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data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1038_en_sum.txt

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+Despite being an uncommon complication of penile strangulation, we report a 45-year-old prison inmate who presented with penile shaft necrosis secondary to using a non-metallic constriction object. The patient reported a 5-day history of progressive penile pain, edema, and skin injury but no urinary symptoms. The patient underwent complete penile skin degloving, circumcision, and insertion of a suprapubic catheter. Postoperatively, the penile tissue appeared healthy, and the wound was granulating. On the eleventh day following degloving, a full-thickness skin graft was taken from the groin area. The patient remained in the hospital for 20 days, during which he was clinically stable with clean, healing wounds.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1049_en_sum.txt

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+The study case was a 29-year-old man, admitted to the hospital four years ago due to esophageal variceal hemorrhage. A biopsy of his liver showed cryptogenic cirrhosis; thus, he was a candidate for liver transplant. The patient visited the outpatient Iranian traditional medicine center, Behesht Clinic, in Tehran, Iran, two years after his bleeding course and began treatment with traditional herbal medicine. In the following month, he stopped taking his previous medications. During the 18-month follow up, he was visited 16 times. During this time, his general health improved and his hemoglobin level increased. Based on the ultrasound reports, the spleen size, the gallbladder wall edema, and the portal vein diameter decreased. Even though the ascites disappeared, the patient gained weight. His model for end-stage liver disease (MELD) score reduced from 10 (prior to the Iranian traditional medicine treatment) to 8. The bilirubin level decreased as well. The alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels increased and the serum albumin level and platelet count decreased.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1075_en_sum.txt

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+A 34-year-old male identified with a definitive diagnosis of KS was hospitalized to our cardiac surgery center through the emergency with chief complaints of acute chest pain and dyspnea. Saddle pulmonary thromboembolism was established from chest Computed Tomography Angiography (CTA). The patient's symptoms resolved after embolectomy via surgery.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1088_en_sum.txt

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+A 31-year-old man who presented with abdominal pain was diagnosed with perforated diverticulitis and sent to our hospital for evaluation. He had morbid obesity (body mass index (BMI) 50 kg/m2), acute renal failure, and uncontrolled diabetes. We performed an emergency operation including laparoscopic lavage and drainage with a diverting ileostomy for this case of Hinchey III diverticulitis. Fifteen months after the first-stage surgery, we performed laparoscopic sigmoidectomy as the second stage. Finally, 5 months later, we performed ileostomy closure. The patient recovered without significant complications.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1094_en_sum.txt

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+The patient was a 66-year-old man who underwent rectal resection and postoperative chemotherapy for rectal cancer. A liver metastasis caused obstructive jaundice and acute cholangitis, necessitating emergency hospitalization. A 3.5 cm mass in the hilar region of the biliary tree caused type IV biliary obstruction according to the Bismuth-Corlette classification of hilar cholangiocarcinoma. ERCP and biliary drainage were performed repeatedly, but had no effect. Given that selective bile duct drainage had proven extremely difficult with the conventional procedures, three-dimensional (3D) images were created from preoperative CT image data using a 3D image reconstruction system (SYNAPSE VINCENT version 5, FUJIFILM Corporation, Tokyo, Japan). Using the 3D images for preoperative planning and intraoperative reference, biliary drainage and stent placement were successfully performed without complications. Postoperatively, the patient had no further cholangitis or need for stent replacement up to his death.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1121_en_sum.txt

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+A 33-year-old Caucasian woman presented with a dichorionic diamniotic twin pregnancy. One fetus showed early growth restriction resulting in fetal death at 20 weeks. The placenta was enlarged with some cysts. Chorionic villus biopsy confirmed triploidy. At 21 weeks, the patient developed preeclampsia with a blood pressure of 154/98 mmHg and proteinuria (24 hour protein excretion of 2.5 g/L), for which she was hospitalized. Without pharmacological interventions, the blood pressure normalized and proteinuria disappeared. At 35 weeks, she again developed preeclampsia. A cesarean section was performed at 38 weeks and a healthy child was born.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1140_en_sum.txt

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+Here, we summarize clinical information of all patients with definite ganciclovir-induced encephalopathy including our own patient, who had severe symptoms, with the highest reported trough concentration of ganciclovir in the blood, and underwent therapeutic dialysis with complete recovery.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1141_en_sum.txt

