at the age of 14 months.",
        "relations": []
    },
    {
        "text_id": "100655",
        "sentence_id": 38,
        "text": "In the last follow-up visit at 18 months postoperatively, the patient had no pain or limitation in walking and running.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 1,
        "text": "A 26-year-old pregnant patient with a history of two previous cesarean deliveries was referred to our tertiary clinic.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 2,
        "text": "The patient was having severe right sided abdominal pain with sudden onset.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 3,
        "text": "She was in the 18 th week of her pregnancy based on last menstrual period.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 4,
        "text": "Obstetric ultrasound measurements revealed a live pregnancy compatible with 18 weeks gestation without any abnormality.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 5,
        "text": "However, a 15x12cm in size edematous multicystic adnexal mass occupying the mid and upper right abdomen without vascularity was identified.",
        "relations": [
            [
                "15x12cm",
                "mass"
            ]
        ]
    },
    {
        "text_id": "100668",
        "sentence_id": 6,
        "text": "The mass was suspected to originate from right ovary.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 7,
        "text": "It was pushing the pregnant uterus into the left and anterior direction.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 8,
        "text": "There was no ultrasonographic evidence of malignancy.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 9,
        "text": "Considering the severe sudden pain complaint and adnexal mass finding, explorative laparotomy was planned for the suspected diagnosis of adnexal torsion.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 10,
        "text": "A mediolateral (near vertical) skin incision was made originated from infra-umbilical level on the lateral side of right rectus muscle.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 11,
        "text": "Specifically, the starting point for this slightly oblique incision was at 3cm lateral to the midline and near to lateral one third of the rectus muscle.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 12,
        "text": "The skin and fascia incisions were approximately 4cm and 2.5cm in length, respectively and this difference was due to the thick subcutaneous fat tissue.",
        "relations": [
            [
                "4cm",
                "length"
            ],
            [
                "2.5cm",
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        ]
    },
    {
        "text_id": "100668",
        "sentence_id": 13,
        "text": "The oblique paramedian incision of the anterior rectus sheath was approximately 2cm medial to the lateral border of the rectus muscle and it was extended to caudal-lateral direction, down to 1/2cm to the lateral border of rectus muscle.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 14,
        "text": "The lateral edge of anterior rectus sheath incision was dissected off from the rectus muscle laterally up to semilunar line of rectus muscle in 1cm width.",
        "relations": [
            [
                "1cm",
                "width"
            ]
        ]
    },
    {
        "text_id": "100668",
        "sentence_id": 15,
        "text": "Then, the rectus muscle was retracted medially to expose the posterior sheath of rectus (below the arcuate line, only the transversalis fascia and parietal peritoneum are exposed).",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 16,
        "text": "An oblique incision was made on the posterior sheath of rectus and peritoneum behind the rectus muscle, in a projection of the anterior sheath incision.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 17,
        "text": "In this manner, the abdominal wall incisions were located at anterior and posterior sheaths of rectus muscle at least 1/2cm medial to the semilunar line and to the lateral border of rectus.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 18,
        "text": "In other words, incision was not made from fascial layers' merging point or by muscle splitting dissection.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 19,
        "text": "Therefore, traction forces from enlarging uterus in advancing pregnant abdomen could be minimized.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 20,
        "text": "A large edematous, necrotic and dark purple torsion of a right adnexal mass was observed.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 21,
        "text": "It was pulled out and was partially dissected from its surface layer following a 2cm incision.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 22,
        "text": "The cystic structure was aspirated and right salpingo-ooferectomy was performed.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 23,
        "text": "The operation was completed by avoiding the manipulation of the pregnant uterus.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 24,
        "text": "Frozen section pathology of the removed specimen was reported as benign (necrotic tissues, teratoma) and final pathology was mucinous cystadenoma.",
        "relations": []
    },
    {
        "text_id": "100668",
        "sentence_id": 25,
        "text": "Follow up on the pregnant patient was uneventful a month later.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 1,
        "text": "A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 2,
        "text": "Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 3,
        "text": "She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US).",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 4,
        "text": "Her neonatal period was unremarkable.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 5,
        "text": "Clinical findings: on physical examination, she was colored and active.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 6,
        "text": "Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg).",
        "relations": [
            [
                "normal limits",
                "parameters"
            ],
            [
                "normal limits",
                "vitals"
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            [
                "10kg",
                "weight"
            ]
        ]
    },
    {
        "text_id": "100700",
        "sentence_id": 7,
        "text": "Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 8,
        "text": "Abdomen was soft on palpation and tympanic on percussion.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 9,
        "text": "The digital rectal examination was unremarkable.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 10,
        "text": "Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid).",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 11,
        "text": "Timeline: our patient experienced first symptoms since August 2019.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 12,
        "text": "Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 13,
        "text": "The patient has been treated and discharged in August 2020 and pathology results were available 11 days later.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 14,
        "text": "Diagnostic assessment: blood results were within normal range.",
        "relations": [
            [
                "normal range",
                "results"
            ]
        ]
    },
    {
        "text_id": "100700",
        "sentence_id": 15,
        "text": "Abdominal X-ray showed distension of an intestinal loop in the left lumbar region.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 16,
        "text": "Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 17,
        "text": "Contrast enema was unremarkable.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 18,
        "text": "Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 19,
        "text": "An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 20,
        "text": "Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 21,
        "text": "Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause.",
        "relations": [
            [
                "ten cm",
                "measured"
            ],
            [
                "ten cm",
                "length"
            ]
        ]
    },
    {
        "text_id": "100700",
        "sentence_id": 22,
        "text": "It measured ten cm in length and had prominent serosal vessels.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 23,
        "text": "Adjacent mesentery was thickened.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 24,
        "text": "No further anatomic anomaly was identified.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 25,
        "text": "A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 26,
        "text": "Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 27,
        "text": "The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 28,
        "text": "Locally diminished actin coloration indicated atrophy of smooth muscle fibers.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 29,
        "text": "Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 30,
        "text": "No ectopic tissue was identified.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 31,
        "text": "The postoperative period was uneventful.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 32,
        "text": "The patient was on parenteral nutrition until day seven postoperatively.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 33,
        "text": "She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days.",
        "relations": []
    },
    {
        "text_id": "100700",
        "sentence_id": 34,
        "text": "For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.",
        "relations": []
    },
    {
        "text_id": "101114",
