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Four adolescent patients presented with polyarticular septic arthritis and were found to have disseminated gonococcal infection. All 4 joints were culture negative and the diagnosis was confirmed using urine PCR (n = 3) or urine culture (n = 1) for N gonorrhoeae. N gonorrhoeae was in fact the most common microbiological diagnosis for septic arthritis alone.

Midsagittal T2-weighted SSFSE MR image of a fetus at 33 GW. Continuous line along the postero-superior surface of the clivus connecting the most cranial part of the clivus with the anterior border of the foramen magnum (basion). Dashed line along the antero-superior surface of the supraocciput cutting the posterior border of the foramen magnum (opisthon). The angle between these two lines is the CSA. b) Measurement of the TDPF. Coronal T2-weighted MR image of a fetus at 33 GW. The distance between the medial surfaces of the lateral bony margins of the posterior fossa at the level of the lateral insertions of the tentorium cerebelli was measured.

His visual acuity was stable in his ranibizumab-treated LE but had further decreased in his RE. Intraocular pressure was normal (16mmHg) in both eyes. Ranibizumab treatment was well tolerated with no adverse events reported throughout the 6-year treatment period.

Figure 6 showed the images of the early age cracks during the process of self-healing. Where (Figure 6A) was specimen in Group G1 and (Figure 6B) was specimen in Group G4. It can be seen that crack was almost filled completely after 5 days in Group 4 which cooperated with self-healing agent. But the specimen in Group G1 with no self-healing agent couldn't be healed even curing 20 days.

Immunohistochemical validation of the tumor‒regressed lymph node. (A‒C) Cytokeratin AE1/AE3 immunostaining. (D-F) Ki- 67 staining. There were no Ki-67(+) proliferating cells around the tumor-regressed remnant keratin debris (Inserts showed higher magnification views).

Pre-surgical evaluation of the tumor-regressed lymph node. (A-B) CT and US strongly suggest node recurrence based on the enhancement pattern (white arrow) and irregular internal echogenicity (mark). (C-D) Aspiration cytology showed tumor recurrence due to the presence of keratin debris and anucleated squama in the aspirates (black arrows).

a and b - 1 month-old boy. a) coronal contrast-enhanced fat-suppressed T1W: on the left femoral epiphysis hypointensity (arrowhead) in comparison to a homogeneously enhanced right femoral epiphysis (arrow). Epiphyseal nuclei are not yet present. b) X Ray study performed one month later showing a small lytic lesion (arrows) on the left side

The present study is a case-series with low-evidence level and has the limitations of being retrospective and including a small population. However we think that our findings deserve to be further investigated by prospective studies with follow-up investigations in patients with isolated SA at presentation.

A 5cm skin incision was made on the palmar aspect of the mid-metacarpus and the SDFT isolated using hemostats. In six horses the lateral 50% by width of the isolated SDFT at the mid-metacarpal level was transected using a scalpel blade. Sham-operated horses had the SDFT isolated but not transected. The skin incision was closed with simple interrupted sutures and a bandage was applied. Phenylbutazone (2.2mg/kg orally BID) was continued for three days after surgery. Horses were kept in compatible groups of three in small yards (12 m x 12 m) with shelter available for six weeks. They were fed 2.5% (w/w) lucerne hay in divided feeds daily and had unlimited access to fresh water. Bandages and sutures were removed two weeks after surgery.

Case 33. Cranial MRI examination revealed unilateral thalamus glioma located in the right thalamus and midbrain with mixed hypointense and hyperintense (a) and hyperintense T2 (b) signals with clear enhancement (c–e). Postoperative MRI confirmed subtotal resection (f–j). Original magnification ×100

The patient was born at full term and had no problems prenatally. Her past medical history was significant for seizure disorder and developmental delay. She had previously had a normal MRI of the brain and brain stem which showed no structural etiology for the existing seizure disorder or developmental delay. She was currently taking no medications. She was up to date on her immunizations and lived with her parents. Her family history was negative for seizure disorders.

Two representative cases treated with conventional orthodontic method (Panels a and b) or with PBM (Panels c and d). Panel a Baseline (Day 0); LII is 8.80 mm. Panel b. Day 131; LII is 0.00 mm. Panel c. Baseline (Day 0); LII is 9.07 mm. Panel d. Day 50; LII is 0.00 mm

A fourth embryo (Embryo 2) was disaggregated on Day 4 into 8 single blastomeres and one two-cell sample (10 cells in total). All of these cells had identical Karyomaps and the presence of trisomy 1 was confirmed in each case (Table 2). There were no other mosaic chromosome abnormalities except for partial loss of maternal chromosome 13 (approximately 40.5 Mb) in one cell.

Chest X-ray examination revealed the presence of diffuse subcutaneous emphysema of the neck extending along the left lateral chest wall. Pneumomediastinum was also appreciable: air within the superior mediastinum on both sides and along the left paravertebral space. A loss of volume of the left lung due to left inferior lobe atelectasis was associated with the elevation of the left diaphragmatic dome

This report describes an unusual but potentially lethal presentation of obstructive lung atelectasis due to mucous plug formation during the nighttime sleep. It also illustrates the importance of the coughing reflex as one of several defensive reflexes protecting the airways from the potentially damaging effects of aspirate and accumulated secretions.