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+We experienced a case of a 47-yo woman with recent history of systemic lupus erythematosus (SLE) diagnosed with endometrial cancer, initially suspected to have metastasized to pelvic and para-aortic lymph nodes based on preoperative diagnostic imaging. Subsequent pathological diagnosis revealed stage IB endometrial cancer without evidence of lymph node involvement. Instead, enlarged pelvic and para-aortic lymph nodes were found to be due to extrapulmonary LAM, from a primary lesion found inside the uterine myometrium. SLE improved after surgery.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1216_en_sum.txt

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+Herein, we report the case of a 24-year-old female who on her first visit to the hospital, presented with pregnancy combined with extremely high hyperlipidemia and hyperlactic acidosis with anemia, and frequent hypoglycemia occurred during the treatment. Genetic tests revealed a mutation in the G6Pase gene (G6PC) at 17q21, the patient was finally diagnosed with glycogen storage disease type Ia for the first time after 22 years of inaccurate treatment. She has been treated with a continuous double filtration plasmapheresis (DFPP) strategy to remove blood lipids, and a cornstarch diet therapy. The patient did not develop pancreatitis during the course of the disease and a healthy baby girl weighing 3 kg was delivered.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1232_en_sum.txt

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+A 57-year-old Japanese woman presented with a 1.5-year history of right hip pain. She had a history of bilateral developmental dysplasia of the hip and had undergone bilateral arthroplasties in childhood. A physical examination revealed a large, firm, immobile mass at her right ilium. Based on radiographic findings, a type of slow-growing bone tumor was suspected, and an incisional biopsy was performed. A histopathologic examination revealed large amounts of old clotted blood within the lesion, and the capsule of the lesion was composed of dense, fibrous, connective tissue. There was no evidence of neoplasia, and chronic expanding hematoma was suspected. The lesion was resistant to conservative treatment, and so we performed an internal hemipelvectomy (including the capsule of the mass) and a reconstruction by hip transposition 2.5 years after the incisional biopsy. There was no recurrence of chronic expanding hematoma at the most recent follow-up of 1 year and 8 months postoperatively.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1260_en_sum.txt

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+A four-year-old girl presented with fever and a painful limp in the left hip. Pain characteristics and anemia detected in the blood analyses were the first warning signs that the hip process was not standard. Although the primary suspicion was of septic arthritis, a CT scan of the abdomen revealed an adrenal neuroblastoma.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1268_en_sum.txt

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+We report a case of RM patient accompanied with SLE and Hashimoto's thyroiditis of primary hypothyroidism. Progressing, diffuse, symmetric, and reticular hyperpigmentation was seen on the face, neck, and upper limbs, manifesting as typical melanosis. Skin microscopy showed diffuse black-pepper-like changes and telangiectasias. The diagnosis of SLE and primary hypothyroidism were confirmed by follow-up investigations. The hyperpigmentation turned notably lighter after 14 months of treatment with prednisone, hydroxychloroquine, and L-thyroxine.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1296_en_sum.txt

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+We report a case in which we successfully used LIPUS in a 19-year-old Caucasian man with a nonunion of his ring finger after injury and first treatment with K-wire osteosynthesis.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1306_en_sum.txt

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+Here, we report a patient who developed acute bilateral hearing loss, ataxia and paraparesis subsequently to intravenous methadone-abuse. While the patient gradually recovered from these deficits, widespread magnetic resonance imaging changes progressed and delayed-onset encephalopathy with signs of cortical dysfunction persisted. This was associated with changes in the composition of monocyte and natural killer cell subsets in the cerebrospinal fluid.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1397_en_sum.txt

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+A 61-year-old man presented with swelling, pain, and bruising of his penis, along with gross hematuria. He reported that he sustained this injury while having sex with his wife. We suspected a penile fracture and obtained magnetic resonance imaging, which showed a rupture of the ventral corpus spongiosum and clarified the appropriate approach for repair. We used a direct transverse incision to repair both the urethral injury and the corpus spongiosum. Surgery went well, without any significant intraoperative or postoperative complications. We removed the urinary catheter on postoperative day 8, and cystoscopy showed no urethral stenosis on postoperative day 17. The patient's postoperative erectile function was the same as before his injury.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1411_en_sum.txt

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+We present a case of a 48-year-old Thai woman who presented with nephrotic syndrome due to systemic lupus erythematosus-related nephritis. Initially, few B. coli cysts were found in urine sediment, but these increased substantially following treatment with prednisolone. She made an uneventful recovery with 10 days of oral tetracycline therapy. No B. coli cysts were found in her stool.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1420_en_sum.txt

