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5217 Video Q (Week 16). The sharply-demarcated hypoechoic mass in the ventral left lung extends for about 60 mm and has displaced the heart off the chest wall. There are several 3–5 mm hypoechoic areas involving the visceral pleura dorsal to the main lesion. There is 15 mm deep sharply-demarcated triangular lesion at the ventral margin of the right lung which displaces the base of the heart from the chest wall. There are numerous very small anechoic lesions involving the visceral pleura from which originate comet tails. (MP4 17044 kb)

One sheep (16610) had a lesion that increased in depth but when the sheep died without premonitory signs there was histological evidence of bacterial infection only. Sheep 2584 also died unexpectedly during the monitoring period; severe suppurative pneumonia as well as OPA were noted at PME and confirmed by histology. The third sheep that died unexpectedly was unavailable for necropsy and is not included in Table 1.

The G-401 cell line was established from a 3-month old infant (8). In this cell line we have observed some cells with an aberrant chromosome 12. With increasing passage numbers more cells with a derivative chromosome 12 have been observed. The FISH analysis showed that these cells carried an additional 7p-segment at the end of the one of chromosomes 12q (partial trisomy 7p). In all cells both chromosomes 7 were structurally normal.

Traditional and improved anchoring nails were implanted 10–15 mm below the inferior margin of the posterior inclined plane of the condylar process. The two anchoring nails were placed symmetrically and the distance between them was more than 3 mm (Fig. 2).Fig. 2Condyle specimen. Traditional and modified anchoring nails were implanted in the condyle

On hospital day 9 Aspergillus fumigatus was finally identified on her admission BAL. She was immediately started on voriconazole. Further diagnostic evaluation included serum Fungitell ((1–3)-ß-D-Glucan) and Aspergillus antigen which were strongly positive. Repeat bronchoscopy showed a whitish collection of material in the left main bronchus (Fig. 3) which was biopsied and revealed abundant fungal hyphae on pathology consistent with Aspergillus.Fig. 3Bronchoscopy on HD 9 showing white fungus ball in left main bronchus.Fig. 3

The female patient was born without a history of in utero teratogenic exposure to a G3P3 mother and nonconsanguineous parents at 40–3/7 weeks gestation. The birth weight was 6 pounds 2 ounces and birth length was 19 inches. There was no history of hypotonia or other neonatal concerns.

FIGURE 4A) Echoendoscopic image of the dilatation (0.85 cm) of the main pancreatic duct (short white arrow) in the head of the pancreas and distal portion and vegetation inside (long white arrow); B) 22G needle puncture time to collect material from the interior of the main pancreatic duct and vegetation (short white arrow).

(A) Growth restriction was sustained from birth through childhood. References shown are WHO standards. (B) Retinal imaging showing bilateral hyperpigmented deposits. (C) MRI showing prominence of the ventricles and sulci without parenchymal signal abnormalities.

Case 1: Radiograph series of left tibia‐fibula after osteotomy and intramedullary nail (IMN) fixation. (A) Three years after left tibial fracture; before replacement therapy and operative treatment. (B) One month after elective osteotomy; 2 months after asfotase alfa initiation. Some callus formation at the osteotomy site. (C) Five months post‐op; 6 months on medication. Definite increase in callus formation. (D) Ten months post‐op; 11 months on medication. Tibial and fibular osteotomies appear to have gone on to union.

Case 1: Radiograph series of right subtrochanteric femoral pseudofracture. (A) Right femur pseudofracture 12 years after identification; before asfotase alfa treatment. (B) Stable 17 years after fracture; 1 month before asfotase alfa therapy. (C) Eleven months of uninterrupted asfotase alfa treatment; radiograph demonstrates progressive healing of femoral pseudofracture. (D) Fourteen months on medication; continued bone healing.

The postoperative management was uneventful. Patients were encouraged to ambulate with a hard brace in 5 days postoperatively and the hard brace was kept for 3 months. All the included patients were followed for at least 12 months. Instrumentation would be taken out approximately 12 months after surgery in both groups.

Cedecea lapagei can be distinguished from other Cedecea strains by its ability to grow in media lacking thiamine . It was not until 2006 that Cedecea lapagei was recognized as a potential pathogen to humans. It was first described in a case study involving a 55-year-old man in ambulatory peritoneal dialysis with hypertension and a recent liver transplant secondary to cirrhosis. He subsequently developed peritonitis and the culture from the peritoneal fluid isolated Cedecea lapagei indicating sensitivity to multiple antibiotics. He was treated with intraperitoneally and intravenously administered antibiotics which concluded with a complete recovery .