Our series showed that the combination of P + S has activity in STS and chondrosarcoma patients selected by previous response to P. The goal of therapy for patients with metastatic sarcoma is to prolong life and palliate symptoms. Thus the favored approach remains to use less toxic drugs. P is currently the only approved targeted small molecule in second-line and beyond treatment in STS with a favorable toxicity profile which differs greatly from that of chemotherapy. Resistance to P eventually develops and the addition of S serves to prolong the chemotherapy-free window. This retrospective series proposes to enhance the therapeutic landscape of STS patients. We suggest that the current results serve as proof of concept for the use of combination P + S after escape from P and should be explored prospectively in a large randomized control trial to evaluate the efficacy of combination therapy in different sarcoma subtypes.

Patient was advised a review appointment once in 3 months in order to assess the eruption of unerupted tooth and to examine the recurrence of the odontoma. The position of the impacted tooth was determined on IOPA radiograph by drawing a perpendicular line from the most apical point on the incisal edge of the impacted tooth to a line connecting the incisal edges of the adjacent nonimpacted teeth (Fig. 10). The length was measured in millimeters.

Clinical experience suggests and the dental literature supports that an individualized radiographic examination of any pediatric patient who presents clinical evidence of delayed permanent tooth eruption or temporary tooth displacement with or without a history of previous dental trauma should be performed. Early diagnosis of odontomas allows adoption of a less complex and less expensive treatment and ensures better prognosis.

Three female patients (aged 64–73 years) with severe alveolar bone resorption originating from periodontal disease or trauma were enrolled in this study. None smoked or had systemic pathologies affecting the immune system and contraindications for surgery and sinus grafting. Preoperative CT revealed clear maxillary sinuses and bone height from the alveolar ridge to the sinus floor of 1–2 mm (Fig. 1a). All the patients gave written consent for bone removal during dental implant surgery and its analysis.Fig. 1CT scan before sinus graft. The original bone thickness from the alveolar ridge to the sinus floor was approximately 1–2 mm in average (a). CT image after maxillary sinus augmentation (b). A postoperative image for estimating the dental implant placement site (c). Photograph obtained after harvesting the bone cores and preparation for dental implant placement (d). Hydroxyapatite particles are visible in the lateral window. The operated sinus floors did not shown signs of inflammation. Scale 1 mm

CT scan before sinus graft. The original bone thickness from the alveolar ridge to the sinus floor was approximately 1–2 mm in average (a). CT image after maxillary sinus augmentation (b). A postoperative image for estimating the dental implant placement site (c). Photograph obtained after harvesting the bone cores and preparation for dental implant placement (d). Hydroxyapatite particles are visible in the lateral window. The operated sinus floors did not shown signs of inflammation. Scale 1 mm

Intra-operative photographs. a – A view after the median sternotomy. The pericardium is distended. b – The pericardium was opened. The right atrial aneurysm occupies almost all pericardial space. c – Aortic cannula is being placed (green arrow points to the aorta). d – The heart was decompressed as bi-caval cardiopulmonary bypass was instituted. The aneurysm is being opened by a longitudinal incision. e – The aneurysm is opened and inspected. The green arrows show the protruding right coronary artery. f – The wall of the aneurysm is being excised above the right coronary artery (indicated by the green arrow)

Histology revealed chronic lymphadenitis with perinodal abscess formation. There were no acid fast bacilli in the direct smear. Initial culture results showed a scanty growth of Pseudomonas sp. and E. coli which was sensitive to ceftazidime and treatment commenced according to the sensitivity pattern.

The patient was discharged after completion of four weeks of intravenous ceftazidime with a plan to continue oral antibiotics for 12 weeks. However she presented to the outpatient follow up 2 weeks after discharge with an itchy rash which was presumed to be an adverse effect of co-trimoxazole. The rash improved after co-trimoxazole was replaced by co-amoxyclav. The patient was able to tolerate the co-amoxyclav/doxycycline combination and completed 12 weeks of eradication therapy. At the time of this writing she was well without evidence of recurrence or relapse.

Our patient had diabetes but she did not have any known exposure to soil or water. There was no history of travelling to a known endemic area suggesting that she had acquired the disease in Sri Lanka and that the disease is more prevalent than previously thought.

Our patient had only intravenous ceftazidime for four weeks in the acute phase. Combination of co-trimoxazole with ceftazidime is not recommended in the acute phase as there is no added benefit . Oral co-trimoxazole and doxycycline was chosen for the eradication phase of antibiotics. They were overlapped with ceftazidime for one week as this is the vulnerable period where reactivation can occur .

(A) Myelin-stained sagittal section from case 1 with electrophysiological borders. V1 is identified by the dense band of myelin in layer 4B. V2 is relatively densely myelinated in this section. Myelination is reduced on entering DLp. There is a further subtle reduction in myelination and thinning of intermediate and lower cortical layers upon entering DLi. The electrophysiological border of DLi with DLa/MTc (2 lesions above star) as myelin intensifies entering DLa/MTc. There was a sharp increase in myelination and a further thickening of the intermediate and lower layers entering MT. Myelination drops in peripheral MT just after it bends down into the superior temporal sulcus. (B) Surface location of visually responsive recording sites for case 1 on a photo of exposed cortex at same magnification as sagittal section in A. Position of magnified view is shown in lower left inset. White circles along the superior temporal sulcus mark deeper penetrations containing multiple recording sites. The nearly horizontal black dashed line indicates the position of the myelin-stained sagittal section (star on dashed line shows position of star in sagittal section). Auditory-only responses are marked “a”. The superior temporal sulcus was unfolded in subsequent illustrations to bring deep recording sites to the surface. Locations of area labels are preserved in succeeding maps to aid comparisons.