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+A 38-year-old female nursing technician complained of three episodes of anaphylaxis in one year, all in the workplace. To investigate latex allergy, the patient underwent the prick test with latex, and immediately developed a rash, itchy skin, hoarseness, dyspnea and dry cough. Her condition improved promptly after appropriate measures were established for controlling her anaphylaxis.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1456_en_sum.txt

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+A patient with a history of prostate cancer presented with pleural fluid, peripheral edema and bone pain. A super scan of the bone was found which suggested diffuse skeletal metastasis of the prostate cancer but the patient also had a prostate specific antigen level which was not compatible with this diagnosis. Further investigations revealed the paraneoplastic phenomenon of hypertrophic osteoarthropathy, related to an incurable carcinoma of the lung, to be the cause of the super scan.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_147_en_sum.txt

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+A 67 year-old man who presented with weight loss, chest pain and epigastric pain was found to have pericardial effusion and pneumopericardium on computed imaging. Endoscopy and histology confirmed a gastric adenocarcinoma within a hiatus hernia, which had fistulated to the pericardium. His condition was complicated by pulmonary emboli and lobar infarction, all contributing to rapid deterioration and death.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1483_en_sum.txt

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+We report a case of a 25-year-old Sri Lankan woman presenting with features of recurrent upper small intestinal obstruction and biliary obstruction. She had clinical as well as biochemical evidence of intermittent biliary obstruction. Evidence of duodenal intussusception was found in a computed tomography enterogram and a duodenal polyp was noted as the lead point. Marked elongation and distortion of her lower common bile duct with intrahepatic duct dilatation was also noted and the ampulla was found to be on the left side of the midline pulled toward the intussusceptum. Open polypectomy and reduction of intussusception were done and she became fully asymptomatic following surgery. Histology of the resected specimen was reported as a typical "Peutz-Jeghers polyp". As there was not enough evidence to diagnose Peutz-Jeghers syndrome this was considered to be a sporadic Peutz-Jeghers polyp.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1524_en_sum.txt

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+A 36-year-old male patient with severe, continuous pain and swelling of tongue for 6 weeks was presented to Goba Referral Hospital. The swelling was 2 cm by 1 cm, located on posterior central tongue, and frank pus oozed from the center of the swelling. He had associated dysphagia, odynophagia, and speech difficulty. He had no previous personal and family history of similar illness and tonsillitis. Gram staining revealed the presence of Gram-positive cocci in clusters. Pyogenic lingual abscess was the diagnosis. Treatment included incision and drainage with the administration of systemic antibiotics, which covered both aerobic and anaerobic organisms, and anti-pain drugs. The condition did not relapse in 6 months of follow-up.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1539_en_sum.txt

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+We describe the case of a 74-year-old woman with left frontotemporal lobe atrophy who presented with progressive anarthria and non-fluent aphasia. Her brother had been diagnosed with corticobasal syndrome (CBS) with right-hand limb-kinetic apraxia, aphasia, and a similar pattern of brain atrophy. Laboratory blood examinations did not reveal abnormalities that could have caused cognitive dysfunction. In the cerebrospinal fluid, cell counts and protein concentrations were within normal ranges, and concentrations of tau protein and phosphorylated tau protein were also normal. Since similar familial cases due to mutation of GRN and microtubule-associated protein tau gene (MAPT) were reported, we performed genetic analysis. No pathological mutations of MAPT were identified, but we identified a novel GRN frameshift mutation (c.1118_1119delCCinsG: p.Pro373ArgX37) that resulted in progranulin haploinsufficiency.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1553_en_sum.txt

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+A 27-year-old woman visited our gynecology department because of abdominal pain and genital bleeding. Magnetic resonance imaging (MRI) revealed a 3-cm-sized cystic mass in the left retrorectal area, and she was referred to our department for detailed examinations and treatment. She was diagnosed with a presacral cystic tumor and decided to undergo surgery. We used a transsacral approach to perform tumor excision. Since it was difficult to confirm the deep part of the tumor through direct visualization, we used GelPOINT® Path (a transanal access platform) and AirSEAL® System (insufflation device) to remove the tumor endoscopically. The postoperative course was uneventful with no bladder or rectal dysfunction. Histopathological examination revealed a mature teratoma.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1575_en_sum.txt