A buccogingival incision was made in the maxillary vestibule approximately 5 mm superior to the mucogingival junction and extended from the second molar to the contralateral second molar. Periosteal elevators were used to elevate the tissues in the subperiosteal plane fist over the anterior maxilla and then extending widely to encompass posterior tissues behind the zygomaticomaxillary buttress. The infraorbital neurovascular bundle was identified superiorly and dissected. Subperiosteal dissection along the piriform aperture stripped the attachments of the nasal labial muscularture to allow its complete release from the midface skeleton. The mucoperiosteal flap was elevated up to the piriform aperture.

Dissection through the intercarilaginous incision allowed access to the nasal dorsum and bones (Fig. 4b). Sharp subperichondrial dissection with a scalpel or a blunt dissection with scissors freed the soft tissues above the upper lateral cartilage as in a standard open rhinoplasty. The dissection should be within the subperichondrium plane to prevent injury to the overlying musculature and blood vessels of the nose. Elevation extended laterally to the nasomaxillary sutures and superiorly to the glabella. Retraction of the freed soft tissues allowed sharp incision to be made with a scalpel or with sharp periosteal elevators through the periosteum at the inferior edge of the nasal bones. Elevation of the soft tissue laterally to the piriform aperture was also performed so that the maxillary vestibular dissection was easily connected to this pocket.

Surgical excision of the mass resulted in complete resolution of symptoms up to 3 years postop. Histologic examination confirmed a well differentiated neuroendocrine tumor with immunostainings positive for chromogranin and synaptophysin and a KI index of <2%.

This report describes a case of a true BAA after AVF closure following renal transplantation. The BAA was treated by excision and end-to-end brachial artery reconstruction. We also reviewed cases of idiopathic true BAAs and evaluated the etiology and optimal treatment for true BAAs.

Staged bilateral cordectomy was performed in one patient with T1b carcinoma. One patient underwent CO2 laser re-excision due to superficial patient margin positive for Cis. Histopathology of re-excision showed severe dysplasia. None of the patients was further treated by external beam radiation.

Sagittal (A) and bilateral parasagittal (B and C) computed tomography (CT) scans showing atlanto-occiptial dissociation diagnosed by the basion interval index > 12 mm (red line A) and atlanto-axial dislocation with increased distraction of the atlanto-axial joints bilaterally (red lines B and C). Note that the condyle-C1 (CCI) interval was normal (B and C).

Morphology of Burkitt lymphoma. Giemsa-stained FNA smear from an eBL tumour with cells showing characteristic cytoplasmic vacuoles (white arrows) and a cell with a prominent mitotic figure (black arrow) (a). Haematoxylin-eosin-stained FFPE tumour tissue section (20× magnification) showing cells with mitotic figures (arrows) and characteristic “starry sky” staining due to weakly stained macrophages among numerous densely stained tumour cells (b). Immunohistochemistry-stained FFPE tumour tissue section showing prominent C-MYC expression (brown) (c)

She was subsequently treated surgically for primary HPT. The right and left superior parathyroid showed hypercellular parathyroid on pathology. The patient was normocalcemic after surgery. The calcium on follow-up visit about a week after surgery was 9.8 mg/dL (8.5-12.1).

Case 2.1 If \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$i+a \le 2n-2k$$\end{document}i+a≤2n-2k and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$w_{i+a}>k$$\end{document}wi+a>k then \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$i+a < 2n-2k$$\end{document}i+a<2n-2k and we continue the whole process by considering \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$w_{i+a+1}$$\end{document}wi+a+1.

Case 2.2 If \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$i+a \le 2n-2k$$\end{document}i+a≤2n-2k and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$w_{i+a}=k$$\end{document}wi+a=k then all entries in \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$W_{i+a}{\setminus } W_i$$\end{document}Wi+a\Wi are 0s and hence \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$W_{i+a}=1^{k-a}|0^{k-a}1^a|0^{a+1}$$\end{document}Wi+a=1k-a|0k-a1a|0a+1 is a k-ear by Observation 3.

We report a rare case of the co-inheritance of both SS disease and WS4 who presented to a specialist Sickle Cell Center (SCC). This case report is unusual as it is believed that this may be the first reported case to describe the blended phenotype of WS4 and SS disease and draws attention to the need for the further investigation of patients with one genetic disorder who present with atypical features. The report may raise awareness of the co-occurrence of SS disease and WS4.

a H&E stain. 40× magnification. Infarcted cortex with hemorrhage. From allograft nephrectomy 2 months following rejection episode. b H&E stain. 200× magnification. Arcuate artery demonstrating acute endothelialitis and chronic transplant arteriopathy. From allograft nephrectomy 2 months following rejection episode. c H&E stain. 200× mag: Partially viable glomerulus with endocapillary hypercellularity (aka: glomerulitis). From allograft nephrectomy 2 months following rejection episode

We present three patients where breakage of the Fixion® nail during surgery caused problems in nail extraction. Technical difficulties in removal of the Fixion® expandable intra-medullary nail have not been reported to date and it presents a difficult situation to manage as the extraction kit does not include appropriate instrumentation to remove a broken nail.