In our described case the reduction of the reverse Hill-Sachs lesion by use of inflation osteoplasty enabled us to achieve an almost anatomical reduction in the humeral head without limitation of external rotation as commonly found in patients after remplissage or tendon transfers and there we see the great advantage of the presented technique. In cases with isolated reverse Hill-Sachs lesions the application of the balloon osteoplasty might be even performed arthroscopically and thereby further reducing the comorbidity of the open surgical approach.

CT of the chest/abdomen/pelvis eight months after the TME revealed a 1.5 × 0.8 cm spiculated mass in the left lower lung. Pathology confirmed moderately differentiated adenocarcinoma consistent from a colorectal primary tumor. He subsequently underwent video-assisted thoracoscopic surgery (VATS) with left lobectomy. Chemotherapy was offered but it was deferred by the patient.

IHC staining suggested a colorectal primary. Direct laryngoscopy and esophagoscopy revealed a 3 cm mass along the anterior two-thirds of the right tongue which did not cross the midline. It extended to the undersurface of the tongue but did not occupy the floor of the mouth. The posterior tongue was unremarkable. PET scan revealed hypermetabolic activity in the tongue and neck consistent with metastatic disease (Figures 7(a) and 7(b)).

Neurotoxicity of 5-FU has been described in patients receiving capecitabine in combination with oxaliplatin such as acute leukoencephalopathy and posterior reversible encephalopathy syndrome (PRES) or with cisplatin in combination with epirubicin or capecitabine with bevacizumab . The present case is unique in uncovering the first patient to develop 5-FU multifocal leukoencephalopathy as a result of XELOX (plus BV) chemotherapy with beneficial reintroduction of lower doses (metronomic chemotherapy).

The periodontal dressing was removed after a week and healing was found to be satisfactory (Figs 7 to 9). The patient was then placed on a schedule of periodic recall visits for maintenance care (every three months). The oral hygiene maintenance was reinforced at every recall. No recurrence of gingival enlargement was observed one year after the surgery (Fig. 10). The patient will be undergoing orthodontic treatment for the correction of malaligned teeth.

All surgeries and intravitreal injections were performed by Dr. Xiaoyu Wang and Dr. Lan Liu. Eighteen eyes with NVG received IVR injection under topical anesthesia in the aseptic condition of an operating room. 0.5 mg (0.05 ml) Ranibizumab was injected through the pars plana with a 25G needle. The patients were given topical antibiotics and previous antiglaucoma medicines for 1 week after injection. The surgery of trabeculectomy with MMC was performed 1 week later. The globe was pulled inferiorly by a traction suture. The conjunctival incision was made along the limbus to create a fornix-based conjunctival flap in the superotemporal quadrant. A half thick 4 mm × 4 mm square scleral flap was made. MMC (0.4 mg/ml) soaked sponge was placed under the scleral flap for 1 to 2 min. Then the area was irrigated with plenty of saline. Trabecular meshwork (1 × 1.5 mm) was cut and the peripheral iridectomy (1 × 1 mm) was preformed. The scleral flap was closed with two 10-0 nylon sutures at its corners. The conjunctiva was sutured with 8-0 vicryl sutures.

Anterior segment photography of a neovascular glaucoma patient before and after intravitreal ranibizumab injection (IVR). a. Massive new vessels (black arrows) were seen on the iris around the pupil before IVR. b. New vessels were regressed (black arrows) three days after IVR from the same patient of A

Glomerular basement membrane immunofluorescent histology evaluation for IgG subclasses 1–4 was positive only for IgG2 which was strongly suggestive of secondary membranous nephropathy. Staining for anti-phospholipase A2 receptor (anti-PLA2R) antibodies was negative.

Direct sequencing of the TPO gene revealed a homozygous C to T (c.1618C>T) in both affected siblings which results in a stop codon leading to truncation of the enzyme molecule (p.R540X). Both parents carried the mutation at heterozygous state (Figure 2) which was consistent with the linkage data. These results indicated the proper segregation of the mutation with the disease status in the family according to an autosomal recessive inheritance pattern as expected in consanguineous families. Mutation analysis in the rest of the TPO sequence revealed no other mutations in the family. The mutation was not present in 400 ethnically-matched control chromosomes. The results of the mutation screening by NGS indicated that neither case nor the other family members carried any mutation in the remaining causative CH genes.

Indications for a temporary diverting stoma were presence of abscess irrespective of drainage before surgery and/or severe intestinal edema and/or ≥2 anastomosis performed and/or complex fistula requiring large intestinal resection. Faecal diversion was performed using end stoma. Delayed anastomosis was performed 3–6 months later when the general condition of the patient had improved.