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+An 81-year-old Lithuanian woman was diagnosed with caecal cancer and had undergone elective surgery. A right hemicolectomy was performed and a Meckel's diverticulum was observed and excised. Histological results showed a poorly differentiated G3 adenocarcinoma of her large intestine and heterotopic pancreas tissue in the Meckel's diverticulum and mesenteric adipose tissue.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1585_en_sum.txt

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+A case of verruciform xanthoma on the tongue of a 56-year-old female with oral lichen planus is reported. An asymptomatic pink-white lesion with a granular surface was observed in the left lateral lingual border, which was closely associated with a white plaque and striae. An incisional biopsy was performed, and histologically, epithelial projections in a verrucous pattern were observed. In the subepithelial connective tissue, aggregates of foamy cells that exhibited immunoreactivity for CD68 were noted. The final diagnosis was verruciform xanthoma. The mucosa adjacent to the lesion demonstrated histopathological features consistent with lichen planus.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1605_en_sum.txt

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+A 71-year-old man with severe COPD, Global Initiative for Obstructive Lung Diseases stage 3 underwent an 8-wk remotely monitored inspiratory muscle training with a device based on the test of incremental respiratory endurance method. Spirometry, body plethysmography, test of incremental respiratory endurance examination, 6-min walking test, body mass index, airflow obstruction, dyspnea, exercise capacity index, and subjective perception of dyspnea were performed as part of the initial and final examination. The patient performed training at home, and the physiotherapist monitored the patient remotely through a web application that allowed the physiotherapist to evaluate all training parameters in real-time and respond to any problems. After 8 wk of home training, there was a significant increase in all monitored values: maximal inspiratory pressure, a novel parameter sustained maximal inspiratory pressure, forced expiratory volume in 1 s, total lung capacity, forced vital capacity, peak expiratory flow, and inspiratory capacity. There was also an improvement in the perception of dyspnea according to the COPD Assessment Test and a modified Medical Research Council Breathlessness Scale, an increase in exercise tolerance according to the 6-min walking test, and a decrease in the exercise capacity index as a predictor of prognosis.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1643_en_sum.txt

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+A 14-month-old male castrated domestic shorthair cat, which 2 months prior to presentation underwent hindlimb amputation following a road traffic accident, presented for investigation of four suspected generalised tonic-clonic seizures. Neurological examination was unremarkable. Routine blood work (haematology, biochemistry, ammonia, preprandial bile acids) was unremarkable. MRI of the brain identified marked symmetrical T2-weighted hyperintensities of the cerebellum and brainstem, mainly affecting the grey matter. Urine amino acid and mucopolysaccharide levels were unremarkable. Urine organic acids on two separate samples, 35 days apart, identified highly increased excretion of 2-hydroxyglutaric acid, indicative of 2-hydroxyglutaric aciduria. The cat was started on anticonvulsant therapy with phenobarbitone, which, at the point of writing, has improved seizure control, although the cat has not achieved seizure freedom.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1648_en_sum.txt

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+We report a 64-year-old female admitted for sudden onset of severe right abdominal pain after IVC filter placement for 3 mo. The patient had a history of failed endovascular IVC filter retrieval. Computed tomography showed that the retrieval hook of the filter penetrated the right common iliac artery and vein, leading to right iliac artery pseudoaneurysm accompanied by right ureteral obstruction with ipsilateral hydronephrosis, and bilateral iliac veins were occluded. Emergency open repair was performed to remove the IVC filter, the right iliac pseudoaneurysm, and the compromised segments of the iliac veins and IVC with right common iliac artery reconstruction. Staphylococcus aureus was isolated from the tissue culture. The patient was discharged on postoperative day 12 with anticoagulation therapy and antibiotic therapy after discharge. Six-month follow-up computed tomography revealed that the right common iliac artery was patent, and only mild hydronephrosis was detected.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1658_en_sum.txt

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+We report a 54-year-old male with peripheral neuropathy of bilateral lower limbs, sclerotic bone lesions, elevated vascular endothelial growth factor (VEGF) levels, splenomegaly, extravascular volume overload, endocrinopathy, and skin hemangiomas. Of note, serum and urine protein electrophoresis (PEP) and immunofixation electrophoresis (IFE) of this patient indicated undetectable M-protein and the normal ratio of free light chains κ and λ (FLC-R (κ/λ)). No monoclonal PCs were found in bone marrow examinations or biopsy of diseased bones. However, his clinical manifestations matched most of the diagnostic criteria. After excluding other diseases that are easily confused with POEMS syndrome, the diagnosis of variant POEMS syndrome with undetectable M-protein was proposed. The patient obtained clinically significant improvement and elevated VEGF returned to normal after 6 months of treatment with lenalidomide plus dexamethasone.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1679_en_sum.txt

