e3c_v3.0_en_test.json

[
    {
        "text": "A 50 - years-old woman , hypertensive , hospitalized for a large cervical mass appeared 30 years ago .",
        "entities": [
            {
                "entity_text": "cervical mass",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "In the family history , her mother , sisters and cousins underwent a surgery for MNG .",
        "entities": [
            {
                "entity_text": "MNG",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Despite of the large volume of the mass , the patient never described signs of cervical compression whatsoever respiratory , digestive , laryngeal , vascular or neurologic signs .",
        "entities": [
            {
                "entity_text": "mass",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "cervical compression",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "respiratory , digestive , laryngeal , vascular or neurologic signs",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She never suffered from thyroid dysfunction .",
        "entities": [
            {
                "entity_text": "thyroid dysfunction",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Her neck was deformed by the voluminous formation classified grade III according to the WHO modified classification .",
        "entities": []
    },
    {
        "text": "The mass took the front and the two sides of the neck .",
        "entities": [
            {
                "entity_text": "mass",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Its surface was embossed and covered by a thin normal skin .",
        "entities": []
    },
    {
        "text": "There were some veins of the collateral circulation limited to the neck .",
        "entities": []
    },
    {
        "text": "The goiter measured 18 x 11 cm .",
        "entities": []
    },
    {
        "text": "The mass was firm , painless , and mobile with the swallowing movements .",
        "entities": [
            {
                "entity_text": "mass",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Lymphadenopathy research was difficult and found no palpable lymph nodes .",
        "entities": [
            {
                "entity_text": "Lymphadenopathy",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The laboratory tests ( T 3 , T 4 and TSH ) were normal .",
        "entities": []
    },
    {
        "text": "Thoracic radiography showed a large cervical opacity roughly round and strewn with microcalcifications associated with a right eccentricity of the trachea .",
        "entities": [
            {
                "entity_text": "microcalcifications",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Cervical and chest CT revealed the presence of a partially calcified thyroid mass slightly plunging in the anterior mediastinum .",
        "entities": [
            {
                "entity_text": "thyroid mass",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "It took heterogeneously the contrast and then evocate a large MNG .",
        "entities": [
            {
                "entity_text": "MNG",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The trachea was surrounded by the goiter , slightly narrowed and right deviated as well as the lower part of the larynx .",
        "entities": []
    },
    {
        "text": "The right and left vascular axes of the neck ( carotid artery and jugular vein ) were deviated backward .",
        "entities": []
    },
    {
        "text": "The patient underwent a surgery for her enormous MNG slightly plunging in the mediastinum .",
        "entities": [
            {
                "entity_text": "MNG",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Endotracheal intubation was relatively easy by the laryngoscope .",
        "entities": []
    },
    {
        "text": "The incision performed was a Kocher cervicotomy .",
        "entities": []
    },
    {
        "text": "There was a multinodular , hypervascularized goiter .",
        "entities": []
    },
    {
        "text": "Its lower end plunges behind the sternal manubrium .",
        "entities": []
    },
    {
        "text": "The larynx was deviated towards the right side .",
        "entities": []
    },
    {
        "text": "The total thyroidectomy was performed in two steps : initially a right lobo-isthmectomy , then the left lobectomy .",
        "entities": []
    },
    {
        "text": "The retrosternal part of the goiter was released using the finger by the same incision .",
        "entities": []
    },
    {
        "text": "Both recurrent laryngeal nerves ( RLN ) were not identified because of the hemorrhage .",
        "entities": [
            {
                "entity_text": "hemorrhage",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "One parathyroid gland was accidently devascularized and was autotransplanted to the ipsilateral sternocleidomastoid muscle .",
        "entities": []
    },
    {
        "text": "The operation was finished by double aspiration drainage .",
        "entities": []
    },
    {
        "text": "In the first hours after surgery , the patient developed a large cervical hematoma .",
        "entities": [
            {
                "entity_text": "hematoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She was readmitted to the operating room , and after evacuation of the hematoma there was no vessels bleeding .",
        "entities": [
            {
                "entity_text": "hematoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The operation was completed with a double suction drainage .",
        "entities": []
    },
    {
        "text": "In the immediate postoperative period , the patient developed hemodynamic collapse requiring the introduction of dobutamine .",
        "entities": [
            {
                "entity_text": "hemodynamic collapse",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "After 48 hours of hemodynamic support , the blood pressure stabilized and dobutamine was stopped .",
        "entities": []
    },
    {
        "text": "Histological study concluded in multinodular colloid goiter .",
        "entities": [
            {
                "entity_text": "multinodular colloid goiter",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient was discharged from the hospital after 20 days in good health .",
        "entities": []
    },
    {
        "text": "A 21 - year-old male was referred to the gastroenterology clinic for incidental findings of severe chronic pancreatitis on cross-sectional imaging but no associated symptoms of pancreatitis .",
        "entities": [
            {
                "entity_text": "chronic pancreatitis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "pancreatitis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He had presented to the emergency department for abdominal pain consistent with prior episodes of renal colic .",
        "entities": [
            {
                "entity_text": "abdominal pain",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "renal colic",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Computed tomography scan confirmed the presence of renal calculi that passed with conservative management .",
        "entities": [
            {
                "entity_text": "renal calculi",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "An incidental finding on the imaging showed marked pancreatic atrophy with multiple sub-centimeter calcifications consistent with severe chronic pancreatitis .",
        "entities": [
            {
                "entity_text": "pancreatic atrophy",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "chronic pancreatitis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Remarkably , he did not report having any symptoms associated with pancreatic insufficiency including epigastric pain , vomiting , steatorrhea and weight loss .",
        "entities": [
            {
                "entity_text": "pancreatic insufficiency",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "epigastric pain",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "vomiting",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "steatorrhea",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He denied having any prior episodes of acute pancreatitis and had no history of alcohol use .",
        "entities": [
            {
                "entity_text": "acute pancreatitis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "His laboratory tests were all within normal range , including complete blood count , liver function tests , amylase and lipase .",
        "entities": []
    },
    {
        "text": "His family history was significant as his father had an isolated episode of pancreatitis which required abdominal surgery .",
        "entities": [
            {
                "entity_text": "pancreatitis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Magnetic resonance cholangiopancreatography ( MRCP ) showed severe parenchymal atrophy and pancreatic ductal stones with ductal dilation to 9 mm .",
        "entities": []
    },
    {
        "text": "Due to his young age and atypical presentation , he was referred for genetic testing and counselling .",
        "entities": []
    },
    {
        "text": "He underwent genetic testing for various genes known to cause hereditary pancreatitis : CASR , CFTR , CTRC , PRSS 1 , SPINK 1 .",
        "entities": [
            {
                "entity_text": "hereditary pancreatitis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He tested positive for homozygous variant of SPINK 1 ( N 34 S ) mutation .",
        "entities": []
    },
    {
        "text": "Reflex testing of at-risk relatives confirmed that both of his parents were heterozygous carriers of the same SPINK 1 ( N 34 S ) mutation and a review of their extended pedigree revealed that they were distant cousins .",
        "entities": []
    },
    {
        "text": "Given his asymptomatic clinical course , he remains under close follow-up without requiring any specific treatment for pancreatic insufficiency .",
        "entities": [
            {
                "entity_text": "pancreatic insufficiency",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Due to the severity of pancreatitis noted on imaging and long expected lifespan , he was counselled about the increased risk of pancreatic malignancy and is undergoing regular cross-sectional imaging for the detection and prevention of cancer .",
        "entities": [
            {
                "entity_text": "pancreatitis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "cancer",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "We present a case of a 77 - year-old Caucasian woman with obstructive jaundice .",
        "entities": [
            {
                "entity_text": "obstructive jaundice",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Laboratory tests revealed that she had elevated bilirubin and liver enzyme levels .",
        "entities": []
    },
    {
        "text": "A computed tomographic scan showed a homogeneous 5 × 3 - cm mass obstructing the common bile duct .",
        "entities": []
    },
    {
        "text": "The results of brush cytology were consistent with a bile duct villous papilloma .",
        "entities": [
            {
                "entity_text": "villous papilloma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "However , on the basis of the tumor ' s radiological features , a preliminary diagnosis of extrahepatic bile duct malignant tumor was made .",
        "entities": [
            {
                "entity_text": "tumor ' s",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "extrahepatic bile duct malignant tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "After discussion among the multidisciplinary team , a surgical resection of the bile duct tumor was performed .",
        "entities": [
            {
                "entity_text": "bile duct tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Histopathological examination confirmed a villous adenoma .",
        "entities": [
            {
                "entity_text": "villous adenoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient ' s postoperative course was uneventful .",
        "entities": []
    },
    {
        "text": "A 77 - year-old Tunisian woman was hospitalized because of massive painful ascites .",
        "entities": []
    },
    {
        "text": "Her family history did not include any autoimmune disease .",
        "entities": [
            {
                "entity_text": "autoimmune disease",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She denied a history of hepatitis , jaundice or alcohol use .",
        "entities": [
            {
                "entity_text": "hepatitis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "jaundice",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She had a history of diabetes , hypertension treated by glinide and calcium blocker .",
        "entities": [
            {
                "entity_text": "diabetes",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hypertension",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She was explored 4 years prior to admission for exudative pleuritis of the right lung without any established diagnosis after multiple explorations including thoracoscopy with biopsies .",
        "entities": [
            {
                "entity_text": "exudative pleuritis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "On admission , blood pressure was 150 / 70 mmHg , her rate was 80 / mn and body temperature was 37 ° C .",
        "entities": []
    },
    {
        "text": "The physical examination showed only abdominal distension related to the important ascites without collateral venous circulation .",
        "entities": [
            {
                "entity_text": "ascites",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She had no skin lesions , lymphadenopathy , or hepatosplenomegaly and lower extremities showed no edema .",
        "entities": []
    },
    {
        "text": "Laboratory investigations showed : leucopenia with white blood cell count = 3100 / mm 3 , lymphopenia = 840 / mm 3 , hemoglobin = 10 . 5 g / dL ; low serum albumin level = 29 g / L , 47 ; -globulin = 19 g / L . blood glucose levels = 180 mg / dl and hemoglobin A 1 c = 8 . 6 % .",
        "entities": []
    },
    {
        "text": "Urine analysis showed trace protein ( 0 . 03 g / 24 h ) .",
        "entities": []
    },
    {
        "text": "Platelet count , activated partial thromboplastin time , liver function tests , blood urea nitrogen , serum creatinine , erythrocyte sediment rate and total cholesterol were within normal limits .",
        "entities": []
    },
    {
        "text": "Tests for HBsAg and HCV were negative .",
        "entities": []
    },
    {
        "text": "Abdominal ultrasonography showed ascitic fluid without any sign of bowel loop thickening or enteritis .",
        "entities": []
    },
    {
        "text": "Neither lymphadenopathy nor liver abnormality was present .",
        "entities": []
    },
    {
        "text": "A chest X-ray film disclosed bilateral pleural effusion .",
        "entities": [
            {
                "entity_text": "bilateral pleural effusion",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Ascitic obtained by aspiration contained 170 cells mm 3 ( 67 % lymphocytes ) , 46 g / L protein , but no malignant cells .",
        "entities": []
    },
    {
        "text": "Cultures for bacteria and mycobacteria gave no growth .",
        "entities": []
    },
    {
        "text": "Tuberculosis investigation including initial tuberculin skin test and the research of Koch bacilli in sputum and urine were negative .",
        "entities": []
    },
    {
        "text": "Echocardiogram and electrocardiogram were normal .",
        "entities": []
    },
    {
        "text": "Computed tomographic scan showed massive ascites , no dysmorphic liver , and a mild bilateral pleural effusion .",
        "entities": [
            {
                "entity_text": "ascites",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "bilateral pleural effusion",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Pelvic examination was normal .",
        "entities": []
    },
    {
        "text": "Oesogastroduodenoscopy showed hiatal hernia without oesophageal varices .",
        "entities": [
            {
                "entity_text": "hiatal hernia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "An exploratory laparoscopy was performed , revealing a large amount of ascite , a normal liver appearance , and no granulations suggesting tuberculosis or peritoneal carcinosis .",
        "entities": [
            {
                "entity_text": "ascite",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Histological examination of the peritoneum showed non specific chronic inflammation .",
        "entities": []
    },
    {
        "text": "Systemic lupus erythematosus was suspected based on pleuritis , lymphopenia and leucopenia .",
        "entities": [
            {
                "entity_text": "Systemic lupus erythematosus",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "pleuritis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "lymphopenia",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "leucopenia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "An additional serologic survey revealed markedly elevated anti-nuclear antibody ( ANA ) titer of 1 / 1600 and a significantly elevated titer of antibody to double-stranded DNA ( 83 IU / mL ; normal < 30 IU / mL ) .",
        "entities": []
    },
    {
        "text": "She had also positive serum antibody against the Smith antigen and low serum level of C 3 complement component : 67 mg / dL ( serum normal range : 84 – 151 ) .",
        "entities": []
    },
    {
        "text": "Relying on these findings , the patient was diagnosed with SLE since 4 of the 11 diagnostic criteria of the American College of Rheumatology were met .",
        "entities": [
            {
                "entity_text": "SLE",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The SLEDAI score according to Systemic Lupus Erythematosus Disease Activity Index was estimated to be 7 on admission .",
        "entities": []
    },
    {
        "text": "Hydroxychloroquine 200 mg daily in combination with diuretics was initiated .",