The panel identified a missense mutation (chr1:115258745; c.37G > C) in NRAS that results in a p. G13R amino acid substitution. The allelic frequency of the nucleotide change in the brain tumor and the cutaneous nevus (58% and 33% respectively) is consistent with a heterozygous mutation (Table 1). The same change was observed at an allelic frequency of 4.8% in the normal skin and 2.7% in the buccal swab of the patient. Deep sequencing of DNA extracted from the buccal swabs from both parents did not reveal NRAS mutations. A BRAF somatic nucleotide change (chr7: 140481441; c.1397G > T) resulting in amino acid substitution p. G466V was detected only in the nevus at an allelic frequency of 32%. A single nucleotide polymorphism (SNP) resulting in a missense mutation (chr7: 116411990; c. 3209C > T; p.T1010I;) was found in the MET gene of the child’s tumor and buccal swab as well as in the buccal swab of the father.Table 1 Allelic frequency of nucleotide change in NRAS and BRAF from deep amplicon sequencing of pathology specimens and buccal swabs Gene NRAS BRAF Chromosome position (hg19)1:1152587457:140481411Nucleotide changec.37G > Cc.1397G > TAmino acid changep. Gly13Argp. Gly466ValAllelic frequencies (%)Mesenchymal brain tumor58.00.0Melanocytic nevus33.032.0Normal skin4.80.0Buccal swab2.70.0Mother buccal swab0.00.0Father buccal swab0.00.0

The patient with the recurrence was treated with a MAF + PRP again after another 3 months of seton treatment and developed another recurrence. One of the patients with a persisting fistula chose to have a colostomy and did not want other treatment for the CDRF. This fistula closed several months after colostomy placement. The other patient with a persisting fistula was treated with a MAF + PRP after another 3 months of seton treatment. This fistula is still not closed to date.

Intraoperative images. A. Exposure of the bony lesion following temporalis muscle separation. B. Final view following surgical excision and reconstruction using a synthetic bone flap fixed to the surrounding apparently healthy bone with miniplates and screws.

The hyperechoic linear echo representing the normal visceral pleura was lost with superficial lung abscess which appeared as an uniform anechoic area containing many hyperechoic dots representing gas echoes bordered by a broad concave white abscess capsule (Figures 3 and 4). The abscess extended for 7 cm from the chest wall in Figure 4.

To date reports related to AIGO are very rare. Majority of available literature are case studies/presentations which demonstrated that the AIGO occurs within 2-3 months of onset at a dose of 10 mg/day and rarely within first 6 months of onset at a lower dose of 5 mg/day . The present case is interesting as AIGO occurred with a low dose of amlodipine (5 mg/day) and appeared on after several years of administration.

Only one patient experienced a DLT which was grade 3 cardiac chest pain requiring permanent discontinuation of protocol treatment during cycle 1. No dose de-escalation step for selumetinib was required. Toxicity associated with the selumetinib dose of 75 mg bd was manageable.

Written informed consent was obtained from the patient’s next of kin for publication of this case report and any accompanying images. The study was accepted by the Ethics Committee of the hospital and they encouraged us to publish the article. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Postoperative care followed a standardized protocol and was uncomplicated. Six-week follow-up with X-rays (Figure 2) was reassuring and the patient resumed exercise 3 months after the procedure. Four-month and 1-year postoperative outpatient visits revealed no objective or subjective complaints other than a sore knee after extensive running. The X-rays remained reassuring.

(A) Computed tomography (CT) demonstrated a large right-sided pleural mass with invasion to superior lobe of right lung. (B) CT showed nodule lying in the costophrenic angle. (C) Fluorodeoxyglucose (18F-FDG) position-emission tomography (PET)-CT after surgery revealed the residual disease and metastasis of bone (D).

Blood from a patient was cultivated in a blood culture bottle for 7 days; one culture positive and one negative sample were subjected to microarray analysis. Samples from blood culture bottle were used directly as a template for nested PCR amplification. The microarray result was consistent with the identification made by the Chiba University Hospital clinical laboratory.

Decrement of the CMAP was observed at all tested frequencies. Sweep speed and sensitivity settings are identical to those in Figure 2. Control tracings are from the peroneal nerve of a healthy 5 month old Beagle with no decrement seen at low frequency stimulation and normal pseudofaciliation (CMAP gets taller and narrower) with tetanic stimulation.

The probands in this study presented with an early onset neuromuscular disorder characterized by severe exercise-induced weakness. The lack of specific morphological changes in muscle and peripheral nerve biopsies excluded an underlying congenital myopathy or neuropathy. Electrodiagnostic findings and decreased AChR concentration in the muscle indicated a disorder of neuromuscular transmission. The autoimmune disease myasthenia gravis was eliminated based on the early age of onset and an absence of AChR antibodies in serum and AChR-bound antibodies in the muscle. The clinical diagnosis in the Labrador Retrievers was CMS.

At treatment week 3 the patient developed itching red papules around 1 to 3 mm in diameter on the forearms and feet. Some of them were confluent to plaques and had a scaly aspect. Symptomatic treatment with cetirizine and hydrating lotion was started. Over the next weeks the exanthema was confluent and therapy with oral prednisone (0.7 mg/kg body weight) was added at treatment week 6 (Fig. 2). After an initial improvement the exanthema worsened again. Serological tests for HIV and syphilis were repeatedly negative and ribavirin was stopped at week 9. At week 10 the whole therapy was ceased because of increasing severe erythrodermia (Fig. 3). There were no oral lesions. One week after treatment cessation skin lesions aggravated further. A dermatologist was involved and a skin biopsy performed. The biopsy showed papillomatosis with vessel convolutes that reached the stratum corneum as well as neutrophiles in the dermis and parakeratosis consistent with psoriasis vulgaris (Fig. 4). Systemic prednisone doses were further increased to 1 mg/kg body weight (70 mg) and complemented with local whole body clobetasol propionate applications. HCV-RNA was not detectable at end of treatment and during follow up consistent with a sustained virological response (Fig. 1).Fig. 2Psoriatic skin lesions at treatment week 6Fig. 3Erythrodermic psoriasis at treatment week 10Fig. 4Histopathology of the skin biopsy

The report highlights the importance of a throughout patient history and clinical examination at hepatitis C treatment initiation and – most importantly – in regular intervals thereafter. It is of utmost importance to recognise autoimmune processes like psoriasis early to be able to initiate an adequate therapy early and avoid hepatitis C treatment interruptions. It should be noted that a well-controlled psoriasis is not a contraindication to a treatment with peg-INF-α and ribavirin since combination therapies with immunosuppressive treatment seem safe .

