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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 .
[ { "entity_text": "ovarian cyst", "type": "CLINENTITY" } ]
The patient underwent menopause at age 48 years , with an uneventful past menstrual cycle .
[]
She had no medical history except the benign thyroid nodule , no relevant surgical history and had not received hormonal therapy .
[ { "entity_text": "benign thyroid nodule", "type": "CLINENTITY" } ]
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 .
[]
Uterine cervical cytology at the time of admission was normal .
[]
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 .
[ { "entity_text": "ovarian unilocular cyst", "type": "CLINENTITY" } ]
The uterus size was 6 cm × 4 cm × 3 cm , and a 1 cm uterine myoma was found in the fundus .
[ { "entity_text": "uterine myoma", "type": "CLINENTITY" } ]
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 .
[ { "entity_text": "unilocular cystic lesion", "type": "CLINENTITY" }, { "entity_text": "lymphadenopathy", "type": "CLINENTITY" }, { "entity_text": "ascites", "type": "CLINENTITY" } ]
CT scan indicated benign ovarian cystic tumors .
[ { "entity_text": "benign ovarian cystic tumors", "type": "CLINENTITY" } ]
The patient underwent laparoendoscopic single-site ( LESS ) surgery .
[]
On laparoscopic inspection , the cyst was found to be located in the ampullary and fimbrial regions of the left fallopian tube .
[ { "entity_text": "cyst", "type": "CLINENTITY" } ]
The left fallopian tube was grossly unremarkable and the left ovary was atrophied .
[ { "entity_text": "left ovary was atrophied", "type": "CLINENTITY" } ]
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 .
[ { "entity_text": "cyst", "type": "CLINENTITY" }, { "entity_text": "cyst", "type": "CLINENTITY" } ]
Clinical diagnosis was suggestive of left paratubal cyst .
[ { "entity_text": "paratubal cyst", "type": "CLINENTITY" } ]
The patient underwent hysterectomy and BSO .
[]
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 .
[ { "entity_text": "malignancy", "type": "CLINENTITY" } ]
Frozen sections were prepared from surgery specimens and confirmed a benign cyst .
[ { "entity_text": "benign cyst", "type": "CLINENTITY" } ]
After surgery , the pelvic cavity was explored and no specific findings were found in the abdominal cavity .
[]
Histopathological examination of the paratubal cyst revealed the presence of polypoid lesions on the internal surface of the cyst .
[ { "entity_text": "polypoid lesions", "type": "CLINENTITY" }, { "entity_text": "cyst", "type": "CLINENTITY" } ]
The tumor cells showed nuclear atypism and stratification , which are histological characteristics of borderline tumor .
[ { "entity_text": "tumor cells", "type": "CLINENTITY" } ]
A final diagnosis of paratubal borderline serous tumor was confirmed .
[ { "entity_text": "paratubal borderline serous tumor", "type": "CLINENTITY" } ]
The patient was discharged from the hospital on postoperative day 3 .
[]
CT images were retrospectively evaluated , focusing on the left ovary , fallopian tube , and paratubal cyst after surgery .
[ { "entity_text": "paratubal cyst", "type": "CLINENTITY" } ]
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 .
[ { "entity_text": "cyst", "type": "CLINENTITY" }, { "entity_text": "paratubal cyst", "type": "CLINENTITY" } ]
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 .
[ { "entity_text": "tumor", "type": "CLINENTITY" } ]
Pelvic ECT , TVS and tumor markers were checked every three months .
[]
The patient remains asymptomatic and follow-up at 24 months showed no evidence of recurrence or metastasis .
[ { "entity_text": "metastasis", "type": "CLINENTITY" } ]
A 61 - year-old man presented with chronic left ear discharge , left-sided headache , diplopia associated with vertigo , tinnitus , and hearing impairment .
[ { "entity_text": "left ear discharge", "type": "CLINENTITY" }, { "entity_text": "left-sided headache", "type": "CLINENTITY" }, { "entity_text": "hearing impairment", "type": "CLINENTITY" } ]
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 .
[ { "entity_text": "petrositis", "type": "CLINENTITY" }, { "entity_text": "chronic tympanomastoiditis", "type": "CLINENTITY" }, { "entity_text": "lesion", "type": "CLINENTITY" } ]
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 .
