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13
107405
4
Magnetic resonance imaging of our patient's pituitary gland failed to demonstrate the presence of an adenoma.
[]
107405
5
Spiral computed tomography of her chest only revealed the presence of a non-specific 7 mm lesion in her left inferobasal lung segment.
[ [ "7 mm", "lesion" ] ]
107405
6
Functional imaging, including a positron emission tomography scan using 18-fluorodeoxyglucose and gallium-68-DOTA-D-Phe1-Tyr3-octreotide, also failed to show increased metabolic activity in the lung lesion or in her pituitary gland.
[]
107405
7
Our patient was commenced on medical treatment with ketoconazole and metyrapone to control the clinical features associated with her excess cortisol secretion.
[]
107405
8
Despite initial normalization of her urinary free cortisol excretion rate, levels began to rise eight months after commencement of medical treatment.
[]
107405
9
Repeated imaging of her pituitary gland, chest and pelvis again failed to clearly localize a source of her excess adrenocorticotropic hormone secretion.
[]
107405
10
The bronchial nodule was stable in size on serial imaging and repeatedly reported as having a nonspecific appearance of a small granuloma or lymph node.
[]
107405
11
We re-explored the treatment options and endorsed our patient's favored choice of resection of the bronchial nodule, especially given that her symptoms of cortisol excess were difficult to control and refractory.
[]
107405
12
Subsequently, our patient had the bronchial nodule resected.
[]
107405
13
The histological appearance of the lesion was consistent with that of a carcinoid tumor and immunohistochemical analysis revealed that the tumor stained strongly positive for adrenocorticotropic hormone.
[ [ "strongly positive", "stained" ] ]
107405
14
Furthermore, removal of the lung lesion resulted in a normalization of our patient's 24-hour urinary free cortisol excretion rate and resolution of her symptoms and signs of hypercortisolemia.
[]
107424
1
Here, we present a case of unicentric Castleman's disease in a 37-year-old woman without associated neoplastic, autoimmune or infectious diseases.
[]
107424
2
The lesion was located in the femoral region of the right lower extremity and surgically resected after radiographic workup and excisional biopsy examinations.
[]
107424
3
The tumor comprised lymphoid tissue with numerous germinal centers with central fibrosis, onion-skinning and rich interfollicular vascularization.
[]
107424
4
CD23-positive follicular dendritic cells were detected in the germinal centers and numerous CD138-positive plasma cells in interfollicular areas.
[]
107424
5
The diagnosis of mixed cellularity type Castleman's disease was established and the patient recovered well.
[]
107559
1
A 24-year-old African-American man presented to our Emergency Department with a one-week history of fever, dyspnea, cough, and abdominal pain.
[]
107559
2
A computed tomography scan of his chest and abdomen revealed bilateral lower lobe pneumonia and two retained Jackson-Pratt drains in the right upper quadrant.
[]
107559
3
He was taken to the operating room for drain removal, a right hemicolectomy, debridement of a duodenal injury, a Roux-en-y duodenojejunostomy, and an end ileostomy.
[]
107559
4
He subsequently became increasing hypoxemic in the intensive care unit and a bronchoperitoneal fistula was diagnosed.
[]
107559
5
He required high-frequency oscillatory ventilation followed by lung isolation, and was successfully resuscitated using these techniques.
[]
108139
1
A 45 year old Indian female of Nordic origin presented 5 years back with a lump in the right breast and the axilla.
[]
108139
2
She underwent modified radical mastectomy.
[]
108139
3
Histophotomicrograph of the excised breast lesion showed a 2.1 cm duct carcinoma, positive for ER and PR with 1 out of 25 lymph nodes positive for metastasis.
[ [ "positive", "ER" ], [ "positive", "PR" ], [ "positive", "metastasis" ] ]
108139
4
She received 6 cycles of chemotherapy with cyclophosphamide, epirubicin, and 5-fluorouracil.
[]
108139
5
This was followed by tamoxifen 20 mg per day for five years.
[]
108139
6
She was doing well on follow up until the completion of fifth year of her disease, when she presented with complaints of mild fever and weakness.
[]
108139
7
Examination revealed generalized lymph node enlargement along with hepatomegaly.
[]
108139
8
Hemogram showed mild anemia, normal platelet count and a leukocyte count of 1.2 x 10(11)/L.
[ [ "normal", "count" ], [ "1.2 x 10(11)/L", "count" ] ]
108139
9
Peripheral blood examination revealed medium sized lymphoid cells, constituting almost 75% of total nucleated cell population.