(a) Sanger sequencing chromatograms showing III:1 carrier and IV:1 homozygous mutant (b) Family pedigree and segregation of a novel missense mutation (c.4934G>A; p.Arg1645Glu) in the LTBP2 gene in a PCG family. (c). Multiple sequence alignment of the region of the LTBP2 protein surrounding the novel Arg1645Glu mutation in various species. The arginine residue (indicated with an arrow) is highly conserved among all species analyzed.

(a) DNA chromatogram of the relevant PXDN fragment for the carrier and homozygous variant are shown (b). Family pedigree and segregation of a novel missense mutation (c.3496G>A; p.Gly1166Arg) in the PXDN gene. (c). Multiple sequence alignment of the region of the PXDN protein surrounding the novel Gly1166Arg mutation in various species. The glycine residue (indicated with an arrow) is highly conserved among all species analyzed.

Karyotyping was performed on the affected proband and her parents by the Yorkshire Regional Cytogenetics Laboratory. DNA was extracted from peripheral blood of the affected proband using a standard salting out method. Ethical approval was granted by the Leeds East Research Ethics Committee (07/H1306/113). The individual in this manuscript has given informed written consent (as outlined in the PLOS consent form) to publish these case details. Investigations were conducted according to the principles expressed in the Declaration of Helsinki.

(A) Arrows showing the breakpoint locations. Greek letters facilitate interpretation of the resulting pericentric inversion. Sanger sequencing results for the normal and breakpoint spanning amplicons for (B) the 7p15 and (C) the 7q21 inversion boundaries. The vertical dashed read line highlights the breakpoint. For ease of comparison a dashed black line has been drawn onto the normal sequence. (+): sense strand sequence; (-): antisense strand sequence. The inversion has resulted in an AT dinucleotide duplication which is shown arbitrarily assigned to the 7p15 breakpoint.

Orthodontic treatments in the Experimental group were commenced 6 months before SABG by craniofacial orthodontics specialists and continued for 4 months after surgery. All such patients were treated with fixed appliances to align the rotated and inclinated central incisor adjacent to the cleft.

She subsequently also underwent a right total hip replacement for intractable osteoarthritis. After bilateral hip replacements she was independently mobile and led an active life. Radiographs obtained are shown in Figure 1. Incidental findings of left bifocal pubic rami fractures were found at routine follow-up three years following her left hip revision without any history of traumatic injury. At follow-up aged 61 these fractures had healed and the patient continued mobilizing well.

The patient made a good postoperative recovery. She was discharged home after 10 days of intravenous antibiotics pending the results of extended cultures which were negative. At follow-up she remained well and her mobility had improved. A postoperative AP radiograph is shown in Figure 3.

There was no temporal connection between the pubic rami and the stem fracture in this patient. This case however presents the rare possibility that chronically increased stresses in a replaced hip may lead to consecutive insufficiency failure both of the biology (pubic rami) and of the metallurgy. Furthermore we do not believe the cause of stem failure in this patient was due to the high centre of rotation or indeed due to a single biomechanical parameter. It is however of note that the parameters which comprise the specific biomechanical construct in this patient's left hip may have been associated with a dual biomechanical failure: fatigue failure of bone (pubic rami and proximal femoral insufficiency) as well as fatigue failure of the metal implant. Indeed complex interactions of all the factors discussed following successful initial arthroplasty may all have contributed ultimately towards stem failure.

Radiographic images of Case 1. Pelvic computerized tomography (CT) scan: (A) Left image at time of presentation that shows a large hetergenous pelvic mass (9×8.8×5.5 cm) involving the vagina and upper part of the cervix. (B) Right image is taken post-radiotherapy and shows significant interval regression of the mass size.

Example of HARM in a 67-year old patient with left posterior cerebral artery (PCA) infarction: A. Acute ischemic lesion in the left thalamus on DWI. B. Hypoperfusion in the left PCA territory on PWI. C. Proximal occlusion of the left PCA on TOF-MRA. D. Acute ischemic lesion in the left thalamus on follow-up DWI. E. HARM in the left PCA territory on FLAIR images. E. Magnification (1.5x) of HARM on FLAIR images (arrows).

Progressive to complete weight bearing was allowed on the 35th postoperative day after the appearance of callus on radiographs. The patient reached the complete weight bearing on the 60th postoperative day. We considered union to have occurred at 3.5 months of follow-up when radiologically anteroposterior and lateral radiographs showed bridging of at least three of the four bony cortices and clinically the patient was able to walk full weight bearing without any pain.

Liver biopsy was performed before the patient's referral to our clinic. The biopsy showed enlarged hepatocytes with intracytoplasmic glycogen loading and stellate as well as periportal bridging fibrosis with incomplete nodular transformation. Cardiac ultrasound showed a hypertrophic obstructive myocardiopathy with biventricular hypertrophy on electrocardiogram (EKG).

