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The patient was admitted to hospital as a case of postbariatric surgery myeloneuropathy or GBS. IVIG was given for a complete course of five continuous days. Thiamine loading and maintenance were given parentally. Vitamin B12 and D levels were within normal limits. She was discharged with persistent weakness to undergo rehabilitation. No MRI or NCS was done at admission. | 100 |
She continued to receive vitamin supplementation and physiotherapy. Plasma exchange was discussed but declined by the family. She will require ongoing extensive neurorehabilitation at a dedicated center at King Faisal Specialist Hospital and Research Centre or King Fahad Medical City in Riyadh. | 99.94 |
CBCT images of maxillary teeth. R – Right. a Axial slice of maxillary central and lateral incisors and canines displaying single canals (b) Axial slice of a three-rooted left maxillary first premolar displaying one canal in each root. c Axial slice of a right maxillary second premolar displaying two canals (d) Axial slice of a left maxillary second premolar displaying two canals. e Axial slice of a right maxillary first molar displaying a second mesiobuccal (MB2) canal in its mesial root. f Axial slice of a left maxillary first molar displaying a second mesiobuccal (MB2) canal in its mesial root. g Sagittal slice of a right maxillary first molar displaying a second palatal canal. h Axial slice of a right maxillary second molar displaying a second mesiobuccal (MB2) canal in its mesial root. i Axial slice of a left maxillary second molar displaying a second mesiobuccal (MB2) canal in its mesial root | 99.4 |
CBCT images of mandibular teeth. R – Right. a Axial slice of mandibular central incisors displaying two canals. b Axial slice of mandibular lateral incisors displaying two canals and canines displaying one canal. c Axial slice of a right mandibular canine displaying two canals. d Sagittal slice of a two-rooted left mandibular canine displaying two canals. e Axial slice of a two-rooted right mandibular first premolar displaying one canal in each root. f Axial slice of a left mandibular first premolar displaying two canals. g Sagittal slice of a single-rooted right mandibular second premolar displaying two canals. h Axial slice of a two-rooted left mandibular second premolar displaying one canal in each root | 99.1 |
Initial treatment of metastatic melanoma. a 18FDG-PET-CT scan of the patient when the metastatic disease was diagnosed. b 18FDG-positive lung lesion at the initial diagnosis of metastatic BRAF mutated melanoma. c Initial treatment response to BRAF and MEK inhibitors and to pembrolizumab over time | 99.94 |
Response of pulmonary inflammatory lesions to immune suppressive therapy. a CT-scan at the time point when the inflammatory lesions were first detected after 2 years of pembrolizumab therapy. b Initial response to corticosteroid therapy (1 mg/kg prednisone). Pulmonary inflammatory lesions were clearly regressing after initial therapy. c CT-scan acquired during immune suppression with mycophenolate and after tapering of prednisone (before start infliximab). d CT-scan after 6 months of infliximab therapy. No inflammatory lesions can be observed anymore. e 18FDG-PET-CT scan after the infliximab therapy was stopped. A durable remission in terms of the melanoma and the pneumopathy was found | 99.94 |
Intraoperative thoracic wall defect status post wide local excision. a Resected tumor requiring external oblique musculocutaneous flap. b Image showing exposed external oblique muscle used for repair. c Postoperative results showing a repaired defect of 30 cm × 30 cm. d Image showing appropriate wound healing after 6 months status post procedure | 99.94 |
Postoperative thoracic wall defect status post EOM flap. Image illustrates postoperative results status post re-elevation and mobilization of the left EOM flap required for replacement of the aortic valve. The EOM flap has healed well even with elevation and placement | 99.94 |
A 59-yearold female patient was referred to the endoscopy department with a history of a small amount of fresh haematemesis during an episode of vomiting with a stomach bug. There was no weight loss or abdominal pain. The patient had a past medical history of myeloma with normal renal function and calcium. A hysterectomy had been carried out due to fibroids. The patient denied any history of asbestos exposure and any history of mesothelioma. | 100 |
