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Type B ERSA lesion. a. Axial PDFS image of the thigh demonstrating a subfascial ring of increased signal in adductor longus (white arrow). b. Axial PDFS image of the thigh in a different patient illustrating a subfascial ring of increased signal in rectus femoris muscle (white arrowhead)
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Type C ERSA lesion. a. Axial PDFS image of the thigh illustrating a peritendinous ovoid region (white arrowhead) and subfascial ring (white arrow) of increased signal in rectus femoris. b. Axial PDFS image of the thigh in a different patient demonstrating a type C lesion in rectus femoris (white arrow) and a type B lesion in adductor longus (white arrowhead)
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Craniocaudal extent of ERSA and comparison with acute muscle injury. a. Coronal PDFS image of the thigh showing the craniocaudal extent of a type A ERSA lesion in rectus femoris (arrow). b. Coronal PDFS image of the thigh in a different patient illustrating an acute muscle injury of rectus femoris with similar craniocaudal length but with typical ‘feathery’ edema of acute muscle injury (arrowhead)
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In addition to the above patients other immune or inflammatory mechanisms may have contributed to COVID-19-associated ATM. Patient 22 is a 27-year-old HIV-positive man from Moldova (28) who developed paraplegia due to LEATM involving C4-Th5. Patient 32 is a 72-year-old man from Mexico (37) with preexisting cervical spondylotic myelopathy that evolved to tetraparesis after SARS-CoV-2 infection due to ATM at the C1-C3-C6 levels.
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The biliary tract is well known for variations in its anatomy. Failure to identify these variations may lead to intraoperative catastrophes. A hepaticocystic duct is one such rare anomaly wherein the right and left hepatic ducts are found to be draining into the gallbladder with agenesis of the common hepatic and common bile ducts (CBDs). 1 Further drainage of the bile from the gallbladder to the duodenum is via a long cystic duct. Few cases of hepaticocystic duct have been reported in literature so far and this is the only case diagnosed preoperatively. 1 2 3 4 5 6 7 8 9 10 11 Preoperative diagnosis helps plan definitive biliary diversion and also gives the option of using the gallbladder to establish bilioenteric continuity.
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Our patient had type IV anomaly and the importance in identifying this particular type preoperatively is that the gallbladder forms an important part of bilioenteric continuity. Failure of initial recognition of the anomaly may be followed by removal of the gallbladder inevitably resulting in discontinuity of biliary drainage leading to disastrous consequences.
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The injection site was in the temporal quadrant. We measured 4 mm from the limbus using calipers (Fig. 3A) and injected 0.1 ml triamcinolone inside the suprachoroidal space (SCS) (Fig. 3B). The needle was withdrawn obliquely from the eye (Fig. 3C).Fig. 3A Measuring 4 mm away from the limbus. B Insert the needle perpendicular to the sclera and apply gentle pressure on the sclera while injecting. C Withdrawing the needle obliquely from the eye.
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The postoperative anticoagulation regimen included initial subcutaneous low-molecular weight heparin for the first days and in parallel oral anticoagulation with vitamin K antagonist. Oral anticoagulation was continued for 6 weeks after an uncomplicated repair and adapted to the needs of atrial fibrillation or implanted prostheses thereafter. All patients received a TTE at discharge.
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12-lead ECG and ultrasonic cardiogram in the patient. (A) 12-lead ECG in resting time showing sinus arrhythmia; slight hypertrophy (RV5/SV1 = 1.51/0.00 mV) evident in the right ventricular. (B–I) Ultrasonic cardiogram of the patient. The red arrow indicates the site of an atrial septal defect in the left and right pulmonary arteries.
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The E-VAC was changed every 3–4 days and the treatment was continued until the leak was closed and healing was confirmed by an oral contrast swallow (success). E-VAC was suspended (failure) in case of patient’s intolerance or no signs of leak improvement or deterioration of the patient’s clinical conditions.
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We present the case of a 42-year-old man who presented to the emergency department with a complaint of abdominal pain and diarrhea for 3 days. The abdominal pain started in the periumbilical region and was shifted to the right lower quadrant of the abdomen. The pain started gradually and had been progressing in severity. He described the pain as a stabbing in nature. It was exacerbated by movement and food intake. The pain was partially relieved by oral analgesic medications like paracetamol. The pain was associated with low-grade fever and decreased appetite. The patient also complained of diarrhea with five bowel motions/day. The stools were watery with no mucus or blood. He reported that diarrhea developed after he received an oral antibiotic therapy (cefuroxime) for a recent upper respiratory tract infection.
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The past medical history of the patient was remarkable for diabetes mellitus that was well-controlled with oral antidiabetic agents. He did not undergo any previous abdominal surgeries. He had a smoking history of 15 pack-years. He had never drunk alcohol before. He worked as a taxi driver. The family history was unremarkable for any inherited gastrointestinal disorders.
