e3c_v3.0_en_train.json

[
    {
        "text": "We present a case of a 32 - year-old woman with a history of gradual enlargement of the anterior neck .",
        "entities": [
            {
                "entity_text": "enlargement of the anterior neck",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The medical history was unremarkable and no comorbidities existed .",
        "entities": []
    },
    {
        "text": "There was no history of radiation exposure .",
        "entities": []
    },
    {
        "text": "Clinical examination revealed a multinodular goiter .",
        "entities": [
            {
                "entity_text": "multinodular goiter",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Computed tomography showed a thyroid nodule of the left lobe extended to the isthmus and the right lobe with anterior and posterior capsular rupture contracting close contact with the vascular axis left carotid-jugular plunging into the cervicothoracic away from the hole aortic arch .",
        "entities": [
            {
                "entity_text": "thyroid nodule",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There was no evidence of lung lesions .",
        "entities": [
            {
                "entity_text": "lung lesions",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient underwent a surgical exploration .",
        "entities": []
    },
    {
        "text": "There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea .",
        "entities": [
            {
                "entity_text": "lobe nodule",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The intraoperative consultation pathology diagnosis was : undifferentiated carcinoma .",
        "entities": [
            {
                "entity_text": "undifferentiated carcinoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A total thyroidectomy was realized .",
        "entities": []
    },
    {
        "text": "Histological examination showed a proliferation of elongated spindle-shaped cells , arranged in interweaving fascicles of varying sizes , intersected at right angles .",
        "entities": [
            {
                "entity_text": "proliferation of elongated spindle-shaped cells",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Tumor cells are atypical with strange nuclei .",
        "entities": [
            {
                "entity_text": "Tumor cells",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Chromatin is distributed inhomogeneously .",
        "entities": []
    },
    {
        "text": "The cytoplasmic membrane is irregular and thick .",
        "entities": []
    },
    {
        "text": "The nucleolus is very large .",
        "entities": []
    },
    {
        "text": "The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule .",
        "entities": [
            {
                "entity_text": "tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The mitotic rate was extremely high ( 19 mitosis / 10 high power field ) , and atypical mitotic figures were also present .",
        "entities": []
    },
    {
        "text": "The neoplasia showed invasion of the peri-glandular fat tissue .",
        "entities": [
            {
                "entity_text": "neoplasia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Immuno-histochemical staining of the slides with caldesmon , desmin , PanCK , CK 5 -6 , CK 7 , myogenin , epithelial membrane antigen ( EMA ) , CEA , thyroid transcription factor ( TTF- 1 ) , pancytokeratin , smooth muscle actin ( SMA ) , MelanA , S 100 protein , CD 45 , CD 3 , CD 30 , CD 20 , CD 15 , CD 34 , ALK , calcitonin and KI 67 protein was performed .",
        "entities": []
    },
    {
        "text": "The tumour was strongly positive for caldesmon , SMA , desmin , and negative for pancytokeratin and other epithelial , lymphoid and melanocytic markers .",
        "entities": [
            {
                "entity_text": "tumour",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "On the basis of the clinical , radiographic , histopathological and immunohistochemical features , the final diagnosis was primary thyroid leiomyosarcoma , FNCLCC grade 3 .",
        "entities": [
            {
                "entity_text": "thyroid leiomyosarcoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "In multidisciplinary tumour board , it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin .",
        "entities": []
    },
    {
        "text": "Here we report a case of aggressive metastatic cholangiocarcinoma ( MCC ) in 72 - year-old man , sequentially treated with two targeted chemotherapies .",
        "entities": [
            {
                "entity_text": "metastatic cholangiocarcinoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Initially disease quickly progressed during best clinical practice care ( gemcitabine in combination with cisplatin or capecitabine ) , which was accompanied by significant decrease of life quality .",
        "entities": []
    },
    {
        "text": "Monotherapy with TKI sorafenib was prescribed to the patient , which resulted in stabilization of tumor growth and elimination of pain .",
        "entities": [
            {
                "entity_text": "pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The choice of the inhibitor was made based on high-throughput screening of gene expression in the patient ' s tumor biopsy , utilized by Oncobox platform to build a personalized rating of potentially effective target therapies .",
        "entities": []
    },
    {
        "text": "However , time to progression after start of sorafenib administration did not exceed 6 months and the regimen was changed to monotherapy with Pazopanib , another TKI predicted to be effective for this patient according to the same molecular test .",
        "entities": []
    },
    {
        "text": "It resulted in disease progression according to RECIST with simultaneous elimination of sorafenib side effects such as rash and hand-foot syndrome .",
        "entities": [
            {
                "entity_text": "rash",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hand-foot syndrome",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "After 2 years from the diagnosis of MCC the patient was alive and physically active , which is substantially longer than median survival for standard therapy .",
        "entities": [
            {
                "entity_text": "MCC",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A 36 year old female farmer gravida 5 para 4 at 27 weeks gestation presented to our facility .",
        "entities": []
    },
    {
        "text": "Her main complaint was a 3 month history of epigastric abdominal pain , which was gradual in onset , dull and persistent .",
        "entities": [
            {
                "entity_text": "epigastric abdominal pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Pain had gradually worsened over the months with no known relieving or aggravating factors but with intermittent radiation to the chest .",
        "entities": []
    },
    {
        "text": "There was a history of significant weight loss but no associated early satiety , jaundice , fever , itch or spontaneous bleeding .",
        "entities": []
    },
    {
        "text": "No history of blood transfusion and patient was on her routine hematinic from the antenatal clinic ( ANC ) .",
        "entities": []
    },
    {
        "text": "She is not a known diabetic , Hypertensive and has no known chronic illness .",
        "entities": [
            {
                "entity_text": "diabetic",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "Hypertensive",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Patient did not know her Hepatitis status .",
        "entities": []
    },
    {
        "text": "Denied to taking any alcohol or smoking .",
        "entities": []
    },
    {
        "text": "There were no cardiorespiratory nor urogenital symptoms .",
        "entities": []
    },
    {
        "text": "She did not store grains at home and had no known contact with chemicals or ionizing radiation .",
        "entities": []
    },
    {
        "text": "Clinical signs on examination included wasting , mild pallor , a tinge of jaundice but well hydrated , afebrile and no palpable lymphnodes .",
        "entities": []
    },
    {
        "text": "She had palmer erythema but no clubbing and parotid enlargement .",
        "entities": []
    },
    {
        "text": "Respiratory , cardiovascular and neurological examinations were unremarkable .",
        "entities": []
    },
    {
        "text": "Abdomen was grossly distended with distorted contour in the upper half and visibly distended anterior abdominal wall veins draining away from the umbilicus .",
        "entities": []
    },
    {
        "text": "Liver was enlarged 12 cm below the costal margin with a span of 17 cm .",
        "entities": []
    },
    {
        "text": "The liver was hard , nodular with irregular edge , mild tendernes and had a bruit on auscultation .",
        "entities": []
    },
    {
        "text": "The spleen was not palpable but with demonstrable mild ascites and bipedal eodema up to the mid shin .",
        "entities": []
    },
    {
        "text": "Symphysio fundal height was 26 cm , with longitudinal lie and breech presentation .",
        "entities": []
    },
    {
        "text": "Fetal heart rate was 134 bpm and regular .",
        "entities": []
    },
    {
        "text": "Rectal and vaginal examination were unremarkable .",
        "entities": []
    },
    {
        "text": "Initial diagnosis of hepatocellular Carcinoma in pregnancy was made .",
        "entities": []
    },
    {
        "text": "Laboratory assesment revealed HB- 10 . 3 g / dl , WBC 10200 cells / dl ; Neutrophils 59 . 3 % , lymphocytes 26 . 1 % , Monocytes 10 . 1 % and Eosinophils 2 . 7 % .",
        "entities": []
    },
    {
        "text": "Platelets 350000 / ul .",
        "entities": []
    },
    {
        "text": "Normal bilirubin but GGT and AST were raised ( 4 times upper limit ) .",
        "entities": []
    },
    {
        "text": "Total protein and albumin were low , 44 g / L and 29 g / L respectively with INR- 1 . 3 . HBsAg was positive , HBeAg negative with HBV DNA level of 126869 IU / ml \\ ( Viral load ) .",
        "entities": []
    },
    {
        "text": "VDRL positive but TPHA not done .",
        "entities": []
    },
    {
        "text": "Alphafeto protein ( AFP ) > 50000 KU / L .",
        "entities": []
    },
    {
        "text": "She tested negative to HIV and HCV .",
        "entities": []
    },
    {
        "text": "Abdominal ultrasound showed a heterogeneous coarse liver with multiple hypoechoic lessions .",
        "entities": []
    },
    {
        "text": "The liver measured 17 . 2 cm and there was mild ascites .",
        "entities": []
    },
    {
        "text": "Pelvic scan revealed a 27 week , 3 day old fetus , with active fetal movements .",
        "entities": []
    },
    {
        "text": "A revised diagnosis of hepatocellular carcinoma on a cirrhotic liver with decompensation in pregnancy was made .",
        "entities": [
            {
                "entity_text": "hepatocellular carcinoma on a cirrhotic liver",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She was managed with analgesia , furosemide , spironolactone and lamivudine added for prevention of mother to child trasmission of the hepatitis B infection .",
        "entities": []
    },
    {
        "text": "The plan was to allow pregnancy to continue to at least 32 completed weeks to improve the chance of neonatal survival .",
        "entities": []
    },
    {
        "text": "However because of the progressive unbearable abdominal pain , pregnancy was terminated at 30 weeks 3 days by successful induction of labour .",
        "entities": [
            {
                "entity_text": "abdominal pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The outcome was a fresh stillbirth weight 1 . 2 kg .",
        "entities": []
    },
    {
        "text": "Pain was markedly reduced post delivery and was discharged home after 5 days .",
        "entities": []
    },
    {
        "text": "She was booked for a follow up visit at the gastrointestinal clinic .",
        "entities": []
    },
    {
        "text": "She was seen at the clinic at 2 weeks and four weeks post discharge but was lost to follow up afterwards .",
        "entities": []
    },
    {
        "text": "We report the case of a male patient , 79 years old , diabetic for 10 years on metformin , hypertensive for 5 years on amilodipine ; occasional alcoholic weaned 4 years ago .",
        "entities": []
    },
    {
        "text": "He was initially admitted for mental confusion with sudden onset dysarthria dating back 48 hours before .",
        "entities": [
            {
                "entity_text": "mental confusion",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "dysarthria",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Initial assessment found Glasgow score ( GCS ) of 12 / 15 ( eye opening at 5 , verbal response at 2 , motor response at 5 ) , symmetrical and reactive pupils , without feeling-motor deficit , normal osteotendinous reflexes , slightly polypneic at 24 cycles / min , pulsed oxygen saturation ( SpO 2 ) at 97 % in ambient air , he was tachycardic at 115 bpm and hypertensive at 160 / 95 mmHg , his capillary blood glucose at 2 . 24 g / L , and glycosuria on the urine dipstick test without ketonuria .",
        "entities": [
            {
                "entity_text": "tachycardic",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hypertensive",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient was apyretic .",
        "entities": []
    },
    {
        "text": "Arterial gas testing showed normal corrected anion gap metabolic acidosis , with hypokalaemia at 3 mmol / L and normal lactatemia at 0 . 43 mmol / L .",
        "entities": [
            {
                "entity_text": "hypokalaemia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Diagnosis of diabetes decompensation was made despite absence of ketone bodies on urine dipstick test .",
        "entities": []
    },
    {
        "text": "After conditioning , the patient was put on a hydration regimen with hypokalaemia correction and insulin therapy , and then referred to intensive care for additional management in face of non-improvement in his neurological condition .",
        "entities": []
    },
    {
        "text": "A brain scan was performed objectifying multiple parietal ischemic foci , chest scanner showed a thickening of the septal and foci of bronchial dilation without sign of pneumopathy linked to COVID- 19 infection ; abdominal ultrasound did not show any abnormalities .",
        "entities": []
    },
    {
        "text": "An electrocardiogram was performed showing no electrical signs of hypokalaemia or repolarization disturbances , transthoracic echocardiography was normal , as was ultrasound of supraortic trunks .",
        "entities": [
            {
                "entity_text": "hypokalaemia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Laboratory workup showed an elevated C-reactive protein ( CRP ) of 45 . 5 with negative procalcitonin ( 0 . 04 ng / ml ) , white blood cells at 12 , 500 ( PNN at 9280 and normal lymphocytes at 2140 ) , no thrombocytopenia , normal ferritinemia , fibrinogen levels elevated to 5 . 37 and negative D-dimers .",
        "entities": [
            {
                "entity_text": "elevated C-reactive protein",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "thrombocytopenia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Natremia , magnesemia , corrected serum calcium , phosphoremia and thyroid assessment was normal .",
        "entities": []
    },
    {
        "text": "SARS-CoV- 2 reverse transcription polymerase chain reaction ( RT-PCR ) by nasopharyngeal swab was negative , COVID- 19 serology ( IgM and IgG ) was also negative .",
        "entities": []
    },
    {
        "text": "Faced with concept of ischemic lesions on a brain scan , anticoagulation at a prophylactic dose , antiplatelet aggregation with aspirin and statins were initiated as well as an antibiotic therapy at a meningeal dose with ceftriaxone pending results of the lumbar puncture which subsequently showed a clear liquid with a high proteinorachia at 0 . 58 g / l ( normal between 0 . 15 and 0 . 45 ) , a normal glycorachia / blood sugar ratio at 0 . 58 ( normal at 0 . 5 ) ; with a culture showing less than 3 elements , sterile after 24 hours .",
        "entities": []
    },
    {
        "text": "Cerebral Magnetic resonance angiography performed on day 2 of admission showed signs in favor of vascular leukopathy , with some calcifications in basal ganglia and cortical atrophy .",
        "entities": [
            {
                "entity_text": "calcifications in basal ganglia",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "cortical atrophy",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Electroencephalogram showed signs of epilepsy , which prompted us to retain the diagnosis of nonketotic hyperglycemia-related epileptic seizures .",
        "entities": [
            {