The initial endoscopy demonstrated lumpy gastritis in the cardia and fundus. Biopsies were taken and a repeat scope was arranged 4 weeks later to ensure healing. The histology from the biopsies revealed blue rubber bleb naevus disease. A second endoscopy was carried out to check if the bleeding had settled. It showed continued bleeding from the blebs. The patient was treated with an intravenous infusion of a proton pump inhibitor and remained stable. | 100 |
(A) Contrast-enhanced computed tomography at initial diagnosis showing the thickened aortic valve extending to the left ventricular outflow tract wall. (B) The preoperative contrast-enhanced computed tomography showing regression of the thickened aortic valve and left ventricular outflow tract wall. | 99.9 |
The dose of prednisolone was tapered by 2.5 mg every 2 months in combination with azathioprine 50 mg after surgery. The transthoracic echocardiography 1 year after the surgery showed regression of the LV dilatation and normal function of the prosthetic valve. | 99.94 |
The balance reciprocal translocation was confirmed by whole chromosome FISH and Acro-P-Arm FISH probes and the short arm of the derivative 13 showed green signals confirming the chromosome 11 material (Figure 2A) and the Acro-P-Arm FISH showed signals on derivative chromosome 11 (Data not shown). | 99.9 |
In this report we shared our findings of an unusual phenomenon and how we reached the diagnosis. What was first perceived as a simple case of sepsis turned out to be one of the rarest aberrancies in myeloid disorders. Tetrasomy 8 is a rare genetic abnormality in hematologic disorders including acute myelogenous leukemia. It is an independent poor prognostic marker in patients with acute myelogenous leukemia. The ongoing improvements in molecular and cytogenetic approaches will provide further information on the exact role of tetrasomy 8 in leukemogenesis. | 99.94 |
The efficacy and complication are shown in Table 2. One stent could not be implanted successfully since the guide wire could not pass through the narrow lesions. There was one case after stent placement showed no improvement in symptoms. The other patients showed improvements of 2 grades in the level of dietary intake in the second week after stent placement. The GOOSS score after stent implantation was significantly improved compared with that before stent implantation (P < 0.05). | 99.94 |
Fig. 2 A The dissection of Mg was continued tracing the anterior pancreatic space (arrow) at the surface of GDA and CHA. B The total supra-pyloric mesentery was dissected tracing the surface of PHA upward to the hepatic hilum. C The RGA was released from the GDA and CHA and ligated at the root. D The diagram of rEME in the infra-pyloric region. (Color figure online) | 99.94 |
A The dissection of Mg was continued tracing the anterior pancreatic space (arrow) at the surface of GDA and CHA. B The total supra-pyloric mesentery was dissected tracing the surface of PHA upward to the hepatic hilum. C The RGA was released from the GDA and CHA and ligated at the root. D The diagram of rEME in the infra-pyloric region. (Color figure online) | 99.6 |
Fig. 4 A The dissection began from the fusion plane of Mg and Mc (arrow). B Open the anterior pancreas space (*). C The diagram of approach and separation space. D The LGEV and LGEA were visible in turn and ligated at the root. E The separation was then turned to the wall of stomach. F The diagram of rEME in the supra-pancreatic region. (Color figure online) | 99.4 |
Initial situation. The patient consulted for a pain caused by the mobility of the maxillary right central incisor (a). An intraoral radiography confirmed the partial extrusion of the tooth (b). A digital impression of the patient’s maxillary arches was made with an intraoral scanner (c and d) and color registration was performed (e) | 100 |
Tooth extraction and denture try-in. The loose central incisor was extracted atraumatically (a) and the immediate denture was placed without any correction (b and c). The patient was recalled after one week to confirm the good functional and aesthetic integration of the prosthesis (d) and to check oral mucosa wound healing (e) | 99.94 |