A female patient in her 30s was referred to our institution with a complaint of persistent cough. Chest radiography revealed a mass in the right middle lung field (Figure 1(a)). Noncontrast CT showed a mass approximately 8 centimeters in diameter with relatively smooth margins in the right lung segment 6 (Figure 1(b)). A malignant lung tumor was suspected and fluorodeoxyglucose-positron emission tomography (FDG-PET/CT) was done. FDG accumulation was seen in the lung mass (standardized uptake value max. 3.6) as well as in the mediastinum suggesting a malignant lung tumor with mediastinal lymph node metastasis (Figure 1(c)). Bronchoscopy revealed a tumorous lesion obstructing right B6 (Figure 1(d)). Biopsy of this lesion showed proliferation of spindle cells raising suspicion of sarcoma or spindle cell carcinoma.

Here we report on a fulminant parainfectious ADEM related to acute pneumococcal meningitis in an unvaccinated splenectomized patient. Some aspects emerge from this instructive example of successful early immunosuppressive treatment in a rare autoimmune mediated parainfectious comorbidity.

We report an uncommon case of AFH located around the anus without systematic symptoms. This patient suffered a frequent recurring AFH mass and underwent 3 surgical resections. AFH is a rare disease that is often initially misdiagnosed. It is a challenge to avoid overtreatment or undertreatment. Our case emphasizes the need to correctly diagnose soft-tissue tumors using a variety of diagnostic modalities to ensure that the patient receives proper treatment.

Grassi et al. recently proposed that PD signals in patients with early arthritis may be related to increased perfusion of nutritional vessels at the level of either bone-perforating canals and/or the fat pad . Such a phenomenon may imply that preexisting vascularity to joint components functions as a gateway to articular inflammation at the beginning of RA. It would be interesting to speculate that the unusually prominent tendinitis in this patient at the onset of RA was induced by the unusual preexisting hypervascularity in the tendons due to tendon xanthomas.

Figure 1Case 1: A) Intraoral view of clinical periimplant disease implant body exposure. B) Advanced periimplant disease in orthopantomography around three mandibular implants. Maxillary fixed prothesis supported by four implants without signs of PI. C) Central implant removed and prothesis fixed again.

Case 1: A) Intraoral view of clinical periimplant disease implant body exposure. B) Advanced periimplant disease in orthopantomography around three mandibular implants. Maxillary fixed prothesis supported by four implants without signs of PI. C) Central implant removed and prothesis fixed again.

Figure 2Case 1: A) Anterior mandibular fracture at the site of one of the implants with PI. B) Extraoral approach to expose mandibular fracture. C) Orthopantomography postoperative showing fracture reduction and stabilization by titanium reconstruction plate.

The panoramic X-ray revealed a left mandibular fracture around distal implant and bone loss around most of the fixations (Fig. 3). The prosthese was removed with the two distal implants. Nevertheless the transmucosal abutments the design of the prostheses clearly favored plaque acumulation.

A 20-year-old male was admitted by the urology team after being referred by his GP with a 6-month history of increasing right testicular swelling that had been gradually increasing in size. The patient had no significant past medical or surgical history of note and no family history of any cancer. This patient also had no history of cryptorchidism.

Dr Johnson then focused on the immune reconstitution inflammatory syndrome and presented cases that were detailed in her recent publication (Johnson et al. 2013). These demonstrated CNS IRIS with no evidence of productive HIV infection but with evidence of Tat on cerebral biopsy.

The authors identify a novel missense mutation in the ATG5 gene in two ataxia patients. A partial reduction of the autophagic activity is observed in patients' cells as well as in yeast and fly having corresponding mutations. Locomotor abnormalities are also reproduced in fly mutants. This is the first report of a human disease having a pathogenic mutation in non-redundant core ATG genes.

Muscular hypotonia was noticed during infancy. Motor development was delayed. He started to crawl late and began to walk during the third year of life. Speech development was also delayed. He started to vocalize simple words such as “mama” and “papa” well after three years of age. A recently performed hearing test was normal. At age 7 his developmental state was assessed according to the Denver Developmental Screening Test. Fine motor skills and speech corresponded to a 6 year old. Social competence and gross motor development were delayed by 1.5 years.

The patient has typical features of the 8p23.1 duplication syndrome. Both motor and linguistic development are markedly delayed. This is found in >90% of patients. He is intellectually disabled. In addition he displays symptoms of autism spectrum disorder which has not been reported in other cases . He is not able to control his emotions and barely interacts with other children. His self-absorbed writing of a nonsensical text during the office visit further supports the diagnosis autism spectrum disorder (Figure 1B).

The duplicated region in the patient (1.80 Mbp) is about half the size of the previously defined critical interval (3.68 Mbp) delineated in currently 12 thoroughly investigated patients [summarized in 1]. DECIPHER Database currently lists 31 cases with 8p23.1 duplications overlapping the region found in the patient. The newly defined interval includes 7 HGNC and 4 MIR genes. Of the dose sensitive genes it contains SOX7 and TNKS1 but not GATA4. MIR124-1 and MIR598 that potentially contribute to disease are also within this interval. XKR6 is only partially included since the proximal duplication breakpoint lies within the gene. The patient carries one truncated (only exons 2 to 3) and two complete copies of this gene. XKR6 is therefore unlikely to contribute to the phenotype.