                "entity_text": "epilepsy",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "epileptic seizures",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Anticonvulsant treatment was started with sodium valproate .",
        "entities": []
    },
    {
        "text": "The Patient worsened neurologically despite correction of his metabolic acidosis , he was intubated on day 3 of his admission ( day 5 of symptoms onset ) .",
        "entities": []
    },
    {
        "text": "A cerebral computerized tomography ( CT ) scan was performed without showing any progressive lesions .",
        "entities": [
            {
                "entity_text": "lesions",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Faced with installation of lymphopenia ( HIV serologies 1 and 2 negative ) with increased CRP , a multiplex RT-PCR in protected distal bronchial sample as well as in Cerebrospinal fluid ( CSF ) were performed , the first was positive to SARS-CoV- 2 .",
        "entities": []
    },
    {
        "text": "Reverse transcription polymerase chain reaction of SARS-CoV- 2 in CSF was positive but with a cycle threshold ( CT ) of 38 . 6 .",
        "entities": []
    },
    {
        "text": "The diagnosis of SARS-CoV- 2 encephalopathy was retained .",
        "entities": [
            {
                "entity_text": "SARS-CoV- 2 encephalopathy",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient is still in intensive care .",
        "entities": []
    },
    {
        "text": "A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week ’ s duration .",
        "entities": [
            {
                "entity_text": "epigastric pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There was no vomiting or weight loss .",
        "entities": [
            {
                "entity_text": "vomiting",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "weight loss",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Bowel movements were normal .",
        "entities": []
    },
    {
        "text": "Clinical examination at the time was unrevealing .",
        "entities": []
    },
    {
        "text": "An abdominal ultrasound examination was reported as normal .",
        "entities": []
    },
    {
        "text": "The patient ’ s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution .",
        "entities": []
    },
    {
        "text": "The CT scan showed a large tumour ( 6 cm in largest diameter ) in the body and tail of pancreas with no evidence of metastasis .",
        "entities": [
            {
                "entity_text": "tumour",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "metastasis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She was prepared for exploratory laparotomy .",
        "entities": []
    },
    {
        "text": "The pancreas was explored through the gastrocolic omentum .",
        "entities": []
    },
    {
        "text": "The body and tail of the pancreas including the tumour were resected .",
        "entities": [
            {
                "entity_text": "tumour",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The spleen was also removed .",
        "entities": []
    },
    {
        "text": "The end of the pancreas was suture ligated .",
        "entities": []
    },
    {
        "text": "Her post-operative recovery was uneventful .",
        "entities": []
    },
    {
        "text": "Histological examination of the specimen showed a well circumscribed ovoid tumour 60 mm x 50 mm across .",
        "entities": [
            {
                "entity_text": "tumour",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm , mostly regular nuclei with indistinct nucleoli .",
        "entities": []
    },
    {
        "text": "Areas of necrosis were present with hemorrhage .",
        "entities": [
            {
                "entity_text": "necrosis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hemorrhage",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete .",
        "entities": [
            {
                "entity_text": "tumour",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "No capsular of vascular invasion was seen .",
        "entities": []
    },
    {
        "text": "Immuno-peroxidase staining was positive for chromogranin A .",
        "entities": []
    },
    {
        "text": "Synaptophysin was strongly positive , CD 10 was negative , Ki- 67 was less than 2 % positive and the mitotic count was between 2-20 per 10 hpf .",
        "entities": []
    },
    {
        "text": "The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas .",
        "entities": [
            {
                "entity_text": "neuroendocrine carcinoma of the pancreas",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The final staging of the completely excised tumour was T 3 N 0 M 0 .",
        "entities": []
    },
    {
        "text": "Following discharge , she was followed up regularly and remains symptom free .",
        "entities": []
    },
    {
        "text": "A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence .",
        "entities": []
    },
    {
        "text": "A 49 - year-old white Caucasian woman presented with vaginal bleeding .",
        "entities": [
            {
                "entity_text": "vaginal bleeding",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A pelvic examination revealed a cystic lesion arising from her cervix .",
        "entities": [
            {
                "entity_text": "cystic lesion",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Examination of a biopsy specimen revealed a poorly differentiated neoplasm , with sheets of small hyperchromatic cells , staining weakly for neuroendocrine markers .",
        "entities": []
    },
    {
        "text": "She was diagnosed with small cell carcinoma and started on concurrent chemotherapy and radiation .",
        "entities": [
            {
                "entity_text": "small cell carcinoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "However , additional positive immunostaining for CD 99 was strongly suggestive of Ewing ' s sarcoma .",
        "entities": [
            {
                "entity_text": "Ewing ' s sarcoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Fluorescence in situ hybridization revealed ESWR 1 gene rearrangement , confirming Ewing ' s sarcoma .",
        "entities": [
            {
                "entity_text": "Ewing ' s sarcoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Our patient underwent surgery , which confirmed stage IIB Ewing ' s sarcoma .",
        "entities": [
            {
                "entity_text": "Ewing ' s sarcoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She received adjuvant chemotherapy but died from progressive metastatic disease after four cycles .",
        "entities": [
            {
                "entity_text": "metastatic disease",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A 62 - year-old woman presented with complaints of epigastric pain and vomiting .",
        "entities": [
            {
                "entity_text": "epigastric pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Computed tomography showed a 27 - mm , hyper-enhancing tumor in the prepyloric antrum .",
        "entities": [
            {
                "entity_text": "tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Upper endoscopy also showed a submucosal tumor causing subtotal obstruction of the gastric outlet .",
        "entities": [
            {
                "entity_text": "submucosal tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Because a gastrointestinal stromal tumor was suspected , distal gastrectomy was performed .",
        "entities": [
            {
                "entity_text": "gastrointestinal stromal tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Histopathological examination revealed spindle cell proliferation in the submucosal layer .",
        "entities": [
            {
                "entity_text": "spindle cell proliferation",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The spindle cells had invaded the muscularis propria layer and extended to the subserosal layer .",
        "entities": []
    },
    {
        "text": "The tumor was finally diagnosed as an IFP based on immunohistochemical findings .",
        "entities": [
            {
                "entity_text": "tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "No mutations were identified in the platelet-derived growth factor receptor alpha ( PDGFRA ) gene via molecular genetic analysis .",
        "entities": []
    },
    {
        "text": "A 36 - year-old female showed mild swelling in the right upper eyelid .",
        "entities": []
    },
    {
        "text": "She lost her RGP contact lens seven months prior to her first visit , from trauma by her child ' s kick to the right eye .",
        "entities": []
    },
    {
        "text": "At the first examination , we felt a firm lump inferior to the right brow .",
        "entities": [
            {
                "entity_text": "lump",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Eversion of the upper eyelid also revealed a firm subconjunctival mass superior to the upper tarsus .",
        "entities": [
            {
                "entity_text": "subconjunctival mass",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "After incising the conjunctiva , the RGP contact lens was found without a fibrous capsule and granulation tissue in the subconjunctival space .",
        "entities": []
    },
    {
        "text": "Three years after removal of the lens , the patient did not show any complications , including ptosis .",
        "entities": [
            {
                "entity_text": "ptosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A 17 year-old woman with a history of moderate persistent allergic asthma has benefited from a first desensitization protocol at age 3 .",
        "entities": [
            {
                "entity_text": "moderate persistent allergic asthma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The protocol has been interrupted 4 years later because of a mild skin reaction .",
        "entities": []
    },
    {
        "text": "Her doctor decided to stop the specific immunotherapy .",
        "entities": []
    },
    {
        "text": "But another doctor restarted a new protocol of desensitization at age 16 against pollens because of a lack of control of his condition .",
        "entities": []
    },
    {
        "text": "She was never hospitalized , she was receiving no medication and she was doing well one year after she received a new regimen of pneumallergens ( Alustal ® Stallergenes SA , France ) .",
        "entities": []
    },
    {
        "text": "Indeed , 12 hours after initiation of treatment , she complained of abdominal pain , vomiting and diarrhea without fever .",
        "entities": [
            {
                "entity_text": "abdominal pain",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "vomiting",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "diarrhea",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Several hours after , she consulted to the emergency department where a surgical emergency was ruled out .",
        "entities": []
    },
    {
        "text": "She was then admitted to the internal medicine ward .",
        "entities": []
    },
    {
        "text": "Two days later , she developed an acute respiratory failure and was referred to the intensive care unit where laboratory tests revealed multiorgan failure : liver enzymes , 5000 U / L ( normal level , 0 -37 U / L ) ; creatine phosphokinase , 59000 U / L ( normal level , 10 -200 U / L ) ; cardiac troponin T , 21 ng / ml ( normal level , under 0 , 01 ng / ml ) ; leucopenia , 2600 / mm 3 ( normal level , 4000-9000 / mm 3 ) ; thrombocytopenia , 13000 / mm 3 ( normal level , 150000-400000 / mm 3 ) ; prothrombin time , 38 % ( normal level , 70-100 % ) .",
        "entities": [
            {
                "entity_text": "acute respiratory failure",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "multiorgan failure",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Chest X-ray demonstrated bilateral interstitial markings with a normal cardiac silhouette .",
        "entities": [
            {
                "entity_text": "interstitial markings",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Viral serology was normal for hepatitis A , B , C , D , and E , Epstein-Barr virus and Cytomegalovirus .",
        "entities": []
    },
    {
        "text": "A skin morbilliform rash and facial edema appeared later .",
        "entities": [
            {
                "entity_text": "skin morbilliform rash",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "facial edema",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient received a fluid resuscitation , platelet and erythrocyte transfusion , steroids and antibiotics .",
        "entities": []
    },
    {
        "text": "A hypoxic coma occurred on day 4 leading to intubation and mechanical ventilation .",
        "entities": [
            {
                "entity_text": "hypoxic coma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Rapidly , she experienced intractable shock and acute renal impairment despite inotropic agents leading to death on day 5 .",
        "entities": [
            {
                "entity_text": "shock",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "acute renal impairment",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Here , we present a case of unicentric Castleman ' s disease in a 37 - year-old woman without associated neoplastic , autoimmune or infectious diseases .",
        "entities": [
            {
                "entity_text": "Castleman ' s disease",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "neoplastic , autoimmune or infectious diseases",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The lesion was located in the femoral region of the right lower extremity and surgically resected after radiographic workup and excisional biopsy examinations .",
        "entities": [
            {
                "entity_text": "lesion",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The tumor comprised lymphoid tissue with numerous germinal centers with central fibrosis , onion-skinning and rich interfollicular vascularization .",
        "entities": [
            {
                "entity_text": "tumor",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "lymphoid tissue",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "fibrosis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "onion-skinning",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "CD 23 - positive follicular dendritic cells were detected in the germinal centers and numerous CD 138 - positive plasma cells in interfollicular areas .",
        "entities": [
            {
                "entity_text": "CD 23 - positive follicular dendritic cells",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The diagnosis of mixed cellularity type Castleman ' s disease was established and the patient recovered well .",
        "entities": [
            {
                "entity_text": "Castleman ' s disease",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "An eleven year old girl presented to the paediatric eye clinic of the University College Hospital , Ibadan , Nigeria with a history of squint and poor vision .",
        "entities": [
            {
                "entity_text": "poor vision",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year .",
        "entities": [
            {
                "entity_text": "poor distance vision",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There was no history of antecedent trauma to the head or face .",
        "entities": []
    },
    {
        "text": "There was no history of double vision ( diplopia ) or pains on ocular movements .",
        "entities": [
            {
                "entity_text": "double vision",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "diplopia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There was no associated headache , fever , vomiting , joint pains or skin rashes / lesions .",
        "entities": [
            {
                "entity_text": "headache",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "fever",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "vomiting",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "skin rashes / lesions",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The review of systems was essentially normal and she had enjoyed good health since early childhood .",
        "entities": []
    },
    {
        "text": "Her pregnancy and delivery were uneventful ; and her development was normal .",
        "entities": []
    },
    {
        "text": "All other family members were well and there was no family history of squint .",
        "entities": [
            {
                "entity_text": "squint",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Unaided visual acuity was 6 / 24 in the right eye and counting fingers ( CF ) in the left eye .",
        "entities": []
    },
    {
        "text": "During refraction , her visual acuity improved to 6 / 9 and 6 / 60 in the right and left eyes respectively .",
        "entities": []
    },
    {
        "text": "The refractive error was a hypermetropia of + 4 . 50 diopters in each eye .",
        "entities": [
            {