The initial nail was removed and an expandable retrograde nail was inserted. Two months later an Ilizarov frame was applied over the nail to provide further compression. The non-union united and the frame were removed three months later. The nail was left for six more months in order to allow further consolidation of the non-union.

Two and a half years later the patient requested removal of the nail because of chronic heel pain presumably due to slight prominence at the bottom end of the nail. Using the standard extraction technique an attempt to remove the nail was performed but resulted in fracture of the nail at the junction of the valve and fins (Fig. 6). The end cup and valve were removed but attempts to remove the remaining part of the nail with grabbers failed and the procedure was abandoned.Fig. 6Fractured nail at the junction of the valve and fins during its extraction.Fig. 6

TABLE IIIThe clinical evolution of the 49 patients who presented with exclusively ulcered lesions throughout the treatment duration Complete re-epithelisation n (%)Complete re-epithelisation with no inflammatory signs n (%)Second week (one infiltration)6 (12)0 (0)Third week (two infiltrations)11 (22)3 (6)Fourth week (three infiltrations)12 (24)7 (14)Fifth week (four infiltrations)16 (33)8 (16)Sixth week (five infiltrations)21 (43)14 (28)Seventh week (six infiltrations)27 (55)21 (42)Eighth week (seven infiltrations)34 (69)27 (55)

FA in the late phase displayed the presence of an enlarged foveal avascular zone (FAZ) corresponding to the area of detachment with perilesional leakage and papillitis. Intermediate phase ICGA evidenced a macular hypocianescent area with indefinite borders and hypercianescent striae inside the lesion (Figure 12).

“I confirmed a pesticide as being a Paraquat - and as a result this altered patient disposition dramatically and resulted in a case being reported to NDOH and farm owner investigated … the guideline has also improved my knowledge on how to report and I also found point chart to be very useful.” [R1]

“I confirmed a pesticide as being a Paraquat - and as a result this altered patient disposition dramatically and resulted in a case being reported to NDOH and farm owner investigated … the guideline has also improved my knowledge on how to report and I also found point chart to be very useful.” [R1]

The appearance of the both eye There was no obvious hyperaemia in the left eyes (a). The right eye exhibits severe diffuse corkscrew hyperaemia (b-d). Imaging revealed that the AVM (The red arrow) is fed by the posterior cerebral artery and pericallosal artery and drains to the medial atrial vein (e)

This case study was carried out in accordance with the recommendations of the Ethical Committee of China Medical University. The case study has been approved by the Ethics Committee of China Medical University. The subject gave written informed consent in accordance with the Declaration of Helsinki. Written informed consent was also obtained from each patient for the publication of this case report.

Axial T1 magnetic resonance image of the brain. a Precontrast. b Postcontrast. A small white focus is seen on the motor strip within the left hemisphere after contrast is added (white arrow). The same area is unremarkable before contrast. This contrast-enhancing lesion is a probable tuberculoma. The location of this lesion corresponds to the patient’s right-sided epilepsia partialis continua seizures

Pedigrees of the families carrying mutations in BRCA1/2 other than the Ashkenazi founder mutations. Circles: women; squares: men; half blackened symbols: individuals affected with cancer; white symbols: unaffected individuals; TN: triple negative breast cancer; slash diagonal line: deceased. The cancer and age at diagnosis are indicated below each individual when available. An arrow indicates the proband. (A) BRCA1 c.2728C>T - p.(Gln910*); (B) BRCA1 c.5407-?_(*1_?)del; (C) BRCA1: c.5445G>A-p.(Trp1815*); (D) BRCA2: c.5351dup - p.(Asn1784Lysfs*3); (E) BRCA2 c.7308del - p.(Asn2436Lysfs*33); (F) BRCA2 c.9026_9030del - p.(Tyr3009Serfs*7).

Computed tomography scan (CT) of the head and neck was performed which showed a tiny subarachnoid hemorrhage (SAH) on the right parietal-occipital area (Figure 1). There was no evidence of calvarial fracture (Figure 2). There was also no evidence of cervical spine fracture. The patient was subsequently transferred to our level II trauma center for further workup and management.