There was the lowest activity in patient 14. There was the highest urinary GAG exertion in patient 5. There was no significant relationship between genotype and related phenotype in the studied subject (data not shown). Table 5 shows the mutation‐caused disease and biochemical findings at the time of diagnosis in studied subjects. | 99.9 |
Adjuvant chemotherapy is associated with improved survival in early breast cancer (EBC) and is used as standard treatment for many patients following surgery. We present a case of Pneumocystis jirovecii pneumonia (PJP)—a rare and under‐recognized complication with potentially fatal consequences—in an otherwise well patient undergoing adjuvant chemotherapy in a dose‐dense fashion. | 99.9 |
The patient in this case report received 40 mg of dexamethasone every 2 weeks as CINV prophylaxis or 19 mg prednisone equivalents/day. This higher steroid exposure is a reflection of older guidelines that predated the advent of novel anti‐emetic agents such as Akynzeo®. | 99.9 |
FDG-PET (a) performed for follow-up of a patient with a germline succinate dehydrogenase subunit B mutation and a known left glomus jugulare paraganglioma (arrowhead) demonstrates a new area of FDG-avidity just below the skull base on the right (arrow). The subsequent post-contrast MRI (b) supports that this is a new paraganglioma rather than a metastasis | 99.94 |
Two case studies of mutation in OncoBase. (A). Circos plot of 3D and 1D information related to rs977747 and chr19:49990694:49990694:G:A. (B). Regulatory network of mutation and its target genes produced by Google PageRank method for rs977747. (C) Recurrent mutation in promoter can affect binding of ETS family protein. (D) Regulatory network of mutation and its target genes produced by Google PageRank method for chr19:49990694:49990694:G:A. | 99.5 |
His full blood count showed a white cell count of 9.2 × 103/dl (Normal Range (NR) 4–11 × 103) with neutrophil predominance (77%). Haemoglobin was 6.9 g/dl (NR 11–15) and platelet count on admission was 7 × 103 (NR150–400 × 103). His coagulation profile was normal with prothrombin time of 12.8 s (NR 10–13) and APTT 30 s (NR 26–40). Serum creatinine was slightly elevated at 137 mmol/l (NR 60–120 umol/L) and the electrolytes were normal. There was indirect hyperbilirubinaemia with total bilirubin of 44.7 μmol/l (NR 1.7–20.5) and direct bilirubin of 7.3 μmol/l (NR 1.7–5.1). The serum lactate dehydrogenase level was 3115 U/l (NR 160–450). Direct coombs test and dengue serology were negative. Non-contrast CT scan of the brain was normal. Blood picture showed evidence of severe thrombocytopenia with microangiopathic haemolytic anaemia (MAHA). | 99.94 |
This is the first report of CMV induced refractory TTP in an immunocompetent individual. All previous reports of CMV induced TTP had been in immunocompromised hosts [5–7]. Our case report also highlights the occurrence of spinal neurological deficits as a complication of haemorrhage related to TTP. | 99.94 |
The only curative treatment of pHPT is surgery consisting in the removal of the pathological gland. The clinical or analytical persistence of primary hyperparathyroidism after parathyroid surgery can occur if the location of the adenoma is a supernumerary or ectopic gland that during surgery had gone unnoticed. The presentation of a parathyroid adenoma in a supernumerary gland is rare and a challenge for the surgeon expert in thyroid and parathyroid surgery. | 99.44 |
The MIP (maximum intensity projection) of 18F-FDG (fluoro-D-glucose) PET/CT (A) revealed multiple hypermetabolic lesions in the whole body (black arrows). Axial slices showed normal ribs (B) (SUVmax = 10.3) and multiple hypermetabolic lesions of the spine (C) (white arrows). | 99.75 |
Surgical procedures for each patient with preoperative echocardiography. a Patient 1: A2 reconstruction with autologous pericardium + two pairs of artificial chordae + P2 quadrangular resection and suture + mitral annuloplasty using a 26-mm Physio II ring. b Patient 2: P3 reconstruction with autologous pericardium + mitral annuloplasty using a 28-mm Physio II ring. c Patient 3: A3/P2–3 reconstruction with autologous pericardium + three pairs of artificial chordae + mitral annuloplasty using a 26-mm Physio II ring. d Patient 4: P2–3 reconstruction with autologous pericardium + one pair of artificial chordae + mitral annuloplasty using a 32-mm Physio II ring | 99.9 |