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Additional file 1: Supplementary Figure 1 Somatic variation Circos plot display. Supplementary Figure 2. Public datas (source: Onco KB). Supplementary Table 1. The Primers of somatic and germline mutations. Supplementary Table 2. The germline variants in Fanconi’s anemia pathway genes in the proband’s corresponding non-tumor tissue by WES.
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Additional file 1: Supplementary Figure 1 Somatic variation Circos plot display. Supplementary Figure 2. Public datas (source: Onco KB). Supplementary Table 1. The Primers of somatic and germline mutations. Supplementary Table 2. The germline variants in Fanconi’s anemia pathway genes in the proband’s corresponding non-tumor tissue by WES.
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A 48 years old man who underwent surgery of lung cancer 6 years ago complained of increasing osphyalgia during the previous 1 month and was found to have metastatic lesion in T8-10; His preoperative Frankel grade was D. (A) Preoperative anteroposterior and lateral radiograph revealed abnormal bone mineral density in T9. (B–D) Sagittal and axial magnetic resonance imaging (MRI) showing signal intensity abnormalities in T8-10 and a pathological fracture of T9. (E) Postoperative anteroposterior and lateral radiograph. (F) Postoperative sagittal MRI.
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A 59 years old woman with breast cancer bone metastasis in L5; Her preoperative Frankel grade was D. (A) Preoperative anteroposterior and lateral radiograph revealed uneven density in L5. (B) Preoperative sagittal T2-weighted and axial T1-weighted MRI revealed the metastatic lesion with an intraspinal lesion. The protrusion of soft tissue resulted in compression of the dura and canal stenosis. (C) Postoperative anteroposterior and lateral radiograph showed that posterior spinal fusion with anterior reconstruction was performed. (D) Postoperative sagittal T1-weighted MRI.
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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) B.1.1.529 (Omicron) variant of concern has been suggested to be more transmissible than previous variants of concern (1). We describe an outbreak caused by the Omicron variant that originated from 1 person with an imported case and rapidly spread within 3 weeks to the community in South Korea.
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The most important conclusion of the present report is that a successful clinical and radiological outcome can be expected without KW stabilization of the DRUJs in bilateral Galeazzi fracture-dislocations after anatomical open reduction and internal fixation (ORIF) of the radial shaft fractures.
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Fig. 3 A Sagittal cervicothoracic and (B) lumbar spine T2-weighted MR images obtained several hours later with progression of expansile heterogeneous hyperintensity now extending from C5 to the conus medullaris. Axial T1 post-contrast images of the (C) upper and (D) lower thoracic spine demonstrate foci of ring enhancement within the right hemi-cord (arrows). E The peripheral ring-enhancement is also visible on sagittal T1 post-contrast images
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A Sagittal cervicothoracic and (B) lumbar spine T2-weighted MR images obtained several hours later with progression of expansile heterogeneous hyperintensity now extending from C5 to the conus medullaris. Axial T1 post-contrast images of the (C) upper and (D) lower thoracic spine demonstrate foci of ring enhancement within the right hemi-cord (arrows). E The peripheral ring-enhancement is also visible on sagittal T1 post-contrast images
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Stereotactic MR guided radiotherapy of a hepatic metastasis in a patient with pancreatic cancer (10 × 5 Gy): (A) planning CT scan (portal venous phase); (B) online liver simulation at the MR-Linac; (C) pre-radiotherapy FDG-PET CT scan; (D) first (3 months after radiotherapy) post-radiotherapy MRI scan (liver imaging with volume acceleration-flexible MRI); (E) second (4 months) post-radiotherapy MRI (liver imaging with volume acceleration-flexible MRI); (F) post-radiotherapy (4 months) FDG-PET CT scan. Comment: later hemihepatectomy revealed complete remission of the radiated liver metastasis.
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One of the crucial steps is to diagnose the cesarean ectopic pregnancy correctly. Its differential diagnosis includes a normally sited intrauterine pregnancy and a cervical pregnancy as the management of each type differs drastically. Transabdominal ultrasound in our patient fulfilled the following diagnostic criteria as described in the Green-top Guideline (GTG) of Royal College of Obstetrics and Gynecology: Diagnosis and Management of Ectopic Pregnancy GTG 21 .
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A 38-year-old Brazilian man was admitted in our service with chief complaint of fecaluria and pneumaturia for eight months that started after an intense abdominal pain at the time. His occupation was teaching and he walked into the urology emergency by his own means. The patient evolved with repeated episodes of urinary infection associated with dysuria and hematuria. He was treated with several antibiotics with no resolution of the main complaint of fecaluria and pneumaturia.
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There were 6 female and 4 male DM (types I and II) patients with a mean age of 40 years (SD ± 5.5). The mean duration of DM among the patients was 6 years (SD ± 2.8). All the 10 patients who received antidepressants were in clinical remission by week 6 (defined as a HAM-D score ≤ 17). Five participants received 20 mg of Fluoxetine daily and 3 received 75 mg of Amitriptyline.