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+Our patient developed pustular cutaneous lesions at 1 year of age. At the age of 12 years, she was hospitalized for arthralgia of her knees, elbows, and ankles and arthritis of the left knee, with simultaneous pustular cutaneous lesions. She was admitted to the intensive care unit because of septicemia and respiratory insufficiency during follow-up. A skin biopsy of hyperpigmented lesions demonstrated neutrophil infiltration in the epidermis and subepidermal pustular dermatosis. Interleukin-1 receptor antagonist deficiency was suspected, and genetic analysis revealed a homozygous mutation (p.R26X) in IL1RN, which led to a diagnosis of interleukin-1 receptor antagonist deficiency. Treatment with canakinumab (recombinant human anti-human interleukin-1β monoclonal antibody) 150 mg subcutaneously once every 6 weeks was initiated. Our patient did not experience further cutaneous lesions or arthritis. Her post-treatment inflammatory markers were normal; she gained weight; and she was able to walk independently.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_167_en_sum.txt

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+We present a case report of a 53-year-old white man who presented with atraumatic, posterior knee pain and was found to have a congenital, anomalous band originating from the fabella, causing semimembranosus impingement. This was diagnosed with magnetic resonance imaging; he underwent division of the anomalous band, which resulted in complete resolution of his symptoms.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1682_en_sum.txt

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+We report a 21-year-old male presented with one month history of fever, loss of appetite, weight loss and reduced hair growth with an examination revealing an oral ulcer, cervical and axillary lymphadenopathy simulating hematological malignancy. Investigations showed pancytopenia, positive anti-nuclear factor and double-stranded DNA, high erythrocyte sedimentation rate with normal C-reactive protein levels and hypocomplementemia. The diagnosis of systemic lupus erythematosus was made and treatment with oral prednisolone conferred a dramatic clinical and biochemical improvement within one week.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1718_en_sum.txt

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+A 12-day-old neonate born with a bilateral cleft of lip and alveolus was referred from the Department of Plastic Surgery. PNAM was planned in consultation with the plastic surgeon. A customized nasoalveolar molding plate was fabricated, and tissue molding was carried out. Following nasoalveolar molding, primary surgical repair was done.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1722_en_sum.txt

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+We report on a child presenting severe ambiguous genitalia. Due to access constraints, specialized care did not start until the child was 10 months old. Parents are consanguineous and were born in an area of high isonymy that is a cluster for rare recessive diseases. A new homozygous missense variant c.785G > T was found in exon 10 of the HSD17B3 gene.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_172_en_sum.txt

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+We report the case of a 68-year-old Asian man with metastatic lung adenocarcinoma harboring an EGFR L858R mutation, which was initially treated with gefitinib. He developed disease progression 1 year later. Re-biopsy of the right lower lobe primary lesion revealed only an EGFR L858R mutation in the absence of a T790M mutation. The patient also experienced persistent confusion and generalized fatigue, and magnetic resonance imaging (MRI) of the brain demonstrated extensive LM. At this time, a liquid biopsy revealed an EGFR T790M mutation. Following initiation of treatment with osimertinib, the patient exhibited a rapid response with MRI of the brain showing substantial improvement of the LM after 6 months. Unfortunately, the LM recurred after 1 year at which time the patient declined further systemic chemotherapy.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1787_en_sum.txt

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+We present a case of a previously healthy 26-year-old woman who presented with a 2-month history of fevers. Blood cultures on admission were positive for S. gordonii. Echocardiography demonstrated a congenital bicuspid aortic valve with vegetations and abscess, supporting a diagnosis of infective endocarditis. A magnetic resonance imaging (MRI) brain revealed a small cerebral empyema. She was treated with intravenous antibiotics and underwent an aortic valve replacement.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1806_en_sum.txt