(A) A 51-year-old male patient with primary septic arthritis of the left hip joint. The hip joint was destructive with a collapsed femoral head. (B) Antibiotic-loaded cement spacer inserted in the left hip joint after resection arthroplasty. (C) Revision total-hip arthroplasty performed after controlling infection of the left hip joint.

Hepatic angiogram showing a large 40-mm hepatic tumor corresponding to the lesion on plane computed tomography. The hypervascular tumor in the left lobe is depicted as a round mass of contrast opacification (straight white arrow) and as being supplied by the left hepatic artery

Images of the resected specimen. a The tumor did not invade the hepatic parenchyma. b Venous infiltration was found in the specimen on hematoxylin and eosin staining (loupe). c Tumor thrombosis did not invade the liver parenchyma on desmin staining (loupe)

(a) Endoscopic images of gastric lesions. The upper two endoscopic images showing the same yellow-white gastric lesion at the gastric fundus measuring 0.7 cm. The lower two endoscopic images showing a single pedunculated gastric polyp at the antrum measuring 1.0 cm. (b) Photograph of the gastric biopsy showing a large aggregate of foamy macrophages with adjacent inflamed mucosa (H&E stain ×200). (c) Inflamed gastric mucosa showing numerous foamy macrophages consistent with xanthoma in the gastric lamina propria. Note the presence of active acute on chronic gastritis in the adjacent gastric glands (H&E stain ×200). (d) Low power microscopic view of gastric polyp (H&E stain ×40). (e) Inflamed gastric hyperplastic polyp containing cystic glands lined by clear Parietal cells. Note the presence of goblet cells in the upper left side of the picture which is indicative of intestinal metaplasia (H&E stain ×100).

Histopathology of the jaw from the smolt in Fig 2; H&E stain. (A) Oblique section of the jaw. The epidermis is completely missing and the outer surface is covered with a thick mat of long thin rod-shaped T. maritimum-like bacteria that have infiltrated the submucosa (arrow "a"). Only one tooth (arrow "b") remains and holes are present where there used to be more teeth (arrow "c"). The black boxes labelled "B" and "C" outline the areas included in Fig 4B and 4C. (B) A mat of bacteria with T. maritimum morphology is on the outer surface (arrow "d") and the bacteria have infiltrated the underlying submucosa. (C) Large quantities of bacteria with T. maritimum morphology are within the destructed submucosa surrounding the tooth (arrow "e"). Some intact red blood cells (arrow "f") are within the mass of bacteria and remnants of tissue.

The infected soft caries was excavated using sterile sharp spoon excavator. Bleeding was controlled with 2.5% NaOCl (Vishal Dentocare Pvt Ltd.) soaked sterile cotton plug. The disinfection of the cavity was done with 2% Chlorhexidine gluconate solution. MTA (MTA ANGELUS®) was mixed as per manufacturer’s instructions and was applied as pulp capping material followed by the placement of moist cotton and temporization was done. The patient was recalled after 24 h to remove the cotton pellet from the cavity and restored with glass ionomer (GC Glass Ionomer Universal Restorative) restoration.

The infected soft caries was excavated using a sterile sharp spoon excavator leaving behind a layer of affected dentin. The disinfection of the cavity was done with 2% chlorehexidine gluconate (Vishal Dentocare Pvt Ltd.) solution. The disinfection of the cavity was carried out. MTA was applied as pulp capping material followed by the placement of moist cotton and temporization done. The patient was recalled after 24 h to remove the cotton pellet from the cavity and restored with glass ionomer restoration and composite.

Gross internal photographs of the decedent demonstrating thoracic and abdominal adhesions and a dilated transverse colon. (A) Posterior view of the thoracic and upper abdominal structures demonstrating patent thoracic duct and right-sided aorta. (B) Internal organs of the chest and abdomen demonstrated significant adhesions and a distended transverse colon.

a Maximum intensity projection in the coronal plane of a 64-years old male patient. Avulsion of the right lower incisor with an associated non-displaced fracture of the mandible. The tooth is directly adjacent to the tube. b Axial plane. The finding was correctly reported by the radiologist

This case was the first description of management of a long-term sore and ulcer of breast cancer metastatic recurrence with the internal vitality supporting method of Chinese herbal medicine. The patient was effectively cured due to cross-disorder and interdisciplinary collaboration. The holistic concept of TCM provided a novel therapeutic strategy for mind–body medicine.

All consecutive patients presenting to our hospital from January 2014 to July 2021 with acute aneurysmal SAH and subsequent cerebral vasospasm who had undergone at least one intra-arterial spasmolysis were retrospectively recovered from our radiology information system.

