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13
100184
11
The refractive error was a hypermetropia of +4.50 diopters in each eye.
[ [ "+4.50 diopters", "hypermetropia" ] ]
100184
12
Examination revealed normal anterior and posterior segments bilaterally.
[]
100184
13
There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture.
[]
100184
14
Her palpebral fissures were normal and equal on both sides in the primary position of gaze.
[]
100184
15
Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze.
[]
100184
16
The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements.
[]
100184
17
Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction.
[ [ "positive", "test" ] ]
100184
18
Her systemic examination was completely normal.
[ [ "normal", "examination" ] ]
100184
19
A diagnosis of congenital left Brown syndrome with severe amblyopia was made.
[]
100184
20
Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school).
[]
100184
21
Her mother was counselled and educated about the condition as well as the treatment plan.
[]
100184
22
Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy.
[]
100184
23
A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
[]
100265
1
A 36 year old female farmer gravida 5 para 4 at 27 weeks gestation presented to our facility.
[]
100265
2
Her main complaint was a 3 month history of epigastric abdominal pain, which was gradual in onset, dull and persistent.
[]
100265
3
Pain had gradually worsened over the months with no known relieving or aggravating factors but with intermittent radiation to the chest.
[]
100265
4
There was a history of significant weight loss but no associated early satiety, jaundice, fever, itch or spontaneous bleeding.
[]
100265
5
No history of blood transfusion and patient was on her routine hematinic from the antenatal clinic (ANC).
[]
100265
6
She is not a known diabetic, Hypertensive and has no known chronic illness.
[]
100265
7
Patient did not know her Hepatitis status.
[]
100265
8
Denied to taking any alcohol or smoking.
[]
100265
9
There were no cardiorespiratory nor urogenital symptoms.
[]
100265
10
She did not store grains at home and had no known contact with chemicals or ionizing radiation.
[]
100265
11
Clinical signs on examination included wasting, mild pallor, a tinge of jaundice but well hydrated, afebrile and no palpable lymphnodes.
[]
100265
12
She had palmer erythema but no clubbing and parotid enlargement.
[]
100265
13
Respiratory, cardiovascular and neurological examinations were unremarkable.
[]
100265
14
Abdomen was grossly distended with distorted contour in the upper half and visibly distended anterior abdominal wall veins draining away from the umbilicus.
[]
100265
15
Liver was enlarged 12cm below the costal margin with a span of 17cm.
[ [ "17cm", "span" ] ]
100265
16
The liver was hard, nodular with irregular edge, mild tendernes and had a bruit on auscultation.
[]
100265
17
The spleen was not palpable but with demonstrable mild ascites and bipedal eodema up to the mid shin.
[]
100265
18
Symphysio fundal height was 26 cm, with longitudinal lie and breech presentation.
[ [ "26 cm", "height" ] ]
100265
19
Fetal heart rate was 134 bpm and regular.
[ [ "134 bpm", "rate" ] ]
100265
20
Rectal and vaginal examination were unremarkable.
[]
100265
21
Initial diagnosis of hepatocellular Carcinoma in pregnancy was made.
[]
100265
22
Laboratory assesment revealed HB-10.3g/dl, WBC 10200 cells/dl; Neutrophils 59.3%, lymphocytes 26.1%, Monocytes 10.1% and Eosinophils 2.7%.
[ [ "10.3g/dl", "HB" ], [ "10200 cells/dl", "WBC" ], [ "59.3%", "Neutrophils" ], [ "26.1%", "lymphocytes" ], [ "10.1%", "Monocytes" ], [ "2.7%", "Eosinophils" ], [ "350000/ul", "Platelets" ] ]
100265
23
Platelets 350000/ul.
[ [ "Normal", "bilirubin" ] ]
100265
24
Normal bilirubin but GGT and AST were raised (4 times upper limit).
[]
100265
25
Total protein and albumin were low, 44g/L and 29g/L respectively with INR-1.3.HBsAg was positive, HBeAg negative with HBV DNA level of 126869 IU/ml \(Viral load).
[ [ "low", "albumin" ], [ "low", "protein" ], [ "44g/L", "protein" ], [ "29g/L", "albumin" ], [ "1.3", "INR" ], [ "positive", "HBsAg" ], [ "negative", "HBeAg" ], [ "126869 IU/ml \\(Viral load)", "level" ], [ "positive", "VDRL" ] ]
100265
26
VDRL positive but TPHA not done.
[]
100265
27
Alphafeto protein (AFP) >50000KU/L.
[ [ "negative", "HCV" ], [ "negative", "HIV" ] ]
100265
28
She tested negative to HIV and HCV.
[]
100265
29
Abdominal ultrasound showed a heterogeneous coarse liver with multiple hypoechoic lessions.
[ [ "17.2cm", "measured" ] ]
100265
30
The liver measured 17.2cm and there was mild ascites.
[]
100265
31
Pelvic scan revealed a 27 week, 3 day old fetus, with active fetal movements.
[]
100265
32
A revised diagnosis of hepatocellular carcinoma on a cirrhotic liver with decompensation in pregnancy was made.
[]
100265
33
She was managed with analgesia, furosemide, spironolactone and lamivudine added for prevention of mother to child trasmission of the hepatitis B infection.
[]
100265
34
The plan was to allow pregnancy to continue to at least 32 completed weeks to improve the chance of neonatal survival.
[]
100265
35
However because of the progressive unbearable abdominal pain, pregnancy was terminated at 30 weeks 3days by successful induction of labour.
[]
100265
36
The outcome was a fresh stillbirth weight 1.2kg.
[ [ "1.2kg", "weight" ] ]
100265
37
Pain was markedly reduced post delivery and was discharged home after 5 days.
[]
100265
38
She was booked for a follow up visit at the gastrointestinal clinic.
[]
100265
39
She was seen at the clinic at 2 weeks and four weeks post discharge but was lost to follow up afterwards.
[]
103442
1
A 62-year-old woman presented with complaints of epigastric pain and vomiting.
[]
103442
2
Computed tomography showed a 27-mm, hyper-enhancing tumor in the prepyloric antrum.
[]
103442
3
Upper endoscopy also showed a submucosal tumor causing subtotal obstruction of the gastric outlet.
[]
103442
4
Because a gastrointestinal stromal tumor was suspected, distal gastrectomy was performed.
[]
103442
5
Histopathological examination revealed spindle cell proliferation in the submucosal layer.
[]
103442
6
The spindle cells had invaded the muscularis propria layer and extended to the subserosal layer.
[]
103442
7
The tumor was finally diagnosed as an IFP based on immunohistochemical findings.
[]
103442
8
No mutations were identified in the platelet-derived growth factor receptor alpha (PDGFRA) gene via molecular genetic analysis.
[]
104891
1
A 36-year-old female showed mild swelling in the right upper eyelid.
[]
104891
2
She lost her RGP contact lens seven months prior to her first visit, from trauma by her child's kick to the right eye.
[]
104891
3
At the first examination, we felt a firm lump inferior to the right brow.
[]
104891
4
Eversion of the upper eyelid also revealed a firm subconjunctival mass superior to the upper tarsus.
[]
104891
5
After incising the conjunctiva, the RGP contact lens was found without a fibrous capsule and granulation tissue in the subconjunctival space.
[]
104891
6
Three years after removal of the lens, the patient did not show any complications, including ptosis.
[]