        "sentence_id": 1,
        "text": "A 29-year-old man was admitted to our hospital with an unidentified fever.",
        "relations": []
    },
    {
        "text_id": "101114",
        "sentence_id": 2,
        "text": "He was diagnosed with malignant lymphoma (extra-nodal NK/T cell lymphoma nasal type), and chemotherapy was administered.",
        "relations": []
    },
    {
        "text_id": "101114",
        "sentence_id": 3,
        "text": "After chemotherapy, nodular lung shadows along with new brain, cervical, and myocardial abscesses appeared, despite anti-bacterial/fungal therapy.",
        "relations": []
    },
    {
        "text_id": "101114",
        "sentence_id": 4,
        "text": "Gene analysis of the cervical abscess biopsy revealed the presence of Aspergillus fumigatus species, and the transesophageal echocardiogram showed a mobile mural vegetation in the left ventricle (22 × 8 mm).",
        "relations": []
    },
    {
        "text_id": "101114",
        "sentence_id": 5,
        "text": "He underwent surgical resection of this mural vegetation.",
        "relations": []
    },
    {
        "text_id": "101114",
        "sentence_id": 6,
        "text": "His postoperative course was uneventful.",
        "relations": []
    },
    {
        "text_id": "101114",
        "sentence_id": 7,
        "text": "He remains healthy at 28 months after surgery with continued oral antifungal therapy.",
        "relations": []
    },
    {
        "text_id": "101783",
        "sentence_id": 1,
        "text": "A 46-year-old man with hypertension and dyslipidemia diagnosed 4-months before, as well as new-onset diabetes mellitus unveiled 1-month earlier, was referred to emergency department for hypokalemia.",
        "relations": []
    },
    {
        "text_id": "101783",
        "sentence_id": 2,
        "text": "Hormonal study and dynamic biochemical tests performed indicated ECS.",
        "relations": []
    },
    {
        "text_id": "101783",
        "sentence_id": 3,
        "text": "Imaging and cytological findings pointed toward a likely primary right parotid malignancy with liver metastases.",
        "relations": []
    },
    {
        "text_id": "101783",
        "sentence_id": 4,
        "text": "Somatostatin receptor scintigraphy has shown an increased uptake in the parotid gland and mild expression in liver metastasis.",
        "relations": []
    },
    {
        "text_id": "101783",
        "sentence_id": 5,
        "text": "The patient underwent right parotidectomy, and histopathologic examination confirmed ACC.",
        "relations": []
    },
    {
        "text_id": "101783",
        "sentence_id": 6,
        "text": "Meanwhile, hypercortisolism was managed with metyrapone, ketoconazole, and lanreotide.",
        "relations": []
    },
    {
        "text_id": "101783",
        "sentence_id": 7,
        "text": "Despite chemotherapy onset, a rapid disease progression and clinical course deterioration was observed.",
        "relations": []
    },
    {
        "text_id": "103266",
        "sentence_id": 1,
        "text": "A 61-year-old man presented with chronic left ear discharge, left-sided headache, diplopia associated with vertigo, tinnitus, and hearing impairment.",
        "relations": []
    },
    {
        "text_id": "103266",
        "sentence_id": 2,
        "text": "MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis; in the context of chronic tympanomastoiditis, there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7th-8th nerve complex.",
        "relations": []
    },
    {
        "text_id": "103266",
        "sentence_id": 3,
        "text": "The patient was treated conservatively with local and systemic antimicrobial agents, he had satisfactory response and improvement regarding symptoms of ear discharge, vertigo, and diplopia, but there is no remarkable response regarding hearing loss and tinnitus.",
        "relations": []
    },
    {
        "text_id": "103589",
        "sentence_id": 1,
        "text": "This is a case report of a 59-year old woman with a 5-year clinical history of perimenopausal uterine bleeding and three explorative curettages.",
        "relations": []
    },
    {
        "text_id": "103589",
        "sentence_id": 2,
        "text": "Gynaecological and ultrasound examinations revealed ovarian enlargement with a diameter of 50 mm with hypoechoic zones suspected of benign teratoma.",
        "relations": [
            [
                "50 mm",
                "enlargement"
            ]
        ]
    },
    {
        "text_id": "103589",
        "sentence_id": 3,
        "text": "The diagnostic test such as Ca-125, AFP, free-T4 and TSH was in normal range.",
        "relations": [
            [
                "normal range",
                "test"
            ]
        ]
    },
    {
        "text_id": "103589",
        "sentence_id": 4,
        "text": "A smooth, solid right ovarian 50 an mm-size tumour, as well as small amount of fluid in the Douglas pouch, was found during the total abdominal hysterectomy, bilateral salpingo-oophorectomy and staging biopsy.",
        "relations": []
    },
    {
        "text_id": "103589",
        "sentence_id": 5,
        "text": "The histopathology revealed teratoma with strumal carcinoid tumour IA stage according to AJCC 2010 of the right ovary and negative cytopathology of the fluid from the Douglas pouch.",
        "relations": []
    },
    {
        "text_id": "103589",
        "sentence_id": 6,
        "text": "On the postoperative 2-year control, the patient was tumour free, and Ca-125, free-T4 and TSH were in normal range.",
        "relations": [
            [
                "normal range",
                "Ca-125"
            ],
            [
                "normal range",
                "TSH"
            ],
            [
                "normal range",
                "free-T4"
            ]
        ]
    },
    {
        "text_id": "104655",
        "sentence_id": 1,
        "text": "Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation.",
        "relations": []
    },
    {
        "text_id": "104655",
        "sentence_id": 2,
        "text": "Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome.",
        "relations": []
    },
    {
        "text_id": "104655",
        "sentence_id": 3,
        "text": "Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation.",
        "relations": [
            [
                "normal",
                "analysis"
            ]
        ]
    },
    {
        "text_id": "104655",
        "sentence_id": 4,
        "text": "She was treated with intravenous immunoglobulin resulting in a remarkable recovery.",
        "relations": []
    },
    {
        "text_id": "104655",
        "sentence_id": 5,
        "text": "Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.",
        "relations": []
    },
    {
        "text_id": "105023",
        "sentence_id": 1,
        "text": "In May 2014 a 49 year gentleman was admitted for widespread mucocutaneous blistering diagnosed as PV by histology and immunofluorescence.",
        "relations": []
    },
    {
        "text_id": "105023",
        "sentence_id": 2,
        "text": "After 6 weeks of treatment with systemic steroids and azathioprine the patient developed pulmonary emboli and started oral anticoagulation with warfarin.",
        "relations": []
    },
    {
        "text_id": "105023",
        "sentence_id": 3,
        "text": "In late September, the patient re-presented with a severe flare of PV and a recurrent deep vein thrombosis despite oral anticoagulation within therapeutic range.",
        "relations": []
    },
    {
        "text_id": "105023",
        "sentence_id": 4,
        "text": "Warfarin was changed to subcutaneous low molecular heparin in therapeutic dose while treatment for pemphigus was escalated: first azathioprine was switched to mycophenolate mofetil and the steroids dose increased; then due to poor response, intravenous immunoglobulins were given for three courses and finally he received four infusions of Rituximab that induced sustained remission.",
        "relations": []
    },
    {
        "text_id": "105023",
        "sentence_id": 5,
        "text": "In April 2015 the dose of mycophenolate was decreased but anticoagulation was continued until the beginning of July 2015 to ensure that decreasing immune suppression did not allow the emergence of another flare with attendant thrombotic risk.",
        "relations": []
    },
    {
        "text_id": "105551",
        "sentence_id": 1,
        "text": "A 3-day-old boy from Kosovo with dextro-transposition of the great arteries who developed progressive heart failure required an emergency arterial switch operation.",
        "relations": []
    },
    {
        "text_id": "105551",
        "sentence_id": 2,
        "text": "Because of persistent pulmonary edema after completion of the arterial switch operation at our institution, the patient could not be weaned off mechanical ventilation.",
        "relations": []
    },
    {
        "text_id": "105551",
        "sentence_id": 3,
        "text": "Transthoracic echocardiography revealed an anomalous accelerated flow, indicating an anomalous systemic pulmonary shunt.",
        "relations": []
    },
    {
        "text_id": "105551",
        "sentence_id": 4,
        "text": "Arterial catheterization revealed an abnormal bronchial artery originating from the left subclavian artery and bifurcating to both lungs.",
        "relations": []
    },
    {
        "text_id": "105551",
        "sentence_id": 5,
        "text": "The anomalous ectatic bronchial artery was successfully occluded by coil embolization.",
        "relations": []
    },
    {
        "text_id": "105551",
        "sentence_id": 6,
        "text": "The improvement of the patient's hemodynamic status resulted in an uneventful post-operative course.",
        "relations": []
    },
    {
        "text_id": "106156",
        "sentence_id": 1,
        "text": "A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling.",
        "relations": []
    },
    {
        "text_id": "106156",