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Additional file 1. Table S1: Causative variants identified in 86 of 168 Korean inherited retinal degeneration probands.Additional file 2. Table S2: Possible causative variants in 30 of 168 Korean inherited retinal degeneration probands.Additional file 3. Figure S1: Phenotypes of case 103 who carries compound heterozygous mutations in the RP1 gene.
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The patient was admitted in the intensive care unit; he received motor kinesitherapy with a dual antiplatelet therapy based on aspirin (70 mg per day) and clopidogrel (75 mg per day). The outcome was favorable; he regained his motor functions in his right side.
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The incidence of cerebral infraction secondary to angioplasty repair of coarctation of aorta is rare . It was the first case in our department. The study conducted by Lefort et al. about the outcome of balloon angioplasty for recurrent aortic coarctation in patients aged less than 1 year showed that only one patient among 20 developed a transient ischemic stroke with complete recovery at discharge.
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Herein we report the case of a Brazilian man who developed acute blurring of vision associated with optic disc swelling and exudates in a macular star pattern soon after an infestation of fleas broke out among his cats. Signs and symptoms remitted only after initiation of antimicrobial therapy.
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FIGURE 1:(A): a retinography image from a 24-year-old male patient shows a pattern of neuroretinitis with unilateral right optic disc swelling in the inferior margin and hard exudates in classic stellate distribution (macular star pattern); (B): The left eye was normal.
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The routine postoperative anticoagulation practice was oral warfarin and subcutaneous enoxaparin started in the evening of the day of surgery. Enoxaparin was continued until therapeutic INR > 2.0 was reached. Warfarin was continued for 3 months unless there was an indication for permanent anticoagulation. Antiplatelet agents were not used routinely postoperatively. Medication was at the treating physician's discretion.
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Intraoperative findings. a Mucosal marking around the tumor and injection of sodium hyaluronate solution with indigo carmine around the tumor under endoscope guidance. b A circumferential seromuscular incision around the tumor. c Dissecting a full-layer specimen using a laparoscopic-stapling device. d Linear suturing of the seromuscular layers
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BMAC intervention strategy to treat femoral head ON. Bone marrow (BM) aspiration was performed from the posterior superior iliac crest area and the BM aspirate was concentrated (BMAC) using a commercial filtration system to concentrate the mononuclear fraction containing BMSC and BM-EPC. Five sequential intralesional and intraarticular BMAC injection sessions were performed in both knees using ultrasound guidance. Twelve months post-treatment radiological improvements were observed in previously ON areas that supported the positive clinical progression.
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The patient did not have any history of coagulation disorders or any history of previous pulmonary embolism or deep vein thrombosis. Wells score was 1.5 (low probability for pulmonary embolism). BMI was 24.3 kg/m2. The patient transferred to the coronary care unit (CCU) and the labetalol drip started. The patient did not have any respiratory symptoms and arterial blood gas (ABG) was normal.
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The laboratory results showed a sterile culture. The hematoxylin and eosin-stained sections revealed a subperiosteal benign schwannoma that was completely excised. The pathology report mentioned the presence of a well-encapsulated lesion formed of spindle cells in addition to thin wavy spindle nuclei and nuclear palisading (Verocay bodies). There was no mitosis or necrosis area. Immunohistochemistry staining showed diffuse expression of S100 proteins.
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This CT scan image represents the results of the wedge resection and radiofrequency ablation (RFA) of various hepatic lesions. The yellow arrow represents a fluid hepatic collection as a result of radiofrequency. The blue arrow indicates a clip as a result of wedge resection
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A case report of a 48-year-old female by Horton et al. in 1948 showed significant relief in symptoms of TN after administration of first-generation antihistamines. The patient had exacerbation and severe episodes of TN in the spring. The seasonal exacerbation and alleviation of TN symptoms after administration of antihistamine hinted at an underlying allergic etiology .
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A representative image for selecting the foreground and background areas. Image of a 76-year-old female patient with myopic choroidal neovascularisation (mCNV) in the right eye. Foreground (within the yellow line) and background (within the red line) areas were selected to calculate the contrast-to-noise ratio (CNR). The darkest area around the CNV was set as the background and the whole CNV area was set as the foreground (CNR 1.6).
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HE and immunological staining observation of the renal tumor: (A) Sheet of clear cells in the tumor (original magnification × 400); (B) CD10 staining revealed diffuse positivity among the tumor cells (original magnification × 400); (C) hepatocyte staining of tumor cells was completely negative (original magnification × 400).
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Pulmonary manifestations are increasingly being recognized as complications of inflammatory bowel disease (IBD) since it was first described in 1976 . Our series highlights six cases where surgical biopsy was required to definitively exclude infectious pulmonary processes prior to initiation of therapy.