        "entities": []
    },
    {
        "text": "One month later , there was no detectable ascitic fluid and no pleural effusions .",
        "entities": []
    },
    {
        "text": "Five months later she remained free from symptoms while continuing to take Hydroxychloroquine",
        "entities": []
    },
    {
        "text": "A 13 - year-old boy diagnosed with WHO diagnostic criteria of probable NS was referred from Atanga HC III in Pader district where he was enrolled and undergoing care at the nodding syndrome treatment center ; he came with a history of progressive swelling and pain in the right lumbar region .",
        "entities": [
            {
                "entity_text": "NS",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "nodding syndrome",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "swelling and pain in the right lumbar region",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The swelling was associated with a high grade fever which was constant and only partially relieved by analgesics .",
        "entities": [
            {
                "entity_text": "swelling",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "fever",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "These symptoms were not associated with vomiting , constipation , yellow eyes , loss of appetite or weight loss .",
        "entities": [
            {
                "entity_text": "vomiting",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "constipation",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "yellow eyes",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "loss of appetite",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "weight loss",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient reported a history of falling from a tree during one of the nodding episodes in October 2012 and hit his abdomen onto a tree branch .",
        "entities": [
            {
                "entity_text": "nodding",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "On further probe on his childhood history , his mother reported that he was born normally at home by a Traditional Birth Attendant ( TBA ) in one of the Internally Displaced peoples ( IDP ) camps in 2000 .",
        "entities": []
    },
    {
        "text": "She reported that there was an uneventful pregnancy which was carried to term and delivery by Spontaneous vaginal delivery ( SVD ) .",
        "entities": []
    },
    {
        "text": "She reported that during her pregnancy , she had exclusive feeding on the relief food provided by WFP ( beans , yellow posho and cooking oil ) during the IDP camps and denies history of ingestion of herbs or medications which caused adverse events during and after the pregnancy .",
        "entities": []
    },
    {
        "text": "She reported that her child had a normal physical , cognitive and social childhood development before the onset of nodding which began in May 27 th 2011 immediately after returning home from IDP camps .",
        "entities": [
            {
                "entity_text": "nodding",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The child was enrolled in Atanga treatment centre and was being managed with Carbamazepine , multivitamins and Ivermectin .",
        "entities": []
    },
    {
        "text": "She reported that in spite of these medications the child continued to have seizures and nodding at least twice a day and had since dropped out of school .",
        "entities": [
            {
                "entity_text": "seizures",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "nodding",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "On general examination , he was dehydrated , febrile and moderately wasted .",
        "entities": [
            {
                "entity_text": "dehydrated",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "febrile",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There was a right lumbar region mass , tender , indurated and non-fluctuant .",
        "entities": []
    },
    {
        "text": "The spleen and liver were not palpable .",
        "entities": []
    },
    {
        "text": "There was no renal or supra-pubic tenderness .",
        "entities": []
    },
    {
        "text": "The rectum was full of faecal material which was of normal colour and consistency .",
        "entities": []
    },
    {
        "text": "The anal tone was normal and there was no blood on examining fingure .",
        "entities": []
    },
    {
        "text": "Haematological investigations were conducted and showed neutrophilia , lympocytosis , monocytosis , and eosinophilia .",
        "entities": [
            {
                "entity_text": "neutrophilia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There were immature granulocytes and atypical lymphocytes seen on the peripheral film report .",
        "entities": []
    },
    {
        "text": "Other laboratory results including liver function tests ( ALT , AST ) were elevated while serum protein levels were low ; renal functions tests ( serum creatinine , blood urea and nitrogen level ) , and serum electrolytes ( K + , Na + , Cl- , HC 03 - ) which were within normal ranges .",
        "entities": []
    },
    {
        "text": "Abdominal Ultrasound showed inflamed internal and external oblique muscles of the anterior abdominal wall .",
        "entities": []
    },
    {
        "text": "The patient underwent incision and drainage at Gulu Hospital and wound left open for 14 days and thereafter secondary wound closure was conducted .",
        "entities": []
    },
    {
        "text": "He received supplementary food rehabilitation and his seizure medication was changed to Sodium Valproate 200 mg once a day under direct observation therapy ( DOTS ) and close monitoring of the vital signs .",
        "entities": []
    },
    {
        "text": "The patient continued to have regular follow up in the surgical ward ; seizures and nodding stopped completely from the time of intervention in the hospital .",
        "entities": [
            {
                "entity_text": "seizures",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "nodding",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "With these interventions for over one month the child had no seizures nor nodding and the child returned to normal life .",
        "entities": [
            {
                "entity_text": "seizures",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "nodding",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A subsequent review of the haematological and clinical chemistry findings 2 weeks later showed that renal function tests , serum electrolytes were normal except the liver enzymes level were elevated and were still high .",
        "entities": []
    },
    {
        "text": "A 21 year old female patient with the diagnosis of SWS suffering from headaches admitted to our clinic .",
        "entities": []
    },
    {
        "text": "She had a 2 year history of frequent non-pulsating headaches .",
        "entities": [
            {
                "entity_text": "headaches",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Her headache was relieving with non-steroidal anti-inflammatory drugs and was not worsening with physical activity .",
        "entities": [
            {
                "entity_text": "headache",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There was no nausea or aura like symptoms accompanying the headache .",
        "entities": [
            {
                "entity_text": "nausea",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "aura",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "headache",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Headaches were lasting for hours .",
        "entities": [
            {
                "entity_text": "Headaches",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The pain was bilateral , generalized and pressing in quality .",
        "entities": [
            {
                "entity_text": "pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The family history for headache was negative .",
        "entities": [
            {
                "entity_text": "headache",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She had a history of seizures occurring in the fifteenth day of life described as attacks of tonic clonic contractions and that ' s when she was diagnosed with SWS .",
        "entities": [
            {
                "entity_text": "seizures",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "tonic clonic contractions",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "SWS",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "At the age of 6 she had a history of callosotomy to control her seizures .",
        "entities": [
            {
                "entity_text": "seizures",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "At the age of 18 during a laser treatment done in order to get rid of her port wine birthmark she had her first seizure since callosotomy .",
        "entities": [
            {
                "entity_text": "port wine birthmark",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "seizure",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "After that she was prescribed carbamazepine 400 mg at daily dose and never had a seizure since then .",
        "entities": [
            {
                "entity_text": "seizure",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "According to the story taken from her parents even though she had a normal development at infancy she barely graduated from elementary school and she ' s hardly literate .",
        "entities": []
    },
    {
        "text": "There was nothing significant on her family history except for her elder sister ' s port wine stain on her face .",
        "entities": [
            {
                "entity_text": "port wine stain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The elder sister had no feature of SWS and no researches were done regarding her stain .",
        "entities": [
            {
                "entity_text": "SWS",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She was inscribed daily doses of ketiapin 25 mg for anxiety disorder and venlafaxine 75 mg for both anxiety disorder and the chronic headaches .",
        "entities": [
            {
                "entity_text": "anxiety disorder",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "anxiety disorder",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "chronic headaches",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She was also inscribed NSAID drugs .",
        "entities": []
    },
    {
        "text": "After the first week of this treatment her headaches were slightly decreased by heaviness but the frequency was the same .",
        "entities": [
            {
                "entity_text": "headaches",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "At her physical examination a facial nevus -occurred due to choroid angioma-on the right forehead , right eyelid , nasal wing and the cheek was observed .",
        "entities": []
    },
    {
        "text": "Intra oral examination showed a right sided overgrowth of gingiva .",
        "entities": []
    },
    {
        "text": "Gingival overgrowth was bright red in color and showed blanching on applying pressure suggesting angiomatous enlargement .",
        "entities": []
    },
    {
        "text": "On her extremities a mild asymmetry was visible .",
        "entities": []
    },
    {
        "text": "Her left arm and leg was slightly smaller in portions and showed hemiparesis both in the upper and lower extremities of the same size .",
        "entities": [
            {
                "entity_text": "hemiparesis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "On her ophthalmological evaluation she was diagnosed with glaucoma of the right eye .",
        "entities": [
            {
                "entity_text": "glaucoma of the right eye",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "On her psychiatric examination she showed signs of anxiety disorder .",
        "entities": [
            {
                "entity_text": "anxiety disorder",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Her neurological examination was not remarkable except for her hemiparesis .",
        "entities": [
            {
                "entity_text": "hemiparesis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Cranial CT scans showed diffuse atrophy in the right hemisphere and irregular double-contoured gyriform cortical calcifications in the right occipital area .",
        "entities": []
    },
    {
        "text": "Gadolinium enhanced brain MRI revealed multiple dilated pial venous vascular structures on right hemisphere also with the diffuse atrophy on the same side .",
        "entities": []
    },
    {
        "text": "Axial T 1 weighted cranial MRI shows right calvarial thickness compared to the left and right hemisphere is asymmetrically smaller than the left .",
        "entities": []
    },
    {
        "text": "In addition to that , T 2 weighted MRI shows extensive venous formations around corpus of right lateral ventricle and at Gallen vein localization and widespread vascular formations are seen at perivascular space , anterior to third ventricle at Willis polygon localization and at right temporooccipital area at quadrigeminal cistern localization .",
        "entities": []
    },
    {
        "text": "She was performed a proteus intelligence test in which she had 75 points and accepted as mildly mentally retarded .",
        "entities": [
            {
                "entity_text": "mildly mentally retarded",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Proteus intelligence test in which she had 75 points and accepted as mildly mentally retarded .",
        "entities": [
            {
                "entity_text": "mildly mentally retarded",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A 32 - year-old female patient with Kniest syndrome presented at our department with a painful pseudarthrosis after femoral valgisation osteotomy 8 years ago .",
        "entities": [
            {
                "entity_text": "Kniest syndrome",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A Wagner cone stem and acetabular roof cup with a cemented Ecofit cup 2 M ( dual-articulation acetabular cup system ) were implanted due to a dysplastic femur with a small medullary space .",
        "entities": [
            {
                "entity_text": "dysplastic femur",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The Ecofit cup itself is associated with a reduced risk of dislocation .",
        "entities": []
    },
    {
        "text": "The patient was satisfied with the range of motion after hip endoprosthesis and reported a significant increase in quality of life .",
        "entities": []
    },
    {
        "text": "The patient is still comfortable with the hip prosthesis at the most recent follow-up 4 years after implantation .",
        "entities": []
    },
    {
        "text": "Follow-up radiographs over 4 years have not revealed any signs of loosening or migration , and no Trendelenburg sign was reported for the affected side .",
        "entities": [
            {
                "entity_text": "Trendelenburg sign",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A 35 - year-old mentally ill man was transferred from a local psychiatric hospital after attempted suicide by fire 3 days before admission .",
        "entities": []
    },
    {
        "text": "He acquired full-and partial-thickness injury in approximately 38 % of his TBSA , including face and neck ( 5 % ) , both upper extremities ( 8 % ) , right thigh ( 4 % ) , left thigh and leg ( 3 % ) , and most of his anterior and posterior trunk ( 16 % ) .",
        "entities": []
    },
    {
        "text": "The patient was hospitalized for 66 days and underwent five debridement surgeries .",
        "entities": []
    },
    {
        "text": "The psychiatric diagnosis was schizophrenia type ICD 10 F 20 . 3 , treated with Haloperidol 1 . 5 mg and Diazepam 5 mg daily .",
        "entities": [
            {
                "entity_text": "schizophrenia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient was occasionally restrained due to rebellious and self-destruction behavior .",
        "entities": []
    },
    {
        "text": "The nutrition management of this patient was started after a week of hospitalization , which is considered late .",
        "entities": []
    },
    {
        "text": "In the initial nutrition assessment , the patient was 40 kg weight and 150 cm tall thus the body mass index ( BMI ) was 17 , 57 kg / m 2 or underweight .",
        "entities": []
    },
    {
        "text": "Gastrointestinal symptoms and signs were not found .",
        "entities": []
    },
    {
        "text": "Information regarding the patient ' s dietary intake in the last two weeks and weight change within the last 6 months could not be obtained , but his mother claimed that the patient seemed to lose weight because he refused any food that had been offered to him ; he only smoked and drank coffee .",
        "entities": []
    },
    {
        "text": "Albumin level was 3 . 6 gr / L with imbalanced electrolyte levels .",
        "entities": []
    },
    {
        "text": "Signs of fluid accumulation were not found .",
        "entities": []
    },
    {
        "text": "According to the subjective global assessment ( SGA ) tool , the patient belonged to group C ( severely malnourished ) .",
        "entities": []
    },
    {
        "text": "Energy and protein were given starting from 30 kcal / kg , increasing gradually to 50 kcal / kg , and 2 gp / kg divided into oral nutrition and oral nutrition supplements ( ONS ) with a 50 : 50 ratio .",
        "entities": []
    },
    {
        "text": "The patient was also given micronutrient supplementations , specifically vitamin A 100 , 000 units for the first week , vitamin C 100 mg 3 times a day , and zinc 20 mg once a day .",
        "entities": []
    },
    {
        "text": "During the early weeks of hospitalization , the patient ' s weight loss continued .",
        "entities": []
    },
    {
        "text": "At the end of the second week , his body weight was 36 kilograms while his serum albumin level was 2 . 7 gr / L .",