In conclusion the finding of a duplication within 8p23.1 half the size of the common duplication in the 8p23.1 duplication syndrome further documents an important pathogenic role of SOX7 and TNKS1. Absence of congenital heart disease is consistent with two copies and thus normal expression of GATA4 in the patient.

Procedure 2 . A 49-year-old 86 kg male sustained 49% circumferential full thickness burns to both legs and left arm and the left torso following attempted self-immolation. He was admitted to our unit 2 h after injury and taken to the operating room for escharotomies and initial debridement. On hospital admission day 2 the patient was taken back to the operating room for staged excision and grafting of the burn wounds to his legs. The nasogastric tube was temporarily removed and an EHED inserted to a length of 40 cm at the lips. 32% body surface area was excised during an operative time of six hours (Figure 2). During the course of the procedure the ambient temperature was reduced from approximately 26°C to 24°C while patient core and peripheral temperatures were maintained.

A 49-year-old 86 kg male sustained 49% circumferential full thickness burns to both legs and left arm and the left torso following attempted self-immolation. He was admitted to our unit 2 h after injury and taken to the operating room for escharotomies and initial debridement. On hospital admission day 2 the patient was taken back to the operating room for staged excision and grafting of the burn wounds to his legs. The nasogastric tube was temporarily removed and an EHED inserted to a length of 40 cm at the lips. 32% body surface area was excised during an operative time of six hours (Figure 2). During the course of the procedure the ambient temperature was reduced from approximately 26°C to 24°C while patient core and peripheral temperatures were maintained.

This ewe is recumbent due to listeriosis but the changes to facial symmetry are subtle (minor changes in the shape of the ocular and nasal aperture and set of the lip and ear) and the animal may be misdiagnosed if the cranial nerve function were not assessed

Radiograph showing (a) vertebral body destruction and disruption of the normal spinal architecture due to vertebral body osteomyelitis affecting the lumbar vertebrae. (b) New bone formation and loss of normal architecture (arrows) around the C2-C3 articulation on the right-hand side caused by a perivertebral abscess

Myelograph showing (a) narrowing and dorsal deviation of both the dorsal and ventral columns of contrast material at the level of T11-T12. This lamb had vertebral body osteomyelitis resulting in erosion of vertebral bodies of T11 and T12. (b) Pooling of contrast material at the injection site (the lumbosacral junction). This myelograph has been taken too soon after administration of the contrast material as the dorsal contrast column is well established only as far as L3. The lesion in this case was at T10

Video 4:This gimmer presented with a two-week history of paresis progressing to tetraplegia. Note the intact panniculus reflex and the normal-to-exaggerated myotatic reflexes of the fore- and hindlimbs. Clonus is present following stimulation of the patellar reflex of the right hindlimb. The lesion was localised to region C1-C5 and careful palpation of the neck revealed a swelling on the right-hand side. Ultrasonography suggested a perivertebral abscess (a radiograph from this ewe can be seen in Fig 5)10.1136/inp.h5547.video04BMJ Journals Video Playerinpracth5547media4

This gimmer presented with a two-week history of paresis progressing to tetraplegia. Note the intact panniculus reflex and the normal-to-exaggerated myotatic reflexes of the fore- and hindlimbs. Clonus is present following stimulation of the patellar reflex of the right hindlimb. The lesion was localised to region C1-C5 and careful palpation of the neck revealed a swelling on the right-hand side. Ultrasonography suggested a perivertebral abscess (a radiograph from this ewe can be seen in Fig 5)

Our case also confirms the possibility of false-negative Strongyloides serology in immunocompromised patients21–23 with severe forms of strongyloidiasis demonstrating the irreplaceable and complementary role of appropriate parasitological investigation (particularly stool culture).

Central venous catheterization is an invasive intervention used for drug administration and hemodynamic monitoring both in operating rooms and in intensive care units. The frequency of complications is between 5 and 29% . Case reports regarding catheter malposition have already been published . We have encountered cases of knotted guide wire in the literature review .

Abdominal computed tomography scans. (A) Abdominal computed tomography scan on day 3 showing normal adrenal glands. (B) Abdominal computed tomography scan on day 14 showing infiltration with increased adrenal gland volume. (C) Abdominal computed tomography scan on day 21 showing bilateral adrenal hemorrhagic infarction. (D) Abdominal computed tomography scan on day 435 showing small atrophic adrenal glands.

Written informed consent for publication of this case report and accompanying images was unobtainable from the deceased patient's next of kin despite all reasonable efforts. Every effort has been made to protect the identity of our deceased patient and there is no reason to believe that our patient would have objected to publication.

Lateral positioning was used and with open technique the abdomen was entered. A 10 mm trocar was inserted at the umbilicus and two more trocars were placed in the left upper quadrant. Once the abdomen was entered a gian cyst located in the spleen was observed (Figure 2). The ligaments were divided with electronic shears (Figure 3 A) and the splenic vein and artery were ligated by using hemolocks (Figure 3 B-D)

Seven patients were treated with surgery only. The majority of the patients in this group presented with early stage disease (Table 1) and excision was considered complete in all patients though one patient (case 2) required further excision in order to achieve the clear margins. Three patients had adverse features of lymphovascular and perineural invasion but two out of these patients did very well and both are alive with no evidence of disease recurrence after 49 and 44 months of diagnosis. Only one patient (case 4) in this group died of recurrent disease. He was an 84-year-old man who underwent surgery for pT2 base of tongue tumour. He died of recurrent disease 33 months after his diagnosis.