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Case 1. A 29-year-old male patient with pseudoaneurysm of the right common carotid artery caused by head trauma (Figure 1)Case 2. A 36-year-old female patient presented with a pseudoaneurysm of the left superficial femoral artery due to a comminuted pelvic fracture (Figure 2)
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Such acute conditions since the beginning tended to more frequent and each time the child’s condition worsened. Most patients developed congenital heart defects. Mitral and tricuspid valve defects and pulmonary hypertension progressed from moderate to severe within 3–4 months.
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Patients with FAP and intraabominal desmoid tumors had a tendency for severe complications. A 44-year-old patient developed chylous ascites after radiotherapy for intraabdominal multilocalized desmoid tumors. He developed peritonitis and required opening of an abscess after paracentesis. Several times the patient developed sepsis which was contributed to cholangitis. In the location of the previous desmoid he developed an interenteric retention due to fistula. After five consecutive operations for persisting multiple fistula and perforations a jejunostomy was performed and the patient received a total parenteral nutrition (Supplemented Table 1).
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Our patient was extubated on postoperative day 1 and the chest tube was removed on postoperative day 4. He was clinically stable for discharge by postoperative day 7. He has been followed in clinic for 6 months with good respiratory function and a normal chest X-ray.
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PET/MR images of a small liver metastasis. a T2-weighted axial image showing small area of slight hyperintensity in S8 (arrow); b axial VIBE with a small hypointense lesion of 7 mm in S8 (arrow); c axial b1000 diffusion-weighted imaging (DWI) confirming the signal restriction of the mass (arrow); d axial PET/MR fused image with hypermetabolism of the liver lesion (arrow)
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Biodistribution and lesion targeting of 89Zr∙Df-HER2-Fab-PAS200 in a mBCa patient. a Whole-body MIP images of 89Zr∙Df-HER2-Fab-PAS200. b Magnification of 89Zr∙Df-HER2-Fab-PAS200 accumulation in axillary lymph node metastases (blue arrow) and in the presumed primary tumor (green arrow) 24 h after injection. c Overlay of PET/CT images in the region of the presumed primary tumor in the left breast. d MRT scan of multiple brain metastases (yellow arrows)
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Four patients (40%) had a history of intubation prior to development of symptoms and were found to have subglottic stenosis on fiberoptic laryngoscopic (FOL) examination and labeled as acquired subglottic stenosis. Two patients with acquired subglottic stenosis were born prematuraly with a mean gestational age of 28 wks and were intubated for the same. Both these patients developed stridor immediately after extubation. One of the patients with acquired subglottic stenosis had developed neonatal septicemia and remained intubated for 6 weeks. The patient presented with repeated episodes of desaturation which were aggravated by upper respiratory tract infection (URTI). The patient had developed fibrosis and granulations predominantly posteriorly and was tracheostomised. Another patient with acquired subglottic stenosis presented at the age of 18 months when he had undergone repeated intubations for multiple surgeries for congenital vesicourinary anomalies (Figures 1–3) and needed tracheostomy at the time of presentation. All the patients with acquired subglottic stenosis had fibrous subglottic stenosis with grade I in two patients and grade II in two patients.
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A plain computed tomography (CT) scan of the abdomen revealed pancreatic tumor and he was referred for surgery. An enhanced CT scan revealed pancreatic head cancer and multiple liver metastases (Fig. 1). The decision was made to initiate chemotherapy (gemcitabine + nab-paclitaxel) for unresectable pancreatic head cancer.Fig. 1Enhanced computed tomography scan demonstrates pancreatic head cancer and multiple liver metastases.Fig. 1
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Open access methods were used to place a laparoscopic trocar into the umbilicus for carbon dioxide (CO2) pneumoperitoneum. The peritoneum was opened above the spina iliaca anterior superior which then revealed a hydrocele of the canal of Nuck and an indirect hernia. The hydroceles were excised laparoscopically and a TAPP with a 10 × 15 cm polypropylene mesh placed over the hernia and glued with 1ml of fibrin before suturing the peritoneal flap.
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The histopathological examination showed a mesothelium-coated cyst wall with chronic macrophage-rich inflammation and was consistent with those of a Nuck hydrocele. The patient was discharged two days after surgery and her follow up remains uneventful 6 months postoperatively.
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We performed a laparoscopic excision of the type 2 hydrocele and a left sided inguinal hernioplasty by TAPP. The histopathological examination showed peritonealized soft tissue with marks of chronic inflammation. Based on the intraoperative and histopathological picture the findings were compatible with a hydrocele of the canal of Nuck. The early postoperative period was uneventful and the patient was discharged home the next day in good clinical condition. On follow up an inguinal hemato-seroma measuring 7 × 4 cm occurred 8 days postoperatively which was self-absorbed. No other complications occurred during a 12-month follow-up.
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The patient decided to proceed with elective surgical therapy. The cyst was excised and a right-sided Lichtenstein hernioplasty was performed to cover the hernia defect. The histopathological examination revealed a peritoneal inclusion cyst matching a cyst in the canal of Nuck. The patient was discharged home in stable condition two days after surgery. The patient was asymptomatic in our 6-month follow-up routine.