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+We report a 40-year-old female who presented with chronic headache over a decade associated with recurrent neurological abnormalities including optic neuritis, hemisensory loss, migraine, facial nerve palsy, and recurrent vertigo. Although there was an initial perceived response to steroids, the patient had a subsequent progressive course. On investigations, she was found to have a diffused dural thickening on contrast MRI with a strongly positive Mantoux test with caseating necrotizing granulomatous inflammation on dural histology. With initiation of antituberculous medication with steroids, the patient markedly improved, and the medication for tuberculosis was continued for a year with good response.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1832_en_sum.txt

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+a 37-year-old woman presented with a painless mass in the vulva. Magnetic resonance imaging (MRI) showed a well-circumscribed 7 cm mass in the subcutis of the vulva. The tumor was resected. Histopathologically, the tumor was characterized by sparsely populated spindle-shaped cells in the fibromyxoid stroma. Thin-walled blood vessels were detected. Mitoses or pleomorphism was not found. Tumor cells were positive for vimentin, ER, PgR, and desmin. Some cells were positive for alpha-SMA and CD34. All cells were negative for S100 protein.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1835_en_sum.txt

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+A 5-year old girl with a scoliosis of 58.5 degrees at T1-9 and 72.8 degrees at T9-L4 had a single MCGR inserted and anchored at T3-4 and L3-4. At postoperative 13 months the MCGR was noted to have lost of distraction between lengthening episodes due to unrestricted turning of the internal magnet. To prevent further loss of distraction, an external magnet was placed outside the skin to prevent the magnet from turning back. The overall balance was suboptimal and after the rod was fully distracted, proximal junctional kyphosis occurred. Subsequently, the MCGR was modified with an internal keeper plate to prevent loss of distraction and a dual set of these rods were implanted when the patient was 9 years old. Extension proximally to C7-T1 was done to manage the proximal junctional kyphosis. Her spinal balance improved and distractions continued. She subsequently developed add-on below and the piston rod was not aligned with the actuator. The lumbar spine was also observed to have autofusion. She subsequently had final fusion surgery performed at the age of 15 from C7-L4 leaving a residual tilt below to avoid fusion to the pelvis. The final extracted rod on the left side indicated the "crooked rod sign" on X-ray and rod dissections revealed a new failure mechanism of stud fracture close to the barrel opening. Body fluids and tissue may infiltrate the rod despite no obvious deformation or fractures resulting in hastened wearing of the threads.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1843_en_sum.txt

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+A 56-year-old woman was referred to our hospital because of serous retinal detachment (SRD) in her left eye. At the initial examination, her best-corrected visual acuity (BCVA) was 1.5 oculus dexter (OD) and 0.8 oculus sinister (OS). An irregular, flat, brownish lesion was noted around the macula OS. Optical coherence tomography showed a choroidal structure with marked hyporeflectivity and SRD where the retinal thickness was preserved. Indocyanine green angiography demonstrated fluorescence blockade throughout. Fundus autofluorescence revealed enlarged macular hypofluorescence, suggesting chronic retinal pigment epithelium damage associated with prolonged SRD. B-mode echography showed no choroidal elevation. Based on the clinical findings, the left eye was diagnosed with choroidal melanocytosis. Four years and 10 months after the initial visit, her BCVA was 0.5 and SRD remained. During the entire period of observation, the mean blur rate (MBR) (mean ± standard deviation) of choroidal blood flow velocity on LSFG was 10.15 ± 0.72 arbitrary units (AU) OD and 1.31 ± 0.06 AU OS.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1883_en_sum.txt

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+This study reports a case of metacarpal synovial sarcoma occurring in the hand-wrist of a 32-year-old Iranian man presented with the chief complaint of a lump on the dorsal ulnar side of his left hand and wrist. Initially, the first physician suspected the case to be a ganglion cyst. After two months of conservative treatment, the size of the lesion gradually increased. Magnetic resonance imaging (MRI) was performed and after an excisional biopsy and a postoperative histological analysis, the tumor was identified as a synovial sarcoma. The patient underwent a scheduled surgical procedure. Unfortunately, he had poor follow-ups and brought the pathologic results two months later when, the tumor had incredible growth, which makes this presentation rare.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1893_en_sum.txt

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+In this case report, we describe a novel approach in treating oesophageal lichen planus in a patient with budesonide orodispersible tablets, a treatment normally reserved for eosinophilic oesophagitis. The patient achieved complete relief of dysphagia, with a follow-up oesophagogastroduodenoscopy 2 months after treatment commencement being macroscopically and microscopically free of inflammatory activity. This case report is to our knowledge the first to report this treatment regimen in oesophageal lichen planus.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1909_en_sum.txt