        "entities": []
    },
    {
        "text": "On the 28 th day , the patient ' s body weight was 33 kilograms while his serum albumin level was 2 . 1 gr / L .",
        "entities": []
    },
    {
        "text": "Energy and protein intake was maintained , but the ratio of oral intake and ONS was modified to 70 : 30 .",
        "entities": []
    },
    {
        "text": "During the treatment , the patient ' s appetite was unstable .",
        "entities": []
    },
    {
        "text": "The patient was also hardly cooperative with enteral access .",
        "entities": []
    },
    {
        "text": "The patient often writhed in pain and became more aggressive .",
        "entities": []
    },
    {
        "text": "The patient did not respond well to analgesics and sedations .",
        "entities": []
    },
    {
        "text": "Partially parenteral nutrition ( PN ) enriched with branched-chain amino acid ( BCAA ) was administered to support protein needs .",
        "entities": []
    },
    {
        "text": "However , his BMI continued to decline , and on the 42 nd day , his body weight dropped to 32 kilograms with a serum albumin level of 2 gr / L .",
        "entities": []
    },
    {
        "text": "On the 66 th day , granulation tissues appeared on the wound bed .",
        "entities": []
    },
    {
        "text": "Considering the mental and nutrition status of the patient , it was decided not to continue with the skin graft surgery .",
        "entities": []
    },
    {
        "text": "The patient had lost 24 % of body weight ( BMI 11 . 96 kg / m 2 ) and the serum albumin level was 2 . 5 gr / L .",
        "entities": []
    },
    {
        "text": "The patient displayed severe muscle wasting and subcutaneous fat loss .",
        "entities": [
            {
                "entity_text": "muscle wasting",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "subcutaneous fat loss",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "However , the general and mental condition was relatively better .",
        "entities": []
    },
    {
        "text": "The patient was discharged from the hospital .",
        "entities": []
    },
    {
        "text": "This case report describes the condition of a 30 - year-old man involved in a motor vehicle collision .",
        "entities": []
    },
    {
        "text": "Clinical examination , X-rays , and computed tomography scan revealed a posterior hip dislocation with an ipsilateral femoral head and mid-shaft fractures .",
        "entities": [
            {
                "entity_text": "posterior hip dislocation",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "ipsilateral femoral head and mid-shaft fractures",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient was treated by closed reduction of hip dislocation using a temporarily applied external fixator followed by intramedullary nailing of the femoral shaft .",
        "entities": []
    },
    {
        "text": "Achieving a closed reduction is a challenge with ipsilateral fractures but it should be favored over open reduction due to a lower risk of complications .",
        "entities": []
    },
    {
        "text": "The type of femoral head fracture , in this case , may have aided in an easier reduction .",
        "entities": [
            {
                "entity_text": "femoral head fracture",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A 12 - year-old girl was referred to Department of Oral Surgery , with a complaint of pain and swelling in the left of maxilla that appeared 3 months ago .",
        "entities": [
            {
                "entity_text": "pain and swelling in the left of maxilla",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The swelling was slowly progressive , associated with pain .",
        "entities": [
            {
                "entity_text": "swelling",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "However , the patient did not refer any motor or sensory deficit .",
        "entities": []
    },
    {
        "text": "There was no family history of similar swelling .",
        "entities": []
    },
    {
        "text": "Physical examination revealed a left maxillary swelling .",
        "entities": [
            {
                "entity_text": "maxillary swelling",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There was no facial palsy .",
        "entities": [
            {
                "entity_text": "facial palsy",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "No cervical lymph node enlargement was seen .",
        "entities": []
    },
    {
        "text": "The oral examination showed a 4 cm x 5 cm , tender , compressible mass in the left maxilla , from the lateral incisor to the second premolar teeth .",
        "entities": []
    },
    {
        "text": "The tumor surface was smooth and red-purple .",
        "entities": [
            {
                "entity_text": "tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Several teeth were involved and displaced in the tumor mass .",
        "entities": [
            {
                "entity_text": "tumor mass",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "We noted the absence of canine .",
        "entities": []
    },
    {
        "text": "Vitality tests proved negative on the central and lateral incisor .",
        "entities": []
    },
    {
        "text": "Hight mobility of lateral incisor was noted .",
        "entities": []
    },
    {
        "text": "Orthopantomography and occlusal radiography showed a wide osteolytic area of the anterior left maxilla , extending from the first permanent molar to the central incisor .",
        "entities": []
    },
    {
        "text": "The canine was impacted .",
        "entities": []
    },
    {
        "text": "No root resorption was observed .",
        "entities": []
    },
    {
        "text": "The radiolucency was closely related to maxillary sinus and involving the nasal cavity .",
        "entities": []
    },
    {
        "text": "Haematological investigations showed normal serum calcium , phosphorus and parathormone ( PTH ) levels .",
        "entities": []
    },
    {
        "text": "The provisional diagnosis of benign tumor of the maxilla was made .",
        "entities": [
            {
                "entity_text": "benign tumor of the maxilla",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient underwent excision and curettage of the mass with extraction of the canine and lateral incisor tooth .",
        "entities": []
    },
    {
        "text": "The wound was closed with interrupted sutures .",
        "entities": []
    },
    {
        "text": "The post-operative histopathological report revealed multinuclear giant cells scattered randomly throughout the cellular and fibrous vascular-rich tissue .",
        "entities": []
    },
    {
        "text": "New bone formation and granulation tissue rich in mononuclear inflammatory cells was revealed .",
        "entities": []
    },
    {
        "text": "The giant cells were multinucleated with bland-appearing nuclei , and the background stromal cells displayed no evidence of atypical mitoses .",
        "entities": []
    },
    {
        "text": "A diagnosis of giant cell tumor was established .",
        "entities": [
            {
                "entity_text": "giant cell tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "During a 1 - year serial clinical and radiological follow-up , there was no evidence of recurrence .",
        "entities": []
    },
    {
        "text": "The facial contour and masticatory function were well-preserved .",
        "entities": []
    },
    {
        "text": "A 43 - year-old non-diabetic Indian male reported to our outpatient department with chief complaints of cough with expectoration , chest pain , reduced appetite , fever with chills , and night sweats for two weeks .",
        "entities": [
            {
                "entity_text": "chest pain",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "reduced appetite",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "fever with chills",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "night sweats",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He also complained of breathlessness on exertion and had two episodes of blood in his sputum .",
        "entities": [
            {
                "entity_text": "breathlessness",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "blood in his sputum",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient explained that the cough was continuous and was relieved after taking cough syrup .",
        "entities": [
            {
                "entity_text": "cough",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He also mentioned that the episodes of fever were initially intermittent and then daily for the last two weeks and were relieved after taking Paracetamol .",
        "entities": [
            {
                "entity_text": "fever",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The chest pain was localized to the middle of the chest and was aggravated on exertion .",
        "entities": [
            {
                "entity_text": "chest pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He was a businessman by profession with no history of smoking , alcoholism , or any other substance abuse .",
        "entities": []
    },
    {
        "text": "Also , there was no history of any contact of TB or COVID- 19 in the family or close contacts .",
        "entities": []
    },
    {
        "text": "And there was no history of foreign travel in the recent past .",
        "entities": []
    },
    {
        "text": "But he had reported having traveled by a domestic airline about twenty days back .",
        "entities": []
    },
    {
        "text": "There was no history of weight loss or any other major illness in the past .",
        "entities": []
    },
    {
        "text": "On examination his vitals were-pulse- 108 / minute , arterial BP- 130 / 80 mm of Hg , respiratory rate of 30 breaths / minute , Sp 02 -899 % on room air , temperature- 101 - degree centigrade .",
        "entities": []
    },
    {
        "text": "His Sp 02 fell by 70 % on room air after waking .",
        "entities": []
    },
    {
        "text": "On auscultation , there was crepitation on the bilateral middle lobes of the lungs .",
        "entities": [
            {
                "entity_text": "crepitation",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Also , dyspnea on exertion was noted .",
        "entities": [
            {
                "entity_text": "dyspnea",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The rest of the systemic examination was within normal limits .",
        "entities": []
    },
    {
        "text": "Considering this as a probable case of TB with COVID- 19 he was advised a chest radiograph with sputum microscopy ( Ziehl Neelsen ( ZN ) staining for acid-fast bacilli ) , Cartridge-based nucleic acid amplification test ( CBNAAT ) of the sputum and other routine investigations .",
        "entities": [
            {
                "entity_text": "TB",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "COVID- 19",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "To check for the COVID- 19 he was advised qualitative polymerase chain reaction ( PCR ) test from the oropharyngeal swab .",
        "entities": [
            {
                "entity_text": "COVID- 19",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The results were surprising with Mycobacterium tuberculosis detected on sputum fluorescent microscopy and were also confirmed by the CBNAAT .",
        "entities": [
            {
                "entity_text": "Mycobacterium tuberculosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "However , there was no resistance to Rifampicin .",
        "entities": []
    },
    {
        "text": "The results of the PCR were positive for RNA specific to SARS-CoV- 2 .",
        "entities": [
            {
                "entity_text": "SARS-CoV- 2",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Besides , the chest radiograph PA-view was suggestive of bilateral consolidations on the middle lobes of lungs with ill-defined borders .",
        "entities": [
            {
                "entity_text": "consolidations on the middle lobes of lungs",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The other investigations revealed a low lymphocyte count ( 1 x 10 9 / L ) and increased levels of C-reactive protein ( CRP ) ( 57 mg / L ) , lactate dehydrogenase ( LDH ) ( 580 U / L ) , and erythrocyte sedimentation rate ( ESR ) ( 70 mm in the 1 st hour ) .",
        "entities": []
    },
    {
        "text": "Also , a sample for liquid culture ( MGIT BACTEC ) was sent to the Intermediate Reference Laboratory ( IRL ) which revealed the growth of Mycobacterium tuberculosis .",
        "entities": [
            {
                "entity_text": "Mycobacterium tuberculosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Computed tomography was not performed as the diagnosis was established by other cheaper and faster methods and also the patient was unwilling for the same .",
        "entities": []
    },
    {
        "text": "All the other routine investigations were within normal limits .",
        "entities": []
    },
    {
        "text": "He was referred to the nearest designated COVID- 19 management center , where he was managed as per national guidelines .",
        "entities": []
    },
    {
        "text": "Besides , he was also started on an antitubercular treatment of four drugs as per the National Tuberculosis Elimination Program ( NTEP ) guidelines .",
        "entities": []
    },
    {
        "text": "He was advised follow-up post completion of his stay at the designated COVID- 19 center , but he has not yet reported back for follow-up .",
        "entities": []
    },
    {
        "text": "Written informed consent was obtained from the patient for using clinical data and images for publication in this study .",
        "entities": []
    },
    {
        "text": "A 45 year old Indian female of Nordic origin presented 5 years back with a lump in the right breast and the axilla .",
        "entities": [
            {
                "entity_text": "lump in the right breast and the axilla",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She underwent modified radical mastectomy .",
        "entities": []
    },
    {
        "text": "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 .",
        "entities": [
            {
                "entity_text": "breast lesion",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "duct carcinoma",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "lymph nodes positive for metastasis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She received 6 cycles of chemotherapy with cyclophosphamide , epirubicin , and 5 - fluorouracil .",
        "entities": []
    },
    {
        "text": "This was followed by tamoxifen 20 mg per day for five years .",
        "entities": []
    },
    {
        "text": "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 .",
        "entities": [
            {
                "entity_text": "mild fever",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "weakness",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Examination revealed generalized lymph node enlargement along with hepatomegaly .",
        "entities": [
            {
                "entity_text": "generalized lymph node enlargement",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hepatomegaly",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Hemogram showed mild anemia , normal platelet count and a leukocyte count of 1 . 2 x 10 ( 11 ) / L .",
        "entities": [
            {
                "entity_text": "mild anemia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Peripheral blood examination revealed medium sized lymphoid cells , constituting almost 75 % of total nucleated cell population .",
        "entities": []
    },
    {
        "text": "Immunophenotying , established a diagnosis of post thymic T-cell prolymphocytic leukemia .",
        "entities": [
            {
                "entity_text": "T-cell prolymphocytic leukemia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "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 .",
        "entities": [
            {
                "entity_text": "anterior mediastinal mass",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "lung metastasis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Fine needle aspiration cytology of the mass showed atypical ductal cells with nuclear pleomorphism , which were positive for ER , PR and Her 2 neu protein .",
        "entities": []
    },
    {
        "text": "This confirmed a co-existent metastatic breast carcinoma .",
        "entities": [
            {
                "entity_text": "metastatic breast carcinoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She was started on chemotherapy for T-PLL along with hormonal therapy with aromatase inhibitor .",
        "entities": [
            {
                "entity_text": "T-PLL",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Unfortunately , both her malignancies progressed after an initial stable disease of two months .",
        "entities": []
    },
    {
        "text": "Our patient was an 87 - year-old African-American woman who was a nursing home resident , with a history of diabetes mellitus type 2 and subarachnoid hemorrhage leading to aphasia , hemiplegia , seizures and dysphagia requiring percutaneous gastric feeds .",
        "entities": [
            {
                "entity_text": "diabetes mellitus type 2",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "subarachnoid hemorrhage",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "While at the nursing home , she had recurrent aspiration pneumonia and large tube-feed residuals consistent with a diagnosis of underlying gastroparesis .",
        "entities": [
            {
                "entity_text": "aspiration pneumonia",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "gastroparesis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Her management included metoclopramide and reduced tube-feeding rates , which improved her symptoms .",
        "entities": []
    },
    {