[ { "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": "CL...
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 .
[ { "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" }, { "e...
No headache , blurred vision or spontaneous bleeding were mentioned .
[ { "entity_text": "headache", "type": "CLINENTITY" }, { "entity_text": "blurred vision", "type": "CLINENTITY" }, { "entity_text": "bleeding", "type": "CLINENTITY" } ]
She was not a known diabetic or hypertensive and has no history of blood transfusion .
[ { "entity_text": "diabetic", "type": "CLINENTITY" } ]
Clinical signs on examination included mild pallor and cholestatic jaundice .
[ { "entity_text": "pallor", "type": "CLINENTITY" }, { "entity_text": "cholestatic jaundice", "type": "CLINENTITY" } ]
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 .
[]
Respiratory , cardiovascular and neurological examinations were unremarkable .
[]
The abdomen was grossly distended with visible collateral veins .
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Liver was enlarged , hard , nodular with a painful irregular edge .
[ { "entity_text": "Liver was enlarged", "type": "CLINENTITY" } ]
The spleen was not palpable .
[]
There was bipedal edema up to the mid shin .
[ { "entity_text": "bipedal edema", "type": "CLINENTITY" } ]
Fetal heart rate was 140 bpm and regular .
[]
Laboratory examination showed leukocytosis , anemia and normal platelet counts .
[ { "entity_text": "leukocytosis", "type": "CLINENTITY" }, { "entity_text": "anemia", "type": "CLINENTITY" } ]
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 .
[]
Her alphafeto-protein ( AFP ) was higher ( 2232 ng / mL ) .
[]
HBsAg was positive .
[]
She tested negative to human immunodeficiency viruses ( HIV ) and HCV .
[ { "entity_text": "human immunodeficiency viruses", "type": "CLINENTITY" }, { "entity_text": "HIV", "type": "CLINENTITY" }, { "entity_text": "HCV", "type": "CLINENTITY" } ]
Abdominal ultrasound showed a heterogeneous coarse liver with multiple hypoechoic lesions .
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Pelvic scan revealed a normal fetus with a gestational age of about 35 weeks .
[]
The diagnosis of hepatocellular carcinoma on a decompensated cirrhosis was made .
[ { "entity_text": "hepatocellular carcinoma", "type": "CLINENTITY" }, { "entity_text": "decompensated cirrhosis", "type": "CLINENTITY" } ]
She was managed with analgesia , spironolactone and tenofovir added for prevention of mother-to-child transmission of the hepatitis B infection .
[ { "entity_text": "hepatitis B infection", "type": "CLINENTITY" } ]
The plan was to have the mother ' s health improved to securely induce the labour .
[]
Unfortunately , at day two of hospitalization , the patient experienced progressive loss of conscious along with epistaxis and multi-organ failure .
[ { "entity_text": "loss of conscious", "type": "CLINENTITY" }, { "entity_text": "epistaxis", "type": "CLINENTITY" }, { "entity_text": "multi-organ failure", "type": "CLINENTITY" } ]
Laboratory assessment revealed HB- 8 . 4 g / dL , WBC 37500 cells / dL , Platelets 436000 / ul , INR- 2 . 57 and recurrent hypoglycemia .
[ { "entity_text": "recurrent hypoglycemia", "type": "CLINENTITY" } ]
Cesarean section was urgently performed and the outcome was a healthy newborn weighted 2 . 9 kg but the mother died soon after .
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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 .
[ { "entity_text": "febrile peaks", "type": "CLINENTITY" } ]
His parents had noted an ankle trauma in the previous week .
[ { "entity_text": "ankle trauma", "type": "CLINENTITY" } ]
The primary care physician had initially suspected a talus fracture .
[ { "entity_text": "talus fracture", "type": "CLINENTITY" } ]
His right ankle was immobilized by a plaster splint and his parents were instructed to apply ice .
[]
However , the child continued to experience ankle pain and fever .
[ { "entity_text": "ankle pain", "type": "CLINENTITY" }, { "entity_text": "fever", "type": "CLINENTITY" } ]
He was returned to the emergency room after two days .
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His symptoms were aggravated .