                "entity_text": "hypermetropia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Examination revealed normal anterior and posterior segments bilaterally .",
        "entities": []
    },
    {
        "text": "There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture .",
        "entities": [
            {
                "entity_text": "hypotropia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Her palpebral fissures were normal and equal on both sides in the primary position of gaze .",
        "entities": []
    },
    {
        "text": "Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right , while elevation of the same eye was almost full on left gaze .",
        "entities": []
    },
    {
        "text": "The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements .",
        "entities": []
    },
    {
        "text": "Forced duction test ( performed under sedation ) was positive and revealed marked restriction of passive elevation of the left eye in adduction .",
        "entities": []
    },
    {
        "text": "Her systemic examination was completely normal .",
        "entities": []
    },
    {
        "text": "A diagnosis of congenital left Brown syndrome with severe amblyopia was made .",
        "entities": [
            {
                "entity_text": "congenital left Brown syndrome",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "amblyopia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day ( after school ) .",
        "entities": []
    },
    {
        "text": "Her mother was counselled and educated about the condition as well as the treatment plan .",
        "entities": []
    },
    {
        "text": "Specifically , she was informed that surgery was necessary to correct the squint , irrespective of the outcome of the amblyopia therapy .",
        "entities": [
            {
                "entity_text": "squint",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A three month follow up visit was scheduled , however , the patient defaulted after the initial visit .",
        "entities": []
    },
    {
        "text": "A 64 - year-old woman was admitted to our institution with palpable lump in her left breast .",
        "entities": [
            {
                "entity_text": "palpable lump",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Patient had not any previous medical and family story of cancer and denied any use of alcohol and cigarettes .",
        "entities": [
            {
                "entity_text": "cancer",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She took oral contraception for 5 years .",
        "entities": []
    },
    {
        "text": "Her menarche was at age 12 .",
        "entities": []
    },
    {
        "text": "Physical examination revealed a 3 cm tumor located on the left breast adhere to deep plans .",
        "entities": [
            {
                "entity_text": "tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There was no retraction of the nipple , skin ulceration or inflammatory changes .",
        "entities": [
            {
                "entity_text": "retraction of the nipple",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "skin ulceration",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The right breast exam was negative and there was no clinical evidence of axillary lymph node involvement .",
        "entities": []
    },
    {
        "text": "Mammography revealed a 2 . 6 cm round hyperdense mass with irregular and speculated margins in the subareolar area with associated microcalcifications within the mass .",
        "entities": [
            {
                "entity_text": "microcalcifications",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The mass was categorized as Breast Imaging Reporting and Data System category 5 .",
        "entities": []
    },
    {
        "text": "Fine needle aspiration and a core biopsy of the lesion were performed and the diagnostic was tubular carcinoma of the breast .",
        "entities": [
            {
                "entity_text": "tubular carcinoma of the breast",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient underwent left lumpectomy with axillary node dissection .",
        "entities": []
    },
    {
        "text": "The macroscopic ( gross ) examination of specimens revealed the presence of a nodule measuring 1 . 5 cm in its largest diameter .",
        "entities": [
            {
                "entity_text": "nodule",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The histology showed that tumor cells were arranged in a rare trabecular pattern with a prominent lymphoid stroma .",
        "entities": [
            {
                "entity_text": "trabecular pattern",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Carcinomatous cells were polygonal with granular amphophilic cytoplasm and a nucleus with fine chromatin .",
        "entities": []
    },
    {
        "text": "Nucleoli were generally inconspicuous .",
        "entities": []
    },
    {
        "text": "Up to 8 mitoses per 10 HPF were counted .",
        "entities": []
    },
    {
        "text": "No lympho-vascular component or intraductal component was noted .",
        "entities": []
    },
    {
        "text": "The tumor was grade II of Scarf Bloom Richardson .",
        "entities": [
            {
                "entity_text": "tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Surgical margin was clear .",
        "entities": []
    },
    {
        "text": "The resected axillary lymph nodes contained metastases , including one / 19 N level I lymph nodes .",
        "entities": [
            {
                "entity_text": "metastases",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The immunohistochemistry study showed an expression of the following antibodies Ck ( AE 1 / AE 3 ) on the carcinomatous component , CD 3 and CD 20 with homogenous distribution in the stroma .",
        "entities": []
    },
    {
        "text": "The Ki- 67 labeling index was : 40 % ( estimated on 10 HPF ) , Estrogen receptor status were 90 % , progesterone receptor 10 % ( both using Allred score ) and the human epidermal growth factor was negative .",
        "entities": []
    },
    {
        "text": "Based on the histopathological and immunohistochemical findings the case has been reported as lymphoepithelioma-like carcinoma of the breast and staged as pT 1 N 1 M 0 .",
        "entities": [
            {
                "entity_text": "lymphoepithelioma-like carcinoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The post-operative pet scan showed no distant metastasis .",
        "entities": [
            {
                "entity_text": "distant metastasis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The laboratory data showed a normal level of carbohydrate antigen 15-3 ( CA 15 -3 : 39 . 8 U / ml ) .",
        "entities": []
    },
    {
        "text": "Following surgery , the patient underwent four cycles of doxorubicin and cyclophosphamide and twelve cycles of paclitaxel chemotherapy .",
        "entities": []
    },
    {
        "text": "She declined endocrine therapy and was treated with radiotherapy commencing 3 weeks after chemotherapy .",
        "entities": []
    },
    {
        "text": "The radiation dose was 50 Gy in 25 fractions using a 6 MV photon tangent pair followed by a boost of 10 Gy in 5 fractions using 6 MV photon tangent pair .",
        "entities": []
    },
    {
        "text": "Regular follow up consists of physical examination every three months .",
        "entities": []
    },
    {
        "text": "At her 1 year follow-up , the patient was doing well with no evidence of recurrent disease .",
        "entities": []
    },
    {
        "text": "A 60 year-old man presented to an outside institution for septic shock with hematesis .",
        "entities": [
            {
                "entity_text": "septic shock",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He had a medical history of diabetes mellitus , hypertension and he was amputated right leg ( trans-femoral amputation ) for diabetic arteriopathy six months before admission complicated by venous thrombosis .",
        "entities": [
            {
                "entity_text": "diabetes mellitus",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hypertension",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "arteriopathy",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "venous thrombosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Home medications included daily pioglitazone , atenolol , furosemide and anticoagulant with poor compliance .",
        "entities": []
    },
    {
        "text": "Initial examination revealed a patient in state of septic shock , respiratory rate 28 cycles per min , his pulse was regular with an apical rate of 120 beats / min , temperature 39 ° C , blood pressure 70 / 40 mmHg , he had necrotic and suppurative amputation stump with peripheral pulse abolished .",
        "entities": [
            {
                "entity_text": "septic shock",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "amputation stump",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Patient was given immediately oxygen , fluids , antibiotics , and drugs to increase blood pressure .",
        "entities": []
    },
    {
        "text": "Six hours later , the patient presented a single episode of hematemesis .",
        "entities": [
            {
                "entity_text": "hematemesis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There was no associated melena or abdominal pain .",
        "entities": [
            {
                "entity_text": "melena",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "abdominal pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He had no history of alcohol use , liver disease , varices , peptic ulcer disease , abdominal aortic surgery , nonsteroidal anti inflammatory drug use , gastroparesis , or previous GI bleeding .",
        "entities": [
            {
                "entity_text": "liver disease",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "varices",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "peptic ulcer disease",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "gastroparesis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "GI bleeding",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Physical examination was unremarkable .",
        "entities": []
    },
    {
        "text": "Pertinent laboratory studies included a hemoglobin level of 10 g / dL , platelet count was normal , blood urea of 1 , 2 g / l ( 0 , 18-0 , 45 g / L ) , and a creatinine level of 68 mg / L ( 7-13 mg / L ) .",
        "entities": []
    },
    {
        "text": "After hemodynamic stabilization , an oesophageo-gastro-duodenoscopy was performed which showed : The upper third of the esophagus was circumferentially congestive , but the middle and lower third showed circumferential black pigmentation : the mucosa was black and covered by an exudate of the same color associated with diffuse bleeding .",
        "entities": [
            {
                "entity_text": "diffuse bleeding",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Gastric mucosa was strictly normal in direct vision and in retrovision , the bulb and duodenum were normal .",
        "entities": []
    },
    {
        "text": "Biopsie specimens were showed necrotic debris , mucosal submucosal necrosis with a local inflammatory response .",
        "entities": [
            {
                "entity_text": "necrotic debris",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "mucosal submucosal necrosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The treatment of this condition was based continuous high dose omeprazole ( 8 mg / h ) after bolus of 80 mg and total parenteral nutrition .",
        "entities": []
    },
    {
        "text": "The patient experienced no further hematemesis or melena .",
        "entities": [
            {
                "entity_text": "hematemesis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "melena",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Due to the severity of the necrosis , and with deterioration of his condition and persistent sepsis he died later in the same day .",
        "entities": [
            {
                "entity_text": "necrosis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "sepsis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A 35 - year-old Caucasian woman known to suffer from late familial hyperinsulinemic hypoglycemia due to a well-known mutation in the insulin receptor gene has been pregnant 6 times .",
        "entities": [
            {
                "entity_text": "familial hyperinsulinemic hypoglycemia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient was treated with injections of Sandostatin LAR ® ( octreotide ) during the first four pregnancies .",
        "entities": []
    },
    {
        "text": "Her first pregnancy in 1999 was unknown until approximately 25 th gestational weeks with fatal intrauterine growth retardation .",
        "entities": [
            {
                "entity_text": "intrauterine growth retardation",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The following two pregnancies were terminated on parental request after a chorion villus biopsy revealed the mutation causing late familial hyperinsulinemic hypoglycemia .",
        "entities": [
            {
                "entity_text": "familial hyperinsulinemic hypoglycemia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "During the fourth pregnancy , in which the fetus also had the mutation , serial ultrasound examinations showed a small fetus with appropriate growth .",
        "entities": []
    },
    {
        "text": "At birth the girl was small for gestational age .",
        "entities": []
    },
    {
        "text": "She was admitted to the neonatal special care unit due to low blood glucose and intravenous glucose and early feeding was initiated .",
        "entities": [
            {
                "entity_text": "low blood glucose",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "intravenous glucose",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "One day old , her condition deteriorated with signs of an abdominal catastrophe indicating necrotizing enterocolitis .",
        "entities": [
            {
                "entity_text": "abdominal catastrophe",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "necrotizing enterocolitis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "After two laparotomies - both confirming necrotizing enterocolitis - the child died 8 days after birth .",
        "entities": [
            {
                "entity_text": "necrotizing enterocolitis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "In the following two pregnancies Sandostatin LAR ® was stopped before pregnancy and the patient was treated only with diet restriction and intensive glucose monitoring .",
        "entities": []
    },
    {
        "text": "Both pregnancies ended successfully .",
        "entities": []
    },
    {
        "text": "One child carried the mutation and was small for gestational age at birth while the other child did not carry the mutation and had normal birth weight .",
        "entities": [
            {
                "entity_text": "small for gestational age",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "normal birth weight",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A 37 - year-old Arabian woman presented with 12 months of progressive Cushing ' s syndrome-like symptoms .",
        "entities": [
            {
                "entity_text": "Cushing ' s syndrome-like",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Biochemical evaluation confirmed adrenocorticotropic hormone -dependent Cushing ' s syndrome .",
        "entities": [
            {
                "entity_text": "adrenocorticotropic hormone -dependent Cushing ' s syndrome",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "However , the anatomical site of her excess adrenocorticotropic hormone secretion was not clearly delineated by further investigations .",
        "entities": []
    },
    {
        "text": "Magnetic resonance imaging of our patient ' s pituitary gland failed to demonstrate the presence of an adenoma .",
        "entities": [
            {
                "entity_text": "adenoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Spiral computed tomography of her chest only revealed the presence of a non-specific 7 mm lesion in her left inferobasal lung segment .",
        "entities": []
    },
    {
        "text": "Functional imaging , including a positron emission tomography scan using 18 - fluorodeoxyglucose and gallium- 68 - DOTA-D-Phe 1 - Tyr 3 - octreotide , also failed to show increased metabolic activity in the lung lesion or in her pituitary gland .",
        "entities": []
    },
    {
        "text": "Our patient was commenced on medical treatment with ketoconazole and metyrapone to control the clinical features associated with her excess cortisol secretion .",
        "entities": []
    },
    {
        "text": "Despite initial normalization of her urinary free cortisol excretion rate , levels began to rise eight months after commencement of medical treatment .",
        "entities": []
    },
    {