        "sentence_id": 2,
        "text": "Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall.",
        "relations": []
    },
    {
        "text_id": "106156",
        "sentence_id": 3,
        "text": "Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck.",
        "relations": []
    },
    {
        "text_id": "106156",
        "sentence_id": 4,
        "text": "The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess.",
        "relations": []
    },
    {
        "text_id": "106156",
        "sentence_id": 5,
        "text": "After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma.",
        "relations": []
    },
    {
        "text_id": "106156",
        "sentence_id": 6,
        "text": "The lesions improved after intraoral incision and drainage, and administration of antibiotics.",
        "relations": []
    },
    {
        "text_id": "107021",
        "sentence_id": 1,
        "text": "A 20 years old man presented with fever, myalgias, arthralgias, retro-orbital pain, vomiting and gum bleeding during a large dengue outbreak in Lahore, Pakistan.",
        "relations": []
    },
    {
        "text_id": "107021",
        "sentence_id": 2,
        "text": "On 7th day of illness patient became afebrile, but he developed severe headaches, unconsciousness followed by altered behavior.",
        "relations": []
    },
    {
        "text_id": "107021",
        "sentence_id": 3,
        "text": "On 9th day of illness patient developed painful neck swelling accompanied by fever, tremors, palpitations, hoarseness of voice and odynophagia.",
        "relations": []
    },
    {
        "text_id": "107021",
        "sentence_id": 4,
        "text": "Examination revealed acutely swollen, tender thyroid gland along with features of hyperthyroidism.",
        "relations": []
    },
    {
        "text_id": "107021",
        "sentence_id": 5,
        "text": "Laboratory evaluation revealed stable hematocrit, thrombocytopenia and leukopenia.",
        "relations": []
    },
    {
        "text_id": "107021",
        "sentence_id": 6,
        "text": "Patient had seroconverted for anti-dengue IgM antibodies on the 10th day of illness.",
        "relations": []
    },
    {
        "text_id": "107021",
        "sentence_id": 7,
        "text": "A non-contrast Computed Tomogram (CT) of the brain showed right frontal lobe hematoma.",
        "relations": []
    },
    {
        "text_id": "107021",
        "sentence_id": 8,
        "text": "Thyroid profile showed increased free T3 and T4 and low TSH.",
        "relations": [
            [
                "increased",
                "T3"
            ],
            [
                "increased",
                "T4"
            ],
            [
                "low",
                "TSH"
            ]
        ]
    },
    {
        "text_id": "107021",
        "sentence_id": 9,
        "text": "Technetium thyroid scan showed reduced tracer uptake.",
        "relations": []
    },
    {
        "text_id": "107021",
        "sentence_id": 10,
        "text": "He was diagnosed as having subacute thyroiditis and treated with oral prednisolone and propranolol.",
        "relations": []
    },
    {
        "text_id": "107021",
        "sentence_id": 11,
        "text": "Follow up CT brain showed resolving hematoma.",
        "relations": []
    },
    {
        "text_id": "107021",
        "sentence_id": 12,
        "text": "Patient's recovery was uneventful.",
        "relations": []
    },
    {
        "text_id": "107423",
        "sentence_id": 1,
        "text": "A 16-year-old Indian boy presented to our hospital with a history of a lump in the lower back region since birth.",
        "relations": []
    },
    {
        "text_id": "107423",
        "sentence_id": 2,
        "text": "Initially, it was small, but its size increased gradually over time to a size of 15 cm × 15 cm at presentation.",
        "relations": [
            [
                "15 cm × 15 cm",
                "size"
            ]
        ]
    },
    {
        "text_id": "107423",
        "sentence_id": 3,
        "text": "There were no other associated abnormalities.",
        "relations": []
    },
    {
        "text_id": "107423",
        "sentence_id": 4,
        "text": "Investigations revealed the lump to be a benign cystic teratoma.",
        "relations": []
    },
    {
        "text_id": "107423",
        "sentence_id": 5,
        "text": "The patient underwent surgery, and the whole tumor, from its base to the vertebrae, was excised.",
        "relations": []
    },
    {
        "text_id": "107423",
        "sentence_id": 6,
        "text": "Bisection of the tumor revealed that it contained hair and pultaceous material consistent with a teratoma, which was later confirmed by histopathologic examination.",
        "relations": []
    },
    {
        "text_id": "108055",
        "sentence_id": 1,
        "text": "A 65 year-old woman with hypertension and Parkinson's disease presented with sudden onset severe chest pain.",
        "relations": []
    },
    {
        "text_id": "108055",
        "sentence_id": 2,
        "text": "Electrocardiogram showed ischemic ST-segment elevation in inferior and lateral leads.",
        "relations": []
    },
    {
        "text_id": "108055",
        "sentence_id": 3,
        "text": "Urgent cardiac catheterization revealed focal dissections in four small caliber coronary arteries in right and left coronary systems including right posterior decending, posterolateral, obtuse marginal and septal arteries.",
        "relations": []
    },
    {
        "text_id": "108055",
        "sentence_id": 4,
        "text": "Angiography demonstrated no significant atherosclerotic coronary artery disease.",
        "relations": []
    },
    {
        "text_id": "108055",
        "sentence_id": 5,
        "text": "The patient was medically managed with Eptifibatide, Aspirin, Clopidogrel and beta blocker since dissected vessels were not technically suitable for percutaneous coronary intervention.",
        "relations": []
    },
    {
        "text_id": "108055",
        "sentence_id": 6,
        "text": "Antiparkinson medications were held as a potential cause of dissection.",
        "relations": []
    },
    {
        "text_id": "108055",
        "sentence_id": 7,
        "text": "She responded well to medical management.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 1,
        "text": "A male patient, born in 1973, fell off the balcony while on holidays in Crete in 1993 and developed complete tetraplegia at C-5 level.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 2,
        "text": "In 1996, deafferentation of sacral nerve roots 2, 3 and 4 were carried out bilaterally.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 3,
        "text": "Brindley sacral anterior root stimulator was implanted.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 4,
        "text": "On eleventh post-operative day, blood stained fluid came out of sacral wound.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 5,
        "text": "Microbiology of exudates showed growth of Pseudomonas aeruginosa, sensitive to gentamicin.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 6,
        "text": "As discharge of serosanguinous fluid persisted, sacral wound was explored.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 7,
        "text": "In March 1997, induration and craggy swelling were noted at the site of receiver.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 8,
        "text": "There was discharge from the surgical wound in the back.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 9,
        "text": "Wound swab grew Pseudomonas aeruginosa.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 10,
        "text": "The receiver was taken out.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 11,
        "text": "Cables were retrieved and tunnelled in left flank.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 12,
        "text": "Laminectomy wound was left open.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 13,
        "text": "In May 1997, cables were removed from left flank through the laminectomy wound.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 14,
        "text": "Grommet was sliced down as much as possible without producing leak of cerebrospinal fluid.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 15,
        "text": "Histoacryl glue was used over the truncated grommet as a sealing agent.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 16,
        "text": "Microbiology of end of S-2 and S-3 cables showed growth of Pseudomonas aeruginosa, which was sensitive to gentamicin.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 17,
        "text": "End of S-4 cable showed scanty growth of Pseudomonas aeruginosa and Klebsiella aerogenes.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 18,
        "text": "Review of this patient in January 1999 revealed presence of sinuses in dorsal wound exuding purulent material.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 19,
        "text": "The wound was explored; grommet and electrodes were removed.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 20,
        "text": "The consequences of failed implantation were severe constipation and loss of reflex penile erection and bladder emptying.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 21,
        "text": "This patient had to spend increasing amount of time for bowels management.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 22,
        "text": "Faecal incontinence limited his mobility.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 23,
        "text": "The problem with his bowels was affecting his confidence in doing anything, as the slightest movement could cause his bowels to work.",
        "relations": []
    },
    {
        "text_id": "108254",
        "sentence_id": 24,
        "text": "The inconvenience and embarrassment of a bowel accident caused distress to the patient and to his mother.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 1,