        "text": "However , within months the aspiration and increased residuals returned .",
        "entities": [
            {
                "entity_text": "aspiration",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "After trials of different medication therapies without success , she started mirtazapine and her residual volume and aspirations decreased with a dose of 15 mg nightly .",
        "entities": [
            {
                "entity_text": "aspirations",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A 45 year old female with history of sickle cell disease presented with abdominal pain .",
        "entities": [
            {
                "entity_text": "sickle cell disease",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "abdominal pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A CT scan revealed an exophytic renal mass measuring 2 . 9 cm x 2 . 0 cm x 2 . 1 cm located on the antero-lateral aspect of her right kidney and an unremarkable spleen .",
        "entities": [
            {
                "entity_text": "renal mass",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She was evaluated by urology and a right partial nephrectomy was planned , however on the day of the procedure , the patient ' s preoperative pregnancy test was positive .",
        "entities": []
    },
    {
        "text": "The procedure was post postponed until after she delivered and interval ultrasounds were obtained throughout her pregnancy to monitor the renal mass .",
        "entities": []
    },
    {
        "text": "The lesion increased minimally in size .",
        "entities": [
            {
                "entity_text": "lesion",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Two months after caesarian section delivery , patient underwent an unremarkable right laparoscopic partial nephrectomy with individual artery and vein vascular occlusion at the level of the renal hilum .",
        "entities": [
            {
                "entity_text": "artery and vein vascular occlusion",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A superficial liver laceration caused by the Veress needle was noted at the beginning of the procedure and effectively managed using bipolar cautery .",
        "entities": [
            {
                "entity_text": "liver laceration",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient ' s post-operative course was notable for marked thrombocytosis with her platelet count increasing for her baseline of 300 , 000 to a zenith of 1 . 3 million .",
        "entities": [
            {
                "entity_text": "thrombocytosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She was started on aspirin therapy and splenomegaly was noted on abdomen ultrasound .",
        "entities": [
            {
                "entity_text": "splenomegaly",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Her platelet count normalized to 334 , 000 .",
        "entities": []
    },
    {
        "text": "On pathology , the renal mass was classified as a papillary renal neoplasm consistent with a translocation carcinoma .",
        "entities": [
            {
                "entity_text": "papillary renal neoplasm",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "carcinoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There was no splenic tissue in the specimen .",
        "entities": []
    },
    {
        "text": "It was noted that the complete lack of staining of any keratins or epithelial membrane antigens was not consistent with a usual renal cell carcinoma and hence the diagnosis of a translocation tumor was made .",
        "entities": [
            {
                "entity_text": "renal cell carcinoma",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient was lost to follow up presenting 2 years later and a follow-up CT scan noted marked splenic atrophy with several splenules .",
        "entities": [
            {
                "entity_text": "splenic atrophy",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient was completely asymptomatic and at the time received all the post-splenectomy vaccination and her platelet count remained within normal limits .",
        "entities": []
    },
    {
        "text": "A 20 - year-old right-handed female factory worker with no medical history is consulting in the emergency ward with an open trauma of the left hand resulting from an occupational accident .",
        "entities": []
    },
    {
        "text": "Her hand was crushed under a heavy object .",
        "entities": []
    },
    {
        "text": "Physical examination found an important swelling and obvious distortion at the dorsum of the hand associated with wounds of the ulnar and radial edges of the left hand .",
        "entities": [
            {
                "entity_text": "swelling",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "distortion at the dorsum of the hand",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "wounds of the ulnar and radial edges of the left hand",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The neurovascular examination was normal ; in particular no sensitive deficit in the median nerve area was noted .",
        "entities": []
    },
    {
        "text": "Plain radiographs with front and lateral views showed a dislocation of the three lesser fingers associated with fractures of the hamatum and the second metacarpal .",
        "entities": [
            {
                "entity_text": "dislocation of the three lesser fingers",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "fractures of the hamatum and the second metacarpal",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The three lesser metacarpals and the distal fragment of the hamatum were medially displaced .",
        "entities": []
    },
    {
        "text": "The patient was immediately brought to the operating theatre .",
        "entities": []
    },
    {
        "text": "The treatment consisted of a reduction and stabilisation using a multiple carpo-metacarpal and cross inter-metacarpal pinning .",
        "entities": []
    },
    {
        "text": "The wound was cleaned up trimmed and sutured .",
        "entities": []
    },
    {
        "text": "The had and the wrist were immobilized with a splint for six weeks .",
        "entities": []
    },
    {
        "text": "The patient had an intense and regular rehabilitation program .",
        "entities": []
    },
    {
        "text": "At one year follow-up , the outcome is good : the patient is painless with good bone consolidation in right position , strictly normal range of motion ( metacarpophalangeal 90 ° , proximal interphalagienne 100 ° and distal interphalageal 90 ° ) and a 80 % grip strength compared to the right side .",
        "entities": []
    },
    {
        "text": "A 24 - year-old African-American man presented to our Emergency Department with a one-week history of fever , dyspnea , cough , and abdominal pain .",
        "entities": [
            {
                "entity_text": "abdominal pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "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 .",
        "entities": [
            {
                "entity_text": "bilateral lower lobe pneumonia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "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 .",
        "entities": []
    },
    {
        "text": "He subsequently became increasing hypoxemic in the intensive care unit and a bronchoperitoneal fistula was diagnosed .",
        "entities": [
            {
                "entity_text": "hypoxemic",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "fistula",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He required high-frequency oscillatory ventilation followed by lung isolation , and was successfully resuscitated using these techniques .",
        "entities": []
    },
    {
        "text": "A 19 - year-old healthy man was admitted to our cardiology department following a syncopal episode .",
        "entities": [
            {
                "entity_text": "syncopal episode",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "His past medical history was unremarkable .",
        "entities": []
    },
    {
        "text": "He no family history of heart disease or sudden death .",
        "entities": [
            {
                "entity_text": "heart disease",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "sudden death",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Two-days prior the syncope , he developed chest pain and an influenza-like illness consisting of fevers , rhinorrhea , and sore throat .",
        "entities": [
            {
                "entity_text": "syncope",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "chest pain",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "fevers",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "rhinorrhea",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "sore throat",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "At the physical exam , the patient was febrile at 39 ° C .",
        "entities": [
            {
                "entity_text": "febrile",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He had an inflamed throat , bradycardia at cardiac auscultation and there were no signs of heart failure .",
        "entities": [
            {
                "entity_text": "inflamed throat",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "bradycardia",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "heart failure",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The electrocardiogram ( EKG ) showed grade III atrioventricular ( AV ) bloc with a ventricular rate of 38 beats per minute .",
        "entities": [
            {
                "entity_text": "grade III atrioventricular ( AV ) bloc",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Laboratory studies were remarkable for a HS-troponin level 181 ng / L , a white blood cell count of 14270 / mm with 48 % lymphocytes , and elevated C-reactive protein at 90 mg / L .",
        "entities": []
    },
    {
        "text": "Serum electrolytes , kidney and liver functions were within normal limits .",
        "entities": []
    },
    {
        "text": "A chest X-ray showed an appropriate cardiac size .",
        "entities": []
    },
    {
        "text": "The initial transthoracic echocardiography ( TTE ) showed a normal global left ventricular function ( left ventricular ejection fraction ( LVEF ) 60 % ) and wall motion abnormalities ( anteroseptal hypokinesia ) , with reduced left ventricular global longitudinal strain ( LV GLS = -14 . 1 % ) .",
        "entities": [
            {
                "entity_text": "hypokinesia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Cardiac magnetic resonance ( CMR ) showed increased signal intensity at the mid-lateral wall on T 2 - weighted images .",
        "entities": []
    },
    {
        "text": "Late enhancement revealed a patchy subepicardial hyperenhancement of the medio-distal segments of the anterior and anterolateral walls which confirm the diagnosis of myocarditis .",
        "entities": [
            {
                "entity_text": "myocarditis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient was treated with cefotaxime and doxycycline .",
        "entities": []
    },
    {
        "text": "All serological tests ( chlamydia , coxiella , mycoplasma , rickettsia , lyme and bartonella ) obtained during the hospitalization were negative .",
        "entities": []
    },
    {
        "text": "Five days later , the patient was asymptomatic .",
        "entities": []
    },
    {
        "text": "The 24 hours ECG monitoring showed a sinus rhythm .",
        "entities": []
    },
    {
        "text": "The TTE revealed a normal LVEF and an improvement in the LVGLS with segmental reduced values concordant with the CMR abnormalities .",
        "entities": []
    },
    {
        "text": "At one-month follow-up the patient made a full recovery without any recurring cardiovascular symptoms or abnormal electrocardiographic or echocardiographic findings .",
        "entities": [
            {
                "entity_text": "cardiovascular symptoms",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A 70 yrs old Female was admitted in our institution diagnosed with severe bilateral Osteoarthritis .",
        "entities": [
            {
                "entity_text": "bilateral Osteoarthritis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The x-rays showed bone on bone Tricompartment OA Knee with Varus Malalignment .",
        "entities": [
            {
                "entity_text": "OA Knee with Varus Malalignment",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She was posted for Single Stage Bilateral Total Knee Replacement and as planned the Left Knee Was Operated first .",
        "entities": []
    },
    {
        "text": "After exposure , Proximal Tibial , Distal Femoral Cuts and measurement of extension gaps the synovium from the anterior Femur was removed and sizing was done .",
        "entities": []
    },
    {
        "text": "The AP cut was then proceeded with .",
        "entities": []
    },
    {
        "text": "We spotted a small Osteochondral Cyst in the Anterior Femur which was curretted to remove the cystic material , which is when we realised that the cyst was large and communicating with the medulary canal .",
        "entities": [
            {
                "entity_text": "Cyst",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "cyst",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The remaining Femoral preparations was done keeping in mind the risk of iatrogenic fracture and extension Stem was used in the femur .",
        "entities": [
            {
                "entity_text": "fracture",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The defect was then packed cancellous bone graft .",
        "entities": []
    },
    {
        "text": "A 31 - year-old woman with no pathological history was admitted to our hospital for chest pain , bone and joint pain , hair loss and asthenia for the last 3 months .",
        "entities": [
            {
                "entity_text": "chest pain",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "bone and joint pain",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hair loss",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "On physical examination , we found fever at 38 ° C , polypnea at 32 cycles / min , arterial hypertension at 160 / 90 mmHg , malar rash , synovitis of wrists , elbows and ankles , and edema on both legs .",
        "entities": [
            {
                "entity_text": "fever",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "synovitis of wrists , elbows and ankles",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "edema",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Diagnostic assessment : laboratory tests disclosed the following values : Increase level of erythrocyte sedimentation rate 120 mm / 1 st hour , C reactive protein was 20 mg / l .",
        "entities": []
    },
    {
        "text": "The blood count showed hemoglobin at 9 g / dl , MCV at 85 3 , lymphopenia at 400 / mm 3 , while platelets were normal 450 000 / mm 3 .",
        "entities": []
    },
    {
        "text": "Direct coombs test was negative .",
        "entities": []
    },
    {
        "text": "Serum Albumin was 25 g / l ; proteins level was low at 50 g / l and proteinuria at 3 . 2 g / day .",
        "entities": []
    },
    {
        "text": "Creatinine was normal .",
        "entities": []
    },
    {
        "text": "Anti-nuclear antibody ANA were positive 1 / 320 with homogeneous pattern , anti-dsDNA level was 160 U / ml .",
        "entities": []
    },
    {
        "text": "Anti-cardiolipin IgG antibodies were positive 25 UGPL .",
        "entities": []
    },
    {
        "text": "Rheumatoid Factor was negative .",
        "entities": []
    },
    {
        "text": "C 3 and C 4 complement fractions were low ( 0 . 2 g / l and 0 . 05 g / l ) .",
        "entities": []
    },
    {
        "text": "Chest x-ray , electrocardiogram and echocardiography were normal .",
        "entities": []
    },
    {
        "text": "Chest computed tomography ( CT ) scan showed proximal pulmonary embolism .",
        "entities": [
            {
                "entity_text": "pulmonary embolism",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Renal ultrasound was normal .",
        "entities": []
    },
    {
        "text": "Renal biopsy reveals immunocomplex nephritis , lupus nephritis , segmental mesangial proliferation , mild activity lupus nephritis class III ( A / C ) .",
        "entities": [
            {
                "entity_text": "nephritis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "lupus nephritis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "mesangial proliferation",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Before starting corticosteroids , we analyzed electrolytes .",
        "entities": []
    },
    {
        "text": "Serum calcium was elevated 132 mg / l with hyper-calciuria 479 mg / 24 h . 25 OHD was normal .",
        "entities": []
    },
    {
        "text": "Alcaline phosphatase was 420 UI / l . the patient did not have any symptoms of hypercalcemia .",
        "entities": []
    },
    {
        "text": "Serum protein Electrophoresis showed polyclonal hypergammaglobulinaemia .",
        "entities": []
    },
    {
        "text": "Serum and urine immunofixation as well as Bence-Jones proteinuria were negative .",
        "entities": []
    },
    {
        "text": "Intact parathyroid hormone ( iPTH ) was high 628 pg / ml .",
        "entities": []
    },
    {
        "text": "CT scan and ultrasound of parathyroid imaging revealed a lower left parathyroid nodule measuring 2 cm x 1 cm .",
        "entities": [
            {
                "entity_text": "nodule",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Femoral and lumbar bone mineral density ( BMD ) showed osteoporosis ( T-score : -2 . 6 ) .",
        "entities": []
    },
    {
        "text": "In addition , we found multiple pelvic osteolytic lesions at CT scan .",
        "entities": []
    },
    {
        "text": "Other causes of hypercalcemia and bone lysis were excluded .",
        "entities": []
    },
    {