        "text": "Repeated imaging of her pituitary gland , chest and pelvis again failed to clearly localize a source of her excess adrenocorticotropic hormone secretion .",
        "entities": [
            {
                "entity_text": "excess adrenocorticotropic hormone secretion",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The bronchial nodule was stable in size on serial imaging and repeatedly reported as having a nonspecific appearance of a small granuloma or lymph node .",
        "entities": [
            {
                "entity_text": "granuloma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "We re-explored the treatment options and endorsed our patient ' s favored choice of resection of the bronchial nodule , especially given that her symptoms of cortisol excess were difficult to control and refractory .",
        "entities": []
    },
    {
        "text": "Subsequently , our patient had the bronchial nodule resected .",
        "entities": []
    },
    {
        "text": "The histological appearance of the lesion was consistent with that of a carcinoid tumor and immunohistochemical analysis revealed that the tumor stained strongly positive for adrenocorticotropic hormone .",
        "entities": [
            {
                "entity_text": "carcinoid tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Furthermore , removal of the lung lesion resulted in a normalization of our patient ' s 24 - hour urinary free cortisol excretion rate and resolution of her symptoms and signs of hypercortisolemia .",
        "entities": [
            {
                "entity_text": "lung lesion",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hypercortisolemia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite , since she was six months old .",
        "entities": [
            {
                "entity_text": "colicky abdominal pain",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "loss of appetite",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Parents kept her at home until they remarked visible peristalsis on the abdominal wall , which lead them to consult our service .",
        "entities": [
            {
                "entity_text": "visible peristalsis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound ( US ) .",
        "entities": []
    },
    {
        "text": "Her neonatal period was unremarkable .",
        "entities": []
    },
    {
        "text": "Clinical findings : on physical examination , she was colored and active .",
        "entities": []
    },
    {
        "text": "Her vitals were within normal limits as well as her anthropometric parameters ( weight : 10 kg ) .",
        "entities": []
    },
    {
        "text": "Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall .",
        "entities": []
    },
    {
        "text": "Abdomen was soft on palpation and tympanic on percussion .",
        "entities": []
    },
    {
        "text": "The digital rectal examination was unremarkable .",
        "entities": []
    },
    {
        "text": "Symptomatic treatment was initiated with lactulose ( five mL bid ) and an antispasmodic , trimebutine ( five mL bid ) .",
        "entities": []
    },
    {
        "text": "Timeline : our patient experienced first symptoms since August 2019 .",
        "entities": []
    },
    {
        "text": "Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall .",
        "entities": [
            {
                "entity_text": "visible peristalsis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient has been treated and discharged in August 2020 and pathology results were available 11 days later .",
        "entities": []
    },
    {
        "text": "Diagnostic assessment : blood results were within normal range .",
        "entities": []
    },
    {
        "text": "Abdominal X-ray showed distension of an intestinal loop in the left lumbar region .",
        "entities": []
    },
    {
        "text": "Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance , with no other additional features .",
        "entities": []
    },
    {
        "text": "Contrast enema was unremarkable .",
        "entities": []
    },
    {
        "text": "Due to financial constraints , upper gastro-intestinal ( GI ) series and abdominal computed tomography ( CT ) could not be performed .",
        "entities": []
    },
    {
        "text": "An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication .",
        "entities": [
            {
                "entity_text": "intestinal duplication",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Therapeutic intervention : after the median laparotomy , a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz ' s angle .",
        "entities": []
    },
    {
        "text": "Its diameter was fourfold greater than of the adjacent bowel , to which the dilatation was connected abruptly , without any identified obstructive cause .",
        "entities": []
    },
    {
        "text": "It measured ten cm in length and had prominent serosal vessels .",
        "entities": []
    },
    {
        "text": "Adjacent mesentery was thickened .",
        "entities": [
            {
                "entity_text": "mesentery",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "No further anatomic anomaly was identified .",
        "entities": []
    },
    {
        "text": "A resection of the dilatated portion was performed , followed by end-to-end jejunal anastomosis using Vicryl 3 / 0 in separate stitches .",
        "entities": []
    },
    {
        "text": "Follow-up and outcomes : microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria .",
        "entities": [
            {
                "entity_text": "lymphocytic infiltration",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD 3 + / 8 + ( C and D ) and some B lymphocytes CD 20 + .",
        "entities": [
            {
                "entity_text": "lymphocytic infiltration",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Locally diminished actin coloration indicated atrophy of smooth muscle fibers .",
        "entities": [
            {
                "entity_text": "atrophy of smooth muscle fibers",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD 56 + cells around lymphocytic infiltration .",
        "entities": [
            {
                "entity_text": "lymphocytic infiltration",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "No ectopic tissue was identified .",
        "entities": []
    },
    {
        "text": "The postoperative period was uneventful .",
        "entities": []
    },
    {
        "text": "The patient was on parenteral nutrition until day seven postoperatively .",
        "entities": []
    },
    {
        "text": "She was discharged on day ten and after three months of monthly follow-up , colicky abdominal pain and chronic constipation had disappeared since the early postoperative days .",
        "entities": [
            {
                "entity_text": "colicky abdominal pain",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "chronic constipation",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "For the future , the follow-up will be done on a three months basis for a year and then , twice yearly .",
        "entities": []
    },
    {
        "text": "A 34 - year-old recently diagnosed HIV positive para 4 was referred to us with a 2 - month history of abdominal pain , abdominal distension and backache which had worsened 2 weeks prior to presentation .",
        "entities": [
            {
                "entity_text": "abdominal pain",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "abdominal distension",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She also had pain on defecation , night sweats and fever .",
        "entities": [
            {
                "entity_text": "pain on defecation",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "night sweats",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "fever",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "On examination she looked ill , in respiratory distress with a respiratory rate of 28 breaths per min .",
        "entities": [
            {
                "entity_text": "respiratory distress",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She was febrile with a temperature of 38 . 2 0 C and had unilateral leg swelling .",
        "entities": [
            {
                "entity_text": "febrile",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "unilateral leg swelling",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size .",
        "entities": [
            {
                "entity_text": "abdomen was asymmetrically distended",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The mass was firm , immobile with an irregular surface not attached to overlying skin .",
        "entities": []
    },
    {
        "text": "There was no ascites and no hepatosplenomegaly .",
        "entities": [
            {
                "entity_text": "ascites",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hepatosplenomegaly",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The cervix looked grossly normal but was displaced anteriorly .",
        "entities": []
    },
    {
        "text": "Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa .",
        "entities": []
    },
    {
        "text": "Examination of the other systems was normal .",
        "entities": []
    },
    {
        "text": "Investigations showed a haemoglobin of 6 . 5 g / dl ( NR 12 -14 g / dl ) , a slightly elevated cancer antigen 125 of 44 U / ml ( NR 0-35 ) , serum beta human chorionic gonadotropin ( HCG ) of 0 . 258 mIU / ml ( NR 0-5 ) and alpha fetoprotein of 7 ng / ml ( NR < 10 ) .",
        "entities": []
    },
    {
        "text": "Her CD 4 count was 63 cells / mm 3 .",
        "entities": []
    },
    {
        "text": "Her renal and hepatic function tests were normal .",
        "entities": []
    },
    {
        "text": "An ultrasound scan showed a solid mass measuring 19 . 6 cm x 12 . 5 cm , posterior to the uterine fundus and extending to the left adnexa .",
        "entities": []
    },
    {
        "text": "The uterus and its endometrium were normal .",
        "entities": []
    },
    {
        "text": "Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy .",
        "entities": [
            {
                "entity_text": "thrombosis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "lymphadenopathy",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient was taken for surgical exploration and staging for ovarian malignancy .",
        "entities": [
            {
                "entity_text": "ovarian malignancy",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon .",
        "entities": [
            {
                "entity_text": "ovarian mass",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The right ovary was enlarged to about 10 cm diameter .",
        "entities": []
    },
    {
        "text": "The left fallopian tube and ovary could not be distinguished and separated from the tumour .",
        "entities": [
            {
                "entity_text": "tumour",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The rest of the abdominal organs and omentum looked grossly normal .",
        "entities": []
    },
    {
        "text": "There was no ascites .",
        "entities": [
            {
                "entity_text": "ascites",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Tumour was friable and was removed by blunt and sharp dissection .",
        "entities": [
            {
                "entity_text": "Tumour",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Total abdominal hysterectomy , bilateral adnexectomy and infracolic omentectomy were done .",
        "entities": []
    },
    {
        "text": "The general surgeons were present and they did a sigmoidectomy and a Hartmann ' s procedure .",
        "entities": []
    },
    {
        "text": "She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity .",
        "entities": [
            {
                "entity_text": "intraoperative bleeding",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "We had encountered significant bleeding from the friable tumor .",
        "entities": [
            {
                "entity_text": "bleeding",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Patient was sent to the high dependency unit where she recovered postoperatively .",
        "entities": []
    },
    {
        "text": "Histology of the specimens showed a large B cell lymphoma .",
        "entities": [
            {
                "entity_text": "B cell lymphoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A haematologist consulted and peripheral blood film and bone marrow aspirate were done .",
        "entities": []
    },
    {
        "text": "Both results were normal , ruling out abnormal cells in both samples .",
        "entities": [
            {
                "entity_text": "abnormal cells",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide , doxorubicin and vincristine .",
        "entities": []
    },
    {
        "text": "She has also been initiated on highly active antiretroviral therapy .",
        "entities": []
    },
    {
        "text": "A 23 - year-old previously healthy man , presented to the hospital ' s emergency department , with a 3 - day history of high-grade fever up to 40 ° C and upper right abdominal pain .",
        "entities": [
            {
                "entity_text": "high-grade fever",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "upper right abdominal pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient ' s past medical history was non-significant .",
        "entities": []
    },
    {
        "text": "He was a student and had not received any medication .",
        "entities": []
    },
    {
        "text": "He had a pet dog and reported no recent travel .",
        "entities": []
    },
    {
        "text": "During physical examination on admission , vital signs were normal and he was febrile with a body temperature of 38 ° C .",
        "entities": [
            {
                "entity_text": "febrile",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Abdominal examination revealed a tender palpable liver , with no signs of peritoneal irritation .",
        "entities": [
            {
                "entity_text": "peritoneal irritation",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The remainder of physical examination was unremarkable .",
        "entities": []
    },
    {
        "text": "Abnormal laboratory results on admission included a white blood cell count ( WBC ) of 20 . 830 ( 4-10 . 5 x 10 / L ) , elevated C-reactive protein ( CRP ) level ( 28 mg / dl , normal ≤ 0 . 5 mg / dl ) , slightly elevated alanine aminotransferase ( ALT ) of 56 IU / L ( normal 5-40 IU / L ) , and lactic dehydrogenase ( LDH ) of 255 IU / L ( normal < 225 IU / L ) .",
        "entities": []
    },
    {
        "text": "Alkaline phosphatase ( ALP ) was normal .",
        "entities": []
    },
    {
        "text": "Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable , hypoechoic lesions .",
        "entities": [
            {
                "entity_text": "enlarged liver and spleen",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Abdominal computed tomography ( CT ) scan revealed the 2 aforementioned lesions in diameter of 5 . 6 cm at the left liver lobe and 5 . 2 cm in the right lobe .",
        "entities": [
            {
                "entity_text": "lesions",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The lesions were hypodense and presented peripheral enhancement after intravenous contrast , similar to the morphology of hepatic abscesses .",
        "entities": [
            {
                "entity_text": "lesions",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hepatic abscesses",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient was admitted for further evaluation and treatment .",
        "entities": []
    },
    {
        "text": "Culture guided antimicrobials and appropriate drainage was our first option .",
        "entities": []
    },
    {
        "text": "Empiric antibiotic therapy with intravenous ciprofloxacin ( 400 mg every 12 hours ) , and metronidazole ( 500 mg every 8 hours ) was initiated .",
        "entities": []
    },
    {
        "text": "All cultures resulted negative .",
        "entities": []
    },
    {
        "text": "Initially , we performed percutaneous sonographic ( U / S ) guided aspiration into the left hepatic abscess cavity .",
        "entities": []
    },
    {
        "text": "A thick , purulent material of 40 cc was drained and sent for culture .",
        "entities": []
    },
    {
        "text": "Microbiology revealed a Gram-negative bacterium that presented slow growth .",
        "entities": []
    },
    {
        "text": "On the 5 th and 8 th days of admission , we performed CT guided catheter drainage of both abscesses .",
        "entities": [
            {
                "entity_text": "abscesses",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted .",
        "entities": [
            {
                "entity_text": "fever",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "night sweats",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Ciprofloxacin discontinued and meropenem at a dose of 1 gr every 8 hours administered .",