        "text": "A 14-year old boy with no significant past medical history presented to a small district hospital in southern Sierra Leone with a 4 day history of facial puffiness, peripheral pitting oedema, abdominal pains, and reduced urine output.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 2,
        "text": "On examination he was afebrile, BP150/110, heart rate 70.",
        "relations": [
            [
                "70",
                "rate"
            ]
        ]
    },
    {
        "text_id": "100017",
        "sentence_id": 3,
        "text": "He had significant periorbital and facial oedema, pitting oedema from the feet to the knees, a distended abdomen, ascites, and tender hepatomegaly.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 4,
        "text": "Lab results showed haemoglobin 10.9 g/dl, packed cell volume 35%, and positive malaria parasites.",
        "relations": [
            [
                "10.9 g/dl",
                "haemoglobin"
            ],
            [
                "35%",
                "volume"
            ],
            [
                "positive",
                "parasites"
            ]
        ]
    },
    {
        "text_id": "100017",
        "sentence_id": 5,
        "text": "Urea (14 mg/dl), creatinine (1.0 mg/dl), sodium (137 mmol/L), and potassium (3.7 mmol/L) were normal.",
        "relations": [
            [
                "14 mg/dl",
                "Urea"
            ],
            [
                "1.0 mg/dl",
                "creatinine"
            ],
            [
                "137 mmol/L",
                "sodium"
            ],
            [
                "3.7 mmol/L",
                "potassium"
            ],
            [
                "normal",
                "sodium"
            ],
            [
                "normal",
                "potassium"
            ],
            [
                "normal",
                "Urea"
            ],
            [
                "normal",
                "creatinine"
            ]
        ]
    },
    {
        "text_id": "100017",
        "sentence_id": 6,
        "text": "Urinalysis, using a urine dipstick, revealed three pluses of proteinurea, which equates to ≥3g urinary protein per day.",
        "relations": [
            [
                "three pluses",
                "proteinurea"
            ]
        ]
    },
    {
        "text_id": "100017",
        "sentence_id": 7,
        "text": "Lab facilities for the measurement of serum albumin were not available.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 8,
        "text": "The diagnosis of nephrotic syndrome was made and the patient was started on a course of prednisolone 60mg/day, Enalapril 2.5mg daily, anti-malarial treatment, and empirical broad spectrum IV antibiotics to cover bacterial infections, in addition to a salt-restricted diet.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 9,
        "text": "On day 3 of admission he showed a clinical response to treatment, as the facial oedema, ascites, and BP had reduced.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 10,
        "text": "Urinalysis showed two pluses of proteinurea (0.5-1.0 gram per day per day).",
        "relations": [
            [
                "two pluses",
                "proteinurea"
            ]
        ]
    },
    {
        "text_id": "100017",
        "sentence_id": 11,
        "text": "The child complained of a moderate headache, but had no fever, meningism, or focal neurological signs.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 12,
        "text": "He was started on oral paracetamol.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 13,
        "text": "The next morning (day 4 of admission) his symptoms evolved: his headache became severe, he had pain behind both eyes, and he was vomiting.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 14,
        "text": "Examination showed a right VI nerve palsy, diplopia, and tinnitus in the right ear, with some hearing loss.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 15,
        "text": "He later became drowsy and had a generalised seizure.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 16,
        "text": "Diagnosis and commencement of treatment was delayed due to the absence of CT/MRI brain imaging facilities in the local district.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 17,
        "text": "In the context of the child's nephrotic status and focal neurological signs, we had a high suspicion of cerebral venous thrombosis, and made a presumptive diagnosis.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 18,
        "text": "The child was started on high dose subcutaneous unfractionated heparin daily.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 19,
        "text": "This decision was made cautiously, but it was felt that the advantages surpassed the risks.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 20,
        "text": "He also received dexamethasone, high flow oxygen, and elevation of the head to 45 degrees, in order to treat features of raised intracranial pressure.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 21,
        "text": "On day 6 of admission his headache had improved and his focal neurological signs began to resolve.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 22,
        "text": "He still had a partial right VI nerve palsy and a convergent squint.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 23,
        "text": "His oedema resolved completely by day 10 of treatment, and he was discharged on day 18.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 24,
        "text": "He continued prednisolone 60mg daily for a total of 6 weeks, followed by a reduced dose of 40mg on alternate days for 6 weeks.",
        "relations": []
    },
    {
        "text_id": "100017",
        "sentence_id": 25,
        "text": "At 12 weeks follow-up, his urinalysis showed a trace proteinurea but he remained in remission.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 1,
        "text": "The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease (IHD) at a private cardiology facility in Lagos.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 2,
        "text": "She had presented in July 2009 with a history suggestive of IHD and angina class III (Canadian Cardiovascular society classification) which was worsening despite medical therapy.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 3,
        "text": "Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery (LAD) and the proximal Circumflex Coronary Artery (Cx).",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 4,
        "text": "The Right Coronary Artery was a dominant artery with some minor irregularities.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 5,
        "text": "Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 6,
        "text": "A 3.0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3.0mm Bare Metal Stent.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 7,
        "text": "The patient was angina-free for one year but represented in July 2010 again with angina class III.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 8,
        "text": "Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 9,
        "text": "She was controlled on medical therapy.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 10,
        "text": "However she presented again in November 2011, this time with unstable angina.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 11,
        "text": "An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50% left main stem stenosis and a 95% proximal LAD stenosis.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 12,
        "text": "She was subsequently referred for surgical revascularization.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 13,
        "text": "Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32kg/m 2.",
        "relations": [
            [
                "32kg/m 2",
                "index"
            ]
        ]
    },
    {
        "text_id": "100024",
        "sentence_id": 14,
        "text": "There were no significant physical findings.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 15,
        "text": "Associated risk factors were intermittent claudication (Ankle-Brachial Index bilaterally was 0.57), bilateral carotid bruits, poorly controlled diabetes mellitus and hyperlipidemia.",
        "relations": [
            [
                "0.57",
                "Index"
            ]
        ]
    },
    {
        "text_id": "100024",
        "sentence_id": 16,
        "text": "Her calculated euroscore was 6.",
        "relations": [
            [
                "6",
                "euroscore"
            ]
        ]
    },
    {
        "text_id": "100024",
        "sentence_id": 17,
        "text": "Medications on admission were Aspirin, Glyceryl trinitrate sublingual spray, Metformin, Glibenclamide, Fluvastatin, Metoprolol and Isosorbide Dinitrate.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 18,
        "text": "Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction.",
        "relations": [
            [
                "good",
                "fraction"
            ]
        ]
    },
    {
        "text_id": "100024",
        "sentence_id": 19,
        "text": "Chest radiogram, 12 lead electrocardiogram and pulmonary function tests were normal.",
        "relations": [
            [
                "normal",
                "radiogram"
            ],
            [
                "normal",
                "electrocardiogram"
            ],
            [
                "normal",
                "tests"
            ]
        ]
    },
    {
        "text_id": "100024",
        "sentence_id": 20,
        "text": "All blood parameters were within acceptable limits.",
        "relations": [
            [
                "acceptable",
                "parameters"
            ]
        ]
    },
    {
        "text_id": "100024",
        "sentence_id": 21,
        "text": "Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 22,