Operative findings and surgical procedure in Patient 5. a Preoperative real-time three-dimensional transesophageal echocardiography showed that the A1–2 and P1–2 segments of the mitral valve had been extensively destroyed. b The schema of the infective mitral valve. c Intraoperative finding of the infective mitral valve. d Surgical procedure: A1–2/P1–2 reconstruction with autologous pericardium + four pairs of artificial chordae + mitral annuloplasty using a 28-mm Memo 3D ring. e Intraoperative finding of the newly reconstructed mitral valve | 99.94 |
Case 1: The laparoscopic pancreaticoduodenectomy was completed with an operation time of 270 min. The intraoperative blood loss was 300 mL and no transfusion was required. The patient recovered well with no post-operative complications and was discharged on the 10th day after the surgery. | 99.94 |
Case 2: The laparoscopic pancreatosplenectomy was completed with an operation time was 180 min. The intraoperative blood loss was 100 mL and no transfusion was required. The patient recovered well with no post-operative complications and was discharged on the 5th day after the surgery. | 100 |
The family tree of the patient pedigree and cataract phenotype. (A) The four-generation 24-member pedigree with dominant congenital cataract. (B) Varied cataract types and severity in patients. Photographs of eyes of two patients were shown. Patient III:6 has bilateral total cataracts. Patient III: 11 has a nuclear cataract in the right eye and a zonular cataract in the left eye. | 99.94 |
We herein describe the adverse impact on the mental health of a physician in charge of a patient with a severe case of COVID-19 who died and his mother who was devastated by his loss. Deaths from COVID-19 can be traumatic not only for family members but also for the HCWs in charge of their care. Excessive empathic engagement in the care of patients who do not survive and their relatives provides high risk for compassion fatigue. These stress-related disorders of HCWs should be more widely recognized so that we can implement improved support systems for them. | 99.9 |
Epiaortic echography confirms the location of the thrombus (white arrow) in the ascending aorta (A). We marked the position on the most cephalad side of the floating thrombus (yellow arrow) and determined the locations for aortic cross-clamping and aortotomy (B) | 99.7 |
OCT of the left eye demonstrated dense sub-retinal and inner layer hyper-reflectivity with subsequent outer layer shadowing consistent with dense sub-retinal and intra-retinal hemorrhages (Figure 2). Sub-foveal hypo-reflectivity was noted as related to the presence of sub-retinal serohematic fluid (Figure 3). No macroaneurysms were visualized. FFA in the right eye was unremarkable (Figure 4). | 99.94 |
Venography of the first revision of the primary TIPS demonstrating (a) absence of flow through an occluded stent (arrows) due to thrombosis; (b) angioplasty with a fully inflated balloon; (c) successful recanalization of the TIPS with restored flow post angioplasty and further stent insertion | 99.9 |
We recruited a family segregating autosomal recessive dHMN. Clinical and genetic analysis was performed and a homozygous nonsense mutation in the SORD gene (c.757delG; p.Ala253GlnfsTer27) was identified. The mutation has been shown to cause a complete loss of SORD protein resultantly an increased sorbitol level in the cells. | 99.94 |
The FMT treatment cleared rCDI from all patients. A single individual (P3) mistakenly restarted vancomycin after transplantation and developed CDI. She was treated successfully with a second FMT and remained asymptomatic throughout the follow-up period (for detailed analysis see Additional file 1: Figure S2). | 99.9 |
Pedigree and Sanger sequencing analysis of the probands from the two Han Chinese families. Panel a: Pedigree and eyelid photographs of the probands from two families in this study before or after surgery. Affected members are indicated by filled symbols; unaffected relatives are indicated by open symbols. The number of siblings is indicated in the symbol. The arrow indicates the proband. Numbers are allotted to family members whose DNA samples were used in this study. Panel b: Sanger sequencing analysis of the two families in this study. | 99.75 |