        "text": "The diagnosis in this case was SLE with lupus nephritis class III and anti-phospholipid syndrome , complicated by pulmonary embolism associated to primary hyperparathyroidism causing severe hypercalcemia , osteoporosis .",
        "entities": [
            {
                "entity_text": "SLE with lupus nephritis class III",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "pulmonary embolism",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hypercalcemia",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "osteoporosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Therapeutic intervention : the patient was given a pulse of methyl-prednisolone 15 mg / kg / day for 3 days followed by oral prednisone 1 mg / kg / day , associated with intravenous cyclophosphamide 750 mg / m 2 / month for 6 months .",
        "entities": []
    },
    {
        "text": "Mycophenolate mofetil 2 g / day was prescribed as a maintenance therapy of lupus nephritis with hydroxychloroquine at a dose of 400 mg / day .",
        "entities": []
    },
    {
        "text": "Treatment of pulmonary embolism was initiated with subcutaneous low molecular weight heparin ( enoxaparin 0 . 1 ml / 10 kg / 12 h ) followed by antivitamin K .",
        "entities": [
            {
                "entity_text": "pulmonary embolism",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "For Hypercalcemia , patient has received intravenous fluid with furosemide .",
        "entities": [
            {
                "entity_text": "Hypercalcemia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She also required Alendronate 70 mg / week with Vitamin D 400 u / day for osteoporosis .",
        "entities": []
    },
    {
        "text": "The left parathyroid gland was surgically removed .",
        "entities": []
    },
    {
        "text": "Histopathological examination revealed parathyroid adenoma .",
        "entities": []
    },
    {
        "text": "Her immediate postoperative parathyroid hormone level was 64 pg / ml with a calcium level of 98 mg / l .",
        "entities": []
    },
    {
        "text": "Follow-up and outcomes : forty-eight hours after the surgery she developed oral paresthesia .",
        "entities": []
    },
    {
        "text": "She had hypocalcemia at 72 mg / l .",
        "entities": []
    },
    {
        "text": "She required oral supplementation for few months .",
        "entities": []
    },
    {
        "text": "Additional investigations for multiple endocrine neoplasia were negative .",
        "entities": []
    },
    {
        "text": "The patient remained asymptomatic .",
        "entities": []
    },
    {
        "text": "Her SLE was calm without any relapse .",
        "entities": [
            {
                "entity_text": "SLE",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Control of proteinuria was negative .",
        "entities": []
    },
    {
        "text": "Corticosteroids was dropped .",
        "entities": []
    },
    {
        "text": "The follow-up was 4 years .",
        "entities": []
    },
    {
        "text": "Forty year old male presented with a huge mass in this left arm .",
        "entities": []
    },
    {
        "text": "The same patient apparently was admitted three years back for excision of the arm swelling which was relatively small that time .",
        "entities": [
            {
                "entity_text": "arm swelling",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "However the patient did not undergo surgery and was takin treatment from local bone setters during the last three years and tumor grew to a larger size during this period .",
        "entities": [
            {
                "entity_text": "tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The current dimensions of tumor was 32 x 28 cms with circumference of 87 cms .",
        "entities": [
            {
                "entity_text": "tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "X-ray showed complete destruction of the upper humerus with central calcification .",
        "entities": []
    },
    {
        "text": "Biopsy releveled a chondrosarcoma .",
        "entities": [
            {
                "entity_text": "chondrosarcoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Skeletal survey and bone scan did not reveal any other lesion in the body .",
        "entities": []
    },
    {
        "text": "A forequarter amputation was done and a 16 kg tumor mass was excised .",
        "entities": [
            {
                "entity_text": "tumor mass",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "At three years follow up , the patient has no complains with no recurrence of the tumor .",
        "entities": [
            {
                "entity_text": "tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A 3 years old girl born from non-consanguineous parents , without any neonatal suffering ; with good psychomotor development , from a popular district in one of our cities , without any obvious contact with dogs ; presented with exophthalmia associated with unilateral blindness evolving rapidly within 3 months .",
        "entities": [
            {
                "entity_text": "unilateral blindness",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Clinical examination showed a non-pulsatile , painless , axial , irreducible exophthalmia with no sign of conjunctivitis or keratitis , and right monocular blindness , right ptosis ; and fundal examination had objectified right papillary oedema .",
        "entities": [
            {
                "entity_text": "exophthalmia",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "conjunctivitis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "keratitis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "monocular blindness",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "right ptosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The rest of the clinical examination was normal .",
        "entities": []
    },
    {
        "text": "Brain and orbital magnetic resonance imaging ( MRI ) revealed an extra-connal right orbital lesion near the orbital apex , measuring 28 x 18 mm , of oval shape , it appeared hypo-signal in T 1 and hyper-signal in T 2 , limited by a thin wall which took contrast product , this lesion compressed the optic nerve towards the nasal region .",
        "entities": [
            {
                "entity_text": "extra-connal right orbital lesion",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "lesion",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Chest x-ray and abdominal ultrasound did not reveal any other localization .",
        "entities": []
    },
    {
        "text": "The patient was operated by performing a right extra-dural frontal approach , a cyst puncture was done in the first intention because the cyst was adherent to the neighbouring structures making its complete removal impossible , then a microscopic extirpation of the cystic membrane , combined with abundant washing by hypertonic serum to sterilize the cystic sit and reduce chances of dissemination .",
        "entities": [
            {
                "entity_text": "cyst",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Histological examination was in favour of intra-orbital hydatidosis .",
        "entities": [
            {
                "entity_text": "hydatidosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Postoperatively , the patient was given an antihelminthic treatment of albendazole at a dose of 10 mg per kilogram per day in 3 doses separated by 2 weeks ; the evolution was marked by the significant regression of the exophthalmia and the gradual improvement of the visual acuity .",
        "entities": [
            {
                "entity_text": "exophthalmia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient however still retains a right unilateral nasal hemianopia after two years of follow-up .",
        "entities": [
            {
                "entity_text": "hemianopia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "An MRI done in the same period shows a cure of the patient by a complete disappearance of the cyst .",
        "entities": [
            {
                "entity_text": "cyst",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "We received a boy 3 - year-old boy with autistic disorder on hospital of pediatric ward A at university hospital Mohammed VI of Marrakesh .",
        "entities": [
            {
                "entity_text": "autistic disorder",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He has no family history of illness or autistic spectrum disorder .",
        "entities": [
            {
                "entity_text": "autistic spectrum disorder",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The history revealed that at 2 years of age .",
        "entities": []
    },
    {
        "text": "The child was diagnosed with a ‘ ‘ severe communication disorder , ' ' with social interaction difficulties and sensory processing delay .",
        "entities": []
    },
    {
        "text": "A composite follow-up of all previous assessments and investigations was undertaken .",
        "entities": []
    },
    {
        "text": "Blood work was normal ( thyroid-stimulating hormone ( TSH ) , hemoglobin , mean corpuscular volume ( MCV ) , and ferritin ) .",
        "entities": []
    },
    {
        "text": "Genetic testing was unremarkable ( normal karyotype , negative for fragile X ) and the magnetic resonance imaging ( MRI ) in search of a demyelinating attack of the white matter , electroencephalography ( EEG ) , optometry assessment were also normal .",
        "entities": []
    },
    {
        "text": "At the conclusion of this composite assessment , the boy was given a primary diagnosis of autistic spectrum disorder .",
        "entities": [
            {
                "entity_text": "autistic spectrum disorder",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A plan was instituted including speech-language therapy , intensive individualized educational programming , and contact was encouraged with the Autism Society .",
        "entities": []
    },
    {
        "text": "For that purpose , the parents moved to morocco to be surrounded by family without any huge improvement .",
        "entities": []
    },
    {
        "text": "Upon direct questioning at initial presentation , the 3 - year-old child was reported by the parents to have unexplained fatigue , Gastrointestinal symptoms included bloating , constipation and diarrhea .",
        "entities": [
            {
                "entity_text": "bloating",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "constipation",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "diarrhea",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Psychiatric symptoms included a frequently depressed mood , disproportionate anger , and emotional lability .",
        "entities": []
    },
    {
        "text": "On exploring his history , the child was born from yemenite father and Moroccan mother in Germany at-term weighing 3500 g with an Apgar score of 9 at 1 minute and 10 at 5 minutes after an uneventful pregnancy and delivery .",
        "entities": []
    },
    {
        "text": "No concerns were present in the neonatal period .",
        "entities": []
    },
    {
        "text": "Development in the first 24 months of life appeared fine according to the parents-his motor skills seemed to progress normally and he achieved expected milestones .",
        "entities": []
    },
    {
        "text": "After 2 years of age , however , his language skills slowly began to regress .",
        "entities": []
    },
    {
        "text": "He also demonstrated a change in temperament as he started to whine repeatedly and to scream without provocation .",
        "entities": []
    },
    {
        "text": "Physical examination revealed a height and weight normal for age .",
        "entities": []
    },
    {
        "text": "He was uncommunicative , restless , and somewhat agitated .",
        "entities": []
    },
    {
        "text": "General examination was unremarkable other than dark rings around the eyes .",
        "entities": []
    },
    {
        "text": "There were no dysmorphic features evident .",
        "entities": []
    },
    {
        "text": "He had difficulty maintaining eye contact , and he appeared disinterested in what was taking place .",
        "entities": []
    },
    {
        "text": "No abnormality was found on abdominal assessment .",
        "entities": []
    },
    {
        "text": "Anti-tissue transglutaminase antibodies levels were 76 U ( normal < 10 ) .",
        "entities": []
    },
    {
        "text": "The patient underwent upper endoscopy as duodenal biopsy to confirm a celiac disease diagnosis .",
        "entities": []
    },
    {
        "text": "It shows a total villous atrophy corresponding to a stage 4 of Marsh classification .",
        "entities": [
            {
                "entity_text": "villous atrophy",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Given the positive screen for celiac disease ( positive anti-tissue transglutaminase antibodies and results of duodenal biopsy ) , dietary intervention was immediately commenced .",
        "entities": [
            {
                "entity_text": "celiac disease",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "All gluten was eliminated from the boy ' s diet .",
        "entities": []
    },
    {
        "text": "Within 1 month , the boy ' s gastrointestinal symptoms were relieved and his behavior had changed .",
        "entities": []
    },
    {
        "text": "The mother reported that her boy became progressively more communicative .",
        "entities": []
    },
    {
        "text": "The child has continued on the gluten-free diet and has progressed well and remained healthy over the following 6 months .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "new-onset diabetes mellitus",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Hormonal study and dynamic biochemical tests performed indicated ECS .",
        "entities": []
    },
    {
        "text": "Imaging and cytological findings pointed toward a likely primary right parotid malignancy with liver metastases .",
        "entities": [
            {
                "entity_text": "primary right parotid malignancy",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "liver metastases",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Somatostatin receptor scintigraphy has shown an increased uptake in the parotid gland and mild expression in liver metastasis .",
        "entities": [
            {
                "entity_text": "liver metastasis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient underwent right parotidectomy , and histopathologic examination confirmed ACC .",
        "entities": [
            {
                "entity_text": "ACC",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Meanwhile , hypercortisolism was managed with metyrapone , ketoconazole , and lanreotide .",
        "entities": [
            {
                "entity_text": "hypercortisolism",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Despite chemotherapy onset , a rapid disease progression and clinical course deterioration was observed .",
        "entities": [
            {
                "entity_text": "disease progression",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": []
    },
    {
        "text": "The delay to consult was 5 hours after the incident .",
        "entities": []
    },
    {
        "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 .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "dislocated head of the right femur",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "fractures of the head of the femur",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The standard radiography of the left shoulder showed a Salter I epiphyseal separation of the humerus .",
        "entities": [
            {
                "entity_text": "Salter I epiphyseal separation of the humerus",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "dislocated hip",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The radiological results were satisfactory with a restored bilateral symmetry of the articular anatomy .",
        "entities": []
    },
    {
        "text": "The Salter I detachment of the humerus was orthopedically reduced then immobilized by a thoracoabdominal plaster be kept during a month .",
        "entities": []
    },
    {
        "text": "The child has been discharged the next day .",
        "entities": []
    },
    {
        "text": "Revised after a month , showed a stable left hip on the clinical examination .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "avascular necrosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 ) .",
        "entities": [
            {
                "entity_text": "not menstruated",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "menstrual pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": []
    },
    {
        "text": "Based on clinical examination and a physical examination , the patient was diagnosed with secondary amenorrhea .",
        "entities": [
            {
                "entity_text": "secondary amenorrhea",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Investigations that were used are ultrasonography , thorax X-ray and CT Scan Head .",
        "entities": []
    },
    {
        "text": "Ultrasonography and thorax X-Ray showed that patient is suspected to have right pleural effusion .",
        "entities": [
            {
                "entity_text": "right pleural effusion",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "CT-Scan examination showed that bilateral ethmoidal sinusitis and pituitary gland was within normal limits .",
        "entities": []
    },
    {
        "text": "The treatment plan in this patient is P test therapy with Prothyra 1 x 10 mg for 7 days , with control on 2 weeks after the use .",
        "entities": []
    },
    {
        "text": "P test showed a negative result , because after 14 days of progesterone consumption the prothyra is not bleeding .",
        "entities": []
    },
    {
        "text": "The treatment is followed by a E + P test ( Estrogen + Progesterone ) with Estrogen 1 x 0 . 625 mg for 21 days and an addition of Progesterone 1 x 10 mg on 12 th -21 st days , while the control was performed one week after the drug runs out .",