        "text": "Surgery was performed in November 2011.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 23,
        "text": "The cardiopulmonary bypass circuit was not primed.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 24,
        "text": "Following median sternotomy and harvesting of the Left Internal Mammary Artery (LIMA) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 25,
        "text": "The LAD which was a 2.5mm vessel was snugged proximally and an arteriotomy performed in its mid-portion.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 26,
        "text": "The arteriotomy site was kept bloodless with CO2 insufflation via an improvised blow-mister.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 27,
        "text": "The LIMA to LAD anastomosis was performed with 6-0 prolene suture.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 28,
        "text": "The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 29,
        "text": "She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 30,
        "text": "Postoperative recovery was delayed by the need to achieve glycaecmic control.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 31,
        "text": "She was discharged home 2 weeks postoperatively.",
        "relations": []
    },
    {
        "text_id": "100024",
        "sentence_id": 32,
        "text": "She has been reviewed in clinic and remains free of angina.",
        "relations": []
    },
    {
        "text_id": "100046",
        "sentence_id": 1,
        "text": "A 33-year man working in Gulf, presented with hemetemesis 15 days ago in the month of February this year.",
        "relations": []
    },
    {
        "text_id": "100046",
        "sentence_id": 2,
        "text": "This was preceeded by low grade fever, bone pain, generalised bodyache, low back ache and generalised macular skin rashes.",
        "relations": []
    },
    {
        "text_id": "100046",
        "sentence_id": 3,
        "text": "There was no history of abdominal pain, jaundice or features of chronic liver disease.",
        "relations": []
    },
    {
        "text_id": "100046",
        "sentence_id": 4,
        "text": "He gave history of intake of analgesics for backache.",
        "relations": []
    },
    {
        "text_id": "100046",
        "sentence_id": 5,
        "text": "After symptomatic treatment he returned back.",
        "relations": []
    },
    {
        "text_id": "100046",
        "sentence_id": 6,
        "text": "He came to our OPD with Complete blood count which showed a haemoglobin of 8g/dl, total count 6700/mm3 platelet count 24000/mm3 and ESR 55mm/hr.",
        "relations": [
            [
                "8g/dl",
                "haemoglobin"
            ],
            [
                "6700/mm3",
                "count"
            ],
            [
                "24000/mm3",
                "count"
            ],
            [
                "55mm/hr",
                "ESR"
            ]
        ]
    },
    {
        "text_id": "100046",
        "sentence_id": 7,
        "text": "On examination patient was pale with non pruritic macular rashes and mild splenomegaly.",
        "relations": []
    },
    {
        "text_id": "100046",
        "sentence_id": 8,
        "text": "Residing in Middle East with background history of fever, backache, skin rash, splenomegaly and a low platelet count possibility of atypical infection like Brucellosis with NSAID induced gi bleed was considered.",
        "relations": []
    },
    {
        "text_id": "100046",
        "sentence_id": 9,
        "text": "He was admitted for further evaluation and endoscopy done showed a nodular ulcerative lesions in the antrum of stomach and histopathologic examination confirmed adenocarcinoma of stomach.",
        "relations": []
    },
    {
        "text_id": "100046",
        "sentence_id": 10,
        "text": "Liver function tests showed a high ALP (1536 U/l), elevated INR (2.15) though bilirubin, transaminases and serum proteins were normal.",
        "relations": [
            [
                "high",
                "ALP"
            ],
            [
                "1536 U/l",
                "ALP"
            ],
            [
                "elevated",
                "INR"
            ],
            [
                "2.15",
                "INR"
            ],
            [
                "normal",
                "proteins"
            ]
        ]
    },
    {
        "text_id": "100046",
        "sentence_id": 11,
        "text": "Brucella agglutination test was negative.",
        "relations": [
            [
                "negative",
                "test"
            ]
        ]
    },
    {
        "text_id": "100046",
        "sentence_id": 12,
        "text": "Xray Chest was normal.",
        "relations": [
            [
                "normal",
                "Xray"
            ]
        ]
    },
    {
        "text_id": "100046",
        "sentence_id": 13,
        "text": "Ultrasound of abdomen showed normal echotexture of liver, no SOL, normal portal vein and no IHBRD.",
        "relations": []
    },
    {
        "text_id": "100046",
        "sentence_id": 14,
        "text": "CT scan of the abdomen revealed gross pylorus thickening with regional lymphadenopathy and skeletal metastasis with sclerotic foci involving vertebrae and pelvic bones and lytic areas in bilateral iliac blades with no liver metastasis or ascites.",
        "relations": []
    },
    {
        "text_id": "100046",
        "sentence_id": 15,
        "text": "A skeletal survey was done which showed lytic lesions in the iliac and femoral bones.",
        "relations": []
    },
    {
        "text_id": "100046",
        "sentence_id": 16,
        "text": "Bone marrow aspirate showed decreased red cells and platelets and marrow biopsy done was reported as metastasis from adenocarcinoma.",
        "relations": [
            [
                "decreased",
                "cells"
            ],
            [
                "decreased",
                "platelets"
            ]
        ]
    },
    {
        "text_id": "100046",
        "sentence_id": 17,
        "text": "Coagulation profile done was suggestive of DIC due to the raised levels of FDP (5,170 ng/dl) and a low fibrinogen \\(152mg/dl).",
        "relations": [
            [
                "5,170 ng/dl",
                "FDP"
            ],
            [
                "low",
                "fibrinogen"
            ],
            [
                "152mg/dl",
                "fibrinogen"
            ]
        ]
    },
    {
        "text_id": "100046",
        "sentence_id": 18,
        "text": "He was transferred to Medical Oncology department for subsequent management and was treated with chemotherapy.",
        "relations": []
    },
    {
        "text_id": "100046",
        "sentence_id": 19,
        "text": "He succumbed to his illness within 10 months of diagnosis.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 1,
        "text": "It is the case of a 29 years old woman, G2P1001, married, at 9 weeks of pregnancy.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 2,
        "text": "She consulted at our emergency service for the exacerbation of a left pelvic pain that has been evolving for two weeks prior to admission.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 3,
        "text": "A transient lull was observed following a treatment with a progesteron (hydroxyprogesterone caproate) and an antispasmodic (tiemonium methylsulfate) in a community clinic.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 4,
        "text": "The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 5,
        "text": "She had first menses at 14 and her menstrual cycle is regular with a length of 30 days.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 6,
        "text": "She has never practiced contraception.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 7,
        "text": "She has been adequately treated for acute pelvic inflammatory disease five years earlier.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 8,
        "text": "Her only child is a girl born vaginally seven years ago.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 9,
        "text": "Her blood group is B rhesus positive and she has never undergone surgery.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 10,
        "text": "She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done.",
        "relations": [
            [
                "positive",
                "test"
            ]
        ]
    },
    {
        "text_id": "100068",
        "sentence_id": 11,
        "text": "On admission, besides the main complain, the patient had vaginal bleeding and nausea but neither fever, nor vomiting.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 12,
        "text": "On physical examination her general condition was good and the blood pressure was 110/70 millimeters of mercury, the respiratory rate: 20 cycles / minute; the pulse rate: 70 pulsations/minute and the temperature: 37.3 degree Celsius.",
        "relations": [
            [
                "110/70 millimeters of mercury",
                "pressure"
            ],
            [
                "20 cycles / minute",
                "rate"
            ],
            [
                "70 pulsations/minute",
                "rate"
            ],
            [
                "37.3 degree Celsius",
                "temperature"
            ]
        ]
    },
    {
        "text_id": "100068",
        "sentence_id": 13,
        "text": "The conjunctivae were pink and the tongue was clean and moist.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 14,
        "text": "There were no cervical adenopathies.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 15,
        "text": "The breast and cardiopulmonary examination revealed no abnormalities.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 16,
        "text": "The abdomen was flat, and mobile with respiration.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 17,
        "text": "On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 18,