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The ankle was noted to be slightly edematous , but warm to the touch , and diffusely tender to palpation .
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His temperature was 39 ° C .
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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 .
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Serum laboratory studies , including CBC count and inflammatory markers , were all elevated .
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An X-ray of the ankle showed a posterior-medial lytic lesion of the talus and soft tissue swelling around the ankle joint .
[ { "entity_text": "lesion of the talus", "type": "CLINENTITY" }, { "entity_text": "soft tissue swelling around the ankle joint", "type": "CLINENTITY" } ]
However , the computed tomography ( CT ) scan findings revealed a talus fracture .
[ { "entity_text": "talus fracture", "type": "CLINENTITY" } ]
A magnetic resonance imaging ( MRI ) was not done as it was not available .
[]
Given the clinical findings a talar osteomyelitis with septic arthritis of the ankle was suspected despite the result of the CT scan .
[ { "entity_text": "osteomyelitis", "type": "CLINENTITY" }, { "entity_text": "septic arthritis", "type": "CLINENTITY" } ]
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 .
[ { "entity_text": "septic arthritis", "type": "CLINENTITY" }, { "entity_text": "bone marrow edema", "type": "CLINENTITY" }, { "entity_text": "osteomyelitis", "type": "CLINENTITY" } ]
Therapeutic intervention : the patient was urgently taken to the operating room .
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During the operation , the ankle joint was explored through an anterior approach .
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There were some false membranes , a thin turbid fluid and a pertuit at the junction bone cartilage of the talus .
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The talar cartilage was regular and normal-looking .
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The pertuit , allowing access to a cavity , was cleaned and the yellow organized fibrinous pus was drained .
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The biopsy specimens for the histopathological examination and culture were taken at that site .
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Curettage and irrigation were performed , and the joint was closed over suction drains .
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An empirical antibiotic treatment IV ( cephalosporin + gentamycine ) was initiated .
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Follow-up and outcomes : febrile peaks persisted during the first three days .
[ { "entity_text": "febrile peaks", "type": "CLINENTITY" } ]
The blood culture and the specimen of the joint isolated Staphylococcus aureus Meti-R .
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The anatomopathological analysis of the ankle specimen showed histological features of an abscess and hyperplastic synovial cells .
[ { "entity_text": "abscess", "type": "CLINENTITY" }, { "entity_text": "synovial cells", "type": "CLINENTITY" } ]
So , the IV antibiotic treatment was substituted by teicoplanin with a better clinical and biological progression .
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Drainage was maintained for twelve days ( until normalization of CRP ) and intravenous antibiotics for 3 weeks .
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In the third week , the peripheral leukocytes count was 8600 / mL , and the CRP decreased to 2 . 43 mg .
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The patient ' s antibiotic was then substituted by oral pristinamycin for three weeks .
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In the fourth week , the ESR and CRP were 7 mm / hr and 3 mg / L , respectively .
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At that time , the patient did not complain of any pain or limitation of the range of motion of the ankle .
[ { "entity_text": "pain", "type": "CLINENTITY" } ]
The cast was removed six weeks after surgery .
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At six months , radiographies showed that the lesion healed completely .
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The parents were very satisfied .
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Their child acquired walking at the age of 14 months .
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In the last follow-up visit at 18 months postoperatively , the patient had no pain or limitation in walking and running .
[ { "entity_text": "pain", "type": "CLINENTITY" } ]
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 .
[ { "entity_text": "bilateral eversion of the upper eyelids", "type": "CLINENTITY" } ]
The baby was a full term product of an uneventful pregnancy delivered via spontaneous vaginal route .
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There was no use of instrumentation and she cried spontaneously at birth .
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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 .
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Examination at presentation revealed an otherwise normal child with bilateral complete eversion of the upper eyelids .
[ { "entity_text": "bilateral complete eversion of the upper eyelids", "type": "CLINENTITY" } ]
There were marked chemosis bilaterally worst in the right .
[ { "entity_text": "chemosis bilaterally", "type": "CLINENTITY" } ]
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 .
[]
Attempt at repositioning the eyelids was unsuccessful because of the marked chemosis .
[ { "entity_text": "chemosis", "type": "CLINENTITY" } ]