Preoperative radiographs were taken in patients at the time of admission; the immediate postoperative film was obtained within hours after surgery; and follow-up images were taken in every visit in our outpatient department. Fracture union was defined as a visible callus bridging the fracture site present within 6 months of surgery . | 99.7 |
Our clinical experience confirms the complex management of pain in children affected by MPS. Poor data are available regarding this topic. More resources should be assigned to research to better understand pathogenesis of pain in MPS and develop new specific molecules; however an adequate pain assessment is the first step to guarantee a good pain management. | 99.6 |
The decision for exploratory laparotomy was made after optimizing the patient. A supraumbilical transverse incision was used to access the abdominal cavity. Intraoperative findings were multiple immature adhesions with pus pockets. The omentum was adhered to the pelvic region. There was a tubular duplication of the small intestine starting at 15 cm from the ligament of Treitz with the proximal part of the duplicate ending blindly and the distal forming a confluence with the terminal ileum (about 20 centimeters from ileocecal junction). The duplicate bowels shared the mesentery spanning the length of about 90 centimeters with a perforation at the mesenteric border of the confluence (Figure 2(d)). The appendix was in retrocaecal position and perforated at its base. | 100 |
Resection of the perforated segment involving the confluence of the two lumens was done followed by end-to-end anastomosis to the terminal ileum. A side-to-side anastomosis for proximal duplicate lumens was done to promote drainage and prevent blind loop syndrome. Appendicectomy was also done. The histology of the resected part of the confluence showed double lumen with the septum containing the muscularis propria (Figure 3(b)). | 99.94 |
Four structural variants were found and they are presented in Table 3. An individual (patient III:65) from a family with phenotypic AFAP was found to carry a 1.9 kb heterozygote deletion located 2 kb upstream of SMAD4 (hg19/chr18:g.48537165_48539080del). The deleted region includes an insulator element 200 bp in size (chr18:g.48537803-48538002). Additional upstream deletions were found in MSH3 (I:34) and CTNNB1 (I:57). Another patient (I:6) had a 24.2 kb duplication in CDH1 intron 1 (hg19/Chr16:g.68802080_68826280del).Table 3Structural variations detected among 91 index patientsClinical group: patient numberLocationGenomic position (GRCh37/hg19)/dbSNP (rs)Approximate size (kb)Classification*III:65Upstream SMAD4hg19/chr18:g.48537165_48539080del1.93I:6Intron 1 CDH1hg19/Chr16:g.68802080_68826280dup24.23I:34Upstream MSH3hg19/Chr5:g.79902126_79904625del2.53I:57Upstream CTNNB1hg19/Chr3:g.41200986_41203204del2.23* manual classification | 99.44 |
The patient (I:6) with the intronic duplication in CDH1also had breast cancer. It is known that CDH1 mutations can be found in patients with lobular breast cancer and in hereditary diffuse gastric cancer. Although no obvious functional elements are found in this region it cannot be ruled out that the duplication has an effect on the transcription or regulation of the gene. | 99.9 |
We report a case of an 18-month-old Sudanese girl who presented at the age of 3 months with swelling of her left forearm following BCG vaccination that was given at birth. Radiological and histological investigations confirmed tuberculous osteitis of the radius. She responded very well to antituberculous treatment with complete healing at follow-up visits. To the best of our knowledge this is the first case report of osteitis of the radius following BCG vaccination described from Sudan. | 100 |
We experienced a patient with advanced BTC who was treated with GEM plus S-1 and achieved pCR. GS regimen may be applicable for advanced BTC. Further cases treated with GS regimen are needed to evaluate its efficacy as conversion chemotherapy regimen for advanced and unresectable BTC. | 99.94 |