        "text": "Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 19,
        "text": "On digital exploration, the cervix was posterior long and closed, the uterus was globular, increased in size and compatible with an eight weeks pregnancy.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 20,
        "text": "The left adnexae presented with a tender, smooth and mobile mass of seven centimeters diameter but the right one were normal.",
        "relations": [
            [
                "seven centimeters",
                "mass"
            ]
        ]
    },
    {
        "text_id": "100068",
        "sentence_id": 21,
        "text": "The posterior cervico-vaginal fornix was neither tender nor bulging.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 22,
        "text": "We suspected a non ruptured extra-uterine pregnancy with the following differentials: heterotopic pregnancy, torsion of ovarian cyst in pregnancy, and intra-cystic ovarian bleeding in pregnancy.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 23,
        "text": "Paraclinical investigations revealed: beta human Chorionic Gonadotropin (β hCG) level of 96 702 milli International Units per milliliter of plasma (mIU/ml).",
        "relations": [
            [
                "96 702 milli International Units per milliliter of plasma",
                "level"
            ]
        ]
    },
    {
        "text_id": "100068",
        "sentence_id": 24,
        "text": "Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter, an empty uterus and no peritoneal effusion.",
        "relations": [
            [
                "82 millimeters",
                "mass"
            ]
        ]
    },
    {
        "text_id": "100068",
        "sentence_id": 25,
        "text": "This comforted our first diagnosis.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 26,
        "text": "After a normal pre-operative work up, an emergency laparotomy was done under general anesthesia.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 27,
        "text": "The findings were: left ovary containing a gestational sac and the corpus luteum, normal right adnexae, normal left tube and normal uterus.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 28,
        "text": "There was no hemoperitoneum.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 29,
        "text": "We dissected the ovarian capsule and carried out ablation of the gestational sac, then we did hemostasis.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 30,
        "text": "The specimen was analysed by the pathologist who found decidual cells and trophoblastic tissue within the ovarian capsule and thus confirmed the ovarian pregnancy.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 31,
        "text": "Post operative course was uneventful and the patient was discharged six days after surgery.",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 32,
        "text": "The ?",
        "relations": []
    },
    {
        "text_id": "100068",
        "sentence_id": 33,
        "text": "hCG level decreased and disappeared 25 days after surgery.",
        "relations": []
    },
    {
        "text_id": "100090",
        "sentence_id": 1,
        "text": "We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth.",
        "relations": []
    },
    {
        "text_id": "100090",
        "sentence_id": 2,
        "text": "The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route.",
        "relations": []
    },
    {
        "text_id": "100090",
        "sentence_id": 3,
        "text": "There was no use of instrumentation and she cried spontaneously at birth.",
        "relations": []
    },
    {
        "text_id": "100090",
        "sentence_id": 4,
        "text": "Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral.",
        "relations": []
    },
    {
        "text_id": "100090",
        "sentence_id": 5,
        "text": "Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids.",
        "relations": []
    },
    {
        "text_id": "100090",
        "sentence_id": 6,
        "text": "There were marked chemosis bilaterally worst in the right.",
        "relations": []
    },
    {
        "text_id": "100090",
        "sentence_id": 7,
        "text": "Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal.",
        "relations": [
            [
                "normal",
                "conditions"
            ]
        ]
    },
    {
        "text_id": "100090",
        "sentence_id": 8,
        "text": "Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis.",
        "relations": []
    },
    {
        "text_id": "100090",
        "sentence_id": 9,
        "text": "The child was admitted into Special baby care unit (SBCU) of our hospital to facilitate close monitoring.",
        "relations": []
    },
    {
        "text_id": "100090",
        "sentence_id": 10,
        "text": "She was also reviewed by the pediatrician and no other abnormality was found.",
        "relations": []
    },
    {
        "text_id": "100090",
        "sentence_id": 11,
        "text": "Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae.",
        "relations": []
    },
    {
        "text_id": "100090",
        "sentence_id": 12,
        "text": "She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3hours once in a day.",
        "relations": []
    },
    {
        "text_id": "100090",
        "sentence_id": 13,
        "text": "She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0.3% w/v) and maxitol ointment at night.",
        "relations": []
    },
    {
        "text_id": "100090",
        "sentence_id": 14,
        "text": "On the 3rd day of admission, the chemosis on the right had resolved significantly but there was still poor right lid opening.",
        "relations": []
    },
    {
        "text_id": "100090",
        "sentence_id": 15,
        "text": "However, on the 5th day of admission, both chemosis had resolved totally with spontaneous eye lid opening.",
        "relations": []
    },
    {
        "text_id": "100090",
        "sentence_id": 16,
        "text": "Both eyeballs were normal.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 1,
        "text": "A 23 year old female patient (weight 67kg, height 171cm, BMI 22.91kg/cm 2) presented to emergency department with fever (39.4oC), tachycardia (116 bpm), hypotension (95/45 mmHg), tachypnoea (25 breaths/min), sore throat, neck pain, diffuse pain and tissue oedema in the right-side gluteal region.",
        "relations": [
            [
                "67kg",
                "weight"
            ],
            [
                "171cm",
                "height"
            ],
            [
                "22.91kg/cm 2",
                "BMI"
            ],
            [
                "39.4oC",
                "fever"
            ],
            [
                "116 bpm",
                "tachycardia"
            ],
            [
                "95/45 mmHg",
                "hypotension"
            ],
            [
                "25 breaths/min",
                "tachypnoea"
            ]
        ]
    },
    {
        "text_id": "100123",
        "sentence_id": 2,
        "text": "She was appointed to hospital by a private outpatient surgical center where she had undergone perineal abscess drainage a week before.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 3,
        "text": "Recent medical history included also endometrial curettage for ERPC a month before and conservative therapy for hemorrhoids 15 days after.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 4,
        "text": "Past medical history included Henoch-Schönlein purpura during childhood.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 5,
        "text": "Social history included smoking (11 pack-years), family history was non-contributory.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 6,
        "text": "She had no known drug allergies.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 7,
        "text": "Complete blood count revealed marked neutrophilic leukocytosis (WBC 23.400 /lt).",
        "relations": [
            [
                "23.400 /lt",
                "WBC"
            ]
        ]
    },
    {
        "text_id": "100123",
        "sentence_id": 8,
        "text": "A CT scan revealed small bilateral pleural effusions, small hepatic enlargement, Gerota's fascia thickening, perineal soft tissue stranding with fascial thickening and small bubbles of air.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 9,
        "text": "Fournier's gangrene was set as working diagnosis (calculated FGSI 8, UFGSI 10 and LRINEC 7) and the patient was transported to operation room for immediate radical surgical debridement of necrotic tissue.",
        "relations": [
            [
                "8",
                "FGSI"
            ],
            [
                "10",
                "UFGSI"
            ],
            [
                "7",
                "LRINEC"
            ]
        ]
    },
    {
        "text_id": "100123",
        "sentence_id": 10,
        "text": "Blood and surgical material was taken for microbiologic analysis.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 11,
        "text": "Due to the extent of the surgical debridement, the patient was admitted postoperatively to the ICU (SOFA score 6, APACHE II score 12); where sedation (midazolam 30 mcg/kg/hr c.iv), analgesia (fentanyl 3 mcg/kg/min c.iv), triple antibiotic regimen with meropenem 2gr q8h i.v., clindamycin 600mg q 6h i.v. and daptomycin 500mg q.d. i.v., gastroprotective and antithrombotic prophylaxis were initiated.",
        "relations": [
            [
                "6",
                "SOFA"
            ],
            [
                "12",
                "APACHE"
            ]
        ]
    },
    {
        "text_id": "100123",
        "sentence_id": 12,
        "text": "During the next 3 days a second CT and an obstetrical consultation were conducted with no significant findings.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 13,