[]
108139
10
Immunophenotying, established a diagnosis of post thymic T-cell prolymphocytic leukemia.
[]
108139
11
Contrast-enhanced computed tomography of the chest and abdomen was done which revealed an anterior mediastinal mass with destruction of sternum along with multiple small nodular shadows in bilateral lung fields suggestive of lung metastasis.
[]
108139
12
Fine needle aspiration cytology of the mass showed atypical ductal cells with nuclear pleomorphism, which were positive for ER, PR and Her2neu protein.
[ [ "positive", "PR" ], [ "positive", "ER" ], [ "positive", "Her2neu" ] ]
108139
13
This confirmed a co-existent metastatic breast carcinoma.
[]
108139
14
She was started on chemotherapy for T-PLL along with hormonal therapy with aromatase inhibitor.
[]
108139
15
Unfortunately, both her malignancies progressed after an initial stable disease of two months.
[]
100022
1
A 60 year-old man presented to an outside institution for septic shock with hematesis.
[]
100022
2
He had a medical history of diabetes mellitus, hypertension and he was amputated right leg (trans-femoral amputation) for diabetic arteriopathy six months before admission complicated by venous thrombosis.
[]
100022
3
Home medications included daily pioglitazone, atenolol, furosemide and anticoagulant with poor compliance.
[]
100022
4
Initial examination revealed a patient in state of septic shock, respiratory rate 28 cycles per min, his pulse was regular with an apical rate of 120 beats/min, temperature 39° C, blood pressure 70/40 mmHg, he had necrotic and suppurative amputation stump with peripheral pulse abolished.
[ [ "28 cycles per min", "rate" ], [ "regular", "pulse" ], [ "120 beats/min", "rate" ], [ "39° C", "temperature" ], [ "70/40 mmHg", "pressure" ] ]
100022
5
Patient was given immediately oxygen, fluids, antibiotics, and drugs to increase blood pressure.
[]
100022
6
Six hours later, the patient presented a single episode of hematemesis.
[]
100022
7
There was no associated melena or abdominal pain.
[]
100022
8
He had no history of alcohol use, liver disease, varices, peptic ulcer disease, abdominal aortic surgery, nonsteroidal anti inflammatory drug use, gastroparesis, or previous GI bleeding.
[]
100022
9
Physical examination was unremarkable.
[]
100022
10
Pertinent laboratory studies included a hemoglobin level of 10 g/dL, platelet count was normal, blood urea of 1,2 g/l (0,18-0,45 g/L), and a creatinine level of 68 mg/L (7-13 mg/L).
[ [ "10 g/dL", "level" ], [ "normal", "count" ], [ "1,2 g/l", "urea" ], [ "68 mg/L", "level" ] ]
100022
11
After hemodynamic stabilization, an oesophageo-gastro-duodenoscopy was performed which showed: The upper third of the esophagus was circumferentially congestive, but the middle and lower third showed circumferential black pigmentation: the mucosa was black and covered by an exudate of the same color associated with diffuse bleeding.
[]
100022
12
Gastric mucosa was strictly normal in direct vision and in retrovision, the bulb and duodenum were normal.
[]
100022
13
Biopsie specimens were showed necrotic debris, mucosal submucosal necrosis with a local inflammatory response.
[]
100022
14
The treatment of this condition was based continuous high dose omeprazole (8 mg / h) after bolus of 80mg and total parenteral nutrition.
[]
100022
15
The patient experienced no further hematemesis or melena.
[]
100022
16
Due to the severity of the necrosis, and with deterioration of his condition and persistent sepsis he died later in the same day.
[]
100029
1
A 17 year-old woman with a history of moderate persistent allergic asthma has benefited from a first desensitization protocol at age 3.
[]
100029
2
The protocol has been interrupted 4 years later because of a mild skin reaction.
[]
100029
3
Her doctor decided to stop the specific immunotherapy.
[]
100029
4
But another doctor restarted a new protocol of desensitization at age 16 against pollens because of a lack of control of his condition.
[]
100029
5
She was never hospitalized, she was receiving no medication and she was doing well one year after she received a new regimen of pneumallergens (Alustal® Stallergenes SA, France).
[]
100029
6
Indeed, 12 hours after initiation of treatment, she complained of abdominal pain, vomiting and diarrhea without fever.
[]
100029
7
Several hours after, she consulted to the emergency department where a surgical emergency was ruled out.
[]
100029
8
She was then admitted to the internal medicine ward.