The remaining two patients in this group presented with locally advanced stage IV disease. One patient (case 10) was a 78-year-old lady with T4 disease of the ethmoid required surgical resection followed by definitive chemoradiotherapy (65 Gy in 30 daily fractions with concurrent cisplatin chemotherapy 40 mg/m2 on a weekly basis). The patient did very well and is alive with no sign of recurrence three years after the diagnosis. The last patient in this group (case 11) presented with T4N2bM0 carcinoma of the base of tongue was managed with surgical resection followed by radical radiotherapy 65 Gy in 30 fractions. The disease recurred 18 months after the treatment and the patient died soon after with progressive disease.

Four patients were treated with palliative intent. The first was a patient (case 12) treated originally with surgery and adjuvant radiotherapy for SpCC of the oropharynx seven years prior to the diagnosis of SpCC. Local recurrence and distant metastases developed two years before the diagnosis of SpCC and was treated with palliative chemotherapy with 5FU/carboplatin and cetuximab with partial response. Further progression in maxillary alveolus was resected and histology revealed features of SpCC. The patient died of progressive disease 12 months later. Another patient (case 15) with T4N0M0 SpCC of the maxilla was deemed medically unfit for surgery and treated with palliative radiotherapy but died after five months of progressive disease.

Reys et al reported two cases of SpCC of the tongue. Both patients presented with locally advanced disease (T4N2M0 and T4aN1M0) and were managed with a combined modality treatment i.e. radical surgery followed by adjuvant chemoradiotherapy. Pulmonary metastasis developed in first patient in five months after surgery while the second patient was disease-free two months after surgery .

The present study also encountered one vancomycin resistant CoNS strain with vancomycin and teicoplanin MIC 32 μg/ml. The strain was later identified as Staphylococcus epidermidis. This strain was isolated from culture of tip of endo-trachial tube of a patient who was admitted in the intensive care unit of teaching hospital.

Individual body weight loss in 10 obese participants at Initial session and 3 mo following a commercial regimen (Minçavi®). Mean group body weight loss showed a statistically significant decrease (Initial session 94.7 +/- 3.0; 3 mo 89.9 +/- 3.0 kg; Student's paired t = 9.90; p < 0.0001; two tailed). The range of body weight loss was from 0.9 kg to 6.8 kg for all participants who followed the Minçavi® diet for three months. One participant (ID. S-MAV-01) was invited to return for a follow-up visit after 6 mo on diet. Her body weight showed a continued decrease of 0.9 kg at 3 mo and 8.6 kg at 6 mo.

The case report presented here illustrates the benefits of weight reduction on the progression of kidney disease. There are few studies investigating the pathophysiology of obesity and its early effects on kidney structure and function. Clinical as well as laboratory animal studies have suggested the role of glomerular hypertension due to renal vasodilatation and increase in hydrostatic pressure leading to increased glomerular wall stress and increased tubular sodium absorption . The other proposed mechanism of excessive tubular sodium re-absorption include increased intra-renal pressures caused by the excess accumulation of adipose tissue in the viscera with compression of the loop of Henle and vasa recta leading to sluggish flow in the renal tubules and vasa recta and thus causing an increase in the tubular sodium re-absorption . Increased sodium re-absorption in the loop of Henle initially reduces the macula densa sodium chloride delivery thereby initiating a macula densa feedback that causes vasodilatation of afferent arterioles; this increases renin secretion despite sodium retention and volume expansion. The compensatory vasodilatation of afferent arterioles resulting in an initial rise in glomerular filtration rate (GFR) and increase in the glomerular wall stress leads to increased extra cellular matrix formation and fibrosis along with injury to the kidneys and nephron loss with a resultant decrease in GFR over a prolonged period of time.

The above observations that bariatric surgery leads to reduction in the risk factors associated with development of ESRD and our case report showing that the progression of CKD was retarded with postponement of dialysis raises the question: Should bariatric surgery be recommended in the morbidly obese who fail to achieve sufficient weight loss using non-surgical approaches especially those who are young and have other metabolic syndrome risk factors and are at a favorable anesthetic/surgical risk?

Fig. 2The results of CNV-seq analysis. (A)The whole genome view. (B)The CNV-seq results of the patient showed a 3.30-Mb deletion (40000-3340000) in 7p22.3-p22.2 and a 32.34-Mb duplication (200000-32540000) on the chromosome in 9p21.1-p24.3. The arrows indicate the breakpoints

The results of CNV-seq analysis. (A)The whole genome view. (B)The CNV-seq results of the patient showed a 3.30-Mb deletion (40000-3340000) in 7p22.3-p22.2 and a 32.34-Mb duplication (200000-32540000) on the chromosome in 9p21.1-p24.3. The arrows indicate the breakpoints

The meibomian gland at two-weeks postnatal A General view of the MG showing its acini (asterisk) that is surrounded by the capsule (C) and separated from it by a hollow space (arrowhead) (Hematoxylin and Eosin (H&E)). B & C The acini of the MG is composed of meibocytes with foamy cytoplasm (asterisks) and darker periphery located basal cells (arrowheads) (H&E and toluidine blue respectively). D The connecting ductules are lined by cuboidal epithelium (arrowhead). The central duct is opened and lined by a keratinizing layer (arrow) (Crossmon’s Trichrome)