The patient was placed on short-duration HD (2 hours) with smaller surface area (cellulose triacetate; membrane area: 0.7 m2) and low blood flow (100 mL/min) to avoid DDS (Figure 3). His consciousness gradually improved and he did not develop symptoms of DDS. | 99.94 |
Sarah was a 3-year-old Italian child who was referred by her parents. Sarah came from an intact family with middle socioeconomic status. Her mother had graduated and worked as an employer; her father was a teacher at an elementary school. They came from intact families and did not report any specific traumatic events in their life. | 99.9 |
Preoperative and postoperative photographs. a Preoperative face frontal view. b One-month postoperative face frontal view. c Two-year postoperative face frontal view. d Preoperative face profile view. e One-month postoperative face profile view. f Two-year postoperative face profile view | 99.9 |
A 21-year-old woman with a previous history of partial saphenectomy sought our Angiology service for treatment for a venous ulcer in the distal third of her left leg. She complained of joint pain and claudication. The ulcer had appeared one year after surgery. During the physical examination we observed angiomas on her left leg and disproportion between limbs (Figure 2). | 100 |
The biopsied tissue showed highly cellular myxoid stroma made of ectomesenchymal cells consisting of plump fibroblasts with ovoid hyperchromatic/vesicular nucleus with indistinct cell borders. Multiple branching strands of odontogenic epithelium simulating the dental lamina were noticed (Figure 3). The epithelial strands consisted of cuboidal to columnar cells with hyperchromatic nuclei. At few areas the epithelial strands were opening into small follicles with peripheral tall columnar cells and central stellate reticulum-like cells. The follicles at few areas showed basal cell hyperplasia. The small follicles of odontogenic epithelium showed the presence of a hyalinized area as a halo resembling dysplastic detinoid-like material (Figure 4). Few mitotic figures were noted. A diagnosis of ameloblastic fibrodentinoma was made. | 99.94 |
Histopathology of the excisional mass was similar to that of the incisional biopsy. The tumor showed the presence of a capsular structure that was incomplete. Multiple layers of collagen were seen as a capsule along with neurovascular bundles at certain areas. The tumor revealed odontogenic strands in the primitive myxoid ectomesenchymal stroma resembling an ameloblastic fibroma. Dentinoid-like material was evident (Figure 6). | 100 |
The postoperative mass was measured to be 20 cm. The final pathological analysis determined the specimen to be an adrenal vein aneurysm consisting mostly of thrombotic material with a conservative measurement of 15.9 cm (Fig. 2b). The wall of the vessel itself was comprised mainly of thick smooth muscle with some elastic fibers and no elastic lamina. The adrenal gland was adherent to the mass and was benign. All of the en bloc surgical specimens were benign. | 99.94 |
Methods: We present the case of a patient with HAE-I who was under prophylactic therapy with C1-INH IV due to a high number of attacks during on-demand therapy. An implanted port guaranteed a periodical and safe apply of the medication until the device had to explanted due to an infection. Because of a bad vein status repeated IV application failed. After stopping the prophylactic therapy he suffered from recurrent and partially severe attacks again. Therefore we tried a subcutaneously off-label use of 1500 IE C1-INH as prophylaxis over more than one year. | 99.94 |
Results: After a brief training session the self-application was easily managed by the patient. Under the prophylaxis the number of attacks was reduced from 4.33 to <1/month. No severe attack and none of the upper airway was noticed. The quality of life measured by the AE-Qol could be improved. The results were similar to those under the approved IV therapy. | 99.75 |
Conclusions: All the new diagnoses of hereditary bradykinin angioedema were done directly at the center and patient didn’t arrive in an emergency Department. The diagnosis of bradykinin-induced angioedema (angiotensin converting enzyme drugs) represent more than one third of the calls and it was unexpected. The emergency number was helpful for the therapeutic care of the angioedema. The long-term follow-up of these patients will allow to confirm or not this diagnosis and to see again in one year if the proportion of bradykinin-induced in our region. | 99.94 |