All patients were monitored in our neurointensive care unit. Nimodipine was given from the day at admission orally (6 × 60 mg/day) or via gastric tube. Mean arterial blood pressure was always sustained above 80 mmHg to avoid reduced cerebral perfusion. A local standard operating procedure for SAH was used (not included).

(A) Shows the patient in an extreme opisthotonos with cervical lordosis and bilateral limb hyperreflexia and cervical lordosis. (B) A preoperative magnetic resonance imaging (MRI) imaged showing a cystic lesion at L1 with tethering of spinal cord. (C) A preoperative MRI imaged showing a cystic lesion at L1 with tethering of spinal cord. (D) A preoperative MRI imaged showing a cystic lesion at L1 with tethering of spinal cord and cervical lordosis.

Fig. 2Indocyanine green (ICG) fluorescence imaging. The catheter balloons were inflated with ICG solution (0.025 mg/ml) plus a drop of blood. A Before catheter insertion. B The intravenous position of the balloon was confirmed using near-infrared fluorescence

Pathological results correlated with a neoplasm of low malignant potential (subtype 1). Taking into account the patient's age and personal preference she underwent laparoscopic total abdominal hysterectomy and bilateral salpingo-oophorectomy without the additional omentectomy and regional lymph node dissection.

A 53-year-old Caucasian male presented with persistent productive cough fevers and malaise. A chest radiograph demonstrated right upper lobe consolidation with background emphysematous changes. The patient had a past history of COPD and had been immunised with BCG without incident during adolescence. HIV 1 and 2 serology and P24 antigen were negative.

The progressive destruction of the tibia over time after inoculation of Walker 256 cells is shown in Figure 4. No radiological changes were seen in normal bone (Figure 4(a)). A clear periosteal reaction was observed in the proximal epiphysis 7 d after injection (Figure 4(b)). Some loss of medullary bone and erosion of cortical bone arose 14 d after injection (Figure 4(c)). Significant cortical bone defects in the tibia occurred 21 d after injection (Figure 4(d)).

Our patient also received ethambutol due to evidence of susceptibility in the DST result; this drug has also been reported to cause peripheral neuropathy rarely . Peripheral neuropathy has also been mentioned as a rare but possible adverse effect of two other drugs he received: cycloserine and prothionamide .

#Group A: 1 patient died of liver failure; group B: 1 patient died of liver failure and 1 died of intra-abdominal bleeding post-discharge within three months; group C: 1 patient died of liver failure and 1 died of intra-abdominal bleeding post-discharge within three months.

The patient was a 51-year-old man who received an allogeneic BMT from his brother for treatment of chronic myelogenous leukemia (CML). Eight years later he developed metastatic melanoma at multiple sites. We received samples of the primary tumor and a left axillary lymph node metastasis that were fixed in formalin and embedded in paraffin (FFPE) by standard histological procedures. Pre-transplant donor and patient lymphocytes were stored at -90°C in the Yale-New Haven Hospital Stem Cell Bank.

A 55-year-old woman was surgically treated to place in the molar region of her left mandible 2 dental implants: surgery was performed without any intraoperatory complication but the day after surgery she referred the appearance of a paraesthesia of the lower lip in its left side associated in some area to anaesthesia. At the evaluation of the radiographic and TC images the distal part of the dental implant was near but non in contact with lower alveolar nerve.

Preoperative radiographic images. a Orthopantomography shows that inadequate bone height was observed in sites #24 (blue line) and #26 (red line). b Coronal CT image of the blue line; vertical bone height is 4 mm. c Coronal CT image of the red line; vertical bone height is only 1 mm

Radiographic image. Four months following 2nd sinus floor augmentation with implant placements. a Significant bone augmentation is achieved in site #26. b Coronal CT image of the red line shows that sufficient bone support with improved radiopacity was achieved in the palatal aspect of sinus cavity

We present here a case of GDI having threatened premature labor in a 16-year-old woman with intact hepatic function who was successfully treated with oral DDAVP tablets. We also performed pathophysiological investigation using serum and placental tissue from the patient.

A 43-year-old woman in good health was referred for evaluation of a superior bulbar conjunctival necrotic lesion in the left eye. She presented with ocular pain and a foreign body sensation in the left eye that had lasted for 1 year. She said that she had no history of trauma or surgery.

The correct diagnosis of hepatic PEComa was made on the basis of morphologic characteristics and immunohistochemical results. The patient recovered uneventfully and was discharged 1 week after surgery. There is no clinical or radiographic evidence of recurrence 9 months after surgery.