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We proceeded with emergency surgical therapy. Laparoscopy revealed an hourglass-shaped Type 3 hydrocele inside the canal of Nuck. A TAPP hernia repair was performed due to widening of the ingunal channel by the hydrocele. The early postoperative period was uneventful and the patient was discharged home two days after surgery in satisfactory condition. The patient remains asymptomatic in our routine follow-up lasting 6 months.
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The case report that we report describes a kidney failure following OAGB and rapid weight loss. The only change in the renal function across surgery was the calcium oxalate levels increase. We therefore make an hypothesis based on a pathophysiological rationale that will need further analysis to be proven.
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The case report described here presents a useful suggestion in deciding which bariatric procedure should be chosen in nephropathic patients.The patient description is well explained and the discussion is well written as it establishes a sort of guide line that deserves to be taken into consideration.Kidney function in obese patients is a main issue and a main concern. Analyzing which kind of pathological disorder lays underneath kidney insufficiency should be done before choosing the type of bariatric procedure.
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A complex nuclear family with triplets (monozygotic and dizygotic siblings) impacted by ASD was initially tested using clinical microarray and whole-exome sequencing. The analysis did not yield any obvious pathogenic variants. We have conducted whole-genome sequencing using illumina technology and identified a variant of unknown significance (VOUS) 151 kb deletion impacting the GOLGA8B gene in chromosome 15 in the triplets (MZ twins and the dizygotic twin). Our analysis of de novo SNVs identified variants impacting DXO and CLCA4 gene were classified a VOUS following the American College of Medical Genetics and Genomics (ACMG) guidelines (Figure S1).
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A 22-year-old right-handed paratrooper was presented to the orthopedic emergency department because he fell on his outstretched right hand after having attempted a wrong landing technique. The accident took place in the island of Rodos where he received first aids and was then transported to our hospital for further treatment.
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Direct magnetic resonance arthrography of a 30-year-old woman with right developmental dysplasia of the hip. The image shows the measurement and calculation of the femoral neck anteversion (FNA) angle. The cross section of the knee joint and the cross section of the femoral neck are sequentially measured. The axial femoral plane angle is added or subtracted with the intersection angle of the hypocondyle angle and the horizontal line of the knee joint. Angle’s addition is for knee internal flip and angle’s subtraction is for the knee external flip. a cross section image of the hip; b cross section image of the knee
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It should be noted that the sensory and motor velocities and distal motor latencies of the left median and ulnar nerves were normal or slightly reduced and are not listed in the table. There was also no evidence of ulnar nerve entrapment at the left elbow. The reduced ulnar sensory amplitude with absent left medial antebrachial cutaneous sensory amplitude with preserved left lateral cutaneous antebrachial cutaneous and median sensory amplitudes are demonstrated graphically below (Figure 4).
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Kawajiri S et al. reported three patients with herpes zoster-associated plexopathy. Two showed a motor weakness of the left shoulder girdle with a herpetic rash in the cervical C5 and C6 dermatomes. The third patient developed thigh weakness and a herpetic rash in the lumbar L2 and L3 dermatome. The electromyograms of all three patients showed acute denervation in the affected muscles. The patients were treated with intravenous acyclovir and corticosteroid pulse therapy. The patients improved .
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DNA was extracted from the patient’s blood cells. Library was prepared for nanopore sequencing using DNA ligation kit (SQK-LSK109) then subjected to PromethION sequencing (Oxford Nanopore Technologies) using one PRO-002 (R9.4.1) flowcell according the manufacturer’s protocol. Base-calling and fastq conversion were performed with MinKNOW ver1.14.2. Control datasets were also sequenced PromethION as previously described . Base-calling and fastq conversion were performed with MinKNOW ver1.11.5.
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Deletion of RAD21-EXT1 but not TRPS1. a Five reported patients have deletions (black bars) disrupting RAD21 and EXT1. This patient also has deletions (red bars) in the same region. b Quantitative RT-PCR shows decreased expression of RAD21 and EXT1. The expression level of TRPS1 is not altered. Error bars: standard deviations from three experiments. Controls are three different individuals without the same disease
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Interstitial syndrome with ‘light beams’ and small peripheral consolidations was diagnosed in all patients. One patient had lobar consolidation with a moderate pleural effusion (Fig. 1). These abnormalities may represent the anatomical substrate for increased dead space and IPS.Fig. 1Consolidated lung in a mechanically ventilated patient with intrapulmonary shunt. Consolidated lung in a mechanically ventilated patient with intrapulmonary shunt. Lung ultrasound demonstrating a large area of consolidated lung (C) surrounded by a moderate pleural effusion (*) in zone 6 of the right lung
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Additional file 2: Video S2. Intravenous microbubble contrast enhanced echocardiographic study demonstrating interatrial shunt. Labelled 2-D subcostal 4 chamber transthoracic echocardiographic (TTE) recording of the heart after intravenous injection of saline microbubble contrast demonstrating grade 4 shunt (opacification of right atrium). Bubbles appeared in the left atrium (LA) within 3 cardiac cycles of opacification of the right atrium (RA) demonstrating the presence of an interatrial shunt. The RA and right ventricle (RV) are dilated and RV function is impaired. These findings are consistent with acute cor pulmonale. LV left ventricle.