Patients with RSTS have an increased predisposition for the development of tumors of the nervous system . We describe the first reported case of a pituitary macroadenoma in a middle-aged female with RSTS that was successfully treated with an endoscopic transnasal transsphenoidal approach. | 99.94 |
A high index of suspicion is required and if in doubt a CT should always be performed. CT also give additional information regarding any associated occult fractures (such as radial head) and associated ligamentous injuries. Ring observed that the complexity so called “isolated” capitellar fractures was underestimated on plain X-rays. He described five different anatomic zones and classified the fracture patterns according to them: capitellum and the lateral aspect of the trochlea; lateral epicondyle; posterior aspect of the lateral column; posterior aspect of the trochlea; medial epicondyle. He also coined the term Apparent capitellar fractures as it emphasizes the “need to look more closely” . | 99.9 |
Microscopic findings of resected specimen. a The tumor cells of invasive ductal carcinoma show round to oval hyperchromatic nuclei with prominent nucleoli. b The tumor cells of neuroendocrine features have small scant cytoplasm and finely granular hyperchromatic nucleus without nucleoli. c The tumor cells are highly immunopositive for both chromogranin A (left) and synaptophysin (right). d The metastasis of axillary lymph node is caused component of neuroendocrine features | 99.9 |
(A) AP medial view; (B) posterior view; (C) (posterior view) Longitudinal sections shows right thigh enlargement with fluid collection and scattered air pockets within vastus lateralis. There was extensive involvement from the lesser trochanter down to the left knee joint level | 99.7 |
We performed WES on three parathyroid and one pancreatic tumor specimens as well as on a whole blood sample from the same patient diagnosed with MEN1. We sequenced the tumor and germline DNA isolated from whole blood to identify somatic changes in the tumors. | 99.9 |
Analysis of multiple endocrine tumors from the same patient. Computed tomography scans and the various nodules present on both the parathyroid glands (red arrow) and pancreas (blue arrow) of the same patient are shown. Each nodule shows the germline defect (blue). A second alteration (yellow) differed between the parathyroid gland and pancreas | 99.9 |
Our findings in 5-10mm segment were in contrast to those of Busquim. He attributed his finding to the similar coronal taper of Reciproc file and final file of BioRace whereas in our study the situation was reverse and the diameter and taper of file tips were the same and the files had different coronal tapers. | 99.7 |
Laboratory findings were essentially within normal limits. The cerebrospinal fluid (CSF) culture was negative and an abdominal computed tomography (CT) scan did not reveal any intra-abdominal pathology. A prophylactic antibiotic regimen that consisted of ceftriaxone (50 mg/kg twice daily) and vancomycin (15 mg/kg twice daily) was commenced 24 hours prior to surgical replacement of the shunt. The entire shunt system was replaced with a Strata® VPS. The distal peritoneal catheter was found to be adherent to the greater omentum and a small laparotomy was necessary by the pediatric surgeon to detach it (Figure 2). | 99.94 |
Fig.1D: He was started on intravenous conventional amphotericin at dosage of 1.5 mg/kg/day. But after four days of therapy he developed renal impairment with rising creatinine. He was switched to Itraconazole 200 mg twice per day which he received for a further two months. His follow-up CT scan showed interval progression in splenic and hepatic hypo-densities. He was again switched to amphotericin at the dosage of 0.7 mg/kg/day for another one month but during this period he again developed amphotericin induced nephrotoxicity. The dose of amphotericin was further reduced to 0.5 mg/kg/day with targeted total cumulative dosage of 250 mg and his renal functions were closely monitored. Follow up CT scan showed compete resolution of hepatic hypo-densities but stable appearance of splenic hypo-densities. He was discharged from hospital with follow up as outpatient with plans for a splenectomy if there was incomplete resolution of the hypodensities in the spleen. Patient remained completely asymptomatic during this whole follow-up period. His subsequent USG scan showed interval decrease in size of splenic hypo-densities that were finally resolved on USG scan [11 months from diagnosis of mucormycosis]. Currently he is doing well and remains in remission. | 100 |