Case 1: A 16-month-old boy who sustained a motor vehicle accident. (a–c) Pre-reduction computed tomography (CT) scans showing the asymmetrical distance between dens and C1 lateral mass on both sides. (d) The difference between the transverse axis of the skull and C2. (e) The alignment of the transverse axis of C1 and skull. (f) The dislocated C1/2 joint on the left side (arrow).

a radiographs of a female with severe ankle arthritis. a preoperative ankle joint. b ankle joint during ankle distraction. c ankle joint after removal of external fixation. d 1 year postoperative. b lateral radiographs of a female with severe ankle arthritis. a lateral view of the same patient before operation. b lateral view of the same patient at 1 year after operation

We also selected scenario 5 for ‘contraindicated’ purposes. In this scenario the patient had been resistant to treatment and there was clear evidence of progressive neurological deterioration and symptomatology. Selection of any option other than the referral choice was deemed to be ‘contraindicated’ (the full rationale is seen in Additional file 1).

In Scenario 9 the patient is not improved at all and there is no obvious (biomechanical) explanation for the intermittent pattern. There are no ‘red flags’ but there is a need to consider if there might not be an underlying depression or some other disease. A second opinion is required. Any continued treatment would be ‘non-indicated’ and would also be described as over-servicing.

Branch-duct intraductal papillary mucinous neoplasm with low-grade intraepithelial dysplasia in March 2009. (A) Histopathology (hematoxylin-eosin staining). Histopathology of the pancreatic head following Whippl procedure in March 2009 reveals an intraductal papillary mucinous neoplasm with low-grade intraepithelial dysplasia characterized by papillary proliferation of an atypical mucus producing ciliated epithelium (arrow). (B) Histopathology using Periodic Acid Schiff staining. Intraductal papillary mucinous neoplasm with low-grade epithelial dysplasia and intraductal periodic acid schiff-positive mucus (arrow).

Thin-sliced abdominal follow-up imaging. (A) Follow-up magnetic resonance imaging (MRI) in May 2015. Unremarkable remnant of the pancreas after Whipple procedure 03/2009 (arrow). (B) Follow-up computed tomography scan in July 2016. Diagnosis of a novel hypodense lesion of 2.4-cm diameter in the pancreatic tail (arrow).

C: Intraoperative film: left (L) and right (R) are marked as seen in the prone position. Myelographic contrast outlining left L3-4 defect due to the facet cyst (white dashed arrow). The radiofrequency (RF) electrode is entering the defect obliquely through the interlaminar space.

Radiographic images of the adult right-sided Bochdalek hernia prior to surgery. a Chest X-ray showed intestinal gas over the liver and an elevated right hemi-diaphragm (white arrow head). b A computed tomography (CT) scan of the abdomen and pelvis demonstrated reduced contrast uptake and thickening of the herniated small intestinal wall. The herniated small intestine was present in the thorax (white arrow head). c CT scan of the abdomen and pelvis demonstrated herniation of the small intestine into the right thoracic cavity from the posterior surface overlying the right hepatic lobe (white arrow head). It also demonstrated reduced contrast uptake and thickening of the herniated small intestinal wall. The liver was not atrophic. d A sagittal sequence of CT scans confirmed herniation of the small intestine into the right thoracic cavity from the posterior surface overlying the right hepatic lobe (white arrow head). e A coronal sequence of CT scans also demonstrated herniation of the small intestine into the right thoracic cavity from the posterior surface overlying the right hepatic lobe (white arrow head). f CT scan of the abdomen and pelvis also demonstrated a torose lesion in the gallbladder (white arrow head)

The figure presents 2 patients’ ocular fixation (each color corresponds to one patient). Green patient answered successfully and the total fixation duration was the most important for the area of interest “button”. Pink patient ocular fixation answered not successfully

Introduction: Morbid obesity and ARDS both affect respiratory mechanics mainly through their respective impacts on chest wall and lung elastances. We present a unique series of patients combining very severe morbid obesity and moderate to severe Acute Respiratory Distress Syndrome (ARDS). We describe the use of trans-pulmonary pressures (TPP) measurements for optimization of external PEEP setting.

Conclusion: Insulin intoxication is rare with some unusual presentations. Basis of treatment are carbohydrates administration and blood glucose monitoring. It is a potentially serious condition with low mortality and a risk of electrolyte disorders and severe neurological sequelae. Early care is the main prognosis factor.

A) Axial computed tomography (CT) scan showing hypodensity in the right hemisphere suggesting right middle cerebral artery stroke; B) Axial T1 magnetic resonance imaging (MRI) sequence with contrast showing mixed cystic and solid (arrow) enhancing right-sided temporal lesion concerning for brain neoplasm. The lesion involves the superior temporal gyrus anteriorly and all three temporal gyri posteriorly with minimal infiltration into the inferior most gray matter at the opercular border; C) Coronal section of the same sequence; D) Fluid-attenuated inversion recovery (FLAIR) sequence and the associated edema (arrow).