        "entities": []
    },
    {
        "text": "Thorough screening for other possible sources of infection , resulted negative .",
        "entities": [
            {
                "entity_text": "infection",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation .",
        "entities": [
            {
                "entity_text": "vegetations",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "mild mitral regurgitation",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Entamoeba histolytica Abs , echinococcus Abs , leismania Abs , brucella Abs were negative .",
        "entities": []
    },
    {
        "text": "Gastrointestinal endoscopic evaluation was unrevealing .",
        "entities": []
    },
    {
        "text": "The patient was also HIV negative and no other immunodeficiency conditions were identified .",
        "entities": [
            {
                "entity_text": "HIV negative",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Eventually , the isolate identified by the Vitek 2 automated system and classified as A . aphrophilus .",
        "entities": []
    },
    {
        "text": "To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry ( MALDI-TOF MS ) .",
        "entities": [
            {
                "entity_text": "strain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The sensitivity test was performed with minimal inhibitory concentration ( MIC ) test strips ; the isolate ' s susceptibility was to ceftriaxone ≤ 0 . 125 ( S ) , cefepime ≤ 0 . 5 ( S ) , ciprofloxacin ≤ 0 . 125 ( S ) , gentamycin ≤ 0 . 5 ( S ) , amikacin ≤ 0 . 125 ( S ) and to meropenem ≤ 0 . 032 ( S ) .",
        "entities": []
    },
    {
        "text": "Percutaneous drainage of both abscesses , combined with antimicrobial treatment , was successful and the patient ' s clinical condition improved .",
        "entities": [
            {
                "entity_text": "abscesses",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Thankfully , no surgical procedure was required .",
        "entities": []
    },
    {
        "text": "The drains were removed immediately the fluid from the abscess cavities became clear .",
        "entities": [
            {
                "entity_text": "abscess",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Meropenem was administered for a total of 2 weeks .",
        "entities": []
    },
    {
        "text": "Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital , in full recovery .",
        "entities": []
    },
    {
        "text": "Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities .",
        "entities": []
    },
    {
        "text": "An 80 year-old Caucasian male was diagnosed at an outside institution with Barrett ' s esophagus with high grade dysplasia and presented to our institution for therapy .",
        "entities": [
            {
                "entity_text": "Barrett ' s esophagus with high grade dysplasia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient underwent endoscopic mucosal resection using a band ligation technique of an area of nodularity within the Barrett esophagus .",
        "entities": [
            {
                "entity_text": "Barrett esophagus",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Microscopic examination demonstrated extensive Barrett esophagus with high-grade dysplasia as well as a second tumor which was morphologically different from the surrounding high-grade dysplasia and which was positive for S- 100 , HMB 45 and Melan-A on immunohistochemistry , consistent with melanoma .",
        "entities": [
            {
                "entity_text": "Barrett esophagus with high-grade dysplasia",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "high-grade dysplasia",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "melanoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Further workup of the patient demonstrated multiple radiologic lesions consistent with metastases .",
        "entities": [
            {
                "entity_text": "multiple radiologic lesions",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "metastases",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Molecular studies demonstrated that the melanoma was positive for the 1799 T > A ( V 600 E ) mutation in the BRAF gene .",
        "entities": [
            {
                "entity_text": "melanoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The overall features of the tumor were most consistent with metastatic melanoma occurring in a background of Barrett esophagus with high-grade dysplasia .",
        "entities": [
            {
                "entity_text": "tumor",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "metastatic melanoma",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "Barrett esophagus with high-grade dysplasia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A 22 - year-old woman , without any formerly diagnosed diseases , presented to the emergency department with a 3 day history of dyspnea , fatigue and central chest pain .",
        "entities": [
            {
                "entity_text": "central chest pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She reported increasing dyspnea that developed in the previous month .",
        "entities": [
            {
                "entity_text": "dyspnea",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She also had intermittent pain in the small joints for several months .",
        "entities": [
            {
                "entity_text": "pain in the small joints",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There was no family history of SLE .",
        "entities": [
            {
                "entity_text": "SLE",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "On examination , she had a temperature of 38 . 2 ° C , a heart rate of 115 beats / minute , blood pressure of 90 / 60 mmHg , respiratory rate of 25 breaths / minute , muffled heart sounds and jugular distention .",
        "entities": [
            {
                "entity_text": "jugular distention",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The electrocardiogram showed sinus tachycardia and low voltage .",
        "entities": [
            {
                "entity_text": "sinus tachycardia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The chest radiograph showed an enlargement of the cardiac silhouette with a right-sided pulmonary effusion .",
        "entities": [
            {
                "entity_text": "pulmonary effusion",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The echocardiography revealed a large circumferential pericardial effusion , with diastolic collapse of the right atrium , dilated inferior vena cava and 30 % respiratory variation of the Doppler mitral valve , confirming the diagnosis of cardiac tamponade .",
        "entities": [
            {
                "entity_text": "circumferential pericardial effusion",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "diastolic collapse of the right atrium",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "cardiac tamponade",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Initial workup showed normochromic normocytic anemia with hemoglobin at 8 . 5 g / dl , CRP : 75 mg / L , renal and liver function tests were normal .",
        "entities": [
            {
                "entity_text": "normochromic normocytic anemia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Emergency pericardiocentesis was indicated but could not be performed because of the incapability to place the guidewire into the pericardial cavity .",
        "entities": []
    },
    {
        "text": "So , urgent surgical pericardiectomy with window procedure was realized , 1200 of clear fluid was evacuated .",
        "entities": []
    },
    {
        "text": "The pericardial fluid contained 2900 white blood cells / mm , 100 red blood cells / mm , bacteriological culture and cytologic examinations yielded negative results .",
        "entities": []
    },
    {
        "text": "The pericardial biopsy showed features of nonspecific inflammation , malignancy and tuberculosis were ruled out .",
        "entities": [
            {
                "entity_text": "nonspecific inflammation",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "malignancy",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "tuberculosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Further investigations were accomplished to determine the etiology .",
        "entities": []
    },
    {
        "text": "Immunological workup revealed antinuclear antibodies titer of 1 : 1280 , positive anti-SSA and anti-SM antibodies and hypocomplementemia .",
        "entities": []
    },
    {
        "text": "The coombs test was positive .",
        "entities": []
    },
    {
        "text": "The diagnosis of systemic lupus erythematosus was established based on hemolytic anemia , serositis , arthralgia , positive anti nuclear and anti SM antibodies and low complement .",
        "entities": [
            {
                "entity_text": "systemic lupus erythematosus",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hemolytic anemia",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "serositis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "arthralgia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient was started on intravenous therapy with methylprednisolone followed by prednisone 60 mg by mouth daily with hydroxychloroquine .",
        "entities": []
    },
    {
        "text": "She had a good clinical response and control echocardiography showed complete resolution of the pericardial effusion without recurrence .",
        "entities": [
            {
                "entity_text": "pericardial effusion",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A 14 - year old boy with no significant past medical history presented to a small district hospital in southern Sierra Leone with a 4 day history of facial puffiness , peripheral pitting oedema , abdominal pains , and reduced urine output .",
        "entities": [
            {
                "entity_text": "facial puffiness",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "pitting oedema",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "abdominal pains",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "reduced urine output",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "On examination he was afebrile , BP 150 / 110 , heart rate 70 .",
        "entities": []
    },
    {
        "text": "He had significant periorbital and facial oedema , pitting oedema from the feet to the knees , a distended abdomen , ascites , and tender hepatomegaly .",
        "entities": [
            {
                "entity_text": "periorbital and facial oedema",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "pitting oedema",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "distended abdomen",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "ascites",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hepatomegaly",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Lab results showed haemoglobin 10 . 9 g / dl , packed cell volume 35 % , and positive malaria parasites .",
        "entities": []
    },
    {
        "text": "Urea ( 14 mg / dl ) , creatinine ( 1 . 0 mg / dl ) , sodium ( 137 mmol / L ) , and potassium ( 3 . 7 mmol / L ) were normal .",
        "entities": []
    },
    {
        "text": "Urinalysis , using a urine dipstick , revealed three pluses of proteinurea , which equates to ≥ 3 g urinary protein per day .",
        "entities": []
    },
    {
        "text": "Lab facilities for the measurement of serum albumin were not available .",
        "entities": []
    },
    {
        "text": "The diagnosis of nephrotic syndrome was made and the patient was started on a course of prednisolone 60 mg / day , Enalapril 2 . 5 mg daily , anti-malarial treatment , and empirical broad spectrum IV antibiotics to cover bacterial infections , in addition to a salt-restricted diet .",
        "entities": [
            {
                "entity_text": "nephrotic syndrome",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "On day 3 of admission he showed a clinical response to treatment , as the facial oedema , ascites , and BP had reduced .",
        "entities": [
            {
                "entity_text": "facial oedema",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "ascites",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Urinalysis showed two pluses of proteinurea ( 0 . 5-1 . 0 gram per day per day ) .",
        "entities": []
    },
    {
        "text": "The child complained of a moderate headache , but had no fever , meningism , or focal neurological signs .",
        "entities": [
            {
                "entity_text": "headache",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "fever",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "meningism",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "focal neurological signs",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He was started on oral paracetamol .",
        "entities": []
    },
    {
        "text": "The next morning ( day 4 of admission ) his symptoms evolved : his headache became severe , he had pain behind both eyes , and he was vomiting .",
        "entities": [
            {
                "entity_text": "headache",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "pain behind both eyes",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "vomiting",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Examination showed a right VI nerve palsy , diplopia , and tinnitus in the right ear , with some hearing loss .",
        "entities": [
            {
                "entity_text": "VI nerve palsy",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "diplopia",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "tinnitus in the right ear",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hearing loss",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He later became drowsy and had a generalised seizure .",
        "entities": [
            {
                "entity_text": "drowsy",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "generalised seizure",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Diagnosis and commencement of treatment was delayed due to the absence of CT / MRI brain imaging facilities in the local district .",
        "entities": []
    },
    {
        "text": "In the context of the child ' s nephrotic status and focal neurological signs , we had a high suspicion of cerebral venous thrombosis , and made a presumptive diagnosis .",
        "entities": [
            {
                "entity_text": "focal neurological signs",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "cerebral venous thrombosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The child was started on high dose subcutaneous unfractionated heparin daily .",
        "entities": []
    },
    {
        "text": "This decision was made cautiously , but it was felt that the advantages surpassed the risks .",
        "entities": []
    },
    {
        "text": "He also received dexamethasone , high flow oxygen , and elevation of the head to 45 degrees , in order to treat features of raised intracranial pressure .",
        "entities": [
            {
                "entity_text": "raised intracranial pressure",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "On day 6 of admission his headache had improved and his focal neurological signs began to resolve .",
        "entities": [
            {
                "entity_text": "headache",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "focal neurological signs",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He still had a partial right VI nerve palsy and a convergent squint .",
        "entities": [
            {
                "entity_text": "VI nerve palsy",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "convergent squint",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "His oedema resolved completely by day 10 of treatment , and he was discharged on day 18 .",
        "entities": [
            {
                "entity_text": "oedema",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He continued prednisolone 60 mg daily for a total of 6 weeks , followed by a reduced dose of 40 mg on alternate days for 6 weeks .",
        "entities": []
    },
    {
        "text": "At 12 weeks follow-up , his urinalysis showed a trace proteinurea but he remained in remission .",
        "entities": []
    },
    {
        "text": "The patient referred to our unit for consideration for coronary artery bypass grafting was a 56 year old teacher who had been managed for Ischaemic Heart Disease ( IHD ) at a private cardiology facility in Lagos .",
        "entities": [
            {
                "entity_text": "Ischaemic Heart Disease ( IHD )",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She had presented in July 2009 with a history suggestive of IHD and angina class III ( Canadian Cardiovascular society classification ) which was worsening despite medical therapy .",
        "entities": [
            {