        "text": "Human immunodeficiency virus and diabetic screen were also negative.",
        "relations": [
            [
                "negative",
                "screen"
            ],
            [
                "negative",
                "virus"
            ]
        ]
    },
    {
        "text_id": "100123",
        "sentence_id": 14,
        "text": "Yet, the patient remained febrile.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 15,
        "text": "Microbiology cultures from material taken from the surgical trauma area revealed Candida albicans, Staphylococcus epidermidis and Klebsiella pneumonia ; hence antibiotic regimen was modified and antimycotic treatment (caspofungin 100mg q.d. i.v.) was initiated too.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 16,
        "text": "Debridements were repeated every 24 hours but due to the extent of the lesions, on the 10 th day, the patient was transported to operation room for temporary ileostomy till the end of the therapy.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 17,
        "text": "Percutaneous tracheotomy was also performed.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 18,
        "text": "Hyperbaric oxygen therapy was not available at the setting.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 19,
        "text": "One day after the second surgery, patient's condition complicated with MRSA ventilation associated pneumonia.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 20,
        "text": "Along with that, a localized oedema appeared in her left upper limb.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 21,
        "text": "A palpable mass along the anterior margin of the sternocleidomastoid muscle was also noticed.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 22,
        "text": "Vascular ultrasound examination revealed occlusion of left internal jugular vein.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 23,
        "text": "Transcranial Doppler examination was normal.",
        "relations": [
            [
                "normal",
                "examination"
            ]
        ]
    },
    {
        "text_id": "100123",
        "sentence_id": 24,
        "text": "Dental consultation and examination of soft palate and peritonsilar tissues showed no abnormalities.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 25,
        "text": "Linezolide 600 mg q12h i.v. was added to antibiotic regimen.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 26,
        "text": "Since debridements were going on, simultaneous anticoagulation therapy was started with only bemiparine 2500 b.i.d. s.c.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 27,
        "text": "Gradually, the patient became afebrile and her clinical condition improved.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 28,
        "text": "She was discharged from ICU 13 days later.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 29,
        "text": "A follow-up CTA confirmed the disappearance of the left jugular vein thrombosis.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 30,
        "text": "About a month after her ICU discharge, an operation was performed for ileostomy closure and reconstruction of the right gluteal region.",
        "relations": []
    },
    {
        "text_id": "100123",
        "sentence_id": 31,
        "text": "On a follow-up examination 6 months later, the young woman had returned to her normal everyday life.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 1,
        "text": "A 38-year-old man presented with a seven month history of progressively worsening bilateral knees pain with associated swelling.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 2,
        "text": "The pain was present when the patient was at rest, and worsened when the legs was bearing weight, thus restricting his walking to short distances.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 3,
        "text": "His knees had become increasingly swollen.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 4,
        "text": "He was otherwise fit and well.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 5,
        "text": "His medical history was unremarkable and he was only taking a paracetamol, codeine and anti-inflammatory drugs for the pain.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 6,
        "text": "Upon examination, the patient was seen to have visibly swollen popliteal fossa and marked quadriceps wasting of his right lower limb.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 7,
        "text": "On palpation, the masses was hard, mobile, well defined, and measured 0.5 - 04 cm.",
        "relations": [
            [
                "0.5 - 04 cm",
                "measured"
            ]
        ]
    },
    {
        "text_id": "100156",
        "sentence_id": 8,
        "text": "The swelling was non-tender and there were no associated skin changes.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 9,
        "text": "He could fully extend his knee, but flexion was restricted to only 110 degrees.",
        "relations": [
            [
                "110 degrees",
                "flexion"
            ]
        ]
    },
    {
        "text_id": "100156",
        "sentence_id": 10,
        "text": "There was a McMurray test proved equivocal and no ligamentous instability.",
        "relations": [
            [
                "equivocal",
                "test"
            ]
        ]
    },
    {
        "text_id": "100156",
        "sentence_id": 11,
        "text": "An examination of the patient’s hip revealed no abnormality.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 12,
        "text": "A plain radiograph of the patient’s knees revealed multiple calcific densities within the soft tissues surrounding it on the right one.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 13,
        "text": "Although some of these appeared to lie within the capsule, the majority appeared to be outside of it, and a solitary image on the left knee.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 14,
        "text": "These appearances were thought to be consistent with idiopathic tumoral calcinosis.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 15,
        "text": "However, to further scrutinize these calcifications, a magnetic resonance imaging (MRI) scan was recommended.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 16,
        "text": "It showed an extensive thickening of the patient’s synovium, multiple intraarticular calcific and ossific loose bodies, and large calcified bursal extensions.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 17,
        "text": "These findings were thought to be consistent with very extensive bilateral synovial chondromatosis.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 18,
        "text": "The patient’s blood tests were normal: C-reactive protein 5 mg/l and the phosphate calcium balance without errors.",
        "relations": [
            [
                "normal",
                "tests"
            ],
            [
                "5 mg/l",
                "protein"
            ]
        ]
    },
    {
        "text_id": "100156",
        "sentence_id": 19,
        "text": "A two-stage procedure was planned following the findings of the MRI scan.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 20,
        "text": "The first stage was arthroscopy, which was able to note Grade IV osteoarthritis alongside florid synovial chondromatosis in the lateral compartment of the right knee.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 21,
        "text": "There were multiple loose bodies within this compartment and nodules were fixed to the synovium.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 22,
        "text": "On the left one, we found an isolated synovial metaplasia in the subvastus quadriceps-sparing.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 23,
        "text": "A synovectomy with debridement and excision of these bodies was thus performed.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 24,
        "text": "The second stage involved an open exploration of the patient’s popliteal fossa.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 25,
        "text": "Multiple calcified masses were found, all enclosed in bursal sacs.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 26,
        "text": "They were lateral to the semimembranosus at the level of the oblique popliteal ligament.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 27,
        "text": "All the masses were excised.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 28,
        "text": "A histological review confirmed our diagnosis of synovial chondromatosis.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 29,
        "text": "The sections showed nests of chondrocytes with focal ossification and focally attenuated synovium overlying the nodules.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 30,
        "text": "After the operation, the patient underwent functional rehabilitation sessions focusing on quadriceps strengthening, with a daily exercise regime to supplement this.",
        "relations": []
    },
    {
        "text_id": "100156",
        "sentence_id": 31,
        "text": "He recovered well and ten weeks after the operation, has regained his right knee’s full range of movement with flexion increased to 130 degrees, which is equal to that of his left knee.",
        "relations": [
            [
                "130 degrees",
                "flexion"
            ]
        ]
    },
    {
        "text_id": "103007",
        "sentence_id": 1,
        "text": "A 54-year-old female patient was admitted to our surgical department with a 2 mo history of decreased appetite, nausea, vomiting, and weight loss, which progressed to difficulty in feeding 3 d prior to her visit.",
        "relations": []
    },
    {
        "text_id": "103007",
        "sentence_id": 2,
        "text": "According to her medical history, she was diagnosed with refractory ITP [platelets (PLT), 3000-8000/μL] 10 years ago.",
        "relations": [