Thirty-eight year-old male with diverticulitis and well-contained perforation. Axial contrast-enhanced CT demonstrates edema and thickening of the sigmoid colon wall with multiple diverticulums. A fluid collection adjacent to the sigmoid colon (arrows) is an abscess caused by perforation of the diverticulitis. Free air pockets (arrowhead) confined to the pericolonic region are seen | 99.94 |
Seventy-two-year-old female with free perforation complicating diverticulitis. Axial contrast enhanced CT images at parenchymal window (a) and bone window (b) demonstrate a ‘dirty mass’ (arrows) formed by stool nearby sigmoid colon diverticulitis. Free air (arrowheads) and inflammatory fat stranding resulting from perforation of diverticulitis are seen posterior to the pararenal fascia | 99.94 |
The involved mesenteric veins in pylephlebitis are closely related with the affected colonic segment. Sigmoid diverticulitis results in thrombosis of the local sigmoid vein with subsequent propagation along the IMV and the portal vein. This process is called ascending thrombophlebitis (Fig. 6) .Fig. 6Sixty-year-old male presenting with diverticulitis and IMV thrombosis. a Axial contrast-enhanced CT image demonstrates thickening of sigmoid colon wall (arrow) with multiple diverticulum. b Axial and coronal c contrast-enhanced CT images reveal thrombus in the IMV (arrows) with adjacent fat stranding representing thrombophlebitis | 99.94 |
Sixty-year-old male presenting with diverticulitis and IMV thrombosis. a Axial contrast-enhanced CT image demonstrates thickening of sigmoid colon wall (arrow) with multiple diverticulum. b Axial and coronal c contrast-enhanced CT images reveal thrombus in the IMV (arrows) with adjacent fat stranding representing thrombophlebitis | 99.94 |
Pulmonary septic emboli in a 58-year-old male resulting from diverticulitis. a Axial contrast-enhanced CT of a 58 year-old man demonstrates edema and thickening of the sigmoid colon wall (arrow) with diverticulum and adjacent fat stranding. b Axial contrast-enhanced CT reveals thrombosis (arrow) in the inferior vena cava lumen. c Axial contrast-enhanced CT image at lung window setting shows multiple cavitary lesions (arrows) with thick wall representing septic emboli | 99.94 |
Intestinal obstruction in a 79-year-old male secondary to diverticulitis. a Axial contrast-enhanced CT of a 75-year-old man presenting with abdominal pain and distention reveals a diverticulitis with the appearance of a inflamed diverticulum and pericolonic fat stranding (arrow) in the transverse colon. Bowel segments proximal to the localization of diverticulitis is dilated. b Axial CT performed 2-months after the first CT reveals thickening of the colonic wall (arrow) leading to intestinal obstruction | 99.94 |
Bleeding diverticulitis in a 70-year-old male. a Axial contrast-enhanced CT of a 70-year-old man without oral contrast agent administration reveals intraluminal high attenuating contrast agent leakage (arrowhead) in transverse colon. b Axial contrast- enhanced CT at venous phase demonstrates increased contrast amount in the lumen (arrow) indicating active hemorrhage. c Oblique reformatted CT image reveals feeding artery (arrow) of the diverticulitis and contrast extravasation (arrowhead) | 99.94 |
Colovesical fistula in a 46-year-old male after diverticulitis. a Axial contrast-enhanced CT of a 62-year-old woman reveals a fluid collection (arrows) in the Douglas pouch with air content and peripherally enhancing wall. b Contrast-enhanced CT reveals thickening of left bladder wall (arrow) adjacent to the diverticulum. c Coronal contrast-enhanced CT performed 5 months after first CT demonstrates a fistula (arrow) between the sigmoid colon and the bladder | 99.94 |