                "entity_text": "IHD",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "angina class III",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Coronary angiography done demonstrated significant lesions in the mid portion of the Left Descending Coronary Artery ( LAD ) and the proximal Circumflex Coronary Artery ( Cx ) .",
        "entities": [
            {
                "entity_text": "lesions in the mid portion of the Left Descending Coronary Artery",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The Right Coronary Artery was a dominant artery with some minor irregularities .",
        "entities": []
    },
    {
        "text": "Percutaneous transluminal coronary angioplasty of both the LAD and Cx was done .",
        "entities": []
    },
    {
        "text": "A 3 . 0 mm Drug Eluting Stent was deployed to stent the LAD and the Cx was stented with a 3 . 0 mm Bare Metal Stent .",
        "entities": []
    },
    {
        "text": "The patient was angina-free for one year but represented in July 2010 again with angina class III .",
        "entities": [
            {
                "entity_text": "angina class III",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Repeat coronary angiogram was done which showed that both stents were patent and there was no new coronary lesion .",
        "entities": [
            {
                "entity_text": "coronary lesion",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She was controlled on medical therapy .",
        "entities": []
    },
    {
        "text": "However she presented again in November 2011 , this time with unstable angina .",
        "entities": [
            {
                "entity_text": "unstable angina",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "An urgent coronary angiogram carried out showed that the previous stents were still patent but with a 50 % left main stem stenosis and a 95 % proximal LAD stenosis .",
        "entities": [
            {
                "entity_text": "stem stenosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She was subsequently referred for surgical revascularization .",
        "entities": []
    },
    {
        "text": "Physical examination on admission revealed a middle aged woman who was clinically obese with a body mass index of 32 kg / m 2 .",
        "entities": [
            {
                "entity_text": "obese",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There were no significant physical findings .",
        "entities": []
    },
    {
        "text": "Associated risk factors were intermittent claudication ( Ankle-Brachial Index bilaterally was 0 . 57 ) , bilateral carotid bruits , poorly controlled diabetes mellitus and hyperlipidemia .",
        "entities": [
            {
                "entity_text": "intermittent claudication",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "bilateral carotid bruits",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "diabetes mellitus",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hyperlipidemia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Her calculated euroscore was 6 .",
        "entities": []
    },
    {
        "text": "Medications on admission were Aspirin , Glyceryl trinitrate sublingual spray , Metformin , Glibenclamide , Fluvastatin , Metoprolol and Isosorbide Dinitrate .",
        "entities": []
    },
    {
        "text": "Investigations done included transthoracic echocardiogram which showed good left ventricular ejection fraction with no evidence of ventricular dysfunction .",
        "entities": [
            {
                "entity_text": "ventricular dysfunction",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Chest radiogram , 12 lead electrocardiogram and pulmonary function tests were normal .",
        "entities": []
    },
    {
        "text": "All blood parameters were within acceptable limits .",
        "entities": []
    },
    {
        "text": "Following review of her coronary angiogram she was scheduled for single vessel grafting of the LAD as an off pump procedure .",
        "entities": []
    },
    {
        "text": "Surgery was performed in November 2011 .",
        "entities": []
    },
    {
        "text": "The cardiopulmonary bypass circuit was not primed .",
        "entities": []
    },
    {
        "text": "Following median sternotomy and harvesting of the Left Internal Mammary Artery ( LIMA ) the Octopus 3 Off-pump stabilizer and foot plate were used to immobilize the anterior myocardial surface with good visualization of the LAD .",
        "entities": []
    },
    {
        "text": "The LAD which was a 2 . 5 mm vessel was snugged proximally and an arteriotomy performed in its mid-portion .",
        "entities": []
    },
    {
        "text": "The arteriotomy site was kept bloodless with CO 2 insufflation via an improvised blow-mister .",
        "entities": []
    },
    {
        "text": "The LIMA to LAD anastomosis was performed with 6-0 prolene suture .",
        "entities": []
    },
    {
        "text": "The procedure was uneventful and the patient was transferred to the Intensive Care Unit on minimal inotropic support .",
        "entities": []
    },
    {
        "text": "She was weaned off the ventilator after 4 hours and inotropic support was discontinued after 24 hours .",
        "entities": []
    },
    {
        "text": "Postoperative recovery was delayed by the need to achieve glycaecmic control .",
        "entities": []
    },
    {
        "text": "She was discharged home 2 weeks postoperatively .",
        "entities": []
    },
    {
        "text": "She has been reviewed in clinic and remains free of angina .",
        "entities": []
    },
    {
        "text": "A male patient , born in 1973 , fell off the balcony while on holidays in Crete in 1993 and developed complete tetraplegia at C- 5 level .",
        "entities": [
            {
                "entity_text": "complete tetraplegia at C- 5 level",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "In 1996 , deafferentation of sacral nerve roots 2 , 3 and 4 were carried out bilaterally .",
        "entities": []
    },
    {
        "text": "Brindley sacral anterior root stimulator was implanted .",
        "entities": []
    },
    {
        "text": "On eleventh post-operative day , blood stained fluid came out of sacral wound .",
        "entities": [
            {
                "entity_text": "sacral wound",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Microbiology of exudates showed growth of Pseudomonas aeruginosa , sensitive to gentamicin .",
        "entities": [
            {
                "entity_text": "Pseudomonas aeruginosa",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "As discharge of serosanguinous fluid persisted , sacral wound was explored .",
        "entities": [
            {
                "entity_text": "sacral wound",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "In March 1997 , induration and craggy swelling were noted at the site of receiver .",
        "entities": [
            {
                "entity_text": "induration",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "swelling",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There was discharge from the surgical wound in the back .",
        "entities": []
    },
    {
        "text": "Wound swab grew Pseudomonas aeruginosa .",
        "entities": [
            {
                "entity_text": "Pseudomonas aeruginosa",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The receiver was taken out .",
        "entities": []
    },
    {
        "text": "Cables were retrieved and tunnelled in left flank .",
        "entities": []
    },
    {
        "text": "Laminectomy wound was left open .",
        "entities": []
    },
    {
        "text": "In May 1997 , cables were removed from left flank through the laminectomy wound .",
        "entities": []
    },
    {
        "text": "Grommet was sliced down as much as possible without producing leak of cerebrospinal fluid .",
        "entities": [
            {
                "entity_text": "Grommet",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "leak of cerebrospinal fluid",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Histoacryl glue was used over the truncated grommet as a sealing agent .",
        "entities": []
    },
    {
        "text": "Microbiology of end of S- 2 and S- 3 cables showed growth of Pseudomonas aeruginosa , which was sensitive to gentamicin .",
        "entities": [
            {
                "entity_text": "Pseudomonas aeruginosa",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "End of S- 4 cable showed scanty growth of Pseudomonas aeruginosa and Klebsiella aerogenes .",
        "entities": [
            {
                "entity_text": "Pseudomonas aeruginosa",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "Klebsiella aerogenes",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Review of this patient in January 1999 revealed presence of sinuses in dorsal wound exuding purulent material .",
        "entities": [
            {
                "entity_text": "sinuses",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "wound exuding purulent material",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The wound was explored ; grommet and electrodes were removed .",
        "entities": []
    },
    {
        "text": "The consequences of failed implantation were severe constipation and loss of reflex penile erection and bladder emptying .",
        "entities": [
            {
                "entity_text": "constipation",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "loss of reflex penile erection and bladder emptying",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "This patient had to spend increasing amount of time for bowels management .",
        "entities": []
    },
    {
        "text": "Faecal incontinence limited his mobility .",
        "entities": [
            {
                "entity_text": "Faecal incontinence",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The problem with his bowels was affecting his confidence in doing anything , as the slightest movement could cause his bowels to work .",
        "entities": []
    },
    {
        "text": "The inconvenience and embarrassment of a bowel accident caused distress to the patient and to his mother .",
        "entities": []
    },
    {
        "text": "A 38 - year-old man presented with a seven month history of progressively worsening bilateral knees pain with associated swelling .",
        "entities": [
            {
                "entity_text": "knees pain",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "swelling",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The pain was present when the patient was at rest , and worsened when the legs was bearing weight , thus restricting his walking to short distances .",
        "entities": [
            {
                "entity_text": "pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "His knees had become increasingly swollen .",
        "entities": []
    },
    {
        "text": "He was otherwise fit and well .",
        "entities": []
    },
    {
        "text": "His medical history was unremarkable and he was only taking a paracetamol , codeine and anti-inflammatory drugs for the pain .",
        "entities": []
    },
    {
        "text": "Upon examination , the patient was seen to have visibly swollen popliteal fossa and marked quadriceps wasting of his right lower limb .",
        "entities": [
            {
                "entity_text": "swollen popliteal fossa",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "On palpation , the masses was hard , mobile , well defined , and measured 0 . 5 - 04 cm .",
        "entities": []
    },
    {
        "text": "The swelling was non-tender and there were no associated skin changes .",
        "entities": [
            {
                "entity_text": "swelling",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He could fully extend his knee , but flexion was restricted to only 110 degrees .",
        "entities": []
    },
    {
        "text": "There was a McMurray test proved equivocal and no ligamentous instability .",
        "entities": []
    },
    {
        "text": "An examination of the patient ’ s hip revealed no abnormality .",
        "entities": []
    },
    {
        "text": "A plain radiograph of the patient ’ s knees revealed multiple calcific densities within the soft tissues surrounding it on the right one .",
        "entities": []
    },
    {
        "text": "Although some of these appeared to lie within the capsule , the majority appeared to be outside of it , and a solitary image on the left knee .",
        "entities": []
    },
    {
        "text": "These appearances were thought to be consistent with idiopathic tumoral calcinosis .",
        "entities": [
            {
                "entity_text": "tumoral calcinosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "However , to further scrutinize these calcifications , a magnetic resonance imaging ( MRI ) scan was recommended .",
        "entities": [
            {
                "entity_text": "calcifications",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "It showed an extensive thickening of the patient ’ s synovium , multiple intraarticular calcific and ossific loose bodies , and large calcified bursal extensions .",
        "entities": []
    },
    {
        "text": "These findings were thought to be consistent with very extensive bilateral synovial chondromatosis .",
        "entities": [
            {
                "entity_text": "synovial chondromatosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient ’ s blood tests were normal : C-reactive protein 5 mg / l and the phosphate calcium balance without errors .",
        "entities": []
    },
    {
        "text": "A two-stage procedure was planned following the findings of the MRI scan .",
        "entities": []
    },
    {
        "text": "The first stage was arthroscopy , which was able to note Grade IV osteoarthritis alongside florid synovial chondromatosis in the lateral compartment of the right knee .",
        "entities": [
            {
                "entity_text": "osteoarthritis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "synovial chondromatosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There were multiple loose bodies within this compartment and nodules were fixed to the synovium .",
        "entities": []
    },
    {
        "text": "On the left one , we found an isolated synovial metaplasia in the subvastus quadriceps-sparing .",
        "entities": [
            {
                "entity_text": "synovial metaplasia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A synovectomy with debridement and excision of these bodies was thus performed .",
        "entities": []
    },
    {
        "text": "The second stage involved an open exploration of the patient ’ s popliteal fossa .",
        "entities": []
    },
    {
        "text": "Multiple calcified masses were found , all enclosed in bursal sacs .",
        "entities": []
    },
    {
        "text": "They were lateral to the semimembranosus at the level of the oblique popliteal ligament .",
        "entities": []
    },
    {
        "text": "All the masses were excised .",
        "entities": []
    },
    {
        "text": "A histological review confirmed our diagnosis of synovial chondromatosis .",
        "entities": [
            {
                "entity_text": "synovial chondromatosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The sections showed nests of chondrocytes with focal ossification and focally attenuated synovium overlying the nodules .",
        "entities": []
    },
    {
        "text": "After the operation , the patient underwent functional rehabilitation sessions focusing on quadriceps strengthening , with a daily exercise regime to supplement this .",
        "entities": []
    },
    {
        "text": "He recovered well and ten weeks after the operation , has regained his right knee ’ s full range of movement with flexion increased to 130 degrees , which is equal to that of his left knee .",
        "entities": []
    },
    {
        "text": "Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy ( AIDP ) variant of Guillain-Barr syndrome 12 years back presented with acute , ascending symmetrical flaccid quadriparasis extending to bulbar muscles , bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation .",
        "entities": [
            {
                "entity_text": "acute inflammatory demyelinating polyneuropathy",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "AIDP",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "Guillain-Barr syndrome",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Nerve conduction study revealed AIDP variant of Guillain-Barr syndrome .",
        "entities": [
            {
                "entity_text": "AIDP",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "Guillain-Barr syndrome",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation .",
        "entities": []
    },
    {
        "text": "She was treated with intravenous immunoglobulin resulting in a remarkable recovery .",
        "entities": []
    },
    {
        "text": "Both episodes had a complete clinical recovery in three and four months ' time respectively , rather a faster recovery than usually expected .",
        "entities": []
    },
    {