            [
                "3000-8000/μL",
                "PLT"
            ],
            [
                "3000-8000/μL",
                "platelets"
            ]
        ]
    },
    {
        "text_id": "103007",
        "sentence_id": 3,
        "text": "After admission, the patient underwent a splenectomy and a distal subtotal gastrectomy (D2 radical resection) with Roux-en-Y reconstruction simultaneously.",
        "relations": []
    },
    {
        "text_id": "103007",
        "sentence_id": 4,
        "text": "She had an uneventful postoperative course with a slight increase in her PLT count.",
        "relations": []
    },
    {
        "text_id": "103007",
        "sentence_id": 5,
        "text": "This case is unique in terms of the patient's complication of severe and medically refractory ITP.",
        "relations": []
    },
    {
        "text_id": "104184",
        "sentence_id": 1,
        "text": "We report a 9-year-old male child who was referred to us with swelling in the posterior aspect of the neck.",
        "relations": []
    },
    {
        "text_id": "104184",
        "sentence_id": 2,
        "text": "Anteroposterior and lateral radiographs of the cervical spine show an elongated left spinous process in the neck at the level of C5 vertebrae.",
        "relations": []
    },
    {
        "text_id": "104184",
        "sentence_id": 3,
        "text": "There was an associated hemivertebra at the C4 level.",
        "relations": []
    },
    {
        "text_id": "104184",
        "sentence_id": 4,
        "text": "Computed tomography examination better depicted this congenital variant and clearly showed the associated schisis of the posterior arch as well as unfused spinous process at the same level on the left side.",
        "relations": []
    },
    {
        "text_id": "104184",
        "sentence_id": 5,
        "text": "This is a very rare congenital anomaly and probably among the few such cases reported in literature.",
        "relations": []
    },
    {
        "text_id": "105114",
        "sentence_id": 1,
        "text": "A male, 63 years old, complaining about a \"wound in the mouth\" for 6 months, without any pain or spontaneous bleeding.",
        "relations": []
    },
    {
        "text_id": "105114",
        "sentence_id": 2,
        "text": "His medical history was free of disease.",
        "relations": []
    },
    {
        "text_id": "105114",
        "sentence_id": 3,
        "text": "The patient was a smoker for 33 years.",
        "relations": []
    },
    {
        "text_id": "105114",
        "sentence_id": 4,
        "text": "Intraoral examination revealed a destructive ulcerative lesion around the upper left first and second molars that resembled an oral squamous cell carcinoma.",
        "relations": []
    },
    {
        "text_id": "105114",
        "sentence_id": 5,
        "text": "Biopsy of the ulcerative lesion was performed and the microscopic features showed an inflammatory infiltrate rich in plasma cells.",
        "relations": []
    },
    {
        "text_id": "105114",
        "sentence_id": 6,
        "text": "Based on this microscopical finding, the final diagnosis was periodontal disease associated with a proliferative non-neoplastic lesion.",
        "relations": []
    },
    {
        "text_id": "105114",
        "sentence_id": 7,
        "text": "The patient was referred to a specialized dental surgeon and underwent periodontal therapy including surgical procedures.",
        "relations": []
    },
    {
        "text_id": "105114",
        "sentence_id": 8,
        "text": "After that, according to follow-up with the patient, there were no signs of disease remission.",
        "relations": []
    },
    {
        "text_id": "105114",
        "sentence_id": 9,
        "text": "The lesion increased in size, although the patient did not complain of any symptoms.",
        "relations": []
    },
    {
        "text_id": "105114",
        "sentence_id": 10,
        "text": "A second biopsy was performed and the microscopic features again showed a rich inflammatory infiltrate with mononuclear cells and histiocytic cells, characterized by pale histiocytes with lobed nuclei, resembling a bean.",
        "relations": []
    },
    {
        "text_id": "105114",
        "sentence_id": 11,
        "text": "A varying number of eosinophils also were observed, without any evidence of atypical cells present in this infiltrate.",
        "relations": []
    },
    {
        "text_id": "105114",
        "sentence_id": 12,
        "text": "An immunohistochemical staining panel was done to determine the nature of this inflammatory infiltrate by using antibodies S-100, CD1a, CD-68 and CD45RO that were positive.",
        "relations": [
            [
                "positive",
                "CD-68"
            ],
            [
                "positive",
                "S-100"
            ],
            [
                "positive",
                "CD1a"
            ],
            [
                "positive",
                "CD45RO"
            ]
        ]
    },
    {
        "text_id": "105114",
        "sentence_id": 13,
        "text": "These immunohistochemical findings were fundamental for the final diagnosis of LCH.",
        "relations": []
    },
    {
        "text_id": "105114",
        "sentence_id": 14,
        "text": "The treatment included surgical extraction of all superior teeth, radiation and systemic corticoid therapies.",
        "relations": []
    },
    {
        "text_id": "105114",
        "sentence_id": 15,
        "text": "After 8 years of treatment, the patient is free of disease.",
        "relations": []
    },
    {
        "text_id": "106489",
        "sentence_id": 1,
        "text": "An 80 year-old Caucasian male was diagnosed at an outside institution with Barrett's esophagus with high grade dysplasia and presented to our institution for therapy.",
        "relations": []
    },
    {
        "text_id": "106489",
        "sentence_id": 2,
        "text": "The patient underwent endoscopic mucosal resection using a band ligation technique of an area of nodularity within the Barrett esophagus.",
        "relations": []
    },
    {
        "text_id": "106489",
        "sentence_id": 3,
        "text": "Microscopic examination demonstrated extensive Barrett esophagus with high-grade dysplasia as well as a second tumor which was morphologically different from the surrounding high-grade dysplasia and which was positive for S-100, HMB 45 and Melan-A on immunohistochemistry, consistent with melanoma.",
        "relations": [
            [
                "positive",
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            ],
            [
                "positive",
                "HMB"
            ],
            [
                "positive",
                "Melan-A"
            ]
        ]
    },
    {
        "text_id": "106489",
        "sentence_id": 4,
        "text": "Further workup of the patient demonstrated multiple radiologic lesions consistent with metastases.",
        "relations": []
    },
    {
        "text_id": "106489",
        "sentence_id": 5,
        "text": "Molecular studies demonstrated that the melanoma was positive for the 1799T>A (V600E) mutation in the BRAF gene.",
        "relations": [
            [
                "positive",
                "mutation"
            ]
        ]
    },
    {
        "text_id": "106489",
        "sentence_id": 6,
        "text": "The overall features of the tumor were most consistent with metastatic melanoma occurring in a background of Barrett esophagus with high-grade dysplasia.",
        "relations": []
    },
    {
        "text_id": "107465",
        "sentence_id": 1,
        "text": "We report the case of a 15-year-old Caucasian girl who was diagnosed with Silver-Russell syndrome at the age of four and a half years.",
        "relations": []
    },
    {
        "text_id": "107465",
        "sentence_id": 2,
        "text": "Recombinant growth hormone was administered for 18 months without an appropriate increase in growth velocity.",
        "relations": []
    },
    {
        "text_id": "107465",
        "sentence_id": 3,
        "text": "At the age of seven years, her serum growth hormone levels were high, and an insulin-like growth factor 1 generation test did not increase insulin-like growth factor 1 levels (baseline insulin-like growth factor 1 levels, 52 μg/L; reference range, 75 μg/L to 365 μg/L; and peak, 76 μg/L and 50 μg/L after 12 and 84 hours, respectively, from baseline).",
        "relations": [
            [
                "high",
                "levels"
            ],
            [
                "52 μg/L",
                "levels"
            ],
            [
                "76 μg/L",
                "levels"
            ],
            [
                "50 μg/L",
                "levels"
            ]
        ]
    },
    {
        "text_id": "107465",
        "sentence_id": 4,
        "text": "The genetic analysis showed that the patient was homozygous for the R217X mutation in the growth hormone receptor gene, which is characteristic of Laron syndrome.",
        "relations": []
    },
    {
        "text_id": "107465",
        "sentence_id": 5,
        "text": "On the basis of these results, the diagnosis of primary growth hormone insensitivity syndrome was made, and recombinant insulin-like growth factor 1 therapy was initiated.",
        "relations": []
    },
    {
        "text_id": "107465",
        "sentence_id": 6,
        "text": "The patient's treatment was well tolerated, but unexplained central hypothyroidism occurred at the age of 12.9 years.",
        "relations": []
    },
    {
        "text_id": "107465",
        "sentence_id": 7,
        "text": "At the age of 15 years, when the patient's sexual development was almost completed and her menstrual cycle occurred irregularly, her height was 129.8 cm, which is 4.71 standard deviations below the median for normal girls her age.",
        "relations": [
            [
                "129.8 cm",
                "height"
            ]
        ]
    }
]