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+We report the case of a 42 year old man with metastatic melanoma and no prior history of diabetes mellitus, who presented with diabetic ketoacidosis (DKA) after 3 cycles of combination checkpoint inhibitor therapy using nivolumab and ipilimumab. New onset diabetes mellitus was diagnosed on the basis of elevated hemoglobin A1c, in the absence of prior personal or family history. Autoimmune or type 1 diabetes mellitus was ruled out with normal levels of anti-glutamic acid decarboxylase 65 (GAD65) antibody, zinc transporter 8 (ZnT8) antibody, and islet antigen-2 (IA-2) antibody.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_1918_en_sum.txt

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+This report describes a rare hourglass constriction of the anterior interosseous nerve in the left forearm in a 47-year-old healthy male who was treated surgically and gradually recovered function over a 6-mo follow-up period.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2056_en_sum.txt

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+This article presents a case of an 82-year-old female with a history of coronary artery disease and untreated gallstones. The patient experienced nausea, vomiting, and abdominal pain for two weeks. Diagnostic procedures revealed a cholecystoduodenal fistula with a 4 cm stone lodged at the duodenojejunal angle. For our patient the gallstone was moved to the jejunum, followed by enterotomy and a latero_lateral gastroenteroanastomosis.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2063_en_sum.txt

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+This study has reported a 33-year-old woman presented with abnormal vaginal discharge. Gynecologic examination revealed a cervical mass with grape- like feature protruding into vagina with posterior- superior vaginal wall involvement. Biopsy has performed and pathologic examination was consistent with embryonal botryoid type rhabdomyosarcoma. She has undergone the staging work up measurements including thoracic computed tomography (CT) scan, abdominopelvic magnetic resonance imaging (MRI), bone scan and bone marrow examination. In exception of abdominopelvic MRI, with 2 suspicious pelvic lymph nodes in addition of cervical mass, all others were normal. Radical hysterectomy with lymph node debulking and ovarian preservation has performed. Final results have shown embryonal botryoid type rhabdomyosarcoma of cervix. ovaries, endometrium, parametrium, and follopian tubes were unremarkable. Pelvic lymph nodes pathology and intraabdominal fluid cytology were negative for malignancy. Lymphovascular invasion was identified. She has advised for adjuvant chemotherapy.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_206_en_sum.txt

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+We describe a 12-year-old patient with a rapid growing orbital mass involving medial part of orbit and medial rectus muscle and imaging findings suggestive of rhabdomyosarcoma. Histopathologic examination showed the mass to be composed of granulomatous inflammation and the thread-like object to be Dirofilaria repens. The patient was well post-operation without morbidity. In this paper, we describe distinct clinical features and imaging findings of this interesting case.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_20_en_sum.txt

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+We present the case of a patient with bilateral osteonecrosis of the femoral head treated with autologous cultured osteoblast injection.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2114_en_sum.txt

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+Our patient was a 39-year-old Chinese woman who had a history of two cesarean sections and one miscarriage. She had a recurrent anterior abdominal wall mass around her cesarean scar, and the mass was initially suspected of being choriocarcinoma of unknown origin. The patient had concomitant negative or mildly increased serum β-human chorionic gonadotropin at follow-up and no abnormal vaginal bleeding or abdominal pain. However, she underwent local excision twice and had two courses of chemotherapy with an etoposide and cisplatin regimen. She finally opted for exploratory laparotomy with abdominal wall lesion removal, subtotal hysterectomy, bilateral salpingectomy, and left ovarian cyst resection, which showed the abdominal wall lesion, whose components were revealed by microscopy and immunohistochemical staining to be approximately 90% epithelioid trophoblastic tumors and 10% choriocarcinomas from a solely extrauterine mixed gestational trophoblastic neoplasm around an abdominal wall cesarean scar.

data/test_raw_data/en_test/multiclinsum_test_en/summaries/multiclinsum_test_2143_en_sum.txt

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+Here, we present a case of a 15-year-old female who presented with lower back pain radiating to her bilateral posterior thighs and knees, with imaging indicating a thoracolumbar spinal extradural arachnoid cyst. After failed conservative treatment, surgical intervention in the form of laminectomy, fenestration of the arachnoid cyst, and repair of the dural defect was required, resolving the patient's symptoms with no recurrence of the cyst.