        "text": "A 61 - year-old woman , gravida 3 para 3 , presented with an increased size of ovarian cyst .",
        "entities": [
            {
                "entity_text": "ovarian cyst",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Her history revealed a diagnosis of left ovarian cyst 3 cm in diameter 3 years previously .",
        "entities": [
            {
                "entity_text": "ovarian cyst",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Her serum cancer antigen ( CA ) 125 and CA 19-9 levels were within the normal ranges , and she was followed up at 6 - month intervals at a private hospital .",
        "entities": []
    },
    {
        "text": "The ovarian cyst size had not changed in size and structure on biannual transvaginal ultrasound ( TVS ) .",
        "entities": [
            {
                "entity_text": "ovarian cyst",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "However , she was referred to our institution in July 2016 with progression of ovarian cyst to 6 cm on a pelvic ultrasonogram 2 weeks ago .",
        "entities": [
            {
                "entity_text": "ovarian cyst",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient underwent menopause at age 48 years , with an uneventful past menstrual cycle .",
        "entities": []
    },
    {
        "text": "She had no medical history except the benign thyroid nodule , no relevant surgical history and had not received hormonal therapy .",
        "entities": [
            {
                "entity_text": "benign thyroid nodule",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Routine blood chemistry and serum tumor marker analysis showed that the levels of carcinoembryonic antigen , CA 19-9 , CA 125 , and human epididymis protein 4 were all within the normal ranges .",
        "entities": []
    },
    {
        "text": "Uterine cervical cytology at the time of admission was normal .",
        "entities": []
    },
    {
        "text": "TVS showed a left ovarian unilocular cyst , size 6 cm × 5 cm × 4 cm , with diffuse low-level internal echoes , thin walled , smooth margined , no septa and no papillary projections .",
        "entities": [
            {
                "entity_text": "ovarian unilocular cyst",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The uterus size was 6 cm × 4 cm × 3 cm , and a 1 cm uterine myoma was found in the fundus .",
        "entities": [
            {
                "entity_text": "uterine myoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Pelvic contrast-enhanced computed tomography ( ECT ) images revealed a unilocular cystic lesion measuring 6 cm at its widest dimension , without enhancing solid intramural nodules and no evidence of lymphadenopathy or ascites .",
        "entities": [
            {
                "entity_text": "unilocular cystic lesion",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "lymphadenopathy",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "ascites",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "CT scan indicated benign ovarian cystic tumors .",
        "entities": [
            {
                "entity_text": "benign ovarian cystic tumors",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient underwent laparoendoscopic single-site ( LESS ) surgery .",
        "entities": []
    },
    {
        "text": "On laparoscopic inspection , the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube .",
        "entities": [
            {
                "entity_text": "cyst",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The left fallopian tube was grossly unremarkable and the left ovary was atrophied .",
        "entities": [
            {
                "entity_text": "left ovary was atrophied",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The left ovary and tube were completely separate from the cyst and the cyst was surrounded by a translucent wall with serous cystic components , but solid components were not seen inside .",
        "entities": [
            {
                "entity_text": "cyst",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "cyst",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Clinical diagnosis was suggestive of left paratubal cyst .",
        "entities": [
            {
                "entity_text": "paratubal cyst",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient underwent hysterectomy and BSO .",
        "entities": []
    },
    {
        "text": "Although tumor markers were normal and there was no presence of papillary projections , the progression in size in the postmenopausal woman indicated a possible malignancy .",
        "entities": [
            {
                "entity_text": "malignancy",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Frozen sections were prepared from surgery specimens and confirmed a benign cyst .",
        "entities": [
            {
                "entity_text": "benign cyst",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "After surgery , the pelvic cavity was explored and no specific findings were found in the abdominal cavity .",
        "entities": []
    },
    {
        "text": "Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst .",
        "entities": [
            {
                "entity_text": "polypoid lesions",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "cyst",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The tumor cells showed nuclear atypism and stratification , which are histological characteristics of borderline tumor .",
        "entities": [
            {
                "entity_text": "tumor cells",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A final diagnosis of paratubal borderline serous tumor was confirmed .",
        "entities": [
            {
                "entity_text": "paratubal borderline serous tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient was discharged from the hospital on postoperative day 3 .",
        "entities": []
    },
    {
        "text": "CT images were retrospectively evaluated , focusing on the left ovary , fallopian tube , and paratubal cyst after surgery .",
        "entities": [
            {
                "entity_text": "paratubal cyst",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Multiplanar reconstruction CT imaging revealed linear fat planes between the left ovary and the cyst , indicating that the left ovary , fallopian tube and paratubal cyst were separate structures , similar to those seen during surgery .",
        "entities": [
            {
                "entity_text": "cyst",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "paratubal cyst",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The tumor was not completely staged , and a comprehensive surgical staging operation was recommended ; however , the patient refused adjuvant surgical treatment and opted for close follow-up .",
        "entities": [
            {
                "entity_text": "tumor",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Pelvic ECT , TVS and tumor markers were checked every three months .",
        "entities": []
    },
    {
        "text": "The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis .",
        "entities": [
            {
                "entity_text": "metastasis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A 61 - year-old man presented with chronic left ear discharge , left-sided headache , diplopia associated with vertigo , tinnitus , and hearing impairment .",
        "entities": [
            {
                "entity_text": "left ear discharge",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "left-sided headache",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hearing impairment",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "MRI with contrast showed asymmetrical signal changes in the bilateral petrous bone with reduced enhancement on the left with high suspicion of petrositis ; in the context of chronic tympanomastoiditis , there was a 10 × 4 mm enhancing lesion in the left internal auditory meatus involving the 7 th- 8 th nerve complex .",
        "entities": [
            {
                "entity_text": "petrositis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "chronic tympanomastoiditis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "lesion",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient was treated conservatively with local and systemic antimicrobial agents , he had satisfactory response and improvement regarding symptoms of ear discharge , vertigo , and diplopia , but there is no remarkable response regarding hearing loss and tinnitus .",
        "entities": [
            {
                "entity_text": "ear discharge",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "vertigo",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "diplopia",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hearing loss",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "tinnitus",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A 27 - year-old pregnant woman presented to our facility at 35 weeks ' gestation with a 3 - months history of right upper abdominal pain associated with generalized itch , tea colored urine , mastic -colored stool , and significant weight loss .",
        "entities": [
            {
                "entity_text": "right upper abdominal pain",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "generalized itch",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "tea colored urine",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "mastic -colored stool",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "weight loss",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "No headache , blurred vision or spontaneous bleeding were mentioned .",
        "entities": [
            {
                "entity_text": "headache",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "blurred vision",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "bleeding",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She was not a known diabetic or hypertensive and has no history of blood transfusion .",
        "entities": [
            {
                "entity_text": "diabetic",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Clinical signs on examination included mild pallor and cholestatic jaundice .",
        "entities": [
            {
                "entity_text": "pallor",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "cholestatic jaundice",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Her blood pressure was 100 / 70 mmHg with a pulse rate of 98 beats / min , respiratory rate about 16 / min and oral temperature of 37 ° C .",
        "entities": []
    },
    {
        "text": "Respiratory , cardiovascular and neurological examinations were unremarkable .",
        "entities": []
    },
    {
        "text": "The abdomen was grossly distended with visible collateral veins .",
        "entities": []
    },
    {
        "text": "Liver was enlarged , hard , nodular with a painful irregular edge .",
        "entities": [
            {
                "entity_text": "Liver was enlarged",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The spleen was not palpable .",
        "entities": []
    },
    {
        "text": "There was bipedal edema up to the mid shin .",
        "entities": [
            {
                "entity_text": "bipedal edema",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Fetal heart rate was 140 bpm and regular .",
        "entities": []
    },
    {
        "text": "Laboratory examination showed leukocytosis , anemia and normal platelet counts .",
        "entities": [
            {
                "entity_text": "leukocytosis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "anemia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Aspartate aminotransferase ( AST ) were raised ( 4 times upper limit ) , total protein and albumin were low , 43 g / L and 25 g / L respectively , INR 1 . 20 and glycaemia 0 . 70 g / L .",
        "entities": []
    },
    {
        "text": "Her alphafeto-protein ( AFP ) was higher ( 2232 ng / mL ) .",
        "entities": []
    },
    {
        "text": "HBsAg was positive .",
        "entities": []
    },
    {
        "text": "She tested negative to human immunodeficiency viruses ( HIV ) and HCV .",
        "entities": [
            {
                "entity_text": "human immunodeficiency viruses",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "HIV",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "HCV",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Abdominal ultrasound showed a heterogeneous coarse liver with multiple hypoechoic lesions .",
        "entities": []
    },
    {
        "text": "Pelvic scan revealed a normal fetus with a gestational age of about 35 weeks .",
        "entities": []
    },
    {
        "text": "The diagnosis of hepatocellular carcinoma on a decompensated cirrhosis was made .",
        "entities": [
            {
                "entity_text": "hepatocellular carcinoma",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "decompensated cirrhosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She was managed with analgesia , spironolactone and tenofovir added for prevention of mother-to-child transmission of the hepatitis B infection .",
        "entities": [
            {
                "entity_text": "hepatitis B infection",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The plan was to have the mother ' s health improved to securely induce the labour .",
        "entities": []
    },
    {
        "text": "Unfortunately , at day two of hospitalization , the patient experienced progressive loss of conscious along with epistaxis and multi-organ failure .",
        "entities": [
            {
                "entity_text": "loss of conscious",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "epistaxis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "multi-organ failure",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Laboratory assessment revealed HB- 8 . 4 g / dL , WBC 37500 cells / dL , Platelets 436000 / ul , INR- 2 . 57 and recurrent hypoglycemia .",
        "entities": [
            {
                "entity_text": "recurrent hypoglycemia",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Cesarean section was urgently performed and the outcome was a healthy newborn weighted 2 . 9 kg but the mother died soon after .",
        "entities": []
    },
    {
        "text": "Patient information : a 9 - month-old boy presented to the emergency room with a 3 - day history of refusal to bear weight on the right lower extremity and febrile peaks of up to 38 . 5 ° C for 24 hours .",
        "entities": [
            {
                "entity_text": "febrile peaks",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "His parents had noted an ankle trauma in the previous week .",
        "entities": [
            {
                "entity_text": "ankle trauma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The primary care physician had initially suspected a talus fracture .",
        "entities": [
            {
                "entity_text": "talus fracture",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice .",
        "entities": []
    },
    {
        "text": "However , the child continued to experience ankle pain and fever .",
        "entities": [
            {
                "entity_text": "ankle pain",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "fever",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "He was returned to the emergency room after two days .",
        "entities": []
    },
    {
        "text": "His symptoms were aggravated .",
        "entities": []
    },
    {
        "text": "The ankle was noted to be slightly edematous , but warm to the touch , and diffusely tender to palpation .",
        "entities": []
    },
    {
        "text": "His temperature was 39 ° C .",
        "entities": []
    },
    {
        "text": "Diagnostic assessment : the hemoglobin was 9 . 5 g / dl , the white blood cell count was 18800 / mm 3 , and the C-reactive protein ( CRP ) was 75 mm / h .",
        "entities": []
    },
    {
        "text": "Serum laboratory studies , including CBC count and inflammatory markers , were all elevated .",
        "entities": []
    },
    {
        "text": "An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint .",
        "entities": [
            {
                "entity_text": "lesion of the talus",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "soft tissue swelling around the ankle joint",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "However , the computed tomography ( CT ) scan findings revealed a talus fracture .",
        "entities": [
            {
                "entity_text": "talus fracture",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A magnetic resonance imaging ( MRI ) was not done as it was not available .",
        "entities": []
    },
    {
        "text": "Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan .",
        "entities": [
            {
                "entity_text": "osteomyelitis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "septic arthritis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The bone scintigraphy demonstrated a septic arthritis and the presence of bone marrow edema in the talus without being able to reach a precise diagnosis of osteomyelitis .",