        "entities": []
    },
    {
        "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 .",
        "entities": []
    },
    {
        "text": "The E + P test showed a negative result , so it was necessary to do hysteroscopy and curettage for the uterus evaluation .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "adhesions in the uterine cavum",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "secondary amenorrhea",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "tuberculosis endometritis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "secondary amenorrhea",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "tuberculosis endometritis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Based on the Anatomical Pathology hysteroscopy result , treatment was done by using anti-tuberculosis drug category I ( FDC 1 X 3 tab ) for 6 months .",
        "entities": []
    },
    {
        "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 .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "progressive heart failure",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": []
    },
    {
        "text": "Transthoracic echocardiography revealed an anomalous accelerated flow , indicating an anomalous systemic pulmonary shunt .",
        "entities": []
    },
    {
        "text": "Arterial catheterization revealed an abnormal bronchial artery originating from the left subclavian artery and bifurcating to both lungs .",
        "entities": [
            {
                "entity_text": "abnormal bronchial artery",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The anomalous ectatic bronchial artery was successfully occluded by coil embolization .",
        "entities": [
            {
                "entity_text": "anomalous ectatic bronchial artery",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The improvement of the patient ' s hemodynamic status resulted in an uneventful post-operative course .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "Macrophage activation syndrome",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "Griscelli syndrome type 2",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "His birth histories , his familie social history and developmental milestones were unremarkable .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "perinatal complications",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Furthermore the boy presented a progressive abdominal distension since birth , progressive pallor and recurrent episodes of fever since 1 year of age .",
        "entities": [
            {
                "entity_text": "abdominal distension",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "fever",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There was history of blood transfusions for last 2 months .",
        "entities": []
    },
    {
        "text": "On the other side there was no history of jaundice , vomiting , urinary or bowel complaints , bleeding from any site or neurological complaints .",
        "entities": [
            {
                "entity_text": "jaundice",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "vomiting",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "bowel complaints",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "hypotonic",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "tachycardic",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "fever",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "lymphoadenopathy",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hepato-splenomegaly",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The blood count showed pancytopenia ; 1980 white blood cells / L ( VN 4000-13 500 / L ) , neutrophils 820 / L , 910 cells / L , hemoglobin ( Hb ) 6 . 3 g / dL ( 11 . 5-14 VN , 5 g / dL ) , platelets 44 000 / L ( VN 150 000-400 000 / L ) , There were no giant cytoplasmic granules in leucocytes .",
        "entities": [
            {
                "entity_text": "pancytopenia",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "cytoplasmic granules",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 . 7 g / l ) .",
        "entities": [
            {
                "entity_text": "low albumin",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "increased alkaline phosphatase",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "low fibrinogen",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Serum triglycerides , ferrintin and lactic dehydrogenase were very high ; respectively 4 . 75 g / L ; 2763 g / L and 597 U / L . the C reactive protein ( CRP ) was elevated at 83 mg / l .",
        "entities": []
    },
    {
        "text": "A chest X-ray was normal while the abdominal ultrasound showed a hepatomegaly and a splenomegaly , free biliary ducts without ascites .",
        "entities": [
            {
                "entity_text": "hepatomegaly",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "splenomegaly",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "ascites",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "hepato-splenomegaly",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "pancytopenia",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hyperferritinemia",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hypofibrinogenemia",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "Macrophage activation syndrome",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "SAM",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": []
    },
    {
        "text": "Serologies of CMV and rubella showed an old immunization .",
        "entities": []
    },
    {
        "text": "The immunological tests such as antinuclear antibodies ( ANA ) , anti-LKM 1 , anti-mitochondria and anti-smooth muscle antibodies were negatives .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "Griscelli Syndrome",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "Griscelli Syndrome",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The molecular biology showed mutation in RAB 27 A gene confirming the diagnosis of a Griscelli syndrome type 2 .",
        "entities": [
            {
                "entity_text": "Griscelli syndrome type 2",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 1 g / 0 . 73 m 2 / day for 3 days then 60 mg / m 2 ) with poor response ; persisting with involvement of the 3 cell lines in the blood count , elevated ferritin and triglycerides .",
        "entities": [
            {
                "entity_text": "Macrophage activation syndrome",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "Griscelli syndrome type 2",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": []
    },
    {
        "text": "On the other side the infectious process was good managed by perfusion of Antibiotics such as Ceftazidim in combination with aminoside .",
        "entities": []
    },
    {
        "text": "The patient was sent home with prednisone and cyclosporine , He was placed on the list of bone marrow transplantation ( BMT ) .",
        "entities": []
    },
    {
        "text": "A 16 - year-old Indian boy presented to our hospital with a history of a lump in the lower back region since birth .",
        "entities": [
            {
                "entity_text": "lump",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Initially , it was small , but its size increased gradually over time to a size of 15 cm × 15 cm at presentation .",
        "entities": []
    },
    {
        "text": "There were no other associated abnormalities .",
        "entities": []
    },
    {
        "text": "Investigations revealed the lump to be a benign cystic teratoma .",
        "entities": [
            {
                "entity_text": "lump",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "benign cystic teratoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient underwent surgery , and the whole tumor , from its base to the vertebrae , was excised .",
        "entities": [
            {
                "entity_text": "tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Bisection of the tumor revealed that it contained hair and pultaceous material consistent with a teratoma , which was later confirmed by histopathologic examination .",
        "entities": [
            {
                "entity_text": "tumor",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "teratoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "In May 2014 a 49 year gentleman was admitted for widespread mucocutaneous blistering diagnosed as PV by histology and immunofluorescence .",
        "entities": []
    },
    {
        "text": "After 6 weeks of treatment with systemic steroids and azathioprine the patient developed pulmonary emboli and started oral anticoagulation with warfarin .",
        "entities": [
            {
                "entity_text": "pulmonary emboli",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "PV",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "deep vein thrombosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "pemphigus",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "retro-orbital pain",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "gum bleeding",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "On 7 th day of illness patient became afebrile , but he developed severe headaches , unconsciousness followed by altered behavior .",
        "entities": [
            {
                "entity_text": "headaches",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "unconsciousness",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "altered behavior",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "On 9 th day of illness patient developed painful neck swelling accompanied by fever , tremors , palpitations , hoarseness of voice and odynophagia .",
        "entities": [
            {
                "entity_text": "neck swelling",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "fever",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "palpitations",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hoarseness of voice",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "odynophagia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Examination revealed acutely swollen , tender thyroid gland along with features of hyperthyroidism .",
        "entities": [
            {
                "entity_text": "swollen",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "tender thyroid gland",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hyperthyroidism",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Laboratory evaluation revealed stable hematocrit , thrombocytopenia and leukopenia .",
        "entities": []
    },
    {
        "text": "Patient had seroconverted for anti-dengue IgM antibodies on the 10 th day of illness .",
        "entities": []
    },
    {
        "text": "A non-contrast Computed Tomogram ( CT ) of the brain showed right frontal lobe hematoma .",
        "entities": []
    },
    {
        "text": "Thyroid profile showed increased free T 3 and T 4 and low TSH .",
        "entities": []
    },
    {
        "text": "Technetium thyroid scan showed reduced tracer uptake .",
        "entities": [
            {
                "entity_text": "reduced tracer uptake",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He was diagnosed as having subacute thyroiditis and treated with oral prednisolone and propranolol .",
        "entities": [
            {
                "entity_text": "subacute thyroiditis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Follow up CT brain showed resolving hematoma .",
        "entities": [
            {
                "entity_text": "hematoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Patient ' s recovery was uneventful .",
        "entities": []
    },
    {
        "text": "A 65 year-old woman with hypertension and Parkinson ' s disease presented with sudden onset severe chest pain .",
        "entities": [
            {
                "entity_text": "Parkinson ' s disease",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "chest pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Electrocardiogram showed ischemic ST-segment elevation in inferior and lateral leads .",
        "entities": [
            {
                "entity_text": "ST-segment elevation",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "focal dissections",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Angiography demonstrated no significant atherosclerotic coronary artery disease .",
        "entities": [
            {
                "entity_text": "no significant atherosclerotic coronary artery disease",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient was medically managed with Eptifibatide , Aspirin , Clopidogrel and beta blocker since dissected vessels were not technically suitable for percutaneous coronary intervention .",
        "entities": [
            {
                "entity_text": "dissected vessels",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Antiparkinson medications were held as a potential cause of dissection .",
        "entities": [
            {
                "entity_text": "dissection",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She responded well to medical management .",
        "entities": []
    },
    {
        "text": "A 28 - year-old female patient presented to outpatient dental clinics for full mouth rehabilitation .",
        "entities": []
    },
    {
        "text": "On physical examination , the patient was awake , alert , oriented , and her blood pressure , temperature and heart rate were within normal limits .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "thymoma MG",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Intraoral examination showed fair oral hygiene multiple fixed prosthodontic restorations and multiple carious teeth , multiple remaining roots and lipomatous tongue atrophy .",
        "entities": [
            {
                "entity_text": "carious teeth",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "tongue atrophy",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "difficulty in breathing , chewing and swallowing",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "thymoma benign tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": []
    },
    {
        "text": "Before proceeding to the dental management of the case ; CBC and blood chemistry had been requested form the patient .",
        "entities": []
    },
    {
        "text": "Creatinine level was below normal ( 42 . 23 umol / l ) , with normal levels of albumin , urea , uric acid , AST , ALT , cholesterol , triglycerides and bilirubin .",
        "entities": []
    },
    {
        "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 ” .",
        "entities": []
    },
    {
        "text": "Consultation with patient neurologist regarding the steroid dose to reduce the susceptibility of developing adrenal crisis .",
        "entities": []
    },
    {
        "text": "Mr F . B a 70 - year-old male patient presented in our institution because of the occurrence of a right epistaxis .",
        "entities": [
            {
                "entity_text": "right epistaxis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "First of all , the patient is not smoking and reported an aneurysm of the abdominal aorta surgically treated by prosthesis under plavix .",
        "entities": [
            {
                "entity_text": "aneurysm of the abdominal aorta",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "right epistaxis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "bloody rhinorrhea",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "eye watering",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Nasal Endoscopy examination revealed a pinnkish burgeoning mass bleeding on contact and filling the right nostril vestibule .",
        "entities": []
    },
    {
        "text": "The patient didn ' t presents neurological signs nor cervical lymph nods .",
        "entities": [
            {
                "entity_text": "neurological signs",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Otherwise , ophthalmologic examination found normal visual acuity and ocular mobility on both sides .",
        "entities": []
    },
    {
        "text": "Sinonasal computed tomography ( CT ) found a right nasal process enhanced after injection of contrast product with relatively little washing at the late time .",
        "entities": []
    },
    {
        "text": "Otherwise , there is no extension involvement at the level of the cavum and the pterygo palate fossa .",
        "entities": []
    },
    {
        "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 .",
        "entities": []
    },
    {
        "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 . 5 cm 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 .",
        "entities": [
            {
                "entity_text": "tissue mass",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "This finding shows ethmoidal sinus fluid retention .",
        "entities": []
    },
    {
        "text": "The appearance , even if it remains unspecific , is compatible with inverted papilloma .",
        "entities": [
            {
                "entity_text": "inverted papilloma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient underwent complete endoscopic removal of the tumor with ethmoidectomy and right maxillary antrostomy .",
        "entities": [
            {
                "entity_text": "tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The extemporaneous examination is in favor of a malignant tumor lesion .",
        "entities": [
            {
                "entity_text": "malignant tumor lesion",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Histopathologic analysis shows a tumor proliferation made of polymorphic cells with major anisocytosis , most often located in lobules .",
        "entities": [
            {
                "entity_text": "tumor proliferation",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There is sometimes a somewhat palisadic seat on the periphery of the tumor mass .",
        "entities": [
            {
                "entity_text": "tumor mass",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The mitotic index is 10 mitoses per 10 high power fields .",