The GJB2 c.524C > A variation was not identified in the 703 genomic DNA samples from a panel of affected individuals or in the 100 control genomic DNA samples from a panel of unaffected individuals. Targeted genes capture and next-generation sequencing (NGS) did not reveal any other possible disease-causing variations.

Our institution's experience illustrates several points not already described in the literature. We describe a technique that can be a single-stage procedure that is technically uncomplicated. Our technique proved to be a useful tool in treating the combination of choledocholithasis and associated cystic duct stump leak. This particular patient had the gastrostomy tube removed 6 weeks after a repeat ERCP and stent removal after confirming resolution of the cystic stump leak. The management of this combination with LAERCP has not been described in the literature before.

The first row contains stereo disc photographs (SDPs) showing recurrent DH in inferotemporal optic disc region (between 2006 and 2010) and subsequent neuroretinal rim thinning. The second row contains red-free retinal nerve fiber layer (RNFL) photography representing gradual enlargement of RNFL defect 3.8 years after initial clinical detection of DH (in 2010). The last row shows visual field progression manifested 9.0 years following the initial DH (in 2015).

Cranial computed tomography scan shows a mass of soft tissue (arrow) surrounding the internal jugular vein and the carotid artery at the left jugular foramen with signs of bone erosion and destruction. The lesion extends medially and causes bone destruction of the left occipital condyle and the left side edge of the clivus and erosion of the posterior edge of the oval hole. In the petrous bone it extends to the middle ear and causes erosion of the anterior wall of the tympanic cavity. The mass goes along the petrous carotid reducing its caliber and causing bone destruction of the anterior edge of the carotid canal extending to the petrous apex

The red arrows indicate the metastasized tumors in the mediastinum. They were enhanced by positron emission tomography-computed tomography (the bottom of the image before CPA). The target lesions did not change during the observation period. The serum level of tumor marker of squamous cell carcinoma (SCC) decreased and was maintained at a reduced level after both treatments.

The first symptomatic TT HEV case in Spain was reported in 2015. The immunocompetent patient developed clinical and laboratory signs of acute hepatitis more than 1 month after transfusion of eight red cell units during and after surgery. Investigation showed that one transfused RBC unit was positive for HEV RNA with 100% identity with the recipient HEV RNA sequences. The implicated donor had occupational exposure in a sausage factory. Platelets from the same infected donation were transfused to a Hodgkin lymphoma patient who died shortly after transfusion . Selective HEV screening of blood donations is under consideration taking into account logistical challenges. Blood banks from central and northern Spain plan to study HEV incidence.

The mean interval before return of bowel movements was 2(1) days. The mean hospital stay was 6·4(1·8) days. The mean VAS for pain evaluation on the first day after surgery was 3·4(0·5) points. A single anastomotic leak following an intersphincteric resection was dealt with by transanal closure and ileostomy on postoperative day 7. The patient had normal defaecation at 3 months after ileostomy closure. Both patients with ileostomies made otherwise uneventful recoveries and the stomas were closed after 2 months.

Case #2 received a combination of a PD1 inhibitor (nivolumab) and an anti-CTLA4 antibody (ipilimumab). Ipilimumab was the first checkpoint blockade immunotherapy shown to improve overall survival in metastatic melanoma patients. Nivolumab was also recently approved for advanced extracerebral melanoma due to its superiority to chemotherapy after disease progression on ipilimumab (33). Nivolumab and ipilimumab can be administered concurrently with a manageable safety profile.

The presence of a high concentration of serum Rabies lyssavirus neutralizing antibodies (RLNAs) in a patient with an illness compatible with rabies and no history of rabies vaccination is considered diagnostic for human rabies. This case definition does not take into account whether the patient has recently received intravenous immune globulin (IVIG).

This girl was born at term after normal pregnancy and delivery from healthy unrelated parents. At 2 months of age parents started to suspect hearing impairment and at 6 months bilateral cochleopathy was diagnosed on the basis of a type A tympanogram and brainstem auditory evoked potential.

Myasthenia gravis (MG) is a rather common disorder. But MG superimposed with proteinuria is very rare and there are only 39 cases reported so far.[1–4] Minimal change disease (MCD) and MG are both related to the dysfunction of T lymphocytes and there may exist some connection between the 2 disorders. Here we report an 82-year-old man diagnosed at the same time with MG and MCD. We will also discuss their relationship and report on the results of literature review regarding the temporal onset of MCD against MG.

Given this background we aimed to develop a gene therapy approach for herPAP using iPSC and TALEN technology to correct the CSF2RA-mediated form of the disease. We here describe for the first time the TALEN-mediated genetic integration of a codon-optimized CSF2RA transgene (CSF2RA coop) into the AAVS1 locus of herPAP patient-derived iPSCs restoring GM-CSF receptor functionality and correcting the in vitro disease phenotype of herPAP iPSC-derived monocytes/macrophages.

“My wife developed complication just a few hours after she returned home (from the local health center) and I have to rush her to the private hospital because she was losing a lot of blood. I do think that the health facilities have the responsibility of discharging her too early after birth without being sure of her health.” Male participant.

“My wife developed complication just a few hours after she returned home (from the local health center) and I have to rush her to the private hospital because she was losing a lot of blood. I do think that the health facilities have the responsibility of discharging her too early after birth without being sure of her health.” Male participant.

The patient underwent complete endoscopic removal of the lesion and temporary tracheostomy for respiratory distress; tracheostomy was closed 32 days later. Neither postoperative complications nor signs of recurrence during an 18-month follow-up were observed.

We enrolled 18 patients with systemic sclerosis (ten male and eight female) with median age at transplant of 52 years (range 24–68). Median number of two apheresis (range 1–5) was needed to harvest a sufficient number of CD34-positive cells for transplant. The median number of mobilized CD34+ cells/kg b.w. was 3.9 × 106/kg (range 2.1–13.9). There have been no life-threatening complications during mobilization and stem cell collection. One patient developed fever of unknown origin and one patient suffered from mild infection of upper respiratory tract. Median hospital stay was 14 days (range 6–24). No blood support was needed.

Imaging examination of the patient. (A) Axial computed tomography (CT) image showed a few of liquid dark areas around the spleen (white arrow); (B) CT recheck indicated the disappearance of the intraperitoneal fluids; and (C) cystography indicated a small amount of suspicious contrast agent leakage (black arrow).

(A) Disseminated tumor cell (DTC) isolated from cerebrospinal fluid of the patient. Staining against EpCAM and DAPI respectively; merged image of EGFR Exon 21 sequencing of an isolated DTC. Arrow indicates the position of the mutation using (L858R missense mutation) antisense sequencing primers (B). Scale bars represent 25 µm.

Angiogram after stenting showed that the right ventricular (RV) branch remained completely occluded. Intravascular ultrasound image from the right coronary artery main vessel at the RV branch bifurcation revealed that the RV branch was detected at 9 o’clock position. The true lumen of the RV branch (white arrow) was collapsed by an expanded false lumen that was presented as a high echogenic lumen (white arrowhead)

Participant 7 reported that her feelings of rejection were so severe that she started to abuse drugs and alcohol in order to fill the void in her life: “Because of my addictive personality I became very addicted. I think it is because of all the rejection I felt from my mom.”

The patient was seen 6 weeks after the initial trauma at a trauma consultation. He described some residual pain in the posterior aspect of the proximal humerus. The clinical examination revealed a normal range of motion. He was able to intensify the rehabilitation.

Naidu et al. reported 3 cases of professional cricket players with avulsion of the latissimus dorsi and teres major muscles. Two underwent surgical repair with excellent results. The unoperated patient experienced discomfort until 7 months postrupture.

Physical examination revealed pink conjunctivae and anicteric sclerae. Her vital parameters were normal and her weight was 65 kg. Her abdomen was grossly distended with full flanks and visible striae (Fig. 1). It was soft and non-tender with an abdominal girth of 115 cm. Percussion notes were dull over the entire abdomen and fluid thrill was present. Examination of the cardiovascular and urogenital systems were unremarkable.Fig. 1Grossly distended abdomen with full flanks and visible striae

A 16-year-old-boy came to our clinic with a 3-year history of painless swelling in the preauricular region. He underwent surgical excision one year ago and the histopathological examination was suggestive of pleomorphic adenoma. The complete details were not available as it was performed in another institution. The swelling recurred one year post excision at the same site.

PLGA arising from the parotid gland is a rare occurrence. The diagnosis of PLGA is difficult and challenging due to its morphological diversity. Wide local excision with negative margins is the treatment of choice. The role of adjuvant radiotherapy is still not defined due to the rarity of this disease and limited literature. The present case is unique because of the younger age of presentation and rare location.

Butler and Pitt reported a case of C tertium SBP in a 42-year-old female with a history of cirrhosis.8 The patient was admitted for management of hepatic encephalopathy with subsequent development of peritonitis. Clinical and microbiological cure was achieved with the cephamycin antibiotic cefoxitin.