[]
100029
9
Two days later, she developed an acute respiratory failure and was referred to the intensive care unit where laboratory tests revealed multiorgan failure: liver enzymes, 5000U/L (normal level, 0-37U/L); creatine phosphokinase, 59000U/L (normal level, 10-200U/L); cardiac troponin T, 21ng/ml (normal level, under 0,01ng/ml); leucopenia, 2600/mm 3 (normal level, 4000-9000/ mm 3); thrombocytopenia, 13000/ mm 3 (normal level, 150000-400000/ mm 3); prothrombin time, 38% (normal level, 70-100%).
[ [ "5000U/L", "enzymes" ], [ "59000U/L", "phosphokinase" ], [ "21ng/ml", "troponin" ], [ "2600/mm 3", "leucopenia" ], [ "13000/ mm 3", "thrombocytopenia" ], [ "38%", "time" ] ]
100029
10
Chest X-ray demonstrated bilateral interstitial markings with a normal cardiac silhouette.
[]
100029
11
Viral serology was normal for hepatitis A, B, C, D, and E, Epstein-Barr virus and Cytomegalovirus.
[ [ "normal", "virus" ], [ "normal", "serology" ], [ "normal", "Cytomegalovirus" ], [ "normal", "hepatitis" ] ]
100029
12
A skin morbilliform rash and facial edema appeared later.
[]
100029
13
The patient received a fluid resuscitation, platelet and erythrocyte transfusion, steroids and antibiotics.
[]
100029
14
A hypoxic coma occurred on day 4 leading to intubation and mechanical ventilation.
[]
100029
15
Rapidly, she experienced intractable shock and acute renal impairment despite inotropic agents leading to death on day 5.
[]
100067
1
A 50-years-old woman, hypertensive, hospitalized for a large cervical mass appeared 30 years ago.
[]
100067
2
In the family history, her mother, sisters and cousins underwent a surgery for MNG.
[]
100067
3
Despite of the large volume of the mass, the patient never described signs of cervical compression whatsoever respiratory, digestive, laryngeal, vascular or neurologic signs.
[]
100067
4
She never suffered from thyroid dysfunction.
[]
100067
5
Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification.
[]
100067
6
The mass took the front and the two sides of the neck.
[]
100067
7
Its surface was embossed and covered by a thin normal skin.
[]
100067
8
There were some veins of the collateral circulation limited to the neck.
[]
100067
9
The goiter measured 18 x 11 cm.
[ [ "18 x 11 cm", "measured" ] ]
100067
10
The mass was firm, painless, and mobile with the swallowing movements.
[]
100067
11
Lymphadenopathy research was difficult and found no palpable lymph nodes.
[]
100067
12
The laboratory tests (T 3, T 4 and TSH) were normal.
[ [ "normal", "tests" ], [ "normal", "T" ], [ "normal", "TSH" ], [ "normal", "T" ] ]
100067
13
Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea.
[]
100067
14
Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum.
[]
100067
15
It took heterogeneously the contrast and then evocate a large MNG.
[]
100067
16
The trachea was surrounded by the goiter, slightly narrowed and right deviated as well as the lower part of the larynx.
[]
100067
17
The right and left vascular axes of the neck (carotid artery and jugular vein) were deviated backward.
[]
100067
18
The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum.
[]
100067
19
Endotracheal intubation was relatively easy by the laryngoscope.
[]
100067
20
The incision performed was a Kocher cervicotomy.
[]
100067
21
There was a multinodular, hypervascularized goiter.
[]
100067
22
Its lower end plunges behind the sternal manubrium.
[]
100067
23
The larynx was deviated towards the right side.
[]
100067
24
The total thyroidectomy was performed in two steps: initially a right lobo-isthmectomy, then the left lobectomy.
[]
100067
25
The retrosternal part of the goiter was released using the finger by the same incision.
[]
100067
26
Both recurrent laryngeal nerves (RLN) were not identified because of the hemorrhage.
[]
100067
27
One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle.
[]
100067
28
The operation was finished by double aspiration drainage.
[]
100067
29
In the first hours after surgery, the patient developed a large cervical hematoma.
[]
100067
30
She was readmitted to the operating room, and after evacuation of the hematoma there was no vessels bleeding.
[]
100067
31
The operation was completed with a double suction drainage.
[]
100067
32
In the immediate postoperative period, the patient developed hemodynamic collapse requiring the introduction of dobutamine.
[]
100067
33
After 48 hours of hemodynamic support, the blood pressure stabilized and dobutamine was stopped.
[]