        "entities": []
    },
    {
        "text": "The immunohistochemical study of the tumor found that the cytokeratin KL 1 and CK 7 and the neuroendocrine marker Chromogranin A , synaptophysin and CD 56 are positive .",
        "entities": [
            {
                "entity_text": "tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Proliferation index Ki 67 is of the order of 80 % .",
        "entities": []
    },
    {
        "text": "Otherwise there is an absence of expression of PS 100 , MelanA , HMB 45 , desmin , p 40 , CD 45 and EBV .",
        "entities": []
    },
    {
        "text": "The clear positivity of cytokeratins formally excludes the diagnosis of olfactory neuroblastoma and leads to neuroendocrine carcinoma .",
        "entities": [
            {
                "entity_text": "olfactory neuroblastoma",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "neuroendocrine carcinoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Given the atypia , the mitotic index , and the Ki 67 proliferation index , it is a high-grade large-cell neuroendocrine carcinoma .",
        "entities": [
            {
                "entity_text": "large-cell neuroendocrine carcinoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Extension assessment , comprising a PET SCAN , was negative .",
        "entities": []
    },
    {
        "text": "Postoperative treatment consisted in adjuvant polychemotherapy , with six cycles ( cisplatin and etoposide ) , Followed by loco regional external radiotherapy .",
        "entities": []
    },
    {
        "text": "After 6 month follow-up , the patient was in complete clinical and radiological remission .",
        "entities": [
            {
                "entity_text": "in complete clinical and radiological remission",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": []
    },
    {
        "text": "It was referred for postpartum hemorrhage .",
        "entities": [
            {
                "entity_text": "postpartum hemorrhage",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "His medical history was featureless .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "hypovolemic shock",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The obstetrical examination objectified an involuted uterus , an absence of vaginal and perineal cervical lesions , a fluid and red blood originating of endouterine .",
        "entities": [
            {
                "entity_text": "involuted uterus",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Furthermore , there was purpura .",
        "entities": []
    },
    {
        "text": "We therefore concluded a significant postpartum hemorrhage complicated by coagulopathy .",
        "entities": [
            {
                "entity_text": "postpartum hemorrhage",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "coagulopathy",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "coagulopathy",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "anemia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Blood count at admission highlighted severe thrombocytopenia 23 0000 platelets and hemoglobin levels of 3 . 9 g / dl .",
        "entities": [
            {
                "entity_text": "severe thrombocytopenia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The post natal care was also administered .",
        "entities": []
    },
    {
        "text": "After seven days of hospitalization , she was going after an amendment to the clinical symptoms and normal laboratory tests .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "bleeding",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "severe anemia",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hypovolemic shock",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The gynecological examination was normal .",
        "entities": []
    },
    {
        "text": "The balance sheet of the coagulation was normal including prothrombin to 92 % and a normal activated partial thromboplastin time .",
        "entities": []
    },
    {
        "text": "The treatments were based on oxytocin , tranexamic acid , etamsylate and strict regular monitoring .",
        "entities": []
    },
    {
        "text": "Transvaginal ultrasound coupled Doppler was normal .",
        "entities": []
    },
    {
        "text": "In the absence of arterial embolization , she was going with ambulatory monitoring .",
        "entities": []
    },
    {
        "text": "Two weeks later she presented again rebleeding requiring hospitalization resulting in a total hysterectomy after conditioning of the patient .",
        "entities": [
            {
                "entity_text": "rebleeding",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "hemorrhage",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The postoperative course was simple .",
        "entities": []
    },
    {
        "text": "A 29 - year-old man was admitted to our hospital with an unidentified fever .",
        "entities": []
    },
    {
        "text": "He was diagnosed with malignant lymphoma ( extra-nodal NK / T cell lymphoma nasal type ) , and chemotherapy was administered .",
        "entities": [
            {
                "entity_text": "malignant lymphoma",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "extra-nodal NK / T cell lymphoma nasal type )",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "After chemotherapy , nodular lung shadows along with new brain , cervical , and myocardial abscesses appeared , despite anti-bacterial / fungal therapy .",
        "entities": [
            {
                "entity_text": "lung shadows",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "brain , cervical , and myocardial abscesses",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 ) .",
        "entities": [
            {
                "entity_text": "Aspergillus fumigatus",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "vegetation",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He underwent surgical resection of this mural vegetation .",
        "entities": [
            {
                "entity_text": "vegetation",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "His postoperative course was uneventful .",
        "entities": []
    },
    {
        "text": "He remains healthy at 28 months after surgery with continued oral antifungal therapy .",
        "entities": []
    },
    {
        "text": "A 33 - year man working in Gulf , presented with hemetemesis 15 days ago in the month of February this year .",
        "entities": []
    },
    {
        "text": "This was preceeded by low grade fever , bone pain , generalised bodyache , low back ache and generalised macular skin rashes .",
        "entities": [
            {
                "entity_text": "fever",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "bone pain",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "generalised bodyache",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "low back ache",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "generalised macular skin rashes",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There was no history of abdominal pain , jaundice or features of chronic liver disease .",
        "entities": [
            {
                "entity_text": "abdominal pain",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "jaundice",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "chronic liver disease",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He gave history of intake of analgesics for backache .",
        "entities": [
            {
                "entity_text": "backache",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "After symptomatic treatment he returned back .",
        "entities": []
    },
    {
        "text": "He came to our OPD with Complete blood count which showed a haemoglobin of 8 g / dl , total count 6700 / mm 3 platelet count 24000 / mm 3 and ESR 55 mm / hr .",
        "entities": []
    },
    {
        "text": "On examination patient was pale with non pruritic macular rashes and mild splenomegaly .",
        "entities": [
            {
                "entity_text": "macular rashes",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "splenomegaly",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "fever",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "backache",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "skin rash",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "splenomegaly",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "Brucellosis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "gi bleed",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "nodular ulcerative lesions",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "adenocarcinoma of stomach",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Liver function tests showed a high ALP ( 1536 U / l ) , elevated INR ( 2 . 15 ) though bilirubin , transaminases and serum proteins were normal .",
        "entities": []
    },
    {
        "text": "Brucella agglutination test was negative .",
        "entities": []
    },
    {
        "text": "Xray Chest was normal .",
        "entities": []
    },
    {
        "text": "Ultrasound of abdomen showed normal echotexture of liver , no SOL , normal portal vein and no IHBRD .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "pylorus thickening",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "lymphadenopathy",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "metastasis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "liver metastasis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "ascites",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A skeletal survey was done which showed lytic lesions in the iliac and femoral bones .",
        "entities": [
            {
                "entity_text": "lytic lesions",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Bone marrow aspirate showed decreased red cells and platelets and marrow biopsy done was reported as metastasis from adenocarcinoma .",
        "entities": [
            {
                "entity_text": "metastasis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "adenocarcinoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Coagulation profile done was suggestive of DIC due to the raised levels of FDP ( 5 , 170 ng / dl ) and a low fibrinogen \\ ( 152 mg / dl ) .",
        "entities": []
    },
    {
        "text": "He was transferred to Medical Oncology department for subsequent management and was treated with chemotherapy .",
        "entities": []
    },
    {
        "text": "He succumbed to his illness within 10 months of diagnosis .",
        "entities": []
    },
    {
        "text": "A 26 - year-old pregnant patient with a history of two previous cesarean deliveries was referred to our tertiary clinic .",
        "entities": []
    },
    {
        "text": "The patient was having severe right sided abdominal pain with sudden onset .",
        "entities": [
            {
                "entity_text": "right sided abdominal pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She was in the 18 th week of her pregnancy based on last menstrual period .",
        "entities": []
    },
    {
        "text": "Obstetric ultrasound measurements revealed a live pregnancy compatible with 18 weeks gestation without any abnormality .",
        "entities": []
    },
    {
        "text": "However , a 15 x 12 cm in size edematous multicystic adnexal mass occupying the mid and upper right abdomen without vascularity was identified .",
        "entities": [
            {
                "entity_text": "adnexal mass",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The mass was suspected to originate from right ovary .",
        "entities": []
    },
    {
        "text": "It was pushing the pregnant uterus into the left and anterior direction .",
        "entities": []
    },
    {
        "text": "There was no ultrasonographic evidence of malignancy .",
        "entities": [
            {
                "entity_text": "malignancy",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Considering the severe sudden pain complaint and adnexal mass finding , explorative laparotomy was planned for the suspected diagnosis of adnexal torsion .",
        "entities": [
            {
                "entity_text": "adnexal mass",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "adnexal torsion",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A mediolateral ( near vertical ) skin incision was made originated from infra-umbilical level on the lateral side of right rectus muscle .",
        "entities": []
    },
    {
        "text": "Specifically , the starting point for this slightly oblique incision was at 3 cm lateral to the midline and near to lateral one third of the rectus muscle .",
        "entities": []
    },
    {
        "text": "The skin and fascia incisions were approximately 4 cm and 2 . 5 cm in length , respectively and this difference was due to the thick subcutaneous fat tissue .",
        "entities": []
    },
    {
        "text": "The oblique paramedian incision of the anterior rectus sheath was approximately 2 cm medial to the lateral border of the rectus muscle and it was extended to caudal-lateral direction , down to 1 / 2 cm to the lateral border of rectus muscle .",
        "entities": []
    },
    {
        "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 1 cm width .",
        "entities": []
    },
    {
        "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 ) .",
        "entities": []
    },
    {
        "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 .",
        "entities": []
    },
    {
        "text": "In this manner , the abdominal wall incisions were located at anterior and posterior sheaths of rectus muscle at least 1 / 2 cm medial to the semilunar line and to the lateral border of rectus .",
        "entities": []
    },
    {
        "text": "In other words , incision was not made from fascial layers ' merging point or by muscle splitting dissection .",
        "entities": []
    },
    {
        "text": "Therefore , traction forces from enlarging uterus in advancing pregnant abdomen could be minimized .",
        "entities": []
    },
    {
        "text": "A large edematous , necrotic and dark purple torsion of a right adnexal mass was observed .",
        "entities": [
            {
                "entity_text": "torsion of a right adnexal mass",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "It was pulled out and was partially dissected from its surface layer following a 2 cm incision .",
        "entities": []
    },
    {
        "text": "The cystic structure was aspirated and right salpingo-ooferectomy was performed .",
        "entities": []
    },
    {
        "text": "The operation was completed by avoiding the manipulation of the pregnant uterus .",
        "entities": []
    },
    {
        "text": "Frozen section pathology of the removed specimen was reported as benign ( necrotic tissues , teratoma ) and final pathology was mucinous cystadenoma .",
        "entities": []
    },
    {
        "text": "Follow up on the pregnant patient was uneventful a month later .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "empty scrotum",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "swelling",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "On clinical examination , a reducible mass was present in the right ileac crest .",
        "entities": []
    },
    {
        "text": "The swelling looked like a spigelian hernia [ 4 ] .",
        "entities": [
            {
                "entity_text": "swelling",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "spigelian hernia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "However no abdominal wall defect could be palpated at that area .",
        "entities": []
    },
    {
        "text": "Moreover the ipsilateral scrotum was empty and the testis could be palpated with difficulty lying in a high inguinal position .",
        "entities": []
    },
    {
        "text": "Ultrasonography showed a loop of herniated small bowel and an undescended testis on the right .",
        "entities": [
            {
                "entity_text": "undescended testis on the right",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "At operation , under general anesthesia , an extended transverse inguinal incision was made .",
        "entities": []
    },
    {
        "text": "Upon entering the inguinal canal a large hernia sac was identified .",
        "entities": [
            {
                "entity_text": "hernia sac",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": []
    },
    {
        "text": "We noticed that the hernia orifice was in a higher than normal position 5 cm from the pubic bone .",
        "entities": []
    },
    {
        "text": "This bulk was easily reduced back to the abdomen along with an ipsilateral mobile intravaginal testis .",
        "entities": []
    },
    {
        "text": "After careful isolation of the sac at a length of 3 cm the ipsilateral testis was isolated .",
        "entities": []
    },
    {
        "text": "The vas and the vessels were intravaginal , the gubernaculum was fixed in an ectopic position and the dorsal inguinal wall was lax .",
        "entities": []
    },
    {
        "text": "We removed the large sac after separating the vas and vessels and the testis .",
        "entities": []
    },
    {
        "text": "Moreover we strengthened the dorsal inguinal wall , fixated the testis in a subdartos pouch and closed the wound .",
        "entities": []
    },
    {
        "text": "Patient stayed for a day in the hospital .",
        "entities": []
    },
    {
        "text": "No postoperative complications happened .",
        "entities": []
    },
    {
        "text": "Three years later the boy was operated for left hydrocele .",
        "entities": [
            {
                "entity_text": "left hydrocele",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The boy remains in perfect health now five years after the initial operation .",
        "entities": []
    },
    {
        "text": "A male , 63 years old , complaining about a \" wound in the mouth \" for 6 months , without any pain or spontaneous bleeding .",
        "entities": []
    },
    {