        "entities": [
            {
                "entity_text": "septic arthritis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "bone marrow edema",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "osteomyelitis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Therapeutic intervention : the patient was urgently taken to the operating room .",
        "entities": []
    },
    {
        "text": "During the operation , the ankle joint was explored through an anterior approach .",
        "entities": []
    },
    {
        "text": "There were some false membranes , a thin turbid fluid and a pertuit at the junction bone cartilage of the talus .",
        "entities": []
    },
    {
        "text": "The talar cartilage was regular and normal-looking .",
        "entities": []
    },
    {
        "text": "The pertuit , allowing access to a cavity , was cleaned and the yellow organized fibrinous pus was drained .",
        "entities": []
    },
    {
        "text": "The biopsy specimens for the histopathological examination and culture were taken at that site .",
        "entities": []
    },
    {
        "text": "Curettage and irrigation were performed , and the joint was closed over suction drains .",
        "entities": []
    },
    {
        "text": "An empirical antibiotic treatment IV ( cephalosporin + gentamycine ) was initiated .",
        "entities": []
    },
    {
        "text": "Follow-up and outcomes : febrile peaks persisted during the first three days .",
        "entities": [
            {
                "entity_text": "febrile peaks",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R .",
        "entities": []
    },
    {
        "text": "The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells .",
        "entities": [
            {
                "entity_text": "abscess",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "synovial cells",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "So , the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression .",
        "entities": []
    },
    {
        "text": "Drainage was maintained for twelve days ( until normalization of CRP ) and intravenous antibiotics for 3 weeks .",
        "entities": []
    },
    {
        "text": "In the third week , the peripheral leukocytes count was 8600 / mL , and the CRP decreased to 2 . 43 mg .",
        "entities": []
    },
    {
        "text": "The patient ' s antibiotic was then substituted by oral pristinamycin for three weeks .",
        "entities": []
    },
    {
        "text": "In the fourth week , the ESR and CRP were 7 mm / hr and 3 mg / L , respectively .",
        "entities": []
    },
    {
        "text": "At that time , the patient did not complain of any pain or limitation of the range of motion of the ankle .",
        "entities": [
            {
                "entity_text": "pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The cast was removed six weeks after surgery .",
        "entities": []
    },
    {
        "text": "At six months , radiographies showed that the lesion healed completely .",
        "entities": []
    },
    {
        "text": "The parents were very satisfied .",
        "entities": []
    },
    {
        "text": "Their child acquired walking at the age of 14 months .",
        "entities": []
    },
    {
        "text": "In the last follow-up visit at 18 months postoperatively , the patient had no pain or limitation in walking and running .",
        "entities": [
            {
                "entity_text": "pain",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "We report a case A 6 day old female neonate was referred to our center on account of bilateral eversion of the upper eyelids since birth .",
        "entities": [
            {
                "entity_text": "bilateral eversion of the upper eyelids",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route .",
        "entities": []
    },
    {
        "text": "There was no use of instrumentation and she cried spontaneously at birth .",
        "entities": []
    },
    {
        "text": "Further information gathered from the referral note revealed that the child has been on gentamycin eye drop and systemic antibiotics but with no apparent improvement 6 days prior to presentation-the reason for referral .",
        "entities": []
    },
    {
        "text": "Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids .",
        "entities": [
            {
                "entity_text": "bilateral complete eversion of the upper eyelids",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There were marked chemosis bilaterally worst in the right .",
        "entities": [
            {
                "entity_text": "chemosis bilaterally",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Both eyes were double-everted using lid retractor in order to assess the conditions of the two eyeballs which were both found to be normal .",
        "entities": []
    },
    {
        "text": "Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis .",
        "entities": [
            {
                "entity_text": "chemosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The child was admitted into Special baby care unit ( SBCU ) of our hospital to facilitate close monitoring .",
        "entities": []
    },
    {
        "text": "She was also reviewed by the pediatrician and no other abnormality was found .",
        "entities": []
    },
    {
        "text": "Perforated transparent catellar shield was applied over the eyes bilaterally to prevent trauma to the conjunctivae .",
        "entities": []
    },
    {
        "text": "She was commenced on hypertonic saline 4 hourly and piece of gauze soaked with hypertonic saline was placed over the prolapsed chemosed palpebral conjunctivae for 3 hours once in a day .",
        "entities": []
    },
    {
        "text": "She was also commenced on 2 hourly ciprofloxacin hydrochloride USP equivalent to ciprofloxacin 0 . 3 % w / v ) and maxitol ointment at night .",
        "entities": []
    },
    {
        "text": "On the 3 rd day of admission , the chemosis on the right had resolved significantly but there was still poor right lid opening .",
        "entities": [
            {
                "entity_text": "chemosis on the right",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "However , on the 5 th day of admission , both chemosis had resolved totally with spontaneous eye lid opening .",
        "entities": [
            {
                "entity_text": "chemosis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Both eyeballs were normal .",
        "entities": []
    },
    {
        "text": "A 26 years old nulliparous woman presented to our observation for severe right-sided epistaxis , non self-limiting .",
        "entities": []
    },
    {
        "text": "She had few episodes in the previous two weeks of epistaxis , even 3-4 per day , usually stopping spontaneously .",
        "entities": [
            {
                "entity_text": "epistaxis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "She reported a negative ENT consultation except for mild hyperemia of nasal mucosa .",
        "entities": [
            {
                "entity_text": "hyperemia of nasal mucosa",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The pregnancy was unremarkable , considered at low risk , at 39 . 6 weeks of gestation .",
        "entities": []
    },
    {
        "text": "Her familiar and personal history was negative for blood coagulopathies and hypertension .",
        "entities": [
            {
                "entity_text": "coagulopathies",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "hypertension",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "We tried to stop severe epistaxis with nasal packing and intravenous tranexamic acid .",
        "entities": [
            {
                "entity_text": "epistaxis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "On the basis of the failure of our procedures an otolaryngologist performed an endoscopy identifying bleeding enlarged vessels .",
        "entities": []
    },
    {
        "text": "Nasal packing with hemostatic sponge was successful , the pregnant woman was admitted to ob & gyn department .",
        "entities": []
    },
    {
        "text": "Her hemoglobin levels dropped down to 6 mg / dl and she needed 4 red cell packs .",
        "entities": []
    },
    {
        "text": "The day after her right nostril despite the tampons started bleeding again .",
        "entities": []
    },
    {
        "text": "She was referred to otolaryngologist who packed again the nose , bilaterally and used hemostatic glue .",
        "entities": []
    },
    {
        "text": "After 2 more days she started bleeding again , her nose was again packed with glue and tampons and further 2 red cell packs were given .",
        "entities": []
    },
    {
        "text": "The obstetric scan revealed biometry at 40 th centile , the Bishop score was 5 , so we decided to induce labour after obtaining her informed written consent .",
        "entities": []
    },
    {
        "text": "The labour induction was performed with intravaginal prostaglandins ( 10 mg dinoprostone ) .",
        "entities": []
    },
    {
        "text": "After 18 hours the labour seemed to proceed well with cervical dilatation of 6 cm , level of head 0 , but the cardiotocography ( CTG ) trace revealed anomalies that after 1 hour induced the shift versus cesarean section .",
        "entities": []
    },
    {
        "text": "No epistaxis happened during labour nor during cesarean section .",
        "entities": [
            {
                "entity_text": "epistaxis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Two days after nasal tampons were removed , the patient was discharged the day after .",
        "entities": []
    },
    {
        "text": "One month later the woman reported general good health and no epistaxis episodes , nor mild nor massive .",
        "entities": [
            {
                "entity_text": "epistaxis",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "A 54 - year-old female patient was admitted to our surgical department with a 2 mo history of decreased appetite , nausea , vomiting , and weight loss , which progressed to difficulty in feeding 3 d prior to her visit .",
        "entities": [
            {
                "entity_text": "decreased appetite",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "weight loss",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "According to her medical history , she was diagnosed with refractory ITP [ platelets ( PLT ) , 3000-8000 / L ] 10 years ago .",
        "entities": [
            {
                "entity_text": "ITP",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "After admission , the patient underwent a splenectomy and a distal subtotal gastrectomy ( D 2 radical resection ) with Roux-en-Y reconstruction simultaneously .",
        "entities": []
    },
    {
        "text": "She had an uneventful postoperative course with a slight increase in her PLT count .",
        "entities": []
    },
    {
        "text": "This case is unique in terms of the patient ' s complication of severe and medically refractory ITP .",
        "entities": []
    },
    {
        "text": "A 2 - year-old Japanese boy recently presented to our department with a chief complaint of neck swelling .",
        "entities": [
            {
                "entity_text": "neck swelling",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall .",
        "entities": [
            {
                "entity_text": "tonsillitis",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "swelling",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space , and a low-density area surrounded by an area without contrast enhancement in the posterior neck .",
        "entities": []
    },
    {
        "text": "The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess .",
        "entities": [
            {
                "entity_text": "infection",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "retropharyngeal abscess",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "After surgery , the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma .",
        "entities": [
            {
                "entity_text": "retropharyngeal abscess",
                "type": "CLINENTITY"
            },
            {
                "entity_text": "cystic lymphangioma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The lesions improved after intraoral incision and drainage , and administration of antibiotics .",
        "entities": [
            {
                "entity_text": "lesions",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "We report a 9 - year-old male child who was referred to us with swelling in the posterior aspect of the neck .",
        "entities": []
    },
    {
        "text": "Anteroposterior and lateral radiographs of the cervical spine show an elongated left spinous process in the neck at the level of C 5 vertebrae .",
        "entities": []
    },
    {
        "text": "There was an associated hemivertebra at the C 4 level .",
        "entities": []
    },
    {
        "text": "Computed tomography examination better depicted this congenital variant and clearly showed the associated schisis of the posterior arch as well as unfused spinous process at the same level on the left side .",
        "entities": []
    },
    {
        "text": "This is a very rare congenital anomaly and probably among the few such cases reported in literature .",
        "entities": []
    },
    {
        "text": "A 53 - year-old woman presented with a posterior left retroauricular mass , that was discovered 10 months ago and resected respectively at a local hospital .",
        "entities": []
    },
    {
        "text": "Ten days after this operation , a pruritic , painless lesion of a size 2 cm x 2 cm was observed at the incision area .",
        "entities": [
            {
                "entity_text": "lesion",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient had no history of migraine , loss of hearing , drug allergy , or trauma .",
        "entities": []
    },
    {
        "text": "Otoscope examination revealed an external auditory meatus protrusion , with a normal tympanic membrane .",
        "entities": []
    },
    {
        "text": "Magnetic resonance imaging ( MRI ) revealed a heterogeneous lesion .",
        "entities": [
            {
                "entity_text": "lesion",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The patient underwent extended left parotidectomy .",
        "entities": []
    },
    {
        "text": "An s-incision of 10 cm long was made extending from the earlobe towards the mandibular angle .",
        "entities": []
    },
    {
        "text": "With palpation , the tumour was located in the parotid gland .",
        "entities": [
            {
                "entity_text": "tumour",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The superficial lobe of the parotid gland was gradually removed with caution to the facial nerve trunk .",
        "entities": []
    },
    {
        "text": "The tumour had invaded the deep lobe of the parotid gland and the posterior wall of the external auditory canal .",
        "entities": [
            {
                "entity_text": "tumour",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "The deep lobe of the parotid gland was removed simultaneously , and the left cervical lymph node dissection was performed in levels II-IV , with its adipose connective tissue .",
        "entities": []
    },
    {
        "text": "The diameter of the larger lymph node being 2 cm .",
        "entities": []
    },
    {
        "text": "A method of sleeve resection was used to remove the protruding posterior wall of the external auditory canal .",
        "entities": []
    },
    {
        "text": "A drainage tube was inserted .",
        "entities": []
    },
    {
        "text": "There was no complication , the operation was completed and the patient recovered well .",
        "entities": []
    },
    {
        "text": "The pathological results showed that the tumour of about 2 cm x 2 cm x 1 . 4 cm , involved the epidermis , vessels , and nerves .",
        "entities": [
            {
                "entity_text": "tumour",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "There was a distribution of the lymph node with metastasis and distribution of the external auditory canal with mucoepidermoid carcinoma .",
        "entities": [
            {
                "entity_text": "mucoepidermoid carcinoma",
                "type": "CLINENTITY"
            }
        ]
    },
    {
        "text": "Immunohistochemistry results showed CK 7 ( + ) , calponin ( - ) , CK 5 / 6 ( + ) , P 63 ( + ) , S- 100 ( - ) , Dog- 1 ( + ) , CD 117 ( - ) , Ki- 67 ( + 5 % ) , P 53 ( - ) , and EMA ( + ) .",
        "entities": []
    },
    {
        "text": "Hematoxylin and eosin ( H & E ) staining indicated a D-PAS positive .",
        "entities": []
    },
    {
        "text": "The clinical diagnosis was pleomorphic adenoma .",
        "entities": [
            {
                "entity_text": "pleomorphic adenoma",
                "type": "CLINENTITY"
            }
        ]
    }
]