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The present case suggests that SAC failure and chromosome number instabilities can accelerate aging in humans and is suggestive of a vicious cycle between increased aneuploid cells and aging. Further studies on the CDC20 p.R286S variant and other MVA syndrome model animals could form the basis of a novel disease model to investigate aging of the body and organs.
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Segmented lead and recording of directional local field potentials. (A) The segmented lead had two levels of directional electrodes and two levels of ring electrodes. Only the most distal level of directional electrodes toward the tip was used for recording and stimulation. (B) Example of filtered traces and power spectral densities (PSD) from Patient 2 for the three directions.
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All the female patients selected for the project had the procedure of inserting the midurethral tapes using the transobturator (TOT) method. The treatments were performed by one surgeon. ABBIS CYRENE slings were used for them. The principles during the surgery included the following procedures:Inserting a catheter in the urinary bladder;incision and dissection of the vaginal mucosa and fascia;proper insertion of the tape;preventing implants from wrapping and rolling up;avoiding infection of the implants;optimal tension-free stitching of vaginal walls .
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a A 52- year-old man who sustained reverse oblique fracture with subtrochanteric extension by high-energy injury. b Postoperative radiograph after open surgery. c Nonunion and implant failure at 14 months after initial surgery. d Revision surgery using closed procedure without bone graft. e Postoperative radiograph. f Bony union at 7 months after revision surgery
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a A 68-year-old female patient who sustained atypical subtrochanteric fracture by low-energy injury. b Postoperative radiographs after open surgery. She underwent a total of three open surgeries. c Nonunion and implant failure at 43 months after initial surgery. d Revision surgery using closed procedure without bone graft. e Postoperative radiograph. f Nonunion at 1 year after revision surgery
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a A 44-year-old male patient. b Postoperative radiographs. c Nonunion and implant failure at 13 months after surgery. d Revision surgery using closed procedure without bone graft. e Postoperative radiographs. f Bony union at 7 months after revision surgery
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Differentiating plasmablastic lymphoma and plasmablastic myeloma is challenging due to overlapping morphological and immunophenotypical features. This case demonstrates the difficulty to distinguish a nonsecretor myeloma with plasmablastic morphology from a plasmablastic lymphoma and the necessity of a multidisciplinary approach to make an accurate diagnosis because the treatment protocols are different.
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This case demonstrates how challenging a correct interpretation of a bone marrow aspirate is when pleomorphic plasmablasts are present. Definite distinction between plasmablastic lymphoma and plasmablastic myeloma is difficult due to overlapping morphological and immunophenotypical features and the lack of distinctive immunophenotypic criteria.
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This study identified the novel and potentially pathogenic heterozygous missense variant c.5417C > A (p.A1806D) in the MYH14 gene; this variant is responsible for postlingual nonsyndromic SNHL in a four-generation Han Chinese family. The findings also highlighted the combined application of gene capture and Sanger sequencing is an efficient approach to screen pathogenic variants associated with genetic diseases such as autosomal dominant nonsyndromic deafness.
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Data about the optimal treatment of PPID are scarce due to its varying aggressive behavior. Combined modality treatment may be required for patients with PPID due to its high recurrence rate. This is the first case reporting reirradiation with hypofractionated SRS for multiple recurrent PPID lesions after the primary disease was controlled with the combination of surgery and conventional fractionated RT. A complete response was achieved without any treatment-related toxicity. Hypofractionated SRS can be an alternative to surgery for recurrent PPID when optimal surgery is not feasible due to its adverse effects and morbidities.
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Here we describe the onset of posterior semicircular canal (PSC) fibrosis on MRI in a patient with a clinical presentation and instrumental findings consistent with acute stroke in the territory supplied by the common cochlear artery (CCA). We also review the relevant literature.
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Takeaway lessons of this case report:Severe electrolyte disturbance due to refeeding or as a result of severe starvation in patients with AN can result in sudden cardiac death even without a preceding cardiac dysfunctionCareful monitoring in early phase of refeeding is of major importanceExtracorporeal resuscitation is recommended as bridge to recovery treatment strategy in cardiac arrest and acute heart failure in AN
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Enhanced chest computed tomography (CT) showed an anterior mediastinal mass invading the superior vena cava and pericardium that measured approximately 13.0 × 8.0 × 6.0 cm in size (Fig. 1b and c). Fluorodeoxyglucose-positron emission tomography indicated a hypermetabolic (SUVmax =10.6) mediastinal mass without additional uptake by other organs or regional lymph nodes (Fig. 1d).
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Additional file 1: Supplementary Fig. 1. (A) Pedigree chart of the patient. The index patient and his son carry the same MEN1 gene mutation. (B) DNA sequencing shows a heterozygous missense mutation in exon 3 (p.Val215Met).Additional file 2: Table S1. Diagnostic criteria of MEN1 *
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Macroscopic images of the explants after 6 and 12 weeks. There were no traces of inflammation or fibrotic tissue surrounding the samples. Small blood vessels were distributed across the connective tissue without any disruption or bleeding. The connective tissue was not integrated into the material and moved smoothly over the materials disks
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A case of a 69-year-old patient International Federation of Gynaecology and Obstetrics (FIGO) staged IIA with a sub-centimetre pelvic lymph nodes on parametric maps of (a) axial fused 18F-fluoro-deoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) image and (b) axial T2-weighted (T2W) image. This patient was classified as metastatic by the IVIM models and correctly staged by the subspecialist but not the non-subspecialist.
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A case of a 67-year-old patient International Federation of Gynaecology and Obstetrics (FIGO) staged IIIB with a sub-centimetre pelvic lymph node on parametric maps of (a) coronal fused 18F-fluoro-deoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) image and (b) axial T2-weighted image. This patient was classified as metastatic by the IVIM models and correctly staged by the subspecialist but not the non-subspecialist.
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The patients have been living with their own families in different districts. Patient 1 is the youngest infant diagnosed with Covid‐19 infection in a hospital in Yichang. The summary of their clinical characteristics and treatment is shown in Table 1. Laboratory test results are shown in Table 2. Their chest computed tomographic (CT) images obtained on admission showed bilateral patchy ground glass opacities (Figure 1). Informed consent was obtained from their parents or guardians for the publication of their clinical data.
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This case highlights the possibility of corneal infection by less common organisms in temperate regions such as Exophiala spp. and in less likely situations. We should suspect a fungal infection if an infiltrate appears in the graft-host interface several weeks after DSAEK. Donor rim cultures are useful for more complete diagnosis as long as culture times should be long enough for fastidious organism to grow.
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EEG holes are visible in spectrograms after intravenous ketamine delivery. (A–F) Spectrograms of EEGs recorded from 5 sheep that received i.v. ketamine (24 mg/kg; red line in A-F). For 3 of these sheep (A–C) the heart rate (HR) was recorded via ECG. Sheep 5 (E) received a repeated dose of ketamine in a separate session 3 days after the first trial (F).
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Colonoscopy was performed and established the diagnosis of florid Crohn’s Disease. Treatment with anti-TNF-α agent infliximab (5mg/kg) was initiated and 1 month after the first infusion her arthritis and pyoderma gangrenosum lesions were significantly improved as were the patient’s laboratory tests after a couple of months. (Figure 3 and Figure 4).
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A technetium-99 m pertechnetate thyroid uptake scan demonstrated homogenous diffuse tracer uptake in both lobes in keeping with a diagnosis of Graves’ disease (Fig. 1.). Sex hormone binding globulin was 92 nmol/l (27–128). Fig. 1Thyroid uptake scan. Thyroid uptake scan (technetium-99 m pertechnetate) demonstrating homogenous tracer uptake in both lobes
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Carbimazole was stopped in January 2013 and the patient was followed in our clinic with serial thyroid function tests. She remained asymptomatic but her blood tests over the next 2 years demonstrated a discordant pattern – a persistently elevated free T4 with a TSH level inappropriately in the normal range (Table 1). She was clinically euthyroid without a goitre.
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ISFTs are much less common than meningiomas. The ISFT in this case had one unusual feature which was the radiological appearance of a “dural tail” mimicking meningioma. This case report highlights the fact that the typical radiological appearance of one lesion may sometimes be misleading. Knowledge of these tumors is essential for neurosurgeons to include them in the preoperative differential diagnosis.
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(A) Electropherogram of ACADVL showing the two heterozygous substitutions c.553G>A (p.G185S) and c.1153C>T (p.R385W) in the proband (pt. 1) and the presence of only c.553G>A (p.G185S) in the son (pt. 2). (B) Family tree shows the segregation of the two G185S and R385W mutations in the analyzed family members.
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The two of our subjects who had leucopenia while taking hydroxyurea at 25 mg/kg had low baseline leucocyte counts. No other subject had leucopenia at the hydroxyurea dosage that was <25 mg/kg. These findings underscore the importance of individualizing the monitoring of patients on hydroxyurea. The findings also corroborate the clamour for a low fixed dosage of hydroxyurea especially in settings where monitoring of patients is beyond the economic reach of the patients. A well-planned randomized control trial may be required to authenticate these observations.
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(A–M) Imaging characteristics of ischemic stroke in COVID-19 patients. A: MRI of the brain showing areas of infarction in the right corpus callosum and left temporal lobe on the diffusion-weighted sequence. B: CT brain showing hypodensities in the bilateral middle cerebral artery territories. C: MRI brain showing a right-sided temporal lobe infarction on the diffusion-weighted sequence. D: CT head showing hypodensity in the left anterior cerebral artery territory. E: MRI brain showing areas of infarction in the left frontal and right temporal lobes on the diffusion-weighted sequence. F: CT head showing hypodensities correlating with infarctions in the left parietal and occipital lobes. G: CT head showing a hypodensity in the left temporal lobe. H: CT head showing a large infarction in the right middle cerebral artery territory. I: MRI brain showing area of infarction in the left superior cerebellum on the diffusion-weighted sequence. J: MRI brain showing areas of infarction in the right corona radiate and left parietal lobe on the diffusion-weighted sequence. K: CT head showing a hypodensity in the left frontal lobe in the middle cerebral artery territory. L: CT head showing bilateral infarctions involving the anterior and posterior circulations. M: MRI head showing bilateral frontoparietal centrum semiovale/corona radiata infarctions on the diffusion-weighted sequence.
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T2 fat sat-weighted image of the shoulder in sagittal plane. Distortion and hyperintense signal of intratendinous tendon of anterior supraspinatus muscle with surrounding oedema (arrow) consistent with myotendinous injury. No degenerative tendinosis of the posterior bundle of the supraspinatus tendon was observed nor concurrent tears/degenerative changes of the other rotator cuff tendons was noted.
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Two patients presented to our center with knee instability following a twisting injury. The first patient was 15-year-old female with 50 kg of weight and 150 cm in height with a confirmed ACL rupture on Magnetic Resonance Imaging (MRI). The second patient was 16-year-old female with 55 kg weight and 155 cm height with a confirmed ACL rupture and meniscus injury on MRI. We performed ACL reconstruction only in the first patient and ACL reconstruction with meniscus repair in the second patient.
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Meniscus was repaired in the second patient and ACL reconstruction was planned with PLT graft considering the activity level and the similarity of body characteristic as the previous patient. We harvest the PLT with the same manner as previous patient. The tendon was surprisingly insufficient 6 mm × 10 cm (after doubled). We decided to take the HT as augmentation and a final 7.5 mm × 10 cm six strand graft was obtained.
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Pain and stability at knee and ankle joint subjectively and objectively evaluated at one-year post operatively. We used the visual analogue scale (VAS) to measure pain before and after surgery. Knee and ankle stability were evaluated using the International Knee Documentation Committee (IKDC) 2000 Standard Evaluation Form and American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score respectively. The power of foot eversion and first ray plantar flexion was examined using Medical Research Council (MRC) scale for muscle strength and compared to the normal sides on contralateral ankles. Other donor-site morbidities at ankle region were also recorded such as numbness or proximal stump irritation. In the second patient ACL graft was re-evaluated on the second look 8 months after the reconstruction.
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The resected margins were free from tumor. A diagnosis of mucinous adenocarcinoma of the right renal pelvis with carcinoma in situ of adjacent ureter was made. The patient did not receive adjuvant radiotherapy or chemotherapy. He has remained disease-free on clinical grounds until six months of postoperative follow-up.
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A case of prophylactic clip application for a large pedunculated polyp. a A 2.5-cm pedunculated polyp with a 4-mm-diameter stalk was noted in the sigmoid colon. b Two clips were placed on the lower part of the stalk for prophylaxis. c Snare polypectomy was performed on the stalk just above the clips. d There was no evidence of bleeding on the resected site
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A case of postpolypectomy bleeding after the removal of a large pedunculated polyp. a A 2-cm pedunculated polyp with a 4-mm-diameter stalk was found in the sigmoid colon. b Snare polypectomy was performed. c Spurting bleeding occurred from the resected site of the stalk. d The bleeding ceased after the application of 2 clips on the bleeding site
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Same patient as in Fig. 1. a Selective angiography of the celiac artery with a Sidewinder I-catheter. b After passage of the gastroduodenal artery and the pancreaticoduodenal arcade with a coaxially inserted microcatheter the SMA is retrogradely filled up to the proximal occlusion
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In all three patients the technical procedure of recanalization was successful using the retrograde passage via collaterals of the CA. The symptoms which caused the treatment disappeared completely so that they were symptom-free immediately after intervention. We didn’t notice any complications caused by the interventions.
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A 32-years-old man was admitted with the complaints of severe and diffuse abdominal pain associated with mild fever for last 8 h. He had no bowel movement within last 24 h and respiratory discomfort for one and half an hour. He was hemodynamically stable with optimum oxygen saturation and temperature was recorded 99 °F with some signs of dehydration. His abdomen was not distended but it was tender all over and rigid and digital rectal examination revealed normal. Treatment started with intravenous crystalloid infusion with antibiotics (cefoperazone + metronidazole) and analgesics.
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