        "text": "His medical history was free of disease .",
        "entities": []
    },
    {
        "text": "The patient was a smoker for 33 years .",
        "entities": [
            {
                "entity_text": "smoker",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Intraoral examination revealed a destructive ulcerative lesion around the upper left first and second molars that resembled an oral squamous cell carcinoma .",
        "entities": [
            {
                "entity_text": "ulcerative lesion",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "oral squamous cell carcinoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Biopsy of the ulcerative lesion was performed and the microscopic features showed an inflammatory infiltrate rich in plasma cells .",
        "entities": [
            {
                "entity_text": "ulcerative lesion",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "inflammatory infiltrate",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Based on this microscopical finding , the final diagnosis was periodontal disease associated with a proliferative non-neoplastic lesion .",
        "entities": [
            {
                "entity_text": "periodontal disease",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "lesion",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient was referred to a specialized dental surgeon and underwent periodontal therapy including surgical procedures .",
        "entities": []
    },
    {
        "text": "After that , according to follow-up with the patient , there were no signs of disease remission .",
        "entities": []
    },
    {
        "text": "The lesion increased in size , although the patient did not complain of any symptoms .",
        "entities": [
            {
                "entity_text": "lesion",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "inflammatory infiltrate",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A varying number of eosinophils also were observed , without any evidence of atypical cells present in this infiltrate .",
        "entities": []
    },
    {
        "text": "An immunohistochemical staining panel was done to determine the nature of this inflammatory infiltrate by using antibodies S- 100 , CD 1 a , CD- 68 and CD 45 RO that were positive .",
        "entities": [
            {
                "entity_text": "inflammatory infiltrate",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "These immunohistochemical findings were fundamental for the final diagnosis of LCH .",
        "entities": [
            {
                "entity_text": "LCH",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The treatment included surgical extraction of all superior teeth , radiation and systemic corticoid therapies .",
        "entities": []
    },
    {
        "text": "After 8 years of treatment , the patient is free of disease .",
        "entities": []
    },
    {
        "text": "A seventy two years old male presented to our clinic with swelling , pain , and limitation of movement at knee joint .",
        "entities": [
            {
                "entity_text": "swelling , pain , and limitation of movement at knee joint",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient ' s history revealed swellings and pain at knee joint for nearly last 20 years .",
        "entities": [
            {
                "entity_text": "swellings and pain at knee joint",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He was prescribed nonsteroidal anti-inflammatory drugs and rest .",
        "entities": []
    },
    {
        "text": "But pain didn ' t relieve and limitations in range of motion occurred at knee joint .",
        "entities": [
            {
                "entity_text": "pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Physical examination findings included a solid and semi-mobile mass at anterior knee region .",
        "entities": []
    },
    {
        "text": "Knee joint range of motion was 80 degrees flexion and 0 degrees extension .",
        "entities": []
    },
    {
        "text": "There wasn ' t any neurovascular pathology .",
        "entities": []
    },
    {
        "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 .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "synovial chondromatosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Scalloping was observed at tibial and femoral surfaces .",
        "entities": []
    },
    {
        "text": "Decision for a surgical intervention was made and after informing the patient , consent was taken .",
        "entities": []
    },
    {
        "text": "Under spinal anesthesia , a tourniquet was applied to right lower extremity .",
        "entities": []
    },
    {
        "text": "Right knee was entered with an anterior longitudinal incision .",
        "entities": []
    },
    {
        "text": "Cutaneous and subcutaneous tissues were passed .",
        "entities": []
    },
    {
        "text": "Quadriceps mechanism was opened with a medial parapatellar incision and patella was toppled to left side .",
        "entities": []
    },
    {
        "text": "Intraarticular mass was exposed .",
        "entities": []
    },
    {
        "text": "The mass was released from surrounding tissues by blunt excision and excised with enucleation .",
        "entities": []
    },
    {
        "text": "Then synovial tissue was excised with synoviectomy .",
        "entities": []
    },
    {
        "text": "Surgical area was irrigated using abundant isotonic solution .",
        "entities": []
    },
    {
        "text": "The excised mass was sent to pathology laboratory .",
        "entities": []
    },
    {
        "text": "Pathology evaluation showed that the mass was consistent with synovial chondromatosis .",
        "entities": [
            {
                "entity_text": "synovial chondromatosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Active and passive exercises were started at an early period after surgery .",
        "entities": []
    },
    {
        "text": "Recurrence was not detected at his last control visit .",
        "entities": []
    },
    {
        "text": "Knee movements were at full range when compared with the other knee .",
        "entities": []
    },
    {
        "text": "There was no pain or other complaints .",
        "entities": []
    },
    {
        "text": "It is the case of a 29 years old woman , G 2 P 1001 , married , at 9 weeks of pregnancy .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "pelvic pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A transient lull was observed following a treatment with a progesteron ( hydroxyprogesterone caproate ) and an antispasmodic ( tiemonium methylsulfate ) in a community clinic .",
        "entities": []
    },
    {
        "text": "The resurgence of that lancinating and permanent pain irradiating to the loins and associated with slight vaginal bleeding prompted consultation .",
        "entities": [
            {
                "entity_text": "vaginal bleeding",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She had first menses at 14 and her menstrual cycle is regular with a length of 30 days .",
        "entities": []
    },
    {
        "text": "She has never practiced contraception .",
        "entities": []
    },
    {
        "text": "She has been adequately treated for acute pelvic inflammatory disease five years earlier .",
        "entities": [
            {
                "entity_text": "acute pelvic inflammatory disease",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Her only child is a girl born vaginally seven years ago .",
        "entities": []
    },
    {
        "text": "Her blood group is B rhesus positive and she has never undergone surgery .",
        "entities": []
    },
    {
        "text": "She presented with sympathetic signs of pregnancy and the urinary pregnancy test was positive but echography was not yet done .",
        "entities": []
    },
    {
        "text": "On admission , besides the main complain , the patient had vaginal bleeding and nausea but neither fever , nor vomiting .",
        "entities": [
            {
                "entity_text": "vaginal bleeding",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "nausea",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "fever",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "vomiting",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": []
    },
    {
        "text": "The conjunctivae were pink and the tongue was clean and moist .",
        "entities": []
    },
    {
        "text": "There were no cervical adenopathies .",
        "entities": []
    },
    {
        "text": "The breast and cardiopulmonary examination revealed no abnormalities .",
        "entities": []
    },
    {
        "text": "The abdomen was flat , and mobile with respiration .",
        "entities": []
    },
    {
        "text": "On palpation there was just a tenderness of the left iliac fossa and the bowel sounds were normal on auscultation .",
        "entities": []
    },
    {
        "text": "Inspection under speculum revealed normal gravid external cervical os and there was no vaginal discharge .",
        "entities": []
    },
    {
        "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 .",
        "entities": []
    },
    {
        "text": "The left adnexae presented with a tender , smooth and mobile mass of seven centimeters diameter but the right one were normal .",
        "entities": []
    },
    {
        "text": "The posterior cervico-vaginal fornix was neither tender nor bulging .",
        "entities": []
    },
    {
        "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 .",
        "entities": []
    },
    {
        "text": "Paraclinical investigations revealed : beta human Chorionic Gonadotropin ( hCG ) level of 96 702 milli International Units per milliliter of plasma ( mIU / ml ) .",
        "entities": []
    },
    {
        "text": "Ultrasonography revealed a heterogenous left ovarian mass of 82 millimeters in diameter , an empty uterus and no peritoneal effusion .",
        "entities": []
    },
    {
        "text": "This comforted our first diagnosis .",
        "entities": []
    },
    {
        "text": "After a normal pre-operative work up , an emergency laparotomy was done under general anesthesia .",
        "entities": []
    },
    {
        "text": "The findings were : left ovary containing a gestational sac and the corpus luteum , normal right adnexae , normal left tube and normal uterus .",
        "entities": []
    },
    {
        "text": "There was no hemoperitoneum .",
        "entities": []
    },
    {
        "text": "We dissected the ovarian capsule and carried out ablation of the gestational sac , then we did hemostasis .",
        "entities": []
    },
    {
        "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 .",
        "entities": []
    },
    {
        "text": "Post operative course was uneventful and the patient was discharged six days after surgery .",
        "entities": []
    },
    {
        "text": "The ?",
        "entities": []
    },
    {
        "text": "hCG level decreased and disappeared 25 days after surgery .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "Silver-Russell syndrome",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Recombinant growth hormone was administered for 18 months without an appropriate increase in growth velocity .",
        "entities": []
    },
    {
        "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 g / L ; reference range , 75 g / L to 365 g / L ; and peak , 76 g / L and 50 g / L after 12 and 84 hours , respectively , from baseline ) .",
        "entities": []
    },
    {
        "text": "The genetic analysis showed that the patient was homozygous for the R 217 X mutation in the growth hormone receptor gene , which is characteristic of Laron syndrome .",
        "entities": [
            {
                "entity_text": "Laron syndrome",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "growth hormone insensitivity syndrome",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient ' s treatment was well tolerated , but unexplained central hypothyroidism occurred at the age of 12 . 9 years .",
        "entities": [
            {
                "entity_text": "central hypothyroidism",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "perimenopausal uterine bleeding",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Gynaecological and ultrasound examinations revealed ovarian enlargement with a diameter of 50 mm with hypoechoic zones suspected of benign teratoma .",
        "entities": [
            {
                "entity_text": "ovarian enlargement",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "benign teratoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The diagnostic test such as Ca- 125 , AFP , free-T 4 and TSH was in normal range .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "tumour",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "teratoma",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "strumal carcinoid tumour",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "On the postoperative 2 - year control , the patient was tumour free , and Ca- 125 , free-T 4 and TSH were in normal range .",
        "entities": []
    },
    {
        "text": "A 23 year old female patient ( weight 67 kg , height 171 cm , BMI 22 . 91 kg / cm 2 ) presented to emergency department with fever ( 39 . 4 oC ) , 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 .",
        "entities": [
            {
                "entity_text": "sore throat",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "neck pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She was appointed to hospital by a private outpatient surgical center where she had undergone perineal abscess drainage a week before .",
        "entities": []
    },
    {
        "text": "Recent medical history included also endometrial curettage for ERPC a month before and conservative therapy for hemorrhoids 15 days after .",
        "entities": []
    },
    {
        "text": "Past medical history included Henoch-Sch nlein purpura during childhood .",
        "entities": [
            {
                "entity_text": "Henoch-Sch nlein purpura",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Social history included smoking ( 11 pack-years ) , family history was non-contributory .",
        "entities": []
    },
    {
        "text": "She had no known drug allergies .",
        "entities": []
    },
    {
        "text": "Complete blood count revealed marked neutrophilic leukocytosis ( WBC 23 . 400 / lt ) .",
        "entities": []
    },
    {
        "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 .",
        "entities": []
    },
    {
        "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 .",
        "entities": [
            {
                "entity_text": "Fournier ' s gangrene",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Blood and surgical material was taken for microbiologic analysis .",
        "entities": []
    },
    {
        "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 2 gr q 8 h i . v . , clindamycin 600 mg q 6 h i . v . and daptomycin 500 mg q . d . i . v . , gastroprotective and antithrombotic prophylaxis were initiated .",
        "entities": []
    },
    {
        "text": "During the next 3 days a second CT and an obstetrical consultation were conducted with no significant findings .",
        "entities": []
    },
    {
        "text": "Human immunodeficiency virus and diabetic screen were also negative .",
        "entities": []
    },
    {
        "text": "Yet , the patient remained febrile .",
        "entities": []
    },
    {
        "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 100 mg q . d . i . v . ) was initiated too .",
        "entities": []
    },
    {
        "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 .",
        "entities": []
    },
    {
        "text": "Percutaneous tracheotomy was also performed .",
        "entities": []
    },
    {
        "text": "Hyperbaric oxygen therapy was not available at the setting .",
        "entities": []
    },
    {
        "text": "One day after the second surgery , patient ' s condition complicated with MRSA ventilation associated pneumonia .",
        "entities": [
            {
                "entity_text": "ventilation associated pneumonia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Along with that , a localized oedema appeared in her left upper limb .",
        "entities": []
    },
    {
        "text": "A palpable mass along the anterior margin of the sternocleidomastoid muscle was also noticed .",
        "entities": []
    },
    {
        "text": "Vascular ultrasound examination revealed occlusion of left internal jugular vein .",
        "entities": [
            {
                "entity_text": "occlusion of left internal jugular vein",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Transcranial Doppler examination was normal .",
        "entities": []
    },
    {
        "text": "Dental consultation and examination of soft palate and peritonsilar tissues showed no abnormalities .",
        "entities": []
    },
    {
        "text": "Linezolide 600 mg q 12 h i . v . was added to antibiotic regimen .",
        "entities": []
    },
    {
        "text": "Since debridements were going on , simultaneous anticoagulation therapy was started with only bemiparine 2500 b . i . d . s . c .",
        "entities": []
    },
    {
        "text": "Gradually , the patient became afebrile and her clinical condition improved .",
        "entities": []
    },
    {
        "text": "She was discharged from ICU 13 days later .",
        "entities": []
    },
    {
        "text": "A follow-up CTA confirmed the disappearance of the left jugular vein thrombosis .",
        "entities": [
            {
                "entity_text": "left jugular vein thrombosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "About a month after her ICU discharge , an operation was performed for ileostomy closure and reconstruction of the right gluteal region .",
        "entities": []
    },
    {
        "text": "On a follow-up examination 6 months later , the young woman had returned to her normal everyday life .",
        